Department of Pharmaceutical Sciences, College of Pharmacy , University of Nebraska Medical Center , Omaha , Nebraska 68198 , United States.
Hospital for Special Surgery , New York , New York 10021 , United States.
Mol Pharm. 2018 Aug 6;15(8):3456-3467. doi: 10.1021/acs.molpharmaceut.8b00433. Epub 2018 Jul 16.
While highly efficacious in treating rheumatoid arthritis (RA), the approved Janus kinase (JAK) inhibitor, Tofacitinib (Tofa, CP-690 550), has dose-dependent toxicities that limit its clinical application. In this study, we have examined whether a prodrug design that targets arthritic joints would enhance Tofa's therapeutic efficacy, which may provide an opportunity for future development of safer Tofa dosing regimens. A prodrug of Tofa (P-Tofa) was synthesized by conjugating the drug to the N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer via an acid cleavable carbamate linker. The therapeutic efficacy of a single dose of P-Tofa was compared to the dose-equivalent daily oral administration of Tofa in an adjuvant-induced arthritis (AA) rat model. Saline treated AA rats and age-matched healthy rats were used as controls. Observational analyses support the superior and sustained efficacy of a single dose P-Tofa treatment compared to the dose-equivalent daily Tofa administration in ameliorating joint inflammation. Micro-CT and histological analyses demonstrated that the P-Tofa treatment provided a structural preservation of the joints better than that of the dose-equivalent Tofa. Optical imaging, immunohistochemistry, and fluorescence-activated cell sorting analyses attribute P-Tofa's superior therapeutic efficacy to its passive targeting to arthritic joints and inflammatory cell-mediated sequestration. In vitro cell culture studies reveal that the P-Tofa treatment produced sustained the inhibition of JAK/STAT6 signaling in IL-4-treated murine bone marrow macrophages, consistent with a gradual subcellular release of Tofa. Collectively, a HPMA-based nanoscale prodrug of P-Tofa has the potential to enhance the therapeutic efficacy and widen the therapeutic window of Tofa therapy in RA.
虽然批准的 Janus 激酶(JAK)抑制剂托法替尼(Tofa,CP-690550)在治疗类风湿关节炎(RA)方面非常有效,但它具有剂量依赖性毒性,限制了其临床应用。在这项研究中,我们研究了靶向关节炎关节的前药设计是否会增强 Tofa 的治疗效果,这可能为未来开发更安全的 Tofa 给药方案提供机会。通过将药物与 N-(2-羟丙基)甲基丙烯酰胺(HPMA)共聚物通过酸可裂解的碳酸酯键连接,合成了 Tofa 的前药(P-Tofa)。将单次剂量的 P-Tofa 的治疗效果与剂量等效的每日口服 Tofa 在佐剂诱导的关节炎(AA)大鼠模型中的治疗效果进行了比较。盐水处理的 AA 大鼠和年龄匹配的健康大鼠用作对照。观察性分析支持单次剂量 P-Tofa 治疗与剂量等效的每日 Tofa 给药相比,在改善关节炎症方面具有更好的持续疗效。微 CT 和组织学分析表明,P-Tofa 治疗提供了更好的关节结构保存,优于剂量等效的 Tofa。光学成像、免疫组织化学和荧光激活细胞分选分析将 P-Tofa 的优越治疗效果归因于其对关节炎关节的被动靶向和炎症细胞介导的隔离。体外细胞培养研究表明,P-Tofa 治疗在 IL-4 处理的小鼠骨髓巨噬细胞中持续抑制 JAK/STAT6 信号,与 Tofa 的逐渐亚细胞释放一致。总之,基于 HPMA 的纳米级 P-Tofa 前药有可能增强 Tofa 治疗 RA 的治疗效果并拓宽治疗窗口。