Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/275—Nitriles; Isonitriles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/38—Heterocyclic compounds having sulfur as a ring hetero atom
  • A61K31/381—Heterocyclic compounds having sulfur as a ring hetero atom having five-membered rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D333/00—Heterocyclic compounds containing five-membered rings having one sulfur atom as the only ring hetero atom
  • C07D333/02—Heterocyclic compounds containing five-membered rings having one sulfur atom as the only ring hetero atom not condensed with other rings
  • C07D333/04—Heterocyclic compounds containing five-membered rings having one sulfur atom as the only ring hetero atom not condensed with other rings not substituted on the ring sulphur atom
  • C07D333/26—Heterocyclic compounds containing five-membered rings having one sulfur atom as the only ring hetero atom not condensed with other rings not substituted on the ring sulphur atom with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to ring carbon atoms
  • C07D333/38—Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/74—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving hormones or other non-cytokine intercellular protein regulatory factors such as growth factors, including receptors to hormones and growth factors
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
  • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
  • G01N2333/475—Assays involving growth factors
  • G01N2333/495—Transforming growth factor [TGF]
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
  • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
  • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
  • G01N2333/71—Assays involving receptors, cell surface antigens or cell surface determinants for growth factors; for growth regulators
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/10—Musculoskeletal or connective tissue disorders
  • G01N2800/108—Osteoporosis
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/32—Cardiovascular disorders
  • G01N2800/323—Arteriosclerosis, Stenosis

Definitions

• TGF-beta dynamically regulates the differentiation of smooth muscle cells, and has been postulated to maintain vessel wall structure. TGF-beta also appears to possess immunosuppressive properties which protect the vascular endothelium against local inflammation and damage. Moreover, TGF-beta may inhibit the proliferation and migration of smooth muscle cells after vascular injury.
• TGF-beta is synthesized as a latent peptide ( Figure 1).
• Latent TGF-beta refers to any of several complexes that include the 25 kD TGF-beta dimer in association with the latency associated peptide (LAP) or any of several additional TGF-beta binding proteins (LTBPs).
• LAP latency associated peptide
• LTBPs additional TGF-beta binding proteins
• Latent TGF-beta has no biological activity, i.e., it does not bind to the TGF-beta receptors.
• TGF-beta dimer is also found associated with matrix components or other plasma proteins ( Figure 1). TGF-beta that is associated with matrix components or other plasma proteins is termed mature TGF-beta. This association also prevents the binding of TGF-beta to the TGF-beta receptors.
• TGF-beta In addition to latent and mature forms of TGF-beta, which cannot bind to the TGF-beta receptors and which possess no known biological activity, TGF-beta also exists in forms which are capable of binding to the TGF-beta receptors and which elicit biological effects ( Figure 1). These forms of TGF-beta are termed "active TGF-beta.”
• active TGF-beta One example of a form of active TGF-beta is the 25 kD TGF-beta dimer which is free from association with LAP/LTBPs, or matrix or plasma components.
• activation The process(es) by which the latent form of TGF-beta is converted to the active form.
• release The process(es) by which the mature form of TGF-beta is converted to the active form.
• Atherosclerosis is a disease of the major arteries, typified by changes in the vessel wall architecture.
• smooth muscle cells from the media of the vessel migrate into the intima.
• leukocytes, and in particular, monocytes and macrophages invade the expanded intima.
• lipid from the circulation is deposited into the intima (reviewed in Ross, Nature. 3J52, 801 (1993); Grainger et al. Biol. Rev. Camb. Philos. Soc. 7J), 571 (1995)).
• TGF-beta activity such as tamoxifen (TMX) (Grainger et al., Biochem. J.. 294. 109 (1993)) and aspirin (Grainger et al., Nat. Med..1, 74 (1995)), can exhibit cardioprotective effects. However, the positive cardioprotective effects of these agents may be counterindicated by their potential side effects.
• TMX can cause liver carcinogenicity in rats, has been correlated with an increased risk of endometrial cancer in women and may increase the risk of certain gut cancers. Aspirin may result in ulcerogenesis and increased bleeding.
• TGF-beta levels may also be useful to prevent or treat diseases or conditions including cancer, Marfan's syndrome, Parkinson's disease, fibrosis, Alzheimer's disease, senile dementia, osteoporosis, diseases associated with inflammation, such as rheumatoid arthritis, multiple sclerosis and lupus erythematosus, and other auto-immune disorders. Such agents may also be useful to promote wound healing and to lower serum cholesterol levels.
• the present invention provides a method to maintain or elevate TGF-beta levels in a mammal, such as a human, in need of such therapy.
• the method comprises administering an effective amount of an aspirinate as defined herein.
• the method can also be carried out by administering an amount of a first therapeutic agent effective to elevate the level of latent TGF-beta and an amount of a second therapeutic agent effective to increase the level of TGF-beta which is capable of binding to the TGF-beta receptors, wherein said amounts are effective to maintain or elevate the level of TGF-beta in said mammal.
• the invention also provides a method of preventing or treating a mammal, such as a human, having, or at risk of, a vascular indication which is associated with a TGF-beta deficiency.
• the method comprises the administration of an amount of an aspirinate that elevates the level of TGF-beta in said mammal so as to inhibit or reduce diminution in vessel lumen diameter.
• the levels of active TGF- beta are elevated after adrninistration of the aspirinate.
• agents useful in the practice of the invention are copper aspirinates.
• the effective amount of aspirinate inhibits lipid accumulation, increases plaque stability, decreases lesion formation or development, promotes lesion regression, or any combination thereof.
• Agents useful in the practice of the method include aspirinate salts such as copper salts of aspirinates, including copper aspirinate itself (copper 2-acetylsalicylate or copper 2-acetoxybenzoate), salicylate salts such as copper salts of salicylates, including copper salicylate (copper 2- hydroxybenzoate), or a compound of formula (I) (see below) including a pharmaceutically acceptable salt thereof, or a combination thereof.
• An aspirinate useful in the present invention is a compound of formula (I):
• X is oxygen, -N(Rj)-, or sulfur
• Y is oxygen or sulfur
• R a is (C r C 6 )a-kanoyl, (C,-C 6 )alkyl, or hydrogen;
• R b is hydrogen or (C,-C 3 )alkyl;
• R e and Rj are each independently hydrogen, (C,-C 4 )alkyl, phenyl,
• R e - Rj are independently hydrogen or (C r C 6 )alkyl; a pharmaceutically acceptable salt thereof; or a combination thereof; provided that R 2 and R 3 are on adjacent positions of the ring to which they are attached, or are on the 2- and 5-positions of the ring; and further provided that when R 2 is hydrogen; R 3 is on the 2-or 5-position of the ring to which it is attached and R 4 is (C r C 4 )alkanoyloxy.
• the compound of formula (I) is not 3-acetoxy-2-carboxythiophene.
• the administration inhibits or reduces diminution in vessel lumen diameter.
• the inhibition or reduction in diminution in vessel lumen diameter preferentially occurs at a site in a vessel where the vascular indication is, or is likely to be, manifested.
• the invention thus provides for combination therapy, e.g., the administration of one agent that can elevate the level of latent TGF-beta, and another agent that can elevate the level of TGF-beta which is available to bind to, or is capable of binding to, the TGF-beta receptor.
• This combination therapy can yield a significantly greater cardiovascular efficacy than would be expected from the administration of either agent singly.
• the therapeutic agents can act in a synergistic, rather than in an additive, manner to elevate TGF-beta levels.
• the therapeutic agents can be ad-missered simultaneously in a single dosage form simultaneously in individual doses, or sequentially.
• a first therapeutic agent useful in this embodiment of the invention includes an aspirinate, e.g., a compound of formula (I).
• Another preferred first therapeutic agent comprises a compound of formula NI (see below).
• a preferred second therapeutic agent useful in this embodiment of the invention comprises at least one omega-3 fatty acid, which can be provided, e.g., by dosages offish oil.
• Another preferred second therapeutic agent is selected from at least one compound of formula VI.
• a compound of formula VI may both elevate latent levels of TGF-beta and elevate the levels of TGF-beta which can bind to the TGF-beta receptors.
• the combination of the therapeutic agents inhibits lipid accumulation, increases plaque stability, decreases lesion formation or development, promotes lesion regression, or any combination thereof.
• a compound useful in the present invention is a compound of formula (VI):
• R 6 is (C,-C 6 )alkyl, or aryl, optionally substituted by 1, 2, or 3 V;
• R 7 is phenyl, optionally substituted by 1, 2, or 3 V; or R 7 is (C r C 12 )alkyl, halo(C,-C 12 )alkyl, (C,-C 6 )cycloalkyl, (C r C 6 )alkylcyclo(C,-C 6 )alkyl, (C,- C 6 )cycloalkenyl, or (C,-C 6 )alkyl(C 1 -C 6 )cycloalkenyl; R 8 is hydrogen or phenyl, optionally substituted at the 2-position with R j , and optionally substituted by 1, 2, or 3 V;
• R 9 is hydrogen, nitro, halo, aryl, heteroaryl, aryl(C,-C 3 )alkyl, heteroaryl(C,-C 3 )alkyl, halo(C,-C 12 )alkyl, cyano(C r C 12 )alkyl, (C,- C 4 )alkoxycarbonyl(C,-C 6 )alkyl, (C,-C 12 )alkyl, (C r C 6 )cycloalkyl, (C r
• — is a single bond or is -C(B)(D)-, wherein B and D are each independently hydrogen, (C]-C 6 )alkyl, or halo;
• R k is amino, optionally substituted with one or two (C,-C 6 )alkyl; or an N-heterocyclic ring optionally containing 1 or 2 additional N(R)), S, or nonperoxide O, wherein R, is H (C 1 -C 6 )alkyl, phenyl, or benzyl;
• R Pain and R- are independently hydrogen, (CpC ⁇ a-kyl, phenyl, benzyl, or (C,-C 6 )alkanoyl; or RRON and R caution together with the nitrogen to which they are attached are a 3, 4, 5, or 6 membered heterocyclic ring; R p is H or (C,-C 6 )alkyl; and
• R,,, and R q are independently hydrogen, (C,-C 6 )alkyl, phenyl, benzyl, or (C,-C 6 )alkanoyl; the compound is MER25; or a pharmaceutically acceptable salt thereof.
• an agent such as fish oil that increases the level of TGF-beta which is capable of binding to the TGF- beta receptors, results in a greater reduction in lesion formation in apoE knockout mice relative to aspirin or fish oil therapy alone.
• the combination of aspirin and fish oil which comprises a plurality of omega-3 fatty acids, exerts a markedly synergistic, rather than an additive, effect.
• a combination of an agent that elevates the level of latent TGF-beta, e.g., low doses of aspirin or an aspirinate, with an agent that increases the level of TGF-beta which can bind to its receptor, e.g., at least one omega-3 fatty acid can be very effective in preventing or treating vascular disease.
• at least one omega-3 fatty acid reflects the fact that one of skill in the art would recognize that natural sources of omega-3 fatty acids contain a plurality, about 1 to 30, preferably about 1 to 25, and more preferably about 2 to 20, of omega-3 fatty acids.
• Another embodiment of the invention is a method for preventing atherosclerosis in a mammal at risk therefor, or treating atherosclerosis in a mammal, by administering to the mammal an amount of a first therapeutic agent and an amount of a second therapeutic agent effective to maintain or elevate the level of TGF-beta.
• the first therapeutic agent preferably increases the level of latent TGF- beta, e.g., is aspirin or an aspirinate, or a combination thereof
• the second therapeutic agent increases the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• the agents of the invention are administered in a combined amount that prevents or inhibits diminution in vessel lumen diameter at, or near, a site or potential site of atherosclerotic lesion formation or development.
• a preferred first therapeutic agent comprises aspirin or an aspirinate.
• a preferred second therapeutic agent comprises at least one omega-3 fatty acid.
• the invention also provides a method to inhibit diminution in mammalian vessel lumen diameter.
• the method comprises administering to a mammal in need of said therapy, an amount of a first therapeutic agent and an amount of a second therapeutic agent effective to maintain or elevate the level of TGF-beta, so as to inhibit or reduce vessel lumen diminution.
• the inhibition or reduction in diminution in vessel lumen diameter preferentially occurs at a site in a vessel where the diminution is or is likely to be manifested.
• the first therapeutic agent increases the level of latent TGF-beta, with the proviso that the first therapeutic agent is not aspirin.
• the first therapeutic agent is preferably an aspirinate.
• the second therapeutic agent increases the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• a combination therapy to maintain or elevate TGF-beta levels in a mammal in need of such treatment.
• the method comprises the admimstration of an amount of a first therapeutic agent and a second therapeutic agent, wherein said amount is effective to maintain or elevate the level of TGF-beta.
• the first therapeutic agent increases the level of latent TGF-beta, while the second therapeutic agent increases the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• a preferred first therapeutic agent comprises aspirin or an aspirinate, while a preferred second therapeutic agent comprises at least one omega- 3 fatty acid.
• the invention also provides a method to maintain or elevate TGF-beta levels in a mammal in need of such treatment.
• the method comprises the administration of an amount of an aspirinate effective to maintain or elevate the level of TGF-beta, preferably active TGF-beta, in said mammal.
• the invention also provides a method of preventing or treating a mammal having, or preventing in a mammal at risk of, a condition which is associated with a TGF-beta deficiency. Also provided is a method to maintain TGF-beta levels in a mammal.
• the methods comprise the administration of one or more agents in an amount effective to elevate or maintain the level of TGF-beta in said mammal.
• the effective amount of the agent or agents may increase the level of latent TGF-beta or the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• Agents useful to increase the level of latent TGF-beta include, but are not limited to, idoxifene, toremifene, raloxifene, droloxifene, ethynyl estradiol, diethylstibestrol, 1,25 dihydroxy- vitamin D3, retinoic acid and ligand pharmaceutical analogs thereof (Mukherjee et al. Nature, 1997, 386: 407-410), dexamethasone, progesterone, thyroid hormone analogues (e.g. sodium liothyronine and sodium levothyroxine), hexamethylene bisacetamide, 4-hydroxyquinazoline, coumarin and benzocaine.
• idoxifene toremifene
• raloxifene droloxifene
• droloxifene ethynyl estradiol
• diethylstibestrol 1,25 dihydroxy- vitamin D3, retinoi
• Agents useful to increase the level of TGF-beta which is capable of binding to the TGF-beta receptors include agents that cause the release of TGF-beta from matrix components or plasma proteins, e.g., agents such as heparin sugar analogs and betaglycan proteoglycan chains, or cause the release of TGF-beta from lipoproprotein complexes, e.g., agents such as vitamin E, simvastatin, VLDL- lowering agents, Apo-ALI-lowering agents, and ApoAI-stimulating agents.
• agents useful to increase the level of TGF-beta which is capable of binding to the TGF-beta receptors include agents that cause an increase in the conversion of the latent form of TGF-beta to the active form of TGF-beta, e.g., hydrocortisone, dexamethasone, compounds of formula VI, vitamin D3, retinoic acid, simvastatin and thrombospondin.
• kits comprising packing material enclosing, separately packaged, at least one device adapted for the delivery of a unit dosage form of a therapeutic agent and at least one unit dosage form comprising an amount of at least one of the therapeutic agents of the invention effective to accomplish at least one of the therapeutic results described herein when administered locally or systemically, as well as instruction means for its use, in accord with the present methods.
• a "device adapted for delivery" of a therapeutic agent includes, but is not limited to, a catheter, a stent, a stet, a shunt, a synthetic graft, and the like.
• kits comprising packing material enclosing, separately packaged, at least one device adapted for the delivery of a therapeutic agent to a site in the lumen of a mammalian vessel and at least one unit dosage form of a first therapeutic agent and one unit dosage form of a second therapeutic agent effective to accomplish at least one of the therapeutic results described herein when administered locally or systemically, as well as instruction means for its use, in accord with the present methods.
• composition comprising a) at least one aspirinate, and b) at least one omega-3 fatty acid, wherein components (a) and (b) are present in a combined amount effective to maintain or increase TGF-beta levels, preferably at or near a site, or potential site, of atherosclerotic lesion formation or development.
• the invention also provides a pharmaceutical composition
• a pharmaceutical composition comprising (a) an amount of a first agent effective to elevate the level of latent TGF-beta; and (b) an amount of a second agent effective to increase the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• the invention also provides a pharmaceutical composition
• a pharmaceutical composition comprising a) an aspirinate, such as copper 2-acetylsalicylate or a compound of formula (I), and b) a compound of formula (VI), wherein components (a) and (b) are present in a combined amount effective to maintain or increase TGF-beta levels, preferably at or near a site, or potential site, of atherosclerotic lesion formation or development.
• novel compounds of formula (I), (II), (III), (IV), (V), (VI), (VH), or (N ⁇ i) or pharmaceutically acceptable salts thereof and pharmaceutical compositions comprising a novel compound of formula (I), (II), (III), (TV), (V), (VI), (Nil), or (V ⁇ i) as described herein or a pharmaceutically acceptable salt thereof, which are useful alone, or in combination, to elevate the level of TGF-beta in a mammal.
• the invention also provides a therapeutic method.
• the method comprises identifying a patient exhibiting a decreased level of active TGF-beta and afflicted with a pathology associated with said decreased level.
• the patient so identified can be treated with an agent that elevates the levels of active TGF-beta so as to alleviate at least one of the symptoms of said pathology.
• the invention also provides a method comprising determining endothelial cell activation in a mammal by detecting immunoglobulins that specifically bind to a TGF- ⁇ Type II receptor or a portion thereof.
• the invention also provides a method comprising diagnosing or monitoring a disease characterized by endothelial cell activation (e.g. atherosclerosis) in a mammal by detecting immunoglobulins that specifically bind to a TGF- ⁇ Type II receptor or a portion thereof.
• a disease characterized by endothelial cell activation e.g. atherosclerosis
• the invention also provides a method comprising detecting mammalian cells having TGF- ⁇ Type II receptors, by combining the cells with a capture moiety that binds TGF- ⁇ type II receptors or a portion thereof, forming a capture complex; and detecting or determining the amount of the capture complex.
• the invention also provides a kit comprising packaging material containing: a) a capture moiety comprising the extracellular domain of the TGF- ⁇ Type II receptor; and b) a detection moiety capable of binding to an immunoglobulin.
• packaging material containing: a) a capture moiety that binds to the extracellular domain of the TGF- ⁇ Type II receptor; and b) a detection moiety capable of binding to an immunoglobulin.
• FIG. 1 is a schematic depicting the different forms of TGF-beta.
• TGF-beta is produced as a small latent complex (1) which is associated with the propeptide region termed LAP (thin black lines).
• LAP propeptide region termed LAP (thin black lines).
• additional proteins hatchched oval
• LTBP-1 bind to the small latent complex to form the large latent complex (2).
• Latent complexes can be converted to the active form of TGF-beta, e.g., the 25 kD dimer (5) or the 25 kD dimer which is associated with a peptide of LAP (6).
• TGF-beta examples of mature forms of TGF-beta are TGF-beta associated with lipoprotein (stippled oval) (3) or TGF-beta associated with a matrix protein (helical fiber) (4), e.g., fibrillin.
• Figure 2 depicts the association of increasing amounts of lipoprotein with (A) a reduction in TGF-beta binding to the TGF-beta receptor (R2X); and (B) an increasing amount of TGF-beta necessary to half maximally inhibit mink lung cell proliferation.
• Figure 3 depicts the association of TGF-beta with different lipoprotein classes.
• Figure 4 depicts the effect offish oil therapy on the association of TGF-beta with lipoprotein.
• Platelet-poor plasma was prepared from 36 individuals prior to receiving fish oil, after 4 weeks of dietary supplementation with 2.4 g/day fish oil and then after 9 weeks with no fish oil supplementation.
• Figure 5 depicts the effect of aspirin on vascular smooth muscle cells.
• Figure 6 depicts the relationship between TGF-beta concentration found in the sera of normal individuals (A), individuals with triple vessel disease (B) and both populations (C), who were undergoing aspirin therapy.
• FIG. 7 depicts the effect of tamoxifen (TMX) treatment on plasma TGF- beta over time. Active TGF-beta (•) and (a + 1) TGF-beta ( ⁇ ) were assayed by
• FIG. 8 depicts the effect of tamoxifen (TMX) on various cardiovascular risk factors.
• Figure 9 depicts the lesion area in C57B16, apo(a) or apo(E)-/- mice fed a normal diet, high fat diet or high fat diet supplemented with TMX.
• Figure 10 depicts the distribution of TGF-beta between the plasma (open segment) and various lipoprotein fractions at baseline (a) and after 8 hours during a fat tolerance test (b).
• Figure 11 shows the structure of the compounds MER25, zindoxifene, DDAC (Analog II), and DTAC (102b).
• Figure 12 depicts the pathways by which steroid and steroid-mimetic drugs act to produce anti-inflammatory effects and also undesirable side effects. The therapeutic action of ER NFkB modulators is also depicted.
• Figure 13 depicts the pathway by which ER/NFkB modulators upregulate cellular mRNA encoding for TGF-beta.
• the invention provides a method of treating a mammal having, or at risk of, a indication (e.g. a vascular indication) associated with a TGF-beta deficiency.
• a indication e.g. a vascular indication
• the invention also provides a method to maintain elevated levels of TGF-beta in a mammal which is not imminently at risk of, or does not have, an indication associated with a deficiency in TGF-beta levels.
• the methods comprise the administration of at least one therapeutic agent that elevates the level of TGF-beta in said mammal.
• the agent elevates the level of latent TGF-beta, for example by causing an increase in the level of TGF-beta mRNA, causing an increase in the translational efficiency of TGF-beta mRNA, or by causing an increase in the secretion of latent TGF-beta.
• Another preferred embodiment is an agent that increases the level of TGF- beta which is capable of binding to the TGF-beta receptors, for example by causing the release of TGF-beta from matrix components of plasma proteins, by causing the release of TGF-beta from lipoprotein complexes, or by causing an increase in the conversion of the latent to the active form of TGF-beta.
• Yet another embodiment of the invention employs the systemic administration of a therapeutic agent, e.g., a compound of formula (I) including a pharmaceutically acceptable salt thereof, or a combination thereof, in an amount effective to inhibit or reduce the diminution in vessel lumen diameter in a diseased, e.g., atherosclerotic, or traumatized, e.g., due to stent placement, vessel.
• a therapeutic agent e.g., a compound of formula (I) including a pharmaceutically acceptable salt thereof, or a combination thereof
• Systemic administration of a therapeutic agent can also be employed to treat or prevent pre-atherosclerotic conditions, e.g., in patients at a high risk of developing atherosclerosis or exhibiting signs of hypertension resulting from atherosclerotic changes in vessels or vessel stenosis due to hypertrophy of the vessel wall.
• the therapeutic agent is administered orally. It is also preferred that the agent useful in the practice of the invention is administered continually over a preselected period of time or administered in a series of spaced doses, i.e., intermittently, for a period of time as a preventative measure.
• the therapeutic agent can be administered before, during or after the procedure, or any combination thereof.
• a series of spaced doses of the therapeutic agent is preferably administered before, during and/or after the traumatic procedure (e.g., angioplasty).
• the dose may also be delivered locally, via a catheter introduced into the afflicted vessel during the procedure.
• a series of follow-up doses can be administered systemically over time, preferably in a sustained release dosage form, for a time sufficient to substantially reduce the risk of, or to prevent, restenosis.
• a preferred therapeutic protocol duration for this purpose involves administration from about 3 to about 26 weeks after angioplasty.
• the invention provides combination therapies, i.e., the administration of at least two therapeutic agents which together are effective to maintain or elevate TGF- beta levels in a mammal. Accordingly, the invention provides a method of preventing or treating a mammal having, or at risk of, an indication which is associated with a TGF-beta deficiency, comprising administering an amount of a first agent effective to elevate the level of latent TGF-beta and an amount of a second agent effective to increase the level of TGF-beta which is capable of binding to the TGF-beta receptors, wherein said amounts are effective to increase the TGF- beta levels in said mammal.
• the invention also provides a method comprising administering an amount of a combination of aspirin or an aspirinate and at least one omega-3 fatty acid, wherein said amount is effective to maintain or elevate the level of TGF-beta in said mammal.
• the invention also provides a method of preventing or treating a mammal having, or at risk of, a vascular indication which is associated with a TGF- beta deficiency, comprising administering an effective amount of a combination of an aspirinate and at least one omega-3 fatty acid, wherein said amount is effective to increase the level of TGF-beta so as to inhibit or reduce vessel lumen diameter diminution.
• the invention also provides for the administration of at least two therapeutic agents which together are effective to elevate the levels of TGF-beta in a mammal so as to inhibit or reduce vessel lumen diameter diminution.
• the invention also provides combination therapies to maintain elevated levels of TGF-beta in a mammal which is not imminently at risk of, or does not have, a vascular indication associated with a deficiency in TGF-beta levels.
• the therapeutic agents can be selected to act in a synergistic, rather than in an additive, manner to elevate TGF- beta levels.
• the therapeutic agents can be administered simultaneously as a single dose, simultaneously in individual doses, or sequentially.
• One embodiment of the invention employs the systemic administration of a first therapeutic agent, e.g., an aspirinate such as copper 2-acetylsalicylate, a compound of formula (I), or a combination thereof, in combination with a second therapeutic agent, e.g., a compound of formula (VI), in an amount effective to increase TGF-beta levels.
• a first therapeutic agent e.g., an aspirinate such as copper 2-acetylsalicylate, a compound of formula (I), or a combination thereof
• a second therapeutic agent e.g., a compound of formula (VI)
• the increase in TGF-beta levels inhibits or reduces the diminution in vessel lumen diameter in a diseased, e.g., atherosclerotic, or traumatized, e.g., due to stent placement, vessel.
• the increase in TGF-beta levels can also inhibit atherosclerotic lesion formation or development, increase plaque stability and/or promote
• Systemic administration of the therapeutic agents can also be employed to treat or prevent pre-atherosclerotic conditions, e.g., in patients at a high risk of developing atherosclerosis or exhibiting signs of hypertension resulting from atherosclerotic changes in vessels or vessel stenosis due to hypertrophy of the vessel wall.
• at least one of the therapeutic agents is administered orally.
• agents useful in the practice of the invention are administered continually over a preselected period of time or administered in a series of spaced doses, i.e., intermittently, for a period of time as a preventative measure.
• a preferred embodiment of the invention provides a method for the treatment or prevention of atherosclerosis, wherein an omega-3 fatty acid in combination with aspirin or an aspirinate, is administered so as to inhibit (block or reduce) atherosclerotic lesion formation or development, e.g., so as to inhibit lipid accumulation, increase plaque stability or promote lesion regression.
• the therapeutic agents are orally administered.
• copper aspirinate and an omega-3 fatty acid are orally administered.
• a preferred source of the omega-3 fatty acid is fish oil.
• Another preferred embodiment of the invention provides a method for the treatment or prevention of atherosclerosis, wherein at least two therapeutic agents of the invention are administered in combination so as to inhibit (block or reduce) atherosclerotic lesion formation or development, e.g., so as to inhibit lipid accumulation, increase plaque stability or promote lesion regression.
• at least one of the therapeutic agents is orally administered.
• Combination therapies are also useful to treat vessels traumatized by interventional procedures.
• a series of spaced doses of at least two of the present therapeutic agents, optionally, in sustained release dosage form are preferably administered before and after the traumatic procedure (e.g., angioplasty).
• the dose may also be delivered locally, via a catheter introduced into the afflicted vessel during the procedure.
• a series of follow-up doses of, optionally, both agents can be administered systemically, preferably in a sustained release dosage form, for a time sufficient to substantially reduce the risk of, or to prevent, restenosis.
• a preferred duration for this purpose is from about 3 to about 26 weeks after angioplasty.
• Kits Comprising a Delivery Device and the Therapeutic Agents of the Invention provides a kit comprising packing material enclosing, separately packaged, at least one device adapted for the local or systemic delivery of a therapeutic agent, e.g., a catheter, a valve, a stent, a stet, a shunt or a synthetic graft, and at least one unit dosage form, as well as instruction means for their use, in accord with the present methods.
• a valve, stent or shunt useful in the methods of the invention can comprise a biodegradable coating or porous non-biodegradable coating, having dispersed therein a therapeutic agent of the invention, preferably a sustained release dosage form of the therapeutic agent.
• the unit dosage form comprises an amount of at least one of the present therapeutic agents effective to accomplish the therapeutic results described herein when delivered locally and/or systemically.
• a preferred embodiment of the invention is a kit comprising a catheter adapted for the local delivery of at least one therapeutic agent to a site in the lumen of a mammalian vessel, along with instruction means directing its use in accord with the present invention.
• the therapeutic agent comprises a copper aspirinate.
• the invention provides a kit comprising packing material enclosing, separately packaged, at least one device adapted for the local or systemic delivery of a therapeutic agent, e.g., a catheter, a valve, a stent, a stet, a shunt or a synthetic graft, and at least one unit dosage form which may comprise an amount of at least two of the present therapeutic agents effective to accomplish the therapeutic results described herein.
• a therapeutic agent e.g., a catheter, a valve, a stent, a stet, a shunt or a synthetic graft
• unit dosage form which may comprise an amount of at least two of the present therapeutic agents effective to accomplish the therapeutic results described herein.
• kits comprising a catheter adapted for the local delivery of at least two therapeutic agents, a unit dosage of a first therapeutic agent, and a unit dosage of a second therapeutic agent, along with instruction means directing their use in accord with the present invention.
• the unit dosage forms of the first and second agents may be introduced via discrete lumens of a catheter, or mixed together prior to introduction into a single lumen of a catheter. If the unit dosage forms are introduced into discrete lumens of a catheter, the delivery of the agents to the vessel can occur simultaneously or sequentially.
• a single lumen catheter may be employed to deliver a unit dosage form of one agent, followed by the reloading of the lumen with another agent and delivery of the other agent to the lumen of the vessel. Either or both unit dosages can act to reduce the diminution in vessel lumen diameter at the target site.
• a unit dosage of one of the therapeutic agents may be administered locally, e.g., via catheter, while a unit dosage of another therapeutic agent is administered systemically, e.g., via oral administration.
• the kit of the invention comprises a non-catheter delivery device, e.g., a valve, stet, stent or shunt, for systemic or local delivery of a compound of formula (I- VI).
• a valve, stent or shunt useful in the methods of the invention can comprise a biodegradable coating or porous non-biodegradable coating, having dispersed therein one or more therapeutic agents of the invention, preferably a sustained release dosage form of the therapeutic agent.
• Abnormal or pathological or inappropriate with respect to an activity or proliferation means division, growth or migration of normal cells, but not cancerous or neoplastic cells, occurring more rapidly or to a significantly greater extent than typically occurs in a normally functioning cell of the same type, or in lesions not found in healthy tissues.
• Agents which activate the latent form of TGF-beta to the active form include, but are not limited to, moieties such as hydrocortisone, dexamethasone, a compound of formula (VI) (such as tamoxifen), Vitamin D3 and retinoic acid (vitamin A); plasmin stimulators, e.g., Lp(a) lowering agents such as tamoxifen, PAI-1 lowering agents (e.g., simvastatin and other VLDL-lowering agents), and agents which exhibit increased tPA activity (e.g., retinoids, such as Vitamin D3); and agents which exhibit non-plasmin mediated activation (e.g., thrombospondin and Vitamin D3).
• moieties such as hydrocortisone, dexamethasone, a compound of formula (VI) (such as tamoxifen), Vitamin D3 and retinoic acid (vitamin A)
• plasmin stimulators e.g., Lp
• Agents which increase the level of TGF-beta which is capable of binding to the TGF-beta receptors includes moieties capable of activating the latent form of TGF-beta to the active form thereof, moieties which release TGF-beta from complexes of matrix components and TGF-beta, complexes of plasma proteins and TGF-beta and/or complexes of lipoproteins and TGF-beta.
• a number of compounds of formula (VI) can increase the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• Agents which release TGF-beta from the extracellular matrix include moieties such as heparin, heparin sugar analogs (e.g., fucoidin) and betaglycan proteoglycan chains.
• Agents which release TGF-beta from lipoprotein sequestration include moieties such as Vitamin E and its salts (e.g., Vitamin E succinate), fish oil, simvastatin, other VLDL-lowering agents, apo-AII-lowering agents, and apoAI- stimulating agents.
• ApoAII-lowering agent includes an agent which decreases the synthesis of apoALI, decreases the post-translational insertion of apoAII into nascent HDL particles or stimulates the clearance of apoAII-containing particles, e.g., by immunoapheresis of plasma with anti-apoAII antibodies.
• ApoAI-stimulating agent includes an agent which stimulates the synthesis of apoAI, stimulates HDL production or extends the half-life of apoAI-HDL particles.
• an agent which stimulates the synthesis of apoAI stimulates HDL production or extends the half-life of apoAI-HDL particles.
• estrogen or estrogen agonists, or analogs and derivatives thereof, an agonist of hepatic nuclear factor (HNF) 3 or 4, or an agonist of the retinoid receptor may increase apoJil transcription.
• Aspirinate refers generally to aspirin derivatives and analogs, including pharmaceutically acceptable salts thereof, with the exception that aspirin itself is not included within the term “aspirinate”.
• the term includes, but is not limited to, 3,5- diisopropyl salicylic acid, salicylic acid, 3,5-di(tertiarybutyl)salicylic acid, adamantylsalicylic acid, 3,5-dibromoacetylsalicylic acid, 3,5-diiodoacetylsalicylic acid, 4-(tertiarybutyl)salicylic acid, 4-nitrosalicylic acid, 4-aminosalicylic acid, 4- acetylaminosalicylic acid, 5-chlorosalicylic acid, 3,5-dichlorosalicylic acid and salts thereof, and compounds of formula (I) and their salts.
• the aspirinate is provided in essentially pure form, most preferably in a unit dosage form, in combination with one or more pharmaceutically acceptable carriers, including vehicles and/or excipients.
• the aspirinate is in a form suitable for oral administration, and more preferably the aspirinate is in combination with a liquid vehicle.
• omega-3 fatty acids when used with respect to omega-3 fatty acids would be recognized in the art as indicating that a plurality, about 1 to 30, preferably about 1 to 25, more preferably about 2 to 20, of omega-3 fatty acids are often present in natural sources of these compounds.
• Autoimmune disease means a disease which is characterized by the presence of autoreactive T lymphocytes resulting in pathological inflammation and subsequent damage or destruction of the target tissue.
• Betaglycan proteoglycan chain includes all or a portion of any of the proteoglycan that comprise the class of molecules termed type-LII TGF-beta receptor, e.g., CD105, endoglin or betaglycan.
• a portion of the proteoglycan may include all or a portion of the protein moiety of the proteoglycan, all or a portion of the polysaccharide moiety of the proteoglycan, all or a portion of the protein moiety and a portion of the polysaccharide moiety, all or a portion of the polysaccharide moiety and a portion of the protein moiety, or a portion of the protein moiety and a portion of the polysaccharide moiety.
• the betaglycan proteoglycan chain has a similar or greater affinity for TGF-beta relative to the affinity of native betaglycan for TGF-beta.
• Bioavailable TGF-beta means TGF-beta which is in a form capable of binding to the TGF-beta receptors, i.e., eliciting a biological effect.
• TGF-beta which is in a complex with matrix components or plasma proteins, or lipoproteins is generally not “bioavailable” or has reduced bioavailability relative to TGF-beta which is not complexed with matrix components, plasma proteins, or lipoproteins.
• “Cholesterol lowering agents” include agents which are useful for lowering serum cholesterol such as for example bile acid sequestering resins (e.g. colestipol hydrochloride or cholestyramine), fibric acid derivatives (e.g.
• clofibrate fenofibrate, or gemfibrozil
• thiazolidenediones e.g. troglitazone
• HMG-CoA reductase inhibitors e.g. fluvastatin sodium, lovastatin, pravastatin sodium, or simvastatin
• nicotinic acid niacin, or probucol.
• “Elevated” TGF-beta levels means that the TGF-beta levels in vivo are greater after administration of the therapeutic agent than before administration.
• active TGF-beta levels may be increased after administration, but may be less than normal levels, similar to normal levels or greater than normal levels of TGF-beta in vivo.
• ' ⁇ eparin sugar analogs includes any sulfated polysaccharide which is a component of heparin sulfate proteoglycan, or a sulfated polysaccharide having a structure similar to the polysaccharide chain of heparin sulphate proteoglycan.
• NFkB means any of the family of transcription factor complexes which have as at least one of their components the subunits known as p65 (RelA), p50, p52, c-rel, p68 (RelB) as well as the complexes which have as at least one of their components the endogenous inhibitors of NFkB activity, known as H B-alpha, MAD3, pp40, IkB-beta and H B-gamma as well as their functional equivalents, analogs and derivatives thereof.
• NFkB activity means activation of genes associated with the inflammatory state resulting from direct binding of an NFkB transcription factor complex to DNA elements, including, but not limited to, the kB element in the immunoglobulin kappa light chain gene.
• NFkB complex is normally retained in the cytoplasm by interaction with its endogenous inhibitor H B.
• NFkB activity must be preceded by localization of the NFkB complex to the nucleus.
• translocation of the NFkB complex to the nucleus does not constitute NFkB activity unless transcription from genes associated with the inflammatory state is stimulated.
• Non- vascular indication means diseases and conditions which are associated with TGF-beta deficiency, other than those diseases and conditions defined herein as vascular indications.
• Non-vascular indications include, but is not limited to cancer, Marfan's syndrome, Parkinson's disease, fibrosis, Alzheimer's disease, senile dementia, osteoporosis, diseases associated with inflammation, such as rheumatoid arthritis, multiple sclerosis and lupus erythematosus, as well as other auto-immune disorders.
• Non-vascular indications also include the promotion of wound healing and the lowering of serum cholesterol levels.
• Omega-3 fatty acid includes synthetic or naturally occurring sources of omega-3 fatty acids, such as fish oil, e.g., cod liver oil, walnuts and walnut oil, wheat germ oil, rapeseed oil, soybean lecithin, soybeans, tofu, common beans, butternuts, seaweed and flax seed oil.
• the omega-3 fatty acids include (C )6 -C 24 ) alkanoic acids comprising 5-7 double bonds, wherein the last double bond is located between the third and fourth carbon atom from the methyl end of the fatty acid chain. These fatty acids have been proposed to yield significant cardiovascular protection (Burr et al., Lancet. 221. 757 (1989)).
• Omega-3 fatty acids include 5, 8, 11, 14, 17-eicosapentaenoic acid and docosahexaenoic acid. See The Merck Index (11th ed. 1989) at entry 3495, and references cited therein.
• “Pathological inflammation” means an increase in the recruitment and activation of immune cells, or residence and activation of immune cells for a longer period of time, in a particular tissue or tissues in an individual relative to an individual not at risk or, or afflicted with, an autoimmune disease.
• the prototypical cells upon which the effects of ER NFkB modulators are felt are cells of the immune system, including but limited to, autoreactive T lymphocytes, alloreactive T lymphocytes, B lymphocytes, monocytes, tissue macrophages, neutrophils, eosinophils and other leukocytes.
• the usefulness of ER/NFkB modulators is not limited to their effects on immune cells in the treatment of autoimmune diseases. Effects on vascular endothelial cells and on the cells composing the target tissue may also contribute to the anti-inflammatory effect of the ER/NFkB modulators by reducing recruitment of leukocytes as well as activation of resident immune cells.
• PAI-1 lowering agent includes an agent which increases insulin sensitivity, decreases production of PAI-1 or decreases the activity of PAI-1 as an inhibitor of plasminogen activators or of plasmin.
• PAI-1 lowering agent includes the thiazolidenediones (e.g. troglitazone).
• Plasmin stimulator includes an agent which increases the activity of plasmin, e.g., a PAI-1 inhibitor, tissue plasminogen activator (tPA) or streptokinase, preferably without disrupting normal hemostasis.
• a plasmin stimulator may increase plasmin levels by catalyzing the conversion of the latent form of plasmin, i.e., plasminogen, to the active form, or stimulate the activity of the plasmin enzyme, e.g., generally or with regard to a specific substrate, e.g., TGF-beta.
• Procedural vascular trauma includes the effects of surgical medical- mechanical interventions into mammalian vasculature, but does not include vascular trauma due to the organic vascular pathologies listed hereinabove, or to unintended traumas, such as due to an accident.
• procedural vascular traumas within the scope of the present treatment method include (1) organ grafting or transplantation, such as transplantation and grafting of heart, kidney, liver and the like, e.g., involving vessel anastomosis; (2) vascular surgery, such as coronary bypass surgery, biopsy, heart valve replacement, atheroectomy, thrombectomy, and the like; (3) transcatheter vascular therapies (TVT) including angioplasty, e.g., laser angioplasty and PTC A procedures discussed hereinbelow, employing balloon catheters, or indwelling catheters; (4) vascular grafting using natural or synthetic materials, such as in saphenous vein coronary bypass grafts, dacron and venous grafts used for peripheral arterial reconstruction, etc.; (5) placement of a mechanical shunt, such as a PTFE hemodialysis shunt used for arteriovenous communications; and (6) placement of an intravascular stent, which may be metallic, plastic or a biodegradable polymer.
• sustained release dosage forms for systemic ad ⁇ ninistration as well as local administration can be employed in the practice of the invention. Examples of sustained release dosage forms are disclosed in co-pending application Serial No. 08/478,936, filed June 7, 1995, the disclosure of which is incorporated by reference herein.
• Tamoxifen includes trans-2-[4-( 1 ,2-diphenyl- 1 -butenyl)phenoxy]-N,N- dimethylemylamine, and the pharmaceutically acceptable salts thereof, which are capable of enhancing the level of active TGF-beta, e.g., by increasing the level of latent TGF-beta or by increasing the level of TGF-beta which is capable of binding to the TGF-beta receptors.
• TGF-beta includes transforming growth factor-beta as well as functional equivalents, derivatives and analogs thereof, e.g., TGF- ⁇ ls TGF- ⁇ 2 and TGF- ⁇ 3 .
• TGF-beta isoforms are a family of multifunctional, disulfide-linked dimeric polypeptides that affect activity, proliferation and differentiation of various cells types.
• a functional equivalent of TGF- ⁇ can include agents that bind to the TGF- ⁇ receptor, e.g. a receptor agonist or antagonist or a neutral binding agent, and/or which induces the same biological response as TGF- ⁇ .
• Vascular indication includes, but is not limited to, a cardiovascular disease, e.g., atherosclerosis, thrombosis, myocardial infarction, and stroke, or a cardiovascular condition, e.g., vessels subjected to trauma associated with interventional procedures ("procedural vascular trauma"), such as restenosis following angioplasty, placement of a shunt, stet, stent, synthetic or natural excision grafts, indwelling catheter, valve or other implantable devices.
• a cardiovascular disease e.g., atherosclerosis, thrombosis, myocardial infarction, and stroke
• a cardiovascular condition e.g., vessels subjected to trauma associated with interventional procedures (“procedural vascular trauma"), such as restenosis following angioplasty, placement of a shunt, stet, stent, synthetic or natural excision grafts, indwelling catheter, valve or other implantable devices.
• vascular indication is non-coronary vessel disease, such as arteriolosclerosis, small vessel disease, nephropathy, greater than normal levels of serum cholesterol, asthma, hypertension, emphysema and chronic obstructive pulmonary disease.
• Vascular indication does not include cancer, including smooth muscle cell carcinomas or neoplasms, or idiopathic symptoms such as forms of angina that are not attributable to vascular diseases.
• Small vessel disease includes, but is not limited to, vascular insufficiency in the limbs, peripheral neuropathy and retinopathy, e.g., diabetic retinopathy.
• VLDL-lowering agent includes an agent which decreases the hepatic synthesis of triglyceride-rich lipoproteins or increases the catabolism of triglyceride-rich lipoproteins, e.g., fibrates such as gemfibrozil, or the statins, increases the expression of the apoE-mediated clearance pathway, or improves insulin sensitivity in diabetics, e.g., the thiazolidene diones.
• agents which increase the level of latent TGF- beta include moieties capable of stimulating the production of TGF-beta protein (generally the latent form thereof).
• the mechanism leading to the increase in TGF- beta protein can include, but is not limited to, up-regulation of mRNA production (transcription), increased translational efficiency of the mRNA, or increased secretion of the latent TGF-beta complex.
• TGF-beta protein agents which increase the production of TGF-beta protein include, but are not limited to, moieties which affect the nuclear hormone receptor pathway (e.g., tamoxifen, idoxifene, toremifene, raloxifene, droloxifene and other anti-estrogen analogues of tamoxifen, ethynyl estradiol, diethylstilbestrol, other synthetic estrogen agonists and compounds disclosed in U.S. Patent Nos.
• moieties which affect the nuclear hormone receptor pathway e.g., tamoxifen, idoxifene, toremifene, raloxifene, droloxifene and other anti-estrogen analogues of tamoxifen, ethynyl estradiol, diethylstilbestrol, other synthetic estrogen agonists and compounds disclosed in U.S. Patent Nos.
• TGF-beta Other agents which increase the level of TGF-beta include aspirin, aspirinates such as copper aspirinate, and red wine extract (see Example IV).
• Red wine extract is a fraction or concentrate derived from red wine that is substantially enriched in copper aspirinate, hexamethylene bisacetamide, 4-hydroxyquinazoline, coumarin and benzocaine.
• halo includes fluoro, chloro, bromo, or iodo.
• alkyl, and alkoxy denote both straight and branched groups; but reference to an individual radical such as “propyl” embraces only the straight chain radical, a branched chain isomer such as "isopropy 1" being specifically referred to.
• Aryl denotes a phenyl radical or an ortho-fused bicyclic carbocyclic radical having about nine to ten ring atoms in which at least one ring is aromatic.
• Heteroaryl encompasses a radical attached via a ring carbon of a monocyclic aromatic ring containing five or six ring atoms consisting of carbon and one to four heteroatoms each selected from the group consisting of non-peroxide oxygen, sulfur, and N(X) wherein X is absent or is hydrogen, O, (C r C 4 )alkyl, phenyl or benzyl, as well as a radical of an ortho-fused bicyclic heterocycle of about eight to ten ring atoms derived therefrom, particularly a benz-derivative or one derived by fusing a propylene, trimethylene, or tetramethylene diradical thereto.
• (C,-C 3 )alkyl can be methyl, ethyl, propyl, or isopropyl;
• (C,- C 4 )alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl or sec-butyl;
• (C,- C 6 )alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl, sec-butyl, pentyl, isopentyl, neopentyl, or hexyl;
• (C 1 -C ⁇ 2 )alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl, sec-butyl, pentyl, isopentyl, neo-pentyl, hexyl, 2-hexyl, 3-hexyl,
• aryl can be phenyl, indenyl, or naphthyl
• heteroaryl can be furyl, imidazolyl, tetrazolyl, pyridyl, (or its N-oxide), thienyl, pyrimidinyl (or its N-oxide), indolyl, or quinolyl (or its N-oxide)
• aryl (C r C 3 )alkyl can be benzyl, indenylmethyl, naphthylmethyl, phenethyl, indenylethyl, naphthylethyl, phenylpropyl, indenylpropyl, or naphthylpropyl
• heteroaryl (C,-C 3 )alkyl can be furylmethyl, imidazolylmethyl, tetrazolylmethyl, pyridylmethyl (or its N-oxide), thienylmethyl, pyrimidinylmethyl (or its
• (C,-C 3 )alkyl can be methyl, ethyl, or propyl;
• (C r C 4 )alkyl can be methyl, ethyl, propyl, or butyl;
• (C r C 6 )alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl, pentyl, or hexyl;
• (C r C 12 )alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl, sec-butyl, pentyl, hexyl, heptyl, or octyl;
• (C 3 - C 6 )cycloalkyl can be cyclopentyl, or cyclohexyl;
• (C 3 -C 6 )cycloalkenyl can be 2- cyclopentenyl,
• a specific aspirinate useful in the present invention is a compound of formula (I):
• R 2 is hydrogen or -XR.;
• Y is oxygen or sulfur; a is (C r C 6 )alkanoyl; R b is hydrogen or (C I -C 3 )alkyl;
• R e is hydrogen or (C r C 6 )alkyl; or a pharmaceutically acceptable salt thereof; provided that R 2 and R 3 are on adjacent positions of the ring to which they are attached, or are on the 2- and 5-positions of the ring; and further provided that when R 2 is hydrogen; R 3 is on the 2-or 5 -position of the ring to which it is attached and R 4 is (CpOalkanoyloxy.
• a specific aspirinate of formula I useful in the present invention is a compound of formula (II):
• a specific aspirinate of formula I useful in the present invention is a compound of formula (III):
• Another specific aspirinate of formula I useful in the present invention is a compound of formula (IN):
• Another specific aspirinate of formula I useful in the present invention is a compound of formula (V):
• a specific aspirinate useful in the present invention is a compound of formula (I):
• R 2 is hydrogen or -XR a ;
• X is oxygen or sulfur
• Y is oxygen or sulfur
• R a is (C,-C 6 )alkanoyl
• R b is hydrogen or (C r C 3 )alkyl
• R e and R d are each independently hydrogen, (C,-C 4 )alkyl, phenyl, COOH, CO 2 (C,-C 4 )alkyl or O[(C,-C 4 )alkyl]; or R. and Rj together with the nitrogen to which they are attached are pyrrolidino, piperidino, piperazin-1-ly or morpholino; and
• R e is hydrogen or (C,-C 6 )alkyl; or a pharmaceutically acceptable salt thereof; provided that R 2 and R 3 are on adjacent positions of the ring to which they are attached, or are on the 2- and 5-positions of the ring; and further provided that when R 2 is hydrogen; R 3 is on the 2-or 5-position of the ring to which it is attached and R 4 is (C,-C 4 )alkanoyloxy.
• a specific aspirinate useful in the present invention is a compound of formula (I) which is not 3-acetoxy-2-carboxythiophene.
• Yet another specific aspirinate useful in the present invention is a compound of formula (I) wherein R 1 is hydrogen.
• a further specific aspirinate useful in the present invention is a compound of formula (I) wherein R 2 is -XR. . .
• a specific aspirinate useful in the present invention is a compound of formula (I) wherein R 4 is.(C,-C 6 )alkyl, (C r C 6 )alkanoyl or (C 2 -C 6 )alkanoyloxy and forms a sulfonium salt with the thiophene sulfiir, wherein the associated counter ion is a pharmaceutically acceptable anion.
• R 4 is.(C,-C 6 )alkyl, (C r C 6 )alkanoyl or (C 2 -C 6 )alkanoyloxy and forms a sulfonium salt with the thiophene sulfiir, wherein the associated counter ion is a pharmaceutically acceptable anion.
• a specific aspirinate useful in the present invention is a compound of formula (I) wherein R 5 is hydrogen.
• a specific aspirinate of formula I useful in the present invention is a compound of formula (II):
• a specific aspirinate of formula I useful in the present invention is a compound of formula (III) :
• Another specific aspirinate of formula I useful in the present invention is a compound of formula (IV):
• Another specific aspirinate of formula I useful in the present invention is a compound of formula (V):
• Another specific aspirinate useful in the present invention is a compound of formula LI, HI, IN or V wherein R 1 is hydrogen; or a pharmaceutically acceptable salt thereof.
• Another specific aspirinate useful in the present invention is a compound of formula II, HI, IN or N wherein R 1 is nitro, halo, cyano, hydroxy, or ⁇ (R) 2 , wherein each R is hydrogen, (C,-C 4 )alkyl, phenyl, COOH, CO 2 (C,-C 4 )alkyl, or O[(C r C 4 )alkyl]; or a pharmaceutically acceptable salt thereof.
• Another specific aspirinate useful in the present invention is a compound of formula II, UJ, IV or V wherein X is S.
• Another specific aspirinate useful in the present invention is a compound of formula II, HI, IN or V wherein Y is S.
• the compounds of formula (I) are useful as anti-inflammatory agents, e.g., as anti-platelet aggregation agents, thrombin inhibitory agents, and vascular smooth muscle cell anti-proliferative agents.
• substitution of electron withdrawing and electron donating functionalities on the thiophene ring system can enhance or diminish the bioavailability of the substituted compounds.
• some of the substituted compounds exhibit higher protein binding affinities, and thus have higher binding affinities to serum proteins.
• the higher binding affinities lead to a longer serum half-life, which provides a longer duration of action for the compounds.
• Other substituted compounds exhibit lower protein binding affinities, and thus have lower binding affinities to serum proteins.
• the lower binding affinities lead to a shorter serum half-life, which provides a shorter duration of action for the compounds.
• the compounds of formula (I) can chelate metal ions, which can result in enhanced transport across membranes.
• the aspirinates of the invention preferably include copper salts, as well as alkali metal or alkaline earth metal aspirinate salts, such as lithium, sodium, potassium, magnesium, zinc, or calcium aspirinate salts, although other salts are envisioned.
• the copper aspirinate salts of the invention can be formed for example by reacting a copper salt such as cupric chloride with the sodium salts of 3,5- diisopropyl salicylic acid, acetylsalicylic acid, salicylic acid, 3,5-ditertiary butyl salicylic acid, adamantylsalicylic acid, 3,5-dibromoacetylsalicylic acid, 3,5- diiodoacetylsalicylic acid, 4-tertiary butylsalicylic acid, 4-nitrosalicylic acid, 4- aminosalicylic acid, 4-acetylaminosalicylic acid, 5-chlorosalicylic acid and 3,5- dichlorosalicylic acid.
• a copper salt such as cupric chloride
• the copper salt of a thiophene-ring based analog or derivative of an aspirinate of the invention can be prepared by reacting a copper salt, e.g., cupric chloride, with the sodium salt of the thiophene-based analog or derivative.
• a copper salt e.g., cupric chloride
• Inorganic copper salts useful in synthesizing copper aspirinate salts of the invention include hydrated copper chloride, and the dehydrate thereof, hydrated copper fluoride and the dehydrate thereof, copper fluorosilicate and the hexahydrate thereof, copper sulfate and the pentahydrate thereof, copper nitrate and the tri- and hexa-hydrates thereof, copper bromide, copper metaborate, copper bromate, copper chlorate, copper iodate and copper fluorophosphate.
• the copper is typically in the Copper (II) oxidation state. It is preferable to produce copper aspirinate coordination solvates rather than anhydrous compounds.
• the copper aspirinate compounds may be solvated with a lower alkanol, e.g., a C 2 -C 6 aliphatic alkanol such as ethanol or isopropanol, a ketone such as acetone or methylethylketone, alkanolamines, pyridine, water, dimethyl formamide, or dimethyl sulfoxide.
• a lower alkanol e.g., a C 2 -C 6 aliphatic alkanol such as ethanol or isopropanol
• a ketone such as acetone or methylethylketone
• alkanolamines pyridine
• water dimethyl formamide
• a specific compound of formula VI is a compound wherein — is a single bond.
• Another specific compound of formula VI is a compound wherein — is -C(B)(D)-, wherein B and D are each halogen; and R 8 and R 9 are both hydrogen.
• Another specific compound of formula VI is a compound wherein R 6 is not phenyl or phenyl substituted by 1 or 2 V.
• Another specific compound of formula VI is a compound wherein R 7 is not phenyl or phenyl substituted by 1 or 2 V.
• Another specific compound of formula VI is a compound wherein R 8 is not phenyl, or phenyl substituted by 1 or 2 V.
• Another specific value for Z is -O-, -OCH 2 -, -CH 2 O-, -
• a specific compound of formula VI is a compound of formula VII:
• R 11 is S-tR-M- ⁇ phenyl, halo(C,-C 12 )alkyl, (C,-C 12 )alkyl, (C 3 - C 6 )cycloalkyl, (C r C 6 )alkylcyclo(C 1 -C 6 )alkyl, (C 3 -C 6 )cycloalkenyl, or (C,- C 6 )alkyl(C 3 -C 6 )cycloalkenyl;
• R 12 is nitro, halo, ethyl,2-cyanoethyl, 2-trifluoromethylethyl,
• R- is amino, optionally substituted with one or two (C,-C 6 )alkyl; or R. is an ⁇ -heterocyclic ring which optionally comprises another hetero atom selected from ⁇ , O, or S in said ring;
• a preferred compound of formula Nil useful in the present invention is a compound wherein R 14 is at the 5-position of the phenyl ring to which it is attached.
• Another specific compound of formula (VI) useful in the present invention is a compound of formula (VIII):
• A is O or S
• R 16 and R 17 are individually (C,-C 4 )alkyl or together with N are a saturated heterocyclic ring, preferably a 5-7 membered heterocyclic ring optionally containing 1-2 additional N(RJ, S or nonperoxide O, wherein R réelle is hydrogen, (C,- C 4 )alkyl, phenyl or benzyl;
• R 18 is hydrogen, (C,-C 6 )alkyl, mercapto, (C r C 4 )alkylthio, hydroxy, (C,-C 6 )alkoxy;
• R 19 is nitro, halo, ethyl, 2-cyanoethyl, 2-trifluoromethylethyl,
• R 20 is H or together with R 19 is -CH 2 -CH 2 - or -S-;
• R 21 is hydrogen, iodo, hydroxy, or O(C,-C )alkyl
• R 22 is hydrogen, (C,-C 6 )alkyl, mercapto, (C,-C 4 )alkylthio, hydroxy, (C,-C 6 )alkoxy, halo, or OPO 3 H 2
• the compound is MER25, zindoxifene, DDAC (Analog II) or DTAC (102b); a pharmaceutically acceptable salt thereof, or mixtures thereof.
• NILI Another specific compound of formula (NI) useful in the present invention is a compound of formula (NILI):
• A is O;
• R 16 and R 17 are individually (C r C 4 )alkyl or together with N are a saturated heterocyclic ring, preferably a 5-7 membered heterocyclic ring optionally containing 1-2 additional N(R 11 ), S or nonperoxide O, wherein R ⁇ is hydrogen, (C,-C 4 )alkyl, phenyl or benzyl;
• R 18 is hydrogen, hydroxy, (C,-C 4 )alkyl, or (C,-C 4 )alkoxy;
• R 19 is nitro, halo, ethyl or chloroethyl
• R 20 is H or together with R 19 is -CH 2 -CH 2 - or -S-;
• R 21 is hydrogen, iodo, hydroxy, or (C,-C 4 )alkoxy
• R 22 is iodo, OPO 3 H 2 , (C,-C 4 )alkoxy or hydrogen; the compound is MER25, zindoxifene, DDAC (Analog II) or DTAC
• a preferred compound of formula VIII useful in the present invention is a compound wherein Z is a covalent bond; R 16 and R 17 are each (C,-C 4 )alkyl or - (CH 2 ) m -; R 18 is hydrogen; R 21 is hydrogen or iodo; and m is 4-6.
• a preferred compound of formula VHI useful in the present invention is a compound wherein R 19 is ethyl or chloroethyl.
• a preferred compound useful in the present invention is a compound of formula VTfl wherein R 19 and R 20 together are -CH 2 -CH 2 -; and R 22 is OCH 3 .
• a preferred compound of formula VTfl useful in the present invention is a compound wherein: Z is OO or a covalent bond;
• R 16 and R 17 are individually (C,-C 4 )alkyl or together with N are a saturated heterocyclic ring, preferably a 5-7 membered heterocyclic ring optionally comprising 1-2 additional N(R), S or nonperoxide O, wherein R is hydrogen, (C,- C 4 )alkyl, phenyl or benzyl; R 18 is hydrogen, hydroxy or O(C,-C 4 )alkyl;
• R 19 is ethyl or chloroethyl
• R 20 is H or together with R 19 is -CH 2 -CH 2 - or -S-
• R 21 is hydrogen, iodo, hydroxy, or O(C r C 4 )alkyl
• R 22 is iodo, OPO 3 H 2 , 0(C,-C 4 )alkyl or hydrogen
• a pharmaceutically acceptable salt thereof, or mixtures thereof
• a specific value for R 18 is hydrogen; for Z is a covalent bond; for R 16 and R 17 is independently (C r C 4 )alkyl, or for R 16 and R 17 taken together is -(CH 2 ) m -; for R 21 is hydrogen or iodo; and for m is 4-6.
• a specific value for R 22 is OCH 3 ; and for R 19 and R 20 together is -CH 2 -CH 2 -.
• Compounds of formula VI useful in the present invention include tamoxifen and structural analogs of tamoxifen having substantial equivalent bioactivity. Such analogs include idoxifene, raloxifene, droloxifene, 3-iodotamoxifen, 4-iodotamoxifen, tomremifene, trioxifene, nafoxidene, 4-hydroxytamoxifen, H- 1285, and pharmaceutically acceptable salts thereof.
• a preferred embodiment ofthe invention is a compound of formula (VIII) wherein R 19 is not ethyl when R 20 , R 21 , and R 22 are H.
• structural analogs thereof with respect to tamoxifen includes, but is not limited to, all ofthe compounds of formula (VI) which are capable of enhancing, increasing or elevating the level of TGF-beta. See, for example, U.S. Patent Nos. 4,536,516, 5,457,113, 5,047,431, 5,441,986, 5,426,123, 5,384,332, 5,453,442, 5,492,922, 5,462,937, 5,492,926, 5,254,594 and U.K. Patent 1,064,629.
• TMX tamoxifen
• TMX tamoxifen
• other tamoxifen analogs may be considered safer to administer if they are less carcinogenic.
• the carcinogenicity of TMX has been attributed to the formation ofcovalent DNA adducts.
• TMX analogs and derivatives only TMX and toremifene have been studied for long-term carcinogenicity in rats. These studies provide strong evidence that covalent DNA adducts are involved in rodent hepatocarcinogenicity of TMX. Toremifene, which exhibits only a very low level of hepatic DNA adducts, was found to be non- carcinogenic. See Potter et al., Carcinogenesis.15_, 439 (1994).
• Idoxifene includes (E)-l-[4-[2-(N- pyrrolidino)ethoxy]phenyl]-l-(4-iodophenyl)-2-phenyl-l-butene and its pharmaceutically acceptable salts and derivatives. See R. McCague et al., Organic Preparations and Procedures Int.. 26. 343 (1994) and S.K. Chandler et al., Cancer Res.. 51, 5851 (1991). Besides its lower potential for inducing carcinogenesis via formation of DNA adducts which can damage DNA, other advantages of EDX compared with TMX are that LDX has reduced residual estrogenic activity in rats and an improved metabolic profile.
• TGF-beta activators or production stimulators or lead compounds including other known stilbene-type antisteroids such as for example, cis- and trans-clomiphene, toremifene, centchroman raloxifene, droloxifene, (l-[4-(2- dimethylaminoethoxy)phenyl]-l-(3-hydroxyphenyl)-2-phenyl-2-butene (see U.S. Patent No.
• 1,2-diphenylethane-type antisteroids include cis-l,2-anisyl-l-[4-(2- diethylaminoethoxy)phenyl]ethane (MRL-37), l-(4-chlorophenyl)l-[4-(2- diethylaminoethoxy)phenyl]-2-phenylethanol (WSM-4613); 1-phenyl-l [4-(2- diethylaminoethoxy)phenyl]-2-anisylethanol (MER-25); 1 -phenyl- 1-[4-(2- diethylaminoethoxy)phenyl)-2-anisyl-ethane, mesobutoestrol (trans- 1,2-dimethyl- l,2-(4-hydroxyphenyl)-ethane), meso-hexestrol, (+)hexestrol and (-)-hexestrol.
• naphthalene-type antisteroids include nafoxidine, l-[4-(2,3- dihydroxypropoxy)phenyl]-2-phenyl-6-hydroxy-l,2,3,4-tetrahydro-naphthalene, 1- (4-hydroxyphenyl)-2-phenyl-6-hydroxy-l ,2,3,4-tetrahydronaphthalene, 1 -[4-(2- pyrrol-N-ylethoxy)-phenyl]-2-phenyl-6-methoxy-3,4-dihydronaphthalene (UI 1 , 100A), and 1 -[4-(2,3-dihydroxypropoxy)phenyl]-2-phenyl-6-methoxy-3,4- dihydronaphthalene (U-23, 469).
• Known antisteroids which do not fall anywhere within these structural classifications include coumestrol, biochanin-A, genistein, methallenstril, phenocyctin, and 1 -[4-(2-dimethylaminoethoxy)phenyl]-2-phenyl-5-methoxyindene (U, 11555).
• anisyl is intended to refer to a 4-methoxyphenyl group.
• compounds of formula (VI) may be prepared using synthetic techniques which are analogous to techniques known in the art, including techniques described in R.A. Magarian, Current Medicinal Chemistry, 1994, 1, 61-104 and techniques described in the references relating to tamoxifen analogs which are cited and incorporated herein.
• the compounds used in the methods ofthe invention form pharmaceutically acceptable acid and base addition salts with a wide variety of organic and inorganic acids and bases and include the physiologically acceptable salts which are often used in pharmaceutical chemistry. Such salts are also part of this invention.
• Typical inorganic acids used to form such salts include hydrochloric, hydrobromic, hydroiodic, nitric, sulfuric, phosphoric, hypophosphoric and the like.
• Such pharmaceutically acceptable salts thus include acetate, phenylacetate, trifluoroacetate, acrylate, ascorbate, benzoate, chlorobenzoate, dinitrobenzoate, hydroxybenzoate, methoxybenzoate, methylbenzoate, o-acetoxybenzoate, naphthalene-2-benzoate, bromide, isobutyrate, phenylbutyrate, ⁇ -hydroxybutyrate, butyne- 1 ,4-dioate, hexyne- 1 ,4-dioate, caprate, caprylate, chloride, cinnamate, citrate, formate, fumarate, glycoUate, heptanoate, hippurate, lactate, malate, maleate, hydroxymaleate, malonate, mandelate, mesylate, nicotinate, isonicotinate, nitrate, oxalate, phthalate, terphthalate, phosphate, mono
• the pharmaceutically acceptable acid addition salts are typically formed by reacting a compound of formula (I) or (VI) with an equimolar or excess amount of acid.
• the reactants are generally combined in a mutual solvent such as diethyl ether or benzene.
• the salt normally precipitates out of solution within about one hour to 10 days and can be isolated by filtration or the solvent can be stripped off by conventional means.
• Bases commonly used for formation of acid salts include ammonium hydroxide and alkali and alkaline earth metal hydroxide, carbonates, as well as aliphatic and primary, secondary and tertiary amines, aliphatic diamines.
• Bases especially useful in the preparation of addition salts include ammonium hydroxide, potassium carbonate, methylamine, diethylamine, ethylene diamine, cyclohexylamine and ethanolamine.
• the pharmaceutically acceptable salts generally have enhanced solubility characteristics compared to the compound from which they are derived, and thus are often more amenable to formulation as liquids or emulsions, and can have enhanced bioavailability.
• Therapeutic agents useful in the practice ofthe invention i.e., agents that elevate or increase TGF-beta levels
• the amounts of latent and/or active TGF-beta present in a sample of physiological fluid, such as a blood fraction, before and/or after the administration ofthe therapeutic agent can be measured by methods disclosed in copending U.S. application Serial No. 08/477,393 and U.S. Patent No. 5,545,569, issued August 13, 1996, the disclosures of which are inco ⁇ orated by reference herein.
• an agent or mixture of agents is first tested on rat aortic vascular smooth muscle cells (rVSMCs) for their ability to stimulate the production of active TGF- ⁇ in the culture medium as originally described for tamoxifen. See Grainger et al. (Biochem. J..).
• explant hVSMCs The use of explant hVSMCs, is essential because (I) explant hVSMCs grown under non-optimal conditions (particularly at low cell densities) will spontaneously produce TGF- ⁇ ; (ii) hVSMC cultures from cells prepared by enzyme dispersal spontaneously produce substantial amounts of TGF- ⁇ in culture (Kirschenlohr et al, Am. J. Physiol. 265. C571 (1993)) and therefore cannot be used for screening; and (iii) the sensitivity of rVSMCs and hVSMCs to agents which induce the cells to produce TGF- ⁇ differs by up to 100-fold.
• hVSMCs In screening for agents likely to be effective for clinical purposes, it is therefore necessary to use hVSMCs to determine both potency and the therapeutic window between effective concentrations and toxic concentrations for human cells.
• Candidate agents which pass the in vitro cell culture screens are then tested on one or more animal models of vascular conditions or disease, e.g., animal models of atherosclerosis include lipid lesion formation in C57B16 mice and mice expressing the human apo(a) transgene that are fed a high fat diet, apoE knockout mice fed a normal diet, or cholesterol-fed Watanabe rabbits.
• ELIS A plates are coated with a chicken antibody that binds both latent and active TGF-beta.
• Patient sera or plasma are incubated with these ELIS A plates, then the plates are washed to remove unbound components ofthe patients' sera or plasma.
• Rabbit anti-TGF-beta antibody capable of binding both latent and active TGF-beta, is then added to the plates and incubated.
• the plates are then washed to remove unbound antibody, and peroxidase-labeled anti-rabbit IgG is added. After incubation and washing, the plates are exposed to the chromogenic substrate, ortho-phenylenediamine.
• TGF-beta The presence of total TGF-beta in patients' sera or plasma is then determined colorimetrically at A 492 by comparison to a standard curve.
• a pretreatment determination of TGF-beta can be compared with post-treatment time points to monitor treatment results and effectiveness.
• TGF-beta type II receptor extracellular domain which recognizes the active form(s) of TGF-beta, but not the mature or latent forms, is coated onto ELISA plates. Patient sera or plasma are added to the plates, and processed as above. This assay measures active TGF-beta present in sera or plasma.
• fluorescent-labeled anti-TGF-beta antibody is used in place of peroxidase labeled second antibody to detect the presence of TGF- beta in patients' sera or plasma.
• anti-TGF-beta antibody is labeled with a radioactive moiety capable of detection by standard means. These latter two assays may be performed in an ELISA format, with or without using the additional anti-TGF-beta antibody described above.
• the therapeutic agents ofthe invention can increase TGF-beta levels by increasing the number of TGF-beta transcripts, increasing the translational efficiency of TGF-beta transcripts, increasing the post-translational processing ofthe latent form of TGF-beta to the active form of TGF-beta, increasing the bioavailability of TGF-beta, and/or increasing the biological effect of active
• TGF-beta e.g., by increasing the affinity of TGF-beta for its receptor, increasing the affinity ofthe receptor for TGF-beta and/or by increasing the number of receptors for TGF-beta on the cell surface, or any combination thereof.
• the administration of aspirin or copper aspirinate can increase the level of latent TGF-beta in a mammal relative to the level of latent TGF-beta in that mammal prior to aspirin or copper aspirinate admimstration.
• Agents useful in the practice ofthe methods ofthe invention can also be identified by the correlation of agent administration with the inhibition or reduction in atherosclerotic plaque development or formation, an increase in lesion regression or plaque stability, or a decrease vascular wall hypertrophy and/or hyperplasia in vivo.
• Agent efficacy is measured by methods available to those skilled in the art including, but not limited to, angiography, ultrasonic evaluation, fluoroscopic imaging, fiber optic endoscopic examination or biopsy and histology.
• the activity ofthe therapeutic agents ofthe invention in vivo can also be monitored indirectly by the measurement ofthe levels of TGF-beta in a patient before and after the administration ofthe therapeutic agent.
• agents useful in the practice ofthe invention can be identified by the correlation of in vivo agent administration with a reduction in a particular pathology associated with the non- vascular indication.
• animal models for multiple sclerosis (Martin et al., Ann. Rev. Immunol.. 10. 153 (1992); Hafler et al., Immunol. Today. JO, 107 (1989), WO 93/16724) and rheumatoid arthritis (WO 93/16724) may be employed to determine the activity of the therapeutic agents ofthe invention in vivo.
• suitable animal models for osteoporosis suspension induced osteoporosis in rats
• cancer DMBA- induced skin cancer
• the therapeutic agents ofthe invention are useful to treat a mammal such as a human patient, afflicted with, or at risk of, a vascular indication.
• the therapeutic agents ofthe invention are useful to treat a mammal afflicted with, or at risk of, a vascular indication associated with a deficiency in TGF-beta.
• a mammal afflicted with, or at risk of, a vascular indication that would benefit from the practice ofthe claimed invention includes a mammal exhibiting a reduced level of TGF-beta within the vessel wall.
• Such mammals may be identified as having one or more risk factors which contribute to reduced TGF-beta activity. These factors include low serum active levels of TGF-beta, elevated circulating PAI-1 antigen or activity, elevated circulating lipoprotein (a), elevated blood concentration of LDL and/or VLDL in the fasting state, the ability to elevate PAI-1 following a fat tolerance test, the presence ofthe 4G allele ofthe PAI-1 promoter, and the like.
• the measurement of PAI-1 /TGF-beta response (Example 7) to fat feeding is one method to dete ⁇ mne whether an individual is at risk of a vascular indication associated with a deficiency in TGF-beta levels.
• low serum active TGF-beta levels can be levels that are less than about 4 ng/ml, preferably less than about 3 ng/ml, and more preferably less than about 2 ng/ml.
• Formulations and Routes of Administration ofthe Therapeutic Agents of the Invention are preferably administered at doses of about 0.001-600 mg/kg, more preferably at doses of about 2.0-165 mg/kg, and even more preferably at doses of about 1.0-100 mg/kg of body weight, although other dosages may provide beneficial results.
• Fish oil, a source of omega-3 fatty acids, is admimstered at doses of about
• accepted and effective daily doses will be from about 0.05 mg/kg/day to about 10 mg/kg/day, preferably about 0.1-1.0 mg/kg/day, more preferably about 0.3-0.5 mg/kg/day.
• an exemplary dose will be about 0.01 to about 1000 ⁇ g/ml, preferably followed by a chronic lower dose, which is preferably administered orally.
• a large loading dose may be employed, e.g., about 10 to about 100 mg/kg, to rapidly establish a therapeutic level ofthe agent.
• the large loading dose is preferably followed by a chronic dose of about 0.1 to about 20 mg/kg/day, preferably about 0.5 to about 2 mg/kg/day.
• a compound of formula (VT) is administered in the form of an acid addition salt, as is customary in the administration of pharmaceuticals comprising a basic group, such as an amino or N-heterocyclic group.
• the amount of therapeutic agent administered is selected to treat a particular vascular indication. For example, to treat vascular traumas of differing severity, smaller doses are sufficient to treat lesser vascular trauma, such as to prevent vascular rejection following graft or transplant, while larger doses are sufficient to treat more extensive vascular trauma, such as restenosis following angioplasty.
• the therapeutic agents ofthe invention are also amenable to chronic use for prophylactic purposes to treat disease states involving proliferation of vascular smooth muscle cells and pericytes derived from the medial layers of vessels, pericytes and fibroblasts in the adventitia, and migrating macrophage/monocyte/foam cells, over time (e.g., atherosclerosis, coronary heart disease, thrombosis, myocardial infarction, stroke, uterine fibroid or fibroma and the like), preferably by systemic administration.
• vascular smooth muscle cells and pericytes derived from the medial layers of vessels, pericytes and fibroblasts in the adventitia, and migrating macrophage/monocyte/foam cells e.g., atherosclerosis, coronary heart disease, thrombosis, myocardial infarction, stroke, uterine fibroid or fibroma and the like
• Administration ofthe therapeutic agents in accordance with the present invention may be continuous or intermittent, depending, for example, upon the recipient's physiological condition, whether the purpose ofthe administration is therapeutic or prophylactic, and other factors known to skilled practitioners.
• the administration ofthe agents ofthe invention may be essentially continuous over a preselected period of time or may be in a series of spaced doses, e.g., either before, during, or after procedural vascular trauma, before and during, before and after, during and after, or before, during and after the procedural trauma.
• One or more suitable unit dosage forms comprising the therapeutic agents of the invention, which, as discussed below, may be formulated for sustained release, can be administered by a variety of routes including oral, or parenteral, including by rectal, transdermal, subcutaneous, intravenous, intramuscular, intrapulmonary and intranasal routes.
• the therapeutic agents ofthe invention are prepared for oral administration, they are preferably combined with a pharmaceutically acceptable carrier, diluent or excipient to form a pharmaceutical formulation, or unit dosage form.
• the total active ingredients in such formulations comprise from 0.1 to 99.9% by weight ofthe formulation.
• pharmaceutically acceptable it is meant the carrier, diluent, excipient, and/or salt must be compatible with the other ingredients ofthe formulation, and not deleterious to the recipient thereof.
• compositions containing the therapeutic agents ofthe invention can be prepared by procedures known in the art using well known and readily available ingredients.
• a copper aspirinate including copper 2- acetylsalicylate, or a compound of formula (I), as well as a compound of formula (NI) can be formulated with common excipients, diluents, or carriers, and formed into tablets, capsules, suspensions, powders, and the like.
• excipients, diluents, and carriers that are suitable for such formulations include the following fillers and extenders such as starch, sugars, mannitol, and silicic derivatives; binding agents such as carboxymethyl cellulose, HPMC, and other cellulose derivatives, alginates, gelatin, and polyvinyl-pyrrolidone; moisturizing agents such as glycerol; disintegrating agents such as calcium carbonate and sodium bicarbonate; agents for retarding dissolution such as paraffin; resorption accelerators such as quaternary ammonium compounds; surface active agents such as cetyl alcohol, glycerol monostearate; adsorptive carriers such as kaolin and bentonite; and lubricants such as talc, calcium and magnesium stearate, and solid polyethyl glycols.
• fillers and extenders such as starch, sugars, mannitol, and silicic derivatives
• binding agents such as carboxymethyl cellulose, HPMC, and other cellulose
• tablets or caplets containing aspirinates ofthe invention can include buffering agents such as calcium carbonate, magnesium oxide and magnesium carbonate.
• Caplets and tablets can also include inactive ingredients such as cellulose, pregelatinized starch, silicon dioxide, hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, starch, talc, titanium dioxide, benzoic acid, citric acid, corn starch, mineral oil, polypropylene glycol, sodium phosphate, and zinc stearate, and the like.
• Hard or soft gelatin capsules containing aspirinates ofthe invention can contain inactive ingredients such as gelatin, microcrystalline cellulose, sodium lauryl sulfate, starch, talc, and titanium dioxide, and the like, as well as liquid vehicles such as polyethylene glycols (PEGs) and vegetable oil.
• inactive ingredients such as gelatin, microcrystalline cellulose, sodium lauryl sulfate, starch, talc, and titanium dioxide, and the like
• liquid vehicles such as polyethylene glycols (PEGs) and vegetable oil.
• PEGs polyethylene glycols
• the enteric coated caplets or tablets ofthe copper aspirinates ofthe invention are designed to resist disintegration in the stomach and dissolve in the more neutral to alkaline environment ofthe duodenum.
• the pharmaceutical formulations ofthe therapeutic agents ofthe invention can take the form of an aqueous or anhydrous solution or dispersion, or alternatively the form of an emulsion or suspension.
• the therapeutic agents ofthe invention can also be formulated as elixirs or solutions for convenient oral administration or as solutions appropriate for parenteral administration, for instance by intramuscular, subcutaneous or intravenous routes.
• formulations can contain pharmaceutically acceptable vehicles and adjuvants which are well known in the prior art. It is possible, for example, to prepare solutions using one or more organic solvent(s) that is/are acceptable from the physiological standpoint, chosen, in addition to water, from solvents such as acetone, ethanol, isopropyl alcohol, glycol ethers such as the products sold under the name "Dowanol”, polyglycols and polyethylene glycols, C,-C alkyl esters of short- chain acids, preferably ethyl or isopropyl lactate, fatty acid triglycerides such as the products marketed under the name "Miglyol", isopropyl myristate, animal, mineral and vegetable oils and polysiloxanes.
• solvents such as acetone, ethanol, isopropyl alcohol, glycol ethers such as the products sold under the name "Dowanol”, polyglycols and polyethylene glycols, C,-C alkyl esters of short- chain acids
• compositions according to the invention can also contain thickening agents such as cellulose and/or cellulose derivatives. They can also contain gums such as xanthan, alginates, guar, or carbo gum or gum arabic, or alternatively thickeners such as polyethylene glycols, bentones and montmorillonites, and the like.
• thickening agents such as cellulose and/or cellulose derivatives. They can also contain gums such as xanthan, alginates, guar, or carbo gum or gum arabic, or alternatively thickeners such as polyethylene glycols, bentones and montmorillonites, and the like.
• an adjuvant chosen from antioxidants, surfactants, preservatives, film-forming, keratolytic or comedolytic agents, perfumes and colorings.
• other active ingredients may be added, whether for the conditions described or some other condition.
• t-butylhydroquinone t-butylhydroquinone
• butylated hydroxyanisole butylated hydroxytoluene and ⁇ -tocopherol and its derivatives
• the galenical forms chiefly conditioned for topical application take the form of creams, milks, gels, dispersion or microemulsions, lotions thickened to a greater or lesser extent, impregnated pads, ointments or sticks, or alternatively the form of aerosol formulations in spray or foam form or alternatively in the form of a cake of soap.
• the agents are well suited to formulation as sustained release dosage forms and the like.
• the formulations can be so constituted that they release the active ingredient only or preferably in a particular part ofthe intestinal tract, possibly over a period of time.
• the coatings, envelopes, and protective matrices may be made, for example, from polymeric substances or waxes.
• the therapeutic agents of the invention can be delivered via patches for transdermal administration. See U.S. Patent No. 5,560,922 for examples of patches suitable for transdermal delivery of a therapeutic agent. Patches for transdermal delivery can comprise a backing layer and a polymer matrix which has dispersed or dissolved therein a therapeutic agent effective for reducing vessel lumen diameter diminution, along with one or more skin permeation enhancers.
• the backing layer can be made of any suitable material which is impermeable to the therapeutic agent.
• the backing layer serves as a protective cover for the matrix layer and provides also a support function.
• the backing can be formed so that it is essentially the same size layer as the polymer matrix or it can be of larger dimension so that it can extend beyond the side ofthe polymer matrix or overlay the side or sides ofthe polymer matrix and then can extend outwardly in a manner that the surface ofthe extension ofthe backing layer can be the base for an adhesive means.
• the polymer matrix can contain, or be formulated of, an adhesive polymer, such as polyacrylate or acrylate/vinyl acetate copolymer.
• an adhesive polymer such as polyacrylate or acrylate/vinyl acetate copolymer.
• Examples of materials suitable for making the backing layer are films of high and low density polyethylene, polypropylene, polyurethane, polyvinylchloride, polyesters such as poly(ethylene phthalate), metal foils, metal foil laminates of such suitable polymer films, and the like.
• the materials used for the backing layer are laminates of such polymer films with a metal foil such as aluminum foil.
• a polymer film ofthe laminate will usually be in contact with the adhesive polymer matrix.
• the backing layer can be any appropriate thickness which will provide the desired protective and support functions. A suitable thickness will be from about 10 to about 200 microns.
• those polymers used to form the biologically acceptable adhesive polymer layer are those capable of forming shaped bodies, thin walls or coatings through which therapeutic agents can pass at a controlled rate.
• Suitable polymers are biologically and pharmaceutically compatible, nonallergenic and insoluble in and compatible with body fluids or tissues with which the device is contacted. The use of soluble polymers is to be avoided since dissolution or erosion ofthe matrix by skin moisture would affect the release rate ofthe therapeutic agents as well as the capability ofthe dosage unit to remain in place for convenience of removal.
• Exemplary materials for fabricating the adhesive polymer layer include polyethylene, polypropylene, polyurethane, ethylene/propylene copolymers, ethylene/ethylacrylate copolymers, ethylene/vinyl acetate copolymers, silicone elastomers, especially the medical-grade polydimethylsiloxanes, neoprene rubber, polyisobutylene, polyacrylates, chlorinated polyethylene, polyvinyl chloride, vinyl chloride- vinyl acetate copolymer, crosslinked polymethacrylate polymers (hydrogel), polyvinylidene chloride, poly(ethylene terephthalate), butyl rubber, epichlorohydrin rubbers, ethylenvinyl alcohol copolymers, ethylene- vinyloxyethanol copolymers; silicone copolymers, for example, polysiloxane- polycarbonate copolymers, polysiloxanepolyethylene oxide copolymers, polysiloxane-polymeth
• a biologically acceptable adhesive polymer matrix should be selected from polymers with glass transition temperatures below room temperature.
• the polymer may, but need not necessarily, have a degree of crystallinity at room temperature.
• Cross-linking monomeric units or sites can be incorporated into such polymers.
• cross-linking monomers can be incorporated into polyacrylate polymers, which provide sites for cross-linking the matrix after dispersing the therapeutic agent into the polymer.
• Known cross-linking monomers for polyacrylate polymers include polymethacrylic esters of polyols such as butylene diacrylate and dimethacrylate, trimethylol propane trimethacrylate and the like.
• a plasticizer and/or humectant is dispersed within the adhesive polymer matrix.
• Water-soluble polyols are generally suitable for this purpose. Incorporation of a humectant in the formulation allows the dosage unit to absorb moisture on the surface of skin which in turn helps to reduce skin irritation and to prevent the adhesive polymer layer ofthe delivery system from failing.
• Therapeutic agents released from a transdermal delivery system must be capable of penetrating each layer of skin.
• a transdermal drug delivery system In order to increase the rate of permeation of a therapeutic agent, a transdermal drug delivery system must be able in particular to increase the permeability ofthe outermost layer of skin, the stratum corneum, which provides the most resistance to the penetration of molecules.
• the fabrication of patches for transdermal delivery of therapeutic agents is well known to the art.
• the local delivery ofthe therapeutic agents ofthe invention can also be by a variety of techniques which administer the agent at or near the diseased or traumatized vascular site. Examples of site-specific or targeted local delivery techniques are not intended to be limiting but to be illustrative ofthe techniques available.
• Examples include local delivery catheters, such as an infusion or indwelling catheter, a needle catheter, shunts and stents or other implantable devices, site specific carriers, direct injection, or direct applications.
• local delivery ofthe therapeutic agents to branch points may be particularly beneficial as active TGF beta levels are lower at branch points, where lesion formation is increased relative to non-branch points.
• Catheters which may be useful in the practice ofthe invention include catheters such as those disclosed in Just et al. (U.S. Patent No. 5,232,444), Abusio et al. (U.S. Patent No. 5,213,576), Shapland et al. (U.S. Patent No. 5,282,785), Racchini et al. (U.S. Patent No. 5,458,568) and Shaffer et al. (U.S. Patent No. 5,049,132), the disclosures of which are incorporated by reference herein.
• a therapeutically/-prophylactically effective dosage ofthe compounds of formula (VI) will be typically reached when the concentration thereof in the fluid space between the balloons ofthe catheter is in the range of about 10 "3 to 10 "12 M.
• the compounds of formula (VI) may only need to be delivered in an anti-proliferative therapeutic/prophylactic dosage sufficient to expose the proximal (6 to 9) cell layers ofthe intimal or tunica media cells lining the lumen thereto. Also, such a dosage can be determined empirically, e.g., by a) infusing vessels from suitable animal model systems and using immunohistochemical methods to detect the compound of formula (VI) and its effects; and b) conducting suitable in vitro studies.
• Local delivery by an implant involves the surgical placement of a matrix that contains the therapeutic agent at the lesion site or traumatized area. The implanted matrix releases the therapeutic agent by diffusion, chemical reaction, or solvent activators. Lange, Science. 249, 1527 (1990).
• An example of targeted local delivery by an implant is the use of a stent.
• Stents are designed to mechanically prevent the collapse and reocclusion ofthe coronary arteries. Incorporating a therapeutic agent into the stent delivers the therapeutic agent directly to the lesion. Local delivery of agents by this technique is described in Koh, Pharmaceutical Technology (October, 1990).
• a metallic, plastic or biodegradable intravascular stent can be employed which comprises an effective amount of a therapeutic agent.
• the stent preferably comprises a biodegradable coating or a porous or permeable non-biodegradable coating comprising the therapeutic agent.
• a more preferred embodiment ofthe invention is a coated stent wherein the coating comprises a sustained-release dosage form ofthe therapeutic agent.
• a biodegradable stent may also have the therapeutic agent impregnated therein, i.e., in the stent matrix.
• a biodegradable stent with the therapeutic agent impregnated therein can further be coated with a biodegradable coating or with a porous non-biodegradable coating having the sustained release-dosage form ofthe therapeutic agent dispersed therein.
• Such a stent can provide a differential release rate ofthe therapeutic agent, i.e., there can be a faster initial release ofthe therapeutic agent from the coating followed by a slower delayed release ofthe therapeutic agent impregnated in the stent matrix, upon degradation ofthe stent matrix.
• the intravascular stent also provides a mechanical means of providing an increase in luminal area of a vessel.
• intravascular stents comprising a therapeutic agent which is an inhibitor of smooth muscle cell proliferation
• a therapeutic agent which is an inhibitor of smooth muscle cell proliferation
• This inhibition of intimal smooth muscle cells and stroma produced by the smooth muscle and pericytes can allow more rapid and complete re-endothelization following the intraventional placement ofthe vascular stent.
• the increased rate of re-endothelization and stabilization ofthe vessel wall following stent placement can reduce the loss of luminal area and decreased blood flow which is the primary cause of vascular stent failures.
• Another example is a delivery system in which a polymer that contains the therapeutic agent is injected into the lesion in liquid form. The polymer then solidifies or cures to form the implant which is retained in situ.
• This technique is described in published PCT application WO 90/03768 (Donn, Apr. 19, 1990).
• Another example is the delivery of a therapeutic agent by polymeric endoluminal sealing. This technique uses a catheter to apply a polymeric implant to the interior surface ofthe lumen. The therapeutic agent incorporated into the biodegradable polymer implant is thereby released at the surgical site.
• This technique is described in published PCT application WO 90/01969 (Schindler, Aug. 23, 1989), the disclosure of which is inco ⁇ orated by reference herein.
• microparticulates may be composed of substances such as proteins, lipids, carbohydrates or synthetic polymers. These microparticulates have the therapeutic agent inco ⁇ orated throughout the microparticle or over the microparticle as a coating. Delivery systems inco ⁇ orating microparticulates are described in Lange, Science. 249.1527 (1990) and Mathiowitz et al., J. App. Polv. Sci.. 26, 809 (1981).
• Local delivery by site specific carriers involves attaching the therapeutic agent to a carrier which will direct the therapeutic agent to the target site, i.e., to a proliferative lesion.
• a carrier such as a protein ligand, e.g., a monoclonal antibody or antibody fragment. Lange, Science. 249.1527 (1990V
• Local delivery by direct application also includes applying the therapeutic agent directly to tissue, such as to the arterial bypass graft during the surgical procedure, or an artificial graft, and then implanting the treated graft or other tissue.
• the therapeutic agents may be formulated as is known in the art for direct application to a target area.
• Conventional forms for this pu ⁇ ose include wound dressings, coated bandages or other polymer coverings, ointments, lotions, pastes, jellies, sprays, and aerosols.
• the percent by weight of a therapeutic agent ofthe invention present in a topical formulation will depend on various factors, but generally will be from 0.5% to 95% ofthe total weight ofthe formulation, and typically 1-25% by weight.
• therapeutically/- prophylactically effective dosages of these therapeutic agents and compositions will be dependent on several factors. For example, with respect to catheter delivery, those factors include a) the atmospheric pressure applied during infusion; b) the time over which the agent administered resides at the vascular site; c) the form of the therapeutic or prophylactic agent employed; and/or d) the nature ofthe vascular trauma and therapy desired.
• those skilled practitioners trained to deliver drugs at therapeutically or prophylactically effective dosages e.g., by monitoring drug levels and observing clinical effects in patients
• infiltration ofthe therapeutic agent into intimal layers of a diseased or traumatized human vessel wall in free or sustained-release form is subject to variation and will need to be determined on an individual basis.
• TGF-beta is a hydrophobic protein known to have affinity for polymeric aliphatic hydrocarbons.
• platelet-poor plasma was prepared from peripheral venous blood drawn from ten healthy donors (A-J) and two donors with diabetes (K and L). The absence of platelet degranulation ( ⁇ 0.02% degranulation) was confirmed by measurement of PF-4 (platelet factor-4) in the plasma by ELISA (Asserchrom PF-4; Diagnostic Stago, FR). A 1 ml aliquot of plasma was diluted to 4 ml with Buffer A (Havel et al. , J. Clin.
• KBr was added to final density of 1.215 g/ml.
• the lipoproteins were separated from the plasma proteins by density gradient ultracentrifugation (235,000 x g) at 4°C for 48 hours. The top 2 ml was collected as the lipoprotein fraction and the lower 2 ml was collected as the lipoprotein deficient plasma fraction. The total cholesterol in each fraction was measured by the cholesterol oxidase enzymatic method (Sigma Diagnostics) as previously described in Grainger et al., Nat. Med..1, 1067 (1995).
• the cholesterol in fractions 0-9 was assumed to be VLDL, in fractions 10-19 to be LDL, and in fractions 20-30 to be HDL, in accordance with the elution positions ofthe major apolipoproteins. Lipoprotein concentrations are reported as mM cholesterol.
• the lipoprotein fraction was subjected to extensive dialysis against serum-free DMEM, and the amount of TGF-beta was measured in the lipoprotein fraction and in the plasma protein fractions after treatment with acid/urea, using the Quantikine ELISA (R&D Systems) in accordance with the manufacturer's instructions. In some individuals (7/10), TGF-beta was detected in the lipoprotein fraction as well as the lipoprotein deficient plasma fraction. The proportion ofthe TGF-beta associated with lipoprotein varied from ⁇ 1% to 39% with a mean of 16%. Thus, plasma TGF-beta, unlike most other plasma proteins, can associate with lipoprotein particles.
• TGF-beta associated with lipoprotein particles was able to bind to the type II TGF-beta signaling receptor and exert biological activity in vitro
• the binding of recombinant TGF-beta to R2X was measured in the absence and presence of increasing concentrations of lipoprotein purified from the plasma of an individual with ⁇ 1 ng/ml TGF-beta in plasma (individual I, Table 1). If the lipoprotein-associated fraction of TGF-beta is unavailable for binding, lipoproteins prepared from an individual with a very low plasma concentration of TGF-beta would be expected to reduce the binding of recombinant active TGF-beta to its receptors.
• the half maximal (ka) binding of recombinant TGF-beta to the recombinant extracellular domain ofthe type II TGF-beta receptor was previously determined to be 17 ⁇ 3 ng/ml (R2X; Grainger et al., Nature. 270. 460 (1994); Grainger et al., Clin. Chim. Acta. 235. 11 (1995)).
• R2X Grainger et al., Nature. 270. 460 (1994); Grainger et al., Clin. Chim. Acta. 235. 11 (1995)
• the recombinant extracellular domain ofthe type II TGF-beta receptor was coated onto ELISA plates (1 ⁇ g/well, Maxiso ⁇ plates, Gibco BRL).
• TGF-beta inhibits the proliferation of mink lung epithelial (MvLu) cells in culture.
• Recombinant active TGF-betal was added to MvLu cells (passage 59-63 from the ATCC) which were growing in DMEM + 10% fetal calf serum) and the concentration of recombinant TGF-beta required to half-maximally inhibit MvLu cells (reported as MvLu cell ID S0 ) was measured as previously described (Danielpour et al., J. Cell Phvsiol.. 138. 79 (1989); Kirschenlohr et al., Am. J. Phvsiol.. 265. C571 (1993).
• Addition of lipoprotein purified from the plasma of individual I caused a dose-dependent increase in the -D 50 of TGF-beta.
• the H 50 was maximal at 0.52 ⁇ 0.08 ng/ml when 3 mM total cholesterol was added.
• the concentration of lipoprotein which half-maximally increased the H 50 was approximately 0.8 mM. Therefore, TGF-beta associated with lipoprotein was less active, or inactive, as an inhibitor of MvLu cell proliferation.
• TGF-beta activity Since low levels of TGF-beta activity have been associated with advanced atherosclerosis, individuals with a large proportion of their plasma TGF-beta sequestered into an inactive lipoprotein-associated pool may be at significantly higher risk of developing the disease.
• the differences in the proportion of TGF-beta associated with lipoprotein among the individuals studied was therefore investigated further.
• the different classes of lipoprotein were separated by size using gel filtration chromatography for ten healthy individuals A-J (Table 1) as well as two diabetic individuals with abnormal lipoprotein profiles (individuals K-L, Table 1). The TGF-beta present in the fractions following the gel filtration ofthe lipoprotein fraction from each ofthe ten individuals was then determined.
• TGF-beta Individual C had little VLDL or chylomicrons but moderately elevated LDL and 24% ofthe plasma TGF-beta was associated with the lipoprotein pool (Figure 3B). As with the other individuals the majority (65%) ofthe TGF-beta was associated with the HDL subtraction. However, this individual had a significant amount of TGF-beta (27%) associated with LDL and the remainder eluted with the VLDL.
• TGF-beta associates with a sub fraction of HDL particles which vary very little in size and which are among the smallest cholesterol-containing lipoproteins present in plasma. Additionally, TGF-beta can associate with both the triglyceride-rich LDL and VLDL particles ( Figure 10). Indeed, under conditions where the concentrations of these particles in plasma is elevated, e.g., in diabetic subjects or patients with hypercholesterolaemia or hypertriglyceridaemia, these particles can become the major lipoprotein fraction responsible for binding TGF- beta. Diabetic individuals, particularly those with poor glucose control, often exhibit elevated plasma concentrations ofthe triglyceride-rich lipoprotein particles.
• Such individuals may therefore have an increased fraction of their plasma TGF-beta associated with the lipoprotein pool, since they may have a major fraction of their plasma TGF-beta associated with the triglyceride-rich lipoprotein particles as well as the subtraction of HDL particles.
• platelet-poor plasma was prepared from 33 donors prior to, and immediately following, four weeks of dietary supplementation with 2.4 g/day fish oil (Wallace et al., Arterial Thromb. Vase. Biol.. 15. 185 (1995)). A further plasma sample was prepared nine weeks after ceasing the supplementation. The fraction of TGF-beta associated with the lipoprotein pool was determined for each plasma sample.
• the concentration of active TGF-beta increased by 21% after four weeks of dietary supplementation with 2.4 g/day fish oil.
• the concentration of active TGF-beta was still significantly above baseline after a further 9 weeks after dietary supplementation, although the increase was less marked (+12%, p ⁇ 0.05).
• increased dietary intake offish oil reduces the fraction of plasma TGF-beta sequestered into the lipoprotein pool, and increases the concentration of active TGF-beta in plasma.
• the reduction in sequestration may be due to the alteration ofthe proportion of different lipoproteins, i.e., fish oil reduces triglyceride rich lipoprotein levels, or by altering the composition and hence sequestering properties of lipoprotein.
• fish oil has no effect on the production of latent TGF-beta or mature TGF-beta but increases TGF-beta bioavailability by decreasing the lipoprotein sequestration ofthe TGF-beta.
• Such an effect would likely result in cardioprotection in individuals with adequate production of latent and mature TGF-beta but limited ability to release TGF-beta from lipoprotein complexes.
• TGF-beta Proportion of TGF-beta associated with lipid following dietary supplementation with fish oil.
• Total triglyceride concentration was measured by the glycerol kinase enzymatic method (Sigma Diagnostics).
• Aspirin Increases Circulating TGF-beta Levels Aspirin has been suggested to have cardioprotective effects and is now in widespread use by patients diagnosed with coronary atherosclerosis. It has been demonstrated to significantly reduce the incidence of a second myocardial infarction (MI) in individuals who have previously suffered an MI. However, any benefit for the primary prevention of MI has not yet been demonstrated rigorously, although some studies have reported encouraging results.
• MI myocardial infarction
• vascular smooth muscle cells vascular smooth muscle cells
• NSMCs vascular smooth muscle cells
• confluent cultures of human explant- derived VSMCs were subcultured into and grown for 24 hours in the presence of 10% FCS. The medium was then changed and triplicate wells were treated with either aspirin (from a stock solution dissolved in ethanol) or sodium aspirinate at various concentrations. The medium was replaced after 48 hours and after 96 hours the cells were released with trypsin and counted by haemocytometer.
• Tamoxifen (5 ⁇ M) was used as positive control, since it has previously been shown to stimulate TGF-beta production under similar conditions.
• aspirin like tamoxifen, stimulates production of TGF-beta by human VSMCs in culture, although the ED 50 for aspirin (12 ⁇ M) was markedly less potent than for tamoxifen (50 nM).
• TGF-beta TGF-beta activity in the circulation of 42 patients with more than 50% stenoses of all three major coronary arteries (TVD) taking low- dose aspirin relative to individuals with normal coronary arteries (NCA) was determined.
• TVD major coronary arteries
• NCA normal coronary arteries
• Platelet-poor plasma was prepared with minimal ( ⁇ 0.1% assessed by PF-4 release) platelet degranulation and active and (a + 1) TGF-beta were measured by ELISA.
• TGF-beta level was significantly higher in patients taking 75 mg/day of aspirin (+ 41%; p ⁇ 0.05), and in patients taking 150 mg/day of aspirin (55%; p ⁇ 0.05). This is consistent with a previous study, where (a + 1) TGF-beta levels were elevated by 66% in patients taking 150 mg aspirin per day. TGF-beta activity was also elevated in NCA individuals taking 150 mg aspirin per day ( Figure 6A), and hence the proportion of TGF-beta in the active form was not significantly changed. TGF-beta production was similarly higher in both men and women taking aspirin (+ 47% in men compared to 44% in women at 150 mg per day; Figure 6C).
• Example IV Copper Aspirinate is a TGF-beta Stimulating Agent
• Red and white grape juice were treated similarly as controls as they are expected to lack the active components produced during fermentation ofthe grape skins.
• Rat vascular smooth muscle cells (rNSMCs) were subcultured into DMEM + 10% fetal calf serum, grown for 24 hours then treated with various concentrations of the wines or grape juices. The medium was replaced after 48 hours and after 96 hours, the cells released with trypsin and counted by haemocytometer. Final concentrations ofthe wine and grape juice on the cells were expressed as a percentage ofthe concentration ofthe original wine or grape juice.
• Cu aspirinate was almost two orders of magnitude more potent than aspirin at stimulating TGF-beta (ED 50 on human cells 200 nM for Cu aspirinate versus 10 ⁇ M for aspirin). It is likely that there is sufficient Cu aspirinate in red wine, and particularly in red wines of Bordeaux origin which are especially rich in copper, to account for most if not all ofthe TGF-beta stimulating activity associated with red wine.
• TGF-beta levels in Tamoxifen Treated Patients To investigate whether TGF-beta levels are elevated after TMX administration, fifteen patients with stable angina and angiographically defined triple vessel disease took TMX daily for ten days at a dose similar to that generally used for breast cancer therapy. Patients with triple vessel disease (TVD) were defined as individuals having at least 50% stenosis of all three coronary arteries by angiography, which was confirmed by two independent observers. All had stable angina, with no myocardial infarction in the previous three months. Patients with unstable angina, poor left ventricular function, ventricular hypertrophy or diabetes were excluded.
• TDD triple vessel disease
• Blood samples were taken and plasma prepared before and during the treatment period, and these samples were analyzed for TGF-beta, Lp(a), PAI-1 and lipoprotein profiles. Patients were asked to fast overnight prior to samples of blood being drawn between 9 a.m. and 10 a.m. the following morning. Blood samples were drawn by venepuncture ofthe antecubital vein with no tourniquet applied using a 21 gauge butterfly needle. Half the blood was allowed to clot for 2 hours at room temperature in polypropylene tubes. The clot was spun down (1,500 x g; 15 minutes) and aliquots ofthe serum was stored at -100°C. The remaining blood was dispensed into Diatube H tubes (Diagnostica Stago) and cooled on ice for
• A A sandwhich ELISA using BD A 19 and BD A5 (R&D Systems) antibodies with no activation step required.
• B The Quantikine TGF-betal ELISA kit (R&D Systems) using acid/urea as the activation buffer in accordance with the manufacturer's instructions
• C The Quantikine TGF-betal ELISA kit (R&D Systems) using acid alone as the activation buffer
• D The BioTrak TGF-betal ELISA kit (Amersham International) using acid urea as the activation buffer
• E The BioTrak TGF-betal ELISA kit (Amersham International) using acid alone as the activation buffer in accordance with the manufacturers instructions
• F The TGF-betal ELISA kit (Genzyme Diagnostics) using acid/urea as the activation buffer in accordance with the manufacturer's instructions
• G The TGF-betal ELISA kit (Promega Co ⁇ oration) using acid alone as the activation buffer in accordance with the manufacturer's instructions
• TGF-beta The partitioning of TGF-beta between the lipoproteins and plasma proteins was analyzed by separating the lipoprotein fraction (d ⁇ 1.215 g/cm 2 ) from the plasma proteins by density ultracentrifugation as described hereinabove. TGF-beta levels were assayed in both fractions using the Quantikine ELISA kit, following release and activation of TGF-beta with acetic acid and urea in accordance with the manufacturer's instructions. None ofthe three TGF-beta ELIS As used here detected TGF-beta in the lipoprotein fraction without prior extraction/activation with acetic acid/urea.
• Plasma triglyceride, total plasma cholesterol, HDL-cholesterol, LDL- cholesterol and VLDL-cholesterol were routinely assayed in all patients. Liver function tests (aspartate transaminase and lactate dehydrogenase) were also performed on samples prior to dosing with TMX and at the end ofthe study by a clinical biochemistry laboratory. Plasma PAI-1 was assayed using an ELISA (American Diagnostica) which recognizes active endothelial PAI-1 as well as inactive PA/PAI-1 complexes.
• ELISA American Diagnostica
• Lipoprotein(a) was assayed by an ELISA for apolipoprotein(a) (Immuno) which showed no detectable cross reactivity with related proteins such as plasminogen. Platelet factor-4 (PF4) and ⁇ - thromboglobulin ( ⁇ TG) were assayed using specific ELISAs (Diagnostica Stago).
• PF4 Platelet factor-4
• ⁇ TG ⁇ - thromboglobulin
• TMX NolvadexTM(tamoxifen citrate), Zeneca Ltd., Macclesfield, UK] at a dose of 40 mg was taken each morning, before breakfast, for 10 days.
• TMX treatment the mean (a + 1) TGF-beta in plasma was 6.2 ⁇ 1.3 ng/ml.
• TMX there was a trend of increasing concentration of
• VLDL-cholesterol (mM) 1.03 ⁇ 0.14 0.84 ⁇ 0.11*
• Plasma PAI-I antigen 29.3 ⁇ 6.4 35.9 ⁇ 5.4*
• Lp(a) mean 61 ⁇ 10 mg/dl at baseline
• the plasma concentration of Lp(a) was decreased by 27% (p ⁇ 0.05 compared to baseline) by day 3 of TMX therapy.
• TGF-beta can be sequestered into lipoprotein particles where it is biologically inactive.
• TMX had significantly altered the lipoprotein profile ofthe patients, the proportion ofthe plasma TGF-beta associated with lipoprotein was measured.
• the lipoproteins were separated from the plasma proteins by density gradient ultracentrifugation.
• the Quantikine ELISA was used following release and activation of any TGF-beta in both the lipoprotein fraction and the plasma protein fraction.
• the TGF-beta was lipoprotein-associated and hence biologically inactive, but this was reduced to 25 ⁇ 3% (p ⁇ 0.01 ) after 10 days of TMX therapy (Figure 8C).
• TMX 40 mg per day elevates the plasma concentration of TGF-beta in men with severe coronary atherosclerosis. This increase was seen irrespective of which ofthe seven different methodologies were employed to measure (a +1) TGF-beta. Consistent with studies in cell culture and in mice, TMX elevates the amount of (a +1) TGF-beta, suggesting that the elevation may have resulted from increased synthesis of latent precursor complexes. In rat and human smooth muscle cell culture, TMX increases TGF-beta production by increasing the amount of TGF-betal mRNA. In other cell types TMX increases the translational efficiency of TGF-beta mRNA and hence increases production ofthe latent precursor protein.
• TGF-beta Another disadvantage of aspirin as a cardiovascular agent, besides the fact that it is not a very potent TGF-beta elevating agent, is that it appears to be a pure stimulator ofthe latent form of TGF-beta. As a result, under conditions where TGF- beta activation or release is not occurring, or is occurring to a reduced extent, e.g., when PAI-1 inhibits activation or lipoproteins sequester TGF-beta, the supply of latent TGF-beta precursors may not be limiting for the generation ofthe active forms. This disadvantage can be overcome by combination therapy.
• the identification of agents that increase the level of mature and/or active TGF-beta can be useful in combination therapies with aspirin or with other agents that are more potent stimulators ofthe latent form of TGF-beta, such as copper aspirinate.
• 8-week-old female apoE knockout mice were fed aspirin or fish oil, or both, to assess the cardioprotective effects of modulating different components ofthe TGF-beta pathway.
• Group D mice were fed chow containing 33 mg/kg/day fish oil (200 ⁇ g Pulse cod liver oil/g food, Seven Seas Ltd., which contains 0.9 g eicosapentaenoic acid (EPA), and 0.3 g docosahexaenoic acid (DHA)) and 3 mg/kg/day aspirin dissolved in water.
• EPA eicosapentaenoic acid
• DHA docosahexaenoic acid
• mice were fed chow containing 33 mg/kg/day fish oil.
• Group F mice were fed chow containing Zocor (simvastatin; Zocor tablets, Merck, Sha ⁇ e & Dohme) at 400 ⁇ g/kg/day (2 ⁇ g/g food).
• Simvastatin is an inhibitor ofthe enzyme HMG-CoA reductase, the committed step in cholesterol biosynthesis. As a result, it has been shown to reduce the total plasma cholesterol concentration in man and in particular the concentration of cholesterol in the more triglyceride-rich particles (VLDL and LDL). If alterations in the lipid profile are responsible for the suppression of lesion formation previously observed with TMX, then simvastatin should reduce lesion formation.
• mice in groups B-F were fasted overnight and then sacrificed. Serum, heart, lungs and aorta samples were collected at the time of sacrifice. The heart, lungs and aorta were removed from each mouse and rinsed in PBS, dabbed dry on tissue and embedded in Cryo-M-bed embedding medium (Bright Instruments, Huntington, U.K.) before snap freezing in liquid nitrogen. Frozen sections (4 ⁇ m thickness) ofthe aortic sinus region were prepared from the heart/lung/aorta blocks according to the sectioning strategy of Paigen et al. (Arteriosclerosis. 10, 316 (1990)). Sections on 5% gelatin-coated slides were stained for neutral lipid by the Oil Red O technique and counter-stained with fast green (Grainger et al., Nature Med..1, 1067 (1995)).
• lipid- filled vascular lesions was determined by the quantitation of oil red O staining for neutral lipid deposited in the aortic sinus region.
• the area of lipid accumulation was measured using a calibrated microscope eye-piece, such that lipid droplets ⁇ 50 ⁇ m 2 were ignored and contiguous regions of lipid staining > 500 ⁇ m 2 in area were classified as lesions.
• the area staining for neutral lipid increased from 10,765 ⁇ 978 to 27,175 ⁇ 1040 ⁇ m 2 /mouse over the three months ofthe experiment for mice fed a normal mouse chow diet, as seen in previous studies of spontaneous lesion development in apoE knockout mice.
• Treatment with aspirin alone did not affect lesion development over the same 3 month period (Table 4).
• Active TGF-beta was measured by quantitative immunofluorescence microscopy using the recombinant extracellular domain ofthe type II TGF-beta receptor (R2X) labeled with fluorescein.
• mice which were treated with both aspirin and fish oil had significantly elevated levels of both (a + 1) TGF-beta (+ 50%) and active TGF-beta (+ 33%) in the vessel wall compared with the control mice.
• the synergism ofthe effects of these drugs on the amount of active TGF-beta in the vessel wall is consistent with the proposed different mechanisms of action for the two drugs.
• an increase in level of active TGF-beta in apo(E)-/- mice correlates with a decrease in lesion number and area.
• Simvastatin treated mice (Group F) showed no difference in the amounts of
• SM- ⁇ -actin smooth muscle ⁇ - actin
• the serum supernatant was aliquoted and stored at -20°C until assayed.
• Total cholesterol and total triglycerides were determined for each mouse using the cholesterol oxidase and glycerol kinase UN end-point enzymatic methods respectively (Sigma Diagnostics).
• 100 ⁇ l of serum from every mouse in each group was pooled (a total of 1 ml serum for each group) and the lipoprotein fraction was separated by density gradient ultracentrifugation.
• the lipoprotein fraction was then further separated by gel filtration FPLC chromatography on a Sepharose 6B column, and the elution positions ofthe lipoprotein particles were detected by measuring cholesterol (by the cholesterol oxidase enzymatic method) in each fraction. VLDL particles eluted in fractions 1-10, LDL in fractions 11-20 and HDL in fractions after 20. Treatment ofthe mice with aspirin for three months had no effect on total plasma cholesterol or on the lipoprotein profile (Table 8).
• mice treated with diets containing fish oil had similar total plasma cholesterol and triglyceride concentrations to control mice, although there was a small reduction in the concentration of both VLDL-cholesterol (-16%) and LDL-cholesterol (-12%) and an increase in HDL-cholesterol (+ 10%). Consistent with the effects of dietary supplementation with fish oil in man, a decrease in cholesterol, primarily in the VLDL fraction, in apoE knockout mice treated with fish oil was observed.
• a single measurement ofthe lipoprotein profile was made on blood pooled from all the mice in the Group.
• aspirin increases the level of latent TGF- beta, but not the amount of active TGF-beta, in the vessel wall of apo(E)-/- mice. Also consistent with data in humans, fish oil lowers VLDL, which results in lower levels of PAI-1 and an increase in the levels of active TGF-beta which are available for TGF-beta receptor binding.
• tamoxifen treatment has been demonstrated to elevate TGF-beta activity and suppress lipid lesion formation in several transgenic mouse models of atherosclerosis (Grainger et al.).
• tamoxifen has a variety of other effects, including reducing total plasma cholesterol and inducing some weight loss, which may have contributed to the observed reduction in lesion development.
• elevating TGF-beta activity reduced lesion formation.
• the study described hereinabove employed agents which elevate TGF- beta activity and which do not affect body weight and have much smaller effects on lipoprotein metabolism.
• simvastatin which has a larger beneficial effect on the lipoprotein profile than the other treatments, does not significantly reduce lipid lesion formation.
• Example VII Use of Therapeutic Agents ofthe Invention to Prevent Autoimmune Disorders
• the therapeutic agents ofthe invention are also useful to prevent or treat other indications associated with TGF-beta, e.g., pathologies which result from a pathological inflammation reaction caused by the recognition of self-antigens
• autoimmune disorders Indications associated with pathological inflammation reactions include, but are not limited to, rheumatoid arthritis, multiple sclerosis and late-onset diabetes.
• the recruitment and activation of both autoreactive T cells and other inflammatory cells to the developing lesion contributes to both the chronic tissue damage and the acute symptoms of autoimmune disorders.
• Agents which reduce or prevent immune cell recruitment and/or activation may ameliorate both the painful symptoms associated with the disorder and the progressive destruction of the target tissue.
• autoimmune disorders include the administration of anti-inflammatory steroids and steroid-mimetic drugs, such as dexamethasone, to reduce recruitment and activation ofthe immune cells in the developing lesions.
• steroids act by binding to the glucocorticoid receptor (GR) which leads to the association ofthe GR with elements ofthe NFkB transcription factor complex.
• GR glucocorticoid receptor
• pro-inflammatory cytokines are inhibited.
• the binding ofthe steroids to the GR also results in the activation of GR.
• Activated GR is a nuclear transcription factor.
• steroids and steroid-mimetic drugs cannot be used chronically to slow the progression of autoimmune diseases because they have an undesirable profile of side effects. Many or all of these side effects result from the direct activation ofthe GR as a transcription factor.
• ER/NFkB modulators agents which modulate the interaction ofthe estrogen receptor (ER) with the NFkB transcriptional complex
• ER/NFkB modulators include idoxifene, raloxifene, droloxifene, toremifene, and tamoxifen, as well as functional equivalents, analogs or derivatives thereof. These agents also inhibit or reduce TNF- alpha mediated NFkB activation.
• ER/NFkB modulators are not characterized by the undesirable side effect profile of GR/NFkB modulators at the doses used to treat autoimmune disorders, they are therefore amenable to chronic use in the prevention or treatment of autoimmune disorders.
• NFkB activity When cells which have NFkB activity, such as human smooth muscle cells (SMCs), were cultured in the presence of 20% fetal calf serum (FCS) in Dulbecco ' s modification of Eagles' Medium (DMEM), more than 95% of NFkB was present in the cytoplasm, as determined by immunostaining for p65.
• FCS fetal calf serum
• DMEM Dulbecco ' s modification of Eagles' Medium
• NFkB NFkB remained in the cytoplasm and there was no detectable change in NFkB activity.
• TNF-alpha (20 ng/ml) and tamoxifen (5 ⁇ M)
• TMX tamoxifen
• 3 H-TMX tritium-labeled tamoxifen
• the affinity purified proteins were separated further by MonoQ ion exchange chromatography and fractions were assayed for 3 H-TMX binding. Three peaks of protein associated with TMX-binding activity were identified. Peak I had an affinity of about 1 ⁇ M and may correspond to site C. Further purification of this protein by gel filtration chromatography and gel electrophoresis allowed a molecular identification ofthe protein by N-terminal sequence analysis as human serum albumin. The amount of protein in the other two peaks of activity was less than the amount necessary to allow molecular characterization of these proteins. Human SMC lysates were treated with a large excess of antibody directed against the human ER protein.
• both sites A and B (the high affinity sites) contain either the human ER or a protein which contains an epitope conserved with the human ER. It is very likely that both TMX binding complexes contain the ER.
• TMX binding sites in human SMC cell lysates are human serum albumin, a complex containing ER and IkB-alpha, and a complex containing ER but not IkB-alpha.
• ER interacts with NFkB transcription factor complexes in a similar manner to that for GR
• agents which modulate ER/NFkB interaction should modulate the inflammatory response without activating GR.
• SMCs in DMEM + 10% FCS were transfected with a vector comprising the MMTV LTR promoter coupled to the chloramphenicol acetyl transferase (CAT) gene and the neomycin resistance gene (neo).
• CAT chloramphenicol acetyl transferase
• neo neomycin resistance gene
• TNF-alpha up to 100 ng/ml
• tamoxifen up to 10 ⁇ M
• both agents did not stimulate expression ofthe CAT gene by more than 10%.
• ER/NFkB modulators would be expected to circumvent the undesirable side-effect profile associated with direct transcriptional activation by GR.
• Tamoxifen may also upregulate expression of TGF-beta through its interaction with the NFkB transcription factor complex, as suggested by the following observations.
• the p68 RelB knockout mouse has a phenotype similar to the TGF-beta knockout mouse, suggesting that RelB may be important in the upregulation of TGF-beta that normally turns off acute inflammation, and
• the kB-like element in the rat TGF-beta- 1 promoter is implicated in the tamoxifen- induced stimulation of TGF-beta expression.
• a second consequence of ER/NFkB modulation by these agents is upregulation of TGF-beta expression.
• TGF-beta has anti-inflammatory and immune- suppressive functions.
• the induction of TGF-beta by ER/NFkB modulating agents may act to synergistically reduce inflammation.
• ER NFkB modulators such as idoxifene
• several exemplary dosing regimens are contemplated depending upon the particular autoimmune disease being treated and the stage to which the condition has progressed.
• a low chronic oral dose of about 0.05 to about 10, preferably about 0.1 mg/kg/day, is employed.
• a large loading dose e.g., in the range of about 10 to about 100 mg/kg, is used to rapidly establish a therapeutic level ofthe ER NFkB modulator in the circulation, followed by low chronic oral doses.
• an exemplary dose regimen is a single pre-loading dose, e.g., between about 10 to about 100 mg/kg, to establish a therapeutically effective amount of ER/NFkB modulator in the circulation, followed by a dose of about 0.1 to about 20, preferably about 0.5 to about 5, mg/kg/day.
• ER/NFkB modulators that act to reduce or inhibit pathological inflammation associated with autoimmune disorders can be identified by the methods described hereinabove. Specifically, the agents may be identified by their ability to bind to NFkB/ER complexes, to inhibit NFkB activation induced by TNF-alpha and/or other pro-inflammatory cytokines, and to prevent activation of autoreactive T lymphocytes.
• Recombinant sRII was coated onto the bottom of high protein binding ELISA plates for two hours in 50 mM carbonate buffer (pH 9), then washed, and non-specific binding blocked using 5% Tween-20 in 5% sucrose in water, containing 0.02% sodium azide (TSA block).
• TSA block sodium azide
• Various serum and plasma samples were then incubated with the coated wells for 2 hours at room temperature with shaking. Unbound serum components were washed off using TBS plus 0.05% Tween-20 with four washing cycles ensuring complete aspiration ofthe well between each cycle. Any bound human immunoglobulin was then detected by adding anti-human-IgG antibodies coupled to horseradish peroxidase in wash buffer for one hour. Bound peroxidase was visualized using TMB substrate.
• Antibodies ofthe IgD class against sRII are also present in normal human serum. Although there may be antibodies ofthe IgM class, interference from rheumatoid factor (IgM directed against IgG) cannot be excluded at this time. Analysis ofthe anti-sRH IgG using IgG sub-class specific detection antisera has demonstrated that the majority of IgG reacting with sRH in normal human serum is ofthe IgG2 sub-class.
• ELISA plate wells are coated with recombinant or purified human sR ⁇ or an immunogenic portion thereof. Wells are blocked against non-specific binding using a blocking agent for the particular sample type, e.g. for serum analysis, a TCA block.
• Serum is added to the well, preferably undiluted and untreated. Plasma or other bodily fluids may also be used. The wells are washed to remove unbound components and the bound anti- sR ⁇ Ig is detected using an appropriate anti-human Ig antiserum, labeled for detection.
• P ⁇ S normal serum
• ⁇ CAs Median 120 units 95% of individuals in the range 50 to 250 units TNDs Median 15 units 95% of individuals in the range ⁇ 10 to 50 units
• Body fluids that contain detectable levels of immunoglobulin may be used, e.g., plasma or serum. Samples can be fresh or frozen.
• the anti-sRII Ig are stable over time for a given individual (intraperson variation on a 3-month time scale is ⁇ 10% ofthe inte ⁇ erson variation). Accurate diagnosis can therefore be achieved on single sample from a given individual.
• the Ig are stable to multiple cycles of freeze thawing and to long storage times at -20°C.
• the assay is still subject to capture interference by subclass or classes of immunoglobulin not otherwise detected.
• the assay may detect little or no IgG against sRTI because ofthe presence of large amounts of IgD against sRII occupying all the available antigen sites.
• Patients with atherosclerosis had approximately a five fold lower median concentration of anti-sRH-IgG compared with individuals with normal coronary arteries ( ⁇ CA individuals).
• ⁇ CA individuals normal coronary arteries
• the absolute amount of sR ⁇ IgG could not readily be determined, but the relative amounts compared with pooled normal serum could be determined by running various dilutions of pooled normal serum as a standard curve with each assay. In all cases a standard pooled serum was used and this serum was arbitrarily designated to have 100 units of anti-sRII IgG.
• the median concentration of anti sRH IgG among 100 individuals with coronary atherosclerosis was 14.6 units, compared with 84.9 units among the individuals with normal coronary arteries. This difference was highly statistically significant (p ⁇ 0.001; Mann- Whitney U-test).
• the detection limit for the ELISA as performed under these conditions was approximately 10 units of anti-sRII-IgG.
• fully 40% ofthe patients with atherosclerosis had levels at or below the detection limit ofthe assay, whereas all ofthe individuals with normal coronary arteries had detectable levels.
• the sensitivity and specificity of this test are estimated to be greater than 90%.
• measurement of anti- sPJI IgG using this assay has far greater diagnostic potential than any existing plasma or serum biochemical marker for coronary heart disease.
• This method can conveniently be used to diagnosis the presence ofthe disease (e.g. athrosclerosis), determine the extent of disease, evaluate prognosis (i.e, determine future risk prior to onset of symptoms), or to monitor the effectiveness of a treatment.
• the disease e.g. athrosclerosis
• prognosis i.e, determine future risk prior to onset of symptoms
• the suppressed levels of anti-sRH IgG in plasma and serum from individuals with atherosclerosis may be due to (a) lower levels of anti-sRH IgG, which assumes that lower detection of anti-sR ⁇ IgG results from the presence of lower levels ofthe IgG; (b) increased levels of anti-sRH IgD, or other non IgG classes, as the assays are subject to inhibition by non-IgG class anti-sRII antibodies; or (c) increased levels of sR ⁇ antigen.
• sRII antigen which is normally expressed on endothelial cells may be shed during phenotypic changes in endothelial cell gene expression pattern, e.g., during activation, a process thought to occur in atherogenesis. sRH in plasma would then form complexes with the anti-sR ⁇ antibodies and make them more difficult to detect. As a result, lower levels of anti-sR ⁇ IgG would be detectable in individuals with increased endothelial cell activation.
• sRII may be a direct measure ofthe state of endothelial cell activation (related, for example, to functional tests of endothelial cells function, e.g., brachial reactivity).
• this assay represents the first useful plasma measure of endothelial cell function, and thus, is a measure of an individual at risk of or having a disease characterized by endothelial cell activation. Moreover, the assay offers many advantages over the low throughput endothelial cell function assays such as brachial reactivity currently being used.
• metholodology described herein can also be utilized to carry out the following assays:
• TGF- ⁇ type II receptors e.g. the extracellular domain ofthe TGF- ⁇ type II receptor
• endothelial cells are believed to shed the extracellular domain ofthe TGF- ⁇ type II receptor during activation, and there is believed to be a correlation between endothelial cell activation and atherogenesis, as well as other diseases.
• the invention also provides a method comprising detecting TGF- ⁇ type II receptors in mammalian cells or tissue, by combining the cells or tissue with a capture moiety that binds TGF- ⁇ type II receptors or a portion thereof, forming a capture complex, and detecting or determining the amount ofthe capture complex.

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• 1998
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