Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—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
  • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
  • A61K31/454—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. pimozide, domperidone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—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
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4709—Non-condensed quinolines and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
  • A61K31/5375—1,4-Oxazines, e.g. morpholine
  • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
  • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/69—Boron compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/05—Dipeptides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
  • G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
  • G01N33/5011—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics for testing antineoplastic activity
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
  • G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
  • G01N33/5076—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics involving cell organelles, e.g. Golgi complex, endoplasmic reticulum
  • G01N33/5079—Mitochondria
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
  • G01N2333/82—Translation products from oncogenes
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2500/00—Screening for compounds of potential therapeutic value
  • G01N2500/04—Screening involving studying the effect of compounds C directly on molecule A (e.g. C are potential ligands for a receptor A, or potential substrates for an enzyme A)
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2500/00—Screening for compounds of potential therapeutic value
  • G01N2500/10—Screening for compounds of potential therapeutic value involving cells

Definitions

• This invention relates generally to methods and compositions for treating cancer and autoimmune diseases.
• Cancer may include hematological malignancies, such as Multiple Myeloma and B-cell lymphoma.
• the invention relates to treating cancers including hematological malignancies, with compounds that inhibit the Bcl-2 family protein Mcl-l as wel l as other of the Bcl-2 family proteins.
• this invention relates to methods for determining selectivity of newly classified "BH3 mimic" compounds to predict efficacy in treating hematological and other malignancies involving Mcl-l .
• NHL non-Hodgkin's lymphoma
• CLL chronic lymphocytic leukemia
• Mcl-l is a key regulator of lymphoid cancers including multiple myeloma (MM) (Zhang, et al. (2002), Blood 99: 1885-1893), non-Hodgkin's lymphomas (Cho- Vega, et. al (2004) Hum. Pathol. 35(9): 1095-100) and chronic lymphocytic leukemia (CLL) (Michaels, et al. (2004), Oncogene 23: 4818-4827). Additionally, treatment of myeloma cells with the proteasome inhibitor Bortezomib (Velcade) has been shown to cause elevated Mcl-l expression (Nencioni,, et al.
• MM multiple myeloma
• CLL chronic lymphocytic leukemia
• Mcl-l inhibitor would enhance the efficacy of Velcade treatment in MM patients.
• Bcl-2 promotes cell survival and normal cell growth and is expressed in many types of cells in eluding lymphocytes, neurons and, self-renewing cells, such as basal epithelial cel ls and hematopoietic progenitor cells in the bone marrow.
• Bcl-2 and Mcl-1 anti-apoptotic Bcl-2 proteins
• Bcl-2 and Mcl-1 block the sensitivity of tumor cells to cytostatic or apoptosis inducing drugs. These proteins are therefore targets for anti-tumor therapy.
• a recently described class of small molecules that inhibit Bcl-2 family proteins are the BH3 mimetic compounds (Andersen, et al. (2005) Nat. Rev. Drug Discov, 4: 399-409). These compounds function by inhibiting BH3 mediated protein/protein interactions among the Bcl-2 family proteins.
• BH3 mimetic small molecules that function as Bcl-2 inhibitors by blocking BH3 binding ⁇ reviewed in Reed, et al.
• Compounds with BH3 mimic function include HA- 14- 1 (Wang, et al. (2000) Proc. Natl. Acad. Sci. USA 97: 7124-9), Antirnycin-A (Tzung, et al. (2001) Nat. Cell. Biol. 3: 183-191), BH3I-1 and BH3I-2 (Degterev, et al. (2001) Nat. Cell. Biol. 3: 173-82), and seven un-named compounds (Enyedy, et al. (2001) J. Med Cheni 44: 4313-24), as well as a series of terphenyl derivatives ( utzki, et al. (2002) J.
• the present invention is based on the discovery of methods and compounds useful for treating cancer and autoimmune diseases, including methods involving the manipulation of Bcl-2 fami ly proteins.
• the invention pertains to methods of using compounds of Formula I in the treatment of various disease states, including those involving Bcl-2 fami ly proteins, where Formula ⁇ is:
• X is O, C, or N, with C or N optionally substituted with hydrogen, substituted or unsubstituted Ci-6 alkyl, hydroxyl-substituted alkyl, substituted or unsubstituted C 5 . io aryl, or substituted carbonyl group;
• Y is CH or N
• Z is C or N
• Z' is CH or N; when Z is C, Ri is: hydrogen, aikoxy, perfluoroalkyl, F, or CI when Z is N, R , is: null; and
• R 2 and R 3 are independently selected from hydrogen or substituted or unsubstituted C] -6 alkyl.
• the invention in another aspect, pertains to methods of using compounds of Formula II in the treatment of various disease states, including those involving Bcl-2 family proteins, where Formula II is:
• R4 is selected from hydrogen, substituted or unsubstituted C 1-6 alkyl, substituted or unsubstituted straight or branched Ci -10 alkyl, C 2-10 alkenyl, C 2-10 alkynyi, substituted or unsubstituted C3.10 cycioalkyl, substituted or unsubstituted C 5 .
• Rs is selected from hydrogen, substituted or unsubstituted Cj-e alkyl, substituted or unsubstituted straight or branched C3 0 alkyl, substituted or unsubstituted C 1-6 alkyl, C2-W alkenyl, C?-io alkynyi, substituted or unsubstituted C3-10 cycioalkyl, substituted or unsubstituted C5-8 cycloalkenyl, substituted or unsubstituted Cj-io aminoalkyl, substituted or unsubstituted C3.J0 aminocycloalkyl, substituted or unsubstituted C 1-10 alkylamino, substituted or unsubstituted C 5-10 aryl, hydroxy!, alkoxy, aminocarbonyl (amido), aminosulfonyl (sulfonamide), halo, or substituted or unsubstituted saturated or unsaturated 3-1 1 member heteroaryl or heteroary
• R is selected from hydrogen, substituted or unsubstituted Cj -6 aikyi, substituted or unsubstituted straight or branched CMO alkyl, C 2-10 aikenyl, C? ⁇ io alkynyl, substituted or unsubstituted C -10 cycloalkyl, substituted or unsubstituted C 5-8 cycloaikenyi, substituted or unsubstituted CMO alkylamino, or substituted or unsubstituted C 5- ] 0 aryl, or substituted or unsubstituted saturated or unsaturated 3- 1 1 member heteroaryl or heteroaryl alkyl containing 1, 2, 3, or 4 heteroatoms selected independently from , O, S, or S(0) 2 and
• R5 is selected from hydrogen, substituted or unsubstituted C 1-6 alkyl, substituted or unsubstituted straight or branched CMO alkyl, substituted or unsubstituted C 1-6 aikyi, C?-io aikenyl, C2-10 alkynyl, substituted or unsubstituted C3-10 cycloalkyl, substituted or unsubstituted C5-8 cycloaikenyi, substituted or unsubstituted CMO aminoalkyl, substituted or unsubstituted C 3-10 aminocycloalkyl, unsubstituted or substituted C3-C10 heterocyclyi, substituted or unsubstituted CMG alkylamino, substituted or unsubstituted C5-10 aryl, hydroxy!, alkoxy, aminocarbonyl (ami do), aminosulfonyl (sulfonamide), halo, or substituted or unsubstituted saturated or
• the invention is directed to the use of compounds of Formulae 1, II, or III in treating cancer and autoimmune diseases in patients with compounds having common substructures or scaffolds identified by analysis of common structural features of the compounds of Formulae I, II, or 01, including but not limited to the scaffolds defined in Formulae I, II, or III.
• the invention is directed to methods of treating cancer in patients with compounds of Formulae ⁇ , II, or 10.
• Cancer may include, for example, hematological malignancies.
• Such hematological malignancies include, for example, Multiple Myeloma, B-cell lymphoma, acute myelogenous leukemia, and chronic lymphocytic leukemia.
• Treatment results in, for example, tumor regression.
• Tumor regression can include, for example, killing a cancer cell.
• Another aspect of the invention is a method for treating particular types of hematopoietic cancers, using a compound of Formulae I, II, or III.
• the use of these compounds for particular types of hematopoietic cancers have unexpected results in terms of, for example, efficacy and/or ability to inhibit particular anti-apoptotic (pro- survival) members of the Bcl-2 family (including, e.g., Mcl-1 ) or to mimic particular members of the pro-apoptotic Bcl-2 family proteins. Accordingly, hematological tumor cells that are hyper-dependent on a particular member of the Bcl-2 family of proteins will be highly impacted by BHD mimics which targets that protein.
• the invention provides a method for killing a cancer cell comprising administering an amount of a compound of Formulae I, , or OI effective to kill a cancer cell of a hematopoietic cancer.
• hematopoietic cancer include, but are not limited to, Multiple Myeloma, B cell lymphoma, chronic lymphocytic leukemia, and acute myelogenous leukemia.
• the invention provides a method for killing a cancer cell comprising administering an amount of a compound of Formulae ⁇ , II, or 10 in combination with a chemotherapeutic agent or agents that increases the level of Mcl-1 in the cancer cell.
• chemotherapeutic agents can include 26S proteasome inhibitors and inhibitors of the BH3 domain containing E3 ligase called Mule.
• Such agents may be, but are not limited to, bortezomib or rituximab.
• the invention provides a method for killing a cancer cell comprising administering an amount of a compound of Formulae I, II or III in combination with a 26S proteasome inhibitor to kill the cancer cell.
• a non-limiting exemplary proteasome inhibitor is bortezomib.
• the compounds of Formulae ⁇ , II, and 10 are used in a method for treating particular types of hematopoietic cancers, such as B-cell lymphoma, to preferentially inhibit the binding of a peptide comprised of the BIB domain of Bak to the Bcl-2 family protein Mcl-1.
• This activity is unique among all of the BH3 mimics reported as of the time of filing this application and directs the use of this compound in treating certain hematological malignancies that are affected principally by the Bel- 2 family proteins and among those proteins, mostly by Mcl-1.
• these compounds are useful in blocking the unwanted cell survival activity of Mcl-1 in tumorogenic lymphoid and myeloid cells, and therefore may be used as a therapy for treating Multiple Myeloma (MM), diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia (CLL), acute myelogenous leukemia (AMI.,), all of which are effected by elevated Mcl-1.
• MM Multiple Myeloma
• DLBCL diffuse large B-cell lymphoma
• CLL chronic lymphocytic leukemia
• AMI. acute myelogenous leukemia
• the invention provides a method for treating particular types of hematopoietic cancers using a combination of one or more compounds selected from the compounds of Formulae I, II, or III, in combination with other therapies, for example, a class of therapeutics known as 26S proteasome inhibitors, such as, for example, Bortezomib (Velcade*)-
• the invention is directed to methods of treating autoimmune diseases in patients with compounds of Formulae I, II, or OL
• the autoimmune disease may be Type I diabetes, rheumatoid arthritis, osteo arthritis, psoriatic arthritis, psoriasis, neuromyaotonia, mayasthenia gravis, lupus erythematosus, endometriosis, Graves disease, granulomatosis, Crohn's disease, interstitial cystitis, or multiple sclerosis, among others.
• the invention provides a method for determining whether a candidate compound mimics a ligand specific for a target, the method comprising the steps of (a) providing in a first reaction, the target, a first labeled peptide specific for the target, and a first unlabeled peptide specific for the target, (b) providing in a second reaction, the target, the first labeled peptide specific for the target, and a first candidate compound, (c) comparing binding specificity of the first unlabeled peptide with binding specificity of the first candidate compound to determine whether the candidate compound mimics the first unlabeled peptide.
• this method further comprises repeating steps (a), (b), and (c) wherein the first labeled peptide specific for the target is replaced with a second labeled peptide specific for the target.
• the target comprises a BH3 domain binding region, such as, for example, a hydrophobic pocket formed by the BH 1, BH2, BH3 and BH4 domains of the anti-apoptotic Bcl-2 family of proteins.
• the invention provides methods for identifying specific activity of BH3 mimic compounds.
• these compounds can have varying potencies in inhibiting BH3 -mediated binding of particular Bcl-2 family proteins, and the difference in potency can be identified by systematically ordering combinations of protein-protein interactions and comparing the blocking activity of BED mimic compounds to that of competing BH3 domain containing peptides.
• a biological activity can be assigned to that compound that correlates to the activity of the BH3 domain containing protein. This information can be used to predict the utility of a BED mimic compounds in treating a particular disease.
• the invention provides an agent, which modulates apoptosis by binding to the Bcl-2 family proteins, including Mel-1 and preferentially blocks BED domain binding.
• the invention provides a method for using a compound of Formulae I, II, or III to preferentially inhibit Mel-1 over other Bcl-2 family members.
• the invention provides a method of using compounds of Formulae I, II, or III which selectively inhibit Mcl-1 while showing dramatically reduced inhibitory activity for Bcl-xL.
• the invention provides a method for blocking binding of the BH3-only Bcl-2 family proteins or parts thereof, including Puma, Noxa, Bim, Bid and Bak, to Mcl-1.
• the invention provides a method for using a compound of Formulae I, II, or III as to target Mcl-1 preferentially as inhibitors to induce apoptosis in cells over expressing Mcl-1.
• the invention provides a method for blocking binding of the BED -only proteins or parts thereof, including Puma, Noxa, Bim, Bid and Bak, to Mcl-1.
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl-2 family protein Mcl-1 and other members of the Bcl-2 family of a ti-apoptotic proteins for the purpose of treating cancer and cancer patients, including those with drug resistance, either alone or in combination with other anti-tumor agents.
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl-2 family protein Mcl-1 and other members of the Bcl-2 family of anti-apoptotic proteins for the purpose of treating lymphoid malignancies either alone or in combination with other a i-tumor agents,
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl- 2 family protein Mcl-1 and other members of the Bcl-2 family of anti-apoptotic proteins for the purpose of treating myeloid cancer either alone or in combination with other and -tumor agents.
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl- 2 family protein Mcl-1 and other members of the Bcl-2 family of anti-apoptotic proteins for the purpose of treating prostate cancer either alone or in combination with other a i-tumor agents.
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl- 2 family protein Mcl-1 and other members of the Bcl-2 family of anti-apoptotic proteins for the purpose of treating non-Hodgkin's lymphoma patients who are resistant to Rituxan either alone or in combination with other anti-tumor agents.
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl- 2 family protein Mcl-1 and other members of the Bcl-2 family of anti-apoptotic proteins for the purpose of treating Chronic Lymphocytic Leukemia patients who are resistant to Rituxan either alone or in combination with other anti-tumor agents.
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bc -2 family protein Mcl-1 and other members of the Bcl-2 family of anti- apoptotic proteins for the purpose of treating breast cancer either alone or in combination with other anti-tumor agents,
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, ⁇ , or III for inhibiting the activity of the Bcl-2 family protein Mcl-1 and other members of the Bcl-2 family of anti- apoptotic proteins for the purpose of treating liver cancer either alone or in combination with other anti-tumor agents,
• the invention provides a method for using a specific BH3 mimic compound of Formulae I, II, or III for inhibiting the activity of the Bcl- 2 family protein Mcl-1 and other members of the Bcl-2 family of anti-apoptotic proteins for the purpose of treating ovarian cancer either alone or in combination with other anti-tumor agents.
• the invention provides a method for treating cancer patients with a compound of Formulae I, II, or III in combination with proteasome inhibitors.
• the invention provides a method for treating myelogenous leukemia with a compound of Formulae I, II, or III in combination with Bortezomib or other proteasome inhibitors.
• the invention provides a method for treating chronic lymphocytic leukemia with a compound of Formulae I, II, or III in combination with Bortezomib.
• the invention provides a method for treating Non- Hodgkm's lymphoma with a compound of Formulae I, II, or III in combination with Bortezomib.
• the invention provides a method for treating breast cancer with a compound of Formulae I, II, or 10 in combination with Bortezomib.
• the invention provides a method for treating prostate cancer with a compound of Formulae I, II, or III in combination with Bortezomib.
• the invention provides a method for treating colon cancer with a compound of Formulae I, II, or III in combination with Bortezomib.
• the invention provides a method for treating pancreatic cancer with a compound of Formulae I, II, or 10 in combination with Bortezomib.
• the invention provides a method for treating liver cancer with a compound of Formulae I, II, or III in combination with Bortezomib.
• the invention provides a method for identifying a compound of the BH3 mimic class of small molecules that is an active against a subset of the BH3 domain containing proteins and therefore has predicted efficacy against particular tumor types.
• the invention provides a method of treating a mammal suffering from migrating transformed B-cell tumors (non-Hodgkin's) comprising the steps of administering a compound of Formulae ⁇ , , or 10 and monitoring said mammal to determine the state of said cancer; wherein said cancer is a cancer sensitive to said chemical targeted to Bcl-2 family proteins; optionally wherein the amount administered is a quantity sufficient to constitute effective treatment, or wherein said cancer is chosen from a group of cancers comprising; lymphoma, breast cancer, leukemia, lung cancer, bone cancer, prostate cancer gastric cancer, colon cancer, rectal cancer, liver cancer, cervical cancer, renal cancer, bladder cancer, nasopharyngeal cancer, esophagus cancer, pituitar gland tumor, thyroid cancer melanoma, and pancreatic cancer.
• the invention provides a method of preventing cancer comprising the step of administering a compound of Formulae I, ⁇ , or III to persons having a high risk of cancer.
• the invention provides a method for selecting specific activity of a BH3 mimic compound based on similar activity to a peptide comprised of a particular BH3 domain,
• a mammal is a human.
• cancer is: Non-Hodgkin's Lymphoma; any other B- cell lymphomas; Small lymphocytic, consistent CI .!.; Follicular, predominantly small
• cleaved cell Follicular, mixed small cleaved and large cell; Intermediate grade Follicular, large cell; Diffuse, small cleaved cell; Diffuse, mixed small cleaved and large cell; Diffuse, large cell (cleaved and non-cleaved); High grade; Large cell, immunoblastic; Lymphoblastic; Small non-cleaved ceil; Burkitt's lymphoma; Non- Burkitt's lymphoma; indolent NHL; B-cell CLL/small lymphocytic lymphoma; Marginal zone lymphoma; MALT; Splenic marginal; zone lymphoma; Nodal marginal zone lymphoma; Lymphomplasmacytoid lymphoma/immunocytoma; Follicle center lymphoma, follicular type Grade I (0-5 centrobiasts/hpf) or Grade II (6-15 centroblasts/hpf) or Grade III (>15 centr
• a mammal is a human; cancer is Multiple Myeloma.
• a compound of the invention is administered by injecting it directly into a tumor; a compound of the invention is administered by injecting it into said mammal's blood stream; a compound of the invention is administered orally; a compound of the invention is administered through said mammal's skin; a compound of the invention is administered in combination with chemotherapy agents; or a compound of the invention are administered in combination with radiation therapy.
• the invention is directed compositions as defined by Formulae I, II, and III.
• the invention is directed pharmaceutical compositions as defined by Formulae I, II, or III.
• FIG. ⁇ is a table showing the MCL-1 and Bcl-xL inhibitory constants (iC 50 , in ⁇ ), obtained as described in Example 1 , and EC 50 values obtained in cytotoxicity assays measuring in vitro activity of the compounds against four cancer cell lines (NCIH929, DHL6, MCL-1 1780, and DHL 10) as described in Example 2 for the small molecule Mcl-1 inhibitors compounds 1-15.
• FIG. 2 is a figure showing the extent of apoptosis induced in cells upon treatment with compound 12 as measured by a fluorescence-based cell-based cytotoxicity assay using 4'-6-diamino-2-phenyl.indole (DAPI).
• DAPI 4'-6-diamino-2-phenyl.indole
• FIG, 3 is a figure showing the extent of cytochrome C release upon treatment of various cell lines with compound 12, as described in Example 4.
• This invention relates generally to methods and compositions for treating cancer, including hematological malignancies, such as Multiple Myeloma and B-cell lymphoma, and autoimmune diseases. Further, the invention relates to treating cancers and autoimmune diseases, with a compound that inhibits the Bcl-2 family protein Mcl-1 as well as other of the Bcl-2 family proteins. In addition, this invention relates to methods for determining selectivity of newly classified "BH3 mimic" compounds to predict efficacy in treating hematological and other malignancies involving Mcl-1. Definitions
• anti-apoptotic-protem is a protein, which when expressed in a cell, decreases cell death as compared to a cell that does not express the anti- apoptotic protein.
• cell death in the cell containing the anti- apoptotic protein is decreased at least about 10% to about 90% relative to a control. For instance cell death may be decreased by about 90%, about 80%. about 70%, about 60%, about 50%, about 40%, about 30%, about 20% or about 10%.
• hematological malignancies refers to any cancer of the blood or bone marrow, such as leukemia or lymphoma.
• leukemia or lymphoma examples include, but are not limited to: Myelomas (e.g. Multiple myeloma and Giant cell myeloma), Acute lymphoblastic leukemia (ALL), Acute myelogenous leukemia (A ML), Acute myelogenous leukemia (AML), Chronic myelogenous leukemia (CML), Acute monocytic leukemia (AMOL), Hodgkin's lymphomas (e.g., all four subtypes).
• Myelomas e.g. Multiple myeloma and Giant cell myeloma
• ALL Acute lymphoblastic leukemia
• a ML Acute myelogenous leukemia
• AML Acute myelogenous leukemia
• CML Chronic myelogenous leukemia
• AOL
• Non-Hodgkin's lymphomas such as Diffuse large B-ceil lymphoma (DLBCL), Follicular lymphoma (FL), Mantle cell lymphoma (MCL), Marginal zone lymphoma (MZL), Burkitt's lymphoma (BL), Burkitt's lymphoma (BL), and other NK- or T-cell lymphomas are included.
• DLBCL Diffuse large B-ceil lymphoma
• FL Follicular lymphoma
• MCL Mantle cell lymphoma
• MZL Marginal zone lymphoma
• Burkitt's lymphoma BL
• Burkitt's lymphoma BL
• BL Burkitt's lymphoma
• other NK- or T-cell lymphomas are included.
• Bcl-2 refers to the protein original!)' discovered as the causal "oncogene” in lymphomas.
• pro-apoptotic protein means a protein that when expressed in a ceil increases ceil death, as compared to a cell that does not express the pro- apoptotic protein.
• cell death in the ceil containing the pro- apoptotic protein is increased at least about 10% to about 90% relative to a control.
• ceil death may be increased by about 90%, about 80%, about 70%, about 60%, about 50%, about 40%, about 30%, about 20% or about 10%.
• disrupts an interaction it is meant that a test compound decreases the ability of two polypeptides to interact with each other. In certain instances the disruption results in at least about a 99% or at least about a 97%, or at least about a 95%) decrease in the ability of the polypeptides to interact with each other. Disruptions can be identified using a combination of virtual screening for molecular structures, which fit the ideal structure of BH3 pocket, and competition binding studies using fluorescence polarization (FP). [0070] "Fluorescence polarization assay” means an assay in which an interaction between two polypeptides is measured.
• one polypeptide is labeled with a fluorescent tag, and this polypeptide emits non-polarized light when excited with polarized light.
• the polarization of emitted light is increased, and this increased polarization of light can be detected.
• Interacts means a compound that recognizes and binds to an anti-apoptotic protein but which does not substantial!)' recognize and bind to other molecules in a sample.
• Alkyi refers to a hydrocarbon chain that may be a straight chain or branched chain, containing the indicated number of carbon atoms.
• -Qo indicates that the group may have from 1 to 10 (inclusive) carbon atoms in it.
• Hydrocarbon chain that may be a straight chain or branched chain, containing the indicated number of carbon atoms, in which at least one of the hydrogen atoms has been substituted with an OH group.
• Aryl refers to an aromatic hydrocarbon group. If not otherwise specified, in this specification the term aryl refers to a Ce-Cnaryl group. Examples of an €V Cj 4 ar l group include, but are not limited to, phenyl, 1 -naphthyl, 2-naphthyl, 3- biphen-! -yl, anthryl, tetrahydronaphthyl, fluorenyl, indanyi, biphenylenyl, and acenaphthenyl, groups.
• An aryl group can be unsubstituted or substituted with one or more of the fol lowing groups: Q-Cealkyl, C 3 -C 10 cyc[oalkyl, Ci-Ceperfluoroalkyl-, halo, haloalkyl-, hydroxy!, Ci-Cehydroxylalkyl-, -NH 2 , aminoaikyi-, diaikylamino-, - COO , carboxylic ester, primary, secondary, or tertiar carboxylic amide, urea, - C(0)0-(C] -C 6 alkyl), -OC(0)(Cj -C 6 alkyl), N-aikyiamido-, -C(0)NH 2 , (d- C 6 alkyl)armdo ⁇ , -S(0) 2 -alkyl, -S(0) 2 N-aryl, alkoxy, or -N0 2 .
• Alkoxycarbonyl refers to the group C(0)-OR where R is an alkyl group, as defined above.
• Aryloxycarbonyl refers to the group C(0)-OR where R is an aryl group, as defined above.
• Alkoxy refers to the group R-O- where R is an alkyl group, as defined above.
• Ci-Cealkoxy groups include but are not limited to methoxy, ethoxy, n-propoxy, 1 -propoxy, n-butoxy and t-butoxy.
• Perfluoroalkyl refers to a hydrocarbon chain that may be a straight chain or branched chain, containing the indicated number of carbon atoms, in which all hydrogen atoms have been substituted with fluorines.
• Alkenyl refers to a straight or branched chain unsaturated hydrocarbon containing at least one double bond.
• Alkynyl refers to a straight or branched chain unsaturated hydrocarbon containing at least one double bond.
• Cycloalkyl refers to a hydrocarbon ring containing the indicated number of carbon atoms.
• Cycloalkenyl refers to a hydrocarbon ring containing the indicated number of carbon atoms and at least one double bond.
• Armnoaikyi refers to an alkyl group, as defined above, wherein one or more of the alkyl group's hydrogen atoms has been replaced with N. This N may be further substituted with alkyl groups, aryl groups, heteroaryl groups, het.eroarylal.kyl. groups, or aminoalkyl groups.
• Alkylamino refers to a N which is connected to an alkyl group, as defined above. This alkyl group may be branched or unbranched or further substituted with aryl groups, heteroaryl groups, heteroaryialkyl groups, or aminoalkyl groups.
• Hydroxyl refers to an OH group.
• Heteroaryl refers to mono and tricyclic aromatic groups of 5 to 10 atoms containing at least one heteroatom and at least one aromatic ring. Heteroatom as used in the term heteroaryl refers to oxygen, sulfur and nitrogen.
• Examples of monocyclic C3-C9 heteroaryls include, but are not limited to, pyrrolyl, oxazinyl, thiazinyl, pyridinvl, diazinvl, triazmyl, tetrazinyl, imidazolyl, tetrazolyl, isoxazolvl, furanyl, furazanyl, oxazolyl, thiazolyl, thiophenyl, pyrazolyl, triazolyl, and pyrimidinyl.
• bicyclic C 4 -C] 0 heteroaryls include but are not limited to, benzimidazolyl, indolyl, indolmyl, isoquinolinyl, quinolinyl, quinazolinyl, benzothiophenyl, benzodioxolyl, benzojl ,2,5]oxadiazolyl, purinyl, benzisoxazolyl, benzoxazolvl, beiizthiazolyl, benzodiazolvl, beiizotriazolyl, isoiiidolyl and indazoiyL
• Aminocarbonyi refers to the group NC(0)R, wherein R may be alkyl, aryi, or heteroaryl, as defined above.
• Aminosulfonyi refers to the group NS(0) 2 R, wherein R may be alkyl, aiyl, or heteroaryl, as defined above,
• Halo refers to the groups F, CI, or Br.
• Heteroarylalkyl refers to an alkyl group, as defined above, wherein one or more of the alky] group's hydrogen atoms has been replaced with a heteroaryl group as defined above.
• the present invention relates to compositions and methods for the treatment of cancer and autoimmune disease. More specifically, the present invention relates to compositions and methods for treating hematological malignancies.
• hematological malignancies include, for example, Multiple Myeloma, B-cell lymphoma, acute myelogenous leukemia, and chronic lymphocytic leukemia.
• Such treatment results in, for example, tumor regression in a mammal, such as a mouse or a human. Tumor regression can include, for example, killing a cancer cell.
• the invention also relates to compounds of Formulae ⁇ , ⁇ , or III, and pharmaceutical compositions thereof.
• the invention also relates to treating hematological malignancies with a compound of Formulae I, II, or III, and/or a BH3 mimic compound that inhibits a broad range of the Bcl-2 family of proteins, most notably Mcl-1. It is contemplated that the activity against the protein Mcl-lof a compound of Formulae I, IL or III as well as derivative compounds will enable therapeutic utility of these compounds as anti-tumor agents in treating cancer, including blood cancers.
• the invention provides a method for treating particular types of hematopoietic cancers, using a BH3 mimic compound of Formulae I, II, or III.
• the use of these compounds for particular types of hematopoietic cancers may have unexpected results in terms of efficacy and/or ability to inhibit particular anti- apoptotic (pro-survi val) members of the Bcl-2 family or to mimic particular members of the pro-apoptotic Bcl-2 family proteins. Accordingly, hematological tumor cells that are hyper-dependent on a particular member of the Bcl-2 family of proteins may be highly affected by that BH3 mimic which targets that protein.
• a compound Formulae 1, II, or III may be particularly useful in a method of treating hematopoietic cancers, by preferentially inhibiting the binding of the activator BH3 only proteins of the Bcl-2 family to protein Mcl-l .
• the high affinity of these compounds to wards VK ' I .- l (about ⁇ 20 ⁇ ) directs the use of these compounds in treating certain hematological malignancies that are affected principally by the Bcl-2 family proteins and among those proteins, mostly by Mcl-l .
• these compounds may be particularly effective in blocking the unwanted cell survival activity of Mcl-l in tumorogenic lymphoid and myeloid cells.
• This feature of compounds of Formulae I, II, or III will direct their use as a potential therapeutic agents for treating Multiple Myeloma (MM), diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia (CLL), acute myelogenous leukemia (AMI.,), all of which are effected by elevated Mcl-l .
• Similar activity in derivatives of compounds of Formulae I, II, or III may direct the use of those compounds in treating lymphoid and myeloid malignancies,
• This invention also relates to using a compound of Formulae I, II, or III to cause tumor regression and enhance survival in B-celi lymphomas. Accordingly, in one embodiment, this invention describes a method for using a compound of Formulae I, II, or III for the treatment of non-Hodgkin's B-cell lymphoma, including CLL, Burkett's, Indolent and Aggressive non-Hodgkin's lymphomas, Multiple Myelomas, or other cancers that are affected by Bcl-2 family of proteins, and in particular the protein Mcl-l .
• non-Hodgkin's B-cell lymphoma including CLL, Burkett's, Indolent and Aggressive non-Hodgkin's lymphomas, Multiple Myelomas, or other cancers that are affected by Bcl-2 family of proteins, and in particular the protein Mcl-l .
• the invention provides a method for treating particular types of hematopoietic cancers using a combination of one or more compounds of Formulae I, II, or ID, in combination with other therapies, for example, a class of therapeutics known as 26S proteasome inhibitors, in some embodiments, the 26S proteasome inhibitor is Bortezomib (Velcade®), [0098] in addition, this invention relates to methods for determining selectivity of a compound of Formulae I, II, or III and BH3 mimic compounds to predict efficacy in treating hematological and other malignancies involving Bcl-2 family proteins.
• these compounds can have varying potencies in inhibiting BH3 mediated- binding of particular Bcl-2 family proteins, and the difference in potency can be identified by systematically ordering combinations of protein-protein interactions and comparing the blocking activity of BH3 mimic compounds to that of competing BH3 domain-containing peptides.
• a biological activity can be assigned to that compound thai- correlates to the activity of the BH3 domain-containing protein. This information can be used to predict the utility of a BED mimic compounds in treating a particular disease.
• This invention also relates to cancer treatments.
• Multiple Myeloma treatments directed to Bcl-2 and Bcl-xL and Mcl-l and Al and Bcl-w (referred as a group as an anti-apoptotic Bcl-2 family) activity.
• the present invention also relates to determining a cellular state with respect to programmed cell death. This state has been named “primed for death”. In addition to alive and dead states, ceils may be primed for death in that they require tonic aiitiapoptotic function for survival.
• BH3 profiling (Certo, et «/.(2G06) Cancer Cell 9(5): 351-65; Deng, et al. (2007) Cancer Cell. 12(2): 171-85; U.S. Patent Publication No. 2008/0199890, which are hereby incorporated by reference in their entirety).
• This method uses a panel of peptides derived from BH3 domains of BH3-only proteins that selectively antagonize individual BCL-2 family members BCL-2, BCL-XL, BCL-w, MCL-1 and BFL-1. It was shown that cellular "addiction" to individual aiitiapoptotic proteins can be diagnosed based on mitochondrial response to these peptides.
• This panel of peptides is shown in Table ⁇ and are referred to herein as BH3 domain peptides.
• Aiitiapoptotic proteins BCL-2, BCL-XL, MCL-1 , BFL-1 and BCL-w each bear a unique pattern of interaction with this panel of proteins.
• Cellular dependence on an antiapoptotic protein for survival is decoded based on the pattern of mitochondrial sensitivity to this peptide panel. This strategy is called BH3 profiling.
• Table 1 BH3 Domain Peptides
• Mitochondria are probed to determine a cell 's state using this panel of sensitizer BH3 -peptides, selective antagonists of antiapoptotic BCL-2 family members. Mitochondria that are primed for death are dependent on antiapoptotic protein function to prevent mitochondrial outer membrane permeabilization (MOMP), so that they release cytochrome c when exposed to sensitizer BH3 peptides. In contrast, unprimed cells do not release cytochrome c when exposed to sensitizer BH3 peptides. Any ceil from which mitochondria can be isolated can therefore be so tested and categorized as being primed or unprimed.
• MOMP mitochondrial outer membrane permeabilization
• BH3 profiling allows capture of information about a fundamental aspect of cellular physiology. Importantly, mitochondrial behavior is correlated to whole cell behavior in several models, and BH3 profiling revealed a dependence on antiapoptotic proteins only when a cellular dependence was also demonstrated.
• Sensitive cells are "primed for death” with death signals carried by a select subset of proapoptotic proteins of the BCL-2 family.
• Some cancer cells may be tonically primed for death, and thus are selectively susceptible to agents that provoke or mimic sensitizer BH3-only domains. It has been postulated that inhibition of apoptosis is a requirement of oncogenesis (Green and Evan, (2002) Cancer Cell. l(l):19-30.; Hanahan and Weinberg, (2000) Cell.i00(l):57 ⁇ 70, which are hereby incorporated by reference in their entirety). In what may be an attempt to meet this requirement, many types of cancer cells overexpress antiapoptotic BCL-2 family members. Understanding how these proteins function is therefore critical to understanding how cancer cells maintain survival.
• the present invention provides a method for determining the "primed to die” state of a cell without using peptides.
• This method allows the investigation of whether a particular antiapoptotic BCL-2 family member, Mcl-l, controls mitochondrial outer membrane permeabilization (MOMP) and commitment to apoptosis.
• Antiapoptotic proteins show selective affinity for binding BH3 peptides derived from BH3-only proteins.
• Mcl-l binds selectively to the BIB peptide Noxa
• antagonism of Mcl-l by Noxa results in MOMP only when Mcl-l is "primed" with activator BH3 proteins, validating the critical role of activator BH3 domains in activating BAX BAK.
• activator "priming" can be observed following experimentally-induced death signaling, and that such priming confers dependence on antiapoptotic family members.
• the dependence on antiapoptotic BCL-2 family members can be captured functionally by the pattern of mitochondrial sensitivity to sensitizer BH3 domains, and Mcl-l dependence can be identified by sensitivity to Noxa.
• the invention includes methods of determining the sensitivity of a cell to a class of therapeutic agents, Mcl-l inhibitors. This method identifies whether or not a cell is primed for death through an Mcl-I dependent mechanism by measuring mitochondrial sensitivity to the Mcl-1 specific inhibitor compounds of Formula I, II, and III.
• this compound can be used for diagnostic purposes. Response of isolated or in situ cancer cell mitochondria to this compound could indicate a patient being predisposed to treatment with appropriately targeted therapeutic compounds.
• X, Y, Z, Z ⁇ Rj , R 2 , and R3 ⁇ 4 are defined as above for Formula ].
• X is oxygen
• X is aminoalkyl
• X is aminoaryi
• X is aminocarbonyl to form an alkyl carbamate
• X is hydroxyl-substituted aminoalkyl
• Y is CH.
• Y is N.
• Z is C.
• Z is .
• /. " is C.
• Z' is N.
• Hi is null.
• R is alkoxy
• Rj is fluoro
• Ri is chloro
• i is trifluoromethy! .
• R 2 and R 3 are hydrogen.
• R 2 and R 3 are alkyl.
• R 4 , and R 5 are defined as above for Formula II.
• R4 is alkyL
• R 4 is ethyl. [0132] in other embodiments, R 4 is phenyl. [0133] In other embodiments, R 4 is pyridyi. [0134] In some embodiments, R 5 is hydrogen. [0135] In other embodiments, R5 is acetamido. [0136] in other embodiments, R5 is sulfonamide). 101 7] in other embodiments, R 3 is methoxy. [0138] In other embodiments, R 5 is isopropoxy.
• R 4 , and Rj are defined as above for Formula III.
• R is alkyl
• R 4 is ethyl
• R 5 is alkyl
• R is methyl
• R 5 is aminocycioaikyl.
• R 5 is acetamido
• R 5 is isopropoxy
• the present invention describes, in part, anti-tumor efficacy and enhanced survivability in mouse models for hematological malignancies by treatment with a compound of Formulae I, II, or III. Efficacy in certain animal models may be correlated to humans afflicted with B-cell lymphoma or other hematological or non- hematological cancers affected by Bcl-2 family proteins.
• This treatment may be administered as a stand-alone therapy, or with other chemotherapy agents, or with radiation therapy, in one embodiment, a compound of Formulae I, II, or III is used for the treatment of B-cell lymphoma or Multiple myeloma by inducing cancer cell death and preventing cancer cell migration to spleen or lymph nodes.
• Mcl-l has emerged as a key member of the Bcl-2 family of proteins for initiating and maintaining certain myeloid as well as B-cell and T-cell malignancies, it is an important target for treatment of many hematological diseases.
• This invention demonstrates, among others, the effectiveness of a compound of Formulae I, II, or III in inhibiting BH3 binding to Mcl-l .
• these compounds are useful for treating Multiple Myeloma, B-cell lymphoma or other hematological cancers or other disease that are affected by Mcl-l activity including prostate, liver, and ovarian cancers.
• the compounds of Formula I- II I have activity against Mcl-l , therefore the compounds of Formula I- III and/or other BH3 mimic compounds against Mcl-l are useful therapeutic compounds in treating MM, NHL, CLL, AML and prostate, liver, and ovarian cancers, among others.
• This activity will also direct the use of these compounds for treatment of certain autoimmune diseases that are affected by excess B or T cell proliferation.
• the present invention relates to the use of a compound of Formula H O, as compositions in inhibiting the activity of Bcl-2 pro-survival proteins, most particularly Mcl-l, in tumor cells and thereby killing those cells.
• Bcl-2 pro-survival proteins most particularly Mcl-l
• the unique ability of these compounds to inhibit Mcl-l function in ceils will makes these compounds effective anti-B-cell, T-cell, and myeloma cell cancer therapeutics for treating non- Hodgkin's lymphoma, CLL, MM, and AMI., as well as prostate, colon, ovarian, and liver cancer, among other diseases,
• a compound of Formula I-III causes tumor regression, for example by killing a cancer cell, and increased survival in several mouse tumor models, including, for example, models for diffuse large B-cell lymphoma (DLBCL) (Cattoretti, et al. (2005) Cancer Cell 7: 445-55), small B cell lymphoma/CLL (Zapata, et al. (2004) Proc. Natl. Acad. Sci. USA 101(47): 16600-5) and migrating B-cell lymphomas (Refaefi, et al. (3018) Proc. Natl. Acad. Sci.
• DLBCL diffuse large B-cell lymphoma
• CLL small B cell lymphoma/CLL
• migrating B-cell lymphomas Refaefi, et al. (3018) Proc. Natl. Acad. Sci.
• the present invention relates to the use of a compound of Formula I-III, in affecting tumor regression in human lymphoid and myeloid cancers.
• These compounds are effective in inducing apoptosis selectively in hematological cancers due to the hyper-dependence of lymphoid and myeloid-derived tumor ceils on the activi ty of the Bcl-2 family anti-apoptotic proteins.
• the Bcl-2 protein is a member of an entire family, the Bcl-2 family of proteins, that have structurally similar genes and that share sequence homology and participate in the control of programmed cell death or "apoptosis" (Corey, et al. (2002) Nat. Rev. Cancer 2: 647-656). Some members of this family (anti-apoptotic Bcl-2 family proteins), such as Bcl-2 Bcl-xL, BcL-w, Bfl-l(Al) and Mcl-1, protect cells from apoptosis. These proteins share sequence homology in four a-helical regions called the Bcl-2 homology (BH)-domains 1-4 (BH1 - BH4).
• BH Bcl-2 homology
• Another class of this family (pro-apoptotic Bcl-2 proteins), such as Bax and Bak, promote apoptosis and share three of these domains, BH1 - BIB.
• a third class of Bcl-2 family proteins such as Bim, Bad, Hrk, Bid, Puma, Noxa, and Bmf, share only one region, the BH3 domain, and are referred to as "BH3-only proteins."
• the BH3-only proteins are pro- apoptotic, and like Bax and Bak, the BH3-only proteins require an intact BH3 domain to promote apoptosis (Adams, et al. (1998) Science 281: 1322-26).
• a complex interplay of the pro-apoptotic and anti-apoptotic proteins affects the integrity of the outer membrane of the mitochondria (Green, et al. (2004) Science 305: 626-29) either causing or preventing the release of certain molecules that activate the cystein aspartyl proteases (caspases).
• the caspases are the eventual effectors of apoptosis (Salvesen (2002) Cell Death and Differentiation 9: 3-5).
• Bax and Bak are essentia! for release of these apoptosis promoting molecules from the mitochondria (Wei, et al. (2001 ) Science 292: 727-30).
• the BH3-only proteins stimulate the activity of Bax and Bak while the anti-apoptotic proteins oppose their activity. Essentially ail of these interactions occur by BH3 domain mediated binding (Chrittenden, et al. (1995) EMBO J. 14: 5589-96).
• Anti-apoptotic family members Bci-2, Bcl-xL and Mcl-1 are over-expressed in many types of cancers, including lymphomas, melanomas, myelomas, and cancer in the prostate and colon ( itada, et al, (2002) Oncogene 21 : 3459-74; Paul-Samojedny, et al. (2005) Bioehem. Biophys. Acta. 1741(1-2): 25-29; Pollack, et al. (2003) Cancer 97(7): 1630-8; Tas, et al. (2004) Melanoma Res. 14(6): 543-6). Animal model studies established that the continuous presence of anti-apoptotic family members is required for tumor survival and growth.
• the pro-survival Bcl-2 proteins are important for the deveiopnient of resistance of tumor cel ls to chemotherapies such as DNA damaging agents.
• the ratio of pro-apoptotic to anti-apoptotic family members has been shown in many cases to hold significant prognostic value for patient outcome.
• Over-expression of anti-apoptotic Bcl-2 family proteins has been reported in many of the hematopoietic malignancies. For example, increased expression of Bcl-2 protein that results from a translocation (tl4; 18) of the BCL2 gene occurs in 80% to 90% of low-grade follicular non-Hodgkin lymphomas (NH Ls) (Kitada, et al. (2002) supra).
• Three different strategies for countering the tumorigenic effects of anti- apoptotic Bcl-2 family proteins in NH L, CLE, MM, and other types of cancer include: (1) inhibiting gene transcription; (2) using antisense oligonucleotides to cause mRNA degradation; and (3) directly inhibiting the proteins with small-molecule drugs (reviewed in Reed, et al. (2005) Blood 106: 408-418).
• One of the desired characteristics of anti-tumor drugs is the ability to induce apoptosis in tumor cells and not in healthy cells.
• Conventional chemotherapy is mostly based on the evidence that proliferating cells are more sensitive to anticancer agents than non-dividing cells (Marehini, et al. (2004) Curr. Med. ( hem. Anticancer Agents 4(3): 247-6).
• tumor cells are generally more sensitive to apoptosis induction by microtubule poisons such as taxol and DNA-damaging drugs such as doxorubicin, than healthy ceils (Abal, et al. (2003) Curr. Cancer Dnig Targets 3(3): 193-203).
• mice deficient in Bcl-2 have no overt problems during lymphocyte differentiation but do have excess apoptosis in peripheral lymphocytes after antigenic stimuli (Veis, et al. (1993) Cell 75: 229, which is hereby incorporated by reference in its entirety).
• Bcl-xL deficient mice are also viable but do show late maturation of erythroid cells (Wagner, et al. (2000) Development 127: 4949-58, which is hereby incorporated by reference in its entirety).
• Mcl-1 deficiency has a pronounced, perhaps principal role in lymphocyte survival.
• Conditional knockouts have been used to determine the role of Mcl-1 in hematopoiesis and lymphocyte survival.
• Conditional deficiency of Mcl-1 results in apoptosis of differentiating lymphocytes and stops development of pre-B-cell and double negative T-cells as well as apoptosis in mature B and T lymphocytes (Rinkenberger, et al. (2000) Genes Dev. 14: 23, which is hereby incorporated by reference in its entirety).
• the anti-apoptotie form of Mcl-1 plays a role in the development and survival of B and T lymphocytes, and may be an ideal target for treating excess growth of lymphoid ceils.
• Targeted gene knockouts for different pro-apoptotic Bf 13 -only members of the Bcl-2 family members have been assessed for disease correlation.
• Transgenic mice deficient in Bim have extensive myeloid proliferation and autoreactive T and B cells that have lost responsiveness to apoptosis inducing drugs (Bouillet, et al. (1999) Science 286: 1735-38, which is hereby incorporated by reference in its entirety), while mice deficient in Bad display high incidence of diffuse large cell lymphoma (Ranger, et al (2003) Proc. Natl. Acad. Sci. USA 100: 9324-29, which is hereby incorporated by reference in its entirety).
• conditional knockouts of the Mcl-1 gene caused profound reduction in B and T lymphocytes (Opferman, et al (2003) Nature 426(6967): 671-6, which is hereby incorporated by reference in its entirety), which is the opposite of a deficiency in the BH3-only protein Bim and in keeping with the understanding that Mcl-1 selectively inhibits the pro-apoptotic protein Bim.
• Embodiments of the present invention also include the combination of one or more compounds of Formulae I, II, or OI with other anti-tumor agents, such as proteasome inhibitors, to yield combination therapies.
• these combination therapies may yield synergistic results as compared to the additive results of the component therapies when used alone.
• these compounds may be particularly effective when used in combination with a class of therapeutics known as 26S proteasome inhibitors.
• Mcl-1 Unwanted side effect of elevated Mcl-1 can be rectified by inhibiting Mcl-1 using the compounds of formula Formulae I, II, or III, and that these compounds will have utility in potentiating the effect of Bortezomib or other 26S proteasome inhibitors as anti-tumor therapeutics.
• proteasome inhibitors exhibit anti-tumor activity against malignancies of different histology.
• the rationale for looking at proteasome inhibitors as cancer therapeutics comes from the understanding that NF-kB is blocked by IkB which, following phosphorylation and ubiquination, is degraded in the 26S proteasome (Li, et al. (1995) supra, which is hereby incorporated by reference in its entirety).
• NF-kB translocates to the nucleus where it functions as a transcription factor
• NF-kB acti vates transcription of growth-promoting genes such as the interieukms as well as anti-apoptosis protein LAP and Bei-2 (Wang, (1998) Science 281; 1680-83; Fahy, (2005) Cancer Chemother. Pharmacol. 56(1): 46-54, which are hereby incorporated by reference in their entirety).
• Blocking the 26S proteasome and degradation of ⁇ - ⁇ then becomes an approach for inhibiting the growth-promoting and anti-apoptotic effects of NF-KB.
• proteasome inhibitor Bortezomib or PS-341 or Velcade ⁇ (Hideshirna, et al. (2001) Cancer Res. 61 : 3071 -76, which is hereby incorporated by reference in its entirety) has a more pronounced effect on human multiple myeloma compared to peripheral -blood mononuclear cells.
• Another proteasome inhibitor MG-132 demonstrates preferential killing of acute mylogenous leukemia (AML) cells over normal CD34+ cells (Guzman, et al. (2002) Proc. Natl. Acad. Sci. 99: 16220-25, which is hereby incorporated by reference in its entirety).
• MG-132 compound is in pre-ciinical studies while MLN-519, a lactacystin synthetic derivative, in phase 1 clinical trials.
• the therapeutic Bortezomib (Velcade®; Millennium Pharmaceuticals, and Johnson & Johnson Pharmaceutical Research & Development) has been approved for use in treatment of multiple myeloma. Introduced in the U.S.
• Velcade provides an improvement in MM therapy, and is approved as a first line therapy in combination with oral melphalan and prednisone, Velcade is now widely prescribed in combination with dexamethasone (Doxil, Adriamycin) or with dexamethasone and the thalidamide drugs Revlicade (lenoiidomide) and Thaiidomid (thalidomide), the so-called RVD treatment.
• dexamethasone Doxil, Adriamycin
• dexamethasone and the thalidamide drugs Revlicade (lenoiidomide) and Thaiidomid (thalidomide) the so-called RVD treatment.
• Mcl-1 may counteract Bortezomib (Velcade®) in CLL, AML and certain NHL cells. Consistent with this, the cytotoxic effects of proteasome inhibitors are enhanced when Mcl-1 levels are contained at normal levels or reduced in a cell culture (Nencioni, et al. (2005) supra, which is hereby incorporated by reference in its entirety). This finding demonstrated that Mcl- 1 accumulation is an unwanted molecular consequence of exposure to proteasome inhibitors.
• the present invention also teaches a method for selecting appropriate BH3 mimic compounds in treating particular tumors. This selection is based on an understanding of the unique activity of compounds of Formulae I, II, or HI to mimic particular BH3 domains. Compounds from this group that have unique activity against either all of the anti-apoptotic Bcl-2 family proteins or a particular member of this family of proteins are useful against particular tumors. Expression levels of particular Bcl-2 family proteins can be assessed using standard assays, such as western blot or immunohisto logical staining of biopsied tumor tissue. Following this assessment, compounds with activity against the elevated proteins in the tumor sample will be selected as an appropriate therapeutic for treating that tumor.
• BH3 mimic compounds that do inhibit Mcl-1 will become important second line therapy for CLL given that tumor ceils from patients who relapse from the current front line therapy Rituxan display high Mcl-1 to Bax ratio, (Bannerji, et al (2003) J. Clin. Oncol, 21 (8): 1466-71 , which is hereby incorporated by reference in its entirety).
• Inhibition of Mcl-1 activity by a compound of Formula I-III, or other BH3 mimic compounds will qualif those compounds as front line therapeutics against MM, CLL, AML, ALL, and NHL as well as prostate, liver, and ovarian cancers and other malignancies that are affected by elevated Mcl-1.
• the present invention also teaches a method for determining selective activity of a BH3 mimic compound against the Bcl-2 family proteins. This method also uses this information to predict efficacy of a selective BH3 mimic compound in treating certain hematological malignancies that are defined by expression levels of Bcl-2 family proteins. Specific activity against such disease-profiled Bcl-2 family proteins is predicted to have the best anti-tumor activity and lowest toxicity against the non- tumor cells in the treated organism.
• BH3 mimic compounds can compare the blocking activity of BH3 mimic compounds to particular BH3 domain-containing peptides.
• the activity is the ability to block binding of certain BH3 domain-containing Be 1-2 proteins.
• BH3 mimic compounds and particular Bi:B -co taming peptides are assessed for patterns of activity in inhibiting particular BH3 mediated protein/protein interactions. Patterns of activity are charted and an algorithm is used to determine overlap between the activity of certain BIB peptides and certain BH3 mimic compounds. The ability to mimic particular BH3 domains is determined.
• a compound that mimics a BH3 domain of a particular Bcl-2 family protein with a given physiological role will replicate the role of that particular BH3- containing protein, in a disease state where that protein is known to have impaired function, the compound would replace that particular function.
• BH3-only proteins have been identified as having a "sensitizing" function compared to the BH3 protein Bid which has an "'effector” function in causing cell death (Letai, (2005) J. Clin. Invest. 115: 2648-2655, which is hereby incorporated by reference in its entirety).
• BH3-only proteins have distinct roles in maintaining the healthy organism.
• the BID -only protein Bim is required for thymocyte killing in response to negative selection signals. Bim function is essential for the maintenance of the healthy thymocyte population.
• Bim recognizes cues such as cytoskeletal abnormalities while binding to the micro tubule- associated dynein motor complex (Puthalakath, et al. ( 1999) Mol Cell. 3(3): 287-96, which is hereby incorporated by reference in its entirety).
• the sensing mechanism and the role that this BH3 protein plays are unique among all of the other BH3-only proteins.
• BFB-oiily proteins have distinct roles in targeting particular members of the multi-domain Bcl-2 protein.
• the binding specificity of the various BID domains to particular multi-domain Bcl-2 family proteins can affect disease outcome.
• An example is the BH3-only protein Noxa that is highly selective for binding to Mcl-1 and not other Bci-2 family proteins (Chen, et al. (2005) Mol Cell. 17(3): 393-403, which is hereby incorporated by reference in its entirety).
• the pro-apoptotic protein Bak is activated through Noxa-dependent displacement from Mcl-1 (Willis, et al. (2005) Genes & Dev. 19(1 1): 1294-305, which is hereby incorporated by reference in its entirety).
• Noxa becomes a more significant death effector protein in the context of a high Mcl-1 background, such as in lymphocytes and myeloid cells under certain conditions. Aberrant control of these interactions leads to lyphomagenesis and myeloid cancer.
• the BH3-only protein Puma is up-regulated, by the oncogene p53 and is strongly implicated in lymphomagenesis (Hemann, et al. (2004) Proc. Natl. Acad. Sci. USA. 101 : 9333-38, which is hereby incorporated by reference in its entirety). Deficiency in p53 activity causes tumor formation. Expression of Puma in certain lymphoid cell background suppresses such p53 deficiency mediated tumorigenesis (Bemann, et al (2004) Proc. Natl. Acad. Sci. USA 101 : 9333-38, which is hereby incorporated by reference in its entirety).
• the invention teaches that selection of a BH3 mimic compound that matches the binding inhibition activity pattern of the Noxa BH3 domain peptide will result in a Noxa BH3 specific mimic. This compound will then be useful in affecting diseases that involve the Noxa-Mcl-1 interaction. These disease indications that would be served by such a compound/therapeutic include NHL, CLL, AML and ALL.
• a BH3 mimic compound that selectively mimics the Puma BH3 domain would suppress tumors resulting from certain types of p53 deficiency by restoring deficient response to DNA damage-mediated apoptotic signals.
• Bim BH3 mimic compound is predicted to have selective efficacy against T-eells that have lost responsiveness to negative selection as happens in certain autoimmune disease or thymocyte malignancies.
• Such a BH3 mimic would provide an effective anti-autoimmune disease therapeutic for treatment of diseases such as Type I diabetes, rheumatoid arthritis, multiple sclerosis, myasthenia gravis, psoriasis, lupus, inflammatory bowel disease, and other diseases.
• BH3-only protem Bad has been described as a sensitizing BH3 protein, unlike Bid or Bim that are effector BH3 proteins, capable of directly activating Bax or Bak and killing cells. It is therefore, likely that mimetic compounds that selectively mimic Bad may have less toxicity than that which mimics the BH3 protein Bid and therefore will be well suited as a general anti-tumor therapeutic.
• the invention also teaches a method for recognizing small molecules that function to mimic distinct members of the BH3 domain containing family of proteins and in doing so, recognize small molecules more likely to become effective drug candidates.
• a compound of Formulae I, II, or III can be administered by any known administration method known to a person skilled in the art.
• routes of administration include but are not limited to oral, parenteral, intraperitoneal, intravenous, intraarterial, transdermal, topical, sublingual, intramuscular, rectal, transbuceal, intranasal, liposomal, via inhalation, vaginal, intraoccular, via local delivery by catheter or stent, subcutaneous, intraadiposal, intraarticular, intrathecal, or in a controlled or extended release dosage form.
• a compound of Formulae I, II, or III can be administered in accordance with any dose and dosing schedule that achieves a dose effective to treat disease.
• the route of administration of a compound of Formulae I, II, or DI can be independent of the route of administration of any additional anti-cancer agents that are used.
• Either at least one of the compounds of Formulae I, II, or III or another compound can be administered, for example, orally, parenterally, intraperitoneally, intravenously, mtraarterially, transdermally, sublingually, intramuscularly, rectally, transbuccalty, mtranasally, liposomaliy, via inhalation, vaginally, intraoccula iy, via local delivery by catheter or stent, subcutaneously, intraadiposaliy, mtraarticularly, intrathecal iy, or in a control led or extended release dosage form.
• a compound of the invention can be administered in oral forms, for example, as tablets, capsules (each of which includes sustained release or timed release formulations), pills, powders, granules, elixirs, tinctures, suspensions, syrups, and emulsions.
• a compound can be administered by intravenous (e.g., bolus or infusion), intraperitoneal, subcutaneous, intramuscular, or other routes using forms well known to those of ordinary skill in the pharmaceutical arts. Particularly useful routes of administration of a compound are oral administration and intravenous delivery.
• a compound can also be administered in the form of a depot injection or implant preparation, which may be formulated in such a manner as to permit a sustained release of the active ingredient.
• the active ingredient can be compressed into pellets or small cylinders and implanted subcutaneously or intramuscularly as depot injections or implants.
• Implants may employ inert materials such as biodegradabie polymers or synthetic silicones, for example, Silastic, silicone rubber or other polymers manufactured by the Dow-Corning Corporation.
• a compound can also be administered in the form of liposome delivery systems, such as small unilamel lar vesicles, large unilamellar vesicles and multilamellar vesicles.
• Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine, or phosphatidylcholines. Liposome versions of a compound may be used to increase tolerance to the agents.
• a compound can also be delivered by the use of monoclonal antibodies as individual carriers to which the compound molecules are coupled.
• a compound can also be prepared with soluble polymers as targetable drug carriers.
• soluble polymers can include polyvinlypyrrolidone, pyran copolymer, polyhydroxy-propyl-memacrylamide-phenol, polyhydroxyethyl-aspartamide-phenol, or poiyethyleiieoxide-polyiysine substituted with palmitoyl residues.
• a compound can be prepared with biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, poiygiycolic acid, copolymers of polylactic and poiygiycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, poiyorthoesters, polyacetais, polydihydropyrans, poiycyanoacrylates and cross linked or arnphipathic block copolymers of hydrogels.
• biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, poiygiycolic acid, copolymers of polylactic and poiygiycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, poiyorthoesters, polyacetais, polydihydropyrans, poiycyanoacrylates and cross linked or arnphipathic block copolymers of hydrogels.
• a compound in a specific embodiment, can be administered orally in a gelatin capsule, which can comprise excipients such as microcrystailine cellulose, croscarmellose sodium and magnesium stearate.
• excipients such as microcrystailine cellulose, croscarmellose sodium and magnesium stearate.
• an embodiment can include 200 mg of solid compound with 89.5 mg of microcrystailine cellulose, 9 mg of sodium croscarmellose, and 1.5 mg of magnesium stearate contained in a gelatin capsule.
• the dosage regimen utilizing a compound of Formulae I, II, or III can be selected in accordance with a variety of factors including type, species, age, weight, and sex of the patient; the type of disease being treated; the severity (e.g., stage) of the disease to be treated; the route of administration; the renal and hepatic function of the patient; and the particular compound or salt thereof employed, among others.
• a dosage regimen can be used, for example, to prevent, inhibit (ful ly or partially), or arrest the progress of the disease.
• a compound of Formulae ⁇ , II, or III can be administered by continuous or intermittent dosages.
• intermittent administration of a compound of Formulae I, II, or III may be administered one to six days per week or it may be administered in cycles with rest periods in between the cycles (e.g., daily administration for two to eight consecutive weeks, then a rest period with no administration for up to one week between treatments) or it may be administered on alternate days.
• a compound of Formula I, II, or III can be administered in a total daily dose of up to about 800 mg.
• a compound of Formiilae II, or III can be administered once daily (QD), or divided into multiple daily doses such as twice daily (BID), and three times daily ( ⁇ ⁇ 3).
• a compound of Formulae I, II, or III can be administered at a total daily dosage of up to about 800 mg, for example, about 200 mg, about 300 mg, about 400 mg, about 600 mg, or about 800 mg, which can be administered in one daily dose or can be divided into multiple daily doses as described above.
• the administration is oral or by intravenous delivery.
• the compound is administered once daily at a dose of about 200- about 600 mg. In another embodiment, the compound is administered twice daily at a dose of about 200- about 400 mg. In another embodiment, the compound is administered twice daily at a dose of about 200- about 400 mg intermittently, for example three, four or five days per week. In one embodiment, the daily dose is about 200 mg which can be administered once-daily, twice-daily or three-times daily. In one embodiment, the dai ly dose is about 300 mg which can be administered once-daily, twice-daily or three-times daily. In one embodiment, the daily dose is about 400 mg which can be administered once-dai ly, twice-daily or three-times daily.
• a compound of Formulae I, II, or III can be administered in accordance with any dose and dosing schedule that achieves a dose effective to treat cancer.
• Each compound can be administered in a total daily dose that may vary from patient to patient, and may be administered at varying dosage schedules.
• a compound of the invention can be administered to the patient at a total daily dosage of between about 25-about 4000 nig/m 2 .
• a compound of Forniii!ae I, II, or III can be administered in a total daily dose of up to about 800 mg, including by oral or intravenous administration, once, twice or three times daily, continuously (every day) or intermittently (e.g., 3-5 days a week).
• the administration can be continuous, e.g., every day, or intermittently.
• a compound of Formulae I, II, or III may be administered according to any of the schedules described above, consecutively for a few weeks, followed by a rest period.
• the patient can receive intravenously or subcutaneously compounds of Formulae I, M, or 10 in quantities sufficient to deliver between about 3-1500 mg/m 2 per day, for example, about 3, about 30, about 60, about 90, about 180, about 300, about 600, about 900, about 1200 or about 1500 mg/m ' per day.
• Such quantities may be administered in a number of suitable ways, e.g. large volumes of low conce trations of the compounds of Formulae I, II, or III can be used during one extended period of time or several times a day.
• the quantities can be administered for one or more consecutive days, intermittent days or a combination thereof per week (7 day period).
• low volumes of high concentrations of the compounds of Formulae I, II, or III can be used during a short period of time, e.g. once a day for one or more days either consecutively, intermittently or a combination thereof per week (7 day period).
• a dose of about 300 mg/m /' per day can be administered for 5 consecutive days for a total of about 1500 mg/iTf per treatment.
• the number of consecutive days can also be 5, with treatment lasting for 2 or 3 consecutive weeks for a total of about 3000 mg/m 2 or about 4500 mg/m' : total treatment.
• An intravenous formulation may be prepared which contains a concentration of a compound of Formulae I, D, or III of between about 1.0 mg/mL to about 10 mg/mL, e.g. about 2.0 mg/mL, about 3.0 mg/mL, about 4.0 mg/mL, about 5.0 mg/mL, about 6.0 mg/mL, about 7.0 mg/mL, about 8.0 mg/mL, about 9.0 mg/mL and about 10 mg/mL and admmistered in amounts to achieve the doses described above.
• a sufficient volume of intravenous formulation can be administered to a patient in a day such that the total dose for the day is between about 300 and about 1500 mg/m 2 .
• Subcutaneous formulations can be prepared according to procedures well known in the art at a pH in the range between about 5 and about 12, which include suitable buffers and are tonicity agents, as described below. They can be formulated to deliver a daily dose of any of compounds of Formulae ⁇ , II, or HI in one or more daily subcutaneous administrations, for example, one, two or three times each day.
• any one or more of the specific dosages and dosage schedules of a compound of Formulae I, II, or III are also applicable to any one or more of the anti-cancer agents to be used in a combination treatment.
• the specific dosage and dosage schedule of a compound of Formulae I, II, or III can further vary, and the optimal dose, dosing schedule, and route of admmistration can be determined based upon the specific drug combination that is being used.
• the various modes of administration, dosages, and dosing schedules described herein merely set forth specific embodiments and should not be construed as limiting the broad scope of the invention. Any permutations, variations, and combinations of the dosages and dosing schedules are included within the scope of the present invention.
• an "effective amount" of a compound of Formulae I, II, or 01 is the quantity which, when administered to a subject having a disease or disorder, results in regression of the disease or disorder in the subject.
• an effective amount of a compound of the disclosed invention is the quantity which, when administered to a subject having a cell proliferation disorder, results in, for example, regression of cell growth or cell death in a subject.
• the amount of the disclosed compound to be administered to a subject will depend on the particular disorder, the mode of administration, co-administered compounds, if any, and the characteristics of the subject, such as general health, other diseases, age, sex, genotype, body weight and tolerance to drugs. The skilled artisan will be able to determine appropriate dosages depending on these and other factors.
• an effective amount refers to an amount of a compound, or a combination of compounds, of the present invention effective when administered alone or in combination as an anti-proliferative agent.
• an effective amount refers to an amount of the compound present in a formulation or on a medical device given to a recipient patient or subject sufficient to elicit biological activity, for example, anti-proliferative activity, such as for example, anti-cancer activity or anti-neop astie activity.
• the combination of compounds optional!)' is a synergistic combination. Synergy, as described, for example, by Chou and Talalay, (1984) Adv.
• Enzyme Regul, 22; 27-55 which is hereby incorporated by reference in its entirety, occurs when the effect of the compounds when administered in combination is greater than the additive effect of the compounds when administered alone as a single agent.
• a synergistic effect is most clearly demonstrated at sub-optimal concentrations of the compounds. Synergy can be in terms of lower cytotoxicity, or increased anti-proliferative effect, or some other beneficial effect of the combination compared with the individual components.
• a “therapeutically effective amount” means the amount of a compound that, when administered to a mammal for treating a disease, is sufficient to effect such treatment for the disease.
• the “therapeutically effective amount” will vary depending on the compound, the disease and its severity and the age, weight, etc., of the mammal to be treated.
• a therapeutically effective amount of one or more of a compound can be formulated with a pharmaceutically acceptable carrier for administration to a human or an animal. Accordingly, a compound or a formulation can be administered, for example, via oral, parenteral, or topical routes, to provide an effective amount of the compound.
• a compound is prepared in accordance with the present invention can be used to coat or impregnate a medical device, e.g., a stent.
• prophylactically effective amount means an effective amount of a compound or compounds, of the present invention that is administered to prevent or reduce the risk of unwanted cellular proliferation.
• pharmacological effect encompasses effects produced in the subject that achieve the intended purpose of a therapy.
• a pharmacological effect means that primary indications of the subject being treated are prevented, alleviated, or reduced.
• a pharmacological effect would be one that results in the prevention, alleviation or reduction of primary indications in a treated subject.
• a pharmacological effect means that disorders or symptoms of the primary indications of the subject being treated are prevented, alleviated, or reduced.
• a pharmacological effect would be one that results in the prevention or reduction of primary indications in a treated subject.
• a "pharmaceutical composition” is a formulation containing a compound of Formulae I, II, or HI in a form suitable for administration to a subject.
• the pharmaceutical composition is in bulk or in unit dosage form.
• the unit dosage form is any of a variety of forms, including, for example, a capsule, an IV bag, a tablet, a single pump on an aerosol inhaler, or a vial.
• the quantity of active ingredient (e.g., a formulation of the compound or salt, hydrate, solvate, or isomer thereof) in a unit dose of composition is an effective amount and is varied according to the particular treatment involved.
• active ingredient e.g., a formulation of the compound or salt, hydrate, solvate, or isomer thereof
• the dosage will also depend on the route of administration.
• routes of administration A variety of routes are contemplated, including oral, pulmonary, rectal, parenteral, transdermal, subcutaneous, intravenous, intramuscular, intraperitoneal, inhalational, buccal, sublingual, intrapleural, intrathecal, intranasal, and the li ke.
• Dosage forms for the topical or transdermal administration of a compound of this invention include powders, sprays, ointments, pastes, creams, lotions, gels, solutions, patches and inhalants.
• the active compound is mixed under sterile conditions with a pharmaceutically acceptable carrier, and with any preservatives, buffers, or propellants that are required.
• the phrase "pharmaceutically acceptable” refers to those compounds, materials, compositions, carriers, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
• “Pharmaceutical ly acceptable excipient” means an excipient that is useful in preparing a pharmaceutical composition that is generally safe, non-toxic and neither biologically nor otherwise undesirable, and includes excipient that is acceptable for veterinary use as well as human pharmaceutical use.
• a “pharmaceutically acceptable excipient” ca include both one and more than one such excipient.
• a compound of Formulae ⁇ , II, or 10 is capable of further forming salts. Al l of these forms are also contemplated within the scope of the claimed invention,
• “Pharmaceutically acceptable salt” of a compound means a salt that is pharmaceutically acceptable and that possesses the desired pharmacological activity of the parent compound.
• “pharmaceutically acceptable salts” refer to derivatives of the disclosed compounds wherein the parent compound is modified by making acid or base salts thereof.
• Examples of pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic residues such as amines, alkali or organic salts of acidic residues such as carboxyiic acids, and the like.
• the pharmaceutically acceptable salts include the conventional non-toxic salts or the quaternary ammonium salts of the parent compound formed, for example, from nontoxic inorganic or organic acids.
• such conventional non-toxic salts include, but are not limited to, those derived from inorganic and organic acids selected from 2-acetoxybenzoic, 2-hydroxyethane sulfonic, acetic, ascorbic, benzene sulfonic, benzoic, bicarbonic, carbonic, citric, edetic, ethane disulfonic, 1,2-ethane sulfonic, fumaric, giucoheptonic, gluconic, glutamic, glycoiic, giycollyarsanilic, hexylresorcinic, hydrabamic, hydrohromic, hydrochloric, hydroiodic, hydroxymaleic, hydroxynaphthoic, isethionic, lactic, lactobionic, lauryl sulfonic, maleic, malic, mandelic, methane sulfonic, napsylic, nitric, oxalic, pamoic, pantothenic, phen
• Other examples include hexanoic acid, cvclopentane propionic acid, pyruvic acid, malonic acid, 3-(4-hydroxybenzoyl)benzoic acid, cinnamic acid, 4- chlorobenzenesuifonic acid, 2-naphthalenesulfonic acid, 4-toluenesulfonic acid, camphorsulfonic acid, 4-methylbicyclo-[2.2, 2]-oct-2-ene-l -carboxyiic acid, 3- phenylpropionic acid, trimethylacetic acid, tertiary butvlacetic acid, muconic acid, and the like.
• the invention also encompasses salts formed when an acidic proton present in the parent compound either is replaced by a metal ion, e.g., an alkali metal ion, an alkaline earth ion, or an aluminum ion; or coordinates with an organic base such as ethano [amine, diethanolamine, triethanol amine, tromethamine, N- methylglucamine, and the like.
• ail references to pharmaceutically acceptable salts include solvent addition forms (solvates) or crystal forms (polymorphs) as defined herein, of the same sal t,
• the pharmaceutically acceptable salts of a compound of Formulae I, II, or 10 can be synthesized from a parent compound that contains a basic or acidic moiety by conventional chemical methods. Generally, such salts can be prepared by reacting the free acid or base forms of these compounds with a stoichiometric amount of the appropriate base or acid in water or in an organic solvent, or in a mixture of the two; generally, non-aqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile may be used. Lists of suitable salts are found in Remington 's Pharmaceutical Sciences, 18th ed. (Mack Publishing Company, 1990). For example, salts can include, but are not limited to, the hydrochloride and acetate salts of the aliphatic amine-containing, hydroxyl amine-containing and imine-containing compound s of the present inv ention.
• a compound of Formulae I, II, or OI can also be prepared as esters, for example pharmaceutically acceptable esters.
• esters for example pharmaceutically acceptable esters.
• a carboxylie acid functional group in a compound can be converted to its corresponding ester, e.g., a methyl, ethyl, or other ester.
• an alcohol group in a compound can be converted to its corresponding ester, e.g. , an acetate, propionate, or other ester.
• a compound of Formulae I, ⁇ , or OI can also be prepared as prodrugs, for example pharmaceutically acceptable prodrugs.
• pro-drug and “prodrug” are used interchangeably herein and refer to any compound that releases an active parent drag in vivo. Since prodrugs are known to enhance numerous desirable qualities of pharmaceuticals (e.g., solubility, bioavailability, manufacturing, etc.) a compound of the present invention can be delivered in prodrug form. Thus, the present invention is intended to cover prodrugs of the presently claimed compounds, methods of delivering the same and compositions containing the same.
• Prodrugs are intended to include any covalently bonded carriers that release an active parent drug of the present invention in vivo when such prodrug is administered to a subject.
• Prodrugs of the present invention are prepared by modifying functional groups present in the compound in such a way that the modifications are cleaved, either in routine manipulation or in vivo, to the parent compound.
• Prodrugs include compounds of the present invention wherein a hydroxy!, amino, sulfhydryl, carboxyl, or carbonyl group is bonded to any group that may be cleaved in vivo to form a free hydroxyl, free amino, free sulfhydryi, free carboxyi or free carbonyl group, respectively.
• prodrugs include, but are not limited to, esters (e.g., acetate, diaikyiaminoacetates, formates, phosphates, sulfates, and benzoate derivatives) and carbamates (e.g., ⁇ , ⁇ -dimethylaniinocarbonyl) of hydroxyl functional groups, ester groups (e.g. ethyl esters, morpholinoethanol esters) of carboxyi functional groups, N- acyl derivatives (e.g.
• N-acetyl N-Mannich bases, Schiff bases and enaminones of amino functional groups, oximes, acetals, ketals and enol esters of ketone and aldehyde functional groups in compounds of the invention including compounds of Formulae I, II, or III or derivatives, and the like, (.see, Bundegaard, "Design of Prodrugs” pgs. 1 -92, Elesevier, New York-Oxford (1985), which is hereby incorporated by reference in its entirety).
• "'Combination therapy” includes the administration of a compound of Formulae I, II, or III and at least a second agent as part of a specific treatment regimen intended to provide the remedii al effect from the co-action of these therapeutic agents.
• the beneficial effect of the combination includes, but is not limited to, pharmacokinetic or pharmacodynamic co-action resulting from the combination of therapeutic agents.
• Administration of these therapeutic agents in combination typically is carried out over a defined time period (usually minutes, hours, days or weeks, depending upon the combination selected).
• “Combination therapy” may, but generally is not, intended to encompass the administration of two or more of these therapeutic agents as part of separate monotherapy regimens that incidentally and arbitrarily result in the combinations of the present invention.
• Combination therapy is intended to embrace administration of these therapeutic agents in a sequential manner, that is, wherein each therapeutic agent is administered at a different time, as well as administration of these therapeutic agents, or at least two of the therapeutic agents, in a substantially simultaneous manner.
• Substantially simultaneous administration can be accomplished, for example, by administering to the subject a single capsule having a fixed ratio of each therapeutic agent or in multiple, single capsules for each of the therapeutic agents.
• Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues.
• the therapeutic agents can be administered by the same route or by different routes.
• a first therapeutic agent of the combination selected may be administered by intravenous injection while the other therapeutic agents of the combination may be administered orally.
• all therapeutic agents may be administered orally or all therapeutic agents may be administered by intravenous injection.
• the sequence in which the therapeutic agents are administered is not narrowly critical.
• Combination therapy also embraces the administration of the therapeutic agents as described above in further combination with other biologically active ingredients and non-drug therapies (e.g., surgery or radiation treatment).
• the combination therapy further comprises a non-drug treatment
• the non-drug treatment may be conducted at any suitable time so long as a beneficial effect from the co- action of the combination of the therapeutic agents and non-drug treatment is achieved.
• the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, perhaps by days or even weeks.
• compositions are described as having, including, or comprising specific components, it is contemplated that compositions also consist essentially of, or consist of, the recited components.
• processes are described as having, including, or comprising specific process steps, the processes also consist essentially of, or consist of, the recited processing steps.
• order of steps or order for performing certain actions are immaterial so long as the invention remains operable.
• two or more steps or actions may be conducted simultaneously.
• a compound of Formulae I, II, or III, or pharmaceutical ly acceptable salts thereof can be administered orally, nasally, transdermaily, pulmonary, inhalationally, buccaily, sublingually, intraperintoneal ly, subcutaneously, intramuscularly, intravenously, rectally, intrapleuraliy, intrathecaily and parenterally. in certain embodiments, the compound is administered orally.
• One skilled in the art will recognize the advantages of certain routes of administration.
• the dosage regimen utilizing the a compound is selected in accordance with a variety of factors including type, species, age, weight, sex and medical condition of the patient; the severity of the condition to be treated; the route of administration; the renal and hepatic function of the patient; and the particular compound or salt thereof employed.
• An ordinarily skilled physician or veterinarian can readily determine and prescribe the effective amount of the drug required to prevent, counter or arrest the progress of the condition,
• the compounds described herein, and the pharmaceutically acceptable salts thereof are used in pharmaceutical preparations in combination with a pharmaceutically acceptable carrier or diluent.
• Suitable pharmaceutically acceptable carriers include inert solid fillers or diluents and sterile aqueous or organic solutions. The compounds will be present in such pharmaceutical compositions in amounts sufficient to provide the desired dosage amount in the range described herein.
• a compound of Formulae I, O, or III are prepared for oral administration, wherein the disclosed compounds or salts thereof are combined with a suitable solid or liquid earner or diluent to form capsules, tablets, pills, powders, syrups, solutions, suspensions and the like.
• the tablets, pills, capsules, and the like contain from about 1 to about 99 weight percent of the active ingredient and a binder such as gum tragacanth, acacias, corn starch or gelatin; excipients such as dicalcium phosphate; a disintegrating agent such as corn starch, potato starch or alginic acid; a lubricant such as magnesium stearate; and/or a sweetening agent such as sucrose, lactose, saccharin, xylitol, and the like.
• a dosage unit form is a capsule, it often contains, in addition to materials of the abo ve type, a liquid carrier such as fatty oil.
• various other materials are present as coatings or to modify the physical form of the dosage unit.
• tablets are coated with shellac, sugar or both, in some embodiments, a syrup or elixir contains, in addition to the active ingredient, sucrose as a sweetening agent, methyl and propylparabens as preservatives, a dye and a flavoring such as cherry or orange flavor, and the like.
• a compound of Formulae ⁇ , II, or 01 or salts, solvates, tautomers or polymorphs thereof can be combined with sterile aqueous or organic media to form injectable solutions or suspensions.
• injectable compositions may be aqueous isotonic solutions or suspensions.
• the compositions may be sterilized and/or contain adjuvants, such as preserving, stabilizing, wetting or emulsifying agents, solution promoters, salts for regulating the osmotic pressure and/or buffers. In addition, they may also contain other therapeutically valuable substances.
• the compositions are prepared according to conventional mixing, granulating or coating methods, respectively, and contain about 0.1 to 75%, or about 1 to 50%, of the active ingredient.
• injectable solutions are produced using solvents such as sesame or peanut oil or aqueous propylene glycol, as well as aqueous solutions of water- soluble phannaceuticaily-acceptable salts of the compounds.
• solvents such as sesame or peanut oil or aqueous propylene glycol
• aqueous solutions of water- soluble phannaceuticaily-acceptable salts of the compounds are prepared in glycerol, liquid polyethylene glycols and mixtures thereof in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms.
• parenteral administration and “administered parenterally” as used herein means modes of administration other than enteral and topical administration, usually by injection, and includes, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticular, subcapsular, subarachnoid, intraspinal and mtrastemal injection and infusion.
• suitable pharmaceutical compositions are, for example, topical preparations, suppositories or enemas. Suppositories are advantageously prepared from fatty emulsions or suspensions.
• the compositions may be sterilized and/or contain adjuvants, such as preserving, stabilizing, wetting or emulsifying agents, solution promoters, salts for regulating the osmotic pressure and/or buffers, in addition, they may also contain other therapeutically valuable substances.
• the compositions are prepared according to conventional mixing, granulating or coating methods, respectively, and contain about 0.1 to 75%, or about 1 to 50%, of the active ingredient,
• a compound of Formulae I, II, or III is formulated to deliver the active agent by pulmonary administration, e.g., administration of an aerosol formulation containing the active agent from, for example, a manual pump spray, nebulizer or pressurized metered-dose inhaler.
• suitable formulations of this type also include other agents, such as antistatic agents, to maintain the disclosed compounds as effective aerosols.
• a drug delivery device for delivering aerosols comprises a suitable aerosol canister with a metering valve containing a pharmaceutical aerosol formulation as described and an actuator housing adapted to hold the canister and allow for drug delivery.
• the canister in the drug delivery device has a headspace representing greater than about 15% of the total volume of the canister.
• the polymer intended for pulmonary administration is dissolved, suspended or emulsified in a mixture of a solvent, surfactant and propellant. The mixture is maintained under pressure in a canister that has been sealed with a metering valve.
• a solid or a liquid carrier can be used.
• the solid carrier includes a coarse powder having particle size in the range of, for example, from about 20 to about 500 microns and such formulation is administered by rapid inhalation through the nasal passages.
• the formulation is administered as a nasal spray or drops and includes oil or aqueous solutions of the active ingredients.
• formulations that are rapidly dispersing dosage forms also known as “flash dose” forms.
• some embodiments of the present invention are formulated as compositions that release their active ingredients within a short period of time, for example, typically less than about five minutes, less than about ninety seconds, less than about thirty seconds and less than about ten or fifteen seconds.
• Such formulations are suitable for administration to a subject via a variety of routes, for example by insertion into a body cavity or application to a moist body surface or open wound.
• a flash dosage is a solid dosage form that is administered orally, which rapidly disperses in the mouth, and hence does not require great effort in swallowing and allows the compound to be rapidly ingested or absorbed through the oral mucosal membranes.
• suitable rapidly dispersing dosage forms are also used in other applications, including the treatment of wounds and other bodily insults and diseased states in which release of the medicament by externally supplied moisture is not possible.
• Flash dose forms are known in the art; see for example, effervescent dosage forms and quick release coatings of insoluble microparticles in U.S. Pat. Nos. 5,578,322 and 5,607,697; freeze dried foams and liquids in U.S. Pat. Nos. 4,642,903 and 5,631,023; melt spinning of dosage forms in U.S. Pat. Nos. 4,855,326, 5,380,473 and 5,518,730; solid, free-form fabrication in U.S. Pat. No. 6,471,992; sacchari debased carrier matrix and a liquid binder in U.S. Pat. Nos. 5,587,172, 5,616,344, 6,277,406, and 5,622,719; and other forms known to the art.
• a compound of Formulae ⁇ , II, or III can also be also formulated as "pulsed release” formulations, in which the compound is released from the pharmaceutical compositions in a series of releases (i.e., pulses).
• the compounds are also formulated as "sustained release” formulations in which the compound is continuously released from the pharmaceutical composition over a prolonged period.
• formulations for example, liquid formulations, including cyclic or acyclic encapsulating or soivating agents, for example, cyclodextrins, poiyethers, or polysaccharides (e.g., methylcellulose), or polyanionic a-eyciodextrin derivatives with a sodium sulfonate salt group separate from the lipophilic cavity by an alk 3. ether spacer group or polysaccharides.
• cyclic or acyclic encapsulating or soivating agents for example, cyclodextrins, poiyethers, or polysaccharides (e.g., methylcellulose), or polyanionic a-eyciodextrin derivatives with a sodium sulfonate salt group separate from the lipophilic cavity by an alk 3. ether spacer group or polysaccharides.
• the agent can be polyanionic cyciodextrin derivative with a sodium sulfonate salt separated from the lipophilic cavity by a butyl ether spacer group, e.g., CAPTISOL® (CyDex, Overland, and S).
• a butyl ether spacer group e.g., CAPTISOL® (CyDex, Overland, and S).
• CAPTISOL® CyDex, Overland, and S.
• One skilled in the art can evaluate suitable agent/disclosed compound formulation ratios by preparing a solution of the agent in water, e.g., about a 40% by we; in solution; preparing serial dilutions, e.g.
• Binding of the recombinant proteins to the fluorescent Bim BH3 domain was confirmed by titration of increasing concentrations of the recombinant proteins against a constant amount of labeled Bim peptide (16,65 nM), Quantitation of binding was accomplished by FP assay with ml 3 measurements made on the Analyst-GT reader (Molecular Devices, Sunnyvale, CA).
• This example demonstrates the activity of the compounds of Formula I-OI and derivatives, in killing certain human tumor-derived ceil lines grown in culture. Leukemia and myeloid cells used to assess cell tumor killing activity of the compounds are described. Compounds active in these cell lines have good potential as therapies to treat leukemia and myeloid cancers. Materials and Methods Cell culture
• the lymphoid derived cell lines DHL-6, DHL-8, and DHL- 10 were obtained from Anthony Letai of the Dana Farber Cancer Research institute, Boston, MA.
• the myeloid derived ceil line NCI-H929 was obtained from the NIH/NCI cell repository.
• the mouse leukemia-derived ceil line MCL-1-1780 (Ryan et aL, Proc. Nat. Acad. Sci USA, 107, 12895-12900, which is hereby incorporated by reference in its entirety) was obtained from Anthony Letai of the Dana Farber Cancer Research Institute, Boston, MA.
• Cells were grown in RPMI 1640 medium (GIBCO-BRL) with 2 mM L- glutamine, 4,5 g/ ' L glucose, 1.0 mM sodium pyruvate and 5% fetal bovine serum.
• the EC 50 values in the cell lines listed above for compounds of the invention are shown in Figure 1.
• the EC 50 values for the compounds of Formulae I, II, or III are between 1.9 ⁇ and >25 ⁇ .
• the EC 50 values for the compounds of Formulae I, II, or III are between 2.1 ⁇ and >25 ⁇ .
• the EC50 values for the compounds of Formulae I, II, or III are between 0.3 ⁇ and >25 ⁇ .
• the EC 50 values for the compounds of Formulae I, II, or III are between 13.9 ⁇ and >25 ⁇ . These data indicate that compounds of this invention are effective at killing tumor cells in culture and are a ti- lymphoid and anti-myeloid tumor compounds. Certain compounds of the invention display EC 50 values of >25 uM in the lymphoid cell line DHL10.
• the DHL 10 cell line is BAX/BAK deficient and therefore will not respond to apoptosis signaling through the BCL-2 pathway.
• This data indicates that compounds of the invention selectively kill BAX/BAK expressing ceil lines over a BAX/BAK deficient cell line, indicating on-target activity of compounds of Formulae I, II, or III as MCL-1 inhibitors.
• Lymphoid and myeloid cells that have elevated expression of Mcl-l tend to be resistant to certain chemotherapies. This includes multiple myeloma (MM) (Zhang, et al. (2002), Blood 99: 1885-1893), non-Hodgkin's lymphomas (Cho-Vega, et. al ( 2004) Hum. Pathol. 35(9): 1095-100) and chronic lymphocytic leukemia (CLL) (Michels, et al. (2004), Oncogene 23:4818-4827) cells. As shown in Example 1 above, the compounds of Formulae I, II, or III inhibit Mcl- l .
• MM myeloma
• CLL chronic lymphocytic leukemia
• the mouse leukemia-derived cell lines Mcl-l -1780 and Bcl-2-1863 (Ryan et al., Proc. Nat. Acad. Sci LISA, 107, 12895-12900, which is hereby incorporated by reference in its entirety) were obtained under license from Dana Farber Cancer Institute.
• Cells were grown in RPMI 1640 medium (GIBCO-BRL) with 2 mM L- glutamine, 4.5 g/L glucose, 1.0 mM sodium pyruvate and 5% fetal bovine serum. Cells were expanded in tissue culture in appropriate media and then sub-cultured into 96-well plates at a seeding density of 20,000 cells per well.
• Suspension ceil lines SUDHL6, SUDHL8, and SUDHL10 were grown in RPMI, washed once in IxPBS and re-suspended at a concentration of 2e6/ml in assay buffer with 0,0025% Digitonin.
• Assay buffer 300 mM Trehalose, 10 mM HEPES- KOH pH 7.7, 80 mM KC1, 1 mM EGTA, 1 mM EDTA, 0.1 % BSA, 5 mM Succinate. Cells are incubated with test and control compounds at 10 6 cells/treatment for 1 hour at room temperature.
• Samples are fixed with 4% formaldehyde in PBS for 20 minutes, washed once in PBS, and blocked with 2%o FBS/0.5%TritonX-I00 in PBS. Samples are re-suspended in blocking buffer with 1 :250 anti-cytochrome c conjugated to Alexa488 (BD Cat#56028) for 1 hour at 4°C, washed once with blocking buffer and re-suspended in 200 u! PBS. Cytochrome c loss was measured by microscopy. At least 100 cells per treatment were counted and scored as positive for cytochrome c loss if they lacked staining. In both methods DMSO was calculated as 0% cytochrome c loss and the Bim response for DHL6 was used to determine 100%) cytochrome c loss.

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