Subcutaneous Drug Development for Portal Hypertension Ascites

门静脉高压腹水的皮下注射药物开发

• 批准号: 8930140
• 负责人: Gerardo M. Castillo
• 金额: $ 28.03万
• 依托单位: PHARMAIN CORPORATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-22 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8930140
• 关键词: Abdomen; Acute; Albumins; Alcoholism; American; Ascites; Blood; Calcium; Carbon; Caring; Cell Culture Techniques; Chronic; Cirrhosis; Cleaved cell; Creation of peritoneovascular shunt; Diuretics; Dose; Drug Delivery Systems; Drug Formulations; Drug Kinetics; Enzyme Activation; Equilibrium; Europe; Family suidae; Fatty Acids; Fluid overload; Functional disorder; Furosemide; Glycine; Goals; Greater sac of peritoneum; Half-Life; Health; Health Care Costs; Hemorrhage; Hepatic Encephalopathy; Hepatorenal Syndrome; Hour; Human; Infection; Injection of therapeutic agent; Intravenous; Intravenous Bolus; Kidney; Lead; Liquid substance; Liver; Liver Cirrhosis; Liver diseases; Lysine; Marketing; Measurable; Medical; Modeling; N-terminal; National Institute of Allergy and Infectious Disease; Necrosis; Operative Surgical Procedures; Outpatients; Paracentesis; Patients; Peptide Hydrolases; Peptides; Peritoneal Fluid; Pharmaceutical Preparations; Phase; Polymers; Portal Hypertension; Portal Pressure; Portal vein structure; Practice Guidelines; Prevalence; Procedures; Process; Prodrugs; Quality of life; Rattus; Recommendation; Refractory; Risk; Safety; Serum; Side; Skin; Small Business Innovation Research Grant; Sodium Chloride; Sodium-Restricted Diet; Spironolactone; Staging; Structure; Subcutaneous Injections; Survival Rate; Syndrome; Technology; Testing; Therapeutic; Time; Transjugular intrahepatic portosystemic shunt procedure; Varicosity; Vasopressins; Viral hepatitis; Weight Gain; base; cost effective; design; dietary restriction; drug candidate; drug development; effective therapy; efficacy testing; hemodynamics; liver transplantation; mortality; nanocarrier; nonalcoholic steatohepatitis; pressure; prevent; response; subcutaneous; success; synthetic peptide; vasoactive agent

DESCRIPTION (provided by applicant): The prevalence of all types of ascites, irrespective of the cause, is 41.7 in 100,000 with 80% of these due to cirrhosis. Ascites is treated with a salt restricted diet and pharmacologic therapy using diuretics. However, in 5% to 10% of patients with ascites, the ascites becomes refractory to medical therapy. Half of patients who develop refractory ascites due to advanced liver cirrhosis will die within a year without a liver transplan and therefore expedited referral for liver transplantation is recommended. Temporary treatment while waiting includes large volume paracentesis, transjugular intrahepatic portasystemic shunt (TIPS), and peritoneovenous shunt surgical procedures. Complications from these procedures that can further increase mortality include paracentesis-induced circulatory dysfunction (PICD) and chronic hepatic encephalopathy from TIPS. Pharmacological therapies that can stop the progression or extend survival and act as a therapeutic bridge to liver transplantation are thus desperately needed. Terlipressin, tri-glycyl [8-lys] vasopressin, is a synthetic peptide drug that reduces portal vein pressure, restores hemodynamic balance, and is an effective treatment for portal hypertension ascites. This prodrug is slowly converted to the vasoactive agent [8-lys] vasopressin in the blood; it is well tolerated and has a far better safety profile than human nativ vasopressin ([8-Arg] vasopressin). Intravenous terlipressin has been available in Europe for the past twenty years and it is one of the most cost-effective and economical drugs for treating bleeding varies and hepatorenal syndrome (HRS) with improvement in survival rates that is well documented. Despite its good safety profile, the use of terlipressin is currently limited to the acute care setting because the short half-life (26min) necessitates administration by IV bolus injection every 4-6h. We believe that a formulation of a new terlipressin derivative that can be administered once-daily, ideally subcutaneously, and would have a significant market opportunity in the U.S. in the outpatient setting (which will reduce overall health care cost) for the treatment of refractory ascites from cirrhosis-induced portal hypertension. We developed a new long acting terlipressin (LAT) based on a proprietary drug delivery technology invented by the PI that gives sustained release of modified terlipressin. LAT demonstrated a substantially longer half-life than unmodified terlipressin peptide (3.3 hours vs. 0.8 hours respectively) and was observed to maintain measurable blood concentrations for more than 20 hours, compared to 5 hours for a rapid clearing of terlipressin. This study will optimize the formulation, determin pharmacokinetics of various metabolites to determine the optimum dose needed, and test the efficacy of the formulation for the treatment of cirrhosis-induced ascites in rat.

描述（由申请人提供）：所有类型腹水的患病率，无论原因如何，为41.7/100，000，其中80%是由于肝硬化。腹水的治疗是限盐饮食和使用利尿剂的药物治疗。然而，在5%至10%的腹水患者中，腹水变得对药物治疗难治。由于晚期肝硬化而发生难治性腹水的患者中有一半会在一年内死亡，无需肝移植，因此建议加速转诊进行肝移植。等待期间的临时治疗包括大容量穿刺术、经颈静脉肝内门体分流术（TIPS）和腹膜静脉分流术。这些手术的并发症可能进一步增加死亡率，包括穿刺术诱导的循环功能障碍（PICD）和TIPS引起的慢性肝性脑病。因此，迫切需要可以阻止进展或延长生存期并作为肝移植治疗桥梁的药物治疗。特利加压素，三甘氨酰[8-赖氨酸]加压素，是一种合成肽类药物，可降低门静脉压力，恢复血流动力学平衡，是门静脉高压腹水的有效治疗方法。这种前药在血液中缓慢转化为血管活性剂[8-lys]加压素;它耐受性良好，安全性远远优于人天然加压素（[8-Arg]加压素）。静脉注射特利加压素在过去二十年中已在欧洲上市，它是治疗各种出血和肝肾综合征（HRS）的最具成本效益和经济的药物之一，有充分的证据证明其生存率有所提高。尽管特利加压素具有良好的安全性，但其使用目前仅限于急性护理环境，因为半衰期短（26分钟），需要每4- 6小时通过IV推注给药。我们相信，一种新的特利加压素衍生物的制剂，可以每天一次，理想地皮下给药，并且在美国门诊患者中具有显著的市场机会（这将降低整体医疗保健成本），用于治疗由腹水诱导的门静脉高压引起的难治性腹水。我们开发了一种新的长效特利加压素（LAT）的基础上，专有的药物输送技术发明的PI，使缓释改性特利加压素。LAT表现出比未修饰的特利加压素肽显著更长的半衰期（分别为3.3小时对0.8小时），并且观察到维持可测量的血液浓度超过20小时，而快速清除特利加压素的时间为5小时。本研究将优化处方，测定各种代谢产物的药代动力学以确定所需的最佳剂量，并测试该制剂对大鼠腹水诱导的腹水的疗效。