Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/12—Cyclic peptides, e.g. bacitracins; Polymyxins; Gramicidins S, C; Tyrocidins A, B or C
  • A61K38/13—Cyclosporins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/1703—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/1703—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
  • A61K38/1709—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection

Definitions

• This invention relates to pharmaceutical formulations useful in the treatment of chronic rejection of allografts and rejection of concordant xenografts.
• the invention therefore relates to the promotion of graft survival, or prevention of graft loss, in a host.
• Allografting is the transplantation of tissue between two members of the same species.
• Xenografting which is the transplantation of tissues between two different species, has been divided by biological criteria into two subsets (Calne, Transpl ant . Proc . II .550-556 (1970)) .
• the two subsets are concordant xenografts and discordant xenografts.
• the distinction between these two subsets is that a vascularised organ graft transplanted between discordant species is rejected hyperacutely, that is to say within a few minutes or hours of revascularisation. Between concordant species, hyperacute rejection of xenografts does not take place. Grafts will, however, be rejected, and often in an accelerated manner, but this will occur over several days and not within hours or minutes.
• species having a concordant relationship include hare-rabbit, hamster-rat and non-human primate-human, including, for example, baboon-human, chimpanzee-human and macaque-human.
• Adachi et al report that "in our study, there was no statistically significant difference in mean survival time between the group treated with cyclosporin A and cobra venom factor and the group treated with cobra venom factor alone" . Mean survival times were between 40 and 50 hours.
• Kemp et al Transplant . Proc . XIX (6) 4471-4474 (1987) also studied various potential discordant xenograft survival promoters in a study of rabbit kidney xenografts into cats.
• Candidate survival promoters included captopril, enalapril, nifedipine, prostacycli , sodium chromoglycate , an azathioprine/corticosteroid combination, cyclosporin A and cobra venom factor. Hyperacute rejection was not prevented by any of these candidate drugs except for cobra venom factor which, the authors state, "had a striking effect, with prolongations in graft survival up to seven days".
• the present invention seeks to promote the better survival of, or to rescue from rejection, concordant xenografts and/or allografts.
• the invention is based on the realisation that concordant xenograft survival, and also allograft survival, can be markedly enhanced by treatment with a combination of cyclosporin A and cobra venom factor, or by combinations of compounds having similar modes of action.
• a pharmaceutical formulation comprising a complement inhibitor and an immunosuppressant with cyclosporin A-like activity.
• a first component is a complement inhibitor.
• the complement inhibitor may either prevent the activation of complement or remove or deplete it, or one or more of its components.
• the complement inhibitor will inhibit both the classical and alternative pathways of complement activation. It is therefore preferred that the complement inhibitor acts to block the pathway at C3, whether by inhibition or removal or depletion.
• antibodies for example monoclonal antibodies against C3 may be used as the complement inhibitor in the present invention.
• Other useful complement inhibitors include soluble decay activating factor (DAF) and soluble membrane cofactor protein (MCP) .
• DAF soluble decay activating factor
• MCP soluble membrane cofactor protein
• One of the most preferred complement inhibitors is cobra venom factor.
• Snake venoms are among the most complex of animal secretions, containing a vast number of substances with different pharmacological and biochemical activities.
• the presence in venoms of principles affecting complement has been known for almost a century.
• the action of the venom of the cobra (Naj a naja kaouthia ) on serum complement has been studied in some detail.
• the active factor is a glycoprotein with a molecular weight of 144kDa, which combines with serum factor B in the presence of magnesium ions.
• Factor B is then split into two components by the proteolytic action of serum factor D, creating Bb and Ba.
• the complex CoF-Bb where CoF represent cobra venom factor, is a highly active C3- and C5-splitting enzyme or convertase.
• the CoF-Bb is resistant to the normal complement regulatory systems. Therefore, its action will continue, until all C3 has been converted, thus effectively depleting the individual of complement activity.
• Splitting of C5 releases C5a, which has anaphylactoid action; not all Naja cobra venom factors possess this C5 convertase activity, but this is not believed to be important for the purposes of the present invention. Inhibition of complement is not restricted to venoms of the Naj a genus.
• Cobra venom factor, and other snake venom factors will generally not be administered in the present invention in their native form, because of the obvious problems of toxicity. In the absence of other measures to combat the toxicity problem, therefore, it will generally be necessary at least partially to purify the active factor from the crude venom. It is not necessary for cobra or other snake venom factor to be purified to homogeneity for use in the present invention, but clearly regulatory problems if nothing else would tend to prescribe the use of a substantially purified factor.
• Cobra venom factor, as a semi-purified preparation can be obtained from chemical suppliers such as Sigma (Sigma Chemicals Limited, Poole, Dorset) , who also supply crude cobra venom for in-house purification. An example of a preparative process for cobra venom factor from crude cobra venom is given in the examples.
• a second component of pharmaceutical formulations in accordance with this invention is an immunosuppressant with cyclosporin A-like activity .
• Such compounds will be well known to those skilled in the art and include cyclosporins other than cyclosporin A , such as cyclosporin C and cyclosporin G .
• Eicosanoids also have cy c l o sp o r i n A- l i k e a ct ivity and i n c l ud e PG I 2 (prostacyclin) , PGE 2 , PGD 2 , rapamycin and FK 506 (Fujisawa) .
• Compound FK 506 is one of those that is preferred for use in the present invention, but the most preferred is cyclosporin A itself. Cyclosporin A is available from Sandoz under the trademark SANDIMUN.
• a particularly preferred embodiment of the present invention is a pharmaceutical formulation which comprises cobra venom factor and cyclosporin A, two of the most preferred individual compounds discussed above.
• a product containing a complement inhibitor and an immunosuppressant with cyclosporin A-like activity for use as a combined preparation for simultaneous, separate or sequential use in promoting allograft or concordant xenograft survival or rescue from rejection.
• kits comprising a pharmaceutical preparation of a complement inhibitor and a pharmaceutical preparation of an immunosuppressant with cyclosporin A-like activity.
• Cyclosporin A and other im unosuppressants with cyclosporin A-like activity will usually be administered parenterally in the practice of the present invention. In such cases, the preparation containing the immunosuppressant will be sterile. However, cyclosporin A itself, and some other immunosuppressants, may be administered orally, in which case sterility is not essential. Cyclosporin A itself is only sparsely soluble in water and for practical purposes it is preferred to dissolve it in an oil, such as a vegetable oil. Olive oil has been found to be acceptable in practice. Dissolution in oil is only necessary when dealing with an immunosuppressant which is not soluble in water, and in general terms, the immunosuppressant may be dissolved in any appropriate physiologically acceptable carrier.
• concentration at which the immunosuppressant is prepared will of course depend on the nature of the immunosuppressant itself and the intended dose, which will generally be under the guidance of the clinician or physician. As a general guide, however, it has been found appropriate to prepare formulations of the cyclosporin at a concentration of from 1 to 100 mg/ml, for example from 1 to 10 mg/ml, typically about 5 mg/ml for parenteral purposes or 25 to 100 mg/ml, for example from 50 to 100 mg/ml, typically about 100 mg/ml for oral administration.
• Complement inhibitors such as cobra venom factor will generally be given parenterally and for this purpose will generally be sterile.
• Cobra venom factor itself may be formulated in phosphate buffered saline (without azide) or any other suitable solvent or carrier. It may be that oral formulations can be developed.
• concentration of complement inhibitor in a pharmaceutical formulation will again depend on the ultimate intended dose, which will be under the control of the clinician or physician.
• a preparation of cobra venom factor in PBS can be made at a concentration ranging from 0.05 mg/ml up to the limit of solubility, which will be dependent on its purity.
• Compositions having a concentration up to 5 mg/ml may be useful in practice, for example those having a concentration of from 0.1 to 2 mg/ml, for example about 0.5 mg/ml.
• cyclosporin A is essentially not soluble in aqueous media, whereas cobra venom factor is, these two preferred active ingredients will generally be formulated separately and administered separately in practice. This is not in principle essential, however, as it may be possible to formulate an appropriate emulsion of the two active ingredients, and different combinations of active ingredients may be soluble in a common solvent or at least suspendable in a common carrier.
• Intravenous injection may be appropriate in some circumstances and subcutaneous injection may have some if not all of the advantages of intramuscular injection. Intraperitoneal injection could be used if circumstances dictate.
• a complement inhibitor and an immunosuppressant with cyclosporin A-like activity in the preparation of an agent for promoting allograft or concordant xenograft survival or rescue from rejection. It will therefore be appreciated that the invention has application in a method of promoting allograft or concordant xenograft survival, or rescue from rejection, in a host, the method comprising administering to a graft recipient or an intended graft recipient a complement inhibitor and an immunosuppressant with cyclosporin A-like activity.
• a primary advantage of the present invention as it relates to allografts is that the combination of active ingredients useful in the present invention would be useful for preventing chronic rejection or managing chronic rejection (ie rescuing from rejection) after its onset; this usually happens many years post-transplant.
• Allograft recipients suffering from chronic graft rejection, or at risk from chronic graft rejection may well be receiving immunosuppression with cyclosporin A or another immunosuppressant having cyclosporin A-like activity.
• cyclosporin A or another immunosuppressant having cyclosporin A-like activity for the purposes of this invention, in order to treat or prevent chronic graft rejection in such patients it is necessary only to add complement inhibitor therapy.
• a complement inhibitor in the preparation of an agent for promoting allograft or concordant xenograft survival, or rescue of such a graft from rejection, in a graft recipient being treated with an immunosuppressant with cyclosporin A-like activity.
• the invention therefore has application in a method of promoting allograft or concordant xenograft survival and/or of rescuing such a graft from rejection, in a host, the method comprising administering to a graft recipient or an intended graft recipient, being treated with an immunosuppressant with cyclosporin A-like activity, a complement inhibitor.
• the immunosuppressant with cyclosporin A-like activity will be administered at any suitable effective but non- toxic level, having regard to the species being treated and the organ being transplanted.
• the upper limit of cyclosporin A tolerance in humans is determined by its nephrotoxicity and the age of the recipient. 20 mg/kg per day may be a safe upper limit for treating humans in many cases, although other species may well have higher tolerances.
• Cyclosporin A is effective at low doses, and so the lowest amount that may be administered will simply be the lowest amount that gives an effective response. Amounts of 1 or 2 mg/kg per day have in some cases found to be effective. As a general guide, between 5 and 10 mg/kg per day can be administered.
• cyclosporin A may be given on alternate days, in which case the dose would be doubled.
• daily dosage will be the regimen of choice; more particularly cyclosporin A may be administered- twice or more frequently per day to give a total daily dose in the order of 5 to 10 mg/kg, for preference.
• Other immunosuppressants with cyclosporin A-like activity will be administered at effective but non-toxic doses, as will be determined by the clinician or physician.
• the complement inhibitor such as cobra venom factor
• CH 50 complement haemolysis 50
• the safe upper limit for the administration of cobra venom factor has not been determined, but doses of 2 mg/kg do not appear to be toxic.
• the minimum dosage of cobra venom factor is species dependent and can readily be determined by the CH 50 assay.
• Daily doses of between 0.01 and 0.1 or 0.2 mg/kg have been found to be effective for cobra -venom factor.
• Effective and non-toxic dosages of other complement inhibitors can also readily be determined by those skilled in the art, for example, using the CH 50 assay.
• Cobra venom factor takes about 6 hours for its initial activity to take effect after intramuscular administration. Once the initial activity is observed, it can last for more than 1 day, for example 2 days, and so daily administration of cobra venom factor may not be necessary. In fact, it is preferred to administer cobra venom factor on alternate days, in which case the preferred daily dosages given above will be doubled on the day of administration. In practice, it has been found that a particularly suitable dosage regimen is to administer 0.4 mg/kg intramuscularly on alternate days.
• Cyclosporin A or other immunosuppressant administration will usually be continuous.
• Cobra venom factor or other complement inhibitor administration will generally not be continuous, but may be prolonged; even this may not in practice be essential, as short term therapy may be all that is needed for the treatment for, or rescue from rejection of, concordant xenografts.
• FIGURE 1 is a graph of hamster heart xenograft survival in rats, with percentage survival being plotted against days post transplant;
• FIGURE 2 is a graph of hamster heart xenograft survival in cyclophosphamide treated rats; the graph otherwise corresponds to Figure l, Preparation
• This preparation gives a protocol for preparing cobra venom factor from crude cobra venom.
• the whole of the cobra venom factor pool was pumped onto a 90cm x 26mm (internal diameter) column of Sephadex G200 (fine) (Pharmacia GB Limited, London) , equilibrated with PBS (no azide) and eluted with PBS at 36 ml per hour. 6 ml fractions were collected and assayed for anti-complementarity activity.
• the cobra venom factor fractions ie the active fractions
• test plate made from: 6
• the rats are DA rats from Banting and
• Example 3 (Comparison Example) 5 6 The procedure of Example 1 was repeated, except that 7 cobra venom factor was administered at a dosage of 0.4 8 mg/kg per alternate day. The cobra venom factor was 9 administered as a 0.5 mg/ml solution in azide-free PBS. 0 The first injection was made intramuscularly at the 1 time of transplantation, and subsequent intramuscular 2 injections were made on alternate days thereafter. The 3 graft rejection data are again presented in Figure 1. 4 The results are shown on line 3, which indicates that 5 the median survival rate for the grafts is 6 days.
• Example 4 8 9 The procedure of Example 1 was repeated, except that 0 both cyclosporin A and cobra venom factor were 1 administered to the recipient. Cyclosporin A was 2 administered at a dose of 20 mg/kg on alternate days, 3 so that the conditions for cyclosporin administration were the same as in Example 2. The cobra venom factor was administered under the same conditions as described in Example 3. Both the cyclosporin A and the cobra venom factor were first administered at the time of transplantation. Graft survival data are again shown in the figure. In this example, no graft rejection is observed, as can be seen from line 4 of Figure 1. At present, median graft survival is in excess of 50 days.
• Example 4 The procedure of Example 4 was repeated, except that cobra venom factor administration was discontinued after 28 days post transplant. Median graft survival was greater than 100 days. Two animals were sacrificed at 103 and 105 days and histological examination of the graft showed normal cardiac architecture. A remaining rat has survived with a beating hamster heart for more than 5 months so far.
• Example 20 rats were given hamster hearts by the protocol described in Example 1. They were treated with cyclosporin A as described in Example 2 , and in addition they were given ENDOXAN cyclophosphamide i.p. (20 mg/kg) one day pre-transplant (day-l) and on day 2 post-transplant.
• ENDOXAN is a trade mark for cyclophosphamide, which is an inhibitor of antibody production.
• the hamster hearts were rejected as shown in line 5 of Figure 2.
• the observed delayed rejection in which the delay was a result of the short cyclophosphamide therapy, simulates a delayed xenograft rejection of the type that would result from inadequate immunosuppressive protocols.
• Example 6 Five rats were treated as in Example 6, but additionally were treated with cobra venom factor as in Example 4 from day 7. Treatment with cobra venom factor lasted for 14 days. All animals were rescued from rejection, as can be seen from line 6 of Figure 2.

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Cited By (7)

• 1990
  • 1990-04-09 GB GB909007971A patent/GB9007971D0/en active Pending
• 1991
  • 1991-04-02 MY MYPI91000550A patent/MY106158A/en unknown
  • 1991-04-03 ZA ZA912467A patent/ZA912467B/xx unknown
  • 1991-04-03 IN IN265MA1991 patent/IN173149B/en unknown
  • 1991-04-04 EP EP91907303A patent/EP0527762B1/en not_active Expired - Lifetime
  • 1991-04-04 WO PCT/GB1991/000522 patent/WO1991015221A1/en not_active Ceased
  • 1991-04-04 DE DE69121401T patent/DE69121401T2/de not_active Expired - Fee Related
  • 1991-04-04 JP JP50651691A patent/JP3518547B2/ja not_active Expired - Fee Related
  • 1991-04-04 ES ES91907303T patent/ES2090325T3/es not_active Expired - Lifetime
  • 1991-04-04 AU AU75555/91A patent/AU7555591A/en not_active Abandoned
  • 1991-04-04 SG SG1996001900A patent/SG47465A1/en unknown
  • 1991-04-04 DK DK91907303.1T patent/DK0527762T3/da active
  • 1991-04-04 AT AT91907303T patent/ATE141167T1/de not_active IP Right Cessation
  • 1991-04-08 IE IE115391A patent/IE911153A1/en not_active IP Right Cessation
  • 1991-04-08 NZ NZ237739A patent/NZ237739A/xx unknown
  • 1991-04-08 PT PT97277A patent/PT97277B/pt not_active IP Right Cessation
  • 1991-04-08 IL IL97788A patent/IL97788A/en not_active IP Right Cessation
  • 1991-04-09 SK SK988-91A patent/SK279949B6/sk unknown
  • 1991-04-09 CZ CS91988A patent/CZ283119B6/cs not_active IP Right Cessation
  • 1991-04-09 CN CN91102859A patent/CN1040178C/zh not_active Expired - Fee Related
• 1996
  • 1996-11-14 GR GR960403013T patent/GR3021642T3/el unknown
• 1997
  • 1997-04-17 HK HK48597A patent/HK48597A/en not_active IP Right Cessation

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