WO1999017763A1 - Postsurgical treatment with dichloroacetate - Google Patents
Postsurgical treatment with dichloroacetate Download PDFInfo
- Publication number
- WO1999017763A1 WO1999017763A1 PCT/US1998/020394 US9820394W WO9917763A1 WO 1999017763 A1 WO1999017763 A1 WO 1999017763A1 US 9820394 W US9820394 W US 9820394W WO 9917763 A1 WO9917763 A1 WO 9917763A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- subject
- administration
- dichloroacetate
- delivering
- surgery
- Prior art date
Links
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
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
- A61P9/02—Non-specific cardiovascular stimulants, e.g. drugs for syncope, antihypotensives
Definitions
- the present invention relates to the field of cardiovascular disease and more particularly, the treatment and prevention of poor cardiac function following surgery, including, but not limited to, open heart surgery.
- the present invention relates to the field of cardiovascular disease and more particularly, the treatment and prevention of poor cardiac function following an ischemic incident, a heart attack, or surgery.
- the procedure can be used before, during and following surgery, and the surgery can be general surgery (e.g., transplantation, such as liver transplantation) or cardiac surgery, such cardiac surgery including, but not limited to, open heart surgery.
- the present invention relates to new methods of treating poor cardiac performance, such as that resulting from ischemia in a surgical setting.
- a patient with a myocardial infarction e.g., due to occlusion of a coronary artery
- the present invention contemplates a method comprising the steps of a) providing: i) a subject having symptoms of poor cardiac performance and ii) means for delivering a solution of dichloroacetate; and b) delivering said solution to said subject with said delivering means under conditions such that said subject has a blood (e.g. serum or plasma) concentration of dichloroacetate in the therapeutic range (such as a concentration of approximately 0.5 mM or greater).
- a blood e.g. serum or plasma
- the present invention contemplates a method comprising the steps of a) providing: i) a subject at risk of poor cardiac performance and ii) means for delivering a solution of dichloroacetate; and b) delivering said solution to said subject with said delivering means under conditions such that said subject has a blood (e.g. serum or plasma) concentration of dichloroacetate of greater than approximately 200 ⁇ M, more preferably greater than 500 ⁇ M, and still more preferably greater than 1 mM, for a period of time longer than 1 hours, and more preferably longer than 6 hours, and most preferably 24 hours or longer.
- said delivering of step (b) is performed where the conditions comprise a first administration, comprising a bolus, and a second administration, wherein said second administration comprises continuous administration.
- the invention be limited to subjects with any one type of symptom of poor cardiac function. Also, the age, sex, or degree of disease state is not intended to be in any way limiting to the present invention, although the invention can be used with particular success on children and infants, including but not limited to neonates.
- the invention is also not limited by the cause of poor cardiac function, although the invention can be used with particular success with patients whose cardiac function is poor following surgery, such as open heart surgery.
- Open heart surgery using cardiopulmonary bypass pump and aortic cross clamp is contemplated as one example of surgery putting patients at risk for poor cardiac function.
- This includes simple lesions such as atrial septal defect or ventricular septal defect, and complex lesions such as transposition- arterial switch, Tetralogy of Fallot. atrioventricular septal defect, repair of total veins, Fontan operation, etc.
- the methods and compositions of the present invention find use in the treatment of myocardial infarction (e.g., during or following thrombolysis).
- dichloroacetate solution can be supplied during reperfusion.
- One means is an intravenous means, such as that achieved by introduction through an intravenous drip.
- Other means include (but are not limited to) delivery with a catheter.
- a preferred means involves direct injection into the aorta.
- dichloroacetate such as sodium dichloroacetate
- l.Occ/kg bolus an approximately lOOmg/ml solution
- dichloroacetate is given as an infusion at approximately 12.5 mg/kg/hr for greater than 10 hours, and more preferably, 24 hours or more. Higher dosages are permitted.
- Dichloroacetate does not have significant side-effects, although some patients experience mild drowsiness.
- Subject refers to a vertebrate.
- the vertebrate is a human.
- Catheter refers to a device for insertion into canals, vessels, passageway or body cavities.
- Cardiac disease refers to a state in which the heart of a subject is no longer able to function within normal parameters.
- Temporal protocol or “dosage regiment” as used herein refers to the time sequence for administration of drug, i.e. the amount of drug given over time.
- Figure 1 shows the results of the unique dosage regiment of the present invention, whereby patient blood levels of dichloroacetate are maintained at high (and therefore therapeutic) levels over a 24 hour period.
- the present invention relates to the field of cardiovascular disease and more particularly, the treatment and prevention of poor cardiac function following surgery, including, but not limited to, open heart surgery.
- One proposed embodiment of the invention contemplates the use of a solution of dichloroacetate (typically sodium dichloroacetate) to reduce or eliminate the morbidity and mortality associated with open-heart surgical techniques, including but not limited to problems associated with the weaning of patients from the heart/lung machine after open heart surgery.
- the present method of treatment is a substantial improvement over existing techniques because it presents a prevention and treatment approach without significant side-effects.
- Glycolysis is an anaerobic process and produces 2ATP per mole of glucose converted to pyruvate.
- Fatty acid, lactate and glucose oxidation are aerobic processes, that is, requiring oxygen, and produce 129 moles of ATP, 18 moles of ATP and 36 moles of ATP per mole of substrate metabolized, respectively.
- Bing and colleagues identified that the adult human heart primarily utilizes glucose, lactate and fatty acids as the major sources of energy. See R.J. Bing et al.. "Metabolic studies on the human heart in vivo. Studies on carbohydrate metabolism of the human heart," Am. J. Med. 15:284 (1953). There is. however, a marked difference in energy substrate utilization between neonatal and adult hearts, with adult hearts preferring fatty acid substrates and newborn hearts more resilient on glucose and lactate as energy substrates.
- the type of energy substrate used by the heart can have a profound impact on the ability of the heart to withstand an episode of hypoxia or ischemia. See G.D. Lopaschuk et al., "Etomoxir, a carnitine palmitoyltransferase I inhibitor, protects hearts from fatty acid- induced ischemic injury independent of changes in long chain acylarnitine," Circ. Res.
- hypoxia can occur in the form of birth asphyxia, or with cyanotic congenital heart disease, and ischemia in the setting of surgery to correct congenital heart defects. Differences in myocardial energy substrate utilization may also affect the ability of the newborn heart to withstand ischemia.
- Rapid return of myocardial oxidative metabolism is critical for post-operative recovery of ventricular function.
- the type of carbon substrate oxidized by the heart during reperfusion is also important for recovery. While it is not intended that the present invention be limited to any particular mechanism by which the methods and compositions achieve a therapeutic result, it is believed that increasing glucose oxidation at the expense of fatty acid oxidation will enhance the recovery of previously ischemic myocardium.
- the beneficial effect of glucose may well result from: 1) an increase in the ratio of ATP produced per oxygen consumed; 2) an increased availability of glycolytically-produced ATP from membrane ion pumps; 3) more rapid return of oxidative metabolism in the immediate reperfusion period; or 4) a decrease in proton production due to an improved coupling between glycolysis and glucose oxidation.
- glucose is not the primary energy substrate of the heart during perfusion.
- fatty acids are the primary energy substrate in the adult heart, with glucose oxidation providing only 30 to 40 percent of myocardial ATP production.
- glucose oxidation provides an even smaller portion of ATP production in hearts reperfused following a period of global ischemia. See G.D. Lopaschuk et al., "Glucose and palmitate oxidation in isolated working rat hearts reperfused after a period of transient global ischemia," Circ. Res. 66:546 (1990).
- One of the primary factors resulting in low glucose oxidation rates post- ischemia is the circulating level of fatty acids; serum fatty acids are potent inhibitors of myocardial glucose oxidation.
- ischemic rat hearts In both aerobic and reperfused ischemic rat hearts, high levels of fatty acids markedly inhibit glucose oxidation rates. This is believed to be the result of marked inhibition by fatty acids of the pyruvate dehydrogenase complex (PDC), a key enzyme complex regulating carbohydrate oxidation. It is further believed that overcoming fatty acid inhibition of PDC will dramatically increase glucose oxidation and improve functional recovery of ischemic hearts.
- PDC pyruvate dehydrogenase complex
- One of the pharmacologic agents that is particularly effective in reversing fatty acid inhibition of PDC is dichloroacetate. Dichloroacetate (DCA) directly stimulates PDC, resulting in a marked stimulation of glucose oxidation. See J.J. McVeigh and G.D. Lopaschuk "Dichloroactetate stimulation of glucose oxidation improves recovery of ischemic rat hearts," Am. J. Physiol.
- DCA administration significantly stimulates PDC in heart muscle, strongly suggesting that glucose oxidation is increased.
- DCA dichloroacetate
- PDC pyruvate dehydrogenase complex
- CABG coronary artery bypass grafting
- the present invention provides methods and compositions that optimize the therapeutic effect of dichloroacetate when used to provide myocardial protection and treatment, during and after cardiac surgery, and in particular, surgery in the pediatric patient.
- the present invention contemplates that the appropriate regiment for optimum therapeutic effect involves, in part, a longer temporal protocol, i.e.
- EXAMPLE This example describes the use of dichloroacetate administered in a bolus followed by infusion for 24 hrs in pediatric patients after cardiopulmonary bypass.
- inotropes All procedures and drugs normally given for infants and children undergoing cardiopulmonary bypass are given as routinely administered. Introduction of inotropes in the post-operative period is most easily documented if introduced in a stepwise manner. For purposes of the experiment, both calcium and sodium bicarbonate will be considered to be inotropes, as they both may significantly change the levels of glucose oxidation in the myocardium. Other inotropes to be considered include: epinephrine, dobutamine, dopamine, norepinephrine, phentolamine, phenylephrine and amrinone. The use of other drugs such as vasodilators, diuretics and analgesics or others, are continued as required. Routine post-operative care and management of complications is also contemplated.
- DCA Dichloroacetate
- l.Occ/kg bolus a bolus of 100 mg/kg of 10 mg/ml solution (l.Occ/kg bolus) is injected into the proximal aorta immediately prior to discontinuing the aortic cross-clamp.
- an infusion of DCA at 12.5 mg/kg/hr is initiated and run for 24 hours or longer.
- this dosage regiment is designed to continuous maintain plasma levels of DCA in the therapeutic range of [0.2-1 mM] - in contrast to transient therapeutic levels.
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA002305183A CA2305183C (en) | 1997-10-03 | 1998-09-30 | Postsurgical treatment with dichloroacetate |
JP2000514634A JP2001523635A (en) | 1997-10-03 | 1998-09-30 | Postoperative treatment with dichloroacetate |
AU95906/98A AU9590698A (en) | 1997-10-03 | 1998-09-30 | Postsurgical treatment with dichloroacetate |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US6091297P | 1997-10-03 | 1997-10-03 | |
US60/060,912 | 1997-10-03 |
Related Child Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09509699 A-371-Of-International | 2000-06-26 | ||
US10/052,453 Continuation US6727284B2 (en) | 1997-10-03 | 2002-01-18 | Postsurgical treatment with dichloroacetate |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1999017763A1 true WO1999017763A1 (en) | 1999-04-15 |
Family
ID=22032515
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1998/020394 WO1999017763A1 (en) | 1997-10-03 | 1998-09-30 | Postsurgical treatment with dichloroacetate |
Country Status (4)
Country | Link |
---|---|
JP (1) | JP2001523635A (en) |
AU (1) | AU9590698A (en) |
CA (1) | CA2305183C (en) |
WO (1) | WO1999017763A1 (en) |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2004000353A1 (en) * | 2002-06-20 | 2003-12-31 | The Governors Of The University Of Alberta | Dichloroacetate in combination with cardioprotective or hemodynamic drugs |
US6727284B2 (en) | 1997-10-03 | 2004-04-27 | University Of Alberta | Postsurgical treatment with dichloroacetate |
WO2005077353A1 (en) * | 2004-01-16 | 2005-08-25 | The Governors Of The University Of Alberta | Dichloroacetate in combination with an inotrope for cardioprotection |
EP1908462A2 (en) * | 2002-06-20 | 2008-04-09 | The Governors Of The University Of Alberta | Dichloroacetate in combination with cardioprotective or hemodynamic drugs |
US7432247B2 (en) | 2002-10-07 | 2008-10-07 | The Governors Of The University Of Alberta | Methods of cardioprotection using dichloroacetate in combination with an inotrope |
US9765393B2 (en) | 2010-06-14 | 2017-09-19 | University Of Florida Research Foundation, Inc. | Methods, assays, and kits related to dichloroacetate (DCA) |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9820982B2 (en) | 2001-07-06 | 2017-11-21 | Endo Pharmaceuticals Inc. | Oxymorphone controlled release formulations |
US20060194878A1 (en) * | 2002-10-07 | 2006-08-31 | Lopaschuk Gary D | Methods of cardioprotection using dichloroacetate in combination with an inotrope |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5587397A (en) * | 1995-06-08 | 1996-12-24 | Cypros Pharmaceutical Corporation | Reduction of elevated blood lactate using twice-daily dichloroacetate |
US5643951A (en) * | 1992-09-16 | 1997-07-01 | Stacpoole; Peter W. | Compositions comprising carbonate/bicarbonate buffered dichloroacetic acid and methods for treatment of metabolic and cardiovascular disorders |
-
1998
- 1998-09-30 CA CA002305183A patent/CA2305183C/en not_active Expired - Fee Related
- 1998-09-30 JP JP2000514634A patent/JP2001523635A/en active Pending
- 1998-09-30 AU AU95906/98A patent/AU9590698A/en not_active Abandoned
- 1998-09-30 WO PCT/US1998/020394 patent/WO1999017763A1/en active Application Filing
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5643951A (en) * | 1992-09-16 | 1997-07-01 | Stacpoole; Peter W. | Compositions comprising carbonate/bicarbonate buffered dichloroacetic acid and methods for treatment of metabolic and cardiovascular disorders |
US5587397A (en) * | 1995-06-08 | 1996-12-24 | Cypros Pharmaceutical Corporation | Reduction of elevated blood lactate using twice-daily dichloroacetate |
Cited By (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6727284B2 (en) | 1997-10-03 | 2004-04-27 | University Of Alberta | Postsurgical treatment with dichloroacetate |
WO2004000353A1 (en) * | 2002-06-20 | 2003-12-31 | The Governors Of The University Of Alberta | Dichloroacetate in combination with cardioprotective or hemodynamic drugs |
EP1908462A2 (en) * | 2002-06-20 | 2008-04-09 | The Governors Of The University Of Alberta | Dichloroacetate in combination with cardioprotective or hemodynamic drugs |
EP1908462A3 (en) * | 2002-06-20 | 2008-06-25 | The Governors Of The University Of Alberta | Dichloroacetate in combination with cardioprotective or hemodynamic drugs |
US7432247B2 (en) | 2002-10-07 | 2008-10-07 | The Governors Of The University Of Alberta | Methods of cardioprotection using dichloroacetate in combination with an inotrope |
WO2005077353A1 (en) * | 2004-01-16 | 2005-08-25 | The Governors Of The University Of Alberta | Dichloroacetate in combination with an inotrope for cardioprotection |
US9765393B2 (en) | 2010-06-14 | 2017-09-19 | University Of Florida Research Foundation, Inc. | Methods, assays, and kits related to dichloroacetate (DCA) |
Also Published As
Publication number | Publication date |
---|---|
JP2001523635A (en) | 2001-11-27 |
AU9590698A (en) | 1999-04-27 |
CA2305183C (en) | 2008-09-23 |
CA2305183A1 (en) | 1999-04-15 |
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