US20120184622A1 - Composition for the treatment of cystic fibrosis - Google Patents

Composition for the treatment of cystic fibrosis Download PDF

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US20120184622A1
US20120184622A1 US13/389,281 US201013389281A US2012184622A1 US 20120184622 A1 US20120184622 A1 US 20120184622A1 US 201013389281 A US201013389281 A US 201013389281A US 2012184622 A1 US2012184622 A1 US 2012184622A1
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treprostinil
prostacyclin
pharmaceutically acceptable
derivative
composition
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Michael Freissmuth
Xaver Koenig
Christina Gloeckel
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Scipharm SARL
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Assigned to FREISSMUTH, MICHAEL reassignment FREISSMUTH, MICHAEL ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: GLOECKEL, CHRISTINA, KOENIG, XAVER
Assigned to SCIPHARM SARL reassignment SCIPHARM SARL ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: FREISSMUTH, MICHAEL
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/5578—Eicosanoids, e.g. leukotrienes or prostaglandins having a pentalene ring system, e.g. carbacyclin, iloprost
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/558—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes
    • A61K31/5585—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes having five-membered rings containing oxygen as the only ring hetero atom, e.g. prostacyclin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • compositions comprising a prostacyclin or a prostacyclin analogue or a pharmaceutically acceptable salt thereof for use in preventing or treating cystic fibrosis.
  • Cystic fibrosis is a genetic disease resulting from mutations in a 230 kb gene on chromosome 7 encoding a 1480 amino acid polypeptide known as the cystic fibrosis transmembrane conductance regulator (CFTR) which serves as a chloride channel in epithelial membranes. Over 1000 mutant alleles have been identified to date. The most common mutation, ⁇ F508, is the deletion of a phenylalanine residue at codon 508 in the cystic fibrosis transmembrane conductance regulator (CFTR) protein.
  • This mutation results in a severe reduction in CFTR function, and leads to the classic cystic fibrosis phenotype characterized with abnormality in exocrine gland functions like raised sweat chloride, recurrent respiratory infection with bronchiectasis, and early-onset of pancreatic insufficiency.
  • CF is usually suspected when one or more typical CF phenotypic features are present in a subject.
  • pancreatic insufficiency and recurrent pancreatitis e.g. pancreatic insufficiency and recurrent pancreatitis
  • salt loss syndromes i.e. obstructive azoospermia
  • obstructive azoospermia azoospermia
  • Ductular dilatation of these glands (associated with blockage by mucus) and the plastering of airway surfaces by thick, viscous, neutrophil dominated mucopurulent debris are among the pathological hallmarks of the disease.
  • Pulmonary inflammation is another major cause of the decline in respiratory function in subjects with cystic fibrosis and may precede the onset of chronic infection. Mucinous impaction and thick concretions within pancreatic ducts lead to chronic fibrosis, fatty replacement of the gland, or both in a large subgroup of subjects with a previous diagnosis of idiopathic or alcoholic pancreatitis.
  • Cystic fibrosis is the most common fatal inherited disease in the Caucasian population, affecting about 4 in 10,000 children.
  • the median age at death has increased from 8.4 years of age in 1969 to 14.3 years of age in 1998.
  • the mean age of death has increased from 14 years in 1969 to 32.4 years of age in 2003 (Cystic Fibrosis Foundation).
  • the median survival is predicted to be over 40 years.
  • a major contributor to the significant increase in life expectancy is improved treatment of chronic respiratory tract infections and elimination of mucus in CF subjects as well as improved nutrition and earlier diagnosis.
  • CFTR cystic fibrosis transmembrane conductance regulator
  • CFTR CFTR-associated degradation
  • ERAD ERAD lags behind the rate of protein synthesis, or during treatment with proteasome inhibitors, aggregates of the mutant protein accumulate.
  • CFTR was the first integral membrane mammalian protein to be identified as a substrate for ubiquitin-proteasome mediated degradation, and it has served as a model for the growing list of diseases of protein conformation, which account for a diverse set of pathological etiologies.
  • ⁇ F508 CFTR Essentially all of the ⁇ F508 CFTR produced by the cell is destroyed by ERAD. Also, due to its complex folding pattern, 60-70% of the wild-type (wt) protein may be similarly degraded, although this may vary among cell types.
  • the proteolytic cleavage patterns of the immature forms of wt and ⁇ F508 CFTR are similar, whereas the digestion pattern of mature wt CFTR is different. This finding supports the concept that at least a portion of the ER-retained mutant CFTR is present in an intermediate conformation that is formed along the normal CFTR folding pathway, as opposed to the formation of a variant protein structure.
  • Prostaglandin I2 is an oxygenated metabolite of arachidonic acid formed enzymatically by the sequential activities of cyclooxygenase and PGI synthase enzymes. It is produced constitutively by vascular endothelial and smooth muscle cells and is induced under inflammatory conditions in vascular cells and macrophages.
  • PGI2 is a potent vasodilator and antithrombotic agent whose effects result from binding to a unique heptahelical G protein-coupled receptor termed the I prostanoid (IP)4 receptor.
  • IP I prostanoid
  • This receptor is coupled to G s - and activates adenylate cyclase, resulting in an acute burst of intracellular cAMP.
  • expression of CFTR and mutated CFTR is dependent on cAMP-dependent, substances which enhance intracellular levels of cAMP are of interest for development of drugs for treatment of CF. Most of these substances, such as forskolin, however, induce a rather unspecific elevation of cAMP, which may have also very harmful effects such as inflammation. Thus there is an unmet need of specific enhancers of cAMP in lung epithelial cells.
  • Treprostinil is a potent IP receptor agonist, although its specificity for this receptor is unknown. Sprague R. S. et al., 2008, showed that Prostacyclin analogues (UT-15, Remodulin) stimulate receptor-mediated cAMP synthesis and ATP release from rabbit and human erythrocytes.
  • WO 08/098196 describes the treatment of pulmonary fibrosis using Treprostinil.
  • the site of action of Treprostinil in pulmonary fibrosis is the vasculature and the interstitial space in the alveola.
  • U.S. 2001/006979 A1 describes the use of prostacyclin derivatives like iloprost or cicaprost for the treatment of fibrotic diseases.
  • Cystic fibrosis is unrelated to pulmonary fibrosis because it is a disease that originates in the bronchial epithelium. Because of the absence of CFTR, there is too little water in the mucus that covers the bronchial epithelium; accordingly, the cilia cannot move the thick mucus and mucociliary clearance breaks down (mucociliary clearance works like a conveyor belt, where the cilia beat rhythmically in a concentred manner to move the mucus back to the trachea and pharynx, from where it may be cleared by swallowing or coughing etc.).
  • cystic fibrosis the site of action is the airway epithelium of the bronchi.
  • the site of action is anatomically distinct (lung interstitium vs. bronchial airway), involves a different set of cells (fibroblasts, vascular smooth muscle cells, endothelium versus absorbing and secreting bronchial epithelial cells) and presumably also involves different receptors (prostacyclin receptor vs possibly EP2-receptor).
  • compositions for treatment that can enhance the expression of ⁇ F508 CFTR and/or chloride channel function in epithelial cells of the lung.
  • the object of the invention is achieved by providing a composition comprising a prostacyclin or an analogue, a derivative or a pharmaceutically acceptable salt thereof for use in preventing or treating cystic fibrosis.
  • the prostacyclin analogue is selected from the group of Treprostinil, Iloprost, Cisaprost or Beraprost or pharmaceutically acceptable salts thereof.
  • the Treprostinil derivative can be selected from the group of acid derivatives, prodrugs, sustained release forms, inhaled forms, oral forms, polymorphs or isomers of Treprostinil.
  • composition of the invention can be administered by intravenous administration, inhalation or it can be in an orally available form selected from the group of tablets or capsules.
  • composition comprises an effective amount of Treprostinil or its derivative, or a pharmaceutically acceptable salt thereof which is at least 1.0 ng/kg of body weight/min.
  • kits for treating or preventing a condition associated with cystic fibrosis in a subject comprising (i) an effective amount of a prostacyclin or prostacyclin analogue or derivative or a pharmaceutically acceptable salt thereof, specifically a pharmaceutically acceptable salt of Treprostinil, (ii) one or more pharmaceutically acceptable carriers and/or additives, and (iii) instructions for use in treating or preventing cystic fibrosis is provided as well.
  • FIG. 1 Accumulation of cAMP in IB3-1 cells after incubation with Treprostinil
  • FIG. 2 Activation of a Cl-current by Treprostinil in the human bronchial epithelial IB3-1 cell line transiently expressing CFTR-wt.
  • prostacyclin or analogues or derivatives or a pharmaceutically acceptable salt thereof can be used for treating cystic fibrosis.
  • Synthetic prostacyclin analogues can be for example, but are not limited to Treprostinil, Iloprost, Cisaprost or Beraprost.
  • Suitable prostacyclin derivatives include but are not limited to acid derivatives, pro-drugs, sustained release forms, inhaled forms and oral forms of Treprostinil, Iloprost, Cisaprost or Beraprost.
  • a pharmaceutically acceptable salt of a prostacyclin or prostacyclin analogue of this invention can be formed between an acid and a basic group of the compound, such as an amino functional group, or a base and an acidic group of the compound, such as a carboxyl functional group.
  • the compound is a pharmaceutically acceptable acid addition salt.
  • Treprostinil or its derivative is useful according to the invention.
  • Treprostinil can successfully enhance the expression of ⁇ F508 CFTR and/or the chloride channel function in epithelial cells of the lung of cystic fibrosis patients.
  • physiologically acceptable salts of Treprostinil include salts derived from bases.
  • Base salts include ammonium salts (such as quaternary ammonium salts), alkali metal salts such as those of sodium and potassium, alkaline earth metal salts such as those of calcium and magnesium, salts with organic bases such as dicyclohexylamine and N-methyl-D- glucamine, and salts with amino acids such as arginine and lysine.
  • a prostacyclin or analogue thereof for example Treprostinil or a derivative or salt thereof might induce expression and gating of CFTR and mutCFTR in a specific manner can be used for treatment of CF.
  • the current invention therefore also relates to a composition
  • a composition comprising a prostacyclin or prostacyclin analogue, specifically Treprostinil or its derivative, or a pharmaceutically acceptable salt thereof for use in treating cystic fibrosis as well as therapies of cystic fibrosis using a prostacyclin or prostacyclin analogue, specifically Treprostinil or its derivative, or a pharmaceutically acceptable salt thereof.
  • Treprostinil is a synthetic analogue of prostacyclin.
  • Treprostinil is marketed as RemodulinTM.
  • Treprostinil is a (1R,2R,3aS,9aS)-[[2,3,3a,4,9,9a-hexahydro-2-hydroxy-1-[(3S)-3-hydroxyoctyl]-1H-benz[f]inden-5-yl] oxy]acetic acid monosodium salt.
  • the derivatives of Treprostinil can be for example acid derivatives of Treprostinil, prodrugs of Treprostinil, sustained release forms of Treprostinil, inhaled forms of Treprostinil, oral forms of Treprostinil, polymorphs of Treprostinil or isomers of Treprostinil.
  • composition of the invention can be present in any form which can be used for administration.
  • composition of the invention can be administered as liquid or powder. It can be administered topically, intravenously, subcutaneously, by inhalation or by using a nebulizer or in orally available form like tablets or capsules. Due to the high metabolic stability of some prostacyclin analogues like Treprostinil, or if provided as lipid based or pegylated forms of the prostacyclins or prostacyclin analogues, the substances can also be administered as depot medicaments.
  • Aerosolized delivery of the prostacyclin analogue may result in a more homogeneous distribution of the agent in a lung, so that deep lung delivery is obtained. Thereby the dosage of application might be reduced to the sustained presence of the agent at the site of action in the lung.
  • composition can be administered with any pharmaceutically acceptable substances or carriers or excipients as known in the art.
  • pharmaceutically acceptable substances or carriers or excipients can be for example, but are not restricted to water, neutralizing agents like NaOH, KOH, stabilizers, DMSO, saline, betaine, taurine etc.
  • pharmaceutically acceptable means approved by a regulatory agency of the Federal or a state government or listed in the U.S.
  • carrier refers to a diluent, adjuvant, excipient, or vehicle with which the pharmaceutical composition is administered.
  • Saline solutions and aqueous dextrose and glycerol solutions can also be employed as liquid carriers, particularly for injectable solutions.
  • Suitable excipients include starch, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, dried skim milk, glycerol, propylene, glycol, water, ethanol and the like. Examples of suitable pharmaceutical carriers are described in “Remington's Pharmaceutical Sciences” by E. W. Martin. The formulation should be selected according to the mode of administration.
  • Treprostinil is of high metabolic stability which specifically allows for administration by various routes.
  • the amount of the inventive composition can be selected by any skilled person, preferably the amount of the prostacyclins or prostacyclin analogues or pharmaceutically acceptable salts thereof, specifically of Treprostinil is at least 1.0 ng/kg of body weight/min.
  • the invention further provides a kit for treating or preventing a condition associated with cystic fibrosis in a subject, comprising (i) an effective amount of a prostacyclin or prostacyclin analogue or derivative or a pharmaceutically acceptable salt thereof, (ii) one or more pharmaceutically acceptable carriers and/or additives, and (iii) instructions for use in treating or preventing cystic fibrosis.
  • the kit comprising (i) an effective amount of a prostacyclin or prostacyclin analogue or a pharmaceutically acceptable salt thereof, (ii) one or more pharmaceutically acceptable carriers and/or additives, and (iii) instructions for use in treating or preventing cystic fibrosis is provided for use in the treatment or prevention of a condition associated with cystic fibrosis in a subject, preferably a human.
  • Said component (i) can be in a form suitable for intravenous administration, for inhalation or for oral administration.
  • the component (i) can be in a form suitable for intravenous administration, for inhalation or for oral administration.
  • the present invention provides the use of a kit comprising i) an effective amount of Treprostinil or a pharmaceutically acceptable salt thereof, (ii) one or more pharmaceutically acceptable carriers and/or additives, and (iii) instructions for use in treating or preventing cystic fibrosis in the treatment or prevention of a condition associated with cystic fibrosis in a subject, preferably a human.
  • component (i) is a pharmaceutically acceptable salt of Treprostinil.
  • component (i) is in a form suitable for intravenous administration or suitable for inhalation or suitable for oral administration.
  • IB3-1 cells were plated on 6 well- plates (0.2*106 cells/well) in complete growth medium (LHC-8+5% FCS). The following day, the adenine nucleotide pool was metabolically labelled by incubation with [3H]adenine (1 ⁇ Ci/well) in Dulbecco's Modified Eagle Medium (DMEM) containing adenosine deaminase (1 unit/ml) for 4 h. Cycic AMP formation was stimulated by 20 ⁇ M forskolin or the PGI2-analogue treprostinil (Remodulin®). The assay was performed in triplicates.
  • DMEM Dulbecco's Modified Eagle Medium
  • [ 3 H]cAMP was determined by sequential chromatography on Dowex 50WX-4 and neutral alumina columns followed by liquid scintillation counting of the eluate.
  • Treprostinil caused a concentration-dependent accumulation of cAMP in IB3-1 cells ( FIG. 1 ). Half-maximum stimulation was seen in the range of 0.3 to 1 ⁇ M.
  • IB 3 -1 cells endogenously express only mutated CFTR- ⁇ F508, which is retained within the cells.
  • appropriated manipulations e.g., pharmacochaperones or low temperature incubations
  • the resulting Cl-conductance is small.
  • Treprostinil caused a robust activation of the current induced by a depolarization from ⁇ 40 mV holding potential to +60 mV. The maximum effect was delayed, i.e. it was only observed several s after wash-in of the compound. Likewise, there was also a hysteresis in the turn-off reaction; the current decayed to basal only ⁇ 100 s after washout.
  • the whole cell patch clamp technique was used for current recordings performed at 22 ⁇ 1.5° C. using an Axoclamp 200B patch clamp amplifier (Axon Instruments). Pipettes had resistances between 1 and 2 M ⁇ when filled with the recording pipette solution (composition: 110 mM CsCl, 5 mM EGTA, 2 mM MgCl 2 , 1 mM K 2 .ATP, 10 mM Hepes, pH adjusted to 7.2 with Cs 0 H). Voltage-clamp protocols and data acquisition were performed with pclamp 6.0 software (Axon Instruments). Data were low-pass filtered at 2 kHz ( ⁇ 3 dB) and digitized at 10-20 kHz.
  • Cells were continuously superfused with external solution (composition: 145 mM NaCl, 4.5 mM KCl, 2 mM CaCl 2 , 1 mM MgCl 2 , 5 mM glucose, 10 mM Hepes, pH adjusted to 7.4 with NaOH).
  • the external solution contained Treprostinil (10 ⁇ M) or forskolin (5 ⁇ M), switching between solutions was achieved by electronically controlled pressure valves.
  • I3B-1 cells were grown on dishes (Nunc, 3.5 cm diameter) covered with fibronectin (10 ⁇ g/mL) rat collagen I (30 ⁇ g/mL) and BSA 10 ⁇ g/mL) in LHC-8 medium (Gibco) containing 5% fetal calf serum (FCS).
  • Cells were transiently transfected with a plasmid driving the expression of human GFP-tagged wild type CFTR by using Lipofectamine plus® (Invitrogen) according to the instructions of the manufacturer.

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US9371264B2 (en) 2013-01-11 2016-06-21 Corsair Pharma, Inc. Treprostinil derivative compounds and methods of using same
US9394227B1 (en) 2015-06-17 2016-07-19 Corsair Pharma, Inc. Treprostinil derivatives and compositions and uses thereof
US9505737B2 (en) 2013-01-11 2016-11-29 Corsair Pharma, Inc. Treprostinil derivative compounds and methods of using same
US9643911B2 (en) 2015-06-17 2017-05-09 Corsair Pharma, Inc. Treprostinil derivatives and compositions and uses thereof

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US9469600B2 (en) 2013-10-25 2016-10-18 Insmed Incorporated Prostacyclin compounds, compositions and methods of use thereof
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