Patent Application
20120041047
This invention relates to the treatment of pathological neovascularization-related conditions, especially in the field of ophthalmology. In particular, this invention relates to an injectable pharmaceutical composition containing an antisense oligonucleotide GS-101, capable of inhibiting the expression of the insulin receptor substrate-1 (IRS-1), to prevent and/or treat ophthalmic pathological neovascularization-related conditions.
Angiogenesis is a fundamental process by means of which new blood vessels are formed. This process is essential in multiple normal physiological phenomena such as reproduction, development and even wound healing.
The formation of neovessels by endothelial cells, involves the migration, growth and differentiation of endothelial cells. Regulation of these biological phenomena is linked to Insulin receptor substrate 1 (IRS-1), which is a cytoplasmic docking protein that functions as an essential signaling intermediate downstream of activated cell surface receptors, including insulin, insulin-like growth factor 1 (IGF-1), prolactin, growth hormone (GH), vascular endothelial growth factor (VEGF) receptors, members of the integrin receptor family, and select cytokine receptors.
Even though neovascularization may be a normal physiological process, pathological neovascularization is a critical situation in a number of diseases, especially in ophthalmology.
In ophthalmology, pathologies of the posterior segment of the eye, and in particular retinal pathologies, are some of the more disabling pathologies of modern society. Numbered among these pathologies are those characterized by abnormal neovascularization of the retina, iris and choroid, with consequent formation of dysfunctional neovessels which can cause leakage or hemorrhages, or can be associated with retinal edema, retinal/vitreous hemorrhage or retinal detachment resulting in the decline of visual acuity (Survey of Ophthalmology, January 2007, Vol. 52, S1, S3-S19). Ocular pathological neovascularization is also known as one of the leading causes of blindness in humans and is found in diverse eye diseases (Bradley, et al., 2007, Angiogenesis 10:141-8; Chen and Smith, 2007, Angiogenesis 10:133-40; Friedlander et al., 2007, Angiogenesis 10:89-101).
Among the therapies currently being practiced to treat ocular posterior segment disorders, such as uveitis, macular degeneration, macular edema and the like, is intravitreal injection of corticosteroids.
However, corticosteroids have well-known drawbacks, and there is still a need for new therapies for treating the disorders, conditions or diseases of the interior of the eye, which are conditions related to pathological neovascularization.
This invention brings a solution: it was now found that a specific oligonucleotide, called GS-101, already known in topical administration for its capacity of inhibiting IRS-1 gene expression (see for example EP 1 409 672) was of particular interest, when administered intraocularly, for the treatment of pathologies of the interior of the eye related to pathological neovascularization. The intraocular route brings the further advantage to make it possible to administrate a therapeutically effective, but low amount of active ingredient, to the patient. It also has a further advantage to control the exact administered amount, and to avoid any non-compliance to the treatment due to patient.
The invention thus proposes a composition for treating or for use in treating ocular disorders of the interior of the eye, linked to pathological neovascularization, wherein said composition comprises a therapeutically effective amount of GS-101 and said composition is administered to a subject in need thereof, by intraocular route.
According to the invention, the composition is formulated in a form suitable for intraocular injections. According to a first embodiment, the composition is an aqueous solution. According to a second embodiment the composition is within an implant. According to a third embodiment, the composition is associated with a sustained delivery system, composition or device. According to a fourth embodiment, the composition may include GS 101 and a polymeric agent.
According to the invention, GS-101 is an antisense oligonucleotide having the sequence SEQ ID NO: 1:
An example of a function conservative sequence of SEQ ID NO: 1 is SEQ ID NO: 2 (5′-TATCCGGAGGGCTCGCCATGCTGCT-3′). Other examples of a function conservative sequence of SEQ ID NO: 1 are the following sequences:
According to an embodiment, said function conservative sequence comprising 9 to 30 nucleotides may be a sequence comprising SEQ ID NO: 1 or SEQ ID NO: 2 between other nucleic acids in C-terminal and N-terminal. Said function conservative sequence may also be a 9 to 12 contiguous nucleotides fragment of SEQ ID NO: 1 or SEQ ID NO: 2.
The pharmaceutical composition may include GS-101 as described above, or a function conservative sequence thereof, as described above, in association with any pharmaceutically acceptable excipients for intraocular route.
The present invention also relates to a method for treating a pathological neovascularization-related condition of the interior of the eye in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising GS-101 as described above, or a function conservative sequence thereof, as described above, in association with a pharmaceutically acceptable excipients, and said composition is administered by intraocular route.
According to an embodiment, GS-101 as described above, or a function conservative sequence thereof, is present in the composition of the invention in a concentration of about 0.01 mg/ml to about 100 mg/ml, preferably 0.1 mg/ml to 80 mg/ml, more preferably 6 to 60 mg/ml.
According to an embodiment, the volume of the injected composition per administration ranges from 1-500 μl, preferably from about 5-400 μl, more preferably from 5-300 μl. According to an embodiment, the volume of the injected composition is of about 50 μl.
In one embodiment, the pharmaceutical composition is such that the intraocular administration is intravitreal administration.
According to an embodiment, the composition is injected at most once every four weeks, even more preferably once every eight weeks. According to an embodiment, the patient is treated with one injection every four weeks during two to five, preferably three months.
According to an embodiment, the duration of the treatment is of three to six months. The treatment may be renewed if a loss of visual acuity is observed in the patient.
In one embodiment of the invention, said pharmaceutical composition as described here above is packaged in the form of unit dose.
In another embodiment, said unit dose is a disposable syringe.
Advantageously, said unit dose is sterile.
According to this invention, the following terms have the following meanings.
“About” means plus or minus ten percent of the number, parameter or characteristic so qualified.
“Interior of the eye” means any area located within the eyeball, including the anterior and posterior segment of the eye, and which generally includes, but is not limited to, any functional (e.g., for vision) or structural tissues found within the eyeball, or tissues or cellular layers that partly or completely line the interior of the eyeball. Specific examples of areas include the anterior chamber, the posterior chamber, the vitreous cavity, the choroid, the macula, and the retina, and blood vessels and nerves which vascularize or innervate a posterior ocular region or site. According to a preferred embodiment, interior of the eye means the posterior segment of the eye, including the posterior chamber, the vitreous cavity, the choroid, the macula, and the retina, and blood vessels and nerves which vascularize or innervate a posterior ocular region or site.
“Conditions related to pathological neovascularization” or “pathological neovascularization-related conditions” are disease where undesired neovascularization is present, and includes the following: uveitis, choroiditis, retinochoroiditis, chorioretinitis, retinal degeneration, AMD, retinal detachment, retinal neovascularization, proliferative vitreoretinopathy, retinopathy of prematurity (ROP), diabetic retinopathy, posterior segment trauma, retinal vascular pathologies, endophthalmitis, macular edema, diabetic retinopathy, inflammatory pathologies of the retina, systemic pathologies with implications for the retina, possibly in combination with other therapies for the treatment of the same pathologies. Especially, the invention aims at addressing blood and lymph neovascularization.
“Therapeutically effective amount” means level or amount of agent that is aimed at, without causing significant negative or adverse side effects to the target, (1) delaying or preventing the onset of a disease, disorder, or condition related to pathological neovascularization; (2) slowing down or stopping the progression, aggravation, or deterioration of one or more symptoms of the disease, disorder, or condition related to pathological neovascularization; (3) bringing about ameliorations of the symptoms of the disease, disorder, or condition related to pathological neovascularization; (4) reducing the severity or incidence of the disease, disorder, or condition related to pathological neovascularization; or (5) curing the disease, disorder, or condition related to pathological neovascularization. A therapeutically effective amount may be administered prior to the onset of the disease, disorder, or condition related to pathological neovascularization, for a prophylactic or preventive action. Alternatively or additionally, the therapeutically effective amount may be administered after initiation of the disease, disorder, or condition related to pathological neovascularization, for a therapeutic action. In one embodiment, the target is the interior of the eye; in this embodiment, a therapeutically effective amount of GS 101, is an amount that is effective in reducing at least one symptom of a pathological neovascularization-related condition of the interior of the eye.
“Intraocularly” means by intraocular route of administration. Preferred intraocular route is intravitreal injection. According to the present invention, the intraocular route is of specific interest, in that it results in administering a rather low, and therapeutically accurate dose of active ingredient (i.e. GS-101 or function conservative sequence thereof) and result in an optimal treatment.
“Subject” refers to a mammal, preferably a human, but also can refer to animals, such as for example pets.
The procedures and protocols were approved by our institutional review board and were performed in accordance with our institutional guidelines and the Guide for the Care and Use of Laboratory Animals of France and Canada. Animals were kept under standard conditions with free access to food and water (24° C.; 12:12 hr light/dark cycle).
Animal study: Male adult New Zealand albino rabbits (n=30, 4 months old, weight range: 2.138 to 3.339 Kg; from the Bergerie de la combe aux loups, Boisset St Priest, France) were used.
Oxygen-induced retinopathy (OIR) rat model was used as previously described (Dorfman A, Dembinska O, Chemtob S, Lachapelle P. Early manifestations of postnatal hyperoxia on the retinal structure and function of the neonatal rat. Invest Ophthalmol Vis Sci 2008; 49:458-466). Newborn litters of Sprague-Dawley rats (Charles River Laboratories, St-Constant, Quebec, Canada) were exposed to 80% oxygen immediately after birth (mixture of medical grade 100% O2 and room air measured with an oxygen meter; MaxO2 Ceramatec, model OM25-ME; Medicana Inc., Montreal, Quebec, Canada). Briefly, exposure to hyperoxia (80% O2) persisted from birth until postnatal day 14 for 22.5 hours daily, interrupted with three intervals of 30 minutes' duration under normoxic conditions (21% O2). After hyperoxic exposure, animals were assigned at P14 to the following experiment, animals were treated at P14 and P16 by an intravitreal injection of 1 μl in one eye of either the vehicle alone (sterile NaCl 0.9%) (n=8), or containing either a scramble GS-101 oligonucleotide (2 mg/ml, 2 μg delivered, n=4), or GS-101 (SEQ ID NO: 2) at the concentration of 0.5 mg/ml (0.5 μg delivered, n=7), 1 (1 μg delivered, n=8), and 2 (2 μg delivered, n=8). Before the injection, rats were anesthetized with halothane (˜2.5%) and injected with a 10 μl-Hamilton syringe attached to a glass capillary of approximately 60 gauge. During the treatment period, rats were maintained in a cyclic lighting environment (80 lux; 12 hours dark/12 hours light). Finally, mothers of the litters were alternated between normoxic and hyperoxic conditions every 24 hours so that pulmonary complications known to arise in adult rats raised in a hyperoxic environment could be avoided. All animals were then euthanized at P18: the eyes were enucleated, the anterior segments dissected, and the eyecups fixed overnight in 4% formalin. Doses detailed above are based on the estimated eye volumes (˜25 μl in third postnatal week vs. ˜50 μl in adult).
Under halothane anesthesia, 1 μl in one eye of either the vehicle alone (sterile NaCl 0.9%) (n=6), or containing GS-101 at the concentration of 0.5 mg/ml (0.5 μg delivered, n=8) was injected at P1 and P3. Rat pup eye volume is approximately 0.3% of that of human adult.
The retinas were subsequently isolated, and flatmounts were prepared for staining with adenosine diphosphatase (ADPase). Specimens were mounted and photographed (40×, Axiophot microscope; Carl Zeiss Meditec, GmbH, Oberkochen, Germany). For the developmental protocol, retinal vascularization area and density have been evaluated using ImagePro Plus 4.5 (Media Cybernetics, Silver Spring, Md.). For the OIR protocol, the severity of retinopathy has been assessed using a retinal scoring system which evaluates the following criteria: blood vessel growth, blood vessel tufts, extra-retinal neovascularization, central vasoconstriction, retinal hemorrhage, and blood vessel tortuosity. In addition, vascular tufts per se have been evaluated on retinal flatmounts.
Statistical analyses were made by ANOVA using the Dunnett posttest (GraphPad Software Inc, San Diego, Calif., USA). P<0.05 were considered significant.
To determine the effective concentration of GS-101 required in the posterior chamber to inhibit retinal neovascularization in rats with OIR, GS-101 was injected in the eye. As shown by
As demonstrated in table 1, intraocular injections of GS-101 does not alter the normal evolution of the vascularization of the retina at concentration that have been shown to be effective in the rat model of OIR (
