IE83403B1 - Method for treating systemic lupus erythematosus - Google Patents
Method for treating systemic lupus erythematosusInfo
- Publication number
- IE83403B1 IE83403B1 IE1992/0556A IE920556A IE83403B1 IE 83403 B1 IE83403 B1 IE 83403B1 IE 1992/0556 A IE1992/0556 A IE 1992/0556A IE 920556 A IE920556 A IE 920556A IE 83403 B1 IE83403 B1 IE 83403B1
- Authority
- IE
- Ireland
- Prior art keywords
- rapamycin
- csa
- mrl
- treated
- lpr
- Prior art date
Links
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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
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
-
- 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
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
- A61K35/66—Microorganisms or materials therefrom
- A61K35/74—Bacteria
Description
PATENTS ACT 1992
920556
METHOD FOR TREATING SYSTEMIC LUPUS ERYTHEMATOSUS
AMERICAN HOME PRODUCTS CORPORATION
This invention relates to use of rapamycin in treating systemic lupus
erythematosus.
Systemic lupus erythematosus (SLE), an autoimmune disease primarily
affecting young females, is characterized by hyperproliferation of T-lymphocytes;
development of autoantibodies directed against nuclear antigens, particularly double-_
stranded DNA; and immune complex mediated pathology [R. Bartlett, Scand. J.
Rheum, 75: 290 (1988 Supp.)]. Complexation of the nuclear autoantibodies with
their respective antigens, which are subsequently deposited in the small blood
vessels, is a direct cause of many of the clinical manifestations of SLE.
Clinical manifestations of SLE are observed in almost all organ systems [see,
I. McKay, Autoimmune Diseases, Charles C. Thomas, pub., p. 70]. These typically
include a facial erythematous rash with a "butterfly" distribution over the nose and
cheeks. Arthritis and arthralgia most commonly affecting the phalangeal and carpal
C joints are observed in a majority of SLE patients. Renal involvement is observed in
approximately 70% of SLE patients, and is considered to be one of the major causes
of mortality from SLE. Glomerulonephritis secondary to the deposition of
autoantibody—antigen complex in the kidney, often leads to renal impairment, as
observed by proteinuria, or ultimately renal failure. Clinical manifestations of SLE
also are observed in the lymphatic, pulmonary, gastrointestinal, hemic, vascular, and
central nervous systems.
Current treatment of SLE depends on the location and severity of the disease;
with the method of treatment often dictated by the organ system affected. Arthritis
or arthralgias can often be controlled with aspirin or other non—steroidal anti-
inflammatory drugs. More severe manifestations of SLE such as hemolytic anemia,
thrombocytopenic purpura,and severe polyserositis have been treated with
prednisone. Currently recommended treatment for renal impairment utilizes
combinations of prednisone with immunosuppressive agents such as azathioprine or
cyclophospharnide. A
As none of the methods of treatment presently available are completely
satisfactory, current research has focused on developing agents for the treatment of
SLE. Several animal models have been utilized to study the etiology of SLE and to
evaluate potential forms of treatment. . . i
The MRL/Mp}/lpr/lpr (MRL/lpr) mouse is a standard animal model for SLE,
in which the autosomal recessive allele, lpr (lymphoproliferation) is associated with
severe lymphadenopathy, early auto—antibodies, circulating immune complexes,
‘glomerulonephritis, splenomegaly, arthritic changes, pulmonary lesions [Y. Kono,
Int. J. Immunother. (2), 149 (1986)], progressive histopathological _changes including
lymphocytic and monocytic cell infiltrations, and inflammation and destruction of
normal tissue architecture; all which contribute to early death (~6 months). These
manifestations, which are at least partially caused by hyperproliferation of
dysfunctional T-lymphocytes, begin to appear at approximately 8 weeks of age. The
MRI./MpJ +/+ is without the recessive gene, lpr, and therefore has a normal lifespan
(2 yrs) with only‘ mild and late symptoms of arthritis and glomerulonephritis. The
MRL/lpr mouse is characterized by lymphadenopathy of double negative (L3T4*,
Lyt-2‘) lymphocytes [Kotzin, J. Exp. Med. 168: 2221 (1988)] which have lost the
normal T cell functions of concanavalin A (Con A) responsiveness and interleukin-2
production (R. Cameron, Immunol 59: 187 (l986)].
suppression of mitogenic responsiveness and IL-2 production is seen with disease
Therefore, a growing
progression.
The immunosuppressants cyclosporine A (CsA) and FK—506, have been
evaluated in the MRL/lpr model of SLE. A decrease in lymphadenopathy was
observed in MRL/lpr mice treated with 25 mg/kg of CsA. However, at this dose
there was no improvement in glomerulonephritis (as evidenced by a decrease in
kidney function and albuminuria), no change in anti—DNA or anti-IgG autoantibody
levels, and no prolongation-of lifespan [J. Berden, Scand J. Immunol. 24: 405
(1986)]. At a dose of 40 mg/kg, CsA decreased lymphadenopathy, arthritis, and
glomerulonephritis and increased the survival time of the MRL/lpr mice, but did not
affect levels of anti—DNA autoantibodies [J. Mountz, J. Immunol. 138: 157 ( 1987)].
A decrease in proteinuria and the progression of neuropathy, and an increase
in survival time was observed in MRL/lpr mice that were treated with 2.5 mg/kg of
FK—506; however, no change in levels of anti—DNA autoantibodies were observed.
[K.Takabayshi, Clin. Immunol. Immunopath. 51: 110 (l989)].
Rapamycin, a macrocyclic triene antibiotic produced by Streptomyces
hygroscopicus [U.S. Patent 3,929,992] has been shown to prevent the formation of
humoral (IgE-like) antibodies in response to an albumin allergic challenge [Martel,
R., Can. J. Physiol.. Pharm. 55: 48 (l977)], inhibit murine T-cell activation [Strauch,
M., FASEB 3: 3411 (l989)]. and prolong survival time of organ grafts in
histoincompatible rodents [Morris, R., Med. Sci. Res. 17: 877 (1989)].
This invention provides use of rapamycin in the preparation of a medicament
for arresting the development or retarding the progression of SLE in a human.
The medicament may comprise a pharmaceutically acceptable carrier, diluent
or excipient. The medicament may be adapted for administration orally,
parenterally, intranasally, intrabronchially, or rectally.
The effect of rapamycin on SLE was established in the MRL/lpr mouse, a
standard animal model for SLE. The procedures used and results obtained are
described below. CsA also was evaluated in the MRL/lpr mouse for the purpose of
comparison.
Female MRL/lpr mice were treated with either rapamycin or CsA beginning
in one test when the mice were 8 weeks of age (Test 1), and in a second test when the
mice were 10 weeks of age (Test 2), and in a third test when the mice were 6 weeks
of age (Test 3). Rapamycin was dissolved in absolute ethanol and prepared in a final
formulation of 8% cremophor and 2% ethanol. CsA was obtained in a formulation
containing cremophor and alcohol and was diluted with water to approximately the
same concentration as the rapamycin solution. The mice in each test were closed by
gavage 3 times per week. MLR/lpr mice treated with vehicle, and untreated
MRL/lpr mice, were used as controls in each of the three tests.
The following table shows the effect of rapamycin and CsA on survival time.
EFFECT OF RAPAMYCIN AND CsA ON SURVIVAL TlIv£E+
Percent Survival
Test 1
Day of Study 190 250 281 Median Survival
(days!
Vehicle 33 27 13 162
Naive 33 13 13 135
Rapamycin 6 mg/kg A 53 47 24 237
Rapamycin 12 mg/kg 80* 60* 52* 283*
CsA 6 mg/kg 40 13 O 171
ILM
Day of Study 129 136 181
Vehicle 58 42 17
Naive 25 25 0
Rapamycin 12.5 mg/kg 83 65 46
Rapamycin 25 mg/kg 92** 92** A 55**
CsA 12.5 mg/kg 50 25 4 8
CsA 25 mg/kg 25 8 8
+ Test 1 based on 15 mice per group and test 2 based on 12 mice per group.
* Significantly (p<0.03) longer survival than vehicle-treated tnice.
** Significantly (p<0.05) longer survival than vehicle-treated mice.
These data demonstrate that rapamycin, at a dose of 12 mg/kg in Test 1 and at a
dose of 25 mg/kg in Test 2, significantly increased the survival time of MRUlpr mice
when compared with MRL/lpr mice treated only with vehicle. The percent survival of
mice treated with rapamycin at each fime period also was greater than that was observed
in mice treated with CsA.
Anti-DNA antibody levels were determined by radioimmunoassay in mice that
were evaluated in Test 2. Blood was drawn at age 10 weeks and at 4 week periods
thereafter. Sera (25 ul) was incubated with 200 pl DNA-I125 for 2 hours at 37° in a
shaking water bath. Ammonium sulfate (1 ml) was added to each tube and the tubes
were vortexed. Each tube was centrifugedfor 15 min at 2000 x g; the supernatant was
aspirated and the precipitate was counted in a gamma counter. The quanity of anti-
double stranded DNA antibodies was determined from a standard curve.
The following table shows the results obtained for MRL/lpr mice treated with
rapamycin or CsA.
MEAN ANTI-DNA ANTIBODY LEVELS
Units/ml
I w s 13 weeks
Vehicle 53 I 183
Naive 34 21 1
Rapamycin 12.5 mg/kg 28 _ 68*
Rapamycin25mg/kg 49 53* ‘
CsA 12.5 mg/kg 58 91
CsA 25 mg/kg 28 240
* No change from prebleed level.
In the MRL/lpr mouse, manifestations of SLE begin to occur at approximately 8
weeks and develop progressively. These data show that rapamycin prevented the
elevation of anti-DNA antibody levels that were observed in control or CsA-treated
MRL/lpr mice.
The effect of rapamycin on renal function was evaluated by measuring urinary
albumin in the MRL/lpr mice used in Test 2. Elevated urinary albumin levels are
indicative of renal impairment. The following procedure was used. Urine was
obtained from the MRL/lpr mice at age 10 weeks and monthly thereafter. The urine
was diluted 1:20 in sterile water, and 200 pl of bromocresol green was added to 100 Lil
urine solution. The absorbance was read at 630 nm. A standard solution of albumin
was treated similarly. The quantity of urinary albumin was determined from a standard
curve. 4
The following table shows the levels of urinary albumin in MRL/lpr mice
treated with rapamycin or CsA.
MEAN URINARY ALBUMIN LEVELS
Azs:_l.0£¢_¢£s +
Vehicle ‘ 540 3253
Naive 596 3406
Rapamycin 12.5 mg/kg 786 879
Rapamycin 25 mg/kg 974 764
CsA 12.5 mg/kg - 699 837
CsA 25 mg/kg 764 712
+ Mean of the last monthly urine sample obtained for each mouse.
The results demonstrate that rapamycin prevented the development of
glomerular nephritis in the MRL/lpr mouse as evidenced by urinary albumin levels that
were not elevated significantly above levels observed when the MRL/lpr mice were 10
weeks of age. Similar results were observed in the MRL/lpr mice treated with CsA.
Urinary albumin levels of untreated mice significantly increased concomitant with
disease progression.
The effect of rapamycin on preventing lymphadenopathy and splenomegaly,
that are observed with SLE, was determined in the MRL/lpr mice used in Test 3. After
2 months of treatment with ‘rapamycin, CsA, or vehicle, the mice were humanly
sacrificed by asphyxiation with C02. The spleen, inguinal, and axillary lymph nodes
were removed. Thespleens were weighed and the diameters of the lymph nodes were
measured immediately. An end section of the spleen was used for histology, and the
middle section was used in standard pharmacological test procedures for splenocyte
proliferation and interleukin 2 (IL-2) production.
The following table shows the effects of rapamycin and CsA on lymph node
diameters.
MR1./lpr MOUSE LYMPH NODE DIAMEFERS
In-a_mne_n_t __Ia_I_aa.. _RrJ_ag._ L Axil R. Axil
Naive 6.9 :t 0.3 6.5 i 0.6 10.3 :1: 0.7 11.0 i 0.7
Vehicle 5.0 i 0.5 4.9 :t 0.5 9.3 .-t 0.7 10.0 3: 0.6
Rapamycin 12.5 mg/kg 3.0 :t 0.3 2.4 : 0.3 3.5 2 0.4 4.1 : 0.3
Rapamycin 25mg/kg 2.9 2 0.2 2.7 at 0.2 3.9 1: 0.2 4.1 it 0.2
CsA 12.5 mg/kg 7.9 : 0.9 5.5 at 0.6 10.3 1 0.8 11.0 : 0.7
CsA25mg/kg 6.9 i 0.4 5.8 :t 0.6 10.0 i 0.4 9.9 It 0.6
These results demonstrate that rapamycin prevented the enlargement of lymph
nodes which is associated with the lymphadenopathy caused by SLE. CsA did not
prevent the enlargement of the lymph nodes and provided similar results to naive and
vehicle-treated MRL/lpr mice.
The following table shows the effect of rapamycin and CsA on spleen weight.
MRI./lpr MOUSE SPLEEN WEIGHTS
TLLt1'_EEAf gram. 5
Naive 0.41 i 0.07
Vehicle 0.28 1 0.03
Rapamycin 12.5 mg/kg 0.19 i 0.01
Rapamycin25_mg/kg 0.14 i 0.00
CsA 12.5 mg/kg 0.38 3: 0.03
CsA 25 mg/kg 0.30 i 0.02
These results demonstrate that rapamycin prevented the enlargement of the
spleen which is associated with the splenomegaly caused by SLE. CsA did not prevent
the enlargement of the spleen, and provided results similar to untreated MRL/lpr mice
or mice treated with vehicle.
The progression of SLE is accompanied by a decrease in the proliferation of
splenocytes in response to rnitogens. In the MRI./lpr mouse, this corresponds to a
diminished splenocyte proliferation in response to mitogens such as concanavalin A
(Con A), lipopolysaccaride (LPS), phytohemagglutinin (PHA), and phorbol myristic
acid (PMA). The effect of rapamycin and CsA on splenocyte proliferation in the
MRL/lpr mice used in Test 3 was evaluated in an ex vivo spleen cell proliferation
standard pharmacological test procedure. The MRL +/+ mouse, the wild strain that
develops only mild SLE symptoms because of the absence of the lpr gene, also was
used as a control to determine normal levels of splenocyte proliferation in response to
the mitogens.
The following standard test procedure was used. Spleens were removed under
sterile conditions and pressed through a stainless steel 500 mesh screen to produce a
single cell suspension. Erythrocytes were lysed by incubating cells for four minutes in
0.83% w/v ammonium chloride and cells were immediately washed twice with RPMI
16409‘ medium. Spleen cells were resuspended to a concentration of 5 X 105 cells/ml
in RPMI 1640” medium containing 10% fetal calf serum, 100 units/ml penicillin,
100 pg/ml streptomycin, 2 mM 1-glutamine, 0.1 mM non—essential amino acids, 1 mM
sodium pyruvate, and 5 x 10'5 M 2-mercaptoethanol. Cells were incubated at 37°C in
% CO2 in 96-well microtiter plates at a concentration of 5 x 105 cells/well for a total of
72 hours. Mitogens were diluted to the appropriate concentrations in the medium
described above, and added to the wells at the beginning of the incubation period to
give a final concentration of 2.0 pg/ml Con A, 10 ttg/ml LPS, 10 pg/ml PHA or 10
ng/ml PNLA in a final volume of 0.2 ml. Spontaneous proliferation (no mitogen) was
also assessed. Proliferation in wells was assessed by [3H] thyrnidine incorporation
(1 },tCi/ml) during the last 18 hours of incubation. Six animals per group were
separately analyzed in culture, with six wells per animal plated and the counts per
minute were averaged for each group.
The following table shows the results obtained for MRL/lpr mice treated with
rapamycin or CsA in the splenocyte proliferation standard pharmacological test
procedure. _
MRL/lpr SPLENOCYTE PROL1FERATION*
Mitogen
1:lsz.Mit9.a:n $299.1: BEA LES EMA
Naive 0.75 It 0.1 3.58 i 0.8 23.54 i 4.0 7.01 it 1.7 3.63 i 0.4
Vehicle (control) 1.05 i 0.1 6.04 i 0.7 33.19 it 2.1 10.14 i 1.5 3.66 It 0.3
Rapamycin 12.5 mg/kg 1.54 It 0.1 27.25 i 2.1 41.73 111.5 24.32 it 1.9 4.49 i 0.3
Rapamycin 25 mg/kg 2.54 it 0.3 38.12 It 2.7 45.88 11.8 22.69 1*: 1.8 5.11 i 1.3
CaA 12.5 mg/kg 1.13 10.0 5.74 3:1.3 31.75 i 1.8 8.78 i 2.2 3.49 i 0.2
CsA 25 mg/Kg ‘ 2.22 i 0.2 7.14 i1.0 39.91 i1.3 16.32 i 3.2 4.33 It 0.3
MRL/+/+ mouse 1.27 :t 0.1 48.82 :t 4.2 59.11 i 3.5 44.93 i 2.0 4.45 is 0.4
* Results expressed in counts per minute x10
These results demonstrate that rapamycin prevented the diminished ability to
proliferate in response to mitogens that is associated with the progression of SLE.
Splenocytes from CsA-treated animals showed only partially restored response to PHA
and LPS stimulation.
Concomitant with the development of SLE is the loss of the ability to.produce
interleukin 2 (IL-2). This manifestation is also observed in the MRL/lpr mouse. The
effect of rapamycin and CsA on IL-2 production in the MRIJlpr mice used in Test 3
was evaluated in an ex yjgg standard pharmacological test procedure using a CITL-2
cell bioassay. The MRL +/+ mouse was used as a control to determine normal levels of
IL-2 production. The following procedure was used to measure IL-2 production.
Spleen cell cultures from the same animals used in the spelocyte proliferation
standard test procedure described above were treated in the same manner as described
in that procedure except that only the mitogen Con A was used. Cells were incubated at
37°C in 5% CO2 in 96-well microtiter plates for 24 hours. Supematants were collected
(600 ttl/sample) and IL-2 content was determined as follows. CI'LL-2 cells were
grown in 75 cm? tissue culture flasks, and were split twice a week. Each flask
contained a total of 25 ml RPMI 1640 medium with 2 mM sodium Pyruvate, 2 mM 1-
glutamine, 15 mM hepes, 8% fetal calf serum, 100 units/ml penicillin, 100 pg/ml
streptomycin, and 5-30 units per ml of recombinant human IL-2 (rhlL-2). Cells were
seeded at 1:100 or 1:50 dilution from a healthy culture. Healthy cultures were
harvested and centrifuged at 1000 rpm for 10 minutes. The spent medium was
removed and the cells resuspended in assay medium (CI'LL-2 maintenance medium
minus rhIL-2). The cells were washed a second time (to remove all residual lL-2) at
1000 rpm for 10 minutes. The supernatant was discarded and the cells resuspended in
fresh assay medium at 5 x 104/ml. The wells of a 96-well microtiter plate were first
filled with 100 pl of sample to be tested (done in triplicate). The standard curve was set
up by filling the appropriate wells with 100 ttl of assay medium, and then 100 pl of
rhIL-2 were added to the first well of each column (also done in triplicate). Two-fold
serial dilutions were made down the plate, the last 100 til being discarded. The
standard curve started at 50 units/ml final concentration of rhlL-2 and eight two-fold
dilutions were made. Triplicate wells of medium alone were set When all samples and
controls were in place, 100 pl of cell suspension were added to each well. The plate
was incubated at 37°C in 5% CO2 overnight or 20 to 24 hours. The plate was then
pulsed with tritiated thymidine, 20 ttl/well, to give a final concentration of 1 [,tCi/ml.
The plate was incubated for an additional 8 hours and the cells harvested onto glass
._9_
fiber filters which were then deposited into scintillation vials. The vials were filled with
2 ml of scintillation fluid and counted for one minute each on a beta counter. Counts
per minute were recorded.
The results obtained in the ex vivo IL-2 production standard pharmacological
test procedure are provided in the following table.
MRl..'lpr IL-2 PRODUCI'ION*
_QB.\i_ __llLu1L__
Naive 2706 i 546 0.191 1 0.031
Vehicle 3531 it 610 0.238 1|: 0.035
Rapamycin 12.5 mg/kg 9166 i 602 0.562 i 0.037
Rapamycin 25 mg/kg 8317 It 1516 0.535 t 0.106
CsA 12.5 mglkg 2573 i 687 -0.174 t 0.042
CsA 25 mg/kg 2438 i 485 0.168 i 0.032
MRL +/+ mouse 13775 i 1273 0.955 i 0.144
* Results expressed in counts per minute (CPM) and Units per milliliter (U/ml)
These results demonstrate that rapamycin prevented the diminution in IL-2
production in response to Con A that is associated with SLE. CsA had no positive
effect on IL-2 production as compared with MRL/lpr mice treated with vehicle.
Histologic examination was conducted on the heart, lung, trachea, two inguinal
and two axillary lymph nodes, spleen,‘ liver, both kidneys with adrenals, and thymus of
MRL/lpr mice that were evaluated in Test 3 following 2 months of treatment. Tissue
sections were stained with hematoxylin and eosin. Histologic changes in the MLR/lpr
mouse are representative of the changes seen in humans with SLE. The effects of
rapamycin and CsA on histologic changes associated with SLE are described below.
Focal peribronchial or perivascular mononuclear cell infiltration in the lung is a
common finding in the MRI./lpr mouse. In the naive control mice the incidence of this
change was 100%, however, rapamycin significantly reduced the incidence and
severity of this change in the lung of these mice. CsA at 12.5 and 25 mglkg
significantly worsened the focal perviascular mononuclear cell infiltration.
Inflammatory changes noted in the liver, such as focal periportal or perivascular
inflammatory cell infiltration, focal inflammation and focal vasculitis were reduced in
incidence in all raparnycin and CsA-treated groups when compared with the vehicle-
treated or naive group. Rapamycin at both doses significantly reduced periportal
inflammatory cell infiltration.
Lymphoid hyperplasia is characterized by an increase in the number of
lymphoid cells and/or size of lymphoid follicles. All animals in groups naive, vehicle,
CsA at 12.5 mg/kg, and CsA at 25 mg/kg revealed lymphoid hyperplasia in the spleen,
lymph nodes and thymus. The severity of this change was similar in all affected
groups. Rapamycin treated animals did not reveal lymphoid hyperplasia in the spleen
and thymus, however, 1 mouse in the 25 mgjkg rapamycin group showed this change
in the lymph node. ‘ '
Both doses of rapamycin significantly reduced focal periportal inflammatory cell
infiltration. In the kidneys, both doses of rapamycin significantly reduced focal
vasculitis, focal pyelitis, and focal interstitial nephritis. CsA 25 at mg/kg significantly
worsened focal fasculitis and focal pyelitis. Both doses of CsA significantly reduced
interstitial nephritis. The naive group had significantly higher scores than the vehicle
for focal pyelitis and significantly lower scores than the vehicle for focal interstitial
nephritis.
Focal vacuolation in the cortex of adrenals is a common finding in the MRL/lpr
mouse; however, both dose levels of rapamycin reduced the incidence of focal
vacuolation significantly.
The results of histologic examination of organs typicallyaffected by SLE
demonstrated that rapamycin prevented adverse histologic changes indicative of the
progression of SLE.
In summary, results of these standard pharmacological test procedures using the
MRL/lpr mouse, a standard animal model for human SLE, demonstrate that rapamycin
is useful for arresting the development and retarding the progression of SLE in a
mammal by virtue of its ability to increase survival time of the MRL./lpr mouse, prevent
the elevation of urinary albumin and anti-DNA autoantibody levels, prevent the
diminution of splenocyte proliferation and IL-2 production in response to mitogens,
and arrest histomorphological changes associated with the progression of SLE.
When rapamycin is employed for arresting the development or retarding the
progression of SLE, it can be formulated into oral dosage forms such as tablets,
capsules and the like. Rapamycin can be administered alone or by combining it with
conventional carriers, such as magnesium carbonate, magnesium stearate, talc, sugar,
lactose, pectin, dextrin, starch, gelatin, tragacanth, methylcellulose, sodium
carboxyrnethylcellulose, low melting wax, cocoa butter and the like. Diluents,
flavoring agents, solubilizers, lubricants, suspending agents, binders, tablet-
disintegrating agents and the like may be employed. Rapamycin may be encapsulated
with or without other carriers. In all cases, the proportion of active ingredients in said
compositions both solid and liquid will be at least to impart the desired activity thereto
on oral administration. Rapamycin may be injected parenterally, in which case it is
used in the form of a sterile solution containing other solutes, for example, enough
saline or glucose to make the solution isotonic. Rapamycin also may be administered
rectally in the form of a conventional suppository. For administration by intranasal or
intrabronchial inhalation or insufflation, rapamycin may be formulated into an ‘aqueous
or partially aqueous solution, which can then be utilized in the form of an aerosol.
The dosage requirements vary with the particular compositions employed, the
route of administration, the severity of the symptoms presented and the particular
subject being treated. Based on the results obtained in the standard pharmacological
test procedures, projected oral daily dosages of active compound would be 0.01 - 75
mg/kg, preferably between 0.1 - 50 mg/kg, and more preferably between 1 - 50 mg/kg.
Projected parenteral daily dosages of active compound would be 0.01 - 50 mg/kg,
preferably between 0.1 — 10 mg/kg, and more preferrably between 0.1 - 1 mg/kg.
Treatment will generally be initiated with small dosages less than the optimum dose of
the compound. Thereafter the dosage is increased until the optimum effect under the
circumstances is reached; precise dosages for oral, parenteral, nasal, or intrabronchial
administration will be determined by the administering physician based on experience
with the individual subject treated. In general. rapamycin is most desirably
administered at a concentration that will generally afford effective results without .
causing any harmful or deleterious side effects, and can be administered either as a
single unit dose, or if desired, the dosage may be divided into convenient subunits
administered at suitable times throughout the day.
Claims (10)
1. Use of rapamycin in the preparation of a medicament for arresting the development or retarding the progression of systemic lupus erythmatosus in a human.
2. Use of rapamycin according to Claim 1 in which the medicament is adapted for administration orally, parentally, intranasally, intrabronchially or rectally.
3. Use of rapamycin according to Claim 1 in which the medicament is adapted for oral administration in unit dosage form.
4. Use of rapamycin as claimed in Claim 3 in which the daily dose of rapamycin is from 0.01 to 75 mg/kg based on the weight of the human to be treated.
5. Use of rapamycin as claimed in Claim 3 in which the daily dose of rapamycin is from 0.01 to 50 mg/kg based on the weight of the human to be treated.
6. Use of rapamycin as claimed in Claim 3 in which the daily dose of rapamycin is from 1 to 50 mg/kg based on the weight of the human to be treated.
7. Use of rapamycin as claimed in Claim 1 in which the medicament is adapted for parenteral administration which is in unit dosage form.
8. Use of rapamycin as claimed in Claim 7 in which the daily dose of rapamycin is 0.01 to 50 mg/kg pased on the weight of the human to be treated.
9. Use of rapamycin as claimed in Claim 7 in which the daily dose of rapamycin is 0.1 to 10 mg/kg based on the weight of the human to be treated.
10. Use of rapamycin as claimed in Claim 7 in which the daily dose of rapamycin is 0.1 to 1 mg/kg based on the weight of the human to be treated. F. R. KELLY & CO., AGENTS FOR THE APPLICANTS.
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US5206018A (en) * | 1978-11-03 | 1993-04-27 | Ayerst, Mckenna & Harrison, Inc. | Use of rapamycin in treatment of tumors |
US6548640B1 (en) * | 1986-03-27 | 2003-04-15 | Btg International Limited | Altered antibodies |
US5221670A (en) * | 1990-09-19 | 1993-06-22 | American Home Products Corporation | Rapamycin esters |
US5378696A (en) * | 1990-09-19 | 1995-01-03 | American Home Products Corporation | Rapamycin esters |
US5321009A (en) * | 1991-04-03 | 1994-06-14 | American Home Products Corporation | Method of treating diabetes |
US5194447A (en) * | 1992-02-18 | 1993-03-16 | American Home Products Corporation | Sulfonylcarbamates of rapamycin |
US5286731A (en) * | 1991-09-17 | 1994-02-15 | American Home Products Corporation | Method of treating immunoinflammatory bowel disease |
US5286730A (en) * | 1991-09-17 | 1994-02-15 | American Home Products Corporation | Method of treating immunoinflammatory disease |
US5164399A (en) * | 1991-11-18 | 1992-11-17 | American Home Products Corporation | Rapamycin pyrazoles |
CA2086642C (en) * | 1992-01-09 | 2004-06-15 | Randall E. Morris | Method of treating hyperproliferative vascular disease |
US5516781A (en) * | 1992-01-09 | 1996-05-14 | American Home Products Corporation | Method of treating restenosis with rapamycin |
US5262424A (en) * | 1992-02-18 | 1993-11-16 | American Home Products Corporation | Composition of sulfonylcarbamates of rapamycin and method of treating diseases requiring immunosuppression therewith |
US5177203A (en) * | 1992-03-05 | 1993-01-05 | American Home Products Corporation | Rapamycin 42-sulfonates and 42-(N-carboalkoxy) sulfamates useful as immunosuppressive agents |
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1991
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1992
- 1992-02-10 IL IL10090492A patent/IL100904A/en not_active IP Right Cessation
- 1992-02-19 ZA ZA921210A patent/ZA921210B/en unknown
- 1992-02-20 PT PT100145A patent/PT100145B/en not_active IP Right Cessation
- 1992-02-20 NZ NZ241671A patent/NZ241671A/en not_active IP Right Cessation
- 1992-02-21 SG SG1996004022A patent/SG52404A1/en unknown
- 1992-02-21 DE DE69231927T patent/DE69231927T2/en not_active Expired - Fee Related
- 1992-02-21 EP EP92907399A patent/EP0572542B9/en not_active Expired - Lifetime
- 1992-02-21 CA CA002103568A patent/CA2103568A1/en not_active Abandoned
- 1992-02-21 IE IE055692A patent/IE920556A1/en not_active IP Right Cessation
- 1992-02-21 DK DK92907399T patent/DK0572542T3/en active
- 1992-02-21 AU AU14691/92A patent/AU664545B2/en not_active Ceased
- 1992-02-21 MX MX9200727A patent/MX9200727A/en unknown
- 1992-02-21 KR KR1019930702484A patent/KR100201517B1/en not_active IP Right Cessation
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- 1992-02-21 ES ES92907399T patent/ES2157901T3/en not_active Expired - Lifetime
- 1992-02-21 WO PCT/US1992/001399 patent/WO1992014477A1/en active IP Right Grant
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1998
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