Pyrimidine nucleotide precursors for treatment of systemic inflammation and inflammatory hepatitis

Abstract

Pyrimidine nucleotide precursors including acyl derivatives of cytidine, uridine, and orotate, and uridine phosphorylase inhibitors, and their use in enhancing resistance to sepsis or systemic inflammation are disclosed.

Description

[0001] This application is a continuation-in-part application of copending U.S. application Ser. No. 158,799, filed Dec. 1, 1993, which in turn is a continuation-in-part application of copending U.S. application Ser. No. 987,730, filed Dec. 8, 1992, which in turn is a continuation-in-part application of U.S. application Ser. No. 438,493, filed June. 26, 1990, which in turn is a continuation-in-part application of U.S. application Ser. No. 115,929 filed Oct. 28, 1987. All of these applications are hereby incorporated by reference.[0002] This invention relates generally to pyrimidine nucleotide precursors including acyl derivatives of cytidine, uridine and orotate, and to the prophylactic and therapeutic uses of these compounds. The invention also relates to the administration of these compounds, alone or in combinations, with or without other agents, to animals. These compounds are capable of enhancing resistance of an animal to bacterial endotoxin and other inflammatory stimuli, and...

AI Technical Summary

Benefits of technology

These compounds effectively prevent or treat the effects of systemic inflammation, improve survival, and reduce tissue damage caused by endotoxin and other inflammatory stimuli, demonstrating supra-normal resistance to toxic effects in vivo, and can be used in conjunction with other therapeutic agents for enhanced efficacy.

Problems solved by technology

Sepsis accounts for tens of thousands of deaths in the United States every year; it is a leading cause of death of patients in surgical intensive care units.

Current treatment of SIRS involves circulatory and respiratory support, but does not directly address improvement of tissue resistance to inflammatory stimuli such as endotoxin, or inflammatory mediators.

However, it is expensive or impractical to use antibodies as prophylaxis in susceptible patients, prior to the onset of symptoms of endotoxin poisoning.

Moreover, it is difficult to determine which patients are likely to benefit from antibody treatment, since the time required to culture and identify infectious organisms often exceeds the time limit for implementation of effective therapy.

Similar problems have been encountered in attempts to use receptor antagonists of specific inflammatory meidators like interleukin-1.

Administration of these cytokines or mediators results in symptoms similar to at least some of those elicited by endotoxin.

Agents or pathological conditions other than bacterial endotoxin can result in elevated production or activity of (or sensitivity to) TNF or IL-1, resulting in tissue damage.

Thus, there are inherent problems with strategies for treating sepsis syndrome or SIRS with agents which directly inactivate inflammatory cytokines.

Moreover, hepatic dysfunction occurs in the early stages of sepsis and may initiate sequential organ failure (Wang et al., Arch. Surg., 1991, 126:219-224)

This can lead to liver damage if the depletion of uridine nucleotides is sufficiently prolonged, due to impairment of RNA and protein synthesis.

However, in contrast to these situations wherein uridine partially reversed experimentally-reduced resistance to endotoxin, uridine was reported to have no protective effect in normal mice challenged with endotoxin (Markley et al., J. Trauma 1970, 10:598-607), i.e., it did not result in greater than-normal resistance to endotoxin.

Orotate is not well absorbed after oral administration, in part due to poor solubility.

Clinical trials involving the administration of uridine (e.g. for the purpose of attenuating host toxicity of the antineoplastic drug 5-fluorouracil), have been complicated due to the biological properties of uridine itself.

Parenteral administration of uridine requires use of a central venous catheter (with consequent discomfort and risk of infection), since phlebitis was a problem in early clinical trials when uridine was administered via a brachial venous catheter (van Groeningen et al.

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