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Definitions

• the present invention generally relates to methods for treating the side effects of chemotherapy and radiation therapy in mammals.
• Cancer is a disease where cells become abnormal (cancerous cells) and begin to multiply without control to develop into an extra mass of tissue called a tumor. These cancerous cells can invade nearby tissue and spread through the blood stream and lymphatic system to other parts of the body.
• the four primary types of cancer treatments are immunotherapy, surgery, radiation therapy, and chemotherapy. These cancer treatments may be applied alone or in conjunction with one another. Accordingly, a cancer patient may undergo one or more treatments at a time. A single treatment could span a period of time with therapies delivered at various time intervals.
• Immunotherapy attempts to stimulate or restore the ability of the immune system to fight the disease. It may also be used to lessen immune-system-related side effects that may be caused by some cancer treatments.
• Surgery seeks to directly remove the tumor from the body.
• Radiotherapy also known as radiotherapy, uses high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors by damaging the cells' genetic material. While cancerous cells are damaged permanently and eventually die, normal cells that are damaged in radiation therapy are able to repair themselves. Side effects that can occur during radiation therapy include skin irritation and hair loss in the area being treated, as well as damage to the bone marrow.
• Chemotherapy uses cytotoxic drugs, alone or in combination, to destroy cancer cells.
• cancer cells can be damaged and eventually die, but healthy cells affected in the process can repair themselves after chemotherapy.
• Cytotoxic drugs work by interfering with the ability of a growing cell to divide and reproduce itself.
• other normal fast-dividing, growing cells can also be affected.
• Bone marrow suppression is one of the many side effects of chemotherapy and radiation therapy. It results in reduced blood cell production, including red blood cells, white blood cells, and platelets. Consequently, a patient can experience fatigue from anemia, become more susceptible to infections, from leukopenia, and bruise easily and bleed more when getting a cut, from thrombocytopenia. Drugs are typically used to counter the bone marrow suppression side effect. For example, Epogen® (epoietin ⁇ ) has been used to counter the side effect of anemia in cancer chemotherapy, and W ⁇ nRho® SDF (Rh 0 (D) immune globulin) has been used to counter the side effects of thrombocytopenia.
• Epogen® epoietin ⁇
• W ⁇ nRho® SDF Rh 0 (D) immune globulin
• G-CSF granulocyte colony stimulating factor
• GM-CSF granulocyte-macrophage-CSF
• EGF epidermal growth factor
• interle ⁇ kin 11 il-1 1
• erythropoietin thrombopoietin
• megakaryocyte development and growth factor pixykines
• stem cell factor FLT-ligand
• interleukins 1, 3, 6, and 7 interleukins 1, 3, 6, and 7, to increase the number of normal cells in various tissues before the start of chemoradiotherapy.
• the mechanisms of protection by these factors while not fully understood, are most likely associated with an increase in the number of normal critical target cells before treatment with cytotoxic agents or radiation therapy, and not associated with increased survival of cells following chemoradiotherapy.
• neutrophils also called polymorphonuclear leukocytes
• neutrophils are the most numerous of the blood cells known as granulocytes.
• Neutrophils are the largest cell population involved in acute inflammatory response. They are thus an important component of natural immunity, responding quickly to chemotactic stimuli. Neutrophils destroy foreign particles such as bacteria by enveloping and digesting them, a process called phagocytosis. Neutrophils may increase in response to bacterial infection. When many neutrophils are needed, they are released from the bone marrow as immature cells, called bands or stab cells. Neutropenia is a hematological disorder characterized by an abnormally low number of neutrophil granulocytes. Therefore, patients with neutropenia are more susceptible to bacterial infections, and these conditions may become life-threatening.
• Neutropenia may occur secondary to another condition such as cancer or Acquired Immunodeficiency Syndrome (AIDS). Neutropenia may also occur secondary to an event such as a drug therapy.
• neutropenia may result from physiological disorders that directly affect the immune system. For example, diminished neutrophil production will result when leukemia, myeloma, lymphoma or a metastatic solid tumor such as, for example, breast or prostate cancer, infiltrate and replace bone marrow.
• Transient neutropenia is often associated with viral infections.
• Chronic neutropenia is often associated with immunodeficiency resulting from a viral infection, for example, AIDS resulting from infection with Human Immunodeficiency Virus (HIV).
• HIV Human Immunodeficiency Virus
• Autoimmune neutropenia may be associated with circulating anti-neutrophil antibodies.
• a much more common cause of neutropenia is as a side effect of drug therapy, particularly chemotherapy and radiation therapy for cancer and bone marrow transplantation associated with cancer therapy.
• Neutropenia secondary to drug therapy can thus be subdivided into two groups. The first involves immune-mediated neutropenia that may arise from drugs that act as haptens to stimulate antibody formation. Acute hypersensitivity reactions such as those caused by diphenylhydantoin and phenobarbital may last a few days. However, chronic hypersensitivity reactions may last for months or years.
• the second area of drug-induced neutropenia involves the severe neutropenia that predictably occurs after large doses of cytoreductive cancer drugs or ionizing radiation therapy.
• cytotoxic therapies induce neutropenia because of the proliferative nature of neutrophil precursor cells and the normal rapid turnover rate of circulating neutrophils.
• the risk of neutropenia secondary to cancer chemotherapy or radiotherapy depends on such factors as the type and stage of the cancer and the type, the dosage and the schedule of cancer treatment.
• Filgrastim is a recombinant version of a human protein, G- CSF, that selectively stimulates the production of white blood cells.
• G-CSF is currently the drug of choice for neutropenia. Since both of these drugs are recombinant proteins they are not active orally and must be administered by injection. In addition, protein- based drugs are often subject to rapid metabolism.
• a method for treating chemotherapy and/or radiation therapy side effects in a mammal undergoing chemotherapy and/or radiation therapy comprising a step of administering to the mammal a therapeutically effective amount of a Retinoic Acid Receptor (RAR) antagonist or a RAR inverse agonist which binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes.
• RAR Retinoic Acid Receptor
• a method for increasing platelet production in a mammal comprising a step of administering to the mammal an effective amount of a RAR antagonist or a RAR inverse agonist which binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes.
• a method for treating a mammal suffering from thrombocytopenia comprising a step of administering to the mammal a therapeutically effective amount of a RAR antagonist or a RAR inverse agonist which binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes.
• a method of treating a mammal suffering from a hematopoietic related condition comprising a step of administering to the mammal a therapeutically effective amount of a RAR antagonist or a RAR inverse agonist which binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes.
• Such conditions include, but are not limited to, reduced hematopoietic function, reduced immune function, reduced neutrophil count, reduced neutrophil mobilization, mobilization of peripheral blood progenitor cells, sepsis, severe chronic neutropenia, bone marrow transplants, infectious diseases, leucopenia, thrombocytopenia, anemia, enhancing engraftment of bone marrow during transplantation, enhancing bone marrow recovery in treatment of radiation, chemical or chemotherapeutic induced bone marrow aplasia or myelosuppression, acquired immune deficiency syndrome and the like and combinations thereof.
• Figures IA- 1C are a graphical representation of the effects of VTP 194310 on the leukocyte, neutrophil and lymphocyte counts in a cyclophosphamide-induced leukopenic mouse model.
• Figures 2A-2D are a graphical representation of the blocking effects of the pan-RAR antagonist VTP 194310 against ATRA-driven neutrophil differentiation of HL60 cells.
• HL60 cells set at 2.5 x 105 cells/ml were treated for 5 days with 100 nM ATRA or 100 nM ATRA together with 100 nM of the pan-RAR antagonist VTP194310.
• A shows the total number of viable cells as enumerated by phase contrast microscopy.
• Figures 3 A and 3B are a graphical representation of the effect of VTP 194310 and G- CSF, alone and in combination, on neutrophil differentiation.
• Human CD34 +ve haemopoietic progenitor cells (CD34-HPC) were column purified to homogeneity and cultured in stem cell factor (100 ng/ml) and IL3 (20 ng/ml) (•), and these conditions together with 10 (D) and 100 nM ( ⁇ ) of the pan-specific RAR antagonist VTP 194310.
• CD34-HPC were cultured in stem cell factor (100 ng/ml), IL3 (5 ng/ml) and G-CSF (30 ng/ml) (A) to promote the optimal production of neutrophils and monocytes.
• Cell phenotypes were determined at intervals by multi-colour FACS assay. Cultures were set up in triplicate and multicolour FACS analyses and single colour analyses for each marker were undertaken in duplicate. Neutrophils are identified as CDl lb+ve/CD65+ve and as CD15+ve cells. Monocytes are identified as CDl lb+ve/CD14+ve cells. Data are shown as mean ⁇ SD.
• Figures 4A-4C are a graphical representation of the effects of VTP 194310 on the neutrophil counts and other parameters in a cyclophosphamide-induced leukopenic mouse model.
• Figures 5 is a graphical representation of the effect of VTP 194310 on the survival of leukopenic mice lethally infected with Staphylococcus aureus.
• Figures 6A-6E are a graphical representation of the changes in total changes in total white blood cell (WBC), neutrophil, lymphocyte, red blood cell (RBC) and platelet numbers in mice that received VTP 194310 or/and PEG-G-CSF.
• WBC white blood cell
• RBC red blood cell
• Vehicle or VTP 194310 at 1 or 3 mg/kg/day was administrated orally on Days -1 to 1, 150 mg/kg CPM was given on Day 0, and PEG-G-CSF was given subcutaneously on Day 2.
• Blood samples were collected as scheduled and the blood cell count was measured by Abbott CeIl-DYN 3700. Data represent mean ⁇ SE of 7-8 mice. The units are numbers of cells or platelets per ⁇ l.
• Figure 7 is a graphical representation of the effect of treatment of neutropenia with a regimen of VTP194310 and PEG-G-CSF, as compared to each agent alone, which further increased the rate of neutrophil recovery in neutropenic mice.
• Mice rendered neutropenic with 150 mg/kg CPM on Day 0 were given mono-therapy with VTP 194310 (3 mg/kg/day on Days -1 to 1) or PEG-G-CSF (lO ⁇ g/kg on Day 2) and combination treatment with these doses.
• Data represent mean ⁇ SE of 7-8 mice. The/; values for the statistical significance between treated groups are indicated.
• the units are numbers of cells or platelets per ⁇ l.
• Figures 8A-8E are a graphical representation of the changes in total white blood cell (WBC), neutrophil, lymphocyte, red blood cell (RBC) and platelet numbers in mice that received VTP 194310 or/and PEG-G-CSF in 5-FU-induced mouse model of neutropenia.
• Vehicle or VTP 194310 3 mg/kg/day was administrated orally on Days 2 to 4, 150 mg/kg 5-FU was given intravenously on Day 0, and PEG-G-CSF was given subcutaneously on Days 5, 6, or 7 as indicated.
• Blood samples were collected as scheduled and the blood cell count was measured by Abbott CeIl-DYN 3700. Data represent mean ⁇ SE of 8 mice.
• the units are numbers of cells or platelets per ⁇ l.
• Figure 9 is a graphical representation of a comparison of the effect of mono-therapy with VTP 194310 or peg-G-CSF and combination treatment on the recovery of neutrophils in 5-FU-induced neutropenic mice.
• Mice rendered neutropenic with 150 mg/kg 5-FU on day 0 were given mono-therapy with VTP 194310 (3mg/kg/day on days 2 to 4) or peg-G-CSF (10 ⁇ g/kg) on day 5, 6, or 7 and combination treatment with these doses and regimens.
• Data represent mean ⁇ SE of 8 mice.
• the present invention is directed to methods for the treatment of chemotherapy and/or radiation therapy (i.e., chemoradiotherapy) side effects in a mammal undergoing chemotherapy and/or radiation therapy employing at least an antagonist and/or an inverse agonist of Retinoic Acid Receptors (RARs) which binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes, i.e., the RAR antagonist or RAR inverse agonist binds to all of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes.
• RARs Retinoic Acid Receptors
• Such side effects include, but are not limited to, chemotherapy-induced alopecia, radiation therapy-induced alopecia, chemotherapy-induced thrombocytopenia, radiation therapy-induced thrombocytopenia, chemotherapy-induced leukopenia, radiation therapy-induced leucopenia, chemotherapy-induced neutropenia, radiation therapy-induced neutropenia and the like and combinations thereof.
• Retinoids in particular ⁇ //-trans retinoic acid (ATRA) are essential to normal mammalian development as they play important roles in controlling the survival, proliferation and differentiation of a wide range of cell types.
• ATRA and synthetic retinoids are capable of binding to and activating two distinct intracellular families of receptors, the RARs and the Retinoid X Receptors (RXRs), resulting in the regulation of gene expression.
• the first retinoic acid receptor identified, designated RAR ⁇ acts to modulate transcription of specific target genes in a manner which is ligand-dependent, as has been shown to be the case for many of the members of the steroid/thyroid hormone intracellular receptor superfamily.
• RAR ⁇ The endogenous low-molecular-weight ligand upon which the transcription-modulating activity of RAR ⁇ depends is ATRA.
• Retinoic acid receptor-mediated changes in gene expression result in characteristic alterations Ln cellular phenotype, with consequences in many tissues manifesting the biological response to ATRA.
• RAR ⁇ and RAR ⁇ Two additional genes closely related to RAR ⁇ are designated as RAR ⁇ and RAR ⁇ .
• the RXRs are also known to have at least three subtypes or isoforms, namely RXR ⁇ , RXR ⁇ , and RXR ⁇ , with corresponding unique patterns of expression (Manglesdorf et al., Genes & Devel., 6: 329-44 (1992)).
• compositions comprising a RAR antagonist and/or a RAR inverse agonist that binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes to a mammal may improve the production of blood neutrophils and platelets thereby resulting in the treatment of side effects of chemotherapy such as chemotherapy-induced neutropenia and/or thrombocytopenia.
• RAR antagonists and inverse agonists that bind to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes and processes for their preparation are well known in the art, e.g., in U.S. Patent Nos. 5,776,699 and 5,958,954 and U.S. Patent Application Publication No. 2002/0193403, the contents of each of which are incorporated by reference herein in their entirety. Many of the following compounds are included in one or more of these applications and/or patents.
• X is S, O, NR where R is H or alkyl of 1 to 6 carbons, or
• X is [C(R 1 ⁇ ] n where R 1 is independently H or an alkyl of 1 to 6 carbons, and n is an integer between, and including, 0 and 2;
• R 2 independently are hydrogen, a lower alkyl of 1 to 6 carbons, F, Cl, Br, I, CF 3 , fluoro substituted alkyl of 1 to 6 carbons, OH, SH, alkoxy of 1 to 6 carbons, or alkylthio of 1 to 6 carbons;
• -CR' N-, -COO-, -OCO-; -OSO-; -OCS-, or -(CR ⁇ CR 1 V- where n is an integer from O to 5;
• A is (CH 2 ) q where q is 0-5, a lower branched chain alkyl having 3 to 6 carbons, cycloalkyl having 3 to 6 carbons, alkenyl having 2 to 6 carbons and 1 or 2 double bonds, alkynyl having 2-6 carbons and 1 or 2 triple bonds;
• B is hydrogen, COOH or a pharmaceutically acceptable salt thereof, COOR 8 , CONR 9 R 10 , CH 2 OH, CH 2 OR 11 , CH 2 OCOR 1 1 , CHO, CH(OR 12 ) 2 , CHOR 13 O, -COR 7 , CR 7 (OR 12 )2, CR 7 OR 13 O, or a tri-lower alkylsilyl;
• R 7 is an alkyl, cycloalkyl or alkenyl group containing 1 to 5 carbons;
• R 8 is an alkyl group of 1 to 10 carbons or trimethylsilylalkyl where the alkyl group has 1 to 10 carbons, a cycloalkyl group of 3 to 10 carbons, phenyl or a lower alkylphenyl;
• R 9 and R 10 independently are hydrogen, an alkyl group of 1 to 10 carbons, a cycloalkyl group of 3 to 10 carbons, phenyl or a lower alkylphenyl;
• R 11 is a lower alkyl, phenyl or lower alkylphenyl
• R 12 is a lower alkyl
• R 13 is a divalent alkyl radical of 2 to 5 carbons
• R 14 is (R l5 ) r -phenyl, (R l5 ) r -naphthyl, or (R l5 ) r -heteroaryl wherein the heteroaryl group has 1 to 3 heteroatoms selected from the group consisting of O, S and N, and r is an integer having the values of 0-5; and
• R 15 is independently H, F, Cl, Br, I, NO 2 , N(R 8 ) 2 , N(R 8 )COR 8 , NR 8 CON(R 8 ) 2 , OH, OCOR 8 , OR 8 , CN, an alkyl group having 1 to 10 carbons, a fluoro substituted alkyl group having 1 to 10 carbons, an alkenyl group having 2 to 10 carbons and 1 to 3 double bonds, an alkynyl group having 2 to 10 carbons and 1 to 3 triple bonds, or a trialkylsilyl or trialkylsilyloxy group where the alkyl groups independently have 1 to 6 carbons.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by Formula I, wherein Z is -CONR 1 -, -CSNR 1 -, -NR 1 CO-, or -NR 1 CS-; and wherein all other variables are as defined above.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the Formula I, wherein:
• R 8 is an alkyl group of 1 to 10 carbons or trimethylsilylalkyl where the alkyl group has 1 to 10 carbons, a cycloalkyl group of 5 to 10 carbons, phenyl or a lower alkylphenyl;
• R 9 and R 10 independently are hydrogen, an alkyl group of 1 to 10 carbons, a cycloalkyl group of 5 to 10 carbons, phenyl or a lower alkylphenyl; and wherein all other variables are as defined above.
• X is -C(R') 2 - or -O-;
• R] is H or Ci-C 6 alkyl;
• R 2 is a lower Ci-C 6 alkyl, -F, -Cl, -Br, -I, -CF 3 , fluoro substituted Ci-C 6 alkyl, -OH, -SH, Ci-C 6 alkoxy, or Ci-C 6 alkylthio; m is an integer from 0 to 3; n is an integer from 0 to 4; o is an integer from 0 to 3;
• R 3 is a lower Ci-C 6 alkyl or -F
• R 8 is a Ci-Cio alkyl, Ci-Ci 0 trimethylsilylalkyl, a C 3 -Ci 0 cycloalkyl, phenyl or a lower alkylphenyl; each is R 15 independently -H, -F, Cl, -Br, -I, -NO 2 , -N(R 8 ) 2 , -COR 8 , -NR 8 CON(R 8 > 2 , -OCOR 8 , -OR 8 , -CN, a C i -C 10 alkyl, fluoro substituted Ci-C) 0 alkyl, a C 2 -C 10 alkenyl having 1 to 3 double bonds, a C 2 -C 1 O alkynyl having 1 to 3 triple bonds, or a Ci-Ce trialkylsilyl or trialkylsilyloxy; t is an integer from 0 to 5; and the -CONH group is in the 6 or 7 position of
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the general Formula II, wherein:
• R 2 is F
• R 8 is an alkyl group of 1 to 10 carbons, trimethylsilylalkyl wherein the alkyl group has 1 to 10 carbons, or a cycloalkyl group of 5 to 10 carbons, phenyl or a lower alkylphenyl;
• R 15 independently is H, F, Cl, Br, I, NO 2 , N(R 8 ) 2 , COR 8 , NR 8 CON(R 8 ) 2 ,
• OCOR 8 , OR 8 , CN an alkyl group having 1 to 10 carbons, fluoro substituted alkyl group having 1 to 10 carbons, an alkenyl group having 1 to 10 carbons and 1 to 3 double bonds, an alkynyl group having 1 to 10 carbons and 1 to 3 triple bonds, or a trialkylsilyl or trialkylsilyloxy group where the alkyl groups independently have 1 to 6 carbons; and wherein all other variables are as defined above.
• X is -C(CH 3 ) 2 - or -O-;
• R 2 is -H or -Br,
• R 2 and R 2 are independently -H or -F; each R 3 is independently -H or -CH 3 ; and R 8 is -H, or a C r C 6 alkyl.
• X 1 is — S- or — O-;
• X 2 is -CH- or -N-;
• R 2 is -H, -F, -CF 3 or Ci-C 6 alkoxy
• R 2 " is -H, -F 5 or -CF 3 ;
• R 8 is -H, or Ci-C 6 alkyl
• R 14 is an unsubstituted phenyl, thienyl or pyridyl, or phenyl, thienyl or pyridyl that are substituted with one to three R 15 groups; and each instance of R 15 is independently a Ci-C 6 alkyl, -Cl, -CF 3 , or a Ci-C 6 alkoxy.
• X 2 is -CH- or -N-;
• R 2 is -H, -F, or -OCH 3 ;
• R 2 * is -H or -F
• R 8 is -H, or Ci-C 6 alkyl
• R 14 is selected from the group consisting of: phenyl, 4-(lower-alkyl)phenyl, 5- (lower-alkyl)-2-thienyl, and 6-(lower-alkyl)-3-pyridyl, where lower alkyl has 1 to 6 carbons.
• R 8 is -H, or a Ci-C ⁇ -alkyl.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the general Formula VII: or a pharmaceutically acceptable salt thereof; wherein R 2 * is -H or -F; R 8 is -H 5 or a Ci-C 6 -alkyl; and R 14 is selected from the group consisting of: phenyl, and 4-(C]-C 6 -alkyl)phenyl.
• R 8 is H, or a pharmaceutically acceptable salt thereof; wherein R 8 is H, or a Cj-C ⁇ -alkyl.
• R 8 is H, this compound is termed AGN 193109.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the general formula IX: or a pharmaceutically acceptable salt thereof; wherein X 1 is -C(RV, -C(RVC(RV, -S-, -O-, -NR 1 -, -C(R V ⁇ -, -(C(RV S-, or -C(R VNR 1 -; wherein each R 1 is independently H or a Ci-C ⁇ -alkyl; each R 2 is independently a Ci-C ⁇ -alkyl, -F, -Cl, -Br, -I, -CF 3 , fluoro substituted
• Ci-Ce-alkyl -OH, -SH, Ci-C 6 -alkoxy, or Ci-C 6 -alkylthio;
• m is an integer from 0 to 4;
• n is an integer from 0 to 2;
• o is an integer from 0 to 3;
• R 3 is -H, Ci-Ce-alkoxy, -F, -Cl, -Br, or -I;
• R 4 is (R 5 ) p -phenyl, (R 5 ) p -naphthyl, or (R 5 ) p -heteroaryl, wherein the heteroaryl group is f ⁇ ve-membered or 6-membered and has 1 to 3 heteroatoms selected from the group consisting of oxygen, sulfur and nitrogen; wherein p is an integer from 0 to 5; each R 5 is independently -F, -Cl, -Br, -I, -NO 2 , -N(R 8 ) 2 , -N(R 8 )COR 8 , -N(R 8 )CON(R 8 ) 2 , -OH, -OCOR 8 , -OR 8 , -CN, -COOH, -COOR 8 , C,-C, 0 -alkyl, a C 1 -C 0 - alkenyl havingl to three double bonds, Ci-Cio-alkynyl having
• R 7 is an alkyl, cycloalkyl or alkenyl group containing 1 to 5 carbons
• R 8 is a Ci-Cio alkyl group, Ci-Ci 0 (trimethylsilyl)alkyl, or a C 5 -Ci 0 cycloalkyl, phenyl or lower alkylphenyl;
• R 9 and R 10 are each independently -H, a Ci-Ci 0 alkyl, a C 5 -C 10 cycloalkyl, phenyl or lower alkylphenyl;
• R 11 is a lower alkyl, phenyl or lower alkylphenyl
• R 12 is a lower alkyl; and R 13 is a divalent alkyl radical of 2-5 carbons.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the general formula X: Y 3 (R 4 )-X-Y l (R 1 )(R 2 )-Z-Y 2 (R 2 )-A-B (X) or a pharmaceutically acceptable salt thereof; wherein Y 1 is phenyl, naphthyl, or heteroaryl selected from the group consisting of pyridyl, thienyl, furyl, pyridazinyl, pyrimidinyl, pyrazinyl, thiazonyl, ozazolyl, imidazolyl, and pyrrazolyl, wherein the phenyl, naphthyl, and heteroaryl groups are optionally substituted with an R 1 group, and optionally further substituted with 1 or 2 R 2 groups;
• R 1 is Ci.Cio alkyl, 1-ademantyl, 2-tetrahydropyranoxy, Ci-C 6 trialkylsilanyloxy, -OH, Ci-Ci 0 alkoxy, Ci-Ci 0 , or -OCH 2 O-(Ci-C 6 alkyl);
• R 2 is Ci-C 6 alkyl, -F, -Cl, -Br, -I, -CF 3 , -CF 2 CF 3 , -OH, -OR 3 , -NO 2 , -N(R 3 ) 2 , -CN, -N 3 , -COR 3 , -NHCOR 3 , -COOH, or -COOR 3 ;
• Y 3 is phenyl, naphthyl, or heteroaryl selected from a group consisting of: pyridyl, thienyl, furyl, pyridazinyl, pyrimidinyl, pyrazinyl, thiazolyl, oxazolyl, imidazolyl and pyrrazolyl; wherein the phenyl, naphthyl and heteroaryl groups are optionally substituted with one to five R 4 groups; each R 4 is independently a Ci-Cio alkyl, C2-C10 alkenyl having 1 to 3 triple bonds, -F, -Cl, -Br, -I, -NO 2 , N(R 3 ) 2 , -N 3 , -COOH, -COO-(C 1 -C 6 alkyl), -OH, -SH, -O- Ci-C 6 alkyl, Or -S-Ci-C 6 alkyl;
• A is (CH 2 ) q , a lower C 3 -C 6 branched alkyl, C 3 -C 6 cycloalkyl, C 2 -C6 alkenyl having 1-2 double bonds, C 2 -C 6 alkynyl having 1 to 2 triple bonds; wherein q is an integer from 0-5;
• B is -H, -COOH, -COOR 8 , -CONR 9 R 10 , -CH 2 OH, -CH 2 OR 11 , -CH 2 OCOR 1 1 , -CHO, -CH(OR 12 ) 2j -CHOR 13 O, -COR 7 , -CR 7 (OR 12 ) 2 , -CR 7 OR 13 O, or -Si(C 1 -C 6 alkyl) 3 ;
• R 7 is an alkyl, cycloalkyl or alkenyl group containing 1 to 5 carbons;
• R 8 is a Ci-Cio alkyl, Ci-Cio trimethylsilylalkyl, a C 3 -C 10 cycloalkyl, phenyl or lower alkylphenyl;
• R 9 and R 10 are independently hydrogen, a C 1 -C 1 0 alkyl, a C 3 -C 1 0 cycloalkyl, phenyl or lower alkylphenyl; R 1 ' is a lower alkyl, phenyl or lower alkylphenyl;
• R 12 is a lower alkyl
• R 13 is divalent alkyl radical of 2 to 5 carbons.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the general Formula X, wherein X is -(C(R 3 ⁇ )-, -S-, -SO-, -SO 2 -, -O-, or -NR 3 -; and Z is -CO-NR 3 -, -CS-NR 3 -, -NR 3 -CO-, or -NR 3 -CS-, and wherein all other variables are as defined above.
• Another particular embodiment of the present invention is a class of compounds that may be used is represented by the general Formula X wherein the phenyl, naphthyl, or heteroaryl groups represented by Y 3 are unsubstituted or substituted by 1-3 R 4 groups, and wherein all other variables are as defined above.
• the present application comtemplates using any compound that is a RAR antagonist or inverse agonist which binds to the receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes, including the compounds described in or claimed in U.S. Patent Nos.: 5,728,846, 5,739,338, 5,763,635, 5,773,594, 5,877,207, 5,952,345, 5,958,954, 5, 998,655, 6,008,204, 6,037,488, 6,043,381, 6,087,505, 6,090,810, 6,117,987, 6,211,385, 6,218,128, 6,225,494, 6,228,848, 6,235,923, 6,313,168, 6,521,624, 6,521,641, 6,538,149, 6,555,690, 6,653,483, 6,720,425, 6,818,775, 6,942,980, 7,105,566, and
• VTP 194310 (and was formerly referred to as AGN 194310).
• Another preferred compound for use in the methods of the present invention is represented by the following structure:
• This compound is referred to as VTP 196996.
• RAR antagonists or inverse agonists are described in U.S. Patent Application Serial No. 08/845,019, Song et al. which is incorporated by reference herein in its entirety; and shares common ownership with the present application.
• compounds useful in the methods of the present invention are disclosed in International Application Publication No. WO 94/14777, Yoshimura et al., which is also incorporated by reference herein in its entirety. This latter application discloses RAR antagonists.
• structures of additional compounds useful in the methods of the present invention are as follows:
• n is an integer from 1 to 10;
• n is an integer from 1 to 10;
• agonist as used herein shall be understood to mean a compound which binds to a receptor and activates it, producing a pharmacological response (e.g., contraction, relaxation, secretion, enzyme activation, etc.).
• inverse agonist as used herein shall be understood to mean a compound which produces an effect opposite to that of an agonist, yet acts at the same receptor.
• inverse agonist is synonymous with the term “negative antagonist.”
• chemoradiotherapy shall be understood to mean chemotherapy, radiation therapy or both.
• treating shall be understood to mean (1) preventing, reducing the severity of or delaying the appearance of a clinical symptom of a state, disease, disorder, injury or condition developing in a mammal, partially or completely, that may be afflicted with or predisposed to the state, disease, disorder, injury or condition but does not yet experience or display clinical or subclinical symptoms of the state, disease, disorder, injury or condition, (2) inhibiting the state, disease, disorder, injury or condition partially or completely, i.e., arresting or reducing the development of the state, disease, disorder, injury or condition or at least one clinical or subclinical symptom thereof, or (3) relieving the state, or reducing the severity of the disease, disorder, injury or condition, partially or completely, i.e., causing regression of the state, disease, disorder, injury or condition or at least one clinical or subclinical symptom thereof.
• delivering shall be understood to mean providing a therapeutically effective amount of a RAR antagonist or RAR inverse agonist capable of binding to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ type to a particular location within a mammal causing a therapeutically effective concentration of the RAR antagonist or RAR inverse agonist which binds to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ type at the particular location.
• subject or “patient” or “host” or “mammal” as used herein refers to mammalian animals, including humans.
• alkyl used alone or as part of a larger moiety, such as “alkoxy”, and "hydroxyalkyl" means a saturated aliphatic containing one to ten carbon atoms.
• Representative saturated straight chain alkyls include methyl, ethyl, n-pr ⁇ pyl, n-butyl, n-pentyl, and the like; while saturated branched alkyls include isopropyl, sec-butyl, isobutyl, tert-butyl, isopentyl, and the like.
• the term “lower alkyl” describes an alkyl containing one to six carbons.
• Alkenyl and alkynyl groups are unsaturated aliphatic groups and contain at least one double or triple bond between adjacent carbon atoms.
• Representative straight chain and branched alkenyls include ethylenyl, propylenyl, 1- butenyl, 2-butenyl, isobutylenyl, 1-pentenyl, 2-pentenyl, 3-methyl-l- butenyl, 2-methyl- 2-butenyl, and the like; while representative straight chain and branched alkynyls include acetylenyl, propynyl, 1-butynyl, 2-butynyl, 1-pentynyl, 2-pentynyl, 3- methyl- 1- butynyl, and the like.
• cycloalkyl means a saturated cyclic hydrocarbon moiety and include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl.
• Cycloalkyls can also include carbocyclic rings systems, such as bi- and tri-cyclic ring systems having from 8 to 10 carbon atoms, such as a cycloalkyl (e.g., cyclopentane or cyclohexane) fused to one or more aromatic (such as phenyl) or non-aromatic (such as cyclohexane) carbocyclic rings.
• heteroaryl refers to heteroaromatic ring groups typically having five to fourteen members, including monocyclic heteroaromatic rings and polycyclic aromatic rings in which a monocyclic heteroaromatic ring is fused to one or more other carbocyclic or heteroaromatic aromatic rings.
• Heteroaryl groups have one or more, typically 1, 2, or 3, ring heteroatoms, such as nitrogen, oxygen and sulfur.
• “Pharmaceutical composition” of the compounds described herein, and their pharmaceutically acceptable salts, solvates and hydrates thereof can be used in pharmaceutical preparations in combination with a pharmaceutically acceptable carrier or diluent.
• Suitable pharmaceutically acceptable carriers include inert solid fillers or diluents and sterile aqueous or organic solutions.
• the SARM compound will be present in such pharmaceutical compositions in amounts sufficient to provide the desired dosage amount in the range described herein. Techniques for formulation and administration of the compounds of the instant invention can be found in Remington: the Science and Practice of Pharmacy, 19 th edition, Mack Publishing Co., Easton, PA (1995).
• “Pharmaceutically acceptable salt” is a salt of a compound containing any acidic or basic functional group.
• a pharmaceutically acceptable salt of an amine or other basic group can be obtained by reacting the compound with a suitable organic or inorganic acid, such as hydrogen chloride, hydrogen bromide, acetic acid, perchloric acid and the like.
• suitable organic or inorganic acid such as hydrogen chloride, hydrogen bromide, acetic acid, perchloric acid and the like.
• Other examples of such salts include hydrochlorides, hydrobromides, sulfates, methanesulfonates, nitrates, maleates, acetates, citrates, fumarates, tartrates [e.g. (+)-tartrates, (-)-tartrates or mixtures thereof, including racemic mixtures], succinates, benzoates and salts with amino acids such as glutamic acid.
• Pharmaceutically acceptable salts of compounds containing a carboxylic acid or other acidic functional group can be prepared by reacting with a suitable base.
• a suitable base which affords a pharmaceutically acceptable cation, which includes alkali metal salts (especially sodium and potassium), alkaline earth metal salts (especially calcium and magnesium), aluminum salts and ammonium salts, as well as salts made from physiologically acceptable organic bases such as trimethylamine, triethylamine, morpholine, pyridine, piperidine, picoline, dicyclohexylamine, N,N'-dibenzylethylenediamine, 2- hydroxyethylamine, bis-(2-hydroxyethyl)amine, tri-(2-hydroxyethyl)amine, procaine, dibenzylpiperidine, N-benzyl- ⁇ -phenethylamine, dehydroabietylamine, N,N'- bisdehydroabietylamine, glucamine, N-methylglu
• the RAR antagonist and RAR inverse agonist compounds which bind to receptors of the RAR ⁇ , RAR ⁇ and RAR ⁇ subtypes for use in the methods of the present invention may be incorporated into a pharmaceutical composition.
• All modes of administrations are contemplated, e.g., orally, rectally, parenterally, topically, or by intravenous, intramuscular, intrastemal or subcutaneous injection or in a form suitable by inhalation.
• the formulations may, where appropriate, be conveniently presented in discrete dosage units and may be prepared by any of the methods well known in the art of pharmacy.
• the compounds will ordinarily be formulated with one or more pharmaceutically acceptable ingredients in accordance with known and established practice.
• the pharmaceutical composition can be formulated as a liquid, powder, elixir, injectable solution, suspension, suppository, etc.
• Formulations for oral use can be provided as tablets or hard capsules wherein the compounds are mixed with an inert solid diluent such as calcium carbonate, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredients are mixed with water or miscible solvents such as propylene glycol, PEGs and ethanol, or an oleaginous medium, e.g., peanut oil, liquid paraffin or olive oil.
• an inert solid diluent such as calcium carbonate, calcium phosphate or kaolin
• water or miscible solvents such as propylene glycol, PEGs and ethanol
• an oleaginous medium e.g., peanut oil, liquid paraffin or olive oil.
• the pharmaceutical compositions can take the form of buccal or sublingual tablet, drops or lozenges formulated in conventional manner.
• the compounds can be formulated as creams, gels, ointments or lotions or as transdermal patches.
• Such compositions can, for example, be formulated with an aqueous or oily base with the addition of suitable thickening, gelling, emulsifying, stabilizing, dispersing, suspending, and/or coloring agents.
• the compounds can also be formulated as depot preparations. Such long acting formulations can be administered by implantation (for example subcutaneously or intramuscularly) or by intramuscular injection.
• the compounds can be formulated with suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives, for example as a sparingly soluble salt.
• the compounds can be formulated for parenteral administration by injection, conveniently intravenous, intramuscular or subcutaneous injection, for example by bolus injection or continuous intravenous infusion. Formulations for injection can be presented in unit dosage from, e.g., in ampoules or in multi-dose containers, with an added preservative.
• compositions can take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and can contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
• the compounds may be in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.
• the compounds can also be formulated in rectal compositions such as suppositories or retention enemas, e.g., containing conventional suppository bases such as cocoa butter or other glyceride.
• the compounds can be used, for example, as a liquid spray, as a powder or in the form of drops.
• the compounds can be conveniently delivered in the form of an aerosol spray presentation from pressurized packs or a nebulizer, with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, tetrafluoroethane, heptafluoropropane, carbon dioxide or other suitable gas.
• a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, tetrafluoroethane, heptafluoropropane, carbon dioxide or other suitable gas.
• a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, tetrafluoroethane, heptafluoropropan
• Aqueous suspensions can include pharmaceutically acceptable excipients such as suspending agents, e.g., sodium carboxymethyl cellulose, methylcellulose, hydroxypropylmethylcellulose, sodium alginate, polyvinylpyrrolidone, gum tragacanth and gum acacia; dispersing or wetting agents such as naturally occurring phosphatide, e.g., lecithin, or condensation products of an alkylene oxide with fatty acids, e.g., polyoxyethylene stearate, or condensation products of ethylene oxide with long chain aliphatic alcohols, e.g, heptadecaethylene-oxycetanol, or condensation products of ethylene oxide with partial esters derived from fatty acids and a hexitol, e.g., polyoxyethylene sorbitol monoleate or condensation products of ethylene oxide with partial esters derived from fatty acids and hexitol anhydrides, e.g., polyoxyethylene sorbitan monoleate.
• the aqueous suspensions can also contain one or more preservatives, e.g., ethyl-or-n-propyl-p-hydroxy benzoate, one or more coloring agents, one or more flavoring agents and one or more sweetening agents, such as sucrose, saccharin or sodium or calcium cyclamate.
• preservatives e.g., ethyl-or-n-propyl-p-hydroxy benzoate
• coloring agents e.g., ethyl-or-n-propyl-p-hydroxy benzoate
• flavoring agents e.g., ethyl-or-n-propyl-p-hydroxy benzoate
• sweetening agents such as sucrose, saccharin or sodium or calcium cyclamate.
• At least one other pharmacologically active substance e.g., a non-narcotic analgesic such as tramadol, acetaminophen, aspirin, diclofenac, diflusinal, etodolac, fenbufen, fenoprofen, flufenisal, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamic acid, mefenamic acid, nabumetone, naproxen, oxaprozin, phenylbutazone, piroxicam, sulindac, tolmetin, zomepirac, and the like and combinations thereof, or a narcotic analgesic such as codeine, oxycodone, dihydrocodeine
• the compounds will be administered in a therapeutically effective amount in accordance with the invention.
• a therapeutic concentration will be that concentration which is effective to treat, for example, the side effects of chemoradiotherapy in a mammal, preferably a human being. These amounts can be determined by one skilled in the art.
• the following are non-limiting examples of the present invention. The examples should not be read as limiting the scope of the invention as defined in the claims.
• VTP 194310 uses 4-2[6-(2,2-dimethyl-(lH)-4-(4-ethylphenyl)-l- benzothiopyran))ethynyl] benzoic acid (VTP 194310 and formerly termed AGN 194310) as synthesized at Allergan Inc. (Irvine, CA) and is a specific pan-RAR antagonist.
• the structure of VTP 194310 is shown hereinabove.
• the Kj of VTP 194310 for binding to RAR ⁇ , ⁇ and ⁇ is 3, 2 and 5 nM, respectively.
• VTP 194310 shows no activity in transactivation assays, but instead blocks the gene transcriptional activity induced by ATRA and other RAR agonists.
• VTP194310 and ATRA were stored as 10 mM stock solutions in 50% ethanol/50% dimethyl sulphoxide (DMSO) at -20 0 C.
• DMSO dimethyl sulphoxide
• mice purchased from Charles River Laboratories (Wilmington, MA) were housed individually in micro-isolater cages in a 12-hour light/dark cycle. They were housed under pathogen-free conditions, and received a normal standard diet and water ad libitum. They were acclimated for one week at the Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC) accredited animal facility (Allergan Inc., Irvine, CA) prior to experiments. Study designs were approved by the Institutional Animal Care and Use Committee. Body weights were monitored throughout each study. Weight of the mice was in the range of 22-27 g at the day of treatment initiation. The mice were healthy, not previously used in other experimental procedures.
• AALAC Laboratory Animal Care
• VTP 194310 dissolved in DMSO was diluted through peanut oil as the vehicle (dosed at 5 ml/kg). Control mice were given DMSO and vehicle alone.
• PEG-r-metHuG-CSF methionyl human granulocyte colony-stimulating factor
• Peripheral blood 60 ⁇ l was collected under anaesthesia from the retroorbital sinus of the mice with heparinized capillary tubes and transferred to EDTA-coated microtainer tubes (Becton Dickinson, Franklin Lakes, NJ).
• White cell, neutrophil, and lymphocyte counts were obtained for at least three mice per group by diluting the blood 1 :4 with PBS containing 5% bovine serum albumin (Fraction V; Sigma, Saint Louis, MO), and by using an Advia 120 Hematology System (Bayer HealthCare Diagnostics Division, Tarrytown, NY).
• Immature (Gr-l lov 7CDl Ib +1 *) and mature (Gr-1 +V 7CD1 1 b +ve ) neutrophils were identified in single cells suspensions prepared from spleen and bone marrow (femur) aspirates by double immunostaining using PE- and FITC-conjugated monoclonal antibodies (Pharmingen, San Diego, CA). Cells were analysed on a FACS Calibur interfaced with CellQuest Pro software program (Becton Dickinson, San Jose, CA).
• VTP 194310 at days -4 to -1 and at days 0 to 3 to mice treated with CPM improved leukocyte recovery in two ways. Leukocyte and neutrophil counts rose quicker in the VT P194310-treated mice as compared to the control group of leukopenic mice. Significant differences in recovery were observed as early as day 5 post-CPM. At day 8, the leukocyte and neutrophil counts in the blood of the VTP 194310-treated neutropenic mice were ⁇ 3 fold higher than counts in the mice treated with CPM alone (see Fig 1).
• Administration of VTP 194310 to leukopenic mice at days 4 to 7 improved the numbers of leukocytes and neutrophils generated, but to an extent that was considerably less than when VTP 194310 was given earlier.
• the lymphocyte counts for the VTPl 94310-treated mice were 4.53 ⁇ 0.39 x 10 3 / ⁇ l (VTP 194310, days -A to -1) and 4.49 ⁇ 0.52 x 10 3 / ⁇ l (VTP 194310, days 0 to 3) as compared to 2.38 ⁇ 0.26 x 10 3 / ⁇ l (p values ⁇ 0.01) for control recovering mice.
• Cultures of the promyeloid cell line HL60 were seeded at 2.5 x 10 5 cells/ml in 4 mis of RPMI 1640 medium (Invitrogen, Paisley, UK) containing 10% foetal bovine serum (FBS, Invitrogen, Paisley, UK), penicillin (100 U/ml), and streptomycin (100 ⁇ g/ml). Differentiation was measured by the ability of cells to reduce nitroblue tetrazolium, acquired expression of the early maturation marker CDl Ib and increased activity of steroid sulphatase (a marker of myeloid maturation).
• SCF human stem cell factor
• IL3 recombinant human interleukin 3
• G-CSF recombinant human granulocyte colony-stimulating factor
• VTP 194310 pan-RAR antagonist VTP 194310 as indicated in the results.
• SCF, IL3 and G-CSF were obtained from R and D Systems, Abingdon, UK. Triplicate cultures were established for each condition.
• Cultures were fed and split, first into microtitre wells and then as 2 ml cultures in Costar wells, so as to maintain the cell density between 2.5 to 10 x 10 5 cells/ml. Cells were grown at 37°C in a humidified incubator and an atmosphere of 5% CO2.
• pan-RAR antagonist VTP 194310 completely blocked the capacity of 100 nM ATRA to induce neutrophil differentiation of HL60 cells.
• Treatment of HL60 cells for 5 days with 100 nM ATRA led to growth arrest, acquisition of the ability to reduce nitroblue tetrazolium, expression of CDl Ib, and increased steroid sulphatase activity. All of these events were abrogated when 100 nM VTP 194310 was co-administered with ATRA (see Fig. 2).
• Figure 3 shows the effects of 10 and 100 nM VTP 194310 on the growth and spontaneous differentiation of purified CD34 +Ve (>99%) haemopoietic progenitor cells.
• CD34 +VC cells were cultured in amounts of SCF (100 ng/ml) and IL3 (20 ng/ml) that ensure survival.
• SCF 100 ng/ml
• IL3 20 ng/ml
• CD38 is retinoid induced, under the direct control of RAR ⁇ , and increases during myeloid differentiation though in CD34 +ve cells differentiation and induction of CD38 i o are not functionally related. Prus et al have shown that VTP194310 inhibits expression of CD38 by human hematopoeitic cells in vitro.
• VTP 194310 (10 and 100 nM) and G-CSF substantially increased both the life span of cultures and the number of cells produced.
• the cultures treated with SCF/IL3 had almost expired by day 33 (cell density 0.6 x 10 5 /ml)
• the cultures that had been treated with VTP194310 (10 and 100 nM)/SCF/IL3 or G-CSF/SCF/IL3 still produced 5 large numbers of cells (Fig. 2A, top panel). Cell densities were at low levels (0.5 to 1.5 x 10 5 cells/ml) in these cultures at day 55.
• the cultures supplemented with 100 nM VTP 194310 generated cells at a slightly lower rate than the other cultures (see fig.
• CD34 +ve cells cultured in SCF/IL3 had fully matured by day 22, whereby 49 ⁇ 4% of cells were neutrophils (CD65 +V 7CD1 lb +ve and as CD15 +VC ) and 53 ⁇ 8% of cells were monocytes (CD14 +v 7CDl lb +ve ). Immature myeloid cells, identified as CD33 +v 7CD15 "v 7CD14 "ve were absent from the cultures by day 19. When cells were cultured in G-CSF/SCF/IL3 equal numbers of neutrophils and monocytes were generated, but in much larger numbers than when SCF/IL3 were used (Fig.3A). By day 22, the G-SCF/SCF/IL3 cultures largely contained mature neutrophils and monocytes (compare total cell number and numbers of neutrophils and monocytes in Fig. 3A).
• the effect of adding 10 nM and 100 nM VTP 194310 to the use of SCF/IL3 to culture of CD34 +ve cells was to increase the number of neutrophils generated (compare bottom two panels in Fig. 3A).
• 10 nM VTP 194310 was more effective than 100 nM VTP 194310.
• the cumulative number of monocytes was not significantly affected by the presence of VTP 194310 (Fig. 3A).
• Visual inspection of the VTPl 94310-treated cultures between days 20 to 30 revealed that blast cells were prevalent in the cultures, marker analyses showed that a substantial proportion of the cells had not matured to either neutrophils or monocytes.
• neutrophils were present at levels of 33% ⁇ 2 (10 nM VTP194310) and 30% ⁇ 5 (10OnM VTP194310) and monocytes at levels of 32% ⁇ 4 (10 nM VTP194310) and 21% ⁇ 5 (100 nM VTP194310).
• Examination of all of the double and triple FACS analyses allowed us to identify two populations of cells that had persisted in the VTP 194310-treated cultures. These were cells that expressed the receptor for SCF and that were CD34 've , and immature myeloid cells, identified as CD33 +v 7CD15 "v 7CD14- ve (Fig. 3B).
• VTP 194310 did not affect the number and persistence of CD34 +VC cells in culture (Fig. 3B). These marker analyses are commensurate with the notion that the increased production of neutrophils in VTP 194310-treated cultures is related to an expansion of myeloid precursor populations and a slowing down of neutrophil differentiation.
• VTP 194310-driven neutrophil recovery in leukopenic mice was systemic by looking at the levels of neutrophils (Grl +ve /CDl lb +vc cells) in the spleen and bone marrow. These mice were gavaged with VTP 194310 on days —1 to 2 in relation to CPM treatment.
• the neutrophil, and lymphocyte counts were significantly elevated in VTP 194310-treated mice at days 6 to 8, as compared to control recovering mice (see Figure 4A).
• Spleen weight was increased at days 7 and 8 in the VTP 194310-treated mice as compared to the controls.
• the absolute number of Gr-l +ve /CDllb +vc cells was significantly increased in the spleen of VTP 194310-treated mice at days 6 and 7 (see Figure 4B).
• immature granulocytes, identified as Gr-l low /CD llb +ve were elevated in the spleen of VTP 194310-treated mice at days 6 and 7.
• ATCC American Type Culture Collection
• mice were rendered leukopenic by i.p. injection of CPM at 200 mg/kg.
• a lethal dose (LD) of S. aureus was determined by intravenous injections of 1 x 10 3 to 1 x 10 8 CFU to groups of 10 mice 4 days after CPM treatment. 10-day survivors were enumerated, and the LD95 of S. aureus was calculated by Probit analysis.
• Treatment with VTP 194310 (at 1 mg/kg) was started one day before CPM and continued for 3 more days.
• the animals were infected intravenously with 4.1 and 2.5 x 10 6 CFU of S. aureus in 200 ⁇ l of PBS. Surviving animals were recorded daily for 14 days after the challenge.
• mice There were 12 mice per condition, and the significance of the protective effect of VTP 194310 was determined by the Logrank Test (GraphPad Prism version 3.0, GraphPad Software, Inc., San Diego, Calif). All experiments were performed in compliance with relevant laws and institutional guidelines, and were approved by the Animal Care and Use Committee.
• VTP 194310 was given a day before CPM, at the same time as CPM and for two days after CPM, and S. aureus was injected at day 4 post-CPM.
• the mice given CPM and 4.I x IO 6 CFU S. aureus had all died by day 10. Only 10% of the mice receiving the lower dose of S. aureus were alive, and these mice had died by day 11. At day 10, 83% of the mice that had received VTP 194310 and each of the doses of S. aureus were alive.
• VTP 194310-treated mice given S. aureus was not due to activity of VTP 194310 against S. aureus.
• the compound was analyzed at an appropriate concentration in several assays for activity against S. aureus EMRSA- 16 252 and 5. aureus MSSA 476. Growth of bacteria on agar was not inhibited by the presence of 2 ⁇ M VTP194310 incorporated into the agar, or when 50 ⁇ l of 2 ⁇ M VTP194310 were added to an agar-well-diffusion assay. Furthermore, neither strain demonstrated any alteration in growth rate during growth in liquid culture in the presence of 2 ⁇ M VTP 194310.
• Granulocyte-colony stimulating factor is a key factor that drives recovery of neutrophils in neutropenia and is used clinically for the treatment of chemotherapy- induced severe neutropenia. It is therefore important to compare the effects of monotherapy VTP 194310, monotherapy G-CSF and the combined use of VTP 194310 with G-CSF.
• Monotherapy with VTP194310 (3mg/kg, Days -1 to 1) and pegylated-G- CSF (lODg/kg, Day 2) enhanced neutrophil recovery relative to control in neutropenic mice (150 mg/kg CPM).
• Combination treatment with these doses and regimens of VTP 194310 and pegylated-G-CSF further increased the rate of neutrophil recovery.
• VTP 194310 and pegylated G-CSF were slightly greater than additive.
• VTP 194310 together with G- CSF gave a rise in neutrophils that was sustained for longer than when G-CSF was used alone.
• VTP 194310 DMSO stock solution was made by weighing out VTP 194310 and dissolved in DMSO (25 mg/1.33 ml DMSO). This stock soltion was then mixed with
• VTP 194310 solution was made by mixing 39.2 ml Corn Oil + 0.8 ml
• VTP 194310 DMSO Stock The 1.0 mg/kg VTP 194310 solution was made by diluting the VTP 194310 DMSO
• the 150 mg/kg CPM solution was made by weighing out 187.5 mg 5-FU and mixing with 1O g saline.
• the 1 and 10 ⁇ g/kg PEG-G-CSF solutions were made by diluting 6 mg/ml stock with PBS.
• mice Male BDFl mice (C57B1 x DBA2), 7-8 weeks old, DOB: 01 June 2006) were used in this experiment. Blood samples:
• 35 ⁇ l of blood (via the submandibular vein) were collected according to the scheduled time points or until the full recovery of blood cells and platelets.
• the blood samples were analyzed after 1 :5 dilution with PBS saline containing 2% BSA (Fraction V) and 0.2 mM EDTA on the Hematology Analyzer CeIl-DYN 3700 (Abbott Diagnostics).
• mice were treated with vehicle, VTP 194310 at 3 mg/kg, PEG-G-CSF at 3 mg/kg, PEG-G-CSF at 3 mg/kg
• VTP 194310 and PEG-G-CSF further increased the rate of neutrophil recovery as compared to the monotherapy with either VTP 194310 or PEG-G-CSF.
• VTP 194310 together with PEG-G-CSF gave a rise in neutrophils that was sustained for longer than when PEG-G-CSF was used alone.
• VTP 194310 appears to be similarly effective to PEG-G-CSF at 10 ⁇ g/kg in enhancing neutrophil recovery in CPM-induced mouse model of neutropenia. Combination treatment with VTP 194310 and PEG-G-CSF further increased recovery.
• Granulocyte-colony stimulating factor is a key factor that drives recovery of neutrophils in neutropenia and is therefore used to treat chemotherapy-induced severe neutropenia in patients. It is important to compare the effect of monotherapy VTP 194310, monotherapy G-CSF and the combined effects of VTP 194310 with G- CSF.
• VTP 194310 monotherapy G-CSF
• PEG-G-CSF PEG-G-CSF
• VTP 194310 DMSO Stock solution was made by weighing out VTP 194310 and dissolving it in DMSO (25 mg/1.33 ml DMSO).
• the Vehicle solution was made by mixing 39.2 ml Corn Oil + 0.8 ml DMSO.
• VTP194310 solution was made by mixing 39.2 ml Corn Oil + 0.8 ml
• the 150 mg/kg 5-FU solution was made by weighing out 187.5 mg 5-FU and mixing it with 1O g saline.
• the 10 ⁇ g/kg PEG-G-CSF solution was made by diluting 6 mg/ml stock with PBS.
• mice Male BDFl mice (C57B1 x DBA2), 9 weeks old, DOB: 26 June 2006) were used in this experiment.
• mice were treated with 150 mg/kg 5-FU intravenously on Day 0, vehicle or VTP 194310 orally by gavage at 3 mg/kg/day on Days 2 to 4, and/or subcutaneously with PEG-G-CSF at 10 ⁇ g/kg on Days 5, 6, or 7 according to the regimens listed in the table.
• the mean numbers of total white blood cells (WBC), neutrophils, lymphocytes, red blood cells (RBC) and platelets and standard error (SE) of data obtained for each treated group are shown in Figure 8.
• VTP 194310 at 3 mg/kg/day for three days on Days 2 to 4 is more effective than PEG-G-CSF at 10 ⁇ g/kg given on Days 5, 6, or 7 in enhancing neutrophil recovery in the 5-FU-induced mouse model of neutropenia.
• Combination treatment with VTP 194310 and PEG-G-CSF appears to be more effective than either monotherapy with VTP194310 or with PEG-G-CSF at provoking neutrophil recovery in this 5- FU-induced neutropenia model.
• VTP 194310 has the following chemical structure:
• This compound 4-[[4-(4-ethylphenyl)-2,2-dimethyl-(2H)-thiochromen-6-yl]-ethynyl]- benzoic acid, may be synthesized using conventional organic synthetic means.
• the following reaction scheme is a currently preferred method of making this compound.
• Step 1 A heavy- walled screw cap tube was charged with 3-methyl-2-butenoic acid (13.86 g, 138.4 mmol), 4-methoxy thiophenol (20.0 g, 138.4 mmol), and piperidine (3.45 g, 41.6 mmol). This mixture was heated to 10 0 C for 32 hours, cooled to room temperature and dissolved in EtOAc (700 mL). The resulting solution was washed with IM aqueous HCl, H 2 O, and saturated aqueous NaCl before being dried over Na 2 SO 4 . Concentration of the dry solution under reduced pressure afforded an oil which upon standing in the freezer provided a crystalline solid.
• Step 2 To a solution of 3-(4-methoxy-phenylsulfanyl)-3-methyl-butyric acid (20.0 g, 83.2 mmol) in 250 mL of benzene at room temperature was added a solution of oxalyl chloride (15.84 g, 124.8 mmol) in 10 mL of benzene over 30 minutes. After 4 hours the solution was washed with ice cold 5% aqueous NaOH (CAUTION: a large volume of gas is released during this procedure), followed by ice cold H 2 O, and finally saturated aqueous NaCl. The solution was dried (Na 2 SO 4 ) and concentrated under reduced pressure to give a clear yellow oil.
• CAUTION a large volume of gas is released during this procedure
• Step 3 To a solution of the acyl chloride product of Step 2 (21.5 g, 83.2 mmol) in 250 mL OfCH 2 Cl 2 at 0 0 C was added dropwise to a solution Of SnCl 4 (21.7 g, 83.2 mmol) in 30 mL of CH 2 C ⁇ . After 2 hours the reaction was quenched by slow addition of 150 mL H 2 O. The organic layer was washed with IM aqueous HCl, 5% aqueous NaOH, H 2 O, and finally saturated aqueous NaCl before being dried over MgSO.».
• Step 4 To a solution of 6-methoxy-2,2-dimethyl-thiochroman-4-one (6.0 g, 27 mmol) in 50 mL CH 2 Cl 2 cooled to -23°C was added BBr 3 (20.0 g, 80.0 mmol; 80.0 mL of a IM solution in CH 2 Cl 2 ) over a 20 minute period. After stirring for 5 hours at -23 0 C the solution was cooled to -78°C and quenched by the slow addition of 50 mL OfH 2 O.
• Step 5 To a solution of 6-hydroxy-2,2-dimethylthiochroman-4-one (165.0 mg, 0.79 mmol) in 5.0 mL of anhydrous pyridine at 0 0 C was added trifluoromethanesulfonic anhydride (245.0 mg, 0.87 mmol). After 4 hours at 0 0 C the solution was concentrated and the residual oil dissolved in Et 2 O, washed with H 2 O followed by saturated aqueous NaCl, and dried over MgSO 4 .
• Step 6 A solution of 2,2-dimethyl-4-oxo-thiochroman-6-yl trifluoromethanesulfonate (2.88 g, 8.50 mmol) in 10 mL Et 3 N and 20.0 mL DMF was purged with argon for 10 minutes. To this solution was added trimethylsilylacetylene (4.15 g, 42.0 mmol) and bis(triphenylphosphine)-palladium (II) chloride (298.0 mg, 0.425 mmol). The solution was heated to 95°C for 5 hours, cooled to room temperature, and diluted with H 2 O.
• Step 7 A solution of 2,2-dimethyl-6-trimethylsilanylethynylthiochroman-4-one (110.0 mg, 0.38 mmol) and K 2 CO 3 (40.0 mg, 0.29 mmol) in 10.0 mL MeOH was stirred overnight at room temperature. The solution was diluted with H 2 O and extracted with Et 2 O. The combined organic layers were washed with H 2 O and saturated aqueous NaCl and dried over MgS O 4 . Removal of the solvent under reduced pressure afforded 81 mg (99%) of the 6-ethynyl-2 5 2-dimethylthiochroman-4-one as an orange oil.
• Step 8 A solution of 6-ethynyl-2,2-dimethylthiochroman-4-one (82.0 mg, 0.38 mmol) and ethyl 4-iodobenzoate (104.9 mg, 0.38 mmol) in 5.0 mL Et 3 N was purged with argon for 10 minutes. To this solution were added bis(triphenylphosphine)-palladium (II) chloride (88.0 mg, 0.12 mmol) and copper (I) iodide (22.9 mg, 0.12 mmol). After purging for an additional 5 minutes with argon, the solution was stirred overnight at room temperature. The reaction mixture was filtered through a pad of Celite using an Et 2 O wash.
• Step 9 A solution of sodium bis(trimethylsilyl)amide (1.12 g, 6.13 mmol) in 16.2 mL of THF was cooled to -78°C and a solution of ethyl 4-(2,2-dimethyl-4-oxo-thiochroman-6- ylethynyl)-benzoate (1.86 g, 5.10 mmol) in 15.0 mL was added slowly. After 30 minutes a solution of 2-[N,N-bis(trifluoromethanesulfonyl)amino]-5-pyridine (2.40 g, 6.13 mmol) in 10 mL of THF was added. After 5 minutes the solution was warmed to room temperature and stirred overnight.
• Step 10 A solution of 4-ethylbromobenzene (670.9 mg, 3.63 mmol) in 4.0 mL of THF was cooled to -78°C; and tert-butyllithium (464.5 mg, 7.25 mmol, 4.26 mL of a 1.7M solution in pentane) was added to give a yellow solution. After 30 minutes a solution of ZnCl 2 (658.7 mg, 4.83 mmol) in 8.0 mL THF was slowly added via cannula.
• Step 11 To a solution of ethyl 4-[[4-(4-ethylphenyl)-2,2-dimethyl-(2H)-thiochromen-6- yl]-ethynyl]-benzoate (940.0 mg, 2.08 mmol) in 10.0 mL THF and 5.0 mL EtOH was added NaOH (416.0 mg, 10.4 mmol, 5.2 mL of a 2M aqueous solution). The resulting solution was stirred overnight at room temperature. The reaction mixture was acidified with 10% aqueous HCl and extracted with EtOAc.

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