WO2019009359A1 - 経鼻投与用医薬組成物 - Google Patents
経鼻投与用医薬組成物 Download PDFInfo
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- WO2019009359A1 WO2019009359A1 PCT/JP2018/025512 JP2018025512W WO2019009359A1 WO 2019009359 A1 WO2019009359 A1 WO 2019009359A1 JP 2018025512 W JP2018025512 W JP 2018025512W WO 2019009359 A1 WO2019009359 A1 WO 2019009359A1
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- Prior art keywords
- rifampicin
- administration
- dementia
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Images
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
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0043—Nose
-
- 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
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
-
- 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
- A61K9/10—Dispersions; Emulsions
-
- 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
Definitions
- the present invention relates to a pharmaceutical composition for nasal administration, and relates to a pharmaceutical composition useful for the prevention or treatment of dementia by having a high therapeutic effect and suppressing side effects.
- Dementia include cerebrovascular dementia that develops in cerebrovascular disease, and degenerative dementia in which abnormal proteins accumulate in the brain and develop.
- the latter includes Alzheimer's disease (AD) in which amyloid ⁇ (A ⁇ ) and tau accumulate, frontotemporal dementia (FTD) in which tau or TDP-43 accumulates, Lewy body dementia (DLB in which ⁇ -synuclein accumulates) )and so on.
- AD Alzheimer's disease
- a ⁇ amyloid ⁇
- FTD frontotemporal dementia
- LLB Lewy body dementia
- DLB Lewy body dementia
- AD Alzheimer's disease
- a ⁇ vaccines that remove A ⁇ from the brain, A ⁇ antibodies, etc.
- a ⁇ antibodies etc.
- rifampicin which is well known as an antibiotic, has been used as an oral medicine since its antibacterial action. Furthermore, rifampicin is also known to have a free radical removing action, and as one of its actions, involvement in suppression of A ⁇ aggregation reaction has been reported (see Non-Patent Document 1).
- a ⁇ -targeting drugs A ⁇ -producing enzyme inhibitors, A ⁇ vaccines, A ⁇ antibodies, etc.
- a ⁇ -targeting drugs A ⁇ -producing enzyme inhibitors, A ⁇ vaccines, A ⁇ antibodies, etc.
- the timing of administration is too late, apart from the problem of side effects It is considered.
- removing A ⁇ is thought to be meaningless before the onset of dementia, in which neurons start to die.
- the role of A ⁇ targeting drugs should be in prevention rather than treatment.
- tau aggregation inhibitor first entered into the clinical trial for the tau target drug does not show the cognitive function improvement effect in the clinical trial for AD. This result is also considered to indicate that even tau-targeted drugs are too late to be administered after onset of dementia.
- the present inventors have found that rifampicin suppresses oligomerization of A ⁇ , tau, and ⁇ synuclein in vitro, and orally administered to AD model mice that accumulate A ⁇ and FTD model mice that accumulate tau. We found that it suppresses the accumulation in the brain of oligomers and restores the cognitive function of mice. Therefore, the present inventor examined the repositioning of the oral drug rifampicin, which has been used as an antibiotic, to a drug for preventing dementia using this effect of rifampicin in order to put it into practical use.
- drug interaction refers to a phenomenon in which rifampicin induces cytochrome P450 (CYP) and P-glycoprotein involved in drug metabolism in hepatocytes, thereby reducing the effect of another drug taken simultaneously. .
- CYP cytochrome P450
- rifampicin when rifampicin is ingested orally, it is absorbed from the small intestine and transported to the liver via the portal vein. Usually, most of the absorbed drug is degraded and inactivated in the liver, and it is only a small part of the administered drug that enters the general circulation with activity maintained (this is called the first pass effect). Furthermore, there is a blood-brain barrier (BBB) that restricts substance exchange between blood and the brain, and only a small part (several percent to several tens percent) of rifampicin in the blood enters the brain. is there.
- BBB blood-brain barrier
- an object of the present invention is to provide rifampicin dosing technology capable of long-term administration by enhancing the direct transfer of rifampicin to the brain and suppressing the first pass to the liver.
- the inventors of the present invention have found that the above problems can be solved by nasal administration of rifampicin as a result of intensive studies.
- the present invention has been completed by further studies based on such findings.
- Item 1 A pharmaceutical composition for nasal administration comprising rifampicins selected from the group consisting of rifampicin, its derivatives, and salts thereof as an active ingredient and used for the prevention or treatment of dementia.
- Item 2. The pharmaceutical composition for nasal administration according to Item 1, wherein the effective dose of the rifampicins is 0.15 to 3.75 mg / kg ⁇ day.
- Item 3. The pharmaceutical composition for nasal administration according to Item 1 or 2, which is used for the prevention of dementia.
- Item 4. The pharmaceutical composition for nasal administration according to any one of Items 1 to 3, wherein the dementia is Alzheimer's disease.
- rifampicins selected from the group consisting of rifampicin, its derivatives, and salts thereof for the manufacture of a pharmaceutical composition for nasal administration for the prevention or treatment of dementia.
- Item 6. A method for treating dementia, comprising the step of nasally administering to a patient with dementia, an effective amount of rifampicins selected from the group consisting of rifampicin, its derivatives, and salts thereof.
- Item 7 A method for preventing dementia, comprising the step of intranasally administering an effective amount of rifampicin, a derivative thereof, and a salt thereof to a naive person at high risk of developing dementia.
- preparation of rifampicin as a nasally administered drug provides a noninvasive, high efficacy, and low side effects, thereby providing a dosage technique capable of long-term administration. It can be applied not only to treatment but also to dementia prevention.
- the pharmaceutical composition of the present invention comprises rifampicins selected from the group consisting of rifampicin, its derivatives, and salts thereof as an active ingredient, which is used for the prevention or treatment of dementia and is administered nasally It is characterized by being.
- the pharmaceutical composition of the present invention comprises, as an active ingredient, rifampicins selected from the group consisting of rifampicin, its derivatives, and salts thereof.
- Rifampicins have the effect of suppressing the oligomerization of amyloid ⁇ , tau, ⁇ -synuclein which is a causative protein of Alzheimer's disease which is a degenerative dementia, frontotemporal dementia, Lewy body dementia etc.
- Rifampicins have a naphthohydroquinone or naphthoquinone structure, and this structure is considered to contribute to the action of rifampicin as a free radical scavenger.
- Rifampicin is usually a compound represented by the following formula (I).
- the derivative of rifampicin is not particularly limited as long as it has a naphthohydroquinone or naphthoquinone structure and is pharmaceutically acceptable.
- the metabolite 25-Desacetyl-RFP etc. are mentioned.
- derivatives having no 3-substituent of 1,4-dihydroxynaphthalene structure, such as Rifamycin SV, having antibiotic activity are preferable.
- These rifampicin derivatives may be used alone or in combination of two or more.
- the salt of rifampicin is not particularly limited as long as it forms a salt with rifampicin or a derivative of rifampicin and is pharmaceutically acceptable.
- salts of alkali metals potassium, sodium, etc.
- salts of alkaline earth metals calcium, magnesium, etc.
- ammonium salts pharmaceutically acceptable organic amines (tetramethylammonium, triethylamine, methylamine, dimethylamine, Salts of cyclopentylamine, benzylamine, phenethylamine, piperidine, monoethanolamine, diethanolamine, tris (hydroxymethyl) aminomethane, lysine, arginine, N-methyl-D-glucamine etc.
- inorganic acid salts hydroiodides, sulfates, phosphates, nitrates, etc.
- organic acid salts acetates, lactates, tartrates
- one of rifampicin, a salt of rifampicin, a derivative of rifampicin and a salt of a derivative of rifampicin may be selected and used, or two or more types may be used in combination.
- rifampicins rifampicin and rifamycin SV are preferably mentioned.
- the pharmaceutical composition of the present invention is prepared as a nasal administration.
- the intranasal agent is formulated by the means known per se using the above-mentioned rifampicins as an active ingredient, and a pharmacologically acceptable base and / or additives may be appropriately mixed. .
- the pharmacologically acceptable base and / or additive includes, for example, excipients, thickeners, lubricants, binders, disintegrants, solvents, solubilizers, suspending agents, emulsifiers, etc. Examples thereof include tonicity agents, buffers, soothing agents, stabilizers and the like.
- additives such as preservatives (preservatives), pH adjusters, refreshing agents, antioxidants, wetting agents, adhesives, odorants and the like may be included as necessary.
- the excipient for example, lactose, sucrose, D-mannitol, starch, corn starch, crystalline cellulose, light anhydrous silicic acid and the like can be mentioned.
- the thickener for example, glycerin, polyhydric alcohols such as macrogol, celluloses such as methyl cellulose, carboxymethyl cellulose, hydroxypropyl methyl cellulose etc., polyvinyl alcohol, polyvinyl pyrrolidone, carboxyvinyl polymer, sodium carboxymethyl cellulose, methyl cellulose, hydroxy methyl cellulose, Examples thereof include hydrophilic polymers such as hydroxyethyl cellulose and hydroxypropyl cellulose, sodium alginate, chondroitin sulfate, cyclodextrin, d- ⁇ -tocopheryl polyethylene glycol 1000 succinic acid, polyethylene glycol and the like.
- lubricant for example, magnesium stearate, calcium stearate, talc, colloidal silica and the like can be mentioned.
- binder for example, crystalline cellulose, sucrose, D-mannitol, dextrin, hydroxypropylcellulose, hydroxypropylmethylcellulose, polyvinylpyrrolidone, starch, sucrose, gelatin, methylcellulose, carboxymethylcellulose sodium and the like can be mentioned.
- disintegrant for example, starch, carboxymethylcellulose, carboxymethylcellulose calcium, croscarmellose sodium, carboxymethyl starch sodium, L-hydroxypropylcellulose and the like can be mentioned.
- solvent examples include water, ethanol, isopropyl alcohol, acetone, propylene glycol, macrogol, sesame oil, corn oil and the like.
- solubilizers include celluloses such as methylcellulose, carboxymethylcellulose, hydroxypropyl methylcellulose and the like; polyethylene glycol, propylene glycol, D-mannitol, benzyl benzoate, ethanol, trisaminomethane, cholesterol, triethanolamine, sodium carbonate, Sodium citrate, polyvinyl pyrrolidone, macrogol and the like can be mentioned.
- suspending agents include surface-active agents such as stearyltriethanolamine, sodium lauryl sulfate, laurylaminopropionic acid, lecithin, benzalkonium chloride, benzethonium chloride, glycerin monostearate, polyoxyethylene hydrogenated castor oil, polysorbate, etc.
- polyhydric alcohols such as glycerin and macrogol
- saccharides such as sorbitol, mannitol and sucrose
- celluloses such as methyl cellulose, carboxymethyl cellulose and hydroxypropyl methyl cellulose
- polyvinyl alcohol polyvinyl pyrrolidone
- carboxy vinyl polymer sodium carboxymethyl cellulose and methyl cellulose
- Hydrophilic polymers such as hydroxymethyl cellulose, hydroxyethyl cellulose, hydroxypropyl cellulose, etc. Chondroitin sulfate, etc., and the like.
- the tonicity agent examples include glucose, D-sorbitol, sodium chloride, glycerin, D-mannitol, potassium chloride, concentrated glycerin, propylene glycol, sucrose and the like.
- a buffer for example, phosphate (sodium hydrogen phosphate, sodium dihydrogen phosphate etc.), boric acid, borax, acetate (sodium acetate etc.), carbonate (sodium carbonate, calcium carbonate, potassium carbonate etc.) And citric acid, sodium L-glutamate and the like.
- the soothing agent for example, benzyl alcohol, chlorobutanol, propylene glycol, ethyl aminobenzoate, lidocaine and the like can be mentioned.
- Alcohol Sugars, phenol, thymol, quinone, cumarone, phenols such as Isokumaron, dibutylhydroxytoluene, glycine, glutamic acid, lysine, phenylalanine, casein, amino acids such as edestin, proteins and the like.
- glycerin ester glycerin monooleate
- saponin Enjusaponin, Quillaja extract, soybean saponin etc.
- sucrose fatty acid ester lecithin (plant lecithin, egg yolk lecithin, soybean lecithin etc.), polyhydric alcohol (Oleyl alcohol, stearyl alcohol, cetyl alcohol etc.), fatty ester (octyl dodecyl myristate etc.), medium chain fatty acid triglyceride (MCT), various surfactants (alkyl benzene sulfonate type emulsifier, benzalkonium chloride, sesquioleic acid Sorbitan, dodecylbenzene sulfonic acid etc.), triethanolamine etc.
- preservatives examples include parahydroxybenzoic acid esters such as propyl parahydroxybenzoate and butyl parahydroxybenzoate, parabens such as methylparaben, ethylparaben, propylparaben and butylparaben, benzalkonium chloride, benzethonium chloride Reverse soaps such as chlorhexidine gluconate and cetylpyridinium chloride, alcohol derivatives such as chlorobutanol, benzyl alcohol and phenethyl alcohol, organic acids such as sodium dehydroacetate, sorbic acid and sodium sorbate and salts thereof, parachloromethoxy Phenols and phenols such as parachlorometacresol can be mentioned.
- parahydroxybenzoic acid esters such as propyl parahydroxybenzoate and butyl parahydroxybenzoate
- parabens such as methylparaben, ethylparaben, propylparaben and butylparaben
- pH adjusters include sodium hydroxide, potassium hydroxide, trisodium phosphate, disodium hydrogen phosphate, hydrochloric acid, nitric acid, citric acid, boric acid, acetic acid and the like.
- refreshing agent include l-menthol, camphor, peppermint water and the like.
- antioxidant include sulfite, ascorbic acid, citric acid, sodium edetate and the like.
- Wetting agents include propylene glycol, polysorbate, macrogol, glycerin and the like.
- the adhesive include hydroxypropyl cellulose, hydroxypropyl methylcellulose 2208, carboxyvinyl polymer, propylene glycol, polysorbate 80 and the like.
- flavoring agent include trehalose, malic acid, maltose, potassium gluconate, anise essential oil, vanilla essential oil, cardamom essential oil, herbal medicine ingredients and the like.
- the pharmaceutical composition of the present invention may be either a solution or a solid, and preferably includes a solution.
- a liquid preparation rifampicins and, if necessary, a solvent, a solubilizer, a suspending agent, a tonicity agent, a buffer, a soothing agent, etc. are mixed and dissolved, suspended or emulsified. It can be manufactured. Furthermore, it is also preferable to add a thickener to increase viscosity and impart retention.
- a solid preparation uniformly mix rifampicins with an excipient, a binder, a disintegrant or other suitable additive, and obtain a granulated product by an appropriate granulation method, and further necessary Correspondingly, it can be produced by drying into powder or fine particles.
- the content of rifampicin in the pharmaceutical composition of the present invention is not particularly limited as long as it is prepared as a nasally administered drug, and is appropriately adjusted so that it can be administered at the dose described below.
- the content of rifampicin in the pharmaceutical composition of the present invention is 0.4 w / v% or more, preferably 0.5 w / v% or more.
- the content of rifampicin in the pharmaceutical composition of the present invention is 2 w / v% or more, 2.5 w / v% or more, 5 w / v% or more Or 30 w / v% or more.
- the content of rifampicin in the pharmaceutical composition of the present invention is 95 w / v% or less, and from the viewpoint of obtaining the sprayability of the nasally administered drug well, 85 w / v% or less, or 50 w Specific ranges of the content of rifampicin in the pharmaceutical composition of the present invention, which may be, for example, 0.4 to 95 w / v%, 0.4 to 85 w / v%, 0.
- the pharmaceutical composition of the present invention can be used by filling in a container for nasal administration.
- the container for nasal administration can use a commercially available thing suitably.
- the pharmaceutical composition of the present invention is prepared for nasal administration, it can exert medicinal effects beyond oral administration at doses smaller than oral administration, and can also reduce the side effects of liver injury. Therefore, a smaller dose than when orally administered as an antibiotic can be continuously administered for a longer period of time than in the case.
- the effective dosage of rifampicin to humans of the pharmaceutical composition of the present invention is, for example, 1 / l of the dosage (for example, 7.5 to 10 mg / kg ⁇ day) when orally administered as an antibiotic from the viewpoint of drug efficacy expression. 50 or more, preferably 1/25 or more, more preferably 1/10 or more, still more preferably 1 / 7.5 or more, and from the viewpoint of side effect suppression, a dose when orally administered as an antibiotic (eg 7 For example, 1/2 or less, preferably 1/3 or less, more preferably 1 / 3.75 or less of 0.5 to 10 mg / kg ⁇ day) can be mentioned.
- a specific range of the effective dose of rifampicin to humans is, for example, 1/50 to 1/2, 1/0 of the dose (for example, 7.5 to 10 mg / kg ⁇ day) when orally administered as an antibiotic. 50 to 1/3, 1/50 to 1 / 3.75, 1/25 to 1/2, 1/25 to 1/3, 1/25 to 1 / 3.75, 1/10 to 1/2, 1/10 to 1/3, 1/10 to 1 / 3.75, 1 / 7.5 to 1/2, 1 / 7.5 to 1/3, 1 / 7.5 to 1 / 3.75, In particular, for example, 1/50 or more and 1/2 or less, preferably 1/25 or more and 1/3 or less, more preferably 1/10 or more and 1/3 or less, further preferably 1 / 7.5 or more and 1/3 .75 or less is mentioned.
- the effective dose of rifampicin of the pharmaceutical composition of the present invention is, for example, 0.15 mg / kg ⁇ day or more, preferably 0.3 mg / kg ⁇ day or more, more preferably 0 .75 mg / kg ⁇ day or more, more preferably 1 mg / kg ⁇ day or more, and from the viewpoint of suppressing side effects, for example, 3.75 mg / kg ⁇ day or less, preferably 2.5 mg / kg ⁇ day or less, more preferably Is 2 mg / kg ⁇ day or less.
- a specific range of the effective dose of rifampicin of the pharmaceutical composition of the present invention is 0.15 to 3.75 mg / kg ⁇ day, 0.15 to 2.5 mg / kg ⁇ day, 0.15 to 2 mg / day kg day, 0.3 to 3.75 mg / kg day, 0.3 to 2.5 mg / kg day, 0.3 to 2 mg / kg day, 0.75 to 3.75 mg / kg day, 0.75 to 2.5 mg / kg day, 0.75 to 2 mg / kg day, 1 to 3.75 mg / kg day, 1 to 2.5 mg / kg day, 1 to 2 mg / kg day
- 0.15 to 3.75 mg / kg ⁇ day preferably 0.3 to 2.5 mg / kg ⁇ day, more preferably 0.75 to 2.5 mg / kg ⁇ day, still more preferably 1 to 2 mg / kg ⁇ day (particularly 1.67 mg / kg ⁇ day) can be mentioned.
- the pharmaceutical composition of the present invention is suitable for continuous administration because administration in small doses is possible. Therefore, it can be administered over a long period of time.
- administration can be for 6 months or more, for example 6 months to 3 years.
- the administration interval may be every other day, or once or twice a week.
- the pharmaceutical composition of the present invention can be used for the prevention of dementia and the treatment of dementia. Preferably, it can be used for the prevention of dementia.
- Dementia include degenerative dementia and cerebrovascular dementia, preferably degenerative dementia.
- Examples of degenerative dementia include dementia caused by accumulation of a protein causing dementia such as amyloid ⁇ (A ⁇ ), tau, TDP-43, ⁇ -synuclein etc.
- amyloid ⁇ (A ⁇ ) Disease such as Alzheimer's disease (AD) in which leucine and tau accumulate, frontotemporal dementia (FTD) in which tau or TDP-43 accumulates, Lewy body dementia (DLB) in which ⁇ -synuclein accumulates, etc., preferably Alzheimer's disease Disease (AD).
- AD Alzheimer's disease
- FDD frontotemporal dementia
- DLB Lewy body dementia
- AD Alzheimer's disease Disease
- the pharmaceutical composition of the present invention is used for the prevention of dementia, it is not particularly limited as long as it has no high risk of onset.
- the low-risk persons with high risk of onset there can be mentioned healthy individuals with positive senile plaques, families with familial Alzheimer's disease families, and the like.
- the administration target is not particularly limited as long as it is a patient who is diagnosed with dementia and needs to prevent the progression of the disease state of dementia.
- the dendrites of olfactory epithelial neurons come to the nasal mucosa in the upper part of the nasal cavity, and the odor information obtained by the olfactory receptor on the cell surface is sent to the olfactory bulb of the brain along the axons of the olfactory epithelial neurons.
- BBB blood-brain barrier
- BCSFB blood cerebrospinal fluid barrier
- the active ingredient rifampicins having reached the nasal mucosa is taken into olfactory epithelial neurons and cerebrospinal fluid without being damaged by BBB and BCSFB, and transferred into the brain. be able to.
- the direct transfer of rifampicins to the brain is enhanced, so that the first pass to the liver can be suppressed. Therefore, the pharmaceutical composition of the present invention is not only noninvasive in terms of administration mode, but also has high efficacy by enhancing direct transfer to the brain, and by suppressing the first pass to the liver. Low side effects are exhibited.
- Rifampicins reached the brain are, in the case of degenerative dementia, the formation or aggregation suppression of oligomers of dementia causing proteins such as amyloid ⁇ (A ⁇ ), tau, TDP-43, ⁇ -synuclein, or the formation or aggregation of dementia It leads to the disappearance of the oligomer of the causative protein. This results in delaying the onset of dementia or amelioration of symptoms of the onset dementia (eg, recovery of memory impairment due to restoration of synapses).
- rifampicins having reached the brain ameliorate cerebrovascular disease by neuroprotection through radical scavenging. This brings about the symptom improvement of dementia.
- APP OSK mice (Subject of administration) Eleven-month-old male APP OSK mice (Tomiyama et al. J Neurosci. 2010; 30: 4845-56) were prepared. The weight of APP OSK mice is about 30 g. 60 APP OSK mice were divided into 5 groups of 12 AE each. Separately, 12 wild-type mice (non-Tg littermate) of the same age were prepared.
- the APP OSK mouse is an amyloid precursor protein (APP) transgenic mouse (Alzheimer's disease model), and shows accumulation of amyloid ⁇ (A ⁇ ) protein.
- APP amyloid precursor protein
- a ⁇ amyloid ⁇
- Oral administration was performed using an oral rodent probe, intranasal administration was performed using a pipetman (white tip), and subcutaneous administration was performed using a syringe under anesthesia.
- mice were subjected to a behavioral test to compare the effects of rifampicin on cognitive function of mice. Behavioral testing was performed by measuring the spatial reference memory of mice with the Morris water maze according to the method of Umeda et al. Brain 2016; 139: 1568-86. In addition, 12 mice (Comparative Example 1, Example 1, Example 2), 11 mice (Reference Example 1, Reference Example 2, Reference Example 3), except mice that died during the administration period, were subjected to the behavioral test. ).
- mice were bled after completion of the behavioral test, and the serum was separated to prepare a serum sample.
- Serum liver enzymes AST (GOT) and ALT (GPT) were measured to compare the degree of liver dysfunction due to rifampicin.
- a ⁇ oligomers are believed to cause tau phosphorylation and a decrease in synaptophysin
- Staining of synaptophysin (synaptic marker protein) and phosphorylated tau was performed.
- 11A1 antibody (manufactured by Immune Biological Research Institute, Inc.) is used for staining A ⁇ oligomers
- SVP-38 antibody (manufactured by Sigma) is used for staining synaptophysin
- mouse monoclonal PHF-1 antibody is used for staining phosphorylated tau (Anti-p-Ser 396 / 404-tau antibody, provided by Dr. Davies, Albert Einstein Medical School) was used.
- NIH image-J was used to quantify A ⁇ oligomers, synaptophysin, and phosphorylated tau.
- FIG. 2 The photographs of the tissues after immunostaining of A ⁇ oligomers (A ⁇ oligomers) and synaptophysin (Synaptophysin) are shown in FIG.
- the upper stage shows hippocampus CA3 tissue
- the lower stage shows hippocampus CA2 / 3 tissue.
- RFP comparative example 1
- nasal administration example 1, example 2
- subcutaneous administration reference example 3
- a ⁇ oligomers are at least at the same level as wild type mice (reference example 1) Decreased to Above all, when compared at the same dose, the reduction effect of A ⁇ oligomer was the highest in nasal administration (Example 1).
- the quantitative result of synaptophysin obtained from the immunostaining result of FIG. 2 is shown in FIG.
- the hippocampal synaptophysin showed a recovery tendency in any of oral administration of RFP (Comparative Example 1), nasal administration (Example 1, Example 2) and subcutaneous administration (Reference Example 3).
- the effect by oral administration is weak, while intranasal administration (example 1, example 2) and subcutaneous administration (reference example 3), wild-type mice (reference example 1) It recovered to the level.
- FIG. 5 shows hippocampal CA2 / 3 tissue.
- any of oral administration Comparative Example 1
- nasal administration Example 1, Example 2
- subcutaneous administration Reference Example 3
- phosphorylated tau accumulated in the brain decreased.
- FIG. 5 The quantitative result of phosphorylated tau obtained from the immunostaining result of FIG. 5 is shown in FIG.
- any of oral administration of RFP Comparative Example 1
- nasal administration Example 1, Example 2
- subcutaneous administration Reference Example 3
- phosphorylated tau in the hippocampus showed a decreasing tendency.
- the effect by oral administration was weak
- the effect by nasal administration Example 1, Example 2)
- subcutaneous administration Reference Example 3
- the reducing effect of phosphorylated tau was the highest with nasal administration (Example 1).
- nasal administration of rifampicin is superior to oral administration in terms of high efficacy and low side effects, and superior to subcutaneous administration in that it is noninvasive.
- the administration period of 1 month to mice that produce such effects corresponds to about 3.3 years in human. Therefore, it was shown that nasal administration of rifampicin is suitable not only for the treatment of dementia but also for the prevention of dementia as it is suitable for long-term administration.
- the effective dose of (1) is shown, and from the results obtained, an effect can be expected even at a dose of about 10% of these doses.
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Abstract
Description
項1. リファンピシン、その誘導体、及びそれらの塩よりなる群から選択されるリファンピシン類を有効成分として含み、認知症の予防又は治療に用いられる、経鼻投与用医薬組成物。
項2. 前記リファンピシン類の有効投与量が0.15~3.75mg/kg・日である、項1に記載の経鼻投与用医薬組成物。
項3. 認知症の予防に用いられる、項1又は2に記載の経鼻投与用医薬組成物。
項4. 前記認知症がアルツハイマー病である、項1~3のいずれかに記載の経鼻投与用医薬組成物。
項5. 認知症の予防又は治療のための経鼻投与用医薬組成物の製造のための、リファンピシン、その誘導体、及びそれらの塩よりなる群から選択されるリファンピシン類の使用。
項6. 認知症患者に、有効量のリファンピシン、その誘導体、及びそれらの塩よりなる群から選択されるリファンピシン類を経鼻投与する工程を含む、認知症の治療方法。
項7. 認知症発症リスクの高い未発症者に、有効量のリファンピシン、その誘導体、及びそれらの塩よりなる群から選択されるリファンピシン類を経鼻投与する工程を含む、認知症の予防方法。
本発明の医薬組成物は、有効成分として、リファンピシン、その誘導体、及びそれらの塩よりなる群から選択されるリファンピシン類を含む。リファンピシン類は、変性性認知症であるアルツハイマー病、前頭側頭型認知症、レビー小体型認知症などの原因タンパク質であるアミロイドβ、タウ、αシヌクレインのオリゴマー形成を抑える作用がある。リファンピシン類は、ナフトハイドロキノンまたはナフトキノン構造を有し、この構造が、リファンピシンのフリーラジカルスカベンジャーとしての作用に寄与していると考えられる。
本発明の医薬組成物は、経鼻投与剤として調製されたものである。経鼻投与剤は、上述のリファンピシン類を有効成分として、それ自体公知の手段によって製剤化されたものであり、薬理学的に許容される基剤及び/又は添加物が適宜混合されていてよい。
本発明の医薬組成物は、経鼻投与用に調製されているため、経口投与よりも少ない用量で経口投与以上の薬効が出るとともに、肝障害の副作用も軽減することができる。したがって、抗生物質として経口投与される場合よりも少ない用量を、当該場合よりも長期間連続して投与することができる。
本発明の医薬組成物は、認知症の予防及び認知症の治療に用いることができる。好ましくは、認知症の予防に用いることができる。認知症には、変性性認知症及び脳血管性認知症が挙げられ、好ましくは変性性認知症が挙げられる。変性性認知症としては、アミロイドβ(Aβ)、タウ、TDP-43、αシヌクレインなどの認知症原因タンパク質が集積することにより発症する認知症が挙げられ、具体的には、アミロイドβ(Aβ)とタウが蓄積するアルツハイマー病(AD)、タウまたはTDP-43が蓄積する前頭側頭型認知症(FTD)、αシヌクレインが蓄積するレビー小体型認知症(DLB)等が挙げられ、好ましくはアルツハイマー病(AD)が挙げられる。
鼻腔上部の鼻粘膜には嗅上皮ニューロンの樹状突起が来ており、その細胞表面にある嗅覚受容体で得られたにおい情報は嗅上皮ニューロンの軸索を伝って脳の嗅球へ送られる。鼻粘膜と嗅上皮ニューロンの間には血液脳関門(BBB)は存在しない。嗅上皮ニューロンの軸索を束ねた神経束の周囲には脳脊髄液が存在するが、血液と脳脊髄液の間での物質交換を阻む血液脳脊髄液関門(BCSFB)もここには存在しない。したがって、本発明の医薬組成物の経鼻投与により、鼻粘膜に到達した有効成分リファンピシン類は、BBB及びBCSFBによる障害を受けることなく嗅上皮ニューロンや脳脊髄液に取り込まれ、脳内に移行することができる。
[実験例]
本実験例では、リファンピシンを含有する又は含有しない投与組成物を、表1に示す用量及び用法で、表1に示すマウスへ1ヶ月毎日投与した。
11カ月齢の雄のAPPOSKマウス(Tomiyama et al. J Neurosci. 2010; 30: 4845-56)を用意した。APPOSKマウスの体重は約30gである。APPOSKマウス60匹を、12匹ずつA-Eの5群に分けた。別途、同月齢の野生型マウス(non-Tg littermate)12匹用意した。なお、APPOSKマウスは、アミロイド前駆体タンパク質(APP)トランスジェニックマウス(アルツハイマー病モデル)であり、アミロイドβ(Aβ)タンパク質の蓄積を示す。
0.5w/v%のカルボキシメチルセルロース(CMC;Sigma-Aldrich, Carboxymethylcellulose sodium salt low viscosity, C5678)溶液にリファンピシン薬(RFP;Sigma-Aldrich, Rifampicin ≧97% (HPLC), powder、別名:3-(4-メチルピペラジニルイミノメチル)リファマイシンSV, リファマイシンAMP, リファンピン, R3501)を表1の比較例1、実施例1~2、参考例3に示す容量となる配合量で懸濁し、投与組成物を調製した。
経口投与はげっ歯類用経口ゾンデを用い、経鼻投与はピペットマン(ホワイトチップ)を用い、皮下投与は注射器を用い、すべて無麻酔下で行った。
投与終了後(12カ月齢)のマウスを行動試験に供し、マウスの認知機能に対するリファンピシンの効果を比較した。行動試験は、Umeda et al. Brain 2016; 139: 1568-86の方法に従ってモリス水迷路によるマウスの空間参照記憶を測定することにより行った。なお、行動試験に供したマウスは、投与期間中に死亡したマウスを除く、12匹(比較例1、実施例1、実施例2)、11匹(参考例1、参考例2、参考例3)である。
行動試験終了後のマウスから採血し、血清を分離して血清試料を調製した。血清試料の肝酵素AST(GOT)及びALT(GPT)の測定を行い、リファンピシンによる肝機能障害の程度を比較した。
行動試験終了後のマウスから脳を取り出し、免疫組織化学染色によって、Aβオリゴマー、シナプトフィジン、リン酸化タウに対するリファンピシンの効果を比較した。
RFPの経口投与(比較例1)、経鼻投与(実施例1、実施例2)、皮下投与(参考例3)のいずれでも、海馬のシナプトフィジンは回復傾向を示した。中でも、経口投与(比較例1)による効果は弱く、一方で、経鼻投与(実施例1、実施例2)、皮下投与(参考例3)によると、野生型マウス(参考例1)と同レベルにまで回復した。さらに、行動試験の結果と同様に、経鼻投与の場合、用量を5分の1(0.05 mg/day)に下げた場合(実施例2)であっても、その効果は経口投与(比較例1)よりも高いことを確認した。
Claims (4)
- リファンピシン、その誘導体、及びそれらの塩よりなる群から選択されるリファンピシン類を有効成分として含み、認知症の予防又は治療に用いられる、経鼻投与用医薬組成物。
- 前記リファンピシン類の有効投与量が0.15~3.75mg/kg・日である、請求項1に記載の経鼻投与用医薬組成物。
- 認知症の予防に用いられる、請求項1又は2に記載の経鼻投与用医薬組成物。
- 前記認知症がアルツハイマー病である、請求項1~3のいずれかに記載の経鼻投与用医薬組成物。
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