WO1995008990A1 - Augmentation de l'ecoulement de l'humeur aqueuse - Google Patents

Augmentation de l'ecoulement de l'humeur aqueuse Download PDF

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Publication number
WO1995008990A1
WO1995008990A1 PCT/US1993/009378 US9309378W WO9508990A1 WO 1995008990 A1 WO1995008990 A1 WO 1995008990A1 US 9309378 W US9309378 W US 9309378W WO 9508990 A1 WO9508990 A1 WO 9508990A1
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WO
WIPO (PCT)
Prior art keywords
eye
outflow
aqueous humor
ethacrynic acid
organic group
Prior art date
Application number
PCT/US1993/009378
Other languages
English (en)
Inventor
Charles Gluchowski
Alice Cheng-Bennett
David L. Epstein
Original Assignee
Allergan, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Allergan, Inc. filed Critical Allergan, Inc.
Priority to PCT/US1993/009378 priority Critical patent/WO1995008990A1/fr
Publication of WO1995008990A1 publication Critical patent/WO1995008990A1/fr

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Classifications

    • 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
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4406—Non condensed pyridines; Hydrogenated derivatives thereof only substituted in position 3, e.g. zimeldine
    • 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
    • A61K31/33—Heterocyclic compounds
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/365—Lactones
    • A61K31/366—Lactones having six-membered rings, e.g. delta-lactones

Definitions

  • Glaucoma is characterized by intraocular pressure resulting at least in part from a diminished outflow of aqueous humor through the trabecular meshwork.
  • Epstein et al. (1982) Invest. Ophthalmol. Vis. Sci. 22, 6, 752-756 describes experiments in which eyes from dead calves, macaques, and baboons were fitted with stainless-steel corneal fittings. The eyes were perfused, by filling the anterior chambers at 15 mm Hg and 22°C, with a solution containing the toxic compound N-ethylmaleimide (NEM) , a compound reactive with sulfhydryl groups. It was found that a "dosage of NEM of 4.7 mM or greater produced a significant increase in the facility of outflow in the . calf eye.” "NEM also caused an increase in outflow in the monkey eye.” The paper goes on:
  • cellular -SH groups can also alter the egress of aqueous humor from the trabecular meshwork.
  • Cellular or intercellular permeability to fluid flow in the aqueous outflow channels may be influenced by the state of cell membrane protein sulfhydryls.
  • Trabecular -SH groups may be intimately involved in the normal process of aqueous outflow, especially if located at sites of normal resistance in the juxtacanalicular tissue or endothelium of Schlemm's canal.
  • -SH groups may exert only a secondary influence on outflow through nonspecific structural changes in trabecular cell membranes.
  • the invention features a method of increasing aqueous humor outflow in the eye of a human patient to treat glaucoma, which method comprises topically administering to the eye an outflow increasing amount of analogs of ethacrynic acid and their ester or amide derivatives, and pharmaceutically acceptable salts thereof, having a margin of safety of at least 2.0 and being of the general formula
  • each X and X 2 independently, is a halogen, H, or CH_, or X. and X- together form a substituted or unsubstituted aromatic ring;
  • X_ is an organic group, preferably, a sulfhydryl reactive organic group; and
  • X. is OH or an organic group; provided that where X, and. X 2 are Cl and X is OH, X_ cannot be 2-methylene-l-oxobutyl; and where, preferably, each X. and 2 , independently, is H, Cl, CH_, or X. and 2 together form a phenyl ring; and
  • X 3 is one of
  • X4 is one of OH
  • a is 2-20, and b and c are, independently, 0-20.
  • the invention provides effective, non-surgical treatment of glaucoma in a manner which increases fluid outflow while causing minimal non-fluid related ocular functions.
  • Compounds of the invention are reactive with the trabecular meshwork so as to increase aqueous humor outflow; some are reactive with sulfhydryl groups of the trabecular meshwork.
  • the reactivity of the compounds must not cause an unacceptable amount of swelling of the cells of the trabecular meshwork, particularly the inner wall endothelial cells of Schlemm's canal, because swelling can decrease outflow.
  • "Unacceptable amount of . swelling” means an amount of swelling which completely counteracts the outflow increasing effects of the compounds, resulting in no net outflow increase. Whether swelling ' is caused by a particular compound can be determined by testing the compound in the system described in Epstein et al., _id, and examining the trabecular meshwork cells morphologically.
  • the compounds may contain chemical groups which are capable of reacting with the sulfhydryl groups of the trabecular meshwork to increase aqueous humor outflow.
  • Compounds which cor.tain chemical groups capable of reacting with sulfhydryl groups must react with the sulfhydryl groups in a manner which does not cause an unacceptable amount of swelling of cells of the trabecular meshwork, as described above.
  • a good leaving group e.g., halogen, tosyl, or mesyl.
  • substitution is primary, rather than secondary or tertiary, for greater reactivity.
  • margin of safety refers to the ratio of the dosage of the outflow increasing compounds which causes medically unacceptable toxic side effects, and the dosage which causes substantial (i.e., medically useful) increase in aqueous humor outflow in a typical human patient with advanced open angle glaucoma.
  • the margin of safety of the compounds must be at least 2.0, and more preferably at least 4.0.
  • Compounds to be administered to the eye topically must be sufficiently lipophilic to penetrate the corneal membrane.
  • Sufficient lipophilicity can be provided by a non-polar structure, the presence of at least one aryl group (e.g., a substituted or unsul stituted phenyl ring),* at least one halogen atom, and/or hydrophobic alkyl groups.
  • aryl group e.g., a substituted or unsul stituted phenyl ring
  • the compound it is also desirable that the compound not carry excessive charge; i.e., of absolute value greater than 2, at physiological pH.
  • Lipophilicity is expressed in terms of octanol: water coefficient, determined by the standard technique of radiolabelling the compound and introducing a small amount into equal volumes of octanol and Tris buffer (50 mM, pH 7.4).
  • the coefficient of the compounds is preferably at least 0.005, and more preferably at least 0.01. Administration
  • the outflow-increasing compounds can be administered either topically or by microinjection into the anterior chamber or trabecular meshwork.
  • a pharmaceutically acceptable carrier substance e.g., physiological saline.
  • the liquid carrier medium can contain an organic solvent, e.g., 3% methyl cellulose, in which solubility is greater.
  • Methyl cellulose also provides, by its high viscosity, increased contact time between the compound and the eye surface, and therefore increased corneal penetration.
  • Corneal penetration can also be increased by administering the compound mixed with an agent which slightly disrupts the corneal membrane, e.g., 0.001% benzalkonium chloride.
  • Administration is by periodically (e.g., one time per week to ten times per day) applying drops of the compound in solution using an eye dropper, such that an effective amount of the compound is delivered through the cornea to tne trabecular meshwork.
  • the amount of the compound to be delivered in one administration will depend on individual patient characteristics, e.g., severity of disease, as well as characteristics of the compound, e.g., the specific affinity for trabecular meshwork sulfhydryl groups, and the magnitude of the margin of safety.
  • each drop contains 50-100 microliters of a 5-10 mM solution of the compound, so that 0.025 to 0.10 moles of the compound are delivered to each eye per day.
  • Direct microinjection of the solubilized compound into the anterior chamber or trabecular meshwork offers the advantage of concentrating the compound in the location where it is needed, while avoiding the possibility of side effects resulting from generalized exposure of the eye to the compound.
  • Microinjection also provides the advantage of permitting infrequent periodic administration, e.g., every few weeks, months, or even years, in contrast to the more frequent administrations required in the case of topical administration.
  • direct microinjection may promote the washing out of the trabecular meshwork of extracellular material interferring with fluid outflow.
  • Dosage for microinjection like that for topical administration, varies with the above-mentioned parameters. Typically, microinjection dosage is such that a final concentration of the compound within the anterior chamber or trabecular meshwork of 0.01 to 1.0 mM is reached.
  • Ethacrynic acid sodium salt
  • Ethacrynic acid can be purchased from Merck, Sharp, and Dome', and is described in U.S. Pat. No. 3,255,241, hereby incorporated by reference.
  • Ethacrynic acid has the chemical formula [2,3-dichloro-4-(2-methylene-l-oxobutyl) phenoxy] acetic acid.
  • Any suitable analog described in U.S.P. 3,255,241 or its ester or amide derivative can also be used as described herein; for example, the following compounds may be used and are available from Allergan, Inc. (Irvine, CA) , as indicated by the code number below the structure.
  • AGN 190557-A AGN 190558-A
  • AGN 190663-A AGN 190662-A
  • AGN 190687-A AGN 190688-A
  • AGN 190465 Each animal was randomly assigned one eye for the experimental and the other for its control perfusion. The animals were fasted the night before the experiment. They were anesthetized intramuscularly with Methohexital Sodium 15mg/kg and Pentobarbital Sodium 35mg/kg. Supplemental anesthesia as required was carried out with Pentobarbital lOmg/kg/hour. Needles were placed through the cornea into the anterior chamber and a two-step constant pressure perfusion method was performed in order to determine aqueous humor outflow facility. The basic medium for perfusion was Dulbecco's phosphate buffered saline with added 5.5mM glucose. A 10 microliter bolus of the experimental or control solution (that would produce the desired final concentration in the anterior chamber) was injected through a T shaped connector piece in the infusion line.
  • Each vial of ethacrynic acid contained ethacrynate sodium powder equivalent to 50mg of ethacrynic acid.
  • the inactive ingredients were 62.5mg mannitol and 0.1 milliliters thimerosol (as preservative).
  • the powder was diluted with the above basic medium (Dulbecco's with added glucose) to yield the desired concentration.
  • the solution was mixed at room temperature until dissolved, and the pH was determined (always 7.2) before use; the solution was filtered with a 0.2 micron filter (Nuclepore); this produced a solution which was stable for 24 hours.
  • the control solution was composed of 9.5mg sodium chloride (to osmotically balance the experimental solution), 62.5mg mannitol and 0.1 miHiliter thimerosol dissolved in Dulbecco's phosphate buffered saline with 5.5mM added glucose to yield the desired concentration.
  • a 10 microliter bolus injection was made using a Hamilton syringe. Since the monkey anterior chamber is approximately 200 microliters, 10 microliters of lOmM ethacrynic acid was infused to achieve a final concentration of 0.5mM ethacrynic acid.
  • Intraocular pressure could not be reliably taken until a few days after the perfusion experiments (due to the possibility of leaks in the cornea through the needle placements), and at that time intraocular pressure was symmetrical and normal in both eyes.
  • the protocol was as follows. Baseline intraocular pressu- e was taken in each eye using 0.5% proparacaine hydrochloride for topical anesthesia. Then a 100 microliter drop of either control solution or ethacrynic acid dissolved in 3% methylcellulose (Dow Corporation, lot number 14728) was instilled into one of the two eyes. In a half hour this was repeated. Two hours later intraocular pressure was measured in each eye. In some animals intraocular pressure was also measured five hours later and all animals had measurement of intraocular pressure the following day.
  • Ethacrynic acid powder was dissolved in 3% methylcell.ulose to yield the desired concentration.
  • the solution was mixed at room temperature for one hour and was stable for 24 hours.
  • a similar osmotically balanced control solution was prepared from methyl cellulose powder dissolved in distilled water using low heat for several hours. The solution was refrigerated over night to yield a transparent, viscous fluid.
  • the pH of the solution was determined by mixing one part of the control or experimental solution with five parts of distilled water. The pH ranged between 6.2 and 6.5 for both the control and experimental solutions.
  • the 3% methylcellulose solution was refrigerated when not in use.
  • the pressure data was as follows: for 5mM ethacrynic acid in 3% methylcellulose in eight animals, two hours following instillation intraocular pressure in the ethacrynic treated eye had decreased from 22.4 to 19.6mm Hg (p less than 0.01) whereas the control eye had shown a slight increase from 21.5 to 23.1mm Hg. The next day intraocular pressure was equal in the two eyes being 22.4mm in the ethacrynic treated eye and 22.7mm in the control eye.
  • corneal toxicity corneal ed.jma
  • anterior chamber inflammation was apparent for several days. However, these resolved without apparent sequelae.
  • esters of ethacrynic acid RCOOCH 2 CH 2 N(CH 2 CH 3 ) 2
  • esteer B COOCH 2 CH 2 CH 2 N(CH 2 CH 3 ) 2

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  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Medicinal Preparation (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

L'invention se rapporte à un procédé servant à augmenter l'écoulement de l'humeur aqueuse dans l'÷il d'un patient afin de traiter le glaucome, ce procédé comprenant l'instillation dans l'÷il d'une quantité favorisant l'augmentation de cet écoulement, cette quantité consistant en un analogue de l'acide étacrynique possédant une marge de sûreté d'au moins 2,0 et ayant la formule (I) dans laquelle X1 et X2 sont chacun indépendamment halogène, H, ou CH3, ou ils forment ensemble un noyau aromatique substitué ou non substitué; X3 est un groupe organique; et X4 est OH ou un groupe organique; à condition que lorsque X1 et X2 sont Cl et que X4 est OH, X3 ne puisse être 2-méthylène-1-oxobutyle. L'invention concerne également un sel pharmaceutiquement acceptable dudit acide.
PCT/US1993/009378 1993-09-30 1993-09-30 Augmentation de l'ecoulement de l'humeur aqueuse WO1995008990A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US1993/009378 WO1995008990A1 (fr) 1993-09-30 1993-09-30 Augmentation de l'ecoulement de l'humeur aqueuse

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1993/009378 WO1995008990A1 (fr) 1993-09-30 1993-09-30 Augmentation de l'ecoulement de l'humeur aqueuse

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WO1995008990A1 true WO1995008990A1 (fr) 1995-04-06

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5650541A (en) * 1993-04-19 1997-07-22 Alcon Laboratories, Inc. Ethacrynic acid-like compounds and use thereof to treat glaucoma
WO2006047466A2 (fr) * 2004-10-21 2006-05-04 Duke University Medicaments ophtalmologiques

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4757089A (en) * 1985-06-14 1988-07-12 Massachusetts Eye And Ear Infirmary Increasing aqueous humor outflow

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4757089A (en) * 1985-06-14 1988-07-12 Massachusetts Eye And Ear Infirmary Increasing aqueous humor outflow

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5650541A (en) * 1993-04-19 1997-07-22 Alcon Laboratories, Inc. Ethacrynic acid-like compounds and use thereof to treat glaucoma
WO2006047466A2 (fr) * 2004-10-21 2006-05-04 Duke University Medicaments ophtalmologiques
WO2006047466A3 (fr) * 2004-10-21 2006-09-21 Univ Duke Medicaments ophtalmologiques
US8642644B2 (en) 2004-10-21 2014-02-04 Duke University Ophthamological drugs

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