CN110694051B - 一种神经导向因子Sema在制备治疗骨关节炎注射剂中的应用 - Google Patents
一种神经导向因子Sema在制备治疗骨关节炎注射剂中的应用 Download PDFInfo
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Abstract
本发明公开了一种神经导向因子Sema在制备治疗骨关节炎注射剂中的应用,所述神经导向因子Sema选自Sema 3a蛋白,Sema 3a蛋白可以选自天然蛋白或重组蛋白。另一方面,本发明公开了一种基于神经导向因子Sema的注射剂及其制备方法,所述注射剂包括神经导向因子Sema和磷酸盐缓冲溶液,所述神经导向因子Sema在磷酸盐缓冲液中的浓度为5‑10μg/mL。临床试验证明,本发明制备的注射剂对早期退行性骨关节炎患者有良好的治疗效果。
Description
技术领域
本发明属于生物医药领域,具体涉及一种神经导向因子Sema大分子蛋白在制备治疗骨关节炎注射剂中的用途。
背景技术
骨关节炎(OA)是指以软骨丢失及伴有关节周围骨反应为特点的一种滑膜关节病,又称骨关节病、退行性骨关节病、肥大性或增生性关节炎等,是全球范围内最常见的风湿性疾病。骨关节炎是由于增龄、肥胖、劳损、创伤、关节先天性异常、关节畸形等诸多因素引起的关节软骨退化损伤、关节边缘和软骨下骨反应性增生。骨关节炎是中老年人群中最常见的关节疾病,调查研究显示,60岁以上的人群中患病率可达50%,75岁以上人群中则达80%,该病致残率高达53%,调查显示,骨关节炎已成为老年人致残头号杀手。
骨关节炎病症大多起病隐袭,进展缓慢,受累关节可间断出现轻中度钝痛,且所述病症可因过度活动、气候变化等原因诱发或加重,严重者症状体征明显且持续不缓解,甚至出现关节畸形、功能障碍。
骨关节炎的治疗目的是减轻症状,延缓关节结构改变,维持关节功能,提高生活质量。2000年ACR制定的OA治疗指南以及欧洲风湿病学会联盟(EULAR)对膝OA治疗的建议基本都是三个方面,即非药物治疗、药物治疗、手术治疗。其中,在药物治疗中非甾体抗炎药(NSAIDs)是一类化学结构不同的具有抗炎、止痛、解热等功能的非类固醇药物,常用于骨关节炎的治疗。值得注意的是,一些试验观察到某些NSAIDs抑制软骨合成,加速软骨退化,此外,口服非甾体抗炎药经常会导致胃肠道问题(尤其是对于老年患者),长期使用通常伴有肾脏、肝脏和其他功能异常。除了NSAIDs,类固醇类药物由于可迅速改善症状而经常应用于骨关节炎治疗,但频繁使用类固醇药物可能损害关节,所以应慎重考虑类固醇注射治疗。其次,使用透明质酸注射液关节腔内注射,即粘弹性补充疗法在治疗骨关节炎病症中越来越普遍,在中国销售的关节腔内注射制剂含鸡冠花来源的透明质酸钠,平均分子量为800,000道尔顿。其虽然具有缓解疼痛、抗炎特性、改善关节活动度、暂无严重药物不良反应等效应,但却无法抑制骨关节炎进程且仅对早期骨关节炎有效。
Semaphorin蛋白家族是一类以半胱氨酸富集区域为特征的一组分泌型或膜相关的蛋白家族,最初作为影响神经发育的神经轴突导向因子而被发现,Semaphorin是一大类分泌型或跨膜型糖蛋白分子,参与机体多项重要生理过程的调节,包括调控神经系统的轴突发育、血管形成、骨分化、心血管发育等。根据其组成特点将其分为8型,其中有部分家族蛋白分子参与免疫功能的调节从而将其命名为Immune Semaphorin,如Semaphorin 4D(Sema4D,又名CD100)、Semaphorin 3A(Sema3A)、和Semaphorin 7A(Sema7A)等。其中,Sema3A最早被发现,也是最经典的Sema家族成员之一,可调控和引导神经轴突的生长。近年来研究发现Sema3A除发挥神经轴突导向作用外,还与细胞迁移、肿瘤生长、血管生成、骨代谢及免疫调节等多种机体的病理生理现象密切相关。
非专利文献“Semaphorin 3A在类风湿关节炎患者血清及外周血单个核细胞中的表达及意义”中提到Semaphorin3A(Sema3A)在类风湿关节炎(RA)患者外周血及血清中的表达水平,探讨Sema3A在RA发病机制中的作用。结果显示RA患者血清Sema3A水平显著高于健康人,且血清Sema3A水平与血小板计数、ESR、IgM、类风湿因子、HRF-IgG呈正相关。
非专利文献“骨改建中潜在的作用靶点-信号素Sema3A的研究进展”中研究证明Sema3A具有促进成骨细胞生成以及同时抑制破骨细胞生成的功能,且骨折愈合与神经纤维长入骨痂密切相关,神经生长导向因子Sema3A可通过调控感觉神经纤维长入调节骨量代谢。
专利文献“一种采用Sema3A基因促进脂肪干细胞成骨分化、抑制成脂分化的方法”公开了一种采用Sema3A基因促进脂肪干细胞成骨分化、抑制成脂分化的方法。所述发明构建了含有Sema3A基因序列的重组质粒,通过将Sema3A重组质粒和辅助包装质粒转染进入293T细胞获得Sema3A慢病毒载体,慢病毒载体在polybrene的协助下将Sema3A基因导入脂肪干细胞,显著地促进了脂肪干细胞的成骨分化,同时也抑制了脂肪干细胞向成脂方向的分化,导入Sema3A基因可以更好地将脂肪干细胞应用于促进骨缺损愈合和种植体骨结合。
虽然现有技术公开了Sema3A用于治疗骨相关疾病的应用,而且仅是针对骨的治疗,而未涉及软骨,本发明所述的骨关节炎是由于增龄、肥胖、劳损、创伤、关节先天性异常、关节畸形等诸多因素引起的关节软骨退化损伤。因此,本发明所述的药物制剂与现有制剂应用的疾病病种不同,且现有技术未曾公开由Sema大分子蛋白作为有效成分制备的注射剂在治疗骨关节中的应用。
发明内容
为了改善现有技术的缺陷,本发明提供一种神经导向因子Sema在制备治疗骨关节炎注射剂中的应用,另外,本发明提供一种基于神经导向因子Sema的注射剂及其制备方法。
第一方面,本发明提供一种神经导向因子Sema在制备治疗骨关节炎注射剂中的应用,所述神经导向因子Sema的序列选自下列氨基酸序列中的一种:
1)所述神经导向因子Sema的氨基酸序列如SEQ ID NO:1所示序列的全部或部分;
2)所述神经导向因子Sema的氨基酸序列为与SEQ ID NO:1具有至少90%、91%、92%、93%、94%、95%、96%、97%、98%或99%的同一性程度的序列;
3)所述神经导向因子Sema的氨基酸序列与SEQ ID NO:1所示序列的差异不超过5、4、3、2或1个氨基酸;
4)所述神经导向因子Sema的氨基酸序列为SEQ ID NO:1的变体,其中所述变体与SEQ ID NO:1的差异包括取代、缺失和/或插入一个或多个氨基酸残基的序列或至少一个N-/C-末端延伸。
优选的,所述神经导向因子Sema选自Sema 3a蛋白,所述Sema 3a蛋白的氨基酸序列如SEQ ID NO:1所示。
本发明中SEQ ID NO:1的氨基酸序列如下所示:
第二方面,本发明提供一种基于神经导向因子Sema的注射剂,所述注射剂包括:神经导向因子Sema、磷酸盐缓冲溶液,所述神经导向因子Sema在磷酸盐缓冲液中的浓度为5-10μg/mL。
优选的,所述神经导向因子Sema在磷酸盐缓冲液中的浓度为5-7μg/mL。
在本发明的优选实施方式中,所述神经导向因子Sema在磷酸盐缓冲液中的浓度为5μg/mL。
所述神经导向因子Sema的序列选自下列氨基酸序列中的一种:
1)所述神经导向因子Sema的氨基酸序列如SEQ ID NO:1所示序列的全部或部分;
2)所述神经导向因子Sema的氨基酸序列为与SEQ ID NO:1具有至少90%、91%、92%、93%、94%、95%、96%、97%、98%或99%的同一性程度的序列;
3)所述神经导向因子Sema的氨基酸序列与SEQ ID NO:1所示序列的差异不超过5、4、3、2或1个氨基酸;
4)所述神经导向因子Sema的氨基酸序列为SEQ ID NO:1的变体,其中所述变体与SEQ ID NO:1的差异包括取代、缺失和/或插入一个或多个氨基酸残基的序列或至少一个N-/C-末端延伸。
优选的,所述神经导向因子Sema选自Sema 3a蛋白,所述Sema 3a蛋白的氨基酸序列如SEQ ID NO:1所示。
在本发明中,所述Sema 3a蛋白可以选自天然蛋白或重组蛋白,优选的,所述Sema3a蛋白为人源重组蛋白。
在本发明的优选实施例中,所述磷酸盐缓冲溶液pH=7.4,每1L磷酸盐缓冲溶液中含有磷酸二氢钾(KH2PO4)0.24g、磷酸氢钠(Na2HPO4)1.44g、氯化钠(NaCl)8g、氯化钾(KCl)0.2g。
优选的,所述注射剂中还包括抗氧剂、抑菌剂、止痛剂、pH调节剂中的一种或两种的组合。
所述抗氧剂选自亚硫酸钠、焦亚硫酸氢钠、亚硫酸氢钠、硫代硫酸钠、维生素C中的一种或两种以上的组合。
所述抑菌剂与止痛剂选自三氯叔丁醇、苯甲醇中的一种或两种的组合。
所述pH调节剂选自酒石酸-酒石酸盐、枸橼酸-枸橼酸钠、磷酸氢二钠-磷酸二氢钠、氢氧化钠、盐酸中的一种或两种以上的组合。
第三方面,本发明提供一种基于神经导向因子Sema的注射剂的制备方法,包括如下步骤:
(1)配液,按比例将神经导向因子Sema加入磷酸盐缓冲溶液中配成一定浓度药液;
(2)活性炭处理,向药液中加入溶液总量0.1-1.0%的针用活性炭吸附处理;
(3)初滤,用滤纸将药液进行过滤;
(4)过滤除菌,用孔径为0.22μm的微孔滤膜对药液进行除菌,除热源;
(5)分装,灌封,即得注射液。
优选的,所述步骤(1)中神经导向因子Sema的浓度为5-10μg/mL,更优选的浓度为5-7μg/mL,最优选的浓度为5μg/mL。
优选的,所述步骤(2)中活性炭使用前经干燥活化3-4小时。
优选的,所述步骤(3)中还可使用的滤材有绸布或滤板。
优选的,所述步骤(3)和(4)中的过滤方法采用加压过滤或减压过滤,在本发明中,所述过滤采用加压过滤。
优选的,所述步骤(5)中制备的注射液为单位剂型,每1ml药液中含有5-7μg神经导向因子Sema。
最优选的,每1ml药液中含有5μg神经导向因子Sema。
所述神经导向因子Sema的序列选自下列氨基酸序列中的一种:
1)所述神经导向因子Sema的氨基酸序列如SEQ ID NO:1所示序列的全部或部分;
2)所述神经导向因子Sema的氨基酸序列为与SEQ ID NO:1具有至少90%、91%、92%、93%、94%、95%、96%、97%、98%或99%的同一性程度的序列;
3)所述神经导向因子Sema的氨基酸序列与SEQ ID NO:1所示序列的差异不超过5、4、3、2或1个氨基酸;
4)所述神经导向因子Sema的氨基酸序列为SEQ ID NO:1的变体,其中所述变体与SEQ ID NO:1的差异包括取代、缺失和/或插入一个或多个氨基酸残基的序列或至少一个N-/C-末端延伸。
优选的,所述神经导向因子Sema选自Sema 3a蛋白,所述Sema 3a蛋白的氨基酸序列如SEQ ID NO:1所示。
本发明的有益效果为:现有的治疗技术手段仅能缓解骨关节炎症状,而目前FDA及中国均仍还没有批准用于预防或减缓疾病进展的药物,本发明提供的一种基于神经导向因子Sema的注射剂能预防和减缓骨关节炎进展。另外,关节腔作为一个封闭腔体,直接本发明提供的注射液注射后,药物浓度能长效维持并直接作用于关节滑膜及软骨,与经皮吸收相比,药物损失较低。用关节腔穿刺的方法注射药物,技术难度低,无门槛,大部分正规医疗机构均可开展,注射体积相较于玻璃酸钠小,注射后关节肿胀和不适感也相对较轻,患者依从性较好。
附图说明
图1Sema 3a蛋白注射剂临床试验定量MRI散点图
具体实施方式
下面将对本发明实施例中的技术方案进行清楚、完整地描述,显然,所描述的实施例仅是本发明的部分实施例,而不是全部。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。
实施例1注射剂的制备
S1:配液,取100μg的Sema 3a蛋白(1mg/ml)溶于19.9mL磷酸盐缓冲溶液中,配成药物浓度为5μg/mL的药液;
S2:活性炭处理,向药液中加入溶液总量0.2%的针用活性炭吸附处理0.5小时;
S3:初滤,用滤纸将药液进行过滤;
S4:过滤除菌,用孔径为0.22μm的微孔滤膜对药液进行除菌,除热源;
S5:以2mL为单位对药液进行分装,灌封,得到注射液。
实施例2注射剂的制备
制备方法及原料同实施例1,区别仅在于S1,取140μg的Sema 3a蛋白(1mg/ml)溶于19.86mL磷酸盐缓冲溶液中,配成药物浓度为7μg/mL的药液。
实施例3注射剂的制备
制备方法及原料同实施例1,区别仅在于S1,取200μg的Sema 3a蛋白(1mg/ml)溶于19.8mL磷酸盐缓冲溶液中,配成药物浓度为10μg/mL的药液。
效果例1注射剂质量检验
对本发明制备的注射剂1-3进行质量检验,检验项目包括注射剂性状、pH值、过敏试验、异常毒性、无菌检验、热源检验及长期毒性测定,检测方法如下:
性状:本发明制备的含Sema 3a蛋白注射剂应为无色澄明液体,若视检为无色透明溶液、无杂质、无沉淀,则检验合格。
pH值:按照中国药典2000年版二部附录VIH的检测方法对待测注射液进行pH值检测,若pH值为6.5-7.5,则检验合格。
过敏试验:每组使用体重250-350g的健康合格豚鼠6只,每只腹腔注射待测注射剂0.5mL,连续注射3次,在末次注射后第14天,再通过静脉注射待测注射液1mL,注射后15分钟内,若6只豚鼠出现过敏反应,如竖毛、呼吸困难、喷嚏、干呕或咳嗽3声以上中的两种或两种以上者,或有啰音、抽搐、虚脱或死亡等现象之一者,应判为阳性,若未出现上述过敏反应,则检验合格。
异常毒性:按照中国药典2000年版二部附录XIC规定的方法,每组使用体重200-250g的健康小白鼠6只,静脉注射待测注射液0.5ml,规定时间内观察小鼠出现的死亡情况,若未出现任何毒性反应,则检验合格。
无菌检验:参照中国药典2000年版二部附录XIH规定的检测方法进行检测,将待测注射液加入100mL0.9%无菌氯化钠溶液中,摇匀,用薄膜过滤法处理后,依规定检验,若无菌,则检验合格。
热原检验:参照中国药典2000年版二部附录XID规定的方法,利用家兔测定待测注射剂所含的细菌内毒素(或热原)限量,注射剂量按家兔体重每1kg注射0.5mL的剂量给药,若未产生热原反应,则检验合格。
长期毒性测定:每组使用体重200-250g的健康小白鼠6只,静脉注射待测注射液0.5ml,连续给药三个月,每次给药后2天进行血尿检查,若均为出现异常,则检验合格。
本发明制备的3组注射剂检验结果如下表所示。
表1注射剂质量检验结果
组别 | 性状 | pH值 | 过敏试验 | 异常毒性 | 无菌检验 | 热源检验 | 长期毒性 |
实施例1 | 合格 | 合格 | 合格 | 合格 | 合格 | 合格 | 合格 |
实施例2 | 合格 | 合格 | 合格 | 合格 | 合格 | 合格 | 合格 |
实施例3 | 合格 | 合格 | 合格 | 合格 | 合格 | 合格 | 合格 |
通过以上质量检验数据可以证明,本发明制备的Sema 3a蛋白注射液安全性符合注射剂要求,无任何毒性作用,应用人体安全性较高。
效果例2临床药效试验
本次试验按照《药物临床试验质量管理规范》相关要求拟定临床研究方案,经过四川大学华西医院伦理委员会审查批准,并在四川大学华西医院药物临床试验机构备案。
1、试验目的:评价基于Sema 3a蛋白的注射剂治疗早期退行性骨关节炎患者的临床疗效及安全性。
2、入组标准如下:
①基于美国风湿病学会临床分类标准诊断为膝关节骨关节炎的患者;
②研究侧膝关节分级为Kellgren-Lawrence 1级或2级,研究对侧膝关节的分级不超过研究侧。
③慢性疼痛至少持续1个月;
④第0周时在0–10分数字评定量表中确定的平均骨关节炎指数(WOMAC)疼痛分项评分(5项)符合方案要求;
⑤大于或等于40岁且小于70岁的患者,且在充分知情的情况下自愿签署知情同意书;
⑥不需借助轮椅支持即能行走的门诊患者。
3、排除标准如下:
①诊断为继发性膝关节骨关节炎的患者;
②有其他导致膝关节功能受损的疾病/障碍的患者;
③对侧膝关节有骨关节炎并需要关节腔内药物治疗缓解疼痛的患者;
④不适合采用药物治疗的患者(如有手术指征的患者);
⑤在首次使用研究药物前2周内接受下面一种或多种治疗的患者:
1)双侧或任意一侧膝关节运动治疗;
2)使用中成药治疗膝关节骨关节炎;
⑥在首次使用研究药物前4周内接受下面一种或多种治疗的患者:
1)双侧或任意一侧膝关节局部注射糖皮质激素或麻醉剂、外用糖皮质激素治疗;
2)使用糖皮质激素的口服、栓剂或静脉制剂治疗;
⑦在首次使用研究药物前的24周内接受膝关节(双侧或任意一侧)玻璃酸注射治疗;
⑧同侧髋关节或踝关节病变;
⑨风湿性疾病或状况;
⑩双侧或任意一侧下肢关节成形术病史;
无法评价其临床表现的患者;
关节部位周围的皮肤病或皮肤感染,有导致注射感染的风险;
严重心脏疾病、肾衰竭、血液学疾病和糖尿病;
对研究用药品(IMP)中任何成分有超敏反应史;
发生妊娠、可疑妊娠、哺乳期女性患者或在研究期间拒绝使用避孕措施患者(男性或女性);
当前有重度肝损害或有重度肝损害病史;
当前患有恶性肿瘤或筛选前5年内有恶性肿瘤病史;
在首次使用研究药物前24周内接受其他IMP治疗的患者;
研究者或助理研究者判定不适于参与该研究的其他患者。
4、试验过程如下:
①通过临床门诊招募符合入排标准的原发性退行性膝关节炎病人25人,对受试者进行编号,并随机分配为5组,每组各5人。
②在接受治疗前对他们的受试膝关节进行定量核磁共振成像检测(MRI),检测数据以感兴趣区域(ROI,Region Of Interest)面积表示。
③向1-3组患者受试膝关节腔内注射实施例1-3制备的含Sema 3a蛋白的注射剂,一周一次,一共注射5针。设置第4组为对照组,对照组受试者膝关节腔内根据药品说明书注射玻璃酸钠(HA)注射液。第5组为空白对照组,空白对照组受试者膝关节腔内注射不含Sema3a蛋白的磷酸盐缓冲溶液2mL,一周一次,一共注射5针。治疗期间,患者可正常生活但不得过度疲劳,负重以及运动,也不得对受试膝关节进行其它任何内服外敷的治疗。
接受完5周(一个疗程)治疗后,对患者受试膝关节进行定量MRI,通过治疗前后定量MRI,可得患者股骨远端软骨恢复情况,计算ROI的增长率(%)=(治疗后ROI-治疗前ROI)/治疗前ROI×100。
④实验结果如下表所示:
表2基于Sema 3a蛋白的注射剂临床疗效数据
通过测量T2弛豫时间观测到软骨内成分的变化,治疗后与治疗前的T2值相比,增长率越高,说明受试者关节软骨恢复程度越好。通过实施例1-3与空白对照组受试者股骨远端软骨恢复情况可知,Sema 3a蛋白注射液对早期退行性骨关节炎患者有治疗效果,其治疗效果与临床常用的玻璃酸钠注射液相比有更好的趋势,且本发明制备的注射剂受试者依从性好,在试验周期内没有1例受试者脱落,且未出现任何AE(不良事件)和SAE(严重不良事件)案例,安全性较好。
最后应说明的是:以上各实施例仅用以说明本发明的技术方案,而非对其限制;尽管参照前述各实施例对本发明进行了详细的说明,本领域的普通技术人员应当理解:其依然可以对前述各实施例所记载的技术方案进行修改,或者对其中部分或者全部技术特征进行等同替换;而这些修改或者替换,并不使相应技术方案的本质脱离本发明各实施例技术方案的范围。
序列表
<110> 四川大学华西医院
<120> 一种神经导向因子Sema在制备治疗骨关节炎注射剂中的应用
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Ala Arg Leu Ile Cys Ser Val Pro Gly Pro Asn Gly Ile Asp Thr His
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Arg Ser Val
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Claims (1)
1.一种神经导向因子Sema作为药物活性成分在制备治疗骨关节炎注射剂中的应用,所述神经导向因子Sema选自Sema 3a蛋白,所述Sema 3a蛋白的氨基酸序列如SEQ ID NO:1所示。
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