WO2003073997A2

WO2003073997A2 - Treatment of septic shock

Info

Publication number: WO2003073997A2
Application number: PCT/US2003/006350
Authority: WO
Inventors: Luis Molina; Ronald E. Keeney
Original assignee: Luis Molina; Keeney Ronald E
Priority date: 2002-03-01
Filing date: 2003-03-03
Publication date: 2003-09-12
Also published as: AU2003217862A1; AU2003217862A8; WO2003073997A3

Abstract

T he present invention relates to a method of treating gram-positive sepsis in a subject in need of treatment thereof, as well as a pharmaceutical composition useful for treating gram-positive sepsis.

Description

TREATMENT OF SEPTIC SHOCK

CROSS-REFERENCE TO RELATED PATENT APPLICATIONS

N/A

STATEMENT REGARDING GOVERNMENT RIGHTS

N/A

BACKGROUND OF THE INVENTION

Field of the Invention

The present invention relates to a method of treating gram-positive sepsis in a subject in need of treatment thereof, as well as a pharmaceutical composition useful for treating gram-positive sepsis.

Background of the Invention

Gram positive sepsis affects approximately one half of sepsis patients. Recent studies show an increasing incidence of gram-positive sources of sepsis. It appears that gram-positive organisms may also be more virulent in fomenting the disease. This may result from the ability of gram-positive organisms to produce more inflammation- causing cell wall constituents, as well as unbound exotoxms, Bone R.C. Arch. Inter.Med. 154, (1), 26-34 1994.

There are qualitative differences between sepsis/septic shock caused by gram negative bacteria (e.g. Escherichia coli) and gram positive bacteria(e.g. Staphylococcus aureus) (Hmshaw L.B. et al. Circ. Shock 26: 257-265, (1998) and Hmshaw L.B. et al. N. Engl. J. Med. 317: 659-655, (1987)). For instance, gram-positive organisms are better suited to invade host tissues generating a more vigorous phagocytic response than gram- negative organisms. The lack of endotoxin in the outer cell wall is compensated for by the presence of peptidoglycan, and secreted toxins in gram-positive bacteria, Sriskandan, S., Cohen, J. Infect.Dis. Clin.North Am. 13,(2), 397-412, 1999.

Because of these differences, some agents, developed for treating gram-negative infections, are not effective against gram-positive sepsis. For example, animal and clinical data suggest that, unlike endotoxin-mediated shock, gram-positive infection produces a modest tumor necrosis factor (TNF) response and does not respond to anti- TNF therapies, Sriskandan, S., Cohen, J. Infect.Dis. Clin.North Am. 13,(2), 397-412, 1999.

It has now been found that the transition metal complex diethylenetriaminepentaacetic acid iron (III) increases the survival rate in mice subjected to Staphylococcus aureus challenge in addition to its activite in an endotoxin model of sepsis, demonstrating that this treatment is particularly useful for treating gram-positive sepsis.

SUMMARY OF THE INVENTION

The present invention relates to a method of treating gram-positive sepsis in a subject in need of treatment thereof, comprising administering a pharmaceutically effective amount of a transition metal complex to said subj ect. The present invention also relates to a pharmaceutical composition comprising a pharmaceutically effective amount of a transition metal complex and pharmaceutically acceptable excipient.

BRIEF DESCRIPTION OF THE DRAWINGS

N/A DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention relates to a method of treating gram-positive sepsis in a subject in need of treatment thereof, comprising administering a pharmaceutically effective amount of a transition metal complex to said subject.

As used herein, the term subject is used to mean an animal, preferably a mammal, including a human or non-human. The terms patient and subject may be used interchangeably. Furthermore, the terms "condition" and "infection" may also be used interchangeably, herein.

The treatment envisioned by the current invention can be used in subjects with a pre-existing septic condition, or for patients pre-disposed to a septic condition or pre- disposed to a recurring septic condition. Additionally, the method of the current invention can be used to correct or compensate for cellular or physiological abnormalities involved in conferring susceptibility to gram-positive sepsis or infection in patients, and/or to alleviate symptoms of a gram-positive sepsis or infection in patients, or as a preventative measure in patients. Additionally, the method of the current invention can be used to alleviate symptoms caused by a septic condition in subjects. The terms treatment and therapy are used interchangeably.

Sepsis, as used herein should be obvious to one of ordinary skill in the art, and refers to an infection of microorganisms in a subject, or the conditions resulting from the presence of such microorganisms. For example, conditions that result from the presence of gram-positive infections can mean the poisonous condition arising from the presence of the microorganism's toxins in the blood of a subject. Other conditions arising from the presence of gram-positive infections include, but are not limited to abcesses, bacteremia, endocarditis, pneumonia, osteomyelitis, cellulitis, pharyngitis, scarlet fever, otitis externa, otitis media, sinusitis, erysipelas, toxic shock-like syndrome, meningitis, arthritis, acute rheumatic fever and urinary tract infections. As used herein, the phrase infection is used to mean an interaction between microorganism, for example a bacterial cell, and the host organism (subject). The infections may be localized, meaning that the bacteria grow, or its toxins remain, near the point of initial interaction. The infection may also be generalized, where the bacteria, or its toxins, may become more widespread beyond the initial point of interaction, including spreading to the surrounding tissue or organ and even being distributed and growing throughout the entire host organism, such as in the host's circulatory system. As used herein, the term interaction (of a host and microorganism) is used to mean a process where the microorganism invades and grows in or around a particular tissue, or cause a toxin to be produced that injures adjacent or distant tissues as a result of local spread or blood stream dissemination.

Types of gram-positive bacteria are well-known in the art and new species of gram-positive bacteria are easily identifiable using the standard Gram technique of staining. Specifically, gram-positive bacteria are identified by their ability to retain the crystal violet-iodine complex when subjected to a decolorizing agent. Examples of gram- positive bacteria include, but are not limited to, Lysteria monocytogenes, Bacillus anthracis, Bacillus, Enter ococcus, Streptococcus, Peptostreptococcus, Staphylococcus aureus, Staphylococcus epidermidis Clostridium perfringens, Clostridium difficile, Clostridium botulinum, Yersinia pestis (plague), and, Francisells tularensis (tularemia).

The treatment of gram-positive sepsis as used herein, comprises administering a pharmaceutically effective amount of a transition metal complex. A transition metal is easily recognizable by its position in the periodic table of elements. Although there may be some controversy in the scientific community, the elements zinc, cadmium and mercury are included as transition metals herein. As used herein, a complex of a transition metal is used to mean a transition metal that is linked to another compound or chemical agent. The linked compound or agent includes, but is not limited to, a chemical, a chelator, another element, such as chloride (e.g. FeCLf), a carbohydrate, a protein, a proteoglycan, a glycoprotein, a nucleotide or nucleic acid, and a polynucleotide. The linkage which forms the complex can be of any form, for example a covalent bond, an ionic bond, hydrophobic or hydrophilic forces.

In one embodiment, the transition metal complex administered in the present invention comprises iron. In another embodiment, the transition metal complex is selected from the group consisting of: Diethylenetriaminepentaacetic acid iron (III), Ferrioxamine B and Ferric pyridoxal isonicotinoyl hydrazone.

As used herein, "a pharmaceutically effective amount" is intended to mean an amount effective to elicit a therapeutic response that is clinically significant, without excessive levels of side effects. As with any therapy, the exact amount necessary to elicit the desired therapeutic response will vary from individual to individual, and will also vary with route of administration.

The transition metal complex used in the current invention need not be a pharmaceutical, although the quantity given must be a pharmaceutically effective amount. For example, in one embodiment, the transition metal complex comprises a composition, hi another embodiment, the transition metal complex, comprising a composition, is selected from the group consisting of pharmaceutical composition, a food or food additive. As used herein, composition can mean the pure compound or complex, or a mixture of two or more compounds, complexes, agents or substances.

In yet another embodiment, the composition used in the methods of the current invention is a pharmaceutical composition. The pharmaceutical composition of the present invention can be administered in any acceptable route. For example, the pharmaceutical composition can be administered orally, nasally, parenterally, by inhalation, intrasystemically, intraperitoneally, topically (as by drops or transdermally), bucally, or as an oral or nasal spray. The term "parenteral," as used herein, refers to modes of administration which include intravenous, intraarterial, intramuscular, intraperitoneal, intrasternal and subcutaneous injection and infusion. The pharmaceutical compositions as contemplated by the current invention may also include a pharmaceutically acceptable carrier.

The present invention also provides a pharmaceutical composition comprising a pharmaceutically effective amount of a transition metal complex and pharmaceutically acceptable excipient.

As previously described herein, a composition can be the pure compound or complex, or a mixture of two or more compounds, complexes, agents or substances. Substance, agent and compound are used interchangeably and examples of such include, but are not limited to, a chemical, a chelator, an element, such as chloride, a carbohydrate, a protein, a proteoglycan, a glycoprotein, a nucleotide or nucleic acid, and a polynucleotide.

As with any therapy, the exact amount necessary to elicit the desired therapeutic response will vary from individual to individual, and will also vary with route of administration. The pharmaceutical composition of the present invention can be administered in any acceptable route. For example, the pharmaceutical composition can be administered orally, nasally, parenterally, infrasystemically, intraperitoneally, topically (as by drops or transdermally), bucally, or as an oral or nasal spray or by aerosol inhalation. The term "parenteral," as used herein, refers to modes of administration which include intravenous, intraarterial, intramuscular, intraperitoneal, intrasternal and subcutaneous injection and infusion.

As used herein, a pharmaceutically acceptable excipient is an inert additive in the pharmaceutical composition. Examples of excipients include, but are not limited to carriers, diluents, binders, lubricants, glidants, disintegrants, coloring agents and flavoring agents. Excipients may be employed for any number of reasons, such as, for example, to enhance processing of the composition or to delay release of the active (controlled release formulations), to increase desirable physical characteristics (e.g., taste) of the dosage form or to prolong the bioactivity or bioavailability of the active substance.

The formulations include those suitable for types of administration previously described, although the most suitable route may depend upon for example the condition and disorder of the recipient. For example, the formulation may be best suited for oral or parenteral administration. The formulations may conveniently be presented in unit dosage form and may be prepared by any of the methods well known in the art of pharmacy. Preferred unit dosage formulations are those containing an effective dose, as herein below recited, or an appropriate fraction thereof, of the active ingredient. In general the formulations are prepared by uniformly and intimately bringing into association the active ingredient with liquid excipients or finely divided solid excipients or both and then, if necessary, shaping the product into the desired formulation.

A pharmaceutical composition of the present invention for parenteral injection can comprise pharmaceutically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions as well as sterile powders for reconstitution into sterile injectable solutions or dispersions just prior to use. Examples of suitable aqueous and nonaqueous carriers, diluents, solvents or vehicles include water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), carboxymethylcellulose and suitable mixtures thereof, vegetable oils (such as olive oil), and injectable organic esters such as ethyl oleate. Proper fluidity can be maintained, for example, by the use of coating materials such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.

Formulations for parenteral administration can also include anti-oxidants, buffers, bacteriostats and solutes which render the formulation isotonic with the blood of the intended recipient. Further, the suspensions may include suspending agents and thickening agents. The formulations may be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid carrier, for example, saline, water- for-injection, immediately prior to use. Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets of the kind previously described.

The compositions of the present invention can also contain adjuvants such as, but not limited to, preservatives, wetting agents, emulsifying agents, and dispersing agents. Prevention of the action of microorganisms in the formulation of the present invention can be ensured by the inclusion of various antibacterial and antifungal agents, for example, paraben, chlorobutanol, phenol, sorbic acid, and the like. It can also be desirable to include isotonic agents such as sugars, sodium chloride, and the like.

In some cases, to prolong the effect of the drugs, it is desirable to slow the absorption from subcutaneous or intramuscular injection. This can be accomplished by the use of a liquid suspension of crystalline or amorphous material with poor water solubility. The rate of absorption of the drug then depends upon its rate of dissolution which, in turn, can depend upon crystal size and crystalline form. Alternatively, delayed absorption of a parenterally administered drug form is accomplished by dissolving or suspending the drug in an oil vehicle. Prolonged systemic absorption of the injectable pharmaceutical form can also be brought about by the inclusion of agents which delay absorption such as aluminum monostearate and gelatin.

Injectable depot forms are made by forming microencapsule matrices of the drug in biodegradable polymers such as polylactide-polyglycolide. Depending upon the ratio of drug to polymer and the nature of the particular polymer employed, the rate of drug release can be controlled. Examples of other biodegradable polymers include poly(orthoesters) and poly(anhydrides). Depot injectable formulations are also prepared by entrapping the drug in liposomes or micro emulsions which are compatible with body tissues. The injectable formulations can be sterilized, for example, by filtration through a bacterial-retaining filter, or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved or dispersed in sterile water or other sterile inj ectable medium just prior to use.

Formulations of the present invention suitable for oral administration may be present as discrete units such as in solid forms such as capsules, cachets or tablets each containing a predetermined amount of the active ingredient; as a powder or granules; as a solution or a suspension in an aqueous or a non-aqueous liquid; or as an oil-in-water liquid emulsion or a water-in-oil liquid emulsion. The active ingredient may also be presented as a bolus, electuary or paste.

Solid dosage forms for oral administration include, but are not limited to, capsules, cachets, tablets, pills, powders, and granules. In such solid dosage forms, the active compounds can be mixed with at least one item pharmaceutically acceptable excipient such as sodium citrate or dicalcium phosphate and/or a) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and silicic acid, b) binders such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidone, sucrose, and acacia, c) humectants such as glycerol, d) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate, e) solution retarding agents such as paraffin, f) absorption accelerators such as quaternary ammonium compounds, g) wetting agents such as, for example, acetyl alcohol and glycerol monostearate, h) absorbents such as kaolin and bentonite clay, and i) lubricants such as talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, and mixtures thereof. In the case of capsules, tablets and pills, the dosage form can also comprise buffering agents.

A tablet may be made by compression or moulding, optionally with one or more accessory ingredients. Compressed tablets may be prepared by compressing in a suitable machine the active ingredient in a free-flowing form such as a powder or granules, optionally mixed with a binder, lubricant, inert diluent, lubricating, surface active or dispersing agent. Moulded tablets may be made by moulding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent. The liquids may optionally be coated or scored and may be formulated so as to provide slow or controlled release of the active ingredient therein.

Solid compositions of a similar type can also be employed as fillers in soft and hard filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polyethylene glycols and the like.

The solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings and other coatings well known in the pharmaceutical formulating art. They can optionally contain opacifying agents and can also be of a composition that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner. Examples of embedding compositions which can be used include polymeric substances and waxes.

The active compounds can also be in micro-encapsulated form, if appropriate, with one or more of the above-mentioned excipients.

Liquid dosage forms for oral administration include, but are not limited to, pharmaceutically acceptable emulsions, solutions, suspensions, syrups and elixirs. In addition to the active compounds, the liquid dosage forms can contain inert diluents commonly used in the art such as, for example, water or other solvents, solubilizing agents and emulsifiers such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, dimethyl formamide, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor, and sesame oils), glycerol, tetrahydrofurfuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof. Besides inert diluents, the oral compositions can also include adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, and perfuming agents.

Suspensions, in addition to the active compounds, can contain suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, and tragacanth, and mixtures thereof.

Alternatively, the composition can be pressurized and contain a compressed gas, such as nitrogen or a liquefied gas propellant. The liquefied propellant medium and indeed the total composition is preferably such that the active ingredients do not dissolve therein to any substantial extent. The pressurized composition can also contain a surface active agent. The surface active agent can be a liquid or solid non-ionic surface active agent or can be a solid anionic surface active agent. It is preferred to use the solid anionic surface active agent in the form of a sodium salt.

Formulations for inhalation may be presented as dry powders, solutions and suspensions to be delivered by dry powder inhaler devices, metered-dose aerosolization, nebulization or electrostatically generated atmospheric suspensions (clouds).

Formulations for rectal administration may be presented as a suppository with the usual carriers such as cocoa butter or polyethylene glycol.

Formulations for topical administration in the mouth, for example buccally or sublingually, include lozenges comprising the active ingredient in a flavoured basis such as sucrose and acacia or tragacanth, and pastilles comprising the active ingredient in a basis such as gelatin and glycerin or sucrose and acacia.

The compositions of the present invention can also be administered in the form of liposomes. As is known in the art, liposomes are generally derived from phospholipids or other lipid substances. Liposomes are formed by mono- or multi-lamellar hydrated liquid crystals that are dispersed in an aqueous medium. Any non-toxic, physiologically acceptable and metabolizable lipid capable of forming liposomes can be used. The present compositions in liposome form can contain, in addition to the compounds of the invention, stabilizers, preservatives, excipients, and the like. The preferred lipids are the phospholipids and the phosphatidyl cholines (lecithins), both natural and synthetic. Methods to form liposomes are known in the art (see, for example, Prescott, Ed., Meth. Cell Biol. 14:33 et seq (1976)).

One of ordinary skill will appreciate that effective amounts of the agents of the invention can be determined empirically and can be employed in pure form or, where such forms exist, in pharmaceutically acceptable salt, ester or prodrug form. The agents can be administered to a subject, in need of treatment of gram-positive sepsis, as pharmaceutical compositions in combination with one or more pharmaceutically acceptable excipients. It will be understood that, when administered to a human patient, the total daily usage of the agents or composition of the present invention will be decided by the attending physician within the scope of sound medical judgement. The specific therapeutically effective dose level for any particular patient will depend upon a variety of factors: the type and degree of the cellular or physiological response to be achieved; activity of the specific agent or composition employed; the specific agents or composition employed; the age, body weight, general health, sex and diet of the patient; the time of administration, route of administration, and rate of excretion of the agent; the duration of the treatment; drugs used in combination or coincidental with the specific agent; and like factors well known in the medical arts. For example, it is well within the skill of the art to start doses of the agents at levels lower than those required to achieve the desired therapeutic effect and to gradually increase the dosages until the desired effect is achieved.

Dosing can also be arranged in a patient specific manner to provide a dose of from about 0.1 mg/kg/day to 100 mg/kg/day. Further, dosing can also be arranged to provide a predetermined concentration of the agents in the blood, as determined by techniques accepted and routine in the art. Thus patient dosing can be adjusted to achieve regular on-going blood levels, as measured by HPLC, on the order of, for example, from 50 to lOOO ng/ml.

When the transition metal complexes are given by injection, this will normally be in the form of an intravenous bolus or by infusion. The dose range for adult humans is generally from 7mg to 2.5g/day. Tablets or other forms of presentation provided in discrete units may conveniently contain an amount of compound of the invention which is effective at such dosage or as a multiple of the same, for instance, units containing 5mg to 500 mg, usually around lOmg to 200mg.

It will be readily apparent to one of ordinary skill in the relevant arts that other suitable modifications and adaptations to the methods and applications described herein can be made without departing from the scope of the invention or any embodiment thereof.

The following examples are meant to be illustrative only. They are not intended to limit the scope of the disclosure in any way.

Examples

Example 1 : Material

Diethylenetriaminepentaacetic acid iron (III) is commercially available from Sigma- Aldrich, Milwaukee WL

Example 2: Septic Shock in vivo Model (Live Bacteria Induced Septic Shock in Mice) The Live Bacteria Septic Shock Model in Mice is used to test compounds for their capacity to ameliorate gram positive induced septic shock.

Male CD-I mice, 25-30g (Charles River) were injected i.v. with 2xlOⁿ colony forming units per kg (CFU/kg). Two hours later the mice were injected i.v. with 20 mg/kg of Ampicillin. The drugs were dissolved or suspended in saline for intravenous dosing. Mice were monitored over the next 48 hours for survival. The results of the experiment are given in Table 1.

TABLE 1

^a Compounds dosed iv at lOmg/kg in saline at indicated times after injection of live bacteria

DTPA Iron (III) - diethylenetriaminepentaacetic acid iron (III)

Claims

WHAT IS CLAIMED IS:

1. A method of treating gram-positive sepsis in a subject in need of treatment thereof, comprising administering a pharmaceutically effective amount of a transition metal complex to said subject.

2. The method of claim 1 wherein said transition metal complex comprises diethylenetriaminepentaacetic acid iron (III).

3. The method of claim 1 wherein said transition metal complex is selected from the group consisting of: Diethylenetriaminepentaacetic acid iron (III), Ferrioxamine B and Ferric pyridoxal isonicotinoyl hydrazone.

4. The method of claim 1, wherein said transition metal complex comprises a composition.

5. The method of claim 4, wherein said composition is selected from the group consisting of pharmaceutical composition, a food or food additive.

6. The method of claim 5, wherein said composition is a pharmaceutical composition.

7. The method of claim 6, wherein said pharmaceutical composition is administered orally, by inhalation, parenterally, intravenously, mtraarterially, intrathecally, subcutaneously, intramuscularly, transdermally, or rectally.

8. The method of claim 6, wherein said composition administered orally, parenterally, intravenously, mtraarterially, intrathecally, subcutaneously, intramuscularly, transdermally, or rectally.