WO2020032252A1 - 母体と胎児との関係における液性免疫関連疾患の治療薬 - Google Patents
母体と胎児との関係における液性免疫関連疾患の治療薬 Download PDFInfo
- Publication number
- WO2020032252A1 WO2020032252A1 PCT/JP2019/031622 JP2019031622W WO2020032252A1 WO 2020032252 A1 WO2020032252 A1 WO 2020032252A1 JP 2019031622 W JP2019031622 W JP 2019031622W WO 2020032252 A1 WO2020032252 A1 WO 2020032252A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- group
- pregnancy
- fetal
- hydrogen atom
- formula
- Prior art date
Links
Images
Classifications
-
- 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
- A61K31/4353—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 ortho- or peri-condensed with heterocyclic ring systems
- A61K31/436—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 ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having oxygen as a ring hetero atom, e.g. rapamycin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
-
- 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
- A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
- A61K31/407—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with other heterocyclic ring systems, e.g. ketorolac, physostigmine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
- A61K38/12—Cyclic peptides, e.g. bacitracins; Polymyxins; Gramicidins S, C; Tyrocidins A, B or C
- A61K38/13—Cyclosporins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P37/00—Drugs for immunological or allergic disorders
- A61P37/02—Immunomodulators
- A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
Definitions
- the present invention comprises a specific immunosuppressive component, a disease associated with humoral immunity in the relationship between the mother and the fetus, such as infertility and infertility caused by humoral immunity in the relationship between the mother and the fetus,
- the present invention relates to an agent for treating or ameliorating blood group incompatible pregnancy or fetal hemochromatosis, and use thereof.
- Acquired immunity is further classified into “cellular immunity” and “humoral immunity” depending on the type of helper T cells and the manner of action.
- Diseases or symptoms of the immune system related to the mother and the fetus for example, for “cellular immunity”, infertility due to implantation disorders, infertility due to placental construction disorders, pregnancy hypertension, etc.
- the “humoral immunity” relating to the mother and the fetus includes infertility / infertility caused by humoral immunity in the relationship between the mother and the fetus, blood group incompatible pregnancy, or fetal hemochromatosis.
- Patent Literature 1 describes a therapeutic agent containing a specific immunosuppressant as an active ingredient as a therapeutic agent for infertility / infertility caused by “cellular immunity”.
- FMT fetal-maternal transfusion
- Pathogenic antibodies to fetal antigens are produced in the mother if they have antigenicity that exceeds the mother's ability to tolerate and are recognized as foreign antigens.
- the pathogenic antibodies produced either attack the fetal components that make up the fertilized egg or placenta, or, like other IgG antibodies, travel through the placenta to the fetal circulation, where it is targeted on the cell membrane in the fetus and on extracellular and extracellular targets. Attack fetal antigens.
- Frequent exposure to the same fetal antigen including repetition failure, habitual miscarriage after first pregnancy, miscarriage surgery, stillbirth, and childbirth, increases the virulence in proportion to the number of repetition failures and pregnancies Antibodies are produced and may be present in the mother before pregnancy.
- the pathogenic antibody attacks the fertilized egg at implantation, it will cause infertility, and if it attacks the fetal component that builds the placenta after implantation, it will miscarriage, and will attack the fetal component that builds a continuous placenta even if the miscarriage is avoided This can lead to infertility.
- pathogenic antibodies do not attack the fetal components that make up the placenta and do not cause infertility or infertility, they migrate through the placenta to the fetal circulation and target fetal antigens on the fetal cell membrane or inside or outside the cell To attack.
- the amount of antigen transferred from the fetus to the mother increases with the course of pregnancy. Therefore, maternal production of the pathogenic antibody to the fetus is also increased, and the deterioration of the fetus condition is observed in proportion to the production of the pathogenic antibody, and is accelerated particularly in the second trimester and thereafter.
- a pregnancy in which the mother is Rho (D) negative and the fetus is Rho (D) positive is regarded as a blood group mismatch pregnancy.
- a small amount of fetal antigens, including blood cell components are transferred from the fetus to the mother via the placenta.
- pathogenic antibodies are produced by the mother against antigens in which the transferred fetal antigens exceed the mother's ability to tolerate or are not tolerated, and the pathogenic antibodies pass through the placenta like other antibodies. It migrates to the fetus and attacks fetal antigens on the fetal cell membrane and inside and outside the cell.
- Rh-incompatible pregnant women must be treated with RhD immunoglobulin (Ig) during pregnancy, and if the patient has not been sensitized yet give birth or Should be treated after abortion. This is not only for RhD, but also for other blood types, blood type mismatch pregnancy may occur due to mismatch between the mother and fetus.
- Ig RhD immunoglobulin
- Mothers with anti-D antibodies need to be managed based on Doppler ultrasonography to measure maternal blood antibody titers and fetal middle cerebral artery (MCA) blood flow velocity, a predictor of fetal anemia during pregnancy [Ref. 5].
- MCA fetal middle cerebral artery
- fetal hemochromatosis is a disease that causes severe hepatic failure in the fetal and neonatal period, and it is estimated that alloimmune fetal liver damage is the cause. No pathogenic antigen has been identified, but it develops when a woman becomes pregnant in a situation in which proteins (such as enzymes) related to fetal iron metabolism differ from those of the mother.
- fetal proteins related to fetal iron metabolism are transferred to the mother through the placenta after the placental construction is completed, and the maternal immune response to the transferred fetal protein antigen produces pathogenic antibodies in the mother.
- Pathogenic antibodies produced in the mother migrate to the fetus through the placenta, and the basic pathology is a disorder of fetal iron metabolism that develops when the pathogenic antibodies attack fetal proteins related to iron metabolism in the fetus .
- the recurrence rate of fetal hemochromatosis from the same mother was 90%, and since 1990, medical therapy using iron chelators and antioxidants and liver transplantation have been combined.
- the survival rate of the infant was at most about 50%.
- a new treatment method was proposed, which included a postnatal fetal exchange transfusion and high-dose gamma globulin therapy.
- the survival rate of infants has improved to 75%.
- the current treatment method for fetal hemochromatosis is to prevent the onset of fetal hemochromatosis by administering a large amount of gamma globulin therapy to the mother during pregnancy.
- gamma globulin therapy to prevent the onset of fetal hemochromatosis by administering a large amount of gamma globulin therapy to the mother during pregnancy.
- the need for large amounts of gamma globulin has led to a need for additional therapeutic methods.
- the present invention relates to diseases associated with humoral immunity in the relationship between the mother and the fetus, for example, infertility / infertility due to humoral immunity in the relationship between the mother and the fetus, blood group mismatch pregnancy, or fetal hemochromatosis. It is intended to provide an agent for treatment or improvement.
- the present invention includes the following embodiments.
- each adjacent pair of R 1 and R 2 , R 3 and R 4 , R 5 and R 6 is each independently (A) represents two adjacent hydrogen atoms, or R 2 may be an alkyl group, or (b) forms another bond between each of the bonded carbon atoms Often;
- R 7 is a hydrogen atom, a hydroxy group, a protected hydroxy group, or together with R 1 represents an oxo group;
- R 8 and R 9 independently represent a hydrogen atom, a hydroxy group;
- R 10 represents a hydrogen atom, an alkyl group, an alkyl group substituted by one or more hydroxy groups, an alkenyl group, an alkenyl group substituted by one or more hydroxy groups, or an alkyl group substituted by an oxo group;
- X represents an oxo group, a (hydrogen atom, a hydroxy group), a (hydrogen atom, a hydrogen atom), or a group
- a heterocyclic group containing one or more heteroatoms selected from atoms may be formed, wherein the heterocyclic group is an alkyl group, a hydroxy group, an alkyloxy group, a benzyl group, a compound of the formula —CH 2 Se (C 6 Or a pharmaceutically acceptable salt thereof, which may be substituted with one or more groups selected from a group represented by H 5 ) and an alkyl group substituted by one or more hydroxy groups.
- a disease associated with humoral immunity in a relationship between a mother and a fetus comprising as an active ingredient a compound selected from the group consisting of (ii) cyclosporins, and (iii) rapamycin or a derivative thereof. Drugs.
- Embodiment 2 The agent according to embodiment 1, wherein the compound represented by the formula (I) is tacrolimus or a pharmaceutically acceptable salt thereof.
- Embodiment 3 Embodiment 1 wherein the active ingredient is a compound represented by the formula (I) or a pharmaceutically acceptable salt thereof, and the compound represented by the formula (I) is tacrolimus or a pharmaceutically acceptable salt thereof.
- the drug according to the above. Embodiment 4) 4.
- Embodiment 6 4.
- the disease associated with humoral immunity in the relationship between the mother and the fetus is fetal hemochromatosis.
- Embodiment 7 The medicament according to any of embodiments 4 to 6, which is applied to the second and subsequent pregnancies.
- Embodiment 8) The agent according to any of embodiments 4 to 7, which is administered from early in pregnancy.
- the present invention also includes the following embodiments.
- (Embodiment 12) A compound of formula (I) or a pharmaceutically acceptable salt thereof, (Ii) treatment of a disease associated with humoral immunity in a maternal-fetal relationship, comprising administering to the patient a compound selected from the group consisting of: cyclosporins, and (iii) rapamycin or a derivative thereof.
- Method. Embodiment 13
- Embodiment 13 Embodiment 13.
- (Embodiment 14) The treatment method according to embodiment 12 or 13, wherein the disease associated with humoral immunity in the relationship between the mother and the fetus is a blood group-incompatible pregnancy.
- Embodiment 15 The method of embodiment 12 or 13, wherein the disease associated with humoral immunity in the relationship between the mother and the fetus is fetal hemochromatosis.
- Embodiment 16 Embodiment 16.
- Embodiment 17 The treatment method according to any of embodiments 14 to 16, which is administered from an early stage of pregnancy.
- Embodiment 18 The treatment method according to any of embodiments 14 to 16, wherein the treatment is administered at a dose of 1 to 10 mg / day from the early stage of pregnancy.
- Embodiment 19 Embodiment 14.
- Method of treatment A compound for the treatment of a disease associated with humoral immunity in a relationship between a mother and a fetus, wherein the compound is a compound represented by the formula (I) or a pharmaceutically acceptable salt thereof: A compound selected from the group consisting of (ii) cyclosporins, and (iii) rapamycin or a derivative thereof.
- (Embodiment 21) Tacrolimus or a pharmaceutically acceptable salt thereof for the treatment of a disease associated with humoral immunity in a relationship between a mother and a fetus.
- the compound according to embodiment 20 or 21, or a pharmaceutically acceptable salt thereof, wherein the disease associated with humoral immunity in the relationship between the mother and the fetus is fetal hemochromatosis.
- the present invention it is possible to treat or ameliorate a disease associated with humoral immunity in the relationship between the mother and the fetus, for example, blood group-incompatible pregnancy or fetal hemochromatosis.
- the upper part is a graph showing Th1 and Th2 of the patient and their ratio. An initially high Th1 / Th2 ratio suggests infertility due to immune system abnormalities.
- the lower part is a graph showing the titers of anti-D antibodies of pregnant women during the gestation week. The antibody titer was slowly increased by the administration of tacrolimus from the early pregnancy, but the titer increased rapidly (5 mg / day) at the 28th week of pregnancy, which started to increase rapidly, and the titer did not further increase and was stable. You can see that it is doing. It is a graph which shows the weight of the fetus in the gestation week, and the blood flow velocity of a middle cerebral artery. Body weight continued to increase steadily after 28 weeks when tacrolim administration had to be increased (5 mg / day) from the early pregnancy, and the blood flow rate, a measure of fetal anemia, was equivalent to the number of weeks.
- each adjacent pair of R 1 and R 2 , R 3 and R 4 , R 5 and R 6 is each independently (A) represents two adjacent hydrogen atoms, or R 2 may be an alkyl group, or (b) forms another bond between each of the bonded carbon atoms Well (ie, form a double bond);
- R 7 is a hydrogen atom, a hydroxy group, a protected hydroxy group, or together with R 1 represents an oxo group;
- R 8 and R 9 independently represent a hydrogen atom, a hydroxy group;
- R 10 represents a hydrogen atom, an alkyl group, an alkyl group substituted by one or more hydroxy groups, an alkenyl group, an alkenyl group substituted by one or more hydroxy groups, or an alkyl group substituted by an oxo group;
- X represents an oxo group, a (hydrogen atom, a hydroxy group), a (hydrogen atom, a hydrogen
- a heterocyclic group containing one or more heteroatoms selected from the group consisting of an alkyl group, a hydroxy group, an alkyloxy group, a benzyl group, a compound of the formula —CH 2 Se (C 6 H 5 ) may be substituted with one or more groups selected from an alkyl group substituted with one or more hydroxy groups) or a pharmaceutically acceptable salt thereof;
- a disease associated with humoral immunity in a relationship between a mother and a fetus comprising as an active ingredient a compound selected from the group consisting of (ii) cyclosporins, and (iii) rapamycin or a derivative thereof.
- Drug provide.
- R 24 represents a ring which may contain one or more heteroatoms which may be optionally substituted, specifically a 5- to 7-membered carbon ring or Or a 6-membered heterocyclic group.
- the 5- or 6-membered heterocyclic group include a saturated or unsaturated 5- or 6-membered heterocyclic group containing at least one heteroatom selected from a nitrogen atom, a sulfur atom and an oxygen atom. It is.
- Preferred examples of R 24 include a cyclo (C 5 -C 7 ) alkyl group which may have a suitable substituent, and examples thereof include the following groups.
- R 20 represents hydroxy, alkyloxy, oxo, or OCH 2 OCH 2 CH 2 OCH 3
- R 21 may be hydroxy, —OCN, alkyloxy, optionally having a substituent.
- the cyclopentyl group may be methoxymethyl, optionally protected hydroxymethyl, acyloxymethyl (wherein the acyl moiety may optionally be quaternized dimethylamino or esterified May be substituted with one or more optionally protected amino and / or hydroxy groups or aminooxalyloxymethyl, a preferred example being the 2-formyl-cyclopentyl group
- “Lower” shall mean a group having from 1 to 6 carbon atoms unless otherwise indicated.
- alkyl moiety of the “alkyl group” and the “alkyloxy group” include a linear or branched aliphatic hydrocarbon residue, such as methyl, ethyl, propyl, isopropyl, butyl, isobutyl, pentyl, Examples thereof include lower alkyl groups having 1 to 6 carbon atoms such as neopentyl and hexyl.
- alkenyl group examples include a linear or branched aliphatic hydrocarbon residue containing one double bond, for example, vinyl, propenyl (allyl, etc.), butenyl, methylpropenyl, pentenyl And lower alkenyl groups such as hexenyl.
- aryl group examples include phenyl, tolyl, xylyl, cumenyl, mesityl, naphthyl and the like.
- Preferred protecting groups in “protected hydroxy group” and “protected amino” include, for example, methylthiomethyl, ethylthiomethyl, propylthiomethyl, isopropylthiomethyl, butylthiomethyl, isobutylthiomethyl, hexylthiomethyl and the like.
- a 1- (lower alkylthio) (lower) alkyl group such as a lower alkylthiomethyl group, more preferably a C 1 -C 4 alkylthiomethyl group, most preferably a methylthiomethyl group;
- Tri (lower) alkylsilyls such as trimethylsilyl, triethylsilyl, tributylsilyl, tert-butyl-dimethylsilyl, tri-tert-butylsilyl and the like, for example methyl-diphenylsilyl, ethyl-diphenylsilyl, propyl-diphenylsilyl, tertiary Tri-substituted silyl groups such as lower alkyl-diarylsilyl such as butyl-diphenylsilyl and the like, more preferably tri (C 1 -C 4 ) alkylsilyl group and C 1 -C 4 alkyldiphenyls
- aliphatic acyl group examples include suitable substituents such as carboxy such as formyl, acetyl, propionyl, butyryl, isobutyryl, valeryl, isovaleryl, pivaloyl, hexanoyl, carboxyacetyl, carboxypropionyl, carboxybutyryl and carboxyhexanoyl.
- a lower alkanoyl group optionally having one or more Suitable substitutions such as lower alkyl, for example cyclopropyloxyacetyl, cyclobutyloxypropionyl, cycloheptyloxybutyryl, menthyloxyacetyl, menthyloxypropionyl, menthyloxybutyryl, menthyloxypentanoyl, menthyloxyhexanoyl and the like.
- a carboxy (lower) alkylcarbamoyl group such as carboxymethylcarbamoyl, carboxyethylcarbamoyl, carboxypropylcarbamoyl, carboxybutylcarbamoyl, carboxypentylcarbamoyl, carboxyhexylcarbamoyl, or, for example, trimethylsilylmethoxycarbonylethylcarbamoyl, trimethylsilylethoxycarbonylpropylcarbamoyl, triethylsilyl
- a carboxy or protected carboxy group such as a tri (lower) alkylsilyl (lower) alkyloxycarbonyl (lower) alkylcarbamoyl group such as ethoxycarbonylpropylcarbamo
- aromatic acyl group examples include an aroyl group optionally having one or more suitable substituents such as nitro, such as benzoyl, toluoyl, xyloyl, naphthoyl, nitrobenzoyl, dinitrobenzoyl, and nitronaphthoyl;
- aroyl group optionally having one or more suitable substituents such as nitro, such as benzoyl, toluoyl, xyloyl, naphthoyl, nitrobenzoyl, dinitrobenzoyl, and nitronaphthoyl
- Arenesulfonyl optionally having one or more suitable substituents such as halogens, for example, benzenesulfonyl, toluenesulfonyl, xylenesulfonyl, naphthalenesulfonyl, fluorobenzenesulfonyl, chlorobenzenes
- Examples of the aliphatic acyl group substituted with an aromatic group include phenylacetyl, phenylpropionyl, phenylbutyryl, 2-trifluoromethyl-2-methoxy-2-phenylacetyl, 2-ethyl-2-trifluoromethyl- Aryl which may have one or more suitable substituents such as lower alkyloxy or trihalo (lower) alkyl such as 2-phenylacetyl, 2-trifluoromethyl-2-propoxy-2-phenylacetyl, etc. Lower) alkanoyl groups and the like.
- acyl groups include a C 1 -C 4 alkanoyl group which may have a carboxy group and a cyclo (C 5 -C 6 ) group having two (C 1 -C 4 ) alkyls in the cycloalkyl moiety.
- a 5- to 7-membered cycloalkyl group or cycloalkenyl group is exemplified, for example, cyclopentyl, cyclohexyl, cycloheptyl, cyclopentenyl, cyclohexenyl or cycloheptenyl.
- Preferred examples of the “saturated or unsaturated 5- or 6-membered heterocyclic group containing one or more hetero atoms selected from a nitrogen atom, a sulfur atom and an oxygen atom” include a pyrrolyl group and a tetrahydrofuryl group And the like.
- heteroaryl optionally having a substituent in the “heteroaryloxy optionally having a substituent” is a group represented by the formula in EP-A-532,088.
- group R 1 of the compound to be obtained include, but preferably, 1-hydroxyethylindol-5-yl. The disclosure is incorporated herein by reference.
- Active Ingredient in the present invention, (i) a compound represented by the formula (I) or a pharmaceutically acceptable salt thereof, (ii) a cyclosporin, or (iii) rapamycin or a derivative thereof as an active ingredient Can be used.
- the active ingredient two or more kinds of (i) the compound represented by the formula (I), (ii) cyclosporins, or (iii) rapamycin or a derivative thereof may be used in combination.
- each active ingredient will be described.
- FR900506 FK506, tacrolimus
- FR900520 ascomycin
- FR900523 and FR900525 are of the genus Streptomyces, for example Streptomyces tsukubaensis. 9993 (Deposited organization: 1-3 1-3 Higashi, Tsukuba-shi, Ibaraki, Japan; Institute of Biotechnology, Institute of Industrial Science and Technology, Ministry of International Trade and Industry (former name: Institute of Microbial Engineering, Institute of Industrial Science and Technology, Ministry of International Trade and Industry); Deposit Date: 1984 No. 927, October 5, 1998) or Streptomyces hygroscopicus subspecies yaksimaensis No.
- FK506 (general name: tacrolimus) represented by the following structural formula is a typical compound.
- the compounds of formula (I) are such that each adjacent pair of R 3 and R 4 , R 5 and R 6 is between each carbon atom to which they are attached. Forming another bond (thus forming a double bond at the R 3 and R 4 , R 5 and R 6 moieties); R 1 , R 2 , R 8 and R 23 are each independently a hydrogen atom; R 9 is a hydroxy group, R 10 is a methyl, ethyl, propyl or allyl group; R 7 is hydroxy; X is (hydrogen atom, hydrogen atom) or an oxo group; Y is an oxo group, R 14 , R 15 , R 16 , R 17 , R 18 , R 19 and R 22 are each a methyl group, R 24 is, 3-R 20 -4-R 21 - is a cyclohexyl group, Wherein R 20 is hydroxy, alkyloxy, oxo, or —OCH 2 OCH 2 CH 2
- the compound represented by the formula (I) includes tacrolimus, ascomycin or a derivative thereof.
- salts of Compounds of Formula (I) refers to non-pharmaceutically acceptable salts.
- pharmaceutically acceptable non-toxic bases including inorganic bases and organic bases.
- Salts derived from such inorganic bases include aluminum, ammonium, calcium, copper (second and first), ferric, ferrous, lithium, magnesium, manganese (second and first), potassium, Salts such as sodium and zinc are included. Salts of ammonium, calcium, magnesium, potassium and sodium are preferred.
- Salts prepared from pharmaceutically acceptable non-toxic organic bases include salts of primary, secondary and tertiary amines from both natural and synthetic sources.
- Pharmaceutically acceptable non-toxic organic bases include, for example, arginine, betaine, caffeine, choline, N, N'-dibenzylethylenediamine, diethylamine, 2-diethylaminoethanol, 2-dimethylaminoethanol, ethanolamine, ethylenediamine , N-ethylmorpholine, N-ethylpiperidine, glucamine, glucosamine, histidine, hydravamine, isopropylamine, dicyclohexylamine, lysine, methylglucamine, morpholine, piperazine, piperidine, polyamine resin, procaine, purine, theobromine, triethylamine, trimethylamine, Tripropylamine, tromethamine and the like.
- the compound of formula (I) of the present invention is basic, its corresponding salt can be conveniently prepared from pharmaceutically acceptable non-toxic inorganic and organic acids.
- Such acids include, for example, acetic acid, benzenesulfonic acid, benzoic acid, camphorsulfonic acid, citric acid, ethanesulfonic acid, fumaric acid, gluconic acid, glutamic acid, hydrobromic acid, hydrochloric acid, isethionic acid, lactic acid, maleic acid , Malic acid, mandelic acid, methanesulfonic acid, mucoic acid, nitric acid, pamoic acid, pantothenic acid, phosphoric acid, succinic acid, sulfuric acid, tartaric acid, p-toluenesulfonic acid and the like.
- Preferred are citric, hydrobromic, hydrochloric, maleic, phosphoric, sulfuric and tartaric acids.
- the compound of formula (I) of the present invention can exist in an amorphous form and / or in one or more crystalline forms; All such amorphous and crystalline forms of the compounds represented by and mixtures thereof are intended to be included within the scope of the present invention. Furthermore, some of the compounds of formula (I) may form solvates with water (ie, hydrates) or solvates with common organic solvents. Such solvates and hydrates of the compounds of the formula (I), in particular pharmaceutically acceptable solvates and hydrates, are likewise non-solvated anhydrous forms of the compounds. Along with the forms, they fall within the scope of the compounds defined by formula (I) and pharmaceutically acceptable salts thereof.
- Solvate or hydrate of the compound represented by the formula (I) can form a solvate, and such a case is also included in the scope of the present invention. It is. Preferred solvates include hydrates and ethanolates.
- Cyclosporins examples include cyclosporins A, B, and D. These are described in Merck Index (12th edition) No. 2821. Cyclosporin is commercially available from Novartis Pharma Co., Ltd., for example, under the trade name Sandy Mün.
- Rapamycin Derivatives Rapamycin includes Merck Index (12th edition) No. 8288, and its derivatives can also be used.
- the hydroxy at position 40 of Formula A on page 1 of WO 95/16691 is substituted with -OR 1, wherein R 1 is hydroxyalkyl, hydroalkyloxyalkyl, acylaminoalkyl and aminoalkyl.
- O-substituted derivatives eg, 40-O- (2-hydroxy) ethyl-rapamycin, 40-O- (3-hydroxy) propyl-rapamycin, 40-O- [2- (2-hydroxy) ethoxy] ethyl-rapamycin And 40-O- (2-acetaminoethyl) -rapamycin.
- Rapamycin sirolimus
- the compounds of formula (I), cyclosporins, rapamycin and derivatives thereof according to the invention have a similar basic skeleton, ie a tricyclomacrolide skeleton, and have at least one similar biological property. (Eg, immunosuppressive action).
- the drug according to the present invention in addition to the above-mentioned active ingredients, has no risk of inhibiting the activity of the active ingredients and is not harmful to the administration target (hereinafter, also referred to as a patient). May contain one or more therapeutically active substances that have a therapeutic effect on.
- the drug of the present invention is selected from the group consisting of (i) a compound represented by the formula (I) or a pharmaceutically acceptable salt thereof, (ii) cyclosporins, and (iii) a rapamycin derivative. It contains the selected compound as an active ingredient, and may further contain a pharmaceutically acceptable carrier that is not harmful to the administration subject.
- the carrier that can be used may be any of solid, semi-solid, and liquid types, and includes, for example, any one selected from water, an electrolyte solution, and a sugar solution, but is not limited thereto. Not done.
- the medicament may contain adjuvants.
- Auxiliaries include lubricants, stabilizers, preservatives, emulsifiers, thickeners (thickeners), coloring agents, flavors (flavoring agents), excipients, preservatives, buffers, flavoring agents, Suspending agents, emulsifiers, solubilizers and the like can be mentioned.
- the medicament containing the active ingredient of the present invention can be provided in various forms, such as tablets, capsules, pills, granules, powders, syrups, suppositories, and troches. , Pellets, emulsions, suspensions, and other known forms.
- oral preparations tablets, capsules, pills, granules, powders, solutions, syrups, and jellies are preferable, and tablets, capsules, and , Granules, and more preferably tablets.
- it may be formulated as a parenteral administration preparation such as an injection, a suppository, and a transdermal absorption preparation.
- the drug according to the present invention can be produced by using a known production method. As an example, it is manufactured by separately producing an active ingredient and any other components for each component, and then mixing each component to a desired content.
- subjects to which the drug is administered include mammals.
- mammals include humans and non-human animals such as domestic animals such as cows, horses, pigs and sheep, monkeys, chimpanzees, and pets such as dogs, cats, rats and rabbits, and preferably humans. Is mentioned.
- Administration route The administration method (administration route) of the drug of the present invention can be appropriately determined depending on the age, condition, treatment period, and the like of the administration subject. Specifically, either oral administration or parenteral administration may be used, but oral administration is preferred (oral administration in Examples). Examples of parenteral administration include injection, administration as a suppository, administration as a transdermal preparation, and the like. Types of injection administration include, for example, intramuscular, intraperitoneal, subcutaneous, intravenous, and local injection. In addition, the agents of the present invention can be administered via various routes, such as transdermal, nasal, vaginal, and rectal.
- the dosage of the drug varies depending on the type, severity, and various test results of the disease, disease or symptom of the patient receiving the drug, the type of active ingredient of the drug, and the like. Further, the dose of the drug differs depending on the age of the patient to be treated, the number of times of treatment by the treatment method of the present invention, various test results, and the like.
- the medicament of the present invention in view of the content of the active ingredient contained in the medicament, at a dose lower than the dose when used as an immunosuppressant in the treatment of biological transplantation and immune system diseases, etc. Is administered.
- the amount of the active ingredient per day is preferably in the range of 0.5 to 10 mg or 1 to 10 mg, more preferably An amount in the range 0.5 to 6 mg or 3 to 6 mg is administered.
- the description regarding the dose of the drug is applied to a case where the target is a human, and the dose is expressed as the amount of the active ingredient.
- the number of administrations per day is preferably 1 to 4 times, more preferably 1 to 3 times, and further preferably 1 to 2 times.
- the same dosage form can be used.
- the dosage form and route of administration should be selected according to the compatibility of the drugs being combined.
- co-administration is understood to include simultaneous or sequential administration of the two agents or administration as a fixed dose combination of the two active ingredients.
- Infertility / Infertility due to humoral immunity in the relationship between the mother and the fetus is a concept that includes both “Infertility” and “Infertility”.
- infertility broadly indicates that the mother is in a state of difficulty in pregnancy as compared with a normal state, and is a concept including infertility.
- infertility refers to a case where a baby is desired and then pregnancy cannot be established within one year without contraception.
- infertility refers to a state in which a fetus cannot be developed or a state in which fetal development is delayed or poorly developed in a mother's uterus after pregnancy, and is a concept including infertility.
- infertility means that pregnancy (including natural insemination, artificial insemination and in vitro fertilization) is established, but miscarriage, premature birth or stillbirth is repeated once or twice or more, Refers to the case that does not reach.
- infertility includes egg factors, fallopian tube factors, uterine factors, cervical factors, and immune factors.
- causes of infertility including infertility include genetic factors, anatomical factors, endocrine factors, coagulation factors, and autoimmune factors.
- infertility / infertility caused by humoral immunity in the relationship between the mother and the fetus refers to, among “infertility / infertility", in particular, abnormal humoral immunity in the relationship between the mother and the fetus. Includes only infertility and infertility caused by the disease. Therefore, the “infertility / infertility caused by humoral immunity in the relationship between the mother and the fetus” in the present specification does not include the “infertility / infertility” caused by abnormal cellular immunity.
- Infertility / infertility caused by humoral immunity in the relationship between the mother and the fetus is a disorder that occurs in the following cases, for example.
- the cause is unknown and parameters for confirming abnormalities of cell-mediated immunity such as the Th1 / Th2 cell ratio show normal values (that is, when abnormalities of cell-mediated immunity are not the cause).
- a pathogenic antibody targeting a fertilized egg or a fetal cell membrane or an intracellular or extracellular fetal antigen is present in the mother's body, and the mother directly attacks the fertilized egg or fetal component in the uterus via the pathogenic antibody; When pathogenic antibodies that have passed through the placenta attack the fetus.
- the dose of the compound as the active ingredient of the present invention is preferably 1 to 10 mg / day, more preferably 3 to 6 mg / day.
- Blood-Incompatible pregnancy is a disorder that occurs in the following conditions: (I) antigens not present on the maternal red blood cell membrane are present on the fetal red blood cell membrane; (Ii) After fetal blood flows into the mother via the placenta, pathogenic antibodies to antigens on the fetal erythrocyte membrane are produced in the mother (pathogenic antibodies, for example, an increase in anti-D antibody titer, anti-erythrocyte antibody, etc.) , (Iii) the pathogenic antibody passes through the placenta to the fetus and attacks fetal red blood cells; (Iv) Fetal red blood cells lyse, resulting in fetal anemia.
- the agent of the present invention for example, tacrolimus
- the rise in pathogenic antibody titer is suppressed (suppression of antibody production).
- the dose is, for example, 1 mg / day to 10 mg / day as an active ingredient.
- the dosage is between 3 and 6 mg / day.
- the fetal erythrocyte attack by the pathogenic antibody that passed through the placenta is such that the female fetal erythrocyte membrane-like antigen is recognized once (by the previous pregnancy or miscarriage), Since the memory remains, the blood type mismatch pregnancy is more likely to occur in the second and subsequent pregnancies than in the first child.
- the drug of the present invention (1 to 4 mg / day as an active ingredient)
- the administration is continued and, for example, the pathogenic antibody titer is increased.
- the drug of the present invention may be administered in a further increased dose (for example, 5 to 10 mg / day as an active ingredient).
- the agent of the present invention may be administered (for example, 1 to 10 mg / day as an active ingredient).
- Fetal hemochromatosis is a condition that occurs in the following conditions: (I) an enzyme related to fetal iron metabolism is different from that of the mother, (Ii) after fetal blood flows into the mother through the placenta, pathogenic antibodies to the enzyme are produced in the mother; (Iii) the pathogenic antibody migrates through the placenta to the fetus and attacks fetal iron metabolizing enzymes; (Iv) Fetal iron metabolism stops, iron is deposited in the liver, and cirrhosis occurs.
- the agent of the present invention for example, tacrolimus
- the agent of the present invention for example, tacrolimus
- the increase in the pathogen titer is suppressed (antibody production suppression)
- Symptoms caused by sexual antibodies can be suppressed, and thus fetal hemochromatosis can be treated or ameliorated.
- the dose of the compound as the active ingredient of the present invention is preferably 1 to 10 mg / day, more preferably 3 to 6 mg / day.
- the indirect Coombs test is a test that checks whether hemagglutination occurs by adding anti-immunoglobulin antibodies to a mixture of patient's serum and blood of a healthy person (detects the presence of irregular antibodies in the serum). (For the Coombs test, see, for example, Nissan Women's Magazine Vol. 59, No. 10, N-617 to N-623).
- Th1 / Th2 cell ratio In recent years, the incidence of external insemination (IVF) and embryo transfer (ET) has increased worldwide. Accompanying this is an increasing number of women who experience multiple IVF failures, including repeated implantation failure.
- IVF / ET embryos are implanted into the uterine cavity between 2 and 5 days after fertilization. Pregnancy is established by the successful implantation of so-called semi-allograft embryos into the maternal decidua with the establishment of maternal immune tolerance [7]. Establishing an appropriate immune response at the time of implantation is key to successful implantation. Thus, immunological etiology appears to play an important role in RIF following IVF / ET.
- T helper (Th) 1, Th2, Th17, Treg cells play important roles in immune responses such as immune rejection and tolerance [Ref. 8]. It is generally agreed that pregnancy immune status is associated with Th2 predominance and Th1 immune response is associated with embryonic rejection [6, 9]. The mechanism underlying embryo rejection is thought to be similar to rejection in allotransplantation [Ref. 10]. Implanted embryos during IVF / ET may fail to implant due to an immune response similar to allograft rejection.
- Th1 and Th2 cells A total of 10 ml of venous blood was collected for the purpose of evaluating the baseline value of the Th1 / Th2 cell ratio. Th1 and Th2 cells were determined by detecting the production of intracellular interferon (IFN) - ⁇ and IL-4.
- IFN intracellular interferon
- lymphocytes Specific staining of lymphocytes was performed by incubating whole blood with anti-CD4-PC5 or anti-CD8-PC5-conjugated monoclonal antibodies (mAbs) (Beckman Coulter, Fullerton, Ca, USA). Erythrocytes (RBCs) were removed by hemolysis (using FACS Lysing solution; Becton Dickinson, BD 134 Biosciences, Franklin Lake. NJ, USA) and lymphocytes were analyzed by flow cytometry (FACSCaicuron with FACSCaicuron). Activated whole blood samples were surface stained with anti-CD4-PC5-conjugates (Abs) followed by hemolysis of RBC and FastImmune TM IFN- ⁇ - according to the manufacturer's instructions.
- mAbs monoclonal antibodies
- Th1 cells were defined as CD4 + lymphocytes with intracellular IFN- ⁇ but without intracellular IL-4.
- Th2 cells were detected as CD4 + lymphocytes with intracellular IL-4, but without intracellular IFN- ⁇ .
- the ratio of intracellular IFN- ⁇ -positive Th cells to intracellular IL-4 positive Th cells was expressed as the Th1 / Th2 cell ratio.
- Example 1 Treatment of a blood-mismatched pregnancy with tacrolimus
- the patient is a 35-year-old woman with blood group A.
- the following treatment was performed on maternal Rho (D) -negative and fetal Rho (D) -positive blood group-incompatible pregnancy patients. That is, at the time of the first pregnancy, anti-D immunoglobulin was not administered during pregnancy, sensitization was established before childbirth, and the anti-D antibody titer at the time of childbirth was eight-fold. At 39 weeks, she was delivered by emergency cesarean section with early exfoliation of the upper placenta. Five months after giving birth, the antibody titer showed a maximum of 64 times.
- the anti-D antibody titer was 4 times, but reached 16 times at 24 weeks and 32 times at 26 weeks (the upper part of FIG. 1). Thereafter, transfer of fetal antigen to the mother via the placenta was expected to increase further, and preparation for plasma exchange and fetal transfusion was started in preparation for a rapid rise in anti-D antibody titer. At the same time, taking into consideration that Th1 at 28 weeks showed a tendency to increase again, the amount of tacrolimus was increased to 5 mg / day (oral administration: 3 mg in the morning and 2 mg in the evening).
- the anti-D antibody titer was not expected to rise at all, and the fetal anemia (increased blood flow velocity in the middle cerebral artery) was maintained at 32 times without any increase.
- the day gave birth to a 2834 g healthy boy.
- the blood flow velocity in the middle cerebral artery and the estimated weight of the fetus were measured by fetal ultrasonography.
- FIG. 2 is a graph showing changes in the weight of the fetus during the gestation week. Weight has increased over time, indicating that the fetus is growing for the number of weeks of gestation. FIG. 2 also shows the blood flow velocity of the middle cerebral artery, indicating that fetal anemia did not develop during the entire pregnancy.
- the cord blood tacrolimus concentration was below the detection limit by chemiluminescence immunoassay (ECLIA), and the anti-D antibody titer was doubled.
- the blood type of the infant was positive for Rho (D) type A, and the Hb (hemoglobin) value at birth was slightly low at 13.6. However, there was no external malformation or visceral malformation, and there was no problem with physical function.
- HbF Fetal hemoglobin
- the inventors treated patients with tacrolimus and were able to suppress cellular immunity against infertility. Detailed mechanisms and results relating to Th1 cells have been described previously [13-15]. Based on these results, administration of tacrolimus was started before pregnancy as a treatment for infertility, and administration was continued after the establishment of pregnancy because the Th1 cell population did not show a tendency to decrease. Since the Th1 cell population increased at 28 weeks of gestation, 5 mg was administered. / Day increased. The maternal and fetal condition was stable with no complications, the pregnancy progressed smoothly, and the patient achieved safe childbirth.
- anti-D antibody titer could rise sharply in response to the invasion of large amounts of fetal erythrocytes, but as a result, production of anti-D antibody was suppressed, and intensive treatment of mother and baby until childbirth was unnecessary.
- this treatment offers the benefit of mitigating the acceleration of antibody production without the use of intense treatments such as plasmapheresis, high-dose gamma globulin, or high-dose steroid treatment.
- intense treatments such as plasmapheresis, high-dose gamma globulin, or high-dose steroid treatment.
- tacrolimus is beneficial for alloimmune pregnancy.
- Neonatal hemochromatosis treatment The main purpose of this treatment is to suppress the recognition of fetal antigens in the mother and reduce the ability to produce pathogenic antibodies.
- the fetal antigen flows into the mother from the fetus after completion of the placenta construction, and is recognized by the mother after the completion of the placenta construction, and a pathogenic antibody against the antigen is produced. Transfer to the fetus through the placenta causes disease in the fetus.
- the disease is severe enough that the pathogenic antibody inhibits proteins related to fetal iron metabolism, deposits iron in the liver, results in liver failure, and results in intrauterine fetal death or postnatal death or liver transplantation. Often.
- the mechanism of this treatment is explained as suppression of T cell function by inhibition of the calcineurin / NFAT pathway, thereby inhibiting B cell activation and antibody production, thereby inhibiting recognition of fetal antigen and production of anti-pathogen antibody. can do.
- Maternal high-dose gamma globulin therapy the only existing preventive method, is purified from large volumes of pooled blood and is therefore at risk for exposure to infections that may be contained in the blood. Parvovirus infection, which causes fetal anemia, is particularly problematic, but there is no risk of infection, including other viruses, with this treatment.
- Neonatal blood findings include coagulation disorders, cholestasis, and abnormal transaminases.
- Disseminated intravascular coagulation syndrome not caused by sepsis, high ferritin ⁇ -fetoprotein high, and high transferrin saturation were shown, and MRI T2-weighted images showed a low signal suggesting iron deposition in organs other than the liver on MRI T2-weighted images.
- This treatment can be evaluated by improving the findings of these pregnant fetuses and postnatal neonates.
- diseases associated with humoral immunity in the relationship between the mother and the fetus for example, infertility / infertility caused by humoral immunity in the relationship between the mother and the fetus, blood group incompatible pregnancy, or fetal hemochromatosis Can be treated or ameliorated, and continuation of pregnancy and delivery of a healthy child can be achieved.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Immunology (AREA)
- Animal Behavior & Ethology (AREA)
- Pharmacology & Pharmacy (AREA)
- Medicinal Chemistry (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Chemical & Material Sciences (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Epidemiology (AREA)
- Gastroenterology & Hepatology (AREA)
- Proteomics, Peptides & Aminoacids (AREA)
- Transplantation (AREA)
- Chemical Kinetics & Catalysis (AREA)
- General Chemical & Material Sciences (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Organic Chemistry (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Nitrogen And Oxygen Or Sulfur-Condensed Heterocyclic Ring Systems (AREA)
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
Abstract
Description
例えば母体がRho(D)陰性であって胎児Rho(D)陽性の妊娠は、血液型不適合妊娠とされている。胎盤構築後、微量ではあるが血球成分を含む胎児抗原は胎児から胎盤を介して母体へ移行する。この時、移行してきた胎児抗原が母体の免疫寛容能力を超えた抗原もしくは寛容されない抗原に対しては母体により病原性抗体が産生され、その病原性抗体は他の抗体と同様に胎盤を介して胎児へ移行し、胎児の細胞膜上や細胞内外の胎児抗原を標的として攻撃する。血液型不適合妊娠では母体から産生された抗D抗体が胎盤を介して胎児へ移行し、胎児血中の赤血球を破壊し、胎児貧血、後には重篤な胎児水腫や子宮内胎児死亡を引き起こす[参考文献4]。この病態は初回妊娠では顕著ではなく、2回目の妊娠以降、感作の機会が増すごとに重症化する。また、胎盤の構築が行われた後、移行抗原量は妊娠経過とともに徐々に増すため妊娠週数とともに病態が進行する。特に移行量の多くなる中期以降に急速に悪化することが多い。現在知られている治療は、母体より産生された抗D抗体を除去するための血漿交換、貧血に陥ってしまった胎児へ対し胎児輸血を行い、リスクの低い状態での出産を促すことである。或いは、D抗原への感作を防ぐために、Rh不適合の妊娠の女性は、妊娠中にRhD免疫グロブリン(Ig)で治療しなければならず、患者がまだ感作されていない場合には出産または中絶後に治療するべきである。これはRhDにのみならず、他の血液型でも母体胎児間で不適合であることによって血液型不適合妊娠が発症する可能性はある。
(i) 式(I)
(化1)
(式中、R1及びR2、R3及びR4、R5及びR6の隣接するそれぞれの対は、各々独立して、
(a)2つの隣接する水素原子を表すか、もしくはR2はアルキル基であってもよく、又は
(b)結合しているそれぞれの炭素原子どうしの間でもうひとつの結合を形成してもよく;
R7は、水素原子、ヒドロキシ基、保護されたヒドロキシ基であるか、もしくはR1と一緒になってオキソ基を表わし;
R8及びR9は独立して、水素原子、ヒドロキシ基を表わし;
R10は、水素原子、アルキル基、1以上のヒドロキシ基によって置換されたアルキル基、アルケニル基、1以上のヒドロキシ基によって置換されたアルケニル基、又はオキソ基によって置換されたアルキル基を表わし;
Xは、オキソ基、(水素原子、ヒドロキシ基)、(水素原子、水素原子)、又は式-CH2O-で表わされる基を表わし;
Yは、オキソ基、(水素原子、ヒドロキシ基)、(水素原子、水素原子)、又は式N-NR11R12もしくはN-OR13で表わされる基を表わし;
R11及びR12は独立して、水素原子、アルキル基、アリール基又はトシル基を表わし;
R13、R14、R15、R16、R17、R18、R19、R22及びR23は独立して、水素原子又はアルキル基を表わし;
R24は、所望により置換されていてもよい、1以上の複素原子を含み得る環を表わし;
nは1又は2を表わし、
上記の意味に加え、さらにY、R10及びR23は、それらが結合している炭素原子と一緒になって、飽和もしくは不飽和の5員もしくは6員環の、窒素原子、硫黄原子及び酸素原子より選択される1以上の複素原子を含有する複素環基を形成してもよく、その複素環基は、アルキル基、ヒドロキシ基、アルキルオキシ基、ベンジル基、式-CH2Se(C6H5)で表わされる基、及び1以上のヒドロキシ基によって置換されたアルキル基から選ばれる1以上の基によって置換されていてもよい)で表される化合物又はその薬学的に許容される塩、
(ii)サイクロスポリン類、及び
(iii)ラパマイシンまたはその誘導体、よりなる群から選択される化合物を有効成分として含む、母体と胎児との関係における液性免疫が関連する疾患を治療するための薬剤。
(実施形態2)
式(I)で表される化合物がタクロリムス又はその薬学的に許容される塩である、実施形態1に記載の薬剤。
(実施形態3)
有効成分が式(I)で表される化合物又はその薬学的に許容される塩であり、式(I)で表される化合物がタクロリムス又はその薬学的に許容される塩である、実施形態1に記載の薬剤。
(実施形態4)
母体と胎児との関係における液性免疫が関連する疾患が、母体と胎児との関係における液性免疫に起因する不妊・不育症である、実施形態1~3のいずれかに記載の薬剤。
(実施形態5)
母体と胎児との関係における液性免疫が関連する疾患が、血液型不適合妊娠である、実施形態1~3のいずれかに記載の薬剤。
(実施形態6)
母体と胎児との関係における液性免疫が関連する疾患が、胎児へモクロマトーシスである、実施形態1~3のいずれかに記載の薬剤。
(実施形態7)
第2子以降の妊娠に適用される、実施形態4~6のいずれかに記載の薬剤。
(実施形態8)
妊娠初期より投与される、実施形態4~7のいずれかに記載の薬剤。
(実施形態9)
妊娠初期より1~10mg/日の用量で投与される、実施形態4~7のいずれかに記載の薬剤。
(実施形態10)
妊娠初期より3~6mg/日の用量で投与される、実施形態9に記載の薬剤。
(実施形態11)
血液型不適合妊娠の可能性のある患者に、妊娠初期より1~10mg/日の投与量で投与される、実施形態1~3、5、7~9のいずれかに記載の薬剤。
(実施形態12)
式(I)で表される化合物又はその薬学的に許容される塩、
(ii)サイクロスポリン類、及び
(iii)ラパマイシンまたはその誘導体、よりなる群から選択される化合物を患者に投与することを含む、母体と胎児との関係における液性免疫が関連する疾患の治療方法。
(実施形態13)
タクロリムス又はその薬学的に許容される塩を患者に投与することを含む、実施形態12に記載の治療方法。
(実施形態14)
母体と胎児との関係における液性免疫が関連する疾患が、血液型不適合妊娠である、実施形態12または13に記載の治療方法。
(実施形態15)
母体と胎児との関係における液性免疫が関連する疾患が、胎児へモクロマトーシスである、実施形態12または13に記載の治療方法。
(実施形態16)
第2子以降の妊娠に適用される、実施形態14または15に記載の治療方法。
(実施形態17)
妊娠初期より投与される、実施形態14~16のいずれかに記載の治療方法。
(実施形態18)
妊娠初期より1~10mg/日の用量で投与される、実施形態14~16のいずれかに記載の治療方法。
(実施形態19)
血液型不適合妊娠の可能性のある患者に式(I)で表される化合物が妊娠初期より1~10mg/日の投与量で投与される、実施形態14、16~18のいずれかに記載の治療方法。
(実施形態20)
母体と胎児との関係における液性免疫が関連する疾患の治療用の化合物であって、該化合物は、式(I)で表される化合物又はその薬学的に許容される塩、
(ii)サイクロスポリン類、及び
(iii)ラパマイシンまたはその誘導体、よりなる群から選択される、化合物。
(実施形態21)
母体と胎児との関係における液性免疫が関連する疾患の治療用のタクロリムス又はその薬学的に許容される塩。
(実施形態22)
母体と胎児との関係における液性免疫が関連する疾患が、血液型不適合妊娠である、実施形態20または21に記載の化合物又はその薬学的に許容される塩。
(実施形態23)
母体と胎児との関係における液性免疫が関連する疾患が、胎児ヘモクロマトーシスである、実施形態20または21に記載の化合物又はその薬学的に許容される塩。
(i) 式(I)
(化2)
(式中、R1及びR2、R3及びR4、R5及びR6の隣接するそれぞれの対は、各々独立して、
(a)2つの隣接する水素原子を表すか、もしくはR2はアルキル基であってもよく、又は
(b)結合しているそれぞれの炭素原子どうしの間でもうひとつの結合を形成してもよく(すなわち、二重結合を形成する);
R7は、水素原子、ヒドロキシ基、保護されたヒドロキシ基であるか、もしくはR1と一緒になってオキソ基を表わし;
R8及びR9は独立して、水素原子、ヒドロキシ基を表わし;
R10は、水素原子、アルキル基、1以上のヒドロキシ基によって置換されたアルキル基、アルケニル基、1以上のヒドロキシ基によって置換されたアルケニル基、又はオキソ基によって置換されたアルキル基を表わし;
Xは、オキソ基、(水素原子、ヒドロキシ基)、(水素原子、水素原子)、又は式-CH2O-で表わされる基を表わし;
Yは、オキソ基、(水素原子、ヒドロキシ基)、(水素原子、水素原子)、又は式N-NR11R12もしくはN-OR13で表わされる基を表わし;
R11及びR12は独立して、水素原子、アルキル基、アリール基又はトシル基を表わし;
R13、R14、R15、R16、R17、R18、R19、R22及びR23は独立して、水素原子又はアルキル基を表わし;
R24は、所望により置換されていてもよい、1以上の複素原子を含み得る環を表わし;
nは1又は2を表わし、
上記の意味に加え、さらにY、R10及びR23は、それらが結合している炭素原子と一緒になって飽和もしくは不飽和の5員もしくは6員環の、窒素原子、硫黄原子及び酸素原子より選択される1以上の複素原子を含有する複素環基を形成してもよく、その複素環基は、アルキル基、ヒドロキシ基、アルキルオキシ基、ベンジル基、式-CH2Se(C6H5)で表わされる基、及び1以上のヒドロキシ基によって置換されたアルキル基から選ばれる1以上の基によって置換されていてもよい)で表される化合物又はその薬学的に許容される塩、
(ii)サイクロスポリン類、及び
(iii)ラパマイシンまたはその誘導体、よりなる群から選択される化合物を有効成分として含む、母体と胎児との関係における液性免疫が関連する疾患を治療するための薬剤、を提供する。
(a)3,4-ジオキソ-シクロヘキシル基;
(b)3-R20-4-R21-シクロヘキシル基、
ここで、R20は、ヒドロキシ、アルキルオキシ、オキソ、又はOCH2OCH2CH2OCH3を表わし、及びR21は、ヒドロキシ、-OCN、アルキルオキシ、適当な置換基を有していてもよいヘテロアリールオキシ、-OCH2OCH2CH2OCH3、保護されたヒドロキシ、クロロ、ブロモ、ヨード、アミノオキザリルオキシ、アジド基若しくはp-トリルオキシチオカルボニルオキシ、又はR25R26CHCOO-(式中、R25は所望により保護されていてもよいヒドロキシ基、又は保護されたアミノ基を表わし、及びR26は水素原子又はメチルを表わす)を表わすか、又はR20とR21は一緒になって、エポキシド環の酸素原子(すなわち、-O-)を形成する;又は
(c)シクロペンチル基であって、そのシクロペンチル基は、メトキシメチル、所望により保護されたヒドロキシメチル、アシルオキシメチル(その中において、アシル部分は、所望により4級化されていてもよいジメチルアミノ基又はエステル化されていてもよいカルボキシ基である)、1以上の保護されていてもよいアミノ及び/又はヒドロキシ基、又はアミノオキザリルオキシメチルで置換されていてもよく、好ましい例は、2-ホルミル-シクロペンチル基である。
例えばトリメチルシリル、トリエチルシリル、トリブチルシリル、第三級ブチル-ジメチルシリル、トリ第三級ブチルシリル等のトリ(低級)アルキルシリル、例えばメチル-ジフェニルシリル、エチル-ジフェニルシリル、プロピル-ジフェニルシリル、第三級ブチル-ジフェニルシリル等の低級アルキル-ジアリールシリル等のようなトリ置換シリル基、さらに好ましいものとしてトリ(C1~C4)アルキルシリル基及びC1~C4アルキルジフェニルシリル基、最も好ましいものとして第三級ブチル-ジメチルシリル基及び第三級ブチル-ジフェニルシリル基;
カルボン酸、スルホン酸及びカルバミン酸から誘導される脂肪族アシル基、芳香族アシル基及び芳香族基で置換された脂肪族アシル基のようなアシル基;等が挙げられる。
例えばシクロプロピルオキシアセチル、シクロブチルオキシプロピオニル、シクロヘプチルオキシブチリル、メンチルオキシアセチル、メンチルオキシプロピオニル、メンチルオキシブチリル、メンチルオキシペンタノイル、メンチルオキシヘキサノイル等の、低級アルキルのような適当な置換基を1個以上有していてもよいシクロ(低級)アルキルオキシ(低級)アルカノイル基;
カンファースルホニル基;
例えばカルボキシメチルカルバモイル、カルボキシエチルカルバモイル、カルボキシプロピルカルバモイル、カルボキシブチルカルバモイル、カルボキシペンチルカルバモイル、カルボキシヘキシルカルバモイル等のカルボキシ(低級)アルキルカルバモイル基、又は例えばトリメチルシリルメトキシカルボニルエチルカルバモイル、トリメチルシリルエトキシカルボニルプロピルカルバモイル、トリエチルシリルエトキシカルボニルプロピルカルバモイル、第三級ブチルジメチルシリルエトキシカルボニルプロピルカルバモイル、トリメチルシリルプロポキシカルボニルブチルカルバモイル基等のトリ(低級)アルキルシリル(低級)アルキルオキシカルボニル(低級)アルキルカルバモイル基等の、カルボキシもしくは保護されたカルボキシのような適当な置換基を1個以上有する低級アルキルカルバモイル基等が挙げられる。
例えばベンゼンスルホニル、トルエンスルホニル、キシレンスルホニル、ナフタレンスルホニル、フルオロベンゼンスルホニル、クロロベンゼンスルホニル、ブロモベンゼンスルホニル、ヨードベンゼンスルホニル等の、ハロゲンのような適当な置換基を1個以上有していてもよいアレーンスルホニル基等が挙げられる。
本発明においては、有効成分として、(i)式(I)で表される化合物若しくはその薬学的に許容される塩、(ii)サイクロスポリン類、又は、(iii)ラパマイシン若しくはその誘導体を用いることができる。尚、有効成分として、(i)式(I)で表される化合物、(ii)サイクロスポリン類、又は、(iii)ラパマイシン若しくはその誘導体の2種以上を併用して用いてもよい。以下にそれぞれの有効成分について説明する。
本発明において使用される式(I)で表される化合物又はその薬学的に許容される塩は、前記で説明したとおりであるが、具体的には、例えば、EP-A-184162、EP-A-323042、EP-A-423714、EP-A-427680、EP-A-465426、EP-A-480623、EP-A-532088、EP-A-532089、EP-A-569337、EP-A-626385、WO89/05303、WO93/05058、WO96/31514、WO91/13889、WO91/19495、WO93/5059等に記載されている。
化学名:17-アリル-1,14-ジヒドロキシ-12-[2-(4-ヒドロキシ-3-メトキシシクロヘキシル)-1-メチルビニル]-23,25-ジメトキシ-13,19,21,27-テトラメチル-11,28-ジオキサ-4-アザトリシクロ[22.3.1.04,9]オクタコス-18-エン-2,3,10,16-テトラオン。
R1、R2、R8及びR23は、独立して水素原子であり、
R9は、ヒドロキシ基であり、R10は、メチル、エチル、プロピル又はアリル基であり、
R7は、ヒドロキシであり、
Xは、(水素原子、水素原子)又はオキソ基であり、
Yは、オキソ基であり、
R14、R15、R16、R17、R18、R19及びR22は、それぞれメチル基であり、
R24は、3-R20-4-R21-シクロヘキシル基であり、
ここで、R20は、ヒドロキシ、アルキルオキシ、オキソ、又は-OCH2OCH2CH2OCH3であり、
R21は、ヒドロキシ、-OCN、アルキルオキシ、適当な置換基を有していてもよいヘテロアリールオキシ、1-テトラゾリル又は2-テトラゾリル、-OCH2OCH2CH2OCH3、保護されたヒドロキシ、クロロ、ブロモ、ヨード、アミノオキザリルオキシ、アジド基若しくはp-トリルオキシチオカルボニルオキシであるか、又は、R25R26CHCOO-(式中、R25は所望により保護されていてもよいヒドロキシ基、又は保護されたアミノ基、及びR26は水素原子又はメチル)であるか、或いは
R20とR21は一緒になって、エポキシド環の酸素原子(すなわち-O-)を形成し、そしてnは1又は2である。
本発明の式(I)で表される化合物において「薬学的に許容される塩」という用語は、薬学的に許容される非毒性塩基または酸から調製される塩を指す。本発明の式(I)で表される化合物が酸性である場合、その対応する塩は、無機塩基及び有機塩基を含む、薬学的に許容される非毒性塩基から好都合に調製することができる。そのような無機塩基に由来する塩には、アルミニウム、アンモニウム、カルシウム、銅(第二及び第一)、第二鉄、第一鉄、リチウム、マグネシウム、マンガン(第二及び第一)、カリウム、ナトリウム、亜鉛などの塩が含まれる。アンモニウム、カルシウム、マグネシウム、カリウム及びナトリウムの塩が好ましい。薬学的に許容される非毒性の有機塩基から調製される塩は、天然起源と合成供給源の両方に由来する一級、二級、及び三級アミンの塩を含む。薬学的に許容される非毒性の有機塩基には、例えばアルギニン、ベタイン、カフェイン、コリン、N,N’-ジベンジルエチレンジアミン、ジエチルアミン、2-ジエチルアミノエタノール、2-ジメチルアミノエタノール、エタノールアミン、エチレンジアミン、N-エチルモルホリン、N-エチルピペリジン、グルカミン、グルコサミン、ヒスチジン、ヒドラバミン、イソプロピルアミン、ジシクロヘキシルアミン、リジン、メチルグルカミン、モルホリン、ピペラジン、ピペリジン、ポリアミン樹脂、プロカイン、プリン、テオブロミン、トリエチルアミン、トリメチルアミン、トリプロピルアミン、トロメタミンなどが含まれる。
本発明の式(I)で表される化合物は、非晶質形態及び/又は1以上の結晶質形態で存在することができ、式(I)で表される化合物のそのようなすべての非晶質形態及び結晶質形態並びにそれらの混合物は、本発明の範囲内に含まれることが意図される。さらに、式(I)で表される化合物の一部は、水との溶媒和物(すなわち、水和物)又は通常の有機溶媒との溶媒和物を形成し得る。式(I)で表される化合物のそのような溶媒和物及び水和物、特に、薬学的に許容され得る溶媒和物及び水和物は、同様に、該化合物の溶媒和されていない無水形態とともに、式(I)によって定義される化合物及びその薬学的に許容され得る塩の範囲内に包含される。
本発明の式(I)で表される化合物においては、コンホーマーあるいは不斉炭素原子及び二重結合に起因する光学異性体及び幾何異性体のような1対以上の立体異性体が存在することがあり、そのようなコンホーマーあるいは異性体も本明の化合物の範囲に包含される。
本発明の式(I)で表される化合物は溶媒和物を形成することも出来るが、その場合も本願発明の範囲に含まれる。好ましい溶媒和物としては、水和物及びエタノレートが挙げられる。
本発明の式(I)で表される化合物は、文献公知のものであり、その製法方法は、例えば、EP-A-184162、EP-A-323042、EP-A-423714、EP-A-427680、EP-A-465426、EP-A-480623、EP-A-532088、EP-A-532089、EP-A-569337、EP-A-626385、WO89/05303、WO93/05058、WO96/31514、WO91/13889、WO91/19495、WO93/5059等に開示されている。又、タクロリムスは、アステラス製薬株式会社から、プログラフ(登録商標)の販売名で市販されている。
サイクロスポリン類としては、例えばサイクロスポリンA、B、D等が挙げられ、これらはメルクインデックス(12版)No.2821に記載されている。尚、サイクロスポリンは、例えば、サンディミュンという販売名でノバルティスファーマ株式会社から市販されている。
ラパマイシン(シロリムスとも呼ばれる)としては、メルクインデックス(12版)No.8288に記載されており、その誘導体も使用することが可能である。好ましい例としては、WO95/16691の1頁の式Aの40位のヒドロキシが-OR1(ここで、R1はヒドロキシアルキル、ヒドロアルキルオキシアルキル、アシルアミノアルキル及びアミノアルキル)で置換されているO-置換誘導体、例えば、40-O-(2-ヒドロキシ)エチル-ラパマイシン、40-O-(3-ヒドロキシ)プロピル-ラパマイシン、40-O-[2-(2-ヒドロキシ)エトキシ]エチル-ラパマイシン及び40-O-(2-アセトアミノエチル)-ラパマイシンが挙げられる。尚、ラパマイシン(シロリムス)は、ラパリムスという販売名でノーベルファーマ株式会社から市販されている。
本発明に係る薬剤は、上記の有効成分の他に、有効成分の活性を阻害する虞がなく、投与対象(以下、患者ともいう)にとって有害でないものである限り、他の疾病、疾患及び状態に対して治療作用を有する治療活性物質を1つ以上含んでいてもよい。
本発明の薬剤は、(i)式(I)で表される化合物又はその薬学的に許容される塩、(ii)サイクロスポリン類、(iii)ラパマイシン誘導体、よりなる群から選択される化合物を有効成分として含み、更に、投与対象に有害でない、薬学的に受容可能な担体を含んでいてもよい。用いることが可能な担体は、固体、半固体、又は液体型の何れであってもよく、例えば、水、電解質液、及び、糖液等から選択される何れかが挙げられるが、これらに限定されない。さらに、該薬剤は、補助剤を含んでいてもよい。補助剤としては、滑沢剤、安定化剤、防腐剤、乳化剤、増粘剤(粘稠剤)、着色剤、香料(着香剤)、賦形剤、保存剤、緩衝剤、矯味剤、懸濁化剤、乳化剤、溶解補助剤などが挙げられる。
本発明の有効成分を含む薬剤は、種々の剤型で提供することができ、その剤型としては、錠剤、カプセル剤、丸剤、顆粒剤、散剤、シロップ剤、坐剤、トローチ剤、ペレット、エマルジョン、懸濁液、及び、公知のその他の形態が挙げられる。これらの中でも、例えば、経口投与製剤として、錠剤、カプセル剤、丸剤、顆粒剤、散剤、液剤、シロップ剤、及び、ゼリー剤のうちのいずれかであることが好ましく、錠剤、カプセル剤、及び、顆粒剤のうちのいずれかであることがより好ましく、錠剤であることがさらに好ましい。なお、後述する通り、例えば、注射剤、坐剤、及び、経皮吸収型製剤のような非経口投与製剤として製剤されてもよい。
本発明に係る薬剤は、公知の製造方法を利用して製造することができる。一例として、有効成分と任意のその他の成分とを成分毎に別途に製造したのち、それぞれの成分を所望の含有量となるように混合することによって製造される。
本発明の薬剤の投与対象としては、哺乳動物が挙げられる。哺乳類としては、ヒトならびにヒト以外の動物としてウシ、ウマ、ブタ及びヒツジなどのような家畜、サル、チンパンジー、並びに、犬、猫、ラット及びウサギなどのような愛玩動物が挙げられ、好ましくはヒトが挙げられる。
本発明の薬剤の投与方法(投与経路)は、投与対象の年齢、状態、及び、治療期間等により適宜決定することができる。具体的には、経口投与又は非経口投与の何れであってもよいが、経口投与であることが好ましい(実施例は経口投与)。非経口投与としては、注射投与、坐剤としての投与、経皮吸収型製剤としての投与などの方法が挙げられる。注射投与の種類としては、例えば、筋肉内、腹腔内、皮下、静脈内、及び、局所注射が挙げられる。また、本発明の薬剤は、経皮、経鼻、経膣、及び、直腸経由などの様々な経路を介して投与することができる。
薬剤の投与量は、薬剤投与を受ける患者の疾病、疾患又は症状の種類、重篤度、各種検査結果、及び薬剤の有効成分の種類などによって異なる。さらに、薬剤の投与量は、処置されるべき患者の年齢、本発明の治療方法による治療の実施回数、及び、各種検査結果などに依存しても異なる。一例として、本発明の薬剤は、薬剤に含まれる有効成分の含有量の観点で、生体移植及び免疫系疾患等の治療において免疫抑制剤として用いられる場合の投与量よりも低用量となる用量において投与される。例えば、薬剤の投与対象がヒトである場合は、特に限定されるわけではないが、一日につき、有効成分の量として、好ましくは0.5~10mgか1~10mgの範囲内、より好ましくは0.5~6mgか3~6mgの範囲内の範囲内の量を投与する。なお、以下、特に断りが無い限り、薬剤の投与量に関する記載はヒトが対象である場合に適用され、投与量は有効成分の量として表されているものとする。
「不妊・不育症」とは、「不妊」と「不育」の両方を含む概念である。本明細書において「不妊」とは、広義には、正常な状態と比較して母体が妊娠困難な状態にあることを指し、不妊症を含む概念である。本明細書において「不妊症」とは、挙児を希望したのち避妊なしで1年以内に妊娠が成立しない場合を指す。本明細書において「不育」とは、妊娠した後に母体の子宮内において胎児が発達不能な状態又は胎児の発達遅延もしくは発達不良がみられる状態を指し、不育症を含む概念である。本明細書において「不育症」とは、妊娠(自然妊娠の他、人工授精や体外受精の場合も含む)は成立するものの、流産、早産又は死産を1回または2回以上繰り返し、挙児に至らない場合を指す。
本明細書における「母体と胎児との関係における液性免疫に起因する不妊・不育症」は、「不妊・不育症」のうち特に、母体と胎児との関係における液性免疫の異常に起因する不妊・不育症のみを含む。したがって、本明細書における「母体と胎児との関係における液性免疫に起因する不妊・不育症」には、細胞性免疫の異常に起因する「不妊・不育症」は含まれない。
(i)不妊の要因として公知である卵因子、卵管因子、子宮因子、頸管因子及び免疫因子(特に細胞免疫因子)のいずれにも起因しない場合。
(ii)不育の原因として公知である遺伝的因子、解剖的因子、内分泌的因子、凝固的因子及び自己免疫的因子のいずれにも起因しない場合。
(iii)原因不明であり、Th1/Th2細胞比率等の細胞性免疫の異常を確認するパラメータは正常値を示す場合(すなわち、細胞性免疫の異常は原因でない場合)。
(iv)受精卵もしくは胎児の細胞膜上もしくは細胞内外の胎児抗原を標的とする病原抗体が母体内に存在し、母体が病原抗体を介して子宮内で受精卵や胎児成分を直接攻撃するか、胎盤を介して移行した病原抗体が胎児を攻撃する場合。
血液型不適合妊娠は、以下のような状態で生じる障害である。
(i)母体の赤血球膜上に無い抗原が胎児の赤血球膜上に存在する、
(ii)胎児血が胎盤を介して母体へ流入後、胎児赤血球膜上の抗原に対する病原性抗体が母体内で産生される(病原性抗体、例えば抗D抗体価、抗赤血球抗体などの上昇)、
(iii)病原性抗体は胎盤を介して胎児へ移行して胎児赤血球を攻撃する、
(iv)胎児の赤血球は溶血し、胎児貧血となる。
投与量は、有効成分として1mg/日~10mg/日が例示される。好ましくは、投与量は、3~6mg/日である。
尚、女性が不妊症を患っており、例えば本発明の薬剤(有効成分として1~4mg/日)を用いて妊娠が成立した場合には、継続して投与し、例えば病原性抗体価の上昇が認められた時に本発明の薬剤を更に増量して(例えば有効成分として5~10mg/日)投与してもよい。
胎児へモクロマトーシスは、以下のような状態で生じる症状である。
(i)胎児の鉄代謝に関連する酵素が母体のそれとは異なる、
(ii)胎児血が胎盤を介して母体へ流入後、その酵素に対する病原性抗体が母体内で産生される、
(iii)病原性抗体は胎盤を介して胎児へ移行して胎児の鉄代謝酵素を攻撃する、
(iv)胎児の鉄代謝は止まり、肝臓内に鉄が沈着し肝硬変となる。
この際の本発明の有効成分である化合物の投与量としては、1~10mg/日が好ましく、より好ましくは3~6mg/日である。
間接クームス試験により行う。間接クームス試験とは、患者の血清と健常者の血液を混合したものに抗免疫グロブリン抗体を加え赤血球凝集反応が起きるか否かを検査するものである(血清中に存在する不規則抗体を検出する)(クームス試験については、例えば日産婦誌59巻10号、N-617~N-623参照のこと)。
近年、世界中で、対外授精(IVF)及び胚移植(ET)の発生率が高まっている。これに伴い、反復着床不全を含む、複数回のIVFの失敗を経験する女性の数が増加している。IVF/ETを行う際、受精後2~5日の間に、胚を子宮腔へ移植する。いわば半同種移植片(semi-allograft)たる胚が、母体側の免疫寛容の確立を伴って、母体の脱落膜に成功裏に着床することによって、妊娠が確立される[参考文献7]。着床時における、適切な免疫応答の確立が、成功裏な着床の鍵である。従って、免疫上の病因学は、IVF/ET後のRIFにおいて重要な役割を果たしていると考えられる。
Th1/Th2細胞比率のベースライン値を評価する目的で、全部で10mlの静脈血を採取した。Th1細胞、及びTh2細胞は、細胞内インターフェロン(IFN)-γ及びIL-4の産生を検出することによって決定した。
タクロリムスによる血液型不適合妊娠の治療
患者は血液型Aの35歳の女性である。母体Rho(D)陰性、胎児Rho(D)陽性の血液型不適合妊娠の患者に対して下記の処置を行った。すなわち、初回妊娠時、抗D免疫グロブリンを妊娠中に投与しておらず、出産前に感作が成立し出産時の抗D抗体価は8倍であった。39週で上位胎盤早期剥離にて緊急帝王切開で出産した。出産後は5ヶ月後に抗体価は最高値64倍を示していた。
臍帯血タクロリムスの濃度は、化学発光免疫測定法(ECLIA)で、検出限界値以下であり、抗D抗体価は2倍であった。児の血液型はA型Rho(D)陽性であり、出生時のHb(ヘモグロビン)値は13.6と軽度低値であったが、外表奇形、内臓奇形なく身体機能も問題なかった。
胎児ヘモグロビン(HbF)は、妊娠初期から母体血液中に存在し得る。母体血液中のHbFは妊娠初期に検出され、胎児血液中のHbFから母体血液中への移行は一般的に妊娠9週頃より観察される[参考文献4、11、12]。これらの知見は、胎児抗原へ対する母体の免疫応答は、胎児抗原の母体への流入が始まる妊娠初期より起こりうることを示唆している。一方、胎児への抗D抗体の移行は胎盤構築完成後に始まる。
上昇した抗D抗体価および増加したTh1細胞集団は、体液性免疫および細胞性免疫によってそれぞれ誘導された。これらは、外来抗原および胎児抗原に対する通常の免疫応答である。
新生児ヘモクロマト―シス治療
本治療法は母体内での胎児抗原の認識を抑制、病原性抗体産生能力の低下を主な目的とした。
1:American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.75: Management of Alloimmunization. Obstet Gynecol 2006;108: 457-464.
2:Moise KJ Jr. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol 2002;100:600-611.
3:Wylie BJ, D'Alton ME. Fetomaternal hemorrhage. Obstet Gynecol 2010;115:1039-1051.
4:Pollack W, Ascari WQ, Kochesky RJ, O'Connor RR, Ho TY, Tripodi D. Studies on Rh prophylaxis. 1. Relationship between doses of anti-Rh and size of antigenic stimulus. Transfusion 1971;11:333-339.
5:Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr, Dorman KF, Ludomirsky A, Gonzalez R, Gomez R, Oz U, Detti L, Copel JA, Bahado-Singh R, Berry S, Martinez-Poyer J, Blackwell SC. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 2000;342:9-14.
6: Kwak‐Kim J, Chung‐Bang HS, Ng SC, Ntrivalas EI, Mangubat CP, Beaman KD, Beer AE, Gilman‐Sachs A: Hum Reprod 2003; 18: 767‐773.
7: Schjenken JE, Tolosa JM, Paul JW, Clifton VL, Smith R: Croatia, INTECH, 2012, pp211‐242.
8: aito S, Nakashima A, Shima T, Ito M: Am J Reprod Immunol 2010; 63: 601‐610.
9: Ng SC, Gilman‐Sachs A, Thakar P, Beaman KD, Beer AE, Kwak‐Kim J: Am J Reprod Immunol 2002; 48: 77‐86.
10: Riley JK: Immunol Invest 2008; 37: 395‐426.
11:Zilliacus H, Vartiainen E. Ottelin AM. Adult hemoglobin in the blood of very young human embryos. Nature 1962;193:386-387.
12:Clayton EM Jr, Feldhaus WD, Whitacre FE. Fetal erythrocytes in the maternal circulation of pregnant women. Obstet Gynecol 1964;23:915-919.
13:Nakagawa K, Kwak-Kim J, Ota K, Kuroda K, Hisano M, Sugiyama R, Yamaguchi K. Immunosuppression with Tacrolimus Improved Reproductive Outcome of Women with Repeated Implantation Failure and Elevated Peripheral Blood Th1/Th2 Cell Ratios. Am J Reprod Immunol. 2015; 73: 353-61.
14:Nakagawa K, Kwak-Kim J, Kuroda K, Sugiyama R, Yamaguchi K. Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures. Am J Reprod Immunol. Sep;78(3). doi: 10.1111/aji.12682. Epub 2017 May 3.
15:Nakagawa K, Kuroda K, Sugiyama R, Yamaguchi K. After 12 consecutive miscarriages, a patient received immunosuppressive treatment and delivered an intact baby. Reprod Med Biol. 2017;16:297-301.
16:De la Camara C, Arrieta R, Gonzalez A, Iglesias E, Omenaca F. High-dose intravenous immunoglobulin as the sole prenatal treatment for severe Rh immunization. N Engl J Med 1988;318:519-520.
17:Margulies M, Voto LS, Mathet E, Margulies M. High-dose intravenous IgG for the Treatment of severe rhesus alloimmunization. Vox Sang 1991;61:181-189.
18:Ruma MS, Moise KJ Jr., Kim E, Murtha AP, Prutsman WJ, Hassan SS, Lubarsky SL. Combined plasmapheresis and intravenous immunoglobulin for the treatment of severe maternal red cell alloimmunization. Am J Obstet Gynecol 2007;196: 138e1-138e6.
19:Isojima S, Hisano M, Suzuki T, Sago H, Murashima A and Yamaguchi K. Early plasmapheresis followed by high-dose -globulin treatment saved a severely Rho-incompatible pregnancy. Journal of Clinical Apheresis 2011; 26: 216-8.
Claims (11)
- (i) 式(I)
(化1)
(式中、R1及びR2、R3及びR4、R5及びR6の隣接するそれぞれの対は、各々独立して、
(a)2つの隣接する水素原子を表すか、もしくはR2はアルキル基であってもよく、又は
(b)結合しているそれぞれの炭素原子どうしの間でもうひとつの結合を形成してもよく;
R7は、水素原子、ヒドロキシ基、保護されたヒドロキシ基であるか、もしくはR1と一緒になってオキソ基を表わし;
R8及びR9は独立して、水素原子又はヒドロキシ基を表わし;
R10は、水素原子、アルキル基、1以上のヒドロキシ基によって置換されたアルキル基、アルケニル基、1以上のヒドロキシ基によって置換されたアルケニル基、又はオキソ基によって置換されたアルキル基を表わし;
Xは、オキソ基、(水素原子、ヒドロキシ基)、(水素原子、水素原子)、又は式-CH2O-で表わされる基を表わし;
Yは、オキソ基、(水素原子、ヒドロキシ基)、(水素原子、水素原子)、又は式N-NR11R12もしくはN-OR13で表わされる基を表わし;
R11及びR12は独立して、水素原子、アルキル基、アリール基又はトシル基を表わし;
R13、R14、R15、R16、R17、R18、R19、R22及びR23は独立して、水素原子又はアルキル基を表わし;
R24は、所望により置換されていてもよい、1以上の複素原子を含み得る環を表わし;
nは1又は2を表わし、
上記の意味に加え、さらにY、R10及びR23は、それらが結合している炭素原子と一緒になって飽和もしくは不飽和の5員もしくは6員環の、窒素原子、硫黄原子及び酸素原子より選択される1以上の複素原子を含有する複素環基を形成してもよく、その複素環基は、アルキル基、ヒドロキシ基、アルキルオキシ基、ベンジル基、式-CH2Se(C6H5)で表わされる基、及び1以上のヒドロキシ基によって置換されたアルキル基から選ばれる1以上の基によって置換されていてもよい)で表される化合物又はその薬学的に許容される塩、
(ii)サイクロスポリン類、及び
(iii)ラパマイシンまたはその誘導体、よりなる群から選択される化合物を有効成分として含む、母体と胎児との関係における液性免疫が関連する疾患を治療するための薬剤。 - 式(I)で表される化合物がタクロリムス又はその薬学的に許容される塩である、請求項1に記載の薬剤。
- 有効成分が式(I)で表される化合物又はその薬学的に許容される塩であり、式(I)で表される化合物がタクロリムス又はその薬学的に許容される塩である、請求項1に記載の薬剤。
- 母体と胎児との関係における液性免疫が関連する疾患が、母体と胎児との関係における液性免疫に起因する不妊・不育症である、請求項1~3のいずれか一項に記載の薬剤。
- 母体と胎児との関係における液性免疫が関連する疾患が、血液型不適合妊娠である、請求項1~3のいずれか一項に記載の薬剤。
- 母体と胎児との関係における液性免疫が関連する疾患が、胎児へモクロマトーシスである、請求項1~3のいずれか一項に記載の薬剤。
- 第2子以降の妊娠に適用される、請求項4~6のいずれか一項に記載の薬剤。
- 妊娠初期より投与される、請求項4~7のいずれか一項に記載の薬剤。
- 妊娠初期より1~10mg/日の用量で投与される、請求項4~7のいずれか一項に記載の薬剤。
- 妊娠初期より3~6mg/日の用量で投与される、請求項9に記載の薬剤。
- 血液型不適合妊娠の可能性のある患者に、妊娠初期より1~10mg/日の投与量で投与される、請求項1~3、5、7~9のいずれか一項に記載の薬剤。
Priority Applications (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP19847406.6A EP3834826A4 (en) | 2018-08-10 | 2019-08-09 | THERAPEUTIC AGENT FOR HUMORAL IMMUNITY-RELATED DISEASES IN THE MATERNO-FETAL RELATIONSHIP |
JP2020535917A JP7465806B2 (ja) | 2018-08-10 | 2019-08-09 | 母体と胎児との関係における液性免疫関連疾患の治療薬 |
AU2019318035A AU2019318035A1 (en) | 2018-08-10 | 2019-08-09 | Therapeutic agent for humoral immunity-related diseases in materno-fetal relationship |
CN201980051818.7A CN112533599A (zh) | 2018-08-10 | 2019-08-09 | 与母体和胎儿的关系中的体液免疫相关的疾病的治疗药 |
CA3108863A CA3108863A1 (en) | 2018-08-10 | 2019-08-09 | Therapeutic agent for humoral immunity-related diseases in materno-fetal relationship |
US17/267,237 US20210228551A1 (en) | 2018-08-10 | 2019-08-09 | Therapeutic agent for humoral immunity-related diseases in maternofetal relationship |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2018152084 | 2018-08-10 | ||
JP2018-152084 | 2018-08-10 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2020032252A1 true WO2020032252A1 (ja) | 2020-02-13 |
Family
ID=69414992
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/JP2019/031622 WO2020032252A1 (ja) | 2018-08-10 | 2019-08-09 | 母体と胎児との関係における液性免疫関連疾患の治療薬 |
Country Status (7)
Country | Link |
---|---|
US (1) | US20210228551A1 (ja) |
EP (1) | EP3834826A4 (ja) |
JP (1) | JP7465806B2 (ja) |
CN (1) | CN112533599A (ja) |
AU (1) | AU2019318035A1 (ja) |
CA (1) | CA3108863A1 (ja) |
WO (1) | WO2020032252A1 (ja) |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP3900729A4 (en) * | 2018-12-18 | 2022-09-07 | Koushi Yamaguchi | AGENT FOR TREATING INFERTILITY, RECURRENT MISSORAGE AND IMPROVING PREGNANCY |
CN113769065B (zh) * | 2021-09-18 | 2023-07-18 | 苏州市立医院 | 环孢素a在制备提高反复胚胎着床失败患者胚胎种植率的药物中的应用 |
Citations (24)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
FR900523A (fr) | 1942-11-11 | 1945-07-02 | Procédé de préparation d'extraits de protéines d'origine animale | |
FR900520A (fr) | 1943-12-13 | 1945-07-02 | Nouveau système de trusquin | |
FR900525A (fr) | 1943-12-13 | 1945-07-02 | Réchaud, notamment pour le plein air | |
FR900506A (fr) | 1943-12-10 | 1945-07-02 | Oerlikon Buehrle Ag | Culasse pour armes à feu à canon coulissant et à chargement par le recul |
EP0184162A2 (en) | 1984-12-03 | 1986-06-11 | Fujisawa Pharmaceutical Co., Ltd. | Tricyclo compounds, a process for their production and a pharmaceutical composition containing the same |
WO1989005303A1 (en) | 1987-12-11 | 1989-06-15 | MERCK Patent Gesellschaft mit beschränkter Haftung | Process for producing metallic alkyl compounds |
EP0323042A1 (en) | 1987-12-09 | 1989-07-05 | FISONS plc | Process to macrocyclic compounds |
EP0423714A2 (en) | 1989-10-16 | 1991-04-24 | Fujisawa Pharmaceutical Co., Ltd. | Hair revitalizing agent |
EP0424714A2 (en) | 1989-10-27 | 1991-05-02 | Lexmark International, Inc. | Nonaqueous thermaljet ink compositions |
EP0427680A1 (en) | 1989-11-09 | 1991-05-15 | Sandoz Ltd. | Heteroatoms-containing tricyclic compounds |
WO1991013889A1 (en) | 1990-03-13 | 1991-09-19 | Fisons Plc | Immunosuppressive macrocyclic compounds |
WO1991019495A1 (en) | 1990-06-11 | 1991-12-26 | Fujisawa Pharmaceutical Co., Ltd. | Use of a macrolide compound such as fk 506 for manufacturing a medicament for treating idiopathic thrombocytopenic purpura and basedow's disease |
EP0465426A1 (en) | 1990-07-02 | 1992-01-08 | Sandoz Ltd. | Heteroatoms-containing tricyclic compounds |
EP0474126A1 (en) | 1990-09-04 | 1992-03-11 | Fujisawa Pharmaceutical Co., Ltd. | Ointments containing tricyclic compound |
EP0480623A1 (en) | 1990-10-11 | 1992-04-15 | Merck & Co. Inc. | New halomacrolides and derivatives having immunosuppressive activity |
EP0484936A1 (en) | 1990-11-08 | 1992-05-13 | Fujisawa Pharmaceutical Co., Ltd. | Suspensions containing tricyclic compounds |
EP0532088A1 (en) | 1991-09-09 | 1993-03-17 | Merck & Co. Inc. | O-Heteroaryl, O-alkylheteroaryl, O-alkenylheteroaryl and O-alkynylheteroaryl macrolides |
EP0532089A1 (en) | 1991-09-09 | 1993-03-17 | Merck & Co. Inc. | N-heteroaryl, N-alkylheteroaryl, N-alkenylheteroaryl & N-alkynylheteroarylmacrolides |
WO1993005059A1 (en) | 1991-09-09 | 1993-03-18 | Merck & Co., Inc. | Imidazolidyl macrolides |
EP0569337A1 (en) | 1992-05-07 | 1993-11-10 | Sandoz Ltd. | Heteroatoms-containing tricyclic compounds |
EP0626385A1 (en) | 1993-05-27 | 1994-11-30 | Sandoz Ltd. | Tetrahydropyran derivatives |
WO1995016691A1 (en) | 1993-12-17 | 1995-06-22 | Sandoz Ltd. | Rapamycin derivatives useful as immunosuppressants |
WO1996031514A1 (en) | 1995-04-06 | 1996-10-10 | Novartis Ag | Ascomycins |
WO2016068208A1 (ja) | 2014-10-28 | 2016-05-06 | 国立研究開発法人国立成育医療研究センター | 妊娠状態を改善するための薬剤及びその利用 |
Family Cites Families (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CA2624825A1 (en) * | 2005-10-07 | 2007-04-19 | Lifecycle Pharma A/S | Tacrolimus combination products |
-
2019
- 2019-08-09 JP JP2020535917A patent/JP7465806B2/ja active Active
- 2019-08-09 AU AU2019318035A patent/AU2019318035A1/en not_active Abandoned
- 2019-08-09 US US17/267,237 patent/US20210228551A1/en active Pending
- 2019-08-09 CA CA3108863A patent/CA3108863A1/en not_active Abandoned
- 2019-08-09 WO PCT/JP2019/031622 patent/WO2020032252A1/ja unknown
- 2019-08-09 CN CN201980051818.7A patent/CN112533599A/zh active Pending
- 2019-08-09 EP EP19847406.6A patent/EP3834826A4/en not_active Withdrawn
Patent Citations (25)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
FR900523A (fr) | 1942-11-11 | 1945-07-02 | Procédé de préparation d'extraits de protéines d'origine animale | |
FR900506A (fr) | 1943-12-10 | 1945-07-02 | Oerlikon Buehrle Ag | Culasse pour armes à feu à canon coulissant et à chargement par le recul |
FR900520A (fr) | 1943-12-13 | 1945-07-02 | Nouveau système de trusquin | |
FR900525A (fr) | 1943-12-13 | 1945-07-02 | Réchaud, notamment pour le plein air | |
EP0184162A2 (en) | 1984-12-03 | 1986-06-11 | Fujisawa Pharmaceutical Co., Ltd. | Tricyclo compounds, a process for their production and a pharmaceutical composition containing the same |
EP0323042A1 (en) | 1987-12-09 | 1989-07-05 | FISONS plc | Process to macrocyclic compounds |
WO1989005303A1 (en) | 1987-12-11 | 1989-06-15 | MERCK Patent Gesellschaft mit beschränkter Haftung | Process for producing metallic alkyl compounds |
EP0423714A2 (en) | 1989-10-16 | 1991-04-24 | Fujisawa Pharmaceutical Co., Ltd. | Hair revitalizing agent |
EP0424714A2 (en) | 1989-10-27 | 1991-05-02 | Lexmark International, Inc. | Nonaqueous thermaljet ink compositions |
EP0427680A1 (en) | 1989-11-09 | 1991-05-15 | Sandoz Ltd. | Heteroatoms-containing tricyclic compounds |
WO1991013889A1 (en) | 1990-03-13 | 1991-09-19 | Fisons Plc | Immunosuppressive macrocyclic compounds |
WO1991019495A1 (en) | 1990-06-11 | 1991-12-26 | Fujisawa Pharmaceutical Co., Ltd. | Use of a macrolide compound such as fk 506 for manufacturing a medicament for treating idiopathic thrombocytopenic purpura and basedow's disease |
EP0465426A1 (en) | 1990-07-02 | 1992-01-08 | Sandoz Ltd. | Heteroatoms-containing tricyclic compounds |
EP0474126A1 (en) | 1990-09-04 | 1992-03-11 | Fujisawa Pharmaceutical Co., Ltd. | Ointments containing tricyclic compound |
EP0480623A1 (en) | 1990-10-11 | 1992-04-15 | Merck & Co. Inc. | New halomacrolides and derivatives having immunosuppressive activity |
EP0484936A1 (en) | 1990-11-08 | 1992-05-13 | Fujisawa Pharmaceutical Co., Ltd. | Suspensions containing tricyclic compounds |
EP0532088A1 (en) | 1991-09-09 | 1993-03-17 | Merck & Co. Inc. | O-Heteroaryl, O-alkylheteroaryl, O-alkenylheteroaryl and O-alkynylheteroaryl macrolides |
EP0532089A1 (en) | 1991-09-09 | 1993-03-17 | Merck & Co. Inc. | N-heteroaryl, N-alkylheteroaryl, N-alkenylheteroaryl & N-alkynylheteroarylmacrolides |
WO1993005058A1 (en) | 1991-09-09 | 1993-03-18 | Merck & Co., Inc. | O-heteroaryl, o-alkylheteroaryl, o-alkenylheteroaryl and o-alkynylheteroarylmacrolides |
WO1993005059A1 (en) | 1991-09-09 | 1993-03-18 | Merck & Co., Inc. | Imidazolidyl macrolides |
EP0569337A1 (en) | 1992-05-07 | 1993-11-10 | Sandoz Ltd. | Heteroatoms-containing tricyclic compounds |
EP0626385A1 (en) | 1993-05-27 | 1994-11-30 | Sandoz Ltd. | Tetrahydropyran derivatives |
WO1995016691A1 (en) | 1993-12-17 | 1995-06-22 | Sandoz Ltd. | Rapamycin derivatives useful as immunosuppressants |
WO1996031514A1 (en) | 1995-04-06 | 1996-10-10 | Novartis Ag | Ascomycins |
WO2016068208A1 (ja) | 2014-10-28 | 2016-05-06 | 国立研究開発法人国立成育医療研究センター | 妊娠状態を改善するための薬剤及びその利用 |
Non-Patent Citations (26)
Title |
---|
AITO SNAKASHIMA ASHIMA TITO M, AM J REPROD IMMUNOL, vol. 63, 2010, pages 601 - 610 |
AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS: "ACOG Practice Bulletin No.75: Management of Alloimmunization", OBSTET GYNECOL, vol. 108, 2006, pages 457 - 464 |
AMY G FELDMAN; PETER F WHITINGTON: "Neonatal hemochromatosis", JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY, vol. 3, no. 4, 2013, pages 313 - 320, XP055685302, ISSN: 0973-6883, DOI: 10.1016/j.jceh.2013.10.004 * |
ANDREW GEORGE: "Immunology", BASIC SCIENCE IN OBSTETRICS AND GYNAECOLOGY, 2010, pages 131 - 142, XP009525910, ISBN: 978-0-443-10281-3, DOI: 10.1016/B978-0-443-10281-3.00012-9 * |
CLAYTON EM JRFELDHAUS WDWHITACRE FE: "Fetal erythrocytes in the maternal circulation of pregnant women", OBSTET GYNECOL, vol. 23, 1964, pages 915 - 919 |
DE BRUYNE R; BOGAERT D; DE RUYCK N; LAMBRECHT B N; VAN WINCKEL M; GEVAERT P; DULLAERS M: "Calcineurin inhibitors dampen humoral immunity by acting directly on naive B cells", CLINICAL AND EXPERIMENTAL IMMUNOLOGY , vol. 180, no. 3, 1 June 2015 (2015-06-01), pages 542 - 550, XP055685303, ISSN: 0009-9104, DOI: :10.1111/cei.12604 * |
DE LA CAMARA CARRIETA RGONZALEZ AIGLESIAS EOMENACA F: "High-dose intravenous immunoglobulin as the sole prenatal treatment for severe Rh immunization", N ENGL J MED, vol. 318, 1988, pages 519 - 520 |
ISOJIMA SHISANO MSUZUKI TSAGO HMURASHIMA AYAMAGUCHI K: "Early plasmapheresis followed by high-dose -globulin treatment saved a severely Rho-incompatible pregnancy", JOURNAL OF CLINICAL APHERESIS, vol. 26, 2011, pages 216 - 8 |
KOUSHI YAMAGUCHI: "Tacrolimus treatment for infertility related to maternal-fetal immune interactions", AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY , vol. 81, no. 4, e13097, 1 April 2019 (2019-04-01), pages 1 - 11, XP055685300, ISSN: 1046-7408, DOI: 10.1111/aji.13097 * |
KWAK-KIM JCHUNG-BANG HSNG SCNTRIVALAS EIMANGUBAT CPBEAMAN KDBEER AEGILMAN-SACHS A, HUM REPROD, vol. 18, 2003, pages 767 - 773 |
MARGULIES MVOTO LSMATHET EMARGULIES M: "High-dose intravenous IgG for the Treatment of severe rhesus alloimmunization", VOX SANG, vol. 61, 1991, pages 181 - 189 |
MARI GDETER RLCARPENTER RLRAHMAN FZIMMERMAN RMOISE KJ JRDORMAN KFLUDOMIRSKY AGONZALEZ RGOMEZ R: "Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses", N ENGL J MED, vol. 342, 2000, pages 9 - 14 |
MOISE KJ JR: "Management of rhesus alloimmunization in pregnancy", OBSTET GYNECOL, vol. 100, 2002, pages 600 - 611 |
NAKAGAWA KKURODA KSUGIYAMA RYAMAGUCHI K: "After 12 consecutive miscarriages, a patient received immunosuppressive treatment and delivered an intact baby", REPROD MED BIOL, vol. 16, 2017, pages 297 - 301 |
NAKAGAWA KKWAK-KIM JKURODA KSUGIYAMA RYAMAGUCHI K: "Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures", AM J REPROD IMMUNOL, vol. 78, no. 3, 3 May 2017 (2017-05-03) |
NAKAGAWA KKWAK-KIM JOTA KKURODA KHISANO MSUGIYAMA RYAMAGUCHI K: "Immunosuppression with Tacrolimus Improved Reproductive Outcome of Women with Repeated Implantation Failure and Elevated Peripheral Blood Thl/Th2 Cell Ratios", AM J REPROD IMMUNOL, vol. 73, 2015, pages 353 - 61, XP002781119, DOI: 10.1111/aji.12338 |
NG SCGILMAN-SACHS ATHAKAR PBEAMAN KDBEER AEKWAK-KIM J, AM J REPROD IMMUNOL, vol. 48, 2002, pages 77 - 86 |
NISSAN, WOMEN'S JOURNAL, vol. 59, no. 10 |
POLLACK WASCARI WQKOCHESKY RJO'CONNOR RRHO TYTRIPODI D: "Studies on Rh prophylaxis. 1. Relationship between doses of anti-Rh and size of antigenic stimulus", TRANSFUSION, vol. 11, 1971, pages 333 - 339 |
RILEY JK, IMMUNOL INVEST, vol. 37, 2008, pages 395 - 426 |
RUMA MSMOISE KJ JR.KIM EMURTHA APPRUTSMAN WJHASSAN SSLUBARSKY SL: "Combined plasmapheresis and intravenous immunoglobulin for the treatment of severe maternal red cell alloimmunization", AM J OBSTET GYNECOL, vol. 196, 2007, pages 138e1 - 138e6 |
SARA MORELLI; MILI MANDAL; LAURA T GOLDSMITH; BANAFSHEH N KASHANI; NICHOLAS M PONZIO: "The maternal immune system during pregnancy and its influence on fetal development", RESEARCH AND REPORTS IN BIOLOGY, vol. 2015, no. 6, 1 October 2015 (2015-10-01), pages 171 - 189, XP055685306, DOI: 10.2147/RRB.S80652 * |
SCHJENKEN JETOLOSA JMPAUL JWCLIFTON VLSMITH R, CROATIA, INTECH, 2012, pages 211 - 242 |
See also references of EP3834826A4 |
WYLIE BJD'ALTON ME: "Fetomaternal hemorrhage", OBSTET GYNECOL, vol. 115, 2010, pages 1039 - 1051 |
ZILLIACUS HVARTIAINEN EOTTELIN AM: "Adult hemoglobin in the blood of very young human embryos", NATURE, vol. 193, 1962, pages 386 - 387 |
Also Published As
Publication number | Publication date |
---|---|
JPWO2020032252A1 (ja) | 2021-08-10 |
JP7465806B2 (ja) | 2024-04-11 |
CN112533599A (zh) | 2021-03-19 |
US20210228551A1 (en) | 2021-07-29 |
AU2019318035A1 (en) | 2021-03-04 |
CA3108863A1 (en) | 2020-02-13 |
EP3834826A1 (en) | 2021-06-16 |
EP3834826A4 (en) | 2022-07-27 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
JP7383657B2 (ja) | 妊娠状態を改善するための薬剤及びその利用 | |
Kennedy et al. | The role of corticosteroid therapy in children with pneumococcal meningitis | |
ES2405255T3 (es) | Un método para reducir la probabilidad del fracaso de la implantación en un sujeto | |
WO2012174055A1 (en) | Wound healing using complement inhibitors | |
JP7465806B2 (ja) | 母体と胎児との関係における液性免疫関連疾患の治療薬 | |
US20230103337A1 (en) | Medicine for improving state of pregnancy, and use thereof | |
US20120237472A1 (en) | Methods and compositions for treating or preventing autoimmune diseases using immunomodulatory agents | |
Stetson et al. | Eosinophilic dermatoses | |
US20240101671A1 (en) | Method and composition for inducing tolerance | |
De Jongh et al. | The fetomaternal dependency of cord blood interleukin-6 | |
WO2020129348A1 (ja) | 不妊・不育症または妊娠状態を改善するための薬剤 | |
US20240043838A1 (en) | Compositions targeting wdr37 and methods of use thereof | |
Gourley | Systemic lupus erythematosus—disease management | |
EP4256335A1 (en) | Compositions targeting pacs1 and methods of use thereof | |
Craig et al. | Stem-Cell Transplantation for Refractory Crohn’s Disease | |
Craig et al. | Stem-Cell Transplantation for | |
Jaroń et al. | PREGNANCY IN LIVER RECIPIENTS–MANAGEMENT AND OUTCOME. |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
121 | Ep: the epo has been informed by wipo that ep was designated in this application |
Ref document number: 19847406 Country of ref document: EP Kind code of ref document: A1 |
|
ENP | Entry into the national phase |
Ref document number: 2020535917 Country of ref document: JP Kind code of ref document: A |
|
ENP | Entry into the national phase |
Ref document number: 3108863 Country of ref document: CA |
|
NENP | Non-entry into the national phase |
Ref country code: DE |
|
ENP | Entry into the national phase |
Ref document number: 2019318035 Country of ref document: AU Date of ref document: 20190809 Kind code of ref document: A |
|
ENP | Entry into the national phase |
Ref document number: 2019847406 Country of ref document: EP Effective date: 20210310 |