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
  • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
  • A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives

Definitions

• the present invention describes novel nitrosated and /or nitrosylated prostaglandins, and novel compositions comprising at least one nitrosated and /or nitrosylated prostaglandin, and, optionally, at least one compound that donates, transfers or releases nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor, stimulates endogenous synthesis of nitric oxide or is a substrate for nitric oxide synthase, and/or at least one vasoactive agent.
• the present invention also provides novel compositions comprising at least one prostaglandin and at least one S-nitrosothiol compound, and, optionally, at least one vasoactive agent.
• the prostaglandin is preferably a prostaglandin E 1 compound, more preferably alprostadil, and the S-nitrosothiol compound is preferably S-nitrosoglutathione.
• the present invention also provides methods for treating or preventing sexual dysfunctions in males and females, for enhancing sexual responses in males and females, and for treating or preventing cerebrovascular disorders, cardiovascular disorders, benign prostatic hyperplasia (BPH), glaucoma, peptic ulcers or for inducing abortions.
• the compounds and/or compositions of the present invention can also be provided in the form of a pharmaceutical kit.
• Adequate sexual function is a complex interaction of hormonal events and psychosocial relationships. There are four stages to sexual response as described in the International Journal of Gynecology & Obstetrics, 51(3):265-277 (1995). The first stage of sexual response is desire. The second stage of sexual response is arousal. Both physical and emotional stimulation may lead to breast and genital vasodilation and clitoral engorgement (vasocongestion). In the female, dilation and engorgement of the blood vessels in the labia and tissue surrounding the vagina produce the "orgasmic platform," an area at the distal third of the vagina where blood becomes sequestered. Localized perivaginal swelling and vaginal lubrication make up the changes in this stage of sexual response.
• sexual dysfunction can include, for example, sexual pain disorders, sexual desire disorders, sexual arousal dysfunction, orgasmic dysfunction, dyspareunia, and vaginismus.
• sexual dysfunction can be caused, for example, by pregnancy, menopause, cancer, pelvic surgery, chronic medical illness or medications.
• some pharmacological methods of treating sexual dysfunctions are available, however, such methods have not proven to be highly satisfactory or without potentially severe side-effects.
• Papaverine now widely used to treat impotence is generally effective in cases where the dysfunction is psychogenic or neurogenic and where severe atherosclerosis is not involved. Injection of papaverine, a smooth muscle relaxant, or phenoxybenzamine, a non-specific antagonist and hypotensive, into corpus cavernosum has been found to cause an erection sufficient for vaginal penetration, however, these treatments are not without the serious and often painful side effect of priapism. Also, in cases where severe atherosclerosis is not a cause of the dysfunction, intracavernosal injection of phentolamine, an -adrenergic antagonist, is used.
• PGE j prostaglandin E j
• CANERJECT® Pharmacia & Upjohn Company, Kalamazoo, MI
• MUSE® Nivus Incorporated, Mountain View, CA
• Nitric oxide has been shown to mediate a number of actions including the bactericidal and tumoricidal actions of macrophages and blood vessel relaxation of endothelial cells. NO and NO donors have also been implicated as mediators of nonvascular smooth muscle relaxation. As described herein, this effect includes the dilation of the corpus cavernosum smooth muscle, an event involved in the sexual response process in both males and females. However, the effects of modified prostagiandins, which are directly or indirectly linked with a nitric oxide adduct, have not been previously investigated.
• One embodiment of the present invention provides novel nitrosated and /or nitrosylated prostagiandins.
• the prostagiandins can be nitrosated and /or nitrosylated through one or more sites such as oxygen (hydroxyl condensation), sulfur (sulfhydryl condensation), carbon and/or nitrogen.
• the present invention also provides compositions comprising a therapeutically effective amount of such compounds in a pharmaceutically acceptable carrier.
• compositions comprising at least one nitrosated and/or nitrosylated prostaglandin, and at least one compound that donates, transfers or releases nitrogen monoxide as a charged species, i.e., nitrosonium (NO + ) or nitroxyl (NO-), or as the neutral species, nitric oxide (NO «), and/or stimulates endogenous production of nitric oxide or EDRF in vivo and/or is a substrate for nitric oxide synthase.
• the present invention also provides for such compositions in a pharmaceutically acceptable carrier.
• compositions comprising at least one nitrosated and/or nitrosylated prostaglandin and at least one vasoactive drug, and, optionally, at least one compound that donates, transfers or releases nitrogen monoxide as a charged species, i.e., nitrosonium (NO + ) or nitroxyl (NO-), or as the neutral species, nitric oxide (NO*), and/or stimulates endogenous production of nitric oxide or EDRF in vivo and /or is a substrate for nitric oxide synthase.
• the invention also provides for such compositions in a pharmaceutically acceptable carrier.
• the present invention provides pharmaceutical compositions comprising at least one prostaglandin and at least one S- nitrosothiol compound, and, optionally, at least one vasoactive drug.
• the prostaglandin is preferably a prostaglandin E x (PGE j ) compound, more preferably alprostadil.
• the S-nitrosothiol compound is a compound that is capable of donating, transferring or releasing nitric oxide.
• the S-nitrosothiol compound is preferably S-nitrosoglutathione.
• the compositions can comprise one or more pharmaceutically acceptable carriers.
• the compositions are preferably in a form that can be administered by intracavernosal injection, by transurethral application, or by topical application.
• Yet another embodiment of the present invention provides methods for treating and/or preventing sexual dysfunctions and/or enhancing sexual responses in patients, including males and females, by administering to a patient in need thereof a therapeutically effective amount of at least one nitrosated and /or nitrosylated prostaglandin and, optionally, at least one compound that donates, transfers or releases nitric oxide as a charged species, i.e., nitrosonium (NO + ) or nitroxyl (NO-), or as the neutral species, nitric oxide (NO»), and/or stimulates endogenous production of nitric oxide or EDRF in vivo and/or is a substrate for nitric oxide synthase.
• nitrosonium NO +
• NO- nitroxyl
• NO neutral species
• the methods can further comprise administering a therapeutically effective amount of at least one vasoactive agent.
• the methods for treating and /or preventing sexual dysfunctions and /or enhancing sexual responses in patients can comprise administering a therapeutically effective amount of at least one nitrosated and/or nitrosylated prostaglandin, at least one vasoactive agent, and, optionally, at least one compound that donates, transfers or releases nitric oxide as a charged species, i.e., nitrosonium (NO + ) or nitroxyl (NO-), or as the neutral species, nitric oxide (NO «), and/or stimulates endogenous production of nitric oxide or EDRF in vivo and /or is a substrate for nitric oxide synthase.
• the nitrosated and/or nitrosylated prostagiandins, nitric oxide donors, and/or vasoactive agents can be administered separately or as components of the same composition in one or more pharmaceutically acceptable carriers.
• Another embodiment of the present invention provides methods for preventing or treating sexual dysfunctions or enhancing sexual responses in patients, including males and females, by administering a therapeutically effective amount of at least one prostaglandin and at least one S-nitrosothiol compound, and, optionally, at least one vasoactive agent.
• the prostaglandin is a prostaglandin ⁇ (PGE j ) compound, more preferably alprostadil.
• the S-nitrosothiol compound is a compound that is capable of donating, transferring or releasing nitric oxide.
• the S-nitrosothiol compound is S-nitrosoglutathione (GS-NO).
• the compounds can be administered separately or as components of the same composition.
• the compounds or compositions are preferably administered from about 1 minute to about 60 minutes prior to sexual activity or sexual intercourse, preferably about 2 minutes to about 20 minutes prior to sexual activity or sexual intercourse, more preferably about 5 minutes to about 10 minutes prior to sexual activity or sexual intercourse, to prevent or treat sexual dysfunctions or to enhance sexual responses in patients.
• the compounds or compositions of the invention are preferably administered by intracavernosal injection, by transurethral application or by topical application.
• the present invention also describes methods to prevent and treat cerebrovascular disorders, cardiovascular disorders, benign prostatic hyperplasia (BPH), glaucoma, peptic ulcers and to induce abortions by administering to a patient in need thereof at least one prostaglandin and at least one S-nitrosothiol compound or by administering at least one nitrosated and/or nitrosylated prostaglandin and, optionally, at least one compound that donates, transfers or releases nitric oxide as a charged species or as a neutral species and /or stimulates endogenous production of nitric oxide or EDRF in vivo.
• These methods may further comprise administering at least one vasoactive agent.
• Fig. 1 is a measurement of cyclic GMP (cGMP) levels in trabecular smooth muscle expressed as picomole of cGMP per milligram of protein.
• the prepared tissues were incubated with (a) vehicle, control (filled bar); (b) 1 ⁇ M PGE- (hatched bar); (c) 100 ⁇ M GS-NO (shaded bar); and (d) combination of 1 ⁇ M FGE 1 and 100 ⁇ M GS-NO (open bar).
• Fig. 2 is a concentration response curve in human corpus cavernosum tissue for PGE j alone and for the combination of PGE ! and GS-NO. Tissues were incubated in a physiological salt solution, bubbled with 95% 0 2 , and treated with increasing concentrations of PGE ! alone (open circles); or increasing concentrations of PGE. in the presence of GS-NO (closed circles). The GS-NO concentration was always 100 times greater than the concentration of PGE r The PGE j was alprostadil.
• the GS-NO concentration was always 100 times greater than the concentration of PGE r
• log M [GS-NO] corresponds to ten fold increases of GS-NO from 0.01 ⁇ M (at -8) to 1000 ⁇ M (at -3).
• Fig. 4 is an analysis of the synergy elicited by the combination of PGE.
• GS-NO in human corpus cavernosum tissue.
• the PGE. was alprostadil. Considering the response obtained with the two compounds individually, the theoretical concentrations required to achieve a specified level of relaxation (i.e., 10%, 20%, 40%, 60% and 70% relaxation) was calculated assuming an additive effect (open circles). The experimental values obtained from Fig. 2 are denoted by closed circles. In the y axis, the concentration of PGE. plus 100 fold GS-NO ranges from 0.01 nM to 1000 nM. P ⁇ 0.05 by ANOVA analysis for the theoretical curve when compared to the experimental curve.
• “Patient” refers to animals, preferably mammals, more preferably humans.
• Transdermal refers to the delivery of a compound by passage through the skin and into the blood stream.
• Transmucosal refers to delivery of a compound by passage of the compound through the mucosal tissue and into the blood stream.
• Poration enhancement refers to an increase in the permeability of the skin or mucosal tissue to a selected -
• pharmacologically active compound such that the rate at which the compound permeates through the skin or mucosal tissue is increased.
• Carriers or “vehicles” refers to carrier materials suitable for compound administration and include any such material known in the art such as, for example, any liquid, gel, solvent, liquid diluent, solubilizer, or the like, which is non-toxic and which does not interact with any components of the composition in a deleterious manner.
• Nitric oxide adduct or “NO adduct” refers to compounds and functional groups which, under physiological conditions, can donate, release and /or directly or indirectly transfer any of the three redox forms of nitrogen monoxide (NO + , NO " , NO«), such that the biological activity of the nitrogen monoxide species is expressed at the intended site of action.
• Nitric oxide releasing or “nitric oxide donating” refers to methods of donating, releasing and /or directly or indirectly transferring any of the three redox forms of nitrogen monoxide (NO + , NO-, NO ⁇ ), such that the biological activity of the nitrogen monoxide species is expressed at the intended site of action.
• Nitric oxide donor or “NO donor” refers to compounds that donate, release and /or directly or indirectly transfer a nitrogen monoxide species, and /or stimulate the endogenous production of nitric oxide or endothelium-derived relaxing factor (EDRF) in vivo and /or elevate endogenous levels of nitric oxide or EDRF in vivo.
• NO donor also includes compounds that are substrates for nitric oxide synthase.
• Alkyl refers to a lower alkyl group, a haloalkyl group, an alkenyl group, an alkynyl group, a bridged cycloalkyl group, a cycloalkyl group or a heterocyclic ring, as defined herein.
• Lower alkyl refers to branched or straight chain acyclic alkyl group comprising one to about ten carbon atoms (preferably one to about eight carbon atoms, more preferably one to about six carbon atoms).
• Exemplary lower alkyl groups include methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, t-butyl, pentyl, neopentyl, iso-amyl, hexyl, octyl, and the like.
• Haloalkyl refers to a lower alkyl group, an alkenyl group, an alkynyl group, a bridged cycloalkyl group, a cycloalkyl group or a heterocyclic ring, as defined herein, to which is appended one or more halogens, as defined herein.
• exemplary haloalkyl groups include trifluoromethyl, chloromethyl, 2- bromobutyl, l-bromo-2-chloro-pentyl, and the like.
• alkenyl refers to a branched or straight chain C 2 -C 10 hydrocarbon (preferably a C 2 -C 8 hydrocarbon, more preferably a C 2 -C 6 hydrocarbon) which can comprise one or more carbon-carbon double bonds.
• alkenyl groups include propylenyl, buten-1-yl, isobutenyl, penten-1-yl, 2,2-methylbuten-l-yl, 3- methylbuten-1-yl, hexan-1-yl, hepten-1-yl, octen-1-yl, and the like.
• Alkynyl refers to an unsaturated acyclic C 2 -C 10 hydrocarbon (preferably a C 2 -C 8 hydrocarbon, more preferably a C 2 -C 6 hydrocarbon) which can comprise one or more carbon-carbon triple bonds.
• exemplary alkynyl groups include ethynyl, propynyl, butyn-1-yl, butyn-2-yl, pentyl-1-yl, pentyl-2-yl, 3-methylbutyn-l-yl, hexyl-1-yl, hexyl-2-yl, hexyl-3-yl, 3,3-dimethyl-butyn-l-yl, and the like.
• Bridged cycloalkyl refers to two or more cycloalkyl groups, heterocyclic groups, or a combination thereof fused via adjacent or non-adjacent atoms.
• Bridged cycloalkyl groups can be unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylairuno, hydroxy, halo, carboxyl, alkylcarboxylic acid, aryl, amidyl, ester, alkylcarboxylic ester, carboxamido, alkylcarboxamido, oxo and nitro.
• Exemplary bridged cycloalkyl groups include adamantyl, decahydronapthyl, quinuclidyl, 2,6- dioxabicyclo[3.3.0]octane, 7-oxabycyclo[2.2.1]heptyl, 8-azabicycio[3,2,l]oct-2-enyl and the like.
• Cycloalkyl refers to a saturated or unsaturated cyclic hydrocarbon comprising from about 3 to about 8 carbon atoms. Cycloalkyl groups can be unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, arylamino, diarylamino, alkylarylamino, aryl, amidyl, ester, hydroxy, halo, carboxyl, alkylcarboxylic acid, alkylcarboxylic ester, carboxamido, alkylcarboxamido, oxo and nitro.
• Exemplary cycloalkyl groups include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cyclohexenyl, cyclohepta,l,3-dienyl, and the like.
• Heterocyclic ring or group refers to a saturated, unsaturated, cyclic or aromatic or polycyclic hydrocarbon group having about 3 to about 12 carbon atoms (preferably about 4 to about 6 carbon atoms) where 1 to about 4 carbon atoms are replaced by one or more nitrogen, oxygen and/or sulfur atoms. Sulfur maybe in the thio, sulfinyl or sulfonyl oxidation state.
• the heterocyclic ring or group can be fused to an aromatic hydrocarbon group.
• Heterocyclic groups can be unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, arylamino, diarylamino, alkylarylamino, hydroxy, oxo, thial, halo, carboxyl, carboxylic ester, alkylcarboxylic acid, alkylcarboxylic ester, aryl, arylcarboxylic acid, arylcarboxylic ester, amidyl, ester, carboxamido, alkylcarboxamido, arylcarboxamido, sulfonic acid, sulfonic ester, sulfonamido and nitro.
• heterocyclic groups include pyrrolyl, 3-pyrrolinyl,4,5,6-trihydro-2H-pyranyl, pyridinyl, 1,4- dihydropyridinyl, pyrazolyl, triazolyl, pyrimidinyl, pyridazinyl, oxazolyl, thiazolyl, imidazolyl, indolyl, thiophenyl, furanyl, tetrhydrofuranyl, tetrazolyl, 2- pyrrolinyl, 3-pyrrolinyl, pyrrolindinyl, oxazolindinyl 1,3-dioxolanyl, 2,6- dioxabicyclo[3,3,0]octanyl, 2-imidazonlinyl, imidazolindinyl, 2-pyrazolinyl, pyrazolidinyl, isoxazolyl, isothiazolyl, 1,2,3-oxadiazolyl
• Heterocyclic compounds refer to mono- and polycyclic compounds comprising at least one aryl or heterocyclic ring.
• Aryl refers to a monocyclic, bicyclic, carbocyclic or heterocyclic ring system comprising one or two aromatic rings.
• exemplary aryl groups include phenyl, pyridyl, napthyl, quinoyl, tetrahydronaphthyl, furanyl, indanyl, indenyl, indoyl, and the like.
• Aryl groups can be unsubstituted or substituted with one, two or three substituents independently selected from alkyl, alkoxy, amino, alkylamino, dialkylamino, arylamino, diarylamino, alkylarylamino, hydroxy, carboxyl, carboxylic ester, alkylcarboxylic acid, alkylcarboxylic ester, aryl, arylcarboxylic acid, arylcarboxylic ester, alkylcarbonyl, arylcarbonyl, amidyl, ester, carboxamido, alkylcarboxamido, carbomyl, sulfonic acid, sulfonic ester, sulfonamido and nitro.
• Exemplary substituted aryl groups include tetrafluorophenyl, pentafluorophenyl, sulfonamide, alkylsulfonyl, arylsulfonyl, and the like.
• Alkylaryl refers to an alkyl group, as defined herein, to which is appended an aryl group, as defined herein.
• Exemplary alkylaryl groups include benzyl, phenylethyl, hydroxybenzyl, fluorobenzyl, fluorophenylethyl, and the like.
• Arylalkyl refers to an aryl radical, as defined herein, attached to an alkyl radical, as defined herein.
• Cycloalkylalkyl refers to a cycloalkyl radical, as defined herein, attached to an alkyl radical, as defined herein.
• Heterocyclicalkyl refers to a heterocyclic ring radical, as defined herein, attached to an alkyl radical, as defined herein.
• Cycloalkenyl refers to an unsaturated cyclic hydrocarbon having about 3 to about 10 carbon atoms (preferably about 3 to about 8 carbon atoms, more preferably about 3 to about 6 carbon atoms) comprising one or more carbon- carbon double bonds.
• Arylheterocyclic ring refers to a bi- or tricyclic ring comprised of an aryl ring, as defined herein, appended via two adjacent carbon atoms of the aryl ring to a heterocyclic ring, as defined herein. Exemplary arylheterocyclic rings include dihydroindole, 1, 2,3,4- tetra-hydroquino line, and the like.
• Alkoxy refers to R 50 O-, wherein R 50 is an alkyl group, as defined herein.
• exemplary alkoxy groups include methoxy, ethoxy, t-butoxy, cyclopentyioxy, and the like.
• Arylalkoxy or alkoxyaryl refers to an alkoxy group, as defined herein, to which is appended an aryl group, as defined herein.
• exemplary arylalkoxy groups include benzyloxy, phenylethoxy, chlorophenylethoxy, and the like.
• Alkoxyalkyl refers to an alkoxy group, as defined herein, appended to an alkyl group, as defined herein.
• Exemplary alkoxyalkyl groups include methoxymethyl, methoxyethyl, isopropoxymethyl, and the like.
• Alkoxyhaloalkyl refers to an alkoxy group, as defined herein, appended to a haloalkyl group, as defined herein.
• exemplary alkoxyhaloalkyl groups include 4- methoxy-2-chlorobutyl and the like.
• Cycloalkoxy refers to R 54 0-, wherein Rg 4 is a cycloalkyl group or a bridged cycloalkyl group, as defined herein.
• Exemplary cycloalkoxy groups include cyclopropyloxy, cyclopentyioxy, cyclohexyloxy, and the like.
• Haloalkoxy refers to a haloalkyl group, as defined herein, to which is appended an alkoxy group, as defined herein.
• Exemplary haloalkyl groups include 1,1,1-trichloroethoxy, 2-bromobutoxy, and the like.
• Oxy refers to -O R 77 wherein R 77 is an organic or inorganic cation.
• Organic cation refers to a positively charged organic ion.
• exemplary organic cations include alkyl substituted ammonium cations, and the like.
• Inorganic cation refers to a positively charged metal ion.
• Exemplary inorganic cations include Group I metal cations such as for example, sodium, potassium, and the like.
• Hydroalkyl refers to a hydroxy group, as defined herein, appended to an alkyl group, as defined herein.
• Amino refers to -NH 2 .
• Nirate refers to -0-N0 2 .
• Nirite refers to -O-NO.
• Thionitrate refers to -S-N0 2 .
• Niro refers to the group -N0 2 and “nitrosated” refers to compounds that have been substituted therewith.
• Niroso refers to the group -NO and “nitrosylated” refers to compounds that have been substituted therewith.
• Halogen or “halo” refers to iodine (I), bromine (Br), chlorine (Cl), and /or fluorine (F).
• Alkylamino refers to R 50 NH-, wherein R 50 is an alkyl group, as defined herein.
• exemplary alkylamino groups include methylamino, ethylamino, butylamino, cyclohexylamino, and the like.
• Arylamino refers to R 55 NH-, wherein R 55 is an aryl group, as defined herein.
• Dialkylamino refers to R 50 R 52 N-, wherein R 50 and R 52 are each independently an alkyl group, as defined herein.
• Exemplary dialkylamino groups include dimethylamino, diethylamino, methyl propargylamino, and the like.
• Diarylamino refers to R 55 R 60 N-, wherein R 55 and R 60 are each independently an aryl group, as defined herein.
• Alkylarylamino refers to R 50 R 55 N-, wherein R 50 is an alkyl group, as defined herein, and R 55 is an aryl group, as defined herein.
• Aminoalkyl refers to an amino group, an alkylamino group, a dialkylamino group, an arylamino group, a diarylamino group, an alkylarylamino group or a heterocyclic ring, as defined herein, to which is appended an alkyl group, as defined herein.
• Aminoaryl refers to an amino group, an alkylamino group, a dialkylamino group, an arylamino group, a diarylamino group, an alkylarylamino group or a heterocyclic ring, as defined herein, to which is appended an aryl group, as defined herein.
• Method refers to -C(S)-.
• Sulfonic acid refers to -S(0) 2 OR 76 , wherein R ⁇ is a hydrogen, an organic cation or an inorganic cation.
• Alkylsulfonic acid refers to a sulfonic acid group, as defined herein, appended to an alkyl group, as defined herein.
• Arylsulfonic acid refers to an sulfonic acid group, as defined herein, appended to an aryl group, as defined herein
• Sulfonic ester refers to -S(0) 2 OR 58 , wherein R 58 is an alkyl group, an aryl group, an alkylaryl group or an aryl heterocyclic ring, as defined herein.
• “Sulfonamido” refers to -S(0) 2 -N(R 51 )(R 57 ), wherein R 51 and R ⁇ are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein, and R 51 and Rs 7 when taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein.
• Alkylsulfonamido refers to a sulfonamido group, as defined herein, appended to an alkyl group, as defined herein.
• Arylsulfonamido refers to a sulfonamido group, as defined herein, appended to an aryl group, as defined herein.
• Alkylthio refers to R 50 S-, wherein R 50 is an alkyl group, as defined herein.
• Arylthio refers to R 55 S-, wherein R S5 is an aryl group, as defined herein.
• Cycloalkylthio refers to R 54 S-, wherein R 54 is a cycloalkyl group or a bridged cycloalkyl group, as defined herein.
• exemplary cycloalkylthio groups include cyclopropylthio, cyclopentylthio, cyclohexylthio, and the like.
• Alkylsulfinyl refers to R 50 -S(O)-, wherein R 50 is an alkyl group, as defined herein.
• Alkylsulfonyl refers to R 50 -S(O) 2 -, wherein R 50 is an alkyl group, as defined herein.
• Arylsulfinyl refers to R 55 -S(0)-, wherein R 55 is an aryl group, as defined herein.
• Arylsulfonyl refers to R 55 -S(0) 2 -, wherein R 55 is an aryl group, as defined herein.
• “Amidyl” refers to R 51 C(0)N(R 57 )- wherein R 51 and R 57 are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein.
• “Ester” refers to R 51 C(0)0- wherein R 51 is a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein.
• Carbamoyl refers to -0-C(0)N(R 51 )(R 57 ), wherein R 51 and R ⁇ are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group or an arylheterocyclic ring, as defined herein, or R 51 and R g7 taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein.
• “Carbamate” refers to R 51 0-C(0)N(R 57 ), wherein R 51 and R ⁇ are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group or an arylheterocyclic ring, as defined herein, or R 51 and R 57 taken together are a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein.
• Carboxyl refers to -C(0)OR 76 , wherein R 76 is a hydrogen, an organic cation or an inorganic cation, as defined herein.
• Carbonyl refers to -C(O)-.
• Alkylcarbonyl or “alkanoyl” refers to R 50 -C(O)-, wherein R 50 is an alkyl group, as defined herein.
• Arylcarbonyl or “aroyl” refers to R 55 -C(0)-, wherein R 55 is an aryl group, as defined herein.
• Carboxylic ester refers to - OJOR ⁇ , wherein R j g is an alkyl group, an aryl group, an alkylaryl group or an aryl heterocyclic ring, as defined herein.
• Alkylcarboxylic acid and “alkylcarboxyl” refer to an alkyl group, as defined herein, appended to a carboxyl group, as defined herein.
• Alkylcarboxylic ester refers to an alkyl group, as defined herein, appended to a carboxylic ester group, as defined herein.
• Arylcarboxylic acid refers to an aryl group, as defined herein, appended to a carboxyl group, as defined herein.
• Arylcarboxylic ester and “arylcarboxyl” refer to an aryl group, as defined herein, appended to a carboxylic ester group, as defined herein.
• Carboxamido refers to -C(0)N(R 51 )(R 57 ), wherein R ⁇ and R 57 are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group or an arylheterocyclic ring, as defined herein, and R 51 and R ⁇ when taken together with the nitrogen to which they are attached form a heterocyclic ring, a cycloalkyl group or a bridged cycloalkyl group, as defined herein.
• Alkylcarboxamido refers to an alkyl group, as defined herein, appended to a carboxamido group, as defined herein.
• Arylcarboxamido refers to an aryl group, as defined herein, appended to a carboxamido group, as defined herein.
• “Urea” refers to -N(R 59 )-C(0)N(R 51 )(R 57 ) wherein R 51 , R ⁇ , and R 59 are each independently a hydrogen atom, an alkyl group, an aryl group, an alkylaryl group, or an arylheterocyclic ring, as defined herein, or R 51 and R 57 taken together with the nitrogen to which they are attached form a heterocyclic ring, as defined herein.
• Phosphoryl refers to -P(R 70 )(R 71 )(R 72 ), wherein R 70 is a lone pair of electrons, sulfur or oxygen, and R 71 and R 72 are each independently a covalent bond, a hydrogen, a lower alkyl, an alkoxy, an alkylamino, a hydroxy or an aryl, as defined herein.
• the term "sexual dysfunction” generally includes any sexual dysfunction in a patient, including an animal, preferably a mammal, more preferably a human. The patient can be male or female. Sexual dysfunctions can include, for example, sexual desire disorders, sexual arousal disorders, orgasmic disorders and sexual pain disorders.
• Female sexual dysfunction refers to any female sexual dysfunction including, for example, sexual desire disorders, sexual arousal dysfunctions, orgasmic dysfunctions, sexual pain disorders, dyspareunia, and vaginismus.
• the female can be pre-menopausal or menopausal.
• Male sexual dysfunction refers to any male sexual dysfunctions including, for example, male erectile dysfunction and impotence.
• the present invention is directed to the treatment and /or prevention of sexual dysfunctions in patients, including males and females, by administering the compounds and compositions described herein.
• the present invention is also directed to improving and/or enhancing sexual responses in patients, including males and females, by administering the compounds and /or compositions described herein.
• the novel compounds and novel compositions of the present invention are described in more detail herein.
• Contemplated prostagiandins for use in the present invention include, for example, naturally occurring prostagiandins such as, for example, PGE 0 , PGE j , PGA PGB ⁇ PGF profession PGF 2 , PGE l ⁇ , 19-hydroxy-PGA j , 19-hydroxy-PGB,, PGE 2 , PGA 2 , PGB 2 , 19-hydroxy-PGA 2 , 19-hydroxy-PGB 2 , PGE 3 , PGF 3 , PGD 2 , PGI 2 , prostacyclins, thromboxanes, leukotrienes, 6-keto-PGE j derivatives and carbacyclin derivatives; or semisynthetic or synthetic derivatives of natural prostagiandins, including, but not limited to, carboprost tromethamine, dinoprost tromethamine, dinoprostone, gemeprost, metenoprost, sulprostone and triprost.
• hydroxy derivatives of PGE 2 including, for example, 19-OH-PGE 2 , 18-OH- PGE 2 ,20-OH-PGE 2 and the salts and esters thereof as disclosed in WO 99/02164, the disclosure of which is incorporated by reference herein in its entirety.
• prostaglandin compound for use in the present invention include isoprostanes, such as 8-iso-PGE 2 ⁇ / 8-iso-PGE 2 , iPF 2 ⁇ -VI, 12-iso-PGF 2 ⁇ and the like, as described by, for example, Rokach et al Prostagiandins, 54: 823-851, (1997) and Rokach et al, Prostagiandins, 54: 853-873, (1997), the disclosure of which is incorporated by reference herein in its entirety.
• isoprostanes such as 8-iso-PGE 2 ⁇ / 8-iso-PGE 2 , iPF 2 ⁇ -VI, 12-iso-PGF 2 ⁇ and the like, as described by, for example, Rokach et al Prostagiandins, 54: 823-851, (1997) and Rokach et al, Prostagiandins, 54: 853-873, (1997), the disclosure of which is incorporated by reference herein in its entirety.
• PGE j compounds include, but are not limited to, alprostadil, misoprostol and enprostil and their ⁇ -cyclodextrin complexes. All the prostagiandins described herein can be nitrosated and /or nitrosylated following the methods described herein.
• Sources of information for the above compounds include Goodman and Gilman, The Pharmacological Basis of Therapeutics (9th Ed.), McGraw-Hill, Inc. (1996), The Physician's Desk Reference (49th Ed.), Medical Economics (1995), Drug Facts and Comparisons (1993 Ed), Facts and Comparisons (1993), Merck Index on CD-ROM, Twelfth Edition, Version 12:1, (1996), STN Express, file phar and file registry, the disclosures of each of which are incorporated herein by reference in their entirety.
• a principal aspect of the present invention relates to novel nitrosated and /or nitrosylated prostagiandins having formula (I):
• R ⁇ is -OD j or -Cl
• R 7 is a hydrogen or -OD ⁇
• R 9 is hydrogen or absent when the carbon to which it is attached is the central carbon of an allene functionality; or R 8 and Rg taken together with the chain to which they are attached form a substituted benzene ring with the proviso that R ⁇ is an oxygen atom which is attached to the carbon atom at the position of the benzene ring defined by B;
• X is -CH 2 OR n , -C(0)OR n or -C(0)N(D.)R 12 ;
• R ⁇ is D j , a lower alkyl group, or
• R 12 is -S(0) 2 CH 3 or -C(0)CH 3 ;
• Z is (a) an ethyl, (b) a butyl, (c) a hexyl, (d) a benzyl,
• R 13 is a hydrogen or -Cl
• D- is a hydrogen or D; with the proviso that at least one D ⁇ in formula (I) must be D; D is Q or K; Q is -NO or -N0 2 ;
• K is -W a -E b -(C(R e )(R f )) p -E c -(C(R e )(R f )) x -W d -(C(R e )(R f )) y -W E r W g -(C(R e )(R f )) z - T-Q; with the proviso that when X is -0(0)00, and O ⁇ is K, then K is not an alkyl, branched alkyl or cycloalkyl mononitrate; a benzoic acid substituted benzyloxy mononitrate; an ethylene glycol mononitrate; a polyethylene glycol mononitrate; the regioisomeric esters of glycerol dinitrate and oligomers thereof as disclosed in WO 98/58910; a, b, c, d, g, i
• h is an integer form 1 to 10
• q is an integer from 1 to 5;
• R e and R f are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, an alkylamino, a dialkylamino, an arylamino, a diarylamino, an alkylarylamino, an alkoxyhaloalkyl, a haloalkoxy, a sulfonic acid, a sulfonic ester, an alkylsulfonic acid, an arylsulfonic acid, an arylalkoxy, an alkylthio, an arylthio, a cycloalkylthio, a cycloalkenyl, a cyano,
• T at each occurrence is independently a covalent bond, a carbonyl, an oxygen, -S(O) 0 - or -N(R a )R,-; o is an integer from 0 to 2; R a is a lone pair of electrons, a hydrogen or an alkyl group;
• R is a hydrogen, an alkyl, an aryl, an alkylcarboxylic acid, an arylcarboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, -CH 2 -C(T-Q)(R e )(R f ), or -(N 2 0 2 -) " «M + , wherein M + is an organic or inorganic cation; with the proviso that when R.
• the "-T- Q" subgroup can be a hydrogen, an alkyl, an alkoxy, an alkoxyalkyl, an aminoalkyl, a hydroxy, a heterocyclic ring or an aryl group.
• R e and R f are a heterocyclic ring or R e and R f taken together with the carbon atoms to which they are attached are a heterocyclic ring, then R, can be a substituent on any disubstituted nitrogen contained within the radical where R. is as defined herein.
• the acid of the compound of formula 1 is converted into the ester of the formula 2 by reaction with an appropriate monoprotected diol.
• Preferred methods for the preparation of esters are forming the mixed anhydride via reaction of the acid with a chloroformate, such as isobutylchloroformate, in the presence of a non-nucleophilic base, such as triethylamine, in an anhydrous inert solvent, such as dichloromethane, diethylether or THF.
• a chloroformate such as isobutylchloroformate
• a non-nucleophilic base such as triethylamine
• an anhydrous inert solvent such as dichloromethane, diethylether or THF.
• the mixed anhydride is then reacted with the monoprotected alcohol, preferably in the presence of a condensation catalyst, such as 4-dimethylamino pyridine (DMAP).
• DMAP 4-dimethylamino pyridine
• the acid may first be converted to the acid chloride by treatment with oxalyl chloride in the presence of a cata
• the acid chloride is then reacted with the monoprotected alcohol, preferably in the presence of a condensation catalyst, such as DMAP, and a tertiary arnine base, such as triethyl amine, to produce the ester.
• a condensation catalyst such as DMAP
• a tertiary arnine base such as triethyl amine
• the acid and monoprotected diol may be coupled to produce the ester by treatment with a dehydration agent, such as dicyclohexylcarbodiimide (DCC) or l-(3-dimethylaminopropyl)-3- ethylcarbodiimide hydrochloride (EDAC-HC1) with or without a condensation catalyst, such as DMAP or 1-hydroxybenzotriazole (HOBt).
• DCC dicyclohexylcarbodiimide
• EDAC-HC1 l-(3-dimethylaminopropyl)-3- ethylcar
• the acid may first be converted into an alkali metal salt, such as the sodium, potassium or lithium salt, and reacted with an alkyl halide that also contains a protected hydroxyl group in a polar solvent, such as DMF, to produce the ester.
• alkali metal salt such as the sodium, potassium or lithium salt
• an alkyl halide that also contains a protected hydroxyl group in a polar solvent, such as DMF
• Preferred protecting groups for the alcohol moiety are silyl ethers, such as a trimethylsilyl or a tert-butyldimethylsilyl ether.
• Deprotection of the hydroxyl moiety in the compound of formula 2 (fluoride ion is the preferred method for removing silyl ether protecting groups) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite or nitrosonium tetrafluoroborate, in a suitable anhydrous solvent, such as dichlormethane, THF, DMF or acetonitrile, with or without an amine base, such as pyridine or triethylamine, produces the compound of formula IA.
• a suitable nitrosylating agent such as thionyl chloride nitrite, thionyl dinitrite or nitrosonium tetrafluoroborate
• a suitable anhydrous solvent such as dichlormethane, THF, DMF or acetonitrile
• an amine base such as pyridine or triethylamine
• Preferred methods for the preparation of esters are initially forming the mixed anhydride via reaction of the acid with a chloroformate, such as isobutylchloroformate, in the presence of a non-nucelophilic base, such as triethylamine, in an anhydrous inert solvent, such as diethylether or THF.
• a chloroformate such as isobutylchloroformate
• a non-nucelophilic base such as triethylamine
• an anhydrous inert solvent such as diethylether or THF.
• the mixed anhydride is then reacted with the protected thiol-containing alcohol, preferably in the presence of a condensation catalyst, such as DMAP.
• the acid may first be converted to the acid chloride by treatment with oxalyl chloride in the presence of a catalytic amount of DMF.
• the acid chloride is then reacted with the protected thiol containing alcohol, preferably in the presence of a condensation catalyst, such as DMAP, and a tertiary amine base, such as triethyl amine, to produce an ester.
• a condensation catalyst such as DMAP
• a tertiary amine base such as triethyl amine
• the appropriate acid and protected thiol-containing alcohol may be coupled to produce the ester by treatment with a dehydration agent, such as DCC or EDAC-HC1, with or without a condensation catalyst, such as DMAP or HOBt.
• the acid may first be converted into an alkali metal salt, such as the sodium, potassium or lithium salt, which is then reacted with an alkyl halide which also contains a protected thiol group in a polar solvent, such as DMF, to produce the ester.
• an alkali metal salt such as the sodium, potassium or lithium salt
• an alkyl halide which also contains a protected thiol group in a polar solvent, such as DMF
• Preferred protecting groups for the thiol moiety are as a thioester, such as thioacetate or thiobenzoate, as a disulfide, as a thiocarbamate, such as N-methoxymethyl thiocarbamate, or as a thioether, such as paramethoxybenzyl thioether, a 2,4,6-trimethoxybenzyl thioether, a tetrahydropyranyl thioether, or a S-triphenylmethyl thioether.
• a thioester such as thioacetate or thiobenzoate
• a disulfide as a thiocarbamate, such as N-methoxymethyl thiocarbamate
• a thioether such as paramethoxybenzyl thioether, a 2,4,6-trimethoxybenzyl thioether, a tetrahydropyranyl thioether, or
• aqueous base or sodium methoxide in methanol is typically used to hydrolyze thioesters, aqueous base removes N-methoxymethyl thiocarbamates and mercuric trifluoroacetate, silver nitrate or strong acids such as trifluoroacetic or hydrochloric acid and heat are used to remove a paramethoxybenzyl thioether, 2,4,6-trimethoxybenzyl thioether, a tetrahydropyranyl thioether or a S-triphenylmethyl thioether group) followed by reaction with a suitable nitrosylating agent, such as thionyl chloride nitrite, thionyl dinitrite, a lower alkyl nitrite,
• the appropriate acid of the compound of formula 1 is converted into the ester of the formula IC by reaction with an appropriate nitrate containing alcohol.
• Preferred methods for the preparation of esters are initially forming the mixed anhydride via reaction of the acid with a chloroformate, such as isobutylchloroformate, in the presence of a non-nucelophilic base, such as triethylamine, in an anhydrous inert solvent, such as diethylether or THF.
• a chloroformate such as isobutylchloroformate
• a non-nucelophilic base such as triethylamine
• an anhydrous inert solvent such as diethylether or THF.
• the mixed anhydride is then reacted with the nitrate containing alcohol, preferably in the presence of a condensation catalyst, such as DMAP.
• the acid may first be converted to the acid chloride by treatment with oxalyl chloride in the presence of a catalytic amount of DMF.
• the acid chloride is then reacted with the protected thiol containing alcohol, preferably in the presence of a condensation catalyst, such as DMAP, and a tertiary amine base, such as triethyl amine, to produce an ester.
• a condensation catalyst such as DMAP
• a tertiary amine base such as triethyl amine
• the appropriate acid and protected thiol-containing alcohol may be coupled to produce the ester by treatment with a dehydration agent, such as DCC or EDAC ⁇ Cl with or without a condensation catalyst, such as DMAP or HOBt.
• the compounds of the present invention include prostagiandins, such as those described herein, which have been nitrosated and/or nitrosylated through one or more sites such as oxygen (hydroxyl condensation), sulfur (sulfhydryl condensation), carbon and/or nitrogen.
• the nitrosated and/or nitrosylated prostagiandins of the present invention are capable of donating, transfering and/or releasing a biologically active form of nitrogen monoxide (i.e., nitric oxide).
• Nitrogen monoxide can exist in three forms: NO- (nitroxyl), NO* (uncharged nitric oxide) and NO + (nitrosonium).
• NO # is a highly reactive shortlived species that is potentially toxic to cells. This is critical because the pharmacological efficacy of NO depends upon the form in which it is delivered.
• NO nitric oxide radical
• NO + nitrosonium
• NO + does not react with 0 2 or 0 2 " species, and functionalities capable of transferring and/or releasing NO + and NO- are also resistant to decomposition in the presence of many redox metals. Consequently, administration of charged NO equivalents (positive and /or negative) is a more effective means of delivering a biologically active NO to the desired site of action.
• nitric oxide and compounds that release nitric oxide i.e., compounds that release nitric oxide or otherwise directly or indirectly deliver or transfer nitric oxide to a site of its activity, such as on a cell membrane, and /or elevate or stimulate production of endogenous nitric oxide or EDRF in vivo and /or is a substrate for nitric oxide synthase.
• “In combination” as used herein can mean that (i) the nitrosated and /or nitrosylated prostaglandin and nitric oxide donor can be present together in the same composition; (ii) the nitrosated and /or nitrosylated prostaglandin and nitric oxide donor can be administered separately; and /or (iii) the nitrosated and /or nitrosylated prostaglandin and nitric oxide donor can be together in the form of a kit.
• nitric oxide encompasses uncharged nitric oxide (NO » ) and charged nitrogen monoxide species, preferably charged nitrogen monoxide species, such as nitrosonium ion (NO + ) and nitroxyl ion (NO-).
• the reactive form of nitric oxide can be provided by gaseous nitric oxide.
• the nitrogen monoxide releasing, delivering or transferring compounds include any and all such compounds which provide nitrogen monoxide to its intended site of action in a form active for its intended purpose.
• NO adducts encompasses any nitrogen monoxide releasing, delivering or transferring compounds, including, for example, S-nitrosothiols, nitrites, nitrates, S-nitrothiols, sydnonimines, 2-hydroxy-2-nitrosohydrazines (NONOates), (E)-alkyl-2-[(E)- hydroxyimino]-5-nitro-3-hexene amines or amides, nitrosoamines, furoxans as well as substrates for the endogenous enzymes which synthesize nitric oxide.
• the "NO adducts" can be mono-nitrosylated, poly-nitrosylated, mono-nitrosated and /or poly-nitrosated or a combination thereof at a variety of naturally susceptible or artificially provided binding sites for biologically active forms of nitrogen monoxide.
• S-nitrosothiols are compounds that include at least one -S-NO group.
• S-nitroso- polypeptides the term “polypeptide” includes proteins and polyamino acids that do not possess an ascertained biological function, and derivatives thereof); S- nitrosylated amino acids (including natural and synthetic amino acids and their stereoisomers and racemic mixtures and derivatives thereof); S-nitrosylated sugars; S-nitrosylated, modified and unmodified, oligonucleotides (preferably of at least 5, and more preferably 5-200 nucleotides); straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted S-nitrosylated hydrocarbons; and S-nitroso heterocyclic compounds.
• S-nitroso amino acids where the nitroso group is linked to a sulfur group of a sulfur-containing amino acid or derivative thereof.
• Such compounds include, for example, S-nitroso-N- acetylcysteine, S-nitroso-captopril, S-nitroso-N-acetylpenicillamine, S-nitroso- homocysteine, S-nitroso-cysteine and S-nitroso-glutathione.
• Suitable S-nitrosylated proteins include thiol-containing proteins (where the NO group is attached to one or more sulfur groups on an amino acid or amino acid derivative thereof) from various functional classes including enzymes, such as tissue-type plasminogen activator (TPA) and cathepsin B; transport proteins, such as lipoproteins; heme proteins, such as hemoglobin and serum albumin; and biologically protective proteins, such as immunoglobulins, antibodies and cytokines.
• TPA tissue-type plasminogen activator
• cathepsin B transport proteins, such as lipoproteins; heme proteins, such as hemoglobin and serum albumin; and biologically protective proteins, such as immunoglobulins, antibodies and cytokines.
• nitrosylated proteins are described in WO 93/09806, the disclosure of which is incorporated by reference herein in its entirety. Examples include polynitrosylated albumin where one or more thiol or other nucleophilic centers in the protein are modified.
• S-nitrosothiols include: (i) HS(C(R e )(R f )) m SNO; (ii) ONS(C(R e )(R f )) m R e ; and (iii) H 2 N-CH(C0 2 H)-(CH 2 ) m -C(0)NH-CH(CH 2 SNO)-C(0)NH-CH 2 -C0 2 H; wherein m is an integer from 2 to 20; R e and R f are each independently a hydrogen, an alkyl, a cycloalkoxy, a halogen, a hydroxy, an hydroxyalkyl, an alkoxyalkyl, an arylheterocyclic ring, an alkylaryl, a cycloalkylalkyl, a heterocyclicalkyl, an alkoxy, a haloalkoxy, an amino, an alkylamino, a dialkylamino
• ⁇ is a hydrogen, an alkyl, an aryl, an alkylcarboxylic acid, an aryl carboxylic acid, an alkylcarboxylic ester, an arylcarboxylic ester, an alkylcarboxamido, an arylcarboxamido, an alkylaryl, an alkylsulfinyl, an alkylsulfonyl, an arylsulfinyl, an arylsulfonyl, a sulfonamido, a carboxamido, a carboxylic ester, an amino alkyl, an amino aryl, -CH 2 -C(T-Q)(R e )(R f ), or -(N 2 0 2 -) "# M + , wherein M + is an organic or inorganic cation; with the proviso that when R.
• -T-Q can be a hydrogen, an alkyl group, an alkoxyalkyl group, an aminoalkyl group, a hydroxy group or an aryl group.
• R l can be a substituent on any disubstituted nitrogen contained within the radical wherein R- is as defined herein.
• Nitrosothiols can be prepared by various methods of synthesis. In general, the thiol precursor is prepared first, then converted to the S-nitrosothiol derivative by nitrosation of the thiol group with NaN0 2 under acidic conditions (pH is about 2.5) which yields the S-nitroso derivative. Acids which can be used for this purpose include aqueous sulfuric, acetic and hydrochloric acids.
• the thiol precursor can also be nitrosylated by reaction with an organic nitrite such as tert-butyl nitrite, or a nitrosonium salt such as nitrosonium tetraflurorborate in an inert solvent.
• NO adducts for use in the present invention, where the NO adduct is a compound that donates, transfers or releases nitric oxide, include compounds comprising at least one ON-0-, ON-N- or ON-C- group.
• the compounds that include at least one ON-O-, ON-N- or ON-C- group are preferably ON-O-, ON-N- or ON-C-polypeptides (the term "polypeptide" includes proteins and polyamino acids that do not possess an ascertained biological function, and derivatives thereof); ON-O, ON-N- or ON-C-amino acids (including natural and synthetic amino acids and their stereoisomers and racemic mixtures); ON-O-, ON-N- or ON-C-sugars; ON-O-, ON-N- or ON-C- modified or unmodified oligonucleotides (comprising at least 5 nucleotides, preferably 5-200 nucleotides); ON-O-, ON-N- or
• NO adducts for use in the present invention include nitrates that donate, transfer or release nitric oxide, such as compounds comprising at least one 0 2 N-0-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- group.
• Preferred among these compounds are 0 2 N-0-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- polypeptides (the term "polypeptide” includes proteins and also polyamino acids that do not possess an ascertained biological function, and derivatives thereof); 0 2 N-0-, 0 2 N- N-, 0 2 N-S- or 0 2 N-C- amino acids (including natural and synthetic amino acids and their stereoisomers and racemic mixtures); 0 2 N-0-, 0 2 N-N-, 0 2 N-S- or 0 2 N- C-sugars; 0 2 N-0-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- modified and unmodified oligonucleotides (comprising at least 5 nucleotides, preferably 5-200 nucleotides); 0 2 N-0-, 0 2 N-N-, 0 2 N-S- or 0 2 N
• Preferred examples of compounds comprising at least one 0 2 N-0-, 0 2 N-N-, 0 2 N-S- or 0 2 N-C- group include isosorbide dinitrate, isosorbide mononitrate, clonitrate, erythrityltetranitrate, mannitol hexanitrate, nitroglycerin, pentaerythritoltetranitrate, pentrinitrol and propatylnitrate.
• NO adducts are N-oxo-N-nitrosoamines that donate, transfer or release nitric oxide and are represented by the formula:
• R 1 R 2 -N(0- M + )-NO where R 1 and R 2 are each independently a polypeptide, an amino acid, a sugar, a modified or unmodified oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbon, or a heterocyclic group, and M + is as defined herein.
• R 1 -(S)-N0 2 Another group of NO adducts are thionitrates that donate, transfer or release nitric oxide and are represented by the formula: R 1 -(S)-N0 2 , where R 1 is a polypeptide, an amino acid, a sugar, a modified or unmodified oligonucleotide, a straight or branched, saturated or unsaturated, aliphatic or aromatic, substituted or unsubstituted hydrocarbon, or a heterocyclic group.
• R 1 is a polypeptide or hydrocarbon with a pair or pairs of thiols that are sufficiently structurally proximate, i.e., vicinal, that the pair of thiols will be reduced to a disulfide.
• Compounds which form disulfide species release nitroxyl ion (NO-) and uncharged nitric oxide (NO «).
• the present invention is also directed to compounds that stimulate endogenous NO or elevate levels of endogenous endothelium-derived relaxing factor (EDRF) in vivo or are substrates for the enzyme, nitric oxide synthase.
• Such compounds include, for example, L-arginine, L-homoarginine, and N- hydroxy-L-arginine, including their nitrosated and nitrosylated analogs (e.g., nitrosated L-arginine, nitrosylated L-arginine, nitrosated N-hydroxy-L-arginine, nitrosylated N-hydroxy-L-arginine, nitrosated L-homoarginine and nitrosylated L-homoarginine), precursors of L-arginine and /or physiologically acceptable salts thereof, including, for example, citrulline, ornithine, glutamine, lysine, polypeptides comprising at least one of these amino acids, inhibitors of the enzyme arginas
• EDRF is a vascular relaxing factor secreted by the endothelium, and has been identified as nitric oxide (NO) or a closely related derivative thereof (Palmer et al, Nature, 327:524-526 (1987); Ignarro et al, Proc. Natl. Acad. Sci. USA, 84:9265-9269 (1987)).
• the present invention is also directed to prostagiandins, preferably PGE, compounds, that are used in combination with NO donors, including those described herein, preferably with S-nitrosothiol compounds.
• PGE, compounds include, but are not limited to, alprostadil, misoprostol, misoprostol acid and enprostil, and their cc-cyclodextrin complexes.
• Alprostadil i.e., 7-(5-((lE)(3S)-3- hydroxyoct-l-enyl)(lR,4R,5R)-4-(hydroxy-2-oxocyclopentyl)heptanoic acid
• the most preferred PGE, compound is represented by formula (II):
• Alprostadil can be provided in a free-acid form or in the form of a pharmaceutically acceptable salt, as described herein.
• Alprostadil is commercially available, for example, in the form of a sterile powder for intracavernosal injection under the trade name CAVERTECT® (Pharmacia & Upjohn Company, Kalamazoo, MI) and in the form of a urethral suppository under the trade name MUSE® (Vivus Incorporated, Mountain View, CA).
• the S-nitrosothiol compounds can release nitric oxide or otherwise directly or indirectly deliver or transfer nitric oxide to an intended site of activity, such as on a cell membrane in vivo.
• nitric oxide encompasses uncharged nitric oxide (NO») and charged nitrogen monoxide species, preferably charged nitrogen monoxide species, such as nitrosonium ion (NO + ) and nitroxyl ion (NO-).
• S-nitrosothiol compounds are potent smooth muscle relaxants.
• U.S. Patent No. 5,380,758 discloses the use of S-nitrosothiol compounds for relaxing vascular and non-vascular smooth muscle.
• U.S. Patent No. 5,648,393 discloses the treatment and prevention of male impotence by administering S-nitrosothiol compounds. The disclosures of each of these patents are incorporated herein by reference in their entirety
• S-nitrosothiol compounds include, for example, S-nitrosoglutathione, S-nitroso-N-acetylcysteine, S-nitrosocysteine, S-nitrosohomocysteine, S-nitrosopenicillamine, S-nitrosocaptopril, and the like.
• S-nitrosothiol compound is S-nitrosoglutathione (GS-NO), which is represented by formula (III):
• S-nitrosoglutathione can be provided in a free-acid or free-base form or in the form of a pharmaceutically acceptable salt.
• S-nitrosoglutathione is commercially available from, for example, Sigma Chemical Company (St. Louis, MO); Cayman Chemical (Ann Arbor, MI); Calbiochem-Novabiochem (San Diego, CA); Precision Biochemicals, Inc. (Vancouver, British Columbia); and Toronto Research Chemicals, Inc. (Ontario, Canada).
• S-nitrosoglutathione monomethyl ester is commercially available from, for example, Calbiochem-Novabiochem (San Diego, CA).
• the present invention is also based on the discovery that the administration of a therapeutically effective amount of the compounds and compositions described herein is effective for treating or preventing sexual dysfunctions or enhancing sexual responses in patients, including males and -
• the patient can be administered a therapeutically effective amount of at least one nitrosated and /or nitrosylated prostaglandin of the present invention.
• the patient can be administered a therapeutically effective amount of at least one nitrosated and/or nitrosylated prostaglandin, and at least one compound that donates, transfers or releases nitric oxide, or elevates levels of endogenous EDRF or nitric oxide, or is a substrate for nitric oxide synthase.
• the patient can be administered a therapeutically effective amount of at least one nitrosated and /or nitrosylated prostaglandin, and at least one vasoactive agent, and, optionally, at least one compound that donates, transfers or releases nitric oxide, or elevates levels of endogenous EDRF or nitric oxide, or is a substrate for nitric oxide synthase.
• the compounds can be administered separately or as components of the same composition.
• vasoactive agent is any therapeutic agent capable of relaxing vascular smooth muscle.
• Suitable vasoactive agents include, but are not limited to, potassium channel activators (such as, for example, nicorandil, pinacidil, cromakalim, minoxidil, aprilkalim, loprazolam and the like); calcium channel blockers (such as, for example, nifedipine, verastrial, diltiazem, gallopamil, niludipine, nimodipins, nicardipine.
• potassium channel activators such as, for example, nicorandil, pinacidil, cromakalim, minoxidil, aprilkalim, loprazolam and the like
• calcium channel blockers such as, for example, nifedipine, verastrial, diltiazem, gallopamil, niludipine, nimodipins, nicardipine.
• ⁇ -blockers such as, for example, butixamine, dichloroisoproterenol, propanolol, alprenolol, bunolol, nadolol, oxprenolol, perbutolol, pinodolol, sotalol, timolol, metoprolol, atenolol, acebutolol, bevantolol, pafenolol, tolamodol, and the like); long and short acting ⁇ -adrenergic receptor antagonist (such as, for example, phenoxybenzamide, dibenamine, doxazosin, terazosin, phentolamine, tolazoline, prozosin, trimazosin, yohimbine, moxisylyte and the like); phosphodiesterase inhibitors (such as, for example, papaverine, zaprinast, sildenafil
• neurokinin B neurokinin B, and the like
• dopamine agonists such as, for example, apomorphine, bromocriptine, testosterone, cocaine, strychnine, and the like
• opioid antagonists such as, for example, naltrexone, and the like
• endothelin antagonists such as, for example, bosentan, sulfonamide endothelin antagonists, BQ-123, SQ 28608, and the like
• ⁇ -blocker such as, for example, phentolamine, prazosin, doxazosin, terazosin, yohimbine and/or moxisylyte
• PDE inhibitor such as, for example, papaverine, zaprinast and/or sildenafil.
• Another embodiment of the present invention provides methods for treating and /or preventing sexual dysfunctions and /or enhancing sexual responses in a patient in need thereof by administering to the patient a therapeutically effective amount of at least one prostaglandin and at least one S- nitrosothiol compound, and, optionally, at least one vasoactive agent.
• the compounds can be administered separately or as components of the same composition.
• the prostaglandin can be any prostaglandin described herein, preferably a PGE, compound, more preferably alprostadil.
• the S-nitrosothiol compound can be any S-nitrosothiol compound described herein, preferably S- nitrosoglutathione.
• Patent No. 5,877,216 describes the use of prostagiandins in combination with nitric oxide releasing agents for the treatment of female sexual dysfunction.
• the disclosure of each of these patents, applications and publications is incorporated by reference herein in their entirety. None of these references, however, disclose, suggest or provide motivation to combine a prostaglandin (preferably PGE,, more preferably alprostadil) with an S- nitrosothiol compound (particularly S-nitrosoglutathione) for treating or preventing sexual dysfunctions, and none of these references disclose or suggest the synergistic or superior effects that are unexpectedly achieved by combining a prostaglandin (preferably PGE,, more preferably alprostadil) with an S- nitrosothiol compound (preferably S-nitrosoglutathione) for treating or preventing sexual dysfunctions, as described and claimed herein.
• a prostaglandin preferably PGE, more preferably alprostadil
• S- nitrosothiol compound preferably S-nitroso
• Another embodiment of the present invention provides methods to prevent or treat cerebrovascular disorders (Chemtob et al, Ada Paediatr., 85(5):517-524 (1996), Kadoi et al, Anesth Analg, 85(5):1054-1059 (1997)); cardiovascular disorders (Utoh et al, Int. ⁇ . Angiology, 7(3):228-230 (1998)); benign prostatic hyperplasia (BPH) (Rolland et al, Eur UroL, 7(l):41-45 (1981)), glaucoma (Camras et al, Am.J. Ophthalmol., 126(3):390-399 (1998), Aim, Prog. Retin.
• cerebrovascular disorders Cerhemtob et al, Ada Paediatr., 85(5):517-524 (1996), Kadoi et al, Anesth Analg, 85(5):1054-1059 (1997)
• cardiovascular disorders Utoh et al, Int.
• the patient can be administered a therapeutically effective amount of at least one nitrosated and/or nitrosylated prostaglandin, and at least one compound that donates, transfers or releases nitric oxide, or elevates levels of endogenous EDRF or nitric oxide or is a substrate for nitric oxide synthase.
• the patient can be administered a therapeutically effective amount of at least one nitrosated and/or nitrosylated prostaglandin, and at least one vasoactive agent, and, optionally, at least one compound that donates, transfers or releases nitric oxide, or elevates levels of endogenous EDRF or nitric oxide, or is a substrate for nitric oxide synthase.
• the patient can be administered a therapeutically effective amount of at least one prostaglandin and at least one S- nitrosothiol compound, and, optionally, at least one vasoactive agent.
• the compounds and compositions of the present invention can also be administered in combination with other medications used for the treatment of these disorders.
• the compounds and compositions of the present invention can be administered in combination with pharmaceutically acceptable carriers and in dosages described herein.
• the compounds and compositions of the present invention are administered as a mixture of at least one nitrosated and /or nitrosylated prostaglandin and at least one nitric oxide donor, or at least one prostaglandin and at least one S-nitrosothiol compound, they can also be used in combination with one or more additional compounds which are known to be effective against the specific disease state targeted for treatment (e.g., vasoactive agents).
• additional compounds which are known to be effective against the specific disease state targeted for treatment
• vasoactive agents e.g., vasoactive agents.
• the nitric oxide donor(s), S-nitrosthiol compound and/or vasoactive agents can be administered simultaneously with, subsequently to, or prior to administration of the prostaglandin(s) and /or other additional compound(s).
• the compounds and compositions of the present invention can be administered by any available and effective delivery system including, but not limited to, orally, bucally, parenterally, by inhalation spray, by topical application, by injection into the corpus cavernosum tissue, by transurethral drug delivery, transdermally, vaginally, or rectally (e.g., by the use of suppositories) in dosage unit formulations containing conventional nontoxic pharmaceutically acceptable carriers, adjuvants, and vehicles, as desired.
• Parenteral includes subcutaneous injections, intravenous injections, intramuscular injections, intrasternal injections, and infusion techniques.
• Parenteral also includes injection into the corpus cavernosum tissue, which can be conducted using any effective injection system including, but not limited to, conventional syringe-and-needle systems or needleless injection devices.
• Transdermal drug administration which is known to one skilled in the art, involves the delivery of pharmaceutical agents via percutaneous passage of the drug into the systemic circulation of the patient.
• Topical administration which is well known to one skilled in the art, involves the delivery of pharmaceutical agents via percutaneous passage of the drug into the systemic circulation of the patient.
• Topical administration includes vaginal administration, vulval administration, penile administration and rectal administration. Topical administration can also involve transdermal patches or iontophoresis devices. Other components can be incorporated into the transdermal patches as well.
• compositions and/or transdermal patches can be formulated with one or more preservatives or bacteriostatic agents including, but not limited to, methyl hydroxybenzoate, propyl hydroxybenzoate, chlorocresol, benzalkonium chloride, and the like.
• Topical administration also includes administering the compounds and compositions to the eyes, particularly for the treatment of glaucoma.
• Dosage forms for topical administration of the compounds and compositions of the present invention preferably include creams, sprays, lotions, gels, ointments, emulsions, coatings for condoms, liposomes, foams, and the like.
• Administration of the cream, spray, lotion, gel, ointment, emulsion, coating, liposome, or foam can be accompanied by the use of an applicator or by transurethral drug delivery using a syringe with or without a needle or penile insert or device, or by clitoral, vulval or vaginal delivery, and is within the skill of the art.
• Lubricants include, for example, K-Y jelly (available from Johnson & Johnson) or a lidocaine jelly, such as XYLOCAINE® 2% jelly (available from Astra Pharmaceutical Products).
• Local anesthetics include, for example, novocaine, procaine, tetracaine, benzocaine and the like.
• Solid dosage forms for oral administration can include capsules, tablets, effervescent tablets, chewable tablets, pills, powders, sachets, granules and gels.
• the active compounds can be admixed with at least one inert diluent such as sucrose, lactose or starch.
• inert diluent such as sucrose, lactose or starch.
• Such dosage forms can also comprise, as in normal practice, additional substances other than inert diluents, e.g., lubricating agents such as magnesium stearate.
• the dosage forms can also comprise buffering agents.
• Soft gelatin capsules can be prepared to contain a mixture of the active compounds or compositions of the present invention and vegetable oil.
• Hard gelatin capsules can contain granules of the active compound in combination with a solid, pulverulent carrier such as lactose, saccharose, sorbitol, mannitol, potato starch, corn starch, amylopectin, cellulose derivatives of gelatin. Tablets and pills can be prepared with enteric coatings.
• Liquid dosage forms for oral administration can include pharmaceutically acceptable emulsions, solutions, suspensions, syrups, and elixirs containing inert diluents commonly used in the art, such as water.
• Such compositions can also comprise adjuvants, such as wetting agents, emulsifying and suspending agents, and sweetening, flavoring, and perfuming agents.
• Suppositories for vaginal or rectal administration of the compounds and compositions of the invention can be prepared by mixing the compounds or compositions with a suitable nonirritating excipient such as cocoa butter and polyethylene glycols which are solid at room temperature but liquid at body temperature, such that they will melt and release the drug.
• a suitable nonirritating excipient such as cocoa butter and polyethylene glycols which are solid at room temperature but liquid at body temperature, such that they will melt and release the drug.
• injectable preparations for example, sterile injectable aqueous or oleaginous suspensions can be formulated according to the known art using suitable dispersing agents, wetting agents and/or suspending agents.
• the sterile injectable preparation can also be a sterile injectable solution or suspension in a nontoxic parenterally acceptable diluent or solvent, for example, as a solution in 1,3-butanediol.
• the acceptable vehicles and solvents that can be used are water, Ringer's solution, and is
• compositions of the present invention will typically be administered in a pharmaceutical composition containing one or more carriers or excipients, i.e., pharmaceutically acceptable organic or inorganic carrier substances suitable for parenteral application which do not deleteriously react with the active compounds.
• carriers or excipients i.e., pharmaceutically acceptable organic or inorganic carrier substances suitable for parenteral application which do not deleteriously react with the active compounds.
• Examples of pharmaceutically acceptable carriers include, for example, water, salt solutions, alcohol, silicone, waxes, petroleum jelly, vegetable oils, polyethylene glycols, propylene glycol, liposomes, sugars, gelatin, lactose, amylose, magnesium stearate, talc, surfactants, silicic acid, viscous paraffin, perfume oil, fatty acid monoglycerides and diglycerides, petroethral fatty acid esters, hydroxymethyl-cellulose, polyvinylpyrrolidone, and the like.
• compositions can also include one or more permeation enhancers including, for example, dimethylsulfoxide (DMSO), dimethyl formamide (DMF), N,N-dimethylacetamide (DMA), decylmethylsulfoxide (C10MSO), polyethylene glycol monolaurate (PEGML), glyceral monolaurate, lecithin, 1 -substituted azacycloheptan-2-ones, particularly l-N-dodecylcyclazacylcoheptan-2-ones (available under the trademark AzoneTM from Nelson Research & Development Co., Irvine, CA), alcohols and the like.
• permeation enhancers including, for example, dimethylsulfoxide (DMSO), dimethyl formamide (DMF), N,N-dimethylacetamide (DMA), decylmethylsulfoxide (C10MSO), polyethylene glycol monolaurate (PEGML), glyceral monolaurate, lecithin,
• the pharmaceutical preparations can be sterilized and if desired, mixed with auxiliary agents which do not deleteriously react with the active compounds, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, colorings, flavoring and /or aromatic substances, and the like.
• auxiliary agents which do not deleteriously react with the active compounds
• auxiliary agents which do not deleteriously react with the active compounds, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, colorings, flavoring and /or aromatic substances, and the like.
• auxiliary agents which do not deleteriously react with the active compounds
• lubricants e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osm
• the composition can also contain minor amounts of wetting agents, emulsifying agents and /or pH buffering agents.
• the composition can be a liquid solution, suspension, emulsion, tablet, pill, capsule, sustained release formulation, or powder.
• the composition can be formulated as a suppository, with traditional binders and carriers such as triglycerides.
• Oral formulations can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium carbonate, and the like.
• compositions of the present invention can be formulated as pharmaceutically acceptable salts.
• Pharmaceutically acceptable salts include, for example, alkali metal salts and addition salts of free acids or free bases.
• Suitable pharmaceutically-accep table acid addition salts may be prepared from an inorganic acid or from an organic acid.
• inorganic acids include, but are not limited to, hydrochloric, hydrobromic, hydroiodic, nitric (nitrate salt), nitrous (nitrite salt), carbonic, sulfuric and phosphoric acid and the like.
• organic acids include, but are not limited to, aliphatic, cycloaliphatic, aromatic, heterocyclic, carboxylic and sulfonic classes of organic acids, such as, for example, formic, acetic, propionic, succinic, glycolic, gluconic, lactic, malic, tartaric, citric, ascorbic, glucuronic, maleic, fumaric, pyruvic, aspartic, glutamic, benzoic, anthrar ⁇ lic, mesylic, salicylic, p- hydroxybenzoic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, ethanesulfonic, benzenesulfonic, pantothenic, toluenesulfonic, 2- hydroxyethanesuifonic, sulfanilic, stearic, algenic, ⁇ -hydroxybutyric, cyclohexylaminosulfonic, galacta
• Suitable pharmaceutically-acceptable base addition salts include, but are not limited to, metallic salts made from aluminum, calcium, lithium, magnesium, potassium, sodium and zinc or organic salts made from primary, secondary and tertiary amines, cyclic amines, N,N'-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine (N-methylglucamine) and procaine and the like. All of these salts may be prepared by conventional means from the corresponding compound by reacting, for example, the appropriate acid or base with the compound.
• “Therapeutically effective amount” refers to the amount of the nitrosated and /or nitrosylated prostaglandin, prostaglandin, nitric oxide adduct and /or vascoactive agent which is effective to achieve its intended purpose. While individual patient needs may vary, determination of optimal ranges for effective amounts of each nitric oxide adduct is within the skill of the art.
• the dosage regimen for treating a condition with the compounds and/or compositions of this invention is selected in accordance with a variety of factors, including the type, age, weight, sex, diet and medical condition of the patient, the severity of the dysfunction, the route of administration, pharmacological considerations such as the activity, efficacy, pharmacokinetic and toxicology profiles of the particular compound used, whether a drug delivery system is used, and whether the compound is administered as part of a drug combination and can be adjusted by one skilled in the art.
• the dosage regimen actually employed may vary widely and therefore may deviate from the preferred dosage regimen set forth herein.
• the amount of a given prostaglandin which will be effective in the treatment of a particular dysfunction or condition will depend on the nature of the dysfunction or condition, and can be determined by standard clinical techniques, including reference to Goodman and Gilman, supra; The Physician's Desk Reference, supra; Medical Economics Company, Inc., Oradell, N.J., 1995; and Drug Facts and Comparisons, Inc., St. Louis, MO, 1993.
• the precise dose to be used in the formulation will also depend on the route of administration, and the seriousness of the dysfunction or disorder, and should be decided by the physician and the patient's circumstances.
• the nitrosated and /or nitrosylated prostagiandins of the invention are used at dose ranges and over a course of dose regimen and are administered in the same or substantially equivalent vehicles /carrier by the same or substantially equivalent as their non-nitrosated /nitrosylated counterparts.
• the nitrosated and /or nitrosylated compounds of the invention can also be used in lower doses and in less extensive regimens of treatment.
• the amount of active ingredient that may be combined with the carrier materials to produce a single dosage form will vary depending upon the host treated and the particular mode of administration.
• the usual doses of prostagiandins are about 0.001 mg to 1 mg and preferably 0.01 mg to about 0.1 mg for intracavernosal administration per injection.
• the dose of prostagiandins is about 0.01 mg to about 10 mg, preferably 0.1 mg to 1 mg.
• the dose of prostaglandin is about 0.1 mg to 10 mg.
• the doses of nitric oxide donors in the pharmaceutical composition can be in amounts of about 0.001 mg to about 6 g and the actual amount administered will be dependent on the specific nitric oxide donor.
• the dose is about 2 g/day to about 6 g/day, preferably about 3 g/day, administered orally at least one hour prior to sexual activity.
• Effective doses may be extrapolated from dose-response curves derived from in vitro or animal model test systems and are in the same ranges or less than as described for the commercially available compounds in the Physician's Desk Reference, supra.
• the prostaglandin in combination with an S-nitrosothiol, is administered by intracavernosal injection in an amount of about 1 ⁇ g to about 40 ⁇ g, preferably about 2.5 ⁇ g to about 20 ⁇ g, more preferably about 2.5 ⁇ g to about 10 ⁇ g per injection.
• the dose of prostaglandin, such as alprostadil is about 100 ⁇ g to about 1 mg, preferably about 125 ⁇ g to about 750 ⁇ g.
• the dose of prostaglandin, such as alprostadil is about 1 ⁇ g to about 5 mg, preferably about 20 ⁇ g to about 2 mg.
• the S-nitrosothiol compound such as S- nitrosoglutathione
• intracavernosal injection in an amount of about 10 ⁇ g to about 5 mg, preferably about 100 ⁇ g to about 2 mg, more preferably about 500 ⁇ g to about 2 mg per injection.
• the dose of S-nitrosothiol, such as S-nitrosoglutathione is about 1 mg to about 100 mg, preferably about 20 mg to about 75 mg.
• the dose of S-nitrosothiol, such as S-nitrosoglutathione is about 5 mg to about 1 g, preferably about 10 mg to about 750 mg.
• the prostaglandin such as a PGE,, more particularly alprostadil
• the S-nitrosothiol compound such as S- nitrosoglutathione
• the prostaglandin (such as PGE for the treatment of male sexual dysfunction is administered in the form of a sterile powder
• the S-nitrosothiol compound such as S-nitrosoglutathione
• the powders are separately reconstituted in bacteriostatic water for injection or sterile water, both preserved with benzyl alcohol.
• the prostaglandin and S-nitrosothiol compounds are administered as separate components in the methods of the present invention, they are preferably administered to the patient at about the same time.
• “About the same time” means that within about thirty minutes of administering one compound (e.g., the prostaglandin or the S-nitrosothiol compound) to the patient, the other compound (e.g., S-nitrosothiol compound or the prostaglandin) is administered to the patient.
• “About the same time” also includes simultaneous administration of the compounds.
• the prostaglandin such as PGE,, more particularly alprostadil
• the S-nitrosothiol compound such as S-nitrosoglutathione
• the composition can be in the form of a sterile powder, wherein the powder is reconstituted prior to injection in to the corpus cavernosum.
• the prostaglandin such as alprostadil
• the S- nitrosothiol compound such as S-nitrosoglutathione
• the composition can be in the form of a gel, spray, ointment, cream, emulsion, lotion, solid, solution, suspension, foam, suppository, coating for a condom or liposome composition.
• the compounds and /or compositions of the present invention can be administered on a regular basis (e.g., daily), they are preferably administered as a single dose prior to sexual activity or sexual intercourse.
• Such single dose administration prior to sexual activity or sexual intercourse allows for the prevention and /or treatment of a sexual dysfunction in a patient and /or enhances sexual responses in a patient.
• the compounds and/or compositions are generally administered about 1 minute to about 60 minutes prior to sexual activity or sexual intercourse; preferably about 2 minutes to about 20 minutes prior to sexual activity or sexual intercourse; more preferably about 5 minutes to about 10 minutes prior to sexual activity or sexual intercourse.
• kits comprising one or more containers filled with one or more of the ingredients of the pharmaceutical compounds and /or compositions of the present invention, including, at least one nitrosated and /or nitrosylated prostaglandin, and one or more of the NO donors, and one or more vasoactive agents described herein.
• kits can also include, for example, other compounds and /or compositions (e.g., permeation enhancers, lubricants, and the like), a device(s) for administering the compounds and/or compositions, and written instructions in a form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals or biological products, which instructions can also reflects approval by the agency of manufacture, use or sale for human administration.
• PGE (specifically alprostadil or 7-[5-((lE)(3S)-3-hydroxyoct- l-enyl)(lR,4R,5R)-4-(hydroxy-2-oxocyclopentyl)heptanoate) was obtained from Upjohn (Belgium) for Example 1 to 7 and from Cayman Chemical (Ann Arbor, MI) for Example 8 to 14.
• GS-NO was prepared according to Example 1. The drugs were dissolved in distilled water, except PGE, which was dissolved at a concentration of 10 mM in ethanol. Dilutions were made in distilled water at the time of the experiment.
• Glutathione (N-(N-L- ⁇ -glutamyl-L-cysteinyl)glycine) (100 g, 0.325 mol) was dissolved in deoxygenated water (200 ml) and 2N HCI (162 ml) at room temperature and then the reaction mixture was cooled to 0 °C. With rapid stirring, a solution of sodium nitrite (24.4 g, 0.35 mol) in water (40 ml) was added. Stirring with cooling of the reaction mixture was continued for approximately 1 hour, after which time the pink precipitate which formed was collected by vacuum filtration. The filter cake was resuspended in chilled 40% acetone-water (600 ml) and collected by vacuum filtration.
• Tissues were maintained at 4-6 °C in M-400 solution (composition per 100 ml: mannitol, 4.19 g; KH 2 P0 4 , 0.205 g; K 2 HP0 4 .3H 2 0, 0.97 g; KC1, 0.112 g; NaHCO,, 0.084 g) until used.
• Corpus cavernosum tissues were typically used between 2 and 16 hours from extraction.
• Example 3 Measurement of cGMP in Human Corpus Cavernosum Tissues
• Tissues were incubated for another 5 minutes then immediately frozen in liquid nitrogen and stored at -80 °C until extraction for cyclic nucleotide assay.
• Tissues were extracted by homogenization in 6% trichloroacetic acid followed by ether (H 2 0-saturated) extraction and lyophilization.
• cGMP levels were determined by ELISA using a kit from Cayman Chemical (Ann Arbor, MI).
• Protein concentration in the corpus cavernosum tissue was determined using the Bio-Rad Protein Assay Kit microtiter plate assay procedure (Bio-Rad, Hercules, CA) with bovine serum albumin as the standard.
• the measured concentrations of cGMP in picomoles were normalized based on milligrams of protein to provide a valid comparison between each tissue sample.
• Statistical analysis were conducted using one way ANOVA analysis followed by Student-Newmann-Keuls post-hoc test using GraphPad InStat software for Apple computers.
• the human corpus cavernosum tissue samples are capable of producing cGMP without the addition of a drug or other stimulating agent (Control).
• Addition of 1 ⁇ M PGE, alone did not produce a significant amount of cGMP when compared to the control.
• Addition of either 100 ⁇ M GS- NO alone or the combination of 1 ⁇ M PGE, and 100 ⁇ M GS-NO resulted in the production of increased amounts of cGMP. This increased amount of cGMP production was demonstrated to be statistically significant compared to the control samples.
• Concentration response relaxation studies of human corpus cavernosum tissues were conducted as follows. Corpus cavernosal tissue strips (3 x 3 x 7 mm), obtained as described in Example 2, were immersed in a 8 ml organ chamber containing physiological salt solution, maintained at 37 °C and aerated with 5% C0 2 /95% air, pH 7.4. Each strip was incrementally stretched to optimal isometric tension, as determined by maximal contractile responses to 1 ⁇ M phenylephrine. Relaxant responses were evaluated by adding increasing cumulative concentrations of compounds to the strips contracted with 0.5 ⁇ M phenylephrine.
• Example 7 Determination of Synergy for the Combination of PGE ⁇ and GS-NO for the Relaxation of Human Corpus Cavernosum Tissue
• the effect of the combination of PGE, and GS-NO for the relaxation of the human corpus cavernosum tissue was calculated to be synergistic using the following formula (Berenbaum, Pharmacol.
• Fig. 4 shows the theoretical relaxation curve calculated assuming an additive effect between PGE, and GS-NO and the experimental curve obtained with the combination of PGE, and GS-NO.
• the combination of PGE, and GS-NO was significantly more potent than expected (if only an additive effect was assumed), and shows a statistically significant reduction of the concentrations required to obtain a specified relaxation compared to the calculated additive theoretical curve. This results suggests that there is an unexpected synergism in the relaxation of the human corpus cavernosum induced by the combination of PGE, and GS-NO.
• Example 8 (2S,3S)-2,3,4-Tris(nitroxy)butyl 7-[5-((lE)(3S)-3-hydroxyoct-l-enyl)(lR,
• Example 8c The product of Example 8c (710 mg, 1.97 mmol) was taken up in methylene chloride (10 mL). Fuming nitric acid (745 mg, 11.8 mmol, 6 eq, 0.53 mL of 90% fuming nitric acid) and acetic anhydride (2.6 mL, 1:5 v/v nitric acid /acetic anhydride) *were premixed (exothermic) and then added to the methylene chloride solution at ambient temperature. The resulting yellow solution was stirred at ambient temperature for 20 minutes. TLC indicated the reaction was complete. The reaction mixture was diluted with methylene chloride (50 mL) and then washed with half saturated NaHC0 3 solution (2x 10 mL).
• Example 8d The product of Example 8d (884 mg, 1.78 mmol) was dissolved in dry T ⁇ F (15 mL). Tetra-butylammonium fluoride (2.0 mmol, 2 mL of a IM solution in THF, 1.1 eq) was added resulting in a brown solution. The reaction mixture was stirred at ambient temperature for 1.5 hours. TLC (3:7 ethyl acetate /hexanes) indicated that the reaction was complete. Silica gel (1.5g) was added to the reaction mixture and the solvent was removed in vacuo.
• the preadsorbed material was then flash chromatographed on a silica gel column (20 g), eluted with 1:9 ethyl acetate /hexanes (250 mL) followed by 1:1 ethyl acetate /hexanes (250 mL). Concentration of the appropriate fractions gave 274 mg of the title compound as a very pale yellow oil (60%).
• Example 9 (2S)-2,3-Bis(nitroxy)propyl 7-[5-((lE)(3S)-3-hydroxyoct-l- enyl)(lR,4R,5R)-4-(hydroxy-2-oxocyclopentyl]heptanoate 2,3-bis(nitroxy)propan-l-ol (145 mg, 0.80 mmol, 1.2 eq) and 7-[5-((lE)(3S)-3- hydroxyoct-l-enyl)(lR,4R,5R)-4-(hydroxy-2-oxocyclopentyl)heptanoic acid (234 mg, 0.66 mmol) were dissolved in dry THF (6 mL) in a dry round-bottomed flask.
• Example 10 (2S)-2,3-Bis(nitroxy)propyl 7-[5-((lE)(3S)-3-(nitrooxyoct-l- enyl)(lR,4R,5R)-4-(nitrooxy)-2-oxocyclopentyl]heptanoate
• the product of Example 9 (232 mg, 0.48 mmole) was dissolved in dry methylene chloride (4 mL ). The solution was cooled to 0 °C.
• Example lib 400 mg, 0.79 mmole was dissolved in THF (5 mL). Tetrabutyl-n-butylammonium fluoride (1.2 eq, 0.94 mmole, 0.94 mL of the IM solution in THF) was added at ambient temperature to produce a dark brown solution. The reaction mixture was stirred at ambient temperature for 1.5 hours. TLC (1:9 EtOAc/hexanes) indicated that the reaction was complete. The reaction mixture was passed through a short pad of silica gel, eluted with 1:1
• reaction mixture was stirred at 0 °C for lhour and then slowly warmed to ambient temperature overnight. Stirring was continued at ambient temperature for 2 days. TLC (EtOAc) indicated the reaction was complete.
• the reaction mixture was diluted with EtOAc and washed with water (2x10 mL). The organic layer was dried over sodium sulfate, the solvent was concentrated in vacuo and then preadsorbed onto silica gel (1 g). The mixture was then flash chromatographed on silica gel (15 g), eluted first with 1:1 EtO AC /hexanes (250 ml) followed by EtOAc (250 mL).
• Example 12 3-Nitrooxy-2,2-bis[(nitrooxy)methyl]propyl 7-[5-[(lE)(3S)-3- (nitrooxyoct-l-enyl)(lR,4R,5R)-4-nitrooxy-2-oxocyclopentyl] heptanoate
• Fuming nitric acid 72 mg, 1.14 mmole, 0.05 mL of the 90% solution
• acetic anhydride (0.25 mL) were premixed (exothermic).
• the resulting yellow solution was added dropwise to the product of Example 11 in dry methylene chloride (4 mL) under argon at 0 °C, resulting in a pale yellow solution.
• Example 13 Methyl 7-[5-((lE)(3S)-3-nitroxyoct-l-enyl)(lR,4R,5R)-4-nitrooxy-2- oxocyclopentyl]heptanoate 13a.
• N-methyl-N-nitrosourea (271 mg, 2.63 mmol, 3 eq) was added to a 1:1 mix of water/diethyl ether (20 mL) and cooled to 0 °C.
• KOH was added to the N-methyl-N-nitrosourea mix at 0 °C, generating diazomethane as evidenced by the formation of a yellow color in the diethyl ether layer.
• the yellow ethereal diazomethane solution was slowly added to the prostaglandin solution via a flame polished pipette slowly resulting in the dissolution of the solid material.
• Example 14 2-[2-(Nitrosothio)adamantan-2-yl]ethyl 7-[5-((lE)(3S)-3-hydroxyoct-l- enyl)(lR,4R,5R)-4-hydroxy-2-oxocyclopentyl]heptanoate.
• APIMS (IS, NH 4 OAc) m/e 283 (MH + ); Anal. Calcd for C, 6 H 26 0 2 S (282.44): C, 68.04; H, 9.28 Found: C, 68.14; H, 9.30. 14c. 2-(2-Sulfanyladamantan-2-yl)ethan-l-ol
• Example 14b To a 0 °C cooled solution of Example 14b (4.1 g, 24.1 mmol) in anhydrous dichloromethane (40 mL) lithium aluminum hydride (1 M solution in THF) (40 mL) was added dropwise over a period of 20 minutes. The reaction mixture was stirred at 0 °C for further 15 minutes and then at room temperature for 30 minutes. The excess L1AIH4 was destroyed by the addition of ethyl acetate. The reaction mixture was then poured over ice cold water, acidified with 1 N HCI and extracted with dichloromethane (2 x 200 mL).
• Example 14c To a 0 °C cooled solution of Example 14c (1.06 g, 5 mmol) in anhydrous dichloromethane (40 mL) was added t-butyl nitrite (7.5 mmol, 890 ⁇ L). The reaction mixture was stirred at 0 °C for 30 minutes and then at room temperature for 30 minutes. The solvent was removed at reduced pressure and product was recrystallized from ethyl ether/hexane to give 1.2 g ( 80% yield) of the title compound as a green crystalline solid, mp 77-79 °C; H NMR (CDCI3): ⁇ 1.7-1.74
• Example 14d (44 mg, 0.182 mmol, 1.8 eq) dissolved in lmL of dry THF.
• the reaction mixture was protected from light by wrapping the reaction flask in aluminum foil. The reaction mixture was stirred at 0 °C for 1 hour and then gradually warmed to ambient temperature. The reaction mixture was stirred at ambient temperature for 2 days during which time the green color of the nitrosothiol was maintained. TLC (EtOAc) indicated that the -
• Example 15 [ ⁇ l-[(4-methylphenyl)sulfonyl]-4-(nitrosothiol)-4-piperidyl ⁇ methyl 7- [5-((lE)(3S)-3-hydroxyoct-l-enyl)(lR,4R,5R)-4-hydroxy-2- oxocyclopentyl] heptanoate.
• reaction was stirred at 0 °C for 1 hour and then warmed gradually to ambient temperature.
• the reaction mixture was stirred at ambient temperature for 2 days during which time the green color of the nitrosothiol was maintained.
• Thin layer chromatography TLC, EtOAc)
• the reaction mixture was directly applied to two 10x20cm 0.25mm thick TLC plates and eluted twice with 1:1 EtOAc/hexanes.
• Example 16 2-methyl-2-(nitrosothio)propyl 7-[5-((lE)(3S)-3-hydroxyoct-l- enyl)(lR,4R,5R)-4-hydroxy-2-oxocyclopentyl]heptanoate.
• 16a 2-methyl-2-sulfanylpropan-l-ol
• Example 16a To a solution of Example 16a (4.4 g, 41.5 mmol) in CH 2 C1 2 (50 ml) was added t-BuONO (5.5 ml, 41.5 mmol). The reaction mixture was stirred at room temperature for 10 minutes and the volatiles were evaporated in vacuo at 40 °C to give 4.6 g (82%) of the title compound as a dark green oil. . ⁇ NMR (300 MHz, CDC1 3 ) ⁇ 4.17 (s, 2H), 1.95 (brs, IH), 1.90 (s, 6H); 13 C NMR (CDCL,) 70.5, 57.7, 25.1. 16c.
• Example 16b (38 mg, 2.5 mmol, 1.8 eq) dissolved in 5 mL of dry THF.
• the reaction mixture was protected from light by wrapping the reaction flask in aluminum foil. The reaction was stirred at 0 °C for 1 hour and then warmed gradually to ambient temperature. The reaction was stirred at ambient temperature for 1 day during which time the green color of the nitrosothiol was maintained. TLC (EtOAc) indicated that the reaction was complete.

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• 2000
  • 2000-03-01 US US09/516,194 patent/US7176238B1/en not_active Expired - Fee Related
  • 2000-03-01 WO PCT/US2000/005286 patent/WO2000051978A1/en active Application Filing
  • 2000-03-01 AU AU37136/00A patent/AU3713600A/en not_active Abandoned
• 2006
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• 2008
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