CN100408035C - 缬沙坦代谢物用于制备抑制血小板凝集药物的用途 - Google Patents
缬沙坦代谢物用于制备抑制血小板凝集药物的用途 Download PDFInfo
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- CN100408035C CN100408035C CNB03810864XA CN03810864A CN100408035C CN 100408035 C CN100408035 C CN 100408035C CN B03810864X A CNB03810864X A CN B03810864XA CN 03810864 A CN03810864 A CN 03810864A CN 100408035 C CN100408035 C CN 100408035C
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- valsartan
- metabolite
- platelet aggregation
- acid
- methyl
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Abstract
本发明涉及抑制血小板凝集的方法,该方法包括施用治疗有效量的ARB或其代谢物,尤其是缬沙坦或其代谢物4-羟基戊酰基缬沙坦。可通过抑制血小板凝集治疗的病症包括急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、TIA(短暂性脑缺血发作或急性脑血管综合征)、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞或再闭塞。
Description
发明背景
缬沙坦可选择性地阻断血管紧张素II与AT1受体的结合,引起血管扩张,并减少醛固酮分泌。最近的临床研究表明缬沙坦在急性血管事件后的患者群体中具有额外的益处。由于血小板活化在冠状血管和脑血管闭塞中起关键作用,并且AT1受体存在于血小板表面,因此评价了缬沙坦及其主要肝代谢物4-羟基戊酰基缬沙坦在具有罹患血管疾病的多重危险因素的个体中对血小板的体外作用。
发明概述
一方面,本发明涉及抑制血小板凝集的方法,该方法包括向有需要的患者施用治疗有效量的血管紧张素II受体阻断剂(“ARB”),优选缬沙坦或其可药用盐,任选存在可药用载体。
在另一项实施方案中,本发明涉及抑制血小板凝集的方法,该方法包括向有需要的患者施用治疗有效量的ARB代谢物,尤其是缬沙坦的代谢物4-羟基戊酰基缬沙坦,任选存在可药用载体。
另一方面,本发明提供了治疗与血小板凝集相关的病症的方法,该方法包括向有需要的患者施用ARB或ARB代谢物。与血小板凝集相关的病症包括急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、TIA(短暂性脑缺血发作或急性脑血管综合征)、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞或再闭塞。
本发明的另一个方面涉及包含ARB或ARB代谢物以及可药用载体的药物组合物。
优选实施方案详述
AT1-受体拮抗剂(又称为血管紧张素II受体拮抗剂)是指那些能够与血管紧张素II受体的AT1-受体亚型结合但不导致受体活化的活性成分。作为其抑制AT1-受体的结果,这些拮抗剂可例如用于预防血小板凝集和治疗与此相关的病症。
AT1-受体拮抗剂类包括具有不同结构特征的化合物,特别优选的是非肽类化合物。本发明范围内的ARB包括缬沙坦,其为式(I)的AT1-受体拮抗剂,即(S)-N-(1-羧基-2-甲基-丙-1-基)-N-戊酰基-N-[2’-(1H-四唑-5-基)联苯-4-基-甲基]胺,
其在EP 0443983A和美国专利5,399,578中公开,在此将其公开的内容全文引入作为参考,就如同在此列出一样。其它的ARB化合物包括但不限于:氯沙坦、坎地沙坦、依普沙坦、依贝沙坦、沙普立沙坦、他索沙坦、替米沙坦、奥美沙坦、佐拉沙坦(1-[[3-溴-2-[2-(1H-四唑-5-基)苯基]-5-苯并呋喃基]甲基]-2-丁基-4-氯-1H-咪唑-5-甲酸和3-(3-溴-2-[2-(1H-四唑-5-基)-苯基]-苯并呋喃-5-基甲基)-2-丁基-5-氯-3H-咪唑-4-甲酸)、又称为LR-B/081的2-[[4-丁基-2-甲基-6-氧代-5-[[2′-(1H-四唑-5-基)[1,1′-联苯]-4-基]甲基]-1(6H)-嘧啶基]甲基]-3-噻吩甲酸甲酯,以及又称为3k,LR-B/081的在3位上引入了(羧基杂芳基)甲基部分的2-[[4-丁基-2-甲基-6-氧代-5-[[2′-(1H-四唑-5-基)[1,1′-联苯]-4-基]甲基]-1-(6H)-嘧啶基]甲基]-3-噻吩甲酸甲酯(Lusofarmaco)、Biol Pharm Bull 2000年2月;23(2):174-81中公开的又称为YM 358的2,7-二乙基-5-[[2′-(1H-四唑-5-基)联苯-4-基]甲基]-5H-吡唑并[1,5-b][1,2,4]-三唑钾盐(Yamanouchi)、Thromb Res 2002年3月15日;105(6):531-6中公开的L-158,809、J Cardiovasc Pharmacol 1995年1月;25(1):22-9中公开的KT3 671、J Cardiovasc Pharmacol 1998年4月;31(4):568-75中公开的TA 606、Fundam Clin Pharmacol 1997;11(5):395-401中公开的TH 142177、Br J Pharmacol 1997年2月;120(3):488-94中公开的UP 269-6、名称为E-1477的下式化合物:
名称为SC-52458的下式化合物:
以及名称为化合物ZD-8731的下式化合物:
或其各自的可药用盐。
另外,已令人惊奇地发现:ARB代谢物也显著减少血小板凝集。ARB代谢物包括:
氯沙坦代谢物,即J Pharmacol Exp Ther 1990年10月;255(1):211-7中公开的又称为EXP-3174的2-正丁基-4-氯-1-[(2′-(1H-四唑-5-基)-联苯-4-基)甲基]咪唑-5-甲酸盐酸盐以及J Chromatogr 1992年1月17日;573(2):295-301中公开的代谢物EXP-3174(II);
依贝沙坦代谢物,即(1)依贝沙坦的四唑N2-β-葡糖苷酸缀合物,(2)丁基侧链ω-1氧化产生的单羟基化代谢物,(3,4)螺环戊烷(spirocylcopentane)环氧化产生的两种不同的单羟基化代谢物,(5)丁基侧链ω-1氧化和螺环戊烷环氧化产生的二醇,(6)ω-1单羟基化代谢物进一步氧化产生的酮代谢物,(7)二醇的ω-1羟基进一步氧化产生的酮-醇,和(8)Drug Metab Dispos 1998年5月;26(5):408-17中公开的丁基侧链的末端甲基氧化产生的羧酸代谢物;
坎地沙坦西酯代谢物,即坎地沙坦(2-乙氧基-1-[[2′-(1H-四唑-5-基)联苯-4-基]甲基]-1H-苯并咪唑-7-甲酸),又称为CV 11974和CV-15959,在ClinPharmacokinet 2002;41(1):7-17、J Chromatogr B Biomed Sci Appl 1999年8月20日;731(2):411-7和J Hum Hypertens 1997年9月;11增刊2:S19-25中公开;
替米沙坦代谢物,即Drug Metab Dispos 1999年10月;27(10):1143-9中公开的替米沙坦1-O-酰基葡糖苷酸;
奥美沙坦酯(olmesartan medoxomil)代谢物,即奥美沙坦或CS866,在JHypertens Suppl 2001年6月;19增刊1:S21-32中公开;
依普沙坦代谢物,即Pharmacotherapy 1999年4月;19(4 Pt 2):73S-78S中公开的葡糖苷酸;
他索沙坦代谢物,即J Pharmacol Exp Ther 2000年11月;295(2):649-54中公开的烯醇他索沙坦以及J.Med.Chem.1998年10月22日,41(22),4251-60中公开的五种其它代谢物;
佐拉沙坦代谢物,即J Pharm Biomed Anal 1994年9月;12(9):1181-7和JPharm Biomed Anal 1994年9月;12(9):1181-7中公开的葡糖苷酸缀合物及五种相关的生物转化产物,三种在脂族侧链上羟基化、一种进一步氧化为酮、一种在苯环上羟基化;
ZD-8731代谢物;
5-[(3,5-二丁基-1H-1,2,4-三唑-1-基)甲基]-2-[2-(1H-四唑-5-基苯基)]吡啶代谢物,又称为SC-52458,在J Cardiovasc Pharmacol 1993年10月;22(4):617-25中公开;
以及以下ARB的代谢物:ZD-8731(Zeneca)、又称为LR-B/081的2-[[4-丁基-2-甲基-6-氧代-5-[[2′-(1H-四唑-5-基)[1,1′-联苯]-4-基]甲基]-1(6H)-嘧啶基]甲基]-3-噻吩甲酸甲酯和又称为3k,LR-B/081的在3位引入了(羧基杂芳基)甲基部分的2-[[4-丁基-2-甲基-6-氧代-5-[[2′-(1H-四唑-5-基)[1,1′-联苯]-4-基]甲基]-1-(6H)-嘧啶基]甲基]-3-噻吩甲酸甲酯(Lusofarmaco)、BiolPharm Bull 2000年2月;23(2):174-81中公开的又称为YM 358的2,7-二乙基-5-[[2′-(1H-四唑-5-基)联苯-4-基]甲基]-5H-吡唑并[1,5-b][1,2,4]-三唑钾盐(Yamanouchi)、Thromb Res 2002年3月15日;105(6):531-6中公开的L-158,809、J Cardiovasc Pharmacol 1995年1月;25(1):22-9中公开的KT3671、J Cardiovasc Pharmacol 1998年4月;31(4):568-75中公开的TA 606、Fundam Clin Pharmacol 1997;11(5):395-401中公开的TH 142177以及BrJ Pharmacol 1997年2月;120(3):488-94中公开的UP 269-6。
优选缬沙坦代谢物,即具有下式结构的4-羟基戊酰基缬沙坦:
其在Waldmeier F.等人,Xenobiotica,1997,27卷,第1期,59-71中公开,在此将其全文引入作为参考,就如同在此完整列出一样。
在此将ARB及其代谢物称为“本发明的化合物”。根据取代基的性质,本发明的化合物可以含有一个或多个不对称中心。形成的非对映异构体、对映体和几何异构体均包括在本发明范围内。
根据所选择的起始原料和方法,所述化合物可以是可能的异构体之一或其混合物形式,例如为基本上纯的几何(顺式或反式)异构体、旋光异构体(对映体)、外消旋物或它们的混合物。上述可能的异构体或其混合物均包括在本发明范围内。
根据各组分的物理化学性质差异,可将得到的任何异构体混合物拆分成纯的几何或旋光异构体、非对映异构体、外消旋物,例如通过色谱法和/或分级结晶进行拆分。
可将得到的任何终产物或中间体外消旋物通过已知方法拆分成旋光对映体,例如通过分离用光学活性的酸或碱获得的其非对映体盐,并释放出光学活性的酸或碱化合物。因此可将羧酸中间体拆分成其旋光对映体,例如通过分级结晶D-或L-(α-甲基苄胺、辛可尼定、辛可宁、奎宁、奎尼定、麻黄碱、脱氢枞胺、番木鳖碱或士的宁)-盐进行拆分。外消旋产物还可以通过手性色谱、例如使用手性吸附剂的高压液相色谱进行拆分。
最后,本发明的化合物可以以游离形式或者如果存在成盐基团以其盐形式被获得。
可以将本发明的酸性化合物用可药用碱例如碱金属氢氧化物水溶液转变成盐,有利的是存在醚或醇溶剂,如低级链烷醇。可以用醚例如乙醚由后者的溶液中沉淀出所述盐。通过用酸处理可将得到的盐转变成游离化合物。这些或其它的盐也可用于纯化所获得的化合物。
可以将具有碱性基团的本发明的化合物转变成酸加成盐,尤其是可药用盐。所述的盐可以例如用以下的酸形成:无机酸,如矿物酸,例如硫酸、磷酸或氢卤酸;或有机羧酸,如未取代或被卤素取代的(C1-C4)-链烷羧酸,例如乙酸,如饱和或不饱和的二元羧酸,例如草酸、琥珀酸、马来酸或富马酸,如羟基-羧酸,例如乙醇酸、乳酸、苹果酸、酒石酸或柠檬酸,如氨基酸,例如天冬氨酸或谷氨酸;或有机磺酸,如(C1-C4)-烷基-磺酸(例如甲磺酸)或未取代或取代(例如被卤素取代)的芳基磺酸。优选与盐酸、甲磺酸和马来酸形成的盐。
鉴于游离化合物和其盐形式的化合物之间的密切关系,因此无论何时在本文中提及某化合物,也意指其相应的盐,条件是在这种情况下所述的盐是可能的或适合的。
包括其盐在内的所述化合物也可以以其水合物形式被获得,或包含其结晶所用的其它溶剂。
本发明的另一方面包括包含治疗有效量的本发明的化合物以及可药用载体的药物组合物。本发明的药物组合物可以通过本身已知的方法制备,并且适于经肠如口服或直肠以及经胃肠外施用于包括人在内的哺乳动物(温血动物),其包含单独的或与一种或多种可药用载体、尤其是适于经肠或经胃肠外应用的可药用载体组合的治疗有效量的药理学活性化合物。典型的口服制剂包括片剂、胶囊剂、糖浆剂、酏剂和混悬剂。典型的注射用制剂包括溶液剂和混悬剂。所述药物组合物可用于治疗由血小板凝集介导的病症,特别是急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、TIA(短暂性脑缺血发作或急性脑血管综合征)、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞或再闭塞。
可用于上述制剂的典型的可药用载体可举例如下:糖如乳糖、蔗糖、甘露醇和山梨醇;淀粉如玉米淀粉、木薯淀粉和马铃薯淀粉;纤维素及其衍生物如羧甲基纤维素钠、乙基纤维素和甲基纤维素;磷酸钙如磷酸二钙和磷酸三钙;硫酸钠;硫酸钙;聚乙烯吡咯烷酮;聚乙烯醇;硬脂酸;碱土金属的硬脂酸盐如硬脂酸镁和硬脂酸钙;硬脂酸;植物油如花生油、棉子油、芝麻油、橄榄油和玉米油;非离子、阳离子和阴离子表面活性剂;乙二醇聚合物;β-环糊精;脂肪醇;和水解的谷类固体(hydrolyzed cerealsolid),以及其它无毒的相容性填充剂、粘合剂、崩解剂、缓冲剂、防腐剂、抗氧剂、润滑剂、矫味剂等常用于药物制剂的物质。
这些药物制剂可经肠如口服和直肠或经胃肠外施用于温血动物,所述制剂包含单独的或与常规的药用辅料一起的药理学活性化合物。例如,药物制剂包含约0.1%至90%、优选约1%至约80%的活性化合物。经肠或经胃肠外施用的药物制剂可以是例如单位剂量形式,如包衣片剂、片剂、胶囊剂或栓剂以及安瓿剂。这些制剂可通过本身已知的方法制备,例如用常规的混合、制粒、包衣、溶解或冻干方法制备。因此,用于口服使用的药物制剂可通过以下方法获得:将活性化合物与固体赋形剂混合,如果需要将所获得的混合物制粒,并且如果需要或必要,加入适宜的辅料后将混合物或颗粒加工成片剂或包衣片芯。
ARB、尤其是缬沙坦以及ARB代谢物、尤其是4-羟基戊酰基缬沙坦可以与其它治疗剂组合使用,例如各自以本领域报道的有效治疗剂量组合使用。所述的治疗剂包括肝素、华法林、t-PA、尿激酶、链激酶、阿司匹林、噻氯匹定、氯吡格雷、阿昔单抗、表非替得和替罗非班、抗高血压药和抗糖尿病药。
活性化合物的剂量取决于多种因素,如施用方式、温血动物的种类、年龄和/或个体状况。
本发明的活性成分的优选剂量为治疗有效剂量,尤其是缬沙坦的市售可得的剂量。
通常,当口服施用本发明的化合物时,据估计,例如用于重约75kg的患者的大约日剂量为约0.1mg至约360mg。
缬沙坦可以以适宜的剂量单位形式、例如胶囊剂或片剂提供给患者,所述的剂量单位形式包含可施用于患者的治疗有效量例如约20至约320mg的缬沙坦。活性成分的施用可以每天不超过三次,例如以20mg或40mg缬沙坦的日剂量开始,增加至每天80mg,并进一步增加至每天160mg直至每天320mg。优选将缬沙坦分别以80mg或160mg的剂量每天一次或每天两次施用于患者。相应的剂量可以例如在早晨、中午或晚上施用。
对于4-羟基戊酰基缬沙坦,优选的剂量单位形式是例如片剂或胶囊剂,其包含例如用于约50至70kg的哺乳动物的约1mg至约1000mg、优选约5mg至约500mg、甚至更优选约20mg至约320mg的所述化合物,每天施用一次。
以上的剂量均包含治疗有效量的本发明的活性成分。
已令人惊奇地发现:ARB、尤其是缬沙坦以及ARB代谢物、尤其是4-羟基戊酰基缬沙坦均对人血小板显示出显著的体外抑制作用。
本发明的化合物可抑制血小板凝集,因此可用于治疗由血小板凝集介导的病症,特别是急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、TIA(短暂性脑缺血发作或急性脑血管综合征)、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞或再闭塞。
此外,本发明还涉及用于预防、延缓发展或治疗由血小板凝集介导的疾病或病症的本发明的化合物,所述的病症或病症特别是急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、TIA(短暂性脑缺血发作或急性脑血管综合征)、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞或再闭塞。
此外,本发明还涉及本发明的化合物在制备药物中的用途,所述药物用于预防、延缓发展或治疗由血小板凝集介导的疾病和病症,特别是急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、TIA(短暂性脑缺血发作或急性脑血管综合征)、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞或再闭塞。
上述性质已通过以下方法得到证实:
由20名具有已知的血管危险因素的志愿者获得用于血小板凝集、流式细胞仪研究以及盒式(cartridge-based)血小板测定分析仪的血液样品。如果研究参加者具有出血素质史、中风史、在过去六个月内有大的手术或显著创伤以及超过200/110mm的高血压,则将其剔除。他们当中任何人均未接受阿司匹林或任何其它抗血小板药。所有受试者均在休息至少30分钟并禁食2小时或更长时间后进行血液采样。为了避免任何日间活动影响,在8至10a.m.之间采集血液,并且在弃去前1.5ml自由流动的血液后,用含有3.8%柠檬酸钠(体积比1∶9)的21号蝴蝶针由肘前静脉采集血液。用11支Vacutainer管(4.5ml)由每名研究参加者身上采集共计49ml全血-柠檬酸盐混合物。将一支管作为内部对照并用缓冲液进行温育。五支管用缬沙坦在37℃下温育60分钟,以达到10nM、100nM、1μM、10μM和100μM的化合物终浓度。剩余的五支管类似地用递增量的4-羟基戊酰基缬沙坦进行温育,以达到10nM、100nM、1μM、10μM和100μM的浓度。缬沙坦和4-羟基戊酰基缬沙坦的浓度处于低于治疗血浆水平至显著高于治疗血浆水平的范围内,所述的治疗血浆水平通过对进行缬沙坦治疗的患者观察得到。摄入160mg缬沙坦后,其峰值血浆浓度可高达7.5μM,而血浆中的4-羟基戊酰基缬沙坦仅为缬沙坦浓度的10%。在进行血小板研究的当天早晨临时配制新鲜的缬沙坦和4-羟基戊酰基缬沙坦溶液。为了避免可能的观察者偏倚,将血液样品编号并使用盲法。采样操作和血小板研究均由不知晓研究方案的人员进行。
血小板凝集
A.富血小板血浆
将柠檬酸盐和全血混合物在1200g下离心5分钟,以获得富血小板血浆(PRP),将其保存在室温下以便在1小时内使用。用库尔特计数器ZM(Coulter公司,Hialeah,FL)对每个PRP样品进行血小板计数。用同源的贫血小板血浆将血小板数调整至3.50×108/ml。用5μM ADP和5μM肾上腺素诱导血小板凝集(PA)。所有激动剂均得自Chronolog公司(Havertown,PA)。用4道Chronolog发光凝集计(Lumi-Aggregometer,型号560-Ca)进行凝集研究。凝集以记录时间结束时偏离基线的透光率变化最大百分数(%max)表示,用贫血小板血浆作为参比。对凝集曲线记录6分钟,并根据国际上制定的标准进行分析,参见Ruggeri ZM,Semin Hemat1994;31:229-239。
B.全血
该方法在Abbate R等人,Amer J Clin Pathol 1986;86:91-96中有详细描述。简言之,将全血-柠檬酸盐混合物用0.5ml TBS按1∶1的比例稀释,然后温和地进行涡旋振荡。将带有搅拌棒的比色杯放置在温育孔中,并将其加温至37℃达5分钟。然后,将样品转移至测定孔中。电极放置在样品比色杯中。用1μg/ml胶原蛋白刺激血小板凝集。血小板凝集研究用使用Aggrolink″软件的Chrono-Log全血凝集计进行。血小板凝集性以电阻抗变化表示,并以欧姆给出。
全血流式细胞术
通过使用以下单克隆抗体测定血小板受体的表达:CD31(血小板内皮细胞粘着分子(PECAM-1))、CD41(糖蛋白[GP]IIb/IIIa,(IIb(3))、CD42b(GP Ib)、CD51/CD61((v(3,或玻连蛋白受体)、CD62p(P-选择蛋白)、CD107a(与溶酶体相关的膜蛋白-1;LAMP-1)、CD107b(LAMP-2)、CD151(血小板/内皮tetraspan抗原-3;PETA-3),以及针对纤维蛋白原-血小板的PAC-1(PharMingen,San Diego,CA)。血小板-白细胞的相互作用通过使用针对泛血小板标记物的双重抗体(CD151)以及CD14、单核细胞/巨噬细胞标记物进行评估。将血-柠檬酸盐混合物(50μl)用450μl Tris缓冲的盐水(TBS)(10mmol/L Tris,0.15mol/L氯化钠)进行稀释,并通过温和地颠倒Eppendorf管2次进行混合。然后,向每个溶液中加入5μl相应抗体,并将样品温育30分钟。温育后,加入400μl 2%的缓冲的低聚甲醛进行固定。如Gurbel PA等人,J Am Coll Cardiol.1998;31:1466-1473中所述,用设定用于测定荧光灯散射的Becton Dickinson FACScan流式细胞仪分析样品。将数据集中在列表式文件中并加以分析。如Gurbel PA等人,AmHeart J 2000;139:320-328中所述,P-选择蛋白以阳性细胞百分数表示。其它抗原以平均荧光强度的对数值表示。
盒式血小板分析仪
血小板功能分析仪(PFA-100′,Dade Behring,Deerfield,IL)是一种在流动状态下模拟小血管损伤后初步止血的变化的装置,参见Kundu SK等人,Semin Thromb Hemost 1995;21(增刊2):106-112。对伤口闭合所需时间进行数字式记录作为切应力诱导的血小板凝集的量度。闭合时间测定一式两份地进行。
使用带有冻干人纤维蛋白原包衣微粒的聚苯乙烯珠包衣的小盒(cartridge)进行快速血小板功能分析盒式试验(RPFA-ASA,Ultegra(r)Accumetrics公司,San Diego,CA,USA),并用棓酸丙酯作为激动剂。将全血-柠檬酸盐混合物加入小盒中,记录血小板和包衣珠之间的凝集。数据反映出血小板凝集的浊度并反映出血小板前列腺素阻断的程度。参见SmithJW等人,Circulation 1999;99:620-625。Ultegra(r)测定一式两份地进行。在对任何一名受试者的样品进行测定前,每天对所用的每台设备进行电子质量控制检验。
统计学分析
所有比较均用t-检验进行计算,以确定基线和缬沙坦/4-羟基戊酰基缬沙坦温育后的血小板凝集、Ultegra(r)结果、Dade-PFA 100(tm)和受体表达的具体差异。使用Mann-Whitney U检验分析非参数性数据。正态分布数据用均值±SE表示,偏斜数据则用中位数(范围)表示。概率值p<0.05表示具有统计学意义上的显著性。通过使用用于进行统计学分析的SPSS 9.0版程序(SPSS公司Chicago,Illinois),对所有研究参加者的正态分布数据进行线性回归分析。
富血小板血浆中的血小板凝集
用递增剂量的缬沙坦预温育仅在超过高于水平的浓度100μM下产生对ADP诱导的血小板凝集的抑制作用,但不影响肾上腺素诱导的血小板凝集。相反,用4-羟基戊酰基缬沙坦温育则在1μM和10μM的浓度下抑制肾上腺素诱导的凝集,但对ADP诱导的凝集没有任何影响。5μM ADP和5μM肾上腺素刺激的凝集的代表性数据如表1所示。
表1.PRP血小板凝集
变量药物浓度 | 缬沙坦(V)p-值与基线相比 | 4-羟基戊酰基缬沙坦(4-羟基戊酰基缬沙坦)p-值与基线相比 | p-值V与4-羟基戊酰基缬沙坦相比 |
5μM ADP诱导的富血小板血浆凝集(%)
基线10nM100nM1μM10μM100μM | 75±874±6 NS75±8 NS76±7 NS75±8 NS55±12 0.0002 | 75±875±6 NS76±8 NS77±9 NS76±8 NS77±9 NS | NSNSNSNS0.001 |
5μM肾上腺素诱导的富血小板血浆凝集(%)
基线10nM100nM1μM10μM100μM | 78±1077±11 NS76±10 NS78±6 NS75±9 NS76±7 NS | 78±1077±10 NS76±9 NS54±11 0.000156±13 0.00152±9 0.0001 | NSNS0.00010.0030.0001 |
全血中的血小板凝集
缬沙坦和4-羟基戊酰基缬沙坦在治疗活性范围内抑制全血中1μM胶原蛋白诱导的人血小板凝集。对于两个化合物均观察到剂量依赖性作用,但用4-羟基戊酰基缬沙坦进行预温育导致血小板凝集性显著降低。胶原蛋白诱导的血小板凝集的结果如表2所示。
表2.全血血小板凝集
变量药物浓度 | 缬沙坦(V)p-值与基线相比 | 4-羟基戊酰基缬沙坦(4-羟基戊酰基缬沙坦)p-值与基线相比 | p-值V与4-羟基戊酰基缬沙坦相比 |
1mg/ml胶原蛋白诱导的全血阻抗血小板凝集(欧姆)
基线10nM100nM1μM10μM100μM | 29±730±8 NS30±7 NS27±7 NS29±6 NS20±8 0.02 | 29±732±8 NS31±9 NS14±6 0.000116±8 0.00417±8 0.01 | NSNS0.00010.001NS |
观察到:随着血小板凝集单位(Ultegra)的减少,闭合时间(PFA)发生恒定的剂量依赖性延迟,显示了高切应力条件下的血小板抑制作用。与全血凝集和肾上腺素诱导的凝集类似,4-羟基戊酰基缬沙坦较缬沙坦具有更强的抗血小板性质。表3给出了用盒式分析仪进行的代表性实验。
表3.盒式分析仪
变量药物浓度 | 缬沙坦(V)p-值与基线相比 | 4-羟基戊酰基缬沙坦(4-羟基戊酰基缬沙坦)p-值与基线相比 | p-值V与4-羟基戊酰基缬沙坦相比 |
用肾上腺素/胶原蛋白盒*的PFA-100TM闭合时间(秒)
基线10nM100nM1μM10μM100μM | 201±22187±30 NS209±21 NS268±19 0.02278±20 0.02200±27 NS | 201±22179±28 NS190±24 NS259±20 0.03257±25 0.04232±31 NS | NSNSNSNSNS |
(血小板活化单位)分析仪
基线10nM100nM1μM10μM100μM | 159±27164±16 NS160±29 NS129±26 NS130±31 NS152±19 NS | 159±27177±23 NS181±31 NS134±29 NS119±38 NS168±35 NS | NSNSNSNSNS |
全血流式细胞术
用缬沙坦和4-羟基戊酰基缬沙坦温育轻微地降低GP IIb/IIIa(CD 41)和纤维蛋白原结合物(fibrinogen bingding,PAC-1)的表达,并且4-羟基戊酰基缬沙坦在治疗浓度下即可达到该效果,而缬沙坦只有在高剂量下才降低CD41的表达。两种物质均显著减少血小板表面的P-选择蛋白浓度,并适度降低玻连蛋白受体的表达,但在缬沙坦和4-羟基戊酰基缬沙坦之间该效果没有统计学意义上的差异。用缬沙坦和4-羟基戊酰基缬沙坦温育对PECAM-1(CD31)、GP Ib(CD42)和LAMP-2(CD107b)、PETA-3(CD151)以及血小板-白细胞微粒(CD151+14)没有任何影响。流式细胞术的结果如表4所示。
表4.缬沙坦和4-羟基戊酰基缬沙坦对主要血小板受体表达的影响
变量药物浓度 | 缬沙坦(V)p-值与基线相比 | 4-羟基戊酰基缬沙坦(4-羟基戊酰基缬沙坦)p-值与基线相比 | p-值V与4-羟基戊酰基缬沙坦相比 |
血小板/内皮细胞粘着分子-1(PECAM-1,CD31,logMFI)的表达
基线10nM100nM1μM10μM100μM | 69.2±10.371.8±11.9 NS70.6±12.6 NS74.5±16.2 NS68.2±16.2 NS70.6±15.8 NS | 69.2±10.374.2±13.4 NS69.7±15.1 NS70.3±16.4 NS73.1±9.3 NS71.2±15.5 NS | NSNSNSNSNS |
血小板糖蛋白IIb/IIIa抗原(GPIIb,CD41,logMFI)的表达
基线10nM100nM1μM10μM100μM | 521.8±98.2531.2±102.5 NS502.9±112.7 NS498.2±94.5 NS506.7±100.1 NS455.2±99.6 0.03 | 521.8±98.2505.6±77.8 NS432.7±116.8 0.03427.2±114.1 0.02515.9±156.2 NS529.3±121.8 NS | NS0.04NSNS0.04 |
糖蛋白Ib(GPIb,CD42b,logMFI)的表达
基线10nM100nM1μM10μM100μM | 246.4±26.7256.4±31.4 NS248.7±20.9 NS264.8±18.2 NS244.3±46.9 NS255.9±19.7 NS | 246.4±26.7236.4±18.7 NS267.9±39.4 NS255.5±24.8 NS249.7±41.8 NS248.1±19.5 NS | NSNSNSNSNS |
血小板玻连蛋白受体(CD51/CD61,logMFI)的表达
基线10nM100nM1μM10μM100μM | 11.2±4.611.9±6.0 NS12.1±5.1 NS7.8±3.6 0.017.6±2.3 0.017.3±4.8 0.006 | 11.2±4.612.1±4.2 NS8.5±3.1 0.028.1±3.8 0.027.2±5.6 0.017.6±3.3 0.01 | NS0.01NSNSNS |
P-选择蛋白(CD 62p,细胞阳性百分数)的表达
基线10nM100nM1μM10μM100μM | 9.1±3.89.8±2.7 NS10.3±4.1 NS7.2±3.2 0.037.2±3.6 0.037.8±4.2 NS | 9.1±3.89.3±4.3 NS10.2±5.4 NS7.3±3.7 0.036.9±4.2 0.038.9±3.8 NS | NSNSNSNSNS |
与溶酶体相关的膜蛋白-1(LAMP-1,CD107a,logMFI)的表达
基线10nM100nM1μM10μM100μM | 8.7±3.29.1±3.8 NS8.9±2.7 NS9.4±3.9 NS6.5±3.2 0.0410.1±4.5 NS | 8.7±3.210.2±3.6 NS9.0±4.0 NS6.6±2.9 0.045.8±3.2 0.038.0±3.4 NS | NSNS0.02NSNS |
与溶酶体相关的膜蛋白-2(LAMP-2,CD107b,logMFI)的表达
基线10nM100nM1μM10μM100μM | 6.6±2.17.6±3.2 NS7.0±2.7 NS6.8±3.5 NS7.1±3.3 NS7.2±3.8 NS | 6.6±2.17.7±3.8 NS7.0±3.0 NS6.6+3.4 NS7.2±3.9 NS7.1±2.9 NS | NSNSNSNSNS |
血小板/内皮tetraspan抗原-3(PETA-3,CD151,logMFI)的表达
基线10nM100nM1μM10μM100μM | 88.7±24.284.1±19.7 NS91.5±23.4 NS81.6±20.1 NS87.9±18.3 NS91.7±22.1 NS | 88.7±24.289.4±18.2 NS92.7±22.2 NS90.5±15.7 NS84.2±31.1 NS93.4±27.4 NS | NSNSNSNSNS |
血小板-白细胞微粒(CD151+CD14,logMFI)的形成
基线10nM100nM1μM10μM100μM | 92.2±19.391.2±20.5 NS88.4±21.9 NS93.5±23.8 NS96.5±18.7 NS90.5±19.2 NS | 92.2±19.399.4±29.7 NS94.3±18.7 NS90.7±20.5 NS89.2±18.7 NS95.6±19.9 NS | NSNSNSNSNS |
糖蛋白IIb/IIIa(纤维蛋白原结合物,PAC-1,logMFI)的活性
基线10nM100nM1μM10μM100μM | 10.3±2.89.3±2.87 NS11.2±3.4 NS7.0±2.9 0.036.9±2.7 0.029.9±3.1 NS | 10.3±2.811.0±4.5 NS9.0±3.3 NS6.7±2.7 0.027.5±3.1 0.049.9±3.0 NS | NSNSNSNSNS |
以下实施例用于举例说明上述发明;然而,这些实施例并不以任何方式限制本发明的范围。
实施例1
合成缬沙坦代谢物的方法
(S)-2-{(4-羟基-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]氨基}-3-甲基-丁酸
将6.7g(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸溶解在60ml甲醇中并冷却至0℃。分小份加入2.25g硼氢化钠以保持搅拌下的反应混合物温度低于27℃(猛烈起泡)。将混合物在室温下搅拌1小时、真空浓缩、溶于二氯甲烷并用2N盐酸水溶液萃取两次。将有机相干燥、真空浓缩,通过色谱分离(快速色谱柱,240g硅胶60,KG40-62微米,使用二氯甲烷、甲醇、浓氨水(30∶10∶1v/v)的混合溶剂)得到产物。将含有产物的级分浓缩、溶于二氯甲烷、用2N盐酸水溶液萃取并用硫酸钠干燥。浓缩后将残余物真空干燥(60℃)3天,得到(S)-2-{(4-羟基-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]氨基}-3-甲基-丁酸,为白色泡沫([α]D 20=-58°(c=1,甲醇)。TLC-Rf:0.18(甲苯/乙酸乙酯/二氯甲烷/甲酸16∶40∶40∶4))。
起始原料(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸可如下制备:
(S)-2-{(2′-氰基-联苯-4-基甲基)-[3-(2-甲基-[1,3]二氧戊环-2-基)-丙酰基]-氨基}-3-甲基-丁酸苄酯
将13.8g(S)-2-[(2′-氰基-联苯-4-基甲基)-氨基]-3-甲基-丁酸苄酯盐酸盐(在EP 443983中有描述)溶解在50ml二氯甲烷中,冷却至0℃,并用23.8ml乙基二异丙胺(Hünig碱)处理。在0℃下向该混合物中加入3-(2-甲基-[1,3]二氧戊环-2-基)-丙酰氯溶液,该溶液由在40ml二氯甲烷中的8.9g 3-(2-甲基-[1,3]二氧戊环-2-基)-丙酸(Tetrahedron 37,307,1981)和10.31ml(1-氯-2-甲基-丙烯基)-二甲基-胺(Tetrahedron 54,9207,1998)制备得到。将反应混合物在室温下搅拌3-4天,这取决于转化的进展。优选在2天中分3-4份加入3-(2-甲基-[1,3]二氧戊环-2-基)-丙酰氯。将反应混合物真空浓缩、溶于乙酸乙酯、用水、1N盐酸水溶液、水洗涤、用硫酸钠干燥并真空浓缩。经快速色谱柱分离(240g硅胶60,40-63微米,石油醚/乙酸乙酯2∶1至1∶1)并将产物在50℃下真空干燥后,得到纯的(S)-2-{(2′-氰基-联苯-4-基甲基)-[3-(2-甲基-[1,3]二氧戊环-2-基)-丙酰基]-氨基}-3-甲基-丁酸苄酯,为金色、粘性残渣。TLC-Rf:0.23(石油醚/乙酸乙酯2∶1)。
(S)-2-[(2′-氰基-联苯-4-基甲基)-(4-氧代-戊酰基)-氨基]-3-甲基-丁酸苄酯
将9.8g(S)-2-{(2′-氰基-联苯-4-基甲基)-[3-(2-甲基-[1,3]二氧戊环-2-基)-丙酰基]-氨基}-3-甲基-丁酸苄酯溶解在100ml四氢呋喃中,并用50ml 1N盐酸水溶液处理。将混合物在室温下搅拌6.5小时、真空浓缩并用二氯甲烷萃取。将有机相用水洗涤、用硫酸钠干燥、真空浓缩、蒸发并在50℃下真空干燥1小时。得到(S)-2-[(2′-氰基-联苯-4-基甲基)-(4-氧代-戊酰基)-氨基]-3-甲基-丁酸苄酯,为橙色粘性的油。TLC-Rf:0.18(石油醚/乙酸乙酯2∶1)。
(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸苄酯
将在20ml二甲苯中的8.64g(S)-2-[(2′-氰基-联苯-4-基甲基)-(4-氧代-戊酰基)-氨基]-3-甲基-丁酸苄酯和12.71g Tributyltinazid(Aldrich)回流28小时。用0.5N氢氧化钠水溶液处理混合物,将水相用醚洗涤,并将醚相用水萃取一次。合并的水相用浓盐酸水溶液酸化、用二氯甲烷萃取、用水洗涤、混悬入活性炭、过滤、用硫酸钠干燥、浓缩并真空干燥。得到产物(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸苄酯,为棕色泡沫。TLC-Rf:0.36(甲苯/二氯甲烷/甲醇/甲酸40∶40∶40∶4)。
(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸
将在160ml四氢呋喃中的7.9g(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸苄酯在常压、室温下、于1.5g披批钯碳(10%)存在下进行氢化,直至达到饱和。将混合物过滤并真空浓缩,得到(S)-3-甲基-2-{(4-氧代-戊酰基)-[2′-(1H-四唑-5-基)-联苯-4-基甲基]-氨基}-丁酸,为几乎白色的泡沫。TLC-Rf:0.1(甲苯/二氯甲烷/甲醇/甲酸40∶40∶40∶4)。
虽然根据其某些优选方案非常详细地阐述了本发明,但不背离本发明所包括的优选方案的精神和范围的其它方案也是可能的。
在此提及的所有出版物和专利均全文引入作为参考,就如同将其在此完整列出一样。
Claims (3)
1. 代谢物4-羟基戊酰基缬沙坦或其可药用盐在任选存在可药用载体的情况下在制备用于抑制血小板凝集的药物中的用途。
2. 代谢物4-羟基戊酰基缬沙坦或其可药用盐在制备用于预防、延缓发展或治疗由血小板凝集介导的病症的药物中的用途。
3. 代谢物4-羟基戊酰基缬沙坦或其可药用盐在制备药物中的用途,所述药物用于预防、延缓发展或治疗由血小板凝集介导的疾病和病症,所述疾病和病症选自急性心肌梗死、缺血性卒中、心绞痛、急性冠状动脉综合征、短暂性脑缺血发作、心力衰竭、缺血性胸痛、X综合征、血栓栓塞、肺动脉高压、糖尿病、外周血管疾病、深静脉血栓形成、任何血管的动脉血栓形成、导管血栓性闭塞和再闭塞。
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
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CN110078640A (zh) * | 2019-03-29 | 2019-08-02 | 浙江美诺华药物化学有限公司 | 一种缬沙坦中间体的合成方法 |
CN110078640B (zh) * | 2019-03-29 | 2022-04-05 | 浙江美诺华药物化学有限公司 | 一种缬沙坦中间体的合成方法 |
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JP2005529913A (ja) | 2005-10-06 |
CN1652774A (zh) | 2005-08-10 |
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EP1505965B1 (en) | 2006-08-02 |
IL164774A (en) | 2010-04-29 |
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HK1074395A1 (en) | 2005-11-11 |
ATE334677T1 (de) | 2006-08-15 |
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IL164774A0 (en) | 2005-12-18 |
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AU2003267447B8 (en) | 2009-08-06 |
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