WO2006000222A2 - The combination of an antipsychotic and a glycine transporter type i inhibitor for the treatment of schizophrenia - Google Patents

The combination of an antipsychotic and a glycine transporter type i inhibitor for the treatment of schizophrenia Download PDF

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Publication number
WO2006000222A2
WO2006000222A2 PCT/DK2005/000422 DK2005000422W WO2006000222A2 WO 2006000222 A2 WO2006000222 A2 WO 2006000222A2 DK 2005000422 W DK2005000422 W DK 2005000422W WO 2006000222 A2 WO2006000222 A2 WO 2006000222A2
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WIPO (PCT)
Prior art keywords
giyt
phenyl
inhibitor
antagonist
schizophrenia
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PCT/DK2005/000422
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French (fr)
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WO2006000222A3 (en
Inventor
Steffen Wad JØRGENSEN
Allan Carsten Dahl
Michael Didriksen
Frank Larsen
Torbjörn WÆRNER
Karina Krøjer SØBY
Dorthe Bach Toft
Thomas Helboe
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H. Lundbeck A/S
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Publication of WO2006000222A2 publication Critical patent/WO2006000222A2/en
Publication of WO2006000222A3 publication Critical patent/WO2006000222A3/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia

Definitions

  • the present invention relates to the combination of an antipsychotic agent selected from D2 receptor antagonists, partial agonists, or inverse agonists, and a glycine transporter type 1 (GIyT-I) inhibitor. Accordingly, the present invention relates to the treatment of patients with schizophrenia, in particular treatment of patients with positive symptoms and negative symptoms, and cognitive impairment in patients with schizophrenia.
  • an antipsychotic agent selected from D2 receptor antagonists, partial agonists, or inverse agonists
  • GyT-I glycine transporter type 1
  • a D2 receptor antagonist, partial agonist, or inverse agonist is referred to as "a D2 antagonist", and is intended to be a compound that has affinity to the D2 receptor and which inhibits or blocks the receptor signal and may without limiting the invention in any way be selected from D2 receptor antagonists like e.g.
  • haloperidol flupenthixol, fluphenazin, perphenazin, pimozide, chlorpromazine, tioridazine, melperone, zuclpentixol, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, sertindole, amisulpiride, asenapine, paloperidone or blonanserine, or from D2 receptor partial agonist such as aripiprazole, or bifeprunox as well as pharmaceutically acceptable salts thereof.
  • a human glycine transporter type Ib inhibitor is referred to as "a GIyT-I inhibitor". While GIyT-I exist in at least three isoforms termed GIyT-Ia, -Ib and -Ic there is no evidence to suggest that they are different in their functional properties or pharmacology. Thus, an inhibitor of GIyTIb is predicted to have similar activity at GIyTIa or GIyT-Ic.
  • the GIyT-I transporter is co-localised with the NMDA receptor complex and has a buffer capacity of 10-100 fold. As a consequence of the highly efficient GIyT-I transporter the glycine site is not fully occupied under physiological condition.
  • Glycine-I inhibitors Compounds blocking the GIyT-I transporter (GIyT-I inhibitors) are expected secondarily to activate the NMDA receptor complex via an increased level of glycine.
  • Typical GIyT-I inhibitors show inhibition below 20000 nM as IC 50 in the "[ 3 H]-Glycine uptake (GIyT-Ib)" test described herein.
  • the invention also covers GIyT-I inhibitors identified according to this method, but is not limited to these assay methods.
  • the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms, negative symptoms, and/or cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
  • positive symptoms, negative symptoms, and/or cognitive impairment means "positive symptoms”, “negative symptoms”, or “cognitive impairment”, as well as any combination thereof, such as “positive symptoms and negative symptoms”, or “cognitive impairment and negative symptoms”. Accordingly, in a further aspect the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of negative symptoms of schizophrenia in patients treated with a D2 antagonist.
  • the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
  • the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of negative symptoms and cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
  • patient is intended to mean a mammalian patient, such as a human patient, such as male or female, young, adult, or elderly.
  • a patient treated with a D2 antagonist means that the patient has received at least one dosage of the D2 antagonist for treatment of schizophrenia.
  • patients with schizophrenia will be co-treated with the GIyT-I inhibitor when they are stabilised, which refer to patients in the non-acute phase of his or her illness, for example if no major change in medication type and dose for at longer period of time.
  • co-treatment is defined as concurrent treatment with a D2 antagonist and the GIyT-I inhibitor, independent of the frequency of dosing of either compound.
  • positive symptoms equal psychotic symptoms.
  • positive and negative symptoms are used as defined by the DSM IV.
  • cogntive impairment of schizophrenia equals expressions like "cognitive symptoms” or “cognitive dysfunction” and comprises e.g. any expression if impaired cognitive function in schizophrenia as lowered IQ, impaired attention/perception/vigilance, reduced memory regardless of type of memory, reduced social cognition, reduced processing speed, reduced ability of logical or abstract thinking/executive functioning/planning/problem solving.
  • the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms, negative symptoms, and cognitive impairment of schizophrenia.
  • the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms and negative symptoms of schizophrenia.
  • the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms and cognitive impairment of schizophrenia.
  • the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of negative symptoms and cognitive impairment of schizophrenia.
  • the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit-of-parts (kit) useful for the treatment of positive symptoms, negative symptoms, and cognitive impairment of schizophrenia.
  • the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit useful for the treatment of positive symptoms and negative symptoms of schizophrenia.
  • the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit useful for the treatment of positive symptoms and cognitive impairment of schizophrenia. Furthermore the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit useful for the treatment of negative symptoms and cognitive impairment of schizophrenia.
  • the invention relates to a pharmaceutical composition or kit comprising a D2 antagonist and a GIyT-I inhibitor, and optionally pharmaceutically acceptable carriers or diluents.
  • composition or kit are considered separate embodiments and may be the subj ect of separate claims .
  • the invention in another aspect relates to a method for the treatment of negative symptoms, and cognitive impairment of schizophrenia comprising administration to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
  • the invention in another aspect relates to a method for the treatment of negative symptoms of schizophrenia comprising administration to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
  • the invention in another aspect relates to a method for the treatment of cognitive impairment of schizophrenia comprising administration to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
  • the invention relates to a method for the treatment of positive symptoms, negative symptoms, and cognitive impairment of schizophrenia comprising administration to a patient in need thereof a therapeutically effective amount of a D2 antagonist and a therapeutically effective amount of a GIyT-I inhibitor.
  • the GIyT-I inhibitor is selective for the human glycine transporter type Ib as defined by a ratio of 3 -fold, such as 10-fold, higher affinity for human GIyT-I over other targets including but not limited to GIy T-2 and the NMDA receptor sites and determined as described in the section "Materials and Methods".
  • the D2 antagonist is selected from any one of haloperidol, flupenthixol, fluphenazin, perphenazin, pimozide, chlorpromazine, tioridazine, melperone, zuclopentixol, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, aripiprazole, sertindole, amisulpiride, bifeprunox, asenapine, paloperidone or blonanserine or pharmaceutically acceptable salts thereof in clinically recommended doses as defined by the product's SmPCs and in oral or parenteral formulations.
  • Each of these D2 antagonists may be claimed individually in accordance with any one of the aspects described herein.
  • the GIyT-I inhibitor is selected from any one of the compounds disclosed in WO0208216, such as any one of N- ⁇ 3 - [5 -Cyano- 1 -(4-fluoropheny I)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl ⁇ glycine ethyl ester, N- ⁇ 3- [5 -Cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]- 1 -propyl ⁇ -N- methylglycine ethyl ester, N- ⁇ 3 - [5 -Cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl ⁇ glycine, N
  • the GIyT-I inhibitor is selected from any one of the compounds disclosed in WO03/053942, such as any one of (+/-)- ⁇ 4-[2-(4-Methoxy-phenylsulfanyl)-phenyl]-tr ⁇ ra-2,5-dimethyl-piperazin-l-yl ⁇ -acetic acid, (+/-)- ⁇ 4-[2-(4-Chloro-phenylsulfanyl)-phenyl]-tr ⁇ r ⁇ -2,5-dimethyl-piperazin-l-yl ⁇ -acetic acid, (+/-)- ⁇ 4-[2-(4-tert-Butyl-phenylsulfanyl)-phenyl]-frflw-2,5-dimethyl-piperazin-l-yl ⁇ -acetic acid, (+/-)- ⁇ 4-[2-(4-Fluoro-phenylsulfanyl)-phenyl]-tr ⁇ r ⁇
  • GIyT-I inhibitors mentioned above may be used in the free form or as a pharmaceutically acceptable acid addition salt or base salt thereof.
  • Each of the GIyT-I inhibitors specified above is intended to be an individual embodiment. Accordingly, each of them and the use thereof may be claimed individually.
  • the GIyT-I inhibitor and D2 antagonist may be administered simultaneously, or the GIyT-I inhibitor may be administered first, or the D2 antagonist may be administered first.
  • the active ingredients comprised within the pharmaceutical composition or kit may be contained in the same unit dosage form, or the active ingredients are contained in discrete dosage forms, optionally contained in the same container or package.
  • an "active ingredient” means a D2 antagonist or a GIyT-I inhibitor.
  • a kit comprises a preparation of the GIyT-I inhibitor in a first-unit dosage form, and the D2 antagonist in a second-unit dosage form, and container means for containing said first and second dosage forms.
  • compositions Each of the active ingredients according to the invention may be administered alone or together or in combination with pharmaceutically acceptable carriers or excipients, in either single or multiple doses.
  • the pharmaceutical compositions according to the invention may be formulated with pharmaceutically acceptable carriers or diluents as well as any other known adjuvants and excipients in accordance with conventional techniques such as those disclosed in Remington: The Science and Practice of Pharmacy, 19 Edition, Gennaro, Ed., Mack Publishing Co., Easton, PA, 1995.
  • compositions may be specifically formulated for administration by any suitable route such as the oral, rectal, nasal, pulmonary, topical (including buccal and sublingual), transdermal, intracisternal, intraperitoneal, vaginal and parenteral (including subcutaneous, intramuscular, intrathecal, intravenous and intradermal) route, the oral route being preferred. It will be appreciated that the preferred route will depend on the general condition and age of the subject to be treated, the nature of the condition to be treated and the specific active ingredient or active ingredients chosen.
  • compositions for oral administration include solid dosage forms such as capsules, tablets, dragees, pills, lozenges, powders and granules. Where appropriate, they may be prepared with coatings such as enteric coatings or they may be formulated so as to provide controlled release of one or more active ingredient such as sustained or prolonged release according to methods well known in the art.
  • Liquid dosage forms for oral administration include solutions, emulsions, suspensions, syrups and elixirs.
  • compositions for parenteral administration include sterile aqueous and nonaqueous injectable solutions, dispersions, suspensions or emulsions as well as sterile powders to be reconstituted in sterile injectable solutions or dispersions prior to use. Depot injectable formulations are also contemplated as being within the scope of the present invention.
  • Suitable administration forms include suppositories, sprays, ointments, cremes, gels, inhalants, dermal patches, implants etc.
  • compositions of this invention or those which are manufactured in accordance with this invention may be administered by any suitable route, for example orally in the form of tablets, capsules, powders, syrups, solutions, etc., or parenterally in the form of solutions for injection.
  • suitable route for example orally in the form of tablets, capsules, powders, syrups, solutions, etc.
  • parenterally in the form of solutions for injection for example orally in the form of tablets, capsules, powders, syrups, solutions, etc.
  • parenterally in the form of solutions for injection for preparing such compositions, methods well known in the art may be used, and any pharmaceutically acceptable carriers, diluents, excipients or other additives normally used in the art may be used.
  • a typical oral dosage of each of the active ingredients is in the range of from about 0.001 to about 100 mg/kg body weight per day, preferably from about 0.01 to about 50 mg/kg body weight per day, and more preferred from about 0.05 to about 10 mg/kg body weight per day administered in one or more dosages such as 1 to 3 dosages.
  • the exact dosage will depend upon the efficacy, safety and tolerability, including the frequency and mode of administration, the sex, age, weight and general condition of the subject treated, the nature and severity of the condition treated and any concomitant diseases to be treated and other factors evident to those skilled in the art.
  • parenteral routes such as intravenous, intrathecal, intramuscular and similar administration
  • typically doses are in the order of about half the dose employed for oral administration.
  • the compounds of this invention are generally utilized as the free substance (e.g. zwitter ion) or as a pharmaceutically acceptable salt thereof.
  • a pharmaceutically acceptable salt thereof is a base addition salt of a compound having the utility of a free acid.
  • salts are prepared in a conventional manner by treating a solution or suspension of a free acid of the active ingredient with a chemical equivalent of a pharmaceutically acceptable base.
  • solutions of one or more active ingredient in sterile aqueous solution aqueous propylene glycol, aqueous vitamin E or sesame or peanut oil may be employed.
  • aqueous solutions should be suitably buffered if necessary and the liquid diluent first rendered isotonic with sufficient saline or glucose.
  • the aqueous solutions are particularly suitable for intravenous, intramuscular, subcutaneous and intraperitoneal administration.
  • the sterile aqueous media employed are all readily available by standard techniques known to those skilled in the art.
  • Solutions for injections may be prepared by dissolving one or more active ingredients and possible additives in a part of the solvent for injection, preferably sterile water, adjusting the solution to a desired volume, sterilising the solution and filling it in suitable ampules or vials. Any suitable additive conventionally used in the art may be added, such as tonicity agents, preservatives, antioxidants, etc.
  • Suitable pharmaceutical carriers include inert solid diluents or fillers, sterile aqueous solution and various organic solvents.
  • solid carriers examples include lactose, terra alba, sucrose, cyclodextrin, talc, agar, pectin, acacia, stearic acid and lower alkyl ethers of cellulose corn starch, potato starch, talcum, magnesium stearate, gelatine, lactose, gums, and the like.
  • any other adjuvants or additives usually used for such purposes such as colourings, flavourings, preservatives etc. may be used provided that they are compatible with the active ingredient or ingredients used.
  • liquid carriers examples include syrup, peanut oil, olive oil, phospho lipids, fatty acids, fatty acid amines, polyoxyethylene and water.
  • the carrier or diluent may include any sustained release material known in the art, such as glyceryl monostearate or glyceryl distearate, alone or mixed with a wax.
  • the pharmaceutical compositions formed by combining one or more active ingredients of the invention with the pharmaceutical acceptable carriers are then readily administered in a variety of dosage forms suitable for the disclosed routes of administration.
  • the formulations may conveniently be presented in unit dosage form by methods known in the art of pharmacy.
  • the active ingredients of the invention may be formulated in similar or dissimilar pharmaceutical compositions and unit forms thereof.
  • the preparation may be tabletted, placed in a hard gelatine capsule in powder or pellet form or it may be in the form of a troche or lozenge.
  • the amount of solid carrier will vary widely but will usually be from about 25 mg to about 1 g.
  • the preparation may be in the form of a syrup, emulsion, soft gelatine capsule or sterile injectable liquid such as an aqueous or non-aqueous liquid suspension or solution.
  • the pharmaceutical composition of the invention may comprise one or more active ingredients in combination with further pharmacologically active substances such as those described in the foregoing.
  • [ 3 H]-Glycine uptake (GIyT-Ib)
  • GIyT-I inhibitors for use in combination with a D2 antagonist, such as risperidone, olanzapine, or aripiprazole are tested in the well-recognised and reliable test measuring glycine uptake (Kim et al, 1994, MoI. Pharmacol. 45, 608-617): Cells transfected with the human GIyT-Ib were seeded in 96 well plates.
  • HBS Hepes-tris (pH 7,4), 2,5 mM KCl, 1 niM CaCl 2 , 2,5 mM MgSO 4 ,
  • test compound for 6 minutes.
  • 10 nM 3 H-glycine was added to each well and the incubation was continued for 15 minutes.
  • the cells were washed twice in HBS. Scintillation fluid was added and the Plates were counted on a Trilux (Wallac) scintillation counter. Based on this test, compounds which are GIyT-I inhibitors show inhibition below 20000 nM as IC 50 in the above-mentioned assay, preferably below 10000 nM.
  • [ 3 H]-GIy cine uptake (GIyT-Ia) The ability of the compound to inhibit glycine uptake by the glycine transporter-2 (GIyT- 2a), was measured using HEK293 cells transiently transfected with the human GlyT-2a cDNA as described previously (Gallagher et al, 1999, MoI. Brain Res. 70, 101-115). At 24 hours after transfection, the cells were seeded in 96 well microtiter plates and incubated for further 24 hours. At the day of the experiment the cells were washed, and incubated with test compound or buffer for 15min (37 °C) followed by incubation for additional 15 min in the presence of 300 nM [ 3 H] -glycine. The cells were washed, scintillation mixture was added and the plate was counted in a scintillation counter.
  • [ 3 H]MMOl binding (NMDA receptor sites) It is well established that [ 3 H]-MK801 binding, by means of allosteric interaction, can be a measure of functional interaction with the receptor at multiple sites including the non ⁇ competitive binding site at the NMDA receptor, the glutamate binding site as well as for the glycine co-agonist site of the NMDA receptor (Foster and Wong, 1987, Br. J. Pharmacol. 91, 403-409; Danysz et al., 1989, MoL Pharmacol. 36, 912-916). Thus, the ability of the compound to either inhibit or stimulate [ 3 H]-MK801 binding to rat cortical membranes in the presence of glycine, glutamate or both was assessed.
  • Membranes (8 mg/well) were mixed with 1 nM 3 H-MOOl, varying concentrations of test compound, glycine and glutamate in a total volume of 1.2 ml and incubated for 60 min at 37 0 C. Membranes and unbound ligand was separated by filtration and the amount of bound radioactivity was measured by scintillation counting.
  • Broad receptor profiling Compounds were submitted to a broad receptor profile at a contract research lab (CEREP, France or MDS Pharma services, USA) covering more than 60 receptors, ionchannels and enzymes according to their standard protocols. The test concentration was at least 10.000 nM.

Abstract

The present invention relates to the combination of an antipsychotic agent selected from D2 receptor antagonists, partial agonists, or inverse agonists, and a glycine transporter type 1 (GlyT-1) inhibitor. Accordingly, the present invention relates to the treatment of patients with schizophrenia, in particular treatment of patients with positive symptoms and negative symptoms, and cognitive impairment in patients with schizophrenia.

Description

The combination of an antipsychotic and a glycine transporter type 1 inhibitor for the treatment of schizophrenia
The present invention relates to the combination of an antipsychotic agent selected from D2 receptor antagonists, partial agonists, or inverse agonists, and a glycine transporter type 1 (GIyT-I) inhibitor. Accordingly, the present invention relates to the treatment of patients with schizophrenia, in particular treatment of patients with positive symptoms and negative symptoms, and cognitive impairment in patients with schizophrenia.
Background
Today positive symptoms as defined in the DSM IV must be or have been present to give the diagnosis of schizophrenia. Furthermore pharmacological treatment of schizophrenia is mainly focusing these positive symptoms, albeit current treatments also to some extent treat other symptom categories of the disorder, such as negative symptoms, affective symptoms and cognitive impairment. Current antipsychotic treatments do though only have minor effects on these symptoms. Apparently, only one drug has been approved in some European countries for treatment of negative symptoms of schizophrenia, namely amisulpride.
Summary of the invention
At the present time there is an unmet need for the treatment of the negative symptoms and cognitive impairment of schizophrenia.
Co-treatment of the positive and negative symptoms, and cognitive impairment of schizophrenia with a GIyT-I inhibitor and a D2 receptor antagonist, partial agonist, or inverse agonist is supported by pre-clinical and clinical observations. It is therefore suggested to co-treat patients (already in treatment with current antipsychotic medication, that is D2 antagonists) with a GIyT-I inhibitor. Description of the invention In the following description "a D2 receptor antagonist, partial agonist, or inverse agonist" is referred to as "a D2 antagonist", and is intended to be a compound that has affinity to the D2 receptor and which inhibits or blocks the receptor signal and may without limiting the invention in any way be selected from D2 receptor antagonists like e.g. haloperidol, flupenthixol, fluphenazin, perphenazin, pimozide, chlorpromazine, tioridazine, melperone, zuclpentixol, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, sertindole, amisulpiride, asenapine, paloperidone or blonanserine, or from D2 receptor partial agonist such as aripiprazole, or bifeprunox as well as pharmaceutically acceptable salts thereof.
In the following description "a human glycine transporter type Ib inhibitor" is referred to as "a GIyT-I inhibitor". While GIyT-I exist in at least three isoforms termed GIyT-Ia, -Ib and -Ic there is no evidence to suggest that they are different in their functional properties or pharmacology. Thus, an inhibitor of GIyTIb is predicted to have similar activity at GIyTIa or GIyT-Ic. The GIyT-I transporter is co-localised with the NMDA receptor complex and has a buffer capacity of 10-100 fold. As a consequence of the highly efficient GIyT-I transporter the glycine site is not fully occupied under physiological condition. Compounds blocking the GIyT-I transporter (GIyT-I inhibitors) are expected secondarily to activate the NMDA receptor complex via an increased level of glycine. Typical GIyT-I inhibitors show inhibition below 20000 nM as IC50 in the "[3H]-Glycine uptake (GIyT-Ib)" test described herein. The invention also covers GIyT-I inhibitors identified according to this method, but is not limited to these assay methods.
In one aspect the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms, negative symptoms, and/or cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
The term "positive symptoms, negative symptoms, and/or cognitive impairment " means "positive symptoms", "negative symptoms", or "cognitive impairment", as well as any combination thereof, such as "positive symptoms and negative symptoms", or "cognitive impairment and negative symptoms". Accordingly, in a further aspect the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of negative symptoms of schizophrenia in patients treated with a D2 antagonist.
Accordingly, in a further aspect the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
Accordingly, in a further aspect the present invention relates to use of a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of negative symptoms and cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
The term "patient" is intended to mean a mammalian patient, such as a human patient, such as male or female, young, adult, or elderly.
A patient treated with a D2 antagonist means that the patient has received at least one dosage of the D2 antagonist for treatment of schizophrenia. Typically, patients with schizophrenia will be co-treated with the GIyT-I inhibitor when they are stabilised, which refer to patients in the non-acute phase of his or her illness, for example if no major change in medication type and dose for at longer period of time.
The term co-treatment is defined as concurrent treatment with a D2 antagonist and the GIyT-I inhibitor, independent of the frequency of dosing of either compound.
The term positive symptoms equal psychotic symptoms. The terms positive and negative symptoms are used as defined by the DSM IV.
The term "cognitive impairment of schizophrenia" equals expressions like "cognitive symptoms" or "cognitive dysfunction" and comprises e.g. any expression if impaired cognitive function in schizophrenia as lowered IQ, impaired attention/perception/vigilance, reduced memory regardless of type of memory, reduced social cognition, reduced processing speed, reduced ability of logical or abstract thinking/executive functioning/planning/problem solving.
In a further aspect the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms, negative symptoms, and cognitive impairment of schizophrenia.
In a further aspect the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms and negative symptoms of schizophrenia.
In a further aspect the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of positive symptoms and cognitive impairment of schizophrenia.
In a further aspect the present invention relates to the use of a D2 antagonist and a GIyT-I inhibitor for the preparation of a pharmaceutical composition for the treatment of negative symptoms and cognitive impairment of schizophrenia.
Moreover the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit-of-parts (kit) useful for the treatment of positive symptoms, negative symptoms, and cognitive impairment of schizophrenia.
Furthermore the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit useful for the treatment of positive symptoms and negative symptoms of schizophrenia.
Furthermore the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit useful for the treatment of positive symptoms and cognitive impairment of schizophrenia. Furthermore the invention relates to the use of a combination of a D2 antagonist and a GIyT-I inhibitor, for the preparation of a pharmaceutical composition or kit useful for the treatment of negative symptoms and cognitive impairment of schizophrenia.
In a further aspect the invention relates to a pharmaceutical composition or kit comprising a D2 antagonist and a GIyT-I inhibitor, and optionally pharmaceutically acceptable carriers or diluents.
The pharmaceutical composition or kit are considered separate embodiments and may be the subj ect of separate claims .
In another aspect the invention relates to a method for the treatment of negative symptoms, and cognitive impairment of schizophrenia comprising administration to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
In another aspect the invention relates to a method for the treatment of negative symptoms of schizophrenia comprising administration to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
In another aspect the invention relates to a method for the treatment of cognitive impairment of schizophrenia comprising administration to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
In yet another aspect the invention relates to a method for the treatment of positive symptoms, negative symptoms, and cognitive impairment of schizophrenia comprising administration to a patient in need thereof a therapeutically effective amount of a D2 antagonist and a therapeutically effective amount of a GIyT-I inhibitor.
Typically, the GIyT-I inhibitor is selective for the human glycine transporter type Ib as defined by a ratio of 3 -fold, such as 10-fold, higher affinity for human GIyT-I over other targets including but not limited to GIy T-2 and the NMDA receptor sites and determined as described in the section "Materials and Methods". In a further embodiment the D2 antagonist is selected from any one of haloperidol, flupenthixol, fluphenazin, perphenazin, pimozide, chlorpromazine, tioridazine, melperone, zuclopentixol, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, aripiprazole, sertindole, amisulpiride, bifeprunox, asenapine, paloperidone or blonanserine or pharmaceutically acceptable salts thereof in clinically recommended doses as defined by the product's SmPCs and in oral or parenteral formulations. Each of these D2 antagonists may be claimed individually in accordance with any one of the aspects described herein.
In a further embodiment the GIyT-I inhibitor is selected from any one of the compounds disclosed in WO0208216, such as any one of N- { 3 - [5 -Cyano- 1 -(4-fluoropheny I)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } glycine ethyl ester, N- { 3- [5 -Cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]- 1 -propyl } -N- methylglycine ethyl ester, N- { 3 - [5 -Cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } glycine, N- { 3-[5 -Cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl} -N- methylglycine, N- { 3 - [1 -(3 -chlorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N-methylglycine, N- { 3 - [ 1 -(3 -trifluoromethy lpheny I)- 1 , 3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N- { 3 - [1 -(3 -trifluoromethylphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N -methyl ( 1 - ethyl)glycine, N- { 3 - [ 1 -(4-methylphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N-methylglycine, N- { 3 - [ 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]- 1 -propyl } -N-methylglycine, N- { 3- [ 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]- 1 -propyl } -N-methylalanine, N- { 3 - [ 1 -(4-fluorophenyl)- 1 , 3 -dihydroisobenzofuran- 1 -y I]- 1 -propyl } -N-methyl ( 1 - ethyl)glycine, N- { 3- [4-chloro- 1 -(3 -methyl-4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]- 1 -propyl } -N- methylglycine, N-{3-[4-chloro-l-(4-chlorophenyl)-l,3-dihydroisobenzofuran-l-yl]-l-propyl}-N- methylglycine, N-{3-[5-chloro-l-(4-chlorophenyl)-l,3-dihydroisobenzofuran-l-yl]-l-propyl}-N- methylalanine, N- { 3 - [6-chloro- 1 -(3 -methyl-4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N- { 3- [6-chloro- 1 -(4-chlorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N- { 3 -[6-chloro- 1 -(4-methylphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl} -N- methylglycine, N- { 3 - [6-chloro- 1 -(4-methoxyphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]- 1 -propyl } -N- methylglycine, N- { 3 - [5 -fluoro- 1 -(4-chlorophenyl)- 1 , 3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N- { 3 -[5 -fluoro- 1 -(4-methoxyphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl} -N- methylglycine, N-{3-[5 -trifluoromethyl- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -y 1] - 1 -propyl } -N- methylglycine, N- { 3 - [5 -trifluoromethyl- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylalanine, N-{3-[5-cyano-l-(3-methyl-4-fluorophenyl)-l,3-dihydroisobenzofuran-l-yl]-l-propyl}-N- methylglycine, N- { 3 - [5 -cy ano- 1 -(4-cyanophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylalanine, N- { 3 - [5 -cyano- 1 -(4-methoxyphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N- { 3- [5 -cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl} -N- methylglycine, N- {2-[5-cyano- 1 -(4-fluorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl]ethyl} -N- methylglycine, N-{3-[5-Chloro-l-(4-chloro-phenyl)-indan-l-yl]-propyl}-N-methylglycine, N- { 3 - [5 -Chloro- 1 -(4-chloro-phenyl)-indan- 1 -yl] -propyl} -N-methylalanine, N- { 3 - [3 -cyclo- 1 -(4-methylphenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N-[3 -(3 ,3-Dimethyl- 1 -phenyl- 1 ,3 -dihydro-benzo [c]thiophen- 1 -yl)-propyl] -N-methylglycine, N- [3 -(3 ,3 -Dimethyl- 1 -phenyl- 1 ,3 -dihydro-benzo [c]thiophen- 1 -yl)-propyl]-N-methylalanine, N- { 3 - [ 1 -(4-Fluoro-phenyl)-3 ,3 -dimethyl- 1 ,3-dihydro-isobenzofuran- 1 -yl] -propyl} -N- methylglycine, N- { 3 - [5 -Bromo- 1 -(4-chlorophenyl)- 1 ,3 -dihydroisobenzofuran- 1 -yl] - 1 -propyl } -N- methylglycine, N-{2-[l-(4-Chloro-phenyl)-3,3-dimethyl-l,3-dihydro-isobenzoruran-l-yl]-ethyl}-N- methylglycine, N- [3 -(3 -methyl- 1 -phenyl- 1 H-inden- 1 -yl)-propyl] -N-methylglycine, N-[3-(5-Chloro-l-thiophen-2-yl-l,3-dihydro-isobenzofuran-l-yl)-propyl]-N-methylglycine, N-[3 -(5 -Chloro- 1 -thiophen-2-yl- 1 ,3-dihydro-isobenzofuran- 1 -yl)-propyl]-N-methyl ( 1 - ethyl)-glycine, N- [3 -(3 -methyl- 1 -phenyl- 1 ,3-dihydro-isobenzofuran- 1 -yl)-propyl] -N-methylalanine, N- [3 -(3 -methyl- 1 -phenyl- 1 ,3-dihydro-isobenzofuran- 1 -yl)-propyl] -N-methyl ( 1 -ethy I)- glycine, N- [3 -(3 ,3 -Dimethyl- 1 -phenyl- 1 ,3-dihydro-isobenzofuran- 1 -yl)-ethyl] -N-methylalanine, N-[3 -(3 ,3 -Dimethyl- 1 -(4-fluoro-phenyl)- 1 ,3-dihydro-isobenzofuran- 1 -yl)-ethyl] -N- methylalanine, N- [3 -(3 ,3-Dimethyl- 1 -phenyl- 1 ,3-dihydro-isobenzofuran- 1 -yl)-ethyl] -N-methyl-(l - ethyl)glycine, N- [3 -(3 ,3 -Dimethyl- 1 -(4-fluoro-phenyl)- 1 ,3-dihydro-isobenzofuran- 1 -yl)-ethyl]-N-methyl- (1 -ethyl) glycine, N-[3 -(3 ,3 -Diethyl- 1 -phenyl- 1 ,3-dihydro-isobenzofuran- 1 -yl)-propyl] -N-methylalanine, N- [3 -(3 ,3 -Diethyl- 1 -(4-chloro-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl)-propyl] -N- methylalanine, N-[3 -(3 ,3-Diethyl- 1 -(4-chloro-phenyl)- 1 ,3-dihydro-isobenzofuran- 1 -yl)-propyl]-N- methylglycine, N- [3 -( 1 -phenyl- 1 ,3 -dihydro-benzo [c]thiophen- 1 -yl)-propyl] -N-methylalanine, N-{3-[l-(4-Chloro-phenyl)-3,3-dimethyl-indan-l-yl]-propyl}-N-methylglycine5 N- { 3 - [ 1 -(4-Chloro-phenyl)-3 ,3 -diethyl- 1 ,3-dihydro-isobenzofuran- 1 -yl] -propyl } -N-methyl- alanine, N- [2-(3 -methyl- 1 -phenyl-indan- 1 -yl)-ethyl]-amino } -N-methyl alanine, N-[3-(l -phenyl-(lH)-inden-l -yl)-propyl]-N-methyl-alanine, N- { 3 -[ 1 -(4-Fluoro-phenyl)-5-(4-trifluoromethyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl] - propyl} -N-methyl-glycine, N-{3-[5-Chloro-l-(4-chloro-phenyl)-indan-l-yl]-propyl}-N-methyl-glycine, N- {3-[5-Chloro- 1 -(4-chloro-phenyl)-indan- 1 -yl] -propyl} -N-methyl-alanine, N-{3-[l-(4-chloro-phenyl)-5-(4-trifluorornethyl-phenyl)-l,3-dihydro-isobenzofuran-l-yl]- ethyl} -N-methyl-glycine, N- { 3 -[I -(4-Chloro-phenyl)-5 -(4-methyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -y l]-ethyl} -N- methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(4-methoxy-phenyl)-l,3-dihydro-isobenzoturan-l-yl]-ethyl}- N-methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(2-thiophenyl)-l,3-dihydro-isobenzofuran-l-yl]-ethyl}-N- methyl-glycine, N- {3 - [ 1 -(4-Chloro-phenyl)-5 -(4-methyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl]-propyl} - N-methyl-glycine, N- { 3 - [ 1 -(4-Chloro-phenyl)-5 -(4-methoxy-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl]- propyl} -N-methyl-glycine, N- { 3 - [ 1 -(4-chloro-phenyl)-5-(4-trifluoromethyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl]- propyl} -N-methyl-glycine, N- { 3 -[ 1 -(4-Chloro-phenyl)-5 -(4-chloro-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl]-ethyl} -N- methyl-glycine, N-{2-[l-(4-Chloro-phenyl)-5-(5-chloro-thiophen-2-yl)-l,3-dihydro-isobenzofuran-l-yl]- ethyl}-N-methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(3-methyl-phenyl)-l,3-dihydro-isobenzofuran-l-yl]-ethyl}-N- methyl-glycine, N- { 3 -[ 1 -(4-Chloro-phenyl)-5 -(2-methyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl]-ethyl} -N- methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(2,5-dichloro-phenyl)-l,3-dihydro-isobenzofuran-l-yl]- ethyl} -N-methyl-glycine, N- { 3 -[I -(4-chloro-phenyl)-5-(3 -trifluoromethyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl] - ethyl} -N-methyl-glycine, N- { 3 -[ 1 -(4-chloro-phenyl)-5 -(3 -trifluoromethyl-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl] - propyl} -N-methyl-glycine , N- { 3 - [ 1 -(4-Chloro-phenyl)-5-(3 ,4-dichloro-phenyl)- 1 ,3 -dihydro-isobenzofuran- 1 -yl]- ethyl}-N-methyl-glycine, N- { 3 - [ 1 -(4-Chloro-phenyl)-5-(4-chloro-phenyl)- 1 ,3-dihydro-isobenzofuran- 1 -yl]-propyl } - N-methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(3-methyl-phenyl)-l,3-dihydro-isobenzofuran-l-yl]-propyl}- N-methyl-glycine, N- { 3 - [1 ~(4-Chloro-phenyl)-5 -(2-methyl-phenyl)- 1 ,3-dihydro-isobenzofuran- 1 -yl]-propyl} - N-methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(2,5-dichloro-phenyl)-l,3-dihydro-isobenzofuran-l-yl]- propyl} -N-methyl-glycine, N-{3-[l-(4-Chloro-phenyl)-5-(3,4-dichloro-phenyl)-l,3-dihydro-isobenzofuran-l-yl]- propyl } -N-methyl-glycine, N-{3-[l-(4-chloro-phenyl)-5-(2-trifluoromethyl-phenyl)-l,3-dihydro-isobenzofuran-l-yl]- propyl} -N-methyl-glycine, or a pharmaceutically acceptable salt thereof.
In a further embodiment the GIyT-I inhibitor is selected from any one of the compounds disclosed in WO03/053942, such as any one of (+/-)-{4-[2-(4-Methoxy-phenylsulfanyl)-phenyl]-trαra-2,5-dimethyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-Chloro-phenylsulfanyl)-phenyl]-trαrø-2,5-dimethyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-tert-Butyl-phenylsulfanyl)-phenyl]-frflw-2,5-dimethyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-Fluoro-phenylsulfanyl)-phenyl]-trαrø-2,5-dimethyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-tert-Butyl-phenylsulfanyl)-phenyl]-2-methyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-wo-Propyl-phenylsulfanyl)-phenyl]-2-methyl-piperazin-l-yl}-acetic acid, (+/-)-2-{4-[2-(4-tert-Butyl-phenylsulfanyl)-phenyl]-tmra-2,5- dimethylpiperazin-l-yl}- propionic acid, {4-[5-Chloro-2-(4-methoxy-phenylsulfanyl)-phenyl]-2(R)-methyl-piperazin-l-yl}-acetic acid, {4- [2-(4~Methoxy-phenylsulfanyl)-phenyl] -2(R),5 (S)-dimethyl-piperazin- 1 -yl} -acetic acid, {4- [5 -Chloro-2-(4-methoxy-phenylsulfanyl)-phenyl]-2,2-dimethyl-piperazin- 1 -yl } -acetic acid, (+/-)- { 4- [5 -Chloro-2-(4-trifluoromethyl-phenylsulfany l)-phenyl] -2-methyl-piperazin- 1 -y 1 } - acetic acid, {4-[5-Chloro-2-(3-methoxy-phenylsulfanyl)-phenyl]-2(R)-methyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-Phenyl-phenyloxy)-phenyl]-2-methyl-piperazin-l-yl}-acetic acid, (+/-)-{4-[2-(4-Methyl-phenylsulfanyl)-phenyl]-trαrø-2,5-dimethyl-piperazin-l-yl}-acetic acid, (+/-)- {4-[2-(4-/>SO-Propyl-phenylsulfanyl)-phenyl]-trani'-2,5-dimetliyl-piperazin- 1 -yl} -acetic acid, (+/-)-{4-[2-(2,4-Dimethyl-phenylsulfanyl)-phenyl]-trαrø-2,5-dimethyl-piperazin-l-yl}- acetic acid, (+/-)-2-{4-[2-(4-tert-Butyl-phenylsulfanyl)-phenyl]-3-methylpiperazin-l-yl} -propionic acid, {4- [2-(4-Isopropyl-phenylsulfanyl)-phenyl] -piperazin- 1 -yl } -acetic acid, (+/-)-2-{4-[2-(4-Methoxy-phenylsulfanyl)-phenyl]-3-methyl-piperazin-l-yl}-propionic acid, or a pharmaceutically acceptable salt thereof.
The GIyT-I inhibitors mentioned above may be used in the free form or as a pharmaceutically acceptable acid addition salt or base salt thereof. Each of the GIyT-I inhibitors specified above is intended to be an individual embodiment. Accordingly, each of them and the use thereof may be claimed individually.
The GIyT-I inhibitor and D2 antagonist may be administered simultaneously, or the GIyT-I inhibitor may be administered first, or the D2 antagonist may be administered first.
The active ingredients comprised within the pharmaceutical composition or kit may be contained in the same unit dosage form, or the active ingredients are contained in discrete dosage forms, optionally contained in the same container or package. As used herein, an "active ingredient" means a D2 antagonist or a GIyT-I inhibitor. Typically, a kit comprises a preparation of the GIyT-I inhibitor in a first-unit dosage form, and the D2 antagonist in a second-unit dosage form, and container means for containing said first and second dosage forms.
Pharmaceutical compositions Each of the active ingredients according to the invention may be administered alone or together or in combination with pharmaceutically acceptable carriers or excipients, in either single or multiple doses. The pharmaceutical compositions according to the invention may be formulated with pharmaceutically acceptable carriers or diluents as well as any other known adjuvants and excipients in accordance with conventional techniques such as those disclosed in Remington: The Science and Practice of Pharmacy, 19 Edition, Gennaro, Ed., Mack Publishing Co., Easton, PA, 1995.
The pharmaceutical compositions may be specifically formulated for administration by any suitable route such as the oral, rectal, nasal, pulmonary, topical (including buccal and sublingual), transdermal, intracisternal, intraperitoneal, vaginal and parenteral (including subcutaneous, intramuscular, intrathecal, intravenous and intradermal) route, the oral route being preferred. It will be appreciated that the preferred route will depend on the general condition and age of the subject to be treated, the nature of the condition to be treated and the specific active ingredient or active ingredients chosen.
Pharmaceutical compositions for oral administration include solid dosage forms such as capsules, tablets, dragees, pills, lozenges, powders and granules. Where appropriate, they may be prepared with coatings such as enteric coatings or they may be formulated so as to provide controlled release of one or more active ingredient such as sustained or prolonged release according to methods well known in the art.
Liquid dosage forms for oral administration include solutions, emulsions, suspensions, syrups and elixirs.
Pharmaceutical compositions for parenteral administration include sterile aqueous and nonaqueous injectable solutions, dispersions, suspensions or emulsions as well as sterile powders to be reconstituted in sterile injectable solutions or dispersions prior to use. Depot injectable formulations are also contemplated as being within the scope of the present invention.
Other suitable administration forms include suppositories, sprays, ointments, cremes, gels, inhalants, dermal patches, implants etc.
The pharmaceutical compositions of this invention or those which are manufactured in accordance with this invention may be administered by any suitable route, for example orally in the form of tablets, capsules, powders, syrups, solutions, etc., or parenterally in the form of solutions for injection. For preparing such compositions, methods well known in the art may be used, and any pharmaceutically acceptable carriers, diluents, excipients or other additives normally used in the art may be used.
A typical oral dosage of each of the active ingredients is in the range of from about 0.001 to about 100 mg/kg body weight per day, preferably from about 0.01 to about 50 mg/kg body weight per day, and more preferred from about 0.05 to about 10 mg/kg body weight per day administered in one or more dosages such as 1 to 3 dosages. The exact dosage will depend upon the efficacy, safety and tolerability, including the frequency and mode of administration, the sex, age, weight and general condition of the subject treated, the nature and severity of the condition treated and any concomitant diseases to be treated and other factors evident to those skilled in the art.
For parenteral routes such as intravenous, intrathecal, intramuscular and similar administration, typically doses are in the order of about half the dose employed for oral administration.
The compounds of this invention are generally utilized as the free substance (e.g. zwitter ion) or as a pharmaceutically acceptable salt thereof. One example is a base addition salt of a compound having the utility of a free acid. When an active ingredient contains a free acid such salts are prepared in a conventional manner by treating a solution or suspension of a free acid of the active ingredient with a chemical equivalent of a pharmaceutically acceptable base.
For parenteral administration, solutions of one or more active ingredient in sterile aqueous solution, aqueous propylene glycol, aqueous vitamin E or sesame or peanut oil may be employed. Such aqueous solutions should be suitably buffered if necessary and the liquid diluent first rendered isotonic with sufficient saline or glucose. The aqueous solutions are particularly suitable for intravenous, intramuscular, subcutaneous and intraperitoneal administration. The sterile aqueous media employed are all readily available by standard techniques known to those skilled in the art.
Solutions for injections may be prepared by dissolving one or more active ingredients and possible additives in a part of the solvent for injection, preferably sterile water, adjusting the solution to a desired volume, sterilising the solution and filling it in suitable ampules or vials. Any suitable additive conventionally used in the art may be added, such as tonicity agents, preservatives, antioxidants, etc.
Suitable pharmaceutical carriers include inert solid diluents or fillers, sterile aqueous solution and various organic solvents.
Examples of solid carriers are lactose, terra alba, sucrose, cyclodextrin, talc, agar, pectin, acacia, stearic acid and lower alkyl ethers of cellulose corn starch, potato starch, talcum, magnesium stearate, gelatine, lactose, gums, and the like.
Any other adjuvants or additives usually used for such purposes such as colourings, flavourings, preservatives etc. may be used provided that they are compatible with the active ingredient or ingredients used.
Examples of liquid carriers are syrup, peanut oil, olive oil, phospho lipids, fatty acids, fatty acid amines, polyoxyethylene and water. Similarly, the carrier or diluent may include any sustained release material known in the art, such as glyceryl monostearate or glyceryl distearate, alone or mixed with a wax. The pharmaceutical compositions formed by combining one or more active ingredients of the invention with the pharmaceutical acceptable carriers are then readily administered in a variety of dosage forms suitable for the disclosed routes of administration. The formulations may conveniently be presented in unit dosage form by methods known in the art of pharmacy.
The active ingredients of the invention may be formulated in similar or dissimilar pharmaceutical compositions and unit forms thereof.
If a solid carrier is used for oral administration, the preparation may be tabletted, placed in a hard gelatine capsule in powder or pellet form or it may be in the form of a troche or lozenge.
The amount of solid carrier will vary widely but will usually be from about 25 mg to about 1 g.
If a liquid carrier is used, the preparation may be in the form of a syrup, emulsion, soft gelatine capsule or sterile injectable liquid such as an aqueous or non-aqueous liquid suspension or solution.
If desired, the pharmaceutical composition of the invention may comprise one or more active ingredients in combination with further pharmacologically active substances such as those described in the foregoing.
Materials and Methods
[3H]-Glycine uptake (GIyT-Ib) The GIyT-I inhibitors for use in combination with a D2 antagonist, such as risperidone, olanzapine, or aripiprazole, are tested in the well-recognised and reliable test measuring glycine uptake (Kim et al, 1994, MoI. Pharmacol. 45, 608-617): Cells transfected with the human GIyT-Ib were seeded in 96 well plates. Prior to the experiment the cells were washed twice in HBS (10 mM Hepes-tris (pH 7,4), 2,5 mM KCl, 1 niM CaCl2, 2,5 mM MgSO4,) and pre-incubated with test compound for 6 minutes. Afterwards, 10 nM 3H-glycine was added to each well and the incubation was continued for 15 minutes. The cells were washed twice in HBS. Scintillation fluid was added and the Plates were counted on a Trilux (Wallac) scintillation counter. Based on this test, compounds which are GIyT-I inhibitors show inhibition below 20000 nM as IC50 in the above-mentioned assay, preferably below 10000 nM.
In vitro tests for GIyT-Ib selectivity
[3H]-GIy cine uptake (GIyT-Ia) The ability of the compound to inhibit glycine uptake by the glycine transporter-2 (GIyT- 2a), was measured using HEK293 cells transiently transfected with the human GlyT-2a cDNA as described previously (Gallagher et al, 1999, MoI. Brain Res. 70, 101-115). At 24 hours after transfection, the cells were seeded in 96 well microtiter plates and incubated for further 24 hours. At the day of the experiment the cells were washed, and incubated with test compound or buffer for 15min (37 °C) followed by incubation for additional 15 min in the presence of 300 nM [3H] -glycine. The cells were washed, scintillation mixture was added and the plate was counted in a scintillation counter.
[3H]MMOl binding (NMDA receptor sites) It is well established that [3H]-MK801 binding, by means of allosteric interaction, can be a measure of functional interaction with the receptor at multiple sites including the non¬ competitive binding site at the NMDA receptor, the glutamate binding site as well as for the glycine co-agonist site of the NMDA receptor (Foster and Wong, 1987, Br. J. Pharmacol. 91, 403-409; Danysz et al., 1989, MoL Pharmacol. 36, 912-916). Thus, the ability of the compound to either inhibit or stimulate [3H]-MK801 binding to rat cortical membranes in the presence of glycine, glutamate or both was assessed. Membranes (8 mg/well) were mixed with 1 nM 3H-MOOl, varying concentrations of test compound, glycine and glutamate in a total volume of 1.2 ml and incubated for 60 min at 37 0C. Membranes and unbound ligand was separated by filtration and the amount of bound radioactivity was measured by scintillation counting. Broad receptor profiling Compounds were submitted to a broad receptor profile at a contract research lab (CEREP, France or MDS Pharma services, USA) covering more than 60 receptors, ionchannels and enzymes according to their standard protocols. The test concentration was at least 10.000 nM.

Claims

Claims:
1. Use of a GIyT- 1 inhibitor for the preparation of a pharmaceutical composition for the treatment of positive, negative symptoms, and/or cognitive impairment of schizophrenia in patients treated with a D2 antagonist.
2. The use of claim 1 wherein the pharmaceutical composition is for the treatment of negative symptoms of schizophrenia.
3. The use of claim 1 or 2 wherein the pharmaceutical composition is for the treatment of cognitive impairment of schizophrenia.
4. The use of any one of claims 1-3 wherein the D2 antagonist is selected from a D2 receptor antagonist, such as any one of haloperidol, flupenthixol, fluphenazin, perphenazin, pimozide, chlorpromazine, tioridazine, melperone, zuclpentixol, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, sertindole, amisulpiride, asenapine, paloperidone, or blonanserine, or pharmaceutically acceptable salts thereof.
5. The use of any one of claims 1-3 wherein the D2 antagonist is selected from a D2 receptor partial agonist, such as aripiprazole, or bifeprunox, or pharmaceutically acceptable salts thereof.
6. The use of claim 4 wherein the D2 receptor antagonist is selected from any one of risperidone, olanzapine, or sertindole, or pharmaceutically acceptable salts thereof.
7. The use of any one of claims 1-6 wherein the GIyT-I inhibitor show inhibition below 20000 nM, such as below 10000 nM, as IC50 in the "[3H]-Glycine uptake (GIyT-Ib)" test described herein.
8. The use of any one of claims 1-7 wherein the GIyT-I inhibitor is administered as an oral dosage form, such as solid or liquid form.
9. A method for the treatment of negative symptoms, and cognitive impairment of schizophrenia comprising administering to a patient treated with a D2 antagonist, a therapeutically effective amount of a GIyT-I inhibitor.
10. A pharmaceutical composition comprising a GIyT-I inhibitor and a D2 antagonist, and optionally pharmaceutically acceptable carriers or diluents.
11. A kit comprising a GIyT-I inhibitor and a D2 antagonist, and optionally pharmaceutically acceptable carriers or diluents.
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JP2013533297A (en) * 2010-08-09 2013-08-22 エフ．ホフマン−ラ ロシュ アーゲー Combination of GlyT1 compound and antipsychotic
US8575172B2 (en) 2006-09-26 2013-11-05 Zysis Limited Pharmaceutical compositions of aripiprazole
JP2014527175A (en) * 2011-08-26 2014-10-09 エフ．ホフマン−ラ ロシュ アーゲー Method for predicting clinical utility in the treatment of mental development, neurological or neuropsychiatric disorders
US10898449B2 (en) 2016-12-20 2021-01-26 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine
US11033512B2 (en) 2017-06-26 2021-06-15 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine and silicone acrylic hybrid polymer
US11337932B2 (en) 2016-12-20 2022-05-24 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine and polysiloxane or polyisobutylene
US11648213B2 (en) 2018-06-20 2023-05-16 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine

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JP2014527175A (en) * 2011-08-26 2014-10-09 エフ．ホフマン−ラ ロシュ アーゲー Method for predicting clinical utility in the treatment of mental development, neurological or neuropsychiatric disorders
US10898449B2 (en) 2016-12-20 2021-01-26 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine
US10980753B2 (en) 2016-12-20 2021-04-20 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine
US11337932B2 (en) 2016-12-20 2022-05-24 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine and polysiloxane or polyisobutylene
US11033512B2 (en) 2017-06-26 2021-06-15 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine and silicone acrylic hybrid polymer
US11648213B2 (en) 2018-06-20 2023-05-16 Lts Lohmann Therapie-Systeme Ag Transdermal therapeutic system containing asenapine

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