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WO2012076193A1 - Préparations combinées contenant des exosomes et un corticostéroïde - Google Patents

Préparations combinées contenant des exosomes et un corticostéroïde Download PDF

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Publication number
WO2012076193A1
WO2012076193A1 PCT/EP2011/057642 EP2011057642W WO2012076193A1 WO 2012076193 A1 WO2012076193 A1 WO 2012076193A1 EP 2011057642 W EP2011057642 W EP 2011057642W WO 2012076193 A1 WO2012076193 A1 WO 2012076193A1
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Prior art keywords
pharmaceutical composition
exosomes
corticosteroid
kit according
cytokine antagonist
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Ceased
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PCT/EP2011/057642
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German (de)
English (en)
Inventor
Peter Wehling
Julio Reinecke
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Orthogen AG
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Orthogen AG
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Priority claimed from PCT/EP2010/069426 external-priority patent/WO2011082950A1/fr
Application filed by Orthogen AG filed Critical Orthogen AG
Publication of WO2012076193A1 publication Critical patent/WO2012076193A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
    • A61K31/537—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines spiro-condensed or forming part of bridged ring systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/177—Receptors; Cell surface antigens; Cell surface determinants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1833—Hepatocyte growth factor; Scatter factor; Tumor cytotoxic factor II
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1841—Transforming growth factor [TGF]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1858—Platelet-derived growth factor [PDGF]
    • A61K38/1866—Vascular endothelial growth factor [VEGF]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/30—Insulin-like growth factors, i.e. somatomedins, e.g. IGF-1, IGF-2
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders

Definitions

  • the present invention relates to pharmaceutical compositions for combination therapy with a corticosteroid and exosomes.
  • diseases such as osteoarthritis, arthritis and / or degenerative spinal disorders can be treated, wherein the treatment is preferably carried out locally.
  • Osteoarthritis in Germany refers to a "joint wear and tear" that exceeds that customary in the age, and is associated with loss of cartilage in the affected joint, resulting in pain and functional deterioration, resulting in an excess of stress, congenital or traumatic causes, such as malalignment of the joints or bony deformity caused by bone diseases such as osteoporosis, and may also be the result of other conditions such as joint inflammation or congestion associated with congestion.
  • all joints can be affected by arthritic changes.
  • the disease In Germany, the disease is most often located in the knee joint.
  • Osteoarthritis is one of the most common consultations in a general medical practice. About 10% of the population in western countries suffers from osteoarthritis. If one calculates the osteoarthritis disorders of the small vertebral joints and the degenerative ones Disk Diseases, even about 15% -20% of the population are affected. The risk of developing osteoarthritis increases with age. About two-thirds of people over 65 are affected by the disease, but not all sufferers also suffer from the symptoms.
  • cortisone also applied locally
  • corticosteroids corticosteroids
  • Exosomes are small, lipid-membrane-enveloped vesicles found in the extracellular space of, for example, the human body. They are formed by cells by cleavage from the cellular plasma membrane and secreted. Normally, these exosomes also contain proteins taken from their cell of origin. Methods for obtaining and administering exosomes are described, for example, in patent application WO 2006/007529 A2. In the in vitro induction of prophylactically or therapeutically effective proteins such as IL-1 Ra by incubation of a blood sample in a suitable vessel such as a syringe, exosomes are formed. Thus, for example, Orthokin contains exosomes.
  • exosomes can be increased by adding an additive that promotes exosome formation.
  • concentration of the exosomes can be increased, for example, by centrifugation at a high centrifugal acceleration.
  • the use of exosomes in the treatment of rheumatoid arthritis is known per se.
  • Another drug that can be used to treat osteoarthritis is the endogenous protein IL-1 Ra or an isoform or fragment thereof that has similar activity.
  • Interleukin-1 receptor antagonist (IL-1 Ra) binds to the same receptors on the cell surface as interleukin-1 (IL-1), but does not elicit the signaling cascade normally caused by IL-1 binding.
  • IL-1Ra By binding to the IL-1 receptor, IL-1Ra blocks the binding of IL-1, thus preventing its signal transduction and thus the pro-inflammatory effect of IL-1 on the target cells.
  • the treatment of patients with endogenous serum in which IL-1 Ra has been enriched is known in the art.
  • the IL-1 Ra thus used is also called Orthokin.
  • a recombinant IL-1 Ra fragment, anakinra had no effect on the treatment of osteoarthritis compared to placebo.
  • Anakinra is an isoform of the human interleukin-1 receptor antagonist, truncated to amino acids 26-177 and terminally L-methionylated, and has a sequence length of 153 amino acids. The production takes place for example by Escherichia coli strains with recombinant methods.
  • the invention therefore an object of the invention to provide a drug osteoarthritis treatment, which has a better efficacy and in particular has a good long-term efficacy.
  • corticosteroids such as cortisone in osteoarthritis, arthritis and degenerative spinal disease
  • corticosteroids such as cortisone in osteoarthritis, arthritis and degenerative spinal disease
  • the use of corticosteroids in combination with exosomes obtained from a blood sample in, for example, an orthokin syringe (eg corticosteroid together with orthokin) is superior to therapy in terms of rapidity of onset of osteoarthritis seems that does not include the drug exosomes.
  • a fast-acting effect can also be observed when an already effective osteoarthritic therapy (such as corticosteroid together with anakinra) adds exosomes as an additional active substance.
  • corticosteroid and exosomes also shows a strikingly good efficacy in the treatment of rheumatoid arthritis, both in terms of the speed of onset and long-term efficacy.
  • This showed a particularly favorable effect due to surprisingly high effectiveness (due to the different pathophysiological starting points) at particularly favorable Side effect profile for the patient.
  • the favorable side effect profile is of particular importance because chronic corticosteroids are associated with significant side effects such as metabolic imbalances, osteoporosis and other side effects.
  • corticosteroids such as cortisone reduces the adverse effects of corticosteroids (cortisone) and increases the efficacy of the treatment.
  • the present invention provides a pharmaceutical composition containing a corticosteroid together with exosomes in the presence or absence of a cytokine antagonist and / or a growth factor.
  • cytokine antagonist in the context of the present invention means that not a single cytokine antagonist is present, this applies correspondingly with regard to the growth factor.
  • the pharmaceutical composition according to the first aspect thus contains in each case a corticosteroid and exosomes. Further, there is either the option of the presence or the option of the absence of a cytokine antagonist; In addition, there is either the option of the present or the option of the absence of a growth factor.
  • the therapeutics can also be administered in two different pharmaceutical compositions simultaneously or in chronological order.
  • a pharmaceutical composition comprising exosomes in the presence or absence of a cytokine antagonist and / or growth factor for use in combination therapy with a corticosteroid, and a pharmaceutical composition containing a corticosteroid in the presence or absence a cytokine antagonist and / or growth factor for use in combination therapy with exosomes.
  • the invention in a fourth aspect provides a pharmaceutical composition containing a cytokine antagonist and / or a growth factor for use in a combination therapy together with a corticosteroid and exosomes.
  • a kit comprising (i) a pharmaceutical composition containing exosomes in the presence or absence of a cytokine antagonist and / or a growth factor and (ii) a pharmaceutical composition containing a corticosteroid in the presence or absence of a cytokine antagonist and / or a growth factor.
  • the invention relates to the use of exosomes in the presence or absence of a cytokine antagonist and / or growth factor for the preparation of a pharmaceutical composition for use in combination therapy with a corticosteroid, and in a seventh aspect the use of a corticosteroid in Presence or absence of a cytokine antagonist and / or growth factor for the preparation of a pharmaceutical composition for use in combination therapy with exosomes.
  • the combination therapy mentioned above in connection with the second, third, fourth, sixth and seventh aspect is preferably a combination therapy together with a cytokine antagonist and / or a growth factor, especially in those cases where in the pharmaceutical composition itself is a cytokine antagonist and / or a growth factor is absent.
  • the present invention relates to a method for producing a corticosteroid and exosome-containing pharmaceutical composition, comprising the steps of: providing a blood sample containing exosomes, preferably concentrating the exosomes and mixing with a corticosteroid.
  • the invention is based on the surprising finding that the treatment of diseases of the joints and spine such as osteoarthritis / arthritis and degenerative spinal disease, as well as in autoimmune diseases such as atopic dermatitis and circular hair loss by corticosteroids can be significantly improved by the additional administration of exosomes.
  • the invention is directed to the combination therapy of such diseases by means of a corticosteroid together with exosomes. This can be done in the presence or absence of a cytokine antagonist and / or a growth factor. A presence of the cytokine antagonist and / or growth factor is preferred.
  • These different active ingredients can be administered simultaneously - in the same formulation or in different formulations - or sequentially.
  • compositions according to the invention which contain only one of the two active substances exosomes and corticosteroid, as well as the kit according to the invention, can therefore be intended, on the one hand, for a simultaneous administration and, on the other hand, for a sequential administration of the exosomes and the corticosteroid.
  • simultaneous administration is preferred, especially in only one formulation.
  • the two pharmaceutical compositions of the kit of the invention may be appropriately mixed before administration to the patient and then administered as a formulation.
  • the various drugs are preferably administered within a period of one week, preferably within five days, three days, one day, or within twelve hours.
  • a cytokine antagonist and / or a growth factor may be present or absent. Presence of the cytokine antagonist and / or growth factor is preferred. Namely, there is a significant beneficial effect on the efficacy, in particular the long-term efficacy, of corticosteroids in diseases of the joints and the spine, if in addition a cytokine antagonist such as Orthokin (natural IL-1 Ra) and anakinra (recombinant IL-1 Ra), especially in the case of local administration of the therapeutics directly into the joint to be treated.
  • a cytokine antagonist such as Orthokin (natural IL-1 Ra) and anakinra (recombinant IL-1 Ra)
  • the cytokine antagonists have an anabolic effect and can abrogate or even reverse the harmful catabolic effect of the corticosteroid known in the affected joints. Therefore, in the treatment of, for example, osteoarthritis in addition to the cytokine antagonists, the corticosteroids may alternatively or additionally be combined with anabolic growth factors to achieve a similar effect. Generally, the cytokine antagonist may also be replaced by a growth factor or combined with a growth factor.
  • the pharmaceutical composition of the present invention (according to the fourth aspect of the present invention) containing a cytokine antagonist and / or a growth factor for use in a combination therapy together with a corticosteroid and exosomes may be used for simultaneous administration on the one hand and for sequential administration of the other Cytokine antagonists and / or growth factor, exosomes and corticosteroids. Concomitant administration is preferred, especially in only one formulation.
  • the cytokine antagonist and / or growth factor may be appropriately mixed with a corticosteroid and exosomes prior to administration to the patient and then administered as a formulation.
  • the cytokine antagonist and / or growth factor, exosomes or corticosteroid may also be administered separately and the other ingredients mixed as a formulation.
  • cytokine antagonist and / or growth factor, exosomes and corticosteroid may also be sequentially administered in any order, or one of these agents may be administered at a different time than the other two.
  • the various drugs are preferably administered within a period of one week, preferably within five days, three days, one day, or within twelve hours.
  • the presence or absence of a cytokine antagonist in the pharmaceutical composition is possible.
  • the presence of a cytokine antagonist is preferred.
  • the combination therapy according to the invention is preferably a combination therapy together with a cytokine antagonist, in particular in cases in which in the pharmaceutical composition itself a cytokine antagonist is absent (see above).
  • the cytokine antagonist used in the invention may be any substance or mixture of substances that reduces or inhibits at least one, preferably substantially all, of the biological activities of one or more cytokines in the body of the patient.
  • the antagonistic effect can be done directly by the antagonist or indirectly, for example by activation or inhibition of other signaling pathways, which in turn act on the biological activity of the cytokine.
  • the biological activity of the cytokine is inhibited by blocking its interaction with one or more of the receptors to which it is capable of binding. This can be achieved, for example, by competitive binding of the antagonist to the corresponding receptor or by binding of the antagonist to the cytokine itself be achieved.
  • the cytokine antagonist inhibits the action of the cytokine IL-1.
  • the cytokine antagonist may be, for example, a protein, a peptide, a nucleic acid, a lipid or an organic compound. Also, the cytokine antagonist may consist of a mixture of two or more cytokine antagonists as described herein. In particular, the cytokine antagonist may be a naturally occurring peptide or protein or even a recombinantly produced peptide or protein. In addition, the cytokine antagonist may be or contain an antibody or an antigen-binding fragment of an antibody, particularly an antibody or antibody fragment capable of binding the particular cytokine or cytokine receptor.
  • cytokine antagonists are interleukin antagonists, in particular IL-1 antagonists such as IL-1 Ra, tumor necrosis factor (TNF) antagonists, in particular a TNF- ⁇ antagonist such as an anti-TNF- ⁇ antibody, interferon antagonists , and chemokine antagonists.
  • IL-1 antagonists such as IL-1 Ra
  • TNF tumor necrosis factor
  • TNF- ⁇ antagonist such as an anti-TNF- ⁇ antibody
  • interferon antagonists chemokine antagonists.
  • chemokine antagonists is particularly preferred.
  • IL-1Ra protein preferably human IL-1Ra, especially orthokin or anakinra.
  • IL-1 Ra preferably comprises or consists preferably of the amino acid sequence of an isoform or a homologue of human IL-1 Ra according to SEQ ID NOs: 1, 2, 3, 4 or 5, an isoform of equine IL-1 Ra according to SEQ ID NOs : 6 or 7, or an isoform of the canine IL-1 Ra according to SEQ ID NO: 8.
  • fragments or derivatives of IL-1Ra can be used as cytokine antagonists as long as they can perform the desired function, that is, reduce or inhibit one or more biological functions of IL-1.
  • Fragments of IL-1 Ra preferably comprise at least 20, more preferably at least 40, 60, 80, or at least 100 amino acids of a natural IL-1 Ra sequence.
  • the fragments are naturally occurring secreted fragments of IL-1 Ra.
  • the IL-1 Ra comprises amino acids 26 to 177 of human IL-1 Ra, preferably amino acids 26 to 177 of the sequence of SEQ ID NO: 1.
  • Derivatives of IL-1 Ra are preferably homologous to natural IL-1 Ra and preferably have a homology or identity to natural IL-1 Ra of at least 60%, more preferably at least 70%, 75%, 80%, 85%, 90%, 95% and most preferably at least 98% over a range of at least 20 contiguous amino acids, preferably at least 40, 60, 80 or at least 100 contiguous amino acids, most preferably the entire length of IL-1 Ra.
  • Particularly preferred are the IL-1 Ra, also called orthokin, which can be isolated from natural biological samples, such as blood, and the IL-1 Ra fragment with the amino acids 26 to 177 of human IL-1 Ra, also called anakinra.
  • the obtained IL-1 Ra solution preferably also contains growth factors. Therefore, according to the invention, a cytokine antagonist may also be present in combination with one or more growth factors or be replaced by one or more growth factors.
  • the growth factor according to the invention preferably has an anabolic effect. Examples of suitable growth factors are TGF- ⁇ , IGF, BMP, HGF and VEGF. Also included are analogs, derivatives and fragments of these growth factors as long as they have the desired effect, i. especially their effect as a growth factor.
  • the corticosteroid used in the invention may be any naturally occurring or synthetically produced corticosteroid.
  • it may be a glucocorticoid, a mineralocorticoid or an androgen, with glucocorticoids preferably being used.
  • glucocorticoids preferably being used.
  • a mixture of two or more corticosteroids may be used as described herein.
  • glucocorticoids examples include cortisone, hydrocortisone, prednisone, prednisolone, cloprednol, deflazacort, fluocortin, triamcinolone, dexamethasone, methylprednisolone, fluprednisolone, clocortolone, clobetasone, alclomethasone, flumethasone, fluopredniden, fluorandrenolone, betamethasone, beclomethasone, fluocortolone, mometasone, fluticasone, halomethasone, Fluocinolone, diflorasone, desoximethasone, fluocinonide, amcinonide, halcinonide, diflucortolone, clobetasol and paramethasone.
  • mineralocorticoids examples include aldosterone, desoxycorticosterone and fludrocortisone, and examples of androgens are dehydroepiandrosterone (DHEA) and estrogens.
  • DHEA dehydroepiandrosterone
  • the corticosteroid can be used as a free compound or in the form of a salt, ester or prodrug.
  • the corticosteroid used is triamcinolone, cortisone, hydrocortisone, prednisolone or prednisone.
  • the corticosteroid is preferably crystalloid.
  • the exosomes in the exosome-containing pharmaceutical compositions of the invention or in the kit of the invention are preferably preparable by a method comprising the steps of: providing a blood sample containing exosomes and preferably concentrating the exosomes.
  • the concentration is preferably carried out by a centrifugation step of at least 100,000 g, since such high centrifugal accelerations are particularly suitable for concentrating exosomes. This step is preferably carried out for at least 30 minutes, in particular for at least 60 minutes, since the concentration is then particularly effective.
  • the step of providing an exosome-containing blood sample preferably comprises the steps of: providing a blood sample taken from a patient, optionally adding an exosome-forming additive, and incubating the blood sample in a vessel suitable for exosome production.
  • the incubation results in the formation of a conditioned blood composition.
  • vials, tubes such as vacuum tubes, microtiter plates, and transfusion bags are suitable for preparing the exosome.
  • the surface for contacting the blood sample preferably comprises glass, plastic (eg polystyrene, polyvinyl chloride, polyethylene or polypropylene), corundum or quartz in vessels suitable for the production of exosomes and preferably consists of one of these materials.
  • surface-enlarging additives of glass, plastic, corundum or quartz, such as spheres, gels, wool, flour, granules or particles are added.
  • the additive promoting exosome formation is preferably IL-1 Ra.
  • the additive promoting exosome formation is preferably used in an amount of 1 to 20 ⁇ g per ml of whole blood.
  • the exosomes are preferably derived from a blood sample.
  • the exosomes are preferably autologous or allogenic with respect to the patient to be treated.
  • the centrifugation step described above is carried out with at least 100,000 g (preferably at least 30 min, in particular at least 60 min) in the treatment of diseases in which an increased concentration of exosomes makes sense, preferably in the treatment of rheumatoid arthritis. More preferably, such a centrifugation step is generally performed in the event that the combination therapy involves exosomes derived from a blood sample of a patient.
  • exosomes in the exosome-containing pharmaceutical compositions according to the invention or in the kit according to the invention preferably contain IL-1 Ra. This applies correspondingly to the exosomes in the case of the invention pharmaceutical compositions for use in combination therapy with exosomes.
  • IL-1 Ra is added in addition to the IL-1 Ra contained in the exosomes or used instead of the exosomes.
  • IL-1 Ra is added in addition to the IL-1 Ra contained in the exosomes or used instead of the exosomes.
  • the pharmaceutical compositions of the invention or the kit of the invention are intended for use in the treatment of joint diseases such as osteoarthritis, arthritis, arthritis and inflammatory cartilage loss, degenerative spinal disorders, joint pain and also autoimmune diseases.
  • the osteoarthritis to be treated may be due to overwork, congenital or traumatic causes, or the result of another condition such as inflammation.
  • the osteoarthritis to be treated is preferably an activated osteoarthritis or an inflammatory osteoarthritis.
  • the pharmaceutical compositions of the present invention may be used for the treatment of osteoarthritis and arthritis on any joint, such as the knee joint, hip joint, ankle joint, shoulder joint, vertebral joints, finger joints, elbow joint, toe joints, temporomandibular joint and wrist.
  • the arthritis to be treated may be an infection-related arthritis such as bacterial arthritis or a non-infection-related arthritis such as rheumatoid arthritis, psoriatic arthritis or gouty arthritis.
  • the pharmaceutical composition of the invention and / or the kit of the invention may also be for use in the treatment of a disease other than one or more of said diseases (such as rheumatoid arthritis).
  • the degenerative spinal disease to be treated may be, for example, a herniated disc.
  • Autoimmune diseases include, among others, autoimmune diseases of the joints such as ankylosing spondylitis, rheumatoid arthritis and systemic lupus erythematosus, as well as other autoimmune diseases such as atopic dermatitis and alopecia areata (circular hair loss).
  • compositions of the invention or the kit according to the invention are preferably suitable for local administration. They are preferably intended for local administration. Therefore, they are in preferred embodiments for injection, in particular for injection into the body region to be treated, in particular in the affected joint, to the affected nerve root or in the affected disc, or determined in the local environment thereof.
  • the Pharmaceutical composition is thus intended in particular for intra-articular and / or periradicular injection.
  • the pharmaceutical compositions of the invention may be formulated for topical administration, particularly as a cream or gel, or for systemic administration, especially oral administration in the form of tablets, capsules or lozenges.
  • the mode of administration depends inter alia on the disease to be treated. In local osteoarthritis or degenerative spinal disease, therefore, local administration of the pharmaceutical compositions of the invention is preferred.
  • the pharmaceutical compositions of the invention or the kit of the invention are intended or suitable only for administration other than systemic administration.
  • compositions according to the invention are suitably formulated for the various administration routes in a manner known to those skilled in the art.
  • a pharmaceutical composition suitable for injection is preferably in the form of a solution or dispersion or else in dry form, e.g. as a powder or lyophilisate, which must be dissolved before injection in a suitable solvent, such as water.
  • the pharmaceutical compositions of the invention contain the exosomes and / or the corticosteroid in therapeutically effective amounts.
  • the corticosteroid is preferably present at a concentration of from 1 to 80 mg / dose, more preferably from 5 to 40 mg / dose in the corticosteroid-containing pharmaceutical compositions.
  • An optional cytokine antagonist is preferably present at a concentration of 0.5 to 150 mg / dose in the cytokine antagonist-containing pharmaceutical compositions, but may also be present in significantly lower concentrations such as 1 ng / dose or more, for example between 1 and 1000 ng / dose. These low dose levels may be used particularly in combination with growth factors and / or in natural IL-1 Ra preparations such as orthokin compositions. The higher dose concentrations are preferred, for example, in recombinantly produced cytokine antagonists such as anakinra.
  • the pharmaceutical compositions of the invention may further contain one or more excipients and / or one or more excipients.
  • the pharmaceutical compositions of the invention may also be intended for the treatment of patients who have already undergone another treatment of the relevant disease, ie, for example, osteoarthritis, arthritis, and / or degenerative spinal disease, especially if that other treatment has not been successful the disease symptoms have at least partially returned despite initially successful treatment.
  • this other treatment is a therapy with exosomes, but without a corticosteroid, or a therapy with a corticosteroid, in particular a glucocorticoid as described above, but without exosomes.
  • Patients according to the invention may be humans as well as animals suffering from any of the diseases described herein.
  • the pharmaceutical compositions of the invention may be useful for the treatment of a human and / or an animal such as a dog, a cat, a horse, a cow, a pig, a goat, a camel or the like.
  • FIGS. 1A to 1C show photographs of the feet of a neurodermatitis patient whose case is described below as case IX (example 4).
  • Figure 1A represents the dermatological changes on both feet just prior to treatment with exosomes and triamcinolone.
  • Fig. 1B shows the condition one week after treatment for the right foot.
  • Fig. 1C shows the condition one week after treatment for the left foot.
  • a cytokine antagonist e.g., recombinant IL-1 Ra recombinant or IL-1 Ra derived from autologous blood samples
  • corticosteroid e.g., corticosteroid
  • VAS visual analog scale for pain sensation (0 to 10)
  • CRP c-reactive protein a blood-detectable marker of inflammation
  • Diagnosis Clinically radiologically there is medial and retropatellar gonarthrosis Ii, grade IV. A total of knee replacement has already been planned on the left;
  • Diagnosis severe shoulder pain II for 6 months (VAS 8); since then significantly disturbed sleep. Patient could hardly sleep in the last 6 months, therefore also disturbance of the general well-being. Numerous injections of cortisone into the left shoulder were unsuccessful. A surgery for the left shoulder was agreed. Here an attempt should be made to avoid the operation. Radiographic and clinical signs of partial rotator cuff rupture and subacromial tightness with complete left shoulder stiffness; Discomfort left arm with weakness of force of hand and forearm left, grade 4.
  • Diagnosis Complete right shoulder stiffness for approx. 8 months. All previous therapies were without success, an operation was planned. Patient wanted attempt of renewed conservative treatment. The night sleep was not possible for several weeks. Shoulder pain starting on the left side, main findings but right shoulder, there VAS 9 with severe acute attacks up to 10, as a result reduced general condition.
  • Therapy Treatment of the right shoulder from a combination of 2 ml Orthokin administered separately together with another syringe from a combination of 150 mg Anakinra and 5 mg Triamcinolone on 6 consecutive days.
  • Diagnosis Severe juvenile rheumatoid arthritis for approx. 15 years.
  • Blood was drawn for preparation of exosomes in a 6 ml syringe (Orthokin syringe). Thereafter, incubation at 37 degrees for 24 h, wherein when filling the syringe with blood previously 1 mg Anankinra (IL-1 Ra) and 2 mg prednisolone were applied to the syringe. After various centrifugation steps (up to 100,000 g), the mixture was then applied to the patient's OSGe and shoulders.
  • IL-1 Ra Anankinra
  • prednisolone prednisolone
  • exosomes prepared according to IL-1 Ra incubation as described
  • exosomes + triamcinolone 10 mg and in the MCP 2 + 3 bds (exosomes with 2 mg triamcinolone per joint).
  • Complication-free course significant pain relief of 90% after a few days; CRP at 3 months 3.0 mg / L; Knee completely swollen after 1 week, no side difference: 5 mg prednisolone was completely discontinued as part of the basic therapy, as the effect of intra-articular injection from exosomes and triamcinolone was persistent.
  • the patient wishes to delay an operation and joint replacement.
  • Severe Bechterewarthritis with iridocyclitis left eye Patient receives as basic therapy prednisolone and MTX in varying dosages. CRP 20.3 mg / l; left OSG distinctly swollen with + 2 cm opposite the other side; left MCP and end joint 1. Fingers left clearly swollen and painful, right shoulder swollen, painful, abduction reduced by 30 degrees from normal. Thereupon injection of exosomes in known technique in the affected joints without pain reduction and CRP reduction, then injection of triamcinolone in a total dose of 40 mg in all affected joints, slight improvement of 20% over 1 week.
  • Diagnosis coxarthrosis re, grade III-IV in radiograph; Hip pain with limp for about 3 years, patient still does not want a hip replacement; clinical limp, IRO / ARO re hip 5/0/5, incidental Lyme disease known;
  • Diagnosis clinically and radiologically rhizarthrosis re moderate with severe pain (VAS 6) with functional impairment when gripping objects. Cortisone injections in the past without success.
  • Diagnosis Radiological and Clinical Inpingement Ii Shoulder for about 2 years; previous cortisone injections without success; Abduction reduced by about 15 degrees
  • Diagnosis Clinically and radiologically medial knee osteoarthritis re grade IV and retropatellar for many years; on the outside, it was recommended to attempt a remodeling osteotomy or knee replacement on the right. However, the patient wanted a conservative therapeutic trial. In the past, injections of hyaluronic acid and cortisone (triamcinolone) were not clinically successful. Therapy: A 10-course anakinra treatment (100 mg per session) with parallel administration of 10 mg triamcinolone (total treatment dose 50 mg) twice weekly was performed.
  • Diagnosis Clinical and radiological (MRI) internal meniscal damage re knee III with marked deterioration in function and pain medial right knee. OP was recommended, patient would like to not surgical alternative.
  • MRI Magnetic resonance Imaging
  • Diagnosis Clinically and radiologically lumbar facet osteoarthritis for many years, incidental diverticulum. Inpatient treatment with cortisone injections into the lumbar facets without success.
  • the pain level was previously defined as 100.
  • the pain level afterward was 30, 0, 30, 0, 35, 0, 40, 60, 40, 50, 80 and 50 for the individual patients.
  • N 129
  • average follow-up period 3 months
  • average pain reduction 71% (i.e., reduction from 100% pain before treatment to 29% after treatment), strikingly rapid onset of action.

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Abstract

La présente invention concerne des compositions pharmaceutiques destinées à une thérapie combinatoire associant un corticostéroïde et des exosomes. Ladite thérapie combinatoire permet de traiter des maladies telles que l'arthrose, l'arthrite et/ou des affections dégénératives de la colonne vertébrale.
PCT/EP2011/057642 2010-12-10 2011-05-11 Préparations combinées contenant des exosomes et un corticostéroïde Ceased WO2012076193A1 (fr)

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Cited By (4)

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Publication number Priority date Publication date Assignee Title
WO2017080668A1 (fr) * 2015-11-13 2017-05-18 Orthogen Ag Préparation pharmaceutique efficace contre les troubles liés au vieillissement
WO2018033226A1 (fr) * 2016-08-17 2018-02-22 Orthogen Ag Préparation pharmaceutique anti-vieillissement
EP3287134A1 (fr) * 2016-08-26 2018-02-28 Orthogen AG Thérapie combinée utilisant une préparation de sang et une préparation helminthique
CN108619114A (zh) * 2018-05-02 2018-10-09 东南大学 一种负载地塞米松的巨噬细胞源微囊泡及其制备方法和应用

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WO2000046249A1 (fr) 1999-02-01 2000-08-10 Orthogen Gentechnologie Gmbh Procede de production d'antagonistes des recepteurs de l'interleukine 1, d'une proteine a activite therapeutique, a partir de fluides corporels
WO2003080122A1 (fr) 2002-03-22 2003-10-02 Orthogen Ag Procede et agent de fabrication de compositions sanguines therapeutiquement actives
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EP0343684A1 (fr) 1988-05-27 1989-11-29 Synergen, Inc. Inhibiteurs d'interleukine-1
WO2000046249A1 (fr) 1999-02-01 2000-08-10 Orthogen Gentechnologie Gmbh Procede de production d'antagonistes des recepteurs de l'interleukine 1, d'une proteine a activite therapeutique, a partir de fluides corporels
WO2003080122A1 (fr) 2002-03-22 2003-10-02 Orthogen Ag Procede et agent de fabrication de compositions sanguines therapeutiquement actives
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BRESNIHAN BARRY ET AL: "Treatment of rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist", ARTHRITIS AND RHEUMATISM, vol. 41, no. 12, December 1998 (1998-12-01), pages 2196 - 2204, XP009146178, ISSN: 0004-3591 *
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SETTAS LUCAS D ET AL: "Reactivation of pulmonary tuberculosis in a patient with rheumatoid arthritis during treatment with IL-1 receptor antagonists (anakinra).", JOURNAL OF CLINICAL RHEUMATOLOGY : PRACTICAL REPORTS ON RHEUMATIC & MUSCULOSKELETAL DISEASES AUG 2007 LNKD- PUBMED:17762459, vol. 13, no. 4, August 2007 (2007-08-01), pages 219 - 220, XP009146179, ISSN: 1076-1608 *

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2017080668A1 (fr) * 2015-11-13 2017-05-18 Orthogen Ag Préparation pharmaceutique efficace contre les troubles liés au vieillissement
WO2017080669A1 (fr) * 2015-11-13 2017-05-18 Orthogen Ag Préparation pharmaceutique efficace contre les troubles liés au vieillissement
WO2018033226A1 (fr) * 2016-08-17 2018-02-22 Orthogen Ag Préparation pharmaceutique anti-vieillissement
WO2018033227A1 (fr) * 2016-08-17 2018-02-22 Orthogen Ag Préparation pharmaceutique anti-vieillissement
WO2018033249A1 (fr) * 2016-08-17 2018-02-22 Orthogen Ag Polythérapie efficace dans le traitement du vieillissement et de troubles liés à l'âge
CN108348549A (zh) * 2016-08-17 2018-07-31 奥索根股份公司 抗衰老药物制剂
EP3763377A1 (fr) * 2016-08-17 2021-01-13 Orthogen AG Préparation pharmaceutique anti-âge
EP3287134A1 (fr) * 2016-08-26 2018-02-28 Orthogen AG Thérapie combinée utilisant une préparation de sang et une préparation helminthique
WO2018036657A1 (fr) * 2016-08-26 2018-03-01 Orthogen Ag Polythérapie utilisant une préparation sanguine et une préparation helminthique
CN108619114A (zh) * 2018-05-02 2018-10-09 东南大学 一种负载地塞米松的巨噬细胞源微囊泡及其制备方法和应用

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