Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/08—Peptides having 5 to 11 amino acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
• • 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
  • A61K38/10—Peptides having 12 to 20 amino acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • 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
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
• • 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
  • A61K9/127—Synthetic bilayered vehicles, e.g. liposomes or liposomes with cholesterol as the only non-phosphatidyl surfactant
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
  • C07K14/47—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K7/00—Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
  • C07K7/04—Linear peptides containing only normal peptide links
  • C07K7/06—Linear peptides containing only normal peptide links having 5 to 11 amino acids
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K7/00—Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
  • C07K7/04—Linear peptides containing only normal peptide links
  • C07K7/08—Linear peptides containing only normal peptide links having 12 to 20 amino acids

Definitions

• Lung inflammation is an important component in the pathogenesis of the acute lung injury (ALI) syndrome that results from diverse etiologies. Lung inflammation associated with the production of reactive oxygen species (ROS) is an important contributor to the ALI syndrome.
• ROS reactive oxygen species
• the invention provides a composition comprising a polypeptide consisting of:
• X 1 may be present or absent and if present is E;
• X 2 may be present or absent and if present is L;
• X 3 may be present or absent and if present is Q;
• X 4 may be present or absent and if present is A or T;
• X 5 may be present or absent and if present is T or E; X 6 is H or Y;
• X 7 is D or E
• X 8 is F or I
• X 9 is R or K.
• the polypeptide is selected from the group consisting of: SEQ ID NO: 5 ELQTELYEIKHQIL, SEQ ID NO: 6 QTELYEIKHQIL and SEQ ID NO: 7 ELYEIKHQIL.
• the polypeptide is selected from the group consisting of: SEQ ID NO: 1 LHDFRHQIL, SEQ ID NO: 2 LYEIKHQIL or SEQ ID NO: 3 LYDIRHQIL.
• the composition further comprises a pharmaceutically acceptable carrier.
• the polypeptide is encapsulated in one or more liposomes.
• the composition is formulated for aerosol inhalation or intratracheal or intravenous injection.
• the pharmaceutical composition is administered to the subject by intravenous injection.
• the invention provides a method of treating acute lung injury in a subject, the method comprising administering to the subject an effective amount of a pharmaceutical composition comprising a polypeptide consisting of:
• X 1 may be present or absent and if present is E;
• X 2 may be present or absent and if present is L;
• X 3 may be present or absent and if present is Q;
• X 4 may be present or absent and if present is A or T;
• X 5 may be T or E
• X 6 is H or Y
• X 7 is D or E
• X 8 is F or I
• X 9 is R or K. and a pharmaceutically acceptable carrier.
• the polypeptide is selected from the group consisting of: SEQ ID NO: 5 ELQTELYEIKHQIL, SEQ ID NO: 6 QTELYEIKHQIL and SEQ ID NO: 7 ELYEIKHQIL.
• the polypeptide is selected from the group consisting of: SEQ ID NO: 1 LHDFRHQIL, SEQ ID NO: 2 LYEIKHQIL or SEQ ID NO: 3 LYDIRHQIL.
• the polypeptide is encapsulated in one or more liposomes.
• the pharmaceutical composition is administered to the subject by aerosol inhalation or by intratracheal or intravenous injection.
• the invention provides a method of treating sepsis in a subject, the method comprising administering to the subject an effective amount of a pharmaceutical composition comprising a polypeptide consisting of:
• X 1 may be present or absent and if present is E;
• X 2 may be present or absent and if present is L;
• X 3 may be present or absent and if present is Q;
• X 4 may be present or absent and if present is A or T;
• X 5 may be T or E
• X 6 is H or Y
• X 7 is D or E
• X 8 is F or I
• X 9 is R or K. and a pharmaceutically acceptable carrier.
• the polypeptide is selected from the group consisting of: SEQ ID NO: 5 ELQTELYEIKHQIL, SEQ ID NO: 6 QTELYEIKHQIL and SEQ ID NO: 7 ELYEIKHQIL
• the polypeptide is selected from the group consisting of: SEQ ID NO: 1 LHDFRHQIL, SEQ ID NO: 2 LYEIKHQIL or SEQ ID NO: 3 LYDIRHQIL.
• the polypeptide is encapsulated in one or more liposomes.
• the pharmaceutical composition is administered to the subject by aerosol inhalation or by intratracheal or intravenous injection. In various embodiments, the pharmaceutical composition is administered to the subject by intravenous injection.
• FIGS. 1A and 1B Wild type C57B1/6 mice at age 8-10 weeks were injected with 2 ug/g body wt of PIP-2 either through an intratracheal catheter (IT) or intravenously (IV).
• the injected peptide was dissolved in saline or was incorporated into unilamellar liposomes consisting of dipalmitoyl phosphatidylcholine (DPPC),egg phosphatidylcholine (PC), phosphatidylglycerol (PG), and cholesterol (molar ratio of lipids, 50:25: 10: 15).
• DPPC dipalmitoyl phosphatidylcholine
• PC egg phosphatidylcholine
• PG phosphatidylglycerol
• cholesterol molar ratio of lipids, 50:25: 10: 15.
• FIGS. 2A-2F depict a time course of lung injury after intratracheal injection of lipopolysaccharide (LPS) by following various markers of tissue oxidation and lung inflammation.
• Bacterial (E.coli) lipopolysaccharide (LPS) was administered to wild type C57B1/6 mice by intratracheal (IT) injection at 5 ug/g body wt. Mice were sacrificed at 12, 16, 24, or 48 h after LPS as indicated. Lungs were removed and lavaged with saline through the trachea to obtain the BALf; the lung was then homogenized.
• FIG. 2A depicts thiobarbituric acid reactive substances
• FIG. 2B depicts 8-isoprostanes.
• FIG. 2C depicts protein carbonyls in the lung homogenate.
• FIG. 2D depicts the number of cells in bronchoalveolar lavage fluid (BALF).
• FIG. 2E depicts total protein in BALF.
• FIG. 2F depicts the ratio of wet to dry weight of the lung.
• FIG. 3A depicts the number of cells in BALF.
• FIG. 3B depicts total protein in BALF.
• FIG. 3C depicts the ratio of wet to dry weight of lung.
• FIG. 3D depicts TBARS.
• FIG. 3E depicts 8-isoprostanes.
• FIG. 3F depicts protein carbonyls in the lung homogenate.
• FIGS. 4 A and 4B Phospholipase A 2 of Prdx6 (aiPLA 2 ) was measured by the liberation of palmitic acid from dipalmitoylphosphatidylcholine under acidic conditions (pH 4) in the absence of Ca 2+ .
• FIG. 4A The effect of increasing concentration of PIP -2 on the aiPLA 2 activity of recombinant human Prdx6.
• FIGS. 5 A and 5B PIP-2, incorporated within liposomes, was instilled intratracheally prior to lung isolation.
• FIG. 5A Isolated lungs were perfused in a recirculating system with artificial medium. NOX2 activity was stimulated by addition of angiotensin II (Ang II). Amplex red along with horseradish peroxidase were added to the perfusate for detection of ROS production. Aliquots of perfusate were analyzed at intervals by
• FIG. 5B Mice were sacrificed at 6, 12, or 24 h after LPS administration (5 mg/g body wt) and lungs were perfused in situ for 15 min with saline solution containing a fluorophore (difluorofluorescein diacetate, DFFDA). Lungs then were homogenized and fluorescence of the lung homogenate was determined as an index of ROS production.
• FIGS. 7A and 7B Kaplan-Meier plots for survival.
• LPS (15 mg/g body wt) was given to all mice either by: FIG. 7 A: intratracheal (IT) or FIG. 7B: intraperitoneal (IP) injection.
• PIP-2 in liposomes or placebo (liposomes alone) was administered intravenously (IV) 12 h after LPS (this is treatment time zero) and then at 12 or 24 h intervals for a total of 5 doses as indicated by the arrows.
• FIG. 8 PLA2 inhibitory peptide (PIP-2) inhibits ROS production stimulated by angiotensin II (Ang II) in isolated perfused mouse lung.
• PIP-2 (2 pg/g body weight) was administered to intact wild type (WT) mice by the IV route. WT basal, WT control and NOX2 null did not receive peptide.
• WT basal, WT control and NOX2 null did not receive peptide.
• lungs were isolated from anesthesized mice and perfused in a recirculating system with added Ang II (50 pM ) as a Nox2 activator and Amplex red plus horseradish peroxidase to detect perfusate ROS.
• WT basal lungs were not stimulated with Ang II.
• FIGS. 9 A and 9B PIP-2 inhibits the increased lung aiPLA2 activity and increased ROS generation after LPS administration.
• LPS (5 pg/g body weight) was administered by intratracheal (IT) instillation along with liposomes alone (labeled as LPS) or with PIP-2 in liposomes (labeled as +PIP-2).
• Control was liposomes alone without LPS (labeled as control).
• Mice were sacrificed at 6, 12, or 24 h after LPS and lungs were perfused in situ for 15 min with saline solution containing the fluorophore difluorofluoroscein diacetate (DFF-DA).Lungs then were homogenized and assayed for: FIG.
• DFF-DA fluorophore difluorofluoroscein diacetate
• FIG. 9A aiPLA2 activity
• FIG. 11 “Protection” (%) by PIP -2 against lung injury evaluated at 24 hr after IT LPS. *Values for PIP-2 effect with administration at 0,12, or 16 h after LPS.
• FIG. 12 Indices of lung injury in PIP-2 treated mice that survive high dose LPS.
• Mice were injected with LPS (15 pg/g wt) either: Line B. intratracheally (IT); or Line C. intraperitoneally (IP).
• LPS 15 pg/g wt
• I Line B. intratracheally
• IP Intraperitoneally
• PIP-2 at 2 pg/g or 20 pg/g body wt in liposomes was injected (IV) at the times indicated in Figure 7.
• Five of the surviving mice were sacrificed at 108 h after the start of treatment (120 h after LPS administration). Results are compared to values for historical control mice (no LPS) (Line A).
• BALf bronchoalveolar lavage fluid
• TBARS thiobarbituric reactive substances.
• FIG. 13 Effect of PIP-2 on ventilation-induced lung injury (VILI).
• mice were mechanically ventilated for 6 h with tidal volume 12 ml/Kg body weight with a respiratory rate l20/min, and 2 cm H 2 0 positive end-expiratory pressure (PEEP).
• PIP-2 (2ug/g body wt) in liposomes was administered by IT injection at the start of mechanical ventilation and mice were sacrificed 6 h later.
• Control represents values for normal (non-ventilated) lungs.
• an element means one element or more than one element.
• “About” as used herein when referring to a measurable value such as an amount, a temporal duration, and the like, is meant to encompass variations of ⁇ 20% or ⁇ 10%, more preferably ⁇ 5%, even more preferably ⁇ 1%, and still more preferably ⁇ 0.1% from the specified value, as such variations are appropriate to perform the disclosed methods.
• Acute lung injury or“ALI” as used herein refer to a syndrome characterized by acute onset of bilateral pulmonary infiltrates with hypoxemia that is not associated with heart failure.
• a disease or disorder is“alleviated” if the severity of a symptom of the disease or disorder, the frequency with which such a symptom is experienced by a patient, or both, is reduced.
• composition or“pharmaceutical composition” refers to a mixture of at least one compound useful within the invention with a
• the pharmaceutical composition facilitates administration of the compound to a patient or subject. Multiple techniques of
• administering exist in the art including, but not limited to, intravenous, oral, aerosol, parenteral, ophthalmic, pulmonary and topical administration.
• An“effective amount” or“therapeutically effective amount” of a compound is that amount of compound that is sufficient to provide a beneficial effect to the subject to which the compound is administered.
• An“effective amount” of a delivery vehicle is that amount sufficient to effectively bind or deliver a compound.
• the terms "patient,” “subject,” “individual,” and the like are used interchangeably herein, and refer to any animal, or cells thereof whether in vitro or in situ, amenable to the methods described herein. In certain non-limiting embodiments, the patient, subject or individual is a human.
• the term“pharmaceutically acceptable” refers to a material, such as a carrier or diluent, which does not abrogate the biological activity or properties of the compound, and is relatively non-toxic, i.e., the material may be administered to an individual without causing undesirable biological effects or interacting in a deleterious manner with any of the components of the composition in which it is contained.
• the term“pharmaceutically acceptable carrier” means a pharmaceutically acceptable material, composition or carrier, such as a liquid or solid filler, stabilizer, dispersing agent, suspending agent, diluent, excipient, thickening agent, solvent or encapsulating material, involved in carrying or transporting a compound useful within the invention within or to the patient such that it may perform its intended function.
• a pharmaceutically acceptable material, composition or carrier such as a liquid or solid filler, stabilizer, dispersing agent, suspending agent, diluent, excipient, thickening agent, solvent or encapsulating material, involved in carrying or transporting a compound useful within the invention within or to the patient such that it may perform its intended function.
• Such constructs are carried or transported from one organ, or portion of the body, to another organ, or portion of the body.
• Each carrier must be“acceptable” in the sense of being compatible with the other ingredients of the formulation, including the compound useful within the invention, and not injurious to the patient.
• materials that may serve as pharmaceutically acceptable carriers include: sugars, such as lactose, glucose and sucrose; starches, such as corn starch and potato starch; cellulose, and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate; powdered tragacanth; malt; gelatin; talc; excipients, such as cocoa butter and suppository waxes; oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and soybean oil; glycols, such as propylene glycol; polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol; esters, such as ethyl oleate and ethyl laurate; agar; buffering agents, such as magnesium hydroxide and aluminum hydroxide; surface active agents; alginic acid; pyrogen-free water; isotonic saline
• “pharmaceutically acceptable carrier” also includes any and all coatings, antibacterial and antifungal agents, and absorption delaying agents, and the like that are compatible with the activity of the compound useful within the invention, and are physiologically acceptable to the patient. Supplementary active compounds may also be incorporated into the compositions.
• The“pharmaceutically acceptable carrier” may further include a pharmaceutically acceptable salt of the compound useful within the invention.
• Other additional ingredients that may be included in the pharmaceutical compositions used in the practice of the invention are known in the art and described, for example in Remington’s Pharmaceutical Sciences (Genaro, Ed., Mack Publishing Co., 1985, Easton, PA), which is incorporated herein by reference.
• PIP-2 means a peptide having SEQ ID NO: 1
• PIP-4 means a peptide having SEQ ID NO: 2
• PIP-5 means a peptide having SEQ ID NO: 3
• treating a disease or disorder means reducing the frequency with which a symptom of the disease or disorder is experienced by a patient.
• Disease and disorder are used interchangeably herein.
• “sepsis” is a potentially life-threatening condition caused by the body's response to an infection and can lead to multiple organ failure.
• “treatment” or“treating” encompasses prophylaxis and/or therapy. Accordingly the compositions and methods of the present invention are not limited to therapeutic applications and can be used in prophylactic ones. Therefore “treating” or“treatment” of a state, disorder or condition includes: (i) preventing or delaying the appearance of clinical symptoms of the state, disorder or condition developing in a subject that may be afflicted with or predisposed to the state, disorder or condition but does not yet experience or display clinical or subclinical symptoms of the state, disorder or condition, (ii) inhibiting the state, disorder or condition, i.e., arresting or reducing the development of the disease or at least one clinical or subclinical symptom thereof, or (iii) relieving the disease, i.e. causing regression of the state, disorder or condition or at least one of its clinical or subclinical symptoms.
• ranges throughout this disclosure, various aspects of the invention can be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, and 6. This applies regardless of the breadth of the range. Description
• the invention is based in part on the engineering of specific peptide inhibitors of aiPLA 2 that may be used to treat ALI.
• the aiPLA 2 inhibiting activity of several peptides of the invention is shown below in Table 1 Table 1: Effect of peptides on aiPLA2 activity of recombinant hPrdx6
• Table 2 Size optimization of inhibitory peptide by effect on aiPLA 2 activity of human recombinant protein
• the invention provides a composition comprising a polypeptide consisting of: SEQ ID NO: 4 X 1 X 2 X 3 X 4 X 5 LX 6 X 7 X 8 X 9 HQIL wherein:
• X 1 may be present or absent and if present is E;
• X 2 may be present or absent and if present is L;
• X 3 may be present or absent and if present is Q;
• X 4 may be present or absent and if present is A or T;
• X 5 may be present or absent and if present is T or E;
• X 6 is H or Y
• X 7 is D or E
• X 8 is F or I
• X 9 is R or K.
• the composition comprises a polypeptide consisting of SEQ ID NO: 1 LHDFRHQIL (PIP-2), SEQ ID NO: 2 LYEIKHQIL (PIP-4) or SEQ ID NO: 3 LYDIRHQIL (PIP-5).
• the composition of the invention may be provided to subjects as a pharmaceutical composition. Accordingly, in various embodiments, the composition further comprises a pharmaceutically acceptable carrier. As shown in FIG. 1, the polypeptides may be effectively administered in liposomes. Accordingly, in various embodiments, the polypeptide is encapsulated in one or more liposomes.
• the composition is formulated for aerosol inhalation or intratracheal or intravenous injection. Appropriate pharmaceutically acceptable carriers as well as inhalable or injectable formulations are described elsewhere herein.
• the invention provides a method of treating acute lung injury in a subject, the method comprising administering to the subject an effective amount of a pharmaceutical composition comprising a polypeptide consisting of:
• X 1 may be present or absent and if present is E;
• X 2 may be present or absent and if present is L;
• X 3 may be present or absent and if present is Q;
• X 4 may be present or absent and if present is A or T; X 5 may be T or E;
• X 6 is H or Y
• X 7 is D or E
• X 8 is F or I
• X 9 is R or K; and a pharmaceutically acceptable carrier.
• the polypeptide may be a polypeptide consisting of SEQ ID NO: 1 LHDFRHQIL, SEQ ID NO: 2
• the polypeptide administered to the subject is encapsulated in one or more liposomes.
• the pharmaceutical composition is administered to the subject by aerosol inhalation or by intratracheal or intravenous injection.
• the invention provides a method of treating sepsis in a subject, the method comprising administering to the subject an effective amount of a pharmaceutical composition comprising a polypeptide consisting of:
• X 1 may be present or absent and if present is E;
• X 2 may be present or absent and if present is L;
• X 3 may be present or absent and if present is Q;
• X 4 may be present or absent and if present is A or T;
• X 5 may be T or E
• X 6 is H or Y
• X 7 is D or E
• X 8 is F or I
• X 9 is R or K; and a pharmaceutically acceptable carrier.
• the polypeptide may be a polypeptide consisting of SEQ ID NO: 1 LHDFRHQIL, SEQ ID NO: 2
• the polypeptide administered to the subject is encapsulated in one or more liposomes.
• the pharmaceutical composition is administered to the subject by aerosol inhalation or by intratracheal or intravenous injection. In various embodiments, the pharmaceutical composition is administered to the subject by intravenous injection.
• the regimen of administration may affect what constitutes an effective amount.
• the therapeutic formulations may be administered to the subject either prior to or after the onset of injury. Further, several divided dosages, as well as staggered dosages may be administered.
• the dose may be continuously infused, or may be a bolus injection. Further, the dosages of the therapeutic formulations may be proportionally increased or decreased as indicated by the exigencies of the therapeutic or prophylactic situation.
• compositions of the present invention may be carried out using known procedures, at dosages and for periods of time effective to treat a lung injury in the patient.
• An effective amount of the therapeutic compound necessary to achieve a therapeutic effect may vary according to factors such as the state of the disease or disorder in the patient; the age, sex, and weight of the patient; and the ability of the therapeutic compound to treat or prevent acute lung injury in the patient.
• Dosage regimens may be adjusted to provide the optimum therapeutic response. For example, several divided doses may be administered daily or the dose may be
• an effective dose range for a therapeutic compound of the invention is from about 1 and 5,000 mg/kg of body weight/per day.
• One of ordinary skill in the art would be able to study the relevant factors and make the determination regarding the effective amount of the therapeutic compound without undue experimentation.
• Actual dosage levels of the active ingredients in the pharmaceutical compositions of this invention may be varied so as to obtain an amount of the active ingredient that is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient.
• the selected dosage level depends upon a variety of factors including the activity of the particular compound employed, the time of administration, the rate of excretion or breakdown of the compound, the duration of the treatment, other drugs, compounds or materials used in combination with the compound, the age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well, known in the medical arts.
• a medical doctor e.g, physician or veterinarian, having ordinary skill in the art may readily determine and prescribe the effective amount of the pharmaceutical composition required.
• the physician or veterinarian could start doses of the compounds of the invention employed in the pharmaceutical composition at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved.
• Dosage unit form refers to physically discrete units suited as unitary dosages for the patients to be treated; each unit containing a predetermined quantity of therapeutic compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical vehicle.
• the dosage unit forms of the invention are dictated by and directly dependent on (a) the unique characteristics of the therapeutic compound and the particular therapeutic effect to be achieved, and (b) the limitations inherent in the art of compounding/formulating such a therapeutic compound for the treatment of a lung injury in a patient.
• the carrier may be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), suitable mixtures thereof, and vegetable oils.
• polyol for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like
• suitable mixtures thereof and vegetable oils.
• compositions of the invention are administered to the patient in dosages that range from one to five times per day or more.
• the compositions of the invention are administered to the patient in range of dosages that include, but are not limited to, once every day, every two, days, every three days to once a week, and once every two weeks. It is readily apparent to one skilled in the art that the frequency of administration of the various combination compositions of the invention varies from individual to individual depending on many factors including, but not limited to, age, disease or disorder to be treated, gender, overall health, and other factors. Thus, the invention should not be construed to be limited to any particular dosage regime and the precise dosage and composition to be administered to any patient is determined by the attending physical taking all other factors about the patient into account.
• Compounds of the invention for administration may be in the range of from about 1 pg to about 10,000 mg, about 20 pg to about 9,500 mg, about 40 pg to about 9,000 mg, about 75 pg to about 8,500 mg, about 150 pg to about 7,500 mg, about 200 pg to about 7,000 mg, about 350 pg to about 6,000 mg, about 500 pg to about 5,000 mg, about 750 pg to about 4,000 mg, about 1 mg to about 3,000 mg, about 10 mg to about 2,500 mg, about 20 mg to about 2,000 mg, about 25 mg to about 1,500 mg, about 30 mg to about 1,000 mg, about 40 mg to about 900 mg, about 50 mg to about 800 mg, about 60 mg to about 750 mg, about 70 mg to about 600 mg, about 80 mg to about 500 mg, and any and all whole or partial increments there between.
• the dose of a compound of the invention is from about 1 mg and about 2,500 mg. In some embodiments, a dose of a compound of the invention used in compositions described herein is less than about 10,000 mg, or less than about 8,000 mg, or less than about 6,000 mg, or less than about 5,000 mg, or less than about 3,000 mg, or less than about 2,000 mg, or less than about 1,000 mg, or less than about 500 mg, or less than about 200 mg, or less than about 50 mg.
• a dose of a second compound as described herein is less than about 1,000 mg, or less than about 800 mg, or less than about 600 mg, or less than about 500 mg, or less than about 400 mg, or less than about 300 mg, or less than about 200 mg, or less than about 100 mg, or less than about 50 mg, or less than about 40 mg, or less than about 30 mg, or less than about 25 mg, or less than about 20 mg, or less than about 15 mg, or less than about 10 mg, or less than about 5 mg, or less than about 2 mg, or less than about 1 mg, or less than about 0.5 mg, and any and all whole or partial increments thereof.
• the present invention is directed to a packaged
• composition comprising a container holding a therapeutically effective amount of a compound of the invention, alone or in combination with a second
• Formulations may be employed in admixtures with conventional excipients, i.e., pharmaceutically acceptable organic or inorganic carrier substances suitable for oral, parenteral, nasal, intravenous, subcutaneous, enteral, or any other suitable mode of administration, known to the art.
• the pharmaceutical preparations may be sterilized and if desired mixed with auxiliary agents, e.g ., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure buffers, coloring, flavoring and/or aromatic substances and the like. They may also be combined where desired with other active agents, e.g. , other analgesic agents.
• routes of administration of any of the compositions of the invention include oral, nasal, rectal, intravaginal, parenteral, buccal, sublingual or topical.
• the compounds for use in the invention may be formulated for administration by any suitable route, such as for oral or parenteral, for example, transdermal, transmucosal (e.g, sublingual, lingual, (trans)buccal, (trans)urethral, vaginal ( e.g ., trans- and perivaginally), (intra)nasal and (trans)rectal), intravesical, intrapulmonary, intraduodenal, intragastrical, intrathecal, subcutaneous, intramuscular, intradermal, intra-arterial, intravenous, intrabronchial, inhalation, and topical administration.
• compositions and dosage forms include, for example, tablets, capsules, caplets, pills, gel caps, troches, dispersions, suspensions, solutions, syrups, granules, beads, transdermal patches, gels, powders, pellets, magmas, lozenges, creams, pastes, plasters, lotions, discs, suppositories, liquid sprays for nasal or oral administration, dry powder or aerosolized formulations for inhalation, compositions and formulations for intravesical administration and the like. It should be understood that the formulations and compositions that would be useful in the present invention are not limited to the particular formulations and compositions that are described herein.
• compositions intended for oral use may be prepared according to any method known in the art and such compositions may contain one or more agents selected from the group consisting of inert, non-toxic pharmaceutically excipients that are suitable for the manufacture of tablets.
• excipients include, for example an inert diluent such as lactose; granulating and disintegrating agents such as cornstarch; binding agents such as starch; and lubricating agents such as magnesium stearate.
• the tablets may be uncoated or they may be coated by known techniques for elegance or to delay the release of the active ingredients.
• Formulations for oral use may also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert diluent.
• the present invention also includes a multi-layer tablet comprising a layer providing for the delayed release of one or more compounds of the invention, and a further layer providing for the immediate release of a medication for treatment of certain diseases or disorders.
• a multi-layer tablet comprising a layer providing for the delayed release of one or more compounds of the invention, and a further layer providing for the immediate release of a medication for treatment of certain diseases or disorders.
• a wax/pH-sensitive polymer mix a gastric insoluble composition may be obtained in which the active ingredient is entrapped, ensuring its delayed release.
• the compounds of the invention may be formulated for injection or infusion, for example, intravenous, intramuscular or subcutaneous injection or infusion, or for administration in a bolus dose and/or continuous infusion.
• Suspensions, solutions or emulsions in an oily or aqueous vehicle, optionally containing other formulatory agents such as suspending, stabilizing and/or dispersing agents may be used. Additional Administration Forms
• Additional dosage forms of this invention include dosage forms as described in U.S. Patents Nos. 6,340,475; 6,488,962; 6,451,808; 5,972,389; 5,582,837; and 5,007,790.
• Additional dosage forms of this invention also include dosage forms as described in U.S. Patent Applications Nos. 20030147952; 20030104062; 20030104053; 20030044466;
• Additional dosage forms of this invention also include dosage forms as described in PCT Applications Nos. WO 03/35041; WO 03/35040; WO 03/35029; WO 03/35177; WO 03/35039; WO 02/96404; WO 02/32416; WO 01/97783; WO 01/56544; WO 01/32217; WO 98/55107; WO 98/11879; WO 97/47285; WO 93/18755; and WO 90/11757.
• the formulations of the present invention may be, but are not limited to, short-term, rapid-offset, as well as controlled, for example, sustained release, delayed release and pulsatile release formulations.
• sustained release is used in its conventional sense to refer to a drug formulation that provides for gradual release of a drug over an extended period of time, and that may, although not necessarily, result in substantially constant blood levels of a drug over an extended time period.
• the period of time may be as long as a month or more and should be a release which is longer that the same amount of agent administered in bolus form.
• the compounds may be formulated with a suitable polymer or hydrophobic material which provides sustained release properties to the compounds.
• the compounds for use the method of the invention may be administered in the form of microparticles, for example, by injection or in the form of wafers or discs by implantation.
• the compounds of the invention are administered to a patient, alone or in combination with another pharmaceutical agent, using a sustained release formulation.
• delayed release is used herein in its conventional sense to refer to a drug formulation that provides for an initial release of the drug after some delay following drug administration and that may, although not necessarily, includes a delay of from about 10 minutes up to about 12 hours.
• pulsatile release is used herein in its conventional sense to refer to a drug formulation that provides release of the drug in such a way as to produce pulsed plasma profiles of the drug after drug administration.
• immediate release is used in its conventional sense to refer to a drug formulation that provides for release of the drug immediately after drug administration.
• short-term refers to any period of time up to and including about 8 hours, about 7 hours, about 6 hours, about 5 hours, about 4 hours, about 3 hours, about 2 hours, about 1 hour, about 40 minutes, about 20 minutes, or about 10 minutes and any or all whole or partial increments thereof after drug administration after drug administration.
• rapid-offset refers to any period of time up to and including about 8 hours, about 7 hours, about 6 hours, about 5 hours, about 4 hours, about 3 hours, about 2 hours, about 1 hour, about 40 minutes, about 20 minutes, or about 10 minutes, and any and all whole or partial increments thereof after drug administration.
• the therapeutically effective amount or dose of a compound of the present invention depends on the age, sex and weight of the patient, the current medical condition of the patient and the progression of acute lung injury in the patient being treated. The skilled artisan is able to determine appropriate dosages depending on these and other factors.
• a suitable dose of a compound of the present invention may be in the range of from about 0.01 mg to about 5,000 mg per day, such as from about 0.1 mg to about 1,000 mg, for example, from about 1 mg to about 500 mg, such as about 5 mg to about 250 mg per day.
• the dose may be administered in a single dosage or in multiple dosages, for example from 1 to 4 or more times per day.
• the amount of each dosage may be the same or different.
• a dose of 1 mg per day may be administered as two 0.5 mg doses, with about a l2-hour interval between doses.
• the amount of compound dosed per day may be administered, in non-limiting examples, every day, every other day, every 2 days, every 3 days, every 4 days, or every 5 days.
• a 5 mg per day dose may be initiated on Monday with a first subsequent 5 mg per day dose administered on
• the administration of the inhibitor of the invention is optionally given continuously; alternatively, the dose of drug being administered is temporarily reduced or temporarily suspended for a certain length of time (i.e., a“drug holiday”).
• the length of the drug holiday optionally varies between 2 days and 1 year, including by way of example only, 2 days, 3 days, 4 days,
• the dose reduction during a drug holiday includes from 10%- 100%, including, by way of example only, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or 100%.
• a maintenance dose is administered if necessary. Subsequently, the dosage or the frequency of administration, or both, is reduced, as a function of the viral load, to a level at which the improved disease is retained.
• patients require intermittent treatment on a long-term basis upon any recurrence of symptoms and/or infection.
• the compounds for use in the method of the invention may be formulated in unit dosage form.
• unit dosage form refers to physically discrete units suitable as unitary dosage for patients undergoing treatment, with each unit containing a predetermined quantity of active material calculated to produce the desired therapeutic effect, optionally in association with a suitable pharmaceutical carrier.
• the unit dosage form may be for a single daily dose or one of multiple daily doses ( e.g ., about 1 to 4 or more times per day). When multiple daily doses are used, the unit dosage form may be the same or different for each dose.
• Toxicity and therapeutic efficacy of such therapeutic regimens are optionally determined in cell cultures or experimental animals, including, but not limited to, the determination of the LD 50 (the dose lethal to 50% of the population) and the ED 50 (the dose therapeutically effective in 50% of the population).
• the dose ratio between the toxic and therapeutic effects is the therapeutic index, which is expressed as the ratio between LD 50 and ED 50.
• the data obtained from cell culture assays and animal studies are optionally used in formulating a range of dosage for use in human.
• the dosage of such compounds lies preferably within a range of circulating concentrations that include the ED 50 with minimal toxicity.
• the dosage optionally varies within this range depending upon the dosage form employed and the route of administration utilized.
• reaction conditions including but not limited to reaction times, reaction size/volume, and experimental reagents, such as solvents, catalysts, pressures, atmospheric conditions, e.g., nitrogen atmosphere, and reducing/oxidizing agents, are within the scope of the present application.
• mice were injected with PIP-2 (2 ug/g body wt) in liposomes (see FIG. 1) either IT (FIG 1A) or IV (FIG 1B); these liposomes contained tracer [ 3 H] in the 9,10 position of the sn-2 palmitate of DPPC.
• IT FIG. 1A
• IV FIG. 1B
• the lungs were removed from mice and studied in an isolated system. The slope of the lines indicates the production of oxidants (H2O2).
• PIP-2 in liposomes injected IV or IT inhibits Prdx6 activity of the lung homogenate. Maximal inhibition was seen within 4 hours after administration of PIP -2. Recovery from inhibition began at ⁇ 36 hours and was complete by 48 hours. Results are similar for PIP-l,2,4 (PIP-3 and -5 were not tested). Based on the mouse results, PIP-2 or 4 could be administered once every 24-36 hours to maintain maximal inhibition of Prdx6 activity and NOX2 activation. Effectiveness requires liposomes for peptide delivery. Inhibition after IT or IV administration was similar. The data are presented in Tables 4-6, below. Table 4: aiPLA2 activity of mouse lung at 24 hours after injection of PIP -4 IV with and without liposomes for delivery
• Table 5 aiPLA2 activity of mouse lung homogenate at increasing time after IT or IV injection of PIP-2: Persistence in vivo
• Example 2 Time course of injury after IT LPS.
• LPS Bacterial (E.coli) lipopolysaccharide
• I intratracheal
• Mice were sacrificed at 12, 16, 24 or 48 hours after LPS as indicated.
• Lungs were removed and lavaged with saline through the trachea to obtain the BALF; the lung was then homogenized.
• the IT model of acute lung injury (ALI) as shown in Table 9 was used to test the effects of PIP-2.
• PIP-2 (2 ug/g body wt) in liposomes was administered IT along with LPS (0 hours) or intravenously (IV) at 12 or 16 hours after LPS. IV administration of PIP-2 was used to avoid a second‘assault’ on the trachea.
• n 4, PIP concentration (2 pg/g wt of mice), LPS 5 pg/g
• n 4; PIP concentration, 2 pg/g wt of mice, LPS 5 pg/g
• Example 4 PIP-2 is stable as a dry powder.
• aiPLA 2 activity was measured at intervals to determine how long the peptide could maintain its efficacy as an inhibitor of aiPLA 2 activity.
• the peptide was stable for the 4 months of observation.
• Table 12 Activity of PIP-2 during 4 months storage as a dry powder at room temp indicates stability.
• mice C57B1/6J or NADPH oxidase (Nox2) null mice were obtained from the Jackson
• LPS Lipopolysaccharide
• HRP horseradish peroxidase
• lipids were purchased from Sigma-Aldrich, St. Louis, MO, USA and liposomes were prepared by evaporation to dryness followed by reconstitution in saline as previously described to reflect the composition of lung surfactant; the liposome composition was, in mol fraction, 0.5
• DPPC dipalmitoylphosphatidylcholine
• PC egg phosphatidylcholine
• PG phosphatidylglycerol
• PIP-2 when added was 0.15 pg PIP-2/pg lipid.
• mice were administered LPS (either 5 or 15 pg/g body weight) in 20 pl saline that was instilled into the lung through an endotracheal catheter placed at the level of the tracheal carina.
• LPS liposomes
• PIP-2 in liposomes was suspended in 20 pl saline for IV or IT injection.
• LPS administration was followed by liposomes ⁇ PIP-2 also given by IT instillation.
• mice were sacrificed by exsanguination under anesthesia. Lungs in situ were cleared of blood by perfusion through the pulmonary artery and then were lavaged through the trachea with saline. The lung was then removed from the thorax for tissue assays.
• the perfusion protocol included a 15 min equilibration period followed by a 60 min experimental period. Aliquots of perfusate were taken at 15 min intervals and analyzed by fluorescence for resorufm ( . excitation 568 nm, E mission 581 nm), the product of Amplex red oxidation. The rate of Amplex red oxidation was calculated and expressed as arbitrary fluorescence units (AFU) with normalization to mouse body wt. There was a low rate of Amplex red oxidation in the absence of HRP in the perfusate ( ⁇ 7% of the Angll-stimulated fluorescence), indicating a non-ROS-mediated oxidation of the fluorophore; this value was subtracted to obtain the reported values.
• AFU arbitrary fluorescence units
• mice were treated with LPS (5 pg/g) ⁇ PIP-2 (2 pg/g).
• Mice were anesthesized at 6, 12, or 24 h after treatment with LPS and lungs in situ were cleared of blood and then perfused for 10 mins with saline solution containing the fluorophore DFF-DA that is hydrolyzed intracellularly to DFF.
• Lungs were then homogenized, and fluorescence of the homogenate was measured at Ex 495 nm, Em 525 nm. Lung fluorescence was expressed as AFU per minute of perfusion with normalization to the mouse body wt.
• lung tissue TBARS, 8-isoprostanes, and protein carbonyls indicates oxidative stress with oxidation of lung tissue lipid and protein components.
• indices of lung injury showed similar values at 12,16 or 24 h after LPS (FIGS. 2A-2F) indicating that the degree of lung injury was essentially stable at 12-24 h after this non-lethal dose of LPS. Partial recovery (-50%, p ⁇ 0.05) in the indices of lung injury was seen at 48 h although they were still elevated compared with control (p ⁇ 0.05).
• mice were treated with LPS (5 pg/g body weight) given IT.
• the dose of LPS was chosen based on our previous studies using the same batch of LPS that showed a relatively low level of lung injury with 1 pg/g body wt and greater injury with no significant mortality using 5 pg LPS/g body wt.
• PIP- 2 (2 pg/g body weight in liposomes) was administered at 0,12, or 16 h after LPS. We have shown previously that this dose of PIP-2 can inhibit lung aiPLA2 activity by -90% for at least 24 h.
• PIP-2 was given IT at time zero and IV at 12 or 16 h in order to avoid excessive damage to the trachea.
• mice treated with low dose LPS suffer significant lung injury, it is transient and essentially all mice will recover from the insult (not shown).
• LPS low dose LPS
• the survival data is plotted with the initial PIP-2 treatment as 0 time; LPS was administered 12 h before PIP- 2 (-12 h that is off of the graph in FIG. 7A and FIG. 7B).
• mice that were treated with placebo showed 73% mortality during the 24 hr after LPS and 100% mortality by 48 h.
• PIP-2 was administered to mice at 12, 24, 48, 72 and 96 h after LPS and mice were sacrificed at 120 h; PIP -2 treated mice showed only 17% mortality (83% survival) at 36 h after the start of PIP-2 treatment and had no further mortality during the period of observation. In addition to the effect on mortality, a marked difference was observed in the behavior of mice that had received PIP-2 after LPS with a return of most mice to normal physical activity by 12 h after receiving PIP -2. Indices of lung injury in treated mice that were sacrificed at 120 h after LPS showed no abnormality (Table 13).
• mice were instilled IT with LPS (15 pg/g wt); PIP-2 (2 pg/g body wt) in liposomes was injected (IV) at the times shown in FIG. 7 A.
• Five of the surviving mice were sacrificed at 120 h after LPS; control mice were given liposomes but not LPS .
• BALf bronchoalveolar lavage fluid; TBARS, thiobarbituric reactive substances.
• mice given LPS 15 pg LPS/g body wt.
• LPS 15 pg LPS/g body wt.
• our dose of LPS was based on our previous study that showed 60% mortality with 10 ug LPS/g body wt; our goal was to produce 100% mortality in the placebo-treated mice, similar to that seen with the high dose IT LPS study.
• Survival of placebo-treated mice (liposomes only) was less than 40% at 24 h after LPS and 100% of mice were dead by 48 h (FIG. 7B).
• PIP -2 (2 pg/g body wt) increased survival at 36 h after LPS to 86% and 43% of mice fully recovered.
• the long term survival rate was significantly greater at 70%.
• PIP-2 markedly increased mouse survival in this model of ALI associated with systemic sepsis.
• ALI is a serious disease syndrome with a mortality rate of -40%. Inflammation is an important factor that can amplify the lung injury associated with the primary insult. To date, there is no approved pharmacologic treatment for the inflammatory component of the syndrome. The mechanisms for lung injury during lung inflammation are complex, but excessive ROS production appears to play a major role.
• SP-A lung surfactant protein A
• PIP-2 PLA 2 -inhibitory peptides
• PIP-4 PIP-5
• PIP-5 inhibit ROS production by Angll-activated NOX2 in the isolated mouse lung.
• PIP- 2 appeared to be slightly more active that the other 2, all 3 PIP compounds were effective as inhibitors, presumably reflecting in part the high degree of conservation of the Prdx6 amino acid sequence among species.
• the site for binding of the 16 amino acid precursor of the PIPs is to the amino acid sequence comprising amino acids 195 to 204 of Prdx6.
• the sequence for this segment of human Prdx6 is: SEQ ID NO: 34 195- EEEAKKLFPK-204; the corresponding mouse sequence is the same for 8 of the 10 amino acids with Q rather than K at position 200 and C rather than L at position 201.
• PIP-2 the PIP that was derived from the relevant sequence in human SP-A, for subsequent investigations.
• the PIP-2 amino acid sequence is: SEQ ID NO: l LHDFRHQIL.
• the primary goal of the present study was to evaluate the effect of PIP-2 on lung injury associated with the intratracheal administration of LPS.
• PIP-2 markedly inhibited Angll-mediated ROS generation Angll is a known activator of NOX2 and, as we have shown previously, activation requires aiPLA 2 activity.
• treatment with LPS resulted in both a marked increase in aiPLA2 activity of the lungs and also a marked increase in ROS production through the activation of NOX2; both the LPS- mediated increase in aiPLA2 activity and ROS production also were inhibited by PIP -2.
• the first study of PIP-2 effectiveness in the lung injury model was the concurrent administration of PIP-2 with LPS which markedly protected against subsequent lung injury.
• Measurements to evaluate acute lung injury following LPS included: a) nucleated cells in BALf (inflammation); b) protein in BALf (alveolar-capillary permeability); c) lung wet to dry weight ratio (lung edema); and d) lung TBARS, 8-isoprostanes, and protein carbonyls (oxidation of tissue lipids and proteins). All of these indices of injury were significantly elevated in lungs that were evaluated at 12-24 h after administration of LPS. However, none of these indices of tissue injury was altered in lungs when PIP-2 was administered concurrently with LPS. Thus, PIP-2 can prevent ALI associated with LPS administration in mice.
• the MJ33 inhibited mouse, the D140A mutant mouse, and the PIP -2 treated mouse all retain the peroxidase activity of Prdx6 while this activity is abolished in the Prdx6 null mouse.
• LPS was administered by the IT route in a) and b) as a model for direct lung injury and by the intraperitoneal route in c) as a model for non-infectious sepsis.
• the mechanism for the protection afforded by PIP -2 is its inhibition of the aiPLA 2 activity of Prdx6 by allosteric effects resulting from binding of the peptide to Prdx6.
• the PIP peptides do not inhibit other lung PLA 2 enzymes as demonstrated experimentally and as expected based on dissimilarity of potential binding sites on the different proteins.
• the inhibition of aiPLA 2 activity prevents the generation of lysoPC and its downstream products, thereby preventing the activation of Rac, a necessary co-factor for Nox2 activation.
• the cholesterol -lowering drug simvastatin also inhibits the activation of Rac, and has been shown to inhibit ROS production by endothelial cells and to be protective in mouse models of LPS- induced ALI. Although there is no definitive evidence as yet, it is possible that inhibition of Rac activation has salutary effects on non-ROS mediated manifestations of ALI in addition to its effect on NOX2 activation.
• NOX2 is a major source of ROS in lungs and that the enzyme is activated in the presence of LPS.
• ROS generation by NOX2 has been shown to play a central role in several other related as well as disparate animal models of ALI including gram negative sepsis, endotoxin, severe trauma, hemorrhagic shock, and oleic acid instillation.
• a major manifestation of the oxidant stress associated with NOX2 activation is the oxidation of tissue macromolecules as shown in the present study.
• NOX2-derived ROS are responsible for the signals leading to neutrophil recruitment to the lung and the resultant lung inflammation that is characteristic of ALI.
• the marked decrease in nucleated cells in BALf after treatment with PIP-2 suggests that this function of ROS is important for the recovery from lung injury.
• a peptide inhibitor of the myristoylated alanine-rich C kinase substrate (Marcks) protein also protects against lung injury with LPS in mice. Although this latter peptide has not been shown to inhibit NOX2 activation, its effects may be mediated through altered cellular motility that prevents PMN influx into the lung.
• PIP-2, simvastatin, the Marcks protein inhibitor, and possibly inhibitors of NOX2 such as apocynin all may prevent PMN influx into the lung after LPS, thereby reversing inflammation and the associated lung injury.
• the peptide inhibitors of NOX2 activation could be effective as preventative agents for patients at risk for ALI as well as for treatment of patients with established ALI.
• toxicity of these small peptides is not expected based on their normal expression in lungs as a component of the SP-A protein, that still must be investigated.
• the antigenic potential of the peptide theoretically is low, but that will need to be confirmed in humans.
• Other possible side effects of the peptides include those associated with inhibition of Rac activation as well as loss of the signaling and regulatory functions of ROS. Of note, no major effects have been reported as yet that could be related to the inhibition of Rac with the widely used drug, simvistatin.
• a potentially more important“side- effect” of treatment with PIP could be the effect of inhibited ROS production on the bactericidal activity of inflammatory cells (PMN and AM) that use superoxide anion generated through activity of NOX2 for the killing of bacteria. Further, it has been shown that some antibiotics require ROS for maximal efficacy. Despite the theoretical possibility of an altered response to infection, an inhibitor of NOX2 activation did not decrease bactericidal activity of PMN in an LPS model of ALI. This may reflect the ability of non-NOX2 pathways to compensate for the loss of NOX2-derived ROS. Although this would emphasize the important role for antibiotic coverage in patients being treated with NOX2 inhibitors, it is important to note that the use of antibiotics alone has not been effective in reducing mortality with this disease to a value significantly below 40%.

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