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
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
  • A61K31/593—9,10-Secocholestane derivatives, e.g. cholecalciferol, i.e. vitamin D3
• • 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
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/02—Drugs for disorders of the urinary system of urine or of the urinary tract, e.g. urine acidifiers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/04—Drugs for disorders of the urinary system for urolithiasis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/08—Drugs for disorders of the urinary system of the prostate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/10—Drugs for disorders of the urinary system of the bladder
• • 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
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/02—Nutrients, e.g. vitamins, minerals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention is concerned with the use of 1-alpha-fluoro-25-hydroxy- 16,23E-diene-26,27-bishomo-20-epi-cholecalciferol (Compound A) for the manufacture of a medicament for the prevention and/or treatment of benign prostatic hyperplasia (BPH) and associated symptoms. It is further concerned with a method for preventing and/or treating benign prostatic hyperplasia and associated symptoms by administering 1 -alpha-fluoro-25-hydroxy-16,23E-diene-26,27-bishomo-20-epi-cholecalciferol in an amount effective to prevent and/or to treat such disease alone or in combination with further active agents.
• BPH is a common disorder in elderly men, occurring in approximately 50% of men aged 60 years and in 90% of those aged 85 years.
• BPH is a specific histopathological entity characterized by stromal and epithelial cell hyperplasia.
• the two known etiologic factors for the pathogenesis of BPH have been aging and the presence of functional testes.
• this concept becomes inadequate as it does not cover all aspects of BPH pathogenesis.
• Additional etiologic factors play a significant role in regulating prostatic growth.
• prostatic growth is under the immediate control of specific growth factors produced by prostatic cells, acting locally on adjacent cells in a paracrine mechanism or to the same cells in an autocrine mechanism.
• BPH is a common cause of chronic lower urinary tract symptoms which may affect both the filling (irritative symptoms) and voiding (obstructive symptoms) phases of the micturition cycle. These symptoms affect the social, psychological, domestic, occupational, physical and sexual lives of the patients leading to a profound, negative impact on their quality of life. In addition to this, BPH can cause more acute urological complications, particularly acute urinary retention (AUR), often considered the most serious complication of BPH and less frequently recurrent urinary tract infections, upper urinary tract dilatation, bladder stone formation and recurrent hematuria. BPH management is associated with extremely high social costs, estimated to be
• alpha 1 receptor antagonists are very effective in reducing symptoms related to lower urinary tract symptoms (LUTS), they are ineffective in reducing the prostate volume and therefore in preventing BPH-related surgery.
• finasteride was not free from anti-androgenic adverse effects on sexual function, such as decreased sexual potency, sexual desire and gynecomastia, that substantially lessen its attractiveness as a cancer-preventing agent.
• finasteride treatment was associated with an increased detection of high-grade prostate cancer, probably because the finasteride-induced low androgen state selected the most aggressive, androgen-insensitive malignant growing cells (see Scardino, P.T. New England Journal of Medicine (2003) 349 p 297-299).
• Vitamin D 3 analogue 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27- bishomo-20-epi-cholecalciferol (Compound A)
• Compound A is a primary example of such a medicament, as it can act against BPH in an androgen-receptor independent manner by targeting multiple pathways controlling BPH cell growth, including growth factor- mediated prostate proliferation.
• calcitriol 1 ,25-dihydroxyvitamin D 3 (1 ,25(OH) 2 D 3 ), the activated form of vitamin D 3 , is a secosteroid hormone that not only plays a central role in bone and calcium metabolism, but is also involved in the regulation of the immune response and the differentiation and apoptosis of many cell types, including malignant cells.
• calcitriol a problem with the therapeutic use of calcitriol is its natural ability to induce hypercalcemia and hyperphosphatemia.
• analogues of calcitriol retaining biological activity but devoid of hypercalcemic side effects, have been developed.
• US Patent 5,939,408 and EP808833 disclose a number of 1 ,25(OH) 2 D 3 analogues including the compound 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27- bishomo-20-epi-cholecalciferol (Compound A).
• US Patent 5,939,408 and EP808833 disclose that the compounds induce differentiation and inhibition of proliferation in various skin and cancer cell lines and are useful for the treatment of hyperproliferative skin diseases such as psoriasis, neoplastic diseases such a leukemia, breast cancer and sebaceous gland diseases such as acne and seborrheic dermatitis and osteoporosis. It has now surprisingly been found in several studies conducted by the Inventors that, unlike certain other 1 ,25(OH) 2 D 3 analogues, the 1 ,25(OH) 2 D 3 analogue Compound A:
• Compound A is an effective pharmacologic agent for the treatment of benign prostatic hyperplasia. As described in the Examples herein, Compound A reduces prostate size.
• Compound A counteracts the in vitro and in vivo proliferative activity of testosterone.
• Compound A does not inhibit type-1 or type-2 5 alpha-reductase activity and can counteract not only testosterone but even dihydrotestosterone induced BPH cell growth.
• These anti-androgenic properties of Compound A are independent from interaction with the AR, as shown by the failure of Compound A both to bind to the AR, or to act as an AR agonist or antagonist.
• Compound A does not affect sex hormone secretion.
• Compound A has no significant effect on prostate specific antigen (PSA) levels thus there appears to be no danger of treatment with Compound A masking this important indicator of possible prostate cancer.
• PSA prostate specific antigen
• a further significant advantage of Compound A is that in vitro studies have revealed that this drug, unlike finasteride, is capable of inhibiting the basal and testosterone-stimulated growth of bladder cells and is expected to be useful in preventing and/or treating of bladder dysfunction in humans.
• In vivo studies in a validated rat bladder outlet obstruction model of bladder dysfunction have also demonstrated the beneficial effect of Compound A. This is significant because bladder dysfunction is a common and troublesome sequela of BPH.
• Compound A is capable of reducing prostate size and ameliorating bladder dysfunction i.e.
• the present invention provides the use of 1-alpha-fluoro-25-hydroxy-16,23E- diene-26,27-bishomo-20-epi-cholecalciferol in the manufacture of a medicament for the prevention and/or treatment of benign prostatic hyperplasia. Also considered within the scope of the invention are pharmaceutically acceptable esters and salts of compound A. The invention thus provides the use of 1-alpha-fluoro-25-hydroxy-16,23E-diene-
• the invention also provides a method for preventing and/or treating benign prostatic hyperplasia, in patients in need of such prevention or treatment comprising administering a therapeutically effective amount of 1-alpha-fluoro-25-hydroxy-16,23E- diene-26,27-bishomo-20-epi-cholecaIciferol or a pharmaceutically acceptable salt or ester thereof thereby to effect prevention and/or treatment of benign prostatic hyperplasia.
• the invention also provides such a method which further comprises the step of obtaining or synthesising the 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27-bishomo- 20-epi-cholecalciferol or a pharmaceutically acceptable salt or ester thereof.
• the compound is formulated together with a pharmaceutically acceptable diluent or carrier.
• the invention also provides a kit containing 1-alpha-fluoro-25-hydroxy-16,23E- diene-26,27-bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof together with instructions directing administration of said compound to a patient in need of prevention and/or treatment of benign prostatic hyperplasia therebv to prevent and/or treat benign prostatic hyperplasia in said patient.
• the invention also provides the use of 1-alpha-fluoro-25-hydroxy-16,23E-diene-
• the invention also provides 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27- bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof, for use in the prevention and/or treatment of benign prostatic hyperplasia.
• the invention also provides the use of 1-alpha-fluoro-25-hydroxy-16,23E-diene- 26,27-bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof, for the prevention and/or treatment of benign prostatic hyperplasia without anti- androgenic prostatic and extra-prostatic adverse effects.
• It also provides a method for preventing and/or treating benign prostatic hyperplasia without anti-androgenic prostatic and extra-prostatic adverse effects, in patients in need of such prevention or treatment, comprising administering a therapeutically effective amount of 1-alpha- fluoro-25-hydroxy-16,23E-diene-26,27-bishomo-20-epi-cholecalciferoI or a pharmaceutically acceptable salt or ester thereof.
• the invention also provides the use of 1-alpha-fluoro-25-hydroxy-16,23E-diene- 26,27-bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof, for the prevention and/or treatment of benign prostatic hyperplasia together with concurrent prevention and/or treatment of bladder dysfunction.
• It also provides a method for preventing and/or treating benign prostatic hyperplasia with concurrent prevention and/or treatment of bladder dysfunction, in patients in need of such prevention or treatment, comprising administering a therapeutically effective amount of 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27-bishomo-20-epi-cholecalciferol or a pharmaceutically acceptable salt or ester thereof.
• 1-Alpha-fluoro-25-hydroxy-16,23E-diene-26,27-bishomo-20-epi-cholecalciferol is a known compound and its preparation is described in US Patent 5,939,408, the description of which is incorporated herein by reference.
• Esters include pharmaceutically acceptable labile esters that may be hydrolysed in the body to release Compound A.
• Salts of Compound A include adducts and complexes that may be formed with alkali and alkaline earth metal ions and metal ion salts such as sodium, potassium and calcium ions and salts thereof such as calcium chloride, calcium malonate and the like.
• Compound A, or salt or ester thereof can be used as a monotherapy or it can be administered in combination with known BPH-active agents, for example an alpha- adrenergic receptor blocking agent such as an alpha 1 receptor antagonist (for example terazosin, doxazosin or tamsulosin or else silodosin, AIO-8507L or RBx-2258) or a 5 alpha-red uctase inhibitor (for example finasteride or dutasteride).
• an alpha- adrenergic receptor blocking agent such as an alpha 1 receptor antagonist (for example terazosin, doxazosin or tamsulosin or else silodosin, AIO-8507L or RBx-2258) or a 5 alpha-red uctase inhibitor (for example finasteride or dutasteride).
• BPH-active agent includes those agents capable of or known to have activity in treating or preventing B
• the combination partner can be admixed with the compound A or its salts or esters in various ratios and can be administered separately, sequentially or simultaneously in separate or combined pharmaceutical formulations. Appropriate doses of known therapeutic agents will be readily appreciated by those skilled in the art.
• Combination of Compound A with two or more (e.g. 3) BPH-active compounds may be envisaged, e.g. combination with an alpha 1 receptor antagonist and a 5 alpha-red uctase inhibitor.
• Combination of Compound A with two or more BPH-active compounds is unknown in the art and represents an aspect of the invention.
• the combination partner(s) When administered in combination with Compound A (or salt or ester) the combination partner(s) may be used at lower doses compared to that used when the combination partner is administered alone, perhaps even a dose which is sub-therapeutic when administered alone.
• the invention also provides the use as defined above wherein the medicament is administered separately, sequentially or simultaneously in separate or combined pharmaceutical formulations with a second BPH-active agent.
• the invention also provides the use of 1-alpha-fluoro-25-hydroxy-16,23E- diene-26,27-bishomo-20-epi-choIecalciferol, or a pharmaceutically acceptable salt or ester thereof, in combination with a second BPH-active agent in the manufacture of a medicament for the prevention and/or treatment of benign prostatic hyperplasia.
• the invention also provides a method for preventing and/or treating benign prostatic hyperplasia, in patients in need of such prevention or treatment comprising administering a therapeutically effective amount of 1-alpha-fluoro-25-hydroxy-16,23E- diene-26,27-bishomo-20-epi-cholecalciferol or a pharmaceutically acceptable salt or ester thereof separately, sequentially or simultaneously in separate or combined pharmaceutical formulations with a second BPH-active agent.
• the combinations referred to above may conveniently be presented for use in the form of a pharmaceutical formulation.
• the pharmaceutical formulations thus produced also represent a further aspect of the invention.
• the aspect of the invention relating to combination therapy in BPH may also be extended to other vitamin D compounds (i.e other vitamin D receptor agonists such as vitamin D, particularly vitamin D3 and analogues thereof).
• a combination therapy comprising use of a vitamin D compound in combination with one or more other BPH-active compounds e.g. an alpha adrenergic receptor blocker and/or a 5-alpha reductase inhibitor in the prevention and/or treatment of BPH.
• a pharmaceutical formulation containing a vitamin D compound in combination with one or more other BPH-active compounds e.g.
• an alpha adrenergic receptor blocker and/or a 5-alpha reductase inhibitor optionally together with a pharmaceutically acceptable diluent or carrier.
• alpha adrenergic receptor blockers and 5-alpha reductase inhibitors are as above mentioned.
• Dosage levels and time course of administration of the active ingredients in the pharmaceutical formulations of the invention may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient.
• An exemplary dose range of Compound A is from 0.1 to 300 ug per day, for example 50-150 ug per day, e.g. 75 or 150 ug per day.
• a unit dose formulation preferably contains 50-150 ug, e.g. 75 or 150 ug, and is preferably administered once per day.
• a preferred dose of Compound A is the maximum that a patient can tolerate and not develop hypercalcemia or other undesirable side effects such as hypercalcuria.
• Compound A is administered at a concentration of about 0.O01 ug to about 100 ug per kilogram of body weight, about 0.001 - about 10 ug/kg or about 0.001 ug - about 100 ug/kg of body weight. Ranges intermediate to the above- recited values are also intended to be part of the invention.
• Compound A may be administered as a pharmaceutically acceptable salt or ester thereof however preferably Compound A is employed as is i.e. it is not employed as an ester or a salt thereof.
• This dosage may be delivered in a conventional pharmaceutical formulation by a single administration, by multiple applications, or via controlled release, as needed to achieve the most effective results, preferably once or twice daily (especially once daily) e.g. by mouth. In certain situations, alternate day dosing may prove adequate to achieve the desired therapeutic response.
• the selection of the exact dose and formulation and the most appropriate delivery regimen will be influenced by, inter alia, the pharmacological properties of the formulation, the nature and severity of the condition being treated, and the physical condition and mental acuity of the recipient.
• Representative delivery regimens include oral, parenteral (including subcutaneous, intramuscular and intravenous), rectal, buccal (including sublingual), pulmonary, transdermal, and intranasal, most preferably oral. Administration may be continuous or intermittent (e.g. by bolus injection).
• the invention also provides a pharmaceutical composition comprising 1-alpha- fluoro-25-hydroxy-16,23E-diene-26,27-bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof, and a pharmaceutically acceptable carrier for the prevention and/or treatment of benign prostatic hyperplasia.
• the invention also provides a packaged formulation which includes a pharmaceutical composition comprising 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27- bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof, and a pharmaceutically-acceptable carrier packaged with instructions for use in the treatment of benign prostatic hyperplasia.
• a pharmaceutical composition comprising 1-alpha-fluoro-25-hydroxy-16,23E-diene-26,27- bishomo-20-epi-cholecalciferol, or a pharmaceutically acceptable salt or ester thereof, and a pharmaceutically-acceptable carrier packaged with instructions for use in the treatment of benign prostatic hyperplasia.
• such compositions may be prepared for parenteral (subcutaneous, intramuscular or intravenous) administration, particularly in the form of liquid solutions or suspensions; for oral or buccal administration, particularly in the form of tablets or capsules; for pulmonary or intranasal administration, particularly in the form of powders, nasal drops or aerosol
• compositions may conveniently be administered in unit dosage form and may be prepared by any of the methods well-known in the pharmaceutical art, for example as described in Remington's Pharmaceutical Sciences, 17th ed., Mack Publishing Company, Easton, PA., (1985).
• Formulations for parenteral administration may contain as excipients sterile water or saline, alkylene glycols such as propylene glycol, polyalkylene glycols such as polyethylene glycol, oils of vegetable origin, hydrogenated naphthalenes and the like.
• Formulations for nasal administration may be solid and may contain excipients, for example, lactose or dextran, or may be aqueous or oily solutions for use in the form of nasal drops or metered spray.
• compositions may comprise one or more physiologically compatible carriers and/or excipients and may be in solid or liquid form.
• Tablets and capsules may be prepared with binding agents, for example, syrup, acacia, gelatin, sorbitol, tragacanth, or poly-vinylpyrollidone; fillers, such as lactose, sucrose, corn starch, calcium phosphate, sorbitol, or glycine; lubricants, such as magnesium stearate, talc, polyethylene glycol, or silica; and surfactants, such as sodium lauryl sulfate.
• binding agents for example, syrup, acacia, gelatin, sorbitol, tragacanth, or poly-vinylpyrollidone
• fillers such as lactose, sucrose, corn starch, calcium phosphate, sorbitol, or glycine
• lubricants such as magnesium stearate, talc, polyethylene glycol, or silica
• surfactants such as sodium lauryl sulfate.
• Liquid compositions may contain conventional additives such as suspending agents, for example sorbitol syrup, methyl cellulose, sugar syrup, gelatin, carboxymethylcellulose, or edible fats; emulsifying agents such as lecithin, or acacia; vegetable oils such as almond oil, coconut oil, cod liver oil, or peanut oil; preservatives such as butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT).
• suspending agents for example sorbitol syrup, methyl cellulose, sugar syrup, gelatin, carboxymethylcellulose, or edible fats
• emulsifying agents such as lecithin, or acacia
• vegetable oils such as almond oil, coconut oil, cod liver oil, or peanut oil
• preservatives such as butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT).
• Liquid compositions may be encapsulated in, for example, gelatin to provide a unit dosage form.
• SEG capsules are of particular interest because they provide distinct advantages over the other two forms (see Seager, H., "Soft gelatin capsules: a solution to many tableting problems"; Pharmaceutical Technology, 9, (1985)).
• Some of the advantages of using SEG capsules are: a) dose- content uniformity is optimized in SEG capsules because the drug is dissolved or dispersed in a liquid that can be dosed into the capsules accurately; b) drugs formulated as SEG capsules show good bioavailability because the drug is dissolved, solubilized or dispersed in an aqueous-miscible or oily liquid and therefore when released in the body the solutions dissolve or are emulsified to produce drug dispersions of high surface area; and c) degradation of drugs that are sensitive to oxidation during long-term storage is prevented because the dry shell of soft gelatin provides a barrier against the diffusion of oxygen.
• the dry shell formulation typically comprises of about 40% to 60% concentration of gelatin, about a 20% to 30% concentration of plasticizer (such as glycerin, sorbitol or propylene glycol) and about a 30 to 40% concentration of water. Other materials such as preservatives, dyes, opacifiers and flavours also may be present.
• the liquid fill material comprises a solid drug that has been dissolved, solubilized or dispersed (with suspending agents such as beeswax, hydrogenated castor oil or polyethylene glycol 4000) or a liquid drug in vehicles or combinations of vehicles such as mineral oil, vegetable oils, triglycerides, glycols, polyols and surface-active agents.
• the soft gelatin capsules are size 2, white, opaque, oval gelatin capsules containing a liquid fill consisting of the active ingredient,
• Compound A dissolved in Miglyol 812 (triglyceride of fractionated C 8 -C ⁇ 2 coconut oil fatty acids) with butylated hydroxytoluene (BHT), and butylated hydroxyanisole (BHA), as preservatives.
• the soft gelatin capsules can be formulated to contain between 0.01 and 25mg, e.g. 75 or 150 ug of Compound A.
• Soft gelatin capsules should be stored at 2 - 8°C and protected from light.
• Formulations containing Compound A, or a pharmaceutically acceptable salt or ester thereof, optionally in combination with a second BPH-active agent, may be prepared by mixing the ingredients.
• Panel B Effect of increasing concentrations (10 "18 -10 -7 M) of Compound A on BPH cell proliferation stimulated by T (10 nM, squares), KGF (10 ng/ml, circles) or Des(1-3)IGF-I (10 ng/ml, triangles).
• BPH cells were incubated for 48 h with Compound A (1 nM) or anti-androgens (finasteride, F, 1 nM; cyproterone acetate, Cyp, 100 nM) in the presence of T (10 nM, Panel A) or DHT (10 nM, Panel B). Results obtained in unstimulated BPH cells are also shown (Panel A). Results are expressed as % variation (mean+SEM) over their relative controls in three different experiments performed in quadruplicate. Compound A and cyproterone acetate significantly blocked both T- and DHT-induced growth, while finasteride was effective only against T.
• Figure 3 shows the lack of agonistic or antagonistic properties of Compound A on human AR.
• the AR deficient PC3 cell line stably transfected with the human AR was plated in 24 well plates at a density of 2x10 4 cells/well.
• the cells were transfected with the AR-responsive plasmid pLSPP and, 48 h later, cells were incubated with increasing concentrations of DHT (squares) or Compound A (circles) (Panel A), or with a fixed concentration of DHT (3 nM) in the presence of bicalutamide (squares) or Compound A (circles)(Pane/ ⁇ ) for 18 h.
• Results are expressed as percentage of bioluminescence per ⁇ g of total proteins.
• FIG. 1 To evaluate agonistic activity 100% luciferase activity was set in the presence of DHT 100 nM (Panel A), whereas to test antagonistic activity 100% luciferase activity was set with DHT 3 nM (Panel B).
• Figure 4 shows inhibition of rat ventral prostate growth by Compound A or finasteride.
• Panel A Castrated rats, injected with T enanthate (30 mg/Kg/week), were orally treated for 5 day/week for two consecutive weeks with vehicle or with increasing doses of Compound A (10, 30, 100 and 300 ⁇ g/Kg) or finasteride (F, 10 and 40 mg/Kg).
• Ventral prostate weight is expressed as % variation (mean+SEM) of the weight of intact, vehicle-treated, rats ( ⁇ P ⁇ 0.05, * P ⁇ 0.01 vs control rats, °P ⁇ 0.01 vs T- supplemented rats).
• Panel B Intact adult rats were orally treated for over one month (5 times/week for a total of 27 administration) with vehicle (control) or increasing concentrations of Compound A (10, 30, 100 and 300 ⁇ g/Kg) or finasteride (F, 10 and 40 mg/Kg).
• Ventral prostate weight is expressed as % variation (mean ⁇ SEM) of the weight of control, vehicle-treated rats ( * P ⁇ 0.01 vs control rats).
• Figure 5 shows the effect of Compound A and finasteride on clusterin gene expression in the rat ventral prostate.
• Panel A Northern analysis of clusterin mRNA expression in the ventral prostate of vehicle-treated intact (lane 1) or orchidectomized (lane 2) rats.
• Lanes 3-6 show clusterin gene expression in orchidectomized rats supplemented for two weeks with T enanthate (30 mg/Kg) and orally treated with vehicle (lane 3), Compound A (300 ug/Kg, lane 4 and 100 ug/Kg, lane 5) or finasteride (40 mg/Kg, lane 6). Every lane was loaded with 10 ug of total RNA.
• the corresponding GAPDH expression and the ethidium bromide staining of the gel are shown below the blot.
• the blot is representative of two separate experiments.
• Panel B Northern analysis of clusterin mRNA expression in the ventral prostate of adult intact rats orally treated for over 1 month (5 times/week, 27 administrations) with vehicle (lane 1), increasing concentrations of Compound A (10, 30, ug/Kg, lane 2 and 3) or finasteride (40 mg/Kg, lane 4). Every lane was loaded with 10 ug of total RNA.
• the corresponding GAPDH expression and the ethidium bromide staining of the gel are shown below the blot.
• the blot is representative of two separate experiments.
• Figure 6 shows the morphological effects of Compound A on ventral prostate of castrated and T-supplemented rats.
• Panels A, B, C and E Representative fields obtained from cross-sections of whole prostate glands immunostained with a monoclonal antibody against rat clusterin and counterstained with haematoxylin.
• clusterin labelling is detectable in the cytoplasm of the atrophic cuboidal epithelial cells (Panel A, 10x). After two-week T supplementation (Panel B, 10x), almost all the clusterin labelling disappeared.
• FIG. 7 shows the morphological effects of Compound A and finasteride on the prostate of intact, adult rats.
• Panels A, B, D, E, F and H Representative fields obtained from cross-sections of whole prostate glands immunostained with a monoclonal antibody against rat clusterin and counterstained with haematoxylin. In Panel A (10x) the primary antibody was omitted.
• Panel B (10x) shows that in untreated adult rats only few, scanty epithelial cells were labelled in some glands (black arrows).
• Figure 8 shows results of a chronic toxicity study in dogs. A clear reduction of prostate weight is shown after 9 months of treatment with Compound A relative to placebo.
• Figure 9 shows results of a chronic toxicity study in dogs. A reduction of prostate weight after recovery from treatment with Compound A relative to placebo.
• Figure 10 shows the effect of Compound A on testosterone-stimulated bladder cell growth.
• "hB” human bladder
• Figure 1 1 shows the effect of Compound A and other comparator compounds on stimulated and basal bladder cell growth.
• Figure 12 shows the effect of Compound A on bladder weight.
• Figure 13 shows the effect of Compound A on spontaneous non-voiding contraction frequency.
• Figure 14 shows the effect of Compound A on spontaneous non-voiding contraction amplitude.
• Figure 15 shows the effect of Compound A on micturition pressure.
• Figure 16 shows the effect of Compound A on residual urine.
• Figure 17 shows the effect of Compound A on the contractile response of bladder strips to EFS (Electrical Field Stimulation).
• Figure 18 shows the effect of Compound A when in combination with finasteride on unstimulated BPH cell growth.
• Example 1 Effects of Compound A on BPH cells in vitro MATERIALS AND METHODS Materials Minimum Essential Medium (MEM), DMEM-F12 1 :1 mixture, Ham's F12 medium, phosphate buffered saline (PBS), bovine serum albumin (BSA) fraction V, glutamine, geneticine, collagenase type IV, vitamin D 3 , testosterone (T), dihydrotestosterone (DHT), cyproterone acetate, ⁇ -nicotinamide adenine dinucleotide 3'-phosphate reduced form (NADPH), dithithreitol (DTT), phenylmethylsulfonyl fluoride (PMSF) and a kit for measuring calcemia were purchased from Sigma (St.
• MEM Minimum Essential Medium
• PBS phosphate buffered saline
• BSA bovine serum albumin
• glutamine glutamine
• geneticine collagenase type IV
• vitamin D 3 testosterone
• DHT dihydr
• the protein measurement kit was from Bio-Rad Laboratories, Inc. (Hercules, CA). Fetal bovine serum (FBS) was purchased from Unipath (Bedford, UK). Monoclonal anti-rat clusterin antibody (mouse monoclonal IgG) specific for beta-chain was from UPSTATE Biotechnology (Lake Placid, NY). Apop Tag kit for in situ end labelling (ISEL) was from Oncor (MD, USA). CHO 1827 and CHO 1829 were provided by Serono International (Geneva, Switzerland). Instagel plus was purchased from Packard (St Louis, MO).
• Finasteride (pure substance) (17 ⁇ -(N,t-butyl)carbamoyl-4-aza-5 ⁇ -androst-1-en-3-one) was a kind gift from Merck Sharp & Dohme Reaserch Laboratories (Rahway, NJ). Bicalutamide was a kind gift from AstraZeneca (AstraZeneca, Milan, Italy). Analogue 1- ⁇ -fluoro-25-hydroxy-16,23E-diene-26,27-bishomo-20-epi-cholecalciferol (Compound A) was provided by Bioxell (Bioxell, Milan, Italy).
• Keratinocyte growth factor was from Pepro Tech EC (London, England) and insulin-like growth factor-l, human, [Des(1- 3)IGF-I] was purchased from GroPep Limited (Adelaide, Australia).
• In Situ Cell Death Detection Kit POD for terminal deoxynucleotidyl transferase (TdT) mediated dUTP nick end-labelling (TUNEL) were from Roche Diagnostics Corporation (Indianapolis, IN).
• Plastic ware for cell cultures was purchased from Falcon (Oxnard, CA).
• Disposable filtration units for growth media preparation were purchased from PBI International (Milan, Italy).
• Lipofectamine 2000 and Opti-MEM I Medium for luciferase transfection were from Invitrogen, Life Technologies (San Giuliano Milanese, Milan, Italy). Thin- layer chromatography (TLC) silica plates were obtained from Merck (Darmstad, Germany). Testosterone enanthate (T enanthate) was from Geymonat (Anagni, Italy). Coat-A-Count® Total Testosterone detection kit was purchased from Medical System (Genova Struppa, Italy). Rat luteinizing hormone (rLH) [ 125 l] assay systems were from Amersham Pharmacia Biotech (Piscataway, NJ). BPH cells Human BPH cells, prepared, maintained and used as previously described in
• AR-transfected PC3 cell line Human prostate adenocarcinoma PC3 cells stably transfected with the plasmid p5HbhAR-A containing human androgen receptor (hAR) as previously described (see Bonaccorsi, L. et al. Endocrinology (2000) 1_4J .
• BPH tissue Prostatic tissues for binding assay were obtained from patients who underwent suprapubic adenomectomy for BPH. No pharmacological treatment was performed in the 3 months preceding surgery. After surgery, the tissues were immediately placed in liquid nitrogen and stored at -80°C until processing. Rat tissues Rat ventral prostate glands were rapidly excised out, weighed and quickly frozen in dry ice.
• the percentage of apoptotic cells was calculated in at least five separate fields per slide in five different slides. Results are expressed as mean ⁇ SEM from three separate experiments.
• 5 ⁇ reductase inhibition test 5 ⁇ reductase inhibition assay was performed using CHO 1827 cells, transfected with 5 ⁇ R-1 , or CHO 1829 cells, transfected with 5 ⁇ R-2, as described (see Guarna, A. et al. Journal of Medicinal Chemistry (2000) 43 3718-3735.). Compound A was added in a concentration range from 10 "9 to 10 "5 M, using finasteride as a control inhibitor in each experiment.
• Binding assay Binding assay on cytosol fractions of BPH fragments were carried out as previously reported (see Crescioli, C. et al. Endocrinology (2003) 144 p 3046-3057), (final protein concentration: 1.8 mg/ml).
• the cells were Iysed directly in the plate with 200 ⁇ l of lysis buffer. Luciferase activity was measured on 20 ⁇ l of cell lysate for 10 s after addition of 100 ⁇ l of luciferine. Total protein measurement was performed on 20 ⁇ l of cell lysate. At least three independent assays were done in duplicate. Results Incubation of BPH cells with increasing concentrations of calcitriol or Compound A inhibits cell growth ( Figure 1 panel A). Both compounds inhibited dose-dependently cell proliferation. ALLFIT (see De Lean, A. et al.
• Table I Affinity constants of androgen agonists (R1881, DHT, T), antagonist (bicalutamide) and Compound A in human BPH homogenates as detected by [ 3 H]R1881 binding.
• the percentage of apoptotic nuclei dramatically increased (270%) after a 48 h exposure to 10 nM Compound A (P ⁇ 0.01 vs control).
• Example 2 Anti-proliferative properties of Compound A in in vivo models of prostate growth Animal protocols Male Sprague Dawley rats (28 days old) were purchased from Charles River Laboratories (Calco, Lecco, Italy). All animal experimentation described was conducted in accord with accepted standards of animal care. Castration was performed via the scrotal route under ketamine/xylazine anaesthesia. Three days after castration, rats (5-8 animals per group) were treated or not with T enanthate (30 mg/Kg) in two separate weekly sc injections.
• Rats were orally treated for 5 days the first week, and 4 days the second week with vehicle (miglyol 812), Compound A (10, 30, 100 and 300 ⁇ g/Kg) or finasteride (10 and 40 mg/Kg) for a total of 9 administrations, and sacrificed one day later.
• vehicle mimacosa
• Compound A 10, 30, 100 and 300 ⁇ g/Kg
• finasteride 10 and 40 mg/Kg
• Blood for calcium and hormone measurements was obtained at the end of each experimental protocol.
• TUNEL In situ DNA fragmentation analysis
• Testosterone and rLH measurement Serum levels of T and rLH hormones were determined by commercially available radioimmunoassay kits, according to the manufacturers' instructions. To measure serum T in rats, samples were first added to 4 volumes of diethyl ether, mixed by gentle inversion for 15 min and then centrifuged for 5 min at 2000 rpm. The aqueous phase was frozen in dry ice and the organic phase was recovered and evaporated to dryness under a nitrogen stream. The dried extract was reconstituted in the assay buffer as follows: (1 vol: 1 vol) in intact rat, and (4 vol: 1 vol) in castrated rats. Statistical analysis Statistical analysis was performed by one-way ANOVA and paired or unpaired
• Binding data were analysed using the computerized program LIGAND (Munson et al, Analytical Biochemistry, (1980), 107, p 220-139).
• the computer program ALLFIT (DeLean et al, American Journal of Physiology, (1978), 235, p E97-E102) was used for the analysis of sigmoid dose-response curves to obtain estimates of half-maximal inhibition values (IC 5 o) and half-maximal stimulatory values (EC 50 ) as well as maximal inhibitory (l ma ⁇ ) and stimulatory (E ma ⁇ ) effects. Data were expressed as (mean ⁇ SEM).
• Table III Calcemia (mg/dl) in T-replaced castrated rats after different doses (10, 30, 100, 300 ⁇ g/Kg) of Compound A.
• Compound A never changed calcium serum levels in castrated rats replaced with T enanthate (30 mg/Kg/week) as compared to controls. Similar results were obtained in intact rats (not shown). Results represent the mean ⁇ SEM of rats/group.
• TdT terminal deoxynucleotidyl transferase
• TUNEL terminal deoxynucleotidyl transferase
• Clusterin is an ubiquitous product gene, strictly related to cell cycle arrest and atrophy, the expression of which is down regulated by androgens.
• Figure 5 Panel A shows the prostatic expression of clusterin mRNA, as detected by Northern analysis, in orchidectomized rats supplemented or not supplemented with T. Castration dramatically up-regulated clusterin mRNA abundance, while this effect was completely reverted by a two-week administration of T.
• the simultaneous treatment with different concentrations of Compound A (300 and 100 ⁇ g/Kg) or F (40 mg/Kg) partially blunted the T-induced down-regulation of clusterin gene expression.
• Panels D and F show TUNEL results in sections adjacent to those shown in Panels C and E.
• Compound A treatment 100 ⁇ g/Kg, panel D and 300 ⁇ g/Kg, Panel F
• induced an evident nuclear fragmentation in epithelial and stromal cells and apoptosis was detectable in both clusterin positive and negative cells.
• the first two panels of Figure 7 show the morphology of the prostate gland of an intact rats processed for clusterin detection, with (Panel A) or without (Panel B) the omission of the primary antibody. Note that clusterin labelling is almost absent in the prostate of untreated adult rats (Panel B), as it is nuclear fragmentation (TUNEL, Panel C).
• Compound A does not affect sex hormone secretion because, in the rat, gonadotropin and T plasma levels were unchanged by daily administration of Compound A for up to one month.
• Compound A acts downstream the AR receptor-ligand interaction. Without wishing to be bound by theory this action most probably occurs via the disruption of testosterone-growth factor cross talk.
• Very low concentrations of Compound A were able to completely antagonize not only T-stimulated BPH cell proliferation, but also proliferation induced by the two most important intra-prostatic growth factors: IGF-I and KGF.
• IGF-I and KGF intra-prostatic growth factors
• Clusterin is a protein tightly regulated in the prostate by androgens (Bettuzzi et al, Biochemical Journal, (1989), 257, P 293-296). Although clusterin function is still not well understood, it is markedly up-regulated in conditions of gland atrophy (Bettuzzi et al, Oncogene, (2002), 21 , p 4328-4334 and Bettuzzi et al, Journal of Endocrinology, (1992), 132.
• Example 3 Reduction of prostate weight in healthy dogs treated with Compound A.
• a 9-month toxicity study was carried out in four groups of male beagle dogs, which were treated by daily oral gavage with 0.5 ug, 1.5 ug and 5 ug/kg body weight/day of Compound A (in vehicle Miglyol 812) or with vehicle alone. This treatment was followed by a 2-month recovery period for the group receiving the highest dose, 5 ug, after which prostate weights was measured.
• a lower prostate weight was observed at the end of treatment with Compound A (see Figure 8) and after recovery (see Figure 9).
• Example 4 Oral Dosage Form Soft Gelatin Capsule A capsule for oral administration is formulated under nitrogen in amber light from 0.01 to 25.0 mg of Compound A in 150 mg of fractionated coconut oil (e.g. Miglyol 812), with 0.015 mg butylated hydroxytoluene (BHT) and 0.015 mg butylated hydroxyanisole (BHA), filled in a soft gelatin capsule.
• the capsule is prepared by the following process: 1.
• BHT and BHA are suspended in fractionated coconut oil (e.g. Miglyol 812) and warmed to around 50 °C with stirring, until dissolved. 2.
• Compound A is dissolved in the solution from step 1 at 50 °C. 3.
• the solution from step 2 is cooled to room temperature. 4.
• the solution from step 3 is filled into soft gelatin capsules.
• Example 4A Oral Dosage Form Soft Gelatin Capsule A capsule for oral administration is formulated under nitrogen in amber light: 150 ⁇ g of Compound A in 150 mg of fractionated coconut oil (Miglyol 812), with 0.015 mg butylated hydroxytoluene (BHT) and 0.O15 mg butylated hydroxyanisole (BHA), filled in a soft gelatin capsule.
• Fr15 mg butylated hydroxytoluene (BHT) and 0.O15 mg butylated hydroxyanisole (BHA) filled in a soft gelatin capsule.
• Example 4B Oral Dosage Form Soft Gelatin Capsule A capsule for oral administration is formulated under nitrogen in amber light: 75 ⁇ g of Compound A in 150 mg of fractionated coconut oil (Miglyol 812), with 0.015 mg butylated hydroxytoluene (BHT) and 0.015 mg butylated hydroxyanisole (BHA), filled in a soft gelatin capsule.
• Frinated coconut oil Miglyol 812
• BHT butylated hydroxytoluene
• BHA butylated hydroxyanisole
• Example 5 Reduction in prostate weight in human clinical trials A randomised double blind placebo controlled parallel group study was performed to determine the effect of Compound A (1-alpha-fluoro-25-hydroxy-16,23E- diene-26,27-bishomo-20-epi-cholecalciferol) in patients with BPH. The principal inclusion criterion was that male patients be diagnosed with BPH and have prostate volume > 40 ml as determined by transrectal ultrasound (TRUS).
• TRUS transrectal ultrasound
• Statistical methods primary efficacy analyses were planned on Per-Protocol (PP) Population and, as support, the same analyses were to be done on Intent-to-treat population.
• Patients evaluatable for the Per-Protocol analysis were all randomized patients compliant to protocol criteria that completed the whole course of study without major protocol violations and have valid assessments of prostate volume.
• Patients valid for intent-to-treat (ITT) population were all randomized patients who received at least one dose of trial medication and for whom the prostate volume at baseline and at 12 weeks visit were available. All patients randomized who took at least one dose of study drug were evaluated for safety analysis. The treatment group comparability was assessed at baseline for all patients with descriptive meaning.
• the data were processed by the Chi-Square test for the categorical variables, and by the ANOVA model for the continuous variables. Descriptive statistics were calculated by means of usual methods: mean, standard deviation, minimum and maximum values on continuous variables, and absolute and relative frequencies for categorical ones.
• the number of patients with adverse events related to Compound A treatment was 3 (5.26%), while the number of patients with adverse events related to treatment was 6 (9.68%) in the Placebo group.
• the events related to Compound A were: dizziness, headache, libido decrease and hot flushes, while the events related to Placebo were: urine phosphate increase, headache, syncope, libido decrease (3 patients), hypercalciuria, erectile dysfunction and hot flushes.
• the calciuria values monitored over the course of the study in the Compound A group did not differ significantly from the Placebo group.
• Example 6 The activity of Compound A on the growth and function of bladder cells Compound A has been shown to be effective in inhibiting the basal and testosterone- stimulated growth of bladder cells.
• Bladder Outlet Obstruction (BOO): The bladder and urethrovesical junction were exposed through a lower abdominal midline incision. A 0.9 mm metal rod was placed alongside the proximal urethra and a 3-0 silk ligature was tied tightly around the urethra and the rod, which was consequently removed. Sham surgery was performed accordingly, without placing the ligature. After 13 days the ligature was be removed and a catheter was inserted into the bladder dome and tunneled subcutaneously.
• the amount of voided urine was measured by means of a fluid collector, connected to a force displacement transducer.
• the bladder was continuously filled with saline at room temperature.
• the catheter was also connected to a pressure transducer. After a stabilization period of 30-60 minutes, when reproducible voiding patterns are achieved, the following parameters were recorded over a period of 30 minutes: Basal bladder pressure, micturition pressure, threshold pressure, micturition interval and volume, and non-voiding contractions.
• the amount of residual urine was investigated manually 3 times, at the end of the cystometry. Bladder capacity was calculated based on the measured values. 2.3.
• the bladder and urethra were separated at the level of the bladder neck, and semicircular strips were prepared from the middle third of the detrusor (1 x 2 x 5 mm). All preparations were used immediately after removal.
• the strips were transferred to 5 ml tissue baths containing Krebs solution.
• the Krebs solution was maintained at 37°C and bubbled continuously with a mixture of 95% 0 2 and 5 % C0 2 , resulting in a pH of 7.4.
• the strips were suspended between two L- shaped hooks by means of silk ligatures. One hook was connected to a movable unit allowing adjustment of passive tension, and the other to a Grass FT03C (Grass Instruments Co, MA, USA) force transducer.
• Isometric tension was recorded using a Grass polygraph (7D). After mounting, the strips were stretched to a passive tension of 4 mN (the same tension for all preparations) and allowed to equilibrate for 45-60 min before further experiments were performed.
• EFS Electrical field stimulation Electrical field stimulation
• the train duration was 5 s, the pulse duration 0.8 ms, and the stimulation interval 2 min.
• the polarity of the electrodes was shifted after each pulse by means of a polarity changing unit.
• the objective was to evaluate whether a vitamin D3 analogue (1-alpha-fluoro-25-hydroxy-16,23e- diene-26,27-bishomo-20-epi-cholecalciferol - compound "A') at the dose of 150 ug/Kg/daily) can prevent bladder hypertrophy and bladder dysfunction such as bladder overactivity.
• a ligature was surgically placed around the outlet of the catheterized bladder, so that when the catheter was removed, the bladder experienced increased urethral resistance.
• the rats underwent continuous cystometry to evaluate bladder function.
• contractile properties of isolated bladder preparation in response to nerve stimulation and exogenous stimuli in vitro were investigated under electrical field stimulation (EFS).
• cystometric parameters were investigated (see Figures 12-16): -micturition pressure (the maximum bladder pressure during micturition), -bladder capacity (residual volume after voiding plus the volume of saline infused to induce the void)

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