JP6347743B2 - コクリエート組成物およびその製造および使用方法 - Google Patents
コクリエート組成物およびその製造および使用方法 Download PDFInfo
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- JP6347743B2 JP6347743B2 JP2014509488A JP2014509488A JP6347743B2 JP 6347743 B2 JP6347743 B2 JP 6347743B2 JP 2014509488 A JP2014509488 A JP 2014509488A JP 2014509488 A JP2014509488 A JP 2014509488A JP 6347743 B2 JP6347743 B2 JP 6347743B2
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- cocreatate
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- lipids
- cation
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Description
本出願は、2012年4月23日に出願された米国仮出願第61/636,793号;2012年4月5日に出願された米国仮出願第61/620,656号;2012年3月8日に出願された米国仮出願第61/608,272号;2012年1月25日に出願された米国仮出願第61/590,531号;2011年10月14日に出願された米国仮出願第61/547,325号;2011年12月13日に出願された米国仮出願第61/570,067号;2011年9月13日に出願された米国仮出願第61/534,075号;および2011年5月5日に出願された米国仮出願第61/482,996号の利益を主張する。前記出願のそれぞれの全文がこの参照により全体として本明細書に組み込まれるものとする。
本発明は、目的の生体関連分子をコクリエート化するための、特に親水性生体関連分子のコクリエート化を増強するための、安定なコクリエート製剤を製造することができるという発見に関する。特に、本明細書に定義される特徴を有する第2の脂質を加えることにより、親水性生体関連分子のコクリエート化効率を劇的に増加させることができることは、驚くべきことであり、予想されなかったことであった。
本明細書において、冠詞「a」および「an」は、1つまたは1つよりも多い(すなわち、少なくとも1つの)冠詞の文法的対象を指す。例として、「要素(an element)」は、1つの要素または1つよりも多い要素を意味する。
アラニン(Ala、A) GCA、GCC、GCG、GCT
アルギニン(Arg、R) AGA、ACG、CGA、CGC、CGG、CGT
アスパラギン(Asn、N) AAC、AAT
アスパラギン酸(Asp、D) GAC、GAT
システイン(Cys、C) TGC、TGT
グルタミン酸(Glu、E) GAA、GAG
グルタミン(Gln、Q) CAA、CAG
グリシン(Gly、G) GGA、GGC、GGG、GGT
ヒスチジン(His、H) CAC、CAT
イソロイシン(Ile、I) ATA、ATC、ATT
ロイシン(Leu、L) CTA、CTC、CTG、CTT、TTA、TTG
リジン(Lys、K) AAA、AAG
メチオニン(Met、M) ATG
フェニルアラニン(Phe、F) TTC、TTT
プロリン(Pro、P) CCA、CCC、CCG、CCT
セリン(Ser、S) AGC、AGT、TCA、TCC、TCG、TCT
スレオニン(Thr、T) ACA、ACC、ACG、ACT
トリプトファン(Trp、W) TGG
チロシン(Tyr、Y) TAC、TAT
バリン(Val、V) GTA、GTC、GTG、GTT
終止コドン(end) TAA、TAG、TGA
遺伝コードの重要で周知の特徴は、その重複性であり、それにより、タンパク質を作るために使用されるアミノ酸のほとんどに対して、1種よりも多いコード化ヌクレオチドトリプレットが使用される(上に示した)。したがって、いくつかの異なるヌクレオチド配列がある1つのアミノ酸配列をコードし得る。このようなヌクレオチド配列は、それらがすべての生物体において同じアミノ酸配列の生産をもたらすので(ある生物体がいくつかの配列を他の配列と比べて効率的に翻訳する場合があるが)、機能的に同等であると考えられる。さらに、時折、あるヌクレオチド配列中にプリンまたはピリミジンのメチル化型が見いだされ得る。このようなメチル化はトリヌクレオチドコドンと対応するアミノ酸の間のコード化関係に影響を与えない。
A. コクリエート
コクリエートおよびそれを製造および使用する方法は、例えば、米国特許第4,078,052号;第5,643,574号;第5,840,707号;第5,994,318号;第6,153,217号;第6,592,894、ならびにPCT公開公報WO 200404/091572;WO 2004/091578;WO 2005/110361および米国特許公開公報2010/0178325(これらのそれぞれがこの参照により本明細書に組み込まれる)に開示されている。コクリエート送達ビヒクルは、単純な天然の材料、例えば、ホスファチジルセリンおよびカルシウムから構成可能な安定な脂質-カチオン沈殿物である。天然の分子(例えば、ダイズ脂質)および/または合成もしくは改変脂質の混合物を利用することができる。
本発明のコクリエートは、好ましくは生体関連分子と混合される、または生体関連分子を「ロード」される。「生体関連分子」はコクリエート化されるべき分子であり、一般にコクリエートの沈殿に使用される脂質およびイオンを指さない。生体関連分子には、生物学的に興味深い特性を有する任意の分子、例えば、生体の生命現象に関与するものが含まれる。生体関連分子は、有機または無機、モノマーまたはポリマー、宿主生物体に対して内因性であるまたはない、天然またはin vitroで合成されたもの等であり得る。
いくつかの実施形態において、本発明のコクリエートは、場合により1種以上の凝集阻害剤を含み得る。本明細書において使用される場合、用語「凝集阻害剤」は、コクリエートの凝集を阻害する薬剤を指す。凝集阻害剤は、典型的には、少なくともコクリエートの表面上に存在し、コクリエートの表面上のみに存在する場合がある(例えば、凝集阻害剤がコクリエート形成後に導入される場合)。凝集阻害剤は、コクリエート形成の前、後、および間に加えることができる。凝集阻害剤のタイプおよび/または量は、所望のコクリエートの粒径および/または分布が得られるように調節することができる。それに加えて、またはそれに代えて、凝集阻害剤(1種または複数種)は、コクリエートの粒径および/または粒径分布を、コクリエートの凝集が最小化または除去されるように安定化するために使用することができる。
一態様において、本発明はコクリエートを形成する方法を提供する。米国特許第4,078,052号;第5,643,574号;第5,840,707号;第5,994,318号;第6,153,217号;第6,592,894号、ならびにPCT公開公報WO 200404/091572;WO 2004/091578;WO 2005/110361および米国特許公報第2010/0178325号(これらのそれぞれがこの参照により本明細書に組み込まれる)に記載されるものを含むがそれらに限定されない公知の方法を、コクリエートを形成するために使用することができる。
さらに別の態様において、本発明は、本明細書に記載される1種以上のコクリエート組成物により治療することができる障害のリスクを有する(もしくは障害に罹りやすい)または障害を有する被験体を治療する予防的および治療的方法の両方を提供する。
一態様において、本発明は、被験体において、少なくとも1種の生体関連分子、例えば、タンパク質、小ペプチド、抗ウイルス剤、麻酔剤、抗感染剤、抗真菌剤、抗癌剤、免疫抑制剤、ステロイド抗炎症剤、非ステロイド抗炎症剤、精神安定剤、粘液溶解剤、拡張剤、血管収縮薬、鬱血除去薬、ロイコトリエン阻害剤、抗コリン剤、抗ヒスタミン剤、または血管拡張剤により治療することができる疾患または障害を予防する方法を提供する。本明細書において言及される薬剤により治療することができる疾患または状態のリスクを有する被験体は、例えば、当業者に公知の診断または予後アッセイのいずれかまたはそれらの組合せにより識別することができる。予防薬の投与は、疾患または障害に特徴的な症状が現れる前に、疾患または障害が予防されるようにおこなうことができ、またはその進行に遅れておこなうことができる。
別の態様において、本発明は治療目的でコクリエート組成物を投与する方法を提供する。一実施形態において、本発明は本発明の組成物の投与により利益を得る可能性がある被験体を治療する方法を提供する。本発明のコクリエート組成物から利益を得る可能性があるあらゆる治療適応を本発明の方法により治療することができる。本発明は、1種以上の生体関連分子により治療することができる疾患または状態のリスクを有するまたは該疾患または障害を有する被験体を治療する方法を提供する。方法は、疾患または障害を予防、改善、その進行を終結または遅延するように、本発明の組成物を被験体に投与する工程を含む。疾患または障害は、本明細書において論じられる疾患または障害のいずれであってもよい。
本発明は、本明細書に記載される予防的および治療的処置への本発明のコクリエート組成物の使用に関する。したがって、本発明の化合物は、投与に好適な医薬組成物中に組み入れることができる。このような組成物は、典型的には本発明の組成物および製薬上許容される担体を含む。本明細書において使用される場合、用語「製薬上許容される担体」は、薬物投与に適合する任意のおよびすべての溶媒、分散媒体、コーティング、抗細菌剤および抗真菌剤、等張化剤および吸収遅延剤等を含むことが意図される。医薬活性物質に対するそのような媒体および薬剤の使用は当業者に周知である。
トリ型結核菌(Mycobacterium avium)(Ma)による感染は、免疫無防備状態の患者および慢性肺疾患を有する個人においてよく見られる。Ma感染の有効な治療はごくわずかの化合物に限られており、アミカシン(amikacin)の使用は投与経路(静脈内または筋肉内)および毒性により制限される。
アミカシンコクリエート(Amkcch)製剤を、使用するPSのタイプ、PS:薬物の比、PS:Caの比、およびNaCl濃度を変化させることにより、アミカシンのコクリエート化効率および粒径に関して最適化した(図1)。
細胞内Ma感染に対するAmkcchの有効性を、トリ型結核菌株MAC 101またはMAC 109に感染したマウス腹膜マクロファージを用いてin vitroで評価した。マウス腹膜マクロファージ(Mo)Raw 264.7細胞を、105細胞/ウェルで播種した。Mo単分子膜を1:10の比で1時間感染させて、細胞外細菌を除去した。単分子膜を遊離アミカシンおよび/またはコクリエート調製物により4日間処理して、細胞内細菌の数を測定した。アッセイを3回繰り返した。
(2) 未処理の対照(4日)と比較してp < 0.05
(3) アミカシン/コクリエートプラセボまたは遊離アミカシンと比較してp < 0.05
表3:トリ型結核菌109感染マクロファージのAmkcch処理後の細菌数
(2) 未処理の対照(4日)と比較してp < 0.05
(3) アミカシン/コクリエートプラセボまたは遊離アミカシンと比較してp < 0.05
表4:トリ型結核菌101感染マクロファージのGecch処理後の細菌数
(2) 未処理の対照(4日)と比較してp < 0.05
(3) ゲンタマイシン/コクリエート対照または遊離ゲンタマイシンと比較してp < 0.05
c. コクリエート調製物の生物学的評価:In vivo C57/BL/6マウス実験
トリ型結核菌複合体に対するアミカシンコクリエートのin vivo有効性を、C57BL/6黒色マウスを用いて評価した。12個体/群のマウスを、尾静脈注射によりトリ型結核菌101(8.1 × 107細菌/マウス)に感染させた。7日後、6個体のマウスを回収し、脾臓中のMACの数を定量して細菌負荷のベースライン(時間0)を確立した。マウスをさまざまなアミカシン調製物(下に示す)により、1 mgアミカシン/マウス/日で2週間治療した。第3週および2日後(2週間の治療の後)に回収して、脾臓をホモジナイズして7H10寒天に塗布した。プレート上のコロニーをカウントして、データを分析した。
(2) コクリエート調製物のI.P./経口投与と比較してp < 0.05
(3) 同じ経路で投与された遊離アミカシンと比較してp < 0.05
結果として、データは、アミカシンコクリエートが、有効な抗トリ型結核菌濃度で経口投与するためのアミノグリコシドの有望な製剤であることを証明している。
アンホテリシンB(AmB;図4)は60年に渡って使用された後でも依然として最も有効な抗真菌剤の1つであるが、市販の製剤は静脈内送達に制限され、また、この分子は高い毒性を有する。コクリエート技術を用いる開発中の先行する製品はアンホテリシンB-コクリエート(CAMB;Bioral(商標)アンホテリシンBとしても知られる)であり、これは両親媒性または疎水性薬物のコクリエート化のモデルとなっている。図5に、CAMBを作るための製造戦略の略図を示す。以下の結果は、全身性カンジダ症およびアスペルギルス症のマウスモデルにおいて、CAMBの経口投与が、同等の注射用量の先行するAmB製剤(ファンギゾン(Fungizone))と同じ有効性を有することを証明する。ファンギゾンは直径がおよそ5〜10 nmであるのに対して、CAMBは直径がおよそ200〜300 nmである。また、CAMBが、存在する市販のAmB製品よりも実質的に低い毒性を有することを証明する。さらに、CAMBはラットおよびイヌにおける7および28日の毒性研究において優れた安全性を示した。
図6に示される結果は、in vitroでのマクロファージへのカンジダ・アルビカンス感染の阻害において、CAMBがファンギゾン(DAMB)よりも効果が高いことを証明している。特に、すべての濃度のCAMB(アンホテリシンBコクリエート)は、マクロファージが存在しない場合のカンジダ培養物の増殖の阻害に対してDAMB(ファンギゾン)と同程度に有効である。しかしながら、カンジダに感染したマクロファージの存在下では、CAMBはDAMBよりも有意に有効性が高く、0.01μg/mlまでほぼ0のCFUを示すのに対して、DAMBはこの濃度でほぼ300のCFUを示す。結果は、CAMBがファンギゾンよりも効果的にAmBをマクロファージの中に送達することを証明している。
図7は、マウスの全身アスペルギルス感染ならびにその後の経口アンホテリシンB-コクリエート(CAMB)およびファンギゾン(DAMB)による治療の生存率の評価および組織負荷分析のための概略プロトコールを示す。簡単に述べると、CAMB製剤の最初の評価は、播種性アスペルギルス症のマウスモデルにおいておこなった。マウスをシクロホスファミドによる一時的免疫抑制により、アスペルギルス・フミガタス(A. fumigatus)により感染されやすくした。マウス(20〜25 g)をシクロホスファミド(200 mg/kg、側部尾静脈からのiv)により処理して、3日後に、尾静脈を105-6アスペルギルス・フミガタス胞子により感染させた。感染の直後に、0〜40 mg/kg/日のCAMBの経口投与により治療を開始して10日間続けた。ファンギゾンは正の対照として用いて、4 mg/kg/日のIP投与をおこなった。これは典型的には50〜80%の生存率をもたらした。未処理のマウスは8〜10日間に100%の死亡率を示した。それぞれの動物から腎臓、肝臓および肺を収集して、組織ホモジネートの段階希釈およびプレーティングにより真菌負荷を評価する。死亡率データはKaplan-Meier分析の後にWilcoxon試験をおこなうことにより統計的に評価した。P<0.05のp値を統計的に有意な差であると見なした。異なる治療群間のコロニー数の比較は、複数の比較によるKruskal-Wallis試験によりおこなった。<0.05のP値を統計的に有意であると見なした。すべての統計的分析をソフトウェアパッケージGBSTAT(Dynamic Microsystems, Inc., Silver Spring, MD.)によりおこなった。
AmB-コクリエートに対する治験薬(IND)研究が開始され、動物において観察された安全性、動物における有効性、保存安定性、再現性のあるGMP製造方法、および対費用効果に基づいて、第I相ヒト臨床試験が順調に開始された。
各コホート(12 CAMB、4プラセボ(薬物を含まないコクリエートビヒクル))に16人のヒト被験体を採用した。CAMBまたは同じ体積のBioralプラセボ(アンホテリシンBを含まない送達媒体)を二重盲検方式で、一晩絶食した後に経口投与した。それぞれの被験体に1回投与をおこなった。安全性および薬物動態学的評価を投与後2週間に渡って実施した。被験体を、200、400、および800 mgの段階的に増加する用量を与えられる3コホートに採用した。これは、健康な志願者による、アンホテリシンBの安全性、耐容性、およびPKプロファイルを決定し、他のアンホテリシン製剤との相互研究比較による相対的バイオアベイラビリティを評価するために設計された、1回投与、二重盲検、用量漸増、薬物動態学的(PK)研究であった。合計で48人の被験体が、治療コホートあたり16人の3コホートで、この研究に参加することが計画された。それぞれの治療コホート内で、12人の被験体が活性薬物を投与され、4人がプラセボを投与された。被験体は第0日に病院に入院し、活性治療(コホートにより200、400、または800 mgのCAMB)またはプラセボにランダム化された。PK分析のための血液サンプルを投与前(0時間)、および第0日の投与後(1、2、4、8、および12時間)および第1日(24時間)に収集した。すべての計画された手順が終了した時に被験体は病院を退院した。さらなる血液サンプルを、通院により第2、3、4、8、9、および14日(48、72、96、192、216、および336時間)に収集した。有害作用(AE)のモニター、同時におこなわれる投薬、健康診断および病歴、ならびに臨床検査室およびバイタルサイン測定により安全性を評価した。
AmB-コクリエートの商業的に実行可能な、対費用効果の高い製造方法が開発され、スケールアップしたAmB-コクリエートの100リットルGMPバッチが製造された。
薬品安全性試験実施基準(GLP)スケールアップ法をアミカシン-コクリエート製剤のために開発することができる。これは1 L、5 L、および20 L、またはより大きいバッチを調製することによりAmB-コクリエートと同様にして調製することができる。調製したすべてのバッチについてAmkcchの物理的および化学的特性を測定する。これらの測定には、アミカシンのコクリエート化効率、脂質:薬物比、および粒径が含まれる。ロット間の製品の再現性も測定する。
液体および組織中の、アミカシンを含むアミノグリコシドの定量のための多くの方法が開発され、報告されている(PaPP, E, Knupp, C., and Barbhaiya, R.H., J. Chomatography, 574: 93 -99, 1992; Soltes, L. Biomedical Chromatography 13: 3-10, 1999)。定量的アミカシンHPLCアッセイを設計することができる。
また、アミカシン活性は、例えば大腸菌(E. Coli)を用いるマイクロタイター-プレートに基づくアッセイを用いて測定することができる。例えば、大腸菌参考株ATCC 25922(American Type Culture Collection)の増殖に対する異なる濃度のアミカシンの影響を、Jose A. Rufian-Henares, Francisco J. Morales (Food Chemistry, 111: 1069-1074, 2008)により記載されたマイクロタイタープレート法により測定した。大腸菌の一晩懸濁液は、250 rpmの速度の振盪器に入れたLBブロス中、37℃で24時間成長させたものである(New Brunswick Scientific mode: INNVOA 40R)。細菌増殖培地であるLBブロスはLife Technologiesにより供給された。低蒸発蓋無菌プレートを有する平底の透明なポリスチレン製96ウェル細胞培養クラスターはFisher distributorにより供給された。
Bartlettアッセイ(Bartlett, G.R., and (1959) J. Bio. Chem. 224, 466)の修正法によりリン脂質サンプルにおけるリン酸濃度を測定する。このアッセイは、リン脂質が製剤中で唯一のリン酸を含む化合物である場合に、コクリエート製剤中のリン脂質濃度を測定するために好適である。薬物を含有するリン脂質コクリエート製剤または薬物を含まない対照のリン脂質コクリエート製剤における総リン脂質濃度を測定する。製剤の薬物濃度を製剤のリン脂質濃度で割って、製剤の薬物対リン脂質の比を決定する。
と45℃で20分間反応させる。これらの条件下で、リン酸はモリブデン酸と反応して青色のモリブデン化合物を形成する。アッセイの標準曲線を作成するために1.00 mMリン酸ナトリウム溶液を使用する。分光光度計を用いて820 nmで標準およびサンプルのO.D.を測定することによりリン酸濃度を測定する。サンプルのリン酸濃度は、それぞれのサンプル製剤についてN=3で測定される。平均mMリン酸濃度および標準偏差を計算する。このアッセイに使用するすべての水が十分に脱イオン化されていることおよびガラス製品が洗剤または他の供給源からの外来性のリン酸により汚染されていないことを確認するために注意を払わなければならない。さらに、多くの他のBartlettを基礎としたリン酸アッセイとは異なり、この方法は過塩素酸加熱工程を使用しない。過塩素酸蒸気は爆発性の塩を付着させる。サンプルを硫酸と共に加熱することが全く同じ作用をして、はるかに安全である。
回折に基づく光散乱によりコクリエート製剤の粒子径体積重量分布を測定する。最終的な結果は、分布のプロット、それぞれの微分ピークの最大粒子径(μm)、総体積の50%未満の粒子径(μm)、1μm未満の粒子径を有する体積のパーセンテージ、および総体積の99%未満の粒子径(μm)を含む。
スケールアップ法の間に調製されたアミカシン-コクリエート製品を、懸濁液および乾燥粉末(凍結乾燥後)として4℃、25℃および40℃で保存する。アミカシン含有量(HPLC)および活性(大腸菌マイクロタイタープレートアッセイ)を6か月間に渡って毎月測定する。
アミカシン-コクリエート製品の経口有効性の研究は、トリ型結核菌感染マウスモデルを用いて測定する。これらの研究は、用量範囲および最大耐量の研究を含む。第2の薬物を併用した場合のアミカシン-コクリエート製品の経口有効性の研究は、トリ型結核菌感染マウスモデルを用いて測定する。これらの研究は、用量範囲および最大耐量の研究を含む。経口アミカシン-コクリエートを遊離アミカシンIPと比較する。感染していないおよび感染した動物の両方を研究する。経口アミカシン-コクリエートを遊離アミカシンIPと比較する。感染していないおよび感染した動物の両方を研究する。クレアチニンおよび血液尿素窒素(腎毒性)について血清を測定し、腎臓(腎毒性)および内耳(聴器毒性)を入手して組織病理学的試験をおこなう。
トリ型結核菌は2つの異なる経路を用いて宿主に感染する。一方は胃腸経路であり、そこから細菌は播種するか、または/およびリンパ節感染を引き起こす可能性がある。他方は呼吸器系路であり、それにより細菌は慢性の肺病態(気管支拡張、肺気腫、嚢胞性線維症)を有する個体に感染を引き起こす。後者の感染経路は潜在的肺疾患を有する個体においてよく見られるので、また肺感染は生物膜の形成を伴うので(Carter G, et al, AAC 48:4907, 2004; Yamazaki Y, et al Cell Microbiol, 8: 808. 2006)、トリ型結核菌肺疾患の動物モデルにおけるコクリエートAK調製物の試験は重要である。
C57BL/6マウスに、以下の群の通りにトリ型結核菌株101を静脈内感染させる:a.感染、無治療;b.感染、コクリエートAK、合計数=70×2群+8または148個体のマウス。感染の第7日までに、8個体のマウスを採取して、感染負荷のベースライン、およびアミカシンに対する耐性の頻度を確立する。次に、マウスをコクリエートAKの経口投与により12週間治療する。対照動物は治療を受けない。トリ型結核菌のアミカシンに対する耐性の頻度を第0、2、4、6、8、10および12週に測定する。脾臓を採取し、アミカシンを含む7H11寒天およびアミカシンを含まない7H11寒天の両方にホモジネートを塗布する。
播種性または肺の両方のトリ型結核菌の治療は、クラリスロマイシン(またはアジスロマイシン(azithromycin))およびエタンブトールのような少数の薬物の活性に頼っている。マクロライドは有効な経口レジメンにとって極めて重要であるが(Chaisson R, et al. Ann Intern Med 121: 905, 1994)、エタンブトールの添加が相乗効果をもたらし、クラリスロマイシンに対する耐性の出現を減少させる(Bermudez LE, et al. J Infect. Dis 174: 1218, 1996)。
トリ型結核菌のクラリスロマイシンまたはアジスロマイシン耐性株は、病態の治療における主要な問題である。マクロライドは非常に効力が高く、治療の重要な構成要素である。マクロライド耐性株により引き起こされる疾患は治療における課題である。クラリスロマイシン耐性(MAC184株、A2275〜C2275における突然変異を有する、MIC 64 mcg/ml)および8 mcg/mlのエタンブトールに対するMIC(MAC101などの感受性のトリ型結核菌株の4 mcg/mlのMICと比較して)を有する臨床的分離株を用いて、以下の群の通りにC57BL/6黒色マウスを静脈内感染させる:a.感染、無治療;b.感染、クラリスロマイシン、100 mg/Kg/日;c.感染、エタンブトール、100 mg/Kg/日;d.感染、コクリエートAK、用量を決定する;e.感染、エタンブトール+コクリエートAK;f.感染、エタンブトール+遊離アミカシン(IM);およびg.感染、薬剤を用いないコクリエート;合計92個体のマウス。
感染した(全身性)および感染していないマウスに、以下の群の通りに遊離アミカシンおよび100 mg/Kg/日の経口コクリエートによる治療をおこなう:a.未感染、腹腔内遊離アミカシン、4週間;b.未感染、経口コクリエートAK、4週間;c.感染、腹腔内遊離アミカシン、4週間;d.感染、経口コクリエートAK、4週間;および毒性研究のための感染、無治療マウス;合計50個体のマウス。
非結核性抗酸菌(NTM)は、土壌ならびに環境水および飲用水中によく見られる生物体であり、選択された患者群における肺疾患と関連している。治療は、特に重い疾患を有する患者または以前の治療の試みに失敗した患者において、低い耐容性および低い有効性を有する可能性がある長期の多剤レジメンを必要とする。現在の治療の推奨を支持する臨床試験は非常に少なく、何年もの間この疾患のための新規の薬物の評価はおこなわれなかった。アミカシンはさまざまなNTMに対して有効な確立された薬物である。しかしながら、その使用は、静脈内投与する必要ならびに聴覚、バランス、および腎機能への毒性により制限されている。ナノコクリエートアミカシンは、経口バイオアベイラビリティおよび低下した毒性の可能性の両方を提供する新規の製剤である。前臨床研究は、トリ型結核菌複合体に対して、既製のアミカシンと比較して大きい有効性を示唆している。
野兎病およびブルセラ病は、それぞれ野兎病菌(Francisella tularensis)およびブルセラ菌(Brucella abortus)の感染により引き起こされる重大なヒトの病気である。このような微生物による感染は、それらの先天性免疫反応を回避する能力および食細胞の中で複製する能力のために治療が困難である。アミカシンおよびゲンタマイシンなどのアミノグリコシドはこれらの微生物の増殖をin vitroで効果的に阻害するが、変更できないIV送達経路、かなりの毒性、および治療的細胞内濃度を達成する能力が限定的であることのために、治療上の使用が限定されてきた。アミノグリコシド-コクリエート製剤は、アミノグリコシドに経口バイオアベイラビリティ、低毒性および治療指数の増加を付与し得る。これは、野兎病菌およびブルセラ菌、ならびに潜在的なさらなる細胞内細菌感染の治療におけるアミノグリコシドの有用性を実質的に向上させる可能性がある。
(2) 第4日の無治療の対照と比較してp < 0.05
(3) 薬物を含まないコクリエートと比較してp < 0.05
(4) 遊離薬物と比較してp < 0.05
実施例4:免疫反応の増強および微生物感染からの保護のためのコクリエート製剤
コクリエートは、ホスファチジルセリンとカルシウムとの相互作用により自発的に形成する、無水の、安定な、多層の脂質結晶である。コクリエート製剤は、粘膜分泌物、血漿および胃腸液を含む生理的液体中で損なわれない。そのため、コクリエートは、経口、粘膜および静脈内を含む多くの投与経路による生物活性化合物の送達を仲介するために使用することができる。
コクリエートは、ホスファチジルセリンとカルシウムとの相互作用により自発的に形成する、無水の、安定な、多層の脂質結晶である。コクリエート製剤は、粘膜分泌物、血漿および胃腸液を含む生理的液体中で損なわれず、それにより、経口、粘膜および静脈内を含む多くの投与経路による生物活性化合物の送達を仲介する。最初に、コクリエートは疎水性薬物を製剤するために使用された。例えば、コクリエート化されたアンホテリシンB(AmB)の経口製剤がヒト臨床試験に入った。しかしながら、親水性分子または親水性領域を有する大分子を認め得る程度にコクリエート化することは困難であった。
本明細書において言及されるすべての出版物、特許、および特許出願は、それぞれの出版物、特許または特許出願が参照により組み込まれることが明確におよび個々に指示されたのと同じ程度に、参照によりその全文が本明細書に組み込まれる。対立する場合には、定義を含め、本出願が支配する。
当業者は、本明細書に記載される本発明の特定の実施形態の多くの同等物を、認識するであろうし、または通常の実験を用いて確認することができるであろう。このような同等物は、以下の特許請求の範囲に包含されることが意図される。
本発明の実施形態として例えば以下を挙げることができる。
[実施形態1]
コクリエートの集団を含むコクリエート組成物であって、コクリエートが、
a) 負に荷電した第1の脂質;
b) 2価カチオンまたはより高い価数のカチオンである、カチオン;
c) カチオンと相互作用するアニオン性官能基を持たない第2の脂質;および
d) さらなる生体関連分子
を含む、前記コクリエート組成物。
[実施形態2]
コクリエートの集団を含むコクリエート組成物であって、コクリエートが、
a) 負に荷電した第1の脂質;
b) 2価カチオンまたはより高い価数のカチオンである、カチオン;
c) カチオンとイオン的に相互作用するカチオン性官能基を有する両親媒性の第2の脂質;および
d) さらなる生体関連分子
を含む、前記コクリエート組成物。
[実施形態3]
第2の脂質が中性またはカチオン性脂質またはステロールである、実施形態1または2に記載のコクリエート組成物。
[実施形態4]
第2の脂質がホスファチジルコリンおよびスフィンゴミエリンからなる群より選択される、実施形態3に記載のコクリエート組成物。
[実施形態5]
第2の脂質が、生体関連分子と水素結合を形成することが可能な脂質を含む、実施形態1または2に記載のコクリエート組成物。
[実施形態6]
第2の脂質が負に荷電した第1の脂質の中に埋め込まれている、実施形態1または2に記載のコクリエート組成物。
[実施形態7]
第2の脂質が、コクリエートの総脂質含有量の50%までを構成する、実施形態1または2に記載のコクリエート組成物。
[実施形態8]
コクリエートの平均粒径が1ミクロン未満である、実施形態1または2に記載のコクリエート組成物。
[実施形態9]
コクリエートの平均粒径が300ミクロン未満である、実施形態1または2に記載のコクリエート組成物。
[実施形態10]
負に荷電した脂質が、ホスファチジルセリン、ジオレオイルPS(DOPS)、およびダイズ由来ホスファチジルセリン(ダイズPS)を含む、実施形態1または2に記載のコクリエート組成物。
[実施形態11]
コクリエートが少量の第3の脂質をさらに含む、実施形態1または2に記載のコクリエート組成物。
[実施形態12]
第3の脂質が、双性イオン性脂質、PEG化脂質、カチオン性脂質、またはポリカチオン性脂質からなる群より選択される、実施形態11に記載のコクリエート組成物。
[実施形態13]
2価またはより高い価数のカチオンが金属イオンである、実施形態1または2に記載のコクリエート組成物。
[実施形態14]
2価またはより高い価数の金属カチオンが、カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される、実施形態13に記載のコクリエート組成物。
[実施形態15]
生体関連分子が親水性である、実施形態1または2に記載のコクリエート組成物。
[実施形態16]
生体関連分子が正または負に荷電している、実施形態1または2に記載のコクリエート組成物。
[実施形態17]
生体関連分子が両親媒性である、実施形態1または2に記載のコクリエート組成物。
[実施形態18]
生体関連分子が疎水性である、実施形態1または2に記載のコクリエート組成物。
[実施形態19]
生体関連分子が、薬物、ビタミン、ミネラル、脂肪酸、アミノ酸、糖類、ポリヌクレオチド、ポリペプチド、抗原、栄養素および香味物質からなる群より選択される少なくとも1つのメンバーである、実施形態1または2に記載のコクリエート組成物。
[実施形態20]
薬物が、抗真菌剤;非ステロイド抗炎症剤;抗癌剤;抗ウイルス剤、麻酔剤、または抗感染剤、免疫抑制剤、ステロイド抗炎症剤、精神安定剤、または血管拡張剤である、実施形態19に記載のコクリエート組成物。
[実施形態21]
薬物が、アンホテリシンBおよびゲンタマイシンからなる群より選択される、実施形態19に記載のコクリエート組成物。
[実施形態22]
薬物がアミノグリコシドである、実施形態19に記載のコクリエート組成物。
[実施形態23]
アミノグリコシドがアミカシンである、実施形態22に記載のコクリエート組成物。
[実施形態24]
ポリヌクレオチドがデオキシリボ核酸(DNA)分子である、実施形態19に記載のコクリエート組成物。
[実施形態25]
DNAが転写されてリボ核酸を生成する、実施形態24に記載のコクリエート組成物。
[実施形態26]
ポリヌクレオチドがリボ核酸(RNA)分子である、実施形態19に記載のコクリエート組成物。
[実施形態27]
リボ核酸が翻訳されて生物活性ポリペプチドを生成する、実施形態26に記載のコクリエート組成物。
[実施形態28]
ポリヌクレオチドがプラスミドまたはリボザイムである、実施形態7に記載のコクリエート組成物。
[実施形態29]
ポリヌクレオチドが、アンチセンス、siRNA、shRNA、成熟miRNA、プレmiRNA、プリmiRNA、miRNA*、またはアンチmiRNA分子である、実施形態19に記載のコクリエート組成物。
[実施形態30]
さらに凝集阻害剤を含む、実施形態1または2に記載のコクリエート組成物。
[実施形態31]
凝集阻害剤が塩化ナトリウムである、実施形態31に記載のコクリエート組成物。
[実施形態32]
有効量の実施形態1または2に記載のコクリエート組成物および製薬上許容される担体を含む医薬組成物。
[実施形態33]
a) 生体関連分子を第1および第2の脂質を含むリポソームと混合すること;および
b) 2価カチオンまたはより高い価数のカチオンであるカチオンを加えて、コクリエート組成物を製造すること
を含む、実施形態1または2に記載のコクリエート組成物を製造する方法。
[実施形態34]
総脂質の生体関連分子に対する比が少なくとも4:1である、実施形態33に記載の方法。
[実施形態35]
第2の脂質が、コクリエートの総脂質成分の50%までを構成する、実施形態33に記載の方法。
[実施形態36]
第1の脂質の第2の脂質に対する比が、総脂質の1〜60%の間である、実施形態33に記載の方法。
[実施形態37]
2価またはより高い価数のカチオンが金属イオンである、実施形態33に記載の方法。
[実施形態38]
2価またはより高い価数の金属カチオンが、カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される、実施形態37に記載の方法。
[実施形態39]
カルシウムカチオンが塩化カルシウムから供給される、実施形態38に記載の方法。
[実施形態40]
混合物の塩化カルシウム濃度が2 mM〜10 mMである、実施形態39に記載の方法。
[実施形態41]
さらに、リポソームと混合する前に生体関連分子を濾過または精製することを含む、実施形態33に記載の方法。
[実施形態42]
さらに、凝集阻害剤をコクリエート組成物と混合する工程c)を含む、実施形態33に記載の方法。
[実施形態43]
凝集阻害剤が塩化ナトリウムである、実施形態42に記載の方法。
[実施形態44]
混合物の塩化ナトリウム濃度が1 mM〜1 Mである、実施形態43に記載の方法。
[実施形態45]
さらに、コクリエート組成物を凍結乾燥により乾燥する工程c)を含む、実施形態33に記載の方法。
[実施形態46]
さらに、コクリエート組成物を凍結乾燥により乾燥する工程d)を含む、実施形態42に記載の方法。
[実施形態47]
それを必要とする宿主に、薬学的に有効な量の実施形態1または2に記載の組成物を投与することを含む治療方法であって、宿主が細胞、細胞培養物、器官、組織、または動物からなる群より選択される、前記治療方法。
[実施形態48]
投与が粘膜または全身経路によるものである、実施形態47に記載の治療方法。
[実施形態49]
投与が、経口、鼻腔内、眼内、肛門内、腟内、および肺内からなる群より選択される粘膜経路によるものである、実施形態48に記載の治療方法。
[実施形態50]
投与が、静脈内、筋肉内、皮下、経皮および皮内からなる群より選択される全身経路によるものである、実施形態48に記載の治療方法。
[実施形態51]
コクリエートの集団を含むアミノグリコシド-コクリエート組成物であって、コクリエートが、
a) 負に荷電した脂質;
b) 2価カチオンまたはより高い価数のカチオンである、カチオン;および
c) アミノグリコシド
を含む、前記アミノグリコシド-コクリエート組成物。
[実施形態52]
アミノグリコシド-コクリエート組成物を製造するために使用されるアミノグリコシドの少なくとも5%が、アミノグリコシド-コクリエート組成物の中に組み込まれる、実施形態51に記載のコクリエート組成物。
[実施形態53]
コクリエートの平均粒径が1ミクロン未満である、実施形態51に記載のコクリエート組成物。
[実施形態54]
負に荷電した脂質が、ホスファチジルセリン、ジオレオイルPS(DOPS)、およびダイズ由来ホスファチジルセリン(ダイズPS)を含む、実施形態51に記載のコクリエート組成物。
[実施形態55]
コクリエートがさらに少量の第2の脂質を含む、実施形態51に記載のコクリエート組成物。
[実施形態56]
第2の脂質が、双性イオン性脂質、PEG化脂質、カチオン性脂質、またはポリカチオン性脂質からなる群より選択される、実施形態55に記載のコクリエート組成物。
[実施形態57]
2価またはより高い価数のカチオンが金属イオンである、実施形態51に記載のコクリエート組成物。
[実施形態58]
2価またはより高い価数の金属カチオンが、カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される、実施形態57に記載のコクリエート組成物。
[実施形態59]
アミノグリコシドがアミカシンまたはゲンタマイシンである、実施形態51に記載のコクリエート組成物。
[実施形態60]
さらに凝集阻害剤を含む、実施形態51に記載のコクリエート組成物。
[実施形態61]
凝集阻害剤が塩化ナトリウムである、実施形態51に記載のコクリエート組成物。
[実施形態62]
有効量の実施形態51に記載のコクリエート組成物および製薬上許容される担体を含む医薬組成物。
[実施形態63]
a) アミノグリコシドを脂質を含むリポソームと混合すること;および
b) 2価カチオンまたはより高い価数のカチオンであるカチオンを加えて、コクリエート組成物を製造すること
を含む、実施形態51に記載のコクリエート組成物を製造する方法。
[実施形態64]
総脂質のアミノグリコシドに対する比が少なくとも10:1である、実施形態63に記載の方法。
[実施形態65]
第2の脂質が、コクリエートの総脂質成分の50%までを構成する、実施形態63に記載の方法。
[実施形態66]
2価またはより高い価数のカチオンが金属イオンである、実施形態63に記載の方法。
[実施形態67]
2価またはより高い価数の金属カチオンが、カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される、実施形態66に記載の方法。
[実施形態68]
カルシウムカチオンが塩化カルシウムから供給される、実施形態67に記載の方法。
[実施形態69]
混合物の塩化カルシウム濃度が2 mM〜10 mMである、実施形態68に記載の方法。
[実施形態70]
さらに、リポソームと混合する前に生体関連分子を濾過または精製することを含む、実施形態63に記載の方法。
[実施形態71]
さらに、凝集阻害剤をコクリエート組成物と混合する工程c)を含む、実施形態63に記載の方法。
[実施形態72]
凝集阻害剤が塩化ナトリウムである、実施形態71に記載の方法。
[実施形態73]
混合物の塩化ナトリウム濃度が1 mM〜1 Mである、実施形態72に記載の方法。
[実施形態74]
さらに、コクリエート組成物を凍結乾燥により乾燥する工程c)を含む、実施形態63に記載の方法。
[実施形態75]
さらに、コクリエート組成物を凍結乾燥により乾燥する工程d)を含む、実施形態71に記載の方法。
[実施形態76]
それを必要とする宿主に、薬学的に有効な量の実施形態1に記載の医薬組成物を投与することを含む治療方法であって、宿主が細胞、細胞培養物、器官、組織、または動物からなる群より選択される、前記治療方法。
[実施形態77]
投与が粘膜または全身経路によるものである、実施形態76に記載の治療方法。
[実施形態78]
投与が、経口、鼻腔内、眼内、肛門内、腟内、および肺内からなる群より選択される粘膜経路によるものである、実施形態77に記載の治療方法。
[実施形態79]
投与が、静脈内、筋肉内、皮下、経皮および皮内からなる群より選択される全身経路によるものである、実施形態77に記載の治療方法。
Claims (41)
- コクリエートの集団を含むコクリエート組成物であって、コクリエートが、
a) 1種以上の負に荷電した第1の脂質;
b) 2価カチオンまたはより高い価数のカチオンである、カチオン;
c) 中性の第2の脂質または中性の第2の脂質の群;および
d) 生体関連分子
を含み、
生体関連分子が親水性である、または親水性領域を含み、
1種以上の負に荷電した第1の脂質の、中性の第2の脂質または中性の第2の脂質の群に対する比が、4:1〜9:1であり、
1種以上の負に荷電した第1の脂質が、ホスファチジルセリンを含み、
中性の第2の脂質または中性の第2の脂質の群がホスファチジルコリン又はスフィンゴミエリンを含み、
生体関連分子が、アミノグリコシドを含む、前記コクリエート組成物。 - 第2の脂質が、生体関連分子と水素結合を形成することが可能な脂質を含む、請求項1に記載のコクリエート組成物。
- 第2の脂質が負に荷電した第1の脂質の中に埋め込まれている、請求項1に記載のコクリエート組成物。
- コクリエートの平均粒径が1ミクロン未満である、請求項1に記載のコクリエート組成物。
- コクリエートの平均粒径が300nm未満である、請求項1に記載のコクリエート組成物。
- ホスファチジルセリンが、ジオレオイルPS(DOPS)またはダイズ由来ホスファチジルセリン(ダイズPS)である、請求項1に記載のコクリエート組成物。
- コクリエートが少量の、第1または第2の脂質とは異なる第3の脂質をさらに含む、請求項1に記載のコクリエート組成物。
- 第3の脂質が、双性イオン性脂質、PEG化脂質、カチオン性脂質、またはポリカチオン性脂質からなる群より選択される、請求項7に記載のコクリエート組成物。
- 2価またはより高い価数のカチオンが金属イオンである、請求項1に記載のコクリエート組成物。
- 2価またはより高い価数の金属カチオンが、カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される、請求項9に記載のコクリエート組成物。
- 生体関連分子が正または負に荷電している、請求項1に記載のコクリエート組成物。
- アミノグリコシドが、ゲンタマイシン、ネチルマイシン、トブラマイシン、アミカシン、カナマイシンA、カナマイシンB、ネオマイシン、パロモマイシン、ネアミン、ストレプトマイシン、ジヒドロストレプトマイシン、アプラマイシン、リボスタマイシン、又はスペクチノマイシンからなる群より選択される、請求項1に記載のコクリエート組成物。
- アミノグリコシドがアミカシンである、請求項12に記載のコクリエート組成物。
- さらに凝集阻害剤を含む、請求項1に記載のコクリエート組成物。
- 凝集阻害剤が塩化ナトリウムである、請求項14に記載のコクリエート組成物。
- コクリエートが胆汁酸塩をさらに含む、請求項1に記載のコクリエート組成物。
- 有効量の請求項1に記載のコクリエート組成物および製薬上許容される担体を含む医薬組成物。
- a) 生体関連分子を、1種以上の負に荷電した第1の脂質および中性の第2の脂質または中性の第2の脂質の群を含むリポソームと混合すること;および
b) カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される2価カチオンまたはより高い価数のカチオンであるカチオンを加えて、コクリエート組成物を製造すること
を含み、
1種以上の負に荷電した第1の脂質の、中性の第2の脂質または中性の第2の脂質の群に対する比が、4:1〜9:1であり、
中性の第2の脂質または中性の第2の脂質の群がホスファチジルコリン又はスフィンゴミエリンを含む、請求項1に記載のコクリエート組成物を製造する方法。 - 総脂質の生体関連分子に対する比が少なくとも4:1である、請求項18に記載の方法。
- 2価の金属カチオンがカルシウムであり、カルシウムカチオンが塩化カルシウムから供給される、請求項18に記載の方法。
- 混合物の塩化カルシウム濃度が2 mM〜10 mMである、請求項20に記載の方法。
- さらに、リポソームと混合する前に生体関連分子を濾過または精製することを含む、請求項18に記載の方法。
- さらに、凝集阻害剤をコクリエート組成物と混合する工程c)を含む、請求項18に記載の方法。
- 凝集阻害剤が塩化ナトリウムである、請求項23に記載の方法。
- 混合物の塩化ナトリウム濃度が1 mM〜1 Mである、請求項24に記載の方法。
- さらに、コクリエート組成物を凍結乾燥により乾燥する工程c)を含む、請求項18に記載の方法。
- さらに、コクリエート組成物を凍結乾燥により乾燥する工程d)を含む、請求項23に記載の方法。
- 疾患または障害を治療するための、請求項1に記載の組成物。
- 疾患または障害が、真菌感染、細菌感染またはウイルス感染である、請求項28に記載の組成物。
- コクリエートの集団を含むアミノグリコシド-コクリエート組成物であって、コクリエートが、
a) 1種以上の負に荷電した第1の脂質;
b) 2価カチオンまたはより高い価数のカチオンである、カチオン;
c) 中性の第2の脂質または中性の第2の脂質の群;および
d) アミノグリコシド;
を含み、
1種以上の負に荷電した第1の脂質の、中性の第2の脂質または中性の第2の脂質の群に対する比が、4:1〜9:1であり、
1種以上の負に荷電した第1の脂質が、ホスファチジルセリンを含み、
中性の第2の脂質または中性の第2の脂質の群がホスファチジルコリン又はスフィンゴミエリンを含む、前記アミノグリコシド-コクリエート組成物。 - アミノグリコシド-コクリエート組成物を製造するために使用されるアミノグリコシドの少なくとも5%が、アミノグリコシド-コクリエート組成物の中に組み込まれる、請求項30に記載のコクリエート組成物。
- コクリエートが少量の、第1または第2の脂質とは異なる第3の脂質をさらに含み、第3の脂質が、双性イオン性脂質、PEG化脂質、カチオン性脂質、またはポリカチオン性脂質からなる群より選択される、請求項30に記載のコクリエート組成物。
- アミノグリコシドがアミカシンまたはゲンタマイシンである、請求項30に記載のコクリエート組成物。
- コクリエートの平均粒径が1ミクロン未満である、請求項30に記載のコクリエート組成物。
- ホスファチジルセリンが、ジオレオイルPS(DOPS)、またはダイズ由来ホスファチジルセリン(ダイズPS)を含む、請求項30に記載のコクリエート組成物。
- 2価またはより高い価数のカチオンが金属イオンである、請求項30に記載のコクリエート組成物。
- さらに凝集阻害剤を含む、請求項30に記載のコクリエート組成物。
- 有効量の請求項30に記載のコクリエート組成物および製薬上許容される担体を含む医薬組成物。
- a) アミノグリコシドを脂質を含むリポソームと混合すること;および
b) カルシウム、亜鉛、バリウム、およびマグネシウムカチオンからなる群より選択される2価カチオンまたはより高い価数のカチオンであるカチオンを加えて、コクリエート組成物を製造すること
を含む、請求項30に記載のコクリエート組成物を製造する方法。 - 総脂質のアミノグリコシドに対する比が少なくとも10:1である、請求項39に記載の方法。
- 中性の第2の脂質または中性の第2の脂質の群が、スフィンゴミエリンを含む、請求項1または30に記載のコクリエート組成物。
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US20100178325A1 (en) | 2006-08-23 | 2010-07-15 | Biodelivery Sciences International, Inc. | Amphiphilic nucleotide cochleate compositions and methods of using the same |
WO2009023355A2 (en) * | 2007-05-25 | 2009-02-19 | Ironwood Pharmaceuticals, Inc. | Compositions and methods for reducing the toxicity of certain toxins |
WO2012151517A1 (en) * | 2011-05-05 | 2012-11-08 | Coordinated Program Development, Llc | Cochleate compositions and methods of making and using same |
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2012
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- 2012-05-04 ES ES12779548T patent/ES2741282T3/es active Active
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- 2012-05-04 US US14/115,770 patent/US20140220108A1/en not_active Abandoned
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ES2741282T3 (es) | 2020-02-10 |
CA2834788C (en) | 2020-11-17 |
EP2704688A1 (en) | 2014-03-12 |
AU2012250568B2 (en) | 2017-06-29 |
US20140220108A1 (en) | 2014-08-07 |
WO2012151517A1 (en) | 2012-11-08 |
JP2014513135A (ja) | 2014-05-29 |
EP2704688A4 (en) | 2014-11-05 |
EP2704688B1 (en) | 2019-07-10 |
AU2012250568A1 (en) | 2013-11-07 |
JP2018138552A (ja) | 2018-09-06 |
CA2834788A1 (en) | 2012-11-08 |
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