WO2005053706A1 - Use of a cyclopentenone prostaglandin for delaying for the onset and/or preventing the continuation of labour - Google Patents
Use of a cyclopentenone prostaglandin for delaying for the onset and/or preventing the continuation of labour Download PDFInfo
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- WO2005053706A1 WO2005053706A1 PCT/GB2004/005087 GB2004005087W WO2005053706A1 WO 2005053706 A1 WO2005053706 A1 WO 2005053706A1 GB 2004005087 W GB2004005087 W GB 2004005087W WO 2005053706 A1 WO2005053706 A1 WO 2005053706A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
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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
- A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
- A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P11/00—Drugs for disorders of the respiratory system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P15/00—Drugs for genital or sexual disorders; Contraceptives
- A61P15/06—Antiabortive agents; Labour repressants
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P15/00—Drugs for genital or sexual disorders; Contraceptives
- A61P15/08—Drugs for genital or sexual disorders; Contraceptives for gonadal disorders or for enhancing fertility, e.g. inducers of ovulation or of spermatogenesis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/04—Antibacterial agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/10—Antimycotics
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/12—Antivirals
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
Definitions
- the present invention relates to agents for improving perinatal outcome in pre-term labour.
- the present invention relates to the use of prostaglandins to prevent and/or reduce an inflammatory response in the reproductive system of a female, thereby delaying the onset of labour.
- Pre-term labour defined as spontaneous labour occurring prior to 37 weeks of gestation (with 39 weeks being term) continues to be a major problem, particularly in developed countries.
- Preterm birth occurs in 5-10% of all pregnancies but is associated with 70% of all neonatal deaths and up to 75% of neonatal morbidity (Rush et al, 1976).
- -Premature neonates are at high risk of cerebral palsy, developmental delay, visual and hearing impairment and chronic lung disease.
- the uterus During pregnancy, the uterus is maintained in a state of non-contractile quiescence whilst the cervix remains firm and closed. With the onset of labour, the cervix needs to become softer and to offer low resistance to force applied and have fibres which move under tension. The uterus also needs to begin contracting.
- PGs increase in maternal urine and blood and in fetal membranes in association with labour (Satoh et al, 1919; Skinner and Challis, 1985).
- PGE 2 stimulates uterine contractions (Dyal and Crankshaw, 1985), indirectly increases fundamentally dominant myometrial contractility by upregulation of oxytocin receptors and synchronisation of contractions (Garfield et al, 1990), and acts in concert with LL-8 to remodel the cervix (reviewed in Kelly, 2002).
- NFKB Nuclear Factor Kappa B
- IL-6 interleukin-6
- COX-1 and COX-2 COX-1 and COX-2
- COX genes are also referred to as prostaglandin H synthase or PG synthase.
- the resulting inflammatory infiltrate mediated by the cytokines
- increase in prostaglandin synthesis leads to cervical ripening, fetal membrane rupture and myometrial contractions.
- NF- ⁇ B/Rel Five members of the NF- ⁇ B/Rel family have been identified in mammals: NF- ⁇ Bl (p50 and its precursor pl05), NF- ⁇ B2 (p52 and its precursor plOO), p65 (RelA), c-rel, and Rel B. These proteins share a structurally conserved amino-terminal region termed the Rel homology domain (RHD).
- the RHD is responsible for dimerisation, DNA binding, and interaction with the inhibitors of kappa B (Ii B) proteins. It also contains a nuclear localisation signal (NLS).
- NF- ⁇ B In its active DNA-binding form NF- ⁇ B consists of heterogeneous dimers of various combinations of NF- ⁇ B subunits: each member of the NF-i B family, except for Rel B, can form homodimers, as well as heterodimers with one another.
- the p65, c-rel and Rel B proteins contain a carboxy-te ⁇ ninal non-homologous transactivation domain, which activates transcription from i B sites in target genes; in contrast, p50 and p52 proteins lack a transactivation domain.
- the various NF-icB dimers exhibit different binding affinities for specific KB sites (Kunsch et al, 1992, Phelps et al, 2000), and differentially stimulate transcription through distinct icB elements (Lin et al, 1995).
- NF-icB dimers are normally sequestered in an inactive form in the cytoplasm by association with the inhibitory I B proteins, which include I ⁇ B ⁇ , Ii B ⁇ and I B ⁇ .
- the Ii Bs are characterised by the presence of multiple ankyrin repeats which mediate binding to the RHD and mask the NLS of NF- B.
- the major NF-icB signalling pathway which is activated by pro- inflammatory stimuli and LPS, targets IicB ⁇ - and IicB ⁇ -bound NF- ⁇ B (for review see Li and Verma 2002).
- IKK I ⁇ B kinase
- the LKK complex consists of several proteins, the main ones being IKK ⁇ (IKK1), LKK ⁇ (LKK2), and NF- B essential modulator (NEMO or IKK ⁇ ).
- IKK1 IKK ⁇
- LKK2 LKK ⁇
- NEMO NF- B essential modulator
- This modification targets IicB ⁇ for rapid degradation by the 26S proteasome.
- the degradation of the IicB inhibitor exposes the NLS of NF-icB resulting in translocation of the p50/p65 dimer to the nucleus where it can bind to cB sites in the promoter of target genes and promote transcription.
- NF-icB The critical inhibitory step in NF-icB inactivation involves binding of newly synthesised I ⁇ B ⁇ to NF-icB in the nucleus. IicB ⁇ is quickly res3mthesised following its degradation. The newly synthesised IicB ⁇ is localised in the nucleus and displaces NFicB from its DNA binding sites. IicB ⁇ contains leucine-rich nuclear export sequences (NES) (Johnson et al 1999), which then enable it to transport NF-icB back to the cytoplasm, thereby completing an autoregulatory post-induction repression.
- NES leucine-rich nuclear export sequences
- IicB ⁇ In many cells nearly half of the NF-icB is sequestered by the other major IKB isoform, IicB ⁇ (Whiteside et al, 1991). In contrast to IicB ⁇ , IicB ⁇ is not NF-icB inducible and does not exert a rapid post-induction repression of NF-icB activity. Rather, IicB ⁇ has been implicated in persistent NF-icB activation. Prolonged exposure to certain stimuli, such as LPS, leads to the long-term induction of NF-icB activity despite high levels of newly synthesised IicB ⁇ .
- I ⁇ B ⁇ is un-phosphorylated and, in contrast to IicB ⁇ or the constitutively phosphorylated I ⁇ B ⁇ , can interact with NF-icB bound to target promoters without displacing it from the DNA (Suyang et al, 1996).
- This interaction of un-phosphorylated I ⁇ B ⁇ with DNA-bound NF-icB is thought to protect NF-icB from nuclear export, and thus inhibition, by IicB ⁇ , and the outcome is a sustained NF-KB response.
- PGs are a family of biologically active molecules having a diverse range of actions depending on the prostaglandin type and cell target. There is considerable evidence to support a central role for PGs in human parturition.
- Labour is associated with increased PG synthesis within the uterus (Turnbull 1977) particularly from the fetal membranes (Skinner and Challis 1985).
- PGs act to mediate cervical ripening and to- stimulate uterine contractions (Cranckshaw and Dyal 1994) and indirectly to increase fundamentally dominant myometrial contractility by up-regulation of oxytocin receptors and synchronisation of contractions (Garfield et al 1990).
- PGs bind to prostanoid receptors localised on the cell surface and act through second messenger systems (Narumiya, 1995).
- PGD 2 metabolites are actively incorporated into the nuclei of cells (Narumiya et al., 1987) and can exert their effects through direct interactions with nuclear receptors.
- Peroxisome proliferator-activated receptors PPARs
- PPARs Peroxisome proliferator-activated receptors
- They exist in three distinct forms, PPAR- ⁇ , PPAR- ⁇ , and PPAR- ⁇ , which form heterodimers with the retinoic X receptor (RXR) and bind to PPAR response elements (PPREs) in the promoter of target genes to induce transcription.
- PPAR- ⁇ can also repress gene transcription by negatively interfering with the NF-icB, AP-1, STAT and C/EBP pathways (Zhou et al, 1999; Subbaramaiah et al, 2001; Takata et al, 2002; Suzawa et al, 2003).
- Intrauterine infection/inflammation has also been identified as a key contributor to the development of cerebral palsy (CP) and schizophrenia (Urakubo et al, 2001; Gibson et al., 2003), and, although CP does occur in term infants, the risk of CP is strongly associated with prematurity (Darnmann et al, 1999).
- inflammatory responses caused by mechanical stretching of the uterus may contribute to the onset of labour.
- Mechanical stretchmg of the uterus occurs to an extent as a normal part of pregnancy and may be responsible for some of the biochemical changes which occur near to term and which cause the normal onset of labour at term.
- mechanical stretch may occur where the uterus is overdistended by multiple pregnancy or by excess amniotic fluid (clinically termed hydramnios or polyhydramnios).
- hydramnios or polyhydramnios
- Stretch leads to an increase in the production of a series of 'labour-associated' proteins including COX-2 (which then increases prostaglandin synthesis), cytokines such as IL-8 and IL-lb and the oxytocin receptor. Increased prostaglandin and cytokine productions causes cervical ripening or further cervical ripening (and may lead to neonatal brain injury). Prostaglandins and OTR receptor lead to uterine contractions.
- ⁇ -sympathomimetics such as Ritodrine, Salbutamol and Terbutaline
- ⁇ -sympathomimetics cause significant maternal cardiovascular, respiratory and metabolic side effects and may lead to pulmonary oedema, cardiac failure and maternal death.
- pulmonary oedema cardiac failure and maternal death.
- tachyphylaxis and become ineffective after 24 to 48 hours.
- Meta-analysis of randomised controlled trials has shown that the value of ⁇ -sympathomimetics is only in the temporary delay of labour to allow in utero transfer or administration of steroid to improve fetal lung surfactant production.
- corticosteroids Other than the antenatal administration of corticosteroids, no obstetric interventions affect neonatal outcome although improvements in neonatal intensive care have dramatically increased survival rates.
- Commonly used agents are dexamethasone or betamethasone.
- Antenatal administration of corticosteroids improves the outcome for the pre-term neonate since it reduces the incidence and severity of respiratory distress syndrome, intracranial haemorrhage and necrotising enterocolitis.
- One function of corticosteroids is to mature the fetal lung, which leads to an increase h surfactant production and therefore prevents or reduces the severity of neonatal respiratory problems.
- Such agents are l ⁇ iown to those skilled hi the art.
- tocolytic drugs are ox ⁇ rtocin receptor antagonists, calcium channel blockers, sympathomimetics and nitric oxide donors.
- a commonly used oxytocin receptor antagonist is Atosiban, that functions by blocking the oxytocin receptor, thereby preventing activation of the receptor by endogenous oxytocin that stimulates uterine contractions.
- a commonly used calcium channel blocker is Nifedipine, that functions to block the influx of calcium into the myometrial cells, which is a requirement for contractions to take place.
- a commonly used sympathomimetic is Ritodrine, that functions by activating adrenergic receptors on the myocyte cell membrane leading to phosphorylation and down-regulation of the activity of myosin light chain kinase, an enzyme essential for contractions.
- a commonly used nitric oxide donor is glyceryl trinitrate, that functions by increasing myocyte cGMP thereby down-regulating the activity of myosin light chain Idnase, an enzyme essential for contractions.
- Indomethacin a cyclo-oxygenase inhibitor
- Indomethacin is effective in preventing the contractions of pre-term labour. It is more effective in short term prolongation of pregnancy than the ⁇ -sympathomimetics and, unlike ⁇ -sympathomimetics, it can reduce the risk of delivery pre-term (Keirse 1995).
- the use of indomethacin is limited by fetal side effects. Indomethacin reduces fetal urine output and constriction of the ductus arteriosus (Moise et al 1995). Clinically significant ductal constriction occurs only in a proportion, increasing with gestational age from 10% at 26 weeks to 50%> at 32 weeks.
- indomethacin is limited in clinical practice to use ⁇ 32 weeks, and to short courses ( ⁇ 48 hours) after which any effects on the constriction of the ductus have been shown to be reversible (Tulzer et al 1991; Moise et al 1993; Respondek et al 1995). Because of these side effects some obstetricians now use Sulindac, which appears to be equally good as a tocolytic (Carlon et al 1992) in place of indomethacin. Sulindac produces a smaller reduction in fetal urine output and minimal effect on ductal patency (Carlon et al 1992; Rasanen and Jouppila 1995). However, Sulindac is far from an ideal choice of tocolytic agent.
- new agents or regimens capable of reducing and/or preventing an inflammatory response in the reproductive system of a female are highly desired.
- Such medicaments or approaches would allow the treatment of pathogenic infection within the reproductive system of a female and/or delay pre-term delivery without causing injury to the fetus/neonate.
- prostaglandins can be used to delay the onset and/or prevent the continuation of labour in a female.
- the present invention provides the use of a cyclopentenone prostaglandin in the manufacture of a medicament for delaying the onset and/or preventing the continuation of labour in a female.
- this is achieved by preventing and/or reducing an inflaimnatory response in the reproductive system of a female.
- the invention stems from the unexpected finding that the cyclopentenone prostaglandins, such as 15-deoxy- ⁇ 12 ' 14 prostaglandin J 2 (15-dPGJ 2 ) and prostaglandin Aj (PGAi), inhibit and/or reduce NFicB activity within uterine cells of the female reproductive system.
- cyclopentenone prostaglandins provide a means for the inliibition and/or reduction of NFicB activity in the reproductive system of a female.
- Medicaments of the invention are believed to inhibit cytokine synthesis and inhibit the biochemical processes of labour, thereby safely prolonging pregnancy. Accordingly, the present invention will improve obstetric management of pre-term labour as the onset of labour may be delayed without injuring the fetus/neonate.
- the cyclopentenone prostaglandins are naturally- occurring substances that contain a cyclopentenone ring structure.
- the cyclopentenone ring is characterised by the presence of a chemically-reactive ⁇ , ⁇ -unsaturated carbon3 and is formed by dehydration of the cyclopentane ring of a precursor prostaglandin.
- the first step in the biosynthesis of prostaglandins involves the intracellular release of arachidonic acid from plasma membrane phospholipids via the action of phospholipase A 2 .
- Arachidonic acid is then converted sequentially to PGG 2 and PGH 2 by the cyclo-oxygenase and peroxidase activities of the PGH synthases, PGH 1 and 2.
- the prostaglandins PGE 2 , PGD 2 and PGF 2 ⁇ are subsequently synthesised from PGH2 via the action of the PGE 2 , PGD 2 and PGF 2 ⁇ synthase, respectively.
- the cyclopentenone prostaglandins, prostaglandin A (PGA 2 ), prostaglandin Ai (PGA and prostaglandin J 2 (PGJ 2 ) are formed by dehydration of prostaglandin E 2 (PGE ), prostaglandin E x (PGE ⁇ and prostaglandin D 2 (PGD 2 ), respectively.
- PGE prostaglandin E 2
- PGE ⁇ prostaglandin E x
- PGD 2 prostaglandin D 2
- PGJ 2 is metabolised further to ⁇ 12 -prostaglanding J 2 ( ⁇ 12 -PGJ 2 ), and 15-deoxy- ⁇ 12 ' 14 prostaglandin J 2 (15-dPGJ 2 ).
- cyclopentenone prostaglandins may alter the clinical effectiveness of the molecule. Such alterations may, for example, increase or decrease the stability or another characteristic of the cyclopentenone prostaglandin, to give a desired change in activity. For example, modification of the 15C residue of cyclopentenone prostaglandins will reduce the metabolism of the compound, thereby increasing its half-life in vivo. Such modifications will be appreciated by those skilled in the art.
- cyclopentenone prostaglandin we include any natural, unnatural or chemically-modified prostaglandin which has a cyclopentenone ring. Cyclopentenone prostaglandin is often abbreviated to "cyPG".
- cyclopentenone prostaglandins include prostaglandin D 2 (PGD 2 ) and its metabolite 15-deoxy- ⁇ 12;1 prostaglandin (15-dPGJ 2 ). Also preferred is prostaglandin Ai (PGAi).
- 15-dPGJ 2 may be obtained from Cayman Chemical, 1180 East Ellsworth Road, Aim Harbour, MI 48108 USA (catalogue number 18570); 9,10-di- hydro-15-deoxy- ⁇ 12:14 -Prostaglandin J 2 may be obtained from Alexis Biochemicals Ltd, PO Box 6757, Bingham, Nottingham, NG13 8LS, UK (catalogue number CAY-18590-M001).
- PGAi may be obtained from Alexis Biochemicals Ltd (address as above; catalogue number 340-045- M005).
- onset of labour and/or “continuation of labour” we mclude the biochemical and/or physiological changes associated with preparation of the tissues of the female reproductive system for delivery.
- the uterus increases in contractility and undergoes contractions.
- the cervix also ripens in readiness for delivery.
- Such changes are well known in the arts of obstetrics, gynaecology and midwifery and, for example, the Bishop's score indicates the degree of cervical ripening (described in Herman et al, 1993).
- delaying the onset of labour in a female and/or preventing the continuation of labour in a female we include the meaning that at least one of these biochemical and/or physiological changes are delayed or prevented.
- female we include any female mammal such as human, or a domesticated mammal, preferably of agricultural significance including a horse, pig, cow, sheep, dog and cat. It is preferred if the female is a human female.
- the present invention provides the use of a cyclopentenone prostaglandin in the manufacture of a medicament for preventing and/or reducing an inflammatory response in the reproductive system of a female.
- Such medicaments are able to inhibit and/or reduce NFicB activity in uterine cells.
- NFicB we include homo- and heterodimers of RelA (p65), RelB, NFicB 1 (p50), NF K B2 (p52) and cRel.
- the RelA (p65), RelB, NFicB 1 (p50), NF ⁇ B2 (p52), and cRel genes and the sequence of the pofypeptide products are described in Li et al. (2002).
- NFicB activity we include the activities of NFicB associated with the expression of genes controlled by any homo- or heterodimer of RelA (p65), RelB, NFicB 1 (p50), NF K B2 (p52) or cRel of the NFicB transcription factor family.
- nuclear translocation of NFicB which can be measured, for example, by Western blottmg analysis of nuclear and cytosolic cellular fractions for the protein of interest (described in Sambrook et al., 1989; Lee et al, 2003); binding of NFicB to target nucleic acid sequences (such as specific regions and sequences of DNA), which can be measured, for example, by Electro-Mobility Shift Assay (EMSA, as described in Dignam et al, 1983; Lee et al., 2003); and NFicB-mediated expression of target genes which can be measured, for example, by northern blotting and/or Western blotting (Sambrook et al, 1989; Lee et al, 2003).
- ESA Electro-Mobility Shift Assay
- uterine cells we include any cells within the ' uterus of a female, or cells derived from the uterus of a female, particularly placental cells, amnion cells, myocytes, uterine and cervical fibroblasts, and maintained as a primary or transformed cell culture or line. These cell types are typically referred to as "gestational tissues"
- Cultures of amnion cells may be prepared from tissue by separating the entire amnion, except for the part overlying the placenta, from the chorion, followed by separating amnion epithelial cells from fibroblasts and maintaining the epithelial cells using mammalian cell culture techniques (Lee et al, 2003).
- Myometrial cell culture may be prepared from tissue from the lower uterine segment, separating cells by incubation with Dispase and collagenase/elastase/DNAase solution and maintaining the myometrial cells using mammalian cell culture techniques (Pieber et al, 2001). Techniques for the generation and maintenance of primary and transformed maimnalian cell cultures will be well known to those skilled in the relevant art.
- reproductive system of a female we mclude any cells and/or tissues and/or organs of a female directly or indirectly involved in the formation, nourishment, maintenance and development of a neonate, embryo or fetus at any gestational stage during pregnancy.
- the medicament is for preventing and/or reducing an inflammatory response in the reproductive system of a female that is pregnant.
- inflaimnatory response we include biochemical and physiological changes associated with inflammation mediated by cells of the host's immune system. Such changes are known in the arts of human and veterinary medicine, immunology, molecular biology and biological science.
- pregnant we include the meaning that the female is carrying a fertilised egg in the uterus, or an embryo or neonate or fetus at any stage of gestational development.
- the present invention provides a use wherein the female is human and the duration of pregnancy is more than approximately 13 weeks of human pregnancy. More preferably, the duration of pregnancy is approximately between 20 and 32 weeks.
- the medicament reduces and/or prevents an inflammatory response in the reproductive system of a female associated with the onset or continuation of labour.
- the biochemical and physiological changes associated with the onset or continuation of labour have been mentioned above.
- certain groups of pregnant females are at high risk of pre-term labour.
- Females that have had one or more instances of pre-term labour previously are at considerably higher risk of a further pre-term labour when pregnant.
- An increased risk of pre-term labour can also be determined by measuring oncofetal fibronectin levels and by cervical examination using methods well l ⁇ iown in the art.
- pre-term labour it is also useful to substantially prevent for a considerable duration pre-term labour using the method of the invention.
- the medicament reduces and/or prevents an inflammatory response in the reproductive system of a female associated with infection by a pathogenic agent
- the pathogenic agent is viral, bacterial or fungal.
- the medicament reduces and/or prevents an inflammatory response in the reproductive system of a female associated with stretch of the uterus.
- stretch of the uterus we include mechanical stretching of the uterus occurring where the uterus is overdistended by multiple pregnancy or by excess amniotic fluid (clinically termed hydramnios or polyhydramnios).
- cervical incompetence There may also be more local stretch of the lower segment of the uterus, the cervix and overlying fetal membranes in cases where there is cervical weakness (clinically termed cervical incompetence).
- the medicament reduces and/or prevents one or more of the following conditions: pre-term labour; pathogenic infection; cervical ripening, uterine contractions.
- preterm labour we include the meaning of spontaneous labour occurring before the usual calculated time for delivery.
- preterm labour is defined as spontaneous labour occurring before 37 weeks of gestation (with 39 weeks being term).
- the usual calculated time of delivery for females as defined by the invention will be well l ⁇ iown in the arts of human and veterinary medicine.
- the medicament reduces and/or prevents fetal or neonatal damage.
- the medicament reduces and/or prevents one or more of the following conditions: astrogliosis; loss of myelin-producing oligodendrocytes; multifocal necroses resulting in cystic change (periventricular leucomalacia, PVL).
- Astrogliosis we include the meaning of hypertrophy (i.e. increasing cell size) of the astroglia, that usually occurs in response to injury.
- Astroglia are the largest and most numerous neuroglial cells in the brain and spinal cord.
- Astrocytes (from “star” cells) are irregularly shaped with many long processes, including those with “end feet” which form the glial (limiting) membrane and directly and indirectly contribute to the blood- brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes can release neuro-transmirters, but their role in signaling (as in many other functions) is not well understood.
- oligodendrocytes we include the meaning of neuroglial cell of the central nervous system (CNS) in vertebrates whose function is to myelinate CNS axons. "Loss of myelin-producing oligodendrocytes” means that there a reduction in the number of these cells.
- multifocal necroses we include the meaning of death of tissue occurring at more than one site.
- cystic change we include the meaning of the development of fluid filled spaces in the region where necrosis has taken place.
- periventricular leucomalacia or “PVL” we include the meaning of damage to the periventrical cerebral white matter which is seen following cytokine induced or hypoxia/ischeamia mduced necroses and which can go on to become cystic change.
- a particularly preferred embodiment of the invention is the use of the cyclopentenone prostaglandin 15-deoxy- ⁇ 12;14 -prostaglandin J 2 and/or prostaglandin Aj.
- the cyclopentenone prostaglandin is provided in the form of a prodrug of 15-deoxy- ⁇ 12 ' 14 -prostaglandin J 2 and/or prostaglandin Ai.
- prodrugs of the cyclopentenone prostaglandins particularly those of 15- deoxy- ⁇ 12 ' 1 -prostaglandin J 2 and/or prostaglandin A are included within the scope of the invention.
- the prodrug is PGD 2 (the precursor of 15-dPG ) or PGEi (the precursor of PGAi).
- the medicament further comprises a pharmaceutically acceptable excipient, diluent or carrier.
- the carrier does not have a deleterious effect on the recipient.
- the carrier will be sterile and pyrogen free.
- the medicament is in a fo ⁇ n adapted for deliver ⁇ ' by mouth, intravenous injection or intra- amniotic injection.
- the medicament is in a form which is compatible with the amniotic fluid. More preferably, the medicament is in a fo ⁇ n which has substantially the same pH and/or osmotic tension as amniotic fluid.
- the amniotic fluid has a distinct pH and a distinct osmotic tension.
- the amniotic fluid pH and osmotic tension are well l ⁇ iown to, or can be readily measured by, the person skilled in the art.
- the medicament further comprises an agent for treating a female who has or is at risk of one or more of the following conditions: pre-term labour; pathogenic infection; cervical ripening, uterine contractions.
- an “agent for treating a female who has or is at risk of one or more of the following conditions: pre-te ⁇ n labour; pathogenic infection; cervical ripening, uterine contractions” we include corticosteroids, tocolytic agents and anti-inflaimnatory prostaglandins.
- the agent is a corticosteroid.
- the agent is capable of preventing and/or reducing respiratory distress syndrome.
- corticosteroids One function of corticosteroids is to mature the fetal lung, which leads to an increase in surfactant production and therefore prevents or reduces the severity of neonatal respiratory problems
- the agent is selected from dexamethasone or betamethasone.
- dexamethasone or betamethasone Such agents are l ⁇ iown to those skilled in the art. Administration of such agents may be two doses of 12mg intra-muscular (IM), 12 or 24 hours apart. Preferably, the agent is capable of delaying delivery.
- the agent capable of delaying delivery is selected from: oxytocin receptor antagonists; calcium channel blockers; sympathomimetics; nitric oxide donors
- the agent is a tocolytic agent.
- tocolytic we include the meaning of a drug whose action is to stop uterine contractions.
- the tocolytic agent is selected from: oxytocin receptor antagonists, calcium channel blockers, sympathomimetics, nitric oxide donors.
- the oxytocin receptor antagonist is Atosiban. More preferably, the calcium channel blocker is Nifedipine. More preferably, the sympathomimetic is Ritodrine. More preferably, the nitric oxide donor is glyceryl trinitrate.
- the inflammatory response is mediated by NFicB in uterine cells.
- the cyclopentenone prostaglandin is capable of hibiting and/or reducing NFicB activity by preventing and/or reducing NFicB DNA- binding in uterine cells.
- the cyclopentenone prostaglandin is capable of inhibiting and/or reducing NFicB activity by preventing and/or reducing NFicB - mediated transcriptional regulation in uterine cells. More preferably, the cyclopentenone prostaglandin is capable of inhibiting and/or reducing NFKB activity by preventing and/or reducing NFicB production in uterine cells.
- a further aspect of the invention is to provide a pharmaceutical composition
- a pharmaceutical composition comprising a cyclopentenone prostaglandin and a pharmaceutically acceptable carrier or exipient, the cyclopentenone prostaglandin being present in an amount effective to prevent and/or reduce an inflammatory response in the reproductive system of a female.
- a further aspect of the invention is a method of treating inflammation within the reproductive system of a female, the method comprising administering an effective amount of a medicament of the invention.
- a further aspect of the invention is to provide a method for identifying a cyclopentenone prostaglandin for delaying the onset and/or preventing the continuation of labour in a female comprising the step of testing the cyclopentenone prostaglandin to determine if it is capable of inhibiting and/or reducing NFicB activity in uterine cells in a PPAR- ⁇ independent manner.
- NFicB activity we include the DNA-binding activity of NFicB and/or NFicB-mediated transcriptional regulation.
- Testing a cyclopentenone prostaglandin to determine if it is capable of mhibiting and/or reducing NFicB activity in uterine cells in a PPAR- ⁇ independent mamier can be perfo ⁇ ned by the methods described in Example 1, below.
- whether a cyclopentenone prostaglandin is capable of inhibiting and/or reducing NFKB activity hi uterine cells in a PPAR- ⁇ independent mamier can be determined by using the PPAR- ⁇ inhibitor GW-9662, as shown in Figure 6, below.
- PPAR- ⁇ independent manner we include the meaning that the activity of a cyclopentenone prostaglandin occurs without it binding to and/or activating the PPAR- ⁇ receptor.
- a further aspect of the present invention is to provide a method for making a pharmaceutical composition for use in deling the onset and/or preventing the continuation of labour in a female comprising providing a cyclopentenone prostaglandin identified by the method of the present invention and combining it with a pharmaceutically acceptable earner.
- Electro-mobility shift assay analysis of NF-icB DNA binding h nuclear protein extracts from (A) 77?yometrial cells, (B) L+ amnion cells, and (C) L- amnion cells treated with 15dPGJ 2 or vehicle for 2 h +/- IL-lb stimulation (15 min). Consensus kB probe used to assess NF-kB DNA bmding, and consensus Oct-1 probe used as control.
- Amnion cells derived from L- or L+ placentas were transiently transfected with the NFKB -dependent reporter construct ⁇ cB.BG.Luc, treated with 15dPGJ 2 , PGAi, troglitazone, WY-14643, or vehicle for 2 h, and then stimulated with IL-l ⁇ (1 ng/ml) for 6 h.
- the mutated icBmut.Luc construct was used as a control to confi ⁇ n NFicB-mediated transactivation. Values are normalised for b-gal reporter activity.
- Myometrial cells were transiently transfected with the NFicB-dependent reporter construct icB.B G.Luc, treated with 15dPGJ 2 or vehicle for 2 h, +/- IL-l ⁇ (1 ng/ml) for 6 h.
- Figure 10 Effect of PGA and PPAR agonists on NFKB transcriptional activity in myometrium
- Myometrial cells were transiently transfected with the NFicB-dependent reporter construct icB.BG.Luc, treated with troglitazone, WY-14643, PGAi or vehicle for 2 h, +/- IL-lb (1 ng/ml) for 6 h.
- Myometrial cells were cotransfected with 0.4 mg of the PPAR- ⁇ -dependent reporter construct 3-PPRE-TK.pGL3 and 100 ng, 200 ng or 300 ng of a PPAR- ⁇ expression construct.
- Cells were treated with 10 mM or 20 mM of (A) troglitazone or (B) GW1929, or vehicle for 24 h. Values are normalised for CMV-renilla reporter activity. Similar results were obtained with transfection of amnion cells.
- FIG. 13 Troglitazone does not inhibit NFicB transcriptional activity in PPAR- ⁇ -transfected cells
- FIG 14 PPAR- ⁇ overexpression does not potentiate 15d-PGJ 2 inhibition of NFkB activity
- Figure 15 15dPGJ 2 inhibition of p65 nuclear localisation, p50 phosphorylation, and IicB a degi-adation
- Figure 16 PGA] inhibition of p65 nuclear localisation and IicBa degradation
- Figure 20 Effect ofl5dPGJ 2 and PPAR agonists on IL-l ⁇ -induced COX-2 protein expression
- FIG. 21 Schematic of the structure of (A) prostaglandin A j (PGA]) and (B) 15-deoxy- ⁇ " prostaglandin J 2 (15-dPGJ 2 )
- Figure 24 The cyclopentenone ring is essential for cyPG inhibition of NF ⁇
- NF- ⁇ cB-DNA binding was measured by EMSA in nuclear protem extracts from myometrial cells pre-treated with vehicle, 15d-PGJ 2 or PGAi for 2 h, followed by stimulation with IL-l ⁇ (1 ng/ml) for 15 min. Antibodies against p50 and p65 were used for supershift analysis.
- Myometrial cells were transiently transfected with a NF-icB-LUC reporter and a ⁇ -gal reporter plasmid, pre-treated with vehicle or PGAi for 2 h, and stimulated with IL-l ⁇ (1 ng/ml) for 6 h. Luciferase activity was normalized for ⁇ -gal reporter readout.
- EDTA Ethylenediaminetetraacetic acid
- EGTA Ethyleneglycol bis-aminoethyltetra acetic acid
- NP-40 Nonidet P-40 SDS-PAGE Sodium dodec3'l sulphate - Polyacrylamide gel electrophoresis PVDF Pobyvhtylidene difluoride PBS-T Phosphate Buffered Saline plus Tween HRP Horseradish peroxidase PBS Phosphate Buffered Saline FCS Foetal Calf Serum DMEM Dulbecco's modified eagle's medium
- M3'ometrial tissue was collected at tenn from the upper margin of uterine incision at the time of lower segment caesarean section either prior to the onset of labour (L-) or during fetal distress (L+).
- L+ samples were collected by Dr Mark Johnson and Dr S Soorrana at Chelsea & Riverside Hospital.
- Myometrial tissue was dissected, rinsed in PBS, and digested in serum-free DMEM containing 15mg/ml collagenase 1A (Sigma), 15mg/ml collagenase X, and 50mg/ml bovine serum albumin for 45min at 37°C.
- the cell suspension was filtered through a cell strainer, centrifuged at 400g for 5min, and the pellet re-suspended and plated out in DMEM, 10% FCS (Helena BioScience), 1% L-glutamine, 1% penicillin-streptomycin. Cells were used between passage numbers 1-4.
- Placentae were obtained from patients at term either at elective Caesarean section prior to labour (L-) or following spontaneous labour onset and vaginal delivery (L+).
- Amnion cells were prepared as described in Bennett et al., (1989). Briefly, the amnion was separated from the placenta, washed 3x in PBS, cut into strips, and incubated in 0.5mM EDTA in PBS for 15min. The strips were washed in PBS 2x and digested with 2.5mg/ml dispase in serum-free DMEM for 35min at 37°C.
- the amnion was then shaken vigorously in DMEM, 10% FCS to dissociate the cells, the remaining strips discarded, and the cell suspension pelleted at 175g for lOmin and cultured in DMEM, 10% FCS (Sigma), 1% L-glutamine, 1% penicillin-streptomycin.
- Nuclear and cytosolic protein extracts were obtained from cultured amnion cells as described by Schreiber et al (1989). For nuclear/cytosolic fractionation, confluent cell monolayers were scraped and lysed using a buffer containing lOmM HEPES, lOmM KC1, O.lmM EDTA, O. lmM EGTA, 2mM DTT, 1% (v/v) NP-40 and complete protease inhibitor tablets (CPIs, Roche), diluted to manufacturer's instructions. Cell lysates were incubated on ice for lOmin and NP-40 added to a final concentration of 1% (v/v).
- Lysates were vortexed for lOsecs and centrifuged for 30secs at 4°C, 12000g.
- the supematants were retained as the cytosolic protein extracts.
- the pellets were resuspended in buffer containing lOmM HEPES, lOmM KC1, O.lmM EDTA, O.lmM EGTA, 2mM DTT, 400mM NaCl, 1% NP-40 (v/v) and CPIs.
- Samples were shaken vigorously for 15min in an ice bath.
- the nuclear protein extracts were obtained in the supernatant following a 5min centrifugation at 4°C, 12000g.
- Tissue samples were rinsed in ice-cold PBS, dissected, flattened between aluminium foil, flash-frozen in liquid nitrogen, and stored at -80°C. Samples were reduced to powder in liquid nitrogen using a pestle and mortar. Powdered tissue was homogenized in a Dounce homogeniser on ice in a buffer containing 0.6% (v/v) NP-40, 150mM HEPES, ImM EDTA, 0.5mM PMSF and any unbroken tissue was removed by centrifugation for 30sec at 2000rpm at 0°C.
- the supernatant was incubated on ice for 5min, centrifuged for lOmin at 4000rpm at 0°C, and the nuclear pellets resuspended in 25% (v/v) glycerol 20mM HEPES, 0.42M NaCl, 1.2 mM MgCl 2 , 0.2mM EDTA, 0.5mM DTT, and CPIs.
- Sense and antisense strands (175nmole/ml each) were incubated in annealing buffer (lOmM Tris-HCl pH7.5, lOOmM NaCl, ImM EDTA) for lOmin at 65°C, and allowed to cool at room temperature for 2h.
- annealing buffer lOmM Tris-HCl pH7.5, lOOmM NaCl, ImM EDTA
- 3-5 ⁇ g protein extracts were incubated on ice for lh with non-radiolabelled non-specific oligonucleotide (poly(dl-dC) or Oct-1) in a binding buffer (20% (v/V) glycerol, 5mM MgCl 2 , 2mM EDTA, 50mM Tris-HCl pH7.5, 250mM NaCl, 2mM DTT), followed by a 45min incubation with 0.035pmole 2 P( ⁇ ATP)-end labelled oligonucleotide probes:
- RNA/DNA complexes were separated in a 4% acrylamide gel, the gel dried under vacuum at 80°C and exposed to X- ray film.
- samples were incubated with 2 ⁇ g antibodies for 30min on ice prior to incubation with oligonucleotides.
- Non- radio-labelled oligonucleotides were used at 100-fold molar excess for specific and non-specific competition for DNA binding.
- Reagents for EMSA were obtained from Promega Life Sciences, Delta House, Chilworth Research Centre, Southampton SOI 6 7NS, United Kingdom.
- Protein samples (20-70 ⁇ g) were mixed with Laemmli sample buffer (l .T) containing ⁇ -mercaptoethanol (5%), and boiled for 5min. Proteins were then separated by SDS-PAGE (12-14% gels) and transfe ⁇ ed onto PVDF membrane (Amersham Pharmacia Biotech). The membranes were blocked overnight in 5% non-fat milk prepared in PBS-T buffer, at 4°C. The blots were incubated with the primary antibody in 1% non-fat milk in PBS-T buffer for lh, and washed three times (lOmin each) in PBS-T with vigorous shaking.
- the blots were then incubated with HRP-conjugated secondary antibody (diluted 1:2000 in 1% non-fat milk in PBS-T buffer) for lh and washed three times (lOmin each) in PBS-T.
- HRP-conjugated secondary antibody diluted 1:2000 in 1% non-fat milk in PBS-T buffer
- washed three times (lOmin each) in PBS-T washed three times (lOmin each) in PBS-T.
- Signal detection was achieved using enhanced chemi-luminescence (ECL plus system, Amersham Pharmacia Biotech) according to manufacturer's instructions.
- blots were incubated for 30min in 50°C stripping buffer (2% SDS, 62.5mM Tris-HCl pH6.7, lOOrnM 2-mercaptoethanol), washed 2x in PBS-T, placed in blotto overnight, and then probed with a new antibody as above.
- 50°C stripping buffer 2% SDS, 62.5mM Tris-HCl pH6.7, lOOrnM 2-mercaptoethanol
- luciferase reporter construct was transfected using a 1 :1 ratio of transfection (i.e., 3 ⁇ l Transfast per I ⁇ g DNA) in serum-free DMEM for lh.
- DMEM, 10% FCS was then added and the cells were incubated at 37°C for 24h.
- the medium was replaced with DMEM, 2% FCS for a further 24h, and the ceUs treated with various agonists/inhibitors or vehicle for 6-8h.
- Transfections were analysed in a dual firefly/renilla (Packard BioSciences/Calbiochem) luciferase assay or f ⁇ refiy/ ⁇ -galactosidase (Promega/Galacton) assay using a luminometer.
- a dual firefly/renilla Packard BioSciences/Calbiochem
- f ⁇ refiy/ ⁇ -galactosidase Promega/Galacton
- pGL3.6 ⁇ B.BG.luc was the reporter construct used to assess NF- ⁇ B- mediated transcription, while the mutant pGL3.6 ⁇ Bmut.luc and empty ⁇ GL3.BG.luc were used as controls (Schwarzer et al, 1998).
- pGL3.6 ⁇ B.BG.luc a NF-icB -dependent reporter construct with 6 copies of the F-icB binding site. It contains two tandem repeats of the sequence 5'- GGG GAC TTT C CC TGG GGA CTT TCC CTG GGG ACT TTC CC-3'. which contains three copies of the decameric NF- ⁇ B binding site (underlined) upstream of a minimal ⁇ -globin promoter driving a luciferase gene.
- pGL3.6 ⁇ Bmut.luc this reporter construct is as above except that the core NF-icB binding site is mutated to 5'-GCC ACT TTC C-3' (mutated bases underlined).
- pGL3.BG.luc this reporter construct contains only the minimal ⁇ -globin promoter.
- Cells were co-transfected with the renilla vector pRL-CMV or a ⁇ - galactosidase vector pCHHO as internal controls for transfection efficiencies.
- pSG5/p65 expression construct was transcribed and translated using a TNT Coupled Reticulocyte Lysate System (Promega), according to manufacturer's instructions.
- QIAGEN Maxi Prep kits were used for plasmid isolation from transfo ⁇ ned JM109 E. coli cells, and all constructs were subsequently precipitated with polyethylene glycol.
- Recombinant cytoldne IL-l ⁇ and TNF ⁇ from R&D Systems 15d-PGJ 2 , PGAi, troglitazone, GW-9662, and 16,16-dimethyl-PGE 2 from Cayman Chemical; WY-14643, MG132 proteasome inliibitor, and PG490 (triptolide) from Calbiochem; HRP-conjugated secondary antibodies and antibodies to p50, p65, c-rel, Rel B, COX-2, IicB ⁇ , IicB ⁇ , and PPAR ⁇ from Santa Cruz; antibodies to p52, Bcl-3 and smooth muscle actin from Upstate Biotechnologies. Antibody to PPAR- ⁇ from Affinity BioReagents, to phospho-p65 from Cell Signalmg, to COX-1 from Alexis Biochemicals, and to lamin B from Oncogene Research Products. Mouse model of preterm labour
- Placentae were washed in phosphate buffered saline (PBS), flash frozen in liquid nitrogen and stored at -80°C until further processing. Fetuses were washed in PBS, then immediately fixed in 4%o paraformaldehyde for 24h and then stored in 70% ethanol until further processing. Placentae were homogenized for 1 minute in the presence of lysis buffer comprising 400mM KC1, 20mM HEPES pH7.4, ImM dithiothreitol, 20% glycerol and 5% (v/v) protease inhibitor cocktail.
- lysis buffer comprising 400mM KC1, 20mM HEPES pH7.4, ImM dithiothreitol, 20% glycerol and 5% (v/v) protease inhibitor cocktail.
- IL-l ⁇ Interlekin-l ⁇
- TNF ⁇ tumour necrosis factor ⁇
- CyPGs but not PPAR agonists, inhibit NF- ⁇ B DNA binding in amnion and myometi'ial cells.
- 15d-PGJ 2 inhibited ILl- ⁇ -induced NF- ⁇ B DNA binding in a dose- dependent manner in myometrial cells, as well as in L- and L+ amnion cells (Fig. 1). Protein binding to a consensus Oct-1 or Sp-1 probe was unaffected by either IL-l ⁇ or 15d-PGJ 2 treatment, conf ⁇ ning that the effects observed are NF-KB -specific.
- PPAR- ⁇ is the putative endogenous receptor for 15d-PGJ 2 , and PPAR expression may be affected by cytokines (Tontonoz et al, 1998, Tanaka et al, 1999), PPAR- ⁇ protein expression was examined in myometrial and amnion cells. PPAR- ⁇ was shown to be expressed predominantly in the nucleus of both cell types, and its expression was not affected by IL-l ⁇ or 15d-PGJ 2 treatment (Fig. 2). 15d-PGJ 2 can also transactivate PPAR- ⁇ , though more weakly than PPAR- ⁇ (Forman et al, 1995). PPAR- ⁇ expression in myometrial and amnion cells was found to be predominantly cytoplasmic (Fig. 3).
- troglitazone had no effect on NF-icB DNA binding at 10-50 ⁇ M doses, although it did cause a slight reduction at lOO ⁇ M (Fig. 4, 5).
- Troglitazone can transactivate PPAR- ⁇ at I ⁇ M and induces weak interactions between PPAR- ⁇ and the co-activators p300 and steroid receptor co-activator (SRC-1) at lO ⁇ M doses; adipogenesis is positively regulated by PPAR- ⁇ , and troglitazone can induce expression of adipogenic markers at 5-lO ⁇ M doses (Prusty et al., 2002).
- NF- ⁇ B DNA binding was assessed in cells treated with 15d-PGJ 2 in the presence of the selective PPAR- ⁇ inhibitor GW-9662.
- GW9662 binds irreversibly to PPAR- ⁇ through covalent modification of Cys " in the ligand-bmd ng domain (Leesnitzer et al., 2002).
- GW-9662 failed to alleviate 15d-PGJ 2 inliibition of NF-icB (Fig. 6).
- PGA b which does not act as a PPAR ligand but does contain a cyclopentenone ring, was able to inhibit NF-icB DNA binding in amnion and myometrial cells, albeit at much higher doses than 15d-PGJ 2 (Fig. 7).
- CyPGs but riot PPAR agonists, inhibit NF- ⁇ B transcriptional activity.
- amnion cells were transfected with the NF-icB-dependent reporter icB.BG.Luc and treated with 15d-PGJ 2 , PGAi, troglitazone, WY-14643 or vehicle, followed by IL-1 ⁇ stimulation (Fig. 8).
- Constitutive reporter activity was seen in both L- and L+ amnion cells, although the levels were lower and showed a greater increase with IL- I ⁇ . in L- cells, in agreement with previous studies by Allport et al (2001). Both 15d-PGJ 2 and PGA ⁇ inhibited IL-l ⁇ -induced NF-icB transcriptional activity, whereas troglitazone and WY-14643 did not.
- IL-l ⁇ -induced NF-icB transcriptional activity in myometrial cells, 15d-PGJ 2 ihibited IL-l ⁇ -induced NF-icB transcriptional activity in a dose-dependent manner, reducing reporter activity to basal levels (Fig. 9). IL-l ⁇ -induced NF-icB transcriptional activity was also reduced to basal levels by PGA], but not troglitazone, GW1929 or WY-14643 (Fig. 10, 11).
- GW1929 and troglitazone were shown to be functional as PPAR- ⁇ ligands, potentiating PPAR- ⁇ -mediated transcription of a PPRE-dependent reporter in both cell types. Endogenous PPAR- ⁇ levels were not sufficient to drive the PPRE reporter in the transfection system used, with transcription requiring overexpression of the receptor. Troglitazone was also unable to inhibit a NF-icB-dependent reporter in PPAR ⁇ -transfected cells, and PPAR ⁇ overexpression did not promote 15d-PGJ 2 inhibition of NF-icB transcriptional activity (Fig. 12, 13, 14).
- CyPGs, but notPGE 2 inhibit NF-icB activation and IicB degradation.
- 16,16-Dimeth ⁇ -PGE2 a PGE 2 analogue with increased half-life, did not inhibit NF- ⁇ B DNA binding (controlled for with Oct-1 binding) or IL-l ⁇ - induced p65 nuclear translocation in myometrial and amnion cells (Fig. 17).
- PGE 2 is l ⁇ iown to be pro-inflammatory, does not contain a cyclopentenone ring, and does not activate PPAR- ⁇ (Forman et al, 1995).
- 16,16-dimeth3 -PGE 2 did not inhibit NF-icB DNA binding or p65 nuclear translocation in myometrial cells (Fig. 18). However, neither did it stimulate NF-icB activity as reported in T cells (Dumais et al., 1998), nor did it synergise with IL-l ⁇ or TNF ⁇ .
- TNF ⁇ and IL-l ⁇ were significantly higher in the placentae proximal to the injection site compared to those in the opposite horn.
- Levels of IL-l ⁇ were approximately 40% lower in proximal placentae injected with LPS + 15d-PGJ 2 compared to those given LPS + vehicle (Fig. 22). This difference was statistically significant (p ⁇ 0.05).
- TNF ⁇ levels were not significantly altered according to drug treatment.
- the cyclopentenone ring is essential for cyPG inhibition ofNF-icB
- 15d-PG is a PPAR agonist
- other prostaglandins such as PGAi
- PGAi shares the effect of 15d-PGJ 2 on NF-icB, but that 9,10-dihydro-15d-PGJ 2 (an analogue of 15d- PGJ 2 which retains PPAR ⁇ agonist activity but in which the cyclopentenone ring has been disrupted) could not reproduce the effects of 15d-PGJ 2 (Fig. 24).
- 15d-PGJ 2 inhibited ILl- ⁇ -induced NF-icB DNA binding and NF-icB- mediated transactivation in myometrial cells, as well as in L- and L+ amnion cells. 15d-PGJ 2 inhibited the nuclear translocation and activation of NF-icB, at least in part, by preventing the degradation of IicB ⁇ by IL-l ⁇ .
- PPAR- ⁇ agonists did not impair TNF ⁇ -mduced NF-icB activation, nuclear translocation, or DNA binding activity; rather, they antagonised the transcriptional regulatory activity of NF-icB, and PPAR- ⁇ overexpression was required to demonstrate such inhibition (Ruan et al., 2003).
- PPAR- ⁇ overexpression potentiated transactivation of a PPRE, it did not enable the PPAR- ⁇ agonists to inhibit NF-icB transcription.
- 15d-PGJ 2 was able to inhibit NF- ⁇ B transcription in the absence of exogenous PPAR- ⁇ and overexpression of this receptor did not promote inhibition.
- IL-l ⁇ -induced COX-2 expression was inhibited by 15d-PGJ 2 but not by PPAR agonists. While PPAR agonists are l ⁇ iown to be anti-inflammatory and can inhibit COX-2 expression (Staels et al, 1998; Subbaramaiah et al, 2001), they have also been reported to enhance COX-2 expression in certain cell types (Meade et al, 1999; Ikawa et al, 2001; Pang et al, 2003).
- CyPGs such as 15d-PGJ 2 are characterised by the presence of a cyclopentenone ring system containing an electrophilic carbon. This ring can react covalently with nucleophiles such as the free sulfhydryls of glutathione and cysteine residues in cellular proteins. Receptor-independent actions of 15d-PGJ 2 have been attributed to its cyclopentenone ring.
- NF-icB proteins contain a conserved cysteine residue in their DNA-binding domain (DBD) and alkylation of this cysteine impairs DNA binding (Toledano et al, 1993).
- PGAi a cyPG that does not act as a PPAR- ⁇ ligand, was able to inhibit NF-icB DNA binding and transactivation, albeit at higher concentrations than 15d-PGJ 2 .
- This ability of PGAi, but not PGE 2 or PPAR agonists, to mimic the effects of 15d-PGJ 2 suggests that these cyPGs may inhibit NF- ⁇ B in amnion and myometrial cells by virtue of their cyclopentenone ring.
- CyPG administration offers an attractive alternative approach to anti-inflammatory treatment since a potential specificity of cyPGs for IKK ⁇ /IicB ⁇ would spare other potentially beneficial pathways of NF-icB activation (e.g., the processing of pi 05 and fonnation of p50 homodimers), which might be disrupted by more broad- spectrum NF-icB inhibitors.
- the use of the cyPGs, able to simultaneously trigger the inhibition of the pro-inflammatory NF-icB and harness the anti- inflammatory activities of endogenous cytoprotective molecules represents a novel therapeutic approach in the treatment of preterm labour and neurodevelopmental disorders of the neonate.
- mice model used is an effective model for the study of prete ⁇ n delivery and agents that may delay the onset of pretenn delivery.
- the finding of lower levels of IL-1 ⁇ and phospho-p65 in mice treated with the cyclopentenone prostaglandin 15d-PGJ 2 suggests that this compound is effective at blocking the inflammatory pathway induced by LPS treatment in vivo.
- EXAMPLE 2 Preferred pharmaceutical formulations and modes and doses of administration.
- the compounds of the present invention may be delivered using an injectable sustained-release drug delivery system. These are designed specifically to reduce the frequency of injections.
- An example of such a system is Nutropin Depot which encapsulates recombinant human growth hormone (rhGH) in biodegradable microspheres that, once injected, release rhGH slowly over a sustained period.
- the compounds of the present invention can be administered by a surgically implanted device that releases the drug directfy to the required site.
- a surgically implanted device that releases the drug directfy to the required site.
- Vitrasert releases ganciclovir directly into the eye to treat CMV retinitis.
- the direct application of this toxic agent to the site of disease achieves effective therapy without the drug's significant systemic side- effects.
- Electroporation therapy (EPT) systems can also be employed for administration.
- EPT Electroporation therapy
- a device which delivers a pulsed electric field to cells increases the penneability of the cell membranes to the drug, resulting in a significant enhancement of intracellular drug delivery.
- Compounds can also be delivered by electroincorporation (El).
- El occurs when small particles of up to 30 microns in diameter on the surface of the skin experience electrical pulses identical or similar to those used in electroporation. In El, these particles are driven through the stratum corneum and into deeper layers of the skin.
- the particles can be loaded or coated with drugs or genes or can simply act as "bullets" that generate pores in the skin through which the drugs can enter.
- An alternative method of administration is the ReGel injectable system that is thermos ens itive. Below body temperature, ReGel is an injectable liquid while at body temperature it immediately forms a gel reservoir that slowly erodes and dissolves into l ⁇ iown, safe, biodegradable polymers. The active drug is delivered over time as the biopolymers dissolve.
- the compounds of the invention can also be delivered orally.
- the process employs a natural process for oral uptake of vitamin B ⁇ 2 in the body to co- deliver proteins and peptides.
- the protein or peptide can move through the intestinal wall.
- Complexes are synthesised between vitamin B ⁇ 2 analogues and the drug that retain both significant affinity for intrinsic factor (IF) in the vitamin 12 portion of the complex and significant bioactivity of the drug portion of the complex.
- Compounds can be introduced to cells by "Trojan peptides". These are a class of polypeptides called penetratins which have translocating properties and are capable of carrying hydrophilic compounds across the plasma membrane. This system allows direct targeting of oligopeptides to the cytoplasm and nucleus, and may be non-cell type specific and highly efficient (Derossi et al, 1998).
- the pharmaceutical fo ⁇ nulation of the present invention is a unit dosage containing a daily dose or unit, daily sub-dose or an appropriate fraction thereof, of the active mgredient.
- the compounds of the invention can be administered orally or by any parenteral route, in the fo ⁇ n of a pharmaceutical fo ⁇ nulation comprising the active ingredient, optionally in the form of a non-toxic organic, or inorganic, acid, or base, addition salt, in a pharmaceutically acceptable dosage fo ⁇ n.
- a pharmaceutical fo ⁇ nulation comprising the active ingredient, optionally in the form of a non-toxic organic, or inorganic, acid, or base, addition salt, in a pharmaceutically acceptable dosage fo ⁇ n.
- the compositions may be administered at varying doses.
- Formulations in accordance with the present invention suitable for oral administration ma3' be presented as discrete units such as capsules, cachets or tablets, each containing a predetermined amount of the active ingredient; as a powder or granules; as a solution or a suspension in an aqueous liquid or a non-aqueous liquid; or as an oil-in-water liquid emulsion or a water-in- oil liquid emulsion.
- the active ingredient may also be presented as a bolus, electuary or paste .
- a tablet may be made by compression or moulding, optionally with one or more accessory ingredients.
- Compressed tablets may be prepared by compressing in a suitable machine the active ingredient in a free-flowing fo ⁇ n such as a powder or granules, optional ⁇ mixed with a binder (e.g. povidone, gelatin, h3 ⁇ droxypropylmethyl cellulose), lubricant, inert diluent, preservative, disintegrant (e.g. sodium starch glycolate, cross-linked povidone, cross-linked sodium carboxymethyl cellulose), surface-active or dispersing agent.
- a binder e.g. povidone, gelatin, h3 ⁇ droxypropylmethyl cellulose
- lubricant e.g. sodium starch glycolate, cross-linked povidone, cross-linked sodium carboxymethyl cellulose
- preservative e.g. sodium starch glycolate, cross-linked povidone, cross-linked sodium carboxymethyl cellulose
- disintegrant
- Moulded tablets may be made by moulding in a suitable machme a mixture of the powdered compound moistened with an inert liquid diluent.
- the tablets may optionally be coated or scored and may be fo ⁇ nulated so as to provide slow or controlled release of the active ingredient therein using, for example, hydrox3'piOpylmethylcellulose h varying proportions to provide desired release profile.
- Formulations suitable for topical administration in the mouth include lozenges comprising the active ingredient in a flavoured basis, usually sucrose and acacia or tragacanth; pastilles comprising the active ingredient in an inert basis such as gelatin and glycerin, or sucrose and acacia; and mouth-washes comprising the active ingredient in a suitable liquid carrier.
- the compounds of the invention can be administered alone but will generally be administered in admixture with a suitable pharmaceutical excipient diluent or can ⁇ er selected with regard to the intended route of administration and standard pharmaceutical practice.
- the compounds of the invention can be administered orally, buccally or sublingually in the form of tablets, capsules, ovules, elixirs, solutions or suspensions, which may contain flavouring or colouring agents, for immediate-, delayed- or controlled-release applications.
- the compounds of the invention may also be administered via intracavemosal injection.
- Such tablets may contain excipients such as microcrystalline cellulose, lactose, sodium citrate, calcium carbonate, dibasic calcium phosphate and glyc ne, disintegrants such as starch (preferably com, potato or tapioca starch), sodium starch glycollate, croscarmellose sodium and certain complex silicates, and granulation binders such as polyvinylpyrrolidone, hydroxypropylmethylcellulose (HPMC), hydroxy-propylcellulose (HPC), sucrose, gelatin and acacia. Additionally, lubricating agents such as magnesium stearate, stearic acid, glyceryl behenate and talc may be included.
- excipients such as microcrystalline cellulose, lactose, sodium citrate, calcium carbonate, dibasic calcium phosphate and glyc ne
- disintegrants such as starch (preferably com, potato or tapioca starch), sodium starch glycollate, croscarmellose sodium and
- Solid compositions of a similar type may also be employed as fillers in gelatin capsules.
- Preferred excipients in this regard include lactose, starch, cellulose, milk sugar or high molecular weight polyethylene glycols.
- the compounds of the invention may be combined with various sweetening or flavouring agents, colouring matter or dyes, with emulsifying and/or suspending agents and with diluents such as water, ethanol, propylene glycol and glycerin, and combinations thereof.
- the compounds of the invention can also be administered parenterally, for example, intravenously, intra-arterially, intraperitoneally, intra-thecally, intraventriculai y, intrasternally, intracranially, intra-muscularly or subcutaneously, or they may be admhiistered by infusion techniques.
- parenterally for example, intravenously, intra-arterially, intraperitoneally, intra-thecally, intraventriculai y, intrasternally, intracranially, intra-muscularly or subcutaneously, or they may be admhiistered by infusion techniques.
- the aqueous solutions should be suitably buffered (preferably to a pH of from 3 to 9), if necessary.
- the preparation of suitable parenteral formulations under sterile conditions is readily accomplished by standard
- Fo ⁇ nulations suitable for parenteral administration include aqueous and non- aqueous sterile injection solutions which may contain anti-oxidants, buffers, bacteriostats and solutes which render the formulation isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents.
- the formulations may be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a freeze-dried (lyophilised) condition requ ⁇ ing only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use.
- Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets of the land previously described.
- oral or parenteral administration of the compounds of the invention is the prefe ⁇ ed route, being the most convenient.
- the compounds of the invention are administered as a suitably acceptable formulation in accordance with normal veterinary practice and the veterinary surgeon will detennine the dosing regimen and route of administration which will be most appropriate for a particular animal.
- the fo ⁇ nulations of the pharmaceutical compositions of the invention may conveniently be presented in unit dosage form and may be prepared by any of the methods well known in the art of pharmacy. Such methods include the step of bringing into association the active ingredient with the carrier which constitutes one or more accessory ingredients. In general the formulations are prepared by uniformly and intimately bringing into association the active mgredient with liquid carriers or finely divided solid earners or both, and then, if necessary, shaping the product.
- Prefe ⁇ ed unit dosage fo ⁇ nulations are those containing a daily dose or unit, daily sub-dose or an appropriate fraction thereof, of an active mgredient.
- a preferred delivery system of the invention may comprise a hydrogel hnpregnated with a compound of the invention, which is preferably earned on a tampon which can be inserted into the cervix and withdrawn once an appropriate cervical ripening or other desirable affect on the female reproductive system has been produced.
- a compound of the invention Whilst it is possible for a compound of the invention to be administered alone, it is preferable to present it as a pharmaceutical fo ⁇ nulation, together with one or more acceptable carriers.
- the carrier(s) must be "acceptable” in the sense of being compatible with the compound of the invention and not deleterious to the recipients thereof.
- the carriers will be water or saline which will be sterile and pyrogen-free.
- Example 3B Ophthalmic Solution
- Active ingredient 0.5 g Sodium chloride, analytical grade 0.9 g Thiomersal 0.001
- Purified water 100 ml pH adjusted to 7.5
- fo ⁇ nulations A and B are prepared by wet granulation of the ingredients with a solution of povidone, followed by addition of magnesium stearate and compression.
- Formulation C mg/tablet Active ingredient 100 Lactose 200 Starch 50
- the following fo ⁇ nulations, D and E are prepared by direct compression of the admixed ingredients.
- the lactose used in formulation E is of the direction compression type.
- the fo ⁇ nulation is prepared by wet granulation of the ingredients (below) with a solution of povidone followed by the addition of magnesium stearate and compression.
- Active Ingredient 500 Hydroxypropylmethylcellulose 112 (Methocel K4M Premium) ® Lactose B.P. 53 Povidone B.P.C. 28 Magnesium Stearate 7 700
- Drug release takes place over a period of about 6-8 hours and was complete after 12 hours.
- a capsule formulation is prepared by admixing the ingredients of Fo ⁇ nulation D in Example C above and filling into a two-part hard gelatin capsule.
- Formulation B (infra) is prepared in a similar manner.
- Formulation C mg/capsule Active ingredient 250 Macrogol 4000 BP 350 600
- Capsules are prepared by melting the Macrogol 4000 BP, dispersing the active ingredient in the melt and filling the melt into a two-part hard gelatin capsule.
- Capsules are prepared by dispersing the active ingredient in the lecithm and arachis oil and filling the dispersion into soft, elastic gelatin capsules.
- the following controlled release capsule fo ⁇ nulation is prepared by extruding ingredients a, b, and c using an extruder, followed by spheronisation of the extradate and drymg. The dried pellets are then coated with release- controlling membrane (d) and filled into a two-piece, hard gelatin capsule.
- mg/capsule Active ingredient 250 Microci stalline Cellulose 125 Lactose BP 125 Ethyl Cellulose 13
- Active ingredient 0.200 g Sterile, pyrogen free phosphate buffer (pH7.0) to 10 ml
- the active ingredient is dissolved in most of the phosphate buffer (35-40°C), then made up to volume and filtered through a sterile micropore filter mto a sterile 10 ml amber glass vial (type 1) and sealed with sterile closures and overseals.
- the sodium benzoate is dissolved in a portion of the purified water and the sorbitol solution added.
- the active ingredient is added and dispersed.
- the glycerol is dispersed the thickener (dispersible cellulose). The two dispersions are mixed and made up to the required volume with the purified water. Further thickening is achieved as required by extra shearing of the suspension.
- Example 3H Suppository mg/suppository Active ingredient (63 ⁇ m)* 250 Hard Fat, BP (Witepsol HI 5 - Dynamit Nobel) 1770
- the active ingredient is used as a powder wherein at least 90% of the particles are of 63 ⁇ m diameter or less.
- Witepsol HI 5 is melted hi a steam-jacketed pan at 45 °C maximum.
- the active mgredient is sifted through a 200 ⁇ m sieve and added to the molten base with mixing, usmg a silverson fitted with a cutting head, until a smooth dispersion is achieved. Maintaining the mixture at 45 °C, the remaining Witepsol HI 5 is added to the suspension and stirred to ensure a homogenous mix.
- the entire suspension is passed through a 250 ⁇ m stainless steel screen and, with continuous stirring, is allowed to cool to 40 °C. At a temperature of 38°C to 40 ° C 2.02 g of the mixture is filled into suitable plastic moulds. The suppositories are allowed to cool to room temperature.
- Example 31 Pessaries mg/pessary Active ingredient 250 Anhydrate Dextrose 380 Potato Starch 30J Magnesium Stearate 7
- Example 3J Creams and ointments
- the compounds of the invention may also be delivered using microsphere fo ⁇ nulations, such as those described in Cleland (1997; 2001).
- the compounds of the invention may be delivered by inhalation, with the aid of a dry powder inhaler delivering micronised particles in metered quantities as described in Ansel (1999).
- Example 3M Aerosol Inhalation
- the compounds of the invention may be delivered by inhalation, with the aid of a suitable inhaler delivering micronised paiticles in metered quantities employing a non CFC propellant as described in Ansel (1999).
- Rasanen and Jouppila Fetal cardiac function and ductus arteriosus during indomethacin and sulindac therapy for threatened pre-term labour; A randomised study. Am J Obstet Gynecol 1995. 173(1), 20-25.
- Skinner KA and Challis JR Changes in the synthesis and metabolism of prostaglandins by human fetal membranes and decidua at labour.
- Slater DM Berger L, Newton R, Moore GE, Bennett PR. Changes in the expression of types 1 and 2 cyclo-oxygenase in human fetal membranes at term.
- Staels B Koenig W, Habib A, Merval R, Lebret M, To ⁇ a IP, Delerive P, Fadel A, Chinetti G, Fmchart JC, Najib J, Maclouf J, Tedgui A.
Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP04805915A EP1827451A1 (en) | 2003-12-02 | 2004-12-02 | Use of a cyclopentenone prostaglandin for delaying for the onset and/or preventing the continuation of labour |
US10/581,532 US20070282004A1 (en) | 2003-12-02 | 2004-12-02 | Use of a Cyclopentenone Prostaglandin for Delaying for the Onset and/or Preventing the Continuation of Labour |
JP2006542016A JP2007513133A (en) | 2003-12-02 | 2004-12-02 | Use of cyclopentenone prostaglandins to delay the onset of labor and / or prevent continued labor |
CA002589908A CA2589908A1 (en) | 2003-12-02 | 2004-12-02 | Use of a cyclopentenone prostaglandin for delaying for the onset and/or preventing the continuation of labour |
AU2004294800A AU2004294800A1 (en) | 2003-12-02 | 2004-12-02 | Use of a cyclopentenone prostaglandin for delaying for the onset and/or preventing the continuation of labour |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GB0327975.9 | 2003-12-02 | ||
GBGB0327975.9A GB0327975D0 (en) | 2003-12-02 | 2003-12-02 | Methods of treatment |
GBPCT/GB2004/001380 | 2004-03-29 | ||
PCT/GB2004/001380 WO2005053705A1 (en) | 2003-12-02 | 2004-03-29 | Use of a cyclopentenone prostaglandin for delaying the onset and/or preventing the continuation of labour |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2005053706A1 true WO2005053706A1 (en) | 2005-06-16 |
Family
ID=34655231
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/GB2004/005087 WO2005053706A1 (en) | 2003-12-02 | 2004-12-02 | Use of a cyclopentenone prostaglandin for delaying for the onset and/or preventing the continuation of labour |
Country Status (5)
Country | Link |
---|---|
EP (1) | EP1827451A1 (en) |
JP (1) | JP2007513133A (en) |
AU (1) | AU2004294800A1 (en) |
CA (1) | CA2589908A1 (en) |
WO (1) | WO2005053706A1 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP3019186A4 (en) * | 2013-07-12 | 2017-03-29 | Patrick J. Casey | Method for the harvesting, processing, and storage of proteins from the mammalian feto-placental unit and use of such proteins in compositions and medical treatment |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
GB2293101A (en) * | 1994-09-14 | 1996-03-20 | British Tech Group | Butaprost compositions for preventing pre-term labour |
WO1999018942A1 (en) * | 1997-10-10 | 1999-04-22 | Imperial College Innovations Ltd. | Use of csaidtm compounds for the management of uterine contractions |
-
2004
- 2004-12-02 AU AU2004294800A patent/AU2004294800A1/en not_active Abandoned
- 2004-12-02 WO PCT/GB2004/005087 patent/WO2005053706A1/en active Application Filing
- 2004-12-02 EP EP04805915A patent/EP1827451A1/en not_active Withdrawn
- 2004-12-02 JP JP2006542016A patent/JP2007513133A/en active Pending
- 2004-12-02 CA CA002589908A patent/CA2589908A1/en not_active Abandoned
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
GB2293101A (en) * | 1994-09-14 | 1996-03-20 | British Tech Group | Butaprost compositions for preventing pre-term labour |
WO1999018942A1 (en) * | 1997-10-10 | 1999-04-22 | Imperial College Innovations Ltd. | Use of csaidtm compounds for the management of uterine contractions |
Non-Patent Citations (4)
Title |
---|
GROSS G ET AL: "INHIBITION OF CYCLOOXYGENASE-2 PREVENTS INFLAMMATION-MEDIATED PRETERM LABOR IN THE MOUSE", AMERICAN JOURNAL OF PHYSIOLOGY, AMERICAN PHYSIOLOGICAL SOCIETY, BETHESDA, MD, US, vol. 278, no. 6, PART 2, June 2000 (2000-06-01), pages R1415 - R1423, XP008008804, ISSN: 0002-9513 * |
LAPPAS M ET AL: "Regulation of proinflammatory cytokines in human gestational tissues by peroxisome proliferator-activated receptor-[gamma]: Effect of 15-deoxy-[delta]<12,14>-PGJ2 and troglitazone", JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 01 OCT 2002 UNITED STATES, vol. 87, no. 10, 1 October 2002 (2002-10-01), pages 4667 - 4672, XP002291977, ISSN: 0021-972X * |
LAPPAS MARTHA ET AL: "Nuclear factor kappa B regulation of proinflammatory cytokines in human gestational tissues in vitro", BIOLOGY OF REPRODUCTION, vol. 67, no. 2, August 2002 (2002-08-01), pages 668 - 673, XP002291976, ISSN: 0006-3363 * |
STRAUS D S ET AL: "CYCLOPENTENONE PROSTAGLANDINS: NEW INSIGHTS ON BIOLOGICAL ACTIVITIES AND CELLULAR TARGETS", MEDICINAL RESEARCH REVIEWS, NEW YORK, NY, US, vol. 21, no. 3, May 2001 (2001-05-01), pages 185 - 210, XP009035137, ISSN: 0198-6325 * |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP3019186A4 (en) * | 2013-07-12 | 2017-03-29 | Patrick J. Casey | Method for the harvesting, processing, and storage of proteins from the mammalian feto-placental unit and use of such proteins in compositions and medical treatment |
Also Published As
Publication number | Publication date |
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JP2007513133A (en) | 2007-05-24 |
EP1827451A1 (en) | 2007-09-05 |
AU2004294800A1 (en) | 2005-06-16 |
CA2589908A1 (en) | 2005-06-16 |
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