CN100425236C - Use of cuminum cyminum extract and piperine for potentiaion of bioeffectacy of anti infectives - Google Patents
Use of cuminum cyminum extract and piperine for potentiaion of bioeffectacy of anti infectives Download PDFInfo
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Abstract
Description
本发明涉及化学治疗领域,特别涉及作为口服药物组合物的制剂,该药物组合物含有增加抗感染剂生物效力(bioefficacy)的生物增强剂(bioenhancer),由此所需该抗感染剂的给药剂量和/或给药次数减少,同时保持这种药物标准剂量的治疗效果不变。The present invention relates to the field of chemotherapeutics, and in particular to formulations as oral pharmaceutical compositions containing bioenhancers that increase the bioefficacy of anti-infective agents, whereby the administration of such anti-infective agents is required The dose and/or frequency of administration is reduced while maintaining the therapeutic effect of standard doses of this drug.
发明背景Background of the invention
多种人类疾病都具有其病原微生物的致病源,其包括细菌、病毒和真菌。这些病原微生物的存在可导致败血症、严重的上下呼吸道感染、CNS感染、脑膜炎、包括腹膜的腹膜内感染、生殖泌尿道感染、皮肤感染、和软组织感染以及多种其它感染,如系统性真菌病、包括皮肤真菌引起的感染的念珠菌病。近100年里,借助作为短期和长期治疗的无数具有不同化学和生物学特性的治疗剂,在与众多微生物家族引起的疾病的斗争中取得了显著的进步。这些抗生素包括氨基糖苷类,青霉素类,头孢菌素类,大环内酯类,糖肽类,氟喹诺酮类,四环素类,一线和二线抗TB药,抗麻风剂,抗病毒剂,多烯、三唑和咪唑抗真菌药,如嘧啶衍生物和甲氧苄氨嘧啶和磺胺甲基异噁唑(sulphamethoxizole)的组合物。Many human diseases have their causative origins from pathogenic microorganisms, including bacteria, viruses and fungi. The presence of these pathogenic organisms can lead to sepsis, severe upper and lower respiratory tract infections, CNS infections, meningitis, intraperitoneal infections including the peritoneum, genitourinary tract infections, skin infections, and soft tissue infections and a variety of other infections such as systemic mycoses , Candidiasis, including infections caused by skin fungi. During the past 100 years, remarkable progress has been made in the fight against diseases caused by numerous microbial families with the help of numerous therapeutic agents with different chemical and biological properties as short-term and long-term treatments. These antibiotics include aminoglycosides, penicillins, cephalosporins, macrolides, glycopeptides, fluoroquinolones, tetracyclines, first- and second-line anti-TB drugs, antileprosy agents, antiviral agents, polyenes, Triazole and imidazole antifungals, such as pyrimidine derivatives and combinations of trimethoprim and sulphamethoxazole.
虽然这些药剂对病原微生物和真菌是有效的,并因而能够用于与这些病原体存在有关的疾病状态的治疗,但不断增加的证据表明这种药剂的使用具有某些限制并引起了临床的关注。引起这些关注的一些因素有:(a)某些细菌和真菌的菌株对一种或多种已知抗感染药物的耐药性不断增加,并导致通常或标准的治疗剂量的有益作用降低,(b)为对抗这种情况所需的更高剂量导致不期望的毒副作用,及(c)治疗的高费用和患者的不顺应性(patient-non-compliance)。这种耐药性病原微生物的出现还归因于未控制的抗生素过度使用和使用不充分甚至剂量不充分、不规律的给药次数。延长和高剂量治疗也是严重关切的事情,特别在妊娠妇女、老年人和儿童中。Although these agents are effective against pathogenic microorganisms and fungi and thus can be used in the treatment of disease states associated with the presence of these pathogens, increasing evidence suggests that the use of such agents has certain limitations and raises clinical concerns. Some of the factors that have given rise to these concerns are: (a) the increasing resistance of certain strains of bacteria and fungi to one or more known anti-infective agents and resulting in a reduction in the beneficial effects of usual or standard therapeutic doses, ( b) higher doses required to combat this result in undesired toxic side effects, and (c) high cost of treatment and patient-non-compliance. The emergence of such drug-resistant pathogenic microorganisms is also attributed to the uncontrolled overuse of antibiotics and insufficient use or even insufficient doses and irregular frequency of administration. Prolonged and high-dose therapy is also a serious concern, especially in pregnant women, the elderly and children.
虽然使抗生素合理使用具体化的方法能够帮助减缓微生物耐药性的问题,但必须发现新的抗生素来对抗现已对大多数(如果不是全部)的现有抗生素具有耐药性的那些菌株。因此,鉴定新的抗菌素的需要不断增加,这可用来进一步补充医生对抗病原微生物的武器库。While methods that crystallize the rational use of antibiotics can help slow the problem of microbial resistance, new antibiotics must be discovered to combat those strains that are now resistant to most, if not all, existing antibiotics. Thus, there is an increasing need to identify new antimicrobials that can be used to further complement the physician's arsenal against pathogenic microorganisms.
在另一种方法中,两种抗感染剂以产生协同效果的方式组合在一起,即一种抗感染剂作为另一种抗感染剂的增效剂发挥作用。这种组合的例子为甲氧苄氨嘧啶-磺胺甲基异噁唑也称复方磺胺甲基异噁唑或TMP-SMX,其作为广谱抗菌素在1968年引入。甲氧苄氨嘧啶是专门开发作为磺胺甲基异噁唑的增效剂对抗菌具有协同作用并可延迟细菌耐药性的发展。甲氧苄氨嘧啶对磺胺甲基异噁唑的1∶5比例能够实现约1∶20的血浆峰值浓度,其对大多数敏感菌是理想的协同作用血清浓度比例(哥特曼(Gutman LT),Pediatr Infect Dis 1984;3:349-57,Olin BR,Facts andComparisons,Inc.1998;408b-409d,库克瑞尔(Cockerill FR),爱得森(Edson RS),Mayo Clin Proc 1991;66:1260-9)。In another approach, two anti-infective agents are combined in a synergistic manner, ie, one anti-infective acts as a synergistic agent of the other. An example of such a combination is trimethoprim-sulfamethoxazole also known as trimethoprim-sulfamethoxazole or TMP-SMX, which was introduced in 1968 as a broad-spectrum antibiotic. Trimethoprim was specifically developed as a synergist of sulfamethoxazole to have a synergistic effect on the antibacterial and delay the development of bacterial resistance. A 1:5 ratio of trimethoprim to sulfamethoxazole achieves a peak plasma concentration of about 1:20, which is an ideal synergistic serum concentration ratio for most susceptible bacteria (Gutman LT , Pediatr Infect Dis 1984; 3:349-57, Olin BR, Facts and Comparisons, Inc. 1998; 408b-409d, Cockerill FR, Edson RS, Mayo Clin Proc 1991; 66: 1260-9).
这种组合还可以是一种抗感染药剂与另一种化学试剂,该化学试剂本身不是抗感染剂但与所述抗感染剂组合后能够增强该抗感染剂的效果。这种组合的例子为阿莫西林+克拉维酸(clavulanic acid),更常称为力百汀(Augmentin)。阿莫西林为青霉素型抗生素。其对不同的细菌例如流感杆菌(H.influenzae)、淋病球菌(N.gonorrhea)、大肠杆菌、肺炎球菌、链球菌和葡萄球菌的某些菌株是有效的。化学上,所述药剂与青霉素和氨苄青霉素密切相关。在力百汀中将克拉维酸加入到阿莫西林中增强了此抗生素对多种其它细菌的抗菌效果,这些细菌通常对阿莫西林耐药。通过克拉维链球菌(Streptomyces clavuligerus)的发酵来产生克拉维酸。它是与青霉素结构相关的β-内酰胺,并通过阻断酶的活性位点而具有灭活众多β-内酰胺酶的作用。克拉维酸对临床重要的质粒介导的β-内酰胺酶具有特异抗性,该酶常负责将耐药性转移致青霉素和头孢菌素类。The combination may also be an anti-infective agent with another chemical agent which is not itself an anti-infective agent but which in combination with said anti-infective agent enhances the effect of the anti-infective agent. An example of such a combination is amoxicillin + clavulanic acid, more commonly known as Augmentin. Amoxicillin is a penicillin-type antibiotic. It is effective against certain strains of various bacteria such as H. influenzae, N. gonorrhea, Escherichia coli, pneumococcus, streptococcus and staphylococcus. Chemically, the agent is closely related to penicillin and ampicillin. The addition of clavulanic acid to amoxicillin in Libertin enhances the antimicrobial effect of this antibiotic against a variety of other bacteria that are often resistant to amoxicillin. Clavulanic acid is produced by fermentation of Streptomyces clavuligerus. It is a β-lactam structurally related to penicillin and has the effect of inactivating numerous β-lactamases by blocking the active site of the enzyme. Clavulanic acid confers specific resistance to the clinically important plasmid-mediated β-lactamases often responsible for the transfer of resistance to penicillins and cephalosporins.
与传统印度药物有关的最显著的特征之一并在Ayurveda中有充分描述的是组合物的使用,当一种药物与其它药物组合使用时,为这种药物提供了附加、协同和强化的效果。在Ayurveda中,有一些天然产物,其已作为许多制剂的必要成分使用,这些制剂用于多种疾病的治疗。其中最突出的是“Trikatu”,其含有黑胡椒,荜拔(long pepper)和干姜。详细和系统的研究表明胡椒的活性成分之一,即胡椒碱,是多种药物和营养制剂的强力的生物利用度和/或生物效力增强剂。在较早的专利中(印度专利第172684号;印度专利第172690号;印度专利第176433号;及美国专利第5439891号)已经公开了获得胡椒碱和包括抗TB抗生素在内的含胡椒碱制剂的方法,这些抗TB抗生素在活性药物剂量较低时具有增强的生物利用度/生物效力。One of the most notable features associated with traditional Indian medicine and well described in Ayurveda is the use of composition, which provides additive, synergistic and potentiating effects to a medicine when used in combination with other medicines . In Ayurveda there are some natural products which have been used as essential ingredients of many preparations used in the treatment of various diseases. The most prominent of these is "Trikatu", which contains black pepper, long pepper and dried ginger. Detailed and systematic studies have shown that one of the active constituents of pepper, piperine, is a potent bioavailability and/or biopotency enhancer of various pharmaceuticals and nutraceuticals. In earlier patents (Indian Patent No. 172684; Indian Patent No. 172690; Indian Patent No. 176433; and U.S. Patent No. 5439891) it has been disclosed to obtain piperine and piperine-containing preparations including anti-TB antibiotics approach, these anti-TB antibiotics have enhanced bioavailability/bioefficacy at lower active drug doses.
发明目的purpose of invention
本发明的主要目的是提供用于增加抗感染剂的生物效力的含有生物增强剂(bioenhancer)的口服药物组合物,并由此需要更低的剂量和/或降低此抗感染剂的给药剂量次数,同时保持此药物的标准剂量的治疗效果不变。The main object of the present invention is to provide an oral pharmaceutical composition containing a bioenhancer (bioenhancer) for increasing the biological effectiveness of an anti-infective agent, and thus requires a lower dose and/or reduces the administered dose of this anti-infective agent times while maintaining the therapeutic effect of the standard dose of this drug.
发明概述Summary of the invention
本发明涉及一种这样的组合,其中当与不同的抗感染药剂组合时,胡椒碱和其它的生物增强剂用作增效剂(potentiator),该抗感染药剂离体利用细菌、病毒和酵母,在体利用小鼠和豚鼠感染模型。本发明的目的是克服和避免现有技术中存在的问题。本发明产物的用途提供了与标准剂量的单独药物相比产生增强治疗作用的低剂量方案。The present invention relates to a combination in which piperine and other biopotentiators are used as potentiators when combined with different anti-infective agents using bacteria, viruses and yeasts ex vivo, In vivo infection models were used in mice and guinea pigs. The purpose of the present invention is to overcome and avoid the problems existing in the prior art. The use of the products of the present invention provides a low dosage regimen resulting in an enhanced therapeutic effect compared to standard dosages of the drug alone.
因此,本发明提供用于在抗微生物感染的抗感染剂剂量减少的情况下增强治疗作用的组合物,该组合物包括抗感染药剂和生物增强剂的混合物,该生物增强剂选自式1的胡椒碱和式2的3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4′-O-β-D-吡喃葡萄糖(3’,5-Dihydroxy flavone7-O-β-D-galacturonide-4’-O-β-D-glucopyranoside)或其混合物。Accordingly, the present invention provides a composition for enhancing the therapeutic effect in the case of a reduced dose of an anti-infective agent against a microbial infection, the composition comprising a mixture of an anti-infective agent and a biological enhancer selected from the group consisting of formula 1 Piperine and 3' of formula 2, 5-dihydroxyflavone 7-O-β-D-galacturin-4'-O-β-D-glucopyranose (3', 5-Dihydroxy flavone7-O-β -D-galacturonide-4'-O-β-D-glucopyranoside) or a mixture thereof.
式1Formula 1
式2Formula 2
在本发明的一个实施方案中,所述抗感染药剂选自包括半合成品的青霉素类,头孢菌素类,氨基糖甙类、糖肽类、氟喹诺酮类,大环内酯类,四环素类,一线和二线抗TB药,抗麻风药,噁唑烷酮类(oxazolidelones),抗真菌药,抗病毒剂及嘧啶衍生物-磺胺类组合物。In one embodiment of the present invention, the anti-infective agent is selected from penicillins including semi-synthetics, cephalosporins, aminoglycosides, glycopeptides, fluoroquinolones, macrolides, tetracyclines , first-line and second-line anti-TB drugs, anti-leprosy drugs, oxazolidelones (oxazolidelones), anti-fungal drugs, anti-viral agents and pyrimidine derivatives-sulfonamide compositions.
在本发明进一步的实施方案中,所述抗真菌剂选自多烯、咪唑和三唑。In a further embodiment of the invention said antifungal agent is selected from polyenes, imidazoles and triazoles.
在本发明的又一实施方案中,所述抗病毒剂选自齐多夫定(Zidovudines),碘苷(idouridine),阿昔洛韦(acyclovir)和利巴韦林(ribavarine)。In yet another embodiment of the present invention, the antiviral agent is selected from Zidovudines, idouridine, acyclovir and ribavirin.
在本发明的另一实施方案中,所述3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4’-O-β-D-吡喃葡萄糖以来自孜然芹(Cuminum cyminum)或亚部位(subfraction)的3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4’-O-β-D-吡喃葡萄糖的纯的形式或HPLC指纹图谱部位(fraction)的形式使用。In another embodiment of the present invention, the 3', 5-dihydroxyflavone 7-O-β-D-galacturon-4'-O-β-D-glucopyranose derived from cumin ( Cuminum cyminum) or subfraction of 3',5-dihydroxyflavone 7-O-β-D-galacturon-4'-O-β-D-glucopyranose in pure form or HPLC fingerprint It is used in the form of fraction.
在本发明的另一实施方案中,所述抗感染剂的浓度为没有所述生物增强剂时该抗感染剂浓度的1/2至1/8。In another embodiment of the present invention, the concentration of the anti-infective agent is 1/2 to 1/8 of the concentration of the anti-infective agent without the biological enhancer.
在本发明的又一实施方案中,所述组合物包括一种或多种药物可接受的添加剂和赋形剂。In yet another embodiment of the present invention, the composition includes one or more pharmaceutically acceptable additives and excipients.
在本发明的另一实施方案中,所述添加剂/赋形剂选自包括蛋白、碳水化合物、糖、滑石、硬脂酸镁、纤维素、碳酸钙、淀粉-凝胶糊的营养剂,和/或药物可接受的载体,稀释剂和溶剂。In another embodiment of the invention, said additive/excipient is selected from nutritional agents comprising protein, carbohydrates, sugar, talc, magnesium stearate, cellulose, calcium carbonate, starch-gel paste, and /or pharmaceutically acceptable carriers, diluents and solvents.
在本发明的另一实施方案中,所述组合物为口服给药的形式。In another embodiment of the present invention, said composition is in the form of oral administration.
在本发明的又一实施方案中,所述抗感染剂与所述生物增强剂的比例为1∶1至1∶5。In yet another embodiment of the present invention, the ratio of the anti-infective agent to the biological enhancer is 1:1 to 1:5.
在本发明的再一实施方案中,所述添加剂对所述组合物的抗感染特性不发挥作用。In yet another embodiment of the invention, said additive does not contribute to the anti-infective properties of said composition.
本发明还提供制备在所述抗微生物感染的抗感染剂剂量减少的情况下用于增强治疗作用的组合物的方法,所述组合物包括抗感染药剂与生物增强剂的混合物,该生物增强剂选自式1的胡椒碱和式2的3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4’-O-β-D-吡喃葡萄糖和其混合物,所述的方法包括物理掺和技术。The present invention also provides a method for preparing a composition for enhancing therapeutic effect in the case of a reduced dose of the anti-infective agent against microbial infection, said composition comprising a mixture of an anti-infective agent and a biological enhancer, the biological enhancer Piperine selected from formula 1 and 3', 5-dihydroxyflavone 7-O-β-D-galacturon-4'-O-β-D-glucopyranose and mixtures thereof of formula 2, the Methods include physical blending techniques.
式1Formula 1
式2Formula 2
在本发明的一个实施方案中,所述物理掺和技术选自透析、分子筛和膜法。In one embodiment of the invention, said physical incorporation technique is selected from dialysis, molecular sieves and membrane methods.
在本发明的另一实施方案中,所述生物增强剂的制备方法包括使用水、醇、水与醇组合、碳氢化合物、酮和醚。In another embodiment of the present invention, the method of preparation of the bioenhancer comprises the use of water, alcohols, combinations of water and alcohols, hydrocarbons, ketones and ethers.
在本发明的一个实施方案中,所述抗感染药剂选自包括半合成品的青霉素类,头孢菌素类,氨基糖甙类、糖肽类、氟喹诺酮类,大环内酯类,四环素类,一线和二线抗TB药,抗麻风药,噁唑烷酮类,抗真菌药,抗病毒剂及嘧啶衍生物-磺胺类组合物。In one embodiment of the present invention, the anti-infective agent is selected from penicillins including semi-synthetics, cephalosporins, aminoglycosides, glycopeptides, fluoroquinolones, macrolides, tetracyclines , first-line and second-line anti-TB drugs, anti-leprosy drugs, oxazolidinones, anti-fungal drugs, anti-viral agents and pyrimidine derivatives-sulfonamide compositions.
在本发明的另一实施方案中,所述抗真菌剂选自多烯、咪唑和三唑。In another embodiment of the present invention, the antifungal agent is selected from polyenes, imidazoles and triazoles.
在本发明的又一实施方案中,所述抗病毒剂选自齐多夫定,碘苷,阿昔洛韦和利巴韦林。In yet another embodiment of the present invention, the antiviral agent is selected from the group consisting of zidovudine, iodinidine, acyclovir and ribavirin.
在本发明的另一实施方案中,所述3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4’-O-β-D-吡喃葡萄糖以来自孜然芹或亚部位的3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4’-O-β-D-吡喃葡萄糖的纯的形式或HPLC指纹图谱部位的形式使用。In another embodiment of the present invention, the 3', 5-dihydroxyflavone 7-O-β-D-galacturon-4'-O-β-D-glucopyranose is derived from cumin or The subsite 3',5-dihydroxyflavone 7-O-β-D-galacturon-4'-O-β-D-glucopyranose was used in pure form or in the form of the HPLC fingerprint site.
在本发明的另一实施方案中,所述抗感染剂的浓度为没有所述生物增强剂时该抗感染剂浓度的1/2至1/8。In another embodiment of the present invention, the concentration of the anti-infective agent is 1/2 to 1/8 of the concentration of the anti-infective agent without the biological enhancer.
在本发明的又一实施方案中,所述组合物包括一种或多种药物可接受的添加剂和赋形剂。In yet another embodiment of the present invention, the composition includes one or more pharmaceutically acceptable additives and excipients.
在本发明的另一实施方案中,所述添加剂/赋形剂选自包括蛋白、碳水化合物、糖、滑石、硬脂酸镁、纤维素、碳酸钙、淀粉-凝胶糊的营养剂,和/或药物可接受的载体,稀释剂和溶剂。In another embodiment of the invention, said additive/excipient is selected from nutritional agents comprising protein, carbohydrates, sugar, talc, magnesium stearate, cellulose, calcium carbonate, starch-gel paste, and /or pharmaceutically acceptable carriers, diluents and solvents.
在本发明的另一实施方案中,所述组合物为口服给药的形式。In another embodiment of the present invention, said composition is in the form of oral administration.
在本发明的又一实施方案中,所述抗感染剂与所述生物增强剂的比例为1∶1至1∶5。In yet another embodiment of the present invention, the ratio of the anti-infective agent to the biological enhancer is 1:1 to 1:5.
在本发明的再一实施方案中,所述添加剂对所述组合物的抗感染特性不发挥作用。In yet another embodiment of the invention, said additive does not contribute to the anti-infective properties of said composition.
附图的简要说明Brief description of the drawings
图1所示为根据棋盘(checker board)法的本发明的抗微生物组合物。Figure 1 shows the antimicrobial composition of the present invention according to the checker board method.
图2所示为小鼠体内感染模型中利福平(rifampicin)单独使用以及与胡椒碱组合使用的效果。Figure 2 shows the effect of rifampicin alone and in combination with piperine in an in vivo infection model in mice.
图3所示为小鼠体内感染模型中利福平单独使用以及与式2的3’,5-二羟基黄酮7-O-β-D-半乳糖醛-4’-O-β-D-吡喃葡萄糖组合使用的效果。Figure 3 shows the use of rifampicin alone and in combination with 3', 5-dihydroxyflavone 7-O-β-D-galacturon-4'-O-β-D- Effects of combined use of glucopyranose.
发明的详细描述Detailed description of the invention
生物效力/生物利用度Biopotency/Bioavailability
来自发明人实验室的研究使得“生物增强剂”概念化,其中该试剂本身并不是治疗实体,但与活性药物组合可使所述药物的药理学作用的增强。已发现这种制剂可增加一些药物的生物利用度/生物效力,甚至当这些制剂中的药物剂量较低的时候。已经对这类药物获得了证据,这些药物(a)生物利用度和/和效力较差,(b)需要长期的治疗,和(c)毒性较高且价格昂贵。例如,印度专利第172690号,第176433号和美国专利第5744161号公开了这类技术。本发明人实验室的进一步研究证明这种生物增强剂通过以下序号(a)至(g)的多种机制不仅能增加多种治疗试剂的生物利用度,而且还能增强生物效力。从而对这些参与降低药物细胞浓度的因素和策略有新的理解,该降低的浓度通常不能达到治疗水平,而且该治疗策略使得甚至能在与标准的高剂量相比更低的浓度下,使这些活性药物的生物利用度和/或生物效力增加。这些因素中的一些为:Research from the inventor's laboratory led to the conceptualization of a "bioenhancer", an agent that is not itself a therapeutic entity, but that, in combination with an active drug, results in an enhancement of the pharmacological action of said drug. Such formulations have been found to increase the bioavailability/bioefficacy of some drugs even when the dose of drug in these formulations is low. Evidence has been obtained for a class of drugs that are (a) poorly bioavailable and/and efficacious, (b) require long-term treatment, and (c) are highly toxic and expensive. For example, Indian Patent No. 172690, No. 176433 and US Patent No. 5744161 disclose such techniques. Further research in the inventor's laboratory proves that this bioenhancer can not only increase the bioavailability of various therapeutic agents through various mechanisms of the following serial numbers (a) to (g), but also enhance the bioefficacy. This leads to a new understanding of the factors and strategies involved in reducing the cellular concentrations of drugs that usually do not reach therapeutic levels, and that the therapeutic strategy enables these drugs to be administered even at lower concentrations compared to standard high doses. The bioavailability and/or biopotency of the active drug is increased. Some of these factors are:
(a)除抑制病原体和异常组织的抗药作用外,还增加所述活性药物对所述病原体的通透性或进入,甚至在该病原体成为持续存在物(persistor)情况下。(a) In addition to inhibiting the drug resistance of pathogens and abnormal tissues, increasing the permeability or entry of said active drug to said pathogens, even when the pathogens become persisters.
(b)化学抗性是药物治疗中的主要问题。新生的和获得性耐药性的临床现象的机制可来自细胞杀伤途径中任何步骤的变化。这些包括药物转输、药物代谢、药物靶点、细胞修复机制和细胞识别有害毒素或病原体的能力。药物细胞积累减少的通常机制是P-糖蛋白(P-gp)的表达增加,一种从这些细胞中有效去除药物的膜转输剂。另一限制因素为细胞色素P450(CYP 450)依赖蛋白的高活性。已经证明这些P-gp和CYP 450蛋白能够调节大多数药物的口服生物利用度。P-gp被认为与MDR有关,该MDR是由该蛋白在肿瘤中和药物治疗后的表达水平引起的。(b) Chemoresistance is a major problem in drug therapy. Mechanisms for the clinical manifestations of de novo and acquired resistance can arise from changes in any step in the cell-killing pathway. These include drug delivery, drug metabolism, drug targets, cellular repair mechanisms and the ability of cells to recognize harmful toxins or pathogens. The usual mechanism for decreased cellular accumulation of drugs is increased expression of P-glycoprotein (P-gp), a membrane transport agent that effectively removes drugs from these cells. Another limiting factor is the high activity of cytochrome P450 (CYP 450)-dependent proteins. These P-gp and CYP 450 proteins have been shown to regulate the oral bioavailability of most drugs. P-gp is thought to be involved in MDR, which is caused by the expression level of this protein in tumors and after drug treatment.
(c)改变信号处理过程来保证药物到所述病原体的可达性上升。不断积累的大量证据表明,钙信号途径在一些药物的治疗活性中发挥主要作用,其通过P-gp非依赖途径外流(维尔博等(Vilpo et al),Haematologica2000:85:806-813)。另一方面,cAMP介导的信号途径与膜流动性的改变有关(福瑞德蓝德等(Friedlander G et al),Biochimica et Biophysica Acta1990;1022:1-7)。(c) Altering signal processing to ensure increased accessibility of the drug to the pathogen. A growing body of evidence suggests that calcium signaling pathways play a major role in the therapeutic activity of some drugs, with their efflux through P-gp-independent pathways (Vilpo et al, Haematologica 2000:85:806-813). On the other hand, the cAMP-mediated signaling pathway is associated with changes in membrane fluidity (Friedlander G et al, Biochimica et Biophysica Acta 1990; 1022: 1-7).
(d)通过NO产生的免疫干预,CMI和/或体液免疫增强,对Th1/Th2平衡产生有利的影响。(d) Immune intervention through NO production, CMI and/or enhancement of humoral immunity, favorably affects Th1/Th2 balance.
(e)如蛋白、DNA、RNA等的特异受体的致敏作用,由此加强和延长导致对病原体和疾病的增强的抗体活性的作用。关于这些机制,已经获得了充分的实验证据。例如,已证明胡椒碱能够较深地插入细胞膜的磷脂中(雷等(Ray et al),Ind.JBiochem.Biophys 1999;36:248-251),调节所述膜的流动性,其可改变膜结合转运蛋白的活性。总通透性的改变可影响(i)特异的离子转运通道,和(ii)还导致亲脂性溶质沿旁细胞途径大量运动。在一些多烯抗生素作用中也观察到这种膜的改变(米尔豪德等(Milhaud J et al),Biochimica et Biophysica Acta,1988;943:315-325)。然而,由胡椒碱引起的这种膜流动性的改变,如已阐述的,是短期的,完全可逆转的但大于任何有选择性的物质。如果不是这样,在抗TB药物制剂剂量减少的II期和III期临床试验中严重的副作用和毒性会自我显现,其中每天给予10mg的胡椒碱共6个月,对应地给予不含胡椒碱的标准剂量的抗TB药物。在全世界含有胡椒碱的黑胡椒几乎是食物的一部分。每人消耗的胡椒平均量换算成的胡椒碱含量远高于本发明制剂中使用的量。(e) Sensitization of specific receptors such as proteins, DNA, RNA, etc., thereby intensifying and prolonging the effects leading to enhanced antibody activity against pathogens and diseases. Regarding these mechanisms, sufficient experimental evidence has been obtained. For example, piperine has been shown to be able to intercalate deeply into the phospholipids of cell membranes (Ray et al., Ind. J Biochem. Biophys 1999; 36:248-251), regulating the fluidity of said membranes, which can alter the Binding transporter activity. Alterations in total permeability can affect (i) specific ion transport channels, and (ii) also cause substantial movement of lipophilic solutes along paracellular pathways. This membrane alteration has also been observed in the action of some polyene antibiotics (Milhaud J et al, Biochimica et Biophysica Acta, 1988; 943:315-325). However, this change in membrane fluidity induced by piperine, as already stated, is short term, fully reversible but greater than that of any selective substance. If not, severe side effects and toxicity manifested themselves in phase II and III clinical trials of reduced doses of anti-TB pharmaceutical preparations, in which 10 mg of piperine was given daily for 6 months, corresponding to standard piperine-free Dosage of anti-TB drugs. Black pepper containing piperine is almost a part of food all over the world. The average amount of pepper consumed per person translates into a much higher piperine content than that used in the formulation of the present invention.
(f)增强药物作用的机制并由此增加其在低剂量下的效力,例如RNA聚合酶转录的抑制导致低于标准剂量一半的利福平的作用增强。(f) Mechanisms for enhancing drug action and thereby increasing its potency at low doses, eg inhibition of RNA polymerase transcription leads to enhanced action of rifampicin at less than half the standard dose.
(g)增加药物的吸收和/或抑制药物的生物转化,由此增加药物的生物利用度。(g) increasing the absorption of the drug and/or inhibiting the biotransformation of the drug, thereby increasing the bioavailability of the drug.
本发明的产物是基于新机制的通过协同和附加效果发挥作用的药物实体,作为上述揭示的机制中的一种和多种的结果,使得所述制剂中的药物更加具有生物效力,并由此增加靶细胞对抗感染剂的敏感性。The products of the present invention are drug entities acting through synergistic and additive effects based on novel mechanisms, as a result of one or more of the mechanisms disclosed above, making the drug in the formulation more biologically effective and thus Increases the sensitivity of target cells to anti-infective agents.
含生物增强剂的制剂的描述Description of formulations containing bioenhancers
本发明的“药物”指具有影响生物体病理生理学的能力,并用于疾病的预防和治疗的化学实体(Chemical entity)。药物包括多种化合物类别但不限于氨基糖甙类,青霉素类,头孢菌素类和其它的β内酰胺试剂,大环内酯类,糖肽类,氟喹诺酮类,四环素类,一线和二线抗TB药,抗麻风药,抗病毒剂,多烯,三唑和咪唑,及如嘧啶类、磺胺甲基异噁唑(sulphamethoxazole)的组合物。药物可以是原药、活化的和代谢的形式,包括带电、不带电、亲水性的、疏水性的或两性离子物质,其通过简单扩散、依赖和不依赖能量需求的载体介导的转运、经离子和/或电压门控通道进入。"Drug" in the present invention refers to a chemical entity (Chemical entity) that has the ability to affect the pathophysiology of an organism and is used for the prevention and treatment of diseases. Drugs include but are not limited to aminoglycosides, penicillins, cephalosporins and other β-lactam agents, macrolides, glycopeptides, fluoroquinolones, tetracyclines, first-line and second-line antibiotics TB drugs, anti-leprosy drugs, antiviral agents, polyenes, triazoles and imidazoles, and combinations such as pyrimidines, sulphamethoxazole. Drugs can be in native, activated and metabolized forms, including charged, uncharged, hydrophilic, hydrophobic, or zwitterionic species, which are transported by simple diffusion, carrier-mediated transport dependent and independent of energy requirements, Entry via ion- and/or voltage-gated channels.
所述“生物增强剂”指胡椒碱(式1)或其它这种分子,作为化学实体的特征化部位(fraction)和/或提取物。获得高于98%纯的化学表征形式的胡椒碱的方法如印度专利第172689、172690、176433号、美国专利第5439891号以及共同未决的美国专利申请第60/306917/2001所公开的。制备来自孜然芹的特征化部位(包括HPLC谱)和纯的化学特征分子(图2)的方法已在共同未决的专利申请第NF 515/2001号中公开。这两种生物增强剂与药物的比例对于所述部位可从1%至50%变化,对于纯化的分子可从0.1%至30%变化,以获得期望的抗感染剂的MIC值的降低。所述药物和所述生物增强剂的比例和/或在组合生物增强剂中的比例由足以产生增强治疗效果的剂量来控制,该治疗效果通过所述制剂的MIC来检测,且所述剂量低于单独使用所述药物时的剂量。药物可接受的载体通常是加入后能使各成分实现良好掺和的惰性松散试剂,并可以是固体或液体。在此方法中使用的标准药物组合物的惰性部分也是本发明的组成部分。The "bioenhancer" refers to piperine (Formula 1) or other such molecules, as characterized fractions and/or extracts of chemical entities. Methods to obtain piperine in a chemically characterized form that is more than 98% pure are disclosed in Indian Patent Nos. 172689, 172690, 176433, US Patent No. 5439891 and co-pending US Patent Application No. 60/306917/2001. The method for preparing characterized fractions (including HPLC profiles) and pure chemically characterized molecules (Figure 2) from cumin has been disclosed in co-pending patent application No. NF 515/2001. The ratio of these two bioenhancers to drug can vary from 1% to 50% for the site and from 0.1% to 30% for the purified molecule to obtain the desired reduction in MIC values of the anti-infective agent. The ratio of the drug and the bioenhancer and/or the ratio of the combined bioenhancer is controlled by a dose sufficient to produce an enhanced therapeutic effect as measured by the MIC of the formulation, and the dose is low Dosage when the drug is used alone. Pharmaceutically acceptable carriers are usually inert bulky agents added to enable good incorporation of the ingredients and can be solid or liquid. Inert parts of standard pharmaceutical compositions used in this method are also part of the invention.
研究设计Research design
棋盘法:Chessboard method:
这是离体评价抗菌素组合物的常用方法。所述“棋盘”指由被检测的两种药物的多种稀释形成的(小管或微滴定板小孔的)图案(EliopoulosGM,Moellering RC.抗微生物组合(Antimicrobila Combinations).见:实验室医学中的抗体(Antibiotics in Laboratory Medicine):美国:Williams&Wilkins)。在本发明的研究中,所述棋盘由纵列与横行构成,每一列中每个小管(或小孔)含有相同剂量的标准药物(抗菌素/抗真菌/抗TB/抗病毒药),该标准剂量药物沿x-轴稀释,并且每一行中每个小管(或小孔)含有相同剂量的生物增强剂,该生物增强剂沿y-轴稀释(图3)。结果是,所述棋盘中每一格(其表示一个小管/小孔或板)含有唯一的所述标准药物和生物增强剂的组合。本发明研究中的标准药物的浓度范围是64μg/ml-0.03μg/ml,而所检测的生物增强剂的范围是500μg/ml-0.2μg/ml。可在液体或半固体(琼脂)的介质中实施此棋盘技术。This is a common method for evaluating antibiotic compositions in vitro. The "checkerboard" refers to the pattern (of vials or wells of a microtiter plate) formed by the multiple dilutions of the two drugs being tested (Eliopoulos GM, Moellering RC. Antimicrobila Combinations). See: In Laboratory Medicine Antibiotics in Laboratory Medicine (Antibiotics in Laboratory Medicine): United States: Williams&Wilkins). In the research of the present invention, the checkerboard is composed of columns and rows, and each small tube (or small hole) in each column contains the same dose of standard drugs (antibiotics/antifungal/anti-TB/antiviral drugs). The dose of drug is diluted along the x-axis, and each vial (or well) in each row contains the same dose of bioenhancer diluted along the y-axis (Figure 3). As a result, each grid of the checkerboard (which represents a vial/well or plate) contained a unique combination of the standard drug and bioenhancer. The concentration range of the standard drug in the present study was 64 μg/ml-0.03 μg/ml, while the range of the bioenhancer tested was 500 μg/ml-0.2 μg/ml. This checkerboard technique can be performed in liquid or semi-solid (agar) media.
琼脂方法:Agar method:
在此方法中,加压处理所述琼脂(Mueller Hinton琼脂,Middlebrook7H10琼脂)并冷却至50℃-55℃。将所述标准药物与所述生物增强剂的组合物加入到所述琼脂中。在适合的溶剂中制备每一种标准药物与所述生物增强剂的系列的2倍稀释液。为保持琼脂和药物所期望的浓度,并避免溶剂的作用,加入到琼脂中的溶剂的量(含标准药物和生物增强剂)控制在较小的量(即≤总体积的5%)。在对琼脂板灌胶并晾干后,利用设计用来输送标准接种物(约104CFU/点)的复制设备将欲检测的细菌涂敷在琼脂的表面。将所述板在37℃培养24小时(结核分枝杆菌为3周)。In this method, the agar (Mueller Hinton agar, Middlebrook 7H10 agar) was pressure treated and cooled to 50°C-55°C. The combination of the standard drug and the bioenhancer was added to the agar. Serial 2-fold dilutions of each standard drug and the bioenhancer were prepared in the appropriate solvent. In order to maintain the desired concentration of agar and drug and avoid the effect of solvent, the amount of solvent (containing standard drug and bioenhancer) added to the agar is controlled in a small amount (ie ≤ 5% of the total volume). After the agar plates are primed and allowed to dry, the bacteria to be tested are spread on the surface of the agar using a replicating device designed to deliver a standard inoculum (approximately 10 4 CFU/spot). The plates were incubated at 37°C for 24 hours (3 weeks for M. tuberculosis).
液体培养方法:Liquid culture method:
也可用液体培养基在微滴定板中进行上述棋盘法分析。此方法也可用于研究抗细菌/抗真菌/抗病毒药物与生物增强剂的组合物。The checkerboard assay described above can also be performed in microtiter plates using liquid culture medium. This method can also be used to study the composition of antibacterial/antifungal/antiviral drugs and bioenhancers.
生物增强剂的抑制作用Inhibition by bioenhancers
在500μg/ml-0.2μg/ml的浓度范围对所有生物增强剂自身的抑制作用(如果存在)进行评价(表1,2和3)。All bioenhancers were evaluated for their own inhibitory effect, if present, over a concentration range of 500 μg/ml-0.2 μg/ml (Tables 1, 2 and 3).
表1:胡椒碱对微生物的作用Table 1: Effects of piperine on microorganisms
甲氧西林耐药性金黄色葡萄球菌Methicillin-resistant Staphylococcus aureus
++++无抑制,+++20%抑制,++50%抑制++++ No suppression, +++20% suppression, ++50% suppression
表2:孜然芹部位(fraction)对微生物的作用Table 2: Effects of cumin fractions on microorganisms
甲氧西林耐药性金黄色葡萄球菌Methicillin-resistant Staphylococcus aureus
++++无抑制,+++20%抑制,++50%抑制++++ No suppression, +++20% suppression, ++50% suppression
表3:孜然芹纯分子对微生物的作用Table 3: Effects of pure molecules of cumin on microorganisms
甲氧西林耐药性金黄色葡萄球菌Methicillin-resistant Staphylococcus aureus
++++无抑制,+++20%抑制,++50%抑制++++ No suppression, +++20% suppression, ++50% suppression
实施例:Example:
以下的实施例旨在说明一些优选的实施方案,而不能解释为对本发明范围的限制。本领域所属技术人员可设计出更多的形式,其也是本发明的一部分。The following examples are intended to illustrate some preferred embodiments and are not to be construed as limiting the scope of the invention. Those skilled in the art can devise more forms, which are also part of the present invention.
实施例1无色、无刺激性99%纯的胡椒碱的制备The preparation of embodiment 1 colorless, non-irritating 99% pure piperine
根据印度专利第1726891号和第172690号以及美国专利第5439891号和美国申请第60/306917/2001号所公开的方法来进行,其在此引用作为本发明的参考。It was performed according to the methods disclosed in Indian Patent Nos. 1726891 and 172690 and US Patent No. 5439891 and US Application No. 60/306917/2001, which are incorporated herein by reference.
实施例2当与胡椒碱和孜然芹部位(fraction)联合时利福平抗结核分枝杆菌、鸟分枝杆菌和胞内分枝杆菌的MIC的降低Example 2 Reduction of the MIC of Rifampicin Against Mycobacterium tuberculosis, Mycobacterium avium and Mycobacterium intracellulare when combined with piperine and cumin fractions
利用本研究设计中所述的方法,对分枝杆菌类分析了利福平单独使用及与胡椒碱联合时的最小抑制浓度(MIC)。The minimum inhibitory concentration (MIC) of rifampicin alone and in combination with piperine was analyzed for mycobacteria using the methods described in the study design.
观察到与胡椒碱和孜然芹部位联合时利福平的MIC降低为1/2(表4a,4b)。A 1/2 reduction in the MIC of rifampicin was observed in combination with piperine and cumin fractions (Table 4a, 4b).
实施例3在系统感染的小鼠模型中与胡椒碱和孜然芹部位联合使用,使利福平的剂量需求降低Example 3 Reduced Rifampicin Dose Requirements in Combination with Piperine and Cumin Fraction in a Mouse Model of Systemic Infection
进行本研究来观察利福平与胡椒碱联合的在体反应。用结核分枝杆菌H37Rv(106CFU/小鼠)静脉内感染瑞士白变种小鼠。将感染的小鼠分组,每组由6只小鼠组成。This study was carried out to observe the in vivo response of the combination of rifampicin and piperine. Swiss albino mice were infected intravenously with M. tuberculosis H 37 Rv (10 6 CFU/mouse). Infected mice were divided into groups, each group consisted of 6 mice.
感染后24小时开始治疗并持续4周,在每周的剂量表中每天1次共计5天。4周后,杀死小鼠,并从肺和肾中计数CFU。单独使用20mg/kg的利福平能够以log 10CFU计降低2-对数级。当与20mg/kg胡椒碱联合时,对10mg/kg的利福平观察到相同的效果。而孜然芹部位更有效,因其在5mg/kg剂量的利福平时以log 10CFU计产生相同的降低(图4a,4b)。Treatment started 24 hours after infection and continued for 4 weeks, once daily for 5 days in a weekly dosing schedule. After 4 weeks, mice were sacrificed and CFU were counted from lung and kidney. Rifampicin at 20 mg/kg alone was able to reduce
表4a利福平单独使用以及与胡椒碱联合使用的MICTable 4a MICs of rifampicin alone and in combination with piperine
表4b利福平单独使用以及与孜然芹部位联合使用的MICTable 4b The MIC of rifampicin used alone and in combination with cumin parts
实施例4当与胡椒碱联合时,环丙沙星抗金黄色葡萄球菌、MRSA和溶血性葡萄球菌的MIC的降低Example 4 Reduction of the MIC of Ciprofloxacin against Staphylococcus aureus, MRSA and Staphylococcus hemolyticus when combined with piperine
利用本研究设计描述的方法,对环丙沙星(Ciprofloxacin)单独使用和与胡椒碱(Piperine)联合时对细菌种类的最小抑制浓度(MIC)进行了分析。观察到与胡椒碱联合中,环丙沙星的MIC降低为1/2至低于1/8(表5)。Using the method described in the study design, the minimum inhibitory concentration (MIC) of ciprofloxacin (Ciprofloxacin) alone and in combination with piperine (Piperine) against bacterial species was analyzed. A 1/2 to less than 1/8 decrease in the MIC of ciprofloxacin was observed in combination with piperine (Table 5).
表5环丙沙星单独使用以及与胡椒碱联合使用的MICTable 5 MIC of ciprofloxacin used alone and in combination with piperine
实施例5当与胡椒碱联合时,氟康唑抗白色念珠菌、近平滑念珠菌和光滑念珠菌的MIC的降低Example 5 Reduction of the MIC of fluconazole against Candida albicans, Candida parapsilosis and Candida glabrata when combined with piperine
利用本研究设计描述的方法,对氟康唑(Fluconazole)单独使用和与胡椒碱联合使用时对真菌种类的最小抑制浓度(MIC)进行了分析。观察到,与胡椒碱联合时氟康唑的MIC降低为1/2至1/8(表6)。The minimum inhibitory concentration (MIC) of fluconazole alone and in combination with piperine against fungal species was analyzed using the method described in the study design. A 1/2 to 1/8 reduction in the MIC of fluconazole was observed in combination with piperine (Table 6).
表6氟康唑单独使用以及与胡椒碱(P)联合使用时的MICTable 6 The MIC of fluconazole used alone and in combination with piperine (P)
实施例6附表7中列举了作为本发明一些例子的药物Drugs as some examples of the present invention are listed in the attached table 7 of Example 6
参考文献references
1.哥特曼(Gutman LT).TMP-SMX在儿童中的使用:副作用与适应症的综述(The use of TMP-SMX in children:a review of adverse reactions and indications).Pediatr Infect Dis 1984;3:349-57.1. Gutman LT. The use of TMP-SMX in children: a review of side effects and indications (The use of TMP-SMX in children: a review of adverse reactions and indications). Pediatr Infect Dis 1984; 3 : 349-57.
2.博施白(Bushby SRM).甲氧苄氨嘧啶与磺胺类药物的协同作用:历史与现状(Synergy of trimethoprim and sulfonamides:History and current status).见:Antibioticsand Antibiosis in Agriculture,London:Butterworths.1977;64-81.2. Bushby SRM. Synergy of trimethoprim and sulfonamides: History and current status. See: Antibiotics and Antibiosis in Agriculture, London: Butterworths. 1977;64-81.
3.奥林(Olin BR),编著.药物事实与比较(Drug Facts and Comparisons).St.Louis,Facts and Comparisons,Inc.;1998:408b-409d.3. Olin BR, Ed. Drug Facts and Comparisons. St.Louis, Facts and Comparisons, Inc.; 1998: 408b-409d.
4.库克瑞尔(Cockerill FR),埃迪生(Edson RS).TMP-SMX.Mayo Clin Proc 1991;66:1260-9.4. Cockerill FR, Edson RS. TMP-SMX. Mayo Clin Proc 1991; 66: 1260-9.
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| US5439891A (en) * | 1993-10-29 | 1995-08-08 | Kapil; Randhir S. | Process for preparation of pharmaceutical composition with enhanced activity for treatment of tuberculosis and leprosy |
| WO1997014319A1 (en) * | 1995-10-20 | 1997-04-24 | Hauser Chemical Research, Inc. | Foods and beverages containing anthocyanins stabilized by plant extracts |
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| US5744161A (en) | 1995-02-24 | 1998-04-28 | Sabinsa Corporation | Use of piperine as a bioavailability enhancer |
| AU7440301A (en) * | 2000-06-26 | 2002-01-08 | Khamar, Bakulesh Mafatlal | Chemosensitizer |
| US20040121028A1 (en) * | 2002-07-18 | 2004-06-24 | Council Of Scientific And Industrial Research | Plant based agents as bioavailability / bioefficacy enhancers for drugs and nutraceuticals |
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| US5439891A (en) * | 1993-10-29 | 1995-08-08 | Kapil; Randhir S. | Process for preparation of pharmaceutical composition with enhanced activity for treatment of tuberculosis and leprosy |
| WO1997014319A1 (en) * | 1995-10-20 | 1997-04-24 | Hauser Chemical Research, Inc. | Foods and beverages containing anthocyanins stabilized by plant extracts |
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