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(12) Patent Application Publication (10) Pub. No.: US 2006/0019890 A1 Kapoun Et Al US 2006OO19890A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2006/0019890 A1 KapOun et al. (43) Pub. Date: Jan. 26, 2006 (54) METHOD FOR TREATING CARDIAC Related U.S. Application Data REMODELING FOLLOWING MYOCARDIAL INJURY (60) Provisional application No. 60/537,221, filed on Jan. 15, 2004. (76) Inventors: Ann M. Kapoun, Mountain View, CA Publication Classification (US); George F. Schreiner, Los Altos, CA (US); Faquan Liang, San (51) Int. Cl. Francisco, CA (US); Zhihe Li, Foster A6IK 38/17 (2006.01) City, CA (US) (52) U.S. Cl. ................................................................ 514/12 (57) ABSTRACT Correspondence Address: Samuel M. Kais The invention concerns methods for treating cardiac remod Scios Inc. eling in a Subject who has undergone myocardial injury, Said 6500 Paseo Padre Parkway method comprising the administration of natriuretic peptide Fremont, CA 94555 (US) to said subject. Preferably the natriuretic peptide is brain natriuretic peptide. The invention also concerns methods for (21) Appl. No.: 11/038,826 treating Structural heart disorders arising from myocardial injury, Said method comprising the administration of a (22) Filed: Jan. 18, 2005 natriuretic peptide to a patient in need thereof. Patent Application Publication Jan. 26, 2006 Sheet 1 of 13 US 2006/0019890 A1 Figure 1 TGFB treated BNP treated Patent Application Publication Jan. 26, 2006 Sheet 2 of 13 US 2006/0019890 A1 Figure 2 TGFB Treated 350 3 OO 250 2OO # genes 150 1 OO 50 Patent Application Publication Jan. 26, 2006 Sheet 3 of 13 US 2006/0019890 A1 Figure 3 TGFB TGFB TGFB TGFB BNP BNP BNP BNP 24h 48h 24h 48h 24h 48h A B C D E F Patent Application Publication Jan. 26, 2006 Sheet 4 of 13 US 2006/0019890 A1 Figure 4 Fibrosis & ECM \ B FGF8 ACTA2 NSG TIMP3 PDGFA MATN3 IGFBP () PDGFA MAPRE2 COLA2 IGF MYH9 IL 1 CTGF SSR Lll PTHLH COL15A1 CSF SERPINE FGF7 MAGP2 GPNMB COL7A CDC25B FBN1 PDGFRA COMP CREG CUL5 / / Inflammation PTGS2 IL1B CXCL3 CCR2 CXCL CCL13 IL1R1 CCL7 It is 24h BNP BNP 24hr. 24hr 48hr Patent Application Publication Jan. 26, 2006 Sheet 6 of 13 US 2006/0019890 A1 Figure 6 s s h 24 43hr OControl oBNP TGF8 STGFR+BNP Patent Application Publication Jan. 26, 2006 Sheet 7 of 13 US 2006/0019890 A1 Figure 7 A C BNP BNP BNP KT U Phospho-ERK wner error an Total ERK B TGFB -- -- -- -- -- -- -- BNP -- -- -- -- -- -- -- KT 1 imol/L. U 10 O. unmol/L PD mol/L -(- Collagen l 1- Actin C - C KT U PD BNP TGF TGF TGF TGF TGF TGF TGF TGF TGF TGF KT U PD BNP BNP BNP BNP BNP BNP KT U U U P) l 10 10 10 10 () 0.1 10 mol/L. Patent Application Publication Jan. 26, 2006 Sheet 8 of 13 US 2006/0019890 A1 Figure 8 Fibrosis Myofibroblast Transformation CTGF Cullagen 1, PA-1, IL 11, Fibronectin, Fibrillin, or-Smooth Muscle Actin, TIMP3 non-muscle myosin heavy chain Proliferation Inflammation IGF1, PDGF, 1 N, COX2, IL-6 TNFAIP6, TNFSF4 IGFBP10, FGF18 Patent Application Publication Jan. 26, 2006 Sheet 9 of 13 US 2006/0019890 A1 Figure 9 Control BNP TGFB TGFB+ BNP Patent Application Publication Jan. 26, 2006 Sheet 10 of 13 US 2006/0019890 A1 Figure 10 2OO 5 O Control Wehicle BNP L-NAME+Angll Patent Application Publication Jan. 26, 2006 Sheet 11 of 13 US 2006/0019890 A1 Figure 11 O.OO5 OOO4 O.OO3 O.OO2 OOO1 OOOO COTtrol Wehicle BNP L-NAME+Angll Patent Application Publication Jan. 26, 2006 Sheet 12 of 13 US 2006/0019890 A1 Figure 12 4.O A 3.0 s: 3 2.0 1.O Control Vehicle BNP 3.0 B 2.5 2.0 15 :::: 1.O O5 OO Control Vehicle BNP C Control Vehicle BNP Patent Application Publication Jan. 26, 2006 Sheet 13 of 13 US 2006/0019890 A1 Figure 13 4OO A Heart Rate B to Stroke Volume 3CO 8 t 2, 200 4. 5 O 2 O o Control Wehicle BNP Control Wehicle BNP L-NAM+Angll L-NAME+Ang C D so Ejection Fraction 4000 ardiac Output 30 3000 as a OOO o 1oco O Control Wehicle BNP Control Yehicle NP L-NAME+Ango L-NAME+Angll 8 E. Stroke Work 2500 F Maximum dpfdt 600 1. food 5 7600 4oo E s o s 250 Control Vehicle BNP Cotr Weice BNP L-NAME+Angll L-NAME+Angll Minimum didt Arterial Elastance g o 60 als i solo as S 4. stoo s 2eo w Control Wehicle BNP Control Wehicle BNP L-NAME+Angll L-NAME+Angll US 2006/OO19890 A1 Jan. 26, 2006 METHOD FOR TREATING CARDIAC inhibitors, BAR antagonists and (at least one type of) aldos REMODELING FOLLOWING MYOCARDIAL terone receptor antagonist can Significantly reduce the inci INJURY dence and extent of cardiac dysfunction and heart failure 0001. This application claims priority to U.S. provisional after myocardial infarction. application Ser. No. 60/537,221. The 60/537,221 provisional 0006 ACE inhibitors are associated with cough in 10% application is herein incorporated by reference in its entirety. of patients and can result in renal failure in the Setting of bilateral renal artery Stenosis or other Severe kidney disease. FIELD OF THE INVENTION BAR antagonists are associated with impotence and depres 0002 The present invention concerns methods of treat Sion, and are contraindicated in patients with asthma, fur ment using one or more natriuretic peptides or derivatives thermore, patients may develop worsened heart failure, thereof. More Specifically, the invention concerns methods hypotension, bradycardia, heart block, and fatigue with of treating or preventing cardiac dysfunction in a Subject initiation of BAR antagonists. Aldosterone receptor antago after Said Subject has undergone myocardial injury. nism causes significant hyperkalemia and painful gyneco mastia in 10% of male patients. Agents without a demon Strated mortality benefit are also associated with problems, BACKGROUND most notable is the consistent finding that many cardiac 0003) Myocardial infarction is a major cause of signifi Stimulants improve Symptoms, but actually increase mortal cant disability and death in the United States and in many ity, likely by triggering lethal cardiac arrhythmias. In Sum other countries around the World, and accounts for approxi mary, presently available pharmacological therapies are mately 2/3 of all heart failure. Hunt et al., AMERICAN ineffective and are limited by Significant unwanted Side COLLEGE OF CARDIOLOGY/AMERICAN Heart ASSO effects, and So development of new therapies with improved ciation. ACC/AHA guidelines for the evaluation and man efficacy and leSS Severe side effects is an important public agement of chronic heart failure in the adult: executive health goal. Summary. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guide SUMMARY OF THE INVENTION lines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Journal of 0007. The present invention is directed to the use of the American College of Cardiology 2001; 38: 2101-2113. natriuretic peptides for the prevention and/or treatment of Several disease-initiating events (e.g. myocardial infarction, cardiac remodeling in a Subject that has undergone myocar untreated hypertension, congenital mutations of contractile dial injury. In a preferred embodiment, the natriuretic pep proteins) can result in a common heart disease phenotype tide(s) comprise brain natriuretic peptide (BNP), also known that consists of dilation of the cardiac chambers, resulting in as neSiritide. In another embodiment, the invention is reduction in contractile function (i.e., a decrease in the directed to the treatment of cardiac dysfunction, Said treat fraction of total blood ejected from each chamber during ment comprising the administration of a therapeutically Systole) that leads to the clinical Syndrome of heart failure. effective amount of natriuretic peptide to a Subject that has This phenotype generally involves a compensatory aspect undergone myocardial injury. that results from myocardial infarction when the normal 0008. In another related embodiment, the invention is compensatory hypertrophy of Surviving, non-infarcted myo directed to a method of alleviating or reversing the effect of cardium is insufficient. Often this compensatory mechanism TGFB mediated cell activation in cardiac tissue on the is a result of the profibrotic response associated with cardiac expression of one or more genes associated with fibrosis, injury. comprising contacting one or more cells or tissues in which 0004 Available therapies for heart dysfunction are insuf the expression of Said genes is altered as a result of TGFB ficient, and new methods of treatment are needed. The heart mediated activation, with BNP. In another related embodi responds to infarction by hypertrophy of Surviving cardiac ment, the targeted gene(s) associated with fibrosis are muscle in an attempt to maintain normal contraction. How Selected from the group consisting essentially of Collagen1, ever, when the hypertrophy is insufficient to compensate, Collagent 3, Fibronectin, CTGF, PAI-1, and TIMP3. cardiac remodeling and reduced cardiac function result, 0009. In another embodiment, the invention is directed to leading to heart failure and death. Despite important a method of inhibiting the production of Collagen 1, Col advances in medical therapies for preventing cardiac dyS lagen 3 or Fibronectin proteins by the administration of a function and heart failure after myocardial infarction, these therapeutically effective amount of BNP to a subject in need problems remain a significant unsolved public health prob thereof. lem. 0005 No pharmacological therapy for post MI cardiac 0010. In another related embodiment, the invention is remodeling is curative or Satisfactory, and many patients die directed to a method of inhibiting TGFB mediated myofi or, in Selected cases, undergo heart transplantation. Presently broblast conversion by administration of a therapeutically available pharmacological therapies for reducing cardiac effective amount of BNP to a mammalian subject in need dysfunction and reducing mortality in patients with heart thereof.
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