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Definitions

• the present invention relates to methods and therapeutic combinations for treating and preventing an autoimmune disorder in a subject comprising the administration of sterol absorption inhibitor(s).
• autoimmune diseases such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriasis and systemic lupus erythmatosus
• phagocytes which include T-cells, B-cells and natural killer (NK) cells
• NK natural killer
• lipid rafts within cell membranes of leukocytes has been demonstrated to play a critical role in immune responses as diverse as T-cell activation, antigen presentation, adhesion molecule function and chemokine receptor signaling, as will now be discussed in further detail below.
• lipid raft microdomains are important for T-cell receptor (TCR)- mediated activation of T-cells.
• TCR T-cell receptor
• Signaling proteins are associated with lipid rafts in T- cells and the TCR itself associates with lipid rafts (see Hreisi V. (2003) Immunol. Rev. 191 : 1438-1464 and Janes et al. (2000) Immunology 12: 23-34).
• kinase Lck a key signaling protein
• lipid rafts in both T-cell and B-cell antigen receptor signaling, disrupting the formation and/or organization of these rafts will likely inhibit the aberrant activation of leukocytes in response to tissue self antigens that occurs in autoimmune disorders.
• T-cells use their antigen-specific receptors (TCRs) to recognize antigens (including self-antigens) bound to MHC molecules.
• TCRs antigen-specific receptors
• MHC Class II molecules are known to be present in raft-like microdomains on APCs and perturbing APC raft integrity profoundly inhibits the ability of APCs to stimulate antigen-specific T-cells.
• Adhesion molecules such as integrins
• integrins are molecules on the surface of cells that assist leukocytes in interacting with their environments through adherence.
• integrins are a group of glycoproteins expressed on both leukocytes and endothelial cells that are predominately involved in the aberrant leukocyte trafficking and extravasation associated with autoimmune diseases. Integrins promote adherence of leukocytes to the surface of endothelial cells on the surface of blood vessels through which leukocytes circulate. Studies have shown that lipid rafts play a role in the regulation of integrin function (Leitinger and Hogg (2002) J. Cell Sci. 115: 963-972).
• a ⁇ integrin functions can be modulated by the phospholipid and cholesterol contents of cell membranes (Gopalakrishna, et al. (2000) J. Cell. Biochem. 77: 517-528). Therefore, it is likely that the aberrant leukocyte trafficking and extravasation which occurs in autoimmune disorders can be inhibited by disrupting lipid raft formation and/or organization in the plasma membrane of leukocytes.
• Chemokines are chemoattractant cytokines that mediate chemotaxis of leukocytes involved in autoimmune diseases. Excess levels of these cytokines are linked to autoimmune disorders.
• the receptors for chemokines are mainly expressed on immune and inflammatory cells, such as T and B lymphocytes, dendritic cells, monocytes/macrophages and granulocytes, in which ligand-receptor interactions lead to cell migration.
• Chemokine expression is either induced at autoimmune disease sites to recruit T-cells that mediate tissue destruction, or is constitutive in lymphoid organs (i.e., lymph nodes and spleen) to orchestrate the response to antigens, including autoantigens, that drive autoimmune diseases.
• a method of treating or preventing autoimmune disorder in a subject comprising the step of administering to a subject in need of such treatment an effective amount of at least one sterol absorption inhibitor or a pharmaceutically acceptable salt or solvate thereof.
• a method of treating or preventing an autoimmune disorder in a subject comprising the step of administering to a subject in need of such treatment an effective amount of at least one sterol absorption inhibitor represented by Formula (II) below:
• the present invention provides a composition comprising: (a) at least one sterol absorption inhibitor or a pharmaceutically acceptable salt or solvate thereof and (b) at least one other agent useful for the treatment of an autoimmune disorder.
• Therapeutic combinations also are provided comprising: (a) a first amount of at least one sterol absorption inhibitor or a pharmaceutically acceptable salt or solvate thereof; and (b) a second amount of at least one other agent useful for the treatment of an autoimmune disorder, wherein the first amount and the second amount together comprise a therapeutically effective amount for the treatment or prevention of an autoimmune disorder in a subject.
• compositions for the treatment or prevention of an autoimmune disorder in a subject comprising a therapeutically effective amount of the above compounds, compositions or therapeutic combinations and a pharmaceutically acceptable carrier also are provided.
• autoimmune disorders are mediated by the aberrant activation, differentiation and trafficking of leukocytes in response to tissue self-antigens.
• Autoimmune reactions can often have fatal consequences. They can cause the destruction of vital tissue which manifests in the development of chronic autoimmune diseases.
• the driving forces in the progression of these diseases are autoreactive immune cells. In most cases, these autoreactive cells are CD4 + T-cells which somehow escaped the self-tolerance control mechanisms of the immune system.
• CD4 + T-cells act as T helper cells, which control or mediate the activation and differentiation of other immune cells such as cytotoxic CD8 + T-cells, NK cells, granulocytes, macrophages and B-cells.
• CD4 + T-cells are no longer just mediators, but are rather key players of the autoimmune response. In particular, they are either directly or indirectly responsible for the characteristic tissue destruction that occurs in autoimmune diseases, which is triggered by the recognition of autoantigens.
• autoantigens are derived from self-proteins of the attacked tissue and are presented to the autoreactive CD4 + T-cells by antigen- presenting cells (APCs), such as macrophages, dendritic cells or B-cells.
• APCs antigen- presenting cells
• B-cells B-cells.
• aberrant T cell-dependent or T cell-independent antibody production by activated B cells plays a critical role in initiating and amplifying tissue damage in autoimmune disorders.
• lipid rafts within the cell membranes of leukocytes has been demonstrated to play a critical role in T-cell and B-cell activation, antigen presentation, adhesion molecule function and chemokine receptor signaling, each of which is associated with the pathogenesis of autoimmune disorders.
• Both cholesterol and plant sterols have been shown to be essential to the structure and organization of lipid rafts, and to the subsequent downstream signaling events mediated by these rafts. Therefore, depleting the amount of cholesterol trafficked to cells will likely disrupt the formation and organization of lipid rafts in the cell membranes of autoreactive T-cells and other leukocytes involved in autoimmune reactions.
• VLDL hepatic lipoprotein
• LDL particles carry cholesterol predominantly as cholesteryl esters.
• cholesteryl esters are transported to late endosomes and lysosomes where they are hydrolyzed to release cholesterol for use by the cell as an essential component of the lipid rafts of cell membranes, for example.
• autoimmune disorders is intended to include any abnormal physical or mental condition, including diseases, which are of an autoimmune etiology, as well as any symptoms which are subject evidence of a disease or disorder.
• Lipid rafts refer to subdomains within the plasma membrane of many ceil types, including leukocytes, which are enriched in cholesterol, sterols derived from plants and sphingolipids. They exist as distinct, liquid-ordered regions of the membrane that are resistant to extraction with non-ionic detergents and exhibit less fluidity than the surrounding plasma membrane due to the presence of cholesterol.
• leukocytes as defined herein are white blood cells produced by the immune system to help defend the body against infection. The different types of leukocytes include neutrophils, lymphocytes (e.g. T-cells, B-cells and natural killer (NK cells), monocytes, macrophages, eosinophils, and basophils.
• U.S. Patents Nos. 5,767,1 15, 5,624,920, 5,656,624 and 5,688,787 disclose hydroxy-substituted azetidinone compounds and substituted ⁇ -lactam compounds useful for inhibiting the absorption of cholesterol, thereby lowering cholesterol levels and/or inhibiting the formation of cholesterol-containing lesions in mammalian arterial walls.
• 5,846,966 and 5,661 ,145 disclose hydroxy-substituted azetidinone compounds or substituted ⁇ -lactam compounds in combination with HMG CoA reductase inhibitors for preventing or treating atherosclerosis and reducing plasma cholesterol levels. Such compounds can also be useful in lowering C-reactive protein levels in subjects.
• autoimmune disorders include, but are not limited to, the following: Alopecia Areata, Ankylosing Spondylitis, Antiphospholipid Syndrome, aplastic anemia, myelodysplastic syndromes, paroxysmal nocturnal hemoglobulinemia, pure red cell aplasia, chronic neutropenias, amegakaryocytic thrombocytopenia, antiphospholipid syndromes, autoimmune thrombocytopenia, autoimmune hemolytic syndromes, antiphospholipid syndromes, autoimmune gastritis, achlorhydria, Autoimmune Addison's Disease, Autoimmune Diabetes, Autoimmune Hemolytic Anemia, Autoimmune Hepatitis, Autoimmune hypophysitis, Autoimmune orchiditis, autoimmune ovarian failure, Behcet's Disease, Bullous Pemphigoid, Cardiomy
• Agammaglobulinemia Primary Biliary Cirrhosis, Psoriasis, Psoriatic Arthritis, Reactive Arthritis, Raynaud's Phenomenon, Reiter's Syndrome, Rheumatic Fever, Rheumatoid Arthritis, Sarcoidosis, Scleritis, Scleroderma, Sj ⁇ gren's Syndrome, Stiff- Man Syndrome, Takayasu Arteritis, Temporal Arteritis/Giant-cell Arteritis, Ulcerative Colitis, Uveitis, Vasculitis, Vitiligo, and Wegener's Granulomatosis.
• the present invention is directed to compositions, pharmaceutical compositions, therapeutic combinations, kits and methods of treatment using the same comprising at least one (one or more) sterol absorption inhibitor(s).
• Suitable sterol absorption inhibitors include substituted azetidinone sterol absorption inhibitors, substituted ⁇ -lactam sterol absorption inhibitors or combinations thereof as discussed in detail below.
• sterol absorption inhibitor means a compound capable of inhibiting the absorption of one or more sterols, including but not limited to, cholesterol and phytosterols (such as sitosterol, campesterol, stigmasterol and avenosterol), when administered in a therapeutically effective (sterol absorption inhibiting) amount to a subject, such as a mammal or human.
• sterol absorption inhibitors useful in the compositions, therapeutic combinations and methods of the present invention are represented by Formula (I) below:
• Ar and Ar are independently selected from the group consisting of aryl and R -substituted aryl;
• Ar is aryl or R -substituted aryl; X, Y and Z are independently selected from the group consisting of
• R and R are independently selected from the group consisting of -OR , -0(CO)R 6 , -0(CO)OR 9 and -0(CO)NR 6 R 7 ;
• R and R are independently selected from the group consisting of hydrogen, lower alkyl and aryl; q is 0 or 1 ; r is 0 or 1 ; m, n and p are independently selected from 0, 1 , 2, 3 or 4; provided that at least one of q and r is 1 , and the sum of m, n, p, q and r is 1 , 2, 3, 4, 5 or 6; and provided that when p is 0 and r is 1 , the sum of m, q and n is 1 , 2, 3, 4 or 5;
• R is 1 -5 substituents independently selected from the group consisting of lower alkyl, -OR 6 , -O(CO)R 6 , -0(CO)OR 9 , -0(CH 2 ) ⁇ 5 OR 6 , -O(CO)NR 6 R 7 , -NR 6 R 7 , -NR 6 (CO)R 7 , -NR 6 (CO)OR 9 , -NR 6 (CO)NR 7 R 8 , -NR 6 S02R 9 , -COOR 6 , -CONR 6 R 7 , -COR 6 , -S0 2 NR 6 R 7 , S(O) 0 . 2 R 9 , -O CH ⁇ . ⁇ -COOR 6 ,
• R is 1-5 substituents independently selected from the group consisting of -OR 6 , -0(CO)R 6 , -O(CO)OR 9 , -0(CH 2 ) 1 . 5 OR 6 , -O(CO)NR 6 R 7 , -NR 6 R 7 , -NR 6 (CO)R 7 , -NR 6 (CO)OR 9 , -NR 6 (CO)NR 7 R 8 , -NR 6 S0 2 R 9 , -COOR 6 , -CONRV, -COR 6 , - S0 2 NR 6 R 7 , S(O) 0 . 2 R 9 , ⁇ (CH ⁇ -COOR 6 , -O(CH 2 ) 1 .
• R is lower alkyl, aryl or aryl-substituted lower alkyl.
• R is 1-3 independently selected substituents, and R is preferably 1-3 independently selected substituents.
• a sterol absorption inhibitor of Formula (I) useful in the compositions, therapeutic combinations and methods of the present invention is represented by Formula (II) (ezetimibe) below:
• the compound of Formula (II) can be in anhydrous or hydrated form.
• the compound of Formula (II) is commercially available in a pharmaceutical formulation ZETIA ® from MSP Pharmaceuticals, Inc.
• alkyl or "lower alkyl” means straight or branched alkyl chains having from 1 to 6 carbon atoms and "alkoxy” means alkoxy groups having 1 to 6 carbon atoms.
• alkyl groups include, for example methyl, ethyl, propyl, and butyl groups. Where an alkyl chain joins two other variables and is therefore bivalent, the term alkylene is used.
• Aryl means an aromatic monocyclic or multicyclic ring system comprising about 6 to about 14 carbon atoms, preferably about 6 to about 10 carbon atoms, such as phenyl, naphthyl, indenyl, tetrahydronaphthyl or indanyl.
• R 1 2 3 each independently selected, but also that where an R, R , R and R variable occurs more than once in a molecule, each occurrence is independently selected (e.g., if R is -OR , wherein R is hydrogen, R 2 can be -OR wherein R is lower alkyl).
• R is -OR , wherein R is hydrogen
• R 2 can be -OR wherein R is lower alkyl.
• Ar is R -substituted aryl
• Ar is R -substituted aryl
• Ar is R -substituted aryl
• Y and Z are independently selected from the group consisting of -CH 2 -, -CH(lower alkyl)- and -C(dilower alkyl)-;
• A is selected from -0-, -S-, -S(O)- or -S(0) 2 ⁇ ;
• R is selected from the group consisting of -OR , -O(CO)R , -0(CO)OR and
• R is selected from the group consisting of hydrogen, lower alkyl and
• R is 1-3 substituents independently selected from the group consisting of
• R and R are independently 1-3 substituents independently selected from the
• R hydrogen, p-iower alkyl, aryl, -N0 2 , -CF 3 and p-halogeno;
• R , R and R are independently selected from the group consisting of g hydrogen, lower alkyl, aryl and aryl-substituted lower alkyl; and R is lower alkyl, aryl or aryl-substituted lower alkyl.
• sterol absorption inhibitors useful in the compositions, therapeutic combinations and methods of the present invention are represented by
• A is selected from the group consisting of R -substituted heterocycloalkyl, R -
• Ar is aryl or R -substituted aryl
• Ar is aryl or R -substituted aryl
• Q is a bond or, with the 3-position ring carbon of the azetidinone, forms the
• R is selected from the group consisting of: -(CH 2 ) q -, wherein q is 2-6, provided that when Q forms a spiro ring, q can also be zero or 1 ;
• G is -0-, -C(O)-, phenylene, -NR 8 - or -S(O) 0.2 _, e is 0-5 and r is 0-5, provided that the sum of e and r is 1-6; "(C 2 -C 6 alkenylene)-; and
• V is C 3 -C 6 cycloalkylene, f is 1-5 and g is 0- 5, provided that the sum of f and g is 1-6; g
• R is selected from:
• fi 7 R and R are independently selected from the group consisting of
• R when Q is a bond, R also can be selected from:
• M is -0-, -S-, -S(O)- or -S(0) 2 -;
• X, Y and Z are independently selected from the group consisting of -CH 2 -, -CH(C r C 6 alkyl)- and -C(di-(C 1 -C 6 ) alkyl);
• R and R are independently selected from the group consisting of
• R and R are independently selected from the group consisting of
• R is 1-3 substituents on the ring carbon atoms selected from the group consisting of hydrogen, (C C ⁇ alkyl, (C 2 -C 10 )alkenyl, (C 2 -C 10 )alkynyl,
• J is -O-, -NH-, -NR - or -CH 2 -; 3 4
• R and R are independently selected from the group consisting of 1-3 substituents independently selected from the group consisting of (C 1 -C 6 )alkyl,
• R is hydrogen, (C 1 -C 6 )alkyl, aryl (C C 6 )alkyl, -C(0)R or -COOR ;
• R and R are independently 1-3 groups independently selected from the group consisting of hydrogen, (C ⁇ C g Jalkyl, (C j -C 8 jalkoxy, -COOH, NO 2 ,
• R and R are independently selected from the group consisting of hydrogen, (C., ⁇ C 6 )alkyl, aryl and aryl-substituted (C j -C ⁇ alkyl;
• R is (C 1 -C 6 )alkyl, aryl or R -substituted aryl;
• 1 ft R is hydrogen or (C.,-C 8 )alkyl
• R is hydrogen, hydroxy or (C C ⁇ alkoxy.
• sterol absorption inhibitors useful in the compositions, therapeutic combinations and methods of the present invention are represented by Formula (V):
• Ar is aryl, R -substituted aryl or heteroaryl; Ar is aryl or R -substituted aryl;
• Ar is aryl or R -substituted aryl
• X and Y are independently selected from the group consisting of -CH 2 -, -CH(lower alkyl)- and -C(dilower alkyl)-;
• R is -OR 6 , -O(CO)R 6 , -0(CO)OR 9 or -O(CO)NR 6 R 7 ;
• R 1 is hydrogen, lower
• R is 1-5 substituents independently selected from the group consisting of lower alkyl, -OR 6 , -0(CO)R 6 , -0(CO)OR 9 , -O(CH 2 ) 1 . 5 OR 6 , -0(CO)NR 6 R 7 , -NR 6 R 7 , -NR 6 (CO)R 7 , -NR 6 (CO)OR 9 , -NR 6 (CO)NR 7 R 8 , -NR 6 S ⁇ 2R 9 , -COOR 6 , -CONR 6 R 7 , -COR 6 , -S0 2 NR 6 R 7 , S(O) 0 . 2 R 9 ,
• R is 1-5 substituents independently selected from the group consisting of -OR 6 , -0(CO)R 6 , -O(CO)OR 9 , -O(CH 2 ) 1 . 5 OR 6 , -0(CO)NR 6 R 7 , -NRV, -NR 6 (CO)R 7 , -NR 6 (CO)OR 9 , -NR 6 (CO)NR 7 R 8 , -NR 6 SO 2 R 9 , -COOR 6 , -CONRV, -COR 6 , - SO 2 NR 6 R 7 , S(O) 0 . 2 R 9 , -O(CH 2 ) 1 .
• R , R and R are independently selected from the group consisting of hydrogen, lower alkyl, aryl and aryl-substituted lower alkyl; g R is lower alkyl, aryl or aryl-substituted lower alkyl; and
• R is 1-5 substituents independently selected from the group consisting of lower alkyl, -OR 6 , -0(CO)R 6 , -O(CO)OR 9 , -O(CO)NR 6 R 7 , -NR 6 R 7 , -NR 6 (CO)R 7 , -NR 6 (CO)OR 9 , -NR 6 (CO)NR 7 R 8 , -NR 6 S0 2 R 9 , -COOR 6 , -CONR 6 R 7 , -COR 6 , -SO 2 NR 6 R 7 , -S(O) 0 . 2 R 9 , -O(CH 2 ) 1 . 10 -COOR 6 , -0(CH 2 ) 1 .
• sterol absorption inhibitors useful in the compositions, therapeutic combinations and methods of the present invention are represented by Formula (VI):
• R2 and R3 are independently selected from the group consisting of:
• R4 is selected from B-(CH2)mC(0)-, wherein m is 0, 1 , 2, 3, 4 or 5; B-(CH2)q-, wherein q is 0, 1 , 2, 3, 4, 5 or 6; B-(CH2)e-Z-(CH2)r, wherein Z is -O-, -C(O)-, phenylene, -N(RQ)- or -S(0)o-2-, e is 0, 1 , 2, 3, 4 or 5 and r is 0, 1 , 2, 3, 4 or 5, provided that the sum of e and r is 0, 1 , 2, 3, 4, 5 or 6; B-(C2-C6 alkenylene)-; B- (C4-C6 alkadienylene)-; B-(CH2)t ⁇ Z-(C2-C6 alkenylene)-, wherein Z is as defined above, and wherein t is 0, 1 , 2 or 3, provided that the sum of t and the number of carbon atoms in the alkenylene chain is 2, 3, 4, 5
• B-(CH2)a-Z-(CH2)b-V-(CH2)d- wherein Z and V are as defined above and a, b and d are independently 0, 1 , 2, 3, 4, 5 or 6, provided that the sum of a, b and d is 0, 1 , 2, 3, 4, 5 or 6; or T-(CH2)s ⁇ , wherein T is cycloalkyl of 3-6 carbon atoms and s is 0, 1 , 2, 3, 4, 5 or 6; or
• B is selected from indanyl, indenyl, naphthyl, tetrahydronaphthyl, heteroaryl or W-substituted heteroaryl, wherein heteroaryl is selected from the group consisting of pyrrolyl, pyridinyl, pyrimidinyl, pyrazinyl, triazinyl, imidazolyl, thiazolyl, pyrazolyl, thienyl, oxazolyl and furanyl, and for nitrogen-containing heteroaryls, the N-oxides thereof, or
• W is 1 to 3 substituents independently selected from the group consisting of lower alkyl, hydroxy lower alkyl, lower alkoxy, alkoxyalkyl, alkoxyalkoxy, alkoxycarbonylalkoxy, (lower alkoxyimino) ⁇ lower alkyl, lower alkanedioyl, lower alkyl lower alkanedioyl, allyloxy, -CF3, -OCF3, benzyl, R7-benzyl, benzyloxy, R7- benzyloxy, phenoxy, R7-phenoxy, dioxolanyl, NO2, -N(R8)(Rg), N(R ⁇ )(R9)-lower alkylene-, N(R ⁇ )(R9)-lower alkylenyloxy-, OH, halogeno, -CN, -N3, -NHC(0)OR ⁇ o, -NHC(0)R1 o, R1102SNH-, (Rl 102S)
• R7 is 1-3 groups independently selected from the group consisting of lower alkyl, lower alkoxy, -COOH, NO2, -N(R ⁇ )(R9), OH, and halogeno;
• R ⁇ and Rg are independently selected from H or lower alkyl
• R10 is selected from lower alkyl, phenyl, R7-phenyl, benzyl or
• R7-benzyl is selected from OH, lower alkyl, phenyl, benzyl, R7-phenyl or
• R12 is selected from H, OH, alkoxy, phenoxy, benzyloxy,
• R13 is selected from -0-, -CH2-, -NH-, -N(lower alkyl)- or -NC(0)R ⁇ g;
• R15 > R16 and R17 are independently selected from the group consisting of H and the groups defined forW; or R15 is hydrogen and R16 and R17, together with adjacent carbon atoms to which they are attached, form a dioxolanyl ring;
• R19 is H, lower alkyl, phenyl or phenyl lower alkyl
• R20 and R21 are independently selected from the group consisting of phenyl,
• sterol absorption inhibitors useful in the compositions, therapeutic combinations and methods of the present invention are represented by Formulas (VIIA) and (VIIB):
• D is -(CH2)mC(0)- or -(CH2)q- wherein m is 1 , 2, 3 or 4 and q is 2, 3 or 4;
• E is Cio to C20 alkyl or -C(0)-(Cg to C- ⁇ g)-alkyl, wherein the alkyl is straight or branched, saturated or containing one or more double bonds;
• R is hydrogen, C1-C15 alkyl, straight or branched, saturated or containing one or more double bonds, or B-(CH2)r -, wherein r is 0, 1 , 2, or 3;
• Rl , R2, R3, R1', R2'. and R3' are independently selected from the group consisting of hydrogen, lower alkyl, lower alkoxy, carboxy, NO2, NH2, OH, halogeno, lower alkylamino, dilower alkylamino, -NHC(O)OR5, R6O2SNH- and -S(0)2NH2; R4 is
• n 0, 1 , 2 or 3;
• R5 is lower alkyl
• R6 is OH, lower alkyl, phenyl, benzyl or substituted phenyl wherein the substituents are 1-3 groups independently selected from the group consisting of lower alkyl, lower alkoxy, carboxy, NO2, NH2, OH, halogeno, lower alkylamino and dilower alkylamino; or a pharmaceutically acceptable salt thereof or a solvate thereof.
• sterol absorption inhibitors useful in the compositions and methods of the present invention are represented by Formula (VIII):
• G and G " ! are independently selected from the group consisting of
• R, R a and !° are independently selected from the group consisting of H, -OH, halogeno, -NH2, azido, (C-
• W is independently selected from the group consisting of -NH-C(O)-, -O-C(O)-, -O-C(0)-N(R 3 1)-, -NH-C(0)-N(R 3 1)- and -O-C(S)-N(R 31 )-;
• R2 and R ⁇ are independently selected from the group consisting of H, (C-
• R 3 , R4, R5, R _ R3a and R4a are independently selected from the group consisting of H, (C ⁇ -C-6)alkyl, aryl(C ⁇ -C6)alkyl, -C(0)(C ⁇ -C6)alkyl and
• R 3 0 is selected from the group consisting of R 3 2-substituted T,
• R 32 -substituted-T-(Ci-C6)alkyl, R 2-substituted-(C2-C4)alkenyl, R 2 -substituted-(C ⁇ -C6)alkyl, R 32 -substituted-(C3-C7)cycloalkyl and
• R 3" ! is selected from the group consisting of H and (C ⁇ -C4)alkyl
• T is selected from the group consisting of phenyl, furyl, thienyl, pyrrolyl, oxazolyl, isoxazolyl, thiazolyl, iosthiazolyl, benzothiazolyl, thiadiazolyl, pyrazolyl, imidazolyl and pyridyl
• R 2 is independently selected from 1-3 substituents independently selected from the group consisting of halogeno, (C-
• Ar is aryl or R ⁇ 1 -substituted aryl
• Q is a bond or, with the 3-position ring carbon of the azetidinone
• Rl is selected from the group consisting of -(CH2)q-, wherein q is 2-6, provided that when Q forms a spiro ring, q can also be zero or 1 ;
• E is -0-, -C(O)-, phenylene, -NR22- or -S(O) ⁇ -2-.
• e is 0-5 and r is 0-5, provided that the sum of e and r is 1-6; -(C2-C6)alkenylene-; and -(CH2)f-V-(CH2)g-, wherein V is C3-C6 cycloalkylene, f is 1-5 and g is
• M is -O-, -S-, -S(O)- or -S(O)2-;
• X, Y and Z are independently selected from the group consisting of -CH2-, -CH(C1-C6)alkyl- and -C(di-(C ⁇ -C6)alkyl);
• R10 and R 1 are independently selected from the group consisting of 1-3 substituents independently selected from the group consisting of (Cl-C6)alkyl, -OR 1 9, -0(CO)Rl 9 , -O(CO)OR 21 , -0(CH2)1-50R 19 , -O(CO)NR19R20, _NR19R20 ; -
• R 9(CO)R20, -NR 9(CO)OR 21 , -NR1 9 (CO)NR20R25 -NR 9S02R 21 , -COOR19, -CONR1 R20 ; .COR ⁇ 9 , -SO2NR19R20 J S(0)O-2R 21 , -O(CH2)1 -10-COOR19 J -O(CH2)1 -10CONR 1 9 R20, -(C ⁇ -C ⁇ alkylene)-COORl9, -CH CH-COORl9, -CF3, -CN, -NO2 and hal
• R " I5 and R ⁇ are independently selected from the group consisting of -OR 19 , -O(CO)R 9 , -0(CO)OR 21 and -O(CO)NR 1 9 R20 ;
• Ar 1 can also be pyridyl, isoxazolyl, furanyl, pyrrolyl, thienyl, imidazolyl, pyrazolyl, thiazolyl, pyrazinyl, pyrimidinyl or pyridazinyl;
• R 1 9 and R20 are independently selected from the group consisting of H, (C ⁇ - C6)alkyl, aryl and aryl-substituted (C-
• R 21 is (C ⁇ -C6)alkyl, aryl or R24- S ubstituted aryl;
• R22 is H, (C ⁇ -C6)alkyl, aryl (C ⁇ -C6)alkyl, -C(0)R 19 or -COOR 1 9;
• R 23 and R24 are independently 1-3 groups independently selected from the group consisting of H, (C ⁇ -C6)alkyl, (C ⁇ -C6)alkoxy, -COOH, N ⁇ 2,
• R 25 is H, -OH or (C ⁇ .-C6)alkoxy.
• sterol absorption inhibitors useful in the compositions and methods of the present invention are represented by Formula (IX) below: or a pharmaceutically acceptable salt or solvate thereof, wherein in Formula (IX): R is selected from the group consisting of H, G, G 1 , G 2 , -S0 3 H and -PO 3 H; G is selected from the group consisting of: H,
• W is independently selected from the group consisting of
• R and R6 are each independently selected from the group consisting of H, (Ci-C6)alkyl, acetyl, aryl and aryl(C ⁇ -C6)alkyl;
• R 3 , R 4 , R5 ; R7 ; 3a anc ⁇ R4a are ⁇ a ch independently selected from the group consisting of H, (C ⁇ -C6)alkyl, acetyl, aryl(C ⁇ -C6)a!kyl, -C(0)(C-
• R 39 is independently selected from the group consisting of R 32 -substituted T, R 32 -substituted-T-(C ⁇ -C6)alkyl, R 32 -substituted-(C2-C4)alkenyl,
• R 32 -substituted-(C ⁇ -C6)alkyl, R 32 -substituted-(C3-C7)cycloalkyl and R 32 - substituted-(C3-C7)cycloalkyl(Ci-C6)alkyl;
• R 31 is independently selected from the group consisting of H and (Ci- C4)alkyl
• T is independently selected from the group consisting of phenyl, furyl, thienyl, pyrrolyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, benzothiazolyl, thiadiazolyl, pyrazolyl, imidazolyl and pyridyl;
• R 2 is independently selected from 1-3 substituents which are each independently selected from the group consisting of H, halo, (C-
• R 33 is independently selected from the group consisting of unsubstituted alkyl, R 34 -substituted alkyl, (R 35 )(R 36 )alkyl-,
• R 34 is one to three substituents, each R 34 being independently selected from the group consisting of HOOC-, HO-, HS-, (CH 3 )S-, H 2 N-, (NH 2 )(NH)C(NH)-, (NH 2 )C(0)- and HOOCCH(NH 2 + )CH 2 SS-;
• R 35 is independently selected from the group consisting of H and NH 2 -;
• R 36 is independently selected from the group consisting of H, unsubstituted alkyl, R 3 -substituted alkyl, unsubstituted cycloalkyl and R 34 -substituted cycloalkyl;
• G 2 is represented by the structure:
• R 37 and R 38 are each independently selected from the group consisting of (CrC 6 )alkyl and aryl;
• R26 is one to five substituents, each R26 being independently selected from the group consisting of: a) H; b) -OH; c) -OCH 3 ; d) fluorine; e) chlorine; f) -O-G; g) -O-G 1 ; h) -O-G 2 ; i) -S0 3 H; and j) -P0 3 H; provided that when R is H, R 26 is not H, -OH, -OCH 3 or -O-G;
• Ar 1 is aryl, R 1 u -substituted aryl, heteroaryl or R 19 -substituted heteroaryl;
• Ar 2 is aryl, R 1 1 -substituted aryl, heteroaryl or R 1 1 -substituted heteroaryl; L is selected from the group consisting of: a) a covalent bond; b) -(CH 2 ) q -, wherein q is 1-6; c) -(CH 2 )e-E-(CH 2 )r-, wherein E is -0-, -C(O)-, phenylene, -NR 22 - or -S(0)o- 2 -, e is 0-5 and r is 0-5, provided that the sum of e and r is 1-6; d) -(C2-C 6 )alkenylene-; e) -(CH 2 )f-V-(CH 2 ) g -, wherein V is C 3 -C 6 cycloalkylene, f is 1-5 and g is 0-5, provided that the sum of f and g is 1-6; and
• M is -0-, -S-, -S(O)- or -S(0) 2 -;
• X, Y and Z are each independently selected from the group consisting of -CH 2 -, -CH(CrC 6 )alkyl- and -C(di-(C C 6 )alkyl)-;
• R 8 is selected from the group consisting of H and alkyl; R 1 0 and R 1 are each independently selected from the group consisting of 1-
• R 15 and R 17 are each independently selected from the group consisting of -OR 19 , -OC(0)R 19 , -OC(0)OR 21 , - OC(0)NR 19 R 20 ;
• Q is a bond, -(CH2)q-, wherein q is 1-6, or, with the 3-position ring carbon of the azetidinone, forms the spiro group
• R 3 and R 1 4 are each independently selected from the group consisting of
• -C6 alkyl) CH-, b is 1 ; provided that when a is 2 or 3, the R 13 's can be the same or different; and provided that when b is 2 or 3, the R 1 4's can be the same or different;
• Ar 1 can also be pyridyl, isoxazolyl, furanyl, pyrrolyl, thienyl, imidazolyl, pyrazolyl, thiazolyl, pyrazinyl, pyrimidinyl or pyridazinyl;
• R 19 and R20 are each independently selected from the group consisting of H,
• R 2 is (C ⁇ -C6)alkyl, aryl or R 2 4-substituted aryl;
• R22 is H, (C ⁇ -C6)alkyl, aryl (C ⁇ -C6)alkyl, -C(0)R 9 or -COOR 9 ;
• R 23 and R 2 are each independently selected from the group consisting of 1- 3 substituents which are each independently selected from the group consisting of H, (C ⁇ -C6)alkyl, (C ⁇
• R 25 is H, -OH or (C ⁇ -C6)alkoxy.
• a more preferred compound is one represented by formula XI:
• azetidinone compounds include N-sulfonyl-2- azetidinones such as are disclosed in U.S. Patent No. 4,983,597, ethyl 4-(2- oxoazetidin-4-yl)phenoxy-alkanoates such as are disclosed in Ram et al., Indian J. Chem. Sect. B. 29B, 12 (1990), p. 1134-7, and diphenyl azetidinones and derivatives disclosed in U.S. Patent Publication Nos. 2002/0039774, 2002/0128252, 2002/0128253 and 2002/0137689, and WO 2002/066464, each of which is incorporated by reference herein.
• the compounds of Formulae l-XII can be prepared by known methods, including the methods discussed above and, for example, WO 93/02048 describes the preparation of compounds wherein -R 1 -Q- is alkylene, alkenylene or alkylene interrupted by a hetero atom, phenylene or cycloalkylene; WO 94/17038 describes the preparation of compounds wherein Q is a spirocyclic group; WO 95/08532 describes the preparation of compounds wherein -R 1 -Q- is a hydroxy-substituted alkylene group; PCT/US95/03196 describes compounds wherein -R 1 -Q- is a hydroxy-substituted alkylene attached to the Ar 1 moiety through an -O- or S(0)rj-2- group; and U.S.
• Compounds of the invention have at least one asymmetrical carbon atom and therefore all isomers, including enantiomers, stereoisomers, rotamers, tautomers and racemates of he compounds of Formulae l-XII are contemplated as being part of this invention.
• the invention includes d and I isomers in both pure form and in admixture, including racemic mixtures.
• Isomers can be prepared using conventional techniques, either by reacting optically pure or optically enriched starting materials or by separating isomers of a compound of the Formulae l-XII. Isomers may also include geometric isomers, e.g., when a double bond is present.
• Compounds of the invention with an amino group can form pharmaceutically acceptable salts with organic and inorganic acids.
• suitable acids for salt formation are hydrochloric, sulfuric, phosphoric, acetic, citric, oxalic, malonic, salicylic, malic, fumaric, succinic, ascorbic, maieic, methanesulfonic and other mineral and carboxylic acids well known to those in the art.
• the salt is prepared by contacting the free base form with a sufficient amount of the desired acid to produce a salt.
• the free base form may be regenerated by treating the salt with a suitable dilute aqueous base solution such as dilute aqueous sodium bicarbonate.
• a suitable dilute aqueous base solution such as dilute aqueous sodium bicarbonate.
• the free base form differs from its respective salt form somewhat in certain physical properties, such as solubility in polar solvents, but the salt is otherwise equivalent to its respective free base forms for purposes of the invention.
• Certain compounds of the invention are acidic (e.g., those compounds which possess a carboxyl group). These compounds form pharmaceutically acceptable salts with inorganic and organic bases. Examples of such salts are the sodium, potassium, calcium, aluminum, gold and silver salts. Also included are salts formed with pharmaceutically acceptable amines such as ammonia, alkyl amines, hydroxyalkylamines, N-methylglucamine and the like.
• solvate means a molecular or ionic complex of molecules or ions of solvent with those of solute (for example, one or more compounds of Formulae l-XII, isomers of the compounds of Formulae l-XII, or prodrugs of the compounds of Formulae l-XII).
• useful solvents include polar, protic solvents such as water and/or alcohols (for example methanol).
• Prodrugs of the compounds of Formulae l-XII are contemplated as being part of this invention.
• prodrug means compounds that are drug precursors which, following administration to a patient, release the drug in vivo via some chemical or physiological process (e.g., a prodrug on being brought to the physiological pH or through enzyme action is converted to the desired drug form).
• the daily dose of the sterol absorption inhibitor(s) administered to the subject can range from about 0.1 to about 1000 mg per day, preferably about 0.25 to about 50 mg/day, and more preferably about 10 mg per day, given in a single dose or 2-4 divided doses.
• the exact dose is determined by the attending clinician and is dependent on the potency of the compound administered, the age, weight, condition and response of the patient.
• the weights indicated above refer to the weight of the acid equivalent or the base equivalent of the therapeutic compound derived from the salt.
• therapeutically effective amount means that amount of a therapeutic agent of the composition, such as a sterol absorption inhibitor(s), or other agent useful for the treatment of an autoimmune disorder and other pharmacological or therapeutic agents described below, that will elicit a biological or medical response of a tissue, system, or subject that is being sought by the administrator (such as a researcher, doctor or veterinarian) which includes alleviation of the symptoms of the condition or disease being treated and the prevention, slowing or halting of progression of the condition (autoimmune disorder and its symptom(s)).
• ACR20 a widely accepted composite index of improvement in rheumatoid arthritis (RA) is the ACR20 score proposed by the American College of Rheumatology (ACR).
• ACR20 refers to a composite improvement of 20% in swollen joint count, tender joint count, and 3 or more of the following measures: patient's own global assessment of RA disease activity; physician's assessment of disease activity; patient's own assessment of pain due to RA; acute-phase reactant (ESR, CRP); and disability (Health Assessment Questionnaire). See “Guidelines for the Management of Rheumatoid Arthritis, 2002 Update", Arthritis and Rheumatism 46(2): 328-346 (2002). The percentage of patients showing improvement in ACR20 score is the generally accepted minimum criteria for all new therapeutics for the treatment of RA.
• suitable subjects that can be treated according to the methods of the present invention include mammals, such as humans or dogs, and other animals.
• “combination therapy” or “therapeutic combination” means the administration of two or more therapeutic agents, such as sterol absorption inhibitor(s) and other agents useful for the treatment of an autoimmune disorder, to prevent or treat an autoimmune disorder or any of its associated conditions.
• Such administration includes coadministration of these therapeutic agents in a substantially simultaneous manner, such as in a single tablet or capsule having a fixed ratio of active ingredients or in multiple, separate capsules for each therapeutic agent.
• Such administration includes use of each type of therapeutic agent in a sequential manner.
• the treatment using the combination therapy will provide beneficial effects in treating the autoimmune condition.
• a potential advantage of the combination therapy disclosed herein may be a reduction in the required amount of an individual therapeutic compound or the overall total amount of therapeutic compounds that are effective in treating the autoimmune condition.
• therapeutic agents can be selected to provide a broader range of complimentary effects or complimentary modes of action.
• the present invention provides a therapeutic combination comprising (a) a first amount of at least one sterol absorption inhibitor or a pharmaceutically acceptable salt thereof or a solvate thereof; and (b) a second amount of at least one other agent or treatment useful for the treatment of an autoimmune disorder, wherein the first amount and the second amount together comprise a therapeutically effective amount for the treatment or prevention of an autoimmune disorder or lessening or amelioration of one or more symptoms of a condition associated with the autoimmune disorder.
• the present invention provides a pharmaceutical composition for the treatment or prevention of an autoimmune disorder and/or lowering a concentration of a sterol in plasma of a subject, comprising a therapeutically effective amount of a composition comprising (a) a first amount of at least one sterol absorption inhibitor or a pharmaceutically acceptable salt thereof or a solvate thereof; (b) a second amount of at least one other agent useful for the treatment of an autoimmune disorder and (c) a pharmaceutically acceptable carrier.
• the present invention provides a method of treating or preventing an autoimmune disorder in a subject, comprising the step of administering to a subject in need of such treatment an effective amount of a composition comprising (a) a first amount of at least one sterol absorption inhibitor or a pharmaceutically acceptable salt thereof or a solvate thereof; and (b) a second amount of at least one other agent useful for the treatment of an autoimmune disorder to prevent or treat an autoimmune disorder or any of its symptoms in the subject.
• Useful agents for treating autoimmune disorders include: (a) disease modifying antirheumatic drugs, including methotrexate, gold salts, D-penicillamine, hydroxychloroquine, auranofin, sulfsalazine; (b) nonsteroidal anitinflammatory drugs, including indomethacin, naproxen, diclofenac, ibuprofen, aspirin and aspirin analogs, acetaminophen; (c) COX-2 selective inhibitors, including celecoxib, rofecoxib, etoricoxib, valdecoxib, lumiracoxib; (d) COX-1 inhibitors; (e) immunosuppressives, including calcineurin inhibitors such as cyclosporin and FK506; p70 S ⁇ kinase inhibitors such as sirolimus and rapamycin; inosine monophosphate dehydrogenase inhibitors such as mycophenolate; leflunomide, cyclo
• compositions or therapeutic combinations that can further comprise one or more pharmacological or therapeutic agents or drugs such as cholesterol biosynthesis inhibitors and/or lipid-lowering agents discussed below.
• Non-limiting examples of cholesterol biosynthesis inhibitors for use in the compositions, therapeutic combinations and methods of the present invention include competitive inhibitors of HMG CoA reductase, the rate-limiting step in cholesterol biosynthesis, squalene synthase inhibitors, squalene epoxidase inhibitors and mixtures thereof.
• HMG CoA reductase inhibitors include statins such as atorvastatin (for example LIPITOR® which is available from Pfizer), lovastatin (for example MEVACOR® which is available from Merck & Co.), pravastatin (for example PRAVACHOL® which is available from Bristol Meyers Squibb), fluvastatin, simvastatin (for example ZOCOR® which is available from Merck & Co.), cerivastatin, CI-981 , rivastatin (sodium 7-(4- fluorophenyl)-2,6-diisopropyl-5-methoxymethylpyridin-3-yl)-3,5-dihydroxy-6- heptanoate) and pitavastatin (such as NK-104 of Negma Kowa of Japan).
• statins such as atorvastatin (for example LIPITOR® which is available from Pfizer), lovastatin (for example MEVACOR® which is available from
• Preferred HMG CoA reductase inhibitors include atorvastatin and simvastatin.
• a total daily dosage of cholesterol biosynthesis inhibitor(s) can range from about 0.1 to about 160 mg per day, and preferably about 0.2 to about 80 mg/day in single or 2-3 divided doses.
• compositions or therapeutic combinations that can further comprise at least one (one or more) activators for peroxisome proliferator-activated receptors (PPAR), such as peroxisome proliferator- activated receptor alpha (PPAR ⁇ ), peroxisome proliferator-activated receptor gamma (PPAR ) and peroxisome proliferator-activated receptor delta (PPARtf).
• PPAR ⁇ activator compounds are useful for, among other things, lowering triglycerides, moderately lowering LDL levels and increasing HDL levels.
• Useful examples of PPAR ⁇ activators include fibrates, such as clofibrate, gemfibrozil and fenofibrate.
• the PPAR activator(s) are administered in a therapeutically effective amount to treat the specified condition, for example in a daily dose preferably ranging from about 50 to about 3000 mg per day.
• compositions, therapeutic combinations or methods of the present invention can further comprise one or more bile acid sequestrants such as cholestyramine, colestipol and colesevelam hydrochloride.
• bile acid sequestrants such as cholestyramine, colestipol and colesevelam hydrochloride.
• a total daily dosage of bile acid sequestrant(s) can range from about 1 to about 50 grams per day, and preferably about 2 to about 16 grams per day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise one or more ileal bile acid transport (“IBAT”) inhibitors (or apical sodium co-dependent bile acid transport (“ASBT”) inhibitors) coadministered with or in combination with the peroxisome proliferator-activated receptor activator(s) and sterol absorption inhibitor(s) discussed above.
• IBAT inhibitors can inhibit bile acid transport to reduce LDL cholesterol levels.
• suitable IBAT inhibitors include benzothiepines such as are disclosed in PCT Patent Application WO 00/38727.
• a total daily dosage of IBAT inhibitor(s) can range from about 0.01 to about 1000 mg/day, and preferably about 0.1 to about 50 mg/day in single or 2-4 divided doses.
• the compositions or treatments of the present invention can further comprise nicotinic acid (niacin) and/or derivatives thereof, such as NIASPAN® (niacin extended-release tablets) which are available from Kos.
• a total daily dosage of nicotinic acid or a derivative thereof can range from about 500 to about 10,000 mg/day, preferably about 1000 to about 8000 mg/day, and more preferably about 3000 to about 6000 mg/day in single or divided doses.
• compositions or treatments of the present invention can further comprise one or more AcylCoA:Cholesterol O-acyltransferase ("ACAT") Inhibitors, which can reduce LDL and VLDL levels.
• ACAT AcylCoA:Cholesterol O-acyltransferase
• useful ACAT inhibitors include avasimibe.
• a total daily dosage of ACAT inhibitor(s) can range from about 0.1 to about 1000 mg/day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise one or more Cholesteryl Ester Transfer Protein ("CETP”) Inhibitors.
• CETP is responsible for the exchange or transfer of cholesteryl ester carrying HDL and triglycerides in VLDL.
• suitable CETP inhibitors are disclosed in PCT Patent Application No. WO 00/38721 and U.S. Patent No. 6,147,090, which are incorporated herein by reference.
• a total daily dosage of CETP inhibitor(s) can range from about 0.01 to about 1000 mg/day, and preferably about 0.5 to about 20 mg/kg body weight/day in single or divided doses.
• compositions or treatments of the present invention can further comprise probucol or derivatives thereof, which can reduce LDL levels.
• a total daily dosage of probucol or derivatives thereof can range from about 10 to about 2000 mg/day, and preferably about 500 to about 1500 mg/day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise low-density lipoprotein (LDL) receptor activators such as HOE-402, an imidazolidinyl- pyrimidine derivative that directly stimulates LDL receptor activity.
• LDL low-density lipoprotein
• a total daily dosage of LDL receptor activator(s) can range from about 1 to about 1000 mg/day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise fish oil, which contains Omega 3 fatty acids (3-PUFA), which can reduce VLDL and triglyceride levels.
• fish oil which contains Omega 3 fatty acids (3-PUFA), which can reduce VLDL and triglyceride levels.
• a total daily dosage of fish oil or Omega 3 fatty acids can range from about 1 to about 30 grams per day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise natural water soluble fibers, such as psyllium, guar, oat and pectin, which can reduce cholesterol levels.
• natural water soluble fibers such as psyllium, guar, oat and pectin
• a total daily dosage of natural water soluble fibers can range from about 0.1 to about 10 grams per day in single or 2-4 divided doses.
• the compositions or treatments of the present invention can further comprise plant sterols, plant stanols and/or fatty acid esters of plant stanols, such as sitostanol ester used in BENECOL® margarine, which can reduce cholesterol levels.
• a total daily dosage of plant sterols, plant stanols and/or fatty acid esters of plant stanols can range from about 0.5 to about 20 grams per day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise antioxidants, such as probucol, tocopherol, ascorbic acid, ⁇ -carotene and selenium, or vitamins such as vitamin B 6 or vitamin B 12 -
• antioxidants such as probucol, tocopherol, ascorbic acid, ⁇ -carotene and selenium
• vitamins such as vitamin B 6 or vitamin B 12 -
• a total daily dosage of antioxidants or vitamins can range from about 0.05 to about 10 grams per day in single or 2-4 divided doses.
• compositions or treatments of the present invention can further comprise monocyte and macrophage inhibitors such as polyunsatu rated fatty acids, gene therapy and use of recombinant proteins such as recombinant apo E.
• monocyte and macrophage inhibitors such as polyunsatu rated fatty acids, gene therapy and use of recombinant proteins such as recombinant apo E.
• a total daily dosage of these agents can range from about 0.01 to about 1000 mg/day in single or 2-4 divided doses.
• compositions, therapeutic combinations or methods of the present invention can further comprise one or more cardiovascular agents or blood modifiers. Mixtures of any of the pharmacological or therapeutic agents described above can be used in the compositions and therapeutic combinations of these other embodiments of the present invention.
• compositions and therapeutic combinations of the present invention can be administered to a subject in need of such treatment in a therapeutically effective amount to treat an autoimmune disorder and its associated conditions as discussed above.
• the compositions and treatments can be administered by any suitable means which produce contact of these compounds with the site of action in the body, for example in the plasma, liver or small intestine of a subject.
• the daily dosage for the various compositions and therapeutic combinations described above can be administered to a subject in a single dose or in multiple subdoses, as desired. Subdoses can be administered 2 to 6 times per day, for example. Sustained release dosages can be used.
• compositions, therapeutic combinations or medicaments of the present invention can further comprise one or more pharmaceutically acceptable carriers, one or more excipients and/or one or more additives.
• the pharmaceutical compositions can comprise about 1 to about 99 weight percent of active ingredient (such as one or more compounds of Formula l-XII), and preferably about 5 to about 95 percent active ingredient.
• Useful pharmaceutically acceptable carriers can be either solid, liquid or gas.
• Non-limiting examples of pharmaceutically acceptable carriers include solids and/or liquids such as magnesium carbonate, magnesium stearate, talc, sugar, lactose, ethanol, glycerol, water and the like.
• the amount of carrier in the treatment composition or therapeutic combination can range from about 5 to about 99 weight percent of the total weight of the treatment composition or therapeutic combination.
• Non-limiting examples of suitable pharmaceutically acceptable excipients and additives include non-toxic compatible fillers, binders such as starch, polyvinyl pyrrolidone or cellulose ethers, disintegrants such as sodium starch glycolate, crosslinked polyvinyl pyrrolidone or croscarmellose sodium, buffers, preservatives, anti-oxidants, lubricants, flavorings, thickeners, coloring agents, wetting agents such as sodium lauryl sulfate, emulsifiers and the like.
• the amount of excipient or additive can range from about 0.1 to about 95 weight percent of the total weight of the treatment composition or therapeutic combination.
• carrier(s), excipients and additives can vary. Further examples of pharmaceutically acceptable carriers and methods of manufacture for various compositions can be found in A. Gennaro (ed.), Remington: The Science and Practice of Pharmacy, 20 th Edition, (2000), Lippincott Williams & Wilkins, Baltimore, MD.
• Useful solid form preparations include powders, tablets, dispersible granules, capsules, cachets and suppositories.
• An example of a preparation of a preferred solid form dosage formulation is provided below.
• Useful liquid form preparations include solutions, suspensions and emulsions. As an example may be mentioned water or water-propylene glycol solutions for parenteral injection or addition of sweeteners and opacifiers for oral solutions, suspensions and emulsions. Liquid form preparations may also include solutions for intranasal administration.
• Aerosol preparations suitable for inhalation may include solutions and solids in powder form, which may be in combination with a pharmaceutically acceptable carrier, such as an inert compressed gas, e.g. nitrogen.
• a pharmaceutically acceptable carrier such as an inert compressed gas, e.g. nitrogen.
• solid form preparations which are intended to be converted, shortly before use, to liquid form preparations for either oral or parenteral administration.
• liquid forms include solutions, suspensions and emulsions.
• the compounds of the invention may also be deliverable transdermally.
• the transdermal compositions can take the form of creams, lotions, aerosols and/or emulsions and can be included in a transdermal patch of the matrix or reservoir type as are conventional in the art for this purpose.
• the compound is administered orally.
• the present invention provides the use of at least one compound represented by Formulae (l-XII) for manufacture of a medicament (such as one of the compositions discussed above) for the treatment of an autoimmune disorder and its associated conditions.
• a medicament such as one of the compositions discussed above
• the term "Active Compound I” designates a sterol absorption inhibitor such as any of the compounds of Formulas l-XII described herein above and the term “Active Compound II” designates at least one other agent useful for the treatment of an autoimmune disorder (such as an immunosuppressive medicament) described herein above.
• the above-described tablet can be coadministered with an injection, tablet, capsule, etc. comprising a dosage of Active Compound II as described above.
• sterol absorption inhibitor For coadministration in separate tablets or capsules, representative formulations comprising a sterol absorption inhibitor, such as are discussed above, are well known in the art and representative formulations comprising at least one other agent useful for the treatment of an autoimmune disorder, such as are discussed above, are well known in the art. It is contemplated that where the two active ingredients are administered as a single composition, the dosage forms disclosed above for sterol absorption inhibitors may readily be modified using the knowledge of one skilled in the art.
• kits are contemplated wherein two separate units are combined: a pharmaceutical composition comprising at least one anti-autoimmune disorder medication and a separate pharmaceutical composition comprising at least one sterol absorption inhibitor as described above.
• the kit will preferably include directions for the administration of the separate components.
• the kit form is particularly advantageous when the separate components must be administered in different dosage forms (e.g., oral and parenteral) or are administered at different dosage intervals.
• the treatment compositions and therapeutic combinations of the present invention can inhibit the intestinal absorption of sterols in subjects and can be useful in the treatment and/or prevention of an autoimmune disorder and associated conditions, such as rheumatoid arthritis, in subjects, in particular in mammals.
• compositions and therapeutic combinations of the present invention can reduce plasma concentration of at least one sterol selected from the group consisting of cholesterol and phytosterols (such as sitosterol, campesterol, stigmasterol and avenosterol) and mixtures thereof.
• the plasma concentration can be reduced by administering to a subject in need of such treatment an effective amount of at least one treatment composition comprising at least one sterol absorption inhibitor described above.
• the reduction in plasma concentration of sterols or can range from about 1 to about 70 percent, and preferably about 10 to about 50 percent.
• Methods of measuring serum total blood cholesterol and total LDL cholesterol are well known to those skilled in the art and for example include those disclosed in PCT WO 99/38498 at page 11 , incorporated by reference herein.
• reaction mixture was stirred vigorously for 4 h at -20°C, then acetic acid was added as a solution in CH2CI2 dropwise over 15 min, the reaction mixture was allowed to warm to 0°C, and H2SO4 (2N) was added. The reaction mixture was stirred an additional 1 h, the layers were separated, washed with water, separated and the organic layer was dried. The crude product was crystallized from ethanol/water to obtain the pure intermediate.
• Step 3 To a solution of the product of Step 2 (8.9 g, 14.9 mmoi) in toluene
• N,0-bis(trimethylsilyl)acetamide (BSA) (7.50 ml, 30.3 mmol). After 0.5 h, solid TBAF (0.39 g, 1.5 mmol) was added and the reaction mixture stirred at 50°C for an additional 3 h. The reaction mixture was cooled to 22°C, CH3OH (10 ml), was added. The reaction mixture was washed with HCI (1 N), NaHC ⁇ 3 (1 N) and NaCl (sat'd.), and the organic layer was dried over MgS ⁇ 4.
• BSA N,0-bis(trimethylsilyl)acetamide
• Step 4) To a solution of the product of Step 3 (0.94 g, 2.2 mmol) in CH3OH
• Step 5 To an efficiently stirred suspension of 4-fluorophenylzinc chloride (4.4 mmol) prepared from 4-fluorophenylmagnesium bromide (1 M in THF, 4.4 ml, 4.4 mmol) and ZnCl2 (0.6 g, 4.4 mmol) at 4°C, was added tetrakis(triphenyl- phosphine)palladium (0.25 g, 0.21 mmol) followed by the product of Step 4 (0.94 g, 2.2 mmol) as a solution in THF (2 ml). The reaction was stirred for 1 h at 0°C and then for 0.5 h at 22°C.
• Step 6) To the product of Step 5 (0.95 g, 1.91 mmol) in THF (3 ml), was added (R)-tetrahydro-1-methyl-3,3-diphenyl-1 H,3H-pyrrolo-[1 ,2-c][1 ,3,2] oxazaborole
• Step 6' (Alternative): To a solution of the product of Step 5 (0.14 g, 0.3 mmol) in ethanol (2 ml), was added 10% Pd/C (0.03 g) and the reaction was stirred under a pressure (60 psi) of H2 gas for 16 h. The reaction mixture was filtered and the solvent was concentrated to afford a 1 :1 mixture of compounds 6A and 6B.
• the compound of Formula II (or any cholesterol absorption inhibitor discussed above) is administered to rodents which have been induced to develop experimental arthritis.
• Useful rodents can include Balb/c, C57BL/6, B10.RIII or DBA/1 mice, or Lewis or Wistar rats (available from Jackson Laboratory, Charles River Laboratories or Taconic Laboratories).
• collagen-induced arthritis (CIA) in DBA/1 or B1 O.RIII mice are used as an animal model of rheumatoid arthritis for in vivo evaluation of the effect of the compound of Formula II on rheumatoid disease.
• the highly susceptible parental strain DBA/1 or B1 O.RIII develop 90-100% arthritis in males and 60-100% arthritis in females.
• the disease is induced by immunization with cartilage-specific type II collagen in Complete Freund's adjuvant and in some cases animals are boosted with Type II collagen or lipopolysaccharide on days 17-25 after immunization.
• the mice are 8-10 weeks old at the time of immunization.
• Rat type II collagen is prepared as previously described (see Miller and Rhodes (1982) Methods Enzymol. 82: 33).
• CIA is induced by intradermal immunization in the base of the tail with 50-100 ⁇ g type II collagen emulsified in Complete Freund's adjuvant (as described in Current Protocols in Immunology, Unit 15, John Wiley & Sons, Inc. NY or in Holmdahl, et al. (1998) Genetic Analysis of Murine Models for Rheumatoid Arthritis In Human Genome Methods, vol. 215, CRC Press, NY).
• the compound of Formula II (or any cholesterol absorption inhibitor discussed above) is administered to mice that have been induced to developed CIA.
• mice can be scored for clinical disease starting at 14 days after immunization with rat type II collagen.
• the compound of Formula II is administered at a dosage of 0.1-100 mg/kg/day either in the diet or by systemic oral, subcutaneous or intraperitoneal administration over a period of 3 days to 10 weeks. Animals are scored daily for clinical disease score as described in Current Protocols in Immunology, Unit 15, John Wiley & Sons, Inc., NY.
• animals are euthanized by isofurane overdose and cytological, histological, immunological and immunohistochemical parameters are assessed by standard techniques well known to those skilled in the art. Serum lipoprotein and cholesterol measurements will be made by methods well known to those skilled in the art and, for example, including those disclosed in PCT WO 99/38498 at page 11 , incorporated by reference herein.
• the compound of Formula II (or any cholesterol absorption inhibitor discussed above) is administered to rodents which have been induced to develop ulcerative colitis.
• Suitable rodents are the same as those described in Example 2.
• the effect of the administration of the compound of Formula II is investigated in 2,4,6-trinitrobenzene sulfonic acid (TNBS) - induced colitis in mice.
• the compound of Formula II is administered at a dosage of 0.1-100 mg/kg/day either in the diet or by systemic oral, subcutaneous or intraperitoneal administration over a period of 3 days to 10 weeks.
• Colitis is induced in mice by intrarectal administration of TNBS (1.5 mg/mouse in 50% ethanol) and disease severity is assessed clinically and by histologic scoring of colon damage, including determination of interleukin (IL)-2, IL-12, interferon (INF)-gamma and tumor necrosis factor (TNF)-alpha (protein and mRNA) and myeloperoxidase (MPO) activity in the colon. Cytokine production by the lamina propia mononuclear cells (LPMC) and luminal bacteria are also typically measured (see Fiorucci, et al. (2002) Digestion 66(4): 246-256).
• IL interleukin
• INF interferon
• TNF tumor necrosis factor
• MPO myeloperoxidase
• mice are euthanized by isofurane overdose and the above- described parameters are assessed using methods described in Current Protocols in Immunology, Unit 15, John Wiley & Sons, Inc. NY and/or using the methods described by Fiorucci, et al. (2002) in Digestion 66(4): 246-256. Serum lipoprotein and cholesterol measurements will be made as described in Example 2.

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