TW201338781A - Heparin composition for the decrease in allergic sensitization and airway inflammation - Google Patents

Abstract

The present invention relates to a pharmaceutical composition for the decrease in airway allergic sensitization and inflammation. The composition comprises heparin of different molecular weight, including the heparin and enoxaparin. We found daily intranasal use of heparin or enoxaparin exerts a long term effect on airway allergic inflammation, especially bronchial asthma. In the mite-induced airway allergic inflammation in BALB/c model, the heparin and enoxaparin can decrease serum mite-specific IgE level, cytokines in lung protein extract, peribronchial and alveolar pathology inflammatory scores and airway hyperreactivity. So, the composition can be used to decrease airway allergic inflammation and modify the atopy sensitization.

Description

Heparin is used to reduce allergic sensitization and airway inflammation

The present invention relates to the use of heparin for the treatment or prevention of allergic airway inflammation, especially chronic airway inflammation. The invention relates in particular to the use of heparin for the prolonged treatment or prevention of asthma.

Asthma is a fairly complex syndrome that can have many different clinical manifestations in adults and children. Its main features include various degrees of airway obstruction, excessive bronchial sensitivity, and airway inflammation. Recent studies have found that there is a sustained inflammatory response in the bronchial slices of asthmatic patients, which occur in the central and peripheral airways and vary with the severity of the disease. In patients with mild to moderate asthma, exfoliation of the airway epidermis, collagen deposition under the basement membrane, release of granules by obese cells, and infiltration of lymphocytes and eosinophils into the airways were observed. Many cells in the airways have been shown to be activated, suggesting that these released and acting or newly synthesized cellular mediators have a direct impact on asthma.

When an allergic person first comes into contact with an allergen, the allergen will run to the airway and stimulate the plasma cells to produce a lot of IgE antibodies (this allergic reaction does not occur in normal people). These IgE antibodies will Linked to mast cells, these mast cells are distributed next to the airway. Once the aforementioned allergic reaction begins, when the individual encounters the same allergen again, the antigen binds to the IgE antibody on the mast cell, and then opens the channel on the mast cell, releasing some cellular mediators, such as histamine, Eosinophilic white blood cell attracting factor, etc., promotes the contraction of smooth muscle and increases the secretion of mucous glands, thus causing acute airway contraction. Then, the medium such as leukotriene and eosinophilic leukocyte attracting factor will attract all the eosinophilic white blood cells to the airway after 6 to 8 hours, causing late reaction and chronic airway inflammation. This inflammatory response can cause recurrent wheezing, difficulty breathing, chest tightness, and coughing at night or early morning in patients with sensitive constitution. These symptoms often combine with extensive and varying degrees of respiratory airflow blockage, which can usually be fully recovered, or at least partially restored, by itself or after treatment. In addition, the inflammatory response also increases the sensitivity of the airway to stimulation.

Risk factors for asthma include two factors: factors that form asthmatic factors and factors that induce asthma attacks. The former is divided into predisposing factors (such as atopic physique, gender), causal factors (such as various indoors, indoor allergens, aspirin, sensitizers in the workplace), and contributing factors ( Contributing factors, such as respiratory infections, underweight at birth, food, air pollution, second-hand smoke, etc. The true cause of asthma is uncertain, but it is certainly caused by a combination of risk factors. Avoiding these risk factors and preventing the formation of asthmatic conditions is called primary prevention. Once the asthmatic constitution is formed, primary prevention is no longer feasible, and prevention must be directed to avoid exposure to induced factors that cause disease progression. Causes of asthma include allergens, air pollution, respiratory infections, exercise and hyperventilation, sulfur dioxide, food additives, medications, and mood changes. This prevention work is called secondary prevention.

In recent decades, treatment with asthma has emphasized long-term inhibition of inflammatory responses, with short-acting bronchodilators (primarily spray-type beta-sympathetic stimulants). Inhaled steroids are most effective in controlling asthma symptoms and improving lung function, but their potential side effects are still worrying, patient acceptance is poor, and new drugs other than steroids are needed for refractory asthma. Additional long-acting type B sympathetic stimulants, theophylline and leukotriene antagonists, etc., have been shown to help with asthma control and to reduce inhaled steroids to the minimum required dose. However, whether used alone or in combination with other treatments, steroids do not necessarily stop the airway inflammation in asthmatic patients. Therefore, other methods that can modulate immunoglobulin E (IgE antibody)-related immunoinflammatory responses continue to be used or developed. In early clinical studies, this antibody attenuated early and late respiratory obstruction induced by allergens and inhibited the accumulation of eosinophils in the respiratory tract. Later studies also found that regular intravenous administration of this preparation was more helpful for patients with moderate to severe asthma than for the control group, and clinically found to significantly reduce the dose of oral and inhaled steroids. These therapeutic effects show that allergic inflammatory reactions play an important role in the physiology and pathology of many asthmatic patients.

The granule protein ECP of eosinophilic leukocytes has been confirmed by studies, which has a great influence on asthma by binding with heparin or heparan sulfate (HS). Previous studies have focused on acute airway stimulation by stimulating animal models with allergens, antigens, or platelet activating factors (PAF), and 5 to 2 hours before the tracheal administration of stimuli. Single intravenous injection; or single/multiple heparin inhalation. Although most experiments have confirmed that heparin treatment does reduce airway inflammation/injury, including infiltration of eosinophilic leukocytes, however, previous trials focused on short-term use of heparin and did not reveal the use of heparin in the medium to long term for allergies. The protective effect of airway inflammation.

Republic of China Patent No. 585771 discloses a pharmaceutical composition for treating asthmatic dual reactions, particularly for treating bronchoconstriction or airway hyperreactivity caused by delayed allergic reactions, characterized by the use of ultra low molecular weight heparin (ULMWH) To prevent and improve the symptoms of delayed asthma. In the patent, the ultra low molecular weight heparin used has an average molecular weight of about 1,000 to 3,000 Daltons, and the aforementioned ultra low molecular weight heparin is presented for the late onset (allergen) by measuring lung gas resistance and airway reactivity. The effect of airway allergy after 8 hours of stimulation. The patent document also states that traditional heparin and medium or low molecular weight heparin (molecules greater than 3,000 Daltons) are administered prior to antigen challenge, although they can inhibit airway hyperreactivity (AHR) in acute responders, but in suppressing double responders There is no meaningful effect on late response and AHR.

Thus, the present invention is directed to the use of heparin drops for medium and long-term use to improve the effects of tracheal sensitivity, plasma allergic globulin E, pathological changes, and inflammatory substances in lung proteins in experimental animals, and to evaluate macromolecular heparin and small molecules. The effect of heparin on reducing the inflammatory response of the airway further completes the present invention.

The present invention relates to a pharmaceutical composition for treating or preventing allergic airway inflammation in the medium and long term, comprising heparin and a pharmaceutically acceptable carrier, diluent or excipient, wherein the heparin is selected from the group consisting of large molecular weight heparin and low molecular weight heparin .

In a specific embodiment of the invention, the aforementioned pharmaceutical composition can be used to treat or prevent asthma. In another embodiment of the present invention, the pharmaceutical composition is for reducing inflammatory factors in the lungs of an allergic patient and reducing the inflammatory response.

In other specific embodiments of the invention, the aforementioned pharmaceutical composition can be used to reduce allergic globulin E in the plasma of an allergic patient. In another embodiment of the invention, the aforementioned pharmaceutical composition can be used to improve allergies.

The specific terms used in the present invention have their original meanings, and certain specific terms are used as follows to provide those skilled in the art to further understand the present invention. For convenience, some special terms will be indicated in italics or quotation marks, but these marked parts will not affect the scope or meaning of the special terms themselves.

Unless otherwise specified, the vocabulary used in the science and technology of the present invention is the same as the vocabulary used in the general general skill. If there is a conflict, the present invention will give a new definition of the noun.

The term "heparin" as used in the present invention means a mucopolysaccharide sulfate composed of D-glucosamine, L-iduronic acid, N-acetylglucosamine and glucuronic acid alternately, wherein the sulfate accounts for 40%. Traditional heparin is currently extracted from pigs, bovine intestinal mucosa and lungs. "Heparin" used in the composition of the present invention includes "large molecular weight heparin" and "low molecular weight heparin", wherein "large molecular weight heparin" means conventional heparin having a molecular weight ranging from 3,000 to 30,000 Daltons and an average molecular weight of about 12,000. It is around 15,000 Daltons. "Low-molecular weight heparin" refers to a product obtained by cleavage of a polysaccharide chain of a conventional heparin by an enzyme or a chemical method, having a molecular weight of between about 1,000 and 10,000 Daltons and an average molecular weight of about 4,500 to 5,000 dol. Around.

In a first aspect of the invention, an effective amount of a pharmaceutical composition of the invention is administered by inhalation to treat or prevent moderate to long-term allergic airway inflammation. Additional doses may be administered after antigen challenge as needed (eg, doctor's advice) to reduce the extent to which patient airflow resistance is affected.

In a second aspect of the invention, a chronic asthmatic patient is administered chronically to an effective amount of a pharmaceutical composition of the invention to reduce and inhibit the production of allergic globulin E (IgE) and pro-inflammatory substances. By "medium and long-term administration", it is meant that a pharmaceutical Dalton composition comprising a therapeutically or prophylactically effective amount of heparin is administered at least for ten consecutive days, preferably for at least twenty consecutive days.

A heparin composition for formulating an inhalant (bronchial) suitable for long-term treatment or prevention of allergic airway inflammation in the present invention, which may be a liquid or powder composition containing an effective amount of heparin, and is suitable for formulation for gasification and bronchi The aerosol composition is administered internally or dispersed in a dosed dose via an aerosol unit.

Suitable liquid compositions comprise, for example, a solution of an effective amount of heparin in a pharmaceutically acceptable inhalant solution, such as isotonic saline or sterile water. The solution can be administered by a pump or squeeze-motorized atomized spray disperser, or in any other manner, to allow the desired dose of liquid composition to be inhaled into the lungs of a human or mammal.

Suitable powder compositions include heparin powder preparations which are completely mixed with an inert powder which is acceptable for lactose or other intrabronchial administration methods. The powder composition can be administered by means of an aerosol dispenser or by means of a device in which the patient can be inserted into a device capable of puncturing the capsule to expel a breakable capsule suitable for inhalation of a steady stream of air.

Aerosol formulations useful in the present invention typically include fluorinated hydrocarbon propellants, surfactants, and co-solvents that can be filled into aluminum containers or other general aerosol containers, followed by appropriate metering valves and propellants. Pressurization is closed to obtain a metered dose inhaler (MDI).

Example

The other features and advantages of the present invention are further exemplified and illustrated in the following examples, which are intended to be illustrative only and not to limit the scope of the invention.

experimental method animal

A total of 44 male BALB/c mice (6-8 weeks old) were purchased from the National Experimental Animal Center (Nangang, Taipei, Taiwan). Feeding normal commercial feed and drinking water during animal feeding. The experimental mice were divided into six groups: (1) control group (n=10), no treatment was given; (2) intratracheal dust mite stimulation (mIT), (n=10); (3) first To 22 days of nasal drop heparin group (hIN+mIT), (n=12); and (4) day 1 to 22 nasal drop low molecular weight heparin group (lmwhIN+mIT), (n=12). Animal use and operational procedures were reviewed and approved by the Taichung Institutional Animal Care and Use Committee (IACUC Approval No: La-95279).

Preparation of dust mite allergen protein

The crude extract of Dust mites Der p was purchased from Greer Lab (Lenior, NC, USA). Dust mites were isolated from the crude extract obtained using a glass-glass homogenizer (Kontes Glass, Vineland, NJ, USA) in phosphate buffered saline (PBS). The concentration of dust mite protein was then determined using the Bradford program (Bio-Rad Protein Assay; Bio-Rad, Hercules, CA, USA).

Induction of tracheal inflammation in experimental mice by dust mite allergen protein

All animals receiving mIT (animals of groups 2, 3, and 4) were immunized on day 1 with dust mite crude extract allergen, subcutaneously injected with 50 μl solution (containing 40 μg of dust mite extract protein in PBS). (25 μl), thoroughly mixed with complete Freund's adjuvant (25 μl). Then, on the 8th day, the above 50 μl of the solution was subcutaneously injected again. On day 15, the mice were intraperitoneally administered with 10 μg of dust mite extract (5 mg/ml) under anesthesia for allergen intratracheal stimulation. Groups 3 and 5 were treated with heparin (50 IU) once daily from days 1 to 22, while animals of groups 4 and 6 received low molecular weight heparin (0.06 μg once daily) from days 1 to 22. ) Treatment, the method of administration by intranasal drip. All animals were tested for lung function on day 22; mice were sacrificed on day 23 and sub-venous blood, alveolar-tracheal irrigation and tracheal tissue samples were obtained from the experimental mice.

Pulmonary function test

Using Buxco Whole Body Plethysmography, a special and patented Chamber allows animals to monitor the lung function index Penh (Enhanced Pause) value in an unconstrained space to determine the pressure of the respiratory tract, with Penh values Can be used for research on airway hyperresponsiveness. In this experiment, mice were given Methacholine at 0, 6.25, 12.5, and 25 mg/ml for stimulation, and Penh changes at various concentrations of stimulation were evaluated.

Tissue sections

The tracheal tissue samples obtained after sacrifice of the mice were subjected to H&E tissue section staining, and the degree of inflammation was quantified by alveolar and tracheal inflammatory scores, which were described by the literature "J. Immunology, 2001, 167: 1769-1777". Inflammation score around the trachea. At the time of interpretation, 3 slide samples were taken and scored under 400 x observation, and the average score was the total score. In addition, the heart, kidney, spleen, liver and small intestine of each mouse were sent for pathological section to determine no bleeding and pathological changes in each organ.

Cytokine analysis of alveolar-tracheal irrigation

Using a protein extraction reagent ^{(PRO-PREP TM Protein Extraction Solution} , iNtRON Biotechnology, Gyeonggi-do, Korea),, to the Bradford assay procedure from the preparation of mouse lung tissue in lung tissue homogenate supernatant (lung tissue homogenate supernatant) Obtaining The total protein concentration contained in the supernatant was adjusted to a final protein concentration of 500 μg/ml using PBS.

In accordance with the ELISA assay procedures provided by the manufacturer of using a DuoSet mouse eotaxin, IL-17A / F kit (purchased from R & D systems (Minneapolis, MN , USA); and ^{BD OptEIA TM Set Mouse IL-5} , IL-10, IL -13, IFN-γ kit (purchased from BD Bioscience, San Jose, CA, USA), determination of eosinophil chemoattractant protein eotaxin, GM-CSF, IL-5, IL- in alveolar-tracheal rinse samples 6. Concentrations of IL-10, IL-13, IL-17A/F, TNF-α and INF-γ.

Experimental result

As shown in Fig. 1, in the animal model of simulated asthma used in this example, mice receiving mid- or long-term heparin or low molecular weight heparin administration (hIN+mIT and lmwhIN+mIT group) were started from the first day of the experiment. The Penh value of the lung function index measured after stimulation of Methacholine was lower than that of the animal (mIT group) administered with intratracheal dust mites, indicating that heparin or low molecular weight heparin was administered in the medium and long term, which effectively reduced the trachea for allergens. Sensitivity. Significant protective effect was obtained at the methacholine 12.5 mg/ml and 25 mg/ml stimulation (p<0.01).

Figure 2 shows the amount of immunoglobulin in the blood of the inferior vena cava of mice that were compared without (mIT group) and those receiving heparin (hIN+mIT group) or low molecular weight heparin (lmwhIN+mIT group). The results showed that mice receiving medium- or long-term heparin or low molecular weight heparin had specific plasma immunoglobulin IgG2a (Th1-related immunoglobulin) and IgE (Th2-related immunoglobulin) for dust mite allergens. There was a significant decrease in the control group without heparin administration, indicating that heparin or low molecular weight heparin was administered in the medium and long term, which was effective in reducing immunoglobulin in plasma, especially allergic E (IgE), which is extremely related to allergic reactions.

The results of the tracheal tissue section staining shown in Figure 3 further showed that the inflammatory fraction of the mice treated with heparin was significantly lower than that of the untreated mice, indicating that the pathological changes of mice administered with heparin or low molecular weight heparin were observed. progress.

Figure 4 shows the results of cytokines analysis in lung protein extracts, in which the concentration of eosinophil chemoattractant protein eotaxin was significantly reduced in mice receiving medium- and long-term low molecular weight heparin; The long-term heparin and low molecular weight heparin administration mice showed a significant decrease in the concentration of cytokines IL-5, IL-13, IL-17A/F, IL-10 and MMP-9. In the case of Eotaxin, only the low molecular weight heparin group was significantly reduced. It means that the treatment with medium or long-term heparin or low molecular weight heparin can effectively reduce the promotion of inflammatory substances in the lung protein of animals and reduce the inflammatory response.

The above experimental results prove that medium- and long-term heparin or low molecular weight heparin can be effectively used for treating chronic airway inflammation and improving allergies.

Other specific aspects

All of the features disclosed in this specification can be combined in any combination. Thus, the individual features disclosed in this specification can be replaced by alternative features that are the same, equivalent, or similar. Therefore, the various features disclosed are merely examples of a series of equivalents or similar features, unless otherwise clearly indicated.

From the foregoing description, those skilled in the art can readily determine the essential features of the invention, and various changes and modifications of the invention can be made to adapt to various different uses and conditions without departing from the scope thereof. Therefore, other specific aspects are included in the scope of patent application.

Figure 1 shows the Penh (Enhanced Pause) value of the lung function index monitored in an unconstrained space, with increasing values of Methacholine after increasing concentrations (0, 6.25, 12.5, and 25 mg/ml). Control group: no treatment, n=10; mIT: intratracheal dust mites stimulation, n=10; mIT+hIN: receiving intratracheal dust mites and intranasal heparin (50 IU) treatment, n= 12; mIT + lmwhIN: received intratracheal dust mites and intranasal low molecular weight heparin (0.06 μg) treatment, n = 12.

Figure 2 shows the results of measurements of immunoglobulins specific to dust mite allergens in the blood of inferior vena cava with or without heparin or low molecular weight heparin. (A) shows the OD450 absorbance of mite-specific IgE in serum; (B) shows the OD450 absorbance of dust mite-specific IgG2 in serum. The control group: no treatment was given; mIT: intratracheal dust mites stimulation; mIT+hIN: intratracheal dust mites and intranasal heparin (50 IU); mIT+lmwhIN: intratracheal dust mites And intranasal low molecular weight heparin (0.06 μg) treatment. (p<0.0001)

Fig. 3 shows the results of tissue staining of a tracheal tissue section sample after sacrifice of the mouse at the end of the experiment (on the 23rd day). (A) is the comparison of the inflammatory scores of the trachea in each group; (B) is the comparison of the alveolar inflammatory scores of each group. The control group: no treatment was given; mIT: intratracheal dust mites were stimulated; mIT+d1IN: intratracheal sputum stimulation and intranasal heparin (50 IU) treatment; mIT+d2IN: intratracheal dust mites stimulation And intranasal low molecular weight heparin (0.06 μg) treatment.

Figure 4 shows the results of cytokine analysis of alveolar-tracheal washings, (A) concentration of eosinophil chemoattractant protein eotaxin; (B) concentration of MMP-9; (C) concentration of IL-5; ) is the IL-13 concentration; (E) is the IL-17A/F concentration; (F) is the measurement result of the IL-10 concentration. In the control group, no treatment was given; mIT, only intratracheal dust mite stimulation; mIT+hN (or mIT+d1IN), intratracheal dust mite stimulation and intranasal heparin (50 IU) treatment; mIT+lmwhIN (or mIT+d2IN); received intratracheal dust mites and intranasal low molecular weight heparin (0.06 μg).

Claims (6)

A pharmaceutical composition for the treatment or prevention of allergic airway inflammation, comprising heparin and a pharmaceutically acceptable carrier, diluent or excipient, wherein the heparin is selected from the group consisting of large molecular weight heparin and low molecular weight heparin. For example, the pharmaceutical composition of claim 1 is for treating or preventing asthma. For example, the pharmaceutical composition of claim 1 is for reducing the airway inflammatory response by reducing the inflammatory factors in the lungs of allergic patients. For example, the pharmaceutical composition of claim 1 is used to reduce the severity of airway resistance (Penh) when the airway of an allergic patient is stimulated. A composition for improving allergic constitution comprising heparin selected from the group consisting of large molecular weight heparin and low molecular weight heparin, and a pharmaceutically or food acceptable carrier, diluent or excipient. The composition of claim 5 is for reducing the concentration of allergic globulin E (IgE) in the plasma of an allergic patient.