Classifications

• • 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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4418—Non condensed pyridines; Hydrogenated derivatives thereof having a carbocyclic group directly attached to the heterocyclic ring, e.g. cyproheptadine
• • 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
  • A61K9/20—Pills, tablets, discs, rods
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics

Definitions

• the present invention relates to the use of a pharmaceutical composition in the form of extended-release tablets containing pirfenidone (PFD-LP), for the induction of the decrease / elimination of accumulations of liver fat or steatosis and its therapeutic application in the regression of advanced liver fibrosis and NAFLD / NASH.
• PFD-LP extended-release tablets containing pirfenidone
• Cirrhosis is the final stage of advanced liver fibrosis (FUA), which is defined as an excessive accumulation of extracellular matrix (ECM) or interstitial scar that occurs as a result of chronic liver injury. Due to the regeneration capacity of the liver, cirrhosis is a pathological process that can develop slowly. In addition, it has been observed that it is a process in which genetic factors are also involved. Changes in medical treatment against advanced liver fibrosis continue in progress, leading the implementation of antifibrogenic and preventive therapies that currently seem to offer hope to millions of patients worldwide. FHA is characterized by an increase in the synthesis of ECM as well as a change in its composition, which results in an abnormal remodeling of liver tissue and consequent distortion of the organ's architecture. This leads to a decrease in liver function. Flaiapathology
• the pathophysiology of this disease is due to an inflammatory process, in which there is an increase in the expression of proinflammatory cytokines such as Interleukin 6 (IL-6), Interleukin 1 beta (IL- ⁇ ) and Tumor Necrosis Factor alpha (TNF - ⁇ ). Inflammation is accompanied by oxidative stress caused by the decrease in the expression of antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT), and an increase in the production of free radicals such as superoxide anion, hydroxyl anion, hydrogen peroxide , among others.
• IL-6 Interleukin 6
• IL- ⁇ Interleukin 1 beta
• TNF - ⁇ Tumor Necrosis Factor alpha
• SOD superoxide dismutase
• CAT catalase
• TGF- ⁇ Transforming Growth Factor beta 1
• COL-1 type 1 collagen
• TGF- ⁇ Transforming Growth Factor beta 1
• COL-1 type 1 collagen
• TGF- ⁇ Transforming Growth Factor beta 1
• COL-1 type 1 collagen
• TGF- ⁇ Transforming Growth Factor beta 1
• COL-1 type 1 collagen
• TGF- ⁇ Transforming Growth Factor beta 1
• COL-1 type 1 collagen
• TGF- ⁇ Transforming Growth Factor beta 1
• COL-1 type 1 collagen
• TGF- ⁇ Metalloprotease 1 Tissue Inhibitor
• CEH Stellar liver cells
• CEHs can migrate through chemoattractant cytosines (chemosins).
• chemoattractant cytosines chemosins
• cytosines cytosines
• MCP-1 MCP-1
• CXCR3 CXCR3.
• CEHs generate fibrosis not only because of the increase in MEC production, but also because of the proliferation of MEC-producing cells.
• the main component studied of the hepatic scar is type 1 collagen (COL-1).
• COL-1 type 1 collagen
• TGF- ⁇ which is given by both paracrine and autocratic agents.
• Downstream signaling in the TGF- ⁇ cascade includes the family of bifunctional molecules known as Smads.
• TGF- ⁇ also stimulates the production of other components of MEC such as fibronectin and proteoglycans.
• the stimulation of TGF- ⁇ to CEH is mediated by hydrogen peroxidation and C / EBP-dependent mechanisms.
• CTGF connective tissue growth factor
• the contractility of CEH could be the main determinant of the early or late increase in portal resistance in the cirrhosis. Collagen bands prevent a normal flow of blood in the portal pathway due to a constriction of sinusoids and contractility throughout the cirrhotic liver. Endothelin-1 and nitric oxide are the main regulators of contractility in CEH. Also included in this list are angiotensinogen II, eicosanoids, atrial natriuretic peptide, somatostatin, carbon monoxide, among many others. The expression of cytoskeleton ⁇ -SMA protein is increased, this gives CEH a potential contractility.
• Non-alcoholic fatty liver disease (NASH, hereinafter identified as NAFLD / NASH) associated with the metabolic syndrome, continue to increase its prevalence worldwide.
• NAFLD non-alcoholic fatty liver disease
• Non-alcoholic fatty liver is expected to be a major cause of liver related morbidity and mortality over the next decades.
• the pathogenesis of fatty liver by alcohol and also that induced by causes beyond alcohol consumption such as non-alcoholic steatohepatitis, is based on the accumulation of triglycerides that leads to hepatic steatosis.
• a second damage is generated by inflammation, orchestrated by an inflammatory reaction and production and infiltration of cells and cytokines [2].
• non-alcoholic steatohepatitis characterized by infiltration of inflammatory cells and liver damage, in the presence or not, of cirrhosis. It is estimated that 20-30% of people in Western countries suffer from non-alcoholic fatty liver, the propensity to develop this condition seems to be related to racial-ethnic origin, which could be represented in 45% Hispanic, 33% Caucasians and 24% African Americans. It has been observed that in the presence of normoglycemia and normal or moderate body weight, NAFLD is characterized by laboratory levels and clinical data similar to those observed in diabetes and obesity [1,3].
• PPARalfa regulates the oxidation of fatty acids by increasing the expression of genes such as CPT1A, which in turn internalizes lipids to the mitochondria to obtain energy from them. [fifteen] .
• LXR has long been known for its ability to increase the rate of lipogenesis by promoting the expression of another master transcriptional factor such as SREBP1 [16].
• Pirfenidone is a medicine consisting of a small molecule, whose chemical name is 5-methyl-l-phenyl-2- (1H) pyridone. It is a synthetic non-peptide molecule with a molecular weight of 185.23 Daltons. Its chemical formula is C12H11N0, and its structure is known. Currently, pirfenidone is under clinical evaluation as a broad-spectrum anti-fibrotic drug. Pirfenidone has anti-fibrotic and anti-fibrotic properties. inflammatory that are reflected in its activity of reducing the expression of TGF- ⁇ , TNF-a, PDGF and most importantly, the expression of different types of collagen.
• pirfenidone reduces the progressive progression of lesions with fibrosis. Most importantly, pirfenidone performs its cellular and molecular functions in a safe and non-toxic manner. On the other hand, it is known that pirfenidone prevents the formation of fibrotic lesions after damage to a particular organ, for example, liver, skin, kidney, etc.
• Pirfenidone is a potent inhibitor of fibrogenic cytokines and TNF-a.
• the object of the present invention is the use of a pharmaceutical composition in the form of a prolonged-release tablet, comprising lOOmg, 200mg, 300mg, 400mg or 600mg of pirfenidone, for the reversal and treatment of alcoholic and non-alcoholic steatohepatitis (NAFLD / NASH).
• a further object of the present invention is the use of a pharmaceutical composition in the form of an extended-release tablet, for the regression of advanced liver fibrosis.
• Another additional object of the present invention is the use of a pharmaceutical composition in the form of an extended-release tablet, for the regression of NAFLD / NASH, which occurs through the serum decrease of cholesterol and triglycerides.
• Another additional object of the present invention is the use of a pharmaceutical composition in the form of an extended-release tablet, for the regression and treatment of NAFLD / NASH, which occurs by decreasing the content of the accumulation of liver fat, both in the form of macro-steatosis as microsteatosis.
• a further object of the present invention is the use of pirfenidone in a prolonged release pharmaceutical composition for the reversal and treatment of advanced liver fibrosis and NAFLD / NASH, the therapeutic effect of which is attributed to pirfenidone that acts as an agonist for PPAR gamma (peroxisome proliferation receptor activated gamma), PPARalfa (peroxisome proliferation receptor activated alpha), LXR and CPT-1.
• PPAR gamma peroxisome proliferation receptor activated gamma
• PPARalfa peroxisome proliferation receptor activated alpha
• LXR peroxisome proliferation receptor activated alpha
• CPT-1 concomitant to these actions, Pirfenidone-LP induces the decrease in the expression of the NFkB master gene, inducer of the hepatic inflammatory process.
• the present invention is illustrated, but not limited by the aforementioned objects; for the treatment or regression of advanced liver fibrosis, and alcoholic and non-alcoholic steatohepatitis (NAFLD / NASH), demonstrating that the pharmaceutical composition in the form of prolonged-release tablets containing pirfenidone, favors the decrease of Hepatotoxic effect of pirfenidone, previously disclosed in the current state of the art.
• NAFLD / NASH alcoholic and non-alcoholic steatohepatitis
• Fig. 1A-D Shows body weights , glucose levels and levels of liver enzymes ALT and AST of mice.
• Fig. 2 Shows the histological examination of the tissues of the livers of the mice included in the control groups, HF and those treated with PFD-LP.
• Fig. 3A-F Shows the analysis of proinflammatory cytokines in the serum of the mice included in each of the indicated groups.
• Fig. 4 Shows the expression of profibrogenic and proinflammatory marker genes.
• Fig. 5 Shows the "western blots" with the proteinic expression of the fat metabolism mediators in NAFLD / NASH, the key metabolic transcription factors LXR and PPARalfa were evaluated in liver tissue.
• mice Male C57BL / 6NHsd (Har ⁇ an, Mexico City) were housed in an atmosphere of 22 and 2 ° C in cycles of 12 hours of light / dark. 5-7 mice were randomized to the standard Chow diet (control) or high fat / high carbohydrate (HF) diet for 16 weeks.
• the control group received the Har ⁇ an TM-2018 diet (18% of fat calories) and had free access to pure water
• the HF group received the Har ⁇ an TD-06414 diet (60% of lipid calories) and had free access to water. with high fructose enriched at a concentration of 42 g / L (proportions in 55% fructose and 45% sucrose).
• the group of PFD mice (HF + PFD) received an HF diet for 8 weeks, followed by the HF diet for 8 weeks and a 100 mg / kg / day PFD extended-release formulation (200mg, 300mg, 400mg concentrations were also used or 600mg of pirfenidone). All regimes received 0.1 mi of vehicle. After one night of fasting, blood samples were analyzed. The weights of the mice and glucose were recorded weekly from the beginning to the sacrifice.
• mice with steatohepatitis (NASH / NAFLD) induced by high fat diet (HF) are shown in Fig. 1A-1D.
• glycemia higher serum glucose levels were observed in the HF group compared to the control group, with a significant difference from week 9 to 13.
• Fig. IB Higher serum levels of AST (Fig. 1C), ALT (Fig. ID), and cholesterol, triglycerides and VLDL-cholesterol (Table 1) were also found in the HF group compared to HF + PFD or control group.
• liver messenger RNA showed a decrease in TGF- ⁇ F expression, and a significant down-regulation of COL1A1 and TNF- ⁇ in the PFD-LP + HF group.
• a significant reduction in the expression of CDllb and MCP1 genes was observed compared to the HF group (Fig. 4).
• Liver X receptor ⁇ is essential for the capillarization of liver sinusoidal endothelial cells in liver injury.

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