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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • 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
  • A61K31/341—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 not condensed with another ring, e.g. ranitidine, furosemide, bufetolol, muscarine
• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/21—Interferons [IFN]
• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/21—Interferons [IFN]
  • A61K38/215—IFN-beta
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
• • 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
• • 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
  • 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
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• Magnetic resonance imaging (MRI) of the brain can add certainty to the diagnosis, by identifying lesions consistent with the occurrence of demyelination.
• Interferons are cytokines with antiviral, antiproliferative, and antitumor activity, although they have different immunomodulatory characteristics. Therefore, these molecules have a great therapeutic potential in neoplastic and viral diseases.
• IFNs interferon-alpha (IFN-a), produced by leucocytes, interferon-beta (IFN- ⁇ ), produced by fibroblasts and interferon-gamma (ING- ⁇ ), produced by lymphocytes-T (Zaragoza et al. 2002, Farmacia Hospitalaria. 26(5):294-301).
• a main object of the present invention is to provide pharmaceutical compositions for treating Multiple Sclerosis (MS) and/or other demyelinating diseases, comprising an interferon (IFN), compound of Formula I, and, optionally, one or more pharmaceutically acceptable excipients and/or carriers.
• MS Multiple Sclerosis
• IFN interferon
• Another object of the present invention is, therefore, to provide a method for treating a subject suffering from MS and/or another demyelinating disease, the method consisting of administering the pharmaceutical compositions of the invention to the subject in an effective amount and for a time sufficient to produce remyelination and to reduce inflammation.
• R 3 is selected from the group consisting of hydrogen or hydroxyl
• R4 is selected from the group consisting of an optionally substituted L 2 -alkyl orL 2 - alkenyl, wherein L 2 is an optionally substituted 3-furanyl or 3-fur-3-enyl moiety, or a pharmaceutically acceptable salt, ester, ether or prodrug thereof, and, optionally, one or more pharmaceutically acceptable excipients and/or carriers.
• L 2 is an optionally substituted 3-furanyl or 3-fur-3-enyl moiety
• the compound of Formula I comprises deoxy- didehydroandrographolide, deoxy-oxoandrographolide or deoxyandrographolide, each structurally closely related to andrographolide. See Bailmain and Connolly (1973).
• the chemotaxis inhibition is explained because andrographolide significantly attenuated C5a-stimulated phosphorylation of ERK1/2, and of its upstream activator, MAP kinase-ERK kinase (MEK1/2) and Akt phosphorylation, a downstream target protein for PI3K (Tsai et al , 2004).
• MEK1/2 MAP kinase-ERK kinase
• Akt Akt phosphorylation
• the interference of ERK1/2 phosphorylation also explains the inhibitoiy effect of andrographolide on TNF-alpha, IL-12a and IL-12b at mRNA level, and production of TNF-alpha and IL-12p70 proteins in a concentration-dependent manner in murine macrophages (Qin et al, 2006).
• MOG-induced EAE mice Using a MOG-induced (myelin-oligodendrocyte-glycoprotein induced) EAE mice model, we found that daily treatment with 2 mg/kg s.c. of andrographolide produced an important improvement in clinical scores of animals treated with andrographolide compared with animals treated with saline. Similarly, in another model of autoimmune disease, the administration of andrographolide reduced the susceptibility, prevented the symptoms and reduced anti-nuclear antibodies and kidney damage of systemic lupus erythematous .
• an “effective amount” refers to an amount of the active ingredients that is sufficient to affect the course and the severity of the disease, leading to the reduction or remission of such pathology.
• the effective amount can be readily determined by a person skilled in the art and will depend on the route of administration, the weight, the age and the condition of the patient, and the goal of the administration (therapeutic, prophylactic or diagnostic goal).
• IFN-beta is the preferred IFN according to the present invention.
• compositions of the present invention can comprise naturally occurring, native, mutant, synthetic or recombinant IFNs.
• the compounds of Formula I are preferably prepared as purified compounds, comprising preferably at least about 90% of the pure compound, more preferably at least about 98% of the pure compound. An adequate diluent can also be used, allowing the reconstitution of the product to the desired concentration prior to administration of the dose.
• the compounds of Formula I can be prepared as pharmaceutical finished dosage forms any known manner, such as a pre-filled syringe, etc.
• a pharmaceutical composition of the invention comprise between 6 and 12 MUI of IFN-beta, and between 50 and 500 mg of compound of Formula I. In a more preferred embodiment, a pharmaceutical composition of the invention comprise between 6 and 12 MUI of IFN-beta, and between 100 and 200 mg of compound of Formula I.
• compositions of the invention are suitable for treating MS and/or other demyelinating diseases.
• compositions of the invention are designed for the simultaneous, separate or sequential use of its active ingredients for the above specified therapy.
• the present invention also provides a method to reduce fatigue in a subject in need thereof, the method consisting of administering the pharmaceutical compositions of the invention to the subject in an effective amount every day or every other day.
• the effective amount of the pharmaceutical composition comprises between 6 and 12 MUI of IFN-beta and between 1 and 5 mg/Kg body weight of compound of Formula I.
• the effective amount of the pharmaceutical composition comprises between 6 and 12 MUI of IFN-beta and 2 mg/ g body weight of compound of Formula I.
• the administration of the pharmaceutical composition is for an unlimited time.
• FIG. 5 Microglial cells from combined therapy (CT) EAE treated mice shows a resting phenotype.
• A spinal cords from non-immunized mice (NI) (left panel), MOG-immunized mice treated with either PBS (middle panel) or combined therapy (CT) EAE treated mice (right panel) that were dissected and analyzed for macrophages/microglia by immunofluorescence using an anti-CDl lb antibody followed by incubation with Alexa-fluor 488-conjugated secondary antibody (green).
• B insets with higher magnification (20x).
• Figure 7 The results of treatment with andrographolide mono-therapy.
• the protocol was exactly the same as for EAE model of MS as described for interferon mono-therapy ( Figure 1) and for andrographolide + interferon combination therapy ( Figures 2 to 5).
• Andrographolide 4mg/day (without accompanying interferon) was injected (intraperitoneally) daily for days 16-31.
• Example 1 Mice with induced Experimental Autoimmune Encephalomyelitis (EAE) administered with combined therapy of andrographolide and interferon.
• EAE Experimental Autoimmune Encephalomyelitis
• C57BL/6 mice were purchased from Jax® mice laboratories and housed at Pontificia Universidad Catolicas animal facility. Animal care and use was performed in accordance with approved animal use protocols and guidelines of Institutional Animal Care and Use Committee.
• EAE Experimental Autoimmune Encephalomyelitis
• IFN- ⁇ was administrated from day 15 to 30 post- immunization, daily.
• Combined therapy was administrated from day 15 to 30 post- immunization, either daily or every second day. At day 36 all animals were sacrificed. Clinical score was registered, and spinal cords were collected for histological analysis.
• H&E hematoxylin eosin staining
• luxol fast blue (LFB) staining was performed. Toraxic spinal cord sections were stained with LFB (SIGMA, USA), and neuron nuclei were staining with cresyl violet. Demyelination was evaluated as LFB staining free area in spinal cord white matter.
• Sections of the spinal cord (20 mm) were treated with a permeabilizatioiVblocking solution containing 10% FCS, 1% glycine, and 0.05% Triton X-100 (Sigma-Aldrich).
• Primary antibody rat anti CDl lb (1 :200; BD, USA) in blocking solution was applied O.N. in a humidified chamber at 4°C.
• Secondary antibody goat anti rat conjugated with fluorescein (Millipore, USA) was applied for 1 h at room temperature.
• MOG-immunized C57BL/6J mice 150 ug MOG-peptide; 500 ug MT; 200 ng PT
• IFN- ⁇ 1 ⁇ g of IFN- ⁇ (IFN- ⁇ ebif 88 ⁇ /ml MERCK SORONO) in 200 PBS, intraperitoneally
• CT combined therapy
• Panel A shows spinal cords from non-immunized mice (NI) (left panel), MOG- immunized mice treated with either PBS (middle panel) or combined therapy (CT) (right panel) that were dissected and analyzed for macrophages/microglia by immunofluorescence using an anti-CDl lb antibody followed by incubation with Alexa-fluor 488-conjugated secondary antibody (green).
• Panel B shows insets with higher magnification (2 Ox).
• CD1 lb+ cells showed long processes compared to control microglial cells that exhibit short and ramified processes.
• Combined therapy might be preventing macrophage infiltration, microglia activation or both.
• Example 2 Human Multiple sclerosis (MS) patients MS Patients receiving Andrographolide ONLY Materials & Methods:
• All eight patients were placed on a non-blinded, 42-month treatment regimen of daily intake (per os) at a dosage of 2mg andrographolide per kilogram of body wieght, 0.15mg of neoandrographolide per kilogram of body weight, and 0.2 mg of deoxyandrographolide per kilogram of body weight.
• One of eight patients improved scattered functionality such as fatigue, leg strength, coordination and walking equilibrium at month six, with sustained progress until now.
• IFN- ⁇ interferon beta
• Improvement in scattered functionality such as fatigue, leg strength, coordination and walking equilibrium with the CT.

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• 2012
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