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
  • A61K31/435—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
  • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
  • A61K31/4439—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. omeprazole
• • 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
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
• • 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
• • 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
  • A61K31/4545—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring hetero atom, e.g. pipamperone, anabasine
• • 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
  • A61K31/455—Nicotinic acids, e.g. niacin; Derivatives thereof, e.g. esters, amides
• • 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
  • A61K31/4965—Non-condensed pyrazines
  • A61K31/497—Non-condensed pyrazines 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
  • A61K31/495—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
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/04—Drugs for skeletal disorders for non-specific disorders of the connective tissue
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • 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
  • C07D401/02—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
  • C07D403/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00
  • C07D403/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings
  • C07D403/04—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings directly linked by a ring-member-to-ring-member bond

Definitions

• aldehyde compounds for use in treating diseases such as pulmonary fibrosis, hypoxia, and connective tissue and autoimmune disease such as scleroderma, lupus, arthritis and related conditions in a mammal.
• Idiopathic pulmonary fibrosis is a deadly lung disease that causes chronic, progressive, and irreversible fibrosis in the lungs. It is characterized by alveolar damage and exaggerated fibrous tissue production that results in obliteration of lung parenchyma and subsequent lung dysfunction (see Wilson, M. S. and T. A. Wynn (2009). "Pulmonary fibrosis: pathogenesis, etiology and regulation.” Mucosal Immunol 2(2): 103-121).
• IPF Idiopathic pulmonary fibrosis
• hypoxia arise in patients with IPF because the body (or a tissue, or a cell) is deprived of oxygen
• One of the clinical manifestations of hypoxia is exertional breathlessness for which there are no available drugs to date (see Baddini Martinez, J. A., T. Y. Martinez, F. P. Lovetro Galhardo and C. A. de Castro Pereira (2002). "Dyspnea scales as a measure of health- related quality of life in patients with idiopathic pulmonary fibrosis.” Med Sci Monit 8(6): CR405- 410; see also Parshall, M. B., R. M. Schwartzstein, L. Adams, R. B. Banzett, H. L. Manning, J.
• Oxygen deprivation resulting from hypoxemia and/or hypoxia can, in turn, cause severe organ damage and even death. Therefore, there continues to be a significant need for drugs useful in the treatment of above diseases or conditions.
• Oxygen loading of hemoglobin is compromised in many conditions, including lung diseases that result in decreased oxygen diffusion in the lungs, such as Idiopathic pulmonary fibrosis (IPF), or with increased altitude ⁇ i.e., low alveolar oxygen availability).
• the compounds provided and/or disclosed herein increase hemoglobin oxygen affinity and improve oxygen uptake under hypoxic conditions or diseases where the lungs lose their ability to transfer oxygen into the bloodstream (such as IPF and lung injury) and increase delivery of oxygen to cells and tissues.
• Compound 1 not only significantly improved hypoxemia, but also attenuated pulmonary inflammation and pulmonary fibrosis.
• Compound 1 binds covalently and reversibly via Schiff base to the N-terminal valine of the hemoglobin (Hb) alpha chain and allosterically modulates the Hb-oxygen (Hb-0 2 ) affinity. Without being bound by any theory, it also believed that Compound 1 elicits a concentration-dependent left shift in the oxygen equilibrium curve with subsequent increase in Hb-0 2 affinity and arterial oxygen loading.
• compounds that increase Hb-0 2 affinity could be useful in the treatment of pulmonary fibrosis including inflammation associated therewith and also in the treatment of connective tissue and autoimmune diseases such as scleroderma, lupus, rheumatoid arthritis, polymyositis and dermatomyositis.
• a method of treating pulmonary fibrosis in a patient in need thereof comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the pulmonary fibrosis is lung fibrosis.
• the pulmonary fibrosis is lung fibrosis.
• the lung fibrosis is fibrosing mediastinitis.
• the pulmonary fibrosis is idiopathic, e.g., IPF.
• the pulmonary fibrosis is caused by the use of certain medicines, including, for example, certain chemotherapeutic drugs ⁇ e.g., methotrexate and cyclophosphamide), heart medications (e.g., amiodarone and propranolol), and antibiotics (e.g., nitrofurantoin and sulfasalazine).
• the pulmonary fibrosis is caused by inhalation exposure to environmental and occupational pollutants, including, for example, asbestos, silica, and hard metal dusts.
• the pulmonary fibrosis is caused by connective tissue diseases, including, for example, systemic lupus erythematosus, rheumatoid arthritis, and scleroderma.
• the pulmonary fibrosis is caused by inflammatory diseases, including, for example, sarcoidosis.
• the pulmonary fibrosis is caused by bacterial or viral infections, including, for example, tuberculosis, and pneumonia.
• a method of treating inflammation associated with pulmonary fibrosis in a patient in need thereof comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the pulmonary fibrosis is idiopathic, e.g., IPF.
• provided herein is a method of treating hypoxia in a patient, comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the patient is in need of such treatment and the patient is suffering from IPF.
• a method of increasing oxygen saturation of arterial blood in a patient with hypoxia comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the patient is in need of such treatment.
• provided herein is a method of improving oxygen delivery to a tissue or a cell of a patient with hypoxia, comprising administering to the patient a
• the patient is in need of such treatment and is suffering from IPF.
• the patient has been or will be exposed to high altitude.
• the patient is suffering from high altitude hypoxia.
• the patient with hypoxia has been or will be diving underwater.
• the patient is suffering from deep or shallow water blackout.
• provided herein is a method for increasing oxygen uptake in the lungs of patients with acidosis in the fluids accumulated in lungs, comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the patient is in need of such treatment.
• provided herein is a method of reducing lactate build-up in a tissue or a cell of a patient with hypoxia, comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the patient is in need of such treatment.
• provided herein is a method of reducing acidosis of arterial blood of a patient with hypoxia, comprising administering to the patient a therapeutically effective amount of a compound described herein.
• the patient is in need of such treatment.
• hypoxia is acute hypoxia. In another embodiment, the hypoxia is chronic hypoxia.
• the hypoxia is caused by decreased oxygen uptake in the lungs.
• the hypoxia is caused by lung disease, such as acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, pulmonary edema, cystic fibrosis of the lungs, asthma, pneumonia, rheumatoid lung disease, acute lung injury (e.g., caused by multi-organ dysfunction syndrome (MODS), ventilator-associated lung injury, smoke-inhalation induced lung injury, or chemical or thermal burn to the lungs), or IPD.
• the hypoxia is caused by lung cancer.
• the hypoxia is caused by pulmonary venous thromboembolism, heart failure, pulmonary hypertension, or congestive heart failure.
• the hypoxia is caused by sleep disordered breathing, for example, obstructive sleep apnea and central sleep apnea.
• the hypoxia is caused by altitude sickness.
• the hypoxia is caused by IPF.
• the ARDS results at least in part from one or more of: breathing vomit into the lungs (aspiration), inhaling chemicals, lung transplantation, pneumonia, septic shock (for example, from infection throughout the body), and trauma.
• RBC red blood cell
• treatment of a patient with a compound as described herein is in combination with a composition or treatment regimen for increasing red blood cells in a patient.
• the cancer treatment is a chemotherapy drug which induces pulmonary toxicity, non-limiting examples of which include etoposide, cyclophosphamide, chlorambucil, busulfan, and bleomycin.
• the hypoxia is characterized by a partial oxygen pressure of less than 80 mm Hg, preferably, less than 60 mm Hg, more preferably less than 40 mm Hg, and yet more preferably less than 20 mm Hg.
• the method provided herein further comprises administering one or more of an anti- infective agent such as an antibiotic, an anti-inflammatory agent, an anti-fibrotic such as pirfenidone or nintedanib, an anti-oxidant, a sedative, and an agent that helps remove fluid from the lungs such as a surfactant.
• an anti- infective agent such as an antibiotic, an anti-inflammatory agent, an anti-fibrotic such as pirfenidone or nintedanib, an anti-oxidant, a sedative, and an agent that helps remove fluid from the lungs such as a surfactant.
• a pharmaceutically acceptable composition comprising a compound described herein.
• the pharmaceutically acceptable composition comprises at least one pharmaceutically acceptable excipient.
• at least one of the pharmaceutically acceptable excipient is a carrier or a diluent.
• the injectable composition further comprises water and a pH adjusting agent.
• the pharmaceutically acceptable composition is a parenteral composition. In one embodiment, the pharmaceutically acceptable composition is an injectable composition.
• FIGURE 1A shows a summary of the effects of compound 1 on Hb 0 2 affinity in whole blood.
• FIGURE IB illustrates the effect of compound 1 on Hb 0 2 affinity in whole blood.
• FIGURE 1 C illustrates the Bohr Effect of compound 1 in whole blood.
• FIGURE ID shows a summary of the effects of compound 2 on Hb 0 2 affinity in whole blood.
• FIGURE IE illustrates the effect of compound 2 on Hb 0 2 affinity in whole blood.
• FIGURE IF illustrates the Bohr Effect of compound 2 in whole blood.
• FIGURE 1G shows a summary of the effects of compound 3 on Hb 0 2 affinity in whole blood.
• FIGURE 1H illustrates the effect of compound 3 on Hb 0 2 affinity in whole blood.
• FIGURE II illustrates the Bohr Effect of compound 3 in whole blood.
• FIGURE 1 J shows a summary of the effects of compound 4 on Hb 0 2 affinity in whole blood.
• FIGURE IK illustrates the effect of compound 4 on Hb 0 2 affinity in whole blood.
• FIGURE 1L illustrates the Bohr Effect of compound 4 in whole blood.
• FIGURE 1M (TABLE 5) shows a summary of the effects of compound 5 on Hb 0 2 affinity in whole blood.
• FIGURE IN illustrates the effect of compound 5 on Hb 0 2 affinity in whole blood.
• FIGURE 10 illustrates the Bohr Effect of compound 5 in whole blood.
• FIGURE IP (TABLE 6) shows a summary of the effects of compound 6 on Hb 0 2 affinity in whole blood.
• FIGURE 1Q illustrates the effect of compound 6 on Hb 0 2 affinity in whole blood.
• FIGURE 1R illustrates the Bohr Effect of compound 6 in whole blood.
• FIGURE 1 S shows a summary of the effects of compound 7 on Hb 0 2 affinity in whole blood.
• FIGURE IT illustrates the effect of compound 7 on Hb 0 2 affinity in whole blood.
• FIGURE 1U illustrates the Bohr Effect of compound 7 in whole blood.
• FIGURE IV shows a summary of the effects of compound 8 on Hb 0 2 affinity in whole blood.
• FIGURE 1 W illustrates the effect of compound 8 on Hb 0 2 affinity in whole blood.
• FIGURE IX illustrates the Bohr Effect of compound 8 in whole blood.
• FIGURE 1 Y (TABLE 9) shows a summary of the effects of compound 9 on Hb 0 2 affinity in whole blood.
• FIGURE 1Z illustrates the effect of compound 9 on Hb 0 2 affinity in whole blood.
• FIGURE 1 A A illustrates the Bohr Effect of compound 9 in whole blood.
• FIGURE 1 AB (TABLE 10) shows a summary of the effects of compound 10 on Hb 0 2 affinity in whole blood.
• FIGURE 1 AC illustrates the effect of compound 10 on Hb 0 2 affinity in whole blood.
• FIGURE IAD (TABLE 11) shows a summary of the effects of compound 11 on Hb 0 2 affinity in whole blood.
• FIGURE 1 AE illustrates the effect of compound 1 1 on Hb 0 2 affinity in whole blood.
• FIGURE 1 AF illustrates the Bohr Effect of compound 11 in whole blood.
• FIGURES 1 AG and 1 AH show effects of compound 1 on oxidative burst in activated neutrophils.
• FIGURES 1 AI, 1AJ, and 1AK show effects of compound 1 on production of TNF-a and IL-6 by macrophages.
• FIGURE 2A illustrates the effect of compound 1 on Hb 0 2 affinity in healthy mice.
• FIGURES 2B and 2C respectively illustrate the effects of compound 1 on Pa0 2 and Sa0 2 during hypoxic challenge.
• FIGURES 2D and 2E respectively illustrate the effect of compound 1 on acidosis and blood lactate during hypoxic challenge.
• FIGURES 2F and 2G respectively illustrate the effect of compound 1 on blood pressure and heart rate during hypoxic challenge.
• FIGURES 2H and 21 respectively illustrate the effect of compound 1 on tissue hypoxia and survival during hypoxic challenge.
• FIGURE 3 A illustrates the effect of Compound 1 on Hb 0 2 affinity in mice with LPS-induced ALL
• FIGURES 3B, 3C, 3D and 3E illustrate the effect of Compound 1 on inflammation induced by intratracheal administration of LPS.
• FIGURE 3F illustrates the effect of Compound 1 on peripheral arterial 0 2 saturation in mice with LPS-induced ALL
• FIGURE 3G illustrates the effect of Compound 1 on survival in mice with LPS-induced ALL FIGURE 4 A (TABLE 12) summarizes the PK of compound 1 in mice.
• FIGURE 4B illustrates the PD effects of Compound 1 in mice with bleomycin-induced fibrosis.
• FIGURES 4C and 4D illustrate the effect of Compound 1 on 0 2 saturation in mice with bleomycin-induced fibrosis.
• FIGURE 4E illustrates the effect of Compound 1 on leukocyte infiltration in mice with bleomycin-induced fibrosis.
• FIGURE 4F illustrates the effect of Compound 1 on collagen deposition in mice with bleomycin- induced fibrosis.
• FIGURE 4G illustrates the effect of Compound 1 on lung weight of mice with bleomycin- induced fibrosis.
• FIGURES 4H and 41 illustrate the effect of Compound 1 on fibrosis in mice treated bleomycin- induced fibrosis.
• FIGURE 5 shows is a XRPD profile and contemplated indexing for free base Form II.
• TABLES 1-12 are included in FIGURES 1A (TABLE 1), ID (TABLE 2), 1G (TABLE 3), 1 J (TABLE 4), 1M (TABLE 5), IP (TABLE 6), I S (TABLE 7), IV (TABLE 8), 1Y (TABLE 9), 1 AB (TABLE 10), IAD (TABLE 11), and 4A (TABLE 12).
• hypoxia refers to insufficient oxygen. Hypoxia, as used herein, includes hypoxemia (low blood oxygen), as well as low oxygen in a cell or one or more tissues/organs.
• compositions and methods are intended to mean that the compositions and methods include the recited elements, but not excluding others.
• Consisting essentially of when used to define compositions and methods shall mean excluding other elements of any essential significance to the combination for the stated purpose. Thus, a composition or process consisting essentially of the elements as defined herein would not exclude other materials or steps that do not materially affect the basic and novel characteristic(s) of the aspects and embodiments provided herein.
• Consisting of shall mean excluding more than trace elements of other ingredients and substantial method steps. Embodiments defined by each of these transition terms are within the scope of the present disclosure.
• Patient refers to a mammal, preferably, a human.
• pharmaceutically acceptable refers to generally safe and non-toxic for in vivo, preferably, human administration.
• pharmaceutically acceptable salt refers to a salt that is pharmaceutically acceptable. Any compound described herein may be administered as a pharmaceutically acceptable salt.
• salt refers to an ionic compound formed between an acid and a base.
• salts include, without limitation, alkali metal, alkaline earth metal, and ammonium salts.
• ammonium salts include, salts containing protonated nitrogen bases and alkylated nitrogen bases.
• Exemplary and non-limiting cations useful in pharmaceutically acceptable salts include Na, K, Rb, Cs, NH 4 , Ca, Ba, imidazolium, and ammonium cations based on naturally occurring amino acids.
• salts include, without limitation, salts of organic acids, such as carboxylic acids and sulfonic acids, and mineral acids, such as hydrogen halides, sulfuric acid, phosphoric acid, and the likes.
• exemplary and non-limiting anions useful in pharmaceutically acceptable salts include oxalate, maleate, acetate, propionate, succinate, tartrate, chloride, sulfate, bisulfate, mono-, di-, and tribasic phosphate, mesylate, tosylate, and the likes.
• treat include alleviating, abating or ameliorating a disease or condition or one or more symptoms thereof, preventing additional symptoms, ameliorating or preventing the underlying metabolic causes of symptoms, inhibiting the disease or condition, e.g., arresting or suppressing the development of the disease or condition, relieving the disease or condition, causing regression of the disease or condition, relieving a condition caused by the disease or condition, or suppressing the symptoms of the disease or condition, and are intended to include prophylaxis.
• the terms also include relieving the disease or conditions, e.g., causing the regression of clinical symptoms.
• the terms further include achieving a therapeutic benefit and/or a prophylactic benefit.
• compositions are administered to an individual at risk of developing a particular disease, or to an individual reporting one or more of the physiological symptoms of a disease, even though a diagnosis of this disease has not been made.
• preventing or prevention refer to a reduction in risk of acquiring a disease or disorder (i.e. , causing at least one of the clinical symptoms of the disease not to develop in a subject that may be exposed to or predisposed to the disease but does not yet experience or display symptoms of the disease).
• the terms further include causing the clinical symptoms not to develop, for example in a subject at risk of suffering from such a disease or disorder, thereby substantially averting onset of the disease or disorder.
• terapéuticaally effective amount refers to an amount that is effective for the treatment of a condition or disorder by a compound or composition described herein.
• an effective amount of any of the compounds, compositions or dosage forms described herein is the amount used to treat hypoxia or a hypoxia-associated condition, or to reduce one or more of its negative effects in a patient in need thereof.
• an effective amount of any of the compounds described herein is the amount used to treat fibrosis and/or inflammation in IPF, or to reduce one or more of its negative effects in a patient in need thereof.
• hypoxia-associated condition is any disease or condition that contributes to or results from hypoxia in a patient. Exemplary hypoxia-associated conditions are described herein.
• a prodrug is a compound that, after administration, is metabolized or otherwise converted to an active or more active form with respect to at least one property.
• a pharmaceutically active compound can be modified chemically to render it less active or inactive, but the chemical modification is such that an active form of the compound is generated by metabolic or other biological processes.
• a prodrug may have, relative to the drug, altered metabolic stability or transport characteristics, fewer side effects or lower toxicity. For example, see Nogrady, 1985, Medicinal Chemistry A Biochemical Approach, Oxford
• Prodrugs can also be prepared using compounds that are not drugs.
• hemoglobin A refers to adult hemoglobin, or ⁇ 2 ⁇ 2, the primary hemoglobin type found in normal adults. Without being bound by theory, it is believed that hypoxemic pulmonary diseases or altitudinal hypoxia and related diseases that are treated by the methods and compounds described herein are treated, at least in part, by increased hemoglobin A oxygen affinity.
• hemoglobin S refers to the most common abnormal hemoglobin type found in patients with sickle cell disease. Hemoglobin S differs from hemoglobin A only by a single amino acid substitution (i.e., valine substituted for glutamine in the 6 th position of the globin beta chain). Without being bound by theory, it is believed that treatment of sickle cell disease by the methods and compounds described herein is due, at least in part, by increased hemoglobin S oxygen affinity.
• ided is a compound of the following formula:
• Compound of formula 10 can be made following modifications of procedures well known to a skilled artisan such as by modifying procedures described in US 2013/0190315.
• ided is a compound of the following formula:
• the polymorph of Compound 5 comprises a crystalline ansolvate of the free base of Compound 5.
• the crystalline ansolvate of the free base of Compound 5 comprises a crystalline anhydrous form.
• the crystalline ansolvate of the free base of Compound 5 comprises Form II, which is characterized by an endothermic peak at (97 ⁇ 2) °C as measured by differential scanning calorimetry.
• the crystalline Form II of the free base of crystalline Compound 5 is characterized by the substantial absence of thermal events at temperatures below the endothermic peak at (97 ⁇ 2) °C as measured by differential scanning calorimetry.
• the crystalline Form II of the free base of crystalline Compound 5 is characterized by an X-ray powder diffraction peak (Cu Ka radiation at one or more of 13.37°, 14.37°, 19.95° or 23.92 °2 ⁇ .
• the crystalline Form II of the free base of crystalline Compound 5 is characterized by an X-ray powder diffraction pattern (Cu Ka radiation) substantially similar to that of FIGURE 5.
• the crystalline Form II of the free base of crystalline Compound 5 is characterized by at least one X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and23.92°20 (each ⁇ 0.2 °2 ⁇ ).
• the crystalline Form II of the free base of crystalline Compound 5 is characterized by at least two X-ray powder diffraction peaks (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °20).
• the crystalline Form II of the free base of crystalline Compound 5 is characterized by at least one X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °20).
• Compound 5 is characterized by at least three X-ray powder diffraction peaks (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• Form II is characterized by 1, 2, 3, 4, or more peaks as tabulated below in Table A.
• Compound 6 and 8-10 are useful in the methods provided herein.
• Other compounds useful in the methods provided herein are 3-chloro-2-hydroxy-6-((2-(l- isopropyl- 1 H-pyrazol-5-yl)pyridin-3 -yl)methoxy)benzaldehyde, 2-hydroxy-6-((2-( 1 -isopropyl- lH-pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5), and others included in the FIGURES and TABLES appended hereto, or a pharmaceutically acceptable salt thereof.
• crystalline Form II of the free base of Compound 5 characterized by at least one X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ), preferably characterized by at least two X-ray powder diffraction peaks (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and23.92°20 (each ⁇ 0.2 °2 ⁇ ), more preferably characterized by at least three X-ray powder diffraction peaks (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• Cu Ka radiation X-ray powder diffraction peak
• a method for treatment of hypoxia in a patient suffering from a lung disease comprising administering to a subject in need thereof a therapeutically effective amount of a compound provided herein, or a pharmaceutically acceptable composition thereof.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l-isopropyl-lH-pyrazol-5-yl)pyridin-3- yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• the lung disease is idiopathic pulmonary fibrosis.
• a compound provided herein, or a pharmaceutically acceptable composition thereof is for use in the treatment of hypoxia in a patient suffering from a lung disease.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l-isopropyl-lH-pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• the lung disease is idiopathic pulmonary fibrosis.
• a method for treatment of idiopathic pulmonary disease in a patient suffering from idiopathic pulmonary disease comprising administering to a subject in need thereof a therapeutically effective amount of a compound provided herein, or a pharmaceutically acceptable composition thereof.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l- isopropyl-lH-pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°20 (each ⁇ 0.2 °2 ⁇ ).
• a compound provided herein, or a pharmaceutically acceptable composition thereof is for use in the treatment of idiopathic pulmonary disease in a patient suffering from idiopathic pulmonary disease.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l-isopropyl-lH-pyrazol-5- yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• a method for treatment of fibrosis in a patient suffering from idiopathic pulmonary disease comprising administering to a subject in need thereof a therapeutically effective amount of a compound provided herein, or a pharmaceutically acceptable composition thereof.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l-isopropyl-lH- pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• a compound provided herein, or a pharmaceutically acceptable composition thereof is for use in the treatment of fibrosis in a patient suffering from idiopathic pulmonary disease.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l-isopropyl-lH-pyrazol-5-yl)pyridin-3- yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°20 (each ⁇ 0.2 °2 ⁇ ).
• a method for increasing oxygen affinity of hemoglobin S in a patient comprising administering to a subject in need thereof a therapeutically effective amount of a compound provided herein, or a pharmaceutically acceptable composition thereof.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l -isopropyl-lH-pyrazol-5-yl)pyridin-3- yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°20 (each ⁇ 0.2 °2 ⁇ ).
• a compound provided herein, or a pharmaceutically acceptable composition thereof is for use in increasing oxygen affinity of hemoglobin S in a patient.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2- hydroxy-6-((2-(l-isopropyl-lH-pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu a radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• a method for treating oxygen deficiency associated with sickle cell anemia or acute respiratory distress syndrome (ARDS) in a patient comprising administering to the patient in need thereof a therapeutically effective amount of a compound herein, or a pharmaceutically acceptable composition thereof.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l- isopropyl-lH-pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• a compound provided herein, or a pharmaceutically acceptable composition thereof is for use in treating oxygen deficiency associated with sickle cell anemia or acute respiratory distress syndrome (ARDS) in a patient.
• the compound is compound 6, 8, 9, or 10.
• the compound is 2-hydroxy-6-((2-(l-isopropyl-lH- pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde (Compound 5).
• the compound is crystalline Form II characterized by at least two X-ray powder diffraction peak (Cu Ka radiation) selected from 13.37°, 14.37°, 19.95° and 23.92°2 ⁇ (each ⁇ 0.2 °2 ⁇ ).
• At least one agent commonly used for treating ARDS is also administered to the patient.
• the at least one agent is a neuromuscular blocking agent.
• the neuromuscular blocking agent is pancuronium, vecuronium, rocuronium, succinylcholine, or cisatracurium.
• a compound as described herein includes a prodrug moiety.
• the prodrug moiety imparts at least a 2 fold, more preferably a 4 fold, enhanced solubility and/or bioavailability to the active moiety, and more preferably is hydrolyzed in vivo.
• Exemplary prodrug moieties are described in U.S. Patent Publication Nos. 2014/0274961 and
• a pharmaceutical composition comprising any of the compounds described herein (preferably compounds 5, 6, 8-10), and at least a pharmaceutically acceptable excipient.
• the compounds of this disclosure will be administered in a therapeutically effective amount by any of the accepted modes of administration for agents that serve similar utilities.
• Therapeutically effective amounts of compounds of this disclosure may range from about l OOmg/day, 200mg/day, 300mg/day, 400mg/day, 500mg/day, 550mg/day, 600mg/day, 650mg/day, 700mg/day, 750mg/day, 800mg/day, 850mg/day, 900mg/day,
• compositions can be formulated for different routes of administration.
• routes of administration Preferably, from about 400mg/day, 500mg/day, 550mg/day, 600mg/day, 650mg/day, 700mg/day, 750mg/day, 800mg/day, or 850mg/day.
• Therapeutically effective amounts of compounds of this disclosure may also range from about 500 to 1000 mg/day, or 600 to 900 mg/day.
• the actual amount of the compound of this disclosure, i.e., the active ingredient, will depend upon numerous factors such as the severity of the disease to be treated, the age and relative health of the patient, the potency of the compound being utilized, the route and form of administration, and other factors.
• Such compositions can be formulated for different routes of administration.
• Routes that may be used include intravenous, intra-arterial, intramuscular, intraperitoneal, intracutaneous, percutaneous, transdermal, oral, pulmonary, rectal, nasal, vaginal, lingual, intracranial, and subcutaneous routes.
• Suitable dosage forms for administering any of the compounds described herein include tablets, capsules, pills, powders, aerosols, suppositories, parenterals, and liquids, including suspensions, solutions and emulsions.
• the compositions are suitable for injection, for example, and without limitation, for intravenous, intra-arterial, intramuscular, intraperitoneal, intracutaneous, intracranial, and subcutaneous routes.
• Sustained release dosage forms may also be used, for example, in a transdermal patch form. All dosage forms may be prepared using methods that are standard in the art (see e.g., Remington's Pharmaceutical Sciences, 16 th ed., A. Oslo editor, Easton PA. 1980).
• compositions in accordance with the aspects and embodiments provided herein are prepared by conventional means using methods known in the art.
• compositions disclosed herein may be used in conjunction with any of the vehicles and excipients commonly employed in pharmaceutical preparations, e.g., talc, gum arabic, lactose, starch, magnesium stearate, cocoa butter, aqueous or non-aqueous solvents, oils, paraffin derivatives, glycols, etc. Coloring and flavoring agents may also be added to preparations, particularly to those for oral administration. Solutions, suspensions, emulsions and the like can be prepared using water or physiologically compatible organic solvents such as ethanol, 1,2- propylene glycol, polyglycols, dimethylsulfoxide, fatty alcohols, triglycerides, partial esters of glycerin and the like.
• Solid pharmaceutical excipients include starch, cellulose, hydroxypropyl cellulose, talc, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, magnesium stearate, sodium stearate, glycerol monostearate, sodium chloride, dried skim milk and the like.
• Liquid and semisolid excipients may be selected from glycerol, propylene glycol, water, ethanol and various oils, including those of petroleum, animal, vegetable or synthetic origin, e.g., peanut oil, soybean oil, mineral oil, sesame oil, etc.
• sustained release formulations such as drug depots or patches comprising an effective amount of a compound provided herein.
• the patch further comprises gum Arabic or hydroxypropyl cellulose separately or in combination, in the presence of alpha- tocopherol.
• the hydroxypropyl cellulose has an average MW of from 10,000 to 100,000. In a more preferred embodiment, the hydroxypropyl cellulose has an average MW of from 5,000 to 50,000.
• compositions the same dosage form, or even the same route of administration be used for administration of both the compounds disclosed herein and the other agent or that the two agents be administered at precisely the same time.
• co-administration can be accomplished conveniently by the same dosage form and the same route of administration, at substantially the same time.
• Such administration most advantageously proceeds by delivering the active ingredients separately or simultaneously in one or more pharmaceutical compositions in accordance with the present disclosure.
• a compounds or pharmaceutical composition disclosed herein is co- administered with an agent that increases RBC count.
• the agent is a blood transfusion.
• the agent is an erythropoiesis-stimulating agent.
• a compound described herein is used to treat a condition associated with hypoxia. In another aspect, a compound described herein is used to treat one or more symptoms associated with the condition (hypoxia). In a further aspect, a compound described herein is used in healthy subjects where there is a need for short to long term oxygenation. In yet a further aspect, a compound described herein is used in treating disease manifesting as hypoxemia and requiring oxygenation support. In yet a further aspect, a compound described herein is used in treating diseases not manifesting as hypoxemia but where increased 0 2 delivery to the tissue may be beneficial.
• ARDS acute respiratory distress syndrome
• ARDS acute respiratory distress syndrome
• ARDS refers to a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood.
• ARDS is also referred to as noncardiogenic pulmonary edema, increased-permeability pulmonary edema, stiff lung, shock lung, or acute lung injury.
• ARDS can be caused by any major injury to the lung. Some common causes include, without limitation: breathing vomit into the lungs (aspiration), inhaling chemicals, lung transplant, pneumonia, septic shock (infection throughout the body), and trauma.
• a method for treating hypoxia associated with lung cancer in a patient comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• a method for treating hypoxia associated with decreased RBC count in a patient being treated for cancer comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• the patient is treated for cancer using chemotherapy.
• the patient is treated for cancer using radiation therapy.
• the method further comprises treating the patient with an agent to increase RBC count.
• Agents for increasing RBC count are known in the art, including blood transfusion or erythropoiesis stimulating agents.
• the erythropoiesis-stimulating agent is erythropoietin, epoetin alfa, epoetin beta, darbepoetin alfa, or methoxy polyethylene glycol-epoetin beta.
• the erythropoiesis-stimulating agent is epoetin alfa or darbepoetin alfa.
• provided herein is a method for treating hypoxia associated with COPD in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• COPD refers to a progressive lung disease that compromises lung function and decreases the amount of oxygen that gets into the lungs and into the blood.
• COPD includes emphysema and chronic bronchitis. The most common causes of COPD include tobacco smoking and pollution.
• At least one agent commonly used for treating COPD is coadministered to the patient.
• the at least one agent is systemically
• corticosteroid administered corticosteroid, locally administered corticosteroid, xolair, beta adrenergic broncodilator, anti-histamine, or anti-mast cell degranulation agent.
• provided herein is a method for treating hypoxia associated with pulmonary edema in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• provided herein is a method for treating hypoxia associated with cystic fibrosis of the lungs in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• provided herein is a method for treating hypoxia associated with asthma in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• At least one agent commonly used for treating asthma is coadministered to the patient.
• the at least one agent is systemically
• corticosteroid administered corticosteroid, locally administered corticosteroid, xolair, beta adrenergic broncodilator, anti-histamine, or anti-mast cell degranulation agent.
• provided herein is a method for treating hypoxia associated with pneumonia in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• provided herein is a method for treating hypoxia associated with rheumatoid lung disease in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• a method for treating hypoxia associated with acute lung injury in a patient the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• a method for treating hypoxia associated with idiopathic pulmonary fibrosis (IPF) in a patient comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• the disease pathology of IPF involves inflammation and lung injury caused by reactive oxygen species (ROS) produced by leukocytes, and fibrosis.
• ROS reactive oxygen species
• an anti-inflammatory compound is co-administered.
• an anti-fibrosis agent is co-administered to the patient.
• the anti-fibrosis agent is selected from the group consisting of pirfenidone, nintenabib, lecithinized superoxide dismutase, and systemic corticosteroids.
• provided herein is a method for treating hypoxia associated with sleep apnea in a patient, the method comprising administering to the patient a
• provided herein is a method for treating hypoxia associated with altitude sickness in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• provided herein is a method for treating hypoxia associated with deep or shallow water blackout in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• provided herein is a method for treating a symptom or condition associated with hypoxia.
• a method of increasing arterial blood saturation in a patient with hypoxia comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• a method of improving oxygen delivery to a tissue of a patient with hypoxia comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• a method of reducing lactate buildup in a tissue of a patient with hypoxia comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• provided herein is a method of reducing acidosis of arterial blood of a patient with hypoxia, comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• the hypoxia is acute. In one embodiment, the hypoxia is chronic.
• the compounds, compositions and methods provided herein are contemplated to be used to treat a variety of vascular inflammatory conditions.
• the methods comprise administering an inflammation inhibiting effective amount of a compound or a composition provided or utilized herein.
• the inflammatory condition is associated with coronary artery disease, cerebral ischemia and peripheral artery disease.
• the inflammatory condition treated is associated with an autoimmune disease, such as, without limitation, lupus erythematosus, multiple sclerosis, rheumatoid arthritis, ocular inflammation and Crohn's disease.
• the condition is an acute or chronic inflammatory condition, such as that associated with allergy, asthma, irritable bowel syndrome, ulcerative colitis, and psoriasis.
• the condition is systemic inflammation of the body, such as sepsis, gram positive or gram negative shock.
• the condition is a malignancy, such as acute leukemia/lymphoma, which displays inflammatory or allergic manifestations.
• the condition is inflammatory condition associated with IPF.
• compositions provided herein are used in the treatment of pulmonary fibrosis in a patient, the method comprising administering to the patient a
• the pulmonary fibrosis is caused by the use of certain medicines, including, for example, certain chemotherapeutic drugs (e.g., methotrexate and cyclophosphamide), heart medications (e.g., amiodarone and propranolol), and antibiotics (e.g., nitrofurantoin and sulfasalazine).
• certain chemotherapeutic drugs e.g., methotrexate and cyclophosphamide
• heart medications e.g., amiodarone and propranolol
• antibiotics e.g., nitrofurantoin and sulfasalazine
• the pulmonary fibrosis is caused by inhalation exposure to environmental and occupational pollutants, including, for example, asbestos, silica, and hard metal dusts.
• the pulmonary fibrosis is caused by connective tissue diseases, including, for example, systemic lupus erythematosus, rheumatoid arthritis, and scleroderma.
• the pulmonary fibrosis is caused by inflammatory diseases, including, for example, sarcoidosis.
• the pulmonary fibrosis is caused by bacterial or viral infections, including, for example, tuberculosis, and pneumonia.
• the compound is Compound 5.
• compositions provided herein are used in the treatment of pulmonary fibrosis, in particular, fibrosis associated with IPF in a patient, the method comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• the compound is Compound 5.
• a method for treating idiopathic pulmonary fibrosis (IPF) in a patient comprising administering to the patient a therapeutically effective amount of a compound as described herein.
• the compound is Compound 5.
• the compounds and compositions provided herein can be administered prophylactically, e.g., and without limitation, for preventing emphysema.
• the compounds and compositions provided herein can be administered prophylactically, e.g., and without limitation, for preventing high altitude hypoxia, or deep or shallow water blackout.
• CRP C-reactive protein
• Step 1
• Step 1
• Step 1
• Step 1
• reaction was judged to be complete by TLC (35% ethyl acetate/hexanes).
• the reaction mixture was cooled to 25 °C, and taken up in a mixture of ethyl acetate (100 mL) and an aqueous saturated sodium bicarbonate solution (100 mL). The phases were separated and the aqueous phase was extracted once more with ethyl acetate (50 mL). The combined organic phases were washed with an aqueous saturated sodium chloride solution (50 mL) and dried over sodium sulfate.
• the reaction was cooled, and poured into a mixture of ethyl acetate (100 mL) and water (50 mL). The phases were separated and the aqueous phase was extracted with more ethyl acetate (2 x 50 mL). The combined organic phases were washed with water (25 mL), an aqueous saturated sodium chloride solution (25 mL), and dried over sodium sulfate.
• Representative compounds disclosed herein were tested for their ability to increase hemoglobin oxygen affinity using hemoximetry.
• Blood (20% or 40% Hct) was incubated with compound at various concentrations followed by hemoximetry.
• Oxygen equilibrium curves for blood treated with compounds were obtained by deoxygenation of 02-equilibrated samples in a Hemox buffer at 37°C, using a Hemox Analyzer.
• the blood samples were transferred to the hemoximeter sample chamber where they were first saturated with compressed air and then deoxygenated with pure nitrogen.
• the absorbance at wavelengths that correspond to the isosbestic point (570 nm) and deoxy Hb (560 nm) was recorded as a function of the sample 02 tension (p02).
• ROS Reactive oxygen species
• compound 1 disclosed herein displayed anti-oxidative (FIGURES 1 AG and 1 AH) and anti-inflammatory activity (FIGURES 1 AI, 1 AJ, and 1 AK) in in vitro experimental systems containing neutrophils and macrophages.
• a previously-described aldehyde compound, 5-hydroxymethyl-2-furfural (5-HMF) does not display this activity (FIGURES 1 AG and 1 AH).
• the compounds described herein could also provide a method to inhibit the adverse effects of inflammation in a patient.
• Reduction in systemic pro-inflammatory cytokines also has the potential to exert a broad anti-inflammatory effect which would supplement the beneficial effect of alleviation of hypoxemia via increased hemoglobin-02 affinity.
• This animal model also mimics conditions of exposure to environments of reduced 0 2 tensions
• mice Male, C57BL mice were fitted with a dorsal skinfold window chamber for direct visualization of an intact microvascular bed (Yalcin & Cabrales 2012). After the window chamber was implanted, the animals were left to recover for at least 2 days, before undergoing surgery a second time for arterial (carotid) catheter implantation (PE50 tubing). After two day of recovery, mice were dosed orally with Compound 1 (70 or 140mg/kg) or vehicle only and Hb 0 2 affinity was determined by hemoximetry. Two hours post dose, conscious mice were placed in a restraining tube with a longitudinal slit from which the protruding window chamber provided a microscopic stage for observation.
• MAP mean arterial pressure
• HR heart rate
• Oxygen equilibrium curves for mice blood were obtained by deoxygenation of 0 2 - equilibrated samples in a Hemox buffer at 37°C, using a Hemox Analyzer (TCS Scientific Corporation, New Hope, PA). The blood samples were transferred to the hemoximeter sample chamber where they were first saturated with compressed air and then deoxygenated with pure nitrogen. The absorbance at wavelengths that correspond to the isosbestic point (570 nm) and deoxy Hb (560 nm) was recorded as a function of the sample 0 2 tension (p0 2 ).
• microcirculation are calculated using the 0 2 equilibrium curves measured.
• Tissue hypoxia was studied via immunohistochemistry staining for pimonidazole bound to hypoxic zones in vital tissues.
• Mice received a bolus intraperitoneal injection (IP) injection of the hypoxic marker Hypoxyprobe-1 (pimonidazole 40 mg/kg) and 5 mg/kg Hoechst 33342 diluted in PBS (total volume, 100 ⁇ ,).
• IP intraperitoneal injection
• mice were euthanized and tissues extracted for histology. Sections are stained with monoclonal antibody against pimonidazole. Images for pimonidazole antibody-stained areas and Hoechst were recorded. Results are reported as the ratio of pimonidazole stained area to the total cellular area by co-localization of pimonidazole and Hoechst.
• FIGURE 2C depicts the changes Sa0 2 in response to changes in Pa0 2 (FIGURE 2B) during hypoxia.
• Arterial blood partial pressure of 0 2 (Pa0 2 ) decreased with increasing level of hypoxia. Since all animals were exposed to the same level of hypoxia, the Pa0 2 was the same in Compound 1 -treated and control mice (FIGURE 2B).
• Arterial blood oxygen saturation (Sa0 2 ) decreased with increasing hypoxia.
• Compound 1 dose-dependently increased Sa0 2 relative to control during hypoxia indicating that Compound 1 increased 0 2 uptake during hypoxia (FIGURE 2C).
• FIGURES 2D and 2E shows the changes in lactate and pH of blood during hypoxia.
• arterial blood pH decreased substantially in control mice during 10% and 5%0 2 hypoxia indicating acidosis.
• arterial blood pH was normal during hypoxia in Compound 1 dosed mice indicating that Compound 1 reduced acidosis.
• Compound 1 reduced lactate levels relative to control during extreme hypoxia (5%0 2 ) (FIGURE 2E).
• Hb 0 2 affinity Compound 1 improved 0 2 delivery to tissues during hypoxia as evidenced by reduced blood lactate levels relative to control.
• MAP mean arterial pressure
• HR heart rate
• FIGURES 2F and 2G show changes in mean arterial pressure (MAP) and heart rate (HR) during exposure to hypoxia.
• MAP and HR decreased in control mice
• Compound 1 -dosed mice sustained higher mean BP (FIGURE 2F) and HR (FIGURE 2G) in a dose-dependent fashion.
• Hb 0 2 affinity leads to increased 0 2 delivery to tissues during hypoxia minimizing the systematic the changes in blood pressure and HR necessary to adjust to hypoxia.
• FIGURES 2H and 21 respectively show the degree of tissue hypoxia and survival of mice during hypoxia.
• Compound 1 reduced hypoxic tissues positively stained by pimonidazole relative to control during extreme hypoxia.
• mice with adequate systolic BP were counted as survived and mice with severe hypotension (BP ⁇ 60 mmHg) were counted as non-survived and were euthanized.
• BP ⁇ 60 mmHg mice with severe hypotension
• This Study demonstrates that a compound that increases the 0 2 affinity of hemoglobin increases arterial 0 2 saturation and improves oxygen delivery to tissues during hypoxia.
• tissue level local milieu allows for efficient 0 2 extraction leading to improved oxygenation as measured by decreased lactic acidosis, improved cardiovascular function and ultimately, survival.
• mice Female, 8-10-week-old male C57BL/6J mice (Jackson Laboratory, Bar Harbor, ME), were anesthetized with isoflurane, injected with 100 ⁇ g LPS (Sigma, St. Louis, MO) in 100 ih PBS by direct intratracheal injection. After 24 hours, mice were given Compound 1 (70 or 140mg/kg formulated in dimethylacetamide, polyethylene glycol 400 (PEG400) and 40% cavitron in a ratio of 1 :5:4, respectively) or vehicle only by oral gavage 2 hours prior to placement in a hypoxia chamber. Mice were exposed to either 10 or 5% 0 2 for 4 hours.
• Oxygen saturation (Sa0 2 ) was measured with a pulse oximeter (STARR Life Sciences, Oakmont, PA) at baseline and hourly during hypoxic exposure. During hypoxic exposure, mice were monitored continuously and a moribund check was done every 15 minutes. Time to death was assessed by time to moribund status. Mice were determined to be moribund if they could not right themselves when placed in a supine position.
• Sp0 2 peripheral arterial 0 2 saturation
• Compound 1 dosed mice compared to control (or vehicle) mice. For example, during 5%0 2 hypoxia, Compound 1 at 70mg/kg or 140mg/kg increased Sp0 2 by 22% or 31% of control value, respectively. Thus Compound 1 increased Sp0 2 relative to control during hypoxia indicating that Compound 1 increased 0 2 uptake during hypoxia in the presence of acute lung injury.
• mice During exposure hypoxia, mice were monitored continuously and a moribund check was done every 15 minutes. Time to death was assessed by time to moribund status. Mice were determined to be moribund if they could not right themselves when placed in a supine position. As shown in FIGURE 3G, 45% of control mice survived after 4 hours of exposure to 5% 0 2 hypoxia, whereas 60% of 70mg/kg Compound 1 dosed mice and 86% of 140mg/kg Compound 1 dosed mice survived. Thus Compound 1 dose-dependently improved survival of mice with acute lung injury during exposure to extreme hypoxia.
• Bleomycin Induced Mouse Model of Hypoxemia and Pulmonary Fibrosis This study was conducted to evaluate whether increased Hb 0 2 affinity could ameliorate hypoxia associated with IPF.
• Compound 1 was evaluated in a bleomycin induced mouse model of hypoxemia and fibrosis. Bleomycin induced pulmonary fibrosis in animals provides a preclinical model for investigating the effect of potential drugs that may reduce hypoxemia associated with IPF.
• hypoxemia was determined by monitoring arterial oxygen saturation (S a 0 2 ), while the severity of pulmonary fibrosis was assessed by histopathologic evaluation and determination of collagen and leukocyte levels in bronchoalveolar lavage fluid (BALF).
• BALF bronchoalveolar lavage fluid
• mice were ear tagged and weighed prior to the start of the study. The animals were distributed into four groups with twelve animals in each group.
• mice Body weights of all mice were recorded daily during the study. Animals in groups 2, 3 and 4 were administered 3U/kg bleomycin sulfate USP (Teva Pharmaceuticals) via oropharyngeal route for 7 days (see Walters, D. M. and S. R. leeberger (2008). "Mouse models of bleomycin- induced pulmonary fibrosis.” Curr Protoc Pharmacol Chapter 5: Unit 5 46.) Animals in group 1 were administered normal saline via oropharyngeal route.
• Compound 1 (formulated in dimethylacetamide: polyethylene glycol 400 (PEG400): 40% cavitron at a 1 :5:4 ratio) was administered at either low dose (first day 50 mg/kg followed by 40 mg/kg daily) or high dose (first day 150 mg/kg followed by 85 mg/kg daily) via oral gavage to bleomycin treated mice once daily from day 8 to day 15. Animals in group 1 were administered vehicle via oral gavage. The dosing volume was 200 ⁇ ,. The study animals were sacrificed on day 15 at 4 hours post final dose.
• PEG400 polyethylene glycol 400
• PK pharmacokinetics
• BAL fluid was collected from the lungs of the animals by lavaging the lung with 1ml Hanks balanced salt media (HBSS). Lungs were harvested from each animal and weighed. They were then inflated by ⁇ 0.5mL of 10% NBF and fixed in a formalin container for subsequent histopathological analysis.
• HBSS Hanks balanced salt media
• Compound 1 blood and plasma concentrations were determined by LC-MS 4 hours after the last dose. Both standard and QC blood samples were pre-incubated at 37°C for 1 hr. After incubation, all standard and QC samples were diluted with 2-fold volume of water to match with the condition of samples. Plasma standard and QC were proceeding without pre-incubation. For all samples, 10 ⁇ ih of blood or plasma sample were mixed with 240 of sodium citrate buffer (pH 3) in a 2-mL 96 well plate. The mixture was vortexed for 10 minutes.
• sodium citrate buffer pH 3
• the peak area of m/z 341 -> 203 product ion (Compound 1) was measured against that of the m/z 345 -> 159 product ion 2-hydroxy-6-((2-(l- (propan-2-yl-d7)-lH-pyrazol-5-yl)pyridin-3-yl)methoxy)benzaldehyde in positive ion mode.
• the analytical range was 50 to 100000 ng/mL for blood sample and 50 to 5000 ng/niL for plasma sample.
• the bleomycin treated mice with the low and high dose regimens of Compound 1 achieved 18.0%> and 36.7%> of calculated Hb occupancy, respectively.
• the average blood/plasma concentration ratio was 22:1 which is equivalent to RBC/plasma ratio of 102: 1.
• the high RBC/plasma ratio of Compound 1 indicated a preferential partitioning of Compound 1, into the red blood cells (Table 12).
• Hemoglobin occupancy by Compound 1 was calculated by dividing the concentration of Compound 1 in RBCs by the Hb concentration in RBCs (5 mM).
• RBC was calculated from whole blood and plasma concentration data using the following equation:
• RBC — p —
• mice treated with Compound 1 demonstrated a significant left shift in the OEC in a dose-response manner indicating a higher Hb-oxygen binding affinity.
• hypoxia is a feature of IPF, and oxygen saturation measurements are often used clinically to evaluate the presence and severity of hypoxia.
• Responses to hypoxia in mice treated with Compound 1 were first evaluated by measuring arterial oxygen saturation (S a 0 2 ). On day 7 and 14 after bleomycin or saline instillation, 50 ⁇ , of arterial blood from the tail artery were used for measurement of arterial oxygen saturation (S a 0 2 ) using whole blood GEM OPL co-oximeter (Instrumentation Laboratory, MA). An additional aliquot of IOOliL of blood were collected from tail artery and arterial blood gases using the i-STAT Handheld Blood Analyzer (ABBOTT) were measured using CG4+ cartridges.
• ABBOTT i-STAT Handheld Blood Analyzer
• FIG. 1C The arterial blood gases (ABG) were also analyzed on day 7 and day 14
• FIGURE 4C Data are expressed as means ⁇ SEM.
• p0 2 arterial oxygen tension
• vehicle-treated bleomycin mice the p0 2 reached a further decline at day 14.
• Compound 1 treatment showed a tendency for an increase p0 2 or prevention of further decline of p0 2 , suggesting a beneficial effect on disease progression (FIGURE 4D).
• mice develop extensive pulmonary fibrosis as well as pulmonary inflammation; thus, the effect of Compound 1 treatment on the phenotype of pulmonary inflammatory cells was examined.
• the BAL fluid was centrifuged at 1 ,000 rpm at 4°C for 5 minutes.
• the BAL cell pellets were suspended in 2mls of lx Pharmalyse buffer (BD Bioscience) to lyse the RBCs.
• PBS + 2% FBS were added to stop the lysis reaction and cells centrifuged again. Leukocytes in the cell pellet were counted using a hemocytometer and the trypan blue exclusion method.
• Treatment with Compound 1 was associated with decreased inflammation, as evident by a significant reduction in total inflammatory cells recovered in BAL fluid on day 15 (*, P ⁇ 0.05; Low dose: Day 8 50mg/kg; Day 9-15 40mg/kg daily; High dose: Day 8 150mg/kg; Day 9-15 85mg/kg daily) (FIGURE 4E). This finding demonstrates that Compound 1 treatment attenuates pulmonary inflammation in this model.
• Compound 1 treatment showed improvement in the fibrotic lesions. Pulmonary fibrosis was induced by administering mice a single dose of bleomycin. Collagen content of was determined by quantifying total soluble collagen in the B ALF supernatant using the Sircol collagen dye binding assay according to the manufacturer's instructions (Biocolor Ltd, Carrick Fergus, UK). Compound 1 treatment resulted in a significant reduction in collagen protein in the lungs (*, PO.05; Low dose: Day 8 50mg/kg; Day 9-15 40mg/kg daily; High dose: Day 8 150mg/kg; Day 9-15 85mg/kg daily) (FIGURE 4F). These results indicate that Compound 1 attenuates pulmonary fibrosis in the bleomycin murine model.
• the lung samples were processed and embedded with all lobes from each mouse in one paraffin block. Coronal sections through the four major lobes were stained with Masson's Trichrome. For each animal, consecutive lung fields were examined in a raster pattern using a 20X objective lens and a 1 OX or 40X ocular lens (200X or 800X). A modified Ashcroft score (Hubner et al. 2008) was recorded for each field. The fibrotic index was calculated as the sum of the modified Ashcroft field scores divided by the number of fields examined.

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