Classifications

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  • A61K38/44—Oxidoreductases (1)
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  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
• • A—HUMAN NECESSITIES
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  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/34—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide
  • A61K31/343—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide condensed with a carbocyclic ring, e.g. coumaran, bufuralol, befunolol, clobenfurol, amiodarone
• • A—HUMAN NECESSITIES
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  • 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
  • A61K31/415—1,2-Diazoles
  • A61K31/4152—1,2-Diazoles having oxo groups directly attached to the heterocyclic ring, e.g. antipyrine, phenylbutazone, sulfinpyrazone
• • A—HUMAN NECESSITIES
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • 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
  • A61K31/4196—1,2,4-Triazoles
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • 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
  • A61K31/425—Thiazoles
  • A61K31/426—1,3-Thiazoles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/53—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with three nitrogens as the only ring hetero atoms, e.g. chlorazanil, melamine
• • 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
  • A61K31/74—Synthetic polymeric materials
  • A61K31/765—Polymers containing oxygen
  • A61K31/77—Polymers containing oxygen of oxiranes
• • 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
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/06—Antiasthmatics
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
  • C12Q1/62—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving uric acid
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Y—ENZYMES
  • C12Y107/00—Oxidoreductases acting on other nitrogenous compounds as donors (1.7)
  • C12Y107/03—Oxidoreductases acting on other nitrogenous compounds as donors (1.7) with oxygen as acceptor (1.7.3)
  • C12Y107/03003—Factor-independent urate hydroxylase (1.7.3.3), i.e. uricase
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
  • G01N33/5308—Immunoassay; Biospecific binding assay; Materials therefor for analytes not provided for elsewhere, e.g. nucleic acids, uric acid, worms, mites
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/12—Pulmonary diseases
  • G01N2800/122—Chronic or obstructive airway disorders, e.g. asthma COPD
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
  • Y10T436/00—Chemistry: analytical and immunological testing
  • Y10T436/14—Heterocyclic carbon compound [i.e., O, S, N, Se, Te, as only ring hetero atom]
  • Y10T436/145555—Hetero-N
  • Y10T436/147777—Plural nitrogen in the same ring [e.g., barbituates, creatinine, etc.]
  • Y10T436/148888—Uric acid

Definitions

• the present invention is directed to the use of a compound capable of reducing the uric acid level in a mammal for the prevention and/or the treatment of IL-I ⁇ driven lung pathology, particularly to treat lung inflammation such as chronic fibrosis, CPOD and interstitial fibrosis and other IL- l ⁇ driven lung pathologies including those of autoimmune origin.
• Preferred compounds capable of reducing the uric acid level are selected from the group consisting of xanthine oxidase inhibitors, such as allopurinol, recombinant enzyme uricase and uricosuric compound capable of enhancing uric acid excretion, such as probenecid.
• the invention further relates to a method for identifying in vitro whether a patient presents an IL- l ⁇ driven lung pathology or is at risk to develop an IL- l ⁇ driven lung pathology, or for the screening of a compound for treating an IL- l ⁇ driven lung pathology in a patient in need thereof.
• Microbial components and cell damage represent danger signals and trigger innate immunity resulting in inflammation and repair (4).
• Dying cells release danger signals that alert the immune system and stimulate innate and adaptive immunity (5,6).
• Danger signals released from dying cells are recognized at the cell level via membrane receptors such as TLRs (7,8,9,39) or cytosolic receptors such as NLRs (10-14,36).
• Nucleic acids from injured cells are rapidly degraded and the purines are converted into uric acid.
• Uric acid a product of purine catabolism, was identified in dying cells inducing the maturation and antigen presentation function of dendritic cells (16). Large amounts of uric acid are produced from injured tissue in vivo after tumor chemotherapy leading to hyperuricemia (17).
• uric acid precipitates and forms crystals which cause inflammation as observed in clinical gout (57).
• Uric acid crystals activate the NALP3 inflammasome containing caspase-1 resulting in the production of active interleukin (IL)- l ⁇ (10).
• Hyperuricemic syndromes including gout can be effectively treated by inhibiting uric acid production, enhancing the degradation or urinary excretion (see the scheme of figure 9 which shows the purine metabolism).
• Interstitial pulmonary fibrosis is a chronic disease with recurrent episodes of acute lung injury which often leads respiratory failure with death. Importantly no effective therapy is available (1).
• the cause of the recurrent lung inflammation resulting in interstitial pulmonary fibrosis is mostly unknown.
• chronic airways irritation by pollutants, irradiation or tumor chemotherapy with bleomycin may cause similar fibrotic lung pathology.
• Bleomycin in experimental settings causes oxidative damage and cell death leading to lung inflammation and fibrosis which resembles interstitial pulmonary fibrosis (2,38).
• IL- l ⁇ is produced in order to provide a method for the prevention and/or the treatment of lung inflammation and lung fibrosis.
• bleomycin-induced inflammation depends on the activation of the NALP3 inflammasome. They have demonstrated here that uric acid is locally produced in the lung upon tissue injury and causes inflammation and fibrosis via the production of the inflammatory cytokine IL- l ⁇ . Uric acid crystals given by the intranasal route caused dose-dependent NALP3 - IL-IRl dependent inflammation (summarized in Figure 8).
• uric acid The metabolism of uric acid is well established and only relevant points are highlighted: Xanthine oxidase oxidizes hypoxanthin to xanthin and uric acid, which is degraded by uricase to allantoin which is eliminated by the kidney. In the kidney uric acid elimination is enhanced by inhibiting tubular reabsorption by blocking the organic anion transporter, URATl .
• inhibitors are well known by the person having ordinary skill in the art and some of them are in clinical use:
• Allopurinol is a xanthine oxidase inhibitor and reduces the formation of uric acid • Recombinant uricase degrades uric acid and thereby reduced hyperuricemia
• therapeutic tools to decrease uric acid levels can be used to reduce injury-induced cell death and lung inflammation and lung fibrosis.
• uric acid is released upon bleomycin lung injury, and present compelling evidence that uric acid is critically involved in the activation of the NALP3 inflammasome resulting in caspase-1 activation which cleaves pro- IL- l ⁇ to mature IL- l ⁇ , which is then causing lung inflammation and fibrosis (Figure 8).
• the present invention relates to the use of a compound capable of reducing the uric acid level in a mammal for the preparation of a composition intended to the prevention and/or the treatment of IL-I ⁇ driven lung pathology.
• the instant invention also comprises a method for the prevention and/or the treatment of IL-I ⁇ driven lung pathology in a mammal, especially humans, in need thereof by administering to such mammal an effective serum uric acid reducing amount of a therapeutical compound.
• said IL- l ⁇ driven lung pathology is selected from the group consisting of lung inflammation, lung fibrosis such as chronic fibrosis, chronic obstructive pulmonary disease (COPD) and interstitial fibrosis and lung pathologies from autoimmune origin.
• COPD chronic obstructive pulmonary diseases
• the preferred chronic obstructive pulmonary diseases are selected from the group consisting of asthma, bronchiectasis, chronic bronchitis, emphysema and any inflammatory lung disease including allergies.
• said IL- l ⁇ driven lung pathology is selected from the group consisting a lung inflammation leading to fibrosis and respiratory failure.
• the compound capable of reducing the uric acid level is selected from the group consisting of:
• xanthine oxidase inhibitor which is able to reduce uric acid concentrations through inhibiting uric acid production, or a pharmaceutically acceptable salt thereof;
• xanthine oxidase inhibitor compounds selected from the group consisting of:
• purified uricase or urate oxydase such as the urate oxydase extracted from Aspergillus flavus (known as Uricozyme®) preferably recombinant uricase or urate oxydase, such as rasburicase (recombinant urate oxydase from Aspergillus flavus expressed in Saccharomyces cerevisiae), or a functional fragment thereof.
• Uricozyme® urate oxydase extracted from Aspergillus flavus
• rasburicase recombinant urate oxydase from Aspergillus flavus expressed in Saccharomyces cerevisiae
• PEGylated uricases which are less antigenic than uricase and which can rapidly reduce serum uric acid concentrations (Bomalaski et al., Curr. Rheumatol. Rep 2004; 6:240-247).
• PEGylated uricases or urate oxydases it is intended to designate naturally occurring or recombinant uricase (urate oxidase) covalently coupled to poly(ethylene glycol) or poly(ethylene oxide) (both referred to as PEG), particularly wherein an average of 2 to 10 strands of PEG are conjugated to each uricase subunit, preferably wherein the PEG has an average molecular weight between about 5 kDa and 100 kDa.
• the resulting PEG-uricase conjugates were shown to be substantially non- immunogenic and to retain at least 75% of the urico lytic activity of the unmodified enzyme (see United States Patent 6,576,235, published on June 6, 2003, the complete disclosure of which is hereby incorporated by reference).
• uricosuric compounds selected from the group consisting of:
• probenecid (4-[(dipropylamino) sulfonyl] benzoic acid, an anion transport inhibitor)
• benzbromarone (3,5-dibromo-4-hydroxyphenyl-2-ethyl-3-benzofuranyl ketone)
• said composition is administered by intravenous injection, by intramuscular injection, by subcutaneous injection or orally.
• the daily dosing of the active ingredient depends of the administration route chosen for the treatment.
• the dose will also depend on the amount of uric acid found in the biological sample in the patient to be tested.
• the skill person knows how to determine the best dosing in function of the age, the body weight and the data obtained relative to the serum, plasma or urine concentrations determined before and/or during the treatment.
• the prevention or the treatment of said IL- l ⁇ driven lung pathology such as lung inflammation, lung fibrosis and lung pathologies from autoimmune origin
• the active allopurinol or Febuxostat xanthine oxidase inhibitor ingredient can be administered to a subject suffering such a pathology for the duration of a few days in a daily dosage of up to about 1500 mg/d, preferably up to about 1000 mg/g, between about 40 and about 750 mg/d, and more preferably a daily dosage in the range of between 80 and 500 mg/d and between 120 and 400 mg/d.
• the active probenicid ingredient via oral route can be from 100 to 250 mg two times a day for about one week, then 200 to 500 mg two times a day for a few weeks.
• the active uricase ingredient can be administered to a subject suffering such a pathology for the duration of a few days in a daily dosage of up to about 2 mg/kg/d, preferably up to about 0.75, 0.50 and 0.35 mg/kg/d, preferably between about 0.10 and 0.30 mg/kg/d and, and more preferably a daily dosage in the range of between about 0.15 and 0.25 mg/kg/d, preferably by intravenous injection.
• the uricase ingredient can be administered as intravenous injections every 2 weeks at 4- and 8-mg doses or every 4 weeks at 8- or 12-mg doses for 12 weeks.
• Serum/plasma uricase concentrations, serum/plasma uric acid or urate, and, optionally, serum/plama antibody anti-uricase can be determined during the treatment for better adjusting the treatment (seng Yue et al., The Journal of Clinical Pharmacology 2008; 48:708).
• the skill person knows how to determine the best doses in function of the age, the body weight and the data obtained relative to said serum/plasma concentrations.
• the present invention is directed to a method for identifying in vitro whether a patient presents a IL- l ⁇ driven lung pathology or is at risk to develop a IL- l ⁇ driven lung pathology, wherein this method comprising the following steps of: a) obtaining from the patient to be tested a biological fluid sample, particularly serum, plasma or urine sample; b) determining the level of uric acid or urate; and c) identifying whether said patient presents or is at risk to develop such a pathology by comparing the level of uric acid obtained for the patient to be tested with the level of uric acid or urate obtained in a blood sample for normal patients and/or for patients exhibiting a IL- l ⁇ driven lung pathology.
• the patient to be tested exhibits lung pathology symptom such as lung inflammation.
• the biological sample is a serum, plasma or urine sample.
• bronchoalveolar lavage sample can be also used.
• an uricemic control superior to 70 mg/L, more preferably 80, 90 and 100 mg/L of uric acid in serum or plasma sample is significant of an increased risk to develop or to present such a lung pathology.
• uric acid in biological fluid sample such as serum or plasma sample
• methods for the determination of uric acid in biological fluid sample are well known by the skill man. They can be for example enzymatic methods utilizing the enzyme uricase, methods based upon the ability of uric acid to reduce alkaline phosphotungstate, or miscellaneous chemical colorimetric methods. They are a wide variety of methods currently in use today for the uric acid or urate assay.
• the uric acid assay kit ((Catalog #K608-100) from Bio Vision (Bio Vision Research Products, 980 Linda Vista Avenue, Mountain View, CA 94043 USA) or the Amp lex® Red Uric Acid/Uricase Assay Kit (A22181) from Molecular Probes (29851 Willow Creek Road, Eugene, OR 97402, USA)) wherein serum uric acid level can be measured using fluorometric or colorimetric methods can be cited.
• the present invention is directed to a method for screening a compound for the treatment of lung pathology associated to IL- l ⁇ pathway ( " IL- l ⁇ driven lung pathology”), wherein this method comprising the following steps of identifying whether said compound to be tested has a xanthine oxidase inhibitor, an uricase or urate oxydase activity, or is an uricosuric compound or an inhibitor of the tubular organic anion transporter resulting to the augment renal elimination of uric acid.
• said lung pathology associated to IL- l ⁇ pathway to be treated is selected from the group consisting of lung inflammation, lung fibrosis such as chronic fibrosis, chronic obstructive pulmonary disease (COPD) and interstitial fibrosis and lung pathologies from autoimmune origin. More preferably, said lung pathology associated to IL- l ⁇ pathway to be treated is a lung inflammation leading to fibrosis and respiratory failure.
• lung fibrosis such as chronic fibrosis, chronic obstructive pulmonary disease (COPD) and interstitial fibrosis and lung pathologies from autoimmune origin.
• COPD chronic obstructive pulmonary disease
• interstitial fibrosis and lung pathologies from autoimmune origin More preferably, said lung pathology associated to IL- l ⁇ pathway to be treated is a lung inflammation leading to fibrosis and respiratory failure.
• Figures 1A-1F Bleomycin induced lung inflammation and fibrosis depends on IL- l ⁇
• Figures 2A-2F Bleomycin induced IL- l ⁇ production in the lung depends on inflammasome activation
• Figures 3A-3E Uric acid is produced in the lung upon bleomycin administration and inhibition of uric acid synthesis by allopurinol prevents lung inflammation
• Figures 4A-4C Uric acid degradation by uricase inhibits bleomycin induced lung inflammation
• Figures 5A-5D Exogenous uric acid crystals cause inflammation and IL- l ⁇ production
• Figures 6A-6H Exogenous uric acid crystals induced inflammation depends on the NALP3 inflammasome activation
• Figure 7 Schematic summary of our published data on bleomycin induced IL- l ⁇ production, inflammation and fibrosis
• Figure 8 Novel data: Pulmonary uric acid production upon bleomycin lung injury activating the NALP3 inflammasome with the production of IL-I ⁇ resulting in lung inflammation and fibrosis
• Figure 9 Synthesis and metabolism of uric acid: Reduction of uric acid by allopurinol and related xanthine oxidase inhibitors and uricase.
• Figures 10A- 1OF Bleomycin- induced pulmonary inflammation and remodeling are dependent on NALP3 and ASC proteins
• A Neutrophil counts in BALF
• B MPO activity in lung homogenates
• C KC
• D IL-6
• E IL- l ⁇
• F TIMP-I concentrations in lung homogenates, 24h after bleomycin (BLM, 10mg/kg) intranasal instillation (i.n.) instillation of wild-type, NALP3, IL-IRl or ASC deficient mice.
• BBM bleomycin
• intranasal instillation i.n.
• Late inflammation and tissue remodeling were evaluated in wild-type and deficient mice 14 days after administrated with bleomycin (5mg/kg, i.n.).
• A Late inflammation measured as lymphocytes in the BALF.
• B Pro-MMP-9 (100 Kd), Pro-MMP-2 (71 Kd) and active MMP-2 (65 Kd) gelatinase activities, were analyzed by zymography in the BALF.
• C TIMP-I as indicator of a fibrotic process was measured in the lungs by ELISA.
• FIGS 13A-13G Bleomycin-induced inflammation is reduced by uric acid synthesis inhibition
• A Uric acid levels in BALF of mice 6h after saline or bleomycin (BLM intranasal instillation (10mg/kg).
• B Uric acid levels in lung of mice 24h after saline or BLM treatment. Mice received a subcutaneous (s.c.) injection of vehicle or allopurinol (25mg/kg) before BLM instillation and 6 and 9 h after.
• C Total cell and
• D neutrophil counts in BALF after s.c. injection of vehicle or allopurinol and saline or BLM instillation.
• Figures 15A-15F Bleomycin-induced repair and fibrosis are mediated by uric acid Mice were injected at day 0 with allopurinol (15mg/kg, s.c), uricase (0.2mg/kg, i.p.) or saline, at 0, 6 and 9h after BLM instillation (5mg/kg, i.n.) and every second days during 8 or 14 days to evaluate remodeling and fibrosis.
• A Late inflammation measured as lymphocytes and neutrophils in the BALF at day 8.
• Figures 16A-16E Exogenous uric acid crystals cause acute lung inflammation and remodeling
• A Alveolar macrophages (AM) uptake of uric acid (UA) crystals 6h after UA crystals instillation (15mg/kg i.n).
• B Dose response of UA crystals-induced cell recruitment in BALF.
• C Neutrophil counts in BALF 6h after UA or allopurinol crystals instillation (15mg/kg i.n).
• D Kinetics of cell recruitment in BALF upon UA crystals instillation (15mg/kg i.n.).
• Figures 17A- 17 J Pulmonary inflammation upon exogenous uric acid (UA) crystals is dependent upon NALP3 inflammasome and IL-lRl/MyD88 pathways Neutrophil counts in BALF from mice deficient for (A) NALP3, (C) ASC, (E) IL-IRl or MyD88 and (F) in BALF from wild-type mice pretreated i.p. with anakinra (10mg/kg), 6h after exogenous UA crystals instillation (15mg/kg).
• IL- l ⁇ dosages in lung homogenates 6h after exogenous UA crystals administration for (B) NALP3, (D) ASC, (F) IL-IRl or MyD88 deficient mice in comparison to wild-type mice.
• G IL-6, (H) KC, (I) TIMP-I and IL- l ⁇ dosages in lung homogenates, 6h after exogenous UA crystals administration of wild-type or IL-IRl or MyD88 gene deficient mice.
• Figures 18A-18D Pulmonary inflammation upon exogenous uric acid (UA) crystals is independent of IL-18R but requires TLR2 or TLR4 for optimal inflammation.
• A Neutrophils count in BALF and
• B IL- l ⁇ in lung homogenates of TLR2, TLR4 or TLR2/TLR4 deficient mice.
• C Neutrophil counts in BALF and
• D IL- l ⁇ in lung homogenates of IL-18R deficient mice. Mice were sacrif ⁇ ed 6h after exogenous UA crystals instillation (15mg/kg).
• Figures 19A and 19B Schematic diagram illustrating the specific cascades and signaling pathways after bleomycin- induced lung injury (A) or after lung exposition to exogenous uric acid crystals (B).
• TLR2 or TLR4 are necessary for IL- l ⁇ production and cellular influx.
• TLR2 and/or TLR4 may be involved in crystal-induced production of pro- IL-l ⁇ or in uric acid crystals uptake by alveolar macrophages and/or resident cells.
• EXAMPLE 1 MATERIALS AND METHODS Mice
• mice are purchased from commercial sources or obtained from their laboratories of origin and bred as previously described (3) and (40). All animal experiments complied with the French Government's ethical and animal experiment regulations. The following mice deficient for MyD88 (19), IL-IRl (20), IL-18R (21), Casp-1 (22), TLR4 (23), TLR2 (24), NALP3 (10) or ASC (25) were used in this study.
• MyD88-/-, Casp-1- /-, TLR2-/-, ASC-/- TLR4-/-, double deficient TLR2-/-TLR4-/- and IL- 18R were backcrossed 10 times on the wild type C57BL/6 genetic background except in Figure 1 where ASC-/-, backcrossed only 4 times were compared to their ASC+/+ littermate.
• IL- IRl-/- mice were backcrossed 7 times and NALP3-/- mice were directly generated on the C57BL/6 genetic background. All mice, including control C57BL/6, were bred in our animal facility at the Transgenose Institute (CNRS, La). For experiments, adult (6-10 weeks old) animals were kept in sterile isolated ventilated cages. All animal experiments complied with the French Government's ethical and animal experiment regulations. Bleomycin-, uric acid or allopurinol crystals-induced inflammation
• Bleomycin sulfate 200-300 ⁇ g or 10-15 mg/kg from Bellon Laboratories (Montrouge, France) in saline, uric acid or allopurinol crystals (100-1000 ⁇ g or 5- 50 mg/kg) in saline or saline alone are given through the airways by nasal instillation in a volume of 40 ⁇ L under light ketamine-xylasine anaesthesia.
• the number of cells, chemokines, cytokines and TIMP-I in the bronchoalveolar space and in the lung were evaluated as described (3).
• Allopurinol (Sigma-Aldrich) was injected at 500 ⁇ g or 25mg/kg subcutaneously in 0.1 -ml sterile NaCl, uricase (Fasturtec, Sanof ⁇ Synthelabo) given at 4 ⁇ g or 0.2 mg/kg by nasal instillation in 40 ⁇ L at the time of bleomycin administration, at 6 and 9 h.
• the IL-IRa (Anakinra, Amgen) was injected at 200 ⁇ g or 10 mg/kg subcutaneously in 0.1 -ml sterile NaCl, at the time of MSU crystals administration, at 2 and 4h.
• Uric acid or allopurinol crystals preparation Uric acid or allopurinol crystals preparation
• Uric acid or allopurinol crystals were obtained by dissolving 1.68 mg of powder in 0.01 M NaOH preheated to 70 0 C and added as required to maintain pH between 7.1 and 7.2. The solution was filtered and incubated at room temperature under slowly and continuously agitation, until crystals have formed. Crystals were washed twice with ethanol 100%, dried, autoclaved and kept sterile. The weight of dry crystals was determined under sterile conditions, crystals are resuspended in PBS by sonication and examined under phase microscopy.
• Bleomycin sulfate (10mg/kg) from Bellon Laboratories, uric acid or allopurinol crystals (5-50mg/kg) in saline or vehicle alone were administered by intranasal instillation under light ketamine-xylasine anesthesia, and BAL and lung tissue assayed after 6h (for uric acid crystal) or 24h (for bleomycin) for markers of inflammation including cell recruitment and in particular neutrophil influx, chemokine and cytokine levels including KC, IL-6 and IL- l ⁇ and 14 days later for markers of tissue remodeling such as gelatinases MMP9 and MMP2 and their inhibitor TIMP-I.
• Allopurinol (Sigma- Aldrich) was injected at 25mg/kg subcutaneously and uricase (Fasturtec, Sanof ⁇ Synthelabo) was given at 0.2mg/kg intraperitonally or intranasally in some experiments with similar efficacy.
• IL-IRa (Anakinra, Amgen) was injected at 10mg/kg subcutaneously. Optimized doses of allopurinol or uricase were tested and repeated administrations were more effective than higher doses (data not shown).
• BALF Bronchoalveolar lavage fluid
• the cell pellet was then resuspended in 0.4ml PBS and, pooled with the second fraction and maintained at 4°C until cell determination.
• Lung homogenization After BAL was performed, the whole lung removed and placed inside a microtube (Lysing matrix D, Q Bio Gene, Illkrich, France) with 1 ml of PBS, total lung tissue extract was prepared using a Fastprep ® system (FP 120, Q Bio Gene, Illkrich, France), the extract was then centrifuged and the supernatant stored at -80 0 C before mediator measurement, MPO or collagen assay with Sircol Collagen Assay (France Biochem Division, France). Myeloperoxidase activity (MPO) in lung Lung tissue MPO activity was evaluated as described (3).
• MPO Myeloperoxidase activity
• the right heart ventricle was perfused with saline to flush the vascular content and lungs were frozen at -20 0 C until use. Lung was homogenized by polytron, centrifuged and the supernatant was discarded. The pellets were resuspended in 1 mL PBS containing 0.5% hexadecyltrimethyl ammonium bromide (HTAB) and 5 mM ethylene-diamine tetra- acetic acid (EDTA).
• HTAB hexadecyltrimethyl ammonium bromide
• EDTA ethylene-diamine tetra- acetic acid
• Total cell count was determined in BAL fluid using a particle counter (Z2 Coulter, Beckman Coulter). Differential cell counts were performed on cytospin preparations (Cytospin 3, Thermo Shandon) after staining with 4 min May-Grunwald stain (MG-IL, Sigma chemical, Saint Louis, USA) and 8 min in 95% Giemsa stain (GS- 500, Sigma chemical, Saint Louis, USA). Differential cell counts were made on 100 cells using standard morphological criteria. Mediator measurements
• IL- l ⁇ , KC, IL-6 and TIMP-I levels in BAL fluid or lung homogenate were determined using ELISA assay kits according to manufacturer's instructions (Mouse DuoSet, R&D system, Minneapolis, USA).
• IL- l ⁇ ELISA assay kit (mouse IL-l ⁇ /IL- 1F2) specific for natural and recombinant mouse IL- l ⁇ exhibited no cross-reactivity or interference with recombinant mouse IL- l ⁇ , IL- Ira, IL-1RI/Fc Chimera or IL-1RII/Fc Chimera (Mouse IL-I specific polyclonal goat IgG and Monoclonal rat IgGl, clone # 30311).
• Uric acid measurement
• Uric acid concentration was determined in bronchoalveolar lavages and lung homogenates using Amplex® Red Uric Acid/Uricase Assay Kit (Molecular Probe, Eugene). Briefly, uricase catalyzes the conversion of uric acid to allantoin, hydrogen peroxide (H 2 O 2 ) and carbon dioxide. In the presence of horseradish peroxidase (HRP), H 2 O 2 reacts stochiometrically with Amplex Red reagent to generate the red-fluorescent oxidation product, resorufm, measured spectrophotometrically. Zymographic analysis of MMPs
• MMP-2 and MMP-9 levels were determined by gelatin zymography. Briefly, non-reduced supernatant samples of BAL fluid (15 ⁇ l) and standards (161-0305, Bio- Rad, Hercule, USA) were loaded onto 7% polyacrylamide gels (wt/vol) incorporating 0.1% (wt/vol) gelatin substrate. The MMP in the gelatino lytic bands were evaluated using as references recombinant murine Pro-MMP-9 (100 Kd) and recombinant murine Pro-MMP-2 (72 Kd). Proteins were subjected to electrophoresis at 20-30 mA for 3 h.
• RNA samples were ground to a fine powder, and homogenized in 2ml of Trizol reagent (In vitrogen Life technology, Paisley, UK). After vigorous shaking, chloroform was added and the samples were centrifuged at 12,00Og for 20min. Total RNA was precipitated with isopropanol and dissolved in RNAse-free water. RNAs were reverse- transcribed into cDNA using SuperScriptTM 11 (Invitrogen Life technologies, Paisley, UK). Real-time quantitative PCR was performed by fluorescent dye SYBR Green methodology, using SYBR Green PCR Master Mix (Applied Biosystems) and the ABI Prism 7000 apparatus (perkin-Elmer, Foster city, CA, USA). The relative quantification of the steady-state of the target mRNA levels was calculated by an active reference, GAPDH. Histology
• Bleomycin administration into the airways causes acute lung injury with inflammation with to IL- l ⁇ production, followed by chronic inflammation and fibrosis
• Anakinra attenuated the lung inflammation. This part of the pathophysiology is novel and has been published (3).
• uric acid production was enhanced in the bronchoalveolar lavage fluid (BALF) ( Figure 3A) and in the lung ( Figure 3B) after bleomycin in comparison to saline. b) Whether inhibition of uric acid levels reduces inflammation
• uricase treatment which rapidly degrades uric acid into soluble allantoin, also reduced bleomycin-induced lung uric acid increase (Figure 4A), lung IL- l ⁇ production and neutrophil influx ( Figures 4B, 4C).
• Figure 4A bleomycin-induced lung inflammation and repair are mediated by uric acid.
• allopurinol or uricase administration reduces uric acid levels and inflammation. Therefore, to uric acid is a major danger signal likely released from dying pulmonary cells upon injury and that uric acid represents a new target to control inflammation upon lung injury.
• EXAMPLE 4 Exogenous uric acid crystals cause inflammation and IL- l ⁇ production Uric acid released from the lung upon bleomycin injury might trigger NALP3 inflammasome activation. Therefore, we asked whether exogenous uric acid given as crystals may cause lung inflammation.
• uric acid crystals were found engulfed by alveolar macrophages in the airways (Figure 5A) and induced a dose-dependent cell recruitment in the BAL (not shown), which was transient with macrophages and neutrophils reaching a maximum at 6h, decreasing at 24h; and the inflammation was resolved at day 14 (Figure 5B).
• TLR2-4 double deficiency resulted in attenuated inflammation showing that the combined action of TLR2 and TLR4 may be required for optimal inflammation (31). Therefore uric acid crystals-induced inflammation is likely TLR2-4 dependent, but IL- 18R independent, activates the NALP3 inflammasome and signals via IL-lRl/MyD88.
• EXAMPLE 6 Bleomycin activates the inflammasome NALP3 leading to IL- l ⁇ production and inflammation in lung
• Intranasal administration of a single dose of bleomycin induces a rapid inflammation of the airways within 24h, followed by tissue remodeling and lung fibrosis within 14 days. Since we showed that bleomycin- induced lung injury causes an inflammation dependent of IL-IRl and IL- l ⁇ (3), we investigated the upstream mechanisms leading to IL- l ⁇ release and in particular the role of the inflammasome, a cytosolic multiprotein complex composed of receptors, adaptors and cysteine proteases which cleaves proIL-l ⁇ into IL-l ⁇ (28).
• NALP3 inflammasome is activated upon bleomycin lung injury resulting in enhanced production of IL-I ⁇ and subsequent inflammation.
• EXAMPLE 7 NALP3 inflammasome is critical for bleomycin-mediated late inflammation and tissue remodeling
• MMP-9 was shown to be largely produced by neutrophils and its activity was associated with neutrophil recruitment whereas MMP2 was produced by fibroblasts and associated with fibrosis (29). 14 days after bleomycin administration, Pro-MMP-9 (100 Kd) and Pro- MMP-2 (71 Kd) activities measured after activation, and active MMP-2 (65 Kd) activity were upregulated in the BALF of wild-type mice, but were significantly reduced in NALP3 and Casp-1 deficient mice ( Figure 12B).
• NALP3 is a major proinflammatory danger receptor activated by uric acid in the gout arthritis model (10). Since uric acid was identified as a principal endogenous danger signal released from injured cells, we hypothesized that uric acid can be important in induction of immunity after lung injury (16). We first assessed whether uric acid is released upon bleomycin-induced lung injury in mice. Uric acid production was enhanced in the BALF ( Figure 13A) and in the lung ( Figure 13B) 24h after intranasal bleomycin administration (i.n.).
• mice with uricase used to treat hyperuricemia in tumor lysis syndrome associated with cancer chemotherapy 17.
• bleomycin-induced lung inflammation and remodeling are largely mediated by uric acid which represents a major danger signal likely released from dying pulmonary cells upon injury and a new target to control inflammation upon lung injury.
• EXAMPLE 9 Bleomycin-induced repair and fibrosis are mediated by uric acid
• TIMP-I was upregulated at 8 days in lung homogenates ( Figure 15C) and BALF (data not shown) of bleomycin-treated mice but inhibited by allopurinol administration.
• Pulmonary alpha-I collagen mRNA content was increased 14 days after BLM administration, but inhibited by uricase or allopurinol treatment ( Figure 15D).
• lung sections showed that BLM-induced alveolar wall destruction, collagen deposition and lung fibrosis at 14 days were significantly reduced when uric acid synthesis was inhibited or after uricase administration ( Figure 15E). The fibrosis induced by bleomycin was assessed semi-quantitatively.
• EXAMPLE 10 Exogenous uric acid causes acute lung inflammation and remodeling
• uric acid crystals dose-dependently induced pulmonary TIMP-I, a marker of incipient fibrosis (Figure 16E), which returned to basal levels at day 14 (data not shown), as reported after exogenous IL- l ⁇ , whereas bleomycin administration induced a long lasting production of TIMP- 1(3). Rapid degradation of uric acid occurs in mice due to their functional uricase, in contrast to humans (30), and repeated uric acid crystal administration may be required to develop lung fibrosis. Thus, local administration of uric acid crystals triggers inflammation and repair in the lung, similar to bleomycin.
• EXAMPLE 11 Uric acid-induced acute lung inflammation is dependent upon inflammasome and MyD88/IL-lRl
• IL-6 Figure 17G
• KC Figure 17H
• TIMP-I Figure 171
• IL-l ⁇ was significantly decreased in lungs from MyD88 deficient mice but not from IL-IRl deficient mice ( Figure 17J) suggesting that other receptors using the common MyD88 adaptor such as TLR or IL- 18R may be involved.
• mice deficient for either TLR2 or TLR4 developed inflammation in response to uric acid crystals ( Figures 18A and 18B), as did IL- 18R deficient mice ( Figures 18C and 18D).
• mice deficient for both TLR2 and TLR4 displayed an attenuated inflammatory response ( Figures 18 A and 18B) showing that the combined action of TLR2 and TLR4 may be required for optimal inflammation in response to uric acid crystals. Therefore uric acid crystals-induced inflammation is likely TLR2/TLR4 dependent, but IL- 18R independent, and activates the NALP3 inflammasome and signals via IL-lRl/MyD88.
• uric acid is locally released and activates the NALP3 inflammasome resulting in IL- l ⁇ production.
• bleomycin- induced lung injury resulting in IL-l ⁇ production and subsequent inflammation is dependent on the inflammasome NALP3 and ASC.
• the partial decrease in IL-l ⁇ measured in lung of NALP3 deficient versus wild-type mice after bleomycin may represent a direct defect in the maturation of IL-l ⁇ by the NALP3 inflammasome or some indirect effects.
• pro-IL-l ⁇ known to be independent on NALP3 inflammasome
• maturation in IL-l ⁇ which depends on inflammasome activation, and secretion of mature IL-l ⁇
• secretion of mature IL-l ⁇ are separate processes allowing to tightly regulate the production of such a powerful inflammatory cytokine.
• caspase-1 caspase-1 in the bleomycin- induced inflammation and confirmed the role of the NALP3 inflammasome in this pathology.
• lung injury results in local accumulation of uric acid which acts as an endogenous danger signal probably activating the NALP3 inflammation and leading to IL- l ⁇ dependent inflammation.
• Exogenous uric acid crystals have been shown to activate the NALP3 inflammasome leading to IL-l ⁇ -dependent inflammation in the peritoneal cavity (10, 11).
• exogenous uric acid crystals given by the airways cause NALP3 inflammasome activation, the production of IL-l ⁇ , IL-lRl/MyD88 dependent lung inflammation and TIMP-I expression, a hallmark for the evolution to fibrosis (26).
• IL- 18R, TLR2 and TLR4 are dispensable for lung inflammation to exogenous uric acid crystals. Nevertheless, we observed that the combined action of TLR2 and TLR4 is required for optimal inflammation in response to uric acid crystals as showed in lung inflammation caused by airway administration of dying cells (34).
• TLR2 and TLR4 may be involved in the generation of the pro-IL-l ⁇ upon uric acid crystals stimulation and maturated after uric acid crystal-mediated activation of the NALP3 inflammasome (10).
• Our data demonstrates the possibility that regulating uric acid production at the level of synthesis or metabolism might be particularly useful in limiting chronic lung inflammation, repair and fibrosis. Indeed, allopurinol is currently used to treat gout, and uricase is an alternative therapy of acute gout arthritis (35) or hyperuricemic syndromes (17).
• Xanthine oxidase inhibitor allopurinol which impairs uric acid synthesis or uricase which rapidly degrades uric acid into soluble allantoin, prevent uric acid release in the lung upon bleomycin and decreases IL- l ⁇ production, inflammation, remodeling and fibrosis suggesting that uric acid crystals activate the NALP3 inflammasome leading to the processing and maturation of pro-IL-l ⁇ into biologically active IL- l ⁇ .
• Administration of exogenous uric acid crystals induce pulmonary inflammation and remodeling typical of evolution toward fibrosis with TIMP-I accumulation.
• IL- l ⁇ production, inflammation and remodeling upon uric acid crystals are dependent on the NALP3 inflammasome.
• TLR2 and TLR4 double deficiency impairs IL- l ⁇ production and cellular influx upon uric acid crystals and may be involved in crystal- induced production of pro-IL-l ⁇ or in uric acid crystals uptake by alveolar macrophages and/or resident cells.
• the inventors show here that exogenous uric acid crystals in the airways induce NALP3 inflammasome activation, the production of mature IL-l ⁇ and IL-lRl/MyD88 dependent lung inflammation and TIMP-I expression, a hallmark for the evolution to fibrosis.
• Allopurinol and uricase are currently used to treat clinical gout arthritis.
• the mode of action of allopurinol, a xanthine oxidase inhibitor and of uricase is given schematically in Figure 9. Therefore, therapeutic interventions reducing uric acid levels may be of benefit in chronic lung inflammation and fibrosis.
• lung injury results in local accumulation of uric acid which acts as endogenous danger signal that activates the NALP3 inflammasome with the production of mature IL- l ⁇ causing lung inflammation, repair and fibrosis.
• Reduction of uric acid levels by with xanthine oxidase inhibitors compound, such as allopurinol or uricase inhibits inflammation leading to interstitial pulmonary fibrosis.
• Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci 4(2):83-93.
• TLR4 Toll- like receptor 4
• Mrp8 and Mrpl4 are endogenous activators of Toll-like receptor 4, promoting lethal, endotoxin-induced shock. Nat. Med. 13, 1042-1049.

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