JP7281835B2 - ドライアイ疾患または他の眼の疾患を診断および処置するためのヒスタチンを使用する方法 - Google Patents
ドライアイ疾患または他の眼の疾患を診断および処置するためのヒスタチンを使用する方法 Download PDFInfo
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Description
本出願は、2018年10月24日に出願された米国仮特許出願番号62/749,785号に対する優先権の利益を主張し、この内容は、その全体が参照されることによって本明細書に組み込まれる。
ドライアイ疾患(DED)は、何百万人もの患者を冒している一般的な障害である。涙液欠乏性DED(Aqueous deficient DED)(ADDE)は、涙腺の機能障害および涙液の水層の喪失に関連する。ADDEについてのいくつかの原因は、これらに限定されないが、シェーグレン症候群(SS)および眼移植片対宿主病(oGVHD)を包含する。涙膜の水層の喪失は、眼表面の炎症、涙の高モル浸透圧濃度およびラクリチン(lacritin)のような涙固有の数多の構成要素の低減に関連し得る。ADDEにおいてどの涙液の構成要素が失われるかを特徴づけることは、疾患の病態生理の理解を提供し、診断の手段の開発を進め、および涙膜の減った構成要素の合理的な置き換えを支持する。
本発明は、以下によってドライアイ疾患を診断するための方法を提供する(a)対象からの生物学的流体試料における1以上のヒスタチンペプチドのレベルを決定することおよび(b)該レベルを参照レベルと比較すること、ここで参照レベルと比較して1以上のヒスタチンペプチドの低減したレベルは、対象がドライアイ疾患を有することを指し示す。いくつかの側面において、ドライアイ疾患は、ADDE疾患である。ある側面において、1以上のヒスタチンは、ヒスタチン1、ヒスタチン2、ヒスタチン3、ヒスタチン4、ヒスタチン5、ヒスタチン6、ヒスタチン7、ヒスタチン8、ヒスタチン9、ヒスタチン10、ヒスタチン11、およびヒスタチン12の群から選択される。他の側面において、1以上のヒスタチンペプチドのレベルは、参照レベルと比較して、少なくとも2倍低減している、および/または1以上のヒスタチンペプチドのレベルは、5μg/ml未満である。方法は、ヒスタチンレベル単独に頼ってドライアイ疾患を診断してもよいが、方法は、さらに、対象の涙膜の質(例として、涙のモル浸透圧濃度、涙産生、涙液層破壊時間、またはそれらの組み合わせを測定することによって査定される)または眼表面の健康状態(例として、角膜フルオレセイン染色、眼表面疾患指標の得点、マイボスケール(Meiboscale)の得点、ドライアイ質問票(Dry Eye Questionnaire)の得点、またはそれらの組み合わせによって査定される)を査定するための試験を包含してもよい。ドライアイ疾患の診断に際して、方法は、抗炎症剤、免疫抑制剤、グルココルチコイド、細胞増殖抑制剤、アルキル化剤、代謝拮抗剤、細胞傷害性抗生物質、オピオイドまたはヒスタチンのうちの1つもしくはその組み合わせを、ドライアイ疾患を有する対象へ投与するステップをさらに包含してもよい。
ヒスタチンは、ヒト涙液中に存在し、およびヒスタチンレベル、とりわけH1、H3およびH5が、ドライアイ疾患を有する対象において低減していることが現在見出されている。具体的に言うと、低減したH1レベルは、無症候性であり、および臨床的に健常である対照(例として、いずれのドライアイの症状または目の障害も有さない対象)と比較して、シェーグレン症候群(SS)を有する対象および眼移植片対宿主病(oGVHD)患者において観察されており、およびH1レベルは、涙液欠乏性ドライアイ(aqueous deficiency dry eye)(ADDE)の従来の臨床指標と有意に相関関係があることが示されている。結果的に、本発明は、ドライアイ疾患または他の眼の疾患を診断する方法およびドライアイ疾患または他の眼の疾患の処置のための対象を選択する方法を提供する。これらの方法は、対象からの生物学的流体試料中の1以上のヒスタチンペプチドのレベルまたは量を決定し、および該レベルを対照または参照レベルと比較するステップを包含し、ここで対照または参照レベルと比較して低減したヒスタチンペプチドレベルは、ドライアイ疾患または他の眼の疾患または同処置を必要とする対象を指示している。
対象参加者および分類。イリノイ大学シカゴ校の施設内治験審査委員会に承認されたプロトコルの下、ヘルシンキ宣言および医療保険の相互運用性と説明責任に関する法律の教義を忠実に守りこの調査研究を行った。ドライアイ疾患(DED)を有する症候性の患者および無症候性の健常対照の対象が登録され、および調査の性質および考えられる帰結を説明した後にすべての参加者からインフォームドコンセントを得た。
患者の人口統計学的および表現型の特徴。患者の人口統計学的および臨床データを、表2に示す。
H1を用いて行われた分析と同様に、ADDE患者および正常な対照からの眼表面洗液を、ELISAを使用してH5のレベルについて試験した。表5中に提示されたレベルによって実証されるように、H5ペプチドは、正常な対照と比較して、ADDE(すなわち、SSおよびoGVHD)を有する対象において減った。
ヒスタチンがドライアイ疾患の症状を改善し得るかどうかを決定するために、細胞生存率アッセイを、毒性のある防腐剤である塩化ベンザルコニウム(BAK)の存在下で実行した(Yang, et al. (2017) Int. J. Mol. Sci. 18(3):509)。ヒト角膜上皮(HCE)細胞を標準的な条件下で培養し、生存率を代謝的に活性な細胞のミトコンドリアのデヒドロゲナーゼによって赤色ホルマザン色素に還元されるテトラゾリウム塩であるWST-1試薬を使用して査定した(Bartok, et al. (2015) EXCLI J. 14:123-132)。この分析の結果は、BAKで処置された細胞をH1またはH5で共処置したときに、HCE生存率が改善することを指し示した(図5)。HCE細胞をH1またはH5で共処置したときに、HCEへのBAKの適用によって誘導されたドライアイ疾患関連サイトカインのmRNAおよびタンパク質の発現のレベルもまた有意に低減した(表6)。
Claims (11)
- 涙液欠乏性ドライアイ(aqueous deficient dry eye)(ADDE)疾患を診断するためのキットであって、以下
(a)生物学的流体試料を収集するためのデバイス、および
(b)生物学的流体試料におけるヒスタチン1またはヒスタチン5のレベルを決定するためのヒスタチン1またはヒスタチン5に選択的に結合する抗体、ここで、参照レベルと比較してヒスタチン1またはヒスタチン5の低減したレベルは、ドライアイ疾患を有すると指し示す、
を含む、前記キット。 - ヒスタチン1またはヒスタチン5のレベルが、参照レベルと比較して少なくとも2倍低減している、請求項1に記載のキット。
- ヒスタチン1またはヒスタチン5のレベルが、5μg/ml未満である、請求項1に記載のキット。
- 対象の涙膜の質または眼表面の健康状態を査定する試験をさらに含む、請求項1に記載のキット。
- 涙膜の質が、涙のモル浸透圧濃度、涙の産生、涙液層破壊時間、またはそれらの組み合わせを測定することによって査定される、請求項4に記載のキット。
- 眼表面の健康状態が、角膜のフルオレセイン染色、眼表面疾患指標の得点、マイボスケール(Meiboscale)の得点、ドライアイ質問票(Dry Eye Questionnaire)の得点、またはそれらの組み合わせによって査定される、請求項4に記載のキット。
- 抗炎症剤、免疫抑制剤、グルココルチコイド、細胞増殖抑制剤、アルキル化剤、代謝拮抗剤、細胞傷害性抗生物質、オピオイドまたはヒスタチンのうちの1つもしくはそれらの組み合わせをさらに含む、請求項1に記載のキット。
- 涙液欠乏性ドライアイ(aqueous deficient dry eye)(ADDE)疾患についての対象を選択し、処置するためのキットであって、以下:
(a)生物学的流体試料を収集するためのデバイス;
(b)生物学的流体試料におけるヒスタチン1またはヒスタチン5のレベルを決定するためのヒスタチン1またはヒスタチン5に選択的に結合する抗体;および
(c)ヒスタチン1またはヒスタチン5のレベルが、参照レベルと比較して対象からの生物学的流体試料において低減しているときに対象に投与される、抗炎症剤、免疫抑制剤、グルココルチコイド、細胞増殖抑制剤、アルキル化剤、代謝拮抗剤、細胞傷害性抗生物質、オピオイドまたはヒスタチン1またはヒスタチン5のうちの1つもしくはそれらの組み合わせ、
を含む、前記キット。 - ヒスタチン1またはヒスタチン5のレベルが、参照レベルと比較して、少なくとも2倍低減している、請求項8に記載のキット。
- ヒスタチン1またはヒスタチン5のレベルが、5μg/ml未満である、請求項8に記載のキット。
- 有効量のヒスタチン1またはヒスタチン5を含む、涙液欠乏性ドライアイ(aqueous deficient dry eye)(ADDE)疾患を処置するためのキット。
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PCT/US2019/057807 WO2020086810A2 (en) | 2018-10-24 | 2019-10-24 | Methods of using histatin for diagnosing and treating a dry eye disease or other ocular diseases |
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