Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K36/00—Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
  • A61K36/18—Magnoliophyta (angiosperms)
  • A61K36/185—Magnoliopsida (dicotyledons)
  • A61K36/28—Asteraceae or Compositae (Aster or Sunflower family), e.g. chamomile, feverfew, yarrow or echinacea
  • A61K36/282—Artemisia, e.g. wormwood or sagebrush
• • 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
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/357—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having two or more oxygen atoms in the same ring, e.g. crown ethers, guanadrel
• • 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
  • A61K31/16—Amides, e.g. hydroxamic acids
  • A61K31/17—Amides, e.g. hydroxamic acids having the group >N—C(O)—N< or >N—C(S)—N<, e.g. urea, thiourea, carmustine
• • 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
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
• • 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
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
• • 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
  • A61K31/28—Compounds containing heavy metals
  • A61K31/282—Platinum compounds
• • 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
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/365—Lactones
  • A61K31/366—Lactones having six-membered rings, e.g. delta-lactones
• • 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
• • 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
  • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • 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
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
  • A61K9/0056—Mouth soluble or dispersible forms; Suckable, eatable, chewable coherent forms; Forms rapidly disintegrating in the mouth; Lozenges; Lollipops; Bite capsules; Baked products; Baits or other oral forms for animals
• • 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
  • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
• • 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
  • A61K9/107—Emulsions ; Emulsion preconcentrates; Micelles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising an artemisinin compound or a pharmaceutically acceptable salt, cocrystal, or solvate thereof, and 5-aminolevulinic acid or methyl-5-aminolevulinic acid or a pharmaceutically acceptable salt or solvate thereof and at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• This pharmaceutical composition is used for the prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer.
• the present application provides a pharmaceutical composition
• a pharmaceutical composition comprising artemisinin or dihydroarteminisin or artesunate and 5-aminolevulinic acid or methyl-5- aminolevulinic acid and at least one chemotherapeutic agent, preferably one anti glioblastoma drug for use in prophylaxis and/or treatment of brain cancer, in particular glioblastoma.
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising artemisinin (1a), artesunate (1e) or dihydroarteminisin (1b) and 5- aminolevulinic acid (2) and at least one chemotherapeutic agent, preferably one anti glioblastoma drug for use in prophylaxis and/or treatment of brain cancer, in particular glioblastoma.
• Artemisinin is a natural medical compound that can be isolated from the plant Artemisia annua, or sweet wormwood. The substance has been used in traditional Chinese medicine for thousands of years to treat fever, colds and other maladies. In the 1970ies, Artemisinin hast been first described as an antimalarial drug by the Chinese scientist Tu Youyou. Together with its derivatives, Artemisinin is one of the most commonly used antimalarial drugs worldwide. It kills the unicellular parasite P. falciparum, that causes malaria, in all of its life stages ⁇ Aweeka, F. T. & German, P. I. Clinical Pharmacology of Artemisinin-Based Combination Therapies. Clinical Pharmacokinetics 47, 91-102 (2008) ⁇ . More recently, the potent anti-cancer properties of artemisinin have been recognized. The variety of the different functions of artemisinin and its applications point towards a wide-ranging mechanism of action of the compound in eukaryotic cells.
• Artemisinin biochemically is a natural endoperoxide. Its endoperoxide properties are strictly required for its antimalarial effect. Once the endoperoxide bridge is being cleaved, artemisinin gets activated and leads to the production of reactive oxygen species (ROS) and free radicals which subsequently alkylate susceptible proteins and macromolecules in the cell. This alkylation reaction alters the structure and function of proteins, damages the DNA and induces cellular stress, eventually resulting in cell death. Artemisinin associates with a wide range of cellular proteins in a non-specific manner and alters multiple pathways, including glycolysis, protein biosynthesis, mitochondrial processes, and antioxidant responses ⁇ Zhang, C.-J. et al.
• ROS reactive oxygen species
• 5-Aminolevulinic acid is an intermediate in heme biosynthesis and a tumor marker which is used to mark tumors for surgery. It is a non-protein amino acid.
• Glioblastoma also known as glioblastoma multiforme (GBM)
• GBM glioblastoma multiforme
• treatment involves surgery, after which chemotherapy and radiation therapy are used. It is the most common cancer that begins within the brain and the second-most common brain tumor, after meningioma. About three per 100,000 people develop the disease a year. It most often begins around 64 years of age and occurs more commonly in males than females.
• glioblastoma Despite maximum treatment, the glioblastoma usually recurs.
• the typical length of survival following diagnosis is 12 to 15 months, with fewer than 3 to 7% of people surviving longer than five years. Without treatment, survival is typically three months. An effective treatment of glioblastoma is still highly requested.
• a pharmaceutical composition comprising an artemisinin compound and 5-aminolevulinic acid or methyl-5- aminolevulinic acid and at least one chemotherapeutic agent, preferably one anti glioblastoma drug is useful for prophylaxis and/or treatment of cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer and especially of glioblastoma.
• Said pharmaceutical composition may further comprise a pharmaceutically acceptable carrier, excipient and/or diluent.
• said pharmaceutical composition is used in combination with radiotherapy, immunotherapy, electromagnetic field therapy, and/or hyperthermia therapy.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the artemisinin compound (1) is selected from artemisinin (1a) arteminol (1b, dihydroarteminisin) artemether (1c) arteether (1d) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate of this artemisinin compound (1).
• the chemotherapeutic agent and preferably the anti-glioblastoma drug is preferably selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadenosine, chloro-2’- deoxyadenosine, 5-nonyloxytryptamine, 2(1H)-pyrimidinone, pitavastatin, sertraline, irinotecan, clofazimine, and docetaxel.
• compositions disclosed herein are useful as medicine and especially for the prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer and preferably brain cancer.
• the glioblastoma is selected from subtypes proneural (PN), mesenchymal (MES), and classical (CL) glioblastoma.
• PN subtypes proneural
• MES mesenchymal
• CL classical glioblastoma
• brain cancer, pancreatic cancer, and liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer, preferably brain cancer, more preferably, glioblastoma, a molar ratio of the artemisinin compound and the 5-aminolevulinic acid or the methyl-5-aminolevulinic acid is preferably in a range of 1:5 to 1:5000, more preferably 1:5 to 1:1000, still more preferably 1:10 to 1:500 in the pharmaceutical composition.
• the pharmaceutical composition further comprises pharmaceutically acceptable carrier, excipient and/or diluent.
• the pharmaceutical composition is used for prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer, preferably brain cancer, more preferably, glioblastoma preferably in combination with a radiotherapy, immunotherapy, electromagnetic field therapy, hyperthermia therapy, chemotherapy, cancer immuntherapy and/or any other small molecule based therapy.
• lung cancer such as non-small cell lung cancer, preferably brain cancer, more preferably, glioblastoma preferably in combination with a radiotherapy, immunotherapy, electromagnetic field therapy, hyperthermia therapy, chemotherapy, cancer immuntherapy and/or any other small molecule based therapy.
• the pharmaceutical composition is used in a form of tablet, capsule, syrup, solution, suspension, emulsion, or gel.
• the pharmaceutical composition is administered by oral or parenteral application.
• the parenteral application includes intradermal, intragastral, intracutaneous, intravasal, intravenous, intramuscular, subcutaneous, sublingual, topical, and transdermal application.
• the artemisinin contained in the pharmaceutical composition is administered in a range of 0.01 to 100 mg/kg per body weight per day and the 5-aminolevulinic acid is administered in a range of 0.01 to 200 mg/kg per body weight per day.
• the pharmaceutical composition is used for prophylaxis and/or treatment of glioblastoma preferably in combination with the at least one chemotherapeutic agent, preferably one anti-glioblastoma drug, wherein the at least one chemotherapeutic agent, preferably the at least one anti-glioblastoma drug is administered in a range of 0.01 to 100 mg/kg per body weight per day.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• compositions disclosed herein containing three pharmaceutically active ingredients namely an artemisinin compound (1) and 5-aminolevulinic acid (2) or methyl-5-aminolevulinic acid (2b) and at least one chemotherapeutic agent, preferably the at least one anti-glioblastoma drug are considerably more effective than the combinations of only two of these active ingredients as evident from Figures 13 to 19.
• artemisinin compound refers to artemisinin (1a), dihydroarteminisin (1b), artemether (1c), arteether (1 d), and artesunate (1e) as shown below and pharmaceutically acceptable salts, cocrystals, or solvates of the artemisinin compounds (1).
• artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e) are preferred as artemisinin compound (1). More preferred are artemisinin (1a) and artesunate (1e) and most preferred is artemisinin (1a).
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• 5-aminolevulinic acid (2) is preferred over methyl-5- aminolevulinic acid (2b).
• 5-aminolevulinic acid (5-ALA) methyl-5-aminolevulinic acid (MAL)
• present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the chemotherapeutic agent preferably the anti-glioblastoma drug is preferably selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadenosine, chloro-2’- deoxyadenosine, 5-nonyloxytryptamine, 2(1H)-pyrimidinone, pitavastatin, sertraline, irinotecan, clofazimine, and docetaxel.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadenosine, chloro-2’-deoxyadenosine, 5-nonyloxytryptamine, 2(1 H)- pyrimidinone, pitavastatin, and sertraline.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, and vinorebine.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, flubendazole, vindesine sulfate, cerivastatin, and vinorebine.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, ribavirin, and vinorebine.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, and vinorebine.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, dactinomycin, and doxorubicin.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, triptolide, homoharringtonin, and dactinomycin. Still more preferably the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, triptolide, and homoharringtonin.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, and homoharringtonin.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, carboplatin, 5-fluorouracil, and triptolide.
• the anti-glioblastoma drug is selected from the group comprising or consisting of temozolomide, lomustine, cisplatin, and 5-fluorouracil. Most preferred is temozolomide.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinore
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topote
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastat
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vin
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinor
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadenosine
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindes
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisol
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadeno
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadenos
• artemisinin compound means a compound selected from the group comprising or consisting of artemisinin (ART or Art or 1a), artemether, arteether, artesunate (ARS or 1e), and dihydroarteminisinin (arteminol or DHA or 1b).
• DHA dihydroarteminisin
• the terms “artemisinin”, “ART”, “Art” are used interchangeably and encompass a well known compound having the chemical structure (1a).
• Basic moieties are capable of forming a wide variety of salts with various inorganic and organic acids.
• the acids that can be used to prepare pharmaceutically acceptable acid addition salts of such basic compounds are those that form non-toxic acid addition salts, e.g ., salts containing pharmacologically acceptable anions.
• Suitable organic acids include, but are not limited to, maleic, fumaric, benzoic, ascorbic, succinic, acetic, formic, oxalic, propionic, tartaric, salicylic, citric, gluconic, lactic, mandelic, cinnamic, oleic, tannic, aspartic, stearic, palmitic, glycolic, glutamic, gluconic, glucaronic, saccharic, isonicotinic, methanesulfonic, ethanesulfonic, p-toluenesulfonic, benzenesulfonic acids, or pamoic (e.g, 1,1’- methylene-bis-(2-hydroxy-3-naphthoate)) acids.
• pamoic e.g, 1,1’- methylene-bis-(2-hydroxy-3-naphthoate
• Suitable inorganic acids include, but are not limited to, hydrochloric, hydrobromic, hydroiodic, sulfuric, phosphoric, or nitric acids.
• Compounds that include an amine moiety can form pharmaceutically acceptable salts with various amino acids, in addition to the acids mentioned above.
• Chemical moieties that are acidic in nature are capable of forming base salts with various pharmacologically acceptable cations. Examples of such salts are alkali metal or alkaline earth metal salts and, particularly, calcium, magnesium, sodium, lithium, zinc, potassium, or iron salts.
• the term “pharmaceutically acceptable salt(s) of 5-aminolevulinic acid (2)” or “pharmaceutically acceptable salt(s) of methyl-5- aminolevulinic acid (2b)”, includes, but is not limited to, salts of acidic or basic moieties of compounds described herein.
• Basic moieties are capable of forming a wide variety of salts with various inorganic and organic acids.
• the acids that can be used to prepare pharmaceutically acceptable acid addition salts of such basic compounds are those that form non-toxic acid addition salts, e.g ., salts containing pharmacologically acceptable anions.
• Suitable organic acids include, but are not limited to, maleic, fumaric, benzoic, ascorbic, succinic, acetic, formic, oxalic, propionic, tartaric, salicylic, citric, gluconic, lactic, mandelic, cinnamic, oleic, tannic, aspartic, stearic, palmitic, glycolic, glutamic, gluconic, glucaronic, saccharic, isonicotinic, methanesulfonic, ethanesulfonic, p- toluenesulfonic, benzenesulfonic acids, or pamoic (e.g, 1 ,T-methylene-bis-(2-hydroxy- 3-naphthoate)) acids.
• pamoic e.g, 1 ,T-methylene-bis-(2-hydroxy- 3-naphthoate
• Suitable inorganic acids include, but are not limited to, hydrochloric, hydrobromic, hydroiodic, sulfuric, phosphoric, or nitric acids.
• Compounds that include an amine moiety can form pharmaceutically acceptable salts with various amino acids, in addition to the acids mentioned above.
• Chemical moieties that are acidic in nature are capable of forming base salts with various pharmacologically acceptable cations. Examples of such salts are alkali metal or alkaline earth metal salts and, particularly, calcium, magnesium, sodium, lithium, zinc, potassium, or iron salts.
• cocrystals As used herein, and unless otherwise specified, the term “cocrystals”, “pharmaceutically acceptable cocrystal(s) of artemisinin compound”, are crystalline materials composed of two or more different molecules, i.e. artemisin compound as active pharmaceutical ingredient (API) and cocrystal formers (“coformers”), in the same crystal lattice.
• API active pharmaceutical ingredient
• cocrystal formers cocrystal formers
• Co-crystal is a formation of mainly hydrogen bond between the drug molecule and co former so API regardless of acidic, basic, or ionisable groups could potentially be co crystallized. Cocrystallization can improve physiochemical properties like solubility, dissolution rate, chemical stability and melting point. Interactions which are responsible for the formation of co-crystals include hydrogen bonding, tt-stacking, and Van der Waals forces.
• the preferred coformer of cocrystal of artemisinin compound may include, but not be limited to nicotinamide, ascorbic acid, urea, tromethamine, theophylline, theophylline-7 - acetic acid, theobromine, sulfamide, sucrose, sorbitol, saccharin, pyridoxine, phloroglucinol, paracetamol, N-methylglucosamine, methanesulfonic acid, D-mannitol, malonic acid.
• the ternTsolvate means a compound that further includes a stoichiometric or non-stoichiometric amount of solvent bound by non-covalent intermolecular forces.
• the solvent may include, but not be limited to, alcohols such as ethanol, propanol, isopropanol, n-butanol, glycol, N-methyl-2- pyrrolidone, acetonitril, N,N'-dimethylformamide, dimethylsulfoxide, water. Where the solvent is water, the solvate is a hydrate.
• the terms “5-aminolevulinic acid”, “delta-aminolevulinic acid”, “ALA” and “5-ALA” are used interchangeably and encompass 5-amino-4-oxopentanoic acid of the chemical structure (2).
• the term “derivatives” includes chemically modified compounds, for example esters such as ALA esters. Such compounds are typically formed by modification of the 5-ALA carboxylic acid group.
• the term “derivatives” is also intended to encompass any 5-aminolevulinic acid compound wherein the 5-amino group may be substituted or unsubstituted.
• the term "derivatives" used in relation to 5-ALA includes compounds wherein - chemical modification occurs at either or both of the carboxylic acid or 5-amino group of ALA.
• Derivatives of 5-ALA are generally known and described in the prior art, e.g. in W096/28412, W002/10120 and W02005/092838.
• Preferred derivatives of 5-ALA for use in the invention are ALA esters, especially those esters of 5-ALA compounds in which the 5-amino group is unsubstituted.
• 5-aminolevulinic acid is a precursor to heme.
• 5-aminolevulinic acid goes through a series of transformations in the cytosol and is finally converted to Protoporphyrin IX inside the mitochondria.
• This protoporphyrin molecule chelates with iron in presence of enzyme ferrochelatase to produce Heme.
• Administration of 5-aminolevulinic acid can thus be used to increase intracellular heme levels and to increase intracellular iron concentrations.
• 5-Aminolevulinic acid can be administered as such or in any pharmaceutically acceptable physical form.
• 5- aminolevulinic acid can be in the form of a pharmaceutically acceptable salt or solvate.
• salts of 5-aminolevulinic acid will typically be derived from ALA or an ALA derivative and a mono-protic acid, e.g. a sulfonic acid such as methanesulfonic acid, thereby forming a 1:1 salt.
• salts may be formed between ALA or an ALA derivative and a di- or tri-protic acid, e.g. a sulfonic acid such as ethane-1 , 2-disulfonic acid, sulfuric acid or phosphoric acid.
• the resulting compound may have a stoichiometric ratio other than 1:1, for example 2:1 (ALA:acid) or 3:1 (ALA:acid), or may comprise a mixture of salts having varying levels of stoichiometry.
• a 2:1 (ALA:acid) salt may form whereas in the case of phosphoric acid a 3:1 (ALA:acid) salt may form.
• Polyprotic acids are also capable of forming other salts with ALA or an ALA derivative.
• Sulfuric acid may provide a 1:1 (ALA: acid) salt based on the HSO4 " anion and phosphoric acid may provide both a 2:1 (ALA: acid) and 1:1 (ALA: acid) salt (or combination thereof) based on the HPO4 2" and H2PO4 " anions, respectively.
• polyprotic acids can also form other salts, e.g. 1:1 salts, with ALA or its derivatives (e.g. with ALA esters) in the form of salts with other physiologically acceptable bases, such as sodium hydroxide, calcium hydroxide, potassium hydroxide and meglumine.
• Salts according to the invention preferably derive from an acid having a pKa of about 4 or less, more preferably about 3 or less.
• the acid may be inorganic or organic.
• Preferred inorganic acids include hydrobromic acid, hydrochloric acid, sulfuric acid, phosphoric acid and nitric acid.
• Preferred organic acids include sulfonic acid and sulfonic acid derivatives. Those salts derived from hydrochloric acid, nitric acid, sulfonic acid and sulfonic acid derivatives are especially preferred.
• the term "sulfonic acid” is intended to include any organic compound containing at least one -SO3H group. Preferably, this may comprise 1, 2 or 3 -SO3H groups, most preferably 1 or 2, e.g. 1.
• derivatives When used in relation to sulfonic acid, the term “derivatives” is intended to encompass any such compounds containing at least one (preferably 1, 2 or 3 , most preferably 1 or 2, e.g. 1) -SO 3 X group (where X is a physiologically tolerable cation, such as a sodium, calcium, potassium, magnesium or meglumine cation).
• treating encompasses to reversing, alleviating or inhibiting the progress of a disease, disorder or condition, or improvement of one or more symptoms of such disease, disorder or condition, to which such term applies.
• treating or “treatment” may also refer to decreasing the probability or incidence of the occurrence of a disease, disorder or condition in a mammal as compared to an untreated control population, or as compared to the same mammal prior to treatment.
• treating may refer to preventing a disease, disorder or condition, and may include delaying or preventing the onset of a disease, disorder or condition, or delaying or preventing the symptoms associated with a disease, disorder or condition.
• treating may also refer to reducing the severity of a disease, disorder or condition or symptoms associated with such disease, disorder or condition prior to a mammal's affliction with the disease, disorder or condition. Such prevention or reduction of the severity of a disease, disorder or condition prior to affliction relates to the administration of the composition of the present invention, as described herein, to a subject that is not at the time of administration afflicted with the disease, disorder or condition.
• the term “treating” may also refer to preventing the recurrence of a disease, disorder or condition or of one or more symptoms associated with such disease, disorder or condition.
• treatment and “therapeutically,” as used herein, refer to the act of treating, as “treating” is defined above.
• a disease, disorder is a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non small cell lung cancer, preferably barin cancer, in particular glioblastoma.
• the effective amount of active compound(s) used to practice the present invention for therapeutic treatment of a disease varies depending upon the manner of administration, the age, body weight, and general health of the subject. Ultimately, the attending physician or veterinarian will decide the appropriate amount and dosage regimen. Such amount is referred to as an "effective" amount.
• patient or "subject,” as used herein, refers to a mammalian subject (primates (e.g.
• the present method may be used for treating a patient who suffers from multiple sclerosis, e.g. with any symptoms as discussed above. In another embodiment, the present method may also be used to prevent a perspective patient from getting glioblastoma.
• Glioblastoma also known as glioblastoma multiforme (GBM)
• GBM glioblastoma multiforme
• the glioblastoma has the subtypes proneural (PN), mesenchymal (MES), and classical (CL) glioblastoma. Therefore, in one embodiment, the glioblastoma is preferably selected from subtypes proneural (PN), mesenchymal (MES), and classical (CL) glioblastoma.
• the applicant conducted a screen to identify targets of artemisinin in haploid murine stem cells (haESC) using genome-wide mutagenesis [Figure 1 A].
• the applicant determined LD-values for the compound in wildtype haESCs and assessed growth rates in different murine tumor cell lines [ Figure 5A, 5B]
• the applicant used two targeting systems for insertional mutagenesis: Retrovirus and Tol2 transposons ⁇ Schniitgen, F. et al. Enhanced gene trapping in mouse embryonic stem cells. Nucleic Acids Research 36, e133-e133 (2008) ⁇ . Selection of those independent libraries led to the recovery of Artemisinin resistant colonies from the mutagenized cell pools, but not from control cells.
• LEF loss-of-function
• PPOX protoporphyrinogen oxidase
• the applicant tested single mutant ESC clones for their susceptibility to artemisinin. Individual colonies were recovered from both mutant libraries directly from the screen and used to establish single cell lines. From these, the applicant generated labelled wild-type (mCherry_ Cre) and knockout (GFP) sister cell clones (via Cre-recombinase- mediated reversion of the knock-out cassette) and monitored their relative growth rates each in presence of artemisinin. While ratios of mixed labelled cells were constant in absence of the compound or control cells, artemisinin exposure resulted in selective loss of wild-type (mCherry_Cre) and strong expansion of knockout cells (GFP).
• mCherry_ Cre wild-type
• GFP knockout
• Insertion site mapping of resistant cells confirmed disruption of porphyrin biosynthesis pathway components [Figure 1 D] These results ratify that mutations of enzymes of the porphyrin biosynthesis pathway induce artemisinin resistance in mouse ESCs.
• the applicant used the pharmacological inhibitor of porphyrin production or heme biosynthesis, the protoporphyrinogen oxidase (PPOX) inhibitor acifluorfen, which blocks conversion of protoporphyrinogen IX to protoporphyrin IX, and observed increased resistance to artemisinin in mouse ESCs [ Figure 2A] ⁇ Witkowski, D. A. & Flailing, B. P. Inhibition of plant protoporphyrinogen oxidase by the herbicide acifluorfen-methyl. Plant Physiol. 90, 1239-1242 (1989) ⁇ .
• Intraoperative fluorescence-guided resection of high-grade malignant gliomas using 5- aminolevulinic acid-induced porphyrins a systematic review and meta-analysis of prospective studies. PloS one 8, e63682 (2013) ⁇ .
• oral or intravenous administration of 5-ALA is used to discriminate malignant tumor tissue from healthy brain matter, as fluorescent protoporphyrins, such as protoporphyrin IX, accumulate specifically in tumor cells ⁇ Marbacher, S. et at.
• Neurosurg Focus 36, E10 (2014). ⁇ The applicant thus assessed if endogenously altered porphyrin biosynthesis in brain cancer can be therapeutically exploited, using a combination of 5-ALA and artemisinin.
• the applicant used a recently established human cerebral tumor organoid model, that is based on genetic manipulation of neuronal precursors in the course of brain organoid development, thus recapitulating important aspects of human tumor formation in vitro ⁇ Lancaster, M. A. et at. Cerebral organoids model human brain development and microcephaly. Nature 501, 373-379 (2013). ⁇ .
• Tumor cells are simultaneously labelled with GFP, allowing spatial monitoring over time and in vitro compound profiling in human cerebral tumor organoids [Figure 3A]
• the applicant first assessed growth rates in presence of artemisinin and 5-ALA in a central nervous system primitive neuroectodermal tumor (CNS-PNET)-like neoplasm model, which is based on the overexpression of the c-MYC oncogene ⁇ Bian, S. et at. Genetically engineered cerebral organoids model brain tumor formation. Nat.
• CNS-PNET central nervous system primitive neuroectodermal tumor
• 5-ALA is used clinically for the diagnosis and therapy of human glioblastomas
• the applicant unambiguously delineates the requirement of porphyrin biosynthesis as the critical endogenous pathway for artemisinin-triggered cytotoxicity in eukaryotic cells.
• the applicant Using a high-throughput genetic screening system, the applicant has identified mitochondrial function and more specifically porphyrin/heme biosynthesis, to be required for the activity of this anti-malarial and anti-cancer compound.
• Genetic as well as pharmacological modulation of porphyrin production was sufficient to modulate artemisinin toxicity, as well as control the levels of artemisinin-induced reactive oxygen species, in multiple cellular contexts and different species.
• heme biosynthesis induction alone slightly elevated cellular ROS levels, sensitizing for artemisinin-induced toxicity.
• the applicant shows in several independent in vitro human cerebral tumor organoid and spheroid model systems, that the applicant can specifically target brain cancer cells, in particular, human glioblastomas, using combination treatment of 5-ALA and artemisinin to induce cell death.
• ART artemisinin
• 5-aminolevulinic acid 5-aminolevulinic acid
• ART artemisinin
• 5-ALA 5-aminolevulinic acid
• the applicant next assessed whether this synergy extends to other ART derivates, additional cancer types, and whether this double combination is synergistic to currently applied cancer treatment regiments, particularly chemotherapy.
• ART itself and the most commonly used ART derivates, dihydroartemisinin (DHA) and artesunate (ARS), in combination with 5-ALA show strongly synergistic, antiproliferative effects on multiple glioblastoma cell lines as well as the highly proliferative mouse embryonic stem cells (ESC, Figure 12). From these data the applicant derived cell- type and compound-specific dose combinations for the following analyses.
• DHA dihydroartemisinin
• ARS artesunate
• Glioblastoma multiforme is a highly aggressive cancer currently treated by maximal surgery resection, followed by radiotherapy plus concomitant and maintenance temozolomide (TMZ) treatment.
• TMZ concomitant and maintenance temozolomide
• the inventors have shown that combination of TMZ with 5-ALA plus ART or DHA is more effective than all possible double combinations in all glioblastoma lines tested ( Figure 13). In ESC for example, only the double combination of DHA and 5-ALA elicits a cytotoxic effect of TMZ, indicating clear synergy.
• Lomustine is an alternative to TMZ in the treatment of brain cancers and, like for TMZ, its cytostatic effects can be particularly strengthened by combination with ART plus 5-ALA as compared to all possible double combinations (Figure 15).
• ART/DHA/ARS chemotherapeutic agents
• carboplatin triptolide
• homoharringtonin dactinomycin
• doxorubicin epirubicin
• vinorebine temozolomide
• lomustine 5-fluorouracil
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug for use in prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer and especially glioblastoma.
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug for use in prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer and especially glioblastoma.
• an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocry
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug for use in prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer and especially glioblastoma.
• chemotherapeutic agent preferably one anti-glioblastoma drug for use in prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer and especially glioblastoma.
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug for use in prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer and especially glioblastoma.
• an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vin
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxyadeno
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine
• a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer
• brain cancer more preferably, glioblastoma
• a molar ratio of the artemisinin compound and the 5-aminolevulinic acid is in a range of 1 :5 to 1 :5000, preferably 1 :5 to 1:1000, more preferably 1 :5 to 1 :500, still more preferably 1:10 to 1:250, most preferably 1:10 to 1:100 in the pharmaceutical composition.
• a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer, preferably, brain cancer, more preferably, glioblastoma
• a molar ratio of the artemisinin compound and the methyl-5-aminolevulinic acid is in a range of 1:5 to 1:5000, preferably 1:5 to 1:1000, more preferably 1:5 to
• the pharmaceutical composition according to the invention comprise an artemisinin compound or a pharmaceutically acceptable salt, cocrystal, solvate thereof and 5- aminolevulinic acid or methyl-5-aminolevulinic acid and preferably 5-aminolevulinic acid and one chemotherapeutic agent, preferably one anti-glioblastoma drug as only active ingredients especially for the treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non-small cell lung cancer, preferably brain cancer and more preferably glioblastoma.
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• a pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of the pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer,
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of the pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of the pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug.
• an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt,
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of the pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharrington
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of the pharmaceutical composition comprising a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin,
• the present invention relates to a method for the prophylaxis and/or treatment of a cancer selected from hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer, and especially glioblastoma comprising administering to a patient in need thereof a therapeutically effective amount of the pharmaceutical composition comprising a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carbo
• the pharmaceutical composition according to the present invention further comprises pharmaceutically acceptable carrier, excipient and/or diluent.
• the pharmaceutical compositions of the present invention can be prepared in a conventional solid or liquid carrier or diluent and a conventional pharmaceutically made adjuvant at suitable dosage level in a known way.
• compositions according to the present invention will typically be administered together with suitable acceptable carrier selected with respect to the intended form of administration, i.e. for oral administration in the form of tablets, capsules (either solid filled, semi-solid filled or liquid filled), powders for constitution, gels, elixirs, dispersable granules, syrups, suspensions, and the like, and consistent with conventional pharmaceutical practices.
• suitable acceptable carrier selected with respect to the intended form of administration, i.e. for oral administration in the form of tablets, capsules (either solid filled, semi-solid filled or liquid filled), powders for constitution, gels, elixirs, dispersable granules, syrups, suspensions, and the like, and consistent with conventional pharmaceutical practices.
• the active drug component may be combined with any oral non-toxic pharmaceutically acceptable carrier, preferably with an inert carrier like lactose, starch, sucrose, cellulose, magnesium stearate, dicalcium phosphate, calcium sulfate, talc, mannitol, ethyl alcohol (liquid filled capsules) and the like.
• suitable binders, lubricants, disintegrating agents and coloring agents may also be incorporated into the tablet or capsule.
• Powders and tablets may contain about 5 to about 95-weight % of the derivatives according to the general formula (I) or analogues compound thereof or the respective pharmaceutically active salt as active ingredient.
• Suitable binders include starch, gelatin, natural sugars, corn sweeteners, natural and synthetic gums such as acacia, sodium alginate, carboxymethylcellulose, polyethylene glycol and waxes.
• suitable lubricants there may be mentioned boric acid, sodium benzoate, sodium acetate, sodium chloride, and the like.
• Suitable disintegrants include starch, methylcellulose, guar gum, and the like. Sweetening and flavoring agents as well as preservatives may also be included, where appropriate. The disintegrants, diluents, lubricants, binders etc. are discussed in more detail below.
• compositions of the present invention may be formulated in sustained release form to provide the rate controlled release of any one or more of the components or active ingredients to optimise the therapeutic effect(s), e.g. anti cancer activity or activity against cancer metastases and the like.
• Suitable dosage forms for sustained release include tablets having layers of varying disintegration rates or controlled release, polymeric matrices impregnated with the active components and shaped in tablet form or capsules containing such impregnated or encapsulated porous polymeric matrices.
• Liquid form preparations include solutions, suspensions, and emulsions. As an example, there may be mentioned water or water/propylene glycol solutions for parenteral injections or addition of sweeteners and opacifiers for oral solutions, suspensions, and emulsions. Liquid form preparations may also include solutions for intranasal administration.
• Aerosol preparations suitable for inhalation may include solutions and solids in powder form, which may be present in combination with a pharmaceutically acceptable carrier such as an inert, compressed gas, e.g. nitrogen.
• a pharmaceutically acceptable carrier such as an inert, compressed gas, e.g. nitrogen.
• a low melting wax such as a mixture of fatty acid glycerides like cocoa butter is melted first, and the active ingredient is then dispersed homogeneously therein e.g. by stirring. The molten, homogeneous mixture is then poured into conveniently sized moulds, allowed to cool, and thereby solidified.
• solid form preparations which are intended to be converted, shortly before use, to liquid form preparations for either oral or parenteral administration.
• liquid forms include solutions, suspensions, and emulsions.
• capsule refers to a specific container or enclosure made e.g. of methylcellulose, polyvinyl alcohols, or denatured gelatins or starch for holding or containing compositions comprising the active ingredient(s).
• Capsules with hard shells are typically made of blended of relatively high gel strength gelatins from bones or pork skin.
• the capsule itself may contain small amounts of dyes, opaquing agents, plasticisers and/or preservatives.
• a compressed or moulded solid dosage form which comprises the active ingredients with suitable diluents.
• the tablet may be prepared by compression of mixtures or granulations obtained by wet granulation, dry granulation, or by compaction well known to a person of ordinary skill in the art.
• Oral gels refer to the active ingredients dispersed or solubilised in a hydrophilic semi solid matrix.
• Powders for constitution refers to powder blends containing the active ingredients and suitable diluents which can be suspended e.g. in water or in juice.
• suitable diluents are substances that usually make up the major portion of the composition or dosage form.
• Suitable diluents include sugars such as lactose, sucrose, mannitol, and sorbitol, starches derived from wheat, corn, rice, and potato, and celluloses such as microcrystalline cellulose.
• the amount of diluent in the composition can range from about 5 to about 95 % by weight of the total composition, preferably from about 25 to about 75 weight %, and more preferably from about 30 to about 60 weight %.
• disintegrants refers to materials added to the composition to support break apart (disintegrate) and release the pharmaceutically active ingredients of a medicament.
• Suitable disintegrants include starches, “cold water soluble” modified starches such as sodium carboxymethyl starch, natural and synthetic gums such as locust bean, karaya, guar, tragacanth and agar, cellulose derivatives such as methylcellulose and sodium carboxymethylcellulose, microcrystalline celluloses, and cross-linked microcrystalline celluloses such as sodium croscaramellose, alginates such as alginic acid and sodium alginate, clays such as bentonites, and effervescent mix tures.
• the amount of disintegrant in the composition may range from about 2 to about 20 weight % of the composition, more preferably from about 5 to about 10 weight %.
• Binders are substances which bind or “glue” together powder particles and make them cohesive by forming granules, thus serving as the “adhesive” in the formulation. Binders add cohesive strength already available in the diluent or bulking agent. Suitable binders include sugars such as sucrose, starches derived from wheat, corn, rice and potato, natural gums such as acacia, gelatin and tragacanth, derivatives of seaweed such as alginic acid, sodium alginate and ammonium calcium alginate, cellulose materials such as methylcellulose, sodium carboxymethylcellulose and hydroxypropylmethylcellulose, polyvinylpyrrolidone, and inorganic compounds such as magnesium aluminum silicate. The amount of binder in the composition may range from about 2 to about 20 weight % of the composition, preferably from about 3 to about 10 weight %, and more preferably from about 3 to about 6 weight %.
• Lubricants refer to a class of substances which are added to the dosage form to enable the tablet granules etc. after being compressed to release from the mould by reducing friction or wear.
• Suitable lubricants include metallic stearates such as magnesium stearate, calcium stearate, or potassium stearate, stearic acid, high melting point waxes, and other water soluble lubricants such as sodium chloride, sodium benzoate, sodium acetate, sodium oleate, polyethylene glycols and D,L-leucine. Lubricants are usually added at the very last step before compression, since they must be present at the surface of the granules.
• the amount of lubricant in the composition may range from about 0.2 to about 5 weight % of the composition, preferably from about 0.5 to about 2 weight %, and more preferably from about 0.3 to about 1.5 weight % of the composition.
• Glidents are materials that prevent caking of the components of the pharmaceutical composition and improve the flow characteristics of granulate so that flow is smooth and uniform.
• Suitable glidents include silicon dioxide and talc.
• the amount of glident in the composition may range from about 0.1 to about 5 weight % of the final composition, preferably from about 0.5 to about 2 weight %.
• Coloring agents are excipients that provide coloration to the composition or the dosage form. Such excipients can include food grade dyes adsorbed onto a suitable adsorbent such as clay or aluminum oxide.
• the amount of the coloring agent may vary from about 0.1 to about 5 weight % of the composition, preferably from about 0.1 to 1 weight %.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug, and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one chemotherapeutic agent, preferably one anti-glioblastoma drug; and d) a pharmaceutically acceptable carrier, excipient and/or diluent.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate,
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincri
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2), methyl-5-aminolevulinic acid (2b), or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincris
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; and b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxya
• the present application relates preferably to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) an artemisinin compound (1) selected from the group consisting of artemisinin (1a), dihydroarteminisin (1b), and artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazo
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or artesunate (1e), or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine,
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artesunate (1e) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, de
• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising or consisting of a) artemisinin (1a) or a pharmaceutically acceptable salt, cocrystal, or solvate thereof; b) 5-aminolevulinic acid (2) or a pharmaceutically acceptable salt or solvate thereof; and c) at least one anti-glioblastoma drug selected from the group comprising or consisting of temozolomide, dexamethasone, lomustine, methotrexate, everolimus, carmustine, cyclophosphamide, cisplatin, carboplatin, 5- fluorouracil, triptolide, homoharringtonin, dactinomycin, doxorubicin, epirubicin, idarubicin, ribavirin, topotecan, flubendazole, itraconazole, vindesine sulfate, cerivastatin, vincristine, vinorebine, nisoldipine, deoxy
• the pharmaceutical composition according to the present invention may be admistered in combination with a radiotherapy, immunotherapy, electromagnetic field therapy, hyperthermia therapy, chemotherapy, cancer immunotherapy and/or a small molecule based therapy.
• the pharmaceutical composition according to the present invention is used for prophylaxis and/or treatment of hematopoietic cancers, brain cancer, pancreatic cancer, liver cancer, breast cancer, and lung cancer such as non small cell lung cancer, preferably brain cancer, more preferably, glioblastoma preferably in combination with only one chemotherapeutic agent, preferably only one anti glioblastoma drug, wherein the one chemotherapeutic agent, preferably the one anti glioblastoma drug is selected from temozolomide.
• fixed combination means that the active ingredients, e.g. a compound of formula 1 and a combination partner, i.e. an anticancer agent, are both administered to a patient simultaneously in the form of a single entity or dosage.
• the active ingredients are present in one dosage form, e.g. in one tablet or in one capsule.
• non-fixed combination means that the active ingredients, e.g. a compound of formula 1 and a combination partner, i.e. an anticancer agent, are both administered to a patient as separate entities either simultaneously, concurrently or sequentially with no specific time limits, wherein such administration provides therapeutically effective levels of the two compounds in the body of a mammal or human in need thereof.
• a combination partner i.e. an anticancer agent
• cocktail therapy e.g. the administration of three or more anticancer agents.
• Said pharmaceutical combination may be administered independently at the same time or separately within time intervals, especially here these time intervals allow that the combination partners show a synergistic effect.
• the term "synergistic effect” means a therapeutic effect observed following administration of two or more active ingredients (e.g., one artemisinin compound, 5-ALA, at least one chemotherapeutic agent or preferably the at least one anti-glioblastoma drug) that is greater than the effect obtained by the administration of each single active ingredient.
• active ingredients e.g., one artemisinin compound, 5-ALA, at least one chemotherapeutic agent or preferably the at least one anti-glioblastoma drug
• antioxidantgistic increase is meant the combination of two or more active ingredients (e.g., one artemisinin compound, 5-ALA, at least one anti-glioblastoma drug) that results in an increase in cancer cell death that exceeds just an additional effect expected by the co-administration of the active ingredients.
• active ingredients e.g., one artemisinin compound, 5-ALA, at least one anti-glioblastoma drug
• synergistic decrease is meant the combination of two or more active ingredients (e.g., one artemisinin compound, 5-ALA, at least one anti-glioblastoma drug) that results in a decrease in one or more symptoms of a cancer that is greater than just an additional effect expected by the co-administration of the active ingredients.
• active ingredients e.g., one artemisinin compound, 5-ALA, at least one anti-glioblastoma drug
• a therapeutic effect is observed for the combination of two or more active ingredients, wherein one or more of the active ingredients are present at a dose that is normally non-therapeutic.
• the combination of two or more active ingredients results in an unexpected decrease in toxicity (i.e. , a level of toxicity that is less than the sum of the toxicity observed following administration of the single agents).
• a synergistic effect can also be obtained by combining the administration of the pharmaceutical composition according to the present invention with a treatment by radiotherapy, immunotherapy, electromagnetic field therapy, hyperthermia therapy, chemotherapy, cancer immuntherapy or, as outlined above, any other small molecule based therapy.
• the pharmaceutical composition is used in a form of tablet, capsule, syrup, solution, suspension, emulsion, or gel.
• the pharmaceutical composition is administered by oral or parenteral application.
• the preferred preparations are adapted for oral application. These administration forms include, for example, pills, tablets, film tablets, coated tablets, capsules, powders and deposits.
• the parenteral application includes dermal, intradermal, intragastral, intracutaneous, intravasal, intravenous, intramuscular, intraperitoneal, intranasal, intravaginal, intrabuccal, percutan, rectal, subcutaneous, sublingual, topical, or transdermal application.
• the parenteral application includes intradermal, intragastral, intracutaneous, intravasal, intravenous, intramuscular, subcutaneous, sublingual, topical, transdermal application and inhalation.
• the transdermal compositions may have the form of a cream, a lotion, an aerosol and/or an emulsion and may be included in a transdermal patch of the matrix or reservoir type as is known in the art for this purpose.
• capsule refers to a specific container or enclosure made e.g. of methyl cellulose, polyvinyl alcohols, or denatured gelatines or starch for holding or containing compositions comprising the active ingredient(s).
• Capsules with hard shells are typically made of blended of relatively high gel strength gelatines from bones or pork skin.
• the capsule itself may contain small amounts of dyes, opaquing agents, plasticisers and/or preservatives.
• Under tablet a compressed or moulded solid dosage form is understood which comprises the active ingredients with suitable diluents.
• the tablet may be prepared by compression of mixtures or granulations obtained by wet granulation, dry granulation, or by compaction well known to a person of ordinary skill in the art.
• Oral gels refer to the active ingredients dispersed or solubilised in a hydrophilic semi solid matrix.
• Powders for constitution refers to powder blends containing the active ingredients and suitable diluents which can be suspended e.g. in water or in juice.
• compositions of the present invention may be formulated in sustained release form to provide the rate controlled release of any one or more of the components or active ingredients to optimise the therapeutic effect(s), e.g. anti cancer activity and the like.
• Suitable dosage forms for sustained release include tablets having layers of varying disintegration rates or controlled release polymeric matrices impregnated with the active components and shaped in tablet form or capsules containing such impregnated or encapsulated porous polymeric matrices.
• the artemisininin compound, in particular artemisinin (1a), contained in the pharmaceutical composition is administered in a range of 0.01 to 100 mg/kg, preferred, 0.1 to 100 mg/kg, more preferred 0.1 to 50 mg/kg, most preferred 0.1 to 15 mg/kg per body weight per day and the 5-aminolevulinic acid is administered in a range of 0.01 to 200 mg/kg, preferred, 0.1 to 200 mg/kg, more preferred 0.1 to 50 mg/kg, most preferred 1 to 50 mg/kg per body weight per day.
• the dose of the invention regarding the artemisinin compound, in particular artemisinin is administered at least 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, 0.40, 0.45, 0.50, 0.55, 0.60, 0.65, 0.70, 0.75, 0.80, 0.85, 0.90, 0.95, 1.00, 1.05, 1.10, 1.15, 1.20, 1.25, 1.30, 1.35, 1.40, 1.45, 1.50, 2.00, 2.50, 3.00, 3.50, 4.00, 4.50, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10.0, 10.5, 11.0, 11.5, 12.0, 12.5, 13.0, 13.5, 14.0, 14.5 or 15.0 mg/kg artemisinin per body weight per day.
• the dose of the invention regarding 5-aminolevulinic acid is administered at least 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, 0.40, 0.45, 0.50, 0.55, 0.60, 0.65, 0.70, 0.75,
• the pharmaceutical composition is used for prophylaxis and/or treatment of glioblastoma preferably in combination with the at least one chemotherapeutic agent, preferably at least one anti-glioblastoma drug, wherein the at least one anti-glioblastoma drug is administered in a range of 0.01 to 100 mg/kg per body weight per day.
• the dose of the invention regarding chemotherapeutic agent preferably the anti-glioblastoma drug is administered at least 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, 0.40, 0.45, 0.50, 0.55, 0.60, 0.65, 0.70, 0.75, 0.80, 0.85, 0.90, 0.95, 1.00, 1.05, 1.10, 1.15, 1.20, 1.25, 1.30, 1.35, 1.40, 1.45, 1.50, 2.00, 2.50, 3.00, 3.50, 4.00, 4.50, 5.0, 5.5, 6.0,
• chemotherapeutic agent or anti-glioblastoma drug respectively per body weight per day.
• compositions include, but are not limited to, solutions ready for injection, dry products ready to be dissolved or suspended in a pharmaceutically acceptable vehicle for injection, suspensions ready for injection, and emulsions.
• Suitable vehicles that can be used to provide pharmaceutical compositions for parenteral administration include, but are not limited to: Water for Injection USP; aqueous vehicles such as, but not limited to, sodium chloride injection, Ringer’s injection, dextrose injection, dextrose and sodium chloride injection, and lactated Ringer’s injection; water-miscible vehicles such as, but not limited to, ethyl alcohol, polyethylene glycol, and polypropylene glycol; and non-aqueous vehicles such as, but not limited to, corn oil, cottonseed oil, peanut oil, sesame oil, ethyl oleate, isopropyl myristate, and benzyl benzoate.
• aqueous vehicles such as, but not limited to, sodium chloride injection, Ringer’s injection, dextrose injection, dextrose and sodium chloride injection, and lactated Ringer’s injection
• water-miscible vehicles such as, but not limited to, ethyl alcohol, polyethylene
• Suitable dosages of the active ingredients may be determined by a skilled medical practitioner. Actual dosage levels of the active ingredients may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient. Thus, the dosage is typically an effective or therapeutically effective dosage.
• the selected dosage level will depend upon a variety of pharmacokinetic factors including the activity of the particular compositions of the present invention employed, the route of administration, the time of administration, the rate of excretion of the particular compound being employed, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular compositions employed, 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.
• Dosage regimens may be adjusted to provide the optimum desired response. For example, a single dose may be administered (e.g. a single dose daily), several divided doses may be administered over time or the dose may be proportionally reduced or increased as indicated by the exigencies of the therapeutic situation.
• Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the subjects to be treated; each unit contains a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier.
• the active ingredients may each, for example, be present at a concentration of between 0.001 and 20% by weight, relative to the total weight of the composition or product, preferably between 0.01 and 10%, more preferably between 0.02 and 5% by weight, and more preferably still between 1 and 4% by weight.
• each of the three active ingredients is present at a concentration of between 1 and 3% by weight.
• the artemisinin compound in particular the artemisinin is formulated for administration at 50 to 500 mg (more preferably 100 to 300 mg such as about 200 mg) daily (based on a body weight of approximately 70 kg; dosages can be adjusted proportionally by body weight).
• the artemisinin is formulated for oral or parenteral administration.
• the artemisinin compound in particular the artemisinin is administered for a period of 3 to 30 days, more preferably 10 to 20 days, such as about 14 days.
• This period may correspond to a cycle of treatment in an administration regime that comprises multiple such cycles of treatment (e.g. at least two, three, four, five, six, or more cycles, for example with such cycles continuing until the desired therapeutic results have been achieved).
• Each cycle of treatment may be separated by a break in the artemisinin compound, in particular artemisinin administration; such a break may, for example, allow for bone marrow recovery.
• the break in administration may comprise not administering the artemisinin compound, in particular the artemisinin for a period of 3 to 14 days, more preferably 5 to 10 days, such as about 7 days.
• the artemisininin compound in particular the artemisinin is administered at about 200 mg daily for a cycle of treatment of two weeks, with each cycle being followed by a one week break.
• said pharmaceutical composition is used for prophylaxis and/or treatment of glioblastoma preferably in combination a radiotherapy, immunotherapy, electromagnetic field therapy and/or hyperthermia therapy.
• said pharmaceutical composition is used for prophylaxis and/or treatment of glioblastoma wherein the glioblastoma is selected from subtypes proneural (PN), mesenchymal (MES), and classical (CL) glioblastoma.
• PN subtypes proneural
• MES mesenchymal
• CL classical
• Figure 1 Haploid screening in mouse stem cells delineates porphyrin biosynthesis as a prerequisite for artemisinin toxicity in mammalian cells.
• Wild-type (mCherry+_ Cre) and knockout (GFP+) sister clones were derived from mutant (retrovirus - intron RE, darker shading, Tol2 transposon - intron T2, lighter shading) resistant colonies, treated with artemisinin, analysed with flow cytometry and sanger sequenced for insertion site mapping.
• Figure 2 Modulation of porphyrin biosynthesis is sufficient to alter artemisinin toxicity in cells via ROS generation.
• A B Cell survival of Artemisinin treated mouse embryoni stem cells in combination with A the Ppox inhibitor acifluorfen or B 5-ALA (0.5mM). Alamar Blue staining was used to assess viability after 48 h of treatment.
• C Cell viability of artemisinin treated mouse breast cancer cells (4T1) in presence and absence of 5-ALA (0.5mM). Alamar Blue was used to determine cell survival after 48 h of treatment.
• FIG. 3 Cerebral tumor organoids (CNS-PNET) display increased sensitivity to artemisinin and 5-ALA combination therapy.
• Figure 4 Human glioblastoma-like neoplastic organoid models display increased sensitivity to artemisinin and 5-ALA combination therapy.
• B Image analysis and quantification of treated organoids. Area of GFP-positive tumor cells on d11 was normalized to d1. Data is shown as box plots (25 th -75 th percentiles, median) n 4.
• C Representative brightfield images of 5-ALA and artemisinin treated patient derived glioblastoma spheroids (VBT92). Images were taken on day 3 of culture and treatment..
• FIG. 5 (related to Figure 1): Artemisinin titration curves and an overview of the porphyrin biosynthesis pathway.
• A B Cell survival of artemisinin treated A mouse ESCs and B primary (MEF p3) fibroblasts, as well as mouse (B16F10, 4T1) and human (MDA-MB-231 , Mcf7, Panel ) cancer cells. Viability was assessed after 48h of treatment using Alamar Blue staining.
• C Porphyrin biosynthesis pathway component integrations sites from artemisinin screens. Genomic locations and targeted introns as well as exons of porphyrin biosynthesis genes (i.e. enzymes, bold), as well as retroviral (upper panel) or Tol2 transposon (lower panel) integrations sites (vertical bars) on the forward (black) and reverse (grey) strand are shown.
• Figure 6 Effects of Artemisinin and 5-ALA combination treatment on survival, ROS production and mitochondrial membrane potential in cancer cell lines
• B C Cell survival of artemisinin treated primary human glioblastoma cells in presence or absence of 5-ALA.
• CellTiter- Glo was used to assess viability, 72h. Values are mean ⁇ SD.
• D E ROS / DHE staining and flow cytometry analysis of piperlongumine or artemisinin treated D Jurkat and E HL- 60 cells (48h).
• JC-1 negative cells have impaired mitochondrial membrane potential associated with apoptotic cell death. DHE fluorescence, relative cell numbers and percentage of JC-1 negative cells were assessed using high throughput flow cytometry and automated cell counting. All experiments were performed in triplicate and repeated once (JC-1) or twice (DHE, cell survival). Values are mean ⁇ SD.
• FIG. 7 Cancer cell population in CNS-PNET tumor organoids displays high sensitivity to artemisinin and 5-ALA combination therapy.
• Figure 8 Staining of CNS-PNET tumor organoid sections following artemisinin and 5-ALA treatment. Representative fluorescent (anti-GFP, DAPI) and FI&E (haematoxylin & eosin stained) images of fixed cryo-sections of control and treated tumor organoids. Regions of rosette-like strucutres (R) or tumor tissue (T) are indicated and magnified (6.8x). Scale bar 500mM.
• Figure 9 (related to Figure 3): Analysis of CNS-PNET tumor organoids following artemisinin and 5-ALA treatment A Representative FACS plots of ROS / DFIE stained dissociated tumor organoids. Flow cytometry analyses (PE, 582/15 nm) of GFP+ tumor cells and GFP- wild-type cells are shown. B Representative microscopy images of yFI2AX, GFP and DAPI stained tumor organoid sections. Scale bar 50mM. C Representative images and analysis masks of yFI2AX stained and scanned tumor organoid slides.
• Figure 10 (related to Figure 3): Continued analysis of CNS-PNET tumor organoids following artemisinin and 5-ALA treatment A Quantification of Caspase 3 (Casp3) and B Ki67-positive cells in 5-ALA and artemisinin treated tumor organoids. Per condition and group, 3 organoids, 6 sections each, were stained with Caspase3 or Ki67, imaged using a high-magnification fluorescent scanner, and 25 regions of interest (ROI 2.500pm 2 ) were chosen and analysed. The numbers of Casp3 or Ki67 positive cells were normalised to the analysed area (per ROI, GFP+ or GFP-) and are shown as box plots (median, 25th-75th percentiles).
• FIG. 1 Representative images of anti-Casp3, anti-GFP and DAPI stained sections. Scale bar 50pm.
• Figure 11 (related to Figure 4): Artemisinin and 5-ALA combination treatment of human glioblastoma-like neoplastic organoid models A Fluorescence images of 5- ALA and artemisinin treated cerebral tumor organoids. Organoids were monitored on d1, d5, d8 and d11. Scale bar 500pm. B Image analysis and quantification of GFP- positive tumor area of treated organoids. Organoids were analysed on d8 and normalized to d1. Data is shown as box plots (25 th -75 th percentiles, median).
• FIG 12 Artemisinsin (ART) and its derivatives Dihydroartemisinin (DHA) and Artesunate (ARS) exert synergistic antiproliferative effects on glioblastoma cell lines and mouse embryonic stem cells (ESC) when combined with 5- Aminolevulinic acid (5-ALA).
• ART Artemisinsin
• DHA Dihydroartemisinin
• ARS Artesunate
• FIG. 13 ART or DHA combined with 5-ALA increases the antiproliferative effect of Temozolomide (TMZ) treatment in glioblastoma cell lines and ESC.
• TTZ Temozolomide
• FIG 14 ARS combined with 5-ALA or Methyl-5-ALA increases the antiproliferative effect of Temozolomide (TMZ) treatment in glioblastoma cell lines and ESC.
• 5-ALA is more potent than Methyl-5-ALA in this setup.
• Figure 15 ART combined with 5 -ALA increases the antiproliferative effect of Lomustine (CCNU) treatment in glioblastoma cell lines and ESC.
• CCNU Lomustine
• CP cisplatin
• 5-FU 5-Fluorouracil
• A-L Cell survival of 5-ALA treated lung cancer lines in combination with the indicated A, D, G, J ART doses, or B, E, H, K, DHA doses, or C, F, I, L, ARS doses and either cisplatin (A-F) or 5-FU (G-L) conditioning compared to untreated controls.
• Values are Mean +SEM from > 4 Independent experiments. Dotted lines mark 100% survival and the survival upon chemotherapeutic (cisplatin or 5-FU) treatment only.
• Figure 17 ART, DHA, or ARS combined with 5-ALA increases the antiproliferative effect of cisplatin (CP) and 5-Fluorouracil (5-FU) treatment in HepG2 cells (liver cancer).
• CP cisplatin
• 5-Fluorouracil (5-FU) 5-Fluorouracil
• Figure 18 ART, DHA, or ARS combined with 5-ALA increases the antiproliferative effect of cisplatin and 5-fluorouracil (5-FU) treatment in MD- M BA-231 cells (breast cancer).
• Figure 19 ART, DHA, or ARS combined with 5-ALA increases the antiproliferative effect of cisplatin and 5-fluorouracil (5-FU) treatment in MiaPaca-2 cells (pancreas cancer).
• Mouse embryonic stem cell clones (clone AN3-12) ⁇ Elling:2011gla ⁇ were cultured in DMEM supplemented with 10% fetal bovine serum (FCS), penicillin-streptomycin, non- essential amino acids, sodium pyruvate (1 mM), l-glutamine (2 mM), b-mercaptoethanol (0.1 mM), and LIF (20 pg ml-1).
• SH-SY5Y cells were cultured in DMEM/F12 1:1 supplemented with 10% FCS (fetal calf serum), penicillin-streptomycin, and L- glutamine.
• 4T1 cells were cultured in IMDM supplemented with 10% fetal calf serum (FCS), penicillin-streptomycin and L-glutamine.
• FCS fetal calf serum
• MEFs Mcf7, MDA-MB-231, Panel, LN229, A549, MiaPaca-2, B16F10 and PlatE cells were cultured in DMEM supplemented with 10% FCS, penicillin-streptomycin and L-glutamine.
• HepG2-, T98G-, and U87MG cells were cultured in EMEM, and SHP77-, VBT92-, and VBT281 cells were cultured in RPMI, each supplemented with 10% FCS, penicillin-streptomycin and L-glutamine. All cells were cultured at 37°C, on f 20%O 2 and 5%C0 2.
• Mouse AN3-12 ESC lines were generated in our laboratory and characterized and authenticated as previously described ⁇ Elling, U. et al. Forward and reverse genetics through derivation of haploid mouse embryonic stem cells. Cell stem cell 9, 563-574 (2011) ⁇ . Haploid murine ESCs were used for insertional mutagenesis and derivation of gene trap knockout cell lines. SH-SY5Y were obtained directly from the supplier (Sigma Aldrich) and used for growth assays and cellular stainings. Jurkat cells as used in in vitro viability and DHE assays were obtained from an in-house source and are functionally described elsewhere ⁇ Reikerstorfer, A., Holz, H., Stunnenberg, H. G. & Busslinger, M.
• Haploid ESCs harbouring gene traps in nomic introns were seeded at low density in normal ESC growth medium and infected for 12h with two viruses, one encoding mCherry plus Cre recombinase and the other coding for GFP, both together with puromycin (Invivogen, ant-pr-1). Infected cells were selected (final concentration of puromycin, 1 pg/ml) after 24h and expanded. Ratios of GFP- to mCherry/Cre- expressing cells in the presence and absence of artemisinin were determined using high-throughput flow cytometry (BD LSRFortessa HTS Cell Analyzer).
• cells were seeded in 96-wells (25.000/ 96-well, in triplicate - where indicated) and subjected to compounds for 48h. Cell viability was assessed using automated cell counting (high-throughput flow cytometry), Alamar Blue staining (Invitrogen, DAL1100) or CellTiter-Glo Luminescent Assay (Promega, G7570, according to the manufacturer’s protocol) respectively.
• Treated cells were collected, washed with 1x HBSS (without Ca2+ and Mg2+), incubated with 1mM DHE (Dihydroethidium (Hydroethidine), Invitrogen, D11347) in 1x HBSS for 45min at 37°C, washed twice and counterstained with DAPI or a viability dye (eBioscienceTM Fixable Viability Dye eFIuorTM 780, 65-0865-18) for 10min on ice. Cells were then collected, strained and analysed using flow cytometry for DHE in the red fluorescent spectrum (PE channel).
• DHE Dihydroethidium (Hydroethidine), Invitrogen, D11347
• Cerebral organoids were generated as described before ⁇ Lancaster, M. A. et at. Cerebral organoids model human brain development and microcephaly. Nature 501, 373-379 (2013) ⁇ . Human embryonic stem cells (feeder-free H9, WiCell) were transferred into low-attachment 96-well-plates (Corning) in a density of 9.000 cells per well and incubated in human stem cell medium.
• the medium was changed to neural induction media, containing Dulbecco’s modified eagle medium DMEM/F12, N2 supplement (Invitrogen), Glutamax (Invitrogen), minimum essential media- nonessential amino acids (MEM-NEAA) and 1pg/ml heparin (Sigma), to promote growth of ectodermal tissue.
• Dulbecco modified eagle medium DMEM/F12, N2 supplement (Invitrogen), Glutamax (Invitrogen), minimum essential media- nonessential amino acids (MEM-NEAA) and 1pg/ml heparin (Sigma), to promote growth of ectodermal tissue.
• EBs embryonic bodies
• DMEM/F12 Neurobasal 1:1, N2 supplement (Invitrogen), B27 supplement (without vitamin A) (Invitrogen), 50mM 2-mercaptoethanol, 1:4,000 insulin (Sigma), Glutamax (Invitrogen), penicillin- streptomycin, MEM-NEAA onto 10cm plates. 5 days later, organoids were transferred to an orbital shaker and maintained in differentiation media containing vitamin A (in B27 supplement).
• Tumor initiation was induced by either oncogene amplification, using a Sleeping Beauty (SB) transposase, or mutation of tumor suppressor genes, using the CRISPR-Cas9 system in day 10 old embryoid bodies (EBs).
• SB Sleeping Beauty
• Plasmids carrying the transposase as well as GFP and the desired oncogenes or expressing Cas9 nuclease were introduced by electroporation.
• a mixture of 1 pg DNA and 10OmI nucleofector solution was added to 10 EBs and transferred to a nucleofection cuvette.
• the Lonza Nucleofector 2b and the A-023 program were used for electroporation/ nucleofection.
• EBs were transferred into 10cm dishes containing differentiation media containing vitamin A and embedded into Matrigel 24 hours later.
• Two different types of tumors were initiated ⁇ Bian:2018gs ⁇ : Central nervous system primitive neuroectodermal tumors (CNS-PNET) were induced by the overexpression of Myc.
• Glioblastoma-like tumor group 2 (GBM-2) was caused by mutagenesis of the tumor suppressor genes p53, NF1 and PTEN. All plasmids were designed by Shan Bian ⁇ Bian, S. et al. Genetically engineered cerebral organoids model brain tumor formation. Nat. Methods 15, 631-639 (2016) ⁇ .
• Cerebral tumor organoids were treated with different compounds and the survival and growth of transformed as well as untransformed neurons was monitored. Fluorescence labeling of tumor cells allowed clear distinguishability of transformed cells as compared to non-labeled throughout the experiment using brightfield microscopy, as well as fluorescence imaging. The transformed tumor tissue and untransformed neurons within the same organoid was monitored using fluorescence imaging, as well as brightfield microscopy throughout the experiment. At the endpoint of the treatment (d5 or d7 respectively), the number of GFP-positive cells was assessed by flow cytometry. Flow cytometry analysis of cerebral tumor organoids
• Cerebral (tumor) organoids were enzymatically and mechanically dissociated using 1x trypsin, 35-45min incubation at 37°C, and gentle shaking. Organoids were singularised by careful resuspension, addition of differentiation medium and straining (Falcon Round-Bottom Tubes with Cell Strainer Cap, 5 ml_, 35 pm nylon mesh cell strainer snap cap). Single cells in suspension were counterstained with DAPI or a viability dye (eBioscienceTM Fixable Viability Dye eFIuorTM 780, 65-0865-18), and analysed using flow cytometry (BD LSRFortessa FITS Cell Analyzer). The amounts of GFP-positive cells were analyzed.
• 5-ALA or Artemisinin treated cerebral organoids were imaged at the indicated time points using the Axio Vert.AI Inverted Microscope system (Zeiss Objective EC Plan- Neofluar 2.5x/0.085 Pol M27, 0.5 camera adapter). Brightfield and green fluorescence images were taken from the same area. Additionally, for image analyses, the Celldiscoverer 7 (Zeiss), a fully integrated high-end automated live cell imaging system, was used.
• Cerebral organoids were fixed in 4% PFA (room temperature, 1 h), incubated with 30% sucrose (4°C, o/n), OCT (Tissue-tek OCT Compound, SANOVA PHARMA GESMBH, 4583) embedded and 20pm sections were cryostat cut (-12/-14°C).
• the organoids were imaged on an LSM780 Axio Imager (point laser scanning confocal microscope, GaAsP (Gallium Arsenide) detectors with QE of 45% and up to 2x SNR) with a standard filter set (CH1: 371-735, CH2: 479-735, CH3 Quasar (GaAsP): 416-690) through a 20x/0.8 plan-Apochromat objective (Carl Zeiss) using laser illumination (Laser Diode 405 - 25mW, Argon 458, 488, 514 - 30mW, DPSS 561 - 15mW, HeNe 633 - 5mW).
• LSM780 Axio Imager point laser scanning confocal microscope, GaAsP (Gallium Arsenide) detectors with QE of 45% and up to 2x SNR
• a standard filter set CH1: 371-735, CH2: 479-735, CH3 Quasar (

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