Drug – bio-affecting and body treating compositions – Designated organic active ingredient containing – Heterocyclic carbon compounds containing a hetero ring...
Reexamination Certificate
2001-05-31
2001-12-25
Ramsuer, Robert W. (Department: 1626)
Drug, bio-affecting and body treating compositions
Designated organic active ingredient containing
Heterocyclic carbon compounds containing a hetero ring...
C514S227800, C514S235800, C514S341000
Reexamination Certificate
active
06333325
ABSTRACT:
TECHNICAL FIELD OF THE INVENTION
This invention relates to methods of treating certain cytokine mediated diseases or conditions using novel aromatic heterocyclic compounds of the formula(I) wherein Ar
1
, Ar
2
,L,Q and X are described herein:
BACKGROUND OF THE INVENTION
Tumor necrosis factor (TNF) and interleukin-1 (IL-1) are important biological entities collectively referred to as proinflammatory cytokines. These, along with several other related molecules, mediate the inflammatory response associated with the immunological recognition of infectious agents. The inflammatory response plays an important role in limiting and controlling pathogenic infections.
Elevated levels of proinflammatory cytokines are also associated with a number of diseases of autoimmunity such as toxic shock syndrome, rheumatoid arthritis, osteoarthritis, diabetes and inflammatory bowel disease (Dinarello, C. A. et al., 1984,
Rev. Infect. Disease
6:51). In these diseases, chronic elevation of inflammation exacerbates or causes much of the pathophysiology observed. For example, rheumatoid synovial tissue becomes invaded with inflammatory cells that result in destruction to cartilage and bone (Koch, A. E., et al., 1995,
J. Invest. Med.
43: 28-38). An important and accepted therapeutic approach for potential drug intervention in these diseases is the reduction of proinflammatory cytokines such as TNF (also referred to in its secreted cell-free form termed TNF&agr;) and IL-1&bgr;. A number of anti-cytokine therapies are currently in clinical trials. Efficacy has been demonstrated with monoclonal antibody directed against TNF&agr; in a number of autoimmune diseases (Heath, P., “CDP571: An Engineered Human IgG4 Anti-TNF&agr; Antibody” IBC Meeting on Cytokine Antagonists, Philadelphia, Pa., April 24-5, 1997). These include the treatment of rheumatoid arthritis, Crohn's disease and ulcerative colitis (Rankin E. C. C., et al., 1997,
British J. Rheum.
35: 334-342 and Stack, W. A., et al. 1997,
Lancet
349: 521-524). The monoclonal antibody is thought to function by binding to both soluble TNF&agr; and to membrane bound TNF.
A soluble TNF&agr; receptor has been engineered that interacts with TNF&agr;. The approach is similar to that described above for monoclonal antibodies directed against TNF&agr;; both agents bind to soluble TNF&agr;, thus reducing its concentration. One version of this construct, called Enbrel (Immunex, Seattle, Wash.) recently demonstrated efficacy in a Phase III clinical trial for the treatment of rheumatoid arthritis (Brower et al., 1997,
Nature Biotechnology
15: 1240). Another version of the TNF&agr; receptor, Ro 45-2081 (Hoffman-LaRoche Inc., Nutley, N.J.) has demonstrated efficacy in various animal models of allergic lung inflammation and acute lung injury. Ro 45-2081 is a recombinant chimeric molecule constructed from the soluble 55 kDa human TNF receptor fused to the hinge region of the heavy chain IgG1 gene and expressed in eukaryotic cells (Renzetti, et al., 1997,
Inflamm. Res.
46: S143). IL-1 has been implicated as an immunological effector molecule in a large number of disease processes. IL-1 receptor antagonist (IL-1ra) had been examined in human clinical trials. Efficacy has been demonstrated for the treatment of rheumatoid arthritis (Antril, Amgen). In a phase III human clinical trial IL-1ra reduced the mortality rate in patients with septic shock syndrome (Dinarello, 1995,
Nutrution
11, 492). Osteoarthritis is a slow progressive disease characterized by destruction of the articular cartilage. IL-1 is detected in synovial fluid and in the cartilage matrix of osteoarthritic joints. Antagonists of IL-1 have been shown to diminish the degradation of cartilage matrix components in a variety of experimental models of arthritis (Chevalier, 1997,
Biomed Pharmacother.
51, 58). Nitric oxide (NO) is a mediator of cardiovascular homeostatis, neurotransmission and immune function; recently it has been shown to have important effects in the modulation of bone remodeling. Cytokines such as IL-1 and TNF are potent stimulators of NO production. NO is an important regulatory molecule in bone with effects on cells of the osteoblast and osteoclast lineage (Evans, et al., 1996,
J Bone Miner Res.
11, 300). The promotion of beta-cell destruction leading to insulin dependent diabetes mellitis shows dependence on IL-1. Some of this damage may be mediated through other effectors such as prostaglandins and thromboxanes. IL-1 can effect this process by controlling the level of both cyclooxygenase II and inducible nitric oxide synthetase expression (McDaniel et al., 1996,
Proc Soc Exp Biol Med.
211, 24).
Inhibitors of cytokine production are expected to block inducible cyclooxygenase (COX-2) expression. COX-2 expression has been shown to be increased by cytokines and it is believed to be the isoform of cyclooxygenase responsible for inflammation (M. K. O'Banion et al.,
Proc. Natl. Acad. Sci. U.S.A.,
1992, 89, 4888). Accordingly, inhibitors of cytokines such as IL-1 would be expected to exhibit efficacy against those disorders currently treated with COX inhibitors such as the familiar NSAIDs. These disorders include acute and chronic pain as well as symptoms of inflammation and cardiovascular disease.
Elevation of several cytokines have been demonstrated during active inflammatory bowel disease (IBD). A mucosal imbalance of intestinal IL-1 and IL-1ra is present in patients with IBD. Insufficient production of endogenous IL-1ra may contribute to the pathogenesis of IBD (Cominelli, et al., 1996,
Ailment Pharmacol Ther.
10, 49). Alzheimer disease is characterized by the presence of beta-amyloid protein deposits, neurofibrillary tangles and cholinergic dysfunction throughout the hippocampal region. The structural and metabolic damage found in Alzheimer disease is possibly due to a sustained elevation of IL-1 (Holden, et al., 1995,
Med Hypootheses
45, 559). A role for IL-1 in the pathogenic of human immunodeficiency virus (HIV) has been identified. IL-1ra showed a clear relationship to acute inflammatory events as well as to the different disease stages in the pathophysiology of HIV infection (Kreuzer, et al., 1997,
Clin Exp Immunol.
109, 54). IL-1 and TNF are both involved in periodontal disease. The destructive process associated with periodontal disease may be due to a disregulation of both IL-1 and TNF (Howells, 1995,
Oral Dis.
1, 266).
Proinflammatory cytokines such as TNF&agr; and IL-1&bgr; are also important mediators of septic shock and associated cardiopulmonary dysfunction, acute respiratory distress syndrome (ARDS) and multiple organ failure. TNF&agr; has also been implicated in cachexia and muscle degradation, associated with HIV infection (Lahdiverta et al., 1988,
Amer. J. Med.,
85, 289). Obesity is associated with an increase incidence of infection, diabetes and cardiovascular disease. Abnormalities in TNF&agr; expression have been noted for each of the above conditions (Loffreda, et al., 1998,
FASEB J.
12, 57). It has been proposed that elevated levels of TNF&agr; are involved in other eating related disorders such as anorexia and bulimia nervosa. Pathophysiological parallels are drawn between anorexia nervosa and cancer cachexia (Holden, et al., 1996,
Med Hypotheses
47, 423). An inhibitor of TNF&agr; production, HU-211, was shown to improve the outcome of closed brain injury in an experimental model (Shohami, et al., 1997,
J Neuroimmunol.
72, 169). Atherosclerosis is known to have an inflammatory component and cytokines such as IL-1 and TNF have been suggested to promote the disease. In an animal model an IL-1 receptor antagonist wash shown to inhibit fatty streak formation (Elhage et al., 1988,
Circulation,
97, 242).
The abnormal expression of inducible nitric oxide synthetase (iNOS) has been associated with hypertension in the spontaneously hypertensive rat (Chou et al., 1998,
Hypertension,
31, 643). IL-1 has a role in the expression of iNOS and therefore may also have a role in the pathogenesis of hypertension (Singh et al., 1996,
Amer. J.
Cirillo Pier F.
Gilmore Thomas A.
Hickey Eugene R.
Regan John R.
Zhang Lin-Hua
Boehringer Ingelheim Pharmaceuticals Inc.
Bottino Anthony P.
Ramsuer Robert W.
Raymond Robert P.
Stempel Alan R.
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