Patent Description:
Psoriasis is a chronic skin inflammation that seriously affects the quality of human life, and belongs to an autoimmune disease. A common symptom is redness, scaly plaque ringworm on the scalp, elbows, knees, etc., also known as Niupixuan. Histological characteristic of the skin of the lesion are significant thickening of the epidermis, invasion of immune cells in the epidermis, and increased number of epithelial dilated blood vessels, etc..

The incidence of psoriasis in adults is as high as <NUM> to <NUM>%, and there are as many as <NUM> million patients worldwide, of which the incidence in Europe and the United States ranks among the top. The global market value of the disease reached <NUM> billion dollars in <NUM>. Due to the huge unmet medical needs of psoriasis worldwide, its pathogenesis has been a research hotspot in the medical field in the past <NUM> years. Many studies have shown that the lack of function of the innate immune system and the adaptive immune system leads to the activation of dendritic cells, the imbalance of immune T cells, the secretion of proinflammatory cytokines, the excessive proliferation of keratinocytes and the changes in terminal differentiation, etc., which eventually form subcutaneous inflammation and characteristic plaques of psoriasis. Among them, immune T cells are highly enriched in patients' blood and skin lesions, and further secrete high levels of tumor necrosis factor alpha (TNF-α), interleukin 17A, and the like. Tumor necrosis factor α alone, or in combination with other pro-inflammatory factors such as interleukin <NUM>, interleukin <NUM>, etc., acts to initiate downstream immune responses. Therefore, tumor necrosis factor α, interleukin 17A, and interleukin <NUM> are all clinicopathological indications and high-value therapeutic targets for psoriasis.

For the target TNF-α, mature products based on macromolecular drugs are already available in the global market, represented by, such as, AbbVie's adalimumab (Humira) and Amgen's Etanercept (Enbrel). The development of small molecule TNF-α inhibitors is challenging in pharmaceutical chemistry. At present, only the phosphodiesterase inhibitor Pentoxifylline is on the market and the anti-inflammatory effect of the secondary development drug Thalidomide is related to the reduction of TNF-α. TNF-α inhibitors are the first class of biological drugs used to treat psoriasis. They have achieved good effects in the treatment of psoriasis in clinical practice by inhibiting the action of TNF-α. For example, TNF-α receptor Fc fusion protein Etanercept has become the standard reference for the development of drugs for psoriasis since its approval in <NUM>; and TNF-α monoclonal antibody adalimumab has also been upgraded from the second-line drug approval in the clinical system to the first-line drug for moderate to severe chronic plaque psoriasis.

Interleukin 17A is a new target for immune regulation that has gradually received attention since <NUM>. This is related to an immunological milestone event: the discovery of T helper <NUM> (Th17 cell) in <NUM>. With the deepening of research and development in the pharmaceutical industry, from <NUM> to <NUM>, Novartis's Secukinumab and Eli Lilly's Ixekizumab were the first to market as IL-17A monoclonal antibody drugs, and showed superior clinical efficacy and safety in the treatment of psoriasis. Compared with other target drugs, IL-17A antibodies showed a stronger clinical response in moderate to severe psoriasis reaching the psoriasis area and severity index (PASI) PASI90 and PASI100, and the efficacy persisted in both short-term and long-term treatments. Based on the above performance, in <NUM>, "Nature" magazine evaluated that "anti-interleukin-<NUM> drugs will become the standard treatment regimen for psoriasis". Compared with other targets, interleukin 17A is currently recognized as a psoriasis treatment target with the highest pathological relevance, the most significant clinical response, superior efficacy and high safety.

Nevertheless, regardless of whether it is an interleukin 17A inhibitor or a tumor necrosis factor α inhibitor, the inhibition of a single factor cannot achieve a satisfactory response in <NUM>% of patients with psoriasis, which suggests that the disease involves multiple mechanisms of action and there are other alternative inflammatory signaling pathways. Therefore, recent strategies include the development of other drug forms such as bispecific antibodies to simultaneously inhibit two pro- inflammatory factors. Targeting these two pro-inflammatory factors at the same time is considered to be a strategy that may achieve a better efficacy. There is no marketed product based on this strategy, and it is a high-value market blank area that deserves attention. Only Janssen's COVA322 in research is a bispecific antibody targeting IL-17A and TNF-α, which is currently in the second phase of psoriasis clinical trial and is worth the wait.

It should be emphasized that macromolecular drugs account for the vast majority of drugs on the global market in the above-mentioned field. The reason is that the signal pathways related to pro-inflammatory factors are intricate, and the pharmaceutical industry usually chooses clear and feasible antibody drug development strategies, such as direct binding of pro-inflammatory factors through antibody macromolecules, blocking their binding receptors and then inhibiting downstream functions. However, macromolecular drugs such as antibodies have many shortcomings: in terms of principle and mechanism, macromolecular drugs are easy to have immunogenicity and are difficult to target intracellular targets; in terms of production and application, the preparation process of macromolecular drugs is complicated, the quality standards are difficult to be unified, and transportation costs are high; most importantly, macromolecular drugs are expensive in terms of prices and markets, and are especially not suitable for countries and regions with large populations and heavy medical security burdens such as China; in addition, because oral administration is not possible, they are not suitable for a considerable number of people who can not tolerate drug injections.

Although the potency of small molecule chemical drugs is usually slightly lower than that of antibody drugs, they still have many advantages, such as oral administration, simple preparation process, low production cost, no immunogenicity, and ability to target intracellular targets. Therefore, small molecule drugs that can effectively inhibit TNF-α or/and IL-17A are expected to become a strong competitor or even a market terminator for similar antibody drugs. This field is basically blank in the market at present due to extremely high professional barriers and practical challenges in many processes such as high-through screening, pharmaceutical chemistry, and translational medicine.

In addition to the treatment of psoriasis, immunosuppressive treatment with the basic characteristic and methodology of reducing/inhibiting pro-inflammatory factors is also widely applicable to many other diseases and symptoms, such as inflammation caused by infection or surgical trauma, other autoimmune diseases including rheumatoid arthritis and psoriatic arthritis. Among them, the total market value of various autoimmune diseases based on immunosuppressive therapy exceeds <NUM> billion dollars. In the case of exogenous pathogen stimulation or increased pathological autoimmune response, lymphoid T cells, macrophages, etc. are activated to secrete pro-inflammatory factors as key signal molecules to initiate the body's inflammatory response, with representative factors being, such as, TNF-α, IL-<NUM>, interleukin <NUM>, interferon-γ, etc. Therefore, the increased expression of pro-inflammatory factors is the main pathological indication and cause of the inflammatory response and immune hyperimmune process. Inhibition of pro-inflammatory factors or their receptors through antibody drug binding to achieve immunosuppression is the mainstream strategy in pharmaceutical reaserch and development and in clinical practice. Besides the aforementioned Adalimumab, developed by Abbvie and targeted to inhibit TNF-α, and Secukinuma, developed by Novartis and targeted to IL-17A, for the treatment of rheumatoid arthritis, psoriasis and other autoimmune diseases, there are humanized antibody Reslizumab developed by Teva and targeted to inhibitor of IL-<NUM> for the treatment of asthma, antibody drug Tocilizumab developed by Roche and Genentech and targeted to inhibit IL-<NUM> receptor for the treatment of rheumatoid arthritis, and monoclonal antibody drug Ustekinumab developed by Johnson & Johnson (J&J) and targeted to inhibit IL-<NUM> and IL-<NUM> for the treatment of Crohn's disease, psoriasis, etc..

In addition to the above-mentioned antibody immunosuppressive drugs, there are many small molecule immunosuppressors used to eliminate inflammation (anti-inflammation) and suppress immune function (immunosuppression). Clinically commonly used fast-acting immunosuppressants such as steroids anti-inflammatory drugs Hydrocortisone and methylprednisolone, etc., can inhibit the activity of neutrophils and macrophages by inhibiting cyclooxygenase <NUM> (COX-<NUM>), reduce the pro-inflammatory cytokines TNF-α , IL-1β, etc., and have clinical practice and efficacy in the treatment of rheumatoid arthritis, asthma, Crohn's disease and other autoimmune diseases. In addition, slow-acting immunosuppressants methotrexate, hydroxychloroquine, etc., can inhibit immune cell activity by interfering with the synthesis of immune cell genetic material and excessive cell proliferation, and can also reduce the level of pro-inflammatory factors such as IL-<NUM>. They are widely used in the treatment of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus (SLE). However, the above-mentioned small molecule immunosuppressants all have several shortcomings, such as insufficient efficacy, easy to develop drug resistance, and serious side effects of long-term use. The newly developed small molecule drugs for immunosuppression also include JAK (Janus kinase) inhibitors, but they also have the defects of insufficient specificity for different subtypes of JAK and extensive side effects on immune regulation.

<CIT> discloses the pharmaceutical use of forskolin derivatives or a physiologically acceptable salt thereof as a spasmolytic agent, therapeutic agent for skin ulcer, peripheral circulation improving agent for limbs and differentiation inducing and promoting agent.

In summary, based on the current market characteristics and unmet needs of current global psoriasis drugs and immunosuppressive therapies, small molecule chemical drugs that can effectively inhibit IL-17A or/and TNF-α will become rare species in the market for similar diseases and drugs with the same mechanism. Among them, small molecule compounds, especially those that can effectively inhibit IL-17A and TNF-α at the same time and have dual mechanisms, will have extremely high competitive advantages and subsequent barriers to competition, which will be one of the most promising research and development directions in the field of psoriasis and immunosuppressive therapy.

The present inventio concerns a pharmaceutical composition for use in treating psoriasis or psoriatic arthritis according to claim <NUM> and a pharmaceutical composition according to claim <NUM>. Preferred embodiments of the invention are the subject-matter of dependent claims.

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by a person of ordinary skill in the art.

Forskolin is a compound extracted from the roots of Coleus forskohlii of the Coleus genus in labiatae family in India in the <NUM>. It acts as an adenylate cyclase activator and has cardiotonic action, hypotensive effect, etc. Its structural formula is shown in formula II:
<CHM>.

The PCT patent application with application number <CIT> reported that a phenomenon was observed in <NUM> that forskolin relieved the pathological symptoms of <NUM> patients with psoriasis. In the same peroid, there were fewer studies showing that forskolin affected the ratio of cAMP to cGMP in epidermal cells by activating cAMP, and further inhibited epidermal cell mitosis in epidermal hyperplasia symptoms such as psoriasis. It should be pointed out that psoriasis is an autoimmune disease, and, in addition to the proliferation of epidermal cells, immune cell invasion and repeated and continuous inflammation at the lesion sites are the most important pathological features. However, the above observations or studies always lacked the explanation and discovery of the mechanism of action (Mechanism of Action) of forskolin on the pathological inflammation of psoriasis. Moreover, because of the extremely limited number of <NUM> clinical patients, there is no obvious logical connection and sufficient data support. For this reason, the development and application of adenylate cyclase activators represented by Forskolin for the above-mentioned diseases have been stagnant for more than <NUM> years thereafter. There are many pharmacodynamic studie on Forskolin compound itself, but its poor water solubility limits its further development into medicine. The present invention chooses the structure-optimized adenylate cyclase agonist forskolin structural derivatives, and demonstrates for the first time that forskolin derivatives can specifically reduce the production of pro-inflammatory factor TNF-α in human monocyte macrophage THP-<NUM> in vitro, and can specifically reduce the production of pro-inflammatory factor IL-17A during the induced differentiation of Naïve CD4+ T cells from mouse spleen to Th17. The above two inhibitory effects are synergistically enhanced when combined with prostaglandin E2 or hydrocortisone. At the same time, the present invention also demonstrates for the first time that the forskolin derivatives have an efficacy equivalent to that of the first-line clinical drug calcipotriol betamethasone in the imiquimod mouse psoriasis model, and have fewer side effects.

Based on a series of in vitro and in vivo pharmacodynamic evaluation studies, the present disclosure reveals for the first time that structural derivatives of the small molecule compound forskolin can effectively reduce the secretion level of tumor necrosis factor α in THP-<NUM> human macrophages in pharmacodynamic experiments in vitro. When used alone, forskolin structure derivatives can reduce the basic level secretion of TNF-α by up to <NUM>%, and show dose-effect dependence (Concentration response). When combined with prostaglandin E2 or hydrocortisone, they can further reduce the basic level secretion of TNF-α by <NUM>%, showing a stronger pharmacodynamic activity. At the same time, the structural derivatives of the small molecule compound forskolin can effectively reduce the secretion level of interleukin 17A in the in vitro pharmacodynamic experiment of inducing the differentiation of Naïve CD4+ T cells from mouse spleen to Th17. When the forskolin derivatives are used alone, they can reduce the basic level secretion of IL-17A by up to <NUM>%, and there is dose-effect dependence (Concentration response). When combined with prostaglandin E2 or hydrocortisone, they can further reduce the basic level secretion of IL-17A, showing astronger pharmacodynamic activity. Furthermore, in a mouse psoriasis model induced by Imiquimod, the structural derivatives of forskolin show the effect of slowing down a number of disease severity indexes. For example, psoriasis-like skin indiction score, inflammatory thickening of the ears of the model, histological change of inflamed skin of the model were changed correspondingly in high and low dose administration groups and combined administration groups. Among them, the efficacy in the groups administrated with PGE2 is comparable to the current first-line clinical external drug calcipotriol betamethasone, while inflammatory redness of the skin is weaker, and there is no side effect of calcipotriol betamethasone, such as, reduction of the body weights of mice. The above findings suggest that the structural derivatives of forskolin, when used alone or in combination, are expected to become a new class of drugs for the treatment of psoriasis and for immunosuppression, and have comparable efficacy and fewer side effects compared with current clinical first-line drugs.

The forskolin derivatives in accordance with the present invention are <NUM>-(<NUM>-aminobutyryl)forskolin, <NUM>-[<NUM>-(dimethylamino)butyryl]forskolin, <NUM>-[<NUM>-aminopropionyl]forskolin, <NUM>-[<NUM>-(methylamino)propionyl]forskolin, and <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin; their structural formulae are shown in Table <NUM>.

It should also be pointed out that HIL568 is also a forskline derivative later developed by Hoechest for the treatment of glaucoma. It can be speculated that as an adenylate cyclase activator, it also has the effect of inhibiting TNF-α and IL-17A and it therefore has a certain value in the treatment field of the present invention. However, because there is no follow-up development report, it is speculated that the compound has defects such as druggability.

In a particularly preferred embodiment, <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride (<NPL>) of the following formula III is used:
<CHM>.

The present invention concerns a pharmaceutical composition including a forskolin derivative, selected from the group consisting of <NUM>-(<NUM>-aminobutyryl)forskolin, <NUM>-[<NUM>-(dimethylamino)butyryl]forskolin, <NUM>-[<NUM>-aminopropionyl]forskolin, <NUM>-[<NUM>-(methylamino)propionyl]forskolin, and <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin, or a pharmaceutically acceptable salt thereof; and a prostaglandin compound or a glucocorticoid compound.

In some embodiments, the present disclosure also considers a drug or a pharmaceutical composition comprising a prodrug of a forskolin derivative, which are the esters or amides of the forskolin derivative, and a prostaglandin compound or a glucocorticoid compound.

These drugs or pharmaceutical compositions can be used for inducing immunosuppression in a subject in need thereof.

"Pharmaceutically acceptable salts" herein refer to inorganic or organic acid addition salts that are basically harmless to animals or humans, such as hydrochloride, hydrobromide, nitrate, perchlorate, phosphate, sulfate, formate, acetate, aconate, ascorbate, benzenesulfonate, benzoate, cinnamate, citrate, enanthate, fumarate, glutamate, hydroxyacetate, lactate, maleate, malonate, mandelate, methanesulfonate, naphthalene-<NUM>-sulfonate, phthalate, salicylate, sorbate, stearate, succinate, tartrate, p-toluenesulfonate, etc. In some embodiments, it is particularly advantageous that the salts of the forskolin derivatives are their hydrochloride. Such salts can be formed by methods well known to those skilled in the art.

The term "co-administration", for example, for a pharmaceutical combination of a forskolin derivative and a prostaglandin compound, includes the forskolin derivative and the prostaglandin compound being administered sequentially and separately, for example, the prostaglandin compound is administered before or after the administration of the forskolin derivative; it also includes the simultaneous administration of the forskolin derivative and the prostaglandin compound in the same pharmaceutical preparation or in the form of separate pharmaceutical preparations. In the embodiment of sequential administration, usually the forskolin derivative and the prostaglandin compound coexist in the subject at least part of the time. In some embodiments of co-administration, the forskolin derivative and the prostaglandin compound may have a synergistic effect, for example, the amount of one compound is lower than the therapeutically effective amount when administered alone, or preferably, amounts of the two compounds are all lower than the therapeutically effective amounts when used alone.

In some embodiments, the present disclosure provides a pharmaceutical kit comprising a forskolin derivative, selected from the group consisting of <NUM>-(<NUM>-aminobutyryl)forskolin, <NUM>-[<NUM>-(dimethylamino)butyryl]forskolin, <NUM>-[<NUM>-aminopropionyl]forskolin, <NUM>-[<NUM>-(methylamino)propionyl]forskolin, and <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin, or a pharmaceutically acceptable salt thereof, such as hydrochloride, and a prostaglandin compound or a glucocorticoid compound. The pharmaceutical kit can be used for inducing immunosuppression in a subject.

In some embodiments of the pharmaceutical kit, the forskolin derivative or a pharmaceutically acceptable salt thereof and the prostaglandin compound or the glucocorticoid compound can be formulated in a pharmaceutical composition, for example, they are mixed and coexist in the same dosage form or unit dosage form. In other embodiments of the pharmaceutical kit, the forskolin derivative or its pharmaceutically acceptable salt and the prostaglandin compound or glucocorticoid compound can be separately formulated and stored. For example, the forskolin derivative or its pharmaceutically acceptable salt and the prostaglandin compound are both in the form of a solution in different containers, or the forskolin derivative or its pharmaceutically acceptable salt is formulated as an injection, and the prostaglandin compound is formulated as an ointment.

In some embodiments, the pharmaceutical kit provided by the present disclosure may include at least two separate kits, one of which includes the forskolin derivative or a pharmaceutically acceptable salt thereof, and the other includes the prostaglandin compound or glucocorticoid compound. The pharmaceutical kit may also include instructions for simultaneously or sequentially administering the two kits to the subject.

In the drugs, pharmaceutical compositions or pharmaceutical kits provided in the present disclosure, the forskolin derivative or a pharmaceutically acceptable salt thereof, as well as the prostaglandin compound and the glucocorticoid compound may be formulated with a pharmaceutically acceptable carrier. "Pharmaceutically acceptable carrier" herein refers to solid or liquid diluents, fillers, antioxidants, stabilizers and other substances that can be safely administered to animals or humans without excessive adverse side effects, and at the same time, it is suitable for maintaining the activity of the drugs or active agents therein. Depending on the route of administration, various carriers well known in the art can be used, including, but not limited to, sugars, starch, cellulose and its derivatives, maltose, gelatin, talc, calcium sulfate, vegetable oils (such as castor oil), synthetic oil, polyol, alginic acid, phosphate buffer, emulsifier, isotonic saline, and/or pyrogen-free water, etc. Suitable administration routes include, for example, oral, intravenous infusion, intramuscular injection, subcutaneous injection, subperitoneal, rectal, sublingual, or inhalation, transdermal, and other routes. Correspondingly, the forskolin derivative or a pharmaceutically acceptable salt thereof, as well as the prostaglandin compound and the glucocorticoid compound can be formulated together with these pharmaceutically acceptable carriers into any clinically acceptable dosage form, such as tablets, granules, powders, capsules, injection preparations, suppositories, drops, external plasters, ointments, medicated oils, or sprays, etc..

As used herein, "subject" refers to an individual (preferably human) who has or is suspected of suffering from a certain disease (in accordance with the invention psoriasis or psoriatic arthritis), or, for example, when predicting the risk of a disease, the "subject" may also include healthy individuals. This term can often be used interchangeably with "patient", "test subject", "treatment subject" and so on. As used herein, "therapeutically effective amount" refers to an amount sufficient to cause a biological or medical response expected by a clinician in the body of the subject, and it can usually be determined by those skilled in the art according to the route of administration, the weight, age, condition of the subject and other factors. For example, a typical daily dose may range from <NUM> to <NUM> of active ingredient per kg body weight. The present disclosure also considers other dosages.

In some specific embodiments, the present disclosure provides a drug comprising <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride itself or a pharmaceutical composition together with prostaglandin E2 or hydrocortisone, as well as methods or uses thereof for inducing immunosuppression in a subject.

In some embodiments, the present disclosure provides an immunosuppressive agent comprising a forskolin derivative, selected from the group consisting of <NUM>-(<NUM>-aminobutyryl)forskolin, <NUM>-[<NUM>-(dimethylamino)butyryl]forskolin, <NUM>-[<NUM>-aminopropionyl]forskolin, <NUM>-[<NUM>-(methylamino)propionyl]forskolin, and <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin, or a pharmaceutically acceptable salt thereof, and optionally a prostaglandin compound or a glucocorticoid compound. In some embodiments, the immunosuppressive agent is a TNF-α inhibitor. In some embodiments, the immunosuppressive agent is an IL-17A inhibitor. In some embodiments, the immunosuppressant suppresses the expression or secretion of TNF-α and IL-17A at the same time.

In some embodiments, the prostaglandin compound is selected from the group consisiting of prostaglandin E2 (PGE2), dinoprost tromethamine, carboprost, carboprost tromethamine, prostaglandin E1 (Alprostadil), bimatoprost, iloprost, limaprost, limaprost α cyclodextrin (Limaprostalfadex), misoprostol, gemeprost, latanoprost, sulprostone, ornoprostil and pharmaceutically acceptable salts thereof.

In some embodiments, the glucocorticoid compound is selected from the group consisiting of dexamethasone, hydrocortisone, prednisone, prednisolone, paramethasone, cortisone, betamethasone, meprednisone, fludrocortisone, triamcinolone acetonide and pharmaceutically acceptable salts thereof.

In some embodiments of the pharmaceutical composition for use of the present disclosure, the forskolin derivative or a pharmaceutically acceptable salt thereof acts by inhibiting the expression or secretion of TNF-α by immune cells, especially monocyte macrophages. In some embodiments thereof, the forskolin derivative or a pharmaceutically acceptable salt thereof acts by inhibiting the secretion of IL-17A by immune cells, especially T lymphocytes. In some embodiments thereof, the forskolin derivative or a pharmaceutically acceptable salt thereof acts by inhibiting the expression or secretion of TNF-α and IL-17A by immune cells.

"Immunesuppression" as used herein refers to the reduction of undesirable immune responses in a subject, including the production of some cytokines such as TNF-α or IL-17A. In some embodiments, the subject in need of immunosuppression is a patient with an autoimmune disease. In some embodiments, the subject in need of immunosuppression is a patient with psoriasis. In other embodiments, the subject in need of immunosuppression is a patient with inflammation.

It should be understood that all drugs that have an anti-inflammatory effect by reducing the body's own immune response rather than inhibiting the activity of foreign pathogens (such as antibiotics) are essentially immunosuppressive drugs. In this case, the concept of anti-inflammatory drugs is equivalent to immunosuppressants.

In summary, the forskolin derivatives involved in the present disclosure can have immunosuppressive functions by inhibiting the production of pro-inflammatory cytokines TNF-α and/or IL-17A, and have potential value in treating or alleviating inflammation and various autoimmune diseases. Based on a new molecular target and mechanism, the forskolin derivatives are expected to become a new type of immunosuppressant to make up for the shortage of current drugs.

The present invention reveals for the first time that structural derivatives of the small molecule compound forskolin have a dual-action mechanism of simultaneously reducing interleukin 17A and tumor necrosis factor α, and has multiple immunosuppressive effects compared with current single-action mechanism drugs on the market. At the same time, the compound itself has been fully optimized in structure and modified in properties, and possesses considerable druggability. It is also a rare small molecule chemical drug species in the drug market with similar action mechanisms and for related diseases. In summary, forskolin structural derivatives have great potential to effectively fill the gaps in the existing market in the field of psoriasis and immunosuppressive therapy.

The present invention is further illustrated with the following examplest.

The compound <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride (Colforsin daropate hydrochdeloride) was able to concentration-dependently reduce the expression level of TNF-α in human monocyte macrophage THP-<NUM> cultured in vitro after stimulation by lipopolysaccharide (LPS), and the reduction of TNF-α is not due to the compound's influence on the cell viability of THP-<NUM>.

As shown in <FIG>, THP-<NUM> cells cultured in vitro showed a significantly increased TNF-α level in the culture supernatant after stimulation with <NUM> ng/ml LPS for <NUM> hours, while the compound <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride could reduced LPS-induced TNF-α secretion in a concentration-dependent manner in the concentration range of <NUM> to <NUM>. At the highest concentration of <NUM>, it could inhibit about <NUM>% of the TNF-α level of the positive control (the TNF-α level induced by LPS without drug treatment). We also investigated forskolin, a compound of the same structural series, which similarly showed the effect of reducing TNF-α (<FIG>), but the drug activity was slightly lower than the aforementioned compound. In order to further investigate whether this effect of TNF-α reduction was due to the dose-dependent decrease of the viability of THP-<NUM> cells casused by the compound <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride, at the end point of the experiment of stimulating with LPS and representative compound <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride for <NUM> hours, we added <NUM> microliters of <NUM>/mL MTT solution to the cell culture supernatant to detect the cell viability level. It was finally determined that there was no significant difference in cell viability between the groups with or without the compound (<FIG>), and thus confirmed that the effect of <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride in reducing TNF-α secretion occured through specific immune regulation pathways rather than indirectly caused by impaired cell viability.

When prostaglandin E2 (PGE2) was used in combination with <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride, it could strengthen the effect of <NUM>[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride in reducing the level of TNF-α.

As shown in <FIG>, we applied <NUM> and <NUM> compound <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride to THP-<NUM> cells cultured in vitro and caused the elevated TNF-α level indced by 100ng/mL lipopolysaccharide to drop to <NUM>% and <NUM>% of the positive control respectively. In order to investigate whether the combined use of this compound and prostaglandin E2 could enhance the above-mentioned effect of the compound, we used <NUM> PGE2 and <NUM> <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride in combination, and the results showed that the addition of <NUM> PGE2 allowed an inhibition of TNF-α level from a <NUM>% reduction when <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride used alone to to a <NUM>% reduction in TNF-α level. The effect of the combined use was better than the inhibitory effect of the higher concentration of <NUM> <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride (<NUM>%), showing the advantage of the combined use over increased dose. At the same time, we also detected the effect of adding <NUM> PGE2 alone, and found that PGE2 also inhibited the secretion and expression of TNF-α to a certain extent. We speculated that this was related to the fact that it similarly increased the intracellular cAMP level. However, compared with the same concentration of <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride, PGE2 alone did not show a stronger inhibitory effect, which suggested that PGE2 alone lacked advantages. Moreover, it ruled out the possibility that the enhanced effect of <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride in combination with PGE2 in inhibiting TNF-α was unilaterally dominated by PGE2 itself.

In order to further clarify that the combined effect of <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride and PGE2 was a synergistic effect rather than a purely additive effect, according to the judgment principle for synergistic effect of compounds in reference [<NUM>-<NUM>]: expected value of combined treatment with A and B = (value of treatment with A alone /control group value)* (value of treatment with B alone/control group value) *control group value, and the ratio of expected value of combined treatment with A and B/ ratio of actual value of combined treatment with A and B is the Combination Index. If the Combination Index is greater than <NUM>, then the compounds A and B have a synergistic effect, otherwise, it is a purely additive effect. According to this principle and the data in Table <NUM> below, it was obtained through calculation that the combined effect of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and PGE2 was a synergistic effect.

Similarly, we added the same amount of MTT solution as mentioned before at the end point of the drug stimulation in the above experiment. The data showed that cell viability was not affected by the drug treatment, and there was no significant difference between the groups (<FIG>), thus confirming that the regulation of TNF-α expression was the result of the regulation in related signal pathways by the above-mentioned drugs, and not resulted indirectly from impaired cell viability.

When hydrocortisone was used in combination with <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride, it could strengthen the compound's effect in reducing TNF-α.

Hydrocortisone is a glucocorticoid drug commonly used clinically to treat psoriasis and for immunosuppression. We also investigated whether it had a synergistic effect with forskolin (or its derivatives) pharmacodynamically. As shown in <FIG>, we applied <NUM> and <NUM> of compound <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride to THP-<NUM> cells cultured in vitro, and inhibited the elevated TNF-α indced by <NUM> ng/mL LPS to <NUM>% and <NUM>% of the positive control level, respectively. In order to investigate whether hydrocortisone could enhance the effect of this compound, we used <NUM> hydrocortisone and <NUM> of this compound in combination, and the results showed that the addition of <NUM> hydrocortisone allowed a further inhibitory effect of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride from a <NUM>% reduction with <NUM> alone to a <NUM>% reduction with the combination in TNF-α levels. The effect of the combination was better than the inhibitory effect of a higher concentration of <NUM> <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride alone (<NUM>%), showing that the combined use of both achieved a better effect than that resulted from increasing the dose of a single compound. At the same time, we also detected the effect of <NUM> hydrocortisone alone. Interestingly, hydrocortisone is an anti-inflammatory glucocorticoid drug commonly used in clinical practice; however, in this experimental system it had an opposite effect that it further stimulated the increase of inflammatory factor TNF-α. It was previously reported that hydrocortisone might have a biphasic effect when the relative order of administration time and inflammation occurrence time was different. In our experimental system for induction of TNF-α factor expression in vitro, a "preventive" drug interference was utilized, in which hydrocortisone or a test compound was pre-incubated with cells for <NUM> hours prior to the inflammation stimulus lipopolysaccharide. After the subsequent addion of the inflammation stimulus lipopolysaccharide, it might be that hydrocortisone promoted a higher level of TNF-α factor expression at this time point, and achieved the effect of enhancing the occurrence of inflammatory response to completely resist the invasion of inflammatory stimulus LPS, which exactly suggested that there might be a mechanism defect in the long-term repeated use of hydrocortisone in the treatment of chronic inflammation such as psoriasis. Nevertheless, based on the above experimental data, we could conclude that hydrocortisone combined with <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride could enhance the effect of reducing the TNF-α level by <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride, and this enhancement was not dominated by hydrocortisone itself. Similarly, through calculation and analysis in Table <NUM> below, we determined that the combined effect of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and hydrocortisone was a synergistic effect.

We also added the same amount of MTT solution as mention before at the end point of the drug stimulation in the above-mentioned experiment. The data results ruled out the possibility that cell viability was affected by drug treatment (<FIG>), confirming that the changes in TNF-α expression resulted from the regulation of immune regulation-related signal pathways by the above drugs.

Animal strain: adult C57BL/<NUM> female mice, <NUM>-<NUM> weeks old.

<NUM>) Pre-coated the <NUM>-well plate with 2µg/mL anti-mouse CD3e and incubated overnight at <NUM> degrees Celsius;
<NUM>) Separated fresh spleens from adult C57BL/<NUM> female mice (<NUM>-<NUM> weeks old), ground and filtered through a <NUM> nylon cell strainer to obtain a single cell suspension in pre-cooled DPBS;
<NUM>) Washed the spleen cells again with DPBS, and resuspended in RoboSepTM buffer at a density of 1x10<NUM>/mL;
<NUM>) Separated primary CD4+ T cells with mouse primary CD4+ T cell isolation kit as required by the kit;
<NUM>) Resuspended the isolated CD4+ T cells in complete medium (RPMI <NUM> medium + <NUM>% inactivated FBS + <NUM>% double antibiotics) at a density of 1x10<NUM>/mL;
<NUM>) Washed the <NUM>-well plate pre-coated with anti-mouse CD3e twice with DPBS, added <NUM>µL of cytokine cocktail, the composition and final concentration of which are shown in Table <NUM> below, and then added <NUM>µL of compound solution (the final concentration of DMSO was <NUM>%). Added <NUM>µL of cell suspension to each well to allow the final cell number per well to be <NUM> x <NUM><NUM>/<NUM>µL;.

<NUM>) Cultured the cells for <NUM> days under the above conditions. The culture conditions were <NUM> degrees Celsius, <NUM>% CO<NUM> concentration;
<NUM>) After <NUM> days, added 1X stimulation cocktail (eBioscience 500X) to the culture medium for <NUM> hours, and then collected cell culture supernatant for detection with IL-17A enzyme-linked immunoassay kit;
<NUM>) Completed the detection of supernatant IL-17A concentration with mouse IL-<NUM> DuoSet ELISA kit;
<NUM>) Read the OD450nm absorbance value with a microplate reader, and generated the standard curve by using the <NUM>-parameter logistic fitting (<NUM>-PL) method.

Compound <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride (Colforsin daropate hydrochdeloride) could concentration-dependently reduce the secretion and expression of IL-17A in mouse primary CD4+ T cells induced to differentiate under the combined action of cytokines TGF-β, IL-<NUM>, IL-<NUM>, etc., and the reduction in IL-17A was not due to the toxicity of the compound to Th17 cells.

As shown in <FIG>, mouse primary CD4+ T cells showed a significantly increased level of IL-17A in the culture supernatant under the induction of cytokine combinations for <NUM> days, while the compound <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride concentration-dependently reduced the induced basic IL-17A secretion in the concentration range of <NUM> to <NUM>, and could inhibit about <NUM>% of the positive control IL-17A level (the level of IL-17A induced by the cytokine combination without drug treatment) at the highest concentration of <NUM>. In order to further investigate whether such effect of IL-17A reduction was caused by the toxicity of the compound <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride weakening the viability of CD4+ T cells, we separately tested the toxicity of the compound on CD4+ T cells. The compound was diluted in the culture medium and incubated with CD4+ T cells for <NUM> hours, and the concentration of lactate dehydrogenase released into the culture medium was measured. The results showed that the compound was not significantly toxic to the cells (<FIG>), thus confirming that the effect of <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride in reducing IL-17A secretion occured through specific immune regulation pathways rather than indirectly caused by impaired cell viability.

When prostaglandin E2 (PGE2) was used in combination with <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride, it could strengthen the action of <NUM>[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride in reducing IL-17A levels.

As shown in <FIG>, during the induced differentiation to Th17 from mouse primary CD4+ T cells, we applied <NUM> and <NUM> of the compound <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and resulted in the elevated IL-17A levels induced by cytokine combination to drop to <NUM>% and <NUM>% of the positive control (no compound treatment). In order to investigate whether a combined use of this compound and prostaglandin E2 could enhance the above-mentioned effects of the compound, we used <NUM> PGE2 and <NUM> <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride in combination. The results showed that the addition of <NUM> PGE2 allowed <NUM> <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride to further inhibit IL-17A levels from a <NUM>% reduction when used alone to a <NUM>% reduction in IL-17A levels. Moreover, the effect of the combined use was better than the inhibitory effect of the higher concentration of <NUM> <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride alone (<NUM>%), showing an advantage of the combined use over increased dose alone. At the same time, we also tested the effect of adding <NUM> PGE2 alone, and found that PGE2 also inhibited the secretion and expression of IL-17A to a certain extent. We speculated that this was related to the fact that it similarly increased the intracellular cAMP level. However, the inhibitory effect of <NUM> PGE2 was comparable to the lower concentration of <NUM> <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride (inhibit to be <NUM>% and <NUM>% of the basic level, respectively). It showed that PGE2 alone did not have a stronger inhibitory effect, suggesting that PGE2 alone lacked advantages, and it further ruled out the possibility that the enhanced effect of <NUM>-[<NUM>-(dimethylamino) propionyl] forskolin hydrochloride in combination with PGE2 in inhibiting IL-17A was unilaterally dominated by PGE2 itself.

Similarly, in order to further clarify that the combined effect of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and PGE2 in inhibiting the secretion of IL-17A was a synergistic effect rather than a purely additive effect, we similarly calculated the relevant combination index as shown in the table below. According to the foregoing principles and the data in Table <NUM> below, it was obtained through calculation that the combined effect of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and PGE2 in reducing IL-17A was a synergistic effect.

Similarly, we tested the toxic effect of the compounds on mouse CD4+ T cells under the aforementioned experimental dosing conditions. The compounds were incubated with cells for <NUM> hours to detect the concentration of lactate dehydrogenase released in the supernatant. The data showed that cell viability was not affected by drug treatment and there was no significant difference between groups (<FIG>), thus comfirming that the regulation of IL-17A expression was the result of the regulation in related signal pathways by the above-mentioned drugs, and not resulted indirectly from impaired cell viability.

When hydrocortisone was used in combination with <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride, it could strengthen the action of <NUM>[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride in reducing IL-17A levels.

Hydrocortisone is a glucocorticoid drug commonly used clinically to treat psoriasis and for immunosuppression. We also investigated whether it had a synergistic effect with forskolin derivatives pharmacodynamically. As shown in <FIG>, during the induced differentiation to Th17 from mouse primary CD4+ T cells, we applied <NUM> and <NUM> of the compound <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and resulted in the elevated IL-17A levels induced by cytokine combination to drop to <NUM>% and <NUM>% of the positive control (no compound treatment group). In order to investigate whether hydrocortisone could enhance the effects of this compound, we used <NUM> hydrocortisone and <NUM> of this compound in combination. The results showed that the addition of <NUM> hydrocortisone allowed a further inhibitory effect of <NUM> <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride on IL-17A from a <NUM>% reduction with <NUM> alone to a <NUM>% reduction with the combination in IL-17A levels. At the same time, we also tested the effect of <NUM> hydrocortisone alone and it reduced the IL-17A level by <NUM>% of the basic level.

Similarly, we calculated and analyzed in Table <NUM> below to clarify that the combined effect of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and hydrocortisone in reducing IL-17A secretion was a synergistic effect.

Animal strain: <NUM> male BALB/c mice, <NUM>-<NUM> weeks old, SPF environment, <NUM> hours light and dark cycle, <NUM>-<NUM> degrees Celsius.

The experimental indicator used was the psoriasis-like index score:.

In the experiment of mouse psoriasis model induced with imiquimod, we used the groups with <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride at a high dose of <NUM>/kg and a low dose of <NUM>/kg (not part of the invention), and at the same time designed a combined administration group of <NUM>/kg <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and <NUM>% prostaglandin E2 (PGE2). The positive treatment group was the current first-line clinical topical combination medicine calcipotriol betamethasone ointment. During <NUM> consecutive days of administration, we observed that the groups with the high and low doses of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride and the combined administration group with PGE2 could all show an effect of slow down various psoriasis-like indicators in a certain period of time. Moreover, compared with the positive control first-line medicine, the combined administration group had better effects as to indicators such as avoiding mouse weight loss, skin inflammation and redness.

As shown in <FIG>, the psoriasis-like index of the skin of the model area on the back of the mouse gradually increased with the increase of the administration time. The statistical significance analysis was shown in Table <NUM>.

The model group was manifested by the severity of skin scurf, redness and rash (<FIG>). The group with the high-dose <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride exhibited a faster effect than that of the low-dose group, and showed an effect of disease alleviation on day <NUM> of the administration, while the low-dose group began to exhibite the effect on day <NUM>. However, the difference in efficacy between the high-dose group and the low-dose group tended to shrink at the end point of day <NUM>, suggesting that although the high-dose group exhibited a fast effect, the efficacies of high and low doses might be the same under long-term administration. In addition, the effect in the combined administration group was better than that in the high-dose group, which was consistent with the in vitro experimental results in the Examples, and its improved effect was equivalent to that of the positive drug calcipotriol betamethasone ointment. It could be seen from <FIG> that compared to the model group induced by imiquimod and groups with high- or low-dose alone, the back skin of the mouse in the combined administration group was smooth and free of plaques, and the skin redness was lighter than that of the positive control group. Table <NUM> showed the statistical differences of back psoriasis-like scores between the groups. Combined with <FIG>, we could conclude that the groups with high or low dose of <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin hydrochloride alone (not part of the invention) and the combined administration group could all significantly slow down the development of psoriasis-like pathological characteristics of the mouse back model skin, and the combined administration group had the same effect as the current first-line drug calcipotriol betamethasone.

In addition, as shown in <FIG> and <FIG>, we measured the thickness of the left and right ears of the mice in parallel, and the results showed that, compared with untreated left ears, the model right ears induced by imiquimod exhibited characteristics such as inflammatory thickening, vasodilatation and skin redness. The characteristics were gradually enhanced during the <NUM>-day continuous period of imiquimod administration. Both the high-dose and low-dose groups of the drug and the combined administration group could all show the effects of relieving the inflammation, thickening and redness of the right ear induced by imiquimod within a certain period of time. At the end point of <NUM>-day administration, the combined administration had the strongest effect (relieving by <NUM>%), similar to the positive drug (relieving by <NUM>%). The high-dose group (relieving by <NUM>%) and the low-dose group (relieving by <NUM>%) had slightly weaker effects, but there was no significant difference between the high and low dose groups, suggesting that the difference in the effects of high and low doses might be reduced in the later stage of continuous administration, similar to the experimental results of the back scores. Table <NUM> listed the significant difference analysis values between the groups in <FIG>.

<FIG> showed different degrees of skin inflammation and redness of the model right ears of each treatment group at the end point of <NUM>-day administration. <FIG> showed the comparison of redness on the left and right ears of the same mouse on day <NUM> of the experiment, suggesting that the high-dose group could exhibit the relief effect earlier on day <NUM> of modeling.

We also analyzed the body weight changes of the mice during the administration period (<FIG>). Except for the positive control group, in which calcipotriol betamethasone treatment resulted in weight loss of the mice, the mice in the other groups showed no obvious changes in body weight. This was consistent with existing research reports and related pre-experimental results of this research system. The hormone components in the positive combination drug would reduce the weight of mice, and it was positively related to its dosage. This suggested that the current first-line medication calcipotriol betamethasone still had its side effects of long-term clinical use, while the ingredients and combination of the present invention did not show an effect on body weight. It was expected to overcome the side effects of existing first-line drugs and became a better medication choice.

The histological analysis of the skin of the back model area (<FIG>) showed that compared with the blank group, the epidermis and stratum corneum of the mouse back skin were thickened in the model group, while there were different degrees of thickness reduction in the groups with high and low doses alone, the combined administration group and the positive control group.

Claim 1:
A pharmaceutical composition for use in treating psoriasis or psoriatic arthritis, comprising:
a forskolin derivative or a pharmaceutically acceptable salt thereof, and
a prostaglandin compound or a glucocorticoid compound,
wherein the forskolin derivative is selected from the group consisting of <NUM>-(<NUM>-aminobutyryl)forskolin, <NUM>-[<NUM>-(dimethylamino)butyryl]forskolin, <NUM>-[<NUM>-aminopropionyl]forskolin, <NUM>-[<NUM>-(methylamino)propionyl]forskolin, and <NUM>-[<NUM>-(dimethylamino)propionyl]forskolin.