Classifications

• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/20—Interleukins [IL]
  • A61K38/2066—IL-10
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • 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

• the present invention concerns pharmaceutical compositions for promoting the healing of wounds or fibrotic disorders, in particular for promoting the healing of wounds or fibrotic disorders with reduced scarring.
• wounds or fibrotic disorders any condition which may result in the formation of scar tissue.
• this includes the healing of skin wounds, the repair of tendon damage, the healing of crush injuries, the healing of wounds to the eye, including wounds to the cornea, the healing of central nervous system (CNS) injuries, conditions which result in the formation of scar tissue in the CNS, scar tissue formation resulting from strokes, and tissue adhesion, for example, as a result of injury or surgery (this may apply to e.g. tendon healing and abdominal strictures and adhesions).
• fibrotic disorders include pulmonary fibrosis, glomerulonephritis, cirrhosis of the liver, systemic sclerosis, scleroderma and proliferative vitreoretinopathy.
• reduced scarring is meant reduced level of scarring relative to an untreated wound or fibrotic disorder.
• compositions for treating and promoting the healing of chronic wounds for example venous ulcers, diabetic ulcers and bed sores (decubitus ulcers), especially in the elderly and wheel chair bound patients.
• Such compositions may be extremely useful in patients where wound healing is either slow or in whom the wound healing process has not yet started.
• Such compositions may be used to "kick- start" wound healing and may then be used in combination with compositions for promoting healing with reduced scarring. Hence not only may a chronic wound be healed, but it may be healed with reduced scarring.
• IL-10 Interleukin-10
• Th2 cells Fiorentino, D.F. and Moddman, T.R., 1989, J. Exp. Med., 170: 2081-2095
• O'Garra, A. et al, 1990, Internal Immunol., 2: 821-823 was originally identified as a product of B - cell lymphomas that prolonged the survival of mast cells and enhanced proliferation of thymocytes.
• Mouse IL-10 (mIL-10) protein consists of 157 amino acids with two potential N- glycosylation sites although glycosylation is not essential for the biological activities of mIL-10.
• Human IL-10 (hIL-10) protein consists of 160 amino acids with one potential N-glycosylation site which is not used (Vieira et al., 1991).
• Both mIL-10 and hIL-10 contain four cysteine residues that form two intramolecular disulphide bonds generating biologically active homodimers with molecular weights of 32 kDa and 39 kDa respectively, and it is not clear whether monomeric forms of IL-l 0 are biologically active. Although there is 80% homology between hIL-10 and mIL-10, only hIL-10 acts on both human and mouse cells, whereas mIL-10 has species specificity activity (Vieira et al, 1991 ; Kim, J.M. et al, 1992, J. Immunol., 148: 3618-3623). There are many cellular sources and major biological activities of IL-l 0, all of which may play some role in the wound microenvironment.
• IL-10 possesses many stimulatory and inhibitory effects - van Vlasselar et al (1994, J. Cell Biol., 124: 569-577) showed that IL-10 inhibited TGF- ⁇ synthesis required for osteogenic commitment of mouse bone marrow cells, and hence the resulting mineralised matrix, whereas Go et al (1990, J. Exp. Med., 172: 1625-1631) showed IL-10 to be a novel B-cell stimulatory factor.
• IL-10 has also been shown by Bogdan et al. (1991, J. Exp. Med., 174: 1549-1555) to directly act on macrophages and inhibit their subsequent activation and hence release of pro-inflammatory cytokines (see also Berg. D. J. et al, 1995, J. Exp. Med., Ji2: 99-10; Chernoff, A. E. et al, 1995, J. Immunol.154 (10): 5492- 5499).
• IL-10 may be used to promote the healing of wounds or fibrotic disorders with reduced scarring. It appears that by inhibiting inflammation at a wound site or site of a fibrotic disorder, in particular at an early stage after wounding/onset, there is a "knock-on" effect upon the resulting collagen matrix, resulting in an improved architecture and reduced scarring. This result is particularly surprising since in the short- term, there was no inhibition of re-epithelialisation or early wound repair, whilst in the longer-term, it improved the quality of later scar formation and reduced scarring.
• IL-10 or a fragment or a partially modified form thereof for use in promoting the healing of wounds or fibrotic disorders with reduced scarring.
• fragment or partially modified form thereof is meant a fragment or partially modified form of IL-10 which retains the anti-inflammatory healing functionality of IL-l 0, although it may of course have additional functionality.
• Partial modification may, for example, be by way of addition, deletion or substitution of amino acid residues.
• a substitution may be a conserved substitution.
• the partially modified molecules may be homologues of IL-l 0. They may, for example, have at least 40% homology with IL-10. They may for example have at least 50, 60, 70, 80, 90 or 95% homology with IL-10.
• IL-10 or a fragment or a partially modified form thereof may be for use in conjunction with a pharmaceutically acceptable carrier, diluent or excipient.
• IL-10 or a fragment or a partially modified form thereof may be for use in conjunction with a composition for promoting the healing of wounds of fibrotic disorders with reduced scarring.
• IL-10 or a fragment or a partially modified form thereof may be for use in conjunction with a composition for promoting the healing of chronic wounds.
• Also provided according to the present invention is a method of promoting the healing of wounds or fibrotic disorders with reduced scarring comprising the use of IL-10 or a fragment or a partially modified form thereof.
• IL-10 or a fragment or a partially modified form thereof may be administered to a wound site or site of a fibrotic disorder.
• IL-10 or a fragment or a partially modified form thereof may be administered at a concentration of between about 1 ⁇ M and about 10 ⁇ M. It may be administered at a concentration of between about 2.5 ⁇ M and about 5 ⁇ M.
• IL-10 or a fragment or a partially modified form thereof may be administered immediately prior to wound healing, but may be effective if administered within about 7 days of wounding. It could be administered on at least two occasions.
• the method may be used in conjunction with a method or composition for promoting the healing of wounds or fibrotic disorders with reduced scarring.
• the method may be used in conjunction with a method or composition for promoting the healing of chronic wounds.
• Figure 1 shows the inflammatory profile of incisional wounds treated with IL-10, injected at day 0;
• Figure 2 shows the inflammatory profile of incisional wounds treated with IL-10, injected at days 0 and 7;
• Figure 3 shows the blood vessel profile of incisional wounds treated with IL-10, injected at day 0;
• Figure 4 shows the blood vessel profile of incisional wounds treated with 11-10, injected at days 0 and 7.
• Rats were wounded and treated with various compositions and then harvested and the wounds analysed in order to analyse the effects of anti-inflammatory cytokines upon wound healing. Results show that in the short-term, there was no inhibition of re- epithelialisation or early wound repair, whilst in the longer-term, it improves the quality of later scar formation and reduced scarring.
• group B were injected with IL-10 or PBS on day 0 prior to wounding and day 7 post wounding (pw).
• a third group (C) had the same injection regime as group B although they were treated with double the dose of IL-l 0 (5 ⁇ g/ml). Animals were killed on days 3 (group A only), 7, 14 and 84 post wounding. Wounds and approximately 0.5 cm of normal skin either side, were excised and bisected for routine wax histology and immunocytochemistry.
• a further group of eight animals were injected with 100 ⁇ l of IL-10 (1.25 ⁇ g/ml) on days 0 and 7 only. Animals were killed on 7 and 84 days post wounding. After macroscopic analysis wounds were excised for routine histology and immunocytochemistry as before.
• a repeat group of eight animals were injected with 100 ⁇ l of IL-l 0 (2.5 ⁇ g/ml) and killed at 84 days post wounding. After macroscopic analysis wounds were excised and treated as before.
• Macroscopic appearances of treated and control wounds were captured using a PC image analysis system. The wounds were scored on a linear scale from 0-5 with 0 being normal dermis and 5 a bad scar. 90% of treated wounds score 2 or less, whereas 10% were in the 3 and 4 bracket. 90% of control wounds scored 3 or more and 10% scored 2 or less. Macroscopically there appears to be less scar formation with treatment of IL-10 compared to controls.
• H&E Haemotoxylin and eosin
• IL-10 treatment decrease the number of inflammatory cells influxing into the wound at day 3 and 7 post wounding when compared to PBS treatment (control).
• the degree of scarring is qualitatively assessed by studying Masson's trichrome stained wound sections at 84 days post wounding and grading features ofthe neodermis such as fibre size, length and density. Wounds treated with IL-10 (2.5 ⁇ g/ml) on day 0 only show improved restitution of the dermal architecture when compared with control wounds.
• the IL-10 treated wounds have larger, less densely packed fibres in a more random orientation (basket weave) compared with control wounds where the collagen fibres are finer, more densely packed and aligned parallel to the epidermis.
• the resultant dermal architecture resembles normal skin with a more basket weave configuration of the collagen fibres within the wound.
• the appearance of the scar is far superior to control wounds and wounds treated with IL-10 on day 0 only.
• 2.5 ⁇ g/ml of IL-10 appears to be the maximal dose as wounds treated with the higher dose (5 ⁇ g/ml) have a more visible macroscopic scar.
• Elastin architecture was assessed using Gomori aldehyde fushin stain. In early control or treated wounds there was little elastin staining when compared to normal dermis but at 84 days although there were fewer fibres in wounds compared to normal dermis there was an increase in elastin staining in IL-10 treated wounds compared to controls. The elastin fibres were associated with the collagen fibres in the scar. Whilst IL-10 treatment appears to inhibit inflammation and improve the quality of later scar formation, it does not inhibit re-epithelialisation or early wound repair.
• Table 1 (Figure 1) Inflammatory cell (EDI) profile of incisional wounds treated with IL-10 (injected at day 0)
• Table 2 ( Figure 2) Inflammatory cell profile of incisional wounds treated with IL-10 (injected at days 0 and 7)
• Table 3 ( Figure 3) Blood vessel profile of incisional wounds treated with IL-10 (Injected at day 0)

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• 1995
  • 1995-08-09 GB GB9516287A patent/GB2304047A/en not_active Withdrawn
• 1996
  • 1996-08-08 WO PCT/GB1996/001930 patent/WO1997005894A1/en not_active Ceased
  • 1996-08-08 AU AU66660/96A patent/AU719089B2/en not_active Ceased
  • 1996-08-08 ES ES96926507T patent/ES2187665T3/es not_active Expired - Lifetime
  • 1996-08-08 DE DE69625516T patent/DE69625516T2/de not_active Expired - Lifetime
  • 1996-08-08 CA CA2229078A patent/CA2229078C/en not_active Expired - Fee Related
  • 1996-08-08 EP EP96926507A patent/EP0871473B1/en not_active Expired - Lifetime
  • 1996-08-08 PT PT96926507T patent/PT871473E/pt unknown
  • 1996-08-08 ZA ZA9606744A patent/ZA966744B/xx unknown
  • 1996-08-08 US US09/011,027 patent/US6387364B1/en not_active Expired - Lifetime
  • 1996-08-08 AT AT96926507T patent/ATE229814T1/de active
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• 2002
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