Long-acting mutant human Fibroblast growth factor 21 for the treatment of non-alcoholic steatohepatitis

Description

Technical Field

[0001] The present disclosure relates to the field of biomedicine, and particularly relates to the use of a PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 in the preparation of drugs for treating non-alcoholic steatohepatitis.Background Art

[0002] Non-alcoholic fatty liver disease (NAFLD), also known as non-alcoholic fatty liver, is caused by a variety of reasons. Lesions of this disease mainly occur in the hepatic lobule characterized by steatosis of hepatic parenchymal cells and triglyceride (TG) accumulation (fat content in liver tissues accounting for over 5% of liver wet weight or more than 1 / 3 hepatic cells presenting steatosis confirmed by histology). NAFLD is similar to alcoholic liver disease (ALD) in terms of pathological changes except absence of history of excessive drinking (equivalent to ethanol consumption, male <140g / week, female <70g / week) and other clinical pathological syndromes caused by specific liver-damaging factors. NAFLD and NASH have become the leading causes of liver disease in Western countries in the past 20 years. Without timely control, NAFLD can easily progress to NASH as fat continues to accumulate excessively. In addition to excessive accumulation of fat, NASH differs from NAFLD in the presence of inflammatory cell infiltration in liver, the degree of hepatic fibrosis, and the degree of liver cell damage. Furthermore, if NASH continues to progress without effective control, it is highly likely to cause hepatic fibrosis, cirrhosis and even liver cancer.

[0003] At present, there are no such drugs for NASH that can be clinically used for long term, safe and effective.

[0004] Fibroblast growth factor-21 (FGF-21) is another metabolic regulator recently discovered in vivo. It belongs to FGF family and specifically acts on liver, fat, and islet cells. FGF-21 can effectively and safely regulate blood glucose and blood fat independently of insulin, which has got researchers' a lot of attention. It has also been reported that FGF-21 can effectively prevent and treat NAFLD induced in vitro (Liu Min et al., Effect of fibroblast growth factor-21 on lipid metabolism of non-alcoholic fatty liver cell model induced in vitro. Journal of Jilin University, May 2012, Vol. 38, No. 3, 477-481.) Further examples may be found in JP 6069198 B2; US 20160168223A1; WO 2005 / 091944 A2 and Zhu et al. ("FGF21 ameliorates non-alcoholic fatty liver disease by inducing autophagy", Mol. Cell. Biochem., Vol. 420, No. 1,July 2016 107-119).

[0005] CN2013101152100 (Publication Number: CN103193878A; Applicant: Harbin Boao Biomedical Technology Development Co., Ltd.) discloses a new long-acting mutant human FGF and the polyethylene glycol (PEG) conjugate thereof. The protein structure of the said FGF-PEG conjugate is shown in Sequence 3 and its preparation method is shown in Example 4. This conjugate was later named by its inventors as PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 (or PEG-hmFGF21 for short).

[0006] PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 has the functions of regulating blood glucose, lowering blood triglycerides, and regulating total cholesterol, et al.. However, there have been no reports of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 in the treatment of NASH so far.Description of the disclosure

[0007] The present invention is directed to subject matter as defined in the claims.

[0008] Disclosed herein the use of a PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 in the preparation of drugs for treating NASH.

[0009] As used herein, the PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21has the amino acid sequence set forth in Sequence 3 disclosed in the patent application CN2013101152100 (Publication Number: CN103193878A) and is obtainable according to the preparation method disclosed in Example 4 of CN2013101152100 (Publication Number: CN103193878A).

[0010] As used herein, the use includes that PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or its salt can lower the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum, improve steatosis and lobular inflammation, reduce the degree of hepatocellular ballooning degeneration, and improve liver damage.

[0011] As used herein, the NASH includes, not limited to, hepatitis-induced NASH, obesity-induced NASH, diabetes-induced NASH, insulin resistance-induced NASH, hypertriglyceridemia-induced NASH, abetalipoproteinemia-induced NASH, NASH induced by glycogen storage disease, NASH induced by Wake's Disease, NASH induced by Wolman disease, and lipodystrophia-induced NASH, et al..

[0012] As used herein, the drugs mean pharmaceutical compositions containing PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or a pharmaceutically acceptable salt thereof as the active pharmaceutical ingredient. The pharmaceutical compositions can be prepared into any pharmaceutically acceptable dosage form, including tablets, capsules, granules, pills, powders, paste, sublimed preparation, dustpowders, solutions, injections, suppositories, sprays, drops, patches, and drop pills. Drugs of the present disclosure are preferably prepared into injectable drugs, such as powder injections or liquid injections. The liquid injections include water injections, organic solvent injections, and suspension injections, et al..

[0013] The preparations of the pharmaceutical compositions for oral administration may contain conventional excipients such as the bonding agent, stuffing bulking agent, diluting agent, tablet compressing agent, lubricating agent, disintegrating agent, coloring agent, flavoring agent, and wetting agent. The suitable stuffing bulking agents include starch, sucrose, cellulose, mannitol, lactose, and other similar ones. The suitable disintegrating agents include starch, polyvinyl pyrrolidone and starch derivatives such as sodium starch glycolate. The suitable lubricating agents include, for example, magnesium stearate. The solid form of the compositions for oral administration can be prepared through conventional methods including mixing, filling, tablet compressing, et al.. Repeated mixing allows the active pharmaceutical substance to be distributed throughout the compositions containing a large amount of stuffing bulking agent. The excipients commonly-used include mannitol, sorbitol, sodium pyrosulfite, sodium hydrogen sulfite, sodium thiosulfate, cysteine hydrochloride, thioglycolic acid, methionine, vitamin C, disodium EDTA, calcium disodium edetate, carbonates of alkali metal and aqueous solutions thereof, acetates of alkali metal and aqueous solutions thereof, phosphates of alkali metal and aqueous solutions thereof, hydrochloric acid, acetic acid, sulfuric acid, phosphoric acid, amino acid, sodium chloride, potassium chloride, sodium lactate, xylitol, maltose, glucose, fructose, dextran, glycine, starch, sucrose, lactose, D- mannitol, silicon derivatives, cellulose and its derivatives, alginate, gelatin, polyvinyl pyrrolidone, glycerol, Tween 80, agar, calcium carbonate, calcium bicarbonate, surfactant, polyethylene glycol, cyclodextrin, β-cyclodextrin, phospholipids, kaolin, pulvistalci, calcium stearate , magnesium stearate, et al..

[0014] The usage and dosage of the pharmaceutical composition of the present disclosure are determined according to conditions of diseases while being used. For example, the pharmaceutical composition can be administered 1-6 times a day for 1-10 doses each, and each dose can be 0.1 mg-1000 mg.

[0015] The new use of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 provided by the present invention has the following advantages: PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 can significantly lower the levels of ALT and AST in serum, improve steatosis and lobular inflammation, reduce the degree of hepatocellular ballooning degeneration, and improve the pathological score of liver damage. The final results demonstrate that the present invention can be used to treat NASH with superior effectiveness to prior art.Detailed description of implementation

[0016] The present disclosure will now be further demonstrated using the following embodiments.

[0017] For the preparation method of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 used in the present invention, see Embodiment 4 of CN2013101152100 (Publication Number: CN103193878A).Embodiment 1: Preparation of water injections

[0018] 1. Composition: PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 protein (concentration: 10mg / mL), histidine (pharmaceutical grade, concentration: 10mg / mL), citric acid-sodium citrate buffer (20mM sodium citrate-citric acid, 100mM NaCl, pH5.5±0.1). 2. Preparation method 1) 12.5mg / mL PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 protein solution, the buffer system is citric acid-sodium citrate, and the pH is adjusted to 5.5±0.1, prepared for use; 2) 50mg / mL histidine mother liquor, the buffer system is citric acid-sodium citrate, the pH is adjusted to pH 5.5±0.1, prepared for use; 3) Mix the PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 protein solution of step 1) and the histidine mother liquor of step 2) according to the volume ratio of 4:1, and transfer 500µL of the mixed solution into 2mL penicillin bottles. Experiment Example 1: Therapeutic effect of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 in an effective dose range in a mouse model of MCD (methionine choline deficient) diet-induced NASH.

[0019] A mouse model of MCD diet-induced NASH is used in this experiment, mainly because this diet has been used for more than 40 years and its production process has become more mature. In addition, the characterization this diet induced has obtained multiple verification in terms of its rapidity (i.e. NASH related symptoms can be triggered in about 4 weeks) and effectiveness (i.e. symptoms induced have great similarity to those of human NASH).1. Experimental method

[0020] After adaptive feeding for two weeks, C57BL male mice of eight-week-old were began to be fed MCD diet. After MCD diet fed for two weeks, the mice were randomly divided into 4 groups according to the body weight: a solvent group, a FGF-21 group, a low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group, and a high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group. There were 10 mice in each group and they were administered once a day via hypodermic injection for two weeks.

[0021] Details of animal grouping and administration are shown in Table 1: Table 1: Animal grouping and administration GroupnDoseAdministration period (day)Solvent group10Solvent in the same volume14dFGF-21 group100.4mg / kg / d14dLow-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group100.125mg / kg / d14dHigh-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21102mg / kg / d14dgroup

[0022] After the administration, the mice were killed and their relevant tissues were removed for subsequent analyses.2. Indices detection

[0023] 2.1 The blood serum was separated and various biochemical indices therein were detected: levels of ALT and AST in serum were determined using a clinically general assay kit (provided by Shanghai Shensuo-UNF Medical. Diagnostic Articles Co.,Ltd ).2.2 Histomorphological examination on mouse liver tissue

[0024] Morphological changes in mouse liver were observed through H&E staining method. The specific steps were as follows: The freshly removed small piece of liver was fixed in formalin solution overnight, and embedded in paraffin after gradient dehydration, then sectioned into 5µm slices. The liver sections were stained with hematoxylin-eosin, and finally the morphology of liver tissue of each mouse was observed under a microscope.2.3 Detection of collagen fibers in mouse liver tissue

[0025] The collagen deposition in mouse liver was observed through Sirius Red (SR) staining method. The specific steps were as follows: The liver sections from paraffin blocks were stained using the Sirius Red staining kit, and finally the fibrosis of liver tissue of each mouse was observed under a microscope.

[0026] There is a scoring system for assessing the severity of NASH in clinical practice, i.e., NASH Clinical Research Network Scores, mainly including three aspects: steatosis, lobular inflammation, and ballooning degeneration. In this experiment, five mice were randomly selected from each group, and five microscopic fields of view within the H&E stained liver tissue sections of the corresponding mouse were randomly selected based on which a score is given from the above three aspects, objectively evaluating the degree of hepatitis of mice in each group.

[0027] 3. SPSS16.0 statistical software was used for statistics and data analysis. A t-test was used to compare the difference between two groups of data. One-way ANOVA test and multiple linear regression analysis were used to compare differences among multiple groups of data. The difference was statistically significant with P<0.05.4. Experimental results

[0028] 4.1 Effect of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 on serum ALT level as shown in Table 2: Table 2 Effect of FG on serum ALT level Solvent groupFGF-21 groupLow-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 groupHigh-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 groupSerum ALT(U / L)199.8±30.8100.2±20.6*51.1±7.7***Δ39.9±4.1***Δ(1) Data shown in the table represented the mean±standard error; (2) * compared with the solvent group P<0.05; *** compared with the solvent group P<0.001; Δ< compared with the FGF-21 group P<0.05.

[0029] As shown in Table 2, after two weeks of treatment, the ALT level of mice with NASH in the FGF-21group decreased to 100.2±20.6 U / L, and there was a significant difference compared with the solvent group with the ALT level 199.8±30.8 U / L (P<0.05). The levels of ALT in the low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group and high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group decreased to 51.1 ±7.7 U / L and 39.9±4.1 U / L, respectively, and a significant difference was found compared with the solvent group (P<0.001) as well as the FGF-21 group (P<0.05). These results indicate that PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 not only has the efficacy of lowering ALT levels but also its efficacy herein is better than FGF-21.

[0030] 4.2 Effect of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 on serum AST level as shown in Table 3: Table 3 Effect of FG on serum AST level Solvent groupFGF-21 groupLow-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 groupHigh-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 groupSerum ALT(U / L)196.9±29.3115.7±15.9*74.4±7.9** Δ< 73.7±7.8** Δ< (1) Data shown in the table represented the mean±standard error; (2) * compared with the solvent group P<0.05; ** compared with the solvent group P<0.01; Δ< compared with the FGF-21 group P<0.05.

[0031] As shown in Table 3, after two weeks of treatment, the AST level of mice with NASH in the FGF-21group decreased to 115.7±15.9U / L, and there was a significant difference compared with the solvent group with the AST level 196.9±29.3 U / L (P<0.05). The levels of AST in the low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group and high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group decreased to 74.4±7.9U / L and 73.7±7.8U / L, respectively, and a significant difference was found compared with the solvent group (P<0.01) as well as the FGF-21 group (P<0.05). These results indicate that PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 not only has the efficacy of lowering ALT levels but also its efficacy herein is better than FGF-21.

[0032] 4.3 Effect of improvement on NASH clinical scores as shown in Table 4: Table 4 Effect of improvement on NASH clinical scores SteatosisLobular inflammationBallooningTotal scoreSolvent group2.2±0.22.6±0.11.3±0.16.0±0.21FGF-21group2.0±0.32.1±0.20.9±0.1**4.7±0.5*Low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group1.8±0.30.7±0.1*** ΔΔΔ< 0.7±0.1**3.2±0.4*** Δ< High-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group0.9±0.3** Δ< 0.6±0.2*** ΔΔΔ< 0.4±0.1*** ΔΔ< 1.9±0.5*** ΔΔ< (1) Data shown in the table represented the mean±standard error; (2) * compared with the solvent group P<0.05; ** compared with the solvent group P<0.01; *** compared with the solvent group P<0.001; Δ< compared with the FGF-21 group P<0.05; ΔΔ< compared with the FGF-21 group P<0.01; ΔΔΔ< compared with the FGF-21 group P<0.001.

[0033] As shown in Table 4, after two weeks of treatment, both the scores for ballooning and NASH total scores in FGF-21 group had improved significantly (P<0.05) compared with the solvent group, whereas no significant improvement in scores for lobular inflammation had been observed (P>0.05). Compared with the solvent group, there was a significant improvement in both low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group and high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group in terms of scores for lobular inflammation, scores for ballooning and NASH total scores. Scores for steatosis in high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group had been significantly improved compared with the solvent group. In addition, in comparison with FGF-21 group, all scores for steatosis, lobular inflammation, ballooning and the total thereof had been significantly improved in low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group and / or high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group. These results indicate that PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 not only has the efficacy of improving lobular inflammation, ballooning, and NASH total scores but also its efficacy herein is better than FGF-21.5. Experimental results

[0034] Detections after injection of PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 show that compared with the solvent group and FGF-21 group, low-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group and / or high-dose PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 group can significantly lower the levels of ALT and AST in serum, improve steatosis and lobular inflammation, reduce the degree of hepatocellular ballooning degeneration, and improve the pathological score of liver damage. These results indicate that PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 has the effect of treating NASH.

[0035] 6. Conclusion: PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 has the clinical application value in the treatment of NASH which is superior to the prior art.

Claims

1. A PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or a pharmaceutically acceptable salt thereof for use in treating non-alcoholic steatohepatitis, wherein the PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 is obtainable by providing a peptide consisting of the amino acid sequence according to: ; and PEGylating said peptide at pH 6 using mPEG-ALD having a molecular weight of 20kD and sodium cyanoborohydride.

2. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 1, wherein the use is selected from lowering the levels of alanine aminotransferase and aspartate aminotransferase in serum, improving steatosis and lobular inflammation, reducing the degree of hepatocellular ballooning degeneration, and improving liver damage.

3. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 1, wherein the non-alcoholic steatohepatitis (NASH) is selected from hepatitis-induced NASH, obesity-induced NASH, diabetes-induced NASH, insulin resistance-induced NASH, hypertriglyceridemia-induced NASH, abetalipoproteinemia-induced NASH, NASH induced by glycogen storage disease, NASH induced by Wake's Disease, NASH induced by Wolman disease, or lipodystrophia-induced NASH.

4. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 1, wherein the drugs are pharmaceutical compositions containing PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or a pharmaceutically acceptable salt thereof as the active pharmaceutical ingredient.

5. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 4, wherein the pharmaceutical compositions can be prepared into any pharmaceutically acceptable dosage form.

6. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 5, wherein the dosage forms are selected from tablets, capsules, granules, pills, powders, paste, sublimed preparation, dustpowders, solutions, injections, suppositories, sprays, drops, patches, and drop pills.

7. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 6, wherein the dosage forms are selected from powder injections or liquid injections.

8. The PEGylated Recombinant Human-mouse Chimeric Fibroblast Growth Factor 21 or pharmaceutically acceptable salt thereof for use according to claim 7, wherein the liquid injections are selected from water injections, organic solvent injections, and suspension injections.