The present invention relates to a pharmaceutical composition, as well as a method, for treatment of epilepsy-associated motor symptom and/or cognitive impairment.
Epilepsy is a neurological medical condition characterized by seizure (epileptic seizure). Many causes will result in epilepsy. Abnormal electrical activity in brain of epilepsy patients will cause seizure.
Valproic acid with a chemical structure shown in
Besides seizure, epilepsy also causes neuron lesion or neuronal cell death in brain, leading to motor symptoms and cognitive impairments. As an example, epilepsy affects not only motor coordination and balance, but also recognition and memory; and therefore, epilepsy patient has reduced quality of life (QoL). However, the conventional anticonvulsant drug such as valproic acid cannot improve neuron lesion caused by epilepsy, but increase γ-aminobutyric acid (GABA), an inhibitory neurotransmitter, level in brain and spinal cord, inhibiting neuronal, behavioral and recognition functions. That is, the administration of the conventional anticonvulsant drug (valproic acid) cannot improve the behavioral symptoms, but will make the symptoms worse.
In light of this, there is a need to provide a method for treatment of epilepsy-associated motor symptom and/or cognitive impairment.
It is therefore an objective of this invention to provide a pharmaceutical composition for treatment of epilepsy-associated motor symptom and/or cognitive impairment.
It is another objective of this invention to provide a method for treatment of epilepsy-associated motor symptom and/or cognitive impairment.
One embodiment of the present invention discloses a pharmaceutical composition, including clavulanic acid and valproic acid, for treatment of epilepsy-associated motor symptom and/or cognitive impairment.
Accordingly, by the synergistic effect of clavulanic acid and valproic acid, the pharmaceutical composition of the present invention can be used to trigger neuroregeneration in hippocampal dentate gyrus area, treating seizure and epilepsy-associated motor symptom and cognitive impairment, such as the motor coordination and balance problems, the cognitive impairment on object recognition ability and the cognitive impairment on memory.
A yet another embodiment of the invention discloses a method for treatment of epilepsy-associated motor symptom and/or cognitive impairment, by co-administering clavulanic acid and valproic acid to an epilepsy subject in need thereof to trigger neuroregeneration in brain of the epilepsy subject, thereby treating epilepsy-associated motor symptom and/or cognitive impairment of the epilepsy subject.
Accordingly, the co-administration with clavulanic acid can reduce the dosage of valproic acid needed, therefore can be rapidly and effectively metabolized by the metabolic organs such as liver and kidney, preventing valproic acid from accumulation in the organism. Furthermore, the reduced dosage of valproic acid can also decrease the burden to the metabolic organs such as liver and kidney, as well as diminish the risk of side effects.
In another preferred form shown, clavulanic acid can be administrated to the epilepsy subject in a dosage of 0.016-10 mg/kg/day. Preferably, clavulanic acid can be administrated to the epilepsy subject in the dosage of 0.016-4.99 mg/kg/day. In addition, valproic acid can be administrated to the epilepsy subject in a dosage of 0.8-30 mg/kg/day. Preferably, valproic acid can be administrated to the epilepsy subject in the dosage of 0.8-19.99 mg/kg/day. As such, epilepsy-associated motor symptom and/or cognitive impairment is effectively treated.
In another preferred form shown, clavulanic acid and valproic acid can be concurrently, sequentially or separately administrated to the epilepsy subject. As such, epilepsy-associated motor symptom and/or cognitive impairment is effectively treated.
In another preferred form shown, clavulanic acid and valproic acid can be continuously or intermittently administrated to the epilepsy subject. As such, epilepsy-associated motor symptom and/or cognitive impairment is effectively treated.
In another preferred form shown, clavulanic acid can be orally or parenterally administrated to the epilepsy subject. As an example, clavulanic acid can be administrated to the epilepsy subject by intravenous injection, intramuscular injection, intraperitoneal injection transdermal administration, sublingual administration or nebulization administration. As such, epilepsy-associated motor symptom and/or cognitive impairment is effectively treated.
In another preferred form shown, valproic acid can be orally or parenterally administrated to the epilepsy subject. As an example, valproic acid can be administrated to the epilepsy subject by intravenous injection, intramuscular injection, intraperitoneal injection, transdermal administration, sublingual administration or nebulization administration. As such, epilepsy-associated motor symptom and/or cognitive impairment is effectively treated.
The present invention will become more fully understood from the detailed description given hereinafter and the accompanying drawings which are given by way of illustration only, and thus are not limitative of the present invention, and wherein:
Clavulanic acid with a chemical structure shown in
In the present invention, clavulanic acid can be administrated to a subject in need thereof, treating epilepsy-associated motor symptom and/or cognitive impairment in the subject. Therefore, clavulanic acid can be used in combination with pharmaceutical acceptable vehicles, excipients, salts or other nutrients, forming a pharmaceutical composition. In addition, valproic acid can be further manufactured into any oral type that is easy to take, such as pastil, capsule, powder, pill or solution.
In the present invention, clavulanic acid can be administrated to the subject via any suitable routes. As an example, clavulanic acid can be orally or parenterally administrated to the subject, such as by intravenous injection (IV injection), intramuscular injection (IM injection), intraperitoneal injection (IP injection), transdermal administration, sublingual administration or nebulization administration.
Moreover, in the present invention, clavulanic acid can be administrated to the subject in a dosage of 0.016-10 mg/kg/day. Preferably, clavulanic acid can be administrated to the subject in the dosage of 0.016-4.99 mg/kg/day, which is lower than the clinical dosage. Clavulanic acid can be continuously or intermittently administrated to the subject. Specifically, clavulanic acid can be administered to the subject one at a predetermined interval of time. The predetermined interval of time being less than or equal to 24 hours indicates continuously administrated clavulanic acid to the subject, while the predetermined interval of time being more than 24 hours indicates intermittently administrated clavulanic acid to the subject. However, the dosage of clavulanic acid may vary according to the differences of the subject, the sequence of administration and the routes of administration, which can be appreciated by a person having ordinary skill in the art.
In addition, clavulanic acid and the conventional anticonvulsant drug (valproic acid) can be co-administrated to the subject, permitting the pharmacological effects of clavulanic acid and valproic acid overlap each other, thereby synergistically treating epilepsy-associated motor symptom and/or cognitive impairment in the subject. Specifically, co-administration of clavulanic acid and valproic acid includes the following ways. In the first way, clavulanic acid and valproic acid can be concurrently administrated to the subject in need thereof, which means administration of clavulanic acid and valproic acid to the subject in need thereof at the same time. In the second way, clavulanic acid and valproic acid can be sequentially administrated to the subject in need thereof, which means after administering clavulanic acid to the subject in need thereof, administering valproic acid to the subject in need thereof when the plasma drug concentration of clavulanic acid remains a therapeutic drug concentration. For example, the time interval between administering clavulanic acid and administering valproic acid is 10 minutes to 8 hours. In the third way, valproic acid and clavulanic acid are sequentially administrated to the subject in need thereof, which means after administering valproic acid to the subject in need thereof, administering clavulanic acid to the subject in need thereof when the plasma drug concentration of valproic acid remains a therapeutic drug concentration. For example, the time interval between administering valproic acid and administering clavulanic acid is 10 minutes to 8 hours. In the fourth way, clavulanic acid and valproic acid can be separately administrated to the subject in need thereof, which means after administering clavulanic acid to the subject in need thereof, administering valproic acid to the subject in need thereof when the plasma drug concentration of clavulanic acid is below the therapeutic drug concentration. For example, the time interval between administering clavulanic acid and administering valproic acid is 8-12 hours. In the fifth way, valproic acid and clavulanic acid can be separately administrated to the subject in need thereof, which means after administering valproic acid to the subject in need thereof, administering clavulanic acid to the subject in need thereof when the plasma drug concentration of valproic acid is below the therapeutic drug concentration. For example, the time interval between administering valproic acid and administering clavulanic acid is 8-12 hours.
Moreover, when valproic acid is administered together with clavulanic acid, valproic acid can be orally or parenterally administrated to the subject, such as IV injection, IM injection, IP injection, transdermal administration, sublingual administration or nebulization administration. Valproic acid can be administrated to the subject in a dosage of 0.8-30 mg/kg/day. Preferably, valproic acid can be administrated to the subject in the dosage of 0.8-19.99 mg/kg/day, which is lower than the clinical dosage. Valproic acid can be continuously or intermittently administrated to the subject. However, the dosage of valproic acid may vary according to the differences of the subject, the sequence of administration and the routes of administration, which can be appreciated by a person having ordinary skill in the art.
In addition, clavulanic acid and valproic acid can be manufactured as a pharmaceutical composition. Clavulanic acid and valproic acid can be concurrently, sequentially or separately administrated to the subject in need thereof by virtue of varying dosage form. In general, the pharmaceutical composition may include at least one pharmaceutical excipient. With such performance, the release of clavulanic acid and/or valproic acid to the subject can be controlled. As an example, liposome can be used as the pharmaceutical excipient for coating one of the active substances (clavulanic acid or valproic acid), assuring the extended releasing of the coated active substance, and therefore, the two active substances can be sequentially or separately administrated to the subject in need thereof.
In order to evaluate whether the co-administration of clavulanic acid and valproic acid can effectively treat epilepsy-associated motor symptom and/or cognitive impairment, the following trials were carried out.
Trial (A).
Wistar male rats (8 week-old) purchased from BioLASCO Taiwan Co., Ltd were used. The rats were housed in an animal room with constant temperature of 21-24° C., where was kept on a 12-hours light and 12-hours dark cycle. The rats were housed and kept on free diet and water.
3 days before the trials, motor functions of the rats were tested by the rotarod test. On the 1st, 3rd, 5th, 7th, 9th, 11th and 13th days, pentylenetetrazol (PTZ, 35 mg/kg) was IP injected to the rats to induce epilepsy rats of groups A1-A5. On the 21st day, after administration of PTZ, seizure severity of the rats was measured.
Referring to TABLE 1, on the 7th, 8th, 9th, 10th, 11th, 12th and 13th days, clavulanic acid and/or valproic acid was IP injected to the epilepsy rats of groups A2-A5. Saline (1 mL/kg/day) was IP injected to the normal rats of group A0, as well as the epilepsy rats of group A1.
On the 14th day, the motor function of the rats of groups A0-A5 was tested by rotarod test. On the 15th, 16th and 17th days, the cognitive impairment on object recognition ability of the rats of groups A0-A5 was tested by object recognition test. On the 18th, 19th and 20th days, the cognitive impairment on memory of the rats of groups A0-A5 was tested by passive avoidance test. Moreover, on the 22nd day, BrdU (5′-bromo-2′-deoxyuridine) was IP injected to the rats of groups A0-A5 to label the proliferating cells. On the 23rd day, the rats of groups A0-A5 were sacrificed and the coronal brain sections were collected. The sections with hippocampal dentate gyrus were used for BrdU staining. The number of BrdU-positive cells in hippocampal dentate gyrus was calculated.
Trial (B).
On the 1st, 3rd, 5th, 7th, 9th, 11th, 13th and 21st days, the seizure severity of the rats of groups A0-A5 was measured by Racine score. The seizure severity was scored according to Racine's scale as follows: 0=normal, nonepileptic activity, 1=mouth and facial movements, hyperactivity, grooming, sniffing, scratching, wet dog shakes, 2=head nodding, staring, tremor, 3=forelimb clonus, forelimb extension, 4=rearing, salivating, tonic clonic activity and 5=falling, status epilepticus.
Referring to
Furthermore, it is worthy to be noted that after the continuously treatment for 7 days (from day 7 to day 13), even though the epilepsy rats were not treated for another 7 days (from day 14 to day 20), the seizure severity of the epilepsy rats of group A3, which had been administered by high-dosage clavulanic acid, as well as that of the epilepsy rats of group A5, which had been co-administered by low-dosage clavulanic acid and low-dosage valproic acid (“▾” and “★” shown in
Trial (C).
Next, motor function of the rats of groups A0-A5 was tested by rotarod test. Specifically, in the training session, the normal rat that had not yet been induced as epilepsy rat by PTZ was used as the rat R under the test. As shown in
On the 14th day, the rats of groups A0-A5 were used as the rats R under the test. Each of the rats R under the test was placed on the rotarod W at a constant speed of 25 rpm for 3 minutes. The faster the rat R under the test falls off the rotarod W as shown in
Referring to
Trial (D).
On the 15th, 16th and 17th days, the cognitive impairment on object recognition ability of the rats of groups A0-A5 was tested by object recognition test. Specifically, during the exposure session, the rat R under the test was placed in the open box, shown as
On the 17th day, during the test session, the rat R under the test was placed in the open box, shown as
Referring to
Trial (E).
On the 18th, 19th and 20th days, the cognitive impairment on memory of the rats of groups A0-A5 was tested by passive avoidance test using a shuttle box shown in
The shuttle box had a light chamber C1 and a dark chamber C2 divided by a guillotine door D. During the exploration session, referring to
Referring to
After the retention session for 24 hours, the rat R under the test was placed in the light chamber C1, and the guillotine door D was opened, as shown in
Referring to
Trial (F).
On the 22nd day, BrdU was IP injected to the rats to label the proliferating cells. On the 23rd day, the rats of groups A0-A5 were sacrificed and the coronal sections of the brain were collected. The sections with hippocampal dentate gyrus were used for BrdU staining The number of BrdU-positive cells in the hippocampal dentate gyrus was calculated, as shown in
Referring to
Besides, the aforesaid dosage can be converted into a dosage suitable for a human subject according to the dose translation formula based on body surface area (Shannon R. S. et al. (2007), FASEB J., 22: 659-661), suggesting that 0.16-10 mg/kg/day of clavulanic acid and 0.8-30 mg/kg/day of valproic acid can be co-administrated to a human subject. Preferably, the dosage lower than the clinical dosage, that is, 0.016-4.99 mg/kg/day of clavulanic acid and 0.8-19.99 mg/kg/day of valproic acid can be co-administrated to a human subject.
Accordingly, by the synergistic effect of clavulanic acid and valproic acid, the pharmaceutical composition of the present invention can be used to trigger neurogenesis in hippocampal dentate gyrus area, treating epilepsy-associated motor symptom and/or cognitive impairment, such as the motor coordination and balance problems, the cognitive impairment on object recognition ability and the cognitive impairment on memory.
Moreover, the co-administration with clavulanic acid can reduce the dosage of valproic acid needed, therefore valproic acid can be rapidly and effectively metabolized by the metabolic organs such as liver and kidney, preventing valproic acid from accumulation in the organism. Furthermore, the reduced dosage of valproic acid can also decrease the burden to the metabolic organs such as liver and kidney, as well as diminish the risk of side effects.
In contrast to that conventional anticonvulsants must be continuously administered to maintain efficacy, effects of co-administration of clavulanic acid and valproic acid, improvement of epilepsy-associated motor and cognitive deficits, are still observed after a period, for example, one week, of drug holiday. In other word, co-administration of clavulanic acid and valproic acid has a long-lasting effect.
It is worthy to be noted that the development of a method for treating a disease ultimately needs to perform clinical trials to verify the efficacy of medications on patients. In the clinical trials, in order to take into account the safety and treatment rights of the patients, one should not rashly stop the currently used medications, so the new medications that are being evaluated and the medications used had better to be subjected to an add-on study. In the present invention, the efficacy of the pharmaceutical composition including clavulanic acid and valproic acid has been verified.
Although the invention has been described in detail with reference to its presently preferable embodiment, it will be understood by one of ordinary skill in the art that various modifications can be made without departing from the spirit and the scope of the invention, as set forth in the appended claims.
Number | Date | Country | Kind |
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108142968 | Nov 2019 | TW | national |
This is a continuation-in-part application of U.S. patent application Ser. No. 16/747,917, filed on Jan. 21, 2020. The application claims the benefit of Taiwan application serial No. 108142968, filed Nov. 26, 2019, the entire contents of which are incorporated herein by reference.
Number | Date | Country | |
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Parent | 16747917 | Jan 2020 | US |
Child | 17153110 | US |