highly bioavailable zero-valent sulfur compositions

专利摘要:
PREPARATION AND HIGHLY BIOAVAILABLE ZERO VALENCE SULFUR COMPOSITIONS AND THEIR USES. The present invention features sulfur-rich compositions and preparations thereof that are safe and effective as highly bioavailable hydrogen sulfide prodrugs. The invention also includes methods for treating pathological conditions associated with oxidative stress through the use of compositions rich in sulfur. The invention also includes compositions rich in sulfur as antidotes and medical food to preserve and promote general health.
公开号:BR112014005144B1
申请号:R112014005144-5
申请日:2012-09-13
公开日:2021-06-08
发明作者:Gabriel Gojon Romanillos；Gabriel Gojon Zorrilla
申请人:Nuevas Alternativas Naturales S.A.P.I. De C.V.；
IPC主号:

专利说明:

Background of the Invention
[001] In general, the invention features compositions rich in sulfur with zero valence and methods of preparation, formulation and prevention and treatment of pathological conditions associated with oxidative stress.
[002] Despite the plethora of medications to lower blood pressure, lower cholesterol, and treat cardiovascular conditions, cardiovascular disease remains the number one cause of death in the United States. The incidence of cardiovascular problems will likely continue to rise steadily as the "Baby Boomer" generation ages and as rates of obesity and diabetes continue to soar. Therefore, the development of better therapies is of the utmost importance.
[003] Hydrogen sulfide (H2S) is a recognized endogenous signaling molecule that has been shown to modulate immune and mitochondrial function, acting both directly and indirectly as an antioxidant and increasing blood flow by a variety of mechanisms. Furthermore, hydrogen sulfide is a potent anti-inflammatory agent and modulator of cell death. This plethora of properties makes hydrogen sulfide an ideal candidate for the treatment of cardiovascular diseases, cancers, inflammatory diseases, diabetes, dyslipidemia, neurodegenerative diseases, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis , and/or immune dysfunction.
[004] While the major physiological roles of H2S are in signaling and cytoprotection in normal (ie, untransformed) cells and tissues, it is now clear that in transformed (ie, malignant) cells, H2S exhibits prooxidant and proapoptotic effects . These effects form the basis for developing a therapeutic and/or prophylactic approach for the treatment of conditions associated with uncontrolled cell growth such as cancer and other hyperproliferative disorders.
[005] Hydrogen sulfide is endogenously produced from cysteine by the enzymes cystathionine beta-synthase, cystathionine gamma-lyase and 3-mercaptopyruvate sulfurtransferase. Hydrogen sulfide prodrugs can provide an exogenous source for hydrogen sulfide in the body, however, currently used hydrogen sulfide prodrugs contain no more than 57% bioactive sulfur (sulfide that can be converted to hydrogen sulfide in vivo). On the other hand, it has become increasingly clear that sodium hydrogen sulfide (NaHS, also known as sodium hydrosulfide), which contains 57% bioactive sulfur, releases hydrogen sulfide in a sudden and uncontrolled manner when injected within the body of a mammal, while it is highly unlikely that cells or tissues will ever be exposed to H2S generated in such a way. Therefore, there is a need to identify hydrogen sulfide prodrugs that are safe and effective, are active when administered orally, release H2S in a controlled and sustained manner, and have high bioavailability for the treatment of cardiovascular disease, cancer, inflammatory diseases, diabetes, dyslipidemia, neurodegenerative disorders, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or immune dysfunction. Invention Presentation
[006] The invention provides a composition comprising 90-99.9% (by weight/weight) of elemental alpha sulfur and 0.01-10% (by weight/weight) of highly polar components. In certain embodiments, the composition can optionally include one or more pharmaceutically acceptable excipients. In other embodiments, the composition can include about 99% (by weight/weight) of zero valent sulfur and about 1% (by weight/weight) of highly polar components, wherein the highly polar components are selected to from sodium sulfate, sodium polythionate and sodium thiosulfate.
[007] The invention also features a composition that includes an elemental alpha sulfur and one or more highly polar components in a ratio of about 10 to about 150 parts elemental alpha sulfur to 1 part highly polar components (by weight/weight ) for enteral, topical or parenteral administration. In certain embodiments, the ratio of Elemental alpha sulfur to the highly polar components is 15:1, 20:1, 30:1, 35:1, 40:1, 45:1, 50:1, 55: 1, 60:1, 70:1, 80:1, 90:1, 100:1, 110:1, 120:1, 130:1, 140:1, or 145:1.
[008] In some embodiments, a composition of the invention is formulated for enteral administration and the elemental alpha sulfur and highly polar components are present together in an amount of 400 mg. In one aspect of the embodiment, the composition is a capsule.
[009] In other embodiments, a composition of the invention is formulated for topical administration and the composition includes 1-20% sulfur content with zero valence. In one aspect of the embodiment, the composition is a cream. In one aspect, the cream includes (i) 5-20% sulfur content with zero valence and (ii) polyethylene glycol or petroleum jelly. In another aspect, the cream includes 5-15% sulfur content with zero valence. In certain embodiments, the cream includes 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15% , 16%, 17%, 18% or 19% sulfur content with zero valence.
[0010] For any of the above compositions, the highly polar components can be selected from the group consisting of sodium polythionate, potassium polythionate, ammonium polythionate, calcium polythionate, sodium thiosulfate, potassium thiosulfate, sodium thiosulfate ammonium, calcium thiosulfate, sodium sulfate, potassium sulfate, ammonium sulfate, sodium bisulfite, potassium bisulfite, ammonium bisulfite, calcium bisulfite, sodium chloride, potassium chloride, ammonium chloride, calcium chloride, sodium acetate, sodium palmitate, potassium palmitate and ammonium laurate.
[0011] In certain embodiments, the compositions of the invention also include a third agent. In some embodiments, the third agent is a cardiovascular disease drug, an anti-inflammatory drug, an anti-neurodegenerative drug, or an anti-cancer/anti-proliferative drug. In other embodiments, the third agent is a dietary supplement. In certain aspects of the invention the elemental alpha sulfur, the highly polar components and the third agent are present in an amount effective to treat a condition associated with oxidative stress. In other aspects, the elemental alpha sulfur, the highly polar components, and the third agent are present in an amount effective to promote or maintain overall health.
[0012] The invention also provides a method for preparing a composition comprising 90-99.9% (by weight/weight) of elemental alpha sulfur and 0.01-10% (by weight/weight) of highly polar components , wherein the method includes: (a) providing a first inorganic compound that includes sulfur in the -2 (minus two) oxidation state; (b) reacting the first inorganic compound with a second compound that includes sulfur in the -2 (minus two) state. oxidation +4 (plus four) and, optionally, an acid, where the reaction produces a composition that includes 90-99.9% (by weight/weight) of elemental alpha sulfur and 0.01-10% (by weight/ weight) of highly polar components.
[0013] In one embodiment, the first inorganic compound is sodium hydrogen sulfide or sodium sulfide. In a second embodiment, the second inorganic compound is sodium metabisulfite, sodium bisulfite, or sodium sulfite. In a third embodiment, the acid is concentrated sulfuric acid.
[0014] The invention also provides a method for treating a condition associated with oxidative stress in an individual in need thereof by administering an effective amount of a composition that includes 90-99.9% (by weight/weight ) elemental alpha sulfur and 0.01-10% (by weight/weight) of highly polar components and optionally includes one or more pharmaceutically acceptable excipients. In certain aspects, the composition can also include about 99% (by weight/weight) of zero valent sulfur and about 1% (by weight/weight) of highly polar components, wherein the highly polar components are selected from of sodium sulfate, sodium polythionate and sodium thiosulfate.
[0015] In another aspect, the invention also features a method for treating a condition associated with oxidative stress in an individual in need thereof by administering an effective amount of a composition that includes an elemental alpha sulfur and one or plus highly polar components at a ratio of about 10 to about 150 parts elemental alpha sulfur to 1 part highly polar components (by weight/weight) for enteral, topical, or parenteral administration.
[0016] In some embodiments, the condition associated with oxidative stress is selected from the group consisting of: schizophrenia, bipolar disorder, fragile X syndrome, sickle cell disease, chronic fatigue syndrome, osteoarthritis cataract , macular degeneration, toxic hepatitis, viral hepatitis, cirrhosis, chronic hepatitis, dialysis oxidative stress, kidney toxicity, kidney failure, ulcerative colitis, bacterial infection, viral infections such as HIV and AIDS, herpes, ear infection, ear diseases. upper respiratory tract, hypertension, baldness and hair loss, infertility in men, physical overpreparedness syndrome related to athletic performance, athlete's foot, psoriasis, eczema, scleroderma, atopic dermatitis, polymyositis, rosacea, dermatitis herpetiformis, other neurodegenerative diseases, other inflammatory diseases and cancer.
[0017] In other embodiments, the condition associated with oxidative stress is a cardiovascular disease. In certain embodiments of the embodiment, cardiovascular disease is selected from the group consisting of: arteriosclerosis, coronary heart disease, ischemia, endothelial dysfunction, in particular those dysfunctions that affect the elasticity of blood vessels, restenosis, thrombosis, angina, high blood pressure, cardiomyopathy, hypertensive heart disease, heart failure, cor pulmonale, cardiac dysrhythmias, endocarditis, inflammatory cardiomegaly, myocarditis, myocardial infarction, valvular heart disease, stroke and cerebrovascular disease, aortic valve stenosis , congestive heart failure and peripheral arterial disease.
[0018] The invention also provides a method for increasing hydrogen sulfide levels in an individual who has a nutritional sulfur deficiency by administering an effective amount of a composition that includes 90-99.9% (by weight/weight ) elemental alpha sulfur and 0.01-10% (by weight/weight) of highly polar components and optionally includes one or more pharmaceutically acceptable excipients.
[0019] In one aspect, the invention also features a method for evaluating the treatment of a cardiovascular disease by administering a composition that includes 90-99.9% (by weight/weight) of elemental alpha sulfur and 0.01 -10% (by weight/weight) of highly polar components and optionally includes one or more pharmaceutically acceptable excipients. The method includes the steps of: determining the level of hydrogen sulfide in an individual sample, adjusting the dose of the composition in an amount sufficient to treat cardiovascular disease, in which an increase in the level of hydrogen sulfide or an improvement in cardiovascular parameter results in the treatment of cardiovascular disease. In certain respects, the cardiovascular parameter is selected from the group consisting of end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, expulsion fraction, heart rate, and cardiac output. Definitions
[0020] By "elemental alpha sulfur" is meant orthorhombic elemental sulfur having the formula S8. Elemental alpha sulfur exists as S8 (cyclooctoenzophre molecules), but it can also include S7 (cycloheptaenzophre molecules) and S6 (cyclohexasulfur molecules).
[0021] By "elemental beta sulfur" is meant monoclinic elemental sulfur which has the formula S8 and consists mainly of cyclooctosulfur molecules.
[0022] By "highly polar component" is meant a compound whose molecules contain at least one ionic bond or a highly polar covalent bond. Highly polar components include, for example, sodium polythionates, potassium polythionates, ammonium polythionates, calcium polythionates, sodium thiosulfate, potassium thiosulfate, ammonium thiosulfate, calcium thiosulfate, sodium sulfate, potassium sulfate, sulfate of ammonium bisulfite, sodium bisulfite, potassium bisulfite, ammonium bisulfite, calcium bisulfite, sodium chloride, potassium chloride, ammonium chloride, calcium chloride, sodium acetate, sodium palmitate, potassium palmitate, and/or ammonium laurate. Highly polar components also include molecules that contain highly polar O-H covalent bonds, for example, water, alcohols, polyols, polythionic acids, carboxylic acids, and/or sorbitan monostearate. Highly polar components also include compounds whose molecules contain highly polar N-H covalent bonds, for example, primary amines, amino acids, primary amides, peptides and proteins.
[0023] By "polythionate" is meant an anion or group of the formula -03S-Sn-S03- (for example, where n is an integer from 1 to 60, preferably from 1-20 and more preferably 1, 2, 3, 4, 5 or 6).
[0024] By "zero valence sulfur" is meant a sulfur atom with an oxidation state of zero, as calculated according to an agreed set of rules well known to those skilled in the art (for example, each molecule of cyclo-octosulfur (S8) contains eight sulfur atoms with zero valence, each thiosulfate ion (S2O3-2) contains one sulfur atom with zero valence, and each polythionate ion contains "n" sulfur atoms with zero valence. zero-valent sulfur can be found in sulfur compounds of sulfuric anhydride.
[0025] By "zero valent sulfur content" is meant the amount of zero valent sulfur present in a composition containing elemental alpha sulfur and highly polar components such as sodium polythionates, potassium polythionates, ammonium polythionates, calcium polythionates, sodium thiosulfate, potassium thiosulfate, ammonium thiosulfate, calcium thiosulfate, sodium sulfate, potassium sulfate, and ammonium sulfate.
[0026] By "sulfuric anhydride sulfur" is meant a volatile highly reactive sulfur atom, in a reduced oxidation state with a valence of 0 or -1, covalently bonded to another sulfur atom. Sulfuric anhydride sulfur compounds can include, for example, persulfides, polysulfides, polythionates, polysulfuric anhydride, thiotaurine, thiosulfate, and/or elemental sulfur. Sulfuric anhydride sulfur compounds can form in anaerobic cysteine sulfur metabolism with the participation of enzymes such as cystathionase, 3-mercaptopyruvate sulfurtransferase, and/or rhodanate. The last step in the enzymatic pathways of H2S generation generally involves sulfur-containing species of sulfuric anhydride. Sulfur-containing compounds from sulfuric anhydride can participate in cell regulation processes through the activation or deactivation of enzymes such as, for example, oxidoreductase containing an iron or molybdenum atom, for example, xanthine oxidase, aldehyde oxidase and malate dehydrogenase.
[0027] By "enteric" is meant administration that involves any part of the gastrointestinal tract. Enteral administration can include: by mouth in the form of tablets, capsules or drops, by gastric feeding tube, duodenal feeding tube, or rectally.
[0028] By "topical" is meant administration that is local or systemic, in particular epicutaneous, by inhalation, eye drops, and/or ear drops.
By "parenteral" is meant the administration of the composition of the invention by other than oral consumption, in particular by injection of a liquid form into the body. Parenteral administration may include: intravenous, intraarterial administration, intraosseous, intramuscular, intracerebral, intracerebroventricular infusion and subcutaneous administration.
By "cardiovascular disease drug" is meant a class of agents or substances that are used for the treatment of diseases that affect the cardiovascular system, in particular cardiac diseases, vascular diseases of the brain and kidneys and peripheral arterial disease.
By "anti-inflammatory drug" is meant an agent or substance that acts by reducing inflammation.
[0032] By "anti-cancer/antiproliferative drug" is meant an agent, a substance and/or a mixture of substances that reduces, prevents and/or interferes with uncontrolled cell growth, its onset, promotion, progression and/or extension to other bodies.
[0033] By "antineurodegenerative drug" is meant an agent, a substance and/or a mixture of substances that restores and/or improves neuronal function by acting directly on neurons or indirectly on trajectories associated with neuronal function (by example, axonal transport trajectories, protein misfolding trajectories, protein degradation trajectories, and programmed cell death trajectories).
[0034] By "dietary supplement" is meant an agent, a substance and/or a mixture of substances that is a food supplement or nutritional supplement intended to supplement the diet and provide nutrients, such as vitamins, mineral salts, fiber, acids fatty acids or amino acids that may be missing or may not be consumed in sufficient amounts in a person's diet.
[0035] By "promoting or maintaining general health" is meant helping to achieve a state of human health that is characterized by a homeostatic balance with the stable condition of properties such as temperature, pH, electrolytes and/or metabolites.
[0036] By "inorganic" is meant a compound that is not an organic compound.
[0037] By "oxidation state" is meant a measure of the degree of oxidation of an atom in a molecule of a substance defined as the charge that an atom can be imagined to have when the electrons are counted according to an agreed set of well-known rules an element skilled in the art.
By "acid" is meant an Arrhenius acid, a Bronsted-Lowry acid and/or a Lewis acid. An Arrhenius acid is a substance that increases the concentration of hydrogen ion when it is dissolved in water. A Bronsted-Lowry acid is a species that donates a proton to a Bronsted-Lowry base. A Lewis acid is a species that accepts a pair of electrons from another species.
[0039] By "conditions associated with oxidative stress" is meant a condition characterized by or arising from the imbalance between the systemic manifestation of reactive oxygen species and the ability of the biological system to easily detoxify reactive intermediates and/or repair the resulting damage.
[0040] By "hydrogen sulfide" is meant a compound having the formula H2S that is produced in small amounts by many cells in the body of a mammal and has a number of biological signaling functions (eg a muscle relaxant smooth, a vasodilator, enhances the NMDA receptor response, facilitates prolonged action potentiation and involvement in memory formation).
[0041] By "increasing hydrogen sulfide levels" is meant increasing the level of hydrogen sulfide produced in the body of a mammal (eg, of cysteine by the enzymes cystathionine beta-synthase and cystathionine gamma-lyase) by at least about 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or 100% as compared to a control reference sample. Hydrogen sulfide levels can be determined using any method known in the prior art.
[0042] By "nutritional sulfur deficiency" is meant a condition characterized by an imbalance in enzyme activity, hormone levels and immune system function due to a lack of sufficient amounts of sulfur in a regular diet. Symptoms of nutritional sulfur deficiency include, for example, impaired liver and kidney function, brittle nails, hair loss, itchy skin or scalp, eczema, acne, diaper rash, migraine headaches, flatulence, indigestion, vomiting, diarrhea, hemorrhoids, impotence, painful and irregular menstruation, frequent episodes of bacterial or viral infections, sore throat, toothache, nose bleeding, mumps, joint pain, allergic rhinitis, fever, enuresis and/or breast problems.
[0043] By "improvement in cardiovascular parameter" is meant a change in a cardiovascular parameter (for example, end diastolic volume (EDV), end systolic volume (ESV), stroke volume, expulsion fraction, heart rate and cardiac output ) to normal classes (eg, an end-diastolic volume (EDV) of about 65-240 ml, an end-systolic volume (ESV) of about 16143 ml, a stroke volume of about 55-100 ml, a fraction expulsion of about 55-70%, a heart rate of about 60-100 bpm, and/or cardiac output of about 4.0-8.0 l/min).
By "treating" is meant subjecting a patient to a management regimen for the purpose of combating an illness or disorder and obtaining beneficial or desired results, such as clinical results. Beneficial or desired outcomes may include, but are not limited to, improvement in quality of life, relief or amelioration of one or more symptoms or conditions; diminishing the extent of the illness, disorder, or condition; stabilization (ie, not worsening) of a state of illness, disorder, or condition; preventing the extent of the illness, disorder or condition; delay or halt in the progress of the disease, disorder or condition; amelioration or mitigation of the illness, disorder or condition; and remission (whether partial or total), whether detectable or undetectable.
[0045] By "individual" is meant a mammal (for example, a human or a non-human being).
By "effective amount" of an agent is meant the amount of the agent sufficient to obtain the beneficial or desired result (e.g., treatment of cardiovascular diseases, cancers (e.g., the hyperproliferation of malignant cells), inflammatory diseases, diabetes, dyslipidemia, neurodegenerative diseases, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or immune dysfunction) and, as such, an amount of the composition sufficient to obtain an increase in the levels of hydrogen sulfide and/or sulfur of sulfuric anhydride in vivo, as compared to the level of hydrogen sulfide and/or sulfur of sulfuric anhydride without administration of the composition.
[0047] By "composition" is meant a system comprising a substance described in the present invention, optionally formulated with an acceptable excipient and manufactured or marketed with the approval of a government regulatory agency as part of a therapeutic regimen for the treatment of illness. in a mammal or to promote and maintain general health. Pharmaceutical compositions may be formulated, for example, for oral administration in a unit dose form (for example, a tablet, a capsule, a pill, a gel capsule, or a syrup); for topical administration (for example, as a cream, gel, lotion or ointment); for intravenous administration (eg, as a sterile solution or a colloidal dispersion free from particulate emboli and in a solvent system suitable for intravenous use); or in any other formulation described in the present invention.
[0048] By "acceptable excipient" is meant any ingredient other than the substance described in the present invention (for example, a vehicle that can suspend or dissolve the active substance and/or substances, for example, petroleum jelly and polyethylene glycol) and which has properties of being non-toxic and non-inflammatory in a patient. Excipients can include, for example: non-sticks, antioxidants, binders, coatings, compression aids, disintegrants, dyes (colors), emollients, emulsifiers, fillings (diluents), film formers or coatings, flavors, fragrances, glidants (enhancers of flux), lubricants, preservatives, printing inks, absorbents, suspending or dispersing agents, colloid stabilizers, sweeteners and water. Exemplary excipients include, but are not limited to: butylated hydroxy toluene (BHT), calcium carbonate, calcium phosphate (dibasic), calcium stearate, croscarmellose, cross-linked polyvinyl pyrrolidone, citric acid, crospovidone, ethyl cellulose, gelatin, hydroxy propyl cellulose, hydroxy propyl methyl cellulose, lactose, magnesium stearate, maltitol, mannitol, methyl cellulose, methyl paraben, microcrystalline cellulose, polyethylene glycol, polyvinyl pyrrolidone, povidone, pregelatinized starch, propyl paraben, shellac, silicon dioxide , sodium carboxy methyl cellulose, sodium starch glycolate, sorbitol, (corn) starch, stearic acid, sucrose, talc, titanium dioxide and xylitol. Excipients can also include diluents (for example, saline and aqueous regulatory solutions), aqueous vehicles and non-aqueous vehicles, for example, water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol and the like) and suitable mixtures thereof , vegetable oils such as olive oil and injectable organic esters such as ethyl oleate.
As used herein in the present invention, the term "about" means ±10% of the recited value.
[0050] In Table 1 a list of abbreviations and meanings of the terminology described in the present invention is provided. Table 1


Brief Description of Figures
[0051] Figures 1A-1H are data showing that heart failure reduces sulfide levels in humans and rats. Figures 1A-1D show representative gas chromatograph peaks and summary data for free circulating hydrogen sulfide (H2S) and sulfuric anhydride sulfur levels in normal controls and heart failure patients. Figures 1E-1F show circulating levels of free H2S and sulfur sulfuric anhydride after six weeks of pressure-overload-induced heart failure (TAC) in groups of rats maintained on a standard diet (TAC + Vehicle) or maintained on a standard diet. diet containing the H2S donor SG-I002 (TAC + SG-1002, 20 mg/kg/day). Figures 1G-1H show the myocardial levels of H2S and sulfur free sulfuric anhydride in the experimental groups. Results are expressed as mean ± SEM. The numbers in bars represent the sample size. **p < 0.01 and ***p < 0.001 versus Simulation.
Figures 2A-2F are data showing that cystathionine gamma lyase (CSE) deficiency exacerbates cardiac dysfunction after CAT. Figure 2A is representative of heart images of wild type rats (WT + TAC), CSE deficient rats (CSE KO + TAC) and CSE KO rats treated with SG-1002 (CSE KO + TAC + SG-1002) a twelve weeks of TAC. Figure 28 shows the ratio of heart weight/tibia length and lung weight/tibia length at twelve weeks after CAT. Figure 2C shows the intraventricular septal end-diastolic dimension (IVSd in mm). Figure 20 shows the LV end-diastolic diameter (LVEDD in mm). Figure 2E shows the end-systolic diameter (LVESD in mm) and Figure 2F shows the LV expulsion fraction (%) after CAT. Wall thickness was similarly increased in all groups from one week to twelve weeks after CAT. CSE KO rats exhibited dilation and dysfunction beginning within six weeks of CAT. WT and CSE KO rats treated with SG-1002 did not exhibit a significant change in LV dimensions and exhibited conserved cardiac function. Results are expressed as mean ± SEM. fp < 0.05, Φp < 0.01 and #p < 0.001 versus WT. *p < 0.05 and ***p < 0.001 versus baseline.
Figures 3A-3F are data showing that cardiac-specific overexpression of CSE attenuates cardiac dilation and cardiac dysfunction after CAT. Figure 3A is representative of photomicrographs of wild-type (WT + TAC) and cardiac specific CSE transgenic (CS-CSE Tg + TAC) rats within twelve weeks of TAC. Figure 38 shows myocardial weights (mg/cm) and lung weights (mg/cm) expressed as tibial length ratio in twelve weeks of CAT. Figure 3C shows IVSd (mm), Figure 3D shows LVEDD (mm), Figure 3E shows LVESD (mm) and Figure 3F shows the LV expulsion fraction (%) after CAT. Wall thickness was similarly increased in WT and CES Tg rats from one week to twelve weeks of CAT. CSE Tg rats experienced significantly less dilatation and cardiac dysfunction compared to WT rats. Results are expressed as mean ± SEM. **p < 0.01l and ***p < 0.001 versus baseline.
Figures 4A-4H are data showing that exogenous H2S therapy prevents cardiac dilation and dysfunction after CAT. Figure 4A are representative heart images of rats treated with Simulation, Vehicle (TAC + Vehicle) and SG-1002 (TAC + SG-1002) at twelve weeks from CAT. Figure 48 shows the heart weight/tibia length ratio. Figure 4C shows the lung weight/tibia length ratio. Figure 4D shows circular BNP levels (ng/ml) at six and twelve weeks from CAT. Figure 4E shows IVSd (mm), Figure 4F shows LVEDD (mm), Figure 4G shows LVESD (mm) and Figure 4H shows the expulsion fraction (%) after CAT. Wall thickness is similarly increased in both groups after CAT. However, the SG-1002 diet prevented cardiac dilation and dysfunction beginning within 6 weeks of CAT. Results are expressed as mean ± SEM. *p < 0.05, **p < 0.01 and ***p < 0.001 versus baseline.
Figures 5A-5C are data showing that H2S attenuates intermuscular and perivascular fibrosis after CAT. Figure 5A are representative photomicrographs of sections of the heart stained with Masson's Trichrome and Picrosirius Red illustrating intermuscular and perivascular fibrosis in the heart from rats treated with Simulation, TAC + Vehicle and TAC+SG-1002 at six weeks of CAT. Figure 58 is a summary of the area of fibrosis as % LV as calculated from the Masson's Trichrome sections. Figure 5C is a summary of the area of fibrosis as % LV calculated from Picrosirius Red sections. Results are expressed as mean ± SEM. **p < 0.01 and ***p < 0.001 versus Simulation.
Figures 6A-6H are data showing that H2S up-regulates Akt phosphorylation, VEGF expression and activates the eNOS-NO pathway after TAC. Figure 6A consists of representative immunoblots of total Akt, Akt-PSer473 and Akt-PThr308. Figure 68 is a densitometric analysis of total Akt expression. Figure 6C is the densitometric analysis of Akt-PSer473 and Akt-PThr308 in hearts from Simulation, CAT + Vehicle and CAT + SG-I002 at six weeks of CAT. Figure 60 consists of immunoblots and representative densitometric analysis of cardiac VEGF expression at six weeks of CAT. Figures 6E-6F are immunoblots and representative densitometric analysis of total eNOS and eNOS-PSer1177 expression in hearts from Simulation, TAC + Vehicle and TAC + SG-1002 at six weeks of TAC. Figures 6G-6H show levels of nitrite and nitrate in the hearts of the experimental groups at six weeks from CAT. Results are expressed as mean ± SEM.
[0057] Figures 7A-7F are data showing that H2S conserves mitochondrial respiratory function and attenuates oxidative stress after CAT. Figure 7A shows mitochondrial respiratory function (j.JM 02/s/mg) in State 3 and State 4 in hearts from Simulation, CAT + Vehicle and CAT + SG-1002 to six weeks of CAT. Figure 78 shows the respiratory control ratio (RCR) from the hearts of the experimental groups at six weeks after CAT. Figures 7C-7D show plasma and heart 8-isoprostane levels at 6 weeks of CAT. Figure 7E is representative of immunoblots and densitometric analysis of NAOPH oxidase 4 (Nox4) in hearts from the experimental groups at six weeks from CAT. Figure 7F is representative of immunoblots and densitometric analysis of hemeoxygenase 1 (HO-1) in hearts from experimental groups at six weeks from CAT. Results are expressed as mean ± SEM. *p < 0.05 and ***p < 0.001 versus Simulation.
[0058] Figures 8A-8D. Figure 8A is representative of immunoblots of cystathionine gamma lyase (CSE), cystathionine beta synthase (CBS) and 3-mercaptopyruvate sulfurtransferase (3-MST) in the hearts of mice treated with Simulation, TAC + Vehicle and TAC + SG-1002 to six weeks of TAC. Figures 8B-8D show the densitometric analysis of CSE, CBS and 3-MST in Simulation, CAT + Vehicle and CAT + SG-1002 groups at six weeks after CAT. Results are expressed as mean ± SEM. The numbers in bars represent the sample size.
[0059] Figures 9A-9D. Figure 9A shows circulating free hydrogen sulfide (H2S) and Figure 9B shows circulating sulfuric anhydride (IJM) sulfur levels in CSE-deficient (CSE KO) and CSE-deficient control, wild-type (WT) rats. KO fed a diet containing the H2S donor SG-1002, Figure 9C shows free H2S and Figure 9D shows sulfuric anhydride sulfur levels (nmol/mg wet weight) in the hearts of WT, CSE KO and rat rats CSE KO + SG-1002. Results are expressed as mean ± SEM. *p < 0.05, **p < 0.01 versus WT.
[0060] Figures 10A-10E. Figure 10A shows Kaplan-Meier survival curves for TAC + WT rats, TAC + CSE KO rats and CSE KO rats fed a diet of SG-1002 (TAC + CSE KO + SG-1002) during the TAC protocol twelve weeks. Figure 10B shows Kaplan-Meier survival curves for cardiac-specific TAC + WT and transgenic CSE mice (TAC + CS-CSE Tg) after twelve weeks of TAC. Figure 10C shows Kaplan-Meier survival curves for rats fed a control diet (TAC + Vehicle) and rats fed a SG-1002 diet (TAC + SG-1002) after twelve weeks of TAC.
[0061] Figure 11 are representative immunoblots of cystathionine beta synthase (CBS) and 3-mercaptopyruvate sulfurtransferase (3-MST) from the hearts of wild-type and CS-CSE transgenic mice.
[0062] Figures 12A-120. Figure 12A shows the end diastolic dimension of the intraventricular septum (IVSd, mm), figure 12B shows the end diastolic diameter LV (LVEOO, mm), figure 12C shows the end systolic diameter LV (LVESO, mm) and figure 120 shows LV expulsion fraction (%) from rats treated with SG-1002 for six weeks after TAC (SG-1002), rats treated with SG-1002 for one week after TAC and then SG-1002 was removed for five weeks and rats treated with SG-1002 for three weeks after CAT and SG-1002 was withdrawn for three weeks. Results are expressed as mean ± SEM. *p < 0.05, ***p < 0.001 versus baseline.
[0063] Figures 13A-13D. Figure 13A shows the serum levels (pg/ml) of VEGF-A in rats treated with TAC + Vehicle and TAC + SG-1002 at six weeks after TAC. Figure 138 are representative immunoblots for myocardial nNOS and iNOS from the hearts of mice treated with Simulation, TAC + Vehicle and TAC + SG-1002 at six weeks of TAC. Figure 13C shows a densitometric analysis of nNOS protein relative to fibrillarin in Simulation, TAC + Vehicle, and TAC + SG-1002 hearts. Fig. 130 shows a bar graph of densitometric analysis of myocardial iNOS protein relative to fibrillarin in Simulation, TAC + Vehicle and TAC + SG-1002 rats after six weeks of CAT. Results are expressed as mean ± SEM. *p < 0.05, **p < 0.01 versus Simulation.
[0064] Figure 14 is a schematic diagram that highlights the proposed mechanism by which cystathionine gamma lyase (CSE) or exogenous hydrogen sulfide protects the heart after transverse aortic constriction (TAC). The data suggest that (CSE) or hydrogen sulfide donor therapy with SG-1002 activates vascular endothelial growth factor (VEGF) and subsequently phosphorylates Akt. Activation of Akt results in phosphorylation and activation of eNOS. After eNOS activation, nitric oxide bioavailability (NO) and nitrite levels are increased. These molecular signals result in reduced myocardial oxidative stress and injury, improvements in mitochondrial respiration, and decreased cardiac fibrosis. Finally, these cryoprotective actions prevent the transition from compensated to decompensated heart failure and the left ventricular (LV) expulsion fraction is conserved. Detailed Description
[0065] A safe and effective hydrogen sulfide prodrug of high bioavailability has been discovered. The bioavailable zero-valent sulfur-rich compositions of the invention contain at least 96% bioactive zero-valent sulfur that readily undergoes bioconversion to hydrogen sulfide.
[0066] Other currently used hydrogen sulfide precursors contain no more than 57% bioactive sulfur. Table 2 shows the percentage of bioactive sulfur contained in various prior art hydrogen sulfide prodrugs and Table 3 shows the effects of hydrogen sulfide on various cancer pathways. Herein the preparation and characterization of the highly bioavailable zero-valent sulfur-rich composition and the methods of administering the composition for the treatment and/or prevention of cardiovascular diseases, cancers, inflammatory diseases, diabetes, dyslipidemia, neurodegenerative diseases are described, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or immune dysfunction. Table 2

*1 = Onset, 2 = Promotion, 3 = Progression, 4 = Metastasis Sulfur-rich compositions Highly bioavailable zero-valent preparations of sulfur-rich compositions
[0067] In one embodiment, highly bioavailable zero-valent sulfur-rich compositions are obtained by Procedure I outlined below for preparing a 2.7 kg batch of a composition comprising highly bioavailable zero-valent sulfur. Raw materials are listed in Table 4 and the appropriate equipment is listed in Table 5. Table 4


Procedure I
[0068] Add by portions and under vigorous stirring, 4.890 kg of Na2S2O5 to 20 l of distilled water contained in the 200 l main reaction vessel provided with a high torque pair stirrer (7-8 shown on the screen). Addition is desirably done for 3-5 minutes and an effort should be made to prevent the powder from forming lumps. Dissolve 7,090 kg of NaHS x H2O in 15 l of distilled water contained in an 80 l auxiliary reaction vessel fitted with the low torque stirrer. Filter the NaHS solution through 3 pieces of Whatman #1 filter paper under reduced pressure using a Kitasato-Buchner union. Collect the filtered elements in a 19 l container. It should be noted that only a very small amount of impurities is normally retained on filter papers.
[0069] Then, rinse the 80 l auxiliary reaction vessel and transfer the filtered NaHS solution from the 19 l vessel to the 80 l auxiliary reaction vessel. Add 30 l of distilled water to the 60 l auxiliary reaction vessel containing the filtered NaHS solution. Pour 1.458 kg of concentrated sulfuric acid (98%) into a stirred mixture of 2.25 kg of ice and 2.25 kg of distilled water contained in a 10 l container. The next two steps should take place simultaneously and should last 40 minutes. Pour 600 ml of the Na2S2O5 solution in one go into the auxiliary reaction vessel, which contains the stirred NaHS solution, and begin to add (from an addition funnel) the dilute sulfuric acid solution (5.958 kg) to the same container with good agitation. The agitation should create a vortex that runs to the impeller. Put on a full face mask (provided with an acid absorbing cartridge), add 2.5 kg of ice to the main reaction vessel containing the Na2S2O5 solution. Start pouring concentrated sulfuric acid (4.95 kg) in small portions and under vigorous stirring. Alternate acid additions with ice additions in such a way that the solution is prevented from getting hot. Measure the temperature of the solutions in both reaction vessels. The temperature of the solution in the 200 l main reaction vessel (Na2S2O5 plus H2SO4) should be about 0°C and that of the solution in the 80 l auxiliary reaction vessel (NaHS plus some Na2S2O5 plus H2SO4) should be at comprised between 30 and 35°C. Load 5 kg of ice in the 200 l reaction vessel (Na2S2O5 plus H2SO4) and then transfer it to the solution contained in the auxiliary 80 l reaction vessel (NaHS plus a little Na2S2O5 plus H2SO4) under vigorous stirring (24 .5-25 in the speed range shown on the screen). This operation should take about 10 minutes and the agitation should create a vortex that goes to the impeller. Before mixing the two solutions, the reaction mixture should change from colorless to canary yellow, fluidity is increased, there is some foaming and a yellowish precipitate is separated. Measure the final temperature of the reaction mixture as well as its pH. The temperature should be between 25 and 30°C and the pH should be close to 3. Continue stirring vigorously for 90 minutes. The agitation should create a vortex that goes to the impeller.
[0070] Allow the reaction mixture to remain undisturbed for 24 hours at room temperature. At the end of this step, the yellowish precipitate should rest on the bottom of the container in the form of a relatively compact mass. Without disturbing the precipitate, transfer as much of the liquid phase as possible to a different vessel by decanting or with a siphon. Transfer the material remaining in the reaction vessel (about 20 l) to a 40 l plastic or glass vessel and shake for an hour to obtain a homogeneous mortar. Filter the mortar through Whatman #1 filter paper using a Buchner-Kitasato union. Wash the filter cake with 1 liter of distilled water or until the filtrate shows no acidity. Washing should be done before the filter cake develops fractures to prevent the formation of channels. Immediately after washing, maintain the vacuum application for 10 minutes or more. The super-dry material will lead to a highly compact filter cake and will cause great difficulties in subsequent steps. The use of an oiled cloth or plastic filter dam (or similar device) is recommended. Transfer the relatively dry filter cake to a 10 l plastic container and add 7 l of pure anhydrous ethanol. Stir until all solid is suspended and keep stirring for 1 hour. If the suspension becomes too thick, add more anhydrous ethanol. Filter the suspension through Whatman #1 filter paper, wash the filter cake with 200 ml of anhydrous ethanol, place the oiled cloth dam on top and continue to apply vacuum for no more than 10 minutes. The super-dry material will lead to a highly compact filter cake and will cause great difficulties in subsequent steps. Transfer filter cake to large glass or stainless steel pans for air drying at room temperature. Allow to dry for about 4 days or until constant weight and absence of ethanol aroma. The dry product is a material consisting of highly brittle lumps and an impalpable powder. De-agglomerate lumps and sieve to ensure material passes through a standard 325 sieve.
[0071] Procedure 1 produces a product (SG-1002) that contains about 99% zero-valent sulfur and about 1% highly polar components (eg, sodium sulfate and trace amounts of sodium polythionate and sodium thiosulfate sodium).
[0072] In some embodiments, variations of Procedure 1 can be used to obtain similar materials. Such procedures include, but are not limited to, the following. Procedure II
[0073] Use sodium sulfide in place of sodium hydrogen sulfide and adjust the amounts of reagents according to rules well known to those skilled in the art, such as increasing the amount of acid, following the process detailed in Procedure l. Procedure III
[0074] Use sodium sulfite in place of sodium metabisulfite and adjust the amount of reagents according to rules well known to those skilled in the art, following the process detailed in Procedure I. Procedure IV
[0075] Use sodium sulfide in place of sodium hydrogen sulfide and sodium sulfite in place of sodium metabisulfite and adjust the amount of reagents according to well-known rules of those skilled in the art, following the process detailed in Procedure 1. Procedure V
[0076] Use concentrated hydrochloric acid in place of concentrated sulfuric acid with substitution of mole by mole and following the procedure detailed in Procedure I. Procedure VI
[0077] Use concentrated hydrochloric acid in place of concentrated sulfuric acid with mole by mole substitution and following the procedure detailed in Procedure II. Procedure VII
[0078] Use concentrated hydrochloric acid in place of concentrated sulfuric acid with substitution of mole by mole and following the procedure detailed in Procedure III. Procedure VIII
[0079] Use concentrated hydrochloric acid in place of concentrated sulfuric acid with mole by mole substitution and following the procedure detailed in Procedure IV. Procedure IX
[0080] Use potassium salt in place of sodium salt and adjust the amount of reagents according to rules well known to those skilled in the art and following the process detailed in Procedure I.
[0081] In some embodiments, the reagents used in the procedure may include any compound comprising sulfur in the oxidation state minus two and another compound comprising sulfur in the oxidation state plus four and optionally an acid and/or catalyst(s) .
[0082] In other embodiments, vacuum-assisted filtration may be replaced by pressure-assisted filtration and/or centrifugation. In other embodiments, closed reactors can be used, a heat exchange cooling system can be substituted for the addition of ice, dew drying can replace air drying and one and/or more steps (e.g., alcohol wash) may be omitted. It should be understood that embodiments involving a greater or lesser range of operation are also within the scope of the present invention. Characterization of highly bioavailable zero-valence sulfur-rich compositions
[0083] The standard yield of dry sieved product is 2.7 kg of a light yellow, spongy, odorless and impalpable microcrystalline powder with the following properties: • Melting range: the average melting temperature is between about 117° C and about 121°C ± 2-3°C (for example, melting occurs between 118-120°C, 116-119°C, or between 119-120°C). • Zero-valent sulfur content (by weight/weight): 90-99.9% (eg 91%, 92%, 93.5%, 94%, 96%, 96.5%, 97.1% , 97.5%, 98%, 98.6%, 98.9% or 99.5%). • Elemental alpha sulfur content (by weight/weight): 90-99.9% (eg 91%, 92%, 93.5%, 94%, 96%, 97.1%, 97.5%, 98%, 98.6%, 98.9% or 99.5%). • Highly polar components (w/w): 0.0110% (eg 0.02%, 0.1%, 0.25%, 0.5%, 0.8%, 1%, 1.5 %, 2%, 3%, 4%, 5%, 5.5%, 6%, 7%, 8%, 9%, 9.5% or 9.9%). • Solubility in water at 25°C: 0%. • Solubility in carbon disulfide: 87-97%. • Bulk density (taken): ~0.6 g/ml. • Average particle size distribution: between about 26 and about 33 micrometers (eg 26.5, 27, 27.3, 28, 28.5, 29, 29.5, 30, 31.3, 32 , 32.5 or 32.9). • Sodium content: ~0.03% • Oxygen content (by difference): ~0.12%.
[0084] The composition obtained by adhering to Procedure 1 consists of sulfur-rich microcrystals with zero valence; its solubility in carbon disulfide is less than that of alpha sulfur (rhombic sulfur) and contains measurable amounts of sodium and oxygen. The composition's X-ray diffraction patterns are consistent with those of alpha sulfur.
[0085] The methods used to obtain the data described in the present invention include the following. The solubility of the composition in carbon disulfide is obtained by adding 6 ml of carbon disulfide to 0.500 g of the final product and the weight of the residue is determined. The zero-valent sulfur content was measured by sulfitolysis without being corrected by the fact that sulfitolysis converts all sulfur atoms in S8 to thiosulfate, but only (n-1) sulfur atoms to Na+-O3S-Sn-SO3-Na+ . Sodium content was determined using a Horiba Instruments Partica LA-950 laser diffraction particle size analyzer.
[0086] Without being limited by any hypothesis, it is likely that the high bioavailability of the above material is associated with the hydrophilic nature of the crystal surfaces, which in turn may be related to the presence of highly polar groups such as -SO3Na and /or =SO3Na2. These groups can be present on polythionate molecules (Na+-O3S-Sn-SO3-Na+, for example, where n = 1, 2 or 3), thiosulfates, or sulfates. Highly polar groups such as -SO3Na can be associated with water molecules of hydration and can, under some circumstances, undergo cation exchange, producing, for example, -SO3H groups. Furthermore, the hydrophilicity of the surface of this unique microcrystalline material is, on the other hand, marked with the hydrophobic nature of the surface of pure alpha or beta elemental sulfur crystals. Pure alpha or beta elemental sulfur, on the other hand, is completely soluble in carbon disulfide. Also without being bound by any hypothesis or theory, it is likely that the low bioavailability of common alpha sulfur is directly related to the hydrophobic nature of its surface.
[0087] In some embodiments, the composition can be micro- or nano-sized, comprising particles rich in alpha sulfur, but also modified in such a way that it has hydrophilic surfaces. Similar compositions also within the scope of the present invention can be obtained by any chemical, electrochemical, mechanochemical, sonochemical, photochemical, microwave-aided, biochemical and/or biotechnology process known in the state of the art. Compositions comprising elemental beta sulfur and surface modifying polar groups also constitute embodiments of the present invention. As stated, elemental alpha sulfur is converted to beta sulfur when heated and vice versa. Determination of zero-valent sulfur content in highly bioavailable zero-valent sulfur-rich compositions
[0088] In one aspect, the zero valent sulfur content of the composition of the invention can be determined using the method described in the present invention to measure the percentage (by weight/weight) of zero valent sulfur in alpha sulfur, thiosulfate. sodium and sodium polythionates. The sulphitolysis method for determining the zero-valent sulfur content described in the present invention is not corrected by the fact that the sulphitolysis of polythionate molecules is arrested in the trithionate as shown in equation (ii), therefore, one of the sulfur atoms with zero valence present in each polythionate molecule escapes sulfitolysis and is not converted to thiosulfate (equation (ii). However, since the sodium content of the composition disclosed in the present invention is small, the error introduced in the % calculation of zero-valent sulfur is correspondingly small.A detailed analysis of sulfitolysis is described in Koh et al., Anal. Sci. 6:3-14, 1990.
[0089] The equation of sulfitolysis reactions (i) and (iI) proceeds as in the volumetric method for the quantitative determination of elemental sulfur in aromatic hydrocarbons reported by Morris et al., Anal. Chem. 20:1037-1039, 1948. The sulfitolysis method described in the present invention is improved compared to the method of Morris et al. in various ways, including the use of n-hexadecyl pyridinium chloride as a sulphitolysis catalyst.

[0090] The reagent solutions and methods of preparing the solutions are shown in Table 6. Table 6


[0091] To determine the zero-valent sulfur content, weigh 0.160 g ± 10 mg of the composition into a 250 ml Erlenmeyer flask. Add 100 ml of a 15% Na2SO3 solution to the flask. Place the flask in a water bath and apply heat until the water boils. Then add 0.5 ml of 1% hexadecylpyridinium chloride monohydrate solution and continue heating until the solid disappears completely. Allow the contents in the flask to cool to room temperature and place a magnetic stir bar inside. While stirring, add 15 ml of a formaldehyde solution, 25 ml of a 6N solution, 10 ml of a 10% K1 solution and 1 ml of 0.5% soluble starch indicating solution. The resulting solution should be colorless. Titrate the contents in the flask with a 0.2N KIO3 solution using a 25 ml burette. As the titration begins, the contents in the flask turn amber, but the color quickly fades. As the equivalence point approaches, great care must be taken that it is not exceeded. The end point is reached when a drop of titration solution produces no color change. Equation (iii): Titration reaction
% sulfur with zero valence* = (VKIO3 (ml) x NKIO3 x 32.07 x 100)/ (1000 x sample weight (g)) *susceptible to undergo sulphitolysis Conditions and disorders
The highly bioavailable zero-valence sulfur-rich compositions described in the present invention can be used for the treatment of cardiovascular diseases, hyperproliferative diseases (e.g. cancer), an inflammatory disease, diabetes, dyslipidemia, a neurodegenative disease, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or immune dysfunction.
[0093] In one aspect, the compositions of the invention are administered to an individual already suffering from a cardiovascular disease, an inflammatory disease, a neurodegenerative disease, AIDS and a pathological condition associated with oxidative stress and/or an imbalance in the homeostasis of oxide-reduction, or cancer. In another aspect, the compositions of the invention can also be administered to an individual at risk of developing a cardiovascular disease, hyperproliferative disease (e.g. cancer), an inflammatory disease, diabetes, dyslipidemia, a neurodegenerative disease, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or immune dysfunction. cardiovascular diseases
[0094] The compositions of the invention are also useful for the treatment of cardiovascular diseases. As used in the present invention, cardiovascular disorders include, but are not limited to, arteriosclerosis, coronary heart disease, ischemia, endothelial dysfunction, in particular those disorders that affect the elasticity of blood vessels, restenosis, thrombosis, angina, high blood pressure, cardiomyopathy, hypertensive heart disease, heart failure, cor pulmonale, cardiac dysrhythmias, endocarditis, inflammatory cardiomegaly, myocarditis, myocardial infarction, valvular heart disease, stroke and cerebrovascular disease, aortic valve stenosis congestive heart disease and peripheral arterial disease. In one aspect, the invention includes methods of administering highly bioavailable zero-valence sulfur-rich compositions for chronic treatment. In another aspect, the invention also includes methods of administering highly bioavailable zero-valent sulfur-rich compositions for acute treatment.
In preferred embodiments, the highly bioavailable zero-valence sulfur-rich compositions of the invention will restore and/or improve cardiovascular parameters to normal ranges in an individual diagnosed with or at risk for a cardiovascular disease. Normal ranges of cardiovascular parameters include, but are not limited to, an end diastolic volume (EDV) of about 65-240 ml, an end systolic volume (ESV) of about 16-143 ml, a stroke volume of about 65-240 ml, about 55100 ml, an expulsion fraction of about 55-70%, a heart rate of about 60-100 bpm, and/or cardiac output of about 4.0-8.0 l/min. inflammatory diseases
The highly bioavailable zero-valent sulfur-rich compositions of the invention can be used for the treatment of inflammatory diseases. Examples of inflammatory disorders include, but are not limited to, acne vulgaris, asthma, autoimmune disorders (e.g., acute disseminated encephalomyelitis (ADEM), Addison's disease, agammaglobulinemia, alopecia areata, amyotrophic lateral sclerosis, ankylosing sponitis, antiphospholipid syndrome , antisynthetase syndrome, atopic allergy, atopic dermatitis, autoimmune aplastic anemia, cardiomyopathy, autoimmune enteropathy, autoimmune hemolytic anemia, autoimmune hepatitis, autoimmune inner ear disease, autoimmune lymphoproliferative syndrome, autoimmune autoimmune progesterone dermatitis, autoimmune autoimmune progesterone dermatitis, autoimmune purine , Balo's concentric sclerosis, Behcet's disease, Berger's disease, Bickers-taff encephalitis, Blau's syndrome, bullous pemphigoid, Castleman's disease, celiac disease, Chagas' disease, chronic inflammatory demyelinating polyneuropathy, osteoplasty chronic recurrent multifocal, chronic obstructive pulmonary disease, Churg-Strauss syndrome, cicatricial pemphigoid, Cogan syndrome, cold agglutinin disease, complement component 2 deficiency, contact dermatitis, cranial arteritis, CREST syndrome, Crohn's syndrome, Cushing, cutaneous leukocytoclastic vasculitis, Dego's disease, Dercum's disease, dermatitis herpetiformis, dermatomyositis, type 1 diabetes mellitus, diffuse cutaneous systemic sclerosis, Dressler's syndrome, drug-induced lupus, discoid lupus erythematosus, eczema, endometriosis, enthesitis-related arthritis , eosinophilic fasciitis, eosinophilic gastroenteritis, acquired epidermolysis bullous, erythema nodosum, erytrablastasis fetalis, essential mixed cryoglobulinemia, Evan's syndrome, fibrodysplasia ossificans progressive, fibrous alveolitis, gastritis, gastrointestinal pemphigoid, good malomeritis, giant cell arthritis, Severe, Guillain-Barre syndrome, encephalic Hashimoto's disease, Hashimoto's thyroiditis, Henoch-Schonlein purpura, herpes gestationis, hidradenitis suppurativa, Hughes-Stovin syndrome, hypogammaglobulinemia, idiopathic inflammatory demyelinating diseases, idiopathic pulmonary fibrosis, thrombocytopenic purpura of idiopathic body nephropathy, , chronic inflammatory demyelinating polyneuropathy, interstitial cystitis, juvenile idiopathic arthritis, Kawasaki's disease, Lambert-Eaton's myasthenic syndrome, leukocytoclastic vasculitis, lichen planus, lichen sclerosus, linear IgA's disease, polyurematous Majiere's disease, polyurematous lupus erythematosus, syndrome microscopic, mixed connective tissue disease, morphea, Mucha-Habermann's disease, myasthenia gravis, myositis, narcolepsy, neuromyelitis optica, neuromyotonia, ocular cicatricial pemphigoid, opsoclonus myoclonus syndrome, Ord's thyroiditis, palindromic degeneration, rheumatism palindromic nocturnal hemoglobinuria paroxys mal, Parry Romberg syndrome, Parsonage-Turner syndrome, pars planitis, pemphigus vulgaris, pernicious anemia, perivenous encephalomyelitis, POEMS syndrome, polyarteritis nodosa, polymyalgia rheumatica, polymyositis, primary biliary cirrhosis, primary scleral cholangitis, progressive inflammatory neuropathy, arthritis psoriatic, gangrenous pyoderma, pure red cell aplasia, Rasmussen encephalitis, Raynaud's phenomenon, recurrent polychondritis, Reiter's syndrome, restless leg syndrome, retroperitoneal fibrosis, rheumatic fever, Schnitzler's syndrome, scleritis, scleroderma, serum sickness, syndrome Sjogren's syndrome, spondyloarthropathy, rigid person syndrome, subacute bacterial endocarditis, Susac's syndrome, Sweet's syndrome, sympathetic ophthalmia, Takayasu's arthritis, temporary arthritis, thrombocytopenia, Tolosa-Hunt syndrome, transverse myelitis, ulcerative colitis, connective tissue disease undifferentiated, undifferentiated spondyloarthropathy, vitiligo and gra Wegener's nullomatosis), celiac disease, chronic prostatitis, glomerulonephritis, hypersensitivities, inflammatory visceral diseases, pelvic inflammatory disease, reperfusion injury, rheumatoid arthritis, sarcoidosis, transplant rejection, vasculitis, interstitial cystitis, and osteoarthritis. neurodegenerative diseases
The highly bioavailable zero-valent sulfur-rich compositions of the invention can be used for the treatment of neurodegenerative disorders. Neurodegenerative diseases are any disease that is characterized by the progressive loss of structure or function of neurons, which includes the death of neurons. Neurodegenerative disorders can be caused by genetic mutations (eg, mutation of CAG nucleotide triplets), incorrect protein duplication (eg, alpha-synuclein clumping, hyperphosphorylated tau protein, and beta amyloid clumping), malregulation in pathways protein degradation (eg, ubiquitin-proteasome pathways and autophagous lysosome pathways), membrane damage, mitochondrial dysfunction, defects in axonal transport, and poor regulation of programmed cell death pathways (eg, apoptosis, autophagy, and cytoplasmic). Examples of neurodegenerative disorders include, but are not limited to, Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis (ALS), Creutzfeldt-Jakob disease, primary progressive aphasia, progressive supranuclear palsy, type 3 spinocerebellar ataxia, frontotemporal dementia, Lewy body dementia, corticobasal degeneration, prion disorders, multiple system atrophy, hereditary spasmodic paraparesis, Friedreich's ataxia, and amyloidosis. Other pathological conditions associated with oxidative stress and/or an imbalance in oxide-reduction homeostasis
[0098] The highly bioavailable zero-valent sulfur-rich compositions of the invention may be useful in the treatment of other conditions associated with oxidative stress including, but not limited to, autism, schizophrenia, bipolar disorder, syndrome Fragile X, sickle cell anemia, chronic fatigue syndrome, osteoarthritis cataract, macular degeneration, toxic hepatitis, viral hepatitis, cirrhosis, chronic hepatitis, dialysis oxidative stress, kidney toxicity, kidney failure , ulcerative colitis, bacterial infection, viral infections such as HIV and AIDS, herpes, ear infection, upper respiratory tract disorders, hypertension, baldness and hair loss, over-preparation syndrome related to athletic performance, eczema, scleroderma , atopic dermatitis, polymyositis and hepetiform dermatitis.
In preferred embodiments, the compositions of the invention may be formulated for topical administration and/or enteral administration for the treatment of conditions such as psoriasis, athlete's foot, and/or rosacea. In some embodiments, the highly bioavailable zero-valent sulfur-rich compositions of the invention may be useful for wound healing by influencing wound healing steps including, but not limited to, hemostasis, inflammatory, proliferative and remodeling. In another embodiment, the highly bioavailable zero-valence sulfur-rich compositions of the invention also improve athletic performance by increasing one or more of the factors: toughness, energy, strength, visual acuity and/or coordination.
[00100] In another preferred embodiment, the compositions of the invention may be formulated for enteral administration for the treatment of infertility in men. Oxidative stress plays an important role in the etiology of sperm dysfunction by inducing peroxidative damage to the plasma membrane. In addition, oxidative stress affects the integrity of sperm nuclear and mitochondrial genomes, leading to DNA strand breaks, aberrant recombination, and/or defective compaction, as well as chromatin crosslinking. The observation of correlations between generation of reactive oxygen species (ROS) by washed human sperm suspensions and their fertilizing capacity is consistent with the clinical significance of oxidative damage to human sperm; this significance is heightened by the demonstration of loss of functional competence and high rates of DNA damage from human sperm directly or indirectly exposed to hydrogen peroxide. When the source of ROS is intracellular, many of the classic antioxidants that are effective versus extracellular oxidative stress (eg, NAC and hypotaurine) end up being useless.
[00101] The high susceptibility to irreversible oxidative damage of mammalian sperm cells can be attributed to: (i) the particularly high content of polyunsaturated fatty acids, plasmalogens and sphingomyelin in their membranes, (ii) the lack of mechanisms of adequate repair for oxidative damage, derived from a death of cytosolic antioxidant enzymes associated with the loss of most of their cytoplasm upon spermation, (iii) the fact that post-epididymal mature sperm cells possess highly condensed nuclear chromatin (due to to the replacement of histones by protamine, with increased disulfide bond formation); this compaction contributes to the silencing of the paternal chromosomes, which are unable to bind in transcription activation by ROS, (iv) the fact that sperm cells are particularly rich in highly active mitochondria, due to the fact that they need a constant supply of energy to support its motility. Sperm were the first cells found to generate significant levels of ROS and these characteristics increase the probability of mitochondrial membrane damage by escaped ROS, (v) the fact that native cysteine-rich secretory proteins (CRISPs) contain unusually high numbers of thiol (non-oxidized) cysteine residues, which makes them especially sensitive to deactivation by oxidants.
[00102] H2S can be used by cells to synthesize L-cysteine, which can serve as a building block in protein synthesis, as described in Predmore et al., Antioxid Redox Signal 17:119-140, 2012. Sulfur deficient diets, however, are common and can lead to cysteine deficiency especially in males and consequently a deficit in the biosynthesis of important cysteine-rich proteins such as CRISPs. CRISPs are found only in vertebrates, within the male reproductive space. CRISPs have been implicated in many aspects of spermatogenesis, as well as in the current fertilization process as reported in Koppers et al., Asian J. Androl. 13:111-117, 2011 and the regulation of CRISP-2 mRNA reduction by a factor of 4.3 in asthenospermic patients was recently reported in Jing et al., Natl. J.Androl. 17:203-207, 2011.
[00103] Srilatha et al., J. Sex Med. 4:1304-1311, 2007, described some pioneering studies that provided evidence for the endogenous formation of hydrogen sulfide and its pro-erectile relaxing effect on the corpus cavernosum of mammals, thus how about the effects of hydrogen sulfide on female sexual function. The first set of results was corroborated by an international team that included Lauis J. Ignarro who won the Nobel Prize in 1998 for his work in demonstrating the signaling properties of nitric oxide. There is also evidence that oxidative stress is compromised in erectile dysfunction in diabetic rodents as described in Bivalacqua et al., J. Sex Med. 2:187-197, 2005 and interventions based on administration of tetrahydrobiopterin and regulation of elevation of antioxidant enzymes may be useful as described in Deng et al., Methods Mol. Biol. 610:213-227, 2010 and Minhas et al., Expert Opin Pharmacother. 3:889-897, 2002. In addition, recent work discusses the effects of endogenous and exogenous H2S on the physiological control of penile tone and the possibility of developing new therapies for erectile dysfunction (ED) that point to this trajectory.
[00104] Sparatore et al., Expert Rev. Clin. Pharmacol. 4:109-121, 2011 developed an H2S donor derivative of sildenafil (ACS6) with possible clinical indications in ED, benign prostatic hypertrophy and lower urinary tract symptoms. The H2S released by ACS6 inhibits the expression activity of both phosphodiesterase type 5 (PDE5) and NADPH oxidase (NOX), whereby this mechanism could form the basis of a new and effective approach to the treatment of patients suffering from ED , benign prostatic hypertrophy and lower urinary tract symptoms. In fact, studies carried out by Shukla et al., BJU lnt. 103:1522-1529, 2009 showed that ACS6 and sildenafil citrate relaxed cavernous smooth muscle equipotently and ACS6 inhibited superoxide formation and expression of p47phox (a subunit of NOX) more than citrate of sildenafil. It was concluded that ACS6 not only promotes erection, but also obtains effective protection from oxidative stress by regulating the elevation of glutathione (GSH) synthesis.
[00105] Furthermore, in an investigation of the effect of NaHS on uterine contractility of pregnant female rats in vitro, Sidhu et al., Pharmacol Toxicol. 88:198-203, 2001 found that this "hydrogen donor" produced significant dose-dependent decreases in spontaneous uterine contractility.
[00106] Showell et al., Cochrane Database Syst Rev. 1:C0007411, 2011 evaluated the effects of oral antioxidants in men with documented sperm DNA damage and/or impaired semen parameters based on clinical evidence where participants were randomly assigned to antioxidant versus placebo an alternative antioxidant, or no treatment. Outcomes considered were: 1) rate of live birth per randomized couple, 2) rate of pregnancy per couple, 3) rate of abortion per couple, or miscarriage, 4) rate of premature death per couple, 5) harm level of Sperm DNA after treatment, 6) sperm concentration, 7) sperm motility and 7) adverse effects. The 44 trials analyzed in this review involved 2,876 couples, carried out for an average duration of treatment of 4.1 months and included the following antioxidants: vitamin B, vitamin C, vitamin E, selenium, magnesium, zinc, zinc plus vitamin E, zinc plus vitamin E plus vitamin C, combined antioxidants plus mineral salts (eg vitamin C, vitamin E, zinc, selenium, folic acid, lycopene and garlic oil), L-acetyl carnitine, L-carnitine, L-acetyl carnitine plus L-carnitine, pentoxifylline, ethyl cysteine, N-acetyl cysteine and docosahexenoic acid. The study concluded that antioxidant supplementation in subfertile males may improve live birth and pregnancy outcomes for subfertile couples undergoing treatment (ART cycles). Additional face-to-face comparisons are needed to identify the superiority of one antioxidant over another. These results indicate that there is currently only scientifically acceptable evidence that antioxidant supplementation improves outcomes for subfertile couples or the available forms of treatment have mainly produced only marginally satisfactory responses, even in the best of appropriate evidence, and that many drugs are being used without any reason. According to Cavallini et al, Asian J. Androl. 8:143-157, 2006, no drug can be defined as unquestionably effective for the treatment of male idopathic oligoasthenoteratozoospermia.
[00107] The highly bioavailable zero-valent sulfur rich composition of the invention was used in a clinical trial conducted by Mexican investigators (see example 8) and the results were highly encouraging for several reasons including: a treatment duration of only 2 .5 months versus an average of 4.1 months for all trials described in Showell et al., Cochrane Database Syst Rev. 1:CD0074l1, 2011 and a one-component formulation rather than an unoptimized mix of 7- 10 or more presumably active ingredients.
[00108] Oxidative stress is associated with an increase in the production of oxidizing species (eg, superoxide, peroxides, free radicals) and/or a significant decrease in the effectiveness and/or levels of antioxidant defenses, such as glutathione. The highly bioavailable zero-valence sulfur-rich compositions of the invention when administered in a desirable manner will act to re-establish cysteine and glutathione levels there, re-establishing oxide-reduction homeostasis in the body. Diabetes
[00109] The compositions of the invention may also be useful for the treatment of diabetes and its complications. Diabetes can be any metabolic disorder in which a person has a high blood sugar content, either due to the fact that the body does not produce enough insulin, or due to the fact that cells do not respond to the insulin that is produced. Non-limiting examples of diabetes include type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, congenital diabetes, cystic fibrosis related diabetes, steroidal diabetes, latent autoimmune diabetes of adults, and monogenic diabetes. Complications associated with diabetes include, but are not limited to, hypoglycemia, diabetic ketoacidosis, non-ketotic hyperosmolar coma, cardiovascular disease, chronic kidney failure, diabetic nephropathy, diabetic neuropathy, foot problems related to diabetes (eg, diabetic foot ulcers) and diabetic retinopathy. Cancers
[00110] Other conditions that can be treated when using the highly bioavailable zero-valent sulfur-rich compositions of the invention include cancers. Cancers are usually characterized by unregulated cell growth, the formation of malignant tumors, and invasion of nearby parts of the body. Cancers can also spread to more distant parts of the body through the lymphatic system or bloodstream.
[00111] Cancers can be a result of genetic damage due to tobacco use, certain infections, radiation, lack of physical activity, obesity, and/or environmental pollutants. Cancers can also be a result of genetic flaws that exist within cells to cause illnesses due to genetic inheritance. Analysis and screenings can be used to detect cancers before any observable symptoms appear and treatment can be given to those who are most at risk of developing cancer (eg, people with a family history of cancer). Examples of screening and screening techniques for cancer include, but are not limited to, physical examination, blood or urine tests, medical imaging, and/or genetic testing. Non-limiting examples of cancers include: bladder cancer, breast cancer, colon and rectal cancer, endometrial cancer, kidney or renal cell cancer, leukemia, lung cancer, melanoma, non-Hodgkin's lymphoma, pancreatic cancer, prostate cancer, ovarian cancer, stomach cancer, depression and thyroid cancer. Transplants
[00112] The zero-valent sulfur-rich composition of the invention is expected to be effective in the treatment of ischemia reperfusion injury from reconstructive and transplant procedures. Water dispersions of fine particles of the zero valent sulfur rich composition can be used for the treatment of tissue cavities from plastic surgery or reconstruction and solid organs from transplants in order to prevent/minimize ischemia-reperfusion injury and to protect mitochondria during operating procedures. Exemplary tissues and organs to be treated using the composition of the invention have active metabolism and enhanced mitochondrial function and are susceptible to reperfusion injury after brief periods of ischemia and include, but are not limited to: skeletal muscle, heart, liver, large intestine, small intestine, brain, skin, extremities (eg arms, legs, feet, hands). Pharmaceutical Compositions and Treatment Methods
[00113] The present invention also relates to pharmaceutical compositions containing highly bioavailable zero-valent sulfur-rich compositions or a combination of one of the highly bioavailable zero-valent sulfur-rich compositions described in the present invention and a second therapeutic agent (for example , an antiplatelet drug, a beta blocker, an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor (ARB) blocker, a statin, fibrates, biguanides, blood pressure lowering agents, cytokines, cholesterol lowering agents , erectile dysfunction drugs, anti-inflammatory drugs, antithrombosis drugs, anticancer drugs, antidiabetic drugs, and/or dietary supplements).
[00114] A composition of the present invention can be administered by a variety of methods known in the art. As will be appreciated by those skilled in the art, the route and/or mode of administration will vary depending on the desired results. Pharmaceutical compositions may be formulated for parenteral, intranasal, topical, oral or local administration, such as by transdermal means, for prophylactic and/or therapeutic treatment. Pharmaceutical compositions can be administered parenterally (for example, by intravenous, intramuscular or subcutaneous injection), or by oral ingestion, or by topical application or intra-articular injection into areas affected by the vascular condition or by cancer. Additional routes of administration include intravascular, intraarterial, intratumoral, intraperitoneal, intraventricular, intraepidural, as well as nasal, ophthalmic, intrascleral, intraorbital, rectal, topical or by aerosol inhalation administration. Sustained release administration is also specifically included in the invention, by means such as depot or implant injections or erosive components. Thus, the invention provides compositions for parenteral administration which comprise the aforementioned agents dissolved, colloidally dispersed, or suspended in an acceptable vehicle, preferably an aqueous vehicle, for example, water, tap water, saline, PBS and the like. The compositions may contain pharmaceutically acceptable auxiliary substances as required to approximate physiological conditions, such as pH adjusting agents and regulators, tonicity adjusting agents, wetting agents, detergents and the like.
[00115] The therapeutic composition may be in the form of a solution, a colloidal dispersion, a suspension, an emulsion, an infusion device, or an implant delivery device or may be presented as a dry powder to be used as such or to be reconstituted with water or another suitable vehicle before use. The composition may be in the form of a tablet, a capsule (for example, hard gelatin capsule and soft gelatin capsule), a liquid, or a sustained release tablet for oral administration; or a liquid for intravenous, intrathecal, subcutaneous or parenteral administration; or a cream or ointment for topical administration, or a polymer or other sustained release vehicle for local administration.
Methods well known in the art for making formulations are found, for example, in "Remington: The Science and Practice of Pharmacy" (20th ed., ed. AR Gennaro AR., 2000, Lippincott Williams & Wilkins, Philadelphia, PA). Formulations for parenteral administration may, for example, contain excipients, sterile water, polyalkylene glycols such as polyethylene glycol, oils of vegetable origin, or hydrogenated naphthalenes. Biocompatible, biodegradable lactide polymer, lactide/glycolide copolymer, or polyoxyethylene-polyoxypropylene copolymers can be used to control the release of substances. Nanoparticle formulations (eg, biodegradable nanoparticles, solid lipid nanoparticles, liposomes) can be used to control the biodistribution of substances. Other potentially useful delivery systems include ethylene-vinyl acetate copolymer particles, osmotic pumps, intrathecal pumps, implantable infusion systems and liposomes. The concentration of the substance in the formulation varies depending on a number of factors, including the dose of drug to be administered and the route of administration.
[00117] To administer a composition of the invention by certain routes of administration, it may be necessary to coat the composition with, or co-administer the composition with a material to prevent its deactivation. For example, the composition can be administered to a subject in an appropriate vehicle, e.g., liposomes, or a diluent. Pharmaceutically acceptable diluents include saline and aqueous regulatory solutions. Liposomes include water-in-oil-in-water CGF emulsions as well as conventional liposomes (Strejan et al., J. Neuroimmunol. 7:27-41, 1984). Pharmaceutically acceptable carriers include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable colloidal solutions or dispersions. The use of such media and agents for pharmaceutically active substances is known in the state of the art and is included in the invention except where any conventional media or agent is incompatible with the active substance. Supplementary active substances can also be incorporated into the compositions.
[00118] The therapeutic compositions must be sterile and stable under the conditions of manufacture and storage. The composition can be formulated as a suspension, microemulsion, liposome, or other ordered structure suitable for high drug concentration. The vehicle may be a solvent or dispersion medium containing, for example, water, ethanol, petroleum jelly (for example, petroleum jelly), polyol (for example, glycerol, propylene glycol and liquid polyethylene glycol and the like) and suitable mixtures thereof , formulated in different percentages (for example, 5, 10, 15, 20, 25, 30, 35, 40, 45 or 50% by weight in a dispersion medium described in the present invention). Proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by maintaining the required particle size in the case of dispersion and by the use of surfactants. In many cases, it may be preferable to include isotonic agents, for example, sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride in the composition. Prolonged absorption of the injectable compositions can be brought about by including in the composition an agent which delays absorption, for example, monostearate salts and gelatin. Colloidal dispersions can be stabilized by the addition of agents well known in the art.
[00119] The compositions of the invention can be sterilized by conventional sterilization techniques, or can be sterile filtered. The resulting aqueous dispersions can be conditioned for use as is, or lyophilized, in which the lyophilized preparation is combined with a sterile aqueous vehicle prior to administration. The pH of the preparations will typically be between 3 and 11, more preferably between 5 and 9 or between 6 and 8 and even more preferably between 7 and 8, such as 7 to 7.5. The resulting compositions in solid or semi-solid form may be packaged in multiple units of a single dose, each containing a fixed amount of the composition, such as in a sealed package of tablets or capsules. The composition in solid form may also be contained in a container for a flexible amount, such as in a squeezable tube designed for a topically applicable cream or ointment.
Preferred formulations of the invention include, but are not limited to: the preparation of hard gelatin capsules containing 100-400 mg of a highly bioavailable zero-valent sulfur rich composition of the invention, the preparation of a suspension of about of 5-20% (5.5%, 6%, 6.5%, 7%, 8%, 10%, 15%, 17% or 19%) of the composition rich in sulfur cerovalen him highly bioavailable of the invention and petroleum jelly ( for example, petroleum jelly) or polyethylene glycol, or a colloidal dispersion of about 5-20% (5.5%, 6%, 6.5%, 7%, 8%, 10%, 15%, 17% or 19 %) of the highly bioavailable zero-valent sulfur rich composition of the invention in water or oil.
Sterile injectable colloidal suspensions can be prepared by incorporating the active compound in the required amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, optionally followed by sterilizing microfiltration. In general, dispersions are prepared by incorporating the active compound into a sterile vehicle which contains a basic dispersion medium and the required other ingredients from those enumerated above. Dosing regimens are adjusted to provide the optimal desired response (eg, a therapeutic response or prophylaxis). For example, a single bolus can be administered, several divided doses can be administered over time, or the dose can be scaled down or increased as indicated by the requirements of the therapeutic situation or prophylaxis. For example, the compositions of the invention can be administered once or twice a week by subcutaneous injection, or once or twice a month by subcutaneous injection.
[00122] Formulation of parenteral compositions in unit dose form for ease of administration and uniformity of dosage is especially advantageous. Unit dose form as used in the present invention refers to physically distinct units suitable as unitary doses for the individuals to be treated, each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic or prophylactic effect, optionally in association with the required pharmaceutical carrier. The specifications for the unit dose forms of the invention are dictated by and directly dependent on (a) the unique characteristics of the active substance and the particular therapeutic or prophylactic effect to be obtained and (b) the inherent limitations in the matter of composition, such as a active substance for the treatment of sensitivity in individuals.
[00123] When the substances of the present invention are administered as pharmaceutical compounds to humans and animals, they can be applied alone or as a pharmaceutical composition containing, for example, from 1 to 100% (more preferably from 10 to 100% , such as from 90 to 100%) of active ingredient, optionally in combination with one or more pharmaceutically acceptable carriers or excipients.
Compositions containing an effective amount can be administered for prophylactic or therapeutic treatments. In prophylactic applications, the compositions can be administered to a patient with a clinically determined predisposition or increased susceptibility to the development of cardiovascular diseases, hyperproliferative diseases (eg cancer), inflammatory diseases, diabetes, dyslipidemia, neurodegenerative diseases, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or an immune dysfunction. The compositions of the invention may be administered to the patient (eg, a human) in an amount sufficient to delay, reduce, or preferably prevent the onset of clinical illness. In therapeutic applications, the compositions are administered to a patient (eg a human) who is already suffering from a cardiovascular disease, a hyperproliferative disease (eg cancer), an inflammatory disease, diabetes, dyslipidemia, a neurodegenerative disease, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxide-reduction homeostasis, and/or immune dysfunction, in an amount sufficient to cure or at least partially contain the symptoms of the conditions and their complications. An amount adequate to accomplish this purpose is defined as a "therapeutically effective dose", an amount of a compound sufficient to substantially ameliorate some symptom associated with a disease or medical condition. For example, in the treatment of a cardiovascular disease, hyperproliferative diseases (eg cancer), an inflammatory disease, diabetes, dyslipidemia, a neurodegenerative disease, AIDS and other pathological conditions associated with oxidative stress, an imbalance in oxidation-reduction homeostasis , and/or immune dysfunction, an agent or substance that lessens, prevents, delays, suppresses or paralyzes any therapeutically effective symptom of the disease or serious condition. A therapeutically effective amount of an agent or substance is not required to cure an illness or condition, but will provide a treatment for an illness or condition such that the onset of the illness or condition is delayed, blocked or prevented, or the symptoms of the illness or condition. condition is improved, or the end of the illness or condition is changed or, for example, is less severe or recovery is accelerated in an individual.
The compositions and formulations of the present invention can be used in combination either with conventional methods of treatment or therapy or can be used separately from conventional methods of treatment or therapy. When the substances and formulations of the present invention are administered in combination therapies with other agents, they may be administered sequentially or concurrently with a subject. Alternatively, pharmaceutical compositions according to the present invention include a combination of a substance or formulation of the present invention optionally in association with a pharmaceutically acceptable excipient as described in the present invention and another therapeutic or prophylactic agent known in the art.
[00126] The formulated agents can be packaged together as a kit. Non-limiting examples include kits that contain, for example, two pills, one pill and one powder, one suppository and one liquid in a bottle, two topical creams, etc. The kit may include optional components that aid in administering the unit dose to patients, such as vials for reconstituting powder forms, syringes for injection, custom IV delivery systems, inhalers, etc. In addition, the unit dose kit can include instructions for preparing and administering the compositions. The kit can be manufactured as a single-use unit dose for one patient, multiple uses for a particular patient (at a constant dose or in which individual compounds may vary in potentiation as therapy progresses); or the kit may contain multiple doses suitable for administration to multiple patients ("packaged in bulk"). Kit components can be assembled into cartons, ampoule packs, bottles, tubes and the like. Dose
[00127] The pharmaceutical compositions of the present invention are formulated into pharmaceutically acceptable dosage forms by conventional methods known to those skilled in the art. The actual dose levels of the active ingredients in the pharmaceutical compositions of the present invention can be varied such that an amount of the active ingredient is obtained that is effective to obtain the desired therapeutic response for a particular patient, composition and mode of administration, without being toxic to the patient. The dose level selected will depend on a variety of pharmacokinetic factors which include the activity of the particular compositions of the present invention employed, the route of administration, the time of administration, the absorption rate of the particular agent being employed, the duration of the treatment, other drugs, substances, and/or materials used in combination with the particular compositions employed, age, sex, weight, condition, general health and prior medical history of the patient being treated, and similar factors well known in the medical arts. A physician or veterinarian who is skilled in the art can easily determine and prescribe the effective amount of pharmaceutical composition required. For example, the physician or veterinarian can start the dosage of the substances of the invention employed in the pharmaceutical composition at levels lower than those required in order to obtain the desired therapeutic effect and gradually increase the dosage until the desired effect is obtained. In general, a suitable daily dose of a composition of the invention will be that amount of the substance which is the lowest dose effective to produce a therapeutic effect. Such an effective dose will generally depend on the factors described above. Preferably, the effective daily dose of a therapeutic composition can be administered as two, three, four, five, six or more sub-doses administered separately at appropriate intervals throughout the day, optionally, in unit dose forms.
Preferred therapeutic dosage levels range from about 800 mg to about 1,600 mg (e.g. 800, 850, 900, 1,000, 1,050, 1,100, 1,200, 1,300, 1,400, 1,450, 1,500, 1550 and 1,600 mg) of the zero-valent active sulfur-rich composition per day administered orally to medium-weight adults afflicted with most of the symptoms, syndromes, and pathological conditions described herein. Preferred prophylactic dose levels are from about 100 mg to about 1,200 mg (e.g., 110, 140, 200, 250, 300, 350, 400, 460, 700, 750, 800, 900, 1,000, 1,100 and 1150 mg). For cancer, AIDS, and other chronic refractory conditions, preferred oral dose levels are 2400 mg per day or more (eg 2450, 2,500, 3,000, 3,500, 4,000, 8,000 mg and 1 g) for an average adult . For children afflicted with cancer, the dose may be titrated (eg, the dose may be gradually escalated until signs of gastrointestinal toxicity such as diarrhea or nausea appear). In preferred embodiments, the highly bioavailable zero-valent sulfur-rich compositions of the invention are extremely safe for oral administration and most patients can tolerate higher doses as treatment progresses.
[00129] In other embodiments, the highly bioavailable zero-valent sulfur-rich compositions of the invention are safe for topical administration. Acceptable dosage forms for topical administration may be formulated as creams, lotions, masses, gels and/or ointments containing the highly bioavailable zero-valent sulfur-rich compositions.
[00130] Final dose forms for administration to human subjects may comprise one of the highly bioavailable zero-valent sulfur-rich compositions as a pharmacologically active agent or further comprise other active agents such as alpha lipoic acid, carnitine, carnitine tartrate, carnitine fumarate, coenzyme Q10, selenium, alpha-ketoglutaric acid, potassium alpha-ketoglutarate, diethyl alpha-ketoglutarate, oxaloacetic acid, sodium oxaloacetate, diethyl oxaloacetate, 2-oxo-3-(ethoxycarbonyl) acid diethyl ester -pentanedioic, L-cystine, paracetamol, a sulfa drug, an NSAID, a corticosteroid, taurine, a vitamin, a prebiotic, another anticancer drug, which includes but is not limited to another mitocane (eg, a chain pointing drug of mitochondrial electron transport), alkylating agents (eg, procarbazine, dacarbazine, altretamine, cisplatin), methotrexate, purine antagonists (eg, m ercaptopurine, thioguanine, cladribine, pentostatin), pyrimidine antagonists (eg fluorouracil, cytarabine, azacitidine), plant alkaloids (eg vinblastine, etoposide, topotecan), hormonal agents (eg tamoxifen, flutamide), antibiotics ( for example, doxorubicin, daunorubicin, mitomycin, bleomycinl, and mitocans (eg, sodium dichloroacetate and 3-bromopyruvic acid. medical food
[00131] The present invention also relates to compositions rich in sulfur with zero valence highly bioavailable as a medical food for daily consumption and to maintain and promote general health. Evidence indicates that daily intake by an average-weight adult of about 800 mg of the highly bioavailable zero-valence sulfur-rich composition described herein for long periods is safe and beneficial to health due to the fact that it entails a marked reduction in frequency. and severity of digestive and respiratory infections (eg viral and bacterial origin and allergy episodes. Daily consumption of the composition of the invention is also associated with a primarily reduced probability of being affected by cancer, AIDS, a neurodegenerative condition, stroke, diabetes and its complications, cardiovascular disease and provides protection against cardiovascular, cerebrovascular, gastric and liver damage caused by xenobiotics that include drugs such as paracetamol, corticosteroids, NSAIDs and antiretrovirals, toxins and poisons (eg, cyanide, thallium, methanol). daily consumption of the composition of the invention may also result in faster growth. faster hair and nails, firmer skin, a prebiotic-like effect and a feeling of general well-being.
[00132] In one aspect, the highly bioavailable zero-valent sulfur-rich compositions of the invention are used as a paravitamin to provide a supplemental source of cysteine and its derivatives. Cysteine and its derivatives (eg, glutathione, taurine, conjugates of taurine with bile acids, hydrogen sulfide, and sulfate ions) play a role similar to that of vitamins. As antioxidant vitamins, cysteine and its derivatives play a role in the oxidant/antioxidant balance and indirectly in the regulation of metabolic processes. Cysteine supplementation in addition to the normal diet can have several beneficial effects, for example, cysteine supplementation can lead to an increase in muscle function, immune function, plasma albumin concentration and a decrease in TNF-α concentration. Supplementation can also replenish the body's deposits of cysteine and glutathione levels that are the driving forces behind multiple aging-related processes.
[00133] In another aspect, paravitamins are medical foods that provide a minimum amount of calories and a maximum amount of a bioavailable form of sulfur intended for humans who do not receive enough sulfur in their diets. Studies from preliminary clinical evidence showed that in 120 male and female participants who received the highly bioavailable zero-valent sulfur-rich composition as a paravitamin, most participants noted faster hair and nail growth. Furthermore, evidence obtained from in vivo experiments has shown that in mammals the levels of hydrogen sulfide, sulfuric anhydride sulfur and glutathione are increased in the blood and tissues by administering highly bioavailable zero-valent sulfur-rich compositions such as paravitamins.
In preferred embodiments, the highly bioavailable zero-valent sulfur-rich composition is quickly and efficiently converted to hydrogen sulfide in the body, which in turn is primarily transformed into L-cysteine. L-Cysteine can be used as a building block in the synthesis of enzymes and peptides and other proteins and biomolecules that contain sulfur (eg the keratin that constitutes 14% of hair and nails, eg glutathione, a necessary tripeptide to regulate and enhance immune function and for cellular protection against oxidants, electrophiles, for example, taurine, which is essential for cardiovascular function, the development and function of skeletal muscle, retina, central nervous system, is a major constituent of bile; it has many key biological roles such as bile acid conjugation, antioxidant, osmoregulation, membrane stabilization and modulation of calcium signaling, eg sulfate, which is required for cartilage synthesis and for detoxification of many drugs including, but not limited to, corticosteroids and acetaminophen.
[00135] In another embodiment, the zero-valent sulfur-rich composition is transformed and stored as sulfuric anhydride sulfur. Sulfur from sulfuric anhydride is conveniently used by the body as a highly versatile hydrogen sulfide precursor that easily releases hydrogen sulfide when and where this species is needed to activate protective genes, block inflammation, and protect cells from free radical damage.
[00136] In even another preferred embodiment, the maximum human lifespan can be increased beyond the previous limit by providing compositions of the invention as paravitamins, glutathione levels will be restored to a normal level in the cells of the system immune system, thereby normalizing the function of the immune system and restoring health and well-being. antidotes
[00137] The present invention also relates to compositions rich in sulfur with zero valence highly bioavailable as antidotes to various poisons and drug overdose. The composition of the invention can be used as an antidote against cyanide poisoning. Cyanide poisoning can occur from inhalation and/or ingestion of poisonous cyanide compounds (eg, hydrogen cyanide gas, potassium cyanide and sodium cyanide), from constant exposure to pesticides and insecticides containing poisonous cyanide compounds , tobacco smoke, smoke inhalation from building fires and groceries that include almonds, apricot bone, cassava, yuca, cassava and apple seeds. Signs of cyanide poisoning can include, but are not limited to, permanent paralysis, nerve damage, hypothyroidism, miscarriages, weakness, mild liver damage, and mild kidney damage.
The composition of the invention can be used as an antidote to drug overdose including, but not limited to, acetaminophen overdose and sulfa drug overdose (eg, sulfamethoxazole, fulfisomidine, dichlorophenamide, acetazolamide , bumetanide, chlorthalidone, clopamide, furosemide, hydrochlorothiazide, mefruside, metolazone, xipamide, acetazolamide, etoxzolamide, sultiama, zonisamide, mafenide, sumatriptan, fulfasalazine, tipranavir and probenecid) . combination therapies
[00139] The pharmaceutical compositions of the invention can be administered in combination therapy, that is, combined with other agents (for example, an antiplatelet drug, a beta blocker, an ACE or ARB inhibitor, a statin, fibrates, biguanides, agents blood pressure lowering agents, cytokines, cholesterol lowering agents, erectile dysfunction drugs, anti-inflammatory drugs, antithrombosis drugs, anticancer drugs, antidiabetic drugs, and/or dietary supplements) depending on the condition being treated. Prevention Drugs for Cardiovascular Diseases
The compositions of the invention can be administered in combination with one or more drugs that are used as secondary prevention drugs for cardiovascular diseases. Examples of preventive drugs include, but are not limited to, beta blockers (for example, non-selective agents, for example, alprenolol, carteolol, oxprenolol, sotalol, timolol, for example, β 1 selective agents, for example, acebutolol, betaxolol, celiprolol, metoprolol eg β2 selective agents eg butaxamine eg β3 selective agents eg SR 59230A), statins (eg atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin , pravastatin, simvastatin and rosuvastatin), fibrates (eg, bezafibrate, ciprofibrate, clofibrate, gemfibrozil and fenofibrate), biguanides (eg metformin, phenformin, buformin and proguanil), and/or ACE inhibitors (eg, agents containing sulfhydryl, eg captopril, zofenopril eg dicarboxylate-containing agents eg enalapril, ramipril, quinapril, perindopril, imidapril eg phosphate containing agents eg fosin opril). Drugs to treat erectile dysfunction
The highly bioavailable zero-valent sulfur-rich composition of the invention can be administered in combination with one or more drugs for the treatment of erectile dysfunction. Examples of drugs for treating erectile dysfunction include, but are not limited to: sildenafil, tadalafil, vardenafil, alprostadil, avanafil and yohimbine. Anti-neurodegenerative drugs
The highly bioavailable zero-valent sulfur-rich composition of the invention can be administered in combination with one or more anti-neurodegenerative drugs. Examples of anti-neurodegenerative drugs include, but are not limited to, acetyl cholinesterase inhibitors (eg, donepezil, galantamine and rivastigmine), anti-glutamate agents (eg, amantadine, GABA-ergic, valproic acid), reserpine, tetrabenazine, neuroleptics typical/atypical, tricyclic antidepressants, SSRIs, carbamazepine, baclofen, tizanidine and lamotrigine. Anti-inflammatory drugs
The highly bioavailable zero-valent sulfur rich composition of the invention can be administered in combination with one or more anti-inflammatory drugs. Examples of anti-inflammatory drugs include, but are not limited to, steroids (e.g. glucocorticoids, e.g., corticosteroids), non-steroidal anti-inflammatory drugs, steroids (NSAIDs) (e.g., aspirin, diflunisal, salsalate, ibuprofen, naproxen, fenoprofen, ketoprofen, flurbiprofen, sulindac, etodolac, ketorolac, nabumetone, piroxicam, mneloxicarn, tenoxicarn, rnefenamic acid, flufenamic acid, tolfenamic acid, celecoxib, rofecoxib, nabumetone, etodolac - selective immunological inflammatory drugs (ImSAIDs) (eg phenylalanine-glutamine-glycine (FEG) and its D-isomeric form (feG) and/or herbs (eg Harpagophytum, hysop, ginger, turmeric, Arnica Montana and willow bark ). Dietary supplements
[00144] The composition of the invention can be administered in combination with one or more dietary supplements to promote and/or maintain general health. Examples of dietary supplements include, but are not limited to, a vitamin (for example, Vitamin A, Vitamin B1, B2, B3, B5, B6, B7, B9, B12, Vitamin E, Vitamin D, Vitamin E and Vitamin K), a mineral salt (eg potassium, chlorine, sodium, calcium, magnesium, phosphorus, zinc, iron, manganese, copper, iodine, selenium and molybdenum), an herb or botanical material (eg San Juan herb , kava, Shilajit and Chinese herbal remedies), an amino acid (eg glycine, serine, methionine, cysteine, aspartic acid, glutamic acid, glutamine, tryptophan and phenylalanine) and a concentrate, a constituent, an extract and/or a combination of any of the above. Anticancer/Antiproliferative Drugs
The highly bioavailable zero-valent sulfur-rich composition of the invention can be formulated or administered in combination with one or more anti-cancer drugs. Examples of anticancer agents include, but are not limited to: chemotherapeutic agents (e.g., arsenic trioxide, cisplatin, carboplatin, chlorambucil, melphalan, nedeplatin, oxaliplatin, tetranitrate triplatin, satraplatin, imatinib, nilotinib, dasatinib, and radicicol), agents immunomodulators (eg, methotrexate, leflunomide, cyclophosphamide, cyclosporin A, minocycline, azathioprine, antibiotics (eg, tacrolimus), methyl prednisolone, corticosteroids, steroids, mycophenolatomofetil, rapamycin, mizoribin, deoxyspergualin, and desoxyspergualin receptors, brequinar cytokine receptor modulators), anti-angiogenic agents (eg, bevacizumab, suramin and etrathiomolybdate), mitosis inhibitors (eg, paclitaxel, vinorelbine, docetaxel, abazitaxel, ixabepilone, larotaxel, ortataxel, tesetaxel, vinblastine, vinflusine and vindesine), nucleoside analogues (eg, gemcitabine, azacitidine, cape citabine, carmofur, cladribine, clofarabine, cytarabine, decitabine, floxuridine, fludarabine, fluorouracil, mercaptopurine, pentostatin, tegafur, and thioguanine), DNA intercalating agents (eg, doxorubicin, actinomycin, bleomycin, mithimeracil and plicamycin), (eg, irinotecan, aclarubicin, amrubicin, Belotecan, camptothecin, daunorubicin, epirubicin, etoposide, idarubicin, mitoxantrone, pyrarubicin, pixantrone, rubitecan, teniposide, topotecan, valrubicin and zorubicin, peextabicin, aminopttimete methotrexate, pralatrexate and raltitrexed), mitocans (eg sodium dichloroacetate and 3-bromo pyruvic acid) and other targeting agents (eg agents that target particular enzymes or proteins involved in cancer or agents that target organs or types of particular cancers) and combinations thereof. Examples
The highly bioavailable zero-valent sulfur-rich compositions of the invention and their uses will now be illustrated by way of the following non-limiting examples. These examples are highlighted merely for illustrative purposes and many other variations can be used. Experimental Methods
[00147] Human Blood Samples from Heart Failure Patients
[00148] Serum samples were obtained from a biorepository of cardiac tissue and blood at the University of Louisville. All procedures have been approved by the University of Louisville Institutional Review Panel. Specimens sought after informed consent from patients with advanced heart failure underwent LV assistive device placement. Additional serum samples from control patients were obtained from a dealer (Innovative Research). experimental animals
CSE deficient (KO) mice (C57/Sv129 background) and cardiac restricted (αMHC) CSE Tg mice (C57BL/6J background) were developed as described in Levy et al., The New England Journal of Medicine. 322: 1561-1566, 1990; Heineke et al., Nature reviews. Molecular Cell Biology. 7: 589-600, 2006. 8-10 week old male C57BL/6J rats were purchased from The Jackson Laboratory (Bar Harbor, ME). All experimental protocols were approved by the Institute for Animal Care and Use Committee of the Emory University School of Medicine and were in accordance with the Guide for the Care and Use of Laboratory Animals, published by the National Institutes of Health (NIH Publication No. 86- 23, 1996 revision) and with federal and state regulations. Transverse Aortic Constriction Protocol (TAC)
To create a pressure overload, the TAC procedure was carried out on 10-14 week old rats. Rats were anesthetized with Ketamine (100 mg/kg) and Xylazine (8 mg/kg) and core body temperature was maintained in the normal range (3637°C). The rats were then orally intubated and placed on a rodent ventilator to maintain breathing during the surgical procedure. The second intercostal muscle was cut to visualize the aortic arch. After identification and dissection of the aortic arch, a 7-0 silk suture was placed around the aortic arch between the brachiocephalic trunk and the left carotid artery and tied around a 27G Roma needle. The needle was removed immediately after the connection. The chest was surgically closed and the rats were placed in a 100% oxygen recovery chamber along with a surgical heating pad to keep core body temperature within normal limits. At the end of the experimental protocol (ie, 6 or 12 weeks after CAT surgery) the rats were euthanized, and heart, lung, and blood samples were collected. Hydrogen Sulfide Donor
[00151] A zero-valent sulfur-rich composition (SG-1002, containing about 99% zero-valent sulfur, melting between 119 and 120°C) was fed to rats in the diet to obtain a dose of 20 mg/kg /day in C57BL/6J mice or 40 mg/kg/day in CSE KO mice at one week before the CAT procedure and was continued until 12 weeks after CAT. In addition, some C57BL/6J rats receiving SG-1002 diet were placed on the control diet at 1 week or 3 weeks after CAT. Echocardiography
[00152] In 2 days before the CAT procedure, transthoracic basal line echocardiography was performed using a 30 MHz probe on a Vevo 2100 instrument (Visualsonics) under anesthesia with isoflurane (0.25 to 0.50% ) supplemented with 100% O2. After the CAT procedure, echocardiography was also carried out in the same way for up to 12 weeks. To determine the cardiac structure and function, the intraventricular septal end-diastolic dimension (IVSd), the LV end-diastolic dimension (LVEDD), the LV end-systolic dimension (LVESD) and the LV expulsion fraction (LVEF) were analyzed. from M-mode images. Measurement of Hydrogen Sulfide and Sulfuric Anhydride Sulfur
[00153] The levels of hydrogen sulfide and sulfuric anhydride sulfur were measured in the heart and in the blood according to methods known in the state of the art. For heart tissues, the amount of H2S is reported as nmol/mg wet weight. For blood, the amount of H2S is reported as µm. Western Transfer Analysis
Western blot analysis was carried out as described in Li et al., Annu. Rev. Pharmacol. Toxicol. 51:169-187, 2011. Equal amounts of protein were loaded onto rows of polyacrylamide-SDS gels. The gels were subjected to electrophoresis, followed by protein transfer to a PVDF membrane. The membrane was then blocked and probed with primary antibodies overnight at 4°C. Immunoblot OPs were then processed with secondary antibodies (anti-rabbit, anti-chicken, or anti-mouse, Cell Signaling) for 1 hour at room temperature. Immunoblots were probed with an ECL+Plus chemiluminescence reagent kit (G Healthcare) to visualize the signal, followed by exposure to an X-ray film (Denville Scientific). The film was scanned to make a digital copy and densitometric analysis was carried out to calculate the relative intensity with ImageJ software from The National Institutes of Health (1.40 g version) using the Rodbard function. Membranes were incubated with the phospho-specific antibody first. The membranes were then removed and incubated with the total specific antibody. Results are presented as the relationship between phosphorylated protein expression and total protein. All experiments were carried out in triplicate. For each membrane, the relative intensity of each band was normalized to the weakest band value (lower intensity). The values for each individual sample were averaged to obtain a value for each sample. The values for each group were then averaged and they were subsequently normalized to the control group mean (Simulation). Measurement of Myocardial Metabolites NO
The analysis of nitrite (NO2-) and nitrate (NO3-) of cardiac tissue was determined by ion chromatography (Analyzer EN020, Eicom) as described previously in Li et al., Annu. Rev. Pharmacol. Toxicol. 51:169-187, 2011. Serum Measurements of VEGF and BNP
Serum levels of VEGF (VEGF ELISA kit, R&D Systems) and brain natriuretic peptide (BNP) (BNP Era kit, Phoenix Pharmaceuticals, Inc.) were determined by ELISA at 6 and/or 12 weeks post TAC Cardiac Mitochondrial Respiration Test
[00157] Myocardial mitochondria were isolated and mitochondrial respiratory capacity was assessed using methods known in the art. Rats were euthanized by cervical dislocation and hearts were quickly excised and placed in an ice-cold isolation regulator (300 mM sucrose, 20 mM Tris, 2 mM EGTA, 1 mM ATP, 5 mM MgCl2 and 1 grease-free BSA %). Hearts were finely minced and homogenized with Tissue Tearor (Biospec Products, Bartlesville, OK) at low to medium speed for ~10 s. The homogenized material was centrifuged for 3 minutes at 2,500 rpm. The supernatant was collected and centrifuged for 5 minutes at 9,000 rpm. The supernatant was discarded and the pellet was resuspended in an isolation regulator and centrifuged for 5 minutes at 10,000 rpm and this was repeated two more times. The final pellet was suspended in 100 µl of isolation regulator. Protein concentration was determined by a Lowry Protein Assay Kit (Bio-Rad Laboratories, Hercules, CA). O2 consumption of isolated mitochondria (500 pg/ml) was monitored using a Clark-type oxygen electrode (Hansatech Instruments, Amesbury, MA). Mitochondria were incubated in a breathing egulator (100 mM KCl, 25 mM sucrose, 5 mM KH2PO4, 1 mM MgCl2, 1 mM EGTA, 10 mM HEPES, 10 mM glutamate and 2.5 mM malate) and respiratory capacity was assessed by measuring state 3 (ie AOP dependent) and state 4 (ie ADP independent) breath. The respiratory control ratio (RCR) was calculated as the ratio of state 3 and state 4 breath rates. 8-Isoprostane Assay
[00158] Plasma and heart concentrations of 8-isoprostane were determined by 8-isoprostane EIA kit according to the manufacturer's instruction (Cayrnan Chemicals, Michigan). Histology
[00159] For histological analysis, the hearts were collected at the indicated times, fixed in formalin regulated at 10% and embedded in paraffin. Serial 5 µm heart sections from each group were stained with Masson's trichrome and Picrosirius Red (to detect fibrosis). Digital images of the holders were captured and analyzed using ImageJ. For each heart, multiple sections taken from the midventricle were analyzed and then these numbers were measured to obtain a single measurement of % Fibrosis/LV for each animal. Statistical analysis
[00160] This was a double-blind, randomized, prospective study evaluated and approved by the Ethics Committee of the University Hospital of the Universidad Autónoma de Nuevo León (Monterrey, Mexico) with registration number BR09-001. The study included patients who attended the Reproductive Biology Clinic of the University Hospital from July 2009 to September 2010 who wanted to become pregnant and met the inclusion criteria. Patients between 20 and 45 years of age with a diagnosis of idiopathic oligoasthenozoospermia wishing to participate in the study after signing an informed consent were included. The diagnosis of oligoasthenozoospermia was confirmed by carrying out two semen analyzes on different dates with an interval of three weeks between them. To obtain the diagnosis, semen analysis results needed to report less than 25% motility of type A sperm or less than 50% motility of type A+B sperm as detailed by The World Health Organization Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interaction, 4th ed. New York: Cambridge University Press, 1999. Type A Motility encompassed rapid progression; type 8 motility comprised medium progression; type C motility comprised slow or clumsy progression; and type D motility comprised immobile. Oligozoospermia was defined as a concentration of less than 20 million sperm per milliliter, according to World Health Organization criteria. Oligoasthenozoospermia was defined as the presence of oligozoospermia and asthenozoospermia in the same patient. In each semen analysis, morphology was manually evaluated using strict Kruger criteria.
[00161] Infertile patients with normal findings on semen analysis, patients who were chronic smokers or who had ingested antioxidants in the last 6 months prior to study entry were excluded. Patients with chronic degenerative diseases such as diabetes or high blood pressure or with hormonal abnormalities were also excluded. All study subjects who did not adhere to the medication provided as prescribed, who discontinued the drug or were hypertensive at the same time were eliminated.
[00162] A complete medical history and physical examination were obtained for all patients. All study participants underwent a second semen analysis to confirm the diagnosis after a 3- to 5-day sexual abstinence. This semen analysis was considered as the baseline (sample 1). On a second visit, this new semen analysis was revised to confirm oligoasthenozoospermia and one of the 3 substances to be ingested was randomly prescribed for 75 days. The substances given were 1.5 g of hydrogen sulfide prodrug as an antioxidant, 50 mg of resveratrol as an antioxidant, and 1.5 g of microcrystalline cellulose as a placebo.
[00163] The randomization of the substance given to each patient was carried out by placing in a drawer at random all the containers that had exactly the same color, size and shape as the three separate substances (hydrogen sulfide prodrug, resveratrol and placebo) without any reference to the content. Each container was labeled with a serial number. The attending physician and the patient were unaware of the contents of the container. A third researcher had a binnacle cabinet and a database for each label and container contents. Each patient was asked to take a container at random and the container number was recorded in the patient's medical record. At the end of the study, before the statistical analysis, the relationship between the numbers on the labels and the levels was obtained, grouping the patients according to substance. Each patient was given a form of treatment adherence (one patient stub) in order to count the days of medication and record adverse events, if they occurred, including type and frequency.
[00164] Patients were scheduled one month after starting treatment (third visit) in order to document adverse effects and adherence to treatment. If the patient did not attend the event, data were compiled by telephone. At the next scheduled visit (fourth visit), carried out 75 days after starting treatment, adherence was checked and adverse effects were reported. For this visit, patients presented with 3 to 5 days of sexual abstinence for post-treatment semen analysis (sample 2). Sperm concentration and motility were assessed and carried out completely with an automated IVOS (Integrated Visual Optical System) device and manually confirmed by laboratory technicians, who submitted blindly to each patient's treatment group. The morphology of each semen analysis was manually assessed according to Kruger criteria.
[00165] Traditional descriptive data, such as central tendency measurements (means, mean and mode) and in the case of quantitative variables, dispersion measurements (variation, standard separation and coefficient of variation) were studied for each variable, along with the frequencies observed in qualitative variables.
[00166] The study subjects were divided according to the assigned group and the statistical variables mentioned were analyzed. The results of each variable by group using hypothesis tests for means (x2) and proportions, according to each type of variable (quantitative and qualitative, respectively) at a 95% confidence interval, with p < 0.05 statistically significant , were also compared and evaluated. Example 1: Sulfide levels declined after heart failure in patients and rats
[00167] Previous studies suggest that both exogenously and endogenously derived H2S exhibit potent cytoprotective effects in models of acute myocardial I/R and ischemia-induced heart failure. However, the role of endogenous H2S in pressure overload-induced heart failure has not been fully elucidated. In the current study, a number of new findings regarding the role of CSE-derived H2S on the severity of heart failure after TAC have been identified and important insights into the mechanism by which oral H2S therapy attenuates heart failure are gained. induced by TAC.
Circulating sulfide levels (free H2S and sulfuric anhydride sulfur) in 20 heart failure patients and 24 age-matched controls were examined. Detailed descriptions of these patients are provided in Table 7. As shown by representative gas chromatograph peaks and data summarized in Figures 1A and 1C, free H2S levels were significantly lower in heart failure patients as compared to the comparison. with controls (p = 0.049), whereas sulfur levels of sulfuric anhydride tended to be lower in patients with heart failure (figures 1B and D; p = 0.054). Next, the effects of TAC-induced heart failure on myocardial expression of the three H2S-producing enzymes were examined, as were the circulating levels and myocardial sulfide levels at 6 weeks of TAC. Analysis revealed that CS expression was unaltered (Figures 8A and 8B). However, CSE expression was up-regulated in vehicle mice compared to sham (Figures 8A and 8C; p < 0.001), whereas 3-MST expression was significantly down-regulated compared to sham levels. Simulation (figures 8A and 8D; p < 0.01). Interestingly, free sulfuric anhydride H2S and sulfur levels were significantly lower in the blood (p < 0.01l) and heart (p < 0.001) of TAC+Vehicle rats when compared to sham operated rats (figures 1E - 1H).
Example 2: CSE deficiency exacerbates cardiac dysfunction after CAT
To investigate the role of endogenous H2S in pressure overload, TAC surgery was performed in CSE K rats and cardiac structure and function were evaluated using echocardiography. Initially, it was confirmed that CSE K rats exhibited lower levels of free H2S and sulfuric anhydride sulfur in blood and heart compared to WT rats (Figures 9A-9D; p < 0.05).
[00170] CSE K rats exhibited significantly greater cardiac enlargement and pulmonary edema at 12 weeks after CAT compared to WT rats (figures 2A-2B). Both groups showed similar degrees of increased IVSd thickness from 1 week to 12 weeks after CAT (Figure 2C). However, CSE KO rats exhibited significant LV cavity dilation, as seen by increments in both LVEDD and LVESD, and exhibited exacerbated cardiac dysfunction from 3 weeks to 12 weeks after CAT compared to WT rats ( 2D-2F figures). Despite the increased cardiac structure and functional changes in CSE K rats, no difference in mortality was observed after CAT compared to WT rats (figure 10A). Example 3: CSE myocardial overexpression attenuates cardiac dysfunction without preventing cardiac hypertrophy after CAT
[00171] Overexpression of CSE has been shown to increase the production of H2S in the heart without changing the expression of CBS. In the present studies, no change in cardiac CBS expressions in CS-CSE Tg rats was observed, but CS-CSE Tg rats exhibited a lower expression of 3-MST compared to WT rats (figure 11). It was examined whether overexpression of CSE specifically within the cardiac myocyte should attenuate cardiac hypertrophy and/or dysfunction after CAT when using CS-CSE Tg mice. CS-CSE Tg rats exhibited significantly less cardiac enlargement and pulmonary edema, as assessed by the ratio of heart and lung weights to tibia length (mg/cm) when compared to WT controls (Figures 3A-3B). In addition, echocardiographic analysis revealed that, although CS-CSE Tg rats did not exhibit a difference in IVSd thickness when compared to WT rats, they did exhibit less cardiac dilation and dysfunction from 6 weeks to 12 weeks after CAT (Figures 3C -3F). Again, no difference in mortality between the two groups was observed (figure 10B).
Taken together, these data indicate that endogenous H2S enzymatically generated by CSE plays an important role in the maintenance of cardiac function after pressure overload-induced hypertrophy independently of the regulation of cardiac myocyte hypertrophy. Example 4: Administration of exogenous H2S prevents cardiac enlargement, conserves LV function and reduces fibrosis after CAT
Next, the effects of oral H2S therapy administration on pressure overload-induced cardiac hypertrophy and dysfunction (Figs. 4A-4H) were examined in wild-type C57BL/6J rats. For these experiments, SG-1002 (20 mg/kg/day) was administered in the diet. In early studies it was found that SG-1002 treatment partially restored free H2S and significantly restored sulfuric anhydride sulfur levels in blood (Figures 1E-1F, p < 0.05 versus TAC + Vehicle) and heart ( figures 1G-1H p < 0.05 versus TAC + Vehicle). Crude morphological analysis at 12 weeks after CAT revealed that hearts from vehicle mice grew to a greater degree compared to mice treated with SG1002 (Figure 4A). This was confirmed by heart weight/tibia length ratios, which found that the hearts of rats treated with both vehicle and SG-1002 were significantly increased compared to sham rats at 6 and 12 weeks after CAT (Figure 4B p < 0.001). However, rats treated with SG-1002 showed significantly less of an increment compared to vehicle rats (Figure 4B; p < 0.001). In addition, SG-1002 treated rats exhibited significantly less pulmonary edema as compared to vehicle rats at both time points (Figure 4C). In addition, circulating BNP levels as an indication of the severity of heart failure after CAT were evaluated. BNP levels increased significantly (p < 0.01) in vehicle rats at 6 and 12 weeks compared to sham rats, but treatment with SG-1002 significantly inhibited BNP levels (p < 0.01 versus CAT + Vehicle) after CAT (figure 40). Echocardiography analysis (Fig. 4F) revealed that treatment with SG-1002 did not alter the increment in IVSd thickness after CAT (Fig. 4E), but prevented cardiac dilation (Figs. 4F-4G p < 0.01 versus CAT + Vehicle) and cardiac contractile dysfunction (figure 4H p < 0.001 versus CAT + Vehicle) from 6 weeks to 12 weeks after CAT. Histological analysis of sections stained with Masson's Trichrome and Picrosirius Red 12 weeks after CAT revealed extensive areas of intermuscular and perivascular fibrosis in hearts from CAT + Vehicle rats (figures 5A-5C p < 0.01 versus sham ). Although fibrosis was evident in sections taken from the hearts of TAC + SG-1002, it was significantly less when compared to the hearts of TAC + Vehicle (p < 0.001 for Masson's Trichrome and p < 0.01 for Red of Picrosirius). Finally, SG-1002 treated rats exhibited a better, although not statistically significantly improved, survival rate compared to vehicle rats (80% versus 61%, p=0.23) (Fig. 10C).
[00174] Further analysis revealed that administration of SG-1002 to CSE KO mice slightly but not significantly increased the levels of free H2S in blood and heart, whereas administration of SG-1002 did not significantly increase the levels of sulfur from sulfuric anhydride neither in blood (p < 0.001) nor in heart (p < 0.05) as compared to CSE KO rats fed a control diet (Figures 9A-9D). Administration of SG-1002 also completely decreased LV cavity dilation in CSE KO rats when compared to CSE KO rats fed a control diet (Figures 2D-2E p < 0.05). Interestingly, CSE KO rats treated with SG-1002 maintained cardiac expulsion fraction after CAT as compared not only to CSE KO rats fed a control diet but also to WT rats at 12 weeks after CAT ( Figure 2F; p < 0.001 versus CSE KO + TAC and p < 0.05 versus WT + TAC). However, no difference in mortality was observed between the CSE KO groups (figure 10A).
Taken together, the results so far indicate that the bioavailability of endogenous H2S is markedly attenuated in heart failure after pressure overload although CSE and CBS expression levels are maintained or upregulated. Furthermore, the increase in H2S levels by genetic or pharmacological approaches prevents the transition from compensated to decompensated cardiac hypertrophy. Example 5: Removal of SG-1002 leads to the development of dilation and cardiac dysfunction
[00176] Experiments were then performed to determine how removal of SG-1002 from the diet might affect the development of cardiac dilation and dysfunction after CAT. For these experiments, SG-1002 was administered in the diet for 1 week and then subjected to different groups of rats 6 weeks after CAT: (1) rats received SG-1002 in the diet for 6 weeks after CAT, (2 ) rats received SG-1002 in the diet for 1 week after CAT and then received normal diet for 5 weeks; (3) rats received SG-1002 in the diet for 3 weeks after CAT and then received normal diet for 3 weeks. Echocardiographic analysis revealed that all three groups of rats exhibited similar grades of increased IV8d girth as well as similar LVEDD diameters from 1 week to 6 weeks after CAT (Figures 12A-12B). Removal of SG-1002 after 1 week of CAT resulted in a greater increment in LVESD and a greater decrease in expulsion fraction at 6 weeks of CAT compared to the non-removal group (figures 12C-12D; p < 0.01 versus SG-1002). Removal of S8G-1002 at 3 weeks of CAT resulted in a non-significant increase in both of these parameters at 6 weeks of CAT when compared to the non-removal group. These data indicate that removal of SG-1002 soon after the establishment of pressure overload does not prevent the development of cardiac dilation and dysfunction, suggesting that the benefits of SG-1002 are obtained when the diet is maintained through the follow-up period. Example 6: H2S therapy increases VEGF-Akt-eNOS-Nitric Oxide signaling after CAT
The serine/threonine kinase Akt regulates cardiac growth, myocardial angiogenesis and survival in cardiac myocytes. SG-1002 treatment was examined to see if activating Akt phosphorylation was activated in the heart after CAT. Representative Western blots for the phosphorylation state of Akt in the heart at 6 weeks after TAC are shown in Figure 6A. SG-1002 treatment did not alter total Akt expression in the heart (Figure 68) but significantly increased phosphorylated Akt expression at threonine residue 30B (Akt_pThr308) (p < 0.001) and serine residue 473 (Akt_pSer473) when compared to the vehicle rat (figure 6E p < 0.001). Next, SG-1002 treatment was examined to determine whether VEGF, a potent angiogenic and cytoprotective cytokine in the myocardium, is up-regulated. At 6 weeks after TAC, rats treated with SG-1002 showed significantly higher VEGF protein expression levels in the heart (Figure 6D; p < 0.01 versus Simulation and p < 0.05 versus TAC + Vehicle), but not in systemic circulation (figure 13A).
[00178] It is known that nitric oxide (NOT) generated from endothelial nitric oxide synthase (eNOS) promotes cytoprotection of vascular and myocardial cells during ischemic conditions. To investigate the potential involvement of eNOS in SG-1002-induced cardioprotection after TAC, the expression and phosphorylation status of eNOS at serine residue 1177 (eNOS-pSer1177) were evaluated by Western blot analysis in the hearts of rats treated with Simulation, vehicle and SG-1002.
[00179] There were no differences in total eNOS expression in the heart between all groups (Figures 6E-6F). However, the eNOS activation site (eNOS-pSer1177) exhibited significantly greater phosphorylation after SG-1002 when compared to Simulation and TAC + Vehicle rats (figures 6E-6F: p < 0.01). Furthermore, SG-1002 treatment increased cardiac NOx (nitrite and nitrate) levels after CAT as compared to Simulation rats (figures 6G-H; p < 0.05), which are indicative of increased NO bioavailability after H2S therapy. Myocardial expression of both nNOS and iNOS in TAC rats that had already received both vehicle and SG-1002 (Figs. 138-130) was investigated. The expression of nNOS in rats treated with both vehicle and SG-1002 tended to be higher than Simulation, but did not reach statistical significance. Interestingly, iNOS expression in the TAC + Vehicle group was up-regulated compared to the Simulation group (p < 0.01), but the SG-1002 rats downregulated this up (p < 0.01 versus TAC + Vehicle). Example 7: H2S therapy attenuates mitochondrial respiratory dysfunction and oxidative stress after CAT
[00180] Mitochondrial energy failure is considered to be one of the central pathological mechanisms in heart failure resulting from cardiac hypertrophy. Therefore, the respiratory function of isolated mitochondria obtained from mouse hearts at 6 weeks after CAT was investigated. A significant decrease in State 3 (figure 7A; p < 0.01) and RCR (figure 78; p < 0.001) respiration rates was observed in the TAC + Vehicle rats compared to the Simulation rats (p < 0, 05 for State 3 and p < 0.01 for RCR). No difference in State 4 breathing was observed between any of the study groups (Fig. 7A).
[00181] Mitochondrial dysfunction leads to impaired ATP production and increased generation of reactive oxygen species (ROS), which can result in increased apoptosis. Therefore, 8-isoprostane levels were examined as a marker of antioxidant deficiency and oxidative stress in both plasma and heart at 6 weeks after CAT. Rats treated with either TAC + Vehicle or TAC + SG-1002 exhibited higher plasma levels of 8-isoprostane compared to sham rats (Fig. 7C, p < 0.05). However, TAC + Vehicle rats exhibited significantly higher levels of 8-isoprostane in the heart compared to sham rats (p < 0.001), whereas administration of SG-1002 attenuated the TAC-induced increment at levels of 8 -isoprostane (Figure 7D; p < 0.05 versus TAC + Vehicle). Next, cardiac Nox4 expression was evaluated as another marker of oxidative stress. At 6 weeks after TAC, the expression of NADPH oxidase 4 (Nox4) in myocardium was significantly up-regulated in the TAC + Vehicle rats compared to the Simulation rats (Fig. 7E; p0.01). However, treatment with SG-1002 significantly inhibited Nox4 up-regulation (p < 0.01 versus TAC + Vehicle). Further analysis revealed that treatment with SG-1002 resulted in an up-regulation of the expression of antioxidant hemioxygenase 1 (HO1) in the heart after CAT (Fig. 7F; p<0.01 versus Simulation and CAT + Vehicle).
[00182] The examples described in examples 1-7 provide several lines of evidence to support the idea that sulfide levels may be an important predictor of the severity of heart failure. First, according to previous clinical studies, additional evidence is provided showing that circulating sulfide levels are lower in patterns of heart failure. Second, data are provided showing that this is reflected in an experimental model of pressure-overload-induced heart failure, as evidenced by the finding that both myocardial and circulating levels of free H2S and sulfuric anhydride sulfur are significantly reduced after TAC. Third, it is shown that a deficiency in endogenously produced H2S results in an exacerbation of cardiac dysfunction after CAT, whereas genetic overexpression of CSE significantly conserved left ventricular function. Finally, chronic administration of an nH2S donor provides protection against adverse remodeling associated with CAT by increasing circulating and cardiac sulfide levels. Although the mechanisms responsible for the heart failure-induced slope in sulfide levels are not currently known, this finding strongly suggests that a deficiency of H2S may contribute to the pathophysiology and progression of heart failure. These findings also suggest that enhancing H2S bioavailability with oral H2S donor therapy significantly conserves cardiac function in the heart failure setting.
[00183] One of the main findings of the current study is that administration of SG-1002 significantly conserves cardiac function after CAT. Due to the fact that H2S is a physiological gas that diffuses freely in multiple intracellular compartments independently of specific receptors, it can be postulated that H2S points to multiple pathological cascades simultaneously. One potential target is VEGF, which ranks among the most potent angiogenic and cytoprotective cytokines. Givvimani et al., J. Appl. Physiol. 110: 1093-1100, 2011 previously reported that sodium hydrogen sulfide (NaHS) in drinking water increased angiogenesis by increasing VEGF expression and inhibiting anti-angiogenic factors (angiostatin and endostatin). Short-term Akt activation in inducible transgenic rats induces physiological hypertrophy with maintained vascular density, whereas Akt deficiency results in exacerbated cardiac dysfunction due to lack of exercise-induced cardiac hypertrophy. In this study, SG-1002 treatment was shown to activate a VEGF-Akt-eNOS-NO signaling pathway at 6 weeks after CAT induction (a time point when cardiac hypertrophy and left ventricular dysfunction are significant) .
[00184] An increase in oxidative stress and/or a deficiency in endogenous antioxidant reserve can also cause contractile dysfunction. The cardioprotective effects of H2S versus myocardial I/R are mediated by antioxidant signaling. In addition, H2S directly removes reactive oxygen species (ROS) in vitro. Therefore, endogenous H2S can directly and/or indirectly contribute to the modulation of oxidative stress in the pressure overload-induced hypertrophy configuration. Here, H2S was shown to attenuate the TAC-induced increment in oxidative stress, as evidenced by the discovery that SG-1002 decreases cardiac levels of B-isoprostane. In terms of mechanism, SG-1002 has been determined to attenuate the ROS-related upregulation of Nox4, a member of the NADPH oxidase family that is a major source of ROS-related cardiac dysfunction in the pressure overload setting. It was also determined that SG-1002 upregulated HO-1 expression and preserved mitochondrial respiratory function. Therefore, mitochondrial respiratory dysfunction in the heart leads to metabolic remodeling, cardiac energy deficit and increased oxidative stress, the conserved mitochondrial respiratory function observed in the current study could be an additional mechanism to explain the inhibition of oxidative stress by H2S after CAT .
[00185] It was generally believed that H2S and NO exert their biological effects through independent signaling pathways. Recent experimental evidence suggests that there is a cross-talk between the H2S and NO signaling pathways, which may provide additional synergistic and regulatory effects. For example, H2S regulates high NO production in endothelial cells by activating eNOS in an Akt-dependent manner. Similarly, NO has been shown to improve H2S production from vascular tissue, and more recently, Coletta et al., Proc. Natl. Academic Sci. USA 109:9161-9166, 2012, demonstrated that NO and H2S are mutually required for the control of vascular function. Therefore, another important finding of the current study is evidence that exogenous H2S therapy very potently activates eNOS and increases the bioavailability of NO within the myocardium. This is important for two reasons: (1) it further supports the evidence that there is cross-talk between the H2S and NO systems, and (2) it provides evidence for the first time that H2S increases NO bioavailability in an infirm disease model. alive. Consequently, eNOS activation by SG-1002 may serve as an important mechanism for the protective effects observed versus TAC. In terms of its effects on hypertrophy, NO produced from eNOS has been shown to have antihypertrophic effects on the heart as evidenced by the findings that eNOS KO mice have hypertension and cardiac hypertrophy and exhibit exacerbated cardiac dysfunction due to induced hypertrophy by pressure overload compared to WT rats. Furthermore, cardiac specific overexpression of eNOS prevents isoproterenol-induced cardiac hypertrophy. However, in sharp contrast, Takimoto et al., J. Clin. Invest. 115:1221-1231, 2011 have suggested that pressure overload results in eNOS uncoupling, resulting in myocardial oxidant production and exacerbated cardiac function. Despite this, doctors have been successfully using drugs that are capable of activating eNOS (ie ACE-1, ARB and beta blockers) in the treatment of heart failure. Therefore, controversy remains regarding the usefulness and efficacy of NO-based therapies in the treatment of heart failure, which warrants further investigation to address these problems. Furthermore, it is known that both NO and H2S increase the levels of HO-1, an enzyme that produces carbon monoxide (CA). This suggests that the activation of one of the endogenously produced gases can lead to the activation of the other two. Under these conditions, the three gases have the ability to synergize to produce anti-apoptotic, antioxidant, anti-inflammatory and anti-hypertrophic effects, which ultimately can lead to cardioprotection.
[00186] The findings of the current study indicate that the conservation of sulfide levels during the development of pressure-overload-induced heart failure conserves cardiac function and prevents the transition from compensated to decompensated cardiac hypertrophy. Furthermore, the current study indicates that administration of an oral H2S donor facilitates these protective effects by activating a VEGF-Akt-eNOS-NO signaling pathway significantly increasing NO bioavailability (Figure 14). This cascade of cardioprotective signaling ultimately results in inhibition of oxidative stress, attenuated cardiac fibrosis, conservation of mitochondrial respiration, and preserved left ventricular function. The study suggests that endogenously produced H2S plays an important role in the preservation of cardiac function in heart failure and that oral H2S therapy may be a therapeutic option for the treatment of LV dysfunction in the setting of hypertrophy induced by overload. pressure. Example 8: Treatment with a highly bioavailable zero-valent sulfur rich composition (SG-1002, containing about 99% zero-valent sulfur) increases sperm concentration and sperm motility in infertile men
[00187] Between July 2009 and September 2010, a total of 435 men, of whom 125 (28.73%) had oligoasthenozoospermia, were evaluated at the University Center for Reproductive Medicine. Seventy-two patients who agreed to join the study were recruited; of these, 18 were eliminated for various reasons (five did not show a combination of oligozoospermia and asthenozoospermia in the second semen analysis before treatment, eight had a chronic degenerative disease, three were chronic smokers, and two had taken antioxidants prior to the study). Fifty-four patients were included in the study who started treatment. Three came out (one mentioned "weird" smelling sweat, one referred to nausea and flatulence during the first three days of ingesting the hard gelatin capsules, each containing 400 mg of SG-1002 (5 capsules per day) and argued that there were too many capsules to take per day). When patients were observed at the end of 75 days of treatment, four did not show up despite insistence by telephone.
[00188] Information from 47 patients who complied with the protocol was analyzed. The mean age of patients was 34.23 years, with 32 years being the most frequent. Patients were divided into three groups (hydrogen sulfide prodrug, resveratrol and placebo), maintaining a similar relationship between groups. Sixteen patients were included in the resveratrol group, 16 in the hydrogen sulfide prodrug group, and 15 in the placebo group. Two assessments were made, a baseline and a post-treatment sample. In each of the two evaluations, variables such as concentration, motility and morphology in fresh and post-training semen were analyzed. The baseline characteristics of the three groups were similar. The mean age of patients in each group was 34.6 years for the hydrogen sulfide prodrug group, 35 years for the resveratrol group, and 33.07 years for the placebo group.
[00189] The mean baseline sperm concentration was 10.84 million per milliliter, with 0.5 million per milliliter being the lowest concentration and 19.9 million per milliliter being the highest concentration. The mean concentration at the first sample was 11.02, 10.9, and 10.64 million per milliliter for the hydrogen sulfide, resveratrol, and placebo prodrug groups, respectively. As for sperm motility recorded at baseline, type A+B motility averaged 13.43%, 14.43% and 8.33% for the hydrogen sulfide prodrug, resveratrol and placebo groups, respectively. . The morphology recorded in sample 1 was also similar in the three groups: 31.6% for the hydrogen sulfide prodrug group, 32.06% for the resveratrol group and 30.06% for the placebo group with no statistically significant difference . Post-sperm capacitance obtained recovered from mobile forms (MFR) was 0.579, 0.40, and 0.371 million for the hydrogen sulfide, resveratrol, and placebo prodrug groups, respectively (Table 8). Table 8
Note: Statistical analysis was carried out using x2 MFR: Mobile Forms Recovery, post sperm capacitation no statistical difference was found between placebo and hydrogen sulfide prodrug b no statistical difference was found between placebo and resveratrol
[00190] Data obtained from the first samples from the placebo group were compared with data obtained from the hydrogen sulfide prodrug. No statistical difference was found between the placebo group and the hydrogen sulfide prodrug group. Samples were collected after treatment showed different data between groups. Sperm concentration for the hydrogen sulfide prodrug group was 17.01 versus 11.18 million for the placebo group (p = 0.038). The A+B motility for the hydrogen sulfide prodrug group was 20.06% versus 10.06% in the placebo group (p = 0.037). The morphology obtained was 36.3% for the hydrogen sulfide prodrug group compared to the placebo group with 30.4% (p = 0.088). Post-MFR capacitation for the hydrogen sulfide prodrug group was 1.62 x 106 versus 0.338 x 106 in the placebo group (p = 0.035) (Table 9). Table 9
Note: Statistical analysis was carried out using x2 MFR: Movable Forms Recovery, post-sperm capacitation
[00191] The results of this study provide support for the use of therapy with antioxidants such as SG-1002 (ie, agents that act not only as scavengers of free radicals/reactive oxygen species, but also as indirect antioxidants that induce genes to generate other small molecule antioxidants, antioxidant enzymes and enzymes that regulate lipid metabolism) as a valid method to improve spermatogenesis in carefully selected patients. This is the first double-blind, randomized, controlled, prospective clinical trial to show that hydrogen sulfide prodrug therapy improves some seminal parameters.
[00192] An increase in sperm concentration was observed in the hydrogen sulfide prodrug group, this is the only group with a statistically significant increase. These findings demonstrate and confirm data obtained in other studies where antioxidant therapy appears to be effective in managing patients with oligoasthenozoospermia.
[00193] In summary, this study demonstrates that hydrogen sulfide prodrugs such as SG-1002 are well tolerated by the human body, without developing significant adverse effects at the doses used and can increase sperm count, motility, normal morphology and post-training of MFR. Example 9: Treatment with a highly bioavailable zero-valence sulfur-rich composition (SG-1002) in osteosarcoma patients
[00194] Two tests were performed in patients diagnosed with different forms of osteosarcoma. In one study, the patient was 11 years old. The baseline condition was characterized as osteoblastic osteosarcoma of the left distal femur, presented with a pathological fracture and tumor-related swelling and loss of function of the adjacent joint. The patient's physical examination was notable for the presence of a soft tissue mass and stiffness at the site of the primary tumor. Evidence of lung metastasis was not recorded. The patient received four cycles of chemotherapy with cisplatin, doxorubicin, ifosfamide and etoposide with no apparent clinical response. Chemotherapy was stopped prior to treatment of the highly bioavailable zero-valent sulfur rich composition. The treatment regimen consisted of administering nine hard gelatin capsules (each containing 400 mg SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition for 12 weeks. By the end of the second week, the patient began to feel better, the pain subsided, and the inflammation also began to decline. X-rays showed a reduction in the extremity soft tissue around the tumor. By the end of the fourth week, the inflammation of the extremity had drastically decreased to almost disappearance. There was no pain and X-ray radiography showed signs of cortical bone growth. By the end of week eight, the inflammation was completely gone. The patient's state of mind was excellent. There was no pain and X-ray radiography showed bone with greater cohesion. At the end of the twelfth week, the X-ray X-ray clearly showed a more cohesive bone. The bone was consolidated with angulation, a product of the original pathological fracture.
[00195] In the second study, the patient was 13 years old. The baseline condition was characterized as osteosarcoma osteosarcoma telangiectasis of the left proximal humerus presented with a pathological fracture and major tumor-related swelling and loss of function of the left shoulder. His physical examination was notable for the presence of a soft tissue mass and stiffness at the site of the primary tumor. At the time of diagnosis, there was evidence of bilateral lung metastasis. Conventional X-rays showed a shiny cystic lesion with a soft tissue mass with periosteal reaction. The patient received six cycles of chemotherapy with cisplatin, doxorubicin, high-dose methotrexate, itostamide and etoposide with a modest clinical response. At the end of the sixth cycle, chemotherapy was interrupted. The treatment regimen consisted of administering 9 capsules per day of the highly bioavailable zero-valent sulfur rich composition for 12 weeks. At the end of the third week, the patient began to feel better, the pain subsided and the inflammation also began to subside. At the end of the fourth week, X-ray radiography showed a reduction in soft tissue from the extremity around the tumor. CAT exploration showed no improvement in lung metastases although metastases did not progress but. By the end of the eighth week, the extremity inflammation had subsided, although it was quite noticeable. The patient had no pain and the X-ray X-ray showed that the tumor had not progressed. At the end of the sweet week, the soft tissue swelling persisted. The patient's state of mind was excellent. There was no pain and X-ray radiography showed no progression of bone cancer. CAT exploration showed no new lung metastases. Example 10: Treatment with a highly bioavailable zero valence sulfur-rich composition (SG-1002) in patients with conditions associated with hydrocephalus
[00196] Three tests were performed on patients showing signs of hydrocephalus. In the first test, the patient was 3 years old. Your baseline condition will be characterized by non-specific signs of hydrocephalus. An MRI showed a mass in the posterior fossa. Surgery was planned and an incomplete resection was performed. The pathology results showed an atypical infratentorial tertoid/rhabdoid tumor with leptomeningeal spread. He was then treated with several cycles of chemotherapy with very modest response. Chemotherapy was discontinued and the patient was placed in palliative care. A treatment regimen consisting of the administration of six hard gelatin capsules (each containing 400 mg SG-1002l per day of the highly bioavailable zero-valent sulfur rich composition) was initiated over a 12-week period. The patient began to show signs of improvement by the end of the second week. Sleepiness improved and by the end of the eighth week the patient was fully conscious and without clinical evidence of headache, vomiting or irritability. The patient had an important neurological recovery and by the end of the twelfth week the patient was able to stand up and walk a few steps. The radiological evidence of the tumor disappeared and the patient was able to walk unaided and eat normally for the next few weeks.
[00197] In the second test, the patient was 2 years old. She presented insidious, nonlocalized signs of increased intracranial pressure with hydrocephalus. MRI showed an intraventricular mass in the lateral ventricle. Surgery was planned, a CSF shunt was placed, and an incomplete resection was performed. The pathology results showed an anaplastic tumor consistent with choroid plexus carcinoma. He was then treated with several cycles of chemotherapy, with a very modest response. The parents decided at that time not to give the child additional treatment. A treatment regimen consisting of the administration of 3 hard gelatin capsules (each containing 400 mg SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition was then started for a period of 12 weeks. The patient began to show signs of improvement by the end of the second week. Drowsiness improved and by the end of the eighth week he was fully conscious and with no clinical evidence of headache, vomiting, or irritability. The patient had a major neurological recovery by the end of the twelfth week and the patient was able to get up and walk a few steps. Radiological evidence of the residual tumor has diminished but has not disappeared.
[00198] The third test was performed on a patient who was 5 years old. She presented with non-specific signs of increased intracranial pressure with hydrocephalus, vomiting, headaches, drowsiness, and a look-up tic. MRI showed an enlarged heterogeneous pineal mass with calcifications. Surgery was planned, a CSF shunt was placed, and an incomplete resection was performed. The pathology results were consistent with pinealoblastoma. She was then treated with several cycles of medulloblastoma-type chemotherapy with good initial response, but months later showed evidence of relapse. The patient's parents decided at that time not to give their daughter additional treatment. A treatment regimen consisting of the administration of six hard gelatin capsules (each containing 400 mg SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition was then started for a period of 12 weeks. The patient began to show improvement in the third week. Drowsiness improved and by the end of the twelfth week the patient was fully conscious and without clinical evidence of headache, vomiting, or irritability. Radiological evidence of the residual tumor has diminished but has not disappeared. Example 11: Treatment of a patient with ependymoma with the highly bioavailable zero-valence sulfur rich composition (SG-1002)
[00199] A test was performed on a 6-year-old patient diagnosed with supratentorial ependymoma. She presented in poor clinical condition with signs of increased intracranial pressure with hydrocephalus, vomiting, headaches, drowsiness and papilledema. MRI showed a locally invasive tumor adjacent to the brain in the thalamus region. Pathology review slides were consistent with a diagnosis of ependymoma. She was treated at that time with incomplete surgery and different cycles of chemotherapy. No radiographs were accepted and her parents decided not to give their daughter any further treatment. She began a treatment regimen of administering six hard gelatin capsules (each containing 400 mg of SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition for 12 weeks. The patient showed an improvement in the third week. Drowsiness gradually improved and by the end of the twelfth week the patient had greatly improved with a great decrease in headache, vomiting and irritability. The radiological evidence of residual tumor decreased and the clinical condition markedly improved. Example 12: Treatment of a macrocephaly patient with a highly bioavailable zero-valence sulfur-rich composition (SG-1002)
[00200] An 18-month-old female patient with evidence of macrocephaly and lethargy alternating with irritability was treated with the composition rich in highly bioavailable sulfur. Pre-treatment MRI revealed hydrocephalus and a tumor mass located in the posterior fossa. Surgery was planned, a CSF shunt was placed, and a partial resection was performed. The pathology results were consistent with ependymoma. Her signs of intracranial pressure improved due to the shunt and her hemiparesis was almost resolved. No additional treatment was accepted by the parents. Four months later an MRI showed that the tumor was increasing in size and the patient began to complain again of headaches, drowsiness and progressive hemiparesis. The treatment regimen consisted of administering six hard gelatin capsules (each containing 400 mg SG-1002) per day of the zero-valently bioavailable sulfur-rich composition for 12 weeks. The patient showed a slight improvement in the third week. The headache and sleepiness improved but did not disappear. By the end of the twelfth week, the patient felt better, had occasional headache, no vomiting, and hemiparesis had not progressed. Radiological evidence of residual tumor after 14 weeks showed that there was no increase in size compared to the last study. Example 13: Treatment of a patient with hamiparesis with a composition rich in highly bioavailable zero-valence sulfur impregnation (SG-I002)
A 5-year-old patient initially presenting with progressive signs of hemiparesis at the age of three was treated with the highly bioavailable zero-valent sulfur-rich composition of the invention for 12 weeks with administration of six hard gelatin capsules (each containing 400 mg of SG-1002l per dla.The patient's baseline condition consisted of nonspecific signs of increased intracranial pressure with morning vomiting, headaches, and drowsiness.MRI showed a supratentorial tumor mass with signs of hemorrhage and calcifications Surgery was planned, a CS shunt was placed and a partial resection was carried out. Pathological results were consistent with anaplastic ependymoma. Her signs of intracranial pressure improved due to the shunt and her hemiparesis nearly resolved. received 12 cycles with almost complete resolution of her signs and symptoms. MRI showed improvement with no macroscopic evidence of t humour. Four months later an MRI showed regional tumor invasion and the patient began to complain again of headaches, drowsiness and progressive hemiparesis. No additional treatment was accepted by the parents. Upon administration of the highly bioavailable zero-valent sulfur-rich composition, the patient began to show slight improvement by the third week. Headache and sleepiness improved. At the end of the dessert week, the patient felt better, she did not have vomiting and the hemiparesis did not progress. Radiological evidence of residual tumor after 14 weeks did not reveal an increase in size compared to the last study. Example 14: Treatment of a patient with medulloblastoma with the highly bioavailable zero-valence sulfur-rich composition (SG-1002)
A test was carried out in a 14-year-old patient with recurrent medulloblastoma and pelvic spread of his original tumor via CSF shunt. He initially presented with abdominal pain, headaches, swelling of the extremities and urinary symptoms, as well as morning nausea and ataxia. He started chemotherapy with modest results. Treatment of the highly bioavailable zero-valence sulfur-rich composition was initiated for 12 weeks by administering nine hard gelatin capsules (each containing 400 mg of SG-1002) per day. The patient showed improvement in the third week. Waist circumference decreased and urinary symptoms disappeared. The headache and ataxia improved but did not disappear. By the end of the twelfth week the patient felt better, and the abdominal/pelvic tumor had significantly decreased. The headache and ataxia improved a lot. Radiological evidence of recurrent medulloblastoma in the posterior fossa was not increased in size compared to previous studies. Example 15: Treatment of a patient with squamous cell carcinoma with the composition rich in highly bioavailable zero-valence sulfur impregnation (SG-1002)
A trial was carried out in a 57-year-old patient with rectal bleeding and pain due to recurrent squamous cell carcinoma of the anal canal treated with surgery, chemotherapy and radiation therapy. His condition recurred three months after his last radiation treatment and he waived further treatment. The patient was placed on a treatment regimen of nine hard gelatin capsules (each containing 400 mg SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition of the invention. The patient showed an improvement in pain 4 or 5 days after starting the treatment regimen. By the third week, the pain was gone and the rectal bleeding had subsided. The patient decided to re-start a rescue chemotherapy program along with the highly bioavailable zero-valent sulfur-rich composition treatment regimen. Example 16: Treatment of a leukemia patient with the rich composition of highly bioavailable carovalent sulfur (SG-1002)
A test was carried out on a 13-year-old female patient diagnosed with pre-B-cala(+) acute lymphoblastic leukemia. She was in first remission and was taking medication according to the BFM85 protocol. After 6 weeks of treatment she started taking hydrogen sulfide precursor capsules and said she felt much better and was able to exercise with better tolerance. She has been running, hiking on weekends and attending school regularly. His treatment regimen consisted of administering six hard gelatin capsules (each containing 400 mg of SG-1002) per day. The patient was able to compare how she felt before and after consuming the hydrogen sulfide precursor. His physical and intellectual ability improved. Now she could tolerate extreme exercise, such as walking the naughty field and running a 5-10 km marathon. His mood also improved. Example 17: Treatment of a patient diagnosed with heart failure with the highly bioavailable zero-valence sulfur rich composition (SG-1002)
[00205] A test was carried out on a 47-year-old patient diagnosed with heart failure at the age of 46 after having increased shortness of breath after moderate activity or exercise and chest pain. After a couple of months of ignoring his symptoms, he had a heart attack. I already had a coronary angioplasty. The patient did not smoke but had a family history of diabetes and high cholesterol levels. His expulsion fraction was less than 40%. He began a treatment regimen of six hard gelatin capsules (each containing 400 mg SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition. The treatment regimen lasted four months. At the end of the second week the patient began to feel better, blood sugar levels were regularized, although the patient continued to use glibenclamide every 12 hours. Shortness of breath improved in the third week. By week eight, sugar levels were stable and glibenclamide use was reduced to one tablet a day with no impact. Shortness of breath with exercise diminished, as did chest pain. At the end of the fourth month a study of the ventricular expulsion fraction revealed more than 40% and the patient felt better and had better exercise tolerance. Example 18: Treatment of a patient with type 2 diabetes with the highly bioavailable zero-valence sulfur rich composition (SG-1002)
A test was carried out on a 44-year-old obese male patient. He has been diagnosed with type 2 diabetes since he was 30 years old. Since then he had been taking glibenclamide with regular sugar control. At the age of 41 he began to notice regular coughing, shortness of breath and orthopnea. He had a heart attack at the age of 42 and his expulsion fraction thereafter was less than 40%. He began a treatment regimen of six hard gelatin capsules (each containing 400 mg SG-1002) per day of the highly bioavailable zero-valent sulfur rich composition. The treatment regimen lasted for three months. By the third week the patient began to feel better, and the sugar levels were regularized, although the patient continued to use glibenclamide. The shortness of breath began to improve towards the end of the seventh week. At the end of the third month, the patient only took glibenclamide in the mornings, but his blood glucose was virtually normal. Other Forms of Achievement
[00207] Although the invention has been described in connection with specific embodiments thereof, it is to be understood that it is susceptible to further modification and this patent application is intended to cover any variation, use or adaptation of the invention in the following generally , the principles of the invention and including such deviations from the present invention as come within common or customary practice in the field to which the invention belongs and may apply to the essential features noted above in the present invention.
[00208] All publications, patents and patent applications are incorporated herein by reference in their entirety to the same degree as if each publication, patent or patent application were specifically and individually indicated for incorporation by reference in their entirety.

权利要求:
Claims (8)
[0001]
1. Composition, characterized in that it comprises: 90 to 99.9% (by weight/weight) of elemental alpha sulfur and 0.01 to 10% (by weight/weight) of highly polar components, and optionally comprises one or plus pharmaceutically acceptable excipients, wherein said highly polar components are selected from the group consisting of sodium polythionate, potassium polythionate, ammonium polythionate, calcium polythionate, polythionic acids, sodium thiosulfate, potassium thiosulfate, ammonium thiosulfate, calcium thiosulfate, sodium sulfate, potassium sulfate and ammonium sulfate, wherein the composition comprises at least 96% of bioactive zerovalent sulfur that readily undergoes bioconversion to hydrogen sulfide.
[0002]
2. Composition according to claim 1, characterized in that said highly polar components are selected from sodium sulfate, sodium polythionates and sodium thiosulfate.
[0003]
3. Composition, characterized in that it comprises: an elemental alpha sulfur and one or more highly polar components in a ratio of 10 to 150 parts of elemental alpha sulfur to 1 part of highly polar components (by weight/weight) for enteral administration , topical, or parenteral in which said highly polar components are selected from the group consisting of sodium polythionate, potassium polythionate, ammonium polythionate, calcium polythionate, polythionic acids, sodium thiosulfate, potassium thiosulfate, ammonium thiosulfate, calcium thiosulfate, sodium sulfate, potassium sulfate and ammonium sulfate, wherein the composition comprises at least 96% of bioactive zerovalent sulfur that readily undergoes bioconversion to hydrogen sulfide.
[0004]
4. Composition according to claim 3, characterized in that said composition is formulated for enteral administration and said elemental alpha sulfur and said highly polar components are present together in an amount of 400 mg.
[0005]
5. Composition according to claim 4, characterized in that said composition is in a capsule.
[0006]
6. Composition according to claim 3, characterized in that it further comprises a third agent.
[0007]
7. Composition according to claim 6, characterized in that said third agent is a drug for cardiovascular diseases, an anti-inflammatory drug, an anti-neurodegenerative drug, or an anti-cancer/anti-proliferative drug, or in which said sulfur elemental alpha, said highly polar components and said third agent are present in an amount effective to treat a condition associated with oxidative stress.
[0008]
8. Composition according to claim 6, characterized in that said third agent is a dietary supplement, or wherein said elemental alpha sulfur, said highly polar components and said third agent are present in an effective amount to promote or maintain health in general.

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法律状态:
2018-01-23| B07D| Technical examination (opinion) related to article 229 of industrial property law [chapter 7.4 patent gazette]|

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2019-07-02| B07E| Notification of approval relating to section 229 industrial property law [chapter 7.5 patent gazette]|Free format text: NOTIFICACAO DE ANUENCIA RELACIONADA COM O ART 229 DA LPI |

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2019-10-29| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-07-07| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2020-07-07| B15K| Others concerning applications: alteration of classification|Free format text: AS CLASSIFICACOES ANTERIORES ERAM: A01N 59/02 , A61K 33/04 , A61K 33/06 Ipc: A61K 33/04 (2006.01), A61K 33/06 (2006.01), A61K 4 |

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2020-11-03| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2021-03-23| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-06-08| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 13/09/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US201161534585P| true| 2011-09-14|2011-09-14|

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US61/534,585|2011-09-14|

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PCT/MX2012/000086|WO2013055199A1|2011-09-14|2012-09-13|Preparation and compositions of zero-valent sulphur having high bioavailability, and uses thereof|BR122020020392-7A| BR122020020392B1|2011-09-14|2012-09-13|METHOD OF PREPARATION OF HIGHLY BIOAVAILABLE ZERO VALENCE SULFUR COMPOSITIONS|