RU2459621C2 - Using fumaric acid derivatives for treating cardiac failure, myocardial infarction and angina - Google Patents

Abstract

FIELD: medicine, pharmaceutics.

SUBSTANCE: what is presented is using fumaric acid derivatives specified in a group consisting of dialkylfumarates, monoalkylhydrofumarates, fumaric acid monoalkyl ester salts, fumaric acid monoamides, fumaric acid monoamide salts, fumaric acid diamides, monoalkyl monoamido fumarates, carbocyclic and oxacarbocyclic oligomers of these compounds or their mixtures for preparing a drug for treatment or prevention of cardiac failure, particularly left-ventricular failure, myocardial infarction and angina.

EFFECT: dimethylfumarate has appeared to reduce considerably an area of infarction caused by ischemia followed by reperfusion.

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Description

The present invention relates to the use of fumaric acid derivatives for the manufacture of medicaments for the treatment of heart failure, myocardial infarction and angina pectoris.

Description of the Related Art

Dialkyl esters of fumaric acid and monoalkyl esters of fumaric acid and their salts have long been successfully used to treat psoriasis. This application has been described in a number of patents, for example DE 2530372, DE 2621214 or EP-B-0312697.

The use of fumaric acid mono- and diesters for the treatment of autoimmune diseases such as polyarthritis or multiple sclerosis (DE 19721099.6 and DE 19853487.6), as well as for use in transplantation medicine (DE 19853487.6 and DE 19839566.3, have also been described. ) Moreover, the use of fumaric acid mono- and diesters for the treatment of NFcappaB mediated diseases, as well as the treatment of mitochondrial diseases and / or an NFcappaB inhibitor, are known from DE 10101307.8 and DE 10000577.2. All of these publications describe fumaric acid mono- and diesters, optionally in the form of certain salts.

The use of fumaric acid mono- and diamides for treatment according to the indicated indications is also known from DE 10133004.9. These amides are formed with amino acids and preferably with specific peptides. Finally, fumaric acid oligomers and their use for the treatment of these diseases are known from DE 10217314.1.

Paroxysmal, pronounced respiratory distress is understood as asthma (bronchial asthma), which affects about 4 to 5% of the population of industrialized countries, with an increasing tendency. This respiratory distress is based on variable and reversible obstruction of the respiratory tract due to the hyperreactivity of the bronchial system, which is triggered by endogenous and exogenous stimuli. The latter include chemical and physical triggers, infections, physical effort, and / or emotional factors. After a long period of illness, secondary diseases, such as chronic bronchitis, pulmonary emphysema, bronchiectasis, atelectasis, or decompensated pulmonary heart or respiratory heart failure, usually develop.

Depending on the cause, differentiation is carried out between the following types of asthma, namely asthma caused by allergies, infections, analgesics, working conditions or physical effort, mixed forms of asthma or asthma cardiale (cardiac asthma), vasomotor rhinitis and uremic asthma. In particular, asthma cardiale can lead to respiratory distress, due to increased stagnation in the pulmonary circulation in case of left ventricular failure.

Currently, in drug therapy and / or for asthma relief, for example, beta-2 sympathomimetics, corticosteroids, parasympatholytics, theophyllines, anti-inflammatory agents and anti-allergic agents are used, in addition to methods for simply avoiding trigger stimuli.

At the molecular level, asthma appears to be characterized by increased activity of Th2 lymphocytes in the lungs, which, in turn, leads to increased release of some Th2 cytokines, which ultimately result in known symptoms of asthma, such as IgE isotype switching, production mucus and recruiting and activation of eosinophils. Moreover, Th2 cytokines appear to lead to differentiation of further Th2 cells along the signal transduction pathway known as JAK-STAT, which results in a circle of self-amplification. Increased proliferation of mesenchymal cells, in particular smooth muscle cells of the bronchi, is also observed.

The so-called JAK-STAT signal transduction pathway (Janus Kinase Signal Transducer and Transcription Pathway Activator) is a pathway for transmitting information transmitted by signal peptides, such as cytokines, into the cell and / or nucleus. Signal transduction occurs using STAT proteins that are present in the cytoplasm and are initially inactivated; 7 different STAT proteins are known in humans. As a result of the attachment of a receptor to the ligand on the cell surface, these STAT proteins are rapidly activated by phosphorylation, for example, Janus kinase. Phosphorylation leads to homo- or heterodimerization of STAT proteins, dimers are transported to the nucleus, where they are attached to the target promoter and dramatically increase the transcription rate of this promoter.

Acute or chronic inability of the heart to pump out the blood flow required for metabolism and to take venous return under stress (stress failure) or even at rest (rest failure) are understood as heart failure. Failure can occur in the form of an isolated left ventricular or right ventricular failure, and can also affect both ventricles.

The clinical picture of heart failure can be associated, for etiology, with various causes, primarily with inflammatory and degenerative changes in the myocardium and endocardium, disorders of the coronary circulation, myocardial infarction and injuries. Subsequently, heart failure leads to changes in peripheral blood circulation, respiratory disorders, in particular cardiac asthma, renal failure and electrolyte metabolism disorders and edema, and reduced skeletal muscle functional capacity.

With respect to indications, differentiation is made between acute heart failure, energy heart failure, energy-dynamic heart failure, and hypodynamic heart failure, also called HEGGLIN II syndrome, excitomotor heart failure, heart failure as a result of cardiac arrhythmia, hypoxemic, latent, primary, compensated, relative or stress insufficiency and / or left ventricular failure.

Currently, substances that stimulate contractions are used for drug therapy of heart failure, glycosides (primarily digoxin and digitoxin) are still used today for the treatment of chronic forms. However, vasodilators (nitro compounds and dihydralazine, alpha blockers, calcium antagonists, and primarily ACE inhibitors) have gained importance over the past few years. ACE inhibitors are most significant for long-term treatment. In addition, diuretics are used. Acute forms are treated with catecholamines, possibly also with amrinone.

The object of the invention is the provision of a new agent for the treatment of heart failure and asthma. In particular, an object of the invention is a therapeutic agent for both cardiac asthma and left ventricular failure in the area in which they overlap. Another object of the invention is a therapeutic agent for both indications individually or in the area in which they overlap, which, due to its good tolerance, is suitable for long-term therapy.

This objective is achieved by the use of fumaric acid derivatives for the manufacture of pharmaceuticals or pharmaceutical preparations for the treatment of asthma and / or heart failure, in particular in humans.

SUMMARY OF THE INVENTION

According to a first aspect, the invention relates to the use of fumaric acid derivatives selected from the group consisting of dialkyl fumarates, monoalkyl hydrofumarates (monoalkyl ester of fumaric acid), salts of monoalkyl esters of fumaric acid, monoamides of fumaric acid, salts of monoamides of fumaroamoramonic acid, di carbocyclic and oxacarbocyclic oligomers of these compounds and mixtures thereof for the manufacture of a pharmaceutical preparation for the treatment or prevention of heart failure, especially left ventricular failure, myocardial infarction and angina pectoris.

According to a second aspect, the invention relates to the use of fumaric acid derivatives selected from the group consisting of dialkyl fumarates, monoalkyl hydrofumarates, salts of fumaric acid monoalkyl esters, fumaric acid monoamides, fumaric acid monoamides, fumaric acid diamides, mono-acylo-acyclic-ammonium compounds mixtures thereof for the manufacture of a pharmaceutical preparation for the treatment of asthma and chronic obstructive pulmonary diseases, in asthma caused by allergies, infections, analgesics, working conditions or physical effort, mixed forms of asthma or asthma cardiale.

The present invention also relates to a method of inhibiting the absorption of ³ H-thymidine by smooth muscle cells of the bronchi and a method of inhibiting the proliferation of these cells, as described below and in the attached claims.

Finally, the present invention relates to a method of using the aforementioned fumaric acid derivatives to inhibit PDGF-induced activation of STAT1.

Description of drawings

Figure 1 is a chart that shows the size of a heart attack after the appointment of DMF, ischemia and control.

Figure 2 shows the percentage inhibition of PDGF-induced uptake of ³ H-thymidine by bronchial smooth muscle cells upon addition of DMF.

FIG. 3 is a graph showing the percentage of cell proliferation of bronchial smooth muscle cells in response to stimulation of PDGF in the absence or presence of DMF and / or dexamethasone.

4 is a diagram showing endodiastolic diameters of the left ventricle of Dahl rats before and after an 8-week high-salt diet in the absence and presence of DMF.

DETAILED DESCRIPTION OF THE INVENTION

According to a first aspect of the description, the present invention relates to the use of fumaric acid derivatives for the manufacture of a pharmaceutical preparation for the treatment of asthma and chronic obstructive pulmonary diseases in general. Preferably, it is asthma caused by allergies, infections, working conditions or physical exertion, particularly preferably asthma cardiale.

According to a second aspect of the description, the invention also relates to the use of fumaric acid derivatives for the manufacture of a pharmaceutical preparation for the treatment or prevention of heart failure, myocardial infarction and angina pectoris. Considered heart failure can be any type of heart failure, regardless of its form and / or etiology. Examples of heart failure that are treated according to the invention are acute heart failure, energy heart failure, energy-dynamic heart failure and hypodynamic heart failure, also called HEGGLIN II syndrome, excitomotor heart failure, heart failure as a result of cardiac arrhythmias, hypoxemic, latent, primary compensated, decompensated, relative or stress insufficiency and / or left ventricle I deficiency, more preferably left ventricular failure. The compositions are also effective in preventing these diseases and / or myocardial infarctions, including primary, recurrent, or subsequent heart attacks.

These applications are based on the discovery that fumaric acid derivatives inhibit PDGF-β (platelet-derived growth factor) induced STAT1 activation. As described above, it was suggested that in asthma, STAT activation leads to a displacement of the cytokine pattern and, ultimately, to a vicious cycle with increased Th2 cell activity and the consequences of mucus secretion, IgE production and eosinophil recruitment (AB Pernis, PB Rothman, “JAK -STAT signalling in asthma ”in: The J. of Clin. Investigation, VOL. 10, No. 1, May 2002).

The shift of the cytokine pattern from Th1 to Th2, which is described in the literature for derivatives of fumaric acid (see the above patent descriptions of inventions), preferably leads to the expectation of intensification of this vicious circle. Accordingly, they will not be suitable for the treatment of asthma. Amazingly, it turned out that fumaric acid derivatives can inhibit the proliferation of smooth muscle cells in the respiratory tract. This, apparently, occurs through the inhibition of PDGF-induced transcription factor STAT1. It was possible to specifically show that fumaric acid derivatives are able to inhibit PDGF-induced activation of STAT1 and PDGF-stimulated incorporation of thymidine in BSM (smooth bronchial muscle) cells. In the absence of a link, therefore, this proliferation-inhibiting effect may be causative for the effectiveness of fumaric acid derivatives in asthma therapy.

One or more fumaric acid derivatives used according to the invention can be selected from the group consisting of dialkyl fumarates (dialkyl esters of fumaric acid, respectively), monoalkyl hydrofumarates (monoalkyl esters of fumaric acid, respectively), salts of monoalkyl esters of fumaric acid (salts of monoalkyl esters , respectively) of physiologically acceptable cations, in particular cations of alkali or alkaline earth metals or transition metal cations such as Li ⁺ , Na ⁺ , K ^+, NH ₄ ^+, Mg ^2+, Ca ^2+, Fe ^2+, Mn ^2+, and Zn ^2+, fumaric acid monoamides and fumaric acid diamides and their salts, carbocyclic and oksakarbotsiklicheskih oligomers of these compounds and mixtures thereof.

In a preferred embodiment, the fumaric acid derivative is selected from the group consisting of optionally substituted dialkyl esters of fumaric acid and monoalkyl esters of fumaric acid in the form of the free acid or its salts and mixtures thereof.

Particularly preferred is the use in this case of dialkyl esters of fumaric acid of the formula (I)

since they are described in DE 19853487.6, where R ₁ and R ₂ , which may be the same or independently different, are a C _1-24 alkyl radical or a C _5-20 aryl radical, and these radicals are optionally substituted with halogen (F, Cl, Br, I), hydroxy, C _1-4 alkoxy, nitro or cyano. Preferably, the dialkyl fumarate is dimethyl fumarate, diethyl fumarate and / or methylethyl fumarate.

In general, an alkyl group is understood to mean a saturated or unsaturated, straight-chain, branched or cyclic hydrocarbon group having, according to the invention, 1-24 carbon atoms, which can be optionally substituted with one or more substituents. Preferably, the alkyl group is methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, pentyl, cyclopentyl, 2-ethylhexyl, hexyl, cyclohexyl, heptyl, cycloheptyl, octyl, vinyl, allyl, 2-hydroxyethyl, 2-hydroxypropyl, 3-hydroxypropyl, 2,3-dihydroxypropyl, 2-methoxyethyl, methoxymethyl, 2-methoxypropyl, 3-methoxypropyl or 2,3-dimethoxypropyl. Most preferred are methyl and ethyl.

According to the invention, an aryl group is to be understood as optionally substituted aryl, alkyl substituted aryl or aralkyl having 5-20 carbon atoms, preferably an aryl, alkyl substituted aryl or aralkyl group having 6-10 carbon atoms, which are phenyl, benzyl, phenethyl, methylphenyl, ethylphenyl , propylphenyl and butylphenyl, tert-butylphenyl, phenyl and benzyl are particularly preferred.

Substituents of these groups are preferably selected from the group consisting of halogen (F, Cl, Br, I), hydroxy, C _1-4 alkoxy, C _1-4 alkyl, nitro and cyano.

Monoalkyl esters of fumaric acid of the formula (II)

as described in DE 19721099.6, can also be successfully applied where R ₁ corresponds to the above definition, A is hydrogen, an alkali or alkaline earth metal cation or a physiologically acceptable transition metal cation, preferably selected from Li ⁺ , Na ⁺ , K ^+, Mg ^2+, Ca ^2+, Zn ^2+, Fe ^2+, and Mn ^2+, and n is 1 or 2 and corresponds to the valence of A.

Exemplary compounds of formulas (I) and (II) are fumaric acid dimethyl ether, fumaric acid diethyl ether, fumaric acid methyl ethyl ester, methyl hydrofumarate, ethyl hydrofumarate, calcium methyl fumarate, calcium ethyl fumarate, magnesium methyl fumarate, magnesium ethyl fumarate, zinc ethyl fumarate. methyl fumarate and iron ethyl fumarate. They can be used individually or as mixtures.

Preferably, the fumaric acid amides used according to the invention are described in DE 10133004.9.

They correspond to the general formula (III)

Where

R _a is an OR ₃ or D or L amino acid radical —NH — CHR ₄ —COOH linked by an amide bond, where R ₃ is hydrogen, straight or branched, optionally substituted C _1-24 alkyl radical, phenyl radical or C _{6 A -10} aryl or aralkyl radical, and R4 is the side chain of a natural or synthetic amino acid; and

R _b represents a D- or L-amino acid radical —NH-CHR ₅ —COOH linked by an amide bond, where R ₅ is the side chain of a natural or synthetic amino acid, or a peptide radical of 2-100 amino acids linked by an amide bond, where each amino acid may be the same or different.

The side chain of a natural or synthetic amino acid is usually a side chain selected from the group consisting of side chains Ala, Val, Leu, Ile, Trp, Phe, Met, Tyr, Thr, Cys, Asn, Gln, Asp, Glu, Lys, Arg , His, Citrulline, Hcy, Hse, Hyp, Hyl, Orn, Sar and Me-Gly. Side chains of Gly, Ala, Val, Ile, Leu and Me-Gly are preferred. If R _a is the L-amino acid radical -NH-CHR ₄ -COOH, R _b is the L-amino acid radical -NH-CHR ₅ -COOH, R4 and R5 may be the same or different. More preferably, when R ₄ and R _{5 are the} same. Most preferably, when R _a and R _b each represents glycine.

Alternatively, R _a may be a —OR ₃ radical, R _b may be a L-amino acid radical —NH — CHR ₅ —COOH or a peptide radical, R ₅ having the above meaning. In this case, the fumaric acid derivative is monoalkyl monoamidofumarate.

The peptide radical is connected by an amide bond and has from 2 to 100, preferably from 2 to 30, most preferably from 2 to 15 amino acids, which may be the same or different. The peptide radical R _{b is} most preferably selected from the group consisting of peptide hormones, growth factors, cytokines, neurotransmitters, neuropeptides, antibody fragments, coagulation factors and cyclosporins, and their derivatives and fragments. Preferably, R _a is methoxy or ethoxy and R _b is Gly, Ala, Val, Ile, Leu and Me-Gly.

Amides of fumaric acid, as defined above, can be used individually or in a mixture, for example, in a mixture with monoalkyl or dialkyl esters of fumaric acid, as defined above.

Finally, carbocyclic or oxacarbocyclic fumaric acid oligomers can also be used, as described in DE 10217314.1. They contain from 2 to 10, preferably from 2 to 6, most preferably 2-3 units derived from fumaric acid and / or its esters and / or amides, as described above, in the form of repeating units.

These fumaric acid oligomers are preferably prepared by (olefin) polymerization of C-C double bonds (for carbocyclic oligomers) and / or C-C double bonds and carbonyl oxygen atoms of the units (for oxacarbocyclic oligomers). Preferably, the units derived from fumaric acid are derived from monomers selected from the group consisting of fumaric acid and dialkyl fumarates, monoalkyl hydrofumarates, fumaric acid monoamides, fumaric acid diamides, monoalkyl monoamidofumarates and their salts and mixtures thereof as defined above. More preferably, the oligomer contains only units derived from one or two monomers. Most preferably, the oligomer contains exclusively identical monomer units.

Carbocyclic oligomers are composed of units derived from fumaric acid, so that the units are joined by 2 and 3 carbon atoms of the fumaric acid backbone via C-C covalent bonds so that a carbocyclic oligomer is formed. The main chain of the oligomer includes an even number of carbon atoms and does not contain any other monomers and / or heteroatoms. This main chain is substituted at each carbon atom of the monomeric unit (s) of the fumaric acid from which it is built, one of the carboxylic acids and / or amide groups of carboxylic acids.

Oxacarbocyclic oligomers are composed of fumaric acid monomers in such a way that the units are linked to each other at 1 and 3 carbon atoms by ether bridges. At the same time, ethylene unsaturation of C ₂ and C ₃ atoms is shifted to C ₁ and C ₂ . Thus, according to the invention, the ring contains polyoxypropene units in the case of oxacarbocyclic oligomers.

As used herein, the term “oligomer” refers to at least two monomeric units of fumaric acid. Typically, the oxacarbocyclic and / or carbocyclic oligomer of fumaric acid contains from 2 to 10, preferably from 2 to 6, most preferably 2-3 units derived from fumaric acid. Preferably, the carboxylic acid and / or amide groups of the carboxylic acid as ring substituents are all in a transposition to each other.

In a preferred embodiment, the carbocyclic oligomer of fumaric acid corresponds to the following formula (IVa)

used where the radicals Rc and Rd are the same or different and are selected from amino radicals (-NR1R2), amino acid radicals -NH-C (COOH) -R5, peptide radicals having from 2 to 100 amino acids, alkoxy radicals (-OR1) and hydroxyl radicals, R1, R2 and R5, as defined above, and n is an integer from 2 to 10 inclusive, preferably from 2 to 6 inclusive.

Preferably, the radicals Rc and Rd are ITOs each independently alkoxyl or hydroxyl radical, at the same time, with the most preference, Rc and Rd, not meaning hydroxyl. Thus, the monomer (s) is (are) preferably one or more monoalkyl hydrofumarates (s). In another embodiment, Rc and Rd may be an alkoxy radical —OR ₁ , which is more preferably identical. In this case, the monomer (s) is dialkyl fumarate (s).

Particularly preferred if r-1, t-2, c-3, t-4-tetrakis (methoxycarbonyl) cyclobutane or r-1, t-2, c-3, t-4, c-5, t-6- hexa (alkoxycarbonyl) cyclohexane, preferably r-1, t-2, c-3, t-4-tetrakis (methoxycarbonyl) cyclobutane and / or r-1, t-2, c-3, t-4, c-5 , t-6-hexa (methoxycarbonyl) cyclohexane are used according to this embodiment.

Alternatively, an oxacarbocyclic oligomer of formula (IVb) is used:

where n = from 2 to 10,

where R ₁ and R _{2 are} represented as defined above, and n is an integer from 2 to 10 inclusive, more preferably from 2 to 6 inclusive.

The fumaric acid derivatives used according to the invention can be manufactured according to known methods, which are, for example, described in DE 19721099.6, DE 10133004.9 or DE 10217314.1. The contents of these publications are incorporated by reference.

The pharmaceutical preparation may be presented in a form suitable for oral, rectal, transdermal, dermal, ophthalmic, nasal, pulmonary or parenteral use. Preferably, the pharmaceutical preparation is suitable for oral administration. Then it can be presented in the form of tablets, coated tablets, capsules, granules, drinking solutions, liposomes, nanoparticles, nanocapsules, microcapsules, microtablets, pellets or powders and in the form of granules packed in capsules or sachets, microtablets, packaged in capsules or sachets, pellets packed in capsules or sachets, nanoparticles packed in capsules or sachets, or powders packed in capsules or sachets. Preferably, the drug is in the form of nanoparticles, pellets or microtablets, which can be optionally packaged in sachets or capsules.

Preferably, all solid dosage forms may be provided with an enteric coating. It, for example, can be applied to tablets, microtablets, pellets, etc., and can also be applied to capsules that contain them.

Oral pharmaceutical forms according to the invention can mainly be manufactured according to the classical compression method, as well as direct compression and as solid dispersions according to the melting method or by spray drying method. If desired, the enteric coating can be cast or sprayed in parts onto the tablet cores in a classic pelletizing boiler or applied using a vortex spraying apparatus according to known processes. Later, after drying is completed, the film coating can be applied in the same apparatus.

Preferably, the fumaric acid derivatives for the manufacture of the pharmaceutical preparations according to the invention are used in such an amount that this pharmaceutical preparation contains the fumaric acid derivative (s) in an amount of one or more per dosage unit that corresponds to and / or is equivalent to an amount of fumaric acid of from 1 to 500 mg preferably from 10 to 300 mg, and generally preferably from 10 to 200 mg.

In the case of parenteral administration by injection (vv, vm, pc, ip), the drug is presented in a form suitable for this. All conventional liquid carriers suitable for injection may be used.

According to a preferred embodiment, the medicament produced according to the invention may individually or in a mixture contain the following: from 10 to 500 mg of dialkyl fumarate, in particular dimethyl fumarate and / or diethyl fumarate, from 10 to 500 mg of calcium alkyl fumarate, in particular calcium methyl fumarate and / or calcium ethyl fumarate, from 0 to 250 mg of zinc alkyl fumarate, in particular zinc methyl fumarate and / or zinc ethyl fumarate, from 0 to 250 mg of alkyl hydrofumarate, in particular methyl hydrofumarate and / or ethyl hydrofumarate, and from 0 to 250 mg of magnesium alkyl fumarate, especially magnesium methyl fumarate and / or magnesium ethyl fumarate, the sum of said amounts corresponding to an equivalent of 1 to 500 mg, preferably from 10 to 300 mg, and most preferably from 10 to 200 mg fumaric acid.

According to the invention, preparations which are used with particular preference contain exclusively dimethyl fumarate in an amount of from 10 to 300 mg.

According to a particularly preferred embodiment, the pharmaceutical preparation is in the form of microtablets or pellets. Preferably, they have a size and / or average diameter of ≤5000 micrometers, preferably from 300 to 2500 micrometers, in particular from 300 to 1000 micrometers for pellets and from 1000 to 2500 micrometers for microtablets. Due to the use of fumaric acid derivatives in the form of microtablets, which is preferably according to the invention, gastrointestinal irritation and / or side effects that cannot be excluded with the use of tablets in standard single doses can be further reduced. Apparently, this is based on the fact that microtablets, preferably enteric-coated microtablets, are already distributed in the stomach and thus enter the gut bolus when the active substances are released in lower local doses at a constant total dose. As a result of this, local irritation of the intestinal epithelial cells can be avoided, it follows that the tolerance of the gastrointestinal tract to microtablets is better compared to conventional tablets.

Production Examples

To explain the use according to the invention, various examples are given below for the manufacture of preferred pharmaceutical preparations. Examples are given for illustrative purposes only, and not to limit the invention.

Example 1

The manufacture of enteric-coated tablets containing 100.0 mg of Ca monomethyl fumarate salt, which corresponds to 78 mg of fumaric acid

Taking the necessary precautions (breathing mask, gloves, protective clothing, etc.), 10 kg of Ca monomethyl fumarate salt are crushed, thoroughly mixed and homogenized using a 800 sieve. An inert filler mixture of the following composition is then made: 21 kg of starch derivatives (STA- RX 1500®), 2 kg of microcrystalline cellulose (Avicel PH 101®), 0.6 kg of polyvinylpyrrolidone (PVP, Kollidon® 25), 4 kg of Primogel®, 0.3 kg of colloidal silicic acid (Aerosil®).

The active ingredient is added to the whole powder mixture, mixed, homogenized with a 200 sieve and processed in the usual way with a 2% aqueous solution of polyvinylpyrrolidone (PVP, Kollidon® 25) into binder granules, and then mixed with the external phase in a dry state. The latter consists of 2 kg of the so-called FST complex, containing 80% talc, 10% silicic acid and 10% magnesium stearate.

After that, the mixture is compressed in the usual way into convex tablets with a weight of 400 mg and a diameter of 10.0 mm Instead of these classic compression methods, other methods can also be used to make tablets, such as direct compression or solid dispersions according to the melting method and the vortex spraying method.

Enterosmobile coating:

A solution of 2.250 kg of hydroxypropyl methylcellulose phthalate (HPMCP, Pharmacoat HP® 50) was dissolved in a mixed solvent consisting of 2.50 L of demineralized water, 13 L of acetone Ph. Helv. VII and 13 L of ethanol (94% by weight), and then 0.240 kg of castor oil (Ph. Eur. II) was added to the solution. The solution is applied or sprayed in parts onto the tablet cores in a coating pan in the usual manner.

After appropriate drying, a film coating is applied. The specified coating consists of a solution of Eudragit® E 12.5% 4.8 kg, talc Ph. Eur. II 0.34 kg, titanium oxide (VI) Cronus RN 56® 0.52 kg, colored varnish ZLT-2 blue (Siegle) 0.21 kg and polyethylene glycol 6000 Ph. Helv. VII. 0.12 kg in a mixed solvent of 8.2 kg of 2-propanol Ph. Helv. VII, 0.06 kg of triacetate glycerol (Triacetin®) and 0.2 kg of demineralized water. Homogeneous distribution in a pan or fluidized bed is followed by drying and polishing in the usual way.

Example 2

The manufacture of enteric-coated capsules containing 86.5 mg of monoethyl fumarate-Ca salt and 110.0 mg of dimethyl fumarate, which correspond to a total of 150 mg of fumaric acid

Taking the necessary precautions (breathing mask, gloves, protective clothing, etc.), 8.65 kg of monoethyl fumarate-Ca salt and 11 kg of dimethyl fumarate are thoroughly mixed with a mixture of 15 kg of starch, 6 kg of lactose Ph. Helv. VII, 2 kg of microcrystalline cellulose (Avicel®), 1 kg of polyvinylpyrrolidone (Kollidon® 25) and 4 kg of Primogel® and homogenized with a 800 sieve.

Together with a 2% aqueous solution of polyvinylpyrrolidone (Kollidon® 25), the entire powder mixture is processed in the usual way into a binder granulate and mixed with the external phase in the dried state. The specified external phase consists of 0.35 kg of colloidal silicic acid (Aerosil®), 0.5 kg of magnesium stearate and 1.5 kg of talc Ph. Helv. VII. The homogeneous mixture is then poured into 500.0 mg portions into suitable capsules, which are then provided with an enterosmobilic (resistant to gastric acid juice) coating consisting of hydroxypropylethyl cellulose phthalate and castor oil as an emollient in the usual manner.

Example 3

Manufacture of enteric microtablets in capsules containing 87.0 mg of monoethyl fumarate-Ca salt, 120 mg of dimethyl fumarate, 5.0 mg of monoethyl fumarate-Mg salt and 3.0 mg of monoethyl fumarate-Zn salt, which correspond to a total of 164 mg of fumaric acid (forte tablets) ")

Taking the necessary precautions (breathing mask, gloves, protective clothing, etc.), 8.7 kg of monoethyl fumarate-Ca salt, 12 kg of dimethyl fumarate, 0.5 kg of monoethyl fumarate-Mg salt and 0.3 kg of monoethyl fumarate-Zn salt crushed, thoroughly mixed and homogenized using a sieve 800. An inert filler mixture of the following composition was made: 18 kg of starch derivatives (STA-RX 1500), 0.3 kg of microcrystalline cellulose (Avicel PH 101), 0.75 kg PVP (Kollidon 120) 4 kg Primogel; 0.25 kg colloidal silicic acid (Aerosil). The entire powder mixture was added to the active ingredient mixture, homogenized with a 200 sieve and processed in the usual way with a 2% aqueous solution of polyvinylpyrrolidone (Kollidon K25) to obtain a binder granulate and mixed in the dry state with an external phase, which consists of 0.5 kg of magnesium stearate and 1.5 kg of talc. The powder mixture is then compressed in the usual way into convex microtablets with a gross weight of 10.0 mg and a diameter of 2.0 mm.

Enterosomobile (resistant to gastric acid) coating is applied in the apparatus of the fluodized layer. To achieve gastric acid resistance, portions of a solution of 2.250 kg of hydroxypropyl methyl cellulose phthalate (HPMCP, Pharmacoat HP 50) are dissolved in a mixture of the following solvents: acetone 13 L, ethanol (94%, denatured with 2% ketone by weight) 13.5 L and demineralized water 2.5 l. 0.240 kg of castor oil is added as a softening agent to the finished solution and applied in parts to the tablet cores in the usual way.

Film coating: After drying in the same machine, a suspension of the following composition is then applied as a film coating: talc 0.340 kg, titanium oxide (VI) Cronus RN 56 0.4 kg, colored varnish L red varnish 86837 0.324 kg, Eudragit E 12.5% 4.8 kg and polyethylene glycol 6000 pH 11 XI 0.12 kg in a solvent mixture of the following composition: 2-propanol 8.17 kg, demineralized water 0.2 kg and glycerol triacetin (Triacetin) 0.6 kg.

Gastric acid acid resistant microtablets were analyzed with respect to their ingredients and then placed in hard gelatine capsules in an appropriate net weight and sealed.

Example 4

The manufacture of enteric microtablets in capsules containing 120.0 mg of dimethyl fumarate, which corresponds to 96 mg of fumaric acid

Taking the necessary precautions (breathing mask, gloves, protective clothing, etc.), 12 kg of dimethyl fumarate are crushed and homogenized using a 800 sieve. An inert filler mixture of the following composition is made: 17.5 kg of starch derivative (STA-RX® 1500 ), 0.30 kg of microcrystalline cellulose (Avicel® PH 101), 0.75 kg of PVP (Kollidon® 120), 4 kg of Primogel®, 0.25 kg of colloidal silicic acid (Aerosil®). The entire powder mixture is added to the active ingredient mixture, mixed, homogenized with a 200 sieve, processed in the usual way with a 2% aqueous solution of polyvinylpyrrolidone (Kollidon® K25) to obtain a binder granulate and mixed in a dry state with an external phase that consists of 0.5 kg Mg stearate and 1.5 kg talc.

The powder mixture is then compressed in the usual way into convex microtablets with a gross weight of 10.0 mg and a diameter of 2.0 mm.

To achieve gastric acid resistance, portions of a solution of 2.25 kg of hydroxypropyl methylcellulose phthalate (HPMCP, Pharmacoat® HP 50), for example, are dissolved in a mixture of the following solvents: acetone 13 l, ethanol (94%, denatured by weight with 2% ketone) 13 , 5 l and demineralized water 1.5 l. Castor oil (0.24 kg) is added as a softening agent to the finished solution and applied in parts to the tablet cores in the usual way.

After drying in the same apparatus, a suspension of the following composition was then applied as a film coating: talc 0.34 kg, titanium oxide (VI) Cronus RN 56 0.4 kg, color varnish L red varnish 86837 0.324 kg, Eudragit E 12.5 % 4.8 kg and polyethylene glycol 6000 pH 11 XI 0.12 kg in a solvent mixture of the following composition: 2-propanol 8.17 kg, demineralized water 0.2 kg and glycerol triacetin (Triacetin) 0.6 kg.

Acid-resistant gastric juice microtablets are analyzed with respect to their ingredients and then placed in hard gelatin capsules in an appropriate net weight and sealed.

Example 5

Preparation of enteric-coated microtablets in capsules containing 120.0 mg of diglycine fumaric acid diamide, which corresponds to 96 mg of fumaric acid

12 kg of diglycine fumaric acid diamide are crushed and homogenized as indicated above. A mixture of an inert filler of the following composition was made: 23.2 kg of microcrystalline cellulose (Avicel® PH 200), 3 kg of croscarmellose sodium (AC-Di-SOL-SD-711), 2.5 kg of talc, 0.1 kg of silicic acid anhydride ( Aerosil® 200) and 1 kg Mg stearate. The entire powder mixture is added to the active ingredient mixture and mixed homogeneously. Then, the powder mixture was pressed by direct compression into convex microtablets with a gross weight of 10.0 mg and a diameter of 2.0 mm.

Subsequently, a solution of 0.94 Eudragit® in isopropanol was prepared, which additionally contains 0.07 kg of dibutyl phthalate. This solution is sprayed onto the core of tablets. Then a dispersion of 17.32 kg of Eudragit® L D-55 and a mixture of 2.8 kg of microtalc, 2 kg of Macrogol 6000 and 0.07 kg of Dimeticon in water were made and sprayed onto the cores.

Subsequently, enteric microtablets were analyzed with respect to their ingredients and placed in hard gelatin capsules in an appropriate net weight and sealed.

Example 6

The manufacture of enteric-coated microtablets in capsules containing 60.0 mg rl, t-2, c-3, t-4-tetrakis (methoxycarbonyl) cyclobutane and 30.0 mg rl, t-2, c-3, t-4 , c-5, t-6-hexa (methoxycarbonyl) cyclohexane

60 kg rl, t-2, cl, t-4-tetrakis (methoxycarbonyl) cyclobutane and 3.0 kg rl, t-2, c-3, t-4, c-5, t-6-hexa (methoxycarbonyl) cyclohexane is crushed, thoroughly mixed and homogenized with a 800 sieve. A mixture of an inert filler of the following composition is made: 18 kg of starch derivatives (STA-RX 1500®), 0.30 kg of microcrystalline cellulose (Avicel PH 101), 0.75 kg PVP (Kollidon 120), 4.00 kg of Primogel, 0.25 kg of colloidal silicic acid (Aerosil). The active ingredient is added to the whole powder mixture and homogenized with a 200 sieve and processed with a 2% aqueous solution of polyvinylpyrrolidone (Kollidon K25) in the usual way into binder granules, then mixed with the external phase in a dry state. The latter consists of 0.50 kg of magnesium stearate and 1.50 kg of talc. After this, the powder mixture is compressed in the usual way into convex microtablets with a gross weight of 10.0 mg and a diameter of 2.0 mm.

Enterosomobile (acid-resistant gastric juice) coating is cast onto the core of tablets in a classic pelletizing boiler. To achieve acid resistance of gastric juice, portions of a solution of 2.250 kg of hydroxypropyl methylcellulose phthalate (HPMCP, Pharmacoat HP 50) are dissolved in a mixture of the following solvents: acetone 13.00 l, ethanol (94%, denatured by weight with 2% ketone) 13.50 l and demineralized water 2.50 l. 0.240 kg of castor oil is added as a softening agent to the finished solution and applied in parts to the tablet cores in the usual way.

Film coating: After drying in the same device as a film coating, a suspension of the following composition is applied: talc 0.340 kg, titanium oxide (VI) Cronus PvN 56 0.400 kg, colored varnish L red varnish 86837 0.324 kg, Eudragit E 12.5% 4,800 kg and polyethylene glycol 6000 pH 11 XI 0.120 kg in a solvent mixture of the following composition: 2-propanol 8.170 kg, demineralized water 0.200 kg and glycerol triacetin (Triacetin) 0.600 kg.

Subsequently, enteric microtablets were analyzed for their active ingredients and placed in hard gelatin capsules in an appropriate net weight and sealed.

Example 7

Preparation of a suspension for parenteral use containing 60.0 mg rl, t-2, c-3, t-4-tetrakis (methoxycarbonyl) cyclobutane and 30.0 mg rl, t-2, c-3, t-4, c -5, t-6-hexa (methoxycarbonyl) cyclohexane.

Ingredients mg / ml r-l, t-2, c-3, t-4-tetrakis (methoxycarbonyl) cyclobutane 60.0 rl, t-2, c-3, t-4, c-5, t-6-hexa (methoxycarbonyl)
cyclohexane 30,0 Methyl cellulose 0.25 Sodium Citrate, Dihydrate 30.00 Benzyl alcohol 9.00 Methyl p-hydroxybenzoic acid 1.80 Propyl p-hydroxybenzoic acid 1,2 Water for injections q.s.a.d. 1.00

The above ingredients are processed into a suspension for parenteral administration using standard techniques.

Application examples

Example A

In vivo data on the treatment of heart failure with DMF using a rat model.

The effects of dimethyl fumarate were investigated in this experiment using a model of acute ischemia and reperfusion in rats. For this purpose, healthy male rats were divided into three groups of 17 animals each. In the tests, ischemia was caused by occlusion of an artery on a naked heart for 45 minutes, and subsequently reperfusion was carried out for 120 minutes. As a result, myocardial infarction was caused by reocclusion, the risk area was determined by phthalocyanine blue staining.

The introduction of the test substance was carried out at the beginning of the first occlusion. The control group received 0.02% DMSO (0.5 ml / kg body weight), the DMF group received 10 mg of dimethyl fumarate in 0.02% DMSO (0.5 ml / kg body weight). In the second group, animals were pre-ischemic (2 times for 5 minutes each ischemia and reperfusion).

The results are presented in figure 1. Obviously, dimethyl fumarate (DMF) and preliminary ischemia (IPC) in our experiments limited the size of the infarct zone to a statistically significant degree, the risk area was similar in all 3 groups. Thus, the data prove that the applied dimethyl fumarate can significantly reduce the size of the infarct zone and, thus, prevent heart failure.

Example B

Inhibition of PDGF-induced thymidine uptake

Successful asthma treatment involves three different paths: (1) reduced release of inflammatory mediators in allergic reactions, (2) inhibition of T-lymphocytic invasion, (3) inhibition of proliferation of mesenchymal cells. It has been proven that glucocorticoids, which are the treatment of choice for asthma, inhibit the proliferation of mesenchymal cells. This test can thus be used to test other possible active substances for the treatment of asthma.

BSM (bronchial smooth muscle) cells were cultured on RPMI, 0.3% albumin and 0.1% DMSO at 37 ° C in the presence of 0, 1, 5, 10 and 20 ng / ml PDGF with and without 10 ^-5 M dimethyl fumarate .

After a predetermined period of time, 5μCi ³ H-thymidine was added to the nutrient medium, the incubation was continued for the next 24 hours. Incorporation was finally stopped by centrifugation, supernatant removal, washing and cell lysis. Incorporation of ³ H-thymidine was measured by determining the radioactivity in lysates in a liquid scintillation device compared to a control. The results are shown in FIG. 2 as percentages compared to control (100%). The addition of PDGF apparently increases the incorporation of ³ H-thymidine and thus cell proliferation, while this increase is significantly reduced by the addition of dimethyl fumarate.

Example C

Bronchial smooth muscle cells were grown in 96-well plates until they reached 60-70% confluency. Then the cells were fasted for 48 hours in serum-free RPMI medium containing 0.3% albumin. One hour before stimulating cell proliferation with 10 ng / ml PDGF, the cells were treated with (a) 10 ^-5 M DMF, (b) 10 ^-8 M dexamethasone (dexa) or (c) 10 ^-5 M DMF and 10 ^-8 M dexa. Untreated cells (buffer only) were used as a control. The cells were treated for 36 hours, after which 5μCi ³ H-thymidine was added over the next 8 hours. Cells were lysed, ³ H-thymidine incorporated into DNA was coupled to filtering membranes, and incorporated cpm was measured in a liquid scintillation device. The results are shown in FIG. 3 as a percentage of control (100%) and compared with PDGF-induced proliferation.

When treating cells with only dexa (10 ^-8 M), which is a therapeutically relevant dose, cell proliferation was reduced to approximately 116 ± 11%. Comparable reduction was observed with 10 ^-5 M DMF (117 ± 4%). The combined use of DMF and dexa at these concentrations led to a synergistic decrease in cell proliferation to an almost basic level (95 ± 11%). These results indicate that DMF may be useful in treating asthma alone, as well as in combination usually with dexamethasone or glucocorticoids.

In a particularly preferred embodiment for the treatment of asthma and chronic obstructive pulmonary diseases, such a treatment is thus presented in combination with a glucocorticoid. The use may be in a single metering device or in separate metering devices. Application may also be parallel or sequential. Preferably, the glucocorticoid is selected from the group consisting of dexamethasone, cortisone, hydrocortisone, prednisone, prednisone, methylprednisolone, fluocortolone, triamcinolone, betamethasone, beclomethasone, budesonide, flunisonide, fluticasone and their pharmaceutically acceptable salts. Most preferably, the glucocorticoid is dexamethasone.

Example D

Dahl-rats, which are salt-sensitive, were exposed to daily doses of varying doses of DMF and placed on a high-salt diet. After 8 weeks of treatment, endodiastolic diameters of the left ventricle were measured in the test and control groups by echocardiographic analysis. The measured groups were: control (0 mg DMF; n = 9); group 1 (2 × 5 mg DMF / kg / d; n = 9) and group 2 (2 × 15 mg DMF / kg / d; n = 11).

In an echocardiographic analysis, DMF prevented dilatation of the left ventricle after an 8-week high-salt diet in a dose-dependent manner. Specifically, in the DMF groups, the inner diameter of the left ventricle remained the same as in the base one (see Figure 4). In contrast, animals in the control group showed an enlarged left ventricle, showing dilatation of the left ventricle. Importantly, dilatation of the left ventricle signifies a transition from compensated hypertrophy to decompensated heart failure. Therefore, DMF delays the transition to cardiac decompensation and thus prevents myocardial infarction.

Claims (19)

1. The use of derivatives of fumaric acid selected from the group consisting of dialkyl fumarates, monoalkyl hydrofumarates, salts of monoalkyl esters of fumaric acid, monoamides of fumaric acid, salts of monoamides of fumaric acid, diamides of fumaric acid, monoalkyl monoamido fumaric acid compounds of the preparation of carbo monoalkido fumaric acid oligomers, carbo-oligomeric fatty acids, a medicine for treating or preventing heart failure. 2. The use according to claim 1, where the fumaric acid derivative is selected from one or more dialkyl esters of fumaric acid of the formula I

where R ₁ and R ₂ , which may be the same or different, independently represent a linear, branched or cyclic, saturated or unsaturated C _1-24 alkyl radical or C _5-20 aryl radical, and where these radicals may optionally be substituted with halogen, hydroxy , C _1-4 alkoxy, C _1-4 alkyl, nitro or cyano group. 3. The use according to claim 1, where the derivative of fumaric acid is selected from one or more monoalkyl esters of fumaric acid of the formula II

Where
- R ₁ represents a linear, branched or cyclic, saturated or unsaturated C _1-24 alkyl radical or C _5-20 aryl radical;
- A represents hydrogen, an alkali or alkaline earth metal cation, or a physiologically acceptable transition metal cation, and
- n is 1 or 2 and corresponds to valency A. 4. The use according to claim 1, where the fumaric acid derivative is selected from the group consisting of fumaric acid dimethyl ester, fumaric acid diethyl ester, fumaric acid methyl ethyl ester, methyl hydrofumarate, ethyl hydrofumarate, calcium methyl fumarate, calcium ethyl fumarate, magnesium methyl fumarate, magnesium zinc magnesium methyl fumarate, zinc ethyl fumarate, iron methyl fumarate and iron ethyl fumarate, and mixtures thereof. 5. The use according to claim 1, where the fumaric acid derivative is selected from one or more fumaric acid amides of the general formula III

,
Where
R _a represents OR ₃ or a D- or L-amino acid radical —NH-CHR ₄ —COOH linked via an amide bond, wherein R ₃ is hydrogen, a linear or branched, optionally substituted C _1-24 alkyl radical, a phenyl radical, or C _6-10 aryl or aralkyl radical and R4 is a side chain of a natural or synthetic amino acid; and
R _b represents a D- or L-amino acid radical —NH-CHR ₅ —COOH linked via an amide bond, where R _s is a side chain of a natural or synthetic amino acid that may be the same or different from R ₄ or a peptide radical of 2- 100 amino acids linked by an amide bond, where each amino acid may be the same or different. 6. The use according to claim 5, where the side chain of a natural or synthetic amino acid is selected from the group consisting of side chains of Ala, Val, Leu, Ile, Trp, Phe, Met, Tyr, Thr, Cys, Asn, Gln, Asp, Glu , Lys, Arg, His, Citrulline, Hcy, Hse, Hyp, Hyl, Orn, Sar, and Me-Gly. 7. The use according to claim 5, where R _a is the radical —OR ₃ , and R _b is the L-amino acid radical —NH-CHR ₅ —COOH or the peptide radical R ₅ , as defined in claim 6. 8. The use according to claim 1, where the fumaric acid derivative is a carbocyclic oligomer consisting of 2-10 fragments of fumaric acid, as repeating fragments, where the fragments of fumaric acid are obtained from monomers selected from the group consisting of fumaric acid, dialkyl fumarates, monoalkyl hydrofumarates , fumaric acid monoamides, fumaric acid diamides, monoalkyl monoamido fumarates and their salts and mixtures. 9. The use according to claim 2, where the alkyl radicals having 1-24 carbon atoms are selected from the group consisting of methyl, ethyl, p-propyl, iso-propyl, p-butyl, sec-butyl, tert-butyl, pentyl, cyclopentyl, 2-ethyl-hexyl, hexyl, cyclohexyl, heptyl, cycloheptyl, octyl, vinyl, allyl, 2-hydroxyethyl, 2- or 3-hydroxypropyl, 2,3-dihydroxypropyl, 2-methoxyethyl, methoxymethyl, 2-methoxypropyl, 3 -methoxypropyl and 2,3-dimethyl-sipropyl. 10. The use according to claim 3, where the alkyl radicals having 1-24 carbon atoms are selected from the group consisting of methyl, ethyl, p-propyl, isopropyl, p-butyl, sec-butyl, tert-butyl, pentyl, cyclopentyl, 2-ethylhexyl, hexyl, cyclohexyl, heptyl, cycloheptyl, octyl, vinyl, allyl, 2-hydroxyethyl, 2- or 3-hydroxypropyl, 2,3-dihydroxypropyl, 2-methoxyethyl, methoxymethyl, 2-methoxypropyl, 3-methoxypropyl and 2 , 3-dimethoxypropyl. 11. The use according to claim 1, where the drug is provided in a form suitable for oral, rectal, transdermal, dermal, ophthalmic, nasal, pulmonary or parenteral administration. 12. The use according to claim 11, where the drug is presented in the form of tablets, coated tablets, capsules, granules, solutions for drinking, liposomes, nanoparticles, nanocapsules, microcapsules, microtablets, pellets or powders and in the form of granules filled in capsules or sachets, microtablets filled into capsules or sachets, pellets filled into capsules or sachets, nanoparticles filled into capsules or sachets, or powder filled into capsules or sachets. 13. The use of claim 12, wherein the drug is in the form of nanoparticles, pellets or microtablets, which optionally can be filled in sachets or capsules. 14. The use according to any one of claims 12 or 13, wherein the solid oral dosage forms are provided with an enteric coating. 15. The use according to claim 1, where the drug contains an amount of the derivative (s) of fumaric acid, corresponding to from 1 to 500 mg of fumaric acid. 16. The use according to claim 1, where heart failure is left ventricular failure. 17. The use according to claim 1, where heart failure is a myocardial infarction. 18. The use according to claim 1, where heart failure is angina pectoris. 19. The use according to claim 1, where the derivative of fumaric acid is dimethyl fumarate.

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