RU2012127790A - Индуцирующие апоптоз агенты для лечения рака и иммунных и аутоиммунных заболеваний - Google Patents

Индуцирующие апоптоз агенты для лечения рака и иммунных и аутоиммунных заболеваний Download PDF

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RU2012127790A
RU2012127790A RU2012127790/04A RU2012127790A RU2012127790A RU 2012127790 A RU2012127790 A RU 2012127790A RU 2012127790/04 A RU2012127790/04 A RU 2012127790/04A RU 2012127790 A RU2012127790 A RU 2012127790A RU 2012127790 A RU2012127790 A RU 2012127790A
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Russia
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methyl
cancer
chlorophenyl
piperazin
sulfonyl
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RU2012127790/04A
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RU2535203C2 (ru
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Милан БРАНКО
Юджиа ДАЙ
Хун ДИН
Джордж А. ДОУЭРТИ
Стивен В. ЭЛМОР
Лиза ХАСВОЛЬД
Лаура ХЕКСАМЕР
Аарон КАНЗЕР
Роберт А. МАНТЕЙ
Уилльям Дж. МАККЛЕЛЛАН
Чанг Х. ПАРК
Чеол-Мин ПАРК
Эндрю М. ПЕТРОС
Сяохун СУН
Эндрю Дж. САУЭРС
Джерард М. САЛЛИВАН
Чжи-фу ТАО
Гари Т. ВАН
Лэ ВАН
Силу ВАН
Майкл Д. УЭНДТ
Тодд М. ХАНСЕН
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Эбботт Лэборетриз
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  • Hydrogenated Pyridines (AREA)
  • Pyridine Compounds (AREA)
  • Pyrane Compounds (AREA)
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Abstract

1. Соединение или его терапевтически приемлемая соль, где соединение выбрано из следующих:N-({3-хлор-4-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]фенил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]бензамид;N-({3-хлор-4-[(4-фтортетрагидро-2H-пиран-4-ил)метокси]фенил}сульфонил)-4-(4-{[4-(4-хлорфенил)-6,6-диметил-5,6-дигидро-2Н-пиран-3-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]бензамид;N-({5-хлор-6-[(транс-4-гидроксициклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]бензамид;N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]бензамид;трет-бутил 5-[(4-{4-[({5-хлор-6-[(4-фтортетрагидро-2H-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)карбамоил]-3-[(6-фтор-1Н-индол-5-ил)окси]фенил}пиперазин-1-ил)метил]-4-(4-хлорфенил)-3,6-дигидропиридин-1(2Н)-карбоксилат;N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[4-(4-хлорфенил)-1-(1,3-дифторпропан-2-ил)-1,2,5,6-тетрагидропиридин-3-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]бензамид;4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]-N-[(4-{[(4-фтортетрагидро-2H-пиран-4-ил)метил]амино}-3-нитрофенил)сульфонил]бензамид;N-({5-хлор-6-[(транс-4-гидроксициклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(7-фтор-1Н-индазол-4-ил)окси]бензамид;N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)

Claims (6)

1. Соединение или его терапевтически приемлемая соль, где соединение выбрано из следующих:
N-({3-хлор-4-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]фенил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]бензамид;
N-({3-хлор-4-[(4-фтортетрагидро-2H-пиран-4-ил)метокси]фенил}сульфонил)-4-(4-{[4-(4-хлорфенил)-6,6-диметил-5,6-дигидро-2Н-пиран-3-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]бензамид;
N-({5-хлор-6-[(транс-4-гидроксициклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]бензамид;
N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]бензамид;
трет-бутил 5-[(4-{4-[({5-хлор-6-[(4-фтортетрагидро-2H-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)карбамоил]-3-[(6-фтор-1Н-индол-5-ил)окси]фенил}пиперазин-1-ил)метил]-4-(4-хлорфенил)-3,6-дигидропиридин-1(2Н)-карбоксилат;
N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[4-(4-хлорфенил)-1-(1,3-дифторпропан-2-ил)-1,2,5,6-тетрагидропиридин-3-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]-N-[(4-{[(4-фтортетрагидро-2H-пиран-4-ил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
N-({5-хлор-6-[(транс-4-гидроксициклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(7-фтор-1Н-индазол-4-ил)окси]бензамид;
N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(7-фтор-1Н-индазол-4-ил)окси]бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[3-нитро-4-({[4-(оксетан-3-ил)морфолин-2-ил]метил}амино)фенил]сульфонил}бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индол-5-ил)окси]-N-{[3-нитро-4-({[4-(оксетан-3-ил)морфолин-2-ил]метил}амино)фенил]сульфонил}бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(7-фтор-1Н-индазол-4-ил)окси]-N-[(4-{[(4-фтортетрагидро-2H-пиран-4-ил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
N-({5-хлор-6-[(транс-4-гидрокси-4-метилциклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[5-хлор-6-(тетрагидро-2Н-пиран-4-илметокси)пиридин-3-ил]сульфонил}-2-[(3-метил-2-оксо-2,3-дигидро-1Н-бензимидазол-4-ил)окси]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({4-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]-3-нитрофенил}сульфонил)-2-[(3-метил-2-оксо-2,3-дигидро-1Н-бензимидазол-4-ил)окси]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(транс-4-
метоксициклогексил)метил]амино}-3-нитрофенил)сульфонил]-2-[(3-метил-2-оксо-2,3-дигидро-1Н-бензимидазол-4-ил)окси]бензамид;
2-[(3-амино-1Н-индазол-4-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(4-фтортетрагидро-2Н-пиран-4-ил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
2-[(3-амино-1Н-индазол-4-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({4-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]-3-нитрофенил}сульфонил)бензамид;
2-[(3-амино-1Н-индазол-4-ил)окси]-N-({5-хлор-6-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензамид;
2-[(3-амино-1Н-индазол-4-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({3-нитро-4-[(тетрагидро-2Н-пиран-4-илметил)амино]фенил}сульфонил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[4-фтор-1-(оксетан-3-ил)пиперидин-4-ил]метокси}-3-нитрофенил)сульфонил]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-2-[(6-фтор-1Н-индазол-4-ил)окси]-N-({4-[(4-фтортетрагидро-2Н-пиран-4-ил)метокси]-3-нитрофенил}сульфонил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(транс-4-гидрокси-4-метилциклогексил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
2-[(3-амино-1Н-индазол-4-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(транс-4-метоксициклогексил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({4-[(цис-4-гидрокси-4-метилциклогексил)метокси]-3-нитрофенил}сульфонил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(цис-4-гидрокси-4-метилциклогексил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[3-хлор-4-(тетрагидро-2Н-пиран-4-илметокси)фенил]сульфонил}-2-[(3-метил-2-оксо-2,3-дигидро-1Н-бензимидазол-4-ил)окси]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(4-циклопропилморфолин-2-ил)метил]амино}-3-нитрофенил)сульфонил]-2-[(3-метил-2-оксо-2,3-дигидро-1Н-бензимидазол-4-ил)окси]бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[3-нитро-4-(2-оксаспиро[3,5]non-7-илметокси)фенил]сульфонил}бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({4-[(транс-4-гидрокси-4-метилциклогексил)метокси]-3-нитрофенил}сульфонил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[4-({[(2S)-4-циклопропилморфолин-2-ил]метил}амино)-3-нитрофенил]сульфонил}бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-N-({5-хлор-6-[(транс-1-фтор-4-гидрокси-4-метилциклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-N-({5-хлор-6-[(цис-1-фтор-4-гидрокси-4-метилциклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензамид;
2-[(3-амино-1Н-индазол-4-ил)окси]-N-({5-хлор-6-[(транс-4-гидрокси-4-метилциклогексил)метокси]пиридин-3-ил}сульфонил)-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензамид;
N-({5-хлор-6-[(транс-4-гидрокси-4-метилциклогексил)метокси]пиридин-3-ил}сульфонил)-2-[(3-хлор-1Н-индазол-4-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[(цис-4-этил-4-гидроксициклогексил)метил]амино}-3-нитрофенил)сульфонил]бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[3-нитро-4-({[(2S)-4-(оксетан-3-ил)морфолин-2-ил]метил}амино)фенил]сульфонил}бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({5-нитро-6-[(тетрагидро-2Н-пиран-4-илметил)амино]пиридин-3ил }сульфонил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({3-нитро-4-[(2-оксаспиро[3,5]non-7-илметил)амино]фенил}сульфонил)бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[4-({[транс-4-(морфолин-4-ил)циклогексил]метил}амино)-3-нитрофенил]сульфонил}бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(4-{[цис-4-(морфолин-4-ил)циклогексил]амино}-3-нитрофенил)сульфонил]бензамид;
4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-({5-циано-6-[(транс-4-гидрокси-4-метилциклогексил)метокси]пиридин-3-ил}сульфонил)-2-[(6-фтор-1Н-индазол-4-ил)окси]бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-{[4-({[4-({[4-(метоксиметил)циклогексил]метил}амино)-3-нитрофенил]сульфонил}амино)-3-нитрофенил]сульфонил}бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(3-нитро-4-{[(3R)-1-(оксетан-3-ил)пирролидин-3-ил]амино}фенил)сульфонил]бензамид;
2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)-N-[(3-нитро-4-{[(3S)-1-(оксетан-3-ил)пирролидин-3-ил]амино}фенил)сульфонил]бензамид;
N-[4-({2-[(6-амино-5-хлорпиридпин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензоил}сульфамоил)-2-нитрофенил]морфолин-4-карбоксамид;
и
N-[4-({2-[(6-амино-5-хлорпиридин-3-ил)окси]-4-(4-{[2-(4-хлорфенил)-4,4-диметилциклогекс-1-ен-1-ил]метил}пиперазин-1-ил)бензоил}сульфамоил)-2-нитрофенил]-4-цианопиперидин-1-карбоксамид.
2. Композиция для лечения рака мочевого пузыря, рака головного мозга, рака молочной железы, рака костного мозга, рака шейки матки, хронического лимфолейкоза, колоректального рака, рака пищевода, гепатоцеллюлярного рака, лимфобластного лейкоза, фолликулярной лимфомы, лимфобластного лейкоза из предшественников Т-клеток или В-клеток, меланомы, миелолейкоза, миеломы, рака ротовой полости, рака яичников, не мелкоклеточного рака легкого, рака простаты, мелкоклеточного рака легкого или рака поджелудочной железы, где указанная композиция содержит инертный наполнитель и терапевтически эффективное количество соединения по п.1.
3. Соединение по п.1 или его терапевтически приемлемая соль для лечения рака мочевого пузыря, рака головного мозга, рака молочной железы, рака костного мозга, рака шейки матки, хронического лимфолейкоза, колоректального рака, рака пищевода, гепатоцеллюлярного рака, лимфобластного лейкоза, фолликулярной лимфомы, лимфобластного лейкоза из предшественников Т-клеток или В-клеток, меланомы, миелолейкоза, миеломы, рака ротовой полости, рака яичников, не мелкоклеточного рака легкого, рака простаты, мелкоклеточного рака легкого или рака поджелудочной железы у пациента.
4. Соединение по п.1 или его терапевтически приемлемая соль и один дополнительный терапевтический агент или более одного дополнительного терапевтического агента для лечения рака мочевого пузыря, рака головного мозга, рака молочной железы, рака костного мозга, рака шейки матки, хронического лимфолейкоза, колоректального рака, рака пищевода, гепатоцеллюлярного рака, лимфобластного лейкоза, фолликулярной лимфомы, лимфобластного лейкоза из предшественников Т-клеток или В-клеток, меланомы, миелолейкоза, миеломы, рака ротовой полости, рака яичников, не мелкоклеточного рака легкого, рака простаты, мелкоклеточного рака легкого или рака поджелудочной железы у пациента.
5. Применение соединения по п.1 или его терапевтически приемлемой соли при получении лекарственного средства для лечения рака мочевого пузыря, рака головного мозга, рака молочной железы, рака костного мозга, рака шейки матки, хронического лимфолейкоза, колоректального рака, рака пищевода, гепатоцеллюлярного рака, лимфобластного лейкоза, фолликулярной лимфомы, лимфобластного лейкоза из предшественников Т-клеток или В-клеток, меланомы, миелолейкоза, миеломы, рака ротовой полости, рака яичников, не мелкоклеточного рака легкого, рака простаты, мелкоклеточного рака легкого или рака поджелудочной железы у пациента.
6. Применение соединения по п.1 или его терапевтически приемлемой соли и одного дополнительного терапевтического агента или более одного дополнительного терапевтического агента при получении лекарственного средства для лечения рака мочевого пузыря, рака головного мозга, рака молочной железы, рака костного мозга, рака шейки матки, хронического лимфолейкоза, колоректального рака, рака пищевода, гепатоцеллюлярного рака, лимфобластного лейкоза, фолликулярной лимфомы, лимфобластного лейкоза из предшественников Т-клеток или В-клеток, меланомы, миелолейкоза, миеломы, рака ротовой полости, рака яичников, не мелкоклеточного рака легкого, рака простаты, мелкоклеточного рака легкого или рака поджелудочной железы у пациента.
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