LV12623B - A novel crystalline form of 6-hydroxy-3-(4-[2-(piperidin-1-yl) ethoxy] phenoxy)-2-(4-methoxyphenyl) benzo [b] thiophene hydrochloride - Google Patents

Abstract

Invention relates to novel hydrated crystalline 6-hydroxy-3-(4-[2-(piperidin-1-yl)ethoxy]phenoxy)-2-(4-methoxyphenyl)benzo[b]thiophene hydrochloride useful as agent in treatment of conditions related to diminishing of estrogen, cardiovascular diseases, hyperlipidemia, osteoporosis, endometriosis, uterine fibrosis, breast cancer, uterine cancer, prostatic cancer, benign prostatic hyperplasia, CNS disorders, including Alzheimer's disease as well as for up-regulating choline acetyltransferase.

Description

Abreviatūru zīmējumos skaidrojošs saraksts DSK (Diferenciālā Skanējošā Kalorimetrija) TGA (Termogravimetrija) RM (Relatīvais Mitrums) KMR (Kodola Magnētiskā Rezonanse) LV 12623 A NOVEL CRYSTALLINE FORM OF 6-HYDROXY-3-(4-[2-(PIPERIDIN-1-YL)ΕΤΗΟΧΥ]

ΡΗΕΝΟΧΥ)-2-(4-METHOXYPHENYL)BENZO[b]THIOPHENE HYDROCHLORIDE

Background of the Invention 6-Hydroxy-3-(4-(2-(piperidin-l-yl)ethoxy]phenoxy)-2-(4-methoxyphenyl)benzo [b] thiophene hydrochloride (arzoxifene) was first described generically in U.S. Patent No. 5,510,357 and was specifically disclosed in U.S..Patent No. 5,723,474 ( '474) and European Patent Application'0729956. Arzoxifene is a nonsteroidal mixed estrogen antagonist/agonist, useful for, iater alia, lowering serum cholesterol and for inhibiting hyperlipidemia, osteoporosis, estrogen dependent cancers including breast and uterine cancer, endometriosis, CNS disorders including Alzheimer's disease, aortai smooth muscle celi proliferation, and restenosis.

Specifically, arzoxifene is useful for, and is being clinically evaluated for the treatment of receptor positive metastatic breast cancer; the adjuvent treatment of receptor positive patients following appropriate systemic or local therapy; the reduction of recurrence of invasive and noninvasive breast cancer; and the reduction of the incidence of invasive breast cancer and ductal carcinoma in situ (DCIS). Arzoxifene is also useful in combination with radiotherapy, aromatase inhibitors, LHRH analogues, and acetyl choline’esterase (AChE) inhibitors. X-ray powder diffraction (XRD), thermogravimetric (TGA), proton nuclear magnetic resonance (½ NMR) and Kari Fischer (KF) analyses of bulk arzoxifene isolated by the procedures taught in '474 later indicated that said material was hydrated, poorly crystalline, and contained variable amounts of an organic volatile (ethyl acetate) in its lattice. 2

Poorly crystalline materiāls are typically less desirable than highly crystalline materiāls for formulation Processing. In addition, it is generally not desirable to formulate pharmaceuticals containing substantial amounts of 5 organic solvent (e.g., ethyl acetate) due to potential solvent toxicity to the recipient thereof and changes in potency of the pharmaceutical as a function of the solvent.

Although the arzoxifene prepared by the .procedures taught in ‘474 could be used as a pharmaceutical, it would 10 be highly desired and advantageous to find a more crystalline form of arzoxifene that did not contain an organic solvent within its crystal lattice which could be reproducibly and efficiently prepared on a commercial scale. 15 Summaxy of the Invention

The present invention is related to a novel non-stoichiometric hydrated crystalline form of 6-hydroxy-3-(4-[2-(piperidin-l-yl)ethoxy]phenoxy)-2-(4- methoxyphenyl)benzo[b]thiophene hydrochloride (F-I) having 20 an X-ray diffraction pattern which comprises the following peaks: 7.9 ±0.2, 10.7 ±0.2, 14.9 ±0.2, 15.9 ±0.2, 18.3 ±0.2, and 20.6 ±0.2° in 2Θ; when obtained from a copper radiation source.

Moreover the present invention relates to a 25 pharmaceutical formulation comprising F-I; one or more pharmaceutical carriers, diluents, or excipients; and optionally estrogen, optionally progestin, optionally ,an aromatase inhibitor, optionaļly an LHRH analogue and optionally an acetyl choline esterase (AChE) inhibitor. 30 In addition, the present invention is related to methods for using F-I to inhibit pathological conditions such as: uterine fibrosis, endometriosis, aortai smooth muscle celi proliferation, restenosis, breast cancer, uterine cancer, prostatic cancer, benign prostatic 4 4 3 LV 12623 hyperplasia, bone loss, osteoporosis, cardiovascular disease, hyperlipidemia, CNS disorders, and Alzheimer's disease and for using F-I for the manufacture of a medicament for inhibiting same. 5 The present invention is further related to methods for using F-I to up-regulate choline acetyltransferase (ChAT) and for using F-I for the manufacture of a medicament for up-regulating same. 10

Brief Description of the Figurēs

Figurē 1 is a representative differential scanning calorimetry (DSC)/TGA trace of S-II.

Figurē 2 is a representative DSC/TGA trace of F-I. 15 20 25

Figurē 3 is a representative DSC/TGA trace of F-III.

Figurē 4 depicts moisture sorption isotherms for F-I and F-III.

Figurē 5 depicts desolvation of S-II as a function of drying time and temperatūre.

Detailed Description o£ the Invention

Bulk arzoxifene prepared by the procedure taught in '474 (Example 41, crystallization from a mixture of ethanol and ethyl acetate, filtration and drying of the filter cake in vacuo to a constant weight at room temperature) was characterized by XRD and was found to be poorly crystalline. NMR confirmed that the bulk material contained 6% e,thyl acetate.

The crystallization procedure taught in '474 was subsequently modified so that ethanol was added to a suspension of crude arzoxifene in refluxing ethyl acetate. Upon cooling and vacuum filtration, the solid that results from this modified procedure is a highly crystalline mixed ethyl acetate/water solvate of arzoxifene (hereinafter 30 4 referred to as S-II) which was later discovered to be a starting material for F-I. F-I may be prepared by removing the ethyl acetate from S-II's crystal lattice by vacuum drying/annealing S-II at 5 elevated temperatures. The time and temperature required to anneal S-II in order to prepare F-I will vary from lot to lot but is typically on the order of 5 days at around 100°C. High temperatures are needed to effect the conversion of S-II to F-I via this procedure, since slurrying S-II in water 10 at ambient temperature or storing a sample at 98% RH for 3 weeks afforded no conversion to F-I. Furthermore, drying S-II in a convection oven at high temperatures did not de-solvate the material either, suggesting that a vacuum is also required to pull the ethyl acetate from S-II's lattice. 15 Preferably, F-I is readily prepared and isolated at ambient temperature by crystallization of arzoxifene (or any polymorph/solvate thereof) from tetrahydrofuran. This crystallization is preferably performed by initially dissolving arzoxifene in wet tetrahydrofuran (1-10% water by 20 volume, preferably 2.5-7.5% and most preferably 4.5 to 5.5%) followed by removal of said water via atmospheric distillation. An example of this crystallization is detailed below in Example 2. When F-I is prepared via this improved crystallization procedure, a total related 25 substance (TRS) Ievel of <0.5 % can be expected.

Suitable arzoxifene starting material for this crystallization includes, but is not limited to, S-II, F-III, arzoxifene prepared by the procedures taught in '474, or any mixture thereof. It is not important which form of arzoxifene one starts with because crystallization from tetrahydrofurap, according to the procedures described herein, results in F-I crystals. For commercial scale synthesis of F-I, it may be advantageous to seed the crystallization with F-I. 30 5 LV 12623 F-III, another non-stoichiometric hydrate of arzoxifene, is readily prepared and~isolated at ambient temperature by crystallization of arzoxifene (or any polymorph/solvate thereof) from a mixture of. isopropyl 5 alcohol (IPA) and water. The ratio of water to IPA (v:v) is generally about 1:1 to 9:1. More preferably, the ratio is between 2.5 and 5.6:1. Most preferably, the ratio is between 3 to 5.6:1. The ratio of IPA to water is not critical to effect crystallization of F-III but does affect 10 the yield. For commercial scale synthesis of F-III, it may be advantageous to seed the crystallization with F-III. Suitable arzoxifene starting material for the above crystallization include, but are not limited to, S-II, F-I, arzoxifene prepared by the procedures taught in '474, or any 15 mixture thereof.

Characterization and Differentiation of S-II, F-I and F-III DSC/TGA and XRD methods were used to characterize S-II, F-I and F-III. TGA is often very useful for distinguishing 20 between different solid forms of a material because the temperature(s) at which a physical chaņge in a material occurs is usually characteristic of the polymorph or solvate. DSC is a technique that is often used to screen compounds for polymorphism and solvate formation. Lastly, 25 XRD is a technique that detects long-range order in a crystalline material.

Arzoxifene prepared by the procedures taught in '474 gavē XRD patterns with poor signal-to-noise ratios and a raised baseline, indicative of poorly crystalline material. 30 Therefore, comparisons of F-I and F-III are made to the material (S-II) produced by the modified arzoxifene crystallization procedure discussed above (addition of ethanol to a suspension of arzoxifene in refluxing ethyl acetate). 6

Representative DSC/TGA traces of S-II, F-I and F-III are shown in Figurēs 1, 2 and 3, respectively. The DSC trace for S-II shows a broad endotherm beginning at about 62°C, corresponding to the loss of ethyl ace-tate and water 5 from the lattice. The endotherm beginning at about 152°C represents a melt. The TGA weight loss of approximately 2.5% occurs simultaneous with the first transition, while the remaining 0.5% weight loss occurs up to trhe onset of melting, suggesting that some solvent molecules are more 10 tightly held in the lattice.

The DSC trace of F-I shows a broad endotherm beginning at about 75°C, followed by a second endotherm beginning at about 155°C corresponding to a melt. The TGA trace of F-I shows a gradual weight loss of 0.3% followed by a sharp loss 15 of 1.5%, which together represent dehydration of the lattice. The onset of the first DSC transition and the corresponding TGA weight loss are offset slightly due to the difference in heating rātes. The initial weight loss represents weakly held waters of hydration while the second 20 weight loss is consistent with approximately 0.5 mole of water present in the lattice at very low relative humidities (below 5% - see moisture sorption data).

The DSC trace of F-III features a broad, low temperature endotherm at about 30°C, followed by a second 25 broad and relatively weak endotherm beginning at about 70°C, and a final transition beginning at about 146°C corresponding to a melt. The sharp 1.5% (~0.5 mole) weight loss in the TGA coincident with the first endotherm corresponds to loss of weakly held water molecules, while 30 the additional -1.6% weight loss above 60°C represents loss of more tightly held water molecules, i.e., those which are present at very low relative humidities. The weight loss observed after 170°C corresponds to decomposition of F-III. 7 LV 12623

The XRD patterns of F-I and F-III feature sharp peaks and a flat baseline, indicative of highly crystalline materiāls. The angular peak positions in 2Θ and corresponding I/I0 data for representative samples of F-I, 5 F-III and S-II is tabulated in Table 1. Although many of the intense reflections are generally at similar diffraction angles, each of the forms gives a different powder pattem, allowing for a clear distinction between S-II, F-I and F-III. 10 It is well known in the crystallography art that, for any given polymorph, the relative intensities of the diffraction peaks may vary due to preferred orientation resulting from factors such as crystal morphology. Where the effects of preferred orientation are present, peak 15 intensities are altered, but the characteristic peak positions of the polymorph are unchanged. See, e.g., The United States Pharmacopeia #23, National Formulary #18, pages 1843-1844, 1995. Thus, based on peak intensities as well as peak position, F-I may be identified by the presence 20 of peaks at 7.9 ±0.2, 10.7 ±0.2, 14.9 ±0.2, 15.9 ±0.2, 18.3 ±0.2, and 20.6 ±0.2° in 2Θ; when the pattern is obtained from a copper radiation source.

Table 1 s-] [I F-I F-III 20 (®) I/Io (*> 20 (°) I/Io (*> 20 (®) I/Io (%> 4.67 1.3 4.92 2.6 4.63 20.8 5.03 6 7.69 34.6 7.82 100 6.83 5.8 7.91 ' 100 9.29 16.9 7.17 16.1 9.89 2.5 10.16 22.7 7.73 100 10.22 2 10.35 5.4 9.03 1.3 10.74 7.4 13.77 10.7 9.31 1.7 14.86 9.1 13.97 15.2 9.66 2.4 15.45 2.3 15.06 6.9 10.27 1.6 15.92 15.9 15.71 22.3 10.47 2.2 16.67 1.7 15.87 7.4 10.91 6.3 16.98 3.1 16.35 34.5 8

Table 1 (continued) S-] [I F-I F-III 20 (®) I/Io (¾) 20 (°) I/Io (%> 20 (°) I/Io (¾) 13.63 2.1 18.28 17.8 16.77 12.3 14.09 4.6 18.56 7 17.28 10 15.10 4.1 20.58 13.1 17.62 47.9 15.52 10.5 20.85 8.8 18.09 43.9 16.45 9.1 21.64 3.9 20.43 42 16.67 7.6 22.19 4.8 20.80 33.6 17.21 4.9 22.65 2.9 21.31 42.7 17.53 2.4 23.28 3.4 . 21.71 13 18.33 28.2 23.97 11.8 - 21.85 14.5 18.69 11.1 24.31 6.3 22.13 12.8 19.37 3.5 25.52 3.9 22.26 16.3 20.29 8.6 26.20 3.4 23.51 13.2 20.64 17.2 26.47 3.1 23.69 15.9 21.02 12.7 28.84 6.4 23.91 25.6 21.68 5.1 30.13 3.5 24.31 38.7 22.01 8.3 · 31.12 2.9 25.22 8 22.29 8 25.67 8.9 23.17 7.8 27.05 18.9 23.39 9.1 27.89 13.3 24.30 13.6 28.24 8.6 25.76 3.4 28.71 21.3 28.10 1.8 29.89 8.9 28.73 10.9 30.24 18.7 29.42 3.2 30.88 5.8 30.00 3.7 31.44 7.6 30.89 2.1 33.06 4.5 31.34 2.4 34.36 6 31.70 1.1 32.81 1 32.91 0.8 33.48 2 26.05 4 26.63 5.5 27.01 3.1 27.49 2.8

5 Further Characterization of F-I and F-III

Hygroscopicicity studies were performed on F-I and F-III. The moisture sorption isotherms for F-I and F-III are shown in Figurē 4. Upon initial exposure of the samples to approximately 5% RH, there was an immediate weight gain of 9 LV 12623 1.5% and 1.7% moisture for F-I and F-III, respectively, equivalent to approximately 0.5 mole of water. Both forms show a continuous sorption of moisture through the entire humidity range, which is likely due to incorporation of 5 water molecules in the lattices.

The difference in the moisture uptake of the two forms likely reflects the amount of water that can be incorporated into the two lattices (i.e., the amount of availabie space in the lattice that can accommodate water molecules). Lack 10 of hysteresis in the sorption-desorption isotherms of F-I and F-III indicates that the crystal forms rapidly equilibrate at any given humidity.

The moisture sorption profilēs for F-I and F-III reveal that these forms are essentially non-stoichiometric 15 hydrates. At ambient relative humidity (about 50% RH), F-I contains approximately 1.7% water, corresponding to 0.5 moles of water, while F-III has sorbed about 3.0% water which corresponds to about 0.85 moles of water.. The bulk forms of F-I and F-III rapidly equilibrate with the 20 atmosphere, so that the water content observed by analytical technigues is a reflection of the relative humidity at the time of data collection. Lot-to-lot differences observed in the DSC data likely results from the samples being hydrated to different extents due to different ambient storage 25 conditions. XRD pattems were obtained for samples of F-I and F-III stored at different relative humidities (0, 22, 50, and 80%). There is a gradual shifting of the initial (0% RH) F- III peaks at about 13.8, 17.6, 18.0, 20.5 and 24.0° in 2Θ as 30 well as slight shifting of less intense peaks, as the relative humidity is increased. These observed changes in the XRD pattems of F-III indicate that the unit celi dimensions are changing, presumably to accommodate weakly held water molecules as the relative humidity is increased. 10

The continuous shifting of peaks with humidity correlates well with moisture sorption data that showed a gradual weight gain over this RH range, providing evidence for variable hydrate formation. 5 A similar experiment was carried out on F-I to determine whether varying the relative humidity would have a similar effect on its lattice (0, 25, 52, 73 and 95% RH). Very slight shifting of the 0% RH peaks at about 7.7, 18.3, 18.5, 20.5, 20.8° in 20 is observed as vthe relative humidity 10 is increased. The peaks at about 7.7,*20.8, and 24.1 also appear to become slightly broadened and less resolved at higher relative humidities, indicating that water is being sorbed into amorphous components (or plasticizes the solid), particularly at 73 and 95% RH. The shifting of peaks in the 15 XRD patteras of F-I is less dramatic than the peak shifts observed as F-IĪI was exposed to different'relative humidities. This suggests that the F-I lattice does not undergo the same expansion and/or contraction as the F-III lattice. 20 F-I and F-III were found to be stable over the entire relative humidity range, despite the ability of F-III to sorb nearly twice as much water. The two forms were found to have comparable crystal size, morphology, aqueous solubilities and dissolution rātes. 25 A drying study was carried out to monitor the desolvation of'S-II as a function of drying time and temperature (see Figurē 5). XRD patterns were taken at various timepoints during the desolvation experiment. Many diffraction peaks from the desolvation study of S-II appear 30 at similar angles to F-I, confirming that the lattices of S-II and F-I are very similar. The disappearance of diffraction peaks at about 6.8, 7.2 and 14.0° in 2Θ after only minimal drying suggests that these reflections may be 11 LV 12623 attributed to crystallographic planēs containing partial electron density of ethyl acetate molecules.

Extended annealing of the solvated material under vacuum at high temperatures yielded F-I. F-T prepared this 5 way showed a high degree of crystallinity by XRD.

Therefore, material generated by crystallization from a solution of ethanol and ethyl acetate followed by vacuum drying for only a few hours as taught in '474 showed very poor crystallinity because such a procedure results in 1 10 partially desolvated S-II. F-I and F-III have several advantages over the prior art form of arzoxifene described above. Relative to the arzoxifene produced by the procedures taught in '474, F-I and F-III are more stable at ambient temperature and are, 15 therefore, more amenable to pharmaceutical development, i.e., development of a dosage formulation. In addition, F-I and F-III are much more crystalline than the form disclosed in '474. Crystalline materiāls are generally less hygroscopic and more stable (e.g., less prone to Chemical 20 degradation, maintains consistent potency) than amorphous materiāls and are, therefore, more desirable for formulation Processing. Furthermore, unlike the form of arzoxifene produced by the procedures taught in '474, which contained ethyl acetate and water in its lattice, F-I and F-III 25 contain only water.

Characterization Methods DSC measurements were performed on a TA Instruments 2920 Modulated DSC attached to a Thermal Analyst 3100 and 30 equipped with a refrigerated cooling system. Samples (3-5 mg) were heated in crimped aluminum pans from 10 to 240°C at a heating rāte of 2°C/min. TGA analyses were performed on a TA Instruments 2050 Thermogravimetric Analyzer attached to a Thermal Analyst 12 3100. Samples (5-10 mg) were heated in open pans from 25°C to 250°C at a heating rāte of 5°C/min. XRD patterns were obtained on a Siemens D5000 X-ray powder diffractometer, equipped with a CuKa source (λ = 5 1.54056 A) and a Kevex solid-state detector, operating at 50 kV and 40 mA. Each sample was scanned between 4° and 35° in 2Θ. Samples were allowed to equilibrate for at least 30 minūtes at the desired temperature and/or relative humidity before data collection.

10 Hygroscopicity measurements were made for F-I and F-III using the VTI method as follows. Each sample was dried under vacuum at 60°C until no further weight 1oss was detected, at which time the sample chamber was brought to 0% relative humidity. Moisture sorption isotherms were 15 obtained at 25°C using a VTI vacuum moisture balance with the following conditions: sample size 10-15 mg, adsorption/desorption range 0-95% relative humidity, step interval 5%, sample interval 10 minūtes.

The following examples further illustrate processes for 20 preparing the hydrate of the present invention. The examples are not intended to be limiting to the scope of these processes in any respect, and should not be so construed. 25 Preparations

Preparation 1 S-II 30 Crude arzoxifene (1.58 g of material prepared by the procedure of Example 41 in U.S. Patent No. 5,723,474, the teachings of which are herein incorporated by reference) was suspended in 28 mL ethyl acetate and heated to reflux. 13 LV 12623

Ethanol (18 mL) was added to effect dissolution. The solution was maintained at reflux for 20 minūtes and then allowed to cool to room temperature. The precipitate was isolated by vacuum filtration and was.washed.with 30 mL 5 ethyl acetate to give 1.05 g of a powdery, white solid.

Examples

Example 1 10 F-I from S-II ' S-II was dried in a vacuum oven (-25 in. Hg) at 100°C for 118 hours to yield F-I. 15 Example 2

Improved Procedure for Preparing F-I from Arzoxifene A 1L, 3-necked round bottom flask equipped with a reflux condenser and an overhead aģitator is charged with 20 25.0 g of arzoxifene, 475 ml of tetrahydrofuran and 25 ml of water. The reaction vessel is then equipped for simple distillation. The reaction mixture is heated to reflux and 250 ml of distillate are removed. Heat is briefly removed and 250 ml of fresh anhydrous tetrahydrofuran is added to 25 the vessel. Atmospheric distillation is continued with removal of an additional 250 ml of distillate. Heat is briefly removed, 250 ml of fresh tetrahydrofuran added, and an additional 250 ml of distillate are removed. An additional 250 ml of tetrahydrofuran is added, and the 30 reaction mixture is held at reflux. With this tetrahydrofuran addition, a white precipitate forms. The agitated reaction mixture is allowed to cool slowly over 3 hours during which time additional solīds precipitate and the slurry reached ambient temperature. The crystalline 14 slurry is filtered and vacuum dried at 50°C for forty eight hours with a slight N2 purge. Yield 22.50 g (90.0%). XRD analysis showed the spectrum of the wet cake and the dry solid are substantially identical, and subst.antially 5 identical to that of F-I previously prepared. DSC analysis afforded a melting point of 157°C while TGA analysis showed a 1.5% mass loss between ambient temperatūre and 100°C. The HPLC purity calculated as the free base was 88.1% vs. a theoretical potency of 92.9%. HPLC analysis showed a total 1 10 related substance Ievel of 0.44%. ' ·

Example 3 F-I from [6-Benzyloxy-3-[4-[2-(piperidin-1-yl)ethoxy)phenoxy]-2-(4-methoxyphenyl)]benzo[b]thiopene-(S-15 oxide)

Tetrahydrofuran (261 ml), water (45 ml) concentrated sulfuric acid (6.14 g) and [6-benzyloxy-3-[4-[2-(piperidin-l-yl)ethoxy)phenoxy]-2-(4-methoxyphenyl)]benzo[b]thiopene-20 (S-oxide) (HPLC potency 99%, HPLC total related substance

Ievel 0.35%) were combined and stirred until homogeneous. 10% Pd/C (5.6 g slurried in 22 ml of water) was added with a 5 ml water rinse. The resulting slurry was evacuated and overlaid with 60 psi of hydrogen. The reaction temperature 25 was adjusted to 30°C. After 2 hours, 10% Pd/C (5.6 g) of was added with water (30 ml). Hydrogenation at 60 psi and 30°C was continued for an additional 22 hours. An additional 4.40 g of 10% Pd/C in 30 ml water was added and hydrogenation at 60 psi and 30°C continued for an additional 30 2.5 hours. The catalyst was removed by filtration and the pH of the filtrate was adjusted to 7.24 with 50% sodium hydroxide. Sodium chloride (8.66 g) dissolved in water (18 ml) was added and the biphasic solution stirred for 30 minūtes. The phases were separated and the agueous phase 15 LV 12623 was back extracted with 50 ml of tetrahydrofuran. The organic phases were combined and concentrated by atmospheric distillation to a volume of 50 ml. To the concentrate at 24°C was added methanol, 180 ml over a 1 hour period. The 5 resulting crystalline slurry was stirred for 30 minūtes at 24°C, cooled to 0°C and stirred for 1 hour. The solīds were isolated by filtration and washed sequentially with 39 ml of water and 39 ml of methanol followed by vacuum drying ovemight at 50°C. Yield 15.52 g (67.8%). t 10 A portion of the product from above (10 g) are recrystallized from tetrahydrofuran and water as described in Example 2.

Utilities 15 As used herein, the term "effective amount" means an amount of F-I that is capable of inhibiting conditions, or detrimental effects thereof, described herein. When F-I is co-administered with estrogen, progestin, an aromatase inhibitor, an LHRH analogue, or an AChE inhibitor, the term 20 "effective amount" also means an amount of such an aģent capable of producing its intended effect.

The terms "inhibiting" and "inhibit" include their generally accepted meaning, i.e., preventing, prohibiting, restraining, alleviating, ameliorating, slowing, stopping, 25 or reversing the progression or severity of a pathological condition, or seguela thereof, described herein.

The terms "preventing", "prevention of", "prophylaxis", "prophylactic" and "prevent" are used herein interchangeably and refer to reducing the likelihood that the recipient of 30 F-I will incur or develop any of the pathological conditions, or sequela thereof, described herein.

The terms "estrogen deprived" and "estrogen deprivation" refer to a condition, either naturally occurring or clinically induced, where a woman can not producē sufficient endogenous estrogenic hormones to maintain estrogen dependent functions, e.g., menses, homeostasis of bone mass, neuronal function, cardiovascular condition, etc. Such estrogen deprived situations arise from, but are not limited to, menopause and surgical or Chemical ovarectomy, including its functional equivalent, e.g., medication with an aromatase inhibitor, GnRH agonists or antagonists, ICI 182780, and the like. Disease States associated with an estrogen deprived. State include, but are not limited to: bone loss, osteoporosis, cardiovascular disease and hyperlipidemia.

As used herein, the term "estrogen" includes steroidal compounds having estrogenic activity such as, for example, 17p-estradiol, estrone, conjugated estrogen (Premarin®), equine estrogen 17p-ethynyl estradiol, and the like. A preferred estrogen-based compound is Premarin®, and norethylnodrel.

As used herein, the term "progestin" includes compounds having progestational activity such as, for example, progesterone, norethylnodrel, nongestrel, megestrol acetate, norethindrone, and the like. Norethindrone is a preferred progestin-based aģent.

As used herein the term "aromatase inhibitor" includes compounds capable of inhibiting aromatase, for example commercially availabie inhibitors such as aminoglutemide (CYTANDREN®), Anastrazole (ARIMIDEX®), Letrozole (FEMARA®) , Formestane (LENATRON®) , Exemestane (AROMASIN®) , and the like.

As used herein, the term ”LHRH analogue" refers to an analogue of lutenizing hormone releasing hormone that inhibits estrogen production in a premenopausal women including for example, goserlin (ZOLADEX ),, leuprolide (LUPRON®) and the like. 17 LV 12623

As used herein, the term "AChE inhibitor" includes compounds that inhibit acetyl choline esterase, for example, physostigmine salicylate, tacrine hydrochloride, donepezil hydrochloride and the like. 5 The term wup-regulate ChAT" refers to increasing the enzymatic activity of ChAT, i.e., promoting the conversion of choline to acetyl choline. This promotion would include an increase in the efficiency and/or rāte of .reaction of ChAT and choline and/or an increase in the amount of ChAT 10 present at the site of action. This increase in the amount of enzyme present may be due to gene regulation or other synthetic step of the enzyme's formation and/or a decrease in the enzyme's de-activation and metabolism. 15 Selected Testing Procedures

General Rat Preparation Procedure: Seventy-five day old (unless otherwise indicated) female Sprague Dawley rats (weight range of 200 to 225g) are obtained from Charles River Laboratories (Portage, Ml). The animals are either 20 bilaterally ovariectomized (OVX) or exposed to a Sham surgical procedure at Charles River Laboratories, and then shipped after one week. Upon arrival, they are housed in mētai hanging cages in groups of 3 or 4 per cage and have ad libitum access to food (calcium content approximately 0.5%) 25 and water for one week. Room temperatūre is maintained at 22.2° ± 1.7°C with a minimum relative humidity of 40%. The photoperiod in the room was 12 hours light and 12 hours dark.

Dosing Regimen Tissue Collection: After a one week 30 acclimation period (therefore, two weeks post-0VX) daily dosing with F-I is initiated. 17a-ethynyl estradiol or F-I is given orally, unless otherwise stated, as a suspension in 1% carboxymethylcellulose or dissolved in 20% cyclodextrin. Animals are dosed daily for 4 days. Following the dosing 18 regimen, animals are weighed and anesthetized with a ketamine: Xylazine (2:1, v:v) mixture and a blood sample is collected by cardiac puncture. The animals are then sacrificed by asphyxiation with C02, the uterus is removed 5 through a midline incision, and a wet uterine weight is determined. 17a-ethynyl estradiol is obtained from Sigma Chemical Co., St. Louis, MO.

Cardiovascular Disease/Hyperlipidemia 10 The blood samples from above are allowed to clot at room temperature for 2 hours, and serum is obtained following centrifugation for 10 minūtes at 3000 rpm. Serum cholesterol is determined using a Boehringer Mannheim Diagnostics high performance cholesterol assay. Briefly the 15 cholesterol is oxidized to cholest-4-en-3-one and hydrogen peroxide. The hydrogen peroxide is then reacted with phenol and 4-aminophenazone in the presence of peroxidase to producē a p-guinone imine dye, which is read spectrophotemetrically at 500 nm. Cholesterol concentration 20 is then calculated against a Standard curve. The entire assay is automated using a Biomek Automated Workstation.

Uterine Eosinophil Peroxidase (EPO) Assay

The uteri from above are ķept at 4°C until time of 25 enzymatic analysis. The uteri are then homogenized in 50 volumes of 50 mM Tris buffer (pH - 8.0) containing 0.005% Triton Χ-100. Upon addition of 0.01% hydrogen peroxide and 10 mM Q-phenylenediamine (final concentrations) in Tris buffer, increase in absorbance is monitored for one minūte 30 at 450 nm. The presence of eosonophils in the uterus is an indication of estrogenic activity of a compound. The maximal velocity of a 15 second interval is determined over the initial, linear portion of the reaction curve. 19 LV 12623

Inhibition of Bone Loss (Osteoporosis) Tēst Procedure

Following the general preparation procedure described above, the rats are treated daily for. thirty.-five days (6 5 rats per treatment group) and sacrificed by carbon dioxide asphyxiation on the 36th day. The thirty-five day time period is sufficient to allow maximal reduction in bone density, measured as described herein. At the time of sacrifice, the uteri are removed, dissected free of 10 extraneous tissue, and the fluid contents are expelled before determination of wet weight in order to confirm estrogen deficiency associated with complete ovariectomy. Uterine weight is routinely reduced about 75% in response to ovariectomy. The uteri are then placed in 10% neutral 15 buffered formalin to allow for subseguent histological analysis.

The right femurs are excised and digitilized X-rays generated and analyzed by an image analysis program (NIH image) at the distal metaphysis. The proximal aspect of the 20 tibiae from these animals are also scanned by quantitative computed tomography. In accordance with the above procedures, F-I or ethynyl estradiol (EE2) in 20% hydroxypropyl 3~cyclodextrin are orally administered to tēst animals. F-I is also useful in combination with estrogen or 25 progestin. MCF-7 Proliferation Assay MCF-7 breast adenocarcinoma celis (ATCC HTB 22) are 30 maintained in MEM (minimal essential medium, phenol red- free, Sigma, St. Louis, MO) supplemented with 10% fetal bovine serum (FBS) (V/V), L-glutamine (2 mM), sodium pyruvate (1 mM) , HEPES {(N-[2-hydroxyethyi]piperazine-N'-[2-ethanesulfonic acid]10 mM}, non-essential amino acids and 35 bovine insulin (1 ug/mL) (maintenance medium). Ten days 20 prior to assay, MCF-7 celis are switched to maintenance medium supplemented with 10% dextran coated charcoal stripped fetal bovine serum (DCC-FBS) assay medium) in place of 10% FBS to deplete internai stores, of ste.roids. MCF-7 5 celis are removed from maintenance flasks using celi dissociation medium (Ca++/Mg++ free HBSS (phenol red-free) supplemented with 10 mM HEPES and 2 mM EDTA). ' Celis are washed twice with assay medium and adjusted to 80,000 cells/mL. Approximately 100 mL (8,000 celis) are added to 10 flat-bottom microculture wells (Costār- 3596) and incubated at 37°C in a 5% C02 humidified incubator for 48 hours to allow for celi adherence and equilibration after transfer. Serial dilutions of drugs or DMSO as a diluent control are prepared in assay medium and 50 mL transferred to triplicate 15 microcultures followed by 50 mL assay medium for a final volume of 200 mL. After an additional 48 hours at 37°C in a 5% C02 humidified incubator, microcultures are pulsed with tritiated thymidine (1 uCi/well) for 4 hours. Cultures are terminated by freezing at -70°C for 24 hours followed by 20 thawing and harvesting of microcultures using a Skatron

Semiautomatic Celi Harvester. Samples are counted by liquid scintillation using a Wallac BetaPlace β counter. DMBA-Induced Mammary Tumor Inhibition 25 Estrogen-dependent mammary tumors are produced in female Sprague-Dawley rats which are purchased from Harlan Industries, Indianapolis, Indiana. At about 55 days of age, the rats receive a single oral feeding of 20 mg of 7,12-dimethylbenz[a]anthracene (DMBA). About 6 weeks after DMBA 30 ādministration, the mammary glands are palpated at weekly intervāls for the appearance of tumors. Whenever one or more tumors appear, the longest and shortest diameters of each tumor are measured with a metric caliper, the 21 LV 12623 measurements are recorded, and that animal is selected for experimentation. An attempt is made to uniformly distribute the various sizes of tumors in the treated and control groups such that average-sized tumors are equivalently 5 distributed between tēst groups. Control groups and tēst groups for each experiment contain 5 to 9 animals. F-I is ādministered either through intraperitoneal injections in 2% acacia, or orally. Orally administered compounds are either dissolved or suspended in 0.2 mL com i 10 oil. Each treatment, including acacia’and corn oil control treatments, is administered once daily to each tēst animal. Following the initial tumor measurement and selection of tēst animals, tumors are measured each week by the above-mentioned method. The treatment and measurements of animals 15 continue for 3 to 5 weeks at which time the final areas of the tumors are determined. For each compound and control treatment, the change in the mean tumor area is determined.

Uterine Fibrosis Tēst Procedures 20 Tēst 1: Between 3 and 20 women having uterine fibrosis are administered F-I. The amount of compound administered is from 0.1 to 1000 mg/day, and the period of administration is 3 months. The women are observed during the period of 25 administration, and up to 3 months after discontinuance of administration, for effects on uterine fibrosis. Tēst 2: The same procedure is used as in Tēst 1, except the period of administration is.6 months. 30 Tēst 3: The same procedure is used as in Tēst 1, except the period of administration is 1 year. Tēst 4: Prolonged estrogen stimulation is used to inducē 35 leiomyomata in sexually mature female guinea pigs. Animals 22 are dosed with estradiol 3-5 times per week by injection for 2-4 raonths or until tumors arise. Treatment consisting of F-I or vehicle is administered daily for 3-16 weeks and then animals are sacrificed and the uteri harvested and analyzed 5 for tumor regression. Tēst 5: Tissue from human leiomyomas are implanted into the peritoneal cavity and/or uterine myometrium of sexually mature, castrated, female, nude mice. Exogenous estrogen is

L 10 supplied to inducē growth of the explanted tissue. In some cases, the harvested tumor celis are cultured in vitro prior to implantation. Treatment consisting of F-I or vehicle is supplied by gastric lavage on a daily basis for 3-16 weeks and implants are removed and measured for growth or 15 regression. At the time of sacrifice, the uteri are harvested to assess the status of the organ. Tēst 6: Tissue from human uterine fibroid tumors is harvested and maintained, in vitro, as primary non-20 transformed cultures. Surgical specimens are pushed through a sterile mesh or sieve, or alternately teased apart from surrounding tissue to producē a single celi suspension.

Celis are maintained in media containing 10% serum and antibiotic. Rātes of growth in the presence and absence of 25 estrogen are determined. Celis are assayed for their ability to producē complement component C3 and their response to growth factors and growth hormone. In vitro cultures are assessed for their proliferative response following treatment with progestins, GnRH, F-I, and vehicle. 30 Levels of steroid hormone receptors are assessed weekly to determine whether important celi characteristics are maintained in vitro. Tissue from 5-25 patients is utilized. 23 LV 12623 Tēst 7: F-I's ability to inhibit estrogen-stimulated proliferation of leiomyoma-derived ELT celi lines is measured substantially as described in Fuchs-Young, et al., "Inhibition of Estrogen-Stimulated Growth of Uterine Leiomyomas by Selective Estrogen Receptor Modulators", Mol. Car., 17(3):151-159 (1996), the teachings of which are herein incorporated by reference.

Endometriosis Tēst Procedures Tēst 1: Twelve to thirty adult CD strain female rats are used as tēst animals. They are divided into three groups of equal numbers. The estrous cycle of ali animals is monitored. On the day of proestrus, surgery is performed on each female. Females in each group have the left uterine horn removed, sectioned into small squares, and the squares are loosely sutured at various sites adjacent to the mesenteric blood flow. In addition, females in Group 2 have the ovaries removed. On the day following surgery, animals in Groups 1 and 2 receive intraperitoneal injections of water for 14 days whereas animals in Group 3 receive intraperitoneal injections of 1.0 mg of F-I per kilogram of body weight for the same duration. Following 14 days of treatment, each female is sacrificed and the endometrial explants, adrenals, remaining uterus, and ovaries, where applicable, are removed and prepared for histological examination. The ovaries and adrenals are weighed. Tēst 2: Twelve to thirty adult CD strain female rats are used as tēst animals. They are divided into two equal groups. The estrous cycle of ali animals is monitored. On the day of proestrus, surgery is performed on each female. Females in each group have the left uterine horn removed, sectioned into small squares, and the squares are loosely sutured at various sites adjacent to the mesenteric blood 24 flow. Approximately 50 days following surgery, animals assigned to Group 1 receive intraperitoneal injections of water for 21 days whereas animals in Group 2 receive intraperitoneal injections of 1.0 mg of F-I per kilogram of body weight for the same duration. Following 21 days of treatment, each female is sacrificed and the endometrial explants and adrenals are removed and weighed. The explants are measured as an indication of growth. Estrous cycles are monitored. Tēst 3: Autographs of endometrial tissue are used to inducē endometriosis in rats and/or rabbits. Female animals at reproductive maturity undergo bilateral oophorectomy, and estrogen is supplied exogenously thus providing a specific and constant Ievel of hormone. Autologous endometrial tissue is implanted in the peritoneum of 5-150 animals and estrogen supplied to inducē growth of the explanted tissue. Treatment consisting of a compound of the present invention is supplied by gastric lavage on a daily basis for 3-16 weeks, and implants are removed and measured for growth or regression. At the time of sacrifice, the intact horn of the uterus is harvested to assess status of endometrium. Tēst 4: Tissue from human endometrial lesions is implanted into the peritoneum of sexually mature, castrated, female, nude mice. Exogenous estrogen is supplied to inducē growth of the explanted tissue. In some cases, the harvested endometrial celis are cultured in vitro prior to implantation. Treatment consisting of F-I supplied by gastric lavage on a daily basis for 3-16 weeks, and implants are removed and measured for growth or regression. At the time of sacrifice, the uteri are harvested to assess the status of the intact endometrium. 25 LV 12623 Tēst 5: Tissue from human endometrial lesions is harvested and maintained in vitro as primary non-transformed cultures. Surgical specimens are pushed through a sterile mesh or sieve, or alternately teased apart from surr.ounding tissue to producē a single celi suspension. Celis are maintained in media containing 10% serum and antibiotic. Rātes of growth in the presence and absence of estrogeri are determined. Celis are assayed for their abiļity to producē complement component C3 and their response to growth factors i and growth hormone. In vitro cultures*are assessed for their proliferative response following treatment with progestins, GnRH, F-I, and vehicle. Levels of steroid hormone receptors are assessed weekly to determine whether inportant celi characteristics are maintained in vitro. Tissue from 5-25 patients is utilized. CNS Disorders Including Alzheimer's Disease

Estrogens, such as ΙΤβ-βε^βάΐοΙ, regulate gene transcription by binding to estrogen receptors (ER) which reside in the cytoplasm of certain celi populations. Ligand activation of the ER is a prerequisite for nuclear transport of the complex where binding to a 13 base-pair palindromic DNA consensus sequence (estrogen response element, or ERE) begins assembly of a transcriptional apparatus which culminates in the activation of appropriate target genes. A variety of genes have been identified which are regulated by estrogen. These include cytoskeletal proteīns, neuro-transmitter biosynthetic and metabolic enzymes and receptors, as well as other hormones and neuropeptides. ERE's have been identified in many estrogen-responsive genes including vitellogenin, c-fos, prolactin, and luteinizing hormone.

Of significance in the Central nervous system, ERE-like seguences have been identified in p75n9r and trkA, both of 26 which serve as signaling molecules for the neurotrophins: nerve growth factor (NGF), brain derived nerve growth factor (BDNGF), and neurotrophin-3. BDNF as well as NGF have been shown to promote the 5 survival of cholinergic neurons in culture. It is postulated that if the interactions between neurotrophins and estrogens are important for the developmerit and survival of basai forebrain neurons (which degenerate in Alzheimer's disease) then clinical conditions in which an estrogen l 10 deficiency exists (as after menopausē) · may contribute to a loss of these neurons.

The following experiment is conducted in ovariectomized rats (prepared as described above) to determine the similarities and/or differences between F-I and estrogen at 15 affecting gene expression in various brain reģions. Six week old rats are dosed daily with subcutaneous injections of estradiol benzoate (0.03 mg/kg), F-I or vehicle (control). After five weeks of treatment, animals are sacrificed and their brains removed and hippocampi coliected 20 by microdissection. The hippocampi are fast frozen in liquid nitrogen and stored at -70°C. Total RNA is prepared from pooled tissue from the appropriate treatment and control groups and reverse transcribed using a 3' oligonucleotide primer which is selected for specific mRNA 25 (poly-A+) populations. Polymerase Chain reactions (PCR) are carried out in a cocktail consisting of: random 5' oligonucleotides (10 base-pairs in length; total of 150), reaction buffer, Taq polymerase, and a

After 40 rounds of amplification, the reaction products are size fractionated on a 6% TBE-urea gel, dried and exposed to X-ray film. The resulting mRNA display patterns are compared between treatment groups. 30 27 LV 12623

Use of F-I in Conjunction with Estrogen Peri- and post-menopausal women often undergo hormone replacement therapy (HRT) to combat negative conseguences associated with the drop in circulating endogenous estrogen, e.g., to treat hot flashes. However, HRT has been associated with increased risks of certain cancers including uterine and breast cancer. F-I may be employed in conjunction with HRT to inhibit these risks.

Use of F-I in Conjunction With an>Aromatase Inhibitor By definition, the ovaries of a postmenopausal woman are not functioning. Her only source of estrogen is through conversion of adrenal androgens to estrogens by the enzyme aromatase, which is found in peripheral tissues (including fat, muscle and the breast tumor itself). Thus, drugs that inhibit aromatase (aromatase inhibitors) deplete the postmenopausal woman of circulating estrogen. Estrogen deprivation by means of aromatase inhibition is an important treatment option for patients with metastatic breast cancer. During therapy with an aromatase inhibitor, lack of circulating estrogen may cause negative, unintended side-effects, for example on serum lipid Ievels. F-I may be employed to inhibit these negative effects.

Use of F-I in Conjunction with a LHRH Analogue Continuous exposure to a LHRH (lutenizing hormone releasing hormone) analogue inhibits estrogen production in the premenopausal women by desensitizing the pituitary gland, which then no longer stimulates the ovaries to producē estrogen. The clinical effect is a "medical oophrectomy* which is reversible upon cessation of the LHRH analogue. During therapy with a LHRH analogue, lack of circulating estrogen may cause negative, ujiintended side-effects, for example on serum lipid Ievels. F-I may be employed to inhibit these negative effects. 28

Increasing Levels of Acetyl Choline

It is known that patients suffering from Alzheimer's disease have a markedly smaller Ievel of cholinergic neurons in the hippocampus than their non-Alzheimer peers. The Progressive loss of these cholinergic neurons appears to mirror the Progressive loss in memory and cognitive function in these patients. It is thought that one reason for the decline of these neurons is the loss or decreased function of the neurotransmitter, acetyl choline.

The Ievel of acetylcholine in aneuron is basically determined by where the equilibrium between its bio-synthesis and bio-degradation lies. The enzyme choline acetyltransferase (ChAT) is primarily responsible for its synthesis and acetylcholineesterase (AChE) for its degradation.

In the order to determine F-I's effect on Ievels of ChAT, the following experiment is performed: Eollowingthe general rat preparation procedure .described.above, 40 rats are dosed daily by subcutaneous injection or oral gavage with F-I at 3 mg/kg/day in a vehicle containing 10% cyclodextrin, estradiol benzoate at 0.03 or 0.3 mg/kg/day, or vehicle control. Animals are treated for 3 or 10 days. There are twenty animals per each dosing regimen. At the appropriate time intervāls, the animals are sacrificed and their brains dissected. The particular portions of the brains are homogenized and assayed. Homogenates from the hippocampus and frontal cortex were processed and determination of ChAT activity is made by a radio-labelled assay of the bio-synthesis of acetyl choline. This procedure may be found in Schoepp et ai., J. Neural Transmiss., 78:183-193, 1989, the teachings of which are incorporated by reference. 29 LV 12623

As expected, in the OVX animals, ChAT Ievels are reduced >50% (p<0.001) compared to the sham operated Controls.

In another embodiment of the present invention, F-I is used in combination with an AChE inhibitor. Use of an AChE inhibitor increases Ievels of acetylcholine by blocking its degradation via inhibition of AChE.

Benign Prostatic Hvperplasia (BPH)

For background on the link betwēen estrogen action and treatment of BPH and prostate carcinoma, see PCT Application No. WO 98/07274, International Publication Datē: October 15, 1998.

In the experiments described below, the ability of F-I to bind at estrogen receptors in several human prostatic cancer celi lines is evaluated.

Lysates of the LNCaP, DU-45 and PC-3 human prostatic cancer celi lines are prepared in a TEG medium comprising 50 nM Tris»HCl pH 7.4, 1.5 mM ethylenediamine tetraacetic acid (EDTA) 0.4 M KCl, 10% glycerol, 0.5 mM 2-ME, and 10 mM sodium molybdate further containing the protease inhibitors pepstatin (1 mg/mL) , leupeptin (2 mg/mL) , aprotinin (5 mg/mL) and phenylmethylsulfonyl fluoride (PMSF, 0.1 mM) (TEGP).

The celi lysates are centrifuged and the pellets resuspended in cold TEGP (1 mL TEGP/100 mg of peliet) and sonicated for 30 seconds (duty cycle 70%, output 1.8) on a Branson Modei 450 Sonifier. Lysates are pelleted by centrifugation at 10,000 x G for 15 minūtes at 4°C after which the supernates are withdrawn and either used immediately or stored at -70°C.

Competitive Binding Assay: The binding buffer is TEG in which the 0.4 M KCl is replaced by 50 mM NaCl and to which 1 mg/mL of ovalbumin had been further added (TEGO). F-I is 30 diluted to 20 nM in TEGO from which 3-fold serial dilutions are prepared. Assays are performed in round-bottom polyprolylene microplates in triplicate microwells. Each well receives 35 mL of tritiated 17P-estradiol (0.5 nM, 5 specific activity 60.1 Ci/mmol, DuPont-New England Nuclear,

Boston, MA) and 35 mL of cold competitot tēst compound (0.1 nM - 5 mM) or TEGO, and following incubation for 5 minūtes at 4°C with shaking, 70 mL of MCF-7 celi line lysate.

Plates are incubated for 24 hours*at 4°C after which 10 time 70 mL of dextran-coated charcoal (DCC) is added to each well followed by vigorous shaking for 8 minūtes at 4°C. The plates are then centrifuged at 1500 x G for 10 minūtes at 4°C. Supernate is harvested from each well into a flexible polystyrene micropl'ate for scintillation counting in a 15 Wallac Micobeta Modei 1450 counter. Radioactivity is expressed as disintegrations per minūte (DPM) after correcting for counting efficiency (35-40%) and background. Additional Controls are total counts and total counts + DCC to defined the lower limit of DCC extractable counts. The 20 results of these competitive binding assays are expressed as mean percent bound (% Bound) + /- Standard deviation using the formula:

DPMtest compound- DPMcotal count + DCC % Bound = - X 100 DPMno tēst compound- DPMtotal count + DCC 25

Prevention of Breast Cancer

This invention also relates to the administration of F-I to a recipient who is at risk of developing de novo breast cancer. The term "de novo", as used herein, means the lack of transformation or metamorphosis of normai breast celis to cancerous or malignant celis in the first instance. Such a transformation may occur in stages in the same or daughter 30 31 LV 12623 celis via an evolutionary process or may occur in a single, pivotal event. This de novo process is in contrast to the metastasis, colonization, or spreading of already transformed or malignant celis from the priraary tumor site to new locations. A person who is at no particular risk of developing breast cancer is one who may develop de novo breast cancer, has no evidence or suspicion of the potential of the disease above normai risk, and who has never had a diagnosis of t having the disease. The greatest risk- factor contributing to the development of breast carcinoma is a personai history of suffering from the disease, or an earlier occurrence of the disease, even if it is in remission with no evidence of its presence. Another risk factor is family history of the disease.

Induction of mammary tumors in rats by administration of the carcinogen N-nitroso-N-methylurea is a well-accepted animal modei for the study of breast cancer and has been found suitable for analyzing the effect of chemopreventive aģents.

In two separate studies, 55-day old female Sprague-Dawley rats are given an intravenous (Study 1) or intraperitoneal (Study 2) dose of 50 mg of N-nitroso-N-methylurea per kilogram of body weight one week prior to feeding ad libitum a diet into which varying amounts of F-I, (Z)-2-[4-(1,2-diphenyl-l-butenyl)phenoxy]-N,N-dimethylethanamine base (tamoxifen base), or control are blended.

In Study 1, the dietary doses of 60 mg/kg of diet and 20 mg/kg of diet translates into roughly comparable doses of 3 and 1 mg/kg of body weight for the tēst animals.

In Study 2, the dietary doses of 20, '6, 2, and 0.6 mg/kg of diet translates roughly into comparable doses of 1, 0.3, 0.1 and 0.03 mg/kg of body weight for the tēst animals. 32

Rats are observed for evidence of toxicity and are weighed and palpated for tumor formation once a week. The animals are sacrificed after thirteen weeks (Study 1) or eighteen weeks (Study 2) and tumors are conf.irmed and 5 weighed at autopsy.

Formulations

The term "pharmaceutical" when used herein as an adjective means substantially non-deleterious to the 10 recipient mammai. By "pharmaceutical formulation" it is meant the carrier, diluent, excipients and active ingredient(s) must be compatible with the other ingredients of the formulation, and not deleterious to the recipient thereof. 15 F-I is preferably formulated prior to administration.

The selection of the formulation should be decided by the attending physician taking into considerations the same factors involved with determining the effective amount.

The total active ingredients in such formulations 20 comprises from 0.1% to 99.9% by weight of the formulation. Preferably, no more than two active ingredients are contained in said formulation. That is, it is preferred to formulate F-I with a second active ingredient selected from an estrogen, progestin, aromatase inhibitor, LHRH analogue 25 and AChE inhibitor. Most preferred formulations are those where F-I is the sole active ingredient.

Pharmaceutical formulations of the present invention are prepared by procedures known in the art using well known and readily available ingredients. For example, F-I, either 30 alone, or in combination with an estrogen, progestin, aromatase inhibitor, LHRH analogue or an AChE inhibitor compound, are formulated with common excipients, diluents, or carriers, and formed into tablets, capsules, suspensions, Solutions, injectables, aerosols, powders, and the like. 33 LV 12623

Pharmaceutical compositions of this invention for parenteral ādministration comprise sterile aqueous or non- agueous Solutions, dispersions, suspensions, or emulsions, as well as sterile powders which are reconstituted 5 immediately prior to use into sterile Solutions or suspensions. Examples of suitable sterile aqueous and non- aqueous carriers, diluents, solvents or vehicles include water, physiological saline solution, ethanol, polyols (such as glycerol, propylene glycol, poly(ethylene glycol), and % 10 the like), and suitable mixtures thereof, vegetable oils (such as olive oil), and injectable organic esters such as ethyl oleate. Proper fluidity is maintained, for example, by the use of coating materiāls such as lecithin, by the maintenance of proper particle size in the case of 15 dispersions and suspensions, and by the use of surfactants.

Parenteral compositions may also contain adjuvants such as preservatives, wetting aģents, emulsifying aģents, and dispersing aģents. Prevention of the action of microorganisms is ensured by the inclusion of antibacterial 20 and antifungal aģents, for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic aģents such as sugars, sodium chloride, and the like. Prolonged absorption of injectable formulations may be brought about by the inclusion of aģents 25 which delay absorption such as aluminum monostearate and gelatin.

In some cases, in order to prolong the effect of the drug, it is desirable to slow the absorption of the drug following subcutaneous or intramuscular injection. This may be accomplished by the use of a liguid suspension of crystalline material of low water solubility or by dissolving or suspending the drug in an oil vehicle. In the case of the subcutaneous or intramuscular injection of a suspension containing a form of the drug with low water 30 34 solubility, the rāte of absorption of the drug depends upon its rāte of dissolution.

Injectable "depot" formulations of F-I are made by forming microencapsulated matrices of.the drug in 5 biodegradable polymers such as poly(lactic acid), poly(glycolic acid), copolymers of lactic and glycolic acid, poly (orthoesters) , and poly (anhydrides) thes'e materiāls which are described in the art. Depending upon the ratio of drug to polymer and the characteristics of the particular 10 polymer employed, the rāte of drug release can be controlled.

Injectable formulations are sterilized, for example, by filtration through bacterial-retaining filters, or by presterilization of the components of the mixture prior to 15 their admixture, either at the time of manufacture or just prior to ādministration (as in the example of a dual chamber syringe package).

Solid dosage forms for oral administration include capsules, tablets, pilis, powders, and granules. In such 20 solid dosage forms, F-I is mixed with at least one inert, pharmaceutical carrier such as sodium citrate, or dicalcium phosphate, and/or (a) fillers or extenders such as starches, sugars including lactose and glucose, mannitol, and silicic acid, (b) binding aģents such as carboxymethyl-cellulose and 25 other cellulose derivatives, alginates, gelatin, poly(vinylpyrrolidine), sucrose and acacia, (c) humectants such as glycerol, (d) disintegrating aģents such as agar-agar, calcium carbonate, sodium bicarbonate, potato or tapioca starch, alginic acid, silicates and sodium 30 carbonate, (e) moisturizing aģents such as glycerol; (f) solution retarding aģents such as paraffin, (g) absorption accelerating aģents such as quaternary ammonium compounds, (h) wetting aģents such as cetyl alcohol and glycerin monostearate, (i) absorbents such as kaolin and bentonite 35 LV 12623 clay, and (j) lubricants such as talc, calcium stearate, magnesium stearate, solid poly(ethylene glycols), sodium lauryl sulfate, and mixtures thereof. īn the case of capsules, tablets and pilis, the dosage forrri. may also contain buffering aģents.

Solid compositions of a similar type may also comprise the fill in soft or hard gelatin capsules usirig excipients such as lactose as well as high molecular weight poly(ethylene glycols) and the like. t

Solid dosage forms such as tablēts, dragees, capsules, pilis and granules can also be prepared with coatings or shells such as enteric coatings or other coatings well knovm in the pharmaceutical formulating art. The coatings may contain opacifying aģents or aģents which release the active ingredient(s) in a particular part of the digestive tract, as for example, acid soluble coatings for release of the active ingredient(s) in the stomach, or base soluble coatings for release of the active ingredient(s) in the intestinal tract.

The active ingredient(s) may also be microencapsulated in a sustained-release coating, with the microcapsules being made part of a pili of capsule formulation.

Liquid dosage forms for oral ādministration of F-I include solution, emulsions, suspensions, syrups and elixirs. In addition to the active components, liquid formulations may include inert diluents commonly used in the art such as water or other pharmaceutical solvents, solubilizing aģents and emulsifiers such as ethanol, isopropanol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, l,3-butylene glycol, dimethyl formamide, oils (in particular, cottonseed, ground nut, corn, germ, olive, castor, and sesame oils), glycerol, tetrahydrofurfuryl alcohol, poly(ethylene glycols), fatty acid esters of sorbitol, and mixtures thereof. 36

Besides inert diluents, the liquid oral formulations may also include adjuvants such as wetting aģents, emulsifying and suspending aģents, and sweetening, flavoring, and perfuming aģents. 5 Liquid suspension, in addition to the active ingredient(s) may contain suspending aģents such as ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite clay, agar-agar, and tragacanth, 10 and mixtures thereof. ' ·

Compositions for rectal or intravaginal administration are prepared by mixing F-I with suitable non-irritating excipients such as cocoa butter, polyethylene glycol or any suppository wax which is a solid at room temperature, but 15 liquid at body temperature and therefore melt in the rectum or vaginai cavity to release the active component(s) . The compounds are dissolved in the melted wax, formed into the desired shape, and allowed to harden into the finished suppository formulation. 20 F-I may also be administered in the form of liposomes.

As is know in the art, liposomes are generally derived from phospholipids or other lipid substances. Lipososome formulations are formed by mono- or multilamellar hydrated liquid crystals which are dispersed in an aqueous medium. 25 Any non-toxic, pharmaceutical, and metabolizable lipid capable of forming liposomes can be used. The present compositions in liposome form can contain, in addition to F-I, stabilizers, excipients, preservatives, and the like.

The preferred lipids are phospholipids and the phosphatidyl 30 cholines (lecithins), both natūrai and synthetic.

Methods for forming liposomes are know in the art as described, for example, in Prescott, Ed., Methods in Celi Biology, Volume XIV, Academic Press, New York, N. Y. (1976), p. 33 et seg. 37 LV 12623

The following formulation examples are illustrative only and are not intended to limit the scope of the present invention. 5 Formulation 1: Gelatin Capsules

Hard gelatin capsules are Quantity (mg/capsule) prepared using the following:Ingredient • F-I -0.1 - 1000 Starch, NF 0 - 650 Starch flowable powder 0 - 650 Silicone fluid 350 centistokes 0 - 15

The formulation above may be changed in compliance with the reasonable variations provided. 10 A tablet formulation is prepared using the ingredients below: 15

Formulation 2: Tablets Ingredient Quantity (mg/tablet) F-I Cellulose, microcrystalline Silicon dioxide, fumed Stearate acid 2.5 - 1000 200 - 650 10 - 650 5 - 15 The components are blended and compressed to form tablets. Formulation 3: Tablets containing approximately 10 and 50 mgs, respectively, of F-I may be prepared as follows: 20 38 38 Ingredient Quantity (mg/tablet) Quantity (mg/tablet) F-I 11.3 56.5 Lactose Anhydrous 176.8 · 128.2 Lactose Spray Dried Special 44.2 32.0 Povidone 11.0 13.0 Polysorbate 80 2.5 '2.6 Crosspovidone (Inside) 6.25 . 6.24 Crosspovidone (Outside) 6.25 6.5 Magnesium Stearate 1.5' 1.7 Microcrystalline Cellulose (Outside) 0.0 13.0

The components are blended and compressed to form tablets.

Alternatively, tablets each containing 2.5 - 1000 mg of F-I are made up as follows:

Formulation 4: Tablets

Quantity (mg/tablet) 25 - 1000 45 35 4 4.5 0.5 1

Ingredient

F-I

Starch

Cellulose, microcrystalline

Polyvinylpyrrolidone (as 10% solution in water)

Sodium carboxymethyl cellulose

Magnesium stearate

Talc F-I, starch, and cellulose are passed through a No. 45 mesh 10 U.S. sieve and mixed thoroughly. The solution of polyvinylpyrrolidone is mixed with the resultant powders which are then passed through a No. 14 mesh U.S. sieve. The granules so produced are dried at 50°-50°C and passed 39 LV 12623 through a No. 18 mesh U.S. sieve. The sodium carboxymethyl starch, magnesium stearate, and talc, previously passed through a No. 60 U.S. sieve, are then added to the granules which, after mixing, are compressed on a tablet machine to 5 yield tablets.

Suspensions each containing 0.1 - 1000 mg of medicament per 5 ml dose are made as follows:

Formulation 5: Suspensions 10

Quantity (mg/5 ml) 0.1 - 1000 mg 50 mg 1.25 mg 0.10 mL q.v. q.v. 5 mL

Ingredient

Sodium carboxymethyl cellulose Syrup

Benzoic acid solution

Flavor

Color

Purified water to

The medicament is passed through a No. 45 mesh U.S. sieve and mixed with the sodium carboxymethyl cellulose and syrup to form a smooth paste. The benzoic acid solution, flavor, 15 and color are diluted with some of the water and added, with stirring. Sufficient water is then added to producē the required volume.

An aerosol solution is prepared containing the following ingredients: 20 40

Formulation 6: Aerosol

Ingredient Quantity (% by weight) _ o.25

Ethanol 25.75

Propellant 22 (Chlorodifluoromethane) ' 70.00 F-I is mixed with ethanol and the mixture added to a portion t 5 of the propellant 22, cooled to 30°C, and transferred to a filling device. The required amount is then fed to a stainless steel Container and diluted with the remaining propellant. The valve units are then fitted to the Container. 10 Suppositories are prepared as follows:

Formulation 7: Suppositories

Quantity (mg/suppository) 250 2,000

Ingredient F-ī

Saturated fatty acid glycerides 15 F-I is passed through a No. 60 mesh U.S. sieve and suspended in the saturated fatty acid glycerides previously melted using the minimal necessary heat. The mixture is then poured into a suppository mold of nominal 2 g capacity, and allowed to cool. 20

An intravenous formulation is prepared as follows: 41 LV 12623

Formulation 8: Intravenous Solution

Ingredient Quantity F-I .25 mg Isotonic saline 1,000 mL The solution of the above ingredients is intravenously 5 administered to a patient at a rāte of about .1 mL per minūte. 42

Formulation 9: Combination Capsule I

Ingredient Quantity (mg/capsule) F-I 50 Premarin 1 Avicel pH 101 50 Starch 1500 117.50 Silicon Oil 2 Tween 80 0.50 Cab-O-Sil 0.25 Formulation 10: Combination Capsule II Ingredient Quantity (mg/capsule) F-I 50 Norethylnodrel 5 Avicel pH 101 82.50 Starch 1500 90 Silicon Oil 2 Tween 80 0.50 Formulation 11: Combination Tablet Ingredient Quantity (mg/capsule) F-I 50 Premarin 1 Corn Starch NF 50 Povidone, K29-32 6 Avicel pH 101 41.50 Avicel pH 102 136.50 Crospovidone XL10 2.50 Magnesium Stearate 0.50 Cab-O-Sil 0.50 43 LV 12623

Dosage

The specific dose of F-I administered according to this invention is determined by the particular circumstances 5 surrounding each situation. These circumstances include, the route of ādministration, the prior medical history of the recipient, the pathological condition or šymptom being treated, the severity of the condition/symptom being treated, and the age and sex of the recipient. i 10 Generally, an effective minimum'daily dose of F-I is about 1, 5, 10, 15, or 20 mg. Typically, an effective maximum dose is about 800, 100, 60, 50, or 40 mg. Most typically, the dose ranges between 15 mg and 60 mg. The exact dose may be determined, in accordance with the 15 Standard practice in the medical arts of "dose titrating" the recipient; that is, initially administering a low dose of the compound, and gradually increasing the does until the desired therapeutic effect is observed.

Although it may be necessary to dose titrate the 20 recipient with respect to the combination therapies discussed above, typical doses of active ingredients other than F-III are as follows: ethynyl estrogen (0.01 - 0.03 mg/day), mestranol (0.05 - 0.15 mg/day), conjugated estrogenic hormones (e.g., Premarin®, Wyeth-Ayerst; 0.3 -25 2.5 mg/day) , medroxyprogesterone (2.5 -10 mg/day), norethylnodrel (1.0 - 10.0 mg/day), nonethindrone (0.5 - 2.0 mg/day), aminoglutemide (250-1250 mg/day, preferably 250 mg four times per day), anastrazole (1-5 mg/day, preferably 1 mg once per day), letrozole (2.5-10 mg/day, preferably 2.5 30 mg once a day), formestane (250-1250 mg per week, preferably 250 mg twice weekly), exemestane (25-100 mg/day, preferably 25 mg once per day), goserlin (3-15 mg/three months, preferably 3.6-7.2 mg once every three months) and 44 leuprolide (3-15 mg/month, preferably 3.75-7.5 mg once every month).

Route of administration F-I can be administered by a variety of routes including oral, rectal, transdermal, subcutaneus, intravenous, intramuscular, and intranasal. The method of ādministration of each estrogen- and progestin-based aģent is consistent with that which is known in the art. F-I, alone or in combination with estrogen,. progestin, or an AChE inhibitor generally will be administered in a convenient formulation.

The pharmaceutical compositions of this invention may be administered to humāns and other mammals (e.g., dogs, cats, horses, swine' and the like) orally, rectally, intravaginally, parenterally, topically, bucally or sublingually, or nasally. The term "parenteral administration" refers herein to modes of administration which include intravenous, intramuscular, intraperitoneal, instrasternal, subcutaneous, or intraarticular injection or infusion.

Mode/Length of Administration For the majority of the methods of the present invention, F-I is administered continuously, from 1 to 3 times daily or as often as needed to deliver an effective amount of F-I to the recipient. Cyclical therapy may especially be useful in the treatment of endometriosis or may be used acutely during painful attacks of the disease. In the case of restenosis, therapy may be limited to short (1-6 months) intervāls following medical procedures such as angioplasty. 45 LV 12623

We claim: 1. Crystalline 6-hydroxy-3-(4-[2-(piperidin-l-yl)ethoxy]phenoxy)-2-(4-methoxyphenyl)benzo[b]thiophene hydrochloride hydrate (F-I) having an X-ray diffraction pattern which comprises the following peaks: 7.9 ±0.2, 10.7 ±0.2, 14.9 ±0.2, 15.9 ±0.2, 18.3 ±0.2, and 20.6 ±0.2° in 2Θ; when obtained from a copper radiation source. 2. A pharmaceutical formulation comprising the crystalline compound of Claim 1; one or more pharmaceutical carriers, diluents, or excipients; and optionally estrogen, optionally progestin, optionally an aromatase inhibitor, optionally an LHRH analogue and optionally an acetyl choline esterase (AChE) inhibitor. 3. The formulation of Claim 2 which comprises the crystalline compound of Claim 1; one or more pharmaceutical carriers, diluents, or excipients,- and estrogen. 4. The formulation of Claim 3 wherein the estrogen is Premarin®. 5. The formulation of Claim 2 which comprises the crystalline compound of Claim 1; one or more pharmaceutical carriers, diluents, or excipients; and progestin. 6. The formulation of Claim 5 wherein the progestin is selected from the group consisting of norethylnodrel and norethindrone. 45 46 7. The formulation of Claim 2 which comprises the crystalline compound of Claim 1; one or more pharmaceutical carriers, diluents, or excipients; and an AChE inhibitor. 8. The formulation of Claim 7 wherein the AChE inhibitor is selected from the group consisting of: physostigmine salicylate, tacrine hydrochloride, and donepezil hydrochloride. 9. The formulation of Claim 2 which comprises the crystalline compound of Claim 1; one or more pharmaceutical carriers, diluents, or excipients; estrogen; and progestin. 10. The compound of Claim 1 for inhibiting a pathological condition selected from the group consisting of: uterine fibrosis, endometriosis, aortai smooth muscle celi proliferation, restenosis, breast cancer, uterine cancer, prostatic cancer, benign prostatic hyperplasia, bone loss, osteoporosis, cardiovascular disease, hyperlipidemia, CNS disorders, and Alzheimer's disease. 11. The compound of Claim 10 for inhibiting breast cancer. 12. The compound of Claim 11 wherein the mode of inhibition is prophylactic. 13. The compound of Claim 10 for inhibiting ovarian cancer. 14. The compound of Claim 10 for inhibiting endometrial cancer. 46 47 LV 12623 15. The compound of Claim 1 for up-regulating choline acetyltransferase (ChAT) in mammals. 16. A process for preparing a compound of Claim 1 5 which comprises crystallizing 6-hydroxy-3-(4-[2-(piperidin-l-yl) ethoxy]phenoxy) -2- (4-methoxyphenyl)benzo [b] thiophene hydrochloride from tetrahydrofuran. 47 LV 12623

ABSTRACT

The present invention is directed to a novel crystalline hydrate of 6-hydroxy-3-(4-[2-(piperidin-l-yl)ethoxy]phenoxy) -2- (4-methoxyphenyl)benzo [b] thiophene 5 hydrochloride and uses for same, including inhibition of disease States associated with estrogen deprivation including cardiovascular disease, hyperlipidemia, and osteoporosis; and inhibition of other pathological conditions such as endometriosis, uterine fibrosis, 10 estrogen-dependent cancer (including breast and uterine cancer), prostate cancer, benign prostatic hyperplasia, CNS disorders including Alzheimer's disease, prevention of breast cancer, and up-regulating ChAT. 1/5 LV 12623 OSC Hait Plo« («w

TGA Halant (X) LV 12623

2/5 ΤβΑ W« lgtlt (X)

OSC Heat FIom (dMI 3/5 LV 12623 TSA W*ignt (X)

DSC Haat FIom ImM) 4/5 % Weight Change

0 10 20 30 40 50 60 70 80 90 100

Form III -Form I LV 12623 5/5 LV 12623

Residual EtOAc (mole % by NMR) 0 I8 0 16 0.14 0 12 0.1 008 0.06 0.04 002

Drying Tiine (lionrs)

Claims (16)

EN 12623 FORMULA 1. Crystalline 6-hydroxy-3- (4- [2- (piperidin-1-yl) ethoxy] phenoxy) -2- (4-methoxyphenyl) benzo [b] thiophene hydrochloride hydrate (FI) with X-ray a diffraction pattern containing the following peaks: 7.9 + 0.2.10.7 + 0.2.14.9 + 0.2, 15.9 + 0.2.18.3 + 0.2, and 20.6 + 0.2 ° with 2Θ; obtained from a copper radiation source. A pharmaceutical composition comprising a crystalline compound according to claim 1; one or more pharmaceutical carriers, solvents or fillers; and optionally an estrogen, optionally a progestin, optionally an aromatase inhibitor, an optional LHRH analogue and an optional acetylcholinesterase (AChE) inhibitor. A composition according to claim 2 comprising a crystalline compound according to claim 1; one or more pharmaceutical carriers, solvents or fillers; and estrogen 4. The composition of claim 3, wherein the estrogen is Premarin®. A composition according to claim 2 comprising a crystalline compound according to claim 1; one or more pharmaceutical carriers, solvents or fillers; and progestin. The composition of claim 5, wherein the progestin is selected from the group consisting of norethyldodel and norethindrone. A composition according to claim 2 comprising a crystalline compound according to claim 1; one or more pharmaceutical carriers, solvents or fillers; and an AChE inhibitor. The composition of claim 7, wherein the AChE inhibitor is selected from the group consisting of: physostigmine salicylate, tacrine hydrochloride, and donepezil hydrochloride. A composition according to claim 2 comprising a crystalline compound according to claim 1; one or more pharmaceutical carriers, solvents or fillers; estrogen; and progestin. 10. A compound according to claim 1 for pathological conditions selected from the group consisting of: uterine ptbrosis, endometriosis, aortic smooth muscle cell proliferation, restenosis, breast cancer, uterine cancer, prostate cancer, benign prostatic hyperplasia, rare bone infections, osteoporosis , cardiovascular diseases, hyperlipidemia, CNS diseases, and Alzheimer's disease. A compound according to claim 10 for preventing breast cancer. The compound of claim 11, wherein the delay is a prophylaxis. A compound according to claim 10 for inhibiting ovarian cancer. A compound according to claim 10 for inhibiting endometrial cancer. A compound according to claim 1 for raising choline acetyltransferase (ChAT) in mammals. 16. A process for the preparation of a compound of claim 1 comprising 6-hydroxy-3- (4- [2- (piperidin-1-yl) ethoxy] phenoxy) -2- (4-methoxyphenyl) benzo [b] thiophene hydrochloride crystallization from tetrahydrofuran.