CN115887452A - Use of rapamycin for treating or preventing hepatitis B - Google Patents

Abstract

The present application provides the use of rapamycin, a deuterogen thereof or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for the treatment or prevention of hepatitis b, in particular the reduction of Hepatitis B Virus (HBV) load and/or HBsAg levels and/or HBeAg levels. The present application also provides a pharmaceutical composition for treating or preventing hepatitis b comprising rapamycin, a deuterogen thereof, or a pharmaceutically acceptable salt thereof, and optionally one or more additional therapeutic or prophylactic agents, and a pharmaceutically acceptable carrier.

Description

Use of rapamycin for treating or preventing hepatitis B

The application is a divisional application of Chinese patent application No. 202210172485.7, which is filed on 24.24.2.2.2022 and is named as the application of rapamycin in treating or preventing hepatitis B.

Technical Field

The application relates to the field of anti-hepatitis B medicines, in particular to application of rapamycin, a deuterogen thereof, a pharmaceutically acceptable salt thereof and a derivative thereof in medicines for treating or preventing hepatitis B, especially in medicines for reducing Hepatitis B Virus (HBV) load and/or HBsAg level and/or HBeAg level.

Background

Human Hepatitis B Virus (HBV) infection is a major public health problem worldwide. After acute hepatitis B virus infection, about 8% of hepatitis B virus still develops into chronic hepatitis B infection, and persistent HBV infection can cause cirrhosis and even liver cancer. Although the new hepatitis B infection rate is effectively controlled along with the wide popularization of hepatitis B vaccines, the hepatitis B carrying population is large, and the prevention and treatment of the hepatitis B become important to public health problems. The hepatitis B transmission pathway is mainly through vertical transmission and horizontal transmission. Vertical transmission refers to mother-to-baby transmission; horizontal transmission is primarily through the blood.

The treatment of hepatitis b is also a long-term process, and the treatment aims to inhibit or eliminate HBV to the maximum extent, relieve inflammation and necrosis of liver cells and liver fibrosis, delay and stop the progress of diseases, and reduce and prevent the occurrence of liver decompensation, liver cirrhosis, HCC and complications thereof, thereby improving the quality of life and prolonging the survival time.

There are many hepatitis b therapeutic drugs on the market today, mainly by antiviral treatment with interferon or nucleoside analogues. In the case of interferon, recombinant DNA leukocyte interferon (IFN-. Alpha.) inhibits the replication of HBV. However, when used for treating hepatitis B, interferon is often accompanied by strong adverse reactions, including myelosuppression, influence on thyroid function, depression and the like.

Nucleoside analogues inhibit HBV production primarily by inhibiting reverse transcriptase activity during HBV replication, and clinically useful drugs include the following classes: lamivudine and famciclovir, such as acyclovir, adefovir, entecavir, tenofovir, foscarnet and the like, and the medicaments have certain HBV inhibiting effect.

Although the reverse transcriptase inhibitors can effectively reduce the DNA level of HBV and enable patients to control the level of hepatitis B virus, the reverse transcriptase inhibitors have no direct effect on the elimination of HBeAg and HBsAg because the target of action is the process of reverse transcription of RNA into DNA. Therefore, the seroconversion probability of HBeAg and HBsAg in the single-drug treatment of the nucleoside analogue is extremely low, hepatitis B cannot be really cured, and patients need to take the drugs for a long time or even for life.

Although the reverse transcriptase inhibitor can control the level of hepatitis B virus, the problems of drug resistance, huge medical cost, serious side effects of the drug and the like are not small. The key point is that no medicine can completely eliminate viruses to functionally cure hepatitis B at present. Therefore, the urgent need in the art is to provide a new drug for treating hepatitis b, which can eliminate HBsAg and achieve a functional cure.

Rapamycin (Rapamycin) is a novel macrolide immunosuppressant, is a white solid crystal, has a melting point of 183-185 ℃, is lipophilic, is soluble in organic solvents such as methanol, ethanol, acetone, chloroform, etc., is very slightly soluble in water, and is hardly soluble in diethyl ether. The novel immunosuppressive agent has the advantages that the novel immunosuppressive agent is developed as early as the 20 th century in the 70 th, is originally used as an antifungal agent with low toxicity, has an immunosuppressive effect in 1977, is used for trial of RAPA as a novel drug for treating rejection reaction of organ transplantation in 1989, and is a novel immunosuppressive agent with good curative effect, low toxicity and no nephrotoxicity from the aspects of animal experiments and clinical application. It is now often used as a drug to maintain the immunological competence of transplanted organs (especially kidney transplantation) to slow down the immunological rejection after organ transplantation surgery, however scientists have recently found another use: can be used for treating Alzheimer disease (senile dementia).

Disclosure of Invention

The application provides the application of the rapamycin which can reduce the level of HBsAg and/or HBeAg and even eliminate the HBsAg and the HBeAg in preventing or treating hepatitis B, and the drug is expected to functionally cure hepatitis B and eliminate hepatitis B virus.

The present application provides a novel therapeutic option for hepatitis b by the use of rapamycin, a deuterogen thereof, or a pharmaceutically acceptable salt thereof for the treatment or prevention of hepatitis b.

In one aspect, the present application provides the use of rapamycin, a deuterogen thereof, a pharmaceutically acceptable salt thereof, or a derivative thereof in the manufacture of a medicament for treating or preventing hepatitis b, particularly reducing the level of HBsAg and/or HBeAg, and even eliminating HBsAg and HBeAg.

In one aspect, the present application provides the use of rapamycin, a deuterogen thereof, a pharmaceutically acceptable salt thereof, or a derivative thereof in the manufacture of a medicament for treating a hepatitis b virus carrier.

In some embodiments, the present application provides a use of rapamycin, a deuterogen thereof, a pharmaceutically acceptable salt thereof, or a derivative thereof in preparing a medicament for reducing HBsAg levels in a hepatitis b virus carrier.

In some embodiments, the present application provides a use of rapamycin, a deuterogen thereof, a pharmaceutically acceptable salt thereof, or a derivative thereof in the manufacture of a medicament for reducing HBsAg levels in an individual in which HBsAg is positive and HBeAg negative.

In a preferred embodiment, the derivative of rapamycin (compound 1) is selected from the following compounds 2-6 and deuterated products thereof, and compounds 1-6 in which the hydroxy group is protected with a protecting group:

wherein the protecting group is preferably an alkanoyloxy group, the alkyl group in the alkanoyloxy group may be, for example, a C1-10 alkyl group (e.g., C) _1-6 Alkyl) or C3-10 cycloalkyl (C3-6 cycloalkyl).

The hydroxy-protected compound may be, for example, as shown in the following formula 1:

wherein R is C1-10 alkyl (e.g. C) _1-6 Alkyl) or C3-10 cycloalkyl (C3-6 cycloalkyl).

The protecting group of the above-mentioned hydroxyl group (i.e., protected by an ester bond) can be degraded in vivo into the active compound itself by the catalytic action of esterase. Moreover, the enrichment expression of esterase in the liver achieves the effect of enriching the liver of active drugs.

In one embodiment, the pharmaceutically acceptable salt is rapamycin sodium salt.

In one embodiment, the medicament is capable of reducing the Hepatitis B Virus (HBV) load, HBsAg and/or HBeAg levels, particularly preferably reducing the HBsAg and/or HBeAg levels, such that it can be used in combination with existing nucleoside analogue drugs for the purpose of a functional cure of hepatitis b.

In one embodiment, the medicament further comprises one or more additional therapeutic or prophylactic agents.

In one embodiment, the additional therapeutic or prophylactic agent is selected from at least one of an interferon, a pegylated interferon, nitazoxanide or an analog thereof, a compound of formula A, or a nucleoside analog,

formula A

The nucleoside analogue is preferably selected from entecavir, tenofovir disoproxil fumarate and tenofovir alafenamide.

In one embodiment, the nucleoside analog is selected from entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide.

In one embodiment, the medicament is administered by a route selected from the group consisting of: oral, rectal, nasal, pulmonary, topical, buccal and sublingual, vaginal, parenteral, subcutaneous, intramuscular, intravenous, intradermal, intrathecal and epidural.

In one embodiment, the medicament is an oral formulation, for example in the form of a tablet or capsule.

In another aspect, the present application provides a pharmaceutical composition comprising a therapeutically effective amount of rapamycin, a deutero-derivative thereof, or a pharmaceutically acceptable salt thereof, and optionally one or more additional therapeutic or prophylactic agents, and a pharmaceutically acceptable carrier and/or excipient. The pharmaceutical composition can be used for treating or preventing hepatitis B.

The technical scheme of this application has following beneficial effect:

1. rapamycin or a pharmaceutically acceptable salt thereof is used in the treatment or prevention of hepatitis b, thus providing a novel therapeutic option for hepatitis b.

2. The rapamycin or the pharmaceutically acceptable salt thereof can effectively reduce the load of Hepatitis B Virus (HBV), the HBsAg level and/or the HBeAg level, has wide application prospect, particularly can reduce the HBsAg level, even can eliminate the HBsAg, can reduce the technical effect of the HBeAg level, and makes the functional cure of hepatitis B possible.

3. Rapamycin or pharmaceutically acceptable salts thereof have excellent clinical safety and pharmacokinetic properties, and have better druggability.

4. Rapamycin or a pharmaceutically acceptable salt thereof can optionally be combined with one or more additional therapeutic or prophylactic agents, in particular with agents that lower viral titres but do not completely eliminate the virus, do not reduce HBsAg and/or HBeAg levels, eliminate hepatitis b virus from different aspects, with the possibility of synergy.

Drawings

FIG. 1: different concentrations of rapamycin, 0.1nM entecavir, 10. Mu.M rapamycin and 0.1nM entecavir, inhibition of Hepatitis B Virus (HBV) load.

FIG. 2 is a schematic diagram: different concentrations of rapamycin, 0.1nM of entecavir, 10. Mu.M of rapamycin, and 0.1nM of entecavir, have inhibitory effect on HBsAg.

FIG. 3: different concentrations of rapamycin, 0.1nM entecavir, 10. Mu.M rapamycin and 0.1nM entecavir, inhibiting HBeAg.

FIG. 4 is a schematic view of: effect of different concentrations of rapamycin, 0.1nM of entecavir, 10 μ M of rapamycin and 0.1nM of entecavir on cell viability.

Detailed Description

In one aspect of the present application, there is provided the use of rapamycin, a deuteride thereof, a derivative thereof or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for the treatment or prevention of hepatitis b, in particular for reducing the Hepatitis B Virus (HBV) load, HBsAg and/or HBeAg levels, particularly preferably for reducing HBsAg and/or HBeAg levels.

In one aspect, the present application provides the use of rapamycin, a deuteron thereof, a derivative thereof, or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for treating or preventing hepatitis b.

In a preferred embodiment, the derivative of rapamycin is selected from compounds 2-6 and deuterates thereof and compounds 1-6 wherein the hydroxy group is protected with a protecting group:

wherein the protecting group is preferably an alkanoyloxy group.

The hydroxy-protected compound may be represented by, for example, the following formula 1:

wherein R is C1-10 alkyl (e.g. C) _1-6 Alkyl) or C3-10 cycloalkyl (e.g., C3-6 cycloalkyl).

The hydroxyl groups therein are protected by ester bonds and can be degraded in vivo by the catalytic action of esterases to the active compounds themselves. Moreover, the enrichment expression of esterase in the liver achieves the effect of enriching the liver of active drugs.

In one embodiment, the present application provides the use of rapamycin deuteration, i.e., deuterated rapamycin, in the treatment of hepatitis b. For those skilled in the art, generally speaking, the deuterated compound does not change the original properties of the compound, but can slow down the metabolic process, thereby prolonging the half-life and more effectively playing the role of the drug.

In one embodiment, the pharmaceutically acceptable salt is rapamycin hydrochloride. In one embodiment, the medicament is capable of reducing Hepatitis B Virus (HBV) load, HBsAg and/or HBeAg levels.

Rapamycin (Rapamycin) is a novel macrolide immunosuppressant, is a white solid crystal, has a melting point of 183-185 ℃, is lipophilic, is soluble in organic solvents such as methanol, ethanol, acetone, chloroform, etc., is very slightly soluble in water, and is hardly soluble in diethyl ether. The novel immunosuppressive agent has the advantages that the novel immunosuppressive agent is developed as early as the 20 th century in the 70 th, is originally used as an antifungal agent with low toxicity, has an immunosuppressive effect in 1977, is used for trial of RAPA as a novel drug for treating rejection reaction of organ transplantation in 1989, and is a novel immunosuppressive agent with good curative effect, low toxicity and no nephrotoxicity from the aspects of animal experiments and clinical application. It is now often used as a drug to maintain the immunological competence of transplanted organs (especially kidney transplantation) to slow down the immunological rejection after organ transplantation surgery, however scientists have recently found another use: can be used for treating Alzheimer disease (senile dementia). However, there are no reports that it can be used for treating hepatitis B, let alone that it can reduce HBsAg and/or HBeAg levels.

Viral hepatitis

The etiological typing of viral hepatitis is currently recognized by five hepatitis viruses, namely hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus and hepatitis E virus, which are respectively written as HAV, HBV, HCV, HDV and HEV, and the rest are RNA viruses except the hepatitis B virus which is a DNA virus.

Hepatitis b is an infectious disease mainly caused by hepatitis b virus, and is a liver disease. Clinically, the symptoms of anorexia, nausea, epigastric discomfort, liver pain and hypodynamia are mainly manifested. Some patients may have jaundice fever and hepatomegaly with impaired liver function. Some patients may become chronically even develop cirrhosis of the liver, and a few may develop liver cancer.

The etiological agent of hepatitis b is hepatitis b virus, abbreviated as HBV, which is DNA virus. The genome is a double-stranded, circular, incompletely closed DNA. The outermost layer of the virus is the outer membrane or coat membrane of the virus, the inner layer is the core part, and the nucleoprotein is the core antigen (HBcAg) and cannot be detected in the serum. The serum of HBsAg positive persons was observed under electron microscope to show 3 kinds of particles, circular and filamentous particles with a diameter of 22nm, and less spherical particles with a diameter of 42 angstroms, also called Dane's particles, as complete HBV particles.

The markers for hepatitis b were detected as follows: (1) HBsAg and anti-HBs: HBsAg positive indicates that HBV is currently in the stage of infection, and anti-HBs positive for immunoprotective antibodies indicates that immunity to HBV has developed. Hepatitis B virus carriers are also called chronic HBsAg carriers, and the diagnosis basis is that only HBsAg is positive, namely HBsAg is positive. Hepatitis B virus carriers usually have no clinical symptoms and signs, and the liver function is normal. (2) HBeAg and anti-HBe: HBeAg positive is an index of HBV active replication and strong infectivity, and the change of the detected serum from HBeAg positive to anti-HBe positive indicates that the disease has remission and weakened infectivity. (3) HBcAg vs anti-HBc: HBcAg positive suggests that there is a direct reaction of complete HBV particles, and active replication of HBV is less clinically useful due to the complex detection method. anti-HBc is a marker of HBV infection, and anti-HBc IgM positive indicates that the virus is replicated in vivo at an early stage of infection. HBsAg, HBeAg and anti-HBc are all positive in chronic mild hepatitis B and HBsAg carriers, and have high infectivity index and are difficult to convert from negative to positive.

Additional therapeutic or prophylactic agents

In one embodiment, the medicament of the present application further comprises one or more additional therapeutic or prophylactic agents. In one embodiment, the additional therapeutic or prophylactic agent is selected from an interferon or a nucleoside analog. In one embodiment, the nucleoside analog is selected from entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide.

The above analogues of nitazoxanide include, but are not limited to, those disclosed in CN102803203B, such as compounds of formula I:

wherein R is ₁ Is the following group: hydroxy or C ₁ -C ₃ An alkanoyloxy group; r ₂ To R ₅ Is H; r ₆ Is CF ₃ (ii) a X is N, W is S, and Y is CH.

In some embodiments, the additional therapeutic or prophylactic agent is selected from one or more of entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide, for example, one selected from entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide or at least two selected from entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide.

Entecavir (Entecavir) is chemically known as 2-amino-1, 9-dihydro-9- [ (1s, 3r, 4s) -4-hydroxy-3- (hydroxymethyl) -2-methylenecyclopentane ] -6H-purin-6-one and has the following structural formula:

US5206244A discloses entecavir and its use for the treatment of hepatitis b virus; a novel method for synthesizing entecavir is disclosed in WO9809964 A1; WO0164421A1 discloses low dose entecavir solid formulations.

Entecavir is a highly effective antiviral agent, developed by schrobo corporation in the 90 s of the 20 th century, and has a strong anti-HBV effect. It can be phosphorylated to active triphosphate, and the half-life of triphosphate in cell is 15h. Entecavir triphosphate inhibits all three activities of the viral polymerase (reverse transcriptase) by competing with deoxyguanosine triphosphate, the natural substrate of HBV polymerase: (1) the initiation of HBV polymerase; (2) formation of a reverse transcribed negative strand of the pregenomic mRNA; (3) synthesis of HBV DNA plus strand.

Tenofovir disoproxil fumarate (British name: tenofovir disoproxil fumarate, TDF; chemical name is (R) - [ [2- (6-amino-9H-purin-9-yl) -1-methylethoxy ] methyl ] phosphonic acid diisopropoxycarbonylmethyl ester fumarate) is an ester precursor of Tenofovir, belongs to a novel nucleotide reverse transcriptase inhibitor, and has the activity of inhibiting HBV viruses.

TDF is another novel open-ring nucleoside phosphonate successfully developed by Gilidard company in the United states following Adefovir dipivoxil, is first marketed in the United states in 10 months in 2001, and is currently marketed in countries such as Europe, australia, and Canada.

TDF inhibits viral polymerase in vivo by competitively binding to the natural deoxyribose substrate and terminates DNA strand synthesis by insertion into DNA. The main action mechanism is that the tenofovir is hydrolyzed into tenofovir after being orally taken, the tenofovir is phosphorylated by cell kinase to generate a metabolite tenofovir diphosphate with pharmacological activity, the tenofovir diphosphate competes with 5 '-triphosphate deoxyadenosine monophosphate to participate in the synthesis of virus DNA, and after entering the virus DNA, the DNA is prevented from being prolonged due to the lack of 3' -OH groups, so that the replication of the virus is blocked. Clinical application shows that TDF has obvious curative effect on HBV virus and less toxic side effect, so that TDF has wide clinical application foreground.

Tenofovir Alafenamide (Tenofovir Alafenamide), a prodrug of the new Nucleoside Reverse Transcriptase Inhibitor (NRTI) Tenofovir (Tenofovir) developed by Gilidard scientific, USA. Compared with the prior generation of similar anti-hepatitis B medicine tenofovir disoproxil TDF, the antiviral activity of tenofovir alafenamide is 10 times, the stability in blood plasma is 200 times, and the half-life period is improved by 225 times. Compared with TDF, the tenofovir alafenamide only needs one tenth of TDF administration dosage to achieve the same antiviral curative effect as TDF. Therefore, the tenofovir alafenamide is used for preventing or/and treating Hepatitis B Virus (HBV) infection and has better curative effect, higher safety and lower drug resistance.

In addition to the active agents described above, the medicaments or pharmaceutical compositions described herein may optionally also compriseContaining one or more additional agents useful for the treatment of HBV, such as, but not limited to, 3-dioxygenase (IDO) inhibitors, antisense oligonucleotides targeted to viral mRNA, apolipoprotein A1 modulators, arginase inhibitors, B-and T-lymphocyte attenuating agent inhibitors, bruton's Tyrosine Kinase (BTK) inhibitors, CCR2 chemokine antagonists, CD137 inhibitors, CD160 inhibitors, CD305 inhibitors, CD4 agonists and modulators, compounds targeting HBcAg, compounds targeting hepatitis B core antigen (HBcAg), covalently closed circular DNA (cccDNA) inhibitors, cyclophilin inhibitors, cytokines, cytotoxic T-lymphocyte-associated protein 4 (ipi 4) inhibitors, DNA polymerase inhibitors, endonuclease modulators, epigenetic modifiers, farnesol X receptor agonists, gene modifiers or editors, HBsAg inhibitors, HBsAg secretion or assembly inhibitors, HBV antibodies, HBV DNA polymerase inhibitors, HBV replication inhibitors, HBV RNase inhibitors, HBV vaccines, HBV viral entry inhibitors, HBx inhibitors, hepatitis B large envelope protein modulators, hepatitis B large envelope protein stimulators, hepatitis B structural protein modulators, hepatitis B surface antigen (HBsAg) inhibitors, hepatitis B surface antigen (HBsAg) secretion or assembly inhibitors, hepatitis B virus E antigen inhibitors, hepatitis B virus replication inhibitors, hepatitis virus structural protein inhibitors, HIV-1 reverse transcriptase inhibitors, hyaluronidase inhibitors, IAP inhibitors, IL-2 agonists, IL-7 agonists, immunoglobulin G modulators, immunomodulators, indoleamine-2, ribonucleotide reductase inhibitors, interferon agonists, interferon alpha 1 ligands, interferon alpha 2 ligands, interferon alpha 5 ligand modulators, interferon alpha ligands, interferon alpha ligand modulators, interferon alpha receptor ligands, interferon beta ligands, interferon receptor modulators, interleukin-2 ligands, ipi4 inhibitors, lysine demethylase inhibitors, histone demethylase inhibitors, KDM5 inhibitors, KDM1 inhibitors, killer lectin-like receptor subfamily G member 1 inhibitors, lymphocyte activation gene 3 inhibitors, lymphotoxin beta receptor activators, microRNA (miRNA) gene therapy agents, axl modulators, B7-H3 modulators, B7-H4 modulators, CD160 modulatorsAgents, CD161 modulators, CD27 modulators, CD47 modulators, CD70 modulators, GITR modulators, HEVEM modulators, ICOS modulators, mer modulators, NKG2A modulators, NKG2D modulators, OX40 modulators, SIRPa modulators, TIGIT modulators, tim-4 modulators, tyro modulators, na ⁺ -a taurate cotransporter polypeptide (NTCP) inhibitor, a natural killer cell receptor 2B4 inhibitor, an NOD2 gene stimulator, a nucleoprotein inhibitor, a nucleoprotein modulator, a PD-1 inhibitor, a PD-L1 inhibitor, PEG-interferon lambda, a peptidyl prolyl isomerase inhibitor, a phosphatidylinositol-3 kinase (PI 3K) inhibitor, a recombinant Scavenger Receptor A (SRA) protein, recombinant thymosin alpha-1, a retinoic acid-inducing gene 1 stimulator, a reverse transcriptase inhibitor, a ribonuclease inhibitor, an RNA DNA polymerase inhibitor, a short interfering RNA (siRNA), a short synthetic hairpin RNA (sshRNA)), a SLC10A1 gene inhibitor, a SMAC zinc finger mimetic, a Src tyrosine kinase inhibitor, an interferon gene stimulator (stingg) agonist, a NOD1 stimulator, a T cell surface glycoprotein CD28 inhibitor, a T cell surface glycoprotein CD8 modulator, a thymosin agonist, a talin alpha 1 ligand, a Tim-3 inhibitor, a TLR-3 agonist, a TLR-7 agonist, a TLR-9 gene stimulator, a TLR-like nuclease (TLR reductase) inhibitor, or a combination thereof.

Definition of terms

As used herein, "therapeutically effective amount" or "effective amount" refers to an amount that is effective at a dose and for a period of time required to achieve a desired therapeutic result. A therapeutically effective amount of a therapeutic agent for hepatitis b will depend on the nature of the disorder or condition and on the particular agent, and can be determined by standard clinical techniques known to those skilled in the art.

As used herein, "treatment" may be, e.g., alleviation of symptoms, prolongation of survival, increased mobility, etc. Treatment need not be a "cure".

By "pharmaceutically acceptable" herein is meant a substance that does not affect the biological activity or properties of the compounds of the present application and is relatively non-toxic, i.e., the substance can be administered to an individual without causing an adverse biological response or interacting in an adverse manner with any of the components contained in the composition.

By "carrier" herein is meant a relatively non-toxic substance that facilitates the introduction of the compounds of the present application into a cell or tissue.

"pharmaceutically acceptable salts" herein refers to pharmaceutically acceptable acid addition salts and pharmaceutically acceptable base addition salts of rapamycin or a derivative thereof. "pharmaceutically acceptable acid addition salts" refers to salts with inorganic or organic acids which retain the biological effectiveness of the free base without other side effects. "pharmaceutically acceptable base addition salts" refers to salts which retain the biological effectiveness of the free acid without other side effects, and may be salts obtained with inorganic or organic bases. Salts derived from inorganic bases include, but are not limited to, sodium, potassium, lithium, ammonium, calcium, magnesium, iron, zinc, copper, manganese, aluminum, and the like. Salts derived from organic bases include, but are not limited to, salts with various amines, such as primary, secondary and tertiary amines, substituted or substituted amines, and the like.

As used herein, "reducing the Hepatitis B Virus (HBV) load" refers to reducing the amount of hepatitis B virus DNA in the blood of a detectable patient.

As used herein, "reducing the level of HBsAg and/or HBeAg" refers to reducing the amount of hepatitis B virus HBsAg and/or HBeAg in the blood of a detectable patient.

The amount of HBsAg and/or HBeAg is often closely related to a curative effect on hepatitis B function.

Route of administration

In one embodiment, the medicament is formulated for administration by a route selected from the group consisting of: oral, rectal, nasal, pulmonary, topical, buccal and sublingual, vaginal, parenteral, subcutaneous, intramuscular, intravenous, intradermal, intrathecal and epidural.

In one embodiment, the medicament is formulated for oral administration, preferably in the form of a tablet or capsule.

The medicament or pharmaceutical composition of the present application is administered by any route suitable for the condition to be treated. Suitable routes include oral, rectal, nasal, pulmonary, topical (including buccal and sublingual), vaginal and parenteral (including subcutaneous, intramuscular, intravenous, intradermal, intrathecal and epidural) and the like. In certain embodiments, the medicament or pharmaceutical composition disclosed herein is administered by intravenous injection. It will be appreciated that the preferred route may vary depending on, for example, the condition of the recipient. One advantage of the medicaments or pharmaceutical compositions of the present application is that they are orally bioavailable and can be administered orally.

Pharmaceutical composition

In certain embodiments, rapamycin, a deuterogen thereof, a pharmaceutically acceptable salt thereof, or a derivative thereof is administered in a pharmaceutical composition. The pharmaceutical compositions of the present application may comprise conventional carriers and/or excipients (which will be selected in accordance with common practice). Tablets may contain excipients such as glidants, fillers, binders and the like. Aqueous formulations are prepared in sterile form and, when used for delivery by non-oral administration, are generally isotonic. All formulations will optionally contain Excipients such as those described in the Handbook of Pharmaceutical Excipients (1986). Excipients include ascorbic acid and other antioxidants, chelating agents such as EDTA, carbohydrates such as dextran, hydroxyalkyl cellulose, hydroxyalkyl methyl cellulose, stearic acid, and the like. The pH of the formulation ranges from about 3 to about 11, but is typically from about 7 to 10. In some embodiments, the pH of the formulation ranges from about 2 to about 5, but is typically about 3 to 4.

The formulations include those suitable for the aforementioned routes of administration. The formulations may conveniently be presented in unit dosage form and may be prepared by any of the methods well known in the art of pharmacy. Techniques and formulations are commonly found in Remington's Pharmaceutical Sciences (Mack Publishing co., easton, PA). Such methods include the step of bringing into association the active ingredient with the carrier which is composed of one or more accessory ingredients. In general, the formulations are prepared by uniformly and intimately bringing into association the active ingredient with liquid carriers or finely divided solid carriers or both, and then shaping the product as necessary.

Pharmaceutical compositions of the present application suitable for oral administration may exist as follows: a capsule or tablet; a powder or granules; solutions or suspensions in aqueous or non-aqueous liquids; or an oil-in-water liquid emulsion or a water-in-oil liquid emulsion.

Tablets are made by compression or molding, optionally with one or more accessory ingredients. Compressed tablets may be prepared by: the active ingredient in a free-flowing form such as a powder or granules is compressed in a suitable machine, optionally mixed with a binder, lubricant, inert diluent, preservative, surfactant or dispersant. Molded tablets may be prepared by molding in a suitable machine a mixture of the powdered active ingredient moistened with an inert liquid diluent. The tablets may optionally be coated or scored and optionally formulated so as to provide sustained or controlled release of the active ingredient therefrom.

Formulations for oral use may also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert solid diluent, for example, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredient is mixed with water or an oil medium, for example peanut oil, liquid paraffin, or olive oil.

The pharmaceutical compositions of the present application may also be in the form of a sterile injectable preparation, such as a sterile injectable aqueous or oleaginous suspension. The suspension may be formulated according to the known art using those suitable dispersing or wetting agents and suspending agents which have been mentioned above. The sterile injectable preparation may also be a sterile injectable solution or suspension in a non-toxic parenterally-acceptable diluent or solvent, for example, as a solution in 1, 3-butanediol, or as a lyophilized powder. Acceptable carriers and solvents that may be employed include water, ringer's solution and isotonic sodium chloride solution. In addition, sterile fixed oils are conventionally employed as a solvent or suspending medium. For this purpose, any bland fixed oil may be employed including synthetic mono-or diglycerides. In addition, fatty acids such as oleic acid find use in the preparation of injectables. Acceptable carriers and solvents that may be employed include water, ringer's solution, isotonic sodium chloride solution and hypertonic sodium chloride solution.

All active ingredients of the pharmaceutical composition can be prepared into one dosage form, and can also be combined into a combined product in independent dosage forms.

Detailed Description

The following examples are for illustrative purposes only and are not intended to limit the present application. Additional objects, advantages and novel features of the present application will become apparent to one of ordinary skill in the art upon examination of the following examples.

Examples

Example 1 evaluation of the in vitro anti-HBV Activity of the test Compound rapamycin Using HepG2-NTCP cells

The compound preparation method comprises the following steps:

in the case of preparation of a concentration of 10mM, the volume (. Mu.l) = sample mass (. Mu.l) × purity ÷ molecular weight ÷ 10X 10 of DMSO as solvent ⁶

Rapamycin was purchased from shanghai pottery biotechnology limited. Control compounds include entecavir (ETV, batch No.: P1214012;99.0% purity) available from Shanghai Tantake Technology, inc.; the mother liquors of the above control compounds were all at 20mM and stored at-20 ℃.

HepG2-NTCP cells were purchased from Shanghai drug Mingkude New drug development, inc. The cell subculture medium was DMEM medium (Gibco cat. No. 11960051) containing 10% fetal bovine serum (FBS, exCell cat. No. FSP 500), 500. Mu.g/ml G418, 1% glutamine, 1% NEAA (non-essential amino acids), 1mM sodium pyruvate, 1% penicillin-streptomycin, and was mainly used for subculture of cells. The cell plating medium was DMEM medium (Gibco cat. No. 11960051) containing 2% fetal bovine serum (FBS, exCell cat. No. FSP 500), 500. Mu.g/ml G418, 1% glutamine, 1% NEAA (non-essential amino acids), 1mM sodium pyruvate, 1% penicillin-streptomycin, the plating mainly used for cells, and the exchange solution.

Table 1: primary reagents and cellular viruses

Experimental protocol cell plating and Compound treatment

HepG2-NTCP planking

Day 0, hepG2-NTCP cells were seeded48 well cell plate (7.5X 10) ⁴ Cells/well).

Infectious virus and compound treatment

On day 2, cells were pretreated by adding a culture medium with a predetermined concentration of a compound for 2 hours, and then D-type HBV was added to infect HepG2-NTCP cells (infection was accompanied by addition of a culture medium with a predetermined concentration of a compound). The tested compound is provided with 3 single-drug concentrations and 1 combined drug concentration, the three single-drug concentrations of the rapamycin are respectively 0.1, 1 and 10 mu M, and the combined drug concentration is rapamycin 10 mu M + ETV 0.1nM; control compounds were ETV,7 concentrations, wells containing DMSO alone without compound were set simultaneously with ETV single drug concentration 0.1nm,2 duplicate wells tested.

The culture medium containing the compound was changed once on day 3, day 5 and day 7. On day 9, cell supernatants were collected for detection of HBV DNA (qPCR), HBeAg and HBsAg (ELISA). After the cell supernatant was collected, cellTiter-Glo (Promega cat # G7558) was added to test the cell viability, and the detailed procedure is shown in Table 2.

Table 2: experimental procedure

Sample detection

1) qPCR method for detecting HBV DNA content in cell culture supernatant

DNA was extracted from the cell culture supernatant according to the QIAamp 96DNA Blood Kit instructions. The sample volume was 120. Mu.l, and the DNA elution volume was 120. Mu.l of supernatant. qPCR detects the HBV DNA content.

As shown in table 3, qPCR reaction solutions were prepared.

TABLE 3.QPCR reaction solution

Composition of PCR reaction solution	1 volume required for the reaction system
		FastStart Universal Probe Master(2×)	5μl
Forward primers (10. Mu.M) were purchased from the drug Mingkude	0.4μl
		Reverse primers (10. Mu.M) were purchased from Yao Mingkude	0.4μl
Probe (10. Mu.M) purchased from the drug Mingkude	0.2μl
		Templates (samples or standards) were purchased from the drug Mingkude	2μl

The qPCR reaction mix was added to 384 well reaction plates and 2 μ l of sample or standard was added to the corresponding wells, with a total volume of 10 μ l per reaction well. And (3) PCR reaction: 10 minutes at 95 ℃;95 ℃,15 seconds, 60 ℃,1 minute, 40 cycles.

2) ELISA method for detecting content of HBsAg and HBeAg in cell culture supernatant

The method refers to the kit specification, and the method is briefly described as follows: respectively taking 50 mu l of standard substance, sample and reference substance, adding 50 mu l of enzyme conjugate into each hole, incubating for 60 minutes at 37 ℃, washing the plate with washing liquor, sucking dry, adding 50 mu l of premixed luminescent substrate, incubating for 10 minutes at room temperature in a dark place, and finally measuring the luminescent value by an enzyme-linked immunosorbent assay.

3) Cell viability assay

After the supernatant was collected, the medium and CellTiter-Glo were mixed in equal volumes, 50. Mu.l of the mixture was added to each well, and the plate was shaken at room temperature in the dark for 10 minutes to measure the luminescence value.

4) Data computation

HBV DNA inhibition (%) = (1-HBV DNA copy number of sample of compound group/HBV DNA copy number of DMSO group) × 100%

HBsAg inhibition (%) = (1-HBsAg value of sample/DMSO control HBsAg value) × 100%

HBeAg inhibition (%) = (1-HBeAg value of sample/DMSO control HBeAg value) × 100%

Cytotoxicity% =100- [ (sample luminescence value-medium control luminescence value)/(DMSO control luminescence value-medium control luminescence value) ] × 100%

Data analysis

As shown in FIG. 1, rapamycin has inhibitory effect on HBV DNA. 10 mu M and 1 mu M rapamycin show obvious inhibition on HBV DNA in HepG2-NTCP cells, and the inhibition rates respectively reach 62.19 percent and 46.28 percent. The inhibition rate of 0.1nM ETV on HBV DNA reaches 50.09%; the inhibition rate of 10 mu M rapamycin +0.1nM ETV on HBV DNA reaches 70.31%. When 10 mu M rapamycin is used together with 0.1nM ETV, the inhibition rate of HBV DNA can be improved.

As shown in FIG. 2, rapamycin has a significant inhibitory effect on HBsAg. The inhibition rates of 10 mu M and 1 mu M of rapamycin on HBsAg in HepG2-NTCP cells reach 99.60 percent and 72.85 percent respectively. The inhibition rate of 10 mu M rapamycin +0.1nM ETV on HBsAg reaches 99.34%.

Compared with the ETV of 0.1nM which has no obvious inhibition effect on the HBsAg, 10 mu M and 1 mu M of rapamycin have obvious inhibition effect on the HBsAg, and the inhibition effect of high-dose rapamycin on the HBsAg is better than that of a low-dose group.

As shown in FIG. 3, rapamycin has a significant inhibitory effect on HBeAg. The inhibition rates of 10 mu M, 1 mu M and 0.1 mu M of rapamycin to HBeAg in HepG2-NTCP cells respectively reach 94.56%, 70.14% and 41.49%, and 0.1nM ETV has no obvious inhibition effect on HBeAg; the inhibition rate of 10 mu M rapamycin +0.1nM ETV on HBeAg reaches 96.08%.

Compared with the ETV of 0.1nM without significant inhibition of HBeAg, the rapamycin with high dose can better play the inhibition of HBeAg.

The results of the cell viability assay are shown in FIG. 4. It can be seen that rapamycin has little effect on cell viability, and particularly, rapamycin at low concentrations of 1 μ M and 0.1 μ M has little effect on cell viability. At low concentrations, the inhibitory rates against HBV DNA and HBsAg, HBeAg, etc. are still high.

The test results show that compared with ETV, the rapamycin 10 mu M drug group has obvious inhibition effect on HBV DNA, HBsAg and HBeAg, and particularly achieves the inhibition effect of more than 90% on HBsAg and HBeAg; rapamycin has a significant inhibitory effect on HBV, particularly HBsAg and HBeAg, so that rapamycin can be used as a candidate drug for functionally curing hepatitis B and eliminating hepatitis B virus, and particularly when the rapamycin is used in combination with a nucleoside analogue drug which can reduce the HBV titer but cannot reduce HBsAg and HBeAg, for example, when the nucleoside analogue drug is used to reduce the virus titer first and the virus content in a human body reaches a lower level, rapamycin is used to further eliminate HBsAg and HBeAg, so that virus can be further eliminated, and even completely cured.

Example 2

Rapamycin is administered to human subjects that are HBsAg positive, and all of the human s antigens are positive, while some of the e antigens are negative and some are positive. Rapamycin was administered orally once daily at a daily dose of 1mg for one month. The results are shown in the following table:

the experimental result shows that rapamycin has more prominent effect of inhibiting s antigen in individuals with positive s antigen and negative e antigen.

While the present application has been described with reference to particular embodiments, those skilled in the art will recognize that changes or modifications can be made to the described embodiments without departing from the spirit and scope of the present application, which is defined by the appended claims.

Claims (9)

1. Use of rapamycin, a deuteride thereof, a pharmaceutically acceptable salt thereof or a derivative thereof in the manufacture of a medicament for reducing the Hepatitis B Virus (HBV) load and/or the level of HBsAg and/or the level of HBeAg.

2. Use according to claim 1, wherein the use is the reduction of HBsAg levels and/or HBeAg levels.

3. Use of rapamycin, a deuteride thereof, a pharmaceutically acceptable salt thereof or a derivative thereof in the manufacture of a medicament for treating or preventing HBsAg-positive and HBeAg-negative viral hepatitis B.

4. Use according to claim 3, characterized in that the HBsAg level of the viral hepatitis B is turned negative.

5. The use of any one of claims 1 to 4, wherein the derivative of rapamycin is selected from the group consisting of compounds in which the hydroxyl group of rapamycin is protected, compounds 2 to 6 and deuterions thereof, and compounds in which the hydroxyl group is protected with a protecting group:

preferably, the protecting group is an alkanoyloxy group.

6. The use of any one of claims 1-5, wherein the pharmaceutically acceptable salt is rapamycin sodium salt.

7. The use of any one of claims 1-6, wherein the medicament further comprises one or more additional therapeutic or prophylactic agents, wherein the additional therapeutic or prophylactic agent is preferably selected from at least one of an interferon, a PEGylated interferon, nitazoxanide or an analog thereof, a compound of formula A, or a nucleoside analog,

the nucleoside analogue is preferably selected from entecavir, tenofovir disoproxil fumarate and tenofovir alafenamide.

8. The use of any one of claims 1-7, wherein the medicament is a medicament administered by a route selected from the group consisting of: oral, rectal, nasal, pulmonary, topical, buccal and sublingual, vaginal, parenteral, subcutaneous, intramuscular, intravenous, intradermal, intrathecal and epidural.

9. A pharmaceutical composition for the treatment or prevention of hepatitis B comprising a therapeutically effective amount of rapamycin, a deuteron thereof or a pharmaceutically acceptable salt thereof, and optionally one or more additional therapeutic or prophylactic agents, wherein the additional therapeutic or prophylactic agent is preferably selected from at least one of an interferon, a PEGylated interferon, nitazoxanide or an analogue thereof, a compound of formula A, or a nucleoside analogue,

the nucleoside analogue is preferably selected from entecavir, tenofovir disoproxil fumarate and tenofovir alafenamide.

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