Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/14—Prodigestives, e.g. acids, enzymes, appetite stimulants, antidyspeptics, tonics, antiflatulents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders

Definitions

• This invention relates to a method for preventing and for treating visceral pain, and gastrointestinal disorders such as functional bowel disorders (FBD) and inflammatory bowel diseases (IBD) through the use of effective amounts of [1S-
• Gabapentin (l-(arninomethyl)cyclohexane acetic acid) is an antiepileptic drug, active in various animal models of epilepsy, and effective in decreasing the frequency of seizures in patients. Gabapentin, although a ⁇ -aminobutyric acid
• GABA GABA structural analogue
• GI disorders include a wide range of disease states that are currently only moderately controlled, including - for FBD, gastro-esophageal reflux, dyspepsia, and the irritable bowel syndrome (IBS), and - for LBD, Crohn's disease, ileitis, and ulcerative colitis, and that all regularly produce visceral pain. It has been shown recently in these pathologies, in particular the irritable bowel syndrome and dyspepsia, that the visceral pain threshold is decreased, indicating a visceral hypersensitivity.
• IBS irritable bowel syndrome
• nonsteroidal anti- inflammatory drugs used to treat mild pain, but whose therapeutic use is limited by GI adverse effects (gastric erosion, peptic ulcer formation, inflammation of the duodenum and colon); 2) morphine and related opioids, used to treat moderate to severe pain but whose therapeutic use is limited by undesirable side effects including constipation, respiratory depression, tolerance, and abuse potential.
• This invention provides a method for preventing and treating visceral pain and GI disorders comprising administering to a subject in need of treatment an effective amount of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid (I)
• This invention also concerns the use of a compound of Formula I for the preparation of a medicament useful for preventing or treating visceral pain and gastrointestinal disorders, in particular by the oral route.
• the compounds utilized in the present invention include solvates, hydrates, pharmaceutically acceptable salts, and polymorphs (different crystalline lattice descriptors) of the compound of Formula I.
• the pharmaceutically acceptable salts include acetate, benzenesulfonate, benzoate, bitartrate, calcium acetate, camsylate, carbonate, citrate, edetate, edisylate, estolate, esylate, fumarate, gluceptate, gluconate, glutamate, glycoloylarsanilate, hexylresorcinate, hydrabamine, hydrobromide, hydrochloride, hydrogencarbonate, hydroxynaphthoate, iodide, isethionate, lactate, lactobionate, malate, maleate, mandelate, mesylate, methylnitrate, methylsulfate, mucate, napsylate, nitrate, pa
• patient is intended to include a mammal, especially a human.
• FBD or IBD is to administer [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid in an amount that is effective to prevent or treat the damaged condition, i.e. to control visceral pain and or FBD or IBD.
• the effective amount of [lS-(l ⁇ , 3 ⁇ )]-(l- aminomethyl-3-methyl-cyclohexyl)-acetic acid to be utilized will generally be from about 1 to about 300 mg / kg of patient body weight. Typical doses will be from about 10 to about 5000 mg per day for an adult patient of normal weight.
• Typical FBD conditions include gastro-esophageal reflux disease, dyspepsia, and
• IBS IBS.
• Typical IBD conditions include ileitis, ulcerative colitis, and Crohn's disease.
• compositions for the treatment or prevention of visceral pain there is provided a pharmaceutical composition for the treatment or prevention of visceral pain
• GI disorders comprising the active component, [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3- methyl-cyclohexyl)-acetic acid, of Formula I.
• Pharmaceutical compositions of the compound of the present invention -including one of its salts are produced by formulating this active component in dosage unit form with at least one pharmaceutically acceptable carrier or excipient.
• pharmaceutically acceptable carriers can be either solid or liquid.
• Solid dosage forms for oral administration include capsules, tablets, pills, powders, and granules. They preferably contain 5% to about 70% of [1 S-(l ⁇ , 3 ⁇ )]- (l-aminomethyl-3-methyl-cyclohexyl)-acetic acid.
• the active component is admixed with at least one inert customary excipient (or carrier) such as sodium citrate or dicalcium phosphate or
• fillers or extenders as for example, starches, lactose, sucrose, glucose, mannitol, and silicic acid
• binders as for example, carboxymethylcellulose, alginates, gelatin, polyvinyl- pyrrolidone, sucrose, and acacia
• humectants as for example, glycerol
• disintegrating agents as for example, agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain complex silicates, and sodium carbonate
• solution retarders as for example paraffin
• absorption accelerators as for example, quaternary ammonium compounds
• wetting agents as for example, cetyl alcohol, and glycerol monostearate
• compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose as well as high molecular weight polyethyleneglycols, and the like.
• Solid dosage forms such as tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells, such as enteric coatings and others well known in the art. They can also be of such composition that they release the active component in a certain part of the intestinal tract in a delayed manner.
• coatings and shells such as enteric coatings and others well known in the art. They can also be of such composition that they release the active component in a certain part of the intestinal tract in a delayed manner.
• embedding compositions which can be used are polymeric substances and waxes.
• the active component can also be in micro-encapsulated form, if appropriate, with one or more of the above-mentioned excipients.
• Liquid dosage forms for oral administration include pharmaceutically acceptable emulsions, solutions, suspensions, syrups, and elixirs.
• the liquid dosage forms may contain inert diluents commonly used in the art, such as water or other solvents, solubilizing agents and emulsifiers, as for example, ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, and the like.
• Suspensions in addition to the active component, may contain suspending agents, as for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, macrocrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, or mixtures of these substances, and the like.
• Compositions for rectal administrations are preferably suppositories which can be prepared by mixing the compound of the present invention with suitable non-irritating excipients or carriers such as cocoa butter, polyethyleneglycol or a suppository wax, which are solid at ordinary temperatures but liquid at body temperature, and therefore melt in the rectum and release the active component.
• compositions suitable for parenteral injection may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions, and sterile powders for reconstitution into sterile injectable solutions or dispersions.
• suitable liquid carriers, diluents, solvents or vehicles include water, ethanol, polyols (propyleneglycol, polyethyleneglycol, glycerol, and the like), and suitable mixtures thereof.
• compositions may also contain adjuvants such as preserving, wetting, emulsifying, and dispersing agents. Prevention of the action of microorganisms can be ensured by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, and the like. It may also be desirable to include isotonic agents, for example sugars, sodium chloride, and the like.
• the pharmaceutical preparation is in unit dosage form.
• the preparation is divided into unit doses containing appropriate quantities of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid.
• the unit dosage form can be a packaged preparation, the package containing discrete quantities of the preparation, for example, packeted tablets, capsules, and powders in vials or ampoules.
• the unit dosage form can also be a capsule, cachet, or tablet itself, or it can be the appropriate number of any of these packaged forms.
• dosage unit forms are tablets, capsules, pills, powders, suppositories, aqueous and nonaqueous oral solutions and suspensions, and parenteral solutions packaged in containers containing either one or some larger number of dosage units and capable of being subdivided into individual doses.
• the percentage of the active component in the foregoing compositions can be varied within wide limits, but for practical purposes it is preferably present in a concentration of at least 10 % in a solid composition and at least 2 % in a primary liquid composition. The most satisfactory compositions are those in which a much higher proportion of the active component is present, for example, from 10 % to
• Routes of administration of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl- cyclohexyl)-acetic acid or its salts are parenteral or, preferably, oral.
• a useful oral dosage is between 20 and 800 mg, and a useful intravenous dose is between 5 and 50 mg.
• the dosage is within the dosing range used in treatment of visceral pain and GI disorders such as FBD or IBD, or as would be dictated by the needs of the patient as described by the physician.
• a unit dosage form of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl- cyclohexyl)-acetic acid to be used in this invention may also comprise other compounds useful in the therapy of visceral pain and GI disorders.
• the advantages of using [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclo- hexyl)-acetic acid in the instant invention include the selective activity of the compound on visceral pain, the relatively nontoxic nature of the compound, the ease of preparation, the fact that the compound is well tolerated, and the ease of i.v. and, in particular, oral administration of the drug.
• Carrageenin-induced hyperalgesia in rats effect of gabapentin and
• Nociceptive pressure thresholds were measured in the rat paw pressure test using an analgesymeter (Randall L.O. and Sellitto J.J. (1957) Arch. Int. Pharmacodyn. 4: 409-419). Male Sprague Dawley rats (70-90 g) were trained on this apparatus before the test day. Pressure was gradually applied to the hind paw of each rat and nociceptive thresholds were determined as the pressure (g) required to elicit paw withdrawal. A cutoff point of 250 g was used to prevent any tissue damage to the paw. On the test day, two to three baseline measurements were taken before animals were administered 100 ⁇ l of 2% carrageenin by intraplantar injection into the right hind paw.
• Nociceptive thresholds were taken again 3 h after carrageenin to establish that animals were exhibiting hyperalgesia. Animals were dosed with either gabapentin, [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl- cyclohexyl)-acetic acid, or saline at 3.5 h after carrageenin, and nociceptive thresholds were examined at 4, 4.5, and 5 h post-carrageenin. Results Effect of gabapentin
• Epilepsy Semicarbazi de-induced tonic seizures in mice: effect of gabapentin and flS-
• mice (l ⁇ , 3 ⁇ 1-(l -aminomethyl-3 -methyl-cyclohexyD-acetic acid
• semicarbazide 750 mg/kg.
• the latency to the tonic extension of forepaws is noted. Any mice not convulsing within 2 h after semicarbazide are considered protected and given a maximum latency score of 120 min.
• gabapentin protected 100% of the animals whereas [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid protected 40%.
• Visceral pain In humans, GI disorders are often associated with visceral pain. In these pathologies, the visceral pain threshold is decreased indicating a visceral hypersensitivity.
• Two experimental models of visceral pain were used to evaluate the effect of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid p.o. : TNBS-induced colitis and septic shock-induced rectal allodynia in awake rats. In each model, the effect is compared with that of gabapentin p. o.
• TNBS-induced chronic visceral allodynia in rats effect of gabapentin and [1S- (l ⁇ .3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid
• TNBS trinitrobenzene sulfonic acid
• mice Male Sprague-Dawley rats weighing 340-400 g are used. The animals are housed 3 per cage in a regulated environment (20 ⁇ 1°C, 50 ⁇ 5 % humidity, with light 8:00 am to 8:00 pm). At day 0, under anesthesia (ketamine 80 mg/kg i.p.; acepromazine 12 mg/kg i.p.), the injection of TNBS (50 mg/kg in ethanol 30 %), or saline (1.5 ml/kg) for control rats, is performed into the proximal colon wall (1 cm from the cecum). After the surgery, animals are individually housed in polypropylene cages and kept in a regulated environment (20 °C, 50 % humidity, with light 8:00 a.m.
• a balloon (5-6 cm length) is inserted by anus, and kept in position (tip of balloon 5 cm from the anus) by taping the catheter to the base of the tail.
• Oral administration of gabapentin or of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl- cyclohexyl)-acetic acid is performed 1 h before the colonic distension cycle: the balloon is progressively inflated by steps of 5 mm Hg (0.667 kPa), from 0 to 75 mm Hg, each step of inflation lasting 30 s.
• Each cycle of colonic distension is controlled by a standard barostat.
• the threshold corresponds to the pressure which produced the first abdominal contraction, and the cycle of distension is then discontinued.
• the colonic threshold is determined after performance of four cycles of distension on the same animal. Data is analyzed by comparing test compound-treated groups with a TNBS only- treated group and the control group. Mean and SEM are calculated for each group. The antiallodynic activity of each oral dose of the test compound is calculated as follows:
• A mean threshold of the test compound-treated group
• T mean threshold of the TNBS only-treated group
• the median effective dose (ED 50 ) of gabapentin is 321 mg/kg p.o.
• the ED 50 of [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid is 22.9 mg/kg p.o.
• [lS-(l , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid produced a potent antiallodynic activity in a model of visceral pain in rats, the compound being more than 10-fold more active than gabapentin in the same conditions.
• the respective ED 50 values are 321 mg/kg p.o. for gabapentin and 23 mg/kg p.o. for [lS-(l ⁇ , 3 ⁇ )]-(l-a ⁇ runomethyl-3-methyl-cyclohexyl)-acetic acid. Furthermore this effect does not involve an opiate mechanism. 2°) LPS-induced rectal hypersensitivity in rats
• LPS lipo-polysaccharide
• Animals are surgically prepared for electromyography: rats are anaesthetized by intraperitoneal injection of acepromazine (0.6 mg/kg) and ketamine (120 mg/kg). Three groups of three electrodes are implanted in the abdominal external oblique musculature, just superior to the inguinal ligament. Electrodes are exteriorized on the back of the neck and protected by a glass tube attached to the skin. Animals are individually housed in polypropylene cages and kept in a temperature-controlled room (21 °C). Food (UAR pellets, Epinay, France) and water are provided ad libitum. Electromyographic recordings begin five days after surgery.
• the electrical activity of abdominal striated muscles is recorded with an electroencephalograph machine (Mini Vm Alvar, Paris, France) using a short time constant (0.03 s) to remove low- frequency signals ( ⁇ 3 Hz) and a paper speed of 3.6 cm/min. Spike bursts are recorded as an index of abdominal contractions.
• Distension procedure Rats are placed in plastic tunnels (6 cm diameter x 25 cm long), where they cannot move, escape, or turn around, in order to prevent damage to the balloon. Animals are accustomed to this procedure for four days before rectal distension in order to minimize stress reactions during experiments.
• the balloon used for distension is an arterial embolectomy catheter (Fogarty, Edwards Laboratories Inc.).
• Rectal distension is performed by insertion of the balloon (2 mm diameter x 2 cm long) into the rectum, at 1 cm from the anus, and catheter is fixed at the base of the tail. It is inflated progressively with tepid water by steps of 0.4 ml, from 0 to 1.2 ml, each step of inflation lasting 5 min. To detect possible leakage, the volume of water introduced in the balloon is checked by complete removal with a syringe at the end of the distension period. Experimental protocol: Rats are injected i.p.
• LPS 1 mg/kg (Escherichia coli, serotype Ol ll:B4) Sigma- Aldrich chemical Co., St Louis, MO.) or its vehicle, and rectal distension with concomitant electromyographic recording of abdominal contractions is performed 9 and 12 h after this adrninistration.
• gabapentin (10 and 30 mg/kg), [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid (3, 10 and 30 mg/kg) or the vehicle (NaCl 0.9 % 0.3 ml/rat) are administered per os 1 h before rectal distension but preceded (12 h) by injection of LPS (1 mg/kg i.p.).
• Drugs All compounds were dissolved in sterile NaCl (0.9 % isotonic saline) immediately before use.
• [lS-(l ⁇ , 3 ⁇ )]-(l- aminomethyl-3-methyl-cyclohexyl)-acetic acid displays a more potent antihyperalgesic activity than gabapentin; the comparison of the active doses show that [lS-(l ⁇ , 3 ⁇ )]-(l-aminomethyl-3-methyl-cyclohexyl)-acetic acid is about 5 times more potent than gabapentin in this model of visceral pain.
• this compound which had proved of similar or less active than gabapentin in animals models of somatic pain and epilepsy, is surprisingly 5 to 10 times more potent than gabapentin in models of visceral pain.

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• 1999
  • 1999-02-23 EP EP99400440A patent/EP1031350A1/de not_active Withdrawn
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