WO2006042408A9 - Secretagogues de la gh et utilisations de ceux-ci - Google Patents

Secretagogues de la gh et utilisations de ceux-ci

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Publication number
WO2006042408A9
WO2006042408A9 PCT/CA2005/001611 CA2005001611W WO2006042408A9 WO 2006042408 A9 WO2006042408 A9 WO 2006042408A9 CA 2005001611 W CA2005001611 W CA 2005001611W WO 2006042408 A9 WO2006042408 A9 WO 2006042408A9
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WO
WIPO (PCT)
Prior art keywords
group
subject
secretagogue
composition
trans
Prior art date
Application number
PCT/CA2005/001611
Other languages
English (en)
Other versions
WO2006042408A1 (fr
Inventor
Thierry Abribat
Villers Andre De
Soraya Allas
Denis Gravel
Alcide Chapdelaine
Original Assignee
Theratechnologies Inc
Thierry Abribat
Villers Andre De
Soraya Allas
Denis Gravel
Alcide Chapdelaine
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US10/969,463 external-priority patent/US7316997B2/en
Priority claimed from CA2485472A external-priority patent/CA2485472C/fr
Priority to CN200580043640XA priority Critical patent/CN101084009B/zh
Priority to EP05797145A priority patent/EP1812048A4/fr
Priority to JP2007537087A priority patent/JP2008516994A/ja
Priority to MX2007004682A priority patent/MX2007004682A/es
Application filed by Theratechnologies Inc, Thierry Abribat, Villers Andre De, Soraya Allas, Denis Gravel, Alcide Chapdelaine filed Critical Theratechnologies Inc
Priority to AU2005297366A priority patent/AU2005297366B2/en
Priority to KR1020077011178A priority patent/KR101228229B1/ko
Priority to BRPI0516935-6A priority patent/BRPI0516935A/pt
Publication of WO2006042408A1 publication Critical patent/WO2006042408A1/fr
Priority to NO20072136A priority patent/NO20072136L/no
Publication of WO2006042408A9 publication Critical patent/WO2006042408A9/fr
Priority to HK08106222.9A priority patent/HK1115803A1/xx

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/27—Growth hormone [GH] (Somatotropin)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/25—Growth hormone-releasing factor [GH-RF] (Somatoliberin)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/26—Psychostimulants, e.g. nicotine, cocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/04—Anorexiants; Antiobesity agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/06—Antihyperlipidemics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • 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
    • A61P31/14—Antivirals for RNA viruses
    • A61P31/18—Antivirals for RNA viruses for HIV
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00—Drugs for disorders of the endocrine system

Definitions

  • the invention relates to growth hormone (GH) secretagogues, such as GH releasing factor (GRF) and analogs thereof, and uses thereof.
  • GH growth hormone
  • GRF GH releasing factor
  • Physiological systems include a number of lipid compounds/molecules such as triglycerides and sterols (e.g. cholesterol) , and associated carriers/complexes such as HDL, LDL, etc. Adverse levels or metabolism of such molecules is associated with related conditions such as fat accumulation, and associated disease.
  • lipid compounds/molecules such as triglycerides and sterols (e.g. cholesterol)
  • sterols e.g. cholesterol
  • associated carriers/complexes such as HDL, LDL, etc.
  • Adverse levels or metabolism of such molecules is associated with related conditions such as fat accumulation, and associated disease.
  • Fat accumulation is observed in a range of conditions or syndromes such as obesity, metabolic syndrome, and the recently described HIV-related lipodystrophy syndrome. All these conditions include features which are known to increase the risk of diabetes and/or cardiovascular diseases.
  • the metabolic syndrome also known as syndrome X, affect persons with frank obesity as well as those with an increased amount of abdominal fat, and is characterized by insulin resistance, dyslipidemia (hypertriglyceridemia, low serum HDL cholesterol levels, and increased LDL cholesterol levels) and hypertension.
  • HIV-infected patients treated with highly active antiretroviral therapy commonly experience changes in fat distribution that include increased visceral and central fat accumulation (1) , as well as loss of extremity and subcutaneous fat (especially in the facial fat pads, limbs and buttocks) in association with insulin resistance and dyslipidemia (2, 3) .
  • Recent data suggest increased cardiovascular disease and myocardial infarction rates in patients treated with prolonged antiretroviral therapy (ART) (4) .
  • WHR waist to hip ratio
  • central fat accumulation is related to increased metabolic risk indices.
  • Growth Hormone is known for its lipolytic properties, and its potential role in reversing several of the body fat and associated metabolic abnormalities has been actively studied. Beneficial effects have been shown in GH- deficient individuals (Gotherstrom G. et al. , J Clin Endocrinol Metab 2001 86 (10) : 4657-4665) and non-HIV patients with abdominal obesity (Johannsson G, et al., J Clin Endocrinol Metab 1997, 82 (3) : 727-734) .
  • Cognitive abilities are impaired in a number of conditions including advancing age. Deleterious changes observed with aging affect particularly fluid intelligence, or abilities involving concept formation, rule discovery, planning behavior, and non-verbal reasoning. Conversely, crystallized intelligence, or abilities dependent upon accumulated experience and education is relatively resistant to age-related decline. It has been suggested that the decline in GH and IGF-I observed with aging contribute to the impaired cognitive function.
  • Immune Function Aging is accompanied by diminished circulating GH and IGF-I levels observed in parallel with a declined function of the immune system, particularly affecting the T- cell mediated immunity.
  • the age-related T-cell immune deficiency has been partly attributed to a progressive atrophy of the thymus gland and is considered to be causally related to the increased risk and severity of acquired infections observed in the elderly.
  • GH and IGF-I are known to play an integrating role in the development and function of the immune system, as endocrine and/or autocrine/paracrine factors, and their administration has been shown to reverse age-related immune changes .
  • Immune enhancing effects of these factors have been investigated in other immune deficiency states and encouraging results have been observed in HIV-positive patients (Napolitano LA, et al., AIDS 2002 16 (8) : 1103-1111) and in animal models of radiotherapy preceding bone marrow transplantation (Sun R, et al., BMT Meetings, Feb 22-26 Orlando, FL, Abstract 27 2002:68-69).
  • GH has been shown to improve nitrogen balance, an index of net whole-body protein balance, after major gastro-intestinal surgery, burn injury, or major trauma.
  • Anabolic effects have been translated into clinical benefits in COPD patients (improvement of the maximal inspiratory pressure) (Papt GS, et al., Chest 1991 99 (6) : 1495-1500) and elderly patient undergoing surgery following hip fracture (improvement of functional recovery defined as return to independence) (Van der LeIy AJ, et al., Eur J Endocrinol 2000 143 (5) : 585-592) .
  • rGH has been recently approved for management of AIDS-wasting based on results showing increased body weight, lean body mass and functional performance following 12 weeks of treatment (Schambelan M, et al., Ann Intern Med 1996 125(11) :873-882) .
  • the use of GH to treat conditions such as those noted above, has been associated with adverse side effects in some cases.
  • the invention relates to GH secretagogues (e.g. GRF and analogs thereof) and uses thereof.
  • the invention provides a method of altering a lipid parameter in a subject, said method comprising administering to said subject an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • the invention provides a package comprising an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and
  • composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; together with instructions for altering a lipid parameter in a subject.
  • the invention provides a use of an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for altering a lipid parameter in a subject .
  • an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for altering a lipid parameter in a subject .
  • the invention provides a use of a growth hormone (GH) secretagogue for the preparation of a medicament for altering a lipid parameter in a subject.
  • GH growth hormone
  • the invention provides a method of altering a first body composition parameter of a subject, the method comprising administering to said subject an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • the invention provides a package comprising an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and
  • composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; together with instructions for altering a first body composition parameter of a subject.
  • the invention provides a use of an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for altering a first body composition parameter of a subject.
  • an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for altering a first body composition parameter of a subject.
  • the invention provides a use of a growth hormone (GH) secretagogue for the preparation of a medicament for altering a first body composition parameter of a subject.
  • GH growth hormone
  • the invention provides a method of treating a condition characterized by deficient or decreased bone formation in a subject, said method comprising administering to said subject an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • the invention provides a package comprising an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and
  • composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; together with instructions for treating a condition characterized by- deficient or decreased bone formation in a subject.
  • the invention provides a use of an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for treating a condition characterized by deficient or decreased bone formation in a subject.
  • a growth hormone (GH) secretagogue for the preparation of a medicament for treating a condition characterized by deficient or decreased bone formation in a subject.
  • the invention relates to a method for (1) stimulating day-time vigilance and/or cognitive functions e.g. in conditions related to aging or mild cognitive impairment, (2) improving metabolic conditions associated with fat accumulation and/or hypercholesterolemia, (e.g. metabolic conditions including obesity, HIV-related lipodystrophy, metabolic syndrome or syndrome X) , (3) improving anabolism in catabolic/wasting conditions (such as those observed in Chronic Renal Failure, congestive heart failure AIDS, following hip fracture, trauma, or major surgery, particularly in elderly subjects) , and/or (4) improving immune function or reconstitution of immunodeficient states such as that associated aging, HIV or following high-dose chemotherapy and/or radiotherapy; the method comprising admininistering. a GH secretagogue (e.g. GRF and analogs thereof) or a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; to a subject.
  • a GH secretagogue e.g. GRF and analogs thereof
  • a composition comprising a
  • the invention relates to uses of a GH secretagogue (e.g. GRF and analogs thereof) or a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier, for (1) stimulating day-time vigilance and/or cognitive functions e.g. in conditions related to aging or mild cognitive impairment,
  • a GH secretagogue e.g. GRF and analogs thereof
  • a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier
  • metabolic conditions associated with fat accumulation and/or hypercholesterolemia e.g. metabolic conditions including obesity, HIV-related lipodystrophy, metabolic syndrome or syndrome X
  • metabolic conditions associated with fat accumulation and/or hypercholesterolemia e.g. metabolic conditions including obesity, HIV-related lipodystrophy, metabolic syndrome or syndrome X
  • anabolism in catabolic/wasting conditions such as those observed in
  • the invention similarly relates to a package comprising an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; together with instructions for (1) stimulating day-time vigilance and/or cognitive functions (2) improving metabolic conditions associated with fat accumulation and/or hypercholesterolemia, (3) improving anabolism in catabolic/wasting conditions, and/or (4) improving immune function or reconstitution of immunodeficient states.
  • GH growth hormone
  • the invention similarly relates to a use of a GH secretagogue for the preparation of a medicament for (1) stimulating day-time vigilance and/or cognitive functions (2) improving metabolic conditions associated with fat ' accumulation and/or hypercholesterolemia, (3) improving anabolism in catabolic/wasting conditions, and/or (4) improving immune function or reconstitution of immunodeficient states.
  • a GH secretagogue e.g. GRF compound or analog thereof
  • the metabolic condition is associated with fat accumulation and/or hypercholesterolemia, e.g. obesity, HIV-related lipodystrophy, metabolic syndrome and syndrome X.
  • hypercholesterolemia e.g. obesity, HIV-related lipodystrophy, metabolic syndrome and syndrome X.
  • the catabolic condition is related to one selected from the group consisting of chronic renal failure, AIDS, hip fracture, trauma or major surgery in a subject.
  • Fig. 1 illustrates the differences between treatment groups in changes from baseline to week 2 in the mean reaction time of the Continuous Performance Test (CPT) ;
  • Fig. 2 illustrates changes from baseline to day 9 in Pz amplitude of evoked related potential (P300) during wakefulness;
  • Fig. 3 illustrates mean AUC of antigen-specific proliferative T cell response;
  • Fig. 4 illustrates the percentage of subjects with protective antibody titers (>l/40) for B/Victoria
  • Fig. 5 illustrates the variation of mean IGF-I levels during time with placebo, 2mg/day TH9507, 0.5 mg/day TH9507 and lmg/day TH9507.
  • Fig. 6 illustrates a flow diagram of patient disposition in respect of the studies described in Example 6.
  • Fig. 7 illustrates results of dose response of TH9507 on A) IGF-I and B) truncal fat, as measured by DEXA, as described in Example 6.
  • 7A "ng/ml” represents ng/ml of IGF-I as measured.
  • 7B "kg” represents change in truncal fat, with the negative values indicating a decrease in truncal fat.
  • Example 5 The studies described herein further demonstrate a beneficial effect of Th9507 on daytime vigilance and cognitive function (Example 2) , immune response (Example 3) , wasting/catabolic conditions (Example 4) and non-HDL cholesterol (Example 5) .
  • the invention provides a method of altering a lipid parameter in a subject, said method comprising administering to said subject an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue ; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • the method results in no or substantially no increase in blood glucose levels in said subject.
  • the invention provides a package comprising an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and
  • the invention provides a use of an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for altering a lipid parameter in a subject.
  • GH growth hormone
  • the above-mentioned alteration of a lipid parameter results in no or substantially no increase in blood glucose levels in said subject.
  • the invention provides a use of a growth hormone (GH) secretagogue for the preparation of a medicament for altering a lipid parameter in a subject.
  • GH growth hormone
  • the above-mentioned alteration of a lipid parameter results in no or substantially no increase in blood glucose levels in said subject.
  • the above-noted the alteration of a lipid parameter is selected from the group consisting of: (a) a decrease in cholesterol; (b) a decrease in non-HDL cholesterol; (c) a decrease in triglyceride; (d) a decrease in the ratio of total cholesterol : HDL cholesterol; and (e) any combination of (a) to (d) .
  • the above-noted lipid parameter is associated with a condition selected from the group consisting of lipodystrophy, lipohypertrophy, obesity, dyslipidemia, hypertriglyceridemia and syndrome X.
  • the invention provides a method of altering a first body composition parameter of a subject, the method comprising administering to said subject an agent selected from the group consisting of (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • GH growth hormone
  • the method results in no or substantially no decrease in a second body composition parameter of the subject, wherein the second body composition parameter is selected from the group consisting of:(i) limb fat; (ii) subcutaneous fat; (iii) subcutaneous abdominal tissue (SAT); and (iv) any combination of (i) to (iii) .
  • the second body composition parameter is selected from the group consisting of:(i) limb fat; (ii) subcutaneous fat; (iii) subcutaneous abdominal tissue (SAT); and (iv) any combination of (i) to (iii) .
  • the invention provides a package comprising an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and
  • a composition comprising a' GH secretagogue and a pharmaceutically acceptable carrier; together with instructions for altering a first body composition parameter of a subject.
  • the above-mentioned alteration of a first body composition parameter results in no or substantially no decrease in a second body composition parameter of the subject, wherein the second body composition parameter is selected from the group consisting of (i) limb fat; (ii) subcutaneous fat; (iii) subcutaneous abdominal tissue (SAT) ; and (iv) any combination of (i) to
  • the invention provides a use of an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for altering a first body composition parameter of a subject.
  • a growth hormone (GH) secretagogue a growth hormone secretagogue
  • a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier
  • the above- mentioned alteration of a first body composition parameter results in no or substantially no decrease in a second body composition parameter of the subject, wherein the second body composition parameter is selected from the group consisting of (i) limb fat; (ii) subcutaneous fat; (iii) subcutaneous abdominal tissue (SAT) ; and (iv) any combination of (i) to (iii) .
  • the invention provides a use of a growth hormone (GH) secretagogue for the preparation of a medicament for altering a first body composition parameter of a subject.
  • GH growth hormone
  • the above-mentioned alteration of a first body composition parameter results in no or substantially no decrease in a second body composition parameter of the subject, wherein the second body composition parameter is selected from the group consisting of (i) limb fat; (ii) subcutaneous fat; (iii) subcutaneous abdominal tissue (SAT) ; and (iv) any combination of (i) to (iii) •
  • the above-mentioned alteration of a first body composition parameter is selected from the group consisting of: (a) an increase in lean body mass; (b) a decrease in trunk fat; (c) a decrease in visceral fat; (d) a decrease in abdominal girth; (e) a decrease in visceral abdominal tissue (VAT) ; (f) a decrease in VATrSAT ratio; and (g) any combination of (a) to (f) .
  • the first body composition parameter is associated with a condition selected from the group consisting of lipodystrophy, lipohypertrophy, obesity, dyslipidemia, hypertriglyceridemia and syndrome X.
  • the above-mentioned alteration of a first body composition parameter results in an improvement of quality of life of the subject.
  • the invention provides a method of treating a condition characterized by deficient or decreased bone formation or for treating bone dysfunction or defect, in a subject, said method comprising administering to said subject an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier.
  • the invention provides a package comprising an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and
  • the invention provides a use of an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for treating a condition characterized by deficient or decreased bone formation in a subject.
  • an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; for treating a condition characterized by deficient or decreased bone formation in a subject.
  • the invention provides a use of a growth hormone (GH) secretagogue for the preparation of a medicament for treating a condition characterized by deficient or decreased bone formation in a subject.
  • GH growth hormone
  • the above-noted condition characterized by deficient or decreased bone formation is selected from the group consisting of osteopenia and osteoporosis.
  • the invention relates to uses of a GH secretagogue (e.g. GRF and analogs thereof) or a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier, for (1) stimulating day-time vigilance and/or cognitive functions e.g. in conditions related to aging or mild cognitive impairment,
  • metabolic conditions associated with fat accumulation and/or hypercholesterolemia e.g. metabolic conditions including obesity, HIV-related lipodystrophy, metabolic syndrome or syndrome X
  • metabolic conditions associated with fat accumulation and/or hypercholesterolemia e.g. metabolic conditions including obesity, HIV-related lipodystrophy, metabolic syndrome or syndrome X
  • anabolism in catabolic/wasting conditions such as those observed in Chronic Renal Failure, congestive heart failure AIDS, following hip fracture, trauma, or major surgery, particularly in elderly subjects
  • immune function or reconstitution of immunodeficient states such as that associated aging, HIV or following high-dose chemotherapy and/or radiotherapy.
  • the invention similarly relates to a package comprising an agent selected from the group consisting of: (a) a growth hormone (GH) secretagogue; and (b) a composition comprising a GH secretagogue and a pharmaceutically acceptable carrier; together with instructions for (1) stimulating day-time vigilance and/or cognitive functions (2) improving metabolic conditions associated with fat ' accumulation and/or hypercholesterolemia, (3) improving anabolism in catabolic/wasting conditions, and/or (4) improving immune function or reconstitution of immunodeficient states .
  • GH growth hormone
  • the invention similarly relates to a use of a GH secretagogue for the preparation of a medicament for (1) stimulating day-time vigilance and/or cognitive functions (2) improving metabolic conditions associated with fat accumulation and/or hypercholesterolemia, (3) improving anabolism in catabolic/wasting conditions, and/or (4) improving immune function or reconstitution of immunodeficient states .
  • the above-mentioned lipodystrophy is HIV-related lipodystrophy.
  • the above-mentioned subject is HIV-related lipodystrophy.
  • the above-mentioned subject is receiving antiviral therapy.
  • the above-mentioned subject suffers from a condition selected from the group consisting of diabetes, glucose intolerance and insulin resistance.
  • the above-mentioned GH secretagogue is administered at a dose of about 0.0001 to about 4 mg, in a further embodiment, about 0.0001 to about ⁇ 2 mg, in a further embodiment, about 1 mg to about 2mg, in a further embodiment, about 1 mg and in a further embodiment, about 2 mg.
  • the agent is administered by a route selected from the group consisting of intravenous, oral, transdermal, subcutaneous, mucosal, intramuscular, intranasal, intrapulmonary, parenteral, intrarectal and topical. In an embodiment, the agent is administered by a subcutaneous route.
  • the subject is a mammal, in a further embodiment, a human.
  • analog is intended to mean a molecule of different structure but having a biological function similar to the structures of the GRF or to a biologically functional fragment thereof which may include peptidomimetics .
  • Peptidomimetics may be conveniently prepared by direct chemical synthesis using methods well known in the art .
  • subject is intended to mean any mammal including, but not limited to, human, canine, feline, equine, caprine, bovine, porcine and ovine.
  • cogntive function is intended to mean functions including, but not limited to thinking, reasoning, memory and problem solving.
  • catabolic/wasting conditions is intended to mean condition including, but not limited to, frail bones, low muscular mass and muscle wasting.
  • the compound identified as TH9507 is the [hexenoyl-trans-3-Tyrl] hGRF (1- 44) NH 2 .
  • the methods and corresponding uses and packages described herein comprise administering to a subject a growth hormone (GH) secretagogue .
  • GH secretagogue refers to any compound or molecule, natural or synthetic, which may result in, either directly or indirectly, GH secretion and/or an increase in GH secretion.
  • the GH secretagogue is a growth hormone-releasing factor (GRF; also referred to as growth hormone releasing hormone [GHRH] ) or GRF analog.
  • GRF growth hormone-releasing factor
  • the GRF is human GRF (hGRF) .
  • hGRF Human growth hormone-releasing factor
  • amino acid sequence of the just- noted 44 amino acid form is as follows:
  • the minimum active core comprises the first 29 amino acids of the above sequence, which is referred to herein as hGRF (1-29) NH 2 , and has the following structure:
  • the 1-44 and 1-29 forms differ in that the 1-44 form contains the following additional amino acids, which correspond to positions 30-44 of the 1-44 form:
  • the above-mentioned GRF analog is a GRF analog of formula A:
  • Al is Tyr or His
  • A2 is VaI or Ala;
  • A8 is Asn or Ser;
  • A13 is VaI or lie;
  • Al5 is Ala or GIy;
  • A18 is Ser or Tyr;
  • A24 is GIn or His ;
  • A25 is Asp or GIu; A27 is Met, lie or NIe; A28 is Ser or Asn; A30 is a bond or amino acid sequence of 1 up to 15 residues ; and
  • X is a hydrophobic tail anchored via an amide bond to the N-terminus of the peptide and the hydrophobic tail defining a backbone of 5 to 7 atoms;
  • backbone can be substituted by Cl-6 alkyl, C3-6 cycloalkyl, or C6-12 aryl and the backbone comprises at least one rigidifying moiety connected to at least two atoms of the backbone;
  • said moiety selected from the group consisting of double bond, triple bond, saturated or unsaturated C3-9 cycloalkyl, and C6-12 aryl.
  • X noted above is selected from the group consisting of:
  • A30 noted above is selected from the group consisting of:
  • the above-noted GRF peptide is selected from the group consisting of:
  • the above- mentioned GH secretagogue may be used therapeutically in formulations or medicaments to effect the above-noted alterations and to prevent or treat the above-noted conditions.
  • the invention provides corresponding methods of medical treatment, in which a therapeutic dose of a GH secretagogue is administered in a pharmacologically acceptable formulation, e.g. to a patient or subject in need thereof.
  • the invention also provides therapeutic compositions comprising a GH secretagogue and a pharmacologically acceptable excipient or carrier.
  • such compositions include GH secretagogue in a therapeutically or prophylactically effective amount sufficient to effect the above-noted alterations and to treat the above-noted conditions.
  • the therapeutic composition may be soluble in an aqueous solution at a physiologically acceptable pH.
  • a “therapeutically effective amount” refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired therapeutic result, such as to effect the above-noted alterations and to reduce the progression of the above-noted conditions.
  • a therapeutically effective amount of a GH secretagogue may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the compound to elicit a desired response in the individual. Dosage regimens may be adjusted to provide the optimum therapeutic response.
  • a therapeutically effective amount is also one in which any toxic or detrimental effects of the compound are outweighed by the therapeutically beneficial effects.
  • a prophylactically effective amount refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired prophylactic result, such as preventing or inhibiting the rate of onset or progression of the above- noted conditions .
  • a prophylactically effective amount can be determined as described above for the therapeutically effective amount. For any particular subject, specific dosage regimens may be adjusted over time according to the individual need and the professional judgement of the person administering or supervising the administration of the compositions .
  • pharmaceutically acceptable carrier includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like that are physiologically compatible.
  • the carrier is suitable for parenteral administration.
  • the carrier can be suitable for intravenous, intraperitoneal, intramuscular, subcutaneous, sublingual or oral administration.
  • Pharmaceutically acceptable carriers include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion. The use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active compound, use thereof in the pharmaceutical compositions of the invention is contemplated. Supplementary active compounds can also be incorporated into the compositions.
  • compositions typically must be sterile and stable under the conditions of manufacture and storage .
  • the composition can be formulated as a solution, microemulsion, liposome, or other ordered structure suitable to high drug concentration.
  • the carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like) , and suitable mixtures thereof.
  • the proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants.
  • isotonic agents for example, sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride in the composition.
  • Prolonged absorption of the injectable compositions can be brought about by including in the composition an agent which delays absorption, for example, monostearate salts and gelatin.
  • a GH secretagogue can be administered in a time release formulation, for example in a composition which includes a slow release polymer.
  • the active compounds can be prepared with carriers that will protect the compound against rapid release, such as a controlled release formulation, including implants and microencapsulated delivery systems.
  • Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, polylactic acid and polylactic, polyglycolic copolymers (PLG) .
  • PLG polylactic, polyglycolic copolymers
  • Sterile injectable solutions can be prepared by- incorporating the active compound (e.g. a GH secretagogue ) in the required amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, followed by filtered sterilization.
  • dispersions are prepared by incorporating the active compound into a sterile vehicle which contains a basic dispersion medium and the required other ingredients from those enumerated above .
  • a sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and freeze-drying which yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof .
  • a GH secretagogue may be formulated with one or more additional compounds that enhance its solubility.
  • compositions of the present invention comprising a GH secretagogue
  • a GH secretagogue may be provided in containers, kits or packages (e.g. commercial packages) which further comprise instructions for its use to effect the above-noted alterations and to prevent or treat the above-noted conditions.
  • the invention further provides a package comprising a GH secretagogue or the above-mentioned composition together with instructions to effect the above- noted alterations and to prevent or treat the above-noted conditions .
  • the invention further provides a use of a GH secretagogue to effect the above-noted alterations and to prevent or treat the above-noted conditions.
  • the invention further provides a use of a GH secretagogue for the preparation of a medicament to effect the above-noted alterations and to prevent or treat the above-noted conditions .
  • Example 1 Study drug
  • hexenoyl trans-3)hGRF (1-44) NH 2 (also referred to as TH9507 herein) , which is a synthetic human growth hormone releasing factor analog that comprises the 44 -amino acid sequence of human growth hormone releasing factor (hGRF) on which a hexenoyl moiety, a C6 side chain has been anchored on Tyr 1 at the n-terminal.
  • hGRF human growth hormone releasing factor
  • NH 2 or Th9507 has the following structure :
  • Th9507 The in vitro half-life of Th9507 is 3-8 hours compared to 0.56 hours for hGRF. Daily 1 and 2 mg doses have been shown to increase IGF-I to the physiological range seen in younger adults (14) . The safety profile of TH9507 is generally good. Th9507 has been studied in patients with Type II DM, and was not shown to aggravate overall glycemic control when administered at a daily dose up to 2 mg (15) .
  • Example 2 Administration of TH9507 for improving daytime vigilance in subjects with sleep maintenance insomnia
  • the present example shows the effect of a 14 day- administration of 2 doses of TH9507 (0.1 mg and 1 mg) on vigilance parameters in subjects of 35 to 50 years of age exhibiting sleep maintenance insomnia.
  • the study was a randomized, double-blind, placebo- controlled, parallel group and multicenter evaluation of two doses of TH9507 (0.1 mg and 1 mg) administered daily by subcutaneous injection at bedtime for 14 consecutive days. To evaluate vigilance and the performance in the morning, patients underwent a battery of cognitive tests including the Continuous Performance Test (CPT) at baseline and at the end of treatment period.
  • CPT Continuous Performance Test
  • the Mean Reaction Time of the CPT was significantly and markedly decreased in the 0.1 mg group when compared to placebo.
  • No significant effect was observed in the 1 mg group.
  • Circulating IGF-I and IGFBP-3 levels were significantly increased at week 2 in the 1 mg group when compared to placebo (P ⁇ 0.0001, ANOVA on changes from baseline) .
  • TH9507 was administered daily for 7 days in a cross-over design. This study involved 12 healthy subjects aged between 50 to 65 years, exhibiting age-related sleep impairment (Pittsburgh Sleep Quality Index Score from 3 to 7) . At the end of the treatment period, daytime vigilance was significantly enhanced when compared to placebo in subjects receiving 1 mg of TH9507, as assessed by P300, an event-related potential test.
  • TH9507 improves daytime vigilance in sleep maintenance insomnia in subjects and would favor a direct mechanism of action of TH9507, not mediated by IGF-I.
  • Data are supported by those obtained by Vitiello et al (Vitiello M. V., et al., Gerontologist 2002 40 (Special Issue 1):39-N/A. using hGRF in cognitive tests involving psychomotor and perceptual processing speed (Deijin JB et al, Psychoneuroendocrinology 1998 23(l):45-55) and may support further clinical investigations in subjects with impaired cognitive functions .
  • Example 3 Effects of TH9507 on the immune response to influenza vaccination in elderly subjects
  • the present example describes immune findings following an influenza vaccination challenge in elderly subjects.
  • Influenza-specific proliferative T cell response and antibody titers were evaluated for each of the 3 strains contained in the vaccine.
  • the proliferative T cell response was assessed by a mitogen assay using tritiated thymidine ( 3 H) incorporation and results were log-base 10 transformed prior to analysis.
  • the antibody titers were determined by standard hemaglutinaion inhibition assay and results were log-base 2 transformed prior to analysis.
  • TH9507 has a therapeutic potential in immune indications.
  • its effect of the T- lymphocyte proliferation response following vaccination makes it attractive to develop in clinical situations where the cell-mediated immune system is depressed, such as viral infections in the elderly and immune-deficient states following HIV infection, high-dose chemotherapy or radiotherapy .
  • Example 4 ThGRF' s benefits in wasting/catabolic conditions
  • the present example shows the effect of a 7-day administration of TH9507 on circulating IGF-I levels in healthy middle-aged men.
  • the study used a randomized, double-blind, placebo-controlled design and was conducted in healthy men, aged 50 to 60 years old. Subjects (8 per group) were injected S. C. once a day for 7 consecutive days with placebo, 0.5, 1 or 2 mg of TH9507. Circulating IGF-I levels were measured on Days 1 to 7. The 12 hour GH response and TH9507 PK profile were determined on Day 1 and 7.
  • IGF-I increased over baseline values by 8% (placebo), 37% (0.5 mg) , 89% (lmg) and 106% (2 mg) ; these increases were statistically significant for all 3 doses of TH9507.
  • the 1 mg and 2 mg doses were equally potent and induced a doubling of IGF-I levels up to levels expected for young adults (286 ⁇ 25 and 284 ⁇ 55 ng/ml, respectively) , none of the subjects exhibited levels greater than 400 ng/ml. A plateau was reached at Day 4 and 6 for the 1 mg and 2 mg doses, respectively.
  • GH response to TH9507 increased rapidly both on
  • PK analysis indicated that Cmax and AUC parameters increased in function of the dose administered.
  • the half-life of the TH9507 ranged between 2 and 5 hours.
  • Example 5 Effects of GRF on non-HDL cholesterol in patients with type 2 Diabetes
  • the present example illustrates beneficial effects of TH9507 on non-HDL cholesterol levels in a diabetic population.
  • HbAIc glycosylated hemoglobin
  • Example 6 Effect of GRF analog on lipid profile, body composition and quality of life in HIV-infected patients
  • Body composition was assessed by DXA and abdominal CT scan,- IGF-I, insulin, glucose, lipid, bone turnover, immunologic, and safety parameters.
  • Treatment with TH9507 resulted in a dose-related increase in serum IGF-I levels within the physiological range [18 (32) ng/mL, 87 (67) ng/mL, 123 (79) ng/mL, mean (SD) for placebo, lmg, 2 mg, respectively, P ⁇ 0.01 for change in each active group vs. placebo] .
  • Lean body mass increased significantly in both treatment groups compared to placebo [-0.5 (1.6) kg, 0.7 (2.0) kg, and 1.7 (2.3) kg; placebo, lmg, 2 mg, respectively; P ⁇ 0.01 for 2 mg dose vs. placebo, P ⁇ 0.05 for the 1 mg group vs. placebo] .
  • TH9507 effectively improved body composition and reduced truncal fat by preferentially decreasing visceral fat while preserving subcutaneous fat in patients with HIV lipodystrophy. TH9507 did not increase glucose levels, even among those with impaired glucose tolerance or diabetes mellitus at baseline, and improved the lipid profile. These data suggest that TH9507, a GRF analog, may be a beneficial treatment strategy for HIV lipodystrophy.
  • Subjects receiving testosterone or estrogen within the prior six months, with known drug or alcohol dependence or who had participated in another clinical trial with an investigational agent within 30 days were also excluded from the study. All subjects were required to be on a stable antiretroviral regimen for 8 weeks prior to enrollment. Subjects receiving lipid lowering medications were required to be on a stable regimen for 3 months prior to enrollment. Subjects were not permitted to begin antidiabetic medication, use systemic corticosteroids for > 10 days, or begin estrogen or testosterone preparations during the study.
  • Study Procedures Subjects underwent a screening visit to determine eligibility. All subjects gave written consent to participate in the study, and the study was approved by the Institutional Review Board at each participating site. BMI, anthropometic measurements, TSH and prolactin were performed. Viral load and CD4 count were performed if not previously done within 8 weeks of the study. A PSA was performed in male subjects and a pregnancy test was performed in female subjects. Mammography was also performed in female subjects if not previously done within 6 months of the study.
  • anthropometric measurements were obtained. Total body lean and fat mass as well as regional fat mass in the trunk and extremities were assessed by DEXA. Abdominal subcutaneous and visceral fat area and the ratio of VAT to SAT were determined by cross-sectional CT at L4- L5. Biochemical parameters including insulin-like growth factor-I, glucose, insulin, lipid profile (cholesterol, HDL, LDL, triglyceride, non HDL and the ratio of cholesterol : HDL) , free fatty acids, HbAlC, IGFBP-3, and bone markers (serum osteocalcin and NTX-I), CD4, viral load, and a pregnancy test for female subjects were determined in the fasting state. In addition, insulin and glucose response to a 75 gram standard glucose challenge were assessed and a quality of life questionnaire was administered.
  • Each vial was reconstituted with sterile water immediately prior to injection. Patients were instructed to inject each AM at approximately 0900 h.
  • Serum IGF-I was measured after acid-ethanol extraction using the Esoterix RIA kit (Esoterix Inc., Calabasas Hill, CA) , with a sensitivity of 10 ng/mL. Intra- and inter-assay coefficients of variation were 4.6-20% and 9-10%, respectively. Serum IGFBP-3 was measured using the Esoterix RIA kit (Esoterix Inc., Calabasas Hill, CA) with a sensitivity of 0.3 mg/mL. Intra- and inter-assay coefficients of variation were 5.1-13% and 5.5-17%, respectively.
  • HDL, LDL, total cholesterol, triglycerides and FFA were determined by enzymatic colorimetric assay.
  • Glucose was measured by enzymatric test (Gluco-quant®, Roche diagnostics, Indianapolis, IN) .
  • HbAIc was determined by chromatography.
  • PSA was determined using the Hybritech®PSA test (Beckman Coulter, Mississauga, Canada) .
  • TSH was measured by microparticle enzyme immunoassay (AxSYM hTSH II, Abbott Laboratories, Abbott Park, IL) .
  • NTX N-terminal telopeptide of type I collagen; a bone resorption marker
  • Osteocalcin was measured using a commercially available enzymatic immunoassay kit (MetraTM osteocalcin, Quidel Corporation, San Diego, CA) . CD4 and viral load were performed by the individual site labs by routine methodo1ogy. HOMA was calculated as :
  • Body composition endpoints included trunk fat and trunk to limb fat ratio by DEXA and VAT and VAT: SAT by CT scan. Other endpoints included IGF-I, lipid parameters, glucose and insulin, CD4, viral load, bone markers, and quality of life.
  • a sample size of 20 patients/group was planned to assess a statistically significant change of 10% or more in intra-group analyses. The planned dropout rate was 25% and therefore 60 patients were enrolled into the study.
  • Baseline data are compared between the groups by F- test based on AJSTOVA for continuous variables and Chi-Square test for categorical variables . Change over time between groups is compared by ANOVA or the Chi-Square test. Where appropriate, data were rank transformed prior to analysis. Changes within each group are determined by t-test.
  • the ITT (intent to treat) population is defined as all subjects who received at least one dose of the study treatment . Descriptive statistics and analyses for all efficacy and safety analyses are performed on the ITT population. End of study, 12 week, data are used to calculate changes in body composition. For biochemical indices, the last observation available is used to calculate change. Imputation for missing data is not performed. For body composition, end of study data are used to calculate change . Interim analyses were not performed. Results are mean (SD) unless otherwise noted. All statistical tests were performed with a two-sided Type I error level of 0.05.
  • Baseline demographic for the three study groups are shown in Table 3. At baseline no significant differences were seen between the groups except, including use of antiretroviral therapy. The percentage of patients with diabetes (fasting glucose ⁇ 7.0 mmol/L or 2h-glucose ⁇ 11.1 mmol/L) and impaired glucose tolerance (6.1 mmol/L ⁇ fasting glucose ⁇ 6.9 mmol/L or 7.8 mmol/L ⁇ 2h-glucose ⁇ 11.1 mmol/L) was not different between the groups. Among the entire study group, 23% of subjects demonstrated IGT and 5% demonstrated diabetes mellitus at baseline.
  • Data are mean (SD) .
  • BMI body-mass index
  • WHR waist/hip ratio
  • WC waist circumference
  • IGF-I increased significantly with the 1 and 2 mg dose compared to placebo [18 (32) ng/mL, 87 (67) ng/mL, 123 (79) ng/mL, placebo, 1 mg 2mg, respectively, P ⁇ 0.01 for each active group vs. placebo] ( Figure 3) .
  • Triglyceride levels decreased in the 2 mg group compared to placebo (-0.2 (1.3), -0.9 (4.2), -0.9 (1.2), last observation values for placebo, 1 mg, 2 mg, respectively, P ⁇ 0.05) and the ratio of cholesterol to HDL improved in both treatment groups compared to placebo (0.3 (1.1), -0.3 (0.7), -0.3 (0.6) , last observation values for placebo, 1 mg, 2 mg, respectively, P ⁇ 0.05).
  • Table 4 Change from Baseline in Body Composition, Biochemical and Immunologic Parameters.
  • Baseline Baseline ⁇ Baseline ⁇ Baseline ⁇ 2 mg f vs. P 1 mg vs . P
  • Trunk Fat (kg] 14.6(3.4) 0.1(1.1) 13.1(3.4) -0.5 (1.4) 12.2(4.6) -1.1(1.3)* 0.0144 0.1782
  • VAT SAT 0.89(0.50) -0.01(0.10) 1.17 (1.25) -0.23 (0.47) * 1.12(0.74) -0.14(0.18) * 0.0084 0.0434
  • IGF-I (ng/itlL) 132.4 (42.4) 18.3 (31.7) 165.3 (62.3) 87.5 (66.9)* 157.0(41.4) 122.6(79.1)* 0.0002 0.0042
  • IGFBP- 3 (Mg/L) 2.7(0.7) 0.1(0.4) 2.9(0.9) 0.6(0.7) *2. 9(0.4) 0.6(0.5)* 0.0007
  • NTX (nMBCE/ mM) 36 .3(17. 7) -0.8(20.8) 37 .1(13. 4) 4.5 (2 ⁇ 1.9) 37 .2(23. 1) -I 3.5(27.7) 1 .0000 1.0000
  • a health-related quality of life questionnaire (PLC, Quality of Life Profile for the Chronocally 111) was self-administered to 61 patients randomized to receive placebo or TH9507 at 1 or 2 mg s.c. daily.
  • the PLC questionnaire included a general, non-specific part assessing 6 dimensions of global health as well as a disease specific part capturing impact of enlarged abdominal girth, abdominal bloating, tenseness and pain, as well as diarrhea, visible facial changes, visible changes in physical appearance, and the feeling of being recognized as an HIV positive person.
  • Study population included 54 men and 7 women.
  • Baseline mean age was 46 + 7 [SD] , BMI 28 + 3 [SD] kg/m 2 , WC 102 cm ⁇ 8 [SD] and WHR 1.0 ⁇ 0.1 [SD]. No significant difference between groups was noted for subscales of the main portion of the PLC. Slight changes were observed within the treated groups in the positive mood and social well- being scores but were not considered clinically significant.
  • Discontinuation rates were not different between the groups (24%, 11%, 29%, placebo, 1 mg, 2 mg respectively) .
  • One subject in the placebo group (arthritis) , none in the 1 mg group and 3 in the 2 mg group (rash, arhtralgia, paresthesia) experienced AE' s leading to treatment discontinuation.
  • Severe AE' s were reported in 6% of the placebo group, 13% of the 1 mg group and 10% of the 2 mg group.
  • Musculoskeletal AE' s e.g. pain and arthralgias were noted in 24%, 26% and 29% of subjects in the placebo, 1 mg and 2 mg groups respectively. Carpal tunnel symptoms were not noted in any patient.
  • Edema and/or peripheral swelling were noted in 1 patient in the 2 mg group only. Headache and/or paresthesias were noted in ⁇ 19%, 32% and 52 % of the subjects in the placebo, lmg and 2 mg groups, respectively. Blood pressure and heart rate did not change between or within the groups .
  • One patient in the placebo group compared to three in the 2 mg group withdrew from the study related to adverse events.
  • Safety laboratory values, including hemoglobin, WBC, LFT' s, creatinine did not differ between the groups (data not shown) .
  • CPK increased in a greater percentage of the 1 (47%) and 2 mg treated subjects (38%) compared to placebo (19%) , but these changes were small and did not result in a greater proportion of abnormal CPK values between the groups.
  • Anti-TH9507 antibodies were not detected after 12 weeks in any patient .
  • CD4 count and viral load did not change .
  • Visceral fat also decreased significantly by more than 15% over 3 months within the 2 mg group.
  • the magnitude of this change on a percentage basis is equivalent to that seen with pharmacologic doses of GH (9), suggesting that this strategy is highly effective and potentially very useful because of the general lack of side effects associated with physiologic increases in GH.
  • the 2mg GRF dose significantly improved triglyceride levels and the cholesterol to HDL ratio.
  • Similar beneficial effects on triglyceride were seen with lower, alternating day, but not higher doses of GH in a study reported by Kotler et al .
  • Growth hormone has been shown to decrease cholesterol and triglycceride levels in GH deficient patients and among otherwise healthy men chosen for abdominal obesity (19, 20) .
  • our data suggest that treatment with TH9507 resulted in an improved lipid profile in dyslipidemic, abdominally obese patients with HIV lipodystrophy.
  • TH9507 was also associated with other benefits in this study. Osteocalcin, a marker of bone formation increased within the 2 mg group, whereas NTX, a marker of bone resorption did not suggesting a net positive effect on bone turnover. Reduced bone density has been described among patients with HIV disease and among those with lipodystrophy, in inverse association with visceral and truncal adiposity (25, 26) . Growth hormone is well known to stimulate bone formation (27) . Relative reductions in GH secretion may therefore contribute to reduced bone density in some patients with lipodystrophy and a positive effect on bone formation, with physiologic increases in GH is an additional benefit of TH9507.
  • TH9507 A new Growth Hormone-Releasing Factor (GRF) analogue is a powerful Insulin-like Growth Factor-1 (IGF-I) inducer in 50-60 years old healthy subjects : A 7-Day, Randomizeed Multidose Study. In: The Endocrine Society's 84 rd Annual Meeting / 2001 / Denver / 2001. p. P2-292. 15. Clemmons D, Miller S, De Villers A, et al . Safety assessment and metabolic effects of TH9507, a Growth Hormone Releasing Factor analog (GRF) in patients with Type 2 diabetes mellitus. In: The Endocrine Society's 86 Annual Meeting / 2003 / Philadelphia / 2003. p. P2-354. 16.
  • IGF-I Insulin-like Growth Factor-1

Abstract

L'invention concerne l'utilisation d'un secrétagogue de la GH (par exemple, GRF ou un analogue de celui-ci) aux fins : (1) de modification d'un paramètre lipidique chez un sujet; (2) de modification d'un paramètre de composition du corps chez un sujet, (3) de traitement d'un état caractérisé par une formation osseuse déficiente ou diminuée chez un sujet, (4) d'amélioration de la vigilance diurne et/ou de la fonction cognitive chez un sujet, (5) d'amélioration d'un état du métabolisme chez un sujet, (6) d'amélioration de l'anabolisme dans un état catabolique chez un sujet et/ou (7) d'amélioration et/ou de reconstitution de la fonction immune chez un sujet.
PCT/CA2005/001611 2003-05-29 2005-10-20 Secretagogues de la gh et utilisations de ceux-ci WO2006042408A1 (fr)

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KR1020077011178A KR101228229B1 (ko) 2004-10-20 2005-10-20 성장 호르몬 분비 촉진물질 및 그의 용도
EP05797145A EP1812048A4 (fr) 2004-10-20 2005-10-20 Secretagogues de la gh et utilisations de ceux-ci
JP2007537087A JP2008516994A (ja) 2004-10-20 2005-10-20 成長ホルモン分泌促進因子およびその使用
MX2007004682A MX2007004682A (es) 2004-10-20 2005-10-20 Secretagogos de gh y usos de los mismos.
CN200580043640XA CN101084009B (zh) 2003-05-29 2005-10-20 Gh促分泌素及其用途
AU2005297366A AU2005297366B2 (en) 2004-10-20 2005-10-20 GH secretagogues and uses thereof
NO20072136A NO20072136L (no) 2004-10-20 2007-04-24 Substans som fremmer GH-sekresjon og anvendelse derav
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AU2005297366A2 (en) 2006-04-27
JP2008516994A (ja) 2008-05-22
AU2005297366A1 (en) 2006-04-27
AU2005297366B2 (en) 2011-12-08
KR101228229B1 (ko) 2013-01-31
WO2006042408A1 (fr) 2006-04-27
EP1812048A4 (fr) 2012-01-18
KR20070069207A (ko) 2007-07-02
EP1812048A1 (fr) 2007-08-01

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