CN1124138A - 用于治疗糖尿病并发症的组合物 - Google Patents

用于治疗糖尿病并发症的组合物 Download PDF

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CN1124138A
CN1124138A CN95107834A CN95107834A CN1124138A CN 1124138 A CN1124138 A CN 1124138A CN 95107834 A CN95107834 A CN 95107834A CN 95107834 A CN95107834 A CN 95107834A CN 1124138 A CN1124138 A CN 1124138A
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D·F·霍罗宾
M·科特
N·卡梅伦
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Abstract

本发明涉及6-去饱和n-6脂肪酸尤其是γ-亚麻酸(GLA)、二高-γ-亚麻酸(DGLA)或花生四烯酸(AA)连同能降低身体细胞内山梨醇水平的药学上可接受的物质特别是醛糖还原酶抑制剂一起在治疗(包括预防性治疗)糖尿病长期并发症方面的用途,以及在制备用于治疗(包括预防性治疗)该疾病的药物方面的用途,并涉及所述物质的药用组合物及6-去饱和n-6脂肪酸(除GLA或DGLA外)的抗坏血酸酯本身。

Description

用于治疗糖尿病并发症的组合物
糖尿病是种常见病,通常将其分为胰岛素依赖型糖尿病和非胰岛素依赖型糖尿病。这两种类型的糖尿病受饮食以及胰岛素(针对第一种类型)和各种药物(针对第二种类型)所控制。尽管认真的病人和医生通常能够令人满意地合理控制血糖的变化,但是,这并不能防止糖尿病造成的对许多组织的长期损害。这种损害可采用许多形式,但主要类型是对眼睛(视网膜病)、神经(神经病)、肾脏(肾病)和心血管系统的损害。尽管某些病人身上出现一种或另一种系统的独立的损害,但在大多数病人身上却是两种以上的损害同时发生,这说明其根本机理是类似的。
有许多方法用来降低或防止被统称作糖尿病的长期并发症的这些类型的损害。本专利说明书涉及其中的两种方法。
一种方法是基于这样的一个事实,即在食物中主要的必需脂肪酸(EFA)亚油酸转化为其第一个代谢物γ—亚麻酸(GLA)(下表1中“6—去饱和”n—6EFAs系列的第一个)的过程中,EFA的代谢受到某种阻滞的干扰。本文中的“6—去饱和EFAs”指的是经过6-去饱和步骤后的一类EFAs,不一定是指该EFA在6位有双键。
            表118∶2△-9.12(亚油酸)
                  |
               △-6去饱和酶
                  ↓18∶3△-6.9.12(γ-亚麻酸)
                  |
               链延长
                  ↓20∶3△-8.11.14(二高-γ-亚麻酸)
                  |
              △-5去饱和酶
                  ↓20∶4△-5,8,11,14(花生四烯酸)
                  |
                链延长
                  ↓22∶4△-7,10,13,16(肾上腺酸)
                  |
              △-4去饱和酶
                  ↓22∶5 △-4,7,10,13,16
因而导致GLA的代谢物包括二高—γ—亚麻酸(DGLA)和花生四烯酸(AA)的水平降低。因为这些代谢物是所有组织细胞膜和神经膜结构中的重要成分,还因为它们是细胞信息传输系统如前列腺素和二酰基甘油的前体和成分,缺乏这些化合物是有害的。尤其是缺乏从DGLA衍生的前列腺素E1和从花生四烯酸衍生的前列环素,它们都是对于维持血液流向许多组织的微循环是必需的血管扩张剂。
由于在患糖尿病并发症的情况下,正常的亚油酸转化为GLA被损害,所以,用GLA和/或其进一步的代谢物DGLA和AA治疗是有益的。已证实在糖尿病动物的神经中前列环素的水平降低,用GLA治疗后恢复。
另一个方法是基于在体内细胞中生成过量葡萄糖代谢物山梨醇导致的损害。葡萄糖在醛糖还原酶作用下转变为山梨醇,但是,在正常葡萄糖浓度下,该过程非常缓慢,所以,山梨醇水平通常是非常低的。相反,当葡萄糖浓度很高时,转化率较高,可以出现高水平的山梨醇。这种高水平的山梨醇可以对细胞产生多种作用,干扰克分子渗透压浓度和破环细胞代谢的多方面,包括肌醇循环。这些作用已被认为是糖尿病并发症的部分起因。如果是这样,用抑制剂阻断酶,或更概括地说,给与能降低山梨醇水平的物质,对于治疗/防止糖尿病并发症可能是有效的。这样的抑制剂,醛糖还原酶抑制剂已由许多制药公司开发出来了。
此外,新的报导(Cunningham等人,J.Am.Coll.Nutrition13卷(第4期)344-350页,(1994年))表明抗坏血酸在抑制还原酶方面同任何该酶抑制剂药物一样有效。
在研究性治疗中,我们通过在注射链脲霉素(它损害胰腺的胰岛素分泌细胞)造成糖尿病的大鼠身上发生减慢神经传导的方法,开发了糖尿病并发症模型。该慢神经传导用胰岛素治疗可以恢复正常。用各种形式的γ—亚麻酸治疗或用各种醛糖还原酶抑制剂治疗也可使其恢复正常。
我们已绘制出表明通过使用GLA和所述酶抑制剂恢复正常神经传导的剂量响应曲线,实验细节见多种出版物,如N.E Cameron,M.A.Corter和S.Robertson,“Diabetes”,40卷,532-39页(1991)。基本上,大鼠用链脲霉素造成糖尿病,六周内不用GLA或其它脂肪酸治疗,然后用该脂肪酸治疗二周,试验中使用或不使用其它物质。该药剂的效果可通过与未治疗的糖尿病组比较传导速度恢复程度来显示。
我们已经研究了GLA和醛糖还原酶抑制剂ZD5522的作用之间的相互关系。在开始的实验中,按阈剂量给与每种活性物质,并期待在糖尿病模型上的传导速度产生约5%的改善。也预计同时给与两种治疗物质时作用最好也不过是相加的,即产生10%的改善。在几次实验中,结果并未由所采用的准确剂量所决定,实际的改善在40-80%的范围内,大约比期待值高1.5—6倍。这是个大出所料的结果,并具有极其重要的治疗意义,有希望极大地增强治疗效果,同时降低副作用,因为使用比通常要低的药物剂量就能达到治疗效果。使用第二个醛糖还原酶抑制剂WAY121509获得了类似的结果。
此外,当用抗坏血酸代替如醛糖还原酶抑制剂(ARIs)这样的药物时,最大的优点就是单独使用已知大剂量时身体可耐受的天然物质,并且,抗坏血酸以抗坏血酸GLA酯(ascorbyl-GLA)等的单一化合物形式非常容易被使用。
图1表示以各种形式存在的GLA的剂量响应曲线,其形式包括月见草油(EPO)、甘油—γ—亚麻酸二亚油酸酯(DLMG)和甘油三—γ—亚麻酸酯(tri-GLA)。该曲线表示链脲霉素致糖尿病大鼠与正常相比神经传导速度恢复的百分率。该曲线也表示当以mg/kg/天的GLA同样剂量(按GLA计)给药时不同来源的GLA的效果。它表明不同形式的GLA具有非常相似的效果。
图2表示当单独或一起给与8mg/kg/天GLA、0.25mg/kg/天ZD5522和0.2mg/kg/天WAY121509后,对正常和糖尿病动物神经传导速度的作用效果。ZD5522是3′,5′—二甲基—4′—硝基甲基—磺酰基(2—(2—甲苯基)N-乙酰苯胺。WAY121509是螺(异喹啉—4(1H),3′—吡咯烷)—1,2′,3′,5′—(2H)四酮。当单独给与所述剂量的这三种化合物时对神经传导只产生小的改善,但是,当将ZD5522或WAY121509与GLA一起使用时,其效果大大超出能由这些化合物的简单相加所预期的效果。
图3显示单独和一起给与GLA和抗坏血酸的效果,也显示单一化合物抗坏血酸GLA酯对坐骨神经血流和传导速率的作用效果。在一同给与GLA和抗坏血酸这两种化合物时的效果几乎等于它们的叠加效果,尽管它们本身均有效。然而,给与作为单一化合物的抗坏血酸GLA酯具有比分别给与GLA或抗坏血酸的效果之和以及一同给与这两种药物的效果明显要大的效果。显然供给单一化合物抗坏血酸GLA酯的效果更好,可能是因为它在体内需要的部位能同时释放出分子中的两种成分。
所以,本发明的一个方面是提供包含6—去饱和n-6脂肪酸尤其是GLA、DGLA或AA以及能降低身体细胞内山梨醇水平的物质尤其是醛糖还原酶抑制剂的药学上可接受的组合物。优选的抑制剂是抗坏血酸本身或其结合形式,如盐、酯或其它衍生物,特别是与脂肪酸所成的酯,但是,“药物”ARIs也可以使用。
本发明的另一个方面在于6-去饱和n-6脂肪酸,特别是GLA、DGLA或AA连同药学上可接受的能降低身体细胞内山梨醇水平的物质一起尤其是当所述物质是醛糖还原酶抑制剂时在治疗(包括预防性治疗)糖尿病长期并发症方面的用途。如上所述,优选抗坏血酸。通常一同给与所述活性物质,但是,本发明包括分别服用脂肪酸和能降低山梨醇水平的物质,但为能使它们在体内以有效量同时存在。
在又一个方面,本发明涉及用于治疗(包括预防性治疗)糖尿病长期并发症药物的制备,一同使用所述活性物质或使用它们中的一种,但在治疗时另一种活性物质也被分别服用。
本发明还提供新化合物6-去饱和n-6脂肪酸(除了GLA或DGLA之外)的抗坏血酸酯,特别是抗坏血酸AA酯,并且同样用于任何治疗中。
所以,本发明特别在于通过将最好选自GIA、DGLA或AA的EFA与抗坏血酸或其它能抑制醛糖还原酶或更一般地讲能降低体内山梨醇水平的物质一同配合使用来治疗糖尿病并发症,特别是神经病、视网膜病、肾病和心血管疾病,但不限于这些。所述活性物质可以单独制剂的方式被提供以一起服用(或如分别服用,则至少要保证在体内同时达到有效剂量),或提供组合的活性物质的制剂,在以上二种情况下均要采用适当的剂型。特别是,可以使用抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯。剂型可以是胶囊、片剂、粉剂、微囊、乳剂、脂质体,胶束或任何其它可供口服、经肠的、非肠道或局部给药的适当剂型,以及所有本领域技术人员所熟知的剂型。
该EFA的剂量可以在例如每日10mg至10g范围内,以每日100mg至5g为佳,以每日300mg至2g为更好,而单位剂量形式可含有以上剂量或该量的约数量。醛糖还原酶抑制剂的剂量与所选的物质有关,在这里只能概述为包括所有已知的该类药物宽范围内的有效日剂量,每种药物的最大用药剂量为0.01—100mg/kg/天,这适用于任何具有降低葡萄糖向山梨醇的转变的物质。例如ponalrestat、tolrestat和epalrestat都按0.1-20mg/kg/天剂量或按照依70kg成人计算相应量的较宽剂量范围内用药。对于抗坏血酸,其剂量例如可以是每日10mg至5g,以50mg至2g为佳,当以抗坏血酸GLA酯或其它结合形式存在时,按抗坏血酸来计算剂量。
EFA可以是在体内可释放出可利用的EFA的任何药学上可接受的形式。除了抗坏血酸EFAs酯外,特别适合的形式包括各种类型的甘油一酯甘油二酯和甘油三酯、游离脂肪酸、胆固醇酯、盐、酰胺和磷脂,并包括所有药学上可接受的形式。天然的月见草油或增加了DLMG(甘油二亚油酸—γ—亚麻酸酯)含量的月见草油是特别合适的,DLMG来自任何来源。也可以使用衍生自EFAs的脂肪醇。
下列的实施例按照先EFAs和已知醛糖还原酶抑制剂药物的组合物、然后EFAs和抗坏血酸的组合物、最后抗坏血酸的EFA酯的制备顺序说明本发明。具有合适的化学结构的“药物”ARIs也可以作为与EFAs一样的化合物,且这样的单一化合物大概会比分别给与这两种物质效果更好。实施例—醛糖还原酶抑制剂药物组合物
有许多不同的醛糖还原酶抑制剂(ARIs),且许多其它的抑制剂可能会被发现。同样可以发现按不同机理抑制山梨醇产生的药物。下列是一些使用已知ARIs的制剂的具体实施例:
1.含以甘油三酯、游离脂肪酸、盐或其它形式存在的GLA、DGLA或AA的400mg硬或软明胶胶囊与含ARI ponalrestat的300mg片剂共服,每日早晚均服2粒EFA胶囊和1片ponalrestat。
2.同实施例1,只是ARI是tolrestat,200mg片bd(每日二次)。
3.同实施例1,只是ARI是epalrestat150mg片bd或100mg tds(每日三次)。
4.同实施例1,只是用ADN-138(Ono)、SNK-860(Sanwa)、M16209(Fuji)、ZD5522(Zeneca)或WAY121509(Wyeth)代替上述的ARIs。
5.同实施例1至4,只是EFA和ARI被一同组合在同一剂型中,无论是胶囊、片剂、计量容器(metercd container),或是任何本领域技术人员所熟知的合适剂型如微囊、粉剂、脂质体、反相脂质体或经肠的、口服的、肠道外的或其它给药途径使用的形式。
6.同实施例1至4,只是EFA是按200mg、300mg、500mg、600mg、800mg或1g的胶囊配制且按每日总剂量为200mg至3g给药。实施例—抗坏血酸组合物
7.同实施例1或6的GLA、DGLA或AA和50mg至2g的抗坏血酸以片剂或其它适当的剂型每日服用。
8.抗坏血酸GLA酯(例如合成过程如下)或抗坏血酸DGLA酯或抗坏血酸AA酯被相应地用来给予每日的抗坏血酸的量,如前所述,特别是采用如下剂型:
(a)片剂,含有50、100、250、500或750mg的抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯,或者是其本身,或者还含有适宜的赋形剂。
(b)软明胶胶囊或硬明胶胶囊,含溶解在增加了GLA或DGLA的游离脂肪酸或甘油三酯中的50、100、250或500mg抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯,其中甘油三酯的一部分或多部分选自GLA或DGLA。
(c)乳剂、粉剂、液体、浆液或溶液,供口服、经肠的或肠道外给与抗坏血酸GLA酯或抗坏血酸DGLA酯。例如,可以用合适的乳化剂如蛋磷脂或燕麦半乳糖脂来制备乳剂,在成品乳剂中,抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯占乳剂重量的2%—30%。
(d)软膏剂、乳膏剂、洗剂、洗发剂或其它适宜的制剂供局部使用抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯。实施例—抗坏血酸EFAs酯的合成
9.抗坏血酸GLA酯
在合成中,在0℃中,将氯化氢气体(2.0g)鼓泡通入N,N—二甲基乙酰胺(26.5ml)中。将抗坏血酸(9.69g)在二氯甲烷(13.25ml)中的浆液加入到生成的浆状液体中,在0℃下搅拌该混合物直到出现澄明溶液。在0℃,氮气下,用4小时时间向该溶液中加入z,z,z—十八碳—6,9,12—三烯酰氯(GLA酰氯)(14.8g),使得到的混合物在上述温度下静置18小时,并在室温下静置1小时。冷却到0℃,加入乙酸乙酯(200ml)和水(100ml),并将该混合物搅拌1小时。用盐水(5×100ml)洗涤有机层,干燥(Na2SO4),并依次在50℃/10mmHg和50℃/0.1mm/4小时蒸发,得到浅黄色蜡状抗坏血酸—6—[(z,z,z)—十八碳—6,9,12—三烯酸酯](18.25g,收率88%)。
10.抗坏血酸GLA酯
将干燥的氯化氢气体(5.4份,g)在(-2)—2℃并搅拌下通入无水二甲基乙酰胺(71.25份,ml)和无水二氯甲烷(40份,ml)的混合物中。将抗坏血酸(26.05份,g)加至该混合物中,搅拌该混合物直至获得澄清的溶液。在氮气下,在(-2)—2℃用4-5小时时间滴加z,z,z—十八碳—6,9,12—三烯酰氯(γ—亚麻酰氯)(39.6份,g),再搅拌1-2小时后,将混合物在(-2)—2℃静置20-24小时。然后减压(25-30℃/20-30mb)除去二氯甲烷,搅拌下向得到的淤渣中加入水(250份,ml)。加入饱和食盐水(250份,ml),在氮气下剧烈搅拌该混合物10-15分钟。静置10-15分钟后,产物分成半固体和上层液体。除去水层,如上用水和盐水再反处理4次。将产物溶于乙酸乙酯(250份,ml)中,用水(2×50份,ml)提取,干燥(无水硫酸钠)。减压(35-40℃/20-30mb)除去乙酸乙酯,将残渣溶于乙醇(250份,ml)中。减压(35-40℃/20-30mb然后70-75℃/0.1—0.5mb/5小时)除去乙醇,得到浅黄色蜡状抗坏血酸—6—(z,z,z—十八碳—6,9,12—三烯酸酯),抗坏血酸GLA酯。
11.抗坏血酸DGLA酯
按类似的方法进行,只是用当量的z,z,z—二十碳—8,11,14—三烯酰氯(二高—γ—亚麻酰氯)代替—γ—亚麻酰氯,得到浅黄色蜡状抗坏血酸—6—(z,z,z—二十碳-8,11,14—三烯酸酯),抗坏血酸DGLA酯。
12.抗坏血酸AA酯
按类似的方法进行,只是用当量的z,z,z,z—二十碳—5,8,11,14—四烯酰氯(花生四烯酰氯)代替γ—亚麻酰氯,得到浅黄色蜡状抗坏血酸—6—(z,z,z,z—二十碳—5,8,11,14—四烯酸酯),抗坏血酸AA酯。

Claims (13)

1.  6—去饱和n—6脂肪酸特别是γ—亚麻酸(GLA)、二高—γ—亚麻酸(DGLA)或花生四烯酸(AA)连同能降低身体细胞内山梨醇水平的物质尤其是醛糖还原酶抑制剂一起的药学上可接受的组合物。
2.按照权利要求1的组合物,其中该抑制剂是抗坏血酸本身或其结合形式。
3.按照权利要求2的组合物,其中所述抗坏血酸是以抗坏血酸EFA酯特别是抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯形式存在的。
4.使用6-去饱和n-6脂肪酸尤其是GLA、DGLA或AA连同能降低身体细胞内山梨醇水平的药学上可接受的物质一起,尤其当所述物质是醛糖还原酶抑制剂时,治疗(包括预防性治疗)糖尿病的长期并发症。
5.按照权利要求4的治疗中,抗坏血酸本身或以结合形式特别是与脂肪酸形成的酯作为抑制剂的用途。
6.按照权利要求4的治疗中,以抗坏血酸EFA酯特别是抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯形式存在的抗坏血酸的用途。
7.按照权利要求4、5或6的治疗中,分别给与所述脂肪酸和能降低山梨醇水平的物质,但为能使它们在体内以有效量同时存在。
8.在制备用于治疗(包括预防性治疗)糖尿病的长期并发症的药物中,或者
a)在所述药物中同时使用6-去饱和n-6脂肪酸尤其是GLA、DGLA或AA和能降低身体细胞内的山梨醇水平的药学上可接受的物质尤其是醛糖还原酶抑制剂;或者
b)在所述药物中使用这样的n-6脂肪酸,当服用该药物时结合服用以单独的组合物形式存在的所述能降低细胞内山梨醇水平的物质;或者
c)在所述药物中使用这样的能降低细胞内山梨醇水平的物质,当服用该药物时结合服用以单独的组合物形式存在的所述脂肪酸。
9.按照权利要求8的用途,其中能降低细胞内的山梨醇水平的物质是抗坏血酸本身或其结合形式。
10.按照权利要求9的用途,其中抗坏血酸是以抗坏血酸EFA酯特别是抗坏血酸GLA酯、抗坏血酸DGLA酯或抗坏血酸AA酯形式存在。
11.  6-去饱和n-6必需脂肪酸(除GLA或DGLA以外)的抗坏血酸酯,特别是抗坏血酸AA酯。
12.用于治疗的6-去饱和n-6必需脂肪酸(除GLA或DGLA之外)的抗坏血酸酯,尤其是用于这样的用途的抗坏血酸AA酯。
13.  6—去饱和n-6必需脂肪酸尤其是GLA、DGLA或AA和抗坏血酸的药学上可接受的组合物,所述脂肪酸和抗坏血酸是分开的或是组合在一起的;所述组合物可有效地改善糖尿病的长期并发症。
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KR960000219A (ko) 1996-01-25
NZ272428A (en) 1997-07-27
US6069168A (en) 2000-05-30
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JPH08169823A (ja) 1996-07-02
AU2176395A (en) 1996-01-11
AU711482B2 (en) 1999-10-14
CA2152321A1 (en) 1995-12-29
FI953180A (fi) 1995-12-29
NO952573D0 (no) 1995-06-27
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