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Title:
USE OF CATIONIC STEROIDAL ANTIMICROBIALS FOR SPORICIDAL ACTIVITY
Document Type and Number:
WIPO Patent Application WO/2018/175582
Kind Code:
A1
Abstract:
This disclosure relates to sporicidal compositions and uses thereof. The sporicidal compositions include one or more cationic steroidal antimicrobials (CSAs). The sporicidal compositions may be applied to an object to kill or deactivate bacterial spores contacting the sporicidal composition. The object may be a food product, food processing equipment, industrial equipment, or healthcare facility objects. The sporicidal composition may be administered to a subject that has, is suspected to have, or is at risk for an infection associated with spore-forming bacteria.

Inventors:
SAVAGE PAUL B (US)
Application Number:
PCT/US2018/023566
Publication Date:
September 27, 2018
Filing Date:
March 21, 2018
Export Citation:
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Assignee:
UNIV BRIGHAM YOUNG (US)
International Classes:
C07J41/00; A61K31/56; A61K31/57; A61K31/575
Foreign References:
US9533063B12017-01-03
US20160096864A12016-04-07
Other References:
PIKTEL ET AL.: "Sporicidal Activity of Ceragenin CSA-13 Against Bacillus Subtilis", SCIENTIFIC REPORTS, vol. 7, 15 March 2017 (2017-03-15), XP055543273, Retrieved from the Internet [retrieved on 20180424]
Attorney, Agent or Firm:
GUYNN, John M. (US)
Download PDF:
Claims:
CLAIMS

1. A method of killing or deactivating bacterial spores on one or more objects, the method including:

applying a sporicidal composition having one or more cationic steroidal antimicrobial (CSA) compounds to the object and/or into the air; and

the sporicidal composition killing or deactivating one or more bacterial spores contacting the sporicidal composition.

2. The method of claim 1, wherein the sporicidal composition further comprises a carrier selected from the group consisting of water, alcohol, oil, organic solvent, organic/aqueous emulsion, and combinations thereof.

3. The method of claim 1 or claim 2, wherein the sporicidal composition is non-oxidizing.

4. The method of any one of claims 1 through 3, wherein the sporicidal composition has a pH of between about 6 and 8, or between about 6.5 and 7.5, or about 7.

5. The method of any one of claims 1 through 4, wherein the sporicidal composition is applied to one or more food products.

6. The method of claim 5, further comprising reducing spoilage and/or extending shelf life of the one or more food products relative to similar food products not treated with the sporicidal composition.

7. The method of any one of claims 1 through 4, wherein the sporicidal composition is applied to food processing equipment.

8. The method of any one of claims 1 through 4, wherein the sporicidal composition is applied to medical devices.

9. The method of any one of claims 1 through 4, wherein the sporicidal composition is applied to drinking water.

10. The method of any one of claims 1 through 4, wherein the sporicidal composition is applied to a hazardous substance known or suspected as including hazardous bacterial spores.

11. The method of any one of claims 1 through 10, wherein the sporicidal composition is applied to the one or more objects in conjunction with heat treatment of the one or more objects.

12. The method of any one of claims 1 through 11, wherein the one or more CSA compounds are provided at concentration according to the temperature at which the sporicidal composition is utilized.

13. The method of any one of claims 1 through 12, wherein the one or more CSA compounds includes CSA-13.

14. The method of any one of claims 1 through 13, wherein the one or more CSA compounds are provided at a concentration of about 10 μg/ml to about 200 μg/ml.

15. The method of any one of claims 1 through 14, wherein the sporicidal composition functions to increase permeability of bacterial spore inner membranes.

16. A method of therapeutically or prophylactically treating an infection associated with spore-forming bacteria, the method comprising:

administering a sporicidal composition having one or more cationic steroidal antimicrobial (CSA) compounds to a subject having or at risk of contracting a spore-forming bacterial infection; and

the sporicidal composition killing or deactivating one or more bacterial spores coming into contact with the sporicidal composition.

17. Use of one or more CSA compounds in the manufacture of a medicament for therapeutic or prophylactic treatment of an infection associated with spore-forming bacteria.

18. A sporicidal composition comprising one or more CSA compounds for therapeutic or prophylactic treatment of an infection associated with spore-forming bacteria.

19. The method, use, or composition of any one of claims 16 to 18, wherein the sporicidal composition includes a pharmaceutically acceptable carrier.

20. The method, use, or composition of any one of claims 16 to 19, wherein the sporicidal composition, or the one or more CSA compounds, are administered orally, rectally, intravenously, or intranasally.

21. The method, use, or composition of any one of claims 16 to 20, wherein the one or more CSA compounds are provided at a concentration of about 10 μg/ml to about 200 μg/ml.

22. The method, use, or composition of any one of claims 16 to 21, wherein the sporicidal composition is administered in conjunction with one or more antibiotics to prophylactically treat or prevent post antibiotic emergence of a spore-forming bacterial infection.

Description:
USE OF CATIONIC STEROIDAL ANTIMICROBIALS

FOR SPORICIDAL ACTIVITY

BACKGROUND

[0001] Spore-forming bacteria are a class of microorganisms with the ability to survive in extreme environmental conditions. Morphological features of spores provide resistance to stress factors such as high temperature, radiation, disinfectants, and drying. Consequently, spore elimination in industrial and medical environments is very challenging.

[0002] Spore-forming bacteria, such as Bacillus and Clostridium species, are able to produce spores in response to environmental conditions such as limited nutrients. Spore formation results in the generation of metabolically dormant and environmentally resistant cells with enhanced ability to survive high temperature, UV and gamma radiation, antibiotic treatment, and extreme environmental conditions. Spore-forming bacteria frequently occur in food products, and they are responsible for food spoilage and food-borne diseases. Importantly, dormant spores of some bacteria, such as Clostridium species, are an infectious and transmissible form of the microbe. In another example, the persistence of spores, their germination, and their outgrowth into the vegetative form is responsible for a re-emergence of Clostridium difficile infections, even after long-term antibiotic treatment.

[0003] Bacterial spores formed in sporulation processes are extremely resistant to physical sterilization processes, antibiotics, and other antimicrobial agents. The structure of a spore plays a crucial role in the protection of cells against stressful environmental conditions. The spore coat aids in the resistance of spores against some chemicals and lytic enzymes and increases resistance of cells to heat, radiation, or a variety of select chemical decontaminates. The inner membrane of spores represents a strong permeability barrier, significantly defending internal structures of spores, including DNA, and playing a vital role in the development of chemical resistance. See Cortezzo, D.E. and Setlow, P., "Analysis of factors that influence the sensitivity of spores of Bacillus subtilis to DNA damaging chemicals," J Appl Microbiol, 2005. 98(3): p. 606-17. Thus, agents with the ability to by-pass permeability barriers of spores can potentially provide sporicidal activity.

[0004] Other factors providing resistance to bacterial spores include lower water content and high mineralization of spore cores, high levels of dipicolinic acid (DP A) and its associated divalent cations (mostly CaDPA), the protection of spore DNA against wet heat damage by its saturation with α/β-type small, acid-soluble proteins (SASPs), the presence of UV-absorbing pigments located in the spore's outer layers and DNA damage repair mechanisms during spore germination and outgrowth.

[0005] Most research on sporicidal agents has focused on the application of reactive chemical compounds, many of which are toxic to humans and therefore have limited application. Oxidizing agents and acid solutions may induce alterations in the spore membranes sufficient to kill the spores or considerably affect their ability to germinate and grow in typical environmental conditions.

[0006] It was reported that peroxynitrite and acids appear to kill spores by damaging the spore's external layers, including the inner membrane, resulting in spore death. See Genest, P.C., et al., "Killing of spores of Bacillus subtilis by peroxynitrite appears to be caused by membrane damage," Microbiology, 2002. 148(Pt 1): p. 307-14. Treatment of spores with hydrogen peroxide causes dysfunction of spore germination. See Melly, E., Cowan, A.E., and Setlow, P., "Studies on the mechanism of killing of Bacillus subtilis spores by hydrogen peroxide," J Appl Microbiol, 2002. 93(2): p. 316-25. However, there are many applications for which these harsh agents cannot suitably be used. Additionally, enzymes present in the spore coat, including superoxide dismutase, might detoxify some of such oxidizing agents before they penetrate into the deeper parts of the spore, which can significantly reduce their usefulness. See Henriques, A.O., Melsen, L.R., and Moran, CP., "Involvement of superoxide dismutase in spore coat assembly in Bacillus subtilis," J Bacteriol, 1998. 180(9): p. 2285-91.

BRIEF SUMMARY

[0007] The disclosure relates generally to sporicidal compositions which include one or more cationic steroidal antimicrobial (CSA) compounds, and methods of killing or deactivating spores using such compositions.

[0008] Some embodiments are directed to methods of killing or deactivating bacterial spores on one or more objects to which a sporicidal composition is applied. In some embodiments, a method includes (1) applying a sporicidal composition having one or more CSA compounds to an object that has or may have bacterial spores, and (2) the sporicidal composition killing or deactivating one or more bacterial spores contacting the sporicidal composition. The object treated can be surfaces, spaces, or regions of confined air of a building, hospital, air duct, restaurant, food preparation facility, school, office, or a medical device.

[0009] At least some of the sporicidal compositions disclosed herein are safe and non-toxic to humans and animals. In particular, the one or more CSA compounds included the disclosed sporicidal compositions are safe and non-toxic relative to the harsh sporicidal agents typically utilized to kill bacterial spores, including agents such as acids and oxidizers. Certain sporicidal compositions described herein may therefore be provided in a non-acidic form and/or in a form that does not rely on oxidation to kill or deactivate bacterial spores. Certain sporicidal compositions described herein may be applied to or mixed with a food product to reduce spoilage of the food product and/or to reduce the occurrence of food borne illness associated with bacterial spores.

[0010] Some embodiments are directed to methods of therapeutically or prophylactically treating or preventing an infection associated with spore-forming bacteria. In some embodiments, a method includes (1) administering a composition having one or more CSA compounds to a subject having or at risk of contracting a spore-forming bacterial infection, and (2) the sporicidal composition killing or deactivating one or more bacterial spores coming into contact with the sporicidal composition, thereby therapeutically or prophylactically treating the subject.

BREIF DESCRIPTION OF DRAWINGS

[0011] To further clarify the above and other advantages and features of the present invention, a more particular description of the invention will be rendered by reference to specific embodiments thereof which are illustrated in the appended drawings. It is appreciated that these drawings depict only illustrated embodiments of the invention and are therefore not to be considered limiting of its scope. The invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:

[0012] Figure 1 illustrates a theorized mechanism of CSA sporicidal activity.

[0013] Figures 2A-2C illustrates examples of cationic steroidal antimicrobial compounds.

[0014] Figure 3 shows TEM micrographs of untreated vegetative (panel A) and spore form of B. subtilis (panel B), and treated sport form (panels C, D, E, F).

[0015] Figure 4 includes graphs showing decreased survival of CSA- 13 -treated B. subtilis spores.

[0016] Figure 5 includes graphs showing inhibitory effect of CSA- 13 on B. subtilis spore germination.

[0017] Figure 6 includes graphs showing affinity of FITC-labeled CSA-13 to membrane of vegetative and spore form of B. subtilis and changes in zeta potential values of ceragenin-treated vegetative and spore of B. subtilis.

[0018] Figures 7 and 8 show Raman spectra collected from B. subtilis spores incubated at RT and at 70° C, respectively, with corresponding confocal microscopy images. DETAILED DESCRIPTION

I. Overview of CSA Compounds

[0019] Cationic sterioidal antibiotic ("CSA") compounds ("CSAs"), which are also known as "ceragenin" compounds (or "ceragenins"), are synthetically produced small molecule chemical compounds that include a sterol backbone having various charged groups (e.g., amine, guanidine, and/or other groups capable of exhibiting cationic properties under biological conditions) attached to the backbone. The backbone can be used to orient the cationic groups on one face, or plane, of the sterol backbone. In general, the term "CSA compound" refers to the type or structure of the CSA, while the term "CSA molecule" refers to the CSAs themselves when used in a sporicidal composition.

[0020] CSAs are cationic and amphiphilic, based upon the functional groups attached to the backbone. They are facially amphiphilic with a hydrophobic face and a polycationic face. Without wishing to be bound to any particular theory, it is theorized that the CSA compounds described herein act as effective sporicidal agents by interacting with and disrupting the multilayered structure of the spores, bypassing the relative impermeability of the spore's inner membrane, and/or damaging the DNA within the spore core. It is also theorized that the charged groups are responsible for interacting with the bacterial spores, and without the charged groups, the CSA molecules would less effectively interact with and disrupt the spores.

[0021] Figure 1 illustrates a theorized mechanism for a CSA molecule's sporicidal activity. Considering that the loss of spore DPA is followed by replacement of this compound by water, it is theorized that alterations in core hydration are associated with the CSA-induced release of CaDPA from the spore core as the result of membrane-permeabilizing properties of the CSA (CSA- 13 is shown as an example). The release of DPA from the spore core results from alterations in permeability of spore barriers, likely including the spore inner membrane, which allows for increased accessibility of the spore core to exogenous factors. This process involves a simultaneous increase in spore hydration. It is therefore possible that sporicidal properties of CSA compounds (which are shown to be elevated at higher temperatures) result from CaDPA release, which is followed by eradication of the DPA-depleted spores and associated increases in sensitivity of the spores.

[0022] An example of a CSA compound is shown below as Formula I. As will be discussed in greater detail below, the R groups of Formula I can have a variety of different functionalities, thus providing a given ceragenin compound with specific, different properties. In addition, as will be appreciated by those of skill in the art, the sterol backbone can be formed of 5-member and/or 6-member rings, so that p, q, m, and n may independently be 1 (providing a 6-member ring) or 0 (providing a 5-member ring).

A number of examples of CSA compounds of Formula I that can be incorporated into the medical devices described herein are illustrated in Figures 2A-2C.

[0023] Typically, the CSAs of Formula I are of two types: (1) CSA compounds having cationic groups linked to the sterol backbone with hydrolysable linkages and (2) CSA compounds having cationic groups linked to the sterol backbone with non-hydrolysable linkages. For example, one type of hydrolysable linkage is an ester linkage, and one type of non- hydrolysable linkage is an ether linkage. CSA compounds of the first type can be "inactivated" by hydrolysis of the linkages coupling the cationic groups to the sterol backbone, whereas CSA compounds of the second type are more resistant to degradation and inactivation.

[0024] In some applications, it may be desirable for a sporicidal composition to maintain sporicidal effects for as long as possible. In other applications, the spreading of CSA molecules beyond the application site may be a concern. Some embodiments can be formed using an appropriate mixture of CSAs having hydrolysable and non-hydrolysable linkages to provide desired duration of CSA activity once the CSAs are exposed to hydrolyzing conditions (e.g., once eaten by a consumer of a treated food product).

[0025] A number of examples of compounds of Formula I that may be used in the embodiments described herein are illustrated in Figures 2A-2C. Examples of CSA compounds with non-hydrolysable linkages include, but are not limited to, CSA-1, CSA-26, CSA-38, CSA- 40, CSA-46, CSA-48, CSA-53, CSA-55, CSA-57, CSA-60, CSA-90, CSA-107, CSA-109, CSA- 110, CSA-112, CSA-113, CSA-118, CSA-124, CSA-130, CSA-131, CSA-139, CSA-190, CSA- 191 and CSA-192. Suitable examples of CSA compounds with hydrolysable linkages include, but are not limited to CSA-27, CSA-28, CSA-29, CSA-30, CSA-31, CSA-32, CSA-33, CSA-34, CSA-35, CSA-36, CSA-37, CSA-41, CSA-42, CSA-43, CSA-44, CSA-45, CSA-47, CSA-49, CSA-50, CSA-51, CSA-52, CSA-56, CSA-61, CSA-141, CSA-142, CSA-144, CSA-145 and CSA-146. In a presently preferred embodiment, at least a portion of the CSA compounds incorporated into the sporicidal composition are CSA-13.

[0026] In Formula I, at least two of R3, R7, or R12 may independently include a cationic moiety attached to the Formula I structure via a hydrolysable (e.g., an ester) or non-hydrolizable (e.g., an ether) linkage. Optionally, a tail moiety may be attached to Formula I at Ris. The tail moiety may be charged, uncharged, polar, non-polar, hydrophobic, or amphipathic, for example, and can thereby be selected to adjust the properties of the CSA and/or to provide desired characteristics.

[0027] The sporicidal activity of the CSA molecules can be affected by the orientation of the substituent groups attached to the backbone structure. In one embodiment, the substituent groups attached to the backbone structure are oriented on a single face of the CSA moleule. Accordingly, each of R3, R7, and R12 may be positioned on a single face of Formula I. In addition, Ris may also be positioned on the same single face of Formula I.

II. Compositions And Methods Utilizing CSA Compounds

[0028] Some embodiments are directed to compositions and methods for killing or deactivating bacterial spores on one or more objects. In some embodiments, a method includes (1) applying a sporicidal composition having one or more CSA compounds to an object that has or may have bacterial spores, and (2) the sporicidal composition killing or deactivating one or more bacterial spores contacting the sporicidal composition. The object treated can be surfaces, spaces, or regions of confined air of a building, hospital, air duct, restaurant, food preparation facility, school, office, or a medical device.

[0029] At least some of the sporicidal compositions disclosed herein are safe and non-toxic to humans and animals. In particular, the one or more CSA compounds included the disclosed sporicidal compositions are safe and non-toxic relative to the harsh sporicidal agents typically utilized to kill bacterial spores, including agents such as acids and oxidizers. Certain sporicidal compositions described herein may therefore be provided in a non-acidic form and/or in a form that does not rely on oxidation to kill or deactivate bacterial spores.

[0030] Further, certain CSA-containing sporicidal compositions may beneficially be utilized to treat food products with relatively minimal chemical disruption of the food product (e.g., without oxidizing the food product and/or without causing proton donation to the food product molecules). In some embodiments, the sporicidal composition is non-oxidizing. In some embodiments, the sporicidal composition has a pH of between about 6 and 8, or between about 6.5 and 7.5, or a pH of about 7.

[0031] In some embodiments, a sporicidal composition is utilized to prophylactically treat, prevent, or reduce infection(s) that may result from contact with a bacterial spore. For example, the sporicidal composition may be utilized in a healthcare facility (such as a doctor's office, hospital, nursing home, etc.) to sanitize surfaces, bedding, clothing, medical devices (e.g., colonoscopes, catheters, feeding tubes, I-V lines, medical implants, specula, dental tools, and the like) and/or other objects by killing or deactivating bacterial spores which may be present. Such a sporicidal composition can function to prevent transmission of bacterial spores from a contaminated object or surface to an individual, thereby preventing or reducing the occurrence of spore-related bacterial infections.

[0032] In some embodiments, a sporicidal composition is utilized to reduce, prevent, or eliminate food spoilage resulting from contamination of food with bacterial spores. For example, the sporicidal composition may be applied to and/or mixed within a food product to extend the shelf life of the food product. Such a sporicidal composition can function to prevent or reduce the occurrence of bacterial spores germinating at or within the food product and spoiling the food product. A sporicidal composition may be applied to and/or mixed with any suitable food product, including produce, bread, cereal, meat, dairy products, processed foods, liquid foods (juice, milk), and the like.

[0033] In certain embodiments, a CSA-containing sporicidal composition is utilized to prevent or reduce food-borne illness(es). When applied to and/or mixed with a food product, the sporicidal composition may kill or deactivate spores associated with a food-borne illness. For example, the sporicidal composition may be utilized to kill or deactivate spores associated with C. Botulinum, C. perfringens, B. cereus, B. subtilis, B. licheniformis, and other spores capable of causing a food-borne illness.

[0034] By way of further example, a CSA-containing sporicidal composition may be used to treat drinking water. Killing and/or deactivating spores within drinking water can beneficially prevent or reduce pathological and public health effects associated with spore-contaminated drinking water.

[0035] In certain embodiments, a CSA-containing sporicidal composition is utilized to treat a subject (e.g., a human or animal) for one or more diseases associated with spore-forming bacteria. For example, a sporicidal composition may be administered to a subject suffering from or at risk of suffering from a C. difficile infection. It will be understood that such treatment may be done as part of treating a diagnosed disease, or as part of a prophylactic regimen intended to prophylactically treat (or prevent) occurrence of the disease. C. difficile infections often arise as a result of antibiotic treatment, which often eliminates bacterial competition in the intestines and allows C. difficile spores to germinate and outgrow relatively unchecked. In one example, therefore, a CSA-containing sporicidal composition may be combined with typical antibiotics or may be administered in conjunction with typical antibiotics to reduce the risk of a resulting spore associated infection.

[0036] In embodiments in which a sporicidal composition is administered to a subject to therapeutically or prophylactically treat or prevent an infection associated with spore-forming bacteria, the sporicidal composition may include a pharmaceutically acceptable carrier, such as a solvent, saline solution, emulsion, suspension, syrup, excipient, dispersion and suspension media, lubricant, stabilizer, thickening agent, tablet, capsule, microbead, powder, granule, crystal, and/or viscosity enhancer. The sporicidal composition may be administered according to particular treatment needs. For example, the sporicidal composition may be administered orally, rectally, intravenously, topically, nasally, parenterally, and/or through other suitable administration routes.

[0037] In some embodiments, a CSA-containing sporicidal composition is utilized to deactivate a dangerous substance or agent. For example, the sporicidal composition may be applied to a composition known or suspected as harboring dangerous bacterial spores, such as spores of the bacterium Bacillus anthracis. Such hazardous spores, or substances known or suspected as harboring such spores, may beneficially be deactivated or made less potent through the application of a CSA-containing sporicidal composition.

[0038] In some embodiments, a sporicidal composition is utilized to sterilize industrial equipment, such as pipes, containers, tanks, reactors, surfaces, and the like. In industrial food processing, for example, bacterial spores are often attracted to surfaces of pipes, tanks, and other equipment, where they can multiply and resporulate, leading to contamination of contacted food processed with the equipment. In some circumstances, typical treatments such as pasteurization are insufficient to kill bacterial spores and instead work to eliminate competition from other vegetative bacteria.

[0039] In some embodiments, a sporicidal composition as described herein kills or deactivates bacterial spores without requiring the addition of heat (e.g., without requiring autoclaving, ultrahigh-temperature (UHT) processing, or other such treatments). In other embodiments, heat may be utilized in conjunction with application of a sporicidal composition having CSAs. Beneficially, use of CSA-containing sporicidal compositions in combination with heat treatment may achieve a given level of spore killing/deactivation at temperatures lower than if heat treatment alone is used. In other words, a CSA-containing sporicidal composition may be utilized to augment a heat treatment process to achieve higher sporicidal activity and/or to achieve similar sporicidal activity at lower required temperatures.

[0040] Similarly, some embodiments may include the use of an acid, oxidizing agent, gamma radiation, or other sporicidal treatment in combination with use of a CSA-containing sporicidal composition. In such implementations, the CSA-containing sporicidal composition may be utilized to augment the sporicidal treatment to achieve higher sporicidal activity and/or to achieve similar sporicidal activity with lower levels of treatment acid, oxidizer, or radiation, for example.

[0041] In some embodiments, the one or more CSA compounds are included by weight in the sporicidal composition at about 0.1%, 0.5%, 1%, 3%, 5%, 10%, 15%, 20%, 25%, or 30% or are included by weight within a range defined by any two of the foregoing percentage values. In some embodiments, the one or more CSA compounds are included at a concentration of about 1 μg/ml, 5 μg/ml, 10 μg/ml, 25 μg/ml, 50 μg/ml, 100 μg/ml, 150 μg/ml, or 200 μg/ml, or are included at a concentration within a range defined by any two of the foregoing concentration values.

[0042] As explained above, when use of a CSA-containing sporicidal composition is combined with another sporicidal treatment, such as heat treatment, the amount or concentration of CSAs can be lowered while still providing the same sporicidal effect. Thus, in some implementations, the concentration of the CSA molecules is provided according to a sliding scale based on the temperature and/or based on the intensity of the other coinciding sporicidal treatment.

[0043] For example, for applications in which the sporicidal composition is utilized at about room temperature, the one or more CSA compounds may be provided at a concentration of about 10 μg/ml to about 200 μg/ml, or about 50 μg/ml to about 150 μg/ml, or about 100 μg/ml. For applications in which the sporicidal composition is utilized at about 70°C, the one or more CSA compounds may be provided at a concentration of about 1 μg/ml to about 40 μg/ml, or about 10 μg/ml to about 30 μg/ml, or about 20 μg/ml. At different temperatures, the one or more CSA compounds may be provided at concentrations determined by interpolating or extrapolating based on the foregoing values. For example, because a temperature of about 45°C is about half way between room temperature (RT) and 70°C, the one or more CSA compounds may be provided at a concentration of about 40 μg/ml to about 80 μg/ml, or about 60 μg/ml.

[0044] It will be understood that in the foregoing examples, the upper concentration endpoints do not necessarily represent a lack of effectiveness at CSA concentrations beyond the upper endpoints. Rather, the upper range endpoints define ranges for which effective sporicidal activity may be achieved without the need for additional CSA compounds, thereby making efficient use of CSA compounds and associated formulation costs. In some implementations, such as where cost efficiency is less important than ensuring sporicidal activity, the one or more CSA compounds may be included at concentrations higher than the foregoing ranges.

[0045] Sporicidal compositions may include a suitable carrier in combination with the one or more CSA compounds. Suitable carriers may include, for example, water, saline, detergent solutions, liposome solutions, alcohols, oils, organic solvents, organic/aqueous emulsions, and combinations thereof. Sporicidal compositions may be formulated as liquid solutions, gels, pastes, foams, dry powders, washes, or other suitable form according to particular application needs.

III. Examples

Example 1

[0046] This example studied the ability of a CSA compound (e.g., CSA-13) to kill sporulated bacterial, namely Bacillus subtilis ATCC 6051 spores. To prepare Bacillus subtilis ATCC 6051 spores, bacteria were grown on LB (Luria-Bertani) agar plates without antibiotics at 37°C for 72 h. Bacteria were harvested, re-suspended in ice-cold phosphate buffered saline (PBS) solution and purified by triple centrifugation (12 000 x g, 10 min, 4°C). The spore suspension was heat treated (75°C, 15 min) to remove remaining vegetative cells, cooled, stored in water at 4°C and protected from light until analysis. Previous studies confirmed that heat activation with subsequent cooling does not significantly affect the properties of spores and their resistance to external factors. Zhang, P., P. Setlow, and Y. Li, Characterization of single heat- activated Bacillus spores using laser tweezers Raman spectroscopy. Opt Express, 2009. 17(19): p. 16480-91. All spores used in this work were free of vegetative cells (>98%), as determined by staining cells using Schaeffer and Fulton Spore Stain Kit (Sigma-Aldrich, St Louis, MO, USA). Additionally, to confirm the formation of spores during preparation, purified samples were investigated using transmission electron microscopy (TEM, Tecnai G2 X-TWIN, FEI, USA).

[0047] As can be seen in Figure 3, TEM micrographs confirmed the presence of B. subtilis spores with characteristic spore-exclusive structures (Figure 3, panel B). As shown in Figure 3, disruption of spore membrane architecture us shown after treatment with 50 μg/mL of CSA-13 at RT (panel C), and at 70°C (panel D), and 200 μg/mL of CSA-13 at RT (panel E), and at 70°C (panel F). Arrows indicate changes in membrane structure upon treatment with CSA-13.

Example 2 [0048] A viability assay of bacterial spores in the presence of a CSA compound was performed according to the protocol presented by Ghosh and Setlow. Ghosh, S. and P. Setlow, Isolation and characterization of superdormant spores of Bacillus species. J Bacteriol, 2009. 191(6): p. 1787-97. Spore suspensions in PBS were brought to 108 CFU/mL and incubated with various concentrations of CSA-13. To evaluate the effect of treatment time on the killing properties of the antibiotic, incubation was performed for 15, 30, 60, 120 and 240 min, respectively. To investigate the effect of temperature on sporicidal properties, incubation at room temperature (RT) and at 70°C was performed. After incubation, the plates were transferred to ice and suspensions were diluted 10- to 1000-fold in PBS. Then, 10 μΐ ^ aliquots were spotted on LB agar plates for overnight culture at 37°C and CFUs were determined. Cell survival, after exposure to the tested agent, was expressed as percent of control.

[0049] Figure 4 includes graphs showing decreased survival of CSA- 13 -treated B. subtilis spores. Figure 4, panels A-C show decline in the survival of B. subtilis culture after incubation with various concentrations of CSA-13. Figure 4, panels D-F show Leve of metabolic activity observed in ceragenin (CSA)-treated spore samples exposed to appropriate environmental conditions when compared to untreated control. Samples were incubated at RT (panels A, D for vegetative form and panels B, E for spore form, respectively) and at 70°C (panels C, F) for 15 (white squares), 30 (grey circles), 60 (black circles), 120 (white triangles) and 240 (grey diamonds) minutes. The data was generated from experiments performed in triplicate.

[0050] As shown in Figure 4, panel A, CSA-13 exerts high antibacterial activity against the vegetative form of B. subtilis at concentrations ranging from 1 to 15 μg/mL. Simultaneously, incubation of CSA-13 with spore suspension results in total inhibition of their growth potential at 100 μg/mL, as presented in Figure 4, panel B. To assess whether the time of incubation significantly affects CSA-13 killing properties, incubation was extended to 4 h. Interestingly, the impact of incubation time was minimal; all vegetative cells were killed at a CSA-13 concentration of 15 μg/mL when incubation time reached 240 min. At the end point of the experiment, similar effects for spore cultures of bacteria were observed. Regardless of the incubation time, the dose of 100 μg/mL was shown to inhibit spore growth.

[0051] To assess the impact of higher temperature on spore viability, we performed additional incubations of spore suspensions with CSA-13 at 70°C. Spore survival after this treatment is shown in Figure 4, panel C. It was confirmed that elevated temperature significantly intensifies the activity of CSA-13. In contrast to samples treated at room temperature, time- and dose-dependent effects during incubation in higher temperature were observed. Incubation lasting 15 min was sufficient to inhibit the growth of spores at a CSA-13 concentration of 20 μ§/ηιί.. Extension of incubation time to 120 and 240 minutes allowed the killing of bacterial spores at 5 μg/mL of CSA-13. At the same time, detection of metabolic activity in treated samples confirms low level of spores which were able to germinate in the presence of antibiotic.

Example 3

[0052] As an additional confirmation of results, the presence of a metabolically active fraction of cells was investigated using MTT assay. After incubation of spores with various concentrations of CSA-13 in a non-growing medium (PBS), 20 μΐ. of MTT solution (thiazolyl blue tetrazolium bromide, Sigma-Aldrich, St Louis, MO, USA, 5 mg/mL) and 100 μΐ. of LB medium broth were added. Incubation at 37°C was continued for 8 h. Medium was removed, and 100 μΕ of dimethyl sulfoxide solution (DMSO) was added to dissolve the MTT precipitate. Cells were allowed to stand at room temperature (RT) for 10 min with shaking. Absorbance values were detected at a wavelength of 570 nm using a microplate spectrophotometer. Absorbance values obtained in control spores cultures (without a tested agent) were taken as 100%. As positive controls, 1 M HC1 (for spore treatment at RT) and 70% ethanol (for spore treatment at 70°C) were employed. The average of all the experiments was presented in comparison to the level of metabolic activity detected in non-treated B. subtilis suspension. Incubation of both vegetative cells and spores of B. subtilis was performed for 15, 30, 60, 120 and 240 min.

[0053] The results of viability testing largely correlate with data obtained in the MTT assay. It has been established that dormant spores of Bacillus species exhibit low metabolism due to poor enzyme activity in the spore core and produce low levels of compounds such as NADH or ATP. However, the reactivation of spores and their return to vegetative metabolism, when the environmental conditions are suitable, is usually possible. The incubation of non-treated spores in LB broth at 37°C results in reactivation of metabolic activity confirmed by increasing formazan reduction and subsequent rise in an absorbance value. Considering this fact, an additional test, allowing for detection of any metabolic activity in CSA-13 -treated samples, was performed.

[0054] According to collected data, in samples treated with corresponding doses of CSA-13, almost no metabolic activity was present. Vegetative cells showed no detectable metabolism when subjected to incubation with CSA-13 at 20 μg/mL, which indicates strong antimicrobial activity of this agent against vegetative form of bacteria (Figure 4, panel D). Importantly, only a small fraction of spores was able to resume proper metabolic activity after exposure to favorable environmental conditions (Figures 4, panel E, and 4, panel F). These results show that CSA-13 strongly interferes the germination of B. subtilis spores. Example 4

[0055] To further assess germination processes in antibiotic-treated samples, a spectrophotometric method was employed. Isolated spores were incubated at RT for 1 h in PBS with concentrations of CSA-13 ranging from 10 to 100 μg/mL. Then 100 μΙ_, of LB broth was added, and optical densities at 600 nm (OD 6 oo) were monitored, using a microplate reader (Synergy HI, BioTek, VT, USA), for 60 min.

[0056] Figure 5 includes graphs showing inhibitory effect of CSA-13 on B. subtilis spore germination assessed by the measurement of optical density for spore suspension with increasing concentrations of the antibiotic (10 μg/mL - white squares; 20 μg/mL - white diamonds; 50 μg/mL - black triangles; 100 μg/mL - black diamonds), when compared with control (CT - grey circles) (panel A). Release of rhodamine 6G from external layers of B. subtilis spores after treatment with 20 μg/ml of CSA-13 (black square) and vancomycin (VAN; grey square) (panel B).

[0057] CSA-13 's strong interference in the germination of B. subtilis spores was shown by measurement of optical density at 600 nm (OD600). The dose-dependent effects of CSA-13 on OD600 are shown in Figure 5, panel A.

Example 5

[0058] The release of rhodamine 6G absorbed on the surface of Bacillus spores was evaluated using the Maesaki method (Maesaki, S., et al., Rhodamine 6G efflux for the detection of CDR1 -over expressing azole-resistant Candida albicans strains. J Antimicrob Chemother, 1999. 44(1): p. 27-31) with minor modifications. To stain cells with rhodamine 6G, the dye was added to a final concentration of 10 μΜ for 10 min. Non-absorbed dye was removed by centrifugation for 2 min at 10 000 x g. Next, stained cells were washed and CSA-13 at 20 μg/mL was added. After incubation for 10, 30, 60 and 120 min, supernatant was collected by centrifugation and absorption at 527 nm was measured. The total concentration of rhodamine 6G released from the surface of spores was calculated using a standard concentration curve. The level of antibiotic-induced release was presented as the difference between the concentration of rhodamine 6G released from treated spores and control samples.

[0059] As shown in Figure 5, panel B, treatment with CSA-13 at a dose of 20 μg/mL resulted in the release of dye, which strongly suggests the existence of a ceragenin-spore surface interactions. Notably, this effect was significantly higher than that of vancomycin. An additional assay employing FITC-labeled CSA-13 confirmed that CSA-13 exerts high affinity for the external layers of B. subtilis spores. Example 6

[0060] To assess the affinity /binding of CSA-13 for the outer bacterial membrane, CSA-13 was labeled with fluorescein isothiocyanate (FITC) and added to the suspensions of vegetative cell and spores, to a final concentration of 20 μg/mL. The affinity of CSA-13 to cell membranes was assessed using fluorimetric measurement (Synergy HI, BioTek, VT, USA) with excitation/emission wavelengths of 298/534 nm recorded for 15 min. To evaluate whether affinity of CSA-13 is influenced by the surface electrical properties of cells, zeta potentials of vegetative bacteria and spore suspensions were assessed using Zetasizer Nano ZS (Malvern Instruments, United Kingdom). Bacterial and spore cultures were brought to OD 6 oo - 0.1 in PBS buffer (pH=7). To evaluate the effect of the ceragenin on zeta potential value, CSA-13 was added at the concentration of 100 μg/mL to the spore suspension, incubated for 15 minutes and transferred to a cuvette. Measurements were conducted at 25°C.

[0061] Figure 6, panel A, is a graph showing affinity of FITC-labeled CSA-13 to membrane of vegetative and spore form of B. subtilis. Figure 6, panel B, shows changes in zeta potential values of ceragenin-treated vegetative and spore of B. subtilis. Interestingly, CSA-13 possessed greater affinity for the spores than for the vegetative form of bacteria (Figure 6, panel A). To investigate the cause of this effect, the zeta-potential of B. subtilis in vegetative and spore forms was measured (Figure 6, panel B). It was confirmed that spores possess more negative surface charge (-26 mV) than vegetative cells (-21 mV), which is the most likely cause of the differences in interactions with positively charged molecules such as CSA-13. Additionally, incubation of samples with 100 μg/mL CSA-13 led to a decrease in the absolute value of the observed zeta-potential (-11 mV).

Example 7

[0062] To visualize alterations in morphology and membrane permeability of treated spores, a suspension of spores (OD 6 oo ~ 0.5) in distilled water was treated with CSA-13 at concentrations of 50 μg/mL and 200 μg/mL and incubated for 1 hour at RT and 70°C. TEM Micrographs of treated spores were made using Tecnai G2 X-TWIN (FEI, Oregon, USA).

[0063] Resulting micrographs clearly illustrate that CSA-13 affects spore structure (Figure 3, panels C-F). Both local and extensive changes in the integrity of external layers of spore lead to alternations within the spore core, which suggests that CSA-13 not only affects the structure of the spore coat but also increases the permeability of the outer and inner spore membranes. In particular, the ability of CSA-13 to bypass the impermeability of spore's inner membrane is considered as vital for the action of this agent, considering that maintained integrity of this layer plays a crucial role in the development of spore resistance to many chemicals. Additionally, considerable alternations in the structure of DNA-consi sting spore core suggest that CSA-13 treatment might also cause DNA damage or change of its condensation resulting in cell death.

Example 8

[0064] For Raman spectroscopy analyses, spores of B. subtilis were suspended in 100 μΙ_, of distilled water and treated with CSA-13 (50 μg/mL and 200 μg/mL) for 1 hour at RT and 70°C. Samples were transferred to polished calcium fluoride (CaF 2 ) optical windows (Crystran, United Kingdom) and dried at 60°C. Raman spectra were recorded using a Renishaw In Via Raman spectrometer equipped with an optical confocal microscope, an air-cooled laser emitting at 532 nm, and an CCD detector thermoelectrically cooled to -70°C. A dry Leica N PLAN EPI (lOOx, NA 0.85) objective was used. The power of the laser at the sample position was ca. 1.5 mW. A sum of 20 scans with integration time of 20 seconds and a resolution of 0.5 cm "1 was collected. The spectrometer was calibrated using the Raman scattering line generated by an internal silicon plate. A laser spot (diameter of ca. 760 nm) was focused on a single spore and then the measurement was performed. All spectra were smoothed and baseline corrected. Results from one representative experiment are provided.

[0065] DPA is considered to be one the key factors determining the resistance of B. subtilis spores to UV radiation and desiccation and as one of the molecules involved in the protection of DNA from damage. Additionally, the release of this molecule occurs during killing of spores by wet heat and is preceded by an increase in inner membrane permeability. Confocal Raman spectroscopy was used for analysis of changes in the chemical composition of spores upon treatment with CSA-13

[0066] Figures 7 and 8 show Raman spectra collected from B. subtilis spores incubated at RT and at 70°C, respectively, with corresponding confocal microscopy images. Panels Al and A2 - control sample, panels Bl and B2 - 50 μg/mL of CSA-13, panels CI and C2 - 200 μg/mL of CSA-13. Asterisks denote CaDPA bands well separated from bands of spore biocomponents. Blue color indicates CaDPA negative spore, while red color indicates CaDPA positive spores. Spectra were normalized to the 1002 cm "1 band.

[0067] DPA forms a complex with divalent ions (mostly Ca 2+ ) and this complex exhibits characteristic bands in Raman spectra. The presence of these bands in spectra obtained from a single spore can be interpreted as high-CaDPA content cell (CaDPA positive), while their absence as low or undetectable CaDPA content cell (CaDPA negative). Following this approach, CSA-13 treated and untreated spores underwent spectroscopic evaluation. Based on Raman spectra it was shown that incubation of spores with the ceragenin resulted in a significant reduction of the number of CaDPA positive cells, while almost all untreated cells contained this complex. When treatment was conducted at 70°C, the percentage of CaDPA negative spores was greater compared to sample treated at room temperature (Figure 8). This effect correlates with observed increase of CSA-13 sporicidal activity at 70°C. IV. Additional Details of CSA Compounds

[0068] More specific examples of CSA compounds according to Formula I are shown below in Formulas II and III, wherein Formula III differs from Formula II by omitting R15 and the ring carbon to which it is attached. The R groups shown in the Formulae can have a variety of different structures. CSA compounds, and a variety of different R groups, useful in accordance with the present disclosure, are disclosed in U.S. Patent Nos. 6,350,738, 6,486,148, 6,767,904, 7,598,234, 7,754,705, 8 975,310, and 9,434,759, which are incorporated herein by reference.

[0069] In some embodiments of Formulas II and III, at least two of R 3 , R7, and R12 may independently include a cationic moiety (e.g., amino or guanidino groups) bonded to the steroid backbone structure via a non-hydrolysable or hydrolysable linkage. For the embodiments of the present disclosure, the linkage is preferably non-hydrolysable under conditions of sterilization and storage, and physiological conditions. Such cationic functional groups (e.g., amino or guanidino groups) may be separated from the backbone by at least one, two, three, four or more atoms.

[0070] Optionally, a tail moiety may be attached to the backbone structures at Ri 8 . The tail moiety may have variable chain length or size and may be charged, uncharged, polar, non-polar, hydrophobic, amphipathic, and the like. The tail moiety may, for example, be configured to alter the hydrophobicity/hydrophilicity of the ceragenin compound. CSA compounds of the present disclosure having different degrees of hydrophobicity/ hydrophilicity may, for example, have different rates of uptake into different target microbes.

[0071] The R groups described herein, unless specified otherwise, may be substituted or unsubstituted.

[0072] In some embodiments shown by Formulas II and III:

each of fused rings A, B, C, and D may be independently saturated, or may be fully or partially unsaturated, provided that at least two of A, B, C, and D is saturated, wherein rings A, B, C, and D form a ring system. Other ring systems can also be used, e.g., 5-member fused rings and/or compounds with backbones having a combination of 5- and 6-membered rings;

Ri through R 4 , R 6 , R7 , Rn , R12, R15, Ri6, and Ris are independently selected from the group consisting of hydrogen, hydroxyl, alkyl, hydroxyalkyl, alkyloxyalkyl, alkylcarboxyalkyl, alkylaminoalkyl, alkylaminoalkylamino, alkylaminoalkylamino-alkylamino, aminoalkyl, aryl, arylaminoalkyl, haloalkyl, alkenyl, alkynyl, oxo, a linking group attached to a second steroid, aminoalkyloxy, aminoalkyloxyalkyl, aminoalkylcarboxy, aminoalkylaminocarbonyl,aminoalkylcarboxamido, di(alkyl)aminoalkyl, H2N-HC(Q5)-C(0)-0-, H 2 N-HC(Q 5 )-C(0)-N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q 5 )-C(0)-0-, guanidinoalkyloxy, quaternary ammonium alkylcarboxy, and guanidinoalkyl carboxy, where Q5 is a side chain of any amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R5, R 8 , R9, Rio, Ri3, Ri4 and Ri 8 are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R 8 , R9, Rio, Ri3, and R14 are independently selected from the group consisting of hydrogen, hydroxyl, alkyl, hydroxyalkyl, alkyloxyalkyl, aminoalkyl, aryl, haloalkyl, alkenyl, alkynyl, oxo, a linking group attached to a second steroid, aminoalkyloxy, aminoalkylcarboxy, aminoalkylaminocarbonyl, di(alkyl)aminoalkyl, H 2 N-HC(Q 5 )-C(0)-0-, H 2 N-HC(Q 5 )-C(0)- N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)-0-, guanidinoalkyloxy, and guanidinoalkyl-carboxy, where Qs is a side chain of any amino acid, P.G. is an amino protecting group.

[0073] In some embodiments, at least one, and sometimes two or three of Ri-4, R 6 , R7, R11, R12, Ri5, Ri6, Ri7, and Ri 8 are independently selected from the group consisting of aminoalkyl, aminoalkyloxy, alkylcarboxyalkyl, alkylaminoalkylamino, alkylaminoalkyl-aminoalkylamino, aminoalkylcarboxy, arylaminoalkyl, aminoalkyloxyaminoalkylamino-carbonyl, aminoalkylaminocarbonyl, aminoalkyl-carboxyamido, a quaternary ammonium alkylcarboxy, di(alkyl)aminoalkyl, H 2 N-HC(Q 5 )-C(0)-0-, H 2 N-HC(Q 5 )-C(0)-N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q 5 )-C(0)-0-, guanidine-alkyloxy, and guanidinoalkylcarboxy.

[0074] In some embodiments, Ri through R 4 , R 6 , R7 , R11 , R12, R15, Ri6, and Ris are independently selected from the group consisting of hydrogen, hydroxyl, (C1-C22) alkyl, (Ci- C22) hydroxyalkyl, (C1-C22) alkyloxy-(Ci-C 2 2) alkyl, (C1-C22) alkylcarboxy-(Ci-C 2 2) alkyl, (Ci- C22) alkylamino-(Ci-C22) alkyl, (C1-C22) alkylamino-(Ci-C22) alkylamino, (C1-C22) alkylamino- (C1-C22) alkylamino- (C1-C22) alkylamino, (C1-C22) aminoalkyl, aryl, arylamino-(Ci-C22) alkyl, (C1-C22) haloalkyl, C2-C6 alkenyl, C2-C6 alkynyl, oxo, a linking group attached to a second steroid, (C1-C22) aminoalkyloxy, (C1-C22) aminoalkyloxy-(Ci-C22) alkyl, (C1-C22) aminoalkylcarboxy, (C1-C22) aminoalkylaminocarbonyl, (C1-C22) aminoalkyl-carboxamido, di(Ci-C 22 alkyl)aminoalkyl, H 2 N-HC(Q 5 )-C(0)-0-, H 2 N-HC(Q 5 )-C(0)-N(H)-, (C1-C22) azidoalkyloxy, (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q 5 )-C(0)-0-, (C1-C22) guanidinoalkyloxy, (C1-C22) quaternary ammonium alkylcarboxy, and (C1-C22) guanidinoalkyl carboxy, where Q5 is a side chain of an amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R5, R 8 , R9, Rio, Ri3, Ri4 and R17 are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R 8 , R9, Rio, Ri3, and R14 are independently selected from the group consisting of hydrogen, hydroxyl, (Ci- C22) alkyl, (C1-C22) hydroxyalkyl, (C1-C22) alkyloxy-(Ci-C22) alkyl, (C1-C22) aminoalkyl, aryl, (C1-C22) haloalkyl, (C2-C6) alkenyl, (C2-C6) alkynyl, oxo, a linking group attached to a second steroid, (C1-C22) aminoalkyloxy, (C1-C22) aminoalkylcarboxy, (C1-C22) aminoalkylaminocarbonyl, di(Ci-C 22 alkyl)aminoalkyl, H 2 N-HC(Q 5 )-C(0)-0-, H 2 N-HC(Q 5 )- C(0)-N(H)-, (C1-C22) azidoalkyloxy, (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Qs)-C(0)-0-, (Ci- C22) guanidinoalkyloxy, and (C1-C22) guanidinoalkylcarboxy, where Q5 is a side chain of any amino acid, and P.G. is an amino protecting group;

provided that at least two or three of Ri-4, R 6 , R7 , R11, R12, R15, Ri6, Rn, and Ri 8 are independently selected from the group consisting of (C1-C22) aminoalkyl, (C1-C22) aminoalkyloxy, (C1-C22) alkylcarboxy-(Ci-C22) alkyl, (C1-C22) alkylamino-(Ci-C22) alkylamino, (C1-C22) alkylamino-(Ci-C22) alkylamino (C1-C22) alkylamino, (C1-C22) aminoalkylcarboxy, arylamino (C1-C22) alkyl, (C1-C22) aminoalkyloxy (C1-C22) aminoalkylaminocarbonyl, (C1-C22) aminoalkylaminocarbonyl, (C1-C22) aminoalkylcarboxyamido, (C1-C22) quaternary ammonium alkylcarboxy, di(Ci-C 22 alkyl)aminoalkyl, H 2 N-HC(Q 5 )-C(0)-0-, H 2 N-HC(Q 5 )-C(0)-N(H)-, (C1-C22) azidoalkyloxy, (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q 5 )-C(0)-0-, (C1-C22) guanidinoalkyloxy, and (C1-C22) guanidinoalkylcarboxy.

[0075] In some embodiments, Ri through R 4 , R 6 , R7 , R11 , R12, R15, Ri6, and Ris are independently selected from the group consisting of hydrogen, hydroxyl, (Ci-Cis) alkyl, (Ci- Ci 8 ) hydroxyalkyl, (Ci-Cis) alkyloxy-(Ci-Ci 8 ) alkyl, (Ci-Ci 8 ) alkylcarboxy-(Ci-Ci 8 ) alkyl, (Ci- Ci 8 ) alkylamino-(Ci-Ci 8 )alkyl, (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 ) alkylamino, (Ci-Ci 8 ) alkylamino- (Ci-Ci 8 ) alkylamino- (Ci-Ci 8 ) alkylamino, (Ci-Ci 8 ) aminoalkyl, aryl, arylamino-(Ci-Ci 8 ) alkyl, oxo, (Ci-Ci 8 ) aminoalkyloxy, (Ci-Ci 8 ) aminoalkyloxy-(Ci-Ci 8 ) alkyl, (Ci-Ci 8 ) aminoalkylcarboxy, (Ci-Ci 8 ) aminoalkylaminocarbonyl, (Ci-Ci 8 ) aminoalkyl-carboxamido, di(Ci-Ci 8 alkyl)aminoalkyl, (Ci-Ci 8 ) guanidinoalkyloxy, (Ci-Ci 8 ) quaternary ammonium alkylcarboxy, and (Ci-Ci 8 ) guanidinoalkyl carboxy; and

R5, R 8 , R9, Rio, Ri3, Ri4 and R17 are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R 8 , R9, Rio, Ri3, and R14 are independently selected from the group consisting of hydrogen, hydroxyl, (Ci- Ci 8 ) alkyl, (Ci-Ci 8 ) hydroxyalkyl, (Ci-Ci 8 ) alkyloxy-(Ci-Ci 8 ) alkyl, (Ci-Ci 8 ) alkylcarboxy-(Ci- Ci 8 ) alkyl, (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 )alkyl, (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 ) alkylamino, (Ci- Ci 8 ) alkylamino-(Ci-Ci 8 ) alkylamino- (Ci-Ci 8 ) alkylamino, (Ci-Ci 8 ) aminoalkyl, aryl, arylamino-(Ci-Ci 8 ) alkyl, oxo, (Ci-Ci 8 ) aminoalkyloxy, (Ci-Ci 8 ) aminoalkyloxy-(Ci-Ci 8 ) alkyl, (Ci-Ci 8 ) aminoalkylcarboxy, (Ci-Ci 8 ) aminoalkylaminocarbonyl, (Ci-Ci 8 ) aminoalkylcarboxamido, di(Ci-Ci 8 alkyl)aminoalkyl, (Ci-Ci 8 ) guanidinoalkyloxy, (Ci-Ci 8 ) quaternary ammonium alkylcarboxy, and (Ci-Ci 8 ) guanidinoalkyl carboxy,

provided that at least two or three of R1-4, R 6 , R7 , R11, R12, R15, Ri6, Rn, and Ri 8 are independently selected from the group consisting of of hydrogen, hydroxyl, an unsubstituted (Ci-Ci 8 ) alkyl, unsubstituted (Ci-Ci 8 ) hydroxyalkyl, unsubstituted (Ci-Ci 8 ) alkyloxy-(Ci-Ci 8 ) alkyl, unsubstituted (Ci-Ci 8 ) alkylcarboxy-(Ci-Ci 8 ) alkyl, unsubstituted (Ci-Ci 8 ) alkylamino- (Ci-Ci 8 )alkyl, unsubstituted (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 ) alkylamino, unsubstituted (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 ) alkylamino- (Ci-Ci 8 ) alkylamino, an unsubstituted (Ci-Ci 8 ) aminoalkyl, an unsubstituted aryl, an unsubstituted arylamino-(Ci-Ci 8 ) alkyl, oxo, an unsubstituted (Ci-Ci 8 ) aminoalkyloxy, an unsubstituted (Ci-Ci 8 ) aminoalkyloxy-(Ci-Ci 8 ) alkyl, an unsubstituted (Ci- Ci 8 ) aminoalkylcarboxy, an unsubstituted (Ci-Ci 8 ) aminoalkylaminocarbonyl, an unsubstituted (Ci-Ci 8 ) aminoalkylcarboxamido, an unsubstituted di(Ci-Ci 8 alkyl)aminoalkyl, unsubstituted (Ci-Ci 8 ) guanidinoalkyloxy, unsubstituted (Ci-Ci 8 ) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci 8 ) guanidinoalkyl carboxy.

[0076] In some embodiments, R 3 , RJ, R12, and Ri 8 are independently selected from the group consisting of hydrogen, an unsubstituted (Ci-Ci 8 ) alkyl, unsubstituted (Ci-Ci 8 ) hydroxyalkyl, unsubstituted (Ci-Ci 8 ) alkyloxy-(Ci-Ci 8 ) alkyl, unsubstituted (Ci-Ci 8 ) alkylcarboxy-(Ci-Ci 8 ) alkyl, unsubstituted (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 )alkyl, unsubstituted (Ci-Ci 8 ) alkylamino-(Ci- Ci 8 ) alkylamino, unsubstituted (Ci-Ci 8 ) alkylamino-(Ci-Ci 8 ) alkylamino- (Ci-Ci 8 ) alkylamino, an unsubstituted (Ci-Ci 8 ) aminoalkyl, an unsubstituted arylamino-(Ci-Ci 8 ) alkyl, an unsubstituted (Ci-Ci 8 ) aminoalkyloxy, an unsubstituted (Ci-Ci 8 ) aminoalkyloxy-(Ci-Ci 8 ) alkyl, an unsubstituted (Ci-Ci 8 ) aminoalkylcarboxy, an unsubstituted (Ci-Ci 8 ) aminoalkylaminocarbonyl, an unsubstituted (Ci-Ci 8 ) aminoalkylcarboxamido, an unsubstituted di(Ci-Ci 8 alkyl)aminoalkyl, unsubstituted (Ci-Ci 8 ) guanidinoalkyloxy, unsubstituted (Ci-Ci 8 ) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci 8 ) guanidinoalkyl carboxy.

[0077] In some embodiments, Ri, R2, R4, R5, R 6 , R 8 , R9, Rio, R11, Ri 3 , R14, R15, Ri6, and R17 are independently selected from the group consisting of hydrogen and unsubstituted (Ci-C 6 ) alkyl.

[0078] In some embodiments, R 3 , R7, R12, and Ri 8 are independently selected from the group consisting of hydrogen, an unsubstituted (Ci-C 6 ) alkyl, unsubstituted (Ci-C 6 ) hydroxyalkyl, unsubstituted (C1-C16) alkyloxy-(Ci-Cs) alkyl, unsubstituted (C1-C16) alkylcarboxy-(Ci-Cs) alkyl, unsubstituted (C1-C16) alkylamino-(Ci-C5)alkyl, (C1-C16) alkylamino-(Ci-C5) alkylamino, unsubstituted (C1-C16) alkylamino-(Ci-Ci6) alkylamino-(Ci-C5) alkylamino, an unsubstituted (C1-C16) aminoalkyl, an unsubstituted arylamino-(Ci-C5) alkyl, an unsubstituted (C1-C5) aminoalkyloxy, an unsubstituted (C1-C16) aminoalkyloxy-(Ci-C5) alkyl, an unsubstituted (C1-C5) aminoalkylcarboxy, an unsubstituted (C1-C5) aminoalkylaminocarbonyl, an unsubstituted (Ci- C5) aminoalkylcarboxamido, an unsubstituted di(Ci-Cs alkyl)amino-(Ci-C5) alkyl, unsubstituted (C1-C5) guanidinoalkyloxy, unsubstituted (C1-C16) quaternary ammonium alkylcarboxy, and unsubstituted (C1-C16) guanidinoalkylcarboxy.

[0079] In some embodiments, Ri, R2, R4, R5, R 6 , R 8 , Rio, R11, R14, Ri6, and R17 are each hydrogen; and R9 and Ri 3 are each methyl. [0080] In some embodiments, R3, R7, R12, and Ris are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkylcarboxyalkyl; and hydroxyalkyl.

[0081] In some embodiments, R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy; and Ris is selected from the group consisting of alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonyloxyalkyl; di(alkyl)aminoalkyl; alkylaminoalkyl; alkyoxycarbonylalkyl; alkylcarboxyalkyl; and hydroxyalkyl.

[0082] In some embodiments, R3, R7, and R12 are the same.

[0083] In some embodiments, R3, R7, and R12 are aminoalkyloxy.

[0084] In some embodiments, Ris is alkylaminoalkyl.

[0085] In some embodiments, Ris is alkoxycarbonylalkyl.

[0086] In some embodiments, Ris is di(alkyl)aminoalkyl.

[0087] In some embodiments, Ris is alkylcarboxyalkyl.

[0088] In some embodiments, Ris is hydroxyalkyl.

[0089] In some embodiments, R3, R7, and R12 are aminoalkylcarboxy.

[0090] In some embodiments, R3, R7, R12, and Ris are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; di-(alkyl)aminoalkyl; alkoxycarbonylalkyl; and alkylcarboxyalkyl.

[0091] In some embodiments, R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy, and wherein Ris is selected from the group consisting of alkylaminoalkyl; di-(alkyl)aminoalkyl; alkoxycarbonylalkyl; and alkylcarboxyalkyl .

[0092] In some embodiments, R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy, and wherein Ris is selected from the group consisting of alkylaminoalkyl; di-(alkyl)aminoalkyl; and alkoxycarbonylalkyl.

[0093] In some embodiments, R3, R7, R12, and Ris are independently selected from the group consisting of amino-C3-alkyloxy; amino-C3-alkyl-carboxy; Cs-alkylamino-Cs-alkyl; C12- alkylamino-C5-alkyl; Cn-alkylamino-Cs-alkyl; Ci6-alkylamino-C5-alkyl; di-(C5-alkyl)amino-Cs- alkyl; C6-alkoxy-carbonyl-C4-alkyl; C8-alkoxy-carbonyl-C4-alkyl; Cio-alkoxy-carbonyl-C4- alkyl; C6-alkyl-carboxy-C4-alkyl; C8-alkyl-carboxy-C4-alkyl; and Cio-alkyl-carboxy-C4-alkyl.

[0094] In some embodiments, R3, R7, R12, and Ris are independently selected from the group consisting of amino-C3-alkyloxy; amino-C3-alkyl-carboxy; Cs-alkylamino-Cs-alkyl; C12- alkylamino-C5-alkyl; Cn-alkylamino-Cs-alkyl; Ci6-alkylamino-C5-alkyl; di-(C5-alkyl)amino-Cs- alkyl; C6-alkoxy-carbonyl-C4-alkyl; C8-alkoxy-carbonyl-C4-alkyl; and Cio-alkoxy-carbonyl-C4- alkyl.

[0095] In some embodiments, R3, R7, and R12, are independently selected from the group consisting of amino-C3-alkyloxy or amino-C3-alkyl-carboxy, and wherein Ris is selected from the group consisting of Cs-alkylamino-Cs-alkyl; Ci2-alkylamino-C5-alkyl; Cn-alkylamino-Cs- alkyl; Ci6-alkylamino-C5-alkyl; di-(C5-alkyl)amino-C5-alkyl; C6-alkoxy-carbonyl-C4-alkyl; Cs- alkoxy-carbonyl-C4-alkyl; Cio-alkoxy-carbonyl-C4-alkyl; C6-alkyl-carboxy-C4-alkyl; Cs-alkyl- carboxy-C4-alkyl; and Cio-alkyl-carboxy-C4-alkyl.

[0096] In some embodiments, R3, R7, and R12, are independently selected from the group consisting of amino-C3-alkyloxy or amino-C3-alkyl-carboxy, and wherein Ris is selected from the group consisting of Cs-alkylamino-Cs-alkyl; Ci2-alkylamino-C5-alkyl; Cn-alkylamino-Cs- alkyl; Ci6-alkylamino-C5-alkyl; di-(C5-alkyl)amino-C5-alkyl; C6-alkoxy-carbonyl-C4-alkyl; Cs- alkoxy-carbonyl-C4-alkyl; and Cio-alkoxy-carbonyl-C4-alkyl.

[0097] In some embodiments, R3, R7, R12, and Ris are independently selected from the group consisting of amino-C3-alkyloxy; amino-C3-alkyl-carboxy; amino-C2-alkylcarboxy; Cs- alkylamino-C5-alkyl; C8-alkoxy-carbonyl-C4-alkyl; Cio-alkoxy-carbonyl-C4-alkyl; Cs-alkyl- carbonyl-C4-alkyl; di-(C5-alkyl)amino-C5-alkyl; Cn-alkylamino-Cs-alkyl; C6-alkoxy-carbonyl- C4-alkyl; C6-alkyl-carboxy-C4-alkyl; Ci6-alkylamino-C5-alkyl; Ci2-alkylamino-C5-alkyl; and hydroxy(C 5 )alkyl.

[0098] In some embodiments, Ris is selected from the group consisting of Cs-alkylamino- Cs-alkyl or C8-alkoxy-carbonyl-C4-alkyl.

[0099] In some embodiments, at least Ris can have the following structure:

wherein R20 is omitted or alkyl, alkenyl, alkynyl, or aryl, and R21 and R22 are independently selected from the group consisting of hydrogen, alkyl, alkenyl, alkynyl, or aryl, provided that at least one of R21 and R22 is not hydrogen.

[00100] In some embodiments, R21 and R22 are independently selected from the group consisting of hydrogen, C1-C24 alkyl, C2-C24 alkenyl, C2-C24 alkynyl, C 6 or C10 aryl, 5 to 10 membered heteroaryl, 5 to 10 membered heterocyclyl, C7-C13 aralkyl, (5 to 10 membered heteroaryl)-Ci-C6 alkyl, C3-C10 carbocyclyl, C4-10 (carbocyclyl)alkyl, (5 to 10 membered heterocyclyl)-Ci-C6 alkyl, amido, and a suitable amine protecting group, provided that at least one of R21 and R22 is not hydrogen. In some embodiments, R21 and R22, together with the atoms to which they are attached, form a 5 to 10 membered heterocyclyl ring.

[00101] In some embodiments, one or more of rings A, B, C, and D is heterocyclic. [00102] In some embodiments, rings A, B, C, and D are non-heterocyclic.

[00103] In some embodiments, the CSA compound is a compound of Formula IV, which is a subset of Formula III, or salt thereof having a steroidal backbone:

[0104] In some embodiments, R 3 , RJ, and R12 are independently selected from the group consisting of hydrogen, an unsubstituted (C1-C22) alkyl, unsubstituted (C1-C22) hydroxyalkyl, unsubstituted (C1-C22) alkyloxy-(Ci-C22) alkyl, unsubstituted (C1-C22) alkylcarboxy-(Ci-C22) alkyl, unsubstituted (C1-C22) alkylamino-(Ci-C22)alkyl, unsubstituted (C1-C22) alkylamino-(Ci- C22) alkylamino, unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino-(Ci-Ci8) alkylamino, an unsubstituted (C1-C22) aminoalkyl, an unsubstituted arylamino-(Ci-C22) alkyl, an unsubstituted (C1-C22) aminoalkyloxy, an unsubstituted (C1-C22) aminoalkyloxy-(Ci-C22) alkyl, an unsubstituted (C1-C22) aminoalkylcarboxy, an unsubstituted (C1-C22) aminoalkyl- aminocarbonyl, an unsubstituted (C1-C22) aminoalkylcarboxamido, an unsubstituted di(Ci-C22 alkyl)aminoalkyl, unsubstituted (C1-C22) guanidinoalkyloxy, unsubstituted (C1-C22) quaternary ammonium alkylcarboxy, and unsubstituted (C1-C22) guanidinoalkyl carboxy.

[0105] In some embodiments, R 3 , R7, and R12 are independently selected from the group consisting of hydrogen, an unsubstituted (Ci-C 6 ) alkyl, unsubstituted (Ci-C 6 ) hydroxyalkyl, unsubstituted (C1-C16) alkyloxy-(Ci-Cs) alkyl, unsubstituted (C1-C16) alkylcarboxy-(Ci-Cs) alkyl, unsubstituted (C1-C16) alkylamino-(Ci-C5)alkyl, unsubstituted (C1-C16) alkylamino-(Ci- C5) alkylamino, unsubstituted (C1-C16) alkylamino-(Ci-Ci6) alkylamino-(Ci-C5) alkylamino, an unsubstituted (C1-C16) aminoalkyl, an unsubstituted arylamino-(Ci-C5) alkyl, an unsubstituted (C1-C5) aminoalkyloxy, an unsubstituted (C1-C16) aminoalkyloxy-(Ci-C5) alkyl, an unsubstituted (C1-C5) aminoalkylcarboxy, an unsubstituted (C1-C5) aminoalkylaminocarbonyl, an

unsubstituted (C1-C5) aminoalkylcarboxamido, an unsubstituted di(Ci-Cs alkyl)amino-(Ci-C5) alkyl, unsubstituted (C1-C5) guanidinoalkyloxy, unsubstituted (C1-C16) quaternary ammonium alkylcarboxy, and unsubstituted (C1-C16) guanidinoalkylcarboxy.

[0106] In some embodiments, R 3 , R7, and R12 are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkylcarboxyalkyl; and hydroxyalkyl. [0107] In some embodiments, R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy.

[0108] In some embodiments, R3, R7, and R12 are the same. In some embodiments, R3, R7, and R12 are aminoalkyloxy. In some embodiments, R3, R7, and R12 are aminoalkylcarboxy.

[0109] In some embodiments, R3, R7, and R12 are independently selected from the group consisting of amino-C3-alkyloxy; amino-C3-alkyl-carboxy; Cs-alkylamino-Cs-alkyl; Cs-alkoxy- carbonyl-C4-alkyl; C8-alkyl-carbonyl-C4-alkyl; di-(C5-alkyl)amino-C5-alkyl; Cn-alkylamino-Cs- alkyl; C6-alkoxy-carbonyl-C4-alkyl; C6-alkyl-carboxy-C4-alkyl; and Ci6-alkylamino-C5-alkyl.

[0110] In some embodiments, CSA compounds as disclosed herein can be a compound of Formula I, Formula II, Formula III, Formula IV, or salts thereof wherein at least Ris of the steroidal backbone includes amide functionality in which the carbonyl group of the amide is positioned between the amido nitrogen of the amide and fused ring D of the steroidal backbone. For example, any of the embodiments described above can substitute Ris for an Ri8 including amide functionality in which the carbonyl group of the amide is positioned between the amido nitrogen of the amide and fused ring D of the steroidal backbone.

[0111] In some embodiments, one or more of R3, R7, or R12 may include a guanidine group as a cationic functional group and may be bonded to the steroid backbone by an ether linkage. For example, one or more of R3, R7, or R12 may be a guanidinoalkyloxy group. An example

includes , wherein the alkyl portion is defined as with the embodiments described above. In a preferred embodiment, the alkyl portion is a straight chain with 3 carbon atoms, and therefore one or more of R3, R7, or R12 may be a guanidinopropyloxy group.

[0112] One of skill in the art will recognize that other cationic functional groups may be utilized, and that the cationic functional groups may be bonded to the steroid backbone through a variety of other tethers or linkages. For example, the cationic functional groups may be bonded to the steroid backbone by an ester linkage. For example, one or more of R3, R7, or R12 may be an aminoalkylcarboxy or guanidinoalkylcarboxy, such as H2N-alkyl-C(=0)-0- or H2N-C(=NH)- H-alkyl-C(=0)-0-, wherein the alkyl portion is defined as with the embodiments described above. In other embodiments, the cationic functional groups may be bonded to the steroid backbone by an amide linkage. For example, one or more of R3, R7, or R12 may be an aminoalkylcarbonylamino (i.e. aminoalkylcarboxamido) or guanidinoalkylcarbonylamino (i.e. guanidinoalkylcarboxamido), such as H 2 N-alkyl-C(=0)- H- or H 2 N-C(= H)- H-alkyl-C(=0)- H-, wherein the alkyl portion is defined as with the embodiments described above.

[0113] Additionally, one of skill in the art will recognize that the tethers may be of varying lengths. For example, the length between the steroid backbone and the cationic functional group (e.g., amino or guanidino group), may be between 1 and 15 atoms or even more than 15 atoms. In other embodiments, the length may be between 1 and 8 atoms. In a preferred embodiment, the length of the tether is between two and four atoms. In other embodiments, there is no tether, such that the cationic functional group is bonded directly to the steroid backbone.

[0114] One of skill in the art will also note that the various cationic functional groups of the present disclosure may be utilized in combination, such that one or more of R 3 , R.7, or Ri 2 may include one variation of cationic functional group while one or more of another of R 3 , R7, or Ri 2 of the same compound may include a different variation of cationic functional group. Alternatively, two or more of R 3 , R7, or Ri 2 may include the same cationic functional group, or all of R 3 , R7, or Ri 2 may include the same cationic functional group (in embodiments where all of R 3 , R7, or Ri 2 are cationic functional groups).

[0115] Additionally, although in a preferred embodiment one or more cationic functional groups are disposed at R 3 , R7, or Ri 2 , one of skill in the art will recognize that in other embodiments, R 3 , R7, or Ri 2 may not be cationic functional groups and/or one or more cationic functional groups may be disposed at other locations of the steroid backbone. For example, one or more cationic functional groups may be disposed at Ri, R 2 , R 3 , R 4 , R 6 , R7, R11, R12, R15, Ri6, Ri7, and/or Ris.

[0116] The compounds and compositions disclosed herein are optionally prepared as salts. The term "salt" as used herein is a broad term, and is to be given its ordinary and customary meaning to a skilled artisan (and is not to be limited to a special or customized meaning), and refers without limitation to a salt of a compound. In some embodiments, the salt is an acid addition salt of the compound. Salts can be obtained by reacting a compound with inorganic acids such as hydrohalic acid (e.g., hydrochloric acid or hydrobromic acid), sulfuric acid, nitric acid, and phosphoric acid. Salts can also be obtained by reacting a compound with an organic acid such as aliphatic or aromatic carboxylic or sulfonic acids, for example formic acid, acetic acid, propionic acid, glycolic acid, pyruvic acid, malonic acid, maleic acid, fumaric acid, trifluoroacetic acid, benzoic acid, cinnamic acid, mandelic acid, succinic acid, lactic acid, malic acid, tartaric acid, citric acid, ascorbic acid, nicotinic acid, methanesulfonic acid, ethanesulfonic acid, p-toluensulfonic acid, salicylic acid, stearic acid, muconic acid, butyric acid, phenylacetic acid, phenylbutyric acid, valproic acid, 1,2-ethanedisulfonic acid, 2-hydroxy ethanesulfonic acid, benzenesulfonic acid, 2-naphthalenesulfonic acid, or naphthalenesulfonic acid. Salts can also be obtained by reacting a compound with a base to form a salt such as an ammonium salt, an alkali metal salt, such as a lithium, sodium or a potassium salt, an alkaline earth metal salt, such as a calcium, magnesium or aluminum salt, a salt of organic bases such as dicyclohexylamine, N- methyl-D-glucamine, tris(hydroxymethyl)methylamine, C1-C7 alkylamine, cyclohexylamine, dicyclohexylamine, triethanolamine, ethylenediamine, ethanolamine, diethanolamine, triethanolamine, tromethamine, and salts with amino acids such as arginine and lysine; or a salt of an inorganic base, such as aluminum hydroxide, calcium hydroxide, potassium hydroxide, sodium carbonate, sodium hydroxide, or the like.

[0117] In some embodiments, the salt is a hydrochloride salt. In some embodiments, the salt is a mono-hydrochloride salt, a di-hydrochloride salt, a tri-hydrochloride salt, or a tetra- hydrochloride salt. Additional examples of salts include sulfuric acid addition salts, sulfonic acid addition salts, disulfonic acid addition salts, 1,5-naphthalenedisulfonic acid addition salts, sulfate salts, and bisulfate salts.

[0118] The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.