Nitric Oxide Releasing Topical Gel for Burn Wound Healing

描述（由申请人提供）：一氧化氮（NO）气体已被证明在促进和调节各种伤口愈合过程（包括烧伤伤口）中发挥重要作用。NO也已被证明有希望作为抗微生物治疗剂，并对人类病原体具有广泛的有效性。大多数目前的一氧化氮治疗（吸入治疗除外）涉及全身或局部治疗的药物，旨在刺激诱导型一氧化氮合酶（NOS）细胞内。除了内源性NO通过NOS在伤口愈合中的作用外，还报道了外源性NO后伤口愈合的改善，包括直接应用NO气体或应用合成NO和其他细胞毒性氮氧化物物质（亚硝酸，NO2）的局部凝胶或乳膏。然而，在十几个或更多当前和待决的基于NO的药物临床试验中，没有一种局部方法利用外源性NO产生凝胶，因此依赖于NOS途径来局部产生微量的NO。已经实现了用于局部/皮肤应用的更治疗相关剂量的NO气体的直接递送，尽管该方法由于NO在空气中的不稳定性而复杂，并且难以在临床环境中产生。更合理的基于NO的伤口愈合治疗在临床环境中应用将是方便和安全的，具有可预测的剂量，并且不会有化学杂质从而影响伤口愈合过程。Lynntech的团队已经开发出一种简单的化学合成方法，用于产生足够持续和高纯度的用于皮肤应用的NO，从而允许将局部“凝胶”应用于伤口治疗-特别是烧伤。这种以凝胶形式合成NO的专有化学方法有可能用作部分厚度烧伤的机械多功能局部治疗剂，并有可能用于清创后和植皮前的全厚度烧伤的伤口愈合。初步结果表明，这种化学物质能够以浓度依赖性方式有效地产生持续量的NO，并且将NO凝胶应用于啮齿动物模型中的全厚度烧伤也显示出愈合（伤口闭合）和再上皮化速率的显著改善。在该项目的第一阶段，Lynntech的团队（毒理学家，世界知名的NO专家，烧伤伤口专家，NO材料化学家，微生物学家和NO生物化学家）将进行分析，体外和体内研究，为第二阶段的临床前试验做准备。第一阶段将集中于化学和凝胶基质的表征和优化，这将允许给定烧伤伤口上的可预测剂量。此外，该项目还将表征对临床烧伤相关病原体的抗菌有效性，并将使用两种不同的剂量定时方案对烧伤伤口的高剂量和低剂量治疗进行体内评价。I期和II期项目的目的是完成临床前试验，以支持向FDA提交IND，并同时向制药行业销售该技术。在美国，每年约有240万人因烧伤而接受治疗，其中65万人需要医疗专业人员的护理，75，000人需要住院治疗。这些患者代表了治疗最昂贵的灾难性伤害之一;烧伤超过全身30%的患者可能需要超过200，000美元的医院，药品和初级保健费用。通过使用单一、廉价和安全的局部凝胶来减少烧伤伤口愈合和防止感染的时间，患者可以期待更好的愈合结果，缩短住院时间和医疗护理时间，并降低护理成本。

DESCRIPTION (provided by applicant): Nitric oxide (NO) gas has been shown to play a significant role in the promotion and regulation of diverse wound healing processes, including burn wounds. NO has also been shown to have promise as an antimicrobial therapeutic and has broad range of effectiveness against human pathogens. Most current nitric oxide therapies (other than inhalation therapies) involve systemic or topical treatments with drugs designed to stimulate inducible nitric oxide synthase (NOS) intracellularly. In addition to a role of endogenous NO in wound healing through NOS, improvement of wound healing following exogenous NO has also been reported, including direct application of NO gas or application of topical gels or creams that synthesize NO and other cytotoxic nitrogen oxide species (nitrous acid, NO2). However, of the dozen or more current and pending NO- based pharmaceutical clinical trials, none of the topical approaches utilize an exogenous NO producing gel and thus rely on NOS pathways to generate minute amounts of NO locally. The direct delivery of more therapeutically relevant doses of NO gas for topical/dermal applications has been accomplished, although the method is complicated by NO's instability in air and difficulty to produce in a clinical setting. A more rational NO-based wound healing treatment would be convenient and safe to apply in a clinical setting, have a predictable dose, and would not have chemical impurities thus impacting the wound healing process. Lynntech's team has developed a simple, chemical synthesis methodology for generating sufficiently sustained and high purities of NO ex-situ for dermal applications, and thus allows for application of a topical 'gel' to wound treatments - specifically burns. This proprietary chemical method for the synthesis of NO in a gel format has the potential to be used as a mechanistically multi-functional topical therapeutic for partial thickness burns, and potentially in wound healing for full thickness burns after debridement and also prior to skin grafting. Preliminary results have shown the ability of this chemistry to efficiently produce sustained amounts of NO in a concentration dependant manner, and application of the NO gel to full thickness burns in a rodent model has also shown significant improvements in rate of healing (wound closure) and re-epithelization. In Phase I of this project, Lynntech's team (toxicologist, world-renowned NO expert, burn wound specialist, NO materials chemist, microbiologist and NO biochemist) will pursue analytical, in vitro and in vivo studies in preparation of preclinical trials to be conducted in Phase II. Phase I will focus on characterization and optimization of the chemistry and gel matrix which will allow for a predictable dose on a given burn wound. Also, the project will characterize the antimicrobial effectiveness against clinically burn relevant pathogens and will conclude with in vivo evaluation of a high and low dose treatment of burn wounds using two different dose timing protocols. The purpose of the Phase I and II projects is to complete preclinical trials to support filing of a IND with the FDA and concurrent marketing of the technology to the pharmaceutical sector. Approximately 2.4 million people a year in the United States are treated for burn injuries, with 650,000 of these cases requiring care by a medical professional and 75,000 requiring hospitalization. These patients represent one of the most expensive catastrophic injuries to treat; a patient sustaining burns over 30% of their total body surface may require upwards of $200,000 in hospital, pharmaceutical, and primary care costs. By reducing the time to heal a burn wound and protect against infection by using a single, inexpensive and safe topical gel, patients can expect better healing outcomes, shortened hospital stays and medical care duration, and reduced cost for that care.