WO2008017521A2 - Compositions with enhanced elasticizing activity - Google Patents

Compositions with enhanced elasticizing activity Download PDF

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Publication number
WO2008017521A2
WO2008017521A2 PCT/EP2007/053793 EP2007053793W WO2008017521A2 WO 2008017521 A2 WO2008017521 A2 WO 2008017521A2 EP 2007053793 W EP2007053793 W EP 2007053793W WO 2008017521 A2 WO2008017521 A2 WO 2008017521A2
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use according
component
present
agents
weight
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PCT/EP2007/053793
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WO2008017521A3 (en
Inventor
Federico Mailland
Paolo Mascarucci
Emanuela Mura
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Polichem SA
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Polichem SA
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Priority to CN2007800296579A priority Critical patent/CN101500550B/en
Priority to HK09104533.7A priority patent/HK1126956B/en
Priority to RSP20100180 priority patent/RS51282B/en
Priority to HR20100212T priority patent/HRP20100212T1/en
Priority to KR1020147007704A priority patent/KR101521166B1/en
Priority to JP2009523211A priority patent/JP2010500309A/en
Priority to EA200900293A priority patent/EA014971B1/en
Priority to US12/310,032 priority patent/US9125806B2/en
Priority to EP20070728255 priority patent/EP2049092B1/en
Priority to MX2009000869A priority patent/MX2009000869A/en
Priority to PL07728255T priority patent/PL2049092T3/en
Application filed by Polichem SA filed Critical Polichem SA
Priority to BRPI0715182A priority patent/BRPI0715182C1/en
Priority to DK07728255T priority patent/DK2049092T3/en
Priority to DE200760004857 priority patent/DE602007004857D1/en
Priority to CA 2655472 priority patent/CA2655472C/en
Priority to AT07728255T priority patent/ATE457723T1/en
Publication of WO2008017521A2 publication Critical patent/WO2008017521A2/en
Publication of WO2008017521A3 publication Critical patent/WO2008017521A3/en
Anticipated expiration legal-status Critical
Priority to NO20091011A priority patent/NO343143B1/en
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/095—Sulfur, selenium, or tellurium compounds, e.g. thiols
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
    • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
    • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
    • A61K31/23—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin of acids having a carboxyl group bound to a chain of seven or more carbon atoms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/425—Thiazoles
    • A61K31/426—1,3-Thiazoles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/20—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing sulfur, e.g. dimethyl sulfoxide [DMSO], docusate, sodium lauryl sulfate or aminosulfonic acids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/22—Heterocyclic compounds, e.g. ascorbic acid, tocopherol or pyrrolidones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/44—Oils, fats or waxes according to two or more groups of A61K47/02-A61K47/42; Natural or modified natural oils, fats or waxes, e.g. castor oil, polyethoxylated castor oil, montan wax, lignite, shellac, rosin, beeswax or lanolin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0034—Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/02—Drugs for genital or sexual disorders; Contraceptives for disorders of the vagina
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/16—Emollients or protectives, e.g. against radiation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P21/00—Drugs for disorders of the muscular or neuromuscular system

Definitions

  • compositions with enhanced elasticizing activity are provided.
  • This invention relates to compositions of thiolated compounds combined to esters of organic acids useful to enhance the elasticizing properties on vaginal and/or perineal tissues.
  • thiolated compounds both those provided with free SH groups, and those with the S- atom blocked by a functional group, have the capability to decrease the rigidity of protein structures, by breaking the disulphur bonds, resulting in increasing the extensibility of the protein molecule.
  • This result is achieved by acting both on ternary and quaternary structure, without affecting the primary and secondary ones, and therefore is reversible.
  • This action is very well known and it is applied in two large fields, like in human therapy of bronchitis, to decrease sputum viscosity and improve bronchial and tracheal clearance both in acute and chronic bronchitis; on the other hand, it is applied by cosmetic industry to improve skin softness in subjects with wrinkles or striae.
  • the structure of keratin is rich of disulphur bonds as a result of interactions between two non contiguous molecules of cisteine, in the aminoacidic chain. Same is to be said for sputum, which constituents are rich of disulphur bonds.
  • the breaking of the disulphur bond by reducing the -SS- bridge to two -SH free groups, allows the protein to extend, by loosing the rigidity due to the covalent bond. On the other hand, this phenomenon is reversible, in fact the two SH free groups may further interact and form an -SS- bridge.
  • Esters of alcohols and organic acids are known in the art and used as skin care and nurturing for the prevention and reduction of stretch marks. They substantially act while keeping essential emollients actively softening and elasticizing.
  • Triglycerides are esters of glycerol, that are physiologically present in the animal and vegetable tissues. Those esters are composed of organic fatty acids, with a Carbon atom chain varying between 6 to 18 Carbon atoms, they may be saturated or unsaturated, mainly mono-, di- or tri- unsaturated. The chain length and the presence of double bonds affect the melting point of the fatty acids and of their esters. The lowering of the melting point confers to these compounds a semisolid or liquid state that is useful for their emollient and humectant properties.
  • Cholesterides are esters of cholesterol and organic fatty acids, also present in nature, mostly in fats and nervous tissues of animals. They also are used in the preparation of creams and ointments due to their emollient properties.
  • Phytosterol esters are the correspondent in the vegetables, where the sterol components of the ingredient vegetable oil phytosterol esters are beta-sitosterol, campesterol, and stigmasterol . These components of vegetable oil phytosterol esters already are present as ingredients in cosmetics as skin care products for their emollient properties, thus they have a similar intended use to cholesterides and triglycerides.
  • Fatty acids that enter in the composition of esters with sterols are also varying between 6 to 18 Carbon atoms, they may be saturated or unsaturated, mainly mono-, di- or tri- unsaturated fatty acids.
  • Esters of alcohols and organic acids may be synthetic, such as isopropyl-miristate and isopropyl palmitate.
  • Isopropyl-myristate is the ester of isopropyl alcohol and myristic acid, a saturated C- 14 fatty acid: it is widely used both in cosmetic and pharmaceutical industry, also for vaginal preparations.
  • compositions object of the present invention contain at least a thiolated compound and an ester of organic acid which act synergistically in improving tissue elasticity in terms of increased both extensibility and elastic recovery. This feature is important to increase elasticity of the distal portion of the vagina and of the perineal tissues during the last trimester of pregnancy. Spontaneous delivery is often accompanied by lacerations of the perineal tissues due to excessive extension during the expulsive phase. Short-medium term complications are often pain, dyspareunia and urinary incontinence in 30 - 50 % of women (Lukacz ES et al . Obst Gynecol . 2006 - Olsen LO, et al Obstet. Gynecol. 1997).
  • episiotomy may decrease the spontaneous lacerations in terms of both rate and severity of lacerations, but it is not devoid of complications, like dyspareunia and rectal incontinence of puerperal women. According to a recent systematic evidence review, although episiotomy is performed in approximately 30-35% of vaginal birth in the United States, no statistically significant difference were reported for severe vaginal or perineal trauma, dyspareunia or urinary incontinence (ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstet. Gynecol. 2006).
  • Perineal massage during the last weeks of pregnancy is a practice known in the art to prepare the tissues to the increased request of extension during spontaneous delivery. Ten-fifteen minutes massage is performed during the last 6-8 weeks before delivery, mostly daily or tri-weekly. Almond oil is used as a lubricant.
  • the practice of the perineal massage is capable to improve the extensibility of the perineal tissues, by significantly reducing the incidence of trauma requiring suturing and number of episiotomy in woman without previous vaginal birth, but no differences were seen in the incidence of 1 st or 2 nd degree perineal tears or 3 rd to 4 th degree perineal trauma compared to women not practicing the perineal massage (Beckmann MM et al . birth 2006).
  • compositions containing at least a thiolated compound and an ester of organic acid and appropriate excipients improve the elasticity of the skin by a synergistic action of the two components, namely the thiolated compound and the ester of organic acid. Furthermore, the regular application of compositions containing at least a thiolated compound and an ester of organic acid and appropriate excipients is capable to increase the elastic properties of the distal part of the vagina and of the perineal tissues.
  • compositions are preferably in form of cream, ointment, gel or lotion, and are preferably topically applied by perineal massage, to improve penetration of the ingredients deeply into the perineal tissues, and to train the vaginal and perineal muscles to the expulsive phase of delivery as well.
  • compositions contain at least a thiolated compound in a proportion ranging between 0.1 to 25 wt.%, preferably from 0.5 to 15 wt.%, more preferably from 1.0 to 10%, with respect to the total weight of the composition.
  • the thiolated compound is preferably a sulphated aminoacid, more preferably a derivative of cysteine, most preferably a salt of carboxymethyl- cysteine.
  • said sulphated amino acid is selected from: 1-methionine, 1- cysteine, 1-cystine, taurine, 4-thiazolidinecarboxylic acid, carboximethylcisteine and/or methylsulphonylmethane, or a physiologically acceptable salt thereof.
  • the compositions contain at least an ester of organic acid in a proportion ranging between 1 to 95 wt.%, preferably from 5 to 70 wt.%, more preferably from 10 to 45%, with respect to the total weight of the composition.
  • the ester of organic acid is preferably an ester of glycerol or an ester of animal or vegetable sterol, such as cholesterol, or a mixture thereof.
  • the organic acid contains from 2 to 30 carbon atoms, preferably from 6 to 18 carbon atoms, more preferably from 12 to 18 carbon atoms.
  • the organic acid is saturated or unsaturated.
  • compositions will be prepared according to conventional techniques, and may include compatible excipients and pharmaceutically acceptable carriers, e.g. ionizing agents, antioxidant agents, chelating agents, moisturizing agents, decongestant agents, disinfectant and/or antimicrobial agents, flavoring and colorants .
  • pharmaceutically acceptable carriers e.g. ionizing agents, antioxidant agents, chelating agents, moisturizing agents, decongestant agents, disinfectant and/or antimicrobial agents, flavoring and colorants .
  • compositions may also contain, in combination, other active principles with complementary or, in any case, useful activity.
  • examples of these compositions prepared according to the present invention include: cream, ointment, gel, lotion or foam.
  • Paraffinun liquidum, Polyglyceryl-3 Beeswax, Prunus amygdalus var. dulcis, Aperoxid TLA and Petrolatum were mixed in a turboemulsor and heated at 70 0 C. When the mass was melted, Hydrogenated castor oil was added under moderate stirring until complete dispersion.
  • the obtained gel contains 21.50% of esters according to the invention; it is ivory and homogeneous in appearance .
  • the obtained gel contains 39.95% of esters according to the invention
  • the formulation was prepared by using the same method described for Example 1.
  • the obtained gel contains 35.5% of esters according to the invention
  • the formulation was prepared by using the same method described for Example 1.
  • the obtained gel contains 24.00% of esters according to the invention
  • the obtained gel contains 27.50% of esters according to the invention
  • the obtained gel contains 20.50% of esters according to the invention
  • the formulation was prepared by using the same method described for Example 1.
  • the obtained gel contains 20.50% of esters according to the invention
  • the formulation was prepared by using the same method described for Example 1.
  • a clinical study on healthy volunteers has been performed with the aim to investigate the skin elasticizing activity of 3 different compositions in acute testing, compared to a standard reference product consisting of white soft paraffin.
  • Aim of the study was to compare the activity of a formulation containing a thiolated compound like a Carboxymethyl Cysteinate salt, and a mixture of esters of fatty acids and glycerol, with that of different formulations containing a thiolated compound alone or ester mixtures alone .
  • the volunteers were 21 women, aged between 24 and 55 years (mean 45 yrs) . Each product has been randomly applied once, by a mild massage, on the volar surface of forearm. Plastoelasticity measurement were performed at baseline and 30 minutes after the application of each product by means of torsiometry measured by the Dermal Torque Meter (Dia-Stron LTD) as described in Sparavigna A, Setaro M, Misurazione delle proprieta meccaniche della cute mediante metodi di torsione, "Diagnostica non invasiva in dermatologia" a cura di Stefania Seidenari, EDRA Medical Publishing & New Media, Milano, 1998, pages 323-328.
  • This method employs the principle of torsion performed in vivo on a skin area, by an apparatus consisting in two concentric circles adhering to the skin through biadhesive tapes.
  • the distance (1 mm) between the two circles limits the area undergoing the torsion.
  • the inner circle by rotating respect to the outer circle, exerts a constant torsion on the skin, that stops when the antagonistic effort of the skin balances the applied twisting moment (9mNm) . Duration of torsion is 1 sec.
  • the apparatus measures the torsion angle ⁇ resulting at the phase of mechanical solicitation and at its cessation as well.
  • compositions employed were as follows:
  • Table 1 percent changes vs. baseline of torsiometric parameters 30 min after application of different investigational product or reference on the forearm skin of 21 healthy volunteers (Student's t test).
  • a clinical study on pregnant women has been performed with the aim to investigate the elasticizing activity on perineal tissues and the capability to prevent traumatic injuries of the perineum during delivery, by regularly applying during the last two months of pregnancy a formulation according to the Example 3.
  • the study was open label, compared versus an historical group.
  • VAS visual analogue scale
  • results were as follows: extensibility was mean ⁇ SD 78.81 ⁇ 8.59, elastic recovery was 78.04 ⁇ 12.4, no episiotomy, 8.3% grade I lacerations, no grade II or III lacerations.
  • the results relative to episiotomies and/or perineal lacerations were compared to an historical group of 425 spontaneous deliveries, including all the deliveries occurred in the same investigational centre during the whole 2004 period. The data are summarized in the following table 2.
  • Table 2 rate of episiotomies and lacerations during spontaneous delivery in the study group compared to an historical group of women

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Abstract

Compositions for improving the elasticity of the vagina and of the perineum during the last trimester of pregnancy, include combining a thiolated compound or mixture thereof with an ester of organic acid or mixture thereof . The compositions according to the present invention improve the elastic properties of the vaginal and/or perineal tissues in terms both of increased extensibility and faster elastic recovery. The compositions according to the present invention may decrease risk of trauma of perineal tissues during delivery, as well as risk of rectal or bladder incontinence as a post-partum short/medium/long term complication.

Description

Title
Compositions with enhanced elasticizing activity
Description
This invention relates to compositions of thiolated compounds combined to esters of organic acids useful to enhance the elasticizing properties on vaginal and/or perineal tissues. BACKGROUND OF THE INVENTION
In the art, thiolated compounds, both those provided with free SH groups, and those with the S- atom blocked by a functional group, have the capability to decrease the rigidity of protein structures, by breaking the disulphur bonds, resulting in increasing the extensibility of the protein molecule. This result is achieved by acting both on ternary and quaternary structure, without affecting the primary and secondary ones, and therefore is reversible. This action is very well known and it is applied in two large fields, like in human therapy of bronchitis, to decrease sputum viscosity and improve bronchial and tracheal clearance both in acute and chronic bronchitis; on the other hand, it is applied by cosmetic industry to improve skin softness in subjects with wrinkles or striae. In fact, the structure of keratin, the main constituent of the skin, is rich of disulphur bonds as a result of interactions between two non contiguous molecules of cisteine, in the aminoacidic chain. Same is to be said for sputum, which constituents are rich of disulphur bonds. The breaking of the disulphur bond, by reducing the -SS- bridge to two -SH free groups, allows the protein to extend, by loosing the rigidity due to the covalent bond. On the other hand, this phenomenon is reversible, in fact the two SH free groups may further interact and form an -SS- bridge.
Esters of alcohols and organic acids are known in the art and used as skin care and nurturing for the prevention and reduction of stretch marks. They substantially act while keeping essential emollients actively softening and elasticizing. Triglycerides are esters of glycerol, that are physiologically present in the animal and vegetable tissues. Those esters are composed of organic fatty acids, with a Carbon atom chain varying between 6 to 18 Carbon atoms, they may be saturated or unsaturated, mainly mono-, di- or tri- unsaturated. The chain length and the presence of double bonds affect the melting point of the fatty acids and of their esters. The lowering of the melting point confers to these compounds a semisolid or liquid state that is useful for their emollient and humectant properties. Cholesterides are esters of cholesterol and organic fatty acids, also present in nature, mostly in fats and nervous tissues of animals. They also are used in the preparation of creams and ointments due to their emollient properties. Phytosterol esters are the correspondent in the vegetables, where the sterol components of the ingredient vegetable oil phytosterol esters are beta-sitosterol, campesterol, and stigmasterol . These components of vegetable oil phytosterol esters already are present as ingredients in cosmetics as skin care products for their emollient properties, thus they have a similar intended use to cholesterides and triglycerides. Fatty acids that enter in the composition of esters with sterols are also varying between 6 to 18 Carbon atoms, they may be saturated or unsaturated, mainly mono-, di- or tri- unsaturated fatty acids. Esters of alcohols and organic acids may be synthetic, such as isopropyl-miristate and isopropyl palmitate. Isopropyl-myristate is the ester of isopropyl alcohol and myristic acid, a saturated C- 14 fatty acid: it is widely used both in cosmetic and pharmaceutical industry, also for vaginal preparations. The compositions object of the present invention contain at least a thiolated compound and an ester of organic acid which act synergistically in improving tissue elasticity in terms of increased both extensibility and elastic recovery. This feature is important to increase elasticity of the distal portion of the vagina and of the perineal tissues during the last trimester of pregnancy. Spontaneous delivery is often accompanied by lacerations of the perineal tissues due to excessive extension during the expulsive phase. Short-medium term complications are often pain, dyspareunia and urinary incontinence in 30 - 50 % of women (Lukacz ES et al . Obst Gynecol . 2006 - Olsen LO, et al Obstet. Gynecol. 1997).
The practice to episiotomy may decrease the spontaneous lacerations in terms of both rate and severity of lacerations, but it is not devoid of complications, like dyspareunia and rectal incontinence of puerperal women. According to a recent systematic evidence review, although episiotomy is performed in approximately 30-35% of vaginal birth in the United States, no statistically significant difference were reported for severe vaginal or perineal trauma, dyspareunia or urinary incontinence (ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstet. Gynecol. 2006).
Perineal massage during the last weeks of pregnancy is a practice known in the art to prepare the tissues to the increased request of extension during spontaneous delivery. Ten-fifteen minutes massage is performed during the last 6-8 weeks before delivery, mostly daily or tri-weekly. Almond oil is used as a lubricant. The usefulness of this practice is controversial: according to the literature, the practice of the perineal massage is capable to improve the extensibility of the perineal tissues, by significantly reducing the incidence of trauma requiring suturing and number of episiotomy in woman without previous vaginal birth, but no differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd to 4th degree perineal trauma compared to women not practicing the perineal massage (Beckmann MM et al . Birth 2006).
It has now been shown that compositions containing at least a thiolated compound and an ester of organic acid and appropriate excipients improve the elasticity of the skin by a synergistic action of the two components, namely the thiolated compound and the ester of organic acid. Furthermore, the regular application of compositions containing at least a thiolated compound and an ester of organic acid and appropriate excipients is capable to increase the elastic properties of the distal part of the vagina and of the perineal tissues. The compositions are preferably in form of cream, ointment, gel or lotion, and are preferably topically applied by perineal massage, to improve penetration of the ingredients deeply into the perineal tissues, and to train the vaginal and perineal muscles to the expulsive phase of delivery as well.
The compositions contain at least a thiolated compound in a proportion ranging between 0.1 to 25 wt.%, preferably from 0.5 to 15 wt.%, more preferably from 1.0 to 10%, with respect to the total weight of the composition. The thiolated compound is preferably a sulphated aminoacid, more preferably a derivative of cysteine, most preferably a salt of carboxymethyl- cysteine. According to a preferred embodiment, said sulphated amino acid is selected from: 1-methionine, 1- cysteine, 1-cystine, taurine, 4-thiazolidinecarboxylic acid, carboximethylcisteine and/or methylsulphonylmethane, or a physiologically acceptable salt thereof.
The compositions contain at least an ester of organic acid in a proportion ranging between 1 to 95 wt.%, preferably from 5 to 70 wt.%, more preferably from 10 to 45%, with respect to the total weight of the composition. The ester of organic acid is preferably an ester of glycerol or an ester of animal or vegetable sterol, such as cholesterol, or a mixture thereof. The organic acid contains from 2 to 30 carbon atoms, preferably from 6 to 18 carbon atoms, more preferably from 12 to 18 carbon atoms. The organic acid is saturated or unsaturated.
The compositions will be prepared according to conventional techniques, and may include compatible excipients and pharmaceutically acceptable carriers, e.g. ionizing agents, antioxidant agents, chelating agents, moisturizing agents, decongestant agents, disinfectant and/or antimicrobial agents, flavoring and colorants .
The compositions may also contain, in combination, other active principles with complementary or, in any case, useful activity. Examples of these compositions prepared according to the present invention include: cream, ointment, gel, lotion or foam.
The pharmaceutical compositions and the uses of the present invention will now be more fully described by the following examples. It should, however, be noted that such examples are given by way of illustration and not of limitation.
EXAMPLE 1
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared:
1) Lysine Carboxymethyl Cysteinate1 5.00%
2) Polyglyceryl-3 Beeswax2 7.50%
3) Prunus amygdalus var. dulcis3 12.00%
4) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid4 0.05%
5) Petrolatum5 15.00%
6) Hydrogenated castor oil6 2.00%
7) Paraffinun liquidum7 q.s. to 100.00%
1EIaStOCeIl(S); 2Cera Bellina (hydrophilic derivative of beeswax in which the free fatty acids have been converted to polyglycerol esters) ; 3Sweet Almond Oil (containing glycerides from oleic acid for about 65%).; 4Aperoxid TLA; 5White Soft Paraffin; 6Cutina ® HR Powder (consisting mainly of triglycerides of hydroxystearic acid (C18)); 7Pharma 55
Paraffinun liquidum, Polyglyceryl-3 Beeswax, Prunus amygdalus var. dulcis, Aperoxid TLA and Petrolatum were mixed in a turboemulsor and heated at 700C. When the mass was melted, Hydrogenated castor oil was added under moderate stirring until complete dispersion.
The melted mass was then cooled at 45°C and Lysine Carboxymethyl Cysteinate was added under stirring until a homogeneous gel was obtained.
The obtained gel contains 21.50% of esters according to the invention; it is ivory and homogeneous in appearance .
EXAMPLE 2
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared:
1) Lysine Carboxymethyl Cysteinate 7.50%
2) Polyglyceryl-3 Beeswax 5.00%
3) Acetylated Lanolin* 2.00%
4) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid 0.05%
5) Petrolatum 38.50%
6) Paraffinun liquidum 14.00%
7) Hydrogenated castor oil 3.00%
8) Soybean oil** q.s. to 100.00% *Modulan™Lanolin Derivative (Noveon) Acetylated Lanolin Alcohol; ** Consisting in glycerides of linoleic acid (50-57%) ; linolenic acid (5-10%) ; oleic acid (17-26%); palmitic acid (9-13%); and stearic acid (3-6%) .
The obtained gel contains 39.95% of esters according to the invention
The formulation was prepared by using the same method described for Example 1.
EXAMPLE 3
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared:
1) Lysine Carboxymethyl Cysteinate 5.00%
2) Polyglyceryl-3 Beeswax 5.00%
3) Prunus amygdalus var. dulcis 12.00%
4) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid 0.10%
5) Petrolatum 15.00%
6) Phytosterol ester* 15.00%
7) Hydrogenated castor oil 3.50%
8) Silica 1.50%
9) Paraffinun liquidum q.s. to 100.00
*Vegapure (Cognis)
The obtained gel contains 35.5% of esters according to the invention The formulation was prepared by using the same method described for Example 1.
EXAMPLE 4
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared:
1) Lysine Carboxymethyl Cysteinate 5.00%
2) Polyglyceryl-3 Beeswax 7.50%
3) Prunus amygdalus var. dulcis 7.00%
4) Isopropyl Myristate* 5.00%
5) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid 0.10%
6) Petrolatum 15.00%
7) Hydrogenated castor oil 4.50%
8) Silica 1.50%
9) Paraffinun liquidum q.s. to 100.00%
*Crodamol IPM (Croda, ester of isopropyl alcohol and myristic acid, saturated C14 fatty acid)
The obtained gel contains 24.00% of esters according to the invention
The formulation was prepared by using the same method described for Example 1. EXAMPLE 5
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared:
1) L-Methionine 5.00%
2) Synthetic Beeswax* 8.50%
3) Prunus amygdalus var. dulcis 12.00%
4) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid 0.05%
5) Petrolatum 15.00%
6) Hydrogenated castor oil 4.00%
7) Silica 2.50%
8) Neem oil** 1.00%
9) Sesame seed oil*** 2.00%
10) Paraffinun liquidum q.s. to 100.00%
* Syncrowax BB4 (Croda)
**Contains a mixture of tryglicerides of linoleic, oleic, palmitic and stearic acids
***Contains glycerides of arachidic acid (0.8%), linoleic acid (40.4%), oleic acid (45.4%), palmitic acid (9.1%), and stearic acid (4.3%)
The obtained gel contains 27.50% of esters according to the invention
The formulation was prepared by using the same method described for Example 1. EXAMPLE 6
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared:
1) Methylsulfonyl methane 5.00%
2) Synthetic Beeswax 5.00%
3) Prunus amygdalus var. dulcis 12.00%
4) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid 0.10%
5) Petrolatum 15.00%
6) Hydrogenated vegetable oil* 3.50%
7) Silica 1.50%
8) Paraffinun liquidum q.s. to 100.00%
*CEGESOFT® HF62 (Cognis, contains a mixture of C16-C24 triglycerides)
The obtained gel contains 20.50% of esters according to the invention
The formulation was prepared by using the same method described for Example 1.
EXAMPLE 7
A lipogel (=homogeneous hydrophobic ointment) formulation having the following w/w % composition was prepared: 1) Lysine Carboxymethyl Cysteinate 5.00%
2) Synthetic Beeswax 5.00%
3) Prunus amygdalus var. dulcis 6.00%
4) Tocopherol, Lecithin, Ascorbyl palmitate, Citric acid 0.10%
5) Petrolatum 15.00%
6) Lanolin Alcohol* 3.50%
7) Lanolin USP** 6.00%
8) Silica 1.50%
9) Paraffinun liquidum q.s. to 100.00%
*Super Hartolan (Croda, cholesterol-rich solid fraction of pharmaceutical grade lanolin); **Medilan™ (Croda, containing a mixture of cholesterol and the esters of several fatty acids
The obtained gel contains 20.50% of esters according to the invention
The formulation was prepared by using the same method described for Example 1.
EXAMPLE 8
Comparative clinical test
A clinical study on healthy volunteers has been performed with the aim to investigate the skin elasticizing activity of 3 different compositions in acute testing, compared to a standard reference product consisting of white soft paraffin. Aim of the study was to compare the activity of a formulation containing a thiolated compound like a Carboxymethyl Cysteinate salt, and a mixture of esters of fatty acids and glycerol, with that of different formulations containing a thiolated compound alone or ester mixtures alone .
The volunteers were 21 women, aged between 24 and 55 years (mean 45 yrs) . Each product has been randomly applied once, by a mild massage, on the volar surface of forearm. Plastoelasticity measurement were performed at baseline and 30 minutes after the application of each product by means of torsiometry measured by the Dermal Torque Meter (Dia-Stron LTD) as described in Sparavigna A, Setaro M, Misurazione delle proprieta meccaniche della cute mediante metodi di torsione, "Diagnostica non invasiva in dermatologia" a cura di Stefania Seidenari, EDRA Medical Publishing & New Media, Milano, 1998, pages 323-328.
This method employs the principle of torsion performed in vivo on a skin area, by an apparatus consisting in two concentric circles adhering to the skin through biadhesive tapes. The distance (1 mm) between the two circles limits the area undergoing the torsion. The inner circle, by rotating respect to the outer circle, exerts a constant torsion on the skin, that stops when the antagonistic effort of the skin balances the applied twisting moment (9mNm) . Duration of torsion is 1 sec. The apparatus measures the torsion angle θ resulting at the phase of mechanical solicitation and at its cessation as well.
Un ulteriore commento: e proprio necessario riportate Ia figura seguente? Non e sufficiente Ia citazione al testo bibliografico di riferimento?
The parameters measured by the a.m. technique were the elastic recovery and the skin elasticity measured as follows : Ue : immediate extensibility
Uf: maximum extensibility
Uv: viscoelasticity
Ur: immediate elastic recovery
Ur/Ue: elastic recovery
Ur/Uf: skin elasticity
Uv/Uc: viscosity τon and τoff time constants on the curves "go on" and "go back"
The compositions employed were as follows:
Product 1: lipogel LPOL514, with composition according to the Example 1
Product 2 : hydrogel LPOL513, with following w/w% composition :
1) Lysine Carboxymethyl Cysteinate1 7.50%
2) Sodium Propylparaben 0.04%
3) Sodium Methyllparaben 0.37%
4) Imidazolidinyl Urea2 0.20%
5) Disodium EDTA 0.10%
6) Hydroxyethylcellulose3 1.50%
7) Carragenine gel4 5.00%
8) Citric acid q.s. to pH 5.5
9) Water q.s. to 100.00%
1EIaStOCeIl(S); 2Gram 1; 3Natrosol 250M; 4Seamollient Product 3 : hydrogel LPOL520, with following w/w% composition :
1) Hydrogenated soybean phosphatidylcholine1 1.03%
2) Cholesterol USP 0.26%
3) Butylated hydroxyanisole (BHA) 0.10%
4) Ascorbic Acid 7.10%
5) Glycerol 5.00%
6) Disodium EDTA2 0.10%
7) Sodium Methylparaben3 0.37%
8) Sodium Propylparaben4 0.04%
9) Imidazolidinyl Urea5 0.21%
10) Hydroxyethylcellulose6 0.70%
11) Xanthan gum7 1.00%
12) Water q.s. to 100.00%
1LiPOiCl S 100-3; 2Dissolvine NA-2; 3Nipagin M sodium; 4Nipasol M sodium; 5Gram 1; 6Natrosol 250M; 7Rhodigel Ultra
Product 4 : reference standard, with the following composition :
1) Petrolatum (= white soft paraffin)
CAS n° 8009-03-8 100%
The results are summarized in the following table 1:
Table 1 : percent changes vs. baseline of torsiometric parameters 30 min after application of different investigational product or reference on the forearm skin of 21 healthy volunteers (Student's t test).
Figure imgf000017_0001
* P<0.05 vs baseline ** P<0.01 vs. baseline *** P<0.001 vs. baseline
The results show a synergistic activity of the thiolated compound, contained in products 1 and 2, and the esters contained in the products 1, 3 and 4. As a matter of fact, when the two main components, thiolated compound and esters, where present alone, as in the product 2 (devoid of activity) or in the product 3 (devoid of activity) , or in the product 4
(reference white soft paraffine, with a mild activity) , the elasticizing activity was none or mild
(not higher than 13%) . On the contrary, when the thiolated compound and the esters were combined in the same formulation, as in product 1, the deriving elasticizing activity was robust (+24% on elasticity, and +23% on elastic recovery) and superior to that of esters alone. The resulting effect was synergistic, being superior for the combination to the sum of the two ingredients alone. EXAMPLE 9
Comparative clinical test
A clinical study on pregnant women has been performed with the aim to investigate the elasticizing activity on perineal tissues and the capability to prevent traumatic injuries of the perineum during delivery, by regularly applying during the last two months of pregnancy a formulation according to the Example 3. The study was open label, compared versus an historical group.
Overall, 36 pregnant women were included in the study. All women were primipara (first pregnancy) , none of them was at risk of caesarean parturition. The product was applied by performing a regular perineal massage daily since the beginning of the 30th week until spontaneous delivery. The application of the product (2-5 g) was done by moisturizing the perineum with the formulation, then by performing a gentle massage by circular movement on the labia and on the distal part of the vagina, for about 15 min.
The parameters assessed at the time of delivery were: extensibility and elastic recovery in a visual analogue scale (VAS) from 0 (none) to 100 (maximum), in the judgment of the gynecologist, percent of episiotomies, rate and grade of lacerations, adverse events and overall judgment of efficacy.
Results were as follows: extensibility was mean ± SD 78.81 ± 8.59, elastic recovery was 78.04 ± 12.4, no episiotomy, 8.3% grade I lacerations, no grade II or III lacerations. The results relative to episiotomies and/or perineal lacerations were compared to an historical group of 425 spontaneous deliveries, including all the deliveries occurred in the same investigational centre during the whole 2004 period. The data are summarized in the following table 2.
Table 2 : rate of episiotomies and lacerations during spontaneous delivery in the study group compared to an historical group of women
Figure imgf000020_0001
It was concluded that the product was highly effective in improving elasticity of the perineum as well as in preventing traumatic complications on perineal tissues during delivery.

Claims

Claims
1 . Use of : a) at least a thiolated compound, and b) at least an ester of organic acid or a mixture thereof; for the manufacture of a topical composition for improving the elasticization of the vagina and of the perineum in pregnant women.
2. Use according to claim 1, wherein component a) is selected from sulphated amino acids and derivatives thereof .
3. Use according to claim 1, wherein component a) is selected from 1-methionine, 1-cysteine, 1-cystine, taurine, 4-thiazolidinecarboxylic acid, carboximethylcisteine and/or methylsulphonylmethane, or a physiologically acceptable salt thereof.
4. Use according to claim 1, wherein component a) is present in an amount of from 0.1 to 25 % by weight.
5. Use according to claim 1, wherein component a) is present in an amount of from 0.5 to 15 % by weight.
6. Use according to claim 1, wherein component a) is present in an amount of from 1.0 to 10 % by weight.
7. Use according to claim 1, wherein component b) is an ester of glycerol or an ester of animal or vegetable sterol or a mixture thereof.
8. Use according to claim 7, wherein said sterol is cholesterol .
9. Use according to claim 1, wherein said organic acid contains from 2 to 30 carbon atoms, preferably from 6 to 18 carbon atoms, more preferably from 12 to 18 carbon atoms .
10. Use according to claim 1, wherein said organic acid is saturated or unsaturated.
11. Use according to claim 1, wherein component b) is present in an amount of from 1.0 to 95% by weight.
12. Use according to claim 1, wherein component b) is present in an amount of from 5 to 70% by weight.
13. Use according to claim 1, wherein component b) is present in an amount of 10 to 45% by weight.
14. Use according to claim 1, characterized by comprising one or more pharmaceutically acceptable excipients .
15. Use according to claim 14 wherein said excipient is selected from the group consisting of: ionizing agents; antioxidant agents; chelating agents; moisturizing agents; thermoviscosizing agents; decongestant agents; disinfectant and/or antimicrobial agents; flavouring and colorants.
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