Title of Invention

A COMBINATION COMPRISING PEPTIDE DERIVATIVES AND A CYTOSTATIC PREPARATION FOR REDUCING HEMATOTOXICITY OF THE CYTOSTATIC PREPARATION

Abstract The invention relates to the induction method for cell differentiation which consists in injecting peptide derivatives having the following general formula (I): and used as a differentiation-inducing factor. Said peptide derivatives are used for curing oncological diseases, in particular for stabilising melanoma growth, increasing the efficiency of melanoma immunotherapy and reducing haematological toxicity of chemotherapy. The utilisation of said peptide derivatives is also disclosed.
Full Text A COMBINATION COMPRISING PEPTIDE DERIVATIVES AND A CYTOSTATIC PREPARATION
FOR -REDUCING HEMATOTOXIV^TY OF THE CYTOSTATIC PREPARATION
Specification
The invention relates to medicine and in particular, to treating cancer diseases and it is
useful in treating tumors of different genesis.
The invention relates to a method for inducing cells differentiation using peptides
derivatives as an agent inducing cells differentiation and in particular, to their use in antitumor
noncytotoxic therapy.
Absence of the ability to differentiate in most tumor cells is known to result in an
uncontrollable tumor growth.
Search for agents of both specific and non-specific induction of cells differentiation is
therefore one of novel approaches to anti-tumor noncytotoxic therapy.
Under "induction of cells differentiation" is averaget the capability of the different
substances to restore (or to drive) the following functions lost or lowered because of the various
reasons: passing a normal cellular cycle by a cell, synthesis of biologically active vitally
important substances therein etc.
Substances or compounds the action mechanism of which is not associated with one
particular cell function and those can cause its differentiation by several parameters, can be
attributed to non-specific differentiatio 1 inductors.
Methods for inducing tumor cells differentiation by administering retinoids or ct-2-
interferon are known [Cancer Res.,40, 2245-3350, 1980].
The cells differentiation inductor polytransretinoic acid (PTRA) is used as an agent to
prolong remission following induction or post-remission therapy of acute promyelocytic
leukemia. Cells differentiation as affected by retinoic acid derivatives leads to stabilization of
tumor cells growth [Abelev G.I. Differentiation and tumor phenotype in cells of leukoses and
lymphomas/ In: The Clinical Oncol ematology (edited by M.A. Volkova). Moscow, the
Meditsina publishers, 2001, Chapter 11 pages 116-123].
The use of a-interferon preparations as immunotherapy agents in treating melanoma is
also associated with induction of tumor cells differentiation in which adhesion capability is
enhanced and antigenic profile changes. Therapy with interferon results in reduced progression
of tumor growth as well as prevents the development and rate of metastasis [Atzpodien J.,
Kirchner H. Cancer, Cytokines, and cytotoxic cells: interleukin-2 in the immunotherapy of
human neoplasms. Klin. Wochenschr, 1!>90, v.68, pp. 1-7].
Preparations that cause hemopoietic cells differentiation damaged owing to cytotoxic

the chemotherapy have been introduced into clinical practice recently. These preparations are
different cytokines prepared from bons marrow such as hematohormones: granulocytic colony-
stimulating factor, granulocytic-macrophagal colony-stimulating factor and others. Their use in
treating different human tumors results in accelerated maturation of the bone marrow cells and
prevents hematologic cytotoxic effect of the chemotherapy preparations [Crawford j., Ozer H.,
Stoller R. et al. Phase II of clinical investigation of GM-CSF by the patients of SCLC with the
dose-intensive the chemotherapy. The New England Journal of Medicicne. 1991, v.325, No.3,
pp.164-170].
Thus, induction of tumor cells differentiation is one of the leading mechanisms of
neoplasm growth stabilization, increased immunotherapy effect and correcting hematologic
toxicity of the chemotherapy preparations.
The present inventors have discovered that the peptides derivartives of general formula



are potent inductors of cells differentiation and are useful as agents for non-cytotoxic therapy of
cancer diseases in particular, melanoma and hemoblastomas as well as hematocorregating
agents.
The compounds of formula (I)

are disclosed in the International application PCT/RU98/00215 as possessing antioxidant,
antiasthmatic, antihypoxic, anti-inflammatory, antiviral, antibacterial, lipidregulating, anti-
metastatic as well as other kinds of therapeutic effect. The compounds of cyclic aspartyl-
histamine and acetyl-aspartyl-histamine structure are disclosed in the work Kvamme, E.;
Reichelt, K.L.; Edminson, P.D.; et al. N-substituted peptides in brain. Fed. Eur. Biochem.
Society Meet, {Proa], 1975,41, 127-136.
The present invention relates to a method for inducing cells differentiation comprising
administration as an active agent an effective amount of the compound of general formula

or pharmaceutically acceptable salts there of,

wherein R1 is C1-C3 hydrocarbon radical substituted by a functional group selected from amino,
G1-C5 arnido- or carboxylic groups, carboxylic group being optionally etherified and amino
group being optionally substituted by acyl substituent; or C1-C3 hydrocarbon radical
simultaneously substituted by amino group, amino group being optionally substituted by acyl
substituent and carboxylic group, curboxylic group being optionally included in C5-C6
membered cyclic imide including N-terminal amino group or -NH- group of-CONH- group; or
C1-C3 hydrocarbon radical substituted by 5-6-membered unsaturated heterocyclic group,
hydrocarbon radical can simultaneously comprises amino group ptionally substituted by acyl
substituent; or
R1 is saturated heterocyclic group;
R2 is hydrogen atom or a functional gro up selected from carboxyl, that can be etherified;
R3 is 5-6-membered saturated or unsaturated cyclic or heterocyclic group, or amino- or carboxyl
group, carboxyl group being optionally be etherified;
n=0-4,m=l-4,k=0-l.
In a preferred embodiment the present invention relates to a method for induction of cells
differentiation comprising administration as an active agent an effective amount of 4-[N-(2-
imidazol-4-yl)ethyl)carbamoyl]butyric acid (Dicarbamine®).
Preferred compounds of general formula (I) used in the present invention are compounds
of general formula (I) shown below:




More preferred compounds of general formula (I) used in the present invention are
compounds of general formula (I) wherein R≈ NH2CH2, HOOC-CH2-, CH3CONH-CH2-,
CH3OCO-CH2-,


The most preferred compound used in the present invention is 4-[N-(2-imidazol-4-
yl)ethyl)carbamoyl]butyric acid (Dicartamine®).
In a preferred embodiment of the invention peptides derivartives of general formula (I)
are administered for a long period of time at a single dose 0.5-5.0 mg/kg body weight.
In another preferred embodiment of the invention peptides derivatives of general
formula (I) are administered in combination with the chemotherapy.
A preferred embodiment of the invention is also a method for induction of cells
differentiation wherein in order to stabilize malignant tumors growth in particular melanoma or
hemoblastosis, peptides derivartives of general formula (I) are administered at the single dose
0.5-5.0 mg/kg body weight for at least 15 days when the capabilities of the chemotherapy has
been exhausted.
Administering peptides derivartives of general formula (I) in combination with the
immunotherapy agent interferon results in enhancement of its efficacy in respect to malignant
tumors cells in particular melanoma.
Yet another preferred embodiment of the present invention is a method for inducion of
cells differentiation wherein in order to enhance efficacy of melanoma immunotherapy, peptides
derivartives of general formula (I) are administered at dose 0.5-5.0 mg/kg body weight for not
less than 15 days together with administering interferon.
A preferred embodiment of the present invention is also a method for inducing cells
differentiation wherein in order to lower hematological toxicity, peptides derivartives of general
formula (I) are administered daily at the single dose 0.5-5.0 mg/kg body weight 5 days before the

chemotherapy course starting, during the chemotherapy and within the period between the
chemotherapy courses until next course of cytotoxic therapy.
Below, the examples illustrating preferred embodiments of the instant invention are
presented.
Example 1. Activity of peptides derivatives of general formula (I) to melanoma M-6
cells differentiation
The study was conducted on 10-12 week old thymus free (nude) female Balb/C mice
weighing 20-22 grams (breeding of the Russian Cancer Research Center (RCRC) named after
N.N.Blokhin of the Russian Academy of Medical Sciences (RAMS)). A human melanoma strain
earlier obtained from primary clinical material was taken from the bank of tumor strains of the
RCRC of the RAMS for transplantation to thymus free "nude" mice. Tumor was disintegrated by
Versen solution with vital Tripan blue staining and inoculated subcutaneously to mice in the
amount of 1.6 million cells per a mouse.
Dicarbamine was administered to mice intragastrically using a metal probe daily at dose
1.0 mg/kg beginning 4 days before the tumor inoculation and thereafter for 10-11 days
(administration course up to 15 days). The mice were sacrificed with ether anesthesia in 12, 24
and 48 hours after the last adrninistratior.
4 groups of mice were used in the experiment:
Group 1 - the control, no Dicarbamine is administered. Mice aree sacrificed at the same
terms as those of the groups received Dicarbamine.
Group 2 - Dicarbamine is administered and mice are sacrificed in 12 hours after
termination of the administration.
Group 3 - Dicarbamine is administered and mice are sacrificed in 24 hours after
termination of the administration.
Group 4 - Dicarbamine is administered and mice are sacrificed in 48 hours after
termination of its administration.
Four morphologic parameters such as the number of cells with pigment and the number
of cells with apoptosis signs (capability to differentiate), the number of mitoses (proliferation
activity) and necrosis area were determined to monitor differentiation and proliferation degree of
M-6 melanoma in the groups of control animals and the Dicarbamine groups. These parameters
were determined dynamically and correlated with general morphologic picture of a tumor growth
as an integral sign. For this purpose the cumor was removed in mice, placed into formaline and
histologically processed for light microscopy. The data obtained are shown in Table 1.
Table 1.
Morphologic parameters of M-6 melanoma (light microscopy)


The conducted study allowed the inventors to establish that human melanoma inoculated
to nude mice at day 9 forms the tumor consisting of polymorph cells that grow by continuous
fields with insignificant stroma development. Small necrosis sites are ennumberered in the
tumor, which sites slightly increase by 48 hours (up to 3-5 % of slice area) as compared to
sacrificing terms 12 and 24 hours (1-2 % and 2-3 % , respectively). 3-5 % of imitoses are
observed in the tumor during all growth periods. Apoptosis is slightly expressed. Cells
containing pigment are rarely found and their number during the first day does not exceed 1-2 %
and only in 48 hours of growth it increases up to 2-3 %. Thus intensity of melanin genesis during
this period is insignificant. The obtained characteristic allows to conclude that melanoma is a
rapidly growing tumor practically lost capability of differentiating on the basis of both apoptosis
degree and first of all, on the basis of the basal functional capability of melanin genesis.
The effect of Dicarbamine on melanoma cells differentiation was assessed on the basis
of the intensity of melanin genesis by numbering the number of cells with melanin in the tumor
slices. With this object, the tumor was excised in mice, placed into glutaraldehyde and

histologically processed for electronic microscopy was done. The Melanin Genesis Intensity
Index (MGII) that reflects the degree of cells differentiation was calculated in the prepared slices
according to the following equation:
MGII = NCMxNM,
wherein: NCM is the number of cells containing melanosomes;
NM is average number of melanosomes per a cell.
The analysis of melanin genesis intensity conducted by this index is shown in Table 2.
Table 2.
Comparative melanin genesis inter.sity in melanoma cells following administration of
Dicarbamine (electronic microscopy)

*beginning from day 9 following the tumor inoculation
Electronic microscopy test shows that as compared to the control, the number of tumor
cells comprising melanosomes and the number of melanosomes per one cell are increased as due
to Dicarbamine effect. The MGII index increases for the observes terms as follows: in 12 hours -
1.9-fold, in 24 hours - 2.4-fold and in 48 hours - 2.3-fold.
Thus following a 15 day administration course of Dicarbamine, average increase of M-6
melanoma tumor cells differentiation degree is 2.2-fold that is supported by melanin genesis
intensity (the MGII index), increase in the number of cells comprising melanosomes (1.3-fold)
and increase in the number of melanosomes (1.3-fold).
Example 2. The effect of Dicarbamine on melanin synthesizing function of inoculated

human melanoma cells
Mice with subcutaneously inoculated human melanoma as described in Example 1, were
daily p.o. dosed with Dicarbamine at a higher single dose 4.5 mg/kg for 3 weeks from the
moment of the tumor transplantation.
Animals were sacrificed in 3 weeks since the tumor transplantation. By sacrifice the
tumors volume was in average 150 mm3. Following sacrifice, the tumor wsa excised in mice and
disintegrated with Versen solution and the cell fraction was isolated in which the number of cells
with pigment was calculated in the Goryaev's chamber during light microscopy.
The conducted studies show that in the control average number of cells with melanin was
39.14±8.72, and in the test it was 108.42±11.91, i.e. the number of cells synthesizing melanin
significantly (p Thus in the conducted series of tests using Dicarbamine at the different doses, a
statistically significant effect of pronounced induction of human melanoma cells differentiation
was obtained as evidenced on the basis of the melanin genesis intensity.
The data are presented in Table 3.
Table 3.
Melanin genesis intensity in human melanoma cells induced by Dicarbamine

Example 3. The effect of Dicarbamine on inoculated human melanoma Mel-6growth
dynamics
The study was conducted on 10-12 week old thymus free "nude" female Balb/C mice
weighing 20-22 grams (breeding of the RCRC named after N.N.Blokhin of the RAMS). A
human melanoma strain Mel-6 earlier obtained from primary clinical material was taken from

the bank of tumor strains of the RCRC of the RAMS for transplantation to thymus free mice.
Dicarbamine at the single doses 1.5 mg/kg and 4.5 mg/kg was p.o. administered daily to
two mice groups for 3 weeks from the moment of the tumor development (from day 15 to day 36
from the tumor transplantation ).
Measurement of the tumor was done, at days 18, 25, 33, 39, 46 and 53 from the
transplantation. Dicarbamine effect was assessed on the basis of the tumor growth dynamics for
8 weeks in multiple measurements of tumor volumes "V" according to the formula:

wherein L is length in mm, s is width in mm; and h is height in mm.
Ratio between volumes of tumors Vt/Vt-1 that was expressed in percent was then
calculated and statistically processed according to the Student's method to calculate statistically
significant difference. The data obtained are shown in Table 4.
The data obtained showed a 7-day delay in maximum tumor mass gain in comparison
with the control. As compared with the control group, statistically significant differences in
tumor growth rate were found at day 25 from the transplantation in the mice group received
Dicarbamine at the single doses 4.5 mg/kg that corresponds to a 10-day course of Dicarbamine
dosing at a course dose 45 mg/kg. In this group average tumor volume increased by
166.0±93.0%, whereas in the control this parameter was 329.0±88.9% (p Example 4. The Dicarbamine affect in combination with the chemotherapy on the
growth of inoculated human M-6 melanoma transplanted to thymus free mice.
The study was conducted according to the technique described in Example 3.
Dicarbamine was administered daily p o. at the single dose 4.5 mg/kg for 3 weeks from the
moment of tumor appearance (from day 15 to day 36). In the groups of combined treatment
Dicarbamine was also administered daily at the single dose 4.5 mg/kg for 3 weeks (days 15-36)
in combination with a single administration of anti-tumor cytostatic agents Cysplatin at dose 6
mg/kg i.v. (day 25) and Aranoza at dose 40 mg/kg i.p. (day 27). Cytostatic therapy with was
commenced at average tumors volume being 200±62 mm3. At days 18, 25, 33, 39, 46 and 53
from the transplantation tumor volumes were measured and the value Vt/Vt_1 was calculated
which value was expressed in percent. The data obtained are shown in Table 5.
Table 5.
The effect of combined the chemotherapy with anti-tumor cytostatic agents and Dicarbamine on
human M-6 melanoma growth dynamics


It follows from the data presented that Dicarbamine in the used dosing routdelays the
tumor growth at initial stagesthat can be shown by decrease in tumor mass gain at day 25
166.0±93.0% as compared to the control where the gain was 329.0±88.9%. Thus the results of
Dicarbamine effect on melanoma growth were reproduced (see Example 3). Combined the
chemotherapy with Aranoza and Cysplntin in the indicated regimes appeared to be inefficient,
i.e. gain of the tumor at this term was higher than the control value (413.0±276.0%). This proves
the absence of sensitivity of the used Mel-6 human melanoma strain to the given the
chemotherapy scheme. Introduction of Dicarbamine into the inefficient the chemotherapy
scheme resulted in a statistically significant (p by 182.0±60.0% that proves its efficacy in case of the absence of the chemotherapy effect.
Example 5. The effect of peptides derivartives of general formula (I) on proliferation
capability of melanoma cells when interferon administration.
The effect of Dicarbamine on proliferation capability of melanoma cells along with a-
interferon (Introne®, IN) administration was studied. It should be noted that Dicarbamine itself
is capable of slowing proliferation activity of melanoma cells without changing their survival.
The study was conducted on two continuous cell cultures growing in the form of a
monolayer in a tissue culture on murine B-16 melanoma cells and human M-5 melanoma cells.
IN was administered at concentrations 7( -700 IU/ml. Dicarbamine (D) was transferred into stock
solution (1.000 uM), sterilized through filters with 0.22 urn pore diameter and then diluted to
concentrations 0.01 and 1.0 μM.

The effect of preparations en cells was assessed on the basis of initial rate of cell
proliferation (IRCP). This index (IRCP) that is usually called colony rate growth, was
determined by numbering the number of cells in micro colonies during the first days following
affection in "test" (with preparations) and "control" (without preparations) dishes, by analyzing
50 colonies in each of them. Each "point" included not less than three Petri dishes with growing
cell colonies in adding specific concentrations of preparations under study. Growth rate of
colonies (in %) was calculated according to the formula:

Cell numbers in micro colonies were calculated for every "point". Toxicity of
preparations in the selected range of concentrations was judged by cells survival that was
determined by the ratio between numbers of the grown colonies in "test" and "control" dishes.
Test results are shown in Table 6.
Table 6.
The effect of Dicarbamine and a-interferon on proliferation activity of murine B-16 melanoma
and human M-5 melanoma cells

One can see from the table that i n the control with M-5 melanoma the IRCP index was
preserved at the 100% level for 96 hours.
In the samples with M-5 cells when a-interferon was added at the concentration 7.0
IU/ml in 48 hours the IRCP index increased up to 111.3% and slowed down to 94.8 and 73.0%
respectively only in 76 and 96 hours. When a-interferon was added at concentration 70 IU/ml in
48 hours the IRCP index slowed down to 53.7%, in 72 hours - down to 51.9% and in 96 hours -
down to 48.8%. I.e. the maximum inhibiting effect of a-interferon at concentration 70 IU/ml

achieves 50% IRCP.
When Dicarbamine at the concentration 0.01 μM was added, the IRCP index in 48 hours
slowed down to 82.4%, in 72 hours - down to 73.6% and in 96 hours - down to 70.2% and when
Dicarbamine at the concentration 1 μM was added, the IRCP index in 48 hours slowed down to
69.0% and in 72 hours - down to 50.0%.
Thus the maximum inhibiting effect of Dicarbamine also achieves 50% of the IRCP
index and was obtained at the preparation concentration 1.0 uM.
In the tests on B-16 melanoma when α-interferon was added at the concentration 70
IU/ml, the IRCP index in 72 hours slowed down to 50.0%, and when Dicarbamine was added at
two indicated concentrations, the IRCP index in 48 hours slowed down to 52.9 and 44.6%
respectively and in 72 hours to 61.0 and 44.6% respectively. Significant reducing the IRCP index
down to 38.0 and 29.8% was obtained only when a-interferon was added at concentration 700
IU/ml.
Thus the conducted tests show that α-interferon and Dicarbamine inhibit M-5 melanoma
and B-16 melanoma cells growth at the level of 40.0-50.0% that is characteristic of
differentiation inductors. A more pronounced effect on the IRCP index can be obtained only in
case of a 100-fold increase in α-interferon concentration.
Combined addition of a-interferon at concentration 70.0 IU/ml and Dicarbamine to M-5
cells showes that in all cases the IRCP index lowered down to 30.7-24.0-31.0%) respectively to
recording terms. The most pronounced effect was obtained on B-16 melanoma when a-interferon
at concentration 700 IU/ml and Dicarbamine at the both concentrations were used in
combination: the IRCP index lowered down to 24.9 and 29.8% in 48 hours and down to 22.0 and
16.0% in 72 hours, respectively.
Thus Dicarbamine similarly to a-interferon slows down murine B-16 melanoma and
human M-5 melanoma cells proliferation and doe:s not show toxicity (according to the survival
index). As it was shown by the given examples, the effect of Dicarbamine is characteristic of
differentiation inductors and has an additive character in combination with the known
differentiation inductor a-interferon on melanoma cells. This effect results in enhancement of
tumor growth inhibition and it is an indication for raising immunotherapy efficacy of
melanomas.
5.2. The effect of peptide derivatives on melanoma cells proliferation capability .
The study was conducted on a continuous cell culture of murine B-16 melanoma growing
in the form of a monolayer in a tissue culture. α-Interferon selected as a preparation of
comparison, was administered at concentration 70 IU/ml.
The tested compounds were transferred into stock solution (1,000 μM), sterilized through

filters with 0.22 μm pore diameter and then diluted down to concentration 100 μM.
The effect of compounds on cells was assessed on the basis of initial rate of cell
proliferation (IRCP). This index was determined by numbering the number of cells in micro
colonies during the first days following affection in "test" (with preparations) and "control"
(without preparations) dishes, by analyzing 50 colonies in each of them.
Growth rate of colonies (in %) was calculated according to the formula:

Calculations of cell numbers in micro colonies were done for every "point". Toxicity was
judged by B-16 melanoma cells survrval that was determined by the ratio between numbers of
the grown colonies in "test" and "control" dishes. Test results are shown in Table 7.
Table 7.
The effect of peptide derivatives at concentration 100 μM and α-interferon at concentration 70
IU/ml on murine B-16 melanoma cells proliferative activity

Differences with the control are s:gnificant (p Data presented in Table 7 show that peptide derivatives inhibit B-16 melanoma cell

colonies growth at the level 50.0-70.0% that is characteristic of differentiation inductors.
Example 6. Distribution of tumor cells by cell cycle phases at different terms following
Dicarbamine administration.
Tests were done on inoculated B-16 melanoma. The effect of Dicarbamine on the
distribution of tumor cells was studied on the basis of DNA content at different terms following
administration of the preparation. From day 6 after the tumor inoculation mice for 10 days were
daily intragastrically given with 0.5 mg/kg Dicarbamine. Animals were sacrificed with
subsequent investigation of tumor material at days 10, 12,16 and 18 after inoculation, i.e. days 5
and 7 respectively after Dicarbamine administration as well as in 2 and 4 days after termination
of Dicarbamine 10-day dosing.
Testal results shows that Dicarbamine caused a significant increase of the portion of
inter-phase tumor cells (IIG1) (≈25%). In a constant portion of proliferating cells (≈30%)
increase in the portion of IIG2 cells (12-14%) is noted. Accordingly the portion of normal
stromal cells (IG1) in the samples compensatory dicrease. Said changes are most clearly
pronounced after 5-10 administrations of Dicarbamine.
Course dosing of Dicarbamine causes kinetic rearrangement of tumor cell population.
Inhibition of cells in the synthetic cycle phase (S-phase) is noted with compensatory decrease in
the portion of cells that are ready for proliferation or proliferating cells (G phase).
Accumulation of tumor cells in the stationary phase G1 simultaneously occurs.
Lowering the level of proliferative activity Dicarbamine promotes accumulation of cells
in stationary (non-proliferating) cell cycle phase. It can slow down tumor growth and promote
transition of cells to a more differentiated state.
Example 7. Efficacy of Dicarbamine in respect to hematological toxicity of
Cyclophosphamide and its combinations with Cysplatin and Carboplatin.
Hematocorregating effect of Dicarbamine was studied on the first generation of male
mice hybrids F1 (CBA x C57BI).
7.1. 4 groups of animals were used to study the effect of Dicarbamine on hematotoxicity
of Cyclophosphamide (CPH):
Group 1 - Dicarbamine, 0.5 mg/kg daily beginning 5 days before CPH administration
and for 5 days after the single administration of CPH at dose 200 mg/kg;
Group 2 - the single administration of 200 mg/kg CPH;
Group 3 - intact control;
Group 4 - Dicarbamine 0.5 mg/kg, daily for 10 days.
The data obtained are shown in Table 8.

Table 8.
Total leukocyte number in peripheral mice blood under Cyclophosphamide effect and

The data obtained show that use of Dicarbamine in combination with CPH allows
reducing hematotoxic effect of the latter and speeding up recovering blood parameters.
7.2. When studying the effect of Dicarbamine on hematotoxic action of CPH
combinations with platinum derivatives, Dicarbamine was intragastrically daily administered to
mice for 20 days daily at a single dose 0.5 mg/kg. Cytostatic preparations were once
administered intraperitoneally at day five from, starting Dicarbamine administration course.
Doses of cytostatic preparations are shown in Tables 10 and 11.
The results of studying the effect of Dicarbamine on leukocytes number in mice
peripheral blood when combined dosing of CPOH with Cysplatin or Carboplatin are shown in
Tables 9 and 10 respectively.
Table 9.
The effect of Dicarbamine on hematotoxicity of Cyclophosphamide in combination with




The presented data show that adready by day 5 in the mice group received cytostatic
preparations at maximal doses along with Dicarbamine, leukocyte number achieved lower border
of physiological norm and by day 7 it practically restored up to the initial level. Without
Dicarbamine restoration was observed only by clay 21 of the test. In mice received cytostatic
preparations at maximum doses without Dicarbamine death of animals was noted at days 3, 4
and 7 of the test. In animals that were given cytostatic preparations at maximum doses along
with Dicarbamine, only delayed death at days 8 and 16 was noted.
Table 10.
The effect of Dicarbamine on hematotoxicity of Cyclophosphamide in combination with



The data presented show (Table 10) that in case of using Dicarbamine together with
Carboplatin and Cyclophosphane at the lethal doses, leukocyte number in peripheral blood and
terms of animals death are similar to the data presented in Table 9.
Thus Dicarbamine inhibits the development of leukopenia in all the courses studied, it
speeds up recovering total leukocyte number and delays term of mice death when using
cytostatic preparations at lethal doses.
7.3. When studying the effect of peptide derivatives of general formula (I) on
hematotoxic action of CPH combinations with Carboplatin, the compounds were intragastrically
administered to mice daily at the dose 0.5 mg/kg for 10 days. At day five after starting
administration of the tested compounds mice were intraperitoneally injected CPH at dose 200
mg/kg and Carboplatin at a single dose 15 mg/kg. Thereafter administration of the tested
compounds was continued for 5 more days.
Before starting dosing the tested compounds, blood was drawn from mice tail to
calculate total leukocyte number. At days 3, 5 and 7 after administration of Cyclophosphamide
with Carboplatin blood also was drawn from mice tail to calculate total leukocyte number. Each
group included 15 animals.
As a control a mice group that received only cytostatic preparations was used.
The data presented in Table 1 show that peptide derivatives of general formula (I)
inhibit the development of leukocytopenia and speed up recovering total leukocyte number.
Table 11.
The effect of peptide derivatives of general formula (I) on hematotoxic action of
Cyclophosphamide combination with Carboplatin



7.4. The effect of Dicarbamine on cells differentiation is supported by the study of mice
peripheral blood differential number under Cyclophosphamide effect in combination with
Dicarbamine in comparison with dosing Cyclophosphamide alone.
Two groups of mice are used. Group one is administered Dicarbamine at dose 0.5 mg/kg
5 days prior to and 5 days after CPH administration at dose 200 mg/kg. Group two of mice is
administered CPH alone at dose 200 mg/kg. Results of the studies are shown in Tables 12 and
13.
Data presented in Tables 12 and 13 show that recovering peripheral blood occurs due to
burst of mature forms that confirms the differentiation effect of Dicarbamine. This is especially
seen at days 3 and 5 by peripheral blood number and cellularity of bone marrow (Tables 12 and
13). In the group with Dicarbamine myelocytes and band neutrophils are absent in peripheral
blood and in group without Dicarbamine these form elements are present (Table 12).
Example 8. Decrease in the rate of and dimensions of subcutaneously inoculated Friend
erythroblastosis (FEB) in mice as effected by peptide derivatives.
The studies were conducted on male mice hybrid 100 BDF1 that were divided into groups
containing 10 mice each. Lineal DBA2 mice were used for passaging FEB in vivo.
A strain of Friend erythroblastosis was obtained from the bank of tumor strains of the GU
RCRC named after N.N.Blokhin of the RAMS, it was twice passaged intraperitoneally using
generations 3-8 in subcutaneous inoculation. Thr inoculation was done using cellular suspension
at amount 1x106 in 0.3 ml 1999 medium
Solutions of the tested compounds were intragastricaally daily administered to mice using
a probe from day 3 to day 7 after tumors inoculation.
Therapy efficacy was assessed on the basis of tumor growth inhibition (TGI, %) and an
average life span (ALS). Increase in life span was determined by the commonly accepted
criterion T/C (%) that was calculated as ratio between ALS in the test and control groups. Tumor
growth rate Vt/V1 was calculated on the basis of change dynamics in average tumor volumes.
Data of the studies on the effect of peptide derivatives on tumor size and on tumor growth
rate are shown in Tables 14 and 15, respectively.
The results obtained show that peptides derivartives cause growth inhibition of
subcutaneously inoculated FEB for 19 days after ternination of therapy. Said effect started to be
recorded immediately after termination of administering compounds at a single dose 1.5 mg/kg

and was preserved at a significant leve. (p during one week following withdrawal of the compounds.
It was established resulting from the conducted studies that the compounds of general
formula (I) possess inhibiting effect on the development of FEB subcutaneous node. The data
obtained allow to consider that the test compounds are useful for therapy of human
hemoblastoses.
Example 9. The effect of Dicarbamine and 2a-interferon (Reaferon) on Friend
erythroblastosis tumor cells.
Friend erythroblastosis was investigated which was inoculated subcutaneously to DBA2
female mice via spleen cells.
4 groups of tests were carried out.
Group 1 - control animals without therapy, a physiological saline was administered;
group 2 - Reaferon at dose 100 thousand IU/kg was administered daily s.c. from day 3 to
day 7 after inoculation;
group 3 - Dicarbamine at a single dose 4.5 mg/kg was administered p.o. from day 3 to
day 7 after inoculation;
group 4 - Dicarbamine and Reaferon were administered simultaneously according to a
similar scheme.
Material for light microscopy was taken in sacrificed animals at days 3, 7 and 14 after
termination of therapy or administration of a physiological saline, material for electronic
microscopy was taken at days 7 and 14.
For histological examination tumor pieces were fixed in 10% neutral formaline and
imbedded into paraffin; slices obtained were stained with hematoxylin-eosin and examined for
glycogen (polysaccharides) content using periodic acid Schiff reaction, for RNA content
according to Brachet, for lipids and iron. Slices were looked through and photographed in the
Polivar light microscope (Austria).
For electronic microscopy tumor pieces were fixed in 2.5% glutaraldehyde solution and
1% osmium quadrioxide, embedded into EPON-812. Semi-thick and ultra-sick slices were
prepared on the LKB-III ultratome (Sweden). The obtained semi-sick slices were stained with
Toluidine blue and looked through in the light microscope. Ultra-sick slices were additionally
stained with uranyl acetate and lead citrate; the slices were looked through and photographed in
the JEOL 1200 EX-II electronic microscope (Japan).
Percentage of cells with different t types of differentiation (blast cells, lymphocytes and
granular leukocytes) was calculated during electronic microscopy for quantitative assessment.
Percentage of mitoses and cells with apoptosis as well as areas of necroses were assessed

during histological examination.
Histological examination
Group 1. Control animals without therapy.
It was found at histological examination that tumor cells are large, polymorphous, their
nuclei are light, cytoplasm is moderately developed. Cellular size sometimes fluctuates and
individual smaller cells are errnumberered but large cells represent the main mass of cells.
Tumor cells form continuous ou:growths. In individual tumors necrosis sites surrounding
preserved fields of tumor cells are errnumberered. Area of necroses did not exceed 10-15% of the
slice surface.
In a majority of tumor cells Brachet reaction for RNA is strongly pronounced, less often
it is weak or absent (in individual small cells).
Periodic acid Schiff reaction had diffuse character, reaction to iron was positive only in
individual cells.
In the tumor among large cells mitoses (up to 1-1.5%) and cells with apoptosis signs (up
to 0.5%) were errnumberered.
As the tumor grew, the area of necroses was increasing up to 20-30% of the slice surface,
the number of metoses increased (up to 1.5-2%), apoptosis activity did not change. The number
of large polymorphous cells significantly prevailed at all terms.
Group II. Administration of Reaferon
Tumors have usual histological structure. As in the control, among large polymorphous
cells smaller cells with hyperchromatic nucleus are found.
By day 14 the area of necroses is 40-50% of the slice surface, mitotic activity is 0.5-1%,
by day 7 apoptosis increased up to 1-2%, but by day 14 it lowered down to 1-1.5%.
Group HI. Administration of Dicarbamine
Increase in the quantity of small tumor cells with hyperchromatic nuclei is noted.
Quantity of large polymorphous cells significantly prevails. The area of necroses did not
significantly change as compared to the picture in group I. Mitotic activity also remained within
the limits of the control figures. At days 3 and 7 the rate of apoptosis slightly lowered (down to
0.1=0.5% at day 7).
Group IV. Simultaneous administration of Dicarbamine and Reaferon
The area of necroses and mitotic activity did not show significant shifts as compared to
the changes in group II. At day 3 apoptosis lowered down to 0.2-0.5%, at days 7 and 14 it is
0.5% (as in the control).
Large polymorphous cells of blast type significantly prevail in the tumor.
Electronic microscopy

Group I. Control animals without treatment
Large polymorphous low-differentiated cells of blast type are mainly found in the tumor
during electronic microscopy. Nuclei in these cells have rounded or slightly irregular shape
occasionally with uneven surface. Diffuse distribution of chromatin is usually seen in them, only
in some of them formation of marginally located heterochromatin is noted. Nuclei usually
occupy a major portion of cytoplasm wherein ribosomes, single mitochondria, occasionally the
structures of slightly rough endoplasmic reticulum prevail. Blast cells amount 90-95% of all the
tumor population.
In addition to blast cells, lymphocytes of different maturity degree are ennumberered, i.e.
lymphoblasts, lymphocytes (large, medium, small). Nuclei in these cells are rounded, oval, often
with uneven surface, they comprise heterochromatin in the form of large accumulations, nucleoli
are ennumberered. Cytoplasm is moderately developed, it comprises a lot of ribosomes; there are
little other organelles, dense granules are occasionally ennumberered.
Granular leukocytes are small, granules characteristic of neutrophils, less often
eosinophils are visible in cytoplasm. Nuclei in cells are segmented or have deep concavities.
Cells having granules in cytoplasm, irregular nucleus and protruding plasmatic membrane in the
form of processes can be occasionally seen (monocytes). Freely lying red blood cells were
ennumberered in the tumor.
Large blast cells mainly prevail in the 1umor (up to 90-95%). Lymphoid cells are
ennumberered within the range 4-8%, granular cells amount 1-2%.
No significant shifts in the ratio between different cell types were noted as the tumor
grew following engrafting.
Group II. Administration of Reaferon
General ultrastructure of tumor cells of different type is preserved.
Quantity of large blast cells does not lower, lymphoid cells amount up to 4-8%, granular
leukocytes amount up to 1-2%. Individual red blood cells are present in the tumor.
Group III. Administration of Dicarbamine
Ultrastructure of tumor cells of different type remains previous. Their quantitative ratio
changes and differentiation level somewhat raises. The quantity of large blast type cells lowers
down to 70-80%), the quantity of lymphocytes and granulocytes increases up to 18-25% and 2-
5% respectively. Individual red blood cells are present in the tumor.
The most constantly found changes are ennumberered at day 7 post treatment
termination.
Group IV. Administration of Reaferon and Dicarbamine
Ultrastructure of tumor cells of different type practically corresponds to what is described

above (see Group I).
The quantity of large blast type cells fluctuates within the range of 70-80%. The number
of lymphocytes achieves 18-25%, the quantity of leukocytes remains at the level of 2-5%. Red
blood cells lying among the other cells are ennumberered.
As in the previous groups, the changes found are most pronounced at day 7.
Thus Dicarbamine orally administered to mice with Friend erythroblastosis at dose 4.5
mg/kg daily for 5 days was established to cause differentiation of immature tumor cells mainly in
the direction of forming granulocytes as well as cells of erythroid lineage.
As compared to tumors of the control animals, when Dicarbamine was used, the quantity
of immature tumor cells lowered down from 90-95% to 70-80%, i.e. by 15-20% and the quantity
of lymphocytes increased from 4-8% up to 18-25%, i.e. 4-fold.
The quantity of granulocyte lineage cells increased less significantly (from 1-2% to about
2-5%).
It should be noted that most frequently changes were found at day 7 after termination of
treatment. At day 14 after termination of treatment these changes got stabilized.
Reaferon in subcutaneous administration for 5 days at dose 100 thousand IU/kg caused
increase in the area of necroses in the tumor (from 15-20% in the control to 40-50% in the test at
day 7 after termination of treatment anc. from 20-30%) to 40-50%) at day 14). The rate of mitoses
somewhat decreased (from 1.5-2% to 0.5-1%) and the quantity of cells with apoptosis signs
increased (from 0.5% to 1-2%) at day 7 after termination of treatment). Differentiation of tumor
cells did not practically change.
In simultaneous administration of Dicarbamine and Reaferon at the same doses and at the
same terms summation of the effect of ea.ch preparation was found. Enhancement of
differentiation of blast immature cells characteristic of the effect of Dicarbamine alone was
observed as well as growing area of nee roses and decrease in the number of mitoses were found
that was seen in administering Reaferon alone.
Thus it has been established that Dicarbamine is capable of enhancing differentiation of
immature tumor hemopoietic cells of Friend erytliroblastosis in different directions in particular
with formation of lymphoid and myeloid lineage tumor cells.
The effect of Dicarbamine on cells differentiation represents its general property as it was
earlier observed in the example of melanoma study.
Example 10. Electronic microscopy of Dicarbamine protective effect in respect to
hemopoietic cells of the bone marrow and peripheral blood in patients with ovarian cancers
during the chemotherapy
In the previous studies devoted to studying action mechanism of Dicarbamine on the

bone marrow, the given preparation was found to protect the bone marrow in animals under
testal conditions against adverse cytotoxic effect of Cyclophosphamide by reducing apopotosis
in normal hemopoietic cells.
Similar data were obtained on the bone marrow puncture biopsies and peripheral blood of
10 patients with stage III-IV ovarian caNcer.
The patients were divided into two equal groups: group I - patients who received the
chemotherapy alone and group II - patients who received the chemotherapy along with
Dicarbamine administration.
Patients in groups I and II received 600 mg/m2 Cyclophosphane and 400 mg/m2
Carboplatin during the first day of therapy; courses were repeated with 3-4 week interval.
Average the chemotherapy course of one patient included 6 courses without Dicarbamine and
5.7 courses with Dicarbamine.
In group II patients received the chemotherapy along with Dicarbamine dosing at a single
dose 100 mg beginning 5 days before the first course and then until the beginning of next course
at the same dose. Duration of Dicarbamine use between two courses averaged 24.5 days.
Average total dose was 2.5 grams.
Puncture biopsy of the bone marrow and peripheral blood for electronic microscopy were
taken in patients prior to the chemotherapy starting and at the end of treatment course with
Dicarbamine or without it.
Fresh bone marrow puncture biopsies were placed on slide plate and many times stirred
with stirring rod until small dense fragments were obtained. The latter were fixed in 2.5%
glutaraldehyde solution additionally fixed in 1% osmium quadrioxide solution; following
washing with phosphate buffer at pH 7.4 they were dehydrated in alcohols of increasing
concentration and embedded into the mixture of epoxy resins EPON-812. Semi-thick and ultra-
sick slices were prepared on the LKB-III ultratome (Sweden). The semi-sick slices were stained
with Methylene or Toluidine blue, ultra-sick slices were contrasted with aqueous solution of
uranyl acetate and lead citrate.
Peripheral blood comprising heparin was centrifuged for 1 hour at 3,000 rpm. Then 2.5%
glutaraldehyde solution was poured on the surface of the film formed for 10-15 minutes the film
was removed and then treatment was proceeded as described above.
Thin slices were jbserved in the light microscope Polivar (Austria) and semi-thin slices
were observed in the electronic microscope JEOL-] 200-CX-l 1 (Japan).
1. Control studies prior to starting of the chemotherapy and Dicarbamine administration.
Patients of groups I and II.
Hemopoietic cells of different maturity degree and differentiation direction are found in

puncture biopsies of the bone marrow a portion of cell being with the signs of vacuolization and
dystrophy.
There are blast non-differentiated cells of large size with narrow cytoplasm rim
comprising mainly ribosomes. In these cells a. nucleus of rounded-oval shape with diffuse
chromatin and individual nucleoli occupy the main portion of cytoplasm.
A portion of the cells differentiates in the direction of granulocytic lineage of leukocytes
of different type and differentiation degree.
Promyelocytes and myelocytes with rounded-oval nuclei, diffuse chromatin comprising
in cytoplasm different amount of specific granules are seen. Red blood cells and more mature
granulocytes are often situated around these cells.
Accumulations of more differentiated granulocytes, i.e. band neutrophils and segmented
neutrophils are often seen. Specific granules of different type characteristic of neutrophils,
eosinophils and basophils are present in their cytoplasm.
Lymphoid cells of different differentiation degree (small, medium, large - lymphoblastic)
are disposed among granulocytes.
Many mature red blood cells, often having different shape as well as normoblasts
comprising nuclei and platelets are ennumberered.
2. Bone marrow following the chemotherapy with Cyclophosphane and Carboplatin -
group I.
In the preserved hemopoietic cells of different type (granulocytes, lymphocytes,
normocytes, red blood cells, platelets) the signs of dystrophy and low degree maturity are
ennumberered in the bone marrow puncture biopsies taken after the chemotherapy course.
In blast cells cytoplasm contains ribosomes and it is often vacuolated. Nuclei are large
with diffuse chromatin or accumulations of heterochromatin, occasionally of irregular shape and
with sites drawn inside.
The quantity of specific granules in promyelocytes and myelocytes is insignificant and
cytoplasm often has pronounced dystrophic changes.
In the preserved granulocytes of band and segmented type dystrophic changes and
insignificant amount of specific granules are also observed. The present granules are also often
dystrophically modified and vacuolated.
The preserved normoblasts are often of irregular shape with processes and projections of
cytoplasm.
It should be noted that in puncture bone marrow biopsies especially among granulocytes
cells with apoptosis signs were ennumberered. In such cells margination of heterochromatin, the
signs of nucleus and cytoplasm fragmentation and formation of apoptotic bodies were noted.

3. Bone marrow after the chemotherapy with Cyclophosphane and Carboplatin along
with Dicarbarnine administration - group II.
In puncture bone marrow biopsies of patients who underwent the chemotherapy along
with Dicarbarnine administration hemopoietic cells of different degree and type of differentiation
(granulocytes, lymphocytes, platelets, normoblasts) are ennumberered.
The cells of blast type are large, they contain rounded nuclei with diffuse chromatin and
individual nucleoli, their cytoplasm is narrow and therein ribosomes, individual mitochondria
and occasionally single primary dense granules are seen.
There are many promyelocytes and myelocytes comprising rounded or oval nuclei with
diffuse or condensed chromatin; their cytoplasm comprises a rather big amount of specific
granules both primary ones (dark) and less mature ones (more mature).
Band and segmented leukocytes are also frequently ennumberered. The have a concave
(bean-like) or segmented nucleus, abundance of specific granules of predominantly neutrophile
type in their cytoplasm, less often of eosmophile type with crystalloid structures.
Lymphocytes of different differentiation degree comprise in cytoplasm mitochondria,
structures of rough endoplasmic reticulum, occasionally single inclusions in the form of single
granules.
Cells of granulocytic type, lymphocytes often form compact accumulations.
Along with red blood cells, normoblasts of different differentiation degree and relatively
usual shape are ennumberered.
Cells with apoptosis signs are rarely ennumberered.
The same regularities of composition that were earlier described for bone marrow
elements were found in studying hemopoaetic cells of peripheral blood.
The conducted comparative electronic microscopy of bone marrow and peripheral blood
hemopoietic cells in patients with ovarian cancer before and after combined the chemotherapy
(Cyclophosphamide + Carboplatin) and daring the chemotherapy along with Dicarbarnine dosing
allowed establishing mechanisms of its protective effect from cytotoxic influence of the used
preparations.
The study showed that the the chemotherapy preparations used in the present work exert
a pronounced cytotoxic effect on different types of hemopoietic cells of granulocytic, lymphoid
and erythroid lineage.
This cytotoxic effect is expressed in the form of dystrophic changes in cytoplasm and
death of specific granules that develop in bone marrow cells (and respectively peripheral blood).
Said disorders especially concern granulocyte and to a less extent lymphoid cells at early
stages of their differentiation, i.e. formation of blast cells, promyelocytes, myelocytes,

lymphoblasts, and they involve erythroid lineage as well that results in insufficient accumulation
of differentiated functionally competent forms of hemopoietic cells.
Further as it was found in the elements of granulocytic lineage the genetically
programmed cell death, i.e. apoptosis is enhanced.
Dystrophic changes and apop:osis generally result in the development of leukopenia,
neutropenia, thrombocytopenia and other disorders of hemopoiesis state and limit capabilities of
the chemotherapy.
Based on the conducted study, Dicarbamine was established to protect hemopoietic cells
of the bone marrow (and respectively peripheral blood) from cytotoxic effect of the used the
chemotherapy preparations, to promote differentiation of young forms to mature cellular
elements and to reduce the events of apoptosis.
As a result of the found effect of Dicarbamine, in the bone marrow of patients during the
chemotherapy accumulation of young (blast) forms of hemopoietic cells occurs and what is
especially important, their differentiation to functionally competent forms is enhanced.
Thus under the conditions of the chemotherapy stimulation of the bone marrow
hemopoietic cells differentiation especially of granulocytic lineage cells, and preventing the
growth of apoptosis are those mechanisms that underlie the protective effect of Dicarbamine.
Example 11. The efficacy of Dicarbamine in respect to reducing hematological toxicity of
the chemotherapy in ovarian cancer
The effect of Dicarbamine was studies in 13 patients with stage III-IV ovarian cancer
who underwent 77 courses of the chemotherapy according to the scheme: 400 mg/m
Carboplatin i.v. drop-wise, once + 600 mg/m2 Cyclophosphan i.v. drop-wise, once; the courses
were repeated in 28 days. Dicarbamine was prescribed daily at dose 100 mg orally after meals
beginning 5 days prior to the first course and then for three weeks. Dosing duration was 26 days,
course dose being 2600 mg. Dicarbamine was given again 5 days prior to second the
chemotherapy course and dosing was continued for 21 days. Total duration of Dicarbamine
intake during two the chemotherapy courses was 52 days.
Hematological toxicity (leukopenia, neutropenia, thrombocytopenia) was assessed in 13
patients who received 77 courses of the chemotherapy with Dicarbamine as compared with the
group of 7 patients who received 25-27 courses of the chemotherapy without Dicarbamibne
(control).
Hemopoiesis parameters were assessed dynamically many times before and after
conducted the chemotherapy (control) as well as dynamically before and after Dicarbamine
dosing in the test group. Below hemopoiesis parameters in individual patients who received the
chemotherapy according to the indicated scheme with Dicarbamine or without it are presented.

8.1. Patients who received the chemotherapy without Dicarbamine
51 year old female, diagnosis: s:age III ovarian cancer; she received the first course of the
chemotherapy according to therapy scheme as follows: 600 mg/m2 Cyclophosphan and 400
mg/m Carboplatin once. Complete blood analysis , course 1 of the chemotherapy

The second course of therapy was delayed by 7 days because of neutropenia.
The second course of the chemotherapy according to therapy scheme was as follows: 600
mg/m Cyclophosphan + 400 mg/m Carboplatin once without Dicarbamine.
Complete blood analysis, course 2 of the chemotherapy

The third course was delayed because of neutropenia.
63 year old female, diagnosis: stage IV ovarian cancer, matastatic involvement of right
groin lymph node, ascites; she received the first course of the chemotherapy according to therapy
scheme as follows: 600 mg/m Cyclophosphan + 400 mg/m Carboplatin once, without
Dicarbamine.
Complete blood analysis, course ] of the chemotherapy




The second course of therapy was delayed for 4 days because of leuko- and neutropenia.
The second course of the chen otherapy was conducted according to therapy scheme was
as follows: 600 mg/m Cyclophosphan + 400 mg/m Carboplatin once without Dicarbamine.
Complete blood analysis, course 2 of the chemotherapy

8.2. Patients who received the chemotherapy together with Dicarbamine
51 year old female, diagnosis: stage III ovarian cancer; she received the first course of the
chemotherapy according to therapy scheme as follows: 600 mg/m Cyclophosphan and 400
mg/m2 Carboplatin at day 1 of therapy. Dicarbamine was prescribed daily at dose 100 mg
beginning 5 days prior to course 1 of the chemotherapy and then for 21 days. Period of therapy
with Dicarbamine was 26 days before course 2.
Complete blood analysis, course 1 of the chemotherapy with Dicarbamine



Course 2 of the chemotherapy was conducted in time according to the scheme of therapy
as follows: 600 mg/m2 Cyclophosphin and 400 mg/m2 Carboplatin once at day 28 after first
course of the chemotherapy was conducted + Dicarbamine. Dicarbamine was administered at
dose 100 mg 5 days prior to course 2 and then daily for 21 days. Total duration of Dicarbamine
intake (2 courses of the chemotherapy) was 52 days.
Complete blood analysis, course 2 of the chemotherapy

75 year old female, diagnosis stage III ovarian cancer, ascites; she received the
chemotherapy with Dicarbamine according to therapy scheme as follows: 600 mg/m
Cyclophosphan and 400 mg/m2 Carboplatin at day 1 of therapy. Dicarbamme was prescribed at
dose 100 mg daily beginning 5 days prior to course 1 of CT and then for 21 days. Period of
therapy with Dicarbamine was 26 days before course 2.
Complete blood analysis, course of the chemotherapy with Dicarbamine




Course 2 of the chemotherapy was conducted in time according to the scheme of therapy
as follows: 600 mg/m2 Cyclophosphan and 400 mg/m2 Carboplatin once at day 28 after the first
course of the chemotherapy was conducted + Dicarbamine. Dicarbamine was administered at
dose 100 mg 5 days prior to course 2 and then daily for 21 days. Total duration of Dicarbamine
intake (2 courses of the chemotherapy) was 52 days.
Complete blood analysis, course 2 of the chemotherapy

65 year old female, diagnosis: stage IV ovarian cancer, ascites, metastatic involvement of
the umbilical region; she received the chemotherapy with Dicarbamine according to therapy
scheme as follows: 600 mg/m2 Cyclophosphan and 400 mg/m2 Carboplatin at day 1 of therapy.
Dicarbamine was prescribed at dose 100 mg daily beginning 5 days prior to course 1 of CT and
then for 21 days. Period of therapy with Dicarbamine was 26 days before course 2.
Complete blood analvsis, course 1 of the chemotherany with Dicarbamine



Course 2 of the chemotherapy was conducted in time according to the scheme of therapy
as follows: 600 mg/m2 Cyclophosphan and 400 mg/m2 Carboplatin once at day 28 after the first
course of the chemotherapy was conducted + Dicarbamine. Dicarbamine was administered at
dose 100 mg 5 days prior to course 2 and then daily for 21 days. Total duration of Dicarbamine
intake (2 courses of the chemotherapy) was 52 days.
Complete blood analysis, course 2 of the chemotherapy

8.3. Comparative data on hematological toxicity in patients who received the
chemotherapy and those who received or not received Discarbamine are shown in Table 16 and

Table 16.
Number (%) of patients with hematological toxicity who received the chemotherapy without
Dicarbamine



Table 17.
Number (%) of patients with hematoi ogical to?dcity who received the chemotherapy with
Dicarbamine

The data obtained show that the limiting hematological toxicity of stage III-IV without
use of Dicarbamine (table 16) achieves on the basis of leukopenia over 23.0%, on the basis of
neutropenia 42.3% and by thrombocytopenia 20.0°/!).
In the group of patients who recei ved Dicarbamine the occurrence rate of leuko-, neutro-
and thrombocytopenia was significantly lower (Table 17). Hematological toxicity on the basis of
leukopenia lowered down to 12.9%, i.e. 1.8-fold, on the basis of neutropenia 2.6-fold and on the
basis of thrombocytopenia 2.2-fold. Thus the use Dicarbamine resulted in reducing all the listed
kinds of hematological toxicity.
Below the data are presented supporting the fact that administration of Dicarbamine does

not lower therapy efficacy with cytostatic agents but on the contrary enhances to some extent the
effect achieved.
Efficacy of therapy was assessed in groups of patients following two courses of the
chemotherapy with or without Dicarbamine according to the above described scheme. Efficacy
was assessed according to the generally accepted parameters: CR - complete remission, PR -
partial remission, SB - stabilization; and Progr. - progression.
The data obtained are presented in Table 18.
Table 18.
Efficacy of treating patients according to scheme Cyclophosphane + Carboplatin with
Dicarbamine

The data presented show that in the group of patients who received the chemotherapy
without Dicarbamine, tumor growth control (CR+PR) amounts to 49.9%. In the group of
patients who received the chemotherapy with Dicarbamine efficacy of therapy is 73.2%.
Thus the use of Dicarbamine in treating patients who receive the chemotherapy results in
reducing main kinds of hematological toxicity without decrease in the efficacy of therapy.
The testal and clinical data presented above evidently prove the efficacy of peptide
derivatives of general formula (I) as non-specific inductors of differentiation that when using
peptide derivatives together with myelosuppressive the chemotherapy is showed by reducing the
degree and number of neutropenias and in use alone results in growth stabilization of murine
hemoblastosis, of differentiating murine and human melanoma including the case of absent
efficacy of the chemotherapy.
The effect of peptide derivatives of general formula (I) on tumor growth was shown to be
associated with delay of proliferation activity of tumor cells and raised degree of differentiation
in particular melanin synthesizing capability of melanoma cells and differentiation induction of
Friend erythroblastosis precursor cells.
Clinical investigations revealed the properties of peptide derivatives of general formula
(I) to significantly lower hematologica toxicity in treating cancer patients using different
schemes of combined the chemotherapy. Thus when treating patients suffering from ovarian
cancer with platinum preparations (Cyclophosphane) along with peptide derivatives, the degree

of limiting neutropenia and thrombocytopenia lowered 2-3-fold. At the same time efficacy of
therapy did not lower.











WE CLAIM:
1. A combination comprising peptide derivatives and a cytostatic preparation for
reducing hematotoxicity of the cytostatic preparation wherein the peptide derivatives are of
general formula (I)

and wherein R1 is C1-C3 hydrocarbon radical substituted by a functional group selected from
amino, C1-C5 amido- or carboxylic groups, carboxylic group being optionally esterified and
amino group being optionally substituted by acyl substituent; or C1-C3 hydrocarbon radical
simultaneously substituted by amino group, amino group being optionally substituted by acyl
substituent and carboxylic group, carboxylic group being optionally included in C5-C6
membered cyclic imide including N terminal amino group or -NH- group of_CONH- group; or
C1-C3 hydrocarbon radical substituted by 5-6-membered unsaturated heterocyclic group,
hydrocarbon radical can simultaneously comprises amino group ptionally substituted by acyl
substituent; or
R1 is saturated heterocyclic group;
R2 is hydrogen atom or a functional group selected from carboxyl, that can be esterified;
R3 is 5-6-membered saturated or unsaturated cyclic or heterocyclic group, or amino- or carboxyl
group, carboxyl group being optionally be esterified;
n=0-4,m=l-4,k=0-l;
or pharmaceutically acceptable salts thereof.
2. A combination comp ising of the peptide derivatives of general formula (I)

wherein R1 is C1-C3 hydrocarbon radical substituted by a functional group selected from amino,
C1-C5 amido- or carboxylic groups, carboxylic group being optionally esterified and amino group
being optionally substituted by acy substituent; or C1-C3 hydrocarbon radical simultaneously
substituted by amino group, amino group being optionally substituted by acyl substituent and
carboxylic group, carboxylic group being optionally included in C5-C6 membered cyclic imide
including N-terminal amino group or -NH- group of -CONH- group; or C1-C3 hydrocarbon

radical substituted by 5-6-membered unsaturated heterocyclic group, hydrocarbon radical can
simultaneously comprises amino group ptionally substituted by acyl substituent; or
R1 is saturated heterocyclic group;
R2 is hydrogen atom or a functional group selected from carboxyl, that can be esterified;
R= is 5-6-membered saturated or unsaturated cyclic or heterocyclic group, or amino- or carboxyl
group, carboxyl group being optionally be esterified;
n=0-4,m=l-4,k=0-l;
or pharmaceutically acceptable salts thereof with the cytostatic preparation for stabilizing
growth of melanoma and hemoblastosis.
3. A combination comprising of the peptide derivatives of general formula (I)

wherein R1 is C1-C3 hydrocarbon racical substituted by a functional group selected from amino,
C1-C5 amido- or carboxylic groups, carboxylic group being optionally esterified and amino group
being optionally substituted by acyl substituent; or C1-C3 hydrocarbon radical simultaneously
substituted by amino group, amino group being optionally substituted by acyl substituent and
carboxylic group, carboxylic group being optionally included in C5-C6 membered cyclic imide
including N-terminal amino group or -NH- group of -CONH- group; or C1-C3 hydrocarbon
radical substituted by 5-6-membered unsaturated heterocyclic group, hydrocarbon radical can
simultaneously comprises amino group ptionally substituted by acyl substituent; or
R1 is saturated heterocyclic group;
R2 is hydrogen atom or a functional group selected from carboxyl, that can be esterified;
R3 is 5-6-membered saturated or unsaturated cyclic or heterocyclic group, or amino- or carboxyl
group, carboxyl group being optional y be esterified;
n=0-4,m=l-4,k=0-l;
or pharmaceutically acceptable salts thereof with interferon for enhancing efficacy of
immunotherapy.
4. A combination as claimed in any one of claims 1-3 wherein R1 = NH2CH2-,
HOOC-CH2-, CH3CONH-CH2, CH3OCO-CH2-,


5. A combination as claimed in any one of claims 1-3, wherein the peptide
derivative is compound of the formula

The invention relates to the induction method for
cell differentiation which consists in injecting peptide derivatives
having the following general formula (I): and used as a
differentiation-inducing factor. Said peptide derivatives are used
for curing oncological diseases, in particular for stabilising
melanoma growth, increasing the efficiency of melanoma
immunotherapy and reducing haematological toxicity of
chemotherapy. The utilisation of said peptide derivatives is also
disclosed.

Documents:

1395-KOLNP-2004-CORRESPONDENCE.pdf

1395-KOLNP-2004-FORM 27 1.1.pdf

1395-KOLNP-2004-FORM 27.pdf

1395-KOLNP-2004-FORM-27.pdf

1395-kolnp-2004-granted-abstract.pdf

1395-kolnp-2004-granted-assignment.pdf

1395-kolnp-2004-granted-claims.pdf

1395-kolnp-2004-granted-correspondence.pdf

1395-kolnp-2004-granted-description (complete).pdf

1395-kolnp-2004-granted-examination report.pdf

1395-kolnp-2004-granted-form 1.pdf

1395-kolnp-2004-granted-form 13.pdf

1395-kolnp-2004-granted-form 18.pdf

1395-kolnp-2004-granted-form 3.pdf

1395-kolnp-2004-granted-form 5.pdf

1395-kolnp-2004-granted-form 6.pdf

1395-kolnp-2004-granted-gpa.pdf

1395-kolnp-2004-granted-pa.pdf

1395-kolnp-2004-granted-reply to examination report.pdf

1395-kolnp-2004-granted-specification.pdf


Patent Number 230155
Indian Patent Application Number 1395/KOLNP/2004
PG Journal Number 09/2009
Publication Date 27-Feb-2009
Grant Date 25-Feb-2009
Date of Filing 21-Sep-2004
Name of Patentee OBSCHESTVO S OGRANICHENNOI OTVETSTVENNOSTIYU "PHARMENTERPRISES"
Applicant Address 117571 MOSCOW, PROSPEKT VERNADSKOGO 86, STROENIE 5
Inventors:
# Inventor's Name Inventor's Address
1 NEBOLSIN VLADIMIR EVGENIEVICH 113648, MOSCOW, SEVERNOE CHERTANOVO, D.4, KORP. 403, KV. 249
2 GORBUNOVA VERA ANDREEVNA RUSSIA 103045, MOACOW, DAEV PER., D.3, KV.11
3 TRESCHALIN IVAN DMITRIEVICH RUSSIA 115446, MOSCOW, UL. AK. MILLIONSCHIKOVA, D.18, KV.394
4 RAIKHLIN NATAN TANFELEVICH RUSSIA 115522, MOSCOW, KASHIRSKOE SHOSSE, D.28, KORP.1, KV.21
5 GARIN AVGUST MIKHAILOVICH RUSSIA 115522, MOSCOW, KASHIRSKOE SHOSSE, D.28, KORP.1, KV.5
6 BYCHKOV MARK BORISOVICH RUSSIA 117571, MOSCOW, PR. VERNADSKOGO, D.119, KV. 25
7 TRESCHALINA ELENA MIKHAILOVNA RUSSIA 115446, UL. AK. MILLIONSCHIKOVA, D.18, KV.394
8 ZHELTUKHINA GALINA ALEXANDROVNA RUSSIA 129344, MOSCOW, UL. ISKRY, D.13, KORP.1, KV.292
PCT International Classification Number A61K 38/00
PCT International Application Number PCT/RU2003/00072
PCT International Filing date 2003-02-28
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 2002105392 2002-02-28 Russia