TW200403988A - Use of inhibitors of the sodium/hydrogen exchanger for the treatment of thrombotic and inflammatory disorders - Google Patents
Use of inhibitors of the sodium/hydrogen exchanger for the treatment of thrombotic and inflammatory disorders Download PDFInfo
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- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
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Description
200403988 A7 _ B7 五、發明說明(1) 本發明係有關人類和動物樂品之細胞細/氫 交換劑(sodium/hydrogen exchanger)抑制劑的應 用,其可用於預防和治療血液溫韋伯氏因子·(ν〇η Willebrand factor)濃度上升所引起之急性或慢性 病症。並因而應用此抑制劑治療血栓形成及發 炎病症。 近年的臨床刚試驗已將納/氫交換劑(Nhe) 抑制劑做為預防心臟組織因灌注不足而導致急 性缺血死亡的最佳物質。NHE抑制劑之保護作 用包括因灌注不足而導致的全部傷害,其肇因 於心肌過度收縮的心律不整和心臟組織死亡的 功能暫失以及其所伴隨的永久損傷。 經濟部智慧財產局員工消費合作社印製 NHE抑制劑的作用機制對NHE活化所致急 性組織灌注不足而造成鈉離子灌流降低的急性 缺血病症極為重要’其因此而導致細胞内的酸 化。此延遲造成組織鈉離子過載。由於心臟組 織内之鈉離子及鉀離子成配對輸送,而避免心 細胞鈣離子過載而危及生命。 已知NHE抑制劑對中樞神經系統(CNS)具 有保護作用’其類似心臟對抗急性缺金狀態之 過程。急性灌注不足導致之病症會造成營養、 -3- 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988 A7 B7 五、發明說明(ο 氧氣或礦物質的供應缺乏。缺血對CNS造成的 傷害最明顯疋中框性的梗塞,例如中風。因 此,當於正常和健康血流之下ΝΗΕ抑制劑^此 急性狀態如預期無保護作用,其原因為心臟或 CNS組織並未產生急性缺血現象。 先前報告曾述及作用於凝血因子的許多物 質可中止凝血之連鎖反應。同樣地,目前發展 出的許多作用原理並非抑制血栓之形成,而是 溶化(溶解)該已形成的血塊。某些介入不同凝血 連鎖反應作用點的原理被應用於預防血栓形成 的藥物,例如維他命 Κ群衍生物[葉g昆 (phylloquinones)];因子 VIII 和因子 IX 產物; 例如乙醯柳酸、待匹力達(dipyridamole)和嗔氯 匹定(ticlopidine)之血小板凝集抑制劑;例如肝 素或類肝素(heparinoids)之抗凝金劑。 經濟部智慧財產局員工消費合作社印製 凝血連鎖反應可如下圖所示分成兩種路 徑,亦即分成内因性和外因性,此兩種路徑最 後相遇於 X因子之活化過程,而導致凝血酶 (thrombin)及其纖維素(fibrin)的產生: -4- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 A7 B7 五、發明說明(3) 内因性 外因性
XII-► Xlla VII + TF
Xa 血小板 凝集 凝血酶 經濟部智慧財產局員工消費合作社印製 X — 凝血酶原 纖維素原-►纖維素 圓表1 :凝血連鎖反應 該凝血抑制劑在做為治療用途時其作用不 得過強或過度完全,因其將抑制微創傷 (microtraumata)時維持生命所必需之微血塊 (microthrombi)及微凝集(microcoagulations)的形 成。由於無法準確控制凝血抑制作用,故不同 個体於不同的時間會呈現不同的反應,並且在 投藥過程中必需進行謹慎的監控。如果該小凝 血塊之形成過程被永久抑制時會造成大量出血 -5- 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公着) 200403988 A7 B7 五、發明說明(4) 的可能(血友病)。 目前已知市售抗凝血治療劑的缺點為易產 生出血性併發症的危險。此危及性命之出&最 常發生在高劑量血栓溶解治療的過程,例如, 在治療急性心肌梗塞或肺栓塞時。因此,亟需 一種即使在過量使用下亦不增加出血危險的治 療劑。 許多已知的抗凝血劑為作用於血小板 (platelet),即thrombocytes,並抑制其功能或活 性。内皮細胞在凝血過程中亦扮演重要角色。 例如,大部分内皮細胞可永久(組織性地)分泌凝 血所需之溫韋伯氏因子(vWF)進入循環血流以利 凝血過程的進行。大部分vWF為儲存於稱為 Weibel-Palade小体(WPB)之細胞質顆粒中,並 在需要時經内皮細胞的剌激而被釋出。如果内 皮細胞無法製造vWF並將其釋入血流中,則會 造成習知的遺傳性 vWF-有關疾病、v0n Willebrand-Jurgens徵候群,其特徵為血流不 止。 最近幾年才漸瞭解因血液中vWF濃度上升 導致的疾病,其例如包括,產生促進血凝及發 炎反應的傾向。因此,Kamphuisen等人根據其 -6- 本紙張尺度適用中國國家標準(CNS)A4規格(21〇 X 297公釐) 計 線 經濟部智慧財產局員工消費合作社印製 五、發明說明(5) 在VIII因子濃度上升和血栓形成的關 • ” [A"erioScler· Thr〇mb Vasc Bi〇i 21{5、 731 738 (2 001)]報告中的大量試驗而認為盔液 中vWF濃度上升和血栓形成疾病的發生率增加 有明顯的關連性。VIII因子和vWF形成凝血先 決條件所需之複合物。因此,血液中存在高濃 度溫韋伯氏因子(vWF)及vWF-結合因子VIII即 代表血检形成的高危險因子。然而,和穩定 VWF結合至VIII因子過程產生拮抗作用之抗血 栓形成劑亦具有其缺點,因為實質上抑制血凝 的結果其在過量時仍會造成不易止血的危險。 在尋找治療因血液中溫韋伯氏因子濃度上 升所造成急性或慢性疾病之有效化合物的2程 中,發現本發明化合物可抑制内皮細胞釋出溫 韋伯氏因子。本發明化合物可抑制於缺血中聚 積之大量pH-有關VWF的釋出。 在已知為約pH 7.4的正常血液pH值下中 vWF進行正常的組織性分泌,並且一部分儲存 於Weibel_paiade小体内,目前發現,當下 降時vWF的分泌產生延遲和減少的現象。當pH 再往下降時,包裹vWF之Weibel_Pa][ade小体的 外分泌作用受到更明顯的抑制。因此,在酸性 -7- 本紙張尺度«中國國家標準(CNS)A4規格(210 χ 297公爱) 200403988 A7 ___ B7 五、發明說明(6) 的環境中,Weibel-palade小体會大量增加因而 大量vWF被儲存於内皮細胞中,同時降低vWF 的分泌量。此可藉染色法之目視及vWF上?青液 的定量測定得到證明。pH明顯降至7以下的酸 性環境可發生於,例如,組織缺血時。等同於 再灌注狀態下之立即再鹼化及刺激内皮細胞之 後’其在數秒之内即再開始進行細胞外分泌, 因此淨空Weibel-Palade小体内物質而釋出大量 刖凝血酶原危險因子(prothrombotie risk factor) ° 除了 vWF之外Weibel_Palade小体亦儲存轉 膜蛋白血小板選擇素(P-selectin)(Wagner,D D 1993 ,Thromb. Haemost., 70 : 105 〜ll〇)。 P-選擇素位於囊泡膜(vesicle membme) 經濟部智慧財產局員工消費合作社印製 内’並且在囊泡融合(外分泌)之後被併入内皮細 胞的質膜内。意即Weibel-Palade小体在每次分 泌時不僅增加vWF的釋出,並且亦增加選擇 素於内皮細胞膜的表現。實例中顯示vWF分泌 於酸血症和其後之重灌注過程中(以酵素免疫分 析法定量測定)。同理,該定量測定亦可經由 Weibel-Palade小体之免疫螢光試驗加以證實。 因此,vWF的測定不僅為血栓形成(增加血小板 -8- 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988 A7 B7 五、發明說明(7) 的凝集)升高(增加VWF之分泌)或降低(減少 vWF之分泌)的趨勢指標,亦為P-選擇素於内皮 細胞膜升高或降低表現的直接指標。選秦素 做為白血球之錨錠,因此可啟動發炎反應 (Vestweber, D.? Blanks, J.E. 1999, Physiol. Rev., 79 · 181 〜213 ; Issekutz,A.C·,Issekutz,Τ·Β· 2002,Immunol.,168: 1934〜1939) 〇 其病理生 理學上意義已廣泛經由缺血/再灌注疾病、血栓 形成及動脈硬化症的證實(Massberg,S.等人, 1998,92 : 507 〜515 ; Kita,T·等人,2001, J㈣·从7·SW·,947 : 199〜2 05)。P-選擇素 除了做為發炎的指標及引發劑的意義之外,其 在癌症的擴散過程中(乂8^,入.,¥&11^3;^.1^· 經濟部智慧財產局員工消費合作社印製 2001,Braz· J· Aied· Bio!· Res· 34 ·· 71Λ 〜717)反各 種關節發炎中(關節炎)(Veihelmann,Α·等人,1999, M/c〜6 : 281 〜290 ; Mclnnes,Ι·Β·等 人,2001,J· Immunol·,167 : 4075 〜4082)亦具有 重要角色。因此,此處所述物質之作用模式亦 可做為治療全部上述P-選擇素-相關疾病的治療 劑。 因此本發明係有關以鈉/氫交換劑抑制劑用 於製造預防及治療血液中vWF濃度上升所導致 -9- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公复) 200403988 A7 B7五、發明說明(8)之急性和慢性疾病的藥物。本發明進一步係有關下列至少一種化合物 的應用。 經濟部智慧財產局員工消費合作社印製
-10- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 A7 B7 五、發明說明(9
本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 A7 B7 經濟部智慧財產局員工消費合作社印製 五、發明說明(10)
和/或上述化合物之立体異構形式和/或該等 形式以任何比例之混合物,和/或上述化合物生 理學上可接受之鹽類,其用於製造預防及治療 血液中vWF濃度上升和/或增加P-選擇素表現所 -12- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 A7 B7 五、發明說明(11) 導致之急性或慢性疾病的藥物。 本發明進一步係有關利用卡力波來 (cariporide)
用於製造預防及治療血液中vWF濃度上升 和/或增加P-選擇素表現所導致之急性和幔性疾 病的藥物。
上述為習知之化合物,並且可依下列所述 之方法製備,例如,EP 〇 416 499、EP 〇 556 673、EP 0 589 336、EP 0 622 356、EP 〇 699 666、EP 0 708 088、EP 0 719 766、EP 0 726 254、EP 0 787 728、EP 0 972 767、DE 經濟部智慧財產局員工消費合作社印製 19529612、DE 19601303、W0 99 00379 或 T· Kawamoto 等人, 以一種新穎胍胺 (aminoguanidine)衍生物T-162559製造具效力及 選擇性抑制作用之人類鈉/氫交換劑的同分異構 物 NHE1,五以尸· j. 420(2001),1 〜8 〇 上述化合物為一定合成比例之非鏡像異構 物和鏡像異構物的混合物,在選擇性對掌載体 -13- 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988 A7 五、發明說明(12) 材料上藉色層分析法將其分離成純立体異構 物’如果上述外消旋化合物能形成鹽類時,亦 了藉以光干'舌性驗或促酸(acid as aid)所形氣之 非鏡像異構物鹽的分步結晶分離出其純立体異 構物。藉薄層或管柱色層分析法分離鏡像異構 物之適當對掌穩定相(chiral stationary phases)的 實例為改良石夕膠載体(silica gel supports)(即所謂 Pirkle phases)及高分子量碳水化合物,例如三 乙酿基纖維素(triacetylcellul〇se)。經熟習本技 藝者的適當衍生化之後,對掌穩定相上之氣相 (gas)層析法亦可被做為分析之用途。分離外消 旋魏酸之鏡像異構物時,利用例如市售之㈠终 驗、(+ )和㈠笨乙胺、奎寧鹼' L_離胺酸或l•和 D-精胺酸之光學活性鹼形成不同溶解度的非鏡 像異構物鹽’溶解度較低成分被分離成固体, 較易溶解的非鏡像異構物沈積於母液,而依此 方法從非鏡像異構物中得到純鏡像異構物。亦 可依相同原理將式I中含例如具有(+ )-樟腦_1〇_ 磺酸、D-和L-酒石酸、D-和L-乳酸及(+ )和㈠· 本乙醇酸之光學活性酸胺基的驗基外消旋化合 物轉變成純鏡像異構物。含乙醇或胺功能的對 掌化合物亦可被適當地孕化或被N•保護純鏡像 -14- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 計 綠 經濟部智慧財產局員工消費合作社印製 200403988 A7 B7 13 五、發明說明 異構胺基酸轉換成對應之酯或醯胺,或相反地 以羧基-保護純鏡像異構胺基酸將對掌羧酸轉換 成酿胺,或以例如乳酸之純鏡像異構羥基羧酸 轉換成對應之不對稱酯(chirai esters)。可利用 鏡像異構物中胺基酸或乙醇殘基的不對稱性 (chirality)藉分離於適當穩定相上之分步結晶或 色層分析所取得的非鏡像異構物而分離其異構 物,然後藉適當方法除去其所含的對掌部分。 上述化合物之酸性或鹼性產物可依其鹽或 游離的型式存在。其以醫藥學上適合之鹽較 佳,例如,鹼金屬或鹼土金屬鹽、或鹽酸化 物、氫溴化物、硫酸鹽、半硫酸鹽、全部適合 之填酸鹽、及胺基酸鹽、天然鹼或羧酸。 經濟部智慧財產局員工消費合作社印製 以本身習知的方法從可形成鹽之上述化合 物製備其生理學上可接受的鹽類,包括其立体 異構物。具有鹼性反應劑的羧酸和氫氧氨酸型 式為例如氫氧化物、碳酸鹽、碳酸氫鹽、醇鹽 (alcoholates)及氨或有機驗,例如三甲基_或三乙 基胺、乙醇胺或三乙醇胺或其他鹼性胺基酸, 例如離胺酸、鳥胺酸或精胺酸、穩定驗金屬、 驗土金屬或選擇性取代銨鹽。雖然上述為具有 鹼性基之化合物,但亦可利用強酸製備其穩定 -15- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公爱) 200403988 A7 B7 五、發明說明(14 酸加成鹽類。適合之無機和有機酸為例如,氫 氣酸、氫溴酸、硫酸、磷酸、甲磺酸、苯磺 酸、P-曱笨績酸、4-溴苯磺酸、環己基胺磺•酸、 三氟甲基磺酸、醋酸、草酸、酒石酸、琥珀酸 或三I酷酸。上述化合物中以甲磺酸鹽最佳。 上述化合物由於其藥理學上的性質,故適 合預防及治療血液中vWF濃度上升和/或增加p_ 選擇素表現所導致之急性或慢性疾病。 言 這些疾病包括缺企及其後再灌注引起之血 拾形成病症;例如急性心肌、腸繋膜血栓症或 其他腦血管梗塞;外科手術過程中或後發生的 血栓形成病症;肺栓塞;長期限制血液流動後 所造成之高發生率深靜脈栓塞,其最常發生於 下肢’例如在長期臥或坐之後;以及缺血及其 後再灌注引起之發炎病症、血管炎期間(例如, 伴隨自体免疫疾病或結缔組織疾病)。 經濟部智慧財產局員工消费合作社印製 這些疾病亦包括因P-選擇素表現增加所引 起的疾病,例如,初期發炎反應;亦可預防和 治療動脈硬化症;以及預防和治療癌症;亦可 做為例如風濕性關節炎之關節發炎和關節性疾 病的治療。 ' 本發明藥物之投與可經由口、吸入、 息腸 -16- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988
或經皮或經由皮下、顎關節内、腹膜内或靜脈 注射。其中以口服投與較佳。 本發明亦係有關製造該藥物之過程,莫包 括以醫藥學上適合及生理學上可接受之載体製 成至少含上述一種化合物的藥劑,以及適當時 可加入適合之活性成分、添加劑或賦形劑製成 適當的劑型。 上述化合物可混合適當的添加物,例如, 載体、定定劑或惰性稀釋劑,以及藉習知的方 法製成適合的劑型,例如,錠劑、包覆錠劑、 兩片膠囊、水溶液、酒精或油性懸浮液,或水 性或油性溶液。可使用之惰性載体的實例為阿 拉伯膠、氧化鎂、碳酸鎂、磷酸鉀、乳糖、葡 萄糖或澱粉,特別是玉米澱粉。可製備成乾顆 粒或濕顆粒。適合之油性載体或溶劑的實例包 括植物或動物油,例如,葵花油或魚肝油。 經濟部智慧財產局員工消費合作社印製 做為皮下、腹膜内或靜脈注射時該活性化 合物可製成✓谷液、懸洋液或乳劑,需要時可力 入例如增溶劑'乳化劑或其他職形劑。適合2 溶劑的實例為生理鹽水或酒精,例如,乙醇、 丙醇、甘油,以及例如葡萄糖或甘露糖醇之糖 溶液,或上述各種溶劑之混合物。 -17- 本紙張尺度適用中國國家標準(CNS)A4規格(210 x 297公釐) 200403988 A7 五、發明說明(16) ,亦可使用習知的調理劑,例如載体、分解 =β齊丨、包覆劑、膨脹劑、滑動劑或潤滑 劑調味劑、甜味劑和增溶劑。最常使用岛賦 形劑為碳酸鎮;二氧化鈦;乳糖;甘露糖醇及 其他糖類’滑石粉;乳蛋白質;凝膠;澱粉; 纖維素和其之衍生物;動物和植物油,例如魚 肝油、葵花油、花生油或芝麻油;聚乙二醇和 命劑,例如滅菌水和一元醇及例如甘油之多元 醇。 經濟部智慧財產局員工消費合作社印製 上^化合物以製成劑量單位之醫藥產品較 佳,其每單位中含固定劑量的式〗化合物。其口 服投與劑量為從0·01毫克/公斤/天至25 〇毫克/ 公斤/天,以從0·01毫克/公斤/天至5 〇毫克/公 斤/天較佳,非經口的投與劑量為從〇 〇〇1毫克/ a斤/天至5·〇毫克/公斤/天,以從〇〇〇1毫克/ 么斤/天至2 · 5毫克/公斤/天較佳。嚴重病例中亦 可增加其劑量。然而,在許多病例中較低劑量 亦即足夠。其投與對象之成人体重約為75公 斤。 上述化合物可單獨使用,或結合抗凝血 劑、血小板凝集_抑制劑或纖維蛋白分解劑共同 使用。共同投與之藥劑可為例如,xa因子抑制 •18- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公爱) 200403988 A7 B7 五、發明說明(17) 劑;標準肝素;低分子量肝素,例如依諾肝素 (enoxaparin) '達肝素(dalteparin)、色卓肝素 (certroparin)、帕納肝素(parnaparin)或亭扎奸素 (tinzaparin);直接凝血酶抑制劑,例如水蛭素 (hirudin)、阿司匹靈(aspirin)、纖維素原受体拮 抗劑、鏈球激酶(streptokinase)、尿激酶 (urokinase)和/或組織血漿蛋白原活化劑(tPA)。 已知鈉/氫交換劑抑制劑可影響金小板之凝 集和具有黏著-抑制效果[請看Rosskopf,Dieter, J· Thromb· 1999),8( 1 ),1 5〜23 ;或
Nieuwland, Rienk ; Akkerman, Jan-Willem Nicolaas. ddv· Mo/· 〇// Sh/· (1997),18(血小 板),353〜366。 比較先前所述對血小板凝集作用的影響, 經濟部智慧財產局員工消費合作社印製
t I
上述化合物亦顯示可抑制過量釋出之vWF因 子。此新穎之抗血栓形成作用原理和先前揭示 之抗血栓形成作用原理比較的關鍵及優點為: a) 在其後的再灌注期中僅作用於缺血組 織,同時其他細胞完全不受局部缺血(缺 血前期)的影響,以及 b) 在溶血治療過程中不需擔心造成任何出 血性併發症的危險。 -19- 本紙張尺度適用中國國家標準(CNS)A4規格(210 χ 297公麓) -一 — 200403988 A7 B7 經濟部智慧財產局員工消費合作社印製 五、發明說明(18 本發明藉由下列實例做更詳細的說明。 下列實例說明細胞外酸血症(pHex=6.4)的影 響,以及上述本發明化合物對細胞内ρΗ(ρΙ^)及 對溫韋伯氏因子(VWF)釋出的影響。全部之實例 均採用人類臍靜脈内皮細胞(HUVEC)。其包括 分離自臍靜脈的初代組織培養細胞。 下列實例之細胞在第一次繼代後培養於膠 化玻璃皿(細胞内質子濃度之測定)或細胞培養皿 (12-孔培養皿,Falcon,美國紐約;vWF釋ψ 35之測 定)。 0- -2 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 Α7 Β7 五、發明說明Ο) 實例1 細胞内pH之測定 以pH-敏感螢光染色劑BCECF-AM[2,,7’-雙-(羧基乙基)-5(6)-狻基榮光黃]測定細胞内質子之 濃度(pH,)和人類臍靜脈内皮細胞(HUVEC)。其 後之螢光測量為利用 DeUascan螢光光度計 (PTI,漢堡)。此測量大致上包括一具紫外線光 源、一個單色光鏡、一台光子型探測器(photon detector)及 Felix 和 Oscar 應用軟体(PTI,漢堡) 以經由電腦控制該系統。在以波長439.5納米 (pH-無關)和490納米(pH-敏感)交替激發之後, 測得發射 BCECF的比例以及經計算後的 pH 值。在連續灌注過程中,控制系統内之溫度和 二氧化碳分壓參數以進行細胞之測定。再灌注 的模擬試驗中,藉系統吹氣和灌流液將其條件 設定在37°C及5%或10%之二氧化碳分壓。 經濟部智慧財產局員工消費合作社印製 在試驗中為了模擬呼吸代謝性酸血症,以 pHex 6·4之碳酸氫鈉緩衝液初步預灌注60分 鐘。然後將該初步灌注液改變為含1 〇微莫耳 (μΜ)組織胺之pH 7·4碳酸氫鈉緩衝液以模擬再 灌注實況。 以再灌注緩衝液中加入10微莫耳之ΝΗΕ抑 制劑卡力波來的試驗和上述控制試驗進行比 -21- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 盘一L·至少維持15分鐘之細胞外酸血症[pI^(酸 血症)]及控制條件下(C〇)的細胞内ppj值 表1 : pHh(酸血症) 6·53± 0.02(平均士 SEM) pHi(Co) 7·23± 0·02(平均土 SEM) 經濟部智慧財產局員工消費合作社印製 A7 B7 五、發明說明(20 ) 較。 其試驗結果摘錄於表1和2。 3 局距離平均值之標準偏差 細胞外酸血症將導致細胞内隨酸血症而維 持的酸化作用。此細胞内酸性p Η實際上等於細 胞外pH(施予pHex=6,4之細胞外酸血症)。 4_1 :含卡力波來(HOE)之緩衝液以及含對照緩 衝液(Co)的再灌注試驗。試驗中重灌注後最初 30秒期間造成酸血症60分鐘後升高p%的最初 速率。 表2 : pH升高速率[ΔρΗ/分1 各別之試驗 平均± SEM Co 0.97 〇.97± 〇·〇4 1.04 0.89 0.88 1.07 HOE 0.30 〇·27± 0.02 0.24 0.23 0.34 0.24 -22- 本紙張尺度適用中國國家標準(CNS)A4規格(210 x 297公爱) 五、發明說明(2〇 田、、、田胞外pH從6.4變成7.4時,其細胞内 pH之升高速率為對照組的3 6倍。因此,在重 灌注期間可利用卡力波來明顯降低其再鹼把速 率。 實例2 重灌注後vWF釋放之測定 此測定於希拉化希拉細胞(Heraeus Heracen) 培養箱中進行。此可於控制之生理環境下7 溫度’ 100°/。相對濕度,二氧化碳分壓恒定於5%) 计鼻腾靜脈内皮細胞,並且可確保不同細胞培 養基之快速變化。 該細胞最初以酸性培養基(ρΗ 6·4含下列成 分:培養基Μ199中含Earle’s和胺基酸,含L- 麩隨胺酸,不含碳酸氫鈉,不含Hepes + 〇.084克 碳酸氫鈉/每升)或pH標準培養基(pH 7.4含下列 成分··培養基M199中含Earle’s和胺基酸,含 經濟部智慧財產局員工消費合作社印製 L-麵醯胺酸’不含碳酸氫納,不含Hepes+2.200 克碳酸氫鈉/每升)培養1、3或48小時。再開始 重灌注前,取上清液樣本在酸性條件下 (vWFacidosis)及控制條件下(vWFe。)測定其vWF濃 度。模擬重灌注時’換成添加10微莫耳Ν Η E抑 制劑卡力波來之pH 7.4培養基(成分··培養基 -23- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988
M199 t含Earle,s和胺基酸,含L_麵醯胺酸, 不含碳酸氫鈉,不含Hepes + 22⑻克碳酸氫鈉/ 每升+1〇微莫耳組織胺)。換成不添加抑制劑之 培養基做為對照。 Γ 取上清液樣本測定其vWF濃度。其測定方 法為利用特定抗体的酵素免疫分析法(酵素連結 免疫及附试驗)。利用國際標準(第二國際標準 8 7/718 ;英國倫敦國家生物製劑標準與管制)計 算標準人類細胞質之VWF含量(德靈,馬堡)。 計 產_^· ·培養1 5分鐘後測定賤性下細胞上清液内 (vWFacidosis)及對照條件下(vwFc。)的VWF濃度。 對照條件下之vWF濃度設定為1〇〇〇/。。 表3 : vWFC0 - 100% vWFacidosis(组織) 46± 1.1% vWFaeidcsis(模擬,组織胺50微莫耳) 52± 2.5% — 線 經濟部智慧財產局員工消費合作社印製 組織性分泌及模擬Weibel-paiade小体分泌 中,酸血症可明顯降低vWF之分泌。酸血症 (pHex=6.4)期間VWF之分泌明顯較對照細胞降低 至約1/2。
表A :模擬試驗的10分鐘重灌注期間測定vWF 的分泌。對照細胞之vWF分泌(VWFC。)設定為 -24- 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐) 200403988 A7 B7 五、發明說明(23 ) 1 〇〇%。預酸化細胞之重灌注期間的vWF濃度 (vWFacidosls)及加入1〇微莫耳卡力波來之預酸化 細胞重灌注期間的vWF濃度(vWFhm)和對裉之 值的比較。 表4 : VWFCft - 100% VWFC0 + hoe 1〇6± 3.0% vWFacidosis 193± 8.0% vWFhoe 139± 16% 重灌注期間含卡力波來之對照細胞 (vWFco+HOE)其vWF分泌大量增加為2倍。以卡 力波來阻斷NHE可減少vWF分泌的增加幾乎達 6 0 /〇,並且因此接近對照值。含卡力波來(1 〇微 莫耳)之對照細胞顯示其VWF分泌無增加或減少 的現象。 經濟部智慧財產局員工消費合作社印製 此實例顯示缺血期間之細胞外酸血症可導 致細胞内酸血症,其造成vWF分泌的減少(組織 性和剌激性),並且降低P-選擇素的表現。其後 内皮細胞的再灌注和剌激可迅速使細胞内再驗 化。同時大為增強vWF之分泌和P-選擇素的表 現。以卡力波來延遲其再鹼化將降低vWF分泌 和P-選擇素表現的增加,而因此可預防血栓的 形成及發炎的反應。此實例顯示細胞外pH決定 -25- 本紙張尺度適用中國國家標準(CNS)A4規格(21〇 χ 297公釐) 200403988 A7 B7 五、發明說明(24) 細胞内之pH。内皮細胞之分泌決定於細胞内之 pH。因此,可藉抑制再鹼化使重灌注期之習知 内皮細胞活化作用大為降低,以及減少和其有 關之血栓形成(vWF分泌)及發炎反應的顧慮。卡 力波來顯示對健康之無酸化對照培養細胞並無 影響。此意味著較無發生副作用的顧慮,以及 可避免因投藥過量而造成不易止血的困擾。本 藥劑僅在缺血狀況下才發生作用。 經濟部智舊財產局員工消費合作社印製 本紙張尺度適用中國國家標準(CNS)A4規格(210 X 297公釐)
Claims (1)
- 200403988 8 8 8 8 ABC Di 夂、申請專利範圍 1 · 一種以納/氫交換劑抑制劑製造預防和治 療急性或慢性病症之藥物的應用,該病症導因 於血液中溫韋伯氏因子的濃度上升和/或P-趣擇 素(P-select in)表現增加。 2 ·如申請專利範圍第1項之應用,其中至 少使用下列一種化合物做為鈉/氫交換劑之抑制 劑0經濟部智慧財產局員工消費合作社印製ΝΗ Ν Η Ν Η Ν 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988 六、申請專利範圍本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988 A8 B8 C8 D8 經濟部智慧財產局員工消費合作社印製 六、申請專利範圍和/或上述化合物之立体異構形式和/或該 等形式以任何比例之混合物’和/或上述 化合物生理學上可接受之鹽類。 3·如申請專利範圍第1或2項之應用,其 中卡力波來(cariporide) -29 - 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988,88 8 81 A B c Dο νη2 被做為鈉/氫交換劑之抑制劑。 4·如申請專利範圍第1至3項中一項或多 、應用其中該病症為缺血及其後再灌注引 起之血板形成病症;例如急性心肌、腸繫膜血 栓症或其他腦血管梗塞;外科手術過程中或後 發生的血栓形成病症;肺栓塞;長期限制血液 流動後所造成之高發生率深靜脈栓塞,其最常 發生於下肢,例如在長期臥或坐之後;以及缺 血及其後再灌注引起之發炎病症;例如伴隨自 体免疫疾病或結締組織疾病之血管炎期間·或 初期發炎反應·,預防和治療動脈硬化症;預防 和治療癌症或治療關節發炎和關節性疾病,例 如,風濕性關節炎。 經濟部智慧財產局員工消費合作社印製 5 ·如申請專利範圍第丨至4項中一項或多 項之應用,其中申請專利範圍第1至3項中述 及之化合物可結合抗凝血劑、血小板凝集-抑制 劑或纖維蛋白分解劑使用。 6 ·如申請專利範圍第5項之應用,其中該 化合物可共同投與Xa因子抑制劑;標準肝素; -30 - 本紙張尺度適用中國國家標準(CNS)A4規格(21〇 x 297公麓) "— 200403988 A8 B8 C8 --- -JD8_______ 六、申請專利範圍 低分子量肝素’例如依諾肝素(en〇Xaparjn)、達 肝素(dalteparin)、色卓肝素(certr〇parin)、帕納 肝素(parnaparin)或亭扎肝素(tinzaparin) ; 1 接 凝血酶抑制劑,例如水經素、阿司匹靈、纖維 素原受体拮抗劑、鍵球激酶、尿激酶和/或組織 血毁蛋白原活化劑。 7·如申請專利範圍第1至6項中一項或多 項之應用,其中該藥物之投與可經由口、吸 入、直腸或經皮或經由皮下、顎關節内、腹膜 内或靜脈注射。 經濟部智慧財產局員工消費合作社印製 本紙張尺度適用中國國家標準(CNS)A4規格(210x297公釐) 200403988 (一) 、本案指定代表圖爲:第_圖(無) (二) 、本代表圖之元件代表符號簡單說明·· 益 4 本案若有化學式時,請揭示最能顯示發明特徵的 化學式:
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