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
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4412—Non condensed pyridines; Hydrogenated derivatives thereof having oxo groups directly attached to the heterocyclic ring
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • 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
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system

Definitions

• the present disclosure concerns certain Src kinase inhibitors, or pharmaceutically- acceptable salts thereof, and their use in the treatment of fibrosis and fibrotic conditions, such as idiopathic pulmonary fibrosis, in a warm-blooded animal such as a human.
• the disclosure also concerns the use of said Src kinase inhibitors, or pharmaceutically- acceptable salts thereof, alone or in combination with at least one additional therapeutic agent for the treatment of fibrosis and fibrotic conditions, such as interstitial lung diseases, e.g., idiopathic pulmonary fibrosis, in a warm-blooded animal such as a human.
• Remodelling is a normal response to tissue injury and inflammation and is observed in many tissues throughout the body. After resolution of the inflammation and repair of tissue damage, the tissue is generally returned to its original condition. However, excessive uncontrolled tissue repair or the failure to stop remodelling when it is no longer required leads to a condition marked by fibrosis. Fibrosis typically involves the accumulation of extracellular matrix constituents that occur following trauma, inflammation, tissue repair, immunological reactions, cellular hyperplasia or neoplasia.
• tissue fibrosis examples include, but are not limited to, pulmonary fibrosis, renal fibrosis, cardiac fibrosis, cirrhosis and fibrosis of the liver, skin scars and keloids, adhesions, fibromatosis, atherosclerosis, and amyloidosis. Fibrosis often severely compromises the normal function(s) of the organ affected and many fibrotic conditions are, in fact, life-threatening or severely disfiguring. Unfortunately, treatment options for these diseases are limited; risky and expensive procedures such as organ transplantation are often the only possible approaches available.
• IPF Idiopathic pulmonary fibrosis
• IPF is a chronic, relentless, and ultimately fatal disorder characterized by scarring (fibrosis) of the lung parenchyma.
• the disease causes debilitating cough, lung function decline, fatigue and dyspnoea and the need for high-levels of supplemental oxygen limit physical activity and dramatically reduce patient quality of life and independence over time.
• the median survival of patients with IPF ranges from 2.5 years to 3.5 years, with most patients dying from respiratory failure due to disease progression (Raghu G, et al., Am J Respir Critical Care Med 2015; Vo. 192, No. 2:
• IPF The disease pathology of IPF is poorly understood and few drug treatment options exist (Mason D P et al., Ann Thoracic Surgery 84:1 121 -8, 2007).
• the FDA approved two new antifibrotic drugs for the treatment of IPF pirfenidone (Esbriet ® ) and nintedanib (OFEV ® ).
• the mechanism of action of pirfenidone has not been fully established.
• Nintedanib is a tyrosine kinase inhibitor that specifically targets the PDGFR a and b receptor, vascular endothelial growth factor receptor (VEGFR 1 -3) and fibroblast growth factor receptor (FGFR 1 -3) kinases.
• pirfenidone which is indicated for mild to moderate IPF, requires titration to very high and frequent doses, presenting both safety and patient compliance issues.
• the recommended daily dose of pirfenidone from day 15 onwards is 2403 mg/day, which requires a patient to take nine Esbriet ® capsules per day (three 267 mg capsules three times a day with food).
• IPF Despite the US approval of Esbriet ® and OFEV ® in 2014, IPF remains a chronic, fatal disease that impairs patients’ quality of life and drives up health care utilization and costs. Thus, there remains an urgent need for development of more effective therapies that safely and more reliably modify the course of the different forms/stages of IPF to maintain/restore quality of life.
• Saracatinib (ADZ0530) is a potent inhibitor of the Src family of tyrosine kinases with high selectivity over other protein kinases involved in signal transduction (Chang YM, et al., Oncogene 2008: 27(49):6365-75 and Greet TO et al., Mol Oncol. 2009; 3(3): 248-61 ).
• the compound together with its manufacture are disclosed in PCT patent application WO 01/94341 , which concerns the use of quinazoline derivatives for the treatment of tumours.
• Saracatinib was originally being developed for the treatment of cancer, however, clinical trials failed to show sufficient efficacy in this indication. Saracatinib has also been investigated in Alzheimer’s disease (Nygaard et al., Alzheimer’s Res Therapeutic, 2015;
• Saracatinib has also been tested in a bleomycin murine lung fibrosis model and found to influence myofibroblast differentiation (Hu M et al., Journal of Pharmacology and Experimental Therapeutics; 2014, 351 : 87-95).
• the bleomycin murine model has the advantage that it is quite easy to perform and does have some similarities in histological alterations seen in IPF.
• numerous agents have been tested and found to exhibit some activity in this disease model, relatively few have been progressed to recapitulate this activity in humans (Moeller A, et al., Int J Biochem Cell Biol. 2008; 40(3): 362-282).
• the model has an acute inflammatory component with a later fibrotic phase that does not replicate IPF and is therefore of limited value in respect to providing information about the profile of activity of a compound in clinical use.
• Many anti-inflammatory mechanisms have demonstrated efficacy in the bleomycin challenge model, but failed to show clinical utility (e.g., tralokinumab, lebrikizumab, SNY program of IL- 4/ 13).
• tralokinumab e.g., lebrikizumab, SNY program of IL- 4/ 13
• Hu et al. whilst bleomycin treatment induces lung fibrosis in rodents, and the resulting fibrosis shares many key features of human lung fibrosis, the bleomycin model does not replicate human IPF and is not a model of progressive fibrosis.
• Fibrosis tends to only persist 3 to 4 weeks post bleomycin instillation before spontaneously resolving, returning the lungs to near-normal state with minimal fibrosis.
• the bleomycin model In addition to diverging from the human disease by exhibiting spontaneous resolution of fibrosis, the bleomycin model also lacks other cell types, processes and structures critically associated with human disease progression, such as hyperplastic type II alveolar epithelial cells (AECs), bronchiolization and honeycomb cysts.
• AECs hyperplastic type II alveolar epithelial cells
• the bleomycin model has significant limitations in regard to understanding the progressive and irreversible nature of human IPF. This is particularly relevant when the clinical activity of a compound in different disease stages and/or different forms of progressive IPF is to be evaluated.
• IPF is recognised as a heterogenous disease that can be characterised by stage and severity.
• Published studies have suggested that the clinical course of IPF is variable but distinct subgroups of patients do exist, for example in whom fibrosis progresses more rapidly (Ley B et al., Ann Intern Med 2012; 156(10):684-91 and Martinez FJ, et al. 2005; 142(12): 963-7).
• Herazo- Maya et al. published a retrospective study identifying a peripheral blood transcriptomic signature predictive of mortality and transplant-free survival in patients with IPF (Herazo-Maya et al. Lancet Respir Med 2017; 5: 857-68). The signature correlates with FVC and, without therapy, is stable over time.
• certain Src kinase inhibitors such as saracatinib
• target multiple drivers of fibrosis pathology are particularly effective in the treatment and/or prevention of fibrosis and fibrotic conditions, such as idiopathic pulmonary fibrosis (including progressive forms and/or different stages of idiopathic pulmonary fibrosis) and/or offer a safer and better-tolerated therapy for such conditions when compared to existing medicines such as pirfenidone and nintedanib.
• Src kinase inhibitors such as saracatinib
• at least one additional therapeutic agent e.g., an anti-fibrotic
• an anti-fibrotic e.g., an anti-fibrotic
• fibrosis and fibrotic conditions such as idiopathic pulmonary fibrosis, in a warm-blooded animal such as a human.
• the Src kinase inhibitors of the current disclosure are surprisingly effective in the treatment of certain fibrosis and specific fibrotic conditions by mechanisms distinct from conventional methods of treatment.
• the fibrosis and fibrotic conditions are characterized by persistent, debilitating abnormal formation of lesions or scars determined by high-resolution computed tomography (HRCT) or biopsy.
• HRCT high-resolution computed tomography
• the fibrosis and fibrotic conditions are characterized by abnormal collagen deposition.
• the present disclosure thus relates to a method of treating such fibrosis and fibrotic conditions in a human patient. Such method comprises administering to the human patient a therapeutically effective amount of a Src kinase inhibitor or a pharmaceutically acceptable salt thereof.
• the Src kinase inhibitor at its safe and tolerable dose is selective for inhibiting Src kinase with a clinically relevant potency.
• the fibrosis and fibrotic conditions are characterized by epithelial to mesenchymal transition (EMT).
• EMT epithelial to mesenchymal transition
• the fibrosis and fibrotic conditions are characterised by increased expression of Collagen-I and/or MMP-9 and/or TIMP-1.
• the fibrotic disease or condition is characterized by increased expression of sVEGF and/or slL-8 and/or slL-6.
• the fibrotic disease or condition is characterized by decreased expression of VCAM-1.
• the fibrosis and fibrotic conditions are characterized by extra cellular matrix (ECM) formation.
• ECM extra cellular matrix
• the present disclosure also relates to a method of treating an interstitial lung disease, characterised by airway basal cell-mediated lung remodelling, in a human patient. The method comprises administering to the human patient a therapeutically effective amount of a Src kinase inhibitor or a pharmaceutically acceptable salt thereof.
• the interstitial lung disease is selected from Idiopathic Pulmonary Fibrosis (IPF), idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs, rheumatoid arthritis-related ILD, fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis, and ILDs related to other occupational exposures.
• IPF Idiopathic Pulmonary Fibrosis
• idiopathic nonspecific interstitial pneumonia idiopathic nonspecific interstitial pneumonia
• unclassifiable idiopathic interstitial pneumonia connective tissue disease-associated ILDs
• connective tissue disease-associated ILDs connective tissue disease-associated ILDs
• rheumatoid arthritis-related ILD connective tissue disease-associated ILDs
• fibrotic chronic hypersensitivity pneumonitis fibrotic chronic sarcoidosis
• the present disclosure also relates to a method of treating pulmonary fibrosis, suitably characterised by airway basal cell-mediated lung remodelling, in a human patient, comprising administering to said human patient a therapeutically effective amount of a Src kinase inhibitor.
• the pulmonary fibrosis is characterized by persistent, debilitating abnormal formation of lesions or scars determined by high-resolution computed tomography (HRCT) or biopsy.
• HRCT high-resolution computed tomography
• the pulmonary fibrosis is characterized by epithelial to mesenchymal transition (EMT).
• EMT epithelial to mesenchymal transition
• the pulmonary fibrosis is characterised by increased expression of Collagen-I and/or MMP-9 and/or TIMP-1.
• the pulmonary fibrosis is characterized by extra cellular matrix (ECM) formation.
• the present disclosure relates to a method of treating fibrosis and fibrotic conditions in a human patient, comprising administering to the human patient a therapeutically effective amount of a Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, in combination with at least one additional therapeutic agent.
• the fibrosis or fibrotic condition is a pulmonary fibrosis.
• the fibrosis or fibrotic condition is an interstitial lung disease (ILD).
• the fibrosis or fibrotic condition is idiopathic pulmonary fibrosis (IPF).
• the at least one additional therapeutic agent is an anti-fibrotic drug.
• the interstitial lung disease (ILD) is selected from Idiopathic Pulmonary Fibrosis (IPF), idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs, rheumatoid arthritis-related ILD, fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis, and ILDs related to other occupational exposures.
• the present disclosure also relates to a method for the treatment of fibrosis and fibrotic conditions as described herein in a human patient, by administering to a patient in need thereof of a pharmaceutical composition comprising a Src kinase inhibitor together with a pharmaceutically suitable carrier.
• a pharmaceutical combination for the treatment of fibrotic diseases and conditions which comprises a Src kinases inhibitor in combination with at least one additional therapeutic agent.
• FIG. 1 shows the hydroxyproline levels in mice after bleomycin (Bleo) induced lung injury and fibrosis following treatment with pirfenidone (PIR) at 200 mg/kg BID, nintedanib (NIN) at 30 mg/kg BID and saracatinib at 1 (0530-1), 3 (0530-3) or 10 (0530-10) mg/kg BID.
• PIR pirfenidone
• FIG. 2 shows the % max aSMA levels of human lung fibroblasts treated with saracatinib (circles), nintedanib (triangles) or pirfenidone (squares).
• FIG. 3 shows the mean IL-6 levels of human lung fibroblasts treated with saracatinib (circles), nintedanib (triangles) or pirfenidone (squares).
• FIG. 4 shows organoid formation of airway basal cells (ABCs) treated with saracatinib, pirfenidone or nintedanib.
• FIG. 5 shows a higher-powered image of organoid formation of ABCs treated with saracatinib (SARA), pirfenidone (Pirf) or nintedanib (Nin) at the concentrations indicated.
• SARA saracatinib
• Pirf pirfenidone
• Nin nintedanib
• FIG. 6 shows the optical density/well and organoid counts/well for ABCs treated with saracatinib, pirfenidone or nintedanib.
• FIG. 7 shows the DiscoverX assay results indicating relative protein expression (log ratio of compound/vehicle control) for saracatinib (3.3 pM).
• FIG. 8 shows the DiscoverX assay results indicating relative protein expression (log ratio of compound/vehicle control) for nintedanib (1 .1 pM).
• FIG. 9 shows the DiscoverX assay results indicating relative protein expression (log ratio of compound/vehicle control) for the combination of saracatinib and nintedanib compared to saracatinib and nintedanib alone.
• FIG. 10 shows the kinase trees of saracatinib (Sara) and nintedanib (Ninte) where each circle marks a kinase inhibited by the respective molecule, and the size of the circle represents potency of this inhibition.
• the phrase“effective amount” means an amount of a Src kinase inhibitor or composition comprising a Src kinase inhibitor which is sufficient to significantly and positively modify the symptoms and/or conditions to be treated (e.g., provide a positive clinical response).
• composition will vary with the particular condition being treated, the severity of the condition, the duration of the treatment, the nature of concurrent therapy, the particular active ingredient(s) being employed, the particular pharmaceutically-acceptable
• excipient(s)/carrier(s) utilized and like factors within the knowledge and expertise of the attending physician.
• the term“pharmaceutically acceptable” refers to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication,
• treating and like terms refer to reducing the severity and/or frequency of symptoms, eliminating symptoms and/or the underlying cause of said symptoms, reducing the frequency or likelihood of symptoms and/or their underlying cause, delaying, preventing and/or slowing the progression of fibrosis, such as IPF, and improving or remediating damage caused, directly or indirectly, by the fibrosis, such as IPF.
• treating is intended to embrace prophylaxis as well as therapeutic treatment.
• the Src kinase inhibitor is a selective Src kinase inhibitor i.e. the Src kinase inhibitor is selective for the Src family kinases over other protein kinases involves in signal transduction.
• the Src family comprises c-Src, c-Yes, Lck, Lyn, and Fyn and in one particular embodiment, the Src kinase inhibitor is selective for c-Src, c-Yes, Lck, Lyn, and c-Fyn kinases.
• the Src kinase inhibitor has an IC 5 o assay for each of c-Src, c-Yes, Lck, Lyn, and c-Fyn kinases of less than or equal to 100 nM, such as less than or equal to 75, 50, 40, 30, 20, 15, 12 or 10 nM. In one embodiment, the Src kinase inhibitor has an IC 5 o assay for PDGFRa and/or PDGFRp of above 1000 nM.
• the Src kinase inhibitor is selective for c-Src kinase and has an IC 5 o assay for c-Src kinase of less than or equal to 100 nM, such as less than or equal to 75, 50, 40, 30, 20, 15, 12, 10, 8, 6, 4 or about 3 nM.
• the Src kinase inhibitor is selective for c-Yes kinase and has an IC 50 assay for c-Yes kinase of less than or equal to 100 nM, such as less than or equal to 75, 50, 40, 30, 20, 15, 12, 10, 8, 6 or 4 nM.
• the Src kinase inhibitor is selective for Lck kinase and has an IC 50 assay for Lck kinase of less than or equal to 100 nM, such as less than or equal to 75, 50, 40, 30, 20, 12, 10, 6 or 4 nM. In yet a further embodiment, the Src kinase inhibitor is selective for Lyn kinase and has an IC 50 assay for Lyn kinase of less than or equal to 100 nM, such as less than or equal to 75, 50, 40, 30, 20, 15, 12, 10, 8, 6 or 5 nM.
• the Src kinase inhibitor is selective for c-Fyn kinase and has an IC 50 assay for c-Fyn kinase of less than or equal to 100 nM, such as less than or equal to 75, 50, 40, 30, 20, 15, 12 or 10 nM. In yet a further embodiment, the Src kinase inhibitor has an IC 50 assay for EGFR of less than or equal to 200 nM, such as less than or equal to 150, 100, 70 or about 66 nM.
• the Src kinase inhibitor has an IC 5 o assay for PDGFRa and/or PDGFRp of greater than or equal to 5000 nM, such as greater than or equal to 6000, 7000, 10000 nm.
• Tyrosine kinase inhibitors such as VEGFR inhibitors and PDGFR inhibitors
• VEGFR inhibitors and PDGFR inhibitors are associated with toxic effects on various organs such as the heart, lungs, liver, kidneys, thyroid, skin, blood coagulation, gastrointestinal tract and nervous system.
• PDGFR PDGFR inhibitors
• the lack of activity against PDGFR advantageously contributes to a better tolerated Src kinase inhibitor which in turn may result in an improved safety profile and/or improved patient compliance (Li et al. Eur J Clin Pharmacol. 2017 Oct;73(10):1209-1217).
• the Src kinase inhibitor is saracatinib or a pharmaceutically acceptable salt thereof.
• FIG. 10 shows the kinase trees of saracatinib and nintedanib demonstrating the superior selectivity of saracatinib in a graphic presentation.
• Saracatinib has the chemical name of N-(5-chlorobenzo[d][1 ,3]dioxol-4-yl)-7-(2-(4-methylpiperazin-1 - yl)ethoxy)-5-((tetrahydro-2H-pyran-4-yl)oxy)quinazolin-4-amine and structure as shown below:
• saracatinib is in form of a fumarate salt. In another embodiment, saracatinib is in form of a difumarate salt. Further details of saracatinib and its analogs, including the preparations thereof, are described in WO 01/94341 published on 13
• the Src kinase inhibitor is selected from dasatinib, bosutinib, or imatinib, or a pharmaceutically acceptable salt thereof.
• a suitable pharmaceutically-acceptable salt of the Src kinase inhibitor is, for example, an acid addition salt or a base salt. Such salts are physiologically non-toxic.
• Examples of pharmaceutically acceptable acid addition salts include acetate, adipate, ascorbate, benzoate, benzenesulfonate, bicarbonate, bisulfate, butyrate, camphorate, camphorsulfonate, choline, citrate, cyclohexyl sulfamate, diethylenediamine,
• ethanesulfonate formate, fumarate, glutamate, glycolate, hemisulfate, 2 hydroxyethyl sulfonate, heptanoate, hexanoate, hydrochloride, hydrobromide, hydroiodide,
• Examples of pharmaceutically acceptable base salts include ammonium salts; alkali metal salts such as sodium, lithium and potassium salts; alkaline earth metal salts such as aluminum, calcium and magnesium salts; salts with organic bases such as
• basic nitrogen containing groups may be quaternized with such agents as: lower alkyl halides, such as methyl, ethyl, propyl, and butyl halides; dialkyl sulfates such as dimethyl, diethyl, dibutyl; diamyl sulfates; long chain halides such as decyl, lauryl, myristyl and stearyl halides; arylalkyl halides such as benzyl bromide and others.
• tissue fibrosis refers to the accumulation of extracellular matrix constituents that occurs following trauma, inflammation, tissue repair, immunological reactions, cellular hyperplasia and neoplasia.
• tissue fibrosis include, but are not limited to, pulmonary fibrosis, renal fibrosis, cardiac fibrosis, cirrhosis and fibrosis of the liver, skin scars and keloids, adhesions, fibromatosis, atherosclerosis and amyloidosis.
• a Src kinase inhibitor or a pharmaceutically acceptable salt thereof as described herein.
• the Src kinase inhibitor demonstrates clinically relevant potency at its safe and tolerable dose.
• the fibrosis and fibrotic conditions are characterized by persistent, debilitating abnormal formation of lesions or scars determined by high-resolution computed tomography (HRCT) or biopsy.
• HRCT high-resolution computed tomography
• the fibrosis and fibrotic conditions are characterized by abnormal collagen deposition.
• the fibrosis and fibrotic conditions are characterised by epithelial to mesenchymal transition (EMT).
• EMT epithelial to mesenchymal transition
• the fibrosis and fibrotic conditions are characterised by increased expression of Collagen-1 and/or MMP-9 and/or TIMP-1 in a human patient.
• the fibrosis and fibrotic conditions are characterised by increased expression of Collagen-I, MMP-9 and TIMP-1 in a human patient.
• the fibrosis and fibrotic conditions are characterised by increased expression of Collagen-1 and MMP-9 in a human patient.
• the fibrosis and fibrotic conditions are characterised by increased expression of Collagen-1 and TIMP-1 in a human patient.
• the fibrosis and fibrotic conditions are characterised by increased expression of MMP-9 and TIMP-1 in a human patient.
• the fibrosis and fibrotic conditions are characterized by extra cellular matrix (ECM) formation.
• ECM extra cellular matrix
• a method of reducing fibrosis in a tissue comprising contacting a fibrotic cell or tissue with a Src kinase inhibitor disclosed herein, in an amount sufficient to decrease or inhibit the fibrosis, wherein the fibrosis is characterised by increased expression of Collagen-I and/or MMP-9 and/or TIMP-1.
• the fibrosis characterised by increased expression of Collagen-I and/or MMP-9 and/or TIMP- 1 includes a fibrotic condition.
• reducing fibrosis, or treatment of a fibrotic condition includes reducing or inhibiting one or more of: formation or deposition of extracellular matrix proteins; the number of pro-fibrotic cell types (e.g., fibroblast or immune cell numbers); cellular collagen or hydroxyproline content within a fibrotic lesion; expression or activity of a fibrogenic protein; or reducing fibrosis associated with an inflammatory response.
• the fibrotic condition is primary fibrosis.
• the fibrotic condition is idiopathic.
• the fibrotic condition is associated with (e.g., is secondary to) a disease (e.g., an infectious disease, an inflammatory disease, an autoimmune disease, a malignant or cancerous disease, and/or a connective disease); a toxin; an insult (e.g., an environmental hazard (e.g., asbestos, coal dust, polycyclic aromatic hydrocarbons), cigarette smoking, a wound); a medical treatment (e.g., surgical incision, chemotherapy or radiation), or a combination thereof.
• a disease e.g., an infectious disease, an inflammatory disease, an autoimmune disease, a malignant or cancerous disease, and/or a connective disease
• a toxin e.g., an infectious disease, an inflammatory disease, an autoimmune disease, a malignant or cancerous disease, and/or a connective disease
• an insult e.g., an environmental hazard (e.g., asbestos, coal dust
• the fibrotic condition is a fibrotic condition of the lung, a fibrotic condition of the liver, a fibrotic condition of the heart or vasculature, a fibrotic condition of the kidney, a fibrotic condition of the skin, a fibrotic condition of the
• a fibrotic condition of the bone marrow or a hematopoietic tissue a fibrotic condition of the nervous system, a fibrotic condition of a joint, or a combination thereof.
• a method of treating a fibrotic condition comprising administering to the human patient a therapeutically effective amount of a Src kinase inhibitor or a pharmaceutically acceptable salt thereof, wherein the fibrotic condition is a fibrotic condition of the lung, a fibrotic condition of the liver, a fibrotic condition of the heart or vasculature, a fibrotic condition of the kidney, a fibrotic condition of the skin, a fibrotic condition of the gastrointestinal tract, a fibrotic condition of the bone marrow or a hematopoietic tissue, a fibrotic condition of the nervous system, a fibrotic condition of a joint, or a combination thereof.
• a Src kinase inhibitor or a pharmaceutically acceptable salt thereof wherein the fibrotic condition is a fibrotic condition of the lung, a fibrotic condition of the liver, a fibrotic condition of the heart or vasculature, a fibrotic condition of the kidney, a fibrotic
• a Src kinase inhibitor for use in treating a fibrotic condition in a human patient, wherein the fibrotic condition is a fibrotic condition of the lung, a fibrotic condition of the liver, a fibrotic condition of the heart or vasculature, a fibrotic condition of the kidney, a fibrotic condition of the skin, a fibrotic condition of the gastrointestinal tract, a fibrotic condition of the bone marrow or a hematopoietic tissue, a fibrotic condition of the nervous system, a fibrotic condition of a joint, or a combination thereof.
• the fibrotic condition is a fibrotic condition of the lung, a fibrotic condition of the liver, a fibrotic condition of the heart or vasculature, a fibrotic condition of the kidney, a fibrotic condition of the skin, a fibrotic condition of the gastrointestinal tract, a fibrotic condition of the bone marrow or a hematopoietic tissue
• the fibrotic condition affects a tissue chosen from one or more of muscle, tendon, cartilage, skin (e.g., skin epidermis or endodermis), cardiac tissue, vascular tissue (e.g., artery, vein), pancreatic tissue, lung tissue, liver tissue, kidney tissue, uterine tissue, ovarian tissue, neural tissue, testicular tissue, peritoneal tissue, colon, small intestine, biliary tract, gut, bone marrow, or hematopoietic tissue.
• skin e.g., skin epidermis or endodermis
• cardiac tissue e.g., vascular tissue (e.g., artery, vein)
• pancreatic tissue e.g., lung tissue, liver tissue, kidney tissue, uterine tissue, ovarian tissue
• neural tissue e.g., testicular tissue, peritoneal tissue, colon, small intestine, biliary tract, gut, bone marrow, or hematopoietic tissue.
• the fibrotic condition is a fibrotic condition of the lung.
• the fibrotic condition of the lung is chosen from one or more of: pulmonary fibrosis, idiopathic pulmonary fibrosis (IPF), usual interstitial pneumonitis (UIP), interstitial lung disease, cryptogenic fibrosing alveolitis (CFA), bronchiolitis obliterans, or
• the fibrosis of the lung is secondary to a disease, a toxin, an insult, a medical treatment, or a combination thereof.
• fibrosis of the lung is associated with one or more of: a disease process such as asbestosis and silicosis; an occupational hazard; an environmental pollutant; cigarette smoking; an autoimmune connective tissue disorders (e.g., rheumatoid arthritis, scleroderma and systemic lupus erythematosus (SLE)); a connective tissue disorder such as sarcoidosis; an infectious disease, e.g., infection, particularly chronic infection; a medical treatment, including but not limited to, radiation therapy, and drug therapy, e.g., chemotherapy (e.g., treatment with as bleomycin, methotrexate, amiodarone, busulfan, and/or nitrofurantoin).
• a disease process such as asbestosis and silicosis
• an occupational hazard such as r
• the fibrotic condition of the lung treated with the methods of the disclosure is associated with (e.g., secondary to) a cancer treatment, e.g., treatment of a cancer (e.g. squamous cell carcinoma, testicular cancer, Hodgkin's disease with bleomycin).
• a cancer e.g. squamous cell carcinoma, testicular cancer, Hodgkin's disease with bleomycin.
• the fibrotic condition is a fibrotic condition of the liver.
• the fibrotic condition of the liver is chosen from one or more of: fatty liver disease, steatosis (e.g., nonalcoholic steatohepatitis (NASH), cholestatic liver disease (e.g., primary biliary cirrhosis (PBC), cirrhosis, alcohol-induced liver fibrosis, biliary duct injury, biliary fibrosis, cholestasis or cholangiopathies.
• fatty liver disease e.g., nonalcoholic steatohepatitis (NASH)
• cholestatic liver disease e.g., primary biliary cirrhosis (PBC), cirrhosis, alcohol-induced liver fibrosis, biliary duct injury, biliary fibrosis, cholestasis or cholangiopathies.
• hepatic or liver fibrosis includes, but is not limited to, hepatic fibrosis associated with alcoholism, viral infection, e.g., hepatitis (e.g., hepatitis C, B or D), autoimmune hepatitis, non-alcoholic fatty liver disease (NAFLD), progressive massive fibrosis, exposure to toxins or irritants (e.g., alcohol, pharmaceutical drugs and environmental toxins).
• the fibrotic condition is a fibrotic condition of the heart.
• the fibrotic condition of the heart is myocardial fibrosis (e.g., myocardial fibrosis associated with radiation myocarditis, a surgical procedure complication (e.g., myocardial post-operative fibrosis), infectious diseases (e.g., Chagas disease, bacterial, trichinosis or fungal myocarditis)); granulomatous, metabolic storage disorders (e.g., cardiomyopathy, hemochromatosis); developmental disorders (e.g., endocardial fibroelastosis); arteriosclerotic, or exposure to toxins or irritants (e.g., drug induced cardiomyopathy, drug induced cardiotoxicity, alcoholic cardiomyopathy, cobalt poisoning or exposure).
• the myocardial fibrosis is associated with an inflammatory disorder of cardiac tissue (e.g., myocardial sarcoidosis).
• the fibrotic condition is a fibrotic condition of the kidney.
• the fibrotic condition of the kidney is chosen from one or more of: renal fibrosis (e.g., chronic kidney fibrosis), nephropathies associated with injury/fibrosis (e.g., chronic nephropathies associated with diabetes (e.g., diabetic nephropathy)), lupus, scleroderma of the kidney, glomerular nephritis, focal segmental glomerular sclerosis, IgA nephropathyrenal fibrosis associated with human chronic kidney disease (CKD), chronic progressive nephropathy (CPN), tubulointerstitial fibrosis, ureteral obstruction, chronic uremia, chronic interstitial nephritis, radiation nephropathy, glomerulosclerosis, progressive glomerulonephrosis (PGN), endothelial/thrombotic microangiopathy injury, HIV
• renal fibrosis e.g
• the fibrotic condition is a fibrotic condition of the skin.
• the fibrotic condition of the skin is chosen from one or more of: skin fibrosis, scleroderma, nephrogenic systemic fibrosis (e.g., resulting after exposure to gadolinium which is frequently used as a contrast substance for MRIs in patients with severe kidney failure), scarring and keloid.
• the fibrotic condition is a fibrotic condition of the
• the fibrotic condition is chosen from one or more of fibrosis associated with scleroderma; radiation induced gut fibrosis; fibrosis associated with a foregut inflammatory disorder such as Barrett's esophagus and chronic gastritis, and/or fibrosis associated with a hindgut inflammatory disorder, such as inflammatory bowel disease (IBD), ulcerative colitis and Crohn's disease.
• IBD inflammatory bowel disease
• ulcerative colitis Crohn's disease
• the fibrotic condition is adhesions.
• the adhesions are chosen from one or more of: abdominal adhesions, peritoneal adhesions, pelvic adhesions, pericardial adhesions, peridural adhesions, peritendinous or adhesive capsulitis.
• the fibrotic condition is a fibrotic condition of the eye.
• the fibrotic condition of the eye involves diseases of the anterior segment of the eye such as glaucoma and corneal opacification; in some embodiments, the fibrotic condition of the eye involves disease of the posterior segment of the eye such as age- related macular degeneration, diabetic retinopathy, retinopathy of prematurity and neovascular glaucoma; in some embodiments, the fibrotic condition of the eye results from fibrosis following ocular surgery.
• the fibrotic condition is a fibrotic condition of the bone marrow or a hematopoietic tissue.
• the fibrotic condition of the bone marrow is an intrinsic feature of a chronic myeloproliferative neoplasm of the bone marrow, such as primary myelofibrosis (also referred to herein as agnogenic myeloid metaplasia or chronic idiopathic myelofibrosis).
• the bone marrow fibrosis is associated with (e.g., is secondary to) a malignant condition or a condition caused by a clonal proliferative disease.
• the bone marrow fibrosis is associated with a hematologic disorder (e.g., a hematologic disorder chosen from one or more of polycythemia vera, essential thrombocythemia, myelodysplasia, hairy cell leukemia, lymphoma (e.g., Hodgkin or non-Hodgkin lymphoma), multiple myeloma or chronic myelogeneous leukemia (CML)).
• a hematologic disorder e.g., a hematologic disorder chosen from one or more of polycythemia vera, essential thrombocythemia, myelodysplasia, hairy cell leukemia, lymphoma (e.g., Hodgkin or non-Hodgkin lymphoma), multiple myeloma or chronic myelogeneous leukemia (CML)).
• a hematologic disorder e.g., a hematologic disorder chosen from
• the bone marrow fibrosis is associated with (e.g., secondary to) a non- hematologic disorder (e.g., a non-hematologic disorder chosen from solid tumor metastasis to bone marrow, an autoimmune disorder (e.g., systemic lupus erythematosus, scleroderma, mixed connective tissue disorder, or polymyositis), an infection (e.g., tuberculosis), or secondary hyperparathyroidism associated with vitamin D deficiency.
• a non- hematologic disorder e.g., a non-hematologic disorder chosen from solid tumor metastasis to bone marrow, an autoimmune disorder (e.g., systemic lupus erythematosus, scleroderma, mixed connective tissue disorder, or polymyositis), an infection (e.g., tuberculosis), or secondary hyperparathyroidism associated with vitamin D deficiency.
• the fibrotic condition is a fibrotic condition of a joint.
• the fibrotic condition of the joint is arthrofibrosis.
• the fibrotic condition of the joint occurs in a knee, a hip, an ankle, a foot joints, a shoulder, an elbow, a wrist, a hand joint, spinal vertebrae, or a combination thereof in some
• arthrofibrosis occurs after totai knee replacement or even partial knee replacement.
• the fibrosis is associated with graft versus host disease (GVHD). In some embodiments, the fibrosis is associated with sclerodermatous GVHD, lung chronic GVHD, or liver chronic GVHD. In some embodiments, the fibrosis is of the liver, lung, pancreas, kidney, bone marrow, heart, skin, intestine, or joints. In some embodiments, the fibrosis is of the liver. In some embodiments, the fibrosis is of the lung. In some
• the fibrosis is of the pancreas.
• the patient has cirrhosis, chronic pancreatitis, cystic fibrosis, or cancer.
• the cancer is a solid tumor cancer.
• the fibrotic condition which is characterised by ECM, or increased expression of Collagen-1, MMP-9 and/or TIMP-1 , or EMT in a human patient is hepatic fibrosis, dilated cardiomyopathy, chronic hypoxia, interstitial lung disease, or idiopathic pulmonary fibrosis.
• the fibrotic condition is an interstitial lung disease (ILD).
• the fibrotic condition is a progressively-fibrosing interstitial lung disease.
• the fibrotic condition is idiopathic pulmonary fibrosis (IPF).
• the fibrotic condition is progressive IPF. Progressive IPF may be characterised in respect to the rate of disease progression. For example, patients with rapidly progressive IPF and patients with slowly progressive IPF can be distinguished. Slowly progressive IPF can be defined as IPF where there is a slow progressive decline in lung function and worsening dyspnoea.
• rapidly progressive IPF patients experience a long duration of symptoms before diagnosis and experience a slowly progressive clinical course (Martinez FX et al., Ann Intern Med 2005; 142: 963-967). Slowly progressive IPF can lead to death within several years of diagnosis. Rapidly progressive IPF involves patients displaying a more rapidly progressive clinical course with a shorter duration of symptoms before diagnosis and progression to death.
• progressive fibrosing interstitial lung diseases include, for example, idiopathic nonspecific interstitial pneumonia, unc!assifiab!e idiopathic interstitial pneumonia, connective tissue disease-associated ILDs (e.g. rheumatoid arthritis-related ILD), fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis and ILDs related to other occupational exposures.
• ILDs connective tissue disease-associated ILDs
• fibrotic chronic hypersensitivity pneumonitis fibrotic chronic sarcoidosis
• ILDs related to other occupational exposures.
• a method of treating an interstitial lung disease comprising administering to the human patient a therapeutically effective amount of a Src kinase inhibitor or a pharmaceutically acceptable salt thereof.
• a Src kinase inhibitor, or a pharmaceutically acceptable salt thereof for use in treating an interstitial lung disease in a human patient.
• the interstitial lung disease is IPF.
• the interstitial lung disease is selected from idiopathic nonspecific interstitial pneumonia, undassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs (e.g.
• pulmonary function tests can provide some indication of the extent and severity of IPF.
• Forced Vital Capacity FVC
• spirometry which is a specific type of pulmonary function test.
• Diffusing capacity of the lung for carbon monoxide (DLCO), which represents the extent to which oxygen passes from the air sacs of the lungs into the blood, can also provide an indication of the extent and severity of IPF in a patient.
• DLCO carbon monoxide
• Both FVC and DLCO can be expressed as a percentage of the predicted normal for a person of the same sex, age and height. The skilled person will be aware of methods to determine and use the FVC and DLCO parameters.
• progressive IPF is characterised by an FVC threshold of between 20% and 80% predicted, such as between 50 and 75%, between 50 and 65%, between 50 and 60% or between 50 and 55% predicted. In one embodiment, progressive IPF is characterised by a DLCO of between 20 and 70% predicted, such as between 35 and 55%, between 35 and 45%, or between 35 and 40% predicted.
• IPF Disease severity of IPF may be classified as mild, moderate or severe. While there is no standardised definition of mild, moderate or severe IPF, clinical trials have generally employed an FVC threshold of 50-55% predicted and a DLCO threshold of 35-40% predicted to separate mild-to-moderate patients from those with severe disease (M Kolb et al., Eur. Respir Rev 2014; 23: 220-224).
• the fibrotic condition is mild, moderate, or mild-to-moderate IPF.
• the mild-to-moderate IPF is characterised by an FVC threshold of greater than or equal to 50% predicted, such as 50 and 75% or 50 to 55% predicted and/or a DLCO threshold of greater than or equal to 35% predicted, such as 20 and 70% predicted or 35 to 40% predicted.
• the fibrotic condition is severe IPF.
• the severe IPF is characterised by FVC threshold of less than 50% predicted, such as less than 45%, 40%, 35%, 30%, 25%, 20%, 10%, or 5% predicted, and/or a DLCO threshold of less than 35% predicted, such as less than 30%, 25%, 20%, 15%, 10%, or 5% predicted.
• progressive IPF is characterised by an annual rate of decline, as measured by FVC, of less than or equal to 0.3 L, such as less than or equal to 0.25L, 0.15 L or 0.12 L.
• the annual rate of decline, as measure by FVC is between 0.1 L and 0.3 L, such as between 0.13 L and 0.21 L.
• the annual rate of decline, as measured by FVC is greater than or equal to 0.05 L, such as greater than or equal to 0.08 L, 0.10 L or 0.13 L.
• progressive IPF is characterised by a rate of decline in FVC is greater than or equal to 1 %, such as greater than or equal to 2%, 4%, 6%, 8%, 10%, 12%, 14%, 16%, 18% or 20%.
• the rate of decline in FVC is less than or equal to 20%, such as less than or equal to 18%, 16%, 14%, 12%, 10%, 8%, 6%, 4%, 2% or 1 %.
• the rate of decline in FVC is about 5%, such as about 10%, about 15% or about 20%.
• progressive IPF is characterised by a rate of decline in DLCO of greater than or equal to 1 %, such as greater than or equal to 2%, 4%, 6%, 8%, 10%, 12%, 14%, 15%, 16%, 18%, 20%, 22% or 25%.
• the rate of decline in DLCO is less than or equal to 25%, such as less than or equal to 22%, 20%, 18%, 16%, 15%, 14%, 12%, 10%, 8%, 6%, 4%, 2% or 1 %.
• the rate of decline in DLCO is about 5%, such as about 10%, such as about 15%, such as about 20%, such as about 25%.
• the fibrotic condition is slowly progressive IPF.
• slowly progressive IPF is characterised by a rate of decline in FVC of greater than or equal to 1 %, such as greater than or equal to 2%, 4%, 6% or 8%.
• slowly progressive IPF is characterised by a rate of decline in FVC of about 5%, such as about 10%.
• slowly progressive IPF is characterised by a rate of decline in DLCO of greater than or equal to 1 %, such as greater than or equal to 2%, 4%, 6%, 8%, 10%, 12% or 14%.
• rapidly progressive IPF is
• the fibrotic condition is rapidly progressive IPF.
• rapidly progressive IPF is characterised by a rate of decline in FVC of greater than or equal to 10%, such as greater than or equal to 12%, 14%, 16%, 18% or 20%.
• rapidly progressive IPF is characterised by a rate of decline in FVC of about 15%, such as about 20%.
• rapidly progressive IPF is characterised by a rate of decline in DLCO of greater than or equal to 15%, such as greater than or equal to 16%, 18%, 20%, 22% or 25%.
• rapidly progressive IPF is characterised by a rate of decline in DLCO of about 15%, such as about 20% or 25%.
• the IPF can be mild, moderate, mild-to-moderate, or severe, and rapidly or slowly progressive. Rapidly and slowly progressive relates to the rate of the progression of the IPF, while mild, moderate, mild-to-moderate and severe relate to what level the IPF has advanced.
• the fibrotic condition is rapidly progressive IPF wherein the IPF is characterised as mild, moderate, mild-to-moderate or severe IPF. In one embodiment, the fibrotic condition is slowly progressive IPF wherein the IPF is characterised as mild, moderate, mild-to-moderate or severe IPF.
• a method of treating rapidly and/or slowly progressive IPF wherein the IPF is characterised as mild, moderate, mild-to-moderate, or severe comprising administering to the human patient a
• a Src kinase inhibitor for use in treating rapidly and/or slowly progressive IPF wherein the IPF is characterised as mild, moderate, mild-to-moderate, or severe in a human patient.
• the Src kinase inhibitor has a well-tolerated safety profile. That is, the Src kinase inhibitor can be used in a dose to elicit efficacy while demonstrating safety and tolerability.
• the Src kinase inhibitor when used to treat IPF, shows the same or improved efficacy with reduced adverse reactions or discontinuations as compared to pirfenidone or nintedanib.
• Adverse reactions are classified by System Organ Class (SOC) into different frequency groupings. Very common refers to an incident rate of >1/10, common as >1/100 to ⁇ 1/10, uncommon as >1/1000 to ⁇ 1/100, and rare as >1/10000 to ⁇ 1/1000. In one embodiment, the number of adverse reactions associated with the Src kinase inhibitor is classified as common, uncommon and/or rare.
• SOC System Organ Class
• the adverse reactions are infections; infestations; blood disorders; lymphatic system disorders; immune system disorders; metabolism disorders; nutritional disorders; psychiatric disorders; nervous system disorders; vascular disorders; respiratory disorders; thoracic disorders; mediastinal disorders; gastrointestinal disorders; hepatobiliary disorders; skin disorders; subcutaneous tissue disorders; musculoskeletal disorders; connective tissue disorders; general disorders; administration site conditions; injury poisoning and/or procedural complications.
• the number of gastrointestinal adverse reactions associated with the Src kinase inhibitor is classified as common, uncommon or rare.
• the number of gastrointestinal adverse reactions associated with the Src kinase inhibitor is classified as common, uncommon or rare.
• gastrointestinal adverse reactions are diarrhoea, nausea, abdominal pain, dyspepsia, gastroesophageal reflux disease, vomiting, abdominal distension, abdominal discomfort, stomach discomfort, gastritis, constipation and/or flatulence.
• the number of hepatobiliary disorders associated with the Src kinase inhibitor is classified as common, uncommon or rare.
• the hepatobiliary disorder results in increased levels of hepatic enzyme in the human patient.
• the number of nutritional disorders associated with the Src kinase inhibitor is classified as common, uncommon or rare.
• the nutritional disorder is anorexia.
• the number of skin disorders and/or subcutaneous tissue disorders associated with the Src kinase inhibitor is classified as common, uncommon or rare.
• the skin disorders are a photosensitivity reaction and/or a rash.
• the number of general disorders associated with the Src kinase inhibitor is classified as common, uncommon or rare. Suitably the general disorder is fatigue.
• the Src kinase inhibitor has an improved safety profile to nintedanib and/or pirfenidone. In one embodiment, the Src kinase inhibitor has a lower incidence rate and/or severity of adverse reactions relative to nintedanib and/or pirfenidone. In one embodiment, the Src kinase inhibitor has a lower incidence rate and/or severity of gastrointestinal adverse reactions relative to nintedanib and/or pirfenidone.
• the Src kinase inhibitor has a lower incidence rate and/severity of diarrhoea, nausea, abdominal pain, dyspepsia, gastroesophageal reflux disease, vomiting, abdominal distension, abdominal discomfort, stomach discomfort, gastritis, constipation and/or flatulence relative to nintedanib and/or pirfenidone.
• administering to the human patient a therapeutically effective amount of a Src kinase inhibitor or a pharmaceutically acceptable salt thereof increases the overall and/or progression free survival rate of the human patient.
• administering to the human patient a therapeutically effective amount of a Src kinase inhibitor or a pharmaceutically acceptable salt thereof improves, prevent and/or maintains the symptoms of fibrosis, suitably the symptoms of IPF, which include cough, lung function decline, fatigue and dyspnoea.
• composition which comprises a Src kinase inhibitor or a pharmaceutically acceptable salt thereof as defined hereinbefore, in association with a pharmaceutically acceptable diluent, excipient or carrier for use in treating fibrosis as herein defined.
• compositions of the disclosure may be in a form suitable for oral use (for example as tablets, lozenges, hard or soft capsules, aqueous or oily suspensions, emulsions, dispersible powders or granules, syrups or elixirs), for topical use (for example as creams, ointments, gels, or aqueous or oily solutions or suspensions), for administration by inhalation (for example as a finely divided powder or a liquid aerosol), for administration by insufflation (for example as a finely divided powder) or for parenteral administration (for example as a sterile aqueous or oily solution for intravenous, subcutaneous, intramuscular or intramuscular dosing or as a suppository for rectal dosing).
• oral use for example as tablets, lozenges, hard or soft capsules, aqueous or oily suspensions, emulsions, dispersible powders or granules, syrups or elixir
• compositions of the disclosure may be obtained by conventional procedures using conventional pharmaceutical excipients, well known in the art.
• compositions intended for oral use may contain, for example, one or more colouring, sweetening, flavouring and/or preservative agents.
• the amount of active ingredient that is combined with one or more pharmaceutically acceptable diluents, excipients or carriers to produce a single dosage form will necessarily vary depending upon the host treated and the particular route of administration.
• a formulation intended for oral administration to humans will generally contain, for example, from 0.5 mg to 0.5 g of active (more suitably from 0.5 to 200 mg, for example from 1 to 150 mg, 75 to 150 mg, 90 to 135 mg, 100 to 125 mg, such as 100 mg, such as about 125 mg) compounded with an appropriate and convenient amount of excipients.
• the size of the dose for therapeutic or prophylactic purposes of a Src kinase inhibitor will naturally vary according to the nature and severity of the conditions, the age sex of the animal or patient and the route of administration, according to well-known principles of medicine.
• a Src kinase inhibitor for therapeutic or prophylactic purposes it will generally be administered so that a daily dose in the range, for example, 0.1 mg/kg to 75 mg/kg body weight is received, given if required in divided doses. In general, lower doses will be administered when a parenteral route is employed. Thus, for example, for intravenous administration, a dose in the range, for example, 0.1 mg/kg to 30 mg/kg body weight will generally be used. Similarly, for administration by inhalation, a dose in the range, for example, 0.05 mg/kg to 25 mg/kg body weight will be used.
• the Src kinase inhibitor such as saracatinib, is administered via oral administration, for example, in tablet or capsule form.
• the therapeutically effective amount of the Src kinase inhibitor is administered once daily, twice daily or three times daily.
• the therapeutically effective amount is administered once daily.
• the therapeutically effective amount is administered once daily for at least two consecutive days, suitably for at least or equal to 4 weeks, suitably for at least or equal to 14 weeks, suitably at least or equal to 26 weeks, suitably for at least or equal to 52 weeks, suitably for at least or equal to 2 years or longer.
• a suitable dosage amount may be determined by reference to the severity of the disease and the size of the subject. Typical dosage amounts are in the range 0.01 mg to 500 mg, such as 0.1 to 175 mg, such as 1 to 125 mg per human dose to be delivered at least once daily, such as once or twice daily.
• the dosage amounts for the Src kinase inhibitor, such as saracatinib can be 100 mg, 125 mg, or up to 250 mg per day.
• the therapeutically effective amount of the Src kinase inhibitor is between 5 and 500 mg per day, suitably between 10 and 400 mg per day, suitably between 20 and 300 mg per day, suitably between 30 and 200 mg per day, suitably between 75 and 150 mg per day, suitably between 100 and 150 mg, suitably between 1 10 and 140 mg, suitably between 120 and 130 mg, or suitably about 125 mg.
• Combination therapy is between 5 and 500 mg per day, suitably between 10 and 400 mg per day, suitably between 20 and 300 mg per day, suitably between 30 and 200 mg per day, suitably between 75 and 150 mg per day, suitably between 100 and 150 mg, suitably between 1 10 and 140 mg, suitably between 120 and 130 mg, or suitably about 125 mg.
• the method of treating fibrosis further comprises administering to the human patient a therapeutically effective amount of the Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, in combination with a therapeutically effective dose of at least one other therapeutic agent.
• the combined administrations can be separate, simultaneous, or sequential.
• the fibrosis is characterised by increased expression of Collagen-I and/or MMP-9 and/or TIMP-1.
• the therapeutic agent refers to a chemical or biological molecule, such a compound, peptide, nucleic acid, protein, and antibody, or fragments thereof, which can produce therapeutic effects in a human patient.
• the therapeutic agent is a pharmaceutically active compound.
• the therapeutic agent is an anti-fibrotic drug.
• Such pharmacologically active compound may be compounds which are, for example, also pharmacologically active in the treatment of fibrosis, for example pirfenidone or nintedanib.
• Such pharmacologically active compounds may also be substances with a secretolytic, broncholytic and/or anti-inflammatory activity, such as anticholinergic agents, beta-2 mimetics, corticosteroids, PDE-IV inhibitors, p38 MAP kinase inhibitors, MK2 inhibitors, galectin inhibitors, NKi antagonists, LTD4 antagonists, EGFR inhibitors, VEGF inhibitors, PDGF inhibitors, FGF inhibitors, TGFbeta inhibitors, LPA1 antagonists, LOXL2 inhibitors, CTGF inhibitors, pentoxyfylline, N-acetylcysteine, anti-IL13 agents, anti IL4 agents, Alpha V integrin inhibitors (including inhibitors of aVp1 , aVp2, a
• pharmacologically active compounds to be used in combination with the Src kinase inhibitor include compounds with an antifibrotic activity, such as PDE-III inhibitors, combined anti-IL4/13 agents, combined PI3k/mTOR inhibitors, autotaxin inhibitors, P2X2 antagonists, CTGF antagonists, 5-LO antagonists, leukotriene antagonists, ROCK inhibitors, PDGFR inhibitors (a and/or b), FGR inhibitors, and/or VEGFR inhibitors.
• the anti-fibrotic drug is selected from pirfenidone, or a pharmaceutically acceptable salt thereof, or nintedanib, or a pharmaceutically acceptable salt thereof.
• the method of treating fibrosis further comprises administering to the human patient a therapeutically effective amount of the Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, and a therapeutically effective dose of at least one anti-fibrotic drug, either separately, simultaneously, sequentially, or in the form of a pharmaceutical composition comprising the Src kinase inhibitor, or a
• An anti-fibrotic drug is a drug, as herein defined, which when administered to a human patient, reduces and/or inhibits fibrosis.
• one anti-fibrotic drug is administered in combination with the Src inhibitor or a pharmaceutically acceptable salt thereof.
• two anti- fibrotic drugs are administered in combination with the Src inhibitor or a pharmaceutically acceptable salt thereof.
• the anti-fibrotic drug may be in the free form (i.e. , free acid or free base) or in the form of a pharmaceutically acceptable salt.
• the anti-fibrotic drug is selected from nintedanib or a pharmaceutically acceptable salt thereof; pirfenidone or a pharmaceutically acceptable salt thereof; and a combination thereof.
• the anti-fibrotic drug is nintedanib or a pharmaceutically acceptable salt thereof.
• the anti- fibrotic drug is pirfenidone or a pharmaceutically acceptable salt thereof.
• a pharmaceutical composition comprising the Src kinase inhibitor, or pharmaceutically acceptable salt thereof, and the at least pharmacologically active compound, or a pharmaceutically acceptable salt thereof, as herein defined.
• a pharmaceutical composition comprising the Src kinase inhibitor, or pharmaceutically acceptable salt thereof, and the at least one anti fibrotic drug, or a pharmaceutically acceptable salt thereof.
• a pharmaceutical composition comprising a Src kinase inhibitor, or a pharmaceutical acceptable salt thereof, and nintedanib, or a pharmaceutically acceptable salt thereof, and/or pirfenidone, or a pharmaceutically acceptable salt thereof.
• a pharmaceutical composition comprising saracatinib, or a pharmaceutical acceptable salt thereof, and nintedanib, or a pharmaceutically acceptable salt thereof, and/or pirfenidone, or a pharmaceutically acceptable salt thereof.
• between 0.5 mg to 0.5 g such as 0.5 to 200 mg, 1 to 150 mg, 75 to 150 mg,
• a pharmaceutical combination comprising (a) saracatinib or a pharmaceutically acceptable salt thereof, and (b) a therapeutically effective amount of at least one additional therapeutic agent; wherein saracatinib is present in an amount of 75 to 500 mg, such as 90 to 135 mg, such as 100 to 125 mg, such as about 100 mg, or such as about 125 mg.
• saracatinib or a pharmaceutically acceptable salt thereof is in an oral dosage form for once per day administration.
• the additional therapeutic agent is selected from nintedanib or a pharmaceutically acceptable salt thereof, pirfenidone or a pharmaceutically acceptable salt thereof, or a combination thereof.
• the pharmaceutical combination is a kit of parts.
• the kit comprises instructions for use and a Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, as herein defined.
• kits of parts comprising instructions for use, a Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, as herein defined, and at least one other pharmacologically active compound, or a
• kits of parts comprising instructions for use, a Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, as herein defined, and at least one anti-fibrotic drug, or a pharmaceutically acceptable salt thereof, as herein defined.
• kit of parts comprising instructions for use and a pharmaceutical composition as herein defined.
• the pharmaceutical composition comprises a Src kinase inhibitor, or a pharmaceutically acceptable salt thereof, and an anti-fibrotic drug, or pharmaceutically acceptable salt thereof.
• IC50 assay values for c-Src, c-Yes, Lck, Lyn, c-Fyn and EGFR kinases, and PGFRTKa and PGFRTKp for Saracatinib, nintedanib and 4-amino-5-(4-chlorophenyl)-7- (dimethylethyl)pyrazolo[3,4-d]pyrimidine (PP2) are presented in Table 1 below.
• the IC 5 o assay values for saracatinib and PP2 are disclosed in Hennequin 2006 DOI:10.1 Q21/jm060434q.
• the IC 5 o assay values for nintedanib are disclosed in Hilberg et al,“Triple Angiokinase Inhibitor with Sustained Receptor Blockade and Good Antitumor Efficacy”, Cancer Res 2008; 68: (12). June 15, 2008.
• Table 1 IC 5 o assay results
• IC 50 assay values presented in Table 1 show that saracatinib is potent and when compared to nintedanib or the compound PP2, is highly selective for the Src- family kinases (c-Src, c-Yes, Lck, Lyn and c-Fyn).
• Bleomycin Sulfate was obtained from Sigma-Aldrich. The IU conversion to enzyme units (U) is approximately 1.5-2 U/mg. For delivery of 4 U/kg in 50 pL, a solution of 2 mg/ml_ was prepared in 0.9% NaCI. Bleomycin or vehicle was dosed on Day 0 intranasally. Compounds were dosed twice daily by oral gavage starting at 7 days post bleomycin induction timed to coincide with the historical start of fibrosis (pirfenidone at 200 mg/kg BID, nintedanib at 30 mg/kg BID, saracatinib at 1 , 3 or 10 mg/kg BID). Body weights and clinical observations were recorded on days 7, 14, and 21 .
• mice were euthanized by cervical dislocation.
• One side of lung tissue was dissected and analyzed for hydroxyproline levels as an indicator of local collagen deposition, and the other side lung was fixed in Formalin for histopathology (Quantitative staining with sirius red).
• Half of the animals from each group were dosed 1 hour prior to terminal blood draw (see below) on Day 21 (for C max ); the other half of the animals were not dosed (C mi n) (Table 2).
• Table 2 Pharmacokinetics (PK) of Saracatinib
• Results are presented in FIG. 1 .
• the observed effects indicate that saracatinib compares favourably to pirfenidone (at much lower doses) and is potentially superior to nintedanib at clinically relevant doses.
• Example 3 Effects on TGF-beta-induced changes in primary human lung fibroblasts from a healthy donor
• Normal human lung fibroblasts from a healthy donor (passage 5) were seeded in 96-well culture plates with 50,000 cells per cm 2 in DMEM culture medium with 10% FBS and 1 % penicillin-streptomycin. They were cultured at 37°C for 24 hours and then washed twice with DPBS and serum-starved for 24 hours before treatment was added in the form of saracatinib, nintedanib, pirfenidone or the positive control SB-525334, an Alk-5 inhibitor, or 0.1 % DMSO as a vehicle control. The cells were incubated for one hour before 0.123ng/ml TGF-beta1 was added on top of the compound/vehicle treatment and the cells were incubated for 24 hours.
• the medium was collected and analysed for IL-6 and the cells were either lysed for RNA isolation, DNA-synthesis and TaqMan quantitative PCR or fixated and stained for alpha-smooth muscle actin (aSMA) and with Hoechst nuclear staining.
• aSMA alpha-smooth muscle actin
• the percentage of cells staining positive for aSMA and thereby displaying the myofibroblast phenotype was determined using high content image analysis.
• the Ct-values from the quantitative PCR were normalised against the geomean Ct values of two reference-genes and presented as fold-expression over those reference genes (2 A -delta Ct).
• FIG 2 and FiG. 3 indeed, saracatinib caused dose-dependent inhibition of aSMA without impacting DCi viability. Nintedanib and pirienidone inhibited aSMA, but at supra-therapeutic concentrations and with some evidence of cell death.
• Airway basal cells (ABC) from IPF patients have been described as“cancer like” in their proliferation, migration, and resistance to apoptosis. They are enriched in areas of bronchiolization, where they extend into fibroblastic foci; structures directly linked to lung function. Healthy control (HC)-ABC can be stimulated to produce 3D organoids in culture with growth factors and cytokines. However, IPF-ABC spontaneously form 3D organoids in culture. Following on to the success observed in oncology, IPF-ABC organoid formation is being explored as a tool to screen for therapeutic activity (A Prasse et al., European Respiratory Journal 2017; 50; and A Prasse et al., Am J Respir Crit Care Med. 2018 Aug 24. doi: 10.1 164/rccm.201712-2551 OC).
• ABC is understood to be relevant to IPF pathology and the signal observed correlates to disease severity (FVC decline, need for lung transplant, and risk of mortality). Indeed, ABC models reproduce the aberrant wound healing in IPF (e.g. formation of fibroblast tubules, 3D organoid structures, production of ECM components). Mice transplanted with human IPF ABC recapitulate broad spectrum of IPF pathology, including robust fibrotic response, migration, invasion of alveolar compartment, cystic structures, etc.
• ABSCs Airway Basal Cells
• HV Human Volunteers (HV) were cultured in Matrigel ® (Corning in a transwell system with or without lung fibroblasts either derived from patients with IPF or normal lung for up-to 35 days in the incubator (5% C0 2 , 37°C)).
• Medium exchange (BEGM (Lonza, Basel, Switzerland, #CC- 3170)/ DMEM (Dulbecco's Modified Eagle Medium (Gibco, Swit Fisher Scientific/Germany); ratio 1 :1) was done every 7 days.
• the conditioned medium was used for Sircol assay (Scientific-Biocolor/UK, # S1000) which was performed as recommended by the manufacturer (https://www.biocolor.co.uk/product/sircol-soluble-collagen-assay/).
• the organoids were treated with 8, 25, 75, 210 or 600 nM saracatinib, or pirfenidone at 1 mM or nintedanib at 1 pM (pirfenidone and nintedanib acting as positive controls). Spheroid formation was documented by Axio Vert.AI /Zeiss/Germany and Axio Observer
• Figures 4 and 5 show spheroid formation of ABCs treated with saracatinib, pirfenidone or nintedanib at different magnification levels.
• Saracatinib is non-cytotoxic at the concentrations tested. Nintedanib and pirfenidone at artificially high, supratherapeutic doses have little to no effect on organoid formation.
• These data in the human IPF ABC mouse model suggest saracatinib is differentiated and uniquely efficacious relative to nintedanib or pirfenidone.
• BioMAP panels consist of human primary cell-based systems designed to model different aspects of the human body in an in vitro format.
• the 12 systems available in the Diversity PLUS panel allow test agent characterization in an unbiased way across a broad set of systems modelling various human disease states.
• BioMAP systems are constructed with one or more primary cell types from healthy human donors, with stimuli (such as cytokines or growth factors) added to capture relevant signalling networks that naturally occur in human tissue or pathological conditions.
• Systems recapitulate aspects of the systemic immune response including monocyte-driven Th1 inflammation (LPS system) or T cell stimulation (SAg system), chronic Th1 inflammation driven by macrophage activation (IMphg system) and the T cell-dependent activation of B cells that occurs in germinal centers (BT system).
• LPS system monocyte-driven Th1 inflammation
• SAg system T cell stimulation
• IMphg system chronic Th1 inflammation driven by macrophage activation
• BT system germinal centers
• the BE3C system (Th1) and the BF4T system (Th2) represent
• Biomarker readouts (7 - 17 per system) are selected for therapeutic and biological relevance, are predictive for disease outcomes or specific drug effects and are validated using agents with known mechanism of action (MoA). Each readout is measured quantitatively by immune- based methods that detect protein (e.g., ELISA) or functional assays that measure proliferation and viability. BioMAP readouts are diverse and include cell surface receptors, cytokines, chemokines, matrix molecules and enzymes.
• BioMAP profile can be compared against a proprietary reference database of > 4,000 BioMAP profiles of bioactive agents (biologies, approved drugs, chemicals and experimental agents) to classify and identify the most similar profiles.
• bioactive agents biologicals, approved drugs, chemicals and experimental agents
• This robust data platform allows rapid evaluation and interpretation of BioMAP profiles by performing the unbiased mathematical identification of similar activities.
• Specific BioMAP activities have been correlated to in vivo biology, and multiparameter BioMAP profiles have been used to distinguish compounds based on MoA and target selectivity and can provide a predictive signature for in vivo toxicological outcomes (e.g., vascular toxicity, developmental toxicity, etc.) across diverse physiological systems.
• Saracatinib and nintedanib were prepared as stock solutions at a 10 mM concentration in 100% DMSO.
• a 4x4 combination array is created to test all mixtures of two serially diluted single test agents/drugs.
• Test agents/drugs are screened at 4 concentrations each (3-fold dilutions: saracatinib at 3.3, 1 .1 , 0.367, and 0.123 mM; nintedanib at 1 , 330, 1 10, and 37 mM), in triplicate, in selected BioMAP Systems (50+ human biology and disease model systems available through BioMAP Combo ELECT).
• FIG. 7 shows that saracatinib causes decreased expression of N-cadherin and increased expression of a-SMA; both of which are associated with myofibroblast activation. Saracatinib also causes decreased expression of TIMP-1 and MMP-9; both of which are associated with fibrosis-related matrices. Saracatinib causes decreased expression of sVEGF. sVEGF expression is associated with tissue remodelling and/or wound healing. Additionally, saracatinib causes decreased expression of slL-8 and slL-6 and increased expression of VCAM-1 proteins. These are associated with inflammation.
• FIG. 8 shows that nintedanib causes decreased expression if TIMP-1 and MMP-9; both of these are associated with fibrosis-related matrices.
• FIG. 9 shows that the combination of saracatinib and nintedanib causes novel inhibition of Collagen-I, and greater inhibition of MMP-9 and TIMP-1 relative to saracatinib or nintedanib alone.

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