Novel therapeutic agent for vascular disorder

Abstract

Provided is a medical agent for effectively treating a vascular disorder caused by the excessive synthesis and secretion of type IV collagen protein from vascular endothelial cells.　Provided are [1] a therapeutic agent for a vascular disorder associated with the excessive synthesis and secretion of type IV collagen protein, [2] a therapeutic agent for diseases caused by the excessive synthesis and secretion of type IV collagen protein, [3] a pharmaceutical composition for treating a vascular disorder associated with the excessive synthesis and secretion of type IV collagen protein, [4] a pharmaceutical composition for treating diseases caused by the excessive synthesis and secretion of type IV collagen protein from vascular endothelial cells, and [5] an agent for inhibiting the excessive synthesis and secretion of type IV collagen protein from vascular endothelial cells, each of which contains sirolimus as an active ingredient.

Description

[0008f]   In another aspect, the present invention provides a use of sirolimus in the manufacture of a medicament for treating a peripheral vascular disorder associated with 2021266505   08 May 2026 excessive synthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes. [0008g]       In a further aspect, the present invention provides a use of sirolimus in the manufacture of a medicament for treating or inhibiting a disease caused by excessive synthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes from a vascular endothelial cell. [0008h]       In yet another aspect, the present invention provides a use of sirolimus in the manufacture of a medicament for inhibiting excessive synthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes from a vascular endothelial cell.

[0009] In other words, the present invention is the following [1] to [5]. [1] A therapeutic agent for a vascular disorder associated with excessive synthesis and secretion of a type IV collagen protein, the therapeutic agent containing sirolimus as an active ingredient. [2] A therapeutic agent for a disease caused by excessive synthesis and secretion of a type IV collagen protein from a vascular endothelial cell, the therapeutic agent containing sirolimus as an active ingredient. [3] A pharmaceutical composition for treatment of a 2021266505   08 May 2026 vascular disorder associated with excessive synthesis and secretion of a type IV collagen protein, the pharmaceutical composition containing sirolimus as an active ingredient and further containing a pharmaceutically acceptable carrier. [4] A pharmaceutical composition for treatment of a disease caused by excessive synthesis and secretion of a type IV collagen protein from a vascular endothelial cell, the pharmaceutical composition containing sirolimus as an active ingredient and further containing a pharmaceutically acceptable carrier. [5] An agent that inhibits excessive synthesis and secretion of a type IV collagen protein from a vascular endothelial cell, the agent containing sirolimus as an active ingredient.

[0010] According to the present invention, it is possible to inhibit the synthesis and secretion of a type IV collagen protein in a vascular endothelial cell, and it is possible to effectively treat a vascular disorder such as a peripheral vascular disorder caused by excessive accumulation of an extracellular matrix containing collagen. Brief Description of Drawings

[0011] Fig. 1 is a graph showing confirmation results of an expression status of type IV collagen genes in vascular endothelial cells (1 case, 2 cell lines) derived from healthy adults and patients with scleroderma. COL4A1 represents a type IV collagen al gene, COL4A2 represents a type IV collagen a2 gene, COL4A5 represents a type IV collagen a5 gene, and COL4A6 represents a type IV collagen a6 gene. Fig. 2 is a graph showing the difference in the amount of a type IV collagen protein depending on the presence or absence of sirolimus in a medium. Fig. 3 is a graph showing the difference in the amount of a type IV collagen protein depending on the presence or absence of digoxin in a medium. Description of Embodiments

[0012] The present invention relates to: [1] a therapeutic agent for a vascular disorder associated with excessive synthesis and secretion of a type IV collagen protein; [2] a therapeutic agent for a disease caused by excessive synthesis and secretion of a type IV collagen protein; [3] a pharmaceutical composition for treatment of a vascular disorder associated with excessive synthesis and secretion of a type IV collagen protein; [4] a pharmaceutical composition for treatment of a disease caused by excessive synthesis and secretion of a type IV collagen protein from a vascular endothelial cell; and [5] an agent that inhibits excessive synthesis and secretion of a type IV collagen protein from a vascular endothelial cell, each of [1] to [5] containing sirolimus as an active ingredient.

[0013] Sirolimus (also known as rapamycin) is a metabolite of the actinomycete Streptomyces hygroscopicus isolated from Easter Island soil and was found in the 1970's as a macrolide antibiotic. Thereafter, sirolimus was found to have an immunosuppressive action, and has been approved as a pharmaceutical product that suppresses rejection after kidney transplantation in 55 countries worldwide.

[0014] The vascular disorder to be treated with the therapeutic agent for a vascular disorder associated with excessive synthesis and secretion of a type IV collagen protein according to the present invention is typically, but not limited to, a peripheral vascular disorder. For example, vascular disorders and the like caused by overproduction of an extracellular matrix containing collagen, such as vascular disorders that develop due to scleroderma, can be treated with the therapeutic agent according to the present invention.  Specific examples thereof include Raynaud's syndrome, which is one of the typical symptoms of scleroderma, pulmonary hypertension, interstitial lung disease, fibrosis of a digestive system, fibrosis of a kidney, fibrosis of a heart, and other vascular lesions associated with Raynaud's syndrome.

[0015] In the therapeutic agent for a disease caused by excessive synthesis and secretion of a type IV collagen protein from a vascular endothelial cell, the therapeutic agent containing sirolimus as an active ingredient according to the present invention, the disease is selected from the following (1) to (3): (1) a peripheral vascular disorder developed due to scleroderma; (2) Raynaud's syndrome; and (3) the following diseases associated with Raynaud's syndrome: pulmonary hypertension, interstitial lung disease, fibrosis of a digestive system, fibrosis of a kidney, fibrosis of a heart, or other vascular lesions.

[0016] The pharmaceutical composition according to the present invention contains a pharmaceutically acceptable carrier in addition to sirolimus as an active ingredient, and can be used in the form of an oral preparation or an external preparation used by being directly applied to an affected area from the outside. In particular, the pharmaceutical composition is preferably used in the form of an oral preparation for a subject to be treated (patient) who has developed a vascular disorder due to a systemic disease. Such a pharmaceutical composition can be produced by a conventionally known method.

[0017] The oral preparation according to the present invention can be, for example, a tablet, an orally disintegrating tablet, a capsule, or a granule. The oral preparation contains a pharmaceutically acceptable carrier such as an excipient, an additive, and / or a vehicle that is usually used as long as the effect of sirolimus as an active ingredient is not impaired. As such a pharmaceutically acceptable carrier, for example, a carrier selected from a binder, a disintegrant, a lubricant, a plasticizer, a surfactant, a stabilizer, an antioxidant, a coating agent, a sweetener, a colorant, a fragrance and the like can be used.

[0018] Specific examples of the usable carriers include anhydrous lactose, lactose hydrate, crystalline cellulose, mannitol, macrogol 400, polyethylene glycol, polyoxyethylene (160) polyoxypropylene (30) glycol, glycerin monooleate, calcium sulfate and the like as binders; dextran, low-substituted hydroxypropyl cellulose, corn starch, partially pregelatinized starch, carmellose sodium, hypromellose and the like as binders; sodium carboxymethyl starch and the like as disintegrants; magnesium stearate, talc, sodium stearyl fumarate, stearic acid, light anhydrous silicic acid, hydrated silicon dioxide and the like as lubricants; triethyl citrate, propylene glycol and the like as plasticizers; glycerin monostearate, sodium lauryl sulfate, polysorbate 80, polysorbate 60 and the like as surfactants; xanthan gum, polyvinylpyrrolidone, urea and the like as stabilizers; butyl parahydroxybenzoate, tocopherol, ascorbic acid and the like as antioxidants; Eudragid, carnauba wax, hypromellose, or derivatives thereof and the like as coating agents; xylitol and the like as sweeteners; titanium oxide and the like as colorants; and menthol and the like as fragrances.

[0019] The external preparation according to the present invention can be in a generally used form such as an ointment, a cream, a lotion, or a gel. Such an external preparation can be prepared by dissolving or dispersing sirolimus as an active ingredient in an appropriate solvent, and then blending a pharmaceutically acceptable carrier such as an excipient or additive that is usually used, such as a gelling agent, a thickener, a pH adjuster, or a stabilizer.

[0020] Dosage and administration The oral preparation that is one embodiment of the therapeutic agent according to the present invention can be used in the same manner as an ordinary oral preparation, for example, by taking the oral preparation together with water. The dose is appropriately determined depending on the type of the target disease, the severity of the disease, or the condition of the subject to be treated (patient).  Usually, 1 to 4 mg / day of sirolimus is orally administered to an adult.

[0021] The external preparation that is one embodiment of the therapeutic agent according to the present invention can be used in the same manner as an ordinary external preparation used for a skin disease or the like, such as directly applying the external preparation to an affected area. The dose is appropriately determined depending on the type of the target disease, the severity of the disease, or the condition of the subject to be treated (patient).  Usually, a dose corresponding to 0.1 to 2 mg / day of sirolimus for an adult can be used by being directly applied to the skin around an affected area. Examples

[0022] Although the present invention will be described below with reference to specific embodiments, it will be understood that the present invention is not limited to the embodiments, and that various changes and modifications therein may be made by those skilled in the art without departing from the scope or spirit of the present invention as defined in the appended claims.

[0023] (Examples) (1) Culture of Vascular Endothelial Cells Derived from Patient iPS Cells As the cells, iPS cells derived from healthy adults and patients with scleroderma established at Kumamoto University were used (Zhongzhi Wang, et al., JDS 2016 Nov; 84(2): 186-196.). Scleroderma is known to cause Raynaud's syndrome, which is one of peripheral vascular disorders, as a symptom of scleroderma, and therefore was employed as a vascular disorder model cell.

[0024] Differentiation induction into vascular endothelial cells was performed by culturing iPS cells derived from healthy adults and patients with scleroderma under the conditions described in Table 1.

[0025] [Table 1] Table 1: Composition of medium for differentiation induction of vascular endothelial cells Day Medium Growth Factor DayO StemPro™-34 SFM BMP4(50 pg / ml), bFGF(50 pg / ml) Dayl~2 VEGF(40 pg / ml), bFGF(5O pg / ml) Day3~4 VEGF(40 pg / ml), bFGF(5O pg / ml), SB431532(20 pM) Day5 VEGF(40 pg / ml), bFGF(50 pg / ml), SB431532(20 pM)

[0026] As the obtained cells, only cells positive for VE-cadherin (CD144) and PECAM-1 (CD31), which are vascular endothelial cell markers, were sorted using flow cytometry. From the morphology of the sorted cells and the expression of the marker genes, it was confirmed that the sorted cells were vascular endothelial cells.

[0027] The sorted vascular endothelial cells derived from iPS cells from healthy adults and patients with scleroderma were cultured in a 10% FBS-containing Humedia EB-2 + Growth Factor medium (hereinafter referred to as serum-containing medium) shown in the lower part of Table 2, and expanded to passage 3. Approximately 1 x 105 cultured cells were seeded on a 6-well plate (coated with type I collagen) using the medium, and cultured for 1 day in an incubator at 37°C, 5% CO2.

[0028] [Table 2] Table 2: Composition of medium for culture of vascular endothelial cells Medium Growth Factor Serum Huinedia EB 2 B27(2%), bFGF(10 pg / ml), VEGF(20 ug / ml) - bFGF(25 ug / ml), VEGF(20 pg / ml) 10% FBS

[0029] After confirming that the cells were fixed to the bottom of the plate, the medium of the supernatant was removed, and the medium in the plate was washed with PBS. The whole was divided into two parts, and for cells for RNA recovery, using the serum-containing medium, a medium containing 0.25% of DMSO as a vehicle control substance or containing 1 pmol / L of sirolimus as test substance 1 and 0.25% of DMSO was prepared.  For cells for recovery of proteins in cell supernatant, a Humedia EB-2 + Growth Factor medium without FBS (hereinafter referred to as serum-free medium) shown in the upper part of Table 2 was used to prepare a medium so that the medium was under the same conditions as mentioned above. Each of the prepared media was added to the plate on which the cells were engrafted and cultured in an incubator at 37°C and 5% CO2 concentration for 3 days.

[0030] (2) Confirmation of Type IV Collagen Gene Expression in Vascular Endothelial Cells Among the cultured cells obtained in the above (1), the cells cultured in the serum-containing medium were used to confirm the expression level of type IV collagen genes in vascular endothelial cells derived from iPS cells from healthy adults and patients with scleroderma by the following procedure.

[0031] After 3 days of culture, the supernatant (medium) was removed from the plate, and the inside of the plate was washed using PBS. An RNA extraction reagent (product name: Sepasol®-RNA I Super G, manufactured by Nacalai Tesque, Inc.) were added and cells were recovered, and then the cell suspension was transferred to a container. Chloroform was added thereto, and the mixture was stirred and centrifuged at 4°C and 12,000 rpm for 15 minutes. Thereafter, only the separated chloroform layer was collected in another container, and RNA was purified using an ethanol precipitation method. cDNA was synthesized from the purified RNA using a reverse transcriptase (product name: SuperScriptTM III Reverse Transcriptase, manufactured by InvitrogenTM), and the expression level of type IV collagen genes was confirmed by a qPCR method using a fluorescent reagent (product name: THUNDERBIRD® SYBR® qPCR Mix, manufactured by Toyobo Co., Ltd.).

[0032] The results are shown in Fig. 1. In vascular endothelial cells derived from patients with scleroderma, it was confirmed that type IV collagen genes (in particular, type IV collagen a5 and a6 genes) were more highly expressed compared with vascular endothelial cells derived from healthy adults. As mentioned above, it is known that patients with scleroderma develop Raynaud's syndrome, which is one of peripheral vascular disorders, as one of the typical symptoms of scleroderma.  Therefore, this result strongly suggests that high expression of type IV collagen genes is involved in thickening of a blood vessel wall.

[0033] (3) Confirmation of Influence of Sirolimus on Synthesis and Secretion of Type IV Collagen Protein in Vascular Endothelial Cells In the above (1), using the cell supernatant cultured in the serum-free medium, the amount of a type IV collagen protein released into the medium was quantified by the following method. First, proteins released into the medium were concentrated. In this operation, it is necessary to perform culture under serum-free conditions considering the influence of proteins contained in serum. For 3 days, only the cell supernatant of the cells cultured in the serum- free medium was recovered, cooled acetone in an amount 4 times the amount of the recovered medium was added thereto, and the mixture was allowed to stand at -20°C overnight. On the next day, after centrifugation at 4°C and 1000 G for 10 minutes, the supernatant was removed, 75% ethanol was added to the precipitate, the mixture was stirred, and centrifugation was performed again under the same conditions.  After removal of ethanol, the precipitate was dried and dissolved in an RIPA buffer, and each sample was adjusted to have a protein concentration of 1 mg / ml using a protein quantification reagent (Bradford Protein Assay, manufactured by Bio-Rad Laboratories, Inc.).  After the adjustment, the protein was denatured by heat block at 95°C, and Western blotting was performed. Each sample was applied to a gel (SuperSepTM Ace 5 to 12%, manufactured by FUJIFILM Wako Pure Chemical Corporation) and after electrophoresis, it was transferred to a membrane (Immobilon-P membrane, manufactured by Merck & Co., Inc.). A Goat Anti-Type IV Collagen antibody (Southern Biotech) was used as a primary antibody, and an HRP-labeled antibody (manufactured by Bio-Rad Laboratories, Inc.) was used as a secondary antibody. After the antibody reaction, a type IV collagen protein was detected with a lumino image analyzer (ImageQuant LAS 4000mini, manufactured by GE Healthcare Japan Corporation) using an HRP chemiluminescent reagent (Immobilon® Western blotting detection reagent, manufactured by Merck & Co., Inc.).

[0034] The results are shown in Fig. 2. As shown in this figure, the amount of a type IV collagen protein in the medium containing test substance 1 (sirolimus) was significantly smaller than that in the vehicle control medium. This result indicates that the synthesis and secretion of a type IV collagen protein in a vascular endothelial cell were inhibited by containing sirolimus. As mentioned above, scleroderma causes thickening of a blood vessel wall for some reason. Therefore, in combination with our experimental results shown in the above (2), it was suggested that high expression of type IV collagen genes in a vascular endothelial cell is responsible for this disorder, and sirolimus has an effect of reducing the amount of a type IV collagen protein. Therefore, it was shown that the present drug effectively acts as a therapeutic agent for peripheral vascular disorders caused by overproduction of an extracellular matrix containing collagen such as Raynaud's syndrome.

[0035] (Comparative Example) The same operation as in Examples was carried out using a medium containing 10 nmol / L of test substance 2 (digoxin) instead of the medium containing test substance 1 in the above (1), and the influence of the presence of digoxin on the expression of type IV collagen was confirmed.

[0036] The results are shown in Fig. 3. As shown in this figure, the amount of a type IV collagen protein in the medium was hardly reduced in the medium containing digoxin, suggesting that digoxin has a low therapeutic effect on peripheral vascular disorders. Digitalis preparations containing digoxin are described in scleroderma treatment guidelines (Clinical Practice Guidelines for Systemic Scleroderma by the Japanese Dermatological Association) as a basic therapy for pulmonary hypertension associated with scleroderma. In addition, the effect of a similar substance of a cardiac glycoside containing digoxin on fibrotic diseases has been reported in a plurality of 2021266505   08 May 2026 publications and the like. Contrary to such conventional findings, the results obtained by us show that the effect of digoxin cannot be expected at least for peripheral vascular disorders, and on the other hand, sirolimus whose therapeutic effect is neither described nor suggested in the guidelines exhibits an effect for the treatment of peripheral vascular disorders caused by overproduction of an extracellular matrix containing type IV collagen.

[0037] Throughout this specification and the claims which follow, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” and “comprising”, will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.

[0038] The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as an acknowledgment or admission or any form of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates.

Claims

1. A method for treating a peripheral vascular disorderin a subject, wherein the peripheral vascular disorder is associated with excessive synthesis and secretion of a typeIV collagen protein expressed by type IV collagen a5 or a6 genes, the method comprising administering sirolimus to thesubject.

2. The method according to claim 1, wherein theperipheral vascular disorder has developed due to scleroderma.

3. The method according to claim 1 or 2, wherein theperipheral vascular disorder is selected from Raynaud's syndrome, pulmonary hypertension, interstitial lung disease, fibrosis of a digestive system, fibrosis of a kidney, fibrosis of a heart, and other vascular lesions associated with Raynaud's syndrome.

4. A method for treating a disease caused by excessivesynthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes from avascular endothelial cell in a subject, the methodcomprising administering sirolimus to the subject.

5. The method according to claim 4, wherein the diseaseis selected from the following (1) to (3):(1) a peripheral vascular disorder developed due to scleroderma;2021266505   08 May 2026(2) Raynaud's syndrome; and(3) the following diseases associated with Raynaud's syndrome: pulmonary hypertension, interstitial lungdisease, fibrosis of a digestive system, fibrosis of a kidney, fibrosis of a heart, or other vascular lesions.

6. A pharmaceutical composition when used for treatmentof a peripheral vascular disorder associated with excessive synthesis and secretion of a type IV collagen proteinexpressed by type IV collagen a5 or a6 genes, thepharmaceutical composition comprising sirolimus as an active ingredient and further comprising a pharmaceutically acceptable carrier.

7. A pharmaceutical composition when used for treatmentof a disease caused by excessive synthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes from a vascular endothelial cell, thepharmaceutical composition comprising sirolimus as an active ingredient and further comprising a pharmaceutically acceptable carrier.

8. The pharmaceutical composition according to claim 6or 7, wherein the pharmaceutical composition is an oral preparation or an external preparation.

9. The method according to any one of claims 1-5,wherein sirolimus is orally administered.

10. A method for inhibiting excessive synthesis and2021266505   08 May 2026secretion of a type IV collagen protein expressed by typeIV collagen a5 or a6 genes from a vascular endothelial cell, comprising contacting the vascular endothelial cellwith sirolimus.

11. Use of sirolimus in the manufacture of a medicamentfor treating a peripheral vascular disorder associated withexcessive synthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes.

12. The use of claim 11, wherein the peripheral vasculardisorder has developed due to scleroderma.

13. The use of claim 11 or 12, wherein the peripheralvascular disorder is selected from Raynaud's syndrome,pulmonary hypertension, interstitial lung disease, fibrosis of a digestive system, fibrosis of a kidney, fibrosis of a heart, and other vascular lesions associated with Raynaud's syndrome.

14. Use of sirolimus in the manufacture of a medicamentfor treating or inhibiting a disease caused by excessivesynthesis and secretion of a type IV collagen proteinexpressed by type IV collagen a5 or a6 genes from a vascular endothelial cell.

15. The use of claim 14, wherein the disease is selectedfrom the following (1) to (3):(1) a peripheral vascular disorder developed due to scleroderma;2021266505   08 May 2026(2) Raynaud's syndrome; and(3) the following diseases associated with Raynaud's syndrome: pulmonary hypertension, interstitial lungdisease, fibrosis of a digestive system, fibrosis of a kidney, fibrosis of a heart, or other vascular lesions.

16. The use according to any one of claims 11-15,wherein the medicament is an oral preparation or an external preparation.

17. Use of sirolimus in the manufacture of a medicamentfor inhibiting excessive synthesis and secretion of a type IV collagen protein expressed by type IV collagen a5 or a6 genes from a vascular endothelial cell.

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