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EP1067951A2 - Verwendung von l-glu-ltrp für behandlung der hiv-infektion - Google Patents

Verwendung von l-glu-ltrp für behandlung der hiv-infektion

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Publication number
EP1067951A2
EP1067951A2 EP99916320A EP99916320A EP1067951A2 EP 1067951 A2 EP1067951 A2 EP 1067951A2 EP 99916320 A EP99916320 A EP 99916320A EP 99916320 A EP99916320 A EP 99916320A EP 1067951 A2 EP1067951 A2 EP 1067951A2
Authority
EP
European Patent Office
Prior art keywords
trp
xaa
glu
compound
hiv
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP99916320A
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English (en)
French (fr)
Inventor
Lawrence R. Green
Nickolay V. Sinackevich
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
CYTRAN Ltd
Original Assignee
CYTRAN Ltd
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Filing date
Publication date
Application filed by CYTRAN Ltd filed Critical CYTRAN Ltd
Publication of EP1067951A2 publication Critical patent/EP1067951A2/de
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A61K38/05—Dipeptides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A61K38/06—Tripeptides

Definitions

  • This invention is directed to prophylactic and therapeutic treatments of retroviral infections and, in particular, HIV infection.
  • HIV-1 and HIV-2 are retroviruses that infect human T-lymphocytes bearing the cell surface marker CD4. By destroying helper T-cells, they cripple the immune system and lead to severe immune deficiency. Immune deficiency leaves the infected person vulnerable to opportunistic infection by invading pathogens and to reduced immune surveillance of malignant cells. Severe immunodeficiency that results from advanced HIV infection is called AIDS, or Acquired Immunodeficiency Syndrome. HIV is spread by exposure to bodily fluids, such as blood and semen, that contain the virus. High risk activities include sexual intercourse with an infected person, use of contaminated hypodermic needles, and transfusion of contaminated blood.
  • HIV infection No completely effective therapeutic treatment of HIV infection has been developed. However, significant progress has been made in treating HIV infection and its sequelae.
  • One class of useful drugs is the inhibitors of reverse transcriptase, such as zyduvine (AZT, 3'-azido-2',3'-dideoxythymidine) and zalcitibine (ddC, 2' ,3'- dideoxycytidine). These drugs are nucleotide analogs.
  • a second class is HIV protease inhibitors, such as indinavir sulphate or saquinavir mesylate. These drugs inhibit the activity of HIV protease that cleaves viral polyprotein precursors to generate functional HIV proteins.
  • a third class of drugs is the immunomodulators, such as thymopentin. These drugs work by enhancing immune system function, thereby making the person's immune system more effective in fighting the infection.
  • L-Glu-L-Trp also known as thymogen
  • thymogen is a dipeptid ⁇ known to normalize immune system function.
  • the drug was found to be the active principle in an extract of the thymus gland called thymosm.
  • thymosm an extract of the thymus gland
  • the dipeptide has been shown to be effective in the treatment of immunodeficient, immunodepressed or hyperactive immune states.
  • L-Glu-L-Trp has anti-angiogenic activity.
  • tryptophan-containing dipeptides are believed to function, at least in part, by reversibly associating with specific cellular receptors, namely "CD2" receptors, thereby inducing conformation changes in the receptor which "trigger” intracellular mechanisms resulting in up-regulation of ad ⁇ nylate cyclase and an increase in AMP. They simultaneously increase the affinity of the CD2 receptor for its "target” ligand. This increase in affinity is believed to heighten the interaction between these cells and their natural ligands, thereby facilitating such interaction and encouraging cellular response to such interaction. (Khavinson et al. , WO 94/20063.)
  • L-Glu-L-Trp While L-Glu-L-Trp is known to have properties as an immunomodulator, it has exceptional and unexpectedly good properties in the treatment of retroviral infections, and, especially, in the treatment of HIV infection. L-Glu-L-Trp inhibits retroviral replication in persons infected with HIV and decreases viral load by a factor of ten. More particularly, this invention provides treatments for persons suffering from AIDS complicated by Kaposi's sarcoma. Such individuals have a mortality rate twice that of persons suffering from AIDS without Kaposi's sarcoma. Quite surprisingly, in cases of AIDS with Kaposi's sarcoma, L-Glu-L-Trp decreases the number of lesions and decreases the mortality rate significantly.
  • this effect is due to a synergy between the immunomodulatory and a i- angiogenic properties of L-Glu-L-Trp. Accordingly, this invention is directed to methods of treating HIV infection by administering an effective amount of L-Glu-L-Trp.
  • this invention provides a method for inhibiting retroviral infection in a subject comprising the step of administering to the subject a pharmacologically effective amount of a trytophan-containing compound selected from: (1) L-Xaa-L-Trp; (2) a cyclic form of L-Xaa-L-Trp; (3) a linear or cyclic polymer of L- Xaa-L-Trp, the polymer having no more than 20 or no more than 10 amino acids; and (4) a derivative of any of the foregoing compounds which hydrolyses in aqueous solution into any of the foregoing compounds, wherein Xaa is Glu, He or Leu.
  • a trytophan-containing compound selected from: (1) L-Xaa-L-Trp; (2) a cyclic form of L-Xaa-L-Trp; (3) a linear or cyclic polymer of L- Xaa-L-Trp, the polymer having no more than 20 or no more than 10 amino acids
  • the compound is L-Glu-L-Trp; Xaa is Glu; or the compound is L-Xaa-L- Trp.
  • the compound is a pro-drug analog of the formula selected from (1) Naa- L-Xaa-L-Trp, wherein Xaa is Glu, He or Leu and Naa is any amino acid or a monosaccharide; and (2) a derivative of Naa-L-Xaa-L-Trp which hydrolyses in aqueous solution into Naa-L-Xaa-L-Trp.
  • the compound is an analog having the structure of formula 1 :
  • X and Y are independently selected from H, lower alkyls, esters, amides, halides, carbohydrates or oligodideoxyribose groups, or, together can be a ketone group.
  • the bond between X or Y and the carbon can be non-hydrolyzable. In that case, X or Y have a mass of less than about 500 D, preferably less than about 100 D.
  • the bond between X or Y and the carbon can be hydrolizable. In that case, any derivatization will result in a analog compound that, when exposed to water or to an enzyme that breaks a hvdolizable bond, will convert or transform to a hydrate or ketone. Such forms are active.
  • the treatment is a prophylactic treatment for inhibiting establishment of infection wherein the subject is not infected with HIV.
  • the compound is administered intranasally or intravenously.
  • the effective amount is about 1 ⁇ g/kg to about 10 mg/kg, about 10 ⁇ g/kg to about 1 mg/kg or about 100 ⁇ g/kg. In one embodiment, the effective amount is about 10 ⁇ g/kg to about 1 mg/kg and the compound is administered 3 times per week to 7 times per week.
  • the subject has a CD4-positive T cell count below about 400 cells per ml.
  • the subject suffers from Kaposi's sarcoma or an opportunistic infection or an opportunistic malignancy.
  • the method involves co-administering a reverse transcriptase inhibitor or an HIV protease inhibitor.
  • the pharmaceutically acceptable carrier is normal saline.
  • this invention provides a kit comprising: (1) a pharmacologically effective amount of a tryptophan-containing compound of this invention; and (2) a label instructing the use of the compound in the treatment of retroviral infection.
  • This invention also provides the use of a tryptophan-containing compound of this invention in the manufacture of a pharmaceutical composition for the treatment of retroviral infection.
  • Fig. 1 is a graph showing percent inhibition of splenomegaly by L-Glu-L- Trp and AZT in various studies.
  • Fig. 2A-2E are graphs showing amounts of HIV RNA, number of raised lesions and CD4 count of AIDS/Kaposi sarcoma patients treated with L-Glu-L-Trp. Co- treatment with other HIV therapies also is indicated.
  • Tryptophan-containing compounds are useful in the methods of this invention for inhibiting retroviral infection. These tryptophan-containing compounds have the formulae:
  • L-Xaa-L-Trp wherein Xaa is Glu, He or Leu; (2) a cyclic form of L-Xaa-L-Trp;
  • a derivative is a pharmaceutically acceptable salt of the above compounds.
  • a “pharmaceutically acceptable salt” is a salt that can be formulated into a compound for pharmaceutical use including, e.g., metal salts (sodium, potassium, magnesium, calcium, etc.) and salts of ammonia or organic amines.
  • a derivative is an analog in which the reactive terminal amine or carboxyl groups are derivatized with amides, imides, esters, anhydrides, ethers, methyl or ethyl-alkyl esters, alkyl, aryl or mixed alkyl/aryl moieties in which the formula weight of the entire compound is less than about 5000 Daltons or less than about 1000 Daltons.
  • Such derivatives are expected to equilibrate into the active form by, for example, hydrolysis in the body.
  • the derivative is an analog in which L-amino acids are substituted for D-amino acids, such as L-Glu-D-Trp or D-Glu-L-Trp, and analogs of tryptophan such as 5-hydroxy-tryptamine, 5-hydroxy-indol-acetic acid and pyrole analogs in which the nitrogen in the indole ring of Trp is replaced with carbon (formula 1) .
  • L-amino acids are substituted for D-amino acids, such as L-Glu-D-Trp or D-Glu-L-Trp
  • analogs of tryptophan such as 5-hydroxy-tryptamine, 5-hydroxy-indol-acetic acid and pyrole analogs in which the nitrogen in the indole ring of Trp is replaced with carbon (formula 1) .
  • a derivative is a pro-drug that is metabolized into the active form, e.g. , L-Xaa-L-Trp.
  • One important class of analogs are trimeric compounds of the formula Naa-L-Xaa-L-Trp, wherein Naa is any L-amino acid or a mono-saccharide. Naa-L-Xaa-L-Trp also is degraded upon administration to the body by the cleavage of the amino-terminal moiety into the active L-Xaa-L-Trp.
  • Another class of analogs are those in which the compound is derivatized by the covalent attachment of a moiety at the amino or carboxy terminus.
  • Representative examples include HEW, EWEW, GEW, EWKHG, EWKKHG, EW-NH-NH-GHK-NH,, Ac-L-Glu-L-Trp-OH, Suc-EW, Cpr-EW, But-EW, RKEWY, RKEW, KEWY, KEW, pEW.
  • the compounds of this invention preferably are delivered as pharmaceutical compositions.
  • “Pharmaceutical composition” refers to a composition suitable for pharmaceutical use in a subject.
  • the pharmaceutical compositions of this invention comprise a pharmacologically effective amount of a compound of the invention and a pharmaceutically acceptable carrier.
  • “Pharmaceutically acceptable carrier” refers to any of the standard pharmaceutical carriers, buffers, and excipients, such as a phosphate buffered saline solution, 5% aqueous solution of dextrose, and emulsions, such as an oil/water or water/oil emulsion, and various types of wetting agents and/or adjuvants. Suitable pharmaceutical carriers and formulations are described in Remington 's Pharmaceutical Sciences, 19th Ed. (Mack Publishing Co., Easton, 1995).
  • Preferred pharmaceutical carriers depend upon the intended mode of administration of the active agent.
  • the compounds of the invention can be formulated for administration in a variety of ways.
  • Typical routes of administration include both enteral and parenteral. These include, without limitation, subcutaneous, intramuscular, intravenous, intraperitoneal, intramedullary, intrapericardiac, intrabursal, oral, sublingual, ocular, nasal, topical, transdermal, transmucosal, or anal.
  • the mode of administration can be, e.g. , via swallowing, inhalation, injection or topical application to a surface (e.g. , eyes, mucus membrane, skin).
  • Particular formulations typically are appropriate for specific modes of administration.
  • Various contemplated formulations include, for example, aqueous solutions, solid formulations, aerosol, gas, vapor or dry powder formulations and transdermal formulations.
  • aqueous solutions include, for example, water, saline, phosphate buffered saline, Hank's solution, Ringer's solution, dextrose/saline, glucose solutions and the like.
  • a preferred carrier for delivery of the tryptophan-containing compounds of this invention is normal (0.09%) saline solution.
  • compositions can contain pharmaceutically acceptable auxiliary substances as required to approximate physiological conditions, such as buffering agents, tonicity adjusting agents, wetting agents, detergents and the like.
  • Additives can also include additional active ingredients such as bactericidal agents, or stabilizers.
  • the solution can contain sodium acetate, sodium lactate, sodium chloride, potassium chloride, calcium chloride, sorbitan monolaurate or triethanolamine oleate.
  • compositions can be sterilized by conventional, well-known sterilization techniques, or can be sterile filtered.
  • the resulting aqueous solutions can be packaged for use as is, or lyophilized, the lyophilized preparation being combined with a sterile aqueous solution prior to administration.
  • Aqueous solutions are appropriate for injection (e.g. intravenous injection).
  • Aqueous solutions also are useful for enteral administration as tonics and administration to mucous or other membranes as, e.g. , nose or eye drops.
  • the composition can contain the compound in an amount of about 1 ⁇ g/ml to about 10 mg/ml, more preferably about
  • Solid compositions are appropriate for enteral administration. They can be formulated in the form of, e.g., pills, tablets, powders or capsules.
  • conventional solid carriers can be used which include, for example, pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharin, talcum, cellulose, glucose, sucrose, magnesium carbonate, and the like.
  • a pharmaceutically acceptable nontoxic composition is formed by incorporating any of the normally employed excipients, such as those carriers previously listed.
  • the carrier can be selected from various oils including those of petroleum, animal, vegetable or synthetic origin, for example, peanut oil, soybean oil, mineral oil, sesame oil, and the like.
  • suitable pharmaceutical excipients include starch, cellulose, talc, glucose, lactose, sucrose, gelatin, maltose, rice, flour, chalk, silica gel, magnesium stearate, sodium stearate, glycerol monostearate, sodium chloride, dried skim milk, glycerol, propylene glycol, water, ethanol, and the like.
  • a unit dosage form such as a tablet, can have about 1 ⁇ g to about 100 mg of the compound.
  • Topical Administration For Transdermal Or Transmucosal Delivery Systemic administration can also be by transmucosal or transdermal means. Transmucosal delivery is particularly attractive for treatment of HIV infection because it can be self-delivered easily.
  • penetrants appropriate to the barrier to be permeated can be used in the formulation. Such penetrations are generally known in the art, and include, for example, for transmucosal administration, bile salts and fusidic acid derivatives. In addition, detergents can be used to facilitate permeation.
  • Transmucosal administration can be through nasal sprays, for example, or using suppositories.
  • Transdermal delivery systems can include, e.g. , patches.
  • the agents are formulated into ointments, creams, salves, powders and gels.
  • the transdermal delivery agent can be DMSO.
  • the compound can be administered in a toothpaste.
  • the compound is preferably administered in the form of an aerosol or mist.
  • the compound preferably is supplied in finely divided form along with a surfactant and propellant.
  • the surfactant preferably is soluble in the propellant.
  • Representative of such agents are the esters or partial esters of fatty acids containing from 6 to 22 carbon atoms, such as caproic, octanoic, lauric, palmitic, stearic, linoleic, linolenic, olesteric and oleic acids with an aliphatic polyhydric alcohol or its cyclic anhydride such as, for example, ethylene glycol, glycerol, erythritol, arabitol, mannitol, sorbitol, the hexitol anhydrides derived from sorbitol, and the polyoxyethylene and polyoxypropylene derivatives of these esters.
  • the surfactant can constitute 0.1 %-20% by weight of the composition, preferably 0.25 % -5 % .
  • the balance of the composition is ordinarily propellant.
  • Liquefied propellants are typically gases at ambient conditions, and are condensed under pressure.
  • suitable liquefied propellants are the lower alkanes containing up to 5 carbons, such as butane and propane; and preferably fluorinated or fluorochlorinated alkanes. Mixtures of the above can also be employed.
  • a container equipped with a suitable valve is filled with the appropriate propellant, containing the finely divided compounds and surfactant. The ingredients are thus maintained at an elevated pressure until released by action of the valve.
  • a nebulizer or aerosolizer device for administering compounds of this invention typically delivers a dose of about concentration of between about 1 ⁇ g/m 3 and about 10 mg/m 3 .
  • compositions of the present invention it can be desirable to modify the complexes of the present invention to alter their pharmacokinetics and biodistribution.
  • pharmacokinetics See, Remington 's Pharmaceutical Sciences, supra, Chapters 37-39.
  • methods for altering pharmacokinetics and biodistribution include protection of the complexes in vesicles composed of substances such as proteins, lipids (for example, liposomes), carbohydrates, or synthetic polymers.
  • the tryptophan-containing compounds of this invention also can be incorporated into foodstuffs.
  • the compound may be incorporated in a soap for transdermal delivery during washing.
  • PROPHYLACTIC OR THERAPEUTIC TREATMENTS FOR INHIBITING RETROVIRAL INFECTION This invention provides methods for the prophylactic or therapeutic treatment of retroviral infection, including HIV infection.
  • “Infection” refers to the multiplication of a parasitic organism, e.g. , a virus, in a cell or in the body.
  • a subject is “infected” with a virus if the subject has detectable amount of the virus or antibodies that specifically bind to the virus in their body.
  • a “subject” of treatment is a mammal, including a human. Non-human animals subject to diagnosis or treatment include, for example, domesticated animals such as cats.
  • “Treatment” refers to prophylactic treatment or therapeutic treatment.
  • a “prophylactic” treatment is a treatment administered to a subject who does not exhibit signs of a disease or exhibits only early signs for the purpose of decreasing ' the risk of developing pathology.
  • a "therapeutic" treatment is a treatment administered to a subject who exhibits signs of pathology for the purpose of diminishing or eliminating those signs.
  • Retroviruses are known to cause a number of diseases. In humans, infection with HIV-1 or HIV-2 can lead to AIDS. Infection with the retrovirus HLPV1 can lead to T cell leukemia. The methods of this invention are useful in inhibiting viral replication of any these retroviruses in any of these diseases. Methods of inhibiting retroviral infection in a subject involve administering to the subject a pharmacologically effective amount of a tryptophan-containing compound of this invention. Single or multiple administrations of the compositions can be carried out with dose levels and pattern being selected by the treating physician. In any event, the pharmaceutical formulations should provide a quantity of a compound of this invention sufficient to treat the patient effectively.
  • the total effective amount of a compound of the present invention can be administered to a subject as a single dose, either as a bolus or by infusion over a relatively short period of time, or can be administered using a fractionated treatment protocol, in which the multiple doses are administered over a more prolonged period of time.
  • concentration of a compound of the present invention required to obtain an effective dose in a subject depends on many factors including the age and general health of the subject, the route of administration, the number of treatments to be administered and the judgment of the prescribing physician. In view of these factors, the skilled artisan would adjust the dose so as to provide an effective dose for a particular use.
  • tryptophan-containing compounds of this invention inhibit infection by retroviruses, they are useful in prophylactic treatments to prevent establishment of mfection in a subject who shows no signs of infection, but who may be at risk of exposure. Administration can begin when the person has been exposed or is suspected of having been exposed to the virus . Persons who are continually at risk of exposure also can be treated with the compound. This includes, for example, health care workers who are exposed to bodily fluids, or intravenous drug users.
  • an effective amount of a compound of this invention is about 1 ⁇ g/kg to about 10 mg/kg of the subject body mass.
  • a more preferable range is about 10 ⁇ g/kg to about 1 mg/kg.
  • about 50 ⁇ g/kg was found to be an effective amount.
  • doses can be given at least three times per week and usually not more than once a day (i.e. , seven times per week).
  • the course of treatment can continue for months.
  • the result of such treatment is a decrease in viral load. This decrease can be at least a factor of two and can be at least a factor of 10.
  • a person who is infected with HIV may show no other pathological sign. However HIV infection usually results in a decrease in CD4-positive cells. Administration of the compound is useful in such persons as a prophylactic against development of full-blown AIDS.
  • a person's CD4-positive cell count can drop below about 400 cells per mm 3 of blood.
  • Such persons are considered to have AIDS .
  • AIDS patients exhibit immunodeficiency. They are particularly subject to opportunistic infections and to opportunistic malignancies, such as Kaposi's sarcoma. In such cases, the compounds of this invention are useful in their immunostimulatory ability to boost immune response to the infection or malignancy.
  • Kaposi's sarcoma is an opportunistic malignancy characterized by a profusion of lesions invaded by blood vessels.
  • L-Glu-L-Trp has been shown to be effective in the treatment of Kaposi's sarcoma. Without wishing to be limited by theory, the anti-angiogenic property of L-Glu-L-Trp may contribute to the effectiveness of the compound in this treatment.
  • the methods of this invention involve administering the tryptophan-containing compounds of this invention with either or both of these drugs in a treatment regimen.
  • mice acute peritonitis model is a standard model for testing immune function. It tests the ability of mice to attenuate a microorganism in the presence or absence of a test compound after a challenge with a pathogen and administration of an antibiotic.
  • the efficacy of the antibiotic depends, in part, on immune system function. Animals having a strong immune response are more capable of withstanding the challenge than those having a weak immune response.
  • mice were given various doses of L-Leu-L-Trp or L-Glu- L-Trp. Then, they were inoculated with a 10 x LD50 dose of a pathogenic microorganism, S. aureus. Within an hour, the animals were administered ampicillin. The number of surviving animals after various numbers of hours was determined. The shock of infection challenges both the humoral and cell-mediated immune responses. Therefore, the test is an excellent indicator of overall immune system function.
  • L-Glu-L-Trp Treatment with L-Glu-L-Trp, L-Leu-L-Trp and L-Ile-L-Trp provided similar protection against infection. All animals in the control group died as a result of inoculation. Administration of ampicillin alone resulted in about 30% survival. In contrast, administration of between 10 mg/kg and 1000 mg/kg of either L-Leu-L-Trp or L-Glu-L-Trp and ampicillin saved over 80% of the animals.
  • L-Leu-L-Trp, L-Ile-L-Trp and L-Glu-L-Trp have similar activity in the acute peritonitis model and the fact that this test measures broad aspects of immune system function, one can expect L-Leu-L-Trp and L-Ile-L-Trp to have similar pharmacological function as L-Glu-L-Trp and to be useful in treatments in which L-Glu-L-Trp is useful.
  • Rauscher MuLV Model of Retroviral Infection In a murine retrovirus model used to screen treatments of HIV infection, administration of L-Glu-L-Trp inhibited virus proliferation.
  • the Rauscher MuLV model is established in the scientific community as a model for inhibiting retroviral, and therefore HIV, replication.
  • the FDA evaluates results using this model in applications for drugs for the treatment of HIV infection.
  • the murine leukemia virus like HIV, is a retrovirus, and it has a pathophysiology that closely parallels that of HIV. Infection with the murine leukemia virus results in immune incompetence, impairment of the lymphoproliferative system and erythroleukemia.
  • the control group had mean spleen mass of 0.09 gms.
  • the group exposed to the virus inoculum had a mean spleen mass of 2.39 gms.
  • animals treated with at least 1 ⁇ g/kg body mass of L-Glu-L-Trp showed less increase in spleen mass.
  • mice treated with 10 ⁇ g/kg body mass of L-Glu-L-Trp had mean spleen mass comparable to animals not inoculated with the virus - 0.08 gms.
  • Thymopentin Another immunomodulating thymic-derived peptide, thymopentin, was known as early as 1987 to increase numbers of lymphocytes and, in particular, to increase numbers of CD4-positive lymphocytes, in HIV-positive subjects exhibiting lymphadenopathy syndrome (LAS) or AIDS-related complex (ARC). Thymopentin is the major active component of a composition called thymostimulin.
  • L-Glu-L-Trp and thymostimulin were compared for their ability to stimulate T-helper lymphocyte activity in a cyclophosphamide-induced immunodeficiency model.
  • T-helper cells are CD4-positiv ⁇ .
  • L-Glu-L-Trp proved to be active at concentrations about 1000-fold lower than thymostimulin.
  • L-Glu-L-Trp and thymostimulin were compared for their ability to induce recovery of T-helper function in a cyclophosphamide-induced immunodeficiency animal model. Briefly, mice were immunized with sheep red blood cells on day 1. On day 2, cyclophosphamide was administered to the mice. From days 1-5 L-Glu-L-Trp or thymostimulin was administered to the mice intraperitoneally. T-helper cell activity was then tested with the Jerne plaque forming assay. The results show that L-Glu-L-Trp administered at doses between 0.1 to 10 ⁇ g/kg body mass had roughly the same activity as the administration of 1 mg/kg body mass of thymostimulin. These results confirm that reasonable evidence from the present results to conclude that L-Glu-L-Trp is an immunomodulating drug.
  • thymopentin is known to stimulate production of T-helper cells in immunodeficient HIV subjects.
  • L-Glu-L- Trp and thymopentin are immunomodulators and stimulate production of T-helper cell activity in an immunodeficiency animal model.
  • L-GLU-L-TRP IS EQUALLY OR MORE EFFECTIVE AT INHIBITING SPLENOMEGALY IN THE RAUSCHER MULV MODEL THAN IS AZT
  • Figure 1 is a graph entitled "L-Glu-L-Trp Influence Inhibiting
  • the graph presents the results of three studies on the ability of L-Glu-L-Trp or AZT to inhibit splenomegaly as a function of dose delivered. Increased percentages of inhibition of splenomegaly indicate increased inhibition of retroviral replication. Note that the dosages for L-Glu-L- Trp are plotted in terms of ⁇ g/kg, while the dosages for AZT are plotted in terms of mg/kg. That is to say, L-Glu-L-Trp is compared with AZT delivered at dosages one thousand times higher. The data presented in Fig.
  • smdies conducted under contract at three institutions: Southern Research Institute ("SRI”), Viromed, and Bio Research Laboratories ("BRL”). The studies were conducted using routine protocols for the MuLV model. As indicated in the graph, the smdies differed according to dose schedule. The study conducted at SRI involved a direct comparison of the ability of AZT and L-Glu-L-Trp to inhibit splenomegaly. The smdies at BRL and Viromed examined only L-Glu-L-Trp and are presented for purposes of corroboration. The data presented in Fig. 1 show that AZT tests positive in the Rauscher MuLV model for the ability to inhibit splenomegaly.
  • SRI Southern Research Institute
  • BRL Bio Research Laboratories
  • AZT represented by red triangles, inhibits splenomegaly maximally at about 40% (100 mg/kg in this study).
  • AZT a compound that tests positively in the model, is currently being used in the treatment of HIV infection to inhibit retroviral replication.
  • L-Glu-L-Trp is equally or more effective than AZT in inhibiting splenomegaly in the Rauscher MuLV model. More specifically, in a direct comparison between AZT (red triangles) and L-Glu-L-Trp (green circles, SRI Glu-Trp mcg/kg), L-Glu-L-Trp showed a greater maximal inhibition of splenomegaly than AZT, about 50% compared with about 40%. Furthermore, L-Glu-L-Trp showed maximal inhibition at about 2000- fold lower concentrations than AZT, that is, about 50 ⁇ g/kg compared with about 100 mg/kg. These results provide further supporting evidence of the effectiveness of L-Glu-L-Trp in the treatment of HIV infection.
  • the data in Fig. 1 also show the reproducibility of activity for L-Glu-L- Trp between the several smdies. More specifically, in each of the three smdies, L-Glu- L-Trp had maximal inhibitory activity in the range of about 10 ⁇ g/kg to about 100 ⁇ g/kg. It should be noted that, because the smdies involved different administration regimens and involved methods in which the ability of animal groups to become infected with the virus varied, there is some scatter in the results.
  • L-Glu-L-Trp was tested in a phase I/II investigation of the AIDS related malignancy known as Kaposi's sarcoma.
  • the protocol involved patients who have acquired a type of malignancy called Kaposi's sarcoma, which commonly occurs with AIDS patients who are at an advanced stage of their disease. Every patient in the study must have AIDS in order to be enrolled in the study protocol. Most of the patients already were taking protease inhibitors.
  • Study subjects are assigned to a specific dose regimen of L-Glu-L-Trp to be given intranasally in a single daily dose, either every other day, or on a schedule where they take the product for 5 consecutive days, followed by a rest off of the peptide for 5 days, after which the cycle is repeated.
  • the test for viral load for HIV was conducted by drawing blood from patients and storing it for analysis in a
  • the time interval to the left of the starting time represents the time prior to starting on L-Glu-L-Trp for which no change, or adverse changes were being followed, and at the top of each graph is a horizontal dark line indicating the medication (protease inhibitor) they were taking, and the time when a change in medication occurred.
  • the patient was taking no inhibitor.
  • Left vertical axis indicates # Raised lesions (square ( ⁇ ) .... darkest solid line on graph) , and the absolute CD4 count (diamond ( ⁇ ) dash line) .
  • Right vertical axis indicates HIV-RNA (copies per ml) (square (* )) ....
  • the slides are labeled as follows and represent 5 human subjects where evidence is strong showing L-Glu-L-Trp 's activity in reducing viral copies of HIV: Pt 61/TAR, Pt 62/F-G, Pt 64/JFS, Pt 67/J-S, Pt 68/IRD.
  • Fig. 2A Pt 61/TAR
  • Crixivan ® Merck & Co.
  • indinavir sulphate inoxivan ®
  • his viral load had remained essentially unchanged.
  • His cancer situation had worsened with a substantial increase in the number of raised lesions.
  • This subject had a very low CD4 count, approximately 8 to 40 over the entire period recorded.
  • the patient had been taking the protease inhibitor Saquinavir for 2 months prior to starting on the protocol with L-Glu-L-Trp. Cancer lesions had remained unchanged, and viral load was increasing.
  • the patient was on Crixivan for a period of 1 month before starting on L- Glu-L-Trp.
  • the cancer and HIV viral load were both rapidly increasing.
  • the cancer lesions reduced and he went into complete remission sustained to 7 months tracking.
  • the viral load for HIV dropped from 19,326 to 1,138 copies per ml. Note that while on Crixivan, the viral load had increased from 641 to 19,326.
  • the patient was taking no protease inhibitors prior to the s dy, and had no change in lesions prior to the start of the smdy.
  • Fig. 2E Pt 68/IRD The patient had been on Crixivan for 12 months prior to the start of L-
  • L-Leu-L-Trp and L-Ile-L-Trp have similar activity to L-Glu- L-Trp, as demonstrated by the acute peritonitis model, a model of general immune system function.
  • L-Glu-L-Trp demonstrates the ability to inhibit proliferation of retroviruses in an accepted model of HIV infection.
  • the administration of L-Glu-L-Trp as a nose drop inhibits viral replication.
  • each responded to peptide administration with a nearly 10-fold drop in viral copies per ml. A response in tumor reduction is noted as well.
  • the present invention provides novel materials and methods for the prophylactic and therapeutic treatment of retroviral and, in particular, HIV infection. While specific examples have been provided, the above description is illustrative and not restrictive. Many variations of the invention will become apparent to those skilled in the art upon review of this specification. The scope of the invention should, therefore, be determined not with reference to the above description, but instead should be determined with reference to the appended claims along with their full scope of equivalents. All publications and patent documents cited in this application are incorporated by reference in their entirety for all purposes to the same extent as if each individual publication or patent document were so individually denoted. Applicants do not admit by their citation of various references in this document that any particular reference is "prior art" to their invention.

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EP99916320A 1998-04-03 1999-04-02 Verwendung von l-glu-ltrp für behandlung der hiv-infektion Withdrawn EP1067951A2 (de)

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AU2001279313B2 (en) 2000-08-04 2007-03-01 Ampio Pharmaceuticals, Inc. Method of using diketopiperazines and composition containing them
CN102210852B (zh) * 2003-05-15 2016-10-19 安皮奥制药股份有限公司 T-细胞介导的疾病的治疗
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WO2012033792A2 (en) 2010-09-07 2012-03-15 Dmi Acquisition Corp. Treatment of diseases
MY172699A (en) 2011-10-10 2019-12-10 Ampio Pharmaceuticals Inc Implantable medical devices with increased immune tolerance, and methods for making and implanting
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JP6231484B2 (ja) 2011-10-28 2017-11-15 アンピオ ファーマシューティカルズ，インコーポレイテッド 鼻炎の処置
CA2906864A1 (en) 2013-03-15 2014-09-18 Ampio Pharmaceuticals, Inc. Compositions for the mobilization, homing, expansion and differentiation of stem cells and methods of using the same
KR20170045274A (ko) 2014-08-18 2017-04-26 앰피오 파마슈티컬스 인코퍼레이티드 관절 징후의 치료
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AU6359594A (en) * 1993-03-04 1994-09-26 Cytoven International N.V. Pharmaceutical tryptophan containing dipeptide compositions and methods of use thereof

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