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Definitions

• provisional application ser. no. 60/028586 filed April 23, 1997 (2) provisional application ser. no. 60/043,974 filed April 23, 1997, (3) provisional application ser. no. 60/055,487 filed August 12, 1997; and (4) provisional application 60/036,094 dated January 14, 1997.
• the present invention relates to the field of nucleosides.
• B lymphocytes B cells
• T lymphocytes T cells
• T cells are generally considered to fall into two subclasses, helper T cells and cytotoxic T cells.
• Helper T cells activate other lymphocytes, including B cells and cytotoxic T cells, and macrophages, by releasing soluble protein mediators called cytokines which are involved in cell-mediated immunity.
• lymphokines are a subset of cytokines.
• Thl and Th2 Thl cells also known as Type 1 cells
• LL-2 interleukin 2
• TNF ⁇ tumor necrosis factor
• IFN ⁇ interferon gamma
• Type 2 cells produce interleukins, IL4, IL-5, LL-6, LL-9, LL-10 and LL-13, and are primarily involved in assisting humoral immune responses such as those seen in response to allergens, e.g. IgE and lgG4 antibody isotype switching (Mosmann, 1989, Annu Rev Immunol, 7: 145-173).
• Thl and Th2 responses
• Thl and Th2 lymphocytes are meant to include the entire range of effects resulting from induction of Thl and Th2 lymphocytes, respectively.
• responses include variation in production of the corresponding cytokines through transcription, translation, secretion and possibly other mechanisms, increased proliferation of the corresponding lymphocytes, and other effects associated with increased production of cytokines, including motility effects.
• nucleosides which are defined herein to include derivatives and analogs of native nucleosides
• lymphocyte responses we have shown that either of Thl and Th2 responses can be selectively suppressed while the other is either induced or left relatively unaffected, and either of Thl or Th2 responses can be selectively induced while the other is either suppressed or left relatively unaffected.
• nucleosides effective in selectively modulating Thl and Th2 responses relative to one another tend to have a bimodal effect.
• nucleosides which tend to generally suppress or induce both Thl and Thl activity at a relatively higher dose, tend to selectively modulate Thl and Th2 relative to each other at relatively lower doses.
• nucleosides and other compounds selectively modulate Thl and Th2 responses relative to each other are still unclear.
• One possibility contemplated by the present inventors is that effective nucleosides alter the pool of guanosine triphosphate (GTP), which in turn affects the rate at which cytokines are produced.
• GTP guanosine triphosphate
• relatively large variations in available GTP are sufficient to affect concentrations of both Thl and Th2 cytokines, while relatively smaller variations in available GTP tend to affect concentrations of Thl and Th2 cytokines to different extents.
• Tumor cells are characterized by high levels of inosine monophosphate dehydrogenase (IMP DH) activity, and it is known that LMP DH is the rate-limiting enzyme of GTP biosynthesis. Weber, G., IMP Dehydrogenase and GTP as Targets in Human Leukemia Treatment. Adv. Exp. Med. Biol. 309B:287-292 (1991).
• Tiazofurin has been shown to selectively block IMP DH activity and deplete guanine nucleotide pools, which in turn forces various tumors into remission.
• Typical initial doses of Tiazofurin are about 4,400 mg/m 2 , with consolidation doses of about 1100 to 3300 mg/m 2 . At these levels synthesis of both Thl and Th2 responses are greatly reduced, thereby essentially shutting down much of the immune system.
• much smaller doses of Tiazofurin in the range of 1/10th to one-half that set forth above, would be sufficient to specifically suppress either a Thl response or a Th2 response without greatly reducing the other response.
• Ribavirin is a potent, broad-spectrum antiviral agent, which has also been shown to inhibit IMP DH. Yamada, Y. et al., Action of the Active Metabolites of Tiazofurin and Ribavirin on Purified IMP Dehydrogenase. Biochem. 27:2193-2196 (1988). Ribavirin proceeds under a different mechanism than Tiazofurin in inhibiting IMP DH, however, acting on a different site on the enzyme molecule. Ribavirin is converted to its active metabolite, ribavirin-monophosphate (RMP), which inhibits the enzyme at the IMP-
• RMP ribavirin-monophosphate
• Ribavirin XMP site of IMP DH.
• the affinity of Ribavirin' s active form to the enzyme is higher than that of the natural metabolite.
• Ribavirin reduces IMP DH activity to such an extent that both Thl and Th2 responses are inhibited.
• Ribavirin promotes a Thl response and suppresses a Th2 response.
• Thl relative to Th2 can be useful in treating a wide variety of conditions and diseases, ranging from infections, infestations, tumors and hypersensitivities to autoimmune diseases.
• autoimmune disease for example, is frequently limited to palliative measures, removal of toxic antibodies (as in myasthenia gravis), and administration of hazardous drugs including corticosteroids, chloroquine derivatives, and antimetabolic or antitumor drugs, and drugs such as cyclosporines which target immune system cells.
• This application relates to the use of nucleosides in the relatively low dosage range to selectively modulate Thl and Th2 responses relative to each other in the treatment of disease.
• administration of a nucleoside or other compound reduces the dosage at which a primary drug is administered.
• an abnormality reflected in increased response in one group of cytokines is treated by administering a nucleoside or other compound which increases response in another group of cytokines.
• a patient is prophylactically treated by administering a nucleoside or other compound which selectively reduces Thl activity without significantly reducing Th2 activity.
• a nucleoside or other compound is administered to a patient at a dose which reduces the patient's GTP pool to a degree that selectively reduces one of the Thl or Th2 response without significantly reducing the other response.
• Controlled release dosage forms are particularly contemplated to achieve that result.
• nucleosides contemplated to be effective in this manner are D- and L- forms of: (a) bicyclic nucleosides corresponding to any of Formulas 1, 1-A through 1-F; and (b) monocyclic nucleosides nucleosides corresponding to any of Formulas 2 through 5.
• anti-viral agents such as Ribavirin , acyclovir, and AZTTM
• anti-fungal agents such as tolnaftate
• anti-parasitics such as MintezolTM, NiclocideTM, VermoxTM
• ⁇ and ⁇ indicate the specific stereochemical configuration of a substituent at an asymmetric carbon atom in a chemical structure as drawn.
• abnormality refers to a condition associated with a disease.
• Thl and/or Th2 responses resulting from an autoimmune disease are considered herein to be abnormalities of the corresponding cytokine(s) even though such cytokine responses may commonly result from the disease.
• aryl refers to a monovalent unsaturated aromatic carbocyclic radical having a single ring (e.g., phenyl) or two condensed rings (e.g., naphthyl), which can optionally be substituted with hydroxyl, lower alky, chloro, and/or cyano.
• the term "effective amount” refers to the amount of a compound of formula (I) which will restore immune function to normal levels, or increase immune function above normal levels in order to eliminate infection.
• enantiomers refers to a pair of stereoisomers that are non-superimposable mirror images of each other. A mixture of a pair of enantiomers, in a 1 : 1 ratio, is a "racemic" mixture.
• heterocycle refers to a monovalent saturated or unsaturated carbocyclic radical having at least one hetero atom, such as N, O or S, within the ring each available position of which can be optionally substituted, independently, with, e.g., hydroxy, oxo, amino, imino, lower alkyl, bromo, chloro and/or cyano. Included within this class of substituents are purines, pyrimidines.
• immunomodulators refers to natural or synthetic products capable of modifying the normal or aberrant immune system through stimulation or suppression.
• isomers refers to different compounds that have the same formula.
• Steps are isomers that differ only in the way the atoms are arranged in space.
• the term "L-configuration” is used throughout the present invention to describe the chemical configuration of the ribofuranosyl moiety of the compounds that is linked to the nucleobases.
• the L-configuration of the sugar moiety of compounds of the present invention contrasts with the D-configuration of ribose sugar moieties of the naturally occurring nucleosides such as cytidine, adenosine, thymidine, guanosine and uridine.
• lower alkyl refers to methyl, ethyl, n-propyl, isopropyl, n-butyl, t-butyl, I- butyl or n-hexyl. This term is further exemplified to a cyclic, branched or straight chain from one to six carbon atoms.
• monocyclic refers to a monovalent saturated carbocyclic radical having at least one hetero atom, such as O, N, S, Se or P, within the ring, each available position of which can be optionally substituted, independently, with a sugar moiety or any other groups like bromo, chloro and/or cyano, so that the monocyclic ring system eventually aromatized [e.g., Thymidine; l-(2'-deoxy-?-D-erythro-pentofuranosyl)thymine].
• hetero atom such as O, N, S, Se or P
• nucleoside refers to a compound composed of any pentose or modified pentose moiety attached to a specific position of a heterocycle or to the natural position of a purine (9-position) or pyrimidine (1 -position) or to the equivalent position in an analog, including especiall both D- and L- forms of nitrogenous bicyclic and monocyclic heterocycles depicted in Figures 1, 1-A through 1-F, and 2 through 5 herein.
• C-nucleosides is used throughout the specification to describe the linkage type that formed between the ribose sugar moiety and the heterocyclic base.
• the linkage originates from the C-1 position of the ribose sugar moiety and joins the carbon of the heterocyclic base.
• the linkage that forms in C-nucleosides are carbon to carbon type.
• D-nucleosides refers to nucleoside compounds that have a D-ribose sugar moiety (e.g., Adenosine).
• L-nucleosides refers to nucleoside compounds that have an L-ribose sugar moiety.
• N-nucleosides is used throughout the specification to describe the linkage type that formed between the ribose sugar moiety and the heterocyclic base. In N-nucleosides, the linkage originates from the C-1 position of the ribose sugar moiety and joins the nitrogen of the heterocyclic base. The linkage that forms in N-nucleosides are carbon to nitrogen type.
• nucleotide refers to a phosphate ester substituted on the 5 '-position of a nucleoside.
• pharmaceutically acceptable salts refers to any salt derived from inorganic and organic acids or bases.
• protecting group refers to a chemical group that is added to, oxygen or nitrogen atom to prevent its further reaction during the course of derivatization of other moieties in the molecule in which the oxygen or nitrogen is located. A wide variety of oxygen and nitrogen protecting groups are known to those skilled in the art of organic synthesis.
• purine refers to nitrogenous bicyclic heterocycles depicted in Figures 1, 1- A through 1-F herein.
• pyrimidine refers to nitrogenous monocyclic heterocycles depicted in Figures 2 through 5 herein.
• tumor refers broadly to all manner of autonomous morbid growth of tissue which may or may not become malignant, including all manner of neoplasms and cancers.
• treating or “treatment” of a disease refers to executing a protocol, which may include administering one or more drugs to a patient, in an effort to alleviate signs or symptoms of the disease.
• treating or “treatment” do not require complete alleviation of signs or symptoms, do not require a cure, and specifically include protocols which have only marginal effect on the patient.
• Contemplated combinations in one aspect of the present invention generally include a primary or "first" drug and another or “second” drug, and contemplated methods involve selecting and combining the first and second drugs in combination therapies.
• a disease is identified which is known to produce an abnormality in at least one cytokine in a patient
• the first drug is selected from among those compounds demonstrated to treat the disease at a monotherapeutic dosage
• the second drug which may be a bimodal nucleoside modulator as herein described, is selected from among those compounds known to exacerbate the very abnormality produced by the disease when administered within a given dosage range.
• the first drug is then administered at less than the monotherapeutic dosage and the second drug is administered in a dosage outside the dosage range which exacerbates the abnormality. Since the second drug has a bimodal activity with respect to at least some of the cytokines of interest, the combination is still effective to treat the disease, and administration of the second drug allows reduction in the administered dosage of the primary or first drug.
• anti-viral agents such as interferon, including but not limited to interferon and ⁇ , Ribavirin , acyclovir, and AZTTM; anti-fungal agents such as tolnaftate, FungizoneTM, Lotrimin,TM Mycelex,TM, Nystatin and Amphoteracin; anti-parasitics such as MintezolTM, NiclocideTM, VermoxTM, and FlagylTM; bowel agents such as ImmodiumTM, LomotilTM and PhazymeTM; anti-tumor agents such as interferon and ⁇ , AdriamycinTM, CytoxanTM, ImuranTM, Methotrexate, MithracinTM, TiazofurinTM, TaxolTM; dermatologic agents such as AclovateTM, CyclocortTM, DenorexTM, FloroneTM, OxsoralenTM, coal tar
• Especially preferred primary drugs are AZT, 3TC, 8-substituted guanosine analogs, 2',3'-dideoxynucleosides, interleukin II, interferons such as I B-interferons, tucaresol, levamisole, isoprinosine and cyclolignans.
• Examples of secondary drugs contemplated to be effective in the invention are D- and L- forms of (a) bicyclic nucleosides corresponding to generic Formula 1 and 1-A through 1-F, and (b) monocyclic nucleosides nucleosides corresponding to Formulas 2 through 5.
• Other nucleoside and non-nucleoside compounds effective in the invention are readily identified through screening of such compounds in vitro for effect on IL-2, TNF- ⁇ , LFN- ⁇ , LL-4 and LL-
• Formula 1 compounds are purine nucleosides having the structure:
• Rj, R 2 , R 3 , R 4 , R 5 , R 2 ' and R 3 ' are independently selected from the group consisting of H, OH, NH 2 , F, Cl, Br, I, N 3 , -CN, -OR', -NR' 2 , -SR', -NHNH 2 , -NHOH, CHO,
• Zj, Z 2 are independently selected from N, C, CH;
• alkyl alkenyl, alkylnyl, aryl, aralkyl, substituted alkyl, substituted alkenyl, substituted alkynyl, substituted aryl, substituted aralkyl, where the substituent is selected from H, -OH, NH 2 , F, Cl, Br, I, N 3 , -CN, -COOR", -CONR" 2 , -OR", -NR" 2 , -SR", -NHNH 2 , -NHOH, -N0 2 , and R', R" are H, alkyl, alkenyl, alkynyl, aryl, aralkyl, acetyl, acyl, sulfonyl;
• X and Y are independently selected from the group consisting of H, OH, NH 2 , F, Cl, Br, I, N 3 , -S-NH 2 , -S(O)-NH 2 , -S(O2)-NH 2 , -CN, -COOR', -CONR' 2 , -OR, -NR' 2 , -SR', - NHNH 2 , -NHOH, alkyl, alkenyl, alkylnyl, aryl, aralkyl, substituted alkyl, substituted alkenyl, substituted alkynyl, substituted aryl, substituted aralkyl, where the substituent is selected from F, Cl, Br, I, N 3 , -CN, -OR", NO 2 , -NR" 2 , SR", -NHNH 2 , -NHOH, and R', R" are H, alkyl, alkenyl, alkynyl, aryl
• Formula 1-A compounds are 8-substituted "-or ⁇ - L- or D- guanosine analogs having the structure:
• X is selected from H, R, F, Cl, Br, I, N 3 , -CN, -OR, -SR, -NR , -NHNH 2 , - NHOH, -CHO, -CONH 2 , -COOR, and -L-A; where R is selected from alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl; L is a linker and selected from alkyl, alkenyl, alkynyl, and aralkyl; and A is selected from H, -OR', -SR, -NR' 2 , -NHNR' 2 , -CHO, -COOR', -CONR' 2 , where R' is selected from H, Me, Et, allyl, acetyl, -COCF3; Y is selected from H, R, F, Cl Br, I, N 3 , CN, OR,
• Formula IB compounds are 7-substituted-8-oxo-"-or ⁇ - L-guanosine analogs having structure:
• Formula 1-C compounds are 7-deaza-7,8-mono- or disubstituted "-or ⁇ - L- or D- guanosine analogs having the structure:
• X ⁇ and X 2 are independently selected from H, R, F, Cl, Br, I, N3, -CN, -OR, -SR, -NR 2 , -NHNH 2 , -NHOH, -CHO, -CONH 2 , -COOR, and -L-A; where R is selected from alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl; L is a linker and selected from alkyl, alkenyl, alkynyl, and aralkyl; and A is selected from H, -OR', -SR', -NR' 2 , -NHNR' 2 , -CHO, - COOR', -CONR' 2 , where R' is selected from H, Me, Et, allyl, acetyl, -COCF3;
• Y is selected from H, R, F, Cl, Br, I, N3, -CN, -OR, -SR, -NR 2 , where R is selected from H, alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl;
• Z is N or CH
• Ri , R 2 , and R 3 are independently selected from H, -OH, -OAc, -OBz, -OP(O 2 )OH.
• Formula 1-D compounds are 7-deaza-8-aza-7-substituted "-or ⁇ - L- or D- guanosine analogs having the structure:
• X is selected from H, R, F, Cl, Br, I, N 3 , -CN, -OR, -SR, -NR 2 , -NHNH 2 , -NHOH, CHO, -CONH 2 , -COOR, and -L-A; where R is selected from alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl; L is a linker and selected from alkyl, alkenyl, alkynyl, and aralkyl; and A is selected from H, -OR, SR, -NR' 2 , -NHNR' 2 , -CHO, -COOR, -CONR' 2 , where R' is selected from H, Me, Et, allyl, acetyl, -COCF3;
• Y is selected from H, R, F, Cl, Br, I, N 3 , -CN, -OR, -SR, -NR2, where R is selected from H, alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl;
• Z is N or CH; Rl, R , and R3 are independently selected from H, -OH, -OAc, -OBz, -OP(O 2 )OH.
• Formula 1-E compounds are thiazolo[4,5-d]pyrimidine "-or ⁇ - L- or D- nucleosides having the structure:
• Y is selected from H, R, F, Cl, Br, I, N 3 , -CN, -OR, -SR, -NR 2 , where R is selected from H, alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl;
• Z is N or CH
• Ri , R , and R3 are independently selected from H, -OH, -OAc, -OBz, -OP(O 2 )OH.
• Formula 1-F compounds are ⁇ -L- or D- purine nucleosides having the structure:
• Formula 1-F X is selected from H, R, -SNH 2 , -S(O)NH 2 , -SO 2 NH 2 , F, Cl, Br, I, N 3 , -CN, -OR, SR, -NR 2 , where R is selected from H, alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl;
• Y is selected from H, R, F, Cl, Br, I, N 3 , -CN, -OR, -SR, -NR 2 , where R is selected from H, alkyl, alkenyl, alkynyl, and aralkyl, acetyl, acyl, sulfonyl;
• Z ⁇ , Z 2 and Z3 are independently selected from C, N, and CH;
• Rl, R 2 , and R 3 are independently selected from H, -OH, -OAc, -OBz, -OP(O 2 )OH.
• Formula 2 compounds have the structure:
• A is independently selected from N or C;
• B, C, E, F are independently selected from CH, CO, N, S, Se, O, NR 1 , CCONH CCH 3 , C-R 2 or P;
• R 1 is independently H, lower alkyl, lower alkylamines, COCH 3 , lower alkyl alkenyl, lower alkyl vinyl or lower alkyl aryls.
• X is independently O, S, CH 2 or NR, where R is COCH 3 , R, and R, are independently selected from H, CN, N 3 , CH 2 OH, lower alkyl and lower alkyl amines,
• X is independently O, S, CH 2 and NR, where R is COCH 3 ;
• R, and R 4 are independently selected from H, CN, N 3 , CH 2 OH, lower alkyl or lower alkyl amines;
• R' is preferably carboxamide or CN and R" is hydrogen or halogens;
• Formula 4 compounds have the structure:
• A is independently selected from N or C;
• B, C, E and F are independently selected from CH, CO, N, S, Se, O, NR 1 , CCONH 2 , CCH 3 , C-R 2 or P;
• R 1 is independently H, lower alkyl, lower alkylamines, COCH 3 , lower alkyl alkenyl, lower alkyl vinyl or lower alkyl aryls.
• X is independently O, S, CH 2 or NR; where R is COCH 3 ;
• R, and R 4 are independently selected from H, CN, N 3 , CH 2 OH, lower alkyl or lower alkyl amines;
• R 1 is preferably H, lower alkyl or allyl
• Formula 5 compounds have the structure:
• A is independently selected from N or C;
• B, C, E, F are independently selected from CH, CO, N, S, Se, O, NR 1 , CCONH 2 , CCH 3 , C-R 2 or P;
• R 1 is independently H, lower alkyl, lower alkylamines, COCH 3 , lower alkyl alkenyl, lower alkyl vinyl or lower alkyl aryls.
• R 2 is independently H, OH, halogens, CN, N 3 ,
• D is independently selected from CH, CO, N, S, Se, O, NR 1 , CCONH 2 , CCH 3 , C-R 2 , P or nothing;
• R 1 is independently H, O, lower alkyl, lower alkylamines, COCH 3 , lower alkyl alkenyl, lower alkyl vinyl or lower alkyl aryls.
• R 2 is independently H, OH, halogens, CN, N 3 .
• NH 2 lower alkyl, lower alkylamines, lower alkyl alkenyl, lower alkyl vinyl, lower alkyl aryls or substituted heterocycles;
• X is independently O, S, CH 2 or NR where R is COCH 3 ;
• R, and R 4 are independently selected from H, CN, N 3 , CH 2 OH, lower alkyl and lower alkyl amines; and
• an abnormality reflected in increased response in one group of cytokines is treated by administering a nucleoside or other compound which increases response in another group of cytokines
• a nucleoside or other compound which increases response in another group of cytokines results in an abnormally elevated Th2 response
• the abnormality is treated by administering Ribavirin at between 600 mg/day and 1,000 mg/day (for a typical adult), at which dose the Thl response is induced
• the treatment is effective because Thl and Th2 have a teeter-totter type relationship in this instance, such that the Th2 response is suppressed
• a patient is prophylactically treated by administering a nucleoside or other compound which selectively reduces Thl activity without significantly reducing Th2 activity
• the prophylaxis can, for example, prepare the patient for organ or tissue transplant, or for anticipated contact with allergens
• a nucleoside or other compound is administered to a patient at a dose which reduces the patient's GTP pool to a degree that selectively reduces one of the Thl or Th2 response without significantly reducing the other response. Controlled release dosage forms are particularly contemplated to achieve that result, especially formulations which maintain the dose of the compound in the serum within a desirable range.
• a controlled release formulation may advantageously have an in vitro dissolution rate when measured by the USP Paddle Method at 100 rpm at 900 ml aqueous buffer (pH between 1.6 and 7.2) between about 15% and 40% by weight of the compound after 1 hour, between about 30% and about 50% by weight of the compound after 2 hours, about 50%) and 70% by weight of the compound after 4 hours, between about 60% and about 80% by weight of the compound after 6 hours
• the claimed combinations will be used to treat a wide variety of conditions, and in fact any condition which responds positively to administration of one or more such combinations. Among other things it is specifically contemplated that such combinations may be used to treat an infection, an infestation, a tumor, a hypersensitivity or an autoimmune disease.
• Infections contemplated to be treated with the compounds of the present invention include respiratory syncytial virus (RSV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex type 1 and 2, herpes genitalis, herpes keratitis, herpes encephalitis, herpes zoster, human immunodeficiency virus (HIV), influenza A virus, hantann virus (hemorrhagic fever), human papilloma virus (HPV), measles and fungus. It is especially contemplated that combinations claimed herein will be useful in treating chronic viral and bacterial infections, including HIV, Tuberculosis, leprosy and so forth.
• Infestations contemplated to be treated with the compounds of the present invention include intracellular protozoan infestations, as well as helminth and other parasitic infestations. Again, it is especially contemplated that combinations claimed herein will be useful in treating chronic infestations.
• Tumors contemplated to be treated include those caused by a virus, and the effect may involve inhibiting the transformation of virus-infected cells to a neoplastic state, inhibiting the spread of viruses from transformed cells to other normal cells and/or arresting the growth of virus-transformed cells.
• Hypersensitivities contemplated to be treated include all types of allergies, including IgE and IgG allergies, hyper IgE syndrome, and dermatic conditions such as atopic dermatitis. It is also contemplated that claimed combinations can be used to treat transplant rejection, (graft vs. host disease) and implant reactions.
• Non-organ-specific autoimmune diseases include rheumatoid arthritis, gout and gouty arthritis, Systemic Lupus Erythematosus (SLE), Sjogren syndrome, scleroderma, polymyositis and dermomyositis, ankylosing spondylitis, and rheumatic fever.
• SLE Systemic Lupus Erythematosus
• Organ-specific autoimmune diseases are known for virtually every organ, including insulin-dependent diabetes, thyroid diseases (Graves disease and Hashimoto thyroiditis), Addison disease, and some kidney and lung diseases including allergy and asthma, multiple sclerosis, myasthenia gravis, uveitis, psoriasis, forms of hepatitis and cirrhosis, celiac disease, inflammatory bowel disease, and some types of male and female infertility.
• Autoimmune processes may also be stimulated by viral infections including the HIV virus, may result from rejection of transplantation, and may accompany certain tumors, or be precipitated by exposure to some chemicals.
• an abnormality reflected in increased response in one group of cytokines can be treated by administering a nucleoside which increases response in another group of cytokines.
• a nucleoside which increases response in another group of cytokines.
• allergies can be treated with Ribavirin, which increases Thl response at low dosages of about 500 mg/day to about 1,000 mg/day.
• a patient is prophylactically treated by administering a compound which selectively reduces Thl activity without significantly reducing Th2 activity.
• the prophylactic treatment may be to reduce expected undesirable effects from an upcoming event, such as an organ or tissue transplant, or to reduce symptoms from an expected pulmonary insult, as from the onset of increase in airborne pollen levels in Spring
• compounds according to the present invention will be administered in any appropriate pharmaceutical formulation, and under any appropriate protocol
• preferred monotherapeutic dosages and protocols for such drugs are set forth in the PDR, or are at least available from the manufacturer or distributor Preferred dosages and protocols for the "second" drugs, such as bi-modal nucleosides described herein, may best be established through experimentation with particular patients Such experimentation need not be extensive, and it is contemplated that "second" drugs comprising nucleosides as described herein will be administered at between about 100 mg/day and about 5,000 mg/day
• a therapeutically effective amount will vary with the infection or condition to be treated, its severity, the treatment regimen to be employed, the pharmacokinetics of the agent used, as well as the patient (animal or human) treated
• effective dosages may range from 1 mg/kg of body weight, or less, to 25 mg/kg of body weight or more
• a therapeutically effective amount of the "second" drug is contemplated to range from slightly less than about 1 mg /kg to about 25 mg /kg of the patient, depending upon the compound used, the condition or infection treated and the route of administration
• This dosage range generally produces effective blood level concentrations of active compound ranging from about 0 04 to about 100 micrograms/cc of blood in the patient It is contemplated, however, that appropriate patient-specific regimens will be developed by administering a small amount, and then increasing the amount until either the side effects become unduly adverse, or the intended effect is achieved.
• Administration of compounds according to the present invention may take place orally, parenterally (including subcutaneous injections, intravenous, intramuscularly, by intraster al injection or infusion techniques), by inhalation spray, or rectally, topically and so forth, and in dosage unit formulations containing conventional non-toxic pharmaceutically acceptable carriers, adjuvants and vehicles.
• compounds according to the present invention can be formulated in admixture with a pharmaceutically acceptable carrier.
• the compounds of the present invention can be administered orally as pharmacologically acceptable salts.
• physiological saline solution e.g., buffered to a pH of about 7.2 to 7.5.
• physiological saline solution e.g., buffered to a pH of about 7.2 to 7.5.
• Conventional buffers such as phosphates, bicarbonates or citrates can be used for this purpose.
• physiological saline solution e.g., buffered to a pH of about 7.2 to 7.5.
• Conventional buffers such as phosphates, bicarbonates or citrates can be used for this purpose.
• one of ordinary skill in the art may modify the formulations within the teachings of the specification to provide numerous formulations for a particular route of administration without rendering the compositions of the present invention unstable or compromising their therapeutic activity.
• the modification of the present compounds to render them more soluble in water or other vehicle may be easily accomplished by minor modifications (salt formulation, esterification, etc.) which are well within the ordinary skill in the art. It is also well within the ordinary skill of the art to modify the route of administration and dosage regimen of a particular compound in order to manage the pharmacokinetics of the present compounds for maximum beneficial effect in patients.
• the pro-drug form of administered compounds especially including acylated (acetylated or other) derivatives, pyridine esters and various salt forms of the present compounds are preferred.
• acylated (acetylated or other) derivatives, pyridine esters and various salt forms of the present compounds are preferred.
• One of ordinary skill in the art will recognize how to readily modify the present compounds to pro-drug forms to facilitate delivery of active compounds to a target site within the host organism or patient.
• One of ordinary skill in the art will also take advantage of favorable pharmacokinetic parameters of the pro-drug forms, where applicable, in delivering the present compounds to a targeted site within the host organism or patient to maximize the intended effect of the compound.
• compounds included in combinations according to the present invention may be administered separately or together, and when administered separately this may occur in any order.
• the amounts of the active ingredient(s) and pharmaceutically active agent(s) and the relative timings of administration will be selected in order to achieve the desired combined therapeutic effect.
• Administration routes of compounds according to the present invention may range from continuous (intravenous drip) to several oral administrations per day (for example, Q.I.D.) and may include oral, topical, parenteral, intramuscular, intravenous, sub-cutaneous, transdermal (which may include a penetration enhancement agent), buccal and suppository administration, among other routes of administration.
• a therapeutically effective amount of a compound is preferably intimately admixed with a pharmaceutically acceptable carrier according to conventional pharmaceutical compounding techniques to produce a dose.
• a carrier may take a wide variety of forms depending on the form of preparation desired for administration, e.g., oral or parenteral.
• any of the usual pharmaceutical media may be used.
• suitable carriers and additives including water, glycols, oils, alcohols, flavoring agents, preservatives, coloring agents and the like may be used.
• suitable carriers and additives including starches, sugar carrier, such as dextrose, mannitol, lactose and related carriers, diluents, granulating agents, lubricants, binders, disintegrating agents and the like may be used.
• the tablets or capsules may be enteric-coated or sustained release by standard techniques.
• the carrier will usually comprise sterile water or aqueous sodium chloride solution, though other ingredients including those which aid dispersion may be included.
• sterile water is to be used and maintained as sterile, the compositions and carriers must also be sterilized.
• injectable suspensions may also be prepared, in which case appropriate liquid carriers, suspending agents and the like may be employed.
• the most preferred uses according to the present invention are those in which the active compounds are relatively less cytotoxic to the non-target host cells and relatively more active against the target.
• L-nucleosides may have increased stability over D-nucleosides, which could lead to better pharmacokinetics. This result may attain because L-nucleosides may not be recognized by enzymes, and therefore may have longer half-lives.

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