WO1998058666A1

WO1998058666A1 - Use of proteolytic enzymes for treating uveitis

Info

Publication number: WO1998058666A1
Application number: PCT/EP1998/003768
Authority: WO
Inventors: Gerhard Stauder; Karl Ransberger
Original assignee: Mucos Pharma Gmbh & Co.
Priority date: 1997-06-20
Filing date: 1998-06-19
Publication date: 1998-12-30
Also published as: DE19726251A1; EP0918538A1; DE19726251C2

Abstract

The invention relates to the use of at least one proteolytic enzyme for treating uveitis, preferably trypsin, bromelain or papain. Rutin can also be used.

Description

Use of proteolytic enzymes to treat uveitis

The present invention relates to the use of at least one proteolytic enzyme and optionally rutoside for the treatment of uveitis.

The immune system is a biological functional unit with highly specific reaction processes on both the humoral and the cellular level. Disorders in this complex system are causing numerous diseases, such as also the uveitis, causally involved.

Uveitis is a general term for inflammatory processes in various parts of the uvea. One differentiates here e.g. posterior uveitis, cyclitis and iridocyclitis. A distinction can also be made between infectious clinical pictures and non-infectious clinical pictures, the infectious clinical picture usually being triggered by bacteria, in particular in the case of billion tuberculosis, syphilis and leprosy, or by fungi, in particular in the case of histoplasmosis and plastomycosis. Both forms run as autoimmunological processes. They trigger an antigen-antibody reaction in the uveal tissue and / or in the vessels. The body's immune system plays a crucial role in the process.

In severe uveitis, in addition to hypersecretion, i.e. an increased formation of aqueous humor and a temporary increase in pressure (secondary glaucoma) lead to scarring. Other complications can include sticking or adhesions in the eye. A cataract can also develop, i.e. a clouding of the lens due to inflammation products in the aqueous humor. Finally, the eyeball may gradually shrink due to atrophy of the ciliary body.

In therapy, antibiotics are given if there is a suspicion of infection, and cortisone application may also be indicated. In addition to treating the basic condition, the affected eye is immobilized internally (dilation of the pupil) and externally (bandage). Experimental auto-immune uveoretinitis (EAU) has been widely used as a model for organ-specific autoimmune diseases. In recent years, lymphocyte adhesion to various types of cells, including vascular endothelial cells, has been found to be important for the immune response. It can be concluded from this that adhesion molecules are involved in the pathogenesis of inflammation. ICAM-1, a 76 to 114 kDa glycoprotein belonging to the immunoglobulin superfamily, is mainly localized in the vascular endothelial cells and epithelial cells. LFA-1, located in the peripheral lymphocytes, is a ligand for ICAM-1 and belongs to the integrin family. The ICAM-1 / LFA-1 adhesion pathway is important for various cell-cell interactions and presumably plays a central role in the generation of the immune response. The intense expression of ICAM-1 in inflammatory sites and on endothelial cells is triggered by various cytokines, including interferon-γ, interleukin-1 (11-1) and the tumor necrosis factor (TNF).

Cytokines are small proteins with molecular weights of 8,000 to 30,000, with each cytokine having its own amino acid sequence and cell surface receptors. They are made from a variety of different cell types and act on almost every tissue and organ system. The names given to the various cytokines do not follow a logical system, but rather correspond to their biological properties. IL-1 and TNF (tumor necrosis factor) are the primary pro-inflammatory cytokines, and furthermore, these two cytokines act in a synergistic manner in inducing inflammation such as e.g. Uveitis.

There has been a strong interest in IL-1 and TNF as an essential element in the development of diseases, such as uveitis, and in the production of systemic acute phase reactions. Neutralizing antibodies against murine or human TNF should protect against uveitis. Antibodies are essential molecules for the humoral response. The heavy and light protein chains forming the antibody are each divided into different functional domains. The variable domain of the heavy chain V _{H is} involved in the binding of the antigen, and the subsequent domains C _H 1, C _H 2 and C _H 3 are responsible for the so-called effector functions of an antibody, such as the binding of complement proteins. The C 2 domain in particular is involved in the initial step of complement activation.

However, the presence of a C _H 2 domain is not restricted to immunoglobulins, but the C _H 2 structure is also very similarly present, for example, in T cell receptor proteins, cell adhesion molecules and the class I and II proteins encoded in the main histocompatibility complex. Numerous proteins with a structure similar to the domain structure of the immunoglobulins are combined to form the proteins of the so-called immunoglobulin superfamily. An overview of proteins containing a C _H 2 structure is given in AF Williams and Barcley, "The Immunoglobulin Superfamily Domains for Cell Surface Recognition", Ann. Rev. Immunol., 1988, 6, 381-405.

In the following, the term “C _H 2 structure” or “C _H 2 domain” means the region of a protein molecule that has a structure similar to the C _H 2 domain of IgG. The term C2 domain or C2 set is also used in the literature for such a structure.

As explained above for the immunoglobulins, the C _H 2 structure also frequently has an effector function in the other members of the immunoglobulin superfamily, which can be involved in the development of a wide variety of clinical pictures, including uveitis.

Table 1 lists the immunological reaction partners for a C _H 2 structure from various proteins and the pathoimmunological or physiological subsequent reactions which can be caused by the interaction of the C _H 2 structure with the immunological reaction partner. TABLE 1 Immunological reaction partners of structures containing CH2

Substances that influence such antibodies positively or negatively could therefore play an important role in the treatment of uveitis.

The present invention was therefore based on the technical problem of specifying substances which can be used for the treatment of uveitis. This object is achieved by the invention specified in claim 1. Advantageous further developments are specified in the subclaims.

According to claim 1, the use of at least one proteolytic enzyme and optionally rutoside is provided for the treatment of uveitis.

The immunoglobulins modulated by the proteolytic enzyme (s) are characterized in that their binding capacity for the complement component C1 q is reduced. This applies to natural C1 q-binding immunoglobulins (subclasses IgG1, IgG2, IgG3, IgM and partly IgA).

The changed C1q binding capacity is - without being bound by any theory - probably caused by a change in the conformation of the C _H 2 domain due to the action of the enzyme. The conformational change can either be caused directly by an enzymatic change in the C 2 domain, or the proteolytic enzymes cause a structural change in the regions adjacent to the C _H 2 domain, and these changes influence the conformation of the C _H 2 domain .

Treatment of neutrophils with proteolytic enzymes significantly reduced expression e.g. of the receptor III for the Fc region of IgG and apparently also influences the number of Fcγ-R-Il on the cell surface. The binding of IgG-covered erytrocytes to neutrophils is increased; their ability to perform IgG-mediated functions, e.g. increases the antibody-dependent cellular cytotoxicity and chemiluminescence induced by IgE. These reactions are completely dependent on Fcγ-R-Il.

In a preferred embodiment, trypsin, bromelain, papain and optionally rutin or a combination thereof is used as the proteolytic enzyme. The enzymes used according to the invention can be isolated inexpensively from the following raw materials.

Bromelain is a proteolytically active enzyme from the pineapple juice and can also be isolated from ripe fruit.

Papain is a proteolytic enzyme obtained from the milk sap of the immature, meaty fruits of the Carica Papaya melon tree. Pure papain is a crystalline polypeptide with an MG. from 23350 consisting of a chain of 212 amino acid residues with 4 disulfide bridges; Sequence and spatial structure are known. Papain is used in a variety of ways: due to its protein-splitting properties as "meat tenderizer" or "short salt", for clarifying beer, for making bread and hard biscuits, in leather preparation, in the textile industry for degassing silk and for preventing wool matting, in the tobacco industry for quality improvement, for the recovery of silver from used photographic material, furthermore in bacteriology for the extraction of peptone. In medicine, papain is already used to support enzymatic digestion, for enzymatic wound cleaning and as an additive to denture cleaning agents. For special purposes, papain preparations are also available bound to plastic polymers or agarose. Papain has also been used as a catalyst for the synthesis of oligopeptides.

Trypsin is a proteolytic enzyme that is also formed in the pancreas and is already used therapeutically in conjunction with other enzymes. It belongs to the serine proteinases. Crystalline trypsin has an MG. of approx. 23300, is soluble in water but not in alcohol, has an optimum effect at pH 7-9 and cleaves peptide chains on the carboxy side of the basic amino acid residues L-lysine and L-arginine. The spatial structure of the 223 amino acid trypsin is known.

A particularly good effectiveness is shown when using a combination of the enzymes bromelain, papain and / or trypsin. Besides the remarkable and unexpected effects of these enzymes in the treatment of uveitis The combined use of the enzymes mentioned has the further advantage that no harmful side effects occur even with long-term use.

Rutoside can also be added to the medication. Rutoside is a glycoside that belongs to the flavonoids.

The combined use of 20 to 100 mg bromelain, 40 to 120 mg papain and 10 to 50 mg trypsin per dose unit is particularly effective.

A combination of 90 mg bromelain, 120 mg papain and 100 mg rutoside x 3H ₂ O is very particularly preferred.

In another preferred embodiment, a combination of 48 mg trypsin, 90 mg bromelain and 100 mg rutoside x 3H ₂ O is used.

In a further preferred embodiment, 10 to 100 mg, particularly preferably 100 mg of rutoside x 3 H ₂ O are used per dose unit.

The medicament can furthermore contain all customary auxiliaries and / or carriers.

Auxiliaries and carriers include e.g. Lactose, magnesium stearate, stearic acid, talc, methacrylic acid, copolymer type A, Shellack, Makrogol 6000, di-butyl phthalate, vanillin, titanium dioxide, white clay, polyindone, yellow wax and carnauba wax.

The following examples are intended to illustrate the invention in detail. example 1

material and methods

1. Material

The RPMI 1640 cell culture medium was used with the following additives: NaHC03 ⁽ biochrom, 2 g / 1); L-glutamine (biochrom, 2 mM), Na pyruvate (biochrom,

1mM), NaN ₃ (Sigma, 0.01%).

If the cells were stimulated, either phythaemagglutinin M (biochrome, 5 μg / ml) or γ-interferon (100 U / ml) was used. The cells were stimulated over 1-3 days with the addition of 10% fetal calf serum (biochrom).

Freshly isolated, human, peripheral, mononuclear blood cells (citrate blood) were used as targets for the enzymes to be examined. After the usual isolation using Ficoll, the cells were washed several times and used fresh in the experiments. Neutrophil granulocytes were also isolated from fresh citrate blood. Here, the lymphocytes / monocytes were separated using a 2-stage Ficoll gradient.

2. Monocional antibodies used

Monocional antibodies were used for the specific recognition of the surface structures of the leukocytes. These recognize a defined epitope on the respective antigens, which occurs only once in the structure of the antigens examined by us. Overview 1 shows the surface markers examined, the monoclonal antibodies and the analyzed target cells.

Overview 1: Analyzed surface markers, monoclonal antibodies and target cells used in enzyme treatment

¹ phycoerythrin, red fluorescence; Fluorescein isothiocyanate, green fluorescence;

³ Becton Dickinson, Heidelberg;

⁴ Ortho Diagnostics

3. Incubation conditions

The freshly isolated and prepared cells were incubated with the enzymes bromelain, papain and trypsin (pharmaceutical ingredients from Mucos) with the concentrations given in the legends of the tables and figures. When the three enzymes were mixed, the mixing ratio corresponded to 22.7: 15.5: 11.9 (bromelain: papain: trypsin, based on 40 μg / ml, “BPT”). Three enzyme concentrations (40, 10, 2.5 μg / ml) were examined. The incubation took place in serum-free medium at 37 ° C.

The proteases were set up immediately before the incubations. The cell culture media contained 0.01% sodium azide. This addition prevents the cells from re-expressing receptor molecules during the incubation process or the washing processes. After washing out the cell culture medium, the cells can be reactivated (not demonstrated).

After appropriate incubation of the cells with the respective enzymes, washing out of the enzymes and labeling with monoclonal antibodies (according to the manufacturers), the analysis of the surface markers was carried out immediately. 4. Analytical flow ctometry

All studies on the modulation of cell surface molecules were carried out by means of analytical flow cytometry (FACSCAN, Becton Dickinson, Heidelberg) using device-specific software (Lysis I). With appropriate setting of the device and the carrying of references, i.e. Cells that were treated without enzymes but in the same procedure were measured.

A corresponding fluorescence-conjugated isotype control was carried out for each subclass of the monoclonal antibodies. This is mouse immunoglobulin, with which the capacity of the non-specific binding of the target cells is determined by flow cytometry.

10,000 cells were measured per histogram. The respective cell population was separated with a so-called "electronic gate", in which there were at least 3 500 cells.

5. Presentation of the results

The evaluation and analysis of the data was carried out independently of the measurement process on the flow cytometer using device-specific software. The histograms of the controls, i.e. H. of the untreated cell samples, compared with the histograms of the enzyme-treated cells.

The raw representation comprises an optically impressive, but relatively confusing histogram, in which various individual measurements are shown superimposed on one another. Here, in particular, the effect of the enzymes can be made optically transparent compared to the reference. For these investigations, it is not the percentage of a subpopulation of the total leukocyte population that is the measured variable, but rather the relative receptor density, which is shown as the fluorescence intensity. From these histograms, which are exemplary and have an illustrative character, data can be derived which reflect the relative fluorescence intensity of the individual measurement. This is a measure of the relative receptor or surface molecule density in a measured cell population.

The bar graphs show the median of the relative fluorescence in logarithmic representation. Compared to the reference, the reduction in the density of the respective surface molecule as a function of the enzyme concentration can thus be represented.

The tables contain the data from independent experiments. The donor numbers are only valid for the respective table and cannot be transferred to other tables. If, for example, a value of 40% is given in the table, this means that in this antigen 40% of all surface molecules are changed by the enzyme in such a way that the specific monoclonal antibody no longer recognizes its epitope. If no reduction is observed, the value "0" appears in the tables. The percentage given thus expresses the enzyme performance compared to the individual antigens. Values up to 20% are not considered relevant in individual cases.

To evaluate the effect of the enzymes on the individual antigens, it is favorable to choose a suitable comparison scale. With a few exceptions, all tests were carried out under standardized incubation conditions. This means that the half-effect concentration known from previous research reports can be given for these experimental conditions.

To calculate the half-effect concentration, the data were evaluated using non-linear regression. The median of the fluorescence intensity versus the enzyme concentration used and the reference are correlated with one another, and from this the amount of enzyme that can be used to calculate a 50% reduction in the relative fluorescence intensity or in the structure changed receptor density leads.

Figure 1: CD2 modulation by proteases; The median of the relative fluorescence intensity is given; Target cells: lymphocytes. The positive control (reference) are untreated cells that were incubated with the monoclonal antibody specific for CD2. The negative controls are untreated cells incubated with the antibody isotype. The incubation time with the enzymes was 60 min. The data from donor 1 (see Tab. 1) are shown as the mean of double determinations and standard deviation.

Figure 2: CD4 (epitope Leu3a) modulation by proteases; The median of the relative fluorescence intensity is given; Target cells: lymphocytes. The positive control (reference) are untreated cells that were incubated with the monoclonal antibody specific for CD4. The negative controls are untreated cells incubated with the antibody isotype. The incubation time with the enzymes was 60 min. The data from donor 2 (see Tab. 2) are shown as the mean of double determinations and standard deviation.

Figure 3: CD4 (Epitope OKT4 and Leu3a) modulation by trypsin; The median of the relative fluorescence intensity is given; Target cells: lymphocytes. The positive control (reference) are untreated cells that were incubated with the monoclonal antibody specific for CD4. The negative controls are untreated cells incubated with the antibody isotype. The incubation time with the enzymes was 60 min. The data from a donor (see Table 3) are shown as the mean of double determinations and standard deviation.

Figure 4: CD25 modulation by proteases; The median of the relative fluorescence intensity is given; Target cells: PHA blasts. The positive control (reference) are untreated cells that were incubated with the monoclonal antibody specific for CD25. The negative controls are untreated Cells incubated with the antibody isotype. The incubation time with the enzymes was 60 min. The data from donor 1 are shown as the mean of duplicate determinations and standard deviation.

Figure 5: Reduction of the Leu3a antigen density by trypsin. Freshly isolated human peripheral, mononuclear blood cells were incubated with trypsin in the serum-free medium, then washed and labeled with the monoclonal antibody anti-Leu3a. The reduction in the relative fluorescence density of CD4 in the lymphocyte population is the measure of enzyme activity. The half-effect concentration of trypsin compared to the epitope Leu3a of CD4 is calculated using the fitted curve.

Results

Table 1: CD2 modulation by proteases; Target cells: lymphocytes. The percentage reduction in the medium of the relative fluorescence intensity is given, which is a measure of the enzyme performance. The incubation time with the enzymes was 60 min. The results of three experiments with cells from three different donors are shown.

Enzyme No. 40 μg / ml 10 μg / ml 2.5 μg / ml

Bromelain 1 11.1 17.9 17.4

2 6.1 12.2 14.3

3 0 0 0

Papain 1 22.4 21, 4 34.7

2 5.4 9.5 17.0

3 0 0 0

Trypsin 1 75.7 73.6 73.0

2 83.7 21, 1 0.7

3 96.3 85.4 50.9

BPT 1 71, 9 54.7 38.2

2 74.1 8.8 18.4

3 94.8 72.6 25.2

Table 2: CD4 (epitope Leu3a) modulation by proteases; Target cells: lymphocytes. The percentage reduction in the median of the relative is given Fluorescence intensity, which is a measure of enzyme performance. The incubation time with the enzymes was 60 min. The results of two experiments with cells from two different donors are shown.

Enzyme No. 40 μg / ml 10 μg / ml 2.5 μg / ml

Bromelain 1 24.6 0 0 2 16.2 0 0

Papain 1 2.5 3.2 0 2 0 0 5.7

Trypsin 1 99.3 93.0 64.1 2 99.4 96.2 57.5

BPT 1 98.3 49.3 23.0 2 99.4 79.2 20.2

Table 3: Modulation of the CD4 epitopes Leu3a and OKT4 by trypsin; Target cells: lymphocytes. The percentage reduction in the median of the relative fluorescence intensity, which is a measure of the enzyme performance, is given. The incubation time with the enzymes was 60 min. The data from a donor are shown.

Enzyme epitope 40 μg / ml 20 μg / ml 10 μg / ml

Trypsin Leu3a 98.5 96.7 87.1

OCT4 6.5 6.3 19.5

Epitope 5 μg / ml 2.5 μg / ml 1, 25 μg / ml

Trypsin Leu3a 65.2 41, 9 28.8

OCT4 13.3 10.8 9.3

Table 4: CD25 modulation by proteases; Target lines: lymphocytes, monocytes, NK cells. The percentage reduction in the median of the relative fluorescence intensity, which is a measure of the enzyme performance, is given. The incubation time with the enzymes was 60 min. The results of two experiments with cells from two different donors are shown. The cells were mitogen stimulated for 3 days prior to the experiment. Enzyme No. 40 μg / ml 10 μg / ml 2.5 μg / ml

Bromelain 1 90.7 80.1 59.7 2 62.6 43.6 0

Papain 1 92.2 81.0 60.7 2 62.6 43.6 0

Trypsin 1 91, 2 88.2 71, 0 2 78.9 73.9 52.8

BPT 1 92.1 89.7 50.9 2 79.4 44.1 12.2

Table 5: Calculated half-effect concentration (μg / ml) of bromelain, papain, trypsin and their combination for the 50% reduction in the density of cellular surface molecules. The enzyme incubation was 1 hour.

Enzymes CD2 CD4 ³ CD25 ⁴

Bromelain half-effect conc. ¹ nwnw 18.4

Area ² - - 14-23

Papain half-effect conc. ¹ nwnw 12.4

Area ² - - 11-14

Trypsin half-effect conc. ¹ 1, 5 2.5 <2.5

Area ² 1-2 2.3-3.1

BPT ⁵ half-effect conc. ¹ 9.3 16.4 16.0

Area ² 7.5-14 15.5-18 13-19

¹ calculated from averages of 2 or 3 independent experiments

² minimum and maximum value, 95% confidence interval = 1 δ, estimated

³ Modulation of CD4 epitope Leu3a present on stimulated cells

⁵ Mix of the proteases in the ratio 22.7: 15.5: 11, 9 -Bromelain: Papain: Trypsin nw: not effective in the system under investigation (max. 40 μg enzyme / ml, 1 h incubation)

Claims

claims

1. Use of at least one proteolytic enzyme and optionally rutoside for the treatment of uveitis.

2. Use according to claim 1, characterized in that trypsin, bromelain or papain or a combination of one or more of these enzymes is used as the proteolytic enzyme.

3. Use according to claim 1 or 2, characterized in that rutoside is additionally used.

4. Use according to one or more of claims 1 to 3, characterized in that 20 to 100 mg bromelain, 40 to 120 mg papain and 10 to 50 mg trypsin are used per dose unit.

5. Use according to one or more of claims 1 to 4, characterized in that 90 mg bromelain, 120 mg papain and 100 mg rutoside are used per unit dose.

6. Use according to one or more of claims 1 to 3, characterized in that 90 mg bromelain, 48 mg trypsin and 100 mg rutoside are used per dose unit.

7. Use according to one or more of claims 1 to 5, characterized in that 10 to 100 mg, preferably 10 mg rutoside x 3H ₂ O are used per dose unit.