Transmucosal botulinum toxin compositions, kits, and methods for treating bladder disorders
The present invention provides methods, compositions, and kits for treating bladder disorders or conditions, in which botulinum toxin is topically administered to the mucosal inner lining or urothelium of the bladder, of a subject in need thereof, for transmucosal delivery across the urothelium to surrounding bladder wall musculature and/or neuronal tissue. Rather than requiring injection, the toxin instead may be administered by instillation in solution via the urethra. In particular, the botulinum toxin is administered in conjunction with a positively charged or lipophilic carrier comprising a positively charged polymeric backbone or a hydrophobic backbone with covalently attached groups that enhance transmucosal transport across the urothelium and may also stabilize the botulinum toxin in aqueous formulations.
1. A method of treating a bladder disorder or condition in a subject in need thereof, the method comprising administering to a luminal surface of the bladder of the subject an effective amount of a composition comprising a botulinum toxin in conjunction with a carrier, said carrier comprising a backbone having covalently attached thereto one or more cell penetrating peptides,
wherein said carrier is a positively charged carrier with the backbone being a positively charged polymeric backbone or a lipophilic carrier with the backbone being a hydrophobic oligomeric or polymeric backbone;
wherein the botulinum toxin is delivered transmucosally via a balloon catheter in an effective amount for treating the subject's bladder disorder or condition,
wherein a balloon end of the balloon catheter is comprised of an inner balloon configured to inflate to occupy the lumen of the bladder and an outer sheath disposed over the inner balloon, having regularly spaced holes, and configured for administration of the composition to the luminal surface through the holes.
2. A method of increasing bladder contraction intervals associated with a hypercontractility bladder disorder or condition in a subject in need thereof, the method comprising administering to a luminal surface of the bladder of the subject an effective amount of a composition comprising a botulinum toxin in conjunction with a carrier, said carrier comprising a backbone having covalently attached thereto one or more cell penetrating peptides,
wherein said carrier is a positively charged carrier with the backbone being a positively charged polymeric backbone;
wherein the botulinum toxin is delivered transmucosally in an effective amount for treating the subject's bladder disorder or condition,
wherein a balloon end of the balloon catheter is comprised of an inner balloon configured to inflate to occupy the lumen of the bladder and an outer sheath disposed over the inner balloon, having regularly spaced holes, and configured for administration of the composition to the luminal surface through the holes.
3. The method according to claim 1 , wherein administration of the composition decreases bladder hypercontractility in the subject, thereby increasing bladder contraction intervals.
4. The method according to claim 1 , wherein the bladder disorder or condition is selected from overactive bladder (OAB) or bladder hyperactivity, urge incontinence due to overactive detrusor activity, idiopathic urge incontinence, interstitial cystitis, and bladder pain syndrome.
5. The method for use according to claim 4 , wherein the bladder disorder or condition is overactive bladder (OAB) or bladder hyperactivity.
6. The method for use according to claim 4 , wherein the bladder disorder or condition is urge incontinence due to overactive detrusor activity.
7. The method for use according to claim 4 , wherein the bladder disorder or condition is idiopathic urge incontinence.
8. The method for use according to claim 4 , wherein the bladder disorder or condition is interstitial cystitis.
9. The method for use according to claim 4 , wherein the bladder disorder or condition is bladder pain syndrome.
10. The method for use according to claim 1 , wherein the botulinum toxin and the positively charged or lipophilic carrier are formulated in the composition, wherein the botulinum toxin directly associates with the carrier to form a non-covalent complex.
11. The method according to claim 1 , wherein the carrier is the positively charged carrier.
12. The method according to claim 11 , wherein the cell penetrating peptides of the positively charged carrier are selected from amino acid sequences -(gly)n1-(arg)n2(SEQ ID NO. 1), wherein n1 is an integer of from 0 to about 20, and n2 is independently an odd integer of from about 5 to about 25; (gly)p-RGRDDRRQRRR- (gly)q (SEQ ID NO. 2); (gly)p-YGRKKRRQRRR-(gly)q (SEQ ID NO. 3);
and (gly)p-RKKRRQRRR-(gly)q (SEQ ID NO. 4), wherein p and q are each independently an integer of from 0 to about 20.
13. The method according to claim 12 , wherein the one or more positively charged efficiency groups have the amino acid sequence -(gly)n1- (arg)n2 (SEQ ID NO. 1), wherein n1 is an integer of from about 0 to about 20 and n2 is independently an odd integer of from about 5 to about 25.
14. The method according to claim 12 , wherein n1 is an integer of from 0 to about 8.
15. The method according to claim 12 , wherein n2 is an odd integer of from about 7 to about 17.
16. The method according to claim 12 , wherein the cell penetrating peptides are selected from (gly)p-RGRDDRRQRRR-(gly)q (SEQ ID NO. 2), (gly)p-YGRKKRRQRRR-(gly)q (SEQ ID NO. 3), or (gly)p-RKKRRQRRR-(gly)q (SEQ ID NO. 4), wherein p and q are each independently an integer of from 0 to about 20.
17. The method according to claim 12 , wherein p and q are each independently an integer of from about 2 to about 5.
18. The method according to claim 12 , wherein the one or more cell penetrating peptide are attached to either end, or both ends, of the positively charged backbone of the positively charged carrier.
19. The method according to claim 1 , wherein the positively charged backbone comprises a positively charged polypeptide.
20. The method according to claim 19 , wherein the positively charged polypeptide comprises a polylysine from about 5 to about 50 lysine residues.
21. The method according to claim 12 , wherein the positively charged carrier comprises the amino acid sequence (G)p-RKKRRQRRR-(G)q- (K)n-(G)q-RKKRRQRRR -(G)p (SEQ ID NO: 8), wherein p is an integer of from 0 to 2, q is an integer of from 0 to 2, and n is an integer of from about 10 to about 20.
22. The method according to claim 21 , wherein p is 0, q is 1, and n is from 10 to 20.
23. The method according to claim 22 , wherein the positively charged carrier is the amino acid sequence RKKRRQRRRG-(K)15-GRKKRRQRRR (SEQ ID NO: 7).
24. The method according to claim 1 , wherein the carrier comprises said lipophilic carrier.
25. The method according to claim 24 , wherein the cell penetrating peptides are selected from the group consisting of KKRPKPGGGGFFFILVF (SEQ ID NO: 21), FFFILVFGGGKKRPKPG (SEQ ID NO: 22), GGGGKKRPKPG (SEQ ID NO: 23), RKKRRORRRGGGGFFFILVF (SEQ ID NO: 24), and GGGGRKKRRQRRR (SEQ ID NO: 25).
26. The method according to claim 24 , wherein said lipophilic carrier is selected from the group consisting of palmitoyl- GGRKKRRQRRR (palmitoyl-TAT, SEQ ID NO: 26) and palmitoyl-glyp-KKRPKPG (SEQ ID NO: 27).
27. The method according to claim 24 , wherein the composition is contained in liposomes.
28. The method according to claim 1 , wherein the botulinum toxin is serotype A.
29. The method according to claim 1 , wherein the botulinum toxin is administered in an amount of about 1 U/kg to about 15 U/kg or about 0.5 to U/cm 2 about 3.5 U/cm 2 .
30. The method according to claim 1 , wherein the composition does not contain human serum albumin.
31. A kit comprising
a composition comprising a botulinum toxin and
a carrier comprising a backbone having covalently attached thereto one or more positively charged efficiency groups, wherein said carrier is a positively charged carrier with the backbone being a positively charged polymeric backbone; and
a balloon catheter, wherein a balloon end of the balloon catheter is comprised of an inner balloon configured to inflate to occupy the lumen of the bladder and an outer sheath disposed over the inner balloon, having regularly spaced holes, and configured for administration of the composition to the luminal surface through the holes.