Methods and compositions for treating conditions associated with an abnormal inflammatory responses
This disclosure features chemical entities (e.g., a compound exhibiting activity as a mitochondrial uncoupling agent or a pharmaceutically acceptable salt and/or hydrate and/or cocrystal thereof; e.g., a compound, such as niclosamide or a pharmaceutically acceptable salt and/or hydrate and/or cocrystal thereof; e.g., a compound, such as a niclosamide analog, or a pharmaceutically acceptable salt and/or hydrate and/or cocrystal thereof) that are useful, e.g., for treating one or more symptoms of a pathology characterized by an abnormal inflammatory response (e.g., inflammatory bowel diseases) in a subject (e.g., a human). This disclosure also features compositions as well as other methods of using and making the same.
1. A solid pharmaceutical composition, which comprises:
an inner phase which is a wet granulated solid preparation comprising niclosamide, or a pharmaceutically acceptable salt thereof; one or more disintegrants; one or more diluents; and one or more binders; and
an external phase comprising one or more glidants and/or one or more lubricants.
2. The composition of claim 1 , wherein the composition comprises from about 40 weight percent to about 80 weight percent of niclosamide, or a pharmaceutically acceptable salt thereof.
3. The composition of claim 1 , wherein the composition comprises from about 0.5 weight percent to about 5 weight percent of the one or more disintegrants.
4. The composition of claim 1 , wherein each of the one or more disintegrants is independently selected from the group consisting of: carmellose calcium, low substituted hydroxypropyl cellulose (L-HPC), carmellose, croscarmellose sodium, partially pregelatinized starch, dry starch, carboxymethyl starch sodium, crospovidone, polysorbate 80 (polyoxyethylenesorbitan oleate), starch, sodium starch glycolate, hydroxypropyl cellulose pregelatinized starch, clays, cellulose, alginine, gums, and cross-linked PVP.
5. The composition of claim 1 , wherein the one or more disintegrants is crospovidone.
6. The composition of claim 1 , wherein the composition comprises from about 0.5 weight percent to about 5 weight percent of the one or more binders.
7. The composition of claim 1 , wherein each of the one or more binders is independently selected from the group consisting of: starch, pregelatinized starch, gelatin, sugars, polyethylene glycol, waxes, natural and synthetic gums, sodium alginate cellulose, veegum, and synthetic polymers.
8. The composition of claim 1 , wherein the one or more binders is povidone.
9. The composition of claim 1 , wherein the composition comprises from about 10 weight percent to about 50 weight percent of the one or more diluents.
10. The composition of claim 1 , wherein each of the one or more diluents is independently selected from the group consisting of: dicalcium phosphate dihydrate, calcium sulfate, lactose, sucrose, mannitol, sorbitol, cellulose, microcrystalline cellulose, kaolin, sodium chloride, dry starch, hydrolyzed starches, pregelatinized starch, silicone dioxide, titanium oxide, magnesium aluminum silicate and powdered sugar.
11. The composition of claim 1 , wherein each of the one or more diluents is lactose monohydrate.
12. The composition of claim 1 , wherein the composition comprises from about 0.05 weight percent to about 5 weight percent of the one or more glidants and/or lubricants.
13. The composition of claim 1 , wherein each of the one or more glidants and/or lubricants is independently selected from the group consisting of: talc, magnesium stearate, calcium stearate, colloidal silica, stearic acid, aqueous silicon dioxide, synthetic magnesium silicate, fine granulated silicon oxide, starch, sodium laurylsulfate, boric acid, magnesium oxide, waxes, hydrogenated oil, polyethylene glycol, sodium benzoate, stearic acid glycerol behenate, polyethylene glycol, and mineral oil.
14. The composition of claim 1 , wherein each of the one or more glidants and/or lubricants is independently selected from the group consisting of: magnesium stearate and talc.
15. A solid pharmaceutical composition, which comprises:
an inner phase which is a wet granulated solid preparation comprising niclosamide, or a pharmaceutically acceptable salt thereof; crospovidone; lactose monohydrate; and povidone; and
an external phase comprising magnesium stearate and talc.
16. The composition of claim 15 , wherein the composition comprises from about 40 weight percent to about 80 weight percent of niclosamide, or a pharmaceutically acceptable salt thereof.
17. The composition of claim 15 , wherein the composition comprises from about about 55 weight percent to about 70 weight percent of niclosamide, or a pharmaceutically acceptable salt thereof.
18. The composition of claim 15 , wherein the composition comprises from about 0.5 weight percent to about 5 weight percent of crospovidone.
19. The composition of claim 15 , wherein the composition comprises from about 1 weight percent to about 3 weight percent of crospovidone.
20. The composition of claim 15 , wherein the composition comprises from about 0.5 weight percent to about 5 weight percent of povidone.
21. The composition of claim 15 , wherein the composition comprises from about 1.5 weight percent to about 4.5 weight percent of povidone.
22. The composition of claim 15 , wherein the composition comprises from about 10 weight percent to about 50 weight percent of lactose monohydrate.
23. The composition of claim 15 , wherein the composition comprises from about 20 weight percent to about 40 weight percent of lactose monohydrate.
24. The composition of claim 15 , wherein the composition comprises from about 0.5 weight percent to about 5 weight percent of talc.
25. The composition of claim 15 , wherein the composition comprises from about 1 weight percent to about 3 weight percent of talc.
26. The composition of claim 15 , wherein the composition comprises from about 0.05 weight percent to about 1 weight percent of magnesium stearate.
27. The composition of claim 15 , wherein the composition comprises from about 0.1 weight percent to about 1 weight percent of magnesium stearate.
28. The composition of claim 15 , wherein the composition comprises:
from about 40 weight percent to about 80 weight percent of niclosamide, or a pharmaceutically acceptable salt thereof;
from about 0.5 weight percent to about 5 weight percent of crospovidone;
from about 0.5 weight percent to about 5 weight percent of povidone;
from about 10 weight percent to about 50 weight percent of lactose monohydrate;
from about 0.5 weight percent to about 5 weight percent of talc; and
from about 0.05 weight percent to about 1 weight percent of magnesium stearate.
29. The composition of claim 15 , wherein the composition comprises:
from about 50 weight percent to about 70 weight percent of niclosamide, or a pharmaceutically acceptable salt thereof;
from about 0.5 weight percent to about 3 weight percent of crospovidone;
from about 1.5 weight percent to about 4.5 weight percent of povidone;
from about 20 weight percent to about 40 weight percent of lactose monohydrate;
from about 0.5 weight percent to about 3 weight percent of talc; and
from about 0.1 weight percent to about 1 weight percent of magnesium stearate.
30. The composition of claim 15 , wherein the composition comprises:
from about 60 weight percent to about 65 weight percent of niclosamide, or a pharmaceutically acceptable salt thereof;
from about 1 weight percent to about 3 weight percent of crospovidone;
from about 2 weight percent to about 3.5 weight percent of povidone;
from about 25 weight percent to about 35 weight percent of lactose monohydrate;
from about 1.5 weight percent to about 2.5 weight percent of talc; and
from about 0.1 weight percent to about 0.5 weight percent of magnesium stearate.
31. The composition of claim 15 , wherein the composition comprises:
Ingredient
Weight Percent
niclosamide
about 62.1 weight percent)
Crospovidone
about 1.93 weight percent
lactose monohydrate
about 31.03 weight percent
Povidone
about 2.76 weight percent
talc
about 1.93 weight percent
Magnesium stearate
about 0.27 weight percent.
32. An enema preparation comprising a separately contained first component and a separately contained second component, wherein:
(i) the first component comprises a solid pharmaceutical composition, which comprises:
an inner phase which is a wet granulated solid preparation comprising niclosamide, or a pharmaceutically acceptable salt thereof; one or more disintegrants; one or more diluents; and one or more binders;
an external phase comprising one or more glidants and/or one or more lubricants; and
(ii) the second component comprises one or more liquids and optionally one or more other pharmaceutically acceptable excipients together forming a liquid carrier.
33. The enema preparation of claim 32 , wherein component (ii) comprises water and one or more of the following excipients:
(a′) one or more thickeners, viscosity enhancing agents, binders, and/or mucoadhesive agents;
(b′) one or more preservatives; and
(c′) one or more buffers.
34. The enema preparation of claim 32 , wherein component (ii) comprises water and one or more of the following excipients:
(a″) a first thickener, viscosity enhancing agent, binder, and/or mucoadhesive agent;
(a′″) a second thickener, viscosity enhancing agent, binder, and/or mucoadhesive agent;
(b″) a first preservative;
(b″) a second preservative;
(c″) a first buffer; and (c′″) a second buffer.
35. The enema preparation of claim 34 , wherein component (ii) comprises: from about 0.05 weight percent to about 5 weight percent of (a″); from about 0.05 weight percent to about 5 weight percent of (a′″); from about 0.005 weight percent to about 0.1 weight percent of (b″); from about 0.05 weight percent to about 1 weight percent of (b′″); from about 0.05 weight percent to about 1 weight percent of (c″); and from about 0.005 weight percent to about 0.5 weight percent of (c′″); and up to 100% of water.
36. The enema preparation of claim 34 , wherein (a″) and (a′″) are independently selected from the group consisting of: a cellulose or cellulose ester or ether or derivative or salt thereof and a polyvinyl polymer; (b″) and (b″) are each an independently selected paraben; and (c″) and (c′″) are each an independently selected phosphate buffer system.
37. The enema preparation of claim 32 , wherein component (ii) comprises water; methyl cellulose; Povidone; propyl 4-hydroxybenzoate; methyl 4-hydroxybenzoate; disodium phosphate dodecahydrate; and sodium dihydrogen phospahate dehydrate.
38. The enema preparation of claim 37 , wherein component (ii) comprises: from about 0.05 weight percent to about 5 weight percent of methyl cellulose; from about 0.05 weight percent to about 5 weight percent of Povidone; from about 0.005 weight percent to about 0.1 weight percent of propyl 4-hydroxybenzoate; from about 0.05 weight percent to about 1 weight percent of methyl 4-hydroxybenzoate; from about 0.05 weight percent to about 1 weight percent of disodium phosphate dodecahydrate; from about 0.005 weight percent to about 0.5 weight percent of sodium dihydrogen phospahate dihydrate; and up to 100% of water.
39. The enema preparation of claim 37 , wherein component (ii) comprises: from about 0.1 weight percent to about 3 weight percent of methyl cellulose; from about 0.1 weight percent to about 2 weight percent of Povidone; from about 0.005 weight percent to about 0.05 weight percent of propyl 4-hydroxybenzoate; from about 0.05 weight percent to about 0.5 weight percent of methyl 4-hydroxybenzoate; from about 0.05 weight percent to about 0.5 weight percent of disodium phosphate dodecahydrate; from about 0.005 weight percent to about 0.3 weight percent of sodium dihydrogen phospahate dihydrate; and up to 100% of water.
40. The enema preparation of claim 37 , wherein component (ii) comprises:
Ingredient
Weight Percent
methyl cellulose
about 1.4 weight percent
Povidone
about 1.0 weight percent
propyl 4-hydroxybenzoate
about 0.02 weight percent
methyl 4-hydroxybenzoate
about 0.20 weight percent
disodium phosphate dodecahydrate
about 0.15 weight percent
sodium dihydrogen phospahate
about 0.15 weight percent
dehydrate
water
up to 100%.
41. The enema preparation of claim 32 , wherein the first component comprises the solid pharmaceutical composition as claimed in claim 15 .
42. The enema preparation of claim 32 , wherein the first component comprises the solid pharmaceutical composition as claimed in claim 28 .
43. The enema preparation of claim 32 , wherein the first component comprises the solid pharmaceutical composition as claimed in claim 29 .
44. The enema preparation of claim 32 , wherein the first component comprises the solid pharmaceutical composition as claimed in claim 30 .
45. An enema formulation comprising water; methyl cellulose; povidone; methylparaben; propylparaben; sodium dihydrogen phosphate dehydrate; disodium phosphate dodecahydrate; crospovidone; lactose monohydrate; magnesium stearate; talc; and niclosamide, or a pharmaceutically acceptable salt thereof.
46. A method for treating iatrogenic autoimmune colitis in a subject, the method comprising administering by enema an effective amount of the enema formulation as claimed in claim 45 to the subject.
47. The method of claim 46 , wherein the iatrogenic autoimmune colitis is selected from the group consisting of colitis induced by one or more chemotherapeutic agents, colitis induced by treatment with adoptive cell therapy, and colitis associated by one or more alloimmune diseases.
48. The method of claim 47 wherein the iatrogenic autoimmune colitis is colitis induced by one or more chemotherapeutic agents.
49. The method of claim 48 , wherein at least one of the one or more chemotherapeutic agents is a chemotherapeutic immunomodulator.
50. The method of claim 49 , wherein the chemotherapeutic immunomodulator is an immune checkpoint inhibitor.
51. The method of claim 50 , wherein the immune checkpoint inhibitor targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1-PD-L1, PD-1-PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9—TIM3, Phosphatidylserine—TIM3, lymphocyte activation gene 3 protein (LAG3), MHC class II-LAG3, 4-1BB-4-1BB ligand, OX40-OX40 ligand, GITR, GITR ligand—GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25-TL1A, CD40L, CD40-CD40 ligand, HVEM-LIGHT-LTA, HVEM, HVEM—BTLA, HVEM—CD160, HVEM—LIGHT, HVEM-BTLA-CD160, CD80, CD80-PDL-1, PDL2—CD80, CD244, CD48—CD244, CD244, ICOS, ICOS-ICOS ligand, B7-H3, B7-H4, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86—CD28, CD86—CTLA, CD80—CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine—TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155.
52. The method of claim 51 , wherein the immune checkpoint inhibitor is selected from the group consisting of: Urelumab, PF-05082566, MEDI6469, TRX518, Varlilumab, CP-870893, Pembrolizumab (PD1), Nivolumab (PD1), Atezolizumab (formerly MPDL3280A) (PDL1), MEDI4736 (PD-L1), Avelumab (PD-L1), PDR001 (PD1), BMS-986016, MGA271, Lirilumab, IPH2201, Emactuzumab, INCB024360, Galunisertib, Ulocuplumab, BKT140, Bavituximab, CC-90002, Bevacizumab, and MNRP1685A, and MGA271.
53. The method of claim 51 , wherein the immune checkpoint inhibitor targets CTLA-4.
54. The method of claim 53 , wherein the immune checkpoint inhibitor is an antibody.
55. The method of claim 54 , wherein the antibody is ipilimumab or tremelimumab.
56. The method of claim 51 , wherein the immune checkpoint inhibitor targets PD1 or PD-L1.
57. The method of claim 56 , wherein the immune checkpoint inhibitor is selected from nivolumab, lambroizumab, and BMS-936559.
58. The method of claim 46 , wherein the subject is a human.
59. The composition of claim 1 , wherein each of the one or more binders is independently selected from the group consisting of: sucrose, glucose, dextrose, lactose and sorbitol, acacia tragacanth, hydroxypropylmethylcellulose, hydroxypropylcellulose, ethylcellulose, acrylic acid, methacrylic acid copolymers, methacrylic acid copolymers, methyl methacrylate copolymers, aminoalkyl methacrylate copolymers, polyacrylic acid/polymethacrylic acid, and polyvinylpyrrolidone (povidone).
60. The composition of claim 1 , wherein the composition is suitable for rectal administration.