Drug – bio-affecting and body treating compositions – Designated organic active ingredient containing – Radical -xh acid – or anhydride – acid halide or salt thereof...
Reexamination Certificate
2001-04-09
2002-12-10
Richter, Johann (Department: 1621)
Drug, bio-affecting and body treating compositions
Designated organic active ingredient containing
Radical -xh acid, or anhydride, acid halide or salt thereof...
C514S563000, C514S569000, C514S576000, C514S577000, C562S460000, C562S462000, C562S463000, C562S465000, C562S472000, C562S474000, C562S475000, C560S170000, C560S171000
Reexamination Certificate
active
06492424
ABSTRACT:
FIELD OF THE INVENTION
This invention relates to novel compounds that are liver-selective glucocorticoid receptor antagonists and liver-selective thyroid receptor agonists, to methods of preparing such compounds, and to methods for using such compounds in the regulation of metabolism, especially lowering serum glucose and low density lipoprotein levels.
BACKGROUND OF THE INVENTION
Glucocorticoid Receptor Antagonists
A major problem with both Type 2 and Type 1 diabetes is that there is excessive and inappropriate production of glucose by the liver. This abnormality is the primary cause of fasting hyperglycemia and occurs in addition to defects in regulation of insulin release and in peripheral sensitivity to insulin. Thus, agents that decrease liver glucose production would be beneficial for treating both Type 2 and also Type 1 diabetes.
Intensive treatment of the hyperglycemia of Type 1 diabetes mellitus has been shown markedly to decrease the development of ocular renal and neuropathic complications, and there is evidence that intensive treatment is also beneficial for Type 2 diabetes. The available data also indicate that most patients are currently not receiving ideal and state-of-the-art treatment for either Type 2 or Type 1 diabetes. This inadequacy exists in spite of the availability of several different types of preparations of insulin for treatment of both Type 2 and Type 1 diabetes, and of a number of additional modalities, including agents that stimulate insulin release (e.g., sulfonylureas), influence liver glucose production (e.g., metformin), affect the sensitivity to insulin (e.g., troglitazone) and glucose absorption (e.g., &agr;-glucosidase inhibitors). In spite of the availability of several different orally-active agents that lower blood glucose levels. many patients with Type 2 diabetes also require insulin for control of their blood sugar levels. Overall, insulin usage in Type 2 diabetes exceeds that for Type 1 diabetes, and there is general agreement that there is a need for additional orally-active agents to treat Type 2 diabetes.
The glucocorticoid secretions of the adrenal gland (dominantly cortisol in humans) were so named because of their ability to regulate glucose metabolism. These steroids stimulate the production of glucose in the liver by promoting gluconeogenesis, which is the biosynthesis of new glucose (i.e. not glucose from glycogen). Thus, in glucocorticoid insufficiency there is a tendency to hypoglycemia, with decreased liver glucose production. Further development of Addison's disease in the diabetic patient generally leads to lowered glucose levels. Conversely, glucocorticoid excess can provoke frank diabetes in individuals with latent diabetes mellitus, and generally aggravates glycemic control in established diabetic patients. Similar influences have been observed in various animal models.
The increased glucose production in response to glucocorticoids is due to effects on a number of proteins. Important among these are effects on various transaminases that convert amino acids to glucose precursors, and induction of glucose-6 phosphatase and phosphoenolpyruvate carboxy-kinase (PEPCK). Even a modest increase of PEPCK, as obtained in transgenic mice, gives rise to hyperglycemia. In mice with Type 2 diabetes and increased levels of corticosterone (the endogenous glucocorticoid of that species) there is increased expression of PEPCK. This over expression of PEPCK can be repressed by treatment with the known GR antagonist RU486 with a concomitant decrease in the hyperglycemia.
The considerations outlined above indicate that if the action of endogenous glucocorticoids on liver glucose production could be blocked in a specific manner, glycemic control could be improved for the benefit of the diabetic patients. However, to date, all means to block glucocorticoid action have been general. Thus, adrenalectomy leaves the patient with frank adrenal insufficiency and the problems of Addison's disease. Blockade of adrenal steroid production, for example by metyrapone, or of glucocorticoid action, for example with RU486, is ordinarily of limited duration of effectiveness and when it is effective also results in generalized adrenal insufficiency. Long term compensatory ACTH hypersecretion and increased cortisol release that override the block generally overcome these treatments. By contrast, a liver-specific GR antagonist would not have these problems, should counteract the increased liver glucose production in diabetes mellitus, and should be useful for treatment of Type 2 diabetes.
A liver selective GR antagonist offers a number of advantages. First, it should decrease liver glucose production. This action will have a significant effect on glycemic control. In fact, excessive liver glucose production can be the major defect in Type 2 diabetes. Secondly, such a drug should enhance insulin sensitivity because of the overall improvement in the metabolic milieu and the amelioration of the hyperglycemia-induced defects in insulin action and secretion. The decreased demand on &bgr;-cell secretion, as a result of a reduction in glycemia, would retard the progressive &bgr;-cell dysfunction characteristic of Type 2 diabetes. Another advantage of GR antagonist treatment compared with sulfonylurea or insulin treatment is that the patient would run a lower risk of hypoglycemia.
Previous efforts to block glucocorticoid action in diabetes have been hampered by the fact that any compounds used would generally block glucocorticoid action in all tissues and would lead to the potential problems of glucocorticoid insufficiency, such as hypotension, shock, and ultimately death if the organism were exposed to sufficiently-strong stress conditions. In contrast, a liver-selective GR-antagonist with minimal effects outside the liver could be used as a front-line therapy for Type 2 diabetes, or could be used in conjunction with other existing therapies.
Thyroid Hormone Receptor Antagonists
Thyroid hormones affect the metabolism of virtually every cell of the body. At normal levels. these hormones maintain body weight, the metabolic rate, body temperature, and mood, and influence serum low density lipoprotein (LDL) levels. Thus, in hypothyroidism there is weight gain, high levels of LDL cholesterol, and depression. In excess with hyperthyroidism, these hormones lead to weight loss, hypermetabolism, lowering of serum LDL levels, cardiac arrhythmias, heart failure, muscle weakness, bone loss in postmenopausal women, and anxiety.
Thyroid hormones are currently used primarily as replacement therapy for patients with hypothyroidism. Therapy with L-thyroxine returns metabolic functions to normal and can easily be monitored with routine serum measurements of levels of thyroid-stimulating hormone (TSH), thyroxine (3,5,3′, 5′-tetraiodo-L-thyronine, or T
4
) and triiodothyronine (3,5,3′-triiodo-L-thyronine, or T
3
). However, certain of the deleterious effects of thyroid hormones limit the rapidity with which replacement therapy can be given and in some circumstances, particularly in older individuals, even completely exclude replacement therapy.
In addition, some effects of thyroid hormones may be therapeutically useful in non-thyroid disorders if adverse effects can be minimized or eliminated. These potentially-useful influences include weight reduction, lowering of serum LDL levels, amelioration of depression and stimulation of bone formation. Prior attempts to utilize thyroid hormones pharmacologically to treat these disorders have been limited by manifestations of hyperthyroidism, and in particular by cardiovascular toxicity.
Development of liver specific and selective thyroid hormone receptor agonists could lead to specific therapies for lowering of serum LDL levels while avoiding the cardiovascular and other toxicities of native thyroid hormones. Tissue-selective thyroid hormone agonist may be obtained by selective tissue uptake or extrusion, topical or local delivery, targeting to cells through other ligands attached to the agonist.
DESCRIPTION OF
Apelqvist Theresa
Goede Patrick
Holmgren Erik
Garabedian Todd E.
Karo Bio AB
Richter Johann
Wiggin & Dana LLP
Zucker Paul A.
LandOfFree
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