DE SMEDT, Thibaut (33 rue du Village, Lutry, CH-1095, CH)
VAN GOOL, Frédéric (Avenue du Pré Fleuri 15, 1950 Kraainem, BE)
GALLI, Mara (Rue du Laboratoire 25, 6000 Charleroi, BE)
OBERDAN, Leo (Rue JB de Keyzer 32, 1970 Wezembeek-Oppem, BE)
DE SMEDT, Thibaut (33 rue du Village, Lutry, CH-1095, CH)
VAN GOOL, Frédéric (Avenue du Pré Fleuri 15, 1950 Kraainem, BE)
GALLI, Mara (Rue du Laboratoire 25, 6000 Charleroi, BE)
CLAIMS
1. Use of an inhibitor of the formation of nicotinamide adenyl dinucleotide for the preparation of a medicament used in the treatment of inflammatory diseases.
2. Use according to claim 1, wherein the inhibitor is a noncompetitive or competitive inhibitor of the enzyme nicotinamide phosphoribosyltransferase.
3. Use according to claim 1 or to claim 2, wherein the inhibitor is (E)-N-[4-(l- benzoylpiperidin-4-yl) butyl]-3-(pyridine-3-yl) acrylamide.
4. Process to manufacture a medicament for treating inflammatory diseases characterized in the use of an effective amount of an inhibitor of the formation of nicotinamide adenyl dinucleotide.
5. Process according to claim 4, wherein the inhibitor is a noncompetitive inhibitor of the enzyme nicotinamide phosphoribosyltransferase.
6. Process according to claim 4 or to claim 5, wherein the inhibitor is (E)-N-[4-(l- benzoylpiperidin-4-yl) butyl]-3-(pyridine-3-yl) acrylamide.
7. A pharmaceutical kit comprising at least an effective amount of an inhibitor of the formation of nicotinamide adenyl dinucleotide together with instructions for use in the treatment of inflammatory diseases. |
New method for the treatment of inflammatory diseases
The present invention relates to the use of an inhibitor of the formation of nicotinamide adenyl dinucleotide for the preparation of a medicament used in the treatment of inflammatory diseases. The invention relates also to a process to manufacture a medicament for treating inflammatory diseases and finally to a pharmaceutical kit comprising such inhibitor.
The preparation of a class of inhibitors of the formation of nicotinamide adenyl dinucleotide and their use thereof, as antitumor agent, are already described in EP 1031564.
One of these inhibitors, (E)-N-[4-(l-benzoylpiperidin-4-yl) butyl]-3-(pyridine-3- yl)-acrylamide, also known and hereinafter referred to as FK866 [International Nonproprietary Name], is especially described in the literature as an anticancer agent.
FK866 may be used for treatment of diseases implicating deregulated apoptosis such as cancer. It has been demonstrated in the prior art that FK866 interferes with nicotinamide adenyl dinucleotide (also known and hereinafter referred to as NAD) biosynthesis and induces apoptotic cell death without any DNA damaging effects.
Antiangiogenic and antitumoral efficacy of FK866 are described in many publications.
The publication "FK866, a high specific non-competitive inhibitor of nicotinamide phosphoribosyltransferase, represents a novel mechanism for induction of tumor cell apoptosis", M. Hasmann et al., Cancer Research 63, 7436-7442, November 1, 2003 describes more generally FK866 as the first high potent and specific inhibitor of nicotinamide phosphoribosyltransferase and its characteristics as antitumor compound.
For example, its efficacy as antitumor agent for the treatment of leukaemia is described in "WKl 75, a novel antitumor agent, decreases the intracellular nicotinamide
adenine dinucleotide concentration and induces the apoptotic cascade in human leukaemia cells", K. Wosikowski et al., Cancer Research 62, 1057-1062, February 15, 2002.
Its efficacy as antitumor agent for the treatment of renal carcinoma is demonstrated in "antiangiogenic potency of FK866/K22.175, a new inhibitor of intracellular NAD biosyntheses, in murine renal cell carcinoma", J. Dreves et al., Anticancer Research 23: 4853-4858 (2003).
Considering the above-mentioned completely different known medical indications of known inhibitors to the formation of nicotinamide adenyl dinucleotide, the activity of the compounds used according to the invention with advantageous therapeutic properties for inflammatory diseases was completely surprising for the person skilled in the art.
The notion of inflammatory diseases delineates a heterogeneous group of pathologies that involve innate or adaptive immune system components and characterized by chronic inflammation in the absence of infection or seemingly unprovoked. Examples of these diseases are hereditary periodic fevers, Muckle- Wells syndrome, familial mediterranean fever, familial cold-induced autoinflammatory syndrome, rheumatoid arthritis, systemic onset juvenile idiopathic arthritis, osteoarthritis, psoriasis, Crohn's disease, multiple sclerosis, the metabolic disorders gout and pseudogout, atherosclerosis, stroke-ischemia, Alzheimer disease, Parkinson disease and asthma.
Tumor necrosis factor-α (TNF-α), interleukin-1 (IL-I), and interleukin-6 (IL-6) are cytokines produced by cells of the innate immune system upon microbial activation, and are important mediators of both local and systemic inflammation. In many instances, the secretion of these cytokines is deregulated in inflammatory diseases leading to chronic inflammation.
Inhibition of TNF-α, EL-I, and IL-6 production is beneficial in several inflammatory diseases, and numerous efforts have been devoted in the design of novel therapies aimed at blocking the production and/or the biological effects of these important pro-inflammatory cytokines.
In the present invention, unexpected anti-inflammatory properties of the inhibition of nicotinamide adenyl dinucleotide have been identified. By inhibiting nicotinamide adenyl dinucleotide biosynthesis, it was surprisingly found that TNF- α, IL-I and IL-6 secretion are inhibited.
In the present invention, it is demonstrated that optimal proinflammatory cytokine levels, including TNF-α, IL-I and IL-6, require adequate nicotinamide adenyl dinucleotide intracellular concentration.
In view of this art, the finding that inhibitors of the formation of nicotinamide adenyl dinucleotide have activities which make them particularly suitable in an excellent manner for the therapy of inflammatory diseases was completely unexpected.
The present invention establishes a functional link between metabolism and inflammation, and demonstrates a potential important role for NAD-dependent enzymes in the regulation of proinflammatory cytokine synthesis, including TNF-α, IL-I and IL-6.
Hence, in a first embodiment, the present invention relates to the use of an inhibitor of the formation of nicotinamide adenyl dinucleotide for the preparation of a medicament used in the treatment of inflammatory diseases.
In a second embodiment, the present invention relates to a process to manufacture a medicament for treating inflammatory diseases.
Furthermore, the present invention concerns also a pharmaceutical kit comprising at least an effective amount of an inhibitor of the formation of nicotinamide adenyl dinucleotide together with instructions for use in the treatment of inflammatory diseases.
The term "inhibitor" refers to a substrate molecule that blocks a particular biologic activity.
The expression "competitive inhibitor" refers to a substrate molecule which directly binds to the same active site as the normal en2yme substrate, without undergoing a reaction.
The expression "non-competitive inhibitor" as used herein defines a substrate molecule which always binds to the enzyme at a site other than the enzyme's active site. The binding affects the activity of the enzyme because the presence of the inhibitor causes a change in the structure and shape of the enzyme but it doesn't change the apparent binding affinity of the normal enzyme substrate.
The term "inflammatory diseases" refers to diseases that are characterized by activation of the immune system to abnormal levels that lead to disease.
The expression "effective amount" generally refers to the quantity for which the active substance has therapeutical effects. In the present case the active substance is the inhibitor of the formation of nicotinamide adenyl dinucleotide.
"Nicotinamide phosphoribosyltransferase" also named NMPRT, NMPRTase or NAmPRTase, (International nomenclature: E.G. 2.4.2.12) is a key enzyme in nicotinamide adenyl dinucleotide (NAD) biosynthesis from the natural precursor nicotinamide.
"Nicotinic acid" is a precursor of NAD.
In the present invention, both terms "TNF" and "TNF-α" are used to designate the cytokine named "Tumor necrosis factor-α".
When used as a therapeutic the inhibitor of the formation of nicotinamide adenyl dinucleotide described herein are preferably administered with a physiologically acceptable carrier. A physiologically acceptable carrier is a formulation to which the compound can be added to dissolve it or otherwise facilitate its administration. Example of a physiologically acceptable carrier includes propylene glycol. An important factor in choosing an appropriate physiologically acceptable carrier is choosing a carrier in which the compound remains active or the combination of the carrier and the compound produces an active compound.
Benefits of the present invention include oral administration of an optimal amount of a NAD biosynthesis inhibitor.
Based on these results, the present invention has important implications for the design of novel treatment strategies for patients with inflammatory diseases.
Thus, a first aspect of the present invention concerns the use of an inhibitor of the formation of nicotinamide adenyl dinucleotide for the preparation of a medicament used in the treatment of inflammatory diseases.
According to the present invention, the inhibitor is preferably a competitive or noncompetitive inhibitor of the enzyme nicotinamide phosphoribosyltransferase.
More preferably, the inhibitor is (E)-N-[4-(l-benzoylpiperidin-4-yl) butyl]-3- (pyridine-3 -yl)-acrylamid.
Further, the present invention relates to a process to manufacture a medicament for treating inflammatory diseases wherein an effective amount of an inhibitor of the formation of nicotinamide adenyl dinucleotide is used.
In the process according to the present invention the inhibitor is preferably a competitive or noncompetitive inhibitor of the enzyme nicotinamide phosphoribosyltransferase.
More preferably, the inhibitor is (E)-N-[4-(l-benzoylpiperidin-4-yl) butyl]-3- (pyridine-3 -yl)-acrylamide.
In the process according to the present invention, the effective amount of the inhibitor may be administrated to the patient in an amount and for a time sufficient to induce a sustained amelioration of symptoms.
According to the invention, the dosage ranges of the inhibitor may vary with the administration routes, as well as the state of the patient (age, sexe, body weight, extent of
the disease etc.). Ideally, the dosage ranges may be between 1 mg to 100 mg/kg of body weight/day.
In the process to manufacture a medicament, a galenic composition comprising a therapeutically effective amount of an inhibitor according to the invention with at least a pharmaceutical acceptable carrier, can be prepared in a manner known per se and is suitable for enteral, such as oral or rectal, and parenteral administration to mammals, including man.
In preparing the compositions for oral dosage form, any convenient pharmaceutical media may be employed. For example, water, glycols, oils, alcohols, flavouring agents, preservatives, colouring agents, and the like may be used to form oral liquid preparations such as suspensions, elixirs and solutions; while carriers such as starches, sugars, microcrystalline cellulose, diluents, granulating agents, lubricants, binders, disintegrating agents, and the like may be used to form oral solid preparations such as powders, capsules and tablets. Because of their ease of administration, tablets and capsules are the preferred oral dosage units whereby solid pharmaceutical carriers are employed. Optionally, tablets may be coated by standard aqueous or non-aqueous techniques.
A tablet containing the composition of this invention may be prepared by compression or molding, optionally with one or more accessory ingredients or adjuvants.
Compressed tablets may be prepared by compressing, in a suitable machine, the combination partners in a free-flowing form such as powder or granules, optionally mixed with a binder, lubricant, inert diluents, surface active or dispersing agent. Moulded tablets may be made by moulding in a suitable machine, a mixture of the powdered compound moistened with an inert liquid diluent. Each tablet preferably contains from about 10 mg to about 2 g of the combination partners and each cachet or capsule preferably containing from about 10 mg to about 2 g of the combination partners.
Pharmaceutical compositions suitable for parenteral ad'ministration may be prepared as solutions or suspensions of the combination partners in water. A suitable surfactant can be included such as, for example, hydroxypropylcellulose. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, propylene glycols, and mixtures
thereof in oils. Further, a preservative can be included to prevent the detrimental growth of micro-organisms.
Pharmaceutical compositions suitable for injectable use include sterile aqueous solutions or dispersions. Furthermore, the compositions can be in the form of sterile powders for the extemporaneous preparation of such sterile injectable solutions or dispersions. In all cases, the final injectable form must be sterile and must be effectively fluid for easy use with a syringe. The pharmaceutical compositions must be stable under the conditions of manufacture and storage; thus, preferably should be preserved against the contaminating action of micro-organisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (e. g., glycerol, propylene glycol and liquid polyethylene glycol), vegetable oils, and suitable mixtures thereof.
Finally, the present invention pertains to a pharmaceutical kit comprising at least an effective amount of an inhibitor of the formation of nicotinamide adenyl dinucleotide together with printed instructions for use in the treatment of inflammatory diseases.
The pharmaceutical kit according to the present invention may comprise a container comprising at least said inhibitor. In a preferred embodiment, the kit container may further include a pharmaceutically acceptable carrier. The kit may further include a sterile diluent, which is preferably stored in a separate additional container.
This invention will be better understood from the Experimental Details that follow. However, one skilled in the art will readily appreciate that the specific methods and results discussed are merely illustrative of the invention as described more fully in the claims which follow thereafter, and are not to be considered in any way limited thereto.
FIGURES LEGEND
Figure 1: Direct relationship between NAD levels in cells and proinflammatory cytokine secretion.
Human monocytic cell line THP-I was cultured overnight in the presence of graded doses of nicotinic acid (NA), a precursor of NAD, and then stimulated with lipopolysaccharide (LPS) from gram-negative bacteria for 2h. The cell supernatant was tested for tumor necrosis factor (TNF) content by ELISA and the intracellular pool of NAD was measured by an enzymatic assay.
Figure 2: FK866, a competitive inhibitor of NMPRT, inhibits proinflammatory cytokine production in inflammatory cells in response to LPS.
Human monocytic cell line THP-I, human peripheral blood mononuclear cells (PBMC), human monocyte-derived dendritic cells, or mouse peritoneal macrophages were isolated and cultured overnight with increasing doses of FK866, and then stimulated with LPS for 6h. The culture supernatants were tested for TNF and IL-6 content by ELISA
Figure 3: Correlation between proinflammatory cytokine secretion and NAD levels in the cell.
(A) The mouse macrophage cell line RAW264.7 was cultured overnight with increasing doses of FK866, and then stimulated with LPS for 2h. The culture supernatants were tested for TNF content by ELISA and intracellular NAD levels were measured by an enzymatic assay.
(B) RAW264.7 cells were cultured overnight in the presence of FK866 and the intracellular pool of NAD was restored by co-incubation of the cells with nicotinic acid (NA). Cells were then stimulated with LPS for 2h and the culture supernatant was tested for TNF content by ELISA.
(C) RAW264.7 cells were cultured overnight in the presence of FK866 and NAD levels were maintained by culturing the cells in the presence of extracelllular NAD. Cells were then stimulated with LPS for 2h and the culture supernatant was tested for TNF content by ELISA.
Figure 4: Inhibition of proinflammatory cytokine secretion induced by lowering intracellular NAD levels is not due to apoptosis induction.
(A) Human PBMC were isolated and cultured overnight with increasing doses of FK866, and then stimulated with LPS for 6h. At the end of the culture, cell viability was assessed using the MTT (3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) assay.
(B) Human monocyte-derived dendritic cells were isolated and cultured overnight with increasing doses of FK866, and then stimulated with LPS for 6h. At the end of the culture, the survival of cells was measured by Annexin-V and propidium iodide staining.
Figure 5: Reduction of disease severity of rheumatoid arthritis (RA) in an experimental mouse model of collagen-induced RA after treatment with FK866.
Male DBA/1 mice between 8-10 weeks of were immunized intradermally at the base of tail with 100 μg of native type II collagen (CII), emulsified in complete Freund's adjuvant containing 5 mg/ml mycobacterium tuberculosis. Twenty-one days later, the mice were boosted with 100 μg collagen in incomplete Freund's adjuvant intradermally at the base of the tail. From day 15 after the first immunization onward, mice are examined daily for the onset of clinical arthritis. The severity of arthritis is scored on a 3-point scale, where 0 = normal appearance, 1 = mild swelling and/or erythema, 2 = pronounced swelling and erythema, and 3 = joint rigidity. Each limb is graded, resulting in a maximal clinical score of 12 per animal. Treatment with FK866 was administered twice daily at 10 mg/kg intraperitoneally for a total of 15 days from the day when CIA became clinically detectable (clinical scoring > 1). Values are ± s.e.m. of clinical score with 10 animals per group.
EXAMPLES
Example 1
This example illustrates the direct relationship between NAD levels in cells and pro-inflammatory cytokine secretion. Human monocytic cell line THP-I was cultured overnight in the presence of nicotinic acid, a precursor of NAD, and then stimulated with lipopolysaccharide (LPS) from gram-negative bacteria for 2h. The cell supernatant was tested for tumor necrosis factor (TNF) content by ELISA and the intracellular pool of
NAD was measured by an enzymatic assay. Fig. 1 shows that TNF secretion and NAD levels were increased in parallel in a dose-dependent fashion in the presence of nicotinic acid.
Example 2
This example describes the inhibition of pro-inflammatory cytokines production by the competitive small molecular weight compound inhibitor of NMPRT, ((E)-N-[4-(l-benzoylpiperidin-4-yl) butyl]-3-(pyridin- 3-yl) acrylamide, designated FK866). Human monocytic cell line THP-I, human peripheral blood mononuclear cells (PBMC), human monocyte-derived dendritic cells, or mouse peritoneal macrophages were isolated and cultured overnight with increasing doses of FK.866, and then stimulated with LPS for 6h. The culture supernatants were tested for TNF and IL-6 content by ELISA. Fig. 2 shows that FK866 inhibited cytokine secretion in a dose-dependent fashion in all inflammatory cells tested.
Example 3
This example illustrates the correlation between proinflammatory cytokine secretion and NAD levels in the cell. The mouse macrophage cell line RAW264.7 was cultured overnight with increasing doses of FK866, and then stimulated with LPS for 2h. The culture supernatants were tested for TNF content by ELISA and intracellular NAD levels were measured by an enzymatic assay. Fig. 3A shows that inhibition of TNF production correlated with the inhibition of intracellular NAD levels.
In another experiment, RAW264.7 cells were cultured overnight in the presence of FK866 and the intracellular pool of NAD was restored by co-incubation of the cells with nicotinic acid. Nicotinic acid is a precursor of NAD, but its transformation into NAD is not dependent upon NMPRT and is thus not inhibited by FK866. Cells were then stimulated with LPS for 2h and the culture supernatant was tested for TNF content by ELISA. Fig. 3B shows that addition of nicotinic acid maintained high levels of NAD, even in the presence of FK866. The synthesis of TNF was also restored showing the direct relationship between NAD levels in cells and pro-inflammatory cytokine secretion.
In another experiment, RAW264.7 cells were cultured overnight in the presence of FK866 and NAD levels were maintained by culturing the cells in the presence of extra-
cellular NAD. Cells were then stimulated with LPS for 2h and the culture supernatant was tested for TNF content by ELISA. Fig. 3C shows that NAD levels remained high even in the presence of FK866, and TNF synthesis was restored.
Example 4
This example illustrates that the inhibition of proinflammatory cytokine secretion induced by lowering intracellular NAD levels is not due to apoptosis induction. Human PBMC were isolated and cultured overnight with increasing doses of FK866, and then stimulated with LPS for 6h. At the end of the culture, cell viability was assessed using the MTT (3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) assay. Fig. 4A shows that cell viability was not affected by FK866.
In another experiment, human monocyte-derived dendritic cells were isolated and cultured overnight with increasing doses of FK866, and then stimulated with LPS for 6h. At the end of the culture, the survival of cells was measured by Annexin-V and propidium iodide staining and no difference in survival was observed in cells treated with FK866 compared to untreated cells (Fig. 4B). This shows that inhibition of NAD and pro-inflammatory cytokine secretion was not simply due to cell death induction.
Example 5
This example describes the reduction of disease severity of rheumatoid arthritis (RA) in an experimental mouse model of collagen-induced RA after treatment with FK866. RA is an autoimmune disorder characterized by chronic inflammation of the joints leading to their destruction. Pro-inflammatory cytokines play a major role in the development and maintenance of the disease, and blocking of TNF or IL-I for alleviating symptoms of RA is now well established in clinical practice. Male DBA/1 mice between 8-10 weeks of were immunized intradermally at the base of tail with 100 μg of native type II collagen (CII), emulsified in complete Freund's adjuvant containing 5 mg/ml mycobacterium tuberculosis. Twenty-one days later, the mice were boosted with 100 μg collagen in incomplete Freund's adjuvant intradermally at the base of the tail. From day 15 after the first immunization onward, mice are examined daily for the onset of clinical arthritis. The severity of arthritis is scored on a 3-point scale, where 0 = normal appearance, 1 = mild swelling and/or erythema, 2 = pronounced swelling and erythema,
and 3 = joint rigidity. Each limb is graded, resulting in a maximal clinical score of 12 per animal. Treatment with FK866 was administered twice daily at 10 mg/kg intraperitoneally for a total of 15 days from the day when CIA became clinically detectable (clinical scoring > 1). Results shown in Fig. 5 indicate that FK866 ameliorates the symptoms of arthritis in an animal model of RA.