U.S. patent application number 11/985068 was filed with the patent office on 2008-11-20 for parenteral formulations of a peptide for the treatment of systemic lupus erythematosus.
This patent application is currently assigned to Teva Pharmaceutical Industries, Ltd.. Invention is credited to Sharon Cohen-Vered, Adrian Gilbert, Ety Klinger, Esmira Naftali, Vera Weinstein.
Application Number | 20080287366 11/985068 |
Document ID | / |
Family ID | 32771763 |
Filed Date | 2008-11-20 |
United States Patent
Application |
20080287366 |
Kind Code |
A1 |
Cohen-Vered; Sharon ; et
al. |
November 20, 2008 |
Parenteral formulations of a peptide for the treatment of systemic
lupus erythematosus
Abstract
The subject invention provides a pharmaceutical composition
comprising an aqueous carrier; from 0.1 mg/ml to 20 mg/ml of the
composition of a pharmaceutically acceptable salt of a peptide
having the structural formula NH.sub.2-Gly Tyr Tyr Trp Ser Trp Ile
Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile Gly-COOH; and a
substituted .beta.-cyclodextrin in an amount effective to dissolve
the peptide in the aqueous carrier, wherein the composition has a
pH between 4 and 9, a process for preparation, and a method of
alleviating symptoms of systemic lupus erythematosus (SLE) in a
human subject comprising administering to the human subject the
pharmaceutical composition.
Inventors: |
Cohen-Vered; Sharon; (Kfar
Sava, IL) ; Naftali; Esmira; (Rosh HaAyin, IL)
; Weinstein; Vera; (Mevaseret Zion, IL) ; Gilbert;
Adrian; (Ra'anana, IL) ; Klinger; Ety; (Tel
Aviv, IL) |
Correspondence
Address: |
John P. White;Cooper & Dunham LLP
1185 Avenue of the Americas
New York
NY
10036
US
|
Assignee: |
Teva Pharmaceutical Industries,
Ltd.
|
Family ID: |
32771763 |
Appl. No.: |
11/985068 |
Filed: |
November 12, 2007 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
10758572 |
Jan 14, 2004 |
7294687 |
|
|
11985068 |
|
|
|
|
60439950 |
Jan 14, 2003 |
|
|
|
Current U.S.
Class: |
514/1.1 ;
514/20.6; 514/58 |
Current CPC
Class: |
A61P 37/02 20180101;
A61P 37/06 20180101; A61K 38/10 20130101; A61K 31/724 20130101;
B82Y 5/00 20130101; A61K 47/6951 20170801; A61K 31/724 20130101;
A61P 37/00 20180101; A61K 38/10 20130101; A61K 9/19 20130101; A61K
9/0019 20130101; A61K 2300/00 20130101; A61K 2300/00 20130101 |
Class at
Publication: |
514/13 |
International
Class: |
A61K 38/10 20060101
A61K038/10 |
Claims
1. A pharmaceutical composition comprising an aqueous carrier; from
0.1 mg/ml to 20 mg/ml of the composition of a pharmaceutically
acceptable salt of a peptide having the structural formula
NH.sub.2-Gly Tyr Tyr Trp Ser Trp Ile Arg Gln Pro Pro Gly Lys Gly
Glu Glu Trp Ile Gly-COOH (SEQ ID NO:1); and a substituted
.beta.-cyclodextrin in an amount effective to dissolve the peptide
in the aqueous carrier, wherein the composition has a pH between 4
and 9.
2. The pharmaceutical composition of claim 1, wherein the
concentration of the salt of the peptide is at least 0.5 mg/ml,
from 0.5 mg/ml to 10 mg/ml, or from 0.5 mg/ml to 2.5 mg/ml.
3. (canceled)
4. (canceled)
5. The pharmaceutical composition of claim 1 wherein the
composition has a pH between 6.5 and 8.5.
6. The pharmaceutical composition of claim 5, wherein the
composition has a pH between 7.5 and 8.5.
7. The pharmaceutical composition claim 1 wherein the
pharmaceutically acceptable salt is an acetate salt.
8. The pharmaceutical composition of claim 1 wherein the
substituted .beta.-cyclodextrin is a hydroxypropyl, a sulfobutyl
ether, or a sulfopropyl ether substituted .beta.-cyclodextrin.
9. The pharmaceutical composition of claim 8, wherein the
substituted .beta.-cyclodextrin is a sulfobutyl ether substituted
.beta.-cyclodextrin.
10. The pharmaceutical composition of claim 7, wherein the
substituted .beta.-cyclodextrin is hepta-(sulfobutyl
ether)-.beta.-cyclodextrin.
11. The pharmaceutical composition of claim 1 further comprising a
pharmaceutically acceptable buffer in an amount and of a type
suitable to make the pH of the pharmaceutical composition in the
range of 4-9.
12. A pharmaceutical composition comprising an aqueous carrier;
from 0.1 mg/ml to 20 mg/ml of the composition of an acetate salt of
a peptide having the structural formula NH.sub.2-Gly Tyr Tyr Trp
Ser Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile Gly-COOH
(SEQ ID NO:1); and from 70 mg/ml to 170 mg/ml of the composition of
hepta-(sulfobutyl ether)-.beta.-cyclodextrin, wherein the peptide
and the hepta-(sulfobutyl ether)-.beta.-cyclodextrin are dissolved
in the aqueous carrier; and wherein the composition has a pH
between 6.5 and 8.5.
13. The pharmaceutical composition of claim 12, wherein the
concentration of the acetate salt of the peptide is at least 0.5
mg/ml, from 0.5 mg/ml to 10 mg/ml, or from 0.5 to 2.5 mg/ml.
14. (canceled)
15. (canceled)
16. The pharmaceutical composition of claim 13, wherein the
concentration of hepta-(sulfobutyl ether)-.beta.-cyclodextrin is
120 mg/ml, and wherein the pH of the composition is between 7.5 and
8.5.
17. The pharmaceutical composition of claim 16, wherein the
concentration of the acetate salt of the peptide is 1.0 mg/ml or
2.5 mg/ml.
18. (canceled)
19. A method of alleviating symptoms of systemic lupus
erythematosus (SLE) in a human subject comprising administering to
the human subject the pharmaceutical composition of claim 1 in an
amount effective to alleviate the symptoms of SLE in the human
subject.
20. (canceled)
21. A process for manufacturing the pharmaceutical composition of
claim 1 comprising the steps of: a) preparing a solution of a
substituted .beta.-cyclodextrin in an aqueous carrier at a
predetermined concentration; b) adding a predetermined amount of a
pharmaceutically acceptable salt of the peptide NH.sub.2-Gly Tyr
Tyr Trp Ser Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile
Gly-COOH (SEQ ID NO:1) to the solution of step a); c) adjusting the
pH of the solution of step b) until the peptide dissolves in the
solution; and d) if necessary, adjusting the pH of the solution of
step c) to a pH of 4-9, thereby manufacturing the pharmaceutical
composition.
22-31. (canceled)
32. A process of lyophilizing the pharmaceutical composition of
claim 2, comprising the steps of: a) lowering the temperature of
the pharmaceutical composition to -40.degree. C.; b) holding the
temperature at -40.degree. C. for a predetermined time; c) raising
the temperature of the solution to 20.degree. C.; d) holding the
temperature at 20.degree. C. for a predetermined time; and e)
reducing the pressure and holding the temperature at 20.degree. C.
for a predetermined time, thereby lyophilizing the pharmaceutical
composition, or comprising the steps of: i) lowering the
temperature of the pharmaceutical composition to -45.degree. C.;
ii) holding the temperature at -45.degree. C. for a predetermined
time; iii) raising the temperature of the solution to -20.degree.
C.; iv) raising the temperature of the solution to 25.degree. C.;
and v) holding the temperature at 25.degree. C. for a predetermined
time, thereby lyophilizing the pharmaceutical composition.
33-40. (canceled)
41. The process of claim 32, wherein the process comprises steps
a)-e), and step a) is performed within 2 hours; step b) is
performed within 3 hours; step c) is performed over 13 hours and at
a pressure of 110 .mu.bar; step d) is performed over 13 hours and
at a pressure of 110 .mu.bar; and step e) is performed over 5 hours
and the pressure is reduced to 10 .mu.bar.
42-51. (canceled)
52. The process of claim 32, wherein the process comprises steps
i)-v), and step i) is performed within 6 hours; step ii) is
performed within 3 hours; step iii) is performed over 19 hours and
at a pressure of 150 .mu.bar; step iv) is performed over 13 hours
and at a pressure of 150 .mu.bar; and step v) is performed over 8
hours and at a pressure of 150 .mu.bar.
53-56. (canceled)
57. A lyophilized pharmaceutical composition comprising a
pharmaceutically acceptable salt of a peptide having the structural
formula NH.sub.2-Gly Tyr Tyr Trp Ser Trp Ile Arg Gln Pro Pro Gly
Lys Gly Glu Glu Trp Ile Gly-COOH (SEQ ID NO:1); and a substituted
.beta.-cyclodextrin.
58. A packaged pharmaceutical composition comprised of: a packaging
material; and a predetermined amount of the lyophilized
pharmaceutical composition of claim 57.
Description
[0001] This application claims the benefit of U.S. Provisional
Application No. 60/439,950, filed Jan. 14, 2003, the entire
contents of which are hereby incorporated by reference.
[0002] Throughout this application, various publications are
referenced by full citations. The disclosures of these publications
in their entireties are hereby incorporated by reference into this
application in order to more fully describe the state of the art as
known to those skilled therein as of the date of the invention
described and claimed herein.
BACKGROUND OF THE INVENTION
[0003] Systemic lupus erythematosus (SLE), or lupus, is a
debilitating autoimmune disease characterized by the presence of an
array of autoantibodies, including antibodies to dsDNA, to nuclear
antigens and to ribonucleoproteins. SLE affects approximately 1 in
2000 individuals (U.S. 1 in 700 women). The disease primarily
affects young women, with a female-to male ratio of approximately
9:1.
[0004] Systemic lupus can affect almost any organ or system of the
body. Systemic lupus may include periods in which few, if any,
symptoms are evident ("remission") and other times when the disease
becomes more active ("flare"). Most often when people mention
"lupus," they are referring to the systemic form of the
disease.
[0005] Corticosteroids are the mainstay in treating systemic
autoimmune disorders. Life threatening, severely disabling
manifestations of SLE are treated with high doses of
glucocorticoids (1-2 mg/kg/day). Undesirable effects of chronic
glucocorticoids include an array of prominent adverse effects such
as cushingoid habitus, central obesity, hypertension, infection,
capillary fragility, hirsutism, accelerated osteoporosis,
cataracts, diabetes mellitus, myopathy and psychosis. In addition
to corticosteroid toxicity, patient compliance to a dosage regimen
also poses a serious problem.
[0006] Cytotoxic agents are also used for controlling active
disease, reducing the rate of disease flares, and reducing steroid
requirements. Undesirable side effects of the latter include bone
marrow depression, increased infections with opportunistic
organisms, irreversible ovarian failure, alopecia and increased
risk of malignancy.
[0007] SLE is an inflammatory disease for which to date there is no
definitive treatment or cure. The disease results in acute and
chronic complications. The only treatments available are
palliative, aimed at relieving acute symptoms and preventing
chronic complications, often with profound side effects. There is
therefore an unmet need in this field, and both physicians and
patients would welcome new treatments which could potentially
eliminate or reduce the unwanted manifestations of the disease.
[0008] Peptides based on the complementarity-determining region of
the human monoclonal anti-DNA 16/6Id antibody capable of
immunomodulating SLE associated responses have been disclosed in
PCT International Publication No. WO 02/067848 A2, the entire
contents of which are hereby incorporated by reference. In
particular, region CDR1 was found to inhibit the proliferative
response of peripheral blood lymphocytes (PBL) of SLE patients to
the human anti-DNA 16/6Id mAB, and to ameliorate disease
manifestations of mice afflicted with spontaneous or experimental
SLE.
[0009] Human CDR1, Compound 1, shown in FIG. 1, is a synthetic
peptide of 19 amino acids based on the complementarity-determining
region 1 (CDR1) of the human anti-dsDNA mAb denoted 16/6 Id
(Waisman, A., et al. "Modulation of murine systemic lupus
erythematosus with peptides based on complementarity determining
regions of pathogenic anti-DNA monoclonal antibodies." Proc. Natl.
Acad. Sci. U.S.A. (1997), 94(4): 4620-4625).
[0010] In experimental SLE models--Balb/c mice and SLE-prone mice,
i.e. (NZBxNZW)F1 mice--treatment with either mCDR based-peptides or
Compound 1 significantly reduced the SLE related findings, notably
immune complex deposits (ICD) in the kidney, proteinuria and
leukopenia. The treatment had no effect on the 16/6 Id specific
antibody response (Waisman, A., et al. "Modulation of murine
systemic lupus erythematosus with peptides based on complementarity
determining regions of pathogenic anti-DNA monoclonal antibodies."
Proc. Natl. Acad. Sci. U.S.A. (1997), 94(4): 620; Eilat, E., et
al., "Prevention of systemic lupus erythematosus-like disease in
(NZBxNZW)F1 mice by treating with CDR1- and CDR3-based peptides of
pathogenic autoantibody" J. Clin. Immunol. (2000), 20: 268; Eilat,
E., et al., "The mechanism by which a peptide based on
complementarity determining region-1 of pathogenic anti-DNA
antibody ameliorates experimental SLE" (2001), Proc. Natl. Acad.
Sci. U.S.A. 98: 1148).
[0011] These peptides, like many peptides, are not very soluble.
Therefore, formulations that improve the solubility of the peptides
are desired.
SUMMARY OF INVENTION
[0012] The subject invention provides a pharmaceutical composition
comprising [0013] an aqueous carrier; [0014] from 0.1 mg/ml to 20
mg/ml of the composition of a pharmaceutically acceptable salt of a
peptide having the structural formula
TABLE-US-00001 [0014] (SEQ ID NO:1) NH.sub.2-Gly Tyr Tyr Trp Ser
Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile Gly-COOH;
and
[0015] a substituted .beta.-cyclodextrin in an amount effective to
dissolve the peptide in the aqueous carrier, [0016] wherein the
composition has a pH between 4 and 9.
[0017] The subject invention also provides a pharmaceutical
composition comprising [0018] an aqueous carrier; [0019] from 0.1
mg/ml to 20 mg/ml of the composition of an acetate salt of a
peptide having the structural formula
TABLE-US-00002 [0019] (SEQ ID NO:1) NH.sub.2-Gly Tyr Tyr Trp Ser
Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile Gly-COOH;
[0020] and [0021] from 70 mg/ml to 170 mg/ml of the composition of
hepta-(sulfobutyl ether)-.beta.-cyclodextrin, [0022] wherein the
peptide and the hepta-(sulfobutyl ether)-.beta.-cyclodextrin are
dissolved in the aqueous carrier; and [0023] wherein the solution
has a pH between 6.5 and 8.5.
[0024] The subject invention also provides a method of alleviating
symptoms of systemic lupus erythematosus (SLE) in a human subject
comprising administering to the human subject any of the above
pharmaceutical compositions in an amount effective to alleviate the
symptoms of SLE in the human subject.
[0025] The subject invention also provides a process for
manufacturing the above pharmaceutical composition comprising the
steps of: [0026] a) preparing a solution of a substituted
.beta.-cyclodextrin in an aqueous carrier at a predetermined
concentration; [0027] b) adding predetermined amount of a
pharmaceutically acceptable salt of the peptide NH.sub.2-Gly Tyr
Tyr Trp Ser Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile
Gly-COOH (SEQ ID NO:1) to the solution of step a); [0028] c)
adjusting the pH of the solution of step b) until the peptide
dissolves in the solution; and [0029] d) if necessary, adjusting
the pH of the solution of step c) to a pH of 4-9, thereby
manufacturing the pharmaceutical composition.
[0030] The subject invention also provides a process of
lyophilizing the above pharmaceutical composition, comprising the
steps of: [0031] a) lowering the temperature of the pharmaceutical
composition to -40.degree. C.; [0032] b) holding the temperature at
-40.degree. C. for a predetermined time; [0033] c) raising the
temperature of the solution to 20.degree. C.; [0034] d) holding the
temperature at 20.degree. C. for a predetermined time; and [0035]
e) reducing the pressure to 10 .mu.bar, thereby lyophilizing the
pharmaceutical composition.
[0036] The subject invention also provides a process of
lyophilizing the above pharmaceutical composition, comprising the
steps of: [0037] a) lowering the temperature of the pharmaceutical
composition to -45.degree. C.; [0038] b) holding the temperature at
-45.degree. C. for a predetermined time; [0039] c) raising the
temperature of the solution to -20.degree. C.; [0040] d) raising
the temperature of the solution to 25.degree. C.; and [0041] e)
holding the temperature at 25.degree. C. for a predetermined time,
thereby lyophilizing the pharmaceutical composition.
BRIEF DESCRIPTION OF FIGURES
[0042] FIG. 1. Human CDR1 (Compound 1) as acetate salt--showing the
molecular and structural formulas of hCDR1, the amino acid
sequence, and physical parameters
[0043] FIG. 2. IL-2 Secretion from cells taken from mice treated
with Compound 1 and Captisol.RTM. solution after the cells were
subsequently activated with a solution of Compound 1 in PBS. [0044]
.box-solid.--Compound 1 (RS) 50 .mu.g/mouse [0045]
.tangle-solidup.--Compound 1 (RS) 200 .mu.g/mouse [0046]
.quadrature.-- DP 50 .mu.g/mouse [0047] .DELTA.--DP 200 .mu.g/mouse
[0048] --12% Captisol.RTM. ampulized
[0049] FIG. 3. IFN-.gamma. Secretion from cells taken from mice
treated with Compound 1 solution after the cells were subsequently
activated with a solution of compound 1 in EM-1 (2.5.times.10.sup.6
cells/well). [0050] .diamond-solid.--Placebo [0051] --Compound 150
.mu.g/mouse (treatment dose) [0052] .DELTA.--Compound 1100
.mu.g/mouse (treatment dose) [0053] X--Compound 1200 .mu.g/mouse
(treatment dose)
[0054] FIG. 4. IFN-.gamma. Secretion from cells taken from mice
treated with Compound 1 solution after the cells were subsequently
activated with a solution of compound 1 in EM-1 (5.times.10.sup.6
cells/well). [0055] .diamond-solid.--Placebo [0056]
.quadrature.--Compound 1 25 .mu.g/mouse [0057] .DELTA.--Compound 1
50 .mu.g/mouse [0058] X--Compound 1 100 pg/mouse [0059] *--Compound
1 200 pg/mouse
[0060] FIG. 5. Anti-dsDNA antibodies in (NZBxNZW)F1 mice after 10
injections with Compound 1 in Captisol.RTM. [OD=Optical Density;
Compound 1 (C)=Compound 1 dissolved in Captisol.RTM.] [0061]
.quadrature.--Placebo [0062] .diamond.--Compound 150 .mu.g/mouse
[0063] .smallcircle.--Compound 125 .mu.g/mouse
[0064] FIG. 6. Kidney sections from (NZBxNZW)F1 mice showing
intensity of Immune Complex Deposits. The top row sections are from
a Captisol.RTM.-treated mouse, the mid-row sections are from a
mouse treated with 50 .mu.g/mouse Compound 1 and the bottom row
sections are from a mouse treated with 25 .mu.g/mouse Compound 1.
Magnification: Left: .times.100, Right: .times.400. FITC
immunohistology.
DETAILED DESCRIPTION
[0065] The subject invention provides a pharmaceutical composition
comprising [0066] an aqueous carrier; [0067] from 0.1 mg/ml to 20
mg/ml of the composition of a pharmaceutically acceptable salt of a
peptide having the structural formula
[0067] NH.sub.2-Gly Tyr Tyr Trp Ser Trp Ile Arg Gln Pro Pro Gly Lys
Gly Glu Glu Trp Ile Gly-COOH (SEQ ID NO:1); and [0068] a
substituted .beta.-cyclodextrin in an amount effective to dissolve
the peptide in the aqueous carrier, [0069] wherein the composition
has a pH between 4 and 9.
[0070] In one embodiment, the concentration of the acetate salt of
the peptide is at least 0.5 mg/ml.
[0071] In one embodiment, the concentration of the salt of the
peptide is from 0.5 mg/ml to 10 mg/ml.
[0072] In another embodiment, the concentration of the salt of the
peptide is from 0.5 mg/ml to 2.5 mg/ml.
[0073] In another embodiment, the concentration of the salt of the
peptide is from 2.5 mg/ml to 5 mg/ml.
[0074] In another embodiment, the concentration of the salt of the
peptide is from 5 mg/ml to 7 mg/ml.
[0075] In another embodiment, the concentration of the salt of the
peptide is from 7 mg/ml to 8.5 mg/ml.
[0076] In another embodiment, the concentration of the salt of the
peptide is from 8.5 mg/ml to 10 mg/ml.
[0077] In another embodiment, the concentration of the salt of the
peptide is from 9 mg/ml to 10 mg/ml.
[0078] In another embodiment, the concentration of the salt of the
peptide is from 10 mg/ml to 15 mg/ml.
[0079] In another embodiment, the concentration of the salt of the
peptide is from 15 mg/ml to 20 mg/ml.
[0080] In another embodiment, the concentration of the salt of the
peptide is 1.0 mg/ml.
[0081] In another embodiment, the concentration of the salt of the
peptide is 2.5 mg/ml.
[0082] In another embodiment, the concentration of the salt of the
peptide is 5 mg/ml.
[0083] In another embodiment, the concentration of the salt of the
peptide is 10 mg/ml.
[0084] In another embodiment, the concentration of the salt of the
peptide is 15 mg/ml.
[0085] In another embodiment, the concentration of the salt is from
0.1 mg/ml to 0.5 mg/ml.
[0086] In another embodiment, the concentration of the salt is from
0.1 mg/ml to 0.2 mg/ml.
[0087] In another embodiment, the concentration of the salt is from
0.2 mg/ml to 0.3 mg/ml.
[0088] In another embodiment, the concentration of the salt is from
0.3 mg/ml to 0.4 mg/ml.
[0089] In another embodiment, the concentration of the salt is from
0.4 mg/ml to 0.5 mg/ml.
[0090] In a further embodiment, the composition has a pH between
6.5 and 8.5.
[0091] In a further embodiment, the composition has a pH between
7.5 and 8.5.
[0092] In a further embodiment, the composition has a pH between 4
and 5.
[0093] In a further embodiment, the composition has a pH between 5
and 6.
[0094] In a further embodiment, the composition has a pH between 6
and 7.
[0095] In a further embodiment, the composition has a pH between 7
and 8.
[0096] In a further embodiment, the composition has a pH between 8
and 9.
[0097] In another embodiment, the pharmaceutically acceptable salt
is an acetate salt.
[0098] In another embodiment, the substituted .beta.-cyclodextrin
is a hydroxypropyl, a sulfobutyl ether, or a sulfopropyl ether
substituted .beta.-cyclodextrin.
[0099] In a further embodiment, the substituted .beta.-cyclodextrin
is a sulfobutyl ether substituted .beta.-cyclodextrin.
[0100] In a further embodiment, the pharmaceutically acceptable
salt is an acetate salt, and the substituted .beta.-cyclodextrin is
hepta-(sulfobutyl ether)-.beta.-cyclodextrin.
[0101] In another embodiment, the composition further comprises a
pharmaceutically acceptable buffer in an amount and of a type
suitable to make the pH of the pharmaceutical composition in the
range of 4-9. The buffer may be acetate buffer, citrate buffer, or
sodium carbonate.
[0102] The subject invention also provides a pharmaceutical
composition comprising [0103] an aqueous carrier; [0104] from 0.1
mg/ml to 20 mg/ml of the composition of an acetate salt of a
peptide having the structural formula
TABLE-US-00003 [0104] (SEQ ID NO:1) NH.sub.2-Gly Tyr Tyr Trp Ser
Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile Gly-COOH;
[0105] and [0106] from 70 mg/ml to 170 mg/ml of the composition of
hepta-(sulfobutyl ether)-.beta.-cyclodextrin, [0107] wherein the
peptide and the hepta-(sulfobutyl ether)-.beta.-cyclodextrin are
dissolved in the aqueous carrier; and [0108] wherein the
composition has a pH between 6.5 and 8.5.
[0109] In one embodiment, the concentration of the acetate salt of
the peptide is at least 0.5 mg/ml.
[0110] In one embodiment, the concentration of the acetate salt of
the peptide is from 0.5 mg/ml to 10 mg/ml.
[0111] In a further embodiment, the concentration of the acetate
salt of the peptide is from 0.5 mg/ml to 2.5 mg/ml.
[0112] In another embodiment, the concentration of the salt is from
0.1 mg/ml to 0.5 mg/ml.
[0113] In another embodiment, the concentration of the salt is from
0.1 mg/ml to 0.2 mg/ml.
[0114] In another embodiment, the concentration of the salt is from
0.2 mg/ml to 0.3 mg/ml.
[0115] In another embodiment, the concentration of the salt is from
0.3 mg/ml to 0.4 mg/ml.
[0116] In another embodiment, the concentration of the salt is from
0.4 mg/ml to 0.5 mg/ml.
[0117] In another embodiment, the concentration of the salt of the
peptide is from 5 mg/ml to 7 mg/ml.
[0118] In another embodiment, the concentration of the salt of the
peptide is from 7 mg/ml to 8.5 mg/ml.
[0119] In another embodiment, the concentration of the salt of the
peptide is from 8.5 mg/ml to 10 mg/ml.
[0120] In another embodiment, the concentration of the salt of the
peptide is from 9 mg/ml to 10 mg/ml.
[0121] In another embodiment, the concentration of the salt of the
peptide is from 10 mg/ml to 15 mg/ml.
[0122] In another embodiment, the concentration of the salt of the
peptide is from 15 mg/ml to 20 mg/ml.
[0123] In a further embodiment, the concentration of acetate salt
of the peptide is 1.0 mg/ml.
[0124] In a further embodiment, the concentration of acetate salt
of the peptide is 2.5 mg/ml.
[0125] In another embodiment, the concentration of the salt of the
peptide is 5 mg/ml.
[0126] In another embodiment, the concentration of the salt of the
peptide is 10 mg/ml.
[0127] In another embodiment, the concentration of the salt of the
peptide is 15 mg/ml.
[0128] In another embodiment, the concentration of
hepta-(sulfobutyl ether)-.beta.-cyclodextrin is 120 mg/ml and the
pH of the composition is between 7.5 and 8.5.
[0129] The subject invention also provides a method of alleviating
symptoms of systemic lupus erythematosus (SLE) in a human subject
comprising administering to the human subject any of the above
pharmaceutical compositions in an amount effective to alleviate the
symptoms of SLE in the human subject.
[0130] The subject invention also provides the above pharmaceutical
compositions for use in treating SLE in a human subject.
[0131] The subject invention also provides a process for
manufacturing any of the above pharmaceutical compositions
comprising the steps of: [0132] a) preparing a solution of a
substituted .beta.-cyclodextrin in an aqueous carrier at a
predetermined concentration; [0133] b) adding predetermined amount
of a pharmaceutically acceptable salt of the peptide NH.sub.2-Gly
Tyr Tyr Trp Ser Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile
Gly-COOH (SEQ ID NO:1) to the solution of step a); [0134] c)
adjusting the pH of the solution of step b) until the peptide
dissolves in the solution; and [0135] d) if necessary, adjusting
the pH of the solution of step c) to a pH of 4-9, thereby
manufacturing the pharmaceutical composition.
[0136] In one embodiment of the process, the resulting final
concentration of the substituted .beta.-cyclodextrin in the
pharmaceutical composition is from 70 mg/ml to 170 mg/ml.
[0137] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 80 mg/ml to 170
mg/ml.
[0138] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 90 mg/ml to 170
mg/ml.
[0139] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 100 mg/ml to 170
mg/ml.
[0140] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 110 mg/ml to 170
mg/ml.
[0141] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 120 mg/ml to 170
mg/ml.
[0142] In one embodiment of the process, the predetermined,
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 0.130 mg/ml to 170
mg/ml.
[0143] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 140 mg/ml to 170
mg/ml.
[0144] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 150 mg/ml to 170
mg/ml.
[0145] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition of from 160 mg/ml to 170
mg/ml.
[0146] In one embodiment of the process, the predetermined
concentration of the substituted .beta.-cyclodextrin is such which
results in a final concentration of substituted .beta.-cyclodextrin
in the pharmaceutical composition is 120 mg/ml.
[0147] In another embodiment, the predetermined amount of peptide
is such which results in a final concentration of peptide in the
pharmaceutical composition is at least 0.1 mg/ml.
[0148] In another embodiment, the predetermined amount of peptide
is such which results in a final concentration of peptide in the
pharmaceutical composition is at least 0.5 mg/ml.
[0149] In another embodiment, the predetermined amount of peptide
is such which results in a final concentration of peptide in the
pharmaceutical composition is 2.5 mg/ml, 2.0 mg/ml, 11.0 mg/ml, 0.5
mg/ml or 0.1 mg/ml.
[0150] In another embodiment, the predetermined amount of peptide
is such which results in a final concentration of peptide in the
pharmaceutical composition is 5 mg/ml, 10 mg/ml or 15 mg/ml.
[0151] In another embodiment of the process, step b) further
comprises mixing the solution for 1 hour.
[0152] In another embodiment, in step c) the pH is adjusted using
HCl or NaOH 1.0N.
[0153] In another embodiment, the process further comprises
filtering the solution of step d) through a cellulose acetate
filter.
[0154] In another embodiment of the above process, [0155] the
predetermined concentration of the substituted .beta.-cyclodextrin
is such which results in a final concentration of substituted
.beta.-cyclodextrin in the pharmaceutical composition is 120 mg/ml;
[0156] the predetermined amount of peptide is such which results in
a final concentration of peptide in the pharmaceutical composition
is 2.5 mg/ml, 2.0 mg/ml, 11.0 mg/ml, 0.5 mg/ml or 0.1 mg/ml; [0157]
step b) further comprises mixing the solution for 1 hour; and
[0158] in step c) the pH is adjusted using HCl or NaOH 1.0N, and
the process further comprises filtering the solution of step d)
through a cellulose acetate filter.
[0159] The subject invention also provides a composition prepared
by the above process.
[0160] The subject invention also provides a process of
lyophilizing the above pharmaceutical composition, comprising the
steps of: [0161] a) lowering the temperature of the pharmaceutical
composition to -40.degree. C.; [0162] b) holding the temperature at
-40.degree. C. for a predetermined time; [0163] c) raising the
temperature of the solution to 20.degree. C.; [0164] d) holding the
temperature at 20.degree. C. for a predetermined time; and [0165]
e) holding the temperature at 25.degree. C. for a predetermined
time, thereby lyophilizing the pharmaceutical composition.
[0166] In one embodiment of the process, step a) is performed
within 2 hours.
[0167] In another embodiment, step b) is performed within 3
hours.
[0168] In a further embodiment, step c) is performed over 13
hours.
[0169] In a further embodiment, step c) is performed at a pressure
of 110 .mu.bar.
[0170] In a further embodiment, step d) is performed over 13
hours.
[0171] In a further embodiment, step d) is performed at a pressure
of 110 .mu.bar.
[0172] In a further embodiment, in step e) the pressure is reduced
to 10 .mu.bar.
[0173] In a further embodiment, step e) is performed over 5
hours.
[0174] In another embodiment of the process, [0175] step a) is
performed within 2 hours; [0176] step b) is performed within 3
hours; [0177] step c) is performed over 13 hours and at a pressure
of 110 .mu.bar; [0178] step d) is performed over 13 hours and at a
pressure of 110 .mu.bar; and [0179] step e) is performed over 5
hours and the pressure is reduced to 10 .mu.bar.
[0180] The subject invention also provides a lyophilized
pharmaceutical composition prepared by the above process.
[0181] The subject invention also provides a process of
lyophilizing the above pharmaceutical composition, comprising the
steps of: [0182] a) lowering the temperature of the pharmaceutical
composition to -45.degree. C.; [0183] b) holding the temperature at
-45.degree. C. for a predetermined time; [0184] c) raising the
temperature of the solution to -20.degree. C.; [0185] d) raising
the temperature of the solution to 25.degree. C.; and [0186] e)
holding the temperature at 25.degree. C. for a predetermined time,
thereby lyophilizing the pharmaceutical composition.
[0187] In one embodiment, step a) is performed within 6 hours.
[0188] In another embodiment, step b) is performed within 3
hours.
[0189] In another embodiment, step c) is performed over 19
hours.
[0190] In another embodiment, step c) is performed at a pressure of
150 .mu.bar.
[0191] In another embodiment, step d) is performed over 13
hours.
[0192] In another embodiment, step d) is performed at a pressure of
150 .mu.bar.
[0193] In another embodiment, step e) is performed over 8
hours.
[0194] In another embodiment, step e) is performed at a pressure of
150 .mu.bar.
[0195] In another embodiment of the process, [0196] step a) is
performed within 6 hours; [0197] step b) is performed within 3
hours; [0198] step c) is performed over 19 hours and at a pressure
of 150 .mu.bar; [0199] step d) is performed over 13 hours and at a
pressure of 150 .mu.bar; and [0200] step e) is performed over 8
hours and at a pressure of 150 .mu.bar.
[0201] The subject invention also provides a lyophilized
pharmaceutical composition prepared by any of the above
processes.
[0202] In one embodiment of the above lyophilized pharmaceutical
composition, the water content of the composition is less than
5%.
[0203] In another embodiment, the water content of the composition
is less than 4.0%.
[0204] In another embodiment, the water content of the composition
is less then 3.5%.
[0205] The subject invention also provides a lyophilized
pharmaceutical composition comprising [0206] a pharmaceutically
acceptable salt of a peptide having the structural formula
TABLE-US-00004 [0206] (SEQ ID NO:1) NH.sub.2-Gly Tyr Tyr Trp Ser
Trp Ile Arg Gln Pro Pro Gly Lys Gly Glu Glu Trp Ile Gly-COOH;
and
[0207] a substituted .beta.-cyclodextrin.
[0208] The subject invention also provides a packaged
pharmaceutical composition comprised of: [0209] a packaging
material; and [0210] a predetermined amount of the above
lyophilized pharmaceutical composition.
[0211] The preparations of the present invention may be given
parenterally, topically, or rectally. They are of course given by
forms suitable for each administration route. For example, they are
administered by injection, inhalation, ointment, suppository, etc.
administration by injection, infusion or inhalation; topical by
lotion or ointment; and rectal by suppositories.
[0212] The phrases "parenteral administration" and "administered
parenterally" as used herein means modes of administration other
than enteral and topical administration, usually by injection, and
includes, without limitation, intravenous, intramuscular,
intraarterial, intrathecal, intracapsular, intraorbital,
intracardiac, intradermal, intraperitoneal, transtracheal,
subcutaneous, subcuticular, intraarticular, subcapsular,
subarachnoid, intraspinal and intrasternal injection and
infusion.
[0213] The phrases "systemic administration," "administered
systematically," "peripheral administration" and "administered
peripherally" as used herein mean the administration of a compound,
drug or other material other than directly into the central nervous
system, such that it enters the patient's system and, thus, is
subject to metabolism and other like processes, for example,
subcutaneous administration.
[0214] Details of general formulation procedures and information on
additional excipients may be found in Remington: The Science and
Practice of Pharmacy, 20.sup.th Edition.
[0215] This invention will be better understood from the
Experimental Details which 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.
EXPERIMENTAL DETAILS
Example 1
Formulation Development for Compound 1
[0216] The human hCDR1 peptide (Compound 1) is described in PCT
International Publication No WO 02/067848, published Sep. 6, 2002,
and can be prepared by methods well known in the art, (see, for
example, Peptides: Synthesis, Structure and Applications, ed. by B.
Gutte, Academic Press, 1995; Peptide Synthesis Protocols, ed. By M.
Pennington and B. Dunn, Humana Press, 1994; Schnolzer, M. et al.,
"In situ neutralization in Boc-chemistry solid phase synthesis.
Rapid, High yield assembly of difficult sequences." Int. J. Pept.
Protein Res. (1992) 40: 180-193).
[0217] Compound 1 is a synthetic polypeptide composed of 19 amino
acids. It is provided as an acetate salt. The aqueous solubility of
the peptide has been determined to be less than 0.5 mg/ml. FIG. 1
shows compound 1 as an acetate salt.
[0218] In order to develop a formulation with peptide concentration
exceeding 2 mg/ml, preferably up to 10 mg/ml, experiments with
several solubility enhancers were performed. The preliminary
experiments indicated that a concentration of 2 mg/ml cannot be
easily attained. In order to develop a formulation for
sub-cutaneous injection, it is also desirable that the pH be in the
range of 4 to 9 and that the solution be iso-osmotic.
[0219] Based on an extensive literature survey, a few principal
approaches were adopted in order to produce a formulation with
maximal solubility. The factors considered were:
pH adjustment and buffers
Solvents
Co-solvents
[0220] Solubilizing agents
Methods
[0221] Compound 1 was dissolved in the chosen solubility enhancer
solution either separately or in combination with other excipients
and the solutions were stirred for at least an hour. The pH was
adjusted if needed. The solutions were visually examined to
estimate the solubility and sent for analytical assay
determination. For a few chosen formulations, biological activity
was also tested.
Results
[0222] Table 1 presents the type of solubility enhancers used for
the formulation development. Tables 2 and 3 summarize the
experiments that were performed with the various solubility
enhancers. Table 2 summarizes the initial screening performed with
peptide concentrations in the range of 5 to 10 mg/ml. The
experimental work that was performed with higher peptide
concentration was then repeated with the lower doses (see table
3)
[0223] Initial tests indicated that Compound 1 was more soluble at
the limits of the desired pH levels, both acidic and basic, but was
less stable at the basic pH range. Thus, several buffers and pH
adjustment agents were tested, including acetate buffer, citrate
buffer and sodium carbonate. None of the initially tested buffers
achieved the desired peptide solubility level. Only above pH 9.2
and below pH 3.0 were solubility levels of 2 mg/ml observed.
Nevertheless, at the initial stage, formulations with acetate
buffer and citrate buffer (with Mannitol as a tonicity agent) were
selected for initial toxicology studies. These formulations were
tested for biological activity and proven active.
[0224] Non aqueous solvents (see table 1) such as Ethanol,
Glycerin, Propylene glycol, Chremophore and their combinations were
tested but did not increase the solubility of Compound 1. A
solution of 30% DMA (dimethyl-acetamide) yielded solubility in the
desired ranges (5 to 9 mg/ml), but was not suitable for a
pharmaceutical formulation due to its toxicity profile. Improved
solubility was also observed using 30% (w/w) PEG 400 (5 to 9
mg/ml). This latter formulation was chosen for the toxicology
studies, but it has proved to be both inactive in the biological
assay, and may have been the cause of some adverse effects in a
mouse toxicity study. Thus, it was decided not to further pursue
this formulation. In view of the preliminary experiments
non-aqueous solvents were not used in the subject formulations.
[0225] Several amino acids (see table 1) including L-Arginine,
L-Glutamic acid, L-Glycine and L-Lysine were tested to improve the
protein solubility. The solubility of the peptide in L-Arginine was
at the desired level but the resulting pH was above 9. An attempt
to decrease the pH or use an Arginine HCl salt resulted in
precipitation of the peptide. Human Serum Albumin was also tested
and improved the solubility of the peptide at low peptide
concentrations (1 mg/ml) (see table 3). However, due to its
potential immunogenicity and the low peptide solubility, it was not
utilized in further experiments.
[0226] Bulking agents (see table 1) including Mannitol, Sorbitol
and Dextran were tested alone and in combination with other
excipients, but did not improve the solubility of the peptide in
solution.
[0227] Co-solvents (see table 1), including Polysorbate 20 and
Polysorbate 80 were tested alone and in combination with other
excipients. While lower concentrations of Polysorbates (up to 6%)
did not improve the solubility of the peptide, higher
concentrations (up to 10%--see table 2) improved the solubility of
the peptide up to 2 mg/ml. However, such high concentrations of
Polysorbates were deemed unsuitable for pharmaceutical
formulations.
[0228] Two types of cyclodextrins, both approved for use in
marketed parenteral products, were also tested:
Hydroxypropyl-.beta.-cyclodextrin and
Sulfobutylether-.beta.-cyclodextrin (Captisol.RTM.). Both markedly
increased the solubility of the peptide (concentrations in the
levels of 10 mg/ml for Hydroxypropyl-.beta.-cyclodextrin and 2.5
for Captisol.RTM.). The biological activity of the two cyclodextrin
formulations was tested and was found to be equal to the activity
of the peptide alone.
[0229] CAPTISOL.RTM. is a commercially available polyanionic
.beta.-cyclodextrin derivative with a sodium sulfonate salt
separated from the hydrophobic cavity by a butyl ether spacer
group, or sulfobutylether (SBE). CAPTISOL.RTM. is the trade name
for CyDex Inc.'s hepta-substituted sulfobutylether
.beta.-cyclodextrin (SBE7-.beta.-CD) preparation
(www.captisol.com). The structure of CAPTISOL.RTM. allows drug
molecules to fit in the hydrophobic cavity, thereby isolating the
drug molecule from the aqueous solvent. Because the outer surface
of CAPTISOL.RTM. is hydrophilic, the solubility of the complexed
drug molecule is thereby enhanced. The use of cyclodextrins to
enhance the solubility of drug molecules is disclosed in U.S. Pat.
Nos. 5,134,127 and 5,376,645, the entire contents of which are
hereby incorporated by reference.
[0230] According to the literature of CyDex Inc., CAPTISOL.RTM. is
safe when administered parenterally and does not exhibit the
nephrotoxicity associated with beta-cyclodextrin. Relative to
beta-cyclodextrin, CAPTISOL.RTM. provides comparable or higher
complexation characteristics and superior water solubility in
excess of 90 grams/100 ml--a 50-fold improvement.
Conclusions
[0231] Several solubility enhancers were found to match the desired
solubility range: DMA, PEG-400, dimethyl-acetamide, polyethylene
glycol, polyoxylated castor oil, N-methyl-2-pyrrolidinone,
1-ethenyl-2-pyrrolidinone, Polysorbate 20, Polysorbate 80,
Hydroxypropyl-.beta.-cyclodextrin and
Sulfobutylether-.beta.-cycldextrin (Captisol.RTM.). Of these
solubility enhancers both cyclodextrins have proven to be superior
with respect to solubility, biological activity and stability.
Thus, it was decided to select Captisol.RTM. as the solubility
enhancer for use in Example 5 formulations and to further study
both cyclodextrin formulations. The final formulation for the
Example 5 clinical studies consists of: 120 mg/ml of Captisol.RTM.
in water with the desired amount of peptide (0.5, 1.0 or 2.5
mg/ml), and HCl and NaOH for pH adjustment.
TABLE-US-00005 TABLE 1 Solubility enhancers used for Compound 1
formulation development Solubility enhancer classification
Solubility Enhancers Solvents Cremophor EL, CMC, Ethanol, DMA,
Gycerin, Propylene Glycol, PEG 400, Monotioglycerol Co-solvents
Polysorbate 20, Ploysorbate 80 Solubilizing agents Argenine, HSA,
Glycine, Creatinine, Glutamic acid, Lysine (acetate salt and free
base), Captisol .RTM., Hydroxypropyl-.beta.-cyclodextrin, Bulking
agents Mannitol, Sorbitol, Dextrose, Lactose Dextran pH Adjustment
Agents Citrate buffer, Acetate buffer, Sodium Carbonate
TABLE-US-00006 TABLE 2 List of Cosolvents and Stabilizers evaluated
in Compound 1 Peptide Formulations. % of Standard Amount of amount
from peptide Solubility Enhancer* % Used the literature added
(mg/ml) Assay, % pH of formulation Remarks Albumin (HSA), 1.5
0.4-5.0 5 6.0 Insoluble Dextrose 1.5 Adjust. to 4.1 Albumin (HSA),
1.0 0.4-5.0 5 -- 5.8 Insoluble Polysorbate 80, 0.6 0.8-4.0 Adjust.
to 4.1 Glycine 2.0 0.2-2.1 Arginine 1.5 0.8-1.6 15 93 9.8 Clear
solution Arginine HCl 2.0 0.8-1.6 5 -- 3.5 Insoluble Arginine 1.5
0.8-1.6 15 93 9.8 When the pH was lowered Lactose 1.5 below 8.5 the
peptide precipitated and the solution turned into gel Captisol
.RTM. 10.0 Up to 30.0 10 86 4.9 Turbid solution 20.0 89 Adjust. to
4.4 CMC (carboxy methyl 0.2 5 90 5.0 For toxicology studies
cellulose) in acetate 0.05M Creatanine 0.8 Up to 0.6 5 -- 6.1
Insoluble Adjust. to 4.1 Cremophor EL 15.0 -10.0 5 -- 4.0 Very
turbid Ethanol 10.0 0.6-32.9 Dimethylacetamide 6.0 0.012-6.0
Dextran 4.0 to 15.0 3.0-30.0 5 -- 3.9 Insoluble Dimethylacetamide
(DMA) 6.0-20.0 0.012-6.0 5 -- 4.6 Insoluble Dimethylacetamide (DMA)
25.0 0.012-6.0 5 87 5.1 Clear solution Dimethylacetamide (DMA) 30.0
0.012-6.0 10 93 5.1 Clear solution Ethanol 10.0 0.6-32.9 5 -- --
Insoluble Glutamic acid 2.0 -- 5 -- 3.7 When the pH was increased
above 4 the peptide precipitated and the solution turned into gel
Glycerin 1.5 1.6-32.5 5 37 4.5 Insoluble Glycerin 30.0 1.6-32.5 5
-- 3.7 Insoluble Glycerin, 10.0 1.6-32.5 5 12 6.5 Insoluble
Polysorbate 80 0.6 0.8-4 Adjust. to 4.5 Glycine 0.4 0.2-2.1 5 --
4.6 Insoluble Hydroxypropyl .beta.-cyclodextrin 20.0 Up to 30.0 10
99 4.6 Clear solution Lysine Acetate Salt 2.0 5 -- 3.8 Insoluble
Lysine Free base 2.0 5 -- 9.2 When the pH was lowered below 8 the
peptide precipitated and the solution turned into gel Mannitol in
Citrate buffer 4.0 2.0-10.0 5 38 3.4 For toxicology studies 0.035M
Mannitol 4.0 2.0-10.0 5 32 4.3 For toxicology studies in acetate
buffer 0.05M Mannitol, 20.0 2.0-10.0 5 14 6.4 Insoluble Glycine 0.4
0.2-2.1 Adjust. to 4.5 Mannitol, 20.0 2.0-10.0 5 22 6.5 Insoluble
Polysorbate 20 0.6 -- Adjust. to 4.5 Monothioglycerol 1.0 0.1-10.0
5 -- 4.5 Turbid solution PEG 400 30.0 Up to 30.0 5 88 4.2 Slightly
opalescent PEG 400 30.0 Up to 30.0 10 89 4.2 Turbid solution PEG
400 30.0 Up to 30.0 5 94 4.2 Clear solution with DMA 6.0 0.012-0.6
PEG 400 10.0 6.0-18.0 5 58 4.2 Insoluble PEG 400 10.0 Up to 30.0 5
-- 4.3 Insoluble DMA 10.0 0.012-0.6 PEG 400 10.0 Up to 30.0 5 --
4.1 Insoluble Propylene glycol PG 10.0 10.0 PEG 400 18.0 Up to 30.0
5 100 4.2 Clear solution Propylene glycol 50.0 10.0 Polysorbate 80
1.6 0.8-4.0 5 24 7.2 Insoluble Adjust. to 4.5 Polysorbate 80 6.0
0.8-4.0 5 -- 3.9 Insoluble Polysorbate 80 6.0 0.8-4.0 5 -- 4.0
Insoluble Creatanine 0.6 up to 0.6 Propylene glycol PG 10.0 10.0 5
-- 4.2 Insoluble DMA 10.0 0.012-0.6 Propylene glycol PG 10.0, 30.0
10.0 5 -- 4.2 Insoluble Sodium Carbonate 1.5 5 -- 11.4 When the pH
was lowered below 8.5 the peptide precipitated and the solution
turned into gel Sorbitol 5.0 10.0-25.0 5 -- 6.9 Turbid solution
Adjust. to 4.5
TABLE-US-00007 TABLE 3 Compound 1 formulations at low peptide
concentrations % of Standard Amount of amount from the peptide
added pH of Solubility Enhancer* % Used literature (mg/ml) Assay, %
formulation Remarks Albumin (HSA), 5.0 0.4-5.0 1.0 90 6.9 Clear
solution 2.5 -- Adjust. to 4.5 Turbid solution Arginine 1.5 0.8-1.6
1.0 24 10.6 When the pH was lowered below 8.5 the peptide Adjust.
to 8.5 precipitated and the solution turned into gel Captisol .RTM.
12.0 Up to 30.0 1.0 106 5.3 Clear solution 2.5 100 6.5 to 8.5
Dextran 20.0 3.0-30.0 1.0 69 4.8 Turbid solution Adjust. to 4.0
Glycerin 30.0 1.6-32.5 1.0 -- 4.8 Turbid solution Adjust. to 4.0
Mannitol 4.0 0.8-4.0 1.0 64 4.7 Turbid solution Adjust. to 4.0
Polysorbate 20 10.0 -- 1.0 95 5.8 Clear solution 2.5 88 Adjust. to
4.8 Clear with small amount of precipitation Polysorbate 20 10.0 --
2.5 115 5.1 Clear solution Mannitol 2.0 2.0-10.0 Adjust. to 4.3
Polysorbate 80 4.0 0.8-4.0 1.0 91 5.5 Clear solution 6.0-10.0 2.5
89 Adjust. to 5.0 Slightly turbid solution Polysorbate 80 4.0
0.8-4.0 2.5 88 5.1 Slightly turbid solution Mannitol 2.0 2.0-10.0
Adjust. to 4.4 Propylene glycol PG 10.0 10.0 1.0 78 5.0 Turbid
solution Adjust. to 4.4 Sorbitol 20.0 10.0-25 1.0 52 4.5 Turbid
solution
Example 2
Preparation Protocol for Solution of Compound 1 in
Captisol.RTM.
[0232] Standard dissolution methods, such as mixing dry Compound 1
and dry Captisol.RTM. into water or adding Compound 1 to a prepared
solution of Captisol.RTM. and water did not result in complete
dissolution at the desired concentrations. Several different
concentrations of both Compound 1 and Captisol.RTM. were tested at
various pH levels. However, the following method for producing a
solution of Compound 1 in Captisol.RTM. resulted in complete
dissolution at the desired concentrations.
Materials: Captisol.RTM., Compound 1 and water
Method:
[0233] 1. Weigh the appropriate amount of Captisol.RTM. to give a
final concentration of 120 mg/ml. [0234] 2. Add 80% of the final
amount of water and mix for 10 minutes with a magnetic stirrer.
[0235] 3. Weigh Compound 1 to give a final concentration of 2.5
mg/ml, 2.0 mg/ml, 1.0 mg/ml, 0.5 mg/ml or 0.1 mg/ml. [0236] 4. Add
the peptide to the Captisol.RTM. solution. Mix for 1 hour. [0237]
5. Raise the pH to obtain clear solution (in the 2.0 mg/ml
formulation there might be a need to raise the pH slightly above
9). pH should be adjusted using HCl 1.0 N and NaOH 1.0 N. Mix for
10 minutes. [0238] 6. Correct the pH to the range of 7.5 to 8.5 if
needed (using either HCl or NaOH 1.0 N). [0239] 7. Add water to
final volume. [0240] 8. Filter the solution through a 0.2.mu.
cellulose acetate filter. [0241] 9. Record final pH. [0242] 10.
Dispense into aliquots and store at the proper temperature.
Example 3
Lyophilization of Compound 1 and Captisol.RTM. Solution
[0243] The current lyophilization process differs from other
lyophilization processes in that the percentage of solids in the
formulation is high (12%) whereas lyophilized products normally
contain between 5 and 10% solids.
Equipment
[0244] The freeze drier used was an Edwards lyophilizer Lyoflex
0.6. The equipment IQ/OQ was performed and checked for compliance
by quality assurance prior to the process development.
[0245] Solutions of Compound 1 and Captisol.RTM. at concentrations
of 0.5 mg/ml, 11.0 mg/ml and 2.5 mg/ml of Compound 1 were prepared.
The fill-volume was adjusted 1 ml (1.05 gr).
Main Process Steps:
1. Freezing
[0246] 2. Holding (at low temperature) 3. Drying under vacuum in
two stages: [0247] 3.1. Primary drying--shelf warming to an upper
hold temperature, controlling shelf temperature at the upper hold
level. [0248] 3.2. Secondary drying--Pressure reduction to a
minimal value at the upper hold shelf temperature.
Batches 1-3
[0249] Freezing--Freezing was from room temperature to -40.degree.
C. within 2 hours. Shelves were held at -40.degree. C. for 3 hours.
Drying--Drying was performed at 110 .mu.bar pressure. Shelf
temperature was increased to 20.degree. C. over 13 hours and held
at that temperature for additional 13 hours.
[0250] Total process time was 31 hours.
Results:
[0251] Water content results were:
Batch no. 1: 3.8%
Batch no. 2: 4.0% and
Batch no. 3: 4.9%
Batches 4 and 5
[0252] Since the water content results of the processes leading to
batches 1, 2 and 3 were higher then the desired value, it was
decided to add a secondary drying step at the same temperature and
at low pressure.
[0253] Drying--Drying was performed at 110 .mu.bar pressure. Shelf
temperature was increased to 20.degree. C. over 13 hours and held
at that temperature for additional 13 hours (Batch 4) or 8 hours
(Batch 5). Pressure was decreased to 10 .mu.bar for additional 5
hours.
[0254] Total process time was 36 hours.
Results:
[0255] Water content results were
Batch 4: Placebo: 3.0%,
[0256] 1 mg/ml: 3.9%.
Batch 5: Placebo: 4.1%
Conclusions
[0257] As shown, a satisfactory lyophilization process for Compound
1 with Captisol.RTM. was developed. Due to the high percentage of
solids and hence the condensed cake, the developed process is
longer then the currently available lyophilization cycles for
peptides and it exhibits an additional secondary drying stage.
Table 4 summarizes the developed process.
TABLE-US-00008 TABLE 4 Compound 1 (Peptide) with Step Captisol
.RTM. Loading 5.degree. C. Freezing 2 hours to -40.degree. C. Hold
at low temp. 3 hours to -40.degree. C. Primary Drying: Warm to
20.degree. C. 13 hours pressure 110 .mu.bar Hold at 20.degree. C.
13 hours pressure 110 .mu.bar Secondary drying: Hold at 20.degree.
C. 5 hours pressure 10 .mu.bar Storage at -20.degree. C. Process
time 36 hours
Example 4
Examination of the In-Vivo Biological Activity of the Lyophilized
Compound Solution (DP, 1 Mg/Vial, 12% Captisol.RTM.)
[0258] The biological activity was monitored by inhibition of IL-2
secretion from Compound 1 reference standard (RS) specific T-cells
following subcutaneous (s.c.) treatment with the lyophilized
compound solution, i.e. the drug product (DP), at two
concentrations. The results of the treatment are compared to those
of treating mice with Compound 1 (RS) in phosphate buffered saline
(PBS). The results are shown in the tables below and in FIG. 2.
Experimental Design:
TABLE-US-00009 [0259] 1. Immunization Day 0 (Compound 1 RS
emulsified with CFA, at all four footpads) 2. Treatment Day 0 (s.c.
at the back of the neck, in 200 .mu.l solution) 3. In-vitro
activation with: Day 10 a. Compound 1 RS at concentrations of 0;
0.5; 1; 2.5; 5; 10; 25; 50 and 100 .mu.g/ml b. a peptide with the
reverse order of amino acids of Compound 1 (negative control). c.
Con A (positive control). 4. Incubation of culture for 20 hrs at
37.degree. C. in a humidified 5% CO.sub.2 incubator. 5. IL-2
measurement by ELISA.
TABLE-US-00010 Table of experimental Groups: Immunization Group
with Treatment A 50 .mu.g 50 .mu.g Compd. 1 RS in PBS B Compound 1
RS 200 .mu.g Compd. 1 RS in PBS C 50 .mu.g DP(batch 2) D 200 .mu.g
DP (batch 2) F Placebo (12% captisol .RTM.)
IL-2 Secretion from Compound 1 (DP) Treated Mice Following In-Vitro
Activation with Compound 1 RS (pg/ml)
TABLE-US-00011 Treated with: Group A B Compd. 1 Compd. 1 C D F RS
RS DP DP Concentration of 12% captisol .RTM. 50 .mu.g/ % 200 .mu.g/
% 50 .mu.g/ % 200 .mu.g/ % Activator activator (.mu.g/ml) Ampulized
mouse inhib. mouse inhib. mouse inhib. mouse inhib. Con A 2.5 5,825
6,215 5,403 3,537 4,069 Compd. 1 RS 0 BQL BQL BQL BQL BQL Compd. 1
RS 0.5 11 9 10 8 BQL Compd. 1 RS 1 10 BQL BQL BQL BQL Compd. 1 RS
2.5 15 8 51 BQL NA 6 61 6 62 Compd. 1 RS 5 20 9 55 8 60 10 48 7 63
Compd. 1 RS 10 25 16 38 11 58 13 48 8 67 Compd. 1 RS 25 29 15 48 11
63 16 45 13 56 Compd. 1 RS 50 40 21 47 15 62 20 50 12 69 Compd. 1
RS 100 42 25 41 18 58 24 43 15 64 Average inhibition (%) 45.6 60.4
46.8 63.7 (at the range of 5-100 .mu.g/ml) BQL = Below Quantitation
Limit Rows 1-4 were not included in the curve NA = Not
Applicable
Example 5
Evaluation of Optimal Dose for Treatment
[0260] The following abbreviations are used in the following
description: [0261] CFA Complete Freund's adjuvant [0262] Con A
Concanavalin A [0263] DP Drug Product [0264] DS Drug Substance
[0265] EM-1 Enriched DCCM-1 Medium [0266] EM-3 Enriched RPMI-1640+
fetal calf serum medium [0267] FCS Fetal Calf Serum [0268]
IFN-.gamma. Interferon-gamma [0269] LN Lymph Node [0270] PBS
Phosphate Buffered Saline [0271] RS Reference Standard [0272] s.c.
Subcutaneous [0273] TB Trypan Blue [0274] TGF-.beta. Transforming
Growth Factor-beta [0275] WFI Water for Injection
Introduction
[0276] A group of 20 mice were immunized with 50 .mu.g/mouse of
Compound 1 RS. The immunized mice were allocated to five treatment
groups as follows: placebo, 25, 50, 100 and 200 .mu.g/mouse of
Compound 1 DP (subcutaneous administration). Ten days post
immunization and treatment, LN was extracted and single cell
suspension was prepared. The in-vitro secretion of IFN-.gamma. and
TGF-.beta. by the cultured cells in response to activation with
several concentrations of Compound 1 RS was then measured.
Experimental Design
TABLE-US-00012 [0277] 1. Immunization -Day 0 2. Treatment with
Compound 1 DP -Day 0 3. In-vitro activation of LN cells -Day 10
from treated mice 4. Collection of culture media -Day 12 (for
IFN-.gamma. determination) 5. Collection of culture media -Day 13
(for TGF-.beta. determination) 6. ELISA for IFN-.gamma. 7. ELISA
for TGF-.beta.
TABLE-US-00013 TABLE 7 Experimental Groups In-vitro activation Exp.
Treatment Compound 1 RS Group Article Mice/group Cells/well
concentration A1 Control 4 2.5 .times. 10.sup.6 Compound 1 RS 12% 5
.times. 10.sup.6 0-100 .mu.g/ml Captisol .RTM. A2 25 .mu.g/mouse 4
2.5 .times. 10.sup.6 5 .times. 10.sup.6 A3 50 .mu.g/mouse 4 2.5
.times. 10.sup.6 5 .times. 10.sup.6 A4 100 .mu.g/mouse 4 2.5
.times. 10.sup.6 5 .times. 10.sup.6 A5 200 .mu.g/mouse 4 2.5
.times. 10.sup.6 5 .times. 10.sup.6
Materials and Reagents
Animals
[0278] Mice: 20 female BALB/c mice, supplied by Harlan animals
breeding center, Rehovot. Age at immunization (week+days): 10
Average weight of mice included in the experiment: 19.01 gr.
Materials
General Reagents
[0279] 70% ethanol was prepared from 96% ethanol by diluting with
purified H.sub.2O.
Preparation of Compound 1 Solutions for Immunization
[0280] CFA-Compound 1 RS emulsion (500 .mu.g/ml, 50 .mu.g/mouse)
was prepared as follows: [0281] 1. 1.874 mg of Compound 1 was
dissolved in 1.87 ml of WFI to yield a solution of 1 mg/ml. [0282]
2. The solution was tested with a pH indicator strip and found to
have a pH of 5. [0283] 3. 1.5 ml of the solution were emulsified
with 1.5 ml CFA resulting in a final concentration of 500
.mu.g/ml.
Preparation of Solutions for Treatment
[0284] Treatment was by a s.c. injection of 200 .mu.l solution.
Preparation of 12% Captisol.RTM. Solution
[0285] 1.2 gr of Captisol.RTM. were dissolved in 10 ml of WFI to
yield a solution of 12% Captisol.RTM..
Experimental Procedure
Mice Weighing
[0286] Mice were weighed before immunization. Average mice weight:
19.01.+-.0.97 gr
Immunization
[0287] The immunization was performed by injecting 100 microliters
of the emulsion (50 microliters into each hind footpad).
Treatment
[0288] Following the immunization step the mice were treated by
s.c. injection of 200 .mu.l from the designated Compound 1 DP or
12% Captisol.RTM. treatment solutions, at the back of their
neck.
In-Vitro Culture
[0289] Mice were sacrificed by cervical dislocation. LN were
extracted from the hind legs and were transferred to a sterile
petri dish containing about 5 mL RPMI. The cells were extracted by
gentle squeezing of the tissue against a 200 micrometer mesh
stainless steel net. The cells were collected and centrifuged at
300 G for 10 minutes at RT.
[0290] Single cell suspensions were prepared from pooled LN of each
experimental group.
[0291] 2.5 and 5.0 million cells/ml/well suspensions were cultured
with Compound 1 RS (0-100 .mu.g/ml) in EM-1.
[0292] Secretion of IFN-.gamma. and TGF-.beta., as indication of
cellular response, were determined by ELISA of culture media (48
hrs for IFN-.gamma. and 72 hrs for TGF-.beta.).
TABLE-US-00014 TABLE 8 The in-vitro experimental groups In-vitro
activation Experimental Treatment Activation substance Group
Article Cells/well concentration A1-2.5 Control 2.5 .times.
10.sup.6 Compound 1 RS A1-5 12% 5 .times. 10.sup.6 0; 3.125; 6.25;
12.5; 50 and Captisol .RTM. 100 .mu.g/ml A2-2.5 DP 2.5 .times.
10.sup.6 Con A 2.5 .mu.g/ml A2-5 25 .mu.g/mouse 5 .times. 10.sup.6
A3-2.5 DP 2.5 .times. 10.sup.6 A3-5 50 .mu.g/mouse 5 .times.
10.sup.6 A4-2.5 DP 2.5 .times. 10.sup.6 A4-5 100 .mu.g/mouse 5
.times. 10.sup.6 A5-2.5 DP 2.5 .times. 10.sup.6 A5-5 200
.mu.g/mouse 5 .times. 10.sup.6
Preparation of Cell Suspensions
TABLE-US-00015 [0293] TABLE 9 Results of cell counting and
preparation of cell suspensions (10 .times. 10.sup.6/ml) EM-1 to
add (ml) Total for Average viable suspension Vol. Dilutn. Viable
Dead % Viable % Dead viable cells of Grp (ml) factor cells cells
cells cells cells (.times.10.sup.6) 10 .times. 10.sup.6 cells/ml A1
10 16 115 -- 100 -- 112 179.2 17.9 109 -- 100 -- A2 10 16 50 4 92.6
7.4 47.5 76 7.6 45 2 95.7 4.3 A3 10 16 80 4 95.2 4.8 80.5 128.8
12.8 81 5 94.2 5.8 A4 10 16 87 -- 100 -- 89 142 14.2 91 -- 100 --
A5 10 16 120 2 98.4 1.6 112.5 180 18 105 2 98.1 1.9
Preparation of Cell Suspensions (5.times.10.sup.6/ml)
[0294] The 10.times.10.sup.6 cells/ml suspensions were diluted 1:2
by adding 5 ml EM-1 to 5 ml cells suspension.
Incubation of LN Cells Cultures in 48 Wells Plates
[0295] 3 tissue culture plates were prepared. The following was
added to each plate.
Background Control (Cells Incubated with Culture Media) 0.5 ml of
cells suspension 0.5 ml of culture media (EM-1) System Positive
Control (Cells Stimulated with Con A) 0.5 ml of cells suspension
0.5 ml of Con A 5 .mu.g/ml in EM-1 (final conc. 2.5 .mu.g/well)
Cells Incubated with Compound 1 Activation Solutions (Samples) 0.5
ml of cells suspension 0.5 ml of Compound 1 RS 6.25-200 .mu.g/ml
(final conc. 3.125-100 .mu.g/ml/well)
Incubation of LN Cells Cultures in 96 Wells Plates
[0296] After the 48-wells plates were prepared, 96-wells plates
were prepared by applying 100 .mu.l from the cell suspension and
100 .mu.l from the activation solutions.
[0297] The culture plates were incubated at 37.degree. C. in a
humidified 5% CO.sub.2 incubator, for either 48 or 72 hrs.
Supernatants Collection
[0298] The cultured plates were centrifuged at 300 g for 10 minutes
at RT. Supernatants (850 .mu.l from each well) were transferred
either to mirror plates or to tubes. The supernatant was then
divided into working aliquots (two aliquots of 200 and one aliquot
of 450 .mu.l), in order to avoid repeated freeze/thawing of the
samples. Each tube was labeled with the following details: [0299]
1. Experimental code and time post incubation. [0300] 2. Group and
sample number [0301] 3. Activator and concentration. [0302] 4. Date
of sup collection
[0303] The supernatants were stored at -20.degree. C. until used
for ELISA.
Results
TABLE-US-00016 [0304] TABLE 10 Summary of Groups Experimental
Groups: Immunization Treatment Exp. Immunization Sub In-vitro
Groups dose group Article activation A 50 .mu.g/mouse A1 12%
Captisol .RTM. Compound 1 Placebo control RS A2 Compound 1
3.125-100 .mu.g/ml 25 .mu.g/M A3 Compound 1 50 .mu.g/M A4 Compound
1 100 .mu.g/M A5 Compound 1 200 .mu.g/M
TABLE-US-00017 TABLE 11-A Final cytokine concentrations Final
cytokine (pg/ml) (2.5 million cells/well) Compound 1 concentration
Placebo 50 .mu.g/M 100 .mu.g/M 200 .mu.g/M 3.125 .mu.g/ml 321.3
54.1 64.5 103.9 6.25 .mu.g/ml 238.6 81.8 116.1 126.1 12.5 .mu.g/ml
397.1 123.1 180.9 129.0 25 .mu./ml 655.5 215.1 262.8 240.3 50
.mu.g/ml 573.9 292.5 518.3 378.1 100 .mu.g/ml 926.0 531.8 582.7
524.1 Con A 322.6 356.2 337.4 BQL
TABLE-US-00018 TABLE 11-B Final cytokine concentrations Final
cytokine (pg/ml) (5 million cells/well) Compound 1 concentration
Placebo 25 .mu.g/M 50 .mu.g/M 100 .mu.g/M 200 .mu.g/M 3.125
.mu.g/ml 522.3 BQL 76.2 90.8 204.4 6.25 .mu.g/ml 634.8 BQL 109.2
157.8 244.1 12.5 .mu.g/ml 962.8 41.9 179.5 257.1 466.1 25 .mu./ml
967.4 70.0 277.9 421.7 660.5 50 .mu.g/ml 1338.8 104.2 373.4 739.7
922.5 100 .mu.g/ml 2010.2 185.2 547.0 995.5 1006.2 Con A 6839.8
2995.3 4837.0 10126.8 7722.8
[0305] The results are also presented in FIGS. 3-4.
Observations
IFN-.gamma. Secretion
[0306] 1. In the placebo group, a linear dose response upon
Compound 1 activation in-vitro was shown. This graph resembles the
graph obtained for the Ex-vivo model with the same immunization
dose (50 .mu.g/mouse) and culturing medium (EM-1). [0307] 2. There
was a dose response upon Compound 1 activation in vitro within all
the tested groups. [0308] 3. Significant inhibition of IFN-.gamma.
secretion was seen with all the doses used for treatment (an
average of 95% inhibition with treated dose of 25 .mu.g/mouse). A
reverse correlation between the dose served for treatment and %
inhibition can be found, mainly when 5.times.10.sup.6 cells/well
were used. When 2.5.times.10.sup.6 cells/well were used, treatment
of animals with 50 .mu.g/mouse gave better inhibition than 100 or
200 .mu.g. The point of 25 .mu.g is missing (lack of cells). [0309]
4. A better inhibition was seen when 5.times.10.sup.6 cells/well
were used instead of 2.5.times.10.sup.6 cells/well. [0310] 5. In
the linear range of the graphs, SD of % inhibition was low. [0311]
6. A technical problem with Con A is apparent when
2.5.times.10.sup.6 cells/well were used.
TGF-.beta. Secretion
[0311] [0312] 1. In the placebo group, no dose response upon in
vitro activation with compound 1 was seen. TGF-.beta. secreted
level was below the detection limit of the ELISA in all other
treatment groups.
Example 6
Optimizations of Freeze Drying Cycle with Compound 1 and
Captisol.RTM. for Injection (0, 0.5, 1.0 and 2.5 mg/vial)
Purpose
[0313] The purpose of this study was to optimize the freeze drying
cycle for Compound 1 with Captisol.RTM. for injection to improve
the shape of the lyophilization cake and avoid collapse and
cracking. Thus it was decided to improve and optimize the
lyophilization cycle. This cycle is transferred to the production
lyophilizers for the manufacturing of the phase I batches.
Process Optimization
[0314] Batches of peptide at concentrations of 0.5 mg/ml 11.0
mg/ml, 2.5 mg/ml and Placebo were prepared and several freeze
drying cycles were performed. The freeze drier used was an Edwards
lyophilizer Lyoflex 0.6.
[0315] Solubility, water content and cake appearance were tested.
According to the obtained results a new lyophilization cycle for
Compound 1 was selected. Due to the high percentage of solids (12%)
and hence the condensed cake, the new process is longer than the
lyophilization cycle in Example 3 and exhibits an additional
primary drying stage. Table 12 summarizes the differences between
the processes.
TABLE-US-00019 TABLE 12 Lyoph. cycle for New Lyoph. cycle for
Compound 1 and Compound 1 and Step Captisol .RTM. of Example 3
Captisol .RTM. Loading 5.degree. C. 5.degree. C. Freezing 2 hours
to -40.degree. C. 6 hours to -45.degree. C. Hold at low 3 hours to
-40.degree. C. 3 hours to -45.degree. C. temp. Primary Drying:
Stage I to 20.degree. C. to -20.degree. C. 13 hours pressure 110
.mu.bar 19 hours pressure 150 .mu.bar Stage II -- to 25.degree. C.
13 hours pressure 150 .mu.bar Hold at 20.degree. C. 13 hours
pressure 110 .mu.bar 8 hours pressure 150 .mu.bar (25.degree. C.)
Secondary drying: Hold at 20.degree. C. 5 hours pressure 10 .mu.bar
-- Storage at 5.degree. C. 5.degree. C. Process time 36 hours 49
hours
Example 7
Effect of Compound 1 (Administered in Captisol.RTM.) on Lupus
Symptoms in the SLE-Prone (NZBxNZW)F1 Female Mouse
[0316] Patients participating in clinical trials are to be treated
with Compound 1 using Captisol.RTM. (sulfobutyl ether
beta-cyclodextrin sodium) as the excipient. For this reason, it was
important to determine whether treatment of (NZBxNZW)F1 mice with
the formulation of Compound 1 given in Captisol.RTM. would have the
same beneficial effects on lupus symptoms as observed when this
strain of mice was treated with Compound 1 in PBS.
[0317] To this end, (NZBxNZW)F1 female mice (about 8 months old)
were divided into 3 groups that were treated subcutaneously once a
week for 10 weeks either with Captisol.RTM. alone (n=8) or with 25
or 50 .mu.g/mouse Compound 1 in Captisol.RTM. (n=9 and 10,
respectively). These doses were selected since prior studies
indicated that doses in this range were more effective in
ameliorating SLE symptoms than the higher doses tested (100 and 200
.mu.g/mouse). The same batch of drug substance was used in this
study and in the first Phase I clinical trial with Compound 1.
[0318] The mice were followed for anti-dsDNA antibodies and for
proteinuria. When the mice were sacrificed, the intensity of ICD
was determined in kidneys.
[0319] As can be seen in FIG. 5, no significant differences between
groups could be observed in the levels of dsDNA-specific antibodies
after 10 treatment injections.
[0320] Table 13 also shows that the beneficial effect of treatment
with Compound 1 could be observed starting from the 5.sup.th
injection and it was sustained up to the 10th injection. The mean
levels of proteinuria in the Captisol.RTM. control group were
consistently higher than in the Compound I-treated groups. Table 13
also shows that a reduction in the intensity of ICD was observed in
kidneys of both Compound 1 dose groups. There was an overall trend
showing that the lower dose (25 .mu.g/mouse) was more effective
than the higher dose (50 .mu.g/mouse) in reducing the clinical
symptoms of SLE in these mice.
TABLE-US-00020 TABLE 13 Clinical Symptoms of SLE in (NZBxNZW)F1
Mice Treated with 25 or 50 .mu.g/mouse Compound 1 (in Captisol
.RTM.) Mean Proteinuria .+-. SEM (g/L) ICD.sup.a Number of Weeks
Following Treatment Initiation (Mean .+-. Study Group 5 7 8 10 SEM)
Captisol .RTM. 1.81 .+-. 1.22 5.74 .+-. 3.13 4.5 .+-. 2.92 4.46
.+-. 2.93 2.29 .+-. 0.28 (n = 8) (n = 8) .sup. (n = 7).sup.b .sup.
(n = 7).sup.b (n = 7) Compound 1 0.75 .+-. 0.3 0.81 .+-. 0.3 1.09
.+-. 0.4 1.29 .+-. 0.3 1.90 .+-. 0.23 (50 .mu.g/mouse) (n = 10) (n
= 10) (n = 10) (n = 10) (n = 10) Compound 1 0.16 .+-. 0.05 1.26
.+-. 1.09 0.5 .+-. 0.31 0.56 .+-. 0.3 1.22.sup.c .+-. 0.32.sup. (25
.mu.g/mouse) (n = 9) (n = 9) (n = 9) (n = 9) (n = 9) .sup.aICD =
Immune Complex Deposits. ICD intensity scale: 0 = none; 1 =
moderate; 2 = severe; 3 = severe/extremely intense. .sup.bThe death
of one animal with a high level of proteinuria resulted in a lower
group mean. .sup.cp < 0.05 (compared to Captisol .RTM.-treated
control mice; Mann-Whitney).
[0321] FIG. 6 shows representative sections of one kidney from each
treatment group. The top row sections are from a
Captisol.RTM.-treated mouse, the mid-row sections are from a mouse
treated with 50 .mu.g/mouse Compound 1 and the bottom row sections
are from a mouse treated with 25 .mu.g/mouse Compound 1. It can be
seen that the intensity of immune complex deposits observed in
kidney sections of mice treated with Compound 1 (dissolved in
Captisol.RTM.) at either dose level was much lower than that
observed in the control group.
Example 8
Phase I Clinical Study
A Phase I, Multicenter, Randomised, Double-Blind, Placebo
Controlled, Single Dose, Four-Arm Study to Assess the Tolerability
and Safety of Compound 1 in Captisol.RTM. Subcutaneous Injection in
SLE Subjects.
[0322] This was the first clinical study with Compound 1 in
Captisol.RTM. in humans, conducted in France. Its main objective
was to evaluate tolerability and safety of Compound 1 in
Captisol.RTM., administered as a single sc injection to SLE
subjects. Its secondary objective was to evaluate immunological
responses following a single sc dose of Compound 1 in Captisol.RTM.
in these subjects.
[0323] Thirty-six (36) subjects participated in the study. To be
eligible for inclusion in the study, SLE patients must have
fulfilled at least four criteria used for the diagnosis of lupus by
the American College of Rheumatology. Patients must also have had
stable, mild/moderate disease and score less than or equal to 10 on
the SLE Disease Activity Index, SLEDAI.
[0324] Each patient received a single sc injection of reconstituted
Compound 1 for injection or its matching placebo (Captisol.RTM.)
according to the following group assignment: [0325] Group A:
Placebo (Captisol.RTM.) [0326] Group B: 0.5 mg Compound 1 in
Captisol.RTM. [0327] Group C: 1 mg Compound 1 in Captisol.RTM.
[0328] Group D: 2.5 mg Compound 1 in Captisol.RTM.
[0329] A standard battery of safety tests, including blood and
urine collection for laboratory tests, was performed at screening,
during the day of dosing, at 24 hours post-dose and at 2, 4 and 8
weeks following dosing. Prior to dosing, and on scheduled follow-up
visits, blood samples were withdrawn for SLE-related immunological
tests, anti-Compound 1 antibodies and PBL proliferation assay. The
following immunology tests were performed: [0330] Coomb's (direct
and indirect) [0331] C3, C4 and CH50 [0332] Total IgG, IgM and IgA
[0333] ANA, anti-dsDNA (Farr assay), anti-ssDNA [0334] Anti-ENA
(including anti-La, anti-Ro, anti-RNP, anti-Sm) [0335]
Anti-cardiolipin antibodies [0336] VDRL [0337] FTA antibodies
[0338] Rheumatoid factor
[0339] The safety and tolerability of Compound 1 in Captisol.RTM.
in the subject population was evaluated on the basis of the
following criteria: [0340] Occurrence of AEs, including SLE flare
[0341] Vital signs [0342] 12-lead ECG [0343] Changes in physical
examination [0344] Routine clinical laboratory tests [0345] SLEDAI
score [0346] Immunological test results
Phase Ia Clinical Study Details
[0347] Study Principal Investigators and Respective Study Sites:
Six (6) study centers in France: Prof. Jean Charles Piette (Hopital
La Pitie Salpetriere, Paris), Prof Oliver Meyer (Hopital Bichat,
Paris), Prof. Jean Revuz (Hopital Henri Mondor, Creteil), Prof.
Loic Guillevin (Hopital Avicenne, Bobigny), Prof. Eric Hachulla
(Hopital Claude Huriez, Lille Cedex), Prof. Xavier Mariette
(Hopital Bicetre, Kremlin Bicetre).
Compound 1 (in Captisol.RTM.), Placebo, Water for
Injection-Ampoules, Dose and Mode of Administration:
[0348] Vials of Compound 1 in Captisol.RTM. (120 mg/vial) were
injected subcutaneously as a single dose per subject in the
following dosages:
0.5 mg Compound 1/vial in Captisol.RTM., 1 mg Compound 1/vial in
Captisol.RTM. and 2.5 mg Compound 1/vial in Captisol.RTM..
[0349] Placebo for Compound 1: 120 mg Captisol.RTM./vial (identical
in appearance to vials of Compound 1 in Captisol.RTM.).
Methodology
[0350] This was a multi-center, randomized; double blind,
placebo-controlled, four-arm study, using a single subcutaneous
injection of Compound 1 or placebo. SLE patients were screened up
to 21 days prior to baseline procedures. Each eligible subject was
randomized to one of the 4 treatment groups: subcutaneous injection
of either 0.5, 1 or 2.5 mg Compound 1 or its matching placebo. All
subjects were admitted to the clinic on pre-dosing day. Each
subject received a single dose of one of the above listed
treatments. Subjects were discharged from the clinic 24 hours after
dosing. Subjects were further monitored at weeks 2, 4 and 8
following dosing. Blood samples (serum and whole blood) for safety
laboratory tests were withdrawn at Screening, Dosing Day
(pre-dose), Day 2 (post dose), at Weeks 2, 4 and 8 (Termination
visit). Blood samples for immunological tests were withdrawn at:
Screening, Dosing Day (pre-dose) and at Weeks 4 and 8. Peripheral
blood lymphocytes (PBL) proliferation was evaluated at Dosing Day
(pre-dose) and at Weeks 2, 4 and 8.
Number of Subjects (Total and for Each Treatment):
[0351] Thirty six (36) subjects were randomized into this study as
follows; 9 subjects into the 0.5 mg treatment group, 9 subjects
into 1 mg treatment group, 10 subjects into the 2.5 mg treatment
group, and 8 subjects into the placebo treatment group.
Diagnosis and Main Criteria for Inclusion:
[0352] Eligible subjects for this study were SLE patients who
fulfilled at least four diagnostic criteria of the American College
of Rheumatology (ACR). Their disease condition had to be stable,
mild to moderate with a score equal to or less than 10 on the SLE
disease activity index, year 2000 updated (SLEDAI 2K).
[0353] Excluded from participation were SLE patients who reported
unstable or severe asthma, stroke, acute myocardial infarction,
unstable angina, cerebral hemorrhage and pulmonary embolism during
the six months prior to study screening. SLE patients who had any
clinically significant or unstable medical or surgical conditions,
diabetes mellitus, liver disease (cirrhosis, active hepatitis,
portal hypertension, and/or ascites), clinically significant
hypertension, a medical history of any malignancy, dialysis, or
chronic obstructive pulmonary disease (COPD) were also excluded
from study participation.
[0354] Also excluded from study participation were SLE patients who
underwent plasmapheresis or were treated during the three months
prior to screening with one of the drugs listed below: prednisone
30 mg/day or greater (or an equivalent dose of another
corticosteroid), intravenous corticosteroids, intravenous
immunoglobulin G (IgG), oral anticoagulants and any cytotoxic
agents (e.g. azathioprine, chlorambucil, cyclophosphamide,
mycophenolate mofetil, methothrexate, tacrolimus.
[0355] In addition, SLE patients initiating treatment with
corticosteroids (more than .+-.10 mg/day prednisone, or an
equivalent dose of another corticosteroid) and/or anti-malarials,
during the last 3 months prior to screening were excluded from the
study.
[0356] While an effort was made to retain baseline SLE medical
treatments throughout the course of the study, investigators could
nevertheless change participant medical treatment at any time
during the study to maintain and optimize patient welfare.
Criteria for Evaluation
Safety:
[0357] The following safety parameters were assessed at Screening,
during the hospitalization and at follow-up visits including
Termination visit: vital signs (systolic blood pressure, diastolic
blood pressure, pulse, oxygen saturation, temperature and weight),
12-lead ECG, change in physical examination and clinical routine
laboratory safety tests. Adverse events were recorded at the Dosing
Day and at each visit thereafter.
Immunology:
[0358] SLE-related immunological tests were performed at Screening,
during the hospitalization and at follow-up visits including
Termination visit.
[0359] Drug-related immunological responses were followed by using
the PBL proliferation assay and anti-Compound 1 antibodies assay at
the Dosing Day and at follow-up visits including Termination
visit.
Disease Activity:
[0360] Disease activity assessment using the SLE disease activity
index score, year 2000 updated (SLEDAI 2K) was assessed at
Screening, during the hospitalization and at follow-up visits
including Termination visit.
Statistical Methods:
[0361] SAS.RTM. version 9.0 software was used to analyze and
present data collected during this study. No power calculation was
performed and no formal hypothesis testing was conducted for this
Phase Ia study.
Adverse Experiences
[0362] The incidence and the frequency of adverse experiences was
presented by System Organ Class and preferred terminology according
to MedDRA dictionary version 5.0. The data is tabulated by
treatment group.
Clinical Laboratory Data
[0363] Descriptive statistics of laboratory values including number
of observations, mean, standard deviation, minimum and maximum were
determined for Screening, Day 1 (pre dose), Day 2, Week 2, 4 and 8
are presented by treatment group. Changes from baseline to each
time point/visit are also presented for each visit by treatment
assignment. Percent of abnormal results (low and high, where
applicable) are presented on a parameter basis, by treatment group
and visit/time point. Shift analyses from baseline to 24-hours post
dose and from baseline to termination visit were performed.
Vital Signs
[0364] Descriptive statistics for vital signs including number of
observations, mean, standard deviation, median, minimum and maximum
values were determined for Screening, Day 1 (pre and post dose, and
at each time point) Day 2, Weeks 2, 4 and 8 are tabulated by the
assigned treatment. Changes from baseline to each time point/visit
is presented in by visit and treatment assignment.
Weight
[0365] Descriptive Statistics of Weight (kg) at baseline,
termination and change from baseline is presented by treatment
group.
ECG
[0366] Descriptive statistics of ECG parameters at baseline,
termination and changes from baseline are presented. Shift analysis
is presented as tables of shift from baseline to termination
between normal/abnormal or present/absent ECG parameters.
Potentially clinically significant (PCS) QTc (Bazett) measurements
were identified according to the predefined criteria. Tables of
shift analysis between PCS and non-PCS Absolute QTc (Bazett) and
incidence table of PCS change in QTc (Bazett) from baseline to any
visit are presented.
Physical Examination
[0367] Physical examination results are analyzed by incidence of
subjects with abnormal or normal findings for each body system at
Baseline and Termination visit. Shift analysis between normal to
abnormal and vice versa was also applied. When no change from
baseline occurred, it was defined as "other".
Compound 1 Related Immunological Tests
[0368] For immunological parameters, descriptive statistics,
including number of observations, mean, standard deviation, median,
minimum and maximum values were calculated and are presented by
treatment group and visit. Change from baseline to each follow-up
visit is also presented by treatment group. Where applicable,
number and percent of subjects with negative/positive results is
presented by treatment group and visit.
SLEDAI 2K
[0369] Descriptive statistics, including mean, standard deviation,
median, minimum and maximum values of SLEDAI 2K are presented.
Results of Phase Ia Clinical Study:
Subject Disposition and SLE Characteristics
[0370] Thirty six (36) study subjects entered and completed this
study per protocol. The majority of subjects (34) in all treatment
groups were female (94.4%) and Caucasian (30, 83.3%). The mean age
for all treatment groups was 35.6 years (range of means from 32 to
39 years). Most of the subjects (91.7%) had between 4 to 6 American
College of Rheumatology (ACR) diagnostic criteria and a mean group
SLEDAI 2K score ranged from 2.1 to 4.1.
Safety Results
[0371] There was no prominent difference between study drug
treatment groups and the placebo group in the incidence of AEs. The
most common AEs in all groups were headache, classified as mild or
moderate in nature and injection site reaction classified as mild
in nature. Dose response was not seen. No serious adverse event
(SAE) or AE classified as severe occurred during the study.
[0372] No clinically significant effect attributable to study drug
was seen for hematology, biochemistry or urinalysis values.
[0373] No clinically significant effect attributable to the study
drug was seen for vital signs parameters (systolic blood pressure,
diastolic blood pressure, pulse, oxygen saturation).
[0374] No clinically significant effect attributable to the study
drug was seen for temperature and weight.
[0375] No differences of clinical significance were seen between
Compound 1-treated groups and placebo for categorical ECG
measurements and digitized ECG parameters. No PCS QTc absolute
value and no QTc change from baseline >60 msec was recorded. A
similar number of subjects in Compound I-treated and placebo groups
had QTcB change from baseline between 30 and 60 msec.
[0376] No clinically significant effects of Compound 1 on physical
exam were noted.
Immunology Results
[0377] Evaluation of serum samples from all subjects indicated that
a single subcutaneous administration of Compound 1 at the dose
levels of 0.5, 1 and 2.5 mg/patient did not induce the development
of anti-Compound 1 specific antibodies. Seven subjects had a
response to Compound 1 above the cut-off. These elevated levels of
antibodies were already present prior to dosing. No increase in the
levels of antibodies was observed in the follow up period (two
months) of the study. The sera of these subjects were analyzed for
the isotype of the reactive antibodies. The response in two of the
subjects was associated with the IgM isotype and with the IgG
isotype in two others. None of the seven had specific IgE
antibodies.
[0378] The peripheral blood lymphocytes (PBL) assay showed that 50%
of the subjects (18) were classified as responders (SI>2) with
similar distribution in all treatment groups. The T cell response
was relatively low and no association between Compound 1 treatment
dose or concentration used in the assay and responder/non-responder
status could be detected, taking into consideration that only a
single SC dose of the study drug was administered. Also, no
indication of increased incidence, of responder status over time
was observed. The tetanus toxoid (TTX) assay that serves as a
safety control shows that the response to TTX was preserved
throughout the study period in all treatment groups indicating that
Compound 1 in Captisol.RTM. did not change the immunological
response to TTX recall antigen.
[0379] The immunological findings are the result of the
administration of only a single dose of the study drug Compound
1.
Disease Activity Results
[0380] No clinically significant effects of Compound 1 on the
SLEDAI score (change of .gtoreq.3, .ltoreq.12 points) were noted
during the study except for one subject in the 0.5 mg treatment
group for whom a change in the SLEDAI score of 2 to 10 points was
recorded between baseline and week 4 on the basis of an urinalysis
showing pyuria. This urinalysis finding was not confirmed by the
investigator as a lupus flare per protocol definition and was
resolved with no treatment change.
Conclusions
[0381] This Phase Ia study showed that a single subcutaneous
injected dose of Compound 1 of 0.5, 1 or 2.5 mg in 120 mg
Captisol.RTM. was safe and well tolerated and allows continuation
to a phase Ib multiple dose study.
Example 9
Phase Ib Clinical Study
A Phase I, Multicenter, Bi-National, Randomized, Double-Blind,
Four-Arm, Placebo Controlled, Multiple Dose Study to Assess the
Tolerability and Safety of Compound 1 in Captisol.RTM. Subcutaneous
Injections in SLE Subjects
[0382] This study is being performed in order to evaluate the
safety and tolerability of repeated Compound 1 sc administration to
SLE subjects. The study's secondary objective is to evaluate
immunological responses following repeated sc administration of
Compound 1 in Captisol.RTM. in SLE subjects.
[0383] Compound 1 is given in doses of 0.5, 1.0 or 2.5 mg in
Captisol.RTM.. The investigational product is administered every
other day (excluding weekends) for a total of 12 sc injections,
i.e. 3 doses a week for 4 weeks. Subjects are monitored on planned
visits scheduled at 2, 4, 8 and 12 weeks after start of dosing.
Safety and tolerability are evaluated using tests similar to those
described in the Phase Ia Clinical Study above.
Results
[0384] This Phase Ib study shows that multiple subcutaneous
injected doses of Compound 1 of 0.5, 1 or 2.5 mg in 120 mg
Captisol.RTM. are safe and well tolerated.
Sequence CWU 1
1
1119PRTArtificial SequenceA synthetic peptide of 19 amino acids
based on the complementarity-determining region 1 (CDR1) of the
human anti-dsDNA mAb denoted 16/6 Id 1Gly Tyr Tyr Trp Ser Trp Ile
Arg Gln Pro Pro Gly Lys Gly Glu Glu1 5 10 15Trp Ile Gly
* * * * *