AU3219600A - Nitrosated and nitrosylated proton pump inhibitors, compositions and methods of use - Google Patents

Description

WO 00/50037 PCT/USOO/02524 NITROSATED AND NITROSYLA TED PROTON PUMP INHIBITORS, COMPOSITIONS AND METHODS OF USE RELATED APPLICATIONS This application claims priority to U. S. Provisional Application No. 5 60/122,111 filed February 26, 1999. FIELD OF THE INVENTION The present invention describes novel nitrosated and/or nitrosylated proton pump inhibitor compounds, and novel compositions comprising at least one proton pump inhibitor compound that is optionally substituted with at least 10 one NO and/or NO 2 group, and, optionally, at least one compound that donates, transfers or releases nitric oxide, stimulates endogenous synthesis of nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor or is a substrate for nitric oxide synthase, and/or at least one nonsteroidal antiinflammatory drug, selective COX-2 inhibitor, antacid, bismuth-containing 15 reagent, acid-degradable antibacterial compound, and mixtures thereof. The present invention also provides methods for treating and/or preventing gastrointestinal disorders; facilitating ulcer healing; decreasing the recurrence of ulcers; improving gastroprotective properties, anti-Helicobacter pylori properties or antacid properties of proton pump inhibitors; decreasing or reducing the 20 gastrointestinal toxicity associated with the use of nonsteroidal antiinflammatory compounds; treating Helicobacter pylori and viral infections. The compounds and/or compositions of the present invention can also be provided in the form of a pharmaceutical kit. BACKGROUND OF THE INVENTION 25 The proton pump, located in the apical membrane of the parietal cell, is responsible for the secretion of acid in the stomach when it is stimulated by the enzyme adenosine triphosphate (H', K*)-ATPase. Proton pump inhibitors are a class of anti-secretory compounds used in the management of gastrointestinal disorders. They suppress gastric acid secretion by the specific inhibition of the 30 (H', K-)-ATPase enzyme system at the secretory surface of the gastric parietal cell. A family of substituted benzimidazoles have been developed as specific proton pump inhibitors. Two of these compounds, omeprazole and lansoprazole, are used clinically in the United States. Structurally they contain a WO 00/50037 PCT/USOO/02524 sulfinyl group bridging between substituted benzimidazole and pyridine rings. At a neutral pH, omeprazole and lansoprazole are chemically stable, are weak bases, are lipid-soluble, and do not show any inhibitory activity. Once these compounds reach the parietal cells and diffuse into the secretory canaliculi, they 5 become protonated. The protonated compounds rearrange to form sulfenic acid and then a sulfenamide. The latter interacts covalently with sulfhydryl groups at critical sites in the extracellular (luminal) domain of the membrane spanning (H*, K*)-ATPase. Inhibition occurs when two molecules of the inhibitor are bound per molecule of the enzyme. The specificity of these proton pump 10 inhibitors arises from the selective distribution of the (H', K*)-ATPase, the acid catalyzed rearrangement of the compounds to generate the active inhibitor, and the trapping of the protonated compound and the cationic sulfenamide within the acidic canaliculi and adjacent to the target enzyme. Omeprazole and lansoprazole are typically administered orally as delay 15 release capsules. The compounds are stable at a neutral pH, but are destroyed by gastric acid. Therefore, if the integrity of the gelatin-coated capsule is destroyed in any way and the patient swallows the enteric-coated grains, the neutral pH in the mouth and the esophagus will break down the microencapsulation, and the compounds will be degraded by the gastric acid in the stomach. The delay release 20 capsules, when appropriately taken, release the omeprazole and lansoprazole after the granules leave the stomach. Despite their good anti-secretory properties, proton. pump inhibitors are not unanimously recognized as gastroprotective agents. In addition, there is a high relapse rate associated with treating gastrointestinal disorders with proton 25 pump inhibitors as they do not eliminate Helicobacter pylori (Campylobacter pylori), the bacteria responsible for peptic ulcer disease, gastric lymphoma and adenocarcinoma. U.S. Patent Nos. 5,599,794 and 5,629,305 describe the administration of proton pump inhibitors in combination with acid-degradable antibacterial compounds for the treatment of infections caused by Helicobacter 30 pylori. A variety of adverse reactions have been ascribed to proton pump inhibitors, such as omeprazole and lansoprazole, reflecting, in part, the very large number of patients who have been treated with these drugs. The incidence of 2 WO 00/50037 PCTIUSOO/02524 adverse reactions is low, and the adverse reactions are generally minor. Due to the profound reduction in gastric acidity, there tends to be an increased secretion of gastrin. Hence, patients who take therapeutic doses of omeprazole and lansoprazole have modest hypergastrinemia. Prolonged administration of high 5 doses of the drugs can cause hyperplasia of oxyntic mucosal cells. The most common side effects of proton pump inhibitors, such as omeprazole and lansoprazole, are nausea, diarrhea, abdominal colic, and central nervous system effects such as headaches and dizziness. Occasionally skin rashes and transient elevations of plasma activities of hepatic aminotransferase have 10 been reported. The drugs can also result in bacterial overgrowth in the gastrointestinal tract and the development of nosocomial pneumonia. There is a need in the art for proton pump inhibitors that have improved gastroprotective properties, decrease the recurrence of ulcers, facilitate ulcer healing and that can be used at low dosages. The present invention is directed to 15 these, as well as other, important ends. SUMMARY OF THE INVENTION The present invention provides proton pump inhibitors to which is linked at least one NO and/or NO 2 group (i.e., nitrosylated and/or nitrosated). The proton pump inhibitors can be, for example, substituted benzimidazoles and 20 substituted azabenzimidazoles, including, for example, omeprazole, pantoprazole, rabeprazole, leminoprazole, lansoprazole, timoprazole, tenatoprazole, disulprazole, esomeprazole, RO 18-5362 and IY 81149. The present invention also provides compositions comprising such compounds in a pharmaceutically acceptable carrier. 25 Another aspect of the invention provides compositions comprising at least one proton pump inhibitor, that is optionally substituted with at least one NO and/or NO 2 group (i.e., nitrosylated and/or nitrosated), and at least one compound that donates, transfers or releases nitric oxide and/or stimulates endogenous production of nitric oxide (NO) or endothelium-derived relaxing 30 factor (EDRF) in vivo and/or is a substrate for nitric oxide synthase. The present invention also provides compositions comprising such compounds in a pharmaceutically acceptable carrier. Yet another aspect of the present invention provides methods for treating 3 WO 00/50037 PCT/US00/02524 gastrointestinal disorders, methods for improving the gastroprotective properties, anti-Helicobacter properties and antacid properties of proton pump inhibitors, methods for facilitating ulcer healing and methods for decreasing the rate of recurrence of ulcers in a patient in need thereof comprising administering 5 to the patient at least one proton pump inhibitor that is substituted with at least one NO and/or NO 2 group, or by administering to the patient at least one proton pump inhibitor, that is optionally substituted with at least one NO and/or NO 2 group, and at least one compound that donates, transfers or releases nitric oxide and/or stimulates endogenous production of nitric oxide or EDRF in vivo. The 10 proton pump inhibitor, that is optionally substituted with at least one NO and/or

NO

2 group, and nitric oxide donor can be administered separately or as components of the same composition in one or more pharmaceutically acceptable carriers. The present invention also provides methods to decrease or reverse 15 gastrointestinal toxicity resulting from the administration of nonsteroidal antiinflammatory drugs (NSAIDs) and/or selective COX-2 inhibitors, and methods to facilitate ulcer healing resulting from the administration of NSAIDs and/or selective COX-2 inhibitors, in a patient in need thereof by administering the compounds and/or compositions of the present invention. The present 20 invention also provides methods to treat infections caused by Helicobacter pylori and/or viruses in patients in need thereof by administering the compounds and/or compositions of the present invention. These and other aspects of the present invention are described in detail herein. 25 BRIEF DESCRIPTION OF THE FIGURES Fig. 1 shows the gastric lesion scores of (a) vehicle alone (open bar, n=10); (b) lanzoprazole in vehicle (stripped bar, n=10); and (c) example 2 (nitrosylated lanzoprazole) in vehicle (checked bar, n=9). Lanzoprazole at 200 pmol/kg did not significantly inhibit the formation of gastric lesions relative to vehicle alone. 30 Example 2 (nitrosylated lanzoprazole) at 200 tmol/kg inhibited the formation of gastric lesions relative to vehicle alone (p<0.05) and lanzoprazole (p<0.0 5 ). DETAILED DESCRIPTION OF THE INVENTION As used throughout the disclosure, the following terms, unless otherwise 4 WO 00/50037 PCT/US0O/02524 indicated, shall be understood to have the following meanings. "Gastrointestinal disorder" refers to any disease or disorder of the upper and lower gastrointestinal tract of a patient including, for example, inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, ulcerative colitis, peptic 5 ulcers, stress ulcers, bleeding peptic ulcers, duodenal ulcers, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylori associated disease, short-bowel (anastomosis) syndrome, hypersecretory states associated with systemic mastocytosis or basophilic leukemia and hyperhistaminemia that 10 result, for example, from neurosurgery, head injury, severe body trauma or burns. "Upper gastrointestinal tract" refers to the esophagus, the stomach, the duodenum and the jejunum. "Lower gastrointestinal tract" refers to the ileum, the colon, the cecum and 15 the rectum. "Ulcers" refers to lesions of the upper gastrointestinal tract lining that are characterized by loss of tissue. Such ulcers include gastric ulcers, duodenal ulcers and gastritis. "Viral infection" refers to both RNA and DNA viral infections. The RNA 20 viral infections include, but are not limited to, orthomyxoviridae, paramyxoviridae, picornaviridae, rhabdoviridae, coronavaridae, togaviridae, bunyaviridae, arenaviridae and reteroviridae. The DNA viral infections include, but are not limited to, adenoviridae, proxviridae, papovaviridae, herpetoviridae and herpesviridae. The most preferable viral infections are those of the 25 herpetoviridae family, such as, for example, herpes simplex viruses HSV-1 and HSV-2, cytomegalovirus (CMV), herpes varicella-zoster (VZV), Epstein-Barr (EBV), HHV6, HHV7, pseudorabies and rhinotracheitis, and the like. "Proton pump inhibitor" refers to any compound that reversibly or irreversibly blocks gastric acid secretion by inhibiting the H*/K*-ATP ase enzyme 30 system at the secretory surface of the gastric parietal cell. "NSAID" refers to a nonsteroidal anti-inflammatory compound or a nonsteroidal anti-inflammatory drug. NSAIDs inhibit cyclooxygenase, the enzyme responsible for the biosyntheses of the prostaglandins and certain 5 WO 00/50037 PCTIUS00/02524 autocoid inhibitors, including inhibitors of the various isozymes of cyclooxygenase (including but not limited to cyclooxygenase-1 and -2), and as inhibitors of both cyclooxygenase and lipoxygenase. "Cyclooxygenase- 2 (COX-2) inhibitor" refers to a compound that selectively 5 inhibits the cyclooxygenase- 2 enzyme over the cyclooxygenase-1 enzyme. Preferably, the compound has a cyclooxygenase-2 IC 50 of less than about 0.5 pIM, and also has a selectivity ratio of cyclooxygenase-2 inhibition over cyclooxygenase-1 inhibition of at least 50, and more preferably of at least 100. Even more preferably, the compound has a cyclooxygenase-1

IC

50 of greater than 10 about 1 pM, and more preferably of greater than 20 pM. The compound can also inhibit the enzyme, lipoxygenase. "Patient" refers to animals, preferably mammals, more preferably humans. "Transdermal" refers to the delivery of a compound by passage through the skin and into the blood stream. 15 "Transmucosal" refers to delivery of a compound by passage of the compound through the mucosal tissue and into the blood stream. "Penetration enhancement" or "permeation enhancement" refers to an increase in the permeability of the skin or mucosal tissue to a selected pharmacologically active compound such that the rate at which the compound 20 permeates through the skin or mucosal tissue is increased. "Carriers" or "vehicles" refers to carrier materials suitable for compound administration and include any such material known in the art such as, for example, any liquid, gel, solvent, liquid diluent, solubilizer, or the like, which is non-toxic and which does not interact with any components of the composition 25 in a deleterious manner. "Nitric oxide adduct" or "NO adduct" refers to compounds and functional groups which, under physiological conditions, can donate, release and/or directly or indirectly transfer any of the three redox forms of nitrogen monoxide (NO*, NO-, NO.), such that the biological activity of the nitrogen monoxide species is 30 expressed at the intended site of action. "Nitric oxide releasing" or "nitric oxide donating" refers to methods of donating, releasing and/or directly or indirectly transferring any of the three redox forms of nitrogen monoxide (NO*, NO-, NOe), such that the biological 6 WO 00/50037 PCTIUS00/02524 activity of the nitrogen monoxide species is expressed at the intended site of action. "Nitric oxide donor" or "NO donor" refers to compounds that donate, release and/or directly or indirectly transfer a nitrogen monoxide species, and/or 5 stimulate the endogenous production of nitric oxide or endothelium-derived relaxing factor (EDRF) in vivo and/or elevate endogenous levels of nitric oxide or EDRF in vivo. "NO donor" also includes compounds that are substrates for nitric oxide synthase. "Alkyl" refers to a lower alkyl group, a haloalkyl group, an alkenyl group, 10 an alkynyl group, a bridged cycloalkyl group, a cycloalkyl group or a heterocyclic ring, as defined herein. "Lower alkyl" refers to branched or straight chain acyclic alkyl group comprising one to about ten carbon atoms (preferably one to about eight carbon atoms, more preferably one to about six carbon atoms). Exemplary lower alkyl 15 groups include methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, t-butyl, pentyl, neopentyl, iso-amyl, hexyl, octyl, and the like. "Haloalkyl" refers to a lower alkyl group, an alkenyl group, an alkynyl group, a bridged cycloalkyl group, a cycloalkyl group or a heterocyclic ring, as defined herein, to which is appended one or more halogens, as defined herein. 20 Exemplary haloalkyl groups include trifluoromethyl, chloromethyl, 2 bromobutyl, 1-bromo-2-chloro-pentyl, and the like. "Alkenyl" refers to a branched or straight chain C 2 -Cl 0 hydrocarbon (preferably a C 2 -C hydrocarbon, more preferably a C 2 -C hydrocarbon) which can comprise one or more carbon-carbon double bonds. Exemplary alkenyl groups 25 include propylenyl, buten-1-yl, isobutenyl, penten-1-yl, 2,2-methylbuten-1-yl, 3 methylbuten-1-yl, hexan-1-yl, hepten-1-yl, octen-1-yl, and the like. "Alkynyl" refers to an unsaturated acyclic C 2

CI

0 hydrocarbon (preferably a

C

2 -C hydrocarbon, more preferably a C,-C, hydrocarbon) which can comprise one or more carbon-carbon triple bonds. Exemplary alkynyl groups include ethynyl, 30 propynyl, butyn-1-yl, butyn-2-yl, pentyl-1-yl, pentyl-2-yl, 3-methylbutyn-1-yl, hexyl-1-yl, hexyl-2-yl, hexyl-3-yl, 3,3-dimethyl-butyn-1-yl, and the like. "Bridged cycloalkyl" refers to two or more cycloalkyl groups, heterocyclic groups, or a combination thereof fused via adjacent or non-adjacent atoms. 7 WO 00/50037 PCT/US00/02524 Bridged cycloalkyl groups can be unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, hydroxy, halo, carboxyl, alkylcarboxylic acid, aryl, amidyl, ester, alkylcarboxylic ester, carboxamido, alkylcarboxamido, oxo and nitro. Exemplary 5 bridged cycloalkyl groups include adamantyl, decahydronapthyl, quinuclidyl, 2,6 dioxabicyclo[3.3.0]octane, 7-oxabycyclo[ 2

.

2 .1]heptyl, 8-azabicyclo[ 3

,

2 ,l]oct-2-enyl and the like. "Cycloalkyl" refers to a saturated or unsaturated cyclic hydrocarbon comprising from about 3 to about 8 carbon atoms. Cycloalkyl groups can be 10 unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, arylamino, diarylamino, alkylarylamino, aryl, amidyl, ester, hydroxy, halo, carboxyl, alkylcarboxylic acid, alkylcarboxylic ester, carboxamido, alkylcarboxamido, oxo and nitro. Exemplary cycloalkyl groups include cyclopropyl, cyclobutyl, 15 cyclopentyl, cyclohexyl, cyclohexenyl, cyclohepta,1,3-dienyl, and the like. "Heterocyclic ring or group" refers to a saturated, unsaturated cyclic or polycyclic hydrocarbon group having about 3 to about 12 carbon atoms (preferably about 4 to about 6 carbon atoms) where 1 to about 4 carbon atoms are replaced by one or more nitrogen, oxygen and/or sulfur atoms. Sulfur maybe in the thio, 20 sulfinyl or sulfonyl oxidation state. The heterocyclic ring or group can be fused to an aromatic hydrocarbon group. Heterocyclic groups can be unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, arylamino, diarylamino, alkylarylamino, hydroxy, oxo, thial, halo, carboxyl, carboxylic ester, 25 alkylcarboxylic acid, alkylcarboxylic ester, aryl, arylcarboxylic acid, arylcarboxylic ester, amidyl, ester, carboxamido, alkylcarboxamido, arylcarboxamido, sulfonic acid, sulfonic ester, sulfonamido and nitro. Exemplary heterocyclic groups include pyrrolyl, 3-pyrrolinyl,4,5,6-trihydro-2H-pyranyl, pyridinyl, 1,4 dihydropyridinyl, pyrazolyl, triazolyl, pyrimidinyl, pyridazinyl, oxazolyl, 30 thiazolvI, imidazolyl, indolyl, thiophenyl, furanyl, tetrhydrofuranyl, tetrazolyl, 2 pyrrolinyl, 3-pyrrolinyl, pyrrolindinyl, oxazolindinyl 1,3-dioxolanyl, 2,6 dioxabicyclo{3,3,O]octanyl, 2-imidazonlinyl, imidazolindinyl, 2-pyrazolinyl, pyrazolidinyl, isoxazolyl, isothiazolyl, 1,2,3-oxadiazolyl, 1,2,3-triazolyl, 1,3,4 8 WO 00/50037 PCT/US0O/02524 thiadiazolyl, 2H-pyranyl, 4H-pyranyl, piperidinyl, 1,4-dioxanyl, morpholinyl, 1,4 dithianyl, thiomorpholinyl, pyrazinyl, piperazinyl, 1,3,5-triazinyl, 1,3,5-trithianyl, benzo(b)thiophenyl, benzimidazolyl, quinolinyl, and the like. "Heterocyclic compounds" refer to mono- and polycyclic compounds 5 comprising at least one aryl or heterocyclic ring. "Aryl" refers to a monocyclic, bicyclic, carbocyclic or heterocyclic ring system comprising one or two aromatic rings. Exemplary aryl groups include phenyl, pyridyl, napthyl, quinoyl, tetrahydronaphthyl, furanyl, indanyl, indenyl, indoyl, and the like. Aryl groups (including bicylic aryl groups) can be 10 unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, arylamino, diarylamino, alkylarylamino, hydroxy, carboxyl, carboxylic ester, alkylcarboxylic acid, alkylcarboxylic ester, aryl, arylcarboxylic acid, arylcarboxylic ester, alkylcarbonyl, arylcarbonyl, amidyl, ester, carboxamido, alkylcarboxamido, 15 carbomyl, sulfonic acid, sulfonic ester, sulfonamido and nitro. Exemplary substituted aryl groups include tetrafluorophenyl, pentafluorophenyl, sulfonamide, alkylsulfonyl, arylsulfonyl, and the like. "Alkylaryl" refers to an alkyl group, as defined herein, to which is appended an aryl group, as defined herein. Exemplary alkylaryl groups include 20 benzyl, phenylethyl, hydroxybenzyl, fluorobenzyl, fluorophenylethyl, and the like. "Arylalkyl" refers to an aryl radical, as defined herein, attached to an alkyl radical, as defined herein. "Cycloalkylalkyl" refers to a cycloalkyl radical, as defined herein, attached 25 to an alkyl radical, as defined herein. "Heterocyclicalkyl" refers to a heterocyclic ring radical, as defined herein, attached to an alkyl radical, as defined herein. "Cycloalkenyl" refers to an unsaturated cyclic hydrocarbon having about 3 to about 10 carbon atoms (preferably about 3 to about 8 carbon atoms, more 30 preferably about 3 to about 6 carbon atoms) comprising one or more carbon carbon double bonds. "Arylheterocyclic ring" refers to a bi- or tricyclic ring comprised of an aryl ring, as defined herein, appended via two adjacent carbon atoms of the aryl ring 9 WO 00/50037 PCTIUS0O/02524 to a heterocyclic ring, as defined herein. Exemplary arylheterocyclic rings include dihydroindole, 1,2,3,4-tetra-hydroquinoline, and the like. "Alkoxy" refers to R 50 0-, wherein R 50 is an alkyl group, as defined herein. Exemplary alkoxy groups include methoxy, ethoxy, t-butoxy, cyclopentyloxy, and 5 the like. "Arylalkoxy or alkoxyaryl" refers to an alkoxy group, as defined herein, to which is appended an aryl group, as defined herein. Exemplary arylalkoxy groups include benzyloxy, phenylethoxy, chlorophenylethoxy, and the like. "Alkoxyalkyl" refers to an alkoxy group, as defined herein, appended to an 10 alkyl group, as defined herein. Exemplary alkoxyalkyl groups include methoxymethyl, methoxyethyl, isopropoxymethyl, and the like. "Alkoxyhaloalkyl" refers to an alkoxy group, as defined herein, appended to a haloalkyl group, as defined herein. Exemplary alkoxyhaloalkyl groups include 4- methoxy-2-chlorobutyl and the like. 15 "Cycloalkoxy" refers to R 54 0-, wherein R 54 is a cycloalkyl group or a bridged cycloalkyl group, as defined herein. Exemplary cycloalkoxy groups include cyclopropyloxy, cyclopentyloxy, cyclohexyloxy, and the like. "Haloalkoxy" refers to a haloalkyl group, as defined herein, to which is appended an alkoxy group, as defined herein. Exemplary haloalkyl groups 20 include 1,1,1-trichloroethoxy, 2-bromobutoxy, and the like. "Hydroxy" refers to -OH. "Oxo " refers to =0. "Oxy " refers to -O~R wherein

R

77 is an organic or inorganic cation. "Organic cation" refers to a positively charged organic ion. Exemplary 25 organic cations include alkyl substituted ammonium cations, and the like. "Inorganic cation" refers to a positively charged metal ion. Exemplary inorganic cations include Group I metal cations such as for example, sodium, potassium, and the like. "Hydroxyalkyl" refers to a hydroxy group, as defined herein, appended to 30 an alkyl group, as defined herein. "Amino" refers to -NH 2 . "Nitrate" refers to -O-NO 2 "Nitrite" refers to -O-NO. 10 WO 00/50037 PCTIUSOO/02524 "Thionitrate" refers to -S-NO 2 . "Thionitrite" and "nitrosothiol" refer to -S-NO. "Nitro" refers to the group -NO2 and "nitrosated" refers to compounds that have been substituted therewith. 5 "Nitroso" refers to the group -NO and "nitrosylated" refers to compounds that have been substituted therewith. "Nitrile" and "cyano" refer to -CN. "Halogen" or "halo" refers to iodine (I), bromine (Br), chlorine (Cl), and/or fluorine (F). 10 "Alkylamino" refers to R 50 NH-, wherein R 50 is an alkyl group, as defined herein. Exemplary alkylamino groups include methylamino, ethylamino, butylamino, cyclohexylamino, and the like. "Arylamino" refers to R 5 5 NH-, wherein R 5 , is an aryl group, as defined herein. 15 "Dialkylamino" refers to R 50

R

5 2N-, wherein R, 0 and Rs 2 are each independently an alkyl group, as defined herein. Exemplary dialkylamino groups include dimethylamino, diethylamino, methyl propargylamino, and the like. "Diarylamino" refers to R 55

R

60 N-, wherein R 55 and R 60 are each 20 independently an aryl group, as defined herein. "Alkylarylamino" refers to R 5

R

55 N-, wherein R 50 is an alkyl group, as defined herein, and R 5 ,is an aryl group, as defined herein. "Aminoalkyl " refers to an amino group, an alkylamino group, a dialkylamino group, an arylamino group, a diarylamino group, an 25 alkylarylamino group or a heterocyclic ring, as defined herein, to which is appended an alkyl group, as defined herein. "Aminoaryl " refers to an amino group, an alkylamino group, a dialkylamino group, an arylamino group, a diarylamino group, an alkylarylamino group or a heterocyclic ring, as defined herein, to which is 30 appended an aryl group, as defined herein. "Thio" refers to -S-. "Sulfinyl" refers to -S(O)-. "Methanthial" refers to -C(S)-. 11 WO 00/50037 PCT/US0O/02524 "Thial" refers to =S. "Sulfonyl" refers to -S(0)2 "Sulfonic acid" refers to -S(O) 2

OR

76 , wherein R 76 is a hydrogen, an organic cation or an inorganic cation. 5 "Alkylsulfonic acid" refers to a sulfonic acid group, as defined herein, appended to an alkyl group, as defined herein. "Arylsulfonic acid" refers to an sulfonic acid group, as defined herein, appended to an aryl group, as defined herein "Sulfonic ester" refers to -S(O)2R58, wherein R 58 is an alkyl group, an aryl 10 group, an alkylaryl group or an aryl heterocyclic ring, as defined herein. "Sulfonamido" refers to -S(O) 2

-N(R

51

)(R

57 ), wherein R 51 and R, 7 are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein, and R 5 , and R 5 , when taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, 15 as defined herein. "Alkylsulfonamido" refers to a sulfonamido group, as defined herein, appended to an alkyl group, as defined herein. "Arylsulfonamido" refers to a sulfonamido group, as defined herein, appended to an aryl group, as defined herein. 20 "Sulfamoyl" refers to R 51

S(O)

2

-N(R

57 )-, wherein R 51 and R, 7 are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein, and R, and R 5 , when taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein. 25 "Alkylthio" refers to R 50 S-, wherein R 50 is an alkyl group, as defined herein. "Arylthio" refers to R5 S-, wherein R55 is an aryl group, as defined herein. "Cycloalkylthio" refers to R, 4 S-, wherein R 54 is a cycloalkyl group or a bridged cycloalkyl group, as defined herein. Exemplary cycloalkylthio groups 30 include cyclopropylthio, cyclopentylthio, cyclohexylthio, and the like. "Alkylsulfinyl" refers to R 50 -S(O)-, wherein R 50 is an alkyl group, as defined herein. "Alkylsulfonyl" refers to R 5 0

-S(O)

2 -, wherein R 50 is an alkyl group, as 12 WO 00/50037 PCTIUSOO/02524 defined herein. "Arylsulfinyl" refers to R 55 -S(O)-, wherein R 5 , is an aryl group, as defined herein. "Arylsulfonyl" refers to R 5

-S(O)

2 -, wherein R 5 , is an aryl group, as defined 5 herein. "Amidyl" refers to R 51

C(O)N(R

57 )- wherein R 5 1 and R 57 are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein. "Ester" refers to R 5 ,C(O)O- wherein R 51 is a hydrogen atom, an alkyl group, 10 an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein. "Carbamoyl" refers to -O-C(O)N(R 51

)(R

57 ), wherein Rj and R, are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group or an arylheterocyclic ring, as defined herein, or R 5 1 and R 57 taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined 15 herein. "Carboxyl" refers to -C(O)OR 7 6 , wherein R 76 is a hydrogen, an organic cation or an inorganic cation, as defined herein. "Carbonyl" refers to -C(O)-. "Alkylcarbonyl" or "alkanoyl" refers to R 50 -C(O)-, wherein R 50 is an alkyl 20 group, as defined herein. "Arylcarbonyl" or "aroyl" refers to R 55 -C(O)-, wherein R 5 is an aryl group, as defined herein. "Carboxylic ester" refers to -C(O)OR 8 , wherein R 58 is an alkyl group, an aryl group, an alkylaryl group or an aryl heterocyclic ring, as defined herein. 25 "Alkylcarboxylic acid" and "alkylcarboxyl" refer to an alkyl group, as defined herein, appended to a carboxyl group, as defined herein. "Alkylcarboxylic ester" refers to an alkyl group, as defined herein, appended to a carboxylic ester group, as defined herein. "Arylcarboxylic acid" refers to an aryl group, as defined herein, appended 30 to a carboxyl group, as defined herein. "Arylcarboxylic ester" and "arylcarboxyl" refer to an aryl group, as defined herein, appended to a carboxylic ester group, as defined herein. "Carboxamido" refers to -C(O)N(R 51

)(R

57 ), wherein R 51 and R 57 are each 13 WO 00/50037 PCTIUSOO/02524 independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group or an arylheterocyclic ring, as defined herein, and R51 and R 57 when taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein. 5 "Alkylcarboxamido" refers to an alkyl group, as defined herein, appended to a carboxamido group, as defined herein. "Arylcarboxamido" refers to an aryl group, as defined herein, appended to a carboxamido group, as defined herein. "Urea" refers to -N(R 59

)-C(O)N(R

51

)(R

57 ) wherein R 51 , R 57 , and R 59 are each 10 independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein, or R 51 and R 57 taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein. "Phosphoryl" refers to -P(R 70

)(R

71

)(R

72 ), wherein R 70 is a lone pair of 15 electrons, sulfur or oxygen, and R 71 and R 72 are each independently a covalent bond, a hydrogen, a lower alkyl, an alkoxy, an alkylamino, a hydroxy or an aryl, as defined herein. Compounds that donate, transfer or release nitric oxide species in vivo have a wide spectrum of advantages and applications. The present invention is 20 based on the discovery of the effects of such compounds together with one or more proton pump inhibitors and/or one or more proton pump inhibitors directly or indirectly linked with one or more nitric oxide moieties. Treatment or prevention of gastrointestinal disorders, improved gastroprotective properties, decreased rate of recurrence of peptic ulcers and faster ulcer healing can be 25 obtained by the use of the nitrosated and/or nitrosylated proton pump inhibitors of the present invention. Treatment or prevention of gastrointestinal disorders, improved gastroprotective properties, decreased rate of recurrence of peptic ulcers and faster ulcer healing can also be obtained by the use of one or more proton pump inhibitors, that are optionally directly or indirectly linked with one 30 or more nitric oxide moieties, in conjunction with one or more compounds that donate, release or transfer nitric oxide or stimulate endogenous production of nitric oxide or EDRF in vivo or are substrates for nitric oxide synthase. Proton pump inhibitors are compounds that selectively inhibit gastric acid 14 WO 00/50037 PCTIUSOO/02524 secretion by the specific inhibition of the (H', K+)-ATPase enzyme system at the secretory surface of the gastric parietal cell. A nitric oxide donor is a compound that contains at least one nitric oxide adduct and releases or chemically transfers a biologically active nitrogen monoxide species. 5 The compounds and compositions of the present invention are novel and can be used to treat numerous gastrointestinal diseases and disorders. Such gastrointestinal disorders include, for example, inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, ulcerative colitis, peptic ulcers, stress ulcers, bleeding peptic ulcers, duodenal ulcers, infectious enteritis, colitis, 10 diverticulitis, gastric hyperacidity, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylori associated disease, short-bowel (anastomosis) syndrome, hypersecretory states associated with systemic mastocytosis or basophilic leukemia and hyperhistaminemia that result, for example, from neurosurgery, head injury, 15 severe body trauma or burns. The compounds and compositions of the present invention can also be used as a pre-anesthetic medication in emergency operations to reduce the danger of aspiration of acidic gastric contents The proton pump inhibitors used in the compounds and compositions of the present invention can be any of those known in the art, such as those 20 exemplified herein. Omeprazole, i.e., 5-methoxy-2((4-methoxy-3,5-dimethyl-2 pyridinyl)methyl)-sulfinyl)-1H-benzimidazole, (marketed under the trade name PRILOSEC® by Astra Merck, Wayne, PA) and lansoprazole, i.e., 2-(((3-methyl-4 (2,2,2-trifluoro-ethoxy)-2-pyridinyl)methyl)sulfinyl)-1H-benzimidazole (marketed 25 under the trade name PREVACID® by TAP Pharmaceutical Inc., Deerfield, IL) are two of the most widely used compounds that inhibit gastric acid secretion. Other useful compounds include rabeprazole, i.e., 2-(((4-(3-methoxypropoxy)-3-methyl 2-pyridinyl)methyl)sulfinyl)-1H-benzimidazole (marketed under the trade name ACIPHEX* by Eisai, Inc.), pantoprazole, i.e., 5-(difluoromethoxy)-2-(((3,4 30 dimethoxy-2-pyridinyl)methyl)sulfinyl)-1H-benzimidazole, leminoprazole, timoprazole, tenatoprazole, disulprazole, esomeprazole, RO 18-5362, IY 81149. These compound do not exhibit anticholinergic or histamine H 2 -receptor antagonist properties, but suppress gastric acid secretion by the specific inhibition 15 WO 00/50037 PCT/USO0/02524 of (H*, K+)-ATPase enzyme system at the secretory surface of the gastric parietal cell. As this enzyme system is regarded as the acid (proton) pump within the parietal cell, these substituted benzimidazoles have been characterized as gastric acid-pump inhibitors as they block the final step of acid production. Although 5 the proton pump inhibitor anti-secretory agents are effective in treating gastrointestinal disorders, they do not have any gastroprotective properties and, in addition, there is a high recurrence of ulcers associated with their use. Another group of proton pump inhibitors are substituted quinolines, which include, for example, 3-butyl-4-(2-methylphenylamino)-8-(2 10 hydroxyethoxy)-quinoline. Other proton pump inhibitors are disclosed in, for example, U. S. Patent Nos. 4,045,564, 4,255,431, 4,634,710, 4,758,579, 4,806,549, 4,806,550, 4,818,760, 4,839,365, 4,845,118, 4,871,734, 4,873,337, 4,956,366, 4,981,861, 5,114,955, 5,149,702, 5,439,917, 5,554,631, 5,665,730, 5,677,302, 5,686,458, 5,703,097, 5,750,531, 5,990,311, 15 5,952,504 and 5,945,425 and in EP 0 033 094 B1, EP 0 045 200 Al, EP 0 221 041 A2, EP 0 234 485 Al, EP 0 246 774 Al, EP 0 254 588 Al, EP 0 259 174 Al and in WO 89/08104, WO 92/12969, WO 95/27714, WO 97/32854, WO 98/18784, WO 98/43968, WO 98/54172; the disclosures of each of which are incorporated by reference herein in their entirety. 20 Several of the above contemplated proton pump inhibitors are described more fully in the literature, such as in Goodman and Gilman, The Pharmacological Basis of Therapeutics (9th Edition), McGraw-Hill, pages 901-915 (1996); Merck Index on CD-ROM, Twelfth Edition, Version 12:1, (1996); STN Express, file phar and file registry, the disclosures of which are incorporated by 25 reference herein in their entirety. The proton pump inhibitors of the present invention can be nitrosated and/or nitrosylated through one or more sites such as oxygen (hydroxyl condensation), sulfur (sulfhydryl condensation), carbon and nitrogen. The proton pump inhibitor compounds that are nitrosated and/or nitrosylated in 30 accordance with the invention and/or are included in the compositions of the invention can be any of those known in the art, including those exemplified below. In one embodiment, the present invention describes nitrosated and/or 16 WO 00/50037 PCT/US00/02524 nitrosylated proton pump inhibitors of Formula (I) or a pharmaceutically acceptable salt thereof: R11

D

1

R

10 B R4 _R3

R

5 J N R1 R2 5 (I) wherein A is S, S(O), or S(0) 2 ; B is -CNR 7

R

7 ' or nitrogen; J is CH or nitrogen; 10 Ri is a hydrogen, an alkoxy group, a lower alkyl group, or an alkylthio group;

R

2 is a hydrogen, an alkoxy group, a lower alkyl group, an alkylthio group, a haloalkoxy group, an alkoxyalkyl group, -NR 7 R7, -ODI, or -SD,; or R 2 and R, taken together with the carbon chain to which they are attached form a cycloalkyl 15 ring or a heterocyclic ring; or R 2 and R 3 taken together with the carbon chain to which they are attached form a cycloalkyl ring or a heterocyclic ring;

R

3 and R 1 1 are each independently a hydrogen, an alkoxy group, a lower alkyl group, or an alkylthio group; or R 3 and R 11 taken together with the carbon chain to which they are attached form a cycloalkyl ring or a heterocyclic ring; 20 R 4 and R 5 are each independently a hydrogen, an alkyl group, a halo group, an alkoxy group, a haloalkyl group, a haloalkoxy group, a cyano group, an aryl group, a heterocyclic ring, -NR 7 R7, -OD,, or -C0 2

R

1 2 ; or R 4 and R 5 taken together are: 17 WO 00/50037 PCT/USOO/02524

H

3 C

H

3 C

R

6

H

3 C CH 3 wherein

R

6 is oxygen or N=O-R 7 ; 5 R 7 and R 7 ' are each independently hydrogen, a lower alkyl group or D; or

R

7 and R 7 ' taken together with the nitrogen to which they are attached form a heterocyclic ring; Rio is a hydrogen; or R 0 and R 1 taken together with the carbon chain to which they are attached form a cycloalkyl ring; 10 R 12 is a lower alkyl group or D; Di is a hydrogen or D; D is Q or K; Q is -NO or -NO 2 ; K is -W,-Eb-(C(Re)(Rf)),-E,-(C(Re)(Rf))x-W-(C(Re)(Rf))y-WEj-Wg-(C(Re)(Rf)), 15 T-Q; a, b, c, d, g, i and j are each independently an integer from 0 to 3; p, x, y and z are each independently an integer from 0 to 10; W at each occurrence is independently -C(O)-, -C(S)-, -T-, -(C(Re)(R))h-, an alkyl group, an aryl group, a heterocyclic ring, an arylheterocyclic ring, or 20 -(CH 2

CH

2 O)q-; E at each occurrence is independently -T-, an alkyl group, an aryl group, -(C(R,)(R,))h-, a heterocyclic ring, an arylheterocyclic ring, or -(CH 2

CH

2 O)q-; h is an integer form 1 to 10; q is an integer from 1 to 5; 25 R, and Rf are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, an alkylamino, a dialkylamino, an arylamino, a diarylamino, an alkylarylamino, an alkoxyhaloalkyl, a haloalkoxy, a sulfonic acid, a sulfonic ester, an alkylsulfonic 18 WO 00/50037 PCT/USOO/02524 acid, an arylsulfonic acid, an arylalkoxy, an alkylthio, an arylthio, a cycloalkylthio, a cycloalkenyl, a cyano, an aminoalkyl, an aminoaryl, an aryl, an arylalkyl, an alkylaryl, a carboxamido, a alkylcarboxamido, an arylcarboxamido, an amidyl, a carboxyl, a carbamoyl, an alkylcarboxylic acid, an arylcarboxylic acid, an 5 alkylcarbonyl, an arylcarbonyl, an ester, a carboxylic ester, an alkylcarboxylic ester, an arylcarboxylic ester, a haloalkoxy, a sulfonamido, an alkylsulfonamido, an arylsulfonamido, a sulfonic ester, a urea, a phosphoryl, a nitro, -T-Q , or (C(R,)(R)),-T-Q, or Re and Rf taken together with the carbons to which they are attached form a carbonyl, a methanthial, a heterocyclic ring, a cycloalkyl group or 10 a bridged cycloalkyl group; k is an integer from 1 to 3; T at each occurrence is independently a covalent bond, a carbonyl, an oxygen, -S(O).- or -N(Ra)Ri-; 15 o is an integer from 0 to 2; R, is a lone pair of electrons, a hydrogen or an alkyl group; Ri is a hydrogen, an alkyl, an aryl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, 20 an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, -CH 2 -C(T-Q)(Re)(R,), or -(N 2

O

2 )-e M*, wherein M* is an organic or inorganic cation; with the proviso that when R, is -CH 2 -C(T-Q)(R,)(Rf) or

-(N

2

O

2 )-e M-, or R, or Rf are T-Q or (C(Re)(Rf))k-T-Q, then the "-T- Q" subgroup can be a hydrogen, an alkyl, an alkoxy, an alkoxyalkyl, an aminoalkyl, a hydroxy, a 25 heterocyclic ring or an aryl group; and with the proviso that the compounds of Formula (I) must contain at least one nitrite, nitrate, thionitrite or thionitrate group. In cases where Re and Rf are a heterocyclic ring or taken together R, and Rf are a heterocyclic ring, then R, can be a substituent on any disubstituted nitrogen 30 contained within the radical where R is as defined herein. In cases where multiple designations of variables which reside in sequence are chosen as a "covalent bond" or the integer chosen is 0, the intent is to denote a single covalent bond connecting one radical to another. For example, E 0 would 19 WO 00/50037 PCT/USOO/02524 denote a covalent bond, while E 2 denotes (E-E) and (C(R,)(Rf)) 2 denotes -C(Re)(Rf)-C(R,)(Rf)-. Another embodiment of the present invention describes compounds of Formula (II) or pharmaceutically acceptable salts thereof: K N (CH2) DI 0 (R9)q 5 II wherein

R

8 is a lower alkyl group, an alkoxyalkyl group, an alkylaryl group, a cycloalkyl group, a cycloalkylalkyl group, an aryl group, an alkylaryl group, or K; 10 R 9 at each occurrence is independently a hydrogen, a lower alkyl group, an akylthio group, a halogen, a cyano group an alkanoyl group, a haloalkyl group, a carbamoyl group, -NR 7 D,, -OD 1 , or-CO2R1;

R

7 1 is a hydrogen, a lower alkyl group, an alkoxy group, or -OD,; J, K, DI, R 7 , R 12 , q and o are as defined herein; and 15 with the proviso that the compounds of Formula (II) must contain at least one nitrite, nitrate, thionitrite or thionitrate group. Another embodiment of the present invention describes compounds of Formula (III) or pharmaceutically acceptable salts thereof: 20 25 20 WO 00/50037 PCT/USOO/02524 A2-A3 A!O N R17

R

13 R14 N Y3 5 III wherein

R

13 and R 14 are each independently a hydrogen a lower alkyl group, an alkoxyalkyl, or a lower alkyl-OD,; or R 13 and R 14 taken together along with the 10 carbons to which they are attached form a cycloalkyl group or an aryl group;

R

1 7 is a hydrogen or a lower alkyl group;

Y

3 is: (a) (b) D1 S or N R 1 6 r N:

R

63 15 wherein

R

15 is a hydrogen or a lower alkyl group;

R

16 is a hydrogen, a halogen, or a lower alkyl group;

R

6 3 is a lower alkyl group or a phenyl group; Al, A2 and A 3 comprise the other subunits of a 5- or 6-membered 20 monocyclic aromatic ring and A 1 , A2 and A3 are each independently: (i) CR 0 , wherein R 0 at each occurrence is hydrogen or -OD; 21 WO 00/50037 PCT/US00/02524 (ii) N-R,, wherein R, at each occurrence is independently a covalent bond to an adjacent ring atom in order to render the ring aromatic, a hydrogen, or K; (iii) a sulfur atom; 5 (iv) an oxygen atom; or (v) Ba= Bb, wherein Ba and Bb are each independently a nitrogen atom or CR; wherein R 0 at each occurrence is hydrogen or

-OD

1 ; Di and K are as defined herein; and 10 with the proviso that the compounds of Formula (III) must contain at least one nitrite, nitrate, thionitrite or thionitrate group. Another embodiment of the present invention describes compounds of Formula (IV) or pharmaceutically acceptable salts thereof:

R

1 8 N R19 X4 15 IV wherein

RI

8 and R 19 at each occurrence are each independently a hydrogen, a lower alkyl group, a halogen, a nitro group, an alkoxy group, -OD 1 , -NR20R2, -O(O)CR 2 0, 20 -O(O)COR 20 , -O(O)CNR 2 0

R

21 , -N(R 2 0

)C(O)R

21 , -N(R 20

)C(O)NR

2 0

R

21 , or

-N(R

2 0

)C(O)OR

21 ; or Ri and R1, when taken together along with the carbons to which they are attached form a heterocyclic ring or a phenyl ring optionally substituted with up to four substituents selected from a hydrogen, a lower alkyl group, a halogen, a nitro group, an alkoxy group, -OD1, -NR20R2, -O(O)CR20, 25 -O(O)COR 20 , -O(O)CNR 20

R

21 , -N(R 20

)C(O)R

21 , -N(R 20

)C(O)NR

2 0

R

21 , or

-N(R

20

)C(O)OR

21 ;

R

2 0 and R 21 at each occurrence are each independently a hydrogen, a lower alkyl group, an aryl group, a lower alkylaryl group, or K;

X

4 is -C(=R)R 22 , a heterocyclic ring, -NR 2 0

R

21 , a halogen, an alkoxy group, 30 an arylalkoxy group, a cycloalkoxy group, a heterocyclicalkoxy group, an 22 WO 00/50037 PCT/US0O/02524 alkylsulfonyl group, an alkylsulfinyl group, an arylsulfonyl group, an arylsulfinyl group an arylalkylsulfonyl group, an arylalkylsulfinyl group, a heterocyclicsulfonyl group, or a heterocyclicsulfinyl group;

R

22 is a hydrogen, an alkyl group, an alkoxy group, an aryl group, an 5 alkylaryl group, a heterocyclic ring, an -0-heterocyclic ring, or an alkylheterocyclic ring;

D

1 , R 6 , and K are defined as herein; and with the proviso that the compounds of Formula (IV) must contain at least one nitrite, nitrate, thionitrite or thionitrate group. 10 Another embodiment of the present invention describes compounds of Formula (V) or pharmaceutically acceptable salt thereof: R24 NX5 H R23 N (O)n (R27)q (V) 15 wherein X5 is: a) R29 R23 (C) N R 31 \ N N-R3 N

R

30 R28 wherein 23 WO 00/50037 PCT/USOO/02524

R

2 3 is a hydrogen, a dialkylamino group, -NRR,', or a heterocyclic ring;

R

2 4 is a hydrogen or halogen;

R

25 is a hydrogen, -OD 1 , or lower alkyl-OD,;

R

27 at each occurrence is independently a hydrogen or an alkoxy group; 5 R 2 , R 29 , and R 30 are each independently a hydrogen, a lower alkyl group, a dialkylamino group, a heterocyclic ring, or a lower alkyl-ODI;

R

3 1 is a hydrogen, a dialkylamino group, or an alkoxy group;

R

3 3 is a hydrogen or a lower alkyl group; n is an integer from 0 to 1; 10 R 7 , R, D and q are as defined herein; and with the proviso that the compounds of Formula (V) must contain at least one nitrite, nitrate, thionitrite or thionitrate group. Another embodiment of the present invention describes compounds of Formula (VI) or pharmaceutically acceptable salts thereof: 15 /4 N A5Q 0R26

A

6 N \ R 35 D1 R 36 VI wherein A4, A, and A 6 are each independently a sulfur or CR 34 with the proviso 20 that one of A 4 , A 5 , or A 6 is a sulfur and the other two are CR 34 ;

R

34 at each occurrence is independently a hydrogen, a halogen, a cyano, a nitro, a trifluoromethyl, a lower alkyl group, a heterocyclic ring, a lower alkyl OD,, an alkoxy, a haloalkoxy, an alkylthio, an alkylsulfinyl, an alkylsulfonyl, an alkylcarbonyl, an alkoxycarbonyl, a carbamoyl, a N-alkylcarbamoyl, a N,N-di 25 alkylcarbamoyl, an ester, a cycloalkyl, an aryl, an alkylaryl, an aryloxy, an arylalkoxyoxy, an arylamino, a alkylarylamino, an arylthio, an arylsulfonyl, an arylsulfinyl, or a sulfonamido;

R

3 5 and R 3 6 are each independently a hydrogen or a lower alkyl group; or R3 and R 41 taken together with the carbon chain to which they are attached form 24 WO 00/50037 PCT/USOO/02524 a cycloalkyl ring;

R

2 6 is: (a) Z (b) R 41 R42 (C) R 41 R42 o6r \/43 X6 R43R4 N N R44

R

45 -N R44 R46 wherein 5 X 6 is nitrogen, and Y 6 is CR 3 7 ; or X 6 is CR 37 , and Y 6 is nitrogen;

R

3 7 is a hydrogen, a halogen, a lower alkyl group, a trifluoromethyl, an alkoxy group, a haloalkoxy group, an aryl group, an arylalkoxy group, a heterocyclic ring, or an aryloxy;

Z

6 is -NR 3 8 R3,, SR 4 0, or an arylalkoxy group; 10 R 3 8 and R 3 9 are each independently a hydrogen, a lower alkyl group, an aryl group, an alkylaryl group, or a cycloalkyl group; or R 38 and R 39 taken together with the nitrogen to which they are attached form a heterocyclic ring;

R

4 . is a hydrogen, a halogen, a lower alkyl group, an alkylaryl group, an alkenyl group, or a haloalkyl group; 15 R 41 , R 42 , R 4 3 , and R44 are each independently a hydrogen, a halogen, a lower alkyl group, an alkoxy group, a haloalkoxy group, an alkoxyaryl group, an alkylthio group, an alkysulfinyl group, an alkylsulfonyl group, a cyano group, -Y-OD, Y-SD 1 , -Y-NR 2 0

R

21 , -Y-O(O)CR 20 , -Y-O(O)CNR 2

R

21 , -Y-N(R 20

)C(O)R

21 , or

-Y-N(R

2 0

)S(O)

2

R

21 ; 20 Y is -(CH 2 )a- or a phenyl group;

R

4 and R 4 6 are each independently a hydrogen, a lower alkyl group, a cycloalkyl group, an alkenyl group, or an alkynyl group; D,, R 2 0 , R 21 , and a are as defined herein; and with the proviso that the compounds of Formula (VI) must contain at 25 least one nitrite, nitrate, thionitrite or thionitrate group. Another embodiment of the present invention describes compounds of Formula (VII) or pharmaceutically acceptable salts thereof: 25 WO 00/50037 PCTIUSOO/02524 D X7N R60 Y7 I-'A7 VII 5 wherein

R

60 is a lower alkyl group, an aryl group, a haloalkyl group, a lower alkyl OD, or heterocyclic ring;

A

7 is oxygen or -ND,;

X

7 is a hydrogen or a halogen; 10 Y 7 is:

R

62

R

6 1 or X 7 , A 7 , and Y 7 taken together along with the carbons to which they are attached is: 0

R

6 2 15 wherein 26 WO 00/50037 PCT/US00/02524

R

61 is a hydrogen, a halogen, a lower alkyl group, -GD 1 , or -NHC(O)O-lower alkyl;

R

6 2 is a hydrogen, a halogen, or a lower alkyl group; and Di is as defined herein. 5 Compounds of the present invention that have one or more asymmetric carbon atoms may exist as the optically pure enantiomers, pure diastereomers, mixtures of enantiomers, mixtures of diastereomers, racemic mixtures of enantiomers, diastereomeric racemates or mixtures of diastereomeric racemates. It is to be understood that the present invention anticipates and includes within 10 its scope all such isomers and mixtures thereof. It is also to be understood that the present invention is intended to include within its scope compounds which may exist in more than one resonance form and the effects that the resonance form may have on the positions at D, substituents designated in the structures described herein. 15 Another embodiment of the present invention provides processes for making the novel compounds of the present invention and to the intermediates useful in such processes. The reactions are performed in solvents appropriate to the reagents and materials used are suitable for the transformations being effected. It is understood by one skilled in the art of organic synthesis that the 20 functionality present in the molecule must be consistent with the chemical transformation proposed. This will, on occasion, necessitate judgment by the routineer as to the order of synthetic steps, protecting groups required, and deprotection conditions. Substituents on the starting materials may be incompatible with some of the reaction conditions required in some of the 25 methods described, but alternative methods and substituents compatible with the reaction conditions will be readily apparent to skilled practitioners in the art. The use of sulfur, oxygen and nitrogen protecting groups is well known in the art for protecting thiol, alcohol, and amino groups against undesirable reactions during a synthetic procedure and many such protecting groups are known and 30 described by, for example, Greene and Wuts, Protective Groups in Organic Synthesis, Third Edition, John Wiley & Sons, New York (1999). The chemical reactions described herein are generally disclosed in terms of their broadest application to the preparation of the compounds of this invention. 27 WO 00/50037 PCT/US0O/02524 Occasionally, the reactions may not be applicable as described to each compound included within the disclosed scope. The compounds for which this occurs will be readily recognized by one skilled in the art. In all such cases, either the reactions can be successfully performed by conventional modifications known to 5 one skilled in the art, e.g., by appropriate protection of interfering groups, by changing to alternative conventional reagents, by routine modification of reaction conditions, and the like, or other reactions disclosed herein or otherwise conventional, will be applicable to the preparation of the corresponding compounds of this invention. In all preparative methods, all starting materials 10 are known or readily prepared from known starting materials. The compounds of Formulas (I), (II), (III), (IV), (V), (VI) and (VII) can be synthesized by one skilled in the art following the methods and examples described herein. The synthesis of the parent proton pump inhibitors (i.e. non nitrosated and non-nitrosylated proton pump inhibitors) are disclosed in, for 15 example, U. S. Patent Nos. 4,045,564, 4,255,431, 4,634,710, 4,758,579, 4,839,365, 4,873,337, 4,981,861, 5,149,702, 5,554,631, 5,703,097 and 5,945,425 and in EP 0 045 200 Al, EP 0 221 041 A2, EP 0 246 774 Al and EP 0 254 588 Al and in WO 98/54172 for the compounds of Formula (I); and in U. S. Patent Nos. 4,806,549, 4,806,550 and 5,952,504 and in EP 0 259 174 Al and in WO 89/08104 and WO 92/12969 for the 20 compounds of Formula (II); and in U. S. Patent Nos. 5,686,458, 5,750,531 and 5,990,311 and in WO 98/18784 and WO 98/43968 for the compounds of Formula (III); and in U. S. Patent No. 5,677,302 for the compounds of Formula (IV); and in WO 97/32854 for the compounds of Formula (V); and in U. S. Patent Nos. 4,818,760, 4,845,118, 4,871,734, 4,956,366 and 5,114,955 and in EP 0 234 485 Al for 25 the compounds of Formula (VI); and in U. S. Patent Nos. 5,439,917 and 5,665,730 and in EP 0 033 094 B1 and in WO 95/27714 for the compounds of Formula (VII); the disclosures of each of which are incorporated by reference herein in their entirety. The nitrosated and nitrosylated proton pump inhibitors of the present 30 invention can be synthesized as shown in reaction Schemes 1 through 7 presented herein. The parent proton pump inhibitor compounds can be nitrosated and/or nitrosylated through one or more sites such as oxygen, sulfur, carbon and/or nitrogen using the methods described in the examples herein and 28 WO 00/50037 PCT/US0O/02524 using conventional methods known to one skilled in the art. For example, known methods for nitrosating and nitrosylating compounds are described in U.S. Patent Nos. 5,380,758 and 5,703,073; WO 97/27749; WO 98/19672; and Oae et al, Org. Prep. Proc. Int., 15(3):165-198 (1983), the disclosures of each of which are 5 incorporated by reference herein in their entirety. The methods of nitrosating and/or nitrosylating the compounds described in the examples herein and in these references can be applied by one skilled in the art to produce any of the nitrosated and/or nitrosylated proton pump inhibitors described herein. Nitroso or nitro compounds of formula (I), where X is a -ONO, -SNO, or 10 -0N0 2 group and R 1 , R 2 , R 3 , R 4 , R 5 , Rjo, R 11 , A, B, J, Re, Rf, and p are as defined herein, and a nitrite, nitrate, or thionitrite containing carbamate is representative of the D, group, as defined herein, may be prepared as shown in Scheme 1. The substituted imidazole nitrogen group of formula 1 is converted to the anion by treatment with one equivalent of a strong non-nucleophilic base, such as sodium 15 hydride or potasium hydride, in an aprotic solvent, such as tetrahydrofuran (THF) or dimethylformamide (DMF). The carbamate of formula IA, IB, or IC where p, X, Re and Rf are as defined herein, is prepared by reacting the imidazole anion with a suitably functionalized chloroformate in an inert solvent, such as THF or DMF. Typically the coupling reaction is performed at a temperature 20 ranging from -78 'C to room temperature. Preferred methods for the formation of chloroformates are reacting one equivalent of a X functionalized alcohol with one equivalent of phosgene at a temperature ranging from -78 'C to 0 0 C in an inert solvent, such as ether or THF and in the presence of an amine base, such as pyridine or triethylamine. Removal of the amine hydrochloride by filtration 25 affords a solution of the desired chloroformate which may be used directly or concentrated and redissolved in the anhydrous solution of choice prior to the coupling reaction with the imidazole anion to afford the carbamate of formula IA, IB, or IC. On occasion it might be desirable to nitrosylate the alcohol or thiol after 30 coupling a chloroformate to the imidazole anion. The chloroformate would be prepared by reacting phosgene with an alcohol containing a protected alcohol or thiol moiety. Preferred protecting groups for an alcohol moiety are silyl ethers, such as a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert 29 WO 00/50037 PCTUSOO/02524 butyldiphenylsilyl ether. After formation of the carbamate, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in 5 a suitable anhydrous solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine affords the compound of formula IA. Preferred protecting groups for the thiol moiety are as a thioester, such as a thioacetate or a thiobenzoate or as a disulfide. Deprotection of the thiol moiety (zinc in dilute aqueous acid, 10 triphenylphosphine in water and sodium borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters) followed by reaction with a suitable nitrosylating agent such, as thionyl chloride nitrite, thionyl dinitrite, a lower alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a 15 suitable anhydrous solvent, such as methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula IB. Nitrosation of the carbamate product may be accomplished by first converting the deprotected alcohol to a leaving group such as a mesylate or a tosylate. This reaction is typically performed at a 20 temperature of 0 'C to room temperature in an inert solvent, such as ether, THF, or dichloromethane with the alcohol, methansulfonyl chloride or para toluensulfonyl chloride, and an amine base, such as triethylamine or pyridine, as the reactants. The corresponding iodide is then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from 25 the alcohol by treatment of the hydroxyl moiety with a phosphorus reagent, such as triphenylphosphine, in the presence of a halide source, such as carbon tetrabromide or N-iodosuccimide, in an inert solvent, such as THF. Treatment of the bromide or iodide with silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula IC. Alternatively, the halide 30 containing carbamate may be formed directly by preparing a halide containing chloroformate from a halide containing alcohol. Preferred halides are bromide and iodide. Coupling of the imidazole anion with the halide containing 30 WO 00/50037 PCT/USOO/02524 chloroformate followed by reaction of the carbamate product with silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula IC. Scheme 1 5 Re.(C) R11 Rf 11 Ri C(11B R1 -_ C 10 B. R4H R4 R4 R3 NR3 N A R R2 R R5 N R 1 R2 IA X=ONO IB X=SNO IC X= ON0 2 Nitroso or nitro compounds of formula (II), where X is a -ONO, -SNO, or -0N0 2 group and R 8 , R,, R 7 1 , Dj, J, R, Rf, o, p, and q are as defined herein, and a nitrite, nitrate, or thionitrite containing alkoxyethyl ester is representative of the 10 K group, as defined herein, may be prepared as shown in Scheme 2. The hydroxyl group of formula 2 is converted to the ester of formula IIA, IIB, or IIC, where p, Re, Rf and X are as defined herein, by reaction with an appropriate nitrite, thionitrite, or nitrate containing activated acylating agent. Preferred methods for the formation of esters are reacting the alcohol with the preformed 15 acid chloride or anhydride of the nitrite, thionitrite, or nitrate containing acid. Preferred methods for preparing acid chlorides are treating the carboxylic acid with oxalyl chloride and a catalytic amount of DMF in an inert solvent, such as ether, THF, dichloromethane, or toluene. Preferred methods for preparing mixed anhydride are reacting the carboxylic acid with a chloroformate such as 20 isobutylchloroformate in the presence of an amine base, such as triethylamine in an inert solvent, such as ether, THF, dichloromethane, or toluene. Alternatively, the alcohol and nitrite, thionitrite, or nitrate containing acid may be condensed in the presence of a dehydrating agent, such as dicyclohexylcarbodiimide (DCC) or 1-ethyl-3 (3-dimethylaminopropyl) 25 carbodiimide hydrochloride (EDAC HCl) with or without a catalyst, such as 4 dimethylaminopyridine (DMAP) or 1-hydroxybenzotriazole (HOBt). 31 WO 00/50037 PCT/USOO/02524 On occasion it might be desirable to nitrosylate the alcohol or thiol after coupling the activated acylating agent to the alcohol. The activated acylating agent would be prepared from an acid containing a protected alcohol or thiol moiety. Preferred protecting groups for an alcohol moiety are silyl ethers, such as 5 a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert-butyldiphenylsilyl ether. After formation of the ester, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous 10 solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula IIA. Preferred protecting groups for the thiol moiety are as a thioester, such as a thioacetate or a thiobenzoate, or as a disulfide. Deprotection of the thiol moiety (zinc in dilute aqueous acid, triphenylphosphine in water and sodium 15 borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters) followed by reaction with a suitable nitrosylating agent such, as thionyl chloride nitrite or thionyl dinitrite, a lower alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as 20 methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula IIB. Nitrosation of the ester product may be accomplished by first converting the deprotected alcohol to a leaving group, such as a mesylate or a tosylate. This reaction is typically performed at a temperature of 0 0 C to room temperature in 25 an inert solvent, such as ether, THF, or dichloromethane with the alcohol, methansulfonyl chloride or para-toluensulfonyl chloride, and an amine base, such as triethylamine or pyridine, as the reactants. The corresponding iodide is then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from the alcohol by treatment of the hydroxyl 30 moiety with a phosphorus reagent, such as triphenylphosphine, in the presence of a halide source, such as carbon tetrabromide or N-iodosuccimide, in an inert solvent, such as THE. Treatment of the bromide or iodide with silver nitrate in an inert solvent, such as acetonitrile affords the compound of formula IIC. 32 WO 00/50037 PCT/US00/02524 Alternatively, the halide containing ester may be formed directly by preparing a halide containing active acylating agent from a halide containing acid. Preferred halides are bromide and iodide. Coupling of the alcohol with the halide containing active acylating agent followed by reaction of the ester product with 5 silver nitrate in an inert solvent, such as acetonitrile affords the compound of formula IIC. Preferred coupling methods for the formation of esters from alcohols are those methods described herein (e.g. with the preformed acid chloride or anhydride or with the carboxylic acid and a dehydration agent, such as DCC or EDAC-HCl). 10 Scheme 2 HOR 0 X-(C)p N Re 0 N R71R R7 R (CH2)0

(CH

2 )N (R9)q 2 (Rg)q IIA X = ONO IIB X = SNO IIC X = ON0 2 Nitroso or nitro compounds of formula (III), where X is a -ONO, -SNO, or -ON0 2 group and RW, R, A 1 , A 2 , A 3 , Re, Rf, Y 3 , and p, are as defined herein, and a 15 nitrite, nitrate, or thionitrite containing acyloxymethyl ester is representative of the R 13 group may be prepared as shown in Scheme 3. The hydroxyl group of formula 3 is converted to the ester of formula IIIA, IIIB, or IIIC, where p, Re, Rf and X are as defined herein, by reaction with an appropriate nitrite, thionitrite, or nitrate containing activated acylating agent. Preferred methods for the formation 20 of esters are reacting the alcohol with the preformed acid chloride or symmetrical anhvdride of the nitrite, thionitrite, or nitrate containing acid. Preferred methods for preparing acid chlorides are treating the carboxylic acid with oxalyl chloride and a catalytic amount of DMF in an inert solvent, such as ether, THF, 33 WO 00/50037 PCT/USO0/02524 dichloromethane, or toluene. Preferred methods for preparing mixed anhydride are reacting the carboxylic acid with a chloroformate, such as isubutylchloroformate, in the presence of an amine base, such as triethylamine in an inert solvent solvent, such as ether, THF, dichloromethane, or toluene. 5 Alternatively, the alcohol and nitrite, thionitrite, or nitrate containing acid may be condensed in the presence of a dehydrating agent, such as DCC or EDAC-HCl with or without a catalyst, such as DMAP or HOBt. On occasion it might be desirable to nitrosylate the alcohol or thiol after coupling the activated acylating agent to the alcohol. The activated acylating 10 agent would be prepared from an acid containing a protected alcohol or thiol moiety. Preferred protecting groups for an alcohol moiety are silyl ethers, such as a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert-butyldiphenylsilyl ether. After formation of the ester, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed 15 by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine affords the compound of formula IIIA. Preferred protecting groups for the thiol moiety are as a thioester, such as a 20 thioacetate or a thiobenzoate or as a disulfide. Deprotection of the thiol moiety (zinc in dilute aqueous acid, triphenylphosphine in water and sodium borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters) followed by reaction with a suitable nitrosylating agent such, as thionyl chloride 25 nitrite or thionyl dinitrite, a lower alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula IIIB. Nitrosation of the ester product may be accomplished by first converting the 30 deprotected alcohol to a leaving group, such as a mesylate or a tosylate. This reaction is typically performed at a temperature of 0 'C to room temperature in an inert solvent, such as ether, THF, or dichloromethane with the alcohol, methansulfonyl chloride or para-toluensulfonyl chloride, and an amine base, 34 WO 00/50037 PCTIUSOO/02524 such as triethylamine or pyridine as the reactants. The corresponding iodide is then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from the alcohol by treatment of the hydroxyl moiety with a phosphorus reagent, such as triphenylphosphine, in the presence 5 of a halide source, such as carbon tetrabromide or N-iodosuccimide, in an inert solvent, such as THF. Treatment of the bromide or iodide with silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula IIIC. Alternatively, the halide containing ester may be formed directly by preparing a halide containing active acylating agent from a halide containing acid. Preferred 10 halides are bromide and iodide. Coupling of the alcohol with the halide containing active acylating agent followed by reaction of the ester product with silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula IIIC. Preferred coupling methods for the formation of esters from alcohols are those methods described herein (e.g. with the preformed acid 15 chloride or anhydride or with the carboxylic acid and a dehydration agent, such as DCC or EDACHCl). Scheme 3 A2--A3

A

2

-A

3 A1/O AO N N HO1 N R17 N -*.-Re 0 R,_ ) R 14 W Y3 RR O 14 Y3 3 IIIA X = ONO IIIB X = SNO IIIC X = ON0 2 20 Nitroso or nitro compounds of formula (IV), where X is a -ONO, -SNO, or 35 WO 00/50037 PCT/USOO/02524

-ONO

2 group and RI R1,, R, R, and p, are as defined herein, and a nitrite, nitrate, or thionitrite containing carboxylic acid ester is representative of the X 4 group may be prepared as shown in Scheme 4. The acid of the formula 4 is converted to the ester of formula IVA, IVB, or IVC, where p, Re, Rf and X are as 5 defined herein, by reaction with an appropriate nitrite, thionitrite, or nitrate containing alcohol. Preferred methods for the preparation of esters are initially forming the mixed anhydride via reaction of 4 with a chloroformate, such as isobutylchloroformate, in the presence of a non nucleophilic base, such as triethylamine, in an anhydrous inert solvent, such as dichloromethane, 10 diethylether or THF. The mixed anhydride is then reacted with the nitrite, thionitrite, or nitrate containing alcohol preferably in the presence of a condensation catalyst, such as DMAP. Alternatively, the acid 4 may be first converted to the acid chloride by treatment with oxalyl chloride in the presence of a catalytic amount of DMF. The acid chloride is then reacted with the nitrite, 15 thionitrite, or nitrate containing alcohol preferably in the presence of a condensation catalyst, such as DMAP, and a tertiary amine base, such as triethylamine, to afford the ester of formula IVA, IVB, or IVC. Alternatively, the acid 4 and nitrite, thionitrite, or nitrate containing alcohol may be coupled to afford the ester of formula IVA, IVB, or IVC by treatment with a dehydration 20 agent, such as DCC or EDAC-HCl, with or without a catalyst, such as DMAP or HOBt. On occasion it might be desirable to nitrosylate the alcohol or thiol after coupling the acid to the alcohol. The ester would be prepared by reacting the carboxylic acid with an alcohol containing a protected alcohol or thiol moiety. 25 Preferred protecting groups for an alcohol moiety are silyl ethers, such as a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert-butyldiphenylsilyl ether. After coupling the acid and alcohol moieties, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed by reaction with a suitable nitrosylating agent, such as thionyl 30 chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula IVA. Preferred protecting groups for the thiol moiety are as a 36 WO 00/50037 PCT/USOO/02524 thioester, such as a thioacetate or a thiobenzoate or as a disulfide. Deprotection of the thiol moiety (zinc in dilute aqueous acid, triphenylphosphine in water and sodium borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze 5 thioesters) followed by reaction with a suitable nitrosylating agent such, as thionyl chloride nitrite, thionyl dinitrite, a lower alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula IVB. 10 Nitrosation of the ester product containing a deprotected alcohol moiety may be accomplished by first converting the alcohol to a leaving group, such as a mesylate or a tosylate. This reaction is typically performed at a temperature of 0 0 C to room temperature in an inert solvent, such as ether, THF, or dichloromethane with the alcohol, methansulfonyl chloride or para 15 toluensulfonyl chloride, and an amine base, such as triethylamine or pyridine, as the reactants. The corresponding iodide is then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from the alcohol by treatment of the hydroxyl moiety with a phosphorus reagent ,such as triphenylphosphine, in the presence of a halide source, such as carbon 20 tetrabromide or N-iodosuccimide, in an inert solvent, such as THE. Treatment of the bromide or iodide with silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula IVC. Alternatively, the halide containing ester may be formed directly by preparing a halide containing active acylating agent from a halide containing acid. Preferred halides are bromide and 25 iodide. Coupling of the alcohol with the halide containing active acylating agent followed by reaction of the ester product with silver nitrate affords the compound of formula IVC. Preferred coupling methods for the formation of esters from alcohols are those methods described herein (e.g. with the preformed acid chloride or anhydride or with the carboxylic acid and a dehydration agent, 30 such as DCC or EDAC-HCl). 37 WO 00/50037 PCT/US00/02524 Scheme 4

R

1

\NR

18 N N N N R1g '_ R19 O_ HO Rf O Re 4 IVA X =ONO IVB X=SNO IVC X = ON0 2 Nitroso or nitro compounds of formula (V), where X is a -ONO, -SNO, or 5 -ON0 2 group and R 23 , R 24 , R 25 , R27, R 29 , R 30 , Re Rf, n and p, are as defined herein, and a nitrite, nitrate, or thionitrite containing ester of a substituted pyridine is representative of the X 5 group may be prepared as shown in Scheme 5. The hydroxyl group of formula 5 is converted to the ester of formula VA, VB, or VC, where p, Re, Rf and X are as defined herein, by reaction with an appropriate 10 nitrite, thionitrite, or nitrate containing activated acylating agent. Preferred methods for the formation of esters are reacting the alcohol with the preformed acid chloride or symmetrical anhydride of the nitrite, thionitrite, or nitrate containing acid. Preferred methods for preparing acid chlorides are treating the carboxylic acid with oxalyl chloride and a catalytic amount of DMF in an inert 15 solvent, such as ether, THF, dichloromethane, or toluene. Preferred methods for preparing mixed anhydride are reacting the carboxylic acid with a chloroformate, such as isubutylchloroformate, in the presence of an amine base, such as triethylamine, in an inert solvent solvent, such as ether, THF, dichloromethane, or toluene. Alternatively, the alcohol and nitrite, thionitrite, or nitrate 20 containing acid may be condensed in the presence of a dehydrating agent, such as DCC or EDACHCl, with or without a catalyst, such as DMAP or HOBt. On occasion it might be desirable to nitrosylate the alcohol or thiol after coupling the activated acylating agent to the alcohol. The activated acylating agent would be prepared from an acid containing a protected alcohol or thiol 38 WO 00/50037 PCTIUSOO/02524 moiety. Preferred protecting groups for an alcohol moiety are silyl ethers, such as a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert-butyldiphenylsilyl ether. After formation of the ester, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed 5 by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine affords the compound of formula VA. Preferred protecting groups for the thiol moiety are as a thioester, such as a 10 thioacetate or a thiobenzoate or as a disulfide. Deprotection of the thiol moiety (zinc in dilute aqueous acid, triphenylphosphine in water and sodium borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride 15 nitrite, thionyl dinitrite, a lower alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula VB. Nitrosation of the ester product may be accomplished by first converting the 20 deprotected alcohol to a leaving group, such as a mesylate or a tosylate. This reaction is typically performed at a temperature of 0 'C to room temperature in an inert solvent, such as ether, THF, or dichloromethane with the alcohol, methansulfonyl chloride or para-toluensulfonyl chloride, and an amine base, such as triethylamine or pyridine as the reactants. The corresponding iodide is 25 then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from the alcohol by treatment of the hydroxyl moiety with a phosphorus reagent, such as triphenylphosphine in the presence of a halide source, such as carbon tetrabromide or N-iodosuccimide in an inert solvent, such as THE. Treatment of the bromide or iodide with silver nitrate in 30 an inert solvent, such as acetonitrile, affords the compound of formula VC. Alternatively, the halide containing ester may be formed directly by preparing a halide containing active acylating agent from a halide containing acid. Preferred halides are bromide and iodide. Coupling of the alcohol with the halide 39 WO 00/50037 PCTIUS00/02524 containing active acylating agent followed by reaction of the ester product with silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula VC. Preferred coupling methods for the formation of esters from alcohols are those methods described herein (e.g. with the preformed acid 5 chloride or anhydride or with the carboxylic acid and a dehydration agent, such as DCC or EDAC-HCl). Scheme 5 R29 R29 NN

R

2 4 N R 24 N ~ ~OH N0R H H

R

23 N S(o)n R 23 N S(O)n 0 Re R25

R

25 (R 27 (R27)q 5 VA X=ONO VB X = SNO VC X=ON0 2 10 Nitroso or nitro compounds of formula (VI), where X is a -ONO, -SNO, or -0N0 2 group and R26, R5, R36,A AA A, AR, R, and p are as defined herein, and a nitrite, nitrate, or thionitrite containing carbamate is representative of the D, group, as defined herein, may be prepared as shown in Scheme 6. The 15 substituted imidazole nitrogen group of formula 6 is converted to the anion by treatment with one equivalent of a strong non-nucleophilic base, such as sodium hydride or potasium hydride in an aprotic solvent, such as THF or DMF. The carbamate of formula VIA, VIB, or VIC where p, X, Re and Rf are as defined herein, is prepared by reacting the imidazole anion with a suitably functionalized 20 chloroformate in an inert solvent, such as THF or DMF. Typically the coupling reaction is performed at a temperature ranging between -78 4C and room temperature. Preferred methods for the formation of cloroformates are reacting one equivalent of X functionalized alcohol with one equivalent of phosgene at a tempeature ranging from -78 'C to 0 'C in an inert solvent, such as ether or THF, 40 WO 00/50037 PCT/USOO/02524 and in the presence of an amine base, such as pyridine or triethylamine. Removal of the amine hydrochloride by filtration affords a solution of the desired chloroformate which may be used directly or concentrated and redissolved in the anhydrous solution of choice prior to the coupling reaction 5 with the imidazole anion to afford the carbamate of the formula VIA, VIB, or VIC. On occasion it might be desirable to nitrosylate the alcohol or thiol after coupling a chloroformate to the imidazole anion. The chloroformate would be prepared by reacting phosgene with an alcohol containing a protected alcohol or 10 thiol moiety. Preferred protecting groups for an alcohol moiety are silyl ethers, such as a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert butyldiphenylsilyl ether. After formation of the carbamate, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed by reaction with a suitable nitrosylating agent, such 15 as thionyl chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula VIA. Preferred protecting groups for the thiol moiety are as a thioester, such as a thioacetate or a thiobenzoate or as a disulfide. 20 Deprotection of the thiol moiety (zinc in dilute aqueous acid, triphenylphosphine in water and sodium borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, a lower 25 alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula VIB. Nitrosation of the carbamate product may be accomplished by first converting the deprotected alcohol to a leaving 30 group, such as a mesylate or a tosylate. This reaction is typically performed at a temperature of 0 'C to room temperature in an inert solvent, such as ether, THF, or dichloromethane, with the alcohol, methansulfonyl chloride or para toluensulfonyl chloride, and an amine base, such as triethylamine or pyridine, as 41 WO 00/50037 PCT/USOO/02524 the reactants. The corresponding iodide is then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from the alcohol by treatment of the hydroxyl moiety with a phosphorus reagent, such as triphenylphosphine, in the presence of a halide source, such as carbon 5 tetrabromide or N-iodosuccimide, in an inert solvent, such as THF. Treatment of the bromide or iodide with silver nitrate in an inert solvent such as acetonitrile affords the compound of formula VIC. Alternatively, the halide containing carbamate may be formed directly by preparing a halide containing chloroformate from a halide containing alcohol. Preferred halides are bromide 10 and iodide. Coupling of the imidazole anion with the halide containing chloroformate followed by reaction of the carbamate product with silver nitrate in an inert solvent such as acetonitrile affords the compound of formula VIC. Scheme 6 15 A0 N R 26 A R2 H R 35 3 r R36 R36 0 O 'R R (C p Re x 6 VIA X = ONO VIB X = SNO VIC X = ON0 2 Nitroso or nitro compounds of formula (VII), where X is a -ONO, -SNO, or -ON0 2 group and R60, A7, X7, Y7, Re, R, and p, are as defined herein, and a nitrite, nitrate, or thionitrite containing acyl group is representative of the D 20 group may be prepared as shown in Scheme 7. The hydroxyl group of formula 7 is converted to the ester of formula VIIA, VIIB, or VIIC, where p, Re Rf and X are as defined herein, by reaction with an appropriate nitrite, thionitrite, or nitrate containing activated acylating agent. Preferred methods for the formation of esters are reacting the alcohol with the preformed acid chloride or symmetrical 42 WO 00/50037 PCTIUSOO/02524 anhydride of the nitrite, thionitrite, or nitrate containing acid. Preferred methods for preparing acid chlorides are treating the carboxylic acid with oxalyl chloride and a catalytic amount of DMF in an inert solvent, such as ether, THF, dichloromethane, or toluene. Preferred methods for preparing mixed anhydride 5 are reacting the carboxylic acid with a chloroformate, such as isubutylchloroformate, in the presence of an amine base, such as triethylamine, in an inert solvent solvent, such as ether, THF, dichloromethane, or toluene. Alternatively, the alcohol and nitrite, thionitrite, or nitrate containing acid may be condensed in the presence of a dehydrating agent, such as DCC or EDAC-HCl 10 with or without a catalyst, such as DMAP or HOBt. On occasion it might be desirable to nitrosylate the alcohol or thiol after coupling the activated acylating agent to the alcohol. The activated acylating agent would be prepared from an acid containing a protected alcohol or thiol moiety. Preferred protecting groups for an alcohol moiety are silyl ethers, such as 15 a trimethylsilyl ether, a tert-butyldimethylsilyl ether, or a tert-butyldiphenylsilyl ether. After formation of the ester, deprotection of the hydroxyl moiety (fluoride ion is the preferred method for removing silyl ether protecting groups) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous 20 solvent, such as dichloromethane, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine affords the compound of formula VIIA. Preferred protecting groups for the thiol moiety are as a thioester, such as a thioacetate or a thiobenzoate or as a disulfide. Deprotection of the thiol moiety (zinc in dilute aqueous acid, triphenylphosphine in water and sodium 25 borohydride are preferred methods for reducing disulfide groups while aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, a lower alkyl nitrite, such as tert-butyl nitrite, or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as 30 methylene chloride, THF, DMF, or acetonitrile, with or without an amine base, such as pyridine or triethylamine, affords the compound of formula VIIB. Nitrosation of the ester product may be accomplished by first converting the deprotected alcohol to a leaving group, such as a mesylate or a tosylate. This 43 WO 00/50037 PCT/USOO/02524 reaction is typically performed at a temperature of 0 0 C to room temperature in an inert solvent, such as ether, THF, or dichloromethane with the alcohol, methansulfonyl chloride or para-toluensulfonyl chloride, and an amine base, such as triethylamine or pyridine as the reactants. The corresponding iodide is 5 then prepared by reacting the mesylate or tosylate with sodium iodide in acetone. The halide may also be formed from the alcohol by treatment of the hydroxyl moiety with a phosphorus reagent, such as triphenylphosphine in the presence of a halide source, such as carbon tetrabromide or N-iodosuccimide in an inert solvent, such as THF. Treatment of the bromide or iodide with silver nitrate in 10 an inert solvent, such as acetonitrile, affords the compound of formula VIIC. Alternatively, the halide containing ester may be formed directly by preparing a halide containing active acylating agent from a halide containing acid. Preferred halides are bromide and iodide. Coupling of the alcohol with the halide containing active acylating agent followed by reaction of the ester product with 15 silver nitrate in an inert solvent, such as acetonitrile, affords the compound of formula VIIC. Preferred coupling methods for the formation of esters from alcohols are those methods described herein (e.g. with the preformed acid chloride or anhydride or with the carboxylic acid and a dehydration agent, such as DCC or EDAC-HCl). 20 Scheme 7 Rf OH O N Re\ ReN N R NX

~A

7 7 7 VIIA X = ONO VIIB X = SNO VIIC X = ON0 2 The compounds of the present invention include proton pump inhibitors, such as those described herein, which have been nitrosated and/or nitrosylated through one or more sites such as oxygen (hydroxyl condensation), sulfur 25 (sulfhydryl condensation), carbon and/or nitrogen. The nitrosated and/or 44 WO 00/50037 PCT/USOO/02524 nitrosylated proton pump inhibitors of the present invention are capable of donating, transfering and/or releasing a biologically active form of nitrogen monoxide (i.e., nitric oxide). Nitrogen monoxide can exist in three forms: NO- (nitroxyl), NO* 5 (uncharged nitric oxide) and NO* (nitrosonium). NO* is a highly reactive short lived species that is potentially toxic to cells. This is critical because the pharmacological efficacy of NO depends upon the form in which it is delivered. In contrast to the nitric oxide radical (NO*), nitrosonium (NO') does not react with 02 or 0- species, and functionalities capable of transferring and/or releasing 10 NO* and NO- are also resistant to decomposition in the presence of many redox metals. Consequently, administration of charged NO equivalents (positive and/or negative) is a more effective means of delivering a biologically active NO to the desired site of action. Compounds contemplated for use in the present invention (e.g., proton 15 pump inhibitors optionally substituted with one or more NO and/or NO 2 groups) can be used in combination with nitric oxide and compounds that release nitric oxide (i.e., compounds that release nitric oxide or otherwise directly or indirectly deliver or transfer nitric oxide to a site of its activity, such as on a cell membrane, in vivo, and/or elevate or stimulate production of endogenous nitric 20 oxide or EDRF in vivo and/or is a substrate for nitric oxide synthase). "In combination," as used herein can mean that (i) the proton pump inhibitor, optionally substituted with at least one NO and/or NO 2 group, and nitric oxide donor can be present together in the same composition; (ii) the proton pump inhibitor, optionally substituted with at least one NO and/or NO 2 group, and 25 nitric oxide donor can be administered separately; and/or (iii) the proton pump inhibitor, optionally substituted with at least one NO and/or NO 2 group, and nitric oxide donor can be together in the form of a kit. The term "nitric oxide" encompasses uncharged nitric oxide (NOe) and charged nitrogen monoxide species, preferably charged nitrogen monoxide 30 species, such as nitrosonium ion (NO*) and nitroxyl ion (NO-). The reactive form of nitric oxide can be provided by gaseous nitric oxide. The nitrogen monoxide releasing, delivering or transferring compounds have the structure F NO, wherein F is a nitrogen monoxide releasing, delivering or transferring 45 WO 00/50037 PCT/US00/02524 moiety, and include any and all such compounds which provide nitrogen monoxide to its intended site of action in a form active for its intended purpose. The term "NO adducts" encompasses any nitrogen monoxide releasing, delivering or transferring compounds, including, for example, S-nitrosothiols, 5 nitrites, nitrates, S-nitrothiols, sydnonimines, 2-hydroxy-2-nitrosohydrazines (NONOates), (E)-alkyl-2-[(E)-hydroxyimino]-5-nitro-3-hexene amines or amides, nitrosoamines, furoxans as well as substrates for the endogenous enzymes which synthesize nitric oxide. The "NO adducts" can be mono-nitrosylated, poly nitrosylated, mono-nitrosated and/or poly-nitrosated or a combination thereof at 10 a variety of naturally susceptible or artificially provided binding sites for biologically active forms of nitrogen monoxide. One group of NO adducts is the S-nitrosothiols, which are compounds that include at least one -S-NO group. These compounds include S-nitroso polypeptides (the term "polypeptide" includes proteins and polyamino acids that 15 do not possess an ascertained biological function, and derivatives thereof); S nitrosylated amino acids (including natural and synthetic amino acids and their stereoisomers and racemic mixtures and derivatives thereof); S-nitrosylated sugars; S-nitrosylated, modified and unmodified, oligonucleotides (preferably of at least 5, and more preferably 5-200 nucleotides); straight or branched, saturated 20 or unsaturated, aliphatic or aromatic, substituted or unsubstituted S-nitrosylated hydrocarbons; and S-nitroso heterocyclic compounds. S-nitrosothiols and methods for preparing them are described in U.S. Patent Nos. 5,380,758 and 5,703,073; WO 97/27749; WO 98/19672; and Oae et al, Org. Prep. Proc. Int., 15(3):165-198 (1983), the disclosures of each of which are incorporated by reference 25 herein in their entirety. Another embodiment of the present invention is S-nitroso amino acids where the nitroso group is linked to a sulfur group of a sulfur-containing amino acid or derivative thereof. Such compounds include, for example, S-nitroso-N acetylcysteine, S-nitroso-captopril, S-nitroso-N-acetylpenicillamine, S-nitroso 30 homocysteine, S-nitroso-cysteine and S-nitroso-glutathione. Suitable S-nitrosylated proteins include thiol-containing proteins (where the NO group is attached to one or more sulfur groups on an amino acid or amino acid derivative thereof) from various functional classes including 46 WO 00/50037 PCT/USOO/02524 enzymes, such as tissue-type plasminogen activator (TPA) and cathepsin B; transport proteins, such as lipoproteins; heme proteins, such as hemoglobin and serum albumin; and biologically protective proteins, such as immunoglobulins, antibodies and cytokines. Such nitrosylated proteins are described in WO 5 93/09806, the disclosure of which is incorporated by reference herein in its entirety. Examples include polynitrosylated albumin where one or more thiol or other nucleophilic centers in the protein are modified. Other examples of suitable S-nitrosothiols include: (i) HS(C(Re)(Rf))mSNO; 10 (ii) ONS(C(Re)(R))mRe; and (iii) H2N-CH(CO2H)-(CH2)m-C(O)NH-CH(CH2SNO)-C(O)NH-CH2CO2H; wherein m is an integer from 2 to 20; Re and Rf are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a 15 heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, an alkylamino, a dialkylamino, an arylamino, a diarylamino, an alkylarylamino, an alkoxyhaloalkyl, a haloalkoxy, a sulfonic acid, a sulfonic ester, an alkylsulfonic acid, an arylsulfonic acid, an arylalkoxy, an alkylthio, an arylthio, a cycloalkylthio, a cycloalkenyl, a cyano, an aminoalkyl, an aminoaryl, an aryl, an arylalkyl, an 20 alkylaryl, a carboxamido, a alkylcarboxamido, an arylcarboxamido, an amidyl, a carboxyl, a carbamoyl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarbonyl, an arylcarbonyl, an ester, a carboxylic ester, an alkylcarboxylic ester, an arylcarboxylic ester, a haloalkoxy, a sulfonamido, an alkylsulfonamido, an arylsulfonamido, a sulfonic ester, a urea, a phosphoryl, a nitro, -T-Q , or 25 (C(R,)(Rf))k-T-Q, or Re and Rf taken together with the carbons to which they are attached form a carbonyl, a methanthial, a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group; Q is -NO or -NO 2 ; and T is independently a covalent bond, a carbonyl, an oxygen, -S(O)0- or -N(Ra)Ri-, wherein o is an integer from 0 to 2, R, is a lone pair of electrons, a hydrogen or an alkyl group; R, is a hydrogen, an 30 alkyl, an aryl, an alkylcarboxylic acid, an aryl carboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, 47 WO 00/50037 PCT/US0O/02524

-CH

2 -C(T-Q)(R)(R), or -(N 2

O

2 -)--M*, wherein M' is an organic or inorganic cation; with the proviso that when R, is -CH2-C(T-Q)(R)(Rf) or -(N 2 0 2 -) . M*; then "-T-Q" can be a hydrogen, an alkyl group, an alkoxyalkyl group, an aminoalkyl group, a hydroxy group or an aryl group. 5 In cases where Re and R, are a heterocyclic ring or taken together R, and Rf are a heterocyclic ring, then R, can be a substituent on any disubstituted nitrogen contained within the radical wherein R, is as defined herein. Nitrosothiols can be prepared by various methods of synthesis. In general, the thiol precursor is prepared first, then converted to the S-nitrosothiol 10 derivative by nitrosation of the thiol group with NaNO 2 under acidic conditions (pH is about 2.5) which yields the S-nitroso derivative. Acids which can be used for this purpose include aqueous sulfuric, acetic and hydrochloric acids. The thiol precursor can also be nitrosylated by reaction with an organic nitrite such as tert-butyl nitrite, or a nitrosonium salt such as nitrosonium tetraflurorborate in 15 an inert solvent. Another group of NO adducts for use in the present invention, where the NO adduct is a compound that donates, transfers or releases nitric oxide, include compounds comprising at least one ON-O-, ON-N- or ON-C- group. The compounds that include at least one ON-O-, ON-N- or ON-C- group are 20 preferably ON-O-, ON-N- or ON-C-polypeptides (the term "polypeptide" includes proteins and polyamino acids that do not possess an ascertained biological function, and derivatives thereof); ON-O, ON-N- or ON-C-amino acids (including natural and synthetic amino acids and their stereoisomers and racemic mixtures); ON-O-, ON-N- or ON-C-sugars; ON-O-, ON-N- or ON-C 25 modified or unmodified oligonucleotides (comprising at least 5 nucleotides, preferably 5-200 nucleotides); ON-O-, ON-N- or ON-C- straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbons; and ON-O-, ON-N- or ON-C-heterocyclic compounds. Another group of NO adducts for use in the present invention include 30 nitrates that donate, transfer or release nitric oxide, such as compounds comprising at least one O 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- group. Preferred among these compounds are O 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- polypeptides (the term "polypeptide" includes proteins and also polyamino acids that do not 48 WO 00/50037 PCT/USO0/02524 possess an ascertained biological function, and derivatives thereof); 0 2 N-O-, 02N-N-, 0 2 N-S- or 0 2 N-C- amino acids (including natural and synthetic amino acids and their stereoisomers and racemic mixtures); 0 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C-sugars; 0 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- modified and unmodified 5 oligonucleotides (comprising at least 5 nucleotides, preferably 5-200 nucleotides); 0 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbons; and O 2 N-O-, 0 2 N-N-, O 2 N-S- or 0 2 N-C- heterocyclic compounds. Preferred examples of compounds comprising at least one 02N-O-, O2N-N-, O2N-S- or 10 O 2 N-C- group include isosorbide dinitrate, isosorbide mononitrate, clonitrate, erythrityltetranitrate, mannitol hexanitrate, nitroglycerin, pentaerythritoltetranitrate, pentrinitrol and propatylnitrate. Another group of NO adducts are N-oxo-N-nitrosoamines that donate, transfer or release nitric oxide and are represented by the formula: 15 R 1

R

2 -N(O-M*)-NO, where R1 and R 2 are each independently a polypeptide, an amino acid, a sugar, a modified or unmodified oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbon, or a heterocyclic group, and where M* is an organic or inorganic cation, such as, for example, an alkyl substituted ammonium cation 20 or a Group I metal cation. Another group of NO adducts are thionitrates that donate, transfer or release nitric oxide and are represented by the formula: R 1 -(S)-NO2, where R' is a polypeptide, an amino acid, a sugar, a modified or unmodified oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted 25 or unsubstituted hydrocarbon, or a heterocyclic group. Preferred are those compounds where R 1 is a polypeptide or hydrocarbon with a pair or pairs of thiols that are sufficiently structurally proximate, i.e., vicinal, that the pair of thiols will be reduced to a disulfide. Compounds which form disulfide species release nitroxyl ion (NO-) and uncharged nitric oxide (NO.). Compounds where 30 the thiol groups are not sufficiently close to form disulfide bridges generally provide nitric oxide as the NO- form and not as the uncharged NO. form. The present invention is also directed to compounds that stimulate endogenous NO or elevate levels of endogenous endothelium-derived relaxing 49 WO 00/50037 PCTIUSO0/02524 factor (EDRF) in vivo or are substrates for the enzyme, nitric oxide synthase. Such compounds include, for example, L-arginine, L-homoarginine, and N hydroxy-L-arginine, including their nitrosated and nitrosylated analogs (e.g., nitrosated L-arginine, nitrosylated L-arginine, nitrosated N-hydroxy-L-arginine, 5 nitrosylated N-hydroxy-L-arginine, nitrosated L-homoarginine and nitrosylated L-homoarginine), precursors of L-arginine and/or physiologically acceptable salts thereof, including, for example, citrulline, ornithine, glutamine, lysine, polypeptides comprising at least one of these amino acids, inhibitors of the enzyme arginase (e.g., N-hydroxy-L-arginine and 2(S)-amino-6-boronohexanoic 10 acid) and the substrates for nitric oxide synthase, cytokines, adenosin, bradykinin, calreticulin, bisacodyl, and phenolphthalein. EDRF is a vascular relaxing factor secreted by the endothelium, and has been identified as nitric oxide (NO) or a closely related derivative thereof (Palmer et al, Nature, 327:524-526 (1987); Ignarro et al, Proc. Natl. Acad. Sci. USA, 84:9265-9269 (1987)). 15 Another aspect of the invention provides methods for preventing and/or treating gastrointestinal disorders by administering to the patient in need thereof a therapeutically effective amount of the compounds and/or compositions described herein. Such gastrointestinal disorders include, for example, inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, 20 ulcerative colitis, peptic ulcers, stress ulcers, bleeding peptic ulcers, duodenal ulcers, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylon associated disease, short-bowel (anastomosis) syndrome, hypersecretory states associated with systemic mastocytosis or basophilic 25 leukemia and hyperhistaminemia that result, for example, from neurosurgery, head injury, severe body trauma or burns. In one aspect of the invention, the patient can be administered at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention to prevent and/or treat the gastrointestinal disorder. In another aspect of the invention, the patient can be administered at 30 least one antacid and at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention to prevent or treat the gastrointestinal disorder. In another aspect of the invention, the patient can be administered at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention and at 50 WO 00/50037 PCT/USOO/02524 least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to prevent and/or treat the gastrointestinal disorder. In still another aspect of the invention, the patient can be administered at least one antacid, at 5 least one nitrosated and/or nitrosylated proton pump inhibitor of the invention, and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to prevent and/or treat the gastrointestinal disorder. In yet another aspect of the present invention, the patient can be administered at least 10 one proton pump inhibitor and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to prevent and/or treat the gastrointestinal disorder. In yet another aspect of the present invention, the patient can be administered at least one antacid, at least one proton pump inhibitor, and at least 15 one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to prevent and/or treat the gastrointestinal disorder. The antacid, proton pump inhibitor that is optionally substituted with at least one NO and/or NO 2 group, and/or the nitric oxide donor can be 20 administered separately or as components of the same composition. These compounds and/or compositions can also be provided in the form of a pharmaceutical kit. The proton pump inhibitors substituted with at least one NO and/or NO 2 group and preferred nitric oxide donors are described in detail herein. Appropriate antacids for use in this aspect of the invention include any 25 antacid known in the art, including, for example, aluminum hydroxide, magnesium hydroxide, magnesium carbonate, calcium carbonate and co-dried gels, such as, for example, aluminum hydroxide-magnesium carbonate co-dried gel. Another aspect of the present invention provides methods to improve the 30 gastroprotective properties, anti-Helicobacter properties and antacid properties of proton pump inhibitors by administering to a patient in need thereof a therapeutically effective amount of the compounds and/or compositions described herein. In one aspect of the invention, the patient can be administered 51 WO 00/50037 PCT/US00/02524 at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention to improve the gastroprotective properties, anti-Helicobacter properties and antacid properties of the proton pump inhibitor. In another aspect of the invention, the patient can be administered a bismuth-complex 5 comprising at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention to improve the gastroprotective properties, anti-Helicobacter properties and antacid properties of the proton pump inhibitor. In another aspect of the invention, the patient can be administered at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention and at least one 10 compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to improve the gastroprotective properties, anti-Helicobacter properties and antacid properties of the proton pump inhibitor. In another aspect of the invention, the patient can be administered a bismuth complex comprising at least one 15 nitrosated and/or nitrosylated proton pump inhibitor of the invention and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to improve the gastroprotective properties, anti-Helicobacter properties and antacid properties of the proton pump inhibitor. In yet another aspect of the 20 invention, the patient can be administered at least one proton pump inhibitor and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to improve the gastroprotective properties, anti-Helicobacter properties and antacid properties of the proton pump inhibitor. In yet another 25 aspect of the present invention, the patient can be administered a bismuth complex comprising at least one proton pump inhibitor and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to improve the gastroprotective properties, anti-Helicobacter properties and antacid 30 properties of the proton pump inhibitor. The bismuth-containing reagent, proton pump inhibitor, that is optionally, substituted with at least one NO and/or NO 2 group, and/or nitric oxide donor can be administered separately or as components of the same 52 WO 00/50037 PCTIUSOO/02524 composition. The proton pump inhibitors, optionally substituted with at least one NO and/or NO 2 group, and nitric oxide donors are described in detail herein. Bismuth complexes are prepared by boiling the aqueous solution of the free base of the proton pump inhibitor with at least one bismuth-containing reagent, 5 including, for example, bismuth citrate, bismuth salicylate, bismuth tartaric acid or mixtures thereof as described in U. S. Patent No. 5,403,830 and in Ivanov et al, J. Pharm. Pharmacol., 48:297-301 (1996), the disclosures of which are incorporated by reference herein in their entirety. Another aspect of the present invention provides methods to facilitate 10 ulcer healing and decrease the recurrence of ulcers by administering to a patient in need thereof a therapeutically effective amount of the compounds and/or compositions described herein. In one aspect of the invention, the patient can be administered at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention to facilitate ulcer healing and decrease the recurrence of ulcers. 15 In another aspect of the invention, the patient can be administered at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase to facilitate ulcer healing and decrease the recurrence of ulcers. In yet 20 another aspect of the invention, the patient can be administered at least one proton pump inhibitor and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to facilitate ulcer healing and decrease the recurrence of ulcers. The proton pump inhibitor, that is optionally, substituted 25 with at least one NO and/or NO 2 group, and/or nitric oxide donor can be administered separately or as components of the same composition. The proton pump inhibitor, optionally substituted with at least one NO and/or NO 2 group, and nitric oxide donors are described in detail herein. Another aspect of the present invention provides methods to decrease or 30 reverse gastrointestinal toxicity and facilitate ulcer healing resulting from, for example, the administration of nonsteroidal antiinflammatory drugs (NSAIDs), selective COX-2 inhibitors, and the like. In particular, the present invention provides methods of administering a therapeutically effective amount of the 53 WO 00/50037 PCT/USOO/02524 compounds and/or compositions described herein, and, optionally, administering a therapeutically effective amount of at least one NSAID or selective COX-2 inhibitor. In one aspect of the invention, the patient can be administered at least one nitrosated and/or nitrosylated proton pump inhibitor 5 of the invention, and, optionally, at least one NSAID and/or selective COX-2 inhibitor, to decrease or reverse gastrointestinal toxicity and/or to facilitate ulcer healing resulting from the NSAID and/or selective COX-2 inhibitor treatment. In another aspect of the invention, the patient can be administered at least one NSAID and/or selective COX-2 inhibitor with a therapeutically effective amount 10 of at least one nitrosated and/or nitrosylated proton pump inhibitor of the invention and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide synthase, to decrease or reverse gastrointestinal toxicity and/or to facilitate ulcer healing resulting from the NSAID and/or selective COX-2 15 inhibitor treatment. In yet another aspect of the present invention, the patient can be administered at least one NSAID and/or selective COX-2 inhibitor with a therapeutically effective amount of at least one proton pump inhibitor and at least one compound that donates, transfers or releases nitric oxide, or elevates endogenous levels of nitric oxide or EDRF, or is a substrate for nitric oxide 20 synthase, to decrease or reverse gastrointestinal toxicity and/or to facilitate ulcer healing resulting from the NSAID and/or selective COX-2 inhibitor treatment. The NSAID and/or selective COX-2 inhibitor, nitrosated and/or nitrosylated proton pump inhibitor, proton pump inhibitor, and/or nitric oxide donor can be administered separately or as components of the same composition. These 25 compounds and/or compositions can also be provided in the form of a pharmaceutical kit. The compounds and compositions of the present invention can be used in this aspect of the invention with any NSAID and selective COX-2 inhibitor known in the art. Such NSAIDs include, for example, aspirin (e.g., acetylsalicylic 30 acid), salicylate esters and salts, acetate esters of salicylic acid, diflurophenyl derivatives (e.g., diflunisal), salicylsalicylic acids (e.g., salsalate), salts of salicylic acids (e.g., sodium salicylate), salicylamide, sodium thiosalicylate, choline salicylate, magnesium salicylate, combinations of choline and magnesium 54 WO 00/50037 PCTIUSOO/02524 salicylates, 5-aminosalicylic acid (e.g., mesalamine), salicylazosulfapyridine (e.g., sulfasalazine), methylsalicylate, and the like. Another group of NSAIDs are the pyrazolon derivatives, which include, for example, phenylbutazone, oxyphenbutazone, antipyrine, aminopyrine, 5 dipyrone and apazone (azapropazone). Another group of NSAIDs are the para aminophenol derivatives, which are the so-called "coal tar" analgesics, including, for example, phenacetin and its active metabolite acetaminophen. Another group of compounds include indomethacin, a methylated indole derivative, and the structurally related compound sulindac. Yet another group 10 of compounds is the fenamates which are derivatives of N-phenylanthranilic acid (e.g., mefenamic, meclofenamic, flufenamic, tolfenamic and etofenamic acids). Another contemplated NSAID is tolmetin. Another group of NSAIDs are the propionic acid derivatives. Principal members of this group are, for example, ibuprofen, naproxen, flurbiprofen, 15 fenoprofen and ketoprofen. Other members of this group include, for example, fenbufen, pirprofen, oxaprozin, indoprofen and tiaprofenic acid. Still other NSAIDs are piroxicam, ampiroxicam, oxicam derivatives (which are a class of antiinflammatory enolic acids), tenoxicam tenidap, diclofenac (one of the series of phenylacetic acid derivatives that have been 20 developed as antiinflammatory agents). Other NSAIDs include etodolac and nabumentone. Selective COX-2 inhibitors are disclosed in, for example, U. S. Patent Nos. 5,681,842, 5,750,558, 5,756,531, 5,776,984 and in WO 98/39330, WO 99/10331 and WO 99/10332 assigned to Abbott Laboratories; and in WO 98/50075 assigned to 25 Algos Pharmaceutical Corporation; and in U. S. Patent No. 5,980,905 assigned to AMBI Inc.; and in U. S. Patent Nos. 5,776,967, 5,824,699, 5,830,911 and in WO 98/04527 and WO 98/21195 assigned to American Home Products Corporation; and in WO 99/18960 assigned to Astra Pharmaceuticals Ltd.; and in U. S. Patent No. 5,905,089 assigned to Board of Supervisors of Louisiana State University; and 30 in WO 97/13767 assigned to Chemisch Pharmazeutische Forschungsgesellschaft MBH; and in WO 96/10021 assigned to The Du Pont Merck Pharmaceutical Company; and in WO 99/13799 assigned to Euro-Celtique; and in U. S. Patent No. 5,134,142 and in WO 99/15505 assigned to Fujisawa Pharmaceutical Co. Ltd.; and 55 WO 00/50037 PCTIUSOO/02524 in U. S. Patent Nos. 5,344,991, 5,393,790, 5,521,207, 5,596,008, 5,616,601, 5,620,999, 5,633,272, 5,643,933, 5,686,470, 5,696,143, 5,700,816, 5,859,257, 5,972,986, 5,990,148 and in WO 94/15932, WO 94/27980, WO 95/15316, WO 96/16934, WO 96/25405, WO 96/38418, WO 96/38442, WO 96/41645, WO 97/38986, WO 98/06708, WO 98/43649, 5 WO 98/47509, WO 98/47890 and WO 99/22720 assigned to G.D. Searle & Co.; and in WO 96/31509 and WO 99/12930 assigned to Glaxo Group Limited; and in WO 97/34882 assigned to Grupo Farmaceutico Almirall; and in WO 97/03953 assigned to Hafslund Nycomed Pharma AG; and in U. S. Patent No. 5,945,539, 5,994,381 and in EP 0 745 596 Al assigned to Japan Tobacco, Inc.; and in U. S. Patent No. 10 5,686,460, 5,807,873 and in WO 97/37984 and WO 99/21585 assigned to Laboratoires USPA; and in U. S. Patent Nos. 5,585,504, 5,840,924, 5,883,267, 5,925,631 and in WO 97/44027, WO 97/44028, WO 97/45420, WO 98/00416, WO 98/47871, WO 99/15503, WO 99/15513, WO 99/20110, WO 99/45913 and WO 99/55830 assigned to Merck & Co. Inc.; and in U. S. Patent Nos. 5,409,944, 15 5,436,265, 5,474,995, 5,536,752, 5,550,142, 5,510,368, 5,521,213, 5,552,422, 5,604,253, 5,604,260, 5,639,780, 5,677,318, 5,691,374, 5,698,584, 5,710,140, 5,733,909, 5,789,413, 5,817,700, 5,840,746, 5,849,943, 5,861,419, 5,994,379 and in EP 0 788 476 B1, EP 0 863 134 Al and in WO 94/20480, WO 94/13635, WO 94/26731, WO 95/00501, WO 96/19469, WO 96/37467, WO 97/14691, WO 97/16435, WO 97/28120, WO 97/28121, 20 WO 97/36863, WO 98/03484, WO 98/43966, WO 99/14194, WO 99/14195 and WO 99/23087 assigned to Merck Frosst Canada & Co., and in WO 99/59635 assigned to Merck Sharp & Dohme Limited; and in U. S. Patent No. 5,380,738 assigned to Monsanto Company; and in WO 99/33796 assigned to Nissin Food Products Co. Ltd.; and in U. S. Patent No. 5,783,597 assigned to Ortho Pharmaceutical 25 Corporation; and in WO 98/07714 assigned to Oxis International Inc.; and in EP 0 937 722 Al and in WO 98/50033 and WO 99/05104 assigned to Pfizer Inc.; and in U. S. Patent No. 5,908,858 assigned to Sankyo Company Limited; and in WO 97/25045 assigned to Smithkline Beecham Corporation; and in U. S. Patent No. 5,475,021 assigned to Vanderbilt University; and in WO 99/59634 assigned to 30 Wakamoto Pharmaceutical Co. Ltd., the disclosures of each of which are incorporated by reference herein in their entirety. Each of the above NSAIDs and selective COX-2 inhibitors is described more fully in the literature, such as in Goodman and Gilman, The 56 WO 00/50037 PCTIUS00/02524 Pharmacological Basis of Therapeutics (8th Edition), McGraw-Hill, pages 617-657 (1993); Merck Index on CD-ROM, Twelfth Edition, Version 12:1, (1996); STN Express, file phar and file registry, the disclosures of which are incorporated by reference herein in their entirety. 5 Other NSAIDs and selective COX-2 inhibitors that can be used in the present invention include those described in U. S. Patent No. 5,703,073, and co pending Application Serial No. 09/441,891 and 60/171,623, the disclosures of which are incorporated by reference herein in their entirety. Another embodiment of the present invention provides methods to treat 10 Helicobacter pylori by administering one or more acid-degradable antibacterial compounds in combination with at least one proton pump inhibitor that is substituted with at least one NO and/or NO 2 group, and, optionally, a therapeutically effective amount of at least one compound that donates, transfers or releases nitric oxide and/or stimulates endogenous production of NO o: EDRF 15 in vivo. Alternatively, this embodiment provides administering one or more acid-degradable antibacterial compounds in combination with at least one proton pump inhibitor, and, a therapeutically effective amount of at least one compound that donates, transfers or releases nitric oxide and/or stimulates endogenous production of NO or EDRF in vivo. U.S. Patent Nos. 5,629,305 and 20 5,599,794, the disclosures of each of which are incorporated by reference herein in their entirety, disclose treating or preventing gastrointestinal disorders resulting from Helicobacter pylori by administering proton pump inhibitors in combination with antibacterial compounds. The proton pump inhibitors increase the intra-gastric pH in the stomach, thereby increasing the bioavailability 25 of the acid-labile antibacterial compound. The antibacterial compound(s), proton pump inhibitor(s), optionally substituted with at least one NO and/or

NO

2 group, and/or nitric oxide donor(s) can be administered separately, or as components of the same composition. The compounds and/or compositions can also be provided in the form of a kit. The proton pump inhibitors that arc 30 optionally substituted with at least one NO group and nitric oxide donors are described herein. The antibacterial compounds contemplated for use in this embodiment of the invention include any acid-degradable antibacterial compound that is known in the art, including, for example antibiotics, such as, 57 WO 00/50037 PCT/USOO/02524 for example, amoxycillin, penicillin, benzylpenicillin, erythromycin base, clarithromycin, and the like. Yet another embodiment of the present invention provides methods to treat viral infections by administering at least one proton pump inhibitor that is 5 substituted with at least one NO and/or NO 2 group, and, optionally, a therapeutically effective amount of at least one compound that donates, transfers or releases nitric oxide and/or stimulates endogenous production of NO or EDRF in vivo. Alternatively, this embodiment provides administering at least one proton pump inhibitor, and, a therapeutically effective amount of at least one 10 compound that donates, transfers or releases nitric oxide and/or stimulates endogenous production of NO or EDRF in vivo. U.S. Patent No. 5,945,425, the disclosure of which is incorporated by reference herein in its entirety, discloses treating viral infections by administering proton pump inhibitors. The proton pump inhibitor(s), optionally substituted with at least one NO and/or

NO

2 15 group, and/or nitric oxide donor(s) can be administered separately, or as components of the same composition. The compounds and/or compositions can also be provided in the form of a kit. The proton pump inhibitors that are optionally substituted with at least one NO group and nitric oxide donors are described herein. 20 The compounds and compositions of the present invention can be administered by any available and effective delivery system including, but not limited to, orally, bucally, parenterally, by inhalation spray, by topical application, by injection, transdermally, or rectally (e.g., by the use of suppositories) in dosage unit formulations containing conventional nontoxic pharmaceutically acceptable 25 carriers, adjuvants, and vehicles, as desired. Parenteral includes subcutaneous injections, intravenous, intramuscular, intrasternal injection, or infusion techniques. Transdermal compound administration, which is known to one skilled in the art, involves the delivery of pharmaceutical compounds via percutaneous 30 passage of the compound into the systemic circulation of the patient. Topical administration can also involve the use of transdermal administration such as transdermal patches or iontophoresis devices. Other components can be incorporated into the transdermal patches as well. For example, compositions 58 WO 00/50037 PCT/US0O/02524 and/or transdermal patches can be formulated with one or more preservatives or bacteriostatic agents including, but not limited to, methyl hydroxybenzoate, propyl hydroxybenzoate, chlorocresol, benzalkonium chloride, and the like. Dosage forms for topical administration of the compounds and compositions can 5 include creams, sprays, lotions, gels, ointments, eye drops, nose drops, ear drops, and the like. In such dosage forms, the compositions of the invention can be mixed to form white, smooth, homogeneous, opaque cream or lotion with, for example, benzyl alcohol 1% or 2% (wt/wt) as a preservative, emulsifying wax, glycerin, isopropyl palmitate, lactic acid, purified water and sorbitol solution. In 10 addition, the compositions can contain polyethylene glycol 400. They can be mixed to form ointments with, for example, benzyl alcohol 2% (wt/wt) as preservative, white petrolatum, emulsifying wax, and tenox II (butylated hydroxyanisole, propyl gallate, citric acid, propylene glycol). Woven pads or rolls of bandaging material, e.g., gauze, can be impregnated with the compositions in 15 solution, lotion, cream, ointment or other such form can also be used for topical application. The compositions can also be applied topically using a transdermal system, such as one of an acrylic-based polymer adhesive with a resinous crosslinking agent impregnated with the composition and laminated to an impermeable backing. 20 Solid dosage forms for oral administration can include capsules, tablets, effervescent tablets, chewable tablets, pills, powders, sachets, granules and gels. In such solid dosage forms, the active compounds can be admixed with at least one inert diluent such as sucrose, lactose or starch. Such dosage forms can also comprise, as in normal practice, additional substances other than inert diluents, 25 e.g., lubricating agents such as magnesium stearate. In the case of capsules, tablets, effervescent tablets, and pills, the dosage forms can also comprise buffering agents. Soft gelatin capsules can be prepared to contain a mixture of the active compounds or compositions of the present invention and vegetable oil. Hard gelatin capsules can contain granules of the active compound in 30 combination with a solid, pulverulent carrier such as lactose, saccharose, sorbitol, mannitol, potato starch, corn starch, amylopectin, cellulose derivatives of gelatin. Tablets and pills can be prepared with enteric coatings. Liquid dosage forms for oral administration can include pharmaceutically 59 WO 00/50037 PCT/US00/02524 acceptable emulsions, solutions, suspensions, syrups, and elixirs containing inert diluents commonly used in the art, such as water. Such compositions can also comprise adjuvants, such as wetting agents, emulsifying and suspending agents, and sweetening, flavoring, and perfuming agents. 5 Suppositories for vaginal or rectal administration of the compounds and compositions of the invention can be prepared by mixing the compounds or compositions with a suitable nonirritating excipient such as cocoa butter and polyethylene glycols which are solid at room temperature but liquid at body temperature, such that they will melt and release the drug. 10 Injectable preparations, for example, sterile injectable aqueous or oleaginous suspensions can be formulated according to the known art using suitable dispersing agents, wetting agents and/or suspending agents. The sterile injectable preparation can also be a sterile injectable solution or suspension in a nontoxic parenterally acceptable diluent or solvent, for example, as a solution in 15 1,3-butanediol. Among the acceptable vehicles and solvents that can be used are water, Ringer's solution, and isotonic sodium chloride solution. Sterile fixed oils are also conventionally used as a solvent or suspending medium. The compositions of this invention can further include conventional excipients, i.e., pharmaceutically acceptable organic or inorganic carrier 20 substances suitable for parenteral application which do not deleteriously react with the active compounds. Suitable pharmaceutically acceptable carriers include, for example, water, salt solutions, alcohol, vegetable oils, polyethylene glycols, gelatin, lactose, amylose, magnesium stearate, talc, surfactants, silicic acid, viscous paraffin, perfume oil, fatty acid monoglycerides and diglycerides, 25 petroethral fatty acid esters, hydroxymethyl-cellulose, polyvinylpyrrolidone, and the like. The pharmaceutical preparations can be sterilized and if desired, mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, colorings, flavoring and/or aromatic substances and the like which do not deleteriously react with 30 the active compounds. For parenteral application, particularly suitable vehicles consist of solutions, preferably oily or aqueous solutions, as well as suspensions, emulsions, or implants. Aqueous suspensions may contain substances which increase the viscosity of the suspension and include, for example, sodium 60 WO 00/50037 PCT/USOO/02524 carboxymethyl cellulose, sorbitol and/or dextran. Optionally, the suspension may also contain stabilizers. The composition, if desired, can also contain minor amounts of wetting agents, emulsifying agents and/or pH buffering agents. The composition can be a 5 liquid solution, suspension, emulsion, tablet, pill, capsule, sustained release formulation, or powder. The composition can be formulated as a suppository, with traditional binders and carriers such as triglycerides. Oral formulations can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium carbonate, 10 and the like. Various delivery systems are known and can be used to administer the compounds or compositions of the present invention, including, for example, encapsulation in liposomes, microbubbles, emulsions, microparticles, microcapsules and the like. The required dosage can be administered as a single 15 unit or in a sustained release form The bioavailabilty of the compositions can be enhanced by micronization of the formulations using conventional techniques such as grinding, milling, spray drying and the like in the presence of suitable excipients or agents such as phospholipids or surfactants. 20 The compounds and compositions of the present invention can be formulated as pharmaceutically acceptable salts. Pharmaceutically acceptable salts include, for example, alkali metal salts and addition salts of free acids or free bases. The nature of the salt is not critical, provided that it is pharmaceutically acceptable. Suitable pharmaceutically-acceptable acid addition salts may be 25 prepared from an inorganic acid or from an organic acid. Examples of such inorganic acids include, but are not limited to, hydrochloric, hydrobromic, hydroiodic, nitrous (nitrite salt), nitric (nitrate salt), carbonic, sulfuric, phosphoric acid, and the like. Appropriate organic acids include, but are not limited to, aliphatic, cycloaliphatic, aromatic, heterocyclic, carboxylic and sulfonic classes of 30 organic acids, such as, for example, formic, acetic, propionic, succinic, glycolic, gluconic, lactic, malic, tartaric, citric, ascorbic, glucuronic, maleic, fumaric, pyruvic, aspartic, glutamic, benzoic, anthranilic, mesylic, salicylic, p hydroxybenzoic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, 61 WO 00/50037 PCT/US0O/02524 ethanesulfonic, benzenesulfonic, pantothenic, toluenesulfonic, 2 hydroxyethanesuifonic, sulfanilic, stearic, algenic, p-hydroxybutyric, cyclohexylaminosulfonic, galactaric and galacturonic acid and the like. Suitable pharmaceutically-acceptable base addition salts include, but are not limited to, 5 metallic salts made from aluminum, calcium, lithium, magnesium, potassium, sodium and zinc or organic salts made from primary, secondary and tertiary amines, cyclic amines, N,N'-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine (N-methylglucamine) and procaine and the like. All of these salts may be prepared by conventional means 10 from the corresponding compound by reacting, for example, the appropriate acid or base with the compound. "Therapeutically effective amount" refers to the amount of the proton pump inhibitor, that is optionally substituted with at least one NO and/or

NO

2 group, nitric oxide donor, antacid, bismuth-complex, NSAID, selective COX-2 15 inhibitor and/or acid-degradable antibacterial compound, that is effective to achieve its intended purpose. While individual patient needs may vary, determination of optimal ranges for effective amounts of each of the compounds and compositions is within the skill of the art. Generally, the dosage required to provide an effective amount of the composition, and which can be adjusted by 20 one of ordinary skill in the art will vary, depending on the age, health, physical condition, sex, weight, extent of the dysfunction of the recipient, frequency of treatment and the nature and scope of the dysfunction or disease. The amount of a given proton pump inhibitor, that is optionally substituted with at least one NO and/or NO 2 group, which will be effective in the 25 treatment of a particular disorder or condition will depend on the nature of the disorder or condition, and can be determined by standard clinical techniques, including reference to Goodman and Gilman, supra; The Physician's Desk Reference, Medical Economics Company, Inc., Oradell, N.J., 1995; and Drug Facts and Comparisons, Inc., St. Louis, MO, 1993. The precise dose to be used in the 30 formulation will also depend on the route of administration, and the seriousness of the disease or disorder, and should be decided by the physician and the patient's circumstances. The amount of nitric oxide donor in a pharmaceutical composition can be 62 WO 00/50037 PCTIUSO0/02524 in amounts of about 0.1 to about 10 times the molar equivalent of the proton pump inhibitor. The usual daily doses of proton pump inhibitors are about 10 mg to about 400 mg per day and the doses of nitric oxide donors in the pharmaceutical composition can be in amounts of about 1 to about 500 mg/kg of 5 body weight daily, preferably about 1 to about 50 mg/kg of body weight daily. Effective doses may be extrapolated from dose-response curves derived from in vitro or animal model test systems and are in the same ranges or less than as described for the commercially available compounds in the Physician's Desk Reference, supra. 10 The present invention also provides pharmaceutical kits comprising one or more containers filled with one or more of the ingredients of the pharmaceutical compounds and/or compositions of the present invention, including, at least, one or more of the proton pump inhibitors, that are optionally substituted with at least one NO moiety, and one or more of the NO 15 donors described herein. Such kits can also include, for example, other compounds and/or compositions (e.g., NSAIDs, antacids and/or antibacterial compounds), a device(s) for administering the compounds and/or compositions, and written instructions in a form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals or biological products, 20 which instructions can also reflect approval by the agency of manufacture, use or sale for human administration. EXAMPLES Example 1: {2-[( 2 -Pyridylmethyl)sulfinyllbenzimidazolyl}methyl-3-{N-[ 2 methyl-2-(nitrosothio)-propyl]-N-benzylcarbamoyl~propanoate 25 la. 2-Methyl-1-(benzylamino)propane-2-thiol A solution of c,ac'-dithiodiisobutyraldehyde (10.31 g, 0.05 mol) and benzylamine (10.71 g, 0.10 mol) in chloroform (150 ml) was heated to reflux for 2 hours. The solution was cooled to room temperature, the chloroform was removed under vacuum and the residue was taken in up methanol (100 nl). 30 Under ice cooling, sodium borohydride (6 g, 0.16 mol) was then added in portions over 1 hour and the resulting solution was stirred at room temperature for 1 hour. The reaction was concentrated under vacuum and the residue was partitioned between water (300 ml) and ethyl acetate (50 ml). The aqueous phase 63 WO 00/50037 PCT/US00/0252 4 was extracted with ethyl ether (2 x 50 ml) and the combined organic phases were washed with brine and dried (Na 2

SO

4 ). The volatiles were evaporated to give an oil (18.45 g, 95%) which was used directly in the next step. 1 H NMR (300 MHz, CDCl 3 ): 8 1.29 (s, 12 H), 2.57 (s, 4H), 3.81 (s, 4H), 7.21-7.33 (m, 10 H). To a solution 5 of the above oil (13.26 g, 0.034 mol) in ether (70 ml) and liquid ammonia (100 ml) cooled over a dry ice/acetone bath was added sodium until a blue color persisted for 40 min (-2 g of sodium was consumed). Ammonium chloride (15 g) was added and the reaction mixture was left overnight at room temperature. Water (100 ml) was added and the ether layer was separated. The aqueous phase was 10 extracted with ether (2 x 50 ml) and the combined ether layers were washed with brine and dried (Na 2

SO

4 ). The solvent was evaporated to give the title compound (12.83 g, 96.3%) as a colorless oil. 1H NMR (300 MHz, CDCl 3 ): 6 1.37 (s, 6 H), 2.61 (s, 2 H), 3.86 (s, 2 H), 7.22-7.36 (m, 5 H); 1 3 C NMR (75 MHz, CDCl 3 ) 6 30.58, 45.43, 54.24, 62.78, 126.86, 127.94, 128.34, 140.64; LCMS (m/e): 196 (M+1). 15 1b. 3-{N-(2-Methyl-2-sulfanylpropyl)-N-benzylcarbamoyllpropanoic acid To a solution of the product of example la (4.52 g, 23.14 mmol) in dichloromethane (70 ml) at 0 'C was added succinic anhydride (2.20 g, 21.98 mmol). The reaction was stirred at room temperature overnight, washed with water (100 ml), the aqueous phase was extracted with dichloromethane (2 x 50 20 ml) and the combined organic phases were washed with brine and dried (Na 2

SO

4 ). The solvent was evaporated under vacuum and the residue triturated with ether/hexane to give the title compound (6.46 g, 99.5%) as a white solid. mp. 123-126 0 C; 'H NMR (300 MHz, CDCl 3 ): 8 1.40 and 1.47 (2 s, 6 H), 1.82 (s, 1H), 2.65 2.86 (m, 4 H), 3.47 and 3.61 (2s, 2 H), 4.89 and 4.93 (2s, 2 H), 7.13-7.54 (m, 5 H), 10.41 25 (br s, 1 H); 13C NMR (75 MHz, CDCl 3 ): 8 28.21, 29.39, 31.27, 46.43, 53.01, 58.51, 125.86, 127.50, 128.96, 136.52, 173.49, 177.63; LCMS (m/e): 296 (M+1). 1c. 3-{N-{2-Methyl- 2 -(nitrosothio)propyl)-N-benzylcarbamoyllpropanoic acid To a solution of the product of example lb (4.46 g, 15.1 mmol) in dichloromethane (100 ml) at 0 'C was added dropwise t-butyl nitrite (1.94 ml, 16.6 30 mmol). The resulting green solution was left at room temperature for 1 hour. The solvent was evaporated and hexane (20 ml) was added to the residue. The mixture was stored at -20 'C for 1 hour, then the hexane was decanted and the solid dried under vacuum to give pure the title compound (4.46 g, 91.1%) as 64 WO 00/50037 PCTIUSOO/0252 4 green crystals. mp. 95-98 0 C; 'H NMR (300 MHz, CDCl 3 ): 8 1.91 and 1.98 (2s, 6 H), 2.63-2.78 (i, 4 H), 4.07 and 4.19 (2 s, 2 H), 4.60 and 4.80 (2 s, 2 H), 7.06-7.37 (m, 5 H); 13C NMR (75 MHz, CDC1): 8 27.65, 28.26, 29.33, 53.04, 55.74, 58.50, 125.96, 127.75, 129.07, 136.06, 173.81, 177.64; LCMS (m/e): 325 (M+1). 5 1d. {2-{( 2 -Pyridylmethyl)sulfinyl1benzimidazolyllmethyl-3-{N-{2-methyl- 2 (nitrosothio)-propyl]-N-benzylcarbamoylIpropanoate A mixture of timoprazole (0.51 g, 1.98 mmol) and 37% formaldehyde (0.80 ml) in acetonitrile (5 ml) was heated at 70 *C for 15 min. The reaction was evaporated to give a solid that was washed twice with ethyl ether/ethyl acetate 10 (4:1) and dissolved in dichloromethane (10 ml). To this solution was added Example Ic (0.65 g, 2 mol), 4 -(N-N-dimethylamino)pyridine (10 mg) and dicyclohexylcarbodiimide (IM in dichloromethane, 4 ml, 4 mmol). After stirring at room temperature for 3 hours, the reaction was concentrated under vacuum and the residue was purified by flash column chromatography (ethyl 15 acetate/hexane, 4:1 to 7:1) to afford the title compound (0.65 g, 54.7%) as a green foam. 'H NMR (300 MHz, CDCl3): 6 1.82 and 1.91 (2 s, 6 H), 2.63 and 2.75 (2br s, 4 H), 4.08 and 4.13 (2 s, 2 H), 4.70 and 4.85 (2 s, 2H), 4.88 (d, J = 14 Hz, 1 H), 4.92 (d, j= 14 Hz, 1 H), 6.36 (d, J = 11.4 Hz, 1H), 6.42 (d, J = 11.4 Hz, 1H), 7.00 and 7.06 (2 d, J= 6.8 Hz, 2 H), 7.20-7.64 (m, 9 H), 7.81 (d, J = 7.7 Hz, 1H), 8.54 (d, J = 4 Hz, 1 H); 3C 20 NMR (75 MHz, CDCl3): 5 27.29, 27.94, 28.88, 52.58, 55.29, 58.18, 62.22, 65.04, 110.73, 120.73, 122.97, 123.85, 125.21, 125.30, 125.58, 127.41, 128.76, 135.03, 135.79, 136.66, 141.70, 149.71, 150.20, 151.66, 171.80, 172.76; LCMS (m/e): 594 (M+1). Example 2: {2-({[3-methy1-4-(2,2,2-trifluoroethyl)-2-pyridyl methyllsulfinyl) benzimidazolyll-methyl-3-{N-[2-methyl-2-(nitrosothio)-propyll-N 25 benzylcarbamoy}propanoate 2a {2-({{3-methyl-4-(2,2,2-trifluoroethyl)-2-pyridyllmethyl sulfinyl) benzimidazolyl] -methyl-3-{N-{2-methyl-2-(nitrosothio)-propyl]-N benzylcarbamoyllpropanoate The procedure described in Example 1d was repeated using lansoprozole 30 (0.739 g, 2 mmol) instead of timoprazole. The title compound (0.82 g, 59.4%) was obtained as a green foam. 'H NMR (300 MHz, CDCl,): 6 1.84 and 1.92 (2 s, 6 H), 2.28 (s, 3 H), 2.65 and 2.76 (2 br s, 4 H), 4.01 and 4.10 (2s, 2 H), 4.39 (q, J = 7.3 Hz, 2 H), 4.56 and 4.72 (2 s, 2 H), 4.96 (d, J = 14 Hz, 1 H), 5.03 (d, J = 14 Hz, 1 H), 6.46 (d, J 65 WO 00/50037 PCT/USOO/0252 4 11 Hz, 1 H), 6.54 (d, J = 11 Hz, 1 H), 6.65 (d, J = 5 Hz, 1 H), 7.00-7.40 (m, 7 H), 7.64 (d, J = 7.4 Hz, 1 H), 7.80 (d, J = 7.5 Hz, 1 H), 8.25 (d, J = 5 Hz, 1H); "C NMR (75 MHz, CDCl 3 ): 8 24.85, 27.47, 28.13, 29.11, 33.82, 52.80, 55.53, 58.37, 59.81, 65.26 (q, J = 36 Hz), 65.36, 105.81, 110.85, 120.93, 122.97, 123.92, 125.28, 125.78, 127.58, 128.93, 135.21, 5 136.01, 141.97, 148.09, 151.30, 152.81, 161.67, 171.96, 172.95; LCMS (m/e): 690 (M+1). Example 3: 2-[2-(Nitrosothio)adamantan-2-yllethyl 2-(1[3-methyl-4-( 2

,

2

,

2 trifluoroethoxy)-2-pyridylmethy}sulfinyl)benzimidazolecarboxylate 3a. Adamantane-2-thione Adamantan- 2 -one (48.46 g, 322.6 mmol) in pyridine (300 mL) was heated to 10 90 0 C and phosphorous pentasulfide (17.84 g, 40.13 mmol) was added. The reaction was maintained at 90 'C for two hours and at room temperature overnight during which time a precipitate formed. The pyridine solution was decanted and concentrated to dryness. The residual semisolid was treated with hexane (400 mL) to give an orange solution with a light brown suspension. The 15 suspension was removed by filtration. The filtrate was concentrated to dryness and dried to vacuum to give an orange solid (50.36 g). This crude product was purified by filtration through a pad of silica gel (hexane). 'H NMR (CDCl 3 , 300 MHz): 83.43 (s, 2H), 2.1-1.9 (m, 12H); 1 3 C NMR (75 MHz, CDCl 3 ): 8 222.4, 57.5, 41.1, 36.5, 27.4. 20 3b. tert-Butyl 2-(2-sulfanyladamantan- 2 -yl) acetate To t-butyl acetate (25 mL, 21.6 g, 186 mmol) in dry THF (400 mL) at -78 'C was added lithium diisopropylamide monotetrahydrofuran (1.5 M solution in cyclohexane, 100 mL, 150 mmol) under nitrogen and the reaction mixture was stirred at -78 'C for 40 minutes. The product of Example 3a (21.88 g, 131.57 mmol) 25 in THF (400 mL) was added. The cold bath was removed and the reaction was stirred at room temperature for two hours. The reaction was diluted with methylene chloride and 2 M HCl (75 mL) was added. The organic phase was separated, washed with brine (4 x 40 mL), dried (MgSO4 ), filtered, and concentrated. The crude product was purified by filtration through a pad of silica 30 gel (5% EtOAc/95% hexane) to give the title compound (34.67 g, 122.7 mmol, 93%). Rf= 0.48 (EtOAc/ hexane 1:19); 1H NMR (CDC1 3 , 300 MHz): 8 2.87 (s, 2H), 2,47 (d, J = 11.5, 2H), 2.38 (s, 1H), 2.11 (d, J = 11.9, 2H), 1.98 (s, 2H), 1.96 (m, 2H), 1.84-1.62 96 (m, 6H), 1.47 (s, 9H); 1 3 C NMR (75 MHz, CDCl 3 ): 8 170.8, 80.7, 54.1, 47.3, 66 WO 00/50037 PCT/US00/02524 39.0, 38.2, 37.2, 36.6, 34.0, 33.3, 28.2, 27.5, 26.9. APIMS (IS, NH 4 OAc) m/e 283 (MH*); Anal. Calcd for C 16

H

2 6 0 2 S (282.44): C, 68.04; H, 9.28 Found: C, 68.14; H, 9.30. 3c. 2-(2-Sulfanyladamantan- 2 -yl)ethan-1-ol To a 0 'C cooled solution of Example 3b (4.1 g, 24.1 mmol) in anhydrous 5 dichloromethane (40 mL) lithium aluminum hydride (1 M solution in THF) (40 mL) was added dropwise over a period of 20 minutes. The reaction mixture was stirred at 0 'C for further 15 minutes and then at room temperature for 30 minutes. The excess LiAlH4 was destroyed by the addition of ethyl acetate. The reaction mixture was then poured over ice cold water, acidified with 1 N HCl and 10 extracted with dichloromethane (2 x 200 mL). The combined extracts were washed with brine (1 x 75 mL), dried over sodium sulfate, filtered and solvent evaporated at reduced pressure to give the title compound (3.1 g), mp 68-70 'C; 1 H NMR (CDCl3): 8 1.16-1.9 (m, 11 H), 2.1 (m, 2 H), 2.22 (t, J"= 6.9 Hz, 3 H), 2.43 (m, 2 H), 3.93 (t, J = 6.9 Hz, 2 H); 1 3 C NMR (CDCl3): 6 26.8, 27.7, 33.2, 33.9, 38.2, 39.1, 15 43.4, 55.8, 59.4; LRMS (APIMS) (m/z) 230 (M + 18) (M + NH4). 3d. 2-[2-(Nitrosothio)adamantan-2-yl]ethan-l-ol To a 0 'C cooled solution of Example 3c (1.06 g, 5 mmol) in anhydrous dichloromethane (40 mL) was added t-butyl nitrite (7.5 mmol, 890 yL). The reaction mixture was stirred at 0 'C for 30 minutes and then at room temperature 20 for 30 minutes. The solvent was removed at reduced pressure and product was recrystallized from ethyl ether/hexane to give 1.2 g ( 80% yield) of the title compound as a green crystalline solid, mp 77-79 'C; 1 H NMR (CDCl3): 6 1.7-1.74 (m, 2 H), 1.83-1.93 (m, 5 H), 2.06 (m, 3 H), 2.42-2.53 (m, 4 H), 2.99 (t, J = 7.3 Hz, 2 H), 3.83 (t, j= 7.6 Hz, 2 H); 1 3 C NMR (CDCl3): 6 27.3, 27.4, 33.2, 33.9, 35.6, 38.97, 39.96, 25 59.1, 68.2; LRMS (APIMS) (m/z) 259 (M + 18) (M + NH4). 3e. 2-{2-(nitrosothio)adamanta-2-yl ethyl chlorooate An ice-cooled solution of 20% phosgene in toluene (2.5 ml, 5.4 mmol) was added dropwise to a solution of Example 3d (0.41 g, 1.7 mmol) and pyridine (0.138 ml, 1.7 mmol) in dichloromethane (4 ml). After stirring at 0 'C for 20 min, the 30 reaction was concentrated using a rotary evaporator. To the residue was added dry ether (20 ml). The reaction mixture was filtered, washed with ether (2 x 5 nl) and the organic layer was concentrated under vacuum to gave the crude product, which was used immediately for next step. 67 WO 00/50037 PCTIUSOO/02524 3f. 2-[2-(Nitrosothio)adamantan-2-yl]ethyl 2-({[3-methyl-4-(2,2,2 trifluoroethoxy)-2-pyridyl]methyl sulfinyl)benzimidazolecarboxylate Lansoprazole (0.50 g, 1.35 mmol) was added to a suspension of sodium hydride (39 mg, 1.63 mmol) in N,N-dimethylformamide (3 ml) at room 5 temperature. The resulting clear solution was cooled in an ice bath. A solution of Example 3e in N,N-dimethylformamide (3 ml) was then added. After stirring at 0 0 C for 30 min, the reaction mixture was diluted with ethyl ether/ethyl acetate (3:2 v/v) (70 ml) and washed with water (2 x 30 ml) and then brine (20 ml). The combined organic extracts were dried over Na 2

SO

4 and evaporated under 10 vacuum. The residue was purified by flash chromatography (SiO 2 , 4/1 to 3/1 dichloromethane /acetone) to give the title compound as a green solid (0.52 g, 60.3%). Mp. 125-130 0 C (dec.)(at 116'C it started to shrink).' H NMR (300 MHz, CDC1 3 ) S 8.06 (d, J = 5.6 Hz, 1 H), 7.90 (d, j = 7.5 Hz, 1H), 7.82 (d, J = 7.7 Hz, 1 H), 7.48-7.38 (m, 2 H), 6.56 (d, J = 5.6 Hz, 1 H), 4.78 (d, J = 13 Hz, 1H), 4.75 (t, J = 7.8 Hz, 15 2H), 4.67 (d, J = 13 Hz, 1H), 4.37 (q, J = 7.8 Hz, 2H), 3.37 (t, J = 7.8 Hz, 2H), 2.60-2.46 (m, 4 H), 2.35 (s, 3H), 2.17-1.76 (m, 10 H) ; "C NMR (75 MHz, CDCl 3 ) 6 161.74, 156.92, 151.19, 149.65, 147.94, 142.77, 133.54, 126.50, 125.24, 124.55, 121.38, 114.61, 105.66, 67.04, 65.88, 65.36 (q, J = 36 Hz), 59.45, 38.74, 35.68, 35.58, 35.52, 33.73, 33.10, 33.08, 27.26, 27.11, 11.37; MS (m/e): 637 (M+1). 20 Example 4: Comparative In Vivo Gastric Lesion Activity The ethanol/HCl mixture-induced gastric lesion test in rats described by Takeuchi et al, J. Pharmacol. Exp. Ther., 286: 115-121 (1998), was used to evaluate gastric lesion activity. Male Sprague Dawley rats (Charles River Laboratories, Wilmington, MA) weighing 230-250 g were used for the experiments. The rats 25 were housed with laboratory chow and water ad libitum prior to the study. The rats were fasted for 24 hours with free access to water and then dosed by oral gavage with vehicle or with the test compounds given at a volume of 0.5 ml/100 g body weight. Thirty minutes after oral dosing all the rats received 1 ml of a solution of 60% ethanol in 150 mM HCl intragastrically. Food was withheld after 30 dosing. Sixty minutes after ethanol/HCl, rats were euthanized by pre-charged

CO

2 . The stomachs were dissected along the greater curvature, washed with a directed stream of 0.9% saline and pinned open on a sylgard based petri dish for examination of the hemorrhagic lesions. Gastric lesion score was expressed in 68 WO 00/50037 PCTIUSOO/02524 mm and calculated by summing the length of each lesion as described by Al Ghamdi et al, J. Int. Med. Res., 19: 2242 (1991). Results are expressed as the mean ± standard error of the mean. Statistical analysis were conducted using ANOVA test followed by a Student-Newman-Keuls post-hoc test using the Abacus 5 Concepts, Super Anova computer program (Abacus Concepts, Inc., Berkeley, CA). Fig. 1 compares the gastric lesion activity of vehicle alone, lanzoprazole in vehicle and Example 2 (nitrosylated lanzoprazole) in vehicle. Ethanol/HCl mixture produced gastric lesion in the control rats treated with vehicle (0.5% Methocel). Lanzoprazole at a dose of 200 pmol/kg failed to significantly inhibit 10 the formation of gastric lesions. The nitrosylated lanzoprazole derivative of Example 2, at 200 smol/kg, significantly inhibited the formation of gastric lesions produced by the ethanol/HCl mixture. The disclosure of each patent, patent application and publication cited or described in the present specification is hereby incorporated by reference herein 15 in its entirety. Although the invention has been set forth in detail, one skilled in the art will appreciate that numerous changes and modifications can be made to the invention, and that such changes and modifications can be made without departing from the spirit and scope of the present invention. 69

Claims (78)

1. A proton pump inhibitor compound comprising at least one NO 5 group, at least one NO 2 group, or at least one NO and NO 2 group, or a pharmaceutically acceptable salt thereof.

2. The proton pump inhibitor compound of claim 1, wherein the compound comprising at least one NO group, at least one NO 2 group, or at least one NO and NO 2 group is a compound of formula (I), formula (II), formula (III), 10 formula (IV), formula (V), formula (VI) or formula (VII), or a pharmaceutically acceptable salt thereof: wherein the compound of formula (I) is: R11 D 1 R 10 B I / A AR1 R2 R R5 N 15 (I) wherein A is S, S(O), orS(O)2; B is -CNR 7 R 7 ' or nitrogen; J is CH or nitrogen; 20 Ri is a hydrogen, an alkoxy group, a lower alkyl group, or an alkylthio group; R 2 is a hydrogen, an alkoxy group, a lower alkyl group, an alkylthio group, a haloalkoxy group, an alkoxyalkyl group, -NR 7 R 7 ', -OD 1 , or -SD,; or R 2 and R, taken together with the carbon chain to which they are attached form a cycloalkyl 25 ring or a heterocyclic ring; or R 2 and R 3 taken together with the carbon chain to which they are attached form a cycloalkyl ring or a heterocyclic ring; R 3 and R 11 are each independently a hydrogen, an alkoxy group, a lower alkyl group, or an alkylthio group; or R 3 and R 11 taken together with the carbon 70 WO 00/50037 PCT/USOO/02524 chain to which they are attached form a cycloalkyl ring or a heterocyclic ring; R 4 and R 5 are each independently a hydrogen, an alkyl group, a halo group, an alkoxy group, a haloalkyl group, a haloalkoxy group, a cyano group, an aryl group, a heterocyclic ring, -NR 7 R 7 ', -OD 1 , or -C0 2 R 12 ; or R 4 and R 5 taken together 5 are: H 3 C H 3 C R6 H 3 C H 3 wherein 10 R is oxygen or N=O-R 7 ; R 7 and R 7 ' are each independently hydrogen, a lower alkyl group or D; or R 7 and R 7 ' taken together with the nitrogen to which they are attached form a heterocyclic ring; Rio is a hydrogen; or R 10 and R, taken together with the carbon chain to 15 which they are attached form a cycloalkyl ring; R 12 is a lower alkyl group or D; DI is a hydrogen or D; D is Q or K; Q is -NO or -N0 2 ; 20 K is -Wa-Eb-(C(Re)(Rf))p-Ec-(C(Re)(R)),-W -(C(Re)(Rf))y-Wi-E-W-(C(Re)(Rf)) T-Q; a, b, c, d, g, i and j are each independently an integer from 0 to 3; p, x, y and z are each independently an integer from 0 to 10; W at each occurrence is independently -C(O)-, -C(S)-, -T-, -(C(Re)(R))h-I an 25 alkyl group, an aryl group, a heterocyclic ring, an arylheterocyclic ring, or -(CH 2 CH.O)q-; E at each occurrence is independently -T-, an alkyl group, an aryl group, -(C(Re)(R))h-, a heterocyclic ring, an arylheterocyclic ring, or -(CH 2 CH 2 O)q-; h is an integer form 1 to 10; 71 WO 00/50037 PCT/US00/02524 q is an integer from 1 to 5; Re and Rf are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, 5 an alkylamino, a dialkylamino, an arylamino, a diarylamino, an alkylarylamino, an alkoxyhaloalkyl, a haloalkoxy, a sulfonic acid, a sulfonic ester, an alkylsulfonic acid, an arylsulfonic acid, an arylalkoxy, an alkylthio, an arylthio, a cycloalkylthio, a cycloalkenyl, a cyano, an aminoalkyl, an aminoaryl, an aryl, an arylalkyl, an alkylaryl, a carboxamido, a alkylcarboxamido, an arylcarboxamido, an amidyl, a 10 carboxyl, a carbamoyl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarbonyl, an arylcarbonyl, an ester, a carboxylic ester, an alkylcarboxylic ester, an arylcarboxylic ester, a haloalkoxy, a sulfonamido, an alkylsulfonamido, an arylsulfonamido, a sulfonic ester, a urea, a phosphoryl, a nitro, -T-Q , or (C(Re)(Rf))k-T-Q, or Re and Rf taken together with the carbons to which they are 15 attached form a carbonyl, a methanthial, a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group; k is an integer from 1 to 3; T at each occurrence is independently a covalent bond, a carbonyl, an oxygen, 20 -S(O)0 or -N(Ra)Ri-; o is an integer from 0 to 2; Ra is a lone pair of electrons, a hydrogen or an alkyl group; Ri is a hydrogen, an alkyl, an aryl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an 25 arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, -CH 2 -C(T-Q)(Re)(R), or -(N 2 O 2 -)*M*, wherein M* is an organic or inorganic cation; with the proviso that when R, is -CH 2 -C(T-Q)(R,)(Rf) or -(N2O2)- M*, or Re or Rf are T-Q or (C(Re)(R))k-T-Q, then the "-T- Q" subgroup can 30 be a hydrogen, an alkyl, an alkoxy, an alkoxyalkyl, an aminoalkyl, a hydroxy, a heterocyclic ring or an aryl group; and with the proviso that the compound of formula (I) must contain at least one nitrite, nitrate, thionitrite or thionitrate group; 72 WO 00/50037 PCT/USOO/02524 wherein the compound of formula (II) is: K N R7 (CH2)o Di (R9)q II wherein 5 R 8 is a lower alkyl group, an alkoxyalkyl group, an alkylaryl group, a cycloalkyl group, a cycloalkylalkyl group, an aryl group, an alkylaryl group, or K; R at each occurrence is independently a hydrogen, a lower alkyl group, an akylthio group, a halogen, a cyano group an alkanoyl group, a haloalkyl group, a carbamoyl group, -NR 7 D 1 , -OD 1 , or -C0 2 R 12 ; 10 R 7 1 is a hydrogen, a lower alkyl group, an alkoxy group, or -OD,; J, K, DI, R 7 , R 12 , q and o are as defined herein; and with the proviso that the compound of formula (II) must contain at least one nitrite, nitrate, thionitrite or thionitrate group; wherein the compound of formula (III) is: 15 wherein A2--A3 A1O R 17N R 1 3 N R14 N Y3 III 73 WO 00/50037 PCT/US00/02524 R 13 and R 14 are each independently a hydrogen a lower alkyl group, an alkoxyalkyl, or a lower alkyl-OD,; or R 13 and R1 taken together along with the carbons to which they are attached form a cycloalkyl group or an aryl group; R 17 is a hydrogen or a lower alkyl group; 5 Y 3 is: (a) R 15 (b) D1 S D1 or N R 16 Wr<N \R/I N __,Z R 6 3 wherein R 15 is a hydrogen or a lower alkyl group; R 16 i s a hydrogen, a halogen, or a lower alkyl group; 10 R 63 is a lower alkyl group or a phenyl group; A 1 , A2 and A 3 comprise the other subunits of a 5- or 6-membered monocyclic aromatic ring and A,, A2and A3 are each independently: (i) CR 0 , wherein R 0 at each occurrence is hydrogen or -ODl; (ii) N-R, wherein RP at each occurrence is independently a 15 covalent bond to an adjacent ring atom in order to render the ring aromatic, a hydrogen, or K; (iii) a sulfur atom; (iv) an oxygen atom; or (v) Ba= Bb, wherein Ba and Bb are each independently a nitrogen 20 atom or CR; wherein R. at each occurrence is hydrogen or -ODI; Di and K are as defined herein; and with the proviso that the compound of formula (III) must contain at least one nitrite, nitrate, thionitrite or thionitrate group; 25 wherein the compound of formula (IV) is: 74 WO 00/50037 PCTIUSOO/02524 R 1 8 N R1g X4 IV wherein 5 R 18 and R 19 at each occurrence are each independently a hydrogen, a lower alkyl group, a halogen, a nitro group, an alkoxy group, -OD 1 , -NR 20 R 21 , -O(O)CR 20 , -O(O)COR 2 0 , -O(O)CNR 2 0 R 21 , -N(R 2 0 )C(O)R 21 , -N(R 2 0 )C(O)NR 2 0 R2, or N(R 20 )C(O)OR 21 ; or R1 and R1 when taken together along with the carbons to which they are attached form a heterocyclic ring or a phenyl ring optionally 10 substituted with up to four substituents selected from a hydrogen, a lower alkyl group, a halogen, a nitro group, an alkoxy group, -OD 1 , -NR 20 R 2 1, -O(O)CR 20 , -O(O)COR 2 0 , -O(O)CNR 2 0 R 21 , -N(R 2 0 )C(O)R 21 , -N(R2 0 )C(O)NR 2 0 R 21 , or -N(R 20 )C(O)OR 21 ; R 20 and R 2 , at each occurrence are each independently a hydrogen, a lower 15 alkyl group, an aryl group, a lower alkylaryl group, or K; X4 is -C(=R)R 22 , a heterocyclic ring, -NR 20R, a halogen, an alkoxy group, an arylalkoxy group, a cycloalkoxy group, a heterocyclicalkoxy group, an alkylsulfonyl group, an alkylsulfinyl group, an arylsulfonyl group, an arylsulfinyl group an arylalkylsulfonyl group, an arylalkylsulfinyl group, a 20 heterocyclicsulfonyl group, or a heterocyclicsulfinyl group; R- is a hydrogen, an alkyl group, an alkoxy group, an aryl group, an alkylaryl group, a heterocyclic ring, an -0-heterocyclic ring, or an alkylheterocyclic ring; D 1 , R 6 , and K are defined as herein; and 25 with the proviso that the compound of formula (IV must contain at least one nitrite, nitrate, thionitrite or thionitrate group; wherein the compound of formula (V) is: 75 WO 00/50037 PCT/USOO/02524 R24 NX5 H R 23 N (O)n R 25 (R27)q (V) wherein X 5 is: 5 :a) R29 (b) R23 (C) _ _ or rN N N-R 33 N R30 R28 R 2 3 is a hydrogen, a dialkylamino group, -NR 7 R 7 ', or a heterocyclic ring; R 24 is a hydrogen or halogen; R 25 is a hydrogen, -OD 1 , or lower alkyl-OD,; 10 R 2 7 at each occurrence is independently a hydrogen or an alkoxy group; R 28 , R 2 9 , and R 30 are each independently a hydrogen, a lower alkyl group, a dialkylamino group, a heterocyclic ring, or a lower alkyl-OD,; R 31 is a hydrogen, a dialkylamino group, or an alkoxy group; R 33 is a hydrogen or a lower alkyl group; 15 n is an integer from 0 to 1; R 7 , R 7 ', DI and q are as defined herein; and with the proviso that the compound of formula (V) must contain at least one nitrite, nitrate, thionitrite or thionitrate group; wherein the compound of formula (VI) is: 20 76 WO 00/50037 PCT/USO0/02524 5N R265 A 6 \ R 35 D 1 R3 6 VI wherein A 4 , A 5 , and A 6 are each independently a sulfur or CR 34 with the proviso 5 that one of A 4 , A 5 , or A 6 is a sulfur and the other two are CR 34 ; R 34 at each occurrence is independently a hydrogen, a halogen, a cyano, a nitro, a trifluoromethyl, a lower alkyl group, a heterocyclic ring, a lower alkyl OD,, an alkoxy, a haloalkoxy, an alkylthio, an alkylsulfinyl, an alkylsulfonyl, an alkylcarbonyl, an alkoxycarbonyl, a carbamoyl, a N-alkylcarbamoyl, a N,N-di 10 alkylcarbamoyl, an ester, a cycloalkyl, an aryl, an alkylaryl, an aryloxy, an arylalkoxyoxy, an arylamino, a alkylarylamino, an arylthio, an arylsulfonyl, an arylsulfinyl, or a sulfonamido; R 35 and R 3 6 are each independently a hydrogen or a lower alkyl group; or R3 and R 4 , taken together with the carbon chain to which they are attached form 15 a cycloalkyl ring; R 26 is: (a) Z 6 (b) R 41 R42 (C) R41 R42 Y6 or X6 R43 \/R43 N N R44 R 45 -N R44 R46 wherein X6 is nitrogen, and Y 6 is CR37; or X, is CR37, and Y is nitrogen; 20 R 37 is a hydrogen, a halogen, a lower alkyl group, a trifluoromethyl, an alkoxy group, a haloalkoxy group, an aryl group, an arylalkoxy group, a heterocyclic ring, or an aryloxy; Z 6 is -NR 3 8 R 3 9 , SR4, or an arylalkoxy group; 77 WO 00/50037 PCT/USOO/02524 R 38 and R 3 9 are each independently a hydrogen, a lower alkyl group, an aryl group, an alkylaryl group, or a cycloalkyl group; or R 38 and R 3 9 taken together with the nitrogen to which they are attached form a heterocyclic ring; R 40 is a hydrogen, a halogen, a lower alkyl group, an alkylaryl group, an 5 alkenyl group, or a haloalkyl group; R 41 , R 4 2 , R 4 3 , and R 4 4 are each independently a hydrogen, a halogen, a lower alkyl group, an alkoxy group, a haloalkoxy group, an alkoxyaryl group, an alkylthio group, an alkysulfinyl group, an alkylsulfonyl group, a cyano group, -Y-OD, -Y-SD,, -Y-NR 2 0 R 21 , -Y-O(O)CR20, -Y-O(O)CNR 2 0 R 21 , -Y-N(R 2 0 )C(O)R 21 , or 10 -Y-N(R20)S(O)2R2; Y is -(CH 2 )a- or a phenyl group; R 4 ,and R46 are each independently a hydrogen, a lower alkyl group, a cycloalkyl group, an alkenyl group, or an alkynyl group; D 1 , R 2 0 , R 21 , and a are as defined herein; and 15 with the proviso that the compound of formula (VI) must contain at least one nitrite, nitrate, thionitrite or thionitrate group; wherein the compound of formula (VII) is: D NRo X7 A7 VII 20 wherein R 60 is a lower alkyl group, an aryl group, a haloalkyl group, a lower alkyl-OD 1 , or heterocyclic ring; A, is oxygen or -ND,; 25 X 7 is a hydrogen or a halogen; Y, is: 78 WO 00/50037 PCT/US0O/02524 R62 R61 or X 7 , A 7 , and Y, taken together along with the carbons to which they are attached is: 0 IR61 R62 5 wherein R 6 is a hydrogen, a halogen, a lower alkyl group, -OD 1 , or -NHC(O)O-lower alkyl; R 6 2 is a hydrogen, a halogen, or a lower alkyl group; and 10 D, is as defined herein.

3. The compound of claim 2, wherein the compound is a benzimidazole, a quinoline, a pyrimidine, a thiadiazole, a sulfinylnicotinamide, a thienoimidazole, or a imidazopyridine.

4. The compound of claim 3, wherein the benzimidazole is 15 omeprazole, lansoprazole, pantoprazole, rabeprazole, leminoprazole, timoprazole, tenatoprazole, disulprazole, esomeprazole, 2-(2-benzimidazolyl) pyridine, a tricyclic imidazole, a thienopydidine benzimidazole, a fluoroalkoxy substituted benzimidazole, a dialkoxy benzimidazole, a N-substituted 2 (pyridylalkenesulfinyl) benzimidazole, a cycloheptenepyridine, a 5-pyrrolyl-2 20 pyridylmethylsulfinyl benzimidazole, a alkylsulfinyl benzimidazole, a fluoro pyridylmethylsulfinyl benzimidazole, an imidazo[4,5-b]pydridine, RO 18-5362 79 WO 00/50037 PCTIUSOO/02524 or IY 81149; wherein the quinoline is a 4-amino-3-carbonyl quinoline, a 4 amino-3-acylnaphthyride, a 4-aminoquinoline, a 4-amino-3-acylquinoline or a 3-butyryl-4-(2-methylphenylamino)-8-(2-hydroxyethoxy)quinoline; wherein the pyrimidine is a quinazoline, a tetrahydroisoquinolin-2-yl pyrimidine or 5 YH 1885; wherein the thiadiazole is 3-substituted 1,2,4-thiadiazolo[4,5-a] benzimidazole or a 3-substituted imidazo[1,2-d]-thiadiazole; wherein the sulfinylnicotinamide is a 2-sulfinylnicotinamide; wherein the thienoimidazole is a pyridylsulfinylbenz imidazole, a pyridylsulfinyl thieno imidazole, a theinoimidazole-toluidine, a 4,5-dihydrooxazole, a 10 thienoimidazole-toluidine or Hoe-731; wherein the imidazopyridine is a imidazo[1,2-a]pyridine, a pyrrolo[2,3-blpyridine or a pharmaceutically acceptable salt thereof.

5. A composition comprising the compound of claim 2 and a pharmaceutically acceptable carrier. 15

6. The composition of claim 5, further comprising at least one of a nonsteroidal antiinflammatory drug, a selective COX-2 inhibitor, an antacid, a bismuth-containing reagent, and an acid-degradable antibacterial compound.

7. A method for treating or preventing a gastrointestinal disorder, facilitating ulcer healing, or decreasing the recurrence of an ulcer in a patient in 20 need thereof comprising administering to the patient a therapeutically effective amount of the composition of claim 5.

8. The method of claim 7, further comprising administering to the patient a therapeutically effective amount of an antacid.

9. The method of claim 7, wherein the gastrointestinal disorder is an 25 inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, ulcerative colitis, a peptic ulcer, a stress ulcers, a bleeding peptic ulcer, a duodenal ulcer, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylori associated disease, short-bowel syndrome, or a hypersecretory 30 state associated with systemic mastocytosis or basophilic leukemia and hyperhistaminemia.

10. A method for improving the gastroprotective properties, the anti Helicobacter pylori properties, or the antacid properties of a proton pump 80 WO 00/50037 PCT/US0O/02524 inhibitor comprising administering to a patient in need thereof a therapeutically effective amount of the composition of claim 5.

11. The method of claim 10, further comprising administering to the patient a therapeutically effective amount of a bismuth-containing reagent. 5

12. A method for decreasing or reversing gastrointestinal toxicity or facilitating ulcer healing resulting from administration of a nonsteroidal antiinflammatory drug and/or a selective COX-2 inhibitor to a patient comprising administering to a patient in need thereof a therapeutically effective amount of at least one composition of claim 5, and, optionally, at least one 10 nonsteroidal antiinflammatory drug and/or selective COX-2 inhibitor.

13. A method for treating Helicobacter pylori comprising administering to a patient in need thereof a therapeutically effective amount of at least one acid degradable antibacterial compound and at least one composition of claim 5.

14. A method for treating a viral infection comprising administering to 15 a patient in need thereof a therapeutically effective amount of the composition of claim 5.

15. The method of claim 14, wherein the viral infection is orthomyxoviridae, paramyxoviridae, picornaviridae, rhabdoviridae, coronavaridae, togaviridae, bunyaviridae, arenaviridae, reteroviridae, 20 adenoviridae, proxviridae, papovaviridae, herpetoviridae, herpesviridae, herpes simplex viruses, cytomegalovirus, herpes varicella-zoster, Epstein-Barr, HHV6, HHV7, pseudorabies or rhinotracheitis.

16. A composition comprising at least one compound of claim 2 or a pharmaceutically acceptable salt thereof, and at least one compound that donates, 25 transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase.

17. The composition of claim 16 further comprising a pharmaceutically acceptable carrier. 30

18. The composition of claim 16, wherein the compound that donates, transfers, or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor or is a substrate for nitric oxide synthase is an S-nitrosothiol. 81 WO 00/50037 PCT/US00/02524

19. The composition of claim 18, wherein the S-nitrosothiol is S nitroso-N-acetylcysteine, S-nitroso-captopril, S-nitroso-N-acetylpenicillamine, S nitroso-homocysteine, S-nitroso-cysteine or S-nitroso-glutathione.

20. The composition of claim 16, wherein the S-nitrosothiol is: 5 (i) HS(C(Re)(Rf))mSNO; (ii) ONS(C(R,)(R))mR,; and (iii) H 2 N-CH(CO 2 H)-(CH 2 )m-C(O)NH-CH(CH 2 SNO)-C(O)NH-CH 2 -CO 2 H; wherein m is an integer from 2 to 20; R, and Rf are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an 10 alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, an alkylamino, a dialkylamino, an arylamino, a diarylamino, an alkylarylamino, an alkoxyhaloalkyl, a haloalkoxy, a sulfonic acid, a sulfonic ester, an alkylsulfonic acid, an arylsulfonic acid, an arylalkoxy, an alkylthio, an arylthio, a cycloalkylthio, 15 a cycloalkenyl, a cyano, an aminoalkyl, an aminoaryl, an aryl, an arylalkyl, an alkylaryl, a carboxamido, a alkylcarboxamido, an arylcarboxamido, an amidyl, a carboxyl, a carbamoyl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarbonyl, an arylcarbonyl, an ester, a carboxylic ester, an alkylcarboxylic ester, an arylcarboxylic ester, a haloalkoxy, a sulfonamido, an alkylsulfonamido, an 20 arylsulfonamido, a sulfonic ester, a urea, a phosphoryl, a nitro, -T-Q , or (C(R,)(R))k-T-Q, or R, and R, taken together with the carbons to which they are attached form a carbonyl, a methanthial, a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group; Q is -NO or -NO 2 ; and T is independently a covalent bond, a carbonyl, an oxygen, -S(O),- or -N(Ra)R-, wherein o is an integer from 0 to 25 2, R, is a lone pair of electrons, a hydrogen or an alkyl group; R, is a hydrogen, an alkyl, an aryl, an alkylcarboxylic acid, an aryl carboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, 30 -CH 2 -C(T-Q)(Re)(Rf), or -(N 2 O 2 -)-. M, wherein M* is an organic or inorganic cation; with the proviso that when R, is -CH 2 -C(T-Q)(R,)(Rf) or -(N 2 O 2 -).M*; then "-T-Q" can be a hydrogen, an alkyl group, an alkoxyalkyl group, an aminoalkyl group, a hydroxy group or an aryl group. 82 WO 00/50037 PCT/USOO/02524

21. The composition of claim 16, wherein the compound that donates, transfers, or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase, is L-arginine, L-homoarginine, N-hydroxy-L-arginine, nitrosated L 5 arginine, nitrosylated L-arginine, nitrosated N-hydroxy-L-arginine, nitrosylated N-hydroxy-L-arginine, citrulline, ornithine, glutamine, lysine, polypeptides comprising at least one of these amino acids or inhibitors of the enzyme arginase.

22. The composition of claim 16, wherein the compound that donates, transfers, or releases nitric oxide, or induces the production of endogenous nitric 10 oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase is: (i) a compound that comprises at least one ON-O-, ON-N- or ON-C group; (ii) a compound that comprises at least one O2N-O-, 02N-N-, 02N-S- or 15 -0 2 N-C- group; (iii) a N-oxo-N-nitrosoamine having the formula: R'R 2 -N(O-M*)-NO, wherein R' and R 2 are each independently a polypeptide, an amino acid, a sugar, an oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbon, or a heterocyclic group, and 20 M- is an organic or inorganic cation.

23. The composition of claim 22, wherein the compound comprising at least one ON-O-, ON-N- or ON-C- group is an ON-O-polypeptide, an ON-N polypepetide, an ON-C-polypeptide, an ON-O-amino acid, an ON-N-amino acid, an ON-C-amino acid, an ON-O-sugar, an ON-N-sugar, an ON-C-sugar, an ON-O 25 oligonucleotide, an ON-N-oligonucleotide, an ON-C-oligonucleotide, a straight or branched, saturated or unsaturated, substituted or unsubstituted, aliphatic or aromatic ON-O-hydrocarbon, a straight or branched, saturated or unsaturated, substituted or unsubstituted, aliphatic or aromatic ON-N-hydrocarbon, a straight or branched, saturated or unsaturated, substituted or unsubstituted, aliphatic or 30 aromatic ON-C-hydrocarbon, an ON-O-heterocyclic compound, an ON-N heterocyclic compound or a ON-C-heterocyclic compound.

24. The composition of claim 22, wherein compound comprising at least one 0 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- group is an O 2 N-O-polypeptide, an 83 WO 00/50037 PCT/US0O/02524 0 2 N-N-polypeptide, an O 2 N-S-polypeptide, an O 2 N-C-polypeptide, an O 2 N-0 amino acid, 0 2 N-N-amino acid, 0 2 N-S-amino acid, an O 2 N-C-amino acid, an 0 2 N-0-sugar, an O 2 N-N-sugar, 0 2 N-S-sugar, an O 2 N-C-sugar, an 0 2 N-0 oligonucleotide, an O2N-N-oligonucleotide, an O 2 N-S-oligonucleotide, an O 2 N 5 C-oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted O 2 N-0-hydrocarbon, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted 0 2 N-N-hydrocarbon, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted O 2 N-S 10 hydrocarbon, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted O 2 N-C-hydrocarbon, an O 2 N-0 heterocyclic compound, an O 2 N-N-heterocyclic compound, an O 2 N-S-heterocyclic compound or an O 2 N-C-heterocyclic compound.

25. The composition of claim 16, further comprising at least one of a 15 nonsteroidal antiinflammatory drug, a selective COX-2 inhibitor, an antacid, a bismuth-containing reagent, and an acid-degradable antibacterial compound.

26. A method for treating or preventing a gastrointestinal disorder, facilitating ulcer healing, or decreasing the recurrence of an ulcer in a patient in need thereof comprising administering to the patient a therapeutically effective 20 amount of the composition of claim 16.

27. The method of claim 26, further comprising administering to the patient a therapeutically effective amount of an antacid.

28. The method of claim 26, wherein the gastrointestinal disorder is an inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, 25 ulcerative colitis, a peptic ulcer, a stress ulcers, a bleeding peptic ulcer, a duodenal ulcer, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylori associated disease, short-bowel syndrome, or a hypersecretory state associated with systemic mastocytosis or basophilic leukemia and 30 hyperhistaminemia.

29. A method for improving the gastroprotective properties, the anti Helicobacter pylori properties, or the antacid properties of a proton pump inhibitor comprising administering to a patient in need thereof a therapeutically 84 WO 00/50037 PCT/USOO/02524 effective amount of the composition of claim 16.

30. The method of claim 29, further comprising administering to the patient a therapeutically effective amount of a bismuth-containing reagent.

31. A method for decreasing or reversing gastrointestinal toxicity or 5 facilitating ulcer healing resulting from administration of a nonsteroidal antiinflammatory drug and/or a selective COX-2 inhibitor to a patient comprising administering to a patient in need thereof a therapeutically effective amount of at least one composition of claim 16, and, optionally, at least one nonsteroidal antiinflammatory drug and/or selective COX-2 inhibitor. 10

32. A method for treating Helicobacter pylori comprising administering to a patient in need thereof a therapeutically effective amount of at least one acid degradable antibacterial compound and at least one composition of claim 16.

33. A method for treating a viral infection comprising administering to a patient in need thereof a therapeutically effective amount of the composition of 15 claim 16.

34. The method of claim 33, wherein the viral infection is orthomyxoviridae, paramyxoviridae, picornaviridae, rhabdoviridae, coronavaridae, togaviridae, bunyaviridae, arenaviridae, reteroviridae, adenoviridae, proxviridae, papovaviridae, herpetoviridae, herpesviridae, herpes 20 simplex viruses, cytomegalovirus, herpes varicella-zoster, Epstein-Barr, HHV6, HHV7, pseudorabies or rhinotracheitis.

35. A composition comprising at least one proton pump inhibitor compound or a pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the 25 production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase.

36. The composition of claim 35, wherein the at least one proton pump inhibitor compound is a benzimidazole, a quinoline, a pyrimidine, a thiadiazole, a sulfinylnicotinamide, a thienoimidazole, or a imidazopyridine. 30

37. The compound of claim 36, wherein the benzimidazole is omeprazole, lansoprazole, pantoprazole, rabeprazole, leminoprazole, timoprazole, tenatoprazole, disulprazole, esomeprazole, 2-(2-benzimidazolyl) pyridine, a tricyclic imidazole, a thienopydidine benzimidazole, a fluoroalkoxy 85 WO 00/50037 PCT/US00/02524 substituted benzimidazole, a dialkoxy benzimidazole, a N-substituted 2 (pyridylalkenesulfinyl) benzimidazole, a cycloheptenepyridine, a 5-pyrrolyl-2 pyridylmethylsulfinyl benzimidazole, a alkylsulfinyl benzimidazole, a fluoro pyridylmethylsulfinyl benzimidazole, an imidazo[4,5-b]pydridine, RO 18-5362 5 or IY 81149; wherein the quinoline is a 4-amino-3-carbonyl quinoline, a 4 amino-3-acylnaphthyride, a 4-aminoquinoline, a 4-amino-3-acylquinoline or a 3-butyryl-4-(2-methylphenylamino)-8-(2-hydroxyethoxy)quinoline; wherein the pyrimidine is a quinazoline, a tetrahydroisoquinolin-2-yl pyrimidine or YH 1885; wherein the thiadiazole is 3-substituted 1,2,4-thiadiazolo[4,5-a] 10 benzimidazole or a 3-substituted imidazo[1,2-d]-thiadiazole; wherein the sulfinylnicotinamide is a 2-sulfinylnicotinamide; wherein the thienoimidazole is a pyridylsulfinylbenz imidazole, a pyridylsulfinyl thieno imidazole, a theinoimidazole-toluidine, a 4,5-dihydrooxazole, a thienoimidazole-toluidine or Hoe-731; wherein the imidazopyridine is a 15 imidazo[1,2-a]pyridine, a pyrrolo[2,3-b]pyridine or a pharmaceutically acceptable salt thereof.

38. The composition of claim 37 further comprising a pharmaceutically acceptable carrier.

39. The composition of claim 35, wherein the compound that donates, 20 transfers, or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase is an S-nitrosothiol.

40. The composition of claim 39, wherein the S-nitrosothiol is S nitroso-N-acetylcysteine, S-nitroso-captopril, S-nitroso-N-acetylpenicillamine, S 25 nitroso-homocysteine, S-nitroso-cysteine or S-nitroso-glutathione.

41. The composition of claim 39, wherein the S-nitrosothiol is: (i) HS(C(Re)(Rf))mSNO; (ii) ONS(C(R)(R))mR,; and (iii) H 2 N-CH(CO 2 H)-(CH 2 )m-C(O)NH-CH(CH 2 SNO)-C(O)NH-CH 2 -CO 2 H; 30 wherein m is an integer from 2 to 20; Re and Rf are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, an alkylamino, a 86 WO 00/50037 PCT/USOO/02524 dialkylamino, an arylamino, a diarylamino, an alkylarylamino, an alkoxyhaloalkyl, a haloalkoxy, a sulfonic acid, a sulfonic ester, an alkylsulfonic acid, an arylsulfonic acid, an arylalkoxy, an alkylthio, an arylthio, a cycloalkylthio, a cycloalkenyl, a cyano, an aminoalkyl, an aminoaryl, an aryl, an arylalkyl, an 5 alkylaryl, a carboxamido, a alkylcarboxamido, an arylcarboxamido, an amidyl, a carboxyl, a carbamoyl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarbonyl, an arylcarbonyl, an ester, a carboxylic ester, an alkylcarboxylic ester, an arylcarboxylic ester, a haloalkoxy, a sulfonamido, an alkylsulfonamido, an arylsulfonamido, a sulfonic ester, a urea, a phosphoryl, a nitro, -T-Q , or 10 (C(Re)(R))k-T-Q, or R, and Rf taken together with the carbons to which they are attached form a carbonyl, a methanthial, a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group; Q is -NO or -NO 2 ; and T is independently a covalent bond, a carbonyl, an oxygen, -S(O),- or -N(Ra)Ri-, wherein o is an integer from 0 to 2, Ra is a lone pair of electrons, a hydrogen or an alkyl group; R, is a hydrogen, an 15 alkyl, an aryl, an alkylcarboxylic acid, an aryl carboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, -CH 2 ,C(T-Q)(R,)(Rf), or -(N 2 O 2 )- *M, wherein M* is an organic or inorganic 20 cation; with the proviso that when R, is -CH 2 _C(T-Q)(Re)(Rf) or -(N 2 0 2 )eM*; then "-T-Q" can be a hydrogen, an alkyl group, an alkoxyalkyl group, an aminoalkyl group, a hydroxy group or an aryl group.

42. The composition of claim 35, wherein the compound that donates, transfers, or releases nitric oxide, or induces the production of endogenous nitric 25 oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase is L-arginine, L-homoarginine, N-hydroxy-L-arginine, nitrosated L arginine, nitrosylated L-arginine, nitrosated N-hydroxy-L-arginine, nitrosylated N-hydroxy-L-arginine, citrulline, ornithine, glutamine, lysine, polypeptides comprising at least one of these amino acids or inhibitors of the enzyme azginase. 30

43. The composition of claim 35, wherein the compound that donates, transfers, or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase is: 87 WO 00/50037 PCT/US0O/02524 (i) a compound that comprises at least one ON-O-, ON-N- or ON-C group; (ii) a compound that comprises at least one O2N-O-, 02N-N-, 02N-S- or -0 2 N-C- group; 5 (iii) a N-oxo-N-nitrosoamine having the formula: R 1 R 2 -N(O-M*)-NO, wherein R' and R 2 are each independently a polypeptide, an amino acid, a sugar, an oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbon, or a heterocyclic group, and M' is an organic or inorganic cation. 10

44. The composition of claim 43, wherein the compound comprising at least one ON-O-, ON-N- or ON-C- group is an ON-O-polypeptide, an ON-N polypepetide, an ON-C-polypeptide, an ON-O-amino acid, an ON-N-amino acid, an ON-C-amino acid, an ON-O-sugar, an ON-N-sugar, an ON-C-sugar, an ON-O oligonucleotide, an ON-N-oligonucleotide, an ON-C-oligonucleotide, a straight or 15 branched, saturated or unsaturated, substituted or unsubstituted, aliphatic or aromatic ON-O-hydrocarbon, a straight or branched, saturated or unsaturated, substituted or unsubstituted, aliphatic or aromatic ON-N-hydrocarbon, a straight or branched, saturated or unsaturated, substituted or unsubstituted, aliphatic or aromatic ON-C-hydrocarbon, an ON-O-heterocyclic compound, an ON-N 20 heterocyclic compound or a ON-C-heterocyclic compound.

45. The composition of claim 43, wherein compound comprising at least one 0 2 N-O-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- group is an O 2 N-0-polypeptide, an 0 2 N-N-polypeptide, an O 2 N-S-polypeptide, an O 2 N-C-polypeptide, an 0 2 N-O amino acid, 0 2 N-N-amino acid, 0 2 N-S-amino acid, an O 2 N-C-amino acid, an 25 0 2 N-O-sugar, an O 2 N-N-sugar, 0 2 N-S-sugar, an O 2 N-C-sugar, an 0 2 N-O oligonucleotide, an O 2 N-N-oligonucleotide, an O 2 N-S-oligonucleotide, an 0 2 N C-oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted 0 2 N-O-hydrocarbon, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or 30 unsubstituted O 2 N-N-hydrocarbon, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted 0 2 N-S hydrocarbon, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted 0 2 N-C-hydrocarbon, an 0 2 N-O 88 WO 00/50037 PCT/USOO/02524 heterocyclic compound, an O 2 N-N-heterocyclic compound, an O 2 N-S-heterocyclic compound or an O2N-C-heterocyclic compound.

46. The composition of claim 35, further comprising at least one of a nonsteroidal antiinflammatory drug, a selective COX-2 inhibitor, an antacid, a 5 bismuth-containing reagent and an acid-degradable antibacterial compound.

47. A method for treating or preventing a gastrointestinal disorder, facilitating ulcer healing, or decreasing the recurrence of an ulcer in a patient in need thereof comprising administering to the patient a therapeutically effective amount of the composition of claim 35. 10

48. The method of claim 47, further comprising administering to the patient a therapeutically effective amount of an antacid.

49. The method of claim 47, wherein the gastrointestinal disorder is an inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, ulcerative colitis, a peptic ulcer, a stress ulcers, a bleeding peptic ulcer, a duodenal 15 ulcer, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylori associated disease, short-bowel syndrome, or a hypersecretory state associated with systemic mastocytosis or basophilic leukemia and hyperhistaminemia. 20

50. A method for improving the gastroprotective properties, the anti Helicobacter pylori properties, or the antacid properties of a proton pump inhibitor comprising administering to a patient in need thereof a therapeutically effective amount of the composition of claim 35.

51. The method of claim 50, further comprising administering to the 25 patient a therapeutically effective amount of a bismuth-containing reagent.

52. A method for decreasing or reversing gastrointestinal toxicity or facilitating ulcer healing resulting from administration of a nonsteroidal antiinflammatory drug and/or a selective COX-2 inhibitor to a patient comprising administering to a patient in need thereof a therapeutically effective 30 amount of at least one composition of claim 35, and, optionally, at least one nonsteroidal antiinflammatory drug and/or selective COX-2 inhibitor.

53. A method for treating Helicobacter pylori comprising administering to a patient in need thereof a therapeutically effective amount of at least one acid 89 WO 00/50037 PCT/US0O/02524 degradable antibacterial compound and at least one composition of claim 35.

54. A method for treating a viral infection comprising administering to a patient in need thereof a therapeutically effective amount of the composition of claim 35. 5

55. The method of claim 54, wherein the viral infection is orthomyxoviridae, paramyxoviridae, picornaviridae, rhabdoviridae, coronavaridae, togaviridae, bunyaviridae, arenaviridae, reteroviridae, adenoviridae, proxviridae, papovaviridae, herpetoviridae, herpesviridae, herpes simplex viruses, cytomegalovirus, herpes varicella-zoster, Epstein-Barr, HHV6, 10 HHV7, pseudorabies or rhinotracheitis.

56. A method for preventing or treating a gastrointestinal disorder, facilitating ulcer healing, or decreasing the recurrence of an ulcer in a patient in need thereof comprising administering to the patient a therapeutically effective amount of the composition of claim 5 or a pharmaceutically acceptable salt 15 thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase.

57. The method of claim 56, further comprising administering at least one antacid. 20

58. The method of claim 56, wherein the gastrointestinal disorder is an inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, ulcerative colitis, a peptic ulcer, a stress ulcers, a bleeding peptic ulcer, a duodenal ulcer, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, 25 Helicobacter Pylori associated disease, short-bowel syndrome, or a hypersecretory state associated with systemic mastocytosis or basophilic leukemia and hyperhistaminemia.

59. A method for preventing or treating a gastrointestinal disorder, facilitating ulcer healing, or decreasing the recurrence of an ulcer in a patient in 30 need thereof comprising administering to the patient a therapeutically effective amount of at least one proton pump inhibitor or a pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium 90 WO 00/50037 PCT/US00/02524 derived relaxing factor, or is a substrate for nitric oxide synthase.

60. The method of claim 59, further comprising administering at least one antacid.

61. The method of claim 59, wherein the gastrointestinal disorder 5 wherein the gastrointestinal disorder is an inflammatory bowel disease, Crohn's disease, irritable bowel syndrome, ulcerative colitis, a peptic ulcer, a stress ulcers, a bleeding peptic ulcer, a duodenal ulcer, infectious enteritis, colitis, diverticulitis, gastric hyperacidity, dyspepsia, gastroparesis, Zollinger-Ellison syndrome, gastroesophageal reflux disease, Helicobacter Pylori associated disease, 10 short-bowel syndrome, or a hypersecretory state associated with systemic mastocytosis or basophilic leukemia and hyperhistaminemia.

62. A method for improving the gastroprotective properties, the anti Helicobacter properties or the antacid properties of a proton pump inhibitor compound comprising administering to a patient in need thereof a 15 therapeutically effective amount of a bismuth complex comprising at least one composition of claim 5.

63. A method for improving the gastroprotective properties, the anti Helicobacter properties or the antacid properties of a proton pump inhibitor compound comprising administering to a patient in need thereof a 20 therapeutically effective amount of a bismuth complex comprising at least one composition of claim 16.

64. A method for improving the gastroprotective properties, the anti Helicobacter properties or the antacid properties of a proton pump inhibitor compound comprising administering to a patient in need thereof a 25 therapeutically effective amount of a bismuth complex comprising at least one composition of claim 35.

65. A method for decreasing or reversing gastrointestinal toxicity or facilitating ulcer healing resulting from administration of a nonsteroidal antiinflammatory drug and/or a selective COX-2 inhibitor to a patient 30 comprising administering to a patient in need thereof a therapeutically effective amount of at least one composition of claim 5, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate 91 WO 00/50037 PCT/USO0/02524 for nitric oxide synthase, and, optionally, at least one nonsteroidal antiinflammatory drug and/or selective COX-2 inhibitor.

66. A method for decreasing or reversing gastrointestinal toxicity or facilitating ulcer healing resulting from administration of a nonsteroidal 5 antiinflammatory drug and/or a selective COX-2 inhibitor to a patient comprising administering to a patient in need thereof a therapeutically effective amount of at least one proton pump inhibitor compound, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, 10 or is a substrate for nitric oxide synthase, and, optionally, at least one nonsteroidal antiinflammatory drug and/or selective COX-2 inhibitor.

67. A method for treating Helicobacter pylori comprising administering to a patient in need thereof a therapeutically effective amount of at least one acid degradable antibacterial compound, at least one composition of claim 5 or a 15 pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase.

68. A method for treating Helicobacter pylori comprising administering 20 to a patient in need thereof a therapeutically effective amount of at least one acid degradable antibacterial compound, at least one proton pump inhibitor compound or a pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, 25 or is a substrate for nitric oxide synthase.

69. A method for treating a viral infection comprising administering to a patient in need thereof a therapeutically effective amount of at least one composition of claim 5 and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or 30 endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase.

70. The method of claim 69, wherein the viral infection is orthomyxoviridae, paramyxoviridae, picornaviridae, rhabdoviridae, coronavaridae, togaviridae, bunyaviridae, arenaviridae, reteroviridae, 92 WO 00/50037 PCT/US00/02524 adenoviridae, proxviridae, papovaviridae, herpetoviridae, herpesviridae, herpes simplex viruses, cytomegalovirus, herpes varicella-zoster, Epstein-Barr, HHV6, HHV7, pseudorabies or rhinotracheitis.

71. A method for treating a viral infection comprising administering to 5 a patient in need thereof a therapeutically effective amount of at least one proton pump inhibitor compound or a pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase. 10

72. The method of claim 71, wherein the viral infection is orthomvxoviridae, paramyxoviridae, picornaviridae, rhabdoviridae, coronavaridae, togaviridae, bunyaviridae, arenaviridae, reteroviridae, adenoviridae, proxviridae, papovaviridae, herpetoviridae, herpesviridae, herpes simplex viruses, cytomegalovirus, herpes varicella-zoster, Epstein-Barr, HHV6, 15 HHV7, pseudorabies or rhinotracheitis.

73. A kit comprising at least one compound of claim 2 or a pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide 20 synthase.

74. The kit of claim 73, wherein the compound of claim 2 or a pharmaceutically acceptable salt thereof, and the at least one compound that donates, transfers or releases nitric oxide, induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric 25 oxide synthase are separate components in the kit or are in the form of a composition in the kit.

75. The kit of claim 73, further comprising at least one of a nonsteroidal antiinflammatory drug, a selective COX-2 inhibitor, an antacid, a bismuth containing reagent and an acid-degradable antibacterial compound. 30

76. A kit comprising at least one proton pump inhibitor compound or a pharmaceutically acceptable salt thereof, and at least one compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide 93 WO 00/50037 PCT/USOO/02524 synthase.

77. The kit of claim 76, wherein the proton pump inhibitor compound or a pharmaceutically acceptable salt thereof, and the compound that donates, transfers or releases nitric oxide, or induces the production of endogenous nitric 5 oxide or endothelium-derived relaxing factor, or is a substrate for nitric oxide synthase are separate components in the kit or are in the form of a composition in the kit.

78. The kit of claim 76, further comprising at least one of a nonsteroidal antiinflammatory drug, a selective COX-2 inhibitor, an antacid, a bismuth 10 containing reagent and an acid-degradable antibacterial compound. 94