WO2007011699A2

WO2007011699A2 - Use of non-antibacterial tetracycline formulations for inhibiting bacterial spores

Info

Publication number: WO2007011699A2
Application number: PCT/US2006/027313
Authority: WO
Inventors: Stephen G. Walker; Lorne M. Golub; Sanford R. Simon
Original assignee: Research Foundation of the State University of New York
Current assignee: Research Foundation of the State University of New York
Priority date: 2005-07-15
Filing date: 2006-07-14
Publication date: 2007-01-25
Anticipated expiration: 2008-01-15
Also published as: KR20080034434A; WO2007011699A3; EP1906970A4; EP1906970A2; AU2006270213A1

Abstract

The invention relates to a method for inhibiting bacterial spores from becoming infectious vegetative cells in a mammal in need thereof. In another embodiment, invention relates to a method for inhibiting outgrowth of bacterial spores in a mammal in need thereof. The method comprises administering to the mammal an effective amount of a non-antibacterial tetracycline formulation. In one embodiment, the non-antibacterial tetracycline formulation comprises an antibacterial tetracycline in a sub-antibacterial amount. In another embodiment, the non-antibacterial tetracycline formulation comprises a non-antibacterial tetracycline.

Description

USE OF NON-ANTIBACTEmAL TETRACYCLINE FORMULATIONS FOR INHIBITING BACTERIAL SPORES

This application asserts priority to U.S. Application Serial No. 11/182,500 filed on July 15, 2005 and U.S. Application Serial No. 11/317,635 filed on December 23, 2005, the specifications of which are hereby incorporated by reference in their entirety.

BACKGROUND OF THE INVENTION

Some species of pathogenic and non-pathogenic bacteria have the capacity to form spores in response to adverse environmental conditions, such as nutrient depletion. Such spores are stable, and highly resistant to heat, chemical agents, and desiccation.

Bacterial spores generally remain metabolically inert until they encounter an environment which permits the spores to germinate into vegetative cells. The vegetative form of the bacteria then grows and reproduces. It is the vegetative form of spore- forming pathogenic bacteria that generally causes disease (e.g., anthrax) in a mammal.

Typically, traditional medications (e.g., antibiotics) given to persons who may have been, or may in the future be, infected by bacterial spores, or have an active infection, act by suppressing the vegetative form of the bacteria. Therefore, the active vegetative form must be present in the person before traditional medications can inhibit the growth of, or kill, the bacteria.

However, once the vegetative cell emerges, production of toxic molecules begins. Toxins produced by the vegetative cell are mainly responsible for mortality and/or morbidity of the mammal.

The compound tetracycline is a member of a class of antibiotic compounds that is referred to as the tetracyclines, tetracycline compounds, tetracycline derivatives and the like. The compound tetracycline exhibits the following general structure:

Structure A

The numbering system of the tetracycline ring nucleus is as follows:

Structure B

Tetracycline, as well as the terramycin and aureomycin derivatives, exist in nature, and are well known antibiotics. Natural tetracyclines may be modified without losing their antibiotic properties, although certain elements must be retained. The modifications that may and may not be made to the basic tetracycline structure have been reviewed by Mitscher in The Chemistry of Tetracyclines, Chapter 6, Marcel Dekker, Publishers, New York (1978). According to Mitscher, the substituents at positions 5-9 of the tetracycline ring system may be modified without the complete loss of antibiotic properties.

Changes to the basic ring system or replacement of the substituents at positions 4 and 10-12, however, generally lead to synthetic tetracyclines with substantially less or effectively no antimicrobial activity. Some examples of chemically modified non- antibacterial tetracyclines (hereinafter COLs) are 4-dedimethylaminotetracyline, 4- dedimethylaminosancycline (6-demethyl-6-deoxy-4-dedimethylaminotetracycline), 4- dedimethylaminominocycline (7-dimethylamino-6-demethyl-6-deoxy-4- dedimethylaminotetracycline), and 4-dedimethylaminodoxycycline (5~hydroxy-6-deoxy- 4-dedimethyaminotetracycline).

In addition to their antimicrobial properties, tetracyclines have been described as having a number of other uses. For example, tetracyclines are also known to inhibit the activity of collagen destructive enzymes produced by mammalian (including human) cells and tissues by non-antibiotic mechanisms. Such enzymes include the matrix metalloproteinases (MMPs), including collagenases (MMP-I, MMP-8 and MMP- 13), gelatinases (MMP-2 and MMP-9), and others (e.g. MMP- 12, MMP- 14). See Golub et al., J. Periodont. Res. 20:12-23 (1985); Golub et al. CrU. Revs. Oral Biol. Med. 2:297- 322 (1991); U.S. Patent Nos. 4,666,897; 4,704,383; 4,935,411; 4,935,412. Also, tetracyclines have been known to inhibit wasting and protein degradation in mammalian skeletal muscle, U.S. Pat. No. 5,045,538, to inhibit inducible NO synthase, U.S. Patent Nos. 6,043,231 and 5,523,297, and phospholipase A₂, U.S. Patent Nos. 5,789,395 and 5,919,775, and to enhance IL-10 production in mammalian cells. These properties cause the tetracyclines to be useful in treating a number of diseases.

Several publications relate to the use of tetracyclines to treat conditions associated with infections of bacteria capable of forming spores. For example, U.S. Published Patent Application No. 2004/0014731 published on January 14, 2004 discloses the administration of tetracycline compounds to mammals to protect and/or treat the mammal for a condition associated with bacteria that produce exotoxin. An example of such bacteria disclosed in U.S. Published Patent Application No. 2004/0014731 is Bacillus anthracis (i.e., bacteria that causes anthrax.).

However, only vegetative forms of bacteria produce exotoxin. Therefore, inhibition of spore germination is not disclosed or suggested in U.S. Published Patent Application No. 20040014731.

Altboum et al. {Infection and Immunity, 2002, 70:6231-6241) examined the effects of tetracyclines on guinea pigs intranasally infected with B. anthracis spores. The tetracyclines in the experiment described in Altboum et al. are administered in antibiotic doses to the guinea pigs post-infection. The authors report that treatment with tetracycline for fourteen days prevented death of infected animals during treatment. However, upon termination of tetracycline treatment, only two of eight animals infected with the VoI him strain of B. anthracis, and one of nine animals infected with the ATCC 6605 strain, survived.

Natalizi et al. {Anticioiica, 1966, 4:218-229) examined oxytetracycline and its effect on the germination of B. subtilis spores in vitro. The authors conclude that oxytetracycline has no effect on the initiation stage (e.g., germination) of the spores.

Thus, there is a need for inhibiting bacterial spores from becoming infectious vegetative cells.

SUMMARY OF THE INVENTION

It has been discovered that these and other objectives can be achieved by the present invention which provides, in one embodiment, a method for inhibiting bacterial spores from becoming infectious vegetative cells in a mammal in need thereof. The method comprises administering to the mammal an effective amount of a non- antibacterial tetracycline formulation.

In another embodiment, the invention provides a method for inhibiting outgrowth of bacterial spores in a mammal in need thereof. The method comprises administering to the mammal an effective amount of a non-antibacterial tetracycline formulation

DETAILED DESCRIPTION OF THE INVENTION

Inhibiting Bacterial Spores

The invention relates to a method for inhibiting bacterial spores from becoming infectious vegetative cells in a mammal in need thereof. The method comprises administering to the mammal an effective amount of a tetracycline formulation. -. Bacterial spores can become Infectious vegetative cells by undergoing various stages, such as germination and outgrowth. The term "germination" refers to the degradation of the spore coat. "Outgrowth," as used herein, refers to the escape of the bacteria from the spore coat. For a review of the germination stage of a bacterial spore, see inter alia, Setlow, Curr. Opin. Microbiol, 2003, 6:550-556.

The invention is not limited to the inhibition of any particular stage in the process of a bacterial spore in becoming an infectious vegetative cell. Rather, the invention relates to the inhibition of bacterial spores from becoming infectious vegetative cells. Thus, the non-antibacterial tetracycline formulation can inhibit any particular stage of a bacterial spore in becoming an infectious vegetative cell.

The term "infectious vegetative cell" is the form of a bacterial cell that produces toxins and causes disease in a mammal. Such cells are capable of forming spores and of producing exotoxins in their infectious vegetative states. Examples of such bacteria include those of the genus Bacillus and Clostridium. Examples of bacteria belonging to the genus Bacillus include Bacillus anthracis, Bacillus subtilis, Bacillus cereus. ' Examples of bacteria belonging to the genus Clostridium include Clostridium bόtulinum, Clostridium per fringens, Clostridium tetani, Clostridium difficile, Clostridium novyi, Clostridium histolyticum and Clostridium septicum.

In accordance with the present invention, bacterial spores are considered to be inhibited from becoming infectious vegetative cells if the rate of differentiation of a bacterial spore into an infectious vegetative cell is reduced by at least about 10%, preferably reduced by at least about 25%, more preferably reduced by at least about 50%, and even more preferably reduced by at least about 75%. Optimally, the tetracycline formulations completely inhibits a bacterial spore from becoming an infectious vegetative cell.

In one embodiment, the non-antibacterial tetracycline formulation inhibits germination of a bacterial spore. Germination of bacterial spores is considered to be inhibited if the rate of germination of the spore is reduced by at least about 10%, preferably at least about 25%, more preferably at least about 50%, and even more preferably at least about 75%. Optimally, the tetracycline formulations completely inhibits germination of bacterial spores.

In another embodiment, the non-antibacterial tetracycline formulation inhibits outgrowth of a bacterial spore. Outgrowth of bacterial spores is considered to be inhibited if the rate of outgrowth of the spore is reduced by at least about 10%, preferably at least about 25%, more preferably at least about 50%, and even more preferably at least about 75%. Optimally, the tetracycline formulations completely inhibits outgrowth of bacterial spores.

Any mammal can benefit from the method of the present invention. Suitable mammals include humans, farm animals, domestic animals, laboratory animals, etc. Some examples of farm animals include cows, pigs, horses, goats, etc. Some examples of domestic animals include dogs, cats, etc. Some examples of laboratory animals include rats, mice, rabbits, guinea pigs, etc.

In one embodiment, mammals in need of inhibition of bacterial spores from becoming infectious vegetative cells, inhibition of germination of bacterial spores or inhibition of outgrowth of germinated spores include a mammal at risk of acquiring a disease or condition associated with infectious vegetative bacterial cells. Mammals at risk of acquiring a condition associated with infectious vegetative bacterial cells include mammals that are susceptible to being, are suspected of having been, or were, exposed to a bacterial spore. Exposure to a bacterial spore may be unintentional or intentional, by, for example, an act of bioterrorism. Such mammals are typically humans, and include, for example, military personnel, individuals who handle animal skins, individuals who live in especially susceptible areas, health care professionals who may treat or have treated infected individuals or animals, and individuals that have been in contact with, or in the vicinity of, an area that has tested positive for the presence of bacterial spores. Generally, mammals that are susceptible to being, or suspected of having been, exposed to a bacterial spore are not known to be infected with bacterial spores.

In another embodiment, mammals in need of inhibiting bacterial spores from becoming vegetative cells, inhibition of germination of bacterial spores or inhibition of outgrowth of germinated spores are mammals that are known to be infected with bacterial spores capable of becoming infectious vegetative cells.

The non-antibacterial tetracycline formulation can be administered to a mammal in need at any time prior to the presence of toxic levels of exotoxin, e.g., lethal factor, in anthrax. Preferably, the non-antibacterial tetracycline formulation is administered as soon as possible after suspected exposure to, or known infection with, bacterial spores.

For instance, the non-antibacterial tetracycline formulation is administered within about one month, preferably within about two weeks, more preferably within about one week, even more preferably within about two days, yet even more preferably within about one day, and most preferably within about twelve hours after suspected exposure to, or known infection with, a bacterial spore.

For mammals that are susceptible to being exposed to a bacterial spore, the non- antibacterial tetracycline formulation is administered at a time prior to potential exposure to bacterial spores wherein the tetracycline formulation achieves sufficient plasma 'levels of the tetracycline compound to inhibit bacterial spores from becoming infectious vegetative cells at the time of potential exposure. For instance, the non-antibacterial tetracycline formulation can be administered up to about one month, preferably up to about one week, more preferably up to about one day, even more preferably up to about twelve hours, even more preferably up to about six hours, and most preferably within one hour, prior to potential exposure with a bacterial spore.

Non-antibacterial Tetracycline Formulation

In this specification, a non-antibacterial tetracycline formulation comprises a sub- antibacterial dose of an antibacterial tetracycline compound, a non-antibacterial tetracycline compound, or a pharmaceutically acceptable salt thereof.

Any antibacterial tetracycline compound may be used in the method of the present invention. Some examples of antibacterial tetracycline compounds include doxycycline, minocycline, tetracycline, oxytetracycline, chlortetracycline, demeclocycline, lymecycline. Doxycycline is preferably administered as its hyclate salt or as a hydrate, preferably monohydrate.

Non-antibacterial tetracycline compounds are structurally related to the antibacterial tetracyclines, but have had their antibacterial activity substantially or completely eliminated by chemical modification. For example, non-antibacterial tetracycline compounds have at least about two times, preferably at least about ten times, even more preferably at least about twenty five times, less antibacterial activity than that of doxycycline. In other words, non-antibacterial tetracycline compounds are incapable of achieving antibacterial activity comparable to that of doxycyline at comparable concentrations.

Any non-antibacterial tetracycline compound may be used in the method of the present invention. Some examples include those compounds disclosed generically or specifically in U.S. Patent No. 6,638,922 issued on October 28, 2003, and assigned to CollaGenex Pharmaceuticals, Inc. The tetracycline compounds disclosed in U.S. Patent No. 6,638,922 are herein incorporated by reference.

Specific examples of non-antibacterial tetracycline compounds (COLs) include 4- de(dimethylamino)tetracycline (COL-I), tetracyclinonitrile (COL-2), 6-demethyl-6- deoxy-4-de(dimethylamino)tetracycline (COL-3), 9-amino-6-diethyl 6-deoxy-4- dedimethylamino tetracycline (COL-308), 7-chloro-4-de(dimethylamino)-tetracycline (COL-4), tetracycline pyrazole (COL-5), 4-hydroxy-4-de(dimethylamino)-tetracycline (COL-6), 4-de(dimethylamino-12α-deoxytetracycline (COL-7), 6-deoxy-5α-hydroxy-4- de(dimethylamino)tetracycline (COL-8), 4-de(dimethylamino)- 12α- deoxyanhydrotetracycline (COL-9), and 4-de(dimethylamino)minocycline (COL-IO).

Tetracycline compounds are either isolated from nature, or are prepared by any method known in the art. For example, natural tetracyclines may be modified without losing their antibacterial properties, although certain elements of the structure must be retained. The modifications that may and may not be made to the basic tetracycline structure have been reviewed by Mitscher in The Chemistry of Tetracyclines, Chapter 6, Marcel Dekker, Publishers, New York (1978). According to Mitscher, the substituents at positions 5-9 of the tetracycline ring system may be modified without the complete loss of antibacterial properties. Changes to the basic ring system or replacement of the substituents at positions 1-4 and 10-12, however, generally lead to tetracyclines with substantially less or effectively no antibacterial activity.

The term "pharmaceutically acceptable salt" refers to a well-tolerated, nontoxic salt prepared from a tetracycline compound and an acid or base. The acids may be inorganic or organic acids of antibacterial tetracycline compounds or non-antibacterial tetracycline compounds. Examples of inorganic acids include hydrochloric, hydrobromic, nitric hydroiodic, sulfuric, and phosphoric acids. Examples of organic acids include carboxylic and sulfonic acids. The radical of the organic acids may be aliphatic or aromatic. Some examples of organic acids include formic, acetic, phenylacetic, propionic, succinic, glycolic, glucuronic, maleic, furoic, glutamic, benzoic, anthranilic, salicylic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, ethanesulfonic, panthenoic, benzenesulfonic, stearic, sulfanilic, alginic, tartaric, citric, gluconic, gulonic, arylsulfonic, and galacturonic acids. Appropriate organic bases may be selected, for example, from N,N-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine (N-methylglucamine), and procaine.

Throughout this specification, parameters are defined by maximum and minimum amounts. Each minimum amount can be combined with each maximum amount to define a range.

Dose

According to the present invention, a non-antibacterial tetracycline formulation comprising an antibacterial tetracycline compound is administered in a sub-antibacterial amount. A sub-antibacterial amount of an antibacterial tetracycline compound is any amount that results in a tetracycline plasma or serum concentration: (i) which is effective for its purpose, but (ii) which has no, or substantially no, therapeutic antibacterial activity. In one embodiment, the purpose is inhibiting bacterial spores from becoming infectious vegetative cells. In another embodiment, the purpose is inhibiting germination of bacterial spores. In a further embodiment, the purpose is inhibiting outgrowth of bacterial spores.

A concentration of an antibacterial tetracycline compound having substantially no antibacterial activity is any concentration that does not significantly prevent the growth of bacteria. That is, a microbiologist would not consider the growth of bacteria to be inhibited from a clinical point of view.

One way in which to quantify the antibacterial activities of tetracycline compounds is by a measure called minimum inhibitory concentration (MIC), as is known by a skilled artisan.

An MIC is the minimum tetracycline concentration that inhibits the growth of a particular strain of bacteria in vitro. MIC values are determined using standard procedures. Standard procedures are, for example, based on a dilution method (broth or agar), or an equivalent, using standard concentrations of inoculum and tetracycline powder. See, for example, National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing - Eleventh Informational Supplement. NCCLS Document MlOO-Sl 1, Vol. 21, No. 1, NCCLS, Wayne, PA, January, 2001.

In order to inhibit the growth of a strain of bacteria in vivo, a tetracycline compound achieves a plasma or serum concentration in excess of the MIC for the strain. Plasma or serum concentration refers to the concentration of a tetracycline compound measured in an individual's blood sample taken at steady state. Steady state is generally achieved after dosing for five to seven terminal half lives. The half lives of different tetracycline compounds vary from hours to days.

In the methods of the present invention, an antibacterial tetracycline compound is administered in an amount that is effective, as described above, and that results in a plasma or serum concentration which is significantly below the MIC for commonly- occurring bacteria. Such amounts are considered to have no, or substantially no, antibacterial activity. Examples of commonly-occurring bacteria that are susceptible to tetracycline are Escherichia coli {e.g., ATCC 25922 and 35218); Neisseria gonorrhoeae {e.g., ATCC 49226); Staphylococcus aureus {e.g., ATCC 29213 and 43300); and Streptococcus pneumoniae {e.g., ATCC 49619).

For example, in the present invention, an antibacterial tetracycline compound is administered in an amount that results in a plasma or serum concentration which is less than approximately 80%, 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%, 25%, 20%, 15%, 10%, 5%, 1% or 0.5% of the MIC for the commonly-occurring bacteria mentioned above. A skilled artisan can readily determine the amount of a particular antibacterial tetracycline compound to administer to achieve such concentrations.

For example, doxycycline is administered in an amount that results in a minimum steady state plasma or serum concentration of about 0.1 μg/ml, 0.2 μg/ml, or 0.3 μg/ml, and a maximum steady state plasma or serum concentration of about

0.7 μg/ml, 0.8 μg/ml, or 0.9 μg/ml. _; i

The sub-antibacterial amount of an antibacterial tetracycline compound can also be expressed by daily dose. The daily dose of an antibacterial tetracycline compound is any amount that is sufficient to produce the effective, sub-antibacterial plasma or serum concentrations described above. Such dose can, for example, be expressed as a percentage of a minimum antibacterial daily dose.

A skilled artisan knows, or is able routinely to determine, the minimum antibacterial daily dose for antibacterial tetracycline compounds. Examples of suitable sub-antibacterial doses of antibacterial tetracycline compounds for the methods of the present invention include less than approximately: 80%, 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%, 25%, 20%, 15%, 10%, 5%, 1% and 0.5% of a minimum antibacterial dose. Some examples of non-antibacterial oral daily doses of antibacterial tetracycline compounds include about 20 mg/twice a day of doxycycline; about 38 mg of minocycline one, two, three or four times a day; and about 60 mg of tetracycline one, two, three or four times a day.

There is no necessary minimum effective amount of the antibacterial tetracycline compound, as long as the amount administered is capable of inhibiting bacterial spores from becoming infectious vegetative cells. For example, when the amount is expressed as a percentage of the MIC plasma or serum concentration, suitable minimum plasma or serum concentrations include approximately 0.1%, 0.5%, 0.8% and 1% of the MIC plasma or serum concentration. When the amount is expressed as a minimum actual plasma or serum concentration, suitable actual plasma or serum concentrations include approximately 0.01 μg/ml, 0.05 μg/ml, 0.1 μg/ml, 0.15 μg/ml, 0.2 μg/ml, 0.25 μg/ml, 0.3 μg/ml, 0.35 μg/ml, 0.4 μg/ml, 0.45 μg/ml, 0.5 μg/ml, 0.55 μg/ml, 0.6 μg/ml, 0.65 μg/ml, 0.7 μg/ml, 0.75 μg/ml, 0.8 μg/ml, 0.85 μg/ml, 0.9 μg/ml, 0.95 μg/ml, and 1.0 μg/ml. When the dose is expressed as a percentage of a minimum antibacterial daily dose, the percentage is approximately 0.1%, 0.2%, 0.5%, 1%, 1.5% and 2% of the minimum antibacterial dose.

In an embodiment, any form of doxycycline {e.g., doxycycline salts, such as doxycycline hyclate; and doxycycline hydrates, such as doxycycline monohydrate) is administered in a daily amount of, or equivalent to, from about 10 to about 60 milligrams of doxycycline, while maintaining a concentration in human plasma below the MIC.

In an especially preferred embodiment, doxycycline, a doxycycline salt, or a doxycycline hydrate is administered at a dose of, or equivalent to, 20 milligram of doxycycline twice daily. Such a formulation is sold for the treatment of periodontal disease by CollaGenex Pharmaceuticals, Inc. of Newtown, Pennsylvania under the trademark Periostat®. Non-antibacterial tetracycline compounds have no, or substantially no, antibacterial activity. Therefore, there is reduced risk of indiscriminate inhibiting of growth of bacteria, and the resulting threat of developing antibiotic-resistant bacteria. Accordingly, a non-antibacterial tetracycline formulation comprising a non-antibacterial tetracycline compound, such as the COLs discussed above, is administered at any effective dose at which side effects, if any, are acceptable.

For example, suitable maximum plasma or serum concentrations of the COLs mentioned above include up to about 10 μg/ml, about 20 μg/ml, about 30 μg/ml, and even up to about 100 μg/ml, about 200 μg/ml and about 300 μg/ml. Suitable maximum daily doses of COLs include about 18 mg/kg/day, about 40 mg/kg/day, about 60 mg/kg/day and about 80 mg/kg/day.

A preferred COL is 6-demethyl-6-deoxy-4-de(dimethylamino)tetracycline (COL-3). COL-3 is suitably administered in doses of up,to about 200 mg/day, preferably

1 about 150 mg/day, more preferably about 100 mg/day, or in amounts that result in plasma or serum concentrations of up to about 50 μg/ml, about 40 μg/ ml, or about 30 μg/ml. For example, a dose of about 10 to about 20 mg/day of COL-3 produces plasma or serum concentrations in humans of about 1.0 μg/ml.

There is no necessary minimum effective dose of COLs. Some typical minimum plasma or serum concentrations of COLs include, for example, about 0.01 μg/ml, 0.1 μg/ml, 0.8 μg/ml, and 1.0 μg/ml. Some typical minimum daily doses of COLs include about 0.05 mg/day, about 0.1 mg/day, about 0.5 mg/day, about 1 mg/day, about 5 mg/day, or about 10 mg/day.

An advantage of the non-antibacterial tetracycline formulations useful in the method of the present invention is that they are administered at a dose which avoids side effects associated with high doses and/or long term administration of antibacterial formulations of tetracyclines. Examples of such side effects include the development of antibiotic resistant bacteria and the overgrowth of fungi and yeast. In order to avoid side effects, antibiotics are normally administered to humans for a period of about eight to twelve days, and usually not more than about two weeks.

The non-antibacterial tetracycline formulations can more safely be administered for periods longer than antibiotic compounds. For example, the non-antibacterial tetracycline formulations can be administered for at least about three weeks, preferably at least about six weeks, more preferably at least about two months, and most preferably at least about six months. Optimally, the non-antibacterial tetracycline formulations can be administered for at least about one year.

Phototoxicity

Preferably, the tetracycline compounds have low phototoxicity, or are administered in an amount that results in a plasma level at which the phototoxicity is acceptable. The preferred amount of the tetracycline compound produces no more phototoxicity than is produced by the administration of a 40 mg total daily dose of doxycycline.

Examples of tetracycline compounds with low phototoxicity include, but are not limited to, tetracycline compounds having general formulae:

Structure K

wherein: R7, R8, and R9 taken together in each case, have the following meanings:

R7 R8 R9 hydrogen hydrogen amino (COL-308) hydrogen hydrogen palmitamide (COL-311) hydrogen hydrogen dimethylamino (COL-306) and

Structure L

Structure M Structure N

Structure O wherein: R7, R8, and R9 taken together in each case, have the following meanings:

R7 R8 R9 hydrogen hydrogen acetamido (COL-801) hydrogen hydrogen dimethylaminoacetamido (COL-802) hydrogen hydrogen palmitamide (COL-803) hydrogen hydrogen nitro (COL-804) hydrogen hydrogen amino (COL-805) and

Structure P

wherein: R8, and R9 taken together are, respectively, hydrogen and nitro (COL- 1002).

Administration

The tetracycline formulation may be administered by any method known in the art. The actual preferred amounts of a non-antibacterial tetracycline formulation in a specified case will vary according to the particular tetracycline compound used, the mode of application, the particular sites of application, and the subject being treated (e.g. age, gender, size, tolerance to drug, etc.)

The non-antibacterial tetracycline formulation may be administered systemically. For the purposes of this specification, "systemic administration" means administration to a human by a method that causes the compounds to be absorbed into the bloodstream.

Preferably, the non-antibacterial tetracycline formulation is administered orally by any method known in the art. For example, the non-antibacterial tetracycline formulation can be administered in the form of tablets, capsules, pills, troches, elixirs, suspensions, syrups, wafers, chewing gum and the like. Additionally, the non-antibacterial tetracycline formulations can be administered enterally or parenterally, e.g., intravenously; intramuscularly; subcutaneously, as injectable solutions or suspensions; intraperitoneally; or rectally. Administration can also be intranasally, in the form of, for example, an intranasal spray; or transdermally, in the form of, for example, a patch.

For the pharmaceutical purposes described above, the non-antibacterial tetracycline formulations useful in the methods of the invention can be formulated per se in pharmaceutical preparations optionally with a suitable pharmaceutical carrier (vehicle) or excipient as understood by practitioners in the art. These preparations can be made according to conventional chemical methods.

In the case of tablets for oral use, carriers commonly used include lactose and corn starch, and lubricating agents such as magnesium stearate are commonly added. For oral administration in capsule form, useful carriers include lactose and corn starch. Further examples of carriers and excipients include milk, sugar, certain types of clay, gelatin, stearic acid or salts thereof, calcium stearate, talc, vegetable fats or oils, gums and glycols.

When aqueous suspensions are used for oral administration, emulsifying and/or suspending agents are commonly added. In addition, sweetening and/or flavoring agents may be added to the oral compositions.

For intramuscular, intraperitoneal, subcutaneous and intravenous use, sterile solutions of the non-antibacterial tetracycline formulations can be employed, and the pH of the solutions can be suitably adjusted and buffered. For intravenous use, the total concentration of the solute(s) can be controlled in order to render the preparation isotonic.

The non-antibacterial tetracycline formulation of the present invention can further comprise one or more pharmaceutically acceptable additional ingredient(s) such as alum, stabilizers, buffers, coloring agents, flavoring agents, and the like. The non-antibacterial tetracycline formulation may be administered at intervals. For example, the tetracycline formulation may be administered 1-6 times a day, preferably 1-4 times a day, more preferably twice a day, and even more preferably once a day, or once every other day.

In an embodiment, the non-antibacterial tetracycline formulation containing any of the above described doses of any antibacterial tetracycline compounds or non- antibacterial tetracycline compounds, such as those mentioned above, e.g., doxycycline and COL-3, is administered by controlled release over a particular period of time, such as a 24 hour period. The level of tetracycline compound over a particular period of time is typically measured by plasma or serum concentration, such as discussed above. Suitable controlled release formulations include delayed, sustained, and immediate (i.e., instantaneous) release.

For example, doxycycline is preferably administered in an amount of about 40 milligrams over the 24 hour period. The controlled-release 40 mg doxycycline can, for example, be formulated to contain 30 mg of doxycycline for instantaneous release and 10 mg of doxycycline for delayed release.

Methods for controlled release of drugs are well known in the art, and are described in, for example, international patent application PCT/US02/10748, which is assigned to CollaGenex Pharmaceuticals, Inc. of Newtown, Pennsylvania and U.S. Patent Nos. 5,567,439; 6,838,094; 6,863,902; and 6,905,708.

The non-antibacterial tetracycline formulation can also be administered topically. The appropriate dose of the non-antibacterial tetracycline formulation for topical administration can be readily determined by those skilled in the art. For example, topical administration of COLs in amounts of up to about 25% (w/w) in a vehicle can be administered without any toxicity in a human. Amounts from about 0.1% to about 10% are preferred. Particular non-antibacterial tetracycline compounds have only limited biodistribution, e.g. COL-5. In such cases, topical application is the preferred method of administration of the compound.

Carrier compositions deemed to be suited for topical use include gels, salves, lotions, creams, ointments, and the like. The non-antibacterial tetracycline compound can also be incorporated into a support base, matrix, tissue adhesive, or the like which can be directly applied to, for example, skin.

Combined or coordinated topical and systemic administration of the tetracycline formulation is also contemplated under the invention. For example, a non-absorbable non-antibacterial tetracycline compound can be administered topically, while an antibacterial or non-antibacterial tetracycline compound capable of substantial absorption and effective systemic distribution in a human can be administered systemically.

In one embodiment, the non-antibacterial tetracycline formulation is administered as a pharmaceutical composition comprising an active ingredient wherein the active ingredient consists essentially of a antibacterial tetracycline compound or a non- antibacterial tetracycline compound in an amount that is effective to achieve its purpose but has substantially no antibacterial activity.

EXAMPLES

Example 1. Germination of Bacillus cereus ATCC 10987

Bacillus cereus ATCC 10987 was grown in CCY medium (Stewart et al., Biochem. J. 198:101-106, 1981) and the spores were prepared as outlined by Clements and Moir (J. Bacteriol, 180:6729-6735, 1998). Phase-contrast microscopy showed the W

spore preparation to consist of bright refractive bodies. Further tests indicated that greater than 95% of the spores were resistant to heating at 7O⁰C for one hour.

Bacterial spores have "germination receptors" which bind germinants (such as inosine). The binding of the germinant to receptor initiates spore early germination. Early germination takes place without active metabolism.

Spore germination was assayed in the presence and absence of 5 μg/ml COL-3. Spores were suspended in 10 mM Tris-HCl (pH 8.0) to an OD at 580 nm of 1.00, and the suspension was incubated for 15 min. at 37⁰C.

Germination was initiated with 5 mM inosine and the optical density was monitored continually. Y-axis is given as percentage of initial OD at 580 nm. Samples were taken every 15 minutes for examination by phase contrast microscopy. Loss of the phase bright appearance of the spores paralleled loss in OD at 580 nm. Both a loss of OD and loss of the phase bright appearance of the spores indicate that the spores are germinating in response to the added inosine.

The experiment was repeated 3 times. Consistent results were obtained between experiments.

COL-3 did not inhibit the early phase of germination in this experiment. The rate of decrease in absorbance was not significantly different in the presence and absence of COL-3

Example 2. Gram-stain observation of germination in the presence and absence of COL-3 η

Five ml of spores (approximately 5 x 10 CFU per ml), suspended in 10 mM Tris- HCl (pH 8), were placed into two test tubes and warmed to 37°C. To one tube, COL-3 was added to a final concentration of 5 μg per ml. The other tube received an equal volume of dimethylsulfoxide (DMSO) vehicle alone. At time = zero, 1.5 ml of pre- warmed Brain Heart Infusion Broth was added to each tube and the tubes were vortexed for 10 seconds. The tubes were then placed back into a 37⁰C heating block.

Starting at time = 0, 0.5 mis were withdrawn at 10 min. intervals and placed into 0.5 ml of 5% formaldehyde-phosphate buffered saline and chilled on ice. At the completion of the experiment, all samples were centrifuged at 10 xg for 5 min. and the supernatant discarded.

The pellets were resuspended in 0.1 ml phosphate buffered saline. These samples were allowed to dry on glass microscope plates and then Gram-stained. At time = zero, the contents of both tubes are in the form of spores and as a result are stained poorly by the procedure. At time = 20 min the contents of both tubes retained more stain, due to the spores germinating. Also note that the control has larger more defined bodies.

At time = 40 min the control sample shows the typical bacillus shape of vegetative cells whereas the COL-3 exposed spores show no further development. At time = 60 min the control shows dividing vegetative cells, but the COL-3 exposed spores do not develop.

This experiment was repeated using different concentrations of COL-3. The minimum concentration of COL-3 to inhibit outgrowth was 1 μg per ml.

In the experiment described in example 1, COL-3 had no effect on the initial stages of germination. The addition of 5 mM inosine in the presence or absence of COL- 3 resulted in the spores germinating at the same rate. Phase contrast microscopy indicated that the spores lost their phase-bright appearance and became phase-dark. The results of the Gram-stain study, described in example 2, also indicated that early germination occurred in both the presence and absence of COL-3, but outgrowth into vegetative cells was inhibited by COL-3.

Claims

What is claimed is:

1. A method for inhibiting bacterial spores from becoming infectious vegetative cells in a mammal in need thereof, the method comprising administering to the mammal an effective amount of a non-antibacterial tetracycline formulation.

2. A method according to claim 1, wherein the non-antibacterial tetracycline formulation comprises an antibacterial tetracycline in a sub-antibacterial amount.

3. A method according to claim 2, wherein the antibacterial tetracycline is doxycycline.

4. A method according to claim 2, wherein the antibacterial tetracycline is minocycline.

5. A method according to claim 1, wherein the non-antibacterial tetracycline ' formulation comprises a non-antibacterial tetracycline.

6. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-3.

7. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-308.

8. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-311.

9. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-306.

10. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-801.

11. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-802.

12. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-803.

13. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-804.

14. A method according to claim 5, wherein the non-antibacterial tetracycline is COL-805.

15. A method according to claim 5, wherein the non-antibacterial tetracycline is COL- 1002.

16. A method according to claim 1, wherein the mammal is human.

17. A method according to claim 1 , wherein the mammal is at risk of acquiring a disease or condition associated with infectious vegetative cells.

18. A method according to claim 1, wherein the bacteria is Bacillus.

19. A method according to claim 1, wherein the bacteria is Clostridium.

20. A method according to claim 18, wherein the Bacillus is Bacillus anthracis or Bacillus cereus.

21. A method according to claim 19, wherein the Clostridium is Clostridium botulinum, Clostridium perfringens, Clostridium tetani, Clostridium difficile, or Clostridium histolyticum.

22. A method according to claim 1, wherein the non-antibacterial tetracycline formulation is administered after suspected exposure to bacterial spore.

23. A method according to claim 1, wherein the non-antibacterial tetracycline formulation is administered after known infection with bacterial spore.

24. A method according to claim 1 , wherein the non-antibacterial tetracycline formulation is administered prior to potential exposure to bacterial spore.

25. A method for inhibiting outgrowth of bacterial spores in a mammal in need thereof, the method comprising administering to the mammal an effective amount of a non-antibacterial tetracycline formulation.

26. A method according to claim 25, wherein the non-antibacterial tetracycline formulation comprises an antibacterial tetracycline in a sub-antibacterial amount.

27. A method according to claim 26, wherein the antibacterial tetracycline is doxycycline.

28. A method according to claim 26, wherein the antibacterial tetracycline is minocycline.

29. A method according to claim 25, wherein the non-antibacterial tetracycline formulation comprises a non-antibacterial tetracycline.

30. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-3.

31. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-308.

32. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-311.

33. A method according to claim 26, wherein the non-antibacterial tetracycline is COL-306.

34. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-801.

35. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-802.

36. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-803.

37. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-804. '

38. A method according to claim 29, wherein the non-antibacterial tetracycline is COL-805.

39. A method according to claim 29, wherein the non-antibacterial tetracycline is COL- 1002.

40. A method according to claim 25, wherein the mammal is human.

41. A method according to claim 25, wherein the mammal is at risk of acquiring a disease or condition associated with infectious vegetative cells.

42. A method according to claim 25, wherein the bacteria is Bacillus.

43. A method according to claim 25, wherein the bacteria is Clostridium.

44. A method according to claim 42, wherein the Bacillus is Bacillus anthracis or Bacillus cereus.

45. A method according to claim 43, wherein the Clostridium is Clostridium botulinum, Clostridium perβingens, Clostridium tetani, Clostridium difficile, or Clostridium histolyticum.

46. A method according to claim 25, wherein the non-antibacterial tetracycline formulation is administered after suspected exposure to bacterial spore.

47. A method according to claim 25, wherein the non-antibacterial tetracycline formulation is administered after known infection with bacterial spore.

48. A method according to claim 25, wherein the non-antibacterial tetracycline formulation is administered prior to potential exposure to bacterial spore.