LEVOSIMENDAN FOR USE IN THE TREATMENT OF MOTOR NEURON DISEASES (E.G. ALS)

Abstract

The present invention relates to a method of treating motor neuron diseases such as amyotrophic lateral sclerosis (ALS) using levosimendan or its active metabolite (II) as an active ingredient. Levosimendan or its active metabolite (II) are able to relieve the loss of skeletal muscle strength or function associated with motor neuron diseases.

Claims

1-11. (canceled)

12. A method for the treatment of motor neuron diseases comprising administering to a patient in need thereof levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts.

13. A method for relieving the loss of muscle strength or function associated with a motor neuron disease in a patient comprising administering to said patient levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts.

14. A method for relieving the loss of skeletal muscle strength or function associated with a motor neuron disease in a patient comprising administering to said patient levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts.

15. The method according to claim 12, wherein the motor neuron disease is amyotrophic lateral sclerosis, myasthenia gravis, spinal muscular atrophy, or Charcot-Marie-Tooth disease.

16. The method according to claim 15, wherein the motor neuron disease is amyotrophic lateral sclerosis.

17. The method according to claim 13, wherein the motor neuron disease is amyotrophic lateral sclerosis, myasthenia gravis, spinal muscular atrophy, or Charcot-Marie-Tooth disease.

18. The method according to claim 17, wherein the motor neuron disease is amyotrophic lateral sclerosis.

19. The method according to claim 14, wherein the motor neuron disease is amyotrophic lateral sclerosis, myasthenia gravis, spinal muscular atrophy, or Charcot-Marie-Tooth disease.

20. The method according to claim 19, wherein the motor neuron disease is amyotrophic lateral sclerosis.

21. The method according to claim 12, wherein levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts is administered orally,

22. The method according to claim 12, wherein levosimendan or a pharmaceutically acceptable salt thereof is administered,

23. The method according to claim 12, wherein the active metabolite (II) of levosimendan or a pharmaceutically acceptable salt thereof is administered.

24. The method according to claim 13, wherein levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts is administered orally,

25. The method according to claim 13, wherein levosimendan or a pharmaceutically acceptable salt thereof is administered.

26. The method according to claim 13, wherein the active metabolite (II) of levosimendan or a pharmaceutically acceptable salt thereof is administered.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0017] FIG. 1. The effect of drug treatment in myasthenia gravis model. The percent change from the baseline in the length of time the animals were able to stay on the rotating rod (Rotarod) is shown. Measurements were made 0.5 h, 1 h, and 2 h after oral drug treatment on day 2. The treatment groups were vehicle, levosimendan and the active metabolite (II). OR-1896 denotes the active metabolite (II) of levosimendan.

[0018] FIG. 2. The effect of drug treatment in myasthenia gravis model. The change in exercise duration of animals running on a treadmill is shown. Measurements were made 2 h after oral drug treatment on day 3. OR-1896 denotes the active metabolite (II) of levosimendan.

DETAILED DESCRIPTION OF THE INVENTION

[0019] The present invention relates to a method of treating motor neuron diseases and to relieving the loss of strength or function of a muscle, particularly a skeletal muscle, in motor neuron diseases. The term “motor neuron disease” as used herein, refers to diseases that primarily (but not necessarily exclusively) affect motor neurons, neuromuscular input or signal transmission at the neuromuscular junction. The motor neuron diseases referred above include, but are not limited to, amyotrophic lateral sclerosis (ALS), myasthenia gravis (MG), spinal muscular atrophy (SMA) or Charcot-Marie-Tooth disease (CMT). The term “skeletal muscle” as used herein, means a striated muscle that is attached to a bone or other connective tissue, and that typically crosses at least one joint. The term “relieving”, as used herein, refers to reducing or inhibiting.

[0020] According to one embodiment of the invention, levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts is used for relieving the loss of skeletal muscle strength or function associated with motor neuron diseases. According to another embodiment of the invention, said skeletal muscle is a striated muscle that is attached to a bone or other connective tissue and crosses at least one joint. According to still another embodiment of the invention, the joint is a synovial joint.

[0021] The administration of levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts can be enteral, e.g. oral or rectal; parenteral, e.g. intravenous; or transdermal or transmucosal. Oral administration is a preferred route.

[0022] Levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts may be administered daily or several times a day or periodically, e.g. weekly or biweekly, depending on the patient's needs.

[0023] Levosimendan or its active metabolite (II) may suitably be administered orally to man in a daily dosage ranging from about 0.1 to 10 mg, preferably from about 0.2 to 5 mg, depending on age, weight and the condition of the patient, given once a day or divided into several doses a day. For the long-term treatment of motor neuron diseases in man, relatively low oral doses are generally preferred, e.g. an oral daily dose from about 0.1 to about 5 mg, preferably from about 0.2 to about 4 mg, more preferably from about 0.25 to about 3 mg, for example from about 0.5 mg to 2 mg.

[0024] Levosimendan can be administered by intravenous infusion using the infusion rate from about 0.01 to 5μg/kg/min, typically from about 0.02 to 3 μg/kg/min, for example from about 0.05 to 0.4 μg/kg/min. The active metabolite (II) can be administered intravenously using an infusion rate, which is from about 0.001 to about 1 μg/kg/min, preferably from about 0.005 to about 0.5 μg/kg/min.

[0025] According to one embodiment of the invention, the active ingredient of the present invention may be given to a patient suffering from a motor neuron disease together with one or more other active ingredients which are useful in the treatment of motor neuron diseases, for example together with riluzole.

[0026] Levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts can be formulated into pharmaceutical dosage forms suitable for the treatment according to the present invention using the principles known in the art. The active ingredient of the invention can be given to a patient as such or preferably in combination with suitable pharmaceutical excipients in the form of tablets, granules, capsules, suppositories, emulsions, suspensions or solutions whereby the contents of the active compound in the formulation is from about 0.5 to 100% per weight. Choosing suitable ingredients for the composition is a routine for those of ordinary skill in the art. It is evident that suitable carriers, solvents, gel forming ingredients, dispersion forming ingredients, antioxidants, colours, sweeteners, wetting compounds, release controlling components and other ingredients normally used in this field of technology may be also used.

[0027] For oral administration of the active ingredient in tablet or capsule form, suitable carriers and excipients include e.g. microcrystalline cellulose, alginic acid, corn starch, stearic acid, lactose, magnesium stearate, calcium phosphate and talc. For controlled release oral compositions release controlling components can be used. Typical release controlling components include hydrophilic gel forming polymers such as hydroxypropylmethyl cellulose, hydroxypropyl cellulose, carboxymethyl celluloses, or a mixture thereof; vegetable fats and oils including vegetable solid oils such as hydrogenated soybean oil, hardened castor oil or castor seed oil (sold under trade name Cutina HR), cotton seed oil (sold under the trade names Sterotex or Lubritab) or a mixture thereof; fatty acid esters such as triglycerides of saturated fatty acids or their mixtures e.g. glyceryl tristearates, glyceryl tripalmitates, glyceryl trimyristates, glyceryl tribehenates (sold under the trade name Compritol) and glyceryl palmitostearic acid ester.

[0028] Tablets can be prepared by mixing the active ingredient or active ingredients with the carriers and excipients and compressing the powdery mixture into tablets. Capsules can be prepared by mixing the active ingredient with the carriers and excipients and placing the powdery mixture in capsules, e.g. hard gelatin or HPMC capsules. Typically a tablet or a capsule comprises from about 0.1 to 5 mg, more typically from about 0.2 to 3 mg, for example from 0.25 to 2 mg, or from 0.25 to 1 mg of levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts.

[0029] Formulations suitable for intravenous administration such as injection or infusion formulation, comprise sterile isotonic solutions of the active ingredient and vehicle, preferably aqueous solutions. Typically an intravenous infusion solution comprises from about 0.01 to 0.1 mg/ml of levosimendan or its active metabolite (II) or any of their pharmaceutically acceptable salts. The pharmaceutical formulation may be also in the form of an intravenous infusion concentrate to be diluted with an aqueous vehicle before use. Such concentrate may comprise as a vehicle a pharmaceutically acceptable organic solvent such as dehydrated ethanol.

[0030] Salts of levosimendan or its active metabolite (II) may be prepared by known methods. Pharmaceutically acceptable salts are useful as active medicaments, however, preferred salts are the salts with alkali or alkaline earth metals.

EXAMPLES

Pharmaceutical Examples

Example 1

Oral Capsule

[0031]

TABLE-US-00001 Levosimendan  1.0 mg Microcrystalline cellulose 96.4 mg Alginic acid 30.0 mg Stearic acid  5.3 mg Hard gelatin capsule size 3

[0032] The pharmaceutical preparation in the form of a capsule was prepared by blending the ingredients and placing the powdery mixture in hard gelatin capsule.

Example 2

Concentrate Solution for Intravenous Infusion

[0033]

TABLE-US-00002 (a) levosimendan 2.5 mg/ml  (b) Kollidon PF12 10 mg/ml (c) citric acid  2 mg/ml (d) dehydrated ethanol ad 1 ml (785 mg)

[0034] The concentrate solution was prepared by dissolving citric acid, Kollidon PF121 and levosimendan to dehydrated ethanol in the sterilized preparation vessel under stirring. The resulting bulk solution was filtered through a sterile filter (0.22 μm). The sterile filtered bulk solution was then aseptically filled into 8 ml and 10 ml injection vials (with 5 ml and 10 ml filling volumes) and closed with rubber closures.

[0035] The concentrate solution for intravenous infusion is diluted with an aqueous vehicle before use. Typically the concentrate solution is diluted with aqueous isotonic vehicles, such as 5% glucose solution or 0.9% NaCl solution so as to obtain an aqueous intravenous solution, wherein the amount of levosimendan is generally within the range of about 0.001-1.0 mg/ml, preferably about 0.01-0.1 mg/ml.

[0036] Experiment 1.

[0037] Effects of levosimendan and its active metabolite (II) in antibody induced Myasthenia Gravis model in female Lewis rats.

[0038] Methods

[0039] The effects of levosimendan and its active metabolite (II) on skeletal muscle weakness were studied in an experimental model of Myasthenia Gravis (Russell A J et al., Nat Med 18 (3), 2012, 452-5). Myasthenia Gravis was induced in female Lewis rats by injecting 500 μg/kg of nAChRα1/3/5 antibody (SC-58604, Santa Cruz Biotechnology) intraperitoneally on day 0. Animals with 40-70% drop in muscle strength from baseline at 48 h after administration of the antibody were randomized into treatment groups: 1) Vehicle control (n=6) (0.5% Methocel 5 ml/kg orally), 2) Levosimendan (n=6) (0.25 mg/kg orally), 3) Active metabolite (II) (n=6) (0.025 mg/kg orally).

[0040] Coordination, balance, and motor skill acquisition were tested using an accelerated rotating rod test (Rotarod, Ugo Basile, Comerio, Italy). Rats were placed on a rod that accelerated smoothly from 4 to 40 rpm over a period of 5 min. The length of time that each animal was able to stay on the rod was recorded. Three consecutive measurements were performed. Rats were trained for the test four times one day before and twice on the day of antibody injection. Effects of different drug treatments on Rotarod response were measured 0.5 h, 1 h, and 2 h after oral treatment on day 2, i.e. 48 hours after the induction of Myasthenia Gravis.

[0041] Exercise capacity measurements were performed with airtight treadmill (Accupacer treadmill, Accuscan Instruments, USA) connected to a respiratory gas analysing system. Rehearsals and exercise capacity measurements were started with familiarising the rats with the treadmill chambers for 15 minutes (restmill). The exercise program consisted of 15 min running at 10 m/min until the rat was incapable to keep up the speed despite of electric shock motivation. Rats were trained for the test three times one day before and twice on the day of antibody injection. Effects of different drug treatments on treadmill responses were measured 1 h and 2 h after oral treatment on day 3 (72h after induction of Myasthenia Gravis).

[0042] Results

[0043] The effects of different drug treatments in Rotarod test are shown in FIG. 1. Levosimendan and its active metabolite (II) produced an acute and transient improvement in muscle function peaking 0.5-1 h after the single oral dosage. Duration of drug responses correlated with the pharmacokinetics of levosimendan (t½ 0.7 h) and active metabolite (II) (in rats t½ 5 h).

[0044] The effects of different drug treatments in the treadmill test are shown in FIG. 2. A positive effect of levosimendan and its active metabolite (II) on skeletal muscle function was found at 2 h post-dosing of repeated dosage on day 3.