State of the art
[0001] The hyaluronic acid is a disaccharide polymer composed of D-glucuronic acid and N-acetylglucosamine,
distributed in the body as intracellular tissue and in the fluids, such as the vitreous
humour and synovial liquid. In EU hyaluronic acid sodium salt is used for intra-articular
and intra-ocular administration. The wide interval in molecular weight and consequent
intrinsic viscosity allow its use in the healing of wounds, in ocular operations,
in osteo-arthritis of the large joints (knee).
[0002] Hyaluronic acid, solution 20-30 mg/vial, has been used for over 15 years for intra-articular
administration with the aim of replacing the hyaluronic acid normally present in the
joint, which, with the progression of the illness undergoes to a more rapid depolymerisation
with consequent increase of severity of the pathology.
[0003] The therapeutic value of its intra-articular administration is well documented (
J.Rheumatol. 25:2203-2212, 1998; ibid
26:1216,1999; ibid
38:602-607, 1999) and the efficacy is substantially attributed to the "lubrication" of the joint (
Arch.Int.Med. 162:245-7, 2002). These results suggest the intra-articular administration as a "supplementation"
of high-viscosity acid and the regulating state of the product was changed in the
last years from medicinal drug product to "medical device".
[0005] Diacerein has a limited bioavailability: its intestinal metabolism produces metabolites
with a laxative action; it is a pro-drug of rhein, that penetrates rapidly into the
synovial liquid at low concentrations (1-10 mmol/L ) and it is rapidly eliminated.
These characteristics - low absorption, hydrolysis in the stomach into rhein, anthraquinonic
metabolites with a laxative effect, rapid elimination - give reason of the poor tolerability
of oral diacerein therapy and of the advantage of using local administration in the
target area.
[0006] Intra-articular administration of diacerein is difficult to realize due to the lack
of solubility of the drug in a carrier compatible with the synovial liquid, and because
of its permanence time in the joint, which has been shown to be too short for an effective
block of the IL-1 synthesis.
[0007] International Patent Application
WO 2005/085293 describes esters of rhein with hyaluronic acid, prepared by warm reacting hyaluronic
acid with rhein chloride and following purification by ultra filtration or dialysis.
[0008] This method of synthesis, due to the stressed conditions of reaction, causes the
formation of a number of red purple coloured by-products of rhein, which resulted
very difficult to remove, either by ultra filtration or by dialysis, for the occurrence
of secondary reactions with hyaluronic acid itself. After ultrafiltration or dialysis,
the final compound appears as a red powder, with a negligible content of hydrolysable
rhein (less that 1%), with a solubitily in water or saline less that 1 mg/ml, useless
for the local administration.
[0009] It the synthesis of hyaluronic acid and rhein chloride is performed in controlled
mild conditions (30-40°C, hydrophobic solvent with moisture less than 1%, absence
of Lewis bases), rhein remains simply "trapped" in the hyaluronic acid structure,
and it is washed during dialysis or ultrafiltration. The final compound after drying
appears almost white but it contains less than 0,1% of active drug.
[0010] In said Patent Application
WO 2005/085293 there are, generically mentioned, but not exemplified, other possible esters of hyaluronic
acid with acyl derivatives of rhein, including the diacetyl derivative or diacerein.
As to the preparation of the diacerein ester of the hyaluronic acid the method described
in
WO2005/085293 proved to be unsuccessful: at the process conditions, the diacerein is hydrolized
into rhein and other derivatives, with subsequent secondary reactions and by-products
formation.
Description of the invention
[0011] The object of the present invention is a process for the preparation of stable esters
of diacerein with hyaluronic acid having a high purity level, which are endowed of
an interesting anti-arthritis activity free from side effects and suitable for intra-articular
administration. The hyaluronic acid used in these esters is preferably of a molecular
weight in the range from 100,000 to 1,500,000 Da.
[0012] The esters of hyaluronic acid and diacerein, prepared according to the method of
the invention, display the following characteristics:
- they do not contain detectable impurities of diacerein derivatives, such as non-linked
diacerein, rhein and their derivatives;
- they are white or straw-white in colour, the intensity of which depends on the diacerein
content;
- they can be administered in physiological solution or in aqueous organic solution,
as saline-glycerol or saline-PEG solution;
- they allow, when administered in the joint, a residence time of diacerein that is
inversely proportional to the depolymerization rate of the hyaluronic acid carrier;
- they perform a double mechanism of action on the pathology: a local supplementation
of hyaluronic acid and the diacerein inhibition of the collagenolytic activity induced
by IL-1β;
- they do not cause local or systemic toxic risks because they do not contain free diacerein,
and the total amount of diacerein is negligible in comparison to the dosage authorized
in humans.
[0013] The process, object of the invention, allows to obtain a non-hydrolyzed diacerein
ester with hyaluronic acid, straw-white in colour, without detectable impurities,
having the formula

[0014] This process envisages protection of the diacerein carboxylic group with N,N-carbodiimidazole
(CDI) in accordance with a classic method used to esterify aminoacids (Synthesis 833,1982).
[0015] The synthesis of imidazolyl diacerinate (CDIDIAC) occurs by stoichiometric reaction
in anhydrous organic solvent at a temperature of 30-40°C. The preferred solvent is
dimethylformamide (DMF), but the synthesis can also occur in other aprotic, polar
solvents, as DMSO.

[0016] Said reaction does not cause the formation of by-products: the excess of CDI decarboxylates
with the liberation of carbon dioxide and imidazole.
[0017] The next step of the synthesis, the esterification with hyaluronic acid of the protected
diacerein, requires the use of previously salified hyaluronic acid with low quaternary
strong bases, such as, for example, the tetrabutylammonium hydroxide (TBAI). Salification
makes hyaluronic acid soluble in the same solvent of CDIDIAC, and available to esterify
the DIAC by substitution of the imidazole amide.
[0018] The salification of the hyaluronic acid with TBAI can be carried out by ionic exchange
on resin in accordance with traditional techniques (
Butyric and Retinoic Mixed Ester of Hyaluronan, The Journal of Biological Chemistry,
Vol. 279, No. 22, Issue of May 28, pp. 23574-23579, 2004; Hyaluronic-acid butyric esters as promising antineoplastic agents in human lung
carcinoma:
A pre-clinical study, Investigational New Drugs 22: 207-217, 2004.). For example, saturating a sulphonated resin, Amberlite IR-20 type, with a concentrated
TBAI solution, washing with water to remove the excess of TBAI, then percolating a
dilute solution of hyaluronic acid sodium salt. The tetrabutylammonium salt of the
hyaluronic acid (HA-TBA) is separated in solid form by lyophilization and stored in
a refrigerator in a container with dehydrating silica gel.
[0019] Esterification occurs by the addition of HA-TBA to the CDIDIAC solution in the selected
solvent, e.g. DMF, allowing it to react under mechanical stirring at a temperature
lower than 40°C for 4-48 hours in an anhydrous environment or made inert with nitrogen.
[0020] For the recovery of the ester the reaction mass can be dialysed, for example, with
a pH 7 aqueous buffer, and/or ultra filtered, to remove the by-products of the reactions,
imidazole and TBAI, then lyophilized.
[0021] Alternately, the ester can be isolated by precipitation with a suitable organic solvent,
i.e. ethyl alcohol or acetone.
[0022] In both cases it is obtained a product with a residual humidity of less than 10%,
straw-white in colour and specific viscosity changed or unchanged with respect to
that of the starting hyaluronic acid, depending on the diacerein content.
[0023] The diacerein content can vary according to the molecular ratio of reagents and by
consequence the colour of the final product can vary: it can reach approximately 5%
substitution ratio using hyaluronic acid having low molecular weight (LMW, approx.
0.1 10
6 Dalton) and decrease to 1.5% using hyaluronic acid with a higher molecular weight
(HMW, 1.2 10
6 Dalton). The colour of the latter derivative is a lighter straw-yellow than the former.
[0024] The level of esterification of the hyaluronate hydroxy groups depends on many factors,
including molecular mass, viscosity, concentration of the HA-TBA solution, as well
as the stoichiometric ratio in reaction with the CDIDIAC, and time and temperature
used.
Example 1
Hyaluronic acid tetrabutylammonium salt (HA-TBA)
[0025] The resin (Amberlite IR-20, in acid form CAS 9002-23-7) has a declared capacity of
1.9 eq/L: to salify 1 litre of it, approximately 1,250 mL of tetrabutylammonium hydroxide
solution at 40% (TBAI) are necessary. To obtain an efficient exchange using a ratio
of 10:1 between the resin sulphonic groups, and the hyaluronic acid carboxylic groups,
one litre of activated resin is sufficient for approximately 75-80 g of sodium hyaluronate.
[0026] Preparation is carried out on a chromatographic column packed with approximately
0.1 L of resin medium, washed with 0.5 L of demineralized water. The quantity of TBAI,
solution at 40% (1.25 L/litre of resin), is percolated and recycled with a pump having
a flow of approximately 0.05 - 0.1 volumes of resin/hour for a time corresponding
to 3-4 recycles (approximately 2-3 days). Once the cycle is completed, the resin is
washed with demineralized water (equal to at least 5-6 volumes of resin) to obtain
an eluate with a stable pH between 9.5 - 10. To obtain a more efficient exchange it
is appropriate to use a jacketed column, thermostatically controlled at 40°C. Grams
8 of sodium (LMW) HA are dissolved in approximately 2 L of demineralized water (suggested
concentration 2-4 g/L of HA of M.W. 0.6 10
6 Dalton) and the solution is treated on resin column (0.1 L) at a temperature lower
than 35°C at a flow of approximately 0.1-0.2 L/h. The column percolate and the washing
waters (approximately 0.5 L) are collected and subjected to lyophilization.
[0027] Grams 7.5 of the product are obtained having humidity lower than 10%.
Example 2
Hyaluronic acid tetrabutylammonim salt (HA-TBA)
[0028] Grams 8 of (HMW) sodium hyaluronate are dissolved in approximately 5 L of demineralized
water (suggested concentration 1-2 g/L per HA of M.W. 1.2 10
6 Dalton) and the solution is treated on resin column (0.1 L) at a temperature lower
than 35°C at a flow of approximately 0.4 L/h. The percolate from the column and the
washing waters (approximately 0.5 L) are collected and are subjected to lyophilization.
[0029] Grams 7.2 of the product are obtained having humidity lower than 10%.
Example 3
(LMW) Hyaluronic acid diacerein ester
[0030] Grams 2.20 of diacerein (∼6 mmol) are dissolved in 100 mL of anhydrous dimethylformamide
to which, under stirring, 1.30 g (∼ 7 mmol) of N,N-carbonyldiimidazole are added:
the mass is left to react at room temperature for 12 hours or overnight in a flask
protected from humidity. Then 5 g of (HMW) HA -TBA dissolved in 250 mL of DMF are
added and left under stirring for 24-48 hours until the mass of the reaction becomes
a transparent and homogeneous red gel. To the residue after sedimentation, 100 mL
of pH 7 phosphate buffer are added and transferred into a dialysis bag. PTFE membrane,
size 200-400 nominal Dalton. Outer dialysis solution was monitored for colour and
changed many times to colourless solution over 48 hours. The dialyzed solution is
lyophilized and 5.8 g of product are obtained having humidity lower that 10%.
Example 4
(HMW) Hyaluronic acid diacerein ester
[0031] In a flask under nitrogen atmosphere 2.2 g of diacerein (~6 mmol) are dissolved in
100 mL of anhydrous DMF and 1.45 g of N,N-carbonyldiimidazole are added thereto under
stirring. The mass is left to react at room temperature till complete solution or
transparency. Grams 5 of HA-TBA (HMW), previously dissolved in 50 mL of dimethylformamide,
are added thereto through a dropping funnel and the reaction mixture, protected from
humidity, is kept under agitation for 24-48 hours.
[0032] The reaction is stopped by adding under stirring 100 mL of a saturated solution of
sodium chloride. The mass is precipitated by addition of about 2 volumes of 96% ethanol
and the supernatant is discharged. The residue is washed several times with ethanol
at different concentration and finally dried under vacuum.
[0033] Grams 5.3 of product are obtained having humidity lower than 10%.
Pharmaceutical formulations containing the hyaluronic acid diacerein ester
[0034] All the preparation must be performed in sterile area with previously sterilised
equipment.
- a. Milligrams 500 of the (HMW) hyaluronic acid diacerein ester, as prepared in Example
4, are dissolved in 50 mL of saline and kept under stirring for 1 h. The final solution
is sterilized by saturated steam at a proper time and temperature, validated by means
of F0, to give an SAL of 10-6 or better. Then 2 mL of the obtained solution are filled in a vial.
- b. Milligrams 500 of the (HMW) hyaluronic acid diacerein ester, as prepared in Example
4, are dissolved in 50 mL pH 7 phosphate buffer 0.01M and kept under stirring for
1 h. The final solution is sterilized by saturated steam at a proper time and temperature,
validated by means of F0, to give an SAL of 10-6 or better. Then 2 mL of the obtained solution are filled in a vial.
- c. Milligrams 500 of the (LMW) hyaluronic acid diacerein ester, as prepared in Example
3, are dissolved in 50 mL of pH 6.5 phosphate buffer 0.01M/glicerol (6:4 v/v) and
kept under stirring for 1 h. The final solution is sterilized by saturated steam at
a proper time and temperature, validated by means of F0, to give an SAL of 10-6 or better. Then 2 mL of the obtained solution are filled in a vial.
Structural identification of hyaluronic acid diacerein ester
[0035] The derivatives of hyaluronic acid and diacerein, prepared according to the process
of the invention, have been proved by
1H and
13C NMR performed on the TBA salt in DMSO. The final esters as sodium salts have not
enough solubility in DMSO to produce significant NMR signals, whereas the TBA salts
have. Due to the low concentration of diacerein in the DMSO solution, it was necessary
to accumulate overnight the signals in both
1H and
13C NMR, in order to identify the specific signals of diacerein.
[0036] The
1H NMR spectrum showed a chemical shift of the aromatic signals of diacerein of about
0.5 ppm, from 7.5-8.5 ppm (pure diacerein) to 7.0-8.0 ppm (ester), due to the ester
bond between diacerein and hyaluronic acid.
[0037] The high noise of signals (due to the overnight accumulation) did not let to see
the signals of the acetyl groups so, in order to demonstrate that diacerein was not
hydrolyzed by the reaction, the
13C NMR was performed.
[0038] As expected, the
13C NMR spectrum demonstrated that the
13C carbon's signal of diacerein's acetyl groups was shifted of about 1 ppm, from 20
ppm (pure diacerein) to 21 ppm (ester).
[0039] The above results combined together demonstrated that the diacerein was not hydrolyzed
and it was structurally bonded to hyaluronic acid.
Analytical properties
[0040] Solubility: > 5mg/mL in water
pH in water: 7.0 - 8.0
Moisture (K.F.): >5%
Identification of diacerein by transacetylation of benzylamine: positive
Free diacerein (HPLC): < 0.01%
Free rhein (HPLC): <0.01%
Substitution ratio: 2-5%
1. Verfahren zum Herstellen stabiler Ester von Diacerein mit Hyaluronsäure, die eine
anhaltende anti-inflammatorische Aktivität aufweisen und für die intraartikuläre Verabreichung
geeignet sind, wobei das Diacerein, das entsprechend an der Carboxylgruppe mit einem
Carbodiimidazolyl-Radikal geschützt ist, mit Hyaluronsäure, die entsprechend mit einer
starken quaternären Base einer Salzbildung unterzogen wurde, bei einer Temperatur
von weniger als 40°C, für eine Zeitdauer von 4 bis 48 Stunden in einem aprotischen
Lösungsmittel und in Gegenwart von Stickstoff umgesetzt wird, und wobei die Reaktionsmasse
dann einer Dialyse unterzogen und lyophilisiert wird, was die gewünschte Verbindung
ergibt.
2. Verfahren nach Anspruch 1, wobei die Hyaluronsäure ein Molekulargewicht zwischen 100000
Da und 1500000 Da aufweist und das Diacerein-Substitutionsverhältnis in dem Ester
mit Hyaluronsäure zwischen 0,5 und 5 % liegt.
3. Stabile Ester von Diacerein mit Hyaluronsäure, die eine anhaltende anti-inflammatorische
Aktivität aufweisen und für die intraartikuläre Verabreichung geeignet sind, wie sie
nach dem Verfahren gemäß Anspruch 1 oder 2 hergestellt werden.
4. Pharmazeutische Zusammensetzung, die eine anhaltende anti-inflammatorische Aktivität
aufweist und für die intraartikuläre Verabreichung geeignet ist, welche eine nach
Anspruch 3 hergestellte Verbindung einschließt, und die entsprechend mit einem pharmazeutisch
geeigneten Träger gemischt wird.