(12) United States Patent (10) Patent No.: US 8,680,042 B2 Bogdanova Et Al
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USOO8680042B2 (12) United States Patent (10) Patent No.: US 8,680,042 B2 Bogdanova et al. (45) Date of Patent: Mar. 25, 2014 (54) METHODS OF TREATING SICKLE CELL (58) Field of Classification Search ANEMA-RELATED CONDITIONS WITH None MK-8O1 OR MEMANTINE See application file for complete search history. (75) Inventors: Anna Yulienva Bogdanova, Zürich (56) References Cited (CH); Max Gassman, Zürich (CH): Jeroen Goede, Wetzikon (CH) PUBLICATIONS ZempskyW. et al. “(399) Low-dose Ketamine for vasoocclusie pain (73) Assignee: Universität Zirich Prorektorat MNW, in pediatric patients with sicle cell disease: A case series' Journal of Zürich (CH) Pain, Saunders, Philadelphia vol. 9, No. 4, Apr. 1, 2008 p. 75. XPO25871572. (*) Notice: Subject to any disclaimer, the term of this Wong et al. “The Anticonvulsant MK-801 is a Potent N Methyl-D- patent is extended or adjusted under 35 Aspartate Antagonist Proceedings of the National Academy of Sci U.S.C. 154(b) by 0 days. ences of the United States of America vol. 83, No. 18, 1986, pp. 7104-7 108, XP002585977. Mosca et al. “17' International Symposium of the European Asso (21) Appl. No.: 13/265,709 ciation for Red Cell Research, EARCR2009, Triuggio, Milano, Italy, Apr. 23-27, 2009” Clinical Biochemistry, Elsevier Inc, US CA (22) PCT Filed: Apr. 18, 2010 LNKD vol. 42, No. 18, Dec. 1, 2009, pp. 1851-1863, XPO26782104. (86). PCT No.: PCT/EP2010/055.077 Primary Examiner — Robert Landsman S371 (c)(1), (74) Attorney, Agent, or Firm — Cozen O'Connor (2), (4) Date: Jan. 19, 2012 (57) ABSTRACT (87) PCT Pub. No.: WO2010/121973 Sickle cell anemia is a genetic disease characterized by red blood cells that assume an abnormal, rigid, sickle shape. PCT Pub. Date: Oct. 28, 2010 Acute complications of Sickle cell anemia are treated Symp tomatically with analgesics and transfusions, and a prophy (65) Prior Publication Data lactic treatment of sickle cell crisis is long term application of US 2012/O116060A1 May 10, 2012 hydroxyurea. According to the present invention, an N-me thyl D-aspartate receptor (NMDAR) blocker is used for the (30) Foreign Application Priority Data treatment of sickle cell anemia and for manufacture of a medicament for the treatment of sickle cell anemia. More Apr. 23, 2009 (EP) ..................................... O9005683 over, a method for Screening for a compound effective in the treatment of sickle cell anemia comprises contacting a can (51) Int. Cl. didate compound with the NMDAR and selecting said can AOIN 6L/00 (2006.01) didate compound as effective if it is found to selectively A6 IK3I/00 (2006.01) reduce activity of the NMDAR. (52) U.S. Cl. USPC .............................................................. S14f1 8 Claims, 3 Drawing Sheets U.S. Patent Mar. 25, 2014 Sheet 1 of 3 US 8,680,042 B2 Sample 1 Sample 2 Sample 3 C Fig 1 U.S. Patent Mar. 25, 2014 Sheet 2 of 3 US 8,680,042 B2 Fig 2 A Fig 2 B U.S. Patent Mar. 25, 2014 Sheet 3 of 3 US 8,680,042 B2 Sample Sarpie 2 Sample 3 ii Fig 3 US 8,680,042 B2 1. 2 METHODS OF TREATING SCKLE CELL and 50 uMMK-801. * denotes p<0.05 compared to the cor ANEMA-RELATED CONDITIONS WITH responding healthy donors samples. MK-8O1 OR MEMANTINE FIG. 3: The examples of morphological changes in eryth rocytes caused by agonists and antagonists of the NMDA This application is the U.S. national stage of PCT Interna receptor depending on the receptor availability and HbSS tional Application No. PCT/EP2010/055077, filed Apr. 18, presence. Sample 1 is a sample from a sickle cell patient, 2010, which claims priority of European Application No. sample 2 is from a person with high levels of NMDA recep 09005683.9, filed Apr. 23, 2009. tors and reticulocytes and sample 3 is from a person with low levels of receptors. Treatment 1 denotes administration of 50 FIELD OF THE INVENTION 10 uM memantine (sample 2) or MK-801 (sample 3), treatment 2 stands for 1 mM NMDA addition, treatment 3 shows mor This invention relates to the treatment of sickle cellanemia, phological changes in the cells pre-treated with mennantine/ using blockers of NMDA. MK-801 and then exposed to 1 mM NMDA. 15 BACKGROUND OF THE INVENTION DETAILED DESCRIPTION OF THE INVENTION The N-methyl D-aspartate receptor (NMDAR) is an iono The present invention relates to a method of treating sickle tropic receptor for glutamate. Blockers of NMDAR have been cell anemia, comprising administering blockers of the used as anesthesia and for treatment of traumatic brain injury, NMDAR, and the use of such blockers in said treatment and stroke, and neurodegenerative diseases such as Alzheimer's, in the manufacture of medicaments for treating sickle cell Parkinson's, and Huntington's. anemia. This invention focuses on the treatment of sickle cell ane The action of the NMDAR can be blocked by administra mia, a genetic disease characterized by red blood cells that tion of antibodies or antibody fragments directed against the assume an abnormal, rigid, sickle shape. Acute complications 25 NMDAR, of molecules that affect the protein or mRNA of Sickle cell anemia are treated symptomatically with anal expression of the NMDAR (sRNA; miRNA), as well as of gesics and transfusions. A prophylactic treatment of sickle small molecules that interfere with the binding of ligands to cell crisis is long term application of hydroxyurea. Further the NMDAR (e.g. blocking the binding site of the neurotrans treatment options are very desirable. mitter glutamate or the glycine site; or inhibiting NMDAR by 30 binding to allosteric sites or blocking the ion channel by SUMMARY OF THE INVENTION binding to a site within it). A further way to prevent binding to the NMDAR is to use soluble NMDAR or fragments thereof. The present invention relates to a method of treating sickle Examples of NMDAR blockers according to the invention cell anemia, using blockers of the NMDAR. Furthermore the are disclosed in the following. However, the invention is not invention relates to blockers of the NMDAR for use in the 35 restricted to the blockers disclosed therein, but extends to all treatment of sickle cell anemia. blockers of NMDAR. The invention further relates to a method of screening for a Preferred blockers of NMDAR according to the invention compound effective in the treatment of sickle cell anemia, a. comprising contacting a candidate compound with the Soluble NMDAR or fragments thereof NMDAR and choosing candidate compounds which selec 40 Antibodies that bind to NMDAR, antigen binding frag tively reduce activity of the NMDAR. The invention further ments of an antibody (e.g. Fab fragments) or antibody relates to compounds selected by these methods of screening. like molecules (e.g. repeat proteins) which by binding to NMDAR block its biological activity. Antibodies BRIEF DESCRIPTION OF THE DRAWINGS against NMDAR are known in the art and include the 45 well characterized antibody NMDA NR1 Pan Antibody, FIG. 1: Samples 1-3 are from three patients with sickle cell mouse monoclonal, Novus biologicals, NB 300-118. anemia. Shown is the specific staining against the NR1 sub Virus-like particles loaded with NMDAR or fragments unit of the NMDA receptor (NRX) and the loading control thereof and therefore inducing an antibody response (LC) of the light (L), middle (M) and high density (H) Sub directed against NMDAR with the effect to block its populations of erythrocytes. 50 biological activity FIGS. 2A and 2B: Potassium and calcium fluxes through Antisense molecules for downregulation of NMDAR. the NMDA receptor in erythrocytes of healthy donors (C) and These antisense molecules are approximately 12-50 patients with sickle cell anemia (H). 2A: Unidirectional K" nucleotides in length and encode a given sequence found influx measured in chloride-free Na-methane sulfate medium in the exons or introns of NMDAR. Moreover, antisense in the presence of 100 uM ouabain, the inhibitor of Na K 55 molecules containing a sequence of the NMDAR pro ATPase. Conditions corresponding to the numbers at the X moters and binding within the promoter region may be axis: (1) control; (2) 50 LM memantine chloride (Sigma used. Finally, antisense molecules binding in the 3' Aldhdge); (3) 100 uMNMDA; (4) NMDA+memantine chlo UTR-non translated regions of NMDAR are contem ride; (5)2 uM prostaglandine E2 (PGE2); (6) PGE2+meman plated tine chloride. * denotes p<0.05 compared to the 60 Small molecules that block the biological activity of corresponding values in healthy donor's erythrocytes, it NMDAR. Small molecules contemplated are synthetic stands for p-0.05 compared to the corresponding non-treated compounds up to a molecular weight of approximately control. Data are means-SEM for 6-7 individuals. 2B: Uni 1000 which have suitable physiological activity and directional Ca" influx in erythrocytes of a single HbSS pharmacological properties making them useful for the patient measured on 3 different occasions and in three healthy 65 application as medicaments. Such small synthetic mol donors. Conditions indicated in numbers at the X axis are: (1) ecules are, for example, found by the screening method non-treated control; (2) 100 MNMDA: (3) 100 uMNMDA of the present invention described below. Alternatively, US 8,680,042 B2 3 4 Such small molecules are designed by molecular mod thereof, for example to a human requiring Such treatment. For elling taking into account possible binding sites of the administration, the blocker is preferably in the form of a NMDAR. pharmaceutical preparation comprising the blocker in chemi Proteins and protein analogs which bind NMDAR and cally pure form and optionally a pharmaceutically acceptable thereby inhibit its biological activity, for example, syn carrier and optionally adjuvants.