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Definitions

• the invention relates to methods and compositions for treating patients having neurological, psychotic, and/or psychiatric disorders. More particularly, the invention relates to methods for treating patients having neurological, psychotic, and/or psychiatric disorders by co-administration of compounds having different dopamine receptor activities to the patient.
• Di and D 2 receptor subtypes each consisting of several molecular forms.
• Di receptors preferentially recognize the phenyltetrahydrobenzazepines and generally lead to stimulation of the enzyme adenylate cyclase, whereas D 2 receptors recognize the butyrophenones and benzamides and often are coupled negatively to adenylate cyclase, or are not coupled at all to this enzyme.
• D 2 receptors recognize the butyrophenones and benzamides and often are coupled negatively to adenylate cyclase, or are not coupled at all to this enzyme.
• at least five dopamine receptor genes encode the D l5 D 2 , D 3 , D 4 , and D 5 receptor isoforms or subtypes.
• Dj- like class comprising the Di (D IA ) and the D 5 (DI B ) receptor subtypes
• D 2 -like class consists of the D 2 , D , D 2S , D 3 , and D 4 receptor subtypes.
• Agonist stimulation of dopamine Di receptors is believed to activate adenylate cyclase to form cyclic AMP (cAMP), which in turn is followed by the phosphorylation of intracellular proteins.
• cAMP cyclic AMP
• Agonist stimulation of D 2 dopamine receptors is believed to lead to decreased cAMP formation. Agonists at both subclasses of receptors are clinically useful.
• Dopamine receptor agonists are of therapeutic interest for a variety of reasons. For example, it has been hypothesized that excessive stimulation of D 2 dopamine receptor subtypes may be linked to schizophrenia. Additionally, it is generally recognized that either excessive or insufficient dopaminergic activity in the central nervous system can cause hypertension, narcolepsy, and other behavioral, neurological, physiological, psychological, and movement disorders, including Parkinson's disease. For example, schizophrenia is among the most common and the most debilitating of psychiatric diseases. Current estimates suggest a prevalence of schizophrenia at between 0.5 and 1% of the population.
• Patients with schizophrenia and other neurological and psychiatric disorders can have both "positive” symptoms, including delusions, hallucinations, impaired cognitive function, and agitation, as well as "negative” symptoms, including emotional unresponsiveness, impaired memory, and impaired cognitive function.
• Patients with these psychotic signs and symptoms can be treated with drugs that fall into the general classes of typical antipsychotic drugs and atypical antipsychotic drugs.
• the typical antipsychotic agents include phenothiazines, butyrophenones, and other non-phenothiazines such as loxapine and molindone.
• the atypical antipsychotic agents include the clozapine-like drugs, such as clozapine, olanzepine, quetiapine, ziprasidone, and the like, as well as several others, including risperidone, aripiprazole, and amisulpiride, among others.
• clozapine-like drugs such as clozapine, olanzepine, quetiapine, ziprasidone, and the like
• risperidone aripiprazole
• amisulpiride among others.
• patients may not find total relief from the negative symptoms that may accompany these antipsychotic agents.
• recent studies suggest that the current antipsychotic therapy for treating positive symptoms of schizophrenia may in some cases exacerbate or facilitate the onset of such negative symptoms.
• Dopamine agonists have also been developed to treat Parkinson's disease in an attempt to avoid some of the limitations of levodopa therapy, because levodopa therapy is not always a successful treatment, for example in certain late- stage disorders.
• levodopa therapy is not always a successful treatment, for example in certain late- stage disorders.
• selective dopamine agonists bypass the degenerating presynaptic neurons.
• these drugs do not rely on the same enzymatic conversion for activity required for levodopa, avoiding issues associated with declining levels of striatal dopa decarboxylase.
• agonists have the potential for longer half -lives than levodopa, and can also be designed to interact specifically with predetermined subpopulations of dopamine receptors.
• D 2 receptor antagonist down regulates Di receptors.
• Such down regulation was shown to have the overall effect of causing or increasing memory and cognition complications.
• Down regulation of Di and/or D 5 receptor rnRNAs has been observed in the prefrontal and temporal cortices but not in the neostriatum of nonhuman primates after chronic treatment with certain antipsychotic medications.
• full D ⁇ agonists may cause Di receptor desensitization and even down regulation of dopamine Di receptor expression.
• Partial Di agonists may cause desensitization but generally do not cause down regulation of receptor expression.
• short-term administration of a D] receptor agonist following the onset of memory or cognition complications arising from administering a D 2 receptor antagonist, alleviated the symptoms of such memory or cognition complications.
• the invention described herein generally pertains to compounds, compositions, and methods for treating neurological, psychotic, and/or psychiatric disorders by administering a plurality of such dopamine receptor active compounds or compositions.
• the compounds useful in the methods and compositions described herein for treating neurological, psychotic, and/or psychiatric disorders include partial and/or full dopamine Di receptor agonists, and dopamine D 2 receptor antagonists.
• the partial and/or full Dj receptor agonists, and D 2 receptor antagonists are co- administered either contemporaneously or simultaneously.
• an effective amount of a partial and/or full Di receptor agonist can be co-administered to a patient having a neurological disorder along with an effective amount of a D 2 receptor antagonist to reduce the symptoms of the neurological, psychotic, and/or psychiatric disorder.
• a dopamine D 2 receptor antagonist is used to reduce the primary symptoms
• a dopamine Di receptor agonist is used to reduce the negative symptoms.
• the partial and or full Di receptor agonist and the D 2 receptor antagonist can be administered to the patient having the neurological disorder either in the same or in a different composition or compositions.
• the term "Di receptor” refers to each and every Di and Di-like receptor, alone or in various combinations, including the Di and D 5 receptors in humans, the D IA and Di B receptors found in rats, and other Di-like receptors.
• the term “D 2 receptor” refers to each and every D 2 and D 2 -like receptor, alone or in various combinations, including the D 2 , D 2L , D 2S , D 3 , and D 4 receptors found in mammals.
• the dopamine agonist is a compound selected from the following group of compounds:
• the groups R, R 1 , R 2 , R 3 , R 4 , R 5 , R 6 , R 7 , R 8 , and X are as defined herein. It is appreciated that each of the foregoing compounds have one or more asymmetric carbon atoms or chiral centers, and that each may be prepared in or isolated in optically pure form, or in various mixtures of enantiomers or diastereomers. Each of the individual stereochemically pure isomers of the foregoing are contemplated herein. In addition, various mixtures of such stereochemically pure isomers are also contemplated, including but not limited to racemic mixtures that are formed from one pair of enantiomers. In another illustrative aspect, the dopamine agonist is a compound selected from the following group of compounds:
• the dopamine D 2 receptor antagonist is an antipsychotic agent, and is illustratively selected from the typical and atypical families of antipsychotic agents. It is appreciated that atypical antipsychotics may generally be associated with less acute extrapyramidal symptoms, especially dystonias, and less frequent and smaller increases in serum prolactin concentrations associated with therapy.
• the typical antipsychotic agents include phenothiazines and non-phenothiazines such as loxapine, molindone, and the like.
• the atypical antipsychotic agents include the clozapine-like agents, and others, including aripiprazole, risperidone (3-[2-[4-(6-fluoro-l,2-benzisoxazol-3- yl)piperidino]ethyl]-2-methyl-6,7,8,9 -tetrahydro-4H-pyrido-[l,2-a]pyrimidin-4-one), amisulpiride, sertindole (l-[2-[4-[5-chloro-l-(4-fluorophenyl)-lH-indol-3-yl ]-l- piperidinyl]ethyl]imidazolidin-2-one), and the like.
• Phenothiazines include, but are not limited to chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, thioridazine, and trifluoperazine.
• Non-phenothiazines include, but are not limited to haloperidol, pimozide, and thiothixene.
• clozapine-like agents include, but are not limited to olanzapine (2-methyl-4-(4-methyl-l-piperazinyl)-10H- thieno[2,3-b][l,5]benzodiazepine), clozapine (8-chloro-l l-(4-methyl-l -piperazinyl)- 5H-dibenzo[b,e][l,4]diazepine), quetiapine (5-[2-(4-dibenzo[b,f][l,4]thiazepin-ll-yl -l-piperazinyl)ethoxy]ethanol), ziprasidone (5-[2-[4-(l,2-benzoisothiazol-3-yl)-l- piperazinyl]ethyl]-6-chloro-l,3-dihyd ro-2H-indol-2-one), and the like.
• a pharmaceutical composition includes a partial and or full dopamine Di receptor agonist, a dopamine D receptor antagonist, and a pharmaceutically carrier, excipient, diluent, or combination thereof.
• the Di receptor agonist is illustratively a compound selected from the group consisting of hexahydrobenzophenanthridines, hexahydrothienophenanthridines, phenylbenzodiazepines, chromenoisoquinolines, naphthoisoquinolines, and pharmaceutically acceptable salts thereof, including combinations of the foregoing.
• the pharmaceutical composition is a unit or unitary dosage form. It is to be understood that such unit or unitary dosage forms include kits or other formats that may require mixing prior to or immediately before administering to a patient.
• a method for treating a patient having a neurological, psychotic, and/or psychiatric disorder is described.
• the method comprises the steps of (a) administering to the patient an effective amount of a partial and/or full Di dopamine receptor agonist, and (b) administering to the patient an effective amount of a D 2 dopamine receptor antagonist.
• the dopamine agonist is a compound selected from the group consisting of hexahydrobenzophenanthridines, hexahydrothienophenanthridines, phenylbenzodiazepines, chromenoisoquinolines, naphthoisoquinolines, analogs and derivatives thereof, and pharmaceutically acceptable salts thereof, including combinations of the foregoing.
• Di dopamine receptor agonist and the D 2 dopamine receptor antagonist are administered to the patient in the same composition.
• the Di dopamine receptor agonist and the D 2 dopamine receptor antagonist are administered to the patient in different compositions.
• either or both of the Di receptor agonist and/or the D 2 receptor antagonist are administered intermittently or discontinuously.
• the D 2 receptor agonist is administered continuously or more regularly than the Di receptor agonist.
• the Di receptor agonist is administered in a discontinues or intermittent manner such that a first dose is administered but is allowed to decrease through the intervention or biological, metabolism, excretion, enzymatic, chemical, or other process to achieve a second lower dose, where the second lower dose is a suboptimal dose sufficiently incapable of agonizing the Di dopamine receptor to a full extent.
• the Di receptor agonist is a compound that has a half-life of less than about six hours.
• Fig. 1 illustrates the chemical conversions detailed in Examples 1-5 for preparation of dihydrexidine and other hexahydrobenzo[ ]phenanthridine compounds: (a) 1. Benzylamine, H 2 O; 2. ArCOCl, Et 3 N; (b) hv; (c) BH 3 -THF; (d) H 2 , 10% Pd/C; (e) 48% HBr, reflux.
• Fig. 2 illustrates the chemical conversions detailed in Examples 6-8 for preparation of dinoxyline and other chromeno[4,3,2-de]isoquinoline compounds: (a) 1. NaH, THF; 2.
• Fig. 3 illustrates the chemical conversions detailed in Example 9 for preparation of 2-methyl-2,3-dihydro-4(lH)-isoquinolone, an illustrative intermediate in the synthesis of dinapsoline and other naphthoisoquinolines, from ethyl 2-toluate:
• Fig. 4 illustrates the chemical conversions detailed in Example 10 for preparation of dinapsoline and other naphthoisoquinolines from substituted benzamides, as illustrated by 2,3-dimethoxy-N,N-diethylbenzamides: (a) 1. sec-butyllithium, TMEDA, Et 2 O, -78 °C, 2. Compound 20, 3. TsO ⁇ , toluene, reflux;
• FIG. 5 illustrates an alternate synthesis for preparation of dinapsoline and other naphthoisoquinolines from substituted benzenes and isoquinolines, as illustrated by l-bromo-3,4-methylenedioxybenzene, which may also be used to prepare optically active compounds: (a) Br /AlCl 3 /neat; (b) 1. n-BuLi, 2. DMF; (c) LDA; (d) add 32 to 33; (e) NaBH 3 CN in HCl/THF; (f) BBr 3 /CH 2 Cl 2 .
• the compounds, compositions, and methods described herein are useful for co-administration of dopamine receptor-binding compounds including partial and/or full dopamine O ⁇ receptor agonists and dopamine D 2 receptor antagonists.
• the dopamine Di receptor agonists may have biological activities ranging from compounds with selective Di receptor agonist activity to compounds with potent activities affecting both Di and D 2 dopamine receptors and various subtypes thereof.
• an effective amount of a partial and/or full Di receptor agonist can be co-administered to a patient having a neurological disorder along with an effective amount of a D 2 receptor antagonist to reduce the symptoms of the neurological disorder (e.g., to reduce both the positive and the negative symptoms of neurological disorders such as schizophrenia).
• the partial and/or full Di receptor agonist and the D 2 receptor antagonist can be administered to the patient having the neurological disorder either in the same or in a different composition or compositions. It is appreciated that in certain variations of the compounds, compositions, and methods described herein, full dopamine Di agonists are included and partial dopamine Di agonists are excluded.
• partial dopamine Di agonists may not be as effective as full dopamine Di agonists.
• compounds of formulae I-IN are used in the compounds, compositions, and methods described herein, and in particular those examples of formulae I-IN that are full dopamine Di receptor agonists.
• Exemplary neurological disorders that can be treated with the method and composition described herein include such neurological disorders as schizophrenia, schizophreniform disorder, schizoaffective disorders, including those characterized by the occurrence of a depressive episode during the period of illness, bipolar disorder, depression in combination with psychotic episodes, and other disorders that include a psychosis.
• the types of schizophrenia that may be treated include Paranoid Type Schizophrenia, Disorganized Type Schizophrenia, Catatonic Type Schizophrenia, Undifferentiated Type Schizophrenia, Residual Type Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Schizoaffective Disorder of the Depressive Type, and Major Depressive Disorder with Psychotic Features.
• the neurological disorders that can be treated have both
• schizophrenia e.g., delusions, hallucinations, impaired cognitive function, and agitation
• negative symptoms e.g., emotional unresponsiveness
• schizophrenia may be treatable using the methods and compositions described herein.
• psychotic conditions as described herein include schizophrenia, schizophreniform diseases, acute mania, schizoaffective disorders, and depression with psychotic features. The titles given these conditions may represent multiple disease states.
• the disease state may be references by the classification in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, published by the American Psychiatric Association (DSM).
• the DSM code numbers for several disease states include Paranoid Type Schizophrenia 295.30, Disorganized Type Schizophrenia 295.10, Catatonic Type Schizophrenia 295.20, Undifferentiated Type Schizophrenia 295.90, Residual Type Schizophrenia 295.60, Schizophreniform Disorder 295.40, Schizoaffective Disorder 295.70, Schizoaffective Disorder of the Depressive Type and Major Depressive Disorder with Psychotic Features 296.24, 296.34.
• psychoses are often associated with other diseases and conditions, or caused by such other conditions, including with neurological conditions, endocrine conditions, metabolic conditions, fluid or electrolyte imbalances, hepatic or renal diseases, and autoimmune disorders with central nervous system involvement, and with use or abuse of certain substances, including but not limited to cocaine, methylphenidate, dexmethasone, amphetamine and related substances, cannabis, hallucinogens, inhalants, opioids, phencyclidine, sedatives, hypnotics, and anxiolytics.
• Psychotic disorders may also occur in association with withdrawal from certain substances. These substances include, but are not limited to, sedatives, hypnotics and anxiolytics.
• Another disease state treatable with the methods and compositions described herein includes schizotypal personality disorder, a schizophrenia spectrum disorder that is related genetically, phenomenology, and neurobiology, and pharmacologically to chronic schizophrenia, and shares many of the cognitive deficits of schizophrenia, although typically to a lesser degree of severity.
• Other disorders that have a psychotic component and a depressive component that can be treated include premenstrual syndrome, anorexia nervosa, substance abuse, head injury, and mental retardation.
• endocrine conditions, metabolic conditions, fluid or electrolyte imbalances, hepatic or renal diseases, and autoimmune disorders with central nervous system involvement which have a psychotic component and a depressive component may be treated with the composition and method described herein.
• administering a Di receptor agonist contemporaneously or simultaneously with a D 2 receptor antagonist may alleviate or cure, or slow or prevent the onset of, symptoms associated with neurological, psychiatric, and/or psychotic disease states.
• the symptoms include memory loss, memory disorders, cognitive disorders, and dementia.
• administering a Di agonist contemporaneously or simultaneously with a D antagonist may avoid the onset of symptoms associated with administering the D 2 antagonist in treatment alone, including avoiding the onset of memory and/or cognition complications.
• a rescue treatment that includes treatment with a dopamine Di receptor agonist following the onset of negative symptoms associated with treatment involving a D 2 antagonist alone also may be effective, in some aspects such cycling of Di receptor activity with the accompanying onset of symptoms may be less desirable than avoiding the symptoms at the outset, which may be advantageous or more desirable. It is further appreciated that in some aspects such cycling may also erode the maximum recovery that may be achieved with such rescue treatment protocols, making less likely the recovery to original levels, as measured by Di activity or evaluations of memory and/or cognition.
• methods of treating patients suffering from or susceptible to suffering from disease states that may respond to treatment according to the methods described herein a long-term protocol are easier to administer and/or monitor when using the simultaneous or contemporaneous treatment protocols described herein.
• Such simultaneous or contemporaneous treatment protocols may remove the need to measure or evaluate negative side effects from D 2 receptor antagonist treatment to decide upon the timing for initiation of a subsequent rescue treatment to alleviate such side effects by treating with a Di receptor agonist.
• Illustrative disease states that may benefit from the simultaneous or contemporaneous treatment protocols described herein include, but are not limited to, schizophrenia, dementia, senile dementia, presenile dementia, bipolar disorder, Alzheimer's disease (AD), Parkinson's disease (PD), psychosis, acute mania, mild anxiety states, depression, including depression in combination with psychotic episodes, memory loss, cognition loss and dysfunction, attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD), drug or substance abuse, sexual dysfunction, autism, other neurodegenerative diseases, and other disease states that may arise from dysregulation or dysfunction of dopamine activity in the central nervous system (CNS).
• CNS central nervous system
• the partial and/or full Di dopamine receptor agonist can be selective for a dopamine Di receptor subtype, such as the Di or D 5 receptor subtype in humans, or the DI A or D IB receptor subtype in rodents, and like receptor subtypes.
• the partial and/or full Di dopamine receptor agonist can exhibit activity at both the Di and D 2 dopamine receptor subtypes.
• the full Di dopamine receptor agonist can be about equally selective for the Di and D 2 dopamine receptor subtypes, or can be more active at the Di compared to the D 2 dopamine receptor subtypes.
• the partial and/or full Di dopamine receptor agonist can be selective for a Di dopamine receptor or receptor subtype associated with a particular tissue.
• the partial and/or full Di dopamine receptor agonist can be selective for a Di dopamine receptor or receptor subtype capable of exhibiting functional selectivity with the Di dopamine receptor agonist.
• references to receptor selectivity include functional selectivity at dopamine receptors. Such functional selectivity may further distinguish the activity of the compounds and compositions described herein to allow the treatment of more specifically predetermined symptoms.
• compounds and compositions that are selective for a particular dopamine receptor illustratively the Di receptor, may yet exhibit a second layer of selectivity where such compounds and compositions show functional activity at dopamine Di receptors in one or more tissues, but not in other tissues.
• Illustrative of such functional selectivity is the reported selectivity of dihydrexidine for postsynaptic neurons over presynaptic neurons. Other functional selectivity is contemplated herein.
• dihydrexidine ( ⁇ )-trans-10,ll-dihydroxy-5,6,6a,7,8,12b- hexahydrobenzo[ ⁇ ]phenanthridine hydrochloride
• iv intravenous
• sc subcutaneous
• po oral
• animal models include evaluation of reference memory in a radial arm maze (Packard et al., J. Neurosci. 9:1465-72 (1989)); Packard and White, Behav. Neural. Biol. 53:39-50 (1990)); Colombo et al., Behav. Neurosci.
• the dopamine agonist is a compound selected from the group consisting of hexahydrobenzophenanthridines, hexahydrothienophenanthridines, phenylbenzodiazepines, chromenoisoquinolines, naphthoisoquinolines, analogs and derivatives thereof, and pharmaceutically acceptable salts thereof, including combinations of the foregoing.
• the dopamine agonist is a compound selected from the following group of compounds:
• the groups R, R 1 , R 2 , R 3 , R 4 , R 5 , R 6 , R 7 , R 8 , and X are as defined herein. It is appreciated that each of the foregoing compounds have one or more asymmetric carbon atoms or chiral centers, and that each may be prepared in or isolated in optically pure form, or in various mixtures of enantiomers or diastereomers. Each of the individual stereochemically pure isomers of the foregoing are contemplated herein. In addition, various mixtures of such stereochemically pure isomers are also contemplated, including but not limited to racemic mixtures that are formed from one pair of enantiomers. In another illustrative aspect, the dopamine agonist is a compound selected from the following group of compounds:
• the Di dopamine receptor agonist is a hexahydrobenzo[ ⁇ ]phenanthridine compound.
• Exemplary hexahydrobenzo[ ⁇ ]phenanthridine compounds for use in the method and composition described herein include, but are not limited to, trans-5,6,6a,7,8,12b- hexahydrobenzo[ ⁇ ]phenanthridine compounds of Formula I:
• R is hydrogen or Ci-C 4 alkyl
• R 1 is hydrogen, acyl, such as Ci-C 4 alkanoyl, benzoyl, pivaloyl, and the like, or an optionally substituted phenyl or phenoxy protecting group, such as a prodrug and the like
• X is hydrogen, fluoro, chloro, bromo, iodo or a group of the formula -OR 5 wherein R 5 is hydrogen, Ci-C 4 alkyl, acyl, such as Ci-C 4 alkanoyl, benzoyl, pivaloyl, and the like, or an optionally substituted phenyl or phenoxy protecting group, provided that when X is a group of the formula -OR 5 , the groups R 1 and R 5 can optionally be taken together to form a -CH 2 - or -(CH 2 ) 2 - group, thus representing a methylenedioxy or ethylenedioxy functional group bridging
• Illustrative acyl groups include, but are not limited to -C 4 alkanoyl, acetyl, propionyl, butyryl, pivaloyl, valeryl, tolyl, trifluoroacetyl, anisyl, and the like.
• X in Formula I is a group of the formula -OR 5
• the groups R 1 and R 5 can be taken together to form a -CH - or -(CH 2 ) 2 - group, thus representing a methylenedioxy or ethylenedioxy functional group bridging the C- 10 and C-ll positions on the hexahydrobenzo[ ⁇ ]phenanthridine ring system.
• at least one of R 2 , R 3 , and R 4 is other than hydrogen. It is appreciated that the phenoxy protecting groups used herein may diminish or block the reactivity of the nitrogen to which they are attached. In addition, the phenoxy protecting groups used herein may also serve as prodrugs, and the like.
• one of R 1 and R 5 is hydrogen or acetyl and the other of R 1 and R 5 is selected from the group consisting of (C 3 -C 20 )alkanoyl, halo- (C 3 -C 20 )alkanoyl, (C 3 -C 20 )alkenoyl, (C -C )cycloalkanoyl, (C 3 -C 6 )-cycloalkyl(C 2 - C ⁇ 6 )alkanoyl, aroyl which is unsubstituted or substituted by 1 to 3 substituents selected from the group consisting of halogen, cyano, trifluoromethanesulphonyloxy, (C ⁇ -C 3 )alkyl and (CrC 3 )alkoxy, which latter may in turn be substituted by 1 to 3 halogen atoms, aryl(C 2 -Ci 6 )alkanoyl which is unsubstituted or substituted in the group consisting of
• R, Ri, and X are as defined in Formula I, and pharmaceutically acceptable salts thereof. It is appreciated that compounds having Formula LT are chiral. It is further appreciated that although a single enantiomer is depicted, each enantiomer alone and/or various mixtures, including racemic mixtures, of each enantiomer are contemplated, and may be included in the compounds, compositions, and methods described herein.
• C ⁇ -C alkyl refers to straight-chain or branched alkyl groups comprising one to four carbon atoms, such as methyl, ethyl, propyl, isopropyl, butyl, isobutyl, sec-butyl, cyclopropylmethyl, and the like.
• the selectivity of the compounds for the dopamine Di and D receptors may be affected by the nature of the nitrogen substituent.
• Optimal dopamine Di agonist activity has been noted where R in formulae I-ll is hydrogen or methyl.
• One compound of Formula II for use in the method and composition of the present invention is trans- 10,11 -dihydroxy-5 ,6 ,6a,7 , 8 , 12b-hexahydrobenzo [a] phenanthridine hydrochloride, denominated hereinafter as "dihydrexidine.”
• All active compounds described herein bear an oxygen atom at the C- 11 position as shown in formulae I-II above.
• the C-10 unsubstituted, C-ll hydroxy compounds possess dopamine Di antagonist, or weak agonist activity, depending on the alkyl group that is attached to the nitrogen atom.
• the more potent dopamine Di agonist compounds exemplified herein have a 10,11-dioxy substitution pattern, in particular, the 10,11-dihydroxy substituents.
• the 10,11-dioxy substituents need not be in the form of hydroxyl groups. Masked hydroxyl groups, or prodrug (hydroxyl protecting) groups can also be used.
• esterification of the 10,11-hydroxyl groups with, for example, benzoic acid or pivalic acid ester forming compounds yields 10,11-dibenzoyl or dipivaloyl esters that are useful as prodrugs, i.e., they will be hydrolyzed in vivo to produce the biologically active 10,11-dihydroxy compound.
• benzoic acid or pivalic acid ester forming compounds e.g., acid anhydrides
• 1011-dibenzoyl or dipivaloyl esters that are useful as prodrugs, i.e., they will be hydrolyzed in vivo to produce the biologically active 10,11-dihydroxy compound.
• a variety of biologically acceptable carboxylic acids can also be used.
• the 10,11-dioxy ring substitution can be in the form of a 10,11-methylenedioxy or ethylenedioxy group. In vivo, body metabolism will cleave this linkage to provide the more active 10,11-dihydroxy functionality.
• Compound potency and receptor selectivity can also be affected by the nature of the nitrogen substituent.
• C 2 , C , and or C 4 -substituted tA-an,s-5,6,6a,7,8,12b- hexahydrobenzo[ ⁇ ]phenanthridines can be used as the Di dopamine receptor agonist.
• the selectivity of these compounds for dopamine receptor subtypes varies, depending on the nature and positioning of substituent groups. Substitution at the C 2 , C 3 , and/or C 4 position on the benzophenanthridine ring system controls affinity for the dopamine receptor subtypes and concomitantly receptor selectivity.
• 2- methyldihydrexidine has Di potency and efficacy comparable to dihydrexidine, while it has a five-fold enhanced selectivity for the Di receptor.
• the compound 3-methyldihydrexidine although retaining Di potency and efficacy comparable to dihydrexidine, has greater D 2 potency, making it less selective but better able to activate both types of receptors.
• R 1 and R 5 are different.
• one of R 1 and R 5 is hydrogen or acetyl and the other of R 1 and R 5 is selected from the group consisting of (C 3 -C o)alkanoyl, halo- (C 3 -C 20 )alkanoyl, (C 3 -C 20 )alkenoyl, (C 4 -C 7 )cycloalkanoyl, (C 3 -C 6 )-cycloalkyl(C 2 - C ⁇ 6 )alkanoyl, aroyl which is unsubstituted or substituted by 1 to 3 substituents selected from the group consisting of halogen, cyano, trifluoromethanesulphonyloxy, (C ⁇ -C 3 )alkyl and (Ci-C 3 )alkoxy, which latter may in turn be substituted by 1 to 3 halogen atoms, aryl(C 2 -C ⁇ 6 )alkanoyl which is unsubstituted or substituted
• chromeno[4,3,2-Je]isoquinoline compounds can be used as the Di dopamine receptor agonist administered in combination therapy with a D 2 dopamine receptor antagonist.
• Exemplary compounds that are used in the method and composition described herein include, but are not limited to compounds having Formula III:
• R 1 , R 2 , and R 3 are each independently selected from hydrogen, Ci-C 4 alkyl, and C 2 -C 4 alkenyl
• R is hydrogen, - alkyl, acyl, or an optionally substituted phenoxy protecting group
• X is hydrogen, halo including fluoro, chloro, bromo, and iodo, or a group of the formula -OR 9 wherein R 9 is hydrogen, C ⁇ -C 4 alkyl, acyl, or an optionally substituted phenoxy protecting group
• R 4 , R 5 , and R 6 are each independently selected from the group consisting of hydrogen, C ⁇ -C 4 alkyl, phenyl, halo, and a group -OR wherein R is hydrogen, acyl, such as benzoyl, pivaloyl, and the like, or an optionally substituted phenyl protecting group, and when X is a group of the formula -OR 9 , the groups R 8 and R 9 can be taken together to
• the compounds also comprise pharmaceutically acceptable salts thereof. It is appreciated that compounds having Formula III are chiral. It is further appreciated that although a single enantiomer is depicted, each enantiomer alone and/or various mixtures of each enantiomer, including racemic mixtures, are contemplated, and may be included in the compounds, compositions, and methods described herein.
• C 2 -C 4 alkenyl refers to branched or straight-chain alkenyl groups having two to four carbons, such as allyl, 2-butenyl, 3-butenyl, and vinyl.
• At least one of R , R 5 , or R 6 is hydrogen. In another embodiment at least two of R 4 , R 5 , or R are hydrogen.
• One compound of Formula III for use in the method and composition described herein is ( ⁇ )-8,9-dihydroxy-l,2,3,l lb-tetrahydrochromeno[4,3,2- e]isoquinoline hydrobromide (16a), denominated hereinafter as "dinoxyline.” Dinoxyline is synthesized from 2,3-dimethoxyphenol (7) and 4-bromoisoquinole (10), as depicted in Fig. 2.
• the phenolic group is protected as the methoxymethyl (“MOM”) derivative 8 followed by treatment with butyllithium, then with the substituted borolane illustrated, to afford the borolane derivative 9.
• MOM methoxymethyl
• this borolane derivative is then employed in a Pd-catalyzed Suzuki type cross coupling reaction with 5-nitro-4-bromoisoquinoline (11), prepared from bromoisoquinoline 10.
• the resulting coupling product 12 is then treated with toluenesulfonic acid in methanol to remove the MOM protecting group of the phenol.
• Treatment of this nitrophenol 13 with potassium carbonate in DMF at 80°C leads to ring closure with loss of the nitro group, affording the basic tetracyclic chromenoisoquinoline nucleus 14.
• Catalytic hydrogenation effects reduction of the nitrogen-containing ring to yield 15a.
• Use of boron tribromide to cleave the methyl ether linkages gives the parent compound 16a. It is apparent that by appropriate substitution on the isoquinoline ring a wide variety of substituted compounds can be obtained. Substitution onto the nitrogen atom in either 14 or 15a, followed by reduction will readily afford a series of compounds substituted with lower alkyl groups on the nitrogen atom. Likewise, the use of alkyl substituents on the 1, 3, 6, 7, or 8 positions of the nitroisoquinoline 11 leads to a variety of ring-substituted compounds. In addition, the 3-position of 14 can also be directly substituted with a variety of alkyl groups.
• Fig. 2 also illustrates the synthesis of N-substituted chromenoisoquinolines 15 and 16.
• Compound 15a is N-alkylated under standard conditions to provide substituted derivatives.
• Alkylating agents such as R-L, where R is methyl, ethyl, propyl, allyl, and the like, and L is a suitable leaving group such as halogen, methylsulfate, or a sulfonic acid derivative, are used to provide the corresponding N-alkyl derivatives.
• the aromatic methyl ethers of compounds 15 are then removed under standard conditions, such as upon treatment with BBr 3 and the like. It appreciated that ⁇ -alkylation may be followed by other chemical transformations to provide the substituted derivatives described herein. For example, alkylation with an allyl halide followed by hydrogenation of the allyl double bond provides the corresponding N-propyl derivative.
• R-L where R is methyl, ethyl, propyl, allyl, and the like
• L is a suitable leaving group such as halogen, methylsulfate, or a sulfonic acid derivative
• R and R are different.
• one of R and R is hydrogen or acetyl and the other of R 8 and R 9 is selected from the group consisting of (C 3 -C 2 o)alkanoyl, halo- (C 3 -C 20 )alkanoyl, (C 3 -C 20 )alkenoyl, (C -C 7 )cycloalkanoyl, (C 3 -C 6 )-cycloalkyl(C 2 - C 16 )alkanoyl, aroyl which is unsubstituted or substituted by 1 to 3 substituents selected from the group consisting of halogen, cyano, trifluoromethanesulphonyloxy, (C ⁇ -C 3 )alkyl and (C ⁇ -C 3 )alkoxy, which latter may in turn be substituted by 1 to 3 halogen atoms, aryl(C 2 -C 16 )alkanoyl which is unsubstituted or
• C 3 )alkyl and (CrC 3 )alkoxy which latter may in turn be substituted by 1 to 3 halogen atoms: and hetero-arylalkanoyl having one to three heteroatoms selected from O, S and ⁇ in the heteroaryl moiety and 2 to 10 carbon atoms in the alkanoyl moiety and which is unsubstituted or substituted in the heteroaryl moiety by 1 to 3 substituents selected from the group consisting of halogen, cyano, trifluoromethanesulphonyloxy, (C ⁇ -C 3 )alkyl, and (Ci-C 3 )alkoxy, which latter may in turn be substituted by 1 to 3 halogen atoms, and the physiologically acceptable salts thereof.
• substituents selected from the group consisting of halogen, cyano, trifluoromethanesulphonyloxy, (C ⁇ -C 3 )alkyl, and (Ci-C 3 )alkoxy, which latter may
• tetrahydronaphtho[l,2,3-de]isoquinoline compounds are used as the Di dopamine receptor agonist for co-administration with a D 2 dopamine receptor antagonist.
• exemplary compounds for use in the method and composition described herein include, but are not limited to compounds having Formula IN:
• R , R , and R are each independently selected from the group consisting of hydrogen, C 1 -C 4 alkyl, and C -C 4 alkenyl;
• R 4 , R 5 , and R 6 are each independently selected from the group consisting of hydrogen, C ⁇ -C alkyl, phenyl, halogen, and a group having the formula -OR, where R is hydrogen, acyl, such as benzoyl, pivaloyl, and the like, or an optionally substituted phenyl protecting group;
• R 7 is selected from the group consisting of hydrogen, hydroxy, -C 4 alkyl, C 2 -C alkenyl, C ⁇ -C 4 alkoxy, and Ci-C 4 alkylthio;
• R 8 is hydrogen, C ⁇ -C 4 alkyl, acyl, or an optionally substituted phenyl protecting group;
• X is hydrogen, fluoro, chloro, bromo, or iodo.
• X is a group having the formula -OR 9 , where R 9 is hydrogen, -C 4 alkyl, acyl, or an optionally substituted phenyl protecting group; or the groups R 8 and R 9 are taken together to form a divalent group having the formula -CH - or -(CH 2 ) 2 -.
• the term "pharmaceutically acceptable salts” as used herein refers to those salts formed using organic or inorganic acids that are suitable for use in contact with the tissues of humans and lower animals without undue toxicity, irritation, allergic response, and the like. Acids suitable for forming pharmaceutically acceptable salts of biologically active compounds having amine functionality are well known in the art.
• the salts can be prepared according to conventional methods in situ during the final isolation and purification of the present compounds, or separately by reacting the isolated compounds in free base form with a suitable salt forming acid.
• phenoxy protecting group refers to substituents on the phenolic oxygen which prevent undesired reactions and degradations during synthesis and which can be removed later without effect on other functional groups on the molecule.
• Such protecting groups and the methods for their application and removal are well known in the art.
• ethers such as methyl, isopropyl, t-butyl, cyclopropylmethyl, cyclohexyl, allyl ethers and the like; alkoxyalkyl ethers such as methoxymethyl or methoxyethoxymethyl ethers and the like; alkylthioalkyl ethers such a methylthiomethyl ethers; tetrahydropyranyl ethers; arylalkyl ethers such as benzyl, o-nitrobenzyl, p-methoxybenzyl, 9-anthrylmethyl, 4-picolyl ethers and the like; trialkylsilyl ethers such as trimethylsilyl, triethylsilyl, t-butyldimethylsilyl, t- butyldiphenylsilyl ethers and the like; alkyl and aryl esters such as acetates, propionates, n-butyrate
• Di dopamine receptor agonist for co-administration with a D dopamine receptor antagonist is ( ⁇ )-8,9-dihydroxy-2,3,7,llb-tetrahydro-lH-naphtho- [l,2,3- e]-isoquinoline (29) denominated hereinafter as "dinapsoline.”
• Dinapsoline is synthesized from 2-methyl-2,3-dihydro-4(lH)-isoquinolone (20) according to the procedure depicted generally in Figs. 3 and 4. Side chain bromination of ethyl 2-toluate (17) with NBS in the presence of benzoyl peroxide produced compound 18.
• N-Detosylation of compound 22 with ⁇ a/ ⁇ g in methanol buffered with disodium hydrogen phosphate gave compound 28.
• compound 28 was treated with boron tribromide to effect methyl ether cleavage yielding dinapsoline (29) as its hydrobromide salt.
• dinapsoline and compounds related to dinapsoline may also be synthesized according to the procedure described by Sattelkau, Qandil, and Nichols, "An efficient synthesis of the potent dopamine Di agonst dinapsoline by construction and selective reduction of 2'-azadimethoxybenzanthrone," Synthesis 2:262-66 (2001), the entirety of the description of which is incorporated herein by reference.
• R 8 and R 9 are different.
• one of R 8 and R 9 is hydrogen or acetyl and the n other of R and R is selected from the group consisting of (C 3 -C 2 o)alkanoyl, halo- (C 3 -C 20 )alkanoyl, (C 3 -C 20 )alkenoyl, (C 4 -C )cycloalkanoyl, (C 3 -C 6 )-cycloalkyl(C 2 - C ⁇ 6 )alkanoyl, aroyl which is unsubstituted or substituted by 1 to 3 substituents selected from the group consisting of halogen, cyano, trifluoromethanesulphonyloxy, (C ⁇ -C )alkyl and (C ⁇ C 3 )alkoxy, which latter may in turn be substituted by 1 to 3 halogen atoms, aryl(
• compounds 35 may be prepared from optionally substituted isoquinolines 30, which generally undergo electrophilic substitution preferentially at the 5-position to give 5-bromo-isoquinolines 31.
• the bromination reaction is illustratively performed neat in the presence of a Lewis Acid catalyst, such as anhydrous aluminum chloride, or alternatively in an inert organic solvent, such as methylene chloride.
• 5-bromo-isoquinolines 31 can be trans- metallated to the corresponding 5-lithio-isoquinolines using n-butyl lithium in a suitable inert organic solvent such as THF, illustratively at a temperature less than about -50, or about -80 °C, followed by alkylation, or optionally acylation, to form the corresponding 5-substituted isoquinolines.
• a suitable inert organic solvent such as THF
• Aldehyde 32 is reacted with 4-bromo- 3-lithio-l,2-(methylenedioxy)benzene 34, prepared by conventional ortho-lithiation methods from the corresponding substituted benzene 33, to give 35. Cyclization of 35 to the corresponding compounds 36 can be initiated by free radical initiated carbon-carbon bond formation, or by a variety of conventional reaction conditions.
• the carbon-carbon bond reaction is illustratively carried out with a hydrogen radical source such as trialkyltin hydride, triaryltin hydride, trialkylsilane, triarylsilane, and the like, and a radical initiator, such as 2,2'-azobisisobutylronitrile, sunlight, UN light, controlled potential cathodic (Pt), and the like in the presence of a proton source such as a mineral acid, such as sulfuric acid, hydrochloric acid, and the like, or an organic acid, such as acetic acid, trifluoroacetic acid, p-toluenesulfonic acid, and the like.
• a hydrogen radical source such as trialkyltin hydride, triaryltin hydride, trialkylsilane, triarylsilane, and the like
• a radical initiator such as 2,2'-azobisisobutylronitrile, sunlight, UN light, controlled potential cathodic (Pt), and
• 36 is prepared by treatment with tributyltin hydride and, 2,2'-azobisisobutylronitrile in the presence of acetic acid.
• Compounds 36 are selectively reduced at the nitrogen bearing heterocyclic ring to give the corresponding tetrahydroisoquinolines 37.
• the selective ring reduction may be carried out by a number of different reduction methods such as sodium cyanoborohydride in an acidic medium in THF, hydride reducing agents such as L-SELECTRIDE or SUPERHYDRIDE, catalytic hydrogenation under elevated pressure, and the like.
• Conversion of the protected compounds 37 to diols 38 may be accomplished using boron tribromide in methylene chloride at low temperatures, such as less than about -60, or less than about -80 °C.
• Compounds 38 may be isolated as the hydrobromide salt.
• the corresponding hydrochloride salt may also be prepared by using boron trichloride.
• the substantially pure (+)-isomer and (-)-isomer of compounds 38 are prepared by chiral separation of the hydroxy-protected compounds 37, by forming a chiral salt, such as the (+)-dibenzoyl-D-tartaric acid salt of compounds 37, followed by removal of the protecting group as described herein.
• heterocyclic-fused phenanthridine compounds such as thieno[l,2- «]phenanthridines, and the like, are used as the Di dopamine receptor agonist for administration in combination therapy with a D 2 dopamine receptor antagonist to patients with neurological disorders.
• exemplary compounds for use in the methods and compositions described herein include, but are not limited to, compounds having Formula N:
• R is hydrogen or - alkyl
• R 1 is hydrogen, acyl, such as Ci-C 4 alkanoyl, benzoyl, pivaloyl, and the like, or a phenoxy protecting group
• X is hydrogen, fluoro, chloro, bromo, iodo, or a group of the formula -OR 3 wherein R 3 is hydrogen, alkyl, acyl, or a phenoxy protecting group, provided that when X is a group of the formula-OR 3 , the groups R 1 and R 3 can be taken together to form a -CH 2 - group or a -(CH 2 ) 2 - group, thus representing a methylenedioxy or ethylenedioxy functional group bridging the C-9 and C-10 positions; and R 2 is selected from the group consisting of hydrogen, -C 4 alkyl, phenyl, fluoro, chloro, bromo, iodo, or a group -OR 4 wherein
• phenyltetrahydrobenzazepine compounds can be used as the Di dopamine receptor agonist for co-administration with a D 2 dopamine receptor antagonist.
• Exemplary compounds for use in the method and composition described herein include, but are not limited to compounds having Formula VI:
• R is hydrogen, alkyl, alkenyl, optionally substituted benzyl, or optionally substituted benzoyl;
• R , R , and R are each independently selected from hydrogen, halogen, hydroxy, alkyl, alkoxy, and acyloxy;
• X is hydrogen, halogen, hydroxy, alkyl, alkoxy, or acyloxy.
• each enantiomer alone and/or various mixtures of each enantiomer, including racemic mixtures, are contemplated, and may be included in the compounds, compositions, and methods described herein.
• Di receptor agonists may be included in the compounds, compositions, and methods described herein, including but not limited to A68930 ((lR,3S)-l-aminomethyl-5,6-dihydroxy-3-phenylisochroman hydrochloride), A77636 ((lR,3S)-3-(l '-adamantyl)-l-aminomethyl-3,4-dihydro-5,6- dihydroxy- lH-2-benzopyran), and the like.
• A77636 may be prepared according to DeNinno et al., Eur. J. Pharmacol. 199:209-19 (1991) and/or DeNinno et al., J. Med. Chem.
• the dopamine Di receptor agonist is selected based on a predetermined half -life.
• dihydrexidine has a short-half life of about 30 min when given intravenously, and a functional half -life of about 3 hr when given subcutaneously.
• dinapsoline has a 3 hr serum half-life with about 7-10 hr of functional activity.
• the D 2 dopamine receptor antagonists that may be used in accordance with the methods and compositions described herein include typical or atypical families of antipsychotic agents.
• the typical antipsychotic agents include phenothiazines and non-phenothiazines such as loxapine, molindone, and the like
• the atypical antipsychotic agents include the clozapine-like agents, and others, including aripiprazole, risperidone, amisulpiride, sertindole, and the like.
• Phenothiazines include, but are not limited to chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, thioridazine, and trifluoperazine.
• Non-phenothiazines include, but are not limited to haloperidol, pimozide, and thiothixene.
• Clozapine-like agents include, but are not limited to the group consisting of olanzapine, clozapine, risperidone, sertindole, quetiapine, and ziprasidone. It appreciated that various combinations of the foregoing typical and atypical antipsychotic agents may be used in the methods and compositions described herein.
• any other antipsychotic agent including any typical or atypical antipsychotic agent such as acetophenazine, acetophenazine maleate, triflupromazine, chlorprothixene, alentemol hydrobromide, alpertine, azaperone, batelapine maleate, benperidol, benzindopyrine hydrochloride, brofoxine, bromperidol, bromperidol decanoate, butaclamol hydrochloride, butaperazine, butaperazine maleate, carphenazine maleate, carvotroline hydrochloride, chlorpromazine hydrochloride, cinperene, cintriamide, clomacran phosphate, clopenthixol, clopimozide, clopipazan mesylate, chloroperone hydrochloride, clothiapine, clothixamide maleate, cyclophenazine hydrochloride, droperidol,
• Olanzapine 2-methyl-4-(4-methyl-l-piperazinyl)-10H-thieno[2,3- b][l,5]benzodiazepine, is a known compound and is described in U.S. Pat. No.
• Clozapine 8-chloro-l l-(4-methyl-l- piperazinyl)-5H-dibenzo[b,e][l,4]diazepine, is described in U.S. Pat. No. 3,539,573 that is incorporated herein by reference.
• Risperidone 3-[2-[4-(6-fluoro-l,2- benzisoxazol-3-yl)piperidino]ethyl]-2-methyl-6,7,8,9 -tetrahydro-4H-pyrido-[l,2- a]pyrimidin-4-one is described in U.S. Pat. No.
• Sertindole l-[2-[4-[5-chloro-l-(4-fluorophenyl)-lH-indol-3-yl ]-l- piperidinyl]ethyl]imidazolidin-2-one, is described in U.S. Pats. Nos. 4,710,500, 5,112,838, and 5,238,945, incorporated by reference herein.
• Quetiapine, 5-[2-(4- dibenzo[b,f][l,4]thiazepin-ll-yl -l-piperazinyl)ethoxy]ethanol is described in U.S. Pat. No.
• the pharmaceutical compositions include one or more dopamine Di receptor agonists, one or more dopamine D 2 receptor antagonists, and one or more pharmaceutically acceptable carriers, diluents, and/or excipients therefor.
• the amount of the dopamine Di receptor agonists and the amount of the dopamine D 2 receptor antagonists are each effective for treating a patient at risk of developing or having a neurological, psychotic, and/or psychiatric disorder.
• the term "effective amounts” refers to amounts of the compounds which prevent, reduce, or stabilize one or more of the clinical symptoms of disease in a patient at risk of developing or suffering from the neurological, psychotic, and/or psychiatric disorder.
• the effective amount may improve the condition of a patient permanently or temporarily.
• the dopamine Di receptor agonists for co- administration with the dopamine D 2 receptor antagonists, may vary in their selectivity for dopamine Di and D receptors and receptor subtypes.
• these dopamine receptor agonists exhibit activity at both the Di and D 2 dopamine receptor, with possible variation at the receptor subtypes.
• this activity at the Di and D 2 dopamine receptor subtypes can be about equal.
• this activity at the Di and D 2 dopamine receptor subtypes can be characterized by being selective for these two dopamine receptor subtypes as compared to other dopamine receptor subtypes.
• the activity exhibited by the dopamine receptor agonists at the Di and D 2 dopamine receptor subtypes may be about equal or not.
• dihydrexidine is 10-fold Di:D 2 selective and dinapsoline is 5-fold D ⁇ :D 2 selective while dinoxyline has equally high affinity for both receptor subtypes.
• substituted analogs of these compounds, as described herein by formulae I-IN may each have a different selectivity for the Di and D 2 dopamine receptors and/or the various Di and D dopamine receptor subtypes.
• Typical dosages of the Di receptor agonist include dosage ranges from about 0.1 to about 100 mg/kg. It is appreciated that depending upon the route of administration, different ranges may be used.
• parenteral administration includes dosage ranges from about 0.1 to about 10, or from about 0.3 to about 3 mg/kg, and oral administration includes dosage ranges from about 0.1 to about 100, or form about 0.3 to about 30 mg/kg.
• Illustrative dosage for dihydrexidine and other hexahydrobenzo[ ]phenanthridine compounds include 2 mg/15 min per day or 0.5 mg/kg dose (35 mg/15 min or 0.031 mg/kg/min per day by intravenous infusion.
• Other illustrative dosage for dihydrexidine and other hexahydrobenzo[ ⁇ ]phenanthridine compounds include 5-20 mg/15 min per day by subcutaneous infusion.
• the dopamine D 2 receptor antagonists for co- administration with the dopamine Di receptor agonists, may vary in their selectivity for dopamine Di and D 2 receptors and receptor subtypes.
• these dopamine receptor antagonists exhibit activity at both the Di and D 2 dopamine receptor, with possible variation at the receptor subtypes.
• this activity at the Di and D 2 dopamine receptor subtypes can be about equal.
• this activity at the Di and D 2 dopamine receptor subtypes can be characterized by being selective for these two dopamine receptor subtypes as compared to other dopamine receptor subtypes.
• the activity exhibited by the dopamine receptor antagonists at the Di and D 2 dopamine receptor subtypes may be about equal or not.
• the dopamine D 2 receptor antagonist does not exhibit significant binding at the dopamine Di receptor.
• the dopamine D 2 receptor antagonist does not exhibit significant functional activity at the dopamine Di receptor.
• the dopamine D 2 receptor antagonist does not exhibit significant agonist activity at the dopamine Di receptor.
• the dopamine D receptor antagonist does not exhibit significant antagonist activity at the dopamine Di receptor.
• Typical dosages of the D receptor antagonist fall in the ranges from about 0.25 to about 50 mg/day, about 1 to about 30 mg/day, and about 1 to about 25 mg day.
• Typical dosages of the D receptor antagonist such as clozapine, fall in the ranges from about 12.5 to about 900 mg/day, and about 150 to about 450 mg/day.
• Typical dosages of the D 2 receptor antagonist such as risperidone, fall in the ranges from about 0.25 to about 16 mg/day, and about 2 to about 8 mg/day.
• Typical dosages of the D 2 receptor antagonist such as sertindole, fall in the range from about 0.0001 to about 1 mg/day.
• Typical dosages of the D 2 receptor antagonist such as quetiapine, fall in the ranges from about 1 to about 40 mg/day, and about 150 to about 450 mg/day.
• Typical dosages of the D 2 receptor antagonist, such as ziprasidone fall in the ranges from about 5 to about 500 mg/day, and about 50 to about 100 mg/day. It is appreciated that such daily dosage regimens can be given advantageously once per day, or in two or more divided doses.
• the compounds for use in the method and composition described herein can be formulated in conventional drug dosage forms, and can be in the same or different compositions.
• co-administration means administration in the same or different compositions or in the same or different dosage forms or by the same or different routes of administration in any manner which provides effective levels of the active ingredients in the body at the same time.
• Combinations of Di dopamine receptor agonists and D 2 dopamine receptor antagonists can also be used in the "co- administration” protocols described above.
• Various dosage forms are contemplated herein, including slid dosage forms such as tablets, pills, capsules, caplets, sublingual tablets, lozenges, and the like, liquid dosage forms such as syrups, elixirs, oral suspensions, and the like, among others. Conventional process are used to prepare such various dosage forms described herein.
• compositions contain the Di receptor agonist or the D 2 receptor antagonist is amounts in the range from about 0.5% to about 50% by weight. It is to be understood that the selection of active ingredient percentage weight is related to the dosage form selected.
• capsules are prepared by mixing the compound with a suitable diluent and filling the proper amount of the mixture in a capsules, such as a gelatin capsule.
• suitable diluents include inert powdered substances such as starch, from a variety of sources, powdered cellulose, including crystalline and microcrystalline cellulose, sugars, including fructose, mannitol, and sucrose, grain flours, and other similar edible or palatable powders.
• tablets are prepared by direct compression, by wet granulation, by dry granulation, and like processes.
• Such formulations typically incorporate diluents, binders, lubricants, disintegrators, and the like along with the compounds described herein.
• Typical diluents include, but are not limited to, various types of starch, lactose, mannitol, kaolin, calcium phosphate or sulfate, inorganic salts, such as sodium chloride, powdered sugar, powdered cellulose derivatives, among others.
• Typical tablet binders are substances such as starch, gelatin, sugars, such as lactose, fructose, glucose, polyethylene glycols, ethylcellulose, waxes, and like binders. Natural and/or synthetic gums may also be included in the tablet dosage forms described herein, including acacia, alginates, methylcellulose, polyvinylpyrrolidine, and the like.
• lubricants such as talc, magnesium and calcium stearate, stearic acid and hydrogenated vegetable oils
• tablet disintegrators such as starches, clays, celluloses, algins gums, corn and potato starches, methylcellulose, agars, bentonites, wood celluloses, powdered natural sponges, cation-exchange resins, alginic acids, guar gums, citrus pulp, carboxymethylcellulose, and sodium lauryl sulfate, and enteric coatings for timed release of the compounds described herein after exiting the stomach, such as cellulose acetate phthalate, poly vinyl acetate phthalate, hydroxypropyl methylcellulose phthalate and hydroxypropyl methylcellulose acetate succinate.
• Routes of administration include, but are not limited to, parenteral administration such as intravenous, intramuscular, subcutaneous injection, subcutaneous depot, intraperitoneal, and the like; transdermal administration such as transdermal patchs, and the like; pumps such as implanted and indwelling pumps, and the like; intranasal administration such as aerosols, pulmonary aerosols, and the like; oral administration such as oral liquids and suspensions, tablets, pills, capsules, and the like; buccal administration such as sublingual tablets and lozenges, and the like; and vaginal administration and suppositories.
• parenteral administration such as intravenous, intramuscular, subcutaneous injection, subcutaneous depot, intraperitoneal, and the like
• transdermal administration such as transdermal patchs, and the like
• pumps such as implanted and indwelling pumps, and the like
• intranasal administration such as aerosols, pulmonary aerosols, and the like
• oral administration such as oral liquids and suspensions, tablets
• the drug dosage forms are formulated for oral ingestion by the use of such dosage forms as syrups, sprays, or other liquid dosage forms, a gel-seal, or a capsule or caplet.
• Syrups for either use may be flavored or unflavored and may be formulated using a buffered aqueous solution of the active ingredients as a base with added caloric or non-caloric sweeteners, flavor oils and pharmaceutically acceptable surfactant/dispersants.
• Other liquid dosage forms, including liquid solutions or sprays can be prepared in a similar manner and can be administered buccally, sublingually, or by oral ingestion.
• buccal and sublingual administration comprises contacting the oral and pharyngeal mucosa of the patient with the Di agonist and the D 2 antagonist either in a pharmaceutically acceptable liquid dosage form, such as a syrup or a spray, or in a saliva-soluble dosage form which is held in the patient's mouth to form a saliva solution.
• a pharmaceutically acceptable liquid dosage form such as a syrup or a spray
• saliva-soluble dosage form which is held in the patient's mouth to form a saliva solution.
• saliva-soluble dosage forms are lozenges, tablets, and the like.
• lozenges can be prepared, for example, by art-recognized techniques for forming compressed tablets where the active ingredients are dispersed on a compressible solid carrier, optionally combined with any appropriate tableting aids such as a lubricant (e.g., magnesium-stearate) and are compressed into tablets.
• a lubricant e.g., magnesium-stearate
• the solid carrier component for such tableting formulations can be a saliva-soluble solid, such as a cold water-soluble starch or a monosaccharide or disaccharide, so that the lozenge will readily dissolve in the mouth to release the active ingredients.
• the pH of the above-described formulations can range from about 4 to about 8.5.
• Lozenges can also be prepared utilizing other art-recognized solid unitary dosage formulation techniques. In another embodiment, tablets are used. Tablets can be prepared in a manner similar to that described for preparation of lozenges or by other art- recognized techniques for forming compressed tablets such as chewable vitamins.
• Tablets can be prepared by direct compression, by wet granulation, or by dry granulation, and usually incorporate diluents, binders, lubricants and disintegrators as well as the active ingredients.
• Typical diluents include, for example, starches, lactose, mannitol, kaolin, calcium phosphate or sulfate, inorganic salts such as sodium chloride, powdered sugar, microcrystalline cellulose, carboxymethyl cellulose, and powdered cellulose derivatives.
• Typical binders include starches, gelatin and sugars such as lactose, fructose, glucose and the like, natural and synthetic gums, including acacia, alginates, methylcellulose, polyvinylpyrrolidine and the like, polyethylene glycol, ethylcellulose, and waxes.
• Typical lubricants include talc, magnesium and calcium stearate, stearic acid, and hydrogenated vegetable oils.
• Typical tablet disintegrators include starches, clays, celluloses, algins and gums, corn and potato starches, methylcellulose, agar, bentonite, wood cellulose, powdered natural sponge, cation- exchange resins, alginic acid, guar gum, citrus pulp, carboxymethylcellulose, and sodium lauryl sulfate. Tablets can be coated with sugar as a flavor and sealant, or tablets can be formulated as chewable tablets, by using substances such as mannitol in the formulation, according to formulation methods known in the art, or as instantly dissolving tablet-like formulations according to known methods.
• Solid dosage forms for oral ingestion administration also include such dosage forms as caplets, capsules, and gel-seals.
• Such solid dosage forms can be prepared using standard tableting protocols and excipients to provide capsules, caplets, or gel-seals containing the active ingredients.
• the usual diluents for capsules and caplets include inert powdered substances such as starch of many different kinds, powdered cellulose, especially crystalline and microcrystalline cellulose, sugars such as fructose, mannitol and sucrose, grain flours and similar edible powders.
• Any of the solid dosage forms for use in accordance with the invention, including lozenges and tablets, may be in a form adapted for sustained release of the active ingredients. In another embodiment, parenteral administration is used.
• Parenteral administration can be accomplished by injection of a liquid dosage form, such as by injection of a solution of the Di agonist and the D 2 antagonist dissolved in a pharmaceutically acceptable buffer.
• Such parenteral administration can be intradermal, subcutaneous, intramuscular, intraperitoneal, or intravenous. Transdermal patches known in the art can also be used.
• a pharmaceutical composition is provided comprising effective amounts of the active ingredients, and a pharmaceutically acceptable carrier therefor.
• a "pharmaceutically acceptable carrier" for use in accordance with the method and composition described herein is compatible with other reagents in the pharmaceutical composition and is not deleterious to the patient.
• the pharmaceutically acceptable carrier formulations for pharmaceutical compositions adapted for oral ingestion or buccal/sublingual administration including lozenges, tablets, capsules, caplets, gel-seals, and liquid dosage forms, including syrups, sprays, and other liquid dosage forms, have been described above.
• the active ingredients can also be adapted for parenteral administration in accordance with this invention using a pharmaceutically acceptable carrier adapted for use in a liquid dose form.
• the active ingredients can be administered dissolved in a buffered aqueous solution typically containing a stabilizing amount (1-5% by weight) of albumin or blood serum.
• a liquid solution can be in the form of a clarified solution or a suspension.
• Exemplary of a buffered solution administered parenterally in accordance with this invention is phosphate buffered saline prepared as follows: A concentrated (20x) solution of phosphate buffered saline (PBS) is prepared by dissolving the following reagents in sufficient water to make 1,000 mL of solution: sodium chloride, 160 grams; potassium chloride, 4.0 grams; sodium hydrogen phosphate, 23 grams; potassium dihydrogen phosphate, 4.0 grams; and optionally phenol red powder, 0.4 grams. The solution is sterilized by autoclaving at 15 pounds of pressure for 15 minutes and is then diluted with additional water to a single strength concentration prior to use. In another embodiment, aerosol administration of the active ingredients can be used.
• PBS phosphate buffered saline
• Aerosol and dry powder formulations for delivery to the lungs and devices for delivering such formulations to the endobronchial space of the airways of a patient are described in U.S. Patent No. 6,387,886, incorporated herein by reference, and in Zeng et al., Int'l J. Pharm., vol. 191: 131-140 and Odumu et al., Pharm. Res., vol. 19: 1009-1012, although any other art-recognized formulations or delivery devices can be used.
• the Di dopamine receptor agonist and the D 2 dopamine receptor antagonist can be in the form of an aerosol or a dry powder diluted in, for example, water or saline, the diluted solution having a pH of, for example, between about 5.5 and about 7.0.
• the solution can be delivered using a nebulized aerosol formulation, nebulized by a jet, ultrasonic or electronic nebulizer, capable of producing an aerosol with a particle size of between about 1 and about 5 microns, for example.
• the formulation can be administered in dry powder form where the active ingredient comprises part or all of the mass of the powder delivered.
• the formulation can be delivered using a dry powder or metered dose inhaler, or the like.
• the powder can have average diameters ranging from about 1 to about 5 microns formed by media milling, jet milling, spray drying, or particle precipitation techniques.
• the doses of the Di agonist and the D 2 antagonist for use in the method and composition depend on many factors, including the indication being treated and the overall condition of the patient.
• effective amounts of the present compounds range from about 1.0 ng/kg to about 15 mg/kg of body weight.
• effective amounts range from about 50 ng/kg to about 10 mg/kg of body weight.
• effective amounts range from about 200 ng/kg to about 5 mg/kg of body weight.
• effective amounts range from about 300 ng/kg to about 3 mg/kg of body weight.
• effective amounts range from about 500 ng/kg to about 1 mg/kg of body weight. In another embodiment effective amounts range from about 1 ⁇ g/kg to about 0.5 mg/kg of body weight.
• treatment regimens utilizing compounds in accordance with the present invention comprise administration of from about 10 ng to about 1 gram of the compounds for use in the method and composition described herein per day in multiple doses or in a single dose. Effective amounts of the compounds can be administered using any regimen such as twice daily, for at least one day to about twenty-one days.
• compositions described herein may also include additional substances that may enhance the effectiveness of the methods described herein, including but not limited to acetylcholine esterase inhibitors, AAD, AAAD, or catechol-O-methyltransferase (COMT) inhibitors. It is appreciated that such inhibitors are used in combination with traditional levodopa therapy.
• the methods described herein are used to treat various stages of the diseases responsive to combination therapy using a Di receptor agonist and a D 2 receptor antagonist.
• the compounds and compositions, and the methods for administering the compounds and compositions described herein are used to treat all stages of diseases such as Parkinson's disease.
• the compounds and compositions, and the methods for administering the compounds and compositions described herein are used to treat advanced stages of diseases such as Parkinson's disease. It is appreciated that early stages of Parkinson's disease may also be treatable with carbidopa, levodopa, pramipexole, ropinirole, entacapone, pergolide, apomorphine, and combinations thereof. It is further appreciated that delaying introduction of levodopa therapy in conjunction with various treatment protocols may be advantageous.
• EXAMPLES The following examples are illustrative of the compounds for use in the presently claimed methods and compositions and are not intended to limit the invention to the disclosed compounds.
• Benzoyl chloride (3.37 g, 24 mmol) was then dissolved in 15 mL of CH C1 2 and this solution was then added dropwise to the cold stirring N-benzyl enamine solution. After complete addition the reaction was allowed to warm to room temperature and was left to stir overnight. The mixture was then washed successively with 2 X 50 mL of 5% aqueous HCl, 2 X 50 mL of 1 N NaOH, saturated NaCl solution, and was then dried over MgSO 4 . After filtration, the filtrate was concentrated.
• the mixture was diluted with 40 mL of water and the aqueous layer was separated.
• the toluene was extracted several times with water, and the aqueous layers were combined. After basification of the aqueous phase with cone. ammonium hydroxide, the free base was extracted into 5 X 25 mL of CH 2 C1 2 .
• This organic extract was washed with saturated NaCl solution, and dried over MgSO . After filtration, the organic solution was concentrated, the residue was taken up into ethanol, and carefully acidified with concentrated HCl.
• the 4-methylbenzoyl chloride acylating agent was prepared by suspending 3.314 g (24.3 mmol) of 4-toluic acid in 200 mL benzene. To this solution was added 2.0 equivalents (4.25 mL) of oxalyl chloride, dropwise via a pressure- equalizing dropping funnel at O°C. Catalytic DMF (2-3 drops) was added to the reaction mixture and the ice bath was removed. The progress of the reaction was monitored using infrared spectroscopy. The solvent was removed and the residual oil was held under high vacuum overnight. The resulting N-benzyl enamine residue was dissolved in 100 mL of
• the residue was placed under high vacuum (0.05 mm Hg) overnight.
• the residue was dissolved in water and was carefully neutralized to its free base initially with sodium bicarbonate and finally with ammonium hydroxide (1-2 drops).
• the free base was isolated by suction filtration and was washed with cold water.
• the filtrate was extracted several times with dichloromethane and the organic extracts were dried, filtered, and concentrated.
• the filter cake and the organic residue were combined, dissolved in ethanol, and carefully acidified with concentrated HCl.
• the 3-methylbenzoyl chloride acylating agent was prepared by suspending 3.016 g (22.0 mmol) of 3-toluic acid in 100 mL benzene. To this solution was added 2.0 equivalents (3.84 mL) of oxalyl chloride, dropwise with a pressure- equalizing dropping funnel at O°C. Catalytic DMF (2-3 drops) was added to the reaction mixture and the ice bath was removed. The progress of the reaction was monitored using infrared spectroscopy. The solvent was removed and the residual oil was held under high vacuum overnight.
• the resulting N-benzyl enamine residue was dissolved in 100 mL of CH 2 C1 2 , and to this solution was added 1.763 g (17.42 mmol) of triethylamine at O°C.
• the 3-methylbenzoyl chloride (2.759 g, 17.84 mmol) was dissolved in 20 mL CH 2 C1 2 and this solution was added dropwise to the cold, stirring N-benzyl enamine solution.
• the reaction was allowed to warm to room temperature and was left to stir under N 2 overnight.
• the reaction mixture was washed successively with 2 X 30 mL of 5% aqueous HCl, 2 X 30 mL of saturated sodium bicarbonate solution, saturated NaCl solution, and was dried over MgSO 4 .
• the 2-methylbenzoyl chloride acylating agent was prepared by suspending 4.750 g (42.2 mmol) of 2-toluic acid in 100 mL benzene. T o this solution was added 2.0 equivalents (7.37 mL) of oxalyl chloride, dropwise via a pressure- equalizing dropping funnel at 0°C. Catalytic DMF (2-3 drops) was added to the reaction mixture and the ice bath was removed. The progress of the reaction was monitored using infrared spectroscopy. The solvent was removed and the residual oil was held under high vacuum overnight. The resulting N-benzyl enamine residue was dissolved in 100 mL of
• the residue was placed under high vacuum (0.05 mm Hg) overnight.
• the residue was dissolved in water and was carefully neutralized to its free base initially with sodium bicarbonate and finally with ammonium hydroxide (1-2 drops).
• the free base was isolated by suction filtration and was washed with cold water, the filtrate was extracted several times with dichloromethane and the organic extracts were dried, filtered, and concentrated.
• the filter cake and the organic residue were combined, dissolved in ethanol and carefully acidified with concentrated HCl.
• 1,3,2-dioxaborolane 9
• the MOM-protected phenol 8 (10 g, 0.0505 mol) was dissolved in 1000 mL of dry diethyl ether and cooled to -78°C. A solution of n-butyl lithium (22.2 mL, 2.5 M) was then added with a syringe. The cooling bath was removed and the solution was allowed to warm to room temperature. After stirring the solution at room temperature for two hours, a yellow precipitate was observed. The mixture was cooled to -78°C, and 15 mL of 2-isopropoxy-4,4,5,5-tetramethyl- 1,3,2-dioxaborolane (0.080 mol) was added through a syringe.
• Phenol 13 (4.65 g, 0.014 mol) was dissolved in 100 mL of dry DMF. The solution was degassed with argon for thirty minutes. Potassium carbonate (5.80 g, 0.042 mol) was added to the yellow solution in one portion. After heating at 80°C for one hour, the mixture had turned brown and no more starting material remained. After the solution was cooled to room temperature, 200 mL of water was added.
• the dimethoxy derivative 15a (0.834 g; 3.0 mmol) was dissolved in 50 mL of anhydrous dichloromethane. The solution was cooled to -78°C and 15.0 mL of a boron tribromide solution (1.0 M in dichloromethane) was slowly added. The solution was stirred overnight, while the reaction slowly warmed to room temperature. The solution was recooled to -78°C, and 50 mL of methanol was slowly added to quench the reaction. The solution was then concentrated to dryness. Methanol was added and the solution was concentrated. This process was repeated three times.
• Tetrahydroisoquinoline 15a (1.273 g; 4.5 mmol) was dissolved in 150 mL of acetone. Potassium carbonate (0.613 g; 4.5 mmol) and 0.4 mL (4.6 mmol) of allyl bromide were added. The reaction was stirred at room temperature for four hours. The solid was then removed by filtration and washed on the filter several times with ether.
• N-AUylamine 15b (0.625 g; 1.93 mmol) was dissolved in 50 mL of dichloromethane. The solution was cooled to-78°C and 10.0 mL of BBr 3 solution (1.0 M in dichloromethane) was slowly added. The solution was stirred overnight, while the reaction slowly warmed to room temperature. After recooling the solution to -78°C, 50 mL of methanol was slowly added to quench the reaction. The reaction was then concentrated to dryness. Methanol was added and the solution was concentrated. This process was repeated three times.
• the N-propyl amine 15c (0.90 g; 2.8 mmol) was dissolved in 200 mL of dichloromethane and cooled to -78°C.
• 125 mL of dry dichloromethane was cooled to -78°C, and 1.4 mL (14.8 mmol) of BBr 3 was added through a syringe.
• the BBr 3 solution was transferred using a cannula to the flask containing the starting material.
• EXAMPLE 10 Dinapsoline (29) 2',3'-Dihydro-4,5-dimethoxy-2'-methylspiro[isobenzofuran- l(3H),4'(l'H)-isoquinoline]-3-one (22).
• ether 1400 mL
• TEDA N,NN',N'-tetramethylenediamine
• sec-butyllithium 53.3 mL, 69 mmol, 1.3 M solution in hexane).
• the reaction mixture was stirred at 80°C under argon for six hours after addition of TFA. Additional tributyltin hydride (0.228 g, 0.80 mmol) was added dropwise. The stirring continued overnight (16 hours). Another 2,2'- azobisisobutylronitrile (0.064 g, 0.39 mmol) and TFA (0.093 g, 0.80 mmol) were added in one portion. A solution of tributyltin hydride (1.14 g, 3.9 mmol) in 10 mL of degassed benzene was also added in two hours. More TFA (0.185 g, 1.6 mmol) was added in four equal portions (1/4 each half hour).
• BBr 3 (25.0 mL of 1 M in C ⁇ 2 C1 2 ,, 25.0 mmol) was added to a cooled solution (-78°C) of methylenedioxy dinapsoline as prepared in Example 6 (1.4 g, 5.3 mmol) in CH 2 C1 2 .
• the mixture was stirred at -78°C under nitrogen for three hours and then at room temperature overnight.
• methanol 50 mL was added dropwise and the solvent was removed by reduced pressure. The residue was dissolved in methanol (100 mL) and the solution was refluxed under nitrogen for 2 hours.
• the solution was allowed to stand at room temperature for 4 hours and the grayish off-white crystals were collected by filtration and subsequently dried in a vacuum oven at 35°C to give 1.3 gm (melting point: 175-176°C, 35.7%).
• the enantiomeric purity was determined by the same chiral ⁇ PLC conditions described above in Example 8: the salt was neutralized with 2M potassium hydroxide solution and the organic materials extracted with methylene chloride. The organic layers were combined and concentrated under reduced pressure to give a white solid which was redissolved in methanol prior to injection into ⁇ PLC Chiral column. The ratio of the second peak to the first was determined to be greater than 40: 1.
• the identical resolution may also be carried out using the unnatural D- tartaric acid.
• the active ingredient, starch and cellulose are passed through a No. 45 mesh U.S. sieve and mixed thoroughly.
• the aqueous solution containing polyvinylpyrrolidone is mixed with the resultant powder, and the mixture then is passed through a No. 14 mesh U.S. sieve.
• the granules so produced are dried at 50°C. and passed through a No. 18 mesh U.S. sieve.
• the sodium carboxymethyl starch, magnesium stearate and talc, previously passed through a No. 60 mesh U.S. sieve, are then added to the granules which, after mixing, are compressed on a tablet machine to yield tablets each weighing 170 mg.
• FORMULATION EXAMPLE 5 Capsules.
• the active ingredient is passed through a No. 45 mesh U.S. sieve and mixed with the sodium carboxymethyl cellulose and syrup to form a smooth paste.
• the benzoic acid solution, flavor and color are diluted with a portion of the water and added, with stirring. S ufficient water is then added to produce the required volume.
• FORMULATION EXAMPLE 8 intravenous formulation
• the light compartment of the chambers were illuminated by a 20 W lamp located in this compartment; the dark side of the chambers will be shielded from light, except for light penetrating the opening connecting the two compartments of each chamber.
• groups of 8 rats were injected with scopolamine (3.0 mg/kg, ip) or vehicle (1.0 ml/kg) 30 min prior to training. Scopolamine served as the dementing agent in this experiment.
• T he latency for each rat to travel from the light to the dark compartment was measured up to a maximum of 300 sec; any animal not entering the dark compartment within 300 sec was discarded from the test group.
• a 1.0 milliampere, 3.0 sec scrambled shock was delivered to the entire grid floor. The animal was allowed to remain in the dark compartment during this 3.0 sec period or to escape to the light compartment.
• Each rat was then returned immediately to its home cage. Twenty-four hr after training, each rat was tested in the same apparatus for retention of the task (to remain passively in the light compartment). The procedure on test day was identical to that of the training day, except that no injections were given and that the rats did not receive a shock upon entering the dark compartment.
• step-through latency The latency for animals to enter the dark compartment on test day (step-through latency) was recorded up to a maximum of 600 sec. Each animal was used only once in a single experiment.
• a one-way analysis of variance (ANONA) and ⁇ ewman-Keuls post- hoc comparisons were used to identify significant deficits in passive avoidance responding produced by scopolamine and their reversal by DHX; a p value of less than 0.05 was used as the level of significance.
• Scopolamine (3.0 mg/kg) produced a severe deficit in the acquisition of the passive avoidance task.
• DHX significantly improved scopolamine-induced deficits in step-through latency at a dose of 0.3 mg/kg (Fig. 1).
• Dihydrexidine produced an inverted U-shaped dose-response curve, typical of potential cognitionenhancing agents in this procedure.
• the improvement in cognitive performance may be due to Dj dopamine receptor-mediated increases in acetylcholine release induced by dihydrexidine in brain regions involved in cognition (e.g., frontal cortex).
• Dihydrexidine has been found to produce dose-related increases in acetylcholine release in the striatum and frontal cortex of conscious, freely-moving rats using in vivo microdialysis.
• METHOD EXAMPLE 3 METHOD EXAMPLE 3.
• Monkeys were trained to retrieve a raisin from one of the food wells after observing the experimenter bait the well. Right and left wells were baited in a randomized, balanced order. Animals were maintained on a restricted diet during the week and tested while food deprived. Training was accomplished with a non-correction procedure, beginning with a 0 s delay and progressing to a 5 s delay. Animals were trained until performance with a 5 s delay was 90% correct or better for at least 5 consecutive days. Each daily session consisted of 25 trials. A response was scored a "mistake” if the monkey made its response choice to a well that was not baited with reward. A "no response" error was scored if the monkey failed to respond to a trial within 30 s.
• MPTP administration began.
• MPTP-HCI in sterile saline
• the monkeys were trained to allow the experimenter to hold one leg and to not struggle during intravenous injection into the saphenous vein.
• Personnel administering MPTP wore a disposable gown, latex gloves, and a face mask with a splash shield.
• the used syringe was filled with a saturated solution of potassium permanganate (to oxidize any remaining MPTP), capped, and discarded as hazardous waste.
• Delayed response testing begins 8 min after compounds and/or compositions administration. On drug testing days, animals are tested for delayed response performance, administered compounds and/or compositions (or saline), and re-tested on the delayed response task. Saline control trials are performed approximately once every third test session. Saline injections control for effects of receiving an injection and for possible changes in performance as a consequence of being tested a second time in one day. A minimum of 3 days separate compounds and/or compositions trials in any particular animal. Compounds and/or compositions test sessions are conducted only if subjects meet the 15% or more performance deficit requirement on any particular day. Data analysis Delayed response performance after dihydrexidine administration was compared with matched control performance obtained on the same day prior to drug administration.
• C-6 glioma cells transfected with the rhesus macaque D1A receptor C-6-mDiA.
• Cells were grown in DMEM-H medium containing 4,500 mg/1 glucose, L-glutamine, 5% fetal bovine serum and 600 ng/ml G418.
• the density of mDi A receptor binding sites in untreated cells was approximately 50 fmol/mg protein for C-6-mDi A cells.
• Cells were plated into 24-well plates and allowed to grow to confluence (usually 2-4 days), after which they were used for either dose-response or desensitization studies. For the binding studies, 75-cm 2 flasks of confluent cells were treated as described below.
• Radioimmunoassay of cAMP The concentration of cAMP in each sample was determined with an RIA of acetylated cAMP (modified as described by Harper & Brooker, J. Cyclic Nucleotide Res. 1:207-218 (1975). Iodination of cAMP was performed according to Patel and Linden, Anal. Biochem. 168:417-420 (1988). Assay buffer was 50 mM sodium acetate buffer with 0.1% sodium azide (pH 4.75). Standard curves of cAMP were prepared in buffer at concentrations of 2 to 500 fmol/assay tube.
• each assay tube contained 10 ⁇ l of sample, 100 ⁇ l of buffer, 100 ⁇ l of primary antibody (sheep, anti-cAMP, 1 : 100,000 dilution with 1 % BS A in buffer) and 100 ⁇ l of
• [ 125 I]cAMP (50,000 d ⁇ m 100 ⁇ l of buffer); total assay volume was -300 ⁇ l. Tubes were vortexed and stored at 4°C overnight (approximately 18 hr). Antibody-bound radioactivity then was separated by the addition of 10 ⁇ l of BioMag rabbit, anti-goat IgG (Advanced Magnetics, Cambridge MA), followed by vortexing and further incubation at4°C for 1 hr. To these samples 1 ml of 12% polyethylene glycol/50 mM sodium acetate buffer (pH 6.75) was added, and all tubes were centrifuged at 1700 x g for 10 min.
• binding buffer 50 mM HEPES, pH 8.0
• Brinkmann Polytron on a setting of 5 for 10 sec
• 1-ml aliquots at -80°C until use in binding assays.
• Aliquots contained approximately 1 mg/ml of protein, as measured with the BCA protein assay reagent (Pierce, Rockford, LL). Competition binding studies were done to evaluate the affinity of the different agonists for the mDIA receptor.
• Membranes were diluted in assay buffer A (50 mM HEPES, 0.9% NaCl, pH 8.0) and 100 ⁇ l of membranes (approximately 50 ⁇ g) was incubated with 0.3 nM [3H]SCH23390 (prepared according to Wyrick et al., J Labelled Compd. Radiopharm. 23:685-692 (1986), specific activity, 85 Ci/mmol, the disclosure of which is incorporated herein by reference) and increasing concentrations of competing drug (0.01 nM-1 ⁇ M) in assay buffer B (50 mM HEPES, 0.9% NaCl, 0.001% BSA, pH 8.0). BSA was omitted from assay buffer A to determine protein levels in the samples accurately.
• assay buffer A 50 mM HEPES, 0.9% NaCl, pH 8.0
• Nonspecific binding was determined by 5 ⁇ M SCH23390, because there is no binding of SCH23390 in wild-type cells. Tubes were run in triplicate in a final volume of 500 ⁇ l. After incubation at 37°C for 15 min, tubes were filtered rapidly through Skatron glass fiber filter mats (11734) and rinsed with 5 ml of ice-cold wash buffer (10 mM Tris, 0.9% NaCl, pH 7.4) with a Skatron Micro Cell Harvester (Skatron Instruments Inc., Sterling, NA). Filters were allowed to dry, then punched into scintillation vials (Skatron Instruments Inc., Sterling, NA).
• OptiPhase 'HiSafe' II scintillation cocktail (1 ml) was added to each vial. After shaking for 30 min, radioactivity in each sample was determined on an LKB Wallac 1219 Rackbeta liquid scintillation counter.
• METHOD EXAMPLE 10 Effect of agonist exposure on Di receptor expression levels Flasks of cells in the same passage were exposed to 7 ml media B, or 7 ml media B supplemented with 10 ⁇ M concentrations of the various drugs for 2 hr. Cells were then rinsed with 7 ml media B (30 min), and then membranes were prepared as described above.
• Membranes were diluted in assay buffer A and 100 ⁇ l of membranes (approximately 50 ⁇ g) was incubated with six concentrations of [ 3 H]SCH23390 (0.09-1.1 nM), prepared in assay buffer B. Nonspecific binding was determined using 5 ⁇ M SCH23390.
• METHOD EXAMPLE 11 Data analysis For dose-response studies, data were calculated for each sample and expressed initially as pmol cAMP per mg protein per min. Base-line values of cAMP were subtracted from the total amount of cAMP produced for each drug condition.
• Subjects include both men and women between 18 and 60 years of age.
• Schizotypal personality disordered patients meet requisite DSM-IN criteria for SPD. Patients may have met criteria for major depressive disorder in the past, but not currently. It is appreciated that a history of depression may be a concomitant of schizotypal and other personality disorders and a past history of depression has not been found to affect the findings to date.
• Exclusion criteria Patients do not meet current or lifetime DSM-IN or RDC criteria for schizophrenia or any schizophrenia related psychotic disorder or for bipolar disorder.
• Other Axis I disorders are transient and preceded by the personality disorder diagnosis primarily responsible for ongoing functional impairment. Patients with neurologic complications, physical illness, low IQ, and poor visual activity are excluded.
• Controls are screened for a personal history of Axis I and II disorders and family history of psychiatric disorders. Demographic characteristics are obtained and subsequently are selected for similarity to patients on the basis of parental SES.
• Clinical Assessment & Diagnostic Assessment The Structured Clinical Interview for DSM-IV (SCLD-I/P) is utilized to evaluate Axis I diagnoses (First et al., 1996).
• the Schedule for Interviewing DSM-IV Personality Disorders-IN (SLOP-IN) is utilized to evaluate criteria for DSM-IV personality disorders on the basis of one or two Master's level psychologists interviewing the patient and a third interviewing an informant close to the patient.
• Cognitive Battery includes measures of attention including a standard visual and auditory continuous performance task: tests of working memory including the modified AX version of the CPT (AX-CPT) (Braver & Cohen, Prog. Brain Res. 121:327-49 (1999)), the N-back task (Callicott et al., Cereb.
• Dihydrexidine is administered in a dose 0.2 mg/kg (but no greater than 20 mg) administered subcutaneously.
• Cognitive testing is administered starting at 1:00PM for a duration of approximately an hour to an hour and a half, in which time the testing is completed on both protocol days. 15 SPD and 15 normal control subjects are entered into these protocols. Subjects are randomized, stratified within group, to a placebo first or active first condition. In addition to cognitive testing clinical assessment of symptoms are obtained using the PANSS, CGI, SPQ, Beck depression, and Spielberger Anxiety Ratings. Patients are medication-free for at least two weeks (six weeks for fluoxetine) and refrain from smoking cigarettes past midnight the night before and throughout the days of the cognitive testing.
• Cognitive impairments may be cardinal features of schizophrenia and predictors of poor vocational and social outcome.
• Imaging studies with verbal fluency tasks (VFT) suggest that in schizophrenia, the combination of a failure to deactivate the left temporal lobe and a hypoactive frontal lobe reflects a functional disconnectivity between the left prefrontal cortex and temporal lobe, or an abnormal cingulate gyrus modulates such fronto-temporal connectivity.
• Brain activity in 6 subjects on stable atypical antipsychotics performing a VFT is serially measured, using BOLD fMRI. Measurements are made at baseline and again after groups are randomized to receive 12 weeks of donepezil (an acetylcholinesterase inhibitor) and placebo in a blind cross-over design.
• Donepezil addition provided a functional normalization with an increase in left/frontal lobe and cingulate activity when compared to placebo and from baseline scans. This study provides support for the cingulate' s role in modulating cognition and neuronal connectivity in schizophrenia.
• METHOD EXAMPLE 14 Human clinical trial for regional brain activity (blood flow and task-specific activation) in patients with schizophrenia This method assesses whether a single dose, illustratively 20 mg subcutaneous (sc) of 6a, when compared to a saline control injection, (a) produces measurable increases in resting blood flow in the prefrontal cortex of patients with schizophrenia (as measured by contrast injection perfusion fMRI), (b) results in increased neural activity in regions involved in working memory (as measured by BOLD fMRI), (c) is tolerated with few side effects and/or (d) demonstrates a potential to improve cognitive performance. This method includes a within subject cross-over design in 20 adults (18-65 yrs of age) with SCLD diagnosed schizophrenia.
• Subjects are outpatients taking stable doses of antipsychotic medications, who have a moderate level of remaining negative symptoms.
• subjects are consented, rated, and receive training and practice on several computer administered neuropsychological tests.
• Subjects are admitted on the evening prior to testing. The following morning at 8 am they are taken to a 3T MRI scanner, with IV's, s.c and hep locks in place. They are scanned with a morning resting blood flow scan, followed by a BOLD fMRI scan during the n-back working memory task. They then receive 20 mg of a DI receptor agonist described herein, such as dihydrexidine 6a, or placebo, sc over 15 minutes.
• a DI receptor agonist described herein such as dihydrexidine 6a, or placebo
• Inclusion Criteria include subjects with DSM-IV criteria for schizophrenia determined by the Structured Clinical Interview for DSM-IV (SCLD) and with some symptoms despite treatment as defined by: PANS score >50 but less then 90, and PANS negative score of at least 4. Patients are between the ages of 18 and 65 of either gender. Patients are on stable doses of antipsychotic medications for at least 2 weeks. Patients are free of the following psychotropic medications: tricyclic antidepressants, phenothiazines, thiothixenes, clozapine, anticholinergics or stimulants for at least two weeks. Concurrent Axis II diagnoses are allowed except for Mental Retardation.
• Exclusion Criteria include a past history of epilepsy or seizure disorder, mass brain lesions, metal in the skull, or a history of major head trauma; subjects who demonstrate recent (2 week) acute exacerbation of their psychosis or with catatonic subtype; subjects diagnosed with schizoaffective disorder according to the DSM-IV; subjects diagnosed with Substance Dependence (DSM-IV) and current Major Depressive Disorder (Calgary depression rating scale > 9), subjects with history of clinically significant cardiovascular or cerebrovascular diseases, uncontrollable blood pressure, or abnormal ECG; subjects with renal or hepatic dysfunction; pregnant women or nursing mothers; smokers with greater than 2 packs per day use; subjects with claustrophobia or who have previously had problems with MRI scanning; and subjects with allergies to injectable contrast agents.
• Prefrontal Cortex Blood Flow Prefrontal Cortex Blood Flow. Resting prefrontal cortex blood flow is measured using the perfusion fMRI technique at baseline and intermittently over the hour following administration of a Di receptor agonist described herein, such as 20 mg of sc of 6a, or placebo, expressed as absolute data, as well as change from the morning baseline (expressed as a percent). Within day as well as between day comparisons are made to test for potentially increased rCBF with the Di receptor agonist. Blood flow changes. Use echoplanar BOLD-MRI on a specially modified 3.0 T MRI scanner to measure relative regional cerebral blood flow (rCBF) during a working memory task (the n-back). Secondary Study Endpoints.
• Di receptor agonist described herein, such as 20 mg of sc of 6a, or placebo
• Dihydrexidine shows full efficacy in stimulating adenylate cyclase in rat, monkey, and human brain tissue. Dihydrexidine is inactive in releasing dopamine or in blocking its reuptake. Effects on cognitive behavior in monkeys As in Parkinson patients, primates with lesions of dopaminergic neurons exhibit difficulty in performing procedural cognitive tasks. Cognitive deficits have been reported in monkeys depleted of dopamine in the prefrontal cortex, and in asymptomatic MPTPtreated primates. Local injection of Di antagonists into the prefrontal cortex of monkeys induced errors and increased latency in performance of a task requiring memory guided saccades suggesting a significant role for the Di receptor in mnemonic, predictive function of the primate prefrontal cortex.
• cyclase in rat brain striatum was as effective as dopamine even when receptor reserve is reduced, indicating equal intrinsic activity.
• Dinapsoline also displayed full agonist activity in stimulating adenylate cyclase (AC) at the cloned human Di-like receptors. Dinapsoline is equally efficacious and more potent at both the Di and D 5 receptors when compared to dopamine.
• AC adenylate cyclase
• Dinapsoline inhibits AC to the same extent as the prototypical D 2 agonist quinpirole. This result is indicative of full agonist activity at D 2L receptors coupled to cAMP synthesis.
• the following table summarizes the effects of dinapsoline at both D 2L and D receptors, indicating that dinapsoline is a full agonist for the inhibition of cAMP synthesis at both D 2L and D 4 receptors expressed in CHO cells.

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