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WO2018116732A1 - Agent thérapeutique contre la stéatohépatite non alcoolique, et kit destiné au traitement de la stéatohépatite non alcoolique - Google Patents

Agent thérapeutique contre la stéatohépatite non alcoolique, et kit destiné au traitement de la stéatohépatite non alcoolique Download PDF

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Publication number
WO2018116732A1
WO2018116732A1 PCT/JP2017/041892 JP2017041892W WO2018116732A1 WO 2018116732 A1 WO2018116732 A1 WO 2018116732A1 JP 2017041892 W JP2017041892 W JP 2017041892W WO 2018116732 A1 WO2018116732 A1 WO 2018116732A1
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Prior art keywords
mesenchymal stem
cells
stem cells
alcoholic steatohepatitis
therapeutic agent
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Japanese (ja)
Inventor
隼人 倉田
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Rohto Pharmaceutical Co Ltd
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Rohto Pharmaceutical Co Ltd
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Priority to CN201780072942.2A priority Critical patent/CN109996550A/zh
Priority to JP2018557627A priority patent/JPWO2018116732A1/ja
Publication of WO2018116732A1 publication Critical patent/WO2018116732A1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
    • A61K35/28—Bone marrow; Haematopoietic stem cells; Mesenchymal stem cells of any origin, e.g. adipose-derived stem cells
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/06—Antihyperlipidemics

Definitions

  • the present invention relates to a non-alcoholic steatohepatitis therapeutic agent and a non-alcoholic steatohepatitis treatment kit.
  • Non-alcoholic steatohepatitis (hereinafter also referred to as “NASH”) is a non-drinker who exhibits similar histological findings to alcoholic hepatitis and is progressive with inflammation and fibrosis along with fat deposition in liver tissue Is a liver disease.
  • NASH Non-alcoholic steatohepatitis
  • the NASH has been attracting attention as one cause of cirrhosis, the cause of which has been unknown.
  • Non-patent Document 3 leptin receptor-deficient mice
  • Non-patent Document 4 hepatocyte-specific Pten-deficient mice
  • dominant inhibition of retinoic acid receptor ⁇ Single-gene-modified mice such as type-gene-modified mice
  • human NASH does not progress with a single gene mutation as in these genetically modified mice, it cannot be said that these genetically modified mice reflect the clinical pathology of human NASH. .
  • Non-patent Documents 6 and 7 methionine / choline-free diet (MCD) (Non-patent Documents 6 and 7) and choline-free L-amino acid defined diet (CDAA) (Non-patent Document 8) are provided to rodents such as mice.
  • MCD methionine / choline-free diet
  • CDAA choline-free L-amino acid defined diet
  • rodents such as mice.
  • a non-human animal model of NASH produced by feeding is also known, but since it shows a decrease in body weight, a decrease in blood lipids, etc., it is reflected in the clinical pathology of human NASH I can't say that. Therefore, even when such a conventional non-human model animal has an effect of improving NASH-like pathology when developing a new therapeutic agent, it is difficult to say that it has an effect on human NASH.
  • Patent Document 1 a novel choline-free, L-amino acid defined (N-CDAA) feed is given to HK-Ay mice that spontaneously develop type II diabetes with insulin resistance as a genetic background. It has been disclosed that a NASH model mouse that exhibits the same clinical pathology was successfully produced. In the model mice, abnormal lipid accumulation in the liver (fatty liver), fibrosis of the liver, and chronic hepatitis due to blood parameters were observed. In particular, the body weight that was not reported in conventional NASH model animals Increased, serum triglycerides increased, and serum total cholesterol increased. Further, in the model mouse, the progression of the gradual pathological condition similar to that in humans is also observed.
  • N-CDAA L-amino acid defined
  • mesenchymal stem cells are pluripotent progenitor cells isolated from bone marrow for the first time by Friedenstein (1982) (Non-patent Document 9). It has been clarified that mesenchymal stem cells exist in various tissues such as bone marrow, umbilical cord, and fat, and mesenchymal stem cell transplantation is expected as a new treatment method for various intractable diseases ( Patent Documents 2 and 3). Recently, it is known that cells having an equivalent function exist in stromal cells of fetal appendages such as adipose tissue, placenta, umbilical cord, and egg membrane. Therefore, the mesenchymal stem cell may be referred to as a stromal cell (Mesenchymal Stroma Cell).
  • JP 2012-80830 A JP 2012-157263 A Special table 2012-508733 gazette
  • An object of the present invention is to provide a novel therapeutic agent for NASH for which no effective drug therapy has been established.
  • the present inventors examined the therapeutic effect of mesenchymal stem cells using NASH model mice exhibiting the same clinical pathology as humans. As a result, the present inventors have found that a therapeutic agent containing mesenchymal stem cells is extremely effective for NASH treatment. That is, the gist of the present invention is as follows.
  • a therapeutic agent for non-alcoholic steatohepatitis containing mesenchymal stem cells.
  • a non-alcoholic steatohepatitis treatment kit comprising the non-alcoholic steatohepatitis therapeutic agent according to any one of [1] to [3], a container, and a label.
  • a novel therapeutic agent for NASH and a novel therapeutic kit for NASH can be provided.
  • FIG. 1 is a diagram showing the NASH therapeutic effect (the effect of reducing the amount of HYP) by four administrations of a non-alcoholic steatohepatitis therapeutic agent containing mesenchymal stem cells.
  • FIG. 2 is a diagram showing the NASH therapeutic effect (the effect of reducing the amount of HYP) by twice administration of a non-alcoholic steatohepatitis therapeutic agent containing mesenchymal stem cells.
  • FIG. 3 is a diagram showing the NASH therapeutic effect (the effect of reducing the amount of HYP) by a single administration of a non-alcoholic steatohepatitis therapeutic agent containing mesenchymal stem cells.
  • FIG. 4 is a diagram showing the NASH therapeutic effect (suppression effect of fibrosis) by a single administration of a non-alcoholic steatohepatitis therapeutic agent containing mesenchymal stem cells.
  • non-alcoholic steatohepatitis therapeutic agent and non-alcoholic steatohepatitis treatment kit of the present invention will be described in detail.
  • the therapeutic agent for non-alcoholic steatohepatitis of the present invention contains mesenchymal stem cells.
  • the non-alcoholic steatohepatitis therapeutic agent of the present invention may contain other components in addition to the above mesenchymal stem cells as long as the effects of the present invention are not impaired.
  • the mesenchymal stem cells and other components contained in the therapeutic agent for non-alcoholic steatohepatitis of the present invention will be described in detail.
  • the mesenchymal stem cell refers to one or more cells belonging to the mesenchymal system, preferably two or more cells, more preferably three or more cells (bone cells, cardiomyocytes, chondrocytes, tendon cells, fat cells, etc.). It means a cell that has differentiation ability and can proliferate while maintaining the ability.
  • the term mesenchymal stem cell used in the present invention means the same cell as the stromal cell, and does not particularly distinguish them. Moreover, it may be simply described as a mesenchymal cell.
  • tissues containing mesenchymal stem cells include adipose tissue, umbilical cord, bone marrow, umbilical cord blood, endometrium, placenta, amniotic membrane, chorion, decidua, dermis, skeletal muscle, periosteum, dental follicle, periodontal ligament, Examples include dental pulp and tooth germ.
  • an adipose tissue-derived mesenchymal stem cell means a mesenchymal stem cell contained in an adipose tissue, and may be referred to as an adipose tissue-derived stromal cell.
  • adipose tissue-derived mesenchymal stem cells adipose tissue-derived mesenchymal stem cells, umbilical cord-derived mesenchymal stem cells, bone marrow-derived mesenchymal stem cells, placenta-derived Leaf stem cells and dental pulp-derived mesenchymal stem cells are preferred, adipose tissue-derived mesenchymal stem cells and umbilical cord-derived mesenchymal stem cells are more preferred, and adipose tissue-derived mesenchymal stem cells are more preferred.
  • the mesenchymal stem cells in the present invention may be derived from the same species as the subject to be treated (subject) or from a different species.
  • examples of the mesenchymal stem cell species in the present invention include humans, horses, cows, sheep, pigs, dogs, cats, rabbits, mice, and rats, preferably cells derived from the same species as the subject to be treated (subject).
  • the mesenchymal stem cells in the present invention may be derived from the subject (subject) to be treated, that is, autologous cells (allogeneic syngeneic), or derived from another subject of the same species, ie, allogeneic cells (allogeneic). System) may be. Preferred are allogeneic cells (allogeneic).
  • the non-alcoholic steatohepatitis treatment agent of the present invention is prepared by pre-cultivating donor cells prepared in advance and cryopreserved. Can be used as mesenchymal stem cells. Therefore, compared to the case of preparing and using autologous mesenchymal stem cells, commercialization is easy, and from the viewpoint that a certain effect can be easily obtained stably, the mesenchymal stem cells in the present invention, More preferably, it is allogeneic.
  • the mesenchymal stem cell means an arbitrary cell population including the mesenchymal stem cell.
  • the cell population is at least 20% or more, preferably 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 93%, 96%, 97%, 98 % Or 99% are mesenchymal stem cells.
  • the adipose tissue in the present invention means a tissue containing mesenchymal stem cells including adipocytes and microvascular cells, and is a tissue obtained by surgical excision or aspiration of mammalian subcutaneous fat, for example. .
  • Adipose tissue can be obtained from subcutaneous fat.
  • the adipose tissue-derived mesenchymal stem cells described later are preferably obtained from the same animal as the subject of administration, and considering administration to humans, human subcutaneous fat is more preferable.
  • An individual supplying subcutaneous fat may be alive or dead, but the adipose tissue used in the present invention is preferably a tissue collected from a living individual.
  • liposuction is exemplified by PAL (power assist) liposuction, Erconia laser liposuction, or body jet liposuction. From the viewpoint of maintaining the state of cells, ultrasound is used. It is preferable not to use.
  • the umbilical cord is a white tubular tissue that connects the fetus and the placenta, and is composed of umbilical vein, umbilical artery, collagenous tissue (Wharton's Jelly), umbilical matrix itself, etc., and mesenchymal stem cells Including many.
  • the umbilical cord is preferably obtained from the same animal as the subject (administration subject) using the therapeutic agent for non-alcoholic steatohepatitis of the present invention, and the therapeutic agent for non-alcoholic steatohepatitis of the present invention is administered to humans. In consideration, the human umbilical cord is more preferable.
  • the bone marrow refers to a soft tissue filling the bone lumen, and is a hematopoietic organ.
  • Bone marrow fluid is present in the bone marrow, and the cells present therein are called bone marrow cells.
  • Bone marrow cells include erythrocytes, granulocytes, megakaryocytes, lymphocytes, adipocytes and the like, as well as mesenchymal stem cells, hematopoietic stem cells, vascular endothelial progenitor cells, and the like.
  • Bone marrow cells can be collected, for example, from human iliac bone, long bone, or other bone.
  • the tissue-derived mesenchymal stem cells such as adipose tissue-derived mesenchymal stem cells, umbilical cord-derived mesenchymal stem cells, and bone marrow-derived mesenchymal stem cells are adipose tissue-derived mesenchymal stem cells and umbilical cord-derived mesenchymal stem cells, respectively. It means any cell population containing mesenchymal stem cells derived from each tissue such as stem cells and bone marrow-derived mesenchymal stem cells.
  • the cell population is at least 20% or more, preferably 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 93%, 96%, 97%, 98 % Or 99% are mesenchymal stem cells derived from each tissue such as adipose tissue-derived mesenchymal stem cells, umbilical cord-derived mesenchymal stem cells, and bone marrow-derived mesenchymal stem cells.
  • Mesenchymal stem cells have growth characteristics (eg, population doubling ability from aging to aging, doubling time), karyotype analysis (eg, normal karyotype, maternal line or neonatal line), flow cytometry ( For example, surface marker expression by FACS analysis, immunohistochemistry and / or immunocytochemistry (eg, epitope detection), gene expression profiling (eg, gene chip array; polymerase chain such as reverse transcription PCR, real-time PCR, conventional PCR, etc. Reaction), miRNA expression profiling, protein array, protein secretion such as cytokines (eg, plasma coagulation analysis, ELISA, cytokine array), metabolites (metabolome analysis), other methods known in the art, etc. May be.
  • growth characteristics eg, population doubling ability from aging to aging, doubling time
  • karyotype analysis eg, normal karyotype, maternal line or neonatal line
  • flow cytometry For example, surface marker expression by FACS analysis, immunohisto
  • Mesenchymal stem cells can be prepared by methods well known to those skilled in the art. Below, the preparation method of an adipose tissue origin mesenchymal stem cell is demonstrated as an example.
  • Adipose tissue-derived mesenchymal stem cells may be obtained, for example, by the production method described in US Pat. No. 6,777,231.
  • the adipose tissue-derived mesenchymal stem cells can be produced by a method including the following steps (i) to (iii).
  • washing may be performed by sedimentation with vigorous stirring using a physiologically compatible saline solution (eg, phosphate buffered saline (PBS)).
  • PBS physiologically compatible saline solution
  • impurities also called debris, such as damaged tissue, blood, and red blood cells
  • washing and sedimentation are generally repeated until the debris is totally removed from the supernatant. Since the remaining cells exist as lumps of various sizes, in order to dissociate them while minimizing damage to the cells themselves, the washed cell lumps are made to have an enzyme (eg, an enzyme that weakens or breaks cell-cell junctions).
  • collagenase dispase or trypsin.
  • the amount of such enzyme and the duration of treatment vary depending on the conditions used, but are known in the art.
  • the cell mass can be broken down by other treatment methods such as mechanical agitation, ultrasonic energy, thermal energy, etc., but with minimal cell damage
  • an enzyme in order to minimize harmful effects on cells, it is desirable to deactivate the enzyme using a medium or the like after a suitable period of time.
  • the cell suspension obtained by the step (i) includes a slurry or suspension of aggregated cells, and various kinds of contaminated cells such as erythrocytes, smooth muscle cells, endothelial cells, and fibroblasts. Therefore, the cells in the aggregated state and these contaminated cells may be separated and removed, but they can be removed by adhesion and washing in step (iii) to be described later. May be. When contaminating cells are separated and removed, this can be achieved by centrifugation that forcibly separates the cells into a supernatant and a precipitate. The resulting precipitate containing contaminating cells is suspended in a physiologically compatible solvent.
  • Suspended cells may contain erythrocytes, but erythrocytes are excluded by selection by adhesion to the individual surface described later, and thus a lysis step is not always necessary.
  • a method for selectively lysing erythrocytes for example, a method well known in the art such as incubation in a hypertonic medium or a hypotonic medium by lysis with ammonium chloride can be used. After lysis, the lysate may be separated from the desired cells, for example, by filtration, centrifugation, or density fractionation.
  • the cells in step (ii), in order to increase the purity of the mesenchymal stem cells in the suspended cells, the cells may be washed once or continuously several times, centrifuged, and resuspended in the medium. Alternatively, cells may be separated based on cell surface marker profile or based on cell size and granularity.
  • the medium used in the resuspension is not particularly limited as long as it is a medium capable of culturing mesenchymal stem cells, but such a medium includes basal medium added with serum and / or albumin, transferrin, fatty acid, One or more serum substitutes such as insulin, sodium selenite, cholesterol, collagen precursor, trace elements, 2-mercaptoethanol, 3′-thiolglycerol, and the like may be added.
  • substances such as lipids, amino acids, proteins, polysaccharides, vitamins, growth factors, low molecular compounds, antibiotics, antioxidants, pyruvate, buffers, inorganic salts, etc. are added as necessary. May be.
  • basal medium examples include IMDM medium, Medium 199 medium, Eagle's Minimum Essential Medium (EMEM) medium, ⁇ MEM medium, Dulbecco's modified Eagle's Medium (DMEM) medium, Ham's F12 medium, Ham's F16 medium.
  • EMEM Eagle's Minimum Essential Medium
  • DMEM Dulbecco's modified Eagle's Medium
  • Ham's F12 medium Ham's F16 medium.
  • Examples include a medium, Fischer's medium, MCDB201 medium, and a mixed medium thereof.
  • the serum examples include, but are not limited to, human serum, fetal bovine serum (FBS), bovine serum, calf serum, goat serum, horse serum, pig serum, sheep serum, rabbit serum, rat serum and the like.
  • FBS fetal bovine serum
  • bovine serum bovine serum
  • calf serum goat serum
  • horse serum horse serum
  • pig serum sheep serum
  • rabbit serum rat serum
  • 5 v / v% to 15 v / v% preferably 10 v / v% may be added to the basal medium.
  • fatty acid examples include, but are not limited to, linoleic acid, oleic acid, linolenic acid, arachidonic acid, myristic acid, palmitoyl acid, palmitic acid, and stearic acid.
  • lipid examples include, but are not limited to, phosphatidylserine, phosphatidylethanolamine, phosphatidylcholine, and the like.
  • Amino acids include, but are not limited to, for example, L-alanine, L-arginine, L-aspartic acid, L-asparagine, L-cysteine, L-cystine, L-glutamic acid, L-glutamine, L-glycine and the like.
  • proteins include, but are not limited to, ecotin, reduced glutathione, fibronectin and ⁇ 2-microglobulin.
  • polysaccharide examples include glycosaminoglycans, and among the glycosaminoglycans, hyaluronic acid, heparan sulfate and the like are particularly exemplified, but the polysaccharide is not limited thereto.
  • Growth factors include, for example, platelet derived growth factor (PDGF), basic fibroblast growth factor (bFGF), transforming growth factor beta (TGF- ⁇ ), hepatocyte growth factor (HGF), epidermal growth factor (EGF) Examples include, but are not limited to, connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF), and the like. From the viewpoint of using the adipose-derived mesenchymal stem cells obtained in the present invention for cell transplantation, it is preferable to use a (xenofree) medium that does not contain components derived from different species such as serum.
  • a (xenofree) medium that does not contain components derived from different species such as serum.
  • Such a medium is provided as a medium prepared in advance for mesenchymal stem cells (stromal cells) from, for example, PromoCell, Lonza, Biological Industries, Veritas, R & D Systems, Corning, and Roto. Has been.
  • the appropriate cell density and the appropriate cell medium are used on the solid surface without differentiating the cells in the cell suspension obtained in step (ii).
  • Culture under culture conditions the “solid surface” means any material that enables binding and adhesion of the adipose tissue-derived mesenchymal stem cells in the present invention.
  • such a material is a plastic material that has been treated to promote the attachment and adhesion of mammalian cells to its surface.
  • the shape of the culture vessel having a solid surface is not particularly limited, but a petri dish or a flask is preferably used. The cells are washed after incubation to remove unbound cells and cell debris.
  • cells that finally remain attached and adhered to the solid surface can be selected as a cell population of adipose tissue-derived mesenchymal stem cells.
  • the surface antigen may be analyzed by a conventional method using flow cytometry or the like. Further, the ability to differentiate into each cell line may be examined, and such differentiation can be performed by conventional methods.
  • Mesenchymal stem cells in the present invention can be prepared as described above, but may be defined as cells having the following characteristics; (1) It exhibits adhesiveness to plastic under the culture conditions in a standard medium. (2) Surface antigens CD44, CD73, CD90 are positive, CD31, CD45 are negative, and (3) Differentiated into bone cells, adipocytes, and chondrocytes under culture conditions.
  • cryopreservation of mesenchymal stem cells As long as the mesenchymal stem cell in the present invention has a therapeutic effect on nonalcoholic steatohepatitis, the cell may be appropriately cryopreserved and thawed.
  • cryopreservation can be performed by suspending and cooling mesenchymal stem cells in a cryopreservation solution well known to those skilled in the art. The suspension can be performed by detaching the cells with a release agent such as trypsin, transferring the cells to a cryopreservation container, treating them appropriately, and then adding a cryopreservation solution.
  • the cryopreservation solution may contain DMSO (dimethylsulfoxide) as a frost damage protective agent.
  • DMSO dimethylsulfoxide
  • DMSO has a property of inducing differentiation of mesenchymal stem cells in addition to cytotoxicity. Is preferably reduced.
  • glycerol, propylene glycol or polysaccharides are exemplified. When DMSO is used, it contains a concentration of 5% to 20%, preferably a concentration of 5% to 10%, more preferably a concentration of 10%.
  • additives described in WO2007 / 058308 may be included.
  • cryopreservation solution for example, cryopreservation provided by Bioverde, Nippon Genetics, Reprocell, Xenoac, Cosmo Bio, Kojin Bio, Thermo Fisher Scientific, etc.
  • a liquid may be used.
  • the cooling rate may be appropriately controlled using a program freezer.
  • the cooling rate may be appropriately selected depending on the components of the cryopreservation solution, and may be performed according to the manufacturer's instructions for the cryopreservation solution.
  • the upper limit of the storage period is not particularly limited as long as the cells cryopreserved under the above conditions are thawed and retain the same properties as before freezing, for example, 1 week or more, 2 weeks or more, 3 weeks or more, 4 weeks or more, 2 months or more, 3 months or more, 4 months or more, 5 months or more, 6 months or more, 1 year or more, or more. Since cell damage can be suppressed by storing at a lower temperature, it may be transferred to a gas phase on liquid nitrogen (from about ⁇ 150 ° C. to ⁇ 180 ° C.). When storing in a gas phase on liquid nitrogen, it can be performed using a storage container well known to those skilled in the art. Although not particularly limited, for example, when storing for 2 weeks or more, it is preferable to store in a gas phase on liquid nitrogen.
  • the thawed mesenchymal stem cells may be appropriately cultured before the next cryopreservation.
  • the mesenchymal stem cells are cultured using the above-described medium capable of culturing mesenchymal stem cells, and are not particularly limited. However, at a culture temperature of about 30 to 40 ° C., preferably about 37 ° C., the CO 2 -containing air is cultured. It may be performed under an atmosphere. The CO 2 concentration is about 2-5%, preferably about 5%. In culture, after reaching the appropriate confluency for the culture container (for example, cells may occupy 50% to 80% of the culture container), the cells are detached with a release agent such as trypsin.
  • a release agent such as trypsin.
  • the culture may be continued by seeding in a separately prepared culture vessel at an appropriate cell density.
  • typical cell densities are 100 cells / cm 2 to 100,000 cells / cm 2 , 500 cells / cm 2 to 50,000 cells / cm 2 , 1,000 to 10,000 cells. / Cm 2 , 2,000 to 10,000 cells / cm 2, etc. are exemplified.
  • the cell density is between 2,000 and 10,000 cells / cm 2 . It is preferable to adjust the period until reaching appropriate confluency from 3 days to 7 days. During culture, the medium may be changed as necessary.
  • Thawing of cryopreserved cells can be performed by methods well known to those skilled in the art. For example, the method performed by standing or shaking in a 37 degreeC thermostat or a hot water bath is illustrated.
  • the mesenchymal stem cells contained in the therapeutic agent for non-alcoholic steatohepatitis of the present invention may be cells in any state, for example, cells collected by detaching cells in culture and cryopreserved. It may be a cell frozen in a liquid. Use of the same lot of cells obtained by expanding and culturing in the same lot is preferable in that the same action and effect can be stably obtained and the handling property is excellent.
  • the mesenchymal stem cells in a cryopreserved state may be thawed immediately before use and directly mixed with a solution for suspending mesenchymal stem cells such as an infusion solution or a medium while being suspended in a cryopreservation solution.
  • the cryopreservation solution may be removed by a method such as centrifugation and then suspended in a solution for suspending mesenchymal stem cells such as an infusion solution or a medium.
  • the “infusion” in the present invention refers to a solution used in human treatment, and is not particularly limited.
  • the mesenchymal stem cell suspension solution such as the above infusion solution or culture medium may be prepared so as to contain other components (pharmaceutically acceptable carriers and additives) described later.
  • the therapeutic agent for non-alcoholic steatohepatitis of the present invention is pharmaceutically acceptable according to a conventional method according to its use and form in addition to the above mesenchymal stem cells, as long as the effects of the present invention are not impaired.
  • Carriers and additives may be included. Examples of such carriers and additives include isotonic agents, thickeners, sugars, sugar alcohols, preservatives (preservatives), bactericides or antibacterial agents, pH regulators, stabilizers, chelating agents.
  • Oily base Oily base, gel base, surfactant, suspending agent, binder, excipient, lubricant, disintegrant, foaming agent, fluidizer, dispersant, emulsifier, buffer, solubilizer , Antioxidants, sweeteners, sour agents, colorants, flavoring agents, fragrances or refreshing agents, but are not limited thereto.
  • typical components include the following carriers and additives.
  • Examples of the carrier include aqueous carriers such as water and hydrous ethanol.
  • examples of tonicity agents include sodium chloride, potassium chloride, calcium chloride, and magnesium chloride;
  • examples of polyhydric alcohols include glycerin, propylene glycol, and polyethylene glycol;
  • examples of the saccharide include carboxyvinyl polymer, hydroxyethyl cellulose, hydroxypropylmethyl cellulose, methyl cellulose, alginic acid, polyvinyl alcohol (completely or partially saponified product), polyvinyl pyrrolidone, macrogol and the like.
  • Examples of the saccharide include cyclodextrin and glucose.
  • Sugar alcohols include, for example, xylitol, sorbitol, mannitol and the like (which may be any of d-form, l-form or dl-form); Hydroxytoluene, butylhydroxyanisole, alkyldiaminoethylglycine hydrochloride, sodium benzoate, ethanol, benzalkonium chloride, benzethonium chloride, chlorhexidine gluconate, chlorobutanol, sorbic acid, potassium sorbate, trometamol, sodium dehydroacetate, paraoxybenzoic acid Methyl, ethyl paraoxybenzoate, propyl paraoxybenzoate, butyl paraoxybenzoate, oxyquinoline sulfate, phenethyl alcohol, benzyl alcohol, biguanide compounds (specifically, polyhexanide hydrochloride (polyhexamethylene biguanide), etc.), Glokill (Rhodia) Product
  • suspending agents examples include honey beeswax and various surfactants. Gum arabic, gum arabic powder, xanthan gum, soybean lecithin, etc .; examples of binders include hydroxyethyl cellulose, hydroxypropyl cellulose, hydroxypropyl methyl cellulose, sodium carboxymethyl cellulose, polyvinyl pyrrolidone, polyvinyl alcohol, etc.
  • Excipients include, for example, sucrose, lactose, starch, corn starch, crystalline cellulose, light anhydrous silicic acid, etc .
  • lubricants include, for example, sucrose fatty acid ester, magnesium stearate, talc, etc .
  • examples of the agent include low-substituted hydroxypropyl cellulose, crospovidone, croscarmellose sodium, etc .
  • examples of the foaming agent include sodium bicarbonate
  • examples of the fluidizing agent include sodium aluminate metasilicate, Examples include light anhydrous silicic acid.
  • the non-alcoholic steatohepatitis therapeutic agent of the present invention can be provided in various forms depending on the purpose, for example, various dosage forms such as a solid preparation, a semisolid preparation, and a liquid preparation.
  • various dosage forms such as a solid preparation, a semisolid preparation, and a liquid preparation.
  • solid preparations tablets, powders, powders, granules, capsules, etc.
  • semi-solid preparations [ointment (hard ointment, ointment etc.), creams, etc.]
  • liquid preparations (lotions, extracts, suspensions) Suspensions, emulsions, syrups, injections (including infusions, implants, continuous injections, injections prepared at the time of use), dialysis agents, aerosols, soft capsules, drinks, etc.] patches
  • It can be used in the form of an agent, a poultice and the like.
  • the therapeutic agent for non-alcoholic steatohepatitis of the present invention can also be used in the form of a solution or emulsion in an oily or aqueous vehicle. Further, the non-alcoholic steatohepatitis therapeutic agent of the present invention can be applied to the affected area by spraying, and the non-alcoholic steatohepatitis therapeutic agent of the present invention is also used in the form of gelation or sheeting at the affected area after spraying. it can.
  • the therapeutic agent for non-alcoholic steatohepatitis of the present invention can be applied to the affected area after the mesenchymal stem cells are made into a sheet or a three-dimensional structure.
  • the therapeutic agent for non-alcoholic steatohepatitis of the present invention comprises the above mesenchymal stem cells and other components (pharmaceutically acceptable carriers and additives), physiological saline, JP physiological saline, 5% glucose solution. , JP glucose injection solution, Ringer solution, JP Ringer solution, Lactated Ringer solution, Ringer acetate solution, Ringer's bicarbonate solution, 1st solution (starting solution), 2nd solution (dehydration replenisher), 3rd solution (maintenance solution), 4th It can be used by suspending or diluting using a solution for suspending mesenchymal stem cells such as a liquid (postoperative recovery solution) or a cell culture medium such as DMEM, preferably a physiological saline solution, It can be used by suspending or diluting with 5% glucose solution, No. 1 solution (starting solution), more preferably with 5% glucose solution, No. 1 solution (starting solution).
  • the mesenchymal stem cell suspension solution may be prepared in advance
  • mesenchymal stem cells and a solution for suspending mesenchymal stem cells are sealed and stored in separate containers, and they may be used by mixing them together. During storage, the mesenchymal stem cells and the mesenchymal stem cell suspension solution may be frozen or refrigerated.
  • the pH of the non-alcoholic steatohepatitis therapeutic agent of the present invention is within a pharmaceutically, pharmacologically (pharmaceutically) or physiologically acceptable range.
  • a pharmaceutically, pharmacologically (pharmaceutically) or physiologically acceptable range is within a pharmaceutically, pharmacologically (pharmaceutically) or physiologically acceptable range.
  • an example is a range of 2.5 to 9.0, preferably 3.0 to 8.5, and more preferably 3.5 to 8.0.
  • the mesenchymal stem cells and the mesenchymal stem cell suspension solution should satisfy the above conditions. Good.
  • the osmotic pressure of the therapeutic agent for non-alcoholic steatohepatitis of the present invention is not particularly limited as long as it is within the range acceptable to the living body.
  • the osmotic pressure ratio of the therapeutic agent for non-alcoholic steatohepatitis of the present invention it is preferably 0.7 to 5.0, more preferably 0.8 to 3.0, still more preferably 0.9 to 1.4. A range is mentioned.
  • the osmotic pressure can be adjusted by a method known in the art using inorganic salts, polyhydric alcohols, sugar alcohols, saccharides and the like.
  • the osmotic pressure ratio is the ratio of the osmotic pressure of the sample to the osmotic pressure of 286 mOsm (0.9 w / v% sodium chloride aqueous solution) based on the 15th revised Japanese Pharmacopoeia. Measure by referring to the freezing point method.
  • the standard solution for osmotic pressure ratio measurement (0.9 w / v% sodium chloride aqueous solution) was prepared by drying sodium chloride (Japanese Pharmacopoeia standard reagent) at 500 to 650 ° C. for 40 to 50 minutes, and then in a desiccator (silica gel).
  • the mixture is allowed to cool and 0.900 g is accurately weighed and dissolved in purified water to make exactly 100 mL, or a commercially available standard solution for osmotic pressure ratio measurement (0.9 w / v% sodium chloride aqueous solution) is used.
  • a commercially available standard solution for osmotic pressure ratio measurement 0.9 w / v% sodium chloride aqueous solution.
  • the mesenchymal stem cell suspension solution should satisfy the above conditions. Good.
  • the route of administration of the non-alcoholic steatohepatitis therapeutic agent of the present invention to a subject includes oral administration, subcutaneous administration, intramuscular administration, intravenous administration, intraarterial administration, intrathecal administration, intraperitoneal administration, sublingual administration, translingual administration.
  • Non-alcoholic steatohepatitis of the present invention includes rectal administration, vaginal administration, intraocular administration, nasal administration, inhalation, transdermal administration, implant, spraying on the liver surface and direct administration by attaching a sheet, etc.
  • the therapeutic agent is preferably an implant, intrahepatic arterial administration, intravenous administration and direct administration by spraying on the liver surface and sticking of a sheet, etc., and more preferable from the viewpoint of reducing the burden on the subject.
  • the dose depends on the patient's condition (weight, age, symptoms, physical condition, etc.) and the dosage form of the therapeutic agent for non-alcoholic steatohepatitis of the present invention. Although it may be different, from the viewpoint of exhibiting sufficient treatment effects for nonalcoholic steatohepatitis, a larger amount tends to be preferable, while from the viewpoint of suppressing the occurrence of side effects, a smaller amount tends to be preferable. It is in.
  • the number of cells is 1 ⁇ 10 3 to 1 ⁇ 10 12 cells / time, preferably 1 ⁇ 10 4 to 1 ⁇ 10 11 cells / time, more preferably 1 ⁇ 10 5 to 1 ⁇ 10 10 cells / time, and further preferably 5 ⁇ 10 5. 6 to 1 ⁇ 10 9 pieces / time.
  • the dose per body weight of the patient is 1 ⁇ 10 to 5 ⁇ 10 10 cells / kg, preferably 1 ⁇ 10 2 to 5 ⁇ 10 9 cells / kg, more preferably 1 ⁇ 10 3 to 5 ⁇ 10 8 cells / kg, and further preferably 1 ⁇ 10 4 to 5 ⁇ 10. 7 / kg.
  • this dose may be administered multiple times as a single dose, or this dose may be administered in multiple doses.
  • the rate of administration of the non-alcoholic steatohepatitis therapeutic agent of the present invention to a subject may vary depending on the patient's condition (weight, age, symptoms, physical condition, etc.) and the administration route of the non-alcoholic steatohepatitis therapeutic agent of the present invention. However, usually when administered to an adult, it is 50 mL / h to 1,000 mL / h, preferably 75 mL / h to 500 mL / h, more preferably 100 mL / h to 250 mL / h. .
  • the administration temperature of the non-alcoholic steatohepatitis therapeutic agent of the present invention to the subject may vary depending on the patient's condition (body weight, age, symptoms, physical condition, etc.) and the administration route of the non-alcoholic steatohepatitis therapeutic agent of the present invention. However, it is usually 4 ° C. to 45 ° C., preferably 15 ° C. to 37 ° C., more preferably room temperature to 37 ° C.
  • the non-alcoholic steatohepatitis therapeutic agent of the present invention may be administered together with one or more other drugs.
  • the other drug include any drug that can be used as a therapeutic drug for the liver, such as a therapeutic drug for hepatitis B (lamivudine, adefovir, entecavir, tenofovir, etc.), an interferon preparation (interferon ⁇ , interferon ⁇ -2b, etc.) , Interferon ⁇ , peginterferon ⁇ -2a, peginterferon ⁇ -2b, etc.), hepatitis C drugs (ribavirin, telapyrevir, simeprevir, vaniprevir, daclatasvir, asunaprevir, sofosbuvir, etc.), corticosteroids (prednisolone, methylprednisolone succinate) Ester sodium, etc.), anticoagulants (dry concentrated human antithrombin III, gabexate mesylate, thrombo
  • non-alcoholic steatohepatitis therapeutic agent of the present invention is administered together with one or more other drugs means that the non-alcoholic steatohepatitis therapeutic agent of the present invention and other drugs are used simultaneously.
  • various cases such as a combination thereof are included.
  • the present invention also includes a kit for treating non-alcoholic steatohepatitis, comprising a mesenchymal stem cell and a mesenchymal stem cell suspension solution.
  • a kit for treating non-alcoholic steatohepatitis comprising a mesenchymal stem cell and a mesenchymal stem cell suspension solution.
  • the description in the section on therapeutic agents for nonalcoholic steatohepatitis can be applied.
  • the non-alcoholic steatohepatitis treatment kit of the present invention can also be expressed as including the non-alcoholic steatohepatitis therapeutic agent of the present invention, a container, and a label.
  • the appropriate container included in the kit of the present invention is not particularly limited, and examples thereof include a cryotube for cell freezing, a bottle for a solution for suspending mesenchymal stem cells, a vial, and a test tube. These containers may be formed from a variety of materials such as glass, metal, plastic, or combinations thereof.
  • the labels on these containers describe the contents that explain the mesenchymal stem cells, the mesenchymal stem cell suspension solution, and the like that are the contents.
  • the kit of the present invention includes other materials desirable from a commercial and user standpoint, including other additives, other drugs, diluents, filters, needles, syringes, and package inserts that describe the usage. can do.
  • the present invention also includes a method for treating nonalcoholic steatohepatitis using mesenchymal stem cells. That is, according to the present invention, administration of mesenchymal stem cells to a non-alcoholic steatohepatitis patient can significantly improve the function of the non-alcoholic steatohepatitis site.
  • the explanation in the section of non-alcoholic steatohepatitis therapeutic agent can be applied to mesenchymal stem cells used in the treatment method of the present invention.
  • adipose-derived mesenchymal stem cells After obtaining consent from a human donor, subcutaneous adipose tissue obtained by a liposuction method was washed with physiological saline. In order to achieve destruction of the extracellular matrix and isolation of the cells, collagenase (Roche diagnostics) (solvent was physiological saline) was added, shaken at 37 ° C. for 90 minutes, and dispersed. Subsequently, the suspension was centrifuged at 800 g for 5 minutes to obtain a precipitate of stromal vascular cell groups.
  • a serum-free medium for mesenchymal stem cells (Rohto) is added to the cell precipitate, the cell suspension is centrifuged at 400 g for 5 minutes, and after removal of the supernatant, a serum-free medium for mesenchymal stem cells (Rohto)
  • the cells were seeded in a flask. Cells were cultured at 37 ° C. for several days in 5% CO 2 . Several days later, the culture was washed with PBS to remove residual blood cells and adipose tissue contained in the culture solution, and mesenchymal stem cells adhered to a plastic container were obtained.
  • adipose tissue-derived mesenchymal stem cells were dispensed into a centrifuge tube, and centrifuged at 400 g for 5 minutes to obtain cell precipitates. After removing the supernatant, an appropriate amount of a cell cryopreservation solution (STEM-CELLBANKER (Zenoac)) was added and suspended. The cell suspension was dispensed into a cryotube, stored at ⁇ 80 ° C. in a freezer, transferred to the gas phase on liquid nitrogen, and the storage was continued.
  • a cell cryopreservation solution STEM-CELLBANKER (Zenoac)
  • N-CDAA non-alcoholic steatohepatitis
  • the cryotube of the fat-derived mesenchymal stem cell prepared in 1 above was removed from liquid nitrogen and placed in a water bath (37 ° C.). Soaking and lysing the cells inside. HBSS was added so that the viable cell density was 1.5 ⁇ 10 6 cells / mL to prepare a fat-derived mesenchymal stem cell suspension.
  • 0.2 mL of a fat-derived mesenchymal stem cell suspension (3 ⁇ 10 5 cells / body) was intravenously administered once every two weeks (Day 8, 22, 36, 50) for a total of 4 times.
  • the liver was collected 9 weeks after the start of feeding the N-CDAA feed and stored in a deep freezer at ⁇ 80 ° C. About the liver preserve
  • PBS PBS (-), manufactured by Wako Pure Chemical Industries, Ltd.
  • PBS PBS (-), manufactured by Wako Pure Chemical Industries, Ltd.
  • a handy homogenizer Hiscotron NS-360D, MICROTEC CO., LTD.
  • 5% liver homogenate solution was finally prepared while washing the blade with PBS.
  • 0.75 mL of hydrochloric acid 35-37% hydrochloric acid (about 10N), Wako Pure Chemical Industries, Ltd.
  • hydrochloric acid 35-37% hydrochloric acid (about 10N)
  • Wako Pure Chemical Industries, Ltd. is added to 0.5 mL of the homogenate solution to a final specified concentration of 6N, and hydrolyzed at about 110 ° C. for over 20 hours. Processed.
  • the reaction product was neutralized with 2.5N sodium hydroxide, and 2 mL of the solution was used as a sample for measuring the HYP content.
  • 1 mL of chloramine T reagent was added to 2 mL of the sample for measuring the HYP content and left at room temperature for 20 minutes, and then 1 mL of perchloric acid reagent was added and left at room temperature for 5 minutes.
  • 1 mL of p-dimethylaminobenzaldehyde reagent was added and heated at 60 ° C. for 20 minutes, followed by filtration using a filter equipped with filter paper (ADVANTEC) to obtain a supernatant.
  • Absorbance at 557 nm was measured with a spectrophotometer, and the HYP content ( ⁇ g / mL) was calculated based on the standard curve.
  • the amount of HYP per gram of liver in the cell non-administered group and the amount of HYP in the whole liver were 562.3 ⁇ 74.4 ⁇ g / g liver and 5001.8 ⁇ 477.6 ⁇ g / Liver.
  • the amount of HYP per gram of liver and the amount of HYP in the whole liver in the cell administration group is 230.8 ⁇ 38.6 ⁇ g / g live and 2073.0 and 430.0 ⁇ g / Liver.
  • a significant decrease in the amount of HYP in the liver was observed by administering the stem cell.
  • Example 3 Therapeutic effect using a non-alcoholic steatohepatitis model (Example 2) KK-Ay / Ta Jcl mice (6 weeks old, male, Nippon Claire Co., Ltd.) were fed with N-CDAA diet (Research Diets Inc., A09042101, Lot. 15072308) for 9 weeks to produce a NASH model.
  • a glass vial containing fat-derived mesenchymal stem cells prepared in the same manner as in Example 1 was taken out of liquid nitrogen, immersed in a water bath (about 37 ° C.), and the internal cell suspension was thawed.
  • adipose-derived mesenchymal stem cell suspension 5 mL / kg (5 ⁇ 10 7 cells / kg) of the adipose-derived mesenchymal stem cell suspension was administered once a day for 2 consecutive days on the 6th week from the start of feeding N-CDAA. It was administered intravenously.
  • the liver was collected 9 weeks after the start of feeding the N-CDAA feed and stored in a deep freezer at ⁇ 80 ° C. The liver was cryopreserved in the same manner as in Example 1, and the HYP content in the liver was measured by the method of Woessner.
  • the amount of HYP per gram of liver in the cell non-administered group and the amount of HYP in the whole liver were 587.1 ⁇ 56.4 ⁇ g / g river and 5999.7 ⁇ 703.0 ⁇ g / Liver.
  • the amount of HYP per 1 g of liver in the cell administration group and the amount of HYP in the whole liver were 408.5 ⁇ 30.8 ⁇ g / gliver and 3737.8 ⁇ 402.0 ⁇ g / liver.
  • Treatment effect 3 using non-alcoholic steatohepatitis model (Example 3) N-CDAA (Research Diets Inc., A09042101, Lot. 15072308) was fed to KK-Ay / Ta Jcl mice (6 weeks old, male, Nippon Claire Co., Ltd.) for 9 weeks to produce a NASH model.
  • a glass vial containing fat-derived mesenchymal stem cells prepared in the same manner as in Example 1 was taken out from liquid nitrogen, immersed in a water bath (about 37 ° C.), and the internal cell suspension was thawed.
  • the adipose-derived mesenchymal stem cell administration group was intravenously administered with 10 mL / kg (5 ⁇ 10 7 cells / kg) of the adipose-derived mesenchymal stem cell suspension on the 6th week after the start of feeding N-CDAA.
  • the liver was collected 9 weeks after the start of feeding the N-CDAA feed and stored in a deep freezer at ⁇ 80 ° C.
  • the liver was cryopreserved and the HYP content in the liver was measured by the method of Woessner in the same manner as in Example 1. Further, the outer left lobe of the removed liver was fixed with a 10% neutral phosphate buffered formalin solution. Sirius red staining was performed according to a conventional method, and the fibrosis area was evaluated by image analysis.
  • the amount of HYP per gram of liver in the cell non-administered group and the amount of HYP in the whole liver were 510.1 ⁇ 25.4 ⁇ g / g river and 4916.5 ⁇ 456.1 ⁇ g / Liver.
  • the amount of HYP per 1 g of liver in the cell administration group and the amount of HYP in the whole liver were 418.9 ⁇ 24.8 ⁇ g / g liver and 3709.1 ⁇ 493.0 ⁇ g / Liver, and the liver by cell administration A significant decrease in the amount of medium HYP was observed.
  • the fibrosis area of the liver was 3.06% in the cell non-administered group, whereas it was 2.16% in the cell-administered group.
  • Human adipose-derived mesenchymal stem cells were found to have an effect of suppressing liver fibrosis.
  • the non-alcoholic steatohepatitis therapeutic agent of the present invention containing fat-derived mesenchymal stem cells has a remarkable non-alcoholic steatohepatitis therapeutic effect even by single administration.
  • a novel non-alcoholic steatohepatitis therapeutic agent containing mesenchymal stem cells and a non-alcoholic steatohepatitis treatment kit are provided.
  • the therapeutic agent and kit of the present invention have a remarkable therapeutic effect against nonalcoholic steatohepatitis for which no effective drug therapy has been established.

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Abstract

La présente invention aborde le problème qui est de fournir un nouvel agent thérapeutique contre la NASH pour laquelle un traitement médicamenteux efficace n'a pas encore été établi. La présente invention est un agent thérapeutique contre la stéatohépatite non alcoolique (NASH) qui contient des cellules souches mésenchymateuses. Les cellules souches mésenchymateuses proviennent de préférence d'une source allogénique, et proviennent de préférence d'un tissu adipeux.
PCT/JP2017/041892 2016-12-22 2017-11-21 Agent thérapeutique contre la stéatohépatite non alcoolique, et kit destiné au traitement de la stéatohépatite non alcoolique Ceased WO2018116732A1 (fr)

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JP2018557627A JPWO2018116732A1 (ja) 2016-12-22 2017-11-21 非アルコール性脂肪肝炎治療剤及び非アルコール性脂肪肝炎治療用キット

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