ANTIINFLAMMATORY AGENTS

Abstract: Use of a polysaccharide selected from the group consisting of sulfated acid mucopolysaccharides and sulfated dextrans, and physiologically acceptable salts thereof for prophylaxis or treatment of inflammations, particularly an adult respiratory distress syndrome (ARDS), ischemic heart diseases, ischemic cerebral diseases, chronic articular rheumatism, atopic dermatitis, and infiltration after organ implantation.

Description: This invention relates to the use of a sulfated hyaluronic acid or its physiologically acceptable salt for preparing a medicament for treatment or prophylaxis of inflammation. Nowadays, corticoids or various non-steroidal anti-inflammatory agents are clinically widely used for the purpose of preventing complications due to inflammation. However, since although corticoids exhibit a strong anti-inflammatory action, grave side effects such as induction of infectious diseases accompany the action, they cannot serially be administered, and non-steroidal anti-inflammatory agents have only weak efficacy in general. Therefore, it is still needed to develop anti-inflammatory agents exhibiting almost no side effect and yet having sufficient efficacy. Incidentally, in the screening systems by which anti-inflammatory agents as mentioned above had been developed, anti-prostaglandin actions (e.g., phospholipase A2 inhibition, cyclooxygenase inhibition, lipoxygenase inhibition) had generally been used as a measure. On the other hand, in this invention, the present inventors intend to solve the above problems from the viewpoint that an utterly novel-type of anti-inflammatory agents may probably be developed by utilizing a screening system constructed based on the findings on induction of inflammation being clarified recently (i.e., a screening system using as a measure inhibition of influx of neutrophils, more specifically, selectin-mediated inhibition of adhesion of neutrophils to vascular endothelial cells). In order to clarify the sense of the screening system used in the invention, the findings of its background are outlined below. For example, inflammation is speculated to be induced by molecules promoting adhesive interactions between leukocytes and vascular endothelial cells, and it has also come to be clarified that certain adhesion promoting molecules play an important role for promotion of the adhesive interaction. Further, it is also revealed that adhesion promoting molecules exist in both leukocytes and activated vascular endothelial cells (blood vessel at the inflammation site), and interactions between these adhesion promoting molecules are the first indispensable stage for influx of leukocytes to the inflammatory site. These adhesion promoting molecules are molecules found in both leukocytes and activated vascular endothelial cells, and selectin family and integrin family are the most important as the molecules. On the other hand, it is also reported to use, for control of the above interactions, monoclonal antibodies (Eur. J. Immunol., 23 , 2181 - 2188, 1993), peptides and further certain oligosaccharides (J. Cell Biol., 99 , 1535, 1984; Tednok et al., J. Cell Biol., 104, 713, 1987; Blood, 70 , 1842, 1987). Further, although leukocytes adhere to endothelial cells in the lymph node through the above action of selectin, it is clarified that this response is inhibited by certain sulfate radical-containing compounds (J. Cell Biol., 111 , 1225, 1990). It is still further reported that inflammatory response can be inhibited in various laboratory animal model by inhibiting the above adhesive interactions (J. Immunol., 150 ,2407; J. Immunol., 150, 1074 etc.). WO-A-94/18989 discloses that heparin and heparin-like polysaccharides etc. can successfully be used for the treatment of acute lung injury. EP-A-0 214 879 and EP-A-0 208 623 disclose that sulfated polysaccharides, e.g., sulfated heparin, heparan sulfate, dermatan sulfate, chondroitin sulfate and hyaluronic acid, inhibit elastase activity in elastase/cathepsin system, and thus can be used for the prophylaxis or the treatment of blood coagulation disorder, thrombosis and atherosclerosis which are accompanied with inflammation, and that said sulfated polysaccharides are further usable for the prophylaxis or the treatment of connective tissue disorders etc. WO-A-88/07060 discloses polysulphated polysaccharide derived from hyaluronic acid, as an example of compounds capable of maintaining the integrity of connective tissue. WO-A-95/25751 which is a document according to Article 54(3) EPC discloses that sulfated hyaluronic acid is usable as anti-inflammation agents in the treatment of TNF-mediated inflammation, systemic toxicity and related pathologies. WO-A-89/05646 discloses the use of sulphated saccharides as anti-inflammatory agents. JP-A-52-035710 discloses compounds which are obtained by subjecting chondroitin sulphuric acid to further sulphation. JP-A-80-92103 which is a document according to Article 54(3) EPC discloses sulfated polysaccharides such as fucoidan or dextran sulfate for the treatment of inflammation. WO-A-94/26759 discloses that a fragment of naturally occurring heparin or heparin-like molecule such as heparan sulfate is used for the treatment of arthritis, asthma, ARDS, etc. EP-A-0 717 995 which is a document according to Article 54(3) EPC discloses that synthetic sulfated saccharide such as chondroitin sulfate, heparitin sulfate, keratan sulfate, dextran sulfate and galactose sulfate is an inhibitor for selectin. WO-A-92/18545 discloses sulfated heparin derivatives for the treatment of ischemic heart diseases. However, it is not clarified whether or not these monoclonal antibodies, peptides, oligosaccharides and sulfate radical-containing compounds can actually be used as anti-inflammatory agents. The present inventors found that the neutrophil-dependent, oxygen radical-mediated and P-, L- or E-selectin-dependent inflammation model obtained by intravenous administration to rats of cobra venom factor (hereafter, sometimes abbreviated as "CVF"), recently proposed in M.S. Mulligan et al., Nature , 364, 149-151, 1993, is an excellent screening method for anti-inflammatory agents. More specifically, they found that specific polysaccharides such as sulfated hyaluronic acid screened using the above laboratory animal model exhibit excellent anti-inflammatory actions, and can, particularly, be used for prophylaxis or treatment of adult respiratory distress syndrome (ARDS). This syndrome is such a grave disease that 50 to 70% of patients suffering therefrom die ( Igaku no Ayumi , 168 (no. 6), 626-631). It was further found that since substances screened using the above laboratory animal model inhibit the influx of neutrophils to the vascular endothelial adhesion tissue mediated by selectin, these substances show efficacy not only on ARDS but widely on general inflammations, and show efficacy further on ischemic heart diseases, ischemic cerebral diseases, chronic articular rheumatism, atopic dermatitis and infiltration after organ implantation. In this connection, although it is suggested that sulfates of various saccharides including sulfated hyaluronic acid is usable for treatment of diseases caused by human immunodeficiency viruses (Japanese Patent Publication No. 7577/1990), it has not hitherto been disclosed in technical literatures that these saccharides can be used as anti-inflammatory agents. The present invention relates to the use of a sulfated hyaluronic acid or its physiologically acceptable salt for preparing a medicament for the treatment of an inflammation selected from the group consisting of an adult respiratory distress syndrome (ARDS), ischemic heart diseases, ischemic cerebral diseases, chronic articular rheumatism, atopic dermatitis, and infiltration after organ implantation. Sulfated hyaluronic acid is a compound obtained by sulfating hyaluronic acid (a straight-chain high molecular saccharide formed by alternate bond of β-D-N-acetyglucosamine and β-D-glucuronic acid) derived from comprehensive natural sources, for example connective tissues of mammals, cockscombs of chickens, gastroantral membranes of silkworms, capsules of streptococci, etc. Since although as to hyaluronic acid varience of molecular weight generally exists depending on the kind of sources, ununiformity on structure is not known, hyaluronic acid of any source can be used. However, in view of availability, hyaluronic acid derived from streptococci, although not limited thereto, can conveniently be used. A specific example thereof is hyaluronic acid prepared according to a process as described in Japanese Laid-Open Patent Publication No. 26692/1983. This has, in general, a molecular weight of about 2,000 kDa. Hyaluronic acid is, if desired, adjusted for molecular weight by partial hydrolysis or the like, and when the rapid action of the final product is expected, one having a low molecular weight (hereafter abbreviated as LMWHA) is used for the succeeding sulfation treatment, and when the prolonged action thereof is expected, one having a high molecular weight (hereafter abbreviated as HMWHA) is used therefor. Although hyaluronic acid can be sulfated according to a process known per se, a process comprising using a sulfuric acid-trimethylamine complex as a sulfating agent is preferable. The use ratio between hyaluronic acid and a sulfating agent can freely be chosen in accordance with the sulfation rate (or sulfur content) of the desired sulfated hyaluronic acid and the reaction conditions. In general, when the reaction is carried out at a temperature of 50 to 60°C over a period from scores of hours to several days, the amount of the sulfating agent is chosen so as to be about two times by weight that of hyaluronic acid. The thus attained sulfation rate is generally about 50 to 60% of the total hydroxyl groups of hyaluronic acid. The resultant sulfated hyaluronic acid can be purified according to purification operations conventionally used for various modified polysaccharides. Specific purification operations include steps of concentrating the reaction mixture under reduced pressure, dialyzing the concentrate against water to desalt it, removing trimethylamine by trifluoroacetic acid treatment and freeze-dry the residue. The sulfated hyaluronic acid can, if desired, be used in the form of a physiologically acceptable salt obtained by reaction with a hydroxide or carbonate of an alkali metal or an amine. The above sulfated hyaluronic acid or a physiologically acceptable salt can be mixed with pharmaceutical auxiliaries, for example, diluents or excipients used for preparation of usual pharmaceutical preparations to give liquids or suspensions which can then be administered parenterally, e.g. intravenously, intraarterially or intraperitoneally. Pharmaceutical auxiliaries usually used in the liquids include, for example, water, ethyl alcohol, propylene glycol, etc., and those in the suspensions include polyoxyethylenesorbitol and sorbitan esters. The optimal mixing ratio between the auxiliaries and the sulfated hyaluronic acid is not limited because it varies depending on the dosage forms, but when sulfated hyaluronic acid is made into injections, it is convenient for treatment of patients to adjust the concentration of the sulfated hyaluronic acid to 0.01 to 10% by weight/volume, preferably 0.05 to 1% by weight/volume in physiological saline. It is of course possible to prepare a concentrated preparation and make it into an injection as mentioned above immediately before use. The optimal dose of sulfated hyaluronic acid as an effective ingredient varies depending on the age of patients, the kind and gravity of diseases, and dosage formes and administration routes, but in the case of intravenous injections, it can be 0.01 to 1,000 mg/kg, preferably 0.1 to 10 mg/kg. Nevertheless, since sulfated hyaluronic acid does not show acute toxicity even at a dose of 2,000 mg/kg or more, it may be used beyond the above dose. The sulfated hyaluronic acid significantly inhibits vascular permeability, hemorrhage accompanying inflammation and myeloperoxidase (MPO) activity on the laboratory animal model caused by administration of cobra venom factor, and therefore can be used widely as an anti-inflammatory agent for treatment particularly of ARDS, ischemic heart diseases, ischemic cerebral diseases, chronic articular rheumatism, atopic dermatitis, and infiltration after organ implantation. This invention is further detailedly described below by specific examples, but the invention should not be limited thereto. Preparation example 1 High molecular hyaluronic acid (HMWHA; molecular weight 1,300 kDa) (200 mg) and 400 mg of sulfuric acid-trimethylamine complex (Aldrich) were dissolved in 6 ml of dimethylformamide, and the solution was stirred at 50 to 60°C for one week in an oil bath. The reaction solution was concentrated under reduced pressure using a vacuum pump, the residue was dissolved in water, and the solution was dialyzed against deionized water overnight and freeze-dried. The resultant dry matter was dissolved in 2 mL of water, trifluoroacetic acid (an amount corresponding to 1.5 times the molar quantity of the total hydroxyl groups of HMWHA) was added, and the mixture was stirred at room temperature for one hour. After dialysis, the reaction solution was freeze-dried to give 200 mg of sulfated hyaluronic acid having a sulfation rate of about 60%. Preparation example 2 The same operations as in Example 1 were repeated except that hyaluronic acid having a low molecular weight (LMWHA, molecular weight 40 kDa) was used in place of the high molecular hyaluronic acid. Thus sulfated low molecular weight hyaluronic acid having a sulfation rate of about 50 to 60% was obtained. Assessment test for anti-inflammatory action (1) Preparation of inflammation model animals and inflammation assessment method Specific pathogen-free, adult (250-350 g) male Long-Evans rats were used. Cobra venom factor (CVF) was isolated from Naja naja crude venom by procedures described in Till et al., J. Clin. Invest. , 69 , 1126-1135, 1982. 20 U/kg body weight of CVF together with an aliquot each of 125 I-BSA (0.5 µ Ci) and 51 Cr-rat red blood cells (RBC) were injected intravenously to the rats as a bolus infusion. Animals were anesthetized with ketamine hydrochloride (100 mg/kg) (Parke Davis and Co. Morris Plains, NJ) and exsanguinated via the posterior vena cava 30 minutes after infusion of CVF. Negative control animals were similarly treated except that phosphate buffered saline (PBS, pH 7.4) was used in placed of CVF. At the 30 minutes interval the lung vasculature was perfused through the right cardiac ventricle with 10 mL of PBS. The lungs were removed, the vasculature perfused with 10 mL of sterile physiological saline, and the amount of radioactivity remaining within the tissue was assessed with a gamma scintillation counter. The positive control value is a value when the test substance was not administered. Lung damage was defined by increased lung vascular permeability (as determined by the ratio of 125 I-BSA radioactivity present within lung tissue to the amount of radioactivity present in 1.0 mL of venous blood obtained at the time of death) and by hemorrhage ( 51 Cr-RBC radioactivity), which was similarly quantitated as a ratio to blood radioactivity. Protection from lung injury was calculated using the following equation: Protection (%) = 100 x Test substance value - Negative control (PBS) value Positive control value - Negative control (PBS) value (2) Tissue myeloperoxidase (MPO) activity To assess MPO activity as a measure of neutrophil influx, known numbers of glycogen-elicited rat peritoneal neutrophils were added to normal rat lungs, the tissue homogenized and extracted, and standard curves produced (see Warren et al., J. Clin. Invest., 84 , 1873-1882, 1989). Lung samples were homogenized with a homogenizer (Polytron; Tekmar Co., Cincinati, OH), 4 x 10 seconds at a setting of 4, using 6 mL of homogenization buffer (50 mM phosphate, pH 6.0) and then subjected to centrifugation (3,000 g, 30 minutes) at 4 °C. MPO activity in supernatant fluids was assayed by measuring the change in absorbance (460 nm) resulting from decomposition of H 2 O 2 in the presence of o-dianisidine. (3) Results Results obtained when various test substances were intravenously administered in an amount of each 1 mg/kg immediately before the administration of CVF of the above (1) are shown in the following table. Exp. No. Test substance intravenously infused Reduction (%) in lung injury Amount Permeability Hemorrhage MPO 1. Sulfated HMWHA 1 mg 84 63 60 (0.001) 2. Sulfated LMWHA 1 mg 62 31 not assayed 3. Heparin sulfates 1 mg 43 -6 not assayed 4. Sulfated dextran 1 mg 8 -31 not assayed 5. HMWHA (control) 1 mg 4 0 0 6. Sialyl-Lews X (Comparison) 1 mg 35 6 not assayed As shown above, sulfated hyaluronic acid can significantly protect lung injury caused by administration of cobra venom factor (CVF). Pharmaceutical preparation example Composition Sulfated HMWHA 1 g Phosphate buffer (PBS) made to be isotonic 1 L Preparation Sulfated HMWHA is dissolved in sterilized PBS. Industrial Applicability This invention provides the use of a sulfated hyaluronic acid or its physiologically acceptable salt agent having a different action mechanism from usual anti-inflammatory agents. The use of the invention exhibits a powerful anti-inflammatory action. Thus, the invention has applicability in the pharmaceutical industry.

Claims: Use of a sulfated hyaluronic acid or its physiologically acceptable salt for preparing a medicament for the treatment of an inflammation selected from the group consisting of an adult respiratory distress syndrome (ARDS), ischemic heart diseases, ischemic cerebral diseases, chronic articular rheumatism, atopic dermatitis, and infiltration after organ implantation. The use according to claim 1, wherein the sulfated hyaluronic acid has a molecular weight of 40 kDa or more. The use according to claim 1 or 2, wherein the sulfated hyaluronic acid is derived from a hyaluronic acid having a molecular weight of 1,300 kDa or more. The use according to claim 1, wherein the amount of sulfation of the sulfated hyaluronic acid is about 50 to 60%. The use according to anyone of claims 1 to 4, wherein the inflammation is ARDS.

Inventors: AKIMA KAZUO, MIYASAKA MASAYUKI, SUZUKI YASUO, WARD PETER A, AKIMA, KAZUO, MIYASAKA, MASAYUKI, SUZUKI, YASUO, WARD, PETER A.
Applicants: SHISEIDO CO LTD, SHISEIDO COMPANY LIMITED
Application year: 1996
Main classification: A61K31
IPC codes: A61K31