Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
  • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
  • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
  • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics

Definitions

• the present invention relates to 4-[6-(6-Memanesulfonyl-2-memyl-pyridin-3-ylarnino)-5- methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester (Compound 1),
• Compound 1 and pharmaceutical compositions thereof are directed to methods useful in the treatment of non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and conditions related thereto.
• NAFLD non-alcoholic fatty liver disease
• NASH non-alcoholic steatohepatitis
• GPRl 19 (e.g., human GPRl 19, GENBANK® Accession No. AAP72125 and alleles thereof; e.g., mouse GPRl 19, GENBANK® Accession No. AY288423 and alleles thereof) is a GPCR located at chromosome position Xp26.1 (Fredricksson, R. et al., "Seven evolutionary conserved human rhodopsin G protein-coupled receptors lacking close relatives", FEBS Lett., 554:381-388 (2003)) and is selectively expressed on pancreatic beta cells.
• the receptor is coupled to Gs, and when stimulated, produces an elevation in cAMP in a variety of cell types including ⁇ -cell-derived insulinomas (Soga, T. et al., "Lysophosphatidylcholine enhances glucose-dependent insulin secretion via an orphan G- protein-coupled receptor", Biochem. Biophys. Res. Comm., 326:744-751 (2005), PCT Publication Nos. WO 04/065380, WO 04/076413, WO 05/007647, WO 05/007658, WO 05/121121, and WO
• the receptor has been shown to be localized to the ⁇ -cells of the pancreas in a number of species as well as in specific cell types of the gastrointestinal tract.
• GPRl 19 has also been referred to as RUP3 (see, International Application WO 00/31258) and as Glucose-Dependent Insulinotropic Receptor GDIR (see, Jones, et al. Expert Opin. Ther. Patents (2009), 19(10): 1339- 1359).
• GPRl 19 agonists also stimulate the release of Glucose-dependent Insulinotropic Polypeptide (GIP), Glucagon-Like Peptide- 1 (GLP-1), and at least one other L-cell peptide, Peptide YY (PYY) (Jones, et al. Expert Opin. Ther. Patents (2009), 19(10): 1339-1359); for specific references related to GPRl 19 agonists and the release of: GIP, see Shah, Current Opinion in Drug Discovery &
• Non-alcoholic fatty liver disease is a disorder affecting as many as 1 in 3-5 adults and 1 in 10 children in the United States, and refers to conditions where there is an accumulation of excess fat in the liver of people who drink little or no alcohol.
• the most common form of NAFLD is a non-serious condition called hepatic steatosis (fatty liver), in which fat accumulates in the liver cells: although this is not normal, by itself it probably does not damage the liver.
• Fatty liver disease is generally detected by observation of elevated serum concentrations of liver-specific enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which serve as indices of hepatocyte injury, as well as by presentation of symptoms which include fatigue and pain in the region of the liver, though definitive diagnosis often requires a biopsy.
• liver-specific enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which serve as indices of hepatocyte injury, as well as by presentation of symptoms which include fatigue and pain in the region of the liver, though definitive diagnosis often requires a biopsy.
• NAFLD most often presents itself in individuals with a constellation of risk factors related to metabolic syndrome, which is characterized by elevated fasting plasma glucose (FPG) with or without intolerance to post-prandial glucose, being overweight or obese, high blood lipids such as cholesterol and triglycerides (TGs) and low high-density lipoprotein cholesterol (HDL-C) levels, and high blood pressure; but not all patients have all the manifestations related to metabolic syndrome.
• FPG fasting plasma glucose
• TGs cholesterol and triglycerides
• HDL-C low high-density lipoprotein cholesterol
• NAFLD Newcastle disease virus
• NASH non-alcoholic steatohepatitis
• NAFLD may be differentiated from NASH by a NAFLD Activity Score (NAS) or a Steatosis, Activity, and Fibrosis (SAF) score.
• NAS NAFLD Activity Score
• SAF Steatosis, Activity, and Fibrosis
• the sum of the histopathology scores of a liver biopsy for steatosis e.g., 0 to 3
• lobular inflammation e.g., 0 to 2
• hepatocellular ballooning e.g., 0 to 2
• steatosis is 0, steatosis is 1, steatosis is 2, steatosis is 3, ballooning degeneration is 0, ballooning degeneration is 1, ballooning degeneration is 2, lobular inflammation is 0, lobular inflammation is 1, lobular inflammation is 2, lobular inflammation is 3, fibrosis is 0, fibrosis is 1, fibrosis is 2, fibrosis is 3, fibrosis is 4, or a combination thereof.
• the scoring system includes steatosis, ballooning degeneration, lobular inflammation, and any combination of the numerical score for each as described above.
• the scoring system includes steatosis, ballooning degeneration, lobular inflammation, fibrosis, and any combination of a numerical score for each as described above.
• a NAS of ⁇ 3 corresponds to NAFLD
• 3-4 corresponds to borderline NASH
• > 5 corresponds to NASH.
• the biopsy can also be scored for fibrosis (e.g., 0 to 4).
• NASH is a leading cause of end-stage liver disease; while NAFLD, and to an even greater degree NASH, are intimately related to metabolic syndrome, including insulin resistance (pre-diabetes) and type 2 diabetes mellitus (T2DM), and abdominal obesity.
• T2DM has been the most prominent predictor for a poor prognosis in NAFLD, whereas elevated liver enzymes are considered unreliable.
• NASH develops much more frequently in the presence of longstanding T2DM, and most patients with cryptogenic cirrhosis are obese and/or diabetic. Studies have demonstrated that 60% of patients with T2DM and NAFLD had biopsy-proven NASH, and that advanced hepatic fibrosis was present in 75% of those with diabetes and hypertension compared to only 7% without either condition.
• NASH is an overlooked complication of T2DM that is frequently associated with fibrosis and in approximately 10% of patients results in cirrhosis; while the risk of hepatocellular carcinoma is also increased in patients with T2DM and NASH.
• Patients with NAFLD and NASH usually demonstrate mixed dyslipidemia and the other metabolic derangements described above, including an atherogenic low-density lipoprotein (LDL) phenotype consisting of predominantly of small dense particles.
• LDL low-density lipoprotein
• Both metabolic syndrome and NAFLD/NASH are characterized by increased cardiovascular inflammation as measured by elevations in high sensitivity C-reactive protein (hsCRP) and other inflammatory cytokines.
• hsCRP high sensitivity C-reactive protein
• MBX-2982 (a GPRl 19 agonist) in mice fed a high-fat diet potently inhibited hepatic lipid accumulation and expression levels of sterol regulatory element binding protein (SREBP-1) and lipogenesis-related genes, whereas the hepatic antilipogenesis effects of MBX-2982 were abolished in GPRl 19 KO mice (Yang et al. "GPRl 19: a promising target for nonalcoholic fatty liver disease", FASEB J. 30, 324-335 (2016)), suggesting that the MBX-2982 alleviated hepatic steatosis or lessened the abnormal retention of lipids in the liver by inhibiting SREBP-1 -mediated lipogenesis in hepatocytes.
• SREBP-1 sterol regulatory element binding protein
• Compound 1 4-[6-(6-Methanesulfonyl-2-methyl-pyridin-3-ylamino)-5-methoxy-pyrimidin-4- yloxy]-piperidine-l-carboxylic acid isopropyl ester.
• the compound 4-[6-(6-Methanesulfonyl-2-methyl-pyridin-3-ylamino)-5- methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester (Compound 1) is a potent (EC 5 0 of 46 nM, HTRF cAMP assay, (human)) and selective (no significant activity in a standard CEREP receptor selectivity panel when tested at 1 ⁇ ), orally bioavailable investigational drug candidate of the GPRl 19 receptor for the treatment of non-alcoholic fatty liver disease (NAFLD), non- alcoholic steatohepatitis (NASH), and conditions related thereto.
• NAFLD non-alcoholic fatty liver disease
• NASH non-alcoholic steatohepatitis
• Compound 1 showed significant reduction of AUC g i u (Figure 1) in normal lean mice during an oral glucose tolerance test (oGTT) at 1 mg kg and 10 mg kg p.o.
• oGTT oral glucose tolerance test
• Compound 1 3-30 mg/kg PO significantly improved glucose handling and markedly reduced the AUC g i u during oGTT (see Figure 2).
• Example 2 for a representative procedure used for the oGTT. More extensive in vivo studies showed Compound 1 to have highly favorable absorption, distribution, metabolism, and excretion (ADME) characteristics. For example, exposure was shown to be high after oral dosing particularly in the mouse, consistent with the excellent effect observed in the oGTT in that species. Additional ADME data are shown in the table below. Species Dose tmax Cmax AUCinf tl/2
• Compound 1 was observed to have high permeability across Caco-2 monolayers (A to B: 26 x 10 "6 cm/s and B to A: 15 x 10 "6 cm/s) and was stable in rat and human liver microsomes (t > 60 min). As stated above, Compound 1 also showed no significant activity in a standard CEREP receptor selectivity panel when tested at 1 ⁇ . In addition, Compound 1 showed no significant inhibition of hERG channel binding (IC50 >10 ⁇ ) and in a patch clamp study Compound 1 showed an IC50 of 13 + 0.2 ⁇ .
• MAP mean arterial blood pressure
• HR heart rate
• ECG electrocardiogram
• Compound 1 was selected for clinical evaluation. Randomized, double -blind, placebo- controlled Phase 1 clinical trials were conducted to evaluate the safety, tolerability, pharmacodynamics, and pharmacokinetics of Compound 1 (2.5-800 mg) in healthy male volunteers. The systemic exposure of Compound 1 in plasma increased in proportion to the dose and was not influenced by coadministration of food. The terminal elimination half-life was -13 h when administered as an oral suspension formulation. Compound 1 was determined to be well tolerated and was not associated with hypoglycemia.
• GLP-1 postmeal plasma glucagon-like peptide 1
• GIP glucose-dependent insulinotropic peptide
• PYY peptide YY
• Plasma systemic exposure of Compound 1 increased with increased dose and was approximately two-fold greater after multiple-dose administration and attained steady-state after approximately 8 days.
• single-dose administration of oral Compound 1 decreased glucose excursion during an oral glucose tolerance test.
• Multiple dosing of Compound 1 increased post-meal total glucagon-like peptide 1 and gastric insulinotropic peptide concentrations compared to baseline; see, Katz et al., "Effects of JNJ-38431055, a novel GPR119 receptor agonist, in randomized, double -blind, placebo-controlled studies in subjects with type 2 diabetes", Diabetes, Obesity and Metabolism 14: 709-716, (2012).
• One aspect of the present invention is directed to, inter alia, methods of treating non-alcoholic fatty liver disease (NAFLD) or a condition related thereto in an individual in need thereof comprising administering a therapeutically effective amount of 4-[6-(6-Methanesulfonyl-2-methyl-pyridin-3- ylamino)-5-methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof.
• NASH non-alcoholic fatty liver disease
• the NAFLD is simple steatosis (NAFL). In some embodiments, the NAFLD is steatohepatitis (NASH). In some embodiments, the NAFLD is liver cirrhosis. In some embodiments, the NAFLD is NASH with a degree of fibrosis selected from Fl, F2, F3, and F4 fibrosis. In some embodiments, the NAFLD is NASH with F4 fibrosis.
• the individual has at least one condition selected from hepatic steatosis, lobular inflammation, and hepatocellular ballooning.
• the NAFLD is characterized by a NAFLD activity score (NAS) greater than or equal to 4.
• treating NAFLD is decreasing the NAS at least 1, 2, or 3 points. In some embodiments, treating NAFLD is reducing the worsening of fibrosis. In some embodiments, treating NAFLD is reversing steatohepatitis. In some embodiments, treating NAFLD is ceasing progression to F3 or F4 fibrosis. In some embodiments, treating NAFLD is resolving NASH. In some embodiments, treating NAFLD is not worsening liver fibrosis. In some embodiments, treating NAFLD is reducing the risk of liver-related death. In some embodiments, treating NAFLD is improving liver fibrosis by at least one stage. In some embodiments, treating NAFLD is improving cardiometabolic and/or liver markers.
• the individual has been determined to have NALFD using a NAFLD fibrosis score.
• Figure 1 shows the effect of Compound 1 (1 mg/kg and 10 mg kg) on glucose excursion in an oGTT in male C57bl/6j mice.
• Left panel Blood glucose levels at various times relative to glucose injection.
• Middle panel AUC's derived from Left panel.
• Right panel Percent change in area under the curve (AUC).
• AUC area under the curve
• Figure 2 shows the effect of Compound 1 (3-30 mg kg p.o.) on glucose excursion in Sprague- Dawley rat after administration of an oral (p.o.) dose of glucose.
• Left panel blood glucose levels at various times relative to glucose injection.
• Right panel AUC' s derived from the left panel (AUC, based on incremental changes post-bolus).
• AUC' s was performed on AUC' s.
• ANOVA revealed a significant main effect of Compound 1.
• Figure 3 shows a representative powder X-ray diffraction (PXRD) pattern measured as described herein of crystalline Form A-I for Compound 1.
• Figure 4 shows a representative powder X-ray diffraction (PXRD) pattern measured as described herein of crystalline Form A-IV for Compound 1.
• Figure 5 shows a representative powder X-ray diffraction (PXRD) pattern measured as described herein of crystalline Form A- VI for Compound 1.
• FIG. 6 shows serum alanine aminotransferase (ALT) after treatment with Compound 1 and
• MBX (MBX-2982) in the High Fat Diet (HFD) Mouse Model.
• the present invention is directed to, inter alia, methods of treating non-alcoholic fatty liver disease (NAFLD) or a condition related thereto in an individual in need thereof comprising administering a therapeutically effective amount of 4-[6-(6-Methanesulfonyl-2-methyl- pyridin-3-ylarrdno)-5-methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester
• NAFLD non-alcoholic fatty liver disease
• the individual is determined to have NAFLD by liver biopsy or by NAFLD fibrosis score. In some embodiments, the individual is determined to have NAFLD by liver biopsy. In some embodiments, the individual is determined to have NAFLD by NAFLD fibrosis score.
• One aspect of the present invention relates to methods of treating non-alcoholic fatty liver disease (NAFLD) or a condition related thereto in an individual in need thereof comprising administering a therapeutically effective amount of 4-[6-(6-Methanesulfonyl-2-methyl-pyridin-3- ylamino)-5-methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof.
• NASH non-alcoholic fatty liver disease
• Compound 1 and pharmaceutically acceptable salts, hydrates, and solvates thereof disclosed herein are useful in the treatment non-alcoholic fatty liver disease (NAFLD) or a condition related thereto.
• NAFLD non-alcoholic fatty liver disease
• One skilled in the art will recognize that when a disorder, or a method of treatment, is disclosed herein, such disclosure encompasses second medical uses (e.g., Compound 1 and pharmaceutically acceptable salts, hydrates, and solvates thereof for use in the treatment of NAFLD or a condition related thereto; use of Compound 1 and pharmaceutically acceptable salts, hydrates, and solvates thereof for the treatment of NAFLD or a condition related thereto; and use of Compound 1 and pharmaceutically acceptable salts, hydrates, and solvates thereof in the manufacture of a medicament for the treatment of the disorder).
• second medical uses e.g., Compound 1 and pharmaceutically acceptable salts, hydrates, and solvates thereof for use in the treatment of NAFLD or a condition related thereto
• One aspect of the present invention relates to a compound selected from the following compound and pharmaceutically acceptable salts, solvates, and hydrates thereof:
• NAFLD non-alcoholic fatty liver disease
• One aspect of the present invention relates to uses of a compound selected from the following compound and pharmaceutically acceptable salts, solvates, and hydrates thereof:
• NAFLD non-alcoholic fatty liver disease
• the total daily dose of Compound 1 or a pharmaceutically acceptable salt thereof is about 2.5 mg to 800 mg.
• the daily therapeutically effective amount of Compound 1 or the pharmaceutically acceptable salt thereof is about 2.5 mg to 800 mg.
• the total daily dose of Compound 1 or a pharmaceutically acceptable salt thereof is about 100 mg to 800 mg. In some embodiments, the daily therapeutically effective amount of Compound 1 or the pharmaceutically acceptable salt thereof is about 100 mg to 800 mg.
• the Compound 1 or a pharmaceutically acceptable salt thereof is administered at a frequency of 4 or less times per day.
• the Compound 1 or the pharmaceutically acceptable salt thereof is administered at a frequency of 1, 2, 3, or 4 times per day.
• the Compound 1 or a pharmaceutically acceptable salt thereof is administered two times per day.
• the Compound 1 or a pharmaceutically acceptable salt thereof is administered orally.
• the administering results in improvement in liver fibrosis compared to levels before administration of the Compound 1 or a pharmaceutically acceptable salt thereof.
• administration of Compound 1 reduces fat content of the liver.
• administration of Compound 1 reduces fat content of the liver compared to the fat content of the liver prior to the administration of Compound 1 or a
• administration of Compound 1 reduces the incidence of or progression of liver cirrhosis.
• administration of Compound 1 reduces the incidence of or progression of liver cirrhosis compared to the incidence of or progression of liver cirrhosis prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• administration of Compound 1 reduces the incidence of hepatocellular carcinoma.
• administration of Compound 1 reduces the incidence of hepatocellular carcinoma compared to the incidence of hepatocellular carcinoma prior to the administration of
• administration of Compound 1 reduces the progression of hepatocellular carcinoma.
• administration of Compound 1 decreases in hepatic aminotransferase levels compared to levels before administration of the composition.
• compositions wherein administration of Compound 1 decreases in hepatic aminotransferase levels compared to the hepatic aminotransferase levels prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• administration of Compound 1 reduces hepatic transaminase compared to levels before treatment.
• the hepatic transaminase is alanine transaminase (ALT) or aspartate transaminase (AST) or both.
• administration of Compound 1 reduces hepatic transaminase of about 5% to about 75% compared to the hepatic transaminase levels before treatment.
• administration of Compound 1 reduces hepatic transaminase levels by about 5% to about 75% compared to the hepatic transaminase levels prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• the hepatic transaminase is alanine transaminase (ALT) or aspartate transaminase (AST) or both.
• administration of Compound 1 reduces alanine aminotransferase (ALT) levels in an individual.
• ALT alanine aminotransferase
• administration of Compound 1 reduces alanine aminotransferase (ALT) levels in an individual to about 75%, about 70%, about 60%, about 50%, about 40%, about 30%, about 20% or about 10% above normal ALT levels, or at about normal ALT levels.
• ALT alanine aminotransferase
• administration of Compound 1 reduces alanine aminotransferase (ALT) levels in an individual to about 75%, about 70%, about 60%, about 50%, about 40%, about 30%, about 20%, or to about 10% above normal ALT levels compared to the ALT levels prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• ALT alanine aminotransferase
• AST aminotransferase
• AST aminotransferase
• administration of Compound 1 reduces aspartate aminotransferase (AST) levels in an individual to about 75%, about 70%, about 60%, about 50%, about 40%, about 30%, about 20%, or to about 10% above normal AST levels compared to the AST levels prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• AST aspartate aminotransferase
• the NAFLD is simple steatosis (NAFL).
• the NAFLD is steatohepatitis (NASH).
• the NAFLD is liver cirrhosis.
• the NAFLD is NASH with a degree of fibrosis selected from Fl, F2, F3, and F4 fibrosis.
• the NAFLD is NASH with F4 fibrosis.
• the individual has at least one condition selected from hepatic steatosis, lobular inflammation, and hepatocellular ballooning.
• the NAFLD is characterized by a NAFLD activity score (NAS) greater than or equal to 4.
• NAS NAFLD activity score
• treating NAFLD is decreasing the NAS at least 1, 2, or 3 points. In some embodiments, treating NAFLD is decreasing the NAS by at least 1, 2, or 3 points.
• treating NAFLD is reducing the worsening of fibrosis.
• treating NAFLD reduces the worsening or the progression of fibrosis in the individual compared to the fibrosis prior to the administration of Compound 1 or a
• treating NAFLD is reversing steatohepatitis.
• treating NAFLD reduced steatohepatitis in the individual compared to the steatohepatitis prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• treating NAFLD is ceasing progression to F3 or F4 fibrosis.
• treating NAFLD is ceasing progression to F3 or F4 fibrosis in the individual compared to the fibrosis prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• treating NAFLD is resolving NASH.
• treating NAFLD is resolving NASH in the individual compared to NASH prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• treating NAFLD is not worsening liver fibrosis.
• treating NAFLD is not worsening liver fibrosis in the individual compared to the liver fibrosis prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• treating NAFLD is reducing the risk of liver-related death.
• treating NAFLD is improving liver fibrosis by at least one stage.
• treating NAFLD is improving liver fibrosis by at least one stage in the individual compared to the stage of liver fibrosis prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• treating NAFLD is improving cardiometabolic and/or liver markers.
• treating NAFLD is improving the levels of the cardiometabolic and/or liver markers in the individual compared to the levels of the cardiometabolic and/or liver markers prior to the administration of Compound 1 or a pharmaceutically acceptable salt thereof.
• the individual has been determined to have NALFD using a NAFLD fibrosis score.
• the individual has been determined to have NALFD by a liver biopsy.
• the method further comprising formulating Compound 1 or a pharmaceutically acceptable salt thereof as a tablet or capsule.
• the method further comprises formulating Compound 1 or a pharmaceutically acceptable salt thereof, in a tablet or capsule.
• the tablet or capsule comprises a pharmaceutically acceptable carrier.
• the administration of the Compound 1 or a pharmaceutically acceptable salt thereof reduces at least ALT, AST, liver fat, or fatty liver index.
• the administration of the Compound 1 or a pharmaceutically acceptable salt thereof reduces at least one of a liver enzyme (e.g., ALT, AST, etc.), liver fat (e.g., determined by ultrasound, etc.), or fatty liver index.
• a liver enzyme e.g., ALT, AST, etc.
• liver fat e.g., determined by ultrasound, etc.
• fatty liver index e.g., fatty liver index.
• the individual has no fibrosis and no inflammation of the liver. In some embodiments, the individual has no fibrosis. In some embodiments, the individual has limited fibrosis. In some embodiments, the individual has intermediate fibrosis. In some embodiments, the individual has advanced fibrosis. In some embodiments, the individual has cirrhosis.
• the individual has stage F0 fibrosis. In some embodiments, the individual has stage Fl fibrosis. In some embodiments, the individual has stage F2 fibrosis. In some embodiments, the individual has stage F3 fibrosis. In some embodiments, the individual has stage F4 fibrosis. In some embodiments, the individual has stage F0-F1 fibrosis. In some embodiments, the individual has stage F1 -F2 fibrosis. In some embodiments, the individual has stage F2-F3 fibrosis. In some embodiments, the individual has stage F3-F4 fibrosis. In some embodiments, the individual has stage F0-F2 fibrosis. In some embodiments, the individual has stage F0-F3 fibrosis. In some embodiments, the individual has stage F1-F3 fibrosis. In some embodiments, the individual has stage F1-F4 fibrosis. In some embodiments, the individual has stage F2-F4 fibrosis.
• NAFLD fibrosis score is a validated scoring system comprised of six routinely measured parameters (i.e., age, hyperglycemia, BMI, platelet counts, albumin, and AST/ALT ratio) which can be used to identify NAFLD patients likely to have F3-F4 fibrosis.
• routinely measured parameters i.e., age, hyperglycemia, BMI, platelet counts, albumin, and AST/ALT ratio
• Compound 1 are described in WO2010/135505. The three different forms are labeled as Form A-l, Form A-IV, and Form A-VI.
• One aspect of the present invention relates to anhydrous Form A-I of 4-[6-(6-Methanesulfonyl- 2-memyl-pyridin-3-ylamino)-5-methoxy-pyrimidin-4-yloxy]-piperidine- 1 -carboxylic acid isopropyl ester (Compound 1). Peaks, in terms of 2 ⁇ , from a powder X-ray diffraction pattern from a representative sample of Form A-I are provided below in TABLE 1. TABLE 1 (Compound 1, Form A-I)
• Compound 1 is anhydrous Form A-I. In some embodiments,
• Compound 1 is Form A-I and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 8.0° + 0.2°, and 17.7° + 0.2°. In some embodiments, Compound 1 is Form A-I and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 8.0° + 0.2°, 16.4° + 0.2°, and 17.7° + 0.2°. In some embodiments, Compound 1 is Form A-I and has a powder X-ray diffraction pattern comprising peaks, in terms of 2(9, at 8.0° + 0.2°, 16.4° + 0.2°, 17.7° + 0.2°, and 21.2° + 0.2°.
• Compound 1 is Form A-I and has a powder X-ray diffraction pattern comprising peaks, in terms of 2(9, at 8.0° + 0.2°, 16.4° + 0.2°, 17.7° + 0.2°, 21.2° + 0.2°, and 24.5° + 0.2°.
• Compound 1 is Form A-I and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 8.0° + 0.2°, 12.1° + 0.2°, 13.6° + 0.2°, 13.8° + 0.2°, 15.2° + 0.2°, 15.6° + 0.2°, 16.2° + 0.2°, 16.4° + 0.2°, 17.2° + 0.2°, 17.7° + 0.2°, 19.8° + 0.2°, 21.2° + 0.2°, 22.6° + 0.2°, 22.9° + 0.2°, and 24.5° + 0.2°.
• Compound 1 is Form A-I and has a powder X-ray diffraction pattern substantially as shown in Figure 3.
• Compound 1 is Form A-I and has a differential scanning calorimetry trace comprising an endotherm with an extrapolated onset temperature of melting of 164.6°C, a peak temperature of melting of 166.8° C and a heat of melting of 86.2 J/g at a scan rate of 10°C/minute.
• Compound 1 is Form A-I and has a
• thermogravimetric analysis profile showing about 0.3% weight loss from ambient temperature up to 165°C and including the melting of the sample.
• One aspect of the present invention relates to anhydrous Form A-IV of 4-[6-(6- Memanesulfonyl-2-methyl-pyridin-3-ylarrdno)-5-methoxy-pyrirrddin-4-yloxy]-piperidine-l-carbox acid isopropyl ester (Compound 1). Peaks, in terms of 2 ⁇ , from a powder X-ray diffraction pattern from a representative sample of Form A-IV are provided below in TABLE 2. TABLE 2 (Compound 1, Form A-IV)
• Compound 1 is anhydrous Form A-IV. In some embodiments,
• Compound 1 is Form A-IV and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 19.9° + 0.2°. In some embodiments, Compound 1 is Form A-IV and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 18.2° + 0.2°, and 19.9° + 0.2°. In some embodiments, Compound 1 is Form A-IV and has a powder X-ray diffraction pattern comprising peaks, in terms of 2(9, at 16.5° + 0.2°, 18.2° + 0.2°, and 19.9° + 0.2°. In some embodiments,
• Compound 1 is Form A-IV and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 9.5° + 0.2°, 16.5° + 0.2°, 18.2° + 0.2°, and 19.9° + 0.2°.
• Compound 1 is Form A-IV and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 9.5° + 0.2°, 16.5° + 0.2°, 18.2° + 0.2°, 19.9° + 0.2° and 23.4° + 0.2°.
• Compound 1 is Form A-IV and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 9.0° + 0.2°, 9.5° + 0.2°, 11.3° + 0.2°, 13.5° + 0.2°, 13.6° + 0.2°, 14.1° + 0.2°, 14.8° + 0.2°, 16.5° + 0.2°, 18.2° + 0.2°, 18.5° + 0.2°, 19.1° + 0.2°, 19.5° + 0.2°, 19.9° + 0.2°, 20.0° + 0.2°, 20.9° + 0.2°, 21.2° + 0.2°, 22.9° + 0.2°, 23.4° + 0.2°, 24.9° + 0.2°, 25.5° + 0.2°, 27.0° + 0.2°, 27.3° + 0.2°, 27.7° + 0.2°, 29.7° + 0.2°, and 31.4° + 0.2°.
• Compound 1 is Form A-IV and has a powder X-ray diffraction pattern substantially as shown in Figure 4.
• Compound 1 is Form A-IV and has a differential scanning calorimetry trace comprising an endotherm with an extrapolated onset temperature of melting of 154.1°C, a peak temperature of melting of 155.6°C and a heat of melting of 86.8 J/g at a scan rate of 10°C/minute.
• Compound 1 is Form A-IV and has a thermogravimetric analysis profile showing about 0.1 % weight loss from ambient temperature up to 165°C and including the melting of the sample.
• One aspect of the present invention relates to anhydrous Form A- VI of 4-[6-(6- Methanesulfonyl-2-methyl-pyridin-3 -y lamino) -5 -methoxy-pyrimidin-4 -yloxy ] -piperidine-l-carboxylic acid isopropyl ester (Compound 1). Peaks, in terms of 2 ⁇ , from a powder X-ray diffraction pattern from a representative sample of Form A- VI are provided below in TABLE 3.
• Compound 1 is anhydrous Form A-VI. In some embodiments,
• Compound 1 is Form A-VI and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 5.8° + 0.2°. In some embodiments, Compound 1 is Form A-VI and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 5.8° + 0.2°, and 23.5° + 0.2°. In some embodiments, Compound 1 is Form A-VI and has a powder X-ray diffraction pattern comprising peaks, in terms of 2(9, at 5.8° + 0.2°, 18.9° + 0.2°, and 23.5° + 0.2°.
• Compound 1 is Form A-VI and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 5.8° + 0.2°, 14.6° + 0.2°, 18.9° + 0.2°, and 23.5° + 0.2°. In some embodiments, Compound 1 is Form A-VI and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 5.8° + 0.2°, 14.6° + 0.2°, 18.9° + 0.2°, 22.2° + 0.2°, and 23.5° + 0.2°.
• Compound 1 is Form A-VI and has a powder X-ray diffraction pattern comprising peaks, in terms of 2 ⁇ , at 5.8° + 0.2°, 13.2° + 0.2°, 13.6° + 0.2°, 14.6° + 0.2°, 14.9° + 0.2°, 16.4° + 0.2°, 17.6° + 0.2°, 18.3° + 0.2°, 18.9° + 0.2°, 19.7° + 0.2°, 21.5° + 0.2°, 22.2° + 0.2°, 22.7° + 0.2°, 23.5° + 0.2°, 24.0° + 0.2°, 24.8° + 0.2°, and 25.1° + 0.2°.
• Compound 1 is Form A-VI and has a powder X-ray diffraction pattern substantially as shown in Figure 5.
• Compound 1 is Form A-VI and has a differential scanning calorimetry trace comprising an endotherm with an extrapolated onset temperature of melting of 162.1°C, a peak temperature of melting of 164.0°C and a heat of melting of 92.2 J/g at a scan rate of 10°C/minute.
• Compound 1 is Form A-VI and has a
• thermogravimetric analysis profile showing about 0.2% weight loss from ambient temperature up to 165°C and including the melting of the sample.
• a further aspect of the present invention pertains to pharmaceutical compositions comprising one or more compounds as described herein and one or more pharmaceutically acceptable carriers. Some embodiments pertain to pharmaceutical compositions comprising a compound of the present invention and a pharmaceutically acceptable carrier.
• Some embodiments of the present invention include a method of producing a pharmaceutical composition comprising admixing at least one compound according to any of the compound embodiments disclosed herein and a pharmaceutically acceptable carrier.
• Formulations may be prepared by any suitable method, typically by uniformly mixing the active compound(s) with liquids or finely divided solid carriers, or both, in the required proportions and then, if necessary, forming the resulting mixture into a desired shape.
• Liquid preparations for oral administration may be in the form of solutions, emulsions, aqueous or oily suspensions and syrups.
• the oral preparations may be in the form of dry powder that can be reconstituted with water or another suitable liquid vehicle before use. Additional additives such as suspending or emulsifying agents, non-aqueous vehicles (including edible oils), preservatives and flavorings and colorants may be added to the liquid preparations.
• Parenteral dosage forms may be prepared by dissolving the compound of the invention in a suitable liquid vehicle and filter sterilizing the solution before filling and sealing an appropriate vial or ampule. These are just a few examples of the many appropriate methods well known in the art for preparing dosage forms.
• a compound of the present invention can be formulated into pharmaceutical compositions using techniques well known to those in the art. Suitable pharmaceutically acceptable carriers, outside those mentioned herein, are known in the art; for example, see Remington, The Science and Practice of Pharmacy, 20 th Edition, 2000, Lippincott Williams & Wilkins, (Editors: Gennaro et al.)
• a compound of the invention may, in an alternative use, be administered as a raw or pure chemical, it is preferable however to present the compound or active ingredient as a pharmaceutical formulation or composition further comprising a pharmaceutically acceptable carrier.
• the invention thus further provides pharmaceutical formulations comprising a compound of the invention or a pharmaceutically acceptable salt, solvate, hydrate or derivative thereof together with one or more pharmaceutically acceptable carriers thereof and/or prophylactic ingredients.
• the carrier(s) must be "acceptable” in the sense of being compatible with the other ingredients of the formulation and not overly deleterious to the recipient thereof.
• active ingredient is defined in the context of a "pharmaceutical composition” and is intended to mean a component of a pharmaceutical composition that provides the primary pharmacological effect, as opposed to an "inactive ingredient” which would generally be recognized as providing no pharmaceutical benefit.
• the dose when using the compounds of the present invention can vary and as is customary and known to the physician, it is to be tailored to the individual conditions in each individual case. It depends, for example, on the nature and severity of the illness to be treated, on the condition of the individual, or on whether an acute or chronic disease state is treated or prophylaxis is conducted or on whether further active compounds are administered in addition to the compounds of the present invention.
• Representative doses of the present invention include, but are not limited to, about 1 mg to about 1000 mg.
• the dose is, or is about, 1, 2, 3, 4, 5, 6, 7, 8 , 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 125, 130, 140, 150, 160, 170, 175, 180, 190, 200, 225, 250, 275, 300, 325, 350, 375, 400, 425, 450, 475, 500, 525, 550, 575, 600, 625, 650, 675, 700, 725, 750, 775, 800, 825, 850, 875, 900, 925, 950, 975, or 1000 mg.
• Multiple doses may be administered during the day, especially when relatively large amounts are deemed to be needed, for example 2, 3 or 4 doses.
• doses described herein may be administered during the day, especially when relatively large amounts are deemed to be needed, for example 2, 3 or 4 doses.
• the amount of active ingredient or an active salt, solvate or hydrate derivative thereof, required for use in treatment will vary not only with the particular salt selected but also with the route of administration, the nature of the condition being treated and the age and condition of the individual and will ultimately be at the discretion of the attendant physician or clinician. Representative factors include the type, age, weight, sex, diet and medical condition of the individual, the severity of the disease, the route of administration, pharmacological considerations such as the activity, efficacy, pharmacokinetic and toxicology profiles of the particular compound employed, whether a drug delivery system is utilized, whether an acute or chronic disease state is being treated or prophylaxis is conducted or whether further active compounds are administered in addition to the compounds of the present invention and as part of a drug combination.
• the dosage regimen for treating a disease condition with the compounds and/or compositions of this invention is selected in accordance with a variety factors including those cited above.
• the actual dosage regimen employed may vary widely and therefore may deviate from a preferred dosage regimen and one skilled in the art will recognize that dosage and dosage regimens outside these typical ranges can be tested and, where appropriate, may be used in the methods of this invention.
• the desired dose may conveniently be presented in a single dose or as divided doses administered at appropriate intervals, for example, as 2, 3, 4 or more sub-doses per day.
• the sub-dose itself may be further divided, e.g., into a number of discrete loosely spaced administrations.
• the daily dose can be divided, especially when relatively large amounts are administered as deemed appropriate, into several, for example 2, 3 or 4 part administrations. If appropriate, depending on individual behavior, it may be necessary to deviate upward or downward from the daily dose indicated.
• the pharmaceutical preparations are preferably in unit dosage forms. In such form, the preparation is subdivided into unit doses containing appropriate quantities of the active component.
• the unit dosage form can be a packaged preparation, the package containing discrete quantities of preparation, such as packeted tablets, capsules and powders in vials or ampoules. Also, the unit dosage form can be a capsule, tablet, cachet, or lozenge itself, or it can be the appropriate number of any of these in packaged form.
• compositions are tablets or capsules for oral administration.
• the compounds according to the invention may optionally exist as pharmaceutically acceptable salts including pharmaceutically acceptable acid addition salts prepared from pharmaceutically acceptable non-toxic acids including inorganic and organic acids.
• Representative acids include, but are not limited to, acetic, benzenesulfonic, benzoic, camphorsulfonic, citric, ethenesulfonic, dichloroacetic, formic, fumaric, gluconic, glutamic, hippuric, hydrobromic, hydrochloric, isethionic, lactic, maleic, malic, mandelic, methanesulfonic, mucic, nitric, oxalic, pamoic, pantothenic, phosphoric, succinic, sulfide, tartaric, oxalic, p-toluenesulfonic and the like, such as those pharmaceutically acceptable salts listed by Berge et al., Journal of Pharmaceutical Sciences, 66: 1-19 (1977), incorporated herein by reference in its entirety.
• the acid addition salts may be obtained as the direct products of compound synthesis.
• the free base may be dissolved in a suitable solvent containing the appropriate acid and the salt isolated by evaporating the solvent or otherwise separating the salt and solvent.
• the compounds of this invention may form solvates with standard low molecular weight solvents using methods known to the skilled artisan.
• pro-drugs refers to compounds that have been modified with specific chemical groups known in the art and that when administered into an individual undergo biotransformation to give the parent compound.
• Pro- drugs can thus be viewed as compounds of the invention containing one or more specialized non-toxic protective groups used in a transient manner to alter or to eliminate a property of the compound.
• the "pro-drug” approach is utilized to facilitate oral absorption.
• Example 1 Preparation of Compound 1 (4-[6-(6-Methanesulfonyl-2-methyl-pyridin-3-ylamino)- 5-methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester) and crystalline forms thereof.
• Compound 1 (4-[6-(6-Methanesulfonyl-2-methyl-pyridin-3-ylamino)-5- methoxy-pyrimidin-4-yloxy]-piperidine-l-carboxylic acid isopropyl ester) is described in International Patent Application No. PCT/US2006/000567, published as International Publication No.
• the oral glucose tolerance test was executed as follows: Compound was administered 0-30 min prior to first blood sample. At time 0, a tail nick and glucose test was performed with a handheld glucometer, then a bolus of glucose (2 mg/kg, p.o.) was administered. Glucose was again tested at 20, 40, 60, and 120 minutes post glucose administration. During the entire oGTT, a total volume of approximately 10 drops of blood was collected.
• Rat Animals are fasted 3-16 h.
• the oral glucose tolerance test was executed as follows: At time minus 30 min, blood was collected via a tail nick and a glucose test performed with a hand-held glucometer, and compound was then administered. At time 0, blood was again collected for glucose reading and then a bolus of glucose (3 g/kg p.o., 6 mL/kg) administered. Blood glucose levels were further tested at 30, 60, and 120 min post glucose administration. During the entire oGTT, a total volume of approximately 8 drops of blood was collected. Rats were used twice with a one week lapse between experiments.
• Example 3 Powder X-Ray Diffraction Patterns (PXRD) for Form A-I, Form A-IV, and Form A- VI for Compound 1.
• the crystalline forms of Compound 1 were characterized as to their powder X-ray diffraction patterns (PXRD), for example as follows.
• the sample was examined using an x-ray diffractometer (Bruker AXS Model 08 Advance) equipped with Gobel mirror incident beam and PSD detector (type lynxEye).
• the sample was placed on to zero-background holder and scanned under ambient conditions of temperature and humidity.
• the sample was scanned from 3 to 40°2 # at a step size of 0.019°2 # and a time per step of 38.4 seconds.
• the radiation was CuKa (45KkV and 40mA).
• the divergence slit and anti-scatter slit were 0.982° and 0.499°, respectively.
• the PXRD measured values which follow herein will vary with various parameters including, but not limited to, precision and method of grinding during sample preparation, crystal size and morphology, diffractometer configuration, and data collection parameters/experimental conditions.
• the crystal forms of the present invention are not limited to crystalline forms which provide a powder X-ray diffraction pattern, and/or peak characteristics identical to those described in the Tables and Figures which follow herein.
• Example 4 Differential Scanning Calorimetry (DSC) for Form A-I, Form A-IV, and Form A-VI for Compound 1.
• the crystalline forms of the present invention were subjected to DSC analysis.
• a representative sample was tested using a TA Instruments DSC Q100 differential scanning calorimeter. The sample was analyzed as received in a crimped TA Instrument aluminum sample pan and was program heated from ambient to 250 °C at 10 °C/min under nitrogen purge.
• Compound 1, Form A-I was observed to have a differential scanning calorimetry trace comprising an endotherm with an extrapolated onset temperature of melting of 164.6°C, a peak temperature of melting of 166.8° C and a heat of melting of 86.2 J/g.
• Compound 1, Form A-IV was observed to have a differential scanning calorimetry trace comprising an endotherm with an extrapolated onset temperature of melting of 154.1°C, a peak temperature of melting of 155.6°C and a heat of melting of 86.8 J/g.
• the crystalline forms of the present invention were subjected to DSC analysis.
• a representative sample was tested for weight loss using a TA Instruments TGA Q50 thermogravimetric calorimeter. The sample was analyzed as received and was program heated from ambient to 300°C at 10 °C/min under nitrogen purge.
• Form A-I was observed to have a thermogravimetric analysis profile showing about 0.3% weight loss from ambient temperature up to 165°C and including the melting of the sample. These results indicate that crystalline Form A-I is an anhydrous form.
• Form A- VI was observed to have a thermogravimetric analysis profile showing about 0.2% weight loss from ambient temperature up to 165°C and including the melting of the sample. These results indicate that crystalline Form A- VI is an anhydrous form.
• Example 6 Treatment of Compound 1 and MBX-2982 in a model of Non-Alcoholic Fatty Liver Disease (NAFLD).
• NAFLD Non-Alcoholic Fatty Liver Disease
• mice Male C57BL/6 mice (8 weeks) were fed either normal or high fat diet (HFD) (60% TD06414, Envigo) and given water ad libitum.
• HFD normal or high fat diet
• animals were treated with one of the following five times per week for six consecutive weeks: 1) normal diet (negative control) and vehicle (60% PEG 400); 2) high fat diet and vehicle; 3) high fat diet and 3 mg kg/day Compound 1; 4) high fat diet and 10 mg/kg/day Compound 1; 5) high fat diet and 30 mg/kg/day Compound 1; and 6) high fat diet and 10 mg/kg/day MBX-2982 (a GPRl 19 agonist).
• mice were sacrificed and serum plasma was collected for measurement of various biochemical parameters, including serum transaminases. Increases in serum ALT (a known marker of hepatocellular injury) were observed in all animals exposed to the high fat diet. These increases were blocked by treatment with Compound 1, but not MBX-2982 (see Figure 6).

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