Patent Application
20230330093
The present invention relates to a use of a nitrogen-containing saturated heterocyclic compound or a pharmaceutically acceptable salt thereof in the preparation of a medicine for the treatment and/or prevention of chronic kidney disease.
Chronic kidney disease (CKD) has the characteristics of high prevalence, low awareness, poor prognosis and high medical costs, which is another disease that seriously endangers human health after cardiovascular and cerebrovascular diseases, diabetes and malignant tumors. In recent years, the prevalence of CKD has increased year by year, and the global prevalence rate of the general population has reached 14.3%, the cross-sectional epidemiological study in China shows that the prevalence of CKD in people over 18 years old is 10.8%. Chronic kidney disease (CKD) is a progressive disease. If the disease is not treated in a timely and effective manner, the condition worsens and progresses, as the course of the disease progresses, patients with chronic kidney disease will develop renal failure. In such a case, without artificial dialysis or kidney transplantation, survival will become difficult. There is currently no particularly effective method for the treatment of chronic kidney disease, therefore, it has great clinical value to actively find medicines that are effective in treating chronic kidney disease and have low toxic and side effects.
CN103562191B discloses a nitrogen-containing saturated heterocyclic compound represented by the following structural formula or a pharmaceutically acceptable salt thereof, which shows an inhibitory effect on renin and can be used to treat hypertension.
In the formula, R1 represents a cycloalkane group, etc., R22 represents a substituted aryl etc., R represents lower alkane group, etc., T represents a carbonyl group, Z represents —O— etc., R3, R4, R5 and R6 are the same or different, and represent a hydrogen atom etc.
CN106928218A discloses a salt of a novel pharmaceutically acceptable morpholine derivative (nitrogen-containing saturated heterocyclic ring), including its malate, tartrate, hydrochloride, acetate and naphthalene diphosphate, wherein, tartrate has three crystalline salt forms: crystal form A, crystal form B and dehydrate, malate, hydrochloride and acetate each have one crystalline salt form, and naphthalene diphosphate is amorphous. Compared with the known free bases of morpholine derivatives, the salts of morpholine derivatives have one or more improved properties, such as better crystalline state, which greatly improve water solubility, light stability and thermal stability, etc. The above salt of morpholine derivative or its crystal form can be used to treat and/or prevent hypertension.
The technical problem to be solved by the present invention is to provide a use of a nitrogen-containing saturated heterocyclic compound or a pharmaceutically acceptable salt thereof in the preparation of a medicine for the treatment and/or prevention of chronic kidney disease in view of the absence of a particularly effective medicine for treating chronic kidney disease in the prior art.
The entire contents of the patent CN103562191B and the patent application CN106928218A described in the background art are hereby incorporated into this description by reference.
In one embodiment of the present invention, provided is a use of a nitrogen-containing saturated heterocyclic compound represented by the following formula I or a pharmaceutically acceptable salt thereof in the preparation of a medicine for the treatment and/or prevention of chronic kidney disease:
In a further embodiment of the present invention, the pharmaceutically acceptable salt is hydrochloride, sulfate, phosphate, hydrobromide, acetate, fumarate, oxalate, citrate, methanesulfonate, benzenesulfonate, p-toluenesulfonate, maleate, malate, tartrate, acetate or naphthalene disulfonate.
In a further embodiment of the present invention, the pharmaceutically acceptable salt is malate, tartrate, hydrochloride, acetate or naphthalene disulfonate.
In one embodiment of the present invention, the pharmaceutically acceptable salt is the malate of the compound of formula I, which is a compound formed by the compound of formula I and malic acid at a molar ratio of 1:1, and the structural formula is as follows:
In one embodiment of the present invention, the malate is a crystal form, the X-ray powder diffraction pattern thereof has characteristic peaks at 2θ of 7.767°±0.2°, 13.897°±0.2°, 14.775°±0.2°, 17.098°±0.2°, 18.999°±0.2°, 20.153±0.2°, 20.960°±0.2°, 21.423°±0.2°, 26.348°±0.2° and 27.892°±0.2°. In particular, the X-ray powder diffraction pattern of the malate crystal further has characteristic peaks at 2θ of 5.598°±0.2°, 7.357°±0.2°, 10.395°±0.2°, 11.108°±0.2°, 16.037°±0.2°, 16.523°±0.2°, 19.410°±0.2°, 22.645°±0.2°, 26.630°±0.2°, 26.891°±0.2°, 27.380°±0.2°, 31.056°±0.2°, 33.306°±0.2°, 33.775°±0.2° and 39.231°±0.2°. More specifically, the malate crystal of the compound of formula I has an X-ray powder diffraction pattern as shown in
In one embodiment of the present invention, the chronic kidney disease includes hypertension with nephropathy, hypertension with nephropathy with abnormal glucose metabolism, chronic renal insufficiency with chronic heart failure or chronic kidney disease with abnormal glucose metabolism.
In one embodiment of the present invention, the chronic kidney disease refers to the G1, G2, G3a, G3b, G4 stages of chronic kidney disease, preferably the G2, G3a or G3b stage.
In one embodiment of the present invention, the hypertension in hypertension with nephropathy is grade 1 hypertension, grade 2 hypertension or grade 3 hypertension, preferably grade 1 hypertension or grade 2 hypertension.
In one embodiment of the present invention, the dosage forms of the medicine include tablet, capsule, intravenous injection, inhalant, aerosol, lyophilized agent, patch, gel, spray, or suppository, preferably tablet.
In one embodiment of the present invention, the medicine is unit dose.
In one embodiment of the present invention, the unit dose of the medicine contains the nitrogen-containing saturated heterocyclic compound represented by formula I or the pharmaceutically acceptable salt thereof in a range of 25 mg to 200 mg, for example, 25 mg, 50 mg, 100 mg, 150 mg, 200 mg of the nitrogen-containing saturated heterocyclic compound represented by formula I or the pharmaceutically acceptable salt thereof.
The “Kidney Disease Outcomes Quality Initiative” (KDOQI) working group under the American Kidney Foundation (NKF) formulated the definition and staging criteria for CKD in 2002.
Chronic kidney disease is defined as abnormal kidney structure or function>3 months. The diagnostic criteria for chronic kidney disease is that any of the indicators in Table 1 below is present for ≥3 months.
Chronic kidney disease staging: Chronic kidney disease is divided into 5 stages according to the glomerular filtration rate (GFR), see Table 2 below.
Definition of hypertension: systolic blood pressure (SBP)≥140 mmHg (1 mmHg=0.133 kPa) and/or diastolic blood pressure (DBP)≥90 mmHg, in the case of not using antihypertensive drugs and that office blood pressure is measured 3 times on different days.
That SBP≥140 mmHg and DBP<90 mmHg is isolated systolic hypertension. When the patient has a history of hypertension and is currently using antihypertensive drugs, although the blood pressure is lower than 140/90 mmHg, it should still be diagnosed as hypertension.
According to the elevated blood pressure level, hypertension is further divided into Grade 1, 2 or 3. The classification and definition of blood pressure levels are shown in Table 3 below.
Heart failure is a clinical syndrome, defined as a group of complex clinical syndromes in which the ability of the ventricle to fill with or eject blood is impaired due to any abnormality in the structure or function of the heart. The main clinical manifestations are dyspnea and fatigue (restricted activity tolerance), and fluid retention (pulmonary congestion and peripheral edema).
According to the left ventricular ejection fraction (LVEF), heart failure is divided into heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction, HFpEF) and heart failure with mid-range ejection fraction (HFmrEF), the definitions of the 3 types of heart failure are shown in Table 4 below:
a B-type natriuretic peptide (BNP)>35 ng/L and/or N-terminal B-type pronatriuretic peptide (NT-proBNP)>125 ng/L;
b E/e′ ≥ 13, e′ average value (ventricular septum and free wall) <9 cm/s;
Abnormal glucose metabolism includes pre-diabetes and diabetes.
Pre-diabetes is impaired glucose regulation, which means that the blood sugar level has exceeded the normal range, but has not yet reached the diagnostic criteria for diabetes, namely, the intermediate state between normal people and diabetic patients.
Diabetes is a group of common metabolic diseases characterized by hyperglycemia, honey-urine, impaired glucose tolerance and abnormal insulin release in test.
The positive and progressive effects of the present invention are: studies on the effectiveness and safety of nitrogen-containing saturated heterocyclic compound salt administered continuously for 8 weeks to rhesus monkeys (middle-aged/elderly) with chronic renal insufficiency with chronic heart failure have shown that, the nitrogen-containing saturated heterocyclic compound or the pharmaceutically acceptable salt thereof provided by the present invention can effectively prevent or treat chronic kidney disease, the chronic kidney disease includes hypertension with nephropathy, hypertension with nephropathy with abnormal glucose metabolism, chronic renal insufficiency with chronic heart failure or chronic kidney disease with abnormal glucose metabolism. At the same time, the nitrogen-containing saturated heterocyclic compound or the pharmaceutically acceptable salt thereof provided by the present invention is very safe, and there is no adverse event related to administration.
The present invention will be further explained by way of examples below, but the present invention is not limited to the scope of the described examples. In the following examples, the experimental methods without specific conditions are selected according to conventional methods and conditions, or according to the product specification.
The malate of the compound of Formula I used in the following examples was prepared and confirmed according to the preparation method described in Example 1 in Patent Application Publication CN106928218A. Valsartan was purchased through commercial channels. The rhesus monkeys used were purchased from Sichuan Premey Xingzhi Biotechnology Co., Ltd. (Premey Primate Research Center).
1. Research Purpose
The improvement of renal function by 8-week continuous administration of the malate of the compound of formula I, and the effective dose in which the renal function can be improved or delayed, the intensity of action and the risk of CVD events were evaluated, in order to provide basis for the dosage design of clinical trials, patient selection criteria and safety. Primary efficacy endpoints (ENDPOINT): 1. Improvement of renal function: glomerular filtration rate eGFRcreat-cys, Cystatin C (CysC), creatinine and UACR; 2. Improvement of cardiac function: analysis of changes of cardiac structure and systolic and diastolic functions before and after administration by echocardiographic indicators; 3. Safety indicators: blood pressure, blood potassium, glucose and lipid metabolism related indicators, etc.
2. Test System
2.1 Rhesus Monkeys with Spontaneous Chronic Renal Insufficiency
Animal species: Macaca mulatta (Rhesus Macaque)
Level: Normal level. The pre-test quarantine was qualified, including physical examination, 2 tubercle bacillus tests, parasite, salmonella, shigella and B virus inspections.
Animal logo: A stainless steel number plate engraved with Arabic numerals was worn on the neck ring, and the chest was tattooed.
Supplier: Sichuan Primed Shines Bio-tech Co., Ltd.Production license number: SCXK (Sichuan) 2019-027.
Animal certificate number: 0016710, 0016944, 0016966.
2.2 Selection Criteria
23 male/female animals, aged 14-24 years (equivalent to adults aged 40-70 years) were selected. The body weight thereof was 8.45-14.93 kg for males, and was 6.43 kg for one female.
They suffered from long-term abnormal glucose and lipid metabolism for more than 3 years. The abnormal glucose metabolism was fasting blood glucose (FPG)>4.8 mmol/1, vs. age-matched control group 4.1±0.3 mmol/1.
CKD-EPI rating G3a-G3b, glomerular filtration rate eGFR: 30˜59 ml/min/1.73 m2; or moderate to severe increase in proteinuria (A2-A3): urine albumin/creatinine ratio (UACR)>15 mg/g-350 mg/g (4-6 hour urine collection), vs. age-matched control group 3±2 mg/g.
Normal blood pressure, grade 1 hypertension or grade 2 hypertension (consistent with clinical patient standard).
HFrEF: LVEF 30%-49% (normal value: 50%-70% Simpson biplane method) or HFpEF (moderate or above damage): Ea<8 or E/Ea>10 (based on clinical diagnostic criteria).
2.3 Exclusion Criteria
Table 5 below shows the underlying causes and characteristics of rhesus monkeys with chronic DKD renal insufficiency in baseline period—each dose group.
3. Experimental Design
3.1 Grouping and Dosage Design
In the trial, animals were brought in three stages. In the first stage, there were two groups: 3 animals (No. 257, No. 4721, No. 287) in a group with 5 mg/kg of the malate of compound of formula I, and 2 animals (No. 1029, No. 4713) in the placebo group. In the second stage, there were three groups: 3 animals (No. 144, No. 5073, No. 6651) in a group with 5 mg/kg of the malate of compound of formula I, 3 animals (No. 2091, No. 4861, No. 6645) in the Valsartan group, and 2 animals (No. 6653, No. 231) in the placebo group. In the third stage, there were two groups: 5 animals (No. 4829, No. 6501, No. 287, No. 4721, No. 2091) in a group with 2 mg/kg of the malate of compound of formula I, and 5 animals (No. 1567, No. 4861, No. 5453, No. 6653, No. 5073) in a group with 1 mg/kg of the malate of compound of formula I.
Among them, 2 animals (No. 287 and No. 4721) in the first stage were subjected to drug withdrawal and elution for about 9 months, and 4 animals (No. 5073, No. 2091, No. 4861 and No. 6653) in the second stage were subjected to drug withdrawal and elution for about 5 months, and then they entered the baseline period of the third stage (the baseline period was 1 month).
See Table 6 below for details.
3.2 Dosing Information
Route of administration: Oral administration.
Dosing frequency: the malate of compound of formula I was administered once a day; in the Valsartan group, the drug was administered once a day during the administration period in the first and second weeks, and twice a day from the third week to the eighth week.
Dosage calculation: the dose for the next week was calculated based on the body weight weighed each time.
Administration time: 08:00-09:00 administration.
3.3 Main Efficacy Indicators
Glomerular filtration rate eGFRcreat-cys: creatinine (Cr—P), urea nitrogen (BUN) and cystatin (CysC) were detected, and the eGFR value was obtained by calculation. It was performed once before the administration and once every two weeks after the administration.
eGFRmale=135×min(Cr/0.9,1)−0.207×max(Cr/0.9,1)−0.601×min(CysC/0.8,1)−0.375×max(CysC/0.8,1)−0.711×0.995Age×3
eGFRfemale=135×min(Cr/0.7,1)−0.284×max(Cr/0.7,1)−0.601×min(CysC/0.8,1)−0.375×max(CysC/0.8,1)−0.711×0.995Age×3×0.969
3.4 Secondary Efficacy Indicators
Serum potassium, twice before administration, once every 2 weeks during the administration period;
Glucose and lipid metabolism and liver function: FPG, FRA, LDL-c, HDL-c, TG, TC, NT-proBNP, ALT, AST, TBIL, etc., twice before administration, once at weeks 4 and 8 respectively after administration;
Other biochemical indicators and hematology testing, once each before and after administration;
Body weight: once before administration, once a week during the administration period;
After administration, the changes in food intake and behavior were observed for 24 hours every day.
3.5 Testing Methods and Equipments
Testing methods: see Table 7 and Table 8 below.
Hematology testing equipment: Siemens ADVIA 2120i Hematology Systems.
Blood biochemical and urine index detection equipment: Roche cobas6000 analyzer series C501 module detection. ELISA kit was used for NT-proBNP test.
3.6 Cardiac Doppler Ultrasound
Anesthesia method: 15 mg/kg of ketamine hydrochloride was used for intramuscular injection anesthesia. According to the animal anesthesia state, the supplemental anesthesia will be performed after judgment by veterinarian. Each supplemental anesthesia dose was ½ of the initial dose.
Detection method: The animal was placed in the left decubitus position, and the 6S-RS probe (frequency 2.7-8.0 MHz) was used for image acquisition.
Analysis method: After the image was collected and saved, the supporting analysis workstation EchoPAC Software was used to repeatedly detect various indicators of systolic and diastolic functions in 3 consecutive cardiac cycles.
Testing indicators and ultrasonic technology: see Table 9 below.
Testing equipment: GE Vivid S5 color Doppler ultrasound diagnostic system.
3.7 Blood Pressure Test
Test method: 15 mg/kg of ketamine hydrochloride was used for intramuscular injection to anesthetize the animal. After anesthesia, the animal was placed in a supine position. The left upper arm was shaved clean, and a suitable size cuff was tied according to the standard. The blood oxygen probe was clamped on the animal's finger or toe (except for the left hand), and the red light-sensitive surface was on the side of the finger pad. The blood pressure of the animal was continuously measured for 3 times in the automatic mode with an interval of 1 min. If the difference of DBP, SBP and MBP of blood pressure measured more than three times was not significant (the difference between the highest value and the lowest value was less than 15 mmHg), the measurement was completed.
Testing indicators: testing indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) and heart rate (HR).
Testing equipment: GE B40i electrophysiological monitor.
3.8 Clinical Observation
Number of observations: Observation was performed once a day.
Observation method: observation in cage.
Observation content: injection site, skin, hair, eyes, ears, nose, oral cavity, chest, abdomen, urogenital, limbs and other parts, as well as breathing, exercise, urinary, defecation and behavior changes.
3.9 Determination of Food Intake
Feeding method: Food was supplied once at 8:009:00 in the morning, 10:00 in the morning, 2:00 in the afternoon, and 4:00 in the afternoon, respectively, to ensure that there was food in the food box and animals ate freely. The remaining feed was removed at 07:40-8:00 in the next day.
Feeding amount: about 250-500 g/animal/day. In the experiment, it was ensured that there was feed in the food box for 24 hours, and the animals can eat freely.
Method for measuring food intake: The feed was estimated by a semi-quantitative method, and the amount of food given, the amount discarded and the remaining amount in food boxes were recorded every day. Food intake=food given−amount discarded−remaining amount in food box.
3.10 Weight Determination
Weighing time: before feeding on the day.
Determination method: The animal was fasted for 14-16 h before weighing, and the animal was awake, after transferred to the transfer cage, it was weighed with a large animal scale.
Measuring instrument: METTLER TOLEDO electronic platform scale.
4.0 Criteria for Termination of the Test
5. Results and Analysis
5.1 Effects on UACR
The effects of administration of each group on proteinuria (UACR) were shown in Table 10 below. In each group, the CKD rhesus monkeys who had moderate to severe increase in proteinuria, manifested by baseline urine albumin/creatinine ratio (UACR) ≥15 mg/g to 350 mg/g (4-6 hours urine collection), were chosen, and the change of albumin/creatinine ratio from baseline to 8-week administration (W8) was analyzed.
Placebo group (n=4): Compared with the baseline, the UACR of W8 measured at the end of the trial period was increased by 30.64±34.50% on average. The UACR of the proteinuria from 4 cases of animals was fluctuated steadily within a certain range, which did not show rapid progress.
Valsartan group (n=3, moderate to severe proteinuria increase was included in the statistics): Compared with the baseline, the UACR from 2 animals (No. 2091, No. 4861) of W8 was decreased by 40%-70%, and both showed benefit. For one animal, the baseline UACR was 15 mg/g, and the W8 UACR after administration was 20.4%, which showed the benefit was not obvious. Due to the small number of animals in the group, there was no statistical difference compared with the placebo group.
The group of the malate of compound of Formula I (5 mg/kg once a day (qd)) (n=6, 4/6 moderate-to-severe proteinuria increase was included in statistics): Compared with the baseline, the W8 UACR after administration was decreased by 46.87±36.93% on average, which was significantly lower than that in the placebo group (p<0.05). Among them, the UACR from 3 animals of W8 on was decreased by 60%-70%, as compared with the baseline, and all showed benefits. One animal showed no benefit.
The group of the malate of compound of formula I (2 mg/kg qd) (n=5, 3/5 moderate to severe proteinuria increase was included in the statistics): Compared with the baseline, the W8 UACR after administration was decreased by 66.00±17.42% on average, which was significantly lower than that in the placebo group (p<0.01). Among them, the UACR from three animals of W8 was decreased by about 50%-80% as compared with the baseline, and they all showed benefits.
The group of the malate of compound of formula I (1 mg/kg qd) (n=5, 2/5 moderate-to-severe proteinuria increase was included in statistics): Compared with the baseline, the UACR from one animal of W8 was decreased by 39%. The benefit was not obvious in one case.
In short, the proteinuria (UACR) can be significantly improved by administering 2-5 mg/kg qd of the malate of compound of formula I for 8 weeks.
−46.87 ± 36.93#
5.2 Effect on Glomerular Filtration Rate eGFRcreat-cys
The effects on eGFR in each group were shown in Table 11 and Table 12 below. Selected eGFRcreat-cys in each group: 30˜59 ml/min/1.73 m2. The changes in the glomerular filtration rate of W8 and baseline were analyzed.
Placebo group (n=4): Compared with the baseline, the glomerular filtration rate eGFRcreat-cys from 4 cases of animal was fluctuated stably within a certain range and no rapid progress was shown.
Valsartan group (n=3): Compared with the baseline, the glomerular filtration rate eGFRcreat-cys of W8 in the Valsartan group was increased by 6±2 ml/min/1.73 m2 on average, which was a very significant increase compared with the change value of the placebo group (p<0.01). The glomerular deterioration was significantly improved, and the curative effect was time-dependent.
The group of the malate of compound of Formula I (5 mg/kg qd) (n=6): Compared with the baseline, the glomerular filtration rate eGFRcreat-cys of W8 was increased by 6±6 ml/min/1.73 m2 on average, which was a significant increase compared with the change value of the placebo group (p<0.05). The curative effect was time-dependent.
The group of the malate of compound of Formula I (2 mg/kg qd) (n=5): Compared with the baseline, the glomerular filtration rate eGFRcreat-cys of W8 was increased by 3±3 ml/min/1.73 m2 on average, which was a significant increase compared with the change value of the placebo group (p<0.05).
The group of the malate of compound of Formula I (1 mg/kg qd) (n=5): Compared with the baseline, the glomerular filtration rate eGFRcreat-cys of W8 was increased by 3±4 ml/min/1.73 m2 on average. Compared with the change value of the placebo group, no statistical change was shown.
In short, the glomerular filtration rate eGFRcreat-cys can be significantly improved by administering 2-5 mg/kg qd of the malate of compound of formula I for 8 weeks.
#change value compared with placebo group p < 0.05,
##change value compared with placebo group p < 0.01.
5.3 Effects on CysC, Cr—P and BUN
The effects on CysC, Cr—P and BUN after administration in each group were shown in Tables 13 to 15.
5.4 Effect on Blood Pressure
See Table 16 for the effects of administration of each administration group on blood pressure. The blood pressure test of primates required anesthesia, so it was necessary to control the variability of heart rate at various time points to make statistics.
Placebo group (n=4, 2/4 hypertension): Compared with the baseline, the blood pressure of 4 cases of animals was fluctuated steadily within a certain range.
Valsartan group (n=3, 1/3 hypertension): Compared with the baseline, SBP and DBP were decreased by 14±4 mmHg and 7±0 mmHg on average respectively after W8 administration, which was extremely significantly lower than the change value of the placebo group (p<0.01).
The group of the malate of compound of Formula I (5 mg/kg qd) (n=6, 4/6 cases of hypertension): Compared with the baseline, SBP and DBP were reduced by 21±8 mmHg and 10±7 mmHg on average respectively after W8 administration, which was extremely significantly lower than the change value of the placebo group (p<0.01). The curative effect was time-dependent.
The group of the malate of compound of Formula I (2 mg/kg qd) (n=5, 2/5 hypertension): Compared with the baseline, SBP and DBP were reduced by 19±9 mmHg and 9±8 mmHg on average respectively after W8 administration, which was extremely significantly lower than the change value of the placebo group (P<0.01). The curative effect was time-dependent.
The group of the malate of compound of Formula I (1 mg/kg qd) (n=5): Compared with the baseline, SBP and DBP were reduced by 11±4 mmHg and 5±4 mmHg on average respectively after W8 administration, which was significantly lower than the change value of the placebo group (p<0.05).
In a word, the malate of compound of formula I showed the activity of lowering the blood pressure when administering 1-5 mg/kg qd for 8 weeks.
#change value compared with placebo group p < 0.05,
##change value compared with placebo group p < 0.01.
5.5 Effect on Heart Function
See Table 17 for the effect on echocardiographic indicators in each group.
There was no obvious adverse reaction in the systolic and diastolic function in each dose group of the malate of the compound of formula I, Valsartan group and placebo group.
In addition, 2 cases of rhesus monkey animals (No. 5073 and No. 287) with low ejection fraction and cardiac insufficiency (SD) in the group with 5 mg/kg of the malate of compound of formula I for 8-week administration had increased LVEF % as compared with the baseline. However, whether this product can treat chronic heart failure needs to be supported by more follow-up research cohort data.
5.6 Effect on Blood Biomarker of Heart Function Impairment
5.6.1 Effect on NT-proBNP
The effect of the malate of the compound of formula I on NT-proBNP was shown in Table 18.
Compared with the baseline period, there was no significant change in NT-proBNP levels in each administration group after 8-week administration.
5.6.2 Effect on K+
The effect of the malate of compound of formula I on K+ was shown in Table 19.
Compared with the baseline period, there was no significant change in serum K+ levels of animals in each administration group for 8-week administration.
5.7 Safety Tolerance Study
During the administration period, there were no adverse events related to administration in the groups administered with malate of the compound of formula I, and no significant changes were observed in liver function, renal function, food intake, body weight, hematological indicators, etc.
6 Conclusion
The proteinuria (UACR) and the glomerular filtration rate eGFRcreat-cys can be significantly improved by administering the malate of compound of formula I in an amount of 2-5 mg/kg qd for 8 weeks. The effect thereof was equivalent to the Valsartan group.
After 8-week administration of the malate of compound of formula I in an amount of 1-5 mg/kg qd, the activity of lowering blood pressure was shown. At the same time, there was no risk of hyperkalemia under the test conditions.
1. Materials and Methods
1.1 Test Substance
The compound of Formula I was prepared and confirmed according to the method in CN103562191B. The 0.5% of sodium carboxymethyl cellulose (CMC-Na) was used as a vehicle. The compound of Formula I was stored at room temperature, protected from light and wetness. For cynomolgus monkey safety studies, the test substance was suspended in 0.5% CMC-Na at the relevant concentrations. The homogeneity, concentration and one week stability of prepared suspension was analyzed to ensure proper administration of the reported doses. The six month accelerated stability of active pharmaceutical ingredient (API) was tested by the inventor.
1.2 Animal Husbandry
Healthy male and female cynomolgus monkeys aged 3-4 years were supplied by Hainan New Source Biotech Co. Ltd. (Hainan, China). The body weight range at the start of treatment was 3.2-5.8 kg for male and 2.5-3.7 kg for female. They were housed for a 36-day acclimation period before study. Once a day in the morning, animals eat and drink freely.
This nonclinical laboratory study has been carried out in compliance with the guidelines from the China Food and Drug Administration (CFDA). This experiment was conducted in facilities approved by the Association for Assessment and Accreditation of Laboratory Animal Care International (AAA LAC), and animals were maintained in accordance with the Guide for the Care and Use of Laboratory Animals (Nussberger et al., 2008).
1.3 Doses and Treatment Schedule
Cynomolgus monkeys (5/sex/group) were selected using a computerized randomization procedure based on body weight, and the compound of Formula I was administered to the cynomolgus monkeys by nasogastric feeding at dose levels of 0 (control), 20, 100, 450 mg/kg/day in a volume of 5 ml/kg. Individual dose volumes were adjusted weekly based on body weight of animals. For all the groups, 2/3 of the animals were randomly selected and euthanized on day 28. The remaining animals were euthanized after 28-day drug free period.
1.4 Clinical Observations
Mortality and clinical signs were evaluated daily from the beginning of the quarantine period. Each animal was examined at least twice daily for any change in behavior, reaction to treatment or illness after administration.
Observations included, but were not limited to the following: changes in skin and fur; eyes and mucous membranes; respiratory, circulatory, autonomic, central nervous systems and behavior patterns. Rectal temperature was measured before administration (twice), at 1 and 24 h after first administration, and before d26 administration and at 1 and 24 h after d26 administration. Body weight was measured every week. Food consumption was estimated for monkey every day. Ophthalmoscopy was conducted for the monkey study using a portable slit lamp (YZ2) and a direct ophthalmoscope (GFJY-01B).
1.5 Laboratory Test
For the monkey study, at quarantine period (twice, d01 and d02), day 14, day 28 and day 56, the following parameters were measured as shown in Table 20. (1) Hematological and coagulation index examination were performed using a Bayer ADVIA2120 (Germany) and a Sysmex CA-1500 (Japan). (2) The serum biochemical examination was assessed using a HITACHI 7080 automated analyzer (Japan) and an Easylyte PLUS electrolyte analyzer (MEDICA, America). (3) The 24-h pooled urine of each animal was collected by a tray under each cage. Urinalysis was carried out using Uritest-300 (China). (4) The 24-h pooled faeces of each monkey were collected by a tray under each cage. Fecal occult blood was detected. (5) ACCESS 2 Chemiluminescence immunoassay was used for myocardial troponin (TropI, non-GLP) test.
1.6 Routine ECG Analysis for the Monkeys Study
Routine ECG analysis was performed at each scheduled time (day 1 after administration, d01 and d02 after administration, 1 and 24 h after administration on day 1, before administration, and 1 and 24 h after administration on day 26 and day 56). P-wave, R-wave, T-wave, P-R intervals, Q-T intervals, QRS duration and heart rate were recorded by an ECG system using derivation DII (ECG-6951E, Shanghai, China).
1.7 Necropsy and Histopathology
A complete gross necropsy was conducted on all animals by visual inspection at the end of the exposure period (day 28) and the recovery phase (day 56). The following selected organs were trimmed, weighed and evaluated in terms of absolute weight and as a percentage of final body weight or brain weight: brain, heart, kidney, liver, spleen, thymus, testes, epididymides, uterus, ovaries, adrenals and thyroid (including the parathyroid). The following tissues were preserved in 10% neutral buffered formalin: brain, pituitary gland, thyroid (including the parathyroid), trachea, heart, pancreas, spleen, adrenal glands, prostate, ovaries, uterus (including cervix uteri and oviduct), vagina, testes, epididymides, seminal vesicle, esophagus, duodenum, jejunum, ileum, cecum, colon, rectum, mesenteric lymph nodes, Peyer's patches, submaxillary lymph nodes, aorta, eyes, skeletal muscle, sciatic nerve, femur (including metaphysis), mammary gland, sternum, salivary glands, spinal cord, urinary bladder, lung (including the bronchi), liver, kidneys, stomach, bone marrow (sternal), thymus, sternum, gallbladder, any gross lesions or masses. The lung tissue was inflated with fixative at the time of necropsy. All the preserved tissues were paraffin embedded, sectioned, stained with hematoxylin and eosin (HE) and examined microscopically. Bone marrow cellular morphology examination was conducted with both smear (sternum) and paraffin-embedded sternum section.
1.8 Toxicokinetics
Blood samples were obtained on day1 and day26 at 0, 0.5, 1.5, 3, 5, 7 and 24 h after administration. On each occasion, approximately 1.0 mL of blood was drawn from the vein and collected into EDTA-K2 anticoagulant tubes. The blood samples were put on ice and then centrifuged (3500 rpm, 5 min) at 4° C. to obtain plasma samples, which were kept frozen at about −80° C. until analysis. Toxicokinetics determination of the compound of Formula I was conducted at the Institute of Materia Medica, Chinese Academy of Sciences (Shanghai, China).
1.9 Statistical Analysis
For each sex, body weight, rectal temperature, ECG, organ weight, hematological parameters and serum biochemical data were analyzed with a statistical software SAS 9.3. Firstly homogeneity of variance was analyzed using Levene's test. If P>0.05, the one-way ANOVA analysis was employed. If P<0.05, the Kruskal-Wallis test was used. If the resulting ANOVA p-value was <0.05, a comparison of each group using the Dunnett T test was performed. If the resulting Kruskal-Wallis test p-value was <0.05, then the Dunnett T test was performed after data rank conversion.
2. Results
2.1 Clinical Observations
Slight declining body weight gain was observed in high dose compared with controls (2.7±0.4 versus 3.2±0.2 for females, 4.1±0.5 versus 4.6±0.5 for males) with no statistical significance.
Treatment related early death occurred in one high dose female on day23, with clinical signs including hypoactivity, hunch back, low body temperature, diarrhea, mild intestinal tympanites and thymus atrophy. There were no apparent clinical signs of toxicity related to treatment observed in other animals.
2.2 Hematology and Coagulation
Increased NEUT % and decreased LYMPH % were seen in all treated females and in high-dose males. The increases of Fbg in mid- and high-dose animals and APTT in high-dose females were also observed (Table 21).
2.3 Serum Biochemistry
Serum chemistry parameters CPK, BUN and CREA were significantly increased in high-dose cynomolgus monkeys of both sexes, and especially in the monkey that died early on d23 (d14 data, BUN: 34.99; CREA: 526). CHOL in high-dose males was significantly decreased. Serum Na level of high-dose males decreased slightly, but statistically significantly on d26. Other statistically significant findings were isolated occurrences and considered of no toxicological significance (Table 22).
2.4 Urinanalysis
No significant changes were reported in any of the urinalysis parameters examined in either male or female monkeys.
2.5 ECG Parameters
Prolonged QTc intervals were seen in one mid-dose female at 1 h after administration on d26 (296 ms for animal No. 303). Sinus arrhythmia was observed in one high-dose male at 1 h after administration on d26 with prolonged QRS intervals (60 ms for animal No. 411). Prolonged QRS intervals were also seen in high-dose females at 1 h after administration on d1 and d26. (Table 23).
2.6 Necropsy
2.6.1 Gross Pathology and Organ Weights
There were no macroscopic findings for monkeys deemed related to administration of the test article except mild intestinal tympanites and thymus atrophy for the monkey that died early. Higher relative weight of liver and kidney, lower relative weight of thymus and lower absolute or relative weight of uterus occurred in high-dose monkeys (Table 24).
2.7 Toxicokinetics
Systemic exposure, which was indicated by the plasma AUC0-24h and Cmax of parent compound and main metabolite, were proportionately greater than the magnitude of the dose increments in the dose range of 20 to 450 mg/kg. After consecutive 28 days of administration, the accumulation was not apparent either.
1. Materials and Methods
1.1 Materials
The compound of Formula I was prepared and confirmed according to the method in CN103562191B.
1.2 Animals
Cynomolgus monkeys (3/sex/group: weight 3-5 kg, age 5-6 years old) were obtained from SuZhou XiShan ZhongKe Laboratory Animals (Shanghai, China). Animals were housed for a 7-day acclimation period before study. The monkeys were individually caged in a controlled temperature (18-26° C.) and humidity (50±20%) animal room with an air flow of 10 plus air changes per hour with fresh air. The lighting cycle was 12 h on and 12 h off, and the monkeys were fed once a day in the morning. All animal experiments were performed in accordance with the Animal Care and Use Guidelines set by the AMMS Animal Care and Use Committee.
2. Intravenous and Oral Administration of the Compound of Formula I
The compound of Formula I was intravenously or orally administered to cynomolgus monkeys fasted overnight. The doses were 1 mg/kg (intravenous), 1 mg/kg, 3 mg/kg, and 9 mg/kg (oral). Blood samples were collected from a limb vein at 0, 5, and 15 min and at 0.25, 0.5, 1, 2, 3, 4, 6, 8, 12, and 24 h (0.2 mL for each time point) after administration. All blood samples were centrifuged immediately after collection at 10,000×g for 5 min and the plasmas were stored at −75±10° C. until analysis. Plasma samples were prepared by protein precipitation. The concentrations of the compound of Formula I in plasma were determined by the validated liquid chromatography-tandem mass spectrometry method.
The pharmacokinetic parameters such as the area under the plasma concentration-time curve (AUC), maximum plasma concentration (Cmax), time to reach Cmax (Tmax), half-life (T1/2), total body plasma clearance (CL), mean residence time (MRT) and volume of distribution at steady state (Vss) were calculated by non-compartmental analysis with WinNonlin v1.3 (Pharsight, Mountain View, CA, USA). For allometric scaling, animal pharmacokinetic data were simulated by a two-compartment model with the Kinetica 5.1 software package (v.3.0; InnaPhase, Philadelphia, PA, USA).
3. Results
Plasma Pharmacokinetics and Bioavailability
Table 25 and
| Number | Date | Country | Kind |
|---|---|---|---|
| 202010921155.4 | Sep 2020 | CN | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/CN2021/116338 | 9/3/2021 | WO |
