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CN111671753A - 血根碱或其盐在抑制淋病奈瑟菌中的应用 - Google Patents

血根碱或其盐在抑制淋病奈瑟菌中的应用 Download PDF

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CN111671753A
CN111671753A CN202010652863.2A CN202010652863A CN111671753A CN 111671753 A CN111671753 A CN 111671753A CN 202010652863 A CN202010652863 A CN 202010652863A CN 111671753 A CN111671753 A CN 111671753A
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neisseria gonorrhoeae
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sanguinarine
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CN111671753B (zh
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梁景耀
曹文苓
张锡宝
黎小东
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Guangzhou Institute Of Dermatology (guangzhou Std Monitoring Center)
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Abstract

本发明涉及血根碱或其盐在抑制淋病奈瑟菌中的应用,具体涉及血根碱或其盐在制备治疗和/或预防淋病奈瑟菌(Neisseria gonorrhoeae)引起的感染和/或并发症的药物的应用,治疗或预防由淋病奈瑟菌(Neisseria gonorrhoeae)引起的感染和/或并发症的药物,抑制或防止淋病奈瑟菌生长的方法和给药装置,本发明所述血根碱或其盐对淋病奈瑟菌,尤其是抗生素耐受或低敏的淋病奈瑟菌具有良好的抑制作用。

Description

血根碱或其盐在抑制淋病奈瑟菌中的应用
技术领域
本发明涉及抑菌领域,具体而言,涉及血根碱或其盐在抑制淋病奈瑟菌中的应用。
背景技术
淋病是目前全世界最常见、危害最大的性传播疾病之一,在细菌性性传播感染性疾病中流行率排第二,其致病菌为淋病奈瑟菌简称淋球菌(Neisseria gonorrhoeae)。
由于淋病奈瑟菌对所有推荐治疗的抗生素均具有超凡的耐药进化能力,加上抗菌药物的广泛应用、或者不正确使用甚至滥用,导致不断出现淋病奈瑟菌耐药。历史上已依次淘汰了曾经作为淋病一线治疗药物如磺胺类、青霉素、四环素、喹喏酮类、大环内脂类等抗生素。
目前,在全球多数地区被当作淋病治疗最后一道防线的头孢曲松也面临着耐药威胁。淋病奈瑟菌对头孢曲松最低抑菌浓度(MIC)呈逐年上升趋势已在全世界各地区被广泛报道。2011年日本报道了首例由广谱耐药(XDR)淋病奈瑟菌H041导致的头孢曲松临床治疗失败病例,标志着淋病奈瑟菌对头孢曲松耐药时代的开始。随后瑞士、斯洛文尼亚、澳大利亚、法国和西班牙等也从头孢曲松临床治疗失败病例中分离出具有相似的基因型的XDR淋病奈瑟菌菌株,显示了头孢菌素耐药菌株的可传播性。最近美国、加拿大、中国和欧洲部分国家纷纷推荐头孢曲松或头孢克肟(头孢曲松不能使用的患者)联合阿奇霉素作为治疗淋病的首选药物。然而,在日本、美国和中国等国家和地区已陆续报道了阿奇霉素治疗淋病失败的病例,而且2014年在伦敦发现头孢曲松联合阿奇霉素临床治疗失败病例。目前国内外推荐治疗淋病的药物仅有头孢曲松、头孢克肟、阿奇霉素和大观霉素,但除了大观霉素,其它三种抗生素均已出现不同程度耐药性,淋病将可能出现无药可治。
有鉴于此,本领域亟待开发新型淋病奈瑟菌抑制剂。
发明内容
本发明的第一目的在于提供一种制药用途,以制备预防和/或治疗淋病奈瑟菌感染或并发症的新型药物;
进一步地,制备治疗和/或预防抗生素耐药性或低敏感性淋病奈瑟菌引起的感染或并发症的新型药物;
更进一步地,制备与其他药物活性成分联用的药物,提高疗效和/或抗菌广谱性;
更进一步地,提供适合治疗和/或预防淋病奈瑟菌的多种药物制剂形式。
本发明的第二目的在于提供一种治疗或预防由淋病奈瑟菌引起的感染和/或并发症的药物。
本发明的第三目的在于提供一种抑制和/或防止淋病奈瑟菌生长方法。
本发明的第四目的在于提供一种包含前述药物的给药装置。
为实现上述发明目的,本发明特提供以下技术方案:
血根碱或其盐在制备治疗和/或预防淋病奈瑟菌(Neisseria gonorrhoeae)引起的感染和/或并发症的药物的应用。
血根碱(Sanguinarine)的分子式为C20H14NO4,相对分子质量为332,分子结构式如图1所示,主要存在于白屈菜的全草、紫堇的块根、博落回的全草、血根草的根、血水草的地上部分。血根碱具有较广泛的生物学活性,包括抗炎、抗肿瘤、抗寄生虫等,但现有技术未见报道其具有抗淋病奈瑟菌活性。本发明首次发现,血根碱作为一种新型的淋病奈瑟菌抑制剂,其MIC范围为2~64μg/ml,MIC50为16μg/ml,MIC90为32μg/ml,与大观霉素抑菌效果相当,展现了良好的淋病奈瑟菌抑制效果(具体参见说明书实施例1)。
在一些具体的实施方案中,所述淋病奈瑟菌具有抗生素耐药性或低敏感性;优选地,所述淋病奈瑟菌耐受或低敏感的抗生素选自以下一种或多种:青霉素、环丙沙星、头孢克肟、头孢曲松或阿奇霉素。
本发明实施例1所示117株临床分离所得淋病奈瑟菌表现出青霉素、环丙沙星、头孢克肟、头孢曲松、阿奇霉素耐药性或低敏感性(详见表2),但均为血根碱敏感株。可见,本发明所述血根碱对抗生素耐药性或低敏性淋病奈瑟菌具有良好的抑制效果,为抑制淋病奈瑟菌提供了更多的化合物选择,避免由于已有的抗生素耐受性而出现淋病奈瑟菌引发的感染或并发症无药可治。
在一些具体的实施方式中,所述由淋病奈瑟菌引起的感染或并发症包括以下一种或多种:泌尿系统感染、淋病、宫颈炎、尿道炎、子宫内膜炎、盆腔炎性疾病、附睾炎、睾丸炎、前列腺炎、阴茎流脓、肿胀、疼痛、结膜炎、咽炎、直肠炎、不育、不孕、异位妊娠、慢性盆腔疼痛、不良妊娠、无症状感染者。
在一些具体的实施方式中,所述药物还包括其他药物活性成分;优选地,所述其他药物活性成分包括以下一种或多种:头孢曲松、头孢克肟、阿奇霉素和大观霉素。
除血根碱外,本发明所述药物还包括例如头孢曲松、头孢克肟、阿奇霉素和/或大观霉素的其他药物活性成分,可扩大其抗菌广谱性,提高治疗效果,避免淋病奈瑟菌产生抗菌效果。
在一些具体的实施方式中,所述盐包括酸加成盐或季铵盐;优选地,所述酸加成盐包括与无机酸形成的盐,例如盐酸、氢溴酸、硫酸、硝酸、氨基磺酸或磷酸;
优选地,所述酸加成盐包括与有机酸形成的盐,例如乙酸、己二酸、富马酸、琥珀酸、马来酸、柠檬酸、苯甲酸、对甲苯磺酸、甲烷磺酸、萘磺酸或酒石酸。
在一些具体的实施方式中,所述药物还包括药学上可接受的载体或赋形剂,优选地,所述药学上可接受的载体或赋形剂包括以下一种或多种:粘合剂、填充剂、压片润滑剂、崩解剂、可接受的润湿剂、悬浮剂、乳化剂、非水性载体、防腐剂、栓剂基质。
在一些具体的实施方式中,所述药物为片剂、粉剂、胶囊剂、颗粒剂、锭剂、栓剂、乳膏或液体制剂。
本发明还提供一种治疗或预防由淋病奈瑟菌(Neisseria gonorrhoeae)引起的感染和/或并发症的药物,所述药物包含血根碱或其盐,和其他抑制由淋病奈瑟菌引起的感染或并发症的药物。
本发明还提供一种抑制或防止淋病奈瑟菌生长的方法,向受试者给予血根碱或其盐;或向物体喷洒、涂敷、填充、浸渍血根碱或其盐。
在一些具体的实施方式中,所述受试者为无症状感染者。
本发明还提供一种给药装置,所述给药装置包括前述药物。
术语定义
本发明所述治疗,是指治愈、改善或减轻疾病的症状,或消除(或减轻如下影响)其病因(例如致病细菌);本发明所述预防,是指提前消除或延迟疾病的发作或发展,或减少(或根除)其在受治疗人群中的发病率。
本发明所述受试者,包括但不限于哺乳动物受试者;所述哺乳动物受试者包括,但不限于:人类,家畜,耕畜,动物园动物,运动动物,宠物动物例如狗、猫、豚鼠、兔、大鼠、小鼠,马,家牛,奶牛;灵长类动物,例如猿、猴、猩猩和黑猩猩;犬科动物,例如狗和狼;猫科动物,例如猫、狮子和老虎;马科动物,例如马、驴和斑马;食用动物,例如奶牛、猪和羊;有蹄类动物,例如鹿和长颈鹿;啮齿动物,例如小鼠、大鼠、仓鼠和豚鼠。
本发明所述粘合剂,包括但不限于糖浆、阿拉伯胶、明胶、山梨糖醇、黄蓍胶或聚乙烯吡咯烷酮。本发明所述填充剂,包括但不限于乳糖、糖、玉米淀粉、磷酸钙、山梨糖醇或甘氨酸。本发明所述压片润滑剂,包括但不限于硬脂酸镁、滑石粉、聚乙二醇或二氧化硅。本发明所述崩解剂,包括但不限于马铃薯淀粉。本发明所述可接受的润湿剂,包括但不限于十二烷基硫酸钠。本发明所述悬浮剂,包括但不限于山梨糖醇、甲基纤维素、葡萄糖糖浆、明胶、羟乙基纤维素、羧甲基纤维素、硬脂酸铝凝胶或氢化食用脂肪。本发明所述乳化剂,包括但不限于卵磷脂、脱水山梨醇单油酸酯、阿拉伯胶。本发明所述非水性载体包括但不限于食用油、杏仁油、甘油、丙二醇、乙醇。本发明所述防腐剂,包括但不限于对羟基苯甲酸甲酯、对羟基苯甲酸丙酯、山梨酸。本发明所述栓剂基质,包括但不限于可可脂或其它甘油酯。
本发明所述MIC(minimum inhibitory concentration),是指在微生物鉴定的稀释法中完全抑制细菌生长的最低药物浓度;本发明所述MIC范围,是指同一种菌不同试验株在测MIC时得到的范围;本发明所述MIC50,是指抑制50%受试菌株生长所需抗菌药物浓度;本发明所述MIC90,是指抑制90%受试菌株生长所需抗菌药物浓度。本发明所述青霉素敏感,是指MIC≤0.03mg/L;本发明所述青霉素低敏,是指0.06~0.50mg/L;本发明所述青霉素耐受,是指MIC≥1mg/L。
本发明所述环丙沙星敏感,是指MIC≤0.03mg/L;本发明所述环丙沙星低敏,是指0.06~0.50mg/L;本发明所述环丙沙星耐受,是指MIC≥1mg/L;
本发明所述头孢曲松敏感,是指MIC≤0.06mg/L;本发明所述头孢曲松低敏,是指MIC≥0.125mg/L;
本发明所述头孢克肟敏感,是指MIC≤0.125mg/L;本发明所述头孢克肟低敏,是指MIC≥0.25mg/L;
本发明所述阿奇霉素敏感,是指MIC≤0.5mg/L;本发明所述阿奇霉素耐受,是指MIC≥1mg/L;
本发明所述大观霉素敏感,是指MIC≤64mg/L;本发明所述大观霉素耐受是指MIC≥128mg/L;
有益效果
与现有技术相比,本发明的有益效果为:
1.本发明提供血根碱或其盐作为新型淋病奈瑟菌抑制药物,其MIC范围为2~64μg/ml,MIC50为16μg/ml,MIC90为32μg/ml,显示良好的淋病奈瑟菌抑制效果;
2.本发明所述药物碱对抗生素(例如青霉素、环丙沙星、头孢曲松、头孢克肟、阿奇霉素)耐药性或低敏性淋病奈瑟菌具有良好的抑制效果,为抑制抗生素耐药性或低敏淋病奈瑟菌提供了更多的化合物选择,避免由于已有的抗生素耐受性而出现淋病奈瑟菌引发的感染或并发症无药可治;
3.除血根碱或其盐外,本发明所述药物还包括例如头孢曲松、头孢克肟、阿奇霉素和/或大观霉素的其他药物活性成分,可扩大其抗菌广谱性,提高治疗效果,避免淋病奈瑟菌产生抗菌效果。
附图说明
图1为血根碱的化学结构式。
具体实施方式
下面将结合实施例对本发明的实施方案进行详细描述,但是本领域技术人员将会理解,下列实施例仅用于说明本发明,而不应视为限制本发明的范围。实施例中未注明具体条件者,按照常规条件或制造商建议的条件进行。所用试剂或仪器未注明生产厂商者,均为可以通过市购获得的常规产品。
实施例1
1.实验菌株、标准菌株和实验药品的准备
从医院临床样本中分离鉴定117株淋病奈瑟菌作为实验菌株;以WHO的D、G、J、L、P标准菌株作质控。实验菌株和标准菌株用T-M平板培养16~24h的淋病奈瑟菌菌苔,用生理盐水制成107CFU/mL菌悬液,备用。
购买青霉素(USP(美国药典标准品),货号1502701,生产批号R082H0)、环丙沙星(USP,货号1134313,生产批号10L049)、头孢曲松(USP,货号1098184,生产批号R07420)、头孢克肟(USP,货号1097658,生产批号R095X0)、阿奇霉素(USP,货号1046056,生产批号R043P0)、大观霉素(USP,货号1618003,生产批号H0M339)、血根碱(麦克林公司产品,货号s855088-100mg,生产批号C10273942),备用。
2.测定最低抑菌浓度(MIC)
采用WHO西太区淋病奈瑟菌耐药监测规划推荐的琼脂稀释法,先将抗菌药物按要求配成原液,再倍比稀释成不同的浓度,血根碱1~128mg/L,青霉素0.03~32mg/L,环丙沙星0.008~32mg/L,大观霉素1~128mg/L,头孢曲松和头孢克肟是0.002~1mg/L,阿奇霉素0.016~8mg/L。将3.7%淋病奈瑟菌基础琼脂高压灭菌,水浴冷却至50℃,加入脱纤维新鲜羊血(终浓度10%)。
取0.2mL倍比稀释好的6种抗菌药物工作液,加入20ml淋病奈瑟菌血液基础培养基,混匀后倾倒平板。从低浓度至高浓度配制各种浓度的平板。
用多头接种器将实验菌株和标准菌株菌悬液接种于各种浓度的平板,置36℃、5%CO2环境下培养24h后观察结果,记录无菌落生长的MIC。药物敏感性判断标准采用WHO西太区淋病奈瑟菌耐药监测规划推荐的标准:
青霉素MIC≤0.03mg/L判为敏感,MIC 0.06~0.50mg/L判低敏,MIC≥1mg/L判为耐药;
环丙沙星MIC≤0.03mg/L判为敏感,MIC 0.06~0.50mg/L判低敏,MIC≥1mg/L判为耐药;
头孢曲松MIC≤0.06mg/L判为敏感,MIC≥0.125mg/L判为低敏;头孢克肟MIC≤0.125mg/L判为敏感,MIC≥0.25mg/L判为低敏;
阿奇霉素MIC≤0.5mg/L判为敏感,MIC≥1mg/L判为耐药;
大观霉素MIC≤64mg/L判为敏感,MIC≥128mg/L判为耐药。
3.结果分析
根据表1所示结果可知,本实施例所述血根碱对117株临床分离所得淋病奈瑟菌的MIC范围为2~32μg/ml,MIC50为16μg/ml,MIC90为32μg/ml,与大观霉素的MIC范围、MIC50和MIC90相同,显示与大观霉素相当的、良好的抑菌活性,为抑制淋病奈瑟菌提供了新的抑制化合物。
而表2所示结果显示本实施例所述117株分离所得淋病奈瑟菌表现出青霉素、环丙沙星、头孢曲松、头孢克肟、阿奇霉素耐药性或低敏,却对血根碱敏感,表明血根碱对抗生素耐药性或低敏性淋病奈瑟菌具有好的抑制效果,可避免由于已有的抗生素耐受性而出现淋病奈瑟菌引发的感染或并发症无药可治的情况。
表1 117株临床分离淋病奈瑟菌对血根碱和大观霉素MIC值的分布情况
Figure BDA0002575635490000091
Figure BDA0002575635490000101
表2
Figure BDA0002575635490000102
最后应说明的是:以上各实施例仅用以说明本发明的技术方案,而非对其限制;尽管参照前述各实施例对本发明进行了详细的说明,但本领域的普通技术人员应当理解:其依然可以对前述各实施例所记载的技术方案进行修改,或者对其中部分或者全部技术特征进行等同替换;而这些修改或者替换,不使相应技术方案的本质脱离本发明各实施例技术方案的范围。

Claims (10)

1.血根碱或其盐在制备治疗和/或预防淋病奈瑟菌(Neisseria gonorrhoeae)引起的感染和/或并发症的药物的应用。
2.根据权利要求1所述的应用,其特征在于,所述淋病奈瑟菌具有抗生素耐药性或低敏感性;优选地,所述淋病奈瑟菌耐受或低敏感的抗生素选自以下一种或多种:青霉素、环丙沙星、头孢克肟、头孢曲松或阿奇霉素。
3.根据权利要求1所述的应用,其特征在于,所述由淋病奈瑟菌引起的感染或并发症包括以下一种或多种:泌尿系统感染、淋病、宫颈炎、尿道炎、子宫内膜炎、盆腔炎性疾病、附睾炎、睾丸炎、前列腺炎、阴茎流脓、肿胀、疼痛、结膜炎、咽炎、直肠炎、不育、不孕、异位妊娠、慢性盆腔疼痛、不良妊娠、无症状感染者。
4.根据权利要求1所述的应用,其特征在于,所述药物还包括其他药物活性成分;优选地,所述其他药物活性成分包括以下一种或多种:头孢曲松、头孢克肟、阿奇霉素和大观霉素。
5.根据权利要求1所述的应用,其特征在于,所述盐包括酸加成盐或季铵盐;优选地,所述酸加成盐包括与无机酸形成的盐,例如盐酸、氢溴酸、硫酸、硝酸、氨基磺酸或磷酸;优选地,所述酸加成盐包括与有机酸形成的盐,例如乙酸、己二酸、富马酸、琥珀酸、马来酸、柠檬酸、苯甲酸、对甲苯磺酸、甲烷磺酸、萘磺酸或酒石酸。
6.根据权利要求1所述的应用,其特征在于,所述药物还包括药学上可接受的载体或赋形剂,优选地,所述药学上可接受的载体或赋形剂包括以下一种或多种:粘合剂、填充剂、压片润滑剂、崩解剂、可接受的润湿剂、悬浮剂、乳化剂、非水性载体、防腐剂、栓剂基质。
7.根据权利要求1~6任一项所述的应用,其特征在于,所述药物为片剂、胶囊、粉剂、颗粒剂、锭剂、栓剂、乳膏或液体制剂。
8.一种治疗或预防由淋病奈瑟菌(Neisseria gonorrhoeae)引起的感染和/或并发症的药物,其特征在于,所述药物包含血根碱或其盐,和其他抑制由淋病奈瑟菌引起的感染或并发症的药物。
9.一种抑制或防止淋病奈瑟菌生长的方法,其特征在于,向受试者给予血根碱或其盐;或向物体喷洒、涂敷、填充、浸渍血根碱或其盐。
10.一种给药装置,其特征在于,所述给药装置包括权利要求1~8任一项所述的药物。
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