Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
  • C07D413/14—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing three or more hetero rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
  • A61K31/4439—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. omeprazole
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/06—Antianaemics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
• • 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
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration

Definitions

• Sickle cell disease is an inherited disorder of hemoglobin synthesis characterized by life-long severe hemolytic anemia, recurrent pain crisis, chronic organ system damage and a marked decrease in life expectancy. SCD results from a mutation in the hemoglobin (Hb) b gene that causes an amino acid substitution in the b globin protein and results in the sickle hemoglobin (HbS) allele b5. In the mouse model of SCD (Townes mice) the murine Hb genes have been deleted and replaced by the human sickle Hb gene.
• mice homozygous for HbS express exclusively human sickle Hb and develop pathologies closely resembling SCD in humans with rigid sickle-shaped red blood cells (sRBCs), hemolytic anemia, iron overload, expansion of splenic red pulp, inflammation, increased adhesion of blood cells to endothelial vasculature leading to vaso-occlusion / vascular occlusion (VO) and organ injuries.
• sRBCs sickle-shaped red blood cells
• VO vascular occlusion
• Polymerization of deoxy-HbS shortens the lifespan of sickle RBCs and promotes intravascular and extravascular hemolysis. The intravascular hemolysis leads to release of cell-free Hb from RBCs.
• Hb The extracellular Hb is easily oxidized from ferrous (Fe 2+ ) to ferric (Fe 3+ ) Hb (metHb), from which heme readily dissociates into the vasculature leading to oxidative stress, inflammation, VO, ischemia and tissue injury (Umbreit J., Am. J. Hematol., 2007).
• L-glutamine oral powder (Endari) helps in reducing the frequency of pain crises.
• Crizanlizumab (Adakveo), an intraveneously administered drug, helps to reduce the frequency of pain crises. Side effects can include nausea, joint pain, back pain and fever.
• Voxelotor an orally administered drug improves anemia in patients with sickle cell disease. Side effects can include headache, nausea, diarrhea, fatigue, rash and fever. Further, pain-relieving medications are regularly administered to SCD patients, which help to relieve pain during sickle cell pain crises, however, without treating the cause of the pain.
• the novel drug or SCD therapy should improve, alleviate or change one or more of the markers, conditions or events relevant with SCD, and as defined further herein, towards a normalized level.
• a further object of the invention was to provide a SCD drug or therapy with improved safety profile compared to conventional hydroxyurea treatment.
• a further object of the invention was to provide a SCD drug or therapy with at least the same or even improved safety profile compared to conventional voxelotor treatment.
• the present invention aims at providing an improved SCD therapy, considering one or more of the aspects discussed herein in more detail below.
• Described herein are methods for treating SCD comprising administering a compound of the following formula (Compound 127) or a pharmaceutically acceptable salt thereof.
• suitable salts are: benzoic acid salt, HCI salt, citric acid salt, fumaric acid salt, lactic acid salt, malic acid salt, maleic salt, methanesulfonic acid salt, phosphoric acid salt, succinic acid salt, sulfuric acid salts, tartaric acid salts and toluenensufonic acid salts.
• the ratio of compound to salt is 1:1, 2:1, 1:2 or 1:3.
• a salt of a compound refers to any ratio of compound to salt unless a specific ratio is indicated.
• Compound 127 and methods for synthesizing Compound 127 are described in W02017/068089 and W02017068090A1, hereby incorporated by reference.
• Specific salts of compound 127, as well as a variety of polymorphs of Compound 127 are described in WO 2018/192973, hereby incorporated by reference.
• the potential use of the specific salts disclosed therein in treating sickle cell disease is generally mentioned in a list among various other indications.
• Example 13 describes single dose intravenous and oral pharmacokinetic studies with H2SO4 and HCI-mono salts of compound 127.
• Vania Manolova "First-in-class oral Ferroportin Inhibitor: Mode of Action and Efficacy in a mouse model of Beta-Thalassemia Intermedia”; EFiA Abstract, 14.06.2019 discloses to use compound 127 in the treatment of thalassemia intermedia but remains silent about any specific salt form thereof. Further, a potential efficacy in the treatment of sickle cell disease is also not mentioned therein.
• Compound 127 competes with hepcidin for ferroportin binding and internalization.
• Compound 127 inhibits ferroportin and thereby blocks iron transport to blood.
• treat in the context of the new use of the present invention includes amelioration of at least one symptom of or pathological condition associated with SCD.
• the term “treat”, “treatment” or “treating” in the context of the present invention further includes prophylaxis.
• the treatment with Compound 127 according to the present invention in particular improves, alleviates or changes one or more of the following markers, conditions or events, e.g. towards a normalized level.
• a particular aspect of the invention relates to the Compound 127 as described anywhere herein for the use in the treatment, prevention or alleviation of one or more of the markers, conditions or events describes supra or infra, or in particular in the Examples.
• treatment of a subject suffering from SCD with Compound 127 decreases hemolysis (e.g., as assessed by a decrease in cell-free hemoglobin (Hb), a decrease in cell-free heme, a decrease in total and indirect plasma bilirubin or a decrease in serum LDH (lactate dehydrogenase).
• Hb cell-free hemoglobin
• heme heme
• serum LDH lactate dehydrogenase
• treatment of a subject suffering from SCD with Compound 127 improves one or more of total serum iron, serum ferritin, serum transferrin, and calculated TSAT (transferrin saturation).
• treatment of a subject suffering from SCD with Compound 127 decreases reticulocytosis, improves reticulocyte counts and/or % reticulocytes.
• treatment of a subject suffering from SCD with Compound 127 decreases one or more of total Hb, RBC counts, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and corpuscular haemoglobin concentration mean (CHCM).
• MCV mean corpuscular volume
• MH mean corpuscular hemoglobin
• CHCM corpuscular haemoglobin concentration mean
• treatment of a subject suffering from SCD with Compound 127 improves one or more of RBC distribution width (RDW), platelet and reticulocyte counts.
• treatment of a subject suffering from SCD with Compound 127 improves microcytic RBC (RBC volume versus Hb scatterplot).
• treatment of a subject suffering from SCD with Compound 127 achieves changes in abnormal RBCs (sickling) and/or improves RBC sickling (peripheral blood smear).
• treatment of a subject suffering from SCD with Compound 127 decreases leukocytosis.
• treatment of a subject suffering from SCD with Compound 127 decreases blood leukocyte counts (e.g., decreases blood neutrophil counts and/or blood lymphocyte counts).
• treatment of a subject suffering from SCD with Compound 127 decreases extravascular and/or intravascular hemolysis.
• treatment of a subject suffering from SCD with Compound 127 improves one or more haemeoloysis markers, such as indirect/total bilirubin, blood inflammatory markers as measured by hsCRP (high sensitivity C-reactive protein), IL-1 and IL-6 (interleukin), TNF-alpha, sVCAM-1, endothelin-1, sP-selectin, slCAM-1, and xanthine oxidase.
• haemeoloysis markers such as indirect/total bilirubin, blood inflammatory markers as measured by hsCRP (high sensitivity C-reactive protein), IL-1 and IL-6 (interleukin), TNF-alpha, sVCAM-1, endothelin-1, sP-selectin, slCAM-1, and xanthine oxidase.
• treatment of a subject suffering from SCD with Compound 127 improves one or more of RBC indices, including Hb concentration, RBC count, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular Hb (MCH), mean corpuscular Hb concentration (MCHC), corpuscular Hb concentration mean (CHCM), RBC distribution width, platelet and reticulocyte counts, % reticulocytes, % hypochromic, microcytic RBC (RBC volume versus Hb scatterplot), CHCM (corpuscular haemoglobin concentration mean), total serum iron, serum ferritin, serum transferrin, calculated TSAT, hepcidin, EPO (erythropoietin), NTBI (non-transferrin bound iron), soluble transferrin receptor (sTFR), (sTFR-2), and LDH.
• RBC indices including Hb concentration, RBC count, haematocrit (Hct), mean corpuscular volume (MCV), mean
• one or more of the parameters mentioned above and below can be determined to evaluate the efficacy of the compound of the present invention in treatment of SCD.
• the Compound 127 of the present invention is suitable to improve at least one of these parameters.
• the term “improves” or “improvement” may cover a modulation or change of the respective marker or condition in the sense of a therapeutic effect.
• SCD ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇ ⁇
• Reduced NTBI levels in a patient by at least 1%, 2%, 3%, 4%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or at least 100%, determined at any time point within a time period of up to 72 hours, up to 60 hours, up to 48 hours, up to 36 hours, up to 24 hours, or up to 12, 8, 6, 5, 4, 3, 2, 1 and 0.5 hours following the administration and as compared to the NTBI levels in the patient determined at any time point within 0.5, 1, 2, 3, 4, 5, 6, 8, 12, 24, 36, or 48 hours, or up to ⁇ 1 week prior to the commencement of treatment of the invention.
• Reduced LPI levels in a patient by at least 1%, 2%, 3%, 4%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or at least 100%, determined at any time point within a time period of up to 72 hours, up to 60 hours, up to 48 hours, up to 36 hours, up to 24 hours, or up to 12, 8, 6, 5, 4, 3, 2, 1 and 0.5 hours following the administration and as compared to the total LPI levels in the patient determined at any time point within 0.5, 1, 2, 3, 4, 5, 6, 8, 12, 24, 36, or 48 hours, or up to ⁇ 1 week prior to the commencement of treatment of the invention.
• Improvement of at least one of the parameters Hct, MCV, MCH, RDW and reticulocyte numbers in the patient by at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or at least 100 %, determined at any time point within a time period of up to one week, up to 2 weeks, up to 3 weeks, up to 4 weeks, up to 3 months following the first administration and as compared to the respective parameter in the subject determined at any time point within 1 week, 2 weeks, 3 weeks, or 4 weeks prior to the commencement of treatment of the invention.
• Reduced serum ferritin levels in the patient by at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or at least 100 %, determined at any time point within a time period of up to one week, up to 2 weeks, up to 3 weeks, up to 4 weeks, up to 3 months following the first administration and as compared to the serum ferritin levels in the patient determined at any time point within 1 week, 2 weeks, 3 weeks, or 4 weeks prior to the commencement of treatment of the invention.
• treatment of a subject suffering from SCD with Compound 127 reduces or prevents further iron accumulation in the liver, kidney and/or spleen.
• the new treatment may result in a decrease in liver, kidney and/or spleen iron concentration in the SCD patient by at least 1%, 2%, 3%, 4%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or at least 100%, determined at any time point within a time period of up to one week, up to 2 weeks, up to 3 weeks, up to 4 weeks, up to 3 months following the first administration and as compared to the levels of liver, kidney and/or spleen iron concentration in the SCD patient determined at any time point within 1 week, 2 weeks, 3 weeks, or 4 weeks prior to the commencement of treatment of the invention.
• treatment with Compound 127 decreases iron overload in kidney.
• treatment of a subject suffering from SCD with Compound 127 reduces vascular inflammation markers, e.g. the levels of sVCAM-1.
• treatment of a subject suffering from SCD with Compound 127 reduces vascular inflammation.
• treatment of a subject suffering from SCD with Compound 127 reduces the blood cell adhesion in inflamed venules or to microvasculature and improves the blood flow in microvessels.
• treatment of a subject suffering from SCD with Compound 127 reduces blood cell adhesion to microvasculature, vaso-occlusion (VO) and alleviates VO events.
• VO vaso-occlusion
• treatment of a subject suffering from SCD with Compound 127 reduces the frequency of VOC or painful VOC crises and/or prevents recurrent painful VOC including ACS (Acute chest syndrome).
• treatment of a subject suffering from SCD with Compound 127 reduces the frequency of VOC or painful VOC crises and/or prevents recurrent painful VOC including ACS in the patient within 1 week, 2 weeks, 3 weeks or 4 weeks, 2 months, 3 months, 4 months, 6 months, 8 months, 9 months, 12 months, 24 months, prior to the commencement of treatment of the invention; or achieving that the SCD patient does not suffer from VOC or painful VOC crises for at least 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks,
• treatment of a subject suffering from SCD with Compound 127 achieves a reduction in mean number of painful (VOC) crises through 48 weeks.
• treatment of a subject suffering from SCD with Compound 127 achieves a reduction in mean number of painful (VOC) crises through 48 weeks in OH- Urea naive patients.
• a preferred aspect relates to the Compound 127 as described anywhere herein for the use in the treatment, prevention or alleviation of vascular inflammation or VO and VO events.
• treatment of a subject suffering from SCD with Compound 127 reduces the need for RBC transfusions, such as in particular reduction of transfusion burden in the patient compared to the transfusion burden for the patient within 1 week, 2 weeks, 3 weeks or 4 weeks, 2 months, 3 months, 4 months, 6 months, 8 months, 9 months, 12 months, 24 months, prior to the commencement of treatment of the invention; or achieving that the SCD patient does not require red blood cell transfusion for at least 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks, 14 weeks, 15 weeks, 16 weeks, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 12 months, 18 months, 24 months or even longer up to independence from red blood cell transfusions after treatment.
• the new treatment may result in an improvement in the quality of life in the SCD patients as compared to the quality of life in the SCD patients determined within the 1, 2, 3, or 4 week(s) prior to the commencement of treatment of the invention.
• the improvement of Quality of life is determined within 3, 6, 9, 12, 15, 18, 21 or 24 months after the commencement of the treatment.
• Quality of Life can be determined by evaluating change in patient reported outcomes (PRO) using Adult Sickle Cell Quality-of-Life Measurement System (ASCQ-ME).
• the subjects to be treated in the new use according to the invention can be any mammals such as rodents and primates, and in a preferred aspect the new medical use relates to the treatment of humans.
• the subjects suffering from SCD and to be treated with the new method according to the invention are also designated as "patients”.
• the subjects to be treated can be of any age.
• a preferred aspect of the invention relates to the treatment of children and adolescents.
• the subjects to be treated with the new methods described herein are ⁇ 18 years old. More particularly, the subjects to be treated with the new methods described herein are ⁇ 16 years old, ⁇ 15 years old, ⁇ 14 years old, ⁇ 13 years old, ⁇ 12 years old, ⁇ 11 years old, ⁇ 10 years old, ⁇ 9 years old, ⁇ 8 years old, ⁇ 7 years old, ⁇ 6 years old, or ⁇ 5 years old.
• the subjects to be treated with the new methods described herein are 1-3 years old, 3-5 years old, 5-7 years old, 7- 9 years old, 9-11 years old, 11-13 years old, 13-15 years old, 15-20 years old, 20-25 years old, 25-30 years old, or > 30 years old.
• pediatric patients to be treated are ⁇
• the subjects to be treated with the new methods described herein are > 2 years old, preferably > 2 years old and ⁇ 16 years old or ⁇ 12 years old.
• the patients are > 12 years old or > 16 years old.
• the subjects to be treated with the new methods described herein are preferably 18 to 50 years old, preferably 18-25 years old, 20-25 years old, 25-30 years old, 30-35 years old, 35-40 years old, 40-45 years old, 45-50 years old. It is also possible to treat elder adults being 50-55 years old, 55-60 years old, or greater than 60 years old.
• the subjects to be treated with the new methods described herein are 60 to 80 years ols, such as 60-65 years old, 65-70 years old, 70-75 years old, 75-80 years old, or greater than 80 years old.
• the treatment of children and adolescents is particularly preferred due to the significant advantages provided by the treatment with the compounds of the present invention.
• Said compounds can be administered orally, which is advantageous over parenteral administration.
• the orally bioavailable compound of the present invention turned out to have a moderate bioavailability and half-life in the body and is thus relatively quickly washed out. This leads to less adverse effects and a faster reversibility of the drug, which is of particular importance in the treatment of children.
• Compound 127 can be used to treat patients suffering from various forms of SCD, including: HbSS, HbSC, Hbspo thalassemia, Hbsp+ thalassemia, HbSD, HbSE, and HbSO.
• Compound 127 can be used to treat patients suffering from HbSS or Hbspo thalassemia.
• Compound 127 can particularly be used to treat patients suffering from SCD, as defined anywhere herein, being inadequately controlled on monotherapy, e.g. with Hydroxyurea.
• Compound 127 can be used to treat patients suffering from SCD, as described herein, having one or more VOC per year.
• Compound 127 can be used to treat patients suffering from SCD, as described herein, having one or more and no more than 6 VOC per year.
• Compound 127 can be used to treat patients suffering from SCD, as described herein, with an absolute reticulocyte count and % reticulocyte count of > 1.5 x upper limit of normal (ULN).
• Compound 127 can be used to treat patients having a history of partial or total splenectomy, having any history or clinically important finding of cardiac or pulmonary disorders, and/or having received or receiving frequently or regularly red blood cell (RBC) transfusion therapy (including chronic, prophylactic, or preventive transfusion to treat SCD).
• RBC red blood cell
• the compounds according to the invention are preferably provided in medicaments or pharmaceutical compositions in the form of oral administration forms, including e.g. pills, tablets, such as enteric-coated tablets, film tablets and layer tablets, sustained release formulations for oral administration, depot formulations, dragees, granulates, emulsions, dispersions, microcapsules, microformulations, nanoformulations, liposomal formulations, capsules, such as enteric-coated capsules, powders, microcrystalline formulations, epipastics, drops, ampoules, solutions and suspensions for oral administration.
• pills such as enteric-coated tablets, film tablets and layer tablets, sustained release formulations for oral administration, depot formulations, dragees, granulates, emulsions, dispersions, microcapsules, microformulations, nanoformulations, liposomal formulations, capsules, such as enteric-coated capsules, powders, microcrystalline formulations, epipastics, drops, ampoules, solutions and suspensions for oral
• the compounds according to the invention are administered in the form of a tablet or capsule, as defined above. More preferred is a capsule filled with the drug Compound 127. These may be present, for example, as acid resistant forms or with pH dependent coatings.
• the drug compound may be filled into capsules as the pure drug substance or in the form of a pharmaceutical composition comprising further pharmaceutically acceptable adjuvants, auxiliaries, solvents, additives etc..
• the administration forms comprising the compound of the present invention may comprise further pharmaceutically acceptable adjuvants, auxiliaries, fillers, solvents, additives etc..
• a said pharmaceutical composition may contain, for example up to 99 weight-% or up to 90 weight-% or up to 80 weight-% or or up to 70 weight-% of the drug compound of the present invention, the remainder being each formed by pharmacologically acceptable carriers and/or auxiliaries and/or solvents and/or optionally further pharmaceutically active compounds.
• the pharmaceutically acceptable carriers, auxiliary substances or solvents etc. are common pharmaceutical carriers, auxiliary substances or solvents, including various organic or inorganic carrier and/or auxiliary materials as they are customarily used for pharmaceutical purposes, in particular for solid medicament formulations.
• excipients such as saccharose, starch, mannitol, sorbitol, lactose, glucose, cellulose, talcum, calcium phosphate, calcium carbonate
• binding agents such as cellulose, methylcellulose, hydroxypropylcellulose, polypropyl pyrrolidone, gelatine, gum arabic, polyethylene glycol, saccharose, starch
• disintegrating agents such as starch, hydrolyzed starch, carboxymethylcellulose, calcium salt of carboxymethylcellulose, hydroxypropyl starch, sodium glycol starch, sodium bicarbonate, calcium phosphate, calcium citrate
• lubricants such as magnesium stearate, talcum, sodium laurylsulfate
• flavorants such as citric acid, menthol
• Liquid medicament formulations such as solutions, suspensions and gels usually contain liquid carrier, such as water and/or pharmaceutically acceptable organic solvents. Furthermore, such liquid formulations can also contain pH-adjusting agents, emulsifiers or dispersing agents, buffering agents, preserving agents, wetting agents, gelatinizing agents (for example methylcellulose), dyes and/or flavouring agents, for example as defined above.
• the compositions may be isotonic, that is, they can have the same osmotic pressure as blood.
• the isotonicity of the composition can be adjusted by using sodium chloride and other pharmaceutically acceptable agents, such as, for example, dextrose, maltose, boric acid, sodium tartrate, propylene glycol and other inorganic or organic soluble substances.
• the viscosity of the liquid compositions can be adjusted by means of a pharmaceutically acceptable thickening agent, such as methylcellulose.
• a pharmaceutically acceptable thickening agent such as methylcellulose.
• suitable thickening agents include, for example, xanthan gum, carboxymethylcellulose, hydroxypropylcellulose, carbomer and the like. The preferred concentration of the thickening agent will depend on the agent selected.
• preserving agents can be used in order to increase the storage life of the liquid composition.
• Benzyl alcohol can be suitable, even though a plurality of preserving agents including, for example, paraben, thimerosal, chlorobutanol and benzalkonium chloride can also be used.
• a further aspect of the present invention relates to the compounds according to the invention, including pharmaceutically acceptable salts, solvates, hydrates and polymorphs thereof, as well as medicaments, compositions and combined preparations comprising the same for the use in the treatment of SCD as defined herein in the form of oral administration forms.
• the compounds according to the invention for the use according to the present invention can be administered by one of the following dosing regimens:
• the compounds according to the invention can be administered to a patient in need thereof in a dose of 0.001 to 500 mg, for example 1 to 4 times a day, preferably once or twice daily.
• the dose can be increased or reduced depending on the age, body weight, condition of the patient, severity of the disease or type of administration.
• the compounds of the invention can be administered as a dose of 0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg, 0.6 mg, 0.7 mg, 0.8 mg, 0.9 mg, 1 mg, 1.5 mg, 2 mg, 2.5 mg, 3 mg, 3.5 mg, 4 mg, 4.5 mg, 5 mg, 6 mg, 7 mg, 8 mg, 9 mg, 10 mg, 11 mg, 12 mg, 13 mg, 14 mg, 15 mg, 16 mg, 17 mg, 18 mg, 19 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 105 mg, 110 mg, 115 mg, 120 mg, 125 mg, 130 mg, 135 mg, 140 mg, 145 mg, 150 mg, 155 mg, 160 mg, 165 mg, 170 mg,
• Preferred is a dose of between 0.5 to 500 mg, more preferred between 1 to 300 mg or 3 to 300 mg, more preferred between 1 to 250 mg or 5 to 250 mg.
• a 30 mg, 60 mg, 90 mg or 120 mg daily dose is preferred which is administered as a single dose once daily.
• a 60 mg or 120 mg daily dose is administered as two 30 mg doses or as two 60 mg doses, respectively, twice daily. It is also possible to administer a 90 mg daily dose as three 30 mg doses, three times daily.
• a dose between 0.001 to 60 mg/kg body weight, between 0.01 to 60 mg/kg body weight, between 0.1 to 60 mg/kg body weight, or between 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35 and up to 60 mg/kg body weight can be administered. It is possible to administer a dose of 120 mg or up to 240 mg for patients with > 50 kg body weight and of 60 mg for patients with > 50 kg body weight, in each case once or twice daily. It is preferred to administer a dose of 60 mg for patients with > 50 kg body weight and of 30 mg for patients with ⁇ 50 kg body weight, in each case once or twice daily. It is further preferred to administer the above defined doses of 30 mg and 60 mg to patients with > 50 kg and ⁇ 100 kg body weight.
• a body weight adjusted dosing is possible and in a further aspect preferred.
• one of the above defined dosages as an initial dose and subsequently administer 1 or more times the same or varying doses of those defined above in repeating intervals of 1 to 7 days, 1 to 5 days, preferably of 1 to 3 days, or every second day.
• the initial dose and the subsequent doses can be selected among the above defined dosages and adjusted / varied in accordance with the need of the patient within the provided ranges.
• the amount of subsequent doses can be appropriately selected depending on the individual patient, the course of disease and the treatment response. It is possible to administer 1, 2, 3, 4, 5, 6, 7, and more subsequent doses.
• the initial dose is equal or different to the one or more subsequent doses. It is further possible, that the subsequent doses are equal or different.
• the repeating intervals can be of the same length or can be varied depending on the individual patient, the course of disease and the treatment response.
• the subsequent doses are of decreasing amount with increasing number of subsequent dosing.
• a dose of between 3 mg and 300 mg, more preferred between 5 mg and 250 mg, most preferred of 5 mg, 15 mg, 30 mg, 60 mg, 90 mg, 120 mg or 240 mg is administered once daily over a treatment period of at least 3 days, at least 5 days, at least 7 days, up to 4 weeks.
• a dose of 30 mg, 60 mg or 120 mg is administered once daily.
• a total daily dose of 30 mg, 60 mg or 120 mg is administered by administering twice daily a 15 mg, 30 mg or 60 mg dose, respectively.
• a total daily dose of 240 mg is administered by administering twice daily a 120 mg dose.
• varying doses are administerd by starting with an initial dose, selected among the doses defined above, for 1 week, 2 weeks, 3 weeks, 4 weeks or more, followed by administering an increased dose, selected among the doses defined above, for an additional time period of 1 week, 2 weeks, 3 weeks, 4 weeks or more.
• an initial daily dose of 30 mg or 60 mg is administered for 4 weeks, followed by administering the same dose for further 4 weeks or followed by administering an increased dose for further 4 weeks.
• Such a treatment regimen may comprise administering 30 mg daily for 4 weeks, followed by administering 60 mg daily for additional 4 weeks.
• doses up to a total daily dose of 240 mg turned out to be safe and well tolerated.
• the preferred dosing regimen further showed fast oral absorption with detectable levels as early as 15 to 30 minutes post-dose. The absorption level can be maintained stable even upon repeated dosing and no critical accumulation is observed.
• the preferred dosing regimen further turned out to efficiently decrease mean serum iron levels and mean calculated transferrin saturation indicating its efficiency for treating SCD.
• a further object of the present invention relates to medicaments or combined preparations containing the compound of the present invention and at least one further pharmaceutically active compound ("combination therapy compound”), preferably an additional active compound being useful in the treatment of SCD.
• Combination therapy compounds may be selected from active compounds used in the prophylaxis and treatment of iron overload and the associated symptoms, including iron-chelating compounds, or compounds for the prophylaxis and treatment of any of the states, disorders or diseases accompanying or resulting from iron overload.
• Suitable combination therapy compounds may be selected from pharmaceutically active compounds for the prophylaxis and treatment of SCD, thalassemia, haemochromatosis, neurodegenerative diseases (such as Alzheimer's disease or Parkinson's disease) and the associated symptoms.
• the at least one additional pharmaceutically active combination therapy compound is selected from drugs for treating SCD, such as Hydroxyurea, Voxelotor, ADAKVEO ® (crizanlizumab), L-glutamine oral powder (Endari), fetal hemoglobin (HbF) inducers, inhibitors of PDE9 (such as IMR-687), and/or pain- relieving medications.
• drugs for treating SCD such as Hydroxyurea, Voxelotor, ADAKVEO ® (crizanlizumab), L-glutamine oral powder (Endari), fetal hemoglobin (HbF) inducers, inhibitors of PDE9 (such as IMR-687), and/or pain- relieving medications.
• the most preferred combination therapy compound from the group of drugs for treating SCD is fetal hemoglobin (HbF) inducers.
• the at least one additional pharmaceutically active combination therapy compound may further be selected from drugs for reducing iron overload (e.g. Tmprss6- ASO) and iron chelators, in particular curcumin, SSP-004184, Deferitrin, deferasirox, deferoxamine and deferiprone as well as JAK2 inhibitors.
• drugs for reducing iron overload e.g. Tmprss6- ASO
• iron chelators in particular curcumin, SSP-004184, Deferitrin, deferasirox, deferoxamine and deferiprone as well as JAK2 inhibitors.
• the most preferred combination therapy compound from the group of iron-chelating compounds is deferasirox.
• combination therapy compounds may be selected from drugs for treating b-thalassemia, such as Luspatercept, LentiGlobin BB305 (a gene therapy developed by the company Bluebird Bio synthetic human hepcidin (UPC-401), the hepcidin peptidomimetic PTG-300 and the anti-sense oligonucleotide targeting Tmprss6 (IONIS-TMPRSS6-L RX).
• drugs for treating b-thalassemia such as Luspatercept, LentiGlobin BB305 (a gene therapy developed by the company Bluebird Bio synthetic human hepcidin (UPC-401), the hepcidin peptidomimetic PTG-300 and the anti-sense oligonucleotide targeting Tmprss6 (IONIS-TMPRSS6-L RX).
• drugs for treating b-thalassemia such as Luspatercept, LentiGlobin BB305 (a gene therapy developed by the company Bluebird Bio synthetic human hep
• the present invention relates to the new use and medical treatment as defined herein, wherein the compounds as defined herein are administered to the patient in need thereof in a combination therapy with one or more of the combination therapy compounds defined above in a fixed dose or free dose combination for sequential use.
• a combination therapy comprises co administration of the compounds as defined in the present invention with the at least one additional pharmaceutically active compound (drug/combination therapy compound).
• Combination therapy in a fixed dose combination therapy comprises co administration of the compounds as defined herein with the at least one additional pharmaceutically active compound in a fixed-dose formulation.
• Combination therapy in a free dose combination therapy comprises co administration of the compounds as defined herein and the at least one additional pharmaceutically active compound in free doses of the respective compounds, either by simultaneous administration of the individual compounds or by sequential use of the individual compounds distributed over a time period.
• a combination therapy comprises concurrent oral administration of the Compound No. 127 and a combination therapy compound from the group of SCD medicaments, preferably of Hydroxyurea and/or pain- relieving drugs.
• a further embodiment of the present invention relates to a combination therapy as described herein, wherein the drug compound is one selected among those described in W02020/123850 Al, in particular one of the particular example compounds thereof as described below.
• a further aspect relates to providing a new combination therapy for treating SCD by administering Compound 127, as described herein, in a combination therapy with Hydroxyurea, Voxelotor, ADAKVEO ® (crizanlizumab), L-glutamine oral powder (Endari), fetal hemoglobin (HbF) inducers, inhibitors of PDE9 (such as IMR-687), and/or pain- relieving medications.
• the most preferred combination therapy compound from the group of drugs for treating SCD in combination with Compound 127 is fetal hemoglobin (HbF) inducers.
• a patient is treated by administering a compound of Formula (I) wherein
• X 1 is N or O
• X 2 is N, S or O; with the provison that X 1 and X 2 are different; R 1 is selected from the group consisting of
• n is an integer of 1 to 3;
• a 1 and A 2 are independently selected from the group of alkanediy; R 2 is
• a 1 and R 2 together with the nitrogen atom to which they are bonded form an optionally substituted 4- to 6-membered ring;
• R 3 indicates 1 , 2 or 3 optional substituents, which may independently be selected from the group consisting of: halogen, cyano, optionally substituted alkyl, optionally substituted alkoxy, and a carboxyl group;
• R 4 is selected from the group consisting of hydrogen, halogen,
• n 1;
• R 2 hydrogen
• R 3 hydrogen
• R 4 hydrogen
• a 1 methylene or ethane-1 ,2-diyl
• a 2 methylene, ethane-1 ,2-diyl or propane- 1 , 3-diyl; or A 1 and R 2 together with the nitrogen atom to which they are bonded form an optionally substituted 4-membered ring, forming compounds according to formula (II) or fomula (III) wherein in formula (II) and (III) m is an integer of 1 , 2 or 3 and
• X 1 , X 2 , and R 1 have the meaning as defined for compounds according to formula (I).
• the patient is treated with a compound selected from the group consisting of: and pharmaceutically acceptable salts thereof.
• the present invention relates to the new use and method of treatment as defined herein, wherein the compounds of the formulae (I), (II) or (III) are selected from the group consisting of: and pharmaceutically acceptable salts thereof.
• the present invention relates to the new use and method of treatment as defined herein, wherein the compounds of the formulae (I), (II) or (III) are selected from the group consisting of: and pharmaceutically acceptable salts thereof.
• the method comprises adminstering a compound selected from and pharmaceutically acceptable salts thereof.
• Optionally substituted alkyl preferably includes: linear or branched alkyl preferably containing 1 to 8, more preferably 1 to 6, particularly preferably 1 to 4, even more preferred 1 , 2 or 3 carbon atoms, also being indicated as Ci-C4-alkyl or Ci-C3-a Iky I.
• Optionally substituted alkyl further includes cycloalkyl containing preferably 3 to
• alkyl residues containing 1 to 8 carbon atoms include: a methyl group, an ethyl group, an n-propyl group, an i-propyl group, an n-butyl group, an i-butyl group, a sec-butyl group, a t- butyl group, an n-pentyl group, an i-pentyl group, a sec- pentyl group, a t-pentyl group, a 2-methylbutyl group, an n-hexyl group, a 1- methylpentyl group, a 2-methylpentyl group, a 3-methylpentyl group, a 4- methylpentyl group, a 1-ethy Ibuty I group, a 2-ethylbutyl group, a 3-ethylbutyl group, a 1 , 1 -dimethyl butyl group, a 2,2-dimethylbutyl group, a
• Ci-C4-alkyl Those containing 1 to 4 carbon atoms (Ci-C4-alkyl), such as in particular methyl, ethyl, n- propyl, i- propyl, n-butyl, i-butyl, sec-butyl, and t-butyl are preferred.
• Ci-C3-alkyl in particular, methyl, ethyl, propyl and i-propyl are more preferred. Most preferred are Ci and Ci alkyl, such as methyl and ethyl.
• Cycloalkyl residues containing 3 to 8 carbon atoms preferably include: a cyclopropyl group, a cyclobutyl group, a cyclopentyl group, a cyclohexyl group, a cycloheptyl group and a cyclooctyl group.
• a cyclopropyl group, a cyclobutyl group, a cyclopentyl group and a cyclohexyl group are preferred.
• a cyclopropyl group is particularly preferred.
• Substituents of the above-defined optionally substituted alkyl preferably include 1 , 2 or 3 of the same or different substituents, selected, for example, from the group consisting of: halogen as defined below, such as preferably F, cycloalkyl as defined above, such as preferably cyclopropyl, optionally substituted heteroaryl as defined below, such as preferably a benzimidazolyl group, optionally substituted amino as defined below, such as preferably an amino group or benzyloxycarbonylamino, a carboxyl group, an aminocarbonyl group as defined below, as well as an alkylene group such as in particular a methylene-group, forming for example a methylene-substituted ethyl-group (CH3-
• Halogen includes fluorine, chlorine, bromine and iodine, preferably fluorine or chlorine, most preferred is fluorine.
• Examples of a linear or branched alkyl residue substituted by halogen and containing 1 to 8 carbon atoms include: a fluoromethyl group, a difluoromethyl group, a trifluoromethyl group, a chloromethyl group, a dichloromethyl group, a trichloromethyl group, a bromomethyl group, a dibromomethyl group, a tribromomethyl group, a 1- fluoroethyl group, a 1-chloroethyl group, a 1 -bromoethyl group, a 2- fluoroethyl group, a 2-chloroethyl group, a 2-bromoethyl group, a difluoroethyl group such as a 1 ,2- difluoroethyl group, a 1 ,2-dichloroethyl group, a 1 ,2-dibromoethyl group, a 2,2- difluoroeth
• Examples of a cycloalkyl-substituted alkyl group include the above-mentioned alkyl residues containing 1 to 3, preferably 1 cycloalkyl group such as, for example: cyclopropylmethyl, cyclobutylmethyl, cyclopentylmethyl cyclohexylmethyl, 2- cyclopropylethyl, 2-cyclobutylethyl, 2- cyclopentylethyl 2-cyclohexylethyl, 2- or 3- cyclopropylpropyl, 2- or 3-cyclobutylpropyl, 2- or 3- cyclopentylpropyl, 2- or 3- cyclohexylpropyl, etc.
• Preferred is cyclopropylmethyl.
• heteroaryl-substituted alkyl group examples include the above-mentioned alkyl residues containing 1 to 3, preferably 1 (optionally substituted) heteroaryl group, such as, for example a pyridinyl, a pyridazinyl, a pyrimidinyl, a pyrazinyl, a pyrazolyl, an imidazolyl, a benzimidazolyl, a thiophenyl, or an oxazolyl group, such as pyridine-2-yl- methyl, pyridine-3-yl-methyl, pyridine-4-yl-methyl, 2-pyridine-2-yl- ethyl, 2-pyridine-l-yl- ethyl, 2-pyridine-3-yl-ethyl, pyridazine-3-yl-m ethyl, pyrimidine-2-yl-methyl, pyrimidine- 4-yl-methyl, pyra
• an amino-substituted alkyl residue examples include the above-mentioned alkyl residues containing 1 to 3, preferably 1 (optionally substituted) amino group, as defined below, such as, for example, aminoalkyl (Nhh-alkyl) or mono- or dialkylamino- alkyl, such as aminomethyl, 2-aminoethyl, 2- or 3-aminopropyl, methylaminomethyl, methylaminoethyl, methylaminopropyl, 2-ethylaminomethyl, 3- ethylaminomethyl, 2- ethylaminoethyl, 3-ethylaminoethyl, etc. with 3-aminopropyl being preferred, or an alkyl group, which may be substituted with an optionally substituted alkyloxycarbonylamino group such as a group according to formula
• R defines a a phenyl group, forming a benzyloxycarbonylaminopropyl group.
• Optionally substituted amino preferably includes: amino (-Nhh), optionally substituted mono- or dialkylamino (alkyl-NH-, (alkyl ⁇ N-), wherein with respect to "alkyl” reference can be made to the definition of optionally substituted alkyl above.
• amino (-Nhh) optionally substituted mono- or dialkylamino
• alkyl-NH- optionally substituted mono- or dialkylamino
• alkyl ⁇ N- optionally substituted alkyl
• Preferred is mono- or dimethylamino, mono- or diethylamino and monopropylamino.
• Most preferred is an amino group (-Nhh), and monopropylamino.
• Optionally substituted alkoxy includes an optionally substituted alkyl-O-group, wherein reference may be made to the foregoing definition of the alkyl group.
• Preferred alkoxy groups are linear or branched alkoxy groups containing up to 6 carbon atoms such as a methoxy group, an ethoxy group, an n-propyloxy group, an i-propyloxy group, an n- butyloxy group, an i-butyloxy group, a sec-butyloxy group, a t-butyloxy group, an n- pentyloxy group, an i-pentyloxy group, a sec-pentyloxy group, a t- pentyloxy group, a 2- methylbutoxy group, an n-hexyloxy group, an i-hexyloxy group, a t-hexyloxy group, a sec- hexyloxy group, a 2-methylpentyloxy group
• methylene, ethane-1 ,2-diyl and propane- 1 , 3-diyl are particularly preferred.
• a preferred substituted alkanediyl radical is a hydroxy-substituted alkanediyl such as a hydroxy- substituted ethanediyl, an oxo-substituted alkanediyl such as an oxo- substituted methylene or ethanediyl radical, forming a carbonyl or an acyl (acetyl) group, a halogen substituted alkanediyl group.
• a 1 having the meaning of a linear or branched alkanediyl group as defined above, and R 2 , having the meaning of an optionally substituted alkyl group as defined above, together with the nitrogen atom to which they are bonded form an optionally substituted 4- to 6-membered ring, which may be substituted with 1 to 3 substituents as defined above.
• a 1 and R 2 may together from a group according to one the following formulae Therein a (substituted or unsubstituted) 4-membered ring- formation is preferred, such as very particularly a group .
• left-hand binding site indicates the direct binding site to the heterocyclic 5-membered ring between the positions X 1 and X 2 in formula (I).
• the right-hand binding site indicates the binding site to the group A2 having the meaning of an alkanediyl group as defined herein.
• n has the meaning of an integer of 1 to 3, including 1, 2 or 3 thus indicating a methylene-group, an ethane-1 ,2-diyl group or a propane- 1 , 3-diyl group. More preferably n is 1 or 2 and even more preferably n is 1, indicating a methylene group.
• X 1 is N or O; and X 2 is N, S or O; with the proviso that XI and X2 are different; thus forming 5-membered heterocycles according to the formulae wherein * indicates the binding site to the aminocarbonyl-group and ** indicates the binding site to the A 1 -group.
• n is an integer of 1 , 2 or 3; preferably n is 1 or 2, more preferably n is 1.
• R 1 is selected from the group consisting of
• R 1 is hydrogen or methyl, more preferably R 1 is hydrogen.
• R 2 is selected from the group consisting of
• R 2 is hydrogen or Ci-C4-alkyl, more preferably R 2 is hydrogen or methyl, even more preferably R 2 is hydrogen.
• R 3 indicates 1, 2 or 3 optional substituents, which may independently be selected from the group consisting of
• R 3 indicates 1 or 2 optional substituents, which may independently be selected from the consisting of
• R 3 indicates 1 or 2 optional substituents, which may independently be selected from the group consisting of
• R 3 is hydrogen, indicating an unsubstituted terminal benzimidazolyl-ring in formula (I)
• R 4 is selected from the group consisting of
• R 4 is selected from the group consisting of
• R 4 is selected from the group consisting of
• R 4 is selected from the group consisting of
• R 4 is hydrogen
• a 1 is alkanediyl, preferably A1 is methylene or ethane-1, 2-diyl, more preferably A 1 is ethane-1,2-
• a 2 is alkanediyl, preferably A 2 is methylene, ethane-1, 2-diyl or propane- 1, 3-diyl, more preferably A 2 is methylene or ethane-1, 2-diyl, even more preferably A 2 is ethane-1, 2-diyl.
• a 1 and R 2 together with the nitrogen atom to which they are bonded form an optionally substituted 4- to 6-membered ring as defined above; therein A 1 and R 2 together with the nitrogen atom to which they are bonded preferably form an optionally substituted 4-membered ring as defined above, therein A 1 and R 2 together with the nitrogen atom to which they are bonded more preferably form an unsubstituted 4-membered ring (azetidinyl-ring).
• the substituents of the compounds of the following (I) may in particular have the following meaning: n has any of the meanings according to B) above and the remaining substituents may have any of the meanings as defined in A) and C) to I).
• R 1 has any of the meanings according to C) above and the remaining substituents may have any of the meanings as defined in A) and B) and D) to I).
• R 2 has any of the meanings according to D) above and the remaining substituents may have any of the meanings as defined in A) to C) and E) to H) or I).
• R 3 has any of the meanings according to E) above and the remaining substituents may have any of the meanings as defined in A) to D) and F) to I).
• R 4 has any of the meanings according to F) above and the remaining substituents may have any of the meanings as defined in A) to E) and G) to I).
• a 1 has any of the meanings according to G) above and the remaining substituents may have any of the meanings as defined in A) to F) and H) or I).
• a 2 has any of the meanings according to H) above and the remaining substituents may have any of the meanings as defined in A) to G) and I).
• R 2 and A 1 have any of the meanings as defined in I) and the remaining substituents may have any of the meanings as defined in A) to C), E), F) and H).
• X 1 is N or O; and X 2 is N, S or O; with the proviso that X 1 and X 2 are different;
• R 1 is hydrogen; n is 1, 2 or 3;
• a 1 is methylene or ethane-1, 2-diyl;
• a 2 is methylene, ethane-1, 2-diyl or propane-1, 3-diyl;
• R 2 is hydrogen or Ci-C4-alkyl; or
• R 3 indicates 1 or 2 optional substituents, which may independently be selected from the group consisting of
• R 4 is selected from the group consisting of
• the salts are selected from salts of the compounds of formula (I) with acids from the group consisting of benzoic acid, citric acid, fumaric acid, hydrochloric acid, lactic acid, malic acid, maleic acid, methanesulfonic acid, phosphoric acid, succinic acid, sulfuric acid, tartaric acid and toluenesulfonic acid, being characterized by a ratio of compound (I) : acid of 1 to 2 : 1 to 3.
• X 1 is N or O; and X 2 is N, S or O; with the proviso that X 1 and X 2 are different;
• R 1 is hydrogen;
• n is 1 or 2;
• a 1 is methylene or ethane-1, 2-diyl;
• a 2 is methylene, ethane-1, 2-diyl or propane-1 ,3-diyl;
• R 2 is hydrogen or methyl;
• a 1 and R 2 together with the nitrogen atom to which they are bonded form an unsubstituted 4-membered ring;
• R 3 indicates 1 or 2 optional substituents, which may independently be selected from the group consisting of
• R 4 is selected from the group consisting of
• the salts are selected from salts of the compounds of formula (I) with acids from the group consisting of benzoic acid, citric acid, fumaric acid, hydrochloric acid, lactic acid, malic acid, maleic acid, methanesulfonic acid, phosphoric acid, succinic acid, sulfuric acid, tartaric acid and toluenesulfonic acid, being characterized by a ratio of compound (I) : acid of 1 to 2 : 1 to 3.
• X 1 is N or O; and X 2 is N, S or 0;with the proviso that X 1 and X 2 are different;
• R 1 is hydrogen;
• n is 1;
• a 1 is methylene or ethane-1, 2-diyl;
• a 2 is methylene, ethane-1, 2-diyl or propane- 1 , 3-d iyl;
• R 2 is hydrogen; or
• R 2 together with the nitrogen atom to which they are bonded form an unsubstituted 4-membered ring;
• R 3 indicates hydrogen, thus forming an unsubstituted terminal benzimidazolyl-ring;
• R 4 is selected from the group consisting of
• salts are selected from salts of the compounds of formula (I) with acids from the group consisting of benzoic acid, citric acid, fumaric acid, hydrochloric acid, lactic acid, malic acid, maleic acid, methanesulfonic acid, phosphoric acid, succinic acid, sulfuric acid, tartaric acid and toluenesulfonic acid, being characterized by a ratio of compound (I) : acid of 1 to 2 : 1 to 3.
• X 1 is N or O; and X 2 is N, S or O; with the proviso that X 1 and X 2 are different;
• R 1 is hydrogen;
• n is 1;
• a 1 is methylene or ethane-1, 2-diyl;
• a 2 is methylene, ethane-1, 2-diyl or propane- 1, 3-diyl;
• R 2 is hydrogen; or
• R 3 indicates hydrogen, thus forming an unsubstituted terminal benzimidazolyl-ring; and
• R 4 is hydrogen; or a salt thereof.
• the salts are selected from salts of the compounds of formula (I), (II), (III) or of the compounds according to W02020/123850 A1 defined below with acids from the group consisting of benzoic acid, citric acid, fumaric acid, hydrochloric acid, lactic acid, malic acid, maleic acid, methanesulfonic acid, phosphoric acid, succinic acid, sulfuric acid, tartaric acid and toluenesulfonic acid, being characterized by a ratio of compound (I) : acid of 1 to 2 : 1 to 3; and
• XI , X2, and R 1 have the meaning as defined above in any embodiment comprising compounds of formula (I).
• R 1 and R 2 are preferably hydrogen.
• R 1 is preferably hydrogen and m is preferably 2.
• the salts of compounds of formula (I), (II) or (III), or of the compounds according to W02020/123850 A1 defined below may be selected from salts having a ratio of base (compound (I), (II) or (III)) : acid of 1 to 2 : 1 to 3, wherein with respect to the salt forming acids reference is made to the selection defined above.
• the compounds can mixed salts of a base (compound (I), (II) or (III)) with one or more of the acids indicated above and which may have the same or different ratios base : acid.
• the acids provide the counter anion for the cationic form of compound (I), (II) or
• the method comprises adminstering a 3HCI salt of the Compound 127
• the Compound 127 may be administered in the form of one of the following salts: a 1:1 sulfate salt having the formula a 1:1 phosphate salt having the formula a 2 : 1 phosphate salt (hemiphosphate)
• Compounds described in W02020/123850 A1 and selected from the above group can be provided as a new combination therapy for treating SCD, by administering the compounds in a combination therapy with fetal hemoglobin (HbF) inducers.
• the compound 2-(2- ⁇ [2-(lH-l,3-benzodiazol-2- yl)ethyl]amino ⁇ ethyl)-N-[(3-fluoropyridin-2-yl)methyl]-[l,3]oxazolo[4,5-c]pyridin-4- amine is provided in a combination therapy with a fetal hemoglobin (HbF) inducer for treating SCD.
• FIG. 1 Effect of Compound 127 on hemolysis of RBC from Townes mice. Shown are the plasma levels of cell-free Hb, heme and lactate dehydrogenase (LDH).
• the hemolysis markers were measured using commercially available kits (cell-free Hb kit # CSB E09632h, Cusabio; heme assays kit #MAK316, Sigma Aldrich), following manufacturer's instructions.
• FIG. 3 Compound 127 corrected elevated WBC counts in Townes mice.
• FIG. 6 Compound 127 decreased the percentage of mature RBC containing mitochondria in sickle mice treated with Compound 127 for 6 weeks.
• FIG. 9 MCHC (left) and CHCM (right) in HbSS and HbAA mice at day 43/44 measured using a Siemens Advia 120 automated blood analyzer. Individual values with mean ⁇ SD are shown. Significant differences to HbSS vehicle group are indicated: * p ⁇ 0.05, ** p ⁇ 0.01, *** p ⁇ 0.001 (One-way ANOVA with Dunnett's multiple comparison test).
• FIG. 10 Percentage of hypochromic (upper left), microcytic (upper right), hyperchromic (lower left) and macrocytic (lower right) RBCs in male and female HbSS and HbAA at day 43/44 measured using a Siemens Advia 120 automated blood analyzer. Individual values with mean ⁇ SD are shown. Significant differences to HbSS vehicle group are indicated: * p ⁇ 0.05, ** p ⁇ 0.01, *** p ⁇ 0.001 (One-way ANOVA with Dunnett's multiple comparison test).
• FIG. 11 Total bilirubin and indirect bilirubin in plasma of HbSS and HbAA mice at study day 43/44. Individual values with mean ⁇ SD are shown. Significant differences to HbSS vehicle group are indicated: * p ⁇ 0.05, ** p ⁇ 0.01, *** p ⁇ 0.001 (One-way ANOVA with Dunnett's multiple comparison test).
• FIG. 12 Plasma levels of sP-selectin (left) and RANTES (right) in plasma of HbSS and HbAA mice at the end of the study. Individual values with mean ⁇ SD are shown. Significant differences to HbSS vehicle group are indicated: * p ⁇ 0.05, ** p ⁇ 0.01, *** p
• FIG. 13 Plasma xanthine oxidase (XO) activity and intracellular ROS in whole blood of HbSS and HbAA mice.
• the plasma activity of XO and the percentage of ROS- positive mature RBCs is shown as individual values with mean ⁇ SD.
• Significant differences compared to HbSS vehicle group are indicated: * p ⁇ 0.05, ** p ⁇ 0.01, *** p
• FIG. 16 Compound 127 reduced a biomarker of liver injury.
• VIT-2763 indicates Compound 127 (in the form of its 3HCI salt).
• Townes mouse have been genetically engineered to exclusively express human sickle hemoglobin (Ryan et al. 1990 Science 247:566). Townes mice have anemia, elevated reticulocyte counts, splenomegaly, vascular inflammation and are prone to VO in response to hypoxia, inflammation and hemolysis.
• HbSS human HbS
• HbAA wild-type human hemoglobin HbA
• mice were purchased from the Jackson Laboratories (B6;129 Hbbtm2 (HBGl,HBB*)Tow/Hbbtm3(HBGl,HBB)Tow Hbatml(HBA)Tow/J, Stock Number: 013071; "Townes mice") at the age of 10 to 12 weeks and were fed a diet with low iron content (10-13 ppm iron, Granovit) and dosed orally twice daily (bid) with Compound 127 at 60 or 120 mg/kg body weight or vehicle (0.5% methylcellulose / water) for 6 weeks excluding weekends.
• mice had access to drinking water containing the stable iron isotope 58 Fe (1 mM 58 Fe(ll)S0 4 supplemented with 10 mM ascorbic acid as a reducing agent) to substitute for the iron present in the standard rodent diets (250 ppm iron).
• the labeled 58 Fe allowed to differentiate between iron absorbed during and before the study.
• mice (6 weeks of age, Jackson Laboratories, stock#013071) homozygous for HbS (HbSS) were fed a low iron diet (LID, Granovit, Cat. 2039, batch 0001906903, iron content 8.6 mg/kg) and dosed with Compound 127 per os (p.o.) twice daily (bid) at 60 mg/kg or with 0.5% methylcellulose (MC) as a vehicle.
• Mice had access to drinking water (DW) supplemented with 1 mM 58 Fe(ll) sulfate and 10 mM ascorbic acid for 6h after the first dose.
• the concentration of 5S Fe(l I) sulfate supplied in the DW has been adjusted to complement dietary iron supplementation to the level of standard rodent diet with iron content of 250 mg/kg. Water without iron and ascorbic acid was provided during the remaining 18h.
• Non-sickling Townes mice (HbAA) expressing normal human hemoglobin (wild type, WT) were dosed bid with vehicle and used as controls. Dosing of Compound 127 or vehicle followed by exposure to 58 Fe-containing water was repeated for 44 days. During the weekends (WE) dosing was paused and mice had access to LID and mineral water without 58 Fe ad libitum.
• Plasma iron was determined using MULTIGENT Iron assay (Abbott Diagnostics).
• Hematological parameters were determined in whole blood samples taken on the last day of the study (day 43/44) and were measured using Siemens Advia ADVIA 120 System.
• ROS in RBCs was detected with the indicator chloromethyl-2',7'- dichlorodihydrofluorescein diacetate (CM-H2DCFDA, Invitrogen, Cat. C6827) in mature RBCs labelled with APC-eFluor780-conjugated rat anti-mouse Terll9 and PE-conjugated rat anti-mouse CD71 antibodies (eBioscience, Cat. 47-5921-82 and 12-0711).
• CM-H2DCFDA indicator chloromethyl-2',7'- dichlorodihydrofluorescein diacetate
• APC-eFluor780-conjugated rat anti-mouse Terll9 and PE-conjugated rat anti-mouse CD71 antibodies eBioscience, Cat. 47-5921-82 and 12-0711.
• the activity of the xanthine oxidase in the plasma was measured using the Xanthine Oxidase Activity Assay Kit (Sigma-Aldrich Cat. MAK078).
• Plasma bilirubin was measured by assay kit (Sigma-Aldrich, Cat. MAK126), according to the manufacturer's instructions.
• Plasma sP-selectin and RANTES were measured by ELISA kits (R&D Systems, Cat. MVC00 and Cat. DY478-05, resp.), according to the manufacturer's instructions.
• the activity of the Compound 127 in prevention of VO for treatment of sickle cell anemia can be determined by using the mouse model described in WO2018/192973, such as e.g. described by Yulin Zhao et al. in "MEK1/2 inhibitors reverse acute vascular occlusion in mouse models of sickle cell disease”; The FASEB Journal Vol. 30, No. 3, pp 1171-1186, 2016. Said mouse model can be suitably adapted to determine the activity of the Compound 127, or of the compounds of further embodiments of the invention, in the treatment of VO in sickle cell anemia. Suitable adaptions to optimized test conditions can be carried out, which is within the routine work of a person skilled in the art.
• Example 1 Compound 127 decreased hemolysis in Townes mice
• RBCs of Townes mice are prone to hemolysis as demonstrated by elevated levels of cell-free Hb, heme, LDH in the control HbSS group treated with vehicle (FIG. 1).
• Compound 127 decreased significantly the levels of cell-free Hb, heme and LDH, suggesting that ferroportin inhibition by Compound 127 reduced hemolysis in Townes mice (FIG. 1).
• HbSS mice are anemic with pathologically altered hematological parameters indicative for hemolytic anemia, such as reduced RBC counts, Hb and compensatory reticulocytosis and elevated leukocyte counts compared to HbAA mice.
• Hematologic parameters were measured in fresh EDTA-blood on an automated blood cell analyzer after 6 weeks of treatment with Compound 127.
• Oral administration of Compound 127 in HbSS mice for six weeks decreased the total Hb, RBC counts, hematocrit, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Lowering of the HbS in RBCs of patients with SCD has been associated with decreased HbS aggregation and clinical benefit (Castro O. Am. J. Hematol., 1994).
• HbSS mice have plasma iron levels, similar to the HbAA controls.
• Compound 127 was dosed in HbSS mice for 44 days twice daily at 60 mg/kg and plasma iron was measured 3h after the last dose of the compound as a marker of acute efficacy. Plasma iron levels in HbSS mice receiving Compound 127 were significantly reduced, demonstrating the efficacy of Compound 127 to inhibit iron transpoprt to blood circulation (FIG. 8).
• MCHC mean corpuscular hemoglobin concentration
• CHCM is not affected by hemolysis and was significantly lower in HbSS mice treated with Compound 127, further demonstrating that iron restriction by Compound 127 reduces the concentration of HbS in the SCD model (FIG. 9, right).
• scatter plot analysis of the distribution of RBCs based on their volume and Hb concentration revealed a significant increase in the percentage of hypochromic and microcytic RBCs in line with a reduction of macrocytic RBCs in HbSS mice treated with Compound 127 (FIG. 10).
• the hematological analysis of blood samples from Townes mice indicate, that by blocking ferroportin, Compound 127 is inducing iron restricted erythropoiesis resulting in reduced HbS concentration in RBCs.
• Endothelial dysfunction in SCD is associated with increased levels of soluble adhesion molecules, such as sVCAM-1 and sP-selectin.
• Heme derived from RBCs can act as a damage-associated molecular pattern that activates the innate immune system, leading to oxidant production, inflammation, vaso- occlusion, ischemia, and tissue injury (Belcher JD et al. J. Clin invest, 2006).
• Townes mice and SCD patients have elevated leukocytes in the circulation, which produce pro- inflammatory cytokines and chemokines, attracting further inflammatory cells and activating endothelium.
• HbSS mice showed increased plasma levels of the chemokine RANTES (CCL5), which is involved in the recruitment of leukocytes to sites of inflammation.
• Treatment with Compound 127 significantly reduced RANTES levels in HbSS mice (FIG. 12, right), suggesting, that Compound 127 not only decreases the counts of leukocytes in blood circulation (FIG. 3), but also suppresses their pro- inflammatory activity.
• Plasma xanthine oxidase (XO) activity is upregulated in SCD patients and was defined as a source of enhanced vascular superoxide and hydrogen peroxide production. Elevated XO activity is reported also in the plasma of Townes mice (Osarogiagbon UR et a I, Blood, 2000; Aslan M et al, PNAS, 2001) and is considered as an important source of ROS production and oxidative tissue damage. Indeed, XO activity was significantly higher in HbSS mice compared to HbAA mice. Compound 127 lowered XO activity in plasma of HbSS mice, suggesting a reduced vascular oxidative damage (FIG. 13 left).
• Compound 127 may have positive effects on sRBCs. Importantly, Compound 127 lowered significantly reticulocyte counts, which are greatly expanded in SCD due to compensatory response to hemolysis (FIG. 2).
• Leukocytosis in SCD is associated with increases in the incidence of pain crisis, acute chest syndrome, stroke and mortality (Platt, NEJM, 1991). Unexpectedly, treatment of Townes mice with Compound 127 significantly lowered blood leukocyte counts, particularly neutrophils and lymphocytes (FIG. 3). This data suggests that Compound 127 may have a beneficial effect on inflammation in SCD.
• Example 4 Compound 127 reduced spleen and liver size in Townes mice
• the spleens of Townes mice are greatly enlarged (up to 7-fold larger compared to WT) due to stress erythropoiesis.
• Compound 127 reduced the spleen size of Townes mice, demonstrating that Compound 127 improves the extramedullary erythropoiesis (FIG. 4, left).
• Compound 127 corrected the increased liver weight of Townes mice to levels close to WT (FIG. 4, middle).
• the kidney weight in Townes mice is within the range of WT littermates and did not change upon Compound 127 treatment (FIG. 4, right).
• Example 5 Compound 127 prevented organ iron loading and decreased the total kidney iron in Townes mice
• Townes mice accumulate excessive iron in organs, such as liver, kidney and spleen as a result of intravascular and extravascular hemolysis of defective RBCs. It is estimated that about 1/3 of hemolysis in SCD is intravascular, due to mechanical destruction of deformed and inelastic sRBCs, while 2/3 is extravascular, resulting from removal of abnormal sRBCs by macrophages (Hebbel RP, Am. J. Hematol., 2011). In addition, anemia results in upregulation of the hypoxia-inducible factor (HIF)-2 alpha in the intestine which causes iron over-absorption (Das N. et al, J.Biol. Chem. 2015).
• HIF hypoxia-inducible factor
• Example 6 Compound 127 decreased apoptosis markers and improved mitochondria clearance in mature sRBCs of Townes mice
• HbS phosphatidylserine
• Example 7 Compound 127 decreased vascular inflammation marker in the Townes model of SCD
• Example 8 Determination of the activity of Compound 127 in the treatment of VO in sickle cell disease in a mouse model
• vascular occlusion (VO) crises are the major cause of morbidity and mortality in SCD patients. Hypoxia, dehydration, inflammation or hemolysis all contribute to increased adherence of sickle RBCs, neutrophils and platelets to activated endothelium in the small vessels promoting coagulation, vessel obstruction, painful crises and irreversible damage of multiple organs. High leukocyte counts, particularly activated neutrophils, have been correlated with early death, silent brain infarcts, hemorrhagic strokes, and acute chest syndrome in SCD patients (Platt OS, NEJM, 1994).
• Sickle RBCs shed microvesicles which trigger reactive oxygen species (ROS) production by endothelial cells, promote leukocyte adhesion, and induce endothelial apoptosis in a phosphatidylserine-dependent manner, contributing to acute VO in SCD (Camus M, Blood, 2012).
• ROS reactive oxygen species
• the Compounds of the present invention may alleviate VO in SCD by decreasing hemolysis in sickle RBCs and consecutively preventing leucocyte adhesion to endothelium.
• leukocytes and RBCs are labeled in vivo by intravenous injection of rhodamine-conjugated Ly6G (Sigma) and phycoerythrin- conjugated anti- TER119 mAb (BioLegend), respectively.
• the adherence of leukocytes and RBS to the endothelium of microvessels is monitored in the following 90 minutes by fluorescent intravital microscopy, as previously described (Zhao et al, FASEB J, 2016).
• anesthetized animals with window chambers are maintained at 37°C, blood flow and cell adhesion events are recorded using a digital video camera C2400 (Hamamatsu Photonics KK, Hamamatsu City, Japan) connected to fluorescent microscope (Axoplan microscope, Carl Zeiss). Twenty to thirty segments of microcapillaries are examined per mouse and cell adherence is quantified on still images by measuring the fluorescence intensity of adherent fluorescence-labeled cells using ImageJ software. Results are expressed as fluorescence units per million cells.
• iron restriction by the oral ferroportin inhibitor Compound 127 significantly reduced hemolysis, oxidative stress, vascular and systemic inflammation and improved RBC morphology, thereby alleviating vaso-occlusive events and improving hemodynamics in the Townes model of SCD.
• Ferroportin inhibitors prevent acute vascular occlusion and organ damage in a mouse model of sickle cell disease.
• Sickle RBCs contain several discrete iron compartments, including denatured hemoglobin and free heme, as well as molecular iron associated with membrane phospholipids. Abnormal iron deposits on sickle RBC membranes have been presumed to mediate oxidative damage to membrane structures resulting in their dysfunction (Browne P, Shalev O, Hebbel RP. The molecular pathobiology of cell membrane iron: the sickle red cell as a model. Free Radic Biol Med. 1998 Apr;24(6):1040-8). In addition, high concentrations of HbS (MCHC and CHCM) in sickle RBCs is also associated with cumulative membrane abnormalities, including oxidative damage possibly due to increased membrane iron.
• HbS MCHC and CHCM
• Vascular inflammation caused by interactions of sRBC, activated leukocytes and free heme with the endothelium is known to promote vaso-occlusion (VO) and organ damage.
• Compound 127 significantly reduced markers of vascular inflammation and leukocytes in peripheral blood suggesting a potential to reduce inflammation, VO and consequent organ injury.
• liver lobes isolated from Townes mice treated with Compound 127 for 6 weeks were fixed in formalin and paraffin- sections were stained with hematoxylin and eosin (H&E) for histological examination.
• H&E hematoxylin and eosin
• the chemokine CXCL1 is a critical inflammatory mediator of acute VO crisis in SCD mice (Jang JE. CXCL1 and its receptor, CXCR2, mediate murine sickle cell vaso- occlusion during hemolytic transfusion reactions. ! Clin Invest. 2011;121(4):1397-1401).
• CXCL1 is expressed by activated endothelial cells and is involved in the hepatic recruitment of neutrophils (Hilscher MB. Mechanical Stretch Increases Expression of CXCL1 in Liver Sinusoidal Endothelial Cells to recruit Neutrophils, Generate Sinusoidal Microthombi, and Promote Portal Hypertension. Gastroenterology. 2019;157(1):193- 209), which play important pathological role in SCD crisis.
• Liver disease is an important cause of morbidity and mortality in patients with SCD.
• the Townes mouse model of SCD is known to recapitulate hepatocellular injury which is reflected by elevated plasma alanine transaminase (ALT) levels, a clinically relevant biomarker for liver injury (Aslan M. Oxygen radical inhibition of nitric oxide- dependent vascular function in sickle cell disease. Proc Natl Acad Sci USA. 2001;98(26):15215-15220).
• ALT alanine transaminase
• Compound 127 significantly lowered plasma ALT levels in Townes mice underlining the potential of the compound to reduce VO tissue injury.
• Acute chest syndrome is a pulmonary complication of SCD patients with a significant overlap with pneumonia.
• ACS is the second most frequent reason for hospitalization and a leading cause of death in individuals with SCD.
• VO crisis often precede ACS and are characterized by RBC sickling, cellular hyper-adhesion and hemolysis (Novelli EM. Crises in Sickle Cell Disease. Chest. 2016;149(4):1082-1093).
• Pro- inflammatory cytokines are elevated in sera of sickle cell patients and are associated with pain crisis and VO.
• IL-Ib is a pro-inflammatory cytokine released by activated monocytes, able to induce endothelial cells activation and playing a driving role in the pathophysiology of pulmonary microvascular occlusion in SCD (Pathare A. Cytokines in Sickle Cell Disease. Hematology. 2003;8(5):329-337).
• Vehicle-treated Townes mice showed an up-regulation of IL-Ib mRNA expression in the lungs compared to vehicle-treated HbAA mice.
• Administration of compound 127 reduced the expression of IL-Ib in the lungs of HbSS mice.
• the decrease of IL- 1b expression in mice treated with the compound was not significant, mostly due to the high variability in HbSS mice treated with vehicle, the tendency was consistent among independent experiments, suggesting that compound 127 has the potential to reduce lungs inflammation and might protect against pulmonary VO and ACS in SCD.

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