WO2013126156A1 - Composés agonistes de récepteurs de glucocorticoïdes sélectifs donneurs d'oxyde nitrique et compositions ophtalmiques - Google Patents

Composés agonistes de récepteurs de glucocorticoïdes sélectifs donneurs d'oxyde nitrique et compositions ophtalmiques Download PDF

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WO2013126156A1
WO2013126156A1 PCT/US2013/021001 US2013021001W WO2013126156A1 WO 2013126156 A1 WO2013126156 A1 WO 2013126156A1 US 2013021001 W US2013021001 W US 2013021001W WO 2013126156 A1 WO2013126156 A1 WO 2013126156A1
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group
substituted
alkyl
aryl
groups
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Brian R. Rohrs
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Bausch & Lomb Incorporated
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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D407/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having oxygen atoms as the only ring hetero atoms, not provided for by group C07D405/00
    • C07D407/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having oxygen atoms as the only ring hetero atoms, not provided for by group C07D405/00 containing two hetero rings
    • C07D407/12—Heterocyclic compounds containing two or more hetero rings, at least one ring having oxygen atoms as the only ring hetero atoms, not provided for by group C07D405/00 containing two hetero rings linked by a chain containing hetero atoms as chain links
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A61P27/06—Antiglaucoma agents or miotics

Definitions

  • the present invention relates to nitric oxide (NO) donating selective glucocorticoid receptor agonist (“NO donating SEGRA”) compounds and ophthalmic compositions useful in the treatment of ocular inflammation or prevention of glaucoma or its progression.
  • NO nitric oxide
  • SEGRA selective glucocorticoid receptor agonist
  • Glaucoma is a group of diseases that are characterized by the death of retinal ganglion cells ("RGCs”), specific visual field loss, and optic nerve atrophy. Glaucoma is the third leading cause of blindness worldwide.
  • An intraocular pressure (“IOP") that is high compared to the population mean is a risk factor for the development of glaucoma.
  • IOP intraocular pressure
  • many individuals with high IOP do not have glaucomatous loss of vision.
  • there are glaucoma patients with normal IOP Therefore, continued efforts have been devoted to elucidate the pathogenic mechanisms of glaucomatous optic nerve degeneration.
  • optic nerve fibers are compressed by high IOP, leading to an effective physiological axotomy and problems with axonal transport.
  • High IOP also results in compression of blood vessels supplying the optic nerve heads ("ONHs"), leading to the progressive death of RGCs.
  • ONHs optic nerve heads
  • TNF-a tumor necrosis factor-a
  • TNF-a receptor- 1 are up- regulated in experimental rat models of glaucoma.
  • TNF-a-mediated RGC death involves the activation of both receptor- mediated caspase cascade and mitochondria-mediated caspase-de pendent and caspase- independent components of cell death cascade.
  • G. Tezel and X. Yang Expt'l Eye Res., Vol. 81, 207 (2005).
  • TNF-a and its receptor were found in greater amounts in retina sections of glaucomatous eyes than in control eyes of age-matched normal donors.
  • G. Tezel et al. Invest. Ophthalmol. & Vis. Sci., Vol. 42, No.8, 1787 (2001).
  • glaucoma may have a root cause in chronic inflammation. Failure to control the insult-induced immune response can result in autoimmune pathogenesis and likely initiates or sustains glaucomatous
  • a traditional therapy for glaucoma has been IOP-lowering medicaments, for example, by topical administration.
  • IOP-lowering medicaments for example, by topical administration.
  • such a course of treatment may not address the inflammatory root cause of the disease that the current body of evidence suggests.
  • Glucocorticoids represent one of the most effective clinical treatment for a range of inflammatory conditions, including acute inflammation.
  • steroidal drugs can have side effects that threaten the overall health of the patient.
  • Chronic administration of glucocorticoids can lead to drug-induced osteoporosis by suppressing intestinal calcium absorption and inhibiting bone formation.
  • Other adverse side effects of chronic administration of glucocorticoids include hypertension, hyperglycemia, hyperlipidemia (increased levels of triglycerides) and hypercholesterolemia (increased levels of cholesterol) because of the effects of these drugs on the body metabolic processes.
  • glucocorticoids have a greater potential for elevating intraocular pressure (“IOP") than other compounds in this class.
  • IOP intraocular pressure
  • prednisolone which is a very potent ocular anti-inflammatory agent
  • fluorometholone which has moderate ocular antiinflammatory activity.
  • IOP elevations associated with the topical ophthalmic use of glucocorticoids increases over time. In other words, the chronic (i.e., long-term) use of these agents increases the risk of significant IOP elevations. Therefore, an inflammatory root cause of glaucoma would not be treated with glucocorticoids, as they would exacerbate the condition they are intended to treat.
  • Nitric oxide donors can also reduce IOP. R. Steele et al., Bioorg. Med. Chem. Lett., Vol. 19, 6565-6570 (2009).
  • Nitric oxide donors are pharmaceutically active substances that contain a nitric oxide moiety and which donate, transfer, or release nitric oxide.
  • Nitric oxide donors include, for example, S-nitrosothiols, nitrites, nitrates, N-oxo-N-nitrosamines, and substrates of various isozymes of nitric oxide synthase. It has been postulated that compounds containing a NO donating moiety undergo hydrolysis by the enzymes present in the eye compartments to release me core drug and NO donating moiety. However, the effects of NO donating selective glucocorticoid receptor agonists have not been previously investigated.
  • the present invention provides compounds and compositions useful for treating or preventing inflammation in subjects, particularly those subjects diagnosed with glaucoma or have a family history of glaucoma.
  • the present invention relates to a compound of formula (I):
  • A is selected from the group consisting of unsubstituted and substituted aryl and heteroaryl groups, unsubstituted and substituted cycloalkyl and heterocycloalkyl groups, unsubstituted and substituted cycloalkenyl and heterocycloalkenyl groups, and unsubstituted and substituted heterocyclic groups;
  • R 1 and R 2 are independently selected from the group consisting of hydrogen, unsubstituted C 1 -C 15 linear or branched alkyl groups, substituted C 1 -C 15 linear or branched alkyl groups, unsubstituted C 3 -C 10 cycloalkyl groups, and substituted C 3 -C 10 cycloalkyl groups wherein R 1 and R 2 together may form an unsubstituted or substituted C 3 -C 10 cycloalkyl group;
  • R 3 is selected from the group consisting of hydrogen, unsubstituted C 1 -C 15 linear or branched alkyl groups, substituted C 1 -C 15 linear or branched alkyl groups, unsubstituted C 3 -C 10 cycloalkyl and heterocycloalkyl groups, substituted C 3 -C 10 cycloalkyl and heterocycloalkyl groups, aryl groups, heteroaryl groups, and heterocyclylic groups;
  • B comprises a carbonyl, amino, divalent hydrocarbon, or heterohydrocarbon group
  • E is hydroxy or amino group
  • D is absent or comprises a carbonyl group, -NH-, or -NR'-, wherein R' comprises an unsubstituted or substituted C 1 -C 8 linear or branched alkyl group;
  • Q is selected from the group consisting of substituted aryl, substituted heteroaryl, substituted cycloalkyl, substituted heterocycloalkyl, substituted cycloalkenyl, substituted heterocycloalkenyl, wherein each group independently is substituted with at least one substituent group of formula (II):
  • X is -O-, -S-, or -NH-;
  • Y is a bivalent radical having the following meaning: a) straight or branched C 1 -C 20 alkylene, being optionally substituted with one or more of the substituents selected from the group consisting of: halogen atoms, hydroxy, sulfoxy, -ONO 2 , or T, wherein T is -OC(O)(C,-C,oalkyl) -ONO 2 or -O(C 1 -C 10 alkyl) -ONO 2 ; b) cycloalkylene with 5 to 7 carbon atoms in the cycloalkylene ring, the ring being optionally substituted with side chains Ti, wherein Ti is straight or branched C 1 -C 10 alkyl; and c) C 6 -C 10 aryl or C 1 -C 8 alkylC 6 -C 10 aryl, optionally substituted with one or more of the substituents listed in a) or b) above.
  • ranges stated in this disclosure and the claims are intended to include the entire range specifically and not just the endpoint(s).
  • a range stated to be 0 to 10 is intended to disclose all numbers between 0 and 10 such as, for example, 1, 2, 3, 4, etc., as well as the endpoints 0 and 10.
  • a selective glucocorticoid receptor agonist is a compound that is capable of binding to the glucocorticoid receptor (which is a polypeptide) and, upon binding, is capable of producing differentiated levels of transrepression and transactivation of gene expression.
  • a compound that binds to a polypeptide is sometimes herein referred to as a ligand.
  • nitric oxide donating refers to methods of donating, releasing, and or directly or indirectly transferring any of the three redox forms of nitrogen monoxide (NO + , NO-, NO-), such that the biological activity of the nitrogen monoxide species is expressed at the intended site of action.
  • alkyl or "alkyl group” means a linear- or branched-chain saturated aliphatic hydrocarbon monovalent group, which may be unsubstituted or substituted. The group may be partially or completely substituted with halogen atoms (F, CI, Br, or I).
  • halogen atoms F, CI, Br, or I.
  • alkyl groups include methyl, ethyl, n-propyl, 1 - methylethyl(isopropyl), n-butyl, n-pentyl, 1,1-dimethylethyl (t-butyl), and the like. It may be abbreviated as "Alk”.
  • alkenyl or "alkenyl group” means a linear- or branched-chain aliphatic hydrocarbon monovalent radical containing at least one carbon-carbon double bond. This term is exemplified by groups such as ethenyl, propenyl, n-butenyl, isobutenyl, 3-methylbut-2-enyl, n-pentenyl, heptenyl, octenyl, decenyl, and the like.
  • alkylene or "alkylene group” means a linear- or branched- chain saturated aliphatic hydrocarbon divalent radical having the specified number of carbon atoms. This term is exemplified by groups such as methylene, ethylene, propylene, n-butylene, and the like, and may alternatively and equivalently be denoted herein as "-(alkyl)-”.
  • alkenylene or "alkenylene group” means a linear- or branched-chain aliphatic hydrocarbon divalent radical having the specified number of carbon atoms and at least one carbon-carbon double bond. This term is exemplified by groups such as ethenylene, propenylene, n-butenylene, and the like, and may alternatively and equivalently be denoted herein as "-(alkylenyl)-”.
  • aryl or “aryl group” means an aromatic carbocyclic monovalent or divalent radical of from 5 to 14 carbon atoms having a single ring (e.g., phenyl or phenylene), multiple condensed rings (e.g., naphthyl or anthranyl), or multiple bridged rings (e.g., biphenyl).
  • the aryl ring may be attached at any suitable carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable carbon atom which results in a stable structure.
  • Non-limiting examples of aryl groups include phenyl, naphthyl, anthryl, phenanthryl, indanyl, indenyl, biphenyl, and the like. It may be abbreviated as "Ar”.
  • alkylaryl means a linear- or branched-chain saturated aliphatic hydrocarbon divalent radical having the specified number of carbon atoms attached to an aryl group having the specified number of carbon atoms. This term is exemplified by groups such as benzyl, phenethyl, phenylpropyl, and the like.
  • heteroaryl or “heteroaryl group” means a stable aromatic 5- to 14-membered, monocyclic or polycyclic monovalent or divalent radical, which may comprise one or more fused or bridged ring(s), preferably a 5- to 7-membered monocyclic or 7- to 10- membered bicyclic radical, having from one to four heteroatoms in the ring(s) independently selected from nitrogen, oxygen, and sulfur, wherein any sulfur heteroatoms may optionally be oxidized and any nitrogen heteroatom may optionally be oxidized or be quaternized.
  • heteroaryl ring may be attached at any suitable heteroatom or carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable heteroatom or carbon atom which results in a stable structure.
  • heteroaryls include furanyl, thienyl, pyrrolyl, oxazolyl, thiazolyl, imidazolyl, pyrazolyl, isoxazolyl, isothiazolyl, oxadiazolyl, triazolyl, tetrazolyl, thiadiazolyl, pyridinyl, pyridazinyl, pyrimidinyl, pyrazinyl, triazinyl, indolizinyl, azaindolizinyl, indolyl, azaindolyl, diazaindolyl, dihydroindolyl, dihydroazaindoyl, isoindolyl, azais
  • furanopyridinyl furanopyrimidinyl, furanopyrazinyl, furanopyridazinyl,
  • azachromanyl quinolizinyl, quinolinyl, dihydroquinolinyl, tetrahydroquinolinyl, isoquinolinyl, dihydroisoquinolinyl, tetrahydroisoquinolinyl, cinnolinyl, azacinnolinyl, phthalazinyl, azaphthalazinyl, quinazolinyl, azaquinazolinyl, quinoxalinyl,
  • azaquinoxalinyl naphthyridinyl, dihydronaphthyridinyl, tetrahydronaphthyridinyl, pteridinyl, carbazolyl, acridinyl, phenazinyl, phenothiazinyl, and phenoxazinyl, and the like.
  • heterocycle means a stable non-aromatic 5- to 14-membered monocyclic or polycyclic, monovalent or divalent, ring which may comprise one or more fused or bridged ring(s), preferably a 5- to 7-membered monocyclic or 7- to 10- membered bicyclic ring, having from one to three heteroatoms in at least one ring independently selected from nitrogen, oxygen, and sulfur, wherein any sulfur heteroatoms may optionally be oxidized and any nitrogen heteroatom may optionally be oxidized or be quatemized.
  • a heterocyclyl group excludes
  • heterocycloalkyl heterocycloalkenyl, and heterocycloalkynyl groups.
  • the heterocyclyl ring may be attached at any suitable heteroatom or carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable heteroatom or carbon atom which results in a stable structure.
  • heterocycles include pyrrolinyl, pyrrolidinyl, pyrazolinyl, pyrazolidinyl, piperidinyl, morpholinyl, thiomorpholinyl, piperazinyl, tetrahydropyranyl,
  • cycloalkyl or "cycloalkyl group” means a stable aliphatic saturated 3- to 10- membered monocyclic or polycyclic monovalent radical consisting solely of carbon and hydrogen atoms which may comprise one or more fused or bridged ring(s), preferably a 5- to 7-membered monocyclic or 7- to 10-membered bicyclic ring. Unless otherwise specified, the cycloalkyl ring may be attached at any carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable carbon atom which results in a stable structure.
  • Exemplary cycloalkyl groups include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, cyclooctyl, cyclononyl, cyclodecyl, norbornyl, adamantyl, tetrahydronaphthyl (tetralin), 1-decalinyl, bicyclo[2.2.2]octanyl, 1-methylcyclopropyl, 2-methylcyclopentyl, 2-methylcyclooctyl, and the like.
  • cycloalkenyl or "cycloalkenyl group” means a stable aliphatic 5- to 10- membered monocyclic or polycyclic monovalent radical having at least one carbon- carbon double bond and consisting solely of carbon and hydrogen atoms which may comprise one or more fused or bridged ring(s), preferably a 5- to 7-membered monocyclic or 7- to 10-membered bicyclic ring.
  • the cycloalkenyl ring may be attached at any carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable carbon atom which results in a stable structure.
  • Exemplary cycloalkenyl groups include cyclopentenyl, cyclohexenyl, cycloheptenyl, cyclooctenyl, cyclononenyl, cyclodecenyl, norbornenyl, 2- methylcyclopentenyl, 2-methylcyclooctenyl, and the like.
  • carbocycle or “carbocyclic group” means a stable aliphatic 3- to 15- membered monocyclic or polycyclic monovalent or divalent radical consisting solely of carbon and hydrogen atoms which may comprise one or more fused or bridged rings, preferably a 5- to 7-membered monocyclic or 7- to 10-membered bicyclic ring. Unless otherwise specified, the carbocycle may be attached at any carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable carbon atom which results in a stable structure.
  • the term comprises cycloalkyl (including spiro cycloalkyl), cycloalkylene, cycloalkenyl, cycloalkenylene, cycloalkynyl, and cycloalkynylene, and the like.
  • heterocycloalkyl mean cycloalkyl, cycloalkenyl, and cycloalkynyl group, respectively, having at least a heteroatom in at least one ring, respectively.
  • Glucocorticoids are among the most potent drugs used for the treatment of allergic and chronic inflammatory diseases or of inflammation resulting from infections.
  • long-term treatment with GCs is often associated with numerous adverse side effects, such as diabetes, osteoporosis, hypertension, glaucoma, or cataract.
  • side effects like other physiological manifestations, are results of aberrant expression of genes responsible for such diseases.
  • Research in the last decade has provided important insights into the molecular basis of GC-mediated actions on the expression of GC-responsive genes. GCs exert most of their genomic effects by binding to the cytoplasmic GC receptor ("GR").
  • GR cytoplasmic GC receptor
  • cytokine synthesis inhibits the transcription, through the transrepression mechanism, of several cytokines that are relevant in inflammatory diseases, including IL-1 ⁇ (interleukin- ⁇ ), EL-2, ⁇ _-3, IL-6, IL- 11, TNF- ⁇ (tumor necrosis factor-a), GM-CSF (granulocyte-macrophage colony- stimulating factor), and chemokines that attract inflammatory cells to the site of inflammation, including IL-8, RANTES, MCP-1 (monocyte chemotactic protein- 1), MCP-3, MCP-4, M ⁇ -1 ⁇ (macrophage-inflammatory protein- la), and eotaxin.
  • proinflammatory transcription factors regulate the expression of genes that code for many inflammatory proteins, such as cytokines, inflammatory enzymes, adhesion molecules, and inflammatory receptors.
  • cytokines inflammatory proteins
  • inflammatory enzymes such as IL-12
  • adhesion molecules such as interleukin-1
  • inflammatory receptors such as interleukin-1 (IL-12)
  • S. Wissink et al. Mol. Endocrinol., Vol. 12, No. 3, 354-363 (1998)
  • PJ. Barnes and M. Karin New Engl J. Med., Vol. 336, 1066-1077
  • both the transrepression and transactivation functions of GCs directed to different genes produce the beneficial effect of inflammatory inhibition.
  • steroid-induced diabetes and glaucoma appear to be produced by the
  • transactivation action of GCs on genes responsible for these diseases.
  • H. Schacke et al. Pharmacol Ther., Vol. 96, 23-43 (2002).
  • the transactivation of certain genes by GCs produces beneficial effects
  • the transactivation of other genes by the same GCs can produce undesired side effects, one of which is glaucoma. Therefore, it is unlikely that GCs would be employed to treat or prevent glaucoma or its progression. Consequently, it is very desirable to provide pharmaceutical compounds and compositions that produce differentiated levels of transactivation and transrepression activity on GC-responsive genes to treat or prevent glaucoma or its progression.
  • the present invention provides compounds and compositions useful for treating or preventing glaucoma or its progression in a subject.
  • such compounds and compositions provide an anti-inflammatory effect, particularly subjects diagnosed with glaucoma or with a family history of glaucoma.
  • the compounds or compositions comprise at least a mimetic of a glucocorticoid.
  • a mimetic of a glucocorticoid is or comprises a compound that exhibits or produces a beneficial physiological effect similar to a glucocorticoid.
  • the compounds or compositions comprise at least a nitric oxide donating selective glucocorticoid receptor agonist ("NO donating SEGRA").
  • NO donating SEGRA selective glucocorticoid receptor agonist
  • a NO donating SEGRA can comprise any enantiomer of the molecule or a racemic mixture of the enantiomers.
  • the compounds or compositions comprise a prodrug, a pharmaceutically acceptable salt, a pharmaceutically acceptable ester of at least a NO donating SEGRA.
  • a prodrug is a compound that is made more active in vivo.
  • the compounds or compositions comprise: (a) a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a
  • said at least a NO donating SEGRA has formula (I):
  • A is selected from the group consisting of unsubstituted and substituted aryl and heteroaryl groups, unsubstituted and substituted cycloalkyl and heterocycloalkyl groups, unsubstituted and substituted cycloalkenyl and heterocycloalkenyl groups, and unsubstituted and substituted heterocyclic groups;
  • R 1 and R 2 are independently selected from the group consisting of hydrogen, unsubstituted C 1 -C 15 (alternatively, C 1 -C 10 , or C 1 -C 5 , or C 1 -C 3 ) linear or branched alkyl groups, substituted C 1 -C 15 (alternatively, C 1 -C 10 , or C 1 -C 5 , or C 1 -C 3 ) linear or branched alkyl groups, unsubstituted C 3 -C 10 cycloalkyl groups, and substituted C 3 -C 10
  • R 3 is selected from the group consisting of hydrogen, unsubstituted C 1 -C 15 (alternatively, C 1 -C 10 , or C 1 -C 5 , or C 1 -C 3 ) linear or branched alkyl groups, substituted C 1 -C 15
  • C 1 -C 10 (alternatively, C 1 -C 10 , or C 1 -C 5 , or C 1 -C 3 ) linear or branched alkyl groups, unsubstituted C 3 -C 10 (alternatively, C 3 -C 6 , or C 3 -C 5 ) cycloalkyl and heterocycloalkyl groups, substituted C 3 -C 10 (alternatively, C 3 -C 6 , or C 3 -C 5 ) cycloalkyl and heterocycloalkyl groups, aryl groups, heteroaryl groups, and heterocyclylic groups;
  • B comprises a carbonyl, amino, divalent hydrocarbon, or heterohydrocarbon group
  • E is hydroxy or amino group
  • D is absent or comprises a carbonyl group, -NH-, or -NR'-, wherein R' comprises an unsubstituted or substituted C 1 -C 8 (alternatively, C 1 -C 5 , or C 1 -C 3 ) linear or branched alkyl group; and Q is selected from the group consisting of substituted aryl, substituted heteroaryl, substituted cycloalkyl, substituted heterocycloalkyl, substituted cycloalkenyl, substituted heterocycloalkenyl, wherein each group independently is substituted with at least one substituent group of formula (II):
  • X is -O-, -S-, or -NH-;
  • Y is a bivalent radical having the following meaning: a) straight or branched C 1 -C 20 alkylene (alternatively, C 1 -C 10 , or C 1 -C 5 , or C 1 -C 3 ), being optionally substituted with one or more of the substituents selected from the group consisting of: halogen atoms, hydroxy, sulfoxy, -ONO 2 , or T, wherein T is -OC(O)(C 1 - C l0 alkyl)-ONO 2 or -O(C 1 -C 10 alkyl)-ONO 2 ; b) cycloalkylene with 5 to 7 carbon atoms in the cycloalkylene ring, the ring being optionally substituted with side chains T 1 , wherein T 1 is straight or branched C 1 -C 10 alkyl (alternatively CH3); and c) C 6 -C 10 aryl or C 1 -C 8 alkyl C 6
  • B can comprise one or more unsaturated carbon-carbon bonds.
  • B can comprise an alkylenecarbonyl, alkyleneoxycarbonyl, alkylenecarbonyloxy, alkyleneoxycarbonylamino, alkyleneamino, alkenylenecarbonyl, alkenyleneoxycarbonyl, alkenylenecarbonyloxy, alkenyleneoxycarbonylamino, alkenyleneamino, arylcarbonyloxy, aryloxycarbonyl, or ureido group.
  • A comprises a dihydrobenzofuranyl group substituted with a halogen atom
  • Q comprises a quinolinyl or isoquinolinyl group substituted with at least one substituent group of formula (II) and a C 1 -C 10 alkyl group
  • R 1 and R 2 are independently selected from the group consisting of unsubstituted and substituted C 1 -C 5 alkyl groups (preferably, C 1 -C 3 alkyl groups)
  • B is a C 1 -C 3 alkylene group
  • D is the - NH- group
  • E is the hydroxy group
  • R 3 comprises a completely halogenated C 1 -C 10 alkyl group (preferably, completely halogenated C 1 -C 5 alkyl group; more preferably, completely halogenated C 1 -C 3 alkyl group).
  • A comprises a dihydrobenzofuranyl group substituted with a fluorine atom
  • Q comprises a quinolinyl or isoquinolinyl group substituted with at least one substituent group of formula (II) and a methyl group
  • R 1 and R 2 are independently selected from the group consisting of unsubstituted and substituted C 1 -C 5 alkyl groups
  • B is a C 1 -C 3 alkylene group
  • D is the -NH- group
  • E is the hydroxy group
  • R 3 comprises a trifluoromethyl group.
  • said at least a NO donating SEGRA has formula ( ⁇ ) or (IV).
  • R 4 and R 5 are independently selected from the group consisting of hydrogen, halogen, cyano, hydroxy, C 1 -Cio (alternatively, C 1 -C 5 or C 1 -C 3 ) alkoxy groups, unsubstituted C 1 -C 10 (alternatively, C 1 -C 5 or C 1 -C 3 ) linear or branched alkyl groups, substituted C 1 -C 10 (alternatively, C 1 -C 5 or C 1 -C 3 ) linear or branched alkyl groups, unsubstituted C3-C 1 0 (alternatively, C 3 -C 6 or C 3 -C 5 ) cyclic alkyl groups, substituted C 3 3 C 10 (alternatively, C 3 -C 6 or C 3 -C 5 ) cyclic alkyl groups, and the substituent group of formula (II) wherein X and Y are as defined above, such that at least one of R 4 and R 5
  • said at least a NO donating SEGRA has formula (I), wherein
  • A is an aryl or heteroaryl group, each optionally independently substituted with one to three substituent groups, which are independently selected from the group consisting of C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 alkynyl, C 1 -C 3 alkanoyl, C 3 -C 8 cycloalkyl, heterocyclyl, aryl, heteroaryl, C 1 -C 5 alkoxy, C 2 -C 5 alkenyloxy, C 2 -C 5 alkynyloxy, aryloxy, acyl, C 1 -C 5 alkoxycarbonyl, aroyl, aminocarbonyl,
  • alkylaminocarbonyl dialkylaminocarbonyl, aminocarbonyloxy, C 1 -C 5
  • alkylaminocarbonyloxy C 1 -C 5 dialkylaminocarbonyloxy, C 1 -C 5 alkanoylamino, C 1 -C 5 alkoxycarbonylamino, C 1 -C 5 alkylsulfonylamino, aminosulfonyl, C 1 -C 5
  • alkylaminosulfonyl C 1 -C 5 dialkylaninosulfonyl, halogen, hydroxy, carboxy, cyano, trifluoromethyl, trifluoromethoxy, nitro, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl or aryl, ureido wherein either nitrogen atom is optionally independently substituted with C 1 -C 5 alkyl, C 1 -C 5 alkylthio wherein the sulfur atom is optionally oxidized to a sulfoxide or sulfone;
  • R 1 and R 2 are each independently hydrogen or C 1 -C 5 alkyl, or R 1 and R 2 together with the carbon atom they are commonly attached to form a C 3 -C 8 spiro cycloalkyl ring;
  • R 3 is a carbocycle, heterocyclyl, aryl, heteroaryl, carbocycle-C 1 -C 8 alkyl, aryl-C 1 -C 8 alkyl, aryl-C 1 -C 8 haloalkyl, heterocyclyl-C 1 -C 8 alkyl, heteroaryl-C 1 -C 8 alkyl, carbocycle-C 2 -C 8 alkenyl, aryl-C 2 -C 8 alkenyl, heterocyclyl-C 2 -C 8 alkenyl, or heteroaryl- C 2 -C 8 alkenyl, each optionally independently substituted with one to three substituent groups;
  • Q comprises a methylated benzoxazinone substituted with at least one substituent group of formula (II).
  • said at least a NO donating SEGRA has formula (I), wherein
  • A is an aryl, heteroaryl, or C 5 -C 15 cycloalkyl group, each optionally independently substituted with one to three substituent groups, which are independently selected from the group consisting of C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 alkynyl, C 1 -C 3 alkanoyl, C 3 -C 8 cycloalkyl, heterocyclyl, aryl, heteroaryl, C 1 -C 5 alkoxy, C 2 -C 5 alkenyloxy, C 2 -C 5 alkynyloxy, aryloxy, acyl, C 1 -C 5 alkoxycarbonyl, aroyl,
  • aminocarbonyl alkylaminocarbonyl, dialkylaminocarbonyl, aminocarbonyloxy, C 1 -C 5 alkylaminocarbonyloxy, C 1 -C 5 dialkylaminocarbonyloxy, C 1 -C 5 alkanoylamino, C 1 -C 5 alkoxycarbonylamino, C 1 -C 5 alkylsulfonylamino, aminosulfonyl, C 1 -C 5
  • alkylaminosulfonyl C 1 -C 5 dialkylaninosulfonyl, halogen, hydroxy, carboxy, cyano, trifluoromethyl, trifluoromethoxy, nitro, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl or aryl, ureido wherein either nitrogen atom is optionally independently substituted with C 1 -C 5 alkyl, C 1 -C 5 alkylthio wherein the sulfur atom is optionally oxidized to a sulfoxide or sulfone;
  • R 1 and R 2 are each independently hydrogen, C 1 -C 5 alkyl, C5-C15 arylalkyl, or R 1 and R 2 together with the carbon atom they are commonly attached to form a C 3 -C 8 spiro cycloalkyl ring;
  • R 3 is the trifluoromethyl group;
  • (d) B is the carbonyl group or methylene group, which is optionally independently substituted with one or two substituent groups selected from C 1 -C 5 alkyl, hydroxy, and halogen;
  • E is the hydroxy group or amino group wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl;
  • Q comprises a pyrrolidine, morpholine, thiomorpholine, piperazine, piperidine, 1H-pyridin-4-one, 1H-pyridin-2-one, 1H-pyridin-4-ylideneamine, 1H- quinolin-4-ylideneamine, pyran, tetrahydropyran, 1,4-diazepane, 2,5- diazabicyclo[2.2.1 ]heptane, 2,3,4,5-tetrahydrobenzo[b][ 1 ,4]diazepine, dihydroquinoline, tetrahydroquinoline, 5,6,7,8-tetrahydro-1H-quinolin-4-one, tetrahydroisoquinoline, decahydroisoquinoline, 2,3-dihydro-1H-iso indole, 2,3-dihydro-1H- indole, chroman, 1,2,3,4-tetrahydroquinoxaline,
  • each additional substituent group of Q is independently C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 alkynyl, C 3 -C 8 cycloalkyl, heterocyclyl, aryl, heteroaryl, C 1 -C 5 alkoxy, C 2 -C 5 alkenyloxy, C 2 -C 5 alkynyloxy, aryloxy, acyl, C 1 -C 5 alkoxycarbonyl, C 1 -C 5 alkanoyloxy, aminocarbonyl, alkylaminocarbonyl,
  • dialkylaminocarbonyl aminocarbonyloxy, C 1 -C 5 alkylaminocarbonyloxy, C 1 -C 5 dialkylaminocarbonyloxy, C 1 -C 5 alkanoylamino, C 1 -C 5 alkoxycarbonylamino, C 1 -C 5 alkylsulfonylamino, C 1 -C 5 alkylaminosulfonyl, C 1 -C 5 dialkylaminosulfonyl, halogen, hydroxy, carboxy, oxo, cyano, trifluoromethyl, trifluoromethoxy, trifluoromethylthio, nitro, amino wherein the nitrogen atom is optionally independently mono- or di- substituted by C 1 -C 5 alkyl, ureido wherein either nitrogen atom is optionally
  • each additional substituent group of Q is optionally independently substituted with one to three substituent groups selected from C 1 -C 3 alkyl, C 1 -C 3 alkoxy, C 1 -C 3 alkoxycarbonyl, acyl, aryl, benzyl, heteroaryl, heterocyclyl, halogen, hydroxy, oxo, cyano, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl, or ureido wherein either nitrogen atom is optionally independently substituted with C 1 -C 5 alkyl.
  • said at least a NO donating SEGRA has formula (I), wherein A, R 1 , R 2 , B, D, E, and Q have the meanings disclosed immediately above, and R 3 is hydrogen, C 1 -C 8 alkyl, C 2 -C 8 alkenyl, C 2 -C 8 alkynyl, carbocycle, heterocyclyl, aryl, heteroaryl, carbocycle-C 1 -C 8 alkyl, carboxy, alkoxycarbonyl, aryl-C 1 -C 8 alkyl, aryl-C 1 - Cg haloalkyl, heterocyclyl-C 1 -C 8 alkyl, heteroaryl-C 1 -C 8 alkyl, carbocycle-C 2 -C 8 alkenyl, aryl-C 2 -C 8 alkenyl, heterocyclyl-C 2 -C 8 alkenyl, or heteroaryl-C 2 -C 8 alkenyl, each optionally independently
  • alkoxycarbonyl C 1 -C 5 alkanoyloxy, aminocarbonyloxy, C 1 -C 5 alkylaminocarbonyloxy, C 1 -C 5 dialkylaminocarbonyloxy, aminocarbonyl, C 1 -C 5 alkylaminocarbonyl, C 1 -C 5 dialkylaminocarbonyl, C 1 -C 5 alkanoylamino, C 1 -C 5 alkoxycarbonylamino, C 1 -C 5 alkylsulfonylamino, C 1 -C 5 alkylaminosulfonyl, C 1 -C 5 dialkylaminosulfonyl, halogen, hydroxy, carboxy, cyano, oxo, trifluoromethyl, nitro, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl, ureido wherein either nitrogen atom is optionally independently substituted with C 1
  • said at least a NO donating SEGRA has formula (I), wherein (a) A is an aryl or heteroaryl group, each optionally independently substituted with one to three substituent groups, which are independently selected from the group consisting of C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 alkynyl, C 1 -C 3 alkanoyl, C 3 -C 8 cycloalkyl, heterocyclyl, aryl, heteroaryl, C 1 -C 5 alkoxy, C 2 -C 5 alkenyloxy, C 2 -C 5 alkynyloxy, aryloxy, acyl, C 1 -C 5 alkoxycarbonyl, aroyl, aminocarbonyl,
  • alkylaminocarbonyl dialkylaminocarbonyl, aminocarbonyloxy, C 1 -C 5
  • alkylaminocarbonyloxy C 1 -C 5 dialkylaminocarbonyloxy, C 1 -C 5 alkanoylamino, C 1 -C 5 alkoxycarbonylamino, C 1 -C 5 alkylsulfonylamino, aminosulfonyl, C 1 -C 5
  • alkylaminosulfonyl C 1 -C 5 dialkylaninosulfonyl, halogen, hydroxy, carboxy, cyano, trifluoromethyl, trifluoromethoxy, nitro, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl or aryl, ureido wherein either nitrogen atom is optionally independently substituted with C 1 -C 5 alkyl, C 1 -C 5 alkylthio wherein the sulfur atom is optionally oxidized to a sulfoxide or sulfone;
  • R 1 and R 2 are each independently C 1 -C 5 alkyl, wherein one or both are independently substituted with hydroxy, C 1 -C 5 alkoxy, C 1 -C 5 alkylthio wherein the sulfur atom is optionally oxidized to a sulfoxide or sulfone, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl or aryl;
  • R 3 is hydrogen, C 1 -Cg alkyl, C 2 -C 8 alkenyl, C 2 -C 8 alkynyl, carbocycle, heterocyclyl, aryl, heteroaryl, carbocycle-C 1 -C 8 alkyl, carboxy, alkoxycarbonyl, aryl-C 1 - C 8 alkyl, aryl-C 1 -C 8 haloalkyl, heterocyclyl-C 1 -C 8 alkyl, heteroaryl-C 1 -C 8 alkyl, carbocycle-C 2 -C 8 alkenyl, aryl-C 2 -C 8 alkenyl, heterocyclyl-C 2 -C 8 alkenyl, or heteroaryl- C 2 -C 8 alkenyl, each optionally independently substituted with one to three substituent groups, wherein each substituent group of R 3 is independently C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 al
  • B is C 1 -C 5 alkylene, C 2 -C 5 alkenylene, or C 2 -C 5 alkynylene, each optionally independently substituted with one to three substituent groups, wherein each substituent group of B is independently C 1 -C 3 alkyl, hydroxy, halogen, amino, or oxo;
  • Q comprises a heteroaryl group substituted with at least one substituent group of formula (II), optionally independently substituted with one to three additional substituent groups, which are independently selected from the group consisting of C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 alkynyl, C 1 -C 3 alkanoyl, C 3 -C 8 cycloalkyl, heterocyclyl, aryl, heteroaryl, C 1 -C 5 alkoxy, C 2 -C 5 alkenyloxy, C 2 -C 5 alkynyloxy, aryloxy, acyl, C 1 -C 5 alkoxycarbonyl, aroyl, aminocarbonyl, alkylaminocarbonyl, dialkylaminocarbonyl, aminocarbonyloxy, C 1 -C 5 alkylaminocarbonyloxy, C 1 -C 5 dialkylaminocarbonyloxy, C 1 - Cs alkanoyla
  • aminosulfonyl C 1 -C 5 alkylaminosulfonyl, C 1 -C 5 dialkylaninosulfonyl, halogen, hydroxy, carboxy, cyano, trifluoromethyl, trifluoromethoxy, nitro, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl or aryl, ureido wherein either nitrogen atom is optionally independently substituted with C 1 -C 5 alkyl, C 1 -C 5 alkylthio wherein the sulfur atom is optionally oxidized to a sulfoxide or sulfone, wherein each additional substituent group of Q is optionally independently substituted with one to three substituent groups selected from the group consisting of C 1 -C 3 alkyl, C 1 -C 3 alkoxy, acyl, C 1 -C 3 silanyloxy, C 1 -C 5 alkoxycarbonyl, carboxy,
  • said at least a NO donating SEGRA has formula (I), wherein (a) A is an aryl or heteroaryl group, each optionally independently substituted with one to three substituent groups, which are independently selected from the group consisting of C 1 -C 5 alkyl, C 2 -C 5 alkenyl, C 2 -C 5 alkynyl, C 1 -C 3 alkanoyl, C 3 -C 8 cycloalkyl, heterocyclyl, aryl, heteroaryl, C 1 -C 5 alkoxy, C 2 -C 5 alkenyloxy, C 2 -C 5 alkynyloxy, aryloxy, acyl, C 1 -C 5 alkoxycarbonyl, aroyl, aminocarbonyl,
  • alkylaminocarbonyl dialkylaminocarbonyl, aminocarbonyloxy, C 1 -C 5
  • alkylaminocarbonyloxy C 1 -C 5 dialkylaminocarbonyloxy, C 1 -C 5 alkanoylamino, C 1 -C 5 alkoxycarbonylamino, C 1 -C 5 alkylsulfonylamino, aminosulfonyl, C 1 -C 5
  • alkylaminosulfonyl C 1 -C 5 dialkylaninosulfonyl, halogen, hydroxy, carboxy, cyano, trifluoromethyl, trifluoromethoxy, nitro, amino wherein the nitrogen atom is optionally independently mono- or di-substituted by C 1 -C 5 alkyl or aryl, ureido wherein either nitrogen atom is optionally independently substituted with C 1 -C 5 alkyl, C 1 -C 5 alkylthio wherein the sulfur atom is optionally oxidized to a sulfoxide or sulfone;
  • R 1 and R 2 are each independently hydrogen or C 1 -C 5 alkyl, or R 1 and R 2 together with the carbon atom they are commonly attached to form a C 3 -C 8 spiro cycloalkyl ring;
  • R 3 is carbocycle, heterocyclyl, aryl, heteroaryl, carbocycle-C 1 -C 8 alkyl, carboxy, alkoxycarbonyl, aryl-C 1 -C 8 alkyl, aryl-C 1 -C 8 haloalkyl, heterocyclyl-C 1 -C 8 alkyl, heteroaryl-C 1 -C 8 alkyl, carbocycle-C 2 -C 8 alkenyl, aryl-C 2 -C 8 alkenyl,
  • D is the -NH- group
  • R 4 is a substituent group of formula (II).
  • the compounds of the present invention can be synthesized as follows. Synthetic Procedure
  • Q 1 is selected from the group consisting of unsubstituted and substituted aryl and heteroaryl groups, unsubstituted and substituted cycloalkyl and heterocycloalkyl groups, unsubstituted and substituted cycloalkenyl and heterocycloalkenyl groups, and unsubstituted and substituted heterocyclic groups;
  • P is H or an amino protecting group, such as tert- butoxycarbonyl or acetyl, or a hydroxy protecting group, such trimethylsilyl, tert-butyl- dimethylsilyl, or acetyl, and those amino and hydroxyl protecting groups described in T.W.
  • the compounds of formula (V) wherein P is an amino or hydroxy protecting group may be prepared from the corresponding compounds where P is H as well known in the art, for example, as described in T.W. Green "Protecting groups in organic synthesis," Harvard University Press, 20074 th edition, pp.
  • step i) when L is Zi, by converting the compound obtained in step i) into a nitro derivative by reaction with a nitrate source such as silver nitrate, lithium nitrate, sodium nitrate, potassium nitrate, magnesium nitrate, calcium nitrate, iron nitrate, zinc nitrate or tetraalkylammonium nitrate (wherein alkyl is C 1 -Qo) in a suitable organic solvent such as acetronitrile, tetrahydrofuran, methyl ethyl ketone, ethyl acetate, DMF, the reaction is carried out, in the dark, at a temperature to the boiling temperature of the solvent.
  • a nitrate source such as silver nitrate, lithium nitrate, sodium nitrate, potassium nitrate, magnesium nitrate, calcium nitrate, iron nitrate, zinc nitrate or tetraalkylammonium nit
  • the preferred nitrate source is silver nitrate and iii) optionally deprotecting the compounds obtained in step i) or ii) as described in T.W. Green "Protecting groups in organic synthesis," Harvard University Press, 2007, 4 th edition, pp. 16-298 and 696-802. Fluoride ion is the preferred method for removing silyl ether protecting group.
  • reaction of a compound of formula (V) wherein W is -OH and A, R 1 , R 2 , R 3 , E, B, D, Qi, and P are as defined above with a compound of formula (VI) wherein Y and L are as defined above and Z is HX may be carried out in the presence of a dehydrating agent such as dicyclohexylcarbodiimide (DCC) or ND-(3-dimethylaminopropyl)-N- ethylcarbodiimide hydrochloride (EDAC) and a catalyst, such as N,N-dimethylamino pyridine (EDAC) and a catalyst, such as N,N-dimethylamino pyridine (DMAP).
  • a dehydrating agent such as dicyclohexylcarbodiimide (DCC) or ND-(3-dimethylaminopropyl)-N- ethylcarbodiimide hydrochloride (EDAC) and
  • the reaction is carried out in an inert organic solvent dry such as N,N'-dimethylformamide, tetrahydrofuran, benzene, toluene, dioxane, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • an inert organic solvent dry such as N,N'-dimethylformamide, tetrahydrofuran, benzene, toluene, dioxane, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • the reaction is completed within a time range from 30 minutes to 36 hours.
  • reaction of a compound of formula (V) wherein W is -OC(0)Rg wherein R 8 is as defined above and P is H or a hydroxy or an amino protecting group, with a compound of formula (VI) whereinY is as above defined, Z is -OH and L is -ONO 2 may be carried out in presence of a catalyst, such as ⁇ , ⁇ -dimethylamino pyridine (DMAP).
  • a catalyst such as ⁇ , ⁇ -dimethylamino pyridine (DMAP).
  • DMAP ⁇ , ⁇ -dimethylamino pyridine
  • the reaction is carried out in an inert organic solvent such as N,N'-dimethylformamide, tetrahydrofuran, benzene, toluene, dioxane, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • the reaction is completed within a time range from 30 minutes to 36 hours.
  • the compounds of formula (V) whereinW is -OC(0)Rg and P is H may be obtained from the corresponding acids wherein W is -OH by reaction with a chloroformate such as isobutylchloroformate, ethylchloroformate in presence of a non-nucleophilic base such as triethylamine in an inert organic solvent such as N,N'-dimethylformamide, tetrahydrofuran, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • a chloroformate such as isobutylchloroformate, ethylchloroformate in presence of a non-nucleophilic base such as triethylamine in an inert organic solvent such as N,N'-dimethylformamide, tetrahydrofuran, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • the reaction of a compound of formula (V) wherein W is -OH and P is H, with a compound of formula (VI) whereinY is defined as above, Z is Zj and L is -ONO 2 may be carried out in presence of a organic base such as 1,8-diazabiciclo[5.4.0]undec-7-ene (DBU), N,N-diisopropylethylamine, diisopropylamine or inorganic base such as alkaline-earth metal carbonate or hydroxide, potassium carbonate, cesium carbonate, in an inert organic solvent such as ⁇ , ⁇ '-dimethylformamide, tetrahydrofuran, acetone, methyl ethyl ketone, acetonitrile, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C, preferably from 5°C to 25°C.
  • a organic base such as 1,8-diazabiciclo[5.4.0]unde
  • the reaction is completed within a time range from 1 to 8 hours.
  • Zi is chosen among chlorine or bromine
  • the reaction is carried out in presence an iodine compound such as KI.
  • the reaction of a compound of formula (V) wherein W is CI and P is as defined above, with a compound of formula (VI) whereinY is as defined above, Z is -OH, and Q is -ONO 2 may be carried out in presence of a organic base such as N,N-dimethylamino pyridine (DMAP), triethylamine, pyridine.
  • DMAP N,N-dimethylamino pyridine
  • the reaction is carried out in an inert organic solvent such as N,N'-dimethylformamide, tetrahydrofuran, benzene, toluene, dioxane, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • an inert organic solvent such as N,N'-dimethylformamide, tetrahydrofuran, benzene, toluene, dioxane, a polyhalogenated aliphatic hydrocarbon at a temperature from -20°C and 40°C.
  • the reaction is completed within a time range from 30 minutes to 36 hours.
  • the compounds of formula HO-Y-ONO 2 , whereinY is as defined above can be obtained as follows.
  • the corresponding diol derivative, commercially available, or synthesized by well known reactions, is converted in HO-Y-Zi wherein Zi is as defined above, by well known reactions, for example by reaction with thionyl or oxalyl chloride, halides of P 111 or P v , mesyl chloride, tosyl chloride in solvents inert such as toluene, chloroform, DMF, etc.
  • the conversion to the nitro derivative is carried out as described above.
  • the diol derivative can be nitrated by reaction with nitric acid and acetic anhydride in a temperature range from -50°C to 0°C according to methods well known in the literature.
  • are defined as above can be obtained from the hydroxyl derivative H-X-Y-OH, commercially available or synthesized according to methods well known in the literature, by well known reactions, for example by reaction with thionyl or oxalyl chloride, halides of P IIl or P v , mesyl chloride, tosyl chloride in solvents such as toluene, chloroform, DMF, etc.
  • the present invention provides an ophthalmic pharmaceutical composition for treating or preventing glaucoma or progression thereof.
  • the ophthalmic pharmaceutical composition comprises: (a) at least a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof; and (b) an anti-inflammatory agent other than said NO donating SEGRA, said prodrug thereof, said pharmaceutically acceptable salt thereof, and said
  • the pharmaceutical composition further comprises a pharmaceutically acceptable carrier.
  • said carrier is an ophthalmically acceptable carrier.
  • the concentration of a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof in such an ophthalmic composition can be in the range from about 0.0001 to about 1000 mg ml (or, alternatively, from about 0.001 to about 500 mg ml, or from about 0.001 to about 300 mg/ml, or from about 0.001 to about 250 mg/ml, or from about 0.001 to about 100 mg ml, or from about 0.001 to about 50 mg/ml, or from about 0.01 to about 300 mg/ml, or from about 0.01 to about 250 mg/ml, or from about 0.01 to about 100 mg/ml, or from about 0.1 to about 100 mg/ml, or from about 0.1 to about 50 mg/ml).
  • a composition of the present invention is in a form of a suspension or dispersion.
  • the suspension or dispersion is based on an aqueous solution.
  • a composition of the present invention can comprise sterile saline solution.
  • micrometer- or nanometer-sized particles of a NO donating SEGRA, or prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof and an anti-inflammatory agent can be coated with a physiologically acceptable surfactant (non-limiting examples are disclosed below), then the coated particles are dispersed in a liquid medium. The coating can keep the particles in a suspension.
  • a liquid medium can be selected to produce a sustained-release suspension.
  • the liquid medium can be one that is sparingly soluble in the ocular environment into which the suspension is administered.
  • the active ingredient or ingredients are suspended or dispersed in a hydrophobic medium, such as an oil.
  • the NO donating SEGRA and anti-inflammatory agent other than said NO donating SEGRA, prodrug thereof, pharmaceutically acceptable salt thereof, and pharmaceutically acceptable ester thereof are present in amounts effective to treat, control, reduce, ameliorate, alleviate, or prevent the condition.
  • such an antiinflammatory agent is selected from the group consisting of non-steroidal antiinflammatory drugs ("NSAIDs”); peroxisome proliferator-activated receptor (“FPAR") ligands (such as PPARa, PPAR5, or PPARy ligands); anti-histaminic drugs; antagonists to or inhibitors of proinflammatory cytokines (such as anti-TNF, anti-interleukin, anti- NF- B); nitric oxide synthase inhibitors; combinations thereof; and mixtures thereof.
  • NSAIDs non-steroidal antiinflammatory drugs
  • FPAR peroxisome proliferator-activated receptor
  • anti-histaminic drugs antagonists to or inhibitors of proinflammatory cytokines (such as anti-TNF, anti-interleukin, anti- NF- B); nitric oxide synthase inhibitors; combinations thereof; and mixtures thereof.
  • anti-histaminic drugs include Patanol® (olopatadine), Emadine® (emeda
  • Non-limiting examples of anti- TNF drugs include Remicade® (infliximab), Enbrel® (etanercept), and Humira® (adalimumab).
  • Non-limiting examples of anti-interleukin drugs include Kineret (anakinra), Zenapax (daclizumab), Simulect (basixilimab), cyclosporine, and tacrolimus.
  • Non-limiting examples of the NSAIDs are: aminoarylcarboxylic acid derivatives (e.g., enfenamic acid, etofenamate, flufenamic acid, isonixin, meclofenamic acid, mefenamic acid, niflumic acid, talniflumate, terofenamate, tolfenamic acid), arylacetic acid derivatives (e.g., aceclofenac, acemetacin, alclofenac, amfenac, amtolmetin guacil, bromfenac, bufexamac, cinmetacin, clopirac, diclofenac sodium, etodolac, felbinac, fenclozic acid, fentiazac, glucametacin, ibufenac, indomethacin, isofezolac, isoxepac, lonazolac, metiazinic acid, mof
  • salicylic acid derivatives e.g., acetaminosalol, aspirin, benorylate, bromosaligenin, calcium acetylsalicylate, diflunisal, etersalate, fendosal, gentisic acid, glycol salicylate, imidazole salicylate, lysine acetylsalicylate, mesalamine, morpholine salicylate, 1-naphthyl salicylate, olsalazine, parsalmide, phenyl acetylsalicylate, phenyl salicylate, salacetamide, salicylamide o-acetic acid, salicylsulfuric acid, salsalate, sulfasalazine), thiazinecarboxamides (e.g., ampiroxicam, droxicam, isoxicam, lornoxicam, piroxicam, ten
  • an anti-inflammatory agent is a PPAR-binding molecule.
  • a PPAR-binding molecule is a PPARa-, PPAR5-, or PPARy-binding molecule.
  • a PPAR-binding molecule is a PPARa, PPAR5, or PPARy agonist.
  • Such a PPAR ligand binds to and activates PPAR to modulate the expression of genes containing the appropriate peroxisome proliferator response element in its promoter region.
  • PPARy agonists can inhibit the production of TNF-a and other inflammatory cytokines by human macrophages (C-Y. Jiang et al., Nature, Vol. 391, 82-86 (1998)) and T lymphocytes (A£. Giorgini et al., Horm. Metab. Res. Vol. 31, 1-4 (1999)). More recently, the natural PPARy agonist 15-deoxy-A-12,14-prostaglandin J2 (or "15-deoxy- A-12,14-PG J2”), has been shown to inhibit neovascularization and angiogenesis (X. Xin et al., J. Biol. Chem. Vol. 274:9116-9121 (1999)) in the rat cornea.
  • a PPARy agonist used in a composition or a method of the present invention is a thiazolidinedione, a derivative thereof, or an analog thereof.
  • thiazolidinedione-based PPARy agonists include pioglitazone, troglitazone, ciglitazone, englitazone, rosiglitazone, and chemical derivatives thereof.
  • PPARy agonists include Clofibrate (ethyl 2-(4-chlorophenoxy)-2-methylpropionate), clofibric acid (2-(4-chlorophenoxy)-2-methylpropanoic acid), GW 1929 (N-(2-benzoylphenyl)-0- ⁇ 2-(methyl-2-pyridinylamino)ethyl ⁇ -L-tyrosine), GW 7647 (2- ⁇ ⁇ 4- ⁇ 2- ⁇ ⁇ (cyclohexylamino)carbonyl ⁇ (4-cyclohexylbutyl)amino ⁇ ethyl ⁇ phenyl ⁇ thio ⁇ -2- methylpropanoic acid), and WY 14643 ( ⁇ 4-chloro-6- ⁇ (2,3-dimethylphenyl)amino ⁇ -2- pyrimidinyl ⁇ thio ⁇ acetic acid).
  • GW 1929, GW 7647, and WY 14643 are commercially available, for example, from Koma Biotechnology, Inc. (Seoul, Korea).
  • the PPARy agonist is 15-deoxy-A-12, 14-PG J2.
  • Non-limiting examples of PPAR- ⁇ agonists include the fibrates, such as fenofibrate and gemfibrozil.
  • a non-limiting example of PPAR- ⁇ agonist is GW501516 (available from Axxora LLC, San Diego, California or EMD Biosciences, Inc., San Diego, California).
  • composition of the present invention further comprises an anti- infective agent (such as an antibacterial, antiviral, antiprotozoal, or antifungal agent, or a combination thereof).
  • an anti- infective agent such as an antibacterial, antiviral, antiprotozoal, or antifungal agent, or a combination thereof.
  • the concentration of such an NSAED, PPAR-binding molecule, anti-histaminic drug, antagonist to or inhibitor of proinflammatory cytokines, nitric oxide synthase inhibitor, or anti-infective agent in such an ophthalmic composition can be in the range from about 0.0001 to about 1000 mg/ml (or, alternatively, from about 0.001 to about 500 mg/ml, or from about 0.001 to about 300 mg ml, or from about 0.001 to about 250 mg/ml, or from about 0.001 to about 100 mg/ml, or from about 0.001 to about 50 mg/ml, or from about 0.01 to about 300 mg/ml, or from about 0.01 to about 250 mg/ml, or from about 0.01 to about 100 mg/ml, or from about 0.1 to about 100 mg/ml, or from about 0.1 to about 50 mg/ml).
  • Non-limiting examples of biologically-derived antibacterial agents include
  • aminoglycosides e.g., amikacin, apramycin, arbekacin, bambermycins, butirosin, dibekacin, dihydrostreptomycin, fortimicin(s), gentamicin, isepamicin, kanamycin, micronomicin, neomycin, neomycin undecylenate, netilmicin, paromomycin, ribostamycin, sisomicin, spectinomycin, streptomycin, tobramycin, trospectomycin), amphenicols (e.g., azidamfenicol, chloramphenicol, florfenicol, thiamphenicol), ansamycins (e.g., rifamide, rifampin, rifamycin sv, rifapentine, rifaximin), ⁇ -lactams (e.g., carbacephems (e.g., loracar
  • penicillins e.g., amdinocillin, amdinocillin pivoxil, amoxicillin, ampicillin, apalcillin, aspoxicillin, azidocillin, azlocillin, bacampicillin, benzylpenicillinic acid, benzylpenicillin sodium, carbenicillin, carindacillin, clometocillin, cloxacillin, cyclacillin, dicloxacillin, epicillin, fenbenicillin, floxacillin, hetacillin, lenampicillin, metampicillin, methicillin sodium, mezlocillin, nafcillin sodium, oxacillin, penamecillin, penethamate hydriodide, penicillin G benethamine, penicillin G benzathine, penicillin G benzhydrylamine, penicillins (e.g., amdinocillin, amdinocillin pivoxil, amoxicillin
  • lincosamides e.g., clindamycin, lincomycin
  • macrolides e.g., azithromycin, carbomycin, clarithromycin, dirithromycin, erythromycin, erythromycin acistrate, erythromycin estolate, erythromycin glucoheptonate, erythromycin lactobionate, erythromycin propionate, erythromycin stearate, josamycin, leucomycins, midecamycins, miokamycin, oleandomycin, primycin, rokitamycin, rosaramicin, roxithromycin, spiramycin, ⁇ oleandomycin), polypeptide, lincosamides (e.g., clindamycin, lincomycin), macrolides (e.g., azithromycin, carbomycin, clarithromycin, dirithromycin, erythromycin, erythromycin acistrate, erythromycin
  • Non-limiting examples of synthetic antibacterial agents include 2,4-diaminopyrimidines (e.g., brodimoprim, tetroxoprim, trimethoprim), nitrofurans (e.g., furaltadone, furazolium chloride, nifuradene, nifuratel, nifurfoline, nifurpirinol, nifurprazine, nifurtoinol, nitrofuirantoin), quinolones and analogs (e.g., cinoxacin, ciprofloxacin, clinafloxacin, difloxacin, enoxacin, fleroxacin, flumequine, gatifloxacin, grepafloxacin, levofloxacin, lomefloxacin, miloxacin, moxifloxacin, nadifloxacin, nalidixic acid, norfloxacin, ofloxaci
  • sulfaguanidine sulfaguanol
  • sulfalene sulfaloxic acid
  • sulfamerazine sulfameter
  • sulfamethazine sulfamethizole
  • sulfamethomidine sulfamethoxazole
  • sulfanilamide 4-sulfanilamidosalicylic acid, n -sulfanilylsulfanilamide, sulfanilylurea, N-sulfanilyl-3,4-xylamide, sulfanitran, sulfaperine, sulfaphenazole, sulfaproxyline, sulfapyrazine, sulfapyridine, sulfasomizole, sulfasymazine, sulfathiazole, sulfathiourea, sulfatolamide, sulfisomidine, sulfisoxazole) sulfones (e.g., acedapsone, acediasulfone, acetosulfone sodium, dapsone, diathymosulfone, glucosulfone sodium, solasulfone, succisulfone, sulfanilic acid
  • a compostion of the present invention comprises an anti-infective agent selected from the group consiting of cinoxacin, ciprofloxacin, clinafloxacin, difloxacin, enoxacin, fleroxacin, flumequine, gatifloxacin, grepafloxacin, levofloxacin, lomefloxacin, miloxacin, moxifloxacin, nadifloxacin, nalidixic acid, norfloxacin, ofloxacin, oxolinic acid, pazufloxacin, pefloxacin, pipemidic acid, piromidic acid, rosoxacin, rufloxacin, sparfloxacin, temafloxacin, tosufloxacin, trovafloxacin, and a fluoroquinolone having the chemical name of 7-[(3R)-3- aminohexahydro- 1 H-azepin- 1
  • antiviral agents include Rifampin, Ribavirin, Pleconaryl, Cidofovir, Acyclovir, Pencyclovir, Gancyclovir, Valacyclovir, Famciclovir, Foscarnet, Vidarabine, Amantadine, Zanamivir, Oseltamivir, Resquimod, antiproteases, PEGylated interferon (PegasysTM), anti HIV proteases (e.g.
  • nucleotide HIV RT inhibitors e.g., AZT, Lamivudine, Abacavir
  • non- nucleotide HIV RT inhibitors e.g., Doconosol, interferons, butylated hydroxytoluene (“BHT”), and Hypericin.
  • Non-limiting examples of biologically-derived antifungal agents include polyenes (e.g., amphotericin B, candicidin, dermostatin, filipin, fungichromin, hachimycin, hamycin, lucensomycin, mepartricin, natamycin, nystatin, pecilocin, perimycin), azaserine, griseofulvin, oligomycins, neomycin undecylenate, pyrrolnitrin, siccanin, tubercidin, and viridin.
  • polyenes e.g., amphotericin B, candicidin, dermostatin, filipin, fungichromin, hachimycin, hamycin, lucensomycin, mepartricin, natamycin, nystatin, pecilocin, perimycin
  • azaserine griseofulvin
  • oligomycins neomycin undecylenate
  • Non-limiting examples of synthetic antifungal agents include allylamines (e.g., butenafine, naftifine, terbinafine), imidazoles (e.g., bifonazole, butoconazole, chlordantoin, chlormidazole, cloconazole, clotrimazole, econazole, enilconazole, fenticonazole, flutrimazole, isoconazole, ketoconazole, lanoconazole, miconazole, omoconazole, oxiconazole nitrate, sertaconazole, sulconazole, tioconazole),
  • imidazoles e.g., bifonazole, butoconazole, chlordantoin, chlormidazole, cloconazole, clotrimazole, econazole, enilconazole, fenticonazole, flutrimazole, isocon
  • thiocarbamates e.g., tolciclate, tolindate, tolnaftate
  • triazoles e.g., fluconazole, itraconazole, saperconazole, terconazole
  • acrisorcin amorolfine, biphenamine, bromosalicylchloranilide, buclosamide, calcium propionate, chlorphenesin, ciclopirox, cloxyquin, coparaffinate, diamthazole dihydrochloride, exalamide, flucytosine, halethazole, hexetidine, loflucarban, nifuratel, potassium iodide, propionic acid, pyrithione, salicylanilide, sodium propionate, sulbentine, tenonitrozole, triacetin, ujothion, undecylenic acid, and zinc propionate.
  • triazoles e.g., fluconazole, itraconazole, sap
  • Non-limiting examples of antiprotozoal agents include polymycin B sulfate, bacitracin zinc, neomycine sulfate (e.g., Neosporin), imidazoles (e.g., clotrimazole, miconazole, ketoconazole), aromatic diamidines (e.g., propamidine isethionate, Brolene), polyhexametfaylene biguanide (“PHMB”), chlorhexidine, pyrimethamine (Daraprim®), sulfadiazine, folinic acid (leucovorin), clindamycin, and trimethoprim-sulfamethoxazole.
  • polymycin B sulfate bacitracin zinc
  • neomycine sulfate e.g., Neosporin
  • imidazoles e.g., clotrimazole, miconazole, ketoconazole
  • aromatic diamidines e.g.
  • the anti-infective agent is selected from the group consisting of bacitracin zinc, chloramphenicol, ciprofloxacin hydrochloride, erythromycin, gatifloxacin, gentamycin sulfate, levofloxacin, moxifloxacin, ofloxacin, sulfacetamide sodium, polymyxin B, tobramycin sulfate, trifluridine, vidarabine, acyclovir, valacyclovir, famcyclovir, foscarnet, ganciclovir, formivirsen, cidofovir, amphotericin B, natamycin, fluconazole, itraconazole, ketoconazole, miconazole, polymyxin B sulfate, neomycin sulfate, clotrimazole, propamidine isethionate, polyhexamethylene biguanide, chlorhexidine, pyrimethamine,
  • a composition of the present invention can further comprise a non- ionic surfactant, such as polysorbates (such as polysorbate 80 (polyoxyethylene sorbitan monooleate), polysorbate 60 (polyoxyethylene sorbitan monostearate), polysorbate 20 (polyoxyethylene sorbitan monolaurate), commonly known by their trade names of Tween® 80, Tween® 60, Tween® 20), poloxamers (synthetic block polymers of ethylene oxide and propylene oxide, such as those commonly known by their trade names of Pluronic®; e.g., Pluronic® F127 or Pluronic® F108) ), or poloxamines (synthetic block polymers of ethylene oxide and propylene oxide attached to ethylene diamine, such as those commonly known by their trade names of Tetronic®; e.g., Tetronic® 1508 or Tetronic® 908, etc., other nonioiuc surfactants such as Brij®, Myr
  • concentration of a non-ionic surfactant, when present, in a composition of the present invention can be in the range from about 0.001 to about 5 weight percent (or alternatively, from about 0.01 to about 4, or from about 0.0 to about 2, or from about 0.01 to about 1, or from about 0.01 to about 0.5 weight percent).
  • a composition of the present invention can include additives such as buffers, diluents, carriers, adjuvants, or other excipients. Any pharmacologically acceptable buffer suitable for application to the eye may be used. Other agents may be employed in the composition for a variety of purposes. For example, buffering agents, preservatives, co-solvents, oils, humectants, emollients, stabilizers, or antioxidants may be employed.
  • Water-soluble preservatives which may be employed include sodium bisulfite, sodium bisulfate, sodium thiosulfate, benzalkonium chloride, chlorobutanol, thimerosal, ethyl alcohol, methylparaben, polyvinyl alcohol, benzyl alcohol, and phenylethyl alcohol. These agents may be present in individual amounts of from about 0.001 to about 5% by weight (preferably, about 0.01% to about 2% by weight). Suitable water-soluble buffering agents that may be employed are sodium carbonate, sodium borate, sodium phosphate, sodium acetate, sodium bicarbonate, etc., as approved by the United States Food and Drug Administration ("US FDA”) for the desired route of administration.
  • US FDA United States Food and Drug Administration
  • Electrolytes such as, but not limited to, sodium chloride and potassium chloride may also be included in the formulation.
  • the pH of the composition is in the range from about 4 to about 11.
  • the pH of the composition is in the range from about 5 to about 9, from about 6 to about 9, or from about 6.5 to about 8.
  • the composition comprises a buffer having a pH in one of said pH ranges.
  • the composition has a pH of about 7.
  • the composition has a pH in a range from about 7 to about 7.5.
  • the composition has a pH of about 7.4.
  • a composition also can comprise a viscosity-modifying compound designed to facilitate the administration of the composition into the subject or to promote the bioavailability in the subject.
  • the viscosity-modifying compound may be chosen so that the composition is not readily dispersed after being administered into the vistreous.
  • Such compounds may enhance the viscosity of the composition, and include, but are not limited to: monomelic polyols, such as, glycerol, propylene glycol, ethylene glycol; polymeric polyols, such as, polyethylene glycol; various polymers of the cellulose family, such as hydroxypropylmethyl cellulose ("HPMC"), carboxymethyl cellulose ("CMC”) sodium, hydroxypropyl cellulose (“HPC”); polysaccharides, such as hyaluronic acid and its salts, chondroitin sulfate and its salts, dextrans, such as, dextran 70; water soluble proteins, such as gelatin; vinyl polymers, such as, polyvinyl alcohol, polyvinylpyrrolidone, povidone; carbomers, such as carbomer 934P, carbomer 941, carbomer 940, or carbomer 974P; and acrylic acid polymers.
  • a desired viscosity can be in the range from about 1 to about 400
  • a method for preparing a composition of the present invention comprises combining: (i) at least a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof; and (ii) a pharmaceutically acceptable carrier.
  • a method for preparing a composition of the present invention comprises combining: (i) at least a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof; and (ii) an anti-inflammatory agent other than said NO donating SEGRA, said prodrug thereof, and said pharmaceutically acceptable salt thereof; and (iii) a pharmaceutically acceptable carrier.
  • a carrier can be a sterile saline solution or a physiologically acceptable buffer.
  • such a carrier comprises a hydrophobic medium, such as a pharmaceutically acceptable oil.
  • such as carrier comprises an emulsion of a hydrophobic material and water.
  • Physiologically acceptable buffers include, but are not limited to, a phosphate buffer or a Tris-HCl buffer (comprising tris(hydroxymethyl)aminomethane and HCl).
  • a Tris-HCl buffer having pH of 7.4 comprises 3 g 1 of tris(hydroxymethyl)aminomethane and 0.76 g/1 of HCl.
  • the buffer is 10X phosphate buffer saline ("PBS") or 5X PBS solution.
  • buffers also may be found suitable or desirable in some circumstances, such as buffers based on HEPES (N- ⁇ 2-hydroxyethyl ⁇ peperazine-N'- ⁇ 2-ethanesulfonic acid ⁇ ) having pK a of 7.5 at 25 °C and pH in the range of about 6.8-8.2; BES (N,N-bis ⁇ 2- hydroxyethyl ⁇ 2-aminoethanesulfonic acid) having pK a of 7.1 at 25°C and pH in the range of about 6.4-7.8; MOPS (3- ⁇ N-morpholino ⁇ propanesulfonic acid) having pK a of 7.2 at 25°C and pH in the range of about 6.5-7.9; TES (N-tris ⁇ hydroxymethyI ⁇ -methyl- 2-aminoethanesulfonic acid) having pK a of 7.4 at 25°C and pH in the range of about 6.8- 8.2; MOBS (4- ⁇ N-morpholino)butanesul
  • TAPSO (2-hydroxy-3 ⁇ tris(hydroxymethyl)methylamino ⁇ -1-propanesulfonic acid) ) having pK a of 7.61 at 25°C and pH in the range of about 7-8.2; TAPS ( ⁇ (2-hydroxy-l,l- bis(hydroxymethyl)ethyl)amino ⁇ -1-propanesulfonic acid) ) having pK a of 8.4 at 25°C and pH in the range of about 7.7-9.1; TABS (N-tris(hydroxymethyl)methyI-4- aminobutanesulfonic acid) having pK a of 8.9 at 25°C and pH in the range of about 8.2- 9.6; AMPSO (N-( 1 , 1 -dimethy I-2-hydroxyethyl)-3-amino-2-hydroxypropanesulfonic acid) ) having pK a of 9.0 at 25°C and pH in the range of about 8.3-9.7; CHES (2- cyclohexylamin
  • a composition of the present invention is formulated in a buffer having an acidic pH, such as from about 4 to about 6.8, or alternatively, from about 5 to about 6.8.
  • the buffer capacity of the composition desirably allows the composition to come rapidly to a physiological pH after being administered into the patient
  • Two mixtures I and II are made separately by mixing the ingredients listed in Table 1. Five parts (by weight) of mixture I are mixed with one part (by weight) of mixture II for 15 minutes or more. The pH of the combined mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • purified water may be substituted with an oil, such as fish-liver oil, peanut oil, sesame oil, coconut oil, sunflower oil, corn oil, or olive oil to produce an oil-based formulation comprising a compound of formula (HI) or (IV).
  • an oil such as fish-liver oil, peanut oil, sesame oil, coconut oil, sunflower oil, corn oil, or olive oil to produce an oil-based formulation comprising a compound of formula (HI) or (IV).
  • Two mixtures I and ⁇ are made separately by mixing the ingredients listed in Table 2. Five parts (by weight) of mixture I are mixed with two parts (by weight) of mixture ⁇ for 15 minutes or more. The pH of the combined mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • purified water may be substituted with an oil, such as fish-liver oil, peanut oil, sesame oil, coconut oil, sunflower oil, corn oil, or olive oil to produce an oil-based formulation comprising a compound of formula ( ⁇ ) or (IV).
  • an oil such as fish-liver oil, peanut oil, sesame oil, coconut oil, sunflower oil, corn oil, or olive oil to produce an oil-based formulation comprising a compound of formula ( ⁇ ) or (IV).
  • mixtures I and ⁇ are made separately by mixing the ingredients listed in Table 3. Five parts (by weight) of mixture I are mixed with two parts (by weight) of mixture II for 15 minutes or more. The pH of the combined mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • mixtures I and ⁇ are made separately by mixing the ingredients listed in Table 4. Five parts (by weight) of mixture I are mixed with one part (by weight) of mixture ⁇ for 15 minutes or more. The pH of the combined mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • HAP denotes hydroxyalkyl phosphonates, such as those known under the trade name Dequest®.
  • the ingredients listed in Table 5 are mixed together for at least 15 minutes.
  • the pH of the mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • BAK denotes benzalkonium chloride
  • the ingredients listed in Table 6 are mixed together for at least 15 minutes.
  • the pH of the mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • the ingredients listed in Table 7 are mixed together for at least 15 minutes.
  • the pH of the mixture is adjusted to 6.2-6.4 using I NaOH to yield a composition of the present invention.
  • the ingredients listed in Table 8 are mixed together for at least 15 minutes.
  • the pH of the mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • the ingredients listed in Table 10 are mixed together for at least 15 minutes.
  • the pH of the mixture is adjusted to 6.2-6.4 using 1 N NaOH to yield a composition of the present invention.
  • a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof, and an antiinflammatory agent are incorporated into a formulation for topical administration, systemic administration, periocular injection, or intravitreal injection.
  • An injectable intravitreal formulation can desirably comprise a carrier that provides a sustained-release of the active ingredients, such as for a period longer than about 1 week (or longer than about 1, 2, 3, 4, 5, or 6 months).
  • the sustained-release formulation desirably comprises a carrier that is insoluble or only sparingly soluble in the vitreous.
  • a carrier can be an oil-based liquid, emulsion, gel, or semisolid.
  • oil-based liquids include castor oil, peanut oil, olive oil, coconut oil, sesame oil, cottonseed oil, corn oil, sunflower oil, fish-liver oil, arachis oil, and liquid paraffin.
  • a compound or composition of the present invention can be injected intravitreally, for example through the pars plana of the ciliary body, to treat or prevent glaucoma or progression thereof using a fine-gauge needle, such as 25-30 gauge.
  • an amount from about 25 ⁇ l to about 100 ul of a composition comprising a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof is administered into a patient.
  • a concentration of such NO donating SEGRA, prodrug thereof, or pharmaceutically acceptable salt thereof is selected from the ranges disclosed above.
  • a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof is incorporated into an ophthalmic device or system that comprises a biodegradable material, and the device is injected or implanted into a subject to provide a long-term (e.g., longer than about 1 week, or longer than about 1, 2, 3, 4, 5, or 6 months) treatment or prevention of glaucoma or progression thereof.
  • a device system may be injected or implanted by a skilled physician in the subject's ocular or periocular tissue.
  • a method for treating or preventing glaucoma or progression thereof comprises: (a) providing a composition comprising a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof; and (b) administering to a subject an effective amount of the composition at a frequency sufficient to treat or prevent said glaucoma or progression thereof.
  • the dosage required to provide an effective amount of the compounds and compositions will vary depending on the age, health, physical condition, sex, diet, weight, extent of the dysfunction of the recipient, frequency of treatment and the nature and scope ofthe dysfunction or disease, medical condition of the patient, the route of administration, pharmacological considerations such as the activity, efficacy, pharmacokinetic and toxicology profiles of the particular compound used, whether a drug delivery system is used, and whether the compound is administered as part of a drug combination.
  • the a NO donating SEGRA is selected from among those disclosed above.
  • such glaucoma can have a root cause in inflammation.
  • such inflammation is chronic inflammation.
  • the present invention provides a method for treating, controlling, ameliorating, alleviating, or preventing an ophthalmic condition that can result in increased IOP or increased risk of glaucoma.
  • an ophthalmic condition is an inflammation.
  • such an ophthalmic condition is ulceris.
  • the composition for use in any of the foregoing method further comprises an anti-inflammatory agent other than a NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, and a pharmaceutically acceptable ester thereof.
  • an anti-inflammatory agent is selected from those disclosed above.
  • concentrations of the NO donating SEGRA, a prodrug thereof, a pharmaceutically acceptable salt thereof, a pharmaceutically acceptable ester thereof, and the antiinflammatory agent are selected to be in the ranges disclosed above.
  • a composition of the present invention is incorporated into an ophthalmic implant system or device, and the implant system or device is surgically implanted in the vitreous cavity or in the back of the eye of the patient for the sustained or long-term release of the active ingredient or ingredients.
  • a typical implant system or device suitable for use in a method of the present invention comprises a biodegradable matrix with the active ingredient or ingredients impregnated or dispersed therein.
  • Non- limiting examples of ophthalmic implant systems or devices for the sustained-release of an active ingredient are disclosed in U.S. Patents 5,378,475; 5,773,019; 5,902,598; 6,001,386; 6,051,576; and 6,726,918; which are incorporated herein by reference.
  • composition of the present invention is administered once a day, several (e.g., twice, three, four, or more) times a day, once a week, once a month, once a year, twice a year, four times a year, or at a suitable frequency that is determined by a skilled physician to be appropriate for treating or preventing glaucoma or progression thereof.
  • the compounds and compositions of the present invention can be used with other therapeutic and adjuvant or prophylactic agents commonly used to reduce, treat, or prevent (a) an increase of intraocular pressure, (b) a loss of retinal ganglion cells, or (c) both, thus providing an enhanced overall treatment or enhancing the effects of the other therapeutic agents, prophylactic agents, and adjunctive agents used to treat and manage the different types of glaucoma.
  • Therapeutic agents used to treat narrow angle or acute congestive glaucoma include, for example, physostigmine salicylate and pilocarpine nitrate.
  • Adjunctive therapy used in the management of narrow angle glaucoma includes, for example, the intravenous administration of a carbonic anhydrase inhibitor such as acetozolamide to reduce the secretion of aqueous humor, or of an osmotic agent such as mannitol or glycerin to induce intraocular dehydration.
  • a carbonic anhydrase inhibitor such as acetozolamide
  • an osmotic agent such as mannitol or glycerin
  • Therapeutic agents used to manage wide angle or chronic simple glaucoma and secondary glaucoma include, for example, prostaglandin analogs, such as Xalatan® and Lumigan®, ⁇ -adrenergic antagonists such as timolol maleate, a-adrenergic agonists, such as brimonidine and apraclonidine, muscarinic cholinergic agents (such as pilocarpine or carbachol), and carbonic anhydrase inhibitors, such as Dorzolamide (Trusopt® or Cosopt®) or brizolamide (Azopt®).
  • Other therapeutic agents used to manage glaucoma include the inhibitors of acetylcholinesterase such as Echothiophate (phospholine iodide).
  • High doses may be required for some currently used therapeutic agents to achieve levels to effectuate the target response, but may often be associated with a greater frequency of dose-related adverse effects.
  • combined use of the compounds or compositions of the present invention with agents commonly used to treat glaucoma allows the use of relatively lower doses of such other agents, resulting in a lower frequency of adverse side effects associated with long-term administration of such therapeutic agents.
  • another indication of the compounds or compositions in this invention is to reduce adverse side effects of prior-art drugs used to treat glaucoma, such as the development of cataracts with long-acting anticholinesterase agents including demecarium,
  • glucocorticoids and NO donating SEGRAs may be compared in their use to treat an exemplary inflammation.
  • a level of at least an adverse side effect is determined in vivo or in vitro.
  • a level of said at least an adverse side effect is determined in vitro by performing a cell culture and determining the level of a biomarker associated with said side effect.
  • biomarkers can include proteins (e.g., enzymes), lipids, sugars, and derivatives thereof that participate in, or are the products of, the biochemical cascade resulting in the adverse side effect. Representative in vitro testing methods are further disclosed hereinbelow.
  • a level of said at least an adverse side effect is determined in vivo at about one day after said glucocorticoid or NO donating SEGRA (or a prodrug thereof, a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof) is first administered to, and are present in, said subject.
  • a level of said at least an adverse side effect is determined about 14 days after said composition is first administered to, and are present in, said subject.
  • a level of said at least an adverse side effect is determined about 30 days after said composition is first administered to, and are present in, said subject.
  • a level of said at least an adverse side effect is determined about 2, 3, 4, 5, or 6 months after said compounds or compositions are first administered to, and are present in, said subject.
  • said glucocorticoid used to treat said exemplary inflammation is administered to said subject at a dose and a frequency sufficient to produce a beneficial effect on said inflammation equivalent to a compound or composition of the present invention after about the same elapsed time.
  • glucocorticoid therapy such as anti- inflammation therapy
  • steroid diabetes One of the most frequent undesirable actions of a glucocorticoid therapy (such as anti- inflammation therapy) is steroid diabetes.
  • the reason for this undesirable condition is the stimulation of gluconeogenesis in the liver by the induction of the transcription of hepatic enzymes involved in gluconeogenesis and metabolism of free amino acids that are produced from the degradation of proteins (catabolic action of glucocorticoids).
  • a key enzyme of the catabolic metabolism in the liver is the tyrosine aminotransferase (' ⁇ '). The activity of this enzyme can be determined photometrically from cell cultures of treated rat hepatoma cells.
  • the gluconeogenesis by a glucocorticoid can be compared to that of a NO donating SEGRA by measuring the activity of this enzyme. For example, in one procedure, the cells are treated for 24 hours with the test substance (a NO donating SEGRA or glucocorticoid), and then the TAT activity is measured. The TAT activities for the selected NO donating SEGRA and glucocorticoid are then compared. Other hepatic enzymes can be used in place of TAT, such as
  • the levels of blood glucose in an animal model may be measured directly and compared for individual subjects that are treated with a glucocorticoid for a selected condition and those that are treated with a NO donating SEGRA for the same condition.
  • glucocorticoid therapy Another undesirable result of glucocorticoid therapy is GC-induced cataract.
  • the cataractogenic potential of a compound or composition may be determined by quantifying the effect of the compound or composition on the flux of potassium ions through the membrane of lens cells (such as mammalian lens epithelial cells) in vitro.
  • Such an ion flux may be determined by, for example, electrophysiological techniques or ion-flux imaging techniques (such as with the use of fluorescent dyes).
  • An exemplary in-vitro method for determining the cataractogenic potential of a compound or composition is disclosed in U.S. Patent Application Publication 2004/0219512, which is incorporated herein by reference.
  • Still another undesirable result of glucocorticoid therapy is hypertension. Blood pressure of similarly matched subjects treated with glucocorticoid and NO donating SEGRA for an inflammatory condition may be measured directly and compared.
  • IOP is increased.
  • IOP of similarly matched subjects treated with glucocorticoid and NO donating SEGRA for an inflammatory condition may be measured directly and compared.
  • a glucocorticoid that is used for comparative testing, for example, in the foregoing procedures can be selected from the group consisting of 21-acetoxypregnenolone, alclometasone, algestone, amcinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetasone, clocortolone, cloprednol, corticosterone, cortisone, cortivazol, deflazacort, desonide, desoximetasone, dexamethasone, diflorasone, diflucortolone, difluprednate, enoxolone, fluazacort, flucloronide, flumethasone, flunisolide, fluocinolone acetonide, fluocinonide, fluocortin butyl, fluocortolone, fluorometholone, fluperolone
  • fiuprednisolone flurandrenolide, fluticasone propionate, formocortal, halcinonide, halobetasol propionate, halometasone, halopredone acetate, hydrocortarnate, hydrocortisone, loteprednol etabonate, mazipredone, medrysone, meprednisone, methylprednisolone, mometasone furoate, paramethasone, prednicarbate, prednisolone, prednisolone 25-diethylamino-acetate, prednisolone sodium phosphate, prednisone, prednival, prednylidene, rimexolone, tixocortol, triamcinolone, triamcinolone acetonide, triamcinolone benetonide, triamcinolone hexacetonide, their physiologically acceptable salts, combinations thereof,
  • glucocorticoid is selected from the group consisting of dexamethasone, prednisone, prednisolone, methylprednisolone, medrysone, triamcinolone, loteprednol etabonate, physiologically acceptable salts thereof, combinations thereof, and mixtures thereof.
  • said glucocorticoid is acceptable for ophthalmic uses.

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Abstract

La présente invention concerne un composé et une composition utiles dans le traitement d'une inflammation oculaire ou dans la prévention d'un glaucome ou sa progression comprenant un agoniste de récepteurs de glucocorticoïdes sélectifs donneurs d'oxyde nitrique (« NO donating SEGRA »), un promédicament correspondant, un sel pharmaceutiquement acceptable correspondant, ou un ester pharmaceutiquement acceptable correspondant. La composition peut comprendre un agent anti-inflammatoire supplémentaire et peut être formulée pour une application topique, une injection, ou une implantation. Elle peut être utilisée en association avec une autre thérapie destinée à réduire la pression intraoculaire ou une inflammation oculaire.
PCT/US2013/021001 2012-02-22 2013-01-10 Composés agonistes de récepteurs de glucocorticoïdes sélectifs donneurs d'oxyde nitrique et compositions ophtalmiques WO2013126156A1 (fr)

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