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  • A61K31/00—Medicinal preparations containing organic active ingredients
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  • 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
  • A61K31/4985—Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
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  • C07D471/12—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, at least one ring being a six-membered ring with one nitrogen atom, not provided for by groups C07D451/00 - C07D463/00 in which the condensed system contains three hetero rings
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  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
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  • 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
  • A61K31/5375—1,4-Oxazines, e.g. morpholine
  • A61K31/5383—1,4-Oxazines, e.g. morpholine ortho- or peri-condensed with heterocyclic ring systems
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  • A61P25/00—Drugs for disorders of the nervous system
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• • A—HUMAN NECESSITIES
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  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
  • A61P25/16—Anti-Parkinson drugs
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/20—Hypnotics; Sedatives
• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
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  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
• • A—HUMAN NECESSITIES
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• • C—CHEMISTRY; METALLURGY
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  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D471/00—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, at least one ring being a six-membered ring with one nitrogen atom, not provided for by groups C07D451/00 - C07D463/00
  • C07D471/12—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, at least one ring being a six-membered ring with one nitrogen atom, not provided for by groups C07D451/00 - C07D463/00 in which the condensed system contains three hetero rings
  • C07D471/16—Peri-condensed systems

Definitions

• the present invention relates to use of particular substituted heterocycle fused gamma-carbolines as described herein, in free, pharmaceutically acceptable salt or prodrug form, and pharmaceutical composition comprising the same, optionally in combination with one or more agents, for the prophylaxis or treatment of one or more disorders associated with dementia, particularly behavioral or mood disturbances (e.g., agitation/aggression), psychosis, depression and/or sleep disturbances among other disorders in patients suffering from dementia.
• behavioral or mood disturbances e.g., agitation/aggression
• psychosis e.g., depression and/or sleep disturbances among other disorders in patients suffering from dementia.
• Dementia is a disorder characterized by the loss of cognitive abilities affecting memory, reasoning, judgment and behavior.
• MCI mild cognitive impairment
• incipient dementia or isolated memory impairment
• AD dementia cognitive impairment beyond that expected based on the age and education of the individual, but which is not significant enough to interfere with their daily activities.
• MCI mild cognitive impairment
• Alzheimer's disease is the most common type of dementia and is an irreversible, progressive neurodegenerative disease that disrupts memory, perception, reasoning, judgment, information processing, emotional behavior, personality as well as social and occupational functions.
• 5.4 million of Americans are believed to be living with Alzheimer's and nearly 36 million people worldwide are believed to be living with this disease or other dementias.
• acetylcholinesterase inhibitors e.g., Tacrine, rivastigmine (Exelon), donepezil (Aricept), and galantamine (Razadyne, formerly called Reminyl)
• NMDA receptor antagonist e.g., memantine (Namenda)
• these drugs do not treat affective symptoms and/or other behavior disruptions such as mood swing, agitation, aggressive/assaultive behavior and paranoia which are common in dementias.
• memantine a drug approved for Alzheimer's disease and often used for dementias in general, may have some adverse effects on neuropsychiatric functioning, particularly agitation/aggression, delusions or hallucinations.
• antipsychotic drugs are used to control aggression and psychosis in dementia, particularly in Alzheimer's disease.
• antipsychotic drugs such as haloperidol, risperidone and quetiapine are associated with serious side effects including extrapyramidal side effects (akinesia or akathisia), bone marrow
• SCN suprachiasmatic nucleus
• agents such as temazepam (Restoril), Zolpidem (Ambien), or zaleplon (Sonata), or sedating antidepressants, such as trazodone (Desyrel, Molipaxin), may be useful in managing insomnia, failure of these drugs to improve sleep quality in addition to the associated risk of falling due to drowsiness and psychomotor impairment caused by these agents render them undesirable for dementia, particularly Alzheimer's patients.
• behavioral/mood disturbances e.g., agitation, aggressive/assaultive behavior
• sleep disturbances in patients suffering from dementia.
• Substituted heterocycle fused gamma-carbolines are known to be agonists or antagonists of 5-HT2 receptors, particularly 5-HT2A and 5-HT2C receptors, in treating central nervous system disorders.
• 5-HT2A and 5-HT2C receptors include 5-HT2A and 5-HT2C receptors.
• These compounds have been disclosed in U.S. Pat. No. 6,548,493; 7,238,690; 6,552,017; 6,713,471 ; U.S. RE39680, and U.S. RE39679, as novel compounds useful for the treatment of disorders associated with 5-HT2A receptor modulation such as obesity, anxiety, depression, psychosis, schizophrenia, sleep disorders, sexual disorders, migraine, conditions associated with cephalic pain, social phobias, and gastrointestinal disorders such as dysfunction of the gastrointestinal tract motility.
• PCT/US08/03340 and U.S. Pat. No. 7,081,455 also disclose methods of making substituted heterocycle fused gamma-carbolines and uses of these gamma-carbolines as serotonin agonists and antagonists useful for the control and prevention of central nervous system disorders such as addictive behavior and sleep disorders.
• WO 2009/145900 discloses use of specific compounds of substituted heterocycle fused gamma- carbolines for the treatment of a combination of psychosis and depressive disorders as well as sleep, depressive and/or mood disorders in patients with psychosis or Parkinson's disease.
• 5-HT 2A receptors Specific genetic polymorphisms of 5-HT 2A receptors are associated with aggression and impulsivity. These Compounds also exhibit efficacy in reducing behavioral disturbances such as agitation and irritability as well as sleep disturbances and symptoms of depression and psychosis. Due to their low off target receptor interactions, the Compounds of the Invention have reduced sedation, cognitive impairment, motor impairment and lower risk of falls. Therefore, Compound of Formula I as described below are effective in treating 5-HT 2A related disorders without having the extrapyramidal side effects, psychomotor sedation, cognitive impairment or cardiovascular safety issues such as QTc prolongation.
• the invention provides a method (Method I) for the prophylaxis or treatment of one or more disorders associated with dementia, e.g., disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke- Korsakoff s syndrome, corticobasal degenerations, and prion disease, comprising administering to a patient in need thereof, a therapeutically effective amount of a compound of Formula I:
• X is -N(H)-, -N(CH 3 )- or -0-;
• Ri is - C -d ⁇ alkyl (e.g., -CCOi-d-salkyl, -C(0)-C 6 _ 15 alkyl or -C(0)-C 16 _ 21 alkyl), preferably said alkyl is a straight chain, optionally saturated or unsaturated and optionally substituted with one or more hydroxy or C 1-22 alkoxy (e.g., ethoxy) groups, for example Ri is -C(0)-C 6 alkyl, -C(0)-C 7 alkyl, -C(0)-C 9 alkyl, -C(0)-C u alkyl, - C(0)-C 13 alkyl or -C(0)-Ci 5 alkyl wherein such compound hydrolyzes to form the residue of a natural or unnatural, saturated or unsaturated fatty acid, e.g., the compound hydrolyzes to form the hydroxy compound on the one hand and octanoic acid, decanoic acid, dodecanoic acid,
• Ri is -C(0)-C 1 _ 2 ialkyl (e.g., -C(0)-C 1 _ 5 alkyl, -C(0)-C 6 - 15 alkyl or -C(0)-C 1 6- 2 ialkyl), preferably said alkyl is a straight chain, optionally saturated or unsaturated and optionally substituted with one or more hydroxy or C 1-22 alkoxy (e.g., ethoxy) groups, for example Ri is -C(0)-C 6 alkyl, -C(O)- C 7 alkyl, -C(0)-C 9 alkyl, -C(0)-Cnalkyl, -C(0)-Ci 3 alkyl or -C(0)-Ci 5 alkyl wherein such compound hydrolyzes to form the residue of a natural or unnatural, saturated or unsaturated fatty acid, e.g., the compound hydrolyzes to form the hydroxy compound on the one hand and octanoi
• disorders associated with dementia are disorders associated with Huntington's disease, Parkinson's disease, Mulitple sclerosis, Amyotrophic lateral sclerosis, Down syndrome, Eldery depression, Wernicke-Korsakoff s syndrome, corticobasal degenerations, and prion disease;
• disorders associated with dementia are disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, fronto temp oral dementia, paraminenculear palsy, dementia with Lewy bodies and vascular dementia;
• dementia are disorders associated with senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paranynculear palsy, dementia with Lewy bodies and vascular dementia;
• dementia are disorders associated with Alzheimer's disease
• dementia are disorders associated with mild cognition impairment
• Method I or any of 1.1-1.18 or 2.1-2.5 wherein the disorder associated dementia to be treated is selected from the group consisting of (1) behavioral or mood disorders such as agitation/irritation, aggressive/assaultive behavior, anger, physical or emotional outbursts; (2) psychosis; (3) depression; and (4) sleep disorders in patients suffering from dementia, particularly Alzheimer's disease; Method I or any of 1.1-1.18 or 2.1-2.6, wherein the disorder to be treated is psychosis in a patient with dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.1-2.7, wherein the disorder to be treated is depression in a patient with dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.1-2.9, wherein the disorder to be treated is behavioral or mood disorders such as agitation/irritation, aggressive/assaultive behavior, anger, physical or emotional outbursts in a patient with dementia, particularly Alzheimer's disease;
• behavioral or mood disorders such as agitation/irritation, aggressive/assaultive behavior, anger, physical or emotional outbursts in a patient with dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.1-2.10, wherein the disorder to be treated is sleep disorders in a patient with dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.1-2.11, wherein the disorder to be treated is sleep maintenance insomnia, frequent awakenings, and waking up feeling unrefreshed in a patient with dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.1-2.12, wherein the disorder to be treated is sleep maintenance insomnia in a patient with dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.1-2.12, wherein the disorder to be treated is advanced sleep-phase syndrome in a patient with dementia, particularly
• Method I or any of 1.1-1.18 or 2.1-2.12, wherein the disorder to be treated is delayed sleep-phase syndrome in a patient with dementia, particularly
• Method I or any of 1.1-1.18 or 2.1-2.16 further comprises administering one or more therapeutic agents useful for the prophylaxis or treatment of dementia, particularly Alzheimer's disease;
• Method I or any of 1.1-1.18 or 2.17 wherein the therapeutic agent useful for the prophylaxis or treatment of dementia, particularly Alzheimer' s disease is a cholinesterase inhibitor (e.g., acetylcholinesterase inhibitor) or an N-Methyl D- Asparate (NMD A) receptor antagonist, in free or pharmaceutically acceptable salt form;
• a cholinesterase inhibitor e.g., acetylcholinesterase inhibitor
• N-Methyl D- Asparate (NMD A) receptor antagonist in free or pharmaceutically acceptable salt form
• cholinesterase inhibitor e.g., acetylcholinesterase inhibitor
• the cholinesterase inhibitor is selected from the group consisting of Tacrine, rivastigmine (Exelon), donepezil (Aricept), and galantamine (Razadyne, formerly called Reminyl)) in free or pharmaceutically acceptable salt form;
• cholinesterase inhibitor e.g., acetylcholinesterase inhibitor
• the cholinesterase inhibitor is donepezil in free or pharmaceutically acceptable salt form
• NMDA receptor antagonist is memantine in free or pharmaceutically acceptable salt form
• Method I any of 1.1-1.18 or 2.17-2.18, wherein the therapeutic agent useful for the prophylaxis or treatment of dementia, particularly Alzheimer' s disease is a combination of a cholinesterase inhibitor (e.g., acetylcholinesterase inhibitor) and an N-Methyl D-Asparate (NMDA) receptor antagonist, in free or
• a cholinesterase inhibitor e.g., acetylcholinesterase inhibitor
• NMDA N-Methyl D-Asparate
• Method I or any of 1.1 - 1.18 or 2.22, wherein the one or more therapeutic agent(s) useful for the prophylaxis or treatment of dementia, particularly Alzheimer's disease or symptoms thereof is a combination of donepezil and memantine in free or pharmaceutically acceptable salt form.
• Method I or any of the foregoing methods further comprises administering one or more therapeutic agents selected from antidepressant compounds, compounds that modulate GABA activity (e.g., enhances the activity and facilitates GABA transmission), a GABA-B agonist, a 5-HT modulator (e.g., a 5 -HT 1A agonist, a 5-HT 2A antagonist, a 5-HT 2A inverse agonist, etc.), a melatonin agonist, an ion channel modulator (e.g., blocker) , a serotonin-2 antagonist/reuptake inhibitor (SARIs), an orexin receptor antagonist, an H3 agonist, a noradrenergic antagonist, a galanin agonist, a CRH antagonist, human growth hormone, a growth hormone agonist, estrogen, an estrogen agonist, a neurokinin- 1 drug, , and an antipsychotic agent, e.g., an atypical antipsychotic agent, in free or pharmaceutically acceptable salt form.
• a therapeutic agents
• the invention provides a pharmaceutical composition
• composition I comprising the compound of Formula I or any of formulae 1.1- 1.18 in combination with one or more therapeutic agents useful for the prophylaxis or treatment of one or more disorders associated with dementia, e.g., disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke-Korsakoff s syndrome, corticobasal degenerations, and prion disease in admixture with a pharmaceutically acceptable diluent or carrier.
• the invention provides the
• composition I as hereinbefore described wherein the therapeutic agent(s) useful for the prophylaxis or treatment of one or more disorders associated with dementia, e.g., disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke- Korsakoff s syndrome, corticobasal degenerations, and prion disease, is a cholinesterase inhibitor (e.g., acetylcholinesterase inhibitor) or an N-Methyl D-Asparate (NMD A) receptor antagonist) as described in any of formulae 2.17-2.23.
• disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paraminen
• the invention provides the
• composition I as hereinbefore described wherein the therapeutic agent(s) useful for the prophylaxis or treatment of one or more disorders associated with dementia is selected from: antidepressant compounds, compounds that modulate GABA activity (e.g., enhances the activity and facilitates GABA transmission), a GABA-B agonist, a 5-HT modulator (e.g., a 5 - HTiA agonist, a 5-HT 2A antagonist, a 5-HT 2A inverse agonist, etc.), a melatonin agonist, an ion channel modulator (e.g., blocker) , a serotonin-2 antagonist/reuptake inhibitor (SARIs), an orexin receptor antagonist, an H3 agonist, a noradrenergic antagonist, a galanin agonist, a CRH antagonist, human growth hormone, a growth hormone agonist, estrogen, an estrogen agonist, a neurokinin- 1 drug, , and an antipsychotic agent, e.g., an atypical antipsychotic
• the invention provides a pharmaceutical composition
• a pharmaceutical composition comprising the Compound of Formula I or any of formulae 1.1-1.18 in admixture with a pharmaceutically acceptable diluent or carrier, or the Pharmaceutical Composition I as hereinbefore described, for use (in the manufacture of a medicament) for the prophylaxis or treatment of one or more disorders associated with dementia, e.g., disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, fronto temporal dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke-Korsakoff s syndrome, corticobasal degenerations, and prion disease, as disclosed in Method I or any of formulae 2.1-2.24.
• disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease,
• the invention provides use of the Compound of Formula I or any of formulae 1.1-1.18 (in the manufacture of a medicament) for the prophylaxis or treatment of one or more disorders associated with dementia, e.g., one or more disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke-Korsakoff s syndrome, corticobasal degenerations, and prion disease, as disclosed in Method I or any of formulae 2.1- 2.24.
• dementia e.g., one or more disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paramine with Lewy bodies, vascular dementia, Huntington's disease,
• the invention provides the Pharmaceutical Composition of the Invention as described herein for use in the manufacture of a medicament for the prophylaxis or treatment of one or more disorders associated with dementia, e.g., disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke-Korsakoff s syndrome, corticobasal degenerations, and prion disease as disclosed in Method I or any of formulae 2.1- 2.24.
• disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, frontotemporal dementia, paramine with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis
• the Compounds of the Invention as hereinbefore described have a selective receptor profile wherein they fully saturate the 5-HT 2A receptors at a low dose and also bind to dopamine receptors and serotonin reuptake transporter (SERT) at a higher dose.
• SERT serotonin reuptake transporter
• the Compounds of the Invention are effective in treating one or more disorders associated with dementia, e.g., one or more disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease, fronto temp oral dementia, paraminenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke-Korsakoff s syndrome, corticobasal degenerations, and prion disease, particularly behavioral/mood disturbances (e.g., agitation, aggressive/assaultive behavior) and sleep disorders, which are inadequately treated by the current marketed drugs for dementia and Alzheimer's disease, as well as treating psychosis and depressive disorders in patients suffering from dementia.
• dementia e.g., one or more disorders associated with mild cognition impairment and dementing illnesses including senile dementia, Alzheimer's disease, Pick's disease,
• the compounds of the Invention may be used in a combination therapy wherein the Compound of Formula I may be administered simultaneously, separately or sequentially with another active agent to treat dementia or dementing illnesses as hereinbefore described, particularly Alzheimer's disease or symptoms thereof.
• the Compound of Formula I in free, pharmaceutically acceptable salt or prodrug form may be administered in a composition, wherein said Compound of Formula I as
• the combination is administered in a combination therapy, the combination may be administered as a fixed combination (wherein the therapeutic agents are in a single dosage form, e.g., the Pharmaceutical Composition I hereinbefore described) or as a free combination (wherein therapeutic agents are in a separate dosage form).
• the second or further therapeutic agents useful for the prophylaxis or treatment of dementia as hereinbefore described, particularly Alzheimer' s disease described in Method I or any of formulae 2.17-2.24 of the invention include but not limited to a cholinesterase inhibitor and/or N-Methyl D-Asparate (NMD A) receptor antagonist.
• NMD A N-Methyl D-Asparate
• Cholinesterase inhibitors e.g., acetylcholinesterase inhibitors, are known in the art and/or are described e.g., in U.S. Pat No. 4,895,841; and U.S. Pat. 4,948,807, the contents of each of which are incorporated by reference in their entirety.
• Preferred cholinesterase inhibitors to be used with the compound of the present invention include donepezil, rivastignmine, galantamine and tacrine.
• NMDA receptor antagonists are also known in the art and are described in U.S. Pat. 5,061,703, the contents of which are incorporated by reference in their entirety.
• Preferred NMDA receptor antagonist to be used with the compound of the present invention is memantine.
• Compounds of Formula I normalize brain dopamine activity, particularly in the prefrontal cortex.
• the Compounds of Formula I bind to 5- HT 2A and dopamine D 2 receptors.
• Compounds of Formula I also exhibit nanomolar binding affinity for SERT compared to known antidepressants. Therefore, the compounds of Formula I are useful for the treatment of (1) behavioral or mood disorders such as agitation/irritation, aggressive/assaultive behavior, anger, physical or emotional outbursts; (2) psychosis; (3) depression; and (4) sleep disorders in patients suffering from dementia, particularly Alzheimer's disease.
• the methods of the invention as hereinbefore described may optionally further comprises one or more therapeutic agents selected from antidepressant compounds, compounds that modulate GABA activity (e.g., enhances the activity and facilitates GABA transmission), a GABA-B agonist, a 5-HT modulator (e.g., a 5 -HT 1A agonist, a 5-HT 2A antagonist, a 5-HT 2A inverse agonist, etc.), a melatonin agonist, an ion channel modulator (e.g., blocker) , a serotonin-2 antagonist/reuptake inhibitor (SARIs), an orexin receptor antagonist, an H3 agonist, a
• antidepressant compounds compounds that modulate GABA activity
• compounds that modulate GABA activity e.g., enhances the activity and facilitates GABA transmission
• a GABA-B agonist e.g., a 5-HT modulator (e.g., a 5 -HT 1A agonist, a 5-HT 2A antagonist,
• the therapeutic agents may be adjunctive to the compounds of the invention.
• the term "adjunctive" refers to any treatment that is used in conjunction with another to increase the chance of cure, or to increase the first treatment's efficacy. In other words, adjunctive therapy acts as an aid to the primary treatment.
• the combinations of the invention can include mixtures of the combined drugs, as well as two or more separate compositions of the drugs, which individual compositions can be, for example, co-administered together to a patient at the same of different times.
• the antidepressant useful for the invention may be selected from amitriptyline, amoxapine, bupropion, citalopram, clomipramine, desipramine, doxepin, duloxetine,
• escitaloprame fluoxetine, fluvoxamine, imipramine, isocarboxazid, maprotiline, mirtazapine, nefazodone, nortriptyline, paroxetine, phenelzine sulfate, protiptyline, sertraline,
• the antidepressant(s) is a selective serotonin reuptake inhibitor (SSRI).
• SSRI selective serotonin reuptake inhibitor
• the SSRI compound is selected from the group consisting of citalopram , escitalopram oxalate, fluoxetine, fluvoxamine maleate, paroxetine, sertraline, and dapoxetine, in free or pharmaceutically acceptable salt form.
• the dosages of a compound of Formula I and/or the antidepressant of Method I can be the same as or lower than the approved dosage for the drug, the clinical or literature test dosage or the dosage used for the drug as a monotherapy.
• the daily dosage of compound of Formula I to be administered in combination with an antidepressant is about 1 mg to about 140 mg, in another embodiment about 1 mg to about 100 mg, in another embodiment about 10 mg to about 100 mg, in another embodiment about 10 mg to about 50 mg, in another embodiment about 10 mg to about 40 mg, in another embodiment about 20 mg to about 40 mg and in another embodiment about 1 mg to about 10 mg.
• the amount of antidepressant to be administered in combination with the compound of Formula I is about 0.01 mg to about 2000 mg, in another embodiment about 0.1 mg to about 200 mg, in another embodiment about 10 mg to about 200 mg.
• the additional therapeutic agent e.g., the antidepressant SSRI is sertraline and the daily dosage of sertraline is between about 20 mg and 100 mg.
• the dosages of a compound of Formula I and/or the second therapeutic agents are lower than when used in a monotherapy. Therefore, in a particular embodiment, the daily dosage of a compound of Formula I is lower than lOOmg once daily, or less than 50mg, or less than 40 mg, or less than 30 mg, or less than 20 mg, or less than lOmg. In another preferred embodiment, the dosages of both the Compound of Formula I and the antidepressant agent are lower than the dosages used for the individual drug as a monotherapy.
• Method I comprises administering (1) a Compound of Formula I at a dosage lower than 100 mg once daily, preferably less than 50 mg, more preferably less than 40 mg, still more preferably less than 30 mg, still more preferably less than 20 mg, still more preferably less than 10 mg; and (2) antidepressant, for example a SSRI such as sertaline, at a daily dosage of less than 50 mg, more preferably, less than 20 mg, still more preferably, less than 10 mg, most preferably less than 6 mg, in free or pharmaceutically acceptable salt form.
• antidepressant for example a SSRI such as sertaline
• GABA refers to gamma- aminobutyric acid.
• the GABA compounds are compounds which bind to the GABA receptor, and include, but are not limited to one or more of doxepin, alprazolam, bromazepam, clobazam, clonazepam, clorazepate, diazepam,
• flunitrazepam flurazepam, lorazepam, midazolam, nitrazepam, oxazepam, temazapam, triazolam, indiplon, zopiclone, eszopiclone, zaleplon, Zolpidem, gabaxadol, vigabatrin, tiagabine, EVT 201 (Evotec Pharmaceuticals) or estazolam.
• 5HT 2A antagonists include ketanserin, risperidone, eplivanserin, volinanserin (Sanofi- Aventis, France), pruvanserin, pimavanserin (ACP-103), MDL 100907 (Sanofi-Aventis, France), HY10275 (Eli Lilly), APD125 (Arena Pharmaceuticals, San Diego, CA), AVE8488 (Sanofi- Aventis, France) and pizotifen.
• 5HTi A agonists include repinotan, sarizotan, eptapirone, buspirone and MN-305 (MediciNova, San Diego, CA).
• Melatonin agonists include melatonin, ramelteon (ROZEREM ® , Takeda
• VEC- 162 (Vanda Pharmaceuticals, Rockville, MD)
• PD-6735 Phase II Discovery and agomelatine.
• Ion channel blockers such as lamotrigine, gabapentin or pregabalin.
• Orexin receptor antagonists include orexin, a 1,3-biarylurea, SB-334867-a
• Serotonin-2 antagonist/reuptake inhibitors include Org 50081 (Organon -
• Neurokinin- 1 drugs include Casopitant (GlaxoSmithKline).
• additional therapeutic agents useful for the current invention include modafinil, armodafinil, doxepin, alprazolam, bromazepam, clobazam, clonazepam, clorazepate, diazepam, flunitrazepam, flurazepam, lorazepam, midazolam, nitrazepam, oxazepam, temazapam, triazolam, indiplon, zopiclone, eszopiclone, zaleplon, Zolpidem, gabaxadol, vigabatrin, tiagabine, EVT 201 (Evotec Pharmaceuticals), estazolam, ketanserin, risperidone, eplivanserin, volinanserin (Sanofi-Aventis, France), pruvanserin, pimavanserin (ACP-103), pizotifen, MDL 10090
• treatment and “treating” are to be understood accordingly as embracing prophylaxis and treatment or amelioration of symptoms of disease and/or treatment of the cause of the disease.
• the word “treatment” and “treating” refers to prophylaxis or amelioration of symptoms of the disease.
• patient may include a human or non-human patient.
• dementia is intended to refer to a condition or disorder characterized by the loss of cognitive ability affecting memory, thinking, language, judgment and behavior.
• Early symptoms of dementia may include difficulty performing tasks that require some thought (balancing a checkbook, playing games (such as bridge); learning new information; getting lost on familiar routes; having language difficulties (difficulties in finding name of familiar objects); losing interest in things previously enjoy; losing social skills.
• More severe symptoms of dementia include change in sleep patterns, often waking up at night; difficulty performing basic tasks such as brushing teeth or preparing a meal; forgetting details about current events; having hallucinations, violent behavior, delusions, depression, agitation; difficulty reading or writing; having poor judgment or loss of ability to recognize danger; losing the ability to recognize family members or understand language.
• the term "dementia” refers to any of the dementing illnesses as described herein regardless of etiology and therefore shall include but not limited to mild or severe cognition impairment and dementing illnesses such as senile dementia,
• Alzheimer's disease Pick's disease, frontotemporal dementia, parenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke- Korsakoff s syndrome, corticobasal degenerations, and prion disease.
• Alzheimer's disease Pick's disease, frontotemporal dementia, parenculear palsy, dementia with Lewy bodies, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, Down syndrome, elderly depression, Wernicke- Korsakoff s syndrome, corticobasal degenerations, and prion disease.
• dementia refers to mild cognitive impairment. In another embodiment, dementia refers to Alzheimer's disease.
• disorder associated with dementia means common co-morbid psychiatric disorders or conditions associated with dementia, which include but not limited to (1) behavioral or mood disorders such as agitation/irritation, aggressive/assaultive behavior, anger, physical or emotional outbursts; (2) psychosis; (3) depression; and (4) sleep disorders.
• the disorders associated with dementia are disorders associated Alzheimer's disease.
• MCI mimaize cognitive impairment
• incipient dementia or isolated memory impairment
• MCI cognitive impairment beyond that expected based on the age and education of the individual, but which is not significant enough to interfere with their daily activities.
• Symptoms of MCI include difficulty performing more than one task at a time, solving problems or making decisions, forgetting recent events or conversations and taking longer to perform more difficult mental activities.
• Alkyl as used herein is a saturated or unsaturated hydrocarbon moiety, e.g., one to twenty-one carbon atoms in length, which may be linear or branched (e.g., n- butyl or tert-butyl), preferably linear, unless otherwise specified.
• “Ci-21 alkyl” denotes alkyl having 1 to 21 carbon atoms.
• alkyl is optionally substituted with one or more hydroxy or Q-iialkoxy (e.g., ethoxy) groups.
• alkyl contains 1 to 21 carbon atoms, preferably straight chain and optionally saturated or unsaturated
• Ri is an alkyl chain containing 1 to 21 carbon atoms, preferably 6- 15 carbon atoms, 16-21 carbon atoms, e.g., so that together with the -C(O)- to which it attaches, e.g., when cleaved from the compound of Formula I, forms the residue of a natural or unnatural, saturated or unsaturated fatty acid.
• Compounds of the Invention refer to Compounds of Formula I, which include any of formulae 1.1-1.18, in free, salt or prodrug form.
• the Compounds of the Invention are intended for use as pharmaceuticals, therefore pharmaceutically acceptable salts are preferred. Salts which are unsuitable for pharmaceutical uses may be useful, for example, for the isolation or purification of free Compounds of the Invention or their pharmaceutically acceptable salts, are therefore also included.
• Pharmaceutically acceptable salts include, for example, the hydrochloride and tosylate salts. Where dosage amounts of salts are given by weight, e.g., milligrams per day or milligrams per unit dose, the dosage amount of the salt is given as the weight of the corresponding free base, unless otherwise indicated.
• Compounds of the Invention may in some cases also exist in prodrug form.
• a prodrug form is compound which converts in the body to a Compound of the Invention.
• these substituents may form physiologically hydrolysable and acceptable esters.
• physiologically hydrolysable and acceptable ester means esters of Compounds of the Invention which are hydrolysable under physiological conditions to yield acids (in the case of Compounds of the Invention which have hydroxy substituents) or alcohols (in the case of Compounds of the Invention which have carboxy substituents) which are themselves physiologically tolerable at doses to be administered.
• Y of the compound of Formula I is -C(H)(OR , and Ri is -C(0)-C 1 _ 2 ialkyl, e.g., -C(0)-C 3 alkyl or -C(0)-C 9 alkyl
• these compounds may hydrolyze under physiological condition to yield a compound of Formula I wherein Y is - C(H)(OH) on the one hand and C 1 _ 2 ialkyl-C(0)OH, e.g., C 3 alkyl-C(0)OH or C 9 alkyl-C(0)OH on the other hand.
• the term thus embraces conventional pharmaceutical prodrug forms.
• a prodrug e.g., the compound of formula (I) wherein R is -C(0)-C 1- 21 alkyl
• the term "simultaneously" when referring to a therapeutic use means administration of two or more active ingredients at or about the same time by the same route of administration.
• the term "separately" when referring to a therapeutic use means administration of two or more active ingredients at or about the same time by different route of administration.
• disorder(s) associated with Alzheimer's disease includes, but is not limited to (1) behavioral or mood disorders such as agitation/irritation, aggressive/assaultive behavior, anger, physical or emotional outbursts; (2) psychosis; (3) depression; and (4) sleep disorders in patients suffering from Alzheimer's disease.
• an amount of the Compound of the Invention for administration refers to or is based on the amount of the Compound of the Invention in free base form (i.e., the calculation of the amount is based on the free base amount).
• a prodrug e.g., the compound of formula (I) wherein Ri is -C(0)-C 1 _ 2 ialkyl
• Compounds of the Invention may be administered by any suitable route, including orally, intra-muscularly, subcutaneously, parenterally or transdermally, but are preferably administered orally.
• Compounds of the Invention may be administered by any suitable route, including orally, parenterally or transdermally, but are preferably administered orally.
• combination therapy one skilled in the art can design a combination based on the level of severity (staging) of and/or the symptoms manifested in dementia, particularly
• the compound of the invention may be administered at a lower dosage, e.g., about 1-lOmg, e.g., 2.5mg-5mg, e.g., 2.5mg, 3mg, 4mg, 5mg or lOmg, of a Compound of Formula I or any of formulae 1.1-1.18, in free, pharmaceutically acceptable salt or prodrug form, once or more than once daily, preferably via oral administration.
• a lower dosage e.g., about 1-lOmg, e.g., 2.5mg-5mg, e.g., 2.5mg, 3mg, 4mg, 5mg or lOmg, of a Compound of Formula I or any of formulae 1.1-1.18, in free, pharmaceutically acceptable salt or prodrug form, once or more than once daily, preferably via oral administration.
• the compounds of the invention may be administered at a higher dosage, e.g., about lmg to lOOmg to 140mg once daily, preferably 2.5mg-60mg, e.g., 20mg-60mg, 20mg- 40mg, e.g., 2.5mg, 5mg, lOmg, 20mg, 30mg, 40mg, 50mg or 60mg, once or more than once daily, for example, greater than 20mg per day, preferably via oral administration.
• a higher dosage e.g., about lmg to lOOmg to 140mg once daily, preferably 2.5mg-60mg, e.g., 20mg-60mg, 20mg- 40mg, e.g., 2.5mg, 5mg, lOmg, 20mg, 30mg, 40mg, 50mg or 60mg, once or more than once daily, for example, greater than 20mg per day, preferably via oral
• Dosages of the second or further therapeutic agent(s) useful for the prophylaxis or treatment of dementia, particularly for the prophylaxis or treatment of Alzheimer's disease or symptoms thereof can vary in range known to a person skilled in the art.
• the dosages can range from about lmg to lOOmg.
• the compound of the Invention may be combined with the second or further therapeutic agent(s) useful for the prophylaxis or treatment of dementia, particularly Alzheimer's disease or symptoms thereof as follows:
• any disclosure of a numerical range, e.g., "up to X” amount is intended to include the upper numerical limit X. Therefore, a disclosure of "up to 60mg” is intended to include 60mg.
• compositions comprising compounds of the Invention may be prepared using conventional diluents or excipients and techniques known in the galenic art.
• oral dosage forms may include tablets, capsules, solutions, suspensions and the like.
• Example 1 Effect of Compound A on Reversal of Social Isolation resulted from Repeated Stress
• mice are tested for social isolation behavior after repeated exposure (once daily for 10 days) to an aggressive resident intruder mouse in the social defeat/resident intruder paradigm as describe by Berton et al., Science (2006) 311:864-868, the contents of which are incorporated by reference. Mice are then dosed chronically, once daily for 30d, with either vehicle (5% DMSO/ 5% Tween-20/ 15% PEG400/ 75% water, 6.7ml/kg volume) or Compound A (lmg/kg, ip) in vehicle solution. On the day after the last drug or vehicle treatment, the mice are placed in the open field in the presence of a resident intruder mouse and the animal's behavior recorded by videotape for lOmin. The videotapes are then scored for the total time each mouse spent during a 10 min period in specified open-field quadrants. The total time (sec) spent by mice
• Results Decreased social function is a core feature of the 'negative' symptoms of schizophrenia that are poorly addressed by existing antipsychotic medications.
• the social defeat/resident intruder model can be used to measure social isolation behavior in rodents.
• Isolation behavior has been shown to be reversed using this model, after chronic administration of anti-depressant medications with potent SERT activity, including fluoxetine (Berton et al., Science (2006) 311:864-868). Neither acute administration of anti-depressant medications or chronic treatment with anti-anxiety medications, like chlordiazepoxide, are similarly effective in this paradigm (Berton et. al., Science (2006) 311:864-868). Thus, the model has been proposed for the identification of compounds to address social isolation behavior, such as social isolation behavior resulted from repeated stress. This assay is therefore used to demonstrate reversal of social isolation behavior.
• mice are subjected to exposure to an aggressive resident intruder mouse in the social defeat/resident intruder paradigm as described in Berton et al., Science (2006) 311:864-868. They are then dosed chronically, once daily for 30d, with either vehicle or Compound A (lmg/kg, IP) in vehicle. On the day after the last drug or vehicle treatment the mice are placed in the open field in the presence of a resident intruder mouse and the total time each mouse spent during a 10 min period in defined open-field quadrants in close proximity to the intruder or in isolation to the intruder is measured.
• mice treated with Compound A following exposure to the intruder paradigm showed no significant reduction in time spent in proximity to the intruder (NS, compared with Compound A alone).
• Compound A treatment alone did not result in differences in time spent in the Interaction Zone, compared with untreated control mice.
• the data indicate that chronic treatment with Compound A results in a reversal of social defeat behavior comparable to that seen after chronic treatment with antidepressant medications such as fluoxetine.
• This experiment shows that Compound A is effective in reversing social isolation resulted from repeated stress. This experiment also shows that Compound A has functional anti-depressant activity.

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