Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D493/00—Heterocyclic compounds containing oxygen atoms as the only ring hetero atoms in the condensed system
  • C07D493/02—Heterocyclic compounds containing oxygen atoms as the only ring hetero atoms in the condensed system in which the condensed system contains two hetero rings
  • C07D493/10—Spiro-condensed systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
  • A61P33/02—Antiprotozoals, e.g. for leishmaniasis, trichomoniasis, toxoplasmosis
  • A61P33/06—Antimalarials
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
  • A61P33/10—Anthelmintics
  • A61P33/12—Schistosomicides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D323/00—Heterocyclic compounds containing more than two oxygen atoms as the only ring hetero atoms
  • C07D323/02—Five-membered rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
  • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
  • C07D405/12—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a chain containing hetero atoms as chain links
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
  • C07D413/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings
  • C07D413/12—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings linked by a chain containing hetero atoms as chain links
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• This invention relates to compositions and methods for treating malaria. Specifically, this invention relates to pharmaceutical compositions including dispiro trioxolanes, and methods of their use and manufacture.
• Malaria is an acute and often chronic infectious disease resulting from the presence of protozoan parasites within red blood cells. Caused by single-celled parasites of the genus Plasmodium, malaria is transmitted from person to person by the bite of female mosquitos.
• Plasmodium protozoan parasites are generally responsible for malaria, including Plasmodium vivax, Plasmodium falciparum, Plasmodium malariae, and Plasmodium ovale. Of the four, Plasmodium falciparum is the most dangerous, accounting for half of all clinical cases of malaria and 90% of deaths from the disease.
• the transmission of malaria begins when a female mosquito bites a human already infected with the malaria parasite.
• sporozoites in the mosquito's saliva are transferred into the blood, which then travel to the liver, hi the liver, the sporozoites divide rapidly, then enter the bloodstream where they invade red blood cells.
• the merozoites multiply rapidly until they cause the red blood cells to burst, releasing into the blood stream a new generation of merozoites that then infect other red blood cells.
• the symptoms associated with malaria are generally associated with the bursting of the red blood cells.
• the destruction of the red blood cells spills wastes, toxin, and other debris into the blood. This in turn causes an intense fever that can leave the infected individual exhausted and bedridden.
• More severe symptoms associated with repeat infections and/or infection by Plasmodium falciparum include anemia, severe headaches, convulsions, delirium and, in some instances, death.
• Quinine an antimalarial compound that is extracted from the bark of the South American cinchona tree, is one of the oldest and most effective pharmaceuticals in existence.
• the downside to quinine is that it is short-acting, and fails to prevent disease relapses. Further, quinine is associated with side effects ranging from dizziness to deafness.
• Chloroquine is a synthetic chemical similar to quinine. It became the drug of choice for malaria when it was developed in the 1940s due to its effectiveness, ease of manufacture, and general lack of side effects. However, in the last few decades, malaria parasites in many areas of the world have become resistant to chloroquine.
• Mefloquine is another synthetic analog of quinine that has been used in the treatment of malaria. Malaria parasites have also developed resistance to mefloquine, however. Mefloquine is also associated with undesirable central nervous side effects in some patients, including hallucinations and vivid nightmares.
• Antifolate drugs are effective against malaria parasites by inhibiting their reproduction. Although the parasites have also developed a resistance to antifolate drugs, the drugs can still be used effectively in combination with other types of antimalarials. The use of combination therapies in treating malaria has the drawbacks of being inconvenient and expensive, however.
• the invention describes a method and composition for treating malaria with dispiro 1 ,2,4-trioxolanes, their prodrugs and analogues.
• preferred trioxolanes of this invention contain a czs- ⁇ '-phenyl substituent on the cyclohexyl ring.
• the compounds of the invention fall into one of following three structural classes:
• the first class is a group consisting of:
• the second class is the first class:
• the invention embraces analogues, achiral, achiral diastereomers, racemic mixtures, as well as enantiomeric forms of the compounds.
• trioxolanes of this invention possess excellent potency and efficacy against Plasmodium parasites.
• the compounds of this invention demonstrate prophylactic activity against malaria and, in many instances, offer one-dose effectiveness.
• several of the trioxolanes are suitable for oral administration.
• the compounds of this invention are structurally simple, easy and inexpensive to synthesize, and can be used effectively alone or in conjunction with other antimalarials.
• the present invention relates to the development of spiro and dispiro 1 ,2,4- trioxolanes for use in the prophylaxis and treatment of malaria.
• the present invention is predicated upon the unexpected discovery that trioxolanes having particular substituents on one side of the trioxolane heterocycle provide metabolic and chemical stability to the trioxolane ring, thereby providing better in vivo activity, especially with respect to oral administration.
• the compounds of this invention provide unexpectedly good antimalarial prophylactic properties, as well as a single dose cure against the disease in many instances.
• the term “prophylaxis-effective amount” refers to a concentration of compound of this invention that is effective in inhibiting, decreasing the likelihood of, or preventing infection and subsequent disease by malarial parasites.
• treatment-effective amount refers to a concentration of compound that is effective in treating malaria in terms of preventing an increase in the concentration of malarial parasites, decreasing the concentration of malarial parasites, and/or "curing" a malaria infection, i.e. in standard mouse models of malaria, this would equate to survival for 30 days post-infection.
• R 1 , R 2 , R 3 , and R 4 represent combinations of ring systems, acyclic systems, and functional groups that provide sufficient steric hindrance about the trioxolane ring in order to give the ring chemical and metabolic stability.
• trioxolane compounds of the present invention are surprisingly iron-stable, and have been found to provide unexpectedly good antimalarial activity.
• Compounds of this structure are orally active, and certain representative compounds have even been found to be malaria-curative with a single dose.
• the preferred compounds of this invention have an improved safety profile in comparison to previously disclosed trioxolane compounds.
• the compounds have the following general structure, with the R groups listed below the main structure.
• OZ (which stands for “ozonide”) is an internal designation for these compounds that will be used throughout the remainder of the application for convenience.
• OZ 4 98 OZ505 OZ513 OZ534 OZ535 OZ537 OZ539 OZ543 OZ545 OZ547 OZ549
• the compounds have the following structure:
• the compounds have the following structure:
• Preferred compounds of the present invention identified thus far include: -cw-adamantane-2-spiro-3'-8 t -[4'-[2'-(4'-morpholinyl)ethoxy]phenyl]-r,2',4 l - trioxaspiro[4.5]decane mesylate (OZ439); -cw-Adamantane-2-spiro-3 l -8'-[4'-[3'-(4'-morpholinyl)propoxy]phenyl]-r,2',4'- trioxaspiro[4.5]decane mesylate (OZ461);
• OZ439 OZ466, OZ493, OZ527, OZ537, OZ539, and OZ555 as they have been found to be malaria-curative in some instances with a single dose.
• dispiro trioxolanes maybe easily synthesized by the coozonolysis of the O- methyl oximes of cycloalkanones in the presence of the requisite cycloalkanone derivatives according to the method of Griesbaum et al. (1997a; 1997b) as illustrated below for the symmetrical dispiro cyclohexyl trioxolane:
• trioxolane Formation of a trioxolane from an oxime ether and a ketone is presumed to be a three-step process.
• the sequence begins by the electrophilic addition of ozone to the oxime double bond to form a primary ozonide.
• the carbonyl oxide undergoes a [3 + 2] cycloaddition with a ketone to give the secondary ozonide or 1 ,2,4— trioxolane. It remains to be
• Most of the new dispiro trioxolanes contain a spiroadamantane and can be synthesized by the coozonolysis of adamantanone 0-methyl oxime in the presence of the requisite cycloalkanone derivative.
• the preferred reaction solvents for the coozonolysis reactions are hydrocarbon solvents such as pentane or cyclohexane; more polar solvents tend to decrease the yield of the reaction.
• a mixed solvent penentane/methylene chloride
• methylene chloride alone may be used.
• the dispiro trioxolane compositions of the present invention may be generally used for the prophylaxis and treatment of malaria.
• the trioxolane compositions of the present invention are administered along with a pharmaceutically acceptable carrier. Any pharmaceutically acceptable carrier may be generally used for this purpose, provided that the carrier does not significantly interfere with the stability or bioavailability of the trioxolane compounds of this invention.
• trioxolanes of this invention can be administered in any effectively pharmaceutically acceptable form to warm blooded animals, including human and other animal subjects, e.g. in topical, lavage, oral, suppository, parenteral, or infusible dosage forms, as a topical, buccal, sublingual, or nasal spray or in any other manner effective to deliver the agents.
• the route of administration will preferably be designed to optimize delivery and/or localization of the agents to target cells.
• the pharmaceutical compositions of this invention may contain suitable excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically.
• Oral dosage forms encompass tablets, capsules, and granules. Preparations which can be administered rectally include suppositories.
• Other dosage forms include suitable solutions for administration parenterally or orally, and compositions which can be administered buccally or sublingualis
• the pharmaceutical preparations of the present invention are manufactured in a manner which is itself well known in the art.
• the pharmaceutical preparations may be made by means of conventional mixing, granulating, dragee-making, dissolving, lyophilizing processes.
• the processes to be used will depend ultimately on the physical properties of the active ingredient used.
• Suitable excipients are, in particular, fillers such as sugars for example, lactose or sucrose mannitol or sorbitol, cellulose preparations and/or calcium phosphates, for example, tricalcium phosphate or calcium hydrogen phosphate, as well as binders such as starch, paste, using, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethylcellulose, sodium carboxymethylcellulose, and/or polyvinyl pyrrolidone.
• fillers such as sugars for example, lactose or sucrose mannitol or sorbitol
• cellulose preparations and/or calcium phosphates for example, tricalcium phosphate or calcium hydrogen phosphate
• binders such as starch, paste, using, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose,
• disintegrating agents may be added, such as the above-mentioned starches as well as carboxymethyl starch, cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof, such as sodium alginate.
• Auxiliaries are flow-regulating agents and lubricants, for example, such as silica, talc, stearic acid or salts thereof, such as magnesium stearate or calcium stearate and/or polyethylene glycol.
• Oral dosage forms may be provided with suitable coatings which, if desired, may be resistant to gastric juices.
• concentrated sugar solutions may be used, which may optionally contain gum arabic, talc, polyvinylpyrrolidone, polyethylene glycol and/or titanium dioxide, lacquer solutions and suitable organic solvents or solvent mixtures.
• suitable cellulose preparations such as acetylcellulose phthalate or hydroxypropylmethylcellulose phthalate, dyestuffs and pigments may be added to the tablet coatings, for example, for identification or in order to characterize different combination of compound doses.
• Other pharmaceutical preparations which can be used orally include push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer such as glycerol or sorbitol.
• the push-fit capsules can contain the active compounds in the form of granules which may be mixed with fillers such as lactose, binders such as starches, and/or lubricants such as talc or magnesium stearate and, optionally, stabilizers.
• the active compounds are preferably dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols. In addition stabilizers may be added.
• Possible pharmaceutical preparations which can be used rectally include, for example, suppositories, which consist of a combination of the active compounds with the suppository base.
• Suitable suppository bases are, for example, natural or synthetic triglycerides, paraffin hydrocarbons, polyethylene glycols, or higher alkanols.
• gelatin rectal capsules which consist of a combination of the active compounds with a base.
• Possible base material include for example liquid triglycerides, polyethylene glycols, or paraffin hydrocarbons.
• Suitable formulations for parenteral administration include aqueous solutions of active compounds in water-soluble or water-dispersible form.
• suspensions of the active compounds as appropriate oily injection suspensions may be administered.
• Suitable lipophilic solvents or vehicles include fatty oils for example, sesame oil, or synthetic fatty acid esters, for example, ethyl oleate or triglycerides.
• Aqueous injection suspensions may contain substances which increase the viscosity of the suspension, including for example, sodium carboxymethyl cellulose, sorbitol and/or dextran.
• Such compositions may also comprise adjuvants such as preserving, wetting, emulsifying, and dispensing agents. They may also be sterilized, for example, by filtration through a bacteria-retaining filter, or by incorporating sterilizing agents into the compositions. They can also be manufactured in the form of sterile solid compositions which can be dissolved or suspended in sterile water, saline, or other injectable medium prior to administration.
• active ingredients may be administered by a variety of specialized delivery drug techniques which are known to those of skill in the art, such as portable infusion pumps.
• the trioxolane compositions of the present invention are administered along with a pharmaceutically acceptable carrier in an amount sufficient to prevent malarial infection and/or treat an active infection.
• the trioxolane compounds of this invention have extremely low toxicity and a low degree of side effects even at high doses.
• the dosing range of the trioxolane compositions will vary depending on a number of factors, such as whether it is used for prophylaxis or treatment of an active infection, route of administration, dosing schedule, etc.
• the therapeutic dose of trioxolane may range between about 0.1-1000 mg/kg/day, with between about 1 - 100 mg/kg/day being preferred.
• the foregoing doses may be administered as a single dose or may be divided into multiple doses for administration. For single dosing, a possible dosing range is from about 0.5-5.0 mg/kg. However, this dosing range may extend much higher.
• trioxolane compositions may be administered once to several times daily.
• a typical dosing schedule could be, for example (other than for single dose cure), 2.0-1000 mg/kg weekly beginning 1 -2 weeks prior to malaria exposure taken up until 1 -2 weeks post-exposure.
• the spiro and dispiro trioxolanes of this invention may be administered as any pharmaceutically effective salt form.
• Such salts are well known in the art and include, but are not limited to acetate, adipate, alginate, citrate, aspartate, benzoate, benzene sulfonate, bisulfate, butyrate, camphorate, camphor sulfonate, digluconate, glycerophosphate, hemisulfate, heptanoate, hexanoate, fumarate, hydrochloride, hydrobromide, hydroiodide, 2-hydroxyethansulfonate (isothionate), lactate, maleate, methane sulfonate, nicotinate, 2- naphthalene sulfonate, oxalate, palmitoate, pectinate, persulfate, 3-phenylpropionate, picrate, pivalate, propionate, succinate,
• Combination therapy with antimalarial drugs is the simultaneous use of two or more blood schizontocidal drugs with independent modes of action and different biochemical targets in the parasite.
• the concept of combination therapy is based on the synergistic or additive potential of two or more drugs, to improve therapeutic efficacy and also delay the development of resistance to the individual components of the combination.
• Examples of current antimalarial drug combinations include artemisinin combinations with chloroquine and mefloquine and quinine based combinations with tetracycline and clindamycin.
• the trioxolanes of the present invention are expected to be administered in combinations with various other antimalarials including, but not limited to, artemether, chloroquine, mefloquine, piperaquine, and pyronaridine.
• the spiro and dispiro trioxolanes of this invention have been found to be effective in the treatment of schistosomiasis.
• Schistosomiasis ranks second behind malaria in terms of socioeconomic and public health importance in tropical and subtropical areas.
• the disease is endemic in 74 developing countries, infecting more than 200 million people in rural agricultural and peri-urban areas. An estimated 500-600 million people worldwide are at risk from the disease.
• schistosomiasis The major forms of human schistosomiasis are caused by five species of water- borne flatworm, or blood flukes, called schistosomes.
• Schistosoma mansoni which has been reported in 53 countries in Africa, the Eastern Mediterranean, the Caribbean, and South America.
• the parasites enter the body through contact with infested surface water, primarily among people engaged in agriculture and fishing.
• the parasites normally infect the host during the cercaria, or larval stage. Once inside the host, the cercaria develop into adults or schistosomes.
• the spiro and dispiro trioxolanes of this invention are active against both cercaria and adult S. mansoni, S. japonicum when administered in the dosages and manner outlined above with respect to treatment of malarial parasites. It is also believed the trioxolanes of this invention will be active against S. haematobium. Preferred dosing levels of the dispiro trioxolanes of this invention are about 100-200 mg/kg/day orally.
• trioxolanes which are compatible with the carrier ingredients may also be incorporated into the carrier.
• Such drugs may be readily ascertained by those of ordinary skill in the art and may include, for instance, antibiotics, other antimalarials, antiinflammatory agents, etc.
• the present invention contemplates the use of not only the above-stated trioxolane compounds themselves, but their prodrugs which metabolize to the compound and the analogues and biologically active salt forms thereof, as well as optical isomers which provide the same pharmaceutical results.
• SSV standard suspending vehicle
• the SSV consists of either 0.5% w/v carboxymethyl cellulose, 0.5% v/v benzyl alcohol, 0.4% v/v Tween 80, and 0.9% w/v sodium chloride in water or 0.5% hydroxypropylmethylcellulose 0.4% v/s Tween 80, and 0.5% v/v benzyl alcohol in water.
• Trioxolanes were administered as single po 30 mg/kg doses. Antimalarial activity was measured by percent reduction in parasitemia on day three post-infection and survival times compared to an untreated control group. Survival to day 30 post-infection is considered to be a cure in this model.
• AS artesunate
• AM artemether
• CQ chloroquine
• MQ mefloquine
• AS artesunate
• AM artemether
• CQ chloroquine
• MQ mefloquine
• trioxolanes containing the cis- 8 '-phenyl substituent on the cyclohexyl ring demonstrated surprisingly improved stability in rat blood at 37 0 C in comparison to the earlier compounds containing a czs-8'-alkyl substituent.
• OZ462 which was found to be metabolically unstable, all of the cz.s-8'-phenyl compounds tested had considerably longer half-lives in rats following oral administration, and correspondingly higher oral bioavailabilities, in comparison to compounds containing the czs- ⁇ '-alkyl substituent.
• Diisopropyl azodicarboxylate (0.36 ml, 1.83 mmol) was added dropwise to a mixture of OZ450 (0.31 g, 0.72 mmol), phthalimide (0.22 g, 1.49 mmol), and triphenylphosphine (0.48 g, 1.83 mmol) in THF (12 ml) at 0 0 C under N 2 .
• the resulting mixture was stirred at rt for 2 d and then quenched with 5% aq. NaHCO 3 (10 ml).
• Diisopropyl azodicarboxylate (0.69 ml, 3.51 mmol) was added dropwise to a mixture of OZ288 (1.00 g, 2.81 mmol), N-(trans- 4-hydroxycyclohexyl)phthalimide (0.85 g, 3.47 mmol), and triphenylphosphine (0.92 g, 3.51 mmol) in THF (50 ml) at 0 0 C under N 2 .
• the resulting mixture was stirred at rt for 24 h.
• trioxolane OZ495 (2.50 g, 63%) as a colorless solid, mp 90-91 0 C; 1 H NMR (500 MHz, CDCl 3 ) ⁇ 1.05-2.11 (m, 28H), 2.21-2.49 (m, 4H); 13 C NMR (125.7 MHz, CDCl 3 ) ⁇ 26.47, 26.87, 27.28, 29.87, 34.39, 34.79, 36.39, 36.79, 40.42, 40.84, 41.02, 108.68, 111.34, 212.17. Anal.
• Step 1 A mixture of phthalic anhydride (1.48 g, 10 mmol) and 5-amino-l-pentanol (1.03 g, 10 mmol) in toluene (20 ml) was heated under reflux overnight.
• Diisopropyl azodicarboxylate (0.69 ml, 3.51 mmol) was added dropwise to a mixture of OZ288 (0.50 g, 1.4 mmol), 7V-(5-hydroxypentyl)phthalimide (0.65 g, 2.79 mmol), triphenylphosphine (0.92 g, 3.51 mmol), and triethylamine (0.5 ml,3.51 mmol) in THF (50 ml) at 0°C under N 2 atmosphere. The resulting mixture was stirred at rt for 24 h.
• Step 3 A mixture of the above phenol ether (0.30 g, 0.53 mmol) and hydrazine monohydrate (1 ml) in chloroform (30 ml) and methanol (3 ml) was heated at 50 °C for 24 h. After the reaction mixture was cooled to rt and filtered to the remove a solid by-product, the filtrate was washed with water (2 x 10 ml) and brine (10 ml), dried over MgSO 4 , filtered, and concentrated. The residue was dissolved in CH 2 Cl 2 (5 ml) and a solution of methanesulfonic acid (0.05 g, 0.52 mmol) in ethyl acetate (20 ml) was added.
• methanesulfonic acid 0.05 g, 0.52 mmol
• trioxolane OZ508 (0.30 g, 83%, 10:1 mixture of two diastereomers) as a colorless solid, mp 138-140°C; 1 H NMR (500 MHz, CDCl 3 ) ⁇ 0.98-2.05 (m, 33H), 3.48-3.55 (m, IH); 13 C NMR (125.7 MHz, CDCl 3 ) ⁇ 26.48, 26.88, 27.21, 28.15, 34.52, 34.79, 35.77,
• Diisopropyl azodicarboxylate (0.32 ml, 1.68 mmol) was added dropwise to a mixture of OZ288 (0.5 g, 1.4 mmol), tert- butyl czs-4-hydroxycyclohexylcarbamate (0.3 g, 1.4 mmol), and triphenylphosphine (0.44 g, 1.68 mmol) in THF (50 ml) at 0°C under N 2 atmosphere. The resulting mixture was stirred at rt for 24 h.
• Step 1 To a stirred solution of trans- 4-aminocyclohexanecarboxylic acid methyl ester hydrochloride (1.0 g, 5.17 mmol) and triethylamine (2 ml) in CH 2 Cl 2 (30 ml) was added BoC 2 O (1.20 g, 5.50 mmol). The resulting mixture was stirred at rt overnight.
• Diisopropyl azodicarboxylate (0.69 ml, 3.24 mmol) was added dropwise to a mixture of OZ288 (1.00 g, 2.80 mmol), tert-butyl trafts-(4-hydroxymethyl)cyclohexylcarbamate (0.64 g, 2.80 mmol), and triphenylphosphine (0.85 g, 3.24 mmol) in THF (50 ml) at 0°C under Ar. The resulting mixture was stirred at rt for 24 h.
• Step 2 To a stirred mixture of ci5-adamantane-2-spiro-3'-8 t -[4'-(4'-bromobutoxy)phenyl]-r,2',4'- trioxaspiro[4.5]decane (0.6 g, 1.22 mmol) and potassium carbonate (2.0 g) in acetonitrile (50 ml) was added morpholine (0.533 g, 6.12 mmol) at rt. After the reaction mixture was stirred for 48 h at 60 °C, the inorganic solid was filtered off and washed with EtOAc (2 x 25 ml). The combined filtrate was evaporated to dryness in vacuo.
• trioxolane OZ561 was filtered, washed with EtOAc (3 x 10 ml), and dried under vacuum at 40 0 C to afford trioxolane OZ561 as a colorless solid (0.15 g, 15%).
• trioxolane OZ562 was filtered, washed with EtOAc (3 x 10 ml), and dried in vacuo at 40 0 C to afford trioxolane OZ562 as a colorless solid (0.65 g, 87%).
• Diisopropyl azodicarboxylate (1.20 g, 5.9 mmol) was added dropwise to a mixture of OZ288 (1.0 g, 2.81 mmol), 4- hydroxy-l-(2-hydroxy-2-methylpropyl)piperidine (1.0 g, 5.8 mmol), and triphenylphosphine (1.55 g, 5.9 mmol) in THF (50 ml) at 0 0 C under N 2 .
• the resulting mixture was stirred at rt for 24 h. After removal of the solvent, the residue was purified by crystallization from EtOH/H 2 O (1 : 1 ) to afford the pure free base as a colorless solid (0.50 g).
• trioxolane OZ572 was collected by filtration to afford trioxolane OZ572 as a colorless solid (0.58 g, 30%). mp 152-153 0 C. 1 H NMR (500 MHz, CDCl 3 ) ⁇ 1.45 (s, 6H), 1.66-2.16 (m, 24H), 2.36 (s, 3H), 2.46-2.54 (m, IH), 2.56-2.67 (m, 2H), 3.04-3.10 (m, 2H), 3.17-3.28 (m, 2H), 3.65-3.73 (m, 2H), 4.61-
• trioxolane OZ575 was filtered, washed with ether (3 x 10 ml), and dried under vacuum at 40 0 C to afford trioxolane OZ575 as a colorless solid (0.60 g, 79%).
• OZ rat whole embryo culture
• WEC whole embryo culture
• NOAELs non observed adverse effect levels
• RBCs Embryonic red blood cells
• the NOAEL for embryonic RBCs was 0.01 ⁇ g/mL for dihydroartemisinin, 0.1 ⁇ g/mL for artemisinin, and 0.2 ⁇ g/mL for O ⁇ 211, whereas it was considerably higher for the newer OZ compounds (5 ⁇ g/mL for OZ439, and
• the spiro and dispiro 1 ,2,4-trioxolane compositions of this invention may contain trioxolanes within the scope of the formulas described above, or prodrugs or analogues of these compounds or a racemic mixture of either the D or the L form.
• the invention is also intended to include all biologically active salt forms of the compounds. Also, minor dosage and formulation modifications of the composition and the ranges expressed herein may be made and still come within the scope and spirit of the present invention.

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• 2007
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