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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
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  • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
  • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/16—Amides, e.g. hydroxamic acids
  • A61K31/17—Amides, e.g. hydroxamic acids having the group >N—C(O)—N< or >N—C(S)—N<, e.g. urea, thiourea, carmustine
• • A—HUMAN NECESSITIES
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/192—Carboxylic acids, e.g. valproic acid having aromatic groups, e.g. sulindac, 2-aryl-propionic acids, ethacrynic acid 
• • A—HUMAN NECESSITIES
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  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
• • A—HUMAN NECESSITIES
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
  • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/60—Salicylic acid; Derivatives thereof
  • A61K31/606—Salicylic acid; Derivatives thereof having amino groups
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  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
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  • A61P19/00—Drugs for skeletal disorders
  • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
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  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
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• • A—HUMAN NECESSITIES
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  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • A—HUMAN NECESSITIES
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  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis

Definitions

• the present invention relates generally to the modification and aging of proteins through reaction with glucose and other reducing sugars, such as fructose or ribose and more particularly to the inhibition of nonenzymatic glycation of proteins which often results in formation of advanced glycation endproducts and crosslinks.
• An elevated concentration of reducing sugars in the blood and in the intracellular environment results in the nonenzymatic formation of glycation and dehydration condensation complexes known as advanced glycation end-products (AGE's).
• AGE's advanced glycation end-products
• brown pigments with spectral and fluorescent properties similar to those of late-stage Maillard products have also been found in vivo in association with several long-lived proteins such as lens crystallin proteins and collagen from aged individuals. An age-related linear increase in pigments was observed in human dura collagen between the ages of 20 to 90 years.
• AGE modified proteins increase slowly with aging and are thought to contribute to normal tissue remodeling. Their level increases markedly in diabetic patients as a result of sustained high blood sugar levels and lead to tissue damage through a variety of mechanisms including alteration of tissue protein structure and function, stimulation of cellular responses through AGE specific receptors or the generation of reactive oxygen species (ROS) (for a recent review see
• ROS reactive oxygen species
• Structural changes on macromolecules by AGE's are known to accumulate under normal circumstances with increasing age. This accumulation is severely accelerated by diabetes and is strongly associated with hyperglycemia. For example, formation of AGE on protein in the subendothelial basement membrane causes extensive cross-link formation which leads to severe structural and functional changes in protein/protein and protein/cell interaction in the vascular wall (Haitoglou et al., 1992; Airaksinen et al., 1993).
• AGE's advanced glycation end products
• AGE's advanced glycation end products
• This process is accelerated by diabetes and has been postulated to contribute to the development of a range of diabetic complications including nephropathy (Nicholls and Mandel, 1989), retinopathy (Hammes et al, 1991) and neuropathy (Cameron et al., 1992).
• tissue damage to the kidney by AGE's leads to progressive decline in renal function and end- stage renal disease (ESRD) (Makita et al., 1994), and accumulation of low-molecular- weight (LMW) AGE peptides (glycotoxins) (Koschinsky et al., 1997) in the serum of patients with ESRD (Makita et al, 1991).
• LMW low-molecular- weight
• LDL low density lipoprotein
• collagen Miyata et al., 1993
• IgM anti-IgG-AGE appears to be associated with clinical measurements of rheumatoid arthritis activity (Lucey et al, 2000).
• a correlation between AGEs and rheumatoid arthritis was also made in North American Indians (Newkirk et al., 1998).
• AGEs are present in brain plaques in Alzheimer's disease and the presence of AGEs may help promote the development of Alzheimer's disease (Durany et al., 1999; Munch et al., 1998; Munch et al., 1997).
• CML carboxyethyl-lysine
• CEL carboxyethyl-lysine
• MOLD methylglyoxal lysine dimer
• Arg-Lys imidazole arginine pyridinium
• cypentodine piperidinedinone enol and alkyl
• formyl diglycosyl-pyrrole
• Examples are D-lysine (Sensi et al., 1993), desferrioxamine (Takagi et al, 1995), D-penicillamine (McPherson et al., 1988), thiamine pyrophosphate and pyridoxamine (Booth et al., 1997) which have no structural similarities to aminoguanidine.
• the compounds of the present invention can be used to inhibit this process of nonenzymatic glycation and crosslinking and therefore to inhibit some of the ill effects caused by diabetes or by aging.
• the compounds are also useful for preventing premature aging, rheumatoid arthritis, Alzheimer's disease, uremia, neurotoxicity, atherosclerosis, and spoilage of proteins in food and can prevent discoloration of teeth.
• Figure 1 represents a general formula encompassing many but not all of the aryl and heterocyclic ureido and aryl and heterocyclic carboxamido phenoxyisobutyric acids of the invention.
• R,, R 2 , R 3 and R 4 may be the same or different and are independently selected from the group consisting of hydrogen, halogen, straight or branched chain alkyl of from 1-6 carbon atoms, aryl, cycloalkyl of 3 to 7 carbon atoms, and alkoxy of 1 to 6 carbon atoms;
• R 5 and R,- may be the same or different and are selected from the group consisting of hydrogen, halogen, straight or branched chain alkyl groups of from 1 to 6 carbon atoms, aralkyl wherein the alkyl portion has from 1 to 6 carbon atoms, cycloalkyl of from 3 to 7 carbon atoms and aryl; and
• R 7 is hydrogen or a straight or branched chain alkyl group of 1 to 6
• Figures 2A-B show the effects of various inhibitor compounds on whole blood incubated for 5 hours ( Figure 2 A) or 16 hours (Figure 2B) with ⁇ -Glu.
• the bars of the graph represent the HbA lc levels obtained. The inhibitors were used at 1 mM final concentrations except for aminoguanidine which was at 50 mM.
• the bars of the graph are: A: baseline control which contains blood and PBS but no ⁇ -Glu; B: contains ⁇ -Glu treated blood with no inhibitor present; C: contains blood plus ⁇ -Glu plus aminoguanidine; D-L: these contain blood plus ⁇ -Glu plus LR26, LR28, LR29, LR33, LR36, LR41, LR45, LR49 and LR62, respectively.
• the bars of the graph are: A: baseline control which contains blood and PBS but no ⁇ -Glu; B: contains ⁇ -Glu treated blood with no inhibitor present; C: contains blood plus ⁇ - Glu plus aminoguanidine; D-L: these contain blood plus ⁇ -Glu plus LR66, LR67, LR71, LR79,
• Figures 3A-B demonstrate the data from a BSA-glucose assay and shows the percent inhibition of AGE formation by 1 mM of inhibitors as compared to 50 mM aminoguanidine.
• the bars of the graph are: A: aminoguanidine; B: LR26, C: LR28, D: LR29, E: LR33,
• Figures 4A-B present the data from a G.K.-ribose assay and shows the percent inhibition of AGE formation by 1 mM of inhibitors as compared to 50 mM aminoguanidine.
• the bars of the graph represent: A: aminoguanidine, B: LR26, C: LR28, D: LR29, E: LR33, F: LR36, G: LR41; H: LR45, I: LR49 and J: LR62.
• the bars of the graph represent: A: aminoguanidine, B: LR66, C: LR67, D: LR71, E: LR79, F: LR80, G: LR81, H: LR85, 1: LR88 and J: LR92.
• Figure 5 shows the structures of LR1-LR14.
• Figure 6 shows the structures of LR15-LR28.
• Figure 7 shows the structures of LR29-LR42.
• Figure 8 shows the structures of LR43-LR56.
• Figure 9 shows the structures of LR57-LR73.
• Figure 10 shows the structures of LR74-LR92.
• Figures 11 A-B show the results of immunochemical studies on the inhibitory effects of representative compounds using a specific ELIS A assay in which inhibition of crosslinking of collagen with AGE-BSA is measured.
• the compounds and their useful compositions utilized in the present invention contain agents capable of reacting with the highly active carbonyl intermediate of an early glycation product thereby preventing those early products from later forming the advanced glycation endproducts which lead to protein crosslinking and to protein aging.
• Other utilities envisioned for the present invention are: prevention of premature aging and of spoilage of the proteins in foodstuffs.
• the present agents are also useful in the area of oral hygiene as they prevent discoloration of teeth.
• the compounds of the present invention collectively are defined as derivatives of aryl and heterocyclic ureido and aryl and heterocyclic carboxamido phenoxy isobutyric acids (Rahbar et al, 1999).
• a general formula encompassing several compounds of the invention is demonstrated in Figure 1. These compounds are part of a series of compounds originally developed for their effects on the modification of oxygen affinity of hemoglobin by lowering the affinity of hemoglobin for oxygen and shifting the hemoglobin-oxygen-dissociation curve to the right
• LR57, LR66, LR74, LR76, LR77, LR82, LR86 and LR87 are clofibric acid derivatives; compounds LR91 and LR92 are formimide derivatives; and compounds LR64, LR65, LR67- LR75, LR78 and LR83-LR85 are arylcarboxylic acid derivatives.
• the above compounds are capable of inhibiting the formation of advanced glycation end products on target proteins and the resulting protein crosslinking.
• the rationale of the present invention is to use agents which block the post-glycation step, i.e., the formation of fluorescent chromophores, the presence of which chromophore is associated with and leads to adverse sequelae of diabetes and aging.
• An ideal agent would prevent the formation of the chromophore and its associated crosslinks of proteins and trapping of proteins on the other proteins, such as occurs in arteries and in the kidneys.
• the compounds of the invention may be administered to mammals including humans to prevent or reduce protein glycation and crosslinking (protein aging).
• the compounds may be administered orally at variable dosage depending on the activity of each agent in a single or individual amounts.
• the compounds may be administered parenterally or rectally.
• the compounds of the invention, the rationale behind the different assay methods of the present invention, and their use are illustrated by the following Examples.
• Example 1 Hemoglobin- ⁇ -Gluconolactone ( ⁇ -Glu) Assay Evaluation of early glycation products (Amadori) formation on hemoglobin (HbA lc ) is performed by incubating red blood cells with an oxidized form of glucose in the presence and the absence of the inhibitor compound followed by determination of (HbA lc ) in the test versus the control (Rahbar and Nadler., 1999). This test is based on a recent report by Lindsay et al. (1997). ⁇ -Glu, an oxidized analogue of glucose, can react rapidly with hemoglobin within the red cells and significantly increases the HbA ]C levels within hours after incubation. By contrast, glucose requires weeks for an equivalent reaction to occur.
• HbA lc The percentage of glycated Hb (HbA lc ) was determined using a dedicated ion- exchange HPLC system (BIORAD DIAMAT). Blood samples were analyzed in triplicate. The % inhibition of HbA lc formation by the compound was calculated according to the following formula: ((B-C)/(B-A)) x 100 where A is HbA lc concentration in the baseline control tube not treated with ⁇ -Glu, B is the HbA lc concentration in blood incubated with ⁇ -Glu, C is the HbA lc content of the test tube treated both with ⁇ -Glu and the inhibitor compound.
• Example 2 BSA-Glucose Assay This test is used to evaluate the ability of the inhibitors to inhibit glucose-mediated development of fluorescence of BSA (Ikeda et al., 1996).
• BSA fraction V
• 800 mM glucose 144 mg/mL
• 1.5 M phosphate buffer pH 7.4 containing NaN 3 0.2 g/L was incubated under aseptic conditions at 37°C for 7 days in the presence or absence of various concentrations of the compounds. After 7 days of incubation each sample was examined for the development of specific fluorescence (excitation, 370 nm; emission, 440 nm). The % inhibition of AGE formation in the test sample versus control was calculated for each inhibitor compound.
• Aminoguanidine 50 mM
• Figures 3 A-B show for a selection of the tested compounds the inhibitory effects of 1 millimole/L of the new inhibitor versus 50 millimoles/L of aminoguanidine.
• the data presented in Figures 3 A-B are from 1 determination. Results which are averaged for 3 determinations for each of the 92 compounds are tabulated in Table 1.
• Example 3 N-Acetyl-Glycyl-Lysine Methyl Ester (G.K. Peptide) - Ribose Assay Evaluation of the late glycation products (AGE's), and AGE-inhibition by the new inhibitor compounds was tested by incubation of G.K. peptide in ribose in the presence or the absence of the agent, followed by determination of chromophores generated in the course of glycation and AGE formation through determination of their specific fluorescence.
• a special ELISA technique (Al-abed et al, 1999) was used to evaluate the ability of the compounds being studied to inhibit the crosslinking of glycated-BSA (AGE-BSA) to a rat tail- tendon-collagen coated 96 well plate (Biocoat microtiter plates from Collaborative Research. Crosslinking of AGE-BSA to a rat tail-tendon-collagen coated plate was performed with and without the testing compound at the desired concentrations. The uncross-linked AGE-BSA was then removed by washing the wells. The AGE-BSA crosslinked to the tail-tendon-collagen coated plate was then quantified by a polyclonal antibody raised against AGE-RNase.
• RNase A Ribonuclease-Ribose Fluorescence - Inhibition and Crosslinking-Inhibition Assays
• Bovine pancreatic ribonuclease A RNase A
• RNase A has been extensively used as a model protein to study protein glycation and AGE formation, as well as the kinetics of AGE-formation (Khalifah et al., 1996).
• RNase A has the advantage of not precipitating during glycation reaction whereas lysozyme tends to precipitate during glycation with ribose and glucose.
• the RNase-ribose assay measures the fluorescence generated as a result of AGE- formation in the presence or absence of the inhibitor as compared to aminoguanidine.
• This assay is also used to detect the inhibitory effects of a compound on protein-crosslinking and the formation of dimers and trimers as shown by SDS-PAGE. Both uninterrupted and interrupted versions of this assay (Nagaraj et al., 1996) have been performed successfully. However, the interrupted technique worked better in our hands. Bovine RNase A type I-A (Sigma) was used throughout our assays.
• RNase 1 mg/mL
• ribose 0.2 M
• sodium phosphate buffer pH 7.5 containing 0.02% sodium azide
• Glycation was then interrupted by diluting the reaction 1 :100 in 0.4 M phosphate buffer and adding the inhibitor under study to the reaction at the desired concentrations.
• the reaction was filtered through a 0.2 micron filter and incubated at 37°C in the dark for four additional days. At the end of the incubation period, samples were analyzed for their fluorescence as described before, and the percent inhibition was calculated.
• the samples were analyzed by SDS-PAGE technique as described before.
• the samples were concentrated by using Centricon 10 (Amicon) and then applied to the gels.

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