WO2007025064A2 - METHODS OF USING SELECTIVE llβ-HSD INHIBITORS TO TREAT GLUOCORTICOID ASSOCIATED STATES - Google Patents

METHODS OF USING SELECTIVE llβ-HSD INHIBITORS TO TREAT GLUOCORTICOID ASSOCIATED STATES Download PDF

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WO2007025064A2
WO2007025064A2 PCT/US2006/033117 US2006033117W WO2007025064A2 WO 2007025064 A2 WO2007025064 A2 WO 2007025064A2 US 2006033117 W US2006033117 W US 2006033117W WO 2007025064 A2 WO2007025064 A2 WO 2007025064A2
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corticosterone
inhibitor
hsdl
keto
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PCT/US2006/033117
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French (fr)
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WO2007025064A3 (en
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David J. Morris
Andrew S. Brem
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The Miriam Hospital
Rhode Island Hospital
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    • 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
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
    • 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
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • 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

Definitions

  • the invention pertains, at least in part, to a method for increasing the concentration of glucocorticoids in a tissue of a subject, by administering to a subject an effective amount of a 1 l ⁇ -HSDl dehydrogenase inhibitor, such that the concentration of glucocorticoids in the tissue are increased, wherein the 1 l ⁇ -HSDl dehydrogenase inhibitor is a 3 ⁇ , 5 ⁇ -reduced steroid (e.g., 1 l-hydroxy-3 ⁇ ,5 ⁇ - TH-testosterone, ll-keto-3 ⁇ ,5 ⁇ -TH-testosterone, etc.), 3 ⁇ ,5 ⁇ -TH-aldosterone, 3 ⁇ ,5 ⁇ - TH-cortisol, 5 ⁇ -DH-corticosterone, 3 ⁇ , 5 ⁇ -TH-corticosterone, 3 ⁇ ,5 ⁇ -TH-l l-dehydro- corticosterone, l l ⁇ -OH-allopregnanolone
  • the invention also pertains, at least in part, to pharmaceutical compositions comprising an effective amount of 3 ⁇ ,5 ⁇ -TH-aldosterone, 3 ⁇ ,5 ⁇ -TH-aldosterone, 3 ⁇ ,5 ⁇ - TH-cortisol, 3 ⁇ ,5 ⁇ -TH-cortisol, 3 ⁇ ,5 ⁇ -TH-cortisone, 3 ⁇ ,5 ⁇ -TH-cortisone, 5 ⁇ -DH- corticosterone, 3 ⁇ ,5 ⁇ -TH-corticosterone, 3 ⁇ ,5 ⁇ -TH-corticosterone, 3 ⁇ ,5 ⁇ -TH-corticosterone, 3 ⁇ ,5 ⁇ -TH-ll- deliydro-corticosterone, 3 ⁇ ,5 ⁇ -TH-l 1-dehydro-corticosterone, 1 l ⁇ -OH- allopregnanolone, 11 ⁇ -OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- pregnanolone, 11
  • the invention in another embodiment, pertains to a method for treating a glucocorticoid associated state in a subject.
  • the method includes administering to the subject an effective amoun of an antibiotic agent or an agent which inhibits the 21-dehydroxylation enzyme present in bacteria.
  • the invention pertains, at least in part, to a method for identifying i subject at risk of suffering from a glucorticoid associated state.
  • the method includes measuring levels of 11 ⁇ -HSD2 dehydrogenase and 11 ⁇ -HSD 1 dehydrogenase inhibitors in a sample from a subject, such that a subject is identified as having or not having a risk of suffering from a glucocorticoid associated state.
  • 1 l ⁇ -HSDl reductase has an important role as a generator of active glucocorticoids in vascular tissue.
  • 11 ⁇ -HSD inactivates glucocorticoid molecules, allowing lower circulating levels of aldosterone to maintain renal homeostasis.
  • Human and rat vascular endolethial cells contain both 11 ⁇ -HSD 1 and 11 ⁇ -HSD2.
  • the invention pertains, at least in part, to a method for treating a glucocorticoid associated state in a subject.
  • the method includes administering to the subject an effective amount of a 11 ⁇ -HSD 1 reductase modulating compound, such that the subject is treated.
  • glucocorticoid associated state is insulin insensitivity.
  • High concentrations of Cortisol in the liver substantially reduce insulin sensitivity, which increases gluconeogenesis and raises blood sugar levels of a subject. This effect is particularly disadvantageous in subjects suffering from impaired glucose tolerance or diabetes mellitus.
  • the antagonism of insulin can provoke diabetes mellitus in subjects.
  • the 1 l ⁇ -HSDl reductase inhibitors can be used to inhibit hepatic gluconeogenesis.
  • Another example of a glucocorticoid associated state is obesity (including centripetal obesity).
  • Glucocorticoids may be involved in the cognitive impai ⁇ nent of aging with or without neuronal loss and also in dendritic attenuation. Furthermore, glucocorticoids have been implicated in the neuronal dysfunction of major depression.
  • glucocorticoid associated states include states which can be treated by raising local levels of glucocorticoids. Examples of such disorders include apparent adrenal insufficiency. Examples of such disorders and states include surgery, post-surgery, sepsis, shock, hypotension, hyponatremia, and conditions where it would be beneficial for a subject for increased glucocorticoid levels in plasma and tissues.
  • the effective amount can vary depending on such factors as the size and weight of the subject, the type of illness, or the particular 1 l ⁇ -HSDl reductase, 1 l ⁇ -HSDl dehydrogenase, or 1 l ⁇ -HSD2 dehydrogenase modulating compound, e.g., inhibiting, compound.
  • the ll ⁇ -HSDl reductase, ll ⁇ -HSDl dehydrogenase, or 11 ⁇ -HSD2 dehydrogenase modulating compound may be administered in combination with a pharmaceutically acceptable carrier.
  • tissues where the concentration of glucocorticoids in a subject may be decreased include tissues which express 1 l ⁇ -HSDl or other wise contain an undesirable concentration of glucocorticoids.
  • tissues include a subject's blood, liver, eye, lung, muscle, adipose tissue, nerve tissue, brain, or vascular tissue.
  • the invention also includes a method for selectively inhibiting 1 l ⁇ -HSDl reductase.
  • the method includes contacting 1 l ⁇ -HSDl reductase with a selective 1 l ⁇ - HSDl reductase inhibitor.
  • the invention includes a method for selectively inhibiting 1 l ⁇ -HSDl dehydrogenase.
  • the method includes contacting 1 l ⁇ -HSDl dehydrogenase with a selective 1 l ⁇ -HSDl dehydrogenase inhibitor.
  • half life includes the length of time the drug is retained in the body in its active form.
  • the half-life of the particular drag is increased 10% or greater, 20% or greater, 30% or greater, 50% or greater, 100% or greater, 150% or greater, or 200% or greater.
  • the compound is effective to increase the levels of Cortisol in a subject's blood or urine by 5% or more, about 10% or more, about 15% or more, about 20% or more, about 25% or more, about 30% or more, about 40% or more, about 50% or more, about 6O 0 A or more, about 70% or more, about 80% or more, about 90% or more, or about 100% of the levels of Cortisol previously found in the subject's blood or urine prior to administration of the compound.
  • the modulation of the metabolism of Cortisol is perfo ⁇ ned by modulating or reducing the rate of 17 ⁇ -HSD enzymatic oxidation of the 17 ⁇ - hydroxyl grouping of 1 l ⁇ -hydroxylated testosterone GALF metabolites.
  • the invention pertains to methods for measuring the levels of the levels of 11 ⁇ -HSD2-GALFs and 1 l ⁇ -HSDl-GALFs in samples from subjects.
  • the samples may include, but are not limited to, plasma, blood, urine, or extracts thereof.
  • Cortisol and corticosterone Two glucocorticoids are synthesized by the human adrenal: Cortisol and corticosterone. Cortisol is metabolized in the liver and other tissues and is excreted via the urine. It had been previously shown that a significant proportion of the second glucocorticoid, corticosterone, is 21- deoxygenated by microorganisms in intestinal flora yielding 11 -oxygenated derivatives of progesterone and its 5 ⁇ -tetrahydro-derivatives, which are then reabsorbed via the enterohepatic circulation andso circulate in the bloodstream prior to their excretion in the urine. Therefore, subjects with essential hypertensive who demonstrate elevated levels of these GALF substances
  • the reductase activity is inhibited at a rate about 2 times or greater, about 3 times or greater, about 4 times or greater, about 5 times or greater, about 10 times or greater, about 15 times or greater, about 20 times or greater, about 25 times or greater, about 50 times or greater, about 75 times or greater, about 100 times or greater, about 150 times or greater, about 200 times or greater, about 300 times or greater, about 400 times or greater, about 500 times or greater, about 1 x 10 3 times or greater, about 1 x 10 4 times or greater, about 1 x 10 5 times or greater, or about 1 x 10 6 or greater as compared with the inhibition of the dehydrogenase activity of 11 ⁇ -HSDl .
  • the 1 l ⁇ -HSDl reductase inhibitors have an ICs 0 of less than 100 ⁇ M.
  • Other examples of 1 l ⁇ -HSDl reductase modulating compounds include carbenoxolone and derivatives thereof.
  • the 1 l ⁇ -HSDl dehydrogenase inhibitor is a small molecule, such as a steroid or a derivative thereof.
  • the steroid is 3 ⁇ , 5 ⁇ - reduced.
  • 3 ⁇ ,5 ⁇ -reduced steroids include 3 ⁇ , 5 ⁇ -reduced-ll ⁇ -OH- progesterone, 3 ⁇ , 5 ⁇ -reduced-l l ⁇ -OH-testosterone, chenodeoxycholic acid, 3 ⁇ , 5 ⁇ - reduced-pregnenolone, 3 ⁇ , 5 ⁇ -reduced-dehydro-epiandrostenedione, 3 ⁇ , 5 ⁇ -reduced- progesterone, 3 ⁇ , 5 ⁇ -reduced deoxycorticosterone, 3 ⁇ , 5 ⁇ -reduced-chenodeoxycholic acid, 3 ⁇ , 5 ⁇ -reduced progesterone, 3 ⁇ , 5 ⁇ -reduced testosterone, 3 ⁇ , 5 ⁇ -reduced chenodoxycholic acid, 3 ⁇ , 5 ⁇ -reduce
  • the 1 l ⁇ -HSDl dehydrogenase inhibitor is a 3 ⁇ , 5 ⁇ - reduced steroid.
  • steroids include 3 ⁇ , 5 ⁇ -reduced-l l ⁇ -OH- progesterone, 3 ⁇ , 5 ⁇ -reduced-l l ⁇ -OH-testosterone, 3 ⁇ , 5 ⁇ -reduced-l l ⁇ -OH- androstendione, 3 ⁇ , 5 ⁇ -reduced-l l ⁇ -OH-pregnenolone, 3 ⁇ , 5 ⁇ -reduced-ll ⁇ -OH- dehydro-epiandrostenedione, 3 ⁇ , 5 ⁇ -reduced-corticosterone, 3 ⁇ , 5 ⁇ -reduced- aldosterone, 3 ⁇ , 5 ⁇ -reduced-pregnenolone, 3 ⁇ , 5 ⁇ -reduced-progesterone, 3 ⁇ , 5 ⁇ -reduced testosterone, 3 ⁇ , 5 ⁇ -deoxycorticosterone, and 3 ⁇ , 5 ⁇ -reduced testosterone
  • the 1 l ⁇ -HSDl dehydrogenase inhibitor has an IC 50 of 0.5 ⁇ M or less. In another embodiment, the 1 l ⁇ -HSDl dehydrogenase inhibitor has an IC 5O of 100 ⁇ M or less, 80 ⁇ M or less, or 20 ⁇ M or less (using 100 nM corticosterone substrate concentration and testicular Leydig cell homogenates).
  • the term "11 ⁇ -HSD2 dehydrogenase inhibitor” includes agents which inhibit or decrease the dehydrogenase activity of 1 l ⁇ -HSD2.
  • the language "in combination with" another agent includes co-administration of the compound of the invention and the agent, administration of the compound of the invention first, followed by the other agent and administration of the other agent first, followed by the compound of the invention.
  • the 17 ⁇ -hydroxylase, 17-HSD, 20 ⁇ -reductase or 20 ⁇ -reductase inhibitors can be found using assays for screening candidate or test compounds which bind to or modulate the activity of a 17 ⁇ -hydroxylase, 17-HSD, 17-HSD, 20 ⁇ -reductase or 20 ⁇ -reductase protein or polypeptide or biologically active portion thereof.
  • Determining the ability of a 17 ⁇ -hydroxylase, 17-HSD, 20 ⁇ -reductase or 20 ⁇ - reductase protein to bind to or interact with a target molecule ⁇ e.g., a steroid substrate) can be accomplished by determining direct binding.
  • BIOA is a technology for studying biospecific interactions in real time, without labeling any of the interactants (e.g., BIAcore). Changes in the optical phenomenon of surface plasmon resonance (SPR) can be used as an indication of real-time reactions between biological molecules.
  • SPR surface plasmon resonance
  • determining the ability of the test compound to modulate the activity of a 17 ⁇ -hydroxylase, 17-HSD, 20 ⁇ -reductase or 20 ⁇ -reductase protein can be accomplished by determining the ability of the 17 ⁇ -hydroxylase, 17- HSD, 20 ⁇ -reductase or 20 ⁇ -reductase protein to further modulate the activity of a target molecule.
  • antioxidants examples include: water soluble antioxidants, such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite and the like; oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, ⁇ -tocopherol, and the like; and metal chelating agents, such as citric acid, ethylenediamine tetraacetic acid (EDTA), sorbitol, tartaric acid, phosphoric acid, and the like.
  • water soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite and the like
  • oil-soluble antioxidants such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin
  • the active ingredient is mixed with one or more pharmaceutically acceptable carriers, such as sodium citrate or dicalcium phosphate, and/or any of the following: fillers or extenders, such as starches, lactose, sucrose, glucose, mannitol, and/or silicic acid; binders, such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinyl pyrrolidone, sucrose and/or acacia; humectants, such as glycerol; disintegrating agents, such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; solution retarding agents, such as paraffin; absorption accelerators, such as quaternary ammonium compounds; wetting agents, such as, for example, cetyl alcohol and glycerol monostea
  • Liquid dosage forms for oral administration of the compounds of the invention include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs.
  • the liquid dosage forms may contain inert diluent commonly used in the art, such as, for example, water or other solvents, solubilizing agents and emulsifiers, such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3- butylene glycol, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor and sesame oils), glycerol, tetrahydrofuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
  • inert diluent commonly used in the art, such as, for example, water or other solvents, solubilizing agents and e
  • the ointments, pastes, creams and gels may contain, in addition to an active compound of this invention, excipients, such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
  • excipients such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
  • compositions may also contain adjuvants such as preservatives, wetting agents, emulsifying agents and dispersing agents. Prevention of the action of microorganisms may be ensured by the inclusion of various antibacterial, antiparasitic and antifungal agents, for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents, such as sugars, sodium chloride, and the like into the compositions. In addition, prolonged absorption of the injectable pharmaceutical form may be brought about by the inclusion of agents which delay absorption such as aluminum monostearate and gelatin.
  • the absorption of the drag in order to prolong the effect of a drug, it is desirable to slow the absorption of the drag from subcutaneous or intramuscular injection. This may be accomplished by the use of a liquid suspension of crystalline or amorphous material having poor water solubility. The rate of absorption of the drug then depends upon its rate of dissolution which, in turn, may depend upon crystal size and crystalline form. Alternatively, delayed absorption of a parenterally-administered drug form may be accomplished by dissolving or suspending the drag in an oil vehicle. The compositions also may be formulated such that its elimination is retarded by methods known in the art.
  • Injectable depot forms are made by forming microencapsule matrices of the subject compounds in biodegradable polymers such as polylactide-polyglycolide. Depending on the ratio of drag to polymer, and the nature of the particular polymer employed, the rate of drag release can be controlled. Examples of other biodegradable polymers include poly(orthoesters) and poly (anhydrides). Depot injectable formulations are also prepared by entrapping the drug in liposomes or microemulsions which are compatible with body tissue.
  • the preparations of the present invention may be given orally, parenterally, topically, or rectally. They are of course given by forms suitable for each administration route. For example, they are administered in tablets or capsule form, by injection, inhalation, eye lotion, ointment, suppository, etc. administration by injection, infusion or inhalation; topical by lotion or ointment; and rectal by suppositories. Oral administration or administration via inhalation is preferred.
  • These compounds may be administered to humans and other animals for therapy by any suitable route of administration, including orally, nasally, as by, for example, a spray, rectally, intravaginally, parenterally, intracisternally and topically, as by powders, ointments or drops, including buccally and sublingually.
  • suitable routes of administration including orally, nasally, as by, for example, a spray, rectally, intravaginally, parenterally, intracisternally and topically, as by powders, ointments or drops, including buccally and sublingually.
  • Other methods for administration include via inhalation.
  • a suitable daily dose of a compound of the invention will be that amount of the compound which is the lowest dose effective to produce a therapeutic effect. Such an effective dose will generally depend upon the factors described above. Generally, intravenous and subcutaneous doses of the compounds of this invention for a patient will range from about 0.0001 to about 100 mg per kilogram of body weight per day, more preferably from about 0.01 to about 50 mg per kg per day, and still more preferably from about 1.0 to about 100 mg per kg per day. An effective amount is that amount treats a glucocorticoid associated state.
  • the effective daily dose of the active compound maybe administered as two, three, four, five, six or more sub-doses administered separately at appropriate intervals throughout the day, optionally, in unit dosage forms. While it is possible for a compound of the present invention to be administered alone, it is preferable to administer the compound as a pharmaceutical composition.
  • Antisense phosphorothioate oligonucleotides targeted to block either 11 ⁇ -HSD2 or 1 l ⁇ -HSDl gene expression, were obtained from Research Genetics, Huntsville AL. Antisense oligomers complementary to 20 bp sequences spanning the ribosome binding/translation start site were used. Oligomer sequences were: 5'-CAT AAC TGC CGT CCA ACA GC-3' (SEQ ID NO. 1) for 1 l ⁇ -HSDl Antisense and 5'-AGG CCA GCG CTC CAT GAC TT- 3' (SEQ ID NO 2) for 11 ⁇ -HSD2 antisense. hi control experiments the corresponding sense sequence was used as the nonsense oligomer. Antisense and nonsense oligomers were added directly to each well at 20 ⁇ g/10:l sterile H 2 O per well for a final concentration of 3 ⁇ mol/L.
  • 11 ⁇ -HSD 1 antisense oligomers attenuated the ability of 11 ⁇ -dehydro-corticosterone to amplify the contractile response to all concentrations of phenylephrine compared to 11- dehydro-corticosterone plus 11 ⁇ -HSD 1 nonsense oligomers.
  • Statistically significant decreases were observed at 100 nmol/L and 1 ⁇ mol/L phenylephrine ( Figure 3).
  • 1 l ⁇ -HSDl antisense also caused a marked decrease in the metabolism of 11 -dehydro-corticosterone back to corticosterone by 11 ⁇ -HSD 1 - reductase.
  • 11 ⁇ -HSD2 and 1 l ⁇ -HSDl in regulating local concentrations of glucocorticoids in vascular tissue. They also indicate that decreased 1 l ⁇ -HSD2 activity may be a possible mechanism in hypertension and other blood pressure associated disorders and that 1 l ⁇ -HSDl - reductase may be a possible target for anti-hypertensive therapy.
  • This example is directed to endogenous 11 -oxygenated, 5 ⁇ and 5 ⁇ - Ring A- reduced metabolites of adrenocorticosteroids, and progestogen and androgen steroid hormones. These substances were tested for their inhibitory properties against 1 l ⁇ - HSD2, 11 ⁇ -HSD 1 dehydrogenase and 11 ⁇ -HSD 1 reductase.
  • Each enzyme reaction (described below) was stopped by adding 750 ⁇ L MeOH. After centrifugation, an aliquot of supernatant was analyzed by HPLC using a DuPont Zorbax C8 column. The separated radioactive products (corticosterone and 11-dehydro- corticosterone) were detected and quantitated by flow-cell scintillation analysis (Latif et al.,1997, Steroids 62:230 -237).
  • Aldosterone and each of its 5 ⁇ and 5 ⁇ - reduced derivatives(3 ⁇ ,5 ⁇ -T ⁇ - aldosterone and 3 ⁇ ,5 ⁇ -TH-aldosteone ) were inactive towards ll ⁇ -HSDl reductase, as were the 5 ⁇ - and 5 ⁇ - reduced derivatives of Cortisol(3 ⁇ ,5 ⁇ -TH-cortisol and 3 ⁇ ,5 ⁇ -TH- cortisol) (Table 4).
  • the 11-dehydro-derivative, 3 ⁇ ,5 ⁇ -TH-corticosterone strongly inhibited 11 ⁇ -HSD 1 reductase with an IC 50 of 4.3 ⁇ M.
  • 5 ⁇ -DH-corticosterone was a strong inhibitor with an IC 5 0 of 6.3 ⁇ M compared to 3 ⁇ ,5 ⁇ -TH-corticosterone which was a weak inhibitor, but interestingly, 3 ⁇ ,5 ⁇ -TH-l 1-Dehydro-corticosterone very potently inhibited 1 l ⁇ -HSDl reductase with an IC 50 of 0.7 ⁇ M.
  • each of the 5 ⁇ - reduced derivatives (3 ⁇ ,5 ⁇ -TH-corticosterone and 3 ⁇ ,5 ⁇ -TH-l 1-Dehydro-corticosterone) was inactive.
  • the 5 ⁇ Ring A- reduced derivatives, l l ⁇ -OH-allopreg-nanolone and 11 ⁇ -OH-androstanediol also potently inhibited l l ⁇ -HSDl dehydrogenase activity with IC 50 5 S of 3.0 ⁇ M and 5.0 ⁇ M, respectively, but 1 l-keto-3 ⁇ ,5 ⁇ -TH- testosterone was a weak inhibitor and 11- keto-allopregnanolone was inactive.
  • l l ⁇ -hydroxy-progesterone its 3 ⁇ 5 ⁇ - tetrahydro-derivative, ll ⁇ -hydroxy- testosterone and its 3 ⁇ 5 ⁇ -tetrahydro-metabolite, (but not 11 ⁇ -hydroxy-androstenedione or its 3 ⁇ 5 ⁇ -tetrahydro-metabolite), potently inhibit 1 l ⁇ -HSDl dehydrogenase.
  • replacement of the 17-OH in the testosterone series with a 17-keto group markedly diminished the inhibitory capability.
  • glucocorticoid a significant proportion (10-15%) of the principal glucocorticoid , Cortisol, secreted in humans is metabolized to 1 l ⁇ -hydroxy- androstenedione in both the adrenal gland and in other target tissues (Cope, 1972; Kornel et al., 1994; Ganis et al.,1956). ll ⁇ -hydroxy- androstenedione is likely metabolized further to l l ⁇ -hydroxy- testosterone by 17-hydoxysteroid dehydrogenase (17 ⁇ -HSD) and converted to 5 ⁇ - tetrahydro-derivatives in target tissues of glucocorticoids.
  • 17 ⁇ -HSD 17-hydoxysteroid dehydrogenase
  • this switch may also be responsible for an increase in local Cortisol levels in vascular tissue in these patients due to the actions of 5 ⁇ —inhibitors, similar to the increased BP observed when 1 i ⁇ -OH-allopregnanolone was infused into normotensive SD rats (Morris et al., 1996).
  • the following compounds stand out as potent candidate inhibitors specific to their respective isoenzymes because of their high potency observed as inhibitors during our screening.
  • These are 5 ⁇ -DH-corticosterone, 3 ⁇ ,5 ⁇ -TH-corticosterone, l l ⁇ -OH- progesterone, 11 ⁇ -OH- allopregnanolone, 11 ⁇ -OH-testosterone, and 11 ⁇ -OH- androstanediol, as candidate inhibitors of 1 l ⁇ -HSDl dehydrogenase; 3 ⁇ ,5 ⁇ -TH-l 1- dehydrocorticosterone, 11-keto-progesterone, 11-keto-allopregnanolone, and 11-keto- 3 ⁇ ,5 ⁇ -TH-testosterone, as candidate inhibitors of 1 l ⁇ -HSDl reductase; and 3 ⁇ ,5 ⁇ -TH- aldosterone, 5 ⁇ -DH-corticosterone, 3 ⁇ ,5 ⁇ -TH-
  • endogenous inhibitors of 1 l ⁇ -HSD2 and both 1 l ⁇ -HSDl dehydrogenase and 1 l ⁇ -HSDl reductase may not only participate or be involved in several disease processes but their identification may also help in the design of exogenous agents in the management of a variety of disease states.
  • IB-HSDl vascular tissue, testis and brain.
  • GLFs glycyrrhetinic acid-like factors
  • Gynecol. 139 353 -358.
  • Pelletier G Luu-The V, Li S, Labrie F. 2005. Localization of type 7 17 ⁇ -hydroxysteroid dehydrogenase in mouse tissues. In situ hybridization studies. J. Steroid Biochem. MoI. Biol. 93: 49- 57.
  • Antisense affects Vascular Contractile Response and glucocorticoid
  • Leydig cells express 11 ⁇ -hydroxylase message and 11 ⁇ -hydroxlated androgens inhibit l l ⁇ -HSDl enzymatic activity. Endocrinology. 143, 621- 626.

Abstract

Methods for treating glucocorticoid associated states using selective 1 lβ-HSDl- dehydrogenase, l lβ-HSDl -reductase and l lβ-HSD2 dehydrogenase modulating compounds are described.

Description

METHODS OF USING SELECTIVE llβ-HSD INHIBITORS TO TREAT GLUOCORTICOID ASSOCIATED STATES
Government Funding: Work described herein was supported, at least in part, by National Institutes of
Health (NIH) under grant HD 33000. The government may therefore have certain rights to this invention.
Related Applications: This application claims priority to U.S. Provisional Patent Application Serial No.
60/737,067, filed on November 15, 2005 and to U.S. Provisional Patent Application Serial No. 60/711,125, filed on August 24, 2005. The entire contents of both these applications are hereby incorporated herein by reference in its entirety.
Background:
Glucocorticoids are steroid hormones. One example of a common glucocorticoid is Cortisol. Modulation of glucocorticoid activity is important in regulating physiological processes in a wide range of tissues and organs. High levels of glucocorticoids may result in excessive salt and water retention by the kidneys, which may lead high blood pressure.
Glucocorticoids play an important role in the regulation of vascular tone and blood pressure. Glucocorticoids can bind to and activate the glucocorticoid receptor (GR) and, possibly, the mineralocorticoid receptor (MR) to potentiate the vasoconstrictive effects of both catecholamines and angiotensin II (Ang II). Tissue glucocorticoid levels are regulated by two isoforms of the enzyme 11 β-hydroxysteroid dehydrogenase (llβ-HSD). llβ-HSD converts glucocorticoids into 11-keto metabolites that are unable to bind to mineralocorticoid receptors (Edwards C R et al. (1988) Lancet 2:986-9; Funder et al, (1988) Science 242, 583,585).
Summary of the Invention:
In one embodiment, the invention pertains, at least in part, to a method for treating a glucocorticoid associated state in a subject, by administering to the subject an effective amount of a llβ-HSDl reductase inhibitor, such that the glucocorticoid associated state is treated. Examples of such 1 lβ-HSDl reductase inhibitor include 3β, 5α-reduced steroids (e.g., ll-keto-3β,5α-TH-testosterone, etc.), 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-ll- dehydro-corticosterone, l lβ-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- androstenedione, and pharmaceutically acceptable prodrug or salts thereof. In another embodiment, the invention includes a method for treating a glucocorticoid associated state in a subject, by administering to the subject an effective amount of a llβ-HSDl reductase inhibitor in combination with a 17α-hydroxylase inhibitor, 17-HSD inhibitor, 20α-reductase inhibitor, or a 20β-reductase inhibitor, wherein the 11 β-HSDl reductase inhibitor is a 3β, 5α-reduced steroid (e.g., 11-keto- 3β,5α-TH-testosterone), 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH- corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-ll-dehydro-corticosterone, l lβ- OH-pregnanolone, 11-keto-allopregnanolone, 11-keto-androstenedione, or a pharmaceutically acceptable prodrug or salt thereof. In yet another embodiment, the invention pertains, at least in part, to a method for increasing the concentration of glucocorticoids in a tissue of a subject, by administering to a subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor, such that the concentration of glucocorticoids in the tissue are increased, wherein the 1 lβ-HSDl dehydrogenase inhibitor is a 3β, 5α-reduced steroid (e.g., 1 l-hydroxy-3β,5α- TH-testosterone, ll-keto-3β,5α-TH-testosterone, etc.), 3α,5α-TH-aldosterone, 3α,5α- TH-cortisol, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-l l-dehydro- corticosterone, l lβ-OH-allopregnanolone, llβ-OH-pregnanolone, llβ-OH- androstanediol, or a pharmaceutically acceptable prodrug or salt thereof.
In another embodiment, the invention also includes a method of increasing the concentration of glucocorticoids in a tissue of a subject. The method includes administering to the subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor in combination with a 17α-hydroxylase inhibitor, 17HSD inhibitor, 20α-reductase inhibitor or 20β-reductase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 1 lβ-HSDl dehydrogenase inhibitor is a 3β, 5α- reduced steroid (e.g., 1 l-hydroxy-3β,5α-TH-testosterone, 1 l-keto-3β,5α-TH- testosterone, etc.), 3α,5α-TH-aldosterone, 3α,5α-TH-cortisol, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 1 lβ-OH-allopregnanolone, 1 lβ-OH-pregnanolone, 1 lβ-OH-androstanediol, or a pharmaceutically acceptable prodrug or salt thereof. In yet another embodiment, the invention includes a method for increasing the concentration of glucocorticoids in a tissue of a subject. The method includes administering to a subject an effective amount of a 1 lβ-HSD2 dehydrogenase inhibitor, such that the concentration of glucocorticoids in the tissue are increased, wherein the 1 lβ-HSD2 dehydrogenase inhibitor is a 3β, 5α-reduced steroid (e.g., 1 l-keto-3β,5α-TH- testosterone, etc.), 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH-corticosterone, 11-dehydro-corticosterone, 3α,5α-TH-l 1-dehydrocorticosterone, 11-keto- allopregnanolone, 11 β-OH-androstanediol, llβ-OH-androstenedione, or a pharmaceutically acceptable salt or prodrug thereof. In yet another embodiment, the invention also includes methods for increasing the concentration of glucocorticoids in a tissue of a subject, by administering to the subject an effective amount of a 1 lβ-HSD2 dehydrogenase inhibitor in combination with a 17α-hydroxylase inhibitor, 17-HSD inhibitor, 20α-reductase inhibitor, or a 20β- reductase inhibitor, such that the concentration of glucocorticoids in the tissue are increased. Examples of llβ-HSD2 dehydrogenase inhibitors iinclude 3α, 5α-TH- aldosterone, 3α, 5α-TH-cortisol, 5a-DH-corticosterone, 11-dehydro-corticosterone, 3a,5a-TH-l 1-dehydrocorticosterone, 11-keto-allopregnanolone, 1 lβ-OH- androstanediol, l lβ-OH-androstenedione, a 3β, 5α-reduced steroid, and pharmaceutically acceptable salt or prodrug thereof.
In yet another embodiment, the invention includes a method for treating hypertension in a subject, by administering to the subject an effective amount of a llβ- HSDl reductase inhibitor, such that the subject is treated, wherein the 1 lβ-HSDl reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-ll-dehydro-corticosterone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto-androstenedione, a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof.
The invention also includes a method for treating hypertension in a subject, by administering to the subject an effective amount of a 1 lβ-HSDl reductase inhibitor, such that the subject is treated, wherein the 11 β-HSDl reductase inhibitor is 3α,5α-TH- cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α- TH- 11-dehydro-corticosterone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11- keto-androstenedione, a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof. In addition, the invention also includes a method for treating hypertension in a subject, by administering to the subject an effective amount of a 1 lβ-HSDl reductase inhibitor in combination with a 17α-hydroxylase inhibitor, a 17-HSD inhibitor, a 20α- reductase inhibitor or a 20β-reductase inhibitor, such that the subject is treated. Examples of such 1 lβ-HSDl reductase inhibitors include 3α,5α-TH-cortisone, 3α,5β- TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-l 1-dehydrocorticosterone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- androstenedione, a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof.
The invention also includes a method for increasing insulin sensitivity of a tissue in a subject. The method comprises administering an effective amount of a 1 lβ-HSDl reductase inhibitor to the subject, such that the insulin sensitivity of the tissue in the subject is increased. Examples of such llβ-HSDl reductase inhibitors include 3α,5α- TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto-androstenedione, a 3β, 5α-reduced steroid and pharmaceutically acceptable prodrug or salt thereof.
The invention also pertains, at least in part, to pharmaceutical compositions comprising an effective amount of 3α,5α-TH-aldosterone, 3α,5β-TH-aldosterone, 3α,5α- TH-cortisol, 3α,5β-TH-cortisol, 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH- corticosterone, 3α,5α-TH-corticosterone, 3α,5β-TH-corticosterone, 3α,5α-TH-ll- deliydro-corticosterone, 3α,5β-TH-l 1-dehydro-corticosterone, 1 lβ-OH- allopregnanolone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- pregnanolone, 11 β-OH-adrostenedione, 11-keto-adrostenedione, llβ-OH- androstanediol, l l-keto-3β,5α-TH-testosterone, l lβ-OH-androsterone, 11-keto- androsterone, a 3β, 5α-reduced steroid (e.g., ll-keto-3β,5α-TH-testosterone, etc.), or any other compound described herein or a pharmaceutically acceptable salt or prodrug thereof, in combination with a 17α-hydroxylase inhibitor, a 17-HSD inhibitor, a 20α- reductase inhibitor, or a 20β-reductase inhibitor. hi yet another embodiment, the invention pertains to pharmaceutical compositions comprising an effective amount of 3α,5α-TH-aldosterone, 3α,5β-TH- aldosterone, 3α,5α-TH-cortisol, 3α,5β-TH-cortisol, 3α,5α-TH-cortisone, 3α,5β-TH- cortisone, 5α-DH-corticosterone, 3α,5α-TH-corticosterone, 3α,5β-TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 3α,5β-TH-l 1-dehydro-corticosterone, llβ-OH- allopregnanolone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- pregnanolone, 11 β-OH-adrostenedione, 11-keto-adrostenedione, l lβ-OH- androstanediol, ll-keto-3β,5α-TH-testosterone, l lβ-OH-androsterone, 11-keto- androsterone, a 3β, 5α-reduced steroid, or any other compound described herein or a pharmaceutically acceptable salt or prodrug thereof and a pharmaceutically acceptable carrier.
In yet another embodiment, the invention pertains to a method for treating apparent adrenal insufficiency in a subject. The method includes administering to the subject an effective amount of an 1 lβ-HDSDl dehydrogenase inhibitor or a 1 lβ-HSD2 dehydrogenase inhibitor, such that said subject is treated for said apparent adrenal insufficiency. Examples of such llβ-HSDl and/or llβ-HSD2 dehydrogenase inhibitors include 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH-corticosterone, 11-dehydro- corticosterone, 3α,5α-TH-ll-dehydrocorticosterone, 11-keto-allopregnanolone, l lβ- OH-androstanediol, llβ-OH-androstenedione, 3α, 5α-TH-corticosterone, l lβ-OH- allopregnanolone, 11 β-OH-pregnanolone, a 3β, 5α-reduced steroid (e.g., 1 l-keto-3β,5α- TH-testosterone, etc.), and pharmaceutically acceptable salts and prodrugs thereof. In yet another embodiment, the invention pertains, at least in part, to a method for increasing the half-life of glucocorticoid drugs in a subject. The method includes administering to the subject an effective amount of a llβ-HSD2 dehydrogenase inhibitor in combination with a glucocorticoid drug. Examples of such 1 lβ-HSD2 dehydrogenase inhibitors include 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH-corticosterone, 11- dehydro-corticosterone, 3α,5α-TH-l 1-dehydrocorticosterone, 11-keto-allopregnanolone, llβ-OH-androstanediol, llβ-OH-androstenedione, a 3β, 5α-reduced steroid (e.g., 11- keto-3β,5α-TH-testosterone, etc.), and pharmaceutically acceptable salts and prodrugs thereof. In a further embodiment, the invention pertains to a method for treating a blood pressure associated disorder in a subject. The method includes administering to the subject an effective amount of a Cortisol modulating compound to modulate Cortisol levels in the subject.
In another embodiment, the invention pertains to a method for treating a glucocorticoid associated state in a subject. The method includes administering to the subject an effective amoun of an antibiotic agent or an agent which inhibits the 21-dehydroxylation enzyme present in bacteria.
In yet another embodiment, the invention pertains, at least in part, to methods for the treatment of a blood pressure disorder. The method includes administering to the subject an effective amount of an antibiotic agent (or an agent which inhibits the 21-dehydroxylation enzyme present in bacteria) in combination with an 1 lβHSD-1 reductase inhibitor, such that the subject is treated for the blood pressure disorder.
In another embodiment, the invention pertains, at least in part, to a method for identifying i subject at risk of suffering from a glucorticoid associated state. The method includes measuring levels of 11 β-HSD2 dehydrogenase and 11 β-HSD 1 dehydrogenase inhibitors in a sample from a subject, such that a subject is identified as having or not having a risk of suffering from a glucocorticoid associated state.
Brief Description of the Drawings:
Figure 1 is a bar graph which shows that the exposure of rat aortic rings to corticosterone and 1 lβ-HSD2 antisense resulted in a statistically significant increase in the contractile response to phenylephrine.
Figure 2 is a bar graph which shows that in aortic rings treated with 11 β-HSD 1 antisense, the contractile responses to all concentrations of phenylephrine were significantly increased compared to aortic rings treated with corticosterone and nonsense oligomers.
Figure 3 is a bar graph which illustrates that 11-dehydro-corticosterone amplifies the contractile responses to phenylephrine in rat aortic rings. Figure 4 is a bar graph which shows that the conversion of corticosterone to 11- dehydrocorticosterone was lower than in aortic rings incubated with corticosterone and llβ-HSDl nonsense oligomers.
Figures 5A-5D are representative HPLC chromatograms showing the metabolism of 3H- 11 -dehydrocorticosterone (11 -dehydroB) by rat aortic rings. In
Figures 5A and 5B, the analysis of the tissue is shown for 1 lβ-HSDl nonsense and 1 lβ- HSDl antisense, respectively. In Figures 5C and 5D, the analysis of the incubation media is shown for 1 lβ-HSDl nonsense and 1 lβ-HSDl antisense, respectively.
Figure 6 is a schematic drawing pertaining to the conversion of adrenal corticosteroids to HSD inhibitors.
Detailed Description of the Invention:
I. Glucocorticoids and llβ-HSDl Reductase, l lβ-HSDl Dehydrogenase and l lβ- HSD2 Dehydrogenase
Glucocorticoids can affect vascular tone by modifying the actions of several vasoactive substances. Glucocorticoids amplify the vasoconstrictive actions of adrenergic catecholamines and angiotensin II on vascular smooth muscle cells. It has been reported that glucocorticoids decrease the biosynthesis of both nitric oxide and prostaglandin I, and attenuate the vasorelaxant actions of atrial natriuretic peptide in vascular tissue. Thus, the multiple effects of glucocorticoids in vascular tissue operate to increase vascular tone. Since vascular smooth muscle cells contain both glucocorticoid and mineralocorticoid receptors it is possible that glucocorticoids mediate their effects in vascular tissue via either or both of these receptor types. Glucocorticoids are metabolized in vascular and other tissue by two isoforms of
11 β-hydroxysteroid dehydrogenase (11 β-HSD). 11 β-HSD2 is unidirectional and metabolizes glucocorticoids to their respective inactive 11-dehydro derivatives, using NAD+ as a co-factor. 11 β-HSD 1 is bi-directional and possesses both dehydrogenase activity as well as reductase activity. The reductase activity of 1 lβ-HSDl regenerates active glucocorticoids from the inactive 11-dehydro derivatives. llβ-HSDl uses
NADP+ as a co-factor. In vascular tissue, glucocorticoids amplify the pressor responses to catecholamines and angiotensin II and down-regulate certain depressor systems such as nitric oxide and prostaglandins. Both 1 lβ-HSD2 and 1 lβ-HSDl are believed to regulate glucocorticoid levels in vascular tissue and are part of additional mechanisms that control vascular tone.
Glucocorticoids are known to play an important role in the regulation of vascular tone and blood pressure. Glucocorticoid receptors and mineralocorticoid receptors are present in aorta, mesenteric arteries and rat vascular smooth muscle cells in culture. Glucocorticoids can bind to and activate glucocorticoid receptors (and possibly mineralocorticoid receptors) to potentiate the vasoconstrictive effects of both catecholamines and Ang II. Human and rat vascular endothelial cells contain both 1 lβ- HSD2 and 11 β-HSDl . It is generally understood that 11 β-HSD2 operates to protect both mineralocorticoid receptors and glucocorticoid receptors from excessive stimulation by glucocorticoids. It has been noted that glucocorticoids further amplify the contractile effects of phenylephrine and Ang II when llβ-HSD enzyme activity is inhibited.
Rat vascular smooth muscle cells contain only 1 lβ-HSDl. Under "physiologic conditions," 1 lβ-HSDl acts largely as a reductase generating active corticosterone from inactive 11-dehydro-corticosterone.
1 lβ-HSDl reductase has an important role as a generator of active glucocorticoids in vascular tissue. 11 β-HSD inactivates glucocorticoid molecules, allowing lower circulating levels of aldosterone to maintain renal homeostasis. Human and rat vascular endolethial cells contain both 11 β-HSD 1 and 11 β-HSD2.
1 lβ-HSD2 operates to protect both mineralocorticoid receptors and glucocorticoid receptors from excessive stimulation by glucocorticoids. It has also been shown that glucocorticoids further amplify the contractile effects of phenylephrine (PE) and Ang II when 1 lβ-HSDl or 2 dehydrogenase enzyme activity is inhibited.
II. Methods of Treating Glucocorticoid Associated States
In an embodiment, the invention pertains, at least in part, to a method for treating a glucocorticoid associated state in a subject. The method includes administering to the subject an effective amount of a 11 β-HSD 1 reductase modulating compound, such that the subject is treated.
The term "glucocorticoid associated states" include states which are associated with the presence or absence of aberrant amounts of glucocorticoids, particularly local levels in target tissues. It includes states which can be treated by modulating, e.g., inhibiting, the activating of a 1 lβ-HSDl reductase, or, alternatively, 1 lβ-HSDl dehydrogenase or 1 lβ-HSD2 dehydrogenase. The term includes 11 β-HSD 1 reductase associated states. Examples of glucocorticoid associated states include blood pressure disorders, obesity, diabetes mellitus, interocular pressure, lung disorders, and neurological disorders. The glucocorticoid associated states may also include states associated with undesirable levels of glucocorticoids in adipose tissue, epithelial tissue in the eye, and interocular pressure. "1 lβ-HSDl reductase associated state" includes states which can be treated by the administration of an 1 lβ-HSDl reductase modulating compound, e.g., an 1 lβ-HSDl reductase inhibitor. In certain embodiments, these states may be characterized by undesirable amounts of glucocorticoids in a tissue, fluid, or elsewhere in the subject. The term "blood pressure disorders" include disorders which are associated with or characterized by abnormal or undesirable blood pressure. Examples of blood pressure disorders include, but are not limited to, high blood pressure, congestive heart failure, chronic heart failure, left ventricular hypertrophy, acute heart failure, myocardial infarction, cardiomyopathy, hypotension, hyponatremia, and hypertension, e.g., arterial hypertension and pulmonary hypertension.
The term "lung disorders" include disorders caused by or related to the presence or absence of glucocorticoids which can be treated by the compounds of the invention, for example, 1 lβ-HSDl reductase inhibitors. The lung contains considerable 1 lβ-HSDl activity (Nicholas and Lugg, J Steroid Biochem 17:113-118, 1982). During fetal development, there is little reductase activity but enzymatic activity increases significantly during lung maturation following birth. In circumstances where excess glucocorticoids are present in lung, there is a predisposition to pulmonary hypertension with an increase in pulmonary artery wall thickness (Cras et al. Am J Physiol Lung Cell MoI Physiol 278:L822-829, 2000) and collagen accumulation (Poiani et alAm JRespir Crit Care Med 149:994-999, 1994). Moreover glucocorticoids enhance endothelin receptor expression in lung (Shima JPediatr Surg 35:203-207, 2000), a factor contributing to increased vascular resistance in the pulmonary arteries. s
Another example of a glucocorticoid associated state is insulin insensitivity. High concentrations of Cortisol in the liver substantially reduce insulin sensitivity, which increases gluconeogenesis and raises blood sugar levels of a subject. This effect is particularly disadvantageous in subjects suffering from impaired glucose tolerance or diabetes mellitus. In Cushing's syndrome, the antagonism of insulin can provoke diabetes mellitus in subjects. The 1 lβ-HSDl reductase inhibitors can be used to inhibit hepatic gluconeogenesis. Another example of a glucocorticoid associated state is obesity (including centripetal obesity). It is thought that inhibition of the 11 β-HSDl reductase may reduce the effects of insulin resistance in adipose tissue in subjects. Not to be limited by theory, but it is thought that by decreasing insulin resistance will result in greater tissue utilization of glucose and fatty acids, thus reducing circulating levels. It is also thought that the compounds may treat obesity by reducing the reactivation of cortisone to Cortisol. Another example of a glucocorticoid associated state are neurological disorders. Glucocorticoid excess potentiates the action of certain neurotoxins, which leads to neuronal dysfunction and loss. Examples of neurological disorders that may be treated by include neuronal dysfunction and loss due to, for example, glucocorticoid potentiated neurotoxicity. Glucocorticoids may be involved in the cognitive impaiπnent of aging with or without neuronal loss and also in dendritic attenuation. Furthermore, glucocorticoids have been implicated in the neuronal dysfunction of major depression.
Other examples of neurological disorders which may be treatable using the 1 lβ- HSDl reductase, l lβ-HSDl dehydrogenase, or l lβ-HSD2 dehydrogenase modulators, e.g., inhibitors, of the invention, include both neuropsychiatric and neurodegenerative disorders such as Alzheimer's disease, dementias related to Alzheimer's disease (such as Pick's disease), Parkinson's and other Lewy diffuse body diseases, senile dementia, Huntington's disease, Gilles de la Tourette's syndrome, multiple sclerosis, amylotropic lateral sclerosis (ALS), progressive supranuclear palsy, epilepsy, and Creutzfeldt- Jakob disease; autonomic function disorders such as hypertension and sleep disorders, and neuropsychiatric disorders, such as depression, schizophrenia, schizoaffective disorder, Korsakoff s psychosis, mania, anxiety disorders, or phobic disorders; learning or memory disorders, e.g., amnesia or age-related memory loss, attention deficit disorder, dysthymic disorder, major depressive disorder, mania, obsessive-compulsive disorder, psychoactive substance use disorders, anxiety, phobias, panic disorder, as well as bipolar affective disorder, e.g., severe bipolar affective (mood) disorder (BP-I), bipolar affective neurological disorders, e.g., migraine and obesity, cognitive impairment of old age, and traumatic brain injury.
Another example of a glucocorticoid associated states include states which can be treated by raising local levels of glucocorticoids. Examples of such disorders include apparent adrenal insufficiency. Examples of such disorders and states include surgery, post-surgery, sepsis, shock, hypotension, hyponatremia, and conditions where it would be beneficial for a subject for increased glucocorticoid levels in plasma and tissues.
The term "subject" includes subjects capable of suffering from a glucocorticoid associated states, such as mammals. Examples of mammals include dogs, cats, bears, rabbits, mice, rats, goats, cows, sheep, horses, and, preferably, humans. The subject may be suffering from or at risk of suffering from a glucocorticoid associated state, e.g., a blood pressure associated disorder (e.g., hypertension, ocular hypertension, etc.), obesity, diabetes, a neurological disorder, or apparent adrenal insufficiency. The subject may be undergoing surgery or treatment for sepsis, hypotension, hyponatremia, or shock. The term "treat" or "treating" includes the prevention, alleviation or reduction of at least one symptom or other indication of a particular glucocorticoid associated state. In one embodiment, the associated state is a blood pressure associated disorder, e.g., hypertension, and the administration of the modulating compound modulates, e.g., reduces, the blood pressure of the subject.
The term "effective amount" of the l lβ-HSDl reductase, l lβ-HSDl dehydrogenase, or 11 β-HSD2 dehydrogenase modulating compound is that amount necessary or sufficient to treat or prevent a particular glucocorticoid associated state, e.g. prevent the various morphological and somatic symptoms of a glucocorticoid associated state. The effective amount can vary depending on such factors as the size and weight of the subject, the type of illness, or the particular 1 lβ-HSDl reductase, 1 lβ-HSDl dehydrogenase, or 1 lβ-HSD2 dehydrogenase modulating compound, e.g., inhibiting, compound.
In a further embodiment, the llβ-HSDl reductase, llβ-HSDl dehydrogenase, or 11 β-HSD2 dehydrogenase modulating compound may be administered in combination with a pharmaceutically acceptable carrier.
In a further embodiment, the invention pertains to a method for treating a blood pressure associated disorder, e.g., hypertension, in a subject, by administering to the subject an effective amount of an 1 llβ-HSDl reductase, llβ-HSDl dehydrogenase, or 1 lβ-HSD2 dehydrogenase modulating, e.g., inhibiting, compound.
In another embodiment, the invention features a method for decreasing the concentration (or amount) of glucocorticoids in a tissue of a subject. The method includes administering an effective amount of a selective 1 lβ-HSDl reductase inhibitor, such that the concentration of glucocorticoids in the tissue are decreased. In a further embodiment, the 1 lβ-HSDl reductase inhibitor is a small molecule, e.g., a steroid or a derivative thereof.
Examples of tissues where the concentration of glucocorticoids in a subject may be decreased include tissues which express 1 lβ-HSDl or other wise contain an undesirable concentration of glucocorticoids. Examples of such tissues include a subject's blood, liver, eye, lung, muscle, adipose tissue, nerve tissue, brain, or vascular tissue.
In another embodiment, the invention features a method for treating a blood pressure associated disorder, such as, for example, hypertension, in a subject. The method includes administering to a subject an effective amount of a 1 lβ-HSDl reductase inhibitor, such that the subject is treated. In a further embodiment, the 1 lβ- HSDl reductase inhibitor is a selective inhibitor. In another embodiment, the reductase inhibitor is a small molecule, e.g. , a steroid or a derivative thereof. In another embodiment, the invention features a method for increasing insulin sensitivity of a tissue in a subject. The method includes administering to a subject an effective amount of a selective 1 lβ-HSDl reductase inhibitor, such that the insulin sensitivity of the tissue in the subject is increased. Examples of tissue where increased insulin sensitivity may be desirable include, for example, the subject's liver, muscle, nerve or adipose tissue.
In yet another embodiment, the invention features a method for increasing the concentration of glucocorticoids in a tissue of a subject. The method includes administering to a subject an effective amount of a selective 1 lβ-HSDl dehydrogenase inhibitor, such that the concentration of glucocorticoids in the tissue are increased.
The tissue may be any tissue which an increase in the concentration of glucocorticosteroids is desired. Examples of such tissues include, but are not limited to, subject's liver, blood, lung, eye, muscle, adipose tissue, nerve tissue, brain, and vascular tissue. In another embodiment, the invention features a method for increasing the concentration of glucocorticoids in a tissue of a subject. The method includes administering to a subject an effective amount of a selective 1 lβ-HSD2 dehydrogenase inhibitor, such that the concentration of glucocorticoids in the tissue are increased.
The tissue may be any tissue which an increase in the concentration of glucocorticoids is desired. Examples of such tissues include, but are not limited to, subject's liver, eye, blood, lung, muscle, adipose tissue, nerve tissue, brain, kidney, and vascular tissue.
The invention also includes a method for selectively inhibiting 1 lβ-HSDl reductase. The method includes contacting 1 lβ-HSDl reductase with a selective 1 lβ- HSDl reductase inhibitor.
In yet another embodiment, the invention includes a method for selectively inhibiting 1 lβ-HSDl dehydrogenase. The method includes contacting 1 lβ-HSDl dehydrogenase with a selective 1 lβ-HSDl dehydrogenase inhibitor.
In another embodiment, the invention pertains to a method for treating apparent adrenal insufficiency in a subject, by administering to the subject an effective amount of an 11 β-HDSDl dehydrogenase inhibitor or a 11 β-HSD2 dehydrogenase inhibitor. In a further embodiment, the subject is undergoing, about to undergo, or has undergone surgery. The subject also may be suffering from or at risk of suffering from sepsis, hyponatremia or hypotension. The 1 lβ-HSDl or 1 lβ-HSD2 inhibitors may be selective inhibitors. hi certain embodiments, the 1 lβ-HSDl dehydrogenase inhibitor is administered in combination with an 1 lβ-HSD2 dehydrogenase inhibitor to the subject. The language "in combination with" a second inhibitor includes coadministration of the first inhibitor with the second agent, administration of the first inhibitor first, followed by the second inhibitor and administration of the second inhibitor first, followed by the first inhibitor. The invention also includes a method for increasing the half-life of glucocorticoid drugs in a subject. The method includes administering to a subject an effective amount of a 11 β-HSD2 dehydrogenase inhibitor in combination with said glucocorticoid drug.
The term "half life" includes the length of time the drug is retained in the body in its active form. In a further embodiment, the half-life of the particular drag is increased 10% or greater, 20% or greater, 30% or greater, 50% or greater, 100% or greater, 150% or greater, or 200% or greater.
The term "glucocorticoid drug" include drugs such as 11-keto glucocorticoid drags and other drags which may be metabolized to Cortisol by the kidney. Examples of 11-keto glucocorticoid drags include prednisone, 9α-fluorocortisone, 9α-fluoro-16α- hydroxyprednisone, and dexamethasone.
The invention also pertains, at least in part, to the discovery that essential hypertension may be due to substances which affect the metabolism of Cortisol. These substances may include 1 lβ-HSD2-GALFs and 1 lβ-HSDl -GALFs. In one embodiment, the invention pertains to a method for treating hypertension in a subect by modulating the metabolism of Cortisol.
The invention also pertains, at least in part, to a method for treating a blood pressure associated disorder in a subject. The method includes administering to the subject an effective amount of a Cortisol modulating compound, such that the blood pressure disorder is treated, and wherein the effective amount is effective to modulate Cortisol levels in the subject.
The term "Cortisol modulating compound" includes compounds which are effective to modulate, e.g., reduce or increase, the levels of Cortisol in a subject, e.g., by modulating the rate of metabolism of Cortisol in a subject. In a further embodiment, the compound is effective to reduce the levels of Cortisol in a subject's blood or urine by 5% or more, about 10% or more, about 15% or more, about 20% or more, about 25% or more, about 30% or more, about 40% or more, about 50% or more, about 60% or more, about 70% or more, about 80% or more, about 90% or more, or about 100% of the levels of Cortisol previously found in the subject's blood or urine prior to administration of the compound. Examples of Cortisol modulating compounds include, but are not limited to, 1 lβ-HSD2 dehydrogenase inhibitors and 1 lβ-HSDl dehydrogenase inhibitor. Other examples of Cortisol modulating compounds include glycyrrhetinic acid-like factors.
In a further embodiment, the compound is effective to increase the levels of Cortisol in a subject's blood or urine by 5% or more, about 10% or more, about 15% or more, about 20% or more, about 25% or more, about 30% or more, about 40% or more, about 50% or more, about 6O0A or more, about 70% or more, about 80% or more, about 90% or more, or about 100% of the levels of Cortisol previously found in the subject's blood or urine prior to administration of the compound.
In a further embodiment, the modulation of the metabolism of Cortisol is performed by modulating or reducing the rate of 20α- or 20β-HSD enzymatic reduction of the side-chain of 1 lβ-hydroxylated progesterone GALFs.
In another further embodiment^ the modulation of the metabolism of Cortisol is perfoπned by modulating or reducing the rate of 17β-HSD enzymatic oxidation of the 17β- hydroxyl grouping of 1 lβ-hydroxylated testosterone GALF metabolites. In one embodiment, the invention pertains to methods for measuring the levels of the levels of 11 β-HSD2-GALFs and 1 lβ-HSDl-GALFs in samples from subjects. The samples may include, but are not limited to, plasma, blood, urine, or extracts thereof.
In a further embodiment, the invention comprises a method for identifying a subject at risk of suffering from a glucorticoid associated state. The method includes measuring levels of 1 lβ- HSD2 GALFs (e.g., 1 lβ-HSD2 dehydrogenase inhibitors) and 1 lβ-HSDl GALFs (e.g., 1 lβ- HSDl dehydrogenase inhibitors) in a sample from a subject. In a further embodiment, subjects with elevated levels of 1 lβ-HSD2 GALFs and 1 lβ-HSDl GALFs may be identified as having a risk of having or developing a glucocorticoid associated state, such as hypertension. In another further embodiment, subjects with normal or below normal levels of 1 lβ-HSD2 GALFs and llβ- HSDl GALFs may be identified as having a low risk of a glucocorticoid associated state, such as hypertension. Examples of glucocorticoid associated states include hypertension, ocular hypertension, insulin resistant diabetes, and obesity
In a further embodiment, the levels of llβ-HSD2-GALFs and 1 lβ-HSDl - GALFs may be measured after re-activating the sample using an enzymatic treatment with (a) rat testicular preparations which contain 17β- HSD reductase and 1 lβ- HSD reductase / NADPH and (b) placental or other bacterial preparations which contain 20α- or 20β-HSD dehyrogenase / NADP.
In a further embodiment, the invention pertains to a method for treating a glucocorticoid associated state in a subject. The method includes administering to the subject an effective amoun of an antibiotic agent (or an agent which inhibits the 21-dehydroxylation enzyme present in bacteria), such that the glucocorticoid associated state is treated. Examples of glucocorticoid associated states include, for example, blood pressure disorders such as hypertension.
Two glucocorticoids are synthesized by the human adrenal: Cortisol and corticosterone. Cortisol is metabolized in the liver and other tissues and is excreted via the urine. It had been previously shown that a significant proportion of the second glucocorticoid, corticosterone, is 21- deoxygenated by microorganisms in intestinal flora yielding 11 -oxygenated derivatives of progesterone and its 5α-tetrahydro-derivatives, which are then reabsorbed via the enterohepatic circulation andso circulate in the bloodstream prior to their excretion in the urine. Therefore, subjects with essential hypertensive who demonstrate elevated levels of these GALF substances
(e.g., 11-oxygenated derivatives of progesterone and their 5α-tetrahydro-derivatives ) maybe treated by antibiotics (e.g., neomycin) which would modulate the production of these GALFs or bj an agent which inhibits the 21-dehydroxylation enzyme present in bacteria. In a further embodiment, the effective amount is effective to reduce deoxygenation of corticosterone. The method may further comprise administering an effective amount of an 11 β-
HSDl reductase inhibitor.
Examples of antibiotic agents which maybe used in the methods of the invention include antibiotics known in the art and clindamycin, erythromycin, tetracycline, mupirocin, gentamycin, metronidizole, bacitracin, neomycin, and polymyxin B. The effective amount of the antibiotic agent maybe effective to modulate, e.g., reduce or increase, the deoxygenation of corticosterone.
In a further embodiment, the effective amount is effective to reduce the levels of 11 -oxygenated derivatives and 5α-tetrahydroderivatives of progesterone.
In a further embodiment, the invention pertains to a method for the treatment of a blood pressure disorder. The method includes administering to a subject an effective amount of an antibiotic agent in combination with an 1 lβHSD-1 reductase inhibitor, such that the subject is treated for the blood pressure disorder. Examples of blood pressure disorders include hypertension.
III. l lβ-HSDl Reductase Modulating Compounds, llβ-HSDl -Dehydrogenase Modulating Compounds and 11 β-HSD2 Dehydrogenase Modulating Compounds
The term "llβ-HSDl reductase modulating compound" include compounds and agents {e.g., oligomers, proteins, etc.) which modulate or inhibit the activity of 1 lβ- HSDl reductase. In an advantageous embodiment, the llβ-HSDl reductase modulating compound is an 1 lβ-HSDl reductase inhibitor (also referred to as "11 β-HSDl reductase inhibiting compound"). The 1 lβ-HSDl reductase modulating compound may be a small molecule, e.g., a compound with a molecular weight below 10,000 daltons.
In a further embodiment, the 1 lβ-HSDl reductase modulating compound is a selective inhibitor of 1 lβ-HSDl reductase. The term "selective 1 lβ-HSDl reductase inhibitor" includes compounds which selectively inhibit the reductase activity of 11 β- HSDl as compared to the dehydrogenase activity. In a further embodiment, the reductase activity is inhibited at a rate about 2 times or greater, about 3 times or greater, about 4 times or greater, about 5 times or greater, about 10 times or greater, about 15 times or greater, about 20 times or greater, about 25 times or greater, about 50 times or greater, about 75 times or greater, about 100 times or greater, about 150 times or greater, about 200 times or greater, about 300 times or greater, about 400 times or greater, about 500 times or greater, about 1 x 103 times or greater, about 1 x 104 times or greater, about 1 x 105 times or greater, or about 1 x 106 or greater as compared with the inhibition of the dehydrogenase activity of 11 β-HSDl .
In a further embodiment, the 1 lβ-HSDl reductase modulating compound may be a steroid or a steroid derivative. The steroid ring system is generally numbered according to IUPAC conventions, as shown below:
Figure imgf000016_0001
Examples of 1 lβ-HSDl reductase modulating compounds include 11-keto steroid compounds, e.g., compounds with the steroid ring system with a carbonyl functional group at the 11 -position of the steroid ring. Examples of steroid compounds with an 11-keto group include, for example, 11-keto progesterone, 11-keto-testosterone, 11-keto-androsterone, 11-keto-pregnenolone, 11-keto-dehydro-epiandrostenedione, 3α, 5α-reduced-ll-ketoprogesterone, 3α, 5α-reduced-l 1-keto-testosterone, 3α, 5α-reduced- 11-keto-androstenedione, 3α,5α-tetrahydro-l l-dehydro-corticosterone, 3α, 5α-reduced- 11-keto-pregnenolone, and 3α, 5α-reduced-ll-keto-dehydro-epiandrostenedione. Other examples of 11 β-HSD 1 reductase modulating compounds of the invention are compounds which conserve a least a portion of the steroid nucleus. These compounds may have additional substituents, such as fatty acid tails at the 22 position, or other modifications (e.g., substitutions of the ring by halogens, formation of esters or other protecting groups for the hydroxyl groups of the steroids, or replacement of functional groups with others that may, for example, advantageously, lengthen the time the molecule is in its active form in a subjects body. Alternatively, the modifications can be such that the reduce the time the compound is in its active form in a subject's body.
Other examples of 1 lβ-HSDl reductase inhibiting compounds include 3α,5α- TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-l l-dehydro-corticosterone, l lβ-OH-pregnanolone, 11-keto-allopregnanolone, and 11-keto-androstenedione.
Examples of 1 lβ-HSDl reductase modulating compounds also include 3α, 5α- reduced steroid compounds. Examples of 3β, 5α-reduced steroid compounds include l l-keto-3β,5α-TH-testosterone. Examples of 3α, 5α-reduced steroid compounds include, 3α, 5α-reduced-l l-ketoprogesterone, 3α, 5α-reduced-l 1-keto-testosterone, 3α, 5α-reduced-l 1-keto-androstenedione, 3α,5α-tetrahydro-l 1-dehydro-corticosterone, 3α, 5 α-reduced- 11-keto-pregnenolone, 3α, 5α- reduced corticosterone, 3α,5α-reduced progesterone, 3α, 5α-reduced testosterone and 3α, 5α-reduced-l l-keto-dehydro- epiandrostenedione. Examples of 1 lβ-HSDl reductase inhibiting compounds also include 3β, 5α- reduced steroids. These compounds may also include a keto group at the 11 position. The term "3β, 5α reduced steroids" includes compounds with a steroid ring structure and a 3β, 5α conformation at the 3 and 5 positions, as described above. These compounds may be further substituted with other substituents known in the art. Examples of 3α, 5β reduced steroids include l l-keto-3β,5α-TH-testosterone, 3β, 5α-reduced-l l- ketoprogesterone, 3β, 5α-reduced-ll-keto-androstenedione, 3β,5α-tetrahydro-ll- dehydro-corticosterone, 3β, 5α-reduced-l l-keto-pregnenolone, 3β, 5α-reduced-l l-keto- dehydro-epiandrostenedione, 3β, 5α- reduced deoxycorticosterone, 3β,5α-reduced progesterone, 3β, 5α-reduced testosterone, and pharmaceutically acceptable salts and prodrugs thereof.
In a further embodiment, the 1 lβ-HSDl reductase modulating compound is 3α, 5β reduced, e.g., 3α, 5β-reduced deoxycorticosterone.
The invention also pertains to derivatives of the compounds described herein, such as steroid derivatives with a steroid ring structure optionally substituted with additional substituents which allow the compound to perform its intended function. Examples of such modifications include compounds modified with acetylenic groups (e.g., 17-acetylenic steroids), alkyl groups (e.g., 2α-alkyl (e.g., methyl), 12α-alkyl, 12β alkyl), halogenation, (e.g., 9α-halogenated, e.g., 9α-fluorinated, etc.), esters (e.g., succinates, hemi-succinates, carbohydrates, glucoronides, glutarates, etc.), or additional unsaturations (e.g., Δl,2-unsaturated steroids). It should be noted that the steroid compounds may be converted to the active form of the modulating compound within the subject. The invention includes administering compounds which are in other forms, e.g., prodrugs, and which are metabolized in vivo to yield the compounds described herein. Additional modifcations can be found in Human Adrenal Cortex, Ciba Symposium, edited by Perry Symington, 1962.
In another embodiment, the 1 lβ-hydroxylated progesterone compounds are protected such that 20α- or 20β-HSD enzymatic reduction of the side-chain is reduced or prevented. In another embodiment, the 1 lβ-hydroxylated testosterone compounds are protected such that 17β-HSD enzymatic oxidation of the 17β- hydroxyl grouping is slowed or prevented.
In one embodiment, the 1 lβ-HSDl reductase inhibitors possess ICs0 's less than about 0.5 μM using 600 nanoM 11-dehydro-corticosterone substrate concentration and testicular leydig cell homogenates. Methods for testing the ICso's of the enzymes are described in further detail in Latif, S. A. et a!. Steroids 62: 230-237, 1997. In another embodiment, the 1 lβ-HSDl reductase inhibitors have an IC50 of 80 μM or less, or, preferably, 15 μM or less. In another embodiment, the 1 lβ-HSDl reductase inhibitors have an ICs0 of less than 100 μM. Other examples of 1 lβ-HSDl reductase modulating compounds include carbenoxolone and derivatives thereof.
The term "1 lβ-HSDl dehydrogenase modulating compound" include compounds and agents (e.g., oligomers, proteins, etc.) which modulate or inhibit the activity of 11 β-HSD 1 dehydrogenase. In an advantageous embodiment, the 11 β-HSD 1 dehydrogenase modulating compound is an 1 lβ-HSDl dehydrogenase inhibitor (also referred to as "1 lβ-HSDl dehydrogenase inhibiting compound"). The 11 β-HSD 1 dehydrogenase modulating compound may be a small molecule, e.g., a compound with a molecular weight below 10,000 daltons. In a further embodiment, the 11 β-HSD 1 dehydrogenase modulating compound is a selective inhibitor of 11 β-HSD 1 dehydrogenase. The term "selective 11 β-HSD 1 dehydrogenase inhibitor" includes compounds which selectively inhibit the dehydrogenase activity of 1 lβ-HSDl as compared to the reductase activity of 1 lβ- HSDl . In a further embodiment, the dehydrogenase activity is inhibited at a rate about 2 times or greater, about 3 times or greater, about 4 times or greater, about 5 times or greater, about 10 times or greater, about 15 times or greater, about 20 times or greater, about 25 times or greater, about 50 times or greater, about 75 times or greater, about 100 times or greater, about 150 times or greater, about 200 times or greater, about 300 times or greater, about 400 times or greater, about 500 times or greater, about 1 x 103 times or greater, about 1 x 104 times or greater, about 1 x 105 times or greater, or about 1 x 106 or greater as compared with the inhibition of the reductase activity of 1 lβ-HSDl .
In one embodiment, the 1 lβ-HSDl dehydrogenase inhibitor is a small molecule, such as a steroid or a derivative thereof. In a further embodiment, the steroid is 3α, 5β- reduced. Examples of 3α,5β-reduced steroids include 3α, 5β-reduced-llβ-OH- progesterone, 3α, 5β-reduced-l lβ-OH-testosterone, chenodeoxycholic acid, 3α, 5β- reduced-pregnenolone, 3α, 5β-reduced-dehydro-epiandrostenedione, 3α, 5β-reduced- progesterone, 3α, 5β-reduced deoxycorticosterone, 3α, 5β-reduced-chenodeoxycholic acid, 3α, 5β-reduced progesterone, 3α, 5β-reduced testosterone, 3α, 5β-reduced chenodoxycholic acid, 3α, 5β-testosterone, and deoxycorticosterone. Other examples of 1 lβ-HSDl dehydrogenase inhibitors include 3α,5α-TH- aldosterone, 3α,5α-TH-cortisol, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α- TH-11-dehydro-corticosterone, l lβ-OH-allopregnanolone, llβ-OH-pregnanolone, llβ- OH-androstanediol, and 3β, 5α-reduced steroids.
In another embodiment, the 1 lβ-HSDl dehydrogenase inhibitor is a 3α, 5α- reduced steroid. Examples of such steroids include 3α, 5α-reduced-l lβ-OH- progesterone, 3α, 5α-reduced-l lβ-OH-testosterone, 3α, 5α-reduced-l lβ-OH- androstendione, 3α, 5α-reduced-l lβ-OH-pregnenolone, 3α, 5α-reduced-llβ-OH- dehydro-epiandrostenedione, 3α, 5α-reduced-corticosterone, 3α, 5α-reduced- aldosterone, 3α, 5α-reduced-pregnenolone, 3α, 5α-reduced-progesterone, 3α, 5α-reduced testosterone, 3α, 5α-deoxycorticosterone, and 3α, 5α-reduced-chenodeoxycholic acid. Other examples of steroids which can be used as 1 lβ-HSDl dehydrogenase inhibitors include 11 β-OH progesterone, 11 β-OH testosterone, l lβ-OH-pregnenolone, l lβ-OH- dehydro-epiandrostenedione, glycyrrhetinic acid or carbenoxolone.
In one embodiment, the 1 lβ-HSDl dehydrogenase inhibitor has an IC50 of 0.5 μM or less. In another embodiment, the 1 lβ-HSDl dehydrogenase inhibitor has an IC5O of 100 μM or less, 80 μM or less, or 20 μM or less (using 100 nM corticosterone substrate concentration and testicular Leydig cell homogenates). The term "11 β-HSD2 dehydrogenase inhibitor" includes agents which inhibit or decrease the dehydrogenase activity of 1 lβ-HSD2.
In one embodiment, the 1 lβ-HSD2 dehydrogenase inhibitor is a small molecule, such as a steroid or a derivative thereof. In one embodiment, the steroid is 3α, 5α- reduced. Examples of 1 lβ-HSD2 dehydrogenase inhibitors include, but are not limited to, 3α, 5α-reduced-l lβ-OH-progesterone, 3α, 5α-reduced-l lβ-OH-testosterone, 3α, 5α- reduced-l lβ-OH-androstenedione, 3α, 5α-reduced-ll-keto-progesterone, 3α, 5α- reduced-11-dehydro-corticosterone, 3α, 5α-reduced-corticosterone, 3α, 5 α-reduced- l lβ- OH-pregnenolone, 3α, 5α-reduced-l lβ-OH-dehydro-epiandrostenedione, 3α, 5α- reduced-pregnenolone, 3α, 5α-reduced-dehydro-epiandrostenedione, 3α, 5α-reduced aldosterone, and 3α, 5α-reduced deoxycorticosterone. Other examples of 1 lβ-HSD2 dehydrogenase inhibitors include 1 lβ-OH-progesterone, l lβ-OH-pregnenolone, l lβ- OH-dehydro-epiandrostenedione, 1 lβ-OH-testosterone, 11-keto-progesterone, 5α- dihydro-corticosterone, 3α, 5α-reduced deoxy- corticosterone, glycyrrhetinic acid or carbenoxolone. Other examples of 11 β-HSD2 dehydrogenase modulating (e.g., inhibiting compounds) include: 3β, 5α-reduced steroids, 3α, 5α-TH-aldosterone, 3α, 5α-TH- cortisol, 5α-DH-corticosterone, 11-dehydro-corticosterone, 3α,5α-TH-l l- dehydrocorticosterone, 11-keto-allopregnanolone, llβ-OH-androstanediol, llβ-OH- androstenedione, and pharmaceutically acceptable salts and prodrugs thereof. In other embodiments, 11 β-HSD2 dehydrogenase modulating compound is a nucleic acid. In another embodiment, the 1 lβ-HSD2 dehydrogenase inhibitor is an antisense nucleic acid. In another embodiment, the 1 lβ-HSD2 dehydrogenase inhibitor is a siRNA.
In one embodiment, the 1 lβ-HSD2 dehydrogenase inhibiting compounds have IC5O 1S less than 2.5 μM (using 50 nM corticosterone substrate concentration and sheep kidney microsomes). In another embodiment, the 1 lβ-HSD2 dehydrogenase inactive compounds have an IC50 of less than lOμM. Examples of 11 β-HSDl -reductase, l lβ-HSDl -dehydrogenase and l lβ-HSD2 dehydrogenase modulating compounds are described in Table 1.
TABLE l
Figure imgf000020_0001
Figure imgf000021_0001
IV. 17α-Hvdroxylase Inhibitors, 17-HSD Inhibitors, 20α-Reductase Inhibitors and 20β-Reductase Inhibitors The invention also pertains to administering to the subject a 17α-hydroxylase inhibitor, a 17-HSD inhibitor, a 20α-reductase inhibitor and/or a 20β-reductase inhibitor, in combination with the methods described above. The inhibitors can be any compound or substance known to inhibit any one of these enzymes. The 17α-hydroxylase, 17- HSD, 20α-reductase and/or 20β-reductase inhibitors are administered in combination with the compounds of the invention described herein.
The language "in combination with" another agent includes co-administration of the compound of the invention and the agent, administration of the compound of the invention first, followed by the other agent and administration of the other agent first, followed by the compound of the invention. The 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase inhibitors can be found using assays for screening candidate or test compounds which bind to or modulate the activity of a 17α-hydroxylase, 17-HSD, 17-HSD, 20α-reductase or 20β-reductase protein or polypeptide or biologically active portion thereof.
The test compounds can be obtained using any of the numerous approaches in combinatorial library methods known in the art, including: biological libraries; spatially addressable parallel solid phase or solution phase libraries; synthetic library methods requiring deconvolution; the 'one-bead one-compound' library method; and synthetic library methods using affinity chromatography selection. The biological library approach is limited to peptide libraries, while the other four approaches are applicable to peptide, non-peptide oligomer or small molecule libraries of compounds (Lam, K.S. (1997) Anticancer Drug Des. 12: 145).
Examples of methods for the synthesis of molecular libraries can be found in the art, for example in: DeWitt et al. (1993) Proc. Natl. Acad. ScL U.S.A. 90:6909; Erb et al. (1994) Proc. Natl. Acad. Sd. USA 91:11422; Zuckermann et al. (1994). J Med. Chem. 37:2678; Cho et al. (1993) Science 261:1303; Carrell et al. (1994) Angew. Chem. Int. Ed. Engl. 33:2059; Carell et al. (1994) Angew. Chem. Int. Ed. Engl. 33:2061; and in Gallop et al. (1994) J. Med. Chem. 37:1233.
Libraries of compounds maybe presented in solution {e.g., Houghten (1992) Biotechniques 13:412-421), or on beads (Lam (1991) Nature 354:82-84), chips (Fodor (1993) Nature 364:555-556), bacteria (Ladner USP 5,223,409), spores (Ladner USP '409), plasmids (Cull et al. (1992) Proc Natl Acad Sd USA 89:1865-1869) or on phage. (Scott and Smith (1990) Science 249:386-390); (Devlin (1990) Science 249:404-406); (Cwirla et al. (1990) Proc. Natl. Acad. Sd. 87:6378-6382); (Felici (1991) J. MoI. Biol. 222:301-310).
Determining the ability of a 17α-hydroxylase, 17-HSD, 20α-reductase or 20β- reductase protein to bind to or interact with a target molecule {e.g., a steroid substrate) can be accomplished by determining direct binding. Determining the ability of the 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein to bind to or interact with a target molecule can be accomplished, for example, by coupling the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein with a radioisotope or enzymatic label such that binding of the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein to a target molecule can be determined by detecting the labeled 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein in a complex. For example, 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase proteins can be labeled with 125 j3 35s, 14c, or -^H, either directly or indirectly, and the radioisotope detected by direct counting of radioemmission or by scintillation counting. Alternatively, 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase proteins can be enzymatically labeled with, for example, horseradish peroxidase, alkaline phosphatase, or luciferase, and the enzymatic label detected by determination of conversion of an appropriate substrate to product.
In yet another embodiment, an assay of the present invention is a cell-free assay in which a 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein or biologically active portion thereof is contacted with a test compound and the ability of the test compound to bind to the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β- reductase protein or biologically active portion thereof is determined. Binding of the test compound to the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein can be determined either directly or indirectly. The assay may include contacting the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein or biologically active portion thereof with a known compound which binds 17α-hydroxylase, 17-HSD, 20α- reductase or 20β-reductase to form an assay mixture, contacting the assay mixture with a test compound, and determining the ability of the test compound to interact with a 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein, wherein determining the ability of the test compound to interact with a 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein comprises determining the ability of the test compound to preferentially bind to 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase or biologically active portion thereof as compared to the known compound. In another embodiment, the assay is a cell-free assay in which a 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein or biologically active portion thereof is contacted with a test compound and the ability of the test compound to modulate (e.g., stimulate or inhibit) the activity of the 17α-hydroxylase, 17-HSD, 20α- reductase or 20β-reductase protein or biologically active portion thereof is determined. Determining the ability of the test compound to modulate the activity of a 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein can be accomplished, for example, by determining the ability of the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein to bind to a target molecule. Determining the ability of the 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein to bind to a target molecule can also be accomplished using a technology such as real-time Biomolecular Interaction Analysis (BIA). Sjolander, S. and Urbaniczky, C. (1991) Anal. Chem. 63:2338-2345 and Szabo et al. (1995) Curr. Opin. Struct. Biol. 5:699-705. As used herein, "BIA" is a technology for studying biospecific interactions in real time, without labeling any of the interactants (e.g., BIAcore). Changes in the optical phenomenon of surface plasmon resonance (SPR) can be used as an indication of real-time reactions between biological molecules.
In an alternative embodiment, determining the ability of the test compound to modulate the activity of a 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein can be accomplished by determining the ability of the 17α-hydroxylase, 17- HSD, 20α-reductase or 20β-reductase protein to further modulate the activity of a target molecule.
In yet another embodiment, the cell-free assay involves contacting a 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein or biologically active portion thereof with a known compound which binds the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein to form an assay mixture, contacting the assay mixture with a test compound, and determining the ability of the test compound to interact with the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein, wherein determining the ability of the test compound to interact with the 17α- hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein comprises determining the ability of the 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein to preferentially bind to or modulate the activity of a target molecule.
It may be desirable to immobilize either 17α-hydroxylase, 17-HSD, 20α- reductase or 20β-reductase or its target molecule to facilitate separation of complexed from uncomplexed forms of one or both of the proteins, as well as to accommodate automation of the assay. Binding of a test compound to a 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein, or interaction of a 17α-hydroxylase, 17-HSD, 20α-reductase or 20β-reductase protein with a target molecule in the presence and absence of a candidate compound, can be accomplished in any vessel suitable for containing the reactants. Examples of such vessels include microtitre plates, test tubes, and micro-centrifuge tubes.
In one embodiment, the invention pertains to the 17α-hydroxylase, 17-HSD, the 20α-reductase, and the 20β-reductase inhibiting compounds which are found using the above described methods.
V. Pharmaceutical Compositions
In yet another embodiment, the invention pertains to a pharmaceutical composition for the treatment of a glucocorticoid associated state. The composition includes an effective amount of an 1 lβ-HSDl reductase, 1 lβ-HSDl dehydrogenase, or
I lβ-HSD2 dehydrogenase modulating, e.g., inhibiting, compound and a pharmaceutically acceptable carrier. In a further embodiment, the glucocorticoid associated state is a blood pressure disorder. In another embodiment, the pharmaceutical compositions may also comprise an inhibitor of 17α-hydroxylase, 17-HSD, 20α- reductase or 20β-reductase.
In another embodiment, the invention pertains, at least in part, to a pharmaceutical composition comprising an effective amount of 1 lβ-OH-progesterone,
I 1 β-OH-testosterone, 3α,5β-reduced-l 1 β-OH-progesterone, 3α,5β-reduced-l 1 β-OH- testosterone, chenodeoxycholic acid, 3α, 5β-reduced-pregnenolone, 3α, 5β-reduced- dehydro-epiandrostenedione, 3α,5α-reduced-l 1 β-OH-progesterone, 3α,5α-reduced- 11 β-OH-testosterone, 3α,5α-reduced-l 1 β-OH-androstenedione, 11-keto-progesterone, 11-keto-testosterone, 11-keto-androstenedione, 3α,5α-reduced-l 1-keto-ρrogesterone, 3α,5α-reduced-ll-keto-testosterone, 3α, 5α-reduced-llβ-OH-pregnenolone, 3α, 5α- reduced- 11 β-OH-dehydro-epiandrostenedione, 11 β-OH-pregnenolone, 11 β-OH- dehydro-epiandrostenedione, 3α, 5α-reduced-pregnenolone, 3α, 5α-reduced-dehydro- epiandrostenedione, 3α,5α-reduced-l 1— keto-androstenedione, 3α,5α-tetrahydro- 11-dehydro-corticosterone, 3α,5α-reduced-corticosterone, 5α-dihydro-corticosterone, 3α, 5β-reduced deoxycorticosterone, 3α, 5α-reduced deoxycorticosterone, 3α, 5α- reduced progesterone, 3α, 5α-reduced testosterone, 3α, 5β-reduced deoxycorticosterone, 3α, 5β-reduced-chenodeoxycholic acid, 3α, 5β-reduced progesterone, 3α, 5β-reduced testosterone, 3α, 5α-reduced deoxycorticosterone, 3α, 5α-reduced aldosterone, 3α,5α- TH-aldosterone, 3α,5β-TH-aldosterone, 3α,5α-TH-cortisol, 3α,5β-TH-cortisol, 3α,5α- TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α,5α-TH-corticosterone, 3α,5β-TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 3α,5β-TH-l 1-dehydro- corticosterone, 11 β-OH-allopregnanolone, 11 β-OH-pregnanolone, 11-keto- allopregnanolone, 11-keto-pregnanolone, 11 β-OH-adrostenedione, 11-keto- adrostenedione, l lβ-OH-androstanediol, ll-keto-3β,5α-TH-testosterone, l lβ-OH- androsterone, 11-keto-androsterone, a 3β, 5α-reduced steroid, and pharmaceutically acceptable salts thereof, in combination with a 17α-hydroxylase inhibitor, a 20α- reductase inhibitor, or a 20β-reductase inhibitor.
The phrase "pharmaceutically acceptable carrier" is art recognized and includes a pharmaceutically acceptable material, composition or vehicle, suitable for administering compounds of the present invention to mammals. The carriers include liquid or solid filler, diluent, excipient, solvent or encapsulating material, involved in carrying or transporting the subject agent from one organ, or portion of the body, to another organ, or portion of the body. Each carrier must be "acceptable" in the sense of being compatible with the other ingredients of the formulation and not injurious to the patient. Some examples of materials which can serve as pharmaceutically acceptable carriers include: sugars, such as lactose, glucose and sucrose; starches, such as corn starch and potato starch; cellulose, and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate; powdered tragacanth; malt; gelatin; talc; excipients, such as cocoa butter and suppository waxes; oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and soybean oil; glycols, such as propylene glycol; polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol; esters, such as ethyl oleate and ethyl laurate; agar; buffering agents, such as magnesium hydroxide and aluminum hydroxide; alginic acid; pyrogen-free water; isotonic saline; Ringer's solution; ethyl alcohol; phosphate buffer solutions; and other non-toxic compatible substances employed in pharmaceutical formulations.
Wetting agents, emulsifiers and lubricants, such as sodium lauryl sulfate and magnesium stearate, as well as coloring agents, release agents, coating agents, sweetening, flavoring and perfuming agents, preservatives and antioxidants can also be present in the compositions. Examples of pharmaceutically acceptable antioxidants include: water soluble antioxidants, such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite and the like; oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, α-tocopherol, and the like; and metal chelating agents, such as citric acid, ethylenediamine tetraacetic acid (EDTA), sorbitol, tartaric acid, phosphoric acid, and the like.
Formulations of the present invention include those suitable for oral, nasal, topical, transdermal, buccal, sublingual, rectal, vaginal, pulmonary and/or parenteral administration. The formulations may conveniently be presented in unit dosage form and may be prepared by any methods well known in the art of pharmacy. The amount of active ingredient which can be combined with a carrier material to produce a single dosage form will generally be that amount of the compound which produces a therapeutic effect. Generally, out of one hundred per cent, this amount will range from about 1 per cent to about ninety-nine percent of active ingredient, preferably from about 5 per cent to about 70 per cent, most preferably from about 10 per cent to about 30 per cent.
Methods of preparing these formulations or compositions include the step of bringing into association a compound of the present invention with the carrier and, optionally, one or more accessory ingredients, hi general, the formulations are prepared by uniformly and intimately bringing into association a compound of the present invention with liquid carriers, or finely divided solid carriers, or both, and then, if necessary, shaping the product. Formulations of the invention suitable for oral administration may be in the form of capsules, cachets, pills, tablets, lozenges (using a flavored basis, usually sucrose and acacia or tragacanth), powders, granules, or as a solution or a suspension in an aqueous or non-aqueous liquid, or as an oil-in-water or water-in-oil liquid emulsion, or as an elixir or syrup, or as pastilles (using an inert base, such as gelatin and glycerin, or sucrose and acacia) and/or as mouth washes and the like, each containing a predetermined amount of a compound of the present invention as an active ingredient. A compound of the present invention may also be administered as a bolus, electuary or paste.
In solid dosage forms of the invention for oral administration (capsules, tablets, pills, dragees, powders, granules and the like), the active ingredient is mixed with one or more pharmaceutically acceptable carriers, such as sodium citrate or dicalcium phosphate, and/or any of the following: fillers or extenders, such as starches, lactose, sucrose, glucose, mannitol, and/or silicic acid; binders, such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinyl pyrrolidone, sucrose and/or acacia; humectants, such as glycerol; disintegrating agents, such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; solution retarding agents, such as paraffin; absorption accelerators, such as quaternary ammonium compounds; wetting agents, such as, for example, cetyl alcohol and glycerol monostearate; absorbents, such as kaolin and bentonite clay; lubricants, such a talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, and mixtures thereof; and coloring agents. In the case of capsules, tablets and pills, the pharmaceutical compositions may also comprise buffering agents. Solid compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugars, as well as high molecular weight polyethylene glycols and the like.
A tablet may be made by compression or molding, optionally with one or more accessory ingredients. Compressed tablets may be prepared using binder (for example, gelatin or hydroxypropymiethyl cellulose), lubricant, inert diluent, preservative, disintegrant (for example, sodium starch glycolate or cross-linked sodium carboxymethyl cellulose), surface-active or dispersing agent. Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent. The tablets, and other solid dosage forms of the pharmaceutical compositions of the present invention, such as dragees, capsules, pills and granules, may optionally be scored or prepared with coatings and shells, such as enteric coatings and other coatings well known in the pharmaceutical-formulating art. They may also be formulated so as to provide slow or controlled release of the active ingredient therein using, for example, hydroxypropylmethyl cellulose in varying proportions to provide the desired release profile, other polymer matrices, liposomes and/or microspheres. They may be sterilized by, for example, filtration through a bacteria-retaining filter, or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved in sterile water, or some other sterile injectable medium immediately before use. These compositions may also optionally contain opacifying agents and may be of a composition that they release the active ingredient(s) only, or preferentially, in a certain portion of the gastrointestinal tract, optionally, in a delayed manner. Examples of embedding compositions which can be used include polymeric substances and waxes. The active ingredient can also be in micro-encapsulated form, if appropriate, with one or more of the above-described excipients.
Liquid dosage forms for oral administration of the compounds of the invention include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs. In addition to the active ingredient, the liquid dosage forms may contain inert diluent commonly used in the art, such as, for example, water or other solvents, solubilizing agents and emulsifiers, such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3- butylene glycol, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor and sesame oils), glycerol, tetrahydrofuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
Besides inert dilutents, the oral compositions can also include adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, coloring, perfuming and preservative agents.
Suspensions, in addition to the active compounds, may contain suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar- agar and tragacanth, and mixtures thereof. Formulations of the pharmaceutical compositions of the invention for rectal or vaginal administration may be presented as a suppository, which may be prepared by mixing one or more compounds of the invention with one or more suitable nonirritating excipients or carriers comprising, for example, cocoa butter, polyethylene glycol, a suppository wax or a salicylate, and which is solid at room temperature, but liquid at body temperature and, therefore, will melt in the rectum or vaginal cavity and release the active compound.
Formulations of the present invention which are suitable for vaginal administration also include pessaries, tampons, creams, gels, pastes, foams or spray formulations containing such carriers as are known in the art to be appropriate. Dosage forms for the topical or transdermal administration of a compound of this invention include powders, sprays, ointments, pastes, creams, lotions, gels, solutions, patches and inhalants. The active compound may be mixed under sterile conditions with a pharmaceutically acceptable carrier, and with any preservatives, buffers, or propellants which may be required. The ointments, pastes, creams and gels may contain, in addition to an active compound of this invention, excipients, such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
Powders and sprays can contain, in addition to a compound of this invention, excipients such as lactose, talc, silicic acid, aluminum hydroxide, calcium silicates and polyamide powder, or mixtures of these substances. Sprays can additionally contain customary propellants, such as chlorofluorohydrocarbons and volatile unsubstituted hydrocarbons, such as butane and propane. Sprays also can be delivered by mechanical, electrical, or by other methods known in the art. Transdermal patches have the added advantage of providing controlled delivery of a compound of the present invention to the body. Such dosage forms can be made by dissolving or dispersing the compound in the proper medium. Absorption enhancers can also be used to increase the flux of the compound across the skin. The rate of such flux can be controlled by either providing a rate controlling membrane or dispersing the active compound in a polymer matrix or gel.
Ophthalmic formulations, eye ointments, powders, solutions and the like, are also contemplated as being within the scope of this invention. Pharmaceutical compositions of this invention suitable for parenteral administration comprise one or more compounds of the invention in combination with one or more pharmaceutically acceptable sterile isotonic aqueous or nonaqueous solutions, dispersions, suspensions or emulsions, or sterile powders which may be reconstituted into sterile injectable solutions or dispersions just prior to use, which may contain antioxidants, buffers, bacteriostats, solutes which render the formulation isotonic with the blood of the intended recipient or suspending or thickening agents.
Examples of suitable aqueous and nonaqueous carriers which may be employed in the pharmaceutical compositions of the invention include water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), and suitable mixtures thereof, vegetable oils, such as olive oil, and injectable organic esters, such as ethyl oleate. Proper fluidity can be maintained, for example, by the use of coating materials, such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
These compositions may also contain adjuvants such as preservatives, wetting agents, emulsifying agents and dispersing agents. Prevention of the action of microorganisms may be ensured by the inclusion of various antibacterial, antiparasitic and antifungal agents, for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents, such as sugars, sodium chloride, and the like into the compositions. In addition, prolonged absorption of the injectable pharmaceutical form may be brought about by the inclusion of agents which delay absorption such as aluminum monostearate and gelatin.
In some cases, in order to prolong the effect of a drug, it is desirable to slow the absorption of the drag from subcutaneous or intramuscular injection. This may be accomplished by the use of a liquid suspension of crystalline or amorphous material having poor water solubility. The rate of absorption of the drug then depends upon its rate of dissolution which, in turn, may depend upon crystal size and crystalline form. Alternatively, delayed absorption of a parenterally-administered drug form may be accomplished by dissolving or suspending the drag in an oil vehicle. The compositions also may be formulated such that its elimination is retarded by methods known in the art. Injectable depot forms are made by forming microencapsule matrices of the subject compounds in biodegradable polymers such as polylactide-polyglycolide. Depending on the ratio of drag to polymer, and the nature of the particular polymer employed, the rate of drag release can be controlled. Examples of other biodegradable polymers include poly(orthoesters) and poly (anhydrides). Depot injectable formulations are also prepared by entrapping the drug in liposomes or microemulsions which are compatible with body tissue.
The preparations of the present invention may be given orally, parenterally, topically, or rectally. They are of course given by forms suitable for each administration route. For example, they are administered in tablets or capsule form, by injection, inhalation, eye lotion, ointment, suppository, etc. administration by injection, infusion or inhalation; topical by lotion or ointment; and rectal by suppositories. Oral administration or administration via inhalation is preferred. The phrases "parenteral administration" and "administered parenterally" as used herein means modes of administration other than enteral and topical administration, usually by injection, and includes, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticular, subcapsular, subarachnoid, intraspinal and intrasternal injection and infusion.
The phrases "systemic administration," "administered systemically," "peripheral administration" and "administered peripherally" as used herein mean the administration of a compound, drug or other material other than directly into the central nervous system, such that it enters the patient's system and, thus, is subject to metabolism and other like processes, for example, subcutaneous administration.
These compounds may be administered to humans and other animals for therapy by any suitable route of administration, including orally, nasally, as by, for example, a spray, rectally, intravaginally, parenterally, intracisternally and topically, as by powders, ointments or drops, including buccally and sublingually. Other methods for administration include via inhalation.
The language :"directed to" includes methods of administration, such as injection, which allow for the higher concentration or active amount of the inhibitor or drug to be located in kidney after administration.
Regardless of the route of administration selected, the compounds of the present invention, which may be used in a suitable hydrated form, and/or the pharmaceutical compositions of the present invention, are formulated into pharmaceutically acceptable dosage forms by conventional methods known to those of skill in the art.
Actual dosage levels of the active ingredients in the pharmaceutical compositions of this invention may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient. The selected dosage level will depend upon a variety of factors including the activity of the particular compound of the present invention employed, or the ester, salt or amide thereof, the route of administration, the time of administration, the rate of excretion of the particular compound being employed, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular compound employed, the age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well known in the medical arts.
A physician or veterinarian having ordinary skill in the art can readily determine and prescribe the effective amount of the pharmaceutical composition required. For example, the physician or veterinarian could start doses of the compounds of the invention employed in the pharmaceutical composition at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved.
In general, a suitable daily dose of a compound of the invention will be that amount of the compound which is the lowest dose effective to produce a therapeutic effect. Such an effective dose will generally depend upon the factors described above. Generally, intravenous and subcutaneous doses of the compounds of this invention for a patient will range from about 0.0001 to about 100 mg per kilogram of body weight per day, more preferably from about 0.01 to about 50 mg per kg per day, and still more preferably from about 1.0 to about 100 mg per kg per day. An effective amount is that amount treats a glucocorticoid associated state.
If desired, the effective daily dose of the active compound maybe administered as two, three, four, five, six or more sub-doses administered separately at appropriate intervals throughout the day, optionally, in unit dosage forms. While it is possible for a compound of the present invention to be administered alone, it is preferable to administer the compound as a pharmaceutical composition.
As set out above, certain embodiments of the present compounds can contain a basic functional group, such as amino or alkylamino, and are, thus, capable of forming pharmaceutically acceptable salts with pharmaceutically acceptable acids. The term "pharmaceutically acceptable salts" is art recognized and includes relatively non-toxic, inorganic and organic acid addition salts of compounds of the present invention. These salts can be prepared in situ during the final isolation and purification of the compounds of the invention, or by separately reacting a purified compound of the invention in its free base form with a suitable organic or inorganic acid, and isolating the salt thus formed. Representative salts include the hydrobromide, hydrochloride, sulfate, bisulfate, phosphate, nitrate, acetate, valerate, oleate, palmitate, stearate, laurate, benzoate, lactate, phosphate, tosylate, citrate, maleate, fumarate, succinate, hemi- succinate, glucuronide, tartrate, napthylate, mesylate, glucoheptonate, lactobionate, and laurylsulphonate salts and the like. (See, e.g., Berge et al. (1977) "Pharmaceutical Salts", J. Farm. SCI. 66:1-19).
In other cases, the compounds of the present invention may contain one or more acidic functional groups and, thus, are capable of forming pharmaceutically acceptable salts with pharmaceutically acceptable bases. The term "pharmaceutically acceptable salts" in these instances includes relatively non-toxic, inorganic and organic base addition salts of compounds of the present invention. These salts can likewise be prepared in situ during the final isolation and purification of the compounds, or by separately reacting the purified compound in its free acid form with a suitable base, such as the hydroxide, carbonate or bicarbonate of a pharmaceutically acceptable metal cation, with ammonia, or with a pharmaceutically acceptable organic primary, secondary or tertiary amine. Representative alkali or alkaline earth salts include the lithium, sodium, potassium, calcium, magnesium, and aluminum salts and the like. Representative organic amines useful for the formation of base addition salts include ethylamine, diethylamine, ethylenediamine, ethanolamine, diethanolamine, piperazine and the like.
The term "prodrug" includes compounds with moieties which can be metabolized in vivo to a hydroxyl group or other functional group and moieties which may advantageously remain in vivo. Preferably, the prodrugs moieties are metabolized in vivo. Examples of prodrugs and their uses are well known in the art (See, e.g., Berge et al. (1977) "Pharmaceutical Salts", J. Pharni. Sd. 66:1-19). The prodrugs can be prepared in situ during the final isolation and purification of the compounds, or by separately reacting the purified compound in its free acid form or hydroxyl with a suitable esterifying agent. Hydroxyl groups can be converted into esters via treatment with a carboxylic acid. Examples of prodrug moieties include substituted and unsubstituted, branch or unbranched lower alkyl ester moieties, {e.g., propionoic acid esters), lower alkenyl esters, di-lower alkyl-amino lower-alkyl esters {e.g., dimethylaminoethyl ester), acylamino lower alkyl esters {e.g., acetyloxymethyl ester), acyloxy lower alkyl esters {e.g., pivaloyloxymethyl ester), aryl esters (phenyl ester), aryl-lower alkyl esters {e.g., benzyl ester), substituted {e.g., with methyl, halo, or methoxy substituents) aryl and aryl-lower alkyl esters, amides, lower-alkyl amides, di- lower alkyl amides, and hydroxy amides.
The invention also pertains to any one of the methods described supra further comprising administering to the subject a pharmaceutically acceptable carrier. EXEMPLIFICATION OF THE INVENTION
Example 1: Ability of Corticosteroid and 11-Dehydro-Corticosterone to Amplify the Contractile Responses of Phenylephrine
Experimental:
Male Sprague-Dawley (150-20Og) rats were anesthetized with pentobarbital (50 mg/kg IP), and a median sternotomy was performed followed by the rapid removal of the thoracic aorta. The adventitia was removed,, but the endothelium was left intact. The aorta was cut into 2-3 mm rings and individual rings were placed into a single well of a twenty four well culture plate and incubated at 37°C under 95% O2- 5% CO2. Each well contained 1 mL of DMEM/F12 containing 1% fetal bovine serum, streptomycin (100 μg/ml), penicillin (100 units/ml) and amphotericin (0.25 μg/ml). Aortic rings were incubated for 24 hours prior to contractility measurements with the following combinations of steroids, and antisense/nonsense oligonucleotides (3 μmol/L):
Corticosterone (10 nmol/L) + 1 lβ-HSD2 antisense or 1 lβ-HSD2 nonsense oligomer
Corticosterone (10 nmol/L) + 1 lβ-HSDl antisense or 1 lβ-HSDl nonsense oligomer
Li 11-dehydrocorticosterone experiments with vehicle alone
11-dehydrocorticosterone (100 nmol/L) + 1 lβ-HSDl Antisense or 1 lβ-HSDl nonsense oligomer
Antisense phosphorothioate oligonucleotides, targeted to block either 11 β-HSD2 or 1 lβ-HSDl gene expression, were obtained from Research Genetics, Huntsville AL. Antisense oligomers complementary to 20 bp sequences spanning the ribosome binding/translation start site were used. Oligomer sequences were: 5'-CAT AAC TGC CGT CCA ACA GC-3' (SEQ ID NO. 1) for 1 lβ-HSDl Antisense and 5'-AGG CCA GCG CTC CAT GAC TT- 3' (SEQ ID NO 2) for 11 β-HSD2 antisense. hi control experiments the corresponding sense sequence was used as the nonsense oligomer. Antisense and nonsense oligomers were added directly to each well at 20 μg/10:l sterile H2O per well for a final concentration of 3 μmol/L.
For contraction measurements, aortic rings were suspended by tungsten wires with 1 g of tension and placed in a vessel bath containing serum free DMEM/F12 media at 37°C aerated with 95% O2-5% CO, at pH 7.4. Vessels were equilibrated for 20 minutes and then tested with phenylephrine (1 nmol/L - lOμmol/L). Although phenylephrine is structurally not a catecholamine, it is considered to be a functional catecholamine as it activates both α and β adrenoceptors. Due to its favorable stability characteristics, it is widely used as a catecholamine substitute in experiments of this nature. The intensity of contraction was assessed by use of a Narishige micromanipulator and model FT03 force transducer (Grass Instrument Co. West Warwick, RI). Measurements were recorded on computer using the Lab view 4.1 Virtual Instrument System (National Instruments, Austin, TX). Adhering to this protocol, test vessel viability by demonstrating the ability of the vessel to vigorously contract when exposed to known vasoconstrictors and relax back to baseline after treatment with acetylcholine.
Results: Effect ofllβ-HSD Antisense on Vascular Contractile Response
Experiments were carried out to determine whether specific 1 lβ-HSD2 antisense oligomers affect the contractile response of vascular rings. Rat aortic rings, with endothelium intact, were incubated for 24 hours with corticosterone (10 nmol/L) and either specific 1 lβ-HSD2 antisense oligomers (3 μmol/L) or nonsense oligomers (3 (μmol/L). Following incubation, the contractile responses to graded concentrations of phenylephrine were determined. Previously, it had been demonstrated that the incubation of aortic rings with corticosterone resulted in amplified contractile responses to graded concentrations of phenylephrine compared to controls. The exposure of rings to corticosterone together with 1 lβ-HSD2 antisense demonstrated a statistically significant increase in the contractile response to all concentrations (1, 10, 100 nmol/L and 1 μmol/L) of phenylephrine (Figure 1).
In the rat, both vascular endothelial and smooth muscle cells contain 1 lβ-HSDl. Even though this isoform operates mainly as a reductase under physiologic conditions, it was examined if 11 β-HSDl antisense oligomers had an effect on the ability of corticosterone to amplify the contractile responses to phenylephrine in vascular tissue. Rings were incubated for 24-hours with corticosterone (10 nmol/L) and either 1 lβ- HSDl antisense oligomers (3 μmol/L) or nonsense oligomers (3 μmol/L). In rings treated with 1 lβ-HSDl antisense the contractile responses to all concentrations of phenylephrine (10 nmol/L, 100 nmol/L and 1 μmol/L) were significantly increased compared to rings treated with corticosterone and nonsense oligomers (Figure 2).
In rat vascular tissue, 1 lβ-HSDl acts predominantly as a reductase metabolizing inactive 11-dehydro-glucocorticoid back to the active parent hormone. 11-dehydro- corticosterone (just like corticosterone) also amplifies the contractile responses to phenylephrine in rat aortic rings (Figure 3). In the rat, 1 lβ-HSDl is present in both vascular endothelial and smooth muscle cells and under physiological conditions this enzyme functions predominantly as a reductase. Furthermore, the effect of 1 lβ-HSDl antisense oligomers on the ability of 11- dehydro-corticosterone to amplify the contractile responses to phenylephrine was studied. Rings were incubated for 24 hours with 11-dehydro-corticosterone (100 nmol/L) and either 1 lβ-HSDl antisense (3 μmol/L) or nonsense (3 μmol/L) oligomers. 11 β-HSD 1 antisense oligomers attenuated the ability of 11 β-dehydro-corticosterone to amplify the contractile response to all concentrations of phenylephrine compared to 11- dehydro-corticosterone plus 11 β-HSD 1 nonsense oligomers. Statistically significant decreases were observed at 100 nmol/L and 1 μmol/L phenylephrine (Figure 3).
In aortic rings incubated (24-hours) with corticosterone (10 nmol/L) and 11 β- HSD2 antisense (3 μmol/L), the contractile response to graded concentrations of phenylephrine (PE: 10 nmol/L - 1 μmol/L) were significantly (P<0.05) increased compared to rings incubated with corticosterone and 1 lβ-HSD2 nonsense. 1 lβ-HSDl antisense oligomers also enhanced the ability of corticosterone to amplify the contractile response to phenylephrine.
Discussion
Earlier experiments showed that inhibitors of 11 β-HSD dehydrogenase activity enhance the ability of corticosterone to amplify the vasoconstrictive actions of phenylephrine and angiotensin II in rat aorta. The examples show that a specific 1 lβ- HSD2 antisense oligomer also enhances the ability of corticosterone to amplify the contractile responses of catecholamines. Since 1 lβ-HSD2 appears to exist only in endothelial cells, this observation supports a role for the action of glucocorticoids in affecting endothelial cell function. Although 11 β-HSD 1 acts predominantly as a reductase in vascular tissue, 11 β-HSD 1 antisense oligomers also enhanced the ability of corticosterone to amplify the contractile effects of phenylephrine in rat aortic rings. This observation suggests that 1 lβ-HSDl -dehydrogenase, in addition to 1 lβ-HSD2, also operates to protect GR and MR from over-activation by glucocorticoids in vascular tissue. Further experiments to determine whether antisense oligomers down-regulate mRNA and protein expression of their respective 11 β-HSD isoform under conditions in which they enhance contractile responses in aortic rings will be done. Using a similar protocol to the one described here, it has been shown using RT-PCR analysis, that 1 lβ- HSD2 antisense and 1 lβ-HSDl antisense down-regulate the expression of their respective enzyme isoforms in cultured rat vascular endothelial and smooth muscle cells. The example confirms that 11-dehydro-corticosterone also amplifies the contractile actions of catecholamines in rat aortic rings. Since 11-dehydro- glucocorticoids do not bind to GR (or MR) to any major extent, it is proposed that 11- dehydro-corticosterone is metabolized back to corticosterone by 1 lβ-HSDl -reductase in vascular smooth muscle and/or endothelial cells. This hypothesis is supported by the discovery that 11-keto-progesterone, a specific inhibitor of 1 lβ-HSDl -reductase activity (backward reaction), diminished the ability of 11-dehydro-corticosterone to amplify the contractile effects of phenylephrine and decreased the metabolism of 11-dehydro- corticosterone back to corticosterone. The examples also demonstrate that 1 lβ-HSDl antisense oligomer also attenuates the ability of 11-dehydro-corticosterone to amplify the contractile responses of phenylephrine indicating that the down-regulation of 1 lβ- HSDl gene expression can affect the regeneration of active glucocorticoid (from 11- dehydro-glucocorticoid) in vascular tissue. Indeed, the examples show that 1 lβ-HSDl antisense can significantly reduce the metabolism of 11-dehydro-corticosterone back to corticosterone in aortic ring preparations.
Example 2: Metabolism of Corticosterone and 11-Dehydro-Corticosterone in Vascular Tissue
Experimental: The effects of 1 lβ-HSDl and 1 lβ-HSD2 antisense on the inter-conversion of 3H- corticosterone and 3H-11-dehydro-corticosterone by aortic rings was also determined. Rings (2-3mm) obtained in a similar manner as those in the contraction studies, were incubated in 1 ml DMEM/F12 media containing 1% FBS at 37°C under 95% O2-5% CO2 in 24-well culture plates. Rings were incubated for 24 hours with:
(i) 3H-corticosterone (10 nmol/L) ± 1 lβ-HSD2 or 1 lβ-HSDl antisense (3 μmol/L); control groups received nonsense oligomers. The amount of 3H-ll-dehydro- corticqsterone in the incubation medium after 24 hrs was then measured. The effects of 1 lβ-HSDl antisense/nonsense were measured in quadruplicate (n = 6 aortic rings per well) and the effects of 1 lβ-HSD2 antisense/nonsense in duplicate (n = 8 aortic rings per well),
(ii) 3H-11-dehydro-corticosterone (10 nmol/L) ± 1 lβ-HSDl antisense (3 μmol/L); this experiment was performed in duplicate (n = 10 aortic rings per well). Control groups were incubated with the appropriate nonsense oligomer. 3H- corticosterone in the incubation medium after 24 hrs was then measured. In this experiment, aortic rings were also analyzed for 3H-corticosterone content. Rings from duplicate incubations (total n = 20) were blotted dry, pooled and homogenized in 50 % methanol using a Polytron. The homogenates were then centrifuged, extracted as below using Sep-Paks and injected onto a HPLC system for analysis.
Incubation media was collected, ran through a Sep-Pak and eluted with 3 mis of methanol, the eluate was then dried under nitrogen and reconstituted in 500:1 methanol. The aortic rings were dried and weighed. The steroids present in the eluate were separated by high-pressure liquid chromatography with a Dupont Zorbax C8 column eluted at 44°C at a flow rate of 1 mL/min using 55% methanol for 10 minutes. Steroids were observed by monitoring radioactivity on-line with a Packard Radiomatic Flo- One/Beta Series A-500 counter connected to a Dell Optiflex 425 S/L computer. Corticosterone and 11 -dehydro-corticosterone were identified by comparing their retention times with that of known standards.
Corticosterone and phenylephrine were obtained from Sigma (St Louis, MO), 11-dehydrocorticosterone from Research Plus (Bayonne, NJ) and 3H-steroids from New England Nuclear (Boston, MA). Where appropriate, data were expressed as mean ± SE and analyzed using ANOVA and the Student's t test with Bonferroni modification. P values of less than 0.05 are considered significant.
Results: Effects of 1 lβ-HSD Antisense on Steroid Metabolism
A series of experiments were then conducted to test whether 1 lβ-HSD2 and 1 lβ- HSDl antisense oligomers did affect the enzymatic conversion of corticosterone and 11- dehydrocorticosterone. In experiments in which aortae were taken from rats (n= 4) and 6 rings cut from each aorta were incubated for 24 hrs with 3H-corticosterone (10 nM) plus l lβ-HSDl antisense (3 μM), the conversion of corticosterone to 11- dehydrocorticosterone was 21% lower than in aortic rings incubated with corticosterone and 1 lβ-HSD 1 nonsense oligomers (Figure 4). In a further two experiments, aortae were taken from rats (n = 2) and 8 aortic rings cut from each. Aortic ring preparations incubated for 24hrs with corticosterone and 1 lβ-HSD2 antisense (3 μM), demonstrated a 24% reduction in the conversion of corticosterone to 11-dehydrocorticosterone compared to aortic rings incubated with corticosterone and 1 lβ-HSD2 nonsense (Figure 4).
To determine the effects of 1 lβ-HSD 1 antisense on 1 lβ-HSD 1 -reductase activity rat aortae were taken from rats( n= 2) and 10 aortic rings cut from each. These aortic rings were then incubated for 24 hours with 3H-11-dehydrocorticosterone and either 1 lβ-HSD 1 antisense or nonsense and the production of corticosterone was measured. The production of 3H-corticosterone was markedly reduced in rings incubated with 11 β- HSDl antisense compared to rings incubated with 1 lβ-HSD 1 nonsense oligomers (Figure 4, representative HPLC chromatograms from these experiments are also shown in Figure 5). Thus, 1 lβ-HSD 1 antisense profoundly diminished the ability of the rat aortic rings to metabolize 11 -dehydro-corticosterone back to corticosterone. The aortic ring tissue in these experiments was also pooled (n = 20) and analyzed for steroid content. The amount of radioactivity in the tissue was approximately 2-3% of the total radioactivity in the incubation media. The production of 3H-corticosterone in aortic rings incubated with 11 β-HSDl antisense was again markedly lower that that in rings incubated with 1 lβ-HSDl nonsense oligomers (see HPLC chromatograms, Figures 5 A - 5D). The levels Of3H-11-dehydrocorticosterone metabolism measured in the incubate and in the aortic tissue were very similar (Figures 5A-5D). This indicates that measuring steroid content in the media does not under-represent the level of steroid metabolism in the tissue compartment.
Discussion
In this example, experiments were undertaken to determine whether antisense oligomers could affect 11 β-HSD enzyme activity and, indeed, it has been demonstrated that 11 β-HSD2 and 11 β-HSD 1 antisense caused moderate reductions (24 and 21 % respectively) in the metabolism of corticosterone. These reductions in metabolism translate to relatively small increases in residual corticosterone levels in the aortic ring tissue that would not appear to account for the relatively large increases in phenylephrine-induced vasoconstriction observed in the contractile studies. However, glucocorticoids have been reported to not only amplify the contractile effects of catecholamines in vascular tissue but to also diminish the effects of certain vasorelaxation pathways (glucocorticoids decrease nitric oxide and prostaglandin I2 synthesis); such actions would serve to further enhance the effects of glucocorticoids on increasing catecholamine-induced vasoconstriction and may explain how small changes in glucocorticoid levels can have profound effects on vascular tone.
In addition, 1 lβ-HSD2 and 1 lβ-HSDl antisense also decreased the metabolism of corticosterone to 11 -dehydro-corticosterone. 11 -dehydro-corticosterone (100 nmol/L) also amplified the contractile response to phenylephrine in aortic rings (P<0.01), most likely due to the generation of active corticosterone by 1 lβ-HSDl -reductase; this effect was significantly attenuated by 1 lβ-HSDl antisense. 1 lβ-HSDl antisense also caused a marked decrease in the metabolism of 11 -dehydro-corticosterone back to corticosterone by 11 β-HSD 1 - reductase. These findings underscore the importance of 11 β-HSD2 and 1 lβ-HSDl in regulating local concentrations of glucocorticoids in vascular tissue. They also indicate that decreased 1 lβ-HSD2 activity may be a possible mechanism in hypertension and other blood pressure associated disorders and that 1 lβ-HSDl - reductase may be a possible target for anti-hypertensive therapy.
The results of these examples underscore the importance of 1 lβ-HSD2 in regulating the access of glucocorticoids to GR and/or MR in vascular tissue and suggest that 11 β-HSD 1 -dehydrogenase may also play a role in protecting GR and MR in this tissue. In addition, they suggest that the antisense oligomers used in these experiments down-regulate 11 β-HSD gene expression and decrease glucocorticoid metabolism in vascular tissue, an effect leading to increased vascular responsiveness to catecholamines. The examples also demonstrate that both 1 lβ-HSD2 and 1 lβ-HSDl regulate local glucocorticoid concentrations in vascular tissue with 1 lβ-HSD2 and 11 β-HSD 1- dehydrogenase working to decrease- and 1 lβ-HSDl -reductase increase the amount of glucocorticoid that can access GR and MR in vascular smooth muscle. Physiological concentrations of both free corticosterone and 11-dehydrocorticosteroiie are similar over the course of the day in rodents. Therefore, significant quantities of not only glucocorticoid, but also of 1 l-dehydro-glucocorticoid are available for conversion back to the glucocorticoid. Since glucocorticoids amplify catecholamine and angiotensin II pressor responses and may inhibit the effects of some vasorelaxant pathways, a possible mechanism that may increase vascular tone and induce hypertension includes a decrease in 1 lβ-HSD2 activity. Interestingly, many patients with essential hypertension also demonstrate decreased 11 β-HSD2 activity as assessed by altered plasma and urinary cortisol/cortisone ratios. Moreover, the plasma half-life of 1 lα-3H-cortisol is prolonged in patients with essential hypertension consistent with the idea that 1 lβ-HSD2 activity is diminished in this condition. The present work also suggests that since 1 lβ-HSDl reductase generates active glucocorticoid in vascular tissue, a possible therapeutic target in the treatment of hypertension could be the specific inhibition of 1 lβ-HSDl reductase activity.
Example 3: Endogenous Selective Inhibitors of llβ-Hydroxysteroid Dehydrogenase Isoforms 1 and 2 of Adrenal Origin
This example is directed to endogenous 11 -oxygenated, 5α and 5β- Ring A- reduced metabolites of adrenocorticosteroids, and progestogen and androgen steroid hormones. These substances were tested for their inhibitory properties against 1 lβ- HSD2, 11 β-HSD 1 dehydrogenase and 11 β-HSD 1 reductase.
This example shows that the following compounds stand out as potent inhibitors. These are 5α-DH-corticosterone, 3α,5α-TH-corticosterone, l lβ-OH-progesterone, llβ- OH-allopregnanolone, llβ-OH-Testosterone, and llβ-OH-androstanediol, inhibitors of 1 lβ-HSDl dehydrogenase; 3α,5α-TH-l l-dehydrocorticosterone, 11-Keto-Progesterone, 11-Keto-allopregnanolone, and 1 l-Keto-3β,5α-TH-Testosterone, inhibitors of 1 lβ- HSDl reductase; and 3 α, 5 α-TH -aldosterone, 5α-DH-corticosterone, 3α,5α-TH- corticosterone ,11-dehydrocorticosterone, 3α,5α-TH-ll-dehydrocorticosterone, l lβ- OH-progesterone, 11-keto-progesterone, 11 β-OH-allopregnanolone, 11-keto- allopregnanolone, l lβ-OH-testosterone, and 11-keto-testosterone, inhibitors of l lβ- HSD2. All of these substances have the potential to be derived from adrenally synthesized corticosteroids. Substances with similar structures to those described may help in the design of exogenous agents for the management of a variety of disease states involving 11 β-HSD isoenzymes. The present example explores both C 19- and C21- steroids and their derivatives, originating from the adrenal gland, for their inhibitory properties and relative potencies. This example focuses on an expanded group of endogenous 11 -oxygenated, 5α and 5β- Ring A- reduced metabolites of adrenocorticosteroids, and progestogen and androgen steroid hormones. These endogenous substances were tested not only for their inhibitory properties against 1 lβ-HSD2 and 1 lβ-HSDl dehydrogenase, but also for their inhibitory activity towards 1 lβ-HSDl reductase. Freshly prepared rat Leydig cell homogenates were chosen since they provide a rich and reliable source of both 1 lβ-HSDl dehydrogenase and reductase (Gao et ah, 1997, Endocrinology 138:156-161), and sheep kidney microsomes for 11 β-HSD2 dehydrogenase.
Experimental
Reagents
[1,2,6,7-3H]-Corticosterone with the specific activity of 70 Ci/mmole was obtained from NEN Life Science Products. Radioactive [1,2,6,7-3H]-11-dehydro- corticosterone (specific activity of 80 Ci/mmole) was synthesized from [3H]- Corticosterone according to previously reported methods (Latif et al, 1997, Steroids 62:230-237). Methanol (HPLC-grade) was obtained from Fisher Scientific. HEPES, Tris-HCl, NAD, NADP, NADPH were from Sigma Chemical Co. Corticosterone, 11- dehydro-corticosterone and other steroids (Table 2) were from Steraloids (Newport, Rhode Island ).
TABLE 2
Figure imgf000040_0001
Figure imgf000041_0001
HPLC
Each enzyme reaction (described below) was stopped by adding 750 μL MeOH. After centrifugation, an aliquot of supernatant was analyzed by HPLC using a DuPont Zorbax C8 column. The separated radioactive products (corticosterone and 11-dehydro- corticosterone) were detected and quantitated by flow-cell scintillation analysis (Latif et al.,1997, Steroids 62:230 -237).
llβ-HSDl Assay for Dehydrogenase and Reductase Activity 1 lβ-HSDl Assay in Rat Leydig Cell Homogenates
Freshly prepared rat Leydig cells were homogenized in 700 μL of 25 mM HEPES buffer; pH 7.4 as previously described (Gao et al., 1997, Endocrinology 138:156-161). 1 lβ-HSDl dehydrogenase was assayed by incubating homogenates (13,000 cells equivalent) with 600 nM [3H]-B (0.5 μCi) in the presence of 3 mM NADP, 50 mM Tris-HCl; pH 8.4 at 37° C for 10 minutes in a total volume of 250 μL. 1 lβ- HSDl reductase was assayed by incubating homogenates (52,000 cells equivalent) with 600 nM [3H]-11-dehydro-corticosterone in presence of 3 mM NADPH, 50 mM Tris- HCl; pH 7.4 at 37° C for 20 minutes in a total volume of 250 μL. Under these conditions 58% [ H]-l l-dehydrocorticosterone and 54% [ H]-corticosterone, respectively, were made.
Assay of 1 lβ-HSD2 Enzyme Activity in Sheep Kidney Microsomes 11B-HSD2 assay was performed as previously described (Latif et al., 1997, Steroids 62:230 -237) incubating sheep kidney microsomal fraction (6.5 μg protein) with 50 nM corticosterone containing lμCi [3H]-corticosterone, 50 mM Tris-HCl buffer; pH 8.4, and 200 μM NAD+ for 10 min at 37°C, in a total volume of 0.25 mL; under these conditions 62% [3H]-11-dehydro-corticosterone was made. The enzymatic reaction was terminated by addition of methanol and synthesis of 11-dehydro- corticosterone was quantitated by HPLC as described above.
To determine the IC50 for each steroid, the percentage inhibition of the reaction was calculated by measuring the decrease in product formation in the presence of varying concentrations of steroid (0.01 to 250 μM) as compared with product formed in the controls (in the presence of vehicle without steroid). Each concentration was tested in triplicate and the dose response curve, showing percentage inhibition versus log concentration of steroid was plotted. The data fitted a log-linear straight line. From these curves, the μM concentration (IC50) that caused a 50% inhibition of the reaction rate was determined.
RESULTS:
Effects of Aldosterone, Cortisol, and Corticosterone and their 5α and 5β metabolites on llβ-HSDl and llβ-HSD2 activities
llβ-HSD2
The 5α Ring A- reduced derivative of aldosterone (3α,5α-TH-aldosterone ) strongly inhibited 1 lβ-HSD2 with an IC50 of 0.5 μM, whereas aldosterone and its 5β Ring A- reduced derivative(3α,5β -TH-aldosterone ) were inactive (Table 3). The 5α Ring A- reduced derivative of cortisol(3α,5α-TH-cortisol) was only a weak inhibitor with an IC50 of 8.0 μM and 3α,5β-TH-cortisol was inactive. Both 5α Ring A- reduced derivatives of corticosterone, 5α-DH-corticosterone and 3α,5α-TH-corticosterone were potent inhibitors of 1 lβ-HSD2 with IC50 's of 0.15 μM and 0.26 μM, respectively, whereas the 5β- form( 3α,5β-TH-corticosterone) was inactive. Both 11-dehydro- corticosterone and its 5α Ring A- reduced product, 3α,5α-TH-l 1-dehydro- corticosterone, were also potent inhibitors of 1 lβ-HSD2 with ICs0 's of 0.47 μM and 0.8μM, respectively, whereas again the 5β-form( 3α,5β-TH-l 1-Dehydro-corticosterone) was inactive. Table 3
Dehydrogenase Compounds [S] = 50 nM
Aldosterone IA
3α,5α-TH-Aldosterone 0.5
3α,5β-TH-Aldosterone IA
3α,5α-TH-Cortisol 8.0
3α,5β-TH- Cortisol IA
5α-DH-Corticosterone 0.15
3α,5α-TH- Corticosterone 0.26
3α,5β-TH-Corticosterone IA
11-dehydro-Corticosterone 0.47
3α,5α-TH-l 1-dehydrocorticosterone 0.80
3α,5β-TH-l 1-dehydro-corticosterone IA
Key; Potent = up to 1.5μM, Moderate = 1.5-5.0 μM, Weak = 5-10μM; Inactive (IA) >10
llβ-HSDl Inhibition of Dehydrogenase activity
Aldosterone and its 5β- reduced derivative(3α,5β -TH-aldosterone) were inactive towards 1 lβ-HSDl dehydrogenase in this assay, however, the 5α - reduced derivative (3α,5α-TH-aldosterone ) was a moderate inhibitor with an IC50 of 25.0 μM, (Table 4). The 5α-reduced derivative of Cortisol(3α,5α-TH-cortisol) was also a moderate inhibitor with an IC50 of 14.0 μM but 3α,5β-TH-cortisol was inactive as were 3α,5α-TH-cortisol and 3α,5β-TH-cortisol. Both 5α Ring A- reduced derivatives, 5α-DH-corticosterone and 3α,5α-TH-corticosterone were potent inhibitors of 1 lβ-HSDl dehydrogenase with IC5O 5S of 2.1 μM and 1.3 μM, respectively, whereas the 5β- form( 3α,5β-TH- corticosterone) was inactive. The 5α-reduced derivative, 3α,5α-TH-l 1-Dehydro- corticosterone, was also a strong inhibitor with an IC50 of 8.0 μM, whereas again the 5β- form( 3α,5β-TH-l 1-Dehydro-corticosterone) was inactive in this assay.
Table 4
Leydig Cell Leydig Cell
Compounds llβ-HSDl llβ-HSDl
Dehydrogenase Reductase [S] = 600 nM [S] = 600 nM
Aldosterone IA IA
3α,5α-TH-Aldosterone 25.0 IA
3α,5β-TH-Aldosterone IA IA
3α,5α-TH-Cortisol 14.0 IA
3α,5β-TH-Cortisol IA IA
3α,5α-TH- Cortisone IA 4.3
3α,5β-TH-Cortisone IA 60.0
5α-DH-Corticosterone 2.1 6.3
3α,5α-TH-Corticosterone 1.3 50.0
3α,5 β-TH-Corticosterone IA IA
11-dehydrocorticosterone IA
3α,5α-TH- 11-dehydrocortiGθsterone 8.0 0.7
3α,5β-TH~l 1-dehydrocorticosterone IA IA
Key; Potent = l-10μM, Moderate = 11-30 μM, Weak = >50μM; Inactive = > lOOμM
Inhibition of Reductase activity
Aldosterone and each of its 5α and 5β- reduced derivatives(3α,5α-TΗ- aldosterone and 3α,5β-TH-aldosteone ) were inactive towards llβ-HSDl reductase, as were the 5α- and 5β- reduced derivatives of Cortisol(3α,5α-TH-cortisol and 3α,5β-TH- cortisol) (Table 4). However, the 11-dehydro-derivative, 3α,5α-TH-corticosterone strongly inhibited 11 β-HSD 1 reductase with an IC50 of 4.3 μM. Of the other 5α - reduced derivatives tested, 5α-DH-corticosterone was a strong inhibitor with an IC50 of 6.3 μM compared to 3α,5α-TH-corticosterone which was a weak inhibitor, but interestingly, 3α,5α-TH-l 1-Dehydro-corticosterone very potently inhibited 1 lβ-HSDl reductase with an IC50 of 0.7 μM. Again, however, each of the 5β- reduced derivatives (3α,5β-TH-corticosterone and 3α,5β-TH-l 1-Dehydro-corticosterone) was inactive.
Effects of llβ-OH and 11 Keto derivatives of Progesterone and Androgens on llβ- HSDl and llβ-HSD2 activities
Uβ-HSD2
Both 11 β-OH-progesterone and 11-keto-progesterone were potent inhibitors of 1 lβ-HSD2 (Latif et al.,1997, Steroids 62:230 -237) with IC50 5S of 0.05 μM and 0.40 μM, respectively. Each of their 5α Ring A- reduced derivatives, 11 β-OH- allopregnanolone and 11-keto-allopregnanolone also potently inhibited llβ-HSD2 activity with IC50 5S of 0.12 μM and 1.5 μM, respectively (Table 5). Both of their 5β- reduced derivatives, 11 β-OH-pregnanolone and 11-keto-pregnanolone were inactive as dehydrogenase inhibitors. llβ-OH-Testosterone and 11-keto-testoesterone were also potent inhibitors of 11 β-HSD2 dehydrogenase activity with IC50 5S of 0.35 μM and 1.35 μM, respectively. 1 lβ-OH- androstanediol and 1 l-keto-3 β,5α-TH-testosterone inhibited of 1 lβ-HSD2 dehydrogenase activity with IC50 's of 4.50 μM and 8.0 μM, respectively (Table 5). 1 lβ-OH-androstenedione was only a weak inhibitor of 1 lβ-HSD2 and 11-keto- androstenedione was inactive as were their 5α Ring A- reduced derivatives.
Table 5
Compounds Sheep kidney llβ-HSD2 [S] = 50 nM
11 β-OH-Progesterone 0.05 11-Keto-Progesterone 0.40
11 β-OH-allopregnanolone 0.12 11 β-OH-pregnanolone IA
11-Keto-allopregnanolone 1.50 11-Keto-pregnanolone IA llβ-OH-Testosterone 0.35 11 β-OH-androstanediol 4.50
11-Keto-Testosterone 1.35 1 l-Keto-3β,5α-TH-Testosterone 8.00
1 lβ-OH- Androstenedione 7.80 11 β-OH-androsterone IA
11-Keto- Androstenedione IA 11-Keto-androsterone IA
Key; Potent = up to 1.5 μM, Moderate = 1.5-5.0 μM, Weak = 5-10 μM Inactive (I A)> 10
llβ-HSDl
Inhibition of Dehydrogenase activity
When tested against testicular Leydig cell homogenates, 1 lβ-OH-progesterone and 1 lβ-OH-testosterone strongly inhibited 1 lβ-HSDl dehydrogenase activity with IC50's of 5.6 μM and 9.0 μM, respectively, whereas 11-keto- progesterone and 11-keto- testosterone were inactive. Both 11 β-OH-androstenedione and 11-keto- androstenedione were inactive as inhibitors of 1 lβ-HSDl dehydrogenase (Table 6). The 5α Ring A- reduced derivatives, l lβ-OH-allopreg-nanolone and 11 β-OH-androstanediol also potently inhibited l lβ-HSDl dehydrogenase activity with IC50 5S of 3.0 μM and 5.0μM, respectively, but 1 l-keto-3β,5α-TH- testosterone was a weak inhibitor and 11- keto-allopregnanolone was inactive. However, all the 5β-reduced derivatives, with exception of 11 β-OH-pregnanolone which moderately inhibited 1 lβ-HSDl with an of 30.0 μM, were inactive as dehydrogenase inhibitors as were the 5β- reduced derivatives of 11 β-OH-androstenedione and 11-Keto- androstenedione.
Table 6
Compounds Leydig Cell Leydig Cell
1 lβ-HSDl 1 lβ-HSDl
Dehydrogenase Reductase
[S] = 600 nM [S] = 600 nM
11 β-OH-Progesterone 5.6 IA
11 β-OH-allopregnanolone 3.0 IA
11 β-OH-pregnanolone 30.0 80.0
11-Keto-Progesterone IA 9.5
11-Keto-allopregnanolone IA 0.8
11 -Keto-pregnanolone IA 65.0
1 lβ-OH-Testosterone 9.0 IA
11 β-OH-androstanediol 5.0 11.5
11-Keto-Testosterone IA 18.0
1 l-Keto-3β,5α-TH-Testosterone 50.0 0.65
11 β-OH- Androstenedione IA IA
11 β-OH-androsterone IA IA
1 1 β_OTT_(=»ti.Λr»lir\iQnr\1r\r-(=» IA IA
11 -Keto-Androstenedione IA 21.0
11-Keto-androsterone IA IA
11-Keto-etiocholanolone IA IA
Key; Potent = l-10μM, Moderate = 11-30 μM, Weak = >50μM; Inactive > 100 μM
Inhibition of Reductase activity
When tested against testicular Leydig cell 1 lβ-HSDl reductase (Table 6), all of the l lβ-hydroxylated steroids, l lβ OH-progesterone, l lβ-OH-testosterone and their Ring A reduced derivatives were inactive. Whereas, the 11-keto derivatives, 11-keto- progesterone,ll-keto-testosterone and 11-keto- androstenedione inhibited reductase activity with ICs0 5S of 9.5μM, 18.0 μM and 21.0 μM, respectively. The 5α-derivatives, 11-keto-allopregnanolone, as well as ll-keto-3 β,5α-TH- testosterone, strongly inhibited 1 lβ-HSDl reductase activity (Table 6) with IC50 's of 0.8 μM and 0.65μM, respectively, their potency being increased by an order of magnitude compared with their corresponding 11- keto-parent steroids (11-keto- progesterone and 11-Keto- testosterone, respectively; Table 6). In addition, these ll-keto-5α-TH- derivatives were also more potent as reductase inhibitors, by an order of magnitude, when comparing the inhibitory properties of their corresponding 1 lβ OH- derivatives towards dehydrogenase activity (llβ-OH- allopregnanolone and 11 β-OH-androstanediol; Table 6). The 5β- reduced derivatives, 11 β-OH-pregnanolone and 11-keto-pregnanolone weakly inhibited l lβ-HSDl reductase with IC50 3S of 80.0 μM, and 65.0 μM, respectively. However, the 5β- reduced derivative of 11-keto-androstenedione was inactive.
Discussion
The relative importance of each of the isoforms of 1 lβ-HSD have become clearer in homeostasis, blood pressure regulation, and several other disease states. Impaired function of 1 lβ-HSD2 permits glucocorticoids to access MR in peripheral target tissues, such as kidney, and lead to increased Na retention and increased BP. 1 lβ- HSDl functions predominantly in the reductase mode, but can also display significant dehydrogenase activity in several tissues(Tomlinson et al., 2005; Morris etal.,2003 ). Alterations in the rates of enzymatic reaction in either of the components of bidirectional 1 lβ-HSD 1 will lead to an adjustment of the set point / functional equilibrium of this enzyme, permitting either increased or decreased local levels of glucocorticoids in their target tissues. In vascular tissue for example, blunting of the dehydrogenase activity would lead to increased BP whereas impaired reductase activity would lead to a potential decrease in BP (Brem et al., 1997; Souness et al., 2002). Similarly, inhibition of either 1 lβ-HSD 1 dehydrogenase or reductase in other target tissues such as adipocytes, the eye, testicular Leydig cells, etc.( Tomlinson et al., 2005; Morris etal.,2003; Bujalska et al., 2002;Rauz et al., 2003), will also alter the eqilibrium set-point of this enzyme and hence local levels of Cortisol.
Previously, it had been found that the 3α5α-tetrahydro-derivatives of several adrenal corticosteroid hormones, particularly aldosterone, corticosterone, and 11- dehydro-corticosterone, selectively inhibit 1 lβ-HSD2 dehydrogenase when compared to their 5β- derivatives (Latif et al., 1997, Steroids 62:230 -237). The present studies demonstrate that 11-hydroxylated derivatives of progestogens and androgens and their 3α5α-tetrahydro-metabolites, all of which may be potentially derived from adrenal corticosterone and Cortisol, also strongly inhibit 1 lβ-HSD2; whereas their 5β- derivatives were inactive. In addition, several 11-keto-derivatives, and particularly their 3α5α-tetrahydro-metabolites, are also potent inhibitors of 1 lβ-HSD2, most likely serving as end-product inhibitors. Similarly, the examples have identified selective inhibitors of 1 lβ-HSDl dehydrogenase and reductase. For example, l lβ-hydroxy-progesterone, its 3α5α- tetrahydro-derivative, llβ-hydroxy- testosterone and its 3α5α-tetrahydro-metabolite, (but not 11 β-hydroxy-androstenedione or its 3α5α-tetrahydro-metabolite), potently inhibit 1 lβ-HSDl dehydrogenase. As can be seen in Table 5, replacement of the 17-OH in the testosterone series with a 17-keto group markedly diminished the inhibitory capability. In contrast, the 11-keto derivatives of both progesterone and testosterone and particularly their 5α-tetrahydro-derivatives were potent inhibitors of the reductase component of 11 β-HSD 1. Surprisingly, it also was a moderate inhibitor of the reductase component of 11 β-HSD 1 (Table 5).
The various 11 -oxygenated steroid metabolites tested in the examples can all be of adrenal origin, and may be synthesized in other endocrine and glucocorticoid and mineralocorticoid target tissues. These 11 -oxygenated C21- and C19-steroidal substances, whether produced in the adrenal gland, or produced elsewhere, may be a source of inhibitors (Figure 6). They may regulate either the overall metabolism of Cortisol by 1 lβ-HSD2 or affect the direction of 1 lβ-HSDl in its various target tissues. Although not widely acknowledged, important earlier work (Honour et al., 1982; Bokkenhauser et al.,1979) had clearly indicated that a significant proportion of the glucocorticoid, corticosterone, in both humans and rodents is 21-deoxygenated by microorganisms in intestinal flora yielding 11 -oxygenated derivatives of progesterone and its 5α-tetrahydro-derivatives. This is exemplified by the very high levels of 1 lβ- hydroxy-progesterone and its 5α- Ring A reduced derivatives (derived from corticosterone) identified by Gas chromatography- Mass Spec analysis in patients with congenital 17-hydroxylase deficiency and adrenal hyperplasia , in addition to their increased levels of corticosterone and deoxycorticosterone (Chapman et al., 1991; Shackleton et al., 1979).
In addition, a significant proportion (10-15%) of the principal glucocorticoid , Cortisol, secreted in humans is metabolized to 1 lβ-hydroxy- androstenedione in both the adrenal gland and in other target tissues (Cope, 1972; Kornel et al., 1994; Ganis et al.,1956). llβ-hydroxy- androstenedione is likely metabolized further to l lβ-hydroxy- testosterone by 17-hydoxysteroid dehydrogenase (17β-HSD) and converted to 5α- tetrahydro-derivatives in target tissues of glucocorticoids. It has been shown (Kornel et al., 1994; Ganis et al.,1956) that Cortisol is converted, possibly by a C17, C20- lyase, to 1 lβ-OH- and 11-keto- androstenedione in vascular tissue of rabbit aorta and kidney tissue. Multiple isoforms of the bi-directional enzyme 17β- hydroxysteroid dehydrogenase/ 17-ketosteroid reductase (17β-HSD) have now been reported ( Khan et al., 2004; Andersson et al., 1997; Pelletier et al., 2005). They are widely distributed and the overall directionality of the enzyme may differ depending on the isoform composition in the various tissues studied. As pointed out above, several investigators ( Monder et al., 1993; Pearson Murphy et al., 1981), have also previously shown that 1 lβ- OH- androstenedione is a poor inhibitor of both 1 lβ-HSDl and 2 isoforms. Nonetheless, the enzymatic reduction of the 17-keto group yielding 17-OH - Cl 9 steroids may transform and markedly activate these steroids into very potent inhibitors of either 11 β- HSD isoenzyme. Many studies have been reported on the ability of target tissues to transform steroid hormones to their Ring A- reduced and other metabolites. However, until now less emphasis has been given to locally synthesised endogenous inhibitors which may regulate the extent of 1 lβ-HSD2 dehydrogenase and 1 lβ-HSDl dehydrogenase and reductase activities.
A consistent finding from these studies is that 5β-Ring A reduced tetrahydro- metabolites are inactive as inhibitors of 1 lβ-HSD2, and these 5β-reduced-l lβ- hydroxylated derivatives are less effective (or inactive) as inhibitors of 1 lβ-HSDl dehydrogenase. In addition the corresponding 5β-l 1-keto derivatives are far less potent (or inactive) as inhibitors of 11 β-HSDl reductase than their corresponding 5α-Ring A reduced tetrahydro-derivatives. Thus, as in the case of licorice ingestion (Stewart et al., 1987) and studies with patients with essential hypertension (Kornel et al., 1969; Soro et al. 1995; Walker et al., 1993), the marked increases in the ratio of 5α/ 5β- reduced steroid metabolites synthesized in vivo, may be more directly linked to the observed increased Na+ retention and high BP. Such a ratio change in the routes of steroid metabolism could account for the prolonged half-life, tm, of Cortisol observed in these earlier studies (Kornel et al., 1969; Soro et al. 1995; Walker et al., 1993) and be responsible for Cortisol being recruited to act as a mineralocorticoid in the kidney. Likewise, this switch may also be responsible for an increase in local Cortisol levels in vascular tissue in these patients due to the actions of 5α —inhibitors, similar to the increased BP observed when 1 iβ-OH-allopregnanolone was infused into normotensive SD rats (Morris et al., 1996). It had been suggested that the presence of endogenous substances in human urine which was termed "glycyrrhetinic acid-like factors (GALFs)", which like the licorice derivative, inhibit 1 lβ-HSD2 (Morris et al., 1992). It was also reported that the levels of urinary 1 lβ-HSD2 inhibitors increased in patients with normal/high renin with essential hypertension who were challenged with a low Na+ dietary intake and correlated with the excretion of free urinary Cortisol (Morris et al., 1998). As mentioned above, earlier studies showed that rats fed a low Na+ diet was associated with a ratio change in 5β- to 5α- Ring A reduced metabolites of adrencorticosteroids (Gorsline et al.,1988). Although the chemical identities of the endogenous 1 lβ-HSD2-GALFs have yet to be determined, the present studies are offered to help determine the types of selective candidate inhibitors of either 1 lβ-HSD2, 1 lβ-HSDl -dehydrogenase or 1 lβ-HSDl -reductase that might be endogenously synthesized. In humans, some of these inhibitor substances have been shown to be synthesized locally, others to be present in the peripheral circulation, and excreted (in some cases as further metabolic products) in urine in both normal and disease states. Thus, they may well serve as endogenous GALF inhibitors of 11 β-HSD2 in kidney, vascular endothelium, and other tissues and play a role to increase local Cortisol levels. Endogenous inhibitors of 1 lβ-HSDl dehydrogenase and 1 lβ-HSDl reductase may also serve as 1 lβ-HSDl -GALFs and adjust the set point of local deactivation /reactivation of Cortisol in vascular and other target tissues of glucocorticoids.
The following compounds stand out as potent candidate inhibitors specific to their respective isoenzymes because of their high potency observed as inhibitors during our screening. These are 5α-DH-corticosterone, 3α,5α-TH-corticosterone, l lβ-OH- progesterone, 11 β-OH- allopregnanolone, 11 β-OH-testosterone, and 11 β-OH- androstanediol, as candidate inhibitors of 1 lβ-HSDl dehydrogenase; 3α,5α-TH-l 1- dehydrocorticosterone, 11-keto-progesterone, 11-keto-allopregnanolone, and 11-keto- 3β,5α-TH-testosterone, as candidate inhibitors of 1 lβ-HSDl reductase; and 3α,5α-TH- aldosterone, 5α-DH-corticosterone, 3α,5α-TH-corticosterone, 11- dehydrocorticosterone, 3α,5α-TH-ll-dehydrocorticosterone, l lβ-OH-Progesterone, 11- keto-progesterone, 11 β-OH- allopregnanolone, 11-keto-allopregnanolone, 11 β-OH- testosterone, and 11-keto-testosterone, as candidate inhibitors of llβ-HSD2. The physiological importance of 1 lβ-HSD2 and bidirectional 1 lβ-HSDl present in a variety of target tissues in several disease states involving salt retention, hypertension, obesity, diabetes, and occular hypertension is slowly emerging (Tomlinson et al., 2005). New agents have recently been reported which blunt the regeneration of active glucocorticoids from their inactive 11-dehydro derivatives in the treatment of high blood glucose levels (Alberts et al., 2002). Thus, endogenous inhibitors of 1 lβ-HSD2 and both 1 lβ-HSDl dehydrogenase and 1 lβ-HSDl reductase, possibly with similar structures to those described in the present studies, may not only participate or be involved in several disease processes but their identification may also help in the design of exogenous agents in the management of a variety of disease states.
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EQUIVALENTS
Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments and methods described herein. Such equivalents are intended to be encompassed by the scope of the following claims.
AU patents, patent applications, and literature references cited herein are hereby expressly incorporated by reference. The entire contents of U.S. S.N. 11/112,723, entitled "Selective 11 β-HSD Inhibitors And Methods Of Use Thereof are hereby incorporated herein by reference.

Claims

1. A method for treating a glucocorticoid associated state in a subject, comprising administering to said subject an effective amount of a 11 β-HSDl reductase inhibitor, such that the glucocorticoid associated state is treated, wherein said 1 lβ-HSDl reductase inhibitor is a 3β, 5α-reduced steroid.
2. A method for treating a glucocorticoid associated state in a subject, comprising administering to said subject an effective amount of a 1 lβ-HSDl reductase inhibitor, such that the glucocorticoid associated state is treated, wherein said 1 lβ-HSDl reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH- corticosterone, 3α,5α-TH-ll-dehydro-corticosterone, l lβ-OH-pregnanolone, 11-keto- allopregnanolone, 11-keto-androstenedione, or a pharmaceutically acceptable prodrug or salt thereof.
3. The method of claim 1 or 2, wherein said glucocorticoid associated state is a blood pressure associated disorder.
4. The method of claim 3, wherein said blood pressure associated disorder is high blood pressure, congestive heart failure, chronic heart failure, left ventricular hypertrophy, acute heart failure, myocardial infarction, cardiomyopathy, or hypertension.
5. The method of claim 1 or 2, wherein said glucocorticoid associated state is obesity, diabetes mellitus, interocular pressure, lung disorder, or a neurological disorder.
6. The method of claim 5, wherein said neurological disorder is associated with glucocorticoid potentiated neurotoxicity.
7. The method of claim 1, wherein said 3β, 5α-reduced steroid is 1 l-keto-3β,5α- TH-testosterone, 3β, 5α-reduced-l l-ketoprogesterone, 3β, 5α-reduced-l 1-keto- androstenedione, 3β,5α-tetrahydro-ll-dehydro-corticosterone, 3β, 5α-reduced-ll-keto- pregnenolone, 3β, 5α-reduced-ll-keto-dehydro-epiandrostenedione, 3β, 5α- reduced deoxycorticosterone, 3β,5α-reduced progesterone, 3β, 5α-reduced testosterone, or a pharmaceutically acceptable salt or prodrug thereof.
8. A method for treating a glucocorticoid associated state in a subject, comprising administering to said subject an effective amount of a 1 lβ-HSDl reductase inhibitor in combination with a 17α-hydroxylase inhibitor, 17-HSD inhibitor, 20α-reductase inhibitor, or a 20β-reductase inhibitor, wherein said 1 lβ-HSDl reductase inhibitor is a 3β, 5α-reduced steroid.
9. A method for treating a glucocorticoid associated state in a subject, comprising administering to said subject an effective amount of a 1 lβ-HSDl reductase inhibitor in combination with a 17α-hydroxylase inhibitor, 17-HSD inhibitor, 20α-reductase inhibitor, or a 20β-reductase inhibitor, wherein said 11 β-HSD 1 reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH- corticosterone, 3α,5α-TH-ll-dehydro-corticosterone, l lβ-OH-pregnanolone, 11-keto- allopregnanolone, 11-keto-androstenedione, or a pharmaceutically acceptable prodrug or salt thereof.
10. The method of claim 8, wherein said 3β, 5α-reduced steroid is 1 l-keto-3β,5α- TH-testosterone, 3β, 5α-reduced-l l-ketoprogesterone, 3β, 5α-reduced-l 1-keto- androstenedione, 3β,5α-tetrahydro-ll-dehydro-corticosterone, 3β, 5α-reduced-ll-keto- pregnenolone, 3β, 5α-reduced-ll-keto-dehydro-epiandrostenedione, 3β, 5α- reduced deoxycorticosterone, 3β,5α-reduced progesterone, 3β, 5α-reduced testosterone, or a pharmaceutically acceptable salt or prodrug thereof.
11. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 1 lβ-HSDl dehydrogenase inhibitor is a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof.
12. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 1 lβ-HSDl dehydrogenase inhibitor is 3α,5α-TH-aldosterone, 3α,5α-TH-cortisol, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, or a pharmaceutically acceptable prodrug or salt thereof.
13. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said llβ-HSDl dehydrogenase inhibitor is 3α,5α-TΗ-ll-dehydro- corticosterone, 11 β-OH-allopregnanolone, 11 β-OH-pregnanolone, 1 lβ-OH- androstanediol, or a pharmaceutically acceptable prodrug or salt thereof.
14. The method of any one of claims 11-13, wherein said tissue is said subject's liver, eye, lung, muscle, adipose tissue, nerve tissue, brain, or vascular tissue.
15. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor in combination with a 17α-hydroxylase inhibitor, 17HSD inhibitor, 20α-reductase inhibitor or 20β-reductase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said llβ-HSDl dehydrogenase inhibitor is a 3β, 5α-reduced steroid or a pharmaceutically acceptable salt or prodrug thereof.
16. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSDl dehydrogenase inhibitor in combination with a 17α-hydroxylase inhibitor, 17HSD inhibitor, 20α-reductase inhibitor or 20β-reductase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 11 β-HSDl dehydrogenase inhibitor is 3α,5α-TH-aldosterone, 3α,5α-TH-cortisol, 5α-DH-corticosterone, 3α, 5α- TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 11 β-OH-allopregnanolone, 11 β-OH-pregnanolone, 1 lβ-OH-androstanediol, or a pharmaceutically acceptable prodrug or salt thereof.
17. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a llβ-HSD2 dehydrogenase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 1 lβ-HSD2 dehydrogenase inhibitor is 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH-corticosterone, 11-dehydro-corticosterone, 3α,5α-TH-l l- dehydrocorticosterone, 11-keto-allopregnanolone, 1 lβ-OH-androstanediol, llβ-OH- androstenedione, or a pharmaceutically acceptable salt or prodrug thereof.
18. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSD2 dehydrogenase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 1 lβ-HSD2 dehydrogenase inhibitor is a 3β, 5α-reduced steroid or a pharmaceutically acceptable salt or prodrug thereof.
19. The method of claim 17 or 18, wherein said tissue is said subject's liver, kidney, eye, lung, muscle, adipose tissue, nerve tissue, brain, or vascular tissue.
20. A method for increasing the concentration of glucocorticoids in a tissue of a subject, comprising administering to a subject an effective amount of a 1 lβ-HSD2 dehydrogenase inhibitor in combination with a 17α-hydroxylase inhibitor, 17-HSD inhibitor, 20α-reductase inhibitor, or a 20β-reductase inhibitor, such that the concentration of glucocorticoids in said tissue are increased, wherein said 1 lβ-HSD2 dehydrogenase inhibitor is 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH- corticosterone, 11-dehydro-corticosterone, 3α,5α-TH-ll-dehydrocorticosterone, 11- keto-allopregnanolone, l lβ-OH-androstanediol, llβ-OH-androstenedione, a 3β, 5α- reduced steroid, or a pharmaceutically acceptable salt or prodrug thereof.
21. A method for treating hypertension in a subj ect, comprising administering to said subject an effective amount of a 1 lβ-HSDl reductase inhibitor, such that said subject is treated, wherein said 1 lβ-HSDl reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH- cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-ll-dehydro- corticosterone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- androstenedione, a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof.
22. A method for treating hypertension in a subject, comprising administering to said subject an effective amount of a 1 lβ-HSDl reductase inhibitor, such that said subject is treated, wherein said 1 lβ-HSDl reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH- cortisone, 5α-DH-corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-ll-dehydro- corticosterone, 11 β-OH-pregnanolone, 11-keto-allopregnanolone, 11-keto- androstenedione, a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof.
23. A method for treating hypertension in a subject, comprising administering to said subject an effective amount of a 1 lβ-HSDl reductase inhibitor in combination with a 17α-hydroxylase inhibitor, a 17-HSD inhibitor, a 20α-reductase inhibitor or a 20β- reductase inhibitor, such that said subject is treated, wherein said 1 lβ-HSDl reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α, 5α-TH- corticosterone, 3α,5α-TH-ll-dehydro-corticosterone, 11 β-OH-pregnanolone, 11-keto- allopregnanolone, 11-keto-androstenedione, a 3β, 5α-reduced steroid or a pharmaceutically acceptable prodrug or salt thereof..
24. A method for increasing insulin sensitivity of a tissue in a subject, comprising administering an effective amount of a 1 lβ-HSDl reductase inhibitor to said subject, such that the insulin sensitivity of said tissue in said subject is increased, wherein said 1 lβ-HSDl reductase inhibitor is 3α,5α-TH-cortisone, 3α,5β-TH-cortisone, 5α-DH- corticosterone, 3α, 5α-TH-corticosterone, 3α,5α-TH-l l-dehydro-corticosterone, 11 β- OH-pregnanolone, 11-keto-allopregnanolone, 11-keto-androstenedione, a 3β, 5α- reduced steroid or a pharmaceutically acceptable prodrug or salt thereof.
25. The method of claim 24, wherein said tissue is said subject's liver, muscle, nerve or adipose tissue.
26. The method of any one of claims 1-25, wherein said subject is a human.
27. The method of any one of claims 1-26, further comprising administering a pharmaceutically acceptable carrier.
28. A pharmaceutical composition comprising an effective amount of 3α,5α-TH- aldosterone, 3α,5β-TH-aldosterone, 3α,5α-TH-cortisol, 3α,5β-TH-cortisol, 3α,5α-TH- cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α,5α-TH-corticosterone, 3α,5β- TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 3α,5β-TH-l 1-dehydro- corticosterone, l lβ-OH-allopregnanolone, llβ-OH-pregnanolone, 11-keto- allopregnanolone, 11-keto-pregnanolone, l lβ-OH-adrostenedione, 11-keto- adrostenedione, llβ-OH-androstanediol, ll-keto-3β,5α-TH-testosterone, l lβ-OH- androsterone, 11-keto-androsterone, a 3β, 5α-reduced steroid, or a pharmaceutically acceptable salt or prodrug thereof, in combination with a 17α-hydroxylase inhibitor, a 17-HSD inhibitor, a 20α-reductase inhibitor, or a 20β-reductase inhibitor.
29. A pharmaceutical composition comprising an effective amount of 3α,5α-TH- aldosterone, 3α,5β-TH-aldosterone, 3α,5α-TH-cortisol, 3α,5β-TH-cortisol, 3α,5α-TH- cortisone, 3α,5β-TH-cortisone, 5α-DH-corticosterone, 3α,5α-TH-corticosterone, 3α,5β- TH-corticosterone, 3α,5α-TH-l 1-dehydro-corticosterone, 3α,5β-TH-l 1-dehydro- corticosterone, l lβ-OH-allopregnanolone, l lβ-OH-pregnanolone, 11-keto- allopregnanolone, 11-keto-pregnanolone, llβ-OH-adrostenedione, 11-keto- adrostenedione, 11 β-OH-androstanediol, 11 -keto-3 β,5α-TH-testosterone, 11 β-OH- androsterone, 11-keto-androsterone, a 3β, 5α-reduced steroid, or a pharmaceutically acceptable salt or prodrug thereof and a pharmaceutically acceptable carrier.
30. A method for treating apparent adrenal insufficiency in a subject, comprising administering to said subject an effective amount of an llβ-HDSDl dehydrogenase inhibitor or a 1 lβ-HSD2 dehydrogenase inhibitor, such that said subject is treated for said apparent adrenal insufficiency, wherein said llβ-HSDl or llβ-HSD2 dehydrogenase inhibitor is 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH- corticosterone, 11-dehydro-corticosterone, 3α,5α-TH-l l-dehydrocorticosterone, 11- keto-allopregnanolone, l lβ-OH-androstanediol, l lβ-OH-androstenedione, 3α, 5α-TH- corticosterone, 11 β-OH-allopregnanolone, l lβ-OH-pregnanolone, a 3β, 5α-reduced steroid, or a pharmaceutically acceptable salt or prodrug thereof.
31. The method of claim 30, wherein said subject is undergoing surgery.
32. The method of claim 30, wherein said subject is being treated for sepsis or hyponatremia.
33. The method of claim 30, wherein an 1 lβ-HSDl dehydrogenase inhibitor is administered in combination with an 1 lβ-HSD2 dehydrogenase inhibitor to said subject.
34. The method of claim 30, wherein said 11 β-HSD 1 dehydrogenase inhibitor or said 11 β-HSD2 dehydrogenase inhibitor is administered to said subject's kidney.
35. A method for increasing the half-life of glucocorticoid drugs in a subject, comprising administering to said subject an effective amount of a llβ-HSD2 dehydrogenase inhibitor in combination with said glucocorticoid drug, such that the half life of said glucocorticoid drug in said subject is increased, wherein said 1 lβ-HSD2 dehydrogenase inhibitor is 3α, 5α-TH-aldosterone, 3α, 5α-TH-cortisol, 5α-DH- corticosterone, 11-dehydro-corticosterone, 3α,5α-TH-ll-dehydrocorticosterone, or a pharmaceutically acceptable salt or prodrug thereof.
36. A method for increasing the half-life of glucocorticoid drugs in a subject, comprising administering to said subject an effective amount of a 1 lβ-HSD2 dehydrogenase inhibitor in combination with said glucocorticoid drug, such that the half life of said glucocorticoid drug in said subject is increased, wherein said 1 lβ-HSD2 dehydrogenase inhibitor is 11-keto-allopregnanolone, l lβ-OH-androstanediol, l lβ-OH- androstenedione, a 3β, 5α-reduced steroid, or a pharmaceutically acceptable salt or prodrug thereof.
37. The method of claim 35 or 36, wherein said drug is selected from the group consisting of prednisone, 9α-fluorocortisone, 9α-fluoro-16α-hydroxyprednisone, and dexamethasone.
38. The method of claim 35 or 36, wherein said 11 β-HSD2 inhibitor is administered to said subject's kidney.
39. A method for treating a blood pressure associated disorder in a subject, comprising administering to said subject an effective amount of a Cortisol modulating compound, such that said blood pressure disorder is treated, wherein said effective amount is effective to modulate Cortisol levels in said subject.
40. The method of claim 39, wherein said Cortisol modulating compound is 11 β-HSD2 dehydrogenase or l lβ-HSDl dehydrogenase inhibitor.
41. The method of claim 39, wherein the levels of Cortisol in said subject are reduced by 5%.
42. The method of claim 41, wherein the levels of Cortisol in said subject are reduced by 25%.
43. The method of claim 42, wherein the levels of Cortisol in said subject are reduced by 50%.
44. The method of claim 39, wherein said Cortisol modulating compounds are glycyrrhetinic acid-like factors.
45. A method for treating a glucocorticoid associated state in a subject, comprising administering to said subject an effective amount of an antibiotic agent or agent that inhibits the 21-dehydroxylation enzyme present in bacteria, such that said glucocorticoid associated state is treated.
46. The method of claim 45, wherein said effective amount is effective to reduce deoxygenation of corticosterone.
47. The method of claim 45, further comprising administering an effective amount of an 11 β- HSDl reductase inhibitor.
48. The method of claim 45, wherein said antibiotic agent is clindamycin, erythromycin, tetracycline, mupirocin, gentamycin, metronidizole, bacitracin, neomycin or polymyxin B.
49. The method of claim 45, wherein said effective amount of said antibiotic agent is effective to modulate the deoxygenation of corticosterone.
50. The method of claim 45, wherein said effective amount is effective to reduce the levels of 11 -oxygenated derivatives and 5α-tetrahydroderivatives of progesterone.
51. The method of claim 45, further comprising selecting said subject based on elevated levels of 11 -oxygenated derivatives and 5α-tetrahydro-derivatives of progesterone.
52. The method of claim 45, wherein said glucocorticoid associated state is a blood pressure disorder.
53. The method of claim 45, wherein said blood pressure disorder is hypertension.
54. A method for the treatment of a blood pressure disorder, comprising administering to a subject an effective amount of an antibiotic agent in combination with an 1 lβHSD-1 reductase inhibitor, such that said subject is treated for said blood pressure disorder.
55. The method of claim 54, wherein said blood pressure disorder is hypertension.
56. A method for identifying a subject at risk of suffering from a glucorticoid associated state, comprising measuring levels of llβ-HSD2 dehydrogenase and llβ-HSDl dehydrogenase inhibitors in a sample from a subject, such that a subject is identified as having or not having a risk of suffering from a glucocorticoid associated state.
57. The method of claim 56, wherein said dehydrogenase inhibitors are selected from the grouj consisting of 3α,5α-TH-corticosterone, Sa^a-TH-ll-dehydrocorticosterone, 11-OH- progesterone, ll-OH-3a,5a-TH-progesterone, and 11-OH-testosterone, and l l-OH-3α,5α-TH- testosterone..
58. The method of claim 56, wherein said glucocorticoid associated state is hypertension, ocular hypertension, insulin resistant diabetes, or obesity.
PCT/US2006/033117 2005-08-24 2006-08-24 METHODS OF USING SELECTIVE llβ-HSD INHIBITORS TO TREAT GLUOCORTICOID ASSOCIATED STATES WO2007025064A2 (en)

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