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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/08—Peptides having 5 to 11 amino acids
  • A61K38/085—Angiotensins
• • A—HUMAN NECESSITIES
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  • A61K31/00—Medicinal preparations containing organic active ingredients
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  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/4164—1,3-Diazoles
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence
  • A61P25/32—Alcohol-abuse
• • A—HUMAN NECESSITIES
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  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D409/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having sulfur atoms as the only ring hetero atoms
  • C07D409/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having sulfur atoms as the only ring hetero atoms containing two hetero rings
  • C07D409/10—Heterocyclic compounds containing two or more hetero rings, at least one ring having sulfur atoms as the only ring hetero atoms containing two hetero rings linked by a carbon chain containing aromatic rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K7/00—Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
  • C07K7/04—Linear peptides containing only normal peptide links
  • C07K7/14—Angiotensins: Related peptides

Definitions

• the present invention refers to a peptidic or non-peptidic angiotensin ⁇ 1-7) (Ang-(l-7)) receptor agonist, preferably a Mas receptor agonist, for the prevention and/or treatment of acute lung injury, preferably acute respiratory distress syndrome.
• Ang-(l-7) angiotensin ⁇ 1-7) receptor agonist
• ALI acute lung injury
• ARDS acute respiratory distress syndrome
• the pathological hallmarks of the disease comprise diffuse alveolo-capillary injury and an increased lung permeability associated with a strong inflammatory response (3,4). These changes underlie the clinical presentation which is characterized by an acute onset, severe hypoxemia and a proteinaceous lung oedema.
• ACE2 angiotensin converting enzyme 2
• ATI Ang II type 1 receptor
• the cleavage product of Ang II by ACE2, Ang-(l-7), is not an inert waste product of the angiotensin-pathway, but may exert active biological functions.
• Ang-(1- 7) binds to the G protein-coupled receptor Mas (14) which appears to be a physiological antagonist of the ATIa receptor (15), and potentially to other receptors. Binding of Ang-(l-7) to its receptor(s) may thus contribute critically to the previously demonstrated beneficial effects of interventions in the angiotensin pathway on the pathology of ALI/ ARDS.
• the patent US 6,235,766 refers to non-peptidic agonists of Ang-(l-7) receptors, and particularly discloses l-(p-thienylbenzyl)imidazoles having a marked action on Ang-(l-7) receptors and mimicking the biological action of the effector hormone Ang-(l-7).
• the international patent application WO 2006/128266 refers to the interaction between the Mas receptor and Ang-(l-7) or its analogues in the context of controlling the functions of the reproductive system.
• the international patent application WO 2007/000036 refers to the use of peptidic or non- peptidic Mas receptor agonists and antagonists as apoptotic activity modulators.
• the international patent application WO 2007/121546 refers to the use of peptidic or non- peptidic Mas receptor agonists for modulating metabolic activities related to the clinical manifestation of the metabolic syndrome or its complications.
• the object of the present invention is to provide means and methods for a pharmacological intervention in the patho-physiologic events underlying ALI/ARDS.
• the object of the present invention is solved by an Ang-(l-7) receptor agonist for use in the prevention and/or treatment of an acute lung injury in a subject.
• the object of the present invention is solved by a method for the prevention and/or treatment of an acute lung injury in a subject using an Ang-(l-7) receptor agonist.
• the object of the present invention is further solved by a use of an Ang-(l-7) receptor agonist for the preparation of a pharmaceutical composition for the prevention and/or treatment of an acute lung injury in a subject.
• the object of the present invention is further solved by a method of prevention and/or treatment of an acute lung injury by administering an Ang-(l-7) receptor agonist to a subject.
• the Ang-(l-7) receptor agonist is a Mas receptor agonist.
• the Ang-(l-7) receptor agonist interacts with a Mas receptor or a receptor associated with a Mas receptor.
• the Ang-(l-7) receptor agonist stimulates a receptor that physically interacts with a Mas receptor.
• the Ang-(l-7) receptor agonist stimulates a receptor that shares pharmacological similarities with a Mas receptor.
• the Ang-(l-7) receptor agonist is an Ang II metabolite sharing structural similarities with the Ang-(l-7) peptide.
• the receptor agonist is a peptidic or non-peptidic agonist.
• the peptidic agonist is an exogenous or endogenous Ang-(l-7) peptide comprising an amino acid sequence Asp'-Arg 2 -Val 3 -Tyr 4 -Ile 5 -His 6 -Pro 7 according to SEQ ID NO: 1 or is a derivative or analogue thereof.
• the peptidic agonist is a derivative or analogue of the Ang-(l-7) peptide, the derivative or analogue comprising an amino acid exchange, deletion or insertion.
• the derivative or analogue has conserved or better agonistic properties.
• the peptidic agonist is a derivative or analogue of the Ang-(l-7) peptide, the derivative or analogue comprising an amino acid sequence Asp 1 -Arg 2 -Val 3 -Ser 4 -Ile 5 -His 6 - Pro 7 according to SEQ ID NO: 2, Asp'-Arg 2 -Val 3 -Tyr 4 -Ile 5 -His 6 -Cys 7 according to SEQ ID NO: 3 or Asp'-Arg ⁇ Val ⁇ Se ⁇ lle'-His ⁇ Cys 7 according to SEQ ID NO: 4.
• the peptidic agonist is a peptide comprising an amino acid sequence according to SEQ ID NO: 2, SEQ ID NO: 3 or SEQ ID NO: 4.
• the peptidic agonist is an exogenous or endogenous NorLeu3-Ang-(l-7) peptide comprising an amino acid sequence Asp'-Arg 2 -NorLeu 3 -Tyr 4 -Ile 5 -His 6 -Pro 7 according to SEQ ID NO: 5 or is a derivative or analogue thereof.
• the peptidic agonist is an exogenous or endogenous Ang IV peptide comprising an amino acid sequence Val 1 -Tyr 2 -Ile 3 -His 4 -Pro 5 -Phe 6 according to SEQ ID NO: 6 or is a derivative or analogue thereof.
• the peptidic agonist is an exogenous or endogenous Ang III peptide comprising an amino acid sequence Arg 1 -Val 2 -Tyr 3 -Ile 4 -His 5 -Pro 6 -Phe 7 according to SEQ ID NO: 7 or is a derivative or analogue thereof.
• the non-peptidic agonist is selected from the group of l-(p- thienylbenzyl)imidazole compounds, and preferably is Ave 0991 (i.e. 5-formyl-4-methoxy-2- phenyl- 1 - [[4- [2-(ethylaminocarbonylsulfonamido)-5 -isobutyl-3 -thienyl]phenyl]methy 1] - imidazole).
• the acute lung injury is an acute respiratory distress syndrome.
• the acute lung injury is related to a pulmonary (direct) or an extrapulmonary (indirect) lung injury.
• the pulmonary lung injury is selected from the group consisting of inhalation trauma, aspiration trauma, toxic lung oedema, lung infection, preferably pneumonia, lung contusion, and embolism.
• the extrapulmonary lung damage is associated with a disorder selected from the group consisting of sepsis, systemic inflammatory response syndrome (SIRS), polytrauma, shock, burn, acute pancreatitis, drug intoxication, alcohol abuse, chronic lung disease, mass transfusion, disseminated intravascular coagulation, erythema, and autoimmune lung disease.
• SIRS systemic inflammatory response syndrome
• the subject is a mammal, preferably a human, most preferably an adult human.
• the object of the present invention is further solved by a pharmaceutical composition comprising an Ang-(l-7) receptor agonist for use in the prevention and/or treatment of an acute lung injury in a subject.
• the object of the present invention is further solved by a method for the prevention and/or treatment of an acute lung injury in a subject using a pharmaceutical composition comprising an Ang-(l-7) receptor agonist.
• the Ang-(l-7) receptor agonist is a Mas receptor agonist.
• the receptor agonist is a peptidic or non-peptidic agonist.
• the peptidic agonist is an Ang-(l-7) peptide comprising an amino acid sequence according to SEQ ID NO: 1 or is a derivative or analogue thereof.
• the peptidic agonist is a peptide comprising an amino acid sequence according to SEQ ID NO: 2, SEQ ID NO: 3 or SEQ ID NO: 4.
• the peptidic agonist is a peptide comprising an amino acid sequence according to SEQ ID NO: 5 or is a derivative or analogue thereof. In one embodiment of the pharmaceutical composition, the peptidic agonist is an Ang IV peptide comprising an amino acid sequence according to SEQ ID NO: 6 or is a derivative or analogue thereof.
• the peptidic agonist is an Ang III peptide comprising an amino acid sequence according to SEQ ID NO: 7 or is a derivative or analogue thereof.
• the non-peptidic agonist is selected from the group of l-(p-thienylbenzyl)imidazole compounds, and preferably is Ave 0991 (i.e. 5-formyl-4-methoxy-2-phenyl-l-[[4-[2-(ethylaminocarbonylsulfonamido)-5-isobutyl-3- thienyl]phenyl]methyl]imidazole).
• the acute lung injury is an acute respiratory distress syndrome.
• the acute lung injury is related to a pulmonary (direct) or an extrapulmonary (indirect) lung injury.
• the pulmonary lung injury is selected from the group consisting of inhalation trauma, aspiration trauma, toxic lung oedema, lung infection, preferably pneumonia, lung contusion, and embolism.
• the extrapulmonary lung damage is associated with a disorder selected from the group consisting of sepsis, polytrauma, shock, burn, acute pancreatitis, drug intoxication, alcohol abuse, chronic lung disease, mass transfusion, disseminated intravascular coagulation, erythema, and autoimmune lung disease.
• the subject is a mammal, preferably a human, most preferably an adult human.
• the pharmaceutical composition is formulated for a parenteral or enteral administration, preferably for a parenteral administration by the route of inhalation, infusion or injection.
• a pharmaceutical composition formulated for an oral, an intramuscular, an intravenous, a subcutaneous, a topical, a transdermal, a rectal, a vaginal, a pulmonary, an intranasal, an intrabuccal, or a sublingual administration is also considered.
• the pharmaceutical composition is formulated as a tablet, a pill, a capsule, granules, a syrup, a spray, an aerosol, a liposomal composition, an ointment, a suppository, an implant, a plaster, or a slow release formulation.
• the pharmaceutical composition further comprises one or more pharmacologically inert and pharmaceutically acceptable excipients such as a polymer carrier, a disintegration agent, a lubricant, a solvent, or a swelling agent.
• pharmacologically inert and pharmaceutically acceptable excipients such as a polymer carrier, a disintegration agent, a lubricant, a solvent, or a swelling agent.
• receptor agonist refers to an agent being capable of activating a receptor, i.e. eliciting a receptor response.
• Ang-(l-7) receptor agonist refers to an agent being capable of activating a receptor that is also activated by Ang-(l-7).
• Mc receptor agonist refers to an agent being capable of activating the G protein-coupled Mas receptor.
• Ang-(l-7) signalling is blocked by A779 ([D-Ala 7 -Ang-(l-7); Asp'-Arg 2 -Val 3 -Tyr 4 -Ile 5 - His 6 -D-Ala 7 , SEQ ID NO: 8) and/or D-Pro 7 -Ang-(l-7) (Asp'-Arg 2 -Val 3 -Tyr 4 -Ile 5 -His 6 -D-Pro 7 , SEQ ID NO: 9), a further characteristic of an Ang-(l-7) agonist is the inhibition of its effects by A779 and/or D-Pro 7 -Ang-(l-7). Further non-competitive or competitive inhibitors are also considered.
• peptidic agonist refers to a compound comprising one or more peptide bonds.
• the term encompasses compounds consisting of a pure peptidic structure, i.e. a peptide composed of two or more amino acids, as well as compounds comprising peptidic and non-peptidic structures.
• non-peptidic agonist refers to a compound not comprising a peptide bond.
• a compound is of low molecular weight, i.e. a small molecule.
• derivative means a compound differing from another compound by a structural modification, for example by replacement of one atom or a group of atoms or a functional group with another atom or group of atoms or functional group.
• analogue means a compound which is similar in structure or function to another compound.
• exogenous Ang-(l-7) means Ang-(l-7) that is produced outside of the subject's body to be treated and is exogenously applied. This, however, does not exclude that Ang-(l-7) is produced in e.g. a transgenic animal not to be treated. Generally considered is Ang-(l-7) produced by biosynthesis or conventional lab synthesis, e.g. solid-phase synthesis.
• endogenous Ang-(l-7) means that Ang-(l-7) is endogenously produced by the subject's body to be treated.
• An (increased) endogenous production of Ang-(l-7) can be the result of a stimulation of its generation from Ang II, e.g. by pharmacologically activating ACE2, by blocking the ATIa receptor, or by inhibiting the degradation of Ang II to Ang III by APA.
• endogenous Ang-(l-7) production can be increased by stimulation of its generation from Ang I by NEP.
• An (increased) endogenous production can also be the result of a gene therapeutic intervention, e.g.
• ACE2 overexpressing ACE2 or a construct that generates directly Ang-(l-7) or one of its precursors.
• An increased concentration of endogenously produced Ang-(l-7) can also result from a reduced degradation of Ang-(l-7) e.g. by pharmacological inhibition of ACE which degrades Ang-(l-7) to Ang-(l-5).
• ACE2 Recombinant or overexpressed ACE2 will increase the concentration of Ang-(l-7) directly by stimulating its conversion from Ang II.
• ACE inhibitors will reduce Ang-(l-7) degradation to Ang-(l-5) while ATIa receptor blockers will increase Ang-(l-7) levels by elevation of ACE2 substrate availability.
• molecules e.g. peptides or proteins, comprising the Ang-(l-7) peptide sequence or chemical structure.
• ALI and ARDS are inflammatory disorders of the lung most commonly caused by sepsis, pneumonia, trauma, and/or aspiration. Inflammation can be locally restricted to the lung, or the pulmonary inflammation can be part of a systemic inflammatory process.
• ALI and ARDS are characterized by hypoxemia and diffuse infiltrates on chest x-ray in the absence of elevated left atrial pressure. ALI and ARDS differ only in the degree of hypoxemia in that ALI is defined as a ratio of arterial oxygen partial pressure over inspiratory oxygen fraction (PaO 2 /FiO 2 ) ⁇ 300 and ARDS as a PaO 2 /FiO 2 ⁇ 200 (16). Diagnosis is by clinical presentation, ABGs (arterial blood gas analyses) and imaging studies. Treatment is with lung- protective, low tidal volume mechanical ventilation, supportive therapy, and treatment of underlying causes.
• Figure 1 shows the effects of Ang-(l-7) and the non-peptidic Ang-(l-7) receptor agonist
• Rats were anesthetized by intraperitoneal injection of medetomidine (0.5 mg/kg bw, Domitor ® , Dr. E. Graeub AG, Basel, Switzerland), fentanyl (0.05 mg/kg bw, JanssenCilag, Neuss, Germany) and midazolam (5 mg/kg bw, Dormicum ® , Roche, Basel, Switzerland) as previously described (17).
• medetomidine 0.5 mg/kg bw, Domitor ® , Dr. E. Graeub AG, Basel, Switzerland
• fentanyl 0.05 mg/kg bw, JanssenCilag, Neuss, Germany
• midazolam 5 mg/kg bw, Dormicum ® , Roche, Basel, Switzerland
• Catheters (internal diameter 0.58 mm; Sims Portex Ltd., Hythe, United Kingdom) were introduced into the left carotid artery and the right internal jugular vein for monitoring of arterial blood pressure (AP), fluid replacement and drug delivery as previously described (18).
• An ultrasonic flowprobe (Transonic ® , Transonic Systems Inc., Ithaca, UY) was placed around the ascending aorta distal to the branching of the coronary arteries for continuous monitoring of cardiac output (CO). After median thoracotomy, a catheter was introduced via the right ventricle into the pulmonary artery for measurement of pulmonary artery pressure (PAP).
• PAP pulmonary artery pressure
• PVR Pulmonary vascular resistance
• Rats were randomly assigned to four groups of six animals each: Animals in group 1 (control) did not receive any pharmacological interventions.
• group 2 ALI was induced by intravenous infusion of 0.2 mg/kg oleic acid (Sigma, Kunststoff, Germany) over 30 min in the absence of any treatment.
• group 3 OA+Ang-(l-7)
• ALI was induced as in group II, and infusion of Ang-(l-7) at 5 pmol/kg per min was initiated immediately after ALI induction.
• group 4 (OA+AVE0991)
• ALI was induced as in group II, and infusion of AVE0991 at 500 pmol/kg per min was initiated immediately after ALI induction.
• MPO activity was determined by a 3,3'-5,5'-tetramethylbenzidine (TMB)-based photometric assay, compared to appropriate standard curves, and expressed as units per gram lung tissue (U/g).
• TMB 3,3'-5,5'-tetramethylbenzidine
• Ang-(l-7) The protective effect of Ang-(l-7) was apparently not attributable to its described vasodilatory effect in systemic blood vessels, since Ang-(l-7) infusion attenuated systemic hypotension in OA-infused rats.
• the non-peptidic Ang-(l-7) receptor agonist AVE0991 similarly attenuated OA-induced ALL Additional MPO analyses in groups 4 and 5 indicate that blockade of the Mas receptor by A779 aggravates OA-induced ALI, and blocks the rescue effect of Ang-(l-7) infusion.

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