US20120088734A1 - Cyclosporin Analogs - Google Patents

Cyclosporin Analogs Download PDF

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Publication number
US20120088734A1
US20120088734A1 US13/270,964 US201113270964A US2012088734A1 US 20120088734 A1 US20120088734 A1 US 20120088734A1 US 201113270964 A US201113270964 A US 201113270964A US 2012088734 A1 US2012088734 A1 US 2012088734A1
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Prior art keywords
sar
cyclosporin
chr
amide
ethyl
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Catherine Simone Victoire Frydrych
William Robert Carling
Michael E. Garst
Michael E. Stern
Christopher S. Schaumburg
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Allergan Inc
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Allergan Inc
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Priority to US13/270,964 priority Critical patent/US20120088734A1/en
Assigned to ALLERGAN, INC. reassignment ALLERGAN, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: GARST, MICHAEL E., SCHAUMBURG, CHRISTOPHER S., STERN, MICHAEL E., CARLING, WILLIAM ROBERT, FRYDRYCH, CATHERINE SIMONE VICTOIRE
Publication of US20120088734A1 publication Critical patent/US20120088734A1/en
Priority to US14/534,677 priority patent/US9493511B2/en
Priority to US15/290,171 priority patent/US10065992B2/en
Abandoned legal-status Critical Current

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K7/00—Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
    • C07K7/64—Cyclic peptides containing only normal peptide links
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K7/00—Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
    • C07K7/64—Cyclic peptides containing only normal peptide links
    • C07K7/645—Cyclosporins; Related peptides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A61P27/04—Artificial tears; Irrigation solutions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A61P27/14—Decongestants or antiallergics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A61P31/20—Antivirals for DNA viruses
    • A61P31/22—Antivirals for DNA viruses for herpes viruses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/08—Antiallergic agents
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K1/00—General methods for the preparation of peptides, i.e. processes for the organic chemical preparation of peptides or proteins of any length
    • C07K1/107—General methods for the preparation of peptides, i.e. processes for the organic chemical preparation of peptides or proteins of any length by chemical modification of precursor peptides
    • C07K1/113—General methods for the preparation of peptides, i.e. processes for the organic chemical preparation of peptides or proteins of any length by chemical modification of precursor peptides without change of the primary structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides

Definitions

  • Cyclosporins are a class of poly-N-methylated cyclic undecapeptides. There are naturally occurring cyclosporins such as cyclosporin A, and non-natural cyclosporin (“Cs”) derivatives.
  • Cyclosporin A for example, has the following structure:
  • the claimed invention relates to novel compounds of the following formula (I) and pharmaceutically acceptable salts thereof:
  • Cs scaffolds refers to different cyclosporins (e.g., Cs A, Cs C, Cs D, etc.) that vary from each other in the identities of one or more of substituents A, B, C, and D.
  • a “Cs scaffold” refers to a novel compound of formula (I) less the moiety at the ⁇ -carbon of the 3-position amino acid.
  • A, B, C, and D are defined as follows.
  • A represents —CH ⁇ CHR, —CH ⁇ CH—CH ⁇ CHR, or —CH 2 CH 2 R, wherein R represents
  • n-propyl i.e., n-propyl
  • D represents —CH 3 or —CH 2 OH.
  • A is —CH ⁇ CHCH 3
  • B is —CH 2 CH 3
  • C is isobutyl
  • D is —CH 3 , as illustrated below in formula (IA):
  • A is —CH ⁇ CHCH 3
  • B is 1-hydroxyethyl
  • C is isobutyl
  • D is —CH 3 , as illustrated below in formula (IB):
  • A is —CH ⁇ CHCH 3
  • B is isopropyl
  • C is isobutyl
  • D is —CH 3 , as illustrated below in formula (IC):
  • A is —CH ⁇ CHCH 3
  • B is n-propyl
  • C is isobutyl
  • D is —CH 3 , as illustrated below in formula (ID):
  • A is —CH ⁇ CHCH 3
  • B is —CH 2 CH 3
  • C is 1-methylpropyl
  • D is —CH 3 , as illustrated below in formula (IE):
  • A is —CH ⁇ CHCH 3
  • B is —CH 2 CH 3
  • C is isobutyl
  • D is —CH 2 OH, as illustrated below in formula (IF):
  • A is —CH ⁇ CHCH 3
  • B is —CH 2 CH 3
  • C is 2-hydroxy isobutyl
  • D is —CH 3 , as illustrated below in formula (IG):
  • the amino acids of various types of cyclosporine scaffold are labeled numerically from 1 to 11.
  • the modifications of the invention occur at the ⁇ -carbon of the position-3 amino acid (sarcosine at the 3-position) of the Cs scaffold.
  • the modification generally comprises replacement of a hydrogen atom at the ⁇ -carbon of the position-3 amino acid with a moiety in formula (I) wherein:
  • R 1 and R 2 which are identical or different, each represents hydrogen or C 1 -C 4 alkyl, or together represent C 3 -C 7 cycloalkyl;
  • X represents sulfur or —S(O) n , wherein n is 1 or 2;
  • R 3 represents hydrogen; straight or branched C 1 -C 6 alkyl; straight or branched C 2 -C 6 alkenyl; straight or branched C 2 -C 6 alkynyl; C 3 -C 7 cycloalkyl; C 4 -C 7 heterocyclyl having 1-3 heteroatoms selected from nitrogen, oxygen, and sulfur; aryl; heteroaryl;
  • n 1, 2, 3, 4, 5, or 6;
  • each R′ is independently H, straight or branched C 1 -C 6 alkyl, straight or branched C 2 -C 6 alkenyl; straight or branched C 2 -C 6 alkynyl; C 3 -C 7 cycloalkyl; C 4 -C 7 heterocyclyl having 1-3 heteroatoms selected from nitrogen, oxygen, and sulfur; aryl; heteroaryl; or is absent (permitting, in such case, —(CHR′) m to represent an unsaturated moiety such as —CH—CH).
  • R 3 may be optionally substituted with one or more groups, identical or different, of C 1 -C 6 alkyl; halogen; hydroxyl; alkoxycarbonyl; carboxyl; cycloalkyl; saturated or partially unsaturated 5-6 member heterocyclyl having 1-3 heteroatoms selected from nitrogen, oxygen, and sulfur, which heterocyclyl is optionally substituted by one or more groups of C 1 -C 6 alkyl; aryl; heteroaryl; amino; monoalkylamino; dialkylamino; amidino; guanidine; or urea.
  • Embodiments of formula (I) include, but are not limited to, the following compounds of formula (I) (only the moiety at the ⁇ -carbon of the position-3 amino acid is shown; wavy lines represent the rest of the Cs compounds of formula (I)):
  • the present invention also relates to novel intermediates useful for the preparation of compounds of formula (I).
  • the novel intermediates are compounds of the following formula (III):
  • the present invention also relates to a process for the preparation of a compound of formula (III), comprising:
  • Alkyl refers to a monovalent linear or branched hydrocarbon radical having 1 to 6 carbon atoms. Examples include, but are not limited to, methyl, ethyl, propyl (e.g., 1-propyl, isopropyl), butyl (e.g., 1-butyl, isobutyl, sec-butyl, tert-butyl), pentyl (e.g., 1-pentyl, neopentyl), and hexyl (e.g., 3-hexyl).
  • propyl e.g., 1-propyl, isopropyl
  • butyl e.g., 1-butyl, isobutyl, sec-butyl, tert-butyl
  • pentyl e.g., 1-pentyl, neopentyl
  • hexyl e.g., 3-hexyl
  • Alkenyl refers to a monvalent linear or branched hydrocarbon radical having 2 to 6 carbon atoms and one or more double bonds. Examples include, but are not limited to, ethenyl, propenyl, and butenyl.
  • Alkynyl refers to a monovalent linear or branched hydrocarbon radical having 2 to 6 carbon atoms and one or more triple bonds. Examples include, but are not limited to, ethynyl, propynyl and butynyl.
  • Cycloalkyl refers to monovalent saturated or partially unsaturated cyclic hydrocarbon radical having 3 to 6 carbon atoms. Examples include, but are not limited to, cyclopropyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • Heterocyclyl refers to monovalent, saturated or partially unsaturated cyclic hydrocarbon radical having 3 to 6 ring atoms, at least one of which is a heteroatom selected from nitrogen, oxygen and sulfur.
  • the radical may be on a carbon or a heteroatom. Examples include, but are not limited to, morpholinyl, piperidinyl, pyrrolidinyl, pyranyl, and pyrazolinyl.
  • Aryl refers to monovalent 5-7 member aromatic hydrocarbon radical. Examples include, but are not limited to, phenyl.
  • Heteroaryl refers to monovalent 5-7 member aromatic hydrocarbon radical having one or more heteroatoms selected from nitrogen, sulfur and oxygen. Examples include, but are not limited to, imidazolyl, pyridinyl, furyl, pyrimidinyl and pyrazinyl.
  • alkyl, alkenyl, alkynyl, cycloalkyl, heterocycly, aryl, and heteroaryl radicals may be independently substituted with one or more substituents described herein.
  • Amino refers to the —NH 2 or amidogen group.
  • “Monoalkylamino” refers to the —NHR′ group, where R′ represents an alkyl, alkenyl, alkynyl and cycloalkyl as defined herein.
  • Dialkyamino refers to the —NRR′ group where R and R′ independently represents an alkyl, alkenyl, alkynyl and cycloalkyl as defined herein.
  • Halogen refers to bromo, chloro, fluoro, or iodo.
  • Haldroxyl refers to the —OH group.
  • Carboxy refers to the group:
  • Alkoxycarbonyl refers to the group:
  • R represents an alkyl as defined herein.
  • “Pharmaceutically acceptable salt” refers to any salt of compounds claimed in this application that possesses the biological effectiveness to the compounds and are not toxic or otherwise harmful for pharmaceutical use; these salts may be derived from organic and inorganic counter ions which are well known in the art.
  • DIPEA diisopropylethylamine
  • the starting materials for the claimed compounds of formula (I), including the Cs scaffolds, can be prepared using synthesis schemes and reagents available in the art, and may be obtained through commercial suppliers. Reagents used for the synthesis of the novel compounds of the present invention can also be obtained through commercial suppliers.
  • the resulting yellow solid was purified by passing through a 5 g SCX cartridge using methanol as the eluant, followed by MPLC chromatography using a polar gradient of 100% dichloromethane ⁇ >95% dichloromethane/5% methanol containing 10% aqueous ammonia (0.88) to give [(S)-2-(3-carboxypropionylamino)ethyl-1-sulfanylmethyl-Sar] 3 cyclosporinA.
  • the resulting yellow solid was purified by passing through a 2 g SCX cartridge using methanol as the eluant, followed by MPLC chromatography using a gradient of 100% dichloromethane ⁇ 95% dichloromethane/5% methanol containing 10% aqueous ammonia (0.88) to give [(S)-2-(acetylamino-acetylamino)ethyl-1-sulfanylmethyl-Sar] 3 cyclosporinA.
  • the protease-free PPlase assay measures the rate of cis to trans conversion of a peptide substrate catalyzed by the enzyme cyclophilin A. Addition of an inhibitor slows the catalyzed rate and a K i value is obtained.
  • Assay Buffer 35 mM HEPES pH 7.8, filtered through a 0.2 ⁇ m filter. 50 M DTT was added prior to use each day and then the buffer was stored on ice.
  • Enzyme human recombinant Cyp A (Sigma C3805) enzyme was diluted to 1 M with enzyme dilution buffer (20 mM HEPES pH 7.8, 40% glycerol, 50 M DTT and 1 ⁇ M BSA) and stored at ⁇ 20° C.
  • Substrate SUC-AAPF-pNA (from Bachem AG, L-1400), 20 mg/ml prepared 0.5 M LiCl in trifluoroethanol.
  • a first order rate equation was fitted to the absorbance data, for each concentration of inhibitor, to obtain the rate constant (the first 10 to 15 seconds were excluded as mixing causes errors in this portion of curve).
  • the catalytic rate was calculated from the enzymatic rate constant minus the background rate constant.
  • An exponential curve was generated using the catalytic rate constants versus the inhibitor concentration to obtain the K, value for the inhibitor.
  • Calcineurin is a serine-threonine protein phosphatase that on activation dephosphorylates members of the nuclear factor of activated T cells (NFAT), which are important in T lymphocyte activation.
  • Cs A bound to cyclophilin A (“Cyp A”) inhibits calcineurin activity, thus resulting in immunosuppressive effects.
  • Cs A only inhibits calcineurin when bound to Cyp A, some Cs A analogues will also bind calcineurin in the absence of Cyp A.
  • exemplary compounds of Formula (I) which are cyclosporin analogues, their ability to inhibit calcineurin activity was measured in the presence and absence of Cyp A.
  • the CaN assay kit used is based on a colorimetric assay for measuring calcineurin phosphatase activity, and it is commercially available (Enzo Life Sciences and Calbiochem). Calmodulin is also required for calcineurin activity and RII phosphopeptide is used as an efficient peptide substrate for calcineurin.
  • 2 ⁇ assay buffer 100 mM Tris, pH7.5, 200 mM NaCl, 12 mM MgCl 2 , 1 mM DTT, 0.05% NP-40, 1 mM CaCl 2 )
  • Calmodulin Human, recombinant: was thawed on ice, diluted 1:50 with 2 ⁇ assay buffer, and then stored on ice.
  • Calcineurin was thawed quickly, stored on ice immediately, diluted 1:12.5 with 1 ⁇ assay buffer, and then stored on ice.
  • Inhibitors 2.5 mM inhibitor in 100% DMSO.
  • Cyp A recombinant human CypA (Sigma C3805), 1 mg/ml
  • Inhibitor dilutions inhibitor compounds were diluted in UPW in polypropylene low-binding 96 well plates at 5 ⁇ the final assay concentration. For samples ‘without Cyp A’, a 4-point dilution series of the inhibitor was prepared in duplicate to obtain a final assay concentration of 10, 1, 0.1 and 0.01 ⁇ M. For samples ‘with Cyp A’, a 7-point dilution series was prepared to obtain a 1:1 complex of the inhibitor with CypA; the inhibitor and Cyp A final assay concentrations of 10, 3.33, 1.11, 0.37, 0.12, 0.04, 0.014 ⁇ M were prepared. Cs A inhibitor controls were also prepared to obtain a final concentration of 10 ⁇ M Cs A with and without 10 ⁇ M Cyp A.
  • Assay Setup using the half area 96 well plates supplied with the kit, 10 ⁇ l UPW was added to duplicate wells to provide the non-inhibited control. 10 ⁇ l of the inhibitor or the inhibitor/Cyp A complex was added to the appropriate sample wells. 25 ⁇ l of the 2 ⁇ assay buffer with CaM was added to all wells, then 5 ⁇ l of CaN was added to all wells (40 U per well final concentration) except duplicate ‘no calcineurin blank’ wells to which 5 ⁇ L 1 ⁇ assay buffer was added. The assay plate was placed in an oven at 30° C. for 15 minutes to equilibrate to the reaction temperature. The reaction was started by the addition of 10 ⁇ l RII-peptide (0.15 mM final concentration).
  • the reaction was allowed to proceed at 30° C. for a time period in which the reaction is linear for about 60 minutes.
  • the reaction was then terminated by adding 100 ⁇ l of the Malachite Green reagent.
  • the color was allowed to develop for 15-30 minutes at room temperature before the absorbance at 620 nm was measured using a plate reader (Molecular Devices—SpectraMax M5).
  • the data were analyzed by subtracting ‘no Calcineurin blank’ from all the absorbance readings and plotting the background corrected absorbances against Log 10 inhibitor concentration.
  • a sigmoidal-dose response curve was fitted to the data using GraphPad Prism Software.
  • the MLR assay is another means of estimating the immunosuppressive potential of test compounds.
  • Complete medium consisted of RPMI 1640 medium containing 25 mM HEPES buffer (HyClone, Logan, Utah) supplemented with 10% heat-inactivated fetal bovine serum (FBS; Atlanta Biologicals, Lawrenceville, Ga.), 100 ⁇ g/mL streptomycin, 100 U/mL penicillin G, 0.25 ⁇ g/mL amphotericin B (HyClone), 2 mM L-glutamine dipeptide (HyClone), and 2 ⁇ 10 ⁇ 5 M 2-mercaptoethanol (Sigma). Cells were washed twice and resuspended in complete medium. Cell counts were performed using a Beckman Coulter Z-1 particle counter (Fullerton, Calif.). Cell viability was determined by propidium iodide (PI) staining using an Accuri C6 flow cytometer (Ann Arbor, Mich.).
  • PI propidium iodide
  • Spleen cells from C57BL/6 (H-2 b ) and BALB/c (H-2 d ) were used as responder (R) and stimulator (S) cells, respectively.
  • Cells were plated in triplicate in 96-well flat microtiter plates (Costar, Cambridge, Mass.) such that each well contained 2 ⁇ 10 5 R and 8 ⁇ 10 5 S cells.
  • Cultures were incubated in the absence or presence of various concentrations of Cs A, test compounds, or medium at 37° C. in humidified 5% CO 2 for five days, pulsed with 3 H-thymidine ( 3 H-TdR) for the final 16 hours of incubation, and harvested using a Brandel 96-well cell harvester (Gaithersburg, Md.).
  • Proliferation was measured by counting the radioactivity on filter mats in a Wallac 1450 Microbeta TriLux scintillation counter (Turku, Finland). Controls to demonstrate effective inactivation by the x-irradiation were performed by incubating the S cells with 5 ⁇ g/mL of PHA at 2 ⁇ 10 5 cells/well. These control cultures were incubated for 3 days under the same conditions as those described for the MLR; lymphoproliferation was determined in the same manner as described above.
  • compositions of the invention may be used to treat patients suffering from dry eye, to treat blepharitis and meibomian gland disease, to restore corneal sensitivity that has been impaired due to surgery on the cornea or other surface of the eye, to treat allergic conjunctivitis and atopic and vernal keratoconjunctivitis, and to treat ptyregia, ocular symptoms of graft versus host disease, ocular allergy, atopic keratoconjunctivitis, vernal keratoconjunctivitis, uveitis, anterior uveitis, Behcet's disease, Steven Johnson syndrome, ocular cicatricial pemphigoid, chronic ocular surface inflammation caused by viral infection, herpes simplex keratitis, ocular rosacea, and pinguecula, and to prevent corneal transplant rejection.
  • the International Dry Eye Workshop defines dry eye as “a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.” It includes those conditions, such as keratoconjunctivitis sicca, that are caused by tear deficiency or excessive evaporation of tears.
  • Blepharitis is a chronic disorder producing inflammation of the anterior and posterior lid margin, with involvement of skin and its related structures (hairs and sebaceous glands), the mucocutaneous junction, and the meibomian glands. It can also affect the conjunctiva, tear film, and the corneal surface in advanced stages and may be associated with dry eye. Blepharitis is commonly classified into anterior or posterior blepharitis, with anterior affecting the lash bearing region of the lids, and posterior primarily affecting the meibomian gland orifices.
  • Meibomian gland disease most often occurs as one of three forms: primary meibomitis, secondary meibomitis, and meibomian seborrhea.
  • Meibomian seborrhea is characterized by excessive meibomian secretion in the absence of inflammation (hypersecretory meibomian gland disease).
  • Primary meibomitis by contrast, is distinguished by stagnant and inspissated meibomian secretions (obstructive hypersecretory meibomian gland disease).
  • Secondary meibomitis represents a localized inflammatory response in which the meibomian glands are secondarily inflamed in a spotty fashion from an anterior lid margin blepharitis.
  • Impaired corneal sensitivity often occurs after refractive surgery, such as photorefractive keratectomy, laser assisted sub-epithelium keratomileusis (LASEK), EPI-LASEK, customized transepithelial non-contact ablation, or other procedures in which the corneal nerves are severed. Impaired corneal sensitivity may also occur after viral infection, such as by HSV-1, HSV-2, and VZV viruses. Patients with impaired corneal sensitivity often complain that their eyes feel dry, even though tear production and evaporation may be normal, suggesting that “dryness” in such patients may actually be a form of corneal neuropathy that results when corneal nerves are severed by surgery or inflamed after viral infection.
  • Allergic conjunctivitis is an inflammation of the conjunctiva resulting from hypersensitivity to one or more allergens. It may be acute, intermittent, or chronic. It occurs seasonally, that is, at only certain time of the year, or it occurs perennially, that is, chronically throughout the year. Symptoms of seasonal and perennial allergic conjunctivitis include, in addition to inflammation of the conjunctiva, lacrimation, tearing, conjunctival vascular dilation, itching, papillary hyperlasia, chemosis, eyelid edema, and discharge from the eye. The discharge may form a crust over the eyes after a night's sleep.
  • Atopic keratoconjunctivitis is a chronic, severe form of allergic conjunctivitis that often leads to visual impairment. Symptoms include itching, burning, pain, redness, foreign body sensation, light sensitivity and blurry vision. There is often a discharge, especially on awakening from a night's sleep; the discharge may be stringy, ropy, and mucoid. The lower conjunctiva is often more prominently affected than the upper conjunctiva. The conjunctiva may range from pale, edematous, and featureless to having the characteristics of advanced disease, including papillary hypertrophy, subepithelial fibrosis, formix foreshortening, trichiasis, entropion, and madurosis.
  • the disease progresses to punctate epithelial erosions, corneal neovascularization, and other features of keratopathy which may impair vision.
  • CD25+ T lymphocytes, macrophages, and dendritic cells are significantly elevated in the substantia intestinal.
  • vernal keratoconjunctivitis is a severe form of allergic conjunctivitis, but it tends to affect the upper conjunctiva more prominently than the lower. It occurs in two forms. In the palpebral form, square, hard, flattened, closely packed papillae are present; in the bulbar (limbal) form, the circumcorneal conjunctiva becomes hypertrophied and grayish. Both forms are often accompanied by a mucoid discharge. Corneal epithelium loss may occur, accompanied by pain and photophobia, as may central corneal plaques and Trantas' dots.
  • Uveitis the inflammation of the uvea, is responsible for about 10% of the visual impairment in the United States.
  • Phacoanaphylactic endophthalmitis is a human autoimmune disease.
  • Panuveitis refers to inflammation of the entire uveal (vascular) layer of the eye.
  • Posterior uveitis generally refers to chorioentinitis
  • anterior uveitis refers to iridocyclitis.
  • the inflammatory products i.e. cells, fibrins, excess proteins
  • these inflammations are commonly found in the fluid spaces if the eye, i.e. anterior chamber, posterior chamber and vitreous space as well as infiltrating the tissue intimately involved in the inflammatory response.
  • Uveitis may occur following surgical or traumatic injury to the eye; as a component of an autoimmune disorder, such as rheumatoid arthritis, Behcet's disease, ankylosing spondylitis, and sarcoidosis; as an isolated immune mediated ocular disorder, such as pars planitis, iridocyclitis etc., unassociated with known etiologies; and following certain systemic diseases which cause antibody-antigen complexes to be deposited in the uveal tissues. Together these disorders represent the non-infectious uveitities.
  • an autoimmune disorder such as rheumatoid arthritis, Behcet's disease, ankylosing spondylitis, and sarcoidosis
  • an isolated immune mediated ocular disorder such as pars planitis, iridocyclitis etc., unassociated with known etiologies
  • systemic diseases which cause antibody-antigen complexes to be deposited in the uveal tissues. Together
  • Phacoanaphylaxis is a severe form of uveitis in which the lens in the causative antigen.
  • the lens proteins are normally secluded by the lens capsule since before birth. When these proteins are released into the eye by injury or by surgery or occasionally during cataract development, they can become intensely antigenic and incite an autoimmune response. If the response is moderate it is seen as chronic uveitis. If it is very fast in progression the eye becomes seriously inflamed in all segments. This latter response is named phacoanaphylaxis.
  • Uveitis is a prominent feature of Behcet's disease, a multi-system inflammatory disorder also characterized by oral and genital ulcers, cutaneous, vascular, joint, and neurological manifestations
  • Rosacea is a chronic and common skin disorder with no identified cause or cure.
  • the pathogenesis of rosacea is thought to have multiple factors. Possible factors include exposure to the demodex folliculorum mite, gastrointestinal disease or a vasodilation disorder, and other triggers such as diet or sunlight.
  • Patients may present with a variety of symptoms, including inflammatory papules, edema, telangiectasia, rhinophyma and ocular symptoms.
  • the ocular signs of rosacea include blepharitis, including anterior blepharitis, conjunctivitis, ulceris, iridocyclitis, keratitis, meibomian gland dysfunction, telangiectasia, erythema, chalazion, hordeolum, interpalpebral hyperemia, conjuctival hyperemia, ciliary base injection, bulbar injection, crusts, sleeves, and superficial punctuate keratopathy.
  • blepharitis including anterior blepharitis, conjunctivitis, ulceris, iridocyclitis, keratitis, meibomian gland dysfunction, telangiectasia, erythema, chalazion, hordeolum, interpalpebral hyperemia, conjuctival hyperemia, ciliary base injection, bulbar injection, crusts, sleeves, and superficial punctuate keratopathy.
  • the ocular symptoms are nonspecific and may include burning, tearing, decreased tear secretion, redness, and foreign body or gritty or dry sensation, irritation, Itchiness, Blurred vision, Photosensitivity, Watery eyes, bloodshot eyes, Burning, telangiectasia, irregularity of the lid margins, and meibomian gland dysfunction.
  • Pinguecula is a benign, yellowish brown proliferative growth that forms on the conjunctiva. Pinguecula may cause irritation and scratchiness of the eye, dry eye, inflammation of the conjunctiva and effect appearance of the eye. Inflamed pinguecula, which cause ocular irritation or become unsightly, may require surgical removal. However, the post-operation scar may be as cosmetically objectionable as the pinguecula and pinguecula regrowth may occur following surgical removal.
  • Allogeneic bone marrow transplantation is a well-established treatment for malignant and non-malignant hematological diseases, and is performed in tens of thousands of patients each year.
  • Mature donor T cells within the stem cell graft are the main mediators of the beneficial immune effects, but they are also responsible for the induction of graft-versus-host disease (GVHD), the major cause of morbidity and mortality in BMT patients.
  • GVHD graft-versus-host disease
  • GVHD graft-versus-host disease
  • Acute or chronic GVHD occurs within a 100-day period post-BMT that leads to dermatitis, enteritis, and hepatitis.
  • Ocular symptoms include blurry vision, foreign body sensation, burning sensation, severe light sensitivity, chronic conjunctivitis, dry eye, and eye pain.
  • the present invention also relates to pharmaceutical compositions comprising at least one compound of general formula (I), the compound being present alone or in combination with one or more pharmaceutically acceptable excipients.
  • a “pharmaceutically acceptable excipient” is one that is compatible with the active ingredient of the composition and not harmful to the person being administered the pharmaceutical composition. Mixtures of two or more of such suitable excipients may be used.
  • compositions may be prepared by combining a therapeutically effective amount of a compound of the invention, or a pharmaceutically acceptable salt thereof, as an active ingredient, with conventional ophthalmically acceptable pharmaceutical excipients, and by preparation of unit dosage forms suitable for topical ocular use.
  • the therapeutically efficient amount typically is between about 0.0001 and about 5% (w/v), preferably about 0.001 to about 1.0% (w/v) in liquid formulations.
  • the actual dose of the active compounds of the present invention depends on the specific compound, and on the condition to be treated; the selection of the appropriate dose is well within the knowledge of one of ordinary skill in the art.
  • a therapeutically effective amount in the claimed pharmaceutical composition is a concentration useful to observe a therapeutic effect as compared to a placebo composition that, except for the absence of a compound of formula (I), is otherwise identical to the pharmaceutical composition.

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