# Patent

## Title
Treatment of osteoarthritis

## Abstract

There is provided a therapeutic agent for treating osteoarthritis, which is a drug comprising hyaluronan as an active ingredient. The hyaluronan is preferably a tetrasaccharide including two units, with a single unit being -D-glucuronic acid-β-1,3-D-N-acetylglucosamine-β-1,4- (HA4).

## Background
TECHNICAL FIELD
The present invention relates to a therapeutic agent for osteoarthritis comprising hyaluronan as an active ingredient.
BACKGROUND ART
Hyaluronan is a long-chain polysaccharide comprising disaccharide repeats of D-glucuronic acid and N-acetyl-D-glucosamine, and it is also known as an oligosaccharide. Hyaluronan is produced from an extract of a body tissue such as the cock's crest, umbilical cord, skin, or synovial fluid, by fermentation using bacteria of the genus Streptococcus, or the like. Since it has no toxicological or immunological effects, hyaluronan is utilized in drugs or cosmetics. For example, treatment of arthritis using an intraarticular injection of hyaluronan is well known. In the following description, HA4 denotes a tetrasaccharide hyaluronan.
It has been reported that HA4 has effects of preserving organs and treating/suppressing hepatopathy and stomach ulcers (Patent Document 1). Furthermore, HA4 is also known to have actions of enhancing the expression of stress proteins and inhibiting cell death (Non-patent Document 1).
Osteoarthritis is a joint disease associated with chronic arthritis, in which degeneration of components of the joint leads to destruction of the cartilage and proliferative change of the bone and cartilage. Furthermore, arthritis (synovitis) occurs secondarily due to the above-mentioned change. At an early stage, pain occurs after overuse of a joint and is relieved with rest. When the disease progresses, pain occurs even during light exercise or at rest, and night pain is often noted. Strong joint bending or extending or exercise makes a rapping noise, and accumulation of a synovial fluid may also occur due to the arthritic swollen joint.
On top of the degeneration of joint components (change with aging), genetic factors, aging, obesity, joint instability, repeated subluxation and luxation, excessive loads on joints due to labor, playing sports, and the like, and so forth are associated with progression of the disease.
Early treatments include administration of anti-inflammatory or analgesic drugs and application of a poultice or a tape containing an analgesic to relieve the pain. Exercise for strengthening the quadriceps femoris is effective for treatment of the knees. Exercise for abduction (lying and raising a leg) is effective for treatment of the hip joints. The use of a cane is also effective for osteoarthritis in the knee or hip joints since it reduces the load on the joints. Intraarticular injection of a joint protecting drug is also effective. Intraarticular steroid injection therapy should be performed with care since it may accelerate joint destruction if abused. When pain or degeneration is severe, surgical operations such as osteotomy and replacement with an artificial joint are indicated for treatment of the knee or hip joint.

    [Patent Document 1] WO2002/004471
    [Non-patent Document 1] Xu H, Ito T, Tawada A, Maeda H, Yamanokuchi H, Isahara K, Yoshida K, Uchiyama Y, Asari A. Effect of hyaluronan oligosaccharides on the expression of heat shock protein 72. J Biol Chem. 2002 10; 277(19): 17308-14.


DISCLOSURE OF THE INVENTION
An object of the present invention is to provide a therapeutic agent for treating osteoarthritis.
The therapeutic agent for treating osteoarthritis of the present invention, which achieves the above-mentioned object, includes hyaluronan as an active ingredient.
Since the drug of the present invention includes hyaluronan as an active ingredient, it has an advantage that it can be easily mass-produced at relatively low cost. Furthermore, since hyaluronan has virtually no toxicity or antigenicity and enhances therapeutic actions and disease preventing actions originally presented in organism, it is anticipated as a therapeutic agent with minimal adverse drug reactions. Thus, according to the present invention, a novel drug effective for treating osteoarthritis can be provided.


BEST MODE FOR CARRYING OUT THE INVENTION
Hereafter, the present invention will be explained in detail. In the following explanation, the therapeutic agent of the present invention will be simply referred to as a drug.
It is sufficient that hyaluronan contained in the drug of the present invention be a di- or higher saccharide basically containing at least one disaccharide unit being β-D-glucuronic acid at the 1st position and β-D-N-acetylglucosamine at the 3rd position linked to each other, and composed of basically 3-D-glucuronic acid and β-D-N-acetylglucosamine. Hyaluronan may also be a saccharide containing these elements bound to one or more disaccharide units or a derivative thereof. For example, hyaluronan having a hydrolysable protection group such as an acyl group and the like can also be used. This saccharide may be an unsaturated saccharide, and examples of the unsaturated saccharide include saccharides with a nonreducing end, glucuronic acid usually with unsaturation between carbons at the 4th and 5th positions, and so forth. Specifically, as hyaluronan used in the present invention, those extracted from natural products such as from animals, obtained by culturing microorganisms, chemically or enzymatically synthesized, and so forth can be used. For example, it can be obtained from body tissues such as the cock's crest, umbilical cord, skin, and synovial fluid by known extraction and purification methods. Furthermore, it can also be produced by fermentation using bacteria of the genus Streptococcus. 
In the present invention, hyaluronan oligosaccharides are also encompassed in the scope of hyaluronan, and hyaluronans from those having a low molecular weight such as the above-mentioned disaccharide including one disaccharide unit and derivatives thereof, to high molecular weight hyaluronans having an average molecular weight of 4,000,000, can be used. Preferred examples thereof include hyaluronans having an average molecular weight of about 380 to 900,000, which are excellent in permeability in tissues and the like, and hyaluronans comprising about 2 to 20 saccharide units are more preferable.
Among hyaluronans, those having a low molecular weight are preferably produced, specifically, by methods for reducing the molecular weight of hyaluronan by known techniques such as enzymatic degradation, alkaline degradation, heat treatment, and ultrasonication (Biochem., 33 (1994) p 6503-6507), chemical or enzymatic synthesis method (Glycoconjugate J., (1993) pp. 435-439; WO93/20827), and the like. Examples of the enzymatic degradation technique include methods for producing hyaluronan oligosaccharides by acting enzymes that degrade hyaluronan such as hyaluronan degrading enzymes (hyaluronidase derived from the testicle, hyaluronidase derived from Streptomyces, hyaluronidase SD, etc.), chondroitinase AC, chondroitinase ACII, chondroitinase ACIII, and chondroitinase ABC on hyaluronan (refer to New Biochemistry Experiment Lecture “Carbohydrate II: Proteoglycan and glycosaminoglycan,” pp. 244-248, 1991, Tokyo Kagaku-dojin Publishing Company, Inc.), and so forth.
Furthermore, examples of the alkaline degradation technique include a method for obtaining hyaluronan having a low molecular weight comprising the steps of adding a base such as about 1 N sodium hydroxide to a hyaluronan solution, heating the mixture for several hours to reduce the molecular weight, and adding an acid such as hydrochloric acid to neutralize the mixture, and so forth. The hyaluronan used in the present invention encompasses the form of a salt, and pharmacologically acceptable salts thereof can be used, if necessary, for formulation. For example, alkali metal salts such as sodium salts and potassium salts, alkaline earth metal salts such as calcium salts and magnesium salts, amine salts such as tri(n-butyl)amine salts, triethylamine salts, pyridine salts, and amino acid salts, and so forth.
The drug of the present invention is not particularly limited, and hyaluronan having a certain molecular weight can be used alone, or hyaluronans having various molecular weights may be used in combinations. The drug of the present invention comprises hyaluronan as an active ingredient, and osteoarthritis can be improved by administering an effective amount thereof to mammals including humans without adverse effect on an organism.
The drug of the present invention can be prepared using hyaluronan or a salt thereof as it is or with carriers, excipients, and other additives, if necessary, as a drug for oral or parenteral administration (interstitial administration such as intraarticular, intravenous, intramuscular, or subcutaneous administration (injection), enteral administration, percutaneous administration, etc.) in a freely selected dosage form, and is preferably administered to a patient by a freely selected method. It is particularly preferable to prepare the drug of the present invention as an oral formulation.
Examples of the oral formulation include solid formulations such as powders, granules, capsules, and tablets and liquid formulations such as syrups, elixirs, and emulsions. A powder can be obtained by mixing with, for example, an excipient such as lactose, starch, crystalline cellulose, calcium lactate, calcium hydrogen phosphate, magnesium aluminometasilicate, or anhydrous silicic acid. A granule can be obtained by further adding, for example, a binder such as sucrose, hydroxypropylcellulose, or polyvinylpyrrolidone, a binder such as carboxymethylcellulose or carboxymethylcellulose calcium, and a disintegrating agent such as carboxymethylcellulose or calcium carboxymethylcellulose, as required, in addition to the above-mentioned excipients and granulating the mixture by a wet or dry process. A tablet can be obtained by tableting the above-mentioned powder or granule as it is or adding a lubricant such as magnesium stearate or talc and tableting the mixture. Furthermore, the above-mentioned tablet or granule can be coated with an enteric vehicle such as hydroxypropylmethylcellulose phthalate, methyl methacrylate copolymers, or ethylcellulose, or Carunauba wax, hydrogenated oil, or the like to obtain an enteric or prolonged-action formulation. A hard capsule can be obtained by filling the above-mentioned powder or granule in a hard capsule. A soft capsule can be obtained by mixing hyaluronan or a salt thereof with glycerine, polyethylene glycol, sesame oil, olive oil, or the like and coating the mixture with a gelatin film. A syrup can be obtained by dissolving a sweetener such as sucrose, sorbitol, or glycerine and hyaluronan or a salt thereof in water. Furthermore, in addition to a sweetener and water, essential oil, ethanol, or the like can be added to obtain an elixir, or gum arabic, tragacanth, polysorbate 80, carboxymethylcellulose sodium, or the like can be added to obtain an emulsion or a suspension. Furthermore, flavoring agents, coloring materials, preservatives, and the like can be added to these liquid formulations as required.
Examples of the parenteral formulation include injection, intrarectal injection, pessary, transdermal topical agent, inhalant, aerosol, eye drops, and so forth. An injection formulation can be prepared by adding a pH modifier such as hydrochloric acid, sodium hydroxide, lactic acid, sodium lactate, monosodium hydrogen phosphate, or sodium dihydrogen phosphate; an isotonizing agent such as sodium chloride or glucose; and distilled water for injection, to hyaluronan or a salt thereof, sterilizing the mixture by filtration, and filling the mixture in an ampoule. Furthermore, an injection to be dissolved before use can be obtained by further adding mannitol, dextrin, cyclodextrin, gelatin, or the like and vacuum-freeze drying the mixture. Furthermore, an emulsion for injection can also be obtained by adding an emulsifier such as lecithin, polysorbate 80, or polyoxyethylene hydrogenated caster oil to hyaluronan or a salt thereof and emulsifying the mixture in water.
An intrarectal injection can be obtained by adding a vehicle for a suppository such as mono-, di-, or triglyceride of cacao fatty acid or polyethylene glycol to hyaluronan or a salt thereof, then dissolving with heating, pouring the mixture into a mold, and cooling it, or mixing hyaluronan or a salt thereof with polyethylene glycol, soybean oil, or the like and then coating the mixture with a gelatin film. A transdermal topical agent can be obtained by adding white Vaseline, beeswax, liquid paraffin, polyethylene glycol, or the like to hyaluronan or a salt thereof, heating the mixture, if necessary, and kneading the mixture. A tape can be obtained by kneading hyaluronan or a salt thereof with a tackifier such as rosin or an alkyl acrylate ester polymer and spreading the mixture on a non-woven fabric or the like. An inhalant can be obtained by dissolving or dispersing hyaluronan or a salt thereof in, for example, a propellant such as a pharmacologically acceptable inert gas and filling the mixture in a pressure-resistant container.
Administration Method
The method for administering the drug of the present invention comprising hyaluronan as an active ingredient is not particularly limited, and examples thereof include intravenous administration, oral administration, and intraarticular administration.
Dosage
The dosage is suitably determined depending on the disease to be treated, patient's age, health conditions, and body weight, and the like, and a common daily dose is 0.05 to 50 mg/kg which is taken once or divided into more than one dose.
Toxicity
The hyaluronan used in the present invention showed no or almost no cytotoxicity at doses at which biological activity as a medicament was observed.
EXAMPLES
The drug of the present invention will be explained more specifically with reference to the following examples. However, the technical scope of the present invention is not limited to these examples.
Example 1
In this example, HA4 was administered to C57BL/6 mice, which spontaneously develop osteoarthritis, to examine effects thereof.
Osteoarthritis Model Animal
20-week-old male C57BL/6 mice were purchased from Charles River Laboratories Japan, Inc., and animals which developed osteoarthritis were used. The animals were divided into the negative control (treated with physiological saline) group and the oral HA4 (100 mg/10 ml/kg) treated group.
Administration of Test Substance
In this example, 10 mg/ml HA4 was prepared. Specifically, HA4 was prepared by the method of Tawada et al. (Tawada A, Masa T, Oonuki Y, Watanabe A, Matsuzaki Y, Asari A. Large-scale preparation, purification, and characterization of hyaluronan oligosaccharides from 4-mers to 52-mers. Glycobiology. 2002; 12(7): 421-6.), and the concentration was adjusted with physiological saline. Furthermore, physiological saline was prepared as a control.
In this example, the test substance or physiological saline was orally given to mice which developed osteoarthritis using an oral sonde once daily for 2 weeks.
Macroscopic Examination
Osteoarthritis curing effects were determined macroscopically. Specifically, India ink was applied to the surface of the knee joint cartilage (shin bone and thigh bone) in all animals in each group and wiped with a gauze. The India ink remaining at the involved site was macroscopically examined using a blind and rated in 5 ranks (Table 1). For this evaluation method, refer to Chang D G, Iverson E P, Schinagl R M, Sonoda M, Amiel D, Coutts R D, Sah R L. Quantitation and localization of cartilage degeneration following the induction of osteoarthritis in the rabbit knee. Osteoarthritis Cartilage. 1997 September; 5(5): 357-72.










TABLE 1







SCORE
PERCENTAGE OF REMAINING INDIA INK









1
 0-20%



2
20-40%



3
40-60%



4
60-80%



5
 80-100%










Results

Results of macroscopic examination of osteoarthritis are shown in Table 2.









TABLE 2







SCORE FOR



EACH ANIMAL




















PHYSIOLOGICAL
5, 5, 4, 5, 5
MEAN 4.8



SALINE GROUP



HA4 GROUP
1, 2, 1, 2, 1
MEAN 1.4










As a result of this example, therapeutic effects against osteoarthritis were confirmed in the HA4 treated group. This result demonstrated that a drug comprising hyaluronan as an active ingredient suppresses osteoarthritis.

## Claims

1. A method for treating osteoarthritis comprising a step of administering an effective amount of hyaluronan to a subject in need of such treatment, wherein the hyaluronan is a tetrasaccharide containing two units, with a single unit being -D-glucuronic acid-β-1,3-D-N-acetylglucosamine-β-1,4- and wherein the hyaluronan is orally administered.

2. The method according to claim 1, wherein the hyaluronan is orally administered daily.

3. The method according to claim 2, wherein the hyaluronan is orally administered daily in an amount between about 0.05 to about 50 mg/kg.