• 专利附录
  • 专利说明
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    • 专利摘要:
    The present invention relates to a method of treating injured muscle by topically administering a neurotoxin, such as botulinum toxin, to promote healing and / or reduce pain associated with injured muscle.
    公开号:KR20030043981A
    申请号:KR10-2003-7004676
    申请日:2001-08-31
    公开日:2003-06-02
    发明作者:그레고리에프. 브룩스；케이로져 아오키
    申请人:알러간, 인코포레이티드；
    IPC主号:
    专利说明:

    METHODS FOR TREATING MUSCLE INJURIES}
    [2] Muscle damage includes severe damage to skeletal muscles such as bruises, lacerations, ischemia, strains and complete ruptures. This damage can cause incredible pain, making the injured person unable to work or even do normal daily activities, making him incompetent. If there is serious injury to skeletal muscle, the upper left (also known as kidney-induced injury) is the most common. For example, sedentary injury accounts for more than 30% of all injuries treated professionally or by sports medicine professionals [Garrett et al. Am J Sports Med., 24 (6): S2-S8,1996.
    [3] Muscle supple injury is characterized by the destruction of the muscle-gun unit. Destruction of the muscle-gun unit can occur anywhere in the muscle. This type of injury often occurs at the myotendinous junction (MTJ) of the superficial muscles that intersect the two joints, such as the femoral muscles, semi-pectoral muscles, and gastrocnemius muscles.
    [4] Muscle situs may be due to exercise biased to one side, or the rare use of muscles. For example, if the contraction is biased to one side, less force is used to generate more force. In this case, during stretching, the overly stretched muscle unit becomes excessively tense. Excessive tension, centered around what is considered a random break of the Z-line, can cause microscopic damage to the contractile elements of the muscle. If the muscle is damaged, the injured person will experience delayed onset muscle pain characterized by pain, weakness and limited movement. The pain is mostly intense for about 1 to 2 days after muscle injury, and weakness and limited movement can last for more than a week. Inappropriate treatment of minor suppression of skeletal muscle can cause more serious damage.
    [5] Muscular contusions are classified into three categories based on the severity of the injury and the nature of the hematoma: (1) mild, (1 degree) contusions; Tearing of some muscle fibers; Slight swelling and discomfort, force does not decrease or decreases to a minimum and entails limited movement; (2) moderate, (2 degrees) upper left; Muscle fibers are damaged more significantly, and the force is surely reduced; (3) severe (third degree) contusion; The rupture extends across the entire muscular bulge, resulting in complete loss of muscle function.
    [6] Rupture of intramuscular vessels in the upper left of the muscle often results in massive hematomas. Two different types of hematoma appear in injured muscles: intramuscular hematoma and intermuscular hematoma. In the first form, intramuscular hematoma is limited in size by intact fascia. Here, extravasation of blood increases intramuscular pressure, compressing the hematoma and limiting its size. This type of hematoma causes pain and loss of muscle function. The second type, intermuscular hematoma, occurs when the fascia ruptures and the extravasated blood spreads to the intermuscular space, so that the intramuscular pressure does not increase significantly. This type of hematoma does not cause severe pain unless the intramuscular pressure increases.
    [7] In the treatment of upper left injuries, it is important to prevent the injured muscles from moving, especially during the first two to three days after the injury, because moving the injured muscle immediately after the injury often re-ruptures. Re-rupture can lead to more severe damage, delayed treatment and scarring tissue (Javinen et al., Curr Opin Rheumatol, vol 12: 155-161 (2000)).
    [8] Re-rupture of the injury site can be prevented by immobilizing the damaged muscle, preferably immediately after the injury. The fixation allows the newly formed granulation tissue to reach sufficient tensile strength to withstand the forces generated during muscle contraction.
    [9] Known methods of fixing injured / injured muscles require the use of physical restraints or casts. For example, cervical collars can be used to fix damaged cervical flexors or extensors. However, using such restraint devices is often cumbersome and inconvenient. Moreover, for damage to certain muscle groups, it is not practical to use a physical restraint, or a physical restraint cannot be used. For example, it is very difficult to fix the upper mitral muscle or gluteus maximus in the upper left using such a restraint device.
    [10] Botulinum Toxin
    [11] The anaerobic, gram-positive bacterium Clostridium botulinum provides a botulinum toxin, a potent polypeptide neurotoxin, which causes a neuropathic disease called botulism in humans and animals. Spores of Clostridium botulinum are found in soil and can be cultured in canned food containers in sealed homes that are not properly sterilized, which causes many botulism. Symptoms of botulism typically appear 18 to 36 hours after eating food infected with Clostridium botulinum culture or spores. Botulinum toxin can appear to attack peripheral motor neurons through the intestinal lining without reducing its toxicity. Symptoms of botulinum toxin poisoning can progress to walking disorders, swallowing disorders and speech disorders, paralysis and death of respiratory muscles.
    [12] Botulinum toxin type A ("BoNT / A") is the most lethal natural biological neurotoxin known to man. The LD 50 of botulinum toxin (purified neurotoxin complex) serotype A commercially available in mice is about 50 picograms. Botulinum toxin 1 unit (U) can be defined as LD 50 via intraperitoneal injection into female Swiss Webster mice weighing 18-20 g each. Seven immunologically distinct botulinum neurotoxins are characterized as neurotoxin serotypes A, B, C 1 , D, E, F and G, respectively, which are distinguished by neutralization with serotype-specific antibodies. Different serotypes of botulinum toxin differ depending on the animal species on which they act and the degree and duration of paralysis they cause. For example, BoNT / A was determined to be 500 times more potent than botulinum toxin type B (BoNT / B) as measured by the paralysis rate occurring in rats. In addition, BoNT / B was determined to be nontoxic even when administered to primates 480 U / kg, about 12 times the primate LD 50 relative to BoNT / A. Botulinum toxin binds to cholinergic motor neurons with strong affinity and is believed to enter neurons and inhibit the release of acetylcholine.
    [13] Botulinum toxin is being used in clinical settings for the treatment of neuromuscular disorders characterized by hyperactive skeletal muscle. BoNT / A is licensed for use in the treatment of essential blepharospasm, strabismus and lateral face cramps by the US Food and Drug Administration. Botulinum serotypes other than toxin type A appear to have a lower potency and / or shorter duration in activity compared to BoNT / A. The clinical effect of intramuscularly injected botulinum toxin (such as BoNT / A) appears in approximately several hours. Therefore, most but not all intramuscular injections of botulinum neurotoxins provide significant muscle paralysis within 1 day after injection, as measured by, for example, a mouse digit abduction scoring assay (DAS). It is important to note that. Aoki KR, reclinical Update on BOTOX (Botulinum toxin type A) -Purified Neurotoxin Complex Relative to Other Botulinum Toxin Preparations, Eur J. Neur 1999, 6 (suppl 4): S3-S10. The typical duration of symptomatic relief from a single intramuscular injection of BoNT / A is about 3 months. Botulinum toxin, including botulinum toxin type A, having a reduced duration of biological activity in vivo , is disclosed in US patent application Ser. No. 09/620840, which is incorporated herein by reference in its entirety.
    [14] Although all botulinum toxin serotypes appear to inhibit the release of the neurotransmitter acetylcholine at neuromuscular junctions, they act on different neurosecretory proteins and / or cleave these proteins at different sites. For example, botulinum types A and E both cleave 25 kD synaptosome related protein (SNAP-25), but target different amino acid sequences of this protein. BoNT / B, D, F and G act on vesicle related proteins (VAMP, so-called synaptobrevin), each serotype cleaves different sites of this protein. Finally, botulinum toxin type C 1 (BoNT / C 1 ) appears to cleave both syntaxin and SNAP-25. The difference in this mechanism of action will affect the relative potency and / or duration by the action of the various botulinum toxin serotypes.
    [15] Regardless of the serotype, the molecular mechanism of toxin poisoning is similar and appears to consist of at least three stages. In the first stage of this process, the toxin binds to the presynaptic membrane of the target neuron by the specific interaction of the heavy chain (H chain) with the cell surface receptors; This receptor is believed to be different for each serotype and tetani toxin of botulinum toxin. The carboxyl terminal fragment of the H chain, Hc, is considered important for the targeting of toxins to the cell surface.
    [16] In the second stage, the toxin passes across the plasma membrane of the poisoned cell. Toxins are first wrapped by cells through receptor-mediated endocytosis, resulting in the formation of endosomes containing the toxin. The toxin then exits the endosomes and enters the cytoplasm of the cell. This last step is believed to be mediated by the amino terminal fragment of the H chain, H N , which causes a structural change of the toxin below about pH 5.5. Endosomes are known to have proton pumps that reduce the endosomal internal pH. Structural relocation exposes the hydrophobic residues of the toxin, allowing the toxin to be surrounded by the endosome membrane. The toxin is then translocated to the cytosol through the endosomal membrane.
    [17] The final step of the botulinum toxin activation mechanism is believed to include the cleavage of the crucial intracellular exocytosis protein by the L chain. The total toxic activity of botulinum and tetani toxins is included in the L chain of the holotoxin; The L chain is a zinc (Zn ++) endopeptidase that selectively cleaves proteins necessary for recognition, docking of neurotransmitter-containing vesicles with the cytoplasmic surface of the plasma membrane, and fusion of the plasma membrane with the vesicles. Tetany neurotoxin, botulinum toxin / B, / D, / F and / G cause the breakdown of synaptobrevin (or vesicle-associated membrane protein (VAMP)), synaptosome membrane protein. Most of the VAMP present on the cytosol surface of synaptic vesicles is eliminated as a result of one of these degradations. Each toxin specifically cleaves different bonds.
    [18] The molecular weight of the botulinum toxin protein molecule is about 150 kD for all seven known botulinum toxin serotypes. Interestingly, botulinum toxin is released by Clostridium-based bacteria as a complex comprising a 150 kD botulinum toxin protein molecule with an associated nontoxic protein. Therefore, BoNT / A complexes can be produced in 900k, 500Dk and 300kD forms by Clostridium bacteria. BoNT / B and C 1 appear to be produced only as a 500 kD complex. BoNT / D is produced as 300kD and 500kD complexes. Finally, botulinum toxin types E and F are produced only as about 300 kD complexes. These complexes (ie, those having a molecular weight greater than about 150 kD) are believed to include non-toxic hemagglutinin proteins and non-toxic and non-toxic hemagglutinin proteins. These two non-toxin proteins (including the related neurotoxin complex with the botulinum toxin molecule) will act to provide stability against botulinum toxin molecule denaturation and protection against digestive acids when the toxin is ingested. In addition, the larger the botulinum toxin complex (molecular weight is greater than about 150 kD), the slower the botulinum toxin will diffuse from the intramuscular injection site of the botulinum toxin complex.
    [19] In vitro studies have shown that botulinum toxin inhibits potassium cation induced release of acetylcholine and norepinephrine from primary cell cultures of brain tissue. Botulinum toxin also has been reported to inhibit the induced release of glycine and glutamate in primary cultures of spinal cord neurons and to inhibit the release of neurotransmitters acetylcholine, dopamine, norepinephrine, CGRP and glutamate, respectively, in brain synaptosome samples. .
    [20] BoNT / A can be obtained by making and culture a culture of Clostridium botulinum in a fermentor and then harvesting and purifying the fermentation mixture in a known manner. Initially all botulinum toxin serotypes are synthesized as inactive single chain proteins that must be cleaved or nicked by proteases and must be neuroactivated. Bacterial strains producing botulinum toxin serotypes A and G have endogenous proteases, so serotypes A and G can be recovered primarily from bacterial cultures as the active form. In contrast, botulinum toxin serotypes C 1 , D, and E are synthesized by non-proteolytic strains and are therefore typically inactivated when recovered from culture. Since serotypes B and F are produced by both proteolytic and non-proteolytic strains, they can be recovered in active or inactive form. However, for example, proteolytic strains that produce BoNT / B serotypes cleave only a portion of the toxin produced. The exact ratio of nicked molecules to unnicked molecules depends on the incubation time and the temperature of the culture. Therefore, as is probably known, BoNT / B is significantly less potent than BoNT / A, for example, a certain percentage of BoNT / B toxins will be inactive. The presence of inactive botulinum toxin molecules in the clinical sample will contribute to the overall protein load of the sample, which is associated with an increase in antigenicity without contributing to the clinical effect. In addition, BoNT / B at the same dosage level is known to have a shorter duration of activity and less potency upon intramuscular injection compared to BoNT / A.
    [21] As described below, the use of BoNT / A in clinical settings has been reported:
    [22] (1) Treatment of cervical dystonia with about 75-125 units of BOTOX® (available from Allergan, Inc., Calif., BOTOX®) per several intramuscular injections ;
    [23] (2) Using 5-10 units of BOTOX® per intramuscular injection to treat glabellar folds (forehead wrinkles) (5 units intramuscularly injected into the nasal muscles and 10 units intramuscularly injected into each cervical muscle) )
    [24] (3) Treating constipation by injecting about 30-80 units of BOTOX® into the sphincter muscle
    [25] (4) Treating blepharospasm by intramuscularly injecting about 1-5 units of BOTOX® per muscle into the lateral prechondral antagonist of the upper eyelid and lateral cartilaginous antagonist of the lower eyelid.
    [26] (5) Treat strabismus by intramuscular injection of approximately 1-5 units of BOTOX® into the extraocular muscle, the dosage depends on the size of the muscle being injected and the desired degree of muscle paralysis (ie desired diopter correction).
    [27] (6) Treating upper extremity spasm after stroke by intramuscularly injecting BOTOX® into five different upper extremity flexors, as follows:
    [28] (a) Deep core flexure: 7.5 U to 30 U
    [29] (b) Cheonji excavation: 7.5 U to 30 U
    [30] (c) lateral carpal tunnel: 10 U to 40 U
    [31] (d) Lumbar carpal tunnel: 15 U to 60 U
    [32] (e) brachial biceps: 50 U to 200 U
    [33] Inject each of the five muscles described above at a time, intramuscularly injecting 90 U to 360 U BOTOX® into the patient's upper extremity at each treatment.
    [34] The success of BoNT / A in a variety of clinical conditions has drawn attention to other botulinum toxin serotypes. Two commercially available BoNT / A formulations (BOTOX® and Dysport®) and BoNT / B and F formulations (both available from Wako Chemical, Japan) have been studied and local muscle weakness efficacy, stability and antigenic potential It was decided. Botulinum toxin preparations were injected into the upper part of the right gastrocnemius (0.5 to 200.0 units / kg) and muscle weakness was assessed using the mouse extremity scoring system (DAS). ED 50 values were calculated from the dose response curve. Another mouse was injected intramuscularly to determine the LD 50 dose. The therapeutic index was calculated as LD 50 / ED 50 . In separate groups of mice, BOTOX® (5.0-10.0 units / kg) or BoNT / B (50.0-400.0 units / kg) was injected into the hind limbs, and muscle weakness and water consumption (models presumed to be dry). Was tested. Antigen likelihood was evaluated by monthly intramuscular injection in rabbits (2.0-8.7 U / kg BoNT / B or 3.0 U / kg BOTOX®). Muscle weakness peaks and durations were dose related in all serotypes. DAS ED 50 values (units / kg) were as follows: BOTOX®: 6.7, Dysport®: 24.7, BoNT / B: 11.8 to 244.0, BoNT / F: 4.3. BOTOX® had a longer duration of action than BoNT / B or BoNT / F. The therapeutic index was as follows: BOTOX®: 10.5, Dysport®: 6.3, BoNT / B: 4.8. Although BoNT / B was less effective for muscle weakness, water consumption was more than that of mice injected with BoNT / B than BOTOX®. Four months after injection, antibodies to BoNT / B were expressed in two of four rabbits (when treated at 1.5 ng / kg) and four of four (when treated at 6.5 ng / kg). In another study, 0 out of 9 BOTOX® treated rabbits showed antibodies to BoNT / A. In the DAS results, BoNT / A showed the same relative maximum potency as BoNT / F, and BoNT / F was larger than BoNT / B. In terms of duration of effect, BoNT / A is greater than BoNT / B, and the effect duration of BoNT / B is greater than that of BoNT / F. The two commercial BoNT / A formulations (BOTOX® and Dysport®) differed in the therapeutic index. The increased water consumption behavior observed after hindlimb injection of BoNT / B indicates that clinically significant amounts of BoNT / B enter the rat large circulation. The results also indicate that in order to obtain an effect equivalent to BoNT / A, the dosage should be increased for the other serotypes tested. Increasing the dosage may involve safety issues. In addition, in rabbits, serotype B was more antigenic than BOTOX®, probably due to higher protein load at an effective amount of BoNT / B.
    [35] Botulinum neurotoxin acts at the neuromuscular junction, while tetany neurotoxin mainly acts at the central nervous system; Both act by inhibiting the release of acetylcholine from the affected axons to the synapse by causing paralysis. The poisoning effect of the affected neurons lasts for a long time and until recently was considered irreversible. Tetany neurotoxin is known to exist as one immunologically distinct serotype.
    [36] Acetylcholine
    [37] Typically, in the mammalian nervous system only a single type of small molecule neurotransmitter is released by each type of neuron. This neurotransmitter acetylcholine is a neurotransmitter of neurons in various parts of the brain, especially large pyramidal cells in the motor cortex, several different neurons in the cerebral nucleus, motor neurons distributed in skeletal muscle, and autonomic nervous system (both sympathetic and parasympathetic) Neurons, post-ganglia neurons of the parasympathetic nervous system and ganglia of the sympathetic nervous system are secreted by several. Originally, most sympathetic neurons post-ganglion neurons secrete the neurotransmitter norepinephrine, whereas only sympathetic fibers after ganglia into sweat glands, brushing muscles and some blood vessels are cholinergic. In most cases, acetylcholine has an excitatory effect. However, acetylcholine is known to have an inhibitory effect at some peripheral parasympathetic nerve endings (eg, inhibition of the heartbeat by the vagus nerve).
    [38] The centrifugal signal of the autonomic nervous system is transmitted to the body through the sympathetic nervous system or parasympathetic nervous system. The ganglion neurons of the sympathetic nervous system extend from ganglion sympathetic neuronal cell bodies located in the medial lateral angle of the spinal cord. Pre-ganglion sympathetic nerve fibers extending from the cell body form synapses with post-ganglion neurons located in the paraspinal sympathetic ganglia or pre-vertebral ganglion. Since pre-ganglion neurons of the sympathetic and parasympathetic nervous system are both cholinergic, applying acetylcholine to the ganglion will excite the neurons after sympathetic and parasympathetic ganglia.
    [39] Acetylcholine activates two types of receptors, muscarinic receptors and nicotinic receptors. Muscarinic receptors are found in all effector cells stimulated by post-ganglion neurons in the parasympathetic nervous system and cholinergic neurons in the sympathetic nervous system. Nicotinic receptors are found at synapses in pre-ganglion and post-ganglion neurons in both the sympathetic and parasympathetic nervous systems. Nicotinic receptors are also found at the neuromuscular junction of several membranes of skeletal muscle fibers.
    [40] Acetylcholine is released from cholinergic neurons when small, smooth, intracellular vesicles fuse with presynaptic neuronal cell membranes. A wide range of non-neuronal secretory cells, such as the adrenal medulla (also PC12 cell line) and islet cells of the pancreas, release catecholamines and parathyroid hormones from large dense-core vesicles, respectively. The PC12 cell line is a clone of rat chromophiloma cells widely used as a tissue culture model for the study of sympathoadrenal develpoment. By allowing toxins to penetrate into denervated cells (by electroshock, etc.) or by direct injection of toxins, botulinum toxin inhibits the release of both compound types in both cell types in vitro . Botulinum toxin is also known to inhibit the release of the neurotransmitter glutamate from cortical synaptosome cell cultures.
    [41] Neuromuscular junctions are formed in skeletal muscle by peripheral axons of muscle cells. Signals transmitted through the nervous system become action potentials at terminal axons and activate ion channels, resulting in the release of the neurotransmitter acetylcholine from synaptic vesicles in neurons, for example in the motor endplates of neuromuscular junctions. . Acetylcholine binds to the acetylcholine receptor protein on the surface of muscle endplates across the extracellular space. Once sufficiently bound, the action potential of muscle cells causes specific membrane ion channel changes, resulting in the contraction of muscle cells. Acetylcholine is then released from muscle cells and metabolized by cholinesterase in the extracellular space. Metabolites are recovered back to terminal axons for regeneration to other acetylcholine.
    [42] As noted above, current methods of treating injured muscle are still insufficient. There is a need for improved methods of treating damaged muscle.
    [1] The present invention relates to a method of treating muscle damage. In particular, the present invention relates to methods of treating injured muscle by administering neurotoxins to the injured muscle.
    [43] summary
    [44] According to the present invention, an effective method of treating injured muscle comprises topically administering an effective amount of neurotoxin to or near the injured muscle in vivo . Neurotoxins provide temporary chemical denervation of injured muscles, reducing the contraction of muscles. It is an object of the present invention to provide a therapy that facilitates treatment and rapidly restores the function of the injured muscle. The injured muscle may be, for example, a muscle that has been wounded. In one embodiment, neurotoxins can be administered intramuscularly or subcutaneously. In another embodiment, administering the neurotoxin is performed before or after physical therapy and / or surgical surgery.
    [45] Furthermore, according to the invention, the step of administering neurotoxins is immediately after or after the muscles are injured in fact as soon as possible. In one embodiment, the neurotoxin is effective to fix or substantially fix the damaged muscle during at least one and / or two steps of the damaged muscle recovery process.
    [46] According to the invention, the neurotoxin may comprise a targeting component, a treatment component and a translocation component. The target component can be coupled to presynaptic motor neurons. In one embodiment, the target component may comprise a carboxyl terminal fragment of a heavy chain of butyricum toxin, tetani toxin, botulinum toxin type A, B, C 1 , D, E, F, G or a modification thereof. The therapeutic component may interfere with or regulate neurotransmitter release or processes from neurons. In one embodiment, the therapeutic component comprises a light chain of butyricum toxin, tetani toxin, or botulinum toxin type A, B, C 1 , D, E, F, G or a variant thereof. The translocation component can facilitate at least a portion of the neurotoxin, eg, the therapeutic component, moving into the cytoplasm of the target cell. In one embodiment, the translocation component may comprise an amino terminal fragment of a heavy chain of butyricum toxin, tetani toxin, botulinum toxin type A, B, C 1 , D, E, F, G or a modification thereof.
    [47] In another embodiment of the invention, the neurotoxin is botulinum toxin type A, B, E and / or F. In a preferred embodiment, the neurotoxin used to treat injured muscle is botulinum toxin type A. Indeed, it is desirable to use botulinum toxin type A because of its commercial availability, known clinical usage, and successful applications for treating muscle damage in accordance with the present invention, as disclosed herein. The use of botulinum toxin type A from about 0.1 U / kg to about 30 U / kg and botulinum toxin type B from about 1 U / kg to about 150 U / kg is within the scope of the method carried out in accordance with the disclosed invention. For other botulinum toxin cell types (including toxin types E and F), as described above, the U / kg dosage used is within the range of about 0.1 U / kg to about 150 U / kg.
    [48] In addition, according to the present invention, neurotoxins can be produced recombinantly.
    [49] Detailed embodiments of the present invention are methods of treating injured muscle, wherein injured muscle is treated (by promoting the treatment of the injured muscle) by topically administering a therapeutically effective amount of botulinum toxin to the injured muscle in vivo . The botulinum toxin may be botulinum toxin type A. In particular, the present invention also includes a method for treating injured muscle related pain, wherein the therapeutically effective amount of botulinum toxin is topically administered to the injured muscle in vivo to reduce pain associated with the injured muscle.
    [50] The properties disclosed herein, and combinations of two or more of these properties, are included within the scope of the present invention, respectively, and both, provided that the properties included in such combinations do not contradict each other.
    [51] Justice
    [52] The following definitions are provided, which apply herein.
    [53] "About" means approximately or nearly, and for the values or ranges described herein, means ± 10% of the values or ranges described or claimed.
    [54] "Heavy chain" refers to the heavy chain of Clostridial neurotoxins. The molecular weight of the heavy chain is preferably about 100 kDa and may be referred to as heavy chain or H.
    [55] “H N ” (preferably with a molecular weight of about 50 kDa) means a fragment derived from the heavy chain of the Clostridial neurotoxin and substantially equivalent to the amino terminal fragment of the heavy chain or a portion corresponding to that fragment of the unmodified heavy chain . It is believed to include a natural or wild type Clostridial neurotoxin moiety, including translocation of L chains across intracellular endosomal membranes.
    [56] "Hc" means a fragment derived from the heavy chain of the (about 50 kDa) Clostridial neurotoxin and substantially equivalent to the carboxyl terminal fragment of the heavy chain, or a portion corresponding to that fragment of the unmodified heavy chain. It is believed to be immune and contain a natural or wild type Clostridial neurotoxin moiety that binds to presynaptic neurons with high affinity.
    [57] "Injured muscles" include muscles that have been injured, torn, or excessively used, and also include bruises, lacerations, ischemia or ruptured muscles.
    [58] "Light chain" means a light chain of Clostridial neurotoxin. The molecular weight of the light chain is preferably about 50 kDa and may be referred to as the proteolytic domain (amino acid sequence) of the L chain, L or Clostridial neurotoxin. When neurotransmitters are released into the cytoplasm of target cells, the light chain is believed to be effective as an inhibitor of neurotransmitter release.
    [59] "Local administration" means direct administration of a drug to, near, or in a site requiring a biological effect of the drug. Topical administration excludes systemic routes of administration such as intravenous or oral administration.
    [60] "Neurotoxin" means a chemical that can interfere with or regulate at least one neuron's function. "Neurtoxins" can be naturally occurring or artificially produced. In addition, a "neurotoxin" can be a small molecule, a large molecule, a polypeptide, a conjugated-polypeptide or a mixture thereof.
    [61] "Variants" are chemicals that differ slightly from their parent chemicals but still exhibit biological effects. The biological effect of the variant may be the same as or better than that of the parent. For example, modified light chains of botulinum toxin with at least one amino acid substituted, altered, deleted or added may have the same or enhanced ability to inhibit the release of neurotransmitter vesicles. In addition, the biological effects of the variants may be reduced. For example, a modified light chain of botulinum toxin type A from which a leucine parent has been removed may have a shorter biological persistence than a parent (or natural) botulinum toxin type A light chain.
    [62] details
    [63] In a broad embodiment, an effective method of treating injured muscle in accordance with the present invention may comprise topically administering a therapeutically effective amount of neurotoxin to the injured muscle. Preferably, the injured muscle is a muscle injured.
    [64] The upper left of the skeletal muscle can be classified as a shearing injury. In the wound, not only muscle fibers but also mysial sheath are torn. Almost immediately after muscle injury, the muscle recovery process begins. The wound healing process can be divided into three stages.
    [65] The first stage is a disruption stage, characterized by the formation of hematomas, myofiber necrosis and inflammatory cell responses. Rupture of other healthy muscles after upper left often occurs near its distal muscle tendon junction (MTJ). The ruptured muscle fibers contract and a gap is formed between the cuts. Since skeletal muscle is richly formed in blood vessels, bleeding from the torn blood vessels is inevitable, so this gap is filled with hematoma and later replaced by scar tissue. In the wound, mechanical forces tear the entire muscle fiber, damage the muscle fiber plasma membrane, and leave the muscle shape open at the distal end. Because the muscle fibers are very long, stringy cells, necrosis disclosed at this site extends along the entire length of the ruptured muscle fibers. In wounds, too, blood vessels tear; Inflammatory cells bearing blood develop immediately at the site of injury, causing inflammation. The first stage lasts about 2 to 3 days after the injury.
    [66] The second phase is the recovery phase, which consists of phagocytosis on necrotic tissue, regeneration of muscle fibers, generation of connective tissue scars, and ingrowth of capillaries. An important step in the regeneration of damaged muscle tissue is angiogenesis of the damaged area. In order to rebuild damaged muscles, the supply through the blood vessels must be restored. New capillaries sprout from the surviving trunk of the vessel, penetrating into the center of the damaged area. These new capillaries help to provide sufficient oxygen to the regeneration area.
    [67] The third phase is the remodeling phase, which consists of maturation of the regenerated muscle fibers, contraction and reorganization of the scar tissue, and restoration of the functional capacity of the restored muscle. The second (recovery) phase and the third (remodeling) phase often proceed simultaneously, followed by the first phase for about two days to about six weeks.
    [68] In one embodiment of the invention, the neurotoxin is administered topically, preferably intramuscularly, to fix the injured muscle, thus facilitating treatment. Topical administration of neurotoxins according to the present invention can also reduce pain caused by muscle damage. Neurotoxins are preferably administered immediately or immediately after injury. In one preferred embodiment, the neurotoxin is effective to fix the injured muscle during the disruption phase (first phase) to prevent the muscle from rupturing.
    [69] While not wishing to limit the invention to the mechanisms of action of a particular theory, it would be beneficial to not fix it during the recovery and / or remodeling phases, as it is good for muscle fiber regeneration and orientation as well as faster and more intensive vascular inward growth of damaged areas. Is considered. Therefore, in one embodiment, the fixative effects of neurotoxins do not appear in the recovery phase (second phase) and / or remodeling phase (third phase). In a more preferred embodiment, the neurotoxin is effective to fix the injured muscle during the first stage but is administered to be ineffective during the second and third stages of the recovery process. For example, if the neurotoxin is injected into the muscle immediately after the injury, preferably intramuscularly, it is desirable for the neurotoxin to fix the injured muscle for about 3 days after administration. On the other hand, a simple movement can cause the neurotoxin's fixation effect only to areas with little or no pain when using injured muscles. When the patient is able to extend these critical areas, the patient should be encouraged to start moving actively and gradually.
    [70] In another embodiment of the present invention, the neurotoxin is effective for anchoring the injured muscle throughout the first to third stages and during the subsequent muscle damage recovery phase.
    [71] Neurotoxins, such as botulinum toxin, that are necessary to exhibit severe clinical muscle paralysis effects for less than about 1 day to about 7 days (where the muscle paralysis effect lasts for several months after injury) are within the scope of the present invention, and such neurotoxins are relatively severe Or long-lasting muscle damage (where long-term muscle fixation is indicative of appropriate treatment).
    [72] In a broad embodiment, the neurotoxin is a neuromuscular blocker. Table 1 lists (but is not limited to) neuromuscular blockers and their actionable sites. In one embodiment, a neuromuscular blocker is administered to treat the injured muscle that can fix the muscle, preferably the injured muscle, for at least about 5 days, preferably at least about 3 days. In a preferred embodiment of the present invention, botulinum neurotoxins are used as neurotoxins because of their known clinical stability and method of treating botulinum neurotoxins, such as botulinum toxin type E, to treat muscle diseases such as muscle stiffness. In a particularly preferred embodiment of the invention, for severe, or third degree muscle injury, the topically administered botulinum toxin is botulinum toxin type E. Botulinum toxin type A may also be used in these embodiments.
    [73] compound NMJ-related site of action Pharmaceutical classification Acetylcholinesterase InducerAconitineadenoregulin (from frog Filomedeusa bicala) Adenosine agonistsAdenosine antagonistsAdenosine modulatorsAtoxin-A antiepileptics Pre- and post-synaptic Pre- and post-synaptic Pre- and post-synaptic Pre-synaptic CNS ACh Esterase Inducer Sodium Channel Activator Adenosine Receptor Regulator Adenosine Adenosine Adenosine Alpha Adrenaline Ach Agonist Antiepileptic
    [74] Antisense Antianxiety Atcurium Atraccurium Besylate (Tracurium) Baccrofen (Lioresal.RTM., Intrathecal, Medtronic Neurological; generic, Athena, Biocrage, WatnerChilcott) Bacteria, Plants and Fungi ProductsBathracotoxinBenzylpiperidine Bungarotoxin-β (β-BuTX) Bupivacaine Captopril (Captopen .RTM., Squibb; Capzide .RTM., (Squibb) choline + acetyltransferase inhibitorscholine esterase inhibitorsguaguaxinleukotoxin MI ( Alpha conotoxin) Presynaptic and postsynaptic postsynaptic postsynaptic postsynaptic presynaptic presynaptic presynaptic gap and postsynaptic and synaptic gap presynaptic presynaptic pre and post synaptic presynaptic gap synaptic presynaptic Messages important for specific protein or neurotransmitter release, antisense technology for receptor production Anti-anxiety antiepileptic AchR antagonist depolarization muscle relaxant AchR antagonist depolarization muscle relaxant GABA analogue Sodium channel activator Ach esterase inhibitor (non-traditional) PLA2 and voltage sensitive Potassium channel blockers Snake toxin derived from Bungaros multi-syncus Mycotoxin Antihypertensive ACE inhibitor Zinc endopeptidase inhibitor CAT inhibitor Ach esterase inhibitor Sodium channel AChR antagonist
    [75] Conotoxin-.mu. GIIIA (mu-CT) conotoxin-.OMEGA. GVIA (omega-CT) Curare Dancrolene Sodium (Dantrium, P & G) Daurycindecametonium BromideDendrotoxinDiaminopyridine (3-DAP) Diazepam Doxacurium Chloride (Nuromax .RTM., BurroughsWellcome) Adriamyocin, Adria; Rubex, Immunex; Cetus Onoclogy) Epivatidine dihydrochloride vbamate (Felvatol, Carter- CNSWallace lic to Schering-Plough) Horoxymitin gabapentin (Neurontin, Parke-Davis) galamine gray antoxin hexahydroasepinyl acetamides And other chemical classifications after Ferzine A Insect Poison Ion Channel Blocker Ion Channel Stimulant Synapse postsynaptic postsynaptic presynaptic presynaptic pre and postsynaptic presynaptic CNS synaptic postsynaptic postsynaptic post synaptic presynaptic presynaptic precNSC synaptic post synaptic presynaptic presynaptic gap before and post synaptic before and after Na + channel blockers Ca2 + channel blockers AChR antagonists non-polar skeletal skeletal muscle relaxants AChR Antagonist Sodium Channel Activator Ach Release Agent ACh Esterase Inhibitor Channel Blocker Channel Stimulant
    [76] Latrotoxin-α Lidocaine, Procaine, Mepivacaine, Dinotripyrine (Dup 996, Dupont Merck) Ropotoxin and Similar Substances Marine Natural Products Metocarbamol (Rabaxin, Robins Co.) Methylcaconitine bakurium chloride ( Mivacro.RTM., BW-BW1090U, BurroughsWellcome) Antibody Muscarinic Agonists and Antagonists for the Modified Clostridium Toxin Monoclonal NMJ Component Reptiles, Insects, and Other Sources Neuroreading Pancuronium Bromide Organon Pancuronium-3-OH Metabolite from Presynaptic presynaptic presynaptic presynaptic postsynaptic postsynaptic presynaptic and postsynaptic presynaptic presynaptic before and after and synaptic gap postsynaptic postsynaptic Calcium Ion Carrier Black Widow Spider Poison Component Local Anesthetic ACh Release Enhancer AChR Antagonist Non-reversible CNS Suppressor, Muscle Relaxant AChR Antagonist Depolarization Muscle Relaxant ACh Release Inhibitor Receptor, Agrin, Neurotransmitter, Circular Membrane Components, Enzyme Inactivation, etc. CNS agonist antagonists sodium channel blockers autonomic nervous system ganglion AChR blockers (no effect in NMJ) AchR antagonists AChR polarization various AChR antagonists nonpolarization muscle relaxants AChR antagonists nonpolarization muscle relaxants
    [77] Popberine HCl (30 mg / ml) Physostigmine and similar substance Pipercuronium (Arduan, Organon) Presynaptic neuronal receptor short-term neurotoxin alpha β-Bungarotoxin (β-BuTX) Succinylcholine chloride (Anectine, Burroughs Wellcome Tetani toxin Tenani toxin carrier Tetrahydroamino-acridine (THA) Tetrodotoxin thiagabine (Novo Nordisk) transglutaminase inhibitors or anti-induced Valium becuronium (Norcuron, Organanon) bacurium-3-OH Metabolite Veratridine Bigabatrin (Sabril, Marion Merrell Dow) Besamichol and other drugs of the same mechanism zinc endopeptidase and other proteases derived from botulinum toxin or tetratan toxin carriers Synapse GapSynaps afterSynaps BeforeSynaps AfterSynaps BeforeSynaps BeforeSynaps BeforeSynaps beforeSynaps before and after CNSSynaps before and afterSynaps afterSynaps beforeSynaps beforeCNSSynaps before Smooth muscle relaxant ACh esterase inhibitors AChR antagonists nonpolar or neuronal receptors neuronal or neuronal receptors AChR antagonists Snake poison AChR receptor agonists depolarizing skeletal muscle relaxant EAA release inhibitors Ach esterase inhibitors sodium channel blockers antiepileptic GABA Absorption Inhibitors Enzymes Diazepam CNS Anti-anxiety AChR Antagonists Vital Polarization Muscle Relaxants AChR Antagonists Vital Polarization Muscle Relaxants Sodium Channel Activators Antiepileptic GABA Metabolism Inhibitors (Irreversible) ACh Vesicular Transport Inhibitors Enzyme Reduction of Neurotransmitter Release
    [78] In a wide variety of embodiments, the neurotoxin may comprise a target component, a therapeutic component and a translocation component. Target components can bind to presynaptic motor neurons. In one embodiment, the target component comprises a carboxyl terminal fragment of a heavy chain of butyricum toxin, tetani toxin, botulinum toxin type A, B, C 1 , D, E, F, G or a modification thereof. In a preferred embodiment, the target component may comprise a carboxyl terminal fragment of botulinum toxin type A.
    [79] The therapeutic component may interfere with or regulate neurotransmitter release from the cell or its process. In one embodiment, the therapeutic component comprises a light chain of butyricum toxin, tetani toxin, or botulinum toxin type A, B, C 1 , D, E, F, G or a variant thereof. In a preferred embodiment, the therapeutic component may comprise a light chain of botulinum toxin type whose biological persistence is short, for example up to about 5 days, preferably up to about 3 hours. Preferably such light chain may be a light chain of botulinum toxin type E or F. This month, the light chain may be a light chain of botulinum toxin type A.
    [80] The translocation component can facilitate at least a portion of the neurotoxin, eg, the therapeutic component, moving into the cytoplasm of the target cell. In one embodiment, the translocation component may comprise an amino terminal fragment of a heavy chain of butyricum toxin, tetani toxin, botulinum toxin type A, B, C 1 , D, E, F, G or a modification thereof. In a preferred embodiment, the translocation component comprises the amino terminal fragment of the heavy chain of botulinum toxin type A.
    [81] In one embodiment, the target component comprises a carboxyl terminal fragment of the heavy chain of botulinum toxin type E or F, the therapeutic component comprises a light chain of botulinum toxin type E or F, and the translocation component of the botulinum toxin type E or F Amino-terminal fragments of the heavy chain. In a preferred embodiment, the neurotoxin comprises botulinum toxin type E. In another preferred embodiment, the neurotoxin comprises botulinum toxin type F. In yet another embodiment, the neurotoxin comprises a mixture of botulinum toxin types E and F.
    [82] In one embodiment, the target component comprises a carboxyl terminal fragment of the heavy chain of botulinum toxin type A, the therapeutic component comprises a light chain of botulinum toxin type A, and the translocation component comprises the amino terminal fragment of the heavy chain of botulinum toxin type A do. In a preferred embodiment, the neurotoxin of the invention comprises botulinum toxin type A. Botulinum toxin type A is suitable for use in the present invention are BOTOX ® (California, said blank material, allergic secretary agent).
    [83] The neurotoxin of the present invention is treated by fixing the injured muscle, but in one embodiment, the nerve can also be administered to the injured muscle to reduce pain and / or spasms. In another embodiment, the neurotoxin can reduce pain associated with the damaged muscle while fixing the damaged muscle. In a preferred embodiment, neurotoxins, such as botulinum toxin type E, most preferably type A, are administered to muscles in the upper left to fix muscles and / or reduce pain associated with these muscles.
    [84] Of course, the skilled practitioner can determine the appropriate dosage and frequency of administration to obtain optimal clinical results. That is, one of ordinary skill in the medical arts will be able to effectively fix the injured muscle (s) by administering an appropriate amount of neuromuscular blocker at appropriate times. The dosage of neurotoxins depends on a variety of factors including muscle size, the severity of muscle damage. In a preferred embodiment, the dose of neurotoxin is such that it anchors the injured muscle for a period not longer than the duration of the first stage of the recovery process. In various methods according to the present invention, botulinum toxin type A of about 0.1 U / kg to about 15 U / kg may be administered to the injured muscle. Preferably, about 1 U / kg to about 20 U / kg of botulinum toxin type A may be administered to the injured muscle. The use of botulinum toxin type A from about 0.1 U / kg to about 30 U / kg and botulinum toxin type B from about 1 U / kg to about 150 U / kg is within the scope of the method described herein. Belongs. For other botulinum serotypes (including toxin types E and F), the U / kg dosage used is within the range of about 0.1 U / kg to about 150 U / kg as described above.
    [85] Although intramuscular injection is the preferred route of administration, other routes of topical administration, such as subcutaneous administration, are also possible.
    [86] In another broad embodiment, a method of treating injured muscle in accordance with the present invention also includes other steps described below. These other steps may be accomplished before, with or after the step of administering the neurotoxin, preferably to the injured muscle. For example, the recommended treatments for muscles currently present in the upper left include rest, ice, compression and elevating. These four steps (or methods) are performed for the same purpose. They minimize bleeding from the ruptured blood vessel to the rupture site. This will prevent the formation of huge hematomas at the last stage of regeneration, which directly affects the size of the scar tissue. Small hematomas in ruptured tissue and limited increase in interstitial edema also shorten the period of ischemia in granulation tissue, accelerating regeneration.
    [87] Other additional steps can be used to treat the injured muscle. In one embodiment, additional steps include administration of nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic ultrasound, hyperbaric oxygen, and in the case of severe injury, surgical procedures may also be used. NSAIDs are part of the initial treatment and should be started immediately after injury. Short-term use of NSAIDs in the early stages of treatment reduces the inflammatory cell response and there is no adverse effect on the tensile or contractile properties of the injured muscle.
    [88] In another embodiment, therapeutic ultrasound is used as an additional step. Therapeutic ultrasound is widely recommended and used for the treatment of muscle injuries. Therapeutic ultrasound is believed to promote the proliferative phase of myogeneration.
    [89] In another embodiment, high pressure oxygen is used as an additional step. For rabbits, hyperbaric oxygen therapy during the early stages of recovery is known to substantially improve the end result. Such hyperbaric oxygen therapy is believed to be helpful in promoting muscle regeneration in other mammals, such as humans.
    [90] In yet another embodiment, surgical intervention takes place as an additional step. Surgical treatment of muscle injuries is limited to use only for the most severe injuries, because in most cases conservative treatments can also yield good results. Surgical treatment is performed only when: (1) a massive intramuscular hematoma, (2) a third degree cleft or torn muscle with little or no agonize muscle, (3) a second degree cleft, or more than half of the muscle swelling torn.
    [91] In another broad embodiment of the invention, recombinant techniques are used to provide at least one neurotoxin component. Such techniques include obtaining genetic material having a code for, for example, one of the therapeutic, translocation, and / or target component (s) from either cloned DNA or synthetic oligonucleotide sequences from a natural source. . Genetic constructs are put into host cells in order to primaryly fuse and amplify cloning vectors such as phages and plasmids and genetic constructs. The cloning vector is then inserted into a host cell, preferably E. Coli. After expression of the recombinant gene in the host cell, the resulting protein can be isolated using conventional techniques. The expressed protein may comprise all three components of the neurotoxin. For example, the expressed protein may be a light chain of botulinum toxin type E (therapeutic component), a heavy chain of botulinum toxin type B, preferably H N (potential component), and Hc of botulinum toxin type A that selectively binds to motor neurons. It may include. In one embodiment, the expressed protein may not include all three components of the neurotoxin. In such cases, components known in the art can be used to chemically combine the components.
    [92] This recombinant production of neurotoxins has many advantages. For example, the preparation of neurotoxins from anaerobic Clostridium culture can be cumbersome and time-consuming, involving several steps of protein precipitation and multiple steps of purification involving long and repeated crystallization of toxins or several steps of column chromatography. It is a process. In particular, because the product is highly toxic, the process must be carried out under strict containment (BL-3). During the fermentation process, folded single-chain neurotoxins are activated by endogenous Clostridial proteases through a process called nicking. This nicking process involves removing about 10 amino acid residues from a single chain to form a double chain form in which the two chains are covalently bonded through interchain disulfide bonds.
    [93] Nicked neurotoxins are much more active than non-nicked forms. The amount and exact location of the nicking depends on the serotype of the bacteria producing the toxin. Single chain neurotoxin activation, ie the yield of nicked toxins, is different because the amounts of serotype and proteolytic activity provided by a given strain are different. For example, more than 99% of Clostridium botulinum serotype A single-chain neurotoxins are activated by Hall A Clostridium botulinum strains, whereas serotypes B and E are less active. Toxin is produced (0 to 75% depending on fermentation time). Therefore, in the commercial production of neurotoxins as therapeutics, highly toxic mature neurotoxins play a major role.
    [94] Thus, the degree of activation of the processed Clostridial toxin is an important consideration in the preparation of such materials. Neurotoxins, such as botulinum toxin and tetani toxin, are recombinantly non-toxic single chains (or reduced toxin activity) that are easy to convert from fast-growing bacteria (such as heterologous E. coli cells) to safe, easy to isolate and fully active forms. Single chain), it would be a great advantage if it can be expressed in high yield.
    [95] Considering safety as a top priority, previous work focuses on the expression in E. coli and purification of the heavy and light chains of tetany and botulinum toxin, respectively; This isolated chain is itself nontoxic. Li et al., Biochemistry 33: 7014-7020 (1994); Zhou et al., Biochemistry 34: 15175-15181 (1995), incorporated herein by reference. Thus, peptide chains can be prepared individually and then, under strictly controlled conditions, the heavy and light chain subunits can be joined by oxidative disulfide bonds to form a neuroparalytic double chain.
    [96] The following non-limiting examples provide preferred methods of treating injured muscle and preferred methods of making recombinant neurotoxins, preferably botulinum toxin. The method for preparing the recombinant botulinum toxin described in Examples 4-8 below is similar to that disclosed in International Patent Application WO 95/32738 to Dolly et al., Which is incorporated herein by reference.
    [97] Example 1
    [98] Ruptured Ruptured Biceps tendon
    [99] Biceps rupture often occurs at the proximal termini and includes the long head of the biceps. This muscle may rupture at the distal end on the radial, but is not common. Rupture is most common in adults over 40 who have a long history of shoulder pain associated with impingement syndrome. Over time, the gun wears out and weakens, eventually breaking partially or fully. In contrast, rupture is often caused by minor events. This rupture is usually associated with tearing the circuit board, especially in the elderly.
    [100] There is a 45-year-old male patient with a swollen lower arm after lifting a heavy box. The patient has experienced a sudden sharp pain with a squeaking sound in the upper arm. This man was diagnosed with a biceps tendon rupture and was early in the first phase of the recovery process. This rupture can be classified as a mild second degree upper left.
    [101] The patient is treated with a neurotoxin of about 0.1 U / Kg to about 25 U / Kg intramuscularly injected into the biceps muscle. Preferably, the neurotoxin is botulinum toxin type E and / or F, more preferably type A. The specific dosage and frequency of administration depend on a variety of factors and can be determined by the attending physician. The patient was also instructed to rest and ice and compress the biceps. Within 3 days of administering the neurotoxin, the patient may bend the arm. In addition, after about three days, the patient's inflammation is reduced, which means that the patient has entered the second and third stages of the recovery process. Pain in the patient is also significantly reduced. In addition, topical administration of about 10 units to about 200 units of botulinum toxin type A can be used for long-term (2-4 months) muscle fixation and pain reduction.
    [102] Example 2
    [103] Extensor appliance rupture
    [104] Rupture of the knee extensor mechanism occurs in one of two ways: as a result of sudden or intense force (such as jumping or lifting a heavy one) in young patients; And in older patients it occurs as a result of relatively minor forces. In each group, there may have been some arching before that. These disorders are typically sitting for some time, older patients who have suddenly increased activity levels, or those who have some preexisting or shared diseases, such as diabetes, rheumatoid arthritis, and other systemic inflammatory diseases, or previous knee surgery. Appears in the.
    [105] There's a 22-year-old woman who can't reach her knees. The patient also cannot make a straight leg raise and can only walk with her knees extended with her hands on her thighs. Simple X-rays show that the patella is below the normal position. The patient was diagnosed with severe quadriceps rupture.
    [106] After the injury was considered severe (3 degrees), the patient agreed to the recovery operation. After surgery, the patient is treated with a concentration of neurotoxin from about 0.1 U / Kg to about 25 U / Kg (botulinum toxin type A from about 10 units to about 400 units) into the quadriceps muscle intramuscularly. Preferably, the neurotoxin is botulinum toxin type A. The specific dosage and frequency of administration depend on a variety of factors and can be determined by the attending physician. The patient is also instructed to rest and ice and compress the quadriceps. Within about 15 days after neurotoxin administration, progressive motor and injury muscle activity became possible. The patient was then moved lightly on the recovering muscles to strengthen the recovering muscles and surrounding muscles. If the toxin's effect is further lost, the patient may then be able to quickly participate in a physiotherapy program or resume daily activities and / or sports. If the patient's livelihood depends on sport, botulinum toxin therapy will help the patient return to these activities quickly. About 10 units to about 200 units of botulinum toxin type A may be administered topically for long term (2-4 months) muscle fixation.
    [107] Example 3
    [108] Treatment of shin splints
    [109] In people running, shin pain in the lower extremities, which causes pain and limits activity, is common. Pain in the lower leg due to shin pain is caused by very small tearing of the leg muscles at the point of attachment to the right angle. There are two forms: 1. Anterior shin pain occurs in the anterior part of the tibia (tibia), and 2. Anterior shin pain occurs in the inner (middle) part of the leg along the tibia.
    [110] Anterior shin pain is due to muscle imbalance, insufficient shock absorption, or toe jumping. Excessive pronation can cause both anterior and posterior shin pain.
    [111] When treating a wounded muscle, such as shin pain, the following five steps are recommended: (1) using splints, pads, and / or clutches to protect the damaged muscle from further damage; (2) Activity is usually limited for 48 to 72 hours to begin the treatment process. Short-acting botulinum toxin type E or F or modified botulinum toxin type A to reduce the duration of biological activity in vivo (ie, short-term relaxation muscle paralysis). For use herein, suitable botulinum toxins, including botulinum toxin type A with reduced biological in vivo duration, are disclosed in pending US patent application 09/620840, which is hereby incorporated by reference in its entirety. Merged into In more severe seats, activity can continue to be restricted for weeks to months. If it is necessary to limit long-term activity, it may be suitable to administer long-acting botulinum toxin, eg, botulinum toxin type B (or unmodified), or more preferably, type A toxin. Without this treatment, the patient may be restricted for several weeks of activity. Once the healing process begins, advise to move and exercise the muscles lightly; (3) ice for 15-20 minutes each hour; (4) there must be continued pressure between the ice packs with elastic bandages, etc .; (5) Increase the damage area to minimize swelling.
    [112] Example 4
    [113] Subcloning of BoNT / A-L Chain Genes
    [114] This example describes a method of cloning a polynucleotide sequence that encodes a BoNT / A-L chain. The DNA sequence encoding the BoNT / AL chain is determined by a PCR protocol using synthetic oligonucleotides having the 5'-AAAGGCCTTTTGTTAATAAACAA-3 '(SEQ ID # 1) and 5'-GGAATTCTTACTTATTGTATCCTTTA-3' (SEQ ID # 2) sequences. Can be amplified. Such primers can be used to introduce Stu I and EcoR I restriction sites into the 5 'and 3' ends of the BoNT / A-L chain gene fragment, respectively. Such restriction sites can then be used to facilitate unidirectional subcloning of the amplified product. This primer also introduces an end codon at the C-terminus of the L chain coding sequence. Chromosomal DNA derived from C. botulinum (strain 63 A) can be provided as a template in the amplification reaction.
    [115] PCR amplification was performed with 10 mM Tris-Hcl (pH 8.3), 50 mM KCl, 1.5 mM MgCl 2 , 0.2 mM each deoxynucleotide triphosphate (dNTP), 50 pmol each primer, 200 ng genome DNA and 2.5 units of Taq-polymer It can be carried out in a volume of 100 μl containing lyase (Promega). The reaction mixture is denatured for 35 cycles (1 minute at 94 ° C.), annealing (2 minutes at 37 ° C.) and polymerization (2 minutes at 72 ° C.). Finally, the reaction is extended for an additional 5 minutes at 72 ° C.
    [116] PCR amplification products were digested using Stu I and EcoR I, purified by agarose gel electrophoresis, and linked to, for example, Sma I and EcoR I digested pBluescript II SK * to bind the plasmid, pSAL. Get Bacterial transformants containing these plasmids are isolated by standard methods. The cloned L chain polynucleotides can be confirmed by double strain plasmid sequencing using SEQUENASE (manufactured by Bio Chemicals, USA) according to the manufacturer's instructions. Synthetic oligonucleotide sequencing primers are prepared as needed to proceed with overlapping sequencing. The cloned sequence is described in Binz et al., In J. Biol. Chem. 265,9153 (1990) and Thompson et al., In Eur. J. Biochem. 189,73 (1990).
    [117] Site-regulated mutations designed to degrade the enzymatic activity of the BoNT / A-L chains can also be generated.
    [118] Example 5
    [119] Expression of Botulinum Toxin Type A-L (BoNt / A-L) Chain Fusion Proteins
    [120] This example describes a method for demonstrating the expression of wild type L chain, which can serve as a therapeutic component, in bacteria containing a pCA-L plasmid. Using well isolated bacterial colonies containing pCAL, inoculate L-Bros containing 100 μg / ml ampicillin and 2% (w / v) glucose and incubate overnight at 30 ° C. with shaking. Overnight cultures are diluted 1: 10 in fresh L-broth containing 0.1 mg / ml ampicillin and incubated for 2 hours. The overnight cultures are diluted 1:10 in fresh L-broth containing 100 μg / ml ampicillin and incubated for 2 hours. IPTG is added to a final concentration of 0.1 mM to induce fusion protein expression. Incubate an additional 4 hours at 30 ° C., then centrifuge at 6,000 × g for 10 minutes to collect bacteria.
    [121] Small scale SDS-PAGE analysis can be performed to confirm the presence of a 90 kDa protein band in samples derived from IPTG-derived bacteria. This Mr is consistent with the expected size of the fusion protein with MBP (-40 kDa) and BoNT / A-L chain (-50 kDa) components. In addition, IPTG-derived clones contain substantially higher amounts of fusion proteins when compared to samples isolated from control cultures.
    [122] In IPTG-derived bacterial extracts, the presence of the desired fusion protein is also described in Cenci di Bello et al., In Eur. J. Biochem. This can be confirmed by Western blot using the polyclonal anti-L chain probe disclosed in 2191: 61 (1993). Reactive bands of PVDF membranes (Pharmacia; Milton Keynes, UK) can be visualized using anti-rabbit immunoglobulin and ECL deletion systems (Amersham, UK) conjugated to horseradish peroxidase (BioRad; Hemel Hempstead, UK). Can be. Western blot results confirm the presence of the dominant fusion protein with several fake bands corresponding to the protein of Mr lower than the full size fusion protein. These observations suggest that limited degradation of the fusion protein occurs in bacteria or during the isolation process. The use of 1 mM or 10 mM benzamidine (Sigma, Pulley, UK) during the separation process does not eliminate this proteolysis.
    [123] The undecomposed fusion protein obtained obtained by the above process remains to a sufficient extent for use in the method described herein. Based on the measurements with the salted SDS-PAGE gel, IPTG induced bacterial clones yielded 5-10 mg of total MBP-wild or mutant L chain fusion protein per liter of culture. Therefore, despite limited proteolysis, the method of producing the BoNT / A-L chain fusion protein described herein is very effective.
    [124] MBP-L chain fusion proteins encoded by pCAL and pCAL-TyrU7 expression plasmids are purified from bacteria using amylose affinity chromatography. The recombinant wild-type or mutant L chain is then separated from the sugar binding domain of the fusion protein by site-specific cleavage with factor X 2 . This cleavage method yields free MBP, free L chains and small amounts of uncleaved fusion protein. The resulting L chain, present in this mixture, appears to have the desired activity, but additional purification steps can also be used. Thus, a mixture of cleavage products is applied to a second amylose affinity column that binds to both MBP and uncleaved fusion protein. The free L chains do not remain in the affinity column and are separated for use in the experiments below.
    [125] Example 6
    [126] Purification of Fusion Proteins and Isolation of Recombinant BoNT / A-L Chains
    [127] This example describes a method for preparing and purifying wild-type recombinant BoNT / A light chains from bacterial clones. Pellets from 1 liter of bacterial culture expressing wild-type BoNT / AL chain protein were transferred to a column buffer containing 1 mM phenylmethanesulfonyl fluoride (PMSF) and 10 mM benzamidine [10 mM Tris-HCl, pH 8.0. ), 200 mM NaCl, 1 mM EGTA, and 1 mM DTT] and dissolved by ultrasound. The lysate is cleared by centrifugation at 15,000 xg for 4 minutes at 4 ° C. The supernatant is applied to an amylose affinity column [2 × 10 cm, 30 ml resin] (New England BioLabs; Hitchin, UK). The unbound protein is washed out of the resin using column buffer until judged by a stable absorbance record at 280 nm until the eluate is free of protein. The bound MBP-L chain fusion protein is then eluted with column buffer containing 10 mM maltose. Aliquots containing the fusion protein were combined and dialyzed for 72 h at 4 ° C. against 20 mM Tris-HCl, pH 8.0 supplemented with 150 mM NaCl, 2 mM CaCl 2 and 1 mM DTT.
    [128] The fusion protein was cleaved with factor X 2 (Promega, Southampton, UK) with enzyme: substrate ratio 1: 100, dialysis against 20 mM Tris-HCl, pH 8.0 buffer supplemented with 150 mM NaCl, 2 mM CaCl 2 and 1 mM DTT. do. Dialysis at 4 ° C. for 24 hours. The mixture of MBP and wild type or mutant L chains obtained from the cleavage step is placed in a 10 ml amylose column equilibrated with column buffer. An aliquot of the effluent passed through the fractions is prepared for SDS-PAGE analysis to identify samples containing L chains. The remainder of the effluent passing through the fractions is stored at -20 ° C. Total E. coli extract or purified protein is solidified in SDS sample buffer and PAGE according to standard methods. The results of this method showed that the recombinant toxin fragments accounted for approximately 90% protein content in the sample.
    [129] The foregoing results indicate that the approach for preparing MBP-L chain fusion proteins described herein can be effectively used to prepare wild type and mutant recombinant BoNT / A-L chains. The results also demonstrate that the recombinant L chain can be purified from the maltose binding domain of the fusion protein and then purified.
    [130] Sensitive antibody-based assays were performed to compare the enzymatic activity of the recombinant L chain product with natural controls. This assay used antibodies having specificity for the unmodified C-terminal region of SNAP25, corresponding to BoNT / A cleavage sites. Western blot of the reaction product for BoNT / A cleavage of SNAP25 showed that the antibody could not bind to the SNAP25 sub-fragment. In other words, the antibody re-negotiation used in the following examples recognized only unmodified SNAP-25. Loss of antibody binding indicates that SNAP-25 proteolysis occurred by the added BoNT / A light chain or recombinant derivatives thereof.
    [131] Example 7
    [132] Evaluation of Proteolytic Activity of Recombinant L Chain against SNAP-25
    [133] This example describes a method that demonstrates that both natural and recombinant BoNT / AL chains can proteolytically SNAP-25 substrates. Quantitative assays are used to compare the ability of the wild type and its recombinant analogs to cleave SNAP-25 substrates. The substrate used for this assay is a glutathione-S-transferase (GST) -SNAP containing a cleavage site for thrombin, expressed using a pGEX-2T vector and purified by affinity chromatography in glutathione agarose. Obtained by -25 fusion protein. Then, SNAP-25 is isolated from the fusion protein with thrombin in 50 mM Tris-HCl (pH 7.5) containing 150 mM NaCl, 2 mM CaCl 2 at an enzyme: substrate ratio of 1: 100 (Smith et al., Gene 67:31). (1988)). Undissolved fusion protein and dissociated glutathione-binding domain bind to the gel. Recombinant SNAP-25 protein is eluted with later buffer and dialyzed for 24 hours at 4 ° C. against 100 mM HEPES (pH 7.5). Total protein concentration is determined by conventional methods.
    [134] Rabbit polyclonal antibodies specific for the C-terminal region of SNAP-25 were generated for synthetic peptides having the amino acid sequence CANQRATKMLGSG (SEQ ID # 3). This peptide corresponds to residues 195 and 206 of the synaptic plasma membrane protein, and N-terminal cysteine residues were not found in native SNAP-25. Synthetic peptides were synthesized using bovine serum albumin (BSA) (Sigma), using maleimidobenzoyl-N-hydroxysuccinimide ester (MBS) (Sigma, Pulley, UK) as cross-linked neurotoxin to enhance antigenicity. Fully, UK) (Liu et al., Biochemistry 18: 690 (1979) 1). N-terminal cysteine residues were added to an aminoalkyl agarose resin (Bio-Rad, Hemel Hempstead, UK), which was activated with iodiacetic acid using a cross-linker ethyl 3- (3-dimethylpropyl) carbodiimide. Affinity purification of the anti-peptide antibody is performed using a column comprising the antigenic peptide conjugated through. The column was washed successively with 25 mM Tris-HCl (pH 7.4) and 150 mM NaCl, then eluted peptide specific antibody with 100 mM glycine (pH 2.5) and 200 mM NaCl solution, and 0.2 ml of 1M Tris-HCl ( pH 8.0) collected in test tubes containing neutralization buffer.
    [135] Before determining enzyme activity, all recombinant samples containing wild type L chains are dialyzed overnight at 100 ° C. HEPES, pH 7.5, containing 0.02% rubrol and 10 μM zinc acetate at 4 ° C. Then, BoNT / A previously reduced at 37 ° C. for 30 minutes using 20 mM DTT, and the dialysis sample are diluted to different concentrations in later HEPES buffer supplemented with 1 mM DTT.
    [136] The reaction mixture comprises 5 μl recombinant SNAP-25 substrate (final concentration 8.5 μM) and 20 μl reduced BoNT / A or recombinant wild type L chain. After incubating all samples for 1 hour at 37 ° C., the reaction is quenched using 25 μl 2% trifluoroacetic acid (TFA) aqueous solution and 5 mM EDTA (Foran et al., Biochemistry 33: 15365 (1994)). SDS-PAGE sample buffer is added and boiled to prepare aliquots of each sample for western blot using SDS-PAGE and polyclonal SNAP-25 antibodies. Anti-SNAP-25 antibody reactivity is monitored using an ECL detection system and quantified by densitometry scanning.
    [137] Western blot results showed a clear difference between the purified mutant L chain and the proteolytic activity of the native or recombinant wild type BoNT / A-L chain. In particular, recombinant wild-type L chains cleave SNAP-25 substrates, although somewhat less potent than the reduced BoNT / A native L chains serving as positive controls of the present method. That is, BoNT / A-L chains in enzymatically active form are provided by recombinant methods and are substantially isolated. Furthermore, substitution of only one amino acid in the L chain protein prevents the recombinant protein from breaking down synaptic terminal proteins.
    [138] As a preliminary experiment on the biological activity of the wild type recombinant BoNT / AL chain, the ability of the MBP-L chain fusion protein to reduce the release of Ca 2+ -induced catecholamines from digittonin-permeable bovine adrenal chromaffin cells was tested. Consistently, the wild type recombinant L chain fusion protein truncated with factor X 2 to produce a mixture containing unmodified or free MBP and recombinant L chains, Ca 2 , equivalent to the inhibition caused by native BoNT / A. + -Dose-dependent inhibition of stimulus release was induced.
    [139] Example 8
    [140] Reconstructed purified H chain, natural L chain, and recombinant wild type L chain
    [141] Natural H and L chains were separated from BoNT / A (List Biological Inc., Campbell, USA) using 2M urea, reduced to 100 mM DTT, and purified by the identified chromatography method (Kozaki et al., Japan J. Med. Sci. Biol. 34:61 (1981)); Maisey et al., Eur. J. Biochem. 177: 683 (1988). The purified H chains are combined with the same molar amount of natural L chains or recombinant wild type L chains. The sample can be reconstituted by dialysis at 4 ° C. for 4 days against a buffer consisting of 25 mM Tris (pH 8.0), 50 μM zinc acetate and 150 mM NaCl. After dialysis, the recombinant L and natural H chains combine to form a disulfide linked 150 kDa double chain, monitored by SDS-PAGE, quantitatively scanned and quantified. For recombinant L chains the proportion of double chain molecules formed is lower than that obtained when natural L chains are used. In fact, at least 90% of the natural L chains are reconstituted with the H chains, whereas only about 30% of the recombinant wild-type or mutant L chains are recombined. Despite this low reconstruction efficiency, materials that contain sufficient recombinant L chains for use in subsequent functional studies are readily produced.
    [142] While the invention has been described with reference to various specific examples and embodiments, it is to be understood that the invention is not so limited, and that it may be practiced variously within the scope of the following claims. Other embodiments, variations, and modifications are possible within the scope of the invention. For example, from about 500 units to about 400 units of botulinum toxin type B can be used to treat injured muscle in accordance with the methods disclosed herein.
    权利要求:
    Claims (13)
    [1" claim-type="Currently amended] A method of treating injured muscle, comprising the step of topically administering a therapeutically effective amount of neurotoxin to an injured muscle.
    [2" claim-type="Currently amended] The method of claim 1,
    The topical administration step is by intramuscular injection.
    [3" claim-type="Currently amended] The method of claim 1,
    And wherein said neurotoxin substantially anchors the injured muscle.
    [4" claim-type="Currently amended] The method of claim 1,
    And wherein said neurotoxin is effective to fix said damaged muscle during the first and second stages of the process of recovery of said damaged muscle.
    [5" claim-type="Currently amended] The method of claim 1,
    Wherein said neurotoxin is effective to fix said damaged muscle during the first stage of the repair process of said damaged muscle.
    [6" claim-type="Currently amended] The method of claim 1,
    The neurotoxin is botulinum toxin type A, B, C 1 , D, E, F or G.
    [7" claim-type="Currently amended] The method of claim 1,
    The neurotoxin is a recombinantly produced neurotoxin.
    [8" claim-type="Currently amended] The method of claim 1,
    Treating said damaged muscle with physiotherapy and / or surgical surgery.
    [9" claim-type="Currently amended] and administering a therapeutically effective amount of botulinum toxin to the injured muscle in vivo to treat the injured muscle.
    [10" claim-type="Currently amended] The method of claim 10,
    The botulinum toxin is botulinum toxin type A.
    [11" claim-type="Currently amended] A method of promoting healing of an injured muscle, comprising topically administering a therapeutically effective amount of botulinum toxin type A to the injured muscle in vivo to promote healing of the injured muscle.
    [12" claim-type="Currently amended] A method of treating pain associated with an impaired muscle, the method comprising topically administering a therapeutically effective amount of botulinum toxin to an injured muscle in vivo to reduce pain associated with the impaired muscle.
    [13" claim-type="Currently amended] The method of claim 12,
    The botulinum toxin is botulinum toxin type A.
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    同族专利:
    公开号 | 公开日
    EP1322324B1|2010-08-18|
    CN102078597A|2011-06-01|
    CN1658897A|2005-08-24|
    NZ524793A|2005-09-30|
    US6423319B1|2002-07-23|
    DK1322324T3|2010-11-01|
    EP2174662A2|2010-04-14|
    US20070128227A1|2007-06-07|
    JP2004518632A|2004-06-24|
    WO2002028425A3|2003-02-27|
    US7108857B2|2006-09-19|
    WO2002028425A2|2002-04-11|
    US20020192240A1|2002-12-19|
    EP1322324A2|2003-07-02|
    ES2348862T3|2010-12-16|
    US7468188B2|2008-12-23|
    MXPA03002576A|2004-04-20|
    EP2174662A3|2010-06-30|
    JP2012229263A|2012-11-22|
    US6955813B2|2005-10-18|
    US20050281846A1|2005-12-22|
    BR0114440A|2004-06-15|
    AU8699101A|2002-04-15|
    CA2424242A1|2002-04-11|
    DE60142839D1|2010-09-30|
    AT477816T|2010-09-15|
    KR100873819B1|2008-12-11|
    AU2001286991B2|2005-05-19|
    TWI292713B|2008-01-21|
    CA2424242C|2007-08-07|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    法律状态:
    2000-10-04|Priority to US09/678,189
    2000-10-04|Priority to US09/678,189
    2001-08-31|Application filed by 알러간, 인코포레이티드
    2001-08-31|Priority to PCT/US2001/027193
    2003-06-02|Publication of KR20030043981A
    2008-12-11|Application granted
    2008-12-11|Publication of KR100873819B1
    2011-05-17|First worldwide family litigation filed
    优先权:
    申请号 | 申请日 | 专利标题
    US09/678,189|US6423319B1|2000-10-04|2000-10-04|Methods for treating muscle injuries|
    US09/678,189|2000-10-04|
    PCT/US2001/027193|WO2002028425A2|2000-10-04|2001-08-31|Methods for treating muscle injuries|
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