The present invention belongs to the field of medicine, and relates to a pharmaceutical composition for preventing and treating diabetes and use thereof.
At present, the prevalence rate of diabetes is rapidly increasing, and diabetes has become another important chronic non-communicable disease that seriously endangers the health of residents after cardiovascular diseases and tumors. The disability and lethality caused by diabetes and its various acute and chronic complications have become the third largest disease threatening human health in the world, which seriously affects the quality of life of patients.
According to statistics, in 2015, about 415 million people aged 20-79 in the world suffered from diabetes (morbidity was 8.8%), and another 318 million people suffered from impaired glucose tolerance (morbidity of pre-diabetes was 6.7%). China is the largest country with diabetes patients in the world. In China, the number of patients in 2015 reached 109.6 million, and 1.3 million people died of diabetes and its complications. Furthermore, IDF predicts that, without intervention, there will be 642 million diabetes patients and 481 million people with pre-diabetes worldwide in 2040, and the number of patients in China will rise to 154 million.
Metformin (referred to as Met) or metformin hydrochloride is the first choice for clinical treatment of type 2 diabetes. Since 1957, metformin has officially entered the market as a hypoglycemic drug for the treatment of type 2 diabetes. After half a century of clinical use, more and more studies have confirmed the safety and effectiveness of metformin. Therefore, metformin has gradually become the first-line drug for diabetes treatment. Because of its low price, metformin has become one of the most widely used hypoglycemic drugs in clinic. In the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2017 Edition), metformin is regarded as the drug of first choice, which highlights the important position of metformin. It is pointed out in the Guidelines that metformin can be used in combination with insulin secretagogues, α-glucosidase inhibitors and insulin sensitizers respectively. The structural formula of metformin is shown in a Formula A below.
Metformin has a variety of mechanisms of action, including delaying the uptake of glucose from the gastrointestinal tract, increasing the utilization of peripheral glucose by increasing insulin sensitivity, and inhibiting excessive liver and kidney gluconeogenesis without reducing blood glucose levels in non-diabetic patients. Clinical trials have proved that metformin can be used for a long time. The most common adverse reactions of metformin are gastrointestinal reactions, including epigastric discomfort, abdominal pain, diarrhea, nausea, vomiting, bloating, fatigue, dyspepsia, etc. In addition, 10% of diabetic patients develop lactic acidosis after taking metformin, leading some patients to give up due to their intolerance to metformin.
Glibenclamide is another common drug for treating diabetes. Glibenclamide binds specifically to a sulfonylurea receptor on a β cell membrane, and stimulates B cells to release insulin. However, long-term use of glibenclamide will cause islet atrophy; especially for patients with liver and kidney insufficiency, insulin-dependent diabetes mellitus, non-insulin-dependent diabetes mellitus with ketoacidosis, coma, severe burn, infection, trauma and leukopenia, glibenclamide is forbidden. In addition, glibenclamide can also cause the above gastrointestinal reactions similar to metformin.
More importantly, metformin and glibenclamide are also the most common dual drugs for treating type 2 diabetes. The above adverse reactions cause some patients to give up treatment with metformin and/or glibenclamide due to their intolerance.
Therefore, it is particularly urgent to find new specific therapeutic drugs to reduce the adverse reactions of metformin and/or glibenclamide while lowering blood sugar.
The inventors have found through in-depth research that while cannabidiol can effectively inhibit type 1 and type 2 diabetes, cannabidiol can also reduce adverse reactions caused by metformin, thereby providing the following invention:
One aspect of the present invention relates to a pharmaceutical composition, including:
In one or more embodiments of the present invention, in the pharmaceutical composition, the hypoglycemic agent is selected from a group consisting of:
In one or more embodiments of the present invention, in the pharmaceutical composition, the hypoglycemic agent is selected from a group consisting of:
In one or more embodiments of the present invention, in the pharmaceutical composition, the pharmaceutical composition consists of cannabidiol and/or a pharmaceutically acceptable salt or ester thereof, one or more hypoglycemic agents and one or more pharmaceutically acceptable auxiliary materials.
In one or more embodiments of the present invention, in the pharmaceutical composition, a weight ratio of the cannabidiol and/or the pharmaceutically acceptable salt or ester thereof to the hypoglycemic agent is:
In one or more embodiments of the present invention, in the pharmaceutical composition, a mass of the cannabinol and/or the pharmaceutically acceptable salt or ester thereof is 5-500 mg, 10-300 mg, 20-200 mg, 50-150 mg, 50-100 mg, 100-300 mg, 100 mg, 200 mg, 300 mg, 400 mg or 500 mg.
In one or more embodiments of the present invention, the pharmaceutical composition is used for treating and/or preventing a disease or symptom selected from:
The preparation form of the pharmaceutical composition can be any pharmaceutically acceptable dosage forms, including tablets, sugar-coated tablets, film-coated tablets, enteric-coated tablets, capsules (such as hard capsules, soft capsules), oral liquids, buccal tablets, granules, dissolved granules, pills, pulvis, ointments, sublimed preparations, suspensions, powders, solutions, injections, suppositories, soft ointments, hard ointments, creams, sprays, drops, and patches; preferably, the pharmaceutical composition is in oral dosage forms, such as capsules, tablets, oral liquids, granules, pills, pulvis, sublimed preparations, ointments, etc. The oral dosage forms may contain common excipients, such as binders, fillers, diluents, tableting agents, lubricants, disintegrating agents, coloring agents, flavoring agents and wetting agents, and the tablets may be coated if necessary. Suitable fillers include cellulose, mannitol, lactose and other similar fillers; suitable disintegrating agents include starch, polyvinylpyrrolidone and starch derivatives, such as sodium starch glycolate; suitable lubricants include, for example, magnesium stearate; and suitable pharmaceutically acceptable wetting agents include sodium dodecyl sulfate.
Preferably, the pharmaceutical composition is an oral preparation.
Another aspect of the present invention relates to a pharmaceutical product, including a first pharmaceutical preparation packaged individually and a second pharmaceutical preparation packaged individually, wherein,
In one or more embodiments of the present invention, in the pharmaceutical product, the hypoglycemic agent is selected from a group consisting of:
In one or more embodiments of the present invention, in the pharmaceutical product, the hypoglycemic agent is selected from a group consisting of:
In one or more embodiments of the present invention, for the pharmaceutical product,
In one or more embodiments of the present invention, in the pharmaceutical product, a weight ratio of the cannabidiol and/or the pharmaceutically acceptable salt or ester thereof to the hypoglycemic agent is:
In one or more embodiments of the present invention, in the pharmaceutical product,
In one or more embodiments of the present invention, the pharmaceutical product is used for treating and/or preventing a disease or symptom selected from:
Still another aspect of the present invention relates to use of the pharmaceutical composition according to the present invention or the pharmaceutical product according to the present invention in preparing a medicament for treating and/or preventing a disease or symptom selected from:
Yet still another aspect of the present invention relates to use of the cannabinol and/or the pharmaceutically acceptable salt or ester thereof according to the present invention in preparing a medicament for treating and/or preventing a disease or symptom selected from:
Yet still another aspect of the present invention relates to use of the cannabinol and/or the pharmaceutically acceptable salt or ester thereof according to the present invention for treating and/or preventing a disease or symptom selected from:
Yet still another aspect of the present invention relates to a method for treating and/or preventing a disease or symptom, including a step of administrating an effective amount of the pharmaceutical composition according to the present invention or the pharmaceutical product according to the present invention to a subject in need thereof, wherein the disease or symptom is selected from:
Yet still another aspect of the present invention relates to a method for treating and/or preventing a disease or symptom, including a step of administrating an effective amount of cannabinol and/or a pharmaceutically acceptable salt or ester thereof to a subject in need thereof, wherein the disease or symptom is selected from:
Yet still another aspect of the present invention relates to a method for treating and/or preventing a disease or symptom, including a step of administrating an effective amount of cannabinol and/or a pharmaceutically acceptable salt or ester thereof and an effective amount of one or more hypoglycemic agents to a subject in need thereof, wherein the disease or symptom is selected from:
It should be pointed out that a dosage and method of using cannabidiol as an active ingredient depend on many factors, including a patient's age, weight, gender, natural health status, nutritional status, activity intensity of the compound, medication cycle, metabolic rate, severity of the disease and subjective judgment of a physician.
Some terms related to the present invention are explained below.
In the present invention, the term “Cannabidiol” (abbreviated as CBD) is one of cannabinoids, with a structural formula as shown in the following Formula I:
The cannabidiol, i.e., the compound of Formula I, can be commercially available (e.g., purchased from Sigma, etc.) or synthesized by the prior art by using commercially available raw materials. After synthesis, it can be further purified by column chromatography, liquid-liquid extraction, molecular distillation or crystallization. Cannabidiol can also be extracted from industrial hemp at any time.
In some embodiments of the present invention, the pharmaceutically acceptable salt of cannabinol may be a salt formed from cannabinol (CBD) with sodium hydroxide, potassium hydroxide, calcium hydroxide, magnesium hydroxide, aluminum hydroxide, lithium hydroxide, zinc hydroxide, barium hydroxide, ammonia, methylamine, dimethylamine, diethylamine, methylpyridine, ethanolamine, diethanolamine, triethanolamine, ethylenediamine, lysine, arginine, ornithine, choline, N,N′-benzhydrylethylenediamine, chloroprocaine, procaine, N-benzylphenylethylamine, N-methylglucosamine piperazine, tris(hydroxymethyl)-aminomethane, etc.
In some embodiments of the present invention, the pharmaceutically acceptable ester of cannabidiol can be a monoester formed by cannabidiol and a C0-C6 alkyl carboxylic acid, or a diester formed by cannabidiol and two same or different C0-C6 alkyl carboxylic acids, the C0-C6 alkyl carboxylic acid can be linear alkyl carboxylic acid, branched alkyl carboxylic acid or cycloalkyl carboxylic acid, for example, HCOOH, CH3COOH, CH3CH2COOH, CH3 (CH2)2COOH, CH3 (CH2)2COOH, CH3 (CH2)+COOH, (CH3)2CHCOOH, (CH3)3CCOOH, (CH3)2CHCH2COOH, (CH3)2CH(CH2)2COOH, (CH3)2CH(CH3) CHCOOH, (CH3)3CCH2COOH, CH3CH2 (CH3)2CCOOH, cyclopropane carboxylic acid, cyclobutane carboxylic acid and cyclopentane carboxylic acid.
The term “type 1 diabetes” has a meaning well known to those skilled in the art, and its original name is insulin-dependent diabetes, which mostly occurs in children and adolescents, and can also occur at various ages, mainly as autoimmune diseases, accounting for about 5% of all diabetes. The onset of the disease is sharp, insulin in the body is absolutely insufficient, and ketoacidosis is easy to occur. It is necessary to treat with insulin to obtain a satisfactory curative effect, otherwise it will endanger life.
The term “type 2 diabetes” has a meaning well known to those skilled in the art, and its original name is adult onset diabetes, which usually occurs after 35-50 years old, accounting for 90% or above of diabetic patients. The ability to produce insulin in patients with type 2 diabetes is not completely lost. Some patients even produce too much insulin, but has poor utilization effect of insulin. Therefore, insulin in patients is relatively deficient, and the utilization efficiency of insulin can be improved by oral medication. However, some patients still need insulin treatment in the later stage.
The term “effective amount” refers to a dose that can achieve treatment, prevention, alleviation and/or remission of the diseases or conditions of the present invention in a subject.
The term “subject” may refer to a patient or other animal, especially a mammal, such as a human, a dog, a monkey, a cow, a horse, etc., which receives the composition of the present invention to treat, prevent, alleviate and/or ameliorate the diseases or conditions described in the present invention.
The term “disease and/or condition” refers to a physical state of the subject, which is related to the disease and/or condition of the present invention.
In the present invention, unless otherwise specified, the first pharmaceutical preparation and the second pharmaceutical preparation are only for clarity of reference, and do not have sequential meanings.
The present invention achieves one or more of the following technical effects:
Embodiments of the present invention will be described in detail with reference to examples, but those skilled in the art will understand that the following examples are only used to illustrate the present invention and should not be regarded as limiting the scope of the present invention. If the specific conditions are not indicated in the embodiment, the conventional conditions or the conditions suggested by the manufacturer shall be followed. The reagents or instruments used are conventional products that are commercially available if not indicating the manufacturers.
C57 male mice aged 4-6 weeks were used as experimental animals. After the mice were fasted for 10-12 hours, they were injected with 50 mg/kg of streptozotocin (STZ) intraperitoneally for 5 consecutive days. Fasting blood glucose levels of mice on the 6th and 10th days were measured to determine whether the induction was successful (the induction was considered successful when fasting blood glucose was greater than 11.1 mmol/L). The mice were applied to Group 2 to 6 in the following step 2).
The mice were randomly divided into 6 groups with 10 mice in each group:
Fasting blood glucose of mice in each group was detected every other three to four weeks; after one month of administration (the model was stable), a glucose tolerance test (GTT) was carried out. The mice were fasted for 10 hours, and was injected with 20% (w/w) glucose intraperitoneally according to their body weights (10 μl/g). The blood glucose of the mice before injection (0 min) and at 15 min, 30 min, 60 min and 120 min after injection were measured respectively.
One week after GTT, an insulin tolerance test (ITT) was carried out. The mice were fasted for 10 hours, and injected with 0.75 U/kg of insulin intraperitoneally. The blood glucose of the mice before injection (0 min) and at 15 min, 30 min, 60 min and 120 min after injection were measured respectively.
The results are as shown in
It can be seen from
It can be seen from the GTT results in
It can be seen from the ITT results in
In addition, metformin should have no effect on type 1 diabetes, and it is not be used as a clinical drug for treating type 1 diabetes.
C57 male mice aged 4-6 weeks were used as experimental animals. The mice were fed with high-fat feed. After the mice were fasted for 10-12 hours, they were injected with 50 mg/kg of streptozotocin (STZ) intraperitoneally for 5 consecutive days. Fasting blood glucose levels of the mice on the 6th and 10th days were measured to determine whether the induction was successful (the induction was considered successful when the fasting blood glucose was more than 11.1 mmol/L, and it was successfully on the 32nd day in the experiment). On the 6th day, the mice whose blood glucose did not reach the standard (which were not induced successfully) were injected with streptozotocin intraperitoneally at a dose of 80 mg/kg on the 8th day. The mice were applied to Group 2 to 8 in the following step 2).
High-fat feed was formed by adding 60% fat to normal feed.
The mice were randomly divided into 8 groups with 10 mice in each group:
One month after administration (after the type 2 diabetes model was stabilized,), a glucose tolerance test (GTT) was carried out. The mice were fasted for 10 hours, and injected with 20% (w/w) glucose was intraperitoneally according to their body weights (10 μl/g). The blood glucose of the mice before injection (0 min) and at 15 min, 30 min, 60 min and 120 min after injection were measured respectively.
One month after administration (after the model was stabilized), an insulin tolerance test (ITT) was carried out. The mice were fasted for 10 hours, and injected with 0.75 U/kg of insulin intraperitoneally. The blood glucose of mice before injection (0 min) and at 15 min, 30 min, 60 min and 120 min after injection were measured respectively.
The experimental results are shown in
It can be seen from the results of
It can be seen from the results of glucose tolerance test in mice in
It can be seen from the results of insulin tolerance test in mice in
It can be seen from
In addition,
In order to study the effect of combined use of CBD and metformin, adult DB/DB mice (spontaneous type 2 diabetic mice, purchased from Model Animal Center of Nanjing University) were randomly divided into 5 groups, with 6 mice in each group:
Group 3 and Group 5 were both positive control groups of the treatment group, Group 3 was low-dose metformin group, and Group 5 was high-dose metformin group. Clinically, patients receive low-dose metformin treatment at first, and then the dose of metformin is gradually increased according to changes in blood glucose, but it cannot exceed the maximum dose. The experiment of this example is to prove that the effect of combined use of CBD and metformin is better than low-dose metformin and high-dose metformin.
The administration routes of the above five groups were all intragastric administration, once a day
After 4 weeks of administration, blood glucose of mice in each group was measured. The relative blood glucose results of mice in each group are shown in
The results showed that during the administration period, the blood glucose of mice in the CBD+metformin group (Group 4) decreased the most sharply fastest and obviously. After 5 weeks of administration, the fasting blood glucose of mice treated with CBD and metformin was significantly lower than those treated with metformin alone (Groups 3 and 5), and also lower than that treated with CBD alone (Group 2).
The results showed that CBD and the combination of CBD and metformin could reduce blood glucose in DB/DB mice, and the combination of CBD and metformin had a better effect.
ICR female mice of 4-6 weeks old were used as experimental animals. The mice ate and drank normally, and were given 8% (w/w) Folium Sennae solution by gavage, 0.2 ml/mouse. Diarrhea index of the mice was counted every other one and a half hours for 6 hours. Folium Sennae was purchased from Tongrentang Pharmacy in Beijing. The 8% (w/w) Folium Sennae solution was prepared by boiling 8 parts by weight of Folium Sennae and 92 parts by weight of water in a conical flask for 10 min.
The mice were randomly divided into 7 groups with 10 mice in each group:
Every day after gavage, the diarrhea index of each mouse was counted every other one and a half hours, 4 times in total (once every 6 hours).
Diarrhea index=loose stool rate*loose stool grade
The results are as shown in
ICR male mice aged 4-6 weeks were used as experimental animals. The mice were administrated by gavage with metformin (260 mg/kg) for induction for three times, with an interval of 12 hours.
The mice were randomly divided into seven groups with five mice in each group:
3) Experimental design: blood samples were collected to detect lactic acid concentration before treatment, and blood samples of mice in each group were collected to detect lactic acid concentration after treatment.
4) The experimental results are shown in
The results show that metformin could induce lactic acidemia in mice, while CBD could significantly inhibit the increase of lactic acid in blood induced by metformin.
Kunming white male mice aged 4-6 weeks were used as experimental animals. After the mice were fasted for 10-12 hours, they were injected with 50 mg/kg of streptozotocin (STZ) intraperitoneally for 5 consecutive days. Fasting blood glucose levels of the mice on the 6th and 10th days were measured to determine whether the induction was successful (the induction was considered successful when fasting blood glucose was greater than 11.1 mmol/L). The mice were applied to the Group 2 to 5 in the following step 3).
During the experiment, mice were fed with high-fat feed containing 60% fat on the basis of normal feed. The mice in Groups 2 to 5 were fed with high-fat feed.
The mice were randomly divided into 5 groups with 10 mice in each group:
After two months of drug treatment, the mice were sacrificed, blood was collected from the heart, serum was taken, and levels of cholesterol, triglyceride, high-density cholesterol, low-density cholesterol and insulin in the serum were measured respectively.
The experimental results are shown in
It can be seen from
A mouse model of chronic renal failure induced by adriamycin was constructed according to a conventional method of inducing kidney injury. After CBD treatment for 14 days, urinary total protein level was measured. The specific method is as follows:
Kunming white male mice aged 4-6 weeks were used as experimental animals. After the mice were fasted for 10-12 hours, they were injected with 50 mg/kg of streptozotocin (STZ) intraperitoneally for 5 consecutive days. Fasting blood glucose levels of the mice on the 6th and 10th days were measured to determine whether the induction was successful (diabetes was considered successfully induced when fasting blood glucose was greater than 11.1 mmol/L). On the 7th day after diabetes induction, the mice in the nephropathy group were injected with adriamycin at 10 mg/kg by caudal vein. The mice were applied to the Group 3 to 6 in the following step 2).
The experimental animals were randomly divided into 6 groups with 10 animals in each group:
The above Group 2 and Group 3 were set up to measure urinary total protein content when only diabetes was induced instead of chronic renal failure.
After successfully inducing the mouse diabetes model, the mice were injected with adriamycin through caudal vein to induce nephropathy model. Urine was collected from the mice on the 14th day of the induction of nephropathy model, and urinary total protein was detected.
The experimental results are shown in
The results show that CBD could significantly reduce urinary total protein level of mice with chronic renal failure induced by adriamycin. Nephropathy is one of the complications of diabetes, so CBD can treat chronic renal failure caused by diabetes.
Three diabetic volunteers in clinic participated in this study: two males, weighing about 65 kg and 70 kg and aged 47 and 52 years respectively; a female, weighing about 55 kg and aged 74 years.
Every patient received oral CBD treatment at 300 mg/day for 8 weeks. Fasting blood glucose was measured at the 0th, 4th and 8th weeks. Glycosylated hemoglobin value was measured at the 0th and 8th weeks. The results are shown in
Although specific embodiments of the present invention have been described in detail, it will be understood by those skilled in the art. Various modifications and substitutions can be made to those details in light of all the teachings that have been disclosed, and these changes are within the scope of protection of the present invention. The full scope of the present invention is defined by the appended claims and any equivalents thereof.
Filing Document | Filing Date | Country | Kind |
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PCT/CN2018/090226 | 6/7/2018 | WO |