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医薬品開発におけるファーマコメトリクスの応用に関する研究

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Title

医薬品開発におけるファーマコメトリクスの応用に関する

研究( 本文(Fulltext) )

Author(s)

小亀, 暁史

Report No.(Doctoral

Degree)

博士(獣医学) 乙第173号

Issue Date

2021-03-15

Type

博士論文

Version

ETD

URL

http://hdl.handle.net/20.500.12099/81635

※この資料の著作権は、各資料の著者・学協会・出版社等に帰属します。

(2)

་⸆ရ㛤Ⓨ࡟࠾ࡅࡿࣇ࢓࣮࣐ࢥ࣓ࢺࣜࢡࢫࡢ

ᛂ⏝࡟㛵ࡍࡿ◊✲

㸰㸮㸰㸮ᖺ





ᒱ㜧኱Ꮫ኱Ꮫ㝔㐃ྜ⋇་Ꮫ◊✲⛉







ᑠட ᬡྐ

(3)

㻌㻌

་⸆ရ㛤Ⓨ࡟࠾ࡅࡿࣇ࢓࣮࣐ࢥ࣓ࢺࣜࢡࢫࡢ

ᛂ⏝࡟㛵ࡍࡿ◊✲㻌

㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌

ᑠட ᬡྐ㻌

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i ➨1 ❶㸸 ⥴ゝ ... 1 1.1 ࡣࡌࡵ࡟ ... 1 1.2 ་⸆ရ㛤Ⓨࡢ㐣⛬࡟ࡘ࠸࡚ ... 1 1.3 ࣇ࢓࣮࣐ࢥ࣓ࢺࣜࢡࢫ࡜ࡣ ... 2 1.4 ᮏ◊✲ࡢ┠ⓗ ... 3 ➨2 ❶㸸 ࣮ࣜࣗࣉࣟࣞࣜࣥ㓑㓟ሷ㸦TAP-144㸧࡜ࡢ⸆ຠẚ㍑ࢆ௓ࡋࡓ ᚋ⥅⸆ TAK-448 㑅ᢥ ࡢጇᙜᛶࡢ᳨ド ... 6 2.1 ࡣࡌࡵ࡟ ... 6 2.2 TAK-448 ࡟ࡘ࠸࡚ ... 6 2.3 ᐇ㦂ᮦᩱ࡜᪉ἲ ... 8 2.3.1 ⿕㦂≀㉁ ... 8 2.3.2 ᢠ⭘⒆άᛶホ౯ࡢࡓࡵࡢື≀ヨ㦂 ... 8 2.3.3 ືែヨ㦂 ... 9 2.3.4 ࢹ࣮ࢱฎ⌮ ... 9 2.3.5 PK ࣔࢹࣝ ... 10 2.3.6 PD ࣔࢹࣝ ... 11 2.3.6.1 ⭘⒆ቑṪ࠾ࡼࡧ⪏ᛶࡢࣔࢹࣝ໬ ... 11 2.3.6.2 ⸆ຠホ౯ࣔࢹࣝ ... 12 2.4 ⤖ᯝ ... 13 2.4.1 PK ࣔࢹࣝ ... 13 2.4.2 PD ࣔࢹࣝ ... 13 2.4.2.1 ⭘⒆ቑṪ࠾ࡼࡧ⪏ᛶࡢࣔࢹࣝ໬ ... 13 2.4.2.2 ⸆ຠホ౯ࣔࢹࣝ ... 14 2.5 ⪃ᐹ ... 14 2.6 ᑠᣓ ... 16 ➨3 ❶㸸 TAK-441 ࡢ⮫ᗋ⮳㐺⏝ἲ࠾ࡼࡧ⏝㔞ุᐃᇶ‽ࡢタᐃ ... 17

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ii 3.1 ࡣࡌࡵ࡟ ... 17 3.2 TAK-441 ࡟ࡘ࠸࡚ ... 18 3.3 ᐇ㦂ᮦᩱ࡜᪉ἲ ... 19 3.3.1 ⿕㦂≀㉁ ... 19 3.3.2 ື≀ ... 19 3.3.3 ᢠ⭘⒆άᛶホ౯ࡢࡓࡵࡢື≀ヨ㦂 ... 20 3.3.4 ⸆≀ືែヨ㦂࠾ࡼࡧࣂ࢖࣐࣮࣮࢜࢝ࡢ ᐃࡢࡓࡵࡢື≀ヨ㦂 ... 20 3.3.5 ศᯒ᪉ἲ ... 21 3.3.5.1 ⾑₢࠾ࡼࡧ⤌⧊୰TAK-441 ⃰ᗘ ... 21 3.3.5.2 Gli1 mRNA ࡢⓎ⌧㔞 ... 22 3.3.6 ࢹ࣮ࢱฎ⌮ ... 22 3.3.7 PK/PD ࣔࢹࣝࡢᵓ⠏ ... 23 3.3.7.1 PK ࣔࢹࣝ ... 23 3.3.7.2 ⸆ຠࣔࢹࣝ ... 23 3.3.7.3 ࣂ࢖࣐࣮࣮࢜࢝ࣔࢹࣝ ... 24 3.4 ⤖ᯝ ... 24 3.4.1 PK ࣔࢹࣝ ... 24 3.4.2 ⤌⧊୰TAK-441 ࡢ⃰ᗘ ... 24 3.4.3 ⸆ຠࡢࣔࢹࣝ ... 25 3.4.4 ࣂ࢖࣐࣮࣮࢜࢝ࣔࢹࣝ ... 25 3.4.5 ࣂ࢖࣐࣮࣮࢜࢝࡜⸆ຠࡢᐃ㔞ⓗ࡞㛵ಀ ... 25 3.5 ⪃ᐹ ... 25 3.6 ᑠᣓ ... 28 ➨4 ❶㸸 Fasiglifam ࡢ⮫ᗋ⏝㔞࡟࠾ࡅࡿᏳ඲ᇦࡢᐃ㔞ⓗホ౯ ... 29 4.1 ࡣࡌࡵ࡟ ... 29 4.2 Fasiglifam ࡟ࡘ࠸࡚ ... 29

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iii 4.3 ᐇ㦂ᮦᩱ࡜᪉ἲ ... 30 4.3.1 ⿕㦂≀㉁࠾ࡼࡧ⏕యヨᩱ ... 30 4.3.2 ື≀ ... 31 4.3.3 ࣐ࢺࣜࢵࢡࢫᨭ᥼࣮ࣞࢨ࣮⬺㞳࢖࢜ࣥ໬㣕⾜᫬㛫ᆺ㉁㔞ศᯒ(MALDI-TOF MS) ... 31 4.3.4 Fasiglifam ࠾ࡼࡧ fasiglifam-G ࡢ⫹Ồ୰⁐ゎᗘ ... 31 4.3.5 ⿕㦂≀㉁ࡢᢞ୚࡜ヨᩱ᥇ྲྀ ... 32 4.3.5.1 ࣛࢵࢺ࡟ [14C]fasiglifam ࢆ⤒ཱྀᢞ୚ࡋࡓ࡜ࡁࡢ⾑₢࠾ࡼࡧ⫢⮚୰⤌ᡂ ... 32 4.3.5.2⫹⟶࢝ࢽ࣮ࣗࣞࢩࣙࣥࣛࢵࢺ࡟ [14C]fasiglifam ࢆ༑஧ᣦ⭠ෆᢞ୚ࡋࡓ࡜ࡁࡢ ⫹Ồ᤼ἥ ... 32 4.3.5.3 ࢖ࢾ࡟ [14C]fasiglifam ࢆ⤒ཱྀᢞ୚ࡋࡓ࡜ࡁࡢ⾑₢㸪⫢⮚࠾ࡼࡧ⫹Ồ୰⤌ᡂ ... 32 4.3.5.4 ⫹⟶࢝ࢽ࣮ࣗࣞࢩࣙࣥ࢖ࢾ࡟ [14C]fasiglifam ࢆ⤒ཱྀᢞ୚ࡋࡓ࡜ࡁࡢ⫹Ồ᤼ἥ ... 33 4.3.6 ศᯒ᪉ἲ ... 33 4.3.6.1 ᨺᑕ⬟ࡢ ᐃ࡜⤌ᡂศᯒ ... 33 4.3.6.2 ⾑₢୰fasiglifam ⃰ᗘࡢᐃ㔞 ... 35 4.3.7 ⫹Ồ୰⃰ᗘண  ... 35 4.4 ⤖ᯝ ... 36 4.4.1 MALDI-TOF MS ... 36 4.4.2 ⾑₢࠾ࡼࡧ⫢⮚୰⤌ᡂ ... 37 4.4.3 ཯᚟ᢞ୚ᚋࡢfasiglifam ࠾ࡼࡧ௦ㅰ≀ࡢ࢖ࢾ⾑₢࠾ࡼࡧ⫢⮚࡬ࡢ⵳✚ ... 37 4.4.4 Fasiglifam ࠾ࡼࡧ௦ㅰ≀ࡢ⫹Ồ᤼ἥ⋡ ... 37 4.4.5 ⫹Ồ୰ᨺᑕ⬟⃰ᗘ᥎⛣ ... 38 4.4.6 ࣛࢵࢺ࠾ࡼࡧ࢖ࢾ࡟࠾ࡅࡿ⫹Ồὶ㔞 ... 38 4.4.7 Fasiglifam ࠾ࡼࡧ fasiglifam-G ࡢ⫹Ồ୰⁐ゎᗘ ... 38 4.4.8 ⫹Ồ୰⃰ᗘண  ... 38 4.5 ⪃ᐹ ... 39 4.6 ᑠᣓ ... 40

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iv ➨5 ❶㸸 ⤫ྜ⪃ᐹ࠾ࡼࡧࡲ࡜ࡵ ... 42 5.1 㠀⮫ᗋ᥈⣴ẁ㝵࡟࠾ࡅࡿ PMx ࢆ⏝࠸ࡓ⸆ຠẚ㍑ ... 42 5.2 㠀⮫ᗋࢹ࣮ࢱࡢ PMx ゎᯒ࡟ࡼࡿ⮫ᗋ⸆ຠホ౯ᇶ‽ࡢタᐃ... 43 5.3 ᚋᮇ⮫ᗋẁ㝵ࡢ㛤Ⓨ໬ྜ≀࡟࠾ࡅࡿ PMx ࢆ฼⏝ࡋࡓᏳ඲ᇦࡢᐃ㔞ⓗホ౯ ... 43 5.4 ࡲ࡜ࡵ ... 45 ㅰ㎡ ... 46 せ᪨ ... 47 Abstract ... 50 ᘬ⏝ᩥ⊩ ... 53 ᅗ⾲ ... 60

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- 1 -

1❶㸸 ⥴ゝ

1.1 ࡣࡌࡵ࡟

་⸆ရ㛤Ⓨࡢ◊✲㛤Ⓨ㈝ࡣᖺࠎቑ኱ࡍࡿഴྥ࡟࠶ࡿࡀ㸪ᢎㄆࡉࢀࡿ⮬♫㛤Ⓨရࡢᩘࡣᶓࡤ࠸࡛ ࠶ࡾ㸪〇⸆௻ᴗ࡟࡜ࡗ࡚㛤Ⓨࡢຠ⋡໬ࡣ኱ࡁ࡞ㄢ㢟࡜࡞ࡗ࡚࠸ࡿࠋ ࡉࡽ࡟㸪㠀ຠ⋡ⓗ࡞㛤Ⓨࡣ㸪 ᪂ࡓ࡞๰⸆ᶆⓗࡢᥦ᱌ࢆ་⸆ရ࡜ࡋ࡚ᡂ❧ࡉࡏࡿࡇ࡜ࢆᅔ㞴࡟ࡋ㸪⛉Ꮫࡢ㐍Ṍࡀᝈ⪅ࡢ฼┈࡜ࡋ ࡚཯ᫎࡉࢀࡿࡇ࡜ࢆጉࡆ࡚࠸ࡿࠋ ࡋࡓࡀࡗ࡚㸪་⸆ရ㛤Ⓨࡢຠ⋡໬ࡢㄢ㢟ࡣ༢࡟〇⸆௻ᴗࡢ཰┈ ࡢၥ㢟ࡔࡅ࡛ࡣ࡞ࡃ㸪་⒪ࡢⓎᒎࡢ೵ࡸ་⒪㈝ࡢ㧗㦐ࢆᣍࡃ♫఍ⓗ࡞ၥ㢟࡜ࡋ࡚ㄆ㆑ࡉࢀ࡚࠸ ࡿࠋ ࡑࡢࡼ࠺࡞⫼ᬒ࡛࢔࣓ࣜ࢝㣗ရ་⸆ရᒁ (FDA: Food and Drug Administration) ࡣ Clitical Path

ⓑ᭩ (17, 18) ࠾ࡼࡧ࢞࢖ࢲࣥࢫ (19) ࢆⓎ⾜ࡋ㸪་⸆ရࡢ᭷ຠᛶ࠾ࡼࡧᏳ඲ᛶࡢホ౯ࡸヨ㦂ࢹࢨ ࢖ࣥタィ࡟ᐃ㔞ⓗ࡞ᡭẁࢆᑟධࡋ㸪་⸆ရࡢホ౯⢭ᗘࡢྥୖࡸຠ⋡ⓗ࡞㛤Ⓨࡢᚲせᛶࢆㄝ࠸࡚࠸ ࡿࠋ ࡇࢀࡽࡢㄢ㢟ࢆゎỴࡍࡿᡭẁ࡜ࡋ࡚ᩘ⌮ࣔࢹࣝࢆ⏝࠸ࡓᐃ㔞ⓗᡭἲ࡛࠶ࡿࣇ࢓࣮࣐ࢥ࣓ࢺࣜ ࢡࢫ (PMx) ࡀὀ┠ࡉࢀ࡚࠾ࡾ㸪㛤Ⓨࡢྛẁ㝵࡟ᑟධࡍࡿࡇ࡜࡛᝟ሗ㔞࡟ᐩࢇࡔពᛮỴᐃࢆྍ⬟࡜ ࡋ㸪㛤Ⓨࡢຠ⋡໬࡟⧅ࡀࡿࡇ࡜ࡀᮇᚅࡉࢀ࡚࠸ࡿࠋ

1.2 ་⸆ရ㛤Ⓨࡢ㐣⛬࡟ࡘ࠸࡚

་⸆ရ㛤Ⓨࡣ኱ูࡍࡿ࡜㠀⮫ᗋ◊✲࡜⮫ᗋヨ㦂࡟ศࡅࡽࢀࡿࠋ 㠀⮫ᗋ◊✲࡛ࡣࡼࡾ᭷ຠ࡛Ᏻ඲ ᛶࡢ㧗࠸ೃ⿵་⸆ရࢆ㑅ᢥࡋࡓᚋ㸪ື≀࡛᭷ຠᛶ࠾ࡼࡧᏳ඲ᛶࢆホ౯ࡍࡿࠋ ⮫ᗋヨ㦂࡟㐍ࡵࡽࢀ ࡿ་⸆ရೃ⿵໬ྜ≀ࡣ㸪㠀⮫ᗋヨ㦂࡛᭷ຠᛶࡸᏳ඲ᛶࡀ☜ㄆࡉࢀࡓ໬ྜ≀࡛࠶ࡿࡀ㸪✀ᕪࡸホ౯ ⣔ࡢ㐪࠸࡟ࡼࡾື≀࡛☜ㄆࡉࢀࡓ᭷ຠᛶࡸᏳ඲ᛶࡀࣄࢺ࡟࠾࠸࡚ࡶ☜ㄆ࡛ࡁࡿ࡜ࡣ㝈ࡽ࡞࠸ࠋ ࡋ ࡓࡀࡗ࡚㸪㠀⮫ᗋヨ㦂ẁ㝵࡛ࡣື≀࡛ࡢ᭷ຠᛶ࠾ࡼࡧᏳ඲ᛶࢆホ౯ࡔࡅ࡛࡞ࡃ㸪⮫ᗋ࡟࠾ࡅࡿ᭷ ຠᛶࡸᏳ඲ᛶࡢண 㸪⮫ᗋຠᯝࡢᣦᶆࡢ㛤Ⓨࡸࡑࡢᨭ᥼ࢆ⾜࠺ࡇ࡜ࡶồࡵࡽࢀࡿࠋ ⮫ᗋヨ㦂ࡣ἞ 㦂࡜ࡶ࿧ࡤࢀ㸪㏻ᖖ3 ࡘࡢẁ㝵ࢆ㋃ࢇ࡛㐍ࡵࡽࢀࡿࠋ➨ 1 ┦ヨ㦂ࡣ೺ᖖேࢆᑐ㇟࡟Ᏻ඲ᛶ࡜⾑୰ ືែࡢホ౯ࢆ⾜࠺ࠋ ➨ 2 ┦ヨ㦂ࡣᑡᩘࡢᝈ⪅ࢆᑐ㇟࡟᭷ຠᛶ࡜Ᏻ඲ᛶࡢ᳨ドࢆ⾜࠸㸪ຠᯝⓗ࡞⏝ ἲ࠾ࡼࡧ⏝㔞ࡢ᳨ウࢆ⾜࠺ࠋ➨3 ┦ヨ㦂ࡣከᩘࡢᝈ⪅ࢆᑐ㇟࡟᭷ຠᛶ࡜Ᏻ඲ᛶࢆ᪤Ꮡࡢ἞⒪ἲ࡜ ẚ㍑ࡋ࡚☜ㄆࡍࡿࠋ 㠀⮫ᗋ࠾ࡼࡧ⮫ᗋヨ㦂ࡢ⤖ᯝࢆᑂᰝᙜᒁ࡟⏦ㄳࡋ㸪ᢎㄆࡉࢀࡿ࡜㈍኎ྍ⬟࡜

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- 2 - ࡞ࡿࠋ

1.3 ࣇ

ࣇ࢓࣮࣐ࢥ࣓ࢺࣜࢡࢫ࡜ࡣ

PMx ࡟ࡘ࠸࡚ࡢ⤫୍ⓗ࡞ᐃ⩏ࡣ☜❧ࡉࢀ࡚࠸࡞࠸ࡀ㸪PMx ࡣ་⸆ရ㛤Ⓨࡸ⸆≀⒪ἲ࡟࠾ࡅࡿ ពᛮỴᐃࢆྜ⌮໬ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡋ㸪⸆≀ືែࡸ⸆ຊᏛⓗᣲືࢆ≉ᚩ࡙ࡅ㸪ࡑࢀࡽࡢᣲື࡟㛵 ࡍࡿ᝟ሗࡢ୙☜ᐇᛶࢆᐃ㔞໬ࡍࡿࡓࡵࡢᩘᏛⓗ࠾ࡼࡧ⤫ィⓗᡭἲࢆ㛤Ⓨ࠾ࡼࡧ㐺⏝ࡍࡿ⛉Ꮫ࡜ࡋ ࡚ゎࡉࢀࡿ (16, 24)ࠋ ་⸆ရ㛤Ⓨ࡛ࡣ⸆≀ືែ㸪⸆ຠ⸆⌮࠾ࡼࡧᏳ඲ᛶ࡞࡝ࡢᵝࠎ࡞ศ㔝ࡢ᝟ሗ ࡀ㞟ࡵࡽࢀࡿࡀ㸪ࡇࢀࡽࡢ᝟ሗࡣ in vivo ࡸ in vitro ࡞࡝ࡢ␗࡞ࡿヨ㦂᮲௳ࡸ㸪ᵝࠎ࡞㛤Ⓨẁ㝵ࡢ ⢭ᗘࡢ␗࡞ࡿ᮲௳࡛ᐇ᪋ࡉࢀࡓࡶࡢࡀྵࡲࢀࡿࠋ ᚑ᮶㸪ࡇࢀࡽࡢ᝟ሗࡣྛᢸᙜ⪅ࡢ㢌ࡢ୰ࡢ࢖࣓ ࣮ࢪ࡛⤫ྜࡉࢀ㸪⸆≀ࡢຠຊࡸ≉ᛶࡲࡓࡣ⑓ែࡢ㐍⾜ࡀᐃᛶⓗ࡟⌮ゎࡉࢀ࡚ࡁࡓࠋ PMx ࡣࡇࢀࡽ ࡢᵝࠎ࡞᝟ሗࢆᩘ⌮ࣔࢹࣝ࡜ࡋ࡚グ㏙ࡍࡿࡇ࡜࡛ྠࡌᅵಥࡢୖ࡟㍕ࡏ㸪᝟ሗࡢ᭕᫕ࡉࡸ୙☜ᐇᛶ ࢆᐃ㔞໬ࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋ ౛࠼ࡤ͆⃰ᗘࡀ㧗࠸͇ࡸ͆⸆ຠࡀᙉ࠸͇࡜࠸ࡗࡓ᭕᫕࡞⾲⌧ࢆලయ ⓗ࡞⃰ᗘࡸ⸆ຠࣃ࣓࣮ࣛࢱ (౛࠼ࡤ Emaxࡸ EC50➼) ࡛グ㏙ࡍࡿࡇ࡜ࡀྍ⬟࡟࡞ࡿࠋ ࡉࡽ࡟㸪⸆ ຠࡸ⑓ែࡢ⤒᫬ኚ໬࡟ࡘ࠸࡚ࡶグ㏙ࡀྍ⬟࡟࡞ࡿࠋ ࡲࡓ㸪ࣔࢹࣝ࡟☜⋡ศᕸࢆᑟධࡍࡿࡇ࡜࡛ࢹ ࣮ࢱࡢࡤࡽࡘࡁ࡜࠸࠺୙☜ᐇᛶࢆศᩓ࡜࠸࠺⤫ィࣃ࣓࣮ࣛࢱ࡛⾲ࡍࡇ࡜ࡀྍ⬟࡟࡞ࡿࠋ ᐃ㔞໬ࡉ ࢀࡓ᝟ሗࡣ㸪ᵝࠎ࡞᝟ሗࡢ⌮ゎࡢඹ᭷໬࡜᝟ሗ㔞࡟ᐩࢇࡔពᛮỴᐃࢆྍ⬟࡜ࡋ㸪་⸆ရ㛤Ⓨࡸ་ ⒪࡟኱ࡁ࡞㈉⊩ࡀ࡛ࡁࡿ࡜ᮇᚅࡉࢀ࡚࠸ࡿࠋ PMx ࡢᡭἲ࡟ࡣᵝࠎ࡞ࡶࡢࡀ࠶ࡿࡀ㸪௦⾲ⓗ࡞ࣔ ࢹࣝ࡜ࡋ࡚⸆≀ືែ (pharmacokinetics㸸PK) ࣔࢹࣝ㸪⸆ຊᏛ (pharmacodynamics㸸PD) ࣔࢹࣝ࠾ࡼ ࡧ୧⪅ࢆྠ᫬࡟ゎᯒࡍࡿPK/PD ࣔࢹࣝࡀᣲࡆࡽࢀࡿࠋ ⸆≀ືែࡣ᫬㛫⤒㐣࡟࡜ࡶ࡞࠸⸆≀ࡀ࡝ࡢࡼ࠺࡟ኚ໬ࡍࡿ࠿ࢆグ㏙ࡍࡿࡶࡢ࡛㸪⏕యෆࡢ⸆≀ ࡢ㔞ⓗ࣭㉁ⓗ࡞ኚ఩࣭ኚ᥮ࡢ㏿ᗘ㐣⛬ࢆ㏣ồࡋ㸪⸆≀⃰ᗘ࠾ࡼࡧ㔞ࡢ᫬㛫᥎⛣ࡢ ᐃ㸪グ㏙㸪ண  ࠾ࡼࡧἲ๎ᛶࡢ᳨ウࢆ⾜࠺ࡇ࡜࡜ᐃ⩏ࡉࢀ࡚࠸ࡿ (41)ࠋ ⡆༢࡟⾲⌧ࡍࡿ࡜⏕యࡀ⸆≀࡟ఱࢆ ࡞ࡍ࠿ࢆㄪ࡭ࡿ㡿ᇦ࡛࠶ࡿࠋ PK ࣔࢹࣝࡣ⸆≀⃰ᗘࡲࡓࡣ㔞ࡢኚື࡟㛵ࢃࡿ㐣⛬ (྾཰㸪ศᕸ㸪 ௦ㅰ㸪ᾘኻ) ࢆ⡆␎໬ (ࣔࢹࣝ໬) ࡋ㸪⸆≀ࡢ⾑₢ࡸ⤌⧊୰⃰ᗘࡲࡓࡣᒀ࣭⣅࣭⫹Ồ୰࡬ࡢ᤼ἥ࡞ ࡝ࢆ㏿ᗘㄽⓗ࡟ㄝ᫂ࡍࡿࡓࡵ࡟ᵓ⠏ࡉࢀࡿࠋ ⸆ຊᏛࡣ⸆≀ࡀ⏕య࡟ఱࢆ࡞ࡍ࠿ࢆㄪ࡭ࡿ㡿ᇦ࡛࠶ࡾ㸪స⏝㒊఩࡟࠾ࡅࡿ⸆≀ࡢ㔞ࡲࡓࡣ⃰ᗘ

(10)

- 3 - ࡜ࡑࡢ⸆⌮స⏝㸪ຠຊ㸪ຠᯝࡢᙉࡉࡢ㛵ಀࢆグ㏙ࡍࡿ (42)ࠋ PD ࣔࢹࣝࡣ⸆≀⃰ᗘኚ໬࡟ᑐࡍࡿ ຠᯝࡢ⾲ࢀ᪉࡟ࡼࡾ㸪┤᥋཯ᛂࣔࢹࣝ࡜㛫᥋཯ᛂࣔࢹࣝ࡟኱ูࡉࢀࡿࠋ ┤᥋཯ᛂࣔࢹࣝࡣ⾑₢ࡲ ࡓࡣస⏝㒊఩⸆≀⃰ᗘࡢኚ໬࡟ᑐࡋ࡚ຠᯝࡀ┤᥋⌧ࢀࡿࣔࢹ࡛ࣝ࠶ࡿࠋ ⸆≀⃰ᗘ࡜ຠᯝࡢ㛵ಀࢆ 2 ḟඖ࡟ࣉࣟࢵࢺࡋ㸪ࡑࡢ㛵ಀࢆグ㏙࡛ࡁࡿ᭱㐺࡞㛵ᩘࢆ㑅ᢥࡋ࡚ࣔࢹࣝ࡜ࡍࡿࠋ ୍⯡ⓗ࡟ࡣ Emax 㛵ᩘ㸪ࢩࢢࣔ࢖ࢻ Emax 㛵ᩘ㸪⥺ᙧ㛵ᩘࡀ⏝࠸ࡽࢀࡿࠋ ୍᪉㸪㛫᥋཯ᛂࣔࢹࣝࡣ⾑₢ࡲࡓࡣస⏝ 㒊఩⸆≀⃰ᗘࡢኚ໬࡟ᑐࡋ࡚ຠᯝࡀ㐜ࢀ࡚⌧ࢀࡿࣔࢹ࡛ࣝ࠶ࡿࠋ ࡇࡢࡼ࠺࡞཯ᛂࡢሙྜ㸪⸆≀⃰ ᗘ࡜ຠᯝࡢ㛵ಀࢆ 2 ḟඖ࡟ࣉࣟࢵࢺࡋ㸪 ᐃ᫬㛫ࡢ㡰࡟Ⅼࢆ⤖ࡪ࡜཯᫬ィᅇࡾࡢࣄࢫࢸࣞࢩࢫࡀ ᥥࡅࡿ (Fig. 1-1)ࠋ In vivo ࡟࠾ࡅࡿ PK ࡜ PD ࡢ㛵ಀ࡟ࣄࢫࢸࣞࢩࢫࡀぢࡽࢀࡿሙྜ㸪1 ࡘࡢ⾑ ୰⃰ᗘ࡛␗࡞ࡿ 2 ࡘࡢ⸆⌮ຠᯝࡀㄆࡵࡽࢀࡿࡇ࡜࡟࡞ࡿࠋ ࡘࡲࡾ㸪┤᥋཯ᛂࣔࢹࣝࡢᵝ࡟ 2 ḟ ඖࣉࣟࢵࢺ࠿ࡽ┤᥋ⓗ࡟⃰ᗘ࡜ຠᯝࡢ㛵ಀࢆグ㏙ࡍࡿ㛵ᩘࢆồࡵࡿࡇ࡜ࡣ࡛ࡁ࡞࠸ࠋ ࡋࡓࡀࡗ࡚㸪 in vivo ࡟࠾࠸࡚ PK ࡜ PD ࡢ㛵ಀ࡟ࣄࢫࢸࣞࢩࢫࡀぢࡽࢀࡿ㝿࡟ࡣ㸪ࣄࢫࢸࣞࢩࢫࢆゎᾘࡍࡿࡓ ࡵ࡟⸆≀ࡢస⏝ᶵᗎࢆ཯ᫎࡋࡓࣔࢹࣝࡢᵓ⠏ࡀᚲせ࡟࡞ࡿࠋ (ලయⓗ࡞グ㏙ࡣ➨ 2 ❶ ͆2.3.6.2 ⸆ຠホ౯ࣔࢹࣝ͆࠾ࡼࡧ➨3 ❶ ͆3.3.7.3 ࣂ࢖࣐࣮࣮࢜࢝ࣔࢹ͇ࣝཧ↷)ࠋ PK/PD ࣔࢹࣝࡣ PK ࡜ PD ࣔࢹࣝࢆྜࢃࡏࡓࣔࢹ࡛ࣝ࠶ࡿࠋ PK ࣔࢹࣝ࡟ࡼࡗ࡚グ㏙ࡉࢀࡓᢞ ୚ᚋࡢ⃰ᗘ-᫬㛫⤒㐣ࢆ㸪PD ࣔࢹࣝ࡟ࡼࡾᐃ㔞໬ࡉࢀࡓ⸆≀⃰ᗘ-ᛂ⟅ࡢ㛵ಀ࡜ྜࢃࡏࡿࡇ࡜࡛㸪 ⏝㔞-⃰ᗘ-ᛂ⟅ࡢ㛵ಀࡢᐃ㔞ⓗグ㏙ࡀྍ⬟࡟࡞ࡿࠋ ࡍ࡞ࢃࡕ㸪⸆≀ᢞ୚ᚋࡢ⸆⌮స⏝ࡸຠຊࡢ⤒ ᫬ⓗኚ໬ࢆᥥࡃࡇ࡜ࡀྍ⬟࡟࡞ࡾ㸪⸆≀ࡢ≉ᛶࡢᢕᥱࡸ἞⒪ࡢ㐺ṇ໬࡟ᙺ❧࡚ࡿࡇ࡜ࡀ࡛ࡁࡿࠋ

1.4 ᮏ

ᮏ◊✲ࡢ┠ⓗ

Ṋ⏣⸆ရᕤᴗᰴᘧ఍♫࡟࠾࠸࡚ぢฟࡉࢀࡓ๓❧⭢ࡀࢇ἞⒪ೃ⿵໬ྜ≀ TAK-448㸪ᢠࡀࢇ๣ೃ⿵ ໬ྜ≀TAK-441 ࠾ࡼࡧ⢾ᒀ⑓἞⒪ೃ⿵໬ྜ≀ fasiglifam ࡣࡑࢀࡒࢀ◊✲㛤Ⓨࡢ᥈⣴㸪㠀⮫ᗋ◊✲ ࠾ࡼࡧ⮫ᗋ◊✲ẁ㝵࡟࠶ࡗࡓࠋ ࡇࢀࡽࡢೃ⿵໬ྜ≀ࢆḟ┦࡟㐍ࡵࡿࡓࡵ㸪TAK-448 ࡣ᪤Ꮡ⸆ (ࣜ ࣮ࣗࣉࣟࣞࣜࣥ㓑㓟ሷ, TAP-144) ࡜ࡢ⸆ຠࡢᙉࡉࡸࡑࡢ≉ᛶࡢẚ㍑㸪TAK-441 ࡣ⮫ᗋ⮳㐺⏝ἲ࠾ ࡼࡧ⏝㔞ุᐃᇶ‽ࡢタᐃ㸪fasiglifam ࡣ࢖ࢾ࡛ㄆࡵࡽࢀࡓ⫢ẘᛶࡀࣄࢺ࡛Ⓨ⑕ࡍࡿྍ⬟ᛶ࡟ࡘ࠸࡚ ࡢホ౯ࡀᚲせ࡛࠶ࡗࡓࠋ TAK-448 ࡣᢸ⒴ࣛࢵࢺホ౯⣔࡟࠾࠸࡚ TAP-144 ࡟ẚ࡭࡚ᙉ࠸ᢠ⭘⒆ຠ ᯝࢆ♧ࡋ㸪᪂つ๓❧⭢ࡀࢇ἞⒪⸆࡜ࡋ࡚ࡢᮇᚅࡀ㧗ࡲࡗ࡚࠸ࡓࠋ TAK-441 ࡣᢸ⒴࣐࢘ࢫホ౯⣔࡟

(11)

- 4 -

࠾࠸࡚ᢠ⭘⒆ຠᯝ࡜ᶆⓗศᏊࡢୗὶࢩࢢࢼࣝ࡟఩⨨ࡍࡿ Gli1 ࡢ mRNA ࡢⓎ⌧㔞ᢚไࢆ♧ࡋ㸪

Gli1 mRNA ࢆࣂ࢖࣐࣮࣮࢜࢝࡜ࡋ࡚฼⏝ࡋࡓ TAK-441 ࡢ⮫ᗋᢞ୚タィࡢྍ⬟ᛶࡀ⪃࠼ࡽࢀࡓࠋ

ࡲࡓ㸪fasiglifam ࡢືែヨ㦂ࡼࡾ㸪࢖ࢾࡢ⫢ẘᛶࡣ㧗⃰ᗘࡢ fasiglifam ࠾ࡼࡧࡑࡢࢢࣝࢡࣟࣥ㓟ᢪ ྜయࡀ⫹⟶ෆ࡛ᯒฟࡍࡿࡇ࡜ࡀཎᅉ࡛࠶ࡿ࡜⪃࠼ࡽࢀ㸪ࣄࢺ࡟࠾࠸࡚ࡶ࢖ࢾ࡜ྠᵝࡢ⫢ẘᛶࡢⓎ ⑕ࡀᠱᛕࡉࢀࡓࠋ ࡇࢀࡽࡢ⸆ຠ⸆⌮ࡸᏳ඲ᛶࡢ㠀⮫ᗋヨ㦂ࡢᡂ⦼ࡣ⮫ᗋࡢᡂ⦼ࡢண ࡸヨ㦂ィ⏬ ࢆ❧᱌ࡍࡿ㝿࡟⪃៖ࡉࢀࡿࠋ ࡋ࠿ࡋ࡞ࡀࡽ㸪✀ᕪࡸホ౯᪉ἲࡢ㐪࠸࡟ࡼࡾ㠀⮫ᗋࡢᡂ⦼ࡀࡑࡢࡲ ࡲ⮫ᗋ࡛཯ᫎࡉࢀࡿ࡜ࡣ㝈ࡽࡎ㸪₍↛࡜ࡋࡓ⮫ᗋ࡟࠾ࡅࡿ⸆ຠࡸᐇ⾜ྍ⬟ᛶ࡟ᑐࡍࡿᮇᚅឤࡸᏳ ඲ᛶ࡬ࡢᠱᛕࡢࡳࢆࡶࡗ࡚ೃ⿵໬ྜ≀ࢆḟ┦࡬㐍ࡵࡿ࠿࡝࠺࠿ࡢุ᩿ࢆ⾜࠺࡟ࡣၥ㢟ࡀ࠶ࡿ࡜⪃ ࠼ࡽࢀࡓࠋ 㠀⮫ᗋ⸆ຠホ౯⣔࡛☜ㄆࡉࢀࡓ TAK-448 ࡜ TAP-144 ࡢ⭘⒆ቑṪᢚไࡢᕪࡣ⸆≀ື ែࡢ┦㐪࡟ࡼࡿࡶࡢ࠿㸪⸆⌮స⏝ࡢᕪ࡟ࡼࡿࡶࡢ࠿ࡢุ᩿࡛ࡁ࡞࠸ࡓࡵ㸪యෆࡢ⸆≀⃰ᗘ (୍⯡ ⓗ࡟ࡣ⾑₢୰⸆≀⃰ᗘ) ࢆ⪃៖ࡋࡓ in vivo ࡟࠾ࡅࡿ⸆ຠࡢᐃ㔞ⓗ࡞ẚ㍑ࡀᚲせ࡛࠶ࡿࠋ TAK-441 ࡢ⮫ᗋ⏝㔞᥈⣴࡟ࣂ࢖࣐࣮࣮࢜࢝ࡢ᝟ሗࢆ฼⏝ࡍࡿࡓࡵ࡟ࡣ㸪ࡉࡽ࡟⸆ຠ (⭘⒆ቑṪᢚไຠ ᯝ) ࡜ࣂ࢖࣐࣮࣮࢜࢝ (Gli1 mRNA ࡢⓎ⌧㔞) ࡜ࡢᐃ㔞ⓗ࡞㛵ಀࢆゎ᫂ࡍࡿᚲせࡀ࠶ࡿࠋ ࡲࡓ㸪 fasiglifam ᢞ୚࡟ࡼࡿࣄࢺ⫢ẘᛶࡢⓎ⑕ࡢྍ⬟ᛶ࡟ࡘ࠸࡚⪃ᐹࡍࡿࡓࡵ࡟ࡣ㸪࢖ࢾ⫢ẘᛶࡢⓎ⑕ᶵ ᗎࡸ࡝ࢀࡃࡽ࠸ࡢ⸆≀⃰ᗘ࡛Ⓨ⑕ࡋ࡚࠸ࡿࡢ࠿ࢆㄪ࡭㸪ࡉࡽ࡟⮫ᗋ⏝㔞࡜ẘᛶⓎ⌧࡜ࡢᏳ඲ᇦࢆ ᐃ㔞ⓗ࡟ゎ㔘ࡍࡿᚲせࡀ࠶ࡿࠋ ࡋࡓࡀࡗ࡚㸪ࡇࢀࡽࡢ㠀⮫ᗋࡢᡂ⦼ࢆ⮫ᗋࡢ⸆ຠࡸẘᛶࡢண 㸪 ⮫ᗋヨ㦂ࡢィ⏬࠾ࡼࡧᢎㄆᑂᰝࡢ㝿ࡢ⛉Ꮫⓗ᰿ᣐ࡜ࡋ࡚฼⏝ࡍࡿࡓࡵ࡟ࡣ㸪ヨ㦂࡛ᚓࡽࢀࡓ⤖ᯝ ࡢᐃ㔞ⓗ࡞ホ౯ࡀᚲせ࡛࠶ࡿࠋ ࡑࡇ࡛ᮏㄽᩥ࡛ࡣୖグ┠ⓗࢆ㐩ᡂࡍࡿࡓࡵ࡟㸪⸆ຠࡸࣂ࢖࣐࣮࣮࢜࢝ࡢ཯ᛂᛶࡲࡓࡣ⸆≀ື ែ➼ࡢᐃ㔞ⓗ࡞ホ౯ࢆྍ⬟࡜ࡍࡿ PMx ࢆྛ㛤Ⓨẁ㝵࡟࠾ࡅࡿೃ⿵໬ྜ≀ࡢホ౯࡟ᑟධࡋ㸪་⸆ ရ㛤Ⓨ࡟࠾ࡅࡿ PMx ᑟධࡢ᭷⏝ᛶ࡟ࡘ࠸᳨࡚ドࡋࡓࠋ ➨஧❶࡛ࡣᢸ⒴ࣛࢵࢺ⸆ຠホ౯⣔࡟࠾࠸ ࡚ㄆࡵࡽࢀࡓ TAK-448 ࡜ TAP-144 ࡜ࡢᢠ⭘⒆άᛶࡢᕪࡢཎᅉࢆヲ⣽࡟ㄪ࡭ࡿࡓࡵ࡟㸪ࡑࢀࡽࡢ ⸆⌮Ꮫⓗຠຊ࠾ࡼࡧ≉ᛶࢆ PK/PD ࣔࢹࣝゎᯒ࡟ࡼࡾᐃ㔞ⓗ࡟ẚ㍑ࡋࡓࠋ ➨୕❶࡛ࡣ TAK-441 ࡢ⮫ᗋ࡟࠾ࡅࡿ⮳㐺⏝ἲ࠾ࡼࡧ⏝㔞ࡢุᐃᇶ‽ࢆタᐃࡍࡿࡓࡵ࡟㸪in vivo ᢸ⒴࣐࢘ࢫホ౯⣔࡟࠾ ࡅࡿࣂ࢖࣐࣮࣮࢜࢝ (Gli1 mRNA ࡢⓎ⌧㔞) ࡜ᢠ⭘⒆άᛶ࡜ࡢ㛵ಀࢆ PK/PD ࣔࢹࣝ࡟ࡼࡾᐃ㔞 ⓗ࡟ゎᯒࡋࡓࠋ ➨ᅄ❶࡛ࡣ࢖ࢾ࡛ㄆࡵࡽࢀࡓ fasiglifam ࡢ⫢ẘᛶࡀࣄࢺ࡛ࡶ㉳ࡁࡿྍ⬟ᛶ࡟ࡘ࠸

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- 5 -

࡚ホ౯ࡍࡿࡓࡵ㸪⫢ẘᛶⓎ⑕ࡢཎᅉ࡜࡞ࡾ࠺ࡿࣄࢺ⫹Ồෆࡢ fasiglifam ࠾ࡼࡧࡑࡢࢢࣝࢡࣟࣥ㓟

ᢪྜయ (fasiglifam-G) ࡢ⃰ᗘࢆ PK ࣔࢹࣝ࡟ࡼࡾ᥎ᐃࡋ㸪ࣄࢺ࡟࠾ࡅࡿᏳ඲ᇦࢆᐃ㔞ⓗ࡟ホ౯ࡋ

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- 6 -

2❶㸸 ࣮ࣜࣗࣉࣟࣞࣜࣥ㓑㓟ሷ㸦TAP-144㸧࡜ࡢ⸆ຠẚ㍑ࢆ௓ࡋࡓ

ᚋ⥅⸆

TAK-448 㑅ᢥࡢጇᙜᛶࡢ᳨ド

2.1 ࡣࡌࡵ࡟

㠀⮫ᗋẁ㝵࡛ぢ࠸ࡔࡉࢀࡓೃ⿵໬ྜ≀ࢆ་⸆ရೃ⿵໬ྜ≀࡜ࡋ࡚ḟ┦ࡢ⮫ᗋẁ㝵࡟㐍ࡵࡿ࠿࡝ ࠺࠿ࡢุ᩿࡟࠾࠸࡚㸪ᙜヱೃ⿵໬ྜ≀࡜௚ࡢೃ⿵໬ྜ≀ࡸඛ⾜໬ྜ≀࡜ࡢ⸆ຠẚ㍑ࡣ㔜せ࡛࠶ࡿࠋ TAK-448 ࡢᑐ㇟⑌ᝈ࡛࠶ࡿ๓❧⭢ࡀࢇࡣ࢔ࣥࢻࣟࢤࣥ㝖ཤ⒪ἲࡀ᭷ຠ࡞἞⒪᪉ἲ࡛࠶ࡿࡀ㸪⭘⒆ ࡀࢸࢫࢺࢫࢸࣟࣥᢚไ࡟ᑐࡍࡿ᢬ᢠᛶࢆ⋓ᚓࡍࡿࡓࡵ㸪㛗ᮇ౑⏝࡛ḟ➨࡟ຠᯝࡀኻࢃࢀࡿࠋ ࡋࡓ ࡀࡗ࡚㸪㠀⮫ᗋ࡟࠾ࡅࡿ๓❧⭢ࡀࢇ἞⒪⸆ࡢ⸆ຠホ౯࡟ࡣ࢔ࣥࢻࣟࢤࣥឤཷᛶ࡜ཤໃ᢬ᢠᛶࡢ୧ ᪉ࡢẁ㝵࡛๓❧⭢ࡀࢇࡢ⮫ᗋⓗ≉ᚩࢆ཯ᫎࡍࡿホ౯ࣔࢹࣝࢆ᥇⏝ࡍࡿᚲせࡀ࠶ࡿࠋ TAK-448 ࡢ ᢠ⭘⒆ຠᯝࡣ㦵㌿⛣ࡋࡓࣄࢺ๓❧⭢ࡀࢇ࠿ࡽᶞ❧ࡋࡓ⣽⬊ᰴ࡛࠶ࡿ vertebral̺cancer of the

prostate (VCaP) ࢆ⛣᳜ࡋࡓᢸ⒴ࣛࢵࢺࡢホ౯⣔࡟࠾࠸࡚㸪TAP-144 ࡜ẚ㍑ࡋ࡚ᐇ᪋ࡉࢀࡓ (26)ࠋ ࡇࡢホ౯⣔ࡣ⮫ᗋࡢ๓❧⭢ࡀࢇࡢ≉ᚩࢆ཯ᫎࡋ࡚࠾ࡾ㸪⛣᳜ࡉࢀࡓ⭘⒆ࡣࢸࢫࢺࢫࢸࣟࣥ౫Ꮡⓗ ࡟ቑṪࡍࡿࠋ ࡲࡓ㸪ࣛࢵࢺ࡟⛣᳜ࡉࢀࡓ⭘⒆ࡣࢸࢫࢺࢫࢸࣟࣥᢚไ࡟ᑐࡍࡿ⪏ᛶ໬ࡶ᭷ࡋ࡚࠾ࡾ㸪 ࢸࢫࢺࢫࢸࣟࣥ⏘⏕ࢆᢚไࡋࡓཤໃ⩌ࡸ⸆≀ᢞ୚⩌࡛ࡣ⭘⒆ࡢ㏥⦰ࡀぢࡽࢀࡓᚋ࡟㸪෌ቑṪࡍࡿ ࡇ࡜ࡀ☜ㄆࡉࢀ࡚࠸ࡿࠋ ᮏ❶࡛ࡣ⾑₢୰⸆≀⃰ᗘ࠾ࡼࡧ⭘⒆య✚ࢹ࣮ࢱࢆ⏝࠸ࡓᐃ㔞ⓗ࡞ゎᯒ᪉ ἲ࡜ࡋ࡚ PK/PD ࣔࢹࣜࣥࢢࢆ⏝࠸ࡓࠋ PK/PD ࣔࢹࣜࣥࢢࡣ⸆≀⃰ᗘ࡜⸆⌮ຠᯝࡢ㛵ಀࢆᐃ㔞ⓗ ࡟グ㏙ࡋ㸪⸆≀ࡢຠᯝ࠾ࡼࡧ๪స⏝࡟㛵ࡍࡿ⌮ゎࢆ῝ࡵࡿᡭἲ࡜ࡋ࡚་⸆ရ㛤Ⓨ࡟฼⏝ࡉࢀ࡚࠸ ࡿ (8, 12, 21, 46)ࠋ ᮏ❶࡛ࡣ TAK-448 ࠾ࡼࡧ TAP-144 ࡢᢠ⭘⒆ຠᯝ࠾ࡼࡧ⪏ᛶ໬ࡢஹ㐍࡟ᑐࡍ ࡿ PK/PD ࣔࢹࣝࢆᵓ⠏ࡋ㸪୧໬ྜ≀ࡢ⸆⌮Ꮫⓗຠຊ࠾ࡼࡧ≉ᛶࢆẚ㍑ࡋࡓࠋ

2.2 TAK-448 ࡟ࡘ࠸࡚

TAK-448 (ୗᅗ 1) ࡣ๓❧⭢ࡀࢇࡢ἞⒪⸆ࢆ┠ᣦࡋ࡚㛤Ⓨࡉࢀ࡚ࡁࡓ⸆≀࡛࠶ࡿࠋ ๓❧⭢ࡀࢇࡣ ࢸࢫࢺࢫࢸࣟࣥ➼ࡢ࢔ࣥࢻࣟࢤࣥ౫Ꮡⓗ࡟ቑṪࡍࡿ࡜࠸࠺≉ᛶࢆᣢࡘࡇ࡜࠿ࡽ㸪࣮ࣜࣗࣉࣟࣞࣜ ࣥ㓑㓟ሷ (TAP-144㸪ୗᅗ 2) ࡞࡝ࡢᛶ⭢่⃭࣍ࣝࣔࣥᨺฟ࣍ࣝࣔࣥ (GnRH) ࢔ࢼࣟࢢ〇๣࡟௦⾲ ࡉࢀࡿ࢔ࣥࢻࣟࢤࣥ㝖ཤ⒪ἲࡀຠᯝⓗ࡞἞⒪ἲ࡜ࡋ࡚ᐇ᪋ࡉࢀ࡚ࡁࡓ (15, 23)ࠋ TAP-144 ࡣୗᆶ

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- 7 -

య࡟స⏝ࡋ㸪ึᅇᢞ୚┤ᚋ୍㐣ᛶ࡟༸⬊่⃭࣍ࣝࣔࣥ (FSH) ࠾ࡼࡧ㯤యᙧᡂ࣍ࣝࣔࣥ (LH) ࢆศ

Ἢࡉࡏࡿࡀ㸪཯᚟ᢞ୚ᚋ㸪ୗᆶయ࠿ࡽࡢࡇࢀࡽࡢ࣍ࣝࣔࣥࡢ⏘⏕࣭ᨺฟࢆపୗࡉࡏࡿࠋ ࡉࡽ࡟㸪

༸ᕢཬࡧ⢭ᕢࡢ FSH ࡸ LH ࡟ᑐࡍࡿ཯ᛂᛶࡀపୗࡋ㸪࢚ࢫࢺࣛࢪ࣮࢜ࣝཬࡧࢸࢫࢺࢫࢸࣟࣥ⏘

⏕⬟ࡀపୗࡍࡿ (35)ࠋ ୍᪉㸪TAK-448 ࡣ࣓ࢱࢫࢳࣥ (࢟ࢫ࣌ࣉࢳࣥ࡜ྠ୍≀㉁࡜ࡋ࡚▱ࡽࢀࡿ)

ࡢάᛶ㒊఩ࡢㄏᑟయ࡛࠶ࡾ㸪どᗋୗ㒊ࡢ⚄⤒⣽⬊࡟ᏑᅾࡍࡿGPR54 (G-protein coupled receptor 54) ࡟స⏝ࡍࡿ⸆≀࡛࠶ࡿ (36)ࠋ TAK-448 ࡀ GPR54 ࢆάᛶ໬ࡉࡏࡿࡇ࡜࡛㸪 GnRH ࡢศἪࡀ୍㐣 ᛶ࡟ୖ᪼ࡍࡿࡀ㸪཯᚟ᢞ୚࡟ࡼࡾ᭱⤊ⓗ࡟ GnRH ࡀᯤῬࡍࡿࠋ ࡑࡢ⤖ᯝ㸪ୗᆶయ࠿ࡽࡢ FSH ࠾ ࡼࡧ LH ࡢศἪࡀపୗࡋ㸪ࡉࡽ࡟㸪ࢸࢫࢺࢫࢸࣟࣥࡢ⏘⏕ࡀᢚไࡉࢀࡿࡇ࡜࡛⭘⒆ቑṪᢚไຠᯝ ࢆⓎ᥹ࡍࡿ࡜⪃࠼ࡽࢀ࡚࠸ࡿ (37)ࠋ ᅗ1 TAK-448 ࡢᵓ㐀ᘧ ᅗ2 ࣮ࣜࣗࣉࣟࣞࣜࣥ㓑㓟ሷ (TAP-144) ࡢᵓ㐀ᘧ N H H N N H H N N H NH H N N H O NH2 O O O O O O O NH NH H3C HN H3C CH3 NH H2N O N O NH CH3 HO O H H H H H OH H3C H H H3C CO2H H H HO

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- 8 -

2.3 ᐇ

ᐇ㦂ᮦᩱ࡜᪉ἲ

ࣔࢹࣝゎᯒ࡟౑⏝ࡋࡓ⭘⒆య✚࠾ࡼࡧ⸆≀⃰ᗘࢹ࣮ࢱࡣ▼ᕝࡽ࡟ࡼࡾᐇ᪋ࡉࢀࡓヨ㦂ࡢ⤖ᯝࢆ ⏝࠸ࡓ (26)ࠋ 2.3.1㹼2.3.3 ࡟ࡑࡢᴫ␎ࢆグ㏙ࡍࡿࠋ

2.3.1 ⿕㦂≀㉁

TAK-448 (2-(N-Acetyl-D-tyrosyl-trans-4-hydroxy-L-prolyl-L-asparaginyl-L-threonyl-L-phenylalanyl) hydrazinocarbonyl-L-leucyl-NZ-methyl-L-arginyl-L-tryptophanamide monoacetate) 㸪 TAP-144 (5-Oxo-L -prolyl-L-histidyl-L-tryptophyl-L-seryl-L-tyrosyl-D-leucyl-L-leucyl-L-arginyl-N-ethyl-L-prolinamide

monoacetate) ࠾ࡼࡧࡑࢀࡽࡢ 1 ࢝᭶ᚎᨺᛶ〇๣ [TAK-448-SR(1M) ࠾ࡼࡧ TAP-144-SR(1M)] ࡣṊ ⏣⸆ရᕤᴗ࡛ྜᡂࡋࡓࡶࡢࢆ⏝࠸ࡓࠋ

2.3.2 ᢠ⭘⒆άᛶホ౯ࡢࡓࡵࡢື≀ヨ㦂

7 㐌㱋ࡢ㞝ᛶ F344/N Jcl-rnu/rnu ࣛࢵࢺ (ྛ⩌ 5 ༉) ࡟ VCaP ⣽⬊ࢆ⓶ୗ࡟⛣᳜ࡋ㸪7 㐌㛫ᚋ ࡟ᢞ୚፹య㸪TAK-448-SR(1M) (0.01㸪0.03㸪0.3 ࠾ࡼࡧ 3 mg/kg) ࡲࡓࡣ TAP-144-SR(1M) (0.1㸪0.3㸪 1 ࠾ࡼࡧ 10 mg/kg) ࢆ⓶ୗ࡬ᢞ୚ࡋ㸪ࡉࡽ࡟ 4 㐌㛫ᚋ࡟㏣ຍࡢᢞ୚ࢆ⾜ࡗࡓࠋ ࡞࠾㸪ཤໃ⩌ࡢ⢭ ᕢ᦬ฟࡣᢞ୚㛤ጞ࡜ྠ᪥࡟⾜ࡗࡓࠋ ⭘⒆ࡢ㛗ᚄཬࡧ▷ᚄࢆࣀࢠࢫ࡛ ᐃࡋ㸪⭘⒆య✚ࡣ㛗ᚄ™▷ ᚄ2™0.5 ࡟࡚⟬ฟࡋࡓࠋ ࡲࡓ㸪ᢞ୚㔞ࡣணഛⓗヨ㦂ࡢ⤖ᯝࡼࡾタᐃࡋࡓࠋ ௨ୗ࡟⩌ᵓᡂࢆ♧ࡍࠋ

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- 9 - ⩌ᵓᡂ ヨ㦂⩌ ᢞ୚㔞 (mg/kg) ᑐ↷ (ᢞ୚፹య) 0 ཤໃ 0 TAK-448-SR 0.01 0.03 0.3 3 TAP-144-SR 0.1 0.3 1 10

2.3.3 ື

ືែヨ㦂

ືែヨ㦂ࡣᢠ⭘⒆άᛶホ౯ࡢࡓࡵࡢື≀ヨ㦂 (2.3.2) ࡜ྠ୍᮲௳࡛ᐇ᪋ࡍࡿࡓࡵ㸪ྠࡌ⣔⤫ࡢ ࣛࢵࢺ࡟㸪ྠࡌ⏝ἲ࣭⏝㔞࡛ TAK-448-SR ࠾ࡼࡧ TAP-144-SR ࢆ⓶ୗᢞ୚ࡋࡓࠋ ⾑₢ࡣᑿ㟼⬦ ࠿ࡽ᥇⾑ᚋ࡟㐲ᚰศ㞳࡟ࡼࡾ᥇ྲྀࡋ㸪⾑₢୰ TAK-448 ࠾ࡼࡧ TAP-144 ࡣࡑࢀࡒࢀ ELISA (Enzyme-Linked ImmunoSorbent Assay) ࢟ࢵࢺ࠾ࡼࡧᾮయࢡ࣐ࣟࢺࢢࣛࣇ࢕࣮-ࢱࣥࢹ࣒㉁㔞ศᯒ ィ(LC-MS/MS) ࢆ⏝࠸࡚ᐃ㔞ࡋࡓࠋ ᐃ㔞ୗ㝈ࡣࡑࢀࡒࢀ 3 pg/mL ࠾ࡼࡧ 50 pg/mL ࡛࠶ࡗࡓࠋ PK ࣔࢹࣝࡢࣃ࣓࣮ࣛࢱ್ࡢ᥎ᐃ⢭ᗘࢆྥୖࡉࡏࡿࡓࡵ㸪TAK-448 (0.01㸪0.1 ࠾ࡼࡧ 1G mg/kg) ࠾ ࡼࡧTAP-144 (0.1 mg/kg) ࢆࣛࢵࢺ࡟㟼⬦ෆᢞ୚ࡋࡓ᫬ࡢ⾑₢୰⃰ᗘࢹ࣮ࢱࡶ⏝࠸ࡓࠋ ⾑₢ࡣᑿ 㟼⬦࠿ࡽ᥇⾑ᚋ࡟㐲ᚰศ㞳࡟ࡼࡾ᥇ྲྀࡋ㸪⾑₢୰ TAK-448 ࠾ࡼࡧ TAP-144 ࡣ LC-MS/MS ࡟࡚ ᐃ㔞ࡋࡓࠋ ᐃ㔞ୗ㝈ࡣࡑࢀࡒࢀ 100G pg/mL ࠾ࡼࡧ 50 pg/mL ࡛࠶ࡗࡓࠋ

2.3.4 ࢹ࣮ࢱฎ⌮

⭘⒆ቑṪ࡜⾑₢୰⸆≀⃰ᗘࡢ PK/PD ࣔࢹࣝゎᯒ࡟ࡣ㸪NONMEM VI (ICON ♫) ࢆ⏝࠸ࡓࠋࣃ ࣓࣮ࣛࢱࡢಶయ㛫ኚື࡟ᑐᩘṇつศᕸࢆ௬ᐃࡋࡓ (ᘧ 2-1)ࠋ ܲ௜ = ܲ௣௢௣ή ݁ݔ݌൫ߟ௣௜൯                               ᘧ 2 െ 1 ࡇࡇ࡛㸪Piࡣಶయi ࡢࣃ࣓࣮ࣛࢱ㸪Ppopࡣ㞟ᅋᖹᆒࣃ࣓࣮ࣛࢱࢆ⾲ࡍࠋ Șpi ࡣಶయ㛫ኚືࢆ♧ࡋ㸪

(17)

- 10 -

ᖹᆒ 0㸪ศᩓ Ȧ2 ࡢṇつศᕸࢆ௬ᐃࡋࡓࠋ ᐇ ್࡜᥎ᐃ್࡜ࡢṧᕪࡢホ౯࡟ࡣẚ౛ㄗᕪࣔࢹࣝࢆ

⏝࠸ࡓ (ᘧ 2-2)ࠋ

ܻ௢௕௦,௜௝= ܻ௣௥௘ௗ,௜௝ή ൫1 + ߝ௜௝൯                            ᘧ 2 െ 2

ࡇࡇ࡛㸪Yobs,ij ࡣಶయi ࡢ j ␒┠ࡢᐇ ್㸪Ypred,ij ࡣࣔࢹࣝ࡟ࡼࡿண ್࡛࠶ࡾ㸪İij ࡣᐇ ್࡜

ண ್࡜ࡢṧᕪࢆ⾲ࡍࠋ İijࡣᖹᆒ0㸪ศᩓ ı2 ࡢṇつศᕸࢆ௬ᐃࡋࡓࠋ ࣔࢹࣝࡢホ౯࠾ࡼࡧ㑅ᢥ ࡣ㸪᥎ᐃࡉࢀࡓࣃ࣓࣮ࣛࢱࡢ⢭ᗘ㸪ᐇ ್࡜ண ್ࡢྠ᫬ࣉࣟࢵࢺ (goodness-of-fit plot) ࡲࡓࡣ┠ ⓗ㛵ᩘ್ (OFV) ࡟ᇶ࡙࠸࡚⾜ࡗࡓࠋ ಶయ㛫ᕪࢆ≉ᐃࡢࣃ࣓࣮ࣛࢱ࡟ྲྀࡾ㎸ࡴࡇ࡜࡟ࡼࡿ OFV ࡢ ኚື (ǼOFV) ࡣ㏆ఝⓗ࡟ࣔࢹࣝ㛫 (ಶయ㛫ᕪࢆ⪃៖ࡋࡓࣔࢹࣝ࡜⪃៖ࡋ࡞࠸ࣔࢹࣝ) ࡢࣃ࣓ࣛ ࣮ࢱᩘࡢᕪ࡟➼ࡋ࠸⮬⏤ᗘࡢ࢝࢖஧஌ศᕸ࡟ᚑ࠺ࠋ ࡋࡓࡀࡗ࡚㸪1 ࡘࡢಶయ㛫ᕪࢆ⾲ࡍࣃ࣓࣮ࣛ ࢱࢆྲྀࡾ㎸ࡴࡇ࡜࡟ࡼࡾǼOFV ࡀ 6.63 ௨ୖῶᑡࡋࡓሙྜ㸪⤫ィⓗ࡟᭷ព㸦p <0.01ࠊ1 ⮬⏤ᗘ㸧࡜ ぢ࡞ࡋࡓࠋ

2.3.5 PK ࣔ

ࣔࢹࣝ

PK/PD ࣔࢹࣝ࡟౑⏝ࡍࡿ⸆≀⃰ᗘࢹ࣮ࢱࡣ▼ᕝࡽࡢሗ࿌ (26) ࡟ࡼࡾᵓ⠏ࡉࢀࡓ PK ࣔࢹࣝ ࢆ⏝࠸࡚᥎ᐃࡋࡓࠋ TAK-448 ࠾ࡼࡧ TAP-144 ࢆ⓶ୗᢞ୚ࡋࡓ㝿ࡢ⾑₢୰⸆≀⃰ᗘ᥎⛣ࡣ஧ᓠᛶ ࢆ♧ࡋࡓࠋ ࡇࡢ⌧㇟ࡣᚎᨺᛶ〇๣ࢆᢞ୚ࡋࡓ㝿࡟㸪〇๣࠿ࡽࡢ⸆≀ࡢึᮇᨺฟ࡟ࡼࡿẚ㍑ⓗ᪩࠸ ྾཰࡜㸪〇๣࠿ࡽᚎᨺࡉࢀࡿ㐜ᘏⓗ࡞྾཰࡜ࡢ஧ࡘࡢ␗࡞ࡿ྾཰㐣⛬࡟ࡼࡾ㉳ࡁࡓ࡜⪃࠼ࡽࢀࡓ ࡇ࡜࠿ࡽ (43)㸪ࡇࢀࡽࡢ⾑₢୰⃰ᗘ᥎⛣ࡣ 2 ࡘࡢ྾཰┦ 㸦༶᫬࠾ࡼࡧ㐜ᘏ྾཰┦㸧 ࢆᣢࡘ 2-ࢥ ࣥࣃ࣮ࢺ࣓ࣥࢺࣔࢹࣝ࡟ࡼࡾグ㏙ࡋࡓࠋ ௨ୗ࡟ࣔࢹࣝᘧࢆ♧ࡍࠋ ݀ܣଵ ݀ݐ = ݇ூோڄ ܣଷ+ ݇ௌோڄ ܣସെ ݇ଵଶڄ ܣଵ+ ݇ଶଵڄ ܣଶെ ݇௘௟ڄ ܣଵ               ᘧ 2 െ 3 ݀ܣଶ ݀ݐ = ݇ଵଶڄ ܣଵെ ݇ଶଵڄ ܣଶ                             ᘧ 2 െ 4 ݀ܣଷ ݀ݐ = െ݇ூோڄ ܣଷ                                ᘧ 2 െ 5 ݀ܣସ ݀ݐ = െ݇ௌோڄ ܣସ                                ᘧ 2 െ 6 A1㸪A2㸪A3 ࠾ࡼࡧ A4 ࡣࡑࢀࡒࢀ⾑₢㸪ᮎᲈ㸪༶᫬ⓗ࡟྾཰ࡉࢀࡿ⓶⭵࠾ࡼࡧᚎᨺⓗ࡟྾཰ࡉ

(18)

- 11 - ࢀࡿ⓶⭵ࢥࣥࣃ࣮ࢺ࣓ࣥࢺࡢ⸆๣㔞ࢆ♧ࡍࠋ kIR ࡜ kSR ࡣࡑࢀࡒࢀึᮇᨺฟ࠾ࡼࡧᚎᨺ࡟ࡼࡿ⓶ ⭵ࢥࣥࣃ࣮ࢺ࣓ࣥࢺ࠿ࡽࡢ྾཰㏿ᗘᐃᩘࢆ♧ࡋ㸪k12 ࡜ k21 ࡣࢥࣥࣃ࣮ࢺ࣓ࣥࢺ㛫ࡢศᕸ㏿ᗘᐃᩘ ࢆ♧ࡍࠋFig. 2-1 ࡟ᵓ⠏ࡋࡓࣔࢹࣝᅗࢆ♧ࡍࠋ

2.3.6 PD ࣔ

ࣔࢹࣝ

ࣛࢵࢺᢸ⒴ホ౯⣔࡛☜ㄆࡉࢀࡓ TAK-448 ࠾ࡼࡧ TAP-144 ᢞ୚ᚋࡢ⭘⒆య✚ࡢኚ໬ࡣ⸆≀ࡢ ࢔ࣥࢻࣟࢤࣥᢚไࢆ௓ࡋࡓᢠ⭘⒆ຠᯝ࡟ຍ࠼㸪⭘⒆ࡢ࢔ࣥࢻࣟࢤࣥᢚไ࡟ᑐࡍࡿ⪏ᛶࡢஹ㐍ࡀᙳ 㡪ࡍࡿࠋ ࡑࡇ࡛㸪⸆≀ࡢᢠ⭘⒆ຠᯝࡢ PD ࣔࢹࣝࡣ㸪 2.3.6.1 ࠾ࡼࡧ 2.3.6.2 ࡟♧ࡍ஧ẁ㝵ࡢᡭ 㡰࡛ᵓ⠏ࡋࡓࠋ ᭱ึ࡟㸪㠀ฎ⨨⩌࠾ࡼࡧཤໃ⩌ࡢࢹ࣮ࢱࢆ⏝࠸࡚㸪ࡑࢀࡒࢀ⸆≀㠀ᢞ୚ୗ࡛ࡢ⭘ ⒆ቑṪ࠾ࡼࡧ࢔ࣥࢻࣟࢤࣥ࣍ࣝࣔࣥᢚไ࡟ᑐࡍࡿ⪏ᛶࡢஹ㐍ࢆࣔࢹࣝ໬ࡋࡓࠋ ḟ࡟㸪⸆≀ᢞ୚⩌ ࡢࢹ࣮ࢱࢆ⏝࠸࡚㸪TAK-448 ࠾ࡼࡧ TAP-144 ࡢ࣍ࣝࣔࣥ౫Ꮡⓗ⭘⒆ቑṪᢚไຠᯝࢆグ㏙ࡍࡿ⸆ ຠホ౯ࣔࢹࣝࢆᵓ⠏ࡋࡓࠋ Fig. 2-2 ࡟ᵓ⠏ࡋࡓࣔࢹࣝᅗࢆ♧ࡍࠋ

2.3.6.1 ⭘⒆ቑṪ࠾ࡼࡧ⪏ᛶࡢࣔࢹࣝ໬

㠀ฎ⨨⩌࡟⛣᳜ࡋࡓ⭘⒆ࡣ༢ㄪ࡟ቑṪࡋࡓࠋ ࡑࡢቑṪࡣ⥺ᙧቑṪࣔࢹࣝࢆᇶ࡟ḟᘧ 2-7 ࢆᵓ⠏ ࡋ࡚㸪ᐇ ್࡜ࡢࣇ࢕ࢵࢸ࢕ࣥࢢࢆ⾜ࡗࡓࠋ ܸ݀ܶ ݀ݐ = ܮ െ㹩௔௣ή ܸܶ                              ᘧ 2 െ 7 ึᮇ᮲௳㻌t=0 ; ヨ㦂㛤ጞ᫬ࡢ⭘⒆య✚㻌 TV ; ⭘⒆య✚㻌 L ; 0 ḟࡢ⭘⒆ቑṪ㏿ᗘᐃᩘ㻌 kap ; 1 ḟࡢ⭘⒆ᾘኻ㏿ᗘᐃᩘ㻌 ཤໃ⩌ࡢ⭘⒆య✚ࡣ᭱ึ㏥⦰ࢆ♧ࡋࡓࡀ㸪ࡑࡢᚋ෌ࡧቑṪࢆ♧ࡋࡓࠋ ⛣᳜ࡉࢀࡓ VCaP ⣽⬊ ࡣ㸪㔝⏕ᆺࡢ࢔ࣥࢻࣟࢤࣥཷᐜయࢆⓎ⌧ࡋ㸪ࡑࡢᡂ㛗ࡀ࢔ࣥࢻࣟࢤࣥ࣍ࣝࣔࣥ࡟ࡼࡗ࡚ไᚚࡉࢀ ࡿ࢔ࣥࢻࣟࢤࣥឤཷᛶ๓❧⭢⒴⣽⬊࡜ࡋ࡚▱ࡽࢀ࡚࠸ࡿࡇ࡜࠿ࡽ㸪ࡇࡢ෌ቑṪࡣ VCaP ࡀ࢔ࣥࢻ

(19)

- 12 - ࣟࢤࣥ࣍ࣝࣔࣥࣞ࣋ࣝࡢపୗ࡟ᑐࡍࡿ⪏ᛶࢆ⋓ᚓࡋ㸪ཤໃ࡟ࡼࡿ࣍ࣝࣔࣥᢚไຠᯝࡀ᫬㛫⤒㐣࡜ ࡜ࡶ࡟ῶᙅࡍࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿࠋ ⪏ᛶ⋓ᚓࡢஹ㐍ࡣ᫬㛫౫Ꮡⓗ㛵ᩘ (ᘧ 2-8) ࡛グ㏙ࡋ㸪㠀ฎ ⨨⩌ࡢࣔࢹࣝ (ᘧ 2-7) ࢆᇶ࡟௨ୗࡢࣔࢹࣝ (ᘧ 2-9) ࢆᵓ⠏ࡋࡓࠋ ܶܦܨ = 1 െ ܴܶ௠௔௫ή ܶ݅݉݁ఊ ܶ݅݉݁ఊ+ ܧܶ ହ଴ ఊ                         ᘧ 2 െ 8 ܸ݀ܶ ݀ݐ = ܮ ή (1 െ ܶܦܨ) െ㹩௔௣ή ܸܶ                        ᘧ 2 െ 9 TRmax ; ᭱኱⪏ᛶຠᯝ㻌 ET50 ; ᭱኱⪏ᛶຠᯝࡢ 50%࡟฿㐩ࡍࡿࡓࡵ࡟せࡍࡿ᫬㛫㻌 Time ; ヨ㦂㛤ጞ࠿ࡽࡢ⤒㐣᫬㛫㻌 Ț ; ᫬㛫࡜ᛂ⟅ࡢ㛵ಀࡢ໙㓄ࢆ⾲ࡍಀᩘ㻌

2.3.6.2 ⸆

⸆ຠホ౯ࣔࢹࣝ

⸆≀ᢞ୚⩌࡟࠾࠸࡚ࡶ⭘⒆ቑṪࡢᢚไࡀㄆࡵࡽࢀࡓࠋ TAK-448 ࠾ࡼࡧ TAP-144 ࡣ࢔ࣥࢻࣟࢤ ࣥ࣍ࣝࣔࣥࡢᢚไࢆ௓ࡋ࡚⭘⒆ቑṪࢆᢚไࡍࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࡿࡇ࡜࠿ࡽ㸪⸆≀ຠᯝࡣ⸆≀ࡀ ࣍ࣝࣔࣥࡢ⏕ᡂࢆᢚไࡍࡿ㛫᥋཯ᛂࣔࢹࣝ (11) ࡛グ㏙ࡋࡓ (ᘧ 2-10, 2-11)ࠋ ܴ݀ܶ ݀ݐ = ݇௜௡ή (1 െ ܪܦܧ) െ㹩௢௨௧ή ܴܶ                       ᘧ 2 െ 10 ܪܦܧ = ܧ௠௔௫ή ܥ݌ ܧܥହ଴௠+ ܥ݌                              ᘧ 2 െ 11 ึᮇ᮲௳ t=0 ; ヨ㦂㛤ጞ᫬ࡢ࣍ࣝࣔࣥࣞ࣋ࣝ TR=1㻌 TR ; ௬᝿࣍ࣝࣔࣥࡢ཯ᛂ㻌 HDE ; ࣍ࣝࣔࣥ౫Ꮡⓗ࡞⸆ຠ㻌 kin ; 0 ḟࡢ࣍ࣝࣔࣥ⏕ᡂ㏿ᗘᐃᩘ㻌 kout ; 1 ḟࡢ࣍ࣝࣔࣥᾘኻ㏿ᗘᐃᩘ㻌 Emax ; ᭱኱⸆ຠ㻌 EC50 ; ᭱኱⸆ຠࡢ 50%ࢆ♧ࡍ⸆≀⃰ᗘ㻌 ⭘⒆ࡢቑṪࡀ࣍ࣝࣔࣥࣞ࣋ࣝࡢᙳ㡪ࢆཷࡅࡿࡓࡵ㸪⸆≀ᢞ୚࡟ࡼࡾ࣍ࣝࣔࣥࡀᢚไࡉࢀࡿ࡜⭘

(20)

- 13 - ⒆ቑṪࡀᢚไࡉࢀࡿࡀ㸪ཤໃ⩌࡜ྠᵝ࡟㸪⪏ᛶࡢஹ㐍࡜࡜ࡶ࡟⸆≀࡟ࡼࡿ࣍ࣝࣔࣥᢚไຠᯝࡀ᫬ 㛫⤒㐣࡜࡜ࡶ࡟ῶᙅࡋ㸪⭘⒆ࡢ෌ቑṪࡀㄆࡵࡽࢀࡓࠋ ࡋࡓࡀࡗ࡚㸪⸆≀ᢞ୚ᚋࡢ⭘⒆ቑṪᢚไࡣ ⸆≀࡟ࡼࡿ࣍ࣝࣔࣥᢚไ࡜⪏ᛶ໬ஹ㐍ࡢ୧᪉ࡢᙳ㡪ࢆ⪃៖ࡋࡓ௨ୗࡢࣔࢹࣝ (ᘧ 2-12, 2-13) ࢆᵓ ⠏ࡋ࡚ᐇ ್࡜ࡢࣇ࢕ࢵࢸ࢕ࣥࢢࢆ⾜ࡗࡓࠋ ܸ݀ܶ ݀ݐ = ܮ ή ܪܦܴܶ െ㹩௔௣ή ܸܶ                          ᘧ 2 െ 12 ܪܦܴܶ = ܴܶ ή ܶܦܨ + (1 െ ܶܦܨ)                        ᘧ 2 െ 13 HDTR ; ⭘⒆ቑṪ࡟ᑐࡍࡿ࣍ࣝࣔࣥ౫Ꮡⓗ཯ᛂ㻌 ୖグࣔࢹ࡛ࣝࡣ⪏ᛶ໬ࡢஹ㐍ࡣཤໃ⩌࡜⸆≀ᢞ୚⩌࡜࡛ྠࡌ࡛࠶ࡿ࡜௬ᐃࡋ㸪L ࠾ࡼࡧ kap ࡣ 2.3.6.1 ࡛᥎ᐃࡋࡓ್ࢆ౑⏝ࡋࡓࠋ 㠀ฎ⨨⩌ࡢ࣍ࣝࣔࣥࣞ࣋ࣝࡣヨ㦂ᮇ㛫୰ኚ໬ࡋ࡞࠸࡜⪃࠼ࡽ ࢀࡿࡇ࡜࠿ࡽ㸪TR=1 ࡜ࡋ㸪ཤໃ⩌ࡢ࣍ࣝࣔࣥࣞ࣋ࣝࡣཤໃ┤ᚋ࡟᳨ฟ㝈⏺ᮍ‶࡟࡞ࡾ㸪ࡑࡢᚋኚ ໬ࡋ࡞࠸ࡇ࡜࠿ࡽ TR=0 ࡜ࡋࡓࠋ ࡇࢀࡽࡢ௬ᐃ࡟ᇶ࡙࠸ࡓ HDTR ࡣ㠀ฎ⨨⩌࡛ 1㸪ཤໃ⩌࡛ (1-TDF) ࡜࡞ࡾ㸪ࡑࢀࡒࢀࡢ⭘⒆ቑṪ㏿ᗘࡣᘧ 2-7 ࠾ࡼࡧᘧ 2-9 ࡢグ㏙࡜▩┪ࡀ࡞࠸ࠋ

2.4 ⤖

⤖ᯝ

2.4.1 PK ࣔࢹࣝ

PK ࣔࢹࣝࡣ 2 ࡘࡢ྾཰┦ (༶᫬࠾ࡼࡧ㐜ᘏ྾཰┦) ࢆᣢࡘ 2-ࢥࣥࣃ࣮ࢺ࣓ࣥࢺࣔࢹࣝ࡟ࡼࡾ 㐺ษ࡟ᐇ ࢹ࣮ࢱࢆグ㏙ࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࡗࡓ (Fig. 2-3)ࠋ

2.4.2 PD ࣔࢹࣝ

2.4.2.1 ⭘⒆ቑṪ࠾ࡼࡧ⪏ᛶࡢࣔࢹࣝ໬

ᢞ୚፹యᢞ୚⩌࠾ࡼࡧཤໃ⩌࡟࠾ࡅࡿ⭘⒆య✚ࡢ⤒᫬ኚ໬ࡣ㸪 2.3.6.1 ࡛ᵓ⠏ࡋࡓ⥺ᙧቑṪࣔࢹ ࣝ࠾ࡼࡧ᫬㛫౫Ꮡⓗ㛵ᩘࣔࢹࣝ࡟ࡼࡾグ㏙ࡍࡿࡇ࡜ࡀ࡛ࡁࡓࠋ ᥎ᐃࡉࢀࡓࣃ࣓࣮ࣛࢱ࠾ࡼࡧࣇ࢕ ࢵࢸ࢕ࣥࢢࡢ⤖ᯝࢆࡑࢀࡒࢀ Table 2-1 ࠾ࡼࡧ Fig. 2-4 ࡟♧ࡍࠋ ᥎ᐃࡉࢀࡓ ET50 ್ࡣ 18.3 ᪥ ࡛࠶ࡾ㸪⛣᳜ࡋࡓ⭘⒆ࡀ᢬ᢠᛶࢆ⋓ᚓࡋ㸪࣍ࣝࣔࣥᢚไ࡟ᑐࡍࡿ཯ᛂࡀ༙ῶࡍࡿࡲ࡛࡟ᩘ㐌㛫᥃ ࠿ࡿࡇ࡜ࢆ♧ࡉࢀࡓࠋ ᥎ᐃࡉࢀࡓ TRmax ್ࡣ 1 ᮍ‶࡛࠶ࡾ (0.85)㸪࣍ࣝࣔࣥᢚไ࡟ᑐࡍࡿ཯ᛂ

(21)

- 14 - ᛶࡀ᭱኱࡛ 85%పୗࡍࡿࡇ࡜ࢆ♧ࡉࢀࡓࠋ

2.4.2.2 ⸆

⸆ຠホ౯ࣔࢹࣝ

⸆≀ᢞ୚⩌࡟࠾ࡅࡿ⭘⒆య✚ࡢ⤒᫬ኚ໬ࡣ㸪 2.3.6.2 ࡛ᵓ⠏ࡋࡓ⸆ຠホ౯ࣔࢹࣝ࡟ࡼࡾグ㏙ࡍ

ࡿࡇ࡜ࡀ࡛ࡁࡓࠋ ᥎ᐃࡉࢀࡓࣃ࣓࣮ࣛࢱ࠾ࡼࡧࣇ࢕ࢵࢸ࢕ࣥࢢࡢ⤖ᯝࢆࡑࢀࡒࢀ Table 2-2 ࠾ࡼ ࡧFig. 2-5 ࡟♧ࡍࠋ ⸆ຠࢆ♧ࡍ EC50 ࡣ TAK-448 ࡀ 1.74G pg/mL㸪TAP-144 ࡀ 132G pg/mL ࡛࠶ࡾ㸪

TAK-448 ࡢ᪉ࡀ 80 ಸᙉ࠸ࡇ࡜ࡀ♧ࡉࢀࡓࠋ ୍᪉㸪⭘⒆య✚ࡣ TAK-448 ࡢ᪉ࡀᙉࡃᢚไࡋ࡚࠸ ࡓ࡟ࡶ࠿࠿ࢃࡽࡍ㸪୧໬ྜ≀ࡢ᭱኱ᢚไάᛶࢆ♧ࡍࣃ࣓࣮ࣛࢱ (Emax) ࡟ᕪࡣぢࡽࢀ࡞࠿ࡗࡓࠋ ᮏ ࣔࢹࣝࡀ୧໬ྜ≀ࡢ⭘⒆య✚ࡢ᭱኱ᢚไࡢ㐪࠸ࢆグ㏙ྍ⬟࡛࠶ࡿ࠿ࢆ☜ㄆࡍࡿࡓࡵ㸪᭱㧗⏝㔞ࡢ 1000 ಸ࡟࠾ࡅࡿ⭘⒆య✚ࡢኚ໬ࢆࢩ࣑࣮ࣗࣞࢩࣙࣥࡋࡓࠋ ࡑࡢ⤖ᯝ㸪TAK-448 ࡣ⭘⒆ࡢቑṪࢆ ཤໃ⩌࡜ྠ⛬ᗘ࡟ᢚไࡍࡿࡢ࡟ᑐࡋ㸪TAP-144 ࡣ⏝㔞ࢆୖࡆ࡚ࡶཤໃ⩌ࡸ TAK-448 ࡢ⭘⒆ᢚไ ⋡࡟⮳ࡽ࡞࠸ࡇ࡜ࡀ♧ࡉࢀࡓ (Fig. 2-6)

௬᝿ⓗ࣍ࣝࣔࣥࡢᾘኻ㏿ᗘࢆ♧ࡍࣃ࣓࣮ࣛࢱ (kout) ࡣ TAK-448 ࡢ᪉ࡀ኱ࡁࡃ (Table 2-2) 㸪

TAK-448 ฎ⨨⩌ࡢ࣍ࣝࣔࣥࡢᾘኻࡀ TAP-144 ࡼࡾࡶ㏿࠸ࡇ࡜ࢆ♧ࡋࡓࠋ ୧໬ྜ≀ࡢ௬᝿ⓗ࣍ࣝ

ࣔࣥࡢኚ໬ࢆ 2.4.2.1 ࡛ᚓࡽࢀࡓ⪏ᛶ໬ࡢஹ㐍࡜ẚ࡭ࡿ࡜㸪TAK-448 ฎ⨨⩌࡛ࡣ࣍ࣝࣔࣥࣞ࣋ࣝ

ࡀᩘ᪥௨ෆ࡟᭱኱ᢚไ࡟㐩ࡋ࡚࠸ࡿࡢ࡟ᑐࡋ㸪TAP-144 ฎ⨨⩌ࡢ᭱኱ᢚไࡣ⪏ᛶ໬ࡢஹ㐍ࡀ༙ศ (18 ᪥) ௨ୖ㐍ࢇࡔ 21 ᪥ᚋ࡟ぢࡽࢀࡓ (Fig. 2-7)ࠋ

2.5 ⪃ᐹ

VCaP ࢆ⛣᳜ࡋࡓᢸ⒴ࣛࢵࢺホ౯⣔࡟࠾࠸࡚㸪TAK-448 ࡣ TAP-144 ࡟ẚ࡭࡚ᙉ࠸ᢠ⭘⒆ຠᯝ ࢆ♧ࡋࡓࡀ㸪㧗⏝㔞࡟࠾ࡅࡿࣛࢵࢺ⾑₢୰ࡢࢸࢫࢺࢫࢸࣟࣥࡢᢚไࡣ୧໬ྜ≀࡛ྠ➼࡛࠶ࡾ㸪࠸ ࡎࢀࡢ໬ྜ≀ࡶࢸࢫࢺࢫࢸࣟࣥࢆཤໃࣞ࣋ࣝࡲ࡛ᢚไࡋ࡚࠸ࡓ (26)ࠋ ࡋࡓࡀࡗ࡚㸪༢⣧࡞ࢸࢫࢺ ࢫࢸࣟࣥศἪᢚไ⬟ຊࡢẚ㍑࡛ࡣ୧໬ྜ≀ࡢᢠ⭘⒆ຠᯝࡣẚ㍑୙ྍ⬟࡜⪃࠼ࡽࢀࡓࠋ ࡉࡽ࡟㸪⛣ ᳜ࡋࡓ VCaP ࡣࢸࢫࢺࢫࢸࣟࣥ࡟ᑐࡍࡿ⪏ᛶ໬ࢆ᭷ࡋ࡚࠸ࡿࡓࡵ㸪⸆≀ᢞ୚࡟ࡼࡿ⭘⒆య✚ࡢኚ ໬ࡣ⸆≀ࡢᢠ⭘⒆ຠᯝ࡟ຍ࠼࡚㸪⤒᫬ⓗ࡟ኚ໬ࡍࡿ⭘⒆ࡢ⪏ᛶ໬ࡀྠ᫬࡟ᙳ㡪ࡍࡿࠋ ࡑࡢࡓࡵ㸪 ⸆ຠࡢẚ㍑ࡣ༢⣧࡟⭘⒆య✚ࡢኚ໬ࢆẚ㍑ࡍࡿࡔࡅ࡛ࡣ࡞ࡃ㸪⪏ᛶ໬ࡢᙳ㡪ࢆ⪃៖ࡋ࡚⾜࠺ᚲせ

(22)

- 15 - ࡀ࠶ࡿࠋ ࡑࡇ࡛㸪ᮏ◊✲࡛ࡣ⸆⌮స⏝࡟ຍ࠼࡚⪏ᛶࡢஹ㐍࡟ࡘ࠸࡚ࡶࣔࢹࣝ໬ࢆ⾜࠸㸪⪏ᛶ໬ࡢ ᙳ㡪ࢆ⪃៖ࡋࡓ୧໬ྜ≀ࡢ⸆⌮Ꮫⓗຠຊ࡜≉ᛶࢆᐃ㔞ⓗ࡟ホ౯ࡋࡓࠋ ཤໃ⩌࡟࠾ࡅࡿ⭘⒆ቑṪࡣ㸪㛤ጞ᪩ᮇ࡛ࡣ⭘⒆ࡢ㏥⦰ࡀぢࡽࢀࡓࡀ㸪ࡑࡢᚋ෌ࡧቑṪࢆ㛤ጞࡋ ࡓࠋ ࡇࡢ⭘⒆య✚ࡢ⤒᫬ኚ໬ࡣ᫬㛫౫Ꮡⓗ࡞㛵ᩘࡢࣔࢹ࡛ࣝグ㏙ࡍࡿࡇ࡜ࡀ࡛ࡁࡓ (ᘧ 2-8, 2-9)ࠋ ᥎ᐃࡉࢀࡓ ET50 ್ࡣ 18.3 ᪥࡛࠶ࡾ㸪⛣᳜ࡋࡓ⭘⒆ࡀ᢬ᢠᛶࢆ⋓ᚓࡍࡿࡲ࡛࡟ᩘ㐌㛫᥃࠿ࡿࡇ࡜ ࢆ♧ࡋࡓࠋ ᐇ㝿㸪ཤໃ⩌ࡢ⭘⒆య✚ࡣヨ㦂㛤ጞ࠿ࡽ⣙ 2 㐌㛫๓ᚋ࡟㏥⦰࠿ࡽቑṪ࡟㌿ࡌ࡚࠾ࡾ㸪 ᥎ᐃࡉࢀࡓET50್ࡣ㐺ษ࡟⪏ᛶ໬ࢆグ㏙ࡋ࡚࠸ࡿ࡜⪃࠼ࡽࢀࡓࠋ ᥎ᐃࡉࢀࡓ TRmax ್ࡣ 1 ᮍ‶ ࡛࠶ࡾ (0.85)㸪⪏ᛶ໬ࡀ୙᏶඲࡛࠶ࡿࡇ࡜ࢆ♧ࡋࡓࠋ ᢸ⒴ホ౯⣔࡟࠾ࡅࡿ⪏ᛶ໬ࡢஹ㐍ᶵᗎ࡜ࡋ ࡚㸪 VCaP ⣽⬊࡛ࡢ࢔ࣥࢻࣟࢤࣥཷᐜయࡢ㐣๫Ⓨ⌧࡟ࡼࡿ࢔ࣥࢻࣟࢤࣥ࡟ᑐࡍࡿឤཷᛶࡢቑຍ (32)㸪⭘⒆ෆ࢔ࣥࢻࣟࢤࣥ de novo ྜᡂ (5)㸪࢔ࣥࢻࣟࢤࣥཷᐜయࡢኚ␗࡟ࡼࡿ㠀࢔ࣥࢻࣟࢤࣥࢫ ࢸࣟ࢖ࢻࡼࡿάᛶ໬ (14) ࡀ⪃࠼ࡽࢀࡿࠋ ᢞ୚፹యᢞ୚⩌࡟࠾ࡅࡿ⭘⒆ቑṪࡣ㸪඲ヨ㦂ᮇ㛫࡟ࢃࡓࡗ࡚⥺ᙧቑṪࢆ♧ࡋ࡚࠾ࡾ㸪0 ḟ㏿ᗘᐃ ᩘ࡟ࡼࡿ⥺ᙧቑṪࣔࢹ࡛ࣝグ㏙ࡍࡿࡇ࡜ࡀ࡛ࡁࡓ (ᘧ 2-7)ࠋ ᢸ⒴ホ౯⣔࡟⛣᳜ࡋࡓ⭘⒆ࡢቑṪࡣ㸪 ୍⯡࡟ 3 ࡘࡢẁ㝵࡟ศࡅࡽࢀ㸪ึᮇࡢᣦᩘⓗቑṪᚋ࡟⥺ᙧቑṪᮇ࡟⛣⾜ࡋ㸪‽⥺ᙧቑṪᮇࢆ⤒࡚ ᭱኱య✚࡟฿㐩ࡍࡿࠋᮏ◊✲࡛ࡣ㸪ື≀೔⌮ࢆ⪃៖ࡋ࡚‽⥺ᙧቑṪᮇ๓࡟ヨ㦂ࢆ᏶஢ࡋࡓࠋࡲࡓ ⛣᳜࠿ࡽ 7 㐌㛫ᚋࡢヨ㦂㛤ጞ᫬࡟ࡣึᮇࡢᣦᩘⓗቑṪᮇ࠿ࡽࡍ࡛࡟⥺ᙧቑṪᮇ࡟⛣⾜ࡋ࡚࠸ࡓ ࡜⪃࠼ࡽࢀࡿࠋ TAK-448 ࠾ࡼࡧ TAP-144 ࡢᢠ⭘⒆ຠᯝࡣ LH ࠾ࡼࡧࢸࢫࢺࢫࢸࣟࣥࡢᢚไࢆ௓ࡋ࡚Ⓨ᥹ࡉ ࢀࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࡿ (36)ࠋ ୖグ࡛ᵓ⠏ࡋࡓཤໃ⩌ (⪏ᛶ໬ஹ㐍) ࠾ࡼࡧ፹యᢞ୚⩌ (↓ฎ⨨ ≧ែ࡛ࡢ⭘⒆ቑṪ) ࡢࣔࢹࣝ࡟㸪⸆≀స⏝ᶵᗎࡢグ㏙ࢆຍ࠼࡚ࣔࢹࣝࢆᵓ⠏ࡋࡓ(ᘧ 2-10㹼2-13)ࠋ ࣔࢹࣝ࡟ࡼࡿ୧໬ྜ≀ࡢᢠ⭘⒆ቑṪຠᯝࡢグ㏙࡟ᡂຌࡋ㸪ࣃ࣓࣮ࣛࢱ್ࡀ᥎ᐃࡉࢀࡓ (Fig. 2-5,

Table 2-1, 2-2)ࠋ ᥎ᐃࡉࢀࡓ EC50 ್ࡣ TKA-448 ࡢ᪉ࡀ TAP-144 ࡟ẚ࡭࡚ 80

ಸᑠࡉࡃ㸪TAK-448 ࡢᙉ࠸㜼ᐖάᛶࢆ♧ࡋ࡚࠾ࡾ㸪ࢸࢫࢺࢫࢸࣟࣥ࡟ᑐࡍࡿ TAK-ಸᑠࡉࡃ㸪TAK-448 ࡢ㜼ᐖຠᯝࡀ TAP-144 ࡼ ࡾࡶᙉຊ࡛࠶ࡿࡇ࡜࡜▩┪ࡢ࡞࠸ࡶ࡛࠶ࡗࡓ (36)ࠋ ᥎ᐃࡉࢀࡓ kout ್ࡣ TKA-448 ࡢ᪉ࡀ

144 ࡟ẚ࡭࡚኱ࡁࡃ㸪ࣔࢹࣝࡢ௬᝿ⓗ࡞࣍ࣝࣔࣥࡢᾘኻࡀ TKA-448 ࢆᢞ୚ࡋࡓ᫬ࡢ᪉ࡀ TAP-144 ࡟ẚ࡭࡚㏿࠸ࡇ࡜ࢆ♧ࡋࡓࠋ ࣛࢵࢺࡢ⸆ຠホ౯ࣔࢹࣝ࡟࠾࠸࡚㸪TAK-448 ࡢࢸࢫࢺࢫࢸࣟࣥ

(23)

- 16 - ࡢᢚไࡀ TAP-144 ࡼࡾࡶ㏿࠸ࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ (36)ࠋ TAK-448 ࡣ⾑₢୰ࢸࢫࢺࢫࢸࣟࣥࢆ 3 ᪥௨ෆ࡟᳨ฟ㝈⏺ᮍ‶ࡲ࡛ᢚไࡍࡿࡀ㸪TAP-144 ࡣࢸࢫࢺࢫࢸࣟࣥࡢ᭱኱ᢚไ࡟ 2 㐌㛫᥃࠿ࡾ㸪 ᮏࣔࢹ࡛ࣝ᥎ᐃࡉࢀࡓ࣍ࣝࣔࣥࣞ࣋ࣝࡢ᥎⛣ࡣᐇ㝿ࡢ⸆≀ᢞ୚ᚋࡢࢸࢫࢺࢫࢸࣟࣥࡢ᥎⛣ࡢ≉ᚩ ࢆ཯ᫎࡋ࡚࠸ࡓࠋ ᥎ᐃࡉࢀࡓ௬᝿ⓗ࡞࣍ࣝࣔࣥࣞ࣋ࣝࡢ᥎⛣ࢆ⪏ᛶ໬ࡢஹ㐍࡜ẚ㍑ࡍࡿ࡜ (Fig. 2-7)㸪TAK-448 ࢆฎ⨨ࡋࡓ㝿ࡢ࣍ࣝࣔࣥࣞ࣋ࣝࡣ⪏ᛶ໬ࡀ᭦᪂ࡍࡿ๓ (ᩘ᪥௨ෆ) ࡟᭱኱ᢚไ࡟㐩 ࡍࡿࡀ㸪TAP-144 ࡛ࡣ⪏ᛶ໬ࡀ༙ศ௨ୖ᭦᪂ࡋࡓ 18 ᪥௨㝆࡟᭱኱ᢚไ࡟㐩ࡍࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ

ࡋࡓࡀࡗ࡚㸪TAK-448 ࡣ TAP-144 ࡼࡾࡶᙉ࠸࣍ࣝࣔࣥ㜼ᐖຠᯝࢆ᭷ࡍࡿࡇ࡜࡟ຍ࠼㸪TAK-448

ࡢ࣍ࣝࣔࣥᢚไస⏝ࡣ TAP-144 ࡟ẚ࡭᪩ࡃⓎ᥹ࡉࢀ㸪⭘⒆ࡀ⪏ᛶࢆ⋓ᚓࡍࡿࡼࡾࡶ᪩ࡃࡑࡢຠᯝ ࡀⓎ᥹ࡉࢀࡿࡇ࡜ࡀ♧ࡉࢀ㸪ࡇࢀࡽࡢ⸆≀ࡢᛶ㉁ࡀ㸪ࢸࢫࢺࢫࢸࣟࣥࡀ୧໬ྜ≀࡛ཤໃࣞ࣋ࣝࡲ ࡛ᢚไࡉࢀ࡚࠸ࡿ࡟ࡶ࠿࠿ࢃࡽࡎ㸪TAK-448 ࡢ᪉ࡀ TAP-144 ࡟ẚ࡭࡚ᙉ࠸ᢠ⭘⒆άᛶࢆ♧ࡋࡓ せᅉ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡓࠋ

2.6 ᑠ

ᑠᣓ

ᢸ⒴ࣛࢵࢺࢆ⏝࠸ࡓ⸆ຠホ౯⣔࡟࠾ࡅࡿ TAK-448 ࠾ࡼࡧ TAP-144 ࡢᢠ⭘⒆ຠᯝࢆ PK/PD ࣔࢹࣝ࡟ࡼࡗ࡚ᐃ㔞ⓗ࡟ホ౯ࡋࡓࠋ TAK-448 ࡢᢠ⭘⒆ຠᯝࡣ TAP-144 ࡟ẚ࡭࡚ 80 ಸᙉࡃ㸪 TAK-448 ࡢ࣍ࣝࣔࣥᢚไస⏝ࡣ TAP-144 ࡟ẚ࡭᪩ࡃⓎ᥹ࡉࢀ㸪⭘⒆ࡀ⪏ᛶࢆ⋓ᚓࡍࡿࡼࡾࡶ᪩ ࡃࡑࡢຠᯝࡀⓎ᥹ࡉࢀࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ

(24)

- 17 -

3❶㸸 TAK-441 ࡢ⮫ᗋ⮳㐺⏝ἲ࠾ࡼࡧ⏝㔞ุᐃᇶ‽ࡢタᐃ

3.1 ࡣࡌࡵ࡟

㠀⮫ᗋẁ㝵࡛☜ㄆࡉࢀࡓೃ⿵໬ྜ≀ࡢ⸆ຠ⸆⌮ヨ㦂ࡢᡂ⦼ࡣ㸪✀ᕪࡸホ౯⣔ࡢ㐪࠸࡟ࡼࡾ⮫ᗋ ヨ㦂࡛෌⌧ࡉࢀࡿ࡜ࡣ㝈ࡽ࡞࠸ࠋࡑࡢࡓࡵ㸪⮫ᗋ࡟࠾࠸࡚ࡶೃ⿵໬ྜ≀ࡀ᝿ᐃࡋࡓస⏝ᶵᗎ࡛⸆ ຠࢆⓎ᥹ࡋ࡚࠸ࡿࡇ࡜ࢆ☜ㄆࡍࡿᚲせࡀ࠶ࡿࠋ ࡇࡢࡇ࡜ࢆ Proof of Mechanism (PoM) ࡜ࡼࡧ㸪ೃ ⿵໬ྜ≀ࡢ⮫ᗋ࡟࠾ࡅࡿ⸆ຠࡢぢᴟࡵ࡟࠾࠸࡚㔜せ࡞ุ᩿ᇶ‽࡟࡞ࡗ࡚࠸ࡿࠋ PoM ࡢ☜ㄆ࡟ࡣ ࣂ࢖࣐࣮࣮࢜࢝ࡀ฼⏝ࡉࢀࡿࠋ⡿ᅜࡢ National Institute of Health (NIH) ࡣ㸪ࠕࣂ࢖࣐࣮࣮࢜࢝ࡣᐈ ほⓗ࡟ ᐃࡉࢀ㸪ホ౯ࡉࢀࡿ≉ᛶ್࡛࠶ࡾ㸪ṇᖖ࡞⏕≀Ꮫⓗࣉࣟࢭࢫ㸪⑓⌮Ꮫⓗࣉࣟࢭࢫ㸪ࡲࡓ ࡣ἞⒪ฎ⨨࡟ᑐࡍࡿ⸆⌮Ꮫⓗ཯ᛂࡢᣦᶆ࡜ࡋ࡚⏝࠸ࡽࢀࡿࡶࡢࠖ࡜ᐃ⩏ࡋ࡚࠾ࡾ㸪PoM ࡢ☜ㄆ࡟ ࡣ໬ྜ≀ࡢᶆⓗࡲࡓࡣୗὶࡢࢩࢢࢼࣝ⤒㊰࡟ᒓࡍࡿࢱࣥࣃࢡ㉁ࡸ㑇ఏᏊࡢኚ໬ࡀࣂ࢖࣐࣮࣮࢜࢝ ࡜ࡋ࡚฼⏝ࡉࢀࡇ࡜ࡀከ࠸ࠋ ࡲࡓ㸪㠀⮫ᗋ࡜⮫ᗋ࡜࡛ඹ㏻ࡋࡓࣂ࢖࣐࣮࣮࢜࢝ࢆ ᐃࡍࡿࡇ࡜࡛㸪 ⮫ᗋ࡟࠾ࡅࡿ⸆ຠࢆ㠀⮫ᗋࡢ⸆ຠホ౯⣔ࡢᡂ⦼࠿ࡽ᥎ ࡍࡿࡇ࡜ࡀྍ⬟࡜࡞ࡿࠋ㏆ᖺ࡛ࡣ㠀⮫ᗋ ⸆ຠホ౯⣔࡟࠾ࡅࡿ⸆ຠ࡜ࣄࢺ࡟እᤄྍ⬟࡞ࣂ࢖࣐࣮࣮࢜࢝ࡢ཯ᛂᛶࡢ㛵ಀࢆ PK/PD ࣔࢹࣜࣥ ࢢ࡟ࡼࡾᐃ㔞໬ࡋ㸪⮫ᗋ࡟࠾ࡅࡿ⸆ຠࡢᐃ㔞ⓗ࡞ண ࡸ⮳㐺⏝ἲ࠾ࡼࡧ⏝㔞Ỵᐃ࡟฼⏝ࡉࢀ࡚࠸ ࡿ (51)ࠋ Gli1 ࡣ TAK-441 ࡢᶆⓗ࡛࠶ࡿ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡢୗὶ࡟఩⨨ࡍࡿ㌿෗ᅉᏊ࡛࠶ ࡾ㸪ࡑࡢ཯ᛂࡣ TAK-441 ࡢ⸆ຠ࡟┦㛵ࡍࡿ࡜⪃࠼ࡽࢀ㸪⮳㐺⏝ἲ࠾ࡼࡧ⏝㔞タᐃࡢࡓࡵࡢࣂ࢖࢜ ࣐࣮࣮࢝࡜ࡋ࡚฼⏝ࡉࢀࡿࡇ࡜ࡀᮇᚅࡉࢀࡿࠋ ࡑࡇ࡛ᮏ❶࡛ࡣ㸪ᢸ⒴࣐࢘ࢫホ౯⣔࡟࠾ࡅࡿᢠ⭘ ⒆άᛶ࡜ Gli1 mRNA ࡢⓎ⌧㔞ࡢ㛵ಀࢆ PK/PD ࣔࢹࣜࣥࢢࢆ⏝࠸࡚ᐃ㔞໬ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡋ㸪 ⭘⒆୰ Gli1 mRNA ࡢⓎ⌧㔞ࡢ⸆ຠࢆண ࡍࡿࣂ࢖࣐࣮࣮࢜࢝࡜ࡋ࡚ࡢ᭷⏝ᛶࢆホ౯ࡋࡓࠋ ࡲࡓ㸪 ⮫ᗋ࡛ࡢ⭘⒆୰ࡢࣂ࢖࣐࣮࣮࢜࢝ࡢ ᐃ࡟࠾࠸࡚ࡣ㸪ヨᩱ᥇ྲྀ᫬ࡢᏳ඲ᛶࡸ೔⌮㠃࠿ࡽࡑࡢ฼⏝ ࡀไ㝈ࡉࢀࡿࡓࡵ㸪௦᭰⤌⧊࡜ࡋ࡚㑅ᢥࡋࡓ⓶⭵୰ࡢ Gli1 mRNA ࡢⓎ⌧㔞࡟ࡘ࠸࡚ࡶࣂ࢖࣐࢜ ࣮࣮࢝࡜ࡋ࡚ࡢ᭷⏝ᛶࢆホ౯ࡋࡓࠋ

(25)

- 18 -

3.2 TAK-441 ࡟

࡟ࡘ࠸࡚

TAK-441 (ୗᅗ 1) ࡣ㑅ᢥⓗ࡟࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡢ⭷㈏㏻άᛶᅉᏊ (smoothened, SMO) ࡜⤖ྜࡋ࡚ࢩࢢࢼࣝఏ㐩ᶵᵓࢆ㜼ᐖࡋ㸪ࡀࢇࡢ἞⒪⸆ࢆ┠ᣦࡋ࡚㛤Ⓨࡉࢀ࡚ࡁࡓ⸆≀࡛࠶ ࡿࠋ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡣ㸪ࣜ࢞ࣥࢻ࡛࠶ࡿ࣊ࢵࢪ࣍ࢵࢢ࡜ࡑࡢཷᐜయ࡛࠶ࡿ Patched (Ptch)㸪㞄᥋ࢱࣥࣃࢡࡢ SMO ࠾ࡼࡧࡑࡢୗὶࡢ㌿෗ㄪ⠇ᅉᏊ࡛࠶ࡿ Gli ࠿ࡽᵓᡂࡉࢀ࡚࠸ࡿ (20)ࠋ ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡣඖࠎࢩࣙ࢘ࢪࣙ࢘ࣂ࢚ࢆ⏝࠸ࡓ⬇Ⓨ⏕ᮇࡢࣃࢱ࣮ࣥᙧᡂ ኚ␗యࡢࢫࢡ࣮ࣜࢽࣥࢢ࡟ࡼࡾⓎぢࡉࢀ㸪⏕యࡢᙧែᙧᡂ࡜⣽⬊ቑṪࢆไᚚࡍࡿ⤒㊰࡛࠶ࡿࡇ࡜ ࡀ᫂ࡽ࠿࡜࡞ࡗࡓ (20)ࠋ ◊✲ࡀ㐍ࡳ㸪ᵝࠎ࡞ࡀࢇ✀࡟࠾࠸࡚࡜࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡀ άᛶ໬ࡉࢀ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡜࡞ࡾ (6, 33, 48, 49, 52, 54)㸪ᮏ⤒㊰ࡀࡀࢇ㡿ᇦ࡟࠾ࡅࡿศᏊᶆⓗ ࡜ࡋ࡚ὀ┠ࡉࢀࡿࡼ࠺࡟࡞ࡗࡓ (9, 48)ࠋ ࣊ࢵࢪ࣍ࢵࢢࣜ࢞ࣥࢻࡀᏑᅾࡋ࡞࠸≧ែ࡛ࡣ㸪Ptch ࡣ SMO ࡢάᛶ໬ࢆᢚไࡋ࡚࠸ࡿࡀ㸪࣊ࢵࢪ࣍ࢵࢢࣜ࢞ࣥࢻࡀ Ptch ࡟⤖ྜࡍࡿ࡜㸪SMO ࡢᢚไࡀ ゎ㝖ࡉࢀୗὶࡢ Gli ࡢ㌿෗άᛶࡀୖ᪼ࡋ㸪Gli ࡢไᚚୗ࡟࠶ࡿ㑇ఏᏊࡣ⣽⬊ࡢቑṪࡸศ໬ࢆㄪ⠇ ࡍࡿ (7, 25)ࠋ TAK-441 ࡣ SMO ࡟⤖ྜࡋ㸪SMO ࠿ࡽୗὶࡢࢩࢢࢼࣝఏ㐩ࢆ㜼ᐖࡍࡿࡇ࡜࡟ࡼ ࡾ㸪࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡀάᛶ໬ࡉࢀࡓࡀࢇ✀࡟ᑐࡋ࡚ຠᯝࢆⓎ᥹ࡍࡿ࡜⪃࠼ࡽࢀ࡚ ࠸ࡿ (22)ࠋ ୗᅗ 2 ࡟࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰࡜ TAK-441 ࡢస⏝ᶵᗎࡢᶍᘧᅗࢆ♧ࡍࠋ ᅗ1 TAK-441 ࡢᵓ㐀ᘧ N N O O O CH3 CH3 O HN N O OH F F F

(26)

- 19 - ᅗ2 ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰࡜ TAK-441 ࡢస⏝ᶵᗎ

3.3 ᐇ

ᐇ㦂ᮦᩱ࡜᪉ἲ

3.3.1 ⿕㦂≀㉁

TAK-441 (6-Ethyl-N-[1-(hydroxyacetyl)piperidin-4-yl]-1-methyl-4-oxo-5-(2-oxo-2-phenylethyl)-3-(2,2,2-trifluoroethoxy)-4,5-dihydro-1H-pyrrolo[3,2-c]pyridine-2-carboxamide) ࡣṊ⏣⸆ရᕤᴗ࡛ྜᡂࡋ ࡓࡶࡢࢆ⏝࠸ࡓࠋ ⤒ཱྀᢞ୚ࡢᢞ୚ᾮࡣ TAK-441 ࢆ࣓ࢳࣝࢭ࣮ࣝࣟࢫ⁐ᾮ (0.5%w/v) ࡛ᠱ⃮ࡋㄪ 〇ࡋࡓࠋ ⓶ୗᢞ୚࡛ࡣ TAK-441 ࢆࢪ࣓ࢳࣝࢫࣝ࣍࢟ࢩࢻ/࣏࢚ࣜࢳࣞࣥࢢࣜࢥ࣮ࣝ 㸦1㸸1㸪v / v㸧 ࡟⁐ゎࡋࡓࠋ

3.3.2 ື≀

8 㐌㱋ࡢ㞤ᛶ BALB/c-nu/nu ࣐࢘ࢫ (᪥ᮏࢳ࣮ࣕࣝࢫ࣭ࣜࣂ࣮ᰴᘧ఍♫) ࢆ⏝࠸ࡓࠋ ࡇࢀࡽࡢ ື≀࡟ᅛᙧ㣫ᩱ (CRF-1㸪࢚࢜ࣜࣥࢱࣝ㓝ẕᕤᴗᰴᘧ఍) ࡜Ỉ㐨Ỉࢆ୚࠼㸪 ᗘ 20㹼26Υ㸪‵ᗘ 40㹼75%㸪᫂ᬯࢧ࢖ࢡࣝ 12 ᫬㛫ࡢ㣫⫱ᐊ࡛㣫⫱ࢆ⾜ࡗࡓࠋ ࡞࠾㸪඲࡚ࡢື≀ヨ㦂ࡣ㸪Ṋ⏣⸆ရ ᕤᴗ◊✲ᡤࡢື≀೔⌮ጤဨ఍ࡢᑂᰝࡢᢎㄆᚋ࡟ᐇ᪋ࡋࡓࠋ

(27)

- 20 -

3.3.3 ᢠ

ᢠ⭘⒆άᛶホ౯ࡢࡓࡵࡢື≀ヨ㦂

8 㐌㱋ࡢ࣐࢘ࢫ (య㔜㸹18㹼26 g) ࡟࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝࡢάᛶ໬ࡀ☜ㄆࡉࢀࡓࣄࢺ⮅⮚ࡀࢇ ⣽⬊ᰴ (PAN-04) ࢆ⓶ୗ࡟⛣᳜ࡋ㸪1 㐌㛫ᚋ࡟ᢞ୚፹య (0.5%࣓ࢳࣝࢭ࣮ࣝࣟࢫ) ࠾ࡼࡧ TAK-441 ࡢᢞ୚ࢆ㛤ጞࡋࡓ (ྛ⩌ 5 ༉)ࠋ ⸆≀ࡣ 1㸪10 ࠾ࡼࡧ 25 mg/kg ࡛ 16 ᪥㛫 1 ᪥ 1 ᅇ⤒ཱྀᢞ ୚ࡋࡓࠋ ⭘⒆ࡢ㛗ᚄཬࡧ▷ᚄࢆࣀࢠࢫ࡛ ᐃࡋ㸪⭘⒆య✚ࡣ㛗ᚄ™▷ᚄ2™0.5 ࡟࡚⟬ฟࡋࡓࠋ

3.3.4 ⸆≀ືែヨ㦂࠾ࡼࡧࣂ࢖࣐࣮࣮࢜࢝ࡢ ᐃࡢࡓࡵࡢື≀ヨ㦂

TAK-441 ࡢ⸆≀ືែホ౯ࡢࡓࡵࡢ⾑₢୰⸆≀⃰ᗘࡢᐃ㔞࠾ࡼࡧࣂ࢖࣐࣮࣮࢜࢝ࡢ཯ᛂᛶࢆゎ ᯒࡍࡿࡓࡵࡢ Gli1 mRNA ࡢ ᐃࡣྠ୍ಶయ࠿ࡽ᥇ྲྀࡋࡓヨᩱࢆ⏝࠸࡚⾜ࡗࡓࠋ ᢞ୚㔞ࡣ༢ᅇ⤒ ཱྀᢞ୚࡛ࡣ100 mg/kg㸪3 ᪥㛫ࡢ཯᚟⤒ཱྀᢞ୚࡛ࡣ 5 mg/kg (1 ᪥ 2 ᅇ) ࡲࡓࡣ 10 ࠾ࡼࡧ 25 mg/kg (1 ᪥ 1 ᅇ) ࡜ࡋࡓࠋ ⓶ୗᢞ୚࡛ࡣ Alzet ᾐ㏱ᅽ࣏ࣥࣉ (DURECT ♫) ࢆ⓶ୗ࡟ᇙࡵ㎸ࡳ㸪1 ᪥ᙜ ࡓࡾ 0.5㸪1㸪2.5㸪5 ࠾ࡼࡧ 10 mg/kg ࡢ⏝㔞࡛ 3 ᪥㛫ᣢ⥆ᢞ୚ࢆ⾜ࡗࡓࠋ ࡲࡓ㸪ู㏵㸪1 ࠾ࡼ ࡧ 25 mg/kg ࢆ༢ᅇ⤒ཱྀᢞ୚ࡋࡓື≀ࢆ PK ࣔࢹࣝࡢᵓ⠏ࡢࡓࡵࡢࢧࢸࣛ࢖ࢺ⩌࡜ࡋࡓࠋ ⾑₢ࡣ⭡኱㟼⬦࠿ࡽ඲᥇⾑ᚋ࡟㐲ᚰศ㞳࡟ࡼࡾ᥇ྲྀࡋ㸪⸆≀⃰ᗘᐃ㔞⏝ヨᩱ࡜ࡋࡓࠋ ࡞࠾㸪ᢠ จᅛ๣࡜ࡋ࡚࣊ࣃࣜࣥࢼࢺ࣒ࣜ࢘ࢆ⏝࠸ࡓࠋ ࡲࡓ㸪ᒕẅᚋࡢື≀࠿ࡽ⓶⭵࠾ࡼࡧ⭘⒆ࢆ᥇ྲྀࡋ㸪

⤌⧊୰⸆≀⃰ᗘࡢᐃ㔞࠾ࡼࡧ Gli1 mRNA ࣞ࣋ࣝ ᐃ⏝ヨᩱ࡜ࡋࡓ (⤌⧊୰ TAK-441 ⃰ᗘࡢᐃ

(28)

- 21 - ⩌ᵓᡂ ᢞ୚⤒㊰ ᢞ୚㔞 (mg/kg) ᢞ୚㢖ᗘ ⤒ཱྀ 1* ༢ᅇ 25* 100 5 1 ᪥ 2 ᅇ (3 ᪥㛫) 10 1 ᪥ 1 ᅇ (3 ᪥㛫) 25 ⓶ୗ 0.5 3 ᪥㛫 1    1 ᫬Ⅼ࠶ࡓࡾࡢື≀ᩘࡣ࠸ࡎࢀࡶ 3 ༉ࠋ *1 ࠾ࡼࡧ 25 mg/kg ࡢ༢ᅇᢞ୚⩌ࡣ⾑₢ࡢࡳ᥇ྲྀࡋࡓࠋ

3.3.5 ศ

ศᯒ᪉ἲ

3.3.5.1 ⾑₢࠾ࡼࡧ⤌⧊୰ TAK-441 ⃰ᗘ

TAK-441 ࡢᐃ㔞ࡣᾮయࢡ࣐ࣟࢺࢢࣛࣇ࢕࣮-ࢱࣥࢹ࣒㉁㔞ศᯒィ (LC-MS/MS) ࢆ⏝࠸࡚⾜ࡗࡓࠋ ⾑₢ࡲࡓࡣ⓶⭵࠾ࡼࡧ⭘⒆࣍ࣔࢪࢿ࣮ࢺ୰ࡢ TAK-441 ࡣ࢔ࢭࢺࢽࢺࣜࣝࡢῧຍ࡟ࡼࡾ㝖ࢱࣥࣃ ࢡࡋ࡚ᢳฟࡋࡓࠋ 㐲ᚰศ㞳ᚋ㸪ୖΎࢆ 0.2%ࡢࢠ㓟ࢆྵࡴ 10 mmol/L ࢠ㓟࢔ࣥࣔࢽ࣒࡛࢘ᕼ㔘ࡋ㸪 㧗㏿ᾮయࢡ࣐ࣟࢺࢢࣛࣇ࢕࣮ (HPLC) ⿦⨨࡟ὀධࡋࡓࠋ ᐃ㔞ୗ㝈ࡣ⾑₢୰ࡀ 0.003 μg/mL㸪⤌⧊ ୰ࡀ0.015 μg/g ࡛࠶ࡗࡓࠋ HPLC ᮲௳

࣒࢝ࣛ 㸸Shimadzu Shim-pack XR-ODS (2.2 μm, 2.0 x 30 mm, Shimadzu) ⛣ື┦A 㸸10 mmol/L ࢠ㓟࢔ࣥࣔࢽ࣒࢘/ࢠ㓟 (100:0.2㸪ᐜ㔞ẚ)

(29)

- 22 - ࢢࣛࢪ࢚ࣥࢺ ᫬㛫㸦ศ㸧 B (%) 0 5 0.2 5 1.3 99 2.0 99 2.01 5 2.6 5 ὶ㏿ 㸸0.7 mL/min ࣒࢝ࣛ ᗘ 㸸50Υ MS/MS ᮲௳ ࢖࢜ࣥ໬ἲ 㸸ከ㔜཯ᛂࣔࢽࢱࣜࣥࢢ ㉁㔞㟁Ⲵẚ 㸸577.4 Ѝ 419.3

3.3.5.2 Gli1 mRNA ࡢ

ࡢⓎ⌧㔞

⭘⒆ࡲࡓࡣ⓶⭵࠿ࡽࡢ඲ RNA ࡢᢳฟࡣ RNeasy Mini Kit (࢟࢔ࢤࣥ♫) ࢆ౑⏝ࡋ㸪ࡑࡢᚋ㸪 cDNA ㏫㌿෗࢟ࢵࢺ (࢔ࣉࣛ࢖ࢻࣂ࢖࢜ࢩࢫࢸ࣒ࢬ♫) ࢆ౑⏝ࡋ࡚㸪RNA ࠿ࡽ cDNA ࢆྜᡂࡋ

ࡓࠋᐃ㔞ⓗ㏫㌿෗࣏࣓࣮ࣜࣛࢮ㐃㙐཯ᛂࡣ㸪ABI Prism 7900 㓄ิ᳨ฟࢩࢫࢸ࣒ (࢔ࣉࣛ࢖ࢻࣂ࢖

࢜ࢩࢫࢸ࣒ࢬ♫) ࢆ⏝࠸㸪ࣉࣛ࢖࣐࣮࡟ࡣ Mm00494645_m1 (Gli1) ࠾ࡼࡧ Mm01162710_m1 (SMO㸸ෆ㒊ᶆ‽) ࢆ౑⏝ࡋࡓࠋ㏫㌿෗࣏࣓࣮ࣜࣛࢮ㐃㙐཯ᛂ࡟ࡼࡿ⏘≀ࡢቑṪ᭤⥺࡜㜈್⥺࡜ࡢ ஺Ⅼࢆ Ct ್࡜ࡋ㸪ᑐ↷ Ct ್ (SMO) ࢆ Gli1 ࡢ Ct ್࠿ࡽῶ⟬ࡋ㸪Ǽ㹁t ࢆᚓࡓ (Ct[Cli1] – Ct[SMO])ࠋGli1 㑇ఏᏊ࡜ᑐ↷㑇ఏᏊࡢ┦ᑐẚࡣ 2-ǼCT ࡜ࡋ࡚ィ⟬ࡋࡓࠋ Gli1 㑇ఏᏊࡢ┦ᑐⓗ mRNA Ⓨ⌧㔞ࡣᢞ୚፹యᢞ୚⩌ࡢ┦ᑐẚ࡟ᑐࡍࡿ๭ྜ (%) ࡜ࡋ࡚⾲ࡋࡓࠋ

3.3.6 ࢹ࣮ࢱฎ⌮

⭘⒆ቑṪ࡜⾑₢୰⸆≀⃰ᗘ࠾ࡼࡧࣂ࢖࣐࣮࣮࢜࢝࡜⸆≀⃰ᗘࡢ PK/PD ࣔࢹࣝゎᯒ࡟ࡣ㸪 NONMEM VI (ICON ♫) ࢆ⏝࠸ࡓࠋ ⸆ຠࣔࢹࣝ (3.3.7.2) ࡢࣃ࣓࣮ࣛࢱࡢಶయ㛫ኚື㸪ṧᕪ࠾ࡼ ࡧࣔࢹࣝࡢホ౯ࡣ 2.3.4 ࡜ྠᵝ࡟ᐇ᪋ࡋࡓࠋ ࡲࡓ㸪PK ࣔࢹࣝ (3.3.7.1) ࠾ࡼࡧࣂ࢖࣐࣮࣮࢜࢝ࣔ ࢹࣝ (3.3.7.3) ࡟࠾࠸࡚ࡣಶయ㛫ኚືࢆホ౯ࡏࡎ㸪ಶయ㆑ูࡋ࡞࠸඲ほ ್ࢆేྜࡋࡓࢹ࣮ࢱ࡟ᇶ

(30)

- 23 - ࡙࠸࡚ṧᕪ࠾ࡼࡧࣔࢹࣝࡢホ౯ࢆ⾜ࡗࡓ (naive-pooled data ἲ)ࠋ

3.3.7 PK/PD ࣔ

ࣔࢹࣝࡢᵓ⠏

3.3.7.1 PK ࣔࢹࣝ

༢ᅇ⤒ཱྀᢞ୚ (1㸪25 ࠾ࡼࡧ 100 mg/kg)㸪཯᚟⤒ཱྀᢞ୚ (5 mg/kg ࡛ 1 ᪥ 2 ᅇ㸪10 ࠾ࡼࡧ 25 mg/kg ࡛ 1 ᪥ 1 ᅇ)㸪࠾ࡼࡧ⓶ୗᢞ୚ (1 ᪥ᙜࡓࡾ 0.5㸪1㸪2.5㸪5 ࠾ࡼࡧ 10 mg/kg ࡢ⏝㔞࡛ 3 ᪥㛫ᣢ⥆ᢞ୚) ࡢࢹ࣮ࢱࢆྠ᫬࡟ࣔࢹࣝゎᯒࡋࡓࠋ ࡇࢀࡽࡢ⸆≀ືែࡣᾘ໬⟶࠾ࡼࡧ⓶⭵࠿ࡽࡢ ஧ࡘࡢ1 ḟ྾཰㐣⛬ࢆྵࡴ㸪1-ࢥࣥࣃ࣮ࢺ࣓ࣥࢺࣔࢹࣝ࡟ࡼࡾグ㏙ࡋࡓ (ᘧ 3-1)ࠋ ⤒ཱྀᢞ୚ᚋࡢ ᾘ໬⟶ࢥࣥࣃ࣮ࢺ࣓ࣥࢺ࠿ࡽ⾑₢ࢥࣥࣃ࣮ࢺ࣓ࣥࢺ࡬ࡢ⸆≀ࡢ྾཰ࡣ Emax 㛵ᩘ࡛グ㏙ࡋ (ᘧ 3-2)㸪⓶ୗᢞ୚ᚋࡢ⓶⭵ࢥࣥࣃ࣮ࢺ࣓ࣥࢺ࠿ࡽ⾑₢ࢥࣥࣃ࣮ࢺ࣓ࣥࢺ࡬ࡢ⸆≀ࡢ྾཰ࡣ 1 ḟ྾཰㏿ ᗘ㐣⛬࡜ࡋࡓ (ᘧ 3-3)ࠋ ௨ୗ࡟ࣔࢹࣝᘧࢆ♧ࡍࠋ ݀ܣଶ ݀ݐ = ܸ௠௔௫ή ܣଵ ݇௠+ ܣଵ + ݇௔ή ܣଷെ ܥܮ ή ܥ௣                        ᘧ 3 െ 1 ݀ܣଵ ݀ݐ = െ ܸ௠௔௫ή ܣଵ ݇௠+ ܣଵ                                ᘧ 3 െ 2 ݀ܣଷ ݀ݐ = െ݇௔ή ܣଷ                                ᘧ 3 െ 3 A1㸪A2 ࠾ࡼࡧ A3 ࡣࡑࢀࡒࢀᾘ໬⟶㸪⾑₢࠾ࡼࡧ⓶⭵ࡢࢥࣥࣃ࣮ࢺ࣓ࣥࢺෆࡢ⸆≀㔞ࢆ♧ࡍࠋ Vmax ࠾ࡼࡧ km ࡣࡑࢀࡒࢀ㸪྾཰㏿ᗘࡢ᭱኱್࠾ࡼࡧ Michaelis-Menten ᐃᩘࢆ♧ࡍࠋ Cp ࡣ⾑₢ ୰ TAK-441 ࡢ⃰ᗘ㸪ka ࡣ྾཰㏿ᗘᐃᩘࢆ♧ࡍࠋ

3.3.7.2 ⸆ຠࣔࢹࣝ

⭘⒆ࡢቑṪࡣᣦᩘ㛵ᩘࣔࢹ࡛ࣝグ㏙ࡋ㸪TAK-441 ⃰ᗘ࡜ࡑࢀ⮬㌟ࡢ⭘⒆ࢧ࢖ࢬ (T) ࡟౫Ꮡࡋ࡚ ᢚไࡉࢀࡿࡶࡢ࡜ࡋࡓࠋ ḟᘧ 3-4 ࠾ࡼࡧ 3-5 ࡟ࣔࢹࣝࢆ♧ࡍࠋ ݀ܶ ݀ݐ = ݇௜௡ή ൬1 െ ܶ ܶܩହ଴+ ܶ ൰ ή (1 െ ܦܨܨ) ή ܶ                     ᘧ 3 െ 4 ܦܧܨ = ܫ୫ୟ୶ _௧௨௠௢௥ή ܥ௣ ܫܥହ଴_௧௨௠௢௥+ ܥ௣                             ᘧ 3 െ 5 kin ࡣ 1 ḟቑṪ㏿ᗘᐃᩘ㸪TG50 ࡣ⭘⒆ቑṪ㏿ᗘࡢ 50%㜼ᐖࡍࡿ⭘⒆ࢧ࢖ࢬࢆ♧ࡍࠋ Imax_tumor ࡜

(31)

- 24 -

IC50_Tumor ࡣ㸪⸆ຠࢆ⾲ࡍ⸆≀ᅛ᭷ࡢࣃ࣓࣮ࣛࢱ࡛㸪ࡑࢀࡒࢀ⭘⒆ࢧ࢖ࢬࡢ᭱኱ᢚไ⋡࡜ 50%ࡢ

Imax_tumor ࢆ♧ࡍ⾑₢୰ TAK-441 ⃰ᗘࢆ⾲ࡍࠋ

3.3.7.3 ࣂ

ࣂ࢖࣐࣮࣮࢜࢝ࣔࢹࣝ

⾑₢୰ TAK-441 ⃰ᗘ࡜ࣂ࢖࣐࣮࣮࢜࢝ (⓶⭵࠾ࡼࡧ⭘⒆୰ Gli1 mRNA) ࡢ཯ᛂᛶ (R) ࡜ࡢ㛵 ಀࡣ㛫᥋཯ᛂࣔࢹࣝ (11) ࢆ⏝࠸࡚グ㏙ࡋ㸪Gli1 mRNA ࡢ⏕ᡂࡀ TAK-441 ⃰ᗘ࡟౫Ꮡࡋ࡚ᢚไ

ࡉࢀࡿࡶࡢ࡜ࡋࡓࠋḟᘧ3-6 ࠾ࡼࡧ 3-7 ࡟ࣔࢹࣝᘧࢆ♧ࡍࠋ ܴ݀ ݀ݐ = ܴ௜௡ή (1 െ ܧܨܨ) െ ܴ௢௨௧ή ܴ                          ᘧ 3 െ 6 ܧܨܨ =ܫ୫ୟ୶ _ீ௟௜ή ܥ௣ ܫܥହ଴ಸ೗೔+ ܥ௣                                ᘧ 3 െ 7 Rin࠾ࡼࡧ Routࡣࡑࢀࡒࢀ Gli1 mRNA ࡢ 0 ḟ⏕ᡂ㏿ᗘᐃᩘ࠾ࡼࡧ 1 ḟᾘኻ㏿ᗘᐃᩘࢆ♧ࡍࠋ

Imax_Gli ࡜ IC50_Gli ࡣ㸪⸆ຠࢆ⾲ࡍ⸆≀ᅛ᭷ࡢࣃ࣓࣮ࣛࢱ࡛㸪ࡑࢀࡒࢀ⓶⭵࠾ࡼࡧ⭘⒆୰ Gli1

mRNA ࡢ᭱኱ᢚไ⋡࡜ 50㸣ࡢ Imax_Gli ࢆ♧ࡍ⾑₢୰ TAK-441 ⃰ᗘࢆ⾲ࡍࠋ

3.4 ⤖ᯝ

3.4.1 PK ࣔࢹࣝ

⤒ཱྀ࠾ࡼࡧ⓶ୗᢞ୚ᚋࡢ⾑₢୰ TAK-441 ⃰ᗘ᥎⛣ࢆᘧ 3-1㸪3-2 ࠾ࡼࡧ 3-3 ࡟♧ࡍ㐃❧ᚤศ᪉ ⛬ᘧ࡟ྠ᫬࡟ᙜ࡚ࡣࡵࡓ⤖ᯝ㸪Table 3-1 ࡟♧ࡍ཰᮰ゎࢆᚓࡓࠋFig. 3-1 ࡟ TAK-441 ᢞ୚ࡋࡓ࡜ࡁ ࡢ⾑₢୰ TAK-441 ⃰ᗘࡢᐇ ್࡜㸪PK ࣔࢹࣝ࡟ࡼࡿண ್ࢆ♧ࡍࠋ ᐇ ್࡜ண ್ࡣࡼࡃ୍ ⮴ࡋࡓࠋ

3.4.2 ⤌⧊୰ TAK-441 ࡢ⃰ᗘ

3 ᪥㛫ᣢ⥆⓶ୗᢞ୚ࢆ⾜ࡗࡓ࡜ࡁࡢ⾑₢㸪⭘⒆࠾ࡼࡧ⓶⭵୰ TAK-441 ⃰ᗘࢆ Fig. 3-2 ࡟♧ࡍࠋ ⭘⒆୰TAK-441 ⃰ᗘࡣ⾑₢୰⃰ᗘࡼࡾࡶ㧗࠿ࡗࡓࡢ࡟ᑐࡋ㸪⓶⭵୰⃰ᗘࡣ⾑₢୰⃰ᗘ࡜ྠ➼࡛࠶ ࡗࡓࠋ

(32)

- 25 -

3.4.3 ⸆

⸆ຠࡢࣔࢹࣝ

TAK-441 ࡣ࣐࢘ࢫᢸ⒴ホ౯⣔࡟࠾ࡅࡿ⭘⒆ቑṪࢆ 1㸪10㸪࠾ࡼࡧ 25 mg/kg ࡛⏝㔞౫Ꮡⓗ࡟ᢚไ ࡋࡓࠋ TAK-441 ᢞ୚⩌࠾ࡼࡧ㠀ฎ⨨⩌ࡢ⭘⒆య✚ࢹ࣮ࢱࢆᘧ 3- 4 ࠾ࡼࡧ 3-5 ࡟♧ࡍᣦᩘ㛵ᩘࣔ ࢹࣝ࡟ᙜ࡚ࡣࡵࡓ⤖ᯝ㸪Table 3-2 ࡟♧ࡍ཰᮰ゎࢆᚓࡓࠋ Fig. 3-3 ࡟⭘⒆య✚ࡢᐇ ್࡜㸪ୖグࡢ ᘧ࡟ࡼࡿண ್ࢆ♧ࡍࠋ ᐇ ್࡜ண ್ࡣࡼࡃ୍⮴ࡋࡓࠋ

3.4.4 ࣂ࢖࣐࣮࣮࢜࢝ࣔࢹࣝ

⤒ཱྀ࠾ࡼࡧ⓶ୗᢞ୚ᚋࡢ⭘⒆୰ Gli1 mRNA ࡢⓎ⌧㔞ࢆ㛫᥋཯ᛂࣔࢹࣝ (ᘧ 3-6, 3-7) ࡟ᙜ࡚ࡣ ࡵࡓ⤖ᯝ㸪Table 3-3 ࡟♧ࡍ཰᮰ゎࢆᚓࡓࠋFig. 3-4 ࡟ TAK-441 ࢆᢞ୚ࡋࡓ࡜ࡁࡢ⭘⒆୰ Gli1 mRNA ࡢⓎ⌧㔞ࡢᐇ ್࡜㸪ࣔࢹࣝ࡟ࡼࡿண ್ࢆ♧ࡍࠋ ᐇ ್࡜ண ್ࡣࡼࡃ୍⮴ࡋࡓࠋ ࡲ

ࡓ㸪⓶⭵୰ࡢ Gli1 mRNA ࡢⓎ⌧㔞࡟ࡘ࠸࡚ࡶྠᵝ࡟㛫᥋཯ᛂࣔࢹࣝ࡟ᙜ࡚ࡣࡵࡓ⤖ᯝ (Table

3-3)㸪ᐇ ್࡜ண ್ࡣࡼࡃ୍⮴ࡋࡓ (Fig. 3-5)ࠋ

3.4.5 ࣂ࢖࣐࣮࣮࢜࢝࡜⸆ຠࡢᐃ㔞ⓗ࡞㛵ಀ

⸆ຠࡢࣔࢹࣝ࡟࠾࠸࡚᥎ᐃࡉࢀࡓ⸆ຠࣃ࣓࣮ࣛࢱ್ (Imax_tumor ࠾ࡼࡧ IC50_tumor) ࢆ Emax 㛵ᩘ

(ᘧ 3-5) ࡟ᙜ࡚ࡣࡵ࡚᥎ᐃࡋࡓ᭱኱ᢠ⭘⒆ຠᯝࡢ 90%࡟┦ᙜࡍࡿ⾑₢୰ TAK-441 ⃰ᗘࡣ 0.68 μg/ml ࡛࠶ࡗࡓࠋ ࡇࡢ⃰ᗘ࡜ࣂ࢖࣐࣮࣮࢜࢝ࣔࢹࣝ࡟࠾࠸࡚᥎ᐃࡉࢀࡓ⸆ຠࣃ࣓࣮ࣛࢱ್

(Imax_Gli࠾ࡼࡧIC50_Gli) ࢆ Emax 㛵ᩘ (ᘧ 3-7) ࡟ᙜ࡚ࡣࡵ࡚᥎ᐃࡋࡓ Gli1 mRNA Ⓨ⌧ࡢᢚไࡣ⭘

⒆୰࡛ 94%㸪⓶⭵୰࡛ 83㸣࡛࠶ࡗࡓࠋ ࡋࡓࡀࡗ࡚㸪᭱኱ᢠ⭘⒆ຠᯝࡢ 90%࡟┦ᙜࡍࡿࣂ࢖࣐࢜ ࣮࣮࢝ࡢᢚไ⋡ࡣ⭘⒆୰࡛94%㸪⓶⭵୰࡛ 83%࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓ (Fig.3-6)ࠋ

3.5 ⪃ᐹ

⮫ᗋ࡛ࡢ⭘⒆୰ࡢࣂ࢖࣐࣮࣮࢜࢝ࡢ ᐃࡣ㸪ヨᩱ᥇ྲྀ᫬ࡢᏳ඲ᛶࡸ೔⌮㠃࠿ࡽࡑࡢ฼⏝ࡀไ㝈 ࡉࢀࡿࡓࡵ㸪㠀⮫ᗋ◊✲࡟࠾࠸࡚ࡣᶆⓗ⤌⧊ࡔࡅ࡛࡞ࡃ㸪௦᭰⤌⧊࡟࠾ࡅࡿࣂ࢖࣐࣮࣮࢜࢝ࡢ཯ ᛂᛶ࡟ࡘ࠸࡚ࡶホ౯ࡍࡿᚲせࡀ࠶ࡿ (50)ࠋ ௦᭰⤌⧊ࡢ㑅ᢥࡣࡑࡢ᥇ྲྀࡀᐜ࡛᫆࠶ࡿࡇ࡜࡟ຍ࠼㸪 ࣂ࢖࣐࣮࣮࢜࢝ࡢ཯ᛂᛶ࠾࠸࡚ᶆⓗ⤌⧊୰ࡢ཯ᛂ࡜ྠᵝ࡛࠶ࡿࡇ࡜ࡀồࡵࡽࢀࡿࠋ Gli1 㑇ఏᏊ

(33)

- 26 - ࡣ⣽⬊ࡢቑṪࡸศ໬࡟㛵ࢃࡿ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡢୗὶ࡟ᒓࡍࡿ㑇ఏᏊ࡛࠶ࡿࡇ࡜࠿ ࡽ (20) , ᮍศ໬ࡢ⣽⬊ࡀከࡃྵࡲࢀࡿ⤌⧊࡛άᛶ໬ࡉࢀ࡚࠸ࡿ࡜⪃࠼ࡽࢀࡿࠋ ᥇⾑ࡣ⓶⭵⏕᳨ ࡼࡾࡶᐜ࡛᫆࠶ࡿࡓࡵᮎᲈ⾑୰ࡢ᭷᰾⣽⬊ࡀ௦᭰⤌⧊ࡢೃ⿵࡜࡞ࡾᚓࡿࡀ㸪⾑ᾮ୰࡟ࡣቑṪࡸศ ໬ࢆࡋ࡞࠸ᡂ⇍⣽⬊ࡀከࡃྵࡲࢀ࡚࠸ࡿࠋ ୍᪉㸪⓶⭵࡟ࡣࡉࡲࡊࡲ࡞Ⓨ㐩ẁ㝵ࡢࡉࡲࡊࡲ࡞✀㢮 ࡢ⣽⬊ࡀྵࡲࢀ࡚࠾ࡾ㸪⣽⬊ቑṪࡢࢩࢢࢼࣝఏ㐩ࡀάᛶ໬ࡉࢀ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿ (45)ࠋ ࡉࡽ࡟㸪 ࣄࢺ⓶⭵୰࡛࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡀάᛶ໬ࡉࢀ࡚࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ (47)ࠋ ࡇ

ࢀࡽࡢࡇ࡜࠿ࡽ⓶⭵࡟࠾ࡅࡿ mRNA Gli1 Ⓨ⌧ࡢኚ໬ࡣ TAk-441 ࡢᢠ⭘⒆ຠᯝࡢ᥎ᐃ࡟฼⏝࡛

ࡁࡿ࡜⪃࠼ࡽࢀࡓࠋ ࡋ࠿ࡋ࡞ࡀࡽ㸪⭘⒆୰ࡢ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡣ⒴⣽⬊࠿ࡽ⏕ᡂࡉ

ࢀࡿ࣊ࢵࢪ࣍ࢵࢢࣜ࢞ࣥࢻ࡟ᖖ࡟άᛶ໬ࡉࢀ࡚࠸ࡿࡓࡵ㸪ṇᖖ⤌⧊࡛࠶ࡿ⓶⭵୰ࡢ Gli1 mRNA

ࡢⓎ⌧ࡢᛂ⟅ᛶࡣ⭘⒆୰࡜␗࡞ࡿྍ⬟ᛶࡀ࠶ࡿࠋ ࡋࡓࡀࡗ࡚ᮏ◊✲࡛ࡣ⭘⒆୰࡟ຍ࠼㸪⓶⭵୰ࡢ

Gli1 mRNA ࡢ཯ᛂᛶ࡟ࡘ࠸࡚ࡶ PK/PD ࣔࢹࣜࣥࢢ࡟ࡼࡾᐃ㔞ⓗ࡟ホ౯ࡋࡓࠋ

࣐࢘ࢫᢸ⒴ホ౯⣔࡟࠾࠸࡚ TAK-441 ࡣ⭘⒆࠾ࡼࡧ⓶⭵୰ࡢ Gli1 mRNA ࡢⓎ⌧㔞ࢆ⏝㔞౫Ꮡ

ⓗ࡟ᢚไࡋࡓ (Fig. 3-4, 3-5)ࠋ⤒ཱྀᢞ୚⩌࡟࠾࠸࡚㸪ࡇࢀࡽࡢ཯ᛂࡢ᭱኱ᢚไຠᯝࡣ 8㹼24 ᫬㛫࡟

ㄆࡵࡽࢀ㸪⾑₢୰᭱኱⸆≀⃰ᗘ࡟㐩ࡍࡿ᫬㛫 (Tmax㸸᭱኱ 4 ᫬㛫) ࡼࡾࡶ㐜ࡃ࡟ㄆࡵࡽࢀࡓࠋ ࡇ

ࡢ཯ᛂࡢ㐜ᘏࡣ TAK-441 ࡀ┤᥋ Gli1 mRNA Ⓨ⌧㔞ࡢኚ໬ࡉࡏࡿࡢ࡛ࡣ࡞ࡃ㸪 SMO ࡬ࡢ⤖ྜ ࠿ࡽୗὶࡢࢩࢢࢼࣝఏ㐩ࢆྵࡴ୍㐃ࡢ㛫᥋ⓗ࡞཯ᛂࡀⓎ⌧㔞ࡢኚ໬࡟㛵୚ࡍࡿࡇ࡜ࡀཎᅉ࡛࠶ࡿ

࡜⪃࠼ࡽࢀࡿࠋ 㛫᥋཯ᛂࣔࢹࣝ (11) ࡣ㸪ࡇࡢᵝ࡞⏕యࡢ཯ᛂࡢ㐜ᘏࡀࡑࡢ཯ᛂ࡟㛵ࢃࡿ⏕యෆ

≀㉁ࡢ⏕ᡂࡸᾘኻ࡟ᑐࡋ࡚⸆≀ࡀ㜼ᐖࡲࡓࡣಁ㐍ࡍࡿࡇ࡜࡟ࡼࡾᘬࡁ㉳ࡇࡉࢀ࡚࠸ࡿሙྜ࡟ᛂ⏝

ࡉࢀ࡚࠸ࡿࠋ TAK-441 ᢞ୚ᚋࡢ⭘⒆࠾ࡼࡧ⓶⭵୰ࡢ Gli1 mRNA ࡢⓎ⌧㔞ࡣ⏝㔞౫Ꮡⓗ࡟ᢚไࡉ

ࢀ㸪㛫᥋཯ᛂࣔࢹࣝࡣࡇࢀࡽࡢ཯ᛂࢆ㐺ษ࡟グ㏙ࡋࡓࠋ ᥎ᐃࡉࢀࡓ IC50 ࡢ್ࡣ⭘⒆୰࡛

0.0457 μg/mL㸪⓶⭵୰࡛ 0.113 μg/mL ࡛࠶ࡾ㸪⭘⒆୰ࡢ Gli1 mRNA ࡢ཯ᛂᛶࡢ᪉ࡀ⓶⭵࡟ẚ࡭࡚

ࡸࡸ㧗࠸ഴྥࢆ♧ࡋࡓࠋ ࡇࡢཎᅉࡢ୍ࡘ࡜ࡋ࡚㸪TAK-441 ࡢ⤌⧊⛣⾜ᛶࡀ⭘⒆࡜⓶⭵࡛␗࡞ࡿࡇ

࡜ࡀ⪃࠼ࡽࢀࡓࠋ ⭘⒆୰ࡢ TAK-441 ࡢ⃰ᗘࡣ⓶⭵୰ࡢ⃰ᗘࡼࡾࡶ㧗ࡃ (Fig. 3-2)㸪IC50 ࡣ⾑₢୰

⃰ᗘࢆ⏝࠸࡚᥎ᐃࡋ࡚࠸ࡿࡓࡵ㸪⭘⒆୰ࡢ Gli1 ࡢ཯ᛂᛶࡀ⓶⭵ࡼࡾࡶ㧗ࡃホ౯ࡉࢀࡓྍ⬟ᛶࡀ

⪃࠼ࡽࢀࡿࠋ ௚ࡢཎᅉ࡜ࡋ࡚㸪ୖ㏙ࡢ㏻ࡾ㸪⭘⒆࡜ṇᖖ⤌⧊࡟࠾࠸࡚ࡣ Gli1 ࡢ཯ᛂᛶࡀ␗࡞ࡗ

(34)

- 27 -

㛫᥋཯ᛂࣔࢹࣝ࡟ࡼࡾ᥎ᐃࡉࢀࡓ⾑₢୰⸆≀⃰ᗘ࡟ᑐࡍࡿ⭘⒆࠾ࡼࡧ⓶⭵୰ Gli1 mRNA Ⓨ⌧ᢚ

ไࡢ㛵ಀ࡜㸪ᣦᩘ㛵ᩘࣔࢹ࡛ࣝ᥎ᐃࡉࢀࡓ⾑₢୰⸆≀⃰ᗘ࡟ᑐࡍࡿᢠ⭘⒆ຠᯝࢆẚ㍑ࡋࡓ (Fig.

3-6)ࠋ ᣦᩘ㛵ᩘࣔࢹࣝࡼࡾ⭘⒆ቑṪᢚไࡢ IC90ࡣ 0.68 μg/mL ࡜᥎ᐃࡉࢀ㸪ࡇࡢ⃰ᗘࡣ⓶⭵୰ Gli1

mRNA Ⓨ⌧ࡢ 83㸣ᢚไ࡜⭘⒆୰ Gli1 mRNA Ⓨ⌧ࡢ 94㸣ᢚไ࡟┦ᙜࡋࡓࠋ ࡋࡓࡀࡗ࡚࣊ࢵࢪ ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰࡟౫Ꮡⓗ࡞⭘⒆ቑṪࢆ༑ศ (>90%) ࡟ᢚไࡍࡿࡇ࡜ࢆ┠ᶆ࡟ࡍࡿሙྜ㸪 ⭘⒆࠾ࡼࡧ⓶⭵୰ࡢ Gli1 mRNA ࡢⓎ⌧ࡣࡑࢀࡒࢀ>94%࠾ࡼࡧ>83%ᢚไࡍࡿᚲせࡀ࠶ࡿࡇ࡜ࡀ ♧ࡉࢀࡓࠋ ࡲࡓ㸪ୖ㏙ࡢ㏻ࡾ㸪⭘⒆࡜⓶⭵୰ࡢ Gli1 mRNA ࡢ཯ᛂᛶ࡟ⱝᖸࡢ㐪࠸ࡀㄆࡵࡽࢀࡓ ࡀ㸪࠸ࡎࢀࡢ⤌⧊ࡢ Gli1 mRNA ࡢⓎ⌧㔞࡛⭘⒆ቑṪᢚไࢆホ౯ࡋ࡚ࡶ㸪ຠᯝⓗ࡞⭘⒆ቑṪᢚไ ࡟ࡣ࠸ࡎࢀࡶ㧗࠸ᢚไࡀᚲせ࡛࠶ࡾ㸪ྠᵝࡢຠᯝࡀᚓࡽࢀࡿࡇ࡜࠿ࡽ㸪⓶⭵ࢆ௦᭰⤌⧊࡜ࡋࡓ Gli1 mRNA ࡢⓎ⌧㔞ࡣ⸆ຠࢆண ࡍࡿࣂ࢖࣐࣮࣮࢜࢝࡜ࡋ࡚฼⏝࡛ࡁࡿ࡜⪃࠼ࡽࢀࡓࠋ 㐍⾜ᅛᙧࡀࢇᝈ⪅ࢆᑐ㇟࡜ࡋࡓ TAK-441 ࡢ➨ 1 ┦ヨ㦂ࡀᐇ᪋ࡉࢀ㸪ࡑࡢ㝿࡟ᝈ⪅ࡢ⓶⭵୰

Gli1 mRNA ࡀࣂ࢖࣐࣮࣮࢜࢝࡜ࡋ࡚ ᐃࡉࢀࡓ (22)ࠋ 50 mg/man ࡢ⏝㔞࡟࠾࠸࡚㸪Gli1 mRNA

ࡢⓎ⌧㔞ࡀ⣙ 90%ᢚไࡉࢀ࡚࠾ࡾ㸪ࡑࡢ㝿ࡢ Cmaxࡀ 0.73 μg/mL ࡛࠶ࡗࡓࠋ ୍᪉㸪࣐࢘ࢫ⓶⭵

୰ࡢ Gli1 mRNA ࡟ᑐࡍࡿ IC90ࡀ⣙ 1.5 μg/mL ࡛࠶ࡗࡓࡇ࡜࠿ࡽ㸪⾑₢୰ TAK-441 ⃰ᗘ࡟ᑐࡍ

ࡿࣄࢺ࡜࣐࢘ࢫࡢ⓶⭵୰ Gli1 mRNA ࡢ཯ᛂᛶࡣྠ⛬ᗘ࡛࠶ࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ TAK-441 ࡢ⭘⒆

ࡢᢚไࡣࡀࢇ✀࡟ࡼࡗ࡚ᕪࡀㄆࡵࡽࢀࡓ (22)ࠋ ⓶⭵ࡀࢇ (ᇶᗏ⣽⬊ࡀࢇ㸪Basal cell carcinoma, BCC) ࡛ࡣ 71%ࡢ BCC ᝈ⪅࡛ Stable disease (⭘⒆ࡢࢧ࢖ࢬࡀኚࢃࡽ࡞࠸) ࠿ partial response (⦰ ᑠ) ࡀぢࡽࢀࡓࡀ㸪௚ࡢᅛᙧ⒴࡟ᑐࡍࡿᢠ⭘⒆άᛶࡣᙅ࠿ࡗࡓࠋ ࡇࡢཎᅉ࡜ࡋ࡚㸪BCC ࡢቑṪ࡟

࠾ࡅࡿ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝࡢᐤ୚⋡ࡀ㧗࠸ࡇ࡜ࡀ⪃࠼ࡽࢀࡓࠋ ࡍ࡞ࢃࡕ㸪BCC ࡣ Ptch ࡢኚ␗

ࡀᘬࡁ㔠࡜࡞ࡗ࡚Ⓨ⑕ࡋ࡚࠸ࡿ࡜⪃࠼ࡽࢀ࡚࠸ࡿ (44)ࠋ ࡲࡓ㸪Ptch ࡣ⣽⬊⭷ୖ࡟Ꮡᅾࡋ㸪㏻ᖖࡣ SMO ࡜⤖ྜࡋ࡚ SMO ࡢάᛶ໬ࢆᢚไࡋ࡚࠸ࡿࡀ㸪Ptch ࡟ኚ␗ࡀ㉳ࡁࡿ࡜ SMO ࠿ࡽࡢࢩࢢࢼࣝ ఏ㐩άᛶࡀᢚไ࡛ࡁ࡞ࡃ࡞ࡾ㸪㐣๫ࡢࢩࢢࢼࣝࡀ⣽⬊ෆ࡟ఏ㐩ࡉࢀࡿ (40)ࠋ ࡋࡓࡀࡗ࡚ Ptch ࡢ

ኚ␗ࡣ⒴໬࡟῝ࡃ㛵୚ࡋ࡚࠸ࡿ࡜⪃࠼ࡽࢀ㸪ᐇ㝿࡟ BCC ᝈ⪅ࡢከࡃࡀ Ptch ࡟ኚ␗ࢆᣢࡘࡇ࡜ࡀ

▱ࡽࢀ࡚࠸ࡿ (44)ࠋ ࡇࢀࡽࡢࡇ࡜࠿ࡽ㸪BCC ࡢቑṪࡣ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰ࡢᐤ୚⋡

ࡀ㧗ࡃ㸪TAK-441 ࡞࡝ࡢ SMO ࢆᢚไࡍࡿ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝ㜼ᐖ⸆ࡢዌຌ⋡ࡶ㧗ࡃ࡞ࡿ࡜⪃

(35)

- 28 - ࡛㸪TAK-441 ࡔࡅ࡛ࡣ᭷ຠᛶࡀᮇᚅ࡛ࡁࡎ㸪௚ࡢᢠࡀࢇ๣࡜ࡢే⏝ࡀᚲせ࡟࡞ࡿ࡜⪃࠼ࡽࢀࡓࠋ ௨ୖࡢᡂ⦼ࡣ㠀⮫ᗋ࡟࠾࠸᳨࡚ウࡋࡓ TAK-441 ࡟ᑐࡍࡿࣂ࢖࣐࣮࣮࢜࢝ࡢ཯ᛂᛶࡸࣂ࢖࣐࣮࢜ ࣮࢝࡜⸆ຠࡢᐃ㔞ⓗ࡞㛵ಀࡀ⮫ᗋ࡟࠾࠸࡚ࡶ෌⌧ࡉࢀࡓࡇ࡜ࢆ♧ࡋ㸪㠀⮫ᗋ࡟࠾ࡅࡿࣂ࢖࣐࣮࢜ ࣮࢝ࡢ᝟ሗࢆ฼⏝ࡋࡓ PK/PD ࣔࢹࣜࣥࢢࡢ⤖ᯝࡀ⮫ᗋ࡟࠾ࡅࡿ⮳㐺⏝ἲ࠾ࡼࡧ⏝㔞ࡢタᐃ࡟᭷ ຠ࡛࠶ࡿࡇ࡜ࡀ⪃࠼ࡽࢀࡓࠋ

3.6 ᑠ

ᑠᣓ

㠀⮫ᗋࡢ⸆ຠホ౯ࣔࢹ࡛ࣝᚓࡽࢀࡓ⤖ᯝ࠿ࡽࣂ࢖࣐࣮࣮࢜࢝ (Gli1 mRNA) ࡢ཯ᛂᛶ࡜ᢠ⭘⒆ ຠᯝ࡜ࡢᐃ㔞ⓗ࡞㛵ಀࢆ PK/PD ࣔࢹࣝ࡟ࡼࡾ᫂ࡽ࠿࡟ࡋ㸪TAK-441 ࡢ⮫ᗋ࡟࠾ࡅࡿ⮳㐺⏝ἲ࠾ ࡼࡧ⏝㔞タᐃ࡟㔜せ࡞᝟ሗࢆᥦ౪ࡋࡓࠋ ࣊ࢵࢪ࣍ࢵࢢࢩࢢࢼࣝఏ㐩⤒㊰࡟౫Ꮡⓗ࡞⭘⒆ቑṪࢆ༑ ศ (>90%) ࡟ᢚไࡍࡿࡇ࡜ࢆ┠ᶆ࡟ࡍࡿሙྜ㸪ࣂ࢖࣐࣮࣮࢜࢝ࡢⓎ⌧ࢆ>80%ᢚไࡍࡿᚲせࡀ࠶ࡿ ࡇ࡜ࡀ♧ࡉࢀࡓࠋ

(36)

- 29 -

4❶㸸 Fasiglifam ࡢ⮫ᗋ⏝㔞࡟࠾ࡅࡿᏳ඲ᇦࡢᐃ㔞ⓗホ౯

4.1 ࡣࡌࡵ࡟

ẘᛶヨ㦂࡛ㄆࡵࡽࢀࡓホ౯ື≀ࡢẘᛶࡢࣄࢺ࡬ࡢእᤄᛶࡸᏳ඲ᇦࡢ᥎ᐃࡣ㸪⮫ᗋ࡟࠾ࡅࡿ⸆๣ ࡢᏳ඲ᛶࡢุ᩿࡟࠾࠸࡚㔜せ࡛࠶ࡿࠋ ⮫ᗋ➨ 2 ┦ヨ㦂୰࡟ᐇ᪋ࡋࡓ fasiglifam ࡢ࢖ࢾࡢ཯᚟ᢞ୚ ẘᛶヨ㦂࡟࠾࠸࡚࢖ࢾ≉᭷ࡢ⫢ẘᛶࡀⓎ⑕ࡋࡓࠋ ⫢ẘᛶࢆⓎ⑕ࡋࡓಶయࡢ⫢⮚⑓⌮⤌⧊᳨ᰝ࡟࠾ ࠸࡚㸪⫹⟶ෆࡸ␗≀⫗ⱆ⭘ෆ࡟⤖ᬗᙧᡂࢆక࠺㛛⬦/㛛⬦࿘ᅖ⫗ⱆ⭘ᛶ⅖⑕ࡀ☜ㄆࡉࢀࡓࡀ㸪ࡇࡢ ⌧㇟ࡣࣛࢵࢺ࡛ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ ࡇࡢ⤖ᬗᛶࡢ␗≀ࡣ fasiglifam ࡟⏤᮶ࡋࡓ≀㉁࡛࠶ࡿ࡜⪃ ࠼ࡽࢀ㸪ࡇࡢẘᛶࡢⓎ⑕࣓࢝ࢽࢬ࣒࠾ࡼࡧ✀ᕪࡢゎ᫂ࡣ⸆≀ືែࡢほⅬ࠿ࡽㄝ࡛᫂ࡁࡿ࡜⪃࠼ࡽ ࢀࡓࠋ Fasiglifam ࡢ⸆≀ືែࡣ⸆ຠ⏝㔞࡟࠾࠸࡚ࡣࣄࢺࢆྵࡵ࡚ࣛࢵࢺ࡜࢖ࢾ࡛ྠᵝ࡛࠶ࡿࡇ࡜ࡀሗ ࿌ࡉࢀ࡚࠾ࡾ (31)㸪࠸ࡎࢀࡢ✀࡟࠾࠸࡚ࡶ⤒ཱྀᢞ୚࡛ࡼࡃ྾཰ࡉࢀ㸪୺࡟⫢⮚࡛ࢢࣝࢡࣟࣥ㓟ᢪ ྜࢆཷࡅࡓᚋ࡟⫹Ồ᤼ἥࢆ௓ࡋ࡚⣅୰࡟᤼ἥࡉࢀࡿ࡜⪃࠼ࡽࢀࡓࠋ ࡲࡓ㸪✀≉␗ⓗ࡞௦ㅰ≀ࡣㄆ ࡵࡽࢀࡎ㸪࢖ࢾ⫢ẘᛶࡣ࢖ࢾ≉␗ⓗ࡞௦ㅰ≀ࡢ⏕ᡂ࡟ࡼࡿࡶࡢ࡛ࡣ࡞࠸࡜⪃࠼ࡽࢀࡓࠋ ࡉࡽ࡟㸪 ࢢࣝࢡࣟࣥ㓟ᢪྜࡀ୺࡞௦ㅰᾘኻ⤒㊰࡛࠶ࡿࡇ࡜࠿ࡽ㸪fasiglifam ࠾ࡼࡧࡑࡢࢢࣝࢡࣟࣥ㓟ᢪྜయ (fasiglifam-G) ࡀ⫢ẘᛶ࡟㛵୚ࡋ࡚࠸ࡿྍ⬟ᛶࡀ⪃࠼ࡽࢀࡓࠋ ᮏ❶࡛ࡣ⫹⟶࡟ㄆࡵࡽࢀࡓ⤖ᬗᛶ␗≀ࡢྠᐃࢆ㉁㔞ศᯒἲ࡟ࡼࡾ⾜ࡗࡓࠋ ࡲࡓ㸪⫢ẘᛶⓎ⑕ࡢ ✀ᕪ࠾ࡼࡧ࣓࢝ࢽࢬ࣒ࢆゎ᫂ࡍࡿࡓࡵ㸪ẘᛶⓎ⑕⏝㔞࡟࠾ࡅࡿࣛࢵࢺ࠾ࡼࡧ࢖ࢾࡢ fasiglifam ࡢ ືែ࡜⫹Ồ୰࡟࠾ࡅࡿ fasiglifam ࠾ࡼࡧ fasiglifam-G ࡢ⁐ゎᗘࢆ᳨ウࡋࡓࠋ ࡉࡽ࡟㸪㠀⮫ᗋヨ㦂 ࡢ᳨ウ࠿ࡽ᥎ ࡉࢀࡓ⫢ẘᛶⓎ⑕࡟㛵ࢃࡿ fasiglifam ࡢືែࢆࣔࢹࣝ໬ࡋ㸪⮫ᗋ⏝㔞 (50 mg) ࡟ ࠾ࡅࡿᏳ඲ᇦࢆᐃ㔞ⓗ࡟ホ౯ࡋࡓࠋ

4.2 Fasiglifam ࡟ࡘ࠸࡚

Fasiglifam (ୗᅗ) ࡣ GPR40 (G protein-coupled receptor 40) సື⸆࡛࠶ࡾ㸪2 ᆺ⢾ᒀ⑓἞⒪⸆ࢆ┠

ᣦࡋ࡚㛤Ⓨࡉࢀ࡚ࡁࡓ⸆≀࡛࠶ࡿࠋ 2 ᆺ⢾ᒀ⑓ࡢᡂᅉ࡟ࡣ㸪୺࡟࢖ࣥࢫࣜࣥศἪ୙඲࡜࢖ࣥࢫࣜ

(37)

- 30 - ࡜⪃࠼ࡽࢀ࡚࠸ࡿ (39)ࠋ 2 ᆺ⢾ᒀ⑓ࡢ⸆๣἞⒪࡟ࡣ㸪࢖ࣥࢫࣜࣥศἪࢆಁ㐍ࡍࡿ⸆๣㸪࢖ࣥࢫࣜ ࣥ᢬ᢠᛶࢆᨵၿࡉࡏࡿ⸆๣࠾ࡼࡧᾘ໬⟶࠿ࡽࡢ⢾ࡢ྾཰ࢆ㐜ᘏࡉࡏࡿ⸆๣ࡀ୺࡟౑⏝ࡉࢀ࡚࠸ࡿ ࡀ㸪ࡇࢀࡽࡢ⸆๣࡟ࡣప⾑⢾ࡢࣜࢫࢡ (13) ࡸ⮅ș⣽⬊ࡢ⑂ᘢ࡟㉳ᅉࡍࡿ஧ḟ↓ຠ (27) ࡢၥ㢟ࡀ ᣦ᦬ࡉࢀ࡚࠸ࡿࠋ GPR40 ࡣ࢖ࣥࢫࣜࣥศἪ⣽⬊࡛࠶ࡿ⮅ș⣽⬊࡟㧗Ⓨ⌧ࡍࡿ G ࢱࣥࣃࢡ㉁ඹᙺ ᆺཷᐜయ࡜ࡋ࡚Ⓨぢࡉࢀ㸪ࡑࡢᚋࡢᶵ⬟ゎᯒ࠿ࡽ㸪ࡇࡢཷᐜయࡀ㐟㞳⬡⫫㓟࡟ࡼࡿ࢖ࣥࢫࣜࣥศ Ἢస⏝ࢆᢸ࠺ࡇ࡜ࡀ♧ࡉࢀࡓࠋ GPR40 ࢆ௓ࡋࡓ࢖ࣥࢫࣜࣥศἪಁ㐍స⏝ࡣࢢࣝࢥ࣮ࢫ⃰ᗘ౫Ꮡ ⓗ࡛࠶ࡿࡇ࡜࠿ࡽ㸪ࡇࡢཷᐜయࢆࢱ࣮ࢤࢵࢺ࡜ࡋࡓྜᡂపศᏊ࢔ࢦࢽࢫࢺࡣ㸪ప⾑⢾ࣜࢫࢡࡢᑡ ࡞࠸᪂ࡓ࡞࢖ࣥࢫࣜࣥศἪಁ㐍⸆࡟࡞ࡿ࡜⪃࠼ࡽࢀࡓ (53)ࠋ ⮫ᗋヨ㦂࡟࠾࠸࡚ fasiglifam ࡣ࢖ ࣥࢫࣜࣥศἪಁ㐍స⏝ࢆ᭷ࡍࡿࡇ࡜ࡸ㸪ప⾑⢾ࣜࢫࢡࡀ᪤Ꮡ⸆ࡼࡾࡶప࠸ࡇ࡜ࡀ☜ㄆࡉࢀ (1, 4)㸪 ᪂つ⤒ཱྀ2 ᆺ⢾ᒀ⑓἞⒪⸆࡜ࡋ࡚ᮇᚅࡉࢀࡓࠋ ᅗ Fasiglifam ࡢᵓ㐀ᘧ

4.3 ᐇ

ᐇ㦂ᮦᩱ࡜᪉ἲ

4.3.1 ⿕㦂≀㉁࠾ࡼࡧ⏕యヨᩱ

Fasiglifam ([(3S)-6- ^މމ-dimethyl-މ-[3-(methylsulfonyl)propoxy]biphenyl-3-yl}methoxy)-2,3-dihydro-1-benzofuran-3-yl]acetic acid hemihydrate) ࠾ࡼࡧ މމ-dimethyl-މ-[3-(methylsulfonyl)

propoxy]biphenyl-3-carboxylic acid (M-I) ࡣ㸪Ṋ⏣⸆ရᕤᴗ࡛ྜᡂࡋࡓࡶࡢࢆ⏝࠸ࡓࠋ14C ࡛ᶆ㆑ࡋ

ࡓfasiglifam ([14C]fasiglifam) ࠾ࡼࡧ fasiglifam-G ([14C]fasiglifam-G) ࡣࡑࢀࡒࢀ➨୍໬Ꮫ⸆ရ♫࠾

ࡼࡧࣅ࢜ࣈࣜࢵࢪ♫࡟࡚ྜᡂࡉࢀࡓࡶࡢࢆ⏝࠸ࡓࠋ࢖ࢾ⫹Ồࡣ໭ᒣࣛ࣋ࢫ♫㸪ࣄࢺ⫹Ồࡣࢣ࣮࣭ ࢚࣮࣭ࢩ࣮♫࠾ࡼࡧᐩኈࣇ࢖࣒ࣝ࿴ග⣧⸆♫ࡼࡾ㉎ධࡋࡓࠋ O O CO2H CH3 CH3 O S H3C O O 䞉0.5H2O

(38)

- 31 -

4.3.2 ື

ື≀

㞝ᛶ Crl CD (SD) ࣛࢵࢺ (8 㐌㱋㸪య㔜㸸 251㹼282 g㸪᪥ᮏࢡࣞ࢔♫)㸪㞝ᛶࣅ࣮ࢢࣝ≟ (7㹼11 ᭶㱋㸪య㔜㸹8.41㹼11.2 kg㸪໭ᒣࣛ࣋ࢫ♫) ࢆ⏝࠸ࡓࠋ ࡇࢀࡽࡢື≀࡟ᅛᙧ㣫ᩱ (ࣛࢵࢺ⏝ CR-LPF㸹࢚࢜ࣜࣥࢱࣝ㓝ẕ㸪࢖ࢾ⏝ CD-5M㸹᪥ᮏࢡࣞ࢔♫) ࡜Ỉ㐨Ỉࢆ୚࠼㸪 ᗘ 18㹼28Υ㸪‵ᗘ 38㹼82%㸪᫂ᬯࢧ࢖ࢡࣝ 12 ᫬㛫ࡢ㣫⫱ᐊ࡛ 1 㐌㛫௨ୖࡢணഛ㣫⫱ࢆ⾜ࡗࡓᚋ㸪ᐇ㦂࡟⏝࠸ࡓࠋ ࡞࠾㸪඲࡚ࡢື≀ヨ㦂ࡣ㸪Ṋ⏣⸆ရᕤᴗ◊✲ᡤࡢື≀೔⌮ጤဨ఍ࡢᑂᰝࡢᢎㄆᚋ࡟ᐇ᪋ࡋࡓࠋ

4.3.3 ࣐ࢺࣜࢵࢡࢫᨭ᥼࣮ࣞࢨ࣮⬺㞳࢖࢜ࣥ໬㣕⾜᫬㛫ᆺ㉁㔞ศᯒ(MALDI-TOF MS)

39 㐌ẘᛶヨ㦂࡛⫢ẘᛶࢆ♧ࡋࡓ࢖ࢾࡢ⫢⮚⤌⧊ษ∦࡟ㄆࡵࡽࢀࡓ␗≀ࡢ⤌ᡂࡣ MALDI-TOF MS ἲ࡟ࡼࡾศᯒࡋࡓࠋ ษ∦ࢆ࣑ࢡࣟࢺ࣮࣒ (CM1950; ࣛ࢖࣐࢝࢖ࢡࣟࢩࢫࢸ࣒ࢬ♫) ࡛ཌࡉ 10 μm ࡢⷧษࡾ࡟ࡋ㸪ᑟ㟁ᛶࢫࣛ࢖ࢻ࢞ࣛࢫ (࢖ࣥࢪ࣒࢘ࢫࢬ㓟໬≀࡛ࢥ࣮ࢸ࢕ࣥࢢࡉࢀࡓࢫࣛ࢖ ࢻ࢞ࣛࢫ) ୖ࡛ศᯒࡲ࡛-80Υ࡛ಖᏑࡋࡓࠋ ศᯒࡢᑡ࡞ࡃ࡜ࡶ 20 ศ๓࡟⤌⧊ษ∦ࢆᐊ ࡟ᖹ⾮ ໬ࡉࡏ㸪ࢫࣛ࢖ࢻ࢞ࣛࢫࡣ AXIMA MS ࣉ࣮ࣞࢺ (ᓥὠ〇సᡤ) ୖ࡟⨨ࡁ㸪୧㠃ᑟ㟁ᛶࢸ࣮ࣉ࡛ᅛ ᐃࡋࡓࠋ ヨᩱࢆ࢖࢜ࣥ໬ࡉࡏࡿࡓࡵࡢ࣐ࢺࣜࢵࢡࢫ⁐ᾮ (50㸣࢔ࢭࢺࢽࢺࣜࣝ/0.1%ࢺࣜࣇࣝ࢜ ࣟ㓑㓟࡟20 mg/ml ࡛ 2,5-ࢪࣄࢻࣟ࢟ࢩᏳᜥ㤶㓟ࢆ⁐ゎࡉࡏࡓ) ࢆ␗≀ࡀ☜ㄆࡉࢀࡓ㏆ഐ࡟ሬᕸࡋ ࡓᚋ㸪 MALDI-TOF MS ⿦⨨ (AXIMA-Resonance㸪ᓥὠ〇సᡤ) ࡟౪ࡋ࡚␗≀ࡢᡂศࡢྠᐃࢆ⾜ ࡗࡓࠋ ศᯒࢆ⾜ࡗࡓษ∦㡿ᇦࡢගᏛⓗ⏬ീࢆ Fig. 4-1 ࡟♧ࡍࠋ

4.3.4 Fasiglifam ࠾ࡼࡧ fasiglifam-G ࡢ⫹Ồ୰⁐ゎᗘ

⫹ Ồ ୰ ⁐ ゎ ᗘ ࡣ ῧ ຍ ࡋ ࡓ 14C ᶆ ㆑ య ࡢᅇ ཰ ⋡࡟ ࡼ ࡾ ホ ౯ ࡋ ࡓࠋ [14C]Fasiglifam ࠾ ࡼࡧ [14C]fasiglifam-G ࢆ⫹Ồ࡟ in vitro ࡛ῧຍ (1㸪3㸪10 μg/mL) ࡋ࡚14C ⃰ᗘ (C tot)ࢆ ᐃࡋ㸪୍㒊ࢆ 1850™g ࡛ 10 ศ㛫 25Υ࡟࡚㐲ᚰࡋࡓᚋ㸪ᚓࡽࢀࡓୖΎ୰ 14C ⃰ᗘ (Csup) ࢆ ᐃࡋࡓࠋ ⁐ゎᗘ (ᅇ཰⋡) ࡢィ⟬ࡣḟᘧ 4-1 ࢆ⏝࠸࡚⟬ฟࡋࡓࠋ ⁐ゎᗘ ൫ᅇ཰⋡൯ % = ൬ܥ௦௨௣ ܥ௧௢௧ ൰ × 100                        ᘧ 4 െ 1

Figure 1-1. Concentration-effect curve with hysteresis. Hysteresis loops suggest that there is a time  lag in the relationship between the measured drug concentration and the observed drug effect
Table 2-1 Parameter estimates for tumor growth in intact and castration groups
Figure 2-1. Scheme for the PK models for TAK-448 and TAP-144. The PK profiles of sustained- sustained-release formulations of TAK-448 and TAP-144 were described by a two-compartment model with  two processes of absorption: an immediate first-order input de
Figure 2-2. Scheme of the PK/PD models for TAK-448 and TAP-144 administrated to rats bearing  VCaP xenograft tumors
+7

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