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  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D491/00—Heterocyclic compounds containing in the condensed ring system both one or more rings having oxygen atoms as the only ring hetero atoms and one or more rings having nitrogen atoms as the only ring hetero atoms, not provided for by groups C07D451/00 - C07D459/00, C07D463/00, C07D477/00 or C07D489/00
  • C07D491/02—Heterocyclic compounds containing in the condensed ring system both one or more rings having oxygen atoms as the only ring hetero atoms and one or more rings having nitrogen atoms as the only ring hetero atoms, not provided for by groups C07D451/00 - C07D459/00, C07D463/00, C07D477/00 or C07D489/00 in which the condensed system contains two hetero rings
  • C07D491/10—Spiro-condensed systems
  • C07D491/107—Spiro-condensed systems with only one oxygen atom as ring hetero atom in the oxygen-containing ring
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
• • C—CHEMISTRY; METALLURGY
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  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
  • C07D401/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings
  • C07D401/06—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
  • C07D401/14—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
  • C07D405/14—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
  • C07D413/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings
  • C07D413/04—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings directly linked by a ring-member-to-ring-member bond
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
  • C07D413/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings
  • C07D413/06—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
  • C07D413/14—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D417/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and sulfur atoms as the only ring hetero atoms, not provided for by group C07D415/00
  • C07D417/14—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and sulfur atoms as the only ring hetero atoms, not provided for by group C07D415/00 containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D471/00—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, at least one ring being a six-membered ring with one nitrogen atom, not provided for by groups C07D451/00 - C07D463/00
  • C07D471/02—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, at least one ring being a six-membered ring with one nitrogen atom, not provided for by groups C07D451/00 - C07D463/00 in which the condensed system contains two hetero rings
  • C07D471/10—Spiro-condensed systems
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D487/00—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, not provided for by groups C07D451/00 - C07D477/00
  • C07D487/02—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, not provided for by groups C07D451/00 - C07D477/00 in which the condensed system contains two hetero rings
  • C07D487/04—Ortho-condensed systems
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D491/00—Heterocyclic compounds containing in the condensed ring system both one or more rings having oxygen atoms as the only ring hetero atoms and one or more rings having nitrogen atoms as the only ring hetero atoms, not provided for by groups C07D451/00 - C07D459/00, C07D463/00, C07D477/00 or C07D489/00
  • C07D491/02—Heterocyclic compounds containing in the condensed ring system both one or more rings having oxygen atoms as the only ring hetero atoms and one or more rings having nitrogen atoms as the only ring hetero atoms, not provided for by groups C07D451/00 - C07D459/00, C07D463/00, C07D477/00 or C07D489/00 in which the condensed system contains two hetero rings
  • C07D491/10—Spiro-condensed systems

Definitions

• the present invention relates generally to novel substituted tetrahydroisoquinoline compounds, and their analogues thereof, which are inhibitors of factor XIa and/or plasma kallikrein, compositions containing them, and methods of using them, for example, for the treatment or prophylaxis of thromboembolic disorders , or for the treatment of retinal vascular permeability associated with diabetic retinopathy and diabetic macular edema.
• thromboembolic diseases remain the leading cause of death in developed countries despite the availability of anticoagulants such as warfarin (COUMADIN®), heparin, low molecular weight heparins (LMWH), and synthetic pentasaccharides and antiplatelet agents such as aspirin and clopidogrel (PLAVIX®).
• the oral anticoagulant warfarin inhibits the post-translational maturation of coagulation factors VII, IX, X and prothrombin, and has proven effective in both venous and arterial thrombosis.
• its usage is limited due to its narrow therapeutic index, slow onset of therapeutic effect, numerous dietary and drug interactions, and a need for monitoring and dose adjustment.
• safe and efficacious oral anticoagulants for the prevention and treatment of a wide range of thromboembolic disorders has become increasingly important.
• Factor XIa is a plasma serine protease involved in the regulation of blood coagulation, which is initiated in vivo by the binding of tissue factor (TF) to factor VII (FVII) to generate factor Vila (FVIIa).
• the resulting TF:FVIIa complex activates factor IX (FIX) and factor X (FX) that leads to the production of factor Xa (FXa).
• the generated FXa catalyzes the transformation of prothrombin into small amounts of thrombin before this pathway is shut down by tissue factor pathway inhibitor (TFPI).
• TFPI tissue factor pathway inhibitor
• the process of coagulation is then further propagated via the feedback activation of Factors V, VIII and XI by catalytic amounts of thrombin.
• Plasma prekallikrein is a zymogen of a trypsin-like serine protease and is present in plasma at 35 to 50 ⁇ g/mL.
• the gene structure is similar to that of factor XL
• the amino acid sequence of plasma kallikrein has 58% homology to factor XL
• Plasma kallikrein is thought to play a role in a number of inflammatory disorders.
• the major inhibitor of plasma kallikrein is the serpin CI esterase inhibitor.
• Patients who present with a genetic deficiency in CI esterase inhibitor suffer from hereditary angioedema (HAE) which results in intermittent swelling of face, hands, throat, gastro-intestinal tract and genitals.
• HAE hereditary angioedema
• Blisters formed during acute episodes contain high levels of plasma kallikrein which cleaves high molecular weight kininogen liberating bradykinin leading to increased vascular permeability.
• Treatment with a large protein plasma kallikrein inhibitor has been shown to effectively treat HAE by preventing the release of bradykinin which causes increased vascular permeability (Lehmann, A., "Ecallantide (DX-88), a plasma kallikrein inhibitor for the treatment of hereditary angioedema and the prevention of blood loss in on-pump cardiothoracic surgery", Expert Opin. Biol. Ther., 8: 1187-1199 (2008)).
• the plasma kallikrein-kinin system is abnormally abundant in patients with advanced diabetic macular edema. It has been recently published that plasma kallikrein contributes to retinal vascular dysfunctions in diabetic rats (Clermont, A. et al., "Plasma kallikrein mediates retinal vascular dysfunction and induces retinal thickening in diabetic rats", Diabetes, 60: 1590-1598 (201 1)). Furthermore, administration of the plasma kallikrein inhibitor ASP-440 ameliorated both retinal vascular permeability and retinal blood flow abnormalities in diabetic rats. Therefore, a plasma kallikrein inhibitor should have utility as a treatment to reduce retinal vascular permeability associated with diabetic retinopathy and diabetic macular edema. Other complications of diabetes such as cerebral hemorrhage, nephropathy, cardiomyopathy and neuropathy, all of which have associations with plasma kallikrein may also be considered as targets for a plasma kallikrein inhibitor.
• the present invention provides novel substituted tetrahydroisoquinoline compounds, their analogues, including stereoisomers, tautomers, pharmaceutically acceptable salts, or solvates thereof, which are useful as selective inhibitors of serine protease enzymes, especially factor XIa and/or plasma kallikrein.
• the present invention also provides processes and intermediates for making the compounds of the present invention.
• the present invention also provides pharmaceutical compositions comprising a pharmaceutically acceptable carrier and at least one of the compounds of the present invention or stereoisomers, tautomers, pharmaceutically acceptable salts, or solvates thereof.
• the compounds of the invention may be used in the treatment and/or prophylaxis of thromboembolic disorders.
• the compounds of the invention may be used in the treatment of retinal vascular permeability associated with diabetic retinopathy and diabetic macular edema.
• the compounds of the present invention may be used in therapy.
• the compounds of the present invention may be used for the manufacture of a medicament for the treatment and/or prophylaxis of a thromboembolic disorder.
• the compounds of the invention can be used alone, in combination with other compounds of the present invention, or in combination with one or more, preferably one to two other agent(s).
• the present invention provides, inter alia, compounds of
• ring A is independently selected from the group consisting of: C 3-10 carbocycle and 5- to 10-membered heterocycle containing carbon atoms and 1-4 heteroatoms selected from the group consisting of N, O, and S(0) p , each optionally substituted with one or more R 1 as valence allows;
• ring B is 5- to 6-membered heterocycle comprising: carbon atoms and 1-4 heteroatoms selected from N, O and S(0) p , and optionally substituted with one or more R 2 as valence allows;
• ring C is independently selected from the group consisting of: phenyl and 5- to 6-membered heterocycle containing carbon atoms and 1-4 heteroatoms selected from the group consisting of N, NR 6 , O, and S(0) p and optionally substituted with one or more R 5 as valence allows;
• Q is independently selected from the group consisting of: C, CH, and N;
• R 1 is independently selected from the group consisting of: H, halo, NO2, OH, CN, Ci_6 alkyl, Ci_ 4 alkoxy, -CHF 2 , -CF 3 , -CH 2 NH 2 , -OCHF 2 , -CO(Ci_ 4 alkyl), -CONH 2 , -COOH, and 5- to 7-membered heterocycle;
• R 3 is independently selected from the group consisting of: Ci_6 alkyl substituted with 1-3 R 3a , C3-1 0 carbocycle substituted with 1-3 R 3a , and 5-10 membered heterocycle containing carbon atoms and 1-4 heteroatoms selected from , NR 7 , O, and S(0) p ;
• heterocycle is substituted with 1-3 R 3a ;
• R 3a is independently selected from the group consisting of: H, halogen, Ci_ 4 alkyl,
• -OH, 0, -CH 2 OH, Ci_ 4 alkoxy, -CN, -NH 2 , -NH(Ci_ 4 alkyl), -N(C 1-4 alkyl) 2 , -C0 2 H, -CH 2 C0 2 H, - C0 2 (Ci-4 alkyl), -CH 2 C0 2 (Ci- 4 alkyl), -C0 2 -Ci- 4 alkylene-0(Ci- 4 alkyl), -C0 2 -Ci_4 alkylene-N(Ci_4 alkyl) 2 , -C0 2 -Ci_ 4 alkylene-0-Ci_ 4 alkylene-N(Ci_ 4 alkyl) 2 , -C0 2 -Ci_ 4 alkylene-0-Ci_4 alkylene-0(Ci_ 4 alkyl), -CONH 2 , -CONH(Ci_ 6 alkyl),
• R 4 is independently selected from the group consisting of: H, halo, and Ci_ 4 alkyl;
• R 5 is independently selected from the group consisting of: H, halo, Ci_ 4 alkyl substituted with 1-2 R b , C 2 _ 4 alkenyl substituted with 1-2 R b , C 2 _ 4 alkynyl substituted with 1-2 R b OH, CN, NH 2 , -NH(Ci- 4 alkyl), N(C 1-4 alkyl) 2 , C 1-4 alkoxy, -OCO(C 1-4 alkyl), -0-Ci_ 4 alkylene-0(Ci_4 alkyl), -0-C 1-4 alkylene-N(Ci_ 4 alkyl) 2 , -C0 2 H, -C0 2 (Ci_ 4 alkyl), -CONH 2 , -(CH 2 ) 2 CONH 2 , -CONR 9 (Ci_ 4 alkyl), -CONR 9 -Ci_ 4 alkylene-0(Ci_ 4 alkyl), -CON(C
• R 6 is independently selected from the group consisting of: H, C 1-4 alkyl, C 1-4 alkyl, COCi_4 alkyl, C0 2 Ci_ 4 alkyl, C0 2 Bn, phenyl, and benzyl;
• R 7 is independently selected from the group consisting of: H and C 1-4 alkyl
• R 8 is independently selected from the group consisting of: -(CH 2 ) n -C3 -1 o
• R 9 is independently selected from the group consisting of: H and C 1-4 alkyl
• R a is independently selected from the group consisting of: H, C 1-4 alkyl substituted with 1-2 R d , -(CH 2 ) n OH, CO(Ci_ 4 alkyl), COCF 3 , CH 2 CF 3 , C0 2 (Ci_ 4 alkyl), -CONH 2 , -CONH-Ci_ 4 alkylene-C0 2 (Ci_4 alkyl), Ci_ 4 alkylene-C0 2 (Ci_ 4 alkyl), R c , C0 2 R c , and CONHR c ;
• R a and R b are combined to form a 5-6 membered heterocyclic ring containing carbon atoms and 1-4 heteroatoms selected from , O, and S(0) p , and optionally substituted with 1-3 R e ;
• R c is independently selected from the group consisting of: -(CH 2 ) n -C3_6 cycloalkyl, -(CH 2 ) n -phenyl, and -(CH 2 ) n -5- to 6-membered heterocycle containing carbon atoms and 1-4 heteroatoms selected from the group consisting of: N, NH, N(C 1-4 alkyl), O, and S(0) p ; wherein each ring moiety is substituted with 1-3 R d ;
• R e is independently selected from the group consisting of: H, halo, C 1-4 alkyl, C 1-4 alkoxy, OCF 3 , NH 2 , N0 2 , N(Ci_ 4 alkyl) 2 , CO(Ci_ 4 alkyl), CO(Ci_ 4 haloalkyl), C0 2 (Ci_ 4 alkyl), CONH 2 , -CONH(Ci_ 4 alkyl), -CON
• n is independently selected from 0, 1, 2, 3, and 4;
• p is independently selected from 0, 1, and 2.
• the present invention provides compounds of Formula (II):
• ring A is selected from the group consisting of: aryl and 5- to 10-membered heterocycle containing carbon atoms and 1-3 heteroatoms selected from the group consisting of N, NH, NCi_ 4 alkyl, O, and S(0) p , each optionally substituted with 1-3 R 1 ;
• ring B is 5- to 6-membered heterocycle comprising: carbon atoms and 1-4 heteroatoms selected from N, NH, S(0) p , and O and optionally substituted withl-3 R 2 ;
• R 5 is selected from the group consisting of: H, halo, C 1-4 alkyl substituted with 1-2 R b , C 2 _4 alkenyl substituted with 1-2 R b , OH, CN, NH 2 , Ci_ 4 alkoxy, -0-C 1-4
• R 8 is selected from the group consisting of: -(CH 2 ) n -aryl, -(CH 2 ) n -C3-6 cycloalkyl and -(CH 2 ) n -5- to 10-membered heterocycle containing carbon atoms and 1-4 heteroatoms selected from the group consisting of: N, NR a , O, and S(0) p ; wherein said carbocycle or heterocycle is substituted with 1-3 R b ;
• the present invention provides compounds of Formula (III):
• — is an optional bond
• W is selected from the group consisting of CR b R b , N, NR a , O, and S(0) p ;
• J, K, P, U, and V are each independently selected from the group consisting of: N, NH, O, S(0) p , CR 2 , and CR 2 R 2 ;
• R 4a , R 4b , R 4c , and R 4d are independently selected from the group consisting of: H, F, and Ci_ 4 alkyl;
• R a is selected from the group consisting of: H, C 1-4 alkyl substituted with 1-2 R d , -(CH 2 ) n OH, CH 2 CF 3 , C0 2 (Ci_ 4 alkyl), -CONH 2 , and R c ;
• R a and R b together form a 5-6 membered heterocyclic ring containing carbon atoms and 1-4 heteroatoms selected from , O, and S(0) p , and substituted with 1-3 R e ;
• R c is selected from the group consisting of: -(CH 2 ) n -C3_6 cycloalkyl,
• R e is selected from the group consisting of: H, halo, C 1-4 alkyl, C 1-4 alkoxy, OCF 3 , NH 2 , N(Ci_ 4 alkyl) 2 , CO(Ci_ 4 alkyl), CO(Ci_ 4 haloalkyl), C0 2 (Ci_ 4 alkyl), CONH 2 , -CONH(Ci_ 4 alkyl), -CON(Ci_ 4 alkyl) 2 , -NHC0 2 (Ci_ 4 alkyl), -(CH 2 ) n -C 3 - 6 cycloalkyl, -(CH 2 ) n -phenyl, and -(CH 2 ) n -5- to 6-membered heterocycle;
• q is selected from 0, 1, and 2;
• r is selected from 0, 1, and 2;
• the present invention provides compounds of Formula (IV):
• R la is selected from the group consisting of: H, halo, CN, OH, C 1-4 alkoxy, -CHF 2 , -CF 3 , -CH 2 NH 2 , -OCHF 2 , -CO(Ci_ 4 alkyl), -CONH 2 , and -COOH;
• R is selected from the group consisting of: H and halo
• R lc is selected from the group consisting of: H, halo, alkyl, and methoxy;
• R 3 is selected from the group consisting of: phenyl substituted with 1-2 R 3a , pyridyl substituted with 1-2 R 3a , quinolinyl substituted with 1-2 R 3a , tetrahydroquinolinyl substituted with 1-2 R 3a , isoquinolinyl substituted with 1-2 R 3a , indolinyl substituted with 1-2 R 3a , C3-6 cycloalkyl substituted with 1-2 R 3a , and bicycle[2,2,2]octane substituted with 1-2 R 3a ; and
• R 4c and R 4d are independently selected from the group consisting of: H and Me; other variables are as defined in Formula (III) above.
• the present invention provides compounds of Formula (IV), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R 3a is selected from the group consisting of: H, halo, C 1-4 alkyl, OH, CH 2 OH, Ci alkoxy, CN, NH 2 , -C0 2 H, -CH 2 C0 2 H, -C0 2 (Ci- 4 alkyl), -C0 2 (CH 2 )i_ 2 0(Ci- 4 alkyl), alkyl) 2 , -CONH 2 , CONH(Ci_ 4 alkyl), -CON(Ci_ 4 alkyl) 2 ,
• R b is selected from the group consisting of: H, C 1-4 alkyl, OH, CN, NH 2 , -N(C 1-4 alkyl) 2 , Ci_ 4 alkoxy, -OCO-Ci_ 4 alkyl, -C0 2 H, -C0 2 (Ci_ 4 alkyl), -CONH 2 , -CONR 9 (Ci_ 4 alkyl), -CON(Ci_ 4 alkyl) 2 , R 8 , -OR 8 , -COR 8 , and -C0 2 R 8 ; and
• R e is selected from the group consisting of: H, halo, C 1-4 alkyl, C 1-4 alkoxy, OCF 3 , NH 2 , N0 2 , N(Ci_ 4 alkyl) 2 , CO(Ci_ 4 alkyl), CO(Ci_ 4 haloalkyl), C0 2 (Ci_ 4 alkyl), CONH 2 , -CONH(Ci_ 4 alkyl), -CON(Ci_ 4 alkyl) 2 , -NHC0 2 (Ci_ 4 alkyl), -(CH 2 ) n -C 3 - 6 cycloalkyl, -(CH 2 ) n -phenyl, and -(CH 2 ) n -5- to 6-membered heterocycle.
• the present invention provides compounds of Formula (IV), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R lb is selected from the group consisting of: H and F;
• the present invention provides compounds of Formula (IV), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R la is selected from the group consisting of: H, F, CI, CN, COMe, OH, OMe,
• H and F; is selected from the group consisting of:
• R b is selected from the group consisting of: H, F, Me, Et, i-propyl, CN, OH, -OMe, -C0 2 Me, -C0 2 Et, -CON(Me) 2 , NH 2 , -N(Me) 2 , -0(CH 2 )N(Me) 2 , -0(CH 2 )OMe,
• R e is selected from the group consisting of: H, halo, C 1-4 alkyl, C 1-4 alkoxy, OCF 3 , NH 2 , CO(Ci_4 alkyl), CO(Ci_ 4 haloalkyl), C0 2 (Ci_ 4 alkyl), CONH 2 , -CONH(Ci_ 4 alkyl), -CON(Ci_ 4 alkyl) 2 , -NHC0 2 (Ci_ 4 alkyl), -(CH 2 ) n -C 3 - 6 cycloalkyl, and -(CH 2 ) n -phenyl; other variables are as defined in Formula (IV) above.
• the present invention provides compounds of Formula (V):
• — is an optional bond
• R la is selected from the group consisting of: H, F, CI, CHF 2 , and CF 3 ;
• R lb is selected from the group consisting of: H, F, and CI;
• R lc is selected from the group consisting of: H and CI;
• R 3a is selected from the group consisting of: H, F, CI, CN, C0 2 H, - CH 2 C0 2 H, C0 2 Me, -C0 2 Et, -C0 2 (7-Pr), -C0 2 (?-Bu), -C0 2 ( «-Bu), -C0 2 (7-Bu), - and HC0 2 Me; q is 1 or 2; and r is 1 or 2;
• the present invention provides compounds of Formula (II), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R 3 is selected from the group consisting of: phenyl substituted with 1-2 R 3a , C3-6 cycloalkyl substituted with 1-2 R 3a , and heterocycle substituted with 1-2 R 3a ;
• R 3a is selected from the group consisting of: H, halo, -OH, -0(Ci_4 alkyl), -CN, -C0 2 H, -CONH 2 , -C0 2 (Ci_4 alkyl), -C0 2 -Ci_ 4 alkylene-0(Ci_ 4 alkyl), -C0 2 -Ci_ 4 alkylene-N(Ci_ 4 alkyl) 2 , -C0 2 -Ci_ 4 alkylene-0-Ci_ 4 alkylene-N(Ci_ 4 alkyl) 2 , -C0 2 -Ci_ 4 alkylene-O-Ci-4 alkylene-0(Ci- 4 alkyl), -NHC0 2 (Ci- 4 alkyl), R c , and -C0 2 R c ;
• R 5 is selected from the group consisting of: H, R 8 , -OR 8 , COR 8 , -CONHR 8 , and NHCONHR 8 ;
• R 8 is selected from the group consisting of: -(CH 2 ) n -C 3 _6 cycloalkyl
• R a is selected from the group consisting of: H, Ci_ 4 alkyl, -(CH 2 ) n OH, CO(Ci_ 4 alkyl), COCF 3 , CH 2 CF 3 , C0 2 (Ci_ 4 alkyl), -CONH-Ci_ 4 alkylene-C0 2 (Ci_ 4 alkyl), Ci_ 4 alkylene-C0 2 (Ci-4 alkyl), R c , and C0 2 R c ;
• alkylene-N(Ci_ 4 alkyl) 2 -NHCO(Ci_ 4 alkyl), -NHC0 2 (Ci_ 4 alkyl), -S(0) 2 NH 2 ,
• R c is selected from the group consisting of: -(CH 2 ) n -C 3 _6 cycloalkyl,
• the present invention provides compounds of Formula (VI):
• R la is selected from the group consisting of: H, F, CI, CN, OH, C 1-4 alkoxy, -CHF 2 , -CF 3 , -CH 2 NH 2 , -OCHF 2 , -CO(Ci_ 4 alkyl), -CONH 2 , and -COOH;
• R lb is selected from the group consisting of: H and halo;
• R lc is selected from the group consisting of: H, halo, C 1-2 alkyl, and methoxy;
• R 3 is selected from the group consisting of: phenyl substituted with 1-2 R 3a , pyridyl substituted with 1-2 R 3a , quinolinyl substituted with 1-2 R 3a , tetrahydroquinolinyl substituted with 1-2 R 3a , isoquinolinyl substituted with 1-2 R 3a , indolinyl substituted with 1-2 R 3a , C3-6 cycloalkyl substituted with 1-2 R 3a , and bicycle[2,2,2]octane substituted with 1-2 R 3a ; and
• the present invention provides compounds of Formula (VI), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R la is selected from the group consisting of: H, F, CF 3 , and CO(Ci_ 4 alkyl);
• R lb is selected from the group consisting of: H and F;
• R lc is CI
• R 3 is selected from the roup consisting of:
• R 3a is selected from the group consisting of: F, -OH, -OMe, -OEt, -CN, -C0 2 H, -CONH 2 , -C0 2 Me, -C0 2 Et, -C0 2 (?-butyl), -C0 2 (CH 2 ) 2 OMe, -C0 2 (CH 2 ) 2 N(d_ 4 alkyl) 2 , -CO ⁇ CH ⁇ O CH ⁇ d ⁇ alkyl) 2 , -C0 2 (CH 2 ) 2 0(CH 2 ) 2 OMe, -NHC0 2 Me, R c , and -C0 2 R c ;
• R a is selected from the group consisting of: H, Me, Et, -(CH 2 ) 3 OH, COCF 3 , COMe, C0 2 Me, C0 2 Et, C0 2 (?-butyl), -CONH(CH 2 ) 2 C0 2 (Ci_ 4 alkyl), R c , and C0 2 R c ;
• R b is selected from the group consisting of: H, Me, Et, CI, OMe, OCF 3 , N0 2 , NH 2 , N(Me) 2 , C0 2 Me, C0 2 Et, CONH 2 , -CONH(Ci_ 4 alkyl), -CON(Ci_ 4 alkyl) 2 ,
• R c is selected from the group consisting of: -(CH 2 ) n -C3_6 cycloalkyl,
• the present invention provides compounds of Formula (VI), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R la is selected from the group consisting of: H, F, CF3, and C(0)Me;
• R lb is selected from the group consisting of: H and F;
• R lc is CI
• R 3a is selected from the group consisting of: F and -C0 2 H;
• R b is selected from the group consisting of: CI, OMe, OCF 3 , N0 2 , CONH 2 , -CONHMe, -CONHEt, -CON(Me) 2 , -CON(Et) 2 , -CONH(CH 2 )!_ 2 0(Ci_ 4 alkyl),
• R c is selected from the group consisting of: -(CH 2 ) n -C 3 _6 cycloalkyl,
• the present invention provides compounds of Formula (II), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R 3 is selected from the group consisting of: phenyl substituted with 1-2 R 3a and pyridyl substituted with 1-2 R 3a ;
• R 5 is selected from the group consisting of: H, halo, Ci_ 4 alkyl substituted with 1-2 R b , C 2 _ 4 alkenyl substituted with 1-2 R b , -OH, CN, -NH 2 , -N(C 1-4 alkyl) 2 , -NH 2 -Ci_ 4 alkylene-OH, -0-Ci_ 4 alkylene-0(Ci_ 4 alkyl), -0-Ci_ 4 alkylene-N(Ci_ 4 alkyl) 2 ,
• R 3a is selected from the group consisting of: CH 2 OH and -CO 2 H;
• R is selected from the group consisting of: NH 2 , CONH 2 , C0 2 (Ci_4 alkyl), R c , and COR c ;
• R c is selected from the group consisting of: -(CH 2 ) n -C3_6 cycloalkyl,
• the present invention provides compounds of Formula (II), or stereoisomers, tautomers, pharmaceutically acceptable salts, solvates, or prodrugs thereof, wherein:
• R 5 is selected from the group consisting of: H, C 1-4 alkyl substituted with 1-2 R b , C 2 -4 alkenyl substituted with 1-2 R b , -N(Me) 2 , -0(CH 2 ) 2 N(Me) 2 , 0(CH 2 ) 2 OMe,
• R 3a is selected from the group consisting of: F, CN, CH 2 OH, C0 2 H, C0 2 Me, C0 2 Et, C0 2 (i-Bu), and HC0 2 Me;
• R a is selected from the group consisting of: H, methyl, -(CH 2 V 3 OH, COMe, COCF3, C0 2 Me, R c , and C0 2 R c ;
• R b is selected from the group consisting of: H, CI, OMe, OCF 3 , N0 2 , NH 2 , -N(Me) 2 , -C0 2 Me, -C0 2 Et, CONH 2 , -CONHMe, -CONHEt, -CON(Me) 2 ,
• R c is selected from the group consisting of: -(CH 2 ) 0 -iphenyl, pyrrolidine, pyrazole, imidazole, triazole, -(CH 2 ) 0 - 2 morpholine, piperidine, methylpiperidine, and
• the present invention provides compounds of Formula (VII), (VIII), and (IX):
• ring A is selected from the group consisting of: C3-10 carbocycle and 5- to 10-membered heterocycle containing carbon atoms and 1-3 heteroatoms selected from , NH, NCi_ 4 alkyl, O, and S(0) p , each optionally substituted with one or more R 1 as valence allows;
• J, K, P, U, and V are each independently selected from the group consisting of: N, NH, O, S(0) p , CR 2 , and CHR 2 ;
• R 1 is selected from the group consisting of: H, halo, NO 2 , Ci_6 alkyl, OH, OMe, and CN;
• R 3 is selected from the group consisting of: Ci_6 alkyl substituted with 1-3 R 3a , C3- 10 carbocycle substituted with 1-3 R 3a , and 5-10 membered heterocycle containing carbon atoms and 1-4 heteroatoms selected from the group consisting of N, NR 7 , O, and S(0) p ; wherein said heterocycle is substituted with 1-3 R 3a ;
• R 3a is selected from the group consisting of: H, halogen, Ci_ 4 alkyl, -OH, Ci_ 4 alkoxy, -CN, -NH 2 , -NH(Ci_ 4 alkyl), -N(C 1-4 alkyl) 2 , -C0 2 H, -CH 2 C0 2 H, -C0 2 (Ci_ 4 alkyl), -C0 2 -Ci_ 4 alkylene-0(Ci_ 4 alkyl), -C0 2 -Ci_ 4 alkylene-N(Ci_ 4 alkyl) 2 , -C0 2 -Ci_ 4 alkylene-O-Ci-4 alkylene-N(Ci_ 4 alkyl) 2 , -C0 2 -Ci_ 4 alkylene-0-Ci_ 4 alkylene-0(Ci_ 4 alkyl), -CONH 2 , -CONH(Ci_ 6 alkyl), -CON(Ci_ 4
• R 4a , R 4b , R 4c , and R 4d are independently selected from the group consisting of: H,
• R 5 is selected from the group consisting of: H, halo, Ci_ 4 alkyl, and -NH 2 ; and R 6 is selected from the group consisting of: H and Ci_ 4 alkyl.
• the compounds of the present invention have Factor XIa or plasma kallikrein Ki values ⁇ 10 ⁇ .
• the compounds of the present invention have Factor XIa Ki or plasma kallikrein values ⁇ 1 ⁇ .
• the compounds of the present invention have Factor XIa Ki or plasma kallikrein values ⁇ 0.5 ⁇ .
• the compounds of the present invention have Factor XIa Ki or plasma kallikrein values ⁇ 0.1 ⁇ . II. OTHER EMBODIMENTS OF THE INVENTION
• the present invention provides a composition comprising at least one of the compounds of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a pharmaceutically acceptable carrier and at least one of the compounds of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate, thereof.
• the present invention provides a pharmaceutical composition, comprising: a pharmaceutically acceptable carrier and a therapeutically effective amount of at least one of the compounds of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof.
• the present invention provides a process for making a compound of the present invention.
• the present invention provides an intermediate for making a compound of the present invention.
• the present invention provides a pharmaceutical composition further comprising additional therapeutic agent(s).
• the present invention provides pharmaceutical composition, wherein the additional therapeutic agent(s) are an anti-platelet agent or a combination thereof.
• the anti-platelet agent(s) are clopidogrel and/or aspirin, or a combination thereof.
• the present invention provides a method for the treatment and/or prophylaxis of a thromboembolic disorder comprising administering to a patient in need of such treatment and/or prophylaxis a therapeutically effective amount of at least one of the compounds of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof.
• the present invention provides a compound of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof, for use in therapy.
• the present invention provides a compound of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof, for use in therapy for the treatment and/or prophylaxis of a thromboembolic disorder.
• the present invention also provides the use of a compound of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof, for the manufacture of a medicament for the treatment and/or prophylaxis of a thromboembolic disorder.
• the present invention provides a method for treatment and/or prophylaxis of a thromboembolic disorder, comprising: administering to a patient in need thereof a therapeutically effective amount of a first and second therapeutic agent, wherein the first therapeutic agent is a compound of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof, and the second therapeutic agent is at least one agent selected from a factor Xa inhibitor such as apixaban, rivaroxaban, betrixaban, edoxaban, an anti-coagulant agent, an anti-platelet agent, a thrombin inhibiting agent such as dabigatran, a thrombolytic agent, and a fibrinolytic agent.
• a factor Xa inhibitor such as apixaban, rivaroxaban, betrixaban, edoxaban
• an anti-coagulant agent an anti-platelet agent
• a thrombin inhibiting agent such as
• the second therapeutic agent is at least one agent selected from warfarin, unfractionated heparin, low molecular weight heparin, synthetic pentasaccharide, hirudin, argatroban, aspirin, ibuprofen, naproxen, sulindac,
• the second therapeutic agent is at least one anti-platelet agent.
• the anti-platelet agent(s) are clopidogrel and/or aspirin, or a combination thereof.
• the thromboembolic disorder includes arterial cardiovascular thromboembolic disorders, venous cardiovascular thromboembolic disorders, arterial cerebrovascular thromboembolic disorders, and venous cerebrovascular thromboembolic disorders.
• thromboembolic disorder examples include, but are not limited to, unstable angina, an acute coronary syndrome, atrial fibrillation, first myocardial infarction, recurrent myocardial infarction, ischemic sudden death, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombosis, deep vein thrombosis, thrombophlebitis, arterial embolism, coronary arterial thrombosis, cerebral arterial thrombosis, cerebral embolism, kidney embolism, pulmonary embolism, and thrombosis resulting from medical implants, devices, or procedures in which blood is exposed to an artificial surface that promotes thrombosis.
• the present invention provides a method for the treatment and/or prophylaxis of an inflammatory disorder comprising: administering to a patient in need of such treatment and/or prophylaxis a therapeutically effective amount of at least one of the compounds of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof.
• the inflammatory disorder include, but are not limited to, sepsis, acute respiratory distress syndrome, and systemic inflammatory response syndrome.
• the present invention provides a method for the prophylaxis of a disease or condition in which plasma kallikrein activity is implicated comprising administering to a patient in need of such treatment and/or prophylaxis a therapeutically effective amount of at least one of the compounds of the present invention or a stereoisomer, a tautomer, a pharmaceutically acceptable salt, or a solvate thereof.
• the disease or condition in which plasma kallikrein activity is implicated includes, but not limited to, impaired visual acuity, diabetic retinopathy, diabetic macular edema, hereditary angioedema, diabetes, pancreatitis, nephropathy, cardio myopathy, neuropathy, inflammatory bowel disease, arthritis, inflammation, septic shock, hypotension, cancer, adult respiratory distress syndrome, disseminated intravascular coagulation, and cardiopulmonary bypass surgery.
• the present invention provides a combined preparation of a compound of the present invention and additional therapeutic agent(s) for simultaneous, separate or sequential use in therapy.
• the present invention provides a combined preparation of a compound of the present invention and additional therapeutic agent(s) for simultaneous, separate or sequential use in treatment and/or prophylaxis of a thromboembolic disorder.
• Optically active forms may be prepared by resolution of racemic forms or by synthesis from optically active starting materials. All processes used to prepare compounds of the present invention and intermediates made therein are considered to be part of the present invention. When enantiomeric or diastereomeric products are prepared, they may be separated by conventional methods, for example, by
• the end products of the present invention are obtained either in free (neutral) or salt form. Both the free form and the salts of these end products are within the scope of the invention. If so desired, one form of a compound may be converted into another form. A free base or acid may be converted into a salt; a salt may be converted into the free compound or another salt; a mixture of isomeric compounds of the present invention may be separated into the individual isomers. Compounds of the present invention, free form and salts thereof, may exist in multiple tautomeric forms, in which hydrogen atoms are transposed to other parts of the molecules and the chemical bonds between the atoms of the molecules are consequently rearranged.
• stereoisomer refers to isomers of identical constitution that differ in the arrangement of their atoms in space. Enantiomers and diastereomers are examples of stereoisomers.
• enantiomer refers to one of a pair of molecular species that are mirror images of each other and are not superimposable.
• diastereomer refers to stereoisomers that are not mirror images.
• racemate or “racemic mixture” refers to a composition composed of equimolar quantities of two enantiomeric species, wherein the composition is devoid of optical activity.
• R and S represent the configuration of substituents around a chiral carbon atom(s).
• the isomeric descriptors “R” and “S” are used as described herein for indicating atom configuration(s) relative to a core molecule and are intended to be used as defined in the literature (IUPAC Recommendations 1996, Pure and Applied Chemistry, 68:2193-2222 (1996)).
• chiral refers to the structural characteristic of a molecule that makes it impossible to superimpose it on its mirror image.
• homochiral refers to a state of enantiomeric purity.
• optical activity refers to the degree to which a homochiral molecule or nonracemic mixture of chiral molecules rotates a plane of polarized light.
• alkyl or “alkylene” is intended to include both branched and straight-chain saturated aliphatic hydrocarbon groups having the specified number of carbon atoms.
• Ci to Cio alkyl or “Ci_io alkyl” (or alkylene) is intended to include Ci, C 2 , C3, C 4 , C5, Ce, C7, C 8 , C9, and Cio alkyl groups.
• Ci to Ce alkyl or "C ⁇ -Ce alkyl” denotes alkyl having 1 to 6 carbon atoms.
• Alkyl group can be unsubstituted or substituted with at least one hydrogen being replaced by another chemical group.
• Example alkyl groups include, but are not limited to, methyl (Me), ethyl (Et), propyl (e.g., n-propyl and isopropyl), butyl (e.g., n-butyl, isobutyl, ?-butyl), and pentyl (e.g., n-pentyl, isopentyl, neopentyl).
• Me methyl
• Et ethyl
• propyl e.g., n-propyl and isopropyl
• butyl e.g., n-butyl, isobutyl, ?-butyl
• pentyl e.g., n-pentyl, isopentyl, neopentyl.
• Alkenyl or “alkenylene” is intended to include hydrocarbon chains of either straight or branched configuration having the specified number of carbon atoms and one or more, preferably one to two, carbon-carbon double bonds that may occur in any stable point along the chain.
• C2 to Ce alkenyl or “C2-6 alkenyl” (or alkenylene) is intended to include C 2 , C3, C 4 , C5, and Ce alkenyl groups.
• alkenyl examples include, but are not limited to, ethenyl, 1-propenyl, 2-propenyl, 2-butenyl, 3-butenyl, 2-pentenyl, 3-pentenyl, 4-pentenyl, 2-hexenyl, 3-hexenyl, 4-hexenyl, 5-hexenyl, 2-methyl-2- propenyl, and 4-methyl-3-pentenyl.
• Alkynyl or “alkynylene” is intended to include hydrocarbon chains of either straight or branched configuration having one or more, preferably one to three, carbon-carbon triple bonds that may occur in any stable point along the chain.
• C2 to Ce alkynyl or “C2-6 alkynyl” (or alkynylene) is intended to include C 2 , C3, C 4 , C5, and Ce alkynyl groups; such as ethynyl, propynyl, butynyl, pentynyl, and hexynyl.
• alkoxy or "alkyloxy” refers to an -O-alkyl group. "Ci to Ce alkoxy” or
• Ci-6 alkoxy (or alkyloxy), is intended to include Ci, C 2 , C3, C 4 , C5, and Ce alkoxy groups.
• Example alkoxy groups include, but are not limited to, methoxy, ethoxy, propoxy (e.g., n-propoxy and isopropoxy), and ?-butoxy.
• alkylthio or “thioalkoxy” represents an alkyl group as defined above with the indicated number of carbon atoms attached through a sulphur bridge; for example methyl-S- and ethyl-S-.
• Halo or halogen includes fluoro (F), chloro (CI), bromo (Br), and iodo (I).
• Haloalkyl is intended to include both branched and straight-chain saturated aliphatic hydrocarbon groups having the specified number of carbon atoms, substituted with 1 or more halogens.
• haloalkyl include, but are not limited to, fluoromethyl, difluoromethyl, trifluoromethyl, trichloromethyl, pentafluoroethyl, pentachloroethyl, 2,2,2-trifluoroethyl, heptafluoropropyl, and heptachloropropyl.
• haloalkyl also include "fluoroalkyl” that is intended to include both branched and straight-chain saturated aliphatic hydrocarbon groups having the specified number of carbon atoms, substituted with 1 or more fluorine atoms.
• Haloalkoxy or "haloalkyloxy” represents a haloalkyl group as defined above with the indicated number of carbon atoms attached through an oxygen bridge.
• “Ci to Ce haloalkoxy” or “Ci_6 haloalkoxy” is intended to include Ci, C 2 , C3, C 4 , C5, and Ce haloalkoxy groups.
• Examples of haloalkoxy include, but are not limited to, trifluoromethoxy, 2,2,2-trifluoroethoxy, and pentafluorothoxy.
• haloalkylthio or “thiohaloalkoxy” represents a haloalkyl group as defined above with the indicated number of carbon atoms attached through a sulphur bridge; for example trifluoromethyl-S-, and pentafluoroethyl-S-.
• alkylcarbonyl refer to an alkyl or substituted alkyl bonded to a carbonyl.
• hydroxy or "hydroxyl” refers to OH.
• cycloalkyl refers to cyclized alkyl groups, including mono-, bi- or poly-cyclic ring systems. "C3 to C7 cycloalkyl” or “C3-7 cycloalkyl” is intended to include C3, C 4 , C5, Ce, and C7 cycloalkyl groups.
• Example cycloalkyl groups include, but are not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and norbornyl. Branched cycloalkyl groups such as 1-methylcyclopropyl and 2-methylcyclopropyl are included in the definition of "cycloalkyl".
• carrier or “carbocyclic residue” is intended to mean any stable 3-, 4-, 5-, 6-, 7-, or 8-membered monocyclic or bicyclic or 7-, 8-, 9-, 10-, 11-, 12-, or 13-membered bicyclic or tricyclic hydrocarbon ring, any of which may be saturated, partially unsaturated, unsaturated or aromatic.
• carbocycles include, but are not limited to, cyclopropyl, cyclobutyl, cyclobutenyl, cyclopentyl, cyclopentenyl, cyclohexyl, cycloheptenyl, cycloheptyl, cycloheptenyl, adamantyl, cyclooctyl, cyclooctenyl, cyclooctadienyl, [3.3.0]bicyclooctane, [4.3.0]bicyclononane,
• bridged rings are also included in the definition of carbocycle (e.g., [2.2.2]bicyclooctane).
• Preferred carbocycles are cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, phenyl, and indanyl.
• a bridged ring occurs when one or more carbon atoms link two non-adjacent carbon atoms. Preferred bridges are one or two carbon atoms. It is noted that a bridge always converts a monocyclic ring into a tricyclic ring. When a ring is bridged, the substituents recited for the ring may also be present on the bridge.
• bicyclic carbocycle or "bicyclic carbocyclic group” is intended to mean a stable 9- or 10-membered carbocyclic ring system that contains two fused rings and consists of carbon atoms. Of the two fused rings, one ring is a benzo ring fused to a second ring; and the second ring is a 5- or 6-membered carbon ring which is saturated, partially unsaturated, or unsaturated.
• the bicyclic carbocyclic group may be attached to its pendant group at any carbon atom which results in a stable structure.
• the bicyclic carbocyclic group described herein may be substituted on any carbon if the resulting compound is stable. Examples of a bicyclic carbocyclic group are, but not limited to, naphthyl, 1 ,2-dihydronaphthyl, 1,2,3,4-tetrahydronaphthyl, and indanyl.
• Aryl groups refer to monocyclic or polycyclic aromatic hydrocarbons, including, for example, phenyl, naphthyl, and phenanthranyl. Aryl moieties are well known and described, for example, in Lewis, R.J., ed., Hawley's Condensed Chemical Dictionary, 13th Edition, John Wiley & Sons, Inc., New York (1997). "Ce or C 10 aryl” or “C6-io aryl” refers to phenyl and naphthyl.
• aryl may be unsubstituted or substituted with 1 to 5 groups, preferably 1 to 3 groups, OH, OCH 3 , CI, F, Br, I, CN, N0 2 , NH 2 , N(CH 3 )H,
• benzyl refers to a methyl group on which one of the hydrogen atoms is replaced by a phenyl group, wherein said phenyl group may optionally be substituted with 1 to 5 groups, preferably 1 to 3 groups.
• heterocycle or “heterocyclic group” is intended to mean a stable 3-, 4-, 5-, 6-, or 7-membered monocyclic or bicyclic or 7-, 8-, 9-, 10-, 1 1-, 12-, 13-, or 14-membered polycyclic heterocyclic ring that is saturated, partially unsaturated, or fully unsaturated, and that contains carbon atoms and 1 , 2, 3 or 4 heteroatoms independently selected from the group consisting of N, O and S; and including any polycyclic group in which any of the above-defined heterocyclic rings is fused to a benzene ring.
• the nitrogen and sulfur heteroatoms may optionally be oxidized (i.e., N ⁇ 0 and S(0) p , wherein p is 0, 1 or 2).
• the nitrogen atom may be substituted or unsubstituted (i.e. , N or NR wherein R is H or another substituent, if defined).
• the heterocyclic ring may be attached to its pendant group at any heteroatom or carbon atom that results in a stable structure.
• the heterocyclic rings described herein may be substituted on carbon or on a nitrogen atom if the resulting compound is stable.
• a nitrogen in the heterocycle may optionally be quaternized. It is preferred that when the total number of S and O atoms in the heterocycle exceeds 1, then these heteroatoms are not adjacent to one another.
• heterocycle it is intended to include heteroaryl.
• heterocycles include, but are not limited to, acridinyl, azetidinyl, azocinyl, benzimidazolyl, benzofuranyl, benzothiofuranyl, benzothiophenyl, benzoxazolyl, benzoxazolinyl, benzthiazolyl, benztriazolyl, benztetrazolyl,
• Examples of 5- to 10-membered heterocycles include, but are not limited to, pyridinyl, furanyl, thienyl, pyrrolyl, pyrazolyl, pyrazinyl, piperazinyl, piperidinyl, imidazolyl, imidazolidinyl, indolyl, tetrazolyl, isoxazolyl, morpholinyl, oxazolyl, oxadiazolyl, oxazolidinyl, tetrahydrofuranyl, thiadiazinyl, thiadiazolyl, thiazolyl, triazinyl, triazolyl, benzimidazolyl, lH-indazolyl, benzofuranyl, benzothiofuranyl, benztetrazolyl, benzotriazolyl, benzisoxazolyl, benzoxazolyl, oxindolyl, benzoxazolinyl,
• Examples of 5- to 6-membered heterocycles include, but are not limited to, pyridinyl, furanyl, thienyl, pyrrolyl, pyrazolyl, pyrazinyl, piperazinyl, piperidinyl, imidazolyl, imidazolidinyl, indolyl, tetrazolyl, isoxazolyl, morpholinyl, oxazolyl, oxadiazolyl, oxazolidinyl, tetrahydrofuranyl, thiadiazinyl, thiadiazolyl, thiazolyl, triazinyl, and triazolyl. Also included are fused ring and spiro compounds containing, for example, the above heterocycles.
• bicyclic heterocycle or "bicyclic heterocyclic group” is intended to mean a stable 9- or 10-membered heterocyclic ring system which contains two fused rings and consists of carbon atoms and 1, 2, 3, or 4 heteroatoms independently selected from the group consisting of N, O and S.
• one ring is a 5- or 6-membered monocyclic aromatic ring comprising a 5-membered heteroaryl ring, a 6- membered heteroaryl ring or a benzo ring, each fused to a second ring.
• the second ring is a 5- or 6-membered monocyclic ring which is saturated, partially unsaturated, or unsaturated, and comprises a 5-membered heterocycle, a 6-membered heterocycle or a carbocycle (provided the first ring is not benzo when the second ring is a carbocycle).
• the bicyclic heterocyclic group may be attached to its pendant group at any heteroatom or carbon atom which results in a stable structure.
• the bicyclic heterocyclic group described herein may be substituted on carbon or on a nitrogen atom if the resulting compound is stable. It is preferred that when the total number of S and O atoms in the heterocycle exceeds 1, then these heteroatoms are not adjacent to one another. It is preferred that the total number of S and O atoms in the heterocycle is not more than 1.
• bicyclic heterocyclic group examples include quinolinyl, isoquinolinyl, phthalazinyl, quinazolinyl, indolyl, isoindolyl, indolinyl, lH-indazolyl, benzimidazolyl, 1,2,3,4-tetrahydroquinolinyl, 1,2,3,4-tetrahydroisoquinolinyl, 5,6,7,8- tetrahydro-quinolinyl, 2,3-dihydro-benzofuranyl, chromanyl, 1,2,3,4-tetrahydro- quinoxalinyl, and 1,2,3,4-tetrahydro-quinazolinyl.
• aromatic heterocyclic group or "heteroaryl” is intended to mean stable monocyclic and polycyclic aromatic hydrocarbons that include at least one heteroatom ring member such as sulfur, oxygen, or nitrogen.
• Heteroaryl groups include, without limitation, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, furyl, quinolyl, isoquinolyl, thienyl, imidazolyl, thiazolyl, indolyl, pyrroyl, oxazolyl, benzofuryl, benzothienyl, benzthiazolyl, isoxazolyl, pyrazolyl, triazolyl, tetrazolyl, indazolyl, 1,2,4- thiadiazolyl, isothiazolyl, purinyl, carbazolyl, benzimidazolyl, indolinyl,
• benzodioxolanyl and benzodioxane.
• Heteroaryl groups are substituted or unsubstituted.
• the nitrogen atom is substituted or unsubstituted (i.e., N or NR wherein R is H or another substituent, if defined).
• the nitrogen and sulfur heteroatoms may optionally be oxidized (i.e., N ⁇ 0 and S(0) p , wherein p is 0, 1 or 2).
• Bridged rings are also included in the definition of heterocycle.
• a bridged ring occurs when one or more atoms (i.e., C, O, N, or S) link two non-adjacent carbon or nitrogen atoms.
• Examples of bridged rings include, but are not limited to, one carbon atom, two carbon atoms, one nitrogen atom, two nitrogen atoms, and a carbon-nitrogen group. It is noted that a bridge always converts a monocyclic ring into a tricyclic ring. When a ring is bridged, the substituents recited for the ring may also be present on the bridge.
• counterion is used to represent a negatively charged species such as chloride, bromide, hydroxide, acetate, and sulfate.
• a dotted ring When a dotted ring is used within a ring structure, this indicates that the ring structure may be saturated, partially saturated or unsaturated.
• substituted means that at least one hydrogen atom is replaced with a non-hydrogen group, provided that normal valencies are maintained and that the substitution results in a stable compound.
• 2 hydrogens on the atom are replaced.
• Keto substituents are not present on aromatic moieties.
• a ring system e.g., carbocyclic or heterocyclic
• nitrogen atoms e.g., amines
• these may be converted to N-oxides by treatment with an oxidizing agent (e.g., mCPBA and/or hydrogen peroxides) to afford other compounds of this invention.
• an oxidizing agent e.g., mCPBA and/or hydrogen peroxides
• shown and claimed nitrogen atoms are considered to cover both the shown nitrogen and its N-oxide (N ⁇ 0) derivative.
• phrases "pharmaceutically acceptable” is employed herein to refer to those compounds, materials, compositions, and/or dosage forms that 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, and/or other problem or complication, commensurate with a reasonable benefit/risk ratio.
• 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 groups such as amines; and alkali or organic salts of acidic groups such as carboxylic acids.
• the pharmaceutically acceptable salts include the conventional non-toxic salts or the quaternary ammonium salts of the parent compound formed, for example, from non-toxic inorganic or organic acids.
• such conventional non-toxic salts include those derived from inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, and nitric; and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic,
• inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, and nitric
• organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic,
• the pharmaceutically acceptable salts of the present invention can be synthesized from the 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, nonaqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are preferred. Lists of suitable salts are found in Remington 's Pharmaceutical Sciences, 18th Edition, Mack Publishing Company, Easton, PA (1990), the disclosure of which is hereby incorporated by reference.
• compounds of formula I may have prodrug forms. Any compound that will be converted in vivo to provide the bioactive agent (i.e., a compound of formula I) is a prodrug within the scope and spirit of the invention.
• a prodrug within the scope and spirit of the invention.
• Various forms of prodrugs are well known in the art. For examples of such prodrug derivatives, see:
• Compounds containing a carboxy group can form physiologically hydrolyzable esters that serve as prodrugs by being hydrolyzed in the body to yield formula I compounds per se.
• Such prodrugs are preferably administered orally since hydrolysis in many instances occurs principally under the influence of the digestive enzymes.
• Parenteral administration may be used where the ester per se is active, or in those instances where hydrolysis occurs in the blood. Examples of physiologically
• hydrolyzable esters of compounds of formula I include Ci- 6 alkyl, Ci_ 6 alkylbenzyl, 4-methoxybenzyl, indanyl, phthalyl, methoxymethyl, Ci_6 alkanoyloxy-Ci_ 6 alkyl (e.g., acetoxymethyl, pivaloyloxymethyl or propionyloxymethyl), Ci- 6 alkoxycarbonyloxy- Ci- 6 alkyl (e.g., methoxycarbonyloxymethyl or ethoxycarbonyloxymethyl, glycyloxymethyl, phenylglycyloxymethyl, (5-methyl-2-oxo-l,3-dioxolen-4-yl)methyl), and other well known physiologically hydrolyzable esters used, for example, in the penicillin and cephalosporin arts. Such esters may be prepared by conventional techniques known in the art.
• the present invention is intended to include all isotopes of atoms occurring in the present compounds.
• Isotopes include those atoms having the same atomic number but different mass numbers.
• isotopes of hydrogen include deuterium and tritium.
• isotopes of carbon include 13 C and 14 C.
• Isotopically-labeled compounds of the invention can generally be prepared by conventional techniques known to those skilled in the art or by processes analogous to those described herein, using an appropriate isotopically-labeled reagent in place of the non-labeled reagent otherwise employed. Such compounds have a variety of potential uses, e.g., as standards and reagents in determining the ability of a potential
• “Stable compound” and “stable structure” are meant to indicate a compound that is sufficiently robust to survive isolation to a useful degree of purity from a reaction mixture, and formulation into an efficacious therapeutic agent. It is preferred that compounds of the present invention do not contain a N-halo, S(0)2H, or S(0)H group.
• solvate means a physical association of a compound of this invention with one or more solvent molecules, whether organic or inorganic. This physical association includes hydrogen bonding. In certain instances the solvate will be capable of isolation, for example when one or more solvent molecules are incorporated in the crystal lattice of the crystalline solid.
• the solvent molecules in the solvate may be present in a regular arrangement and/or a non-ordered arrangement.
• the solvate may comprise either a stoichiometric or nonstoichiometric amount of the solvent molecules.
• “Solvate” encompasses both solution-phase and isolable solvates. Exemplary solvates include, but are not limited to, hydrates, ethanolates, methanolates, and isopropanolates. Methods of solvation are generally known in the art.
• the compounds of the present invention can be prepared in a number of ways known to one skilled in the art of organic synthesis. rv. BIOLOGY
• blood coagulation is essential to the regulation of an organism's hemostasis, it is also involved in many pathological conditions.
• a blood clot, or thrombus may form and obstruct circulation locally, causing ischemia and organ damage.
• embolism the clot may dislodge and subsequently become trapped in a distal vessel, where it again causes ischemia and organ damage.
• thromboembolic disorders Diseases arising from pathological thrombus formation are collectively referred to as thromboembolic disorders and include acute coronary syndrome, unstable angina, myocardial infarction, thrombosis in the cavity of the heart, ischemic stroke, deep vein thrombosis, peripheral occlusive arterial disease, transient ischemic attack, and pulmonary embolism.
• thrombosis occurs on artificial surfaces in contact with blood, including catheters, stents, artificial heart valves, and hemodialysis membranes.
• Antithrombotic agents are frequently given to patients at risk of developing thromboembolic disease because of the presence of one or more predisposing risk factors from Virchow's triad to prevent formation of an occlusive thrombus (primary prevention).
• primary prevention For example, in an orthopedic surgery setting (e.g., hip and knee replacement), an antithrombotic agent is frequently administered prior to a surgical procedure.
• the antithrombotic agent counterbalances the prothrombotic stimulus exerted by vascular flow alterations (stasis), potential surgical vessel wall injury, as well as changes in the composition of the blood due to the acute phase response related to surgery.
• an antithrombotic agent for primary prevention is dosing with aspirin, a platelet activation inhibitor, in patients at risk for developing thrombotic cardiovascular disease.
• well recognized risk factors in this setting include age, male gender, hypertension, diabetes mellitus, lipid alterations, and obesity.
• Antithrombotic agents are also indicated for secondary prevention, following an initial thrombotic episode.
• patients with mutations in factor V also known as factor V Leiden
• additional risk factors e.g., pregnancy
• anticoagulants to prevent the reoccurrence of venous thrombosis.
• Another example entails secondary prevention of cardiovascular events in patients with a history of acute myocardial infarction or acute coronary syndrome.
• a combination of aspirin and clopidogrel or other thienopyridines may be used to prevent a second thrombotic event.
• Antithrombotic agents are also given to treat the disease state (i.e., by arresting its development) after it has already started.
• patients presenting with deep vein thrombosis are treated with anticoagulants (i.e., heparin, warfarin, or LMWH) to prevent further growth of the venous occlusion. Over time, these agents also cause a regression of the disease state because the balance between prothrombotic factors and
• anticoagulant/pro fibrinolytic pathways is changed in favor of the latter.
• Examples on the arterial vascular bed include the treatment of patients with acute myocardial infarction or acute coronary syndrome with aspirin and clopidogrel to prevent further growth of vascular occlusions and eventually leading to a regression of thrombotic occlusions.
• antithrombotic agents are used widely for primary and secondary prevention (i.e., prophylaxis or risk reduction) of thromboembolic disorders, as well as treatment of an already existing thrombotic process.
• Drugs that inhibit blood coagulation, or anticoagulants are "pivotal agents for prevention and treatment of thromboembolic disorders" (Hirsh, J. et al, Blood, 105:453-463 (2005)).
• Factor Xlla has a number of target proteins, including plasma prekallikrein and factor XL Active plasma kallikrein further activates factor XII, leading to an amplification of contact activation.
• plasma prekallikrein and factor XL Active plasma kallikrein further activates factor XII, leading to an amplification of contact activation.
• factor Xllf has a number of target proteins, including plasma prekallikrein and factor XL Active plasma kallikrein further activates factor XII, leading to an amplification of contact activation.
• the serine protease serine protease
• prolylcarboxylpeptidase can activate plasma kallikrein complexed with high molecular weight kininogen in a multiprotein complex formed on the surface of cells and matrices (Shariat-Madar et al, Blood, 108: 192-199 (2006)).
• Contact activation is a surface mediated process responsible in part for the regulation of thrombosis and inflammation, and is mediated, at least in part, by fibrinolytic-, complement-, kininogen/kinin-, and other humoral and cellular pathways (for review, Coleman, R., "Contact Activation Pathway", Hemostasis and Thrombosis, pp.
• factor XII deficient mice More specifically, factor XII deficient mice were protected from thrombotic vascular occlusion in several thrombosis models as well as stroke models and the phenotype of the XII deficient mice was identical to XI deficient mice (Renne et al, J. Exp. Med., 202:271-281 (2005);
• factor XI is downstream from factor Xlla, combined with the identical phenotype of the XII and XI deficient mice suggest that the contact activation system could play a major role in factor XI activation in vivo.
• Factor XI is a zymogen of a trypsin-like serine protease and is present in plasma at a relatively low concentration. Proteolytic activation at an internal R369-1370 bond yields a heavy chain (369 amino acids) and a light chain (238 amino acids). The latter contains a typical trypsin-like catalytic triad (H413, D464, and S557). Activation of factor XI by thrombin is believed to occur on negatively charged surfaces, most likely on the surface of activated platelets.
• Platelets contain high affinity (0.8 nM) specific sites (130-500/platelet) for activated factor XL After activation, factor XIa remains surface bound and recognizes factor IX as its normal macromolecular substrate. (Galiani, D., Trends Cardiovasc. Med., 10: 198-204 (2000)).
• thrombin activates thrombin activated fibrinolysis inhibitor (TAFI), a plasma carboxypeptidase that cleaves C-terminal lysine and arginine residues on fibrin, reducing the ability of fibrin to enhance tissue-type plasminogen activator (tPA) dependent plasminogen activation.
• TAFI thrombin activated fibrinolysis inhibitor
• tPA tissue-type plasminogen activator
• baboon cross-reactive, function blocking antibodies to human factor XI protect against baboon arterial - venous shunt thrombosis (Gruber et al, Blood, 102:953- 955 (2003)).
• Evidence for an antithrombotic effect of small molecule inhibitors of factor XIa is also disclosed in published U.S. Patent Publication No. 2004/0180855 Al. Taken together, these studies suggest that targeting factor XI will reduce the propensity for thrombotic and thromboembolic diseases.
• factor XI is not required for normal homeostasis, implying a superior safety profile of the factor XI mechanism compared to competing antithrombotic mechanisms.
• hemophilia A factor VIII deficiency
• hemophilia B factor IX deficiency
• mutations of the factor XI gene causing factor XI deficiency result in only a mild to moderate bleeding diathesis characterized primarily by postoperative or posttraumatic, but rarely spontaneous hemorrhage. Postoperative bleeding occurs mostly in tissue with high concentrations of endogenous fibrinolytic activity (e.g., oral cavity, and urogenital system). The majority of the cases are fortuitously identified by preoperative prolongation of aPTT (intrinsic system) without any prior bleeding history.
• aPTT intrinsic system
• factor XI activation can be determined by complex formation with either C 1 inhibitor or alpha 1 antitrypsin.
• AMI acute myocardial infarction
• This study can be viewed as evidence that at least in a subpopulation of patients with AMI, factor XI activation contributes to thrombin formation (Minnema, M.C. et al, Arterioscler. Thromb. Vase. Biol, 20:2489-2493
• aPTT activated partial thromboplastin time
• PT prothrombin time
• patient encompasses all mammalian species.
• treating cover the treatment of a disease-state in a mammal, particularly in a human, and include: (a) inhibiting the disease-state, i.e., arresting it development; and/or (b) relieving the disease-state, i.e., causing regression of the disease state.
• prophylaxis or “prevention” cover the preventive treatment of a subclinical disease-state in a mammal, particularly in a human, aimed at reducing the probability of the occurrence of a clinical disease-state.
• Patients are selected for preventative therapy based on factors that are known to increase risk of suffering a clinical disease state compared to the general population.
• "Prophylaxis” therapies can be divided into (a) primary prevention and (b) secondary prevention.
• Primary prevention is defined as treatment in a subject that has not yet presented with a clinical disease state, whereas secondary prevention is defined as preventing a second occurrence of the same or similar clinical disease state.
• risk reduction covers therapies that lower the incidence of development of a clinical disease state.
• primary and secondary prevention therapies are examples of risk reduction.
• “Therapeutically effective amount” is intended to include an amount of a compound of the present invention that is effective when administered alone or in combination to inhibit factor XIa and/or plasma kallikrein and/or to prevent or treat the disorders listed herein.
• the term refers to combined amounts of the active ingredients that result in the preventive or therapeutic effect, whether administered in combination, serially, or simultaneously.
• thrombosis refers to formation or presence of a thrombus (pi. thrombi); clotting within a blood vessel that may cause ischemia or infarction of tissues supplied by the vessel.
• emblism refers to sudden blocking of an artery by a clot or foreign material that has been brought to its site of lodgment by the blood current.
• thromboembolism refers to obstruction of a blood vessel with thrombotic material carried by the blood stream from the site of origin to plug another vessel.
• thromboembolic disorders entails both "thrombotic” and “embolic” disorders (defined above).
• thromboembolic disorders includes arterial cardiovascular thromboembolic disorders, venous cardiovascular or cerebrovascular thromboembolic disorders, and thromboembolic disorders in the chambers of the heart or in the peripheral circulation.
• thromboembolic disorders also includes specific disorders selected from, but not limited to, unstable angina or other acute coronary syndromes, atrial fibrillation, first or recurrent myocardial infarction, ischemic sudden death, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombosis, deep vein thrombosis, thrombophlebitis, arterial embolism, coronary arterial thrombosis, cerebral arterial thrombosis, cerebral embolism, kidney embolism, pulmonary embolism, and thrombosis resulting from medical implants, devices, or procedures in which blood is exposed to an artificial surface that promotes thrombosis.
• the medical implants or devices include, but are not limited to: prosthetic valves, artificial valves, indwelling catheters, stents, blood oxygenators, shunts, vascular access ports, ventricular assist devices and artificial hearts or heart chambers, and vessel grafts.
• the procedures include, but are not limited to:
• thromboembolic disorders includes acute coronary syndrome, stroke, deep vein thrombosis, and pulmonary embolism.
• the present invention provides a method for the treatment of a thromboembolic disorder, wherein the thromboembolic disorder is selected from unstable angina, an acute coronary syndrome, atrial fibrillation, myocardial infarction, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombosis, deep vein thrombosis, thrombophlebitis, arterial embolism, coronary arterial thrombosis, cerebral arterial thrombosis, cerebral embolism, kidney embolism, pulmonary embolism, and thrombosis resulting from medical implants, devices, or procedures in which blood is exposed to an artificial surface that promotes thrombosis.
• the thromboembolic disorder is selected from unstable angina, an acute coronary syndrome, atrial fibrillation, myocardial infarction, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombosis, deep vein thrombosis,
• the present invention provides a method for the treatment of a thromboembolic disorder, wherein the thromboembolic disorder is selected from acute coronary syndrome, stroke, venous thrombosis, atrial fibrillation, and thrombosis resulting from medical implants and devices.
• the present invention provides a method for the primary prophylaxis of a thromboembolic disorder, wherein the thromboembolic disorder is selected from unstable angina, an acute coronary syndrome, atrial fibrillation, myocardial infarction, ischemic sudden death, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombosis, deep vein thrombosis, thrombophlebitis, arterial embolism, coronary arterial thrombosis, cerebral arterial thrombosis, cerebral embolism, kidney embolism, pulmonary embolism, and thrombosis resulting from medical implants, devices, or procedures in which blood is exposed to an artificial surface that promotes thrombosis.
• the thromboembolic disorder is selected from unstable angina, an acute coronary syndrome, atrial fibrillation, myocardial infarction, ischemic sudden death, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease,
• the present invention provides a method for the primary prophylaxis of a thromboembolic disorder, wherein the thromboembolic disorder is selected from acute coronary syndrome, stroke, venous thrombosis, and thrombosis resulting from medical implants and devices.
• the present invention provides a method for the secondary prophylaxis of a thromboembolic disorder, wherein the thromboembolic disorder is selected from unstable angina, an acute coronary syndrome, atrial fibrillation, recurrent myocardial infarction, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombosis, deep vein thrombosis, thrombophlebitis, arterial embolism, coronary arterial thrombosis, cerebral arterial thrombosis, cerebral embolism, kidney embolism, pulmonary embolism, and thrombosis resulting from medical implants, devices, or procedures in which blood is exposed to an artificial surface that promotes thrombosis.
• the thromboembolic disorder is selected from unstable angina, an acute coronary syndrome, atrial fibrillation, recurrent myocardial infarction, transient ischemic attack, stroke, atherosclerosis, peripheral occlusive arterial disease, venous thrombo
• the present invention provides a method for the secondary prophylaxis of a thromboembolic disorder, wherein the thromboembolic disorder is selected from acute coronary syndrome, stroke, atrial fibrillation and venous thrombosis.
• thromboembolic disorder is selected from acute coronary syndrome, stroke, atrial fibrillation and venous thrombosis.
• stroke refers to embolic stroke or atherothrombotic stroke arising from occlusive thrombosis in the carotid communis, carotid interna, or intracerebral arteries.
• thrombosis includes vessel occlusion (e.g., after a bypass) and reocclusion (e.g., during or after percutaneous transluminal coronary angioplasty).
• the thromboembolic disorders may result from conditions including but not limited to atherosclerosis, surgery or surgical complications, prolonged immobilization, arterial fibrillation, congenital thrombophilia, cancer, diabetes, effects of medications or hormones, and complications of pregnancy.
• Thromboembolic disorders are frequently associated with patients with atherosclerosis.
• Risk factors for atherosclerosis include but are not limited to male gender, age, hypertension, lipid disorders, and diabetes mellitus. Risk factors for atherosclerosis are at the same time risk factors for complications of atherosclerosis, i.e., thromboembolic disorders.
• thromboembolic disorders Similarly, arterial fibrillation is frequently associated with thromboembolic disorders. Risk factors for arterial fibrillation and subsequent thromboembolic disorders include cardiovascular disease, rheumatic heart disease, nonrheumatic mitral valve disease, hypertensive cardiovascular disease, chronic lung disease, and a variety of miscellaneous cardiac abnormalities as well as thyrotoxicosis.
• Risk factors for the more common type 2 include, but are not limited to, are family history, obesity, physical inactivity, race/ethnicity, previously impaired fasting glucose or glucose tolerance test, history of gestational diabetes mellitus or delivery of a "big baby", hypertension, low HDL cholesterol, and polycystic ovary syndrome.
• Risk factors for congenital thrombophilia include gain of function mutations in coagulation factors or loss of function mutations in the anticoagulant- or fibrinolytic pathways.
• Thrombosis has been associated with a variety of tumor types, e.g., pancreatic cancer, breast cancer, brain tumors, lung cancer, ovarian cancer, prostate cancer, gastrointestinal malignancies, and Hodgkins or non-Hodgkins lymphoma. Recent studies suggest that the frequency of cancer in patients with thrombosis reflects the frequency of a particular cancer type in the general population (Levitan, N. et al, Medicine
• VTE venous thromboembolism
• Cancer patients at risk for thrombosis may possess any or all of the following risk factors: (i) the stage of the cancer (i.e., presence of metastases), (ii) the presence of central vein catheters, (iii) surgery and anticancer therapies including chemotherapy, and (iv) hormones and antiangiogenic drugs.
• stage of the cancer i.e., presence of metastases
• central vein catheters i.e., central vein catheters
• surgery and anticancer therapies including chemotherapy iv
• hormones and antiangiogenic drugs hormones and antiangiogenic drugs.
• the effectiveness of compounds of the present invention as inhibitors of the coagulation Factors XIa, Vila, IXa, Xa, Xlla, plasma kallikrein or thrombin can be determined using a relevant purified serine protease, respectively, and an appropriate synthetic substrate.
• the rate of hydrolysis of the chromogenic or fluorogenic substrate by the relevant serine protease was measured both in the absence and presence of compounds of the present invention.
• Factor XIa determinations were made in 50 mM HEPES buffer at pH 7.4 containing 145 mM NaCl, 5 mM KC1, and 0.1% PEG 8000 (polyethylene glycol; JT Baker or Fisher Scientific). Determinations were made using purified human Factor XIa at a final concentration of 25-200 pM (Haematologic Technologies) and the synthetic substrate S-2366 (pyroGlu-Pro-Arg-pNA; CHROMOGENIX® or AnaSpec) at a concentration of 0.0002-0.001 M.
• Factor IXa determinations were made in 0.005 M calcium chloride, 0.1 M sodium chloride, 0.0000001 M Refludan (Berlex), 0.05 M TRIS base and 0.5% PEG 8000 at a pH of 7.4. Refludan was added to inhibit small amounts of thrombin in the commercial preparations of human Factor IXa. Determinations were made using purified human Factor IXa (Haematologic Technologies) at a final assay concentration of 20-100 nM and the synthetic substrate PCIXA2100-B (CenterChem) or Pefafluor IXa 3688 (H-D-Leu- Ph'Gly-Arg-AMC; CenterChem) at a concentration of 0.0004-0.0005 M.
• Factor Xa determinations were made in 0.1 M sodium phosphate buffer at a pH of 7.5 containing 0.2 M sodium chloride and 0.5% PEG 8000. Determinations were made using purified human Factor Xa (Haematologic Technologies) at a final assay
• Factor Xlla determinations were made in 0.05 M HEPES buffer at pH 7.4 containing 0.145 M NaCl, 0.005 M KC1, and 0.1% PEG 8000. Determinations were made using purified human Factor Xlla at a final concentration of 4 nM (American Diagnostica) and the synthetic substrate SPECTROZYME® #312 (H-D-CHT-Gly-L-Arg- pNA.2AcOH; American Diagnostica) at a concentration of 0.00015 M.
• Plasma kallikrein determinations were made in 0.1 M sodium phosphate buffer at a pH of 7.5 containing 0.1-0.2 M sodium chloride and 0.5% PEG 8000. Determinations were made using purified human plasma kallikrein (Enzyme Research Laboratories) at a final assay concentration of 200 pM and the synthetic substrate S-2302 (H-(D)-Pro-Phe- Arg-pNA; CHROMOGENIX®) at a concentration of 0.00008-0.0004 M.
• Thrombin determinations were made in 0.1 M sodium phosphate buffer at a pH of 7.5 containing 0.2 M sodium chloride and 0.5% PEG 8000. Determinations were made using purified human alpha thrombin (Haematologic Technologies or Enzyme Research Laboratories) at a final assay concentration of 200-250 pM and the synthetic substrate S- 2366 (pyroGlu-Pro-Arg-pNA; CHROMOGENIX® or AnaSpec) at a concentration of 0.0002-0.0004 M.
• K m The Michaelis constant, K m , for substrate hydrolysis by each protease, was determined at 25 °C or 37 °C in the absence of inhibitor. Values of Ki were determined by allowing the protease to react with the substrate in the presence of the inhibitor.
• v 0 is the velocity of the control in the absence of inhibitor
• v s is the velocity in the presence of inhibitor
• V max is the maximum reaction velocity
• I is the concentration of inhibitor
• A is the minimum activity remaining (usually locked at zero);
• B is the maximum activity remaining (usually locked at 1.0);
• n is the Hill coefficient, a measure of the number and cooperativity of potential inhibitor binding sites;
• IC5 0 is the concentration of inhibitor that produces 50% inhibition under the conditions;
• 3 ⁇ 4 is the dissociation constant of the enzyme: inhibitor complex
• S is the concentration of substrate
• K m is the Michaelis constant for the substrate.
• the effectiveness of compounds of the present invention as inhibitors of coagulation can be determined using a standard or modified clotting assay.
• An increase in the plasma clotting time in the presence of inhibitor is indicative of anticoagulation.
• Relative clotting time is the clotting time in the presence of an inhibitor divided by the clotting time in the absence of an inhibitor.
• the results of this assay may be expressed as IC1.5x or IC2x, the inhibitor concentration required to increase the clotting time by 50 or 100 percent, respectively.
• the IC1.5x or IC2x is found by linear interpolation from relative clotting time versus inhibitor concentration plots using inhibitor concentration that spans the IC1.5x or IC2x.
• Clotting times are determined using citrated normal human plasma as well as plasma obtained from a number of laboratory animal species (e.g., rat, or rabbit). A compound is diluted into plasma beginning with a 10 mM DMSO stock solution. The final concentration of DMSO is less than 2%. Plasma clotting assays are performed in an automated coagulation analyzer (SYSMEX®, Dade-Behring, Illinois). Similarly, clotting times can be determined from laboratory animal species or humans dosed with compounds of the invention.
• SYSMEX® automated coagulation analyzer
• Activated Partial Thromboplastin Time is determined using ALEXIN® (Trinity Biotech, Ireland) or ACTIN® (Dade-Behring, Illinois) following the directions in the package insert.
• Plasma 0.05 mL
• ALEXIN® or ACTIN® 0.05 mL
• Calcium chloride 25 mM, 0.05 mL
• the clotting time is the time in seconds from the moment calcium chloride is added until a clot is detected.
• Prothrombin Time is determined using thromboplastin (Thromboplastin C Plus or IN OVIN®, Dade-Behring, Illinois) following the directions in the package insert. Plasma (0.05 mL) is warmed to 37 °C for 1 minute. Thromboplastin (0.1 mL) is added to the plasma to initiate coagulation. The clotting time is the time in seconds from the moment thromboplastin is added until a clot is detected.

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