WO2023155754A1 - 一种降血糖和/或治疗糖尿病并发症的药物 - Google Patents

一种降血糖和/或治疗糖尿病并发症的药物 Download PDF

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WO2023155754A1
WO2023155754A1 PCT/CN2023/075700 CN2023075700W WO2023155754A1 WO 2023155754 A1 WO2023155754 A1 WO 2023155754A1 CN 2023075700 W CN2023075700 W CN 2023075700W WO 2023155754 A1 WO2023155754 A1 WO 2023155754A1
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lipoic acid
nanoparticles
diabetic
group
mice
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French (fr)
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张仕勇
肖潇
卢小鸾
祝雨红
廖玉龙
廖春燕
吴潇
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四川大学
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Definitions

  • the invention belongs to the technical field of biomedicine, and in particular relates to a medicine for treating diabetes and its complications.
  • Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, with as many as 425 million patients worldwide.
  • Hypoglycemic drugs such as metformin and acarbose are routine drugs for clinical treatment of diabetic patients at this stage, but diabetic patients are usually accompanied by complications such as cardiovascular disease, obesity, kidney, eye and peripheral neuropathy, and these drugs only play a hypoglycemic effect.
  • the existing drugs have no therapeutic effect on complications, and the diabetic patients with complications will still develop and deteriorate. Based on this, it is a clinical trend to develop hypoglycemic agents with the characteristics of improving complications.
  • the hypoglycemic drugs with the above characteristics mainly include glucagon-like peptide 1 agonist (GLP-1RA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i), which are effective in reducing cardiovascular and end-stage renal disease deaths.
  • GLP-1RA glucagon-like peptide 1 agonist
  • SGLT2i sodium-glucose cotransporter 2 inhibitor
  • the risk aspect showed some improvement.
  • GLP-1RA requires daily subcutaneous injection, which leads to poor patient compliance, and long-term use will aggravate the deterioration of patients with diabetic retinopathy, while SGLT2i is prone to urinary and reproductive system infections, and has a higher incidence of gastrointestinal events. Therefore, hypoglycemic agents with the characteristics of improving diabetic complications are far from meeting the clinical needs.
  • the present invention provides a novel drug for lowering blood sugar and/or improving diabetic complications.
  • the drug is mainly composed of nanoparticles formed of lipoic acid and/or lipoic acid derivatives, which can effectively prevent/relieve diabetic complications while controlling blood sugar safely and for a long time, and has good clinical application prospects.
  • a lipoic acid nanoparticle with the function of lowering blood sugar and/or improving diabetic complications is a nanoparticle formed by components containing lipoic acid and/or lipoic acid derivatives.
  • the formation process may include various modifications or modifications to the nanoparticles.
  • the lipoic acid derivatives include lipoic acid salts or pharmaceutically acceptable modifications obtained by non-substantial modification of lipoic acid (including but not limited to lipoic acid molecules) grafted functional groups).
  • the lipoic acid and/or lipoic acid derivatives are cross-linked and polymerized through disulfide bonds.
  • the nanoparticles can be formed in the form of liposomes or polymers. become.
  • the nanoparticles can be formed by modification with polyethylene glycol.
  • the lipoic acid nanoparticles are formed by cross-linking and polymerizing small molecule lipoic acid monomers and/or lipoic acid derivatives through disulfide bonds, without additional introduction of cross-linking molecules. Stable cross-linking can be achieved, and the drug composition is single and controllable. The structure of the cross-linked nano drug is stable, which is conducive to long-term circulation in the blood.
  • the hydrophilic groups are outside the nanoparticles, and the hydrophobic groups are inside the nanoparticles, so that the lipoic acid nanoparticles can be dissolved in water without any co-solvent, and the solubility is much higher than lipoic acid monomer.
  • the particle size of the lipoic acid nanoparticles is 10-300nm, which is much larger than the critical particle size through the capillary wall, so the lipoic acid nanoparticles can pass through the body with the blood Circulating to the nerve tissues of the body greatly prolongs the retention time in the body, so that insulin-sensitive response and diabetic complications can effectively absorb lipoic acid, thereby improving the therapeutic effect.
  • the surface potential of the lipoic acid nanoparticles is negative.
  • the negative surface potential is beneficial to improve the stability of lipoic acid nanoparticles in blood.
  • the surface potential of the lipoic acid nanoparticles is -100mV ⁇ 0mV.
  • the present invention also provides a method for preparing the above-mentioned lipoic acid nanoparticles, specifically: cross-linking and polymerizing the disulfide bonds of the lipoic acid monomer and/or lipoic acid derivatives through a disulfide bond cross-linking polymerization reaction Together to form lipoic acid nanoparticles.
  • the uniform mixing method may be: ultrasonic vibration mixing, vortex vibration mixing, manual shaking mixing, preferably ultrasonic vibration mixing.
  • the method of breaking the disulfide bond of lipoic acid may be ultraviolet light breaking, ultrasonic breaking, thermal breaking, mechanical stress breaking.
  • the method of cross-linking polymerization may be through oxygen, mechanical stress, or catalysis.
  • the invention also discloses an application of the lipoic acid nanoparticle, which is characterized in that it is used to prepare a drug for lowering blood sugar and/or improving diabetic complications.
  • the lipoic acid nanoparticles are made into injection, capsule, tablet, pill or oral liquid.
  • the lipoic acid nanoparticles have good water solubility.
  • lipoic acid nanoparticles are used in combination with other active ingredients in the above applications.
  • the drug for improving diabetic complications achieves the improvement of diabetic complications through the dual effects of lowering blood sugar and inhibiting oxidative stress.
  • the complications of diabetes include one or more of diabetic nephropathy, diabetic ophthalmopathy, diabetic foot, diabetic cardiovascular disease, diabetic cerebrovascular disease and diabetic peripheral neuropathy .
  • the invention also discloses a drug for lowering blood sugar and/or improving diabetic complications, which is characterized in that it contains lipoic acid nanoparticles.
  • the above-mentioned medicines for lowering blood sugar and/or improving diabetic complications also contain other active ingredients.
  • the other active ingredients may be other hypoglycemic drugs or other drugs capable of improving diabetic complications, or other substances that can promote the efficacy of the drug for lowering blood sugar and/or improving diabetic complications.
  • the nanomedicine of the present invention has long-term and high-efficiency hypoglycemic effect, and its hypoglycemic effect and maintenance time are respectively 1.53 times and 3 times that of metformin, a clinical first-line hypoglycemic drug.
  • the nanomedicine overcomes the defect of lack of curative effect on complications of existing hypoglycemic drugs, has excellent therapeutic effects on many complications of diabetes, and has good clinical prospects.
  • Fig. 1 is a schematic diagram of the treatment of diabetes and its complications by lipoic acid nanoparticles
  • Fig. 2 is the hydrated particle size of lipoic acid nanoparticles after crosslinking
  • Fig. 3 is the Zeta potential of the lipoic acid nanoparticle of cross-linking stability
  • Fig. 4 is the dilution stability determination of cross-linked lipoic acid nanoparticles
  • Fig. 5 is the determination of serum stability of cross-linked lipoic acid nanoparticles
  • Fig. 6 is the change of blood sugar, insulin content and insulin resistance index of each group of experimental diabetic mice
  • Fig. 7 is each group experimental diabetic nephropathy mouse blood sugar change
  • Figure 8 shows the urine protein/creatinine ratio, serum CRE, kidney HE, PAS and podocyte pathological changes in mice with experimental diabetic nephropathy in each group;
  • Figure 9 shows the changes of MDA content, SOD activity and gene transcription levels of inflammatory factors TNF- ⁇ , IL-6 and IL-1 ⁇ in the kidney tissues of mice with experimental diabetic nephropathy in each group;
  • Fig. 10 is the variation of thermal pain threshold of mice with experimental diabetic peripheral neuropathy in each group
  • Fig. 11 is the change of the mechanical threshold of mice with experimental diabetic peripheral neuropathy in each group
  • Figure 12 is the change of Na + -K + -ATPase activity in red blood cells (a) and sciatic nerve (b) of mice with experimental diabetic peripheral neuropathy in each group;
  • Fig. 13 is the MDA and GSH content and the activity of SOD in the sciatic nerve of mice with experimental diabetic peripheral neuropathy in each group Variety;
  • Figure 14 is the change of TNF- ⁇ , IL-6, IL-1 ⁇ content in the sciatic nerve of mice with experimental diabetic peripheral neuropathy in each group;
  • Figure 15 shows the changes in the morphological structure of the sciatic nerve in mice with experimental diabetic peripheral neuropathy in each group.
  • LA lipoic acid
  • DMSO dimethylsulfoxide
  • the mother liquor was irradiated by 365nm ultraviolet light for 4 hours to trigger the self-crosslinking of the lipoic acid disulfide bond, adjusted the pH to about 9.0 with NaOH, extracted 3 times with dichloromethane, and removed the 1,4,7-triazanonane in the solution, and then the supernatant Adjust to neutral with dilute HCl, and then dialyze with deionized water for 48h (spectrum/pore, MWCO 2000) to prepare cross-linked lipoic acid nanovesicles.
  • Dilution stability Take the cross-linked lipoic acid nanoparticle solution prepared above, and use RO water to dilute it to 2000/1000/500/250/125/63/32/16/8 ⁇ M (expressed in the concentration of LA ), and carry out particle size measurement to the lipoic acid nanoparticles after each dilution. The results are shown in Figure 4, even when the lipoic acid nanoparticle solution was diluted to 8 ⁇ M, its size remained near the initial size, indicating that the prepared cross-linked lipoic acid nanoparticles had better dilution stability.
  • the nanoparticles obtained above were irradiated with 365nm ultraviolet light to trigger self-crosslinking of lipoic acid disulfide bonds, reacted for 2.5 hours, and dialyzed for 48 hours to obtain crosslinked lipoic acid nanomicelles with a size of about 15nm and a Zeta potential of about -33mv.
  • lipoic acid 41.2 mg was dissolved in 1 mL of N,N-dimethylamide (DMF), and shaken on a shaker for 2 hours to obtain a 0.2 M mother solution of lipoic acid. 50 ⁇ L of the mother solution was added to 5 mL of deionized water under ultrasonic conditions to obtain lipoic acid nanoparticles.
  • the nanoparticles obtained above were irradiated with 365nm ultraviolet light to trigger self-crosslinking of lipoic acid disulfide bonds, reacted for 2.5 hours, and obtained crosslinked lipoic acid aggregates with a size of about 80nm and a Zeta potential of about -30mv after dialysis for 48 hours.
  • db/db mice were used as a model of type 2 diabetes to evaluate the curative effect of lipoic acid nanoparticles on diabetes, and compared with LA monomer and metformin hydrochloride, a first-line clinical hypoglycemic drug.
  • the lipoic acid nanoparticles prepared in Example 1 were dispersed in physiological saline to make a 10 mg/mL solution, and administered to mice at a dose of 100 mg/kg for intragastric administration.
  • Insulin Insulin (Insulin), Shanghai Biyuntian Biotechnology Co., Ltd.;
  • C57BL/KsJ 24 db/db mice were randomly divided into 4 groups according to body weight and blood sugar, 6 in each group, respectively db/db model group, db/db+lipoic acid nanoparticle group (100mg/kg), db/db+lipoic acid Monomer group (100mg/kg) and db/db+metformin group (120mg/kg); Six w/w male mice of the same age and age were used as the solvent control group.
  • Different doses of drugs were given by intragastric administration according to the volume of 10ml/kg. Lipoic acid monomer and metformin were administered once a day, and the lipoic acid nanoparticle group was administered once every three days for 1 month. saline. After a single administration, the blood glucose changes of the mice were continuously monitored within 3 days. During the 1-month treatment period, the blood glucose changes of the mice were detected every 3 days. On the 30th day, 2 hours after the end of administration, the blood glucose of the mice was detected, and the blood glucose reduction percentage of the drug was calculated based on the difference between the blood glucose of the model and the normal control group.
  • mice were sacrificed by enucleation of the eyeballs and bloodletting, the serum samples were collected by centrifugation at room temperature, the serum insulin content was detected using the mouse insulin (Insulin) ELISA detection kit, the insulin resistance index was calculated, and the difference between the model and the normal control group was used as the base to calculate the drug-reduced serum Percentage of insulin content and insulin resistance index.
  • lipoic acid monomer 100mg/kg
  • lipoic acid nanoparticles 100mg/kg
  • metformin 120mg/kg
  • the blood glucose test results are shown in Figure 6B.
  • the blood glucose in the LA monomer treatment group was maintained at around the initial blood glucose value of the diabetic mice, and had no hypoglycemic effect (p>0.05), although the metformin group could reduce the blood glucose level by 50.28 % (p ⁇ 0.05), but it needs to be administered daily, and when the lipoic acid nanoparticles are administered once every 3 days, the blood sugar level of the mice is reduced by 76.84% (p ⁇ 0.01), which is 1.53 times that of the metformin treatment group, showing that it has a significantly better hypoglycemic effect than the clinical first-line drugs.
  • Example 1 Referring to the method for preparing vesicles described in Example 1, the only difference is that deionized water was replaced with an aqueous solution containing 25.0 mg of metformin hydrochloride to prepare lipoic acid nanovesicles loaded with metformin hydrochloride.
  • deionized water was replaced with an aqueous solution containing 25.0 mg of metformin hydrochloride to prepare lipoic acid nanovesicles loaded with metformin hydrochloride.
  • the therapeutic effects of the physical mixture described in this example and the lipoic acid nanovesicles loaded with metformin hydrochloride on diabetes were respectively verified. The results showed that after physical mixing, the hypoglycemic effect was better than that of hydrochloric acid alone.
  • Metformin and lipoic acid nanoparticles are stronger; after treatment with metformin hydrochloride loaded on lipoic acid nanoparticles, the therapeutic effect is further increased compared with the physical mixing method, and the therapeutic effect is synergistically enhanced while reducing the dosage of active ingredients.
  • db/db mice were used as a model of diabetic nephropathy to evaluate the therapeutic effect of lipoic acid nanoparticles prepared in Example 1 on diabetic nephropathy mice, and compared with LA monomer.
  • Creatinine (CRE) assay kit Nanjing Jiancheng Bioengineering Institute
  • BUN Burea nitrogen
  • MDA Malondialdehyde
  • RNApure high-purity total RNA rapid extraction kit spin column type, Beijing Biotech Biotechnology Co., Ltd.;
  • Different doses of drugs were given by intraperitoneal injection at a volume of 10 mL/kg, once a day for four consecutive weeks.
  • the control group and model group were given equal volumes of normal saline by intraperitoneal injection.
  • the changes in blood sugar of the mice were detected every three days, and the blood sugar difference between the model and the normal control group was used as the base to calculate the percentage of blood sugar lowered by the drug to clarify the hypoglycemic effect of the drug.
  • CER creatinine
  • BUN urea Nitrogen Kit Description Detection of CRE and BUN content in mouse serum.
  • the pathological examination results are shown in Figures (8D, E).
  • the glomeruli of mice in the w/w control group have clear structures, normal basement membranes, and a small amount of glycogen deposition in the glomeruli, while the kidneys of mice in the db/db model group Glomerular hypertrophy, basement membrane thickening, a large amount of glycogen deposition in the glomerulus, and partial disappearance of podocyte foot processes indicated that the model group had severe glomerular injury; compared with the db/db model group, the LA monomer group had smaller kidney Ball shrinks 25.50% (p ⁇ 0.05), basement membrane thickness 6.57% (p ⁇ 0.05), the number of foot processes increased by 10.14% (p ⁇ 0.05); while the lipoic acid nanoparticles group, the glomerulus shrunk by 64.41% (p ⁇ 0.01), and the basement membrane thickness decreased by 18.27% (p ⁇ 0.05).
  • the improvement effect of diabetic renal oxidative damage was evaluated by measuring MDA content and SOD activity in renal tissue.
  • the experimental results showed that compared with control mice, the increased MDA and decreased SOD activity levels in the kidneys of diabetic mice indicated that there was oxidative stress damage in the kidneys of the model mice.
  • significantly increased gene transcription levels of inflammatory cytokines including TNF- ⁇ , IL-1 ⁇ , and IL-6 were observed in kidney tissue of diabetic mice.
  • the MDA content decreased by 9.8% (p ⁇ 0.05), and the SOD activity increased by 55% (p ⁇ 0.05), showing that it has a certain improvement effect on renal oxidative stress damage.
  • irbesartan a medicine for treating diabetic nephropathy
  • the therapeutic effect of the lipoic acid nanomedicine loaded with irbesartan on diabetic nephropathy described in this example was verified.
  • the results showed that the curative effect of lipoic acid nanoparticles loaded with irbesartan was better than that of irbesartan monomer or lipoic acid nanoparticles without irbesartan. treatment effect.
  • This embodiment uses db/db mice as a model of diabetic peripheral neuropathy to evaluate the curative effect of lipoic acid nanoparticles prepared in Example 1 on diabetic peripheral neuropathy (DPN), and compares it with the clinical use of small molecule lipoic acid injection .
  • MDA Malondialdehyde
  • Glutathione (GSH) test kit Nanjing Jiancheng Bioengineering Institute
  • TNF- ⁇ Tumor necrosis factor- ⁇ test kit, Nanjing Jiancheng Bioengineering Institute
  • Interleukin-6 (IL-6) test kit Nanjing Jiancheng Institute of Bioengineering
  • Interleukin-1 ⁇ (IL-1 ⁇ ) test kit Nanjing Jiancheng Institute of Bioengineering.
  • Small molecule lipoic acid injection and ⁇ -lipoic acid nanoparticles were injected intraperitoneally three times a week for a total of 8 weeks, and the control group and model group were given an equal volume of normal saline by intraperitoneal injection.
  • the blood sugar changes of the mice were detected every three days to clarify the hypoglycemic effect of the drug.
  • the thermal pain threshold was detected; mice were sacrificed, and related factors were detected using detection kits.
  • mice After 8 weeks of treatment, all mice were sacrificed and the sciatic nerves were isolated.
  • the sciatic nerve was first cut into pieces (100 mg: 1800 ⁇ L) with small scissors in saline and the nerve was homogenized with Beed Ruptor 24Elite. Then, the homogenate was centrifuged at 3500 rpm for 15 minutes at 4 °C, and the supernatant was collected for use.
  • the results of blood sugar testing showed that after 8 weeks of treatment in the LA monomer group, the blood sugar could only be stabilized near the initial blood sugar level of the diabetic mice, and had no hypoglycemic effect (p>0.05), while the lipoic acid nanoparticle group effectively lowered the blood sugar of the diabetic mice. content, showing the promotion effect of lipoic acid nanoparticles in improving glucose metabolism in diabetic peripheral neuropathy.
  • the activity of Na + - K + -ATPase is closely related to the blood supply of microvessels and the injury of peripheral nerves.
  • the results are shown in Figure 12, where a is serum Na + -K + -ATPase activity, b is sciatic nerve Na + -K + -ATPase activity.
  • a serum Na + -K + -ATPase activity
  • b sciatic nerve Na + -K + -ATPase activity.
  • the activity of Na + -K +- ATPase in erythrocytes and sciatic nerves of mice in db/db group decreased.
  • the Na + -K + -ATPase activity in erythrocytes in the small molecule lipoic acid group increased by 137%, and the Na + -K + -ATPase activity in sciatic nerve increased by 120%;
  • the Na + -K + -ATPase activity of erythrocytes in lipoic acid nanoparticle group increased by 234% (p ⁇ 0.05).
  • the activity of Na + -K + -ATPase in sciatic nerve increased by 206% (p ⁇ 0.01), which was 70.80% and 71.67% higher than lipoic acid monomer respectively.
  • the MDA content of the lipoic acid monomer group decreased by 30.79% (p ⁇ 0.05), the SOD activity increased by 15.76% (p ⁇ 0.05), and the GSH content increased by 10.79% (p ⁇ 0.05), while the lipoic acid nanoparticle treatment group MDA content significantly decreased by 51.75% (p ⁇ 0.01), SOD activity increased by 52.94% (p ⁇ 0.01), GSH content increased by 17.72 (p ⁇ 0.01), respectively 1.7, 3.4 and 1.6 times of the same dose of LA monomer (p ⁇ 0.01) 0.05).
  • the above results show the excellent therapeutic effect of lipoic acid nanoparticles on the oxidative stress of sciatic nerve in mice with diabetic peripheral neuropathy.
  • db/db mice Compared to non-diabetic mice w/w, db/db mice exhibited marked axonal demyelination and damage. Compared with db/db mice, the small molecule lipoic acid injection group and the lipoic acid nanoparticle group were significantly remyelinated after 8 weeks of treatment, and the effect of the lipoic acid nanoparticle group was significantly better than that of the small molecule lipoic acid injection group.
  • Figure 15 shows.
  • a is non-diabetic mice w/w
  • b is db/db mice
  • c is small molecule lipoic acid injection group (50mg/kg)
  • d is lipoic acid nanoparticle group (50mg/kg) .
  • the present embodiment is the lipoic acid nanoparticle tablet medicine that utilizes lipoic acid nanoparticle to prepare, comprises the following components expressed with mass fraction: 73% lipoic acid nanoparticle (main drug), 10% microcrystalline cellulose (filler) agent), 10% starch slurry (binder), 6% cornstarch (disintegrant), 0.2% magnesium stearate (lubricant), 0.8% talcum powder (lubricant).
  • the preparation method of this lipoic acid nano particle tablet medicine is:
  • the db/db type 2 diabetic mice were used as a model of diabetic peripheral neuropathy to evaluate the tablet drug prepared with lipoic acid nanoparticles, and the curative effect was compared with that of small molecule lipoic acid tablets currently on sale.
  • the present invention systematically sorts out the existing problems of the existing small-molecule lipoic acid in the treatment of diabetes and its complications, and finds that the existing small-molecule lipoic acid mainly has the following outstanding problems:
  • the small molecule lipoic acid After the small molecule lipoic acid enters the human body through intravenous injection, it will be metabolized by the kidneys as the blood circulates. 80-90% of the small molecule lipoic acid enters the renal tubule through the glomerulus and is excreted with the urine. Nervous tissue, the retention time is short, the action time is short, and the treatment effect is not good.
  • the preparation method of the existing small molecule lipoic acid injection is to increase the solubility of lipoic acid by adding alkaline co-solvents such as meglumine, ethylenediamine and tromethamine in water.
  • alkaline co-solvents such as meglumine, ethylenediamine and tromethamine in water.
  • the solubility of small-molecule lipoic acid in water not only reduces the content of lipoic acid per molar injection, but also increases the risk of poor expected injection effects due to its complex composition.
  • the alkaline co-solvent will increase the possibility of degradation of small molecule lipoic acid.
  • the lipoic acid nanoparticles in the hypoglycemic and/or improving diabetic complications medicine of the present invention have a particle diameter of 10-300nm, which is far greater than the critical particle diameter of the glomerular filtration system, so the lipoic acid nanoparticles can
  • the blood circulates in the body to the nerve tissues throughout the body, which greatly increases the retention time in the body, and enables the peripheral nerve tissues to effectively absorb lipoic acid, thereby improving the therapeutic effect.
  • the disulfide bonds of the monomers are cross-linked and polymerized together, and the more active disulfide bonds are wrapped inside the nanoparticles, thereby improving its stability and making its shelf life longer.
  • the hydrophilic groups are outside the nanoparticles, and the hydrophobic groups are in the nanoparticles, so that the lipoic acid nanoparticles It can be dissolved in water without any co-solvent, and its solubility is much higher than lipoic acid monomer.
  • the improved solubility reduces the cost and risk of injection without adding co-solvents.
  • lipoic acid nanoparticles were prepared, and polyethylene glycol was then esterified with 1-ethyl-(3-dimethylaminopropyl) carbodiimide and 4-dimethylaminopyridine.
  • Alcohol (PEG-1000) was grafted onto the lipoic acid nanoparticles described above. Compared with ungrafted nanoparticles, the surface modification of nanoparticles with PEG-1000 effectively reduces the adsorption of nanoparticles and proteins in the body, delays the removal of nanoparticles, prolongs the time for the drug to exert its efficacy, and presents a better therapeutic effect .

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Abstract

一种降血糖和/或改善糖尿病并发症的药物，属于生物医药技术领域。所述降血糖和/或改善糖尿病并发症的药物是由硫辛酸和/或硫辛酸衍生物形成的纳米粒子，所述硫辛酸纳米粒子在安全、长效控制血糖的同时，能通过降低血糖和抑制氧化应激双重作用实现对糖尿病并发症的预防/治疗，具有良好的临床前景。

Description

一种降血糖和/或治疗糖尿病并发症的药物 技术领域
本发明属于生物医药技术领域，具体涉及一种用于治疗糖尿病及其并发症的药物。
技术背景
糖尿病是一种以高血糖为主要特征的代谢性紊乱疾病，全球患者多达4.25亿。二甲双胍和阿卡波糖等降糖药是现阶段临床糖尿病患者治疗的常规用药，但糖尿病患者通常伴有心血管疾病、肥胖、肾脏、眼部和周围神经病变等并发症，这些单纯发挥降糖作用的药物对并发症无治疗效果，合并并发症的糖尿病患者病情仍会发展恶化。基于此，开发具有改善并发症特点的降糖药是临床趋势。
目前临床上具备以上特点的降糖药物主要有胰高血糖素样肽1激动剂(GLP-1RA)和钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)，它们在降低心血管和终末期肾病死亡风险方面显示出一定的改善作用。遗憾的是，上述药物获益的适应症范围窄，并且能否实现并发症的有效治疗还需进行更深入的临床研究。此外，GLP-1RA需每日皮下注射给药，患者顺应性差，长期使用还会加剧糖尿病视网膜病变患者病情恶化，而SGLT2i的易发生泌尿和生殖系统感染，胃肠道事件发生率较高。因此，具有改善糖尿病并发症特点的降糖药远未满足临床需要。
发明内容
针对以上问题，本发明提供了一种新型降血糖和/或改善糖尿病并发症的药物。该药物主要是由硫辛酸和/或硫辛酸衍生物形成的纳米粒子，在安全、长效控制血糖的同时，能有效预防/缓解糖尿病并发症，具有良好的临床应用前景。
本发明包含以下技术方案：
一种具有降血糖和/或改善糖尿病并发症功能的硫辛酸纳米粒子，所述硫辛酸纳米粒子是由含硫辛酸和/或硫辛酸衍生物成分形成的纳米粒子。所述形成过程可以包括对纳米粒子进行的各种改性或修饰。所述硫辛酸衍生物包括硫辛酸盐或对硫辛酸进行的不影响其核心作用发挥的非实质性改性而获得的药学上可接受的改性物(包括但不限于在硫辛酸分子上接枝官能团)。
作为可选方式，在上述硫辛酸纳米粒子中，所述硫辛酸和/或硫辛酸衍生物通过二硫键交联聚合。
作为可选方式，在上述硫辛酸纳米粒子中，所述纳米粒子可通过脂质体、聚合物负载形 成。
作为可选方式，在上述硫辛酸纳米粒子中，所述纳米粒子可通过聚乙二醇修饰形成。
作为可选方式，在上述硫辛酸纳米粒子中，所述硫辛酸纳米粒子由小分子硫辛酸单体和/或硫辛酸衍生物通过二硫键交联聚合而成，无需额外引入交联分子即可实现稳定交联，药物成分单一、可控。经过交联的纳米药物结构稳定，有利于在血液中长效循环。
作为可选方式，在上述硫辛酸纳米粒子中，亲水基团在纳米粒子外部，疏水基团在纳米粒子内部，使得硫辛酸纳米粒子无需任何助溶剂便能溶于水中，溶解度远远高于硫辛酸单体。
作为可选方式，在上述硫辛酸纳米粒子中，所述硫辛酸纳米粒子的粒径为10-300nm，远大于透过毛细血管壁的临界粒径，因此硫辛酸纳米粒子能随着血液在体内循环至身体各处神经组织，极大地延长了体内留存时间，使胰岛素敏感性响应和糖尿病并发症病变组织能够有效吸收硫辛酸，从而提升治疗效果。
作为可选方式，在上述硫辛酸纳米粒子中，所述硫辛酸纳米粒子的表面电位为负。表面负电位有利于提高硫辛酸纳米粒子在血液中的稳定性。
作为可选方式，在上述硫辛酸纳米粒子中，所述硫辛酸纳米粒子的表面电位为-100mV～0mV。
本发明还提供了一种上述硫辛酸纳米粒子的制备方法，具体为：通过二硫键交联聚合反应，使硫辛酸单体和/或硫辛酸衍生物的二硫键之间相互交联聚合在一起形成硫辛酸纳米粒子。
作为可选方式，在上述硫辛酸纳米粒子的制备方法中，所述混合均匀的方法可以是：超声振荡混合、旋涡震荡混合、手动摇晃混合，优选为超声振荡混合。
作为可选方式，在上述硫辛酸纳米粒子的制备方法中，所述打断硫辛酸的二硫键的方法可以是紫外光打断、超声打断、热打断、机械应力打断。
作为可选方式，在上述硫辛酸纳米粒子的制备方法中，所述交联聚合的方法可以是通氧气、机械应力、催化。
本发明还公开了一种上述硫辛酸纳米粒子的应用，其特征在于，将其用于制备降血糖和/或改善糖尿病并发症的药物。作为可选方式，在上述应用中，将硫辛酸纳米粒子制成注射液、胶囊剂、片剂、丸剂或口服液。
作为可选方式，在上述应用中，所述硫辛酸纳米粒子具有良好的水溶性。
作为可选方式，在上述应用中，将硫辛酸纳米粒子与其他活性成分联用。
作为可选方式，在上述应用中，所述改善糖尿病并发症的药物通过降低血糖和抑制氧化应激双重作用来实现改善糖尿病并发症。
作为可选方式，在上述应用中，所述糖尿病的并发症包括糖尿病肾病、糖尿眼部病变、糖尿病足、糖尿病心血管病变、糖尿病性脑血管病和糖尿病周围神经病变中的一种或者多种。
本发明还公开了一种降血糖和/或改善糖尿病并发症的药物，其特征在于，含有硫辛酸纳米粒子。
作为可选方式，在上述降血糖和/或改善糖尿病并发症的药物中，还含有其他活性成分。进一步的，所述其他活性成分可以是其他降糖药或其他具有改善糖尿病并发症功能的药物，或者是其他能够促进所述降血糖和/或改善糖尿病并发症的药物药效发挥的物质。
本说明书中公开的所有特征，或公开的所有方法或过程中的步骤，除了互相排斥的特征和/或步骤以外，均可以以任何方式组合。
本发明的有益效果：
本发明所述纳米药物具有长时和高效降糖功效，其降糖效果和维持时间分别为临床一线降糖药二甲双胍的1.53倍和3倍。此外，所述纳米药物克服了现有降糖药对并发症缺乏疗效的缺陷，对糖尿病诸多并发症具有优异的治疗效果，具有良好的临床前景。
附图说明：
图1为硫辛酸纳米粒子治疗糖尿病及其并发症示意图；
图2为交联后硫辛酸纳米粒子的水合粒径；
图3为交联稳定的硫辛酸纳米粒子的Zeta电位；
图4为交联硫辛酸纳米粒子的稀释稳定性测定；
图5为交联硫辛酸纳米粒子的血清稳定性测定；
图6为各组实验性糖尿病小鼠血糖、胰岛素含量和胰岛素抵抗指数的变化；
图7为各组实验性糖尿病肾病小鼠血糖变化；
图8为各组实验性糖尿病肾病小鼠尿蛋白/肌酐比值、血清CRE、肾脏HE、PAS和足细胞病理变化；
图9为各组实验性糖尿病肾病小鼠肾脏组织中MDA含量、SOD活性以及炎症因子TNF-α、IL-6和IL-1β基因转录水平的变化；
图10为各组实验性糖尿病周围神经病变小鼠热痛阈值的变化；
图11为各组实验性糖尿病周围神经病变小鼠机械阈值的变化；
图12为各组实验性糖尿病周围神经病变小鼠红细胞(a)与坐骨神经(b)中Na+-K+-ATPase活性的变化；
图13为各组实验性糖尿病周围神经病变小鼠坐骨神经中MDA和GSH含量以及SOD活性的 变化；
图14为各组实验性糖尿病周围神经病变小鼠坐骨神经中TNF-α、IL-6、IL-1β含量的变化；
图15为各组实验性糖尿病周围神经病变小鼠坐骨神经形态结构的变化。
具体实施方式：
以下通过实施例的具体实施方式再对本发明的上述内容作进一步的详细说明。但不应当将此理解为本发明上述主题的范围仅限于以下的实例。在不脱离本发明的精神和原则之内做的任何修改，以及根据本领域普通技术知识和惯用手段做出的等同替换或者改进，均应包括在本发明的保护范围内。
实施例1
1.硫辛酸纳米囊泡的制备
将210mg硫辛酸(LA)和43.5mg模板分子1,4,7-三氮杂壬烷溶于3.5mL的二甲基亚砜(DMSO)中，振荡4h，形成超两亲分子溶液；在超声条件下，将上述超两亲分子溶液缓慢滴加到300mL去离子水中，形成由LA和1,4,7-三氮杂壬烷构筑的硫辛酸纳米囊泡母液。母液通过365nm紫外光照4h引发硫辛酸二硫键自交联，NaOH调节pH至9.0左右，二氯甲烷萃取3次，除去溶液中的1,4,7-三氮杂壬烷，之后上清液用稀HCl调至中性，再用去离子水透析48h(spectrum/pore，MWCO 2000)制备得到交联硫辛酸纳米囊泡。
交联硫辛酸纳米粒子的尺寸、电位检测：
取2mL上述制备的交联硫辛酸纳米粒子于3.5mL标准石英皿中，用动态光散射仪(DLS)测定其尺寸以及Zeta电位。结果显示交联硫辛酸纳米粒子粒径在130nm左右，Zeta电位为-12.2mv。参见图2和图3。
交联硫辛酸纳米粒子的稳定性检测：
(1)稀释稳定性：取上述制备的交联硫辛酸纳米粒子溶液，使用RO水将其分别稀释为2000/1000/500/250/125/63/32/16/8μM(以LA的浓度表示)，并对每次稀释后的硫辛酸纳米粒子进行粒径测定。结果如图4所示，即使硫辛酸纳米粒子溶液稀释至8μM时，其大小仍保持在初始尺寸附近，表明制备得到的交联硫辛酸纳米粒子具有较好的稀释稳定性。(2)血清稳定性：取4.5mL上述交联硫辛酸纳米粒子与0.5mL胎牛血清孵育，在不同时间点分别检测纳米粒子的粒径。结果如图5所示，交联硫辛酸纳米粒子在血清孵育12h的过程中，尺寸未发生明显改变，表明制备得到的交联硫辛酸纳米粒子具有优异的血清稳定性。上述结果说明通过本发明方法制备的硫辛酸纳米粒子稳定性较好，有利于长期保存，允许大批量制备， 减少合成成本。
实施例2
硫辛酸纳米胶束的制备
将300mg LA加入至150mL去离子水中，在搅拌条件下逐滴加入1M的NaOH水溶液直至LA完全溶解，再用1M的HCl溶液滴定LA溶液至中性，溶液冷冻干燥后得到硫辛酸钠粉末。称取41.2mg硫辛酸钠，溶解在1mL去离子水中，超声乳化形成硫辛酸纳米粒子。将上述所得纳米粒子通过365nm紫外光照引发硫辛酸二硫键自交联，反应2.5h，透析48h后得到尺寸约为15nm，Zeta电位约在-33mv的交联硫辛酸纳米胶束。
实施例3
硫辛酸纳米聚集体的制备
将41.2mg硫辛酸溶于1mLN,N-二甲基酰胺(DMF)中，在振荡器上振荡2h后得到0.2M的硫辛酸母液。取50μL该母液在超声条件下加入到5mL去离子水中得到硫辛酸纳米粒子。将上述所得纳米粒子通过365nm紫外光照引发硫辛酸二硫键自交联，反应2.5h，透析48h后得到尺寸约为80nm，Zeta电位约在-30mv的交联硫辛酸聚集体。
实施例4
本实施例利用db/db小鼠作为2型糖尿病模型来评价硫辛酸纳米粒子对糖尿病的疗效，并与LA单体和临床一线降糖药盐酸二甲双胍进行对比。
将实施例1中制得的硫辛酸纳米粒子分散于生理盐水中制成10mg/mL的溶液，按100mg/kg剂量给予小鼠灌胃处理。
1、实验材料与方法
S1、仪器与试剂：
血糖检测仪，三诺生物传感股份有限公司；
胰岛素(Insulin)，上海碧云天生物技术有限公司；
小鼠胰岛素(Insulin)ELISA检测试剂盒，江苏晶美生物科技有限公司；
S2、实验材料和动物处理
8周龄雄性C57BL/KsJ db/db小鼠，SPF级，由江苏集萃药康生物科技有限公司常州分公司提供，合格证号：202012449，初始体重44±2g，适应性饲养一周，C57BL/KsJ db/db小鼠24只，按体重和血糖随机分为4组，每组6只，分别为db/db模型组、db/db+硫辛酸纳米粒子组(100mg/kg)、db/db+硫辛酸单体组(100mg/kg)和db/db+二甲双胍组(120mg/kg)； 同周龄大小的同窝w/w雄性小鼠6只，为溶剂对照组。按10ml/kg体积分别灌胃给予不同剂量的药物，硫辛酸单体和二甲双胍每天一次，硫辛酸纳米粒子组每三天一次，连续1个月，溶剂对照组和模型组灌胃给予等体积的生理盐水。单次给药后，3天内连续监测小鼠血糖变化。为期1个月的治疗周期内，每3天检测一次小鼠血糖变化情况。第30天给药结束2h后，检测小鼠血糖，以模型和正常对照组血糖差值为基数，计算药物降低血糖百分含量。眼球摘除放血处死小鼠，常温离心收集血清样本，使用小鼠胰岛素(Insulin)ELISA检测试剂盒检测血清胰岛素含量，计算胰岛素抵抗指数，并以模型和正常对照组差值为基数，计算药物降低血清胰岛素含量和胰岛素抵抗指数的百分数。
S3、统计学方法
定量实验结果以均数±方差表示。采用SPSS version19.0 Statistical Software(Chicago,IL,USA)，采用单因素方差分析比较各组间差异。当差异显著时(P<0.05)，组间两两比较采用Turkey post hoc法，当P<0.05时，认为差异有统计学意义。
2、实验结果
S1、硫辛酸纳米粒子对实验性糖尿病小鼠血糖的影响
为了研究硫辛酸纳米粒子对二型糖尿病的治疗作用，我们将硫辛酸单体(100mg/kg)、硫辛酸纳米粒子(100mg/kg)和二甲双胍(120mg/kg)通过灌胃递送至db/db小鼠体内，溶剂灌胃w/w小鼠作为对照。单次给药后连续血糖监测结果显示，LA单体组血糖水平和模型组无显著性差异(p>0.05)，二甲双胍组仅在24h内显示出降糖作用(p<0.05)，而硫辛酸纳米粒子组降糖效果长达72h，且最低血糖值可达8.4mmol/L，较二甲双胍最低血糖值下降21.50％(图6A)。实验结果表明，硫辛酸纳米粒子具有长时、高效降低糖尿病小鼠血糖水平的功效。
为期1个月的治疗过程中，血糖检测结果见图6B，LA单体治疗组血糖维持在糖尿病小鼠初始血糖值附近，无降糖作用(p>0.05)，二甲双胍组虽可降低血糖含量50.28％(p<0.05)，但需采用每日持续给药的方式，而硫辛酸纳米粒子在每3天给药一次的情况下，小鼠血糖含量即降低了76.84％(p<0.01)，是二甲双胍治疗组的1.53倍，显示其比临床一线药物明显更优的降糖效果。对照组与db/db小鼠组间显著性差异分析(*P<0.05)；硫辛酸单体组、硫辛酸纳米粒子组与db/db小鼠组间显著性差异分析(#P<0.05，##P<0.01)；硫辛酸纳米粒子组与硫辛酸单体组和二甲双胍组间显著性差异分析(&P<0.05)。
S2、硫辛酸纳米粒子对糖尿病小鼠血清胰岛素含量和敏感性的影响
血清胰岛素含量检测和胰岛素抵抗指数分析如图6C、D所示，db/db模型组小鼠血清胰岛素含量和胰岛素抵抗指数明显高于w/w对照组小鼠(p<0.05)，表明糖尿病小鼠存在严重的胰岛素抵抗效应；与糖尿病组相比，LA单体组血清胰岛素含量和胰岛素抵抗指数较模型组无显著性差异(p>0.05)。二甲双胍作为一种通过增加周围组织对胰岛素的敏感性来降低血糖的抗糖尿病临床药物，治疗周期结束后，将糖尿病小鼠血清胰岛素含量下降34.69％(p<0.05)，胰岛素抵抗指数下降53.68％(p<0.05)。值得注意的是，硫辛酸纳米粒子干预后，糖尿病小鼠血清胰岛素含量下降73.47％(p<0.01)，胰岛素抵抗指数下降79.84％(p<0.01)，分别为二甲双胍的2.1和1.5倍(p<0.05)。上述结果表明硫辛酸纳米粒子比临床一线药物具有更强的胰岛素增敏作用。二甲双胍组(120mg/kg)、硫辛酸纳米粒子组(100mg/kg)与db/db小鼠组间显著性差异分析(*P<0.05,**P<0.01,#P<0.05，##P<0.01)。
在上述实施例中分别将其中的囊泡换成胶束和聚集体，得到了类似的实验结果，说明本发明制备的多种形态的硫辛酸纳米粒子均具有长时、高效降低血糖水平的功效。
实施例5
实验1：
取10mL实施例1制备的硫辛酸纳米囊泡水溶液(10mg/mL)，向其中加入8.3mg盐酸二甲双胍，混匀后获得硫辛酸纳米粒子/二甲双胍物理混合液。
参照实施例1所述制备囊泡的方法，不同之处仅在于，将去离子水替换为含25.0mg盐酸二甲双胍的水溶液，制备得到负载盐酸二甲双胍的硫辛酸纳米囊泡。参照实施例4所述的方法，分别验证本实施例中所述物理混合液和负载盐酸二甲双胍的硫辛酸纳米囊泡对糖尿病的治疗效果，结果显示：物理混合后，降糖效果较单独的盐酸二甲双胍和硫辛酸纳米粒子更强；硫辛酸纳米粒子负载盐酸二甲双胍治疗后，治疗效果较物理混合方式进一步增加，在降低活性成分给药量的同时，协同增强了治疗效果。
实验2：
参照本实施例实验1所述的方法，将其中的盐酸二甲双胍替换为阿卡波糖。参照实施例4所述的方法，验证负载阿卡波糖的硫辛酸纳米囊泡对糖尿病的治疗效果。结果显示：硫辛酸纳米粒子负载阿卡波糖后，治疗效果较单独的阿卡波糖和硫辛酸纳米粒子显著增强，与实验1实验结论基本一致。
取10mL实施例3制备的硫辛酸纳米聚集体水溶液(10mg/mL)，向其中加入25mg吡 格列酮，在超声条件下充分混合后透析48h，制备得到负载吡格列酮的硫辛酸纳米聚集体。参照实施例4所述的方法，验证负载吡格列酮的硫辛酸纳米聚集体对糖尿病的治疗效果。结果显示：硫辛酸纳米聚集体负载吡格列酮后，治疗效果较单独的吡格列酮和硫辛酸纳米粒子显著增强，与实验1实验结论基本一致。
实施例6
本实施例利用db/db小鼠作为糖尿病肾病模型来评价实施例1中制得的硫辛酸纳米粒子对糖尿病肾病小鼠的治疗效果，并与LA单体进行对比。
1、实验材料与方法
S1、仪器与试剂：
血糖检测仪，三诺生物传感股份有限公司；
小鼠白蛋白酶联免疫试剂盒，上海通薇实业有限公司；
肌酐(CRE)测定试剂盒，南京建成生物工程研究所；
尿素氮(BUN)测试盒，南京建成生物工程研究所；
丙二醛(MDA)测定试剂盒，南京建成生物工程研究所；
超氧化物歧化酶(SOD)测试盒，北京索莱宝科技有限公司；
RNApure高纯总RNA快速抽提试剂盒(离心柱型)，北京百泰克生物技术有限公司；
cDNA合成试剂盒，上海碧云天生物技术有限公司；
RT-PCR试剂盒，北京索莱宝科技有限公司；
S2、实验材料和动物处理
10周龄雄性C57BL/KsJ db/db小鼠，SPF级，由江苏集萃药康生物科技有限公司常州分公司提供，合格证号：202012449，初始体重44±2g，适应性饲养2周。按体重和血糖随机分为3组，每组6只，分别为db/db模型组、db/db+硫辛酸纳米粒子组(30mg/kg)和db/db+硫辛酸单体组(30mg/kg)，同周龄大小的同窝w/w雄性小鼠6只，为溶剂对照组。按10mL/kg体积分别腹腔注射给予不同剂量的药物，每天一次，连续四周，对照组和模型组腹腔注射给予等体积的生理盐水。治疗周期内，每三天检测一次小鼠血糖变化情况，以模型和正常对照组血糖差值为基数，计算药物降低血糖百分含量，明确药物的降糖效果。实验动物于第4周末给药2h后，检测血糖含量并将小鼠眼球摘除放血处死，收集血液样本，高速离心机室温下3000转/分，离心15min分离血清标本；按肌酐(CER)、尿素氮(BUN)试剂盒说明检测小鼠血清中CRE和BUN含量。同时，代谢笼收集小鼠尿液样本，用酶联免疫法(Elisa)检 测尿液中白蛋白含量，并计算尿蛋白/肌酐比值(UACR)；小鼠肾脏矢面剖开，取1/4组织经4％多聚甲醛固定，脱水、透明、石蜡包埋、切片，苏木素-伊红(HE)染色观察肾小球形态结构变化，PAS染色法(Periodic Acid-Schiff stain)检测肾小球糖原沉积情况；另取30mg组织抽提总RNA，用于检测炎症因子TNF-α、IL-6和IL-1β基因转录水平；剩余肾脏组织低温匀浆处理后，按丙二醛(MDA)、超氧化物歧化酶(SOD)试剂盒说明检测组织中MDA含量和SOD活性。
S3、统计学方法
定量实验结果以均数±方差表示。采用SPSS version19.0 Statistical Software(Chicago,IL,USA)，采用单因素方差分析比较各组间差异。当差异显著时(P<0.05)，组间两两比较采用Turkey post hoc法，当P<0.05时，认为差异有统计学意义。
2、实验结果
S1、硫辛酸纳米粒子对实验性糖尿病小鼠血糖的影响
血糖检测结果如图7所示，LA单体组治疗后，仅能将血糖稳定在糖尿病小鼠初始血糖值附近，无降糖作用(p>0.05)；而相同剂量的硫辛酸纳米粒子能有效降低血糖含量59.64％(p<0.01)。上述结果显示硫辛酸纳米粒子在改善糖尿病肾病糖代谢中的有益作用。对照组与db/db小鼠组间显著性差异分析(*P<0.05)；硫辛酸单体组、硫辛酸纳米粒子组与db/db小鼠组间显著性差异分析(#P<0.05，##P<0.01)；硫辛酸纳米粒子组与硫辛酸单体组间显著性差异分析(&P<0.05)。
S2、硫辛酸纳米粒子对实验性糖尿病小鼠UACR、CRE和BUN含量和肾脏组织病变的影响
实验结果显示，与模型组相比，LA单体组血清CRE减少21.05％(p<0.05)，BUN含量减少25.45％(p<0.05)，UACR水平降低24.75％(p<0.05)，表明LA单体对糖尿病性肾损伤有一定的改善效果。而硫辛酸纳米粒子组较模型组相比，血清CRE含量减少52.63％(p<0.01)，BUN减少50.91％(p<0.01)，UACR水平降低71.25％(p<0.05)(图8A-C)，分别是相同剂量LA单体的2.5、2.0和3.3倍。此外，病理检测结果如图(8D、E)所示，w/w对照组小鼠肾小球结构清晰，基底膜正常，小球内可见少量糖原沉积，而db/db模型组小鼠肾小球肥大、基底膜明显增厚，小球内大量糖原沉积，足细胞足突部分消失，提示模型组有严重的肾小球损伤；与db/db模型组比较，LA单体组肾小球缩小25.50％(p<0.05)，基底膜厚 度减少6.57％(p<0.05)，足突数目增加10.14％(p<0.05)；而硫辛酸纳米粒子组，肾小球缩小64.41％(p<0.01)，基底膜厚度减少18.27％(p<0.01)，足突数目增加64.17％(p<0.01)，治疗效果分别为同剂量LA单体的2.5、2.8和6.3倍(p<0.05)，显示硫辛酸纳米粒子对糖尿病性肾功能损伤的优异治疗作用。对照组、硫辛酸单体组、硫辛酸纳米粒子组与db/db小鼠组间显著性差异分析(*P<0.05,#P<0.05，##P<0.01)；硫辛酸纳米粒子组与硫辛酸单体组间显著性差异分析(&P<0.05)。
S3、硫辛酸纳米粒子对实验性糖尿病小鼠肾脏组织MDA、SOD以及炎症因子TNF-α、IL-6和IL-1β基因转录水平的影响
糖尿病性肾氧化损伤改善效果通过测定肾组织中MDA含量和SOD活性进行评估。实验结果显示，同对照组小鼠相比，糖尿病小鼠肾脏中增加的MDA和减少的SOD活力水平表明模型小鼠肾脏存在氧化应激损伤。此外，在糖尿病小鼠肾脏组织中观察到包括TNF-α、IL-1β和IL-6在内的炎性细胞因子基因转录水平明显增加。硫辛酸单体治疗4周后，MDA含量减少了9.8％(p<0.05)，SOD活性增加55％(p<0.05)，显示其对肾脏氧化应激损伤有一定改善效果。硫辛酸纳米粒子治疗后，肾组织中MDA含量显著减少46.34％(p<0.05)，SOD活性增加76.92％(p<0.05)(图9A、B)，分别为相同剂量LA单体的4.7和1.4倍(p<0.05)；在抑制炎症反应方面，硫辛酸单体组TNF-α、IL-1β和IL-6转录水平分别降低了22.5％、18.18％和23.33％(p<0.05)，而硫辛酸纳米粒子组相应基因转录水平分别降低60％、52.27％和56.67％(p<0.01)，为相同剂量LA的2.7、2.9和2.4倍(p<0.05)(图9C-E)。以上结果显示硫辛酸纳米粒子对糖尿病性小鼠肾脏氧化应激和炎症损伤的优异治疗作用。对照组、硫辛酸单体组、硫辛酸纳米粒子组与db/db小鼠组间显著性差异分析(*P<0.05,#P<0.05，##P<0.01)；硫辛酸纳米粒子组与硫辛酸单体组间显著性差异分析(&P<0.05)。
实施例7
称取糖尿病肾病治疗药物厄贝沙坦21.0mg，将其加入含100.0mg实施例1制备得到的硫辛酸纳米囊泡水溶液，在超声条件下充分混合后透析48h，制备得到负载厄贝沙坦的硫辛酸纳米囊泡。参照实施例6所述的方法，验证本实施例中所述负载厄贝沙坦硫辛酸纳米药物对糖尿病肾病的治疗效果。结果显示：硫辛酸纳米粒子负载厄贝沙坦后，疗效较厄贝沙坦单体或未负载厄贝沙坦的硫辛酸纳米粒子更好，在降低活性成分给药量的同时，协同增强了治疗效果。
实施例8
本实施例利用db/db小鼠作为糖尿病周围神经病变模型来评价实施例1制得的硫辛酸纳米粒子对糖尿病周围神经病变(DPN)的疗效，并与临床使用小分子硫辛酸注射液进行对比。
1、实验材料与方法
S1、仪器与试剂：
血糖检测仪，三诺生物传感股份有限公司；
光热尾痛仪，成都泰盟公司；
RB-200智能热板仪，成都泰盟公司；
丙二醛(MDA)测定试剂盒，南京建成生物工程研究所；
超氧化物歧化酶(SOD)测试盒，南京建成生物工程研究所；
谷胱甘肽(GSH)测试盒，南京建成生物工程研究所；
Na+-K+-ATP酶(Na+-K+-ATPase)测试盒，南京建成生物工程研究所；
肿瘤坏死因子-α(TNF-α)测试盒，南京建成生物工程研究所；
白细胞介素-6(IL-6)测试盒，南京建成生物工程研究所；
白细胞介素-1β(IL-1β)测试盒，南京建成生物工程研究所。
S2、动物分组与实验材料
选取16周龄雄性C57BL/KsJ db/db小鼠18只，SPF级，由江苏集萃药康生物科技有限公司常州分公司提供，按体重和血糖随机分为3组，每组6只，分别为db/db模型组、db/db+硫辛酸纳米粒子组(50mg/kg)和db/db+硫辛酸注射液组(50mg/kg)。选取同周龄大小的同窝w/w雄性小鼠作为对照组。对所有小鼠在给药前测定热痛阈值确定DPN症状。小分子硫辛酸注射液和α-硫辛酸纳米粒子每周腹腔注射3次，共注射8周，对照组和模型组腹腔注射给予等体积的生理盐水。治疗周期内，每三天检测一次小鼠血糖变化情况，明确药物的降糖效果。第8周结束，检测热痛阈值；小鼠牺牲，使用检测试剂盒检测相关因子。
S3、热痛阈值测定
使用光热尾痛仪与智能热板仪通过试验来监测痛觉刺激并记录刺激后甩尾和鼠爪退缩的潜伏期或阈值。简而言之，将实验装置设置好相应参数，仪器稳定后放入小鼠。当小鼠爪子缩回、挣扎或鼠尾摆动后，立即记录此时仪器所显示的数值并释放小鼠。在两次试验之间的20分钟间隔内对每只小鼠进行3次评估，并将平均值作为阈值。
S4、Na+-K+-ATP酶活性测定
治疗8周后，牺牲所有小鼠，并分离坐骨神经。为了测定小鼠红细胞和坐骨神经中的Na+-K+-ATPase活性，收集10μL全血并将其添加到240μL蒸馏水中进行混合，并立即确定Na+-K+-ATPase的活性；收集小鼠坐骨神经组织，首先在生理盐水中用小剪刀将坐骨神经切成碎片(100mg：1800μL)并用Beed Ruptor 24Elite匀浆神经。然后，在4℃，3500rpm下离心匀浆15分钟，并收集上清液以供使用。
S5、坐骨神经SOD活性、MDA、GSH、TNF-α、IL-6和IL-1β含量测定
实验结束时牺牲小鼠，分离坐骨神经细胞。为了确定坐骨神经中MDA、GSH、SOD、TNF-α、IL-6和IL-1β含量，首先在生理盐水中用小剪刀将坐骨神经切成碎片(100mg：1800μL)并用Beed Ruptor 24Elite匀浆神经。然后，在4℃、3500rpm下离心匀浆15分钟，并收集上清液以供使用。然后，使用商业试剂盒，测定坐骨神经匀浆中SOD活性，MDA、GSH、TNF-α、IL-6和IL-1β的含量。
S6、坐骨神经形态分析
实验结束时牺牲小鼠，在1-3min内分离坐骨神经样本，取样组织2mm×2mm大小，尽量薄。取材时精确到完整的坐骨神经，避免镊子挤压等机械损伤，刀片锋利避免挫伤组织。组织取下后立即投入电镜固定液内室温固定2h，再转移至4℃保存，4℃冰袋运输，在保存和运输过程中保持固定液呈液体状态，后续进行制样与分析。
S7、统计学方法
定量实验结果以均数±方差表示。采用SPSS version19.0 Statistical Software(Chicago,IL,USA)，采用单因素方差分析比较各组间差异。当差异显著时(P<0.05)，组间两两比较采用Turkey post hoc法，当P<0.05时，认为差异有统计学意义。
2、实验结果
S1、硫辛酸纳米粒子对实验性糖尿病周围神经病变小鼠血糖的影响
血糖检测结果显示，LA单体组治疗8周后，仅能稳定血糖在糖尿病小鼠初始血糖值附近，无降糖作用(p>0.05)，而硫辛酸纳米粒子组有效降低了糖尿病小鼠血糖含量，显示硫辛酸纳米粒子在改善糖尿病周围神经病变糖代谢中的促进作用。
S2、各组小鼠热痛阈值的变化
结果如图10、11所示，分别为热板痛阈值和光热痛阈值。与w/w非糖尿病小鼠相比，db/db小鼠热板和甩尾刺激反应的潜伏期延长(p<0.05)，显示糖尿病小鼠出现明显的痛觉迟钝反应。与db/db小鼠相比，小分子硫辛酸注射液组小鼠热板刺激时间缩短13.47％(p<0.05)， 甩尾刺激时间缩短14.18％(p<0.05)，表明LA单体对糖尿病周围神经病变小鼠行为学有一定改善作用；与db/db小鼠相比，硫辛酸纳米粒子组小鼠热板刺激缩短40.43％(p<0.01)，甩尾刺激缩短31.13％(p<0.01)，分别为同剂量小分子硫辛酸注射液的3.0和2.2倍(p<0.05)。上述结果显示硫辛酸纳米粒子在糖尿病周围神经病变小鼠行为学方面的优异治疗效果。对照组与db/db小鼠组间显著性差异分析(*P<0.05)；硫辛酸单体组、硫辛酸纳米粒子组与db/db小鼠组间显著性差异分析(#P<0.05，##P<0.01)；硫辛酸纳米粒子组与硫辛酸单体组间显著性差异分析(&P<0.05)。
S3、各组小鼠Na+-K+-ATP酶活性的变化
Na+-K+-ATPase活性与微血管的血液供应和周围神经损伤密切相关。结果如图12所示，其中，a为血清Na+-K+-ATP酶活性，b为坐骨神经Na+-K+-ATP酶活性。与非糖尿病小鼠相比，db/db组小鼠红细胞和坐骨神经中Na+-K+-ATPase活性降低。治疗8周后，与db/db小鼠相比，小分子硫辛酸组红细胞Na+-K+-ATPase活性增加137％，坐骨神经中Na+-K+-ATPase活性增加120％；与db/db小鼠相比，硫辛酸纳米粒子组红细胞Na+-K+-ATPase活性增加234％(p<0.05)。坐骨神经中Na+-K+-ATPase活性增加206％(p<0.01)，活性较硫辛酸单体分别提高70.80％和71.67％。上述结果表明，在恢复糖尿病周围神经病变小鼠红细胞和坐骨神经中的Na+-K+-ATPase活性方面，硫辛酸纳米粒子具有较临床药物更强的治疗效果。w/w与db/db小鼠组间显著性差异分析(*P<0.05,**P<0.01,***P<0.001)；小分子硫辛酸注射液组(50mg/kg)、硫辛酸纳米粒子组(50mg/kg)与db/db小鼠组间显著性差异分析(#P<0.05,##P<0.01,###P<0.001)。
S4、小鼠坐骨神经SOD活性以及MDA、GSH、TNF-α、IL-6和IL-1β含量的变化
结果如图13所示，与w/w非糖尿病小鼠相比，db/db小鼠坐骨神经中GSH含量和SOD活性降低，MDA含量显著增加(p<0.01)，表明糖尿病组小鼠坐骨神经存在明显的氧化应激损伤。治疗8周后，硫辛酸单体组MDA含量减少了30.79％(p<0.05)，SOD活性增加15.76％(p<0.05)，GSH含量增加10.79(p<0.05)，而硫辛酸纳米粒子治疗组MDA含量显著减少51.75％(p<0.01)，SOD活性增加52.94％(p<0.01)，GSH含量增加17.72(p<0.01)，分别为相同剂量LA单体的1.7、3.4和1.6倍(p<0.05)。以上结果显示硫辛酸纳米粒子对糖尿病周围神经病变小鼠坐骨神经氧化应激的优异治疗作用。w/w与db/db小鼠组间显著性差异分析(*P<0.05,**P<0.01,***P<0.001)；小分子硫辛酸注射液组(50mg/kg)、硫辛酸纳米粒 子组(50mg/kg)与db/db小鼠组间显著性差异分析(#P<0.05,##P<0.01,###P<0.001)。
在抑制炎症反应方面，结果如图14所示，与w/w非糖尿病小鼠相比，db/db小鼠坐骨神经组织中观察到TNF-α、IL-1β和IL-6细胞因子水平明显增加，表现出较强的炎症反应；与db/db小鼠相比，硫辛酸单体组TNF-α、IL-1β和IL-6细胞因子水平分别降低了34.42％、27.46％和38.42％(p<0.05)，而硫辛酸纳米粒子组相应细胞因子水平分别下降50.25％、48.84％和60.34％(p<0.01)，为相同剂量LA的1.5、1.8和1.6倍(p<0.05)，揭示硫辛酸纳米粒子在糖尿病周围神经病变小鼠坐骨神经炎症治疗中的优异作用。w/w与db/db小鼠组间显著性差异分析(*P<0.05,**P<0.01,***P<0.001)；小分子硫辛酸注射液组(50mg/kg)、硫辛酸纳米粒子组(50mg/kg)与db/db小鼠组间显著性差异分析(#P<0.05,##P<0.01,###P<0.001)。
S5、各组小鼠坐骨神经形态的变化
与非糖尿病小鼠w/w相比，db/db小鼠表现出明显轴突脱髓鞘和损伤。与db/db小鼠相比，小分子硫辛酸注射液组和硫辛酸纳米粒子组治疗8周后髓鞘明显再生，且硫辛酸纳米粒子组效果显著优于小分子硫辛酸注射液组，如图15所示。
在图15中，a为非糖尿病小鼠w/w，b为db/db小鼠，c为小分子硫辛酸注射液组(50mg/kg)，d为硫辛酸纳米粒子组(50mg/kg)。
实施例9
本实施例为利用硫辛酸纳米粒子制备的硫辛酸纳米粒子片剂药物，包括用质量分数表示的以下组分：73％的硫辛酸纳米粒子(主药)、10％的微晶纤维素(填充剂)、10％的淀粉浆(粘合剂)、6％的玉米淀粉(崩解剂)、0.2％的硬脂酸镁(润滑剂)、0.8％的滑石粉(润滑剂)。
该硫辛酸纳米粒子片剂药物的制备方法为：
S1、将73％的硫辛酸纳米粒子(主药)、10％的微晶纤维素(填充剂)和6％的玉米淀粉(崩解剂)分别过100目筛，再将上述材料预混后过20目筛；
S2、加入10％的淀粉浆(粘合剂)制得软材，将软材过20目筛网制成湿颗粒；
S3、将湿颗粒于40℃干燥箱中干燥60min，干燥后的颗粒过20目筛进行整粒；
S4、加入0.2％的硬脂酸镁(润滑剂)和0.8％的滑石粉(润滑剂)混合均匀；
S5、用冲模进行压片。
利用db/db二型糖尿病小鼠作为糖尿病周围神经病变模型来评价应用硫辛酸纳米粒子制备的片剂药物，并与现售小分子硫辛酸片剂的疗效进行对比。
选取16周龄雄性C57BL/KsJ db/db小鼠18只，SPF级，由江苏集萃药康生物科技有限 公司常州分公司提供，按体重和血糖随机分为3组，每组6只，分别为db/db模型组、db/db+硫辛酸纳米粒子片剂组(50mg/kg)和db/db+小分子硫辛酸片剂组(50mg/kg)。选取同周龄大小的同窝w/w雄性小鼠作为对照组。对所有小鼠在给药前测定热痛阈值确定DPN症状。小分子硫辛酸片剂和硫辛酸纳米粒子片剂每周口服3次，每次两片，共8周，治疗周期内，每3天检测一次小鼠血糖变化情况，明确纳米药物的降糖效果。第8周结束，检测热痛阈值；小鼠牺牲，使用检测试剂盒检测其他相关因子。结果表明，硫辛酸纳米粒子片剂治疗8周后，在降低血糖和热痛阈值、提升Na+-K+-ATPase活性、改善组织病变以及缓解炎症方面均显著优于小分子硫辛酸片剂，显示本实施例所制备得到的硫辛酸纳米粒子片剂对于糖尿病周围神经病变的优异治疗效果。
本发明对现有的小分子硫辛酸用于糖尿病及其并发症治疗时存在的问题进行了系统梳理，研究发现现有的小分子硫辛酸主要存在以下突出问题：
1、小分子硫辛酸在静脉注射进入人体后，随着血液循环时会经过肾脏代谢，80-90％小分子硫辛酸透过肾小球进入到肾小管内，随尿液排出，无法到达部分神经组织，留存时间短，作用时间短，治疗效果不佳。
2、小分子硫辛酸存放过程中，由于结构中的二硫键不稳定，在受热或光照射时会导致二噻茂环中的二硫键断裂，形成不稳定自由基，导致硫辛酸失活；在较低的pH以及高湿环境下二硫键断裂形成的巯基杂乱无章地聚合在一起，形成一些明显的淡黄色胶状物质，这些胶状物质是硫辛酸聚合物的降解产物，难以溶解且吸收困难，因此现有的小分子硫辛酸保质期短，保存条件苛刻。
3、由于硫辛酸在水溶液中的溶解度较低，现有小分子硫辛酸注射液的制备方法是通过在水中添加碱性助溶剂如葡甲胺、乙二胺和氨丁三醇等，来增加小分子硫辛酸在水中的溶解度，不仅使单位摩尔量的注射液硫辛酸含量降低，其复杂的成分也提高了注射预期效果不良的风险。而且碱性助溶剂会增加小分子硫辛酸降解的可能性。
而本发明所述降血糖和/或改善糖尿病并发症药物中的硫辛酸纳米粒子，其粒径为10-300nm，远大于肾小球滤过系统的临界粒径，因此硫辛酸纳米粒子能随着血液在体内循环至身体各处神经组织，极大地提升了体内留存时间，使周围神经组织能够有效吸收硫辛酸，从而提升治疗效果。其单体的二硫键之间相互交联聚合在一起，将较为活泼的二硫键包裹在纳米粒子内部，从而提升其稳定性，使其保质期更长。
硫辛酸纳米粒子中亲水基团在纳米粒子外，疏水基团在纳米粒子内，使得硫辛酸纳米粒 子无需任何助溶剂便能溶于水中，溶解度远远高于硫辛酸单体。此外，溶解度的提高，无需添加助溶剂降低了成本与注射风险。
实施例10
取实施例3制备得到的硫辛酸纳米聚集体25.0mg，将其加入含100mg聚乳酸-羟基乙酸共聚物(PLGA)的水溶液，在超声条件下充分混合并透析后制备得到负载于PLGA胶束的硫辛酸纳米粒子；取实施例3制备得到的硫辛酸纳米聚集体25.0mg，将其加入含100mg聚乳酸(PDLLA)的水溶液，在超声条件下充分混合并透析后制备得到负载于PDLLA胶束的硫辛酸纳米粒子。参照实施例4所述方法验证本实例所得两种载体负载的硫辛酸纳米粒子的降血糖效果。结果显示，不同载体负载后，硫辛酸纳米粒子清除时间延长，药物发挥药效时间增加，呈现出更优的治疗效果。
实施例11
参照实施例1所述方法，制备硫辛酸纳米粒子，然后用1-乙基-(3-二甲基氨基丙基)碳酰二亚胺和4-二甲氨基吡啶酯化法将聚乙二醇(PEG-1000)接枝到上述硫辛酸纳米粒子上。与未接枝纳米粒子相比，纳米粒子表面修饰PEG-1000后，有效降低了纳米粒子与体内蛋白吸附，延缓了纳米粒子的清除，延长了药物发挥药效时间，呈现出更优的治疗效果。
以上所述仅为本发明的优选实施例，对本发明而言仅是说明性的，而非限制性的；本领域普通技术人员理解，在本发明权利要求所限定的精神和范围内可对其进行许多改变，修改，甚至等效变更，但都将落入本发明的保护范围。

Claims (10)

  1. 一种硫辛酸纳米粒子的应用，其特征在于，将其用于制备降血糖和/或改善糖尿病并发症的药物。
  2. 根据权利要求1所述的应用，其特征在于，所述硫辛酸纳米粒子是由包含硫辛酸和/或硫辛酸衍生物的成分形成的纳米粒子。
  3. 根据权利要求1所述的应用，其特征在于，所述改善糖尿病并发症的药物能够通过降低血糖和抑制氧化应激双重作用实现改善糖尿病并发症。
  4. 根据权利要求4所述的应用，其特征在于，所述糖尿病并发症包括糖尿病肾病、糖尿眼部病变、糖尿病足、糖尿病心血管病变、糖尿病性脑血管病和糖尿病周围神经病变中的一种或者多种。
  5. 根据权利要求1所述的应用，其特征在于，将硫辛酸纳米粒子与其他活性成分联用。
  6. 一种适用于权利要求1所述应用的硫辛酸纳米粒子，其特征在于，所述硫辛酸纳米粒子是由包含硫辛酸和/或硫辛酸衍生物的成分形成的纳米粒子。
  7. 根据权利要求6所述的硫辛酸纳米粒子，其特征在于，所述硫辛酸和/或硫辛酸衍生物通过二硫键交联聚合。
  8. 根据权利要求6所述的硫辛酸纳米粒子，其特征在于，所述硫辛酸纳米粒子的粒径为10-300nm。
  9. 一种降血糖和/或改善糖尿病并发症的药物，其特征在于，含有硫辛酸纳米粒子。
  10. 根据权利要求9所述的降血糖和/或改善糖尿病并发症的药物，其特征在于，还含有其他活性成分。
PCT/CN2023/075700 2022-02-15 2023-02-13 一种降血糖和/或治疗糖尿病并发症的药物 WO2023155754A1 (zh)

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