Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
  • C07K16/40—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against enzymes
• • 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
  • A61K38/28—Insulins
• • 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
  • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
  • A61K38/46—Hydrolases (3)
  • A61K38/48—Hydrolases (3) acting on peptide bonds (3.4)
  • A61K38/4873—Cysteine endopeptidases (3.4.22), e.g. stem bromelain, papain, ficin, cathepsin H
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/46—Ingredients of undetermined constitution or reaction products thereof, e.g. skin, bone, milk, cotton fibre, eggshell, oxgall or plant extracts
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Y—ENZYMES
  • C12Y304/00—Hydrolases acting on peptide bonds, i.e. peptidases (3.4)
  • C12Y304/22—Cysteine endopeptidases (3.4.22)
  • C12Y304/22033—Fruit bromelain (3.4.22.33), i.e. juice bromelain

Definitions

• the present application relates to the enhancement of gut permeability, in particular to increase the absorption of macromolecules from the intestine.
• Oral administration of pharmaceutical compounds is very often the preferred route of administration. Patients tend to prefer to take medication orally rather than by other routes, such as intravenous or intramuscular injection and thus the formulation of a medication for oral administration is generally acknowledged to lead to increased patient compliance.
• the intestinal epithelium represents the largest interface (more than 2,000,000 cm ⁇ ) between the external environment and the internal host milieu and constitutes the major barrier through which molecules can either be absorbed or secreted.
• the intestinal epithelium acts as a barrier which prevents the free mixing of lumenal contents with underlying interstitial and vascular fluids.
• the absorption of large and hydrophilic macromolecules is almost exclusively limited to the paracellular pathway (Madara and Trier, 1986). Under normal conditions, transport of molecules via the paracellular route is restricted to molecules having a molecular radius smaller than 11X (Bakker and Groot, 1989).
• the major barrier to paracellular transport is the tight junctions, or zonula occludens, which are narrow belt-like structures on the plasma membrane of epithelial cells that circumferentially wraps each cell and adjoin it with its neighbours (Madara, 1988).
• the tight junctions have two known functions. First, they assist in the maintenance of surface polarity of the membrane which is required for vectorial transepithelial transport processes, such as salt absorption. Second, they act as a diffusion barrier.
• Zot's action is mediated by activation of a protein kinase C which leads to polymerisation of actin filaments and their rearrangement, thereby modulating tight junction and intestinal permeability (Fasano et al. , 1995).
• the action of Zot is reversible, time and dose-dependent, and is confined to the small intestine, since Zot does not affect colon permeability (Fasano, 1991; Uzzau, 1996). Since Zot modulates tight junction activity and the paracellular pathway, Zot may be of use to enhance intestinal absorption of orally administered macromolecules via the paracellular pathway.
• bromelain from pineapple stems, acts physiologically in a Zot- like manner.
• bromelain causes a dose-dependent increase in intestinal permeability, which is readily reversible. Bromelain is therefore of use in a method for increasing the permeability of the intestine.
• bromelain is useful in a method of increasing the absorption of large molecules from the intestine.
• bromelain in the preparation of an orally adminstrable agent for increasing the absorption of a macromolecular biologically active agent from the intestine.
• the invention is particularly advantageous as enables proteins and other macromolecular biologically active agents to be adminstered by the oral route. This greatly increases the likelihood of patient compliance.
• An additional advantage is that bromelain is a well known substance which is widely available at relatively low cost and, unlike Zot, is not derived from a pathogenic organism. Furthermore, since the action of bromelain on the tight junctions is reversible, any unwanted side effects can be rapidly and easily treated. Finally, it appears that bromelain does not, as might have been expected, have an adverse effect on nutrient influx.
• Bromelain has been reported to increase the absorption of small molecules such as the antibiotics, tetracycline and penicillin (reviewed by Lotz-Winter 1989). The mechanism of action was unknown but it was thought that bromelain increased absorption by a non-specific mechanism such as damage to the intestinal lining. Such a mechanism would suggest that bromelain would not be a suitable agent for pharmaceutical use. Furthermore, since antibiotics are relatively small molecules, it would not have been predicted that bromelain would increase the absorption of macromolecules which are much larger than antibiotics.
• bromelain reversibly increases intestinal epithelial permeability without causing damage. It is thus able to increase the absorption of macromolecular biologically active agents as well as the absorption of smaller molecules. Furthermore, because the effect is reversible, it appears that the toxicity of bromelain is much lower than previously believed.
• Bromelain is the collective name for the proteolytic enzymes found in the tissues of the plant Bromeliaceae .
• Bromelain is a mixture of various moieties derived from the stem of the pineapple ⁇ Ananas comosus). It contains at least five proteolytic enzymes but also non-proteolytic enzymes, including an acid phosphatase and a peroxidase; it may also contain amylase and cellulase activity. In addition, various other components are present, in particular, organically bound calcium.
• Bromelain is reviewed by Taussig and Batkin (J. Ethnopharmacol. , 22, 191-202 (1988)). It is available in various countries under the trade marks ANANASE, ANANASE FORTE, EXTRANASE, PORTEOLIS, RESOLVIT, ROGORIN, BROMASE and TRAUMANASE.
• macrolcular biologically active agent refers to any molecule having biological activity and which is a protein, glycoprotein, oligo- or polypeptide, polynucleotide, for example DNA or RNA, a polysaccharide or other large molecule having a molecular radius greater than 11X.
• proteins and peptides for example Insulin glucagon, parathyroid hormone and its antagonists, calcitonin, vasopressin, renin, prolactin, growth hormones, thyroid stimulating hormone, carticitropin, follicle stimulating hormone, luteinising hormone, chorionic gonadotropin, interferon, tissue plasminogen activator, gamaglobulin and blood clotting factors such as Factor VIII.
• the macromolecular biologically active agent is insulin.
• active molecule which may be administered with bromelain are physiologically active enzymes such as transferases, hydrolases, isomerases, proteases, ligases and oxidoreductases such as esterases, phosphatases, glycosidases and peptidases and enzyme inhibitors such as leupeptin, chymostatin and pepstatin and growth factors such as tumour antiogenesis factor , epidermal growth factor, nerve growth factor and insulin-like growth factors.
• the macromolecule may be an antibody or a vaccine which ⁇ iay be a proteinaceous vaccine or even an attenuated organism.
• the bromelain and the macromolecular biologically active agent may be administered together or separately and therefore in a further aspect of the invention, there is provided a product comprising bromelain and a macromolecular biologically active agent as a combined oral preparation for simultaneous, separate or sequential use in the treatment of a condition for which the macromolecular biologically active agent is a therapeutic agent.
• the invention also provides a pharmaceutical composition for oral administration comprising bromelain together with a macromolecular biologically active agent and a pharmaceutically acceptable excipient or carrier.
• the bromelain may be provided either together with or separately from the biologically active agent in any formulation which is suitable for oral administration.
• Such formulations include syrups, elixirs, tablets and capsules and the preparation of all of these types of formulation is familiar to those skilled in the art of formulation.
• the formulation may take the form of an emulsion, microemulsion, or micellar or liposomal solution.
• bromelain In order to assist the survival of the various components of the bromelain mixture through the stomach, it may be advisable to formulate the bromelain in an enteric- protected preparation.
• Enteric-coated tablets of bromelain are available (for example under the trade mark ANANASE FORTE in the United Kingdom).
• Other orally adminstrable formulations include syrups, elixirs and hard and soft gelatin capsules, which may also be enteric coated.
• this preparation may also include the biologically active agent or, alternatively, the biologically active agent may be administered separately or sequentially.
• Bromelain activity is stable over a wide pH range (pH 2-9). Therefore, it may not be necessary to enteric-protect (or enteric coat) the bromelain from the acid conditions of the stomach. It may, however, be necessary to protect the bromelain from digestion by acid proteases in the gut. Bromelain may therefore be administered with a buffering agent, for example bicarbonate.
• bromelain Dosage of bromelain is conventionally measured in Rorer units, FIP units, BTU (bromelain tyrosine units), CDU (casein digestion units), GDU (gelatin digestion units) or MCU (milk clotting units).
• Rorer unit of protease activity is defined as that amount of enzyme which hydrolyses a standardisation casein substrate at pH 7 and 25°C so as to cause an increase in absorbence of 0.00001 per minute at 280nm.
• FIP unit of bromelain activity is contained in that amount of a standard preparation which hydrolyses a suitable preparation (FIP controlled) under the standard conditions at an initial rate such that there is liberated per minute an amount of peptide, not precipitated by a specific protein precipitation reagent, which gives the same absorbence as 1 :mol of tyrosine at 275nm.
• BTUs, CDUs, GDUs and MCUs are as defined in the literature as follows:
• One bromelain tyrosine unit is that amount of enzyme which will liberate one micromole of tyrosine per minute under the conditions of the assay (for example, after digestion of an acid denatured haemoglobin substrate at pH 5 and 30°C).
• the enzyme activity which liberates one milligram (10 3 g) of amino nitrogen from a standard gelatin solution after 20 minutes digestion at 45°C and at pH 4.5.
• While the precise dosage will be under the control of the physician or clinician, it may be found that daily dosages of from 50 to 4000 GDU/day is appropriate, for example from 100 10 1000 GDU/day.
• the precise dosage pattern will be dependent upon the dosage pattern of the macromolecular biologically active agent since the bromelain will be administered at a time such that the permeability of the intestine will be increased at the appropriate time for the biologically active agent to be absorbed.
• one of the particular advantages of the present invention is that the increased intestinal permeability induced by bromelain is easy to reverse. This may be brought about by the administration to the patient of an anti- bromelain antibody.
• This antibody will usually be of the IgG isotype and may be raised in a conventional manner, for example by injecting rabbits with bromelain and extracting the antibody from them at an appropriate time thereafter.
• an anti- bromelain antibody in the preparation of an agent for reversing increased intestinal permeability induced by bromelain.
• the mechanism of action of bromelain is thought to be mediated by its ability to modulate the activity of intracellular signalling pathways.
• Physiological regulation of the tight junctions and barrier function are influenced by second messengers and signalling pathways that control the assembly and disassembly of the actin cytoskeleton.
• Rho GTPase family tyrosine kinases, Ca 2+ , protein kinase C, adenosine 3 ' ,5 '-cyclic monophosphate (cAMP) and phospholipase C appear to be key players in controlling actin cytoskeleton organisation (Anderson and Van Itallie, 1995; Tapon and Hall, 1997). Earlier, we have shown that bromelain prevents the effects of the intracellular second messengers, cAMP, cGMP and Ca 2+ (Mynott et al , 1997).
• FIGURE 1 shows the effect of bromelain on rabbit ileal Isc. Bromelain ( ) (15
• FIGURE 2 shows the effect of bromelain on rabbit ileal Rt.
• Tissues were discarded if they showed an increase in I sc , reflective of Na-glucose co-transport, because serosally added glucose diffused via perforations to the mucosal surface. All experiments were conducted on tissues of similar resistance (_+ 10%).
• Influx experiments were conducted as previously described (Guandalini et al , 1988). Male New Zealand White rabbits (2 to 3 kg) were killed by cervical dislocation. A 25 cm segment of distal ileum was excised, opened along the mesenteric border and rinsed free of intestinal contents with cold Ringer solution. Two 10 cm segments of intestine were rapidly mounted in Lucite influx chambers, where four adjacent portions of the mucosal side (surface area of 0.28 cm ⁇ ) were exposed to the pre-incubation solution for 30 min at 37°C and gassed with 95 % O 2 /5% CO 2 .
• the pre-incubation solutions contained bromelain at 1 mg/ml for studies observing glucose influx, and 15 ⁇ g/ml for amino acid and dipeptide influx.
• Control tissues were incubated with Ringer solution alone. Studies commenced when the pre-incubation solution was replaced with Ringer's containing ⁇ -labelled nutrient and - Inulin as a marker of the extracellular space. Incubation in this solution was for 45-50 sec and stopped by quickly removing the solutions containing label and adding cold 0.3 M mannitol. Each piece of exposed tissue was then excised, gently blotted on filter paper, homogenized in 10% trichloroacetic acid and centrifuged to sediment particulate matter.
• Bromelain addition also caused a reduction in R t in a dose-dependent manner (Figure 2A).
• the reduction in R t was readily reversible; removal of bromelain was followed by an increase in R t (Figure 2B) to baseline values.
• Figure 2A In control tissues, -or tissues incubated with bromelain plus anti-bromelain IgG, no change in R t was observed.
• Gly-Phe glycine-phenylalanine
• Glut. Ac. glutamic acid
• Bromelain treatment of intestinal epithelium increased intestinal permeability in a dose-dependent manner, which was reversed when bromelain was removed.
• transepithelial resistance reflects modification of tissue permeability through the intercellular space, since plasma membrane resistances are relatively high (Madara, 1989). Since tight junctions represent the major barrier of the paracellular pathway, it is possible that bromelain is modulating tight junctions. This effect is intriguing and is pronounced of a Zot-like activity (Fasano et al , 1991) whereby an increase in transepithelial permeability by Zot coincided with modification of the structure of intercellular tight junctions. The time course of Zot and bromelain effects are similar.
• bromelain caused a transient increase in I sc in rabbit ileum, which could also be neutralised with specific antibodies.
• the effect of bromelain on tissue I sc and R t may be modulated by Ca 2 + .
• Agents such as thapsigargin, calcium ionophores and carbachol cause a transient increase in I sc in tissues, which return to baseline values after 20 to 30 mins (Dharmsathaphorn and Pandol, 1986; Traynor- Kaplan et al , 1994).
• An increase in tissue permeability is also associated with Ca- agonist action.
• Bromelain did not have an adverse effect on nutrient influx suggesting that the use of this substance is safe. Indeed, bromelain has been in clinical use for many years with indications that include uses as an anti-inflammatory agent and for the debridement of third-degree burns (reviewed by Taussig and Batkin, 1988).
• bromelain The ability of bromelain to modulate intracellular signalling pathways linked to tight junctional activity and its ability to increase intestinal permeability suggests that bromelain will be a useful agent to enhance the absorption of macromolecules.

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• 1997
  • 1997-06-27 GB GBGB9713667.5A patent/GB9713667D0/en active Pending
• 1998
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  • 1998-06-26 WO PCT/GB1998/001895 patent/WO1999000141A1/en not_active Application Discontinuation
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