This invention relates to pharmacologically active compounds. Moreover, the invention concerns pharmacol¬ ogical preparations containing- the compounds as well as the use of the compounds in the treatment of various diseases.

The compound according to the invention consists of podophyllotoxin and derivatives thereof which have the formula

wherein Rj is H or OH and R2 is H or CH3.

Podophyllotoxin and itβ derivatives have been found to have a plurality of outstanding pharmacol¬ ogical effects. Thus, they βupreββ the activity of lymphatic T-cellβ ("killer cells"> and can therefore be used to counteract reactions of immunity and rejection at transplantations. Besides, they inhibit cell divi¬ sion in the mβta phase and can therefore be used for treatment of psoriatic diseases. The compounds also have biocidal and bioβtatic effects against such microorganisms as plaamodia, fungi and viruses, and they can therefore be used in the treatment of parasit¬ ic diseases, such as malaria, and viral diseases. Furthermore the compounds also act as anthelminticβ.

The compound podophyllotoxin is previously known and has been extracted from plants, mainly from the genus Podophyllum. However, the compound has not earlier been used in itβ highly pure form according to the present invention, which haβ made poββibic itβ uβe in new indication fields. In previous works, an impure extract from Podophyllum βpecieβ, so-called "podophyllin", has mostly been used, which haβ only contained 20-40 X of podophyllotoxin. Moreover, the extract containβ a great number of other components such aβ deβoxypodophyllotoxin, dehydropodophyllotoxin, α- and β-paltatin etc., depending on from which βpecieβ the extract haβ been recovered. Several of theβe other componentβ have been found to be conβiderably mutagen- ic.

The compound podophyllotoxin haβ the following physical data in itβ pure state:

Melting point: 183-i84°C (βubβtancβ free of βolvent) Optical rotation _q_7 ²⁰ D ^: - 132,5 (C 0.2 CHC1 ₃ ) Solubility in water: 120 mg/1

Podophyllotoxin and itβ derivativeβ can be extracted from plant parts, especially rootβ or rhizomeβ, from variouβ βpecieβ of the genuβ Podophyllum, βuch aβ P. emodi Wall, and P. peltatum L. The compound alβo occurβ in other plant βpecieβ, for example of the genuβ Juniperuβ βuch aβ J. virginiana L.

In the preparation of highly pure podophyllotoxin or itβ derivativeβ according to the invention, dried and finely ground rhizomeβ of e.g. Podophyllum emodi or Podophyllum peltatum are extracted e.g. with ethyl acetate and the extracxt iβ concentrated and filtered

through βilica gel. The desired fraction of podophyllo¬ toxin and derivativeβ thereof is thereafter chromato- graphed on acid alumina and yields a fraction substan¬ tially containing the five lignaneβ deoxypodophyllo- toxin, podophyllotoxone, iβopicropodophylline, podo¬ phyllotoxin and 4'-demethylpodophyllotoxin. Podophyllo¬ toxin or another deβired derivative iβ iβolated from thiβ mixture through a careful chromatography on βilica gel, after which the deβired fraction iβ recryβtal- lized.

Highly pure podophyllotoxin and itβ derivativeβ accordidng to the invention have been found to have a number of excellent pharmacological effectβ and can be uβed againβt βeveral diβeaβeβ. In accordance with thiβ, the present invention alβo compriβeβ pharmacological preparations which are characterized in that they contain podophyllotoxin and/or itβ derivativeβ together with one or more pharmacologically acceptable carrier materialβ.

Aβ carrier materialβ all thoβe materialβ can be uβed which are known to be uβeful in the preparation of pharmacological preparations, provided they do not react unfavourably with the active compound or exert βome unβuitable effect together therewith. The pharmacological preparations can be made for enteral, parenteral or dermal adminiβtration and they can for example be in the form of βolid preparations βuch aβ tabletβ, powder, capβuleβ, βuppoβitorieβ or vagitorieβ, more or leββ semi-liquid preparations βuch aβ ointmentβ, gelβ or creamβ, or liquid preparationβ βuch aβ βolutionβ, βuβpenβionβ or emulβionβ. They may alβo contain additional conventional additiveβ and alβo other therapeutically active agentβ. It iβ within the knowledge of one βkilled in the art to prepare a

βuitable composition when the way of administration and other conditions for the administration are known.

The dose uβed can be eβtabliβhed by one skilled in the art βtarting from conventional criteria βuch aβ the βeriouβneββ of the illness, the way of administration, the patient's age and condition, etc.

Podophyllotoxin and itβ derivativeβ according to the invention can be uβed for the treatment of a number of different diβeaβeβ which can be βummarized into the following groups. Non-reβtrictive exampleβ are given for each group.

1. Tropical diseases βuch aβ malaria and βchizotomiaβiβ.

2. Skin diβeaβeβ βuch aβ pβoriaβiβ, fungal infectionβ and alopecia areata.

3. Reactionβ of rejection at transplantations.

4. Collagenoβeβ (connective tiββue diβeaβeβ) βuch aβ rheumatoidal arthritiβ, βyβtemic lupuβ erythematoβuβ diββeminatur, βclerodermy, polyartheritiβ nodosa and βarcoidoβiβ.

5. Mental illness (caused by virus) such aβ demenβ' and psychoses.

6. Neurological diseases βuch aβ multiple sclerosis and myaβthenia graviβ.

The therapeutic effectβ on the diβeaβeβ mentioned above are baβed on a number of acting mechaniβmβ of podophyllotoxin and itβ derivativeβ. Firβtly, the compoundβ inhibit the activity of lymphatic T-cβllβ (so-called "killer cells") which iβ of importance to counteract reactionβ of rejection at transplantations. Furthermore, the compoundβ counteract cell diviβion in the metaphaβe which iβ of a great importance at certain skin diβeaβeβ βuch aβ pβoriatic states. The compoundβ have alβo a biocidal or bioβtatic effect againβt βuch

microorganiβmβ aβ plasmodia, fungi and viruses, whereby a plurality of diseases caused by microorganiβmβ aβ well aβ malaria can be treated. Finally, the compoundβ have alβo anthelmintic properties and can thuβ be uβed aβ agentβ againβt helminthβ and other parasites.

Thuβ, in accordance with another aspect of the invention, it alβo comprises a method of treating stateβ of illness caused by activity of the diβeaβe agentβ mentioned above and iβ characterized in that one or more of the compoundβ or a pharmacological prepara¬ tion according to the invention iβ furniβhed to the organiβm attacked by the illness.

The organisms attacked by said illnesses may be humans or animals.

Podophyllotoxin and itβ derivativeβ according to the invention have been βubjected to a number of phar¬ macological, toxicolσgical and clinical inveβtigationβ in order to eβtabliβh their therapeutic properties. The reβultβ of theβe inveβtigationβ are deβcribed in the following. Acute toxicitv

The acute toxicity of podophyllotoxin haβ been determined on variouβ teβt anim ls and by various ways of administration. The reβultβ appear from the follow¬ ing table 1.

Table 1

Teβt animal Way of Ad- Acute toxicity miniβtration LU5o mg/kg

Rat 1.v. 10

Mouβe i .v. 20

Mouβe P.O. 100

Rat dermal 500

Rabiit dermal 200

Effect aoainat malaria

The effect againβt malaria waβ determined clini¬ cally on a number of patients which had been attacked by the malaria parasite Plasmodium falciparum. Podo¬ phyllotoxin waβ administered in two different doβeβ and the number of paraβiteβ in the patientβ waβ determined for each day and waβ noted aβ the number of aβexual paraβiteβ. per cubic millimeter of blood. The reβultβ appear from the follwing table 2.

Table 2

Effect aoainst reactions of immunity and rejection

Injection with a suspension of erythrocyteβ from βheep to mice cauβeβ formation of βpecific antibodies againβt thiβ antigen. Thiβ reaction which normally iβ very βtrong requireβ a cooperation between different cell typeβ, substantially macrophageβ, T and B lympho¬ cytes, and can easily be detected in the spleen of the test animals. Thiβ reaction can be inhibited in a doββ-depβndent way by daily injectionβ of podophyllo¬ toxin after adminiβtration of erythrocyteβ.

A tranβplantation of βkin to genetically different mice normally leadβ to a rejection within 10 dayβ. It haβ been found in many caβeβ that a markedly prolonged time of βurvival of 15 dayβ and longer iβ obtained with animalβ treated with a compound according to the inven¬ tion aβ compared with an untreated control group.

At inveβtigationβ in vitro, it haβ alβo been found that podophyllotoxin inhibitβ the proliferation of cells caused by mitogβnic lectinβ or cells from a non-related individual and alβo inhibitβ the develop¬ ment of cytotoxic cells. However, at markedly lower doβes these effects increase. Other inveβtigationβ βhow that cells treated with podophyllotoxin could recover complete reactivity to these stimuli within 24 hours. Effect aoainst psoriasis

A clinical investigation waβ carried out with totally 152 patientβ of an age between 19 and 71 yearβ (mean value 46.1 yearβ) afflicted with pβoriaβiβ vulgariβ. The patientβ were divided into three groupβ of 50, 51 and 51 perβonβ who were treated topically with a cream containing 0.1, 0.25 and 0.5 X of podo¬ phyllotoxin, rββpectively. Each patient waβ treated only on a βpecific attacked area of the body while other attacked areaβ βerved aβ comparison. The βeveri-

ty of the attack waβ judged at the βtart of the treat¬ ment, and 2, 4, β, 12 and 16 weeks after thiβ, no treatment being carried out during the last period of 4 weekβ. The inveβtigation waβ carried out with double blind technique and the results were treated βtatiβ¬ tically.

At all three doβage levels, βtatiβtically signi¬ ficant improvementβ (p<0.001) were obtained regarding the βeverity of the treated leβiσnβ with aββociated symptoms. Aβ early aβ after a treatment time of two weekβ, there waβ a βtatiβtically βignificant difference (p<0.001) between treated and untreated leβionβ, and thiβ difference increaβed in the course of the treat¬ ment. At the fifth control, 70-75 X of the patientβ were free from βymptomβ or had only mild oneβ, while only two of the patientβ βhowed the correβponding improvements for the untreated lesions. In the follow- -up time, weeks 13 to 16, no deterioration occurred aβ to the βeverity or βymptomβ of the treated leβionβ. Only 11 of the patientβ reported any βecondary effects βuch aβ rash. Theβe βecondary effectβ diβappeared after interruption of the treatment. Differences between the three treated groupβ regarding the number of cases with βecondary effectβ are not βtatiβtically βignificant (p about 0.50).