Drug – bio-affecting and body treating compositions – In vivo diagnosis or in vivo testing – Diagnostic or test agent produces visible change in mouth
Patent
1997-09-03
1999-03-16
Dees, Jose' G.
Drug, bio-affecting and body treating compositions
In vivo diagnosis or in vivo testing
Diagnostic or test agent produces visible change in mouth
424 96, 424 91, 424 103, A61K 4900
Patent
active
058826270
DESCRIPTION:
BRIEF SUMMARY
This invention relates to in vivo methods for detection of premalignant oral lesions and oral carcinomas.
In another respect the invention pertains to compositions for carrying out such diagnostic procedures.
In another aspect the invention relates to such in vivo diagnostic procedures and compositions useful therein which are especially useful in screening patients for possible oral cancer as part of routine dentist's or physician's examinations, or procedures such as periodic check-up's, dental cleaning, etc.
In yet another aspect the invention relates to such procedures and compositions which utilize dye stains which are more readily available and/or less expensive and less complicated to synthesize and/or purify then the dyes employed in prior art procedures.
In yet another respect the invention concerns such in vivo procedures and compositions employing dyes which are less potentially toxic than prior art fluorescein derivatives and methylene blue and which may, therefore, be applied by rinsing the entire oral cavity and/or gargling.
In-vivo diagnostic procedures for detection of premalignant oral lesions or oral carcinomas, employing dye compositions which are selectively retained by tissues rendered abnormal due to dysplasia, hyperplasia, tumorigenesis, and other active surface lesions, are known in the art. For example, procedures employing fluorescein or fluorescein derivatives are disclosed in Chenz, Chinese Journal of Stomatology (27:44-47 (1992)) and Filiurin (Stomatologiia (Russian) 72:44-47 (1993)). These procedures involve application of the dye, followed by examination under ultraviolet light to detect the cancerous/precancerous tissue, which is selectively fluorescent.
Another prior art procedure involves in-vivo application by rinsing with toluidine blue O, followed by normal visual examination to detect any selectively stained tissue. Such procedures are disclosed, for example in the U.S. Patent to Tucci, et al. U.S. Pat. No. 5,372,801 and in U.S. Pat. No. 4,321,251 to Mashberg. Toluidine blue, has been used for decades as a histopathological stain for in-vitro use. Through this use it has become known as a metachromatic dye, staining nuclei rich in DNA and RNA a purple to pink color. The inherent deep blue color of toluidine blue is changed to purple or pink when the dye is bound to a nucleic acid or other acidic cellular macromolecule. Of course, this type of staining is dependent on the dye gaining access to internal subcellular structures such as the nucleus. Such access is readily obtained only by "fixing" a tissue sample of formaldehyde or other reagent that disrupts the cellular membrane without destroying general cellular structure.
In contrast to the mechanism involved with in-vitro use, the staining of oral tissue in-vivo by toluidine blue O is due to its ability to penetrate the enlarged and more accessible interstitial spaces of dysplastic tissue, which retains the dye longer than areas containing normal tissue with its tight intercellular junctions. Empirically, the observation is made that toluidine blue simply does not penetrate normal intercellular spaces efficiently than those of normal tissue, and becomes temporarily localized, it diffuses out with time and does not remain bound to the cells as it would if it actually "stained" acidic substructures.
The Mashberg procedure involves application of the toluidine blue O solution as a rinse of the entire oral cavity, with gargling, following by rinses with water and acidic acid to remove the dye which is not retained by the cancerous or precancerous tissue. The preliminary Mashberg diagnosis is then confirmed by direct application of the toluidine blue O composition to the suspect site 10-14 days later.
The Tucci '801 patent discloses an improved toluidine blue O composition for use according to the general Mashberg procedure.
An in-vivo procedure involving use of Lugol's solution (iodine) and toluidine blue O was proposed for detecting esophageal cancer synchronous with upper aerodigestive tract cancers in Papazian (Gastroe
REFERENCES:
patent: 3852413 (1974-12-01), Cammarata
patent: 4321251 (1982-03-01), Mashberg
patent: 5372801 (1994-12-01), Malmros et al.
Dees Jos,e G.
Hartley Michael G.
Zila Pharmaceuticals, Inc.
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