CA2886957C - Use of thia oxo compounds for lowering apo c3 - Google Patents

Abstract

The present disclosure relates to use of a pharmaceutically effective amount of a compound of Formula (1):

Description

CA 2,886,957 Blakes Ref: 72571/00022

2 [001] The present disclosure relates to a method of reducing apolipoprotein C-

3 III (apoC-III) mRNA or protein in a subject in need thereof, comprising administering to the

4 subject a pharmaceutically effective amount of a compound of Formula (I):

6 Formula (I) 7 or a pharmaceutically acceptable salt or ester thereof, 8 wherein R1 and R2 are independently chosen from a hydrogen atom or linear, branched, 9 and/or cyclic Ci-C6 alkyl groups, with the proviso that R1 and R2 are not both hydrogen. Such methods, compounds, and compositions are useful to treat conditions caused by, associated 11 with, or aggravated by, elevated hepatic and /or plasma apoC-III such as hypertriglyceridemia 12 (HTG), hyperchylomicronemia, dyslipidemia, pancreatitis and in the prevention and/or treatment 13 of one or more of cardiovascular disease or metabolic disorder, or a symptom thereof.
14 [002] Dietary polyunsaturated fatty acids (PUFAs), including omega-3 fatty acids, have effects on diverse physiological processes impacting normal health and chronic diseases, 16 such as the regulation of plasma lipid levels, cardiovascular and immune functions, insulin 17 action, neuronal development, and visual function.
18 [003] Omega-3 fatty acids, e.g., (5Z,8Z,11Z,14Z,17Z)-icosa-

5,8,11,14,17-pentaenoic 19 acid (EPA) and (4Z,7Z,10Z,13Z,16Z,19Z)-docosa-4,7,10,13,16,19-hexaenoic acid (DHA), regulate plasma lipid levels, cardiovascular and immune functions, insulin action, and neuronal 21 development, and visual function. Omega-3 fatty acids have been shown to have beneficial 22 effects on the risk factors for cardiovascular diseases, for example hypertension and 23 hypertriglyceridemia (HTG), and on the coagulation factor VII
phospholipid complex activity.
24 [004] WO 2010/128401 discloses that 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoic acid favorably influences lipid profiles and inhibits i.a. development of 26 atherosclerosis, decreases total cholesterol and increases HDL
cholesterol as compared to a 27 control. Those results demonstrate that 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-28 pentaenyloxy)butanoic acid and its derivatives may be useful in the prevention or treatement of 29 various conditions, such as inflammation, hyperlipidemic conditions, obesity, fatty liver disease, atherosclerosis, peripheral insulin resistance, and/or diabetic conditions.
Further use of 2-22713041.2 Date Recue/Date Received 2021-08-30 CA Application Blakes Ref: 72571/00022 1 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoic acid and its derivatives for 2 treating different diseases or conditions is disclosed in WO 2012/059818.
3 [005] More particularly W02012/059818 describes a method of treating or preventing 4 at least one disease or condition selected from elevated Apo B, primary hypercholesterolemia (heterozygous familial and nonfamilial), and primary dysbetalipoproteinemia (Fredrickson Type

6 III) in a subject in need thereof, comprising administering to the subject a pharmaceutically

7 effective amount of a compound of Formula (I). However although it is already established that

8 Apo B and Apo E (dysbetalipoproteinemia) related pathways are positively affected by

9 compounds of Formula (I), data from 2 clinical studies in distinct patient populations surprisingly revealed that an additional apolipoprotein, apoC-Ill, is also potently reduced by compounds of 11 Formula (I).
12 [006] ApoC-Ill is a glycoprotein produced primarily by the liver whose function is 13 believed to involve promoting the assembly and secretion of triglyceride-rich VLDL particles 14 from hepatic cells under lipid-rich conditions (Sundaram Met al., J
Lipid Research, vol. 51, 2010). In plasma it is largely associated with very low-density lipoprotein (VLDL), high-density 16 lipoprotein (HDL) and chylomicrons. An increase in apoC-III levels induces the development of 17 hypertriglyceridemia. The mechanisms by which apoC-III expression increase plasma 18 triglycerides are partially mediated via inhibition of lipoprotein lipase and hepatic lipase; it 19 thereby delays the catabolism of triglyceride-rich particles. ApoC-III
is also thought to inhibit hepatic uptake of triglyceride rich particles. The clinical importance of apoC-III has been 21 established by studies demonstrating that carriers of rare mutations that disrupt apoC-III
22 function have both lower TG levels and a reduced risk of coronary/ischemic heart disease (N
23 Engl J Med. 2014 Jul 3;371(1):22-31, Loss-of-function mutations in APOC3, triglycerides, and 24 coronary disease).
[007] The long-chain omega-3 fatty acids, EPA and DHA, are well established in the 26 treatment of HTG. Given the recent identification of apoC-III as both a pivotal regulator in 27 triglyceride levels and as a genetically validated target for the prevention of coronary heart 28 disease, the effects of omega-3 fatty acids in various forms and compositions upon plasma 29 apoC-III levels have been investigated. By way of example US2014/0221486 claims a method for reducing an apoC-Ill level of a subject either on statin therapy and having baseline fasting 31 triglycerides of about 200 mg/di to about 499 mg/di, or a subject having fasting baseline 32 triglycerides of at least about 500 mg/di, by administering a pharmaceutical composition 33 comprising about 1 g to about 4 g of ethyl eicosapentaenoate per day to the subject. US

22713041.1 CA Application Blakes Ref: 72571/00022 1 2013/0177643 claims a method of lowering serum or plasma apoC-III levels, comprising 2 administering a pharmaceutical composition comprising: EPA, substantially in free acid form, in 3 an amount of at least about 50% (ala); DHA, substantially in free acid form, in an amount of at 4 least about 15% (a/a); DPA, substantially in free acid form, in an amount of at least about 1%
(a/a); in an amount and for a duration sufficient to reduce serum or plasma apoC-III from pre-6 treatment levels. Yet another example can be found in US2014/0094520 claiming a method of 7 reducing a lipid parameter level in a subject from a baseline lipid parameter level, wherein the 8 lipid parameter is selected from a group consisting of inter alia apoC-Ill, comprising 9 administering to the subject a composition comprising fatty acids, wherein at least 50 percent by weight of the fatty acids comprise omega-3 fatty acids, salts, esters, or derivatives thereof, 11 wherein the omega-3 fatty acids comprise eicosapentaenoic acid (EPA), docosapentaenoic acid 12 (DPA) and wherein the ratio of docosahexaenoic acid to DHA to EPA
(DHA:EPA) is less than 13 1:10, and wherein the ratio of DHA to DPA (DHA:DPA) is less than 2:1.
14 [008] Effective lowering of hepatic/plasma apoC-III with an orally delivered omega-3/omega-3 derivative offers an attractive treatment option for selected patient populations if 16 clinically relevant reductions can be achieved. Although it is yet to be determined what degree 17 of reduction in apoC-III is 'clinically relevant', studies in subjects with loss-of-function apoC-III
18 mutations show that apoC-III levels 46% lower than non-carriers are associated with a 40%
19 lower risk of coronary heart disease (CHD) (N Engl J Med. 2014 Jul 3;371(1):22-31, Loss-of-function mutations in APOC3, triglycerides, and coronary disease). In addition to the reduced 21 apoC-III concentrations, carriers also had 39% lower TG concentrations than non-carriers.
22 Given that loss-of-function represents life-long exposure, it is therefore conceivable that 23 therapies aimed at reducing apoC-III over a shorter time frame should aim for apoC-III
24 reductions as close to (or higher) than those associated with loss-of-function mutations if beneficial effects upon CHD are to be achieved. As the apoC-III results achieved with naturally 26 occurring omega-3 lipids are relatively modest (see Example 26), compounds that more potently 27 reduce apoC-Ill may offer not only superior triglyceride lowering but also superior 28 cardioprotective effects.
29 [009] The present disclosure relates to a method of reducing apolipoprotein C-III (apoC-III) mRNA or protein in a subject in need thereof, comprising adrhinistering to the 31 subject a pharmaceutically effective amount of a compound of Formula (I):

22713041.1 CA Application Makes Ref: 72571/00022 o,,===\cõ,,OH

2 Formula (I) 3 or a pharmaceutically acceptable salt or ester thereof, 4 wherein R1 and R2 are independently chosen from a hydrogen atom or linear, branched, and/or cyclic 01-C2 alkyl groups, with the proviso that RI and R2 are not both hydrogen.
6 [010] A number of metabolic diseases or conditions are closely associated with 7 increased risk of cardiovascular events. Such diseases or conditions include, but are not limited 8 to, diabetes mellitus type I and type II, metabolic syndrome, dyslipidemic conditions such as 9 hypercholesterolemia, hyperlipidemia, mixed dyslipidemia, hypertriglyceridemia, hyperchyolomicronemia, and various familial dyslipidemias.
11 [011] In at least one embodiment the disease or condition is chosen from any of 12 hypertriglyceridemia (HTG), hyperchylomicronemia, dyslipidemia, and pancreatitis and in the 13 prevention and/or treatment of one or more of cardiovascular disease or metabolic disorder, or a 14 symptom thereof.
[012] The present disclosure also includes a method of reducing apoC-III in a subject 16 in need thereof, the method comprising administering to the subject a pharmaceutically effective 17 amount of 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yloxy)butanoic acid:

19 or a pharmaceutically acceptable salt or ester thereof.
21 Brief description of the drawings 22 [013] Figure 1 discloses the relative hepatic apoC-III gene expression for a compound 23 of Formula (I), a control, and a reference compound.
24 Description [014] Particular aspects of the disclosure are described in greater detail below. The 26 terms and definitions as used in the present application and as clarified herein are intended to 27 represent the meaning within the present disclosure.
28 [015] The singular forms ''a," "an," and "the" include plural reference unless the context 29 dictates otherwise.

22713041.1 CA Application Blakes Ref: 72571/00022 1 [016] The terms "approximately" and "about mean to be nearly the same as a 2 referenced number or value. As used herein, the terms "approximately" and "about"
3 should be generally understood to encompass 5% of a specified amount, frequency, or 4 value.
[017] The terms "treat," "treating," and "treatment" include any therapeutic 6 application that can benefit a human or non-human mammal. Both human and veterinary 7 treatments are within the scope of the present disclosure. Treatment may be responsive 8 to an existing condition or it may be prophylactic, i.e., preventative.
9 [018] The terms "administer," "administration,'' and "administering" as used herein refer to (1) providing, giving, dosing and/or prescribing by either a health practitioner or his 11 authorized agent or under his direction a compound or composition according to the 12 present disclosure, and (2) putting into, taking or consuming by the human patient or 13 person himself or herself, or non-human mammal a compound or composition according 14 to the present disclosure.
[019] The term "pharmaceutically effective amount" means an amount sufficient to 16 achieve the desired pharmacological and/or therapeutic effects, i.e., an amount of the 17 disclosed compound that is effective for its intended purpose. While individual 18 subject/patient needs may vary, the determination of optimal ranges for effective amounts 19 of the disclosed compound is within the skill of the art. Generally, the dosage regimen for treating a disease and/or condition with the compounds presently disclosed may be 21 determined according to a variety of factors such as the type, age, weight, sex, diet, and/or 22 medical condition of the subject/patient.
23 [020] The term "pharmaceutical composition" means a compound according to 24 the present disclosure in any form suitable for medical use.
[021] The compounds of Formula (I) may exist in various stereoisomeric forms, 26 including enantiomers, diastereomers, or mixtures thereof. It will be understood that the 27 invention encompasses all optical isomers of the compounds of Formula (I) and mixtures 28 thereof. Hence, compounds of Formula (I) that exist as diastereomers, racemates, and/or 29 enantiomers are within the scope of the present disclosure.
[022] The present disclosure relates to a method of reducing apolipoprotein C-III
31 (apoC-III) mRNA or protein in a subject in need thereof, comprising administering to the subject 32 a pharmaceutically effective amount of a compound of Formula (I):

22713041.1 CA Application Blokes Ref: 72571/00022 OH
O)C

2 Formula (I) 3 or a pharmaceutically acceptable salt or ester thereof, 4 wherein RI and R2 are independently chosen from a hydrogen atom or linear, branched, and/or cyclic C1-C6 alkyl groups, with the proviso that R1 and R2 are not both hydrogen.
6 [023] In at least one embodiment, the present disclosure relates to use of a 7 pharmaceutically effective amount of a compound of Formula (I):

9 Formula (I) or a pharmaceutically acceptable sailor ester thereof, for reducing apolipoprotein 11 C-III (apoC-III) nnRNA or protein in a subject in need thereof, 12 wherein RI and R2 are independently chosen from a hydrogen atom or linear, branched, 13 and/or cyclic C1-06 alkyl groups, with the proviso that Aland R2 are not both hydrogen.
14 [024] In at least one embodiment, R1 and R2 are chosen from a hydrogen atom, a methyl group, an ethyl group, a n-propyl group, and an isopropyl group.
16 [025] In at least one embodiment, R1 and R2are chosen from a hydrogen atom, a 17 methyl group, and an ethyl group.
18 [026] In at least one embodiment, one of R1 and R2 is a hydrogen atom and the other 19 one of R, and R2 is chosen from a C1-03 alkyl group. In one embodiment one of R1 and R2 is a hydrogen atom and the other one of RI and R2 is chosen from a methyl group or an ethyl group.
21 [027] In at least one embodiment, the compound is present in its various 22 stereoisonneric forms, such as an enantiomer (R or S), diastereomer, or mixtures thereof.
23 [028] In at least one embodiment, the compound is present in racennic form.
24 [029] In cases, where the compound according to Formula (I) is a salt of a counter-ion with at least one stereogenic center, or ester of an alcohol with at least one 26 stereogenic center, the compound may have multiple stereocenters. In those situations, 27 the compounds of the present disclosure may exist as diastereomers.
Thus, in at least 28 one embodiment, the compounds of the present disclosure are present as at least one 29 diastereomer.

22713041.1 CA Application Blakes Ref: 72571/00022 1 [030] In at least one embodiment, the compound of the present disclosure is 2-2 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yloxy)butanoic acid:

4 [031] In at least one embodiments the compound of the present disclosure is present in its S and/or R form represented by the formulas:
6 0 and - o 7 [032] In at least one embodiment the disease or condition is chosen from any of 8 hypertriglyceridemia (HTG), hyperchylomicronemia, dyslipidemia, and pancreatitis and in the 9 prevention and/or treatment of one or more of cardiovascular disease or metabolic disorder, or a symptom thereof. In one embodiment the disease or condition is chosen from any of 11 hyperchylomicronemia, pancreatitis and in the prevention and/or treatment of one or more of 12 cardiovascular disease or metabolic disorder, or a symptom thereof. In one embodiment the 13 disease or condition is chosen from any of hyperchylomicronemia and pancreatitis.
14 [033] Compounds of Formula (I) can be prepared as described, for example, in PCT Application WO 2010/128401 filed May 7,2010, and according to Examples 1-16 below.
17 [034] Examples 1-23 are exemplary and one skilled in the art would understand 18 how to apply these general methods to arrive at other compounds within the scope of 19 Formula (I). Compounds of the present disclosure may be in the form of a pharmaceutically acceptable salt or ester. For example, the compounds of Formula (I) may be in the form of 21 esters, such as a phospholipid, a glyceride or a C1-C6-alkyl ester. In at least one 22 embodiment, the ester is chosen from a glyceride or a 01-C6-alkyl ester.
In at least one 23 embodiment, the ester is chosen from a triglyceride, a 1,2-diglyceride, a 1,3-diglyceride, a 24 1-monoglyceride, a 2-monoglyceride, a methyl ester, an ethyl ester, a propyl ester, a isopropyl ester, a n-butyl ester and a tert-butyl ester. In at least one embodiment, the 26 compound of Formula (I) is present as a methyl ester, an ethyl ester, an isopropyl ester, a 27 n-butyl ester or a tert-butyl ester, for example as a methyl ester or an ethyl ester. It has 28 been proven by in-vitro digestion studies in a bio relevant media that esters represented by 22713041.1 CA Application Blakes Ref: 72571/00022 1 Formula (I) (i.e., the ethyl ester and the butyl ester) will be rapidly hydrolyzed in the 2 gastrointestinal tract.
3 [035] Salts suitable for the present disclosure include, but are not limited to, salts 4 of NH4'; metal ions such as Li, Na, K., Mg2 , or Ca2.; a protonated primary amine such as tert-butyl ammonium, (3S,5S,7S)-adamantan-1-ammonium, 1,3-dihydroxy-2-6 (hydroxymethyl)propan-2-ammonium, a protonated aminopyridine (e.g., pyridine-2-7 ammonium); a protonated secondary amine such as diethylammonium, 2,3,4,5,6-8 pentahydroxy-N-methylhexan-1-ammonium, N-ethylnaphthalen-1-ammonium, a protonated 9 tertiary amine such as 4-methylmorpi iolin-4-ium, a protonated quaternary amine such as 2-hydroxy-N,N,N-trimethylethan-1-aminium and a protonated guanidine such as amino((4-11 amino-4-carboxybutyl)amino)methaniminium or a protonated heterocycle such as 1 H-12 imidazol-3-ium. Additional examples of suitable salts include salts of a diprotonated 13 diamine such as ethane-1,2-diammonium or piperazine-1,4-diium. Other salts according 14 to the present disclosure may comprise protonated Chitosan:
OH \ OH
\ 0 \ HO 0 HO
NH3* NH2 /
m 15=
16 [036] In at least embodiment the salts are chosen from a sodium salt, a calcium 17 salt, and a choline salt.
18 [037] The present disclosure provides for a method of reducing apoC-III in a 19 subject in need thereof, comprising administering to the subject a pharmaceutically effective amount of a compound of Formula (I). The subject may be a human or a non-21 human mammal. The compounds presently disclosed may be administered as a 22 medicament, such as in a pharmaceutical composition.
23 [038] In at least one embodiment, the present disclosure relates to a method for 24 reducing an apoC-III level of a subject on statin therapy and having baseline fasting triglycerides of about 200 mg/di to about 499 mg/dl by administering to the subject a 26 pharmaceutical effective amount of a compound of Formula (I). In another embodiment the 27 present disclosure relates to use of a pharmaceutical effective amount of a compound of 28 Formula (I), in the manufacture of a medicament for reducing an apoC-III
level of a subject 29 on statin therapy and having baseline fasting triglycerides of about 200 mg/dlto about 499 22713041.1 CA Application Blakes Ref: 72571/00022 1 mg/c11. The apoC-111 level can be reduced by at least about 20%, by at least about 25%, by 2 at least about 30% or by at least about 35%.
3 [039] In at least one embodiment, the disclosure relates to a method for reducing 4 an apoC-III level of a subject having baseline fasting triglycerides of about 200 mg/ell to about 499 mg/di by administering to the subject a pharmaceutical effective amount of a 6 compound of Formula (1). In another embodiment the present disclosure relates to use of a 7 pharmaceutical effective amount of a compound of Formula (1), in the manufacture of a 8 medicament for reducing an apoC-III level of a subject having baseline fasting triglycerides 9 of about 200 mg/di to about 499 mg/ell. The apoC-III level can be reduced by at least about 20%, by at least about 25%, by at least about 30% or by at least about 35%.
11 [040] In at least one embodiment, the present disclosure relates to a method for 12 reducing an apoC-III level of a subject on statin therapy and having baseline fasting 13 triglycerides of above 500 mg/dl by administering to the subject a pharmaceutical effective 14 amount of a compound of Formula (I). In another embodiment the present disclosure relates to use of a pharmaceutical effective amount of a compound of Formula (1), in the 16 manufacture of a medicament for reducing an apoC-III level of a subject on statin therapy 17 and having baseline fasting triglycerides of above 500 mg/d1. The apoC-III level can be 18 reduced by at least about 25%, by at least about 30%, by at least about 35% or by at least 19 about 40%.
[041] In at least one embodiment, the disclosure relates to a method for reducing 21 an apoC-111 level of a subject having baseline fasting triglycerides of above 500 mg/di by 22 administering to the subject a pharmaceutical effective amount of a compound of Formula 23 (I). In another embodiment the present disclosure relates to use of a pharmaceutical 24 effective amount of a compound of Formula (I), in the manufacture of a medicament for reducing an apoC-III level of a subject having baseline fasting triglycerides of above 500 26 mg/c11. The apoC-111 level can be reduced by at least about 25%, by at least about 30%, by 27 at least about 35% or by at least about 40%.
28 [042] The present disclosure also relates to a method for reducing an apoC-III
29 level of a subject having baseline fasting LDL-cholesterol of at least 2.5 nnmol/L (-97mg/dI) by administering to the subject a pharmaceutical effective amount of a compound of 31 Formula (1). In another embodiment the present disclosure relates to use of a 32 pharmaceutical effective amount of a compound of Formula (I), in the manufacture of a 33 medicament for reducing an apoC-III level of a subject having baseline fasting LDL-22713041.1 CA Application Blakes Ref: 72571/00022 1 cholesterol of at least 2.5 mmol/L (-97mg/dI). The apoC-III level can be reduced by at least 2 about 25%, by at least about 30%, by at least about 35% or by at least about 40%.
3 [043] In at least one embodiment the present disclosure relates to a method for 4 reducing apoC-III in a subject in need thereof, comprising administering to the subject a pharmaceutically effective amount of a dyslipidemic agent such as for example a statin and a 6 compound of Formula (I).
7 [044] The composition presently disclosed may comprise at least one compound 8 of Formula (I) and optionally at least one non-active pharmaceutical ingredient, i.e., 9 excipient. Non-active ingredients may solubilize, suspend, thicken, dilute, emulsify.
stabilize, preserve, protect, color, flavor, and/or fashion active ingredients into an 11 applicable and efficacious preparation, such that it may be safe, convenient, and/or 12 otherwise acceptable for use. Examples of excipients include, but are not limited to, 13 solvents, carriers, diluents, binders, fillers, sweeteners, aromas, pH
modifiers, viscosity 14 modifiers, antioxidants, extenders, humectants, disintegrating agents, solution-retarding agents, absorption accelerators, wetting agents, absorbents, lubricants, coloring agents, 16 dispersing agents, and preservatives. Excipients may have more than one role or 17 function, or may be classified in more than one group; classifications are descriptive only 18 and are not intended to be limiting. ;-1 some embodiments, for example, the at least one 19 excipient may be chosen from corn starch, lactose, glucose, microcrystalline cellulose, magnesium stearate, polyvinylpyrrolidone, citric acid, tartaric acid, water, ethanol, glycerol, 21 sorbitol, polyethylene glycol, propylene glycol, cetylstearyl alcohol, carboxymethylcellulose, 22 and fatty substances such as hard fat or suitable mixtures thereof. In some embodiments, 23 the compositions presently disclosed comprise at least one compound of Formula (I) and 24 at least one pharmaceutically acceptable antioxidant, e.g., tocopherol such as alpha-tocopherol, beta-tocopherol, gamma-tocopherol, and de/ta-tocopherol, or mixtures thereof, 26 BHA such as 2-tert-butyl-4-hydroxyanisole and 3-tert-butyl-4-hydroxyanisole, or mixtures 27 thereof and BHT (3,5-di-tert-butyl-4-hydroxytoluene), or mixtures thereof.
28 [045] The compositions presently disclosed may be formulated in oral 29 administration forms, e.g., tablets or gelatin soft or hard capsules.
The dosage form can be of any shape suitable for oral administration, such as spherical, oval, ellipsoidal, cube-31 shaped, regular, and/or irregular shaped. Conventional formulation techniques known in 32 the art, may be used to formulate the compounds according to the present disclosure. In 33 some embodiments, the composition may be in the form of a gelatin capsule or a tablet.
22713041.1 CA Application Blakes Ref: 72571/00022 1 [046] A suitable daily dosage of a compound of Formula (I) may range from 2 about 5 mg to about 2 g. For example, in some embodiments, the daily dose ranges from 3 about 50 mg to about 1 g, from about 100 mg to about 1 g, from about 50 mg to about 800 4 .. mg, from about 100 mg to about 800 mg, from about 100 mg to about 600 mg.
In at least one embodiment, the daily dose ranges from about 200 mg to about 600 mg. The 6 compounds may be administered, for example, once, twice, or three times per day. In at 7 .. least one embodiment, the compound of Formula (I) is administered in an amount ranging 8 .. from about 200 mg to about 800 mg per dose. In at least one embodiment, the compound 9 of Formula (I) is administered once per day.
[047] The present inventors have found that compounds of Formula (I), such as 11 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yloxy)butanoic acid, have 12 remarkably good pharmaceutical activity. Surprisingly, the compounds of Formula (I) 13 .. presently disclosed exhibit improved biological activity compared to naturally occurring 14 .. omega-3 fatty acids, such as EPA and DHA for reducing apoC-Ill.
[048] In some embodiments, for example, compounds of Formula (I) may reduce 16 the median levels of apoC-III in plasma or in the liver by at least 25-30% versus 17 baseline, i.e., a superior decrease to that achieved with available EPA/DHA/DPA
18 .. combinations. As compounds of Formula (I) have been shown to decrease hepatic 19 .. apoC-III mRNA in pre-clinical models (and thus presumably also hepatic production/secretion), the addition of lipid-lowering drugs that reduce apoC-III via 21 increased hepatic uptake of apo B particles, e.g., statins or PCSK-9 inhibitors, could 22 .. be expected to exert additional plasma apoC-III lowering effects.
23 Examples 24 [049] The present disclosure may be further described by the following non-limiting examples, in which standard techniques known to the skilled chemist and 26 techniques analogous to those described in these examples may be used where 27 .. appropriate. It is understood that the skilled artisan will envision additional embodiments 28 .. consistent with the disclosure provided herein.
29 [050] Unless otherwise stated, reactions were carried out at room temperature, .. typically in the range between 18-25 C with solvents of HPLC grade under anhydrous 31 conditions. Evaporations were carried out by rotary evaporation in vacuo. Column 32 .. chromatography was performed by the flash procedure on silica gel.
Nuclear magnetic 33 .. resonance (NMR) shift values were recorded on a Bruker Avance DPX 200 or 300, or on 22713041.1 CA Application Blakes Ref: 72571/00022 1 an AVII 400 instrument with peak multiplicities described as follows: s, singlet; d, doublet;
2 dd, double doublet; t, triplet; q, quartet; p, pentet; m, multiplett; br, broad. Mass spectra 3 were recorded with a GI956A mass spectrometer (electrospray, 3000 V) switching positive 4 and negative ionization mode. Reported yields are illustrative and do not necessarily represent the maximum yield attainable.
6 [051] Example 1: Preparation of fert-butyl 2-((5Z,8Z,11Z,14Z,17Z)-icosa-7 5,8,11,14,17-pentaen-1-yloxy)butanoate:
o -----õ---,-----......-----.0 -.....--)y - 8 _,-,.. 6 9 [052] Tetrabutylammonium chloride (0.55 g, 1.98 mmol) was added to a solution of (5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-ol, (3.50 g, 12.1 mmol) in toluene 11 (35 mL) at room temperature under nitrogen. An aqueous solution of sodium hydroxide 12 (50% (w/w), 11.7 mL) was added under vigorous stirring at room temperature, followed by 13 t-butyl 2-bromobutyrate (5.41 g, 24.3 mmol). The resulting mixture was heated to 50 C and 14 additional t-butyl 2-bromobutyrate was added after 1.5 hours (2.70 g, 12.1 mmol), 3.5 hours (2.709, 12.1 mmol) and 4.5 hours (2.709, 12.1 mmol) and stirred for 12 hours in 16 total. After cooling to room temperature, ice water (25 mL) was added and the resulting 17 two phases were separated. The organic phase was washed with a mixture of NaOH (5%) 18 and brine, dried (MgSO4), filtered and concentrated. The residue was purified by flash 19 chromatography on silica gel using increasingly polar mixtures of heptane and ethyl acetate (100:0 -> 95:5) as eluent. Concentration of the appropriate fractions afforded 1.87 g (36%
21 yield) of the title compound as an oil. 1H NMR (300 MHz, CDCI3): 5 0.85-1.10 (m, 6H), 22 1.35-1.54 (m, 11H), 1.53-1.87 (m, 4H), 1.96-2.26 (m, 4H), 2.70-3.02 (m, 8H), 3.31 (dt, 1H), 23 3.51-3.67 (m, 2H), 5.10-5.58 (m, 10H).
24 [053] Example 2: Preparation of 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoic acid (Compound A):
26 roil 27 [054] tert-Butyl 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-28 yloxy)butanoate (19.6 g, 45.5 mmol) was dissolved in dichloromethane (200 mL) and 29 placed under nitrogen. Trifluoroacetic acid (50 mL) was added and the reaction mixture was stirred at room temperature for one hour. Water was added and the aqueous phase was 22713041.1 CA Application Blakos Ref: 72571/00022 1 extracted twice with dichloromethane. The combined organic extract was washed with 2 brine, dried (Na2SO4), filtered and concentrated. The residue was subjected to flash 3 chromatography on silica gel using increasingly polar mixtures of heptane, ethyl acetate 4 and formic acid (90: 10:1 ->80:20:1) as eluent. Concentration of the appropriate fractions afforded 12.1 g (71% yield) of the title compound as an oi1.11-1-NMR (300 MHz, C0CI3): 6 6 0.90-1.00 (m, 6H), 1.50 (m, 2H), 1.70 (m, 2H), 1.80 (m, 2H), 2.10 (m, 4H), 2.80-2.90 (m, 7 8H), 3.50 (m, 1H), 3.60 (m, 1H), 3.75 (t, 1H), 5.30-5.50 (m, 10H); MS
(electrospray): 373.2 8 [M-H].
9 [055] Example 3: Preparation of (4S,5R)-3-((S)-2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoy1)-4-methy1-5-phenyloxazolidin-2-one and (4S,5R)-11 3-((R)-2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoy1)-4-methy1-5-12 phenyloxazolidin-2-one:
/-13 o 6 a 14 [056] DMAP (1.10 g, 8.90 mmol) and DCC (1.90 g, 9.30 mmol) were added to a mixture of 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoic acid (3.20 g, 16 8.50 mmol) in dry dichloromethane (100 nnL) held at 0 C under nitrogen.
The resulting 17 mixture was stirred at 0 C for 20 minutes. (4S,5R)-4-methyl-5-phenyloxazolidin-2-one (1.50 18 g, 8.50 mmol) was added and the resulting turbid mixture was stirred at ambient 19 temperature for five days. The mixture was filtrated and concentrated under reduced pressure to give a crude product containing the desired product as a mixture of two 21 diastereomers. The residue was purified by flash chromatography on silica gel using 15%
22 ethyl acetate in heptane as eluent. The two diastereomers were separated and the 23 appropriate fractions were concentrated. (4S,5R)-3-((S)-2-((5Z,8Z,11Z,14Z,17Z)-icosa-24 5,8,11,14,17-pentaenyloxy)butanoy1)-4-methy1-5- phenyloxazolidin-2-one eluted first and was obtained in 1.1 9(40% yield) as an oil. (4S,5R)-3-((R)-2-((57,87,11Z,147,17Z)-icosa-26 5,8,11,14,17-pentaenyloxy)butanoy1)-4-methy1-5-phenyloxazolidin-2-one was obtained in 27 0.95 g (34% yield) as an oil.
28 [057] (4S,5R)-3-((S)-2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-29 pentaenyloxy)butanoy1)-4-methy1-5-phenyloxazolidin-2-one (El ):1H-NMR
(300 MHz, CDCI3): b 0.90 (d, 3H), 1.00 (t, 3H), 1.07 (t, 3H), 1.45-1.57 (m, 2H), 1.62-1.76 (m, 3H), 1.85-22713041.1 CA 2,886,957 Blakes Ref: 72571/00022 1 1.95 (m, 1H), 2.05-2.15 (m, 4H), 2.87 (m, 8H), 3.39 (m, 1H), 3.57 (m, 1H), 4.85-4.92 (m, 2 2H), 5.30-5.45 (m, 10H), 5.75 (d, 1H), 7.32 (m, 2H), 7.43 (m, 3H).
3 [058] (4S,5R)-3-((R)-2-((5Z,8Z,11Z,14Z,17Z)-icosa-5, 8,11,14,17-4 pentaenyloxy)butanoyI)-4-methyl-5-phenyloxazolidin-2-one (E2): 1H-NMR
(300 MHz, CDCI3): 6 0.98 (d, 3H), 0.99 (t, 3H), 1.08 (t, 3H), 1.40-1.52 (m, 2H), 1.55-1.75 (m, 3H), 1.80-6 1.90 (m, 1H), 2.05-2.15 (m, 4H), 2.84 (m, 8H), 3.39 (m, 1H), 3.56 (m, 1H), 4.79 (pent, 1H), 7 4.97 (dd, 1H), 5.30-5.45 (m, 10H), 5.71 (d, 1H), 7.33 (m, 2H), 7.43 (m, 3H).
8 [059] Example 4: Preparation of (S)-24(52,8Z,11Z,14Z,17Z)-icosa-9 5,8,11,14,17-pentaenyloxy)butanoic acid:
OH
11 [060] Hydrogen peroxide (35% in water, 0.75 mL, 8.54 mmol) and lithium 12 hydroxide monohydrate (0.18 g, 4.27 mmol) was added to a solution of (45,5R)-34(S)-2-13 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoyI)-4-methyl-14 phenyloxazolidin-2-one (1.10 g, 2.13 mmol) in tetrahydrofuran (12 mL) and water (4 mL) held at 0 C under nitrogen. The reaction mixture was stirred at 0 C for 30 minutes. 10%
16 Na2S03 (aq) (30 mL) was added, the pH was adjusted to -2 with 2M HCI and the mixture 17 was extracted twice with heptane (30 mL). The combined organic extract was dried 18 (Na2SO4), filtered and concentrated. The residue was subjected to flash chromatography 19 on silica gel using increasingly polar mixtures of heptane and ethyl acetate (98:8 -> 1:1) as eluent. Concentration of the appropriate fractions afforded 0.48 g (60 %
yield) of the title 21 compound as an oil. 1H-NMR (300 MHz, CDCI3): 6 0.90-1.00 (m, 6H), 1.48 (m, 2H), 1.65 22 (m, 2H), 1.85 (m, 2H), 2.10(m, 4H), 2.80-2.90 (m, 8H), 3.55 (m, 1H), 3.60 (m, 1H), 3.88 (t, 23 1H), 5.35-5.45 (m, 10H); MS (electrospray): 373.3 [M-H]; Rik -37 (c=0.104, ethanol).
24 [061] Example 5: Preparation of (R)-2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoic acid:

27 [062] Hydrogen peroxide (35% in water, 0.65 mL, 7.37 mmol) and lithium 28 hydroxide monohydrate (0.15 g, 3.69 mmol) was added to a solution of (4S,5R)-3-((R)-2-29 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)butanoyI)-4-methyl-23872079.1 CA 2,886,957 Blakes Ref: 72571/00022 1 phenyloxazolidin-2-one (0.95 g, 1.84 mmol) in tetrahydrofuran (12 mL) and water (4 mL) 2 held at 0 C under nitrogen. The reaction mixture was stirred at 0 C for 30 minutes. 10%
3 Na2S03 (aq) (30 mL) was added, the pH was adjusted to 2 with 2M HCI and the mixture 4 was extracted twice with heptane (30 mL). The combined organic extract was dried (Na2SO4), filtered and concentrated. The residue was subjected to flash chromatography on 6 silica gel using increasingly polar mixtures of heptane and ethyl acetate (98:8 -> 50:50) as 7 eluent. Concentration of the appropriate fractions afforded 0.19 g (29%
yield) of the title 8 compound as an oil. 1H-NMR (300 MHz, CDC13); 50.90-1.00 (m, 6H), 1.48 (m, 2H), 1.65 9 (m, 2H), 1.85 (m, 2H), 2.10 (m, 4H), 2.80-2.90 (m, 8H), 3.55 (m, 1H), 3.60 (m, 1H), 3.88 (t, 1H), 5.35-5.45 (m, 10H); MS (electrospray): 373.3 EM-H]-; [a]D -31 (c=0.088, ethanol).
11 [063] Example 6: Preparation of fert-butyl 2-((5Z,8Z,11Z,142,172)-icosa-12 6,8,11,14,17-pentaenyloxy)propanoate:

14 [064] A mixture of (5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-ol, (1.00 g, 3.47 mmol), tetrabutylammonium chloride (0.24 g, 0.87 mmol) and t-butyl 2-bromo-16 propionate (3.62 g, 17.3 mmol) was dissolved in toluene (36 mL) and placed under 17 nitrogen. An aqueous solution of sodium hydroxide (50%, 8 mL) was added slowly under 18 vigorous stirring and the resulting mixture was stirred at ambient temperature for twenty 19 hours. Water was added and the mixture was extracted three times with ether. The combined organic extract was washed with brine, dried (Na2SO4), filtered and 21 concentrated. The residue was purified by flash chromatography on silica gel using 2%
22 ethyl acetate in heptane as eluent. Concentration of the appropriate fractions afforded 23 1.40 g (90% yield) of the title compound as an oil. 1H-NMR (300 MHz, CDCI3): 50.95 (t, 24 3H), 1.41 (d, 3H), 1.48 (s, 9H), 1.48-1.66 (m, 4H), 2.05 (m, 4H), 2.83 (m, 8H), 3.35 (m, 1H), 3.55 (m, 1H), 3.79 (q, 1H), 5.32-5.44 (m, 10H).
26 [065] Example 7: Preparation of 2-((5Z,8Z,11Z,14Z,17Z)-icosa-6,8,11,14,17-27 pentaenyloxy)propanoic acid:

23872079.1 CA Application Blakes Ref: 72571/00022 1 [066] Trifluoroacetic acid (2 mL) was added to a solution of 2-2 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)propanoate (1.40 g, 3.36 mmol) in 3 dichloromethane (10 mL) held under nitrogen and the reaction mixture was stirred at room 4 temperature for three hours. Diethyl ether (50 mL) was added and the organic phase was washed with water (30 mL), dried (Na2SO4) and concentrated. The residue was subjected 6 to flash chromatography on silica gel using increasingly polar mixtures of heptane, ethyl 7 acetate and formic acid (95:5:0.25 ->80:20:1) as eluent. Concentration of the appropriate 8 fractions afforded 0.67 g of slightly impure product. This material was dissolved in heptane 9 (15 mL), washed three times with water (5 mL). dried (Na2SO4), filtered and concentrated to afford 0.50 g (41% yield) of the title compound as an oil. 1H-NMR (300 MHz, CDCI3):
11 0.99 (t, 3H), 1.40-1.48 (m, 5H), 1.67 (m, 2H), 2.09 (m, 4H), 2.80-2.60 (m, 8H), 3.53 (m, 12 2H), 4.01 (q, 1H), 5.31-5.47 (m, 10H); MS (electrospray): 359.2 [M-H].
13 [067] Example 8: Preparation of tert-butyl 2-((5Z,8Z,11Z,14Z,17Z)-icosa-14 5,8,11,14,17-pentaenyloxy)-2-methylpropanoate:

-16 [068] A mixture of (5Z,87,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-ol, (0.83 g, 17 3.14 mmol), tetrabutylammonium chloride (0.24 g, 0.85 mmol) and t-butyl 2-bromo 18 isobutyrate (3.509, 15.7 mmol) was dissolved in toluene (15 mL) and placed under 19 nitrogen. An aqueous solution of sodium hydroxide (50%, 5 mL) was added slowly under vigorous stirring at room temperature. The resulting mixture was heated to 60 C and stirred 21 for six hours. The mixture was cooled, added water and extracted three times with ether.
22 The combined organic extract was washed with brine, dried (Na2SO4), filtered and 23 concentrated. The residue was purified by flash chromatography on silica gel using a 24 gradient of 5-10% ethyl acetate in heptane as eluent. Concentration of the appropriate fractions afforded 0.60 g (44% yield) of the title compound as an oil. MS
(electrospray):
26 453.3 [M+Na].
27 [069] Example 9: Preparation of 2-((5Z,BZ,11Z,14Z,17Z)-icosa-5,8,11,14,17-28 pentaenyloxy)-2-methylpropanoic acid:
Ar-011 - -22713041.1 CA Application Blakes Ref: 72571/00022 1 [070] Trifluoroacetic acid (5 mL) was added to a solution of tert-butyl 2-2 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaenyloxy)-2-methylpropanoate (600 mg, 1.39 3 mmol) in dichloromethane (20 mL) under nitrogen and the reaction mixture was stirred at 4 room temperature for two hours. Water was added and the aqueous phase was extracted twice with dichloromethane. The combined organic extract was washed with brine, dried 6 (Na2SO4), filtered and concentrated. The residue was purified by flash chromatography on 7 silica gel using a mixture of heptane, ethyl acetate and formic acid (80:20:1) as eluent. The 8 appropriate fractions were concentrated and the residue (135 mg) was purified further by 9 flash chromatography on silica gel using a gradient of 5-10% of a mixture of ethyl acetate and formic acid (95:5) in heptane as eluent. Concentration of the appropriate fractions 11 afforded 80 mg slightly impure product. This material was dissolved in heptane (5 mL), 12 washed twice with water (5 mL), dried (Na2SO4), filtered and concentrated to afford 40 mg 13 (8% yield) of the title compound as an oil. 1H-NMR (300 MHz, 0DCI3): 5 0.99 (t, 3H), 1.47 14 (s, 6H), 1.64 (m, 2H), 2.07 (m, 4H), 2.81-2.88 (m, 8H), 3.46 (t, 2H), 5.29-5.44 (m, 10H); MS
(electrospray): 373.3 [M-H].
16 [071] Example 10: Preparation of tert-butyl 2-ethy1-2-((5Z,8Z,11Z,14Z,17Z)-17 icosa-5,8,11,14,17-pentaen-1-yloxy)butanoate:

19 [072] tert-Butyl 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yloxy)butanoate (480 mg, 1.11 mmol) was added dropwise over 30 minutes to a solution of 21 lithium diisopropylamine (LDA) (2.0 M, 750 L, 1.50 mmol) in dry tetrahydrofuran (10 mL) 22 held at -70 C under nitrogen. The reaction mixture was stirred for 30 minutes. Ethyl iodide 23 (312 mg, 2.00 mmol) was added in one portion and the resulting mixture was warmed to 24 ambient temperature during 1 hour. The reaction mixture was stirred at ambient temperature for 17 hours. The mixture was poured into saturated NH4CI (aq.) (50 mL) and 26 extracted with heptane (2 x 50 mL). The combined organic phases was washed 27 successively with brine (50 mL), 0.25 M HCI (50 mL) and brine (50 mL), dried (MgSO4), 28 filtered and concentrated. The residue was purified by flash chromatography on silica gel 29 using increasingly polar mixtures of heptane and ethyl acetate (100:0 ->
95:5) as eluent.
Concentration of the appropriate fractions afforded 343 mg (67% yield) of the title 31 compound as an oil. 11-I NMR (300 MHz, CDCI3): 5 0.84 (t, 6H), 0.99 (td, 3H), 1.35-1.55 (m, 22713041.1 = CA 02886957 2015-04-01 CA Application Blakes Ref: 72571/00022 1 11 H), 1.54-1.69 (m, 2H), 1.68-1.87 (m, 4H), 1.99-2.24 (m, 4H), 2.74-2.99 (m, 8H), 3.31 (t, 2 2H), 5.23-5.52 (m, 10H); MS (electrospray): 401.3 [M-1]-.
3 [073] Example 11: Preparation of 2-ethy1-2-((5Z,8Z,11Z,14Z,17Z)-icosa-4 5,8,11,14,17-pentaen-1-yloxy)butanoic acid:
_ 1 6 [074] A mixture of formic acid (5 ml) and tert-butyl 2-ethyl-2-7 ((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yloxy)butanoate (250 mg, 0.55 mmol) 8 was stirred vigorously under nitrogen at room temperature for 4.5 hours.
The formic acid 9 was removed in vacuo. The residue was purified by flash chromatography on silica gel using increasingly polar mixtures of heptane and ethyl acetate (100:0 ->
80:20) as eluent.
11 Concentration of the appropriate fractions afforded 163 mg (74% yield) of the title 12 compound as an oil. 1H NMR (300 MHz, CDCI3): 5 0.86 (t, 6H), 0.99 (t, 3H), 1.36-1.57 (m, 13 2H), 1.68 (dd, 2H), 1.73-1.98 (m, 4H), 2.11 (tt, 4H), 2.70-3.01 (m, 8H), 3.39 (t, 2H), 5.20-14 5.56 (m, 10H). MS (electrospray): 481.4 [M+Na]*.
[075] Example 12: Preparation of ethyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-16 5,8,11,14,17-pentaen-1-yl)oxy)butanoate:
17 oio 18 [076] Dicyclohexylmethanediimine (DCC) (304 mg, 1.47 mmol) and N,N-19 dimethylpyridin-4-amine (DMAP) (10 mg, 0.067 mmol) were added to a stirred solution of 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butaroic acid (501.3 mg, 1.335 21 mrrol) in dichloromethane (DCM) (4 mL) at 0 C under N2-atmosphere. The mixture was stirred 22 for 5 minutes, before ethanol (Et0H) (0.16 mL, 2.67 mmol) was added. The resulting mixture 23 was stirred at room temperature for 20 hours. The reaction mixture was purified by flash 24 chromatography on silica gel using increasingly mixtures of heptane and ethyl acetate (100:0 99:1) as eluent. Concentration of the appropriate fractions afforded 473 mg (88% yield) of the 26 title compound as an oil. 1H NMR (300 MHz, chloroform-d) 5 0.95 (2 x t, 6H), 1.37-1.48 (m, 2H), 27 1.54-1.79 (m, 4H), 2.01-2.10 (m, 4H), 2.77-2.84 (m, 8H), 3.27-3.34 (m, 1H), 3.53-3.60 (m, 1H), 28 3.69-3.73 (dd, 1H), 4.13-4.24 (m, 2H), 5.25-5.33 (m, 10H), MS
(electrospray): 425.3 [M+Na];
29 HRMS (electrospray): Found 425.3021 [M Na], calcd. for [C26H4203+Nalt 425.3031.

22713041.1 CA Application Blakes Ref: 72571/00022 1 [077] Example 13: Preparation of isopropyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-2 5,8,11,14,17-pentaen-1-yl)oxy)butanoate 3 o 4 [078] DOC (310 mg, 1.47 mmol) and DMAP (9 mg, 0.067 mmol) were added to a stirred solution of 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid 6 (501 mg, 1.335 mmol) in DCM (4 mL) at 0 C under N2-atmosphere. The mixture was stirred for 7 5 minutes, before isopropanol (rPrOH) (0.16 mL, 2.67 mmol) was added. The resulting mixture 8 was stirred at room temperature for 20 hours. The mixture was filtered and concentrated in 9 vacuo. The residue was added heptane (50 mL), filtered and concentrated in vacuo. The residue was purified by flash chromatography on silica gel using 1 % ethyl acetate in heptane as 11 eluent, Concentration of the appropriate fractions afforded 496 mg (89%
yield) of the title 12 compound as an oil. 1E1 NMR (300 MHz, CDCI3): 6 0.97(2 x t, 6H), 1.25 (m, 6H), 1.42-1.50 (m, 13 2H), 1.61-1.70 (m, 2H), 1.70-1.77 (m, 2H), 2.05-2.12 (m, 4H), 2.79-2.86 (m, 8H), 3.29-3.34 (m, 14 1H), 3.54-3.59 (m, 1H), 3.67-3.71 (m, 1H), 5.06-5.10 (m, 1H), 5.31-5.42 (m, 10 H); MS
(electrospray): 439.3 [M+Na].
16 [079] Example 14: Preparation of methyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-17 5,8,11,14,17-pentaen-1-yl)oxy)butanoate:

19 [080] Sulphuric acid (0.049 :711, 0.918 mmol) was added to a solution of 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid ((385 mg, 1,028 21 mmol) in methanol (20 ml) at room temperature under N2-athmosphere and the resulting mixture 22 was stirred at room temperature overnight. MS (electrospray): 389.3 [M+1]+, 23 [081] Example 15: Preparation of butyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-24 5,8,11,14,17-pentaen-1-yl)oxy)butanoate:
26 [082] Sulphuric acid (0.049 ml, 0.918 mmol) was added to a solution of 2-27 (((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid ((33 g, 88 mmol) in 22713041.1 CA Application Blakes Ref: 72571/00022 1 butan-1-ol (400 mL, 4.37 mol) at room temperature under N2-atmosphere and the reaction 2 mixture was stirred for 120 hours. Heptane (400 mL) and ethyl acetate (400 mL) was added, 3 and the solution was washed with saturated aq. NaHCO3 (3x300 mL) and water (2x300 mL).
4 The combined aqueous phase was extracted with heptane/ether (1:1) (2x300 mL). The combined organic phase was dried (Na2SO4), filtered and concentrated in vacua.
The residue 6 was purified by flash chromatography using increasingly mixtures of heptane and ethyl acetate 7 (99:1 4 96:4) as eluent. Concentration of the appropriate fractions afforded 26.3 g (67% yield) 8 of title compound as an oil. 1H NMR (400 MHz, CD0I3) 5 0.93-1.02 (m, 9H), 1.36-1.51 (m, 4H), 9 1.60-1.70 (m, 4H), 1.72-1,84 (m, 2H), 2.05-2.16 (m,4H), 2.78-2.92 (m, 8H), 3.28-3.39 (m, 1H), 3.54-3.65 (m, 1H), 3.70-3.82 (m, 1I-1), 4.08-4.24 (m, 2H), 5.27-5.48 (m, 10H), MS (electrospray):
11 453.2 [M+Na].
12 [083] Example 16: Preparation of 2,3-dihydroxypropyl 2-(((5Z,8Z,11Z,14Z,17Z)-13 icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate:
14 [084] Step a) Preparation (2,2-dimethy1-1,3-dioxolan-4-yl)methyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate oX/r i=/

17 [085] 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid (25 18 g, 66,7 mmol) and DMAP (8.15 g, 66.7 mmol) were added to a solution of 2,2-dimethy1-1,3-19 dioxolane-4-methanol (7.54 mL, 60.7 mmol) in chloroform (150 mL) under nitrogen atmosphere.
A solution of DCC (13.77 g, 66,7 mmol) in chloroform (65 mL) was then added drop wise at 21 ambient temperature. The mixture was stirred overnight and concentrated in vacua The 22 residue was purified by flash chromatography on silica gel using increasingly polar mixtures of 23 10 % ethyl acetate in heptane as eluent. Concentration of the appropriate fractions afforded 24 19.6 g (66% yield) of the title product as an oil. 1H NMR (300 MHz, CDCI3) 6 0.99 (t, 6H), 1.37-1.40 (m, 3H), 1.41-1.53 (m, 5H), 1.59-1.71 (m, 2H), 1.72-1.85 (m, 2H), 2.05-2.14 (m, 4H), 2.74-26 2.95 (m, 8H), 3.31-3.38 (m, 1H), 3.57-3.65(m, 1H), 372-3.86(m, 2H), 4.07-4.12 (m, 1H), 4.15-27 4.27 (m, 2H), 4.29-4.40 (m, 1H), 5.23-5.50 (m, 10H). MS (electrospray):
511.3 [M+Na].
28 [086] Step b) Preparation of 2,3-dihydroxypropyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-29 5,8,11,14,17-pentaen-1-yl)oxy)butanoate 22713041.1 CA Application Blakes Ref: 72571/00022 ¨ ¨ 0 2 [087] To a solution of (2,2-dimethy1-1,3-dioxolan-4-yl)methyl 2-3 (((5Z,8Z,117,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate (27.5 g, 56.3 mmol) in 4 dioxane (280 mL) at room temperature under nitrogen was added aq. HCI
(37% (w/w), 28 mL, 341 mmol) and the mixture was stirred for 60 minutes. The mixture was then carefully poured 6 into sat. aq. NaHCO3 (500 mL) and extracted with Et0Ac (2x300 mL). The organic phase was 7 washed with 1M HG] (200 mL), brine (200 mL), dried (Na2SO4), filtered and concentrated in 8 vacuo. The residue was purified by flash chromatography on silica gel using heptane and ethyl 9 acetate (50:50) as eluent. Concentration of the appropriate fractions afforded 19 g of the title product as an oil, contaminated with -10% of the isomer 1,3-dihydroxypropan-2-y12-11 (((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate. The material was mixed 12 with 1.35 gram of another batch, before further purified by preparative HPLC. An isocratic 17:83 13 mixture of water/acetonitrile (9:1) to acetonitrile (100%) was used as eluent. Concentration of 14 the appropriate fractions afforded 11.3 g (38% yield) of the title product as an oil. 'H NMR (300 MHz, CDCI3) 5 0.97-1.03 (m, 6H), 1.41-1.51 (m, 2H), 1.59-1.69 (m, 2H), 1.72-1.87 (m, 2H), 16 2.05-2.14 (m, 5H), 2.56 (s, 1H), 2.73-2.94 (m, 8H), 3.33-3.40 (m, 1H), 3.55-3.68 (m, 2H), 3.69-17 3.77 (m, 1H), 3.79-3.85 (m, 1H), 3.93-4.03 (m, 1H), 4.15-4.37 (m, 2H), 5.25-5.51 (m, 10H). MS
18 (electrospray): 471.3 [M+Na].
19 [088] Example 17: Preparation of 1,3-dihydroxypropan-2-yi 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate 21 [089] Step a) Preparation of oxiran-2-ylmethyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-22 5,8,11 ,14,17-pentaen-1-yl)oxy)butanoate /0\
offo 24 [090] A mixture of 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-yl)oxy)butanoic acid (800 mg, 2.14 mmol), glycidol (0.17 mL, 2.56 mmol), 1-(3-26 dimethylaminopropy1)-3-ethylcarbodiimide hydrochloride (EDC*HCI) (491 mg, 2.56 mmol) and 4-27 dimethylaminopyridine (DMAP) (313 mg, 2.56 mmol) in dry DCM (7 mL) was stirred at room 28 temperature under N2-atmosphere. The reaction mixture was concentrated in vacua The 29 residue was purified by flash chromatography on silica gel using increasingly polar mixtures of 22713041.1 CA Application Blakes Ref: 72571/00022 1 heptane and ethyl acetate (99:1 --> 95:5) as eluent. Concentration of the appropriate fractions 2 afforded 527 mg (57% yield) of the title product as an oil. 1H NMR (400 MHz, 000I3) 5 0.94-3 0.98 (m, 6H), 1.40-1.44(m, 2H), 1.57-1.64(m, 2H), i.70-1.82(m, 2H), 2.02-2.12 (m, 4H), 2.63 4 (bs, 1H), 2.78-2.84 (m, 9H), 3.20 (bs, 1H), 3.30-3.35 (m, 1H), 3.55-3.61 (m, 1H), 3.77-3.80 (m, 1H), 3.94-4.01 (m, 1H), 4.42-4.48 (m, 1H), 5.36-5.26 (m, 10H). MS
(electrospray): 453.3 6 [M+Na].
7 [091] Step b) Preparation of 2-((2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-8 1-yl)oxy) butanoyl)oxy)propane-1 ,3-diy1 bis(2,2,2-trifluoroacetate) [092] Trifluoroacetic anhydride (TFAA) (0.55 mL, 3.96 mmol) in dry DCM (3 mL) was 11 added portion wise to a precooled solution of oxiran-2-ylmethyl 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-12 5,8,11,14,17-pentaen-1-yl)oxy)butanoate (286 mg, 0.66 mmol) in dry DCM
(3 mL) at -20 C
13 under N2-atmosphere. The cooling bath was removed and the mixture was stirred for 19 hours 14 at ambient temperature, before reaction mixture was concentrated in vacuo pressure. The residue was dissolved in toluene (6 mL) and passed through a pad of silica (6.5 g) eluting with 16 toluene (150 mL). Concentration in vacuo to afforded 357 mg (84% yield) of the title compound 17 as an oil. 1H NMR (400 MHz, CDCI3) 50.95 (2xt, 6H), 1.38-1.45 (m, 2H), 1.57-1.63 (m, 2H), 18 1.66-1.78 (m, 2H), 2.09-2.02 (m, 4H), 2.78-2.84 (m, 8H), 3.27-3.33 (m, 1H), 3.51-3.56(m, 1H), 19 3.77 (dd, 1H), 4.30-4.53 (m, 2H), 4.60-4.69 (m, 2H), 5.17-5.43 (m, 10H), 5.43-5.55 (m, 1H). MS
(electrospray): 661.1 [M+Na].
21 [093] Step c) Preparation of 1,3-dihydroxypropan-2-y12-(((5Z,8Z,11Z,14Z,17Z)-icosa-22 5,8,11,14,17-pentaen-1-yl)oxy)butanoate oco.,1))H
n 24 [094] A solution of pyridine (0.4 m1_, 4.95 mmol) and methanol (0.3 mL, 7.41 mmol) in pentane/DCM (2:1) (4.5 mL) was added drop wise to a solution of 2-((2-(((5Z,8Z,11Z,14Z,177)-26 icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoyl)oxy)propane-1,3-diy1 bis(2,2,2-trifluoroacetate) 27 (354 mg, 0.552 mmol) in pentane/DCM (2:1) (5 mL) cooled to -20 C under N2-atmosphere.
28 The cooling bath was removed and the mixture was stirred for 3 hours at room temperature, 29 before concentrated in vacuo. The residue was purified by flash chromatography on silica gel 22713041.1 CA Application Blakes Ref: 72571/00022 1 using increasingly polar mixtures of heptane and ethyl acetate (95:5 -> 90:10 80:20 -> 50:50) 2 as eluent. Concentration of the appropriate fractions afforded 223 mg of the title product as 3 crude oil. Purification by preparative HPLC afforded 58 mg (22% yield) of the title compound as 4 an oil. 1H NMR (400 MHz, CDCI3) O 0.95 (t, 3H), 0.96 (t, 3H), 1.38-1.45 (m, 2H), 1.54-1.64 (m, 2H), 1.67-1.84 (m, 2H), 2.01-2.09 (m, 4H), 2.45 (bs, 2H), 2.83-2.77 (m, 8H), 3.36-3.30 (m, 1H), 6 3.60-3.55 (m, 1H), 3.84-3.78 (m, 5H), 4.98-4.93 (m, 1H), 5.65-5.09 (m, 10H). MS (electrospray):
7 471.1 [M+Nar.
8 [095] Example 18: Preparation of 3-hydroxypropane-1,2-diy1 bis(2-9 (((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate) [096] Step a) Preparation of tert-butyl((2,2-dimethy1-1,3-dioxolan-4-11 yl) methoxy)dimethylsi lane \--OTBDMS
13 [097] fert-Butyl-chlorodimethylsilane (14.41 g, 91 mmol) was added to a solution of 14 (2,2-dimethy1-1,3-dioxolan-4-yl)methanol (10 g, 76 mmol) and imidazole (7.73g, 114 mmol) in THF (100 mL) at ambient temperature under nitrogen atmosphere. The mixture was stirred for 16 1.5 hours, poured into water (200 mL) and extracted with tert-butyl methyl ether (2x150 mL).
17 The phases were separated and the organic layer was washed with water (100 mL), brine (100 18 mL), dried (Na2SO4), filtered and concentrated in vacuo. The residue was purified by flash 19 chromatography on silica gel using 3% ethyl acetate in heptane as eluent. Concentration of the appropriate fractions afforded 18 g (97% yield) of the title compound as an oil. 1H NMR (300 21 MHz, CDCI3) 6 0.02-0.05 (m, 6H), 0.85-0.89 (m, 9H), 1.31-1.35 (m, 3H), 1.35-1.40 (m, 3H), 22 3.50-3.60 (m, 1H), 3.63-3.72 (m, 1H), 3.75-3.85 (m, 1H), 3.96-4.05 (m, 1H), 4.07-4.18 (m, 1H).
23 MS (electrospray): 229.2 [M+Na].
24 [098] Step b) Preparation of 3-((tert-butyldimethylsilyl)oxy)propane-1,2-diol HO OH
OTBDMS
26 [099] To a solution of tert-butyl((2,2-dimethy1-1,3-dioxolan-4-yl)methoxy)-27 dimethylsilane in chloroform (60 mL) was added FeCI3x6H20 absorbed on silica gel (30 g, 11.9 28 mmol) and the mixture was stirred overnight. The mixture was filtered and concentrated in 29 vacuo. The residue was purified by flash chromatography on silica gel using increasingly polar 22713041.1 CA Application Blakes Ref: 72571/00022 1 mixtures of heptane and ethyl acetate (50:50 ¨> 25:75) as eluent.
Concentration of the 2 appropriate fractions afforded 760 mg (9% yield) of the title compound as an oil. 1H NMR (300 3 MHz, CDCI3) 5 0.09-0.12 (m, 6H). 0.91- 0.95 (m, 9H), 2.11-2.17 (m, 1H), 2.60 (d, 1H), 3.57-4 3.85 (m, 5H). MS (electrospray): 229.2 [M+Na].
[0100] Step c) Preparation of 3-((tert-butyldimethylsilyl)oxy)propane-1,2-diy1 bis(2-6 (((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate) _ oOTBDMS

8 [0101] To a solution of 3-((tert-butyldimethylsilyl)oxy)propane-1,2-diol (0.91 g, 4.41 9 mmol) in DMF (20 ml) under N2-atmosphere at ambient temperature were added 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid (3.47 g, 9.3 mmol), 11 DMAP (1.13 g, 9.3 mmol), 1-(3-dimethylaminopropy1)-3-ethylcarbodiimide hydrochloride (DCI) 12 (1.776 g, 9.26 mmol) and dry DCM (60 m1). The mixture was stirred overnight, before the 13 reaction mixture was diluted with diethyl ether (200 mL). The mixture was washed with 1M HCI
14 (100 mL) and brine (100 mL), dried (Na2SO4), filtered and concentrated in vacuo. The residue was purified by flash chromatography on silica gel using 3% ethyl acetate in heptane as eluent.
16 Concentration of the appropriate fractions afforded 2.26 g (56% yield) of the title compound as 17 an oil. 1H NMR (300 MHz, CDCI3) 6 0.08 (s, 6H), 0.90 (d, 9H), 0.95-1.03 (m, 12H), 1.40-1.52 18 (m, 4H), 1.58-1.69(m, 4H), 1.70-1.83(m, 4H), 2.04-2.15(m, 8H), 2.77-2.92 (m, 16H), 3.27-3.37 19 (m, 2H), 3.57-3.67 (m, 2H), 3.72-3.80 (in, 4H), 4.14-4.32 (m, 1H), 4.41-4.56 (m, 1H), 5.09-5.22 (m, 1H), 5.23-5.49 (m, 20H). MS (electrospray): 941.6 [M+Na].
21 [0102] Step d) Preparation of 3-hydroxypropane-1.2-diy1 bis(2-(((5Z,8Z,11Z,14Z,17Z)-22 icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate) o o 24 [0103] To a solution of 3-((tert-butyldimethylsilypoxy)propane-1,2-diy1 bis(2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate) (2.26 g, 2.46 mmol) in 26 dioxane (100 mL) was added aq. HC1 (37% (w/w, 2 mL) and the mixture was stirred for 3 hours 27 under nitrogen atmosphere at ambient temperature, before concentrated in vacuo. The residue 22713041.1 CA Application Blakes Ref: 72571/00022 1 was purified by flash chromatography on silica gel using 15 `)/0 ethyl acetate in heptane as 2 eluent. Concentration of the appropriate fractions afforded 0.83 g (42%
yield) of the title 3 compound as an oil. 1H NMR (300 MHz, 00CI3) 5 0.96-1.03 (m, 12H), 1.40-1.53 (m, 4H), 1.58-4 1.68(m, 4H), 1.70-1.85 (m, 4H), 1.87-2.01 (m, 1H), 2.05-2.15(m, 8H), 2.75-2.95 (m, 16H), 3.28-3.41 (m, 2H), 3.56-3.65(m, 2H), 3.73-3.85(m, 4H), 4.24-4.37(m, 1H), 4.42-4.53(m, 1H), 5.14-6 5.23 (m. 1H), 5.26-5.51 (m, 20H). MS (electrospray); 827.5 [M+Na].
7 [0104] Example 19: Preparation of 2-hydroxypropane-1,3-diy1 bis(2-8 (((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate):
9 [0105] Step a) 2-oxopropane-1,3-diy1 bis(2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14.17-pentaen-1-yl)oxy)butanoate) 12 [0106] 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid 13 (5.0 g, 13.4 mmol) and DMAP (1,63 g, 13.4 mmol) were added to a solution of 1,3-14 dihydroxyacetone dimer (1.1459, 6.36 mmol) in chloroform (25 mL) under nitrogen atmosphere.
A solution of DCC (2.75 g, 13.35 mmol) in chloroform (10 mL) was then added drop wise at 16 ambient temperature. The mixture was stirred overnight at room temperature, before 17 concentrated in vacuo. The residue was purified by flash chromatography on silica gel using 18 increasingly polar mixtures of heptane and ethyl acetate (90:10 88:12) as eluent.
19 Concentration of the appropriate fractions afforded 2.4 g (47% yield) of the title compound as an oil. 'H NMR (300 MHz, CD0I3) 50.97-1.06 (m, 12H). 1.38-1.53 (m, 4H), 1.57-1.73 (m, 4H), 21 1.73-1.96 (m, 4H), 2.03-2.17 (m, 8H), 2.76-2.92 (m, 16H), 3.35-3.42 (m, 2H), 3.63-3.70 (m, 2H), 22 3.89 (dd, 2H), 4.75-4.93 (m, 4H), 5.27-5.49 (m, 20H). MS (electrospray):
827.5 [M-FNar.
23 [0107] Step b) 2-hydroxypropane-1,3-diy1 bis(2-(((5Z,8Z,11Z,14Z,17Z)-icosa-24 5,8,11,14,17-pentaen-1-yl)oxy)butanoate) ecOH
.r y0 26 [0108] NaBH4 (0.336 g, 8.87 mmol) was added carefully to a solution of 2-oxopropane-27 1,3-diy1 bis(2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1 -yl)oxy)butanoate) (3.24 g, 28 4.03 mmol) in THF (55 mL) and water (4 mL) at 0 C. The mixture was stirred for 15 minutes at 29 0 CC. Acetic acid (1 mL) was then added carefully followed by ethyl acetate (100 mL). The 22713041.1 CA Application Blakes Ref: 72571/00022 1 mixture was washed with water (100 mL), saturated aq. NaHCO3 (100 mL) and brine, before 2 dried (Na2SO4), filtered and concentrated in vacua The residue was combined with another 3 batch of the material before purified by flash chromatography on silica gel using 15% ethyl 4 acetate in heptane as eluent. Concentration of the appropriate fractions afforded 1.62 g (50%
yield) of the title compound as an oil. 1H NMR (300 MHz, CDCI3) 5 0.97-1.03 (m, 12H), 1.41-6 1.52 (m, 4H), 1.58-1.69 (m, 6H), 1.71-1.87 (m, 4H), 2.05-2.14 (m, 8H), 2.38-2.42 (m, 1H). 2.78-7 2.92 (m, 16H), 3.32-3.39 (m, 2H), 3.57-3.64 (m, 2H), 3.80-3.84 (m, 2H), 4.05-4.34 (m, 5H), 5.26-8 5.49 (m, 20H). MS (electrospray): 827.5 [M+Na].
9 [0109] Example 20: Preparation of propane-1,2,3-triy1 tris(2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)hutanoate) 0 o ¨

12 [0110] 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid 13 (4.0 g, 10.7 mmol), 4-dimethylaminopyridine (1.305 g, 10.7 mmol), 1-(3-dimethylaminopropyI)-3-14 ethylcarbodiimide hydrochloride (2.047 g, 10.7 mmol) and dry DCM (30 ml) was added to a solution of glycerol (0,173 ml, 2,373 mmol) in DMF (10 ml) under N2-atmosphere at room 16 temperature. The mixture was stirred overnight, before the reaction mixture was diluted with 17 diethyl ether (250 mL). The mixture was washed with aq. 1M HCI (100 mL) and brine (100 mL), 18 before dried (Na2SO4), filtered and evaporated in vacuo. The residue was purified by flash 19 chromatography on silica gel using 5% ethyl acetate in heptane as eluent. Concentration of the appropriate fractions afforded 2.1 g (73 % yield) of the title compound as an oil. 1H NMR (300 21 MHz, CDCI3) 0.91-1.05 (m, 18H), 1.40-1.52 (m, 6H), 1.57-1.69 (m, 6H), 1.69-1.86 (m, 6H), 22 2.01-2.17 (m, 12H), 2.69-2.96 (m, 24H), 3.27-3.38 (m, 3H), 3.53-3.67 (m, 3H), 3.73-3.81 (m, 23 3H), 4.17-4.27 (m, 2H), 4.37-4.54 (m, 2H), 5.28-5.47 (m, 30H). MS
(electrospray): 1183.8 24 [M+Na].
[0111] Example 21: Preparation of calcium 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-26 5,8,11,14,17-pentaen-1-yl)oxy)butanoate 22713041.1 CA Application Blakes Ref: 72571/00022 ¨ ¨
cw-- ¨ ¨ ¨ ¨

2 [0112] 2-(((5Z,8Z,11Z,14Z,17Z)-lcosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid 3 (1.87 g, 4.99 mmol, 93%) was mixed with CaCO3 (0.25 g, 2.50 mmol). Water (1 ml) was added 4 and the mixture was stirred with mechanical stirring at RT for 1 hour.
CO2 develops. Dense and homogeneous pasta was formed. With stirring, acetone (7 ml) was added. A solid materiel 6 separates. The solid materiel was filtered of and dried over nitrogen sealed and stored in the 7 fridge at 4 'C. Yield: 1.86 grams (95 %). The solid was not further characterized by analytical or 8 spectroscopic methods, but a few experiments indicating that the calcium salt has formed was 9 performed:
= The solid materiel melts on a hot plate below 100 C. No sharp melting point was 11 determined 12 = The material do not liberate CO2 on addition of acid, but "dissolves" and 13 precipitates as an oil 14 [0113] Example 22: Preparation of sodium 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate 16 [0114] 2-(((5Z,8Z,11Z,14Z,17Z)-lcosa-5,8,11 ,14,17-pentaen-1-yl)oxy)butanoic acid 17 (1.87g. 4.99 mmol, 93%) was mixed with NaHCO3 (0.420 g, 5.00 mmol).
Water (1 ml) was 18 added and the mixture was stirred with mechanical stirring at RT for 1 hour. CO2 develops, and 19 a thick homogeneous pasta was formed. With stirring, ethanol (7 ml) was added to the reaction flask. The sodium salt formed from 2-(((5Z,8Z,11Z,14Z,17Z)-lcosa-5,8,11,14,17-pentaen-1-21 yl)oxy)butanoic acid goes into solution upon addition of ethanol (7 m1).
Small amounts of 22 unreacted NaHCO3 was filtered of and the solution was evaporated to dryness. The crude 23 slightly viscous oil was evaporated two times with 96 % ethanol to remove traces of water.
24 [0115] Example 23: Preparation of 2-hydroxy-N,N,N-trimethylethan-1-aminium 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoate 26 [0116] Choline hydroxide (327.7 pL) in water was pipetted into a scintillation vial with 27 ca. 2.5mL MTBE and 7.5 mL of n-Heptane. Within a nitrogen chamber, 2-28 (((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic acid (500 mg, 95.8%) was 29 transferred into the vial. Within a nitrogen chamber ca.1.0 mL of water was added to the vial 22713041.1 CA Application Blakes Ref: 72571/00022 1 slowly and under stirring. The vial was then sealed. The reaction mixture was stirred for ca. 30 2 minutes. The formed 2-(((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yl)oxy)butanoic 3 acid choline salt was a rigid, gel-like material which was filtered on a Buchner funnel. The wet 4 material on the filter was washed 3 times using 1mL of MTBE. The washed material appeared as a rigid gel-like solid.
6 [0117] Example 24 Pre-clinical Study 7 [0118] Evaluation of apoC-Ill regulation in a dyslipidennic mouse model 8 (APOE*3Leiden transgenic mice) 9 [0119] The APOE*3Leiden transgenic mouse is expressing a variant of the human apolipoprotein E3 (APOE3), the APOE*3Leiden, in addition to the human apolipoprotein Cl 11 (APOC1). The APOE*3Leiden transgenic mice exhibit elevated plasma cholesterol and 12 triglyceride levels, mainly confined to the VLDL/LDL sized lipoprotein fraction (Van den 13 Maagdenberg AMJM et al, Transgenic mice carrying the apolipoprotein E3-Leiden gene exhibit 14 hyperlipoproteinemia, J Biol Chem 1993; 268:10540-10545). In contrast to normal wild-type mice, the APOE*3Leiden transgenic mice are highly responsive to diet and hypolipidemic drugs 16 affecting plasma VLDL and chylomicron levels (Van Vlijmen B et al, Diet-induced 17 hyperlipoproteinemia and atherosclerosis in apolipoprotein E3-Leiden transgenic mice, J Clin 18 Invest 1994; 93:1403-1410; Groot PHE, at al, Quantitative assessment of aortic atherosclerosis 19 in apoE3Leiden transgenic mice and its relationship to serum cholesterol exposure, Arterioscler Thromb Vasc Biol 1996; 16: 926-933). Consequently, this model is appropriate to evaluate 21 effects of lipid lowering drugs.
22 [0120] In this study, female APOE*3Leiden transgenic mice were put on a semi-23 synthetic Western-type diet (WTD; 15% cocoa butter, 40% sucrose and 0.25% cholesterol; all 24 wiw). After 4 weeks with this diet the plasma cholesterol level reached mildly elevated levels of about 12-15 mmo1/1. The mice were then sub-divided into groups of 10 mice each, matched for 26 plasma cholesterol, triglycerides and body weight (t=0). The test substances were tested at 0.3 27 mmol/kg bw/day and were administered orally as admix to the WTD. After 4 weeks, all animals 28 were sacrificed and serum and tissues were collected.
29 [0121] Liver tissues were stored in RNA later (Qiagen) at -80 C. Tissue was homogenized in RLT buffer with dithiothreitol (Qiagen) and RNA was isolated using the RNeasy 31 kit (Qiagen), following the manufacturer's procedure. The quality of the isolated RNA was tested 32 on a Bioanalyser (Agilent) showing RIN (RNA integrity number) values between 8.1 and 9.5 33 which indicates good quality. cDNA was synthesized by the "RNA to cDNA"
kit (Applied 22713041.1 CA Application Blakes Ref: 72571/00022 1 Biosystems). Gene expression was measure using Low Density Arrays (LDA, specific for 2 mouse RNA (Applied Biosystems)). Each sample was measured in 3 parallels, and the results 3 are presented as the mean value relative to control (WTD without addition). The fold change in 4 gene expression was calculated by the AACI method, using Rp1p0 as housekeeping gene and the mean of the control samples as calibrator.
6 [0122] The results shown in Figure 1 establish that mice fed Compound A
(Example 2) 7 have significantly lower apoC-III expression than mice fed a standard WTD
(P< 0.05, Student T-8 test). The effect of Compound A is more potent than the effect of reference Compound 12, an 9 EPA derivative prepared according to Example 20 of W02010/008299 having the following structure:
¨ sQ(OH

12 Reference Compound 12 13 [0123] In addition, the ability of both compounds to reduce plasma TG
was measured.
14 Both compounds reduced TG levels with 69% compared to control. This confirms that there is no direct correlation between the observed apoC-III reduction and TG lowering-effect.
16 [0124] Example 25 Clinical Studies 17 [0125] The apoC-III reducing properties of Compound A have been demonstrated in two 18 12-week studies and one 4-week study in patients with dyslipidemia. All three studies 19 demonstrated clinically and statistically significant reductions in apoC-III with Compound A
treatment.
21 [0126] Example 25A Population having sever hypertriglyceridemia 22 [0127] This study investigated patients with fasting plasma triglyceride levels above 23 500 mg/dL. The primary objective of this study was to evaluate the efficacy of Compound A
24 (Example 2) 600 mg once daily (QD) orally by assessment of the percentage change in triglycerides (TG) from baseline after 12 weeks of treatment. One of the secondary objectives 26 was to evaluate the impact of Compound A on plasma levels of apoC-Ill.
27 [0128] This Phase II, multicenter, proof of concept study consisted of a 6-to 8-week 28 screening period (which included a 4- or 6-week diet and lifestyle stabilization/washout period 29 and a 2-week TG qualifying period), and a 12-week, double-blind, randomized, parallel group, placebo-controlled treatment period.

22713041,1 CA Application Blakes Ref: 72571/00022 1 [0129] After confirmation of qualifying fasting TG values, eligible subjects entered the 2 12-week, randomized, double-blind treatment period. At Visit 4 (Week 0), subjects were 3 randomly assigned in a 1:1 ratio to 1 of the following treatment groups:
Compound A 600 mg 4 QD or placebo QD.
[0130] Approximately 43 subjects per treatment group (approximately 86 subjects 6 total) were to be randomized in this study. Stratification was by baseline TG level (700 mg/dL
7 or >700 mg/dL), statin use at randomization, and gender.
8 [0131] The population for this study was men and women (women of childbearing 9 potential were required to use adequate methods to avoid pregnancy) between the ages of 18 to 79 years of age, inclusive. Subjects on stable lipid-lowering statin therapy and subjects not on 11 non-statin lipid-lowering therapy were eligible to enroll in the study.
Subjects were required to 12 have an average fasting TG level .500 mg/dL and _1500 mg/dL from Visit 2 and Visit 3 values 13 or Visit 3 and Visit 3.1 values prior to randomization.
14 [0132] The Intent-to-Treat (ITT) Population consisted of all randomized subjects who took at least 1 dose of investigational product, had a baseline efficacy measurement, and had at 16 least 1 post-randomization efficacy measurement. The ITT Population was the primary analysis 17 population. All efficacy analyses were performed on the ITT Population.
18 [0133] Summary statistics (n, mean, standard deviation [SD], median, minimum, and 19 maximum) for the baseline and post-baseline measurements, the percent changes, or changes from baseline were presented by treatment group and by visit for all efficacy variables analyzed.
21 [0134] The primary efficacy analysis was performed using an analysis of covariance 22 (ANCOVA) model with treatment, gender, and the use of statin therapy at randomization as 23 factors and baseline TG value as a covariate. The least-squares means, standard errors, and 2-24 tailed 95% confidence intervals (Cis) for each treatment group and for the comparison between Compound A and placebo were provided.
26 [0135] An ANCOVA model was used for the analysis of secondary efficacy variables 27 with treatment, gender, and the use of statin therapy at randomization as factors and the 28 baseline value of the respective efficacy variable as a covariate.
29 [0136] The population recruited for the current study included men (69.0%) and women (31.0%) with a mean age of 52.5 years. Approximately 21% of subjects in both 31 treatment groups received statin therapy through the study. All other non-statin lipid-altering 32 medications were discontinued at screening. Mean compliance to study medication during the 33 study was 96.5% for the placebo group and 99.9% for the Compound A 600 mg group.
22713041.1 CA Application Blakes Ref: 72571/00022 1 [0137] In the ITT Population, the least-squares (LS) mean percent change in apoC-III
2 was -38.0 % (-47.5, -28.5) vs baseline and -34.7% (-46.5, -22.8) versus placebo.
3 [0138] Example 25B Population having mixed dyslipidemia 4 [0139] This study investigated patients with fasting plasma TO levels between 200 and 499 mg/dL and non-high density lipoprotein cholesterol (non-HDL-C) above 130 mg/dL already 6 receiving treatment with statins. The primary objective of this study was to evaluate the efficacy 7 of Compound A (Example 2) 600 mg QD orally by assessment of the percentage change in 8 triglycerides non-HDL-C from baseline after 12 weeks of treatment. One of the secondary 9 objectives was to evaluate the impact of Compound A on plasma levels of apoC-Ill.
[0140] This Phase II, multicenter, proof of concept study consisted of a 6-to 8-week 11 screening period (which included a 4- or 6-week diet and lifestyle stabilization/washout period 12 and a 2-week TG and non-HDL-C qualifying period), and a 12-week, double-blind, randomized, 13 parallel group, placebo-controlled treatment period.
14 [0141] After confirmation of qualifying fasting TO and non-HDL-C values, eligible subjects entered the 12-week, randomized, double-blind treatment period. At Visit 4 (Week 0), 16 subjects were randomly assigned in a 1:1 ratio to 1 of the following treatment groups:
17 Compound A 600 mg QD or placebo QD.
18 [0142] The population for this study was men and women (women of childbearing 19 potential were required to use adequate methods to avoid pregnancy) between the ages of 18 to 79 years of age, inclusive. Subjects on stable lipid-lowering statin therapy and subjects not on 21 non-statin lipid-lowering therapy were eligible to enroll in the study.
Subjects were required to 22 have an average fasting TG level between 200 and 499 mg/dL and non-HDL-C
values above 23 130 mg/dL from Visit 2 and Visit 3 values or Visit 3 and Visit 3.1 values prior to randomization.
24 [0143] The Intent-to-Treat (ITT) Population consisted of all randomized subjects who took at least 1 dose of investigational product, had a baseline efficacy measurement, and had at 26 least 1 post-randomization efficacy measurement. The ITT Population was the primary analysis 27 population. All efficacy analyses were performed on the ITT Population.
28 [0144] Summary statistics (n, mean, standard deviation [SD], median, minimum, and 29 maximum) for the baseline and post-baseline measurements, the percent changes, or changes from baseline were presented by treatment group and by visit for all efficacy variables analyzed.
31 [0145] The primary efficacy analysis was performed using an ANCOVA model with 32 randomization as factor and baseline non-HDL-C value as a covariate. The least-squares 22713041.1 CA Application Blakes Ref: 72571/00022 1 means, standard errors, and 2-tailed 95% Cls for each treatment group and for the comparison 2 between Compound A and placebo were provided.
3 [0146] The primary efficacy analysis was based on the 12-week completer population.
4 [0147] The population recruited for the current study included men (58.4%) and women (46.1%) with a mean age of 58.3 years. All subjects were required to be on statin 6 therapy (with or without ezetimibe) during the study. All other non-statin lipid-altering 7 medications were discontinued at screening. Mean compliance to study medication during the 8 study was 97.2% for the placebo group and 95.3% for the Compound A group.
9 [0148] The baseline mean non-HDL-C level for the study population was 165.9 mg/cIL;
the baseline median TG level was 262.0 mg/dL.
11 [0149] In the 12-week completer population, the LS mean percent change in ApoC-III
12 was -32.5 % (-38.4, -26.6) vs baseline and - 20.8 cYc, (-28.8, -12.7) vs placebo.
13 [0150] Example 25A refers to studies in patients with very high triglycerides (TG 500-14 2000 mg/di). Example 25B refers to studies in statin stable patients with mixed dyslipidemia and persistent hypertriglyceridernia (TG 200-499 mg/di). The studies included in each section are 16 similar in design, with comparable patient populations.
17 [0151] Example 25C Population having hypercholesterolemia 18 [0152] This study investigated subjects with fasting LDL-C of at least 2.5 mmol (-97 19 mg/di). The objective of the study was to determine the pharmacodynamics and lipid lowering effects of Compound A (Example 2) following 4 weeks of treatment in male, 21 hypercholesterolemic subjects withdrawn from stable statin therapy.
22 [0153] The population for this study consisted of men between 18 and 65 years of any 23 ethnic origin and with a BM' between 18.0 and 35.0 kg/m2.
24 [0154] This Phase lb study consisted of a 4-5 week screening period, and a 4 week double-blind, randomized, placebo-controlled treatment period.
26 [0155] All subjects had to be on lipid-lowering statin therapy for at least 3 months prior 27 to the first screening visit, and at stable statin dose for at least 4 weeks prior to the first 28 screening vist.
29 [0156] Statin treatment was withdrawn at the first screening visit, and remained withdrawn for the entire screening period. Following withdrawal of statin medication for at least 31 21 days subject had to have an LDL-C of at least 2.5 mmo1/1 (-97 mmo1/1) at the secondary 32 screening visit and an increase in LDL-C of at least 20% between the first screening visit and 33 the secondary screening visit prior to randomization.

22713041.1 CA Application Blakes Ref: 72571/00022 1 [0157] After confirmation of qualifying fasting LDL-C, eligible subjects entered a 4-2 week double blind, randomized, placebo-controlled treatment period.
Subjects were randomly 3 assigned in a 3:1 ratio to one of the following treatment groups:
Compound A 600 mg OD
4 (N=18) or placebo QD (N=6).
[0158] Blood lipids were measured at the end of the screening period and after 6 weeks of treatment. Exploratory pharmacodynarnic measurements included LDL-C, VLDL-C, 7 TC, TG, HDL-C, Non-HDL-C, and Apo B. The impact of Compound A on Apo C-III was also 8 measured.
9 [0159] Summary statistics for baseline is given as mean with coefficient of variance.
The mean changes from baseline with 95% confidence intervals were presented by treatment 11 group for efficacy variables analyzed.
12 [0160] Analyses were performed using analysis of covariance (ANCOVA) model on 13 changes from baseline with baseline included as covariate 14 [0161] The population recruited for the current study included white males (100%) with a mean age of 55 years, mean weight of 85 kg, and mean BMI of 27.9 kg/m2.
16 [0162] The mean percent change in Apo C-III after treatment with Compound A was -17 42% vs baseline. This change was statistically significant.
18 [0163] Example 26 Comparative reductions in apoC-111 achieved by EPA/DHA
19 versus Compound A
[0164] (a) Effects of EPA/DHA formulations versus Compound A on plasma apoC-III
21 and other lipid parameters in sublects with severe HTG
22 [0165] The MARINE trial:
23 [0166] In a double blind, randomized, placebo controlled study the effect of 24 eicosapentaenoic acid ethyl ester (>96% by weight of the concentrate) (Vascepa) on apoC-III
was investigated in 229 patients with fasting plasma TG of 500-2000 mg/d1.
Vascepa 4 g/day for 26 12 weeks reduced median apoC-III levels from 25.6 mg/dl to 19.7 mg/di, corresponding tea 27 median change from baseline of -10.1% [Journal of Clinical Lipidology 2014;8(3): 313-314, 28 lcosapent Ethyl (eicosapentaenoic acid ethyl ester): Effects on Apolipoprotein C-III in patients 29 from the MARINE and ANCHOR studies.] (Table 1).
[0167] The EVOLVE trial:
31 [0168] In a double blind, randomized, placebo controlled study the effect of a 32 combination of EPA and DHA as free fatty acids (55% by weight of EPA and 20 cY. by weight of 33 DHA) (Epanova) on apoC-III was investigated in 399 patients with fasting plasma TG of 500-22713041.1 CA Application Bakes Ref: 72571/00022 =
1 2000 mg/d1. Epanova 4 g/day for 12 weeks resulted in a median apoC-III
change from baseline 2 of -15% [Circulation 2012;126: A19030, Abstract 19030: Apolipoprotein C-III is Significantly 3 Reduced by Prescription Omega-3 Free Fatty Acids (Epanova) in Patients with Severe 4 Hypertriglyceridemia and Changes Correlate with Increases in LDL-C: A Sub-analysis of the EVOLVE trial] (Table 1).

7 Table 1. Effect of treatment with omega-3 prescription pharmaceuticals and Compound A in 8 subjects with TG > 500 mg/di. Values are median % changes from baseline.
Non-TG ApoC-III VLDL-C LDL-C HDL-C
HDL-C
Compound A -51 -41 -8 -51 43 24 Vascepa (omega-3) -26.6 -10.1 -7.7 -25.2 -4.5 -3.5 Epanova (omega-3) -30.9 -15.0 -9.6 -33.0 19.4 5.8 [0169] (b) Effects of EPA/DHA formulations versus Compound A on plasma ApoC-III
11 and other lipid parameters in statin stable subjects with mixed dyslipidemia and persistent 12 hypertriolyceridemia 13 [0170] The ANCHOR trial:
14 [0171] In a double blind, randomized, placebo controlled study the effect of eicosapentaenoic acid ethyl ester (Vascepa) on apoC-III was investigated in 702 statin stable 16 patients with mixed dyslipidemia and persistent hypertriglyceridemia with fasting plasma TG of 17 200-499 mg/c11. Vascepa 4 g/day for 12 weeks reduced median apoC-III
levels from 15.2 mg/di 18 to 13.7 mg/d1, corresponding to a median change from baseline of -9.4%
[Journal of Clinical 19 Lipidology 2015, in press, http://dx.doi.orq/10.1016/i.jacl.2014.11.009, Effects of icosapent ethyl on lipoprotein particle concentration and size in statin-treated patients with persistent high 21 triglycerides (the ANCHOR study)] (Table 2).
22 [0172] The ESPRIT trial:
23 [0173] In a double blind, randomized, placebo controlled study the effect of a 24 combination of EPA and DHA as free fatty acids (Epanova) on apoC-III was investigated in 647 statin stable patients with mixed dyslipidemia and persistent hypertriglyceridemia with fasting 26 plasma TG of 200-499 mg/d1. Epanova 4 g/day for 12 weeks resulted in a mean apcC-111 27 change from baseline of -13.1% [JACC 2013;61: E1468, A highly bioavailable omega-3 fatty 22713041.1 CA Application Blakes Ref: 72571/00022 1 acid reduces non-high density lipoprotein cholesterol in high-risk patients treated with a statin 2 and residual hypertriglyceridemia (ESPRIT trial)] (Table 2).
3 [0174] The COMBOS trial:
4 [0175] In a double blind randomized study the effect of a combination of EPA and DHA
ethyl esters (46.5 % by weight of EPA EE and 37.5 % by weight of DHA EE) (Lovaza) on apoC-6 III was investigated in 256 statin stable patients with mixed dyslipidemia and persistent 7 hypertriglyceridemia with fasting plasma TG of 200-400 mg/d1. Lovaza 4 g/day for weeks 8 resulted in a median apoC-III change from baseline of -7.8% [Clinical Therapeutics 2007;29(7):
9 1354-1367, Efficacy and tolerability of adding prescription Omega-3 fatty acids 4 g/cIto simvastatin 40 mg/d in hypertriglyceridemic patients: An 8-week, randomized, double-blind, 11 placebo-controlled study] (Table 2).

13 Table 2. Effect of treatment with omega-3 prescription pharmaceuticals and Compound A in 14 subjects with mixed dyslipidemia with persistent hypertriglyceridemia (TG = 200-499 mg/di).
Values are median % changes from baseline *.
Non-TG ApoC-Ill Apo B VLDL-C LDL-C
HDL-C
Compound A -43 -35 -10 -6 -39 0 Vascepa (omega-3) -17.5 -9.4 -5.0 -2.2 -12.1 1.5 Epanova (omega-3) -20.6 -13.1* -6.9 -2.1 -21.5 1.3 Lovaza (omega-3) -29.5 -7.8 -9.0 -4.2 -27.5 0.7 16 * ApoC-111 value for Epanova is mean % change from baseline 18 [0176] Summary of comparative reductions in plasma apoC-III with EPA/DHA
19 versus Compound A
[0177] Although head-to-head trials have not been completed, the comparable patient 21 populations and study designs provide a reasonable benchmark from which to compare the 22 efficacy of Compound A versus EPA/DHA in lowering plasma apoC-Ill. There are two notable 23 differentiating factors between the naturally occurring omega-3 fatty acids and Compound A.
24 [0178] The first is the superior potency of Compound A, which achieved a median reductions in apoC-III of 35 and 41% in the mixed dyslipidemic and severe HTG
patient 26 populations respectively. This compares with apoC-III reductions of only 7.8-15% in the 27 EPA/DHA studies.
22713041.1 CA Application Blakes Ref: 72571/00022 1 [0179] The second differentiating factor is the low-dose of Compound A
needed 2 (600mg QD) versus the 4g dose in the EPA/DHA studies. On a gram for gram basis, this 3 difference is even greater for Compound A and clearly demonstrates the potency of this 4 molecule in reducing plasma apoC-III versus EPA/DHA. As previously mentioned, pre-clinical models suggest that the apoC-III lowering is independent of TG lowering (Figure 1).

22713041.1

Claims (13)

Claims:

1. Use of a pharmaceutically effective amount of 2-((5Z,8Z,11Z,14Z,17Z)-icosa-5,8,11,14,17-pentaen-1-yloxy)butanoic acid (Compound A):
or a pharmaceutically acceptable salt thereof, for reducing apolipoprotein C-III (apoC-III) mRNA or apoC-III protein in a subject in need thereof, wherein the pharmaceutically effective amount is 600 mg per dose; and wherein the subject in need has severe hypertriglyceridemia, wherein the fasting plasma triglyceride levels are above 500 mg/dl.

2. The use according to claim 1, wherein the compound is present in its R
form.

3. The use according to claim 1, wherein the compound is present in its S
form.

4. The use according to claim 1, wherein the compound is present in racemic form.

5. The use according to any one of claims 1-4, wherein the subject is a human.

6. The use according to any one of claims 1-5, wherein the compound is for administration once daily.

7. The use according to any one of claims 1-6, wherein the compound is formulated as a pharmaceutical composition for oral administration.

8. The use according to claim 7, wherein the pharmaceutical composition is in the form of a gelatin capsule or a tablet.

9. The use according to claim 7 or claim 8, wherein the pharmaceutical composition further comprises at least one binder, excipient, diluent, or any combinations thereof.

10. The use according to any one of claims 7-9, wherein the pharmaceutical composition further comprises an antioxidant.

11. The use according to claim 10, wherein the antioxidant is chosen from tocopherol, BHA, and BHT, or mixtures thereof.

12. The use according to any one of claims 1-11, wherein the subject is on statin therapy.

13. The use according to any one of claims 1-11, wherein the subject has fasting LDL-cholesterol of at least 2.5 mmol/L.