TWI478721B - 細胞緊密連接效應劑之配方 - Google Patents
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Description
本發明主張美國暫時申請案號60/771,454號之優先權,其係於2006年2月9日申請,該申請案之完整內容係列為本案之參考。
本發明係關於一種醫療劑型,包括某些細胞緊密連接拮抗劑或促效劑以及腸覆膜。
腸內細胞緊密連接障礙會發生在多種臨床狀況中,包括食物過敏、消化道感染、自體免疫疾病、發炎性腸道疾病等。健康、成熟的腸道黏膜與其完整的細胞緊密連接,作為巨分子通過的主要屏障。在健康狀態中,小量的免疫活性蛋白會通過腸道屏障。這些蛋白質經由至少兩種途徑穿過腸道而被吸收。主要被吸收的蛋白質(超過90%)經由細胞內途徑通過腸道屏障,接著經由溶酶降解將蛋白質轉化為較小且不會引起免疫反應之胜肽。其他蛋白質係藉由細胞間途徑而以完整蛋白質形式被運送,此牽涉到細緻而複雜的細胞間緊密連接調控,而引發蛋白質(抗原)耐受性。當細胞緊密連接系統的完整性被破壞時,例如早熟或暴露至放射線、化療、及/或毒物後,則可能發生對於環境抗原(包括自體免疫疾病以及食物過敏)的有害反應。
為了達成在上皮處所遭遇的生理上與病理上的挑戰,細胞緊密連接或閉合帶(zonula occludens,ZO)必須能夠進行快速、生理、可逆、短暫、需能、並協同的反應,因此需要複雜的調控系統。
由霍亂弧菌(Vibrio cholerae
)所產生的閉合帶毒素(zonula occludens toxin),已經被Fasanoet al
在Proc.Natl.Acad.Sci.,USA
,8:5242-5246(1991)所分離出來,且其序列已經被確立(GenBank Accesion no.A43864)。霍亂弧菌噬菌體CXTΦ所製造的ZOT蛋白質可以探究細胞緊密連接調控的生理機制。ZOT具有多個區域,使得此蛋白質具有霍亂弧菌噬菌體CXTΦ的形態發生噬菌體胜肽、以及控制腸道細胞緊密連接之腸道毒素等雙重功能。在兔子的迴腸黏膜測試時,閉合帶毒素(ZOT)藉由控制細胞間細胞緊密連接結構而增加了腸道通透性。
研究發現,ZOT能可逆地開啟腸道黏膜的細胞緊密連接,因此當ZOT用於腸道藥物傳遞之口服劑型組成物而與一醫療劑共同服用時,可以影響此醫療劑的經腸吸收效果(WO 96/37196;and U.S.Pat.No.5,665,389;andFasano et al.,J.Clin.Invest
.,99:1158-1164(1997))。在美國專利5,864,014號中,已從一小腸細胞株中(CaCo2細胞)鑑定並純化出一ZOT受器。此外,在美國專利5,912,323中,已經從人類腸道、心臟與腦組織中鑑識並純化出ZOT受器。
ZOT藉由與腸道細胞表面反應,而調節一系列細胞內反應。ZOT的結合效率會隨著小腸各區段不同而不同,在空腸與迴腸末端可以偵測到,沿著絨毛窩腺軸而減少,到結腸則無法偵測。此結合分佈與ZOT對於腸道通透性之影響相符合。
與ZOT在免疫上與功能上相關的哺乳類蛋白質已經被辨識出來。在美國專利5,945,510號中,鑑識並純化了與ZOT在免疫上與功能上相關、並同時作用為哺乳類細胞緊密連接生理調控子的新穎哺乳類蛋白質。這些蛋白質(通稱為閉合帶蛋白(zonulin))係作用為哺乳類細胞緊密連接的生理效應劑(effector)。
此所提及的細胞緊密連接促效劑(例如閉合帶蛋白(zonulin)的促效劑),係已經確認其可與ZOT受器結合。這些促效劑以可逆地並可重複地快速打開細胞緊密連接,因此可以用以增加醫療或免疫產生劑之腸道生體利用率,如同ZOT作為腸道傳輸增強劑之相同效果,其已在下列專利文獻中提及:WO 05/010022;WO 96/37196;美國專利5,827,534號;美國專利5,665,389號;以及美國專利5,908,825號。
此所提及之細胞緊密連接拮抗劑(例如閉合帶蛋白(zonulin)拮抗劑),係經確認可與ZOT受器結合者,但在生理上並非用以調節哺乳類細胞緊密連接的開啟。請參見美國專利6,498,925號。此胜肽拮抗劑會競爭性地抑制ZOT和閉合帶蛋白(zonulin)與ZOT受器結合,因此抑制ZOT與閉合帶蛋白(zonulin)控制哺乳類細胞緊密連接的開啟功能。在不同解剖學屏障方面抑制細胞緊密連接的開啟可能對於治療自體免疫疾病會有用處。
本發明提供了一種組成物,其包括一種或以上之細胞緊密連接效應劑。此組成物可包括一核顆粒、一基底覆層於核顆粒之外、以及一延遲釋放覆膜於基底覆層之外。在某些實施例中,此基底覆層可包括一種或以上之細胞緊密連接拮抗劑及/或一種或以上之細胞緊密連接促效劑。在某些實施例中,延遲釋放覆膜在胃液中是實質上穩定的。在一特定實施例中,基底覆層可包括一種或以上之細胞緊密連接拮抗劑、一種或以上之細胞緊密連接促效劑、或者一種或以上之細胞緊密連接拮抗劑與細胞緊密連接促效劑的組合。在某些實施例中,延遲釋放覆膜可包括一尤特奇(Eudragit)L化合物。
典型地,延遲釋放覆膜包括一腸內劑,其在酸性環境中係實質上穩定、而在進中性至鹼性的環境中係實質上不穩定。適合的延遲釋放覆膜可包括一種或以上之三酸甘油酯以及一披覆支撐劑,其中三酸甘油酯係選自一群組包括:三硬脂酸甘油酯(tristearin)、三油酸甘油酯(triolein)、三辛酸甘油酯(tricaprylin)、三癸酸甘油酯(tricaprin)、三肉豆蔻酸甘油酯(trimyristin)、三棕櫚酸甘油酯(tripalmitin)、以及三月桂酸甘油酯(trilaurin)。
細胞緊密連接促效劑的示例之一為閉合帶毒素(ZOT),其係由霍亂弧菌所產生。認為ZOT受器促效劑是一種使用同於ZOT所使用的受器而調節細胞緊密連接開啟的化合物。在另一實施例中,一細胞緊密連接促效劑可包括閉合帶蛋白(zonulin)。認為閉合帶蛋白(zonulin)受器促效劑是一種使用同於閉合帶蛋白(zonulin)所使用的受器而調節細胞緊密連接開啟的化合物。ZOT受器促效劑與閉合帶蛋白(zonulin)受器促效劑,兩者均為細胞緊密連接促效劑的範例。不受理論限制地,咸信ZOT與閉合帶蛋白(zonulin)使用相同受器當作用為細胞緊密連接促效劑。在一特定實施例中,本發明的組成物可包括一細胞緊密連接拮抗劑其包括含有SEQ ID NO:1的胜肽。在另一特定實施例中,本發明之組成物可包括一細胞緊密連接促效劑,該細胞緊密連接促效劑包括一胜肽,該胜肽包含有SEQ ID NO.2。
本發明的組成物可包括一種或以上之醫療及/或免疫產生劑。當使用醫療及/或免疫產生劑時,其可位於核顆粒、基底覆層及/或延遲釋放覆膜中。典型地,醫療劑及/或免疫產生劑係位於基底覆層及/或核顆粒中。適合的醫療劑範例包括但不限於:葡萄糖代謝劑(例如胰島素、瑞格列奈(Repaglinide)、乙醯苯磺醯環己脲(acetohexamide)、甲苯磺丁脲(tolbutamide)、氯磺丙脲(chlorpropamide)、胰舒寧(tolazamide)、米格列醇(miglitol)、瑪爾胰(glimepiride)、以及其類似物)、抗生素、抗癌劑、抗高血壓藥物、抗癲癇藥物、中樞神經系統藥物、以及免疫系統抑制劑。
在一實施例中,本發明之一組成物於一錠劑、膠囊、或粉囊中可包括複數個延遲釋放顆粒。
本發明的組成物可用以治療多種疾病與醫療狀況。在一實施例中,本發明提供一種用以治療消化道發炎之方法,包括使一需要治療之對象口服一醫療劑型,該醫療劑型包括本發明之組成物。在另一實施例中,本發明提供一種用以治療一人類腸胃道發炎之方法,該人類已被一醫療人員檢查出腸胃道發炎並診斷需要治療該腸胃道發炎,該方法包括使該人類口服一包括本發明之組成物的醫藥劑型。在另一實施例中,本發明提供一種用以治療人類糖尿病之方法,此名人類已被一醫療人員檢查出糖尿病並診斷需要治療該糖尿病,此方法包括使該人類口服一包括本發明之組成物的醫藥劑型,此時本發明之組成物包括一細胞緊密連接促效劑(例如閉合帶蛋白(zonulin)促效劑)以及胰島素。
在另一實施例中,本發明提供一種組成物其包括多個延遲釋放包覆顆粒。這些顆粒可以是相同或不同的顆粒,舉例而言,可以包括一種或以上之相同或不同的細胞緊密連接效應劑、醫藥劑、及/或免疫產生劑,以及延遲釋放覆膜。此一組成物的範例可包括一第一核顆粒,一第一基底覆層於核顆粒之外,其中第一基底覆層包括一種或以上之細胞緊密連接效應劑,一第一延遲釋放覆膜於第一基底覆層之外而形成第一延遲釋放顆粒,其中此第一延遲釋放覆膜在胃液中係實質上穩定;以及一第二核顆粒,一第二基底覆層於第二核顆粒之外,其中第二基底覆層包括一種或以上之細胞緊密連接效應劑,以及一第二延遲釋放覆膜於第二基底覆層之外而形成第二延遲釋放顆粒;其中第二延遲釋放覆膜在胃液中係實質上穩定的。在某些實施例中,第一延遲釋放覆膜與第二延遲釋放覆膜係在不同的時間延遲釋放。舉例而言,第一延遲釋放顆粒中之細胞緊密連接效應劑之大約一半,係在接觸至腸液約5至約10分鐘之後釋放,而在第二延遲釋放顆粒中之細胞緊密連接效應劑之大約一半,係在接觸至腸液約12至約18分鐘之後釋放。在此型的組成物中,細胞緊密連接效應劑可以任何形式分佈,例如第一延遲釋放顆粒中之細胞緊密連接效應劑可占該組成物中之細胞緊密連接效應劑總重量約60%至約90%,而在第二延遲釋放顆粒中之細胞緊密連接效應劑可占該組成物中之細胞緊密連接效應劑總重量約10%至約40%。相似地,第一延遲釋放顆粒可包括一細胞緊密連接拮抗劑及/或一細胞緊密連接促效劑,而第二延遲釋放顆粒可包括一細胞緊密連接拮抗劑及/或一細胞緊密連接促效劑。此型組成物的合適細胞緊密連接拮抗劑包括但不限於,包括有SEQ ID NO:1的細胞緊密連接拮抗劑。此型組成物的合適細胞緊密連接促效劑包括但不限於,包括有SEQ ID NO:2的細胞緊密連接促效劑。此型組成物可更包括一種或以上之醫療劑及/或免疫產生劑,以任何方式配置。舉例而言,一第一延遲釋放顆粒及/或第二延遲釋放顆粒可包括一種或以上之醫療劑及/或免疫產生劑。此型的組成物可包括複數個第一延遲顆粒及/或第二延遲顆粒。此型的組成物可用以治療多種疾病及/或醫療狀況。舉例而言,本發明提供一種用以治療腸胃道發炎之方法,包括使一需要治療之病人口服此組成物,此組成物則包括第一延遲釋放顆粒與第二延遲釋放顆粒。
在一特定實施例中,本發明提供一組成物其包括一核顆粒,一基底覆層於核顆粒之外,其中基底覆層包括了含有SEQ ID:1的細胞緊密連接拮抗劑,以及一延遲釋放覆膜於基底覆層之外,其中延遲釋放覆膜在胃液中是實質上穩定的。此組成物的適合核顆粒的尺寸可介於約25至約30網目之間。此基底覆層可包括一黏結劑(例如貝克糖(Baker’s sugar))且延遲釋放覆膜可包括尤特奇(Eudragit)L30D。可使用任何含量的一種或以上之細胞緊密連接拮抗劑,例如,在此組成物中可包括約0.1 wt%至約20 wt%、約1 wt%至約20 wt%、約1 wt%至約10 wt%、或約4 wt%至約6 wt%之細胞緊密連接拮抗劑。
在另一特定實施例中,本發明提供一種組成物包括一核顆粒、一基底覆層於核顆粒之外,其中基底覆層包括一含有SEQ ID:2的細胞緊密連接促效劑,以及一延遲釋放覆膜於基底覆層之外,其中延遲釋放覆膜在胃液中是實質上穩定的。此組成物的適合核顆粒的尺寸可介於約25至約30網目之間。此基底覆層可包括一黏結劑(例如貝克糖(Baker’s sugar))且延遲釋放覆膜可包括尤特奇(Eudragit)L30D。可使用任何含量的一種或以上之細胞緊密連接促效劑,例如,在此組成物中可包括約0.1 wt%至約20 wt%、約1 wt%至約20 wt%、約1 wt%至約10 wt%、或約4wt%至約6 wt%之細胞緊密連接促效劑。此組成物可更包括一種或以上之醫療劑及/或一種或以上之免疫產生劑。適合的醫療劑包括但不限於,葡萄糖代謝劑(例如,胰島素、瑞格列奈(Repaglinide)、乙醯苯磺醯環己脲(acetohexamide)、甲苯磺丁脲(tolbutamide)、氯磺丙脲(chlorpropamide)、胰舒寧(tolazamide)、米格列醇(miglitol)、瑪爾胰(glimepiride)、以及其類似物)、抗生素、抗癌劑、抗高血壓藥物、抗癲癇藥物、中樞神經系統藥物、以及免疫系統抑制劑。適合的免疫產生劑包括但不限於疫苗(例如:胜肽疫苗、減弱毒性微生物疫苗、以及減弱毒性病毒疫苗)。
本發明係有關於一種組成物,其包括有一種或以上之細胞緊密連接促效劑及/或細胞緊密連接拮抗劑。當使用於此時,「細胞緊密連接效應劑」係總和地指細胞緊密連接促效劑與細胞緊密連接拮抗劑。此詞彙「拮抗劑」係定義為會防止、抑制、減少、或逆轉由一促效劑所引發之反應的化合物。因此,在此所使用的細胞緊密連接促效劑係為調節細胞緊密連接開啟的化合物(例如可引起這些細胞緊密連接生理、暫時分離的化合物);一細胞緊密連接拮抗劑係為防止、抑制、減少、或逆轉由一促效劑所引發之反應的化合物(例如可防止這些細胞緊密連接生理、暫時分離的化合物)。在某些實施例中,一細胞緊密連接促效劑可藉由結合至ZOT/閉合帶蛋白(zonulin)受器而操作,換言之,可以是ZOT/閉合帶蛋白(zonulin)受器的促效劑。在某些實施例中,細胞緊密連接拮抗劑可藉由結合至ZOT/閉合帶蛋白(zonulin)受器而操作,換言之,可以是ZOT/閉合帶蛋白(zonulin)受器的拮抗劑。在某些實施例中,細胞緊密連接促效劑並不包括可以物理上中斷細胞緊密連接結構的藥劑,例如一清潔劑。在某些實施例中,一細胞緊密連接拮抗劑並不包括直接與細胞緊密連接促效劑結合方式而作用的化合物。適合的細胞緊密連接效應劑包括但不限於,胜肽其包括一個或以上之下列序列:GGVLVQPG(SEQ ID NO:1,一細胞緊密連接拮抗劑)與FCIGRL(SEQ ID NO:2,一細胞緊密連接促效劑),以及這些序列的其他具有功能性的衍生物。
舉例而言,胜肽GGVLVQPG的的功能性衍生物包括但不限於:Gly Arg Val Cys Val Gln Pro Gly(SEQ ID NO:3),Gly Arg Val Cys Val Gln Asp Gly(SEQ ID NO:4),Gly Arg Val Leu Val Gln Pro Gly(SEQ ID NO:5),Gly Arg Val Leu Val Gln Asp Gly(SEQ ID NO:6),Gly Arg Leu Cys Val Gln Pro Gly(SEQ ID NO:7),Gly Arg Leu Cys Val Gln Asp Gly(SEQ ID NO:8),Gly Arg Leu Leu Val Gln Pro Gly(SEQ ID NO:9),Gly Arg Leu Leu Val Gln Asp Gly(SEQ ID NO:10),Gly Arg Gly Cys Val Gln Pro Gly(SEQ ID NO:11),Gly Arg Gly Cys Val Gln Asp Gly(SEQ ID NO:12),Gly Arg Gly Leu Val Gln Pro Gly(SEQ ID NO:13),Gly Arg Gly Leu Val Gln Asp Gly(SEQ ID NO:14),Gly Gly Val Cys Val Gln Pro Gly(SEQ ID NO:15),Gly Gly Val Cys Val Gln Asp Gly(SEQ ID NO:16),Gly Gly Val Leu Val Gln Asp Gly(SEQ ID NO:17),Gly Gly Leu Cys Val Gln Pro Gly(SEQ ID NO:18),Gly Gly Leu Cys Val Gln Asp Gly(SEQ ID NO:19),Gly Gly Leu Leu Val Gln Pro Gly(SEQ ID NO:20),Gly Gly Leu Leu Val Gln Asp Gly(SEQ ID NO:21),Gly Gly Gly Cys Val Gln Pro Gly(SEQ ID NO:22),Gly Gly Gly Cys Val Gln Asp Gly(SEQ ID NO:23),Gly Gly Gly Leu Val Gln Pro Gly(SEQ ID NO:24),Gly Gly Gly Leu Val Gln Asp Gly(SEQ ID NO:25),以及Val Asp Gly Phe Gly Arg Ile Gly(SEQ ID NO:26)。
舉例而言,胜肽FCIGRL的功能性衍生物包括但不限於Xaa1
Cys Ile Gly Arg Leu(SEQ ID NO:27),Phe Xaa2
lle Gly Arg Leu(SEQ ID NO:28),Phe Cys Xaa3
Gly Arg Leu(SEQ ID NO:29),Phe Cys Ile Xaa4
Arg Leu(SEQ ID NO:30),Phe Cys Ile Gly Xaa5
Leu(SEQ ID NO:31),以及Phe Cys Ile Gly Arg Xaa6
(SEQ ID NO:32)。
Xaa1
可以選自Ala,Val,Leu,Ile,Pro,Trp,Tyr,與Met所組群組;Xaa2
可以選自Gly,Ser,Thr,Tyr,Asn,以及Gln所組群組;Xaa3
可以選自Ala,Val,Leu,Ile,Pro,Trp,以及Met所組群組;Xaa4
可以選自Gly,Ser,Thr,Tyr,Asn,Ala,以及Gln所組群組;Xaa5
可以選自Lys以及His所組群組;Xaa6
可以選自Ala,Val,Leu,Ile,Pro,Trp,以及Met所組群組。
其他(SEQ ID NO:2)的功能性衍生物包括:Xaa1
Xaa2
Ile Gly Arg Leu(SEQ ID NO:33),Xaa1
Cys Xaa3 Gly Arg Leu(SEQ ID NO:34),Xaa1
Cys Ile Xaa4 Arg Leu(SEQ ID NO:35),Xaa1
Cys Ile Gly Xaa5
Leu(SEQ ID NO:36),Xaa1
Cys Ile Gly Arg Xaa6
(SEQ ID NO:37),Phe Xaa2
Xaa3
Gly Arg Leu(SEQ ID NO:38),Phe Xaa2
Ile Xaa4 Arg Leu(SEQ ID NO:39),Phe Xaa2
Ile Gly Xaa5
Leu(SEQ ID NO:40),Phe Xaa2
Ile Gly Arg Xaa6
(SEQ ID NO:41),Phe Cys Xaa3
Xaa4
Arg Leu(SEQ ID NO:42),Phe Cys Xaa3
Gly Xaa5
Leu(SEQ ID NO:43),Phe Cys Xaa3
Gly Arg Xaa6
(SEQ ID NO:44),Phe Cys Ile Xaa4
Xaa5
Leu(SEQ ID NO:45),Phe Cys Ile Xaa4
Arg Xaa6
(SEQ ID NO:46),以及Phe Cys Ile Gly Xaa5
Xaa6
(SEQ ID NO:47)。
Xaa1
可以選自Ala,Val,Leu,Ile,Pro,Trp,Tyr,與Met所組群組;Xaa2
可以選自Gly,Ser,Thr,Tyr,Asn,以及Gln所組群組;Xaa3
可以選自Ala,Val,Leu,Ile,Pro,Trp,以及Met所組群組;Xaa4
可以選自Gly,Ser,Thr,Tyr,Asn,Ala,以及Gln所組群組;Xaa5
可以選自Lys以及His所組群組;Xaa6
可以選自Ala,Val,Leu,Ile,Pro,Trp,以及Met所組群組。
本發明同時考慮到包括有熟悉該項技藝者所分類為小分子、胜肽、類胜肽、以及基於胜肽SEQ ID Nos.1-47之胜肽類似物之細胞緊密連接效應劑的組成物。本發明之組成物可以配製為適合腸道傳輸,舉例而言,可包括一層以上的覆膜,例如延遲釋放覆膜包括一種或以上之腸內劑。一延遲釋放覆膜典型地在胃液中係實質上穩定,而在腸液中係實質上不穩定(例如快速溶解、或物理上不穩定),因而在十二指腸或空腸中從該組成物中實質釋放出細胞緊密連接效應劑。本發明同時考慮到該組成物可選擇性地包括一種或以上之醫療或免疫產生之活性分子。
本發明之組成物可包括一種或以上之細胞緊密連接效應劑,其含量占總組成物重量的約0.1 wt%至約20 wt%、約0.1 wt%至約18 wt%、約0.1 wt%至約16 wt%、約0.1 wt%至約14 wt%、約0.1 wt%至約12 wt%、約0.1 wt%至約10 wt%、約0.1 wt%至約8 wt%、約0.1 wt%至約6 wt%、約0.1 wt%至約4 wt%、約0.1 wt%至約2 wt%、約0.1 wt%至約1 wt%、約0.1 wt%至約0.9 wt%、約0.1 wt%至約0.8 wt%、約0.1 wt%至約0.7 wt%、約0.1 wt%至約0.6 wt%、約0.1 wt%至約0.5 wt%、約0.1 wt%至約0.4 wt%、約0.1 wt%至約0.3 wt%、或約0.1 wt%至約0.2 wt%之間。本發明的組成物可包括一種或以上之細胞緊密連接效應劑,其含量占總組成物重量的約0.1 wt%、約0.2 wt%、約0.3 wt%、約0.4 wt%、約0.5 wt%、約0.6 wt%、約0.7 wt%、約0.8 wt%、或約0.9 wt%。
本發明之組成物可包括一種或以上之細胞緊密連接效應劑,其含量占總組成物重量的約1 wt%至約20 wt%、約1 wt%至約18 wt%、約1 wt%至約16 wt%、約1 wt%至約14 wt%、約1 wt%至約12 wt%、約1 wt%至約10 wt%、約1 wt%至約9 wt%、約1 wt%至約8 wt%、約1 wt%至約7 wt%、約1 wt%至約6 wt%、約1 wt%至約5 wt%、約1 wt%至約4 wt%、約1 wt%至約3 wt%、或約1 wt%至約2 wt%。本發明的組成物可包括一種或以上之細胞緊密連接效應劑,其含量占總組成物重量的約1 wt%、約2 wt%、約3 wt%、約4 wt%、約5 wt%、約6 wt%、約7 wt%、約8 wt%、或約9 wt%。
「在胃液中穩定」或「在酸性環境中穩定」係指稱在大約六十分鐘內,在pH 5以下的胃液中或在模擬的pH 5以下的胃液中,此組成物釋放出30%以下總重量的細胞緊密連接拮抗劑或促效劑。本發明之組成物可在大約六十分鐘內,在pH 5以下的胃液中或在模擬的pH 5以下的胃液中,釋放出細胞緊密連接拮抗劑或促效劑總重量之約0 wt%至約30 wt%、約0 wt%至約25 wt%、約0 wt%至約20 wt%、約0 wt%至約15 wt%、約0 wt%至約10 wt%、約5 wt%至約30 wt%、約5 wt%至約25 wt%、約5 wt%至約20 wt%、約5 wt%至約15 wt%、約5 wt%至約10 wt%。在本說明中,「約」係用以修正在此數值的平均10%以內。本發明之組成物可在大約六十分鐘內,在pH 5以下的胃液中或在模擬的pH 5以下的胃液中,釋放出細胞緊密連接拮抗劑或促效劑總重量之約1 wt%、約2 wt%、約3 wt%、約4 wt%、約5 wt%、約6 wt%、7 wt%、約8 wt%、約9 wt%、或約10 wt%。
「在腸液中不穩定」係指稱在大約六十分鐘內,在腸液中或在模擬的腸液中,此組成物釋放出70%以上總重量的細胞緊密連接拮抗劑或促效劑。「在近中性至鹼性環境中不穩定」係指稱在大約九十分鐘內,在pH 5以上的腸液中或在模擬的pH 5以上的腸液中,此組成物釋放出70%以下總重量的細胞緊密連接拮抗劑或促效劑。舉例而言,一組成物在約5分鐘至約90分鐘、約10分鐘至約90分鐘、約15分鐘至約90分鐘、約20分鐘至約90分鐘、約25分鐘至約90分鐘、約30分鐘至約90分鐘、約5分鐘至約60分鐘、約10分鐘至約60分鐘、約15分鐘至約60分鐘、約20分鐘至約60分鐘、約25分鐘至約90分鐘、約30分鐘至約60分鐘之內,在一pH值大於約5之液體中(例如pH值約5至約14、約6至約14、約7至約14、約8至約14、約9至約14、約10至約14、或約11至約14之液體)釋放出細胞緊密連接拮抗劑或促效劑總重量之70%以上。
在一實施例中,此延遲釋放覆膜在胃液中可維持實質上完整,或可實質上不可溶解。延遲釋放覆膜的穩定性可隨pH值改變。隨pH值改變的延遲釋放覆膜可在酸性環境中(pH小於5)實質穩定,並在近中性至鹼性環境中(pH大於5)實質不穩定。舉例而言,此延遲釋放覆膜可在近中性至鹼性環境中(例如小腸中的環境)分解或溶解。
模擬胃液與模擬腸液的範例包括但不限於,在2005 Pharmacopeia 23NF/28USP第2858頁的Test Solutions所揭露者,或者熟悉該項技藝者所知悉的其他模擬胃液與模擬腸液,例如不具有酵素之模擬胃液與模擬腸液。
或者,延遲釋放被覆層的穩定性可以隨著酵素不同而改變。隨酵素改變的延遲釋放被覆層可以在不含有特定酵素的液體中實質穩定,而在含有該特定酵素的液體中實質不穩定。此延遲釋放被覆層會實質上分解或溶解於包括有適當酵素的液體中。酵素控制可以使用僅在暴露至小腸酵素才繪示放活性組成物的材料,例如半乳糖甘露聚醣(galactomannans)。
在本文中,細胞緊密連接拮抗劑可防止、抑制或減少細胞緊密連接的開啟。細胞緊密連接促效劑調節或促進或增強細胞緊密連接的開啟。細胞緊密連接拮抗劑可抑制細胞緊密連接促效劑(例如ZOT與閉合帶蛋白(zonulin))與一個或以上之受器分子(例如ZOT受器)的結合,進而抑制或減少促效劑生理上調節細胞緊密連接開啟的功能。
細胞緊密連接促效劑或細胞緊密連接拮抗劑從本發明組成物釋放後的目標臟器之一是小腸,尤其是十二指腸與空腸。美國專利6,458,925、5,945,510與5,827,534討論了經腸傳輸之細胞緊密連接拮抗劑、閉合帶蛋白(zonulin)或ZOT,以此領域所描述之抗胃酸錠劑或膠囊方式的口服劑型組成物可能性。關於此等錠劑或膠囊的製備,請參見Remington's Pharmaceutical Sciences,16th Ed.,Eds.Osol,Mack Publishing Co.,Chapter 89(1980);Digenis et al,J.Pharm.Sci.,83:915-921(1994);Vantini et al,Clinica Terapeutica,145:445-451(1993);Yoshitomi et al,Chem.Pharm.Bull.,40:1902-1905(1992);Thoma et al,Pharmazie,46:331-336(1991);Morishita et al,Drug Design and Delivery,7:309-319(1991);以及Lin et al,Pharmaceutical Res.,8:919-924(1991)。
在一實施例中,本發明之腸劑型可使用一種或以上之延遲釋放被覆層、以及一惰性核,以提供細胞緊密連接促效劑或拮抗劑選擇性地與其他醫療劑或免疫產生劑結合後,有效、延遲而實質的傳輸。這些經被覆的組成物在酸性環境或胃液中實質上穩定,並且在近中性至鹼性環境或腸液中實質上不穩定。本發明之組成物也可在不背離本發明精神的範圍內,包括額外的化合物,例如緩衝劑、賦形劑、滑石或黏結劑。
包括細胞緊密連接促效劑或拮抗劑的顆粒、以及腸被覆層。
在一實施例中,本發明提供一種組成物包括:一核顆粒其具有一基底被覆層包括一種或以上之細胞緊密連接促效劑及或一種或以上之細胞緊密連接拮抗劑,以及一延遲釋放被覆層置於經被覆核顆粒之外。延遲釋放被覆層可在酸性環境中及/或胃液中實質上穩定,及/或在近中性至鹼性環境或腸液中實質不穩定,以將經被覆核顆粒暴露至腸液中。基底被覆層包括一種或以上之細胞緊密連接促效劑及/或一種或以上之細胞緊密連接促效劑,並可更包括一種或以上之醫療劑。選擇性地,複數個基底被覆層可施加至核顆粒上,每一基底被覆層包括一細胞緊密連接效應劑及/或一醫療劑。選擇性地,核顆粒可包括一種或以上之細胞緊密連接效應劑及/或一種或以上之醫療劑。
在一實施例中,可以錠劑或膠囊形式提供上述組成物予一需要治療的對象,此錠劑或膠囊包括了經被覆的核顆粒。此錠劑或膠囊可以口服。或者,可以提供一包括有此經被覆核顆粒的粉囊至此對象,粉囊選擇性地包括一種或以上之佐藥如增甜劑或香料。此對象可接著將粉末與一液體混合,並口服此混合物。
核顆粒可包括球行或顆粒其平均尺寸介於約5至約50網目、約5至約45網目、約5至約40網目、約5至約35網目、約5至約30網目、約5至約25網目、約5至約20網目、約5至約15網目、約5至約10網目、約10至約50網目、約10至約45網目、約10至約40網目、約10至約35網目、約10至約30網目、約10至約25網目、約10至約20網目、約10至約15網目、約15至約50網目、約15至約45網目、約15至約40網目、約15至約35網目、約15至約30網目、約15至約25網目、約15至約20網目、約20至約50網目、約20至約45網目、約20至約40網目、約20至約35網目、約20至約30網目、約20至約25網目、約25至約50網目、約25至約45網目、約25至約40網目、約25至約35網目、約25至約30網目、約30至約50網目、約30至約45網目、約30至約40網目、或約30至約35網目。核顆粒可塗覆有塗層組成物,該塗層組成物可包含此文中所描述之一種或以上之細胞緊密連接促效劑與/或一種或以上之細胞緊密連接拮抗劑與/或一種或以上之治療劑。
核顆粒可為水不溶性顆粒其包括不同的氧化物、纖維素、有機聚合物與其他材料、及其混合物,或可為水溶性顆粒包括不同的無機鹽類、醣類、non-pareils、以及其他材料、及其混合物。核顆粒可占最終顆粒組成物的約25至約75、約30至約75、約35至約75、約40至約75、約45至約75、約50至約75、約55至約75、約60至約75、約65至約75、約70至約75、約25至約70、約25至約65、約25至約60、約25至約55、約25至約50、約25至約45、約25至約40、約25至約35、約25至約30、約30至約60、約35至約55、約40至約50、約42至約47、或約42至約45 wt%。在一實施例中,核顆粒係占最終顆粒組成物的43.2 wt%。此核顆粒的通常形式可以在商業上以CelpheresTM
或non-pareils方式購得。核顆粒可以選擇性地包括一種或以上之細胞緊密連接效應劑化合物及/或一種或以上之醫療劑。核顆粒可以利用此領域習知之技術被覆,例如在美國專利6,248,363號(尤其是在實施例中)、與6,294,192號(尤其是在實施例中)的技術。
本發明之組成物耶可包括一種或以上之下列此領域習知佐劑,例如界面活性劑、填充劑、分解劑、鹼性材料及/或黏結劑。
適用於本發明的界面活性劑包括但不限於,任何藥學上可接受的非毒性界面活性劑。適合用於本發明組成物中的界面活性劑分類包括但不限於,聚乙氧基脂肪酸(polyethoxylated fatty acids)、PEG脂肪酸二酯(PEG-fatty acid diesters)、PEG脂肪酸單酯與二酯混合物(PEG-fatty acid mono-and di-ester)、聚乙烯乙二醇脂肪酸甘油酯(polyethylene glycol glycerol fatty acid esters)、醇油交酯化產物(alcohol-oil transesterification)、聚甘油脂肪酸(polyglycerized fatty acids)、丙二醇脂肪酸酯(propylene glycol fatty acid esters)、丙烯16乙二醇酯-甘油酯(propylene 16 glycol esters-glycerol esters)混合物、單與雙甘油酯、固醇(sterol)及固醇衍生物、聚乙烯乙二醇脂肪酸山梨酯(polyethylene glycol sorbitan fatty acid esters)、PEG烷基醚(polyethylene glycol alkyl ethers)、糖酯(sugar esters)、PEG烷基酚(polyethylene glycol alkyl phenols)、聚氧乙烯-氧丙烯塊體共聚物(poly oxyethylene-olyoxypropylene block copolymers)、脂肪酸山梨酯(sorbitan fatty acid esters)、低級醇脂肪酸酯(lower alcohol fatty acid esters)、離子介面活性劑(ionic surfactants)、及其混合物。在某些實施例中,本發明之組成物可包括一種或以上之界面活性劑,包括但不限於:月桂硫酸鈉(sodium lauryl sulfate)、聚山梨酸鹽20(polysorbate 20)、聚山梨酸鹽40(polysorbate 40)、聚山梨酸鹽60(polysorbate 60)、聚山梨酸鹽80(polysorbate 80)、以及三乙基檸檬酸鹽(triethyl citrate)。這些界面活性劑的含量可占最終顆粒組成物總重量的約0.1 wt%至約5 wt%、0.1 wt%至約4.5 wt%、0.1 wt%至約4.0 wt%、0.1 wt%至約3.5 wt%、0.1 wt%至約3.0 wt%、0.1 wt%至約2.5 wt%、0.1 wt%至約2.0 wt%、0.1 wt%至約1.5 wt%、0.1 wt%至約1.0 wt%、0.1 wt%至約0.5 wt%、0.5 wt%至約5.0 wt%、1.0 wt%至約5.0 wt%、1.5 wt%至約5.0 wt%、2.0 wt%至約5.0 wt%、2.5 wt%至約5.0 wt%、3.0 wt%至約5.0 wt%、3.5 wt%至約5.0 wt%、4.0 wt%至約5.0 wt%、4.5 wt%至約5.0 wt%、0.25 wt%至約2.5 wt%、1.0 wt%至約2.0 wt%、或1.5 wt%至約2.0 wt%。在某些實施例中,界面活性劑在本發明組成物中的含量可為最終顆粒組成物之總重量的約1.0 wt%、1.1 wt%、1.2 wt%、1.3 wt%、1.4 wt%、1、5 wt%、1.6 wt%、1.7 wt%、1.8 wt%、1.9 wt%、2.0 wt%。在一實施例中,本發明之組成物可包括占最終顆粒組成物的總重量1.8 wt%的界面活性劑。
適用於本發明組成物中的鹼性材料包括但不限於,鈉鹽類、鉀鹽類、鈣鹽類、鎂鹽類、及鋁鹽類之酸,例如磷酸、碳酸、檸檬酸、與其他鋁/鎂化合物。此外,鹼性材料可選自解酸劑材料例如氫氧化鋁、氫氧化鈣、氫氧化鎂、以及鎂氧化物。這些鹼性劑的含量可占被覆組成物總重量的約1 wt%至約20 wt%、約1 wt%至約18 wt%、約1 wt%至約16 wt%、約1 wt%至約14 wt%、約1 wt%至約12 wt%、約1 wt%至約10 wt%、約1 wt%至約8 wt%、約1 wt%至約6 wt%、約1 wt%至約4 wt%、或約1 wt%至約2 wt%,視鹼性材料的相對強度而定。在某些實施例中,鹼性材料可占本發明組成物之被覆組成物總重量的約1 wt%、約2 wt%、約3 wt%、約4 wt%、約5 wt%、約6 wt%、約7 wt%、約8 wt%、約9 wt%、約10 wt%、約11 wt%、約12wt%、約13 wt%、約14 wt%、約15 wt%、約16 wt%、約17 wt%、約18 wt%、約19 wt%、或約20 wt%。
適用於本發明組成物中之黏結劑包括但不限於,任何藥學上可接受之非毒性黏結劑。黏結劑可為一水溶性聚合物。在某些實施例中,黏結劑可包括一個或以上之選自下列群組的黏結劑:聚乙烯醇(polyvinyl alcohol)、聚乙烯吡咯烷酮(polyvinylpyrrolidone)、甲基纖維素(methylcellulose)、羥丙基纖維素(hydroxypropyl cellulose)、羥甲基纖維素(hydroxymethyl cellulose)、及其類似物。當使用一水溶性黏結劑時,此黏結劑可以使用一如水之水性媒介。本發明之組成物可以占被覆組成物總重量之約1 wt%至約15 wt%,視此鹼性材料的相對強度而定。醣類(如乳糖、葡萄糖、蔗糖、與麥芽糖)、微結晶纖維素以及其類似物的填充劑,可以包括於被覆組成物中。較佳的商業可購得填充劑為貝克斯特殊糖(Bakers Special Sugar)。
施加延遲釋放被覆層到經被覆核顆粒之前,此顆粒可選擇性地被一層以上的分隔層覆蓋,分隔層包括藥學賦形劑,包括鹼性化合物如pH-緩衝化合物等。此分隔層實質上將經被覆核顆粒與延遲釋放被覆層分隔開來。
分隔層可利用被覆或層化程序而施加到經被覆核顆粒上,被覆裝備如被覆鍋、被覆造粒器、或在一流體化床裝置中使用水及/或有機溶劑於被覆製程中。做為一替代方式,分隔層可以利用粉末塗佈技術而塗佈到核材料上。分隔層的材料為醫藥可接受的化合物,例如醣類、聚乙烯二醇(polyethylene glycol)、聚乙烯吡咯烷酮(polyvinylpyrrolidone)、聚乙烯醇(polyvinyl alcohol)、聚醋酸乙烯酯(polyvinyl acetate)、羥丙基纖維素(hydroxypropyl cellulose)、甲基纖維素(methyl-cellulose)、乙基纖維素(ethylcellulose)、羥丙基甲基纖維素(hydroxypropyl methylcellulose)、羧甲基纖維素鈉(carboxymethylcellulose sodium)及其他,單獨使用或以混合物方式使用均可。塑化劑、著色劑、染料、填充劑、抗黏劑、與抗靜電劑例如硬酯酸鎂、二氧化鈦、滑石與其他添加物等,亦可包括於分隔層中。
在一實施例中,延遲釋放被覆層包括一腸劑其在酸性環境中實質穩定,並在近中性至鹼性環境中實質上不穩定。一延遲釋放被覆組成物可被分散或溶解於水貨適當的有機溶劑中,並藉由此領域中所熟知之方法而塗佈到核顆粒之外。可以塗佈一層以上的延遲釋放被覆層到經被覆核顆粒之外。同時,如前所述,在塗佈延遲釋放塗佈層之前,可以選擇性將分隔層塗佈到經被覆核顆粒上。
腸劑可以從下列群組中選擇:例如甲基丙烯酸共聚物(methacrylic acid copolymers)、纖維素醋酸鄰苯二甲酸酯(cellulose acetate phthalate)、羥丙基甲基纖維素鄰苯二甲酸酯(hydroxypropylmethyl cellulose phthalate)、聚乙烯醋酸鄰苯二甲酸酯(polyvinyl acetate phthalate)、羰甲基乙基纖維素(carboxymethylethylcellulose)、以及尤特奇型(Eudragit-type)聚合物(poly(methacrylic acid、methylmethacrylate)、羥丙基甲基纖維素醋酸琥珀酸酯(hydroxypropyl methylcellulose acetate succinate)、纖維素醋酸偏苯三甲酸酯(cellulose acetate trimellitate)、蟲膠(shellac)或其他合適的腸被覆聚合物的溶液或分散液。尤特奇(Eudragit)型聚合物,包括尤特奇(Eudragit)L、NE、RL、RS等。較佳係使用尤特奇(Eudragit)L聚合物。腸劑可為前述溶液或分散液的組合。
在另一實施例中,延遲釋放被覆層在水性溶液中,若無關pH及/或酵素時,可能以時間為函數降解。此一被覆層可能包括水不溶性聚合物。其在水性溶液中的溶解度因此則與pH值無關。本文中「與pH值無關」一詞表示,聚合物的水通透性與其釋放醫藥組成物的能力,並非pH值的函數,並且僅與pH值有非常輕微的相關性。此被覆層可用以製備長效釋放劑型。合適的水不溶性聚合物包括醫藥可接受的非毒性聚合物,其在水性媒介(例如水)中實質上不可溶,並且與溶液的pH值無關。合適的聚合物包括但不限於:纖維素醚類(cellulose ethers)、纖維素酯類(cellulose esters)、或纖維素醚酯類(cellulose ether-esters),亦即一纖維素衍生物,其中纖維素骨架上的一些羥基係被烷基所取代,而一些羥基則以烷酰基修飾之。範例包括乙基纖維素、乙醯基纖維素、硝酸纖維素、極其類似物。其他不可溶聚合物包括但不限於,漆、壓克力、及/或甲基丙醯酸酯聚合物,具有低四級銨的丙醯酸酯或丙醯酸甲酯的聚合物或共聚物,或者其混合物與類似物。其他不可溶聚合物包括尤特奇(EUDRAGIT)RS、尤特奇(EUDRAGIT)RL、以及尤特奇(EUDRAGIT)NE。在本發明中可使用的不可溶聚合物包括聚乙烯酯(polyvinyl esters)、聚乙烯乙縮醛(polyvinyl acetals)、聚丙烯酸酯(polyacrylic acid esters)、丁二烯苯乙烯共聚物(butadiene styrene copolymers)、及其類似物。
在另一實施例中,延遲釋放被覆層包括一腸劑其在胃液中實質穩定。此腸劑可對胰臟脂解酶(pancreatic lipase)敏感。對胰臟脂解酶敏感的腸劑包括三酸甘油酯、三硬脂酸甘油酯(tristearin)、三油酸甘油酯(triolein)、三辛酸甘油酯(tricaprylin)、三癸酸甘油酯(tricaprin)、三肉桂酸甘油酯(trimyristin)、三棕櫚酸甘油酯(tripalmitin)以及三月桂酸甘油酯(trilaurin)。一種或以上之這些三酸甘油酯與一被覆支撐劑(例如纖維素型材料,例如乙基纖維素)的組合,係用以製備一延遲釋放被覆組成物,其接著塗佈到經被覆核顆粒上。
延遲釋放皮不組成物可包括從0.1 wt%至5 wt%的三酸甘油酯或三酸甘油酯混合物,以及0.5 wt%至10 wt%的被覆支撐劑。另一延遲釋放被覆組成物可包括從0.5 wt%至3 wt%的三酸甘油酯或三酸甘油酯混合物,以及1 wt%至5 wt%的被覆支撐劑。
一種或以上之延遲釋放被覆層可被塗佈到經被覆核顆粒上。舉例而言,除了對胰臟脂解酶敏感之腸劑之外,可塗佈一額外的延遲釋放被覆層至核顆粒上。此一額外被覆層可以包括一腸劑,此腸劑係如本文所述而在一酸性環境中實質穩定。同時,如上所述,在塗佈延遲釋放被覆層之前,可塗佈一選擇性的分隔層至核顆粒之外。
延遲釋放被覆組成物亦可包括一種或以上之惰性製程輔劑,其含量係占被覆組成物總重量之10至80 wt%。此惰性製程輔劑包括精細分離形式的滑石、二氧化矽、硬酯酸鎂等。
延遲釋放被覆組成物亦可包括醫藥可接受的塑化劑,以獲得理想的機械性質,例如彈性與硬度。此塑化劑包括但不限於,三乙酸甘油酯(triacetin)、檸檬酸酯(citric acid esters)、鄰苯二甲酸酯(phthalic acid esters)、癸二酸二丁酯(dibutyl sebacate)、鯨蠟醇(cetyl alcohol)、PEG(polyethylene glycols)、聚山梨酯(polysorbates)或其他塑化劑。
塑化劑的含量係以每一延遲釋放被覆層與選定使用腸劑間的關係,而進行最佳化。選定的塑化劑與腸劑的塗佈量,係根據理想的機械性質(延遲釋放被覆層的亦即彈性與硬度)而進行最佳化。延遲釋放被覆層的硬度,經常以維克氏硬度(Vickers hardness)做為例子,並且經過調整以使得最終被覆顆粒的耐酸性,在將顆粒壓製成錠劑的過程中不會大幅下降。其他化合物可以被加入至延遲釋放被覆組成物中,以增加薄膜厚度,並增加對胃中酸性胃液的耐酸性。
此延遲釋放被覆組成物亦可包括一種或以上之應用溶劑。可應用於此延遲釋放被覆組成物中的某些較常使用的溶劑包括,異丙醇、丙酮、二氯甲烷、及其類似物。一般而言,腸劑與惰性製程輔劑將占被覆組成物(包括溶劑重量)的5 wt%至60 wt%。
具有延遲釋放被覆層的被覆顆粒,可以進一步以一外覆層覆蓋之。此外覆層可以與其他被覆組成物相同的方式塗佈。此外覆層的材料係為醫藥可接受的化合物,例如醣類、聚乙烯基乙二醇(polyethylene glycol)、聚乙烯吡咯烷酮(polyvinylpyrrolidone)、聚乙烯醇(polyvinyl alcohol)、聚醋酸乙烯酯(polyvinyl acetate)、羥丙基纖維素(hydroxypropyl cellulose)、甲基纖維素(methyl-cellulose)、乙基纖維素(ethylcellulose)、羥丙基甲基纖維素(hydroxypropyl methylcellulose)、CMC鈉(carboxymethylcellulose sodium)等,單獨使用或混合使用。外覆層材料可以防止這被覆有延遲釋放被覆層之顆粒所可能發生的結塊,保護此延遲釋放被覆層在壓縮製程或壓錠製程之中不會破裂。
可以理解的是,最終產品的整體釋放數據,可以藉由結合兩種以上的顆粒類型與不同的釋放數據而調整。舉例而言,在一實施例中,大約一半的經被覆核顆粒為第一經被覆核顆粒型其具有腸劑被覆而在約5至約10分鐘後將細胞緊密連接促效劑或拮抗劑暴露於腸液中,且另一半的經被覆核顆粒為一第二經被覆核顆粒型其具有腸劑被覆而在約12至約18到60分鐘後將細胞緊密連接促效劑或拮抗劑暴露至腸液中。在另一實施例中,在此組成物的細胞緊密連接效應劑總量中,第一經被覆顆粒占60%至90%的重量,而第二經被覆顆粒占10%至40%的重量。
包括一種或以上之細胞緊密連接拮抗劑之組成物在一實施例中本發明之組成物可包.括一種或以上之細胞緊密連接拮抗劑。合適的閉合帶蛋白(zonulin)拮抗劑的範例之一,是胜肽GGVLVQPG(SEQ ID NO:1)及其衍生物,尤其是具有一個或以上之保守胺基酸替換的衍生物。此組成物可用以治療多種疾病,包括但不限於,自體免疫疾病。可利用本發明之組成物治療的自體免疫疾病包括但不限於,腹腔疾病、原發性膽汁硬化(primary biliary cirrhosis)、A型免疫球蛋白腎病(IgA nephropathy)、韋格納肉芽腫(Wegener's granulomatosis)、多發性硬化症(Multiple Sclerosis)、硬皮病(Scleroderma)、全身性硬化症(Systemic sclerosis)、第1型糖尿病(type 1 diabetes mellitus)、類風濕性關節炎(rheumatoid arthritis)、克隆氏症(Crohn's disease)、紅斑狼瘡(Lupus Erythematosus)、橋本氏甲狀腺炎(Hashimoto’s thyroiditis(underactive thyroid))、葛瑞夫茲氏病(Graves’disease,overactive thyroid)、自體免疫性肝炎(autoimmune Hepatitis)、自體免疫性內耳疾病(autoimmune inner ear disease)、大水皰性類天皰瘡(Bullous pemphigoid)、載維斯症候群(Devic's syndrome)、古德巴斯德症候群(Goodpasture's syndrome)、癌肌症(Lambert-Eaton myasthenic syndrome.(LEMS))、自體免疫淋巴增生症候群(autoimmune lymphoproliferative syndrome,ALPS)、次腫瘤症候群.(paraneoplastic syndromes)、多發性腺體自體免疫症(polyglandular autoimmune syndromes(PGA))、以及頭皮圓型禿(alopecia areata)。
本發明之組成物可以用作為抗發炎藥物以治療消化道發炎,而消化道發炎則會導致腸道通透性的增加。因此,此拮抗劑用於會使得蛋白質失去腸道治療的治療腸道狀況時是非常有用的。失去腸道治療的蛋白質可能導因於:感染,例如C.difficile感染、結腸炎、志賀氏菌痢疾、腸炎、寄生蟲、細菌過度生長、惠普爾病(Whipple's disease,WD):與黏膜侵蝕或潰瘍有關的疾病,例如胃炎、胃癌、膠狀性腸炎(collagenous colitis)、發炎性腸疾病(inflammatory bowel disease);以及不具潰瘍的黏膜疾病,例如蒙尼柴爾病(Menetrier's disease)、麩質過敏症(Celiac Disease)、嗜伊紅胃腸炎(eosinophilic gastroenteritis)。
其他可以利用本發明之組成物與方法治療的疾病,包括但不限於,由淋巴阻礙作為徵兆的疾病,例如先天性腸淋巴管擴張症(congenital intestinal lymphangiectasia)、肉狀淋巴瘤(sarcoidosis lymphoma、腸系膜結核病(mesenteric tuberculosis)、以及外科手術後之先天性心臟病(after surgical correction of congenital heart disease);以及免疫疾病,例如全身性紅斑狼瘡(systemic lupus erythematosus)或食物過敏,主要對牛奶過敏(請參見Pediatric Gastrointestinal Disease Pathophysiology Diagnosis Management,Eds.Wyllie et al,saunders Co.(1993),pages 536-543的表40-2,該文獻在此列為本案之參考)。
閉合帶蛋白(zonulin)的拮抗劑的醫療有效組成物會隨著所治療疾病的類型或狀況而改變,以及受治療對象的年紀、體重、以及性別。一般而言,用以抑制消化道發炎(例如抑制閉合帶蛋白(zonulin)的生物活性)所使用的拮抗劑含量係介於約1.0 μg到1000 μg之間,較佳係為1.0 μg至100 μg。
胜肽細胞緊密連接拮抗劑可以利用習知技術而化學合成並純化,例如在High Performance Liquid Chromatography of Peptides and Proteins:Separation Analysis and Conformation,Eds.Mant et al,C.R.C.Press(1991)中所描述者,以及一胜肽合成劑,例如Symphony(Protein Technologies,Inc);或藉由使用重組DNA技術,亦即將譯碼為胜肽的核甘酸序列插入到適當的表現載體中,例如一E.coli或酵母菌表現載體,而在對應的宿主細胞中表現,進而利用習知技術純化。
包括一個或以上之細胞緊密連接促效劑之組成物在一實施例中,一細胞緊密連接促效劑可包括一胜肽序列。適合的胜肽序列為FCIGRL(SEQ ID NO:2)及其衍生序列,尤其是具有一個或以上之保守胺基酸取代的衍生序列。一胜肽序列可被單獨使用或可為一較大分子的一部份,例如一多肽鍊。當閉合帶蛋白(zonulin)促效劑包括一多肽鍊時,此一多肽鍊的長度典型地係少於100個胺基酸,或少於50、40、30、20、10、或8個胺基酸。多肽鍊此可包括僅六個胺基酸FCIGRL(SEQ ID NO:2),或其可包括額外的胺基酸。其他的胺基酸可提供其他功能,例如抗原標籤,以利於純化。
在一實施例中,本發明的組成物可包括一個或以上之細胞緊密連接促效劑以及一個或以上之醫療劑及/或免疫產生劑。在一實施例中,本發明之一組成物可包括一醫療劑及/或一免疫產生劑以及人體閉合帶蛋白(zonulin)受器的促效劑與霍亂弧菌噬菌體CTXΦZOT蛋白質,上述之醫療劑及/或免疫產生劑係用以治療、改善、或預防一種或以上之疾病。本發明同時包含,此組成物可以一醫療套件的形式存在,其中該促效劑與醫療劑係共同包裝,以同時、近乎同時、或接續地使用。在接續使用的實施例中,促效劑與醫療劑係可以在12、8、4、2或1小時之內相繼服用,或可在5、10、或15分鐘之內相繼服用。
可以用於本發明組成物中的醫療劑包括,可以作用於身體之任何臟器的藥劑,例如心臟、腦、小腸或腎臟。
使用於本組成物中的特定醫療劑或免疫產生劑,可為任何小分子化合物、生物活性胜肽、疫苗、或任何其他無法經由細胞內途徑良好吸收的團基,無論其分子大小或所帶電荷。
可以用於本發明中的藥物化合物包括但不限於,作用於心血管系統之藥物、作用於中央神經系統之藥物、抗癌藥物、以及抗生素。作用於心血管系統的藥物包括但不限於,抗高血壓藥物(antihypertensives)、施德丁(statins)、腺苷(adenosine)、dobutamine、多巴胺(dopamine)、腎上腺素(Epinephrine)、正腎上腺素(norepinephrine)、以及酚妥拉明(phentolamine)。其他此領域習知的藥物亦可使用。
作用於中央神經系統的藥物包括但不限於,多沙普倫(doxapram)、阿華吩坦尼(alfentanil)、戴若欣(dezocin)、那布紛(nalbuphine)、似普羅啡(Buprenorphine)、納洛酮(naloxone)、克多羅拉柯(ketorolac)、米達諾(midazolam)、以及丙泊酚(propofol)。其他的範例包括但不限於,抗精神病劑(Antipsychotics)、抗憂鬱劑(antidepressants)、抗癲癇劑(antiepileptics)、以及用以治療阿茲海默症(Alzheimers disease)的藥物。亦可使用其他此領域習知的藥物。
抗癌藥物包括但不限於,賽達命(cytarabine)、排多癌(mitomycin)、艾黴素(doxorubicin)、安可平(vincristine)及敏畢瘤(vinblastine)、佳鉑帝(carboplatin)、西伯拉丁(cisplatin)、草酸鉑(oxaloplatin)、溫諾平(vinorelbine)、克癌易(docetaxel)、汰癌勝(paclitaxel)、紫杉烷(taxane)、5-氟尿苷(5-fluorouridine)相關藥物、截瘤達(xeloda)、絕西他必(germcitabine)、以及安舒羅克林(anthracline)。額外的範例包括但不限於,爾必得舒(Erbitux)、賀癌平(Herceptin)、癌思停(AvastinTM
)、以及雌激素受器的拮抗劑與促效劑。也可使用其他此領域習知的藥物。
抗生素的範例包括但不限於甲氧西林(methicillin)、美洛西林(mezlocillin)、達梭黴素(piperacillin)、塞駝西定(cetoxitin)、頭孢尼西(cefonicid)、塞分訥他若(cefinetazole)、及安達菌素(aztreonam)。也可使用其他此領域習知的藥物。
任何類型的醫療及/或免疫產生劑,可用以實施本發明。特定類型的藥劑包括但不限於RNAi、治療用適體、抗病毒藥物(例如麥斯克(amantadine)、金剛乙胺(rimantadine)、札那米韋(zanamavir)、及奧斯他韋(oseltamivir))、免疫抑制劑(例如塞孢靈A(cyclosporine A))、HIV融合抑制劑(例如恩夫韋肽(enfuvirtide))、以及HIV蛋白酶抑制劑(例如諾易亞(ritonavir)、服妥美(saquinavir)、克濾滿(indinavir)、安普納韋(amprenavir)、耐非納韋(nelfinavir)、洛匹納韋(lopinavir)、瑞塔茲(atazanavir)、恩曲他濱(entricitabine)、以及夫沙納韋鈣(fosamprenavir calcium))。
生物活性胜肽的範例包括賀爾蒙、淋巴激素(lymphokines)、球蛋白、以及白蛋白。可使用於本發明中的賀爾蒙範例包括睪固酮、諾龍激素(nandrolene)、尿促性素(menotropins)、胰島素、生長激素、副甲狀腺賀爾蒙(PTH)以及俄豐錯匹素(urofolltropin)。也可使用其他該領域習知的藥物。若該生物活性組成物是胰島素,則口服劑型組成物可用於治療糖尿病。可使用於本發明中的淋巴激素(lymphokines)範例包括干擾素-α(interferon-α)、干擾素-β(interferon-β)、干擾素-γ(interferon-γ)、介白素-1(interleukin-1)、介白素-2(interleukin-2)、介白素-4(interleukin-4)、以及介白素-8(interleukin-8)。
球蛋白的範例包括:α-球蛋白、β-球蛋白以及γ-球蛋白(免疫球蛋白)。可使用於本發明的免疫球蛋白範例包括:多價性IgG或專一性IgG、IgA、及IgM,例如抗破傷風抗體。可使用的白蛋白的範例之一是人類血清白蛋白。也可使用其他在此領域熟知者。
可用於該組成物的疫苗包括,胜肽以及減弱毒性之微生物與病毒。胜肽抗原的範例包括腸毒性大腸桿菌之熱不穩定腸毒素之B次單位、霍亂毒素之B次單位、腸病原的膠囊抗原、腸病原的絨毛或鞭毛、HIV表面抗原、灰塵過敏原、以及蟎抗原。也可使用其他在該領域中習知的免疫產生化合物。
可用於該組成物中的減弱毒性微生物與病毒包括、腸毒性大腸桿菌、腸寄生性Escherichia coif
、hibrio cholerae
、Shigella flexneri
、Salmonella typhi
、及輪狀病毒(Fasano et al,In:Le Vaccinazioni in Pediatria,Eds.Vierucci et al,CSH,Milan,pages 109-121(1991);Guandalini et al,In:Management of Digestive and Liver Disorders in Infants and Children,Elsevior,Eds.Butz et al,Amsterdam,Chapter 25(1993);Levine et al,Sem.Ped.Infect.Dis.,5.243-250(1994);and Kaper et al,Clin.Micrbiol.Rev.,8:48-86(1995),每一份文件均列為本案的參考)。
本發明的醫療組成物可用以治療、改善及/或預防疾病。此疾病可選自一群組包括:癌症、自體免疫、血管、病毒感染、胃炎、胃癌、膠狀性腸炎(collagenous colitis)、發炎性腸疾病(inflammatory bowel disease)、骨質疏鬆、全身性紅班狼瘡、食物過敏、氣喘、以及激躁性結腸症(Irritable Bowel Syndrome)。
在另一實施例中,該組成物可用於一種治療病人的方法中,此病人與健康控制組個體相較之下,具有過度表現的閉合帶蛋白(zonulin)。在此例中,此醫療劑可為一抗體其係對抗胺基酸SLIGKVDGTSHVTG(SEQ ID NO:48)。舉例而言,抗體可以結合至表現於CaCo2細胞中之一蛋白質,其係與一被合成抑制胜肽SEQ ID NO:1所結合之蛋白質共同局部化。該抗體並不結合至表現有重組人類PAR-2基因的人類或大鼠細胞。此抗體並非SAM11。
可以瞭解的是,對於本發明中之任何拮抗劑與促效劑胜肽而言,可以產生一種或以上之保守取代,其中一胺基酸係由另一具有相似性質的胺基酸所取代。特定胺基酸的保守取代可以在閉合帶蛋白(zonulin)的促效劑胜肽中以及閉合帶蛋白(zonulin)的拮抗劑胜肽中產生。舉例而言,可以在促效劑胜肽所產生的保守取代,其序列可如SEQ ID NO:1-47的任何依序列所示。保守取代的範例包括但不限於GlyAla、VaIIeLeu、AspGlu、LysArg、AsnGln、以及PheTrpTyr。保守胺基酸取代典型地係為1至2個胺基酸取代。
用以決定哪一個胺基酸可以被取代而不會破壞其生物或免疫活性的指南,可以使用電腦程式與習知技術所獲得,例如DNASTAR軟體,或在Dayhoffet al
.(1978)inAtlas of Protein Sequence and Structure
(Natl.Biomed.Res.Found.,Washington,D.C.)論文中。
胺基酸取代的定義,係為一對一的胺基酸替換。當被替換的胺基酸具有相類似的結構及/或化學性質時,則它們是天然保守的。保守替換的範例係為將白胺酸取代為異白胺酸或纈胺酸,將天冬胺酸替換為麩胺酸,或將穌胺酸替換為絲胺酸。
尤其較佳的寡胜肽類似物包括保守的取代,也就是在同一家族的胺基酸發生取代,此家族的胺基酸的側鍊是彼此相關連的。尤其,胺基酸大致分為下列家族:(1)酸性-天冬胺酸與麩胺酸;(2)鹼性-離胺酸、精胺酸、組胺酸;(3)非極性-丙胺酸,纈胺酸,白胺酸,異白胺酸,脯胺酸,苯丙胺酸,甲硫胺酸,色胺酸;(4)不帶電極性-甘胺酸,天冬醯胺酸,麩醯胺酸,胱胺酸,絲胺酸穌胺酸,酪胺酸;(5)芳香胺基酸-苯丙胺酸,色胺酸,酪胺酸。舉例而言,可以合理地推測,在將白胺酸取代為異白胺酸或纈胺酸、將天冬胺酸取代為麩胺酸、將穌胺酸取代為絲胺酸、或類似的保守取代而將一胺基酸取代為結構相似的胺基酸等獨立替換發生時,將不會對生物活性產生重大改變。
以上所述的組成物可以一日服用數次。典型的閉合帶蛋白(zonulin)促效劑或拮抗劑的每日劑量會隨著不同因素而改變,例如各個病人的需求量、服用方式、以及疾病等。在一實施例中,閉合帶蛋白(zonulin)拮抗劑是在進食前服用。此種服用方式的應用,包括治療腹腔疾病。
大致而言,閉合帶蛋白(zonulin)的促效劑或拮抗劑的每日劑量,係介於1-1000 mg的活性組成物。
一包括SEQ ID NO:1細胞緊密連接拮抗劑的基底覆層,係藉由在2000g的水中緩慢加入15 g的拮抗劑胜肽混合而製成。一旦胜肽分散以後,加入15 g的貝克特殊糖(Baker Special Sugar)。加入額外的水而將總重量調整到2107 g。熟知該項技藝者可以瞭解,可以使用除了貝克斯特殊糖(Bakers Special Sugar)以外的黏結劑。適合的黏結劑典型地係為醫藥可接受的黏結劑,包括但不限於,澱粉、凝膠、天然糖類如葡萄糖或beta-乳糖,玉米增甜劑、天然與合成膠例如阿拉伯膠、特拉加康斯膠或海藻鈉、CMC(carboxymethylcellulose)、聚乙烯乙二醇(polyethylene glycol)、蠟等。其他適合的黏結劑包括醫藥可接受的黏結劑,例如聚乙烯吡咯烷酮(polyvinyl pyrrolidone)、羥丙基纖維素(hydroxypropyl cellulose)、羥乙基纖維素(hydroxyethyl cellulose)、乙基纖維素(ethylcellulose)、聚丙烯酸甲酯(polymethacrylate)、蠟等。也可使用上述黏結劑的混合物。
完成溶解後,塗佈基底覆層。所使用基底覆層的數量,係由理想腸覆膜珠的最終重量所決定。根據上述的數量,係加入3270 g的基底覆層加入到一沃斯特單位(Wurster unit),並在下列條件中加入1000 g Non-pareils 25/30網目(3.27 g基底披覆/克的non-pareils),直到塗佈完成:135-150℉,製程空氣體積(SCFM)10-25調整至維持流體化狀態;噴霧速率3-10 g/min/nozzle;以及原子空氣壓力25 psi。
同時製備一包括有尤特奇(Eudragit)L30D延遲釋放披覆覆膜。15 g的滑石粉係加入至500 g的水中,並劇烈攪拌10分鐘。850 g的尤特奇(Eudragit)L30D(Type C)係篩濾經過60網目的篩子,不加入空氣而藉由漩渦混合而進入混合容器中。30 g的醫藥等級三乙基檸檬酸酯(triethyl citrate)係接著緩慢地加入,並在類似的條件下混合10分鐘,接著持續進行混合直到完整的溶解與分散。加入額外的水而將總重量調整為1500 g。
延遲釋放披覆接著在下列條件中加入到沃斯特單位中(包括經基底披覆的顆粒),直到披覆完成:135-150℉,製程空氣體積(SCFM)10-25調整至維持流體化狀態;噴霧速率3-10 g/min/nozzle;以及原子空氣壓力25 psi。
最終組成物如下所示:
包括有4-6%細胞緊密連接拮抗劑胜肽(SEZ ID NO:1)的延遲釋放顆粒的穩定性係被測試。如上所製備的延遲釋放顆粒係暴露至模擬胃液(SGF),其包括0.1% v/v Tween 80K,並在控制溫度(37℃±0.5℃)下、在一溶解裝置中攪拌一小時。小珠從SGF中移除,並暴露至模擬腸液(SIF)中,其包括0.1% v/v Tween 80K。從水浴中抽取試樣,並以HPLC在220nm處、以Inertsil ODS-2 HPLC Column(150 mm x 3 mm,5μm)以及一ODS-2 HPLC Guard Column(20 mm x 4.6 μm,5μm)分析。動態相A:92:8水:ACN,0.1% TFA動態相B:ACN,0.1% TFA)。色層分析條件如下所示:
執行時間:17分鐘偵測:220 nm反應時間:0.5 secColumn溫度:40℃±1℃自動取樣溫度:10℃±2℃注入體積:5 μl溶液
所釋放的總細胞緊密連接效應劑係藉由與效應劑的標準參考值比較而決定。
在60分鐘的時間內,少於8%的SEQ ID NO:1拮抗劑胜肽在含有0.1% v/v Tween 80K的模擬胃液(SGF)中釋放。
模擬胃液可以藉由下列方式製備:每一升中,至入下列組成物於一容器中:2.0克的氯化鈉、7.0 mL的濃鹽酸、以及1.0 L的水。攪拌直至完全溶解。確認pH值並以稀鹽酸或NaOH調整至1.2±0.1。將媒介去氣。在此溶液中加入Tween 80至0.1%(v/v)。或者,可使用商業可購得的SGF(Ricca Chemical Company,Arlington,Texas)並加入Tween 80K。
在15分鐘內,超過90%的SEQ ID NO:1拮抗劑胜肽在含有0.1% v/v Tween 80K的模擬腸液(SIF)中釋放,並且在60分鐘內實質上釋放了所有的胜肽。SIF可以由下列方式製備:將下列組成物置於一容器中:1.9 Kg的蒸餾水、136 g的單鹼磷酸鉀、以及18.1克的氫氧化鈉。攪拌直到完全溶解。將此溶液以18.0 Kg的水稀釋。確認pH值並以稀鹽酸或NaOH調整至6.8±0.1。將媒介去氣。在此溶液中加入Tween 80K至0.1%(v/v)。或者,可使用商業可購得的SIF(Ricca Chemical Company,Arlington,Texas)並加入Tween 80K。
上述實施例僅係為了方便說明而舉例而已,本發明所主張之權利範圍自應以申請專利範圍所述為準,而非僅限於上述實施例。
圖1係自本發明一較佳實施例中,所製出含兩種不同小珠之配方於pH值6之溶解媒介下,其細胞緊密連接效應劑隨時間函數釋出之百分比。
<110> 阿爾巴醫療公司
<120> 細胞緊密連接效應劑之配方/FORMULATIONS FOR A TIGHT JUNCTION EFFECTOR
<130> PI641
<150> US 60/771,454
<151> 2006-02-09
<160> 47
<170> Patentln version 3.4
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Claims (23)
- 一種口服劑型組成物,包括一有效量之一SEQ ID NO.1之胜肽,以及包括第一延遲釋放顆粒及第二延遲釋放顆粒,該第一延遲釋放顆粒及第二延遲釋放顆粒於一服用其之病患的十二指腸及空腸中釋放該胜肽,其中該第一延遲釋放顆粒包括:一第一核顆粒;一第一覆層於該第一核顆粒之外,且該第一覆層包括該SEQ ID NO.1之胜肽;以及一第一延遲釋放覆膜位於該包括該胜肽的第一覆層之外,且該第一延遲釋放覆膜包括一共聚物,該共聚物包括甲基丙烯酸及乙基丙烯酸,其中該第一延遲釋放覆膜係穩定於模擬胃液中,並且於接觸pH5值大於5的模擬腸液約90分鐘時,釋放至少70%之於該第一延遲釋放顆粒中的該胜肽,其中該第二延遲釋放顆粒於該第一延遲釋放顆粒釋放後的約30分鐘時釋放該胜肽,且該第二延遲釋放顆粒包括:一第二核顆粒;一第二覆層於該第二核顆粒之外,且該第二覆層包括該SEQ ID NO.1之胜肽;以及一第二延遲釋放覆膜位於該包括該胜肽的第二覆層之外,且該第二延遲釋放覆膜包括一共聚物,該共聚物包括甲基丙烯酸及乙基丙烯酸,其中該第二延遲釋放覆膜係穩定於模擬胃液中。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該核顆粒之尺寸係介於約15至約40網目(mesh)之間。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該核顆粒的材料包括一氧化物、纖維素、一有機聚合物、一無機鹽類、或一醣類。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該核顆粒的材料為一醣類。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該共聚物係一1:1之甲基丙烯酸及乙基丙烯酸之共聚物。
- 如申請專利範圍第1項所述之口服劑型組成物,更包括一外覆層位於該延遲釋放覆膜之外。
- 如申請專利範圍第6項所述之口服劑型組成物,其中該外覆層包括:醣類、聚乙烯基乙二醇(polyethylene glycol)、聚乙烯吡咯烷酮(polyvinylpyrrolidone)、聚乙烯醇(polyvinyl alcohol)、聚醋酸乙烯酯(polyvinyl acetate)、羥丙基纖維素(hydroxypropyl cellulose)、甲基纖維素(methyl-cellulose)、乙基纖維素(ethylcellulose)、及/或羥丙基甲基纖維素(hydroxypropyl methylcellulose,HPMC)。
- 如申請專利範圍第7項所述之口服劑型組成物,其中該外覆層包括羥丙基甲基纖維素(hydroxypropyl methylcellulose,HPMC)。
- 如申請專利範圍第1項所述之口服劑型組成物,該包括該SEQ ID NO.1之胜肽的覆層更包括一醫藥可接受的黏結劑。
- 如申請專利範圍第9項所述之口服劑型組成物,其中該黏結劑包括:一醣類、甲基纖維素(methylcellulose)、聚乙烯吡咯烷酮(polyvinyl pyrrolidone)、羥丙基纖維素(hydroxypropyl cellulose)、羥甲基纖維素(hydroxymethyl cellulose)、以及微結晶纖維素(microcrystalline cellulose)。
- 如申請專利範圍第9項所述之口服劑型組成物,其中該黏結劑包括:一醣類。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該延遲釋放覆膜更包括滑石。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該延遲釋放覆膜包括一惰性製程輔劑及/或塑化劑。
- 如申請專利範圍第13項所述之口服劑型組成物,其中該惰性製程輔劑包括二氧化矽、滑石、及/或硬酯酸鎂。
- 如申請專利範圍第13項所述之口服劑型組成物,其中該塑化劑包括:檸檬酸酯(citric acid esters)、三乙酸甘油酯(triacetin)、鄰苯二甲酸酯(phthalic acid esters)、癸二酸二丁酯(dibutyl sebacate)、鯨蠟醇(cetyl alcohol)、聚乙二醇(polyethylene glycols,PEG)、及/或聚山梨酯(polysorbates)。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該口服劑型組成物係一膠囊。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該模擬胃液及該模擬腸液不含有酵素。
- 如申請專利範圍第1項所述之口服劑型組成物,其中以該口服劑型組成物之總重為基準,該口服劑型組成物包括0.1wt%至6wt%的該胜肽。
- 如申請專利範圍第1項所述之口服劑型組成物,其中該模擬胃液的pH值約為1.2。
- 如申請專利範圍第19項所述之口服劑型組成物,其中在約60分鐘的時間內,少於8%的該胜肽在該模擬胃液中釋放。
- 一種如申請專利範圍第1項所述之口服劑型組成物之用以製備治療腸胃道發炎之醫藥組成物的用途。
- 如申請專利範圍第21項所述之用途,其中該醫藥組成物係用於治療腹腔疾病。
- 如申請專利範圍第21項所述之用途,其中該醫藥組成物係用於治療發炎性腸道疾病。
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| MM4A | Annulment or lapse of patent due to non-payment of fees |