US20100152295A1 - Methods of reducing small, dense ldl particles - Google Patents

Methods of reducing small, dense ldl particles Download PDF

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US20100152295A1
US20100152295A1 US12/579,996 US57999609A US2010152295A1 US 20100152295 A1 US20100152295 A1 US 20100152295A1 US 57999609 A US57999609 A US 57999609A US 2010152295 A1 US2010152295 A1 US 2010152295A1
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ldl
pattern
compound
human
particle size
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David Karpf
Ronald M. Krauss
Yun-Jung Choi
Xueyan Wang
Francine M. Gregoire
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CymaBay Therapeutics Inc
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Metabolex Inc
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Priority to US16/176,349 priority patent/US11007162B2/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/192—Carboxylic acids, e.g. valproic acid having aromatic groups, e.g. sulindac, 2-aryl-propionic acids, ethacrynic acid 
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/02—Halogenated hydrocarbons
    • A61K31/025—Halogenated hydrocarbons carbocyclic
    • A61K31/03—Halogenated hydrocarbons carbocyclic aromatic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/075—Ethers or acetals
    • A61K31/085—Ethers or acetals having an ether linkage to aromatic ring nuclear carbon
    • A61K31/09—Ethers or acetals having an ether linkage to aromatic ring nuclear carbon having two or more such linkages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/12—Ketones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/4015—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil having oxo groups directly attached to the heterocyclic ring, e.g. piracetam, ethosuximide
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/06—Antihyperlipidemics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2121/00—Preparations for use in therapy

Definitions

  • LDL low density lipoprotein
  • CHD coronary heart disease
  • LDL particle size and density An additional atherogenic risk factor identified in 1982 is LDL particle size and density, which can be used to define specific LDL subclasses in individual subjects (Krauss, R. M. and Burke, D. J., J Lipid Res, 23:97-104 (1982)).
  • MI myocardial infarction
  • Small, dense LDL has also been shown to be a significant risk factor for premature CAD in women, independent of age, menopausal status, smoking, hypertension, diabetes and LDL cholesterol level (Kamigaki, A. S. et al., Am J Epidemiol, 153(10):939-45 (2001)).
  • Small LDL particle size has also been linked to the risk of developing atherosclerosis as assessed by coronary angiography (Swinkels, D. W. et al., Atherosclerosis, 77:59-67 (1989); Tornvall, P. et al., Atherosclerosis, 90:67-80 (1991); Tornvall, P.
  • the atherogenicity of small, dense LDL particles appears to result from several potential mechanisms, including: increased susceptibility to oxidation; enhanced vascular permeability; decreased affinity for (and hence, clearance by) the LDL receptor; conformational changes in apo B within small, dense particles; the clear association of this LDL subfraction with insulin resistance/metabolic syndrome; and the association of this LDL pattern with hypertriglyceridemia and low HDL cholesterol levels (Austin, M. A. and Edwards, K. L., Curr Opin Lipid, 7(3):167-71 (1996)).
  • the fraction of small, dense LDL particles is strongly correlated with levels of lipoprotein(a) [Lp(a)] (Moon, J-Y et al., Cardiology, 108:282-289 (2007)), a known cardiovascular risk factor (Dahlen, G. H. et al., Circulation, 74:758-65 (1986); Terres, W. et al., Circulation, 91:948-50 (1995); Hahnmann, H. W. et al., Atherosclerosis, 144:221-8 (1999); Uusimaa, P. et al., Heart Vessels, 16:37-41 (2002)).
  • lipoprotein(a) [Lp(a)]
  • Lp(a) is also correlated with the level of oxidized phospholipids, which may play a role in the pathophysiology of atherosclerosis (Tsimikas, S. et al., J Am Cell Cardiol, 41:360-70 (2003)).
  • the fibrates decrease the level of small, dense LDL particles in patients with combined hyperlipidemia (Tsai, M. Y. et al., Atherosclerosis, 95:35-42 (1992); Bruckert, E. et al., Atherosclerosis, 100:91-102 (1993); Yuan, J. et al., Atherosclerosis, 110:1-11 (1994)), but not in patients with hypercholesterolemia but normal triglyceride levels (Yuan, J.
  • thiazoledinediones have consistently demonstrated increases in LDL particle size and decreases in LDL particle density, which appears related to improvements in insulin sensitivity but not to reductions in hypertriglyceridemia (Tack, C. J. J. et al., Diabetes care, 21:796-9 (1998); Freed, M. I. et al., Am J Cardiol, 90:947-52 (2002); Winkler, K. et al., Diabetes Care, 26:2588-94 (2003); Shadid, S. et al., Atherosclerosis, 188:370-6 (2006)).
  • the present invention provides for methods of decreasing the amount of small, dense LDL particles in a human having LDL particle size pattern I or B.
  • the method comprises administering a therapeutically-effective amount of a compound of Formula I or a salt, prodrug or isomer thereof to the human wherein the LDL particle size pattern is changed after administration: from pattern Ito pattern A; or from pattern B to pattern I or A.
  • the human has a lower level of LDL-III particles after the administrating step compared to prior to the administering step. In some embodiments, the human has a lower level of LDL-IV particles after the administrating step compared to prior to the administering step.
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the human has an LDL particle size pattern A after 10 days (e.g., after 20 days, e.g., between 10400, 10-1000 days) after the administering step.
  • the human has LDL particle size pattern I after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) after the administering step.
  • the method further comprises measuring the LDL particle diameter of the human prior to the administering step. In some embodiments, the method further comprises measuring the LDL particle diameter of the human after the administering step.
  • the human has an LDL particle size pattern B prior to the administering step. In some embodiments, the human has an LDL particle size pattern I prior to the administering step.
  • the human has diabetes. In some embodiments, the human is insulin resistant. In some embodiments, the human does not have diabetes. In some embodiments, the human has atherosclerosis. In some embodiments, the human has metabolic syndrome. In some embodiments, the human has human has dyslipidemia. In some embodiments, the human does not have atherosclerosis. In some embodiments, the human does not have diabetes. In some embodiments, the human is not insulin resistant. In some embodiments, the human does not have metabolic syndrome. In some embodiments, the human does not have dyslipidemia.
  • Apolipoprotein B-100 blood levels are reduced at least 5 or at least 10% or at least 15% or at least 20% after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) of the administering step.
  • absorption of cholesterol is reduced by least or at least 10% or at least 15% or at least 20% after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) of the administering step.
  • cholesterol synthesis is reduced at least 5% or at least 10% or at least 15% or at least 20% after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) of the administering step.
  • LDL cholesterol blood levels are reduced by at least 15% after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) of the administering step.
  • triglyceride blood levels are reduced by at least 20% after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) of the administering step.
  • HDL cholesterol blood levels are increased by at least 5% after 10 days (e.g., after 20 days, e.g., between 10-100, 10-1000 days) of the administering step.
  • the present invention also provides methods of reducing triglycerides and LDL blood levels in a human having LDL particle size pattern I or B.
  • the method comprises administering a therapeutically-effective amount of a compound of Formula I or a salt, prodrug or isomer thereof to the human wherein the LDL particle size pattern is changed after administration: from pattern Ito pattern A; or from pattern B to pattern I or A.
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the method further comprises administrating a statin to the human.
  • the statin is Atorvastatin.
  • the present invention also provides for methods of identifying a candidate individual for treatment with a compound of Formula I or a salt, prodrug or isomer thereof.
  • the method comprises measuring the LDL peak particle diameter of an individual; and administering the compound to the individual if the individual had a pattern I or B LDL particle size pattern.
  • the individual has a pattern I LDL particle size pattern and the compound is administered to the individual after the measuring step. In some embodiments, the individual has a pattern B LDL particle size pattern and the compound is administered to the individual after the measuring step.
  • the present invention also provides for therapeutically-effective amount of a compound of Formula I or a salt, prodrug or isomer thereof for use in a human having LDL particle size pattern I or B, wherein the amount is sufficient to change the human's LDL particle size pattern from pattern Ito pattern A; or from pattern B to pattern I or A.
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the amount is sufficient such that the human has an LDL particle size pattern A after 10 days after the administering step. In some embodiments, the human has an LDL particle size pattern B prior to the administering step. In some embodiments, the human has an LDL particle size pattern I prior to the administering step.
  • the compound is for use in a human who has diabetes. In some embodiments, the compound is for use in a human who is insulin resistant. In some embodiments, the compound is for use in a human who has atherosclerosis. In some embodiments, the compound is for use in a human who has metabolic syndrome. In some embodiments, the compound is for use in a human who has dyslipidemia.
  • the amount is sufficient such that Apolipoprotein B-100 blood levels are reduced at least 10% after 10 days of the administering step.
  • the amount is sufficient such that absorption of cholesterol is reduced by least 5% after 10 days of the administering step.
  • the amount is sufficient such that cholesterol synthesis is reduced at least 5% after 10 days of the administering step.
  • the amount is sufficient such that absorption of cholesterol is reduced by least 10% after 10 days of the administering step.
  • the amount is sufficient such that cholesterol synthesis is reduced at least 10% after 10 days of the administering step.
  • the amount is sufficient such that absorption of cholesterol is reduced by least 20% after 10 days of the administering step.
  • the amount is sufficient such that cholesterol synthesis is reduced at least 20% after 10 days of the administering step.
  • the amount is sufficient such that LDL cholesterol blood levels are reduced by at least 15% after 10 days of the administering step.
  • the amount is sufficient such that triglyceride blood levels are reduced by at least 20% after 10 days of the administering step.
  • the amount is sufficient such that HDL cholesterol blood levels are increased by at least 5% after 10 days of the administering step.
  • the present invention also provides for a method comprising:
  • Providing as used in this context is not intended to refer to administration, but instead encompasses formulation of the drug for the human and/or giving the human the compound (e.g., in pill form) that the human can consume then or later.
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the compound is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-N-phenyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the method further comprises measuring the LDL particle diameter of the human after the providing step and after the human has introduced the compound into the human's body.
  • the human has an LDL particle size pattern B prior to the providing step. In some embodiments, the human has an LDL particle size pattern I prior to the providing step.
  • the human has diabetes. In some embodiments, the human is insulin resistant. In some embodiments, the human does not have diabetes. In some embodiments, the human has atherosclerosis. In some embodiments, the human has metabolic syndrome. In some embodiments, the human has dyslipidemia.
  • FIG. 1 illustrates the effect of the compound of Formula II on LDL-cholesterol and Apo lipoprotein B-100.
  • FIG. 2 illustrates the effect of Compound II on LDL pattern after 21 days of treatment.
  • FIG. 3 illustrates changes in LDL particle distribution as a function of dosage of Compound II (determined by AIM).
  • FIG. 4 illustrates the effect of Compound II on peak LDL diameter after 21 days of treatment.
  • FIG. 5 illustrates the effect of Compound II after 21 days on LDL particle subclasses.
  • FIG. 6 summarizes the effect of Compound II on various blood components in obese subjects as described in the Example.
  • FIG. 7 illustrates the percentage of patients having LDL pattern A after various treatment regimens.
  • FIG. 8 illustrates the percentage of patients having LDL pattern B or I after various treatment regimens.
  • FIG. 9 illustrates quantity of lanosterol, desmosterol, and lathosterol (all cholesterol intermediates) in blood of individuals following administration of Compound II.
  • FIG. 10 illustrates the effect of Compound II on cholesterol absorption in mice following administration of Compound II.
  • FIG. 11 illustrates the absorption of phytosterols in humans following administration of Compound II.
  • LDL particle diameter or “LDL particle size” refers to the diameter of LDL particles in blood. See, e.g., Krauss, R M, et al., J. Lipid. Res. 23:97-104 (1982); Shen, M M S, et al., J. Lipid. Res. 22:235-244 (1981).
  • GGE gradient-gel electrophoresis
  • AIM Airborne Ion Mobility
  • Particles can be categorized based on their diameter. For example, LDL particles can be divided into four categories (I-IV), where I is the largest particle and IV is the smallest.
  • LDL-I corresponds to particles of diameter 21.99-23.80 nm
  • LDL-II corresponds to particles of diameter 21.10-21.99 nm
  • LDL-III corresponds to particles of diameter 20.17-21.10 nm
  • LDL-IV corresponds to particles of diameter 18.00-20.17 nm. See, e.g., Berneis and Krauss, J. Lipid Res. 43:1363-1379 (2002).
  • one size LDL particle predominates (i.e., is present in the highest amount) compared to LDL particles of other sizes.
  • the predominant LDL particle size can vary between different individuals. Smaller particles are considered risk factors for some diseases including but not limited to coronary disease (see, e.g., Berneis and Krauss, J. Lipid Res. 43:1363-1379 (2002)).
  • Individuals with a smaller predominant LDL particle (less than 25.75 nm as measured by GGE) have “pattern B”, which are associated with a poorer diagnosis.
  • Individuals with a large predominant LDL particle greater than 26.34 nm as measured by GGE have “pattern A”).
  • Individuals with a predominant LDL particle size between pattern A and pattern B are referred to as having “pattern I.”
  • therapeutically-effective amount means the amount of the subject compound that will elicit the biological or medical response of a tissue, system, animal or human that is being sought by the researcher, veterinarian, medical doctor or other clinician.
  • a therapeutically effective amount includes the amount of a compound that, when administered to a mammal for treating a disease, is sufficient to effect such treatment for the disease.
  • the therapeutically effective amount will vary depending on the compound, the disease and its severity and the age, weight, etc., of the mammal to be treated.
  • insulin resistance can be defined generally as a disorder of glucose metabolism. More specifically, insulin resistance can be defined as the diminished ability of insulin to exert its biological action across a broad range of concentrations producing less than the expected biologic effect (see, e.g., Reaven, G. M., J. Basic & Clin. Phys . & Pharm . (1998) 9: 387-406 and Flier, J. Ann Rev. Med . (1983) 34: 145-60). Insulin resistant persons have a diminished ability to properly metabolize glucose. Manifestations of insulin resistance include insufficient insulin activation of glucose uptake, oxidation and storage in muscle and inadequate insulin repression of lipolysis in adipose tissue and of glucose production and secretion in liver.
  • Insulin resistance can cause or contribute to polycystic ovarian syndrome, Impaired Glucose Tolerance (IGT), gestational diabetes, hypertension, obesity, hypertriglyceridemia, atherosclerosis and a variety of other disorders. Eventually, the insulin resistant individuals can progress to a point where a diabetic state is reached.
  • the association of insulin resistance with glucose intolerance, an increase in plasma triglyceride and a decrease in high-density lipoprotein cholesterol concentrations, high blood pressure, hyperuricemia, smaller denser low-density lipoprotein particles, and higher circulating levels of plaminogen activator inhibitor-1 has been referred to as “Syndrome X” (see, e.g., Reaven, G. M., Physiol. Rev . (1995) 75: 473-486), also known as “metabolic syndrome.”
  • Insulin sensitivity refers to the ability of a cell or tissue to respond to insulin. Individuals having insulin resistance have reduced insulin sensitivity compared to healthy lean individuals. Responses include, e.g., glucose uptake of a cell or tissue in response to insulin stimulation. Sensitivity can be determined at an organismal, tissue or cellular level. For example, blood or urine glucose levels following a glucose tolerance test are indicative of insulin sensitivity. Other methods of measuring insulin sensitivity include, e.g., measuring glucose uptake (see, e.g., Garcia de Herreros, A., and Birnbaum, M. J. J. Biol. Chem. 264, 19994-19999 (1989); Klip, A., Li, G., and Logan, W. J. Am. J.
  • diabetes mellitus or “diabetes” means a disease or condition that is generally characterized by metabolic defects in production and utilization of glucose which result in the failure to maintain appropriate blood sugar levels in the body. The result of these defects is elevated blood glucose, referred to as “hyperglycemia.”
  • Type 1 diabetes is generally the result of an absolute deficiency of insulin, the hormone which regulates glucose utilization.
  • Type 2 diabetes often occurs in the face of normal, or even elevated levels of insulin and can result from the inability of tissues to respond appropriately to insulin.
  • Type 2 diabetic patients are insulin resistant and have a relative deficiency of insulin, in that insulin secretion can not compensate for the resistance of peripheral tissues to respond to insulin.
  • many but not all Type 2 diabetics are obese.
  • Other types of disorders of glucose homeostasis include Impaired Glucose Tolerance, which is a metabolic stage intermediate between normal glucose homeostasis and diabetes, and Gestational Diabetes Mellitus, which is glucose intolerance in pregnancy in women with no previous history of Type 1 or Type 2 diabetes.
  • Obesity refers to, according to the World Health Organization, a Body Mass Index (BMI) greater than 27.8 kg/m 2 for men and 27.3 kg/m 2 for women (BMI equals weight (kg)/height (m 2 ).
  • BMI Body Mass Index
  • Obesity is linked to a variety of medical conditions including diabetes and hyperlipidemia. Obesity is also a known risk factor for the development of Type 2 diabetes (See, e.g., Barrett-Conner, E., Epidemol. Rev . (1989) 11: 172-181; and Knowler, et al., Am. J. Clin. Nutr . (1991) 53:1543-1551).
  • alkyl and alkoxy include straight and branched chains having 1 to 8 carbon atoms, such as C 1-6 , C 1-4 , C 3-8 , C 2-5 , or any other range, and unless otherwise noted, include both substituted and unsubstituted moieties.
  • C 1-6 alkyl radicals include methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, t-butyl, n-pentyl, 3-(2-methyl)butyl, 2-pentyl, 2-methylbutyl, neopentyl, n-hexyl, 2-hexyl and 2-methylpentyl.
  • Alkoxy radicals are formed from the previously described straight or branched chain alkyl groups. “Alkyl” and “alkoxy” include unsubstituted or substituted moieties with one or more substitutions, such as between 1 and 5, 1 and 3, or 2 and 4 substituents.
  • the substituents may be the same (dihydroxy, dimethyl), similar (chloro, fluoro), or different (chlorobenzyl- or aminomethyl-substituted).
  • substituted alkyl include haloalkyl (such as fluoromethyl, chloromethyl, difluoromethyl, perchloromethyl, 2-bromoethyl, trifluoromethyl, and 3-iodocyclopentyl), hydroxyalkyl (such as hydroxymethyl, hydroxyethyl, 2-hydroxypropyl), aminoalkyl (such as aminomethyl, 2-aminoethyl, 3-aminopropyl, and 2-aminopropyl), alkoxylalkyl, nitroalkyl, alkylalkyl, cyanoalkyl, phenylalkyl, heteroarylalkyl, heterocyclylalkyl, phenoxyalkyl, heteroaryloxyalkyl (such as 2-pyridyloxyalkyl), heterocycly
  • a di(C 1-3 alkyl)amino group includes independently selected alkyl groups, to form, for example, methylpropylamino and isopropylmethylamino, in addition dialkylamino groups having two of the same alkyl group such as dimethyl amino or diethylamino.
  • alkenyl includes optionally substituted straight chain and branched hydrocarbon radicals as above with at least one carbon-carbon double bond (sp 2 ).
  • Alkenyls include ethenyl (or vinyl), prop-1-enyl, prop-2-enyl (or allyl), isopropenyl (or 1-methylvinyl), but-1-enyl, but-2-enyl, butadienyls, pentenyls, hexa-2,4-dienyl, and so on.
  • Hydrocarbon radicals having a mixture of double bonds and triple bonds, such as 2-penten-4-ynyl, are grouped as alkynyls herein.
  • Alkenyl includes cycloalkenyl. Cis and trans or (E) and (Z) forms are included within the invention. “Alkenyl” may be substituted with one or more substitutions including, but not limited to, cyanoalkenyl, and thioalkenyl.
  • alkynyl includes optionally substituted straight chain and branched hydrocarbon radicals as above with at least one carbon-carbon triple bond (sp).
  • Alkynyls include ethynyl, propynyls, butynyls, and pentynyls.
  • Hydrocarbon radicals having a mixture of double bonds and triple bonds, such as 2-penten-4-ynyl, are grouped as alkynyls herein.
  • Alkynyl does not include cycloalkynyl.
  • halogen or “halo” shall include iodo, bromo, chloro and fluoro.
  • aryl or “Ar” as used herein refer to an unsubstituted or substituted aromatic hydrocarbon ring system such as phenyl and naphthyl.
  • Ar or aryl group when substituted, it may have one to three substituents which are independently selected from C 1 -C 8 alkyl, C 1 -C 8 alkoxy, fluorinated C 1 -C 8 alkyl (e.g., trifluoromethyl), fluorinated C 1 -C 8 alkoxy (e.g., trifluoromethoxy), halogen, cyano, C1-C8 alkylcarbonyl such as acetyl, carboxyl, hydroxy, amino, nitro, C 1 -C 4 alkylamino (i.e., —NH—C 1 -C 4 alkyl), C 1 -C 4 dialkylamino (i.e., —N—[C 1 -C 4 alkyl] 2 wherein the alkyl groups can be
  • heteroaryl represents a stable, unsubstituted or substituted five or six membered monocyclic or bicyclic aromatic ring system which consists of carbon atoms and from one to three heteroatoms selected from N, O and S.
  • the heteroaryl group may be attached at any heteroatom or carbon atom which results in the creation of a stable structure.
  • heteroaryl groups include, but are not limited to, benzimidazolyl, benzisoxazolyl, benzofuranyl, benzopyrazolyl, benzothiadiazolyl, benzothiazolyl, benzothienyl, benzotriazolyl, benzoxazolyl, furanyl, furazanyl, furyl, imidazolyl, indazolyl, indolizinyl, indolinyl, indolyl, isobenzofuranyl, isoindolyl, isothiazolyl, isoxazolyl, oxazolyl, purinyl, pyrazinyl, pyrazolyl, pyridazinyl, pyridinyl, pyrimidinyl, pyrrolyl, quinolinyl, quinolyl, thiadiazolyl, thiazolyl, thiophenyl, or triazolyl.
  • benzimidazolyl benz
  • heterocyclyl includes optionally substituted nonaromatic rings having carbon atoms and at least one heteroatom (O, S, N) or heteroatom moiety (SO 2 , CO, CONH, COO) in the ring.
  • a heterocyclyl may be saturated, partially saturated, nonaromatic, or fused. Examples of heterocyclyl include cyclohexylimino, imdazolidinyl, imidazolinyl, morpholinyl, piperazinyl, piperidyl, pyridyl, pyranyl, pyrazolidinyl, pyrazolinyl, pyrrolidinyl, pyrrolinyl, and thienyl.
  • heteroaryl and heterocyclyl may have a valence connecting it to the rest of the molecule through a carbon atom, such as 3-furyl or 2-imidazolyl, or through a heteroatom, such as N-piperidyl or 1-pyrazolyl.
  • a monocyclic heterocyclyl has between 5 and 7 ring atoms, or between 5 and 6 ring atoms; there may be between 1 and 5 heteroatoms or heteroatom moieties in the ring, and preferably between 1 and 3, or between 1 and 2 heteroatoms or heteroatom moieties.
  • Heterocyclyl and heteroaryl also include fused, e.g., bicyclic, rings, such as those optionally fused with an optionally substituted carbocyclic or heterocyclic five- or six-membered aromatic ring.
  • heteroaryl includes an optionally substituted six-membered heteroaromatic ring containing 1, 2 or 3 nitrogen atoms fused with an optionally substituted five- or six-membered carbocyclic or heterocyclic aromatic ring.
  • Said heterocyclic five- or six-membered aromatic ring fused with the said five- or six-membered aromatic ring may contain 1, 2 or 3 nitrogen atoms where it is a six-membered ring, or 1, 2 or 3 heteroatoms selected from oxygen, nitrogen and sulfur where it is a five-membered ring.
  • ethoxymethyl is CH 3 CH 2 OCH 2 —
  • phenylethyl is a phenyl group linked by —CH 2 CH 2 — to the rest of the molecule (and not a phenyl group linked to the molecule with a CH 3 CH 2 group as a substituent on the phenyl.)
  • parentheses are used, they indicate a peripheral substitution.
  • the present invention is based, in part, on the surprising discovery that a PPAR delta agonist of the present invention is effective in decreasing the amount of small, dense LDL particles in the blood in humans.
  • a PPAR delta agonist of the present invention is effective in decreasing the amount of small, dense LDL particles in the blood in humans.
  • nearly all patients treated with the compound displayed a significantly improved LDL particle distribution.
  • every patient treated with the compound had a LDL subclass pattern A (i.e., a peak LDL particle diameter of greater than 263.4 ⁇ )
  • the patients were a mixture of patterns A, I (between 263.4 and 257.5 ⁇ ) and B (less than 257.5 ⁇ ).
  • both LDL-cholesterol and Apolipoprotein B-100 levels decreased in patients treated with the compound, while HDL levels increased.
  • the compounds of the invention find particular benefit in individuals having a small predominant LDL particle size (e.g., pattern B or I).
  • the present invention allows for methods of decreasing the number of small, dense LDL particles in a human, as well as methods of lowering the levels of Apolipoprotein B-100, LDL-cholesterol and triglycerides, increasing levels of HDL-cholesterol and inhibiting cholesterol synthesis and adsorption, as described herein, using a PPAR delta agonist.
  • PPAR delta agonists are known, including, but not limited to, those disclosed below.
  • PPAR delta agonists can be identified in screening methods, including but not limited to the methods described in US Patent Publication No. 20070037882, and the references cited therein.
  • the invention features PPAR delta agonists that are compounds of Formula (I) below:
  • Z is selected from O, CH—, and CH 2 , provided when Y is O, Z is O;
  • R 1 and R 2 are independently selected from H, C 1-3 alkyl, C 1-3 alkoxy, halo, and NR a R b , wherein R a and R b are independently H or C 1-3 alkyl;
  • R 3 and R 4 are independently selected from H, halo, cyano, hydroxy, acetyl, C 1-5 alkyl, C 1-4 alkoxy, and NR c R d wherein R c and R d are independently H or C 1-3 alkyl, provided that R 3 and R 4 are not both H;
  • R 5 is selected from halo, phenyl, phenoxy, (phenyl)C 1-5 alkoxy, (phenyl)C 1-5 alkyl, C 2-5 heteroaryloxy, C 2-5 heteroarylC 1-5 alkoxy.
  • R 6 is H when —W— represents a group selected from —CH ⁇ , —CH 2 , —CH 2 —CH 2 , —CH 2 —CH ⁇ , and —CH ⁇ CH, or R 6 is absent where —W— represents a group selected from ⁇ CH—, ⁇ CH—CH 2 , and ⁇ CH—CH ⁇ ; and n is 1 or 2;
  • the compounds used in the methods of the invention is the compound shown in Formula II:
  • the compound is
  • the compounds according to this invention may accordingly exist as enantiomers. Where the compounds possess two or more chiral centers, they may additionally exist as diastereomers. It is to be understood that all such isomers and mixtures thereof are encompassed within the scope of the present invention. Furthermore, some of the crystalline forms for the compounds may exist as polymorphs and as such are intended to be included in the present invention. In addition, some of the compounds may faun solvates with water (i.e., hydrates) or common organic solvents, and such solvates are also intended to be encompassed within the scope of this invention.
  • the invention provides the disclosed compounds and closely related, pharmaceutically acceptable forms of the disclosed compounds, such as salts, esters, amides, hydrates or solvated forms thereof; masked or protected forms; and racemic mixtures, or enantiomerically or optically pure forms.
  • Pharmaceutically acceptable salts, esters, and amides include carboxylate salts (e.g., C 1-8 alkyl, cycloalkyl, aryl, heteroaryl, or non-aromatic heterocyclic)amino acid addition salts, esters, and amides which are within a reasonable benefit/risk ratio, pharmacologically effective and suitable for contact with the tissues of patients without undue toxicity, irritation, or allergic response.
  • carboxylate salts e.g., C 1-8 alkyl, cycloalkyl, aryl, heteroaryl, or non-aromatic heterocyclic
  • Representative salts include hydrobromide, hydrochloride, sulfate, bisulfate, nitrate, acetate, oxalate, valerate, oleate, palmitate, stearate, laurate, borate, benzoate, lactate, phosphate, tosylate, citrate, maleate, fumarate, succinate, tartrate, naphthylate, mesylate, glucoheptonate, lactiobionate, and laurylsulfonate.
  • alkali metal and alkali earth cations such as sodium, potassium, calcium, and magnesium, as well as non-toxic ammonium, quaternary ammonium, and amine cations such as tetramethyl ammonium, methylamine, trimethylamine, and ethylamine.
  • alkali metal and alkali earth cations such as sodium, potassium, calcium, and magnesium
  • non-toxic ammonium, quaternary ammonium, and amine cations such as tetramethyl ammonium, methylamine, trimethylamine, and ethylamine.
  • amine cations such as tetramethyl ammonium, methylamine, trimethylamine, and ethylamine.
  • Representative pharmaceutically acceptable amides of the invention include those derived from ammonia, primary C 1-6 alkyl amines and secondary di(C 1-6 alkyl)amines.
  • Secondary amines include 5- or 6-membered heterocyclic or heteroaromatic ring moieties containing at least one nitrogen atom and optionally between 1 and 2 additional heteroatoms.
  • Preferred amides are derived from ammonia, C 1-3 alkyl primary amines, and di(C 1-2 alkyl)amines.
  • Representative pharmaceutically acceptable esters of the invention include C 1-7 alkyl, C 5-7 cycloalkyl, phenyl, and phenyl(C 1-6 ) alkyl esters. In some embodiments, the esters are methyl esters.
  • the invention also includes disclosed compounds having one or more functional groups (e.g., amino, or carboxyl) masked by a protecting group. Some of these masked or protected compounds are pharmaceutically acceptable; others will be useful as intermediates. Synthetic intermediates and processes (e.g., as disclosed in U.S. Pat. No. 7,301,050), and minor modifications thereof, are also within the scope of the invention.
  • functional groups e.g., amino, or carboxyl
  • Protection for the hydroxyl group includes methyl ethers, substituted methyl ethers, substituted ethyl ethers, substitute benzyl ethers, and silyl ethers.
  • substituted methyl ethers include methyoxymethyl, methylthiomethyl, t-butylthiomethyl, (phenyldimethylsilyl)methoxymethyl, benzyloxymethyl, p-methoxybenzyloxymethyl, (4-methoxyphenoxy)methyl, guaiacolmethyl, t-butoxymethyl, 4-pentenyloxymethyl, siloxymethyl, 2-methoxyethoxymethyl, 2,2,2-trichloroethoxymethyl, bis(2-chloroethoxy)methyl, 2-(trimethylsilyl)ethoxymethyl, tetrahydropyranyl, 3-bromotetrahydropyranyl, tetrahydrothiopyranyl, 1-methoxycyclohexyl, 4-methoxytetrahydropyranyl, 4-methoxytetrahydrothiopyranyl, 4-methoxytetrahydrothiopyranyl S,S-dioxido, 1-[(2-chloro-4-
  • substituted ethyl ethers include 1-ethoxyethyl, 1-(2-chloroethoxy)ethyl, 1-methyl-1-methoxyethyl, 1-methyl-1-benzyloxyethyl, 1-methyl-1-benzyloxy-2-fluoroethyl, 2,2,2-trichloroethyl, 2-trimethylsilylethyl, 2-(phenylselenyl)ethyl, t-butyl, allyl, p-chlorophenyl, p-methoxyphenyl, 2,4-dinitrophenyl, and benzyl.
  • substituted benzyl ethers include p-methoxybenzyl, 3,4-dimethoxybenzyl, o-nitrobenzyl, p-nitrobenzyl, p-halobenzyl, 2,6-dichlorobenzyl, p-cyanobenzyl, p-phenylbenzyl, 2- and 4-picolyl, 3-methyl-2-picolyl N-oxido, diphenylmethyl, p,p′-dinitrobenzhydryl, 5-dibenzosuberyl, triphenylmethyl, .alpha.-naphthyldiphenylmethyl, p-methoxyphenyldiphenylmethyl, di(p-methoxyphenyl)phenylmethyl, tri(p-methoxyphenyl)methyl, 4-(4′-bromophenacyloxy)phenyldiphenylmethyl, 4,4′,4′′-tris(4,5-dichlorophthalimidophenyl)methyl,
  • silyl ethers examples include trimethylsilyl, triethylsilyl, triisopropylsilyl, dimethylisopropylsilyl, diethylisopropylsilyl, dimethylthexylsilyl, t-butyldimethylsilyl, t-butyldiphenylsilyl, tribenzylsilyl, tri-p-xylylsilyl, triphenylsilyl, diphenylmethylsilyl, and t-butylmethoxyphenylsilyl.
  • esters include formate, benzoylformate, acetate, chloroacetate, dichloroacetate, trichloroacetate, trifluoroacetate, methoxyacetate, triphenylmethoxyacetate, phenoxyacetate, p-chlorophenoxyacetate, p-P-phenylacetate, 3-phenylpropionate, 4-oxopentanoate(levulinate), 4,4-(ethylenedithio)pentanoate, pivaloate, adamantoate, crotonate, 4-methoxycrotonate, benzoate, p-phenylbenzoate, 2,4,6-trimethylbenzoate(mesitoate)
  • carbonates include methyl, 9-fluorenylmethyl, ethyl, 2,2,2-trichloroethyl, 2-(trimethylsilyl)ethyl, 2-(phenylsulfonyl)ethyl, 2-(triphlenylphosphonio)ethyl, isobutyl, vinyl, allyl, p-nitrophenyl; benzyl, p-methoxybenzyl, 3,4-dimethoxybenzyl, o-nitrobenzyl, p-nitrobenzyl, S-benzyl thiocarbonate, 4-ethoxy-1-naphthyl, and methyl dithiocarbonate.
  • assisted cleavage examples include 2-iodobenzoate, 4-azidobutyrate, 4-nitro-4-methylpentanoate, o-(dibromomethyl)benzoate, 2-formylbenzenesulfonate, 2-(methylthiomethoxy)ethyl carbonate, 4-(methylthiomethoxy)butyrate, and 2-(methylthiomethoxymethyl)benzoate.
  • miscellaneous esters examples include 2,6-dichloro-4-methylphenoxyacetate, 2,6-dichloro-4-(1,1,3,3-tetramethylbutyl)phenoxyacetate, 2,4-bis(1,1-dimethylpropyl)phenoxyacetate, chlorodiphenylacetate, isobutyrate, monosuccinoate, (E)-2-methyl-2-butenoate(tigloate), o-(methoxycarbonyl)benzoate, p-P-benzoate, ⁇ -naphthoate, nitrate, alkyl N,N,N′,N′-tetramethylphosphorodiamidate, N-phenylcarbamate, borate, dimethylphosphinothioyl, and 2,4-dinitrophenylsulfenate.
  • sulfonates include sulfate, methanesulfonate(mesylate), benzylsulfonate, and tosylate.
  • Protection for the amino group includes carbamates, amides, and special —NH protective groups.
  • carbamates examples include methyl and ethyl carbamates, substituted ethyl carbamates, assisted cleavage carbamates, photolytic cleavage carbamates, urea-type derivatives, and miscellaneous carbamates.
  • methyl and ethyl carbamates include methyl and ethyl, 9-fluorenylmethyl, 9-(2-sulfo)fluorenylmethyl, 9-(2,7-dibromo)fluorenylmethyl, 2,7-di-t-butyl-[9-(10,10-dioxo-10,10,10,10-tetrahydrothioxanthyl)]methyl, and 4-methoxyphenacyl.
  • substituted ethyl carbamates examples include 2,2,2-trichloroethyl, 2-trimethylsilylethyl, 2-phenylethyl, 1-(1-adamantyl)-1-methylethyl, 1,1-dimethyl-2-haloethyl, 1,1-dimethyl-2,2-dibromoethyl, 1,1-dimethyl-2,2,2-trichloroethyl, 1-methyl-1-(4-biphenylyl)ethyl, 1-(3,5-di-t-butylphenyl)-1-methylethyl, 2-(2′- and 41-pyridyl)ethyl, 2-(N,N-dicyclohexylcarboxamido)ethyl, t-butyl, 1-adamantyl, vinyl, allyl, 1-isopropylallyl, cinnamyl, 4-nitrocinnamyl, 8-quinolyl, N-hydroxypipe
  • assisted cleavage examples include 2-methylthioethyl, 2-methylsulfonylethyl, 2-(p-toluenesulfonyl)ethyl, [2-(1,3-dithianyl)]methyl, 4-methylthiophenyl, 2,4-dimethylthiophenyl, 2-phosphonioethyl, 2-triphenylphosphonioisopropyl, 1,1-dimethyl-2-cyanoethyl, m-chloro-p-acyloxybenzyl, p-(dihydroxyboryl)benzyl, 5-benzisoxazolylmethyl, and 2-(trifluoromethyl)-6-chromonylmethyl.
  • photolytic cleavage examples include m-nitrophenyl, 3,5-dimethoxybenzyl, o-nitrobenzyl, 3,4-dimethoxy-6-nitrobenzyl, and phenyl(o-nitrophenyl)methyl.
  • urea-type derivatives include phenothiazinyl-(10)-carbonyl derivative, N′-p-toluenesulfonylaminocarbonyl, and N′-phenylaminothiocarbonyl.
  • miscellaneous carbamates include t-amyl, S-benzyl thiocarbamate, p-cyanobenzyl, cyclobutyl, cyclohexyl, cyclopentyl, cyclopropylmethyl, p-decyloxybenzyl, diisopropylmethyl, 2,2-dimethoxycarbonylvinyl, o-(N,N-dimethylcarboxamido)benzyl, 1,1-dimethyl-3-(N,N-dimethylcarboxamido)propyl, 1,1-dimethylpropynyl, di(2-pyridyl)methyl, 2-furanylmethyl, 2-iodoethyl, isobornyl, isobutyl, isonicotinyl, p-(p′-methoxyphenylazo)benzyl, 1-methylcyclobutyl, 1-methylcyclohexyl, 1-methyl-1-cyclopropylmethyl, 1-
  • N-formyl N-acetyl, N-chloroacetyl, N-trichloroacetyl, N-trifluoroacetyl, N-phenylacetyl, N-3-phenylpropionyl, N-picolinoyl, N-3-pyridylcarboxamide, N-benzoylphenylalanyl derivative, N-benzoyl, N-p-phenylbenzoyl.
  • N-o-nitrophenylacetyl N-o-nitrophenoxyacetyl, N-acetoacetyl, (N′-dithiobenzyloxycarbonylamino)acetyl, N-3-(p-hydroxyphenyl)propionyl, N-3-(o-nitrophenyl)propionyl, N-2-methyl-2-(o-nitrophenoxy)propionyl, N-2-methyl-2-(o-phenylazophenoxy)propionyl, N-4-chlorobutyryl, N-3-methyl-3-nitrobutyryl, N-o-nitrocinnamoyl, N-acetylmethionine derivative, N-o-nitrobenzoyl, N-o-(benzoyloxymethyl)benzoyl, and 4,5-diphenyl-3-oxazolin-2-one.
  • N-phthalimide N-dithiasuccinoyl, N-2,3-diphenylmaleoyl, N-2,5-dimethylpyrrolyl, N-1,1,4,4-tetramethyldisilylazacyclopentane adduct, 5-substituted 1,3-'dimethyl-'1,3,5-triazacyclohexan-2-one, 5-substituted 1,3-dibenzyl-1,3,5-triazacyclohexan-2-one, and 1-substituted 3,5-dinitro-4-pyridonyl.
  • esters include formate, benzoylformate, acetate, trichloroacetate, trifluoroacetate, methoxyacetate, phenoxyacetate, p-chlorophenoxyacetate, benzoate.
  • substituted methyl esters include 9-fluorenylmethyl, methoxymethyl, methylthiomethyl, tetrahydropyranyl, tetrahydrofuranyl, methoxyethoxymethyl, 2-(trimethylsilyl)ethoxymethyl, benzyloxymethyl, phenacyl, p-bromophenacyl, .alpha.-methylphenacyl, p-methoxyphenacyl, carboxamidomethyl, and N-phthalimidomethyl.
  • 2-substituted ethyl esters examples include 2,2,2-trichloroethyl, 2-haloethyl, (.omega.-chloroalkyl, 2-(trimethylsilyl)ethyl, 2-methylthioethyl, 1,3-dithianyl-2-methyl, 2-(p-nitrophenylsulfenyl)ethyl, 2-(p-toluenesulfonyl)ethyl, 2-(2′-pyridyl)ethyl, 2-(diphenylphosphino)ethyl, 1-methyl-1-phenylethyl, t-butyl, cyclopentyl, cyclohexyl, allyl, 3-buten-1-yl, 4-(trimethylsilyl)-2-buten-1-yl, cinnamyl, .alpha.-methylcinnamyl, phenyl, p-(methylmercapto)pheny
  • substituted benzyl esters include triphenylmethyl, diphenylmethyl, bis(o-nitrophenyl)methyl, 9-anthrylmethyl, 2-(9,10-dioxo)anthrylmethyl, 5-dibenzosuberyl, 1-pyrenylmethyl, 2-(trifluoromethyl)-6-chromylmethyl, 2,4,6-trimethylbenzyl, p-bromobenzyl, o-nitrobenzyl, p-nitrobenzyl, p-methoxybenzyl, 2,6-dimethoxybenzyl, 4-(methylsulfinyl)benzyl, 4-sulfobenzyl, piperonyl, 4-picolyl and p-P-benzyl.
  • silyl esters examples include trimethylsilyl, triethylsilyl, t-butyldimethylsilyl, i-propyldimethylsilyl, phenyldimethylsilyl and di-t-butylmethylsilyl.
  • activated esters include thiols.
  • miscellaneous derivatives include oxazoles, 2-alkyl-1,3-oxazolines, 4-alkyl-5-oxo-1,3-oxazolidines, 5-alkyl-4-oxo-1,3-dioxolanes, ortho esters, phenyl group and pentaminocobalt(III) complex.
  • stannyl esters examples include triethylstannyl and tri-n-butylstannyl.
  • certain classes of individuals derive a particularly significant benefit from receiving a PPAR delta agonist such as those set forth in Formula I and as described herein.
  • Those deriving a particularly significant benefit include those individuals with a predominant LDL particle that is small (e.g., pattern B or I), those with a high Apolipoprotein B-100 blood level and/or those with high triglycerides and/or cholesterol.
  • compounds of the present invention are effective in addressing each of the above-listed risk factors, i.e., by significantly decreasing the amount of small LDL particles, reducing blood levels of Apolipoprotein B-100, LDL cholesterol, and triglycerides, raising blood levels of HDL cholesterol, and by blocking both cholesterol synthesis and absorption.
  • a compound of the present invention is administered to an individual having a pattern B or pattern I predominant LDL particle size.
  • a compound of the present invention e.g., the compound of Formula II
  • GGE GGE-Geatg., the compound of Formula II
  • a compound of the present invention (e.g., the compound of Formula II) is administered to an individual having a predominant LDL particle size of less than 25.75 nm as measured by GGE, and optionally changing the predominant LDL particle size in the individual to a size greater than 25.75 nm, and optionally greater than 26.34 nm as measured by GGE.
  • a compound of the present invention is administered to an individual having a predominant LDL particle size of less 212.0 nm as measured by AIM, and optionally changing the predominant LDL particle size in the individual to a size greater than 212.0 nm as measured by AIM.
  • a compound of the present invention e.g., the compound of Formula II
  • a compound of the present invention e.g., the compound of Formula II
  • a compound of the present invention is administered to an individual having a predominant LDL-III particle as measured by AIM.
  • a compound of the present invention e.g., the compound of Formula II
  • a compound of the present invention is administered to an individual having an Apolipoprotein B-100 level (e.g., blood level) of at least 130 mg/dl, e.g., at least 150 mg/dl, or 175 mg/dl, optionally also having an LDL particle size pattern B or I.
  • Apolipoprotein B-100 level e.g., blood level
  • a compound of the present invention is administered to an individual having an Apolipoprotein B-100 level of at least 130 mg/dl in an amount and frequency sufficient to reduce the Apolipoprotein B-100 level, e.g., from above 130 mg/dl to below 130 mg/dl over a time period (e.g., 10, 20, 40, 70, 100 or more days) and/or to maintain a desired goal Apolipoprotein B-100 level, e.g., below 130 mg/dl, below 120 mg/dl, below 100 mg/dl, etc.
  • a compound of the present invention is administered to an individual having a non-HDL cholesterol level (e.g., blood level) of at least 130 mg/dL, e.g., at least 150 mg/dL, optionally also having an LDL particle size pattern B or I.
  • a non-HDL cholesterol level e.g., blood level
  • a compound of the present invention is administered to an individual having a non-HDL cholesterol level of at least 130 mg/dL in an amount and frequency sufficient to reduce the non-HDL cholesterol level, e.g., from above 130 mg/dL to below 130 mg/dL, over a time period (e.g., 10, 20, 40, 70, 100 or more days) and/or to maintain a desired goal non-HDL cholesterol level, e.g., below 130 mg/dL.
  • a time period e.g. 10, 20, 40, 70, 100 or more days
  • a compound of the present invention is administered to an individual having an LDL-cholesterol level (e.g., a fasting blood cholesterol level) of at least 130 mg/dL, e.g., at least 150 mg/dL, optionally also having an LDL particle size pattern B or I.
  • LDL-cholesterol level e.g., a fasting blood cholesterol level
  • a compound of the present invention is administered to an individual having a cholesterol level of at least 130 mg/dL in an amount and frequency sufficient to reduce the cholesterol level, e.g., from above 130 mg/dL to below 110 mg/dL, over a time period (e.g., 10, 20, 40, 70, 100 or more days) and/or to maintain a desired goal cholesterol level, e.g., below 110 mg/dL.
  • a compound of the present invention is administered to an individual having metabolic syndrome, optionally also having an LDL particle size pattern B or I.
  • the metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include: (a) abdominal obesity (excessive fat tissue in and around the abdomen); (b) atherogenic dyslipidemia (blood fat disorders—high triglycerides, low HDL cholesterol and high LDL cholesterol—that foster plaque buildups in artery walls); (c) elevated blood pressure; (d) insulin resistance or glucose intolerance (the body can't properly use insulin or blood sugar); (e) prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor—1 in the blood); and (0 proinflammatory state (e.g., elevated C-reactive protein in the blood)
  • a compound of the present invention is administered to an individual having diabetes or who is insulin resistant, optionally also having an LDL particle size pattern B or I, and/or a non-HDL cholesterol level greater or equal to 130 mg/dL.
  • a compound of the present invention is administered to an individual having atherosclerosis, optionally also having an LDL particle size pattern B or I. In some embodiments, a compound of the present invention is administered to an individual not having atherosclerosis, but optionally having LDL particle size pattern B or I.
  • an individual e.g., a human
  • Such tests are useful, e.g., for initially identifying individuals that will derive maximum benefit from the compounds, as well as for monitoring efficacy of the treatment and optionally, for determining treatment can be improved by a modified or alternate treatment.
  • the treatment of the individual is changed following the determination of LDL particle size, Apolipoprotein B-100 level, LDL cholesterol level, triglyceride level, insulin resistance, and/or glucose tolerance.
  • Measurement of blood levels of Apolipoprotein B-100, LDL cholesterol, triglyceride level, LDL particle size or other blood factors are generally determined from a blood sample from a fasting individual.
  • GGE gradient-gel electrophoresis
  • AIM Airborne Ion Mobility
  • a therapeutically effective amount of a PPAR delta agonist e.g., a compound of Formula I
  • a therapeutically effective amount of a PPAR delta agonist can be used to, e.g., decrease the amount of small LDL particles, reduce Apolipoprotein B-100 blood levels, reduce LDL cholesterol blood levels, reduce triglyceride levels, raise HDL cholesterol levels, and/or reduce cholesterol synthesis and/or absorption as described herein.
  • compositions of the invention can include compounds of Formula (I), pharmaceutically acceptable salts thereof or a hydrolysable precursor thereof.
  • the compound is mixed with suitable carriers or excipient(s) in a therapeutically effective amount.
  • PPAR delta agonists including the compounds of Formula (I)
  • administration of the compounds can be achieved in various ways, including oral, buccal, rectal, parenteral, intraperitoneal, intradermal, transdermal, intratracheal administration.
  • the compound can be administered in a depot or sustained release formulation.
  • the compounds can be administered in a liposome.
  • the compounds of Formula (I) can be formulated with common excipients, diluents or carriers and compressed into tablets or formulated as elixirs or solutions for convenient oral administration or administered by the intramuscular or intravenous routes.
  • the compounds can be administered transdermally and can be formulated as sustained release dosage forms and the like.
  • Compounds of Formula (I) can be administered alone, in combination with each other or they can be used in combination with other known compounds.
  • Suitable formulations for use in the present invention are found in Remington's Pharmaceutical Sciences (Mack Publishing Company (1985) Philadelphia, Pa., 17th ed.), which is incorporated herein by reference. Moreover, for a brief review of methods for drug delivery, see, Langer, Science (1990) 249:1527-1533, which is incorporated herein by reference.
  • the pharmaceutical compositions described herein can be manufactured in a manner that is known to those of skill in the art, i.e., by means of conventional mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping or lyophilizing processes. The following methods and excipients are merely exemplary and are in no way limiting.
  • the compounds can be formulated into preparations by dissolving, suspending or emulsifying them in an aqueous or nonaqueous solvent, such as vegetable or other similar oils, synthetic aliphatic acid glycerides, esters of higher aliphatic acids or propylene glycol; and if desired, with conventional additives such as solubilizers, isotonic agents, suspending agents, emulsifying agents, stabilizers and preservatives.
  • the compounds of the present invention can be formulated in aqueous solutions, e.g., in physiologically compatible buffers such as Hanks's solution, Ringer's solution or physiological saline buffer.
  • penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art.
  • the compounds of Formula (I) can be formulated readily by combining with pharmaceutically acceptable carriers that are well known in the art.
  • Such carriers enable the compounds to be formulated as tablets, pills, dragees, capsules, emulsions, lipophilic and hydrophilic suspensions, liquids, gels, syrups, slurries, suspensions and the like, for oral ingestion by a patient to be treated.
  • Pharmaceutical preparations for oral use can be obtained by mixing the compounds with a solid excipient, optionally grinding a resulting mixture and processing the mixture of granules, after adding suitable auxiliaries, if desired, to obtain tablets or dragee cores.
  • Suitable excipients are, in particular, fillers such as sugars, including lactose, sucrose, mannitol or sorbitol; cellulose preparations such as, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodium carboxymethylcellulose and/or polyvinylpyrrolidone (PVP).
  • disintegrating agents can be added, such as the cross-linked polyvinyl pyrrolidone, agar or alginic acid or a salt thereof such as sodium alginate.
  • Dragee cores are provided with suitable coatings.
  • suitable coatings can be used, which can optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol and/or titanium dioxide, lacquer solutions and suitable organic solvents or solvent mixtures.
  • Dyestuffs or pigments can be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
  • compositions that can be used orally include push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol.
  • the push-fit capsules can contain the active ingredients in admixture with filler such as lactose, binders such as starches and/or lubricants such as talc or magnesium stearate and, optionally, stabilizers.
  • the active compounds can be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin or liquid polyethylene glycols.
  • stabilizers can be added. All formulations for oral administration should be in dosages suitable for such administration.
  • compositions can take the form of tablets or lozenges formulated in conventional manner.
  • the compounds for use according to the present invention are conveniently delivered in the form of an aerosol spray presentation from pressurized packs or a nebulizer, with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas or from propellant-free, dry-powder inhalers.
  • a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas or from propellant-free, dry-powder inhalers.
  • a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas or from propellant-free, dry-powder inhalers.
  • the dosage unit can
  • the compounds can be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion.
  • Formulations for injection can be presented in unit dosage form, e.g., in ampules or in multidose containers, with an added preservative.
  • the compositions can take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles and can contain formulator agents such as suspending, stabilizing and/or dispersing agents.
  • compositions for parenteral administration include aqueous solutions of the active compounds in water-soluble form.
  • suspensions of the active compounds can be prepared as appropriate oily injection suspensions.
  • Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil or synthetic fatty acid esters, such as ethyl oleate or triglycerides or liposomes.
  • Aqueous injection suspensions can contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol or dextran.
  • the suspension can also contain suitable stabilizers or agents which increase the solubility of the compounds to allow for the preparation of highly concentrated solutions.
  • the active ingredient can be in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.
  • the compounds can also be formulated in rectal compositions such as suppositories or retention enemas, e.g., containing conventional suppository bases such as cocoa butter, carbowaxes, polyethylene glycols or other glycerides, all of which melt at body temperature, yet are solidified at room temperature.
  • rectal compositions such as suppositories or retention enemas, e.g., containing conventional suppository bases such as cocoa butter, carbowaxes, polyethylene glycols or other glycerides, all of which melt at body temperature, yet are solidified at room temperature.
  • the compounds can also be formulated as a depot preparation.
  • Such long acting formulations can be administered by implantation (for example subcutaneously or intramuscularly) or by intramuscular injection.
  • the compounds can be formulated with suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable oil) or ion exchange resins or as sparingly soluble derivatives, for example, as a sparingly soluble salt.
  • hydrophobic pharmaceutical compounds can be employed.
  • Liposomes and emulsions are well known examples of delivery vehicles or carriers for hydrophobic drugs.
  • long-circulating, i.e., stealth liposomes can be employed.
  • liposomes are generally described in Woodle, et al., U.S. Pat. No. 5,013,556.
  • the compounds of the present invention can also be administered by controlled release means and/or delivery devices such as those described in U.S. Pat. Nos. 3,845,770; 3,916,899; 3,536,809; 3,598,123; and 4,008,719.
  • DMSO dimethylsulfoxide
  • the compounds can be delivered using a sustained-release, such as semipermeable matrices of solid hydrophobic polymers containing the therapeutic agent.
  • sustained-release materials have been established and are well known by those skilled in the art. Sustained-release capsules can, depending on their chemical nature, release the compounds for a few hours up to over 100 days.
  • compositions also can comprise suitable solid or gel phase carriers or excipients.
  • suitable solid or gel phase carriers or excipients include but are not limited to calcium carbonate, calcium phosphate, various sugars, starches, cellulose derivatives, gelatin and polymers such as polyethylene glycols.
  • compositions suitable for use in the present invention include compositions wherein the active ingredients are contained in a therapeutically effective amount.
  • the amount of composition administered will, of course, be dependent on the subject being treated, on the subject's weight, the severity of the affliction, the manner of administration and the judgment of the prescribing physician. Determination of an effective amount is well within the capability of those skilled in the art, especially in light of the detailed disclosure provided herein.
  • a therapeutically effective dose can be estimated initially from cell culture assays or animal models.
  • toxicity and therapeutic efficacy of the compounds described herein can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., by determining the LD 50 (the dose lethal to 50% of the population) and the ED 50 (the dose therapeutically effective in 50% of the population).
  • the dose ratio between toxic and therapeutic effect is the therapeutic index and can be expressed as the ratio between LD 50 and ED 50 .
  • Compounds that exhibit high therapeutic indices are generally preferred.
  • the data obtained from these cell culture assays and animal studies can be used in formulating a dosage range that is not toxic for use in human.
  • the dosage of such compounds lies preferably within a range of circulating concentrations that include the ED 50 with little or no toxicity.
  • the dosage can vary within this range depending upon the dosage form employed and the route of administration utilized.
  • the exact formulation, route of administration and dosage can be chosen by the individual physician in view of the patient's condition. (See, e.g., Fingl et al. 1975 In: The Pharmacological Basis of Therapeutics, Ch. 1).
  • suitable unit doses for the compounds of the present invention can, for example, contain between 10 mg to about 3000 mg of the active compound, e.g., a unit dose between 50 mg to about 1500 mg, e.g. a unit dose between 50 to about 500 mg. As disclosed in the examples, 50, 100, and 200 mg doses of
  • Unit doses can be administered more than once a day, for example 2, 3, 4, 5 or 6 times a day, but optionally 1 or 2 times per day, so that the total daily dosage for a 70 kg adult is in the range of 0.1 to about 250 mg per kg weight of subject per administration.
  • An exemplary dosage is 5 to about 250 mg per kg weight of subject per administration and such therapy can extend for a number of weeks or months and in some cases, years.
  • the specific dose level for any particular patient will depend on a variety of factors including the activity of the specific compound employed; the age, body weight, general health, sex and diet of the individual being treated; the time and route of administration; the rate of excretion; other drugs which have previously been administered; and the severity of the particular disease undergoing therapy, as is well understood by those of skill in the area.
  • a typical dosage can be one 10 to about 1500 mg tablet taken once a day or, multiple times per day or one time-release capsule or tablet taken once a day and containing a proportionally higher content of active ingredient.
  • a dosage of 10, 25, 50, 100, 200, or 300 mg a day is provided.
  • the time-release effect can be obtained by capsule materials that dissolve at different pH values, by capsules that release slowly by osmotic pressure or by any other known means of controlled release.
  • the compounds of the present invention may be used in combination with other pharmaceutically active agents.
  • compositions or the disclosed drug combinations are known in the art for determining effective doses for therapeutic and prophylactic purposes for the disclosed pharmaceutical compositions or the disclosed drug combinations, whether or not formulated in the same composition.
  • joint effective amount means that amount of each active compound or pharmaceutical agent, alone or in combination, that elicits the biological or medicinal response in a tissue system, animal or human that is being sought by a researcher, veterinarian, medical doctor or other clinician, which includes alleviation of the symptoms of the disease or disorder being treated.
  • the term “jointly effective amount” refers to that amount of each active compound or pharmaceutical agent, alone or in combination, that treats or inhibits in a subject the onset or progression of a disorder as being sought by a researcher, veterinarian, medical doctor or other clinician.
  • the present invention provides combinations of two or more drugs wherein, for example, (a) each drug is administered in an independently therapeutically or prophylactically effective amount; (b) at least one drug in the combination is administered in an amount that is sub-therapeutic or sub-prophylactic if administered alone, but is therapeutic or prophylactic when administered in combination with the second or additional drugs according to the invention; or (c) both (or more) drugs are administered in an amount that is sub-therapeutic or sub-prophylactic if administered alone, but are therapeutic or prophylactic when administered together.
  • Anti-diabetic agents include thiazolidinedione and non-thiazolidinedione insulin sensitizers, which decrease peripheral insulin resistance by enhancing the effects of insulin at target organs and tissues, as well as sulfonylureas (e.g., glyburide), biguanides (e.g. metformin), DPP-4 inhibitors (e.g., sitagliptin), incretin analogs (e.g., exenatide), meglitinides (e.g., Nateglinide), and ⁇ -glucosidase inhibitors (e.g., acarbose).
  • sulfonylureas e.g., glyburide
  • biguanides e.g. metformin
  • DPP-4 inhibitors e.g., sitagliptin
  • incretin analogs e.g., exenatide
  • meglitinides e.g., Nateg
  • PPAR-gamma agonists are thiazolidinediones such as: (1) rosiglitazone (2,4-thiazolidinedione, 5-(4-(2-(methyl-2-pyridinylamino)ethoxy)phenyl)methyl)-, (Z)-2-butenedioate (1:1) or 5-((4-(2-(methyl-2-pyridinylamino)ethoxy)phenyl)methyl)-2,4-thiazolidinedione, known as AVANDIATM; also known as BRL 49653, BRL 49653C, BRL 49653c, SB 210232, or rosiglitazone maleate); (2) pioglitazone (2,4-thiazolidinedione, 5-((4-(2-(5-ethyl-2
  • non-thiazolidinediones that act as insulin sensitizing agents include, but are not limited to: (1) JT-501 (JTT 501, PNU-1827, PNU-7,6-MET-0096, or PNU 182716: isoxazolidine-3,5-dione, 4-((4-(2-phenyl-5-methyl)-1,3-oxazolyl) ethylphenyl-4) methyl-); (2) KRP-297 (5-(2,4-dioxothiazolidin-5-ylmethyl)-2-methoxy-N-(4-trifluoromethyl)benzyl)benzamide or 5-((2,4-dioxo-5-thiazolidinyl), methyl)-2-methoxy-N-((4-(trifluoromethyl)phenyl)methyl) benzamide); and (3) Farglitazar (L-tyrosine, N-(2-benzoylphenyl)-O-(2-(5-methyl-2-)
  • PPAR modulator activity such as PPAR gamma, SPPAR gamma, and/or PPAR delta/gamma agonist activity. Examples are listed below: (1) AD 5075; (2) R 119702 ((+ ⁇ )-5-(4-(5-Methoxy-1H-benzimidazol-2-ylmethoxy) benzyl)thiazolin-2,4-dione hydrochloride, or Cl 1037 or CS 011); (3) CLX-0940 (peroxisome proliferator-activated receptor alpha agonist/peroxisome proliferator-activated receptor gamma agonist); (4) LR-90 (2,5,5-tris (4-chlorophenyl)-1,3-dioxane-2-carboxylic acid, PPARdelta/ ⁇ agonist); (5) Tularik (PPAR ⁇ agonist); (6) CLX-0921 (PPAR ⁇ agonist); (7) CGP-52608 (PPAR agonist);
  • the compound according to the above right formula can be the racemate, (+) isomer or the ( ⁇ ) isomer.
  • Methods for making such compounds are taught in U.S. Patent Application Publication No. 20030220399 which is incorporated herein by reference.
  • Methods of resolving alpha-(phenoxy)phenylacetic acid derivatives are taught in U.S. Patent Application Publication No. 20050033084 which is incorporated herein by reference in its entirety.
  • insulin sensitizing agents include, but are not limited to: (1) INS-1 (D-chiroinositol or D-1, 2, 3, 4, 5, 6-hexahydroxycyclohexane); (2) protein tyrosine phosphatase 1 B (PTP-1B) inhibitors; (3) glycogen synthase kinase-3 (GSK3) inhibitors; (4) beta 3 adrenoceptor agonists such as ZD 2079 ((R)—N-(2-(4-(carboxymethyl)phenoxy)ethyl)-N-(2-hydroxy-2-phenethyl) ammonium chloride, also known as ICI D 2079) or AZ 40140; (5) glycogen phosphorylase inhibitors; (6) fructose-1,6-bisphosphatase inhibitors; (7) chromic picolinate, vanadyl sulfate (vanadium oxysulfate); (8) KP 102 (organo-vanadium compound); (9) chromic polysed
  • glucose-6 phosphatase inhibitors (52) glucose-6 phosphatase inhibitors; (53) fatty acid glucose transport protein; (54) glucocorticoid receptor antagonists; and (55) glutamine:fructose-6-phosphate amidotransferase (GFAT) modulators.
  • GFAT glutamine:fructose-6-phosphate amidotransferase
  • C Biguanides, which decrease liver glucose production and increases the uptake of glucose.
  • metformin such as: (1) 1,1-dimethylbiguanide (e.g., Metformin—DepoMed, Metformin—Biovail Corporation, or METFORMINTM GR (metformin gastric retention polymer)); and (2) metformin hydrochloride (N,N-dimethylimidodicarbonimidic diamide monohydrochloride, also known as LA 6023, BMS 207150, GLUCOPHAGETM, or GLUCOPHAGE XRTM.
  • metformin such as: (1) 1,1-dimethylbiguanide (e.g., Metformin—DepoMed, Metformin—Biovail Corporation, or METFORMINTM GR (metformin gastric retention polymer)); and (2) metformin hydrochloride (N,N-dimethylimidodicarbonimidic diamide monohydrochloride, also known as LA 6023, BMS 207150, G
  • Alpha-glucosidase inhibitors which inhibit alpha-glucosidase.
  • Alpha-glucosidase converts fructose to glucose, thereby delaying the digestion of carbohydrates. The undigested carbohydrates are subsequently broken down in the gut, reducing the post-prandial glucose peak.
  • Examples include, but are not limited to: (1) acarbose (D-glucose, 0-4,6-dideoxy-4-(((1S-(1alpha,4alpha,5beta,6alpha))-4,5,6-trihydroxy-3-(hydroxymethyl)-2-cyclohexen-1-yl)amino)-alpha-D-glucopyranosyl-(1-4)-O-alpha-D-glucopyranosyl-(1-4)-, also known as AG-5421, Bay-g-542, BAY-g-542, GLUCOBAYTM, PRECOSETM, GLUCORTM, PRANDASETM, GLUMIDATM, or ASCAROSETTM); (2) Miglitol (3,4,5-piperidinetriol, 1-(2-hydroxyethyl)-2-(hydroxymethyl)-, (2R (2alpha, 3beta, 4alpha, 5beta))- or (2R,3R,4R,5S)-1-(
  • Insulins include regular or short-acting, intermediate-acting, and long-acting insulins, non-injectable or inhaled insulin, tissue selective insulin, glucophosphokinin (D-chiroinositol), insulin analogues such as insulin molecules with minor differences in the natural amino acid sequence and small molecule mimics of insulin (insulin mimetics), and endosome modulators.
  • Examples include, but are not limited to: (1) Biota; (2) LP 100; (3) (SP-5-21)-oxobis (1-pyrrolidinecarbodithioato-S,S′) vanadium, (4) insulin apart (human insulin (28B-L-aspartic acid) or B28-Asp-insulin, also known as insulin X14, INA-X14, NOVORAPIDTM, NOVOMIXTM, or NOVOLOGTM); (5) insulin detemir (Human 29B-(N-6-(1-oxotetradecyl)-L-lysine)-(1A-21A), (1B-29B)-Insulin or NN 304); (6) insulin lispro (“28B-L-lysine-29B-L-proline human insulin,” or Lys(B28), Pro(B29) human insulin analog, also known as lys-pro insulin, LY 275585, HUMALOGTM, HUMALOGTM MIX 75/25, or
  • Insulin secretion modulators such as: (1) glucagon-like peptide-1 (GLP-1) and its mimetics; (2) glucose-insulinotropic peptide (GIP) and its mimetics; (3) exendin and its mimetics; (4) dipeptyl protease (DPP or DPPIV) inhibitors such as (4a) DPP-728 or LAF 237 (2-pyrrolidinecarbonitrile, 1-(((2-((5-cyano-2-pyridinyl)amino)ethyl)amino)acetyl), known as NVP-DPP-728, DPP-728A, LAF-237); (4b) P 3298 or P32/98 (di-(3N-((2S,3S)-2-amino-3-methyl-pentanoyl)-1,3-thiazolidine)fumarate); (4c) TSL 225 (tryptophyl-1,2,3,4-tetrahydroisoquinoline-3-carbox
  • the present compounds may also increase insulin sensitivity with little or no increase in body weight than that found with the use of existing PPAR gamma agonists.
  • Oral anti-diabetic agents may include insulin, sulfonylureas, biguanides, meglitinides, AGI's, PPAR alpha agonists, and PPAR gamma agonists, and dual PPAR alpha/gamma agonists.
  • the present compounds also may increase fat and/or lipid metabolism, providing a method for losing weight, losing fat weight, lowering body mass index, lowering lipids (such as lowering triglycerides), or treating obesity or the condition of being overweight.
  • lipid lowering agents include bile acid sequestrants, fibric acid derivatives, nicotinic acid, and HMGCoA reductase inhibitors.
  • statins such as LIPITORTM, ZOCORTM, PRAVACHOLTM, LESCOLTM, and MEVACORTM
  • pitavastatin nisvastatin
  • ADX-159 extended release lovastatin
  • Colestid Locholest, Questran, Atromid, Lopid, and Tricor.
  • blood pressure lowering agents include anti-hypertensive agents, such as angiotensin-converting enzyme (ACE) inhibitors (Accupril, Altace, Captopril, Lotensin, Mavik, Monopril, Prinivil, Univasc, Vasotec, and Zestril), adrenergic blockers (such as Cardura, Dibenzyline, Hylorel, Hytrin, Minipress, and Minizide) alpha/beta adrenergic blockers (such as Coreg, Normodyne, and Trandate), calcium channel blockers (such as Adalat, Calan, Cardene, Cardizem, Covera-HS, Dilacor, DynaCirc, Isoptin, Nimotop, Norvace, Plendil, Procardia, Procardia XL, Sula, Tiazac, Vascor, and Verelan), diuretics, angiotensin 11 receptor antagonists (such as Atacand, Avapro, Cozaar, and Di
  • the methods of the invention comprise chronic administration of a compound of the invention.
  • LDL low-density lipoprotein
  • the compound of Formula II, a PPAR delta activator effectively increased the predominant LDL particle size, in part by decreasing the amount of smaller LDL particles.
  • GGE gradient-gel electrophoresis
  • AIM Airborne Ion Mobility
  • LDL particle diameters were determined by nondenaturing 2-14% polyacrylamide gradient gel electrophoresis in 0.09 M Tris/0.08 M borate buffer (pH 8.3), 3 mM EDTA at 8-10° C. Samples (whole plasma) were electrophoresed at 40 V for 15 min, then 80 V for 15 min, and then at 125 V for 24 h to allow all particles to run to their size exclusion limits. Gels were stained for protein with Sudan Black and scanned at 555 nm with a Transidyne RFT densitometer.
  • Particle sizes were calculated from a calibration curve using a high molecular weight reference protyin mixture (Pharmacia Biotech., Piscataway, N.J.), 380 ⁇ latex beads (Duke Scientific Corp., Palo Alto, Calif.) and lipoprotein calibrators that are frozen at ⁇ 80° C. and included on each gel run. Plasma samples, stored at ⁇ 80° C. and used as controls for gradient gel analysis procedures, were run in duplicate on each gel. Particle size of LDL peaks in the controls were measured within ⁇ 2 ⁇ (coefficient of variation, ⁇ 1%).
  • Serum samples or controls were briefly mixed by vortex mixing, then 50 of sample or control was mixed with 20 ⁇ l of an albumin removal reagent [7.5 g/L Reactive green 19 dextran (RGD), Sigma-Aldrich; 2.5 g/L dextran sulfate, Sigma-Aldrich; and 0.5 g/L EDTA, Spectrum Chemicals] and incubated on ice for 15 minutes. After incubation, the sample mixture was overlaid on 200 ⁇ l deuterium oxide (Medical Isotopes) in a 42.2 ultracentrifuge tube (Beckman Coulter). The samples were ultracentrifuged at 10° C.
  • an albumin removal reagent [7.5 g/L Reactive green 19 dextran (RGD), Sigma-Aldrich; 2.5 g/L dextran sulfate, Sigma-Aldrich; and 0.5 g/L EDTA, Spectrum Chemicals] and incubated on ice for 15 minutes. After incubation,
  • samples were diluted 1:800 for HDL analysis using 25 mmol/L ammonium acetate, 0.5 mmol/L ammonium hydroxide, pH 7.4.
  • samples were diluted 1:200 with the same diluent containing 5 ⁇ g/mL dextran sulfate to help prevent LDL particles from sticking to the capillary surfaces.
  • Final dilutions were made in deep-well 96-well plates and placed in a Leap HTLC Pal autosampler (Eksigent) with the cooled stack maintained at 6° C.
  • the autosampler was connected to the electrospray generator (Model 3480; TSI) via methyl-deactivated silica capillary (50 ⁇ m i.d.; SGE). Flow was introduced by nano-LC pumps (Eksigent) running a mobile phase of 25 mmol/L ammonium acetate, 0.5 mmol/L ammonium hydroxide, pH 7.4. By means of a capillary metal union (Upchurch Scientific), an autosampler injected 10 ⁇ l sample at 6 ⁇ l/min into a transfer capillary (methyl-deactivated, SGE, 50 ⁇ m, 33 cm long). High voltage (2.1 kV) was applied to the metal capillary union located 33 cm upstream of the electrospray unit.
  • the electrospray Taylor cone was monitored visually and amperometrically to ensure stability. After the sample had filled the capillary and reached the electrospray chamber, the flow was decreased to 200 mL/min and the data recording process was started. The gas (containing approximately 5% CO 2 ) flowing into the electrospray chamber was regulated at 1.6 L/min. The electrosprayed particles passed through a particle-charge neutralizing chamber and then entered the differential mobility analyzer (DMA). Se, e.g., U.S. Pat. No. 7,259,018. Scan time was 2 min and covered a particle range of 17.2 to 542.0 ⁇ .
  • DMA differential mobility analyzer
  • LDL subclass pattern A, B, or I was assigned to each subject samples according to LDL particle peak diameter size (Pattern A: >263.4 ⁇ , Pattern I: 257.5-263.4 ⁇ , Pattern B: ⁇ 257.5 ⁇ ).
  • FIGS. 2 , 3 , and 4 An inverse relationship between plasma triglyceride concentration and peak (i.e., predominant) LDL diameter in day 21 samples was observed.
  • compound II treatment increased the predominant LDL particle size, lowered the proportion of small LDL particles and therefore shifted the predominant LDL particle size from LDL Pattern B or Ito LDL Pattern A at the 50, 100, and 200 mg dosage.
  • Compound II did not affect VLDL particle size but did affect LDL particle distributions in dose dependent fashion.
  • FIG. 5 illustrates the effect of Compound II after 21 days on LDL particle subclasses.
  • Subjects in this study met the following criteria: Non-Diabetic; untreated or diet-treated, with fasting lipids at initial screening and visit 2 (after 4 week run-in): TGs ⁇ 150 but ⁇ 550 mg/dL; LDL ⁇ 130 but ⁇ 280 mg/dL; HDL 60 mg/dL. Subjects were males with waist circumference greater than 38′′ or females with waist circumference greater than 33′′. Data was generated in this second study from 181 subjects.
  • Table I shows the number of subjects having the indicated LDL pattern before or after the indicated time period following the beginning of treatment.
  • 10 subjects had LDL pattern A
  • 3 subjects had LDL pattern 1
  • 16 subjects had LDL pattern B.
  • the number of subjects having the less athrogenic pattern A increased from 8 to 24 and 25, respectively, with a similar drop in the number of pattern B.
  • Treatment with 100 mg of Compound II had similar results with a large decrease in subjects having pattern B and an increase in the number of subjects having pattern A.
  • FIGS. 7-8 show that the percentage of individuals having LDL pattern A went down over time when treated with a placebo but went up dramatically when Compound II was administered.
  • FIG. 8 shows that the percentage of individuals having LDL pattern B went up over time when treated with a placebo but went down dramatically when Compound II was administered.
  • results of various blood chemistry markers from this study are shown in FIG. 6 .
  • these data show that Apo B-100, LDL, total cholesterol and triglycerides were reduced following administration with Compound II while HDL levels increased. This latter observation is interesting as Atorvastin had no effect of HDL levels.
  • Compound II would be particularly beneficial to individuals who require or would otherwise benefit from an increase in HDL levels.
  • ACAT acyl-coenzyme A:cholesterol acyltransferase
  • LACAT Lecithin-cholesterol acyltransferase
  • Lanosterol, desmosterol and lathosterol are all major cholesterol synthesis intermediates and all decreased in a dose-dependent fashion indicating a decrease in cholesterol synthesis with treatment.
  • mice Eight-week-old male C57BL/6 mice were fed standard mouse chow (control) with no added cholesterol (Harlan Teklad diet T.8604) ad libitum. Mice were randomized into five groups: 1) control, water gavaged daily; 2) compound II gavaged daily (in water) at a dose of 3 mg/kg; 3) compound II gavaged daily (in water) at a dose of 10 mg/kg; 4) ezetimibe gavaged daily (in corn oil) at a dose of 5 mg/kg; 5) compound II fed daily as diet admix at a dose of approximately 15 mg/kg.
  • mice were housed individually and monitored daily for food consumption and body weight. Following eight days of feeding/drug administration, (and 1 hour following gavage of drug), nonfasted, unanesthetized animals were bled and plasma was isolated and flash-frozen at ⁇ 80° C. for shipment and measurement of concentrations of Compound II and its metabolites. The following day (day 9), mice were gavaged with drug or control. One hour later, each mouse was gavaged with MCT oil containing [ 14 C]cholesterol and [ 3 H]sitostanol. Mice were housed individually in metabolic cages and ad libitum feeding and daily gavage of each drug was continued. Feces were collected daily from each animal for a period of 4 days. For each individual mouse, the 4-day feces were pooled, dried, saponified, extracted and counted.
  • Intestinal cholesterol absorption in age- and gender-matched C57BL/6 mice was determined by the fecal dual isotope ratio method. C57BL/6 control mice were found to absorb 33.9% of the [ 14 C]cholesterol. See, FIG. 10 .
  • Treatment with compound II by gavage at a dose of 3 mg/kg/d resulted in no significant change ( ⁇ 8%) in cholesterol absorption versus control.
  • treatment with compound II by gavage at a dose of 10 mg/kg/d resulted in a significant 29.4% reduction in cholesterol absorption versus control.
  • Treatment with compound II as an admix to diet at an approximate dose of 15 mg/kg/d resulted in an even greater reduction in cholesterol absorption versus control ( ⁇ 45%, p ⁇ 0.0006).

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