Patent Description:
in the treatment and/or prevention of a disease associated with diabetes and metabolic syndrome.

According to IDF statistics, there were about <NUM> million people with diabetes worldwide in <NUM>, i.e., <NUM> out of every <NUM> people has diabetes. The number of diabetic patients in China is about <NUM> million, ranking first in the world. It is predicted that by <NUM>, <NUM> million people worldwide will have diabetes, and the diabetic patients in China will reach <NUM> million. Diabetes requires life-long monitoring and treatment, and if not being well controlled, it will lead to secondary cardiovascular diseases, blindness, stroke, diabetic nephropathy, diabetic gangrene and other complications in patients, which will seriously endanger human health and life.

More than <NUM>% of diabetes is type II diabetes, and oral hypoglycemic agents are the main treatment method. At present, the main oral hypoglycemic drugs include: sulfonylureas, biguanides, α-glucosidase inhibitors, thiazolidinediones, DPP-<NUM> inhibitors, etc., but the oral hypoglycemic drugs are prone to severe side effects such as drug resistance, low blood glucose, and toxicity to liver and kidney.

Thiazolidinedione compounds, such as rosiglitazone, pioglitazone, are insulin sensitizers that do not stimulate insulin secretion, but enhance the response of surrounding tissues (especially the target tissues of insulin action: skeletal muscle, liver, and adipose tissue) to insulin (sensitivity), thereby increasing the utilization of glucose by muscles, reducing the production of endogenous glucose in liver, promoting the synthesis of fat, inhibiting the decomposition of fat, and normalizing the metabolic disorder in the body, indirectly achieving the therapeutic effect of reducing blood glucose. The main side effects of thiazolidinedione compounds are: not suitable for patients with type I diabetes or diabetic ketoacidosis; prone to encountering the risk of occurring hypoglycemia, abnormal liver function, moderate edema, and mild anemia in patients when used alone in high doses or combined with insulin and other oral hypoglycemic drugs.

The limonoid compounds are mainly present in fruits of rutaceous plants, such as immature bitter orange, navel orange, citrus reticulata, fragrant citrus, pomelo and the like. Their contents are higher in the cores (seeds), and lower in the peel (about <NUM>/<NUM>,<NUM> to <NUM>/<NUM>,<NUM>). About <NUM> kinds of limonoid compounds have been isolated and identified from citrus plants. The limonoid compounds have various biological activities such as antitumor, insect antifeedant, antiviral, analgesic, anti-inflammatory and hypnotic, and can be used in functional food additives, anti-cancer foods, pesticides, feed additives, etc..

Considering the hypoglycemic effect and side effects of thiazolidinedione compounds, it is urgent to find a pharmaceutical composition product that is simple to take, good in effect, and low in side effects.

<CIT> discloses a combination product comprising a limonoid compound and a biguanidc compound for use in the prevention and/or treatment of diseases associated with diabetes and metabolic syndrome.

Note that the references to methods of treatment in this description are to be interpreted as references to the compounds, pharmaceutical compositions and medicaments of the present invention for use in a method for treatment of the human (or animal) body by therapy.

The present invention provides a combination product comprising a limonoid compound (or a pharmaceutically acceptable salt thereof) and a thiazolidinedione compound and a use of this composition for preventing or/and treating a disease associated with diabetes and metabolic syndrome. Compared with thiazolidinedione compound or limonoid compound (or a pharmaceutically acceptable salt thereof) as monotherapy at the same dose, the combination product containing a limonoid compound (or a pharmaceutically acceptable salt thereof) and a thiazolidinedione compound as mentioned in the present invention can significantly enhance therapeutic effects such as hypoglycemic effect, and show synergistic effect. At the same time, the amount of thiazolidinedione compound is reduced, thereby reducing its side effects.

In a first aspect of the present invention, there is provided a combination product comprising a limonoid compound (or a pharmaceutically acceptable salt thereof), and a thiazolidinedione or a combination product comprising only a limonoid compound (or a pharmaceutically acceptable salt thereof), and a thiazolidinedione compound as active ingredients.

The limonoid compound as mentioned in the present invention is a general term for a class of highly oxidized compounds with a <NUM>,<NUM>,<NUM>-trimethyl-<NUM>-furanosteroid skeleton or derivatives thereof (or can be expressed as compounds consisting of variants of furanolactone polycyclic core structure, and having four fused <NUM>-membered rings and one furan ring). Specifically, the limonoid compound is one or more selected from the group consisting of limonin, isolimonic acid, limonin glycoside, isolimonic acid glycoside, isoobacunoic acid, obacunone glycoside, ichangin, ichangensin, ichangin glycoside, nomilin, nomilin acid, deacetylnomilin, nomilin glycoside, deacetylnomilin glycoside and nomilin acid glycoside. The structural formula of an exemplary limonoid compound, i.e., limonin, is shown below.

Further, the glucoside derivatives of the limonoid compound as mentioned in the present invention include, limonin <NUM>-β-glucopyranoiside, ichangin <NUM>-β-D-glucopyranoiside, isolimonic acid <NUM>-β-D-glucopyranoside, deacetylnomilin <NUM>-β-D-glucopyranoside, nomilin <NUM>-β-D-glucopyranoside, obacunone <NUM>-β-D-glucopynoside, nomilinic acid <NUM>-β-D-glucopyranosid.

In some embodiments, the limonoid compound as mentioned in the present invention is in the form of a monomer or an extract. The monomer is extracted or artificially synthesized, and its sources may be commercially available, or they can be easily prepared and obtained by the prior art in the art.

The thiazolidinedione compound as mentioned in the present invention are selected from the group consisting of rosiglitazone, pioglitazone.

In some embodiments, the combination product is in the form of a pharmaceutical composition, and the pharmaceutical composition is in a unit dosage form.

In some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound are each in the form of a separate preparation. Further, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound are each in the form of a separate unit dose. Further, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound can be administered simultaneously or sequentially.

In some embodiments, the thiazolidinedione compound has an amount of <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, or <NUM>, and the ranges between these amounts, wherein the ranges include but are not limited to: <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, and <NUM> to <NUM>.

In some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) has an amount of <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, or <NUM>, and the ranges between these amounts, wherein the ranges include but are not limited to: <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, and <NUM> to <NUM>.

The thiazolidinedione compound is selected from rosiglitazone, pioglitazone and the limonoid compound is one or more selected from: limonin, isolimonic acid, limonin glycoside, isolimonic acid glycoside, isoobacunoic acid, obacunone glycoside, ichangin, ichangensin, ichangin glycoside, nomilin, nomilin acid, deacetylnomilin, nomilin glycoside, deacetylnomilin glycoside and nomilin acid glycoside.

In some embodiments, the combination product further comprises a pharmaceutically acceptable carrier, diluent, or excipient.

In some embodiments, the combination product is in the form of tablet, capsule, granule, syrup, powder, lozenge, sachet, cachet, elixir, suspension, emulsion, solution, syrup, aerosol, ointment, cream and injection.

In a second aspect of the present invention, there is provided a use of the combination product in manufacture of a medicament for the prevention and/or treatment of a disease associated with diabetes and metabolic syndrome. In some embodiments, the diabetes is type I diabetes. In some embodiments, the diabetes is type II diabetes.

In a third aspect of the present invention, there is provided a method of administering the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound in combination to prevent and/or treat a disease. In some embodiments, there is provided a method of administering the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound in combination to prevent and/or treat a disease associated with diabetes and metabolic syndrome. In some embodiments, there is provided a method of administering the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound in combination to lower a blood glucose. In some embodiments, there is provided a method of administering the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound in combination to improve an insulin sensitivity. In some embodiments, there is provided a method of administering the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound in combination to improve a leptin sensitivity.

In some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound can be mixed into a preparation and administered in the form of a pharmaceutical composition (preferably, a dosage unit form); in some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound are each in separate preparation form (preferably, each in separate dosage unit form) and separately administered; in some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound are administered simultaneously; in some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound are administered one after another; in some embodiments, the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound are administered one after another at a time interval of about <NUM> minutes, or about <NUM> hour, or about <NUM> hours, or about <NUM> hours, or about <NUM> hours, or about <NUM> hours. In some embodiments, as required, the combination product comprising the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound according to the present invention that is in the form of pharmaceutical composition (preferably, a dosage unit form) is administered for, including, but are not limited to: <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM> times per day. In some embodiments, as required, the combination product comprising the limonoid compound (or a pharmaceutically acceptable salt thereof) and the thiazolidinedione compound according to the present invention that are each in separate preparation form (preferably, each in separate dosage unit form) is administered for, including, but are not limited to: <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM> times per day.

In some embodiments, the limonin compound (or a pharmaceutically acceptable salt thereof), and the thiazolidinedione compound or the combination product comprising them can be administered by the following administration modes, for example, oral administration, injection administration (e.g., subcutaneous and parenteral administration) and topical administration.

In some embodiments, the limonin compound (or a pharmaceutically acceptable salt thereof), and the thiazolidinedione compound have a daily dosage as follows: as calculated according to adult body weight of <NUM>, the daily dosage of the thiazolidinedione (or a pharmaceutically acceptable derivative thereof) is <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM>, and the ranges between these dosages, wherein the ranges include but are not limited to: <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM> and <NUM> to <NUM>. As calculated according to adult body weight of <NUM>, the daily dosage of the limonoid compound (or a pharmaceutically acceptable salt thereof) is <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> or <NUM>, and the ranges of between these dosages, wherein the ranges includes but are not limited to: <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM>, <NUM> to <NUM> and <NUM> to <NUM>.

In a fourth aspect of the present invention, there is provided a method for preparing a combination product in the form of a pharmaceutical composition. In order to improve its operability as a drug or its absorbability when used in a living body, the limonoid compound or a pharmaceutically acceptable salt thereof and the thiazolidinedione compound are preferably combined with a pharmaceutical adjuvant such as a pharmaceutically acceptable carrier, excipient, diluent, etc., so as to form a preparation, thereby obtaining the form.

In a fifth aspect of the invention, there is provided a kit, the kit comprising the combination product described herein.

The term "pharmaceutically acceptable salt" as used throughout this description refers to a salt of a free acid or a free base, that is typically prepared by reacting the free base with a suitable organic or inorganic acid or by reacting the acid with a suitable organic or inorganic base. The term can be used for any compound, including limonoid compounds (having the function of free acid or free base) and the like. Representative salts include: acetate, benzenesulfonate, benzoate, bicarbonate, bisulfate, hydrogen tartrate, borate, bromide, calcium edetate, camphorsulfonate, carbonate, chloride, clavulanate, citrate, dihydrochloride, edetate, ethanedisulfonate, estolate, esylate, fumarate, glucoheptonate, gluconate, glutamate, glycol lylarsanilate, hexylresorcinate, hydrabamine, hydrobromide, hydrochloride, hydroxynaphthoate, iodide, isethionate, lactate, lactobionate, laurate, malate, maleate, mandelate, methanesulfonate, methobromate, methonitrate, methosulfate, monopotassium maleate, mucate, naphthalenesulfonate, nitrate, N-methylglucosamine salt, oxalate, pamoate, palmitate, pantothenate, phosphate/bisphosphate, polygalacturonate, potassium salt, salicylate, sodium salt, stearate, subacetate, succinate, tannate, tartrate, teoclate, p-toluenesulfonate, triethiodide, trimethylamine salt, and valerate. When an acidic substituent is present, for example, -COOH, an ammonium salt, morpholine salt, sodium salt, potassium salt, barium salt, calcium salt, and the like can be formed for use in a dosage form. When a basic group, for example an amino group or a basic heteroaryl group such as pyridyl, is present, an acidic salt such as a hydrochloride, hydrobromide, phosphate, sulfate, trifluoroacetate, trichloroacetate, acetate, oxalate, maleate, pyruvate, malonate, succinate, citrate, tartrate, fumarate, mandelate, benzoate, cinnamate, mesylate, ethanesulfonate, picrate, etc..

The sources of the thiazolidinedione compound referred to in the present invention may include: rosiglitazone maleate tablets/capsules, rosiglitazone tartrate tablets/capsules, rosiglitazone hydrochloride tablets/capsules, pioglitazone hydrochloride tablets/capsules, rosiglitazone-glimepiride tablets, rosiglitazone-metformin hydrochloride tablets, pioglitazone-metformin tablets, pioglitazone-glimepiride tablets, alogliptin-pioglitazone tablets.

The present invention is further described below through specific examples and comparative examples. However, it should be understood that these examples and comparative examples are only used for more detailed and specific explanation, and should not be understood as limiting the present invention in any form.

In the examples of the present invention, the following diabetic mouse models (the models were well known to those skilled in the art or were easily available according to conventional textbooks, technical manuals, and scientific literature in the art) were used to simulate the pathological conditions of different stages of diabetes in humans. The limonoid compound mentioned in the examples was present in the form of a monomer or an extract. The monomer was extracted or artificially synthesized, and its sources were commercially available, or it could be easily prepared and obtained by the prior art in the art.

In this example, a mouse pancreatic islet β-cell injury model was established by modeling ICR mice with streptozotocin (STZ) (<NPL>), and used to complete the evaluation of hypoglycemic effect in animals (this model could simulate pancreatic islet β-cell damage state of type I and type II diabetics). The limonoid compound was selected from the group consisting of limonin, isolimonic acid, limonin glycoside, and isolimonic acid glycoside, and rosiglitazone single administration group, limonin single administration group, isolimonic acid single administration group, limonin glycoside singe administration group, isolimonic acid glycoside singe administration group, and respective combination thereof with rosiglitazone administration groups were set.

Conditions of experimental feeding: ICR mice (<NUM> ± <NUM>), aged <NUM> weeks, purchased from Zhejiang Academy of Medical Sciences, and subjected to experimental feeding after <NUM> days of preliminary feeding. It should be noted that the conditions for raising the mice were as follows: the temperature was <NUM> ± <NUM>, the humidity was <NUM> ± <NUM>%, the lights were turned on between <NUM> am and <NUM> pm (the lights were turned off at other time), and the mice were allowed to freely take in water and feed. The experimental feed was mouse growth-stable feed (GB M2118), and the daily feeding and management of the animals were under the responsibility of the animal security department, which provided the animals with sufficient diet and fresh drinking water daily.

Experimental grouping: <NUM> male mice were randomly selected as the normal control group. After fasting for <NUM> hours, the remaining mice were intraperitoneally injected once with STZ at a dose of <NUM>/kg, and <NUM> hours later, the mice with blood glucose value of <NUM> to <NUM> mmol/L were undifferentiatedly grouped and used in the experiment, <NUM> animals in each group, and subjected to blood sampling and detection of indicators after two weeks of administration.

Gavage doses: the gavage dose was <NUM>/kg per day for the limonin group, the gavage dose was <NUM>/kg per day for the isolimonic acid group, the gavage dose was <NUM>/kg per day for the limonin glycoside group, the gavage dose was <NUM>/kg per day for the isolimonic acid glycoside group, the gavage dose of rosiglitazone was <NUM>/kg per day for the rosiglitazone group, limonin at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the limonin/rosiglitazone combination group, isolimonic acid at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the isolimonic acid/rosiglitazone combination group, limonin glycoside at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the limonin glycoside/rosiglitazone combination group, isolimonic acid glycoside at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the isolimonic acid glycoside/rosiglitazone combination group, the gavage volume was <NUM>/kg, and the normal group and the model group were administrated with <NUM>/kg of distilled water. Two weeks later, the blood glucose values were measured by tail trimming method (Johnson's blood glucose meter) <NUM> after the last administration, and the average of each group was obtained. SPSS <NUM> software was used for statistical analysis. The data were expressed as mean and standard deviation. The data before and after were analyzed by t-test, and P <<NUM> was considered statistically significant. The test results were shown in Table <NUM> below.

From the above results, it could be seen that, compared with the model group, either in single administration or in combination administration with rosiglitazone, limonin and its derivatives could significantly reduce the blood glucose values of the mice with STZ islet cell injury. The administration of limonin and its derivatives in combination with rosiglitazone had significantly improved the effect as compared with their single administration, showing a synergistic effect. In addition, when limonin and its derivatives were administrated in combination with rosiglitazone, as compared with their single administration, the doses of both could be effectively reduced while comparable glucose-lowering effects could still be achieved, which improved the safety of therapeutic regimen and reduced side effects.

In the present example, db/db mice (line name BKS. Cg-Dock7m+/+Leprdb/Nju) were used to perform hypoglycemic efficacy evaluation test of animals (blood glucose level and leptin). The limonoid compound was selected from obacunone, isoobacunoic acid and obacunone glycoside, and pioglitazone single administration group, obacunone single administration group, isoobacunoic acid single administration group, obacunone glycoside single administered group, and respective combination thereof with pioglitazone administration groups were set.

Conditions for experimental feeding: as type II diabetes model mice, <NUM>-week-old SPF-grade db/db mice were purchased from the Nanjing Model Biology Institute, and subjected to experimental feeding after <NUM> days of preliminary feeding. It should be noted that the conditions for raising the mice were as follows: the temperature was <NUM> ± <NUM>, the humidity was <NUM> ± <NUM>%, the lights were turned on between <NUM> am and <NUM> pm (the lights were turned off at other time), and the mice were allowed to freely take in water and feed. The experimental feed was mouse growth-stable feed (GB M2118), and the daily feeding and management of the animals were under the responsibility of the animal security department, which provided the animals with sufficient diet and fresh drinking water daily.

Experimental grouping: male db/db mice (<NUM> ± <NUM>) were selected, and <NUM> male mice in each group were tested. The experimental groups included normal control group (db/m, n = <NUM>), model group (db/db, n = <NUM>), obacunone group (db/db, n = <NUM>), isoobacunoic acid group (db/db, n = <NUM>), obacunone glycoside group (db/db, n = <NUM>), pioglitazone group (db/db, n = <NUM>), obacunone/pioglitazone combination group (db/db, n = <NUM>), isoobacunoic acid/pioglitazone combination group (db/db, n = <NUM>), obacunone glycoside/pioglitazone combination group (db/db, n = <NUM>).

Gavage doses: obacunone at a dose of <NUM>/kg was gavaged per day for the obacunone group, isoobacunoic acid at a dose of <NUM>/kg was gavaged per day for the isoobacunoic acid group, obacunone glycoside at a dose of <NUM>/kg was gavaged per day for the obacunone glycoside group, pioglitazone at a dose of <NUM>/kg was gavaged per day for the pioglitazone group, obacunone at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the obacunone/pioglitazone combination group, isoobacunoic acid at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the isoobacunoic acid/pioglitazone combination group, obacunone glycoside at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the obacunone glycoside/pioglitazone combination group, the gavage volume was <NUM>/kg, and the normal group and the model group were administrated with <NUM>/kg of distilled water. Two weeks later, the blood glucose values were measured by tail trimming method (Johnson's blood glucose meter) <NUM> after the last administration, and serum leptin levels were measured with blood collected from orbital cavity by enzyme-linked immunosorbent assay (Elisa), and the average of each group was obtained. SPSS <NUM> software was used for statistical analysis. The data were expressed as mean and standard deviation. The data before and after were analyzed by t-test, and P <<NUM> was considered statistically significant. The test results were shown in Table <NUM> below.

From the above results, it could be seen that, compared with the model group, either in single administration or in combination administration with pioglitazone, obacunone and derivatives thereof could significantly reduce the blood glucose levels in the db/db diabetic mice. When obacunone and derivatives thereof were administrated in combination with pioglitazone, significantly improved effect was observed relative to the single administration thereof, showing a synergistic effect. In addition, when obacunone and derivatives thereof were administrated in combination with pioglitazone, as compared with their single administration, the doses of both could be effectively reduced while comparable glucose-lowering effects could still be achieved, which improved the safety of therapeutic regimen and reduced side effects.

Meanwhile, the limonoid compound represented by obacunone and its derivatives could significantly improve the sensitivity to leptin; and especially when administrated in combination with pioglitazone, it could significantly improve the utilization efficiency of leptin in the body, improve the glucose metabolism of the body, and improve the functions relevant to the glucose metabolism in diabetes mice.

In this example, a mouse pancreatic islet β-cell injury model was established by modeling ICR mice with streptozotocin (STZ) (<NPL>), and used to complete the evaluation of hypoglycemic effect in animals (this model could simulate pancreatic islet β-cell damage state of type I and type II diabetics). The limonoid compound was selected from the group consisting of ichangin, ichangensin, and ichangin glycoside, and pioglitazone single administration group, ichangin single administration group, ichangensi single administration group, ichangin glycoside singe administration group, and respective combination thereof with pioglitazone administration groups were set.

Gavage doses: the gavage dose was <NUM>/kg per day for the ichangin group, the gavage dose was <NUM>/kg per day for the ichangensin group, the gavage dose was <NUM>/kg per day for the ichangin glycoside group, the gavage dose of pioglitazone was <NUM>/kg per day for the pioglitazone group, ichangin at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the ichangin/pioglitazone combination group, ichangensin at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the ichangensin/pioglitazone combination group, ichangin glycoside at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the ichangin glycoside/pioglitazone combination group, the gavage volume was <NUM>/kg, and the normal group and the model group were administrated with <NUM>/kg of distilled water. Two weeks later, the blood glucose values were measured by tail trimming method (Johnson's blood glucose meter) <NUM> after the last administration, and the average of each group was obtained. SPSS <NUM> software was used for statistical analysis. The data were expressed as mean and standard deviation. The data before and after were analyzed by t-test, and P <<NUM> was considered statistically significant. The test results were shown in Table <NUM> below.

From the above results, it could be seen that, compared with the model group, either in single administration or in combination administration with pioglitazone, the three limonoid compounds all could significantly lower the blood glucose levels in the mice of the STZ pancreatic islet cell injury model. When they were administrated in combination with pioglitazone, their effects were significantly increased as compared with their single administration, similar to the normal mice in blood glucose level, showing a synergistic effect. In addition, when the above three limonoid compounds were administrated in combination with pioglitazone, as compared with their single administration, the doses of both could be effectively reduced while comparable glucose-lowering effects could still be achieved, which improved the safety of therapeutic regimen and reduced side effects.

In the present embodiment, the limonoid compound was selected from nomilin, deacetylnomilin, nomilin acid, deacetylnomilin acid glycoside, and rosiglitazone single administration group, nomilin single administration group, deacetylnomilin single administration group, nomilin acid single administered group, deacetylnomilin acid glycoside single administration group, and respective combination thereof with rosiglitazone administration groups were set.

Experimental grouping: male db/db mice (<NUM> ± <NUM>) were selected, <NUM> male mice in each group were tested, and drinking bottles were sterilized weekly. The experimental groups included normal control group (db/m, n = <NUM>), model group (db/db, n = <NUM>), nomilin group (db/db, n = <NUM>), deacetylnomilin group (db/db, n = <NUM>), nomilin acid group (db/db, n = <NUM>), deacetylnomilin acid glycoside group (db/db, n = <NUM>), rosiglitazone group (db/db, n = <NUM>), nomilin combination group (db/db, n = <NUM>), deacetylnomilin combination group (db/db, n = <NUM>), nomilin acid combination group (db/db, n = <NUM>), deacetylnomilin acid glycoside combination group (db/db, n = <NUM>).

Gavage doses: nomilin at a dose of <NUM>/kg was gavaged per day for the nomilin group, deacetylnomilin at a dose of <NUM>/kg was gavaged per day for the deacetylnomilin group, nomilin acid at a dose of <NUM>/kg was gavaged per day for the nomilin acid group, deacetylnomilin acid glycoside at a dose of <NUM>/kg was gavaged per day for the deacetylnomilin acid glycoside group, rosiglitazone at a dose of <NUM>/kg was gavaged per day for the rosiglitazone group, nomilin at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the nomilin combination group, nomilin acid at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the nomilin acid combination group, deacetylnomilin at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the deacetylnomilin combination group, deacetylnomilin acid glycoside at a dose of <NUM>/kg and rosiglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the deacetylnomilin acid glycoside combination group, the gavage volume was <NUM>/kg, and the normal group and the model group were administrated with <NUM>/kg of distilled water. Two weeks later, the blood glucose values were measured by tail trimming method (Johnson's blood glucose meter) <NUM> after the last administration, and serum insulin levels were measured with blood collected from orbital cavity by enzyme-linked immunosorbent assay (Elisa), and the average of each group was obtained. SPSS <NUM> software was used for statistical analysis. The data were expressed as mean and standard deviation. The data before and after were analyzed by t-test, and P <<NUM> was considered statistically significant. The test results were shown in Table <NUM> below.

From the above results, it could be seen that, compared with the model group, either in single administration or in combination administration with rosiglitazone, nomilin and derivatives thereof could significantly reduce the blood glucose levels in the db/db diabetic mice. When nomilin and derivatives thereof were administrated in combination with rosiglitazone, significantly improved effect was observed relative to the single administration thereof, showing a synergistic effect. In addition, when nomilin and derivatives thereof were administrated in combination with rosiglitazone, as compared with their single administration, the doses of both could be effectively reduced while comparable glucose-lowering effects could still be achieved, which improved the safety of therapeutic regimen and reduced side effects.

Meanwhile, the limonoid compound represented by nomilin and derivatives thereof could significantly improve the sensitivity to insulin; and especially when administrated in combination with rosiglitazone, it could significantly improve the utilization efficiency of insulin in the body, improve the glucose metabolism of the body, and improve the functions relevant to the glucose metabolism in diabetes mice.

In this example, a mouse model of type II diabetes with pancreatic islet damage and obesity was established by multiple modeling ICR mice with a small dose of streptozotocin (STZ), following with continuous high-fat diets (referring to literature: <NPL>). The limonoid compound was selected from the group consisting of nomilin glycoside, deacetylnomilin glycoside, and nomilin acid glycoside, and pioglitazone single administration group, nomilin glycoside single administration group, deacetylnomilin single administration group, nomilin acid glycoside single administration group, and respective combination thereof with pioglitazone administration groups were set.

Experimental grouping: <NUM> male mice were randomly selected as the normal control group, and the remaining mice were subjected to a high-fat diet (high-fat diet formula: cholesterol <NUM>%, egg yolk powder <NUM>%, lard oil <NUM>%, and basic feed <NUM>%, for establishing an obesity mouse model) for consecutive <NUM> weeks and intraperitoneal injection of STZ at a dose of <NUM>/kg for three consecutive days. After one week, the mice were subject to <NUM> hours of fasting and water deprivation, their fasting blood glucose was measured, and the mice with a blood glucose level of <NUM> to <NUM> mmol/L were selected and undifferentiatedly grouped and used in the experiment, continuously subjected to the high-fat diet, <NUM> mice in each group, and subjected to blood sampling and detection of indicators after <NUM> weeks of administration.

Gavage doses: the gavage dose was <NUM>/kg per day for the nomilin glycoside group, the gavage dose was <NUM>/kg per day for the deacetylnomilin glycoside group, the gavage dose was <NUM>/kg per day for the nomilin acid glycoside group, pioglitazone at a dose of <NUM>/kg was gavaged per day for the pioglitazone group, nomilin glycoside at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the nomilin glycoside/pioglitazone combination group, deacetylnomilin glycoside at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the deacetylnomilin glycoside/pioglitazone combination group, nomilin acid glycoside at a dose of <NUM>/kg and pioglitazone at a dose of <NUM>/kg were simultaneously gavaged per day for the nomilin acid glycoside/pioglitazone combination group, the gavage volume was <NUM>/kg, and the normal group and the model group were administrated with <NUM>/kg of distilled water. Two weeks later, the blood glucose values were measured by tail trimming method (Johnson's blood glucose meter) <NUM> after the last administration, and the average of each group was obtained. SPSS <NUM> software was used for statistical analysis. The data were expressed as mean and standard deviation. The data before and after were analyzed by t-test, and P <<NUM> was considered statistically significant. The test results were shown in Table <NUM> below.

From the above results, it could be seen that, compared with the model group, either in single administration or in combination administration with pioglitazone, the three limonoid glycosides all could significantly lower the blood glucose levels in the mice of the STZ type II diabetes model. When they were administrated in combination with pioglitazone, their effects were significantly increased as compared with their single administration, similar to the normal mice in blood glucose level, showing a synergistic effect. In addition, when the above three limonoid glycosides were administrated in combination with pioglitazone, as compared with their single administration, the doses of both could be effectively reduced while comparable glucose-lowering effects could still be achieved, which improved the safety of therapeutic regimen and reduced side effects.

In this example, a method for preparing a tablet of a combination product (nomilin and rosiglitazone) of the present invention was exemplarily provided. A single tablet contained the following ingredients: <NUM> of nomilin, <NUM> of rosiglitazone hydrochloride, <NUM> of hydroxypropylmethylcellulose, <NUM> of sodium carboxymethylcellulose, and <NUM> of microcrystalline cellulose, <NUM> of magnesium stearate, <NUM> of Opadry, and there were a total of <NUM> tablets.

Claim 1:
A combination product, comprising a limonoid compound or a pharmaceutically acceptable salt thereof, and a thiazolidinedione compound, wherein the thiazolidinedione compound is selected from the group consisting of rosiglitazone and pioglitazone and the limonoid compound is one or more selected from the group consisting of limonin, isolimonic acid, limonin glycoside, isolimonic acid glycoside, isoobacunoic acid, obacunone glycoside, ichangin, ichangensin, ichangin glycoside, nomilin, nomilin acid, deacetylnomilin, nomilin glycoside, deacetylnomilin glycoside and nomilin acid glycoside.