Embodiment describes in detail
Mentioned by time of the present invention previously, keratinocyte is considered in the pathology of the skin inflammatory condition (comprising psoriasis) being critically involved in certain limit.Many permanent anti-inflammatory therapies are considered to make copying of inflammatory cell reduce to minimum valuably, and in view of suppressing the growth of inflammatory cell and/or to copy be preferred, predicted those compounds with antiapoptotic are not considered clinically to be used for the treatment of these diseases.Although these have anti-inflammatory function why, before making the present invention, APC is never proposed the skin disorder making the propagation being characterised in that keratinocyte have excess proliferative, Hypertrophic or other regulation and control abnormal and reduces to some reasons that are the lightest or that eliminate.In fact, before making the present invention, noticing will to inflammatory skin disease to the public data of the stimulation that keratinocyte is bred hint APC therapy about APC, as psoriasis, acne be characterised in that other skin disorder of keratinocyte hyper-proliferative is harmful to.
As described herein; inventor shockingly finds that APC suppresses the apoptosis of slowly growth or normal person’s keratinocyte or cell; but on suppressing abnormal or growth keratinocyte or cell fast propagation without impact, the latter is the mediation person of the inflammatory cutaneous disease of broad range.
Thus inventor has recognized that in the skin disorder relevant to keratinocyte hyper-proliferative, with regard to the reaction of signal that anti-apoptotic APC is mediated, there is the keratinocyte of Liang Ge colony.Specifically, be slow growth, normal, non-inflammatory cell to react those of (namely reacting on the APC of substrate level without undergoing apoptosis) of APC.In addition, be very fast growth, abnormal inflammatory cell to react those of (APC namely reacting on substrate level stands apoptosis) of APC.
Importantly, although inventor has found that APC can stimulate the Normocellular propagation of comparatively slow growth, it has had the distinctive selectivity ability of the propagation suppressing quick auxocyte.Herein video data shows under base condition, and APC strengthens slowly growth or normal cell, comprises the propagation of endothelium and keratinocyte and inhibited apoptosis.But, according to the present invention, the inflammatory states of visual cell and determining, APC Differential regulation cell proliferation-specifically, the growth of the keratinocyte that APC suppresses TNF-α to stimulate and the quick growth Synovial fibroblasts from rheumatoid arthritis synovial.
According to research as herein described, inventor has imagined contrary with the understanding of the document before the present invention, the anti-inflammatory benefit of APC may be characterised in that in the patient of the skin disorder of keratinocyte hyper-proliferative in needs treatment and be achieved, although because anti-inflammatory effect will put on inflammatory cell, selectivity or specificity will be put on non-inflammatory keratinocyte and non-inflammatory keratinocyte by anti-apoptotic effect.
In addition, the result of described treatment should be non-inflammatory keratinocyte and continues normal proliferative (being caused by the anti-apoptotic function of APC) and by using APC, various situation can be provided, comprise antiinflammatory and likely make inflammatory, excess proliferative keratinocyte apoptosis gradually.
As used herein, except context requires in addition, term ” comprises (comprise) ” and the version (as ” comprising (comprising) “, ” comprising (comprises) ” and ” comprising (comprised) “) of described term is not intended to get rid of other additive, component, integer or step.
” keratinocyte ” typically refers to the epidermis cell of accumulated angle albumen and other oroteins and sterin.These cells account for 95% of epidermis, by not break up or basal cell is formed at dermal-epidermal junction.Its characteristic intermediate filament protein is cytokeratin (cytokeratin).At its various successive stages, keratin forms prickle cell layer and GCL, and wherein cell becomes graduation and slowly dead to form end layer horny layer, and it is peeled off gradually.
” hyper-proliferative ” typically refers to cell and reaches abnormal comparatively high proliferation speed by dividing fast.In some cases, hyper-proliferative can by the G being mainly present in cell cycle
1, S or G
2the cell of phase causes.Hyper-proliferative also can be called as hypertrophy, and hyperproliferative cell can be called as hyperplastic cell or tissue.
” excess proliferative keratinocyte ” normally tends to stage interval being present in cell cycle, as G
1, S or G
2keratinocyte.These cells are different from normal keratinization cell, because normal keratinization cell is present in the G as the stage of separating with interval usually
0(gap zero) or restriction point (see G
1at the end of cell cycle checkpoint) after extension G
1interim.The feature of excess proliferative keratinocyte is also to have proinflammatory gene usually, and the expression of the gene related in NF-κ B intracellular signaling path specifically.
” normal keratinization cell ” normally tends to be present in G
0or extend G
1interim keratinocyte.In general, these keratinocytes are normally not yet by those keratinocytes that TNF-α stimulates, and they do not have the expression of the gene in NF-κ B intracellular signaling path usually.
” activated protein C ” or ” APC ” typically refer to by conjugated protein S and proteolytic inactivation factor Va and VIIIa and by and plasminogen-activating factor inhibitor with the serine protease stimulating fibrinolysis to serve as anticoagulant.Walker etc., FASEB J.6,2561-2567 (1992); Esmon, Arterioscler.Thromb.12,135-145 (1992); Van Hinsbergh etc., Blood 65,444-451 (1985).Precursor protein C mainly produces in liver.Activation removes dodecapeptide to reach by the N-terminal place of the heavy chain in PROTEIN C.When thrombin (thrombin) in conjunction with endothelial cell surface protein matter thrombomodulin (thrombomodulin) and PROTEIN C in conjunction with endothelial cell protein C receptor time, PROTEIN C path is activated.By making factor Ⅴ a and VIIIa inactivation, the amount of the thrombin that APC restriction is formed.Esmon，Arterioscler.Thromb.12，135-145(1992)。
” treatment (treating) ” and ” treatment (treatment) ” object typically referred to for resisting disease, condition of illness or disease manages and looks after patient to eliminate described disease, condition of illness or disease, or control property prevents described disease, pathologic condition of illness or the symptom of disease or the outbreak of complication.
” be characterised in that the skin disorder that there is excess proliferative keratinocyte ” and typically refer to wherein excess proliferative keratinocyte and preponderate, and specifically compared to normal structure, disease, condition of illness, syndrome etc. that excess proliferative keratinocyte is abundant.Disease can be inflammatory disease, and be usually directed to following one or more: basal layer (stratum germinativum), spinous layer, granular layer, clear layer and horny layer.The example of skin disorder comprises pustular (suppurative) and non-pustular (apyetous) psoriasis, comprises form as herein described; And acne, comprise acne vulgaris or acne cystica.
” treatment effective dose ” typically refers to the amount that pharmaceutical compound provides required clinical effectiveness.In certain embodiments, the APC for the treatment of effective dose provides the anti-apoptotic effect to normal keratinocyte usually, and or can not provide the cells apoptosis to excess proliferative keratinocyte.In one embodiment, the APC treating effective dose can stop the propagation of excess proliferative keratinocyte and/or provide anti-inflammatory effect.Correlative can be established according to the inventive method disclosed herein or determine.
” apoptosis-inducing amount ” typically refers to the apoptotic amount that APC provides induction excess proliferative keratinocyte.
” growth stimulating amt ” typically refers to APC provides induction non-excess proliferative keratinocyte, and slowly grow specifically, the amount of the propagation of normal, non-inflammatory keratinocyte.
” antiinflammatory amount ” typically refers to APC and provides and make the inflammation of the skin disorder being characterised in that keratinocyte hyper-proliferative reduce to the lightest amount.
b. Therapeutic Method
Under understanding APC does not stop inflammatory excess proliferative keratinocyte to stand apoptosis, inventor has recognized that APC can be used for providing anti-inflammatory effect to the disease of such as psoriasis and acne and not aggravating or worsen these condition of illness, as previously before making the present invention think, if inflammatory keratinocyte is prevented from exempting from apoptosis or being induced in addition to breed or grow, so will there is described aggravation in addition or worsen these condition of illness.Therefore, in certain embodiments, provide a kind of and treat the method that individual feature is the skin disorder that there is excess proliferative keratinocyte.Described method comprises:
-individuality having and be characterised in that the skin area that there is excess proliferative keratinocyte is provided;
-described skin area is contacted with the activated protein C (APC) for the treatment of effective dose;
Thus treat the described skin disorder of described individuality.
According to described method, APC is by making described APC or contacting the skin part or region that are directly delivered to and are characterised in that and there is excess proliferative keratinocyte containing the preparation of described APC with relevant range.Position or region can be as being present in open wound in acne or pustular psoriasis or destroyed skin surface, or it can not be destroyed in fact, namely it can more image patch block or other heave, harden or fibrosed tissue.When position or region are open in destroyed etc. meaning, APC can be coated on the exposure tissue (such as basal layer (stratum germinativum), spinous layer, granular layer, clear layer) destroying surface around and/or usually hide under the surface of the skin.
In this case, an important discovery of inventor is that APC can be delivered the unbroken in fact desired area place of skin wherein, such as, destroying the region place around pustule, or at other unbroken in fact skin surface place.This makes it possible to carry out local delivery by making APC or related preparations directly contact with position, and this is different from previous clinical general completely and uses APC and treat disseminated disease or condition of illness, as septicemia.According to local application APC of the present invention for locality but not Disseminated or systemic disease is favourable and applicatory, because this restriction and send the relevant risk of APC in regional area, and make in fact and such as carry out the relevant risk of systemic delivery APC by continuous infusion and be down to minimum.
In relevant portion, local delivery APC significantly departs from the APC being used for the treatment of Other diseases and condition of illness as known in the art and uses.According to method as known in the art time of the present invention, for people patient, APC is preferred parenteral, and most preferably intravenous is used under the dosage of about 1 μ g/ days to about 500mg/ days or about 1IU/kg/ days to about 6000IU/kg/ days.See such as U.S. Patent number 5,151,268 and 5,571,786.For severe sepsis, Xigris
tMbe about 45ng/ml APC to use to obtain Cpss at infusion after about two hours by continuous infusion under the speed of about 12 μ g/kg/h to about 30 μ g/kg/h.The present invention does not use continuous infusion based on by general substantially.More precisely, it is based on by making skin area contact local application APC with the APC treating as described herein effective dose.
Inflammation is can be with the skin area that contacts of APC for the treatment of effective dose, or during inflammation can be in and disappear.In one embodiment, the feature of skin disorder is one or more or all following processes: apoptosis, inflammation, barrier function damage.
In one embodiment, skin area is inflammation.The example of a particular importance is the skin area relevant to chronic inflammatory disease.Can psoriatic plaques be there is in this skin, and with manifesting pustule, but speckle can right and wrong be pustulosus in fact.
The group of the optional free psoriasis of skin disorder, dermatitis herpetiformis, pemphigus vulgaris, vitiligo and acne vulgaris or acne cystica composition.
Skin disorder can be non-pustular psoriasis, such as psoriasis vulgaris or erythrodermic psoriasis.
Skin disorder can be pustular psoriasis, such as general pustular psoriasis, palmoplantar pustulosis, ring-type pustular psoriasis, acrodermatitis continua or impetigo herpetiformis.
Usually, when condition of illness is psoriasis, the skin area contacted with APC is psoriatic plaques.Therefore, in another embodiment, provide a kind of and treat individual psoriasic method.Described method comprises:
-individuality with psoriatic plaques is provided;
-compositions comprising the activated protein C (APC) for the treatment of effective dose is applied to described speckle;
Thus treat the psoriasis of described individuality.
When condition of illness is acne vulgaris, the skin area contacted with APC can comprise and destroying and unbroken skin.Therefore, in another embodiment, a kind of method for the treatment of individual acne is provided.Described method comprises:
-provide and suffer from carbuncled individuality;
-compositions comprising the activated protein C (APC) for the treatment of effective dose is applied to described acne;
Thus treat the acne of described individuality.
When condition of illness is atoipc dermatitis, the skin area contacted with APC can comprise and destroying and unbroken skin.Therefore, in another embodiment, a kind of method for the treatment of individual atoipc dermatitis is provided.Described method comprises:
-individuality suffering from atoipc dermatitis is provided;
-compositions comprising the activated protein C (APC) for the treatment of effective dose is applied to described atoipc dermatitis;
Thus treat the atoipc dermatitis of described individuality.
Atoipc dermatitis can be a kind of eczema form being selected from the group be made up of endogenous eczema, eczema articulorum, infantile eczema, and it also can be described as ” Besnier prurigo (prurigo Besnier) “, ” neurodermatitis ” or ” diathetic prurigo (prurigo diath6sique) “.
Although as previously mentioned, it will be recognized by one of ordinary skill in the art that known similar factor in the age of the persistent period with the discharge rate of the type of the seriousness of the combination of specific compound used or compound, disease to be treated or condition of illness, disease or condition of illness, local application, compound, treatment, the identity of any other medicines used to animal, animal, stature and species and medical domain changes by APC, PROTEIN C, the medicament of synthesis of increase PROTEIN C and/or the dosage of PROTEIN C activator.In general, applicable every daily dose of the combination of compound or compound is by that amount of the lowest dose level for effectively producing therapeutical effect.The dosage used, dosage form and pattern are determined by looking after doctor in the scope that rational medicine judges.Use the effective dose of the combination of various compound and compound, dosage form and pattern to determine by rule of thumb and make describedly to determine within the technical scope of this area.
In certain embodiments, importantly provide APC to make APC can contact with dermal keratinocytes, although because do not want by hypothesis constraint, but it is believed that APC can provide selectivity anti-apoptotic activity of the present invention (namely having selectivity to the non-hyperproliferative cell of non-inflammatory) and antiphlogistic activity by this contact.Usually, the cell contacted with APC can be identified owing to having following characteristics: the matrix metalloproteinase (MMP)-2 of activation and the level of endothelial protein C receptor (EPCR) activity of map kinase ERK that is higher and that activate lower, and therefore the cell therapeutic efficiency that contacts with APC and therefore treat by assessing these cell phenotypes to determine.
In certain embodiments, the APC treating effective dose provides usually to the anti-apoptotic effect of normal keratinocyte and the cells apoptosis to excess proliferative keratinocyte.This result can be assessed as follows: measure cell survival/propagation (MTT) and measure and apoptosis (TUNEL mensuration), thus determines whether the APC providing treatment effective dose.Show a kind of illustrative methods further herein.
In one embodiment, the APC treating effective dose can stop the propagation of excess proliferative keratinocyte and/or provide anti-inflammatory effect.This result can be assessed as follows:
-measure cell viability/propagation (MTT mensuration);
-for inflammatory cytokine IL-1, IL-6, IL-10, IL-17, IL-21/23 or TNF-α enzyme-linked immunosorbent assay (ELISA) or
-for the ELISA (R & D Systems, Inc., MN) of EPCR;
-with propidium iodide (PI) or PI add that annexin carries out for apoptotic facs analysis;
-print in order to the protein detected as the inflammatory signal transduction molecule of NF-κ B;
Thus determine whether the APC that treatment effective dose is provided.
In another embodiment, above result is by determining that the local tissue concentration of the APC in skin area is that every gram of skin histology 1ug to 100mgAPC obtains.This determines by obtaining skin punctures biopsy body from same chronic plaque under local anesthetic.Then the amount of APC can be measured by method as known in the art.In an example, shred on ice and dissolve biopsy soma.After centrifugation, clarified supernatant is used for measuring PC concentration by ELISA, and measures APC activity by chromogenic substrate Spectrozyme PCa mensuration (AmericanDiagnostica).Enzymatic activity measures by measuring the free chromophoric absorbance increase that time per unit produces under λ 450nm.
In certain embodiments, the treatment effective dose of APC is every square centimeter of skin area 0.1 μ g to the 5000 μ gAPC coated by APC, or every square centimeter of skin area 1 μ g to the 2000 μ g APC coated by APC, or every square centimeter of skin area 10 μ g to the 1000 μ g APC coated by APC, or every square centimeter of skin area 10 μ g to 200 μ g coated by APC or 10 μ g to 400 μ g or 10 μ g to 800 μ g APC.
Depending on the character of condition of illness, APC can once in a week until be used for twice every day.Usually the Consecutive Days of many 20 weeks is continued to or Consecutive Days of 6 weeks provides it at the most.
b.1 Therapeutic Method-locally
When related dermal region is the skin area containing destroyed skin surface, such as use the local therapeutic approaches of paste, gel, cream, oil preparation, lotion, foam, ointment or similar substance to be particularly suitable, have in the relevant layers of inflammatory keratinocyte because this allows APC to infiltrate into the resident of skin histology.But, when skin surface does not destroy in fact, also such as these therapeutic agents can be applied to psoriatic plaques.
In one embodiment, the treatment effective dose of APC can be every square centimeter of skin area 0.1 to 2000 μ g, preferably 20 to 200 μ gAPC.When skin more serious influenced time, higher amount is normally preferred, and usually wherein the severe chronic speckle type psoriasis that exists with ulcer of pathological changes (psorasis area and severity index (PASI) are more than or equal to 12, body surface area (BSA) is more than or equal to 10) be preferred, wherein APC can promote ulcer healing.When skin not serious influenced time, such as, when pathological changes exists without ulcer, relatively low amount can be preferably.
APC concentration in preparation can about between 10ug/ml and 1mg/ml, and the volume being coated on the compositions of skin area is about 100ul to 10ml.
Usually, when related pathologies is psoriasis, usually use sterile surfaces, as finger or medicine spoon provide compositions in the layer of the thickness of about 10mm at the most of skin, preferably about 3mm thickness.It can then be rubbed or be massaged in skin area and peripheral region.Coating is normally extremely weekly once a day, and usually no longer than 20 weeks or no longer than 12 weeks.
Similar coating operation and dosage can be applicable to treatment acne or atoipc dermatitis.
In one embodiment, the compositions containing APC can be coated on solid matrix, i.e. binder, dressing etc., and then substrate is fixed on related dermal region.
b.2 Therapeutic Method-intradermal injection
In certain embodiments, above result obtains higher than at least 2 times, baseline by setting up local APC concentration.This amount of APC is measured by using ELISA as mentioned above and chromogenic substrate Spectrozyme PCa to measure the APC activity measuring skin biopsy body.When horny layer be complete and have APC limited penetration cross the described character of superficial skin layer time, Intradermal or subcutaneous injection are usually preferred as route of administration.Usually, the fine gauge pin about (about 28-34G) pin on 1ml syringe can be used.Can give and amass to cover skin surface with multiple injection, wherein every centimetre of correspondence about 1 injection.The amount of per injection will change from 10 μ l to 1ml, and wherein typical amount is 50 μ l.Usually, from giving to weekly and use once a day, and usually no longer than 20 weeks.Intradermal or subcutaneous injection can use with surface-coated APC simultaneously.Preferred indication is psoriasis or atoipc dermatitis, but is characterised in that other condition of illness of keratinocyte hyper-proliferative can stand this treatment.
One exemplary of subcutaneous/intradermal administration is applicable to severe chronic speckle type psoriasis (psorasis area and severity index (PASI) >=12, body surface area (BSA) >=10), wherein pathological changes with or exist without ulcer.Depending on the size of speckle or pathological changes, APC was under the dosage of 200-2000 μ g, biweekly continues 12 weeks subcutaneous administration, succeeded by 4 weeks tracking periods.Injection is that preferred 1ml carries out by No. 30 pins with cumulative volume 500 μ l to 5ml.APC is that repeatedly (Intradermal or subcutaneous) injection becomes < 10cm just like fruit disease at the position of perilesional equal intervals
2, so there are 4 positions, and number of sites and dosage increase and proportional increase with lesion size.APC is dissolved in the water buffer salt solutions such as preparing.If desired, this treatment can be combined with surface treatment.APC in liquid form can be coated in pathological changes every day, continues the period identical with subcutaneous therapy.Two researchs (with or without surface treatment) in, PASI, static doctor’s total evaluation (sPGA), Dermatology quality of life index (DLQI), adverse events and routine hematology and laboratory values (such as cytokine, histological examination, PC/APC active) can be analyzed.Expected results: expect that, the 12nd week time, the PASI of all patients improves > 30% and the PASI of 50% patient improves > 60%.
In one embodiment, said method comprises the step that skin area is contacted with the APC of antiinflammatory amount.
In one embodiment, said method comprises the step that skin area is contacted with the APC of growth stimulating amt.
In one embodiment, said method comprises the step that skin area is contacted with the APC of apoptosis-inducing amount.
c.APC and preparation thereof
Can composition forms be adopted for the APC in said method, or obtain additionally by method as described below.
APC is prepared from plasma purification or by the PROTEIN C prepared by method well known in the art execution recombinant DNA technology by Activated in Vitro.See such as U.S. Patent number 4,981,952,5,151,268,5,831,025,6,156,734,6,268,344 and 6,395,270.
Or APC can directly be prepared by recombinant DNA technology.See such as U.S. Patent number 4,981,952,5,151,268,6,156,734,6,268,344 and 6,395,270.Restructuring activated protein C produces by Activated in Vitro r-aPC proenzyme or by the direct PROTEIN C from emiocytosis activated form.PROTEIN C can produce in transgenic animal, transgenic plant or multiple eukaryotic cell, comprises and such as secreting from people’s kidney 293 cell with zymogen forms, then carry out purification by the technology known to those of skill in the art and activate.
APC can from any animal species, but people APC is preferred.
The fragment of APC and derivant can be used for implementing the present invention, and prerequisite is that they represent activity as herein described.See such as U.S. Patent number 5,151,268,5,453,373 and 5,516,650 and PCT application WO 89/12685, WO 01/56532, WO 01/59084 and WO01/72328.
APC can be the derivant of the Proteolytic enzyme with people APC of people APC, amide hydrolysis, Ester hydrolysis and biology (anticoagulation, antiinflammatory or short fibrinolysis) living features.The example of PROTEIN C derivant by Gerlitz, etc., U.S. Patent number 5,453,373 and Foster, etc., U.S. Patent number 5,516,650 are described, and whole instructions of described patent are incorporated to herein accordingly by reference.
The applicable pharmaceutical composition of ACC comprises APC and pharmaceutically acceptable carrier.See such as U.S. Patent number 6,395,270 and 6,159,468 and PCT application WO 98/48818, WO 01/56532 and WO 01/72328.Compositions containing ACC can be generally and comprise as what have a highly purified stable freeze-dried product the compositions increasing long-pending agent (as sucrose, mannitol, trehalose and Raffinose), salt (as sodium chloride and potassium chloride), buffer agent (as sodium citrate, Tris-acetate and sodium phosphate) and ACC.For example, agent is amassed in the increasing that stable freeze-dried compositions can comprise between salt between weight ratio about 1 part of ACC, about 7-8 part and about 5-7 part.One example of described stable freeze-dried compositions is: each bottle 5.0mgACC, 30mg sucrose, 38mg NaCl and 7.56mg citrate, pH 6.0.
c.1 the preparation of local application
In a particularly preferred embodiment, ACC is suitable for carrying out the compositions of local application or dosage form provides according to method described under above chapters and sections B to suffering from the related dermal pathological changes of experimenter of associated conditions, speckle or other skin surface.The example of described preparation comprises and can apply directly to relevant surfaces, thus makes it possible to the preparation to region of interest local application ACC.These preparations comprise gel, oil preparation, spray, roll-on formulations, ointment, lotion, foam etc.In one embodiment, APC provides with methyl cellulose gel agent form and can contain stabilizing agent, as carbohydrate and salt.
Skin ointments agent can be organic, healthy, beauty treatment or the combination of medicinal ingredients usually in oil substrate.This gives the formula that skin ointments agent is dense, water solublity is less, and it stops more permanent to make composition can more effectively play a part to treat extensive various problems on bodily surfaces.Many natural and organic skin ointments agent that existence can be ordered from company (as Therapex).
Also clobetasol propionate (CP) foam (0.05%) can be used.This be a kind of the U.S. be used for the treatment of the inflammatory of corticosteroid reaction dermatoses and the pruritic form of expression and in Canada for the inflammatory of moderate to severe atoipc dermatitis and emulsion aerosol foams agent (Olux-E (clobetasol propionate) foam of the pruritic form of expression, 0.05%Stiefel LaboratoriesInc, Research Triangle Park, NC (2011)).
When preparation is gel, it the amount of every gram of gel 10-5000 μ g can contain APC.
c.2 injectable formulation
APC one particularly preferably preparation be at trade mark Xigris by Eli Lilly and Co. (Indianapolis, Indiana)
tMlower product sold.Xigris
tMit is the sterile lyophilized powder form supply for intravenous infusion.Xigris
tMthe 5mg bottle people of containing 5.3mg/ bottle to recombinate the sodium citrate of the sucrose of APC, 31.8mg/ bottle, NaCl and the 10.9mg/ bottle of 40.3mg/ bottle, and Xigris
tMthe 20mg bottle people of containing 20.8mg/ bottle to recombinate the sodium citrate of the sucrose of APC, 124.9mg/ bottle, NaCl and the 42.9mg/ bottle of 158.1mg/ bottle.Bottle restores with USP sterile water for injection with the APC obtaining about 2mg/ml concentration, and APC of this dilution is then added into and feeds to patient with the APC obtaining about 100 to about 5000 μ g/ml concentration in 0.9% sodium chloride injection and use.This be for by as above under chapters and sections B as described in subcutaneous injection technology use the particularly preferably preparation of APC.
No matter use with surface based fashion or by subcutaneous injection, in certain embodiments, related preparations all containing the substitute of PROTEIN C as APC, or except APC, also can contain PROTEIN C.For example, can use the PROTEIN C of effective dose, it in vivo will by the activation of endogenous protein C path to produce APC.See such as U.S. Patent number 5,151,268 and PCT application WO 93/09807.As above, indicated by, PROTEIN C can be prepared from plasma purification or by recombinant DNA technology.See such as U.S. Patent number 4,959,318,4,981,952,5,093,117,5,151,268,5,571,786,6,156,734,6,268,344 and 6,395,270.The applicable pharmaceutical composition comprising PROTEIN C is known (see such as U.S. Patent number 5,151,268 and 5,571,786).
Also by using the reagent of the synthesis of a certain amount of increase PROTEIN C in animal to increase the endogenous output of APC.See such as PCT application WO 93/09807.Applicable reagent comprises anabolic steroid (such as danazol (danazolol)).See such as PCT application WO 93/09807.
In certain embodiments, effectively cause producing a certain amount of PROTEIN C activator of APC to increase the endogenous output of APC from the PROTEIN C of endogenous synthesis and/or from the PROTEIN C used altogether in body by using.See such as PCT application WO 93/09807.PROTEIN C activator is any compound causing or increase APC generation.Be applicable to PROTEIN C activator and comprise thrombin, α-thrombin, avtive spot acidylate thrombin, thrombin analog and mutant (such as thrombin E192Q and thrombin K52E), solubility soluble thrombomodulin complex, by the removing of prevention soluble thrombomodulin complex or the reagent of decline, the reagent of the synthesis strengthening thrombomodulin or the removing postponing thrombomodulin, poisonous substance (as protac (Protac) or Russell (Russel) adder poisonous substance), factor Xa, plasmin, trypsin and other poisonous substance any that can cause or increase from PROTEIN C generation APC, enzyme or compound.See such as PCT application WO 93/09807.Optimization protein C activator is thrombin and avtive spot acidylate thrombin.
In some embodiments, APC can with for controlling inflammation, cell proliferation uses together with one or more another medicament apoptotic.One particularly preferably medicament is anti-IL-17 antibody, Yi Sai pearl monoclonal antibody (Ixekizumab) specifically, its suffer from the II phase of carrying out in the psoriasic patient of chronic plaque study in show compared to placebo, significantly improve (NEJM, 2012) in the score of dermatosis seriousness.Other example for the medicament controlled inflammation comprises TNF-alpha inhibitor and anti-inflammatory cytokine and biological medicine.
It is to be understood that the present invention extends to that two or more are mentioned or according to all alternative combinations of text or graphic apparent individual characteristics disclosed and definited in the present specification.All these various combinations form each substituting aspect of the present invention.
Other embodiment of other side of the present invention and each side described in previous paragraph is by according to mode by way of example and become apparent with reference to the following description given by alterations.
embodiment 1. establishes APC to slowly growing non-inflammatory keratinocyte and Psoriatic skin
the preclinical test of the selectivity anti-apoptotic activity of keratinocyte
Recruit patient and 6 normal individuals that 6 are suffered from active chronic plaque psoriasis.They not yet accepted any treatment at least 4 weeks before sampling.Two 6mm perforation biopsy bodies are obtained from same chronic plaque under local anesthetic.(20) as discussed previously angle of departure keratinocyte cells.
Normal keratinization cell by the mixture process of cytokine (IL-1 α (10ng/ml), IL-6 (5ng/ml), TNF-α (5ng/ml), IL-17A (10ng/ml)) to induce psoriasis phenotype.To add under 1,10 μ g/ml in APC to keratinocyte and process 24,48 and 72 hours.Use MTT mensuration, Brdu proliferation assay examination cell proliferation/survival.Apoptosis is examined or check by TUNEL mensuration, flow cytometry (propidium iodide (PI) or PI add annexin-V).Cytokine production and four selected psoriasis related gene TNF, DEFB4, CAMP, PI3 are detected by RT PCR in real time and ELISA.Activation and the expression of antiapoptotic signals molecule Caspar enzyme (capase)-3, Caspar enzyme-8 and Caspar enzyme-9 and MAK kinases ERK is detected by Western blotting.
Display APC is induced the apoptosis of Psoriatic keratinocyte and slows down its growth by result, and it stimulates growth and the survival of normal keratinization cell.APC also reduces the level of inflammatory cytokine IL-1, TNF-α, IL-17 and IL-6 and psoriasis correlation molecule TNF, DEFB4, CAMP, PI3.In the normal control cells with inflammatory mediators process, Growth of Cells is strengthened and adds APC makes this effect reverse.In a word, result not only can suppress the inflammation relevant to Psoriatic keratinocyte by clearly showing APC, and it also reduces the characteristic hyper-proliferative relevant to these cells.
the subcutaneous APC of embodiment 2. goes through the 2 phases trial test of 12 weeks
Patient selects: recruit the patient that 5 are suffered from severe chronic speckle type psoriasis (psorasis area and severity index (PASI) >=12, body surface area (BSA) >=10).It is 18 to 70 years old that main inclusive criteria comprises patient, has suffered from stabilize plaque psoriasis at least 6 months.Main exclusion standard comprises: i) patient suffers from non-speckle or drug-induced property psoriasis; Ii) before research, biological preparation is used in 28 days, as Rituximab (rituximab), Orencia (abatacept), infliximab, adalimumab (adalimumab), Cyclosporine (cyclosporine) or mycophenolic acid and Embrel (etanercept) or Antril (Synergen) (anakinra); Iii) patient had accepted psoriasis treatment during 8 weeks before research, comprised any Light therapy, and before research during 4 weeks with except gentle emollient for psoriasic any standard surface therapy for treating; Iv) the surperficial therapy used during studying is limited to III to the VII class glucocorticoid only used on scalp, axillary fossa and groin; V) have any activeness or the sign recently infected or have the medical history of malignant tumor or other autoimmune disease, gravid woman is also exclusion standard.
Treatment: biweekly to patient subcutaneous administration 400ugAPC/ speckle, continues nearly 12 weeks or when speckle is eliminated.Evenly inject APC around (as discussed previously) periphery and under psoriatic plaques, and in the contrast speckle being symmetrically located at health opposite side, inject independent vehicle (placebo) similarly.Then continue again to follow the trail of patient in 4 weeks after final treatment.
Measure: analyze PASI, static doctor’s total evaluation (sPGA), Dermatology quality of life index (DLQI), adverse events and routine hematology and laboratory values (such as cytokine, histological examination, PC/APC activity).Security consideration comprises risk of bleeding, headache, fatigue, infection and allergy.Relevant cell and biochemical events comprise leukocyte, neutrophil and platelet count; Antibody for APC in blood coagulation activity, PC/APC level and serum is formed.Obtain 4mm biopsy body to carry out the histological examination of PC/APC and EPCR, and assess main Psoriatic parameter, as the mitogen activation of acanthosis, hyperkeratosis and parakeratosis, epidermis, papillary edema, telangiectasis and distortion and the neutrophil respectively in corium, spinous layer and horny layer.
Statistical analysis: use 1 side 2 sample t-test in significant level 0.05 time comparison base value and the value after each week and treatment of treatments period when 4 weeks.
It is safe with well tolerable that results and discussions: APC treats display, and patient will show psoriasis pathological changes elimination at least 60%, and 3 wherein in 5 patients show specklees and eliminate completely.During 4 weeks follow the trail of, the effect of APC will be continued.All patients all by display PASI, sPGA, DLQI improve and without detrimental effect and react on treatment formed without APC antibody.Can be observed inflammatory cell in epidermal thickness and skin significantly to reduce, and the keratinocyte of EPCR expresses increase, but cycle P C/APC level is unaffected.In a word, display APC is safe for psoriatic plaques by result, well tolerable with highly effective.
2 phases for acne vulgaris that embodiment 3 is carried out in 10 patients with subcutaneous aPC
Patient selects: recruit the patient that 10 are suffered from acne vulgaris.Main inclusive criteria comprises: patient is 18 to 30 years old, has suffered from bilateral face acne at least 6 months.The sign that main exclusion standard includes any activeness or recently infects; Or have the medical history of malignant tumor or other autoimmune disease; Gravid woman.
Treatment: use 200ug APC with gel form to patient once a day, continue 12 weeks or when medicine for treating comedo remove time.To patient provide be marked with the gel of L and R with two pipes and suggestion to the 2cm gel of specifying involved area coating from pipe extruding (L in left side on the face and R on right side on the face), and uniform scratch.Then continue again to follow the trail of patient in 4 weeks after final treatment.
Measure: before treatment and within every 4 weeks, carry out taking a picture and use the image analysis calculation acne area of computer-aided.Analyze adverse events and routine hematology and laboratory values (such as cytokine, histological examination, PC/APC active).Monitoring safety, comprises risk of bleeding, headache, fatigue, infection, allergy.Relevant cell and biochemical events comprise leukocyte, neutrophil and platelet count; Antibody for APC in blood coagulation activity, PC/APC level and serum is formed.
Statistical analysis: use 1 side 2 sample t-test in significant level 0.05 time comparison base value and the value after each week and treatment of treatments period when 4 weeks.
It is safe with well tolerable that results and discussions: APC treats display, and patient will show medicine for treating comedo removes at least 50%.During 4 weeks follow the trail of, the effect of APC will be continued.To not detrimental effect be there is and react on treatment and be formed without APC antibody.Should there is inflammatory cell in epidermal thickness and skin significantly to reduce, the keratinocyte of EPCR is expressed and is increased, but cycle P C/APC level is unaffected.In a word, display APC is safe for acne vulgaris by our result, well tolerable with highly effective.
embodiment 4 gel preparation and treatment coating
This embodiment provides a kind of non-sterile property, low biological load, anticorrosion sodium carboxymethyl cellulose primary surface gel, and it contains active component activated protein C and following non-active ingredient: sodium carboxymethyl cellulose, glacial acetic acid, 1-lysine hydrochloride, metacresol, methyl parahydroxybenzoate, propyl p-hydroxybenzoate, sodium acetate trihydrate, sodium chloride and water for injection.Every gram of gel contains 100ug activated protein C.
embodiment 5 gel preparation and treatment coating
* Ultrez 30 polymer (Lubrizol Advanced Materials, Inc) and xanthan gum are combined under 1% salicylic acid and 5% exists containing electrolyte extraction thing and provide desirable viscosity in this cold process preparations (pH 4).Glucam
tM* E 20 wetting agent gives moisture retention together with glycerol.It is below formula.
1. combine D fractions and mix until salicylic acid crystal dissolves completely.Shelve for adding after a while.
2. EDETATE SODIUM is dissolved in the water.When EDETATE SODIUM dissolves completely, under mixing velocity is arranged on 400-500rpm and will
* Ultrez 30 polymer is slowly dispersed in water, continues mixing until the complete hydration of polymer.
3. part B composition is pre-blended into homogeneous serosity.Be added in part A.Optionally increase mixing velocity to maintain homogeneity.
4. add C part and to A/B part and optionally increase mixing velocity to maintain homogeneity.Continue mixing 10 minutes.
5. add D part and to batch of material and optionally adjust mixing velocity to reduce any splash owing to viscosity B coefficent.Mixing is until homogeneous.
6. premixing E fractions and being added in batch of material.Mixing is until homogeneous.
7. add F fractions separately, wherein fully mix between interpolation.
Add APC to reach the amount of every gram of gel 10-5000 μ g or 0.01-0.05w/w%
This gel can apply directly to lesion region.
embodiment 6 spray agent and treatment coating
As above open in sterile solution for described in injection APC APC being dissolved in wait.Extract pin by using the inclusions of bottle upwards extracted to 2.5ml syringe, reach spray delivery.Sterilizing spray mouth is assemblied in syringe end (substitute pin) and by therapeutic agent (APC or normal saline solution) even spraying on speckle to cover whole influenced surface.Therefore, obtain atomization without the need to propellant, only need to syringe and apply pressure.Repetitive coatings if desired, preferably once a day.This technology is easy to perform in a consistent manner and repeat, thus provides the uniform fold of therapeutic agent.
embodiment 7 is for assessment of the anti-apoptotic effect to normal keratinocyte with to mistake
the technology of the cells apoptosis of degree proliferative keratinocyte.
According to the present invention, the APC for the treatment of effective dose provides usually to the anti-apoptotic effect of normal keratinocyte and the cells apoptosis to excess proliferative keratinocyte.This result can as follows in vitro or add in-place with assessment:
In vitro method 1.
Biopsy perforating machine is used to remove untreated activeness Psoriatic skin, and angle of departure keratinocyte cells.Inventionbriefly, cell (3000 cells/well) to be inoculated in 96 orifice plates to reach final volume 200 μ l, then to hatch 4 hours to allow cell attachment.Then under 0.1,1 and 10 μ g/ml, cell is processed 72 hours with APC.
1) according to cell survival/growth rate that MTT measures: in this measures, the mitochondrial dehydrogenase enzymatic lysis tetrazole ring of living cells, thus produce the purple MTT formazan crystal in water insoluble solution.Can by dissolution of crystals in acidify isopropyl alcohol.Gained purple solution is measured in spectrophotometric mode.Cell number increase causes the amount of the MTT formazan formed to increase and absorbance increases.In first three hour completing process, add 10 μ l 5mg/ml MTT in cell.After hatching again 3 hours, remove MTT solution and replace with 100 μ l DMSO.Under wavelength 570nm, take 630nm as the optical density measuring each hole with reference to wavelength.Cell viability is directly related with OD.APC makes vigor reduce with dosage-dependent manner.
2) apoptosis rate detection is carried out by TUNEL mensuration, the facs analysis adding annexin-V with propidium iodide (PI) or PI and active Caspar enzymatic activity.
Use cells in situ Death Detection Kit to carry out TUNEL mensuration according to manufacturer specification (Roche Diagnostics Australia Pty.Ltd., NSW, Australia).Inventionbriefly, cell 0.1% sodium citrate in addition permeableization of the fresh preparation containing 0.1% triton x-100, and hatch under fluorescein-labeled dUTP exists together with terminal deoxynucleotidyl acyltransferase (at 37 DEG C 60 minutes).The antibody using anti-fluorescein peroxidase (POD) to put together and POD substrate reactions are to observe TUNEL positive cell.DAPI counterstaining is used in section.By unwitting researcher by counting TUNEL positive cell and total cell number and the percentage ratio calculating TUNEL positive cell determines the occurrence rate of apoptotic cell under the high magnification visual field (40 ×).
Facs analysis: to wash with FACS lavation buffer solution (there is the PBS of 5%FCS) with trypsin treatment keratinocyte.200 μ l cell suspensions and propidium iodide (PI) or PI are added together with annexin-V or the antibody puted together hatch, and subsequently by flow cytomery cell cycle/apoptosis and protein expression.Use FlowJo software analysis data.
By Western blotting detection of active Caspar enzymatic activity.After the treatment, keratinocyte PBS and the dissolving buffer (0.15M NaCl, 0.01mM PMSF, 1%NP-40,0.02M Tris, 6M urea/H that are supplemented with protease inhibitor
2o) wash three times, and add fbpase inhibitor (Roche, Indianapolis, IN, USA).Centrifuge cell lysate 15 minutes under 10,000g and by 10% SDS-PAGE (SDS-PAGE) separation of supernatant being transferred in PDVF film.Detect anti-human Caspar enzyme-3, Caspar enzyme-8 and Caspar enzyme-9 antibody.ECL detection system (Amersham, Piscataway, NJ) is used to detect immunoreactivity.Comprise anti-human beta-actin antibody and carry out standardization relative to the useful load such as not.
In all cells apoptosis measures, APC promotes the apoptosis growing keratinocyte fast.
In vitro method 2.
Object is whether the keratinocyte of the speckle determined from APC treatment is more prone to apoptosis than the cell of placebo treatment.(size is about 5-50cm to use following 2 kinds of methods that APC is delivered to psoriatic plaques
2) in: i) surface injection (100ng-1mg); Ii) the sterilizing spray mouth spray solution (10ng-1mg) on the end of 0.5ml syringe is used in.Use biopsy perforating machine removes the activeness Psoriatic skin with APC or placebo treatment, and angle of departure keratinocyte cells.Facs analysis as above is used to measure the apoptosis of cell at once.Result instruction is compared to the skin of placebo treatment, and the level from the apoptotic cell of the skin of APC treatment is significantly higher.
In situ cell apoptosis: object is whether the keratinocyte of the speckle determined from APC treatment is more prone to apoptosis than the cell of placebo treatment.(size is about 5-50cm to use following 2 kinds of methods that APC is delivered to psoriatic plaques
2) in: i) surface injection (100ng-1mg); Ii) the sterilizing spray mouth spray solution (10ng-1mg) on the end of 0.5ml syringe is used in.Use biopsy perforating machine removes the activeness Psoriatic skin with APC or placebo treatment.Fix skin and use cells in situ Death Detection Kit to detect apoptosis according to manufacturer specification (Roche Diagnostics Australia Pty.Ltd., NS W, Australia).Inventionbriefly, cell 0.1% sodium citrate in addition permeableization of the fresh preparation containing 0.1% triton x-100, and hatch under fluorescein-labeled dUTP exists together with terminal deoxynucleotidyl acyltransferase (at 37 DEG C 60 minutes).The antibody using anti-fluorescein peroxidase (POD) to put together and POD substrate reactions are to observe TUNEL positive cell.DAPI counterstaining is used in section.By unwitting researcher by counting TUNEL positive cell and total cell number and the percentage ratio calculating TUNEL positive cell determines the occurrence rate of apoptotic cell under the high magnification visual field (40x).There is compared to the skin of placebo treatment with the skin of APC treatment the TUNEL positive apoptotic cells of remarkable higher level.
Mice psoriasis model
(Raychaudhuri, 2001Br.J.Dermatol) as discussed previously sets up psoriasis xenograft SCID mouse model (needing 82 mices).Inventionbriefly, after the dermatological specimens removing full-thickness, by people’s psoriatic plaques (1cm
2) transplant back in SCID mice in about 8 week age.Psoriatic graft is accepted and psoriasis sample disease maintenance at least 10 week within 3-4 week.Below using after psoriasis manifests, 2 kinds of methods send APC:i) intradermal injection (10ng-100ug); Ii) be used in the sterilizing spray mouth (8/ group) on influenced skin on the end of 0.5ml syringe, continue nearly 8 weeks spray solutions (10ng-100ug) for 3 times weekly.Normal saline solution is used as placebo.By perforation biopsy body (2mm) quick freezing obtained in the 0th day (before treatment) and the 28th day (after the treatment) and process to carry out immunostaining and histologic analysis comes chart skin thickness, trochanterellus length (index of epidermal thickness) and inflammatory cell infiltration.At the 28th day, collect skin to measure inflammatory mediators, differentiation marker and adaptor protein matter.APC treatment makes the number of skin thickness and inflammatory cell (particularly neutrophil and T cell) reduce.Compared to placebo, inflammatory cytokine in the skin of APC treatment reduces, particularly tumor necrosis factor-alpha, and engage related protein increase, especially enclosed area-1 tight junction protein (claudin), closed protein (occludin) and JAM-A.
Use the cell proliferation that BrdU is incorporated to: the cell standing DNA synthesis for reaching labelling, adult mice accepts 1 BrdU (100mg/kg) injection for 2 hours before euthanasia, and collects mouse skin and fix with 10% formalin.Proliferative cell is detected by carrying out immunostaining with anti-BrdU antibody.The cell of APC process represents BrdU and is incorporated to significantly less, thus instruction multiplication capacity is lower.
embodiment 8 goes through the 2 phases prerun carried out in five patients for one month with subcutaneous APC
Suffers from the candidate that stabilize plaque psoriasis 18 to 70 years old patients of at least 6 months have accepted Light therapy or psoriasis universalis therapy or Light therapy or psoriasis universalis therapy.
Get rid of:
Suffer from non-speckle or the psoriasic patient of drug-induced property.
Before research, during 8 weeks, accept psoriasis treatment (comprising any Light therapy) and before research, during 4 weeks, use the patient for psoriasic any standard surface therapy for treating except gentle emollient.The surperficial therapy used during studying will be limited to III to the VII class glucocorticoid only used on scalp, axillary fossa and groin.
There is during 3 weeks the patient of clinical infection sign before research, and there is the patient of cancer medical history.
The 2 phases trial test carried out in five patients for one month is continued once in a week with subcutaneous APC (100ug).
aPC application program.
Select five to suffer from the psoriasic other healthy male patient of chronic plaque to treat for APC.Drug administration in 4 week period is gone through once in a week with dosage 100ug.
Directly at psoriatic plaques single subcutaneous injection APC, and be symmetrically located at the independent vehicle of the contrast speckle hemostasis (placebo) of health opposite side.The research selecting the contrast speckle being similar to two other speckle to carry out both all not inject.
Descriptive analysis (baseline)
Baseline demographic’s data before assessing surface treatment by means of static doctor’s total evaluation, before Light therapy, before Systemic therapy, before biotherapy (age, weight, BMI, race divide) and genius morbi (psoriasis persistent period, the percentage ratio of body area affected by psoriasis, mean P ASI score, the remarkable or psoriasic existence of severe).
effect and safety evaluation
By film recording and/or 20mHz ultrasonic investigate the 1st day (before therapy) until therapy terminate after the effect of 3 days (the 31st day).
Three different patch (comprising APC and vehicle site of administration) of each patient of detailed monitoring are to determine the bad echo zone (both representing epidermal acanthosis in the corium of top and infiltrating) of each patient and reduce and psorasis area and severity index (PASI) improve percentage ratio.
Before APC 4 days, measure for histology and immunohistochemical detection and mRNA one week time and at the skin biopsy body (4mm bore a hole biopsy body) of the 24th day (therapy terminates).
histology and immunohistochemistry
Histology probes into and comprises the main Psoriatic parameter of assessment, as the mitogen activation of acanthosis, hyperkeratosis and parakeratosis, epidermis, papillary edema, telangiectasis and distortion and the neutrophil respectively in corium, spinous layer and horny layer.
immunohistochemistry is probed into
Adverse events, serious adverse events, routine hematology and laboratory values, to be formed for the antibody of APC.
Side effect and pruritus
Delayed-type hypersensitivity reaction (DTH)
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