Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
  • A61K31/739—Lipopolysaccharides
• • 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
• • 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 lipoteichoic acid T for use in treating pleural effusion or pneumothorax.
• the present invention also relates to the use of lipoteichoic acid T (LTA-T) in the manufacture of a medicament for treating pleural effusion or pneumothorax.
• LTA-T lipoteichoic acid T
• the present invention also relates to a kit comprising a pharmaceutical composition comprising lipoteichoic acid T and instructions indicating that the composition is for use as a pleurodesis agent.
• the present invention relates to a method of treating pleural effusion or pneumothorax comprising administration of lipoteichoic acid T to a subject.
• Therapeutic drainage is effective in treating breathlessness caused by pleural fluid but the majority of effusions recur after single drainage (Antunes G et ah, Thorax 2003; 58 Suppl 2:ii29-ii38) and require painful repeated drainage or adherence of the lung to the chest wall by pleurodesis that requires about a week in hospital.
• talc sterilised medical grade talcum
• the present invention relates to the treatment of conditions where the pleural membrane has become separated from the chest wall. This includes the treatment of pleural effusion, where fluid collects in the space between the pleural membrane and the chest wall and pneumothorax, where air collects in the space between the pleural membrane and the chest wall.
• the first aspect of the present invention provides lipoteichoic acid T (LTA-T) for use in treating pleural effusion or pneumothorax.
• LTA-T lipoteichoic acid T
• LTA-T is a gram positive pathogen cell wall motif that allows the pathogen to be immunologically recognised by binding to Toll-like receptors on the cell surface.
• LTA-T is strongly pro-inflammatory in animal models of sepsis, mediating its effects through the Toll-like receptor pathway (via TLR-2), which activates NF-K ⁇ signalling.
• LTA-T is described in US 6,114,161 for use as an antitumour preparation. All aspects of LTA-T from US 6,114,161 are incorporated herein by reference.
• the present invention also includes any substance that binds TLR2, and induces inflammation, for treating pleural effusion or pneumothorax.
• substance include peptidoglycan, atypical LPS, MALP-2 and MALP-404 (lipoproteins), OspA, porin, antigen mixtures, LcrV, lipomannan, GPI anchor, lysophosphatidylserine, lipophosphoglycan (LPG), zymosan, hsp60 and hemagglutinin.
• LTA-T is sensed by inflammatory cells and triggers inflammation.
• the present invention shows for the first time that the inflammation induced by LTA-T leads to therapeutically useful adhesion between the pleural membranes.
• This inflammation stimulates the production of fibrin within the pleural cavity, which is later invaded by scar tissue (collagen), adhering the pleural membranes.
• This adherence of the pleural membranes prevents the collection of unwanted fluid or air in the pleural cavity which causes breathlessness and other medical complications.
• Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.
• Pleural effusions can be caused by a number of different diseases and conditions, such as cancer, heart failure, diseases causing low blood protein levels (for example liver cirrhosis and nephrotic syndrome), bacterial pneumonia, tuberculosis, pulmonary embolism, and diseases causing pleural inflammation (for example, systemic lupus erythematosus, rheumatoid arthritis and other autoimmune diseases), bleeding (often due to chest trauma), chylothorax, accidental infusion of fluids, oesophageal rupture or pancreatic disease, intra- abdominal abscess, rheumatoid arthritis, asbestos pleural effusion, Meig's syndrome and ovarian hyperstimulation syndrome.
• diseases and conditions such as cancer, heart failure, diseases causing low blood protein levels (for example liver cirrhosis and nephrotic syndrome), bacterial pneumonia
• Pneumothorax is air in the pleural cavity.
• Pneumothorax can be caused by a number of different diseases and conditions, such as a penetrating chest wound, barotrauma to the lungs, chronic lung pathologies including emphysema, asthma, acute infections, acupuncture, chronic infections, such as tuberculosis, cancer and catamenial pneumothorax (due to endometriosis in the chest cavity), and can also arise without significant underlying lung disease in the form of a primary spontaneous pneumothorax.
• the LTA-T may be in the form of a pharmaceutical composition as herein described as part of this invention.
• a subject to be treated may be suffering from one or more of these diseases/conditions or any other disease/condition where pleural effusion or pneumothorax has occurred.
• the LTA-T can be used in combination with a further pleurodesis agent.
• Administration of LTA-T and other pleurodesis agents can be simultaneously, separately and/or sequentially.
• a pleurodesis agent is any agent given into the pleural space that can be used to treat pleural effusion or pneumothorax.
• the other pleurodesis agent can be intrapleural talc, minocycline, Cornebacterium parvum, doxycycline, tetracycline, methylprednisolone acetate, fluorouracil, bleomycin, interferon-B, mitomycin-C, cisplatin, doxorubicin, TGF-beta, quinacrine,
• LTA-T for pleurodesis is by intra-pleural administration. Where the LTA-T is administered with another pleurodesis agent, both are preferably administered intra-pleurally.
• the second aspect of the invention is a kit comprising a pharmaceutical composition comprising LTA-T and instructions indicating that the composition is for use as a pleurodesis agent.
• a pleurodesis agent is an agent for treating pleural effusion or pneumothorax, preferably by intra-pleural administration.
• compositions in accordance with the invention may be supplied as part of a sterile, pharmaceutical composition which will normally include a pharmaceutically acceptable carrier.
• This pharmaceutical composition may be in any suitable form. It may be provided in unit dosage form and will generally be provided in a sealed container.
• the kit of the invention may comprise a plurality of said unit dosage forms.
• the pharmaceutical compositions may be formulated as solutions or suspensions.
• excipients which may be used include, for example, water, polyols and sugars.
• inert oils e.g. vegetable oils
• compositions may contain preserving agents, solubilising agents, stabilising agents, wetting agents, emulsifiers, sweeteners, colourants, odourants, salts, buffers, coating agents or antioxidants. They may also contain further therapeutically active agents.
• Dosages of the substances of the present invention can vary between wide limits, depending upon the condition to be treated, the health of the individual to be treated, etc. and a physician may determine appropriate dosages to be used.
• the formulations may conveniently be presented in unit dosage form and may be prepared by any methods well known in the art of pharmacy.
• the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will vary depending upon the host being treated, the particular mode of administration.
• the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will generally be that amount of LTA-T which produces a therapeutic effect.
• the dosage of LTA-T according to the present invention is between 250 micrograms and 3000 micrograms including 300 micrograms to 400 micrograms, 700 micrograms to 800 micrograms and 1450 micrograms to 1550 micrograms. In a further embodiment, the dosage of LTA-T according to the present invention is between 750 micrograms to 1500 micrograms (10-20 micrograms/kilogram) including 900 micrograms to 1100 micrograms. The dosage may be repeated as often as appropriate.
• the dosage of LTA-T is between 50 micrograms to 550 micrograms, including 100 micrograms to 250 micrograms, 250 micrograms to 400 micrograms and 400 to 550 micrograms, and is administered repeatedly.
• the dosage may be repeated hourly, daily, weekly or over any other appropriate time period.
• compositions and uses described in this application are envisaged to have human and veterinary applications. They are preferably applicable to mammals, in particular humans, but are also applicable for use in production animals, in particular sheep, cows, pigs, chickens and goats, as well as companion animals, in particular cats and dogs and sporting animals, such as horses.
• the third aspect of the invention is a method of treating pleural effusion or pneumothorax comprising administering LTA-T to a subject.
• the method is preferably carried out on a subject in need of treatment.
• the subject is a mammal.
• the subject is a human.
• the LTA-T may be in the form of a pharmaceutical composition as herein described as part of this invention.
• treatment is primarily therapeutic treatment.
• LTA-T can be administered to a pleural cavity that does not contain fluid or air after pneumothorax or pleural effusion has been resolved to stop recurrence of pneumothorax or pleural effusion.
• the fourth aspect of the invention is the use of lipoteichoic acid T (LTA-T) in the manufacture of a medicament for treating pleural effusion or pneumothorax.
• LTA-T lipoteichoic acid T
• FIGURE 1 illustrates the chronological scheme of the clinical trial conducted to test LTA-T for treating pleural effusion.
• FIGURE 2 illustrates pleural fluid production by week of study in all patients (figure 2a) and patients receiving 750mcg LTA-T or more (figure 2b). Individual patient results are shown in addition to mean and error bars for each group. P value derived from paired t-test.
• FIGURE 3 illustrates the change in peripheral white cell count 24 hours after administration of intrapleural saline control or LTA-T, in all patients (figure 3a) and patients receiving 750mcg LTA-T or more (figure 3b). Individual results are shown and mean and SD data for each group.
• the protocol included administration of an intrapleural saline control followed by seven days pleural fluid production measurement prior to the administration of LTA- T to allow the assessment of any side-effects from LTA-T administration, and both acute pleural fluid production changes and the frequency of long-term pleurodesis efficacy after intrapleural LTA-T (see figure 1).
• the subjects were adults (aged >18) with histocytologically proven malignant pleural effusion requiring symptomatic treatment.
• the initial dose based on prior human and animal experience was a 250mcg intrapleural. There were no adverse events after administration of intrapleural saline control. The second patient experienced mild fever (subsequently shown to be a concomitant urinary tract infection, table 2), and the dose escalation was halved for patients 3 & 4.
• Patient 8 deteriorated rapidly from progressive malignancy without receiving LTA-T and was withdrawn from the study. This patient's data is excluded from the analysis.
• the study was terminated when patient 14 (3,000 meg), developed a systemic inflammatory reaction likely to be attributable to the trial drug, requiring hospital re-admission.
• the therapeutic dose was found to be 750mcg to 1500 meg based on the presence of detectable systemic inflammation at this dose identified from a rise in white blood cell count, Figure 3b.
• pleural fluid control was assessed by noting which patients required late therapeutic (>500 mis) pleural fluid drainage from their indwelling catheter in association with symptoms (excluding the subject not capable of achieving pleurodesis due to trapped lung). 12/13 (92%) patients did not require any further therapeutic pleural drainage beyond 1 month from trial entry. Between day 14 (when the indwelling catheter was first locked closed) and 1 month, 3 further patients received one therapeutic fluid drainage (pleurodesis success from day 14 9/12 (75%)). In those patients receiving a dose >750mcg of intrapleural LTA-T, 6/7 required no therapeutic drainage at 1 month (86% pleurodesis success rate).
• LTA-T was tested in 13 humans in a phase l/2a clinical trial.
• a dose of 750mcg to 1000 meg produced effective pleurodesis, with almost no pain, no evidence of depressed blood oxygen levels and no other significant adverse effects.
• Toxicity at the therapeutic dose was mild with no consistent side effect profile, and was substantially less than expected with the clinical standard of talc pleurodesis. No blood parameter, performance status or respiratory status toxicities were seen.
• Intrapleural LTA-T administration was followed by a reduction in pleural fluid production over the week after drug administration.
• effective pleurodesis occurred in 75% of subjects after one month, where pleurodesis was technically achievable. This is comparable to the therapeutic efficacy of talc pleurodesis but without the side effects associated with talc pleurodesis.
• LTA-T The toxicity profile of LTA-T compares favourably with that of intra-pleural talc, the most commonly used pleurodesis agent in the UK, USA and worldwide.

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Citations (3)

• 2007
  • 2007-09-07 GB GBGB0717442.8A patent/GB0717442D0/en not_active Ceased
• 2008
  • 2008-09-08 AT AT08788551T patent/ATE545424T1/de active
  • 2008-09-08 WO PCT/GB2008/003019 patent/WO2009030929A1/en not_active Ceased
  • 2008-09-08 EP EP08788551A patent/EP2194991B1/en not_active Not-in-force
  • 2008-09-08 ES ES08788551T patent/ES2382501T3/es active Active
  • 2008-09-08 CN CN2008801059024A patent/CN101801392B/zh not_active Expired - Fee Related
  • 2008-09-08 JP JP2010523589A patent/JP5623906B2/ja not_active Expired - Fee Related
  • 2008-09-08 US US12/676,742 patent/US8536139B2/en not_active Expired - Fee Related

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