EP0581906A1 - ABROGATION OF VIRAL RESISTANCE TO NUCLEOSIDE ANALOGUES BY DOUBLE-STRANDED RNAs - Google Patents
ABROGATION OF VIRAL RESISTANCE TO NUCLEOSIDE ANALOGUES BY DOUBLE-STRANDED RNAsInfo
- Publication number
- EP0581906A1 EP0581906A1 EP92917298A EP92917298A EP0581906A1 EP 0581906 A1 EP0581906 A1 EP 0581906A1 EP 92917298 A EP92917298 A EP 92917298A EP 92917298 A EP92917298 A EP 92917298A EP 0581906 A1 EP0581906 A1 EP 0581906A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- azt
- lock
- dsrna
- mismatched dsrna
- patient
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/70—Carbohydrates; Sugars; Derivatives thereof
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/12—Antivirals
- A61P31/14—Antivirals for RNA viruses
- A61P31/18—Antivirals for RNA viruses for HIV
Definitions
- Nucleoside analogues are commonly employed antiviral agents, particularly against retroviruses. Viruses undergo genetic changes, or mutations, leading to relative resistance to these antiviral agents. When resistance occurs, the viruses multiply more quickly and the underlying disease accelerates. By deploying dsRNAs relatively early in the
- nucleoside analogues are incorporated into viral genetic information which thereby becomes faulty or
- nucleoside analogue administering an effective amount over a suitable time of a mismatched dsRNA prior to therapy with a nucleoside analogue.
- PBMC peripheral blood mononuclear blood cells
- T4 or CD 4 lymphocytes a retrovirus that has become resistant to nucleoside analogues
- the dsRNA may be a complex of a polyinosinate and a polycytidylate containing a proportion of uracil bases or guanidine bases, e.g., from 1 in 5 to 1 in 30 such bases (poly I ⁇ poly(C 4-29 ⁇ >U or G)).
- the dsRNA may be of the general formula
- rI n ⁇ r(c 11-14 ,U)n or rI n .r(C 12 ,U)n.
- dsRNA dsRNA
- mismatched dsRNA are meant those in which hydrogen bonding (base stacking) between the
- counterpart strands is relatively intact, i.e., is interrupted on average less than one base pair in every 29 consecutive base pair residues.
- mismatched dsRNA should be understood accordingly.
- mismatched dsRNAs preferred for use in the present invention are based on copolynucleotides selected from poly (C n ,U) and poly (C n ,G) in which n is an integer having a value of from 4 to 29 and are mismatched analogs of complexes of polyriboinosinic and polyribocytidilic acids, formed by modifying rI n .rC to incorporate unpaired bases (uracil or guanidine) along the polyribocytidylate (rC n ) strand.
- the dsRNA may be derived from poly(I).poly(C) dsRNA by modifying the ribosyl backbone of polyriboinosinic acid (rl n ), e.g., by including 2'-O-methyl ribosyl residues.
- the mismatched complexes may be complexed with an
- RNA-stabilizing polymer such as lysine and
- dsRNAs described therein generally are suitable for use according to the present invention.
- the preferred mismatched dsRNA is rl n ⁇ (C 11-14 ,U) n or AMPLIGEN ® of HEM
- mismatched dsRNA for use in the invention include: - poly (I) ⁇ poly (C 4 ,U)
- dsRNAs suited to the practice of this invention are short dsRNAs of defined structure, for example oligonucleotides of the formula: 5'lock-(I) n -lock 3'
- the short oligonucleotide may have the structure:
- oligonucleotides may have substitutions in one strand not complementary to nucleotides in the opposite strand.
- these oligonucleotides are stabilized by internal registers of complementary heteropolymer and desirably the lock or hinge or both contain regions of complementary heteropolymer.
- oligonucleotides desirably have single-stranded tails. These oligonucleotides are described in
- Patients are treated with intravenous infusions of 200 to 700 mg of rI ⁇ r(C 11-14' U) as required, e.g., once a week to as often as daily in accordance with their clinical improvement.
- the amount of dsRNA administered and the frequency of administration will provide a level of from 0.01 to 1,000 micrograms of dsRNA per milliliter of the patient ' s systemic blood circulation immediately following administration measured at a point distal from the point of infusion.
- nucleoside analogue antiviral agents include Zidovudine (azidothymidine, RETROVAR ® or AZT as commonly used herein) which is
- 3'-azido-3'-deoxythymidine a nucleoside analogue antiviral for the systemic treatment of acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) caused by human immunodeficiency virus (HIV, HTLV-I, HTLV-II, HTLV-III, LAV, ARV and the like designators for various strains).
- AIDS acquired immunodeficiency syndrome
- ARC AIDS-related complex
- HAV human immunodeficiency virus
- the usual adult dose is 200 mg every four hours, around the clock.
- the corresponding dose is 2,9 mg per kg of body weight every four hours.
- nucleoside analog retroviral is used when coadminstered with a mismatched dsRNA, as illustrated further in the discussion that follows.
- Fig. 1 is a table showing the time in months to death or "full blown" AIDS for 298 patients ins terms of proportion of the patients free of critical
- Fig. 2 compares the early use of a dsRNA or its concurrent use with AZT in controlling retroviral growth as compared to rapid retroviral growth in the case of AZT alone.
- Fig. 3 compares the relative effects of a dsRNA and AZT as monotherapies with placebo and dsRNA and AZT as a combinational therapy in long term
- Fig. 4 relates the number of days of
- Ampligen ® extends the period of T4 cell stabilization in HIV disease over that expected with AZT alone.
- Fig. 5 is a graph relating the number of days on the combined Ampligen ® and AZT regimen to the mean percent change (increase) in T4 cells showing that Ampligen ® increases and/or stabilizes T4 cell levels in HIV disease beyond the time period in which AZT is effective.
- Fig. 6 is a graph relating the proportion of HIV patients free of critical events over a period of 12 months for placebo, AZT alone, Ampligen ® monotherapy and the combinational therapy of Ampligen ® and AZT.
- HIV co-culture was performed as described in reference 3 using peripheral blood mononuclear (PBMC) cells from cases 1 and 3. After 4, 7 and 14 days of co-culture, PBMC were harvested and dissolved in a guanidine cyanate solution used to dissolve cells and release viral materials. HIV RNA was measured by molecular hybridization as described in more detail below.
- PBMC peripheral blood mononuclear
- Figure 1 shows the development of critical events (development of full blown AIDS or death) in a well-publicized Veterans' group of HIV infected subjects treated either "early" (e.g., before
- AZT R AZT resistant virus
- AZT sensitivities of typical HIV isolates taken from individuals whose disease progresses despite AZT therapy and compare these results with viral isolates including hepatitis virus from patients whose disease is under relatively better control. It is apparent that emergence of AZT R virus contributes a
- Typical human retroviruses including HTLV-1, HTLV-2 and HTLV-3 and viruses which multiply by similar mechanisms include certain hepatitis viruses.
- the invention can be practiced in multiple ways including: (a) reducing the emergence of AZT R by utilizing specific classes of dsRNAs before exposure of the virus to AZT or other analogues and (b) overcoming the lethal
- AZT R HIV or other virus resistant analogues
- the dsRNA/nucleoside analogue regimen shows unexpected therapeutic synergy against AZT R HIV without a corresponding synergistic toxicity and thus is a truly unique and unexpectedly useful combination of drugs which becomes life saving when used correctly.
- Ampligen ® alone as wild type HIV-virus (5 ⁇ g/ml.
- Ampligen ® 80% inhibition; ED 50 ⁇ 0.5 ⁇ g/ml.). In addition, the Ampligen®-AZT combination produced greater inhibition of HIV (93%) than Ampligen ® alone. Virus from the patients who received
- Ampligen ® alone or the Ampligen ® -AZT combination showed relative resistance to AZT sensitivity to Ampligen ® and even greater sensitivity to the
- CI is defined as CI + (A C /A S ) + (B c /B s ),
- a and B are the concentrations of the drugs used in the combination treatment, and A s and B s are the concentrations of the drugs which, when used
- Fig. 2 I show a typical embodiment of the invention whereby the early use of Ampligen®, or its use concurrently with AZT, in fact results in substantial benefit in terms of lowering the bodily concentration of harmful virus such as retrovirus.
- the rapidly increasing production curve of viral RNA (ribonucleic acid) shown with the open circles is indicative of uncontrolled viral growth, whereas the two flat lines illustrate good control of virus production by the combinational approach.
- the open circles in Fig. 2 illustrative of rapidly developing AZT virus, are thus symbolic of the typical patient in Fig. 1 who, when given AZT alone, proceeds to advance into the more terminal stages of disease.
- dsRNAs notably mismatched dsRNAs, showed synergistic inhibition of retroviruses, when combined with AZT (or other nucleoside analogues) regardless of the drug resistance phenotype (Table 1).
- H112-2 and 6910-6 are well characterized HIV prototype clones displaying typical sensitivity and resistance, respectively.
- cases #1 through #6 are viruses isolated from specific patients exposed to various regimens (e.g., patients # 1, 2, and 3 are the same as those in Fig. 2, and patients 4, 5 and 6 were treated initially with AZT alone as suggested by Fig. 1).
- AZT and other analogues
- CD4 cells are among the immune cells most favored for attack by certain retroviruses and certain herpes viruses (especially HHV 6).
- HHV 6 certain herpes viruses
- parentheses refers to number of subjects studied. By comparison, Ampligen ® alone causes a horizontal
- Patients receiving AZT monotherapy took 200 mg. orally every 4 hours, daily (1200 mg./day).
- combinational treatment shown in Fig. 4 were also infused with typical Ampligen ® doses of 400 mg. twice weekly with an average concomitant AZT daily dose ranging between 300 and 540 mg].
- lymphocyte for the placebo and AZT monotherapy treatment are consistent with evidence that the course of the disease is inexorably downhill. Without effective therapeutic intervention, the median change in placebo patient lymphocyte counts declines. After an initial increase, even patients receiving AZT monotherapy experienced a deterioration in their median T4 cell counts and AZT R HIV appears. This decline from Week 12 onward appears to parallel that seen with the placebo patients.
- the slope of the serial median CD4 level regression line during Ampligen® treatment is not statistically different from a horizontal line reflecting no CD4 cell loss over time
- Ampligen® monotherapy (Fig. 3) abrogates the severe decline in median T4 lymphocytes seen in both placebo patients and in AZT treated patients (after a transitory twelve week rise) but the average T4 level did not increase. Moreover, in the Ampligen ® group, the small (statistically insignificant) decline in., median T4 lymphocytes observed at one year (Fig. 3) can be readily reversed thereby bringing about an even more durable T4 stabilization by increasing the dose to above 200 mg. twice weekly (data not shown). The slope of a regression line constructed from the change in median T4 cells observed from week 12 onward in the Ampligen ® monotherapy group was not significantly different from O thereby indicative of disease stabilization.
- the Ampligen ® monotherapy, AZT monotherapy, or placebo treated groups shown in Fig. 3 had approximately equivalent median and mean absolute T4 (also called CD4) lymphocyte levels. I then compared them with a new group that received combined Ampligen® and AZT treatment. The new group had in fact lower (approximately 33%) median and absolute levels of this prognostic indicator of the progression of HIV infection, thus indicating they were at greater risk of death or other "critical events”.
- the relative effects of Ampligen® and AZT in long term maintenance of CD4 cells per mm 3 in HIV disease is shown in the following table.
- Figure 4 demonstrates the serial changes in median T4 lymphocyte levels during the 1 year of combination treatment which should be compared with Ampligen ® monotherapy, AZT monotherapy, and placebo effects of Fig. 3.
- the baseline for comparison is calculated from the average of the patients' serial absolute T4 lymphocyte counts measured during the three month period immediately before starting the combined therapy.
- a regression line (Figure 5) was constructed from the mean percentage change in T4 Lymphocyte counts over 135 to 630 days of combined dsRNA and AZT therapy. The average of each patient's serial T4 lymphocyte counts during 91-180 days of the combined treatment regimen served as the baseline for
- This baseline was selected as a point after which AZT's anticipated effect on T4 levels typically has dissipated.
- Ampligen ® and AZT therapy successfully abrogated the long-term T4 cell decline expected in untreated patients (4-6 cells/month) or those on long term (> 6 month) AZT monotherapy.
- lymphokines such as interleukins and interferons may be judiciously added after the foundation of control of viral replication is in place.
Abstract
On diminue la rapidité de la résistance virale développée au cours d'un traitement par des analogues de nucléosides antiviraux en administrant des ARN bicaténaires pendant le premier stade du traitement de l'infection ou pendant des stades ultérieurs, lorsque la mutation génétique virale est apparue, afin de restituer la susceptibilité du virus à des agents antiviraux qui autrement seraient inefficaces. On réalise le retard et/ou la diminution de l'apparition de rétrovirus résistants aux analogues de nucléosides, en particulier le VIH, au moyen d'ARN mal appariés, notamment dans les cellules sanguines mononucléaires périphériques, notamment les lymphocytes CD4.The rapidity of viral resistance developed during treatment with antiviral nucleoside analogues is reduced by administering double-stranded RNA during the first stage of treatment of the infection or during later stages, when the viral genetic mutation has appeared, in order to restore the susceptibility of the virus to antiviral agents which would otherwise be ineffective. Delay and / or decrease in the appearance of retroviruses resistant to nucleoside analogs, in particular HIV, is achieved by means of poorly paired RNAs, in particular in peripheral mononuclear blood cells, in particular CD4 lymphocytes.
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US68620091A | 1991-04-16 | 1991-04-16 | |
US686200 | 1991-04-16 |
Publications (2)
Publication Number | Publication Date |
---|---|
EP0581906A1 true EP0581906A1 (en) | 1994-02-09 |
EP0581906A4 EP0581906A4 (en) | 1997-07-23 |
Family
ID=24755338
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP92917298A Withdrawn EP0581906A4 (en) | 1991-04-16 | 1992-03-12 | Abrogation of viral resistance to nucleoside analogues by double-stranded rnas |
Country Status (10)
Country | Link |
---|---|
EP (1) | EP0581906A4 (en) |
JP (1) | JPH06507624A (en) |
CN (1) | CN1082819C (en) |
AU (1) | AU671800B2 (en) |
CA (1) | CA2102221A1 (en) |
IE (1) | IE920873A1 (en) |
MX (1) | MX9201711A (en) |
PT (1) | PT100340A (en) |
WO (1) | WO1992018004A1 (en) |
ZA (1) | ZA922755B (en) |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0286224A2 (en) * | 1987-03-23 | 1988-10-12 | Hem Pharmaceuticals Corp. | Treatment of human viral infection by dsRNA combined with viral inhibitors |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4820696A (en) * | 1985-08-26 | 1989-04-11 | Hem Research, Inc. | Modulation of aids virus-related events by double-stranded RNAS |
US4795744A (en) * | 1986-07-17 | 1989-01-03 | Hem Research, Inc. | Modulation of AIDS virus-related events by double-stranded RNAS |
US4945082A (en) * | 1985-08-26 | 1990-07-31 | Hem Research, Inc. | Controlled dsRNA therapy for human viral infections |
-
1992
- 1992-03-12 WO PCT/US1992/001972 patent/WO1992018004A1/en not_active Application Discontinuation
- 1992-03-12 JP JP4510192A patent/JPH06507624A/en active Pending
- 1992-03-12 EP EP92917298A patent/EP0581906A4/en not_active Withdrawn
- 1992-03-12 CA CA002102221A patent/CA2102221A1/en not_active Abandoned
- 1992-03-12 AU AU18718/92A patent/AU671800B2/en not_active Ceased
- 1992-03-19 IE IE087392A patent/IE920873A1/en unknown
- 1992-03-20 ZA ZA922755A patent/ZA922755B/en unknown
- 1992-04-03 PT PT100340A patent/PT100340A/en not_active Application Discontinuation
- 1992-04-06 CN CN92102227A patent/CN1082819C/en not_active Expired - Fee Related
- 1992-04-13 MX MX9201711A patent/MX9201711A/en unknown
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0286224A2 (en) * | 1987-03-23 | 1988-10-12 | Hem Pharmaceuticals Corp. | Treatment of human viral infection by dsRNA combined with viral inhibitors |
Non-Patent Citations (3)
Title |
---|
AIDS RES HUM RETROVIRUSES, 5 (2). 1989. 193-204., XP000647024 MONTEFIORI D C ET AL: "IN-VITRO EVALUATION OF MISMATCHED DOUBLE-STRANDED RNA AMPLIGEN FOR COMBINATION THERAPY IN THE TREATMENT OF ACQUIRED IMMUNODEFICIENCY SYNDROME" * |
INT. J. IMMUNOPHARM., 1991, 13/SUPPL. I (69-76), UNITED KINGDOM, XP000670844 CARTER W.A. ET AL: "Mismatched double-stranded RNA, Ampligen (poly(I):poly(C12U)), demonstrates antiviral and immunostimulatory activities in HIV disease" * |
See also references of WO9218004A1 * |
Also Published As
Publication number | Publication date |
---|---|
AU671800B2 (en) | 1996-09-12 |
CA2102221A1 (en) | 1992-10-17 |
CN1068035A (en) | 1993-01-20 |
PT100340A (en) | 1993-07-30 |
IE920873A1 (en) | 1992-10-21 |
CN1082819C (en) | 2002-04-17 |
ZA922755B (en) | 1993-04-28 |
WO1992018004A1 (en) | 1992-10-29 |
EP0581906A4 (en) | 1997-07-23 |
JPH06507624A (en) | 1994-09-01 |
MX9201711A (en) | 1992-10-01 |
AU1871892A (en) | 1992-11-17 |
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Legal Events
Date | Code | Title | Description |
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PUAI | Public reference made under article 153(3) epc to a published international application that has entered the european phase |
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18D | Application deemed to be withdrawn |
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