WO1993006832A1

WO1993006832A1 - Method of treating hiv infection

Info

Publication number: WO1993006832A1
Application number: PCT/US1992/008156
Authority: WO
Inventors: Jess G. Thoene
Original assignee: Thoene Jess G
Priority date: 1991-09-30
Filing date: 1992-09-30
Publication date: 1993-04-15
Also published as: OA09917A; MX9205549A; PT100914A; JPH06511008A; BR9206571A; EP0607252A1; CA2120140A1; AU2755792A; ATE173625T1; EP0607252B1; DE69227696D1; DE69227696T2; EP0607252A4; AU675412B2

Abstract

Compounds capable of undergoing a mixed disulfide exchange with a disulfide bond are effective agents for the treatment of HIV infections.

Description

TITLE OF THE INVENTION

METHOD OF TREATING HIV INFECTION BACKGROUND OF THE INVENTION

This application is a continuation-in-part of U.S. Patent Application Serial No: 07/767,802, filed on September 30, 1991.

Field of the Invention:

The present invention relates to a method of treating HIV infections, and diseases caused by such infections, such as AIDS, ARC and related expressions of human immunodeficiency virus (HIV), such as lymphadenopathy, by administering a compound capable of undergoing a mixed disulfide exchange with a disulfide bond, a pharmaceutically acceptable salt thereof, or prodrug thereof, to a patient suffering from HIV infection. Discussion of the Background:

Acquired immunodeficiency syndrome (AIDS) and AIDS related complex (ARC) result from infection with human

immunodeficiency virus (HIV). The need for an effective treatment of AIDS, ARC and lymphadenopathy is great, due to the continuing increase of HIV infections and consequent opportunistic infections in the population. Current

epidemiologic data show that infection with HIV leads to AIDS in over 90% of affected individuals within a ten-year period. The number of individuals already infected means that the number of AIDS cases will continue to increase for the foreseeable future.

AZT (zidovudine) has been approved for the treatment of AIDS and ARC. However, results are less than satisfactory. In particular, AZT therapy is known to cause severe side effects, such as anemia. In addition, there are strains of HIV-1 which are resistant to treatment with AZT.

Penicillamine has also been recommended for the treatment of HIV infections (Schulof et al. Arzneimittal Forschung, vol. 36 (10), pp. 1531-1534 (1986)). However, this treatment is complicated by the toxicity of penicillamine.

Thus, there remains a need for an effective treatment of HIV infection and AIDS, ARC, and lymphadenopathy.

SUMMARY OF THE INVENTION

Accordingly, one object of the present invention is to provide a novel method for the treatment of HIV infections.

It is another object of the present invention to provide a method of treating AIDS.

It is another object of the present invention to provide a novel method for treating ARC.

It is another object of the present invention to provide a novel method for treating lymphadenopathy.

These and other objects, which will become apparent during the following detailed description have been achieved by the inventors' discovery that HIV infections and diseases, such as AIDS, ARC and lymphadenopathy may be treated by administering an effective amount of a compound capable of undergoing a mixed disulfide exchange with a disulfide bond, a pharmaceutically acceptable salt thereof, or a prodrug

thereof, to a patient in need thereof.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Thus, the present invention provides a method for

treating HIV infections, and diseases caused by such

infections, such as AIDS, ARC, and related expressions of human immunodeficiency virus (HIV), such as lymphadenopathy, by administering a compound capable of undergoing a mixed disulfide exchange with a disulfide bond, a pharmaceutically acceptable salt thereof, or a prodrug thereof to a patient suffering from HIV infection. Examples of such compounds include cysteamine, cystamine, phosphocysteamine,

N,N-dimethylcysteamine, pantetheine, pantethine, WR2721, coenzyme A, mercaptoethylgluconamide, thiocholine,

dithiothreitol (DDT), dithioerythritol (DTE),

aminopropanethiol, aminobutanethiol, aminopentanethiol, and related compounds.

By the term "a compound capable of undergoing a mixed disulfide exchange with a disulfide bond" is meant a compound which takes part in the following reaction under physiological conditions

R-S-S-R + R'-S-X → R-S-S-R' + H-S-R

Compound of the

present method Thus, the compounds utilized in the present method are characterized as containing an -S-X group, in which X is -H or a group that is readily replaced by -H in the body, such as -P(=O) (OH)₂. Such compounds are collectively referred to herein after as the compounds of the present method.

Cysteamine is a known compound of the formula:

HSCH₂CH₂NH₂.

Cysteamine may be prepared from ethanolamine and carbon disulfide via 2-mercaptothiazoline as described in

Gabriel et al, Ber.. vol. 31, 2837 (1898); Knorr et al, Ber.. vol. 36, 1281 (1903); and Mills et al, J. Am. Chem. Soc., vol. 62, 1173 (1940); or via ethyleneimine as described in Wenker. J. Am. Chem. Soc., vol. 57, 2328 (1935); Mills et al, J. Am. Chem. Soc., vol. 62, 1173 (1940); and Shirley, Preparation of Organic Intermediates, Wiley, NY, p. 189 (1951).

Cysteamine is useful for the treatment of nephropathic cystinosis: Thoene et al, The Journal of Clinical

Investigation, vol. 58, pp. 180-189 (1976); Thoene et al, The Journal of Pediatrics, vol. 96, pp 1043-1044 (1980); Thoene, in Orphan Drugs and Orphan Diseases: Clinical Realities and Public Policv, Alan R. Liss, NY, pp 125-131 (1983); Thoene, in Cooperative Approaches to Research and Development of Orphan Drugs. Alan R. Liss, NY, pp. 157-162 (1985); Pisoni et al, The Journal of Biological Chemistry, vol. 260, pp. 4791-4798

(1985); Gahl et al, New England Journal of Medicine, vol. 316, pp. 971-977 (1987); and Smolin et al, Pediatric Research, vol. 23, pp. 616-620 (1988). Cysteamine is known to be safe for use in humans and does not give rise to any serious known side-effects.

Cystamine is also a known compound of the formula:

(H₂NCH₂CH₂)₂S₂.

Cystamine may be prepared by the H₂O₂ oxidation of cysteamine: Mills. Jr. et al, J. Am. Chem. Soc., vol. 62, 1173 (1940) and Barnett, J. Chem. Soc., 1944, 5.

Phosphocysteamine is the phosphorothioester of cysteamine and has the formula:

Phosphocysteamine is also known to be useful for the treatment of nephropathic cystinosis: Thoene et al, The Journal of Pediatrics, vol. 96, pp. 1043-1044 (1980); Thoene. in

Cooperative Approaches to Research and Development of Orphan Drugs, Alan R. Liss, NY, pp. 157-162 (1985); and Smolin et al, Pediatric Research, vol. 23, pp. 616-620 (1988).

N,N-dimethylcysteamine has the formula:

(CH₃)₂NCH₂CH₂SH.

The effect of N,N-dimethylcysteamine on the carbohydrate metabolism of Ehrlich ascites tumor is described in Grassetti et al, J. Med. Chem., vol. 10, pp. 1170-2 (1967), incorporated herein by reference.

Pantetheine is a compound of the formula:

The synthesis of pantetheine is described in U.S. Patent Nos. 2,744,119 and 2,835,704, and the uses of pantetheine have been reviewed in Snell et al. Adv. Enzymol., vol. 14, p. 49 (1953) and Snell et al, Methods Enzymol., vol. 3, 918 (1957), all of which are incorporated herein by reference.

Pantethine is the disulfide dimer of pantetheine and is formed by the oxidation of p-.ntetheine (Brown et al, J. Biol. Chem., vol. 198, 375 (1952) incorporated herein by reference).

WR2721 has the formula:

H₂N(CH₂)₃NH(CH₂)₂SP(=O) (OH)₂

The synthesis and activity of WR2721 is described in U.S.

Patent No. 3,892,824, incorporated herein by reference. The use of WR2721 for reducing mucin viscosity is described in Canadian Patent 1157 774, incorporated herein by reference.

Coenzyme A is a compound of the formula:

The isolation of coenzyme A from Streptomyces fradiae has been described by Kaplan et al, J. Biol. Chem., vol. 174, 37

(1948), and the purification has been described by De Vries et al, J. Am. Chem. Soc., vol. 72, 4838 (1950), both incorporated herein by reference. The properties of coenzyme A have been reviewed by Jaenicke et al, in The Enzymes, vol. 3, Boyer et al, Eds, Academic Press, NY, 2nd Ed., pp. 3-103 (1960), incorporated herein by reference.

Mercaptoethylgluconamide has the formula:

Thiocholine is a cation of the formula:

+

(CH₃)₃NCH₂CH₂SH

Thus, thiocholine is administered in the form of a salt, such as the chloride, citrate, dihydrogen citrate, gluconate, lactate, sulfate, tartrate, etc.

Dithiothreitol (threo-1,4-dimercapto-2,3-butanediol) has the formula HSCH₂CH(OH)CH(OH)CH₂SH, and dithioerythritol

(erythro-1,4-dimercapto-2,3-butanediol) has the formula

HSCH₂CH(OH)CH(OH)CH₂SH. Both of these compounds are well known in the art and are commercially available. Amimopropanethiol , aminobutanethiol, and

aminopentanethiol have the following formulae:

H₂NCH₂CH₂CH₂SH H₂NCH₂CH₂CH₂CH₂SH

H₂NCH₂CH₂CH₂CH₂CH₂SH

The radiation protective properties of these compounds in E. coli are discussed in Swartz et al, Radiat. Res., vol. 45, pp.

542-556 (1971), incorporated herein by reference.

Examples of related compounds which are suitable for use in the present method also include:

and N-acetyl derivatives of the compounds containing primary amine groups, in which the positively charged ions are salts with anions such as acetate, tartrate, trifluoroacetate, lactate, maleate, fumarate, citrate, methanesulfonate,

sulfate, phosphate, nitrate, and halide, such as chloride.

Thus, the present invention relates to a method of treating HIV infections and diseases, such as AIDS, ARC and lymphadenopathy, said method comprising or consisting of administering an effective amount of cysteamine, cystamine, phosphocysteamine, N,N-dimethylcysteamine, pantetheine, pantethine, WR2721, co-enzyme A, mercaptoethylgluconamide. thiocholine, dithiothreitol (DDT), dithioerythritol (DTE), aminopropanethiol, aminobutanethiol, aminopentanethiol, and related compounds, or a pharmaceutically acceptable salt thereof to a patient in need thereof.

Although the exact dosage of cysteamine or a

pharmaceutically acceptable salt thereof to be administered will vary according to the size and condition of the patient, a suitable daily dosage range for children is 1 to 3 g/m² of body surface of free base in four divided doses, preferably 1.5 to 2.5 g/m² of body surface in four divided doses, most preferably about 1.95 g/m² of body surface, in four divided doses. For adults, a suitable daily dosage may be 1 to 5g of cysteamine free base q6º; preferably 1.5 to 2.5g, most preferably about 2g. In the case of a pharmaceutically acceptable salt, the dosage should be adjusted to result in administration of the same molar amount of cysteamine by taking into account the relative molecular weights of

cysteamine and the salt thereof.

In the case of cystamine, the suitable, preferred and most preferred dosages correspond to the same respective dosages of cysteamine. In the case of the remaining thiol compounds, the suitable, preferred and most preferred dosages are selected such that the administration of the corresponding number of eqivalents of -SH delivered by administration of the above-given dosages of cysteamine is achieved, by taking into account the relative molecular weights of cysteamine and the other compound to be administered, as well as the number of thiol groups in the compound. The dosage of any disulfide in terms of mass will be the same as the corresponding thiol.

The compound of the present method, or pharmaceutically acceptable salt thereof may be suitably administered according to the present invention intravenously, parenterally, or orally. Oral administration is preferred. The compound of the present method, or pharmaceutically acceptable salt thereof may be administered in any conventional form such as a pharmaceutical composition. Suitable pharmaceutical

compositions are those containing, in addition to the compound of the present method, or pharmaceutically acceptable salt thereof, a pharmaceutically acceptable carrier, such as water, starch, sugar, etc. The composition may also contain

flavoring agents and may take the form of a solution, tablet, pill, capsule, etc. The ratio of the weight of compound of the present method, or pharmaceutically acceptable salt thereof to the weight of the pharmaceutical composition may, of course, vary but is suitably within 1:1 to 1:5000.

It is to be understood that the present method includes embodiments in which the compound of the present method, or pharmaceutically acceptable salt thereof is administered to a patient who is also receiving AZT, DDI or any other AIDS treatment drug. The present compound(s) and AZT or DDI may be administered to the patient in a single composition comprising both the present compounds and AZT or DDI. Alternatively, the present compound(s) and AZT or DDI may be administered separately. Further, the present method includes embodiments in which AZT or DDI is administered, without the compound of the present method, or a pharmaceutically acceptable salt thereof, for a suitable time period of hours, days, or weeks, and the AZT or DDI therapy is either preceded or followed by administration of the compound of the present method, or a pharmaceutically acceptable salt, either with or without AZT or DDI.

In another embodiment, it may be preferred to

coadminister cysteine along with the compound of the present method or salt thereof, to prolong the serum half-life of the the compound of the present method or salt thereof. Of course, the present method also includes administration of mixtures of the compounds of the present method, or salts thereof.

For purposes of the present invention, the term

pharmaceutically acceptable salt thereof refers to any salt of the compounds of the present method which is pharmaceutically acceptable and does not greatly reduce or inhibit the activity of the compound of the present method. Suitable examples include acid addition salts, with an organic or inorganic acid such as acetate, tartrate, trifluoroacetate, lactate, maleate, fumarate, citrate, methanesulfonate, sulfate, phosphate, nitrate, or chloride. In addition, for phosphocysteamine either or both of the hydrogen atoms on the phosphoryl group may be replaced with any suitable cation, such as Na⁺, K⁺, Mg⁺², Ca⁺⁺, NH₄ ⁺, or NR₄ ⁺ (where R is C_1-4 alkyl).

It is to be further understood that the compound of the present method, and pharmaceutically acceptable salts thereof include all the hydrated forms of these compounds as well as the anhydrous forms.

It is to be understood that the present method also encompasses the administration of prodrugs of the compounds of the present method. By prodrug is meant any compound that is metabolized to the compound of the present method by the body.

Thus, the compounds of the present method have now been shown to protect HIV-infected cells from the cytopathic effects of the viral infection, without exhibiting any

cytotoxic effect on uninfected cells. Although not intended to be limiting in any way, a possible explanation for the efficacy of cysteamine for the treatment of HIV infections is as follows.

Human immunodeficiency virus contains coat proteins including GP120 and GP41. GP120 is a transmembrane protein which forms a domain on the exterior surface of the virus which recognizes the CD4 receptor on a subpopulation of T lymphocytes. It is thought that the recognition between the GP120 coat protein and the CD4 receptor not only leads to infection of cells by the virus but also mediates cell death by promoting autofusion, syncytia formation, and other toxic effects not yet well characterized. Crucial to the above reaction is the presence of disulfide bonds which maintain the tertiary structure of the exterior portion of GP120. It is these intrachain disulfide bonds that may be the target for cysteamine. Cysteamine is known to be highly effective in promoting intrachain disulfide scission by direct reaction with the disulfides, leading to mixed disulfide formation.

Such a reaction may lead to disruption of the tertiary

structure of the GP120 molecule, altering its configuration, and inhibit binding to the CD4 receptor, inhibiting viral entry, autofusion, and other toxic effects of HIV.

Although the present method may be utilized to treat HIV infection at any stage, it is preferred that the treatment be initiated before the onset of frank AIDS or ARC, so that the development of frank AIDS or ARC may be prevented.

Other features of the invention will become apparent in the course of the following descriptions of exemplary

embodiments which are given for illustration of the invention and are not intended to be limiting thereof.

EXAMPLES

The effectiveness of cysteamine and cystamine for the treatment of HIV infection was determined as follows.

The assay of cysteamine and cystamine was performed using the CEM human T-lymphocyte cell line as host cells, and the HTLV-III_B strain of HIV-1 as the challenge virus. Cells were first pretreated with the test samples, then infected at a low multiplicity with virus. Twice each day an aliquot of fresh drug was added to the cultures, and the assay was monitored microscopically for signs of virus infection. Starting six days after infection, daily cell counts were performed on the cell and virus control samples to monitor the cell growth and viability. On about the seventh or eighth day postinfection, when viral CPE was maximal as determined by the cell counts, a quantitative colorimetric assay was performed to determine the extent of antiviral activity of the test samples. This assay utilized the metabolic reduction of 3-(4,5-dimethylthiazole-2- yl)-2,5-diphenyl-tetrazolium bromide (MTT) by cells surviving the virus challenge as an indication of the drug-induced suppression of viral CPE.

Cysteamine and cystamine were dissolved in a suitable solvent at a concentration of 100mM (100x for the top dose), and several aliquots were frozen at -90ºC. Dilutions were made in RPMI-1640 medium containing 2mM L-glutamine and 25mM HEPES, and supplemented with 10% fetal bovine serum, 50 units of penicillin G per ml, and 50μg streptomycin sulfate per ml. Cysteamine and cystamine were assayed at concentrations of 1mM, 0.1mM, and 0.01mM.

The assay was done in 96-well tissue culture plates. A volume containing 1×10⁴ CEM cells was dispensed into each well. Each dilution of the test compound (prepared as a 4x

concentration) was added to six wells of cells, and the cells were incubated at 37ºC for one hour. 1000 TCID₅₀ of a frozen culture of HIV-1 was added to four of the wells for each test compound concentration. This resulted in a multiplicity of infection of 0.1 for the HIV-1 infected samples. Culture medium was added to the remaining two wells of each test compound concentration to allow evaluation of cytotoxicity. Each assay plate contained six wells of untreated, uninfected, cell control samples and six wells of untreated, infected, virus control samples. 2',3'-Dideoxyinosine (DDI) and AZT were assayed in parallel as a positive control compounds.

Assay plates were incubated at 37°C in a humidified, 5% CO₂ atmosphere. Twice each day an aliquot of a 100x cysteamine or cystamine concentrate was added to each of the assay wells. The assay plates were observed daily for signs of toxicity and for the appearance of CPE. When the CPE was maximal, samples from each assay well were processed using the colorimetric MTT assay to determine the degree of drug-induced suppression of viral CPE as well as drug cytotoxicity. Quantitation was based on the generation of MTT-formazan by the surviving cells. The results of two cytotoxicity studies and two

antiviral studies are shown in tabular form below.

TABLE 1. CYTOTOXICITY EVALUATION

Compound 1000μM 100μM 10μM

Cystamine 5.2 96.2 108.5

Cysteamine 3.2 120.8 101.6

Compound 100μM 32μM 10μM 3.2μM 1.0μM 0.32μM

DDI 49.0 99.0 101.2 106.3 101.0 103.4

TABLE 2. CYTOTOXICITY EVALUATION

Compound 100μM 50μM 25μM 10μM

Cystamine 101.5 73 .7 71.5 88.5

Cysteamine 72.7 63.5 81.0 88.9

Compound 100μM 32μM 10μM 3.2μM 1.0μM 0.32μM DDI 103.5 98.9 98.0 99.4 98.6 100.3

100μM 10μM 1.0μM 0.1μM 0.01μM 0.001μM

AZT 102.0 100.5 98.1 108.8 101.2 102.9

Values shown for cytotoxicity were determined by dividing the absorbance for drug-treated, uninfected samples by the absorbance for cell control samples, then multiplying by 100. The numbers are mean values for duplicate wells. Values were calculated relative to the cell control samples of each assay plate.

TABLE 3. ANTIVIRAL EVALUATION

Compound 1000μM 100μM 10μM

Cystamine TOXIC 119. ,3 13.1

Cysteamine TOXIC 133. ,0 0.0

Compound 100μM 32μM 10μM 3. 2μM 1.0μM 0.32μM DDI 36.5^a 95.2 84.4 22 .8 0.0 0.0

TABLE 4. ANTIVIRAL EVALUATION

Compound 100μM 50μM 25μM 10μM

Cystamine 99.1 64 .4 63.2 18 .6

Cysteamine 62.8 52.0 17.1 2 .9

Compound 100μM 32μM 10μM 3.2μM 1.0μM 0.32μM

DDI 99.9 93.3 65.7 22.4 3.6 0.9

100 μM 10μM 1. 0μM 0. 1μM 0. 01μM 0. 001μM

AZT 99.0 89.1 78.3 75.6 32.5 1.7

The values shown for antiviral activity are percent inhibition of viral CPE and were calculated using the formula:

Absorbance of drug-treated, _ Absorbance of

infected sample virus control × 100

(Absorbance cell control) - (Absorbance virus control)

The numbers are mean values for four wells. Values were calculated relative to the cell and virus control samples of each assay plate.

aPartial drug toxicity at this test concentration may be causing an artificially low value for the antiviral activity As a result of such testing it was found that although cysteamine and cystamine were toxic to the assay cells at a concentration of 1mM and exhibited little or no antiviral activity at a concentration of 0.01mM, at a concentration of 0.1mM cysteamine and cystamine were non-cytotoxic and completely protected the HIV-infected cells from the

cytopathic effects of the virus infection.

Obviously, numerous modifications and variations of the present invention are possible in light of the above

teachings. It is therefore to be understood that, within the scope of the appended claims, the invention may be practiced otherwise than as specifically described herein.

Claims

WHAT IS CLAIMED AS NEW AND DESIRED TO BE SECURED BY LETTERS PATENT OF THE UNITED STATES IS:

1. A method for treating HIV infection, comprising administering an effective amount of a compound capable of undergoing a mixed disulfide exchange with a disulfide bond, or a pharmaceutically acceptable salt or prodrug thereof to a patient in need thereof.

2. The method of Claim 1, wherein said compound is selected from the group consisting of cysteamine, cystamine, phosphocysteamine, N,N-dimethylcysteamine, pantetheine, pantethine, WR2721, co-enzyme A, mercaptoethylgluconamide, thiocholine, dithiothreitol, dithioerythritol,

aminopropanethiol, aminobutanethiol, aminopentanethiol,

wherein the positively charged ions are salts with an anion selected from the group consisting of acetate, tartrate, trifluoroacetate, lactate, maleate, fumarate, citrate, methanesulfonate, sulfate, phosphate, nitrate, and halide.

3. The method of Claim 1, further comprising

administering an effective amount of AZT or DDI to said patient.

4. A method of treating AIDS, ARC, and lymphadenopathy, comprising administering an effective amount of a compound capable of undergoing a mixed disulfide exchange with a disulfide bond, or a pharmaceutically acceptable salt or prodrug thereof to a patient in need thereof.

5. The method of Claim 4, wherein said compound is selected from the group consisting of cysteamine, cystamine, phosphocysteamine, N,N-dimethylcysteamine, pantetheine, pantethine, WR2721, co-enzyme A, mercaptoethylgluconamide, thiocholine, dithiothreitol, dithioerythritol,

aminopropanethiol, aminobutanethiol, aminopentanethiol, in the present method also include:

wherein the positively charged ions are salts with an anion selected from the group consisting of acetate, tartrate, trifluoroacetate, lactate, maleate, fumarate, citrate,

methanesulfonate, sulfate, phosphate, nitrate, and halide.

6. The method of Claim 4, further comprising

administering an effective amount of AZT or DDI to said patient.