Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
  • A61K31/593—9,10-Secocholestane derivatives, e.g. cholecalciferol, i.e. vitamin D3
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
  • A61P19/10—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease for osteoporosis

Definitions

• This invention relates to vitamin D compounds, and more particularly to pharmaceutical uses for 2-methylene-19-nor-20(S)-1 ⁇ ,25-dihydroxyvitamin D 3 .
• the natural hormone, 1 ⁇ ,25-dihydroxyvitamin D3 and its analog in ergocalciferol series, i.e. 1 ⁇ ,25-dihydroxyvitamin D2 are known to be highly potent regulators of calcium homeostasis in animals and humans, and more recently their activity in cellular differentiation has been established, Ostrem et al., Proc. Natl. Acad. Sci. USA, 84, 2610 (1987).
• vitamin D3 1 ⁇ -hydroxyvitamin D3, 1 ⁇ - hydroxyvitamin D2, various side chain homologated vitamins and fluorinated analogs.
• Some of these compounds exhibit an interesting separation of activities in cell differentiation and calcium regulation. This difference in activity may be useful in the treatment of a variety of diseases as renal osteodystrophy, vitamin D-resistant rickets, osteoporosis, psoriasis, and certain malignancies.
• Another new class of vitamin D analogs i.e. the so called 19-nor-vitamin D compounds, are characterized by the replacement of the A-ring exocyclic methylene group (carbon 19), typical of the vitamin D system, by two hydrogen atoms.
• Patent 5,843,928, and its use for treating a metabolic bone disease where it is desired to maintain or increase bone mass is taught therein.
• human bones are subject to a constant and dynamic remodeling process which includes bone resorption and bone formation.
• Bone resorption is based on the destruction of bone matrix, and is controlled by specialized cells known as osteoclasts.
• Bone formation is accomplished by bone forming cells known as osteoblasts which function to replace the bone resorbed by the osteoclasts.
• From childhood through adolescence i.e. up to about age 20
• bone modeling and remodeling is controlled so that skeletal growth is at an accelerated pace in order to match the growth of other body organs.
• Osteoporosis is a disease characterized by low bone mass and high bone fragility resulting in an increased risk of fractures. It results from an imbalance in the ongoing bone remodeling process, and due to the extremely complex nature of the remodeling process, it is not easily stopped or reversed. Osteoporosis can develop as a result of numerous different causes. It is generally categorized as including osteoporosis induced by hormone deficiency (e.g. estrogen deficiency commonly referred to as postmenopausal osteoporosis) and old age (e.g.
• hormone deficiency e.g. estrogen deficiency commonly referred to as postmenopausal osteoporosis
• old age e.g.
• osteoporosis treatment includes, for example, the administration of estrogens, estrogen/progesterone (referred to as hormone replacement therapy), calcitonin, vitamin D analogs, bisphosphonates, parathyroid hormone, and sodium fluoride.
• hormone replacement therapy a hormone replacement therapy
• Osteoporosis and other diseases characterized by a need to increase the strength of a bone, occur with increasing frequency as humans age, especially after middle age. These types of diseases are some of the most important medical disorders affecting the elderly, and because of the high incidence of fractures and their relatively high costs, their prevention remains one of the major unresolved public health problems facing society. Because bone loss has occurred over many years, and possibly decades, before fractures begin to occur, any drug intervention program aimed at preventing the development of metabolic bone diseases such as osteoporosis should begin earlier rather than later in one's life.
• the present invention is directed toward 2-methylene-19-nor-20(S)- 1 ⁇ ,25-dihydroxyvitamin D 3 , (hereinafter also referred to as 2MD) its biological activity, and various pharmaceutical uses for this compound.
• 2MD 2-methylene-19-nor-20(S)- 1 ⁇ ,25-dihydroxyvitamin D 3
• this 19-nor analog is characterized by the general formula I shown below:
• the solid wedge-shaped line to the methyl substituent at C-20 indicates that carbon 20 has the S configuration.
• the above compound (2MD) exhibits a desired, and highly advantageous, pattern of biological activity.
• 2MD is characterized by intestinal calcium transport activity, similar to that of 1 ⁇ ,25-dihydroxyvitamin D3, but exhibits very high activity, as compared to 1 ⁇ ,25-dihydroxyvitamin D3, in its ability to mobilize calcium from bone.
• the latter finding indicates that 2MD shows preferential activity on osteoblasts (bone forming cells) confirmed by direct osteoblast culture experiments (Shevde et al., Proc. Natl. Acad. Sci. USA 99, 13487 (2002)).
• 2MD is highly specific in its activity.
• 2MD Its preferential activity on mobilizing calcium from bone allows the in vivo administration of 2MD for the treatment and prophylaxis of metabolic bone diseases where bone loss is a major concern. Because of its preferential activity on bone, 2MD would be a preferred therapeutic agent for the treatment and prophylaxis of diseases where bone formation is desired, such as osteoporosis, especially low bone turnover osteoporosis, steroid induced osteoporosis, senile osteoporosis or postmenopausal osteoporosis, as well as osteomalacia.
• the administration of 2MD for the treatment and prophylaxis of such diseases may be transdermai, oral or parenteral.
• 2MD may be present in a composition in an amount from about 0.01 ⁇ g/gm to about 50 ⁇ g/gm of the composition, and may be administered to humans in dosages of from about 0.01 ⁇ g/day to about 100 ⁇ g/day and preferably from about 0.1 ⁇ g/day to about 10 ⁇ g/day in humans.
• the compound (2MD) of the invention is also especially suited for treatment and prophylaxis of human disorders which are characterized by an imbalance in the immune system, e.g.
• autoimmune diseases including multiple sclerosis, diabetes mellitus, host versus graft reaction, and rejection of transplants; and additionally for the treatment and prophylaxis of inflammatory diseases, such as rheumatoid arthritis, as well as the improvement of bone fracture healing and improved bone grafts.
• inflammatory diseases such as rheumatoid arthritis
• skin conditions such as dry skin (lack of dermal hydration), undue skin slackness (insufficient skin firmness), insufficient sebum secretion and wrinkles, and hypertension are other conditions which may be treated with the compound (2MD) of the invention.
• 018] 2MD is also characterized by high cell differentiation activity.
• 2MD also provides a therapeutic agent for the treatment of psoriasis, or as an anticancer agent, especially against neuroblastoma, retinoblastoma, melanoma, leukemia, colon cancer, breast cancer and prostate cancer.
• the compound may be present in a composition to treat psoriasis and/or the above referred to cancers in an amount from about 0.01 ⁇ g/gm to about 50 ⁇ g/gm of the composition, and may be administered topically, transdermally, orally or parenterally in dosages of from about 0.01 ⁇ g/day to about 100 ⁇ g/day, and preferably from about 0.1 ⁇ g/day to about 10 ⁇ g/day in humans.
• one embodiment of the present invention is a method of increasing the strength of a bone comprising administering to a subject an effective amount of 2MD.
• 2MD could also be used in conjunction with bone replacement procedures such as hip replacements, knee replacements, and the like.
• 2MD may also be applied directly on bone by injection in suitable carriers.
• 2MD could be used by athletes requiring strong skeletons such as runners (both long distance runners such as cross-country and marathon runners as well as sprinters), weightlifters, discus and hammer throwers, soccer players, tennis players, football players, baseball players, as well as other athletes.
• Such athletes could be administered 2MD to build bone mass and increase bone strength to thereby inhibit and/or minimize the risk of bone fractures that may occur as a result of playing their chosen sport.
• both the athletes and those having bone replacement procedures are individuals that are not afflicted with or have not been diagnosed with a metabolic bone disease.
• the present invention provides a method for prophylaxis of a disease or disorder characterized by a need to increase the strength of a bone comprising administering to a subject an effective amount of 2MD.
• 2MD could be used to build up bone mass and increase bone strength of individuals with normal bone mass and strength (as measured from and compared to base line bone mineral content (BMC) and/or bone mineral density (MBD) readings) so that they can sustain the later loss of bone caused by various diseases or disorders of the bone without incurring fractures.
• BMC base line bone mineral content
• MBD bone mineral density
• Individuals could be administered 2MD throughout their lifetime (e.g. childhood, adolescence, young adulthood and mature adulthood) or any portion thereof, to develop increased bone mass and strength.
• at the time of administration such individuals are not afflicted with or have not been diagnosed with a metabolic bone disease.
• osteoporosis e.g. postmenopausal osteoporosis in women
• old age senile osteoporosis in men and women
• drug therapy e.g. steroid induced osteoporosis as a result of treatment with anti-inflammatory glucocorticoid drugs
• steroid induced osteoporosis as a result of treatment with anti-inflammatory glucocorticoid drugs
• individuals that have built up their bone mass could sustain the loss of bone caused thereby.
• other circumstances where 2MD could be used as a prophylaxis method include treatment of amenorrheic females usually female athletes, athletes and workers requiring strong skeletons, horses especially race horses (in dosages of about 0.01 ⁇ g/day to about 700 ⁇ g/day), and astronauts under weightless conditions.
• cows especially lactating cows in dosages of about 0.01 ⁇ g/day to about 550 ⁇ g/day
• pigs especially sows being used for rapid farrowing in dosages of about 0.005 ⁇ g/day to about 225 ⁇ g/day.
• the elderly could benefit from an early drug intervention or prophylaxis program for the prevention of bone fractures.
• the present invention is directed toward a method for prophylaxis of osteoporosis, especially postmenopausal osteoporosis, comprising administering to a subject prior to menopause an effective amount of 2MD to increase bone mass.
• Figure 1 is a graph illustrating the relative activity of 2-methylene-19-nor- 20(S)-1 ⁇ ,25-dihydroxyvitamin D 3 (2MD) and 1 ⁇ ,25-dihydroxyvitamin D 3 to compete for binding of [ 3 H]-1 ⁇ ,25-(OH) 2 -D 3 to the nuclear vitamin D receptor;
• Figure 2 is a graph illustrating the intestinal calcium transport activity of 2- methylene-19-nor-20(S)-1 ⁇ ,25-dihydroxyvitamin D 3 (2MD) as compared to 1 ,25- dihydroxyvitamin D 3 (1,25-(OH) 2 D 3 );
• Figure 3 is a graph illustrating the bone calcium mobilization activity of 2- methylene-19-nor-20(S)-1 ⁇ ,25-dihydroxyvitamin D 3 (2MD) as compared to 1 ⁇ ,25- dihydroxyvitamin D 3 (1 ,25-(OH) 2 D 3 );
• Figure 4 is a graph illustrating the change in bone mineral density
• Y- j and Y2 are hydroxy-protecting groups, it being also understood that any functionalities that might be sensitive, or that interfere with the condensation reaction, be suitably protected as is well- known in the art.
• the process shown above represents an application of the convergent synthesis concept, which has been applied effectively for the preparation of vitamin D compounds (e.g. Lythgoe et al., J. Chem. Soc. Perkin Trans. I, 590 (1978); Lythgoe, Chem. Soc. Rev. 9, 449 (1983); Toh et al., J. Org. Chem. 48, 1414 (1983); Baggiolini et al., J. Org. Chem.
• Hydrindanones of the general structure II are known, or can be prepared by known methods.
• BIOLOGICAL ACTIVITY OF 2-METHYLENE-20(S)- 19-NOR-1,25-(OH) 2 D 3 (FIGS. 1-8) 043]
• the introduction of a methylene group to the 2-position of the 20(S) isomer of 19-nor-1 ,25-(OH)2D3 had little or no effect on binding to the porcine intestinal vitamin D receptor.
• This compound bound equally well to the full length recombinant rat receptor as compared to the standard 1 ,25-(OH)2D3 ( Figure 1). Similar results were found when the native receptor from porcine intestine was studied. It might be expected from these results that this compound would have equivalent biological activity.
• Figure 2 shows that 2MD has activity similar to that of 1 ,25- dihydroxyvitamin D 3 (1,25(OH) 2 D 3 ), the natural hormone, in stimulating intestinal calcium transport in vitamin D-deficient rats given a dose of drug by oral gavage for 7 consecutive days followed by assay using the everted gut sac technique. Values represent means ⁇ standard error.
• Figure 3 clearly demonstrates that 2MD is 100 times more potent than 1 ,25(OH) 2 D 3 on bone, i.e. the mobilization of bone calcium. Blood serum calcium was measured 24 hours following the last dose in the rats as described in Figure 2. Values represent mean ⁇ standard error.
• Figure 4 shows that 2MD is extraordinarily effective in building bone mass in ovariectomized rats as compared to the native hormone without increasing serum calcium concentration (Table 1). This is as yet an unprecedented new finding for a vitamin D compound.
• Figure 5 illustrates that 2MD is 10-50 times more potent than 1 ,25(OH) 2 D 3 on HL-60 cell differentiation, making it an excellent candidate for the treatment of psoriasis and cancer, especially against leukemia, neuroblastoma, retinoblastoma, melanoma, colon cancer, breast cancer and prostate cancer.
• Table 1 and Figure 6A illustrate that 2MD is very effective in increasing bone of ovariectomized, old female rats at 32 pmol given 2 times per week as compared to 1 ,25(OH) 2 D 3 given at high doses (250 or 500 pmol) 3 times per week. Note: 2MD also increases % ash in the femur. Values in the figure are mean ⁇ standard error. 049] Table 2 and Figure 6B show that 2MD increases breaking strength in the femurs (cortical strength) and crushing strength in the vertebra (trabecular strength) of animals shown in Table 1. Values in the figure are mean ⁇ standard error.
• Figures 7-9 show a six-week toxicity study in rats and demonstrate that 2MD appears safe at up to 35 pmol/day.
• Figure 10 shows that in Rhesus monkeys, a single oral dose of 29 ⁇ g (1.73 ⁇ g/kg) does not cause significant elevation of serum calcium concentration, suggesting even greater safety in primates.
• Figures 11 , 12A and 12B show that 2MD given at 1.8 pmol/day is highly effective in increasing the bone density in normal adult female rats. Not only does 2MD increase cancellous (trabecular) bone, but it also increases the density of the cortical (shaft) bone as well.
• Figures 13A and 13B show that the remarkable increase in both cortical and cancellous bone are achieved with no adverse effect in either the body weight or serum calcium levels of the animals.
• this work shows that 2MD can be safely used not only in ovariectomized animals but also in normal animals at a dose that is effective in increasing bone density.
• 052 Competitive binding of the analogs to the porcine intestinal receptor was carried out by the method described by Dame et al. (Biochemistry 25, 4523-4534, 1986).
• 053 The differentiation of HL-60 promyelocytic cells into monocytes was determined as described by Ostrem et al. (J. Biol. Chem. 262, 14164-14171, 1987).
• Rats were dosed daily beginning 5-6 weeks post-surgery.
• Neobee oil (vehicle) or 2MD were delivered to the back of the tongue in 100 ⁇ L.
• the dosing solution concentrations were adjusted monthly based on group-average body weights.
• Serum Calcium Analyses 064 At predose and at 1 , 2, 4, 6, 10, 11 , 18 and 25 weeks after dose, blood was collected 24 hr. after the most recent dose from the tail artery of ether- anesthetized rats. Serum was diluted in 0.1% lanthum chloride and the concentration of calcium determined by atomic absorption spectrometry. The values shown are averages for all rats, and include standard errors.
• BMD Bone Mineral Density
• 2MD is obviously effective in increasing bone mass of intact normal female rats.
• normal it is meant a subject that is not afflicted with or has not been diagnosed with a metabolic bone disease or any other disease/disorder that results in a decrease over time of bone mass.
• 2MD increases both cancellous (14%) and cortical (6%) bone. Because it has been previously demonstrated that 2MD acts anabolically on bone, it is believed that 2MD may be used to increase bone mass of normal healthy children, adolescents, young adults and/or mature adults. This would result in skeleton that would survive the bone loss of aging and the menopause.
• 2MD can be used as a prophylaxis or preventative measure against fractures resulting from the bone loss of metabolic bone diseases, especially osteoporosis.
• circumstances where 2MD could be used as a prophylaxis method include treatment of amenorrheic females.
• 2MD could be used in normal subjects when high bone mass is desired, such as athletes. It is envisioned that 2MD can be used to increase bone mass of horses especially race horses and in astronauts preparing for a long journey under weightless conditions.
• Typical commercially significant laying hens include chickens, turkeys, ducks, geese, pheasants, grouse, ostrich and quail.
• the compound of this invention defined by formula I may be formulated for pharmaceutical applications as a solution in innocuous solvents, or as an emulsion, suspension or dispersion in suitable solvents or carriers, or as pills, tablets or capsules, together with solid carriers, according to conventional methods known in the art. Any such formulations may also contain other pharmaceutically-acceptable and non-toxic excipients such as stabilizers, anti-oxidants, binders, coloring agents or emulsifying or taste- modifying agents. 069] The compound 2MD may be administered orally, topically, parenterally or transdermally.
• the compound 2MD is advantageously administered by injection or by intravenous infusion or suitable sterile solutions, or in the form of liquid or solid doses via the alimentary canal, or in the form of creams, ointments, patches, or similar vehicles suitable for transdermai applications.
• Doses of from about 0.01 ⁇ g per day to about 100 ⁇ g per day, preferably from about 0.1 ⁇ g per day to about 10 ⁇ g per day of the compound 2MD are appropriate for treatment purposes in humans, such doses being adjusted according to the disease to be prevented or treated, its severity and the response of the subject as is well understood in the art.
• Doses of from about 0.0001 ⁇ g per day to about 700 ⁇ g per day of the compound 2MD are appropriate for treatment purposes in animals.
• compositions for use in the above-mentioned treatment and/or prophylaxis of humans or animals aimed at maintaining or increasing bone mass or in other applications such as psoriasis and other malignancies comprise an effective amount of the 2-methylene-20(S)-19-nor-vitamin D compound as defined by the above formula I as the active ingredient, and a suitable carrier.
• An effective amount of such compound for use in accordance with this invention is from about 0.01 ⁇ g to about 50 ⁇ g per gram of composition, and may be administered topically, transdermally, orally or parenterally in dosages of from about 0.01 ⁇ g per day to about 100 ⁇ g per day in humans, and preferably from about 0.1 ⁇ g per day to about 10 ⁇ g per day in humans.
• an effective amount of such compound for use in accordance with this invention is from about 0.01 ⁇ g to about 50 ⁇ g per gm of composition, and may be administered topically, transdermally, orally or parenterally in dosages of from about 0.0001 ⁇ g per day to about 700 ⁇ g per day.
• the compound 2MD may be formulated as creams, lotions, ointments, topical patches, pills, capsules or tablets, or in liquid form as solutions, emulsions, dispersions, or suspensions in pharmaceutically innocuous and acceptable solvent or oils, and such preparations may contain in addition other pharmaceutically innocuous or beneficial components, such as stabilizers, antioxidants, emulsifiers, coloring agents, binders or taste-modifying agents.
• the compound 2MD is advantageously administered in amounts sufficient to effect the differentiation of promyelocytes to normal macrophages, and/or in amounts needed to prevent bone loss, maintain bone mass or increase bone mass.
• formulations of the present invention comprise an active ingredient in association with a pharmaceutically acceptable carrier therefore and optionally other therapeutic ingredients.
• the carrier must be "acceptable” in the sense of being compatible with the other ingredients of the formulations and not deleterious to the recipient thereof.
• Formulations of the present invention suitable for oral administration may be in the form of discrete units as capsules, sachets, tablets or lozenges, each containing a predetermined amount of the active ingredient; in the form of a powder or granules; in the form of a solution or a suspension in an aqueous liquid or non-aqueous liquid; or in the form of an oil-in-water emulsion or a water-in-oil emulsion.
• Formulations for rectal administration may be in the form of a suppository incorporating the active ingredient and carrier such as cocoa butter, or in the form of an enema.
• Formulations suitable for parenteral administration conveniently comprise a sterile oily or aqueous preparation of the active ingredient which is preferably isotonic with the blood of the recipient.
• Formulations suitable for injection comprise a sterile oily or aqueous preparation, or a suspension or conjugate of the active ingredient.
• Formulations suitable for topical administration include liquid or semi- liquid preparations such as liniments, lotions, applicants, oil-in-water or water-in- oil emulsions such as creams, ointments or pastes; or solutions or suspensions such as drops; or as sprays.
• the formulations may conveniently be presented in dosage unit form and may be prepared by any of the methods well known in the art of pharmacy.
• dosage unit a unitary, i.e. a single dose which is capable of being administered to a patient as a physically and chemically stable unit dose comprising either the active ingredient as such or a mixture of it with solid or liquid pharmaceutical diluents or carriers.

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• 2004
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