WO2016186821A1

WO2016186821A1 - Cationic steroidal antimicrobial compounds and methods of manufacturing such compounds

Info

Publication number: WO2016186821A1
Application number: PCT/US2016/030505
Authority: WO
Inventors: Paul B. Savage
Original assignee: Savage Paul B
Priority date: 2015-05-18
Filing date: 2016-05-03
Publication date: 2016-11-24
Also published as: US9434759B1; EP3297633A4; CA2985740A1; EP3297633A1; CN108135909A

Abstract

Cationic steroidal antimicrobial (CSA) compounds having amide functionality and methods of manufacturing such CSA compounds. The CSA compound can be a compound of Formula (I), Formula (II), Formula (III), or a salt thereof: where R₁₈ has the following structure: -R₂₀-(C=0)-N-R₂₁R₂₂ R₂₀ is omitted or substituted or unsubstituted alkyl, alkenyl, alkynyl, or aryl, and R₂₁ and R₂₂ are independently selected from hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, or substituted or unsubstituted aryl, provided that at least one of R₂₁ and R₂₂ is not hydrogen.

Description

CATIONIC STEROIDAL ANTIMICROBIAL COMPOUNDS AND METHODS OF MANUFACTURING SUCH COMPOUNDS

BACKGROUND OF THE INVENTION

1. Field

The invention relates to cationic steroidal antimicrobial (CSA) compounds, including

CSA compounds having amide functionality and methods of manufacturing CSA compounds having amide functionality.

2. Related Technology

Antimicrobial peptides are found in organisms ranging from mammals to amphibians to insects to plants. The ubiquity of antimicrobial peptides has been used as evidence that these compounds do not readily engender bacterial resistance. In addition, considering the varied sequences of antimicrobial peptides among diverse organisms, it is apparent that they have evolved independently multiple times. Thus, antimicrobial peptides appear to be one of "Nature's" primary means of controlling bacterial growth. For example, endogenous antimicrobial peptides, such as the human cathelicidin LL-37, play key roles in innate immunity. LL-37 is found in airway mucus and is believed to be important in controlling bacterial growth in the lung. However, clinical use of antimicrobial peptides presents significant issues including the relatively high cost of producing peptide-based therapeutics, the susceptibility of peptides to proteases generated by the host and by bacterial pathogens, and deactivation of antimicrobial peptides by proteins and DNA in lung mucosa.

An attractive means of harnessing the antibacterial activities of antimicrobial peptides without the issues delineated above is to develop non-peptide mimics of antimicrobial peptides that display similar broad-spectrum antibacterial activity utilizing the same or similar mechanism of action. Non-peptide mimics would offer lower-cost synthesis and potentially increased stability to proteolytic degradation. In addition, control of water solubility and charge density may be used to control association with proteins and DNA in lung mucosa.

With over 1,600 examples of known antimicrobial peptides, it is possible to categorize the structural features common to them. While the primary sequences of these peptides vary substantially, morphologies adopted by a vast majority are similar. Those that adopt alpha helix conformations juxtapose hydrophobic side chains on one face of the helix with cationic (positively charged) side chains on the opposite side. Similar morphology is found in antimicrobial peptides that form beta sheet structures: hydrophobic side chains on one face of the sheet and cationic side chains on the other.

Examples of small molecule, non-peptide mimics of antimicrobial peptides, include steroidal compounds known as "ceragenins," an example of which is "CSA-13," which can reproduce the amphiphilic morphology in antimicrobial peptides.

SUMMARY

Disclosed herein are cationic steroidal antimicrobial (CSA) compounds having amide functionality and methods of manufacturing such CSA compounds.

In some embodiments, the CSA compounds disclosed herein can be a compound of Formula (I), Formula (II), or Formula (III), or a salt thereof, having a steroidal backbone, and wherein at least Ris of the steroidal backbone includes amide functionality in which the carbonyl group of the amide is positioned between the amido nitrogen of the amide and fused ring D of the steroidal backbone:

By way of example, at least Ris can have the following structure:

where R₂o is omitted or substituted or unsubstituted alkyl, alkenyl, alkynyl, or aryl, such as substituted or unsubstituted Ci-Cio alkyl, substituted or unsubstituted Ci-Cio alkenyl, substituted or unsubstituted Ci-Cio alkynyl, or substituted or unsubstituted C₆ or Cio aryl, and where R₂i and R₂₂ are independently selected from the group consisting of hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, or substituted or unsubstituted aryl, provided that at least one of R₂i and R₂₂ is not hydrogen.

By way of example, R₂i and R₂₂ are independently selected from the group consisting of hydrogen, optionally substituted Ci-C₂₄ alkyl, optionally substituted C₂-C₂₄ alkenyl, optionally substituted C₂-C₂₄ alkynyl, optionally substituted C₆ or Cio aryl, optionally substituted 5 to 10 membered heteroaryl, optionally substituted 5 to 10 membered heterocyclyl, optionally substituted C7-C13 aralkyl, optionally substituted (5 to 10 membered heteroaryl)-Ci-C6 alkyl, optionally substituted C3-C10 carbocyclyl, optionally substituted C₄- C10 (carbocyclyl)alkyl, optionally substituted (5 to 10 membered heterocyclyl)-Ci-C₆ alkyl, optionally substituted amido, and a suitable amine protecting group, provided that at least one of R₂i and R₂₂ is not hydrogen. In some embodiments, R₂i and R₂₂, together with the atoms to which they are attached, form an optionally substituted 5 to 10 membered heterocyclyl ring. Non-limiting examples of CSA compounds having amide functionality as defined herein include CSA-190, CSA-191, CSA-192, CSA-192MS, and salts thereof:

In some embodiments, a method of manufacturing a CSA compound having amide functionality as disclosed herein includes: (1) reacting cholic acid or derivative of cholic acid with at least one alkyl-, alkenyl-, alkynyl-, or arylamine to yield a final CSA compound or an intermediate CSA compound having desired amide functionality; and (2) optionally further reacting an intermediate CSA compound with one or more reagents to yield a desired CSA compound. Advantanges of the CSA compounds disclosed herein include, but are not limited to, comparable and/or improved antimicrobial activity compared to existing CSA compounds and/or simplified synthetis of final CSA compounds and/or intermediate CSA compounds compared to existing synthetic routes.

Additional features and advantages will be set forth in part in the description that follows, and in part will be obvious from the description, or may be learned by practice of the embodiments disclosed herein. It is to be understood that both the foregoing brief summary and the following detailed description are exemplary and explanatory only and are not restrictive of the embodiments disclosed herein or as claimed.

BREIF DESCRIPTION OF DRAWINGS

Figure 1 illustrates example cationic steroidal antimicrobial compounds;

Figure 2 is a bar graph comparing the percent of animal days with mucositis for laboratory animals treated with various CSA compounds; and

Figure 3 is a line graph comparing oral mucositis severity scores for laboratory animals treated with various CSA compounds.

DETAILED DESCRIPTION

The embodiments disclosed herein will now be described by reference to some more detailed embodiments, with occasional reference to any applicable accompanying drawings. These embodiments may, however, be embodied in different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the embodiments to those skilled in the art

Definitions:

Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which these embodiments belong. The terminology used in the description herein is for describing particular embodiments only and is not intended to be limiting of the embodiments. As used in the specification and the appended claims, the singular forms "a," "an," and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety.

Terms and phrases used in this application, and variations thereof, especially in the appended claims, unless otherwise expressly stated, should be construed as open ended as opposed to limiting. As examples of the foregoing, the term "including" should be read to mean "including, without limitation," "including but not limited to," or the like; the term "comprising" as used herein is synonymous with "including," "containing," or "characterized by," and is inclusive or open-ended and does not exclude additional, unrecited elements or method steps; the term "having" should be interpreted as "having at least"; the term "includes" should be interpreted as "includes but is not limited to"; the term "example" is used to provide exemplary instances of the item in discussion, not an exhaustive or limiting list thereof; and use of terms like "preferably," "preferred," "desired," or "desirable," and words of similar meaning should not be understood as implying that certain features are critical, essential, or even important to the structure or function of the invention, but instead as merely intended to highlight alternative or additional features that may or may not be utilized in a particular embodiment. In addition, the term "comprising" is to be interpreted synonymously with the phrases "having at least" or "including at least". When used in the context of a process, the term "comprising" means that the process includes at least the recited steps, but may include additional steps. When used in the context of a compound, composition or device, the term "comprising" means that the compound, composition or device includes at least the recited features or components, but may also include additional features or components. Likewise, a group of items linked with the conjunction "and" should not be read as requiring that each and every one of those items be present in the grouping, but rather should be read as "and/or" unless expressly stated otherwise. Similarly, a group of items linked with the conjunction "or" should not be read as requiring mutual exclusivity among that group, but rather should be read as "and/or" unless expressly stated otherwise.

It is understood that, in any compound described herein having one or more chiral centers, if an absolute stereochemistry is not expressly indicated, then each center may independently be of R-configuration or S-configuration or a mixture thereof. Thus, the compounds provided herein may be enantiomerically pure, enantiomerically enriched, racemic mixture, diastereomerically pure, diastereomerically enriched, or a stereoisomeric mixture. In addition it is understood that, in any compound described herein having one or more double bond(s) generating geometrical isomers that can be defined as E or Z, each double bond may independently be E or Z a mixture thereof.

Likewise, it is understood that, in any compound described, all tautomeric forms are also intended to be included.

It is to be understood that where compounds disclosed herein have unfilled valencies, then the valencies are to be filled with hydrogens or isotopes thereof, e.g., hydrogen-1 (protium) and hydrogen-2 (deuterium). It is understood that the compounds described herein can be labeled isotopically. Substitution with isotopes such as deuterium may afford certain therapeutic advantages resulting from greater metabolic stability, such as, for example, increased in vivo half-life or reduced dosage requirements. Each chemical element as represented in a compound structure may include any isotope of said element. For example, in a compound structure a hydrogen atom may be explicitly disclosed or understood to be present in the compound. At any position of the compound that a hydrogen atom may be present, the hydrogen atom can be any isotope of hydrogen, including but not limited to hydrogen-1 (protium) and hydrogen-2 (deuterium). Thus, reference herein to a compound encompasses all potential isotopic forms unless the context clearly dictates otherwise.

Unless otherwise indicated, all numbers expressing quantities of ingredients, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term "about." Accordingly, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the present embodiments. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should be construed in light of the number of significant digits and ordinary rounding approaches.

Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the embodiments are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements. Every numerical range given throughout this specification and claims will include every narrower numerical range that falls within such broader numerical range, as if such narrower numerical ranges were all expressly written herein. Where a range of values is provided, it is understood that the upper and lower limit, and each intervening value between the upper and lower limit of the range is encompassed within the embodiments.

As used herein, any "R" group(s) such as, without limitation, Ri, R₂, R₃, R4, R5, R5, R7, R₈, R9, Rio, R11, Ri₂, Ri₃, Ri4, Ri5, R½, R17, and Ri₈ represent substituents that can be attached to the indicated atom. Unless otherwise specified, an R group may be substituted or unsubstituted.

A "ring" as used herein can be heterocyclic or carbocyclic. The term "saturated" used herein refers to a ring having each atom in the ring either hydrogenated or substituted such that the valency of each atom is filled. The term "unsaturated" used herein refers to a ring where the valency of each atom of the ring may not be filled with hydrogen or other substituents. For example, adjacent carbon atoms in the fused ring can be doubly bound to each other. Unsaturation can also include deleting at least one of the following pairs and completing the valency of the ring carbon atoms at these deleted positions with a double bond, such as R₅ and R9; R₈ and Rio; and R13 and R14.

Whenever a group is described as being "substituted" that group may be substituted with one, two, three or more of the indicated substituents, which may be the same or different, each replacing a hydrogen atom. If no substituents are indicated, it is meant that the indicated "substituted" group may be substituted with one or more group(s) individually and independently selected from alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, acylalkyl, alkoxyalkyl, aminoalkyl, amino acid, aryl, heteroaryl, heteroalicyclyl, aralkyl, heteroaralkyl, (heteroalicyclyl)alkyl, hydroxy, protected hydroxyl, alkoxy, aryloxy, acyl, mercapto, alkylthio, arylthio, cyano, halogen (e.g., F, CI, Br, and I), thiocarbonyl, O- carbamyl, N-carbamyl, O-thiocarbamyl, N-thiocarbamyl, C-amido, N-amido, S-sulfonamido, N-sulfonamido, C-carboxy, protected C-carboxy, O-carboxy, isocyanato, thiocyanato, isothiocyanato, nitro, oxo, silyl, sulfenyl, sulfinyl, sulfonyl, haloalkyl, haloalkoxy, trihalomethanesulfonyl, trihalomethanesulfonamido, an amino, a mono-substituted amino group and a di-substituted amino group, R_aO(CH2)_mO-, Rb(CH₂)nO-, RcC(0)0(CH₂)_pO-, and protected derivatives thereof. The substituent may be attached to the group at more than one attachment point. For example, an aryl group may be substituted with a heteroaryl group at two attachment points to form a fused multicyclic aromatic ring system. Biphenyl and naphthalene are two examples of an aryl group that is substituted with a second aryl group.

As used herein, "C_a" or "C_a to Ct," in which "a" and "b" are integers refer to the number of carbon atoms in an alkyl, alkenyl or alkynyl group, or the number of carbon atoms in the ring of a cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl or heteroalicyclyl group. That is, the alkyl, alkenyl, alkynyl, ring of the cycloalkyl, ring of the cycloalkenyl, ring of the cycloalkynyl, ring of the aryl, ring of the heteroaryl or ring of the heteroalicyclyl can contain from "a" to "b", inclusive, carbon atoms. Thus, for example, a "Ci to C₄ alkyl" group refers to all alkyl groups having from 1 to 4 carbons, that is, CH3-, CH3CH2-, CH3CH2CH2-, (CH₃)₂CH-, CH3CH2CH2CH2-, CH₃CH₂CH(CH3)- and (CH₃)₃C-. If no "a" and "b" are designated with regard to an alkyl, alkenyl, alkynyl, cycloalkyl cycloalkenyl, cycloalkynyl, aryl, heteroaryl or heteroalicyclyl group, the broadest range described in these definitions is to be assumed. As used herein, "alkyl" refers to a straight or branched hydrocarbon chain that comprises a fully saturated (no double or triple bonds) hydrocarbon group. The alkyl group may have 1 to 25 carbon atoms (whenever it appears herein, a numerical range such as "1 to 25" refers to each integer in the given range; e.g., "1 to 25 carbon atoms" means that the alkyl group may consist of 1 carbon atom, 2 carbon atoms, 3 carbon atoms, etc., up to and including 25 carbon atoms, although the present definition also covers the occurrence of the term "alkyl" where no numerical range is designated). The alkyl group may also be a medium size alkyl having 1 to 15 carbon atoms. The alkyl group could also be a lower alkyl having 1 to 6 carbon atoms. The alkyl group of the compounds may be designated as "C4" or "C1-C4 alkyl" or similar designations. By way of example only, "C1-C4 alkyl" indicates that there are one to four carbon atoms in the alkyl chain, i.e., the alkyl chain is selected from methyl, ethyl, propyl, iso-propyl, n-butyl, iso-butyl, sec-butyl, and t-butyl. Typical alkyl groups include, but are in no way limited to, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, tertiary butyl, pentyl and hexyl. The alkyl group may be substituted or unsubstituted.

As used herein, "alkenyl" refers to an alkyl group that contains in the straight or branched hydrocarbon chain one or more double bonds. The alkenyl group may have 2 to 25 carbon atoms (whenever it appears herein, a numerical range such as "2 to 25" refers to each integer in the given range; e.g., "2 to 25 carbon atoms" means that the alkenyl group may consist of 2 carbon atom, 3 carbon atoms, 4 carbon atoms, etc., up to and including 25 carbon atoms, although the present definition also covers the occurrence of the term "alkenyl" where no numerical range is designated). The alkenyl group may also be a medium size alkenyl having 2 to 15 carbon atoms. The alkenyl group could also be a lower alkenyl having 1 to 6 carbon atoms. The alkenyl group of the compounds may be designated as "C4" or "C2-C4 alkyl" or similar designations. An alkenyl group may be unsubstituted or substituted.

As used herein, "alkynyl" refers to an alkyl group that contains in the straight or branched hydrocarbon chain one or more triple bonds. The alkynyl group may have 2 to 25 carbon atoms (whenever it appears herein, a numerical range such as "2 to 25" refers to each integer in the given range; e.g., "2 to 25 carbon atoms" means that the alkynyl group may consist of 2 carbon atom, 3 carbon atoms, 4 carbon atoms, etc., up to and including 25 carbon atoms, although the present definition also covers the occurrence of the term "alkynyl" where no numerical range is designated). The alkynyl group may also be a medium size alkynyl having 2 to 15 carbon atoms. The alkynyl group could also be a lower alkynyl having 2 to 6 carbon atoms. The alkynyl group of the compounds may be designated as "C4" or "C2-C4 alkyl" or similar designations. An alkynyl group may be unsubstituted or substituted. As used herein, "aryl" refers to a carbocyclic (all carbon) monocyclic or multicyclic aromatic ring system (including fused ring systems where two carbocyclic rings share a chemical bond) that has a fully delocalized pi-electron system throughout all the rings. The number of carbon atoms in an aryl group can vary. For example, the aryl group can be a C₆- Ci4 aryl group, a C₆-Cio aryl group, or a C₆ aryl group (although the definition of C₆-Cio aryl covers the occurrence of "aryl" when no numerical range is designated). Examples of aryl groups include, but are not limited to, benzene, naphthalene and azulene. An aryl group may be substituted or unsubstituted.

As used herein, "aralkyl" and "aryl(alkyl)" refer to an aryl group connected, as a substituent, via a lower alkylene group. The aralkyl group may have 6 to 20 carbon atoms (whenever it appears herein, a numerical range such as "6 to 20" refers to each integer in the given range; e.g., "6 to 20 carbon atoms" means that the aralkyl group may consist of 6 carbon atom, 7 carbon atoms, 8 carbon atoms, etc., up to and including 20 carbon atoms, although the present definition also covers the occurrence of the term "aralkyl" where no numerical range is designated). The lower alkylene and aryl group of an aralkyl may be substituted or unsubstituted. Examples include but are not limited to benzyl, 2-phenylalkyl, 3-phenylalkyl, and naphthylalkyl.

"Lower alkylene groups" refer to a C1-C25 straight-chained alkyl tethering groups, such as -CH2- tethering groups, forming bonds to connect molecular fragments via their terminal carbon atoms. Examples include but are not limited to methylene (-CH2-), ethylene (-CH2CH2-), propylene (-CH2CH2CH2-), and butylene (-CH2CH2CH2CH2-). A lower alkylene group can be substituted by replacing one or more hydrogen of the lower alkylene group with a substituent(s) listed under the definition of "substituted."

As used herein, "cycloalkyl" refers to a completely saturated (no double or triple bonds) mono- or multi- cyclic hydrocarbon ring system. When composed of two or more rings, the rings may be joined together in a fused fashion. Cycloalkyl groups can contain 3 to 10 atoms in the ring(s) or 3 to 8 atoms in the ring(s). A cycloalkyl group may be unsubstituted or substituted. Typical cycloalkyl groups include, but are in no way limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl and cyclooctyl.

As used herein, "cycloalkenyl" refers to a mono- or multi- cyclic hydrocarbon ring system that contains one or more double bonds in at least one ring; although, if there is more than one, the double bonds cannot form a fully delocalized pi-electron system throughout all the rings (otherwise the group would be "aryl," as defined herein). When composed of two or more rings, the rings may be connected together in a fused fashion. A cycloalkenyl group may be unsubstituted or substituted.

As used herein, "cycloalkynyl" refers to a mono- or multi- cyclic hydrocarbon ring system that contains one or more triple bonds in at least one ring. If there is more than one triple bond, the triple bonds cannot form a fully delocalized pi-electron system throughout all the rings. When composed of two or more rings, the rings may be joined together in a fused fashion. A cycloalkynyl group may be unsubstituted or substituted.

As used herein, "alkoxy" or "alkyloxy" refers to the formula -OR wherein R is an alkyl, an alkenyl, an alkynyl, a cycloalkyl, a cycloalkenyl or a cycloalkynyl as defined above. A non-limiting list of alkoxys are methoxy, ethoxy, n-propoxy, 1-m ethyl ethoxy (isopropoxy), n-butoxy, iso-butoxy, sec-butoxy and tert-butoxy. An alkoxy may be substituted or unsubstituted.

As used herein, "acyl" refers to a hydrogen, alkyl, alkenyl, alkynyl, aryl, or heteroaryl connected, as substituents, via a carbonyl group. Examples include formyl, acetyl, propanoyl, benzoyl, and acryl. An acyl may be substituted or unsubstituted.

As used herein, "alkoxyalkyl" or "alkyloxyalkyl" refers to an alkoxy group connected, as a substituent, via a lower alkylene group. Examples include alkyl-O-alkyl- and alkoxy-alkyl- with the terms alkyl and alkoxy defined herein.

As used herein, "hydroxyalkyl" refers to an alkyl group in which one or more of the hydrogen atoms are replaced by a hydroxy group. Exemplary hydroxyalkyl groups include but are not limited to, 2 -hydroxy ethyl, 3-hydroxypropyl, 2-hydroxypropyl, and 2,2- dihydroxy ethyl. A hydroxyalkyl may be substituted or unsubstituted.

As used herein, "haloalkyl" refers to an alkyl group in which one or more of the hydrogen atoms are replaced by a halogen (e.g., mono-haloalkyl, di-haloalkyl and tri- haloalkyl). Such groups include but are not limited to, chloromethyl, fluoromethyl, difluoromethyl, trifluoromethyl and l-chloro-2-fluorom ethyl, 2-fluoroisobutyl. A haloalkyl may be substituted or unsubstituted.

The term "amino" as used herein refers to a - H₂ group.

As used herein, the term "hydroxy" refers to a -OH group.

A "cyano" group refers to a "-CN" group.

A "carbonyl" or an "oxo" group refers to a C=0 group.

The term "azido" as used herein refers to a -N₃ group.

As used herein, "aminoalkyl" refers to an amino group connected, as a substituent, via a lower alkylene group. Examples include H₂N-alkyl- with the term alkyl defined herein. As used herein, "alkylcarboxyalkyl" refers to an alkyl group connected, as a substituent, to a carboxy group that is connected, as a substituent, to an alkyl group. Examples include alkyl-C(=0)0-alkyl- and alkyl-0-C(=0)-alkyl- with the term alkyl as defined herein.

As used herein, "alkylaminoalkyl" refers to an alkyl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include alkyl- H-alkyl-, with the term alkyl as defined herein.

As used herein, "dialkylaminoalkyl" or "di(alkyl)aminoalkyl" refers to two alkyl groups connected, each as a substituent, to an amino group that is connected, as a substituent,

Alky Alkyl-|- I

to an alkyl group. Examples include with the term alkyl as defined herein.

As used herein, "alkylaminoalkylamino" refers to an alkyl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group that is connected, as a substituent, to an amino group. Examples include alkyl-NH-alkyl- H-, with the term alkyl as defined herein.

As used herein, "alkylaminoalkylaminoalkylamino" refers to an alkyl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group that is connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include alkyl- H-alkyl- H-alkyl-, with the term alkyl as defined herein.

As used herein, "arylaminoalkyl" refers to an aryl group connected, as a substituent, to an amino group that is connected, as a substituent, to an alkyl group. Examples include aryl- H-alkyl-, with the terms aryl and alkyl as defined herein.

As used herein, "aminoalkyloxy" refers to an amino group connected, as a substituent, to an alkyloxy group. Examples include H₂N-alkyl-0- and H₂N-alkoxy- with the terms alkyl and alkoxy as defined herein.

As used herein, "aminoalkyloxyalkyl" refers to an amino group connected, as a substituent, to an alkyloxy group connected, as a substituent, to an alkyl group. Examples include H₂N-alkyl-0-alkyl- and H₂N-alkoxy-alkyl- with the terms alkyl and alkoxy as defined herein. As used herein, "aminoalkylcarboxy" refers to an amino group connected, as a substituent, to an alkyl group connected, as a substituent, to a carboxy group. Examples include H₂N-alkyl-C(=0)0- and H₂N-alkyl-0-C(=0)- with the term alkyl as defined herein.

As used herein, "aminoalkylaminocarbonyl" refers to an amino group connected, as a substituent, to an alkyl group connected, as a substituent, to an amino group connected, as a substituent, to a carbonyl group. Examples include H₂N-alkyl- H-C(=0)- with the term alkyl as defined herein.

As used herein, "aminoalkylcarboxamido" refers to an amino group connected, as a substituent, to an alkyl group connected, as a substituent, to a carbonyl group connected, as a substituent to an amino group. Examples include H₂N-alkyl-C(=0)- H- with the term alkyl as defined herein.

As used herein, "azidoalkyloxy" refers to an azido group connected as a substituent, to an alkyloxy group. Examples include N₃-alkyl-0- and N₃-alkoxy- with the terms alkyl and alkoxy as defined herein.

As used herein, "cyanoalkyloxy" refers to a cyano group connected as a substituent, to an alkyloxy group. Examples include NC-alkyl-O- and NC-alkoxy- with the terms alkyl and alkoxy as defined herein.

A "sulfenyl" group refers to an "-SR" group in which R can be hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. A sulfenyl may be substituted or unsubstituted.

A "sulfinyl" group refers to an "-S(=0)-R" group in which R can be the same as defined with respect to sulfenyl. A sulfinyl may be substituted or unsubstituted.

A "sulfonyl" group refers to an "S0₂R" group in which R can be the same as defined with respect to sulfenyl. A sulfonyl may be substituted or unsubstituted.

An "O-carboxy" group refers to a "RC(=0)0-" group in which R can be hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl, as defined herein. An O-carboxy may be substituted or unsubstituted.

The terms "ester" and "C-carboxy" refer to a "-C(=0)OR" group in which R can be the same as defined with respect to O-carboxy. An ester and C-carboxy may be substituted or unsubstituted.

A "thiocarbonyl" group refers to a "-C(=S)R" group in which R can be the same as defined with respect to O-carboxy. A thiocarbonyl may be substituted or unsubstituted. A "trihalomethanesulfonyl" group refers to an "X3CSO2-" group wherein X is a halogen.

An "S-sulfonamido" group refers to a "-S02N(RARB)" group in which RA and RB can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An S- sulfonamido may be substituted or unsubstituted.

An "N-sulfonamido" group refers to a "RS02N(RA)-" group in which R and RA can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An N-sulfonamido may be substituted or unsubstituted.

An "O-carbamyl" group refers to a "-OC(=0)N(RARB)" group in which RA and RB can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An O- carbamyl may be substituted or unsubstituted.

An "N-carbamyl" group refers to an "ROC(=0)N(RA)-" group in which R and RA can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An N- carbamyl may be substituted or unsubstituted.

An "O-thiocarbamyl" group refers to a "-OC(=S)-N(RARB)" group in which RA and RB can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An O- thiocarbamyl may be substituted or unsubstituted.

An "N-thiocarbamyl" group refers to an "ROC(=S)N(RA)-" group in which R and RA can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An N- thiocarbamyl may be substituted or unsubstituted.

A "C-amido" group refers to a "-C(=0)N(RARB)" group in which RA and RB can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. A C-amido may be substituted or unsubstituted.

An "N-amido" group refers to a "RC(=0)N(RA)-" group in which R and RA can be independently hydrogen, alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, cycloalkynyl, aryl, heteroaryl, heteroalicyclyl, aralkyl, or (heteroalicyclyl)alkyl. An N-amido may be substituted or unsubstituted. As used herein, "guanidinoalkyloxy" refers to a guanidinyl group connected, as a

H

T ^AIkyl-O-?- substituent, to an alkyloxy group. Examples include ^NH and

H

T ^AIkoxy- -

^NH with the terms alkyl and alkoxy as defined herein.

As used herein, "guanidinoalkylcarboxy" refers to a guanidinyl group connected, as a substituent, to an alkyl group connected, as a substituent, to a carboxy group. Examples

include

with the term alkyl as defined herein.

As used herein, "quaternary ammonium alkylcarboxy" refers to a quaternized amino group connected, as a substituent, to an alkyl group connected, as a substituent, to a carboxy

group. Examples include

with the term alkyl as defined herein.

The term "halogen atom" or "halogen" as used herein, means any one of the radio- stable atoms of column 7 of the Periodic Table of the Elements, such as, fluorine, chlorine, bromine and iodine.

Where the numbers of substituents is not specified (e.g. haloalkyl), there may be one or more substituents present. For example "haloalkyl" may include one or more of the same or different halogens.

As used herein, the term "amino acid" refers to any amino acid (both standard and non-standard amino acids), including, but not limited to, a-amino acids, β-amino acids, γ- amino acids and δ-amino acids. Examples of suitable amino acids include, but are not limited to, alanine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, proline, serine, tyrosine, arginine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. Additional examples of suitable amino acids include, but are not limited to, ornithine, hypusine, 2-aminoisobutyric acid, dehydroalanine, gamma- aminobutyric acid, citrulline, beta-alanine, alpha-ethyl-glycine, alpha-propyl-glycine and norleucine. A linking group is a divalent moiety used to link one steroid to another steroid. In some embodiments, the linking group is used to link a first CSA with a second CSA (which may be the same or different). An example of a linking group is (Ci-Cio) alkyloxy-(Ci-Cio) alkyl.

The terms "P.G." or "protecting group" or "protecting groups" as used herein refer to any atom or group of atoms that is added to a molecule in order to prevent existing groups in the molecule from undergoing unwanted chemical reactions. Examples of protecting group moieties are described in T. W. Greene and P. G. M. Wuts, Protective Groups in Organic Synthesis, 3. Ed. John Wiley & Sons, 1999, and in J.F.W. McOmie, Protective Groups in Organic Chemistry Plenum Press, 1973, both of which are hereby incorporated by reference for the limited purpose of disclosing suitable protecting groups. The protecting group moiety may be chosen in such a way, that they are stable to certain reaction conditions and readily removed at a convenient stage using methodology known from the art. A non-limiting list of protecting groups include benzyl; substituted benzyl; alkylcarbonyls and alkoxycarbonyls (e.g., t-butoxycarbonyl (BOC), acetyl, or isobutyryl); arylalkylcarbonyls and arylalkoxycarbonyls (e.g., benzyloxycarbonyl); substituted methyl ether (e.g. methoxymethyl ether); substituted ethyl ether; substituted benzyl ether; tetrahydropyranyl ether; silyls (e.g., trimethylsilyl, triethylsilyl, triisopropylsilyl, t-butyl dimethyl silyl, tn-iso- propylsilyloxymethyl, [2-(trimethylsilyl)ethoxy]methyl or t-butyldiphenylsilyl); esters (e.g. benzoate ester); carbonates (e.g. methoxymethylcarbonate); sulfonates (e.g. tosylate or mesylate); acyclic ketal (e.g. dimethyl acetal); cyclic ketals (e.g., 1,3-dioxane, 1,3- dioxolanes, and those described herein); acyclic acetal; cyclic acetal (e.g., those described herein); acyclic hemiacetal; cyclic hemiacetal; cyclic dithioketals (e.g., 1,3-dithiane or 1,3- dithiolane); orthoesters (e.g., those described herein) and triarylmethyl groups (e.g., trityl; monomethoxytrityl (MMTr); 4,4'-dimethoxytrityl (DMTr); 4,4',4"-trimethoxytrityl (TMTr); and those described herein). Amino-protecting groups are known to those skilled in the art. In general, the species of protecting group is not critical, provided that it is stable to the conditions of any subsequent reaction(s) on other positions of the compound and can be removed at the appropriate point without adversely affecting the remainder of the molecule. In addition, a protecting group may be substituted for another after substantive synthetic transformations are complete. Clearly, where a compound differs from a compound disclosed herein only in that one or more protecting groups of the disclosed compound has been substituted with a different protecting group, that compound is within the disclosure. CSA Compounds: Cationic steroidal anti-microbial (CSA) compounds, sometimes referred to as "CSA compounds" or "ceragenin" compounds, are synthetically produced, small molecule chemical compounds that include a sterol backbone having various charged groups (e.g., amine and cationic groups) attached to the backbone. The sterol backbone can be used to orient amine or guanidine groups on a face or plane of the sterol backbone. CSAs are cationic and amphiphilic, based upon the functional groups attached to the backbone. They are facially amphiphilic with a hydrophobic face and a polycationic face.

Without wishing to be bound to theory, the CSA molecules described herein act as anti-microbial agents (e.g., anti -bacterial, anti-fungal, and anti-viral). It is believed, for example, that anti-microbial CSA molecules may act as an anti-microbial by binding to the cellular membrane of bacteria and other microbes and modifying the cell membrane, e.g., such as by forming a pore that allows the leakage of ions and cytoplasmic materials critical to the microbe's survival, and leading to the death of the affected microbe. In addition, antimicrobial CSA molecules may also act to sensitize bacteria to other antibiotics. For example, at concentrations of anti-microbial CSA molecules below the corresponding minimum bacteriostatic concentration (MIC), the CSA compound may cause bacteria to become more susceptible to other antibiotics by disrupting the cell membrane, such as by increasing membrane permeability. It is postulated that charged cationic groups may be responsible for disrupting the bacterial cellular membrane and imparting anti-microbial properties. CSA molecules may have similar membrane- or outer coating-disrupting effects on fungi and viruses.

By way of background, exemplary CSA compounds are described in U.S. Patent Nos. 6,350,738, 6,486, 148, 6,767,904, 7,598,234, 7,754,705, U.S. Application Nos. 61/786301, 13/288892, 61/642431, 13/554930, 61/572714, 13/594608, 61/576903, 13/594612, 13/288902, 61/605639, 13/783131, 61/605642, 13/783007, 61/132361, 13/000010, 61/534185, 13/615244, 61/534194, 13/615324, 61534205, 61/637402, 13/841549, 61/715277, PCT/US13/37615, 61/749800, 61/794721, and 61/814816, which are incorporated herein by reference. The skilled artisan will recognize the compounds within the generic formulae set forth herein and understand their preparation in view of the references cited herein and the Examples.

The compounds and compositions disclosed herein are optionally prepared as salts. The term "salt" as used herein is a broad term, and is to be given its ordinary and customary meaning to a skilled artisan (and is not to be limited to a special or customized meaning), and refers without limitation to a salt of a compound. In some embodiments, the salt is an acid addition salt of the compound. Salts can be obtained by reacting a compound with inorganic acids such as hydrohalic acid (e.g., hydrochloric acid or hydrobromic acid), sulfuric acid, nitric acid, and phosphoric acid. Salts can also be obtained by reacting a compound with an organic acid such as aliphatic or aromatic carboxylic or sulfonic acids, for example formic acid, acetic acid, propionic acid, glycolic acid, pyruvic acid, malonic acid, maleic acid, fumaric acid, trifluoroacetic acid, benzoic acid, cinnamic acid, mandelic acid, succinic acid, lactic acid, malic acid, tartaric acid, citric acid, ascorbic acid, nicotinic acid, methanesulfonic acid, ethanesulfonic acid, p-toluensulfonic acid, salicylic acid, stearic acid, muconic acid, butyric acid, phenylacetic acid, phenylbutyric acid, valproic acid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid, 2-naphthalenesulfonic acid, or naphthalenesulfonic acid. Salts can also be obtained by reacting a compound with a base to form a salt such as an ammonium salt, an alkali metal salt, such as a lithium, sodium or a potassium salt, an alkaline earth metal salt, such as a calcium, magnesium or aluminum salt, a salt of organic bases such as dicyclohexylamine, N-methyl-D-glucamine, tris(hydroxymethyl)methyl amine, C1-C7 alkylamine, cyclohexylamine, dicyclohexylamine, triethanolamine, ethylenediamine, ethanolamine, diethanolamine, triethanolamine, tromethamine, and salts with amino acids such as arginine and lysine; or a salt of an inorganic base, such as aluminum hydroxide, calcium hydroxide, potassium hydroxide, sodium carbonate, sodium hydroxide, or the like.

In some embodiments, the salt is a hydrochloride salt. In some embodiments, the salt is a mono-hydrochloride salt, a di-hydrochloride salt, a tri -hydrochloride salt, or a tetra- hydrochloride salt. Additional examples of salts include sulfuric acid addition salts, sulfonic acid addition salts, disulfonic acid addition salts, 1,5-naphthalenedisulfonic acid addition salts, sulfate salts, and bisulfate salts.

In some embodiments, CSA compounds as disclosed herein can be a compound of Formula (I), Formula (II), or salt thereof, having a steroidal backbone, and wherein at least Ri8 of the steroidal backbone includes amide functionality in which the carbonyl group of the amide is positioned between the amido nitrogen of the amide and fused ring D of the steroidal backbone:

In some embodiments, at least Ris can have the following structure:

In some embodiments, R₂i and R₂₂ are independently selected from the group consisting of hydrogen, optionally substituted Ci-C₂₄ alkyl, optionally substituted C₂-C₂₄ alkenyl, optionally substituted C₂-C₂₄ alkynyl, optionally substituted C₆ or Cio aryl, optionally substituted 5 to 10 membered heteroaryl, optionally substituted 5 to 10 membered heterocyclyl, optionally substituted C₇.₁₃ aralkyl, optionally substituted (5 to 10 membered heteroaryl)-Ci-C6 alkyl, optionally substituted C3-10 carbocyclyl, optionally substituted C₄.₁₀ (carbocyclyl)alkyl, optionally substituted (5 to 10 membered heterocyclyl)-Ci-C₆ alkyl, optionally substituted amido, and a suitable amine protecting group, provided that at least one of R₂i and R₂₂ is not hydrogen. In some embodiments, R₂i and R₂₂, together with the atoms to which they are attached, form an optionally substituted 5 to 10 membered heterocyclyl ring.

In addition to the foregoing, CSA compounds of Formula (I), Formula (II), and salts thereof are characterized wherein:

rings A, B, C, and D are independently saturated, or are fully or partially unsaturated, provided that at least two of rings A, B, C, and D are saturated;

m, n, p, and q are independently 0 or 1 ;

Ri through R₄, 5 , R7 , Rii , R12, R15, and R½ are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted alkyl, substituted or unsubstituted hydroxyalkyl, substituted or unsubstituted alkyloxyalkyl, substituted or unsubstituted alkylcarboxyalkyl, substituted or unsubstituted alkylaminoalkyl, substituted or unsubstituted alkylaminoalkylamino, substituted or unsubstituted alkylaminoalkylamino- alkylamino, substituted or unsubstituted aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted arylaminoalkyl, substituted or unsubstituted haloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, oxo, linking group attached to a second steroid, substituted or unsubstituted aminoalkyloxy, substituted or unsubstituted aminoalkyloxyalkyl, substituted or unsubstituted aminoalkylcarboxy, substituted or unsubstituted aminoalkylaminocarbonyl, substituted or unsubstituted aminoalkylcarboxamido, substituted or unsubstituted di(alkyl)aminoalkyl, H₂N-HC(Q5)- C(0)-0-, H₂N-HC(Q5)-C(0)-N(H)-, substituted or unsubstituted azidoalkyloxy, substituted or unsubstituted cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)-0-, substituted or unsubstituted guanidinoalkyloxy, substituted or unsubstituted quaternary ammonium alkylcarboxy, and substituted or unsubstituted guanidinoalkyl carboxy, where Q5 is a side chain of any amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R5, R₈, R9, Rio, Ri3, Ri4 and Rn are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R₈, R9, Rio, Ri3, Ri4 and Rn are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted alkyl, substituted or unsubstituted hydroxyalkyl, substituted or unsubstituted alkyloxyalkyl, substituted or unsubstituted aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted haloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, oxo, linking group attached to a second steroid, substituted or unsubstituted aminoalkyloxy, substituted or unsubstituted aminoalkylcarboxy, substituted or unsubstituted aminoalkylaminocarbonyl, substituted or unsubstituted di(alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N-HC(Q₅)-C(0)-N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)-0-, guanidinoalkyloxy, and guanidinoalkyl-carboxy, where Q5 is a side chain of any amino acid, P.G. is an amino protecting group.

In some embodiments, at least one, and sometimes two or three, of R1-4, R6 , R7 , R11, R12, Ri5, Ri6, and R17 are independently selected from the group consisting of substituted or unsubstituted aminoalkyl, substituted or unsubstituted aminoalkyloxy, substituted or unsubstituted alkylcarboxyalkyl, substituted or unsubstituted alkylaminoalkylamino, substituted or unsubstituted alkylaminoalkylaminoalkylamino, substituted or unsubstituted aminoalkylcarboxy, substituted or unsubstituted arylaminoalkyl, substituted or unsubstituted aminoalkyloxyaminoalkylaminocarbonyl, substituted or unsubstituted aminoalkylamino- carbonyl, substituted or unsubstituted aminoalkyl-carboxyamido, quaternary ammonium alkylcarboxy, substituted or unsubstituted di(alkyl)aminoalkyl, H2N-HC(Q5)-C(0)-0-, H2N- HC(Q₅)-C(0)-N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q₅)-C(0)-0-, substituted or unsubstituted guanidine-alkyloxy, and substituted or unsubstituted guanidinoalkylcarboxy.

In some embodiments, Ri through R₄, R5 , R7 , R11 , R12, R15, and R½ are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted (C1-C22) alkyl, substituted or unsubstituted (C1-C22) hydroxyalkyl, substituted or unsubstituted (C1-C22) alkyl oxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) alkylcarboxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino- (C1-C22) alkylamino, substituted or unsubstituted (C1-C22) aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted arylamino-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) haloalkyl, substituted or unsubstituted C2-C6 alkenyl, substituted or unsubstituted C2-C6 alkynyl, oxo, linking group attached to a second steroid, substituted or unsubstituted (C1-C22) aminoalkyloxy, substituted or unsubstituted (C1-C22) aminoalkyl oxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) aminoalkylcarboxy, substituted or unsubstituted (Ci- C22) aminoalkylaminocarbonyl, substituted or unsubstituted (C1-C22) aminoalkyl- carboxamido, substituted or unsubstituted di(Ci-C22 alkyl)aminoalkyl, H2N-HC(Q5)-C(0)-0-, H₂N-HC(Q5)-C(0)-N(H)-, substituted or unsubstituted (C1-C22) azidoalkyloxy, substituted or unsubstituted (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q₅)-C(0)-0-, substituted or unsubstituted (C1-C22) guanidinoalkyloxy, substituted or unsubstituted (C1-C22) quaternary ammonium alkyl carboxy, and substituted or unsubstituted (C1-C22) guanidinoalkyl carboxy, where Q₅ is a side chain of an amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R.5, R₈, R9, Rio, Ri3, Ri4 and Rn are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, Rs>, Rio, Ri3, and Ri₄ are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted (C1-C22) alkyl, substituted or unsubstituted (C1-C22) hydroxyalkyl, substituted or unsubstituted (C1-C22) alkyl oxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted (C1-C22) haloalkyl, substituted or unsubstituted (C2-C₆) alkenyl, substituted or unsubstituted (C2-C₆) alkynyl, oxo, linking group attached to a second steroid, substituted or unsubstituted (C1-C22) aminoalkyloxy, substituted or unsubstituted (C1-C22) aminoalkylcarboxy, substituted or unsubstituted (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted di(Ci-C₂2 alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N- HC(Q5)-C(0)-N(H)-, substituted or unsubstituted (C1-C22) azidoalkyloxy, substituted or unsubstituted (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q₅)-C(0)-0-, substituted or unsubstituted (C1-C22) guanidinoalkyloxy, and (C1-C22) guanidinoalkylcarboxy, where Q5 is a side chain of any amino acid, and P.G. is an amino protecting group; provided that at least two or three of R1-4, R5 , R7 , R11, R12, R15, Ri6, Rn, and Ri₈ are independently selected from the group consisting of substituted or unsubstituted (C1-C22) aminoalkyl, substituted or unsubstituted (C1-C22) aminoalkyloxy, substituted or unsubstituted (C1-C22) alkylcarboxy- (C1-C22) alkyl, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino (C1-C22) alkylamino, substituted or unsubstituted (C1-C22) aminoalkylcarboxy, substituted or unsubstituted arylamino (C1-C22) alkyl, substituted or unsubstituted (C1-C22) aminoalkyloxy (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted (C1-C22) aminoalkylcarboxyamido, substituted or unsubstituted (C1-C22) quaternary ammonium alkylcarboxy, substituted or unsubstituted di(Ci-C22 alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N-HC(Q₅)-C(0)-N(H)-, substituted or unsubstituted (C1-C22) azidoalkyloxy, substituted or unsubstituted (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)-0-, substituted or unsubstituted (C1-C22) guanidinoalkyloxy, and substituted or unsubstituted (C1-C22) guanidinoalkylcarboxy.

In some embodiments, Ri through R₄, R5 , R7 , R11 , R12, R15, and R½ are independently selected from the group consisting of hydrogen, hydroxyl, unsubstituted (Ci- Ci₈) alkyl, unsubstituted (Ci-Ci₈) hydroxyalkyl, unsubstituted (Ci-Ci₈) alkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Cis) alkylcarboxy-(Ci-Cis) alkyl, unsubstituted (Ci-Cis) alkylamino- (Ci-Ci₈)alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino, (Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) aminoalkyl, unsubstituted aryl, unsubstituted arylamino-(Ci-Ci₈) alkyl, oxo, unsubstituted (Ci-Ci₈) aminoalkyloxy, unsubstituted (Ci-Ci₈) aminoalkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxy, unsubstituted (Ci-Ci₈) aminoalkylaminocarbonyl, unsubstituted(Ci-Ci₈) aminoalkyl-carboxamido, unsubstituted di(Ci-Ci₈ alkyl)aminoalkyl, unsubstituted (Ci-Ci₈) guanidinoalkyloxy, unsubstituted (Ci-Ci₈) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₈) guanidinoalkyl carboxy; and

R.5, R₈, R9, Rio, Ri3, Ri4 and R17 are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R₈, R9, Rio, Ri3, and R14 are independently selected from the group consisting of hydrogen, hydroxyl, unsubstituted (Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) hydroxyalkyl, unsubstituted (Ci-Ci₈) alkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylcarboxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈)alkyl, (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) aminoalkyl, unsubstituted aryl, unsubstituted arylamino-(Ci-Ci₈) alkyl, oxo, unsubstituted (Ci-Ci₈) aminoalkyloxy, unsubstituted (Ci-Ci₈) aminoalkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxy, unsubstituted (Ci-Ci₈) aminoalkylaminocarbonyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxamido, unsubstituted di(Ci-Ci₈ alkyl)aminoalkyl, unsubstituted (Ci-Ci₈) guanidinoalkyloxy, unsubstituted (Ci-Ci₈) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₈) guanidinoalkyl carboxy,

provided that at least one of R1-4, R₆ , R7 , R11, R12, R15, R½, and R17 are independently selected from the group consisting of of hydrogen, hydroxyl, unsubstituted (Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) hydroxyalkyl, unsubstituted (Ci-Ci₈) alkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylcarboxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylamino- (Ci-Ci₈)alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) aminoalkyl, unsubstituted aryl, unsubstituted arylamino-(Ci-Ci₈) alkyl, oxo, unsubstituted (Ci-Ci₈) aminoalkyloxy, unsubstituted (Ci-Ci₈) aminoalkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxy, unsubstituted (Ci-Ci₈) aminoalkylaminocarbonyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxamido, unsubstituted di(Ci-Ci₈ alkyl)aminoalkyl, unsubstituted (Ci-Ci₈) guanidinoalkyloxy, unsubstituted (Ci-Ci₈) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₈) guanidinoalkyl carboxy. In some embodiments, Ri, R₂, R₄, R5, R5, Rs, R9, Rio, R11, R13, R14, R15, Ri6, and R17 are independently selected from the group consisting of hydrogen and unsubstituted (Ci-C₆) alkyl.

In some embodiments, Ri, R₂, R₄, R5, R₆, Rs, Rio, R11, R14, Ri6, and R17 are each hydrogen; and R9 and R13 are each methyl.

In some embodiments, one or more of rings A, B, C, and D are heterocyclic.

In some embodiments, rings A, B, C, and D are non-heterocyclic.

In some embodiments, the CSA compound is a compound of Formula (III), or salt thereof, having a steroidal backbone, and wherein at least Ris of the steroidal backbone includes amide functionalit :

wherein,

at least Ris has the following structure:

where R20 is omitted or substituted or unsubstituted alkyl, alkenyl, alkynyl, or aryl, such as substituted or unsubstituted C1-C10 alkyl, substituted or unsubstituted C1-C10 alkenyl, substituted or unsubstituted C1-C10 alkynyl, or substituted or unsubstituted C₆ or C10 aryl, and where R21 and R22 are independently selected from the group consisting of hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, or substituted or unsubstituted aryl, provided that at least one of R21 and R22 is not hydrogen,

R21 and R22 are independently selected from the group consisting of hydrogen, optionally substituted Ci-C₂₄ alkyl, optionally substituted C2-C24 alkenyl, optionally substituted C₂-C₂₄ alkynyl, optionally substituted C₆ or C10 aryl, optionally substituted 5 to 10 membered heteroaryl, optionally substituted 5 to 10 membered heterocyclyl, optionally substituted C7-C13 aralkyl, optionally substituted (5 to 10 membered heteroaryl)-Ci-C₆ alkyl, optionally substituted C3-C10 carbocyclyl, optionally substituted C₄-Cio (carbocyclyl)alkyl, optionally substituted (5 to 10 membered heterocyclyl)-Ci-C₆ alkyl, optionally substituted amido, and a suitable amine protecting group, provided that at least one of R21 and R22 is not hydrogen.

In some embodiments, R21 and R22, together with the atoms to which they are attached, can form an optionally substituted 5 to 10 membered heterocyclyl ring.

In some embodiments, R3, R7, and R12 are independently selected from the group consisting of hydrogen, unsubstituted (C1-C22) alkyl, unsubstituted (C1-C22) hydroxyalkyl, unsubstituted (C1-C22) alkyl oxy-(Ci-C22) alkyl, unsubstituted (C1-C22) alkylcarboxy-(Ci-C22) alkyl, unsubstituted (C1-C22) alkylamino-(Ci-C22)alkyl, unsubstituted (C1-C22) alkylamino- (C1-C22) alkylamino, unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino-(Ci-Cis) alkylamino, unsubstituted (C1-C22) aminoalkyl, unsubstituted arylamino-(Ci-C22) alkyl, unsubstituted (C1-C22) aminoalkyloxy, unsubstituted (C1-C22) aminoalkyl oxy-(Ci-C22) alkyl, unsubstituted (C1-C22) aminoalkylcarboxy, unsubstituted (C1-C22) aminoalkylaminocarbonyl, unsubstituted (C1-C22) aminoalkylcarboxamido, unsubstituted di(Ci-C22 alkyl)aminoalkyl, unsubstituted (C1-C22) guanidinoalkyloxy, unsubstituted (C1-C22) quaternary ammonium alkylcarboxy, and unsubstituted (C1-C22) guanidinoalkyl carboxy.

In some embodiments, R3, R7, and R12 are independently selected from the group consisting of hydrogen, unsubstituted (Ci-C₆) alkyl, unsubstituted (Ci-C₆) hydroxyalkyl, unsubstituted (Ci-Ci₆) alkyloxy-(Ci-C5) alkyl, unsubstituted (Ci-Ci₆) alkylcarboxy-(Ci-C5) alkyl, unsubstituted (Ci-Ci₆) alkylamino-(Ci-C5)alkyl, unsubstituted (Ci-Ci₆) alkylamino- (C1-C5) alkylamino, unsubstituted (Ci-Ci₆) alkylamino-(Ci-Ci6) alkylamino-(Ci-C5) alkylamino, unsubstituted (Ci-Ci₆) aminoalkyl, unsubstituted arylamino-(Ci-C5) alkyl, unsubstituted (C1-C5) aminoalkyloxy, unsubstituted (Ci-Ci₆) aminoalkyl oxy-(Ci-C5) alkyl, unsubstituted (C1-C5) aminoalkylcarboxy, unsubstituted (C1-C5) aminoalkylaminocarbonyl, unsubstituted (C1-C5) aminoalkylcarboxamido, unsubstituted di(Ci-C₅ alkyl)amino- (C1-C5) alkyl, unsubstituted (C1-C5) guanidinoalkyloxy, unsubstituted (Ci-Ci₆) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₆) guanidinoalkylcarboxy.

In some embodiments, R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkyl aminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkylcarboxyalkyl; and hydroxyalkyl.

In some embodiments, R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy and aminoalkylcarboxy.

In some embodiments, R3, R7, and R12 are the same. In some embodiments, R3, R7, and R12 are aminoalkyloxy. In some embodiments, R3, R7, and R12 are aminoalkylcarboxy. In some embodiments, R₃, R7, and R12 are independently selected from the group consisting of amino-C₃-alkyloxy; amino-C₃-alkyl-carboxy; Cs-alkylamino-Cs-alkyl; C₈- alkoxy-carbonyl-C4-alkyl; C₈-alkyl-carbonyl-C4-alkyl; di-(C5-alkyl)amino-C5-alkyl; C₁₃- alkylamino-C5-alkyl; C6-alkoxy-carbonyl-C4-alkyl; C6-alkyl-carboxy-C4-alkyl; and C₁₆- alkylamino-C5-alkyl.

Non-limiting examples of CSA compounds having amide functionality as defined herein include CSA-190, CSA-191, CSA-192, CSA-192MS, and salts thereof:

Pharmaceutical Compositions While it is possible for the compounds described herein to be administered alone, it may be preferable to formulate the compounds as pharmaceutical compositions (i.e., formulations). As such, in yet another aspect, pharmaceutical compositions useful in the methods and uses of the disclosed embodiments are provided. A pharmaceutical composition is any composition that may be administered in vitro or in vivo or both to a subject in order to treat or ameliorate a condition. In a preferred embodiment, a pharmaceutical composition may be administered in vivo. A subject may include one or more cells or tissues, or organisms. In some exemplary embodiments, the subject is an animal. In some embodiments, the animal is a mammal. The mammal may be a human or primate in some embodiments. A mammal includes any mammal, such as by way of non-limiting example, cattle, pigs, sheep, goats, horses, camels, buffalo, cats, dogs, rats, mice, and humans.

As used herein the terms "pharmaceutically acceptable" and "physiologically acceptable" mean a biologically compatible formulation, gaseous, liquid or solid, or mixture thereof, which is suitable for one or more routes of administration, in vivo delivery, or contact. A formulation is compatible in that it does not destroy activity of an active ingredient therein (e.g., a CSA compound), or induce adverse side effects that far outweigh any prophylactic or therapeutic effect or benefit.

In some embodiments, pharmaceutical compositions may be formulated with pharmaceutically acceptable excipients such as carriers, solvents, stabilizers, adjuvants, diluents, etc., depending upon the particular mode of administration and dosage form. The pharmaceutical compositions should generally be formulated to achieve a physiologically compatible pH, and may range from a pH of about 3 to a pH of about 11, preferably about pH 3 to about pH 7, depending on the formulation and route of administration. In alternative embodiments, it may be preferred that the pH is adjusted to a range from about pH 5.0 to about pH 8. More particularly, the pharmaceutical compositions may comprise a therapeutically or prophylactically effective amount of at least one compound as described herein, together with one or more pharmaceutically acceptable excipients. Optionally, the pharmaceutical compositions may comprise a combination of the compounds described herein, or may include a second active ingredient useful in the treatment or prevention of bacterial infection (e.g., anti -bacterial or anti-microbial agents). Optionally, the composition is formulated as a coating. In some embodiments, the coating is on a medical device. In some embodiments, the coating is on medical instrumentation.

Formulations, e.g., for parenteral or oral administration, are most typically solids, liquid solutions, emulsions or suspensions, while inhalable formulations for pulmonary administration are generally liquids or powders, with powder formulations being generally preferred. A preferred pharmaceutical composition may also be formulated as a lyophilized solid that is reconstituted with a physiologically compatible solvent prior to administration. Alternative pharmaceutical compositions may be formulated as syrups, creams, ointments, tablets, and the like.

Compositions may contain one or more excipients. Pharmaceutically acceptable excipients are determined in part by the particular composition being administered, as well as by the particular method used to administer the composition. Accordingly, there exists a wide variety of suitable formulations of pharmaceutical compositions (see, e.g., Remington's Pharmaceutical Sciences).

Suitable excipients may be carrier molecules that include large, slowly metabolized macromolecules such as proteins, polysaccharides, polylactic acids, polyglycolic acids, polymeric amino acids, amino acid copolymers, and inactive virus particles. Other exemplary excipients include antioxidants such as ascorbic acid; chelating agents such as EDTA; carbohydrates such as dextrin, hydroxyalkylcellulose, hydroxyalkylmethylcellulose, stearic acid; liquids such as oils, water, saline, glycerol and ethanol; wetting or emulsifying agents; pH buffering substances; and the like. Liposomes are also included within the definition of pharmaceutically acceptable excipients.

Pharmaceutical compositions may be formulated in any form suitable for the intended method of administration. When intended for oral use for example, tablets, troches, lozenges, aqueous or oil suspensions, non-aqueous solutions, dispersible powders or granules (including micronized particles or nanoparticles), emulsions, hard or soft capsules, syrups or elixirs may be prepared. Compositions intended for oral use may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions, and such compositions may contain one or more agents including sweetening agents, flavoring agents, coloring agents and preserving agents, in order to provide a palatable preparation.

Pharmaceutically acceptable excipients particularly suitable for use in conjunction with tablets include, for example, inert diluents, such as celluloses, calcium or sodium carbonate, lactose, calcium or sodium phosphate; disintegrating agents, such as cross-linked povidone, maize starch, or alginic acid; binding agents, such as povidone, starch, gelatin or acacia; and lubricating agents, such as magnesium stearate, stearic acid or talc.

Tablets may be uncoated or may be coated by known techniques including microencapsulation to delay disintegration and adsorption in the gastrointestinal tract and thereby provide a sustained action over a longer period. For example, a time delay material such as glyceryl monostearate or glyceryl distearate alone or with a wax may be employed.

Formulations for oral use may be also presented as hard gelatin capsules where the active ingredient is mixed with an inert solid diluent, for example celluloses, lactose, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredient is mixed with non-aqueous or oil medium, such as glycerin, propylene glycol, polyethylene glycol, peanut oil, liquid paraffin or olive oil.

In another embodiment, pharmaceutical compositions may be formulated as suspensions comprising a compound of the embodiments in admixture with at least one pharmaceutically acceptable excipient suitable for the manufacture of a suspension.

In yet another embodiment, pharmaceutical compositions may be formulated as dispersible powders and granules suitable for preparation of a suspension by the addition of suitable excipients.

Excipients suitable for use in connection with suspensions include suspending agents, such as sodium carboxymethylcellulose, methylcellulose, hydroxypropyl methylcellulose, sodium alginate, polyvinylpyrrolidone, gum tragacanth, gum acacia, dispersing or wetting agents such as a naturally occurring phosphatide (e.g., lecithin), a condensation product of an alkylene oxide with a fatty acid (e.g., polyoxyethylene stearate), a condensation product of ethylene oxide with a long chain aliphatic alcohol (e.g., heptadecaethyleneoxycethanol), a condensation product of ethylene oxide with a partial ester derived from a fatty acid and a hexitol anhydride (e.g., polyoxyethylene sorbitan monooleate); polysaccharides and polysaccharide-like compounds (e.g. dextran sulfate); glycoaminoglycans and glycosaminoglycan-like compounds (e.g., hyaluronic acid); and thickening agents, such as carbomer, beeswax, hard paraffin or cetyl alcohol. The suspensions may also contain one or more preservatives such as acetic acid, methyl and/or n-propyl p-hydroxy-benzoate; one or more coloring agents; one or more flavoring agents; and one or more sweetening agents such as sucrose or saccharin.

Pharmaceutical compositions may also be in the form of oil-in water emulsions. The oily phase may be a vegetable oil, such as olive oil or arachis oil, a mineral oil, such as liquid paraffin, or a mixture of these. Suitable emulsifying agents include naturally-occurring gums, such as gum acacia and gum tragacanth; naturally occurring phosphatides, such as soybean lecithin, esters or partial esters derived from fatty acids; hexitol anhydrides, such as sorbitan monooleate; and condensation products of these partial esters with ethylene oxide, such as polyoxyethylene sorbitan monooleate. The emulsion may also contain sweetening and flavoring agents. Syrups and elixirs may be formulated with sweetening agents, such as glycerol, sorbitol or sucrose. Such formulations may also contain a demulcent, a preservative, a flavoring or a coloring agent.

Additionally, pharmaceutical compositions may be in the form of a sterile injectable preparation, such as a sterile injectable aqueous emulsion or oleaginous suspension. This emulsion or suspension may be formulated according to the known art using those suitable dispersing or wetting agents and suspending agents which have been mentioned above. The sterile injectable preparation may also be a sterile injectable solution or suspension in a nontoxic parenterally acceptable diluent or solvent, such as a solution in 1,2-propane-diol.

Sterile injectable preparations may also be prepared as a lyophilized powder. Among the acceptable vehicles and solvents that may be employed are water, Ringer's solution, and isotonic sodium chloride solution. In addition, sterile fixed oils may be employed as a solvent or suspending medium. For this purpose any bland fixed oil may be employed including synthetic mono- or diglycerides. In addition, fatty acids such as oleic acid may likewise be used in the preparation of injectables.

To obtain a stable water-soluble dose form of a pharmaceutical composition, a pharmaceutically acceptable salt of a compound described herein may be dissolved in an aqueous solution of an organic or inorganic acid, such as 0.3 M solution of succinic acid, or more preferably, citric acid. If a soluble salt form is not available, the compound may be dissolved in a suitable co-solvent or combination of co-solvents. Examples of suitable co- solvents include alcohol, propylene glycol, polyethylene glycol 300, polysorbate 80, glycerin and the like in concentrations ranging from about 0 to about 60% of the total volume. In one embodiment, the active compound is dissolved in DMSO and diluted with water.

Pharmaceutical composition may also be in the form of a solution of a salt form of the active ingredient in an appropriate aqueous vehicle, such as water or isotonic saline or dextrose solution. Also contemplated are compounds which have been modified by substitutions or additions of chemical or biochemical moieties which make them more suitable for delivery (e.g., increase solubility, bioactivity, palatability, decrease adverse reactions, etc.), for example by esterification, glycosylation, PEGylation, and complexation.

Many therapeutics have undesirably short half-lives and/or undesirable toxicity. Thus, the concept of improving half-life or toxicity is applicable to various treatments and fields. Pharmaceutical compositions can be prepared, however, by complexing the therapeutic with a biochemical moiety to improve such undesirable properties. Proteins are a particular biochemical moiety that may be complexed with a CSA for administration in a wide variety of applications. In some embodiments, one or more CSAs are complexed with a protein. In some embodiments, one or more CSAs are complexed with a protein to increase the CSA's half-life. In other embodiments, one or more CSAs are complexed with a protein to decrease the CSA's toxicity. Albumin is a particularly preferred protein for complexation with a CSA. In some embodiments, the albumin is fat-free albumin.

With respect to the CSA therapeutic, the biochemical moiety for complexation can be added to the pharmaceutical composition as 0.25, 0.5, 0.75, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 10, 20, 50, or 100 weight equivalents, or a range bounded by any two of the aforementioned numbers, or about any of the numbers. In some embodiments, the weight ratio of albumin to CSA is about 18: 1 or less, such as about 9: 1 or less. In some embodiments, the CSA is coated with albumin.

Alternatively, or in addition, non-biochemical compounds can be added to the pharmaceutical compositions to reduce the toxicity of the therapeutic and/or improve the half-life. Suitable amounts and ratios of an additive that can reduce toxicity can be determined via a cellular assay. With respect to the CSA therapeutic, toxicity reducing compounds can be added to the pharmaceutical composition as 0.25, 0.5, 0.75, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 10, 20, 50, or 100 weight equivalents, or a range bounded by any two of the aforementioned numbers, or about any of the numbers. In some embodiments, the toxicity reducing compound is a cocoamphodi acetate such as Miranol® (disodium cocoamphodi acetate). In other embodiments, the toxicity reducing compound is an amphoteric surfactant. In some embodiments, the toxicity reducing compound is a surfactant. In other embodiments, the molar ratio of cocoamphodi acetate to CSA is between about 8: 1 and 1 : 1, preferably about 4: 1. In some embodiments, the toxicity reducing compound is allantoin.

In some embodiments, a CSA composition is prepared utilizing one or more sufactants. In specific embodiments, the CSA is complexed with one or more poloxamer surfactants. Poloxamer surfactants are nonionic triblock copolymers composed of a central hydrophobic chain of polyoxypropylene (poly(propylene oxide)) flanked by two hydrophilic chains of polyoxyethylene (poly(ethylene oxide)). In some embodiments, the poloxamer is a liquid, paste, or flake (solid). Examples of suitable poloxamers include those by the trade names Synperonics, Pluronics, or Kolliphor. In some embodiments, one or more of the poloxamer surfactant in the composition is a flake poloxamer. In some embodiments, the one or more poloxamer surfactant in the composition has a molecular weight of about 3600 g/mol for the central hydrophobic chain of polyoxypropylene and has about 70% polyoxyethylene content. In some embodiments, the ratio of the one or more poloxamer to CSA is between about 50 to 1; about 40 to 1; about 30 to 1; about 20 to 1; about 10 to 1; about 5 to 1; about 1 to 1; about 1 to 10; about 1 to 20; about 1 to 30; about 1 to 40; or about 1 to 50. In other embodiments, the ratio of the one or more poloxamer to CSA is between 50 to 1; 40 to 1; 30 to 1; 20 to 1; 10 to 1; 5 to 1; 1 to 1; 1 to 10; 1 to 20; 1 to 30; 1 to 40; or 1 to 50. In some embodiments, the ratio of the one or more poloxamer to CSA is between about 50 to 1 to about 1 to 50. In other embodiments, the ratio of the one or more poloxamer to CSA is between about 30 to 1 to about 3 to 1. In some embodiments, the poloxamer is Pluronic F127.

The amount of poloxamer may be based upon a weight percentage of the composition.

In some embodiments, the amount of poloxamer is about 10%, 15%, 20%, 25%, 30%, 35%, 40%), about any of the aforementioned numbers, or a range bounded by any two of the aforementioned numbers or the formulation. In some embodiments, the one or more poloxamer is between about 10% to about 40% by weight of a formulation administered to the patient. In some embodiments, the one or more poloxamer is between about 20% to about 30%) by weight of the formulation. In some embodiments, the formulation contains less than about 50%, 40%, 30%, 20%, 10%, 5%, or 1% of CSA, or about any of the aforementioned numbers. In some embodiments, the formulation containes less than about 20% by weight of CSA.

The above described poloxamer formulations are particularly suited for the methods of treatment, device coatings, preparation of unit dosage forms (i.e., solutions, mouthwashes, injectables), etc.

In one embodiment, the compounds described herein may be formulated for oral administration in a lipid-based formulation suitable for low solubility compounds. Lipid- based formulations can generally enhance the oral bioavailability of such compounds.

A pharmaceutical composition may comprise a therapeutically or prophylactically effective amount of a compound described herein, together with at least one pharmaceutically acceptable excipient selected from the group consisting of- medium chain fatty acids or propylene glycol esters thereof (e.g., propylene glycol esters of edible fatty acids such as caprylic and capric fatty acids) and pharmaceutically acceptable surfactants such as polyoxyl 40 hydrogenated castor oil.

In an alternative embodiment, cyclodextrins may be added as aqueous solubility enhancers. Preferred cyclodextrins include hydroxypropyl, hydroxyethyl, glucosyl, maltosyl and maltotriosyl derivatives of α-, β-, and γ-cyclodextrin. A particularly preferred cyclodextrin solubility enhancer is hydroxypropyl-o-cyclodextrin (BPBC), which may be added to any of the above-described compositions to further improve the aqueous solubility characteristics of the compounds of the embodiments. In one embodiment, the composition comprises about 0.1% to about 20% hydroxypropyl-o-cyclodextrin, more preferably about 1%) to about 15%) hydroxypropyl-o-cyclodextrin, and even more preferably from about 2.5% to about 10%) hydroxypropyl-o-cyclodextrin. The amount of solubility enhancer employed will depend on the amount of the compound of the embodiments in the composition.

In some exemplary embodiments, a CSA comprises a multimer (e.g., a dimer, trimer, tetramer, or higher order polymer). In some exemplary embodiments, the CSAs can be incorporated into pharmaceutical compositions or formulations. Such pharmaceutical compositions/formulations are useful for administration to a subject, in vivo or ex vivo. Pharmaceutical compositions and formulations include carriers or excipients for administration to a subject.

Such formulations include solvents (aqueous or non-aqueous), solutions (aqueous or non-aqueous), emulsions (e.g., oil-in-water or water-in-oil), suspensions, syrups, elixirs, dispersion and suspension media, coatings, isotonic and absorption promoting or delaying agents, compatible with pharmaceutical administration or in vivo contact or delivery. Aqueous and non-aqueous solvents, solutions and suspensions may include suspending agents and thickening agents. Such pharmaceutically acceptable carriers include tablets (coated or uncoated), capsules (hard or soft), microbeads, powder, granules and crystals. Supplementary active compounds (e.g., preservatives, antibacterial, antiviral and antifungal agents) can also be incorporated into the compositions.

Cosolvents and adjuvants may be added to the formulation. Non-limiting examples of cosolvents contain hydroxyl groups or other polar groups, for example, alcohols, such as isopropyl alcohol; glycols, such as propylene glycol, polyethyleneglycol, polypropylene glycol, glycol ether; glycerol; polyoxyethylene alcohols and polyoxyethylene fatty acid esters. Adjuvants include, for example, surfactants such as, soya lecithin and oleic acid; sorbitan esters such as sorbitan trioleate; and polyvinylpyrrolidone.

A pharmaceutical composition and/or formulation contains a total amount of the active ingredient(s) sufficient to achieve an intended therapeutic effect. Synthesis

The methods disclosed herein may be as described below, or by modification of these methods. Ways of modifying the methodology include, among others, temperature, solvent, reagents etc., known to those skilled in the art. In general, during any of the processes for preparation disclosed herein, it may be necessary and/or desirable to protect sensitive or reactive groups on any of the molecules concerned. This may be achieved by means of conventional protecting groups, such as those described in Protective Groups in Organic Chemistry (ed. J.F.W. McOmie, Plenum Press, 1973); and P.G.M. Green, T.W. Wutts, Protecting Groups in Organic Synthesis (3rd ed.) Wiley, New York (1999), which are both hereby incorporated herein by reference in their entirety. The protecting groups may be removed at a convenient subsequent stage using methods known from the art. Synthetic chemistry transformations useful in synthesizing applicable compounds are known in the art and include e.g. those described in R. Larock, Comprehensive Organic Transformations, VCH Publishers, 1989, or L. Paquette, ed., Encyclopedia of Reagents for Organic Synthesis, John Wiley and Sons, 1995, which are both hereby incorporated herein by reference in their entirety. The routes shown and described herein are illustrative only and are not intended, nor are they to be construed, to limit the scope of the claims in any manner whatsoever. Those skilled in the art will be able to recognize modifications of the disclosed syntheses and to devise alternate routes based on the disclosures herein; all such modifications and alternate routes are within the scope of the claims.

An exemplary but non-limiting general synthetic scheme for preparing compounds of Formula (I), Formula (II), and Formula (III) is shown in Scheme A, below. Unless otherwise indicated, the variable definitions are as above for Formulae (I), (II) and/or (III).

Scheme A

Cholic Acid (1 ) R{₂

This process begins with cholic acid (1), or a derivative thereof. Treatment of (1) with a primary or secondary amine R21R22 H under amide bond forming conditions yields a final or intermediate CSA compound (2), or a derivative thereof. Amide bond forming conditions include, but are not limited to ED AC [N-(3-dimethylaminopropyl)-N'- ethylcarbodiimide hydrochloride] in the presence of HOBT (1-hydroxybenzotriazole), or HATU [N,N,N',N'-tetramethyl-0-(7-azabenzotriazol-l-yl)uronium hexafluorophosphate) in the presence of diisopropylethylamine, and the like.

In some embodiments, R21 and R22 are independently selected from the group consisting of hydrogen, optionally substituted C1-C24 alkyl, optionally substituted C2-C24 alkenyl, optionally substituted C2-C24 alkynyl, optionally substituted C₆ or C10 aryl, optionally substituted 5 to 10 membered heteroaryl, optionally substituted 5 to 10 membered heterocyclyl, optionally substituted C7-13 aralkyl, optionally substituted (5 to 10 membered heteroaiyl)-Ci-C₆ alkyl, optionally substituted C3-10 carbocyclyl, optionally substituted C4-10 (carbocyclyl)alkyl, optionally substituted (5 to 10 membered heterocyclyl)-Ci-C₆ alkyl, and a suitable amine protecting group, provided that at least one of R21 or R22 is not a hydrogen.

In some embodiments, CSA compound (2), or a derivative thereof, can be treated with an alkoxyacroylonitrile reagent in the presence of acid and a phase transfer catalyst to yield a final or intermediate CSA compound of Formula (3), or a derivative thereof. In some embodiments, the acid is an organic acid. In some embodiments, the acid is an inorganic acid. In some embodiments, the acid is used in catalytic amounts. In some embodiments, the acid is used in stoichiometric amounts. In some embodiments, the acid is used in greater than stoichiometric amounts. In some embodiments, the phase transfer catalyst is tetrabutylammonium iodide. In some embodiments, the phase transfer catalyst is tetrabutylammonium bromide.

In some embodiments, CSA Compound (3), or a derivative thereof, can be subjected to reducing conditions suirable for forming CSA compound (4), or a derivative thereof. Suitable reducing conditions include, but are not limited to RedAl, lithium aluminum hydride, lithium borohydride, sodium borohydride, or treatment with hydrogen in the presence of a suitable metal catalyst (e.g., Raney cobolt), or treatment with silyl hydrides in the presence of a suitable metal catalyst. Suitable metal catalysts are known in the art.

An exemplary synthetic scheme for preparing CSA- 192 is shown in Scheme B below. Scheme B

c o!lc add

Chemical Farmufa; Ο^Η^Ο^ Oiem!cat Formula: ^H^NC^

Exact Mass; 408.28

Molecular Wsighl: 408.57 Molecular Weight; 518,80

Chemical Formula; C_a2(½N¾_| Chemicai Fsrfntifa: 0«Η_ΜΝ₄¾

Exact Mass: S13.43 Sxaci Mass: 672,46

Moiewiaf Weighfc 513.80 Mofccutat WaigW; 672,94

In some embodiments, CSA compounds as disclosed herein can be converted into a mesylate salt form, such as to form a pro-drug or hydrolysable intermediate, by reacting one or more amine groups with methyl sulfonic acid or derivative thereof (e.g., acid halide). For example, CSA-192 can be converted into its mesylate salt form (CSA-192MS) by reacting CSA-192 with 3 equivalents of methylsulfonic acid. Examples

Various CSA compounds were screened to determine and compare therapeutic effect on oral mucositis. The test was conducted according to a Syrian Hamster Model Radiation Induced Oral Mucositis Study Design as in Table 1.

Table 1

*The first dose of test articles on Day 0 was administered approximately 1 hour prior to radiation

The objective of the study was to identify compounds that can maintain oral mucositis score below 3 in hamster model according to the scoring system in Table 2.

Table 2

Score Description

0 Pouch completely healthy. No erythema or vasodilation

1 Light to severe erythema and vasodilation. No erosion of mucosa.

2 Severe erythema and vasodilation. Erosion of superficial aspects of mucosa leaving denuded areas. Decreased stippling of mucosa.

3 Formation of off-white ulcers in one or more places. Ulcers may have a yellow/grey color due to pseudomembrane. Cumulative size of ulcers should equal less than or equal to ¼ of the pouch. Severe erythema and vasodilation.

4 Cumulative seize of ulcers should equal about ½ of the pouch. Loss of pliability. Severe erythema and vasodilation.

5 Virtually all of pouch is ulcerated. Loss of pliability (pouch can only I I partially be extracted from mouth).

The results of the study are shown in Figures 2 and 3. Figure 2 is a bar graph comparing the percent of animal days with mucositis for laboratory animals treated with various CSA compounds. Drug viability is present when a composition provides at least 20% reduction in oral mucositis. Unexpectedly, CSA-192 provided greater than 90% reduction in oral mucositis and was about as effective in this regard as CSA-90, which lacks an amide functionality and includes 4 primary or secondary amine groups while CSA-192 includes only 3 primary amine groups and no secondary amine groups.

Figure 3 is a line graph comparing oral mucositis severity scores for laboratory animals treated with various CSA compounds. CSA-192 (light blue) unexpectedly provided the strongest and longest lasting reduction in oral mucositis, e.g., even stronger and longer than CSA-90 (green).

The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope. What is claimed is:

Claims

where,

- when the CSA compound is of Formula (I):

m, n, p, and q are independently 0 or 1 ;

- when the CSA compound is of Formula (I) or Formular (II):

Ri through R₄, 5 , R7 , R11 , R12, R15, and R½ are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted alkyl, substituted or unsubstituted hydroxyalkyl, substituted or unsubstituted alkyloxyalkyl, substituted or unsubstituted alkylcarboxyalkyl, substituted or unsubstituted alkylaminoalkyl, substituted or unsubstituted alkylaminoalkylamino, substituted or unsubstituted alkylaminoalkylamino-alkylamino, substituted or unsubstituted aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted arylaminoalkyl, substituted or unsubstituted haloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, substituted or unsubstituted aminoalkyloxy, substituted or unsubstituted aminoalkyloxyalkyl, substituted or unsubstituted aminoalkylcarboxy, substituted or unsubstituted aminoalkylaminocarbonyl, substituted or unsubstituted aminoalkylcarboxamido, substituted or unsubstituted di(alkyl)aminoalkyl, H₂N- HC(Q₅)-C(0)-0-, H₂N-HC(Q₅)-C(0)-N(H)-, substituted or unsubstituted azidoalkyloxy, substituted or unsubstituted cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)- 0-, substituted or unsubstituted guanidinoalkyloxy, substituted or unsubstituted quaternary ammonium alkylcarboxy, and substituted or unsubstituted guanidinoalkyl carboxy, where Q₅ is a side chain of any amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R.5, R₈, R-9, Rio, Ri3, Ri4 and Rn are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R₅, R₈, Rs>, Rio, Ri3, Ri4 and Rn are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted alkyl, substituted or unsubstituted hydroxyalkyl, substituted or unsubstituted alkyloxyalkyl, substituted or unsubstituted aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted haloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, oxo, a linking group attached to a second steroid, substituted or unsubstituted aminoalkyloxy, substituted or unsubstituted aminoalkylcarboxy, substituted or unsubstituted aminoalkylaminocarbonyl, substituted or unsubstituted di(alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N-HC(Q₅)-C(0)-N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)-0-, guanidinoalkyloxy, and guanidinoalkyl-carboxy, where Q₅ is a side chain of any amino acid, P.G. is an amino protecting group;

- when the CSA compound is of Formula (III):

R₃, R7, and Ri₂ are independently selected from the group consisting of aminoalkyloxy, aminoalkylcarboxy, alkylaminoalkyl, alkoxycarbonylalkyl, alkyl- carbonyl alkyl, di(alkyl)aminoalkyl, alkylcarboxyalkyl, aminoalkylaminocarbonyl, aminoalkylcarboxamido, guanidinoalkyloxy, guanidinoalkylcarboxy, quaternary ammonium alkylcarboxy, and hydroxyalkyl; and - when the CSA compound is any of Formula (I), Formula (II) or Formula (III):

Ri8 has the following structure:

R₂o is a substituted or unsubstituted Ci-Cio alkyl, a substituted or unsubstituted Ci-Cio alkenyl, a substituted or unsubstituted Ci-Cio alkynyl, or a substituted or unsubstituted C₆ or Cio aryl, and

R₂i and R₂₂ are independently selected from the group consisting of hydrogen, substituted or unsubstituted Ci-C₂₄ alkyl, substituted or unsubstituted C₂-C₂₄ alkenyl, substituted or unsubstituted C₂-C₂₄ alkynyl, or substituted or unsubstituted C₆ or Cio aryl, substituted or unsubstituted 5 to 10 membered heteroaryl, substituted or unsubstituted 5 to 10 membered heterocyclyl, substituted or unsubstituted C7-C13 aralkyl, substituted or unsubstituted (5 to 10 membered heteroaryl)-Ci-C₆ alkyl, substituted or unsubstituted C3-C10 carbocyclyl, substituted or unsubstituted C₄-Cio (carbocyclyl)alkyl, substituted or unsubstituted (5 to 10 membered heterocyclyl)-Ci- C₆ alkyl, substituted or unsubstituted substituted amido, and amine protecting group, provided that at least one of R₂i and R₂₂ is not hydrogen.

2. The C SA compound of claim 1, wherein R₂i and R₂₂, together with the atoms to which they are attached, form an optionally substituted 5 to 10 membered heterocyclyl ring.

3. The CSA compound of claim 1 or 2, wherein when the CSA compound is of Formula (I) or Formula (II) at least one of Ri_-4, R5 , R7 , R11, Ri₂, R15, Ri6, and R17 is independently selected from the group consisting of substituted or unsubstituted aminoalkyl, substituted or unsubstituted aminoalkyloxy, substituted or unsubstituted alkylcarboxyalkyl, substituted or unsubstituted alkylaminoalkylamino, substituted or unsubstituted alkylaminoalkylaminoalkylamino, substituted or unsubstituted aminoalkylcarboxy, substituted or unsubstituted arylaminoalkyl, substituted or unsubstituted aminoalkyloxyaminoalkylaminocarbonyl, substituted or unsubstituted aminoalkylamino- carbonyl, substituted or unsubstituted aminoalkyl-carboxyamido, quaternary ammonium alkylcarboxy, substituted or unsubstituted di(alkyl)aminoalkyl, H₂N-HC(Q5)-C(0)-0-, H₂N- HC(Q₅)-C(0)-N(H)-, azidoalkyloxy, cyanoalkyloxy, P.G.-HN-HC(Q₅)-C(0)-0-, substituted or unsubstituted guanidine-alkyloxy, and substituted or unsubstituted guanidinoalkylcarboxy.

4. The CSA compound of claim 3, wherein:

Ri_-4, R₆ , R7 , R11 , Ri₂, Ri5, and R½ are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted (Ci-C₂₂) alkyl, substituted or unsubstituted (C1-C22) hydroxyalkyl, substituted or unsubstituted (C1-C22) alkyloxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) alkylcarboxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino- (C1-C22) alkylamino, substituted or unsubstituted (C1-C22) aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted arylamino-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) haloalkyl, substituted or unsubstituted C2-C6 alkenyl, substituted or unsubstituted C2-C6 alkynyl, oxo, a linking group attached to a second steroid, substituted or unsubstituted (C1-C22) aminoalkyloxy, substituted or unsubstituted (C1-C22) aminoalkyl oxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) aminoalkylcarboxy, substituted or unsubstituted (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted (C1-C22) aminoalkyl-carboxamido, substituted or unsubstituted di(Ci-C22 alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N-HC(Q₅)-C(0)-N(H)-, substituted or unsubstituted (C1-C22) azidoalkyloxy, substituted or unsubstituted (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)- 0-, substituted or unsubstituted (C1-C22) guanidinoalkyloxy, substituted or unsubstituted (Ci- C22) quaternary ammonium alkylcarboxy, and substituted or unsubstituted (C1-C22) guanidinoalkyl carboxy, where Q5 is a side chain of an amino acid (including a side chain of glycine, i.e., H), and P.G. is an amino protecting group; and

R5, R₈, R9, Rio, Ri3, Ri4 and R17 are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R₈, R9, Rio, Ri3, and R14 are independently selected from the group consisting of hydrogen, hydroxyl, substituted or unsubstituted (C1-C22) alkyl, substituted or unsubstituted (C1-C22) hydroxyalkyl, substituted or unsubstituted (C1-C22) alkyl oxy-(Ci-C22) alkyl, substituted or unsubstituted (C1-C22) aminoalkyl, substituted or unsubstituted aryl, substituted or unsubstituted (C1-C22) haloalkyl, substituted or unsubstituted (C2-C₆) alkenyl, substituted or unsubstituted (C2-C₆) alkynyl, oxo, a linking group attached to a second steroid, substituted or unsubstituted (C1-C22) aminoalkyloxy, substituted or unsubstituted (C1-C22) aminoalkylcarboxy, substituted or unsubstituted (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted di(Ci-C₂2 alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N- HC(Q5)-C(0)-N(H)-, substituted or unsubstituted (C1-C22) azidoalkyloxy, substituted or unsubstituted (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q₅)-C(0)-0-, substituted or unsubstituted (C1-C22) guanidinoalkyloxy, and (C1-C22) guanidinoalkylcarboxy, where Q5 is a side chain of any amino acid, and P.G. is an amino protecting group; provided that at least two or three of R1-4, R5 , R7 , R11, R12, R15, Ri6, R17, and Ri₈ are independently selected from the group consisting of substituted or unsubstituted (C1-C22) aminoalkyl, substituted or unsubstituted (C1-C22) aminoalkyloxy, substituted or unsubstituted (C1-C22) alkylcarboxy- (C1-C22) alkyl, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino, substituted or unsubstituted (C1-C22) alkylamino-(Ci-C22) alkylamino (C1-C22) alkylamino, substituted or unsubstituted (C1-C22) aminoalkylcarboxy, substituted or unsubstituted arylamino (C1-C22) alkyl, substituted or unsubstituted (C1-C22) aminoalkyloxy (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted (C1-C22) aminoalkylaminocarbonyl, substituted or unsubstituted (C1-C22) aminoalkylcarboxyamido, substituted or unsubstituted (C1-C22) quaternary ammonium alkylcarboxy, substituted or unsubstituted di(Ci-C22 alkyl)aminoalkyl, H₂N-HC(Q₅)-C(0)-0-, H₂N-HC(Q₅)-C(0)-N(H)-, substituted or unsubstituted (C1-C22) azidoalkyloxy, substituted or unsubstituted (C1-C22) cyanoalkyloxy, P.G.-HN-HC(Q5)-C(0)-0-, substituted or unsubstituted (C1-C22) guanidinoalkyloxy, and substituted or unsubstituted (C1-C22) guanidinoalkylcarboxy.

5. The CSA compound of claim 3 or 4, wherein:

Ri-4, R-6 , R7 , R11 , R12, Ri5, and R½ are independently selected from the group consisting of hydrogen, hydroxyl, unsubstituted (Ci-Cis) alkyl, unsubstituted (Ci-Cis) hydroxyalkyl, unsubstituted (Ci-Cis) alkyloxy-(Ci-Cis) alkyl, unsubstituted (Ci-Cis) alkylcarboxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈)alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino, (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) aminoalkyl, unsubstituted aryl, unsubstituted arylamino- (Ci-Ci₈) alkyl, oxo, unsubstituted (Ci-Ci₈) aminoalkyloxy, unsubstituted (Ci-Ci₈) aminoalkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxy, unsubstituted (Ci- Ci₈) aminoalkylaminocarbonyl, unsubstituted(Ci-Ci₈) aminoalkyl-carboxamido, unsubstituted di(Ci-Ci₈ alkyl)aminoalkyl, unsubstituted (Ci-Ci₈) guanidinoalkyloxy, unsubstituted (Ci-Ci₈) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₈) guanidinoalkyl carboxy; and

R5, R₈, R9, Rio, Ri3, Ri4 and R17 are independently deleted when one of rings A, B, C, or D is unsaturated so as to complete the valency of the carbon atom at that site, or R5, R₈, R9, Rio, Ri3, and R14 are independently selected from the group consisting of hydrogen, hydroxyl, unsubstituted (Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) hydroxyalkyl, unsubstituted (Ci-Ci₈) alkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylcarboxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈)alkyl, (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) aminoalkyl, unsubstituted aryl, unsubstituted arylamino-(Ci-Ci₈) alkyl, oxo, unsubstituted (Ci-Ci₈) aminoalkyloxy, unsubstituted (Ci-Cis) aminoalkyloxy-(Ci-Cis) alkyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxy, unsubstituted (Ci-Cis) aminoalkylaminocarbonyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxamido, unsubstituted di(Ci-Ci₈ alkyl)aminoalkyl, unsubstituted (Ci-Ci₈) guanidinoalkyloxy, unsubstituted (Ci-Ci₈) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₈) guanidinoalkyl carboxy, provided that

at least one of R1-4, R6 , R7 , R11, R12, R15, R½, and R17 is independently selected from the group consisting of of hydrogen, hydroxyl, unsubstituted (Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) hydroxyalkyl, unsubstituted (Ci-Ci₈) alkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylcarboxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈)alkyl, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) alkylamino-(Ci-Ci₈) alkylamino- (Ci-Ci₈) alkylamino, unsubstituted (Ci-Ci₈) aminoalkyl, unsubstituted aryl, unsubstituted arylamino-(Ci-Ci₈) alkyl, oxo, unsubstituted (Ci-Ci₈) aminoalkyloxy, unsubstituted (Ci-Ci₈) aminoalkyloxy-(Ci-Ci₈) alkyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxy, unsubstituted (Ci-Ci₈) aminoalkylaminocarbonyl, unsubstituted (Ci-Ci₈) aminoalkylcarboxamido, unsubstituted di(Ci-Ci₈ alkyl)aminoalkyl, unsubstituted (Ci-Ci₈) guanidinoalkyloxy, unsubstituted (Ci-Ci₈) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₈) guanidinoalkyl carboxy.

6. The CSA compound of any one of claims 1 to 5, wherein R3, R7, and R12 are independently selected from the group consisting of hydrogen, unsubstituted (Ci-C₆) alkyl, unsubstituted (Ci-C₆) hydroxyalkyl, unsubstituted (Ci-Ci₆) alkyloxy-(Ci-C5) alkyl, unsubstituted (Ci-Ci₆) alkylcarboxy-(Ci-C5) alkyl, unsubstituted (Ci-Ci₆) alkylamino-(Ci- C₅)alkyl, unsubstituted (Ci-Ci₆) alkylamino-(Ci-C5) alkylamino, unsubstituted (Ci-Ci₆) alkylamino-(Ci-Ci6) alkylamino-(Ci-C5) alkylamino, unsubstituted (Ci-Ci₆) aminoalkyl, unsubstituted arylamino-(Ci-C5) alkyl, unsubstituted (C1-C5) aminoalkyloxy, unsubstituted (Ci-Ci₆) aminoalkyl oxy-(Ci-C5) alkyl, unsubstituted (C1-C5) aminoalkylcarboxy, unsubstituted (C1-C5) aminoalkylaminocarbonyl, unsubstituted (C1-C5) aminoalkylcarboxamido, unsubstituted di(Ci-C₅ alkyl)amino-(Ci-C5) alkyl, unsubstituted (C1-C5) guanidinoalkyloxy, unsubstituted (Ci-Ci₆) quaternary ammonium alkylcarboxy, and unsubstituted (Ci-Ci₆) guanidinoalkylcarboxy.

7. The CSA compound of any one of claims 1 to 6, wherein R3, R7, and R12 are independently selected from the group consisting of aminoalkyloxy; aminoalkylcarboxy; alkylaminoalkyl; alkoxycarbonylalkyl; alkylcarbonylalkyl; di(alkyl)aminoalkyl; alkylcarboxyalkyl; and hydroxyalkyl.

8. The CSA compound of any one of claims 1 to 7, wherein R₃, R₇, and R12 are each aminoalkyloxy or aminoalkylcarboxy.

9. The CSA compound of any one of claims 1 to 8, wherein R₃, R₇, and R12 are independently selected from the group consisting of amino-C₃-alkyloxy; amino-C₃-alkyl- carboxy; Cs-alkylamino-Cs-alkyl; C₈-alkoxy-carbonyl-C4-alkyl; C₈-alkyl-carbonyl-C4-alkyl; di-(C5-alkyl)amino-C5-alkyl; Cn-alkylamino-Cs-alkyl; C6-alkoxy-carbonyl-C4-alkyl; C₆- alkyl-carboxy-C4-alkyl; and Ci6-alkylamino-C5-alkyl.

10. A cationic steroidal antimicrobial (CSA) compound of Formula (III), or salt thereof:

where,

R₃, R₇, and R12 are independently selected from the group consisting of hydrogen, aminoalkyloxy, aminoalkylcarboxy, aminoalkylaminocarbonyl, aminoalkylcarboxamido, and quaternary ammonium alkylcarboxy, provided that R₃, R₇, and R12 are not all hydrogen,

Ri₈ has the following structure:

R20 is a C4 alkyl, and

R21 and R22 are independently selected from the group consisting of hydrogen, substituted or unsubstituted C1-C24 alkyl, substituted or unsubstituted C2-C24 alkenyl, substituted or unsubstituted C2-C24 alkynyl, substituted or unsubstituted C₆ or C10 aryl, substituted or unsubstituted 5 to 10 membered heteroaryl, substituted or unsubstituted 5 to 10 membered heterocyclyl, substituted or unsubstituted C₇-Ci₃ aralkyl, substituted or unsubstituted (5 to 10 membered heteroaryl)-Ci-C6 alkyl, substituted or unsubstituted C₃-Cio carbocyclyl, substituted or unsubstituted C4-C10 (carbocyclyl)alkyl, and substituted or unsubstituted (5 to 10 membered heterocyclyl)- Ci-C₆ alkyl, provided that at least one of R21 and R22 is not hydrogen.

11. The CSA compound of claim 10, wherein R₃, R₇, and R12 are each one of aminoalkyloxy or aminoalkylcarboxy.

12. The CSA compound of any one of claims 1 to 11, wherein the CSA compound is selected from the group consisting of:

and salts thereof.

13. The CSA compound of any one of claims 1 to 12, wherein the CSA compound is

or salt thereof.

14. The CSA compound of any one of claims 1 to 13, wherein the CSA compound comprises a salt selected from the group consisting of: (1) salts obtained by reacting a CSA compound with an inorganic acid, a hydrohalic acid, hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, and/or phosphoric acid; (2) salts obtained by reacting a CSA compound with an organic acid, an aliphatic or aromatic carboxylic or sulfonic acid, formic acid, acetic acid, propionic acid, glycolic acid, pyruvic acid, malonic acid, maleic acid, fumaric acid, trifluoroacetic acid, benzoic acid, cinnamic acid, mandelic acid, succinic acid, lactic acid, malic acid, tartaric acid, citric acid, ascorbic acid, nicotinic acid, methanesulfonic acid, ethanesulfonic acid, p-toluensulfonic acid, salicylic acid, stearic acid, muconic acid, butyric acid, phenylacetic acid, phenylbutyric acid, valproic acid, 1,2- ethanedisulfonic acid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid, 2- naphthalenesulfonic acid, and/or naphthalenesulfonic acid; (3) salts obtained by reacting a CSA compound with a base to form an ammonium salt, an alkali metal salt, a lithium, sodium or a potassium salt, an alkaline earth metal salt, a calcium, magnesium and/or aluminum salt; (4) salts of organic bases, dicyclohexylamine, N-methyl-D-glucamine, tris(hydroxymethyl)methyl amine, C 1-C7 alkylamine, cyclohexylamine, dicyclohexylamine, triethanolamine, ethylenediamine, ethanolamine, diethanolamine, triethanolamine, and/or tromethamine, and salts with amino acids such as arginine and lysine; and (5) salts of an inorganic base, aluminum hydroxide, calcium hydroxide, potassium hydroxide, sodium carbonate, and/or sodium hydroxide.

15. The CSA compound of any one of claims 1 to 14, wherein the CSA compound comprises a salt selected from the group consisting of hydrochloride salts, mono-hydrochloride salts, di-hydrochloride salts, tri-hydrochloride salts, tetra-hydrochloride salts, sulfuric acid addition salts, sulfonic acid addition salts, disulfonic acid addition salts, 1,5-naphthalenedisulfonic acid addition salts, sulfate salts, and bisulfate salts.

16. An antimicrobial composition comprising the CSA compound of any one of claims 1 to 15 and a carrier.

17. A pharmaceutical composition comprising the CSA compound, or salt thereof, of any one of claims 1 to 15 and a pharmaceutically acceptable excipient.

18. The pharmaceutical composition of claim 17, wherein the pharmaceutically acceptable excipient comprises at least one member selected from the group consisting of carriers, solvents, stabilizers, adjuvants, diluents, and combinations thereof.

19. The pharmaceutical composition of claim 17 or 18, wherein the pharmaceutical composition is in a dosage form selected from the group consisting of tablets, capsules, solids, emulsions, suspensions, solutions, liquids, powders, syrups, creams, ointments, tablets, troches, lozenges, granules, and elixirs.

20. A method of manufacturing a cationic steroidal antimicrobial (CSA) compound, comprising:

(a) reacting a compound of Formula (1) and R21R22

to form a com ound of Formula (2):

(b) reacting the compound of Formula (2) with a cyano compound in the presence of acid and a phase transfer catalyst, to form a compound of Formula (3):