Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
  • A61K38/2292—Thymosin; Related peptides

Definitions

• the present invention relates to a method of treating septic shock in mammals.
• Thymosin ⁇ ⁇ (“T? 4 ”) is a peptide which has been reported as containing 43 amino acids. Amino acid sequence information on T? 4 is disclosed in U.S. Patent No. 4,297,276, herein incorporated by reference. T / ⁇ 4 has been found to be present in numerous tissue types in mammals and has also been implicated in a wide variety of cellular and physiological processes including inducing terminal deoxynucleotidyl transferase activity of bone marrow cells, stimulating secretion of hypothalamic luteinizing hormone releasing hormone and luteinizing hormone, inhibiting migration and enhancing antigen presentation of macrophages, and inducing phenotypic changes in T-cell lines in vitro.
• Septic shock is a condition in which infection is widely disseminated in many areas of the body, the infection generally being disseminated through the blood from one tissue to another and causing extensive damage.
• Septic shock can occur with numerous medical conditions, including (1) peritonitis caused by the spread of infection from the uterus and fallopian tubes; (2) peritonitis resulting from rupture of the gut, sometimes caused by intestinal disease or wounds; (3) generalized infection resulting from spread of a simple infection; (4) generalized gangrenous infection resulting specifically from gas gangrene bacilli; and (5) infection spreading into the blood from the kidney or urinary tract.
• Septic shock is of critical concern from a clinical viewpoint because, among other reasons, this condition frequently leads to death.
• septic shock is a somewhat common clinical phenomenon, the mechanisms involved as well as the pathological changes remain poorly understood. For example, despite the treatment of bacterial infection, many patients ' deteriorate further, which may be due to clinical sequelae of hypotension with low systemic vascular resistance, renal insufficiency, adult respiratory distress syndrome, severe coagulopathy and severe metabolic dysfunctions. Thus, there is an urgent need in the art for effective methods of treating septic shock.
• a method of treating septic shock in mammals includes administering a septic shock-treating effective amount of TjS 4 to said mammals.
• Thymosin ? 4 and T / S 4 refer to peptides having the amino acid sequence disclosed in U.S. Patent No. 4,297,276, supra.
• Mammalian septic shock occurs in association with a series of events in the mammal's body referred to as the "sepsis cascade" .
• the sepsis cascade typically begins with bacterial infection of the mammalian host resulting in release of bacterial toxins, introduction of endotoxin, activiation of host defense systems, i.e., plasma protein systems as well as cellular defense systems including endothelial cells, macrophages, monocytes and neutrophils, with release of proinflammatory mediators including cytokines, lipid metobolites, proteases, toxic oxygen products, nitric oxide and adhesion proteins.
• host defense systems i.e., plasma protein systems as well as cellular defense systems including endothelial cells, macrophages, monocytes and neutrophils
• proinflammatory mediators including cytokines, lipid metobolites, proteases, toxic oxygen products, nitric oxide and adhesion proteins.
• effective amounts of T/3 4 are administered to a subject to reduce blood free radical levels in the subject, and thereby treat or prevent septic shock in the subject or obstruct progression of sepsis cascade in the subject.
• T/3 4 has been found to reduce blood free radical levels almost as much as SOD (super oxide dismutase) , an enzyme that eliminates free radicals.
• SOD super oxide dismutase
• T3 4 has been found to obstruct the sepsis cascade in mammals. During sepsis, peroxidation of lipids in blood is increased (mMol of malonyldialdehyde) , but returned to normal or about normal with T? 4 administration. Sepsis also reduces circulating blood leves of glutathione. However, administration of T/3 4 returns circulatory gluthathine leves to normal or about normal . As noted above, administration of T3 4 during sepsis decreases blood hydroperoxide levels and blood glutathione levels.
• T3 4 during sepsis also decreases cerebellar cGMP levels, and decreases the blood levels of arachidonic acid metabolites such as Tx/3 2 and 6-keto-PGF ⁇ , PAF, and cytokines such as IL- l ⁇ and TNF-c .
• the methods of the present invention include administration of septic shock-treating effective amounts, septic shock-preventing effective amounts and sepsis cascade progression-obstructing effective amounts of T3 4 to mammals.
• effective amounts of T3 4 are administered to subjects to treat or prevent septic shock in the subjects, or obstruct progression of sepsis cascade in the subjects.
• the subjects preferably are human.
• compositions containing T/3 4 may be formulated in a conventional manner for administration by any suitable route.
• suitable routes of administration include, but are not limited to, oral, rectal, nasal, topical, vaginal, and parenteral (including subcutaneous, intramuscular, intravenous and intradermal) .
• Particularly preferred embodiments utilize oral or parenteral administration, with parenteral administration being a more preferred embodiment.
• the preferred route may vary with the condition, age and species of the recipient .
• T? 4 is administered as part of a pharmaceutical formulation.
• the formulations of the present invention comprise T/3 4 together with one or more pharmaceutically acceptable carriers and optionally with other therapeutic ingredients.
• the carrier(s) are "acceptable” in the sense of being compatible with the other ingredients of the formulation and not deleterious to the recipient thereof.
• the formulations include those suitable for oral, rectal, nasal, topical (including buccal and sublingual) , vaginal or parenteral (including subcutaneous, intramuscular, intravenous and intradermal) administration.
• the formulations may conveniently be presented in unit dosage form, e.g., tablets and sustained release capsules, and may be prepared by any suitable pharmaceutical methods .
• Such methods include, but are not limited to, the step of bringing into association T/3 4 with the carrier which constitutes one or more accessory ingredients.
• formulations are prepared by uniformly and intimately bringing into association T3 4 with liquid carriers or finely divided solid carriers or both, and then, if necessary, shaping the product.
• Formulations of the present invention suitable for oral administration may be presented as discrete units such as capsules, cachets or tablets each containing a predetermined amount of TS 4; as a powder or granules; as a solution or a suspension in an aqueous liquid or a non-aqueous liquid; or as an oil-in-water liquid emulsion or a water-in-oil liquid emulsion, etc.
• a tablet may be made by compression or molding, optionally with one or more accessory ingredients.
• Compressed tablets may be prepared by compressing in a suitable machine T3 4 in a free-flowing form such as a powder or granules, optionally mixed with a binder, lubricant, inert diluent, preservative, surface-active or dispersing agent.
• Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
• the tablets may optionally be coated or scored and may be formulated so as to provide slow or controlled release of the active ingredient therein.
• Formulations suitable for topical administration include lozenges comprising T3 4 in a flavored basis, usually sucrose and acacia or tragacanth; pastilles comprising T/3 4 in an inert basis such as gelatin and glycerin, or sucrose and acacia; and mouthwashes comprising T ⁇ 4 to be administered in a suitable liquid carrier.
• Formulations suitable for topical administration to the skin may be presented as ointments, creams, gels and pastes comprising T/3, and a pharmaceutically acceptable carrier, or may utilize a transdermal patch containing the ingredient to be administered.
• Formulations for rectal administration may be presented as a suppository with a suitable base comprising, for example, cocoa butter or a salicylate.
• Formulations suitable for nasal administration wherein the carrier is a solid include a coarse powder having a particle size, for example, in the range from about 20 to about 500 microns which is administered in the manner in which snuff is taken, i.e., by rapid inhalation through the nasal passage from a container of the powder held close up to the nose.
• Suitable formulations wherein the carrier is a liquid, for administration, as for example, a nasal spray or as nasal drops include aqueous or oily solutions of the active ingredient.
• Formulations suitable for vaginal administration may be presented as tampons, creams, gels, pastes, foams or spray formulations containing, in addition to T / S 4 , suitable carriers.
• Formulations suitable for parenteral administration include aqueous and non-aqueous sterile injection solutions which may optionally contain anti- oxidants, buffers, bacteriostats and solutes which render the formulation isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents .
• the formulations may be presented in unit-dose or multi-dose containers, for example, sealed ampules and vials, and may be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use.
• sterile liquid carrier for example water for injections, immediately prior to use.
• Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets of the kind previously described.
• formulations of this invention may include other suitable agents having regard to the type of formulation in question, for example, those suitable for oral administration may include flavoring agents.
• a proposed dose for administration of the compositions in the present invention is a septic shock-treating, septic shock-preventing or sepsis cascade progression-obstructing effective amount of T/S 4 , which can be in a range of from about 0.4 to about 4 mg of Tj ⁇ 4 per kg of body weight of recipient (mg/kg) , preferably from about 1 to about 4 mg/kg.
• a dose can be administered to the patient daily, one or more times per day of administration, e.g., two or three times per day, and doses can be administered one or more days per week, e.g., two, three, four, five, six or seven days per week.
• the invention is applicable to native (i.e., naturally occurring) T ⁇ t as well as synthetic T ⁇ 4 and recombinant T ⁇ 4 having the amino acid sequence of native Tj ⁇ 4 , biologically active amino acid sequences substantially similar thereto, or a biologically active abbreviated sequence form thereof, and their biologically active analogs (including muteins) having substituted, deleted, elongated, replaced, or otherwise modified sequences which possess bioactivity substantially similar to that of native T3 4 .
• T3 4 can be administered in combination with a therapeutically effective amount of another substance useful in treating septic shock such as, for example, antibiotics, or antibodies (polyclonal or monoclonal) directed to antigens located on endotoxins.
• another substance useful in treating septic shock such as, for example, antibiotics, or antibodies (polyclonal or monoclonal) directed to antigens located on endotoxins.
• the acceptable dosage range of the other substance will depend upon its properties (i.e., the acceptable dosage range will depend upon what other substance is being administered) .
• T? 4 and another substance useful in treating septic shock can be administered "in combination" which, as defined herein, includes various schemes designed to administer T3 4 and the other substance to a subject, whether or not the other substance and T3 4 are administered separately or together, such that the desired dosages of T3 4 and the other substance are present in the subject at the same time. Any suitable scheme can be used to administer T/3 4 and another substance useful in treating septic shock "in combination" in accordance with the present invention.
• Suitable dosages of either T/3 4 alone or T/3 4 in combination with another substance useful in treating septic shock may be administered 1 to 6 times or more per day.
• the precise dose administered will depend on the age, condition and other factors of the recipient.
• T/3 4 was provided by Alpha 1 Biomedicals, Inc. (Two Freedom Center, 6903 Rockledge Drive, Ste. 1200, Bethesda, Maryland 20817) . T/3 4 was prepared by solid phase peptide synthesis.
• Example 2 Swiss-Webster mice 4-6 weeks of age (20-25g) were divided into groups as follows.
• mice treated with a lethal dose of endotoxin 60 mg/kg.
• mice treated with 60 mg/kg endotoxin followed by an injection of 100 ⁇ g T3 4 (5 minutes post administration of endotoxin) .
• Example 3 Using the same materials and methods as in examples 1 and 2, the time and dose-dependency of the protective effect of T3 4 on endotoxin lethality were studied. The results are presented in Tables II and III below.
• T / ⁇ 4 had a protective effect on endotoxin toxicity when given immediately following, 2 and 4 hours after endotoxin treatment.
• the most effective protective dose was 100 ⁇ g T3 4 administered three times.
• T/3 4 partially increased the survival of mice treated with endotoxin when it was administered three times in doses of 50 ⁇ g and 20 ⁇ g T3 4 .
• 10 ⁇ g T3 4 has also sometimes shown positive activity.
• T ⁇ 4 decreased IL-l ⁇ , TNF- ⁇ serum levels as well as PAF, Tx/3 2 and 6- keto-PGF ⁇ plasma levels after administration of a lethal dose of endotoxin.

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• 1994
  • 1994-09-27 EP EP94929888A patent/EP0725652A1/de not_active Withdrawn
  • 1994-09-27 WO PCT/US1994/010879 patent/WO1995009646A1/en not_active Ceased
  • 1994-09-27 AU AU78792/94A patent/AU7879294A/en not_active Abandoned

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