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TW201615222A - 免疫疾病用藥臨床新應用 - Google Patents

免疫疾病用藥臨床新應用 Download PDF

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TW201615222A
TW201615222A TW104134954A TW104134954A TW201615222A TW 201615222 A TW201615222 A TW 201615222A TW 104134954 A TW104134954 A TW 104134954A TW 104134954 A TW104134954 A TW 104134954A TW 201615222 A TW201615222 A TW 201615222A
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cancer
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immune
drug
drugs
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陳丘泓
莊秀美
蕭乃文
梁瑞岳
筱彤 陳
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朗齊生物醫學股份有限公司
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Abstract

本發明提供多種免疫疾病用藥的新臨床之應用。該多種免疫疾病用藥皆是經過衛生署通過核准上市的免疫疾病用藥。本發明提供多種免疫疾病用藥有效的抑制不同類型的癌細胞。

Description

免疫疾病用藥臨床新應用
本發明係為多種免疫疾病用藥的新適應症之應用，尤其該多種藥物為通過臨床實驗且具有抑制多種癌症之用途。
癌症長期高居全球死因之首，且罹患癌症人數更是逐年攀升，因此治療癌症儼然成為重要的課題。癌症的治療可區分為手術治療、放射線治療、化學治療及標靶治療。
一般來說，癌症藥物治療無論是化學治療或標靶治療，目的多是讓癌細胞無法複製、分裂，來阻斷腫瘤的蔓延擴張。在臨床治療選擇上，通常會結合一到數種化療藥物以及標靶治療，希望能藉由不同機制來殺死癌細胞以提高治療效果，但事實上，還是常遇到患者對於治療藥物的反應不佳。進一步，許多癌細胞相繼產生抗藥性，使藥物的使用成效大幅降低，最終導致癌症治療失敗。
免疫力由兩大部分組成，一是細胞免疫，一是體液免疫。前者由T細胞組成，後者由免疫球蛋白組成。一旦當異體物質， 如細菌和各種異性蛋白侵入機體和危害機體健康時，免疫細胞就會將它們包圍、分解、吞噬予以消滅和清除，免疫球蛋白就會大量製造變成抗體加強對入侵者對抗。這就是正常人的免疫力和免疫的方法方式表現。正常的免疫是適度的及時的，在高級神經中樞調節控制下進行。如果調控失常，也會出現和發生不正常的免疫反應，這時不僅對機體無益，甚而會損害機體，形成新的疾病。這種病就稱之為自身免疫性疾病。
免疫疾病(Respiratory Diseases)，免疫調節失去平衡影響機體的免疫應答而引起的疾病。廣義的免疫性疾病還包括先天或後天性原因導致的免疫系統結構上或功能上的異常。
自身免疫性疾病是免疫系統對自身機體的成份發生免疫反應，造成損害而引發疾病。本來，正常情況下免疫系統只對侵入機體的外來物，如細菌、病毒、寄生蟲以及移植物等產生反應，消滅或排斥這些異物。在某些因素影響下，機體的組織成份或免疫系統本身出現了某些異常，致使免疫系統誤將自身成份當成外來物來攻擊。這時候免疫系統會產生針對機體自身一些成份的抗體及活性淋巴細胞，損害破壞自身組織臟器，導致疾病。這好比一支軍隊誤將它本該保護的主人當成了敵人，自己人打自己人。如果不加以及時有效的控制，其後果十分嚴重，最終甚至危害生命。
傳統觀念中，免疫疾病藥物之免疫抑制劑可能會降低人體的抗癌能力。在接受鈣調磷酸酶抑制劑治療的器官移植患者中，約有10%的患者在70個月後會發展出皮膚腫瘤或淋巴腫瘤。又有研究指出，傳統用於心臟移植的免疫抑制劑如Cyclosporine(Neoral)或Azathioprine(Azasan,Imuran)有致癌風險。已有研究指出Mirtazapine(Remeron,Avanza)可抑制大腸癌腫瘤生長。
發明人依據長年的研究經驗，人類的癌症細胞常常有與正常細胞具有不同的表現性狀，型態上的差異或是作用機轉的變化或許也有可能被視為一種外來的侵入者，而每一種癌症細胞所在的位置不同，變異的狀態又與所處的環境有關，因此，第一個提出使用免疫疾病用藥抑制癌症細胞的發明概念並且進行實驗。
相對的，在這些已經使用數十年免疫疾病用藥，是早已被FDA所認可的用藥，具有大量藥物機轉及人體研究成果資料，因此，若應用在癌症方面，這項新發展會更省時、減少成本，也能和其他治療方式結合來提高效果。目前尚未有任何研究針對本發明所使用之藥物，進行癌症治療研究。
儘管如此，藥物開發依然是重要的醫學議題，必須經過繁複的臨床前試驗才能進入臨床試驗，根據統計，平均每一萬個新藥約只有五個能夠進入第一期臨床試驗。此外，除了藥物本身 是否能大量製造的難題外，還需克服藥物安全性、病人篩選、試用劑量等問題，即便藥物已經通過FDA的核准並上市，亦有可能因上市後於人體發現不良反應而強制下架回收，由此可見藥物開發具有一定的困難程度。
為解決上述的問題，本發明係針對通過臨床實驗的多種藥物進行新適應症的研發，而達到老藥新用的目標。
經過實驗設計結果顯示免疫疾病用藥對正常細胞沒有或僅有微小的毒性，但至於免疫疾病用藥在正常細胞與腫瘤細胞之間是否具有選擇性的影響，還待更多的研究釐清，而且並非所有的免疫疾病用藥在相同的條件下均能有效的抑制腫瘤細胞，需要有許多的問題進行克服。
名詞定義
免疫疾病用藥依據藥物的結構可以分為四大類，包含免疫調節劑、免疫抑制劑、免疫增強劑、免疫促進劑及其他免疫疾病藥物。
第一大類：免疫調節劑(immunomodulator)是一種具有功能(化合物、蛋白質、多醣、藥物)可專致的或非專致的增加或減少免疫反應，也是說可以是增效劑(佐劑)，或免疫增進劑或免 疫抑制劑。現在發展的理想之免疫調節製劑，是一方面可抑制過敏反應或自我免疫反應，但另一方面則保留甚至增強對外來入侵物或癌細胞的抵抗作用。本發明中的免疫疾病用藥包含在本類別的有Thalidomide、Imiquimod、Doxitluridine、Oxymetazoline hydrochloride、Hydralazine hydrochloride、Calcium levofolinate、(+,-)-OctopamineHCl、Teriflunomide、Cinchophen。
第二大類：免疫抑制劑，可用以抑制或減少免疫作用的藥物。臨床上用以減少移殖器官或組織排斥(例如心臟、腎臟、肝臟、骨髓)以及治療自我免疫疾病(例如類風濕性關節炎、全身性紅斑狼瘡、重肌無力症等)，這些藥物會減低免疫功能對抗侵犯的外來物((例如微生物、細菌、病毒)感染。其他可能的副作用包括高血壓、血脂異常、高血糖、胃病、肝或腎傷害。臨床上有：醣皮質類固醇glucocorticoids、抗癌藥、抗體、作用在親免素(immunophilins)的藥物。本發明中的免疫疾病用藥包含在本類別的有Rapamycin、Mycophenolate mofetil、Cyclosporine、Prednisone、Azathioprine、Methylprednisolone、Pranlukast、Clemastine Fumarate、Penicillamine、Diphenhydramine HCl、Elvitegravir、Raltegravir、Prednisolone acetate、Prednisolone acetate、Droxidopa、Pidotimod。
第三大類：免疫增強劑，免疫增強劑是通過不同方式，達到增強機體免疫力的一類免疫治療藥物。臨床上常用於治療與免疫功能低下有關的疾病及免疫缺陷病。免疫增強劑種類很多，按其作用的先決條件可分為三類：(1)免疫替代劑，用來代替某些具有免疫增強作用的生物因子的藥物。按其作用機制可分為提高巨噬細胞吞噬功能的藥物，提高細胞免疫功能的藥物，提高體液免疫功能的藥物等；按其作用性質又可分為特異性免疫增強劑和非特異性免疫增強劑；按其來源則可分為細菌性免疫增強劑及非細菌性免疫增強劑。(2)免疫恢復劑，能增強被抑制的免疫功能，但對正常免疫功能作用不大。(3)免疫佐劑，又稱非特異性剌激劑。常用的免疫增強劑如：卡介苗、短小棒狀桿菌、內毒素、免疫核糖核酸、胸腺素、轉移因子、雙鏈聚核苷酸、佐劑等。本發明中的免疫疾病用藥包含在本類別的有Mirtazapine、Fenoprofen calcium hydrate。
第四大類：免疫促進劑。本發明中的免疫疾病用藥包含在本類別的有Fesoterodine fumarate、Rapamycin(Sirolimus)、ThalidomideImiquimod、Gabapentin Hydrochloride、Mycophenolate mofetil、(CellCept)、Cyclosporine(Neoral)、Prednisone(Adasone)、Azathioprine(Azasan,Imuran)、Methylprednisolone、 Pranlukast、Clemastine Fumarate、Penicillamine(Cuprimine)、Diphenhydramine HCl(Benadryl)、Elvitegravir(GS-9137)、Raltegravir(MK-0518)、Pyrimethamine、Mirtazapine(Remeron,Avanza)、Doxifluridine、Flunixinmeglumin、Fesoterodine fumarate(Toviaz)、Nateglinide(Starlix)、Oxymetazoline hydrochloride、Hydralazine hydrochloride、Prednisolone acetate(Omnipred)、Calcium levofolinate(Calcium Folinate)、Fenoprofen calcium hydrate、Droxidopa(L-DOPS)、Pidotimod、(+,-)-OctopamineHCl、Teriflunomide、Cinchophen、Plerixafor(AMD3100)。
本發明提供一種制備抑制癌症之醫藥組合物之方法，其中該醫藥組合物係選自由一免疫疾病藥物所組成群組之藥物。
本發明一實施例中，其中該免疫疾病藥物係選自免疫調節劑、免疫抑制劑、免疫增強劑、免疫促進劑及其他免疫疾病藥物所組成群組之藥物。
本發明一實施例中，其中該免疫疾病藥物係選自由非類固醇抗炎藥物、皮質類固醇類、免疫抑制藥物、免疫調節藥物及其他免疫疾病藥物所組成之藥物。
本發明一實施例中，其中該癌症係選自由肺癌、胃癌、肝癌、直腸癌、皮膚癌、子宮頸癌、腎臟癌、前列腺癌、膀胱 癌、乳癌及血癌所組成之群組。
本發明一實施例中，其中該癌症係選自由肺癌、腸道癌、大腸直腸癌、前列腺癌、肝癌、膀胱癌、子宮頸癌、乳癌及血癌所組成之群組。
本發明一實施例中，其中該藥物的有效劑量濃度為每日20mg/kg~500mg/kg。
現今癌症藥物費用動輒上萬至數百萬元，若未來更進一步證實免疫疾病用藥對腫瘤的療效，對於無法負擔昂貴治療的患者們，這些便宜而歷史悠久的藥物，會是帶來健康的新希望。
第一圖顯示本發明免疫疾病用藥應用於抑制癌細胞分析結果。
建立細胞株
請參考表一，將不同癌症類型的細胞株進行繼代培養，計算細胞數目後，回種2x106細胞數，然後加入培養該細胞株之培養液補至體積為10ml，繼續培養2-3天。之後將細胞計數，並分裝至96孔盤，其中每孔的細胞數目固定為3000顆，且體積為100ul。
IC50即半抑制濃度(或稱半抑制率)。在間接競爭ELISA標準曲線中是一個非常重要的資料，標準曲線是一個S型曲線。ICELISA中，不添加藥物的對照組的OD值定為B0，添加了藥物的實驗組的OD值為B，B/B0%就叫做結合率，在結合率為50%時所對應的藥物的濃度就叫做IC50。一般IC50的數值越小表示藥物的抑制效果越強。
細胞存活分析方法
將96孔盤中原有的培養液吸掉，每孔加入濃度10um、體積100ul的市售藥物，放置72小時後，每孔再加入100ul已稀釋的WST-1試劑，該稀釋比例為培養液與WST-1原液的體積比為9：1，最後每個孔盤的總體積為200ul，然後將96孔盤放置於37度30~90分鐘，利用ELISA reader於OD450偵測吸光值，並計算各癌症細胞株之存活率。
免疫疾病用藥應用於抑制癌細胞分析結果
免疫疾病用藥分為4大類，分別為免疫調節劑、免疫抑制劑、免疫增強劑及免疫促進劑。
實驗結果明顯的顯示有許多的免疫疾病用藥並無法有效的抑制癌症的細胞的生長(表二)。
而相對的各種的免疫疾病用藥分子對於各種癌症細胞的抑制效果也不盡相同(圖一)，經過發明人實驗結果，證實免疫疾病用藥藥物Rapamycin(Sirolimus)、Thalidomide、Imiquimod、Gabapentin Hydrochloride、Mycophenolate mofetil(CellCept)、 Cyclosporine(Neoral)、Prednisone(Adasone)、Azathioprine(Azasan,Imuran)、Methylprednisolone、Pranlukast、Clemastine Fumarate、Penicillamine(Cuprimine)、Diphenhydramine HCl(Benadryl)、Elvitegravir(GS-9137)、Raltegravir(MK-0518)、Pyrimethamine、Mirtazapine(Remeron,Avanza)、Doxifluridine、Flunixinmeglumin、Fesoterodine fumarate(Toviaz)、Nateglinide(Starlix)、Oxymetazoline hydrochloride、Hydralazine hydrochloride、Prednisolone acetate(Omnipred)、Calcium levofolinate(Calcium Folinate)、Fenoprofen calcium hydrate、Droxidopa(L-DOPS)Pidotimod、(+,-)-OctopamineHCl、Teriflunomide、Cinchophen、Plerixafor(AMD3100)等藥物對於不同的癌症細胞有明顯的抑制效果。(表三)
如表三所示，Rapamycin(Sirolimus)對胃癌有抑制效果；Thalidomide對肺癌，胃癌，肝癌，直腸癌，皮膚癌有抑制效果；Gabapentin Hydrochloride對肺癌，胃癌，皮膚癌有抑制效果；Mycophenolate mofetil(CellCept)對肺癌，胃癌，直腸癌，結腸癌，皮膚癌，前列腺癌，膀胱癌有抑制效果；肺癌，胃癌，肝癌，直腸癌，皮膚癌有抑制效果；Cyclosporine(Neoral)對肺癌，胃癌，結腸癌，皮膚癌，膀胱癌，乳癌，血癌有抑制效果；Prednisone(Adasone)對肺癌，胃癌有抑制效果；Azathioprine(Azasan,Imuran)對胃癌，乳癌有抑制效果；Methylprednisolone對皮膚癌，乳癌有抑制效果；Pranlukast對肺癌有抑制效果；Clemastine Fumarate對肺癌，胃癌，結腸癌，前列腺癌，乳癌有抑制效果；Penicillamine(Cuprimine)對肺癌，胃癌，乳癌有抑制效果；Diphenhydramine HCl(Benadryl)對胃癌，結腸癌有抑制效果；Elvitegravir(GS-9137)對肺癌，胃癌有抑制效果；Raltegravir(MK-0518)對肺癌，直腸癌，皮膚癌有抑制效果；Pyrimethamine對肺癌，胃癌，直腸癌，皮膚癌有抑制效果；Mirtazapine(Remeron,Avanza)對肺癌，直腸癌，皮膚癌有抑制效果；Doxifluridine對肺癌，胃癌，結腸癌，皮膚癌，乳癌有抑制效果；Flunixinmeglumin對胃癌有抑制效果；Fesoterodine fumarate(Toviaz)對胃癌，膀胱癌有抑制效果；Nateglinide(Starlix)對膀胱癌有抑制效果；Oxymetazoline hydrochloride對膀胱癌有抑制效果；Hydralazine hydrochloride對肺癌，膀胱癌有抑制效果；Prednisolone acetate(Omnipred)對肺癌，胃癌，結腸癌，皮膚癌，膀胱癌，乳癌，血癌有抑制效果；Calcium levofolinate(Calcium Folinate)對肺癌，胃癌，結腸癌， 前列腺癌，膀胱癌有抑制效果；Fenoprofen calcium hydrate對肺癌，胃癌有抑制效果；Droxidopa(L-DOPS)對肺癌，胃癌有抑制效果；Pidotimod對肺癌，胃癌，結腸癌，皮膚癌，膀胱癌有抑制效果；(+,-)-OctopamineHCl對直腸癌有抑制效果；Teriflunomide對血癌有抑制效果；Cinchophen對肺癌，直腸癌，皮膚癌有抑制效果；Plerixafor(AMD3100)對肺癌，皮膚癌有抑制效果。
重複性實驗
依據表三所示結果，針對對癌症細胞株有效之藥物進行重覆性實驗，其結果如表四所示。
上列詳細說明係針對本發明之一可行實施例之具體說明，惟該實施例並非用以限制本發明之專利範圍，凡未脫離本發明技藝精神所為之等效實施或變更，均應包含於本發明之專利範圍中。

Claims (7)

  1. 一種製備抑制癌症之醫藥組合物之方法，其中該醫藥組合物係選自由一免疫疾病藥物所組成群組之藥物。
  2. 如申請專利範圍第1項所述之方法，其中該免疫疾病藥物係選自免疫調節劑、免疫抑制劑、免疫增強劑、免疫促進劑及其他免疫疾病藥物所組成群組之藥物。
  3. 如申請專利範圍第2項所述之方法，其中該免疫調節劑係選自由Thalidomide、Imiquimod、Doxifluridine、Oxymetazoline hydrochloride、Hydralazine hydrochloride、Calcium levofolinate、(+,-)-OctopamineHCl、Teriflunomide及Cinchophen所組成之藥物。
  4. 如申請專利範圍第2項所述之方法，其中該免疫抑制劑係選自由Rapamycin、Mycophenolate mofetil、Cyclosporine、Prednisone、Azathioprine、Methylprednisolone、Pranlukast、Clemastine Fumarate、Penicillamine、Diphenhydramine HCl、Elvitegravir、Raltegravir、Prednisolone acetate、Prednisolone acetate、Droxidopa及Pidotimod所組成之藥物。
  5. 如申請專利範圍第2項所述之方法，其中該免疫增強劑係選自由Mirtazapine、Fenoprofen calcium hydrate所組成之藥物。
  6. 如申請專利範圍第2項所述之方法，其中該免疫促進劑係選自由Fesoterodine fumarate、Rapamycin(Sirolimus)、ThalidomideImiquimod、Gabapentin Hydrochloride、Mycophenolate mofetil、(CellCept)、Cyclosporine(Neoral)、Prednisone(Adasone)、Azathioprine(Azasan,Imuran)、Methylprednisolone、 Pranlukast、Clemastine Fumarate、Penicillamine(Cuprimine)、Diphenhydramine HCl(Benadryl)、Elvitegravir(GS-9137)、Raltegravir(MK-0518)、Pyrimethamine、Miitazapine(Remeron,Avanza)、Doxifluridine、Flunixinmeglumin、Fesoterodine fumarate(Toviaz)、Nateglinide(Starlix)、Oxymetazoline hydrochloride、Hydralazine hydrochloride、Prednisolone acetate(Omnipred)、Calcium levofolinate(Calcium Folinate)、Fenoprofen calcium hydrate、Droxidopa(L-DOPS)、Pidotimod、(+,-)-OctopamineHCl、Teriflunomide、Cinchophen及Plerixafor(AMD3100)所組成之藥物。
  7. 如申請專利範圍第1項所述之方法，其中該癌症係選自由肺癌、胃癌、肝癌、直腸癌、腎臟癌、皮膚癌、子宮頸癌、前列腺癌、膀胱癌、乳癌及血癌所組成之群組。
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