WO2000059488A2 - Enhanced tissue and subcellular delivery of vitamin e compounds - Google Patents
Enhanced tissue and subcellular delivery of vitamin e compounds Download PDFInfo
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- WO2000059488A2 WO2000059488A2 PCT/US2000/008524 US0008524W WO0059488A2 WO 2000059488 A2 WO2000059488 A2 WO 2000059488A2 US 0008524 W US0008524 W US 0008524W WO 0059488 A2 WO0059488 A2 WO 0059488A2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
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- 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
- A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
- A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
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- 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
- A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
- A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
- A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline
- A61K31/353—3,4-Dihydrobenzopyrans, e.g. chroman, catechin
- A61K31/355—Tocopherols, e.g. vitamin E
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
- A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P39/00—General protective or antinoxious agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P39/00—General protective or antinoxious agents
- A61P39/06—Free radical scavengers or antioxidants
Definitions
- the present invention generally relates to an improved method for delivery and retention of antitumor and antioxidant Vitamin E compounds to tissues and subcellular sites. Specifically, the present invention provides a method to enhance the antioxidant capacity of normal cells and subcellular sites such as mitochondria and to inhibit the growth of and kill tumor cells by administering an aqueous suspension of tris salts of Vitamin E compounds.
- ROS reactive oxygen species
- ⁇ -T d- ⁇ - tocopherol
- ⁇ -T also known as vitamin E.
- ⁇ -T appears to function as the predominant chain-breaking antioxidant in cellular membranes (4-6)
- This lipophilic compound is not synthesized by mammalian cells but rather is derived solely from exogenous sources.
- the antioxidant properties of ⁇ -T result from its ability to trap reactive peroxyl radicals by donating a hydrogen atom, becoming a tocopherol radical in the process.
- ⁇ -T is an extremely lipophilic molecule and as such is absorbed from the intestine in chylomicrons through the lymphatic system and is transported in plasma by a tocopherol-binding protein incorporated in lipoproteins (10).
- the cellular uptake of ⁇ -T has been reported to be mediated by both lipoprotein receptor-dependent and -independent pathways (11). It is generally accepted that in lipid bilayers and biomembranes, ⁇ -T intercalates between phospholipids with the chroman head group (phenolic hydrogen) toward the surface (in close proximity to water-soluble reducing agents for regeneration) and with the hydrophobic phytyl chain buried in the hydrocarbon region (12).
- Biomembranes or lipid bilayers are not limited to this ratio of ⁇ -T to PUFA.
- Lai et al. (16) have shown that lecithin liposomes can be prepared with up to 40 mol % ⁇ -T, while numerous reports indicate that increasing the ⁇ -T content of biomembranes decreases the susceptibility of these membranes to lipid peroxidation (13, 17).
- the concentration of ⁇ -T in biomembranes is kept at such a low mol % (close to the threshold).
- the amount of ⁇ -T embedded in intracellular membranes appears to result from the concentration of ⁇ -T available from the diet and its intracellular transport as well as from the rate of consumption by oxidation and by transport out of the cell.
- a rate limiting factor in providing intracellular membranes with additional active ⁇ -T may be the requirement for a tocopherol transporting protein.
- Niki et al. (18) have demonstrated using artificial phospholipid membranes that the extreme water insolubility conferred on ⁇ -T by the phytyl tail greatly inhibits its ability to exchange between membranes in the absence of any transporting factors.
- Other investigators (19-21) have also suggested that the intracellular transport of ⁇ -T requires a tocopherol transport protein that can carry ⁇ -T to subcellular locations.
- vitamin E antioxidants and antitumor agents
- insolubility in the aqueous solutions which are required for parenteral injection.
- these agents must be solubilized with additional additives that may also cause undesirable and even toxic effects in the patient. It would be highly advantageous to have a means of increasing the solubilization of these compounds in a non-toxic vehicle thus making them amenable to parenteral injection.
- vitamin E succinate, d- ⁇ -tocopheryl succinate, TS succinate derivative of vitamin E
- TS succinate derivative of vitamin E protects experimental animals, tissues, cells and subcellular organelles from toxic cell death (25, 27, 31).
- cytoprotective effects of TS do not appear to be selective for a particular toxic insult, cell type, or species.
- the mechanism for TS cytoprotection appears to be indirect: cellular esterases cleave TS, releasing antioxidant d- ⁇ -tocopherol ( ⁇ -T). It is the released ⁇ -T which confers cytoprotection.
- the present invention provides a method for the delivery of vitamin E compounds to tissues, cells and subcellular sites (including mitochondria) in order to 1) increase the antioxidant capacity and protect normal (non-tumor) tissue, cells, mitochondria, and other subcellular organelles or substances 2) inhibit the growth of and kill tumor cells, and 3) both protect normal tissue while killing tumor cells by administering vitamin E compounds.
- the delivery of vitamin E compounds is achieved by making an aqueous suspension of the tris salts of those compounds by sonication.
- the aqueous suspension may be administered intravenously, transdermally, parenterally, by inhalation of an aerosol, orally, or by other delivery routes.
- the cells to which the vitamin E compound is delivered may be either in vivo or in vitro.
- the subcellular sites to which the vitamin E compounds are delivered are, in particular, the outer and inner mitochondrial membranes.
- ALT Alanine aminotransferase
- LDH lactate dehydrogenase
- CC1 4 carbon tetrachloride
- CYP2E1 cytochrome P450, 2E1 form
- G6Pase glucose-6-phosphatase
- ip intraperitoneal
- iv- intavenous
- PNP p -nitrophenol
- ⁇ -T - ⁇ -tocopherol
- TA d- ⁇ -tocopheryl acetate
- TS d- - tocopheryl hemisuccinate
- TS-FA d- ⁇ -tocopheryl hemisuccinate free acid
- TS-tris d- - tocopheryl hemisuccinate tris salt
- TSE d- ⁇ -tocopheryloxybutyrate
- TSE-tris d- - tocopheryloxybutyrate tris salt
- TS-2,2-dimethyl d- ⁇ -tocopheryl
- FIG. 1 Graph showing the effect of oxidative stress on the induction of lipid peroxidation in mitochondria isolated from the livers of rats treated with TS-tris and TSE-tris.
- a d- ⁇ -tocopheryl hemisuccinate tris salt (TS-tris) and a d- ⁇ -tocopheryloxybutyrate tris salt (TSE-tris) were administered intraperitoneally to rats at a dose of 0.19 mmol/kg 18 h prior to isolation.
- An increase in fluorescence indicates an increase in lipid peroxidation.
- 2A Graph showing the effect of TS-tris suspension in water (after sonication) (#)on the growth and viability of OCM-1 cells.
- 2B. Graph showing the effect of taxol dissolved in ethanol (•), and taxol combined with TS-tris and sonicated in water (O) on the viability of OCM-1 cells.
- cytoprotective effects of vitamin E compounds such as TS appear to be the result of uptake of TS by cells, followed by cleavage of the compound by endogenous esterases. This results in the release of tissue, cellular, and subcellular T from TS, providing an increased antioxidant capacity.
- the antitumor activity of TS appears to be the result of the intact, uncleaved compound.
- the administration of TS or related vitamin E compounds has the potential to provide a two-fold, coordinate result: 1) the killing of tumor cells via accumulation of the intact compound (e.g. TS); and 2) cytoprotective, antioxidant activity via hydrolysis of TS to release the antioxidant ⁇ T.
- the present invention provides a method for the administration of TS (or related vitamin E compounds) in order to both individually and in coordination 1) treat or prevent tumor cell growth and/or formation, and 2) provide increased cytoprotective, antioxidant capacity to normal cells and mitochondria.
- TS or related vitamin E compounds
- coordinate we mean that the administration of a single form of the vitamin E compound has more that one beneficial effect on the tissue or cells to which it is administered. The beneficial effects occurs in concert via two related but distinct mechanisms. For example, traditional anticancer agents often cause extensive oxidative damage to normal cells even as they are killing cancer cells.
- the TS or related vitamin E compound enhances the antioxidant capability of normal tissue to prevent or attenuate such damage. Further, intact TS compound will be taken up by and selectively persist in tumor cells, augmenting tumor killing by the anticancer agent.
- vitamin E the tris salts of anionic vitamin E esters and ethers
- our data suggest that once this formulation of vitamin E (the tris salts of anionic vitamin E esters) has accumulated in normal tissue, cells or subcellular sites (mitochondria), endogenous cellular esterases can cleave these vitamin E esters, thereby releasing the potent antioxidant ⁇ -T, thus providing enhanced antioxidant protection at this site.
- Vitamin E ester-tris salts results in elevated blood, tissue, and mitochondrial levels of ⁇ -T and TS for a longer period of time (i.e. ⁇ -T and TS have a longer half-life) when administered in this manner, compared to the administration of ⁇ -T alone.
- TS-tris salt provides a tissue, cellular and subcellular reservoir of T (in the form of TS) that can be slowly released over time.
- the tris salts of anionic vitamin E esters and ethers are a formulation that provides an aqueous solution for parenteral injection.
- the administration of such a preparation results in an enhanced concentration of the antitumor agent, vitamin E succinate (TS), in tissue, cells and subcellular fractions (e.g. mitochondria) for an extended length of time.
- TS vitamin E succinate
- the present invention provides a method for enhancing the delivery of antitumor and antioxidant Vitamin E compounds to tissues and subcellular organelles (mitochondria).
- the invention is based on the discovery that, upon sonication in saline (0.9% NaCl in water) or in water, the Tris salts of vitamin E compounds, (especially succinate derivatives of Vitamin E), form a suspension that can be administered parenterally. Further, as will be seen in the Examples, parenteral administration of the suspension results in high levels of the Vitamin E compound being present and sustained in the normal tissues and in subcellular organelles (mitochondria), and affords protection against oxidative stress-induced lipid peroxidation and cell death.
- the method described herein can be useful for treating cancer in mammals (for example liver cancer, prostate cancer, ocular melanoma, cutaneous melanoma, colon cancer, lung cancer and the like) by delivering TS and related vitamin E derivatives.
- the method of the present invention can also be used to protect tissue, cells and subcellular organelles (e.g. mitochondria) against oxidative stress-induced injury or disease in mammals.
- Such injuries or diseases may include but are not limited to: neurodegenerative diseases such as Alzheimer's and Parkinson's disease; vascular disease; heart disease (atherosclerosis and ischemic damage); carcinogenesis; aging; cigarette smoking-induced diseases; smog-induced pathologies; diabetes-induced tissue damage; and many other diseases for which the inception and progression of the disease is thought to be, at least in part, due to oxidative stress.
- neurodegenerative diseases such as Alzheimer's and Parkinson's disease
- vascular disease such as Alzheimer's and Parkinson's disease
- heart disease at least in part, due to oxidative stress.
- the suspensions and methods of the present invention will also be useful for the protection of tissue and cells in vitro, in addition to the in vivo uses outlined above.
- the methods of the present invention may be used to increase the antioxidant capacity of tissue and cells during storage, such as tissue, cells and organs to be used for transplants or for other uses. This may include, for example, liver cells or tissue, kidney cells and tissue, whole organs, sperm cells, cells in blood, etc.
- the methods of the present invention may also be used in such procedures as bone marrow transplants, wherein the patient's bone marrow is removed and could be treated with TS to selectively kill tumor cells, and then replaced in the patient.
- tissue according to the methods of the present invention can be used in any procedure in vivo, in vitro, or both combined, in which it is desirable to confer protection from oxidative stress, or to kill tumor cells.
- the methods may also be useful for research purposes in tissue culture procedures, for example, for the passage, maintenance, or storage of immortal or primary tissue culture cells, or subcellular fractions.
- the suspension of a Vitamin E compound is made by sonicating the salt of the compound in saline or water.
- suitable aqueous suspensions may also be used in the practice of the present invention.
- any dispersal technique that results in a suitable suspension of the compound(s) may be utilized in the practice of the invention (for example, vigorous vortexing).
- the Vitamin E compounds which are used in the practice of the present invention include the tris salts of the anionic esters or ethers of Vitamin E (tocopherol and its various forms) prepared individually or in combination, for example: the tris salts of TS, TSE, and TS-2,2-dimethyl and TRF-succinate, including the d and dl isomers of ⁇ , ⁇ , ⁇ and ⁇ forms of tocopherol related compounds.
- TG-2,2-dimethyl and TS-3-monomethyl can also be used in the practice of the present invention.
- the tris salts of the Vitamin E compounds are utilized.
- other pharmaceutically acceptable salts of a Vitamin E compound which is capable of forming an aqueous suspension suitable for administration may be used in the practice of the present invention.
- the suspension of the salt of a Vitamin E compound may be administered by injection either intravenously or parenterally.
- injectable preparations for example, sterile injectable aqueous or oleaginous suspensions may be formulated according to the known art using suitable dispensing or wetting agents and suspending agents.
- the sterile injectable preparation can also be a sterile injectable solution or suspension in a nontoxic parenterally acceptable diluent or solvent, for example, as a solution in 1,3-butanediol.
- the suspension of the salt of a Vitamin E compound may be administered by inhalation of an aerosol.
- This method has the advantage of delivering the antitumor or antioxidant compound directly to the lungs where it could, for example, provide protection against carcinogens and oxidants such as those found in cigarette smoke and atmospheric pollutants, or effectively kill cancer cells located at this site.
- inhalers appropriate for the practice of the invention are available, including those with various dose metering chambers, various plastic actuators and mouthpieces, and various aerosol holding chambers (e.g. spacer and reservoir devices) so that an appropriate dose of the Vitamin E compound can be delivered.
- non-ozone depleting (non-chlorofluorocarbon) propellants such as various hydrofiuoroalkanes (e.g. HFA 134a and HFA 227) are available.
- Administration may also be achieved transdermally using a patch impregnated with the aqueous solution of the salt of the Vitamin E compound, by ocular administration (eye drops), sublingual administration, nasal spray administration and rectal administration (suppository).
- Administration may also be oral.
- oral administration of TSE-tris resulted in high (9.2 nmol/ml) plasma TSE levels (18 hours following administration) that were similar to the levels observed for the same dose of TSE-tris given intraperitoneally (11.3 nmol/ml)
- vitamin E ethers and vitamin E ester compounds that are not hydrolyzable eg. TS-2,2 dimethyl, data not shown
- absorption may be accomplished by coating the tris salt vitamin E compounds (liposomes) with an impermeable polymer membrane that is not susceptible to the action of digestive enzymes (duodenal esterases) or is biodegraded very slowly.
- amino acid polymers such as polylysine could be used. Impermeable polymer films would be degraded by microflora found in the colon. Thus, the vitamin E ester compound would be released in a part of the intestine devoid of secreted digestive enzymes.
- Vitamin E compounds may be administered in any of several forms, including tablets, pills, powders, lozenges, sachets, elixirs, suspensions, emulsions, solutions, syrups, aerosol, soft or hard gelatin capsules, or sterile packaged powders.
- the Vitamin E compound may be administered as a composition which also includes a pharmaceutically acceptable carrier.
- the Vitamin E compound may be mixed with a carrier, or diluted by a carrier, or enclosed within a carrier.
- the carrier is a diluent, it may be a solid, semisolid or liquid material which acts as a vehicle, excipient or medium for the Vitamin E compound.
- Suitable carriers, excipients and diluents include lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum acacia, calcium phosphates, alginate, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, water syrup, methyl cellulose, methyl and propylhydroxybenzoates, talc, magnesium stearate and mineral oil.
- the formulations can also include lubricating agents, wetting agents, emulsifying agents, preservatives, and sweetening or flavoring agents.
- the dose of the Vitamin E compound to be delivered will vary depending on a variety of factors including the route of administration, the particular condition being treated, the condition of the individual patient, the patient's age, gender, weight, etc., and other various factors that will vary from situation to situation.
- the exact dosage will thus be determined on a case by case basis by the attending physician or other appropriate professional, but will generally be in the range of 1 to 100 mg/kg of body weight.
- the dose may be less and will vary according to the exact delivery technology that is employed.
- the Vitamin E compounds may be used alone (i.e. one Vitamin E compound per suspension) or as mixtures of Vitamin E compounds (i.e. more than one Vitamin E compound per suspension).
- TRF-succinate tris salt forms liposomes, indicating that the five different tocopherol and tocotrienol isomers that are contained in TRF are contained together in the liposome. It may be advantageous to deliver to tissue more than one isomer or form of vitamin E compound, especially if different forms of ⁇ -T are able to distribute to different subcellular sites, or protect against different types of oxidative stress, or are hydrolyzed at different rates.
- the Vitamin E compounds may be used by themselves or in combination with other drugs.
- the Vitamin E compounds may be used with other antitumor drugs such as taxol, or with other antitumor agents such as doxorubicin, and with other tocopherol derivatives.
- the Vitamin E compounds may be administered prior to, after, concomitant with, or in the same preparation as the other drugs.
- Absolute ethanol was obtained from J. T. Baker Inc. (Phillipsburg, NJ). Ascorbic acid, HPLC- grade methanol, chloroform and hexane were obtained from Fisher Scientific (Pittsburgh, PA). The tocopherol compounds ⁇ -T (96%) and d- ⁇ -tocopherol (96%) (internal standard) were a generous gift from Henkel (La Grange, IL). TS-tris (99%) was prepared as described by Fariss et al. (7). The compound TSE-tris (>95%) was synthesized according to the procedures reported by Fariss et al. (9).
- CC1 4 (99.9+%) was of the highest purity available and was obtained from Aldrich (Milwaukee, WI). Hemin, bilirubin, TS-FA (99%), -nitrophenol and all other chemicals used for this study were obtained from Sigma (St. Louis, MO). Taxol was a gift from Dr. David Bailey at Hauser, Inc. ⁇ -TS-tris and TRF-S-tris were synthesized by Dr. Doyle Smith. Cell lines
- the cell line OCM1 derived from human ocular melanoma , was used for the taxol studies and was a gift from Dr. June Kan-Mitchell at the University of California, San Diego, CA.
- mice Male Sprague-Dawley rats from Simonsen Labs (Gilroy, CA) weighing 175-225 g were used throughout the course of this study. Animals received water and food (Purina Rat Chow 5001, Ralston Purina, St. Louis, MO) ad libitum for at least three days prior to the onset of the experiment. ⁇ -T was dissolved in olive oil (approx. 100 mg/ml) and administered by ip injection at a dose of 0.19 mmol/kg body weight. The vehicle, olive oil, was administered at a dose of 1 ml/kg body weight.
- Powdered TS-tris and TSE-tris were suspended in saline with brief sonication (30 sec) and were given intraperitoneally at a dose of 0.19 mmol/kg body weight (approximately 100 mg/kg). Saline was given to rats at a dose of 4 ml/kg.
- animals were sacrificed 18, 72 or 120 hours later for tissue procurement (frozen in liquid nitrogen), liver homogenization and subcellular fractionation. In the tissue distribution studies, animals were fasted 18 hours prior to sacrifice. In experiments in which rats were sacrificed 6 h after receiving TS-tris, rats were fasted for a 12 h period prior to receiving TS-tris and for an additional 6 h until sacrifice.
- CC1 4 was dissolved in peanut oil (0.5 g /ml) and given at a dose of 1.0 g/kg. Food was restored 1 h after receiving CC1 4 .
- rats were sacrificed 4 h after receiving CC1 4 and plasma and liver samples were collected for hepatotoxicity determinations. Rats were anesthetized with diethyl ether, and blood samples (4-5 ml) were withdrawn from the inferior aorta. Blood samples were immediately mixed with 15 mg tripotassium EDTA, and aliquots were centrifuged at low speed to prepare plasma samples.
- Liver microsomes were also isolated after 4 h for the determination of lipid peroxides, tocopherol, G6Pase activity and j-»-nitrophenol (PNP) hydroxylase activity levels. All procedures were approved by the Washington State University Animal Care and Use Committee. Tumor cell methods and viability assay
- TS-tris suspensions were prepared by adding 1 ml of water or saline to 30 mg of TS-tris in a microfuge tube and sonicating for 15 sec, twice.
- taxol-TS-tris suspensions 1 mg of taxol was added to 30 mg of TS-tris prior to the addition of water or saline, and the mixture was sonicated for 15 se , twice.
- Alamar Blue Assay 1 mg of taxol was added to 30 mg of TS-tris prior to the addition of water or saline, and the mixture was sonicated for 15 se , twice.
- Alamar blue dye was used to evaluate cell survival and proliferation. Living cells metabolize the non-fluorescent dye to a fluorescent metabolite which can be detected by a fluorescence plate reader. There is a positive correlation between the level of fluorescence and the number of living cells. The fluorescence intensity of the cells treated with a test compound was compared to that of a control group which has no added test compound (vehicle only). The result was expressed as "Cell number (% control)". A reduction in the cell number indicates inhibition of cell growth, or an increase in cell death. PROCEDURE:
- OCM-1 cells were plated at a density of 2.5 or 5 x 10 3 cells/well, depending on the cell type, in a 96- well flat-bottomed plate in DMEM (10% fetal bovine serum) medium.
- DMEM 50% fetal bovine serum
- the medium was replaced with 200 ⁇ L RPMI 1640 (10% fetal bovine serum) medium containing the desired concentration of test compound.
- the concentration of test compound used ranged from 0 to 50 ⁇ M. 200 ⁇ L of medium without cells was plated as a blank.
- Fluroescent values from blank cells were subtracted from fluorescent values of cells treated with test compounds. The resulting values were then divided by the corresponding values obtained from the control samples to give the number of viable cells (% control).
- the IC 50 values concentration required to inhibit cell growth by 50%
- Livers were excised from rats and minced in ice cold homogenization buffer (250 mM sucrose, 10 mM tris and 1 mM EDTA, pH 7.4). The minced liver was subsequently rinsed several times with ice cold homogenization buffer and finally suspended in 2.5 volumes of homogenization buffer. The liver mince was then homogenized with five strokes of a Potter-El vehj em tissue grinder. Aliquots of the homogenate were retained for tocopherol and protein determinations. The remainder of the liver homogenate was used for subcellular fractionation according to previously described procedures (27, 28). In all cases, the subcellular markers corresponding to the appropriate fractions were substantially enriched and were similar to previously reported values (28).
- ice cold homogenization buffer 250 mM sucrose, 10 mM tris and 1 mM EDTA, pH 7.4
- the minced liver was subsequently rinsed several times with ice cold homogenization buffer and finally suspended in 2.5 volumes of homogenization buffer.
- the liver mince was then homogen
- Mitochondria were prepared from either naive rats, or following pretreatment with T or TS as outlined in the Animals section above. Rats were anaesthetized with 0.6 mg/kg pentobarbitone, and livers rapidly excised, weighed and placed in ice-cold 0.25M sucrose, ImM EDTA in lOmM Tris Hcl, pH 7.4 containing 0.5% BSA. The liver was lightly minced, then homogenized by 3 passes of a drill-assisted Dounce homogenizer. The homogenate was centrifuged at 3,000 xg, 4°C for 10 minutes with the pellet containing debris and nuclei being discarded.
- the supernatant was centrifuged at 10,000 xg for 10 minutes, supernatant aspirated and mitochondrial pellet collected.
- the pellet was resuspended in ice cold 0.25M sucrose in lOmM Tris HCI, pH 7.4 containing 0.5% BSA, and centrifuged as before.
- the mitochondrial pellet was washed one further time before being resuspended to a volume being 1 gram wet weight liver per ml. Mitochondria were stored on ice and used immediately for swelling experiments.
- analysis buffer comprised of 0.25M sucrose, 1 rnM potassium dihydrogen orthophosphate and 2 ⁇ M rotenone in lOmM MOPS buffer, pH 7.4.
- a 0.1 ml aliquot of 60mM succinate, prepared in analysis buffer was added to 0.9 ml of analysis buffer in a 1.5 ml cuvette.
- a 0.1 ml aliquot of mitochondria was added, inverted to mix and left at room temperature for a further minute.
- the swelling agent was added and the monitoring of change in absorbance commenced immediately and continued for up to 10 minutes. Prior to investigating mitochondrial swelling to ferrous ammonium sulfate (0-2500 ⁇ M), the ability to swell in the presence of calcium (20 ⁇ M) was used as a positive control.
- Mitochondria were prepared as outlined above with the absence of BSA in the homogenization and washing solutions. The two washings remove the majority of residual microsomal contamination. After the final wash, mitochondria were resuspended in 5 ml of 0.25M sucrose and 1 mM EDTA in lOmM TrisHCI buffer, pH 7.4. Mitochondria were snap frozen in liquid nitrogen and stored at 80°C until use. After thawing, a 1 ml aliquot of mitochondria were diluted with 1 ml of phosphate buffered saline, pH 7.4 and sonicated on ice for 3 seconds.
- the mitochondria were then placed on a sucrose gradient of three 1 ml layers of 51%, 37.7% and 25.3% and centrifuged at 140,000 xg for 3 hours 15 minutes.
- the outer membranes of the mitochondria form a band at the 25.3:37.7 interface.
- the inner mitochondrial membranes form a band at the 37.7:51 interface. Both bands are individually collected, resuspended in 40ml of PBS and centrifuged at 12,000 xg for 20 minutes.
- the inner mitochondrial membranes form a smoky red pellet, which is resuspended in 1 ml of PBS and snap frozen in liquid nitrogen until use.
- the pellet from the outer membrane sample is discarded, and supernatant centrifuged at 120,000 xg for 90 minutes.
- the clear red pellet is resuspended in 1 ml of PBS and snap frozen until use. Protein content of the cellular and subcellular fractions were determined by the BCA protein kit (Pierce, Rockford,
- the mitochondria isolated as described above from TS-tris and TSE-tris animals (18 hour treatment) were examined for their susceptibility to lipid peroxidation by the fluorescence plate reader assay of Tirmenstein et al.
- Rat Hepatocyte Suspensions and Cytotoxicity Studies Adult male Sprague-Dawley rats (200-3 OOg) were obtained from Simonsen Laboratories Inc. (Gilroy, CA). Rats were housed in small groups with food and water ab lib. in a standard 12 hour light/dark cycle for at least 1 week prior to use. Rats were administered either 0.19 mmol/kg ⁇ -tocopherol dissolved in olive oil or ⁇ -tocopherol succinate tris by intraperitoneal injection 18 hours prior to cell isolation. Tocopherol succinate (Tris salt) was prepared in saline with two 15 second sonications on ice to form a fine aqueous suspension.
- Tris salt Tris salt
- Hepatocytes were isolated using the 2 step collagenase perfusion method described in Fariss et al. (50). A yield of 5-7 x 10 8 cells was routinely obtained with viability of >94%, as determined viatrypan blue exclusion. Hepatocyte suspensions (2 x 10 6 cells/mL, 12 mL, total) were prepared in modified Waymouth's medium. After a 15 minute equilibration time, an aliquot of cells was taken as the 0 time point. After collection of the 0 time point, the cytotoxicant under investigation was immediately added. Ferrous ammonium sulphate (0.1 to 5 mM) was prepared in water immediately before addition.
- LDH activity was determined by monitoring the enzymatic formation of NADH for NAD+ in the presence of L-lactic acid. Post-centrifugation supematants were diluted 1:80 with PBS. A 100 ⁇ L aliquot was added to a well of a 96 well plate and mixed with 100 ⁇ L of reagent to give a final concentration of 3.75 mM NAD+ and 25 mM L-lactic acid in 125mM Tris-HCl buffer, pH 8.9. The increase in fluorescense was immediately monitored at room temperature (gain 70) using a CytoFluor 4000, Perceptive Biosystems (Framingham, MA). The percent LDH leakage was calculated by comparing values to total LDH activity. Total LDH was measured from a sample of hepatocytes collected at 0 time and lysed with a final concentration of 0.2% Triton X-100.
- Tocopherol, tocotrienol, and tocopherol ester levels were measured according to the methods described by Fariss et al. (31).
- TSE levels were measured according to the procedures of Tirmenstein et al. (32). Samples were analyzed by reversed-phase high-performance liquid chromatography equipped with fluorimetric detection. Retention times for J- ⁇ -tocopherol (internal standard), ⁇ -T and TSE were 8.0, 11.5 and 13.4 min respectively.
- Microsomes isolated from vehicle and tocopherol-treated animals were washed and resuspended in 0.154 M KC1, 50 mM tris, pH 7.4 buffer and were stored frozen at -80° C prior to assays.
- PNP hydroxylase activity was measured according to the procedures of Koop (33) as modified by Speerschneider and Dekant (34). Aliquots of microsomes were resuspended in 0.1 M potassium phosphate buffer, pH 7.4 at a concentration of 0.75 mg protein/ml with a final volume of 1 ml.
- the NADPH-generating system consisted of 1 mM NADP+, 9 mM glucose-6-phosphate and 0.2 units/ml glucose-6-phosphate dehydrogenase.
- Microsomes were preincubated with the NADPH generating system at 37° C for 5 min. Incubations were started by adding PNP to a final concentration of 450 ⁇ M. After 20 min at 37° C with shaking, incubations were stopped by adding 0.5 ml 0.6 N perchloric acid to 1 ml of samples. Samples were centrifuged at 16,000g for 2 min, and 1 ml of the supernatant was mixed with 0.1 ml of 10 N NaOH. The amount of the reaction product, 4-nitrocatechol, formed was determined by measuring the absorbance at 546 nm (extinction coefficient of 9.53 mM-lcm-1). Microsomal lipid peroxide and G ⁇ Pase activity determinations
- mice were sacrificed 4 h after CC1 4 administration and rat liver microsomes were prepared as previously described (27,28). Microsomes were washed and resuspended in 0.154 M KC1, 50 mM tris HC1, pH 7.4 buffer. After isolation, microsomes were stored frozen at -80° C. Lipid peroxide levels in microsomes were determined according to the procedures of Ohkawa et al. (35). Aliquots of the washed microsomes were also assayed for G ⁇ Pase activity as described by Aronson and Touster (36).
- Results are presented as means ⁇ SD. Analysis of variance was performed with the InStat 2.03 (GraphPad Software, Inc., San Diego, CA) statistical package. Differences between groups were determined using the Dunnett multiple comparison post test.
- tocopherol values were not normalized per mg protein, the majority of the tocopherol found in hepatocytes was associated with mitochondria and microsomes. Our data indicate that these fractions consistently contained the majority of the cell's tocopherol levels, regardless of the tocopherol treatment. Supplementation of rats with ⁇ -T was much less effective in increasing total tocopherol levels in rat liver homogenates and subcellular fractions were increased only about 2 fold in rats receiving ⁇ -T. ⁇ -T is insoluble in water and was dissolved in olive oil prior to administration. In contrast, powdered TS-tris and TSE-tris can be placed in saline and suspended by sonication.
- TS-tris administration to rats also proved to be the most effective means of increasing ⁇ -T levels in the liver and exceeded the ability of TS administration to increase hepatic ⁇ -T levels (Table 1 and reference 27).
- the administration of ⁇ -T produced a modest but significant increase in ⁇ -T levels in all of the fractions except microsomes.
- ⁇ - T administration produced a nonsignificant 1.7 fold increase in ⁇ -T levels.
- TS-tris administration increased microsomal ⁇ -T levels 7.6 fold.
- TS-tris treatments resulted in an up to 10-fold increase in homogenate and subcellular TS levels (Table 1 and reference 27). This superior ability of TS-tris administration to increase cellular and subcellular TS levels was especially high in mitochondria.
- TSE-tris The administration of TSE-tris to rats led to the uptake and incorporation of TSE into hepatocyte membranes that exceeded by up to 10-fold that observed following TSE administration, again with mitochondria showing the largest increase (Table 1 and reference 27).
- TSE-tris did not introduce as much TSE into liver homogenates and subcellular fractions as an equimolar dose of TS-tris.
- Supplementation of rats with TSE-tris did not significantly increase homogenate or subcellular levels of ⁇ -T supporting the observation that TSE is a non-hydroylzable form of TS that will not produce an increase in the antioxidant capacity of a tissue or subcellular fraction (as noted in Example 3, Fig. 1).
- the administration of TSE-tris may prove useful in enhancing the antitumor activity of this compound (26).
- Rats received a 0.19 mmol/kg ip injection of the tocopherol analog, 18 h prior to liver homogenization and subcellular fractionation. Each rat was fasted during this 18 h period and the vehicle was saline. b Values expressed as the mean ⁇ SD (n 3 to 6). c ND, not detected. d Values are significantly different (p ⁇ 0.05) from vehicle treated rats.
- CC1 4 The effects of CC1 4 on microsomal ⁇ -T, lipid peroxide and enzyme activity levels are reported in Table 2.
- the administration of CC1 4 decreased microsomal ⁇ -T levels by about 20% after 4 h. This decrease could not be explained by CCl 4 -induced liver cell death.
- animals Four hours following CC1 4 treatment, animals had plasma ALT values (89 ⁇ 30 units/L) near controls (53 ⁇ 11 units/L) and no liver injury as judged by histopathology (data not shown).
- Microsomal ⁇ -T levels in rats supplemented with TS-tris at 6 and 18 h prior to CC1 4 administration were 7.5 and 16 times higher than controls, respectively.
- microsomal ⁇ -T levels in rats pretreated with ⁇ -T and then administered CC1 4 were only about 1.7 times higher than the microsomal ⁇ -T levels measured in control animals.
- CC1 4 a toxic insult
- the hepatic microsomal ⁇ -T levels in TS-tris treated animals increases significantly from 1.68 (no toxic insult) to 3.83 (toxic insult) nmol/mg protein.
- CC1 4 The administration of CC1 4 to rats is known to inactivate microsomal enzymes such as CYP2E1 (48) and G ⁇ Pase (37). These enzymes were assayed in our study to determine if ⁇ - T or TS-tris supplementation could protect against CCl 4 -dependent enzyme inactivation. As expected, CC1 4 administration significantly decreased both G ⁇ Pase and PNP hydroxylase activities (Table 2). PNP hydroxylase activity was reduced by 86% 4 h after CC1 4 administration. Supplementation of rats with either ⁇ -T or TS-tris provided no protection against CCl 4 -induced inactivation of PNP hydroxylase activity.
- CC1 4 administration also decreased G ⁇ Pase activity levels by about 60% as compared to controls after 4 h.
- Pretreatment of rats with ⁇ -T did not significantly protect against G ⁇ Pase inactivation by CC1 4 .
- supplementation of rats with TS-tris provided partial but significant protection against G ⁇ Pase inactivation by CC1 4 G ⁇ Pase activity levels were decreased by only 23% 4 h after CC1 4 administration in animals pretreated with TS-tris 18 h prior to CC1 4 and by 36% in animals pretreated with TS-tris 6 h prior to CC1 4 .
- CC1 4 is known to be metabolized to the trichloromethyl free radical (CC1 3 ) by CYP2E1. Once formed, CC1 3 can initiate the peroxidation of polyunsaturated fatty acids or covalently bind to cellular proteins. In addition, CC1 3 can react with molecular oxygen and generate secondary radicals such as the trichloromethylperoxyl free radical (CC1 3 O 2 ) which can also initiate free radical reactions. Since ⁇ -T effectively inhibits lipid peroxidation, we examined the relative capacity of tocopherol compounds to protect against CCl 4 -induced lipid peroxide formation (Table 2).
- Lipid peroxidation at these later time points may not be due to CC1 4 radical formation, but instead may involve activation of Kupffer cells and infiltration of neutrophils. Activated Kupffer cells produce reactive oxygen species and blocking Kupffer cell function has been shown to be protective against CC1 4 -induced hepatotoxicity (43).
- the amount of ⁇ -T introduced into hepatocytes following ⁇ -T administration may be sufficient to protect against the initial lipid peroxidation generated by CC1 4 radicals but may eventually be depleted by the generation of reactive oxygen species at later time points.
- TS-tris in contrast may continue to be hydrolyzed to free ⁇ -T by cellular esterases and inhibit lipid peroxidation over a longer period of time.
- Studies by Kagan et al. (44) demonstrated that esterases located in microsomes can hydrolyze tocopherol esters. These results may explain why we found TS- tris especially effective in increasing microsomal ⁇ -T levels 18 h after administration.
- Rats received a 0.19 mmol/kg ip injection of the tocopherol analog, 6 or 18 h prior to receiving CC1 4 (1 g/kg). Each rat was fasted for an 18 h period prior to sacrifice, and the vehicle was saline. Rats were sacrificed and microsomes were isolated 4 h after CC1 4 administration. Following isolation, microsomes were washed and resuspended in 0.154 M KC1, 50 mM tris, pH 7.4 buffer. b Units are expressed as ⁇ mol phosphate formed per h at 37° C. c Units are expressed as nmol/. -nitrocatechol formed per min at 37° C. d Values expressed as the mean ⁇ SD (n 3 or 4). e Values are significantly different (p ⁇ 0.05) from vehicle treated rats. f Values are significantly different (p ⁇ 0.05) from CC1 4 treated rats.
- Fig. 1 shows that hepatic mitochondria isolated from TS-tris treated rats are protected against oxidative stress-lipid peroxidation. (Lipid peroxidation is measured by an increase in fluorescence.) By contrast, hepatic mitochondria isolated from TSE-tris treated or vehicle (saline) treated rats (data not shown) are susceptible to oxidative stress-induced lipid peroxidation. From Table 1 we know that TS-tris administration results in an elevation of mitochondrial ⁇ -T and TS levels as compared to the levels measured in TSE-tris and control mitochondrial. Thus these findings support the hypothesis that an elevation in tissue, cellular or subcellular ⁇ -T and TS concentrations result in an enhanced antioxidant capacity and prevention of oxidative-stress mediated damage.
- TS-tris administration can deliver more vitamin E to tissues (than ⁇ -T) but 18 hr following administration may not be sufficient time for adequate release of ⁇ -T from the TS tissue reservoirs.
- tissue esterase activities that limit the rate of ⁇ -T release from TS or the rate of elimination of tissue TS or TS-released ⁇ -T from each tissue may be accelerated (transport out of the tissue or utilization).
- TS-tris resulted in a tissue distribution of TS and ⁇ -T that was nearly identical to that achieved with TS-tris administered intraperitoneally.
- the only exception was in the lung, where TS levels of intravenously treated animals were almost 5 -fold the levels observed in the lungs of rats which had received TS-tris intraperitoneally.
- TSE-tris intraperitoneally
- TSE accumulation was considerably lower than that observed for TS-tris (ip) and the liver contained the highest concentration of TSE.
- oral administration of TSE-tris by oral administration resulted in plasma levels that were nearly identical to that observed with ip administration.
- ⁇ -T d- ⁇ -Tocopherol
- TS-Tris d- ⁇ -Tocopherol Hemisuccinate Tris Salt
- TSE-tris d- ⁇ - Tocopheryloxybutyrate Tris Salt
- tissue ⁇ -T levels continued to be elevated (as observed after 18 hrs) except for brain, plasma and blood levels which were now back to control levels.
- TS-tris treated animals continued to show plasma and blood ⁇ -T levels that were markedly elevated and similar to the levels observed at 18h (2x control).
- substantial levels of TS were detected in all tissues except brain.
- Plasma, blood and liver TS levels at 72 h had declined by approx. 50% from the 18 h time point.
- liver ⁇ -T levels did not change appreciably.
- T- equivalents (TS + ⁇ -T) are maintained at levels similar to that observed at 18 hrs and the ⁇ -T level in each of these tissues is, if anything, on the rise.
- TS-tris (ip) treated rats The kidney, heart and lung TS levels [from TS-tris (ip) treated rats] are declining at 120 h (as compared with 72 h) but the loss in TS appears to result in an concomitant increase in ⁇ -T levels in these tissues.
- TS- tris administration offers the advantage of maintaining tissue levels of ⁇ -T and TS for an extended length of time and at an enhanced level.
- the loss of TS in many tissues appears to be related to its hydrolysis to ⁇ -T which is retained by the tissue.
- This enhanced maintenance of tissue ⁇ -T levels will provide an increased antioxidant capacity which may protect these tissues from oxidative stress-induced damage and disease.
- the ⁇ -T concentration is maintained at approx. 70-80 nmol/g, a level observed at 18, 72 and 120 h., even though hepatic stores of TS are continuing to be lost during this time period.
- liver has a limited capacity to store high levels of ⁇ -T and/or TS.
- tissue distribution of ⁇ -T and TS was nearly identical to that described above for TS-tris (ip). This again suggests that TS- tris administered intraperitoneally and intravenously result in similar tissue distributions of TS and ⁇ -T.
- OCM-1 Ocular Melanoma Tumor
- taxol alone is a potent antitumor agent with approximately 95% cell kill observed with a 10 nanomolar concentration in the medium.
- 100% cell kill was not observed.
- TS-tris and taxol allows for 100% kill of tumor cells that normally is not observed with taxol alone (see Fig. 2B).
- ⁇ -TS-tris has a distinct and significant advantage (as compared to unesterified ⁇ -tocopherol) in terms of delivering to tissue, cells and subcellular fractions large amounts of TS that can serve as a ⁇ -T reservoir for the release of ⁇ -T over time.
- ⁇ -TS-tris also has an advantage in terms of providing a dramatic maintenance of plasma and blood ⁇ -T levels (in concentration and over time), thus providing a continual source of ⁇ -T for blood (lipoproteins and formed elements) and other tissues.
- Vitamin E is a generic term that includes, in nature, eight substances, d- ⁇ -, d- ⁇ -, d- ⁇ -, d- ⁇ -tocopherol and d- ⁇ -, d- ⁇ -, d- ⁇ -, d- ⁇ -tocotrienol.
- a single dose (0.19 mmol/kg ip injection) of ⁇ -TS-tris or TRF-S-tris.
- an aqueous suspension was prepared for each compound as previously described for ⁇ -TS-tris.
- ⁇ -TS-tris has tissue distribution properties similar to those described in previous examples for ⁇ -TS-tris. This is a significant finding since it is well known that although ⁇ -T is the most abundant form of tocopherol found in nature (plants) and has excellent antioxidant properties, it is poorly retained by our tissues. As a result of these properties, ⁇ -T is found in low concentrations in our cells and tissues (approx. 1-3 nmol/g of tissue) as compared to ⁇ -T which has a 10-fold higher tissue concentration (20-40 nmol/g tissue) (see Tables 5 and 6).
- TRF-S-tris The second substance examined, is a mixture of vitamin E compounds containing the succinate ester tris salt of d- ⁇ - tocopherol (28%) and d- ⁇ - (35%), d- ⁇ -(22%), and d- ⁇ -tocotrienol (16%).
- the presence of the succinate ester of each of these vitamin E derivatives was confirmed by HPLC analysis using base hydrolysis. In naive rat tissues, these tocotrienol compounds were not detectable using our standard analytical methods. In rats, 18h following the single injection of TRF-S-tris (0.19 nmol/kg intraperitoneally) significant vitamin E levels in tissues were only observed for ⁇ -TS.
- EXAMPLE 9 Effect of TS-TRIS administration on the delivery ofTS and T to liver, hepatocytes, and mitochondria and protection against iron-induced lipid peroxidation and cell death.
- TS-tris administration resulted in dramatic increases in both ⁇ T (10-fold higher than ⁇ T-treated) and ⁇ TS levels, indicating that ⁇ TS has a unique ability to selectively concentrate in mitochondria (as compared to homogenate and ⁇ T-treatment data).
- respiring mitochondria were isolated from the treated rats (as described above) and exposed to high levels of iron (a well known oxidative challenge).
- mitochondrial swelling as an indicator of mitochondria damage and dysfunction, we found that only mitochondria isolated from the livers of TS-tris treated rats were completely protected against iron-induced damage (data not shown).
Abstract
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Cited By (6)
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EP1793803A2 (en) * | 2004-10-01 | 2007-06-13 | Ramscor, Inc. | Conveniently implantable sustained release drug compositions |
WO2007071205A3 (en) * | 2005-12-20 | 2007-08-09 | Heaton A S | A taxane derivative containing pharmaceutical composition with improved therapeutic efficacy |
EP2063884A1 (en) * | 2006-09-15 | 2009-06-03 | Stephen John Ralph | Pro-oxidant anti-cancer compounds |
US8541413B2 (en) | 2004-10-01 | 2013-09-24 | Ramscor, Inc. | Sustained release eye drop formulations |
US9011915B2 (en) | 2004-10-01 | 2015-04-21 | Ramscor, Inc. | Conveniently implantable sustained release drug compositions |
US9737606B2 (en) | 2004-10-01 | 2017-08-22 | Ramscor, Inc. | Sustained release eye drop formulations |
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EP1793803B1 (en) * | 2004-10-01 | 2012-11-07 | Ramscor, Inc. | Conveniently implantable sustained release drug compositions |
US9737606B2 (en) | 2004-10-01 | 2017-08-22 | Ramscor, Inc. | Sustained release eye drop formulations |
EP3173072A1 (en) * | 2004-10-01 | 2017-05-31 | Ramscor, Inc. | Conveniently implantable sustained release drug compositions |
US8541413B2 (en) | 2004-10-01 | 2013-09-24 | Ramscor, Inc. | Sustained release eye drop formulations |
WO2007071205A3 (en) * | 2005-12-20 | 2007-08-09 | Heaton A S | A taxane derivative containing pharmaceutical composition with improved therapeutic efficacy |
CZ300305B6 (en) * | 2005-12-20 | 2009-04-15 | Heaton, A. S. | Pharmaceutical composition containing taxane derivative and exhibiting enhanced therapeutic efficiency |
JP2010508242A (en) * | 2006-09-15 | 2010-03-18 | スティーブン・ジョン・ラルフ | Prooxidant anticancer compound |
KR101482803B1 (en) * | 2006-09-15 | 2015-01-15 | 스티븐 존 랄프 | Pro-oxidant anti-cancer compounds |
AU2007295877B2 (en) * | 2006-09-15 | 2013-04-18 | Cancure Limited | Pro-oxidant anti-cancer compounds |
US8410056B2 (en) | 2006-09-15 | 2013-04-02 | Stephen John Ralph | Pro-oxidant anti-cancer compounds |
EP2063884A4 (en) * | 2006-09-15 | 2010-05-19 | Stephen John Ralph | Pro-oxidant anti-cancer compounds |
EP2063884A1 (en) * | 2006-09-15 | 2009-06-03 | Stephen John Ralph | Pro-oxidant anti-cancer compounds |
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