WO2016163886A2

WO2016163886A2 - Administration of taurine or an analog thereof for the treatment of nerve cell damage

Info

Publication number: WO2016163886A2
Application number: PCT/NL2016/050249
Authority: WO
Inventors: Annette Klazina OFFRINGA-HUP
Original assignee: Clues2Cure International B.V.
Priority date: 2015-04-10
Filing date: 2016-04-11
Publication date: 2016-10-13
Also published as: WO2016163886A3

Abstract

The present invention relates to the use of taurine or an analog thereof and/or albumin, for use in the treatment of nerve cell damage. In particular, taurine or a metabolite or precursor thereof and/or albumin may be administered for the treatment of multiple sclerosis, amyotrophic lateral sclerosis, and other neurodegenerative disorders. The compounds may be administered to the central nervous system of an individual in need thereof by a route which bypasses the blood- brain barrier, such as by intraspinal or intrathecal administration. The present invention also relates to the use of taurine or an analog thereof in the treatment of bone disorder or bone injury.

Description

Title: Administration of taurine or an analog thereof for the treatment of nerve cell damage

FIELD OF THE INVENTION

The present invention relates to the use of taurine or an analog thereof and/or albumin, for use in the treatment of nerve cell damage. In particular, taurine or a metabolite or precursor thereof and/or albumin may be administered for the treatment of multiple sclerosis, amyotrophic lateral sclerosis, and other

neurodegenerative disorders. The compounds may be administered to the central nervous system of an individual in need thereof by a route which bypasses the blood- brain barrier, such as by intraspinal or intrathecal administration. The present invention also relates to the use of taurine or an analog thereof in the treatment of bone disease or bone injury. BACKGROUND OF THE INVENTION

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease or Maladie de Charcot, is the most common adult-onset motor neuron disease. ALS is a fatal neuromuscular disease, presenting as progressive weakness, muscle atrophy, and spasticity. The effects are due to degeneration of motor neurons in the spinal cord, brainstem, and the brain cortex. ALS is characterized by the progressive and selective death of motor neurons. The cause of this process is mostly unknown, but evidence suggests that excito toxicity plays an important role.

Motor neurons are especially sensitive to excitotoxicity. In contrast to most other neurons, motor neurons have a low Ca2+-buffering capacity due to the low expression of Ca2+-buffering proteins and a high number of Ca2+ -permeable AMPA receptors resulting from a low expression of the GluR2 sub unit. The combination of these two properties seems to be intrinsic to motor neurons and is most likely essential for their normal function.

Under pathological conditions, motor neurons may become over-stimulated and overwhelmed with Ca2+. An immediate consequence of the lack of Ca2+-buffering proteins is that mitochondria become important for Ca2+ buffering. Excitotoxicity also seems to be an important mechanism in the progression of multiple sclerosis (MS). In MS, plaques of inflammatory demyelination within the CNS are the pathologic hallmark and glutamate excitotoxicity is believed to be at least partly contribute to the autoimmune demyelination. Neuronal loss in MS can be severe and occurs throughout the brain. In addition to its role in neurodegenerative diseases, glutamate signalling also plays a role in osteoblast and osteoclast differentiation.

SUMMARY OF THE INVENTION

In one aspect, the disclosure provides a composition comprising taurine or an analog thereof, for use in the treatment of nerve cell damage in an individual. The disclosure further provides taurine or an analog thereof for use in the preparation of a composition/medicament for use in the treatment of nerve cell damage in an individual. The disclosure further provides methods for treating nerve cell damage in an individual, said method comprising administering a composition comprising taurine or an analog thereof to an individual in need thereof.

Preferably, taurine or an analogue thereof is orally administered to said individual with a dosage of between lOmg/kg/day to 400mg/kg/day

In preferred aspects, the individual is afflicted with multiple sclerosis.

In preferred aspects, the composition is administered to the central nervous system of the individual by a route which bypasses the blood-brain barrier, preferably by intracerebral or intraspinal administration.

Preferably, the taurine or an analog thereof is provided as a compound consisting of taurine or a metabolite or precursor thereof.

Preferably, the compositions comprise taurine, homotaurine, or hypotaurine.

Preferably, the taurine or an analog thereof is formulated in a pharmaceutical composition suitable for administration by a route which bypasses the blood-brain barrier.

Preferably, treatment of nerve cell damage is associated with a glutamate excitatory dependent disorder, a neurological disorder, a central nervous system tumor, an infection of the central nervous system, hypoxia-induced nerve cell damage, or traumatic brain injury. Preferably, the composition comprising taurine or an analog thereof is used for the treatment of amyotrophic lateral sclerosis, multiple sclerosis, progressive spinal muscular atrophy, Alzheimer's disease, Parkinson's disease, or Huntington's disease. Preferably, the composition is administered chronically, preferably the duration of treatment lasts at least one week, at least one month, or at least one year.

Preferably, the treatment with taurine or an analog thereof further comprises providing said individual with albumin.

In one aspect, the disclosure provides a composition comprising albumin, for use in the treatment of nerve cell damage, as disclosed herein, in an individual.

In preferred aspects, the composition is administered to the central nervous system of the individual by a route which bypasses the blood-brain barrier, preferably by intranasal administration. Preferably, the composition comprising albumin is used for the treatment of amyotrophic lateral sclerosis.

In one aspect, the disclosure provides a composition comprising taurine or an analog thereof, for use in the treatment of bone disorder or bone injury in an individual. Preferably, the taurine or an analog thereof is provided as a compound consisting of taurine or a metabolite or precursor thereof. Preferably, the taurine analog is selected from hypotaurine and homotaurine. Preferably, taurine or an analogue thereof is orally administered to said individual with a dosage of between lOmg/kg/day to 400mg/kg/day. Preferably, the bone disease is selected from osteopenia or

osteoporosis. Preferably, the bone injury is a bone fracture. BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1: X-ray of patient from Example 5, 7-months after spontaneous fracturing of the right hip .

Figure 2: X-ray of patient from Example 5, 6-months after beginning taurine treatment. DETAILED DESCRIPTION OF THE DISCLOSED EMBODIMENTS

In one aspect, the present disclosure provides methods for treating nerve cell damage in an individual comprising administering taurine or an analogue thereof and/or albumin to said individual.

As used herein, nerve cell damage preferably refers to the loss/death of neurons. However, nerve cell damage also includes a reduction in nerve cell function, e.g., due to, e.g., oxidative stress and mitochondrial dysfunction. The symptoms resulting from nerve damage vary due to the particular nerves which are damaged. For example, in multiple sclerosis symptoms may relate to the motor, visual, autonomic, and/or sensory systems depending on which neurons in the brain and spinal cord are damaged. As used herein, "treating" nerve cell damage refers to slowing the progression of damage, preventing further damage, or reducing the occurrence or severity of symptoms associated with said nerve damage. In preferred embodiments, the treatment is not used as a prophylaxis, i.e., the treatment is used only after initial nerve cell damage has occurred.

Nerve cell damage may be induced by, e.g., excitotoxic agents, such as glutamate, or by excitotoxicity inducing conditions such as brain injury, spinal cord injury, or stroke. These conditions can lead to hypoxia or osmotic stress, which in turn leads to glutamate accumulation. Activation of glutamate receptors leads to an influx of calcium into cells. It is thought that excitotoxicity may be at least partially due to high internal calcium concentrations. High calcium levels activate a number of different enzymes which in turn can damage cell structures. High calcium levels can also lead to mitochondrial damage. There is also evidence for disturbance of glutathione homeostasis in

(neuro) degenerative diseases (Schulz JBl, Lindenau J, Seyfried J, Dichgans J. Eur J Biochem. 2000 Aug;267(16):4904- ll). Glutathione is an important intracellular antioxidant. Apart from several other environmental or genetic factors, oxidative stress leading to free radical attack on neural cells contributes to neuro-degeneration. (Bayani Uttara, Ajay V. Singh, Paolo Zamboni, and R.T Mahajan. Curr

Neuropharmacol. 2009 Mar; 7(1): 65-74. Oxidative Stress and Neurodegenerative Diseases: A Review of Upstream and Downstream Antioxidant Therapeutic Options.)

Intracellular production of Glutathione depends on the intracellular availability of cystine, which is transported into the cell through the system Xc- Cystine/Glutamate antiporter. An increased extracellular concentration of glutamate, causes reversal of the action of system Xc-, depleting neurons of cystine and eventually glutathione's reducing potential. While not wishing to be bound by theory, the present disclosure hypothesizes that in the pathological situation where excess glutamate causes a reversal of the Cystine/Glutamate antiporter, albumin can function as a cystine donor for glutathione production. Nerve cell damage is also due to glutamate excitotoxicity associated with glioblastoma (Noch et al. Cancer Biol Ther. 2009 Oct;8(19): 1791-7). Bacterial meningitis was also shown to increase glutamate levels in the brain, inducing excitotoxic damage (Wippel et al. PLOS Pathogens 2013). The spasms associated with Infantile Neuroaxonal Dystrophy are also likely due to glutamate excitotoxicity.

In some embodiments, the nerve cell damage is associated with excitotoxicity, in particular glutamate excitotoxicity. In preferred embodiments, the excitotoxicity is associated with a glutamate excitatory dependent disorder, an NBIA disorder, a neurological or neurodegenerative disorder, a central nervous system tumor, an infection of the central nervous system, hypoxia-induced nerve cell damage such as ischemia (e.g. in cardiac arrest, bypass operation, or neonatal distress), traumatic brain injury, or spinal cord injury. Accordingly, the compounds disclosed herein can be used to treat these disorders, in particular the nerve cell damage associated with said disorders.

Preferably, the glutamate excitatory dependent disorder is selected from Amyotrophic Lateral Sclerosis, multiple sclerosis (MS), and progressive spinal muscular atrophy (PMSA). Preferably, the neurological disorder is selected from Alzheimer's disease, Parkinson's disease, Infantile Neuroaxonal Dystrophy, and Huntington's disease. Preferably, the neurological disorder is selected from Alzheimer's disease, Parkinson's disease, and Huntington's disease.

Preferably, the infection of the central nervous system is cerebral malaria or bacterial menengitis.

Preferably, the central nervous system tumor is a cerebrospinal malignancy or glioblastoma.

In most preferred embodiments, the nerve cell damage is associated with amyotrophic lateral sclerosis, Alzheimer's disease, or multiple sclerosis.

NBIA disorders (Neurodegeneration with Brain Iron Accumulation) are a group of neurological disorders characterized by abnormal accumulation of iron in the basal ganglia. While not wishing to be bound by theory, the deposition of iron affects oxidative phosphorylation which indirectly leads to glutamate accumulation and excitotoxicty. NBIAs include PKAN (Pantothenic Kinase-Associated

Neurodegeneration), PLAN (PLA2G6-Associated Neurodegeneration , including INAD (Infantile Neuroaxonal Dystrophy) and NAD (atypical neuroaxonal dystrophy), MPAN (Mitochondrial-membrane Protein-Associated Neurodegeneration), BPAN (Beta- propeller Protein- Associated Neurodegeneration), Aceruloplasminemia,

FAHN (Fatty Acid Hydroxylase-associated Neurodegeneration), Kufor-Rakeb,

Neuroferritinopathy, Woodhouse-Sakati Syndrome, and Idiopathic NBIA. Preferably, the NBIA disorder is INAD.

In some embodiments, the nerve cell damage occurs in attention deficit hyperactivity disorder (ADHD). While not wishing to be bound by theory, the disclosure is based, in part, on the hypothesis ADHD symptoms can be reduced by the treatment with taurine or an analog thereof. Preferably, the ADHD symptoms are lack of

concentration, aggression, difficulties displaying or controlling emotions, and/or hypersensitivity to sensory signals.

An "individual" as used herein refers to any mammal, e.g., primates, domesticated animals including dogs, cats, sheep, cattle, goats, pigs, mice, rats, and rabbits.

Preferably the individual is a human. The present invention is partly based on the surprising discovery that taurine administration resulted in the treatment of multiple sclerosis (Example 1) and Alzheimer's disease (Example 3). Taurine (2-aminoethanesulfonic acid) is a β-amino acid and is the most abundant amino acid in mammals. Although taurine is considered an "amino acid" it is not incorporated into protein, but it is present in high concentrations in mammalian plasma and cells. The level of biosynthesis of taurine in humans is low, but occurs naturally in animal- derived foods, particularly meats and seafood. Taurine deficiency results in the formation of 5-taurinomethyluridine and causes inefficient decoding for the mitochondrial codons of leucine, lysine, glutamate and glutamine. A similar effect is observed in the mitochondrial diseases MELAS

(mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) and MERRF (myoclonic epilepsy and ragged-red fiber syndrome). Oral

administration of taurine (0.25 g/kg/day) was shown to prevent stroke-like episodes in two MELAS patients (Rikamaru et al. Intern Med. 2012;51(24):3351-7). The present invention relates to a different function of taurine, which allows its use in a different set of disorders. The disclosure also encompasses the use of a taurine analog. Taurine analogs are substances that are structurally similar to taurine and exert the same kind of biological activity. In some embodiments, the analog is homotaurine (3-aminopropane- 1-sulfonic acid). Preferably, the analog is a metabolite or precursor of taurine, taurine precursors are substances that, when they are administered to a human or an animal, can be transformed, directly or indirectly, into taurine. Taurine metabolites are substances that are produced in vivo by transformation of taurine. Preferably, the taurine metabolite is hypotaurine.

In some embodiments, the taurine or analog thereof is provided as a compound consisting of taurine or an analog thereof. Preferably, the compound consists of taurine. It is to be understood that a compound consisting of taurine or an analog thereof does not encompass compounds comprising taurine or an analog thereof and another compound, such as a protein or small molecule. For examples, a protein- taurine fusion is not encompassed by a compound consisting of taurine.

Taurine and taurine analogs are commercially available. For example, both Food Grade (>98% purity) and Pharmaceutical Grade (>99,5% purity) taurine is available.

In preferred embodiments, the disclosure provides the use of albumin, optionally with taurine or an analog thereof, for the treatment of nerve cell damage and glutamate excitotoxicity disorders as described herein. In preferred embodiments, the albumin is human serum albumin (HSA). HSA is soluble, monomeric cystine-rich serum protein taken up by many cells. An exemplary sequence of HSA may be found at GenBank accession number AAA98797.1. In additions, modified HAS may be used such as anhydride modified HAS and ML-HAS. HSA has been shown to regulate cellular glutathione levels (Cantin AMI, Paquette B, Richter M, Larivee PAm J Respir Crit Care Med. 2000 Oct; 162(4 Pt 1): 1539-46. While not wishing to be bound by theory, administration of albumin to patients having disorders described herein is believed to increase glutathione levels, which are reduced as a result of glutamate excitotoxicity.

The compositions comprising taurine or an analog thereof and/or albumin may be in the form of nutritional or pharmaceutical composition. Nutritional compositions include dietary, food, or health supplements; concentrate; and functional food (sports nutrition, drinks, food supplement, food for medical purposes, clinical nutrition). Functional food refers to any fresh or processed food comprising one or more components that provide a physiological benefit to the consumer of the food.

Preferably the compositions are pharmaceutically acceptable compositions. To prepare pharmaceutical compositions containing the compounds disclosed herein, a

therapeutically effective amount of taurine or a metabolite or precursor thereof is admixed with a pharmaceutically acceptable carrier, filler, preservative, adjuvant, solubilizer, diluent and/or excipient. Such pharmaceutically acceptable carrier, filler, preservative, adjuvant, solubilizer, diluent and/or excipient may for instance be found in Remington: The Science and Practice of Pharmacy, 20th Edition. Baltimore, MD: Lippincott Williams & Wilkins, 2000. The carrier may contain minor amounts of additives such as substances that enhance isotonicity and chemical stability, e.g., buffers and preservatives, see, e.g., Remington's Pharmaceutical Sciences and U.S. Pharmacopeia: National Formulary, Mack Publishing Company, Easton, Pa. (1984). In a preferred embodiment, oral compositions are provided. For intravenous, subcutaneous, intramuscular, intrathecal and/or intraventricular administration it is preferred that the solution is a physiological salt solution. In a preferred embodiment, an aqueous composition is formulated for administration by a route which bypasses the blood-brain barrier. Aqueous formulations that are traditionally used to deliver therapeutic agents to the CNS include unbuffered isotonic saline and Elliott's B solution. Preferably, the pharmaceutical composition is sterile and/or pyrogen free.

In comparison to other neuroactive amino acids, taurine has a sulfonic acid instead of a carboxylic acid group which presents unique physical properties that make it difficult to cross the blood-brain barrier (BBB). The blood-brain barrier (BBB) is a structural system comprised of endothelial cells that functions to protect the central nervous system (CNS) from deleterious substances in the blood. The effect of which is that the diffusion of substances from the blood into the CSF and CNS is greatly limited. The low passive diffusion of taurine occurs because of its cyclic

conformational form with intra-molecular hydrogen bonding. The concentrations of taurine in the CNS are therefore dependent on a sodium and chloride coupled transport system at the blood brain barrier (BBB) referred to as the Taurine

Transporter (TauT).

It is well within the purview of one skilled in the art to determine the appropriate administration regime. Disorders having a leaky BBB include inflammatory, infectious, and late stage disorders. Exemplary disorders include multiple sclerosis and Alzheimer's disease. As shown in example 1, administration of oral taurine is sufficient to treat a individual afflicted with multiple sclerosis. In contrast, disorders in which the BBB is intact or only mildly affected may require administration by a route which bypasses the blood-brain barrier in order to achieve maximum therapeutic effect. However, treatment of such disorders is also possible via other administration routes. Administration by a route which bypasses the blood- brain barrier merely increases the amount of taurine which reaches the CNS.

Administration by a route which bypasses the blood-brain barrier also has the advantage of bypassing the dependence on TauT for increasing taurine concentrations in the CNS. Accordingly, in preferred embodiments, the compositions are

administered to the central nervous system of an individual by a route which bypasses the blood-brain barrier.

Preferred routes of administration which bypass the BBB are intrathecal

administration and intraspinal administration. Particularly preferred routes of administration which bypass the BBB are intrathecal administration, intraspinal administration, and intranasal administration, more preferably intranasal administration. It has been demonstrated that intranasal formulations of albumin are taken up and distributed in the brain with little albumin entering the blood (Joseph A. Falcone, Therese S. Salameh, Xiang Yi, Benjamin J. Cordy, William G. Mortell, Alexander V. Kabanov, and William A. Banks; THE JOURNAL OF

PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS J Pharmacol Exp Ther 351:54-60, October 2014 U.S. Intranasal Administration as a Route for Drug Delivery to the Brain: Evidence for a Unique Pathway for Albumin).

In embodiments in which both albumin and taurine or an analog thereof are provided to an individual, the two compounds may be provided in a single composition or in two separate compositions. If administered separately, they are preferably administered by the same route. However, the disclosure also encompasses embodiments in which the two compounds are administered by different routes. Disorders having an intact or mildly affected BBB include localized, primary and singularly CNS disorders, as well as in sudden onset diseases and in early stage diseases. However, even for these disorders a particular individual may have microvascular barrier abnormalities, which allow a larger amount of taurine and/or albumin to reach the CNS. It is known, for example, that prolonged exposure to stressful situations can result in impairments in the BBB. Therefore, a physician may decide to first treat an individual with oral, intravenous, subcutaneous, or

intramuscular albumin and/or taurine or an analogue thereof. If symptoms do not improve, then intrathecal or intraspinal administration may be used.

As used herein "intraspinal" means into or within the epidural space, the intrathecal space, the white or gray matter of the spinal cord affiliated structures such as the dorsal root and dorsal root ganglia. Intraspinal administration includes "intrathecal administration" and "peridural administration". The term "intrathecal

administration" refers to the administration a compound into the spinal canal. For example, intrathecal administration may comprise injection in the cervical region of the spinal canal, in the thoracic region of the spinal canal, or in the lumbar region of the spinal canal. Typically, intrathecal administration is performed by injecting a compound into the subarachnoid cavity (subarachnoid space) of the spinal canal, which is the region between the arachnoid membrane and pia mater of the spinal canal.

The term "intracerebral administration" refers to administration of a compound into and/or around the brain. Intracerebral administration includes, but is not limited to, administration of a compound into the cerebrum, medulla, pons, cerebellum, intracranial cavity, and meninges surrounding the brain. Intracerebral

administration may include administration into the dura mater, arachnoid mater, and pia mater of the brain. Intracerebral administration may include, in some embodiments, administration of an agent into the cerebrospinal fluid (CSF) of the subarachnoid space surrounding the brain. Intracerebral administration may include, in some embodiments, administration of an agent into ventricles of the brain. For intracerebral administration, the compound may be delivered by way of a catheter or other delivery device having one end implanted in a tissue, e.g., the brain by, for example, intracranial infusion. Such methods are known in the art and are further described in U.S. Publications 20120116360 and 20120209110, which are hereby incorporated by reference. Administration may be via an injection, infusion, pump, implantable pump, etc.

Intrathecal drug delivery systems are known in the art and generally comprise of a catheter placed in the intrathecal space which is connected to a pump/reservoir, which can be implanted under the skin around the abdomen. The pump delivers the compound via the catheter either continuously or intermittently.

It is clear to a skilled person that a suitable administration regime may include the combination of administration routes. For example, in some embodiments the compounds disclosed herein are administered first intrathecally followed by, e.g., daily oral administration. In some embodiments, the compounds are administered orally for several days or weeks followed by, one or more intrathecal administrations.

Individuals being treated for nerve cell damage associated with chronic conditions, e.g., ALS, MS, Alzheimer's, and Parkinson's disease, are preferably treated

chronically with the compositions disclosed herein. Preferably the duration of treatment lasts at least one week, at least one month, or at least one year. Individuals being treated for nerve cell damage associated with acute conditions, e.g., traumatic or ischemic brain injury, infection of the CNS, may be treated on a more limited basis, e.g., a few weeks or a few days. Individuals receiving chemotherapy for a CNS tumor should be treated throughout chemotherapy or until there are no further signs of ongoing disease.

Actual dosage levels of the pharmaceutical preparations described herein may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient. The selected dosage level will depend upon a variety of factors including the activity of the particular compound, the route of administration, the time of administration, the rate of excretion of the particular compound being employed, the duration of the treatment, other drugs, compounds and/or materials used in combination, the age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well known in the medical arts. A physician or veterinarian having ordinary skill in the art can readily determine and prescribe the effective amount of the pharmaceutical composition required. For example, the physician or veterinarian could start with doses of the compounds described herein at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved.

The recommended dosage of taurine as a nutritional supplement is 2000mg per day (i.e., for an average adult around 25mg/kg/day). In a preferred embodiment of the disclosure, taurine or an analog thereof is orally administered to an individual at a significantly higher dosage. Preferably, taurine or an analog thereof is orally administered at a dosage of at least 5000mg per day, at least 6000 mg per day, or at least 8000 mg per day. Preferably, taurine or an analog thereof is orally administered between 5000 to 30,000 mg per day, more preferably between 6000 to 25000 mg per day. Although the average doses for an adult are in the range of 8000 to 20,000mg per day, in some embodiments the individual begins treatment with lower dosages, e.g., three or four doses of 1500mg per day. In particular, we have found that for the treatment of ADHD in children, lower dosages can be used, e.g., 500-1000mg three or four times per day. In young children, e.g., between 5 to 7 years, positive effects have been shown with as little as 500-1000mg per day.

Although administration may occur once per day, preferably the dosage is divided into two, three, four, or five dosages administered during the day. These dosages are based on an average adult and can be adjusted based on, for example, age and weight. The dosage regime will of course depend of the specific disorder, the progression of the disorder and the phase of the disorder.

Preferably, taurine or an analog thereof is administered at a dose of between

30mg/kg/day to 500mg/kg/day; more preferably between 40mg/kg/day to

400mg/kg/day, even more preferably between 40mg/kg/day to 300mg/kg/day. In some embodiments, taurine or an analog thereof is administered at a dose of between lOOmg/kg/day to 300mg/kg/day. In some embodiments, taurine or an analog thereof is administered at a dose of between 50mg/kg/day to 250mg/kg/day. Preferably, taurine or an analog thereof is administered at a dose of at least 30mg/kg/day, at least 40mg/kg/day, preferably at least 50mg/kg/day, more preferably at least lOOmg/kg/day.

An exemplary embodiment for the treatment for an adult weighing 80kg is as follows. It is clear that the following dosages can be adjusted for patients of different weight and/or age. The individual is treated with 6000mg taurine per day for 1.5 to 2 weeks. The treatment is then increased to lOOOOmg per day. After another two weeks, the treatment may be increased further up to about 25,000mg per day. The symptoms of the individual can be monitored over several weeks or even months. Once the symptoms have decreased or stabilized the dosages may also be reduced to a

"maintenance dosage".

For intraspinal administration, the dosage can be greatly decreased. For example, a typical daily dosage ranges from lmg to lOOmg. Similar to oral administration, the dosages may begin at the lower end of the range and slowly increase after several weeks of treatment. Once symptoms begin to improve or stabilize the dosage may be decreased and/or the administration may be given less frequently.

In a preferred embodiment of the disclosure, albumin is administered to an individual in need thereof in a range of 0. lg to 15g, preferably between 0.5g to lOg per day, more preferably between 2g to 5g per day. In a preferred embodiment of the disclosure, albumin is administered to an individual in need thereof in a range of 0.05mg/kg to 5.0mg/kg per day, preferably between O. lmg/kg to 2.0mg/kg per day, more preferably between 0.025mg/kg to l.Omg/kg per day.

It is clear that the dosages can be adjusted for patients of different weight and/or age. Although administration may occur once per day, preferably the dosage is divided into two, three, four, or five dosages administered during the day. The dosage regime will of course depend of the specific disorder, the progression of the disorder and the phase of the disorder.

In some embodiments, albumin and/or taurine or an analog thereof is used in combination with other medicaments. The other medicaments can be formulated together with the taurine or analog thereof or administered simultaneously or sequentially to the taurine or analog thereof. For example, in the treatment of ALS, albumin and/or taurine or an analog thereof may be used in combination with riluzole. For individuals suffering from MS, albumin and/or taurine or an analog thereof may be used in combination with baclofen. For some patients, the use of albumin and/or taurine or an analog thereof may allow the dosage of the other medicaments to be decreased. Preferably, albumin and/or taurine or an analog thereof is used in combination with vitamin B12. In another aspect, the present disclosure provides methods for treating bone disease or bone injury in an individual comprising administering taurine or an analogue thereof to said individual. Bone undergoes remodelling throughout life. Remodelling is the process by which bone is renewed to maintain bone strength and mineral homeostasis. The remodelling cycle is composed of four sequential phases.

In phase 1, activation involves recruitment and activation of mononuclear monocyte- macrophages osteoclast precursors: mononucleated preosteoclasts.

The second phase consists of osteoclast-mediated bone resorption, in which osteoclast formation, activation, and resorption are regulated by the ratio of RANKL (receptor activator of NF-kappaB ligand) to OPG (osteoprotegerin).

In the reversal phase (phase 3), bone resorption transitions to bone formation.

Preosteoblasts are recruited to begin new bone formation.

The phase of bone formation (phase 4) takes 4 to 6 months. Osteoblasts synthesize new collagenous organic matrix and regulate mineralization. Approximately 30-50% of osteoblasts become osteocytes, the rest (50-70%) undergo apoptosis.

Glutamate is released by osteoblasts and mature osteoclasts. Glutamate signalling mechanisms are able to detect very fast stimulatory signals and self-modify, making them well-suited for responding to mechanical signalling in bone and to stear the process of remodelling. Glutamate overstimulation or excitotoxicity can disrupt normal signalling, leading to disrupted remodelling of bone. While not wishing to be bound by theory, the present disclosure is based, in part, on the hypothesis that glutamate overstimulation is involved in bone degeneration, e.g., osteoporosis. High concentrations of glutamate inhibit pre-osteoblast differentiation (phase 3) in association with glutathione (GSH) depletion. The cystine/glutamate antiporter is expressed and functionally required for the differentiation of pre-osteoblasts, pre- osteoclastic cells, and primary osteoclasts from bone marrow precursor cells.

Differentiation is inhibited by high glutamate concentrations. High concentrations of extracellular glutamate reverse the activity of the antiporter, resulting in cystine being released from the cell, thus reducing intracellular cystine available to generate GSH. This situation of high extracellular concentrations of glutamate, causing excitotoxicity and low concentration of GSH, suppressing the response to oxidative stress, resembles the situation in neurodegenerative diseases like e.g. ALS.

It is well-understood that bone formation is beneficial for the treatment of a wide variety of bone disorders including bone degeneration (e.g., osteoporosis), fracture healing, fusion or arthrodesis, osteogenesis imperfecta, as well as for successful installation of various medical orthopedic and periodontal implants such as screws, rods, titanium cage for spinal fusion, hip joints, knee joint, ankle joints, shoulder joints, dental plates and rods. The present disclosure is based, in part, on the discovery that taurine and its analogs play a role in bone formation.

The present disclosure provides taurine or an analog thereof for treating a bone disorder and/or for increasing bone density and/or bone growth. In a preferred embodiment, the compounds used herein are provided for the treatment of osteoporosis. Preferably, such uses increases the bone density in said patients and/or reduces the risk of bond fractures. In some embodiments, the individual in need thereof is also treated with one or more additional compounds. Suitable compounds for combination treatment include vitamin D, calcium, and bisphosphonates or other bone-active phosphonates (see, e.g., WO1993011786).

Preferably, the bone disorder is a degenerative bone disorder such as osteopenia or osteoporosis. Degenerative bone disorder refers to a disease or condition characterized by a decrease in bone mass and/or an increase in probability of fractures because of compromised structural integrity of the bone. Many degenerative bone disorders arise from an imbalance between bone formation and bone resorption. This imbalance can be caused by a reduction in osteoblast mediated bone formation, an increase in osteoclast mediated bone resorption, or a combination of changes to osteoblast and osteoclast activity. Osteoporosis is a skeletal disorder that is characterized by low bone mass and micro- architectural deterioration of bone tissue. The WHO defines osteoporosis as bone density 2.5 standard deviations below the bone density of a reference standard (i.e., generally a healthy young adult of about 30 years old).

Osteopenia is a condition with lower than normal bone density, specifically, a bone mineral density T-score between -1.0 and -2.5. Both osteoporosis and osteopenia patients are at risk for bone fractures. Bone formation is also involved in the healing of bone injuries. Accordingly, the present disclosure provides taurine or analogue thereof as part of the treatment of bone injury. Preferably, the bone injury is a bone fracture.

Bone fracture healing is a physiological process in which the body repairs the fracture. In order to facilitate the body's healing process, bone fractures are usually treated by resetting the bone (if necessary) and then stabilizing or immobilizing the bone, e.g., with a splint or cast. In the case of degenerated bone, prosthetic devices are often used. The compounds disclosed herein can improve bone fracture healing, e.g., by shortening healing time and/or improving the quality of the resulting repaired bone. Preferably, the compounds are used in combination with traditional methods of treatment such as the immobilization of a bone fracture. Generally, in otherwise healthy or "low risk" individuals, the time needed for fracture consolidation is around four to 12 weeks. In cases with delayed or improper consolidation, surgical intervention is often required.

In "high risk" individual, the consolidation may be considerably delayed or absent. High risk individuals include individuals with degenerative bone disorders. Other factors which can increase the risk of poor fracture consolidation are those factors which are known to have an effect with bone loss or osteoporosis and include, e.g., smoking, excessive alcohol drinking, and underweight and/or malnutrition. In addition, some types of fractures, due to their location, may also have a delayed consolidation time even in "low risk" individuals. For example, fractures of the femoral neck (superolateral), anterior cortical bone of the tibia, medial malleolus, navicular bone, base of the second metatarsal, talus, patella, sesamoids (hallux), and fifth metatarsal have a high risk of delayed consolidation (Costa Astur et al. Rev Bras Ortop. 2016 Jan-Feb; 51(1): 3-10).

The effects of taurine on bone formation improve or assist the bone formation healing process. While taurine or an analogue thereof may be used as part of a treatment regime for treating a low risk fracture in a low risk individual, the invention is particularly advantageous in high risk individuals and/or for high risk fractures.

As used herein, "treating" a bone disorder or bone injury refers to one or more of the following: increasing bone strength, increasing bone density, decreasing brittleness, decreasing bone pain.

In preferred embodiments, the disclosure provides methods for treating a bone fracture in an individual, comprising administering taurine or an analogue thereof to said individual. In particular, said method reduces the consolidation time of the fracture and/or increases consolidation of the bone fracture.

The taurine or analog thereof may be provided as a composition as described herein and by any administration route. Preferably, the composition is provided orally. Preferred dosages are as previously described herein.

Individuals being treated for a bone disorder associated with chronic conditions, e.g., osteoporosis, are preferably treated chronically with the compositions disclosed herein. Preferably the duration of treatment lasts at least one month, at least six months, at least one year, or indefinitely. Individuals being treated for acute conditions, e.g., a bone fracture, may be treated on a more limited basis, e.g., a few weeks or a few months. The treatment period for an acute condition, such as a bone fracture, can be determined based on, e.g., the consolidation of the bone fracture. Definitions

As used herein, "to comprise" and its conjugations is used in its non-limiting sense to mean that items following the word are included, but items not specifically mentioned are not excluded. In addition the verb "to consist" may be replaced by "to consist essentially of meaning that a compound or adjunct compound as defined herein may comprise additional component(s) than the ones specifically identified, said additional component(s) not altering the unique characteristic of the invention.

The articles "a" and "an" are used herein to refer to one or to more than one (i.e., to at least one) of the grammatical object of the article. By way of example, "an element" means one element or more than one element.

The word "approximately" or "about" when used in association with a numerical value (approximately 10, about 10) preferably means that the value may be the given value of 10 more or less 1% of the value.

As used herein, the terms "treatment," "treat," and "treating" refer to reversing, alleviating, delaying the onset of, or inhibiting the progress of a disease or disorder, or one or more symptoms thereof, as described herein. In some embodiments, treatment may be administered after one or more symptoms have developed. In other

embodiments, treatment may be administered in the absence of symptoms. For example, treatment may be administered to a susceptible individual prior to the onset of symptoms (e.g., in light of a history of symptoms and/or in light of genetic or other susceptibility factors). Treatment may also be continued after symptoms have resolved, for example to prevent or delay their recurrence.

All patent and literature references cited in the present specification are hereby incorporated by reference in their entirety.

The invention is further explained in the following examples. These examples do not limit the scope of the invention, but merely serve to clarify the invention. EXAMPLES

Example 1: Treatment of MS with oral administration of taurine

A 56 year old man, suffering of chronic progressive Multiple Sclerosis, who has been wheelchair- dependent for several years and who has not been able to actively contribute to transfers from bed to wheelchair and vice versa for some time, was administered Taurine in a dose of 1500mg, 3 times per day, orally. Within the course of one week, he decreased the dose of baclofen from 6-8 tablets per day to 4 per day. The baclofen was prescribed to decrease the spasms he was suffering from. His spasms decreased with approximately 70% in severity and frequency. After two weeks of therapy, he was able to stand up without help, using a "stand-up chair" to prevent him from falling. Because he complained of increasing spasms after exercise and still some muscle-stiffness, the dose was increased to 1500mg 4 times per day. Ten days later, still improving in coordination and muscle strength, the dose was increased to 4000mg 5 times per day.

Example 2: Treatment of ALS with taurine

A 58 year old woman suffering from ALS is treated with oral taurine. Mainly because of the bulbar involvement of the disease, she is unable to care for herself. She needs non-invasive respiratory assistance and is wheelchair bound. She has been taken

Cobalamin (vitamin B12) injections twice weekly for approximately 2 years, the effect of which cannot be objectified. She has started taking taurine orally in a dose of 15g per day. Example 3: Treatment of Alzheimer's disease with taurine

An 82 year old man with Alzheimers disease is treated with oral taurine. His cognitive functions have declined to a level in which he is only able to call his daughter by telephone through a programmed number. After using the telephone he leaves the receiver off the hook. Shortly after he has had visitors, he is unable to recall who has come to visit or even that anyone has been to visit him. One week after starting taurine dosed orally 3xl500mg per day, his cognitive function has

significantly improved. He puts the receiver back on the hook after using the telephone, and he told his daughter who had been to visit the day before. Example 4: Comparative treatment of oral and intrathecal administration

The reduction in neurological symptoms in an MS patient treated with oral taurine suggested that that other disorders associated with nerve cell damage can also be treated with taurine. While not wishing to be bound by theory, the surprising effect of taurine in MS may be due to a protective function of taurine against glutamate- induced neuronal injury, presumably through its function in regulation of

intracellular free calcium level (Wu et al. Adv Exp Med Biol 2009 643:169-79).

Accordingly, administration of taurine can be used to treat other excitotoxicity related disorders and the nerve damage associated therewith. The following example demonstrates a further excitotoxicity related disorder that can be treated with taurine.

The blood-brain -barrier in MS patients is known to be "leaky", presumably due to inflammation. Orally administered taurine is, presumably, able to reach therapeutic concentrations in the CNS due to the leaky blood-brain-barrier. However, in other disorders oral taurine administration may need to be supplemented or entirely replaced with administration by a route which bypasses the blood-brain barrier (e.g., intracerebral or intraspinal administration) in order to achieve maximum therapeutic effects.

In order to compare the effects of taurine administered orally versus intraspinal, the following study will be performed. Patients afflicted with ALS will be randomly stratified into three groups. Group 1 will be the control group and will receive a placebo treatment Group 2 will be treated with 50mg/kg/day of oral taurine daily for two weeks. Group 3 will be treated with 5 mg of taurine intrathecally administered once per day for two weeks. At the end of the two week study, the patients will be evaluated for motor function. Patients in Group 2 will demonstrate a slight to moderate improvement over Group 1, while patients in Group 3, will demonstrate a moderate to strong improvement over Group 1.

Example 5: Treatment of hip -fracture with taurine

An 86 years old female, with a spontaneous fracture of the right hip, had been wheelchair-bound for 7 months because there was no consolidation of the fracture. (See Figure 1) Due to the condition of her hipbone, hip replacement was not possible. She was unable to move her right leg at all, she had to replace the leg by hand. The patient had been smoking for 70 years, weight 49 kgs and was in a mediocre nutritional condition. At that point it appeared very unlikely that sufficient consolidation would occur.

The patient began treatment with taurine; specifically taurine administered 4x2grs a day, VB12 injections, lOOOmcgs twice a week and intensive physical therapy. Within a few weeks she was able to lift her right leg. After 6 months, consolidation could be seen on X-ray and she could begin walking with crutches. (See Figure 2) The pin was removed and a total hip replacement was performed.

Example 6: Treatment of ADHD

A five-year old boy suffered from various ADHD symptoms including unruly and aggressive behavior, short-temperament, poor concentration, and lack of proactivity. The patient was treated with 1 gram taurine, orally administered 4 times per day. In follow up visits, the patient's parents reported improved behavior including improved concentration, spontaneous exhibition of (positive) emotions, increased proactivity.

While not wishing to be bound by theory, the improvement of ADHD symptoms is believed to be the result of taurine's effect on glycine and/or GABA

neurotransmission. Example 7: Treatment of ALS

A 55 year old patient diagnosed with ALS exhibited hand cramping and difficulty holding up her head, leading to tiredness. The patient was treated with 2 grams taurine, orally administered 4 times per day. In follow up visits the patient reported improved neck strength and ability to hold up her head, which also decreased her tiredness.

Example 8: Treatment of INAD

An 8 year old boy with INAD had severe nystagmus, spasms for which he

used baclofen, he couldn't keep his head up, he had sundowning (in Alzheimer's disease, sundowning is associated with fast progression of dementia), crying from 4pm untill he had had his sleeping medication. Within 3 weeks of treatment with taurine (orally administered 1,5 grams x 4 times a day), the nystagmus disappeared, the spasms decreased, the sundowning disappeared and he could keep his head up much better and even turn his head to look around. After 9 months of treatment, he has grown a lot, he is happier and is less overstimulated, and he no longer uses medications for his spasms or sleeping disorder.

Claims

1. A composition comprising taurine or an analog thereof, for use in the treatment of nerve cell damage in an individual.

2. The composition according to claim 1, wherein the composition is administered to the central nervous system of the individual by a route which bypasses the blood- brain barrier.

3. The composition for use according to claim 2, wherein said route of administration is intracerebral or intraspinal administration.

4. The composition for use according to any of the preceding claims, wherein said the taurine or an analog thereof is formulated in a pharmaceutical composition suitable for administration by a route which bypasses the blood-brain barrier.

5. The composition according to claim 1 or 2, wherein the individual is afflicted with multiple sclerosis or Alzheimer's disease.

6. The composition according to claim 1 or 5, wherein taurine or an analogue thereof is orally administered to said individual with a dosage of at least 40mg/kg/day, preferably at least lOOmg/kg/day.

7. The composition according to any of the preceding claims, wherein the taurine or an analog thereof is provided as a compound consisting of taurine or a metabolite or precursor thereof.

8. The composition for use according to any of the preceding claims, comprising taurine.

9. The composition for use according to any of the preceding claims for the treatment of nerve cell damage associated with a glutamate excitatory dependent disorder, a neurological disorder, a NBIA disorder (Neurodegeneration with Brain Iron Accumulation) a central nervous system tumor, an infection of the central nervous system, hypoxia-induced nerve cell damage, or traumatic brain injury.

10. The composition for use according to any of the preceding claims for the treatment of amyotrophic lateral sclerosis, multiple sclerosis, progressive spinal muscular atrophy, Alzheimer's disease, Parkinson's disease, and Huntington's disease.

11. The composition for use according to claim 10, for the treatment of amyotrophic lateral sclerosis.

12. The composition for use according to any of the preceding claims, wherein said composition is administered chronically, preferably the duration of treatment lasts at least one week, at least one month, or at least one year.

13. The composition for use according to any of the preceding claims, wherein said taurine analog is selected from hypotaurine and homotaurine.

14. The composition for use according to any of the preceding claims, wherein said individual is also administered with albumin.

15. The composition for use according to claim 14, wherein said albumin is provided in an intranasal formulation.

16. A composition comprising albumin, for use in the treatment of nerve cell damage in an individual.

17. The composition for use according to claim 16, wherein said albumin is provided in an intranasal formulation.

18. The composition according to claim 16 or 17, wherein the individual is afflicted with Amyotrophic lateral sclerosis.

19. The composition according to any one of claims 16-18, wherein the albumin is human serum albumin.

20. The composition for use according to any one of claims 16-19 for the treatment of nerve cell damage associated with a glutamate excitatory dependent disorder, a neurological disorder, a NBIA disorder (Neurodegeneration with Brain Iron

Accumulation) a central nervous system tumor, an infection of the central nervous system, hypoxia-induced nerve cell damage, or traumatic brain injury.

21. A composition comprising taurine or an analog thereof, for use in the treatment of bone disorder or bone injury in an individual.

22. The composition for use according to claim 21, wherein the taurine or an analog thereof is provided as a compound consisting of taurine or a metabolite or precursor thereof.

23. The composition for use according to claim 21, wherein said taurine analog is selected from hypotaurine and homotaurine.

24. The composition for use according to claim 21, comprising taurine.

25. The composition for use according to any one of claims 21-24, wherein the bone disorder is selected from osteopenia or osteoporosis.

26. The composition for use according to any one of claims 21-24, wherein the bone injury is a bone fracture.