US20090137660A1 - Cytokine Modulators Using Cyclic Glycerides of Essential Polyunsaturated Fatty Acids - Google Patents

Cytokine Modulators Using Cyclic Glycerides of Essential Polyunsaturated Fatty Acids Download PDF

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US20090137660A1
US20090137660A1 US11/885,254 US88525406A US2009137660A1 US 20090137660 A1 US20090137660 A1 US 20090137660A1 US 88525406 A US88525406 A US 88525406A US 2009137660 A1 US2009137660 A1 US 2009137660A1
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multiple sclerosis
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Laurence S. Harbige
Michael J. Leach
Paul Barraclough
Anthony P. Dolan
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Definitions

  • the present invention relates to a method for treating diseases and disorders in which cytokines are in state of imbalance or otherwise capable of modulation to provide therapeutic benefit.
  • the invention provides a method of treatment of patients in need of therapy for disorders where the cytokines TGF- ⁇ 1, TNF- ⁇ , IL-1 ⁇ , IL4, IL5, IL6, IL8, IL10, IL13, and ⁇ -IFN are dysregulated or capable of modulation to provide therapeutic benefit.
  • disorders such as abnormalities of the immune system, for example systemic lupus erythematosus (SLE), allergy, asthma, crohn's disease and rheumatoid arthritis, but particularly multiple sclerosis, and also neurodegenerative diseases such as sequelae of stroke, head trauma, bleeds and the chronic abnormalities of Alzheimer's and Parkinson's disease.
  • SLE systemic lupus erythematosus
  • CHD coronary heart disease
  • WO2004/100943 relates to the use of synthetic, plant and fungal oils for the treatment of neurodegenerative diseases, particularly multiple sclerosis, stroke, head trauma, Alzheimer's and Parkinson's disease.
  • WO2004/100943 relates to oils characterised by having at high percentages of the essential fatty acid ⁇ -linolenic acid (GLA) at the sn ⁇ 2 position of their lipids, typically being over 40% of the sn ⁇ 2 fatty acid total of the oil.
  • GLA essential ⁇ -linolenic acid
  • WO2005/018632 relates to structured lipids having an sn ⁇ 2 fatty acid residue selected from ⁇ -linolenic acid (GLA), dihomo- ⁇ -linolenic acid (DHGLA) and arachidonic acid (AA).
  • GLA ⁇ -linolenic acid
  • DHGLA dihomo- ⁇ -linolenic acid
  • AA arachidonic acid
  • Cytokines are implicated in the pathogenesis of MS, with many studies showing an increase in myelinotoxic inflammatory cytokines (TNF- ⁇ , IL-1 ⁇ and IFN- ⁇ ) coinciding with the relapse phase of the disease. Conversely, levels of the anti-inflammatory and immunosuppressive cytokine transforming growth factor-beta1 (TGF- ⁇ 1) appear to be reduced during a phase of relapse and increase as the patient enters remission. Thus the balance between biologically active TGF- ⁇ 1 and the pro-inflammatory TNF- ⁇ , IL-1 ⁇ and IFN- ⁇ appears to be dysregulated during MS relapse-remission.
  • TGF- ⁇ 1 myelinotoxic inflammatory cytokines
  • IFN- ⁇ immunosuppressive cytokine transforming growth factor-beta1
  • TGF- ⁇ 1-secreting T-cells inhibit EAE effector cells
  • TGF- ⁇ 1 is expressed in the CNS and, in oral-tolerance-induced protection in EAE, TGF- ⁇ and PGE 2 are expressed in the brain (Karpus & Swanborg (1991); Khoury et al (1992)). Harbige ((1998) concluded that dietary ⁇ -linolenic acid effects on EAE are mediated through Th 3 -like mechanisms involving TGF- ⁇ 1 and possibly through superoxide dismutase antioxidant activity.
  • T cell depleters and modulators such as cyclophosphamide
  • T-cells indeed produce beneficial cytokines, such as TGF- ⁇ 1, as well as deleterious ones in man.
  • David Baker of Institute of Neurology, UK summed up the disparity between what is effective in the EAE and in MS with a paper entitled ‘Everything stops EAE, nothing stops MS’ at the 10 May 2004 UK MS Frontiers meeting of the UK MS Society.
  • the WO2004/100943 study shows that over an 18-month period, patients taking high dose (15 g/day) selected high sn ⁇ 2 ⁇ -linolenic acid borage oil showed significant (p ⁇ 0.001) and marked improvements in EDSS score, a reduced rate of relapse, symptomatic relief of muscle spasticity and painful sensory symptoms, and improved objective measures of cognitive functions. Low doses of 5 g/day of this borage oil were without effect.
  • PBMC peripheral blood mononuclear cell production
  • pro-inflammatory cytokines TNF- ⁇ and IL-1 ⁇ were significantly and markedly ( ⁇ 70%) reduced and they either maintained or increased the PBMC membrane long chain omega-6 fatty acids dihomo- ⁇ -linolenic acid (DHLA) and arachidonic acid (AA) in contrast to patients taking placebo who demonstrated loss of these fatty acids over the course of the trial period.
  • DHLA dihomo- ⁇ -linolenic acid
  • AA arachidonic acid
  • the high sn ⁇ 2 GLA oil treatment apparently targeted maintenance and/or increase of key membrane lipid components that are otherwise specifically lost in MS, being consistent with a correction of a metabolic defect not otherwise effectively treated by current therapies.
  • the present inventors now set out, in view of the results obtained with high sn ⁇ 2- ⁇ -linolenic acid Borage Oil, to demonstrate that it is indeed the presence of an sn ⁇ 2- ⁇ -linolenic acid, dihomo- ⁇ -linolenic acid or arachidonic acid residue in a monoglyceride, particularly an sn ⁇ 2 monoglyceride, or a metabolic precursors thereof, that gives it efficacy in treating cytokine dysregulation.
  • triglycerides themselves are of nearly three times the weight, and thus dose, of monoglyceride counterparts, they have determined that it is possible to administer essential fatty acids of the n ⁇ 3, n ⁇ 6 and n ⁇ 9 type, particularly the n ⁇ 6 type, as metabolic precursors or analogues of sn ⁇ 2 monoglycerides and still obtain beneficial cytokine changes. Particularly these compounds are believed to be more stable than the equally less bulky monoglycerides.
  • the dose advantages of use of monoglycerides over triglycerides may be offset in part by possible increased instability of certain forms as compared with the sn ⁇ 1, sn ⁇ 3 saturated acyl group sn ⁇ 2 EFA triglyceride exemplified in PCT/GB2004/003524.
  • Such instability may be due eg. to transesterification and oxidation.
  • This issue may be addressed by producing the monoglyceride in a more stable form, eg a solid or semi solid rather than a liquid oil.
  • These compounds are particularly cyclic glycerols bearing essential fatty acids, particularly n ⁇ 3, n ⁇ 6 and n ⁇ 9, but particularly n ⁇ 6 fatty acids, in a position equivalent to the sn ⁇ 2 position on the glycerol.
  • the inventors have determined that these compounds are capable of regulating cytokines in a favourable manner to patient health based upon their previous clinical studies with Borage oil and the structured lipid in vivo and in vitro work.
  • Cyclic glycerols are known as a class eg see. Chem Abstracts no 65:8747b and have been used as intermediates in the synthesis of monoacylglycerides eg see Chemical & Pharmaceutical Bulletin (2000), 48(7) 903-907.
  • WO99/64389 directed to analgesia
  • a therapeutically effective amount of cyclic glycerol is 10 mg/day to 1000 mg/day.
  • the present inventors studies on relative effect in animals and on cells has led them to determine that such a dose will be ineffective in the cytokine regulating indication now disclosed.
  • the effective dose in man is expected to be above 1000 mg/day, particularly between 1 g to 10 g per day. More preferably being 2 to 6 g/day, still more preferably 2 to 4 g/day.
  • cytokine regulation Without the cytokine regulation such dosages provide, treatment of diseases such as demyelinating diseases Multiple Sclerosis and Alzheimer's, Parkinson's, Huntingdon's Chorea and trauma and stroke with a view to halting ongoing immune cell and cytokine destruction of tissues cannot be achieved.
  • Mere enhancement of natural anandamide levels by blocking reuptake cannot provide relief where natural anandamide is not present in effective amount, eg. in T-cells and around CNS lesions.
  • the present invention provides a method of treating a patient in need modulation of cytokines, particularly TGF- ⁇ 1, TNF- ⁇ , IL-1 ⁇ , IL4, IL5, IL6, IL8, IL10, IL13 and/or ⁇ -IFN, comprising administering to that patient a therapeutically effective dose of a compound of general formula I
  • n and m are independently selected integers 0, 1 or 2
  • R 4 and R 5 are independently selected from H, C 1-18 alkyl, C 1-18 alkoxy, C 1-18 hydroxyalkyl, C 2-18 alkenyl and C 6-18 aryl or aralykyl
  • R 3 is the a fatty acyl group of an essential polyunsaturated fatty acid.
  • Preferred polyunsaturated fatty acyl groups are those of n ⁇ 3, n ⁇ 6 and n ⁇ 9 fatty acids, more preferably n ⁇ 3 and n ⁇ 6 fatty acids, still more preferably being ⁇ -linolenoyl, ⁇ -dihomolinolenoyl and arachidonoyl.
  • R 1 and R 2 are selected from H or a group —CR 4 R 5 where R 4 and R 5 are independently selected from H and C 1-6 alkyl. Most advantageously R 1 and R 2 form a group —CH 2 — or —CH 2 CH 2 —.
  • disorders of the immune system for example diseases such as systemic lupus erythematosus (SLE), allergy, asthma, crohn's disease and rheumatoid arthritis, but particularly multiple sclerosis, and also neurodegenerative diseases such as sequelae of stroke, head trauma, bleeds and the chronic abnormalities of Alzheimer's and Parkinson's disease.
  • SLE systemic lupus erythematosus
  • CHD coronary heart disease
  • Particularly advantageously treated neurodegenerative diseases are those involving demyelination.
  • the present method is specifically addressed at arresting underlying neurodegeneration and restoring neuronal function.
  • the method preferably normalises neuronal membrane composition, and restores healthy PBMC stimulated or spontaneously released TGF- ⁇ 1/TNF ⁇ ratios and the ratios of TGF- ⁇ 1 with other PBMC released cytokines.
  • the method arrests neurodegeneration in multiple sclerosis of all types but particularly relapsing remitting, primary progressive and chronic progressive MS and the restoration, in part or completely, of neuronal function such as measured, eg. By MRI or CAT scan or by EDSS score.
  • Such method may also be used in treatment of cerebral impairment after stroke, head trauma and intracranial bleeding where there is demyelination or neuronal damage. Further application is provided in treating other chronic demyelination such as in Alzheimer's and Parkinson's disease.
  • the compound of the present invention is administered for a duration and at a dose sufficient to maintain or elevate TGF- ⁇ 1 levels in the patient to therapeutic levels.
  • therapeutic levels is meant levels at least consistent with healthy subjects.
  • the dose is such as to produce a TGF- ⁇ 1/TNF- ⁇ ratio spontaneously released from peripheral blood mononuclear cells (PBMCs) isolated from blood of a patient, after 18 months of daily dosing, of 0.4 to 3.0, at least 0.5, more preferably at least 0.75 and most preferably at least 1.
  • PBMCs peripheral blood mononuclear cells
  • the dose is such as to produce a TGF- ⁇ 1/IL-1 ⁇ ratio in blood of a patient, after 18 months of daily dosing, of at least 0.5, more preferably at least 0.75 and most preferably at least 1.
  • said levels are produced after 12 months and more preferably after 6 months.
  • the present invention further provides a method of treating a patient in need of remyeleination in a demyelinating disease comprising administering to that patient a therapeutically effective amount of a compound of formula I wherein R 3 is selected from ⁇ -linolenoyl, ⁇ -dihomolinolenoyl and arachidonoyl; most preferably ⁇ -linolenoyl and ⁇ -dihomolinolenoyl.
  • the amount of compound administered daily will be between 0.5 and 30 grams, orally dosed, still more preferably between 0.75 and 20 grams and most preferably between 1 and 18 grams, typically 2 to 5 grams. This dose may be given as one single dose or in two or more doses together totally this amount per day.
  • the dose may be toward the higher end of these ranges, but is preferably between 1 and 10 grams/day, more preferably 2 to 6 grams/day. Where the sn ⁇ 2 moiety is that of a dihomo- ⁇ -linolenic acid residue, the dose may be less, whilst where the sn ⁇ 2 moiety is that of an arachidonic acid residue, efficacy is higher, but dosing should be more cautious, due to possibilities of unwanted side effects at higher levels and the pro-inflammatory nature of this PUFA.
  • a second aspect of the present invention provides novel compound of formula I
  • n and m are independently selected integers 0, 1 or 2
  • R 4 and R 5 are independently selected from H, C 1-18 alkyl, C 1-18 alkoxy, C 1-18 hydroxyalkyl, C 2-18 alkenyl and C 6-18 aralkyl
  • R 3 is a fatty acyl group of an essential polyunsaturated fatty acid.
  • Preferred polyunsaturated fatty acyl groups are those of n ⁇ 3, n ⁇ 6 and n ⁇ 9 fatty acids, more preferably n ⁇ 3 and n ⁇ 6 fatty acids, still more preferably being ⁇ -linolenoyl, ⁇ -dihomolinolenoyl and arachidonyl.
  • R 1 and R 2 form a group —CR 4 R 5 where R 4 and R 1 are independently selected from H and C 1-6 alkyl. Most advantageously R 1 and R 2 form a group —CH 2 — or —CH 2 CH 2 —.
  • R 1 and R 2 are independently selected from hydrogen and C 1-6 alkyl.
  • a third aspect of the present invention provides a method for synthesis of a compound of general formula II comprising reaction a 5-hydroxy-1,3-dioxan with an essential fatty acid or an essential fatty acid halide.
  • a fourth aspect of the present invention provides compositions for use in the method of the present invention comprising the compounds of formula I together with a pharmaceutically or nutraceutically acceptable carrier, coating, capsule, diluent and/or preservative.
  • the compounds for use in the present invention may be administered by any of the conventional vehicles known in pharmacy. Most conveniently they are administered as neat oils or in admixture with foodstuffs, in the form of capsules containing such oils, or in enterically coated forms. Other forms will occur to those skilled in the art but Remington Pharmaceutical Sciences 19 th Edition
  • preservative is meant an antioxidant or inhibitor of transesterification. It is particularly preferred that the composition does not include Vitamin E, or includes only levels of Vitamin E that are 0.05 mg/g or less, eg 0.005 to 0.05 mg/g.
  • a fifth aspect of the present invention provides a pharmaceutical composition for regulating the immune system, particularly by modulating cytokines TGF- ⁇ 1, TNF- ⁇ , IL4, IL5, IL6, IL8, IL10, IL13, and/or ⁇ -IFN comprising a compound of general formula I as defined for the method of treatment of the invention.
  • a sixth aspect of the present invention provides use of the compounds of formula I, formula II and formula IIa as described above for the manufacture of a medicament for the treatment of cytokine dysregulation and neurodegenerative diseases as set out for the method of the invention.
  • Particularly preferred medicaments are for the arresting and reversing of neurodegeneration in multiple sclerosis of all types but particularly relapsing remitting, primary progressive and chronic progressive and the restoration, in part or completely, of neuronal integrity function such as measured, eg. By MRI or CAT scan or by EDSS score.
  • Other TGF- ⁇ 1 responsive diseases may be treated as set out previously. Particularly treated is demyelination.
  • beneficial agents may be combined with the compounds for use in the present invention or otherwise form part of a treatment regime.
  • beneficial agents might be ion channel blockers, eg. sodium channel blockers, interferons ( ⁇ , ⁇ , or ⁇ ), T-cell depleters, steroids or other palliative agents.
  • ion channel blockers eg. sodium channel blockers, interferons ( ⁇ , ⁇ , or ⁇ ), T-cell depleters, steroids or other palliative agents.
  • ⁇ , ⁇ , or ⁇ interferons
  • T-cell depleters steroids or other palliative agents.
  • FIG. 1 Shows spontaneous peripheral blood mononuclear cell cytokine production in placebo and high sn ⁇ 2 ⁇ -linolenic acid, WO2004/100943 trial oil treated human MS patients at 18 months.
  • the left hand column in each case is placebo: right treated.
  • FIG. 2 Shows the effect of placebo and low dose (5 g/day) high sn ⁇ 2 GLA Borage oil on human MS patient EDSS score as compared to high dose (15 g/day) displayed as a histogram with months treatment on the x axis.
  • FIG. 3 Shows the effect of placebo, low dose and high dose high sn ⁇ 2 GLA Borage oil on human MS patient Mean Relapse rate (%) as histogram with months on x axis.
  • FIG. 4 Shows synthesis of 2-GLA glycerol formal (aka: 5- ⁇ -linolenoyloxy)-1,3-dioxan and 5-(1,3-dioxanyl)methyl- ⁇ -linolenate)
  • Heparinised whole blood was diluted with an equal volume of Hanks' balanced salt solution (Sigma, UK) and the resulting diluted blood layered onto Lymphoprep (Nycomed, Oslo, Norway). Following density centrifugation at 800 g for 30 minutes the PBMC were removed from the interface and diluted in Hanks' solution. The cells were then washed twice by centrifugation for 10 minutes at 250 g. The resulting final pellet was then resuspended in culture medium consisting of RPMI-1640 medium (Sigma, UK) supplemented with 2 mM L-glutamine, 100 U penicillin and 100 ⁇ g streptomycin (Sigma, UK) and 10% autologous plasma.
  • TNF- ⁇ , IL-1 ⁇ and IFN- ⁇ in cell culture supernatants and plasma were detected using commercially available paired antibodies enabling cytokine detection in an ELISA format (R&D systems Ltd, Abingdon, UK).
  • the sensitivities for the TNF- ⁇ and IFN- ⁇ ELISAs were 15.6-1000 pg/ml and 3.9-250 pg/ml for IL-1 ⁇ .
  • the proton-decoupled 13 C NMR spectra with suppressed NOE were collected at 21° C. in a 5-mm broadband probe on a Joel 500 MHz spectrometer operating at 125.728 MHz.
  • Waltz decoupling was the chosen mode of decoupling and was gated on only during the 14.89s acquisition time.
  • the relaxation delay was set at 30 secs and the pulse angle was 90°.
  • the spectral window used was ca.35 ppm (from 173.5 to 172.6 ppm) with a 170 ppm offset.
  • the spectra were internally referenced to CDCl 3 at 77.0 ppm.
  • the approximate number of scans collected for adequate signal-to-noise ranged from 300 to 1200 scans depending on the concentration and purity of the sample.
  • the total acquisition time for the experiments ranged between 2-8 h e.g 1272 scans; data points 65,536. Concentrated solutions up to 20% w/v were employed when possible to reduce the acquisition time The chemical shifts quoted vary with
  • Oxaloyl chloride (7.8 ml, 11.3 g, 0.089 mol, 0.95 equivalents) was added over 2-3 minutes to a stirred solution of ⁇ -linolenic acid (GLA95, 16.7 g, 0.060 mol, 0.64 equivalents-Scotia) in dichloromethane (100 ml) under N 2 . The mixture was stirred overnight at room temperature and then concentrated in vacuo to give a tan oil.
  • 2-GLA glycerol formal (aka: 5- ⁇ -linolenoyloxy)-1,3-dioxan and 5-(1,3-dioxanyl)-methyl- ⁇ -linolenate)
  • this ester was carried out by acylation of the commercially available glycerol formal mixture using ⁇ -linolenoyl chloride.
  • a mixture of two products is formed and these were separable by column chromatography.
  • the undesired by-product is eluted off the column first; further elution gives the desired acetal-ester.
  • It is a yellow oil at room temperature and appears to have stability properties similar to GLA, stable in air at room temperature for short periods (days) but is best stored long term in a cool place under nitrogen.
  • Oxalyl chloride (2.6 ml, 3.78 g, 30 mmol, 1.5 equiv) was added to a solution of ⁇ -linolenic acid (GLA, 5.56 g, 20 mmol. 1.0 equiv) in dichloromethane (DCM, 40 ml). The resulting solution was stirred under N 2 at room temperature overnight and then concentrated in vacuo.
  • Solublization of Sn ⁇ 2 monoglyceride was performed using ethyl alcohol or DMSO for in vitro work on human peripheral blood mononuclear cells (PBMCs).
  • PBMCs peripheral blood mononuclear cells
  • a tendancy to precipitate at acid pH may have been the cause of some animals regurgitating solid material after gavage suggesting that enterically coated formulation may be preferred.
  • SJL mice were fed sn ⁇ 2 GLA of Example 1 at three doses (50, 125 and 250 ⁇ l) for seven days by gavage. Mice receiving higher doses were prone to regurgitation. After seven days animals were killed and the brain, liver and spleen were removed the liver and brain frozen at ⁇ 70° C.
  • C57/BL mice were dosed orally with 2 GLA MG formal at two doses of 50 and 150 ul for eight days.
  • the compound was supplied in 8 separate tubes to be stored at 4° C. prior to dosing but warmed to 25° C. before use. After eight days the animals were killed and the brain, liver and spleen were removed. Liver and brain were frozen at ⁇ 70° C. and mononuclear cells were isolated from spleens by sieving and density centrifugation on Lymphoprep (Sigma Chemical Co) and cultured at 37° C. in 5% CO 2 atmosphere in 5 ml culture tubes at a cell density of 2 ⁇ 10 6 cells/ml in RPMI 1640 medium in 5% fetal calf serum (FCS).
  • FCS fetal calf serum

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GB0504362D0 (en) 2005-04-06
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DE602006018710D1 (de) 2011-01-20
PL1853254T3 (pl) 2011-07-29
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ES2356925T3 (es) 2011-04-14

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