JP7136786B2 - 痛みの予防および治療に使用するための鎮痛効果を有する化合物 - Google Patents
痛みの予防および治療に使用するための鎮痛効果を有する化合物 Download PDFInfo
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- JP7136786B2 JP7136786B2 JP2019540670A JP2019540670A JP7136786B2 JP 7136786 B2 JP7136786 B2 JP 7136786B2 JP 2019540670 A JP2019540670 A JP 2019540670A JP 2019540670 A JP2019540670 A JP 2019540670A JP 7136786 B2 JP7136786 B2 JP 7136786B2
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- CWWARWOPSKGELM-SARDKLJWSA-N methyl (2s)-2-[[(2s)-2-[[2-[[(2s)-2-[[(2s)-2-[[(2s)-5-amino-2-[[(2s)-5-amino-2-[[(2s)-1-[(2s)-6-amino-2-[[(2s)-1-[(2s)-2-amino-5-(diaminomethylideneamino)pentanoyl]pyrrolidine-2-carbonyl]amino]hexanoyl]pyrrolidine-2-carbonyl]amino]-5-oxopentanoyl]amino]-5 Chemical compound C([C@@H](C(=O)NCC(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCSC)C(=O)OC)NC(=O)[C@H](CC=1C=CC=CC=1)NC(=O)[C@H](CCC(N)=O)NC(=O)[C@H](CCC(N)=O)NC(=O)[C@H]1N(CCC1)C(=O)[C@H](CCCCN)NC(=O)[C@H]1N(CCC1)C(=O)[C@@H](N)CCCN=C(N)N)C1=CC=CC=C1 CWWARWOPSKGELM-SARDKLJWSA-N 0.000 description 1
- CEMZBWPSKYISTN-YFKPBYRVSA-N methyl (2s)-2-amino-3-methylbutanoate Chemical compound COC(=O)[C@@H](N)C(C)C CEMZBWPSKYISTN-YFKPBYRVSA-N 0.000 description 1
- KUGLDBMQKZTXPW-JEDNCBNOSA-N methyl (2s)-2-amino-3-methylbutanoate;hydrochloride Chemical compound Cl.COC(=O)[C@@H](N)C(C)C KUGLDBMQKZTXPW-JEDNCBNOSA-N 0.000 description 1
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- 125000001280 n-hexyl group Chemical group C(CCCCC)* 0.000 description 1
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- 239000002767 noradrenalin uptake inhibitor Substances 0.000 description 1
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- 238000000655 nuclear magnetic resonance spectrum Methods 0.000 description 1
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- 125000003538 pentan-3-yl group Chemical group [H]C([H])([H])C([H])([H])C([H])(*)C([H])([H])C([H])([H])[H] 0.000 description 1
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- UMJSCPRVCHMLSP-UHFFFAOYSA-N pyridine Natural products COC1=CC=CN=C1 UMJSCPRVCHMLSP-UHFFFAOYSA-N 0.000 description 1
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- 150000003246 quinazolines Chemical class 0.000 description 1
- 230000008707 rearrangement Effects 0.000 description 1
- 230000004044 response Effects 0.000 description 1
- MRSZZJSICSXHRC-UHFFFAOYSA-N s-[(4-methoxyphenyl)methyl] ethanethioate Chemical compound COC1=CC=C(CSC(C)=O)C=C1 MRSZZJSICSXHRC-UHFFFAOYSA-N 0.000 description 1
- 229930195734 saturated hydrocarbon Natural products 0.000 description 1
- 125000002914 sec-butyl group Chemical group [H]C([H])([H])C([H])([H])C([H])(*)C([H])([H])[H] 0.000 description 1
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- 125000000547 substituted alkyl group Chemical group 0.000 description 1
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- 125000000999 tert-butyl group Chemical group [H]C([H])([H])C(*)(C([H])([H])[H])C([H])([H])[H] 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 150000003573 thiols Chemical class 0.000 description 1
- 230000000451 tissue damage Effects 0.000 description 1
- 230000007704 transition Effects 0.000 description 1
- IMFACGCPASFAPR-UHFFFAOYSA-N tributylamine Chemical compound CCCCN(CCCC)CCCC IMFACGCPASFAPR-UHFFFAOYSA-N 0.000 description 1
- IMNIMPAHZVJRPE-UHFFFAOYSA-N triethylenediamine Chemical compound C1CN2CCN1CC2 IMNIMPAHZVJRPE-UHFFFAOYSA-N 0.000 description 1
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- 150000003672 ureas Chemical class 0.000 description 1
- 125000000391 vinyl group Chemical group [H]C([*])=C([H])[H] 0.000 description 1
- 230000029663 wound healing Effects 0.000 description 1
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- C07H19/02—Compounds containing a hetero ring sharing one ring hetero atom with a saccharide radical; Nucleosides; Mononucleotides; Anhydro-derivatives thereof sharing nitrogen
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Description
この出願は2017年1月27日に提出された米国仮出願第62/451,322号の利益を主張するものである。
本発明は、疼痛の予防および/または治療に使用するための化合物に関する。特に、本発明は、アデノシン誘導体、および疼痛の予防および/または治療におけるそれらの適用に関する。
痛みは通常、強い刺激または組織/神経の損傷によって引き起こされる不快な感覚である。痛みは、影響する時間によって急性/慢性の2つに分類され得る。急性の痛みは、状況に応じて、ほんの一瞬または数週間持続し得る。急性の痛みは通常、損傷した組織の回復後に消失する。慢性疼痛は、3~6カ月より長く続く痛みとして定義され、これは通常の損傷の治癒時間である。慢性疼痛を有する大きな集団があり、慢性疼痛で報告される患者の約5分の1が主に神経因性疼痛を患っている。神経障害性疼痛は、病変または疾患の影響を受けた神経系から生じる疼痛である。オピオイドまたは非ステロイド系抗炎症薬(NSAID)で緩和され得る侵害受容性疼痛とは異なり、神経障害性疼痛には効果的な治療法がない。
本発明においては、T1-11とサブスタンスPに由来するコンジュゲート化合物Ic-2が合成される。化合物Ic-2は、慢性的な広範な痛みが間欠的寒冷ストレス(ICS)によって誘発される線維筋痛症のマウスモデルにおいて、14μg/kg(160ピコモル)から始まる鎮痛効果を示した。さらに、鎮痛作用をテストするために、アミノ酸(例えば、I-a1)またはペプチド(例えば、I-c1)とのコンジュゲーションによって一連の化合物が調製された。
nは0、1、2または3であり;
XおよびYはそれぞれ独立してNH、OまたはSであり;
R1はOH、NH2、NO2、ハロゲン、アルキル、ハロアルキル、ヒドロキシアルキル、非置換または置換アルコキシ、アルコキシアルキル、アルケニルまたはアルキニルであり;
R2およびR3はそれぞれ独立してOH、NH2、NO2、ハロアルキル、ヒドロキシアルキルまたはアルキルアミノであり;そして
R4はアミノ酸またはペプチドに由来する部分であり、そしてR4は、そのN末端基またはその側鎖アミノ基を介して、構造中のC(=O)と結合しており、ここで、アミノ酸ま たはペプチドのC末端は場合により修飾されている);
その互変異性体もしくは立体異性体;または上記のものの薬学的に許容される塩に関する。
kは1、2または3であり;
XおよびYはそれぞれ独立してNH、OまたはSであり;
R1はOH、NH2、NO2、ハロゲン、アルキル、ハロアルキル、ヒドロキシアルキル、非置換または置換アルコキシ、アルコキシアルキル、アルケニルまたはアルキニルであり;
R2およびR3はそれぞれ独立してOH、NH2、NO2、ハロアルキル、ヒドロキシアルキルまたはアルキルアミノであり;そして
R4はアミノ酸またはペプチドであり;
環Aは、5または6員複素環および縮合複素環を含む置換または非置換芳香族複素環であり;環内のヘテロ原子は、1つまたはそれ以上の窒素、酸素、および/または硫黄ヘテロ原子であり;そして、置換基は、フッ素、塩素、臭素、ヨウ素、ヒドロキシル、ニトロ、アルキル、トリフルオロメチル基および、それらの組み合わせから成る群から選択される);
その互変異性体もしくは立体異性体;および上記のものの薬学的に許容される塩に関する。
(a)前述の化合物またはその薬学的に許容される塩の治療的有効量;および
(b)薬学的に許容される担体、賦形剤または媒体。
定義
特に定義されない限り、本明細書中で使用される全ての技術的および科学的な用語は、本発明が属する当該技術分野の当業者によって一般に理解されるのと同じ意味を有する。矛盾がある場合は、定義を含め、本明細書が優先するものとする。本明細書および添付の特許請求の範囲で使用される場合、単数形の「1つ(a)」、「1つ(an)」、および「その(the)」は、内容が明らかにそうでないことを規定しない限り、複数の参照を含んでいる。
本発明は、式(I)の化合物:
nは0、1、2または3であり;
XおよびYはそれぞれ独立してNH、OまたはSであり;
R1はOH、NH2、NO2、ハロゲン、アルキル、ハロアルキル、ヒドロキシアルキル、非置換または置換アルコキシ、アルコキシアルキル、アルケニルまたはアルキニルであり;
R2およびR3はそれぞれ独立してOH、NH2、NO2、ハロアルキル、ヒドロキシアルキルまたはアルキルアミノであり;そして
R4はアミノ酸またはペプチドに由来する部分であり、そしてR4は、そのN末端基またはその側鎖アミノ基を介して、構造中のC(=O)と結合しており、ここで、アミノ酸 またはペプチドのC末端は場合により修飾されている);
その互変異性体もしくは立体異性体;および上記のものの薬学的に許容される塩を提供する。
kは1、2または3であり;
XおよびYはそれぞれ独立してNH、OまたはSであり;
R1はOH、NH2、NO2、ハロゲン、アルキル、ハロアルキル、ヒドロキシアルキル、非置換または置換アルコキシ、アルコキシアルキル、アルケニルまたはアルキニルであり;
R2およびR3はそれぞれ独立してOH、NH2、NO2、ハロアルキル、ヒドロキシアルキルまたはアルキルアミノであり;そして
R4はアミノ酸またはペプチドであり;
環Aは、5または6員複素環および縮合複素環を含む置換または非置換芳香族複素環であり;環内のヘテロ原子は、1つまたはそれ以上の窒素、酸素、および/または硫黄ヘテロ原子であり;そして、置換基は、フッ素、塩素、臭素、ヨウ素、ヒドロキシル、ニトロ、アルキル、トリフルオロメチル基および、それらの組み合わせから成る群から選択される);
その互変異性体もしくは立体異性体;および上記のものの薬学的に許容される塩を提供する。
別の側面では、本発明は、以下の工程を含む、上記の式(I)の化合物を調製する方法に関する:
(a)N6-(4-ヒドロキシベンジル)アデノシン(2)を酸の存在下でアセトン中の2,2-ジメトキシプロパンと反応させて、式(3)の(2’,3’-O-イソプロピリデン)アデノシン化合物を得る工程;
そして
(e)全ての保護基を化合物(6)から除去して、式(I)の化合物を得る工程;
(b)p-トルエンスルホン酸の存在下で化合物11をアセトン中で2,2-ジメトキシプロパンと反応させて、式(12)のアセトニド化合物を得る;
(c)CDIで化合物12のヒドロキシル基を活性化した後、グリシンメチルエステルと反応させて、式(13)のカルバメート化合物を得る;そして
(d)アセトニド保護基をTFAで除去し、続いてアルカリ条件下で加水分解して、化合物14(II-a1)を得る。
(b)触媒の存在下での水素化分解によりアジド化合物18を還元し、続いて促進剤の存在下でグリシンメチルエステル塩酸塩とカップリング反応させ、式19の化合物を得るが、ここで、触媒はリンドラー触媒であり、促進剤は1,1’-カルボニルジイミダゾールである;
(c)水素化分解によりPMB保護基を除去して、式20の化合物を得る。
(d)2’,3’-ジオールおよびエステルの保護基をそれぞれTFAおよびNaOHにより除去して、式I-d1の化合物を得る。
(b)塩基を用いて化合物21からアセチル基を除去し、続いて促進剤の存在下で2,2,2-トリクロロエチルグリシンとカップリングさせて、式22の化合物を得るが、ここで、塩基は水酸化ナトリウムおよび水酸化カリウムであり得、促進剤は1,1-カルボニルジイミダゾールである;
(c)全ての保護基を除去して、式I-e1の化合物を得る。
別の側面では、本発明は、本発明の化合物と薬学的に許容される担体とを含む医薬組成物を提供する。
別の側面において、本発明は、有効量の本発明の化合物を対象に投与することを含む、疼痛の治療方法を提供する。1つの実施態様では、疼痛は慢性疼痛である。いくつかの実施態様では、疼痛は、組織アシドーシスおよび/または神経損傷に関連し、炎症性疼痛、癌関連疼痛、胸痛、背中の痛み、首の痛み、肩の痛み、片頭痛、頭痛、筋筋膜痛、関節痛、筋肉痛症候群、神経障害性疼痛、末梢痛、交感神経痛、術後痛、心的外傷後痛、多発性硬化症の痛みを含むが、これらに限定はされない。1つの実施態様では、疼痛は機能不全性疼痛である。さらなる実施態様では、機能不全性疼痛には、線維筋痛症、膀胱痛症候群、過敏性腸症候群に起因する疼痛、および顎関節症に伴う疼痛が含まれるが、これらに限定はされない。
全ての試薬および溶媒は試薬グレードであり、特に明記されない限り、さらに精製することなく使用した。テトラヒドロフランとジエチルエーテルはNa/ベンゾフェノンから蒸留し、CH2Cl2はCaH2から蒸留した。空気または湿度に感受性の実験は全て、アルゴン下で実施した。ガラス器具は全てオーブンで2時間以上乾燥させ、デシケーター中で室温まで冷却してから使用した。
H,d,J=8.0Hz),7.12(2 H,d,J=8.0Hz),6.63(1
H,br s),5.82(1 H,d,J=4.8Hz),5.17(1 H,dd,J=5.2,4.8Hz),5.06(1 H,d,J=5.2Hz),4.81(2
H,d,J=18.8Hz),4.46(1 H,s),3.91(1 H,d,J=12.0Hz),3.73(1 H,d,J=12.0Hz),1.57(3 H,s),1.31(3 H,s);13C NMR(CDCl3,100MHz)δ 165.,154.9,152.6,150.0,147.3,139.6,136.0,133.5,130.0,129.2,128.6,128.4,121.8,120.9,113.7,93.9,85.9,82.9,81.5,63.2,43.4,27.4,25.1;C27H28N5O6についてのESI-HRMSの計算値:518.2040,実測値:m/z 518.2050[M+H]+.
NMR(CD3OD,400MHz)δ 8.26(1 H,s),8.20(1 H,s),7.21(2 H,d,J=8.4Hz),6.74(2 H,d,J=8.4Hz),6.03(1 H,d,J=4.8Hz),4.61-4.75(3 H,m),4.37-4.43(1 H,m),4.33(1 H,t,J=4.4Hz),4.20-4.29(2 H,m),3.08(2 H,t,J=6.8Hz),1.38-1.51(2 H,m),1.25-1.37(2 H,m),0.90(3 H,t,J=7.3Hz);13C NMR(CD3OD,100MHz)δ 158.7,158.0,156.2,154.2,140.5,131.1,130.1,121.0,116.5,90.2,84.4,75.7,72.2,65.3,41.8,33.1,21.0,14.1;C22H29N6O6についてのESI-HRMSの計算値:473.2149,実測値:m/z 473.2145[M+H]+.
νmax(フィルム)3482,3414,2929,1701,1619,1560,1546,1517,1459,1438,1340,1259,1129,1087,1053cm-1;1H NMR(CD3OD,400MHz)δ 8.26(1 H,s),8.23(1 H,s),7.21(2 H,d,J=8.4Hz),6.74(2 H,d,J=8.4Hz),6.05(1 H,d,J=5.4Hz),4.82-4.84(2 H,m),4.68(1 H,t,J=5.2Hz),4.33-4.41(2 H,m),4.20-4.31(2 H,m),3.05-3.17(2 H,m),2.18(2 H,t,J=7.2Hz),1.76(2 H,quin,J=7.2Hz);13C NMR(CD3OD,100MHz)δ 183.2,158.7,158.0,156.1,154.2,150.1,140.5,131.0,130.2,120.9,116.5,89.7,84.5,75.6,72.2,65.2,45.0,52.0,36.0,27.6;C22H27N6O8についてのESI-HRMSの計算値:503.1890,実測値:m/z 503.1894[M+H]+.
8~12週齢の雌C57BL/6JNarlマウスを国立実験動物センター(台北、台湾)から購入した。線維筋痛モデルは、植田のグループによって開発されたものであり、マウスを間欠的な寒冷ストレスで2日間処置した(Nishiyori,M.;Ueda,H.Prolonged gabapentin analgesia in an experimental mouse model of fibromyalgia.Mol.Pain 2008,4,52)。間欠的寒冷ストレスにより処置されたマウスは、長く続く(>2週間)機械的および熱的な痛覚過敏を発症した。間欠的寒冷ストレスの5日後、i.p.(0.5%HPβCD中)またはp.o.(1%HPβCD中)経由の化合物I-a1(JMF3737)、およびi.p.(0.5%HPβCD中)経由の化合物I-d1(JMF4413)の鎮痛効果をこれらのマウスでテストした。機械的痛覚過敏は、0.2-mNのvon Freyフィラメント刺激に対するマウス後足の引っ込め反応をテストすることによって分析した。実験結果を図9~12に示す。
Claims (21)
- 式(I)の化合物:
nは0、1、2または3であり;
XはNH、OまたはSであり
YはO、NHまたはSであり;
R1はOH、NH2、NO2、ハロゲン、アルキル、ハロアルキル、ヒドロキシアルキル、非置換または置換アルコキシ、アルコキシアルキル、アルケニルまたはアルキニルであり;
R2およびR3はそれぞれ独立してOH、NH2、NO2、ハロアルキル、ヒドロキシアルキルまたはアルキルアミノであり;そして
R4はグリシン、アラニン、システイン、バリン、ロイシン、イソロイシン、メチオニン、フェニルアラニン、トリプトファン、グルタミン、アスパラギン、スレオニン、アルギニン、リジン、プロリン、γ-アミノ酪酸(GABA)、セリン、チロシン、アスパラギン酸、グルタミン酸、ヒスチジンから選択され、そしてR4は、そのN末端基またはその側鎖アミノ基を介して、構造中のC(=O)と結合しているか、またはR 4 は、ペプチドRPKPQQFFGLM-CONH 2 であり、該ペプチドはKの側鎖アミノ基を介して、構造中のC(=O)と結合しており、ここで、アミノ酸またはペプチドのC末端は場合により修飾されている);
その互変異性体もしくは立体異性体;および、それらの薬学的に許容される塩。 - R1、R2およびR3がそれぞれ独立してOHである、請求項1に記載の化合物。
- nが1である、請求項1に記載の化合物。
- XがNHであり、YがO、NHまたはSである、請求項1に記載の化合物。
- XがSであり、YがNHまたはOである、請求項1に記載の化合物。
- R4が、グリシン、システイン、バリン、フェニルアラニン、またはグルタミンから選択される、請求項1記載の化合物。
- R 4 が、ペプチドRPKPQQFFGLM-CONH 2 であり、該ペプチドが、Kの側鎖アミノ基を介して、構造中のC(=O)に連結されている、請求項1に記載の化合物。
- XがNHであり、YがOである、請求項1記載の式(I)の化合物
(a)N6-(4-ヒドロキシベンジル)アデノシン(2)を酸の存在下でアセトン中の2,2-ジメトキシプロパンと反応させて、式(3)の化合物を得る工程;
酸は、p-トルエンスルホン酸またはカンファースルホン酸である);
(b)塩基の存在下で化合物(3)を薬剤と反応させて、式(4)の化合物を得る工程:
PGは4-メトキシベンジルまたはベンゾイルであり;薬剤は塩化4-メトキシベンジルまたは塩化ベンゾイルであり;そして、塩基は炭酸カリウムまたはトリエチルアミンである);
(c)塩基の存在下で化合物(4)を1,1’-カルボニルジイミダゾール(CDI)と反応させて、式(5)の化合物を得る工程:
塩基は4-ジメチルアミノピリジン(DMAP)である);
(d)化合物(5)を請求項1に記載のR 4 において定義されるアミノ酸またはペプチドの塩またはエステルと反応させて、式(6)の化合物を得る工程:
[A’]-NH-はアミノ酸またはペプチドの塩またはエステルから形成される);および
(e)全ての保護基を除去して、式(IB)の化合物を得る工程:
[A]-NH-は、アミノ酸またはペプチドである)。 - XおよびYが独立してNHである、請求項1記載の式(I)の化合物
(a)化合物(4a)
塩基は1,8-ジアザビシクロ[5.4.0]ウンデカ-7-エン(DBU)である);
(b)触媒の存在下での水素化分解により化合物(18)を還元し、続いて促進剤の存在下でグリシンメチルエステル塩酸塩とカップリングさせて、式(19)の化合物を得る工程:
触媒はリンドラー触媒であり、促進剤は1,1’-カルボニルジイミダゾールである);
(c)全ての保護基とグリシンメチルエステル塩酸塩に由来するエステル基を除去して、式(I-d1)の化合物を得る工程:
- XがNHであり、YがSである、請求項1記載の式(I)の化合物
(a)塩基の存在下で化合物(4a)を塩化メタンスルホニル(MsCl)と反応させ、続いてチオ酢酸カリウムと反応させて、式(21)の化合物を得る工程:
塩基はトリエチルアミンおよび4-ジメチルアミノピリジンである);
(b)塩基を用いて化合物(21)からアセチル基を除去し、続いて促進剤の存在下で2,2,2-トリクロロエチルグリシンとカップリングさせて、式(22)の化合物を得る工程:
塩基は水酸化カリウムであり、促進剤は1,1’-カルボニルジイミダゾールである);
(c)全ての保護基と2,2,2-トリクロロエチルグリシンから誘導されたエステル基を除去して、式(I-e1)の化合物を得る工程:
- 式(II)の化合物:
kは1、2または3であり;
XおよびYはそれぞれ独立してNH、OまたはSであり;
R1はOH、NH2、NO2、ハロゲン、アルキル、ハロアルキル、ヒドロキシアルキル、非置換または置換アルコキシ、アルコキシアルキル、アルケニルまたはアルキニルであり;
R2およびR3はそれぞれ独立してOH、NH2、NO2、ハロアルキル、ヒドロキシアルキルまたはアルキルアミノであり;そして
R4はグリシン、アラニン、システイン、バリン、ロイシン、イソロイシン、メチオニン、フェニルアラニン、トリプトファン、グルタミン、アスパラギン、スレオニン、アルギニン、リジン、プロリン、γ-アミノ酪酸(GABA)、セリン、チロシン、アスパラギン酸、グルタミン酸、ヒスチジンから選択され、そしてR4は、そのN末端基またはその側鎖アミノ基を介して、構造中のC(=O)と結合しているか、またはR 4 は、ペプチドRPKPQQFFGLM-CONH 2 であり、該ペプチドはKの側鎖アミノ基を介して、構造中のC(=O)と結合しており、ここで、アミノ酸またはペプチドのC末端は場合により修飾されており;
環Aは、5または6員複素環および縮合複素環を含む置換または非置換の芳香族複素環であり;環内のヘテロ原子は、1つまたはそれ以上の窒素、酸素、および/または硫黄ヘテロ原子であり;そして、置換基は、フッ素、塩素、臭素、ヨウ素、ヒドロキシル、ニトロ、アルキル、トリフルオロメチル基および、それらの組み合わせから成る群から選択される);
その互変異性体もしくは立体異性体;および、それらの薬学的に許容される塩。 - 以下を含む医薬組成物:
(a)請求項1~9、13および14のいずれか1項に記載の化合物、その互変異性体もしくは立体異性体、または、それらの薬学的に許容される塩の治療的有効量;および
(b)薬学的に許容される担体、賦形剤または媒体。 - 請求項1~9、13および14のいずれか1項に記載の化合物、その互変異性体もしくは立体異性体、またはそれらの薬学的に許容される塩を含む、治療を必要とする対象の疼痛を治療するための医薬組成物。
- 疼痛が組織アシドーシス、神経損傷、またはその両方に関連する、請求項16に記載の医薬組成物。
- 疼痛が機能不全性疼痛である、請求項16に記載の医薬組成物。
- 機能不全性疼痛が、線維筋痛症、膀胱痛症候群、過敏性腸症候群によって引き起こされる疼痛、および顎関節症に関連する疼痛から成る群より選択される、請求項18に記載の医薬組成物。
- 疼痛が、炎症性疼痛、癌関連疼痛、胸痛、背部痛、頸部痛、肩痛、片頭痛、頭痛、筋膜痛、関節痛、筋肉痛症候群、神経因性疼痛、末梢痛、交感神経痛、術後痛、心的外傷後痛、および多発性硬化症疼痛から成る群から選択される、請求項16に記載の医薬組成物。
- 疼痛が慢性疼痛である、請求項16に記載の医薬組成物。
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