Wow. This is big!
Here some exciting excerpts from the patent:
NO's function in the body:
"Nitric oxide (NO) is a neurotransmitter with impact on cognitive function, and with important effects on vasodilalation thus regulating blood flow, also regulating smooth muscle tone in gastrointestinal and urogenital tracts, affecting platelet aggregation and cardiac contractility, and also skeletal muscle. NO has important functions in adequate recovery sleep, and affects sensory hypersensitivity through voltage-gated potassium channels. Thus, a compromised NO system may add to many characteristic symptoms in ME/CFS patients such as cognitive disturbances, sleep problems, and hypersensitivity to stimuli such as light, noise, smell, touch, and pain. Also, disturbance in NO metabolism may explain the lower anaerobic threshold seen in ME/CFS patients, and the inhibited mitochondrial function. Several studies have shown increased lactate in the cerebrospinal fluid in ME/CFS patients (Shungu DC et al., 2012, NMR Biomed 25:1073-1087) and a strong correlation between brainstem grey matter volume and pulse pressure suggested an impaired cerebrovascular autoregulation, findings that may be ascribed to dysregulated nitric oxide. Nitric oxide also impacts on immune cells."
Experimental treatment with NO:
"In particular, the present inventors recognized that an immediate relief after administration of an NO donor can be observed. In contrast to medication administered so far for treatment of CFS, which are characterized by a remarkable lag time of treatment success, as described for example for the treatment with Rituximab or Methotrexate, see e.g. WO 2009/083602. Thus, the administration of a NO donor surprisingly allow a treatment of CFS patients for immediate relief of symptoms without any delay as described for e.g. a B-cell depleting agent, like Rituximab, before. An alternative strategy was applied, using supplement with relatively high doses of L-Arginine 5 g twice daily combined with L-Citrulline 200 mg twice daily. L-Arginine is the sole substrate of Nitric Oxide Synthases (NOS), thus this approach aims to overcome the dysregulated nitric oxide system in CFS/ME patients by providing relatively high doses of the substrate."
Treatment example:
"The patient was a 48 years old woman with previous thyroiditis. She had ME/CFS following mononucleosis in 1997 (33 years of age). She had a Hodgkin lymphoma stage II-A in 2003, and experienced in 2004 a transient response of her ME/CFS symptoms after chemotherapy for lymphoma relapse which has been described [Fluge O, Mella O (2009) BMC Neurol 9:28], and which later led to a pilot case series using Rituximab, also with a major but transient responses of ME/CFS symptoms for this patient. After high-dose chemotherapy with autologous stem cell support, she has been relapse-free from lymphoma since 2006. In autumn 2012, she was admitted to a local hospital with a transient ischemic attach with paresis in left side of 30 minutes duration. She had previously received radiotherapy to the mediastinum and neck as treatment for limited-stage Hodgkin lymphoma, and due to a reduced left ventricular function, her cardiologist started oral isosorbide mononitrate (Imdur®) 30 mg which she received for five days before cessation of the therapy. She had headache and some dizziness the first days, but also noticed an initial response of her ME/CFS symptoms starting within the first 24 hours. She reported a clear improvement on most ME/CFS symptoms during the next days, which she described to be remarkably alike the response she had previously experienced from 6-7 weeks after Rituximab infusion (as a pilot patient in 2007). After Imdur® treatment was stopped on day five, the symptom improvement vanished during the following two days, consistent with a direct symptomatic effect on her ME/CFS disease."
Pilot:
"After discussions with the chairman of the Regional Ethical Committee, we had approval to treat ME/CFS patients that were well-known to us, with Imdur® using low doses (15 mg) initially and then slowly increasing the doses and up to 120mg/day registering subjective symptom changes as compared to baseline, in order to gain experience to draft a protocol in a planned open-label phase-II study.
[0080] All six patients were diagnosed with ME/CFS according to Canadian criteria [Carruthers BM, et al., (2003) J Chronic Fatigue Syndr 11:7-36.] and had performed standard examinations to exclude other disease explaining their condition. Three patients had previously received Rituximab with a clinical response, but then with a later full or partial relapse of ME/CFS symptoms. One patient with very severe ME/CFS had no response to previous Rituximab treatment, and one patient with a post Giardia lamblia ME/CFS had not been given Rituximab previously."
"Observations with the pilot patients
- - Follow-up for more than 3 months.
- - Pure symptomatic effect of isosorbide mononitrate. If exaggerating to much (exercise...) some ME symptoms recur.
- - Two patients forgot to take the dose one day, with markedly symptoms same afternoon.
- - Noctural variation in one (ME symptoms in morning before drug intake, clear improvement during afternoon and
evening).
- - One with very severe ME, clear effect on all symptoms except extreme sensitivity to light.
- - Two patients with no effect after at least two weeks treatment with isosorbide mononitrate. Four out of six had a
clear symptomatic effect after using the drug more than 2 weeks."
Possible treatment scheme:
"The both components may be administered simultaneously, separately or sequentially to said subject suffering from CFS. For example, the NO donor may be administered by inhalation while the B-cell depleting agent is administered by the way of infusion. Furthermore, while the NO donor may be administered on a daily basis, the B-cell depleting agent may be administered initially in once a week over two weeks and, thereafter, in a free determined time of schedule, e.g. every second or every third month.[0075] In particular, the NO donor may be administered during the initial 4 to 12 weeks, like during the first 4 to 8 weeks of treatment, e.g. the initial 4, 5, 6, 7, 8, 9, 10, 11, 12 weeks to allow immediate relief of the symptoms of CFS while the administration at the B-cell depleting agent as defined herein allows relief to the symptoms of the subject suffering from CFS over a long time period due to the delayed effectiveness thereof."
