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• • 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
  • C07K7/06—Linear peptides containing only normal peptide links having 5 to 11 amino acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • 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
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
  • A61P27/06—Antiglaucoma agents or miotics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08G—MACROMOLECULAR COMPOUNDS OBTAINED OTHERWISE THAN BY REACTIONS ONLY INVOLVING UNSATURATED CARBON-TO-CARBON BONDS
  • C08G69/00—Macromolecular compounds obtained by reactions forming a carboxylic amide link in the main chain of the macromolecule
  • C08G69/02—Polyamides derived from amino-carboxylic acids or from polyamines and polycarboxylic acids
  • C08G69/08—Polyamides derived from amino-carboxylic acids or from polyamines and polycarboxylic acids derived from amino-carboxylic acids
  • C08G69/10—Alpha-amino-carboxylic acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides

Definitions

• compositions disclosed here provide therapeutic options for neurological insult with particular reference to stroke, traumatic brain injury, and spinal cord injury (collectively "neuronal injury”).
• stroke traumatic brain injury
• spinal cord injury collectively "neuronal injury”
• a stroke, or cerebrovascular accident (CVA) is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (broadly termed "neurological insult”). As a result, and often worsening over time, brain injury becomes permanent dysfunction/damage. Typically, affected areas of the brain have diminished or complete loss of function. In particular instances this is exhibited as an inability or reduced ability to move one or more limbs on one side of the body, inability to or difficulty in understanding or formulating speech, or an inability to see one side of the visual field.
• Traumatic Brain Injury Methods for Clinical and Forensic Neuropsychiatric Assessment, Second Edition, Robert P. Granacher Jr. (CRC Press 2007); 5. Sports Neuropsychology: Assessment and Management of Traumatic Brain Injury, Ed. Ruben J. Echemendia PhD (The Guilford Press, 2006);
• Blockade of PARP activity attenuates poly(ADP-ribosyl)ation but offers only partial neuroprotection against NMDA-induced cell death in the rat retina. (Goebel and Winkler, J Neuro Chem, 98:1732-1745, 2006) (NMDA-induced chemical stroke in vivo rat retinal neurotoxicity model).
• the Glasgow Coma Scale 15- point test used to assess the initial severity of a brain injury by checking a person's ability to follow directions and move their eyes and limbs. Abilities are scored
• compositions of this invention include a polyarginine peptide of from 5 to 9 arginines. Both d- and l-arginine is contemplated.
• the compositions may further include 1 terminal cysteine.
• Terminal cysteines may be either N-terminus or C-terminus cysteines.
• Options also include the addition of a second cysteine that is linked to the terminal cysteine on the peptide by a disulfide bridge, and/or the placement of a terminal cysteine on both ends of the R(5+n) peptide, with or without the addition of two additional cysteines via disulfide linkage. Particular reference is made to the following compositions.
• RRRRR polyarginine with between 5 and 9 arginines: RRRRR also termed R(5). Similarly, R(6), R(7), R(8) and R(9). Both I- and d- amino acids are contemplated.
• compositions depicted below are similarly expressed mutatis mutandis.
• This invention includes a polyarginine peptide comprising from 5 to 9 arginines. In some embodiments this peptide further comprises 1 or more terminal cysteines. In some instances there are at least 2 terminal cysteines linked by a disulfide bond.
• a particular polyarginine peptide of comprises C-s-s-CRRRRRRR where C is cysteine, C-s-s-C is a disulfide bond between 2 cysteines and R is arginine.
• this peptide the 2 cysteines are N-terminus linked.
• polyarginine peptide comprises CRRRRRRR, or comprises RRRRRRR.
• the noted peptide may include at least 1 d-arginine and additionally at least 1 or more terminal cysteines which are d-cysteine.
• polyarginine peptide comprise up to 2 terminal neutral amino acids.
• This invention is further drawn to a therapeutic method of treating actual or anticipated neuronal injury comprising the step of administering a therapeutically effective dose of a polyarginine peptide of from 5 to 9 arginines.
• the method further includes administering such peptide further comprising 1 or more terminal cysteines.
• the polyarginine peptide is C-s-s-CRRRRRRR. All methods of administration are contemplated including i.v. A useful range for methods of i.v. treatment dosing is from about 0.01 mg/kg to about 20 mg/kg.
• This invention is yet further drawn to a method of protecting against glaucoma associated vision damage to at least one eye in a subject comprising administering to said subject a therapeutically effective dosage of the compositions described herein.
• a polyarginine peptide comprising from 5 to 9 arginines and further comprising 1 or more terminal cysteines.
• Administration may be by any usual form including oral and by eye drops. Doses from about 0.1 to about 10 ⁇ g per 20 ⁇ drop are noted.
• compositions of the present invention act to preserve mitochondria as function organelles, and that this influences the broadly observed neuroprotection disclosed herein.
• C-R-R-R-R-R-R-R-R-R (C is cysteine, R is arginine; composition termed "CR(7)") is effective when the peptide is made with either I- or d- amino acids. Dosing too is substantially I- or d- independent.
• a peptide with at least 5 or more arginines can be flanked by 1 or 2 neutral amino acids and still be therapeutically active.
• cysteine if present, is attached at the arginine end.
• Dosing should be instituted is soon as possible after the subject presents with a neuronal injury; e.g., stroke-like indicia or Traumatic Brain Injury. Dosing is stated for R7 (i.e., 7 arginine peptide) compositions, but is similar for all compositions disclosed herein.
• therapeutically effective intraventricular dosages of from about 1 ,000 ⁇ g/kg to about 1 ⁇ g/kg are noted.
• therapeutically effective dosages from about 20 mg/kg to about 0.01 mg/kg are noted.
• Oral, intrathecal, and indeed all forms of administration are contemplated.
• Dosing is contemplated to begin as soon as possible after the initial neuronal injury. Dosing may be daily for about 10, 20, or 30 days or more post-insult. Dosing every other day or varied regimens based in circulating blood levels of composition are contemplated. l.v. infusion over the initial post-injury 1 to 10 hours is contemplated, but infusion may be usefully be administered daily for about 10, 20, or 30 days or more post-insult.
• Disclosed arginine compositions can be prepared by a variety of well known synthetic techniques. In one embodiment standard fmoc-based protocols were used (Merrifield et al., J. Am Chem .Soc. (1963) 85, 2149-2155). The teachings of this and all references cited herein are incorporated by reference in their entirety.
• compositions of this invention are useful in a variety of clinical situations, most of which are characterized by neurological insult or cellular insult typified by mitochondrial damage. Without being bound by any particular theory, untreated mitochondrial damage is believed to lead to generation of free radical species.
• the compositions of this invention appear to avert or curtail oxidative stress in the retina following NMDA-insult by reducing mitochondrial originated free radical generation. Without being bound by any particular theory, such activity is believed to be significant in neuroprotection arising from the compositions of this invention.
• neuronal injury such as stroke and Traumatic Brain Injury (including closed head injury, e.g. sports, accidental injury involving concussion, blast injury (combat or other).
• football players and boxers are dosed prophylactically prior to a game, practice, or bout. Additionally dosing may be immediately after first contact in a scheduled game or bout. Dosing is based on an assumption of neurological insult or incipient damage without regard to actual (detected) presenting symptoms.
• the pharmacologically active compositions of this invention can be processed in accordance with conventional methods of Galenic pharmacy to produce medicinal agents for administration to subjects, e.g., mammals including humans.
• the therapeutic compositions disclosed herein are usefully prepared an aqueous solutions. Particular not is made of isotonic saline. Other dosage forms are also contemplated. Particularly suitable are injectable, sterile solutions. Ampoules are convenient unit dosages.
• Dosages for a given host can be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject compositions and of a known agent, e.g., by means of an appropriate, conventional pharmacological protocol.
• Fluorescent-tagged R(7) and C-s-s-CR(7) were injected into the vitreal chamber of a rat eyes and analyzed for specific uptake into retinal neurons at multiple time points post- injection. Both compounds demonstrated uptake into the retina within 30 min following injection and showed significant accumulations with retinal neurons and glia cells located in both the ganglion and inner nuclear layers of the retina.
• Preferential accumulation was noted in the neurons located within the hippocampus and cerebral cortex. This approach is a workable option for quick delivery to prevent both stroke or traumatic injury to these tissues.
• Both CR(7) and C-s-s-CR(7) demonstrated long-term protection against NMDA- induced retinal ganglion cell death 14-21 day post-insult, with both peptides providing protection that was not significantly different from results obtained from untreated or sham-treated control retinas. Although R(7) provides full short-term protection. R(7) was less effective in providing longer-term protection against retinal ganglion cell death using a single dosing. Repeated dosing is indicated to extend the period of protection.
• R(7)-C treatment produced both short and long-term protection against an NMDA-insult that was shown not to be significantly different from retinas treated with CR(7) or C-s-s-CR(7).
• R(7)C-s-s-C, 5 mg/kg poly- arginine
• Daily testing of cognitive and motor systems show no deficits in physical or mental capacities.
• CT/MRI imaging show no signs of lesioning in the affected region, immediately following recovery and that this was maintained and confirmed by follow-up imaging and behavior testing.
• a 17 year old high school football player is rushed to the emergency room of a local hospital suffering from a severe concussion following a helmet to helmet impact with an opposing player.
• the patient is initially unconscious on the field for over 20 min.
• EMS personnel arrived to find the patient responding to stimuli, but completely disoriented and unable to coordinate muscle movement, articulate speech or focus eye movements.
• the patient is administered an i.v. containing R(7)C-s-s-C peptide at 0.05mg/kg. Delivery of the peptide continued until brain swelling resulting from the impact returns to normal state (3-5 days).
• the therapeutic is to arrest neuronal cell death resulting from these documented post-traumatic effects . Monitoring the patient though this period (and beyond) shows that he remains symptom free of TBI and post-concussion effects (i.e. avoiding short-term memory loss or exhibiting longer-term learning deficits.
• Example 3 The same scenario of Example 3 is noted except here, the polyarginine is R(7)-C (C-Terminus) and the dosage is 4/mg/kg
• Example 3 The same scenario of Example 3 is noted except here, the polyarginine composition is R(7) and the dosage is 4 mg/kg.
• Example 3 The same scenario of Example 3 is noted except here, the polyarginine is R(7)C- C and the dosage is 0.05mg/kg.
• Example 3 The same scenario of Example 3 is noted except here, the polyarginine composition is R(7) and the dosage is 0.04mg/kg.
• Multislice spiral computed tomography demonstrates a foreign body in spinal canal at the level of the Th1 1 -Th12.
• a Th(1 1 )-L(2) laminectomy is performed along with retrieval of foreign bodies and dura repair.
• the patient is administered an i.v. containing R(7)C-s-s-C peptide at 0.15mg/kg. Delivery of the peptide is continued every other day for 30 days when substantial ability to move her legs is returned.
• a 60 year old female presents with a complaint of blurry vision in her left eye for 1 week.
• Her IOP is above 21 mmHg.
• a diagnosis of glaucoma is made.
• CR(7) in the form of eye drops suspended in a corneal penetrating lipophilic suspension. Each 20 ⁇ drop contains 1 .25 ⁇ g of CR(7) The total applied/ treatment is 2.5 ⁇ g. Two drops are administered morning and two drops at night
• Treatment is continued chronically and no progression of neuronal cell death is detected.

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• 2013
  • 2013-04-17 JP JP2015507143A patent/JP2015514771A/ja active Pending
  • 2013-04-17 EP EP13777758.7A patent/EP2872160A4/en not_active Withdrawn
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