Patent Application
20230364193
The Sequence Listing submitted Jan. 20, 2023, as a text file named “SICH_100_371_ST25.txt” created on Jan. 18, 2023, and having a size of 4,096 bytes is hereby incorporated by reference pursuant to 37 C.F.R. § 1.52(e)(5).
The invention belongs to the field of antiviral drugs.
Coronavirus disease 2019 (COVID-19) is a pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. SARS-CoV-2 is a new type of virus belonging to the coronavirus family. It is the seventh coronavirus pathogen that can infect humans and the third coronavirus pathogen that can cause severe clinical syndrome after SARS-CoV and Middle East Respiratory Syndrome (MERS)-CoV.
COVID-19 broke out in early 2020, and it is still raging around the world. As of Jun. 11, 2020, a total of 7,313,661 cases of COVID-19 have been confirmed worldwide, with a total of 413,854 deaths, posing a great threat to human life and health. On the other hand, due to the high infectiousness of COVID-19, various countries and regions have to adopt very strict control measures, and the global economy has been greatly affected. The even more worrying news is that there may be a large-scale outbreak in autumn and winter since there is currently no drug that can effectively treat COVID-19. Therefore, the importance of developing effective drugs for the treatment of COVID-19 is self-evident.
Researchers have tried a lot of antiviral drugs, including some drugs for treatment of SARS and MERS, but the effects thereof were not desirable. For example, by evaluating the in vitro inhibitory effects of ribavirin, penciclovir, nitazolamide, nafamostat, chloroquine, remdesivir, favipiravir and lopinavir on SARS-CoV-2, it was found that chloroquine, remdesivir, lopinavir, ritonavir, arbidol, etc., showed good effects on SARS-CoV-2 in vitro, but poor results in clinical trials with little therapeutic effect; instead, they were prone to side effects such as serious gastrointestinal reactions and impaired kidney functions, and thus were not suitable for long-term use. At present, there are no relevant reports on drugs with excellent efficacy.
Interferon (IFN) is a low-molecular-weight glycoprotein with similar structure and function produced by the host through antiviral response during the infection of virus. There are 3 main types of interferon: type I interferon, type II interferon and type III interferon. Type I interferon (which can be divided into two classes: α and β) can be used for clinical antiviral therapy. Studies have shown that α-interferon (IFN-α) can be combined with ribavirin, oseltamivir, lopinavir/ritonavir and other antiviral drugs or glucocorticoids to treat SARS and MERS. In the second, third, fourth, fifth, sixth, and seventh editions of the diagnosis and treatment scheme for COVID-19 issued by the National Health Commission of the People's Republic of China, it is proposed that IFN-α be administered by nebulization, at 5 million IU (international unit) plus 2 ml water for injection, twice a day.
Recombinant super-compound interferon (rSIFN-co) is a new type of genetically engineered interferon produced by changing 65 bases of the 60 amino acid genetic code of IFN-α without changing its amino acid composition. rSIFN-co was initially used to fight against SARS and had a good curative effect, but its effect on COVID-19 has not been reported yet.
The problem to be solved by the present invention is to provide a combined drug for treating COVID-19.
The present invention provides the following technical solutions:
Preferably, the amount of rSIFN-co in each unit preparation is 10 million to 14 million IU, and the amount of rSIFN-co in each daily dosage is 20 million to 28 million IU.
Further preferably, the amount of rSIFN-co in each unit preparation is 12 million IU, and the amount of rSIFN-co in each daily dosage is 24 million IU.
Preferably, the amount of rSIFN-co in each unit preparation is 10 million to 14 million IU, and the amount of rSIFN-co in each daily dosage is 20 million to 28 million IU;
Further preferably, the content of rSIFN-co in each unit preparation is 12 million IU, and the content of rSIFN-co in each daily dosage is 24 million IU.
Preferably, the amount of rSIFN-co in each unit preparation is 10 million to 14 million IU, and the amount of rSIFN-co in each daily dosage is 20 million to 28 million IU;
Further preferably, the amount of rSIFN-co in each unit preparation is 12 million IU, and the amount of rSIFN-co in each daily dosage is 24 million IU.
Studies have shown that lopinavir/ritonavir or arbidol alone cannot effectively treat COVID-19. The present invention verified the effect of rSIFN-co against SARS-CoV-2 in vitro, and also verified that the combination of rSIFN-co with lopinavir/ritonavir, or with arbidol had a significant efficacy on COVID-19, and its effect was significantly better than the combination of IFN-α with lopinavir/ritonavir, or with arbidol.
Apparently, based on the above content of the present invention and according to common technical knowledge and conventional means in the art, those skilled in the art can further make other modifications, substitutions or changes in various forms without departing from the spirit of the present invention.
The above content of the present invention will be further described in detail below through specific examples. However, this should not be construed as limiting the scope of the present invention to the examples. All technical solutions achieved based on the contents of the present invention belong to the scope of the present invention.
In order to evaluate the pharmacodynamics of rSIFN-co against SARS-CoV-2 viruses with different multiplicity of infection in vitro, the present inventors conducted the following experiments.
Test drugs:
Instruments:
Multifunctional microplate reader (Thermo), carbon dioxide incubator (Thermo), etc.
Specifically, the detection of antiviral activity was performed on a Vero-E6 cell model, with triplicate wells for each experiment, repeated for three times. The following steps were performed.
CPE inhibition rate (%)=(OD450 of drug group-OD450 of virus group without drug)/(OD450 of normal cell group-OD450 of virus group without drug).
At the same time, half effective concentration (EC50) of the drug was calculated. The results were shown in Table 1.
Specifically, the final concentration of each gradient of rSIFN-co was set as: 6×108 pg/ml, 3×108 pg/ml, 1.5×108 pg/ml, 7.5×107 pg/ml, 3.75×107 pg/ml, 1.875×107 pg/ml, and 0 pg/ml, and the final concentration of each gradient of recombinant human interferon α2b injection (Pseudomonas) was set as: 2×107 pg/ml, 1×107 pg/ml, 5×106 pg/ml, 2.5×106 pg/ml, 1.25×106 pg/ml, 6.25×105 pg/ml, and 0 pg/ml;
At the same time, the positive control chloroquine was serially diluted by 2-fold with DMEM medium containing 2% FBS, and 6 concentration gradients were set;
At the same time, half cytotoxicity concentration (CC50) of the drug was calculated, and the results were shown in Table 2. CC50/EC50 was calculated as therapeutic index TI, and the results were shown in Table 3.
The results showed that: in the Vero-E6 cell model, when the initial multiplicity of infection MOI were 0.005, 0.05 and 0.5, the half effective concentration (EC50) of positive control chloroquine in inhibiting the replication of SARS-CoV-2 virus were 1.94, 3.41 and 5.34 μM respectively; the half cytotoxicity concentration (CC50) for Vero-E6 cells was 61.37 μM, and when the virus multiplicity of infection MOI were 0.005, 0.05 and 0.5, the therapeutic indexes (TI) of chloroquine were 31.63, 18.00 and 11.50, respectively.
In the Vero-E6 cell model, when the initial multiplicity of infection MOI were 0.005, 0.05 and 0.5, the half effective concentration (EC50) of recombinant human interferon α2b injection (Pseudomonas) in inhibiting the replication of SARS-CoV-2 virus were 134.87, 578.97 and 2308.33 pg/ml, respectively. The half cytotoxicity concentration (CC50) of recombinant human interferon α2b injection (Pseudomonas) to Vero-E6 cells was 1.37×107 pg/ml. When the virus multiplicity of infection MOI were 0.005, 0.05 and 0.5, the therapeutic indexes (TI) of recombinant human interferon α2b injection (Pseudomonas) were 1.02×105, 2.37×104 and 5.94×103, respectively.
Recombinant super-compound interferon (rSIFN-co) could inhibit SARS-CoV-2 replication in Vero-E6 cell model in a dose-dependent manner
When the initial multiplicity of infection (MOI) were 0.005, 0.05 and 0.5, the half effective concentration (EC50) of rSIFN-co in inhibiting virus replication were 13.30, 123.30 and 151.20 pg/ml, respectively, showing strong anti-SARS-CoV-2 activity. The half cytotoxicity concentration (CC50) of rSIFN-co to Vero-E6 cells was 7.12×108 pg/ml, showing low cytotoxicity. When the initial multiplicity of infection MOI were 0.005, 0.05 and 0.5, the therapeutic indexes (TI) of rSIFN-co were 5.35×107, 5.77×106 and 4.71×106, respectively, which were much higher than those of the positive control chloroquine, and higher than those of recombinant human interferon αm2b.
To sum up, in vitro tests showed that rSIFN-co had a strong anti-SARS-CoV-2 activity, low cytotoxicity, excellent therapeutic index, and had the potential as a therapeutic drug for diseases caused by SARS-CoV-2 virus.
From Feb. 10, 2020 to Apr. 5, 2020, the inventors conducted a multi-center, randomized, controlled, single-blinded, phase 2 clinical trial.
The rSIFN-co used in the trial was obtained from Sichuan Huiyang Life Science & Technology Corp., and the IFN-α was obtained from Tianjin Hualida Bioengineering Co., Ltd.
The nucleotide sequence encoding rSIFN-co (SEQ ID NO.1) was as follows:
The amino acid sequence of rSIFN-co (SEQ ID NO.2) was as follows:
Previous studies showed that administration of rSIFN-co in large dosage was safe, and each dosage could be >10 million IU; however, IFN-α was prone to lead to side effects and could not be used in large dosage, and thus should be administrated at the dosage described in the diagnosis and treatment scheme for COVID-19 issued by the National Health Commission of the People's Republic of China.
Specific methods: A total of 102 patients with moderate or severe COVID-19 were recruited, and 94 subjects in a safety analysis set were randomly divided into rSIFN-co group (46 subjects) and IFN-α group (48 subjects). While receiving baseline treatment, subjects were administrated rSIFN-co (12 million IU) or IFN-α (5 million IU) by nebulization, twice a day. The main endpoint of research was disease remission by day 28, including clinical remission time, imaging inflammation absorption time, time for viral nucleic acid to become negative and clinical remission rate.
The aforementioned baseline treatment means: treatment with lopinavir/ritonavir (trade name Kaletra) or Arbidol. Lopinavir/ritonavir were administrated orally, 2 capsules each time (wherein each capsule contained 200 mg lopinavir and 50 mg ritonavir), twice a day, and the course of treatment did not exceed 10 days; Arbidol was administrated orally, 200 mg each time, three times a day. The course of treatment did not exceed 10 days.
In the two groups, the numbers of subjects receiving baseline treatment (lopinavir/ritonavir, or abidol) were: 22 and 24 subjects in the rSIFN-co group, and 20 and 28 subjects in the IFN-α group, p=0.548; the difference was not statistically significant, and the proportions of the patients of the two groups receiving baseline treatment were the same.
The criteria for imaging inflammation absorption was as follows: based on changes of ground-glass opacities and consolidation areas in the lungs of patients compared with the baseline chest CT, the CT results were graded by two independent radiologists to judge the inflammation absorption.
The standard for viral nucleic acid to turn negative was: real-time fluorescence quantitative PCR detections of two consecutive nasopharyngeal swabs, sputum or lower respiratory tract secretions were negative for SARS-CoV-2 nucleic acid, and the sampling interval between the two detections was greater than 24 hours.
Overall, referring to Table 4, the rSIFN-co group had a shorter period for clinical remission (median 11.5 days vs 14.0 days, p=0.019), a faster absorption of inflammation (median 8.0 days vs 10.0 days; p=0.002), and a shorter period for viral nucleic acid to turn negative (median 7.0 days vs 10.0 days; p=0.018) as compared to the IFN-α group. On day 28, the clinical remission rate of the rSIFN-co group was significantly higher than that of the IFN-α group (93.5% vs 77.1%). Adverse reactions in the two groups were generally mild. There was no serious adverse reaction in the rSIFN-co group, and 1 case of serious adverse reaction (respiratory failure) in the IFN-α group.
The results showed that, compared with the group administrated by adding IFN-α, the group administrated by adding rSIFN-co in the baseline treatment improved the condition of patients with moderate to severe COVID-19 faster and more significantly.
The existing clinical randomized controlled trials and large-sample retrospective analysis results showed that the baseline therapeutic drug (lopinavir/ritonavir or arbidol) alone was ineffective for the treatment of COVID-19; therefore, it could be reasonably concluded that the combined administration of rSIFN-co and the above baseline therapeutic drug achieved a significant and effective therapeutic effect on COVID-19, and such antiviral effects mainly resulted from the synergistic effect of interferon and the baseline therapeutic drug. Therefore, the present invention provides a combined drug for the treatment of COVID-19, a method for the treatment of COVID-19, and a pharmaceutical composition containing rSIFN-co for the treatment of COVID-19.
In conclusion, rSIFN-co can be combined with lopinavir/ritonavir or arbidol to prepare a combined drug for the treatment of COVID-19 with good clinical effect, which is of great significance for the prevention and treatment of COVID-19.
| Number | Date | Country | Kind |
|---|---|---|---|
| 202010577357.1 | Jun 2020 | CN | national |
This application is a National Phase application under 35 U.S.C. 371 of PCT/CN2021/101213 filed Jun. 21, 2021, which claims the benefit of and priority to Chinese Provisional Application No. 202010577357.1 filed Jun. 22, 2020.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/CN2021/101213 | 6/21/2021 | WO |
