US20170266169A1 - Cyp2j2 antagonists in the treatment of pain - Google Patents

Cyp2j2 antagonists in the treatment of pain Download PDF

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US20170266169A1
US20170266169A1 US15/503,643 US201515503643A US2017266169A1 US 20170266169 A1 US20170266169 A1 US 20170266169A1 US 201515503643 A US201515503643 A US 201515503643A US 2017266169 A1 US2017266169 A1 US 2017266169A1
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pain
antagonist
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treatment
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Marco SISIGNANO
Christian BRENNEIS
Klaus Scholich
Gerd Geisslinger
Sebastian ZINN
Michael John PARNHAM
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Fraunhofer Gesellschaft zur Forderung der Angewandten Forschung eV
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Definitions

  • the present invention pertains to novel treatments of neuropathic pain; in particular chemotherapy induced peripheral neuropathic pain (CIPNP).
  • CIPNP chemotherapy induced peripheral neuropathic pain
  • the invention provides antagonists cytochrome P450 epoxygenases (CYP), and more specifically antagonists of CYP2J2, as therapeutics for use in the treatment of neuropathic pain such as CIPNP.
  • CYP2J2 antagonists were identified to alleviate CIPNP in-vivo, and therefore are provided additionally in combination with chemotherapeutics for the treatment of diseases such as cancer or other proliferative disorders.
  • the CYP2J2 antagonists reduce chemotherapeutic induced pain and therefore allow for a higher and better dosing of the chemotherapeutic during cancer treatment.
  • the invention relates to the use of CYP2J2 agonists, or metabolites of CYP2J2, for sensitizing TRPV1.
  • the invention proposes to use combinations of CYP2J2 agonist or metabolites and transient receptor potential vanilloid 1 (TRPV1) agonists to treat disorders that respond to TRPV1 agonists, such as neuropathic pain.
  • TRPV1 transient receptor potential vanilloid 1
  • Neuropathic pain is a persistent or chronic pain syndrome that can result from damage to the nervous system, the peripheral nerves, the dorsal root ganglion, dorsal root, or to the central nervous system.
  • Neuropathic pain syndromes include allodynia, various neuralgias such as post herpetic neuralgia and trigeminal neuralgia, phantom pain, and complex regional pain syndromes, such as reflex sympathetic dystrophy and causalgia.
  • Causalgia is often characterized by spontaneous burning pain combined with hyperalgesia and allodynia.
  • neuropathic pain Treatment of neuropathic or chronic pain is a challenge for physicians and patients since there are no medications that specifically target the condition, and since the medications presently used result in only little relief and are based on their efficacy in acute pain conditions or on their efficacy on relieving secondary effects like anxiety and depression. Incidence of chronic pain is increasing in society and its burden on society is huge in both health care and lost productivity. Currently there are no scientifically validated therapies for relieving chronic pain. As a result, the health community targets ‘pain management’ where multi-modal therapies are used concurrently with the hope of providing some improvement in quality of life. Thus, there is an urgent need for drugs that can relieve chronic pain.
  • Chemotherapy induced peripheral neuropathic pain is a severe dose limiting side effect of cytostatics, such as taxanes, platinum derivates, vinca alkaloids and others.
  • the symptoms usually start with tingling and can lead to burning, stabbing and aching pain as well as cold and mechanical allodynia.
  • Due to CIPNP some patients stop anticancer therapy with cytostatics too early, resulting in a higher risk of tumor progression.
  • Many promising substances, that are already approved for the treatment of different kinds of neuropathic pain such as gabapentin oramitriptyline seem to have little or no analgesic effect in monotherapy of CIPNP. Understanding the cellular and molecular mechanisms is necessary to treat or even prevent CIPNP and may improve the general success rate of cytostatic therapy.
  • TRPV1, TRPA1 and TRPV4 transient receptor potential-family of ion channels
  • Activation or sensitization of TRPV1 and TRPA1 can lead to enhanced release of CGRP and substance P both of which can cause neurogenic inflammation and recruitment of T-cells.
  • Cytochrome P450 (CYP)-epoxygenases can metabolize ⁇ -6 fatty acids, such as arachidonic acid (AA) and linoleic acid (LA) generating either lipid epoxides such as EETs (epoxyeicosatrienoid acids) or w-hydroxides such as 20-HETE.
  • AA arachidonic acid
  • LA linoleic acid
  • EETs epoxyeicosatrienoic acids
  • DHETs dihydroxyeicosatrienoic acids
  • HETEs omega terminal hydroxyeicosatetraenoic acids
  • allylic oxidation leads to the formation of midchain HETEs.
  • cytochrome P450 epoxygenases have been identified, including members of the CYP1A, CYP2B, CYP2C, CYP2E, and CYP2J subfamilies. Attention has recently been focused on proteins of the CYP2J subfamily.
  • One particular isoform, CYP2J2 is highly expressed in human cardiac myocytes, where arachidonic acid is metabolized to produce EETs.
  • CYP2J2 proteins are also found in epithelial cells in the airway and in the gut. In contrast to the other P450 enzymes, CYP2J2 proteins are distributed uniformly along the length of the gut, in epithelial and non-epithelial cells.
  • CYP2J2 proteins High levels of the CYP2J2 proteins are found in cells of the autonomic ganglia, epithelial cells, and intestinal smooth muscle cells.
  • Several CYP2J homologues have been identified in animals including rat CYP2J3, rat CYP2J4, mouse CYP2J5 and mouse CYP2J6.
  • Capsaicin is a highly selective agonist for transient receptor potential vanilloid 1 receptor (TRPV1; formerly known as vanilloid receptor 1 (VR1)), a ligand-gated, non-selective cation channel preferentially expressed on small-diameter sensory neurons, especially those C-fibers which specialize in the detection of painful or noxious sensations.
  • TRPV1 responds to noxious stimuli including capsaicin, heat, and extracellular acidification, and will integrate simultaneous exposures to these stimuli.
  • the initial effect of the activation of TRPV1-expressing (capsaicin-sensitive) nociceptors are burning sensations, hyperalgesia, allodynia, and erythema.
  • capsaicin after prolonged exposure to low-concentration capsaicin or single exposures to high-concentration capsaicin or other TRPV1 agonist, the small-diameter sensory axons become less sensitive to a variety of stimuli, including capsaicin or thermal stimuli. This prolonged exposure is also characterized by reduced pain responses. These later-stage effects of capsaicin are frequently referred to as “desensitization” and are the rationale for the development of local capsaicin formulations for the treatment of various pain syndromes and other conditions.
  • capsaicin, capsaicinoids and TRPV1 agonists may be useful for amelioration of a plurality of diseases.
  • they may be used to treat neuropathic pain (including pain associated with diabetic neuropathy, postherpetic neuralgia, HIV/AIDS, traumatic injury, complex regional pain syndrome, trigeminal neuralgia, erythromelalgia and phantom pain), pain produced by mixed nociceptive and/or neuropathic mixed etiologies (e.g., cancer), osteoarthritis, fibromyalgia, lower back pain, inflammatory hyperalgesia, vulvar vestibulitis or vulvodynia, sinus polyps interstitial cystitis, neurogenic or overactive bladder, prostatic hyperplasia, rhinitis, surgery, trauma, rectal hypersensitivity, burning mouth syndrome, oral mucositis, herpes (or other viral infections), prostatic hypertrophy, dermatitis, pruritis, itch, tin
  • CIPNP chemotherapy-induced peripheral neuropathic pain
  • a cytochrome P450 epoxygenase (CYP)-antagonist for use in the prevention or treatment of pain in a subject.
  • the CYP-antagonist is selected from the group consisting of a CYP1A-, CYP2B, CYP2C-, CYP2E-, and preferably a CYP2J-antagonist.
  • the CYP-antagonist is an antagonist of a mammalian homologue of CYP2J2 (CYP2J2-antagonist), preferably human CYP2J2, such as telmisartan, aripiprazole or most preferably terfenadine.
  • CYP2J2 antagonist preferably a selective CYP2J2 antagonist.
  • selective CYP2J2 antagonist pertains to antagonists of CYP2J2 that selectively inhibit activity, function or expression of CYP2J2 but not of other related enzymes such as for example CYP3A molecules.
  • a luminogenic cytochrome P450 glow assay can be employed.
  • CYP proteins catalyse the formation of arachidonic acid metabolites.
  • Luminogenic CYP assays use prosubstrates for the light-generating reaction of luciferase.
  • CYPs convert the prosubstrates to luciferin or a luciferin ester, which produces light in a second reaction with a luciferase reaction mix called Luciferin Detection Reagent (LDR).
  • LDR Luciferin Detection Reagent
  • luminogenic CYP assays specific for other CYP enzymes such as CYP3A4 can be employed. Comparing the inhibitory activity of a candidate antagonist against CYP2J2 with the inhibitory activity of the same antagonist against another CYP protein such as CYP3A4, therefore provides information about the selectivity of the candidate antagonist.
  • Preferred selective CYP2J2 antagonists in context of the present invention are selected from the group of the herein newly disclosed CYP2J2 antagonists consisting of estradiol, phenoxybenzamine-HCl, loratadine, clobetasol propionate, doxazosin mesylate, fenofibrate, levonorgestrel, aripiprazole, halcinonide, telmisartan, clofazimine, levothyroxine-Na, alosetron-HCl, fluocinonide, liothyronine-Na, meclizine dihydrochloride and terfenadine and derivatives thereof.
  • said pain to be treated is preferably neuropathic pain (including pain associated with diabetic neuropathy, postherpetic neuralgia, HIV/AIDS induced neuropathic pain, traumatic injury, complex regional pain syndrome, trigeminal neuralgia, erythromelalgia and phantom pain), pain produced by mixed nociceptive and/or neuropathic mixed etiologies (e.g., cancer), osteoarthritis, fibromyalgia, lower back pain, inflammatory hyperalgesia, vulvar vestibulitis or vulvodynia, sinus polyps interstitial cystitis, neurogenic or overactive bladder, prostatic hyperplasia, rhinitis, surgery, trauma, rectal hypersensitivity, burning mouth syndrome, oral mucositis, herpes (or other viral infections), prostatic hypertrophy, dermatitis, pruritis, itch, tinnitus, psoriasis, warts, cancers,
  • neuropathic pain
  • the present invention now provides a pain therapy comprising the inhibition of the activity of in particular CYP2J2 which produces the metabolic compound 9,10-EpOME—according to the invention, a sensitizer of ion channel-mediated pain perception.
  • CYP2J2 which produces the metabolic compound 9,10-EpOME—according to the invention, a sensitizer of ion channel-mediated pain perception.
  • the inhibition of CYP2J2 in accordance with the invention proved to be effective in-vivo to alleviate neuropathic pain induced by paclitaxel in a mouse model, indicating the use of CYP2J2 antagonists as analgesic against neuropathic pain, in particular CIPNP.
  • One further embodiment of the invention relates to the above mentioned prevention or treatment of pain, which comprises the administration of said CYP antagonist of the invention to a subject suffering from said pain, and wherein said subject received, receives or will receive chemotherapy. Therefore, the subject is in preferred embodiments a subject suffering from, or diagnosed with, a cancer disease.
  • Chemotherapy in context of the invention preferably involves the administration of a chemotherapeutic agent to a subject in need of such a treatment selected from pyrimidinone-based anti-neoplastic agents such as cytarabine, 5-flurouracil or platin agents, such as cisplatin, or taxanes, such as paclitaxel, docetaxel or cabazitaxel, or derivatives thereof.
  • a chemotherapeutic agent selected from pyrimidinone-based anti-neoplastic agents such as cytarabine, 5-flurouracil or platin agents, such as cisplatin, or taxanes, such as paclitaxel, docetaxel or cabazitaxel, or derivatives thereof.
  • chemotherapeutic agents are known to induce neuropathic pain, in particular this is known for taxanes, which are therefore preferred in context of the invention. Most preferred is paclitaxel.
  • said prevention or treatment of pain in accordance with the invention comprises the concomitant or sequential administration of said CYP antagonist and said chemotherapeutic agent. See for this embodiment also the description below for a combination of the invention.
  • 9,10-epoxy-12Z-octadecenoic acid (9,10-EpOME)-antagonist for use in the prevention or treatment of pain in a subject.
  • 9,10-EpOME was found to be generated by CYP activity. Therefore, instead of antagonizing CYP, the inventive result may be alternatively achieved by antagonizing the 9,10-EpOME directly in order to avoid a sensitization of pain mediating neurons.
  • Such 9,10-EpOME-antagonists of the invention are preferably small molecules but also proteins or peptides (e.g. antibodies or fragments thereof) binding to 9,10-EpOME and inhibiting the sensitization of TRPV1.
  • the problem is additionally solved by a combination comprising (i) a CYP antagonist or an 9,10-EpOME-antagonist and (ii) a chemotherapeutic agent for concomitant or sequential use in the prevention or treatment of a disease, wherein the disease is selected from a proliferative disorder, such as cancer, or pain, such as CIPNP.
  • proliferative disorder is used herein in a broad sense to include any disorder that requires control of the cell cycle, for example cardiovascular disorders such as restenosis and cardiomyopathy, auto-immune disorders such as glomerulonephritis and rheumatoid arthritis, dermatological disorders such as psoriasis, anti-inflammatory, antifungal, antiparasitic disorders such as malaria, emphysema and alopecia.
  • the compounds of the present invention may induce apoptosis or maintain stasis within the desired cells as required.
  • the proliferative disorder is a cancer or leukaemia, most preferably cancer of the breast, lung, prostate, bladder, head and neck, colon, ovarian cancer, uterine cancer, sarcoma or lymphoma.
  • the present embodiment also relates to the treatment of a subject group suffering from pain, wherein the subjects are under the treatment with a chemotherapeutic.
  • the CYP-antagonist of the invention therefore may be administered during the same period of time as the cancer treatment, or alternatively is done before or after, which can be preferable in order to avoid accumulating adverse effects.
  • the inventive result is achieved when the physiological effects of a CYP-antagonist of the invention and the pain inducement of a chemotherapeutic are combined in a subject in need of such a treatment. After the last dose of a medicament is administered during therapy, the physiological effects induced by the medicament will not diminish immediately, but most likely later.
  • the antagonists of the invention are administered in advance of a chemotherapy instead at the same time, still leads to a combination of the clinical effects of both compounds in the patient, and therefore falls under the meaning of the combination therapy of the present invention.
  • combination means in this context an active substance combination of two or more active substances in a formulation and also as a combination in the sense of individual formulations of the active substances administered at specified intervals from one another in a therapeutic treatment.
  • combination shall include the clinical reality of a co-administration of two or more therapeutically effective compounds, as it is described in context of the present invention.
  • Co-administration In the context of the present application, co-administration of two or more compounds is defined as administration of the two or more compounds to the patient within one year, including separate administration of two or more medicaments each containing one of the compounds as well as simultaneous administration whether or not the two or more compounds are combined in one formulation or whether they are in two or more separate formulations.
  • the combination of the invention in one embodiment includes that (i) and (ii) are combined by sequential or concomitant administration to a subject during said prevention or treatment, preferably wherein the antagonists and chemotherapeutics are concomitantly administered during said prevention or treatment.
  • a chemotherapeutic is preferably selected from pyrimidinone-based anti-neoplastic agents such as cytarabine, 5-flurouracil or platin agents, such as cisplatin, or taxanes, such as paclitaxel or docetaxel, or derivatives thereof. Most preferably the chemotherapeutic is paclitaxel or docetaxel.
  • Antagonists of the herein described invention are preferably selected from the group of compounds consisting of inhibitory RNA, inhibitory antibodies or fragments thereof, and/or small molecules.
  • a detailed description of preferred CYP-antagonists is provided.
  • At least one additional therapeutic effective against pain for example a morphine, an opioid or a non-opioid analgesic or other analgesic, is administered to said subject.
  • a method for the prevention or treatment of pain in a subject comprising the step of administering to said subject a therapeutically effective amount of a CYP-antagonist or a 9,10-EpOME-antagonist in accordance with the present invention.
  • the CYP-antagonist is preferably selected from the group consisting of a CYP1A-, CYP2B-, CYP2C-, CYP2E-, and CYP2J-antagonist.
  • the CYP2J-antagonist is preferably an antagonist of a mammalian homologue of CYP2J2 (CYP2J2-antagonist), preferably, human CYP2J2, such as terfenadine or telmisartan, as well as biosimilars or derivatives thereof.
  • CYP2J2-antagonist a mammalian homologue of CYP2J2
  • human CYP2J2 such as terfenadine or telmisartan
  • CYP antagonists are selected from the group consisting of estradiol, phenoxybenzamine-HCl, loratadine, clobetasol propionate, doxazosin mesylate, fenofibrate, levonorgestrel, aripiprazole, halcinonide, telmisartan, clofazimine, levothyroxine-Na, alosetron-HCl, fluocinonide, liothyronine-Na, meclizine dihydrochloride and terfenadine.
  • At least one additional therapeutic effective against pain is administered to said patient, such as other analgesics, for example an opioid or a non-opioid analgesic.
  • An additional aspect of the invention then relates to a method for increasing sensitivity of Transient Receptor Potential Vanilloid 1 (TRPV1) in a subject, comprising administering to said subject a therapeutically effective amount of 9,10-EpOME or of an CYP2J2 agonist.
  • TRPV1 Transient Receptor Potential Vanilloid 1
  • 9,10-EpOME sensitises the TRPV1 channel protein, which is a major mediator of pain perception. Therefore, the present invention in a preferred embodiment provides 9,10-EpOME as an TRPV1 agonist, which is particularly useful in medicine. Combinations of 9,10-EpOME and the TRPV1 agonist capsaicin significantly enhanced capsaicin activity.
  • One embodiment for example pertains to the treatment of a disease characterized by a pathological suppressed sensation of pain or insensitivity of pain.
  • 9,10-EpOME may be used in a method for enhancing the activity of TRPV1-agonists, such as capsaicin.
  • Capsaicin is used as an analgesic in topical ointments, nasal sprays, and dermal patches to relieve pain. It may be applied in cream form for the temporary relief of minor aches and pains of muscles and joints associated with arthritis, backache, strains and sprains, often in compounds with other rubefacients. It is also used to reduce the symptoms of peripheral neuropathy such as post-herpetic neuralgia caused by shingles.
  • capsaicin's analgesic and/or anti-inflammatory effects occurs is purportedly by mimicking a burning sensation; overwhelming the nerves by the calcium influx, leading to desensitisation and/or apoptosis of nociceptors and thereby rendering the nerves unable to report pain for an extended period of time.
  • nociceptors of neurons Underwent apoptosis, leading to reduction in sensation of pain and blockade of neurogenic inflammation. If capsaicin is removed, the nociceptive neurons recover over time. Therefore, the use of 9,10-EpOME of the invention may greatly increase the medical effects of capsaicin and related compounds, or alternatively may help to reduce capsaicin dosing.
  • a method for treating a disease in a subject comprising the administration of a therapeutically effective amount of (i) 9,10-EpOME or of an CYP2J2 agonists, and (ii) an TRPV1 agonist.
  • a disease is preferably selected from neuropathic pain (including pain associated with diabetic neuropathy, postherpetic neuralgia, HIV/AIDS, traumatic injury, complex regional pain syndrome, trigeminal neuralgia, erythromelalgia and phantom pain), pain produced by mixed nociceptive and/or neuropathic mixed etiologies (e.g., cancer), osteoarthritis, fibromyalgia, lower back pain, inflammatory hyperalgesia, vulvar vestibulitis or vulvodynia, sinus polyps interstitial cystitis, neurogenic or overactive bladder, prostatic hyperplasia, rhinitis, surgery, trauma, rectal hypersensitivity, burning mouth syndrome, oral mucositis, herpes (or other viral infections), prostatic hypertrophy, dermatitis, pruritis, itch, tinnitus, psoriasis, warts, cancers, headaches, and wrinkles.
  • any disease is comprised which
  • Exemplary and preferred TRPV1 agonist of the invention are selected from the group consisting of capsaicin, piperine, 6-gingerol, 6-shogaol, ⁇ -sanshool, ⁇ -sanshool, ⁇ -sanshool, ⁇ -sanshool, hydroxyl ⁇ -sanshool, and hydroxyl ⁇ -sanshool.
  • Another aspect then pertains to a 9,10-EpOME or an CYP2J2 agonists for use in a method as described herein above.
  • Yet another aspect pertains to a combination of (i) 9,10-EpOME or of an CYP2J2 agonist, and (ii) an TRPV1 agonist, for use in medicine, preferably in the treatment of a disease selected from neuropathic pain (including pain associated with diabetic neuropathy, postherpetic neuralgia, HIV/AIDS, traumatic injury, complex regional pain syndrome, trigeminal neuralgia, erythromelalgia and phantom pain), pain produced by mixed nociceptive and/or neuropathic mixed etiologies (e.g., cancer), osteoarthritis, fibromyalgia, lower back pain, inflammatory hyperalgesia, vulvar vestibulitis or vulvodynia, sinus polyps interstitial cystitis, neurogenic or overactive bladder, prostatic hyperplasia, rhinitis, surgery, trauma, rectal hypersensitivity, burning mouth syndrome, oral mucositis, herpes (or other viral infections), prostatic
  • the TRPV1 agonist is preferably selected from the group consisting of capsaicin, piperine, 6-gingerol, 6-shogaol, ⁇ -sanshool, ⁇ -sanshool, ⁇ -sanshool, ⁇ -sanshool, hydroxyl ⁇ -sanshool, and hydroxyl ⁇ -sanshool.
  • a subject in accordance with the herein described invention is preferably a mammal, preferably a human, most preferably a human receiving a chemotherapeutic treatment, such as a cancer patient.
  • CYP antagonists in context of the present invention are preferably selected from the group consisting of a CYP1A-, CYP2B-, CYP2C-, CYP2E-, and more preferably a CYP2J-antagonist.
  • the CYP-antagonist is an antagonist of a mammalian homologue of CYP2J2 (CYP2J2-antagonist), preferably human CYP2J2. Therefore, in most preferred embodiments and aspects of the herein described invention the term “CYP-antagonist” is a CYP2J2 antagonists, or antagonists of mammalian homologs of human CYP2J2.
  • CYP-antagonist means a substance that affects a decrease in the amount or rate of CYP expression or activity. Such a substance can act directly, for example, by binding to CYP and decreasing the amount or rate of CYP expression or activity.
  • a CYP-antagonist can also decrease the amount or rate of CYP expression or activity, for example, by binding to CYP in such a way as to reduce or prevent interaction of CYP with a CYP receptor; by binding to CYP and modifying it, such as by removal or addition of a moiety; and by binding to CYP and reducing its stability.
  • a CYP-antagonist can also act indirectly, for example, by binding to a regulatory molecule or gene region so as to modulate regulatory protein or gene region function and affect a decrease in the amount or rate of CYP expression or activity.
  • a CYP-antagonist can act by any mechanisms that result in decrease in the amount or rate of CYP expression or activity.
  • a CYP-antagonist can be, for example, a naturally or non-naturally occurring macromolecule, such as a polypeptide, peptide, peptidomimetic, nucleic acid, carbohydrate or lipid.
  • a CYP-antagonist further can be an antibody, or antigen-binding fragment thereof, such as a monoclonal antibody, humanized or human antibody, chimeric antibody, minibody, bifunctional antibody, single chain antibody (scFv), variable region fragment (Fv or Fd), Fab or F(ab)2.
  • a CYP-antagonist can also be polyclonal antibodies specific for CYP.
  • a CYP-antagonist further can be a partially or completely synthetic derivative, analog or mimetic of a naturally occurring macromolecule, or a small organic or inorganic molecule.
  • a CYP-antagonist that is an antibody can be, for example, an antibody that binds to CYP and inhibits binding to a CYP receptor, or alters the activity of a molecule that regulates CYP expression or activity, such that the amount or rate of CYP expression or activity is decreased.
  • An antibody useful in a method of the invention can be a naturally occurring antibody, including a monoclonal or polyclonal antibodies or fragment thereof, or a non-naturally occurring antibody, including but not limited to a single chain antibody, chimeric antibody, bifunctional antibody, complementarity determining region-grafted (CDR-grafted) antibody and humanized antibody or an antigen-binding fragment thereof.
  • a CYP-antagonist that is a nucleic acid can be, for example, an anti-sense nucleotide sequence, an RNA molecule, or an aptamer sequence.
  • An anti-sense nucleotide sequence can bind to a nucleotide sequence within a cell and modulate the level of expression of CYP, or modulate expression of another gene that controls the expression or activity of CYP.
  • an RNA molecule such as a catalytic ribozyme, can bind to and alter the expression of the CYP gene, or other gene that controls the expression or activity of CYP.
  • An aptamer is a nucleic acid sequence that has a three dimensional structure capable of binding to a molecular target.
  • RNA interference is a process of sequence-specific gene silencing by post-transcriptional RNA degradation, which is initiated by double-stranded RNA (dsRNA) homologous in sequence to the silenced gene.
  • RNAi double-stranded RNA
  • dsRNA double-stranded RNA
  • RNAi contains sense and antisense strands of about 21 contiguous nucleotides corresponding to the gene to be targeted that form 19 RNA base pairs, leaving overhangs of two nucleotides at each 3′ end (Elbashir et al., Nature 411:494-498 (2001); Bass, Nature 411:428-429 (2001); Zamore, Nat. Struct. Biol. 8:746-750 (2001)).
  • dsRNAs of about 25-30 nucleotides have also been used successfully for RNAi (Karabinos et al., Proc. Natl. Acad. Sci. USA 98:7863-7868 (2001).
  • dsRNA can be synthesized in vitro and introduced into a cell by methods known in the art.
  • Preferred CYP2J2 antagonists are selected from the group consisting of estradiol, phenoxybenzamine-HCl, loratadine, clobetasol propionate, doxazosin mesylate, fenofibrate, levonorgestrel, aripiprazole, halcinonide, telmisartan, clofazimine, levothyroxine-Na, alosetron-HCl, fluocinonide, liothyronine-Na, meclizine dihydrochloride and terfenadine.
  • compositions and Kits for Treating or Preventing Pain or Other Neurological Disorders are provided.
  • compositions and kits for treating or preventing pain or proliferative disorder by using the compounds or combinations of the invention.
  • the composition comprises compounds as described herein above, wherein the compounds are preferably selected from an antibody, antibody fragment, short interfering RNA (siRNA), aptamer, synbody, binding agent, peptide, aptamer-siRNA chimera, single stranded antisense oligonucleotide, triplex forming oligonucleotide, ribozyme, external guide sequence, agent-encoding expression vector, small molecule and a pharmaceutically acceptable carrier.
  • siRNA short interfering RNA
  • the language “pharmaceutically acceptable carrier” is intended to include any and all solvents, solubilizers, fillers, stabilizers, binders, absorbents, bases, buffering agents, lubricants, controlled release vehicles, diluents, emulsifying agents, humectants, lubricants, dispersion media, coatings, antibacterial or antifungal agents, isotonic and absorption delaying agents, and the like, compatible with pharmaceutical administration.
  • the use of such media and agents for pharmaceutically active substances is well-known in the art. Except insofar as any conventional media or agent is incompatible with the active compound, use thereof in the compositions is contemplated. Supplementary agents can also be incorporated into the compositions.
  • the pharmaceutically acceptable carrier comprises serum albumin.
  • the pharmaceutical composition of the invention is formulated to be compatible with its intended route of administration.
  • routes of administration include parenteral, e.g., intrathecal, intra-arterial, intravenous, intradermal, subcutaneous, oral, transdermal (topical) and transmucosal administration.
  • Solutions or suspensions used for parenteral, intradermal, or subcutaneous application can include the following components: a sterile diluent such as water for injection, saline solution, fixed oils, polyethylene glycols, glycerine; propylene glycol or other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or sodium bisulfate; chelating agents such as ethylenediaminetetraacetic acid; buffers such as acetates, citrates or phosphates and agents for the adjustment of tonicity such as sodium chloride or dextrose. pH can be adjusted with acids or bases, such as hydrochloric acid or sodium hydroxide.
  • the parenteral preparation can be enclosed in ampoules, disposable syringes or multiple dose vials made of glass or plastic.
  • compositions suitable for injectable use include sterile aqueous solutions (where water soluble) or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion.
  • suitable carriers include physiological saline, bacteriostatic water, Cremophor ELTM (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS).
  • the injectable composition should be sterile and should be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms such as bacteria and fungi.
  • the carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyetheylene glycol, and the like), and suitable mixtures thereof.
  • the proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the requited particle size in the case of dispersion and by the use of surfactants.
  • Prevention of the action of microorganisms can be achieved by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like.
  • isotonic agents for example, sugars, polyalcohols such as manitol, sorbitol, and sodium chloride in the composition.
  • Prolonged absorption of the injectable compositions can be brought about by including in the composition an agent which delays absorption, for example, aluminum monostearate and gelatin.
  • Sterile injectable solutions can be prepared by incorporating the active compound (e.g., a neuregulin) in the required amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, followed by filtered sterilization.
  • the active compound e.g., a neuregulin
  • dispersions are prepared by incorporating the active compound into a sterile vehicle which contains a basic dispersion medium and the required other ingredients from those enumerated above.
  • the preferred methods of preparation are vacuum drying and freeze-drying which yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof.
  • Oral compositions generally include an inert diluent or an edible carrier. They can be enclosed in gelatin capsules or compressed into tablets. For the purpose of oral therapeutic administration, the active compound can be incorporated with excipients and used in the form of tablets, troches, or capsules. Oral compositions can also be prepared using a fluid carrier for use as a mouthwash, wherein the compound in the fluid carrier is applied orally and swished and expectorated or swallowed. Pharmaceutically compatible binding agents, and/or adjuvant materials can be included as part of the composition.
  • the tablets, pills, capsules, troches and the like can contain any of the following ingredients, or compounds of a similar nature: a binder such as microcrystalline cellulose, gum tragacanth or gelatin; an excipient such as starch or lactose, a disintegrating agent such as alginic acid, Primogel, or corn starch; a lubricant such as magnesium stearate or Stertes; a glidant such as colloidal silicon dioxide; a sweetening agent such as sucrose or saccharin; or a flavoring agent such as peppermint, methyl salicylate, or orange flavoring.
  • a binder such as microcrystalline cellulose, gum tragacanth or gelatin
  • an excipient such as starch or lactose, a disintegrating agent such as alginic acid, Primogel, or corn starch
  • a lubricant such as magnesium stearate or Stertes
  • a glidant such as colloidal silicon dioxide
  • the compounds are delivered in the form of an aerosol spray from pressured container or dispenser which contains a suitable propellant, e.g., a gas such as carbon dioxide, or a nebulizer.
  • a suitable propellant e.g., a gas such as carbon dioxide, or a nebulizer.
  • Systemic administration can also be by transmucosal or transdermal means.
  • penetrants appropriate to the barrier to be permeated are used in the formulation.
  • penetrants are generally known in the art, and include, for example, for transmucosal administration, detergents, bile salts, and fusidic acid derivatives.
  • Transmucosal administration can be accomplished through the use of nasal sprays or suppositories.
  • the pharmaceutical compositions are formulated into ointments, salves, gels, or creams as generally known in the art.
  • the pharmaceutical composition is formulated for sustained or controlled release of the active ingredient.
  • Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic acid. Methods for preparation of such formulations will be apparent to those skilled in the art. The materials can also be obtained commercially from e.g. Alza Corporation and Nova Pharmaceuticals, Inc. Liposomal suspensions (including liposomes targeted to infected cells with monoclonal antibodies to viral antigens) can also be used as pharmaceutically acceptable carriers. These can be prepared according to methods known to those skilled in the art.
  • Dosage unit form as used herein includes physically discrete units suited as unitary dosages for the subject to be treated; each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier.
  • the specification for the dosage unit forms of the invention are dictated by and directly dependent on the unique characteristics of the active compound and the particular therapeutic effect to be achieved, and the limitations inherent in the art of compounding such an active compound for the treatment of individuals.
  • Toxicity and therapeutic efficacy of such compounds can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., for determining the LD50 (the dose lethal to 50% of the population) and the ED50 (the dose therapeutically effective in 50% of the population).
  • the dose ratio between toxic and therapeutic effects is the therapeutic index and it can be expressed as the ratio LD50/ED50.
  • Compounds which exhibit large therapeutic indices are preferred. While compounds that exhibit toxic side effects may be used, care should be taken to design a delivery system that targets such compounds to the site of affected tissue in order to minimize potential damage to uninfected cells and, thereby, reduce side effects.
  • the data obtained from the cell culture assays and animal studies can be used in formulating a range of dosage for use in humans.
  • the dosage of such compounds lies preferably within a range of circulating concentrations that include the ED50 with little or no toxicity.
  • the dosage may vary within this range depending upon the dosage form employed and the route of administration utilized.
  • the therapeutically effective dose can be estimated initially from cell culture assays.
  • a dose may be formulated in animal models to achieve a circulating plasma concentration range that includes the IC50 (i.e., the concentration of the test compound which achieves a half-maximal inhibition of symptoms) as determined in cell culture.
  • IC50 i.e., the concentration of the test compound which achieves a half-maximal inhibition of symptoms
  • Such information can be used to more accurately determine useful doses in humans.
  • the pharmaceutical compositions can be included in a container, pack, or dispenser together with instructions for administration.
  • FIG. 1 Concentrations of oxidized linoleic acid metabolites during paclitaxel CIPNP or inflammation. Shown are the concentrations of 9,10-EpOME (a) and 12,13-EpOME (b) in sciatic nerves, DRG and the spinal dorsal horn 24 h after i.p. injection of vehicle (black) or paclitaxel (grey, 6 mg-kg-1) in C57B16/N mice; n.d.: not determined. Concentrations of 9-HODE (c) and 13-HODE (d) in sciatic nerves, L4-L6-DRGs and the corresponding section of the spinal dorsal horn 24 h after i.p.
  • FIG. 2 Direct effects of 9,10-EpOME on DRG-neurons.
  • 910-EpOME [10 ⁇ M, 30 s] causes calcium transients on DRG neurons which respond to high potassium (50 mM KCl, 30 s). A representative trace is shown.
  • (b) Dose response relationship of 9,10-EpOME dependent calcium increases in DRG neurons related to the number of responding neurons Data represents the mean ⁇ SEM of five measurements per concentration.
  • (c) and (d) Calcium transients caused by 9,10-EpOME [10 ⁇ M, 30 s] can be disrupted using calcium-free medium containing EGTA (2 mM) washed in 2 minutes before and after 9,10-EpOME stimulation.
  • Data represents the mean ⁇ SEM of 24 (calcium-free) or 16 (control) neurons.
  • (e) and (f) Calcium transients of 9,10-EpOME [10 ⁇ M, 30 s] can be blocked by a selective TRPV1 antagonist (AMG 9810, 1 ⁇ M) but not by a selective TRPA1 antagonist (HC-030031, 20 ⁇ M) washed in for two minutes prior to the second 9,10-EpOME stimulation.
  • Data represents the mean ⁇ SEM of 16 (control), 31 (AMG 9810) or 18 (HC-030031) neurons; **p ⁇ 0.01, student's t-test.
  • FIG. 3 9,10-EpOME dose-dependently sensitizes TRPV1 in DRG neurons and potentiates capsaicin-induced increases in spontaneous EPSC frequency in lamina II neurons of spinal cord slices.
  • DRG neurons were double-stimulated with capsaicin (200 nM, 15 s each) and incubated with either vehicle or 9,10-EpOME [1 ⁇ M] for two minutes prior to the second capsaicin stimulation.
  • (b) Dose-dependent difference in ratio between the first and the second capsaicin response using the same protocol as described in (a).
  • Data represent the mean ⁇ SEM of the following number of neurons: 27 (control), 26 (250 nM 9,10-EpOME), 21 (500 nM 9,10-EpOME), 19 (750 nM 9,10-EpOME), 41 (1 ⁇ M 9,10-EpOME), 18 (2 ⁇ M 9,10-EpOME) or 28 (using 50 ⁇ M AITC for 20 s instead of capsaicin); *p ⁇ 0.05, **p ⁇ 0.01,***p ⁇ 0.001 student's t-test.
  • sEPSCs spontaneous EPSCs
  • FIG. 4 TRPV1-sensitization by 9,10-EpOME in DRG neurons is mediated by a Gs-coupled receptor and the cAMP-PKA pathway.
  • 9,10-EpOME catalyzed the [ ⁇ -35S]-GTP binding in membrane fractions of rat DRGs. Experiments were carried out using membrane fractions of rat DRGs in the presence of 30 ⁇ M GDP and vehicle (Methyl Acetate. 0.7% (v/v)), adenosine [10 ⁇ M] or 9,10-EpOME [1 ⁇ M] for 30 minutes. The data were obtained from 3 measurements of membrane fractions from a total of 15 animals.
  • Data represent mean ⁇ SEM of 15 (vehicle), 19 (EpOME) or 33 neurons (EpOME with H89 preincubation). (e) and (f) TRPV1 sensitization by 9,10-EpOME [1 ⁇ M] is not affected by preincubation with a PKC-inhibitor (GF 109203X, 10 ⁇ M for 1 h). Data represent mean ⁇ SEM of 18 (vehicle), 23 (EpOME) or 39 neurons (EpOME with GFX preincubation); *p ⁇ 0.05, **p ⁇ 0.01 student's t-test; n.s. not significant.
  • FIG. 5 Intraplantar or intrathecal injection of 9,10-EpOME reduces pain thresholds and sensitizes capsaicin induced mechanical thresholds in wild type mice.
  • FIG. 6 Release of iCGRP from isolated sciatic nerves or neuron enriched DRG cultures after 9,10-EpOME stimulation.
  • SIF synthetic intestinal fluid
  • SIF+EpOME 1 ⁇ M
  • vehicle DMSO 0.03% (v/v)
  • SIF+EpOME or vehicle+capsaicin (500 nM)
  • SIF represents mean ⁇ SEM from six individual sciatic nerves.
  • FIG. 7 CYP2J6 is upregulated during paclitaxel-induced neuropathic pain.
  • FIG. 8 Inhibition of CYP2J6 by terfenadine reduces lipid concentrations and ameliorates paclitaxel-induced CIPNP in vivo.
  • Data represents mean ⁇ SEM from the DRGs of five mice per group; *p ⁇ 0.05, **p ⁇ 0.01, student's t-test.
  • mice Data represent mean ⁇ SEM from 8-9 mice per group; #,*p ⁇ 0.05, two-way ANOVA with Bonferroni post hoc test (*1 mg kg-1, #2 mg kg-1 terfenadine).
  • FIG. 9 Correlation of calculated inhibition values of CYP2J2 and CYP3A4. Antagonists located in the upper left quadrant are selective for CYP2J2.
  • Luminogenic CYP2J2 assays were conducted according to the manufacturer's protocol (https://www.promega.de/resources/pubhub/enotes/cytochrome-p450-2j2-enzyme-assay-using-a-novel-bioluminescent-probe-substrate/).
  • mice Prostanoid-receptor deficient mice (DP1 ⁇ / ⁇ , IP ⁇ / ⁇ , EP2 ⁇ / ⁇ and EP4 ⁇ / ⁇ ) were bred in the Institute of Clinical Pharmocology, Frankfurt, as described previously.
  • Paclitaxel was solved in Cremophor EL/Ethanol 1:1 and diluted in saline.
  • the dose for intraperitoneal injection was set to 6 mg/kg as described previously.
  • mice were kept in test cages on an elevated grid for at least 2 h to allow accommodation.
  • Baseline measurements were performed using a Dynamic Plantar Aesthesiometer or a Hargreaves Apparatus (Ugo Basile, Comerio, VA, Italy) detecting withdrawal latency of the hind paws after mechanical stimulation.
  • the steel rod was pushed against the mid-plantar hind paw with linear ascending force (0-5 g over 10 seconds, increasing 0.5 g/s) until a fast withdrawal response occurred. Slow movements of the paw were not counted.
  • Paw withdrawal latencies (PWL) were determined in seconds (s) ⁇ 0.1 with a cut-off time of 20 s.
  • mice were kept in test cages on a warmed glass plate (32° C.) for at least 2 h on the first day to allow accommodation. Then, the mid-plantar region of the paws was stimulated with a radiant heat device, consisting of a high intensity projector lamp, until withdrawal occurred. The non-injected and injected paws were measured alternately in intervals of 5-10 min. For all behavioral tests the investigator was blinded for treatment or genotype of the mice.
  • Murine DRGs were dissected from spinal segments and directly transferred to ice cold HBSS with CaCl2 and MgCl2 (Invitrogen, Carsbad, Calif., USA). Next, isolated DRGs were incubated with collagenase/dispase (500 U/ml Collagenase; 2.5 U/ml Dispase) in neurobasal medium containing L-glutamine [2 mM] penicillin (100 U/ml), streptomycin (100 ⁇ g/ml), B-27 and gentamicin (50 ⁇ g/ml) (all from Invitrogen, Carlsbad, Calif., USA) at 37° C. for 75 min.
  • collagenase/dispase 500 U/ml Collagenase; 2.5 U/ml Dispase
  • neurobasal medium containing L-glutamine [2 mM] penicillin (100 U/ml), streptomycin (100 ⁇ g/ml), B-27 and gentamicin (
  • neurobasal medium containing 10% FCS and incubated for 10 min with 0.05% trypsin (Invitrogen, Carlsbad, Calif., USA). The washing steps were repeated and the cells were mechanically dissociated with a 1 ml Gilson pipette. Finally, the neurons were plated on poly-1-lysine (Sigma, Deisenhofen, Germany) coated glass cover slips and incubated with neurobasal medium containing L-glutamine [2 mM] penicillin (100 U/ml), streptomycin (100 ⁇ g/ml), B-27 and gentamicin (50 ⁇ g/ml) over night until assessment by calcium imaging.
  • poly-1-lysine Sigma, Deisenhofen, Germany
  • a Leica Calcium-imaging setup consisting of a Leica DMI 4000 b inverted microscope equipped with a DFC360 FX (CCD-) camera, Fura-2 filters and an N-Plan 10 ⁇ /0.25 Ph1 objective (all from Leica Microsystems, Wetzlar, Germany). Images were taken every 2 seconds and processed with the LAS AF-software. For each experiment the inventor's chose an area with large cell numbers and monitored 40-110 cells simultaneously. Calcium-Imaging experiments were performed using DRG-neurons 24-48 hours after preparation. Cells were loaded with 5 ⁇ M fura-2-AM-ester and 0.02% Pluronic F127 (both Biotium, Hayward, Calif. and incubated for 30 to 60 min. at 37° C.
  • Pluronic F127 both Biotium, Hayward, Calif.
  • the cells were washed with external solution (containing in mM: NaCl [145], CaCl2 [1.25], MgCl2 [1], KCl [5], D-glucose [10], HEPES [10]; adjusted to pH 7.3). Baseline measurements were performed in external solution at a flow rate of 1-2 ml/min. Calcium free solutions were generated by removal of CaCl2 and addition of EGTA [2 mM] and osmotically controlled by increasing NaCl concentrations to 150 mM.
  • Lumbal DRGs were dissected from mice at indicated time points and RNA was extracted using the mirVanaTM miRNA Isolation Kit (Ambion, life technologies, Carlsbad, Calif., USA). Reverse transcription and Real-time PCR were prefomed using the TaqMan® system (life technologies, Carlsbad, Calif., USA) and evaluated with the ⁇ C(T)-method as described previously 24,25. The following oligonucleotides were used for amplification of cDNA:
  • Sample extraction and standards Sample extraction was performed as described previously. Briefly, stock solutions with 2500 ng/ml of all analytes were prepared in methanol. Working standards were obtained by further dilution with a concentration range of 0.1-250 ng/ml for EETs, EpOMEs and DiHOMEs and HODEs Sample extraction was performed with liquid-liquid-extraction. Therefore tissue or cell culture medium was extracted twice with 600 ⁇ l ethyl acetate. The combined organic phases were removed at a temperature of 45° C. under a gentle stream of nitrogen.
  • the residues were reconstituted with 50 ⁇ l of methanol/water/(50:50, v/v), centrifuged for 2 min at 10,000 ⁇ g and then transferred to glass vials (Macherey-Nagel, Duren, Germany) prior to injection into the LC-MS/MS system.
  • the LC-MS/MS system consisted of an API 4000 triple quadrupole mass spectrometer (Applied Biosystems, Darmstadt, Germany), equipped with a Turbo-V-source operating in negative ESI mode, an Agilent 1100 binary HPLC pump and degasser (Agilent, Waldbronn, Germany) and an HTC Pal autosampler (Chromtech, Idstein, Germany) fitted with a 25 ⁇ L LEAP syringe (Axel Semrau GmbH, Sprockhövel, Germany).
  • High purity nitrogen for the mass spectrometer was produced by a NGM 22-LC-MS nitrogen generator (cmc Instruments, Eschborn, Germany).
  • a Gemini NX C18 column and precolumn were used (150 mm ⁇ 2 mm i. d., 5 ⁇ m particle size and 110 ⁇ pore size from Phenomenex, Aillesburg, Germany).
  • a linear gradient was employed at a flow rate of 0.5 ml/min mobile phase with a total run time of 17.5 minutes.
  • Mobile phase A was water/ammonia (100:0.05, v/v) and B acetonitrile/ammonia (100:0.05, v/v).
  • the gradient started from 85% A to 10% within 12 min. This was held for 1 min at 10% A. Within 0.5 min the mobile phase shifted back to 85% A and was held for 3.5 min to equilibrate the column for the next sample.
  • GTP ⁇ S binding assays were performed with membrane preparations of DRGs from adults rats using 1 ⁇ M 9,10-EpOME (Cayman, Ann Arbor, Mich., USA) and fresh [35S] GTP ⁇ S (1250 Ci/mmol, Perkin Elmer, Waltham, Mass., USA).
  • CGRP-measurements were performed as described previously 32 using a CGRP-enzyme immune assay kit (SpiBio, Bertin pharma, France).
  • CGRP-enzyme immune assay kit SpiBio, Bertin pharma, France.
  • DRGs of wild type BL/6N mice were dissected and treated as described above and cultured overnight in 48 well plates.
  • CYP2J2 and CYP3A4 Glo assays were performed according to manufacturers instructions (P450-GloTM, Promega).
  • CYP-derived lipids may play a role in chemotherapy-induced neuropathic pain
  • the inventors injected paclitaxel or vehicle in wild type BL/6N mice and dissected the sciatic nerves, DRGs and the spinal dorsal horn 24 h post injection. Lipid concentrations were determined using LC-MS/MS. It was found that the concentrations of the oxidized linoleic acid metabolite 9,10-EpOME ( FIG. 1A ) but not of its sister lipid 12,13-EpOME ( FIG. 1B ) or their dihydro-metabolites 9,10- and 12,13-DiHOME (see Supplementary FIG. 1 ) is strongly elevated in DRGs respectively ( FIG. 1A ).
  • FIG. 1C, 1D Also quantified was the levels of 9- and 13-HODE ( FIG. 1C, 1D ), which are generated during inflammatory pain and are endogenous activators of TRPV1 33.
  • the inventors could not detect any difference in their levels following paclitaxel treatment.
  • zymosan was injected in the hind paw of wild type BL/6N mice in order to induce inflammatory pain.
  • the L4-L6-DRGs and the corresponding section of the dorsal horn were dissected 24 h post injection at the peak of inflammation. Lipid quantification by LC-MS/MS did not reveal any difference in 9,10-EpOME levels during inflammatory pain ( FIG. 1E ).
  • the inventors characterized 9,10-EpOME concerning its effects on DRG-neurons in calcium imaging experiments.
  • the inventors observed, that a short stimulation of 30 s with 10 ⁇ M 9,10-EpOME caused a calcium transient in DRG neurons ( FIG. 2A ).
  • the inventors performed dose response analysis to investigate the potency of 9,10-EpOME in evoking calcium transients and found a maximum of 10.3% of DRG neurons responding to 25 ⁇ M of 9,10-EpOME with no significant increase in the percentage of responding neurons to higher concentrations ( FIG. 2B ).
  • the inventors used calcium-free external solution, containing 2 mM EGTA and stimulated DRG neurons twice with 10 ⁇ M 9,10-EpOME for 30 s. Two minutes before the second stimulation, calcium-free external solution was washed in and the neurons did not respond to 9,10-EpOME any more, thus indicating influx of external calcium caused by 9,10-EpOME ( FIGS. 2C, 2D ). The positive control for neurons was a final stimulation with 50 mM KCl for 30 s.
  • TRPV1 AMG 9810, 1 ⁇ M
  • TRPA1 TRPA1
  • HC-030031 20 ⁇ M
  • DRG neurons were stimulated twice with 9,10-EpOME (10 ⁇ M, 30 s) and the cells were pre-incubated with the TRP channel antagonists for two minutes prior to the second 9,10-EpOME stimulus.
  • the inventors observed, that the selective TRPV1 antagonist AMG 9810, but not the TRPA1 antagonist HC-030031 could block the second 9,10-EpOME-evoked calcium transient, indicating TRPV1 as targeted channel by 9,10-EpOME ( FIGS. 2E, 2F ).
  • the inventors analyzed if 9,10-EpOME was also capable of sensitizing TRPV1 or TRPA1 in a lower and more physiological concentration (1 ⁇ M).
  • the inventors therefore stimulated DRG neurons twice with capsaicin (200 nM, 15 s) and incubated the cells for two minutes with 9,10-EpOME [1 ⁇ M] or vehicle prior to the second capsaicin stimulus and observed a significantly stronger response of DRG neurons to capsaicin that were incubated with 9,10-EpOME, thus indicating sensitization of TRPV1 by 9,10-EpOME ( FIG. 3A ).
  • the inventors measured sEPSCs from lamina II neurons of spinal cord slices using two capsaicin stimulations [1 ⁇ M] and incubating the cells prior to the second capsaicin stimulus with 9,10-EpOME [1 ⁇ M] ( FIG. 3C ).
  • 9,10-EpOME alone slightly increased the frequency of sEPSCs.
  • the sEPSC frequency was strongly potentiated ( FIG. 3D ).
  • no difference in the amplitude of sEPSCs could be observed with either 9,10-EpOME, TRPV1 or the combination of both substances ( FIG. 3E ).
  • lipid mediated TRPV1-sensitization mostly involves activation of a G-protein coupled receptor
  • the inventor's performed GTP ⁇ S assays to analyze whether 9,10-EpOME is capable of activating a GPCR in DRGs and observed a significantly increased signal of GTP ⁇ S after incubation with 1 ⁇ M 9,10-EpOME ( FIG. 4A ).
  • the inventor's next measured cAMP in neuron enriched DRG cultures that were stimulated with either vehicle, 9,10-EpOME, the IP-receptor agonist cicaprost or forskolin [1 ⁇ M each] for 15 minutes.
  • the inventor's observed that 9,10-EpOME caused a significant increase in cAMP concentrations compared to its vehicle ( FIG. 4B ).
  • TRPV1 can be phosphorylated by PKA and PKC, both resulting in increased activity and sensitization of the channel 35
  • the inventors could reproduce the capsaicin-dependent TRPV1 sensitization using the same protocol as mentioned above with double capsaicin stimulation and an in-between incubation with 9,10-EpOME.
  • FIGS. 4C, 4D The use of the PKC-inhibitor GF 109203X (GFX) under the same conditions (10 ⁇ M, preincubation for 1 h) did not have any effect on 9,10-EpOME derived TRPV1 sensitization ( FIGS. 4E, 4F ), thus pointing toward PKA- but not PKC-mediated TRPV1 sensitization by 9,10-EPOME.
  • the inventors then tested the Galphas-coupled prostanoid receptors for their potential involvement in 9,10-EpOME dependent TRPV1 sensitization in calcium imaging experiments.
  • Prostanoid receptors have varying specificity for their ligand prostanoids and may as well be activated by other lipids.
  • the inventors could not observe any reduction in 9,10-EpOME evoked TRPV1-sensitization in the DRGs of either Prostaglandin E receptors EP2 and EP4 or prostaglandin D- or I-receptor (DP- and IP-receptor) deficient mice (not shown).
  • 9,10-EpOME lipid in hind paws of wild type BL/6N mice and measured the thermal ( FIG. 5A ) and mechanical thresholds ( FIG. 5B ) up to 5 h post injection.
  • 9,10-EpOME caused a significant reduction of the pain thresholds lasting 1 h (thermal) or 2 h (mechanical) after injection ( FIG. 1A, 1B ).
  • the inventors then injected 9,10-EpOME intrathecally and measured thermal and mechanical thresholds in short time intervals. A significant but rather weak reduction of the thermal thresholds 30 minutes after i.th. injection was observed ( FIG. 5C ). However, the mechanical thresholds were decreased for up to 1.5 h after i.th. injection of 9,10-EpOME ( FIG. 5D ).
  • CGRP calcitonin gene related peptide
  • 9,10-EpOME synthesis is regulated during paclitaxel CIPNP. Since 9,10-EpOME is supposed to be synthesized by CYP-epoxygenases of the subfamilies 2C and 2J 16,38, the inventors examined the expression of murine CYP-expoxygenases of these subfamilies. Eight days after paclitaxel treatment, the inventors observed a stable plateau in the mechanical thresholds of paclitaxel treated mice ( FIG. 7A ).
  • the inventors then dissected DRGs of vehicle and paclitaxel treated mice and investigated the expression of murine CYP2C29, CYP2C37, CYP2C38, CYP2C39, CYP2C44, CYP2J6 and CYP3A11.
  • CYP isoforms 2C29 and 2C44 could not be detected in murine DRGs.
  • the inventors observed that CYP2J6 showed the strongest expression in the DRGs of paclitaxel treated mice compared to vehicle treatment ( FIG. 7B ). This increased expression in CYP2J6 correlates with increased levels of 9,10-EpOME eight days after paclitaxel treatment, as analyzed by LC-MS/MS measurement of sciatic nerve, lumbar DRGs and the spinal cord.
  • Terfenadine a potent inhibitor of the human CYP2J2, which is the analogue protein of murine CYP2J6, was used as an antagonist. Since the interaction sites of Terfenadone and the human CYP2J2 have already been described, the inventors aligned the amino acids of the murine CYP2J6 and the human CYP2J2 and found all putative interaction sites with Terfenadone (Leu83, Met116, Ile127, Phe30, Thr315, Ile376, Leu378, Va1380, Leu402 and Thr488) at the same position in both proteins except Arg117 which is exchanged to glutamine.
  • Terfenadine Based on the surprising amino acid sequence similarity between CYP2J2 and CYP2J6 Terfenadine interacts as well with CYP2J6 and inhibits the protein.
  • the inventors injected mice that had received paclitaxel eight days before with 1 mg ⁇ kg-1 Terfenadine i.v. After two hours, the inventors dissected the sciatic nerve, DRGs and the dorsal spinal cord and quantified epoxylipids in these tissues. The inventors could observe a significant reduction of the 9,10-EpOME concentrations in all investigated tissues ( FIG. 8A ).
  • the inventors also observed, that the remaining concentrations of all measured epoxylipids and their (9,10-EpOME, 12,13-EpOME, 9,10-DiHOME, 12,13-DiHOME and 14,15-EET) were reduced significantly in DRGs, the spinal dorsal horn and the plasma, but not in the sciatic nerve of Terfenadine treated animals respectively ( FIG. 8B ).
  • Terfenadine is a histamine-1-receptor antagonist
  • the inventors used Loratadine, another H1-receptor-antagonist that does not inhibit CYP2J2, to investigate, if the antinociceptive effects are really caused by inhibition of CYP2J2, or the histamine-1-receptor.
  • Treatment with Loratadine did not reduce paclitaxel-induced CIPNP compared to the vehicle ( FIG. 8D ).
  • the Screens-Well® FDA Approved Drug Library v2 was screened for new selective antagonists of CYP2J2 for use in the context of the herein described invention.
  • the enzymatic CYP-Glo luciferase based reaction was used to assay the activity of CYP2J2 and as unselective control CYP3A4. Tefenadine was used as positive control in the experiments.
  • the Results from both screens are depicted in FIG. 9 .
  • Antagonists that showed over 60% inhibition against CYP2J2 and about 0% inhibition of CYP3A4 are regarded as selective CYP2J2 antagonists and are useful for the methods and uses as described herein, and are listed in table 2 below:
  • 9,10-EpOME is capable of sensitizing TRPV1 in DRG neurons via a cAMP-PKA dependent mechanism in submicromolar concentrations, leading to subsequent release of iCGRP from DRGs.
  • the inventors could also detect 9- and 13-HODE in murine tissue, most predominantly in peripheral tissues.
  • the inventors used the CYP2J2-inhibitor Terfenadine to reduce synthesis of 9,10-EpOME and could reduce the levels of epoxylipids to about 50%. Treatment with Terfenadine resulted in reduced mechanical hypersensitivity in mice during paclitaxel CIPNP. Antagonists of CYP2J2 and its homologs are therefore useful for treating or preventing CIPNP, which was confirmed because animals that were treated with Loratadine, a selective H1-receptor antagonist, that does not affect CYP2J2, did not show an improvement in paclitaxel CIPNP, thus indicating that the effect that was observed with Terfenadine is due to inhibition of CYP2J2 and not of the histamine 1-receptor.
  • Chemotherapy-induced neuropathic pain and subsequent sensory dysfunctions still remain the most severe side effects of cytostatics. Especially during paclitaxel-treatment, an early acute pain syndrome can be observed which seems to be mediated by sensitization of nociceptive neurons. However, there is no information available on endogenous mediators that may contribute to this pathophysiological state. According to the inventor's data, 9,10-EpOME-dependent TRPV1 sensitization and increased activity of nociceptive neurons may thus contribute to paclitaxel acute pain syndrome (P-APS).
  • P-APS paclitaxel acute pain syndrome
  • CYP2J2-inhibitors may be superior over using antioxidants, because they have been reported to even reduce cancer growth in vitro and in vivo by activating caspase-3, Bax and Bcl-2 and by reducing tumor cell migration and adherence.

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