United States Patent (19) 11 Patent Number: 4,666,701 Horrobin Et Al
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United States Patent (19) 11 Patent Number: 4,666,701 Horrobin et al. 45) Date of Patent: May 19, 1987 54 PHARMACEUTICAL AND DIETARY 58) Field of Search .......................................... 424/10. COMPOSITIONS Primary Examiner-Stanley J. Friedman 75) Inventors: David F. Horrobin, Surrey, England; Attorney, Agent, or Firm-Nixon & Vanderhye Mehar S. Manku; Yung S. Huang, both of Nova Scotia, Canada 57) ABSTRACT Efamol Limited, Surrey, England Gamma-linolenic acid or dihomo-gamma-linolenic acid 73) Assignee: for use in the reduction or prevention of gastro-intesti (21) Appl. No.: 839,228 nal bleeding and other side effects shown by NSAIDs 22 Filed: Mar, 13, 1986 when administered on a continuing basis, including use in allowing said administration to be replaced by admin (30) Foreign Application Priority Data istration of said acid alone in arthritis and other condi Mar. 19, 1985 GB United Kingdom ................. 8507058 tions without exacerbation of symptoms. 51) Int. Cl. .............................................. A61K27/00 52 U.S. C. ...................................................... 424/10 5 Claims, No Drawings 4,666,701 1. 2 been found that the 22:4n-6 acid produced from arachi PHARMACEUTICAL AND DIETARY donic acid gives rise to a series of homo-2-series PGs, COMPOSITIONS though their importance is as yet unknown. DGLA is the key substance. GLA is almost com FIELD OF THE INVENTION pletely and very rapidly converted in the body to The invention relates in one aspect to the prevention DGLA and so for practical purposes the oral adminis or reduction of side effects of aspirin and other non tration of DGLA and GLA amounts to the same thing. steroidal anti-inflammatory drugs (NSAID), and in DGLA can be converted to a storage form or to PGs of another aspect to reduction or elimination of their use. 10 the 1-series or, through arachidonic acid, to PGs of the 2-series. GENERAL BACKGROUND Considering dietary requirements, it is well known, NSAID are very widely used in clinical medicine. There is a very large number of drugs in this group for example, that linoleic acid cannot be made by the including such compounds as aspirin, indomethacin, body and so must be taken in the diet. However, it has Diclofenac, Fenoprofen, flufenamic acid, mefenamic 15 been generally thought that the body can metabolise acid, flurbiprofen, ibuprofen, ketoprofen, naproxen, linoleic acid to all the other n-6 acids and therefore that phenylbutazone, piroxicam and sulindac. Although provided linoleic acid intake is adequate, no lack of the compounds with many different structures come into other n-6 acids will be found. this class it is believed that their common biological In previous patent applications (for example, Pub mechanism of action is inhibition of the formation o f 20 lished European Patent Application No. A 0 003 407, prostaglandins (PGs). The drugs can produce a very U.S. Pat. No. 4,273,763; Published European Patent wide range of side effects, the most common and consis Application No. A 0004770, U.S. Pat. No. 4,309,415; tent of which is gastro-intestinal bleeding. It is believed Published European Patent Application No. 0 019423, that the majority of these side effects, including the U.S. Pat. No. 4,388,324) it has, however been pointed bleeding, result from the inhibition of PG synthesis. 25 out that the first enzyme in the pathway, the delta-6 Although they are implicated in inflammation, PGs have many desirable actions, including a poorly under desaturase which, for example, converts linoleic acid to stood cytoprotective effect. PGs of the 1-series, derived gamma-linolenic acid, is not fully effective in a variety from DGLA, have particularly desirable actions but of conditions. The administration of gamma-linolenic unfortunately NSAID inhibit formation of these PGs as 30 acid or dihomo-gamma-linolenic acid or both has been well as the 2-series PGs and other compounds, of part suggested and has been successful in treating a number desirable, part undesirable effect, formed from arachi of clinical conditions. donic acid. In the above patent applications attention is primarily The outline of production of 1-series and 2-series PGs paid to the function of essential fatty acids in prosta in the body is believed to be as shown in the following 35 glandin (PG) metabolism and in particular to their role diagram: in securing a proper balance between 1-series and 2-ser ies PGs. cis-Linoleic Acid We are, however, becoming increasingly aware of (9,12-octadecadienoic acid) the significance of the essential fatty acids in them 40 selves, in which considerable general interest has been shown in recent years, primarily in the acids of the n-6 GLA series both as such and in relation to prostaglandin me (6,9,12-octadecatrienoic acid) tabolism, but also in the acids of the n-3 series. The n-6 45 acids in particular are required in the body for the struc ture of membranes in and around cells, being believed to be necessary for maintaining normal flexibility, fluidity esterDGLA S(8,11,14)-eicosarienoic DGLA acid)->1 endoperoxides series and permeability of such membranes. reset Ves The pathways of metabolism of the n-6 essential fatty (small) 50 acids and the related n-3 acids sharing, it is believed, series common enzymes in the two pathways, are: PG's Large AA AA ester (Arachidonic acid i.e. n-6 n-3 reserves 5,8,11,14-eicosatetraenoic acid) 55 18:2 delta-9,12 (linoleic acid) 18:3 delta-9,12,15 (alpha linolenic acid) 2 series t desaturase endoperoxides 60 18:3 delta-6,9,12 (gamma-linolenic 18:4 delta-6,9,12,15 acid) 2 series PG's e The broad outline of this pathway is well known, and 20:3 delta-8,11,14 (dihomo-gamma 20:4 delta-8, 1,14, 17 it brings out clearly that a major function of essential 65 linolenic acid) fatty acids is to act as precursors for prostaglandins, 1-series PGs being formed from DGLA and 2-series s desaturase PGs from arachidonic acid. Further, it has recently . 4,666,701 3. 4. ratio of DGLA products (1-series PGs) to arachidonic -continued acid products (2-series PGs) will therefore be increased. n-6 n-3 20:4 delta-5,8,11,14 (arachidonic 20:5 delta-5,8,11,14, 17 DISCOVERY BEHIND PRESENT INVENTION acid) We have discovered a new way of preventing or reducing the gastro-intestinal ulceration and bleeding which can occur in the presence of NSAID. We believe e that his depends on a hitherto unrecognised biological 22:4 delta-7,10,13,16 (adrenic acid) 22:5 delta-7,10,13,16,19 effect of NSAID and that the mechanism has general i- desaturase 10 relevance to many of the other side effects of NSAID. We have also found a method whereby patients can be 22:5 delta-4,7,10,13,16 22:6 deta-4,7,10,13,16,19 withdrawn from treatment with NSAID without any exacerbation of their symptoms and we believe that this The pathways are not normally reversible nor, in man, will prove of major therapeutic value, since GLA and are n-3 and n-6 series acids interconvertible. 5 DGLA are inherently much safer to administer than the The acids, which naturally are of the all-cis configu NSAIDS. In experimental work five male and five female nor ration, are systematically named as derivatives of the mal adult humans in their 20s were each given 1200 mg corresponding octadecanoic, eicosanoic or docosanoic per day of soluble aspirin for a period of seven days. acids e.g. delta-9,12-octadecadienoic acid or delta 20 Blood for measurement (by the method of Pelick et al, 4,7,10,13,16, 19 docosahexaenoic acid, but numerical cited later herein) of fatty acids in plasma was taken designation such as, correspondingly, 18:2 n-6 or 22:6 before starting treatment and on the seventh day. No n-3 is convenient. Initials, for example, DHA for 22:6 consistent change with regard to many fatty acids oc n-3 (docosahexaenoic acid), are also used but do not curred but with linoleic acid and its metabolite gamma serve when n-3 and n-6 acids of the same chain length 25 and degree of unsaturation exist. Trivial names in more linolenic acid (GLA) the following were found: or less common use in the n-6 series are as shown. Of the n-3 series only 18:3 n-3 has a commonly used trivial Linoleic/ GLA name, alpha-linolenic acid. It was characterised earlier Linoleic Acid GLA Ratio than gamma-linolenic acid and reference in the litera 30 ture simply to linolenic acid, especially in the earlier Total plasma lipid: Before Aspirin 25.18 - 4.40 0.30 - 0.27 85 literature, is to the alpha-acid. After Aspirin 27.99 5.9 0.10 - 0.19 280 In the body, the n-3 acids are metabolised preferen Cholesterol ester fraction: tially and as a result, in plasma for example, levels of Before Aspirin 52.14 6.48 0.55 - 0.60 95 alpha-linolenic acid (18:3n-3) are low and 18:4n-3 and 35 After Aspirin 56.81 - 4.26 0.6 - 0.46 355 20:4n-3 are in trace amounts only. In contrast the n-6 Phospholipid fraction: acids are normally present in moderate amounts, though Before Aspirin 24.26 4.0 0.48 - 0.09 50.5 gamma-linolenic acid (GLA) is at low levels, being After Aspirin 26.48 4.92 0.18 0.05 147 apparently converted to dihomo-gamma-linolenic acid (DGLA) more rapidly than its relatively slow produc 40 It can be seen that in each case linoleic acid levels went tion from linoleic acid.