C1 inhibitor with short half-life transient treatment

Abstract

The present invention relates to the use of a C1 inhibitor (C1INH) with shorter half-life than plasma-derived C1INH for the preparation of a medicament for the transient treatment of an individual. It relates to both therapeutic and prophylactic treatment. The method of the invention allows for the administration of C1INH at certain therapeutic levels for a concise pre-determined time span. Pharmaceutical compositions based on C1INH with shorter half-lives may be used both in situations where transient treatment is merely and advantage. The advantage of the use according to the invention is that an individual is not exposed to C1INH for longer than required, since the levels of the C1INH more rapidly subsides after administration has stopped. In contrast, levels of plasma-derived C1INH would remain elevated for a prolonged period of time.

1. A method of treating an individual suffering from an absolute or relative deficiency of functional C1 inhibitor, comprising
 determining a transient treatment regime of a C1 inhibitor based on it having a shorter half-life than plasma-derived C1 inhibitor; 
 administering the C1 inhibitor to the individual in the transient treatment regime. 
 
     
     
       2. The method according to  claim 1  wherein the treatment is for a condition or disease in which it is beneficial to control the concentration or the time span of presence of the C1 inhibitor. 
     
     
       3. The method according to  claim 1  wherein the C1 inhibitor with shorter half-life is prepared by modification of the carbohydrate structure of the plasma-derived C1 inhibitor. 
     
     
       4. The method according to  claim 3  wherein the half-life of the C1 inhibitor is shortened by the presence of more terminal galactose, N-acetylglucosamine, mannose, fucose or phosphomannose moieties than on the plasma-derived C1 inhibitor. 
     
     
       5. The method according to  claim 4  wherein the presence of more terminal galactose, N-acetylglucosamine, mannose, fucose or phosphomannose moieties is due to in vivo or in vitro glycosylation. 
     
     
       6. The method according to  claim 1  wherein the C1 inhibitor with shorter half-life is a recombinantly produced C1 inhibitor. 
     
     
       7. The method according to  claim 1  wherein the C1 inhibitor with shorter half-life is produced in a microorganism or in a non-human transgenic mammal. 
     
     
       8. The method according to  claim 1  wherein the individual is a new-born. 
     
     
       9. The method according to  claim 1  wherein the treatment is for an individual suffering from a disorder associated with ischemic reperfusion injury. 
     
     
       10. The method according to  claim 1  wherein the individual is suffering from or susceptible to any of acquired angioedema (AAE), hereditary angioedema (HAE), sepsis, septic shock, acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), preeclampsia, vascular leakage syndrome (VLS), graft versus host disease (GVHD), severe burns, thermal trauma; rheumatoid arthritis; systemic lupus erythematosus; meningitis: cardio-pulmonary bypass (CPB), extra corporal circulation (ECC) and (hyper)acute graft rejection; acute myocardial infarction (AMI); ischemic reperfusion injury after emergency coronary surgery for failed percutaneous transluminal coronary angioplasty (PCTA), or after any vascular surgery with blood vessel cross clamping (e.g. of aorta, leading to skeletal muscle ischemia); stroke; after hemorragic shock; after or during ECC; after/during CPB; after/during any transplantation surgery (lung, liver, kidney, heart); intestinal ischemia; pancreatitis after manipulation of pancreatic or bile duct (ERCP). 
     
     
       11. The method according to  claim 1  wherein the C1 inhibitor is for intravenous administration at a dose of more than 25 U/kg body weight of the individual. 
     
     
       12. The method according to  claim 11  wherein the C1 inhibitor is for intravenous administration at a dose of more than 50 U/kg body weight of the individual. 
     
     
       13. The method according to  claim 1  wherein the C1 inhibitor with a shorter half-life has a half-life which is less than 60% of the half-life of plasma-derived C1 inhibitor. 
     
     
       14. The method of  claim 1  wherein the dose is higher than that of an equivalent pharmaceutical composition comprising plasma derived C1 inhibitor and clearance is faster relative to that of the plasma-derived C1 inhibitor. 
     
     
       15. A method of treating an individual suffering from an absolute or relative deficiency of functional C1 inhibitor, comprising determining a transient treatment regime of a plasma derived C1 inhibitor based on it having a modification of a carbohydrate structure that produces a plasma derived C1 inhibitor having a shorter half-life than natural plasma-derived C1 inhibitor; administering the plasma derived C1 inhibitor having a shorter half-life than natural plasma-derived C1 inhibitor to the individual in the transient treatment regime; wherein the plasma derived C1 inhibitor with shorter half-life has a half-life which is less than 60% of the half-life of natural plasma-derived C1 inhibitor. 
     
     
       16. A method of treating an individual suffering from an absolute or relative deficiency of functional C1 inhibitor, comprising determining a transient treatment regime of a plasma derived C1 inhibitor based on it having a modification of a carbohydrate structure that produces a plasma derived C1 inhibitor having a shorter half-life than natural plasma-derived C1 inhibitor; administering the plasma derived C1 inhibitor having a shorter half-life than natural plasma-derived C1 inhibitor to the individual in the transient treatment regime; wherein the plasma derived C1 inhibitor with shorter half-life has a half-life which is less than 60% of the half-life of natural plasma-derived C1 inhibitor, and wherein the plasma derived C1 inhibitor having a shorter half-life is administered at dose that is higher than that of an equivalent pharmaceutical composition comprising natural plasma derived C1 inhibitor and clearance is faster relative to that of the natural plasma-derived C1 inhibitor. 
     
     
       17. A method of treating an individual suffering from an absolute or relative deficiency of functional C1 inhibitor, comprising determining a transient treatment regime of a recombinant C1 inhibitor based on it having a modification of a carbohydrate structure that produces a recombinant plasma derived C1 inhibitor having a shorter half-life than natural plasma-derived C1 inhibitor; administering the recombinant plasma derived C1 inhibitor to the individual in the transient treatment regime; wherein the recombinant C1 inhibitor has a half-life which is less than 60% of the half-life of natural plasma-derived C1 inhibitor. 
     
     
       18. A method of treating an individual suffering from an absolute or relative deficiency of functional C1 inhibitor, comprising determining a transient treatment regime of a recombinant C1 inhibitor based on it having a modification of a carbohydrate structure that produces a recombinant C1 inhibitor having a shorter half-life than natural plasma-derived C1 inhibitor; administering the recombinant C1 inhibitor to the individual in the transient treatment regime; wherein the recombinant C1 inhibitor has a half-life which is less than 60% of the half-life of natural plasma-derived C1 inhibitor, and wherein the recombinant C1 inhibitor is administered at dose higher than that of an equivalent pharmaceutical composition comprising natural plasma derived C1 inhibitor and clearance of the recombinant C1 inhibitor is faster relative to that of the natural plasma-derived C1 inhibitor. 
     
     
       19. The method according to claim 17 wherein the treatment is for a condition or disease in which it is beneficial to control the concentration or the time span of presence of the C1 inhibitor. 
     
     
       20. The method according to claim 17 wherein the half-life of the C1 inhibitor is shortened by the presence of more terminal galactose, N-acetylglucosamine, mannose, fucose or phosphomannose moieties than on the natural plasma-derived C1 inhibitor. 
     
     
       21. The method according to claim 20 wherein the presence of more terminal galactose, N-acetylglucosamine, mannose, fucose or phosphomannose moieties is due to in vivo or in vitro glycosylation. 
     
     
       22. The method according to claim 17 wherein the recombinant C1 inhibitor with shorter half-life is produced in a microorganism. 
     
     
       23. The method according to claim 17, wherein the recombinant C1 inhibitor with shorter half-life is produced in a non-human transgenic mammal. 
     
     
       24. The method according to claim 17 wherein the individual is a newborn. 
     
     
       25. The method according to claim 17 wherein the treatment is for an individual suffering from a disorder associated with ischemic reperfusion injury. 
     
     
       26. The method according to claim 17 wherein the individual is suffering from or susceptible to any of acquired angioedema (AAE), hereditary angioedema (HAE), sepsis, septic shock, acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), preeclampsia, vascular leakage syndrome (VLS), graft versus host disease (GVHD), severe burns, thermal trauma; rheumatoid arthritis; systemic lupus erythematosus; meningitis; cardiopulmonary bypass (CPB), extra corporal circulation (ECC) and (hyper)acute graft rejection; acute myocardial infarction (AMI); ischemic reperfusion injury after emergency coronary surgery for failed percutaneous transluminal coronary angioplasty (PCTA), or after any vascular surgery with blood vessel cross clamping (e.g. of aorta, leading to skeletal muscle ischemia); stroke; after hemorragic shock; after or during ECC; after/during CPB; after/during any transplantation surgery (lung, liver, kidney, heart); intestinal ischemia; pancreatitis after manipulation of pancreatic or bile duct (ERCP). 
     
     
       27. The method according to claim 17 wherein the recombinant C1 inhibitor is administered intravenously at a dose of more than 25 U/kg body weight of the individual. 
     
     
       28. The method according to claim 27 wherein the recombinant C1 inhibitor is administered intravenously at a dose of more than 50 U/kg body weight of the individual. 
     
     
       29. The method according to claim 17 wherein the recombinant C1 inhibitor is administered intravenously at a dose of 50 U/kg body weight of the individual. 
     
     
       30. The method according to claim 17 wherein the recombinant C1 inhibitor is administered intravenously at a dose of 100 U/kg body weight of the individual.