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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
  • A61K31/16—Amides, e.g. hydroxamic acids
  • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
  • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/357—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having two or more oxygen atoms in the same ring, e.g. crown ethers, guanadrel
  • A61K31/36—Compounds containing methylenedioxyphenyl groups, e.g. sesamin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/4245—Oxadiazoles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
  • A61K31/536—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines ortho- or peri-condensed with carbocyclic ring systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
  • A61P31/14—Antivirals for RNA viruses
  • A61P31/18—Antivirals for RNA viruses for HIV
• • 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

Definitions

• the present invention relates to the use of N-hydroxy-benzamide-based histone deacetylase inhibitors for treating humans infected by human immunodeficiency virus (HIV).
• HIV human immunodeficiency virus
• HAART highly active antiretroviral therapy
• HIV-1 infection may be efficiently controlled, maintaining the HIV-1 viremia below the detectable values.
• HAART highly active antiretroviral therapy
• the elimination of HIV- 1 infection through extended HAART therapy is not yet possible.
• Upon interruption of the HAART there occurs the viremia rebound, typically after two weeks [Imamichi H. et al. J Infect. Dis. 183, 36 (2001)].
• the source of viral rebound is a long-term cell pool, most probably the memory T-cells reservoir which are infected more slowly, which hosts the HIV-1 integrated pro viral DNA. Consolidated techniques for quantifying the latent cell pool are available and it is calculated that one memory cell out of a million of an HIV-1 positive patient carries a replication-competent integrated pro virus.
• the mechanisms that maintain the proviral DNA transcriptionally inactive in quiescent cells are known. However, it has been long believed that the mechanism includes a chromatin-associated regulation [Quivy V. et al. Subcell Biochem. 41, 371 (2007)].
• the integrated proviral DNA is densely organised in nucleosomes.
• the long terminal repeat (LTR) 5' of HIV-1, containing the promoter and enhancer elements, is the target of the binding of numerous transcription factors and it is organized into two nucleosomes (nuc-0 and nuc-1).
• the NFKB p50 homodimer as well as AP-4, YYl and LSFl, recruits the histone deacetylase/s (HDAC) to LTR, which in turn results in the deacetylation of local histones, in the compaction of chromatin, and in the prevention of the binding of RNA-polymerase II.
• HDAC histone deacetylase/s
• HDACi The HDAC inhibitors (HDACi), a new class of synthetic compounds, may invalidate the enzymatic activity of HDACs and the relative repression of the HIV-1 gene expression. Furthermore, contrary to the NFKB cell activators, like IL-2, OKT3 or TNFa, HDACi may facilitate gene expression without the general activation of the T-cells.
• Histone deacetylases are enzymes capable of removing the acetyl group bound to the lysine residues in the N-terminal portion of the histones or in other proteins.
• HDACs may be divided into four classes, according to structural homologies.
• Class I HDACs HDAC 1, 2, 3 and 8 are similar to the RPD3 yeast protein and they are found in the cell nucleus.
• Class II HDACs HDAC 4, 5, 6, 7, 9 and 10 are similar to the HDA1 yeast protein and they are found both in the nucleus and in the cytoplasm.
• Class III HDACs are a structurally distinct form of NAD- dependent enzymes correlated to the SIR2 yeast protein.
• Class IV HDAC 11
• HDAC 11 currently consists of a single enzyme having particular structural characteristics.
• Classes I, II and IV HDACs are enzymes containing zinc and they may be inhibited by various molecular classes: hydroxamic acid derivatives, cyclic tetrapeptides, short chain fatty acids, aminobenzamides, electrophilic ketone derivatives, and the like.
• Class III HDACs are not inhibited by hydroxamic acids, and the inhibitors thereof have structural characteristics different from those of the other classes.
• histone deacetylase inhibitor it is meant to indicate any molecule of natural origin, recombinant or synthetic, capable of inhibiting the activity of at least one of the enzymes classified as class I, II or IV histone deacetylase.
• Histone deacetylase inhibitors are a class of molecules having an anti-neoplastic and anti-inflammatory activity.
• the histone deacetylase inhibitors inhibit the cellular proliferation and induce cellular death and differentiation [Gaofeng Bi and Guosheng Jiang in Cellular & Molecular Immunology 3, 285-290 (2006)].
• Histone deacetylase inhibitors are also capable of modulating the production of cytokines and other pro-iiiflammatory factors by the immunocompetent cells and they have proven, in vivo, anti-inflammatory properties [Frederic Blanchard and Celine Chipoy in Drug Discovery Today 10, 197 -204 (2005); IM Adcock in British Journal of Pharmacology 150, 829-831 (2007)].
• HDAC inhibitors were proven capable of inducing the HIV-1 gene expression from a latently infected cell line; however, concerns about possible toxic effect of the inhibitors, at the concentration required for performing the induction, have been raised [Shehu-Xhilaga, M. et al. AIDS 23, 2047 (2009)]; regarding this, is it has been recently proposed [Archin, NM et al. AIDS 23, 1799 (2009)] that selective Class I HDAC inhibitors could be potent inducers of HIV with lower cytotoxicity.
• Valproic acid a carboxylic acid HDACi, prescribed for convulsive and mental disorders, was combined with HAART in some clinical studies but without leading to any considerable diminution of the latent reservoir [Lehrman G et al. Lancet 366 (9485), 549 (2005)]. Thus, these studies with VPA did not resolve the potential of HDACi to eliminate the virus.
• WO 2008/097654 discloses the use of SAHA for the treatment of HIV infection; SAHA is a HDACi, not having a N-hydroxy-benzamide structure, which is available in the market as Vorinostat or Zolinza.
• SAHA is indicated to induce the HIV-1 gene expression in the ACH-2 cell line, with an EC 50 of 0.632 ⁇ .
• the Zolinza package leaflet indicates that a possibly effective circulating concentration of SAHA for treating patients affected by Cutaneous T-Cell Lymphoma may be obtained with a dosage of 400 mg/day.
• SAHA may cause numerous, serious adverse effects such as diarrhoea, tiredness, nausea, thrombocytopenia, anorexia and dysgeusia.
• SAHA is mutagenic in vitro in the bacterial back-mutation assays (Ames test), it causes chromosome aberrations in vitro in Chinese Hamster Ovary (CHO) cells and it increases the incidence of micronucleated erythrocytes when administered to mice (Mouse Micronucleus Assay).
• diethyl-[6-(4-hydroxycarbamoyl-phenylcarbamoyloxymethyl)-naphtalen-2- yl-methyl]-ammonium chloride preferably in monohydrate form, more preferably in monohydrate crystal form (ITF2357, Givinostat)
• ITF2357 monohydrate crystal form
• Givinostat is capable of inducing the HIV-1 gene expression, in the ACH-2 cell line, at a concentration preferably between 125 and 250 nM.
• ITF2357 revealed to be non-mutagenic [Monzani, VM et al. presented at EUROTOX 2007, 44 th Congress of toxicology, poster G33]; therapeutic circulating concentrations between 125 and 250 nM may be easily obtained, in the clinical treatment, by administering 50-200 mg of ITF2357.
• the dosages within this range were used in numerous clinical studies and the detected toxic effects were extremely low; an equivalent dose of 1.5 mg/kg/day was administered to children with systemic onset juvenile idiopathic arthritis (SOJIA) with encouraging results and without detection of any toxic effect [Vojinovic, J. et al. presented at The 72 nd annual meeting of the American College of Rheumatology, San Francisco, California, 29 October 2008].
• SOJIA systemic onset juvenile idiopathic arthritis
• HDAC inhibitors which are 4-amino-N-hydroxy-benzamide derivatives (which include ITF2357) may be extremely effective at inducing the HIV gene expression at concentrations that do not reveal any considerable toxicity; this seems to be in contrast with the previous opinions [Shehu-Xhilaga, M. et al. AIDS 23, 2047 (2009)] which suggest that the two effects, HIV gene induction and toxicity, may depend on the same structural and/or mechanistic reasons.
• the object of the present invention is represented by a compound of general formula I for use in the treatment of HIV infections, preferably HIV-1 infections,
• X is O, CH or it is absent
• AT is aryl or saturated, unsaturated or partially unsaturated mono-, di-, tricyclic carbocyclic residue, or a saturated, unsaturated or partially unsaturated mono-, di-, tricyclic heterocyclic residue comprising one or more heteroatoms selected from among N, S and O; said carbocyclic or heterocyclic aryl residue being optionally substituted with one or more identical or different halogens, C ! -C 4 alkyl, C 1 -C4 alkoxyl, C C 4 haloalkyl, alkylsulfonyl, cycloalkyl, (cycloalkyl)alkyl, alkanoyl, amino, (C !
• R is absent or it is an R'-CO-NH- residue
• R 1 is aryl, arylalkyl, linear or branched -C4 alkyl, or saturated, unsaturated or partially unsaturated mono-, di-, tricyclic carbocyclic residue, or a saturated, unsaturated or partially unsaturated mono-, di-, tricyclic heterocyclic residue comprising one or more heteroatoms selected from among N, S and O; said aryl, arylalkyl, linear or branched CrC 4 alkyl, carbocyclic or heterocyclic residue optionally being selected, with one or more residues, mutually identical or different, from among: halogen, Q-C4 alkyl, Q-C4 alkoxyl, Q-C4 haloalkyl, alkylsulfonyl, cycloalkyl, (cycloalkyl)alkyl, alkanoyl, amino, (C 1 -C4) mono- or dialkylamino, (Q-C4) aminoalkyl mono- or disubstituted with
• X is O or CH
• AT is 6-diethylaminomethyl-naphtalen-2-yl or naphtalen-2-yl.
• the compound of formula I is mainly intended for administration to a human, preferably to obtain a blood concentration between 125 and 250 nM; preferably, such compound is administered at a dosage ranging from 50 to 200 mg/day, more preferably from 100 to 200 mg/day.
• it is administered at a dosage ranging from 50 mg twice a day to 200 mg once a day.
• anti-retroviral agent preferred anti-retroviral agents include nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, entry inhibitors, integrase inhibitors, co-receptor antagonists, viral adsorption inhibitors, viral specific transcription inhibitors and/or cyclin dependent kinase inhibitors: the most preferred anti-retroviral agents being efavirenz, indinavir sulfate and/or raltegravir potassium.
• ACH2 cells were obtained through AIDS Research and Reference Reagent Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. The cells were cultured in flasks, washed in RPMI and resuspended in RPMI/10% FCS at a concentration of 2 x 10 6 cells/mL. 250 ⁇ of cells, 200 ⁇ of media and 50 ⁇ . of HDAC inhibitors solution at various concentrations (from 0 to 250 nM), containing 0.01% DMSO, were divided into aliquotes in a 48-wells polystyrene tissue culture plate (Falcon, Lincoln Park, NJ).
• the cellular death as determined by the LDH activity after 24 hours was not considerably different in the cells exposed to HDAC inhibitors with respect to the non-treated cells.
• p24 was measured using specific antibodies immobilized on magnetic beads as previously described [Nold M.F. et al. J. Immunol. 181, 557 (2008)]. The levels of p24 for each experiment without HDAC inhibitors were fixed at 1.0 and the increase values by the number of times for each experiment and each analogous were calculated. The results are shown in the table below.
• Table 1 increase of the number of times in the level of p24 expressed in the presence of inhibitors with respect to the level obtained in the control
• Recombinant human enzymes were acquired from BPS Biosciences (CA, USA). Isoforms of Class I HDAC1, 2, 3; HDAC6, 10 of Class lib and Class IV HDAC11 were tested using the Fluor-de-Lys fluorogenic synthetic substrate (Enzo Life Sciences, Plymouth Meeting, PA). Isoforms of Class Ila HDAC4, 7, 9 were tested using the Boc-L-Lys(Tfa)-MCA (TFAL) derivative, described as a specific substrate for these enzymes [Jones P. et al. Bioorg Med Chem Lett. 18, 3456 (2008)]. The recombinant human HDAC8 assay was performed using HDAC8 Fluorimetric Drug Discovery Kit (Enzo) according to the manufacturer instructions.
• Each inhibitor was dissolved in DMSO and then further diluted in an assay buffer. Concentrations of DMSO lower than 0.5% do not affect the activity of the assay.
• the assays were performed by pre-incubating each enzyme with the inhibitors for 15 minutes at 37 °C. The reaction was started by adding the substrate at 37 °C and allowed to proceed for 60 minutes.
• the fluorescent signal was generated by adding 50 ⁇ , of a twice concentrated developer solution 2 (Enzo) containing trichostatin A 4 ⁇ . The generated fluorescence was detected at 355nm (excitation) and 460nm (emission) wavelengths.
• the results, expressed as IC 50 concentration required to reduce the enzymatic activity by 50%), are shown in the table below (the SAHA values were also measured and they are shown in the table).

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