IE912825A1 - Immunosuppressive compositions - Google Patents

Abstract

A pharmaceutical composition containing a non-specific (NS) suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound and a pharmaceutically acceptable carrier or diluent, and method of inducing an immunosuppressive effect in a mammal, including a human, in need thereof which comprises administering an effective dose of a NS suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound to such mammal.

Description

IMMUNOSUPPRESSIVE COMPOSITIONS This invention relates to a pharmaceutical composition containing a non-specific (NS) suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound and a pharmaceutically 2θ acceptable carrier or diluent. This invention also relates to a method of inducing an immunosuppressive effect in a mammal, including a human, in need thereof which comprises administering an effective dose of a NS suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound to such mammal.

BACKGROUND OF THE INVENTION Conventional drugs used in the treatment of autoimmune diseases and graft/transplantation rejection, such as cyclosporin A, corticosteroids, azathioprine, - 2 polyclonal anti-lymphocyte globulins and monoclonal T cell antibodies are somewhat effective in electing an immunosuppressive response. However, their toxicity profiles frequently limit their clinical benefit. Thus, the treatment of autoimmune diseases, graft/transplantation rejection and other maladies requiring immunosuppression with agents having low-toxicity profiles remains a major clinical problem.

The use of monoclonal anti-IL2 receptor antibodies in combination with cyclosporin A has been reported. See, Diamantstein, T, et al., (1986) Immunobiol. 172:391-399; Kupiec-Weglinski, J.W. , et al., 15 (1988) Transplant Proc 20:207-216 and Hancock, W.W., et al., (1990), Transplantation 49:416-421. The use of bromocriptine in combination with cyclosporin A (Carrier, M. , et al., (1990), Ann. Thorac. Surg. 49:129-32)and thalidomide in combination with cyclosporin A (Tamura, F., et al., (1990) transplantation 49:20-25) has also been reported.

Non-specific suppressor cell inducing compounds are agents which induce the production of a population of natural suppressor cells which do not have the characteristics of mature T cells, B cells, macrophages or natural killer cells and are therefore of the null or non-specific phenotype. Natural suppressor cells are capable of inhibiting a variety of immune responses in The immunosuppressive activity associated with total lymphoid irradiation (TLI) has been attributed to the generation of a population(s) of natural suppressor cells. See, Strober, S., (1984) Ann. Rev. Immun. 2:219 and Maier, T., et al., (1986), Immuno1. Today 7:312. The use of TLI as part of a combination treatment with - 3 cyclosporine and either cyclophosphamide (See, Yamaguchi, Y. , et al., (1990), Transplantation 49:13-17) or splenectomy (See, Miyamura, K., et al., (1988), Bone Barrow Transplantation 3:457-461) has been reported.

Classes of compounds known to induce NS suppressor cells include N-amino alkyl azaspirogermanium alkanes (See, e.g., Badger, A., et al., (1985), Immunopharm. 10:201 and DiMartino, M. J. , et al., (1986), J. Pharm. Exp. Ther. 236:103) and N-amino alkyl azaspiro alkanes (See, e.g., Badger, A., et al., (1989), Int. J. Immunopharmac. 11.:839-846 and European Patent Application Publication Number 0310321 A2).

It has now been discovered that combining a NS suppressor cell inducing compound with a non-NS suppressor cell inducing immunosuppressive compound increases immunosuppressive activity in vivo to an extent beyond 2Q which either compound achieves alone or would be expected to achieve when combined.

SUMMARY OF THE INVENTION This invention relates to a pharmaceutical composition containing a NS suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound such as cyclosporin A. This invention also relates to a method of inducing an immunosuppressive effect in a mammal, including a human, in need thereof which comprises administering an effective amount of a NS suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound to such mammal. - 4 DETAILED DESCRIPTION OF THE INVENTION By the term cyclosporin A as used herein is 5 meant the cyclic polypeptide of the formula Cyclosporin A is produced as a metabolite by the fungus 2Q species Tolypocladium inflatum Gams. Chemically, cyclosporin A is designated as [R-[R,R-(E)]]-cyclic-(L-alanyl-D-alanyl-N-methyl-L leucyl-N-methyl-L-leucyl-N-methyl-L-valyl-3hydroxyN, 4-dimethyl-L-2-amino-6-octenoyl-L- Cyclosporin A is commercially available in oral dosage form or intravenous dosage form under the trade A name Sandimmune and is manufactured by Sandoz Ltd., Basle Switzerland for Sandoz Pharmaceuticals Corporation, East Hanover, N.J. 07936. The total synthesis of cyclosporin A has been reported by Wenger, Transplant Proc 15 (4), suppl. 1, 2230 (1983).

By the term FK-506 as used herein is meant the macrolide immunosuppressant of the formula: o ό» J-./Sai, FK-506 is isolated from Streptomyces tsukubaensis No. 9993 and is claimed in European Patent Application No. 184,162 (1986 to Fujisawa). Chemically, FK-506 is designated as [3S-[3R*[E(IS*,3S*,4S*)],4S*,5R*»8S*,9E,12R*,14R*,15S*,16R*, 18S*,19S*,26aR*]1-5,6,8,11,12,13,14,15,16,17,18,19,24,25,26, 26a-Hexadecahydro-5,19-dihydroxy-3-[2-(4-hydroxy-3methoxycyclohexy 1 )-l-methylethenyl 1-14,16-dimethoxy-4,10 ,12,18-tetramethy1-8-(2-propenyl)-15,19-epoxy-3H-pyr ido[2, ίο ][1,4]oxaazacyclotricosine-l,7,20,21(4H,23H)-tetrone.

By the term SPERGUALIN as used herein is meant the compound of the formula: Spergualin is isolated from Bacillus Laterosporus and is a known immunosuppressive agent. (see, Ameniya, H et al. , (1990), Transplantation 49 :337:343).

By the term RAPAMYCIN as used herein is meant the macrolide immunosuppressant of the formula: Rapamycin is a fermentation product of Streptomyces Hyqroscopicus and was first reported in 1975 (J. Antibiot 28:727 (1975).

By the term RS-61443 as used herein is meant a prodrug of mycophenolic acid. RS-61443 is a known immunosuppressive agent under investigation by Syntex.

By the term non-NS suppressor cell inducing immunosuppressive compound as used herein is meant any immunosuppressive agent that does not induce the in vivo production of a population of natural or non-specific suppressor cells.

Preferred non-NS suppressor cell inducing compounds for use in the compositions and methods of the invention include: FK-506, spergualin, rapamycin, RS-61443 and cyclosporin A.

By the term NS suppressor cell inducing compound as used herein is meant any compound which induces the in vivo production of a population of natural suppressor cells. Such natural suppressor cells do not have the characteristics of. mature T cells, B cells, macrophages or natural killer cells and are therefore of the null or non-specific phenotype. Natural suppressor cells are capable of inhibiting a variety of immune responses in vivo.

Preferred NS suppressor cell inducing compounds for use in the compositions and methods of the invention include the N-aminoalkyl azaspirogermanium alkanes reported by Badger et al. , Immunopharm. , 14):201 (1985) and DiMartino et al., J. Pharm. Exp, Ther., 236:103 (1986), including: N-(3-dimethylaminopropyl)-2-aza-8,8-dimethyl-8germanspiro[4,5]decane; N-(3-dimethylaminopropyl)-2-aza-8,8-diethyl-8germanspiro[4,5]decane; N-(3-dimethylaminopropyl)-2-aza-8,8-dipropyl-8germanspiro[4,5]decane; and N-(3-dimethylaminopropyl)-2-aza-8,8-dibutyl-8germanspi ro[4,5]decane.

Additional preferred NS suppressor cell inducing compounds for use in the composition and method of the invention include the N-aminoalkylazaspiro alkanes described in U.S. Patent Application Serial Number 25 07/244,229 filed September 13, 1988 the entire disclosure of which is hereby incorporated by reference, for example, compounds of the formula: - 8 wherein: n is 3-7; m is 1 or 2; and R2 are the same or different and are selected from hydrogen or straight chain, branched chain or cyclic alkyl, provided that the total number of carbon atoms contained by R^ and R2 when taken together is 4-10; or R^ and R2 are joined together to form a cyclic alkyl group containing 3-7 carbon atoms; R_ and R, are the same or different and are selected from hydrogen or straight chain alkyl containing 1-3 carbon atoms; or R3 and R4 are joined together to form a cyclic alkyl group containing 4-7 carbon atoms; provided that when R^ and R2 are CH3CH2, R3 and R4 are CH3 and m is 1 or 2, n is other than 3; and further provided that when R^ is H; R2 is (CH3)3C; R3 and j^4 are CH3 and m is 1 or 2, n is other than 3; and further provided that when R2 is H; ,θ Rj^ is (CH3)3C; R3 and R4 are CH3 and m is 2, n is other than 3; or a pharmaceutically acceptable salt, hydrate or solvate thereof.

Especially preferred are the following N-aminoalkyl azaspiro alkane derivatives: 1 ^OCL... . 5 .,χχν.'.X//C' ! .._< : Al io * 10 H χ<χι .η Sgg._.;, 15 >»oa π H OOC.^... iXX] . ^a^vnx ; 20 ^CX]^;N0 ; 25 OOC!^„q : >XDC )θΟΟ(νχΛΛ,0 30 »θα_<, XDQ^e - xXDQ~.q , or a salt thereof. - 10 The most preferred NS suppressor cell inducing compound is N,N-dimethyl-8,8-dipropyl-2-azaspiro[4,5]decane-2-propanamine, (hereinafter referred to as 'Compound A') Persons skilled in the art can readily determine if a compound other than ones specifically referred to herein induces non-specific suppressor cell activity by utilizing the assay described in Badger et al., Immunopharm, 16, 33-43 (1988), the entire disclosure of which is hereby incorporated by reference. Thus, all such compounds are therefore included within the scope of the term 'non-specific suppressor cell inducing compound' as used herein.

By the term administering an effective amount of a NS suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound as used herein is meant either simultaneous administration or any manner of consecutive administration, i.e., either the non-NS suppressor cell inducing immunosuppressive compound or the non-specific suppressor cell inducing compound may be administered first. Preferably, if the administration is not simultaneous, the two compounds are administered in a close time proximity to each other. Furthermore, it does not matter if the compounds are both administered in the same dosage form, e.g., the non-NS suppressor cell cell inducing immunosuppressive compound may be administered by injection and the non-specific suppressor cell inducing compound may be administered orally.

The therapeutic efficacy of a pharmaceutical composition of the invention was tested according to the procedure of Kupiec-Weglinski, J.W., et al., (1988) Transplant Proc. 20:207-216 (hereinafter KupiecIE 912825 - 11 Weglinski) to determine its in vivo potency as an acute transplantation/graft rejection modulator.

Briefly, to preform these experiments, the following protocol was employed. Male inbred adult rats (Lewis-Brown Norway FI Hybrid rats, obtained from Harlan sprague - Dawley Inc., Indianapolis, Indiana) were used. Lewis-Brown Norway FI Hybrid cardiac allografts were transplanted to the abdominal great vessels of Lewis recipients. The animals were administered compounds according to the following five distinct regimens.

Protocol I.

Protocol II Pretreatment Protocol - 20 mg/kg/day of Compound A was administered orally for 7 consecutive days prior to transplantation (days —7 to -1).

Treatment Protocol - 20 mg/kg/day of Compound A was administered orally for 7 consecutive post-transplant days (days 0-6) followed by intermittent 5 day courses (days 9-13 and 16-20).

Protocol III Pretreatment and Treatment Protocol - 20 mg/kg/day of Compound A was administered orally for 7 consecutive days prior to transplantation (days -7 to -1) followed by intermittent 5 day courses (days 9-13 and 16-20).

Protocol IV Combination Protocol - 20 mg/kg/day of Compound A was administered orally and 1.5 mg/kg/day of cyclosporin A was administered by injection for 7 consecutive post-transplant days (days 0-6).

Protocol V Untreated. - 12 1 Ventricular contractions were assessed daily by palpation through the recipient flank. Rejection was defined as the day of cessation of myocardial contractions and confirmed histologically.

In the rats treated with a single compound (i.e., pretreatment protocol, treatment protocol or pretreatment and treatment protocol), the graft survival time was increased from an average of 7 days in the untreated model to an average of 16 days using Compound A. Cyclosporin A, at a dose of 1.5 mg/kg/day, when used alone in this model increased the graft survival time from an average of 7 days in the untreated model to an average of 12 days.

(See, Kupiec-Weglinski). Alternatively, in the rats treated with the combination protocol, the transplants were routinely retained for over 40 days. To increase the graft survival time to equal that of the Combination Protocol using cyclosporin A alone requires a dosage an order of magnitude higher than that used in the combination protocol, i.e., 15 mg/kg/day (See, Kupiec-Weglinski). Thus, the administration of the claimed pharmaceutical composition was synergistic, i.e., it extended the graft survival time significantly longer than can be obtained by either compound. The efficacious dosage of cyclosporin A was reduced by one order of magnitude. Since cyclosporin A is known to be highly nephrotoxic, and the level of nephrotoxicity increases with increasing dosages, reducing the dosage cyclosporin A required to obtain the desired immunosuppressive effect is highly desirable. Thus, it is expected that the discovery that the compositions and method of this invention are synergistic will enable the treatment of disorders requiring immunosuppression with the efficacy of - 13 1 conventional treatment methods but with lower toxicity problems. The results of the above experiment are summarized in the following Table I.

TABLE I Effects of Various Treatment Protocols with Compound A on Lewis Rat Recipients of Lewis-Brown Norway FI hybrid Cardiac Allografts.

N GRAFT SURVIVAL (days) MEAN+SD Protocol I 7 10,11,12,13,14,16,27 14.7 + 5,8 Protocol II 7 14,16,16,16*,16*,19,20 16,7.+ 2.0 Protocol III 7 8,15,16,16,16,19,22 16.0 + 4.3 Protocol IV 3 42,42,indefinite survival Protocol V 7 6,7,7,7,8,8,8 7.3 + 0.8 (Untreated) N is the number of rats tested * graft survival in hosts treated for 7 post-transplant days only The data in the above Table 1 clearly demonstrates the synergistic effects of a combination of cyclosporin A and a non-specific suppressor cell inducing compound on the rejection of cardiac allografts in adult male rats.

The claimed pharmaceutical compositions are incorporated into convenient dosage forms such as capsules, tablets, or injectable preparations. Solid or liquid pharmaceutical carriers are employed. Solid carriers include starch, lactose, calcium sulfate dihydrate, terra alba, sucrose, talc, gelatin, agar. - 14 10 pectin, acacia, magnesium stearate, and stearic acid. Liquid carriers include syrup, peanut oil, olive oil, saline, and water. Similarly, the carrier or diluent may include any prolonged release material, such as glyceryl monostearate or glyceryl distearate, alone or with a wax. The amount of solid carrier varies widely but, preferably, will be from about 25 mg to about 1 g per dosage unit.

When a liquid carrier is used, the preparation will be in the form of a syrup, elixir, emulsion, soft gelatin capsule, sterile injectable liquid such as an ampoule, or an aqueous or nonaqueous liquid suspension.

The pharmaceutical preparations are made following conventional techniques of a pharmaceutical chemist involving mixing, granulating, and compressing, when necessary, for tablet forms; or mixing, filling and dissolving the ingredients, as appropriate, to give the desired oral or parenteral products.

The pharmacokinetic properties of each active component of the pharmaceutical composition of the invention must be contemplated when formulating conventional dosage regimens. Both components can be incorporated into a timed release dosage unit form in which several doses are treated for delayed or sustained release of the medicament. Such dosage units may comprise sustained release granules, sugar centered spheres or multilayered tablets in each of which the availability of the active ingredient is controlled by coating with a lupid or polymeric material.

The claimed pharmaceutical composition and method are useful in effecting immunosuppression in mammals.

Thus, they have therapeutic and/or prophylactic utility in treating diseases and conditions wherein inducing an immune suppression response is desired. Such diseases and conditions include, but are not limited to, Rheumatiod arthritis, systemic lupus erythematosis, multiple sclerosis, acute transplantation/graft rejection, - 15 myasthenia gravis, progressive systemic sclerosis, multiple myeloma, atopic dermatitis,-hyperimmunoglobin E, hepatitis B antigen negative chronic active hepatitis, Hashimoto's thyroiditis, Familial Mediterranean fever, Grave's disease, autoimmune hemolytic anemia, primary biliary cirrhosis, insulin dependent diabetes meilitus and inflammatory bowel disease.

This invention also relates to a method of inducing an immunosuppressive effect in a mammal, including a human, in need thereof which comprises administering a non-specific suppressor cell inducing compound and a non-NS suppressor cell inducing immunosuppressive compound to such mammal. Both prophylactic and therapeutic induction are contemplated. One of skill in the art will recognize that the exact dosage and treatment regimen to be utilized in any particular situation will necessarily depend on the exact .disease state to be treated, the age, weight sex and health of the particular animal being treated and that such optimums can be determined by conventional techniques To maximize its synergistic effect, the individual compounds of the claimed combinations can be administered as a single pharmaceutical composition or consecutively in separate pharmaceutical compositions.

One of skill in the art using conventional techniques can determine the most appropriate way to administer the two compounds (consecutively versus simultaneously) depending on such factors as the age, sex, weight and health of the patient and the disease state to be treated. Als.o. during therapy the appropriate administration scheme will be apparent to one of skill in the art.

The dose of the NS suppressor cell inducing compounds to be used in the method of the invention is selected from the range of 0.01 - 1000 mg/kg of body - 16 weight per day, preferably 0.01-100 mg/kg. The dose of the non-NS suppressor cell inducing immunosuppressive compound to be used in the method of the invention is selected from the range of 0.01 mg/kg - 20 mg/kg of body weight per day, preferably 0.01 mg/kg - 2.0 mg/kg.

The selected dose is administered to a mammal in need of immounosuppression from 1-6 times daily, and is administered topically, orally, rectally, by injection, or continuously by infusion. The administration route which is most appropriate is readily determined by one of skill ,in the art using conventional techniques. Oral dosage units for human administration preferably contain from 0.01 to 500 mg of each active compound^ Oral administration, which uses lower’dosages is preferred. Parenteral administration, at higher dosages, however, also can be used when safe and convenient for the patient.

The following examples illustrate preparation of the claimed pharmaceutical compositions. The examples are not intended to limit the scope of the invention as defined hereinabove and as claimed below.

EXAMPLE 1 - Hard Gelatin Capsule An oral dosage form for administering the claimed compounds and compositions is produced by screening, mixing and filling into hard gelatin capsules the ingredients in the proportions shown in Table II below. - 17 1 Table II Ingredients Amounts N,N-dimethyl-8,8-dipropyl-2azaspiro[4,5]decane-2propanamine Cyclosporin A Magnesium stearate Lactose Starch 10 100 2 30 10 mg mg mg mg mg EXAMPLE 2 - Tablet 15 The microcrystalline cellulose, lactose and claimed compounds listed in Table III below, are screened, mixed and granulated in the proportions gelatin solution. The wet granules are mixed with the starch, talc and stearic compressed into a tablet. shown with a 10% screened, dried, acid, screened and Table III 25 Ingredients Amounts N,N-dimethyl-8,8-dipropyl-2- 10 mg azaspiro[4,5]decane-2propanamine 30 Cyclosporine A 100 mg Microcrystalline cellulose 30 mg Lactose 30 mg Starch 10 mg Talc 4 mg 35 Stearic acid 4 mg - 18 1 EXAMPLE 3 - Injectable Preparation Cyclospirin A and N,N-dimethyl-8,8-dipropyl-25 azaspiro[4,5]decane-2-propanamine are solubilized or dispersed in oil based systems shown below to prepare an injectable formulation: Ingredients Amounts N,N-dimethyl-8,8-dipropyl-2- . 10 mg azaspiro[4,5]decane-2- < propanamine Cyclosporine A 100 mg Polyoxyethylated Castor Oil 13 mg or Arachis Oil Alcohol 33% v/v Sterile Water for Injection 1 ml EXAMPLE 4 The following compounds (expressed as base weight) are mixed together with 30 mg of lactose, 2 mg of magnesium stearate and 10 mg starch then filled into a hard gelatin capsule. These capsules are administered from 1-6 times daily to a patient in need of immunosuppressive activity.

A. N,N-dimethyl-8,8-dipropyl-2-azaspiro[4,5]decane-2 propanamine 10 mg; cyclosporin A 100 mg.

B. N,N-dimethyl-8,8-diethyl-2-azaspiro[4,5]decane-2propanamine 10 mg; cyclosporin A 100 mg.

C. N-(3-dimethylaminopropyl)-2-aza-8-diethyl-8germanspiro[4,5]decane 10 mg; cyclosporin A 100 mg. - 19 EXAMPLE 5 - Soft Gelatin Capsule An oral dosage form for administering the claimed compounds and compositions is produced by dispersing claimed compounds in polyethylene glycol vegetable oil and filling into soft gelatin capsules: Ingredients N,N-dimethyl-8,8-dipropyl-2azaspiro[4,5]decane-2propanamine Cyclosporin A Polyehtylene Glycol Vegetable Oil Amounts mg 100 mg 50 mg 50 mg EXAMPLE 6 - Micorparticulate System The microcyrystalline cellulose, starch, and claimed.compounds listed below are screened, mixed and spheronized in the proportions shown with a 10% gelatin solution. The wet particles are screened, dried, and sized. The resulting dried particles can be film-coated and filled into a hard gelatin capsule or compressed into a tablet with the addition of magnesium stearate.

Ingredients Amounts N,N-dimethyl-8,8-dipropyl-2azaspiro[4,5]decane-2- 10 mg propanamine Cyclosporin A 100 mg Microcrystalline Cellulose 50 mg Starch 10 mg Magnesium Stearate 2 mg - 20 1 EXAMPLE 7 - Oral Solution An oral solution dosage form for administering 5 the claimed compounds and compositions is produced by disolving claimed compounds in propylene glycol and mixing with remaining ingredients in the following proportions shown below: Ingredients Amounts N,N-dimethyl-8,8-dipr.bpyl-2- 10 mg azaspiro[4,5]decane-2propanamine Cyclosporin A 100 mg Sorbitol Solution 10 mg Propylene Glycol 40 mg Purified Water 40 mg EXAMPLE 8 - Oral Emulsion An oral emulsion dosage form for administering the claimed compounds and compositions is produced by dissolving claimed compunds in vegetable oil. The 25 polyoxyethylene sorbitan ester and sorbitol solution are dissolved in water, and the oil mixture is dispersed in the water mixture forming an oil-in-water emulsion.

Ingredients Amounts N,N-dimethyl-8,8-dipropyl-2- 10 mg azaspiro[4,5]decane-2- propanamine Cyclosporin A 100 mg Vegetable Oil 50 mg Polyoxyethylene Sorbitan Ester 20 mg Sorbitol Solution 10 mg Purified Water 100 mg - 21 While the preferred embodiments of the invention are illustrated by the above, it is to be understood that the invention is not limited to the precise instructions herein disclosed and that the right to all modifications coming within the scope of the following claims is reserved.

Claims (25)

What is claimed is:

1. A pharmaceutical composition comprising a nonspecific (NS) suppressor cell inducing compound and a non5 NS suppressor cell inducing immunosuppressive compound, and a pharmaceutically acceptable carrier or diluent

2. The composition of Claim 1 in which the NS suppressor cell inducing compound is an N-aminoalkyl 10 azaspiro alkane derivative and the non-NS suppressor cell inducing immunosuppressive compound is: FK-506, spergualin, rapamycin, RS-61443 or cyclosporin A.

3. The composition of Claim 1 in which the NS 15 suppressor cell inducing compound is an N-amino alkyl azaspirogermanium alkane derivative and the non-NS suppressor cell inducing immunosuppressive compounds is: FK-506, spergualin, rapamycin, RS-61443 or cyclosporin A. 20

4. The composition of Claim 2 in which the quantity of the N-aminoalkyl azaspiro alkane derivative is selected from 0.01-2000 mg and the quantity of the non-NS suppressor cell inducing immunosuppressive compound is selected from 0.1-4000 mg.

5. The composition of Claim 2 in which the quantity of the N-aminoalkyl azaspiro alkane derivative is selected from 0.1-1000 mg and the quantity of the non-NS suppressor cell inducing immunosuppressive compound is selected from 30. 0.1-1000 mg.

6. The composition of Claim 2 in which the quantity of the N-aminoalkyl azaspiro alkane derivative is selected from 1-200 mg and the quantity of the non-NS suppressor 35 cell inducing immunosuppressive compound is selected from 0.1-200 mg .

7. The composition of Claim 2 in which the Naminoalkyl azaspiro alkane derivative is N,N-dimethyl-8,8 dipropyl-2-azaspiro[4,5]decane-2-propanamine or a salt thereof.

8. The composition of Claim 2 in which the Naminoalkyl azaspiro alkane derivative is: \ . < 'X . =500. \ > χ,ν ; XOCL H N' '•s 'u · ,/30, H H . N' SOCI or a salt thereof.

9. The composition of Claim 2 in which the Naminoalkyl azaspiro alkane derivative is N,N-dimethyl-8,8 diethyl-2-azaspiro[4,5]decane-2-propanamine or a salt 5 thereof.

10. The composition of claim 2 in which the non-NS suppressor cell inducing immunosuppressive compound is cyclosporin A.

11. The composition of Claim 3 in which the NAminoalkyl azaspirogermanium alkane derivative is N-(3dimethylaminopropyl)-2-aza-8,8-diethyl-8germanspiro[4,5]decane or a salt thereof.

12. The composition of claim 3 in which the non-NS suppressor cell inducing immunosuppressive compound is cyclosporin A. 20

13. The composition of Claim 2 which is in oral dosage form.

14. The composition of Claim 2 which is in parenteral dosage form.

15. A method for the preparation of a pharmaceutical composition according to claim 1, which method comprises admixing the combination of a nonspecific (NS) suppressor cell inducing compound, a non-NS 30 suppressor cell inducing immunosuppressive compound and a pharmaceutically acceptable carrier or diluent.

16. A pharmaceutical composition according to claim 1 for use as an active therapeutic substance.

17. A pharmaceutical composition according to claim 1 for use in inducing immunosuppression.

18. Use of a pharmaceutical composition according to claim 1 in the manufacture of a medicament for use in the inducement of immunosuppression.

19. Use of a non-specific (NS) suppressor cell inducing compound in the manufacture of a medicament for use in the inducement of immmunosuppression with the simultaneous administration of a non-NS suppressor cell 10 inducing immunosuppressive compound.

20. Use of a non-NS suppressor cell inducing immunosuppressive compound in the manufacture of a medicament for use in the inducement of immunosuppression 15 with the consecutive administration of a non-specific (NS) suppressor cell inducing compound.

21. Use of a non-specific (NS) suppressor cell inducing compound in the manufacture of a medicament for 20 use in the inducement of immunosuppression with the consecutive administration of a non-NS suppressor cell inducing immunosuppressive compound.

22. Use of a non-NS suppressor cell inducing 25 immunosuppressive compound in the manufacture of a medicament for use in the inducement of immunosuppression with the simultaneous administration of a non-specific (NS) suppressor cell inducing compound. - 27

23. The composition of Claim 1, substantially as described herein by way of Example.

24. The method of Claim 15, substantially as described herein by way of Example.

25. The composition of Claim 1 when prepared by the method of Claim 15 or 24.