U.S. patent application number 10/200599 was filed with the patent office on 2003-10-30 for combinations of ileal bile acid transport inhibitors and cholesteryl ester transfer protein inhibitors for cardiovascular indications.
This patent application is currently assigned to G.D. SEARLE, LLC. Invention is credited to Connolly, Daniel T., Glenn, Kevin C., Keller, Bradley T., Schuh, Joseph R., Sikorski, James A., Smith, Mark E..
Application Number | 20030203892 10/200599 |
Document ID | / |
Family ID | 26811682 |
Filed Date | 2003-10-30 |
United States Patent
Application |
20030203892 |
Kind Code |
A1 |
Keller, Bradley T. ; et
al. |
October 30, 2003 |
Combinations of ileal bile acid transport inhibitors and
cholesteryl ester transfer protein inhibitors for cardiovascular
indications
Abstract
The present invention provides combinations of cardiovascular
therapeutic compounds for the prophylaxis or treatment of
cardiovascular disease including hypercholesterolemia,
atherosclerosis, or hyperlipidemia. Combinations disclosed include
an ileal bile acid transport inhibitor combined with a cholesteryl
ester transfer protein (CETP) inhibitor.
Inventors: |
Keller, Bradley T.;
(Chesterfield, MO) ; Sikorski, James A.; (Des
Peres, MO) ; Glenn, Kevin C.; (Maryland Heights,
MO) ; Connolly, Daniel T.; (Ballwin, MO) ;
Smith, Mark E.; (Webster Groves, MO) ; Schuh, Joseph
R.; (St. Louis, MO) |
Correspondence
Address: |
BANNER & WITCOFF
1001 G STREET N W
SUITE 1100
WASHINGTON
DC
20001
US
|
Assignee: |
G.D. SEARLE, LLC
P.O. Box 5110
Chicago
IL
60680
|
Family ID: |
26811682 |
Appl. No.: |
10/200599 |
Filed: |
July 23, 2002 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10200599 |
Jul 23, 2002 |
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09466415 |
Dec 17, 1999 |
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6458851 |
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60143047 |
Jul 7, 1999 |
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60113955 |
Dec 23, 1998 |
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Current U.S.
Class: |
514/211.09 |
Current CPC
Class: |
A61K 31/785 20130101;
A61K 31/575 20130101; Y10S 514/824 20130101; A61K 31/585 20130101;
A61K 45/06 20130101; A61P 9/00 20180101; A61P 9/10 20180101; A61P
3/06 20180101; A61K 31/55 20130101; A61K 31/55 20130101; A61K
2300/00 20130101; A61K 31/575 20130101; A61K 2300/00 20130101; A61K
31/585 20130101; A61K 2300/00 20130101; A61K 31/785 20130101; A61K
2300/00 20130101 |
Class at
Publication: |
514/211.09 |
International
Class: |
A61K 031/554 |
Claims
What is claimed is:
1. A therapeutic combination comprising a first amount of an ileal
bile acid transport inhibiting compound and a second amount of a
cholesteryl ester transfer protein inhibiting compound wherein the
first amount and the second amount together comprise an
anti-hyperlipidemic condition effective amount, an
anti-atherosclerotic condition effective amount, or an
anti-hypercholesterolemic condition effective amount of the
compounds.
2. The therapeutic combination of claim 1 wherein the ileal bile
acid transport inhibiting compound is a compound having the
structure of formula B-2: 63or an enantiomer or racemate
thereof.
3. The therapeutic combination of claim 1 wherein the ileal bile
acid transport inhibiting compound has the structure of formula
B-12: 64or an enantiomer or racemate thereof.
4. The therapeutic combination of claim 1 wherein the ileal bile
acid transport inhibiting compound has the structure of formula
B-29: 65or an enantiomer or racemate thereof, wherein PEG is an
about 3000 to about 4000 molecular weight polyethylene glycol
polymer chain.
5. The therapeutic combination of claim 1 wherein the ileal bile
acid transport inhibiting compound has the structure of formula
B-7: 66or an enantiomer or racemate thereof.
6. The therapeutic combination of claim 1 wherein the combination
comprises a composition comprising the ileal bile acid transport
inhibiting compound and the cholesteryl ester transfer protein
inhibiting compound.
7. A method for the prophylaxis or treatment of a hyperlipidemic
condition comprising administering to a patient in need thereof a
combination in unit dosage form wherein the combination comprises a
first amount of an ileal bile acid transport inhibiting compound
and a second amount of a cholesteryl ester transfer protein
inhibiting compound wherein the first amount and the second amount
together comprise an anti-hyperlipidemic condition effective amount
of the compounds.
8. A method for the prophylaxis or treatment of an atherosclerotic
condition comprising administering to a patient in need thereof a
combination in unit dosage form wherein the combination comprises a
first amount of an ileal bile acid transport inhibiting compound
and a second amount of a cholesteryl ester transfer protein
inhibiting compound wherein the first amount and the second amount
together comprise an anti-atherosclerotic condition effective
amount of the compounds.
9. A method for the prophylaxis or treatment of
hypercholesterolemia comprising administering to a patient in need
thereof a combination in unit dosage form wherein the combination
comprises a first amount of an ileal bile acid transport inhibiting
compound and a second amount of a cholesteryl ester transfer
protein inhibiting compound wherein the first amount and the second
amount together comprise an anti-hypercholesterolem- ic condition
effective amount of the compounds.
Description
[0001] This application claims priority of U.S. provisional
application Ser. No. 60/143,047 filed Jul. 7, 1999 and of U.S.
provisional application Ser. No. 60/113,955 filed Dec. 23,
1998.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to methods of treating
cardiovascular diseases, and specifically relates to combinations
of compounds, compositions, and methods for their use in medicine,
particularly in the prophylaxis and treatment of hyperlipidemic
conditions such as are associated with atherosclerosis,
hypercholesterolemia, and other coronary artery disease in mammals.
More particularly, the invention relates to ileal bile acid
transporter (IBAT) inhibiting compounds. The invention also relates
to cholesteryl ester transfer protein (CETP) activity inhibiting
compounds.
[0004] 2. Description of Related Art
[0005] It is well-settled that hyperlipidemic conditions associated
with elevated concentrations of total cholesterol and low-density
lipoprotein (LDL) cholesterol are major risk factors for coronary
heart disease and particularly atherosclerosis. Since high levels
of LDL cholesterol increase the risk of atherosclerosis, methods
for lowering plasma LDL cholesterol would be therapeutically
beneficial for the treatment of atherosclerosis and other diseases
associated with accumulation of lipid in the blood vessels. These
diseases include, but are not limited to, coronary heart disease,
peripheral vascular disease, and stroke.
[0006] Atherosclerosis underlies most coronary artery disease
(CAD), a major cause of morbidity and mortality in modern society.
High LDL cholesterol (above about 180 mg/dl) and low HDL
cholesterol (below 35 mg/dl) have been shown to be important
contributors to the development of atherosclerosis. Other diseases
or risk factors, such as peripheral vascular disease, stroke, and
hypercholesterolaemia are negatively affected by adverse HDL/LDL
ratios.
[0007] Interfering with the recirculation of bile acids from the
lumen of the intestinal tract is found to reduce the levels of
serum cholesterol in a causal relationship. Epidemiological data
has accumulated which indicates such reduction leads to an
improvement in the disease state of atherosclerosis. Stedronsky, in
"Interaction of bile acids and cholesterol with nonsystemic agents
having hypocholesterolemic properties," Biochimica et Biophysica
Acta, 1210, 255-287 (1994) discusses the biochemistry, physiology
and known active agents surrounding bile acids and cholesterol.
[0008] Transient pathophysiologic alterations are shown to be
consistent with interruption of the enterohepatic circulation of
bile acids in humans with an inherited lack of IBAT activity, as
reported by Heubi, J. E., et al. See "Primary Bile Acid
Malabsorption: Defective in Vitro Ileal Active Bile Acid
Transport", Gastroenterology, 83, 804-11 (1982).
[0009] In another approach to the reduction of recirculation of
bile acids, the ileal bile acid transport system is a putative
pharmaceutical target for the treatment of hypercholesterolemia
based on an interruption of the enterohepatic circulation with
specific transport inhibitors (Kramer, et al., "Intestinal Bile
Acid Absorption" The Journal of Biological Chemistry, 268 (24),
18035-46 (1993).
[0010] In several individual patent applications, Hoechst
Aktiengesellschaft discloses polymers of various naturally
occurring constituents of the enterohepatic circulation system and
their derivatives, including bile acid, which inhibit the
physiological bile acid transport with the goal of reducing the LDL
cholesterol level sufficiently to be effective as pharmaceuticals
and, in particular for use as hypocholesterolemic agents. The
individual Hoechst patent applications which disclose such bile
acid transport inhibiting compounds are each separately listed
below.
[0011] R1. Canadian Patent Application No. 2,025,294.
[0012] R2. Canadian Patent Application No. 2,078,588.
[0013] R3. Canadian Patent Application No. 2,085,782.
[0014] R4. Canadian Patent Application No. 2,085,830.
[0015] R5. EP Application No. 0 379 161.
[0016] R6. EP Application No. 0 549 967.
[0017] R7. EP Application No. 0 559 064.
[0018] R8. EP Application No. 0 563 731.
[0019] Selected benzothiepines are disclosed in world patent
application number WO 93/321146 for numerous uses including fatty
acid metabolism and coronary vascular diseases.
[0020] Other selected benzothiepines are known for use as
hypolipaemic and hypocholesterolaemic agents, especially for the
treatment or prevention of atherosclerosis as disclosed in
application No. EP 508425. A French patent application, FR 2661676
discloses additional benzothiepines for use as hypolipaemic and
hypocholesterolaemic agents. Furthermore, patent application no. WO
92/18462 lists other benzothiepines for use as hypolipaemic and
hypocholesterolaemic agents. U.S. Pat. No. 5,994,391 (Lee et al.)
Each of the benzothiepine hypolipaemic and hypocholesterolaemic
agents described in these individual patent applications is limited
by an amide bonded to the carbon adjacent the phenyl ring of the
fused bicyclobenzothiepine ring.
[0021] Further benzothiepines useful for the treatment of
hypercholesterolemia and hyperlipidemia are disclosed in patent
application no. PCT/US95/10863. More benzothiepines useful for the
prophylaxis and treatment of hypercholesterolemia and
hyperlipidemia as well as pharmaceutical compositions of such
benzothiepines are described in PCT/US97/04076. Still further
benzothiepines and compositions thereof useful for the prophylaxis
and treatment of hypercholesterolemia and hyperlipidemia are
described in U.S. application Ser. No. 08/816,065.
[0022] In vitro bile acid transport inhibition is disclosed to
correlate with hypolipidemic activity in The Wellcome Foundation
Limited disclosure of the Patent Application No. WO 93/16055 for
"Hypolipidemic Benzothiazepine Compounds." That publication
describes a number of hypolipidemic benzothiazepine compounds.
Additional hypolipidemic benzothiazepine compounds (particularly
2,3,4,5-tetrahydrobenzo-1-thi-4-a- zepine compounds) are disclosed
in Patent Application No. WO 96/05188. A particularly useful
benzothiazepine disclosed in WO 96/05188 is the compound of formula
B-2. Further hypolipidemic benzothiazepine compounds are described
in Patent Application No. WO 96/16051. 1
[0023] Other benzothiazepine compounds useful for control of
cholesterol are described in PCT Patent Application No. WO
99/35135. Included in that description is the compound of formula
B-7. 2
[0024] Further IBAT inhibitor compounds include a class of
naphthalene compounds, described by T. Ichihashi et al. in J.
Pharmacol. Exp. Ther., 284(1), 43-50 (1998). In this class, S-8921
(methyl
1-(3,4-dimethoxyphenyl)-3-(3-ethylvaleryl)-4-hydroxy-6,7,8-trimethoxy-2-n-
aphthoate) is particularly useful. The structure of S-8921 is shown
in formula B-20. Further naphthalene compounds or lignin
derivatives useful for the treatment or prophylaxis of
hyperlipidemia or atherosclerosis are described in PCT Patent
Application No. WO 94/24087. 3
[0025] Inhibition of cholesteryl ester transfer protein (CETP) has
been shown to effectively modify plasma HDL/LDL ratios, and is
expected to check the progress and/or formation of certain
cardiovascular diseases. CETP is a plasma protein that facilitates
the movement of cholesteryl esters and triglycerides between the
various lipoproteins in the blood (Tall, J. Lipid Res., 34, 1255-74
(1993)). The movement of cholesteryl ester from HDL to LDL by CETP
has the effect of lowering HDL cholesterol. It therefore follows
that inhibition of CETP should lead to elevation of plasma HDL
cholesterol and lowering of plasma LDL cholesterol, thereby
providing a therapeutically beneficial plasma lipid profile.
Evidence of this effect is described in McCarthy, Medicinal Res.
Revs., 13, 139-59 (1993). Further evidence of this effect is
described in Sitori, Pharmac. Ther., 67, 443-47 (1995)). This
phenomenon was first demonstrated by Swenson et al., (J. Biol.
Chem., 264, 14318 (1989)) with the use of a monoclonal antibody
that specifically inhibits CETP. In rabbits, the antibody caused an
elevation of the plasma HDL cholesterol and a decrease in LDL
cholesterol. Son et al. (Biochim. Biophys. Acta, 795, 743-480
(1984)) describe proteins from human plasma that inhibit CETP. U.S.
Pat. No. 5,519,001, herein incorporated by reference, issued to
Kushwaha et al., describes a 36 amino acid peptide derived from
baboon apo C-1 that inhibits CETP activity. Cho et al. (Biochim.
Biophys. Acta 1391, 133-144 (1998)) describe a peptide from hog
plasma that inhibits human CETP. Bonin et al. (J. Peptide Res., 51,
216-225 (1998)) disclose a decapeptide inhibitor of CETP. A
depspeptide fungal metabolite is disclosed as a CETP inhibitor by
Hedge et al. in Bioorg. Med. Chem. Lett., 8, 1277-80 (1998).
[0026] There have been several reports of non-peptidic compounds
that act as CETP inhibitors. Barrett et al. (J. Am. Chem. Soc.,
188, 7863-63 (1996)) describe cyclopropane-containing CETP
inhibitors. Further cyclopropane-containing CETP inhibitors are
described by Kuo et al. (J. Am. Chem. Soc., 117, 10629-34 (1995)).
Pietzonka et al. (Bioorg. Med. Chem. Lett., 6, 1951-54 (1996))
describe phosphonate-containing analogs of cholesteryl ester as
CETP inhibitors. Coval et al. (Bioorg. Med. Chem. Lett., 5, 605-610
(1995)) describe Wiedendiol-A and -B. and related sesquiterpene
compounds as CETP inhibitors. Lee et al. (J. Antibiotics, 49,
693-96 (1996)) describe CETP inhibitors derived from an insect
fungus. Busch et al. (Lipids, 25, 216-220, (1990)) describe
cholesteryl acetyl bromide as a CETP inhibitor. Morton and
Zilversmit (J. Lipid Res., 35, 836-47 (1982)) describe that
p-chloromercuriphenyl sulfonate, p-hydroxymercuribenzoate and ethyl
mercurithiosalicylate inhibit CETP. Connolly et al. (Biochem.
Biophys. Res. Comm., 223, 42-47 (1996)) describe other cysteine
modification reagents as CETP inhibitors. Xia et al. describe
1,3,5-triazines as CETP inhibitors (Bioorg. Med. Chem. Lett., 6,
919-22 (1996)). Bisgaier et al. (Lipids, 29, 811-8 (1994)) describe
4-phenyl-5-tridecyl-4H-1,2,4-triazole-thiol as a CETP inhibitor.
Additional triazole CETP inhibitors are described in U.S. patent
application Ser. No. 09/153,360, herein incorporated by reference.
Sikorski et al. disclosed further novel CETP inhibitors in PCT
Patent Application No. WO 9914204.
[0027] Substituted 2-mercaptoaniline amide compounds can be used as
CETP inhibitors and such therapeutic compounds are described by H.
Shinkai et al. in PCT Patent Application No. WO 98/35937.
[0028] Some substituted heteroalkylamine compounds are known as
CETP inhibitors. In European Patent Application No. 796846, Schmidt
et al. describe 2-aryl-substituted pyridines as cholesterol ester
transfer protein inhibitors useful as cardiovascular agents. One
substituent at C.sub.3 of the pyridine ring can be an hydroxyalkyl
group. In European Patent Application No. 801060, Dow and Wright
describe heterocyclic derivatives substituted with an aldehyde
addition product of an alkylamine to afford 1-hydroxy-1-amines.
These are reported to be .beta.3-adrenergic receptor agonists
useful for treating diabetes and other disorders. In Great Britain
Patent Application No. 2305665, Fisher et al. disclose 3-agonist
secondary amino alcohol substituted pyridine derivatives useful for
treating several disorders including cholesterol levels and
atherosclerotic diseases. In European Patent Application No. 818448
(herein incorporated by reference), Schmidt et al. describe
tetrahydroquinoline derivatives as cholesterol ester transfer
protein inhibitors. European Patent Application No. 818197, Schmek
et al. describe pyridines with fused heterocycles as cholesterol
ester transfer protein inhibitors. Brandes et al. in German Patent
Application No. 19627430 describe bicyclic condensed pyridine
derivatives as cholesterol ester transfer protein inhibitors. In
PCT Patent Application No. WO 9839299, Muller-Gliemann et al.
describe quinoline derivatives as cholesteryl ester transfer
protein inhibitors.
[0029] Polycyclic compounds that are useful as CETP inhibitors are
also disclosed by A. Oomura et al. in Japanese Patent No. 10287662.
For example, therapeutic compounds having the structures C-1 and
C-8 were prepared by culturing Penicillium spp.
[0030] Cycloalkylpyridines useful as CETP inhibitors are disclosed
by Schmidt et al. in European Patent No. EP 818448. For example,
the therapeutic compound having the structure C-9 is disclosed as
being particularly effective as a CETP inhibitor.
[0031] Substituted tetrahydronaphthalene compounds useful as CETP
inhibitors are described in PCT Patent Application No. WO 9914174.
Specifically described in that disclosure as a useful CETP
inhibitor is
(8S)-3-cyclopentyl-1-(4-fluorophenyl)-2-[(S)-fluoro(4-trifluoromethylphen-
yl)methyl]-8-hydroxy-6-spirocclobutyl-5,6,7,8-tetrahydronaphthalene.
[0032] Some 4-heteroaryl-tetrahydroquinolines useful as CETP
inhibitors are described in PCT Patent Application No. WO 9914215.
For example, that disclosure describes
3-(4-trifluoromethylbenzoyl)-5,6,7,8-tetrahydroquino- lin-5-one as
a useful CETP inhibitor.
[0033] Some combination therapies for the treatment of
cardiovascular disease have been described in the literature.
Combinations of IBAT inhibitors with HMG CoA reductase inhibitors
useful for the treatment of cardiovascular disease are disclosed in
U.S. patent application Ser. No. 09/037,308.
[0034] A combination therapy of fluvastatin and niceritrol is
described by J. Sasaki et al. (Id.). Those researchers conclude
that the combination of fluvastatin with niceritrol "at a dose of
750 mg/day dose does not appear to augment or attenuate beneficial
effects of fluvastatin."
[0035] L. Cashin-Hemphill et al. (J. Am. Med. Assoc., 264 (23),
3013-17 (1990)) describe beneficial effects of a combination
therapy of colestipol and niacin on coronary atherosclerosis. The
described effects include nonprogression and regression in native
coronary artery lesions.
[0036] A combination therapy of acipimox and simvastatin shows
beneficial HDL effects in patients having high triglyceride levels
(N. Hoogerbrugge et al., J. Internal Med., 241, 151-55 (1997)).
[0037] Sitostanol ester margarine and pravastatin combination
therapy is described by H. Gylling et al. (J. Lipid Res., 37,
1776-85 (1996)). That therapy is reported to simultaneously inhibit
cholesterol absorption and lower LDL cholesterol significantly in
non-insulin-dependent diabetic men.
[0038] Brown et al. (New Eng. J. Med., 323 (19), 1289-1339 (1990))
describe a combination therapy of lovastatin and colestipol which
reduces atherosclerotic lesion progression and increase lesion
regression relative to lovastatin alone.
[0039] A combination therapy of an apoB secretion inhibitor with a
CETP inhibitor was disclosed by Chang et al. in PCT Patent
Application No. WO 9823593.
[0040] Buch et al. (PCT Patent Application No. WO 9911263) describe
a combination therapy comprising amlodipine and a statin compound
for treating subjects suffering from angina pectoris,
atherosclerosis, combined hypertension and hyperlipidemia, and to
treat symptoms of cardiac arrest. Buch et al. describe in PCT
Patent Application No. WO 9911259 a combination therapy comprising
amlodipine and atorvastatin.
[0041] Scott et al. (PCT Patent Application No. WO 9911260)
describe a combination therapy comprising atorvastatin and an
antihypertensive agent.
[0042] Dettmar and Gibson (UK Patent Application No. GB 2329334 A)
claim a therapeutic composition useful for reducing plasma low
density lipoprotein and cholesterol levels, wherein the composition
comprises an HMG CoA reductase inhibitor and a bile complexing
agent.
[0043] The above references show continuing need to find safe,
effective agents for the prophylaxis or treatment of cardiovascular
diseases.
SUMMARY OF THE INVENTION
[0044] To address the continuing need to find safe and effective
agents for the prophylaxis and treatment of cardiovascular
diseases, combination therapies of cardiovascular drugs are now
reported.
[0045] Among its several embodiments, the present invention
provides a combination therapy comprising the use of a first amount
of an IBAT inhibitor and a second amount of another cardiovascular
therapeutic useful in the prophylaxis or treatment of
hyperlipidemia, atherosclerosis, or hypercholesterolemia, wherein
said first and second amounts together comprise an
anti-hyperlipidemic condition effective amount, an
anti-atherosclerotic condition effective amount, or an
anti-hypercholesterolemic condition effective amount of the
compounds. For example one of the many embodiments of the present
invention is a combination therapy comprising therapeutic dosages
of an IBAT inhibitor and a CETP inhibitor. A preferred embodiment
of the present invention is a combination therapy comprising
therapeutic dosages of a benzothiepine IBAT inhibitor and a CETP
inhibitor.
[0046] A further embodiment of the instant invention comprises the
use of any of the cardiovascular combination therapies described
herein for the prophylaxis or treatment of hypercholesterolemia,
atherosclerosis, or hyperlipidemia. Therefore, in one embodiment
the present invention provides a method for the prophylaxis or
treatment of a hyperlipidemic condition comprising administering to
a patient in need thereof a combination in unit dosage form wherein
the combination comprises a first amount of an ileal bile acid
transport inhibiting compound and a second amount of a CETP
inhibiting compound wherein the first amount and the second amount
together comprise an anti-hyperlipidemic condition effective amount
of the compounds.
[0047] In another embodiment, the present invention provides a
method for the prophylaxis or treatment of an atherosclerotic
condition comprising administering to a patient in need thereof a
combination in unit dosage form wherein the combination comprises a
first amount of an ileal bile acid transport inhibiting compound
and a second amount of a CETP inhibiting compound wherein the first
amount and the second amount together comprise an
anti-atherosclerotic condition effective amount of the
compounds.
[0048] In still another embodiment, the present invention provides
method for the prophylaxis or treatment of hypercholesterolemia
comprising administering to a patient in need thereof a combination
in unit dosage form wherein the combination comprises a first
amount of an ileal bile acid transport inhibiting compound and a
second amount of a CETP inhibiting compound wherein the first
amount and the second amount together comprise an
anti-hypercholesterolemic condition effective amount of the
compounds.
[0049] Further scope of the applicability of the present invention
will become apparent from the detailed description provided below.
However, it should be understood that the following detailed
description and examples, while indicating preferred embodiments of
the invention, are given by way of illustration only since various
changes and modifications within the spirit and scope of the
invention will become apparent to those skilled in the art from
this detailed description.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0050] The following detailed description is provided to aid those
skilled in the art in practicing the present invention. Even so,
this detailed description should not be construed to unduly limit
the present invention as modifications and variations in the
embodiments discussed herein can be made by those of ordinary skill
in the art without departing from the spirit or scope of the
present inventive discovery.
[0051] The contents of each of the references cited herein,
including the contents of the references cited within these primary
references, are herein incorporated by reference in their
entirety.
[0052] a. Definitions
[0053] The following definitions are provided in order to aid the
reader in understanding the detailed description of the present
invention:
[0054] "Ileal bile acid transporter" or "IBAT" is synonymous with
apical sodium co-dependent bile acid transporter, or ASBT.
[0055] "Benzothiepine IBAT inhibitor" means an ileal bile acid
transport inhibitor which comprises a therapeutic compound
comprising a 2,3,4,5-tetrahydro-1-benzothiepine 1,1-dioxide
structure.
[0056] As used herein the term "CETP inhibitor" or "CETP inhibiting
compound" means any therapeutic compound derived from chemical or
biological sources which inhibits cholesteryl ester transfer
protein activity.
[0057] "Combination therapy" means the administration of two or
more therapeutic agents to treat a hyperlipidemic condition, for
example atherosclerosis and hypercholesterolemia. Such
administration encompasses co-administration of these therapeutic
agents in a substantially simultaneous manner, such as in a single
dosage form having a fixed ratio of active ingredients or in
multiple, separate dosage forms for each inhibitor agent. In
addition, such administration also encompasses use of each type of
therapeutic agent in a sequential manner. In either case, the
treatment regimen will provide beneficial effects of the drug
combination in treating the hyperlipidemic condition.
[0058] The phrase "therapeutically effective" is intended to
qualify the combined amount of inhibitors in the combination
therapy. This combined amount will achieve the goal of reducing or
eliminating the hyperlipidemic condition.
[0059] "Therapeutic compound" means a compound useful in the
prophylaxis or treatment of a hyperlipidemic condition, including
atherosclerosis and hypercholesterolemia.
[0060] b. Combinations
[0061] The combinations of the present invention will have a number
of uses. For example, through dosage adjustment and medical
monitoring, the individual dosages of the therapeutic compounds
used in the combinations of the present invention will be lower
than are typical for dosages of the therapeutic compounds when used
in monotherapy. The dosage lowering will provide advantages
including reduction of side effects of the individual therapeutic
compounds when compared to the monotherapy. In addition, fewer side
effects of the combination therapy compared with the monotherapies
will lead to greater patient compliance with therapy regimens.
[0062] Another use of the present invention will be in combinations
having complementary effects or complementary modes of action. For
example, IBAT inhibitors control blood serum cholesterol levels by
inhibiting the reabsorption of bile acids in the ileum. In
contrast, CETP inhibitors inhibit the movement of cholesteryl
esters and triglycerides between the various lipoproteins in the
blood.
[0063] Compounds useful in the present invention encompass a wide
range of therapeutic compounds. Some IBAT inhibitors useful in the
present invention are disclosed in patent application no.
PCT/US95/10863, herein incorporated by reference. More IBAT
inhibitors are described in PCT/US97/04076, herein incorporated by
reference. Still further IBAT inhibitors useful in the present
invention are described in U.S. application Ser. No. 08/816,065,
herein incorporated by reference. More IBAT inhibitor compounds
useful in the present invention are described in WO 98/40375,
herein incorporated by reference. Additional IBAT inhibitor
compounds useful in the present invention are described in U.S.
application Ser. No. 08/816,065, herein incorporated by reference.
Further IBAT inhibiting compounds useful in the present invention
are disclosed in U.S. Pat. No. 5,994,391, herein incorporated by
reference. IBAT inhibitors of particular interest in the present
invention include those shown in Table 1, as well as the
diastereomers, enantiomers, racemates, salts, and tautomers of the
IBAT inhibitors of Table 1.
1TABLE 1 Compound Number Structure B-1 4 B-2 5
(3R,5R)-3-butyl-3-ethyl-2,3,4,5-tetrahydro-
7,8-dimethoxy-5-phenyl-1-4-benzothiazepine 1,1-dioxide B-3 6 B-4 7
B-5 8 B-6 9 B-7 10 B-8 11 B-9 12 B-10 13 B-11 14 B-12 15 B-13 16
B-14 17 B-15 18 B-16 19 B-17 20 B-18 21 B-19 22 B-20 23 B-21 24
B-22 25 B-23 26 B-24 27 B-25 28 B-26 29 B-27 30 B-28 31 B-29 32
B-30 33 B-31 34 B-32 35 B-33 36 B-34 37 B-35 38 B-36 39 B-37 40
B-38 41 B-39 42
[0064] Some individual CETP inhibitor compounds useful in the
present invention are separately described in the following
individual patent applications, each of which is individually
herein incorporated by reference.
[0065] R9. U.S. Patent Application Serial No. 60/101,661.
[0066] R10. U.S. Patent Application Serial No. 60/101,711.
[0067] R11. U.S. Patent Application Serial No. 60/101,660.
[0068] R12. U.S. Patent Application Serial No. 60/101,664.
[0069] R13. U.S. Patent Application Serial No. 60/101,668.
[0070] R14. U.S. Patent Application Serial No. 60/101,662.
[0071] R15. U.S. Patent Application Serial No. 60/101,663.
[0072] R16. U.S. Patent Application Serial No. 60/101,669.
[0073] R17. U.S. Patent Application Serial No. 60/101,667.
[0074] R18. U.S. patent application Ser. No. 09/401,916.
[0075] R19. U.S. patent application Ser. No. 09/405,524.
[0076] R20. U.S. patent application Ser. No. 09/404,638.
[0077] R21. U.S. patent application Ser. No. 09/404,638.
[0078] R22. U.S. patent application Ser. No. 09/400,915.
[0079] R23. U.S. Pat. No. 5,932,587.
[0080] R24. U.S. Pat. No. 5,925,645.
[0081] CETP inhibitor compounds of particular interest in the
present invention include those shown in Table 2, as well as the
diastereomers, enantiomers, racemates, salts, and tautomers of the
CETP inhibitors of Table 2.
2TABLE 2 Compound Number Structure C-1 43 C-2 44 C-3 45 C-4 46 C-5
47 C-6 48 C-7 49 C-8 50 C-9 51 C-10 52 C-11 53 C-12 54 C-13 55 C-14
56 C-15 57 C-16 58 C-17 59 C-18 60 C-19 61 C-20 62
[0082] The compounds (for example, ileal bile acid transport
inhibiting compounds or CETP inhibiting compounds) useful in the
present invention can have no asymmetric carbon atoms, or,
alternatively, the useful compounds can have one or more asymmetric
carbon atoms. When the useful compounds have one or more asymmetric
carbon atoms, they therefore include racemates and stereoisomers,
such as diastereomers and enantiomers, in both pure form and in
admixture. Such stereoisomers can be prepared using conventional
techniques, for example by reacting enantiomeric starting
materials, or by separating isomers of compounds of the present
invention.
[0083] Isomers may include geometric isomers, for example
cis-isomers or trans-isomers across a double bond. All such isomers
are contemplated among the compounds useful in the present
invention.
[0084] The compounds useful in the present invention also include
tautomers.
[0085] The compounds useful in the present invention as discussed
below include their salts, solvates and prodrugs.
Dosages, Formulations, and Routes of Administration
[0086] The compositions of the present invention can be
administered for the prophylaxis or treatment of hyperlipidemic
diseases or conditions by any means, preferably oral, that produce
contact of these compounds with their site of action in the body,
for example in the ileum, the plasma, or the liver of a mammal,
e.g., a human.
[0087] For the prophylaxis or treatment of the conditions referred
to above, the compounds useful in the compositions and methods of
the present invention can be used as the compound per se.
Pharmaceutically acceptable salts are particularly suitable for
medical applications because of their greater aqueous solubility
relative to the parent compound. Such salts must clearly have a
pharmaceutically acceptable anion or cation. Suitable
pharmaceutically acceptable acid addition salts of the compounds of
the present invention when possible include those derived from
inorganic acids, such as hydrochloric, hydrobromic, phosphoric,
metaphosphoric, nitric, sulfonic, and sulfuric acids, and organic
acids such as acetic, benzenesulfonic, benzoic, citric,
ethanesulfonic, fumaric, gluconic, glycolic, isothionic, lactic,
lactobionic, maleic, malic, methanesulfonic, succinic,
toluenesulfonic, tartaric, and trifluoroacetic acids. The chloride
salt is particularly preferred for medical purposes. Suitable
pharmaceutically acceptable base salts include ammonium salts,
alkali metal salts such as sodium and potassium salts, and alkaline
earth salts such as magnesium and calcium salts.
[0088] The anions useful in the present invention are, of course,
also required to be pharmaceutically acceptable and are also
selected from the above list.
[0089] The compounds useful in the present invention can be
presented with an acceptable carrier in the form of a
pharmaceutical composition. The carrier must, of course, be
acceptable in the sense of being compatible with the other
ingredients of the composition and must not be deleterious to the
recipient. The carrier can be a solid or a liquid, or both, and is
preferably formulated with the compound as a unit-dose composition,
for example, a tablet, which can contain from 0.05% to 95% by
weight of the active compound. Other pharmacologically active
substances can also be present, including other compounds of the
present invention. The pharmaceutical compositions of the invention
can be prepared by any of the well known techniques of pharmacy,
consisting essentially of admixing the components.
[0090] Optionally, the combination of the present invention can
comprise a composition comprising an ileal bile acid transport
inhibiting compound and a CETP inhibiting compound. In such a
composition, the ileal bile acid transport inhibiting compound and
the CETP inhibiting compound can be present in a single dosage
form, for example a pill, a capsule, or a liquid which contains
both of the compounds.
[0091] These compounds can be administered by any conventional
means available for use in conjunction with pharmaceuticals, either
as individual therapeutic compounds or as a combination of
therapeutic compounds.
[0092] The amount of compound which is required to achieve the
desired biological effect will, of course, depend on a number of
factors such as the specific compound chosen, the use for which it
is intended, the mode of administration, and the clinical condition
of the recipient.
[0093] In general, a total daily dose of an IBAT inhibitor can be
in the range of from about 0.01 to about 1000 mg/day, preferably
from about 0.1 mg to about 50 mg/day, more preferably from about 1
to about 10 mg/day.
[0094] For a CETP inhibitor, a daily dose of about 0.01 to about
100 mg/kg body weight/day, and preferably between about 0.5 to
about 20 mg/kg body weight/day, may generally be appropriate.
[0095] The daily doses described in the preceding paragraphs for
the various therapeutic compounds can be administered to the
patient in a single dose, or in proportionate multiple subdoses.
Subdoses can be administered 2 to 6 times per day. Doses can be in
sustained release form effective to obtain desired results.
[0096] In the case of pharmaceutically acceptable salts, the
weights indicated above refer to the weight of the acid equivalent
or the base equivalent of the therapeutic compound derived from the
salt.
[0097] Oral delivery of the combinations of the present invention
can include formulations, as are well known in the art, to provide
prolonged or sustained delivery of the drug to the gastrointestinal
tract by any number of mechanisms. These include, but are not
limited to, pH sensitive release from the dosage form based on the
changing pH of the small intestine, slow erosion of a tablet or
capsule, retention in the stomach based on the physical properties
of the formulation, bioadhesion of the dosage form to the mucosal
lining of the intestinal tract, or enzymatic release of the active
drug from the dosage form. For some of the therapeutic compounds
useful in the present invention (e.g., IBAT inhibitors or CETP
inhibitors), the intended effect is to extend the time period over
which the active drug molecule is delivered to the site of action
(e.g., the ileum) by manipulation of the dosage form. Thus,
enteric-coated and enteric-coated controlled release formulations
are within the scope of the present invention. Suitable enteric
coatings include cellulose acetate phthalate, polyvinylacetate
phthalate, hydroxypropylmethylcellulose phthalate and anionic
polymers of methacrylic acid and methacrylic acid methyl ester.
[0098] The combinations of the present invention can be delivered
orally either in a solid, in a semi-solid, or in a liquid form.
When in a liquid or in a semi-solid form, the combinations of the
present invention can, for example, be in the form of a liquid,
syrup, or contained in a gel capsule (e.g., a gel cap). In one
embodiment, when an IBAT inhibitor is used in a combination of the
present invention, the IBAT inhibitor can be provided in the form
of a liquid, syrup, or contained in a gel capsule. In another
embodiment, when a CETP inhibitor is used in a combination of the
present invention, the CETP inhibitor can be provided in the form
of a liquid, syrup, or contained in a gel capsule.
[0099] The dose of any of these therapeutic compounds can be
conveniently administered as an infusion of from about 10 ng/kg
body weight to about 100 ng/kg body weight per minute. Infusion
fluids suitable for this purpose can contain, for example, from
about 0.1 ng to about 10 mg, preferably from about 1 ng to about 10
mg per milliliter. Unit doses can contain, for example, from about
1 mg to about 10 g of the compound of the present invention. Thus,
ampoules for injection can contain, for example, from about 1 mg to
about 100 mg.
[0100] Pharmaceutical compositions according to the present
invention include those suitable for oral, rectal, topical, buccal
(e.g., sublingual), and parenteral (e.g., subcutaneous,
intramuscular, intradermal, or intravenous) administration,
although the most suitable route in any given case will depend on
the nature and severity of the condition being treated and on the
nature of the particular compound which is being used. In most
cases, the preferred route of administration is oral.
[0101] Pharmaceutical compositions suitable for oral administration
can be presented in discrete units, such as capsules, cachets,
lozenges, or tablets, each containing a predetermined amount of at
least one therapeutic compound useful in the present invention; as
a powder or granules; as a solution or a suspension in an aqueous
or non-aqueous liquid; or as an oil-in-water or water-in-oil
emulsion. As indicated, such compositions can be prepared by any
suitable method of pharmacy which includes the step of bringing
into association the active compound(s) and the carrier (which can
constitute one or more accessory ingredients). In general, the
compositions are prepared by uniformly and intimately admixing the
active compound with a liquid or finely divided solid carrier, or
both, and then, if necessary, shaping the product. For example, a
tablet can be prepared by compressing or molding a powder or
granules of the compound, optionally with one or more assessory
ingredients. Compressed tablets can be prepared by compressing, in
a suitable machine, the compound in a free-flowing form, such as a
powder or granules optionally mixed with a binder, lubricant, inert
diluent and/or surface active/dispersing agent(s). Molded tablets
can be made by molding, in a suitable machine, the powdered
compound moistened with an inert liquid diluent.
[0102] Pharmaceutical compositions suitable for buccal (sublingual)
administration include lozenges comprising a compound of the
present invention in a flavored base, usually sucrose, and acacia
or tragacanth, and pastilles comprising the compound in an inert
base such as gelatin and glycerin or sucrose and acacia.
[0103] Pharmaceutical compositions suitable for parenteral
administration conveniently comprise sterile aqueous preparations
of a compound of the present invention. These preparations are
preferably administered intravenously, although administration can
also be effected by means of subcutaneous, intramuscular, or
intradermal injection. Such preparations can conveniently be
prepared by admixing the compound with water and rendering the
resulting solution sterile and isotonic with the blood. Injectable
compositions according to the invention will generally contain from
0.1 to 5% w/w of a compound disclosed herein.
[0104] Pharmaceutical compositions suitable for rectal
administration are preferably presented as unit-dose suppositories.
These can be prepared by admixing a compound of the present
invention with one or more conventional solid carriers, for
example, cocoa butter, and then shaping the resulting mixture.
[0105] Pharmaceutical compositions suitable for topical application
to the skin preferably take the form of an ointment, cream, lotion,
paste, gel, spray, aerosol, or oil. Carriers which can be used
include petroleum jelly (e.g., Vaseline), lanolin, polyethylene
glycols, alcohols, and combinations of two or more thereof. The
active compound is generally present at a concentration of from 0.1
to 50% w/w of the composition, for example, from 0.5 to 2%.
[0106] Transdermal administration is also possible. Pharmaceutical
compositions suitable for transdermal administration can be
presented as discrete patches adapted to remain in intimate contact
with the epidermis of the recipient for a prolonged period of time.
Such patches suitably contain a compound of the present invention
in an optionally buffered, aqueous solution, dissolved and/or
dispersed in an adhesive, or dispersed in a polymer. A suitable
concentration of the active compound is about 1% to 35%, preferably
about 3% to 15%. As one particular possibility, the compound can be
delivered from the patch by electrotransport or iontophoresis, for
example, as described in Pharmaceutical Research, 3(6), 318
(1986).
[0107] In any case, the amount of active ingredient that can be
combined with carrier materials to produce a single dosage form to
be administered will vary depending upon the host treated and the
particular mode of administration.
[0108] The solid dosage forms-for oral administration including
capsules, tablets, pills, powders, gel caps, and granules noted
above comprise one or more compounds useful in the present
invention admixed with at least one inert diluent such as sucrose,
lactose, or starch. Such dosage forms may also comprise, as in
normal practice, additional substances other than inert diluents,
e.g., lubricating agents such as magnesium stearate or solubilizing
agents such as cyclodextrins. In the case of capsules, tablets,
powders, granules, gel caps, and pills, the dosage forms may also
comprise buffering agents. Tablets and pills can additionally be
prepared with enteric coatings.
[0109] Liquid dosage forms for oral administration can include
pharmaceutically acceptable emulsions, solutions, suspensions,
syrups, and elixirs containing inert diluents commonly used in the
art, such as water. Such compositions may also comprise adjuvants,
such as wetting agents, emulsifying and suspending agents, and
sweetening, flavoring, and perfuming agents.
[0110] Injectable preparations, for example, sterile injectable
aqueous or oleaginous suspensions may be formulated according to
the known art using suitable dispersing or setting agents and
suspending agents. The sterile injectable preparation may also be a
sterile injectable solution or suspension in a nontoxic
parenterally acceptable diluent or solvent, for example, as a
solution in 1,3-butanediol. Among the acceptable vehicles and
solvents that may be employed are water, Ringer's solution, and
isotonic sodium chloride solution. In addition, sterile, fixed oils
are conventionally employed as a solvent or suspending medium. For
this purpose any bland fixed oil may be employed including
synthetic mono- or diglycerides. In addition, fatty acids such as
oleic acid find use in the preparation of injectables.
[0111] Pharmaceutically acceptable carriers encompass all the
foregoing and the like.
[0112] In combination therapy, administration of two or more of the
therapeutic agents useful in the present invention may take place
sequentially in separate formulations, or may be accomplished by
simultaneous administration in a single formulation or separate
formulations. Administration may be accomplished by oral route, or
by intravenous, intramuscular, or subcutaneous injections. The
formulation may be in the form of a bolus, or in the form of
aqueous or non-aqueous isotonic sterile injection solutions or
suspensions. These solutions and suspensions may be prepared from
sterile powders or granules having one or more
pharmaceutically-acceptable carriers or diluents, or a binder such
as gelatin or hydroxypropylmethyl cellulose, together with one or
more of a lubricant, preservative, surface active or dispersing
agent.
[0113] For oral administration, the pharmaceutical composition may
be in the form of, for example, a tablet, capsule, suspension, or
liquid. Capsules, tablets, etc., can be prepared by conventional
methods well known in the art. The pharmaceutical composition is
preferably made in the form of a dosage unit containing a
particular amount of the active ingredient or ingredients. Examples
of dosage units are tablets or capsules. These may with advantage
contain one or more therapeutic compound in an amount described
above. For example, in the case of an IBAT inhibitor, the dose
range may be from about 0.01 mg/day to about 500 mg/day or any
other dose, dependent upon the specific inhibitor, as is known in
the art. In the case of an bile acid sequestrant the dose range can
be from about 1,000 mg/day to about 30,000 mg/day or any other
dose, dependent upon the specific bile acid sequestrant, as is
known in the art.
[0114] The active ingredients may also be administered by injection
as a composition wherein, for example, saline, dextrose, or water
may be used as a suitable carrier. A suitable daily dose of each
active therapeutic compound is one that achieves the same blood
serum level as produced by oral administration as described
above.
[0115] The therapeutic compounds may further be administered by any
combination of oral/oral, oral/parenteral, or parenteral/parenteral
route.
[0116] Pharmaceutical compositions for use in the treatment methods
of the present invention may be administered in oral form or by
intravenous administration. Oral administration of the combination
therapy is preferred. Dosing for oral administration may be with a
regimen calling for single daily dose, or for a single dose every
other day, or for multiple, spaced doses throughout the day. The
therapeutic compounds which make up the combination therapy may be
administered simultaneously, either in a combined dosage form or in
separate dosage forms intended for substantially simultaneous oral
administration. The therapeutic compounds which make up the
combination therapy may also be administered sequentially, with
either therapeutic compound being administered by a regimen calling
for two-step ingestion. Thus, a regimen may call for sequential
administration of the therapeutic compounds with spaced-apart
ingestion of the separate, active agents. The time period between
the multiple ingestion steps may range from a few minutes to
several hours, depending upon the properties of each therapeutic
compound such as potency, solubility, bioavailability, plasma
half-life and kinetic profile of the therapeutic compound, as well
as depending upon the effect of food ingestion and the age and
condition of the patient. Circadian variation of the target
molecule concentration may also determine the optimal dose
interval. The therapeutic compounds of the combined therapy whether
administered simultaneously, substantially simultaneously, or
sequentially, may involve a regimen calling for administration of
one therapeutic compound by oral route and another therapeutic
compound by intravenous route. Whether the therapeutic compounds of
the combined therapy are administered by oral or intravenous route,
separately or together, each such therapeutic compound will be
contained in a suitable pharmaceutical formulation of
pharmaceutically-acceptable excipients, diluents or other
formulations components. Examples of suitable
pharmaceutically-acceptable formulations containing the therapeutic
compounds for oral administration are given above.
Treatment Regimen
[0117] The dosage regimen to prevent, give relief from, or
ameliorate a disease condition having hyperlipidemia as an element
of the disease, e.g., atherosclerosis, or to protect against or
treat further high cholesterol plasma or blood levels with the
compounds and/or compositions of the present invention is selected
in accordance with a variety of factors. These include the type,
age, weight, sex, diet, and medical condition of the patient, the
severity of the disease, the route of administration,
pharmacological considerations such as the activity, efficacy,
pharmacokinetics and toxicology profiles of the particular compound
employed, whether a drug delivery system is utilized, and whether
the compound is administered as part of a drug combination. Thus,
the dosage regimen actually employed may vary widely and therefore
deviate from the preferred dosage regimen set forth above.
[0118] Initial treatment of a patient suffering from a
hyperlipidemic condition can begin with the dosages indicated
above. Treatment should generally be continued as necessary over a
period of several weeks to several months or years until the
hyperlipidemic disease condition has been controlled or eliminated.
Patients undergoing treatment with the compounds or compositions
disclosed herein can be routinely monitored by, for example,
measuring serum LDL and total cholesterol levels by any of the
methods well known in the art, to determine the effectiveness of
the combination therapy. Continuous analysis of such data permits
modification of the treatment regimen during therapy so that
optimal effective amounts of each type of therapeutic compound are
administered at any point in time, and so that the duration of
treatment can be determined as well. In this way, the treatment
regimen/dosing schedule can be rationally modified over the course
of therapy so that the lowest amount of the therapeutic compounds
which together exhibit satisfactory effectiveness is administered,
and so that administration is continued only so long as is
necessary to successfully treat the hyperlipidemic condition.
[0119] A potential advantage of the combination therapy disclosed
herein may be reduced dosage amount of of any individual
therapeutic compound, or all therapeutic compounds, effective in
treating hyperlipidemic conditions such as atherosclerosis and
hypercholesterolemia. The dosage lowering will provide advantages
including reduction of side effects of the individual therapeutic
compounds when compared to the monotherapy.
[0120] One of the several embodiments of the present invention
comprises a combination therapy comprising the use of a first
amount of an IBAT inhibitor and a second amount of another
cardiovascular therapeutic useful in the prophylaxis or treatment
of hyperlipidemia, atherosclerosis, or hypercholesterolemia wherein
said first and second amounts together comprise an
anti-hyperlipidemic condition effective amount, an
anti-atherosclerotic condition effective amount, or an
anti-hypercholesterolemic condition effective amount of said
compounds. For example one of the many embodiments of the present
invention is a combination therapy comprising therapeutic dosages
of an IBAT inhibitor and a CETP inhibitor. A preferred embodiment
of the present invention is a combination therapy comprising
therapeutic dosages of a benzothiepine IBAT inhibitor and a CETP
inhibitor.
[0121] The embodiments of the present invention can comprise a
combination therapy using two or more of the therapeutic compounds
described or incorporated herein. The combination therapy can
comprise two or more therapeutic compounds from different classes
of chemistry, e.g., an IBAT inhibitor can be therapeutically
combined with a CETP inhibitor. Therapeutic combinations can
comprise more than two therapeutic compounds. For example, the
therapy can comprise the use of an IBAT inhibitor, a CETP
inhibitor, and a HMG CoA reductase inhibitor. Alternatively, two or
more therapeutic compounds from the same class of chemistry can
comprise the therapy, e.g. a combination therapy comprising two or
more IBAT inhibitors or two or more CETP inhibitors.
[0122] A further embodiment of the instant invention comprises the
use of any of the cardiovascular combination therapies described
herein for the prophylaxis or treatment of hypercholesterolemia,
atherosclerosis, or hyperlipidemia.
[0123] The following non-limiting examples serve to illustrate
various aspects of the present invention.
c. Examples
[0124] Table 3 illustrates examples of some of the many
combinations of the present invention wherein the combination
comprises a first amount of IBAT inhibitor and a second amount of a
CETP inhibitor, wherein said first and second amounts together
comprise an anti-hyperlipidemic condition effective amount, an
anti-atherosclerotic condition effective amount, or an
anti-hypercholesterolemic condition effective amount of said
compounds.
3TABLE 3 Example Number Component 1 Component 2 1 B-1 C-1 2 B-1 C-2
3 B-1 C-3 4 B-1 C-4 5 B-1 C-5 6 B-1 C-6 7 B-1 C-7 8 B-1 C-8 9 B-1
C-9 10 B-1 C-10 11 B-1 C-11 12 B-1 C-12 13 B-1 C-13 14 B-1 C-14 15
B-1 C-15 16 B-1 C-16 17 B-1 C-17 18 B-1 C-18 19 B-1 C-19 20 B-1
C-20 21 B-2 C-1 22 B-2 C-2 23 B-2 C-3 24 B-2 C-4 25 B-2 C-5 26 B-2
C-6 27 B-2 C-7 28 B-2 C-8 29 B-2 C-9 30 B-2 C-10 31 B-2 C-11 32 B-2
C-12 33 B-2 C-13 34 B-2 C-14 35 B-2 C-15 36 B-2 C-16 37 B-2 C-17 38
B-2 C-18 39 B-2 C-19 40 B-2 C-20 41 B-3 C-1 42 B-3 C-2 43 B-3 C-3
44 B-3 C-4 45 B-3 C-5 46 B-3 C-6 47 B-3 C-7 48 B-3 C-8 49 B-3 C-9
50 B-3 C-10 51 B-3 C-11 52 B-3 C-12 53 B-3 C-13 54 B-3 C-14 55 B-3
C-15 56 B-3 C-16 57 B-3 C-17 58 B-3 C-18 59 B-3 C-19 60 B-3 C-20 61
B-4 C-1 62 B-4 C-2 63 B-4 C-3 64 B-4 C-4 65 B-4 C-5 66 B-4 C-6 67
B-4 C-7 68 B-4 C-8 69 B-4 C-9 70 B-4 C-10 71 B-4 C-11 72 B-4 C-12
73 B-4 C-13 74 B-4 C-14 75 B-4 C-15 76 B-4 C-16 77 B-4 C-17 78 B-4
C-18 79 B-4 C-19 80 B-4 C-20 81 B-5 C-1 82 B-5 C-2 83 B-5 C-3 84
B-5 C-4 85 B-5 C-5 86 B-5 C-6 87 B-5 C-7 88 B-5 C-8 89 B-5 C-9 90
B-5 C-10 91 B-5 C-11 92 B-5 C-12 93 B-5 C-13 94 B-5 C-14 95 B-5
C-15 96 B-5 C-16 97 B-5 C-17 98 B-5 C-18 99 B-5 C-19 100 B-5 C-20
101 B-6 C-1 102 B-6 C-2 103 B-6 C-3 104 B-6 C-4 105 B-6 C-5 106 B-6
C-6 107 B-6 C-7 108 B-6 C-8 109 B-6 C-9 110 B-6 C-10 111 B-6 C-11
112 B-6 C-12 113 B-6 C-13 114 B-6 C-14 115 B-6 C-15 116 B-6 C-16
117 B-6 C-17 118 B-6 C-18 119 B-6 C-19 120 B-6 C-20 121 B-7 C-1 122
B-7 C-2 123 B-7 C-3 124 B-7 C-4 125 B-7 C-5 126 B-7 C-6 127 B-7 C-7
128 B-7 C-8 129 B-7 C-9 130 B-7 C-10 131 B-7 C-11 132 B-7 C-12 133
B-7 C-13 134 B-7 C-14 135 B-7 C-15 136 B-7 C-16 137 B-7 C-17 138
B-7 C-18 139 B-7 C-19 140 B-7 C-20 141 B-8 C-1 142 B-8 C-2 143 B-8
C-3 144 B-8 C-4 145 B-8 C-5 146 B-8 C-6 147 B-8 C-7 148 B-8 C-8 149
B-8 C-9 150 B-8 C-10 151 B-8 C-11 152 B-8 C-12 153 B-8 C-13 154 B-8
C-14 155 B-8 C-15 156 B-8 C-16 157 B-8 C-17 158 B-8 C-18 159 B-8
C-19 160 B-8 C-20 161 B-9 C-1 162 B-9 C-2 163 B-9 C-3 164 B-9 C-4
165 B-9 C-5 166 B-9 C-6 167 B-9 C-7 168 B-9 C-8 169 B-9 C-9 170 B-9
C-10 171 B-9 C-11 172 B-9 C-12 173 B-9 C-13 174 B-9 C-14 175 B-9
C-15 176 B-9 C-16 177 B-9 C-17 178 B-9 C-18 179 B-9 C-19 180 B-9
C-20 181 B-10 C-1 182 B-10 C-2 183 B-10 C-3 184 B-10 C-4 185 B-10
C-5 186 B-10 C-6 187 B-10 C-7 188 B-10 C-8 189 B-10 C-9 190 B-10
C-10 191 B-10 C-11 192 B-10 C-12 193 B-10 C-13 194 B-10 C-14 195
B-10 C-15 196 B-10 C-16 197 B-10 C-17 198 B-10 C-18 199 B-10 C-19
200 B-10 C-20 201 B-11 C-1 202 B-11 C-2 203 B-11 C-3 204 B-11 C-4
205 B-11 C-5 206 B-11 C-6 207 B-11 C-7 208 B-11 C-8 209 B-11 C-9
210 B-11 C-10 211 B-11 C-11 212 B-11 C-12 213 B-11 C-13 214 B-11
C-14 215 B-11 C-15 216 B-11 C-16 217 B-11 C-17 218 B-11 C-18 219
B-11 C-19 220 B-11 C-20 221 B-12 C-1 222 B-12 C-2 223 B-12 C-3 224
B-12 C-4 225 B-12 C-5 226 B-12 C-6 227 B-12 C-7 228 B-12 C-8 229
B-12 C-9 230 B-12 C-10 231 B-12 C-11 232 B-12 C-12 233 B-12 C-13
234 B-12 C-14 235 B-12 C-15 236 B-12 C-16 237 B-12 C-17 238 B-12
C-18 239 B-12 C-19 240 B-12 C-20 241 B-13 C-1 242 B-13 C-2 243 B-13
C-3 244 B-13 C-4 245 B-13 C-5 246 B-13 C-6 247 B-13 C-7 248 B-13
C-8 249 B-13 C-9 250 B-13 C-10 251 B-13 C-11 252 B-13 C-12 253 B-13
C-13 254 B-13 C-14 255 B-13 C-15 256 B-13 C-16 257 B-13 C-17 258
B-13 C-18 259 B-13 C-19 260 B-13 C-20 261 B-14 C-1 262 B-14 C-2 263
B-14 C-3 264 B-14 C-4 265 B-14 C-5 266 B-14 C-6 267 B-14 C-7 268
B-14 C-8 269 B-14 C-9 270 B-14 C-10 271 B-14 C-11 272 B-14 C-12 273
B-14 C-13 274 B-14 C-14 275 B-14 C-15 276 B-14 C-16 277 B-14 C-17
278 B-14 C-18 279 B-14 C-19 280 B-14 C-20 281 B-15 C-1 282 B-15 C-2
283 B-15 C-3 284 B-15 C-4 285 B-15 C-5 286 B-15 C-6 287 B-15 C-7
288 B-15 C-8 289 B-15 C-9 290 B-15 C-10 291 B-15 C-11 292 B-15 C-12
293 B-15 C-13 294 B-15 C-14 295 B-15 C-15 296 B-15 C-16 297 B-15
C-17 298 B-15 C-18 299 B-15 C-19 300 B-15 C-20 301 B-16 C-1 302
B-16 C-2 303 B-16 C-3 304 B-16 C-4 305 B-16 C-5 306 B-16 C-6 307
B-16 C-7 308 B-16 C-8 309 B-16 C-9 310 B-16 C-10 311 B-16 C-11 312
B-16 C-12 313 B-16 C-13 314 B-16 C-14 315 B-16 C-15 316 B-16 C-16
317 B-16 C-17 318 B-16 C-18 319 B-16 C-19 320 B-16 C-20 321 B-17
C-1 322 B-17 C-2 323 B-17 C-3 324 B-17 C-4 325 B-17 C-5 326 B-17
C-6 327 B-17 C-7 328 B-17 C-8 329 B-17 C-9 330 B-17 C-10 331 B-17
C-11 332 B-17 C-12 333 B-17 C-13 334 B-17 C-14 335 B-17 C-15 336
B-17 C-16 337 B-17 C-17 338 B-17 C-18 339 B-17 C-19 340 B-17 C-20
341 B-18 C-1 342 B-18 C-2 343 B-18 C-3 344 B-18 C-4 345 B-18 C-5
346 B-18 C-6 347 B-18 C-7 348 B-18 C-8 349 B-18 C-9 350 B-18 C-10
351 B-18 C-11 352 B-18 C-12 353 B-18 C-13 354 B-18 C-14 355 B-18
C-15 356 B-18 C-16 357 B-18 C-17 358 B-18 C-18 359 B-18 C-19 360
B-18 C-20 361 B-19 C-1 362 B-19 C-2 363 B-19 C-3 364 B-19 C-4 365
B-19 C-5 366 B-19 C-6 367 B-19 C-7 368 B-19 C-8 369 B-19 C-9 370
B-19 C-10 371 B-19 C-11 372 B-19 C-12 373 B-19 C-13 374 B-19 C-14
375 B-19 C-15 376 B-19 C-16 377 B-19 C-17 378 B-19 C-18 379 B-19
C-19 380 B-19 C-20 381 B-20 C-1 382 B-20 C-2 383 B-20 C-3 384 B-20
C-4 385 B-20 C-5 386 B-20 C-6 387 B-20 C-7 388 B-20 C-8 389 B-20
C-9 390 B-20 C-10 391 B-20 C-11 392 B-20 C-12 393 B-20 C-13 394
B-20 C-14 395 B-20 C-15 396 B-20 C-16 397 B-20 C-17 398 B-20 C-18
399 B-20 C-19 400 B-20 C-20 401 B-21 C-1 402 B-21 C-2 403 B-21 C-3
404 B-21 C-4 405 B-21 C-5 406 B-21 C-6 407 B-21 C-7 408 B-21 C-8
409 B-21 C-9 410 B-21 C-10 411 B-21 C-11 412 B-21 C-12 413 B-21
C-13 414 B-21 C-14 415 B-21 C-15 416 B-21 C-16 417 B-21 C-17 418
B-21 C-18 419 B-21 C-19 420 B-21 C-20 421 B-22 C-1 422 B-22 C-2 423
B-22 C-3 424 B-22 C-4 425 B-22 C-5 426 B-22 C-6 427 B-22 C-7 428
B-22 C-8 429 B-22 C-9 430 B-22 C-10 431 B-22 C-11 432 B-22 C-12 433
B-22 C-13 434 B-22 C-14 435 B-22 C-15 436 B-22 C-16 437 B-22 C-17
438 B-22 C-18 439 B-22 C-19 440 B-22 C-20 441 B-23 C-1 442 B-23 C-2
443 B-23 C-3 444 B-23 C-4 445 B-23 C-5 446 B-23 C-6 447 B-23 C-7
448 B-23 C-8 449 B-23 C-9 450 B-23 C-10 451 B-23 C-11 452 B-23 C-12
453 B-23 C-13 454 B-23 C-14 455 B-23 C-15 456 B-23 C-16 457 B-23
C-17 458 B-23 C-18 459 B-23 C-19 460 B-23 C-20 461 B-24 C-1 462
B-24 C-2 463 B-24 C-3 464 B-24 C-4 465 B-24 C-5 466 B-24 C-6 467
B-24 C-7 468 B-24 C-8 469 B-24 C-9 470 B-24 C-10 471 B-24 C-11 472
B-24 C-12 473 B-24 C-13 474 B-24 C-14 475 B-24 C-15 476 B-24 C-16
477 B-24 C-17 478 B-24 C-18 479 B-24 C-19 480 B-24 C-20 481 B-25
C-1 482 B-25 C-2 483 B-25 C-3 484 B-25 C-4 485 B-25 C-5 486 B-25
C-6 487 B-25 C-7 488 B-25 C-8 489 B-25 C-9 490 B-25 C-10 491 B-25
C-11 492 B-25 C-12 493 B-25 C-13 494 B-25 C-14 495 B-25 C-15 496
B-25 C-16 497 B-25 C-17 498 B-25 C-18 499 B-25 C-19 500 B-25 C-20
501 B-26 C-1 502 B-26 C-2 503 B-26 C-3 504 B-26 C-4 505 B-26 C-5
506 B-26 C-6 507 B-26 C-7 508 B-26 C-8 509 B-26 C-9 510 B-26 C-10
511 B-26 C-11 512 B-26 C-12 513 B-26 C-13 514 B-26 C-14 515 B-26
C-15 516 B-26 C-16 517 B-26 C-17 518 B-26 C-18 519 B-26 C-19 520
B-26 C-20 521 B-27 C-1 522 B-27 C-2 523 B-27 C-3 524 B-27 C-4 525
B-27 C-5 526 B-27 C-6 527 B-27 C-7 528 B-27 C-8 529 B-27 C-9 530
B-27 C-10 531 B-27 C-11 532 B-27 C-12 533 B-27 C-13 534 B-27 C-14
535 B-27 C-15 536 B-27 C-16 537 B-27 C-17 538 B-27 C-18 539 B-27
C-19 540 B-27 C-20 541 B-28 C-1 542 B-28 C-2 543 B-28 C-3 544 B-28
C-4 545 B-28 C-5 546 B-28 C-6 547 B-28 C-7 548 B-28 C-8 549 B-28
C-9 550 B-28 C-10 551 B-28 C-11 552 B-28 C-12 553 B-28 C-13 554
B-28 C-14 555 B-28 C-15 556 B-28 C-16 557 B-28 C-17 558 B-28 C-18
559 B-28 C-19 560 B-28 C-20 561 B-29 C-1 562 B-29 C-2 563 B-29 C-3
564 B-29 C-4 565 B-29 C-5 566 B-29 C-6 567 B-29 C-7 568 B-29 C-8
569 B-29 C-9 570 B-29 C-10 571 B-29 C-11 572 B-29 C-12 573 B-29
C-13 574 B-29 C-14 575 B-29 C-15 576 B-29 C-16 577 B-29 C-17 578
B-29 C-18 579 B-29 C-19 580 B-29 C-20 581 B-30 C-1 582 B-30 C-2 583
B-30 C-3 584 B-30 C-4 585 B-30 C-5 586 B-30 C-6 587 B-30 C-7 588
B-30 C-8 589 B-30 C-9 590 B-30 C-10 591 B-30 C-11 592 B-30 C-12 593
B-30 C-13 594 B-30 C-14 595 B-30 C-15 596 B-30 C-16 597 B-30 C-17
598 B-30 C-18 599 B-30 C-19 600 B-30 C-20 601 B-31 C-1 602 B-31 C-2
603 B-31 C-3 604 B-31 C-4 605 B-31 C-5 606 B-31 C-6 607 B-31 C-7
608 B-31 C-8 609 B-31 C-9 610 B-31 C-10 611 B-31 C-11 612 B-31 C-12
613 B-31 C-13 614 B-31 C-14 615 B-31 C-15 616 B-31 C-16 617 B-31
C-17 618 B-31 C-18 619 B-31 C-19 620 B-31 C-20 621 B-32 C-1 622
B-32 C-2 623 B-32 C-3 624 B-32 C-4 625 B-32 C-5 626 B-32 C-6 627
B-32 C-7 628 B-32 C-8 629 B-32 C-9 630 B-32 C-10 631 B-32 C-11 632
B-32 C-12 633 B-32 C-13 634 B-32 C-14 635 B-32 C-15 636 B-32 C-16
637 B-32 C-17 638 B-32 C-18 639 B-32 C-19 640 B-32 C-20 641 B-33
C-1 642 B-33 C-2 643 B-33 C-3 644 B-33 C-4 645 B-33 C-5 646 B-33
C-6 647 B-33 C-7 648 B-33 C-8 649 B-33 C-9 650 B-33 C-10 651 B-33
C-11 652 B-33 C-12 653 B-33 C-13 654 B-33 C-14 655 B-33 C-15 656
B-33 C-16 657 B-33 C-17 658 B-33 C-18 659 B-33 C-19 660 B-33 C-20
661 B-34 C-1 662 B-34 C-2 663 B-34 C-3 664 B-34 C-4 665 B-34 C-5
666 B-34 C-6 667 B-34 C-7 668 B-34 C-8 669 B-34 C-9 670 B-34 C-10
671 B-34 C-11 672 B-34 C-12 673 B-34 C-13 674 B-34 C-14 675 B-34
C-15 676 B-34 C-16 677 B-34 C-17 678 B-34 C-18 679 B-34 C-19 680
B-34 C-20 681 B-35 C-1 682 B-35 C-2 683 B-35 C-3 684 B-35 C-4 685
B-35 C-5 686 B-35 C-6 687 B-35 C-7 688 B-35 C-8 689 B-35 C-9 690
B-35 C-10 691 B-35 C-11 692 B-35 C-12 693 B-35 C-13 694 B-35 C-14
695 B-35 C-15 696 B-35 C-16 697 B-35 C-17 698 B-35 C-18 699 B-35
C-19 700 B-35 C-20 701 B-36 C-1 702 B-36 C-2 703 B-36 C-3 704 B-36
C-4 705 B-36 C-5 706 B-36 C-6 707 B-36 C-7 708 B-36 C-8 709 B-36
C-9 710 B-36 C-10 711 B-36 C-11 712 B-36 C-12 713 B-36 C-13 714
B-36 C-14 715 B-36 C-15 716 B-36 C-16 717 B-36 C-17 718 B-36 C-18
719 B-36 C-19 720 B-36 C-20 721 B-37 C-1 722 B-37 C-2 723 B-37 C-3
724 B-37 C-4 725 B-37 C-5 726 B-37 C-6 727 B-37 C-7 728 B-37 C-8
729 B-37 C-9 730 B-37 C-10 731 B-37 C-11 732 B-37 C-12 733 B-37
C-13 734 B-37 C-14 735 B-37 C-15 736 B-37 C-16 737 B-37 C-17 738
B-37 C-18 739 B-37 C-19 740 B-37 C-20 741 B-38 C-1 742 B-38 C-2 743
B-38 C-3 744 B-38 C-4 745 B-38 C-5 746 B-38 C-6 747 B-38 C-7 748
B-38 C-8 749 B-38 C-9 750 B-38 C-10 751 B-38 C-11 752 B-38 C-12 753
B-38 C-13 754 B-38 C-14 755 B-38 C-15 756 B-38 C-16 757 B-38 C-17
758 B-38 C-18 759 B-38 C-19 760 B-38 C-20 761 B-40 C-1 762 B-40 C-2
763 B-40 C-3 764 B-40 C-4 765 B-40 C-5 766 B-40 C-6 767 B-40 C-7
768 B-40 C-8 769 B-40 C-9 770 B-40 C-10 771 B-40 C-11 772 B-40 C-12
773 B-40 C-13 774 B-40 C-14 775 B-40 C-15 776 B-40 C-16 777 B-40
C-17 778 B-40 C-18 779 B-40 C-19 780 B-40 C-20
BIOLOGICAL ASSAYS
[0125] The utility of the combinations of the present invention can
be shown by the following assays. These assays are performed in
vitro and in animal models essentially using procedures recognized
to show the utility of the present invention.
[0126] In Vitro Assay of Compounds That Inhibit IBAT-Mediated
Uptake of [.sup.14C]-Taurocholate (TC) in H14 Cells
[0127] Baby hamster kidney cells (BHK) transfected with the cDNA of
human IBAT (H14 cells) are seeded at 60,000 cells/well in 96 well
Top-Count tissue culture plates for assays run within in 24 hours
of seeding, 30,000 cells/well for assays run within 48 hours, and
10,000 cells/well for assays run within 72 hours.
[0128] On the day of assay, the cell monolayer is gently washed
once with 100 .mu.l assay buffer (Dulbecco's Modified Eagle's
medium with 4.5 g/L glucose+0.2% (w/v) fatty acid free bovine serum
albumin--(FAF)BSA). To each well 50 .mu.l of a two-fold concentrate
of test compound in assay buffer is added along with 50 .mu.l of 6
.mu.M [.sup.14C]-taurocholate in assay buffer (final concentration
of 3 .mu.M [.sup.14C]-taurocholate). The cell culture plates are
incubated 2 hours at 37.degree. C. prior to gently washing each
well twice with 100 .mu.l 4.degree. C. Dulbecco's
phosphate-buffered saline (PBS) containing 0.2% (w/v) (FAF)BSA. The
wells are then gently washed once with 100 .mu.l 4.degree. C. PBS
without (FAF)BSA. To each 200 .mu.l of liquid scintillation
counting fluid is added, the plates are heat sealed and shaken for
30 minutes at room temperature prior to measuring the amount of
radioactivity in each well on a Packard Top-Count instrument.
[0129] In Vitro Assay of Compounds That Inhibit Uptake of
[.sup.14C]-Alanine.
[0130] The alanine uptake assay is performed in an identical
fashion to the taurocholate assay, with the exception that labeled
alanine is substituted for the labeled taurocholate.
[0131] Measurement of Rat Fecal Bile Acid Concentration (FBA)
[0132] Total fecal output from individually housed rats is
collected for 24 or 48 hours, dried under a stream of nitrogen,
pulverized, mixed, and weighed. Approximately 0.1 gram is weighed
out and extracted into an organic solvent (butanol/water).
Following separation and drying, the residue is dissolved in
methanol and the amount of bile acid present is measured
enzymatically using the 3.alpha.-hydroxysteroid steroid
dehydrogenase reaction with bile acids to reduce NAD. (see Mashige,
F. et al. Clin. Chem., 27, 1352 (1981), herein incorporated by
reference).
[0133] Rat Gavage Assay
[0134] Male Wister rats (275-300 g) are to be administered IBAT
inhibitors using an oral gavage procedure. Drug or vehicle (0.2%
TWEEN 80 in water) is administered once a day (9:00-10:0 a.m.) for
4 days at varying dosages in a final volume of 2 mL per kilogram of
body weight. (TWEEN 80 is a 20 molar polyethyleneoxide sorbitan
monooleate surfactant manufactured by ICI Specialty Chemicals,
Wilmington, Del., U.S.A.) Total fecal samples are collected during
the final 48 hours of the treatment period and analyzed for bile
acid content using an enzymatic assay as described below. Compound
efficacy will be determined by comparison of the increase in fecal
bile acid (FBA) concentration in treated rats to the mean FBA
concentration of rats in the vehicle group.
[0135] [.sup.3H]Taurocholate Uptake in Rabbit Brush Border Membrane
Vesicles (BBMV)
[0136] Rabbit Ileal brush border membranes are to be prepared from
frozen ileal mucosa by the calcium precipitation method describe by
Malathi et al. (Biochimica Biophysica Acta, 554, 259 (1979), herein
incorporated by reference). The method for measuring taurocholate
is essentially as described by Kramer et al. (Biochimica Biophysica
Acta, 1111, 93 (1992), herein incorporated by reference) except the
assay volume will be 200 .mu.l instead of 100 .mu.l. Briefly, at
room temperature a 190 .mu.l solution containing 2 .mu.M
[.sup.3H]-taurocholate(0.75 .mu.Ci), 20 mM tris, 100 mM NaCl, 100
mM mannitol pH 7.4 is incubated for 5 sec with 10 .mu.l of brush
border membrane vesicles (60-120 .mu.g protein). The incubation is
initiated by the addition of the BBMV while vortexing and the
reaction is to be stopped by the addition of 5 ml of ice cold
buffer (20 mM Hepes-tris, 150 mM KCl) followed immediately by
filtration through a nylon filter (0.2 .mu.m pore) and an
additional 5 ml wash with stop buffer.
[0137] Measurement of Hepatic Cholesterol Concentration (HEPATIC
CHOL)
[0138] Liver tissue is to be weighed and homogenized in
chloroform:methanol (2:1). After homogenization and centrifugation
the supernatant is separated and dried under nitrogen. The residue
is to be dissolved in isopropanol and the cholesterol content will
be measured enzymatically, using a combination of cholesterol
oxidase and peroxidase, as described by Allain, C. A. et al., Clin.
Chem., 20, 470 (1974) (herein incorporated by reference).
[0139] Measurement of Hepatic HMG CoA-Reductase Activity (HMG
COA)
[0140] Hepatic microsomes are to be prepared by homogenizing liver
samples in a phosphate/sucrose buffer, followed by centrifugal
separation. The final pelleted material is resuspended in buffer
and an aliquot will be assayed for HMG CoA reductase activity by
incubating for 60 minutes at 37.degree. C. in the presence of
.sup.14C-HMG-COA (Dupont-NEN). The reaction is stopped by adding 6N
HCl followed by centrifugation. An aliquot of the supernatant is
separated, by thin-layer chromatography, and the spot corresponding
to the enzyme product is scraped off the plate, extracted and
radioactivity is determined by scintillation counting. (Reference:
Akerlund, J. and Bjorkhem, I. (1990) J. Lipid Res. 31, 2159).
[0141] Measurement of Hepatic Cholesterol 7-.alpha.-Hydroxylase
Activity (7a-OHase)
[0142] Hepatic microsomes are to be prepared by homogenizing liver
samples in a phosphate/sucrose buffer, followed by centrifugal
separation. The final pelleted material is resuspended in buffer
and an aliquot will be assayed for cholesterol
7-.alpha.-hydroxylase activity by incubating for 5 minutes at
37.degree. C. in the presence of NADPH. Following extraction into
petroleum ether, the organic solvent is evaporated and the residue
is dissolved in acetonitrile/methanol. The enzymatic product will
be separated by injecting an aliquot of the extract onto a C.sub.18
reversed phase HPLC column and quantitating the eluted material
using UV detection at 240 nm. (Reference: Horton, J. D., et al.
(1994) J. Clin. Invest. 93, 2084).
[0143] Determination of Serum Cholesterol (SER.CHOL, HDL-CHOL, TGI
and VLDL+LDL)
[0144] Total serum cholesterol (SER.CHOL) are to be measured
enzymatically using a commercial kit from Wako Fine Chemicals
(Richmond, Va.); Cholesterol C11, Catalog No. 276-64909. HDL
cholesterol (HDL-CHOL) will be assayed using this same kit after
precipitation of VLDL and LDL with Sigma Chemical Co. HDL
Cholesterol reagent, Catalog No. 352-3 (dextran sulfate method).
Total serum triglycerides (blanked) (TGI) will be assayed
enzymatically with Sigma Chemical Co. GPO-Trinder, Catalog No.
337-B. VLDL and LDL (VLDL+LDL) cholesterol concentrations will be
calculated as the difference between total and HDL cholesterol.
[0145] Measurement of Hamster Fecal Bile Acid Concentration
(FBA)
[0146] Total fecal output from individually housed hamsters is to
be collected for 24 or 48 hours, dried under a stream of nitrogen,
pulverized and weighed. Approximately 0.1 gram is weighed out and
extracted into an organic solvent (butanol/water). Following
separation and drying, the residue is dissolved in methanol and the
amount of bile acid present is measured enzymatically using the
3.alpha.-hydroxysteroid steroid dehydrogenase reaction with bile
acids to reduce NAD. (Mashige, F. et al. Clin. Chem., 27, 1352
(1981), herein incorporated by reference).
[0147] Dog Model for Evaluating Lipid Lowering Drugs
[0148] Male beagle dogs, obtained from a vendor such as Marshall
farms and weighing 6-12 kg are fed once a day for two hours and
given water ad libitum. Dogs may be randomly assigned to a dosing
groups consisting of 6 to 12 dogs each, such as: vehicle, i.g.; 1
mg/kg, i.g.; 2 mg/kg, i.g.; 4 mg/kg, i.g.; 2 mg/kg, p.o. (powder in
capsule). Intragastric dosing of a therapeutic material dissolved
in aqueous solution (for example, 0.2% Tween 80 solution
[polyoxyethylene mono-oleate, Sigma Chemical Co., St. Louis, Mo.])
may be done using a gavage tube. Prior to initiating dosing, blood
samples may be drawn from the cephalic vein in the morning before
feeding in order to evaluate serum cholesterol (total and HDL) and
triglycerides. For several consecutive days animals are dosed in
the morning, prior to feeding. Animals are to be allowed 2 hours to
eat before any remaining food is removed. Feces are to be collected
over a 2 day period at the end of the study and may be analyzed for
bile acid or lipid content. Blood samples are also to be taken, at
the end of the treatment period, for comparison with pre-study
serum lipid levels. Statistical significance will be determined
using the standard student's T-test with p<0.05.
[0149] Dog Serum Lipid Measurement
[0150] Blood is to be collected from the cephalic vein of fasted
dogs in serum separator tubes (Vacutainer SST, Becton Dickinson and
Co., Franklin Lakes, N.J.). The blood is centrifuged at 2000 rpm
for 20 minutes and the serum decanted.
[0151] Total cholesterol may be measured in a 96 well format using
a Wako enzymatic diagnostic kit (Cholesterol CII) (Wako Chemicals,
Richmond, Va.), utilizing the cholesterol oxidase reaction to
produce hydrogen peroxide which is measured colorimetrically. A
standard curve from 0.5 to 10 .mu.g cholesterol is to be prepared
in the first 2 columns of the plate. The serum samples (20-40
.mu.l, depending on the expected lipid concentration) or known
serum control samples are added to separate wells in duplicate.
Water is added to bring the volume to 100 .mu.l in each well. A 100
.mu.l aliquot of color reagent is added to each well and the plates
will be read at 500 nm after a 15 minute incubation at 37 degrees
centigrade.
[0152] HDL cholesterol may be assayed using Sigma kit No. 352-3
(Sigma Chemical Co., St. Louis, Mo.) which utilizes dextran sulfate
and Mg ions to selectively precipitate LDL and VLDL. A volume of
150 .mu.l of each serum sample is to be added to individual
microfuge tubes, followed by 15 .mu.l of HDL cholesterol reagent
(Sigma 352-3). Samples are to be mixed and centrifuged at 5000 rpm
for 5 minutes. A 50 .mu.l aliquot of the supernatant is to be then
mixed with 200 .mu.l of saline and assayed using the same procedure
as for total cholesterol measurement.
[0153] Triglycerides are to be measured using Sigma kit No. 337 in
a 96 well plate format. This procedure will measure glycerol,
following its release by reaction of triglycerides with lipoprotein
lipase. Standard solutions of glycerol (Sigma 339-11) ranging from
1 to 24 .mu.g are to be used to generate the standard curve. Serum
samples (20-40 .mu.l, depending on the expected lipid
concentration) are added to wells in duplicate. Water is added to
bring the volume to 100 .mu.l in each well and 100 .mu.l of color
reagent is also added to each well. After mixing and a 15 minute
incubation, the plates will be read at 540 nm and the triglyceride
values calculated from the standard curve. A replicate plate is
also to be run using a blank enzyme reagent to correct for any
endogenous glycerol in the serum samples.
[0154] Dog Fecal Bile Acid Measurement
[0155] Fecal samples may be collected to determine the fecal bile
acid (FBA) concentration for each animal. Fecal collections may be
made during the final 48 hours of the study, for two consecutive 24
hour periods between 9:00 am and 10:00 am each day, prior to dosing
and feeding. The separate two day collections from each animal are
to be weighed, combined and homogenized with distilled water in a
processor (Cuisinart) to generate a homogeneous slurry. About 1.4 g
of the homogenate is to be extracted in a final concentration of
50% tertiary butanol/distilled water (2:0.6) for 45 minutes in a
37.degree. C. water bath and centrifuged for 13 minutes at
2000.times.g. The concentration of bile acids (mmoles/day) may be
determined using a 96-well enzymatic assay system (1,2). A 20 .mu.l
aliquot of the fecal extract is to be added to two sets each of
triplicate wells in a 96-well assay plate. A standardized sodium
taurocholate solution and a standardized fecal extract solution
(previously made from pooled samples and characterized for its bile
acid concentration) will also analyzed for assay quality control.
Twenty-microliter aliquots of sodium taurocholate, serially diluted
to generate a standard curve are similarly to be added to two sets
of triplicate wells. A 230 .mu.l reaction mixture containing 1M
hydrazine hydrate, 0.1 M pyrophosphate and 0.46 mg/ml NAD is to be
added to each well. A 50 .mu.l aliquot of 3a-hydroxysteroid
dehydrogenase enzyme (HSD; 0.8 units/ml) or assay buffer (0.1 M
sodium pyrophosphate) are then added to one of the two sets of
triplicates. All reagents may be obtained from Sigma Chemical Co.,
St. Louis, Mo. Following 60 minutes of incubation at room
temperature, the optical density at 340 nm will be measured and the
mean of each set of triplicate samples will be calculated. The
difference in optical density .+-.HSD enzyme is to be used to
determine the bile acid concentration (mM) of each sample based on
the sodium taurocholate standard curve. The bile acid concentration
of the extract, the weight of the fecal homogenate (grams) and the
body weight of the animal are to be used to calculate the
corresponding FBA concentration in mmoles/kg/day for each animal.
The mean FBA concentration (mmoles/kg/day) of the vehicle group is
to be subtracted from the FBA concentration of each treatment group
to determine the increase (delta value) in FBA concentration as a
result of the treatment.
[0156] Plasma Lipids Assay in Rabbits
[0157] Plasma lipids can be assayed using standard methods as
reported by J. R. Schuh et al., J. Clin. Invest., 91, 1453-1458
(1993), herein incorporated by reference. Groups of male, New
Zealand white rabbits are placed on a standard diet (100 g/day)
supplemented with 0.3% cholesterol and 2% corn oil (Zeigler
Bothers, Inc., Gardners, Pa.). Water is available ad lib. Groups of
control and treated animals are killed after 1 and 3 months of
treatment. Tissues are removed for characterization of
atherosclerotic lesions. Blood samples are taken for determination
of plasma lipid concentrations.
[0158] Plasma Lipids
[0159] Plasma for lipid analysis is obtained by withdrawing blood
from the ear vein into EDTA-containing tubes (Vacutainer; Becton
Dickenson & Co., Rutherford, N.J.), followed by centrifugal
separation of the cells. Total cholesterol is determined
enzymatically, using the cholesterol oxidase reaction (C. A. Allain
et al., Clin. Chem., 20, 470-475 (1974), herein incorporated by
reference). HDL cholesterol is also measured enzymatically, after
selective precipitation of LDL and VLDL by dextran sulfate with
magnesium (G. R. Warnick et al., Clin. Chem., 28, 1379-1388 (1982),
herein incorporated by reference). Plasma triglyceride levels are
determined by measuring the amount of glycerol released by
lipoprotein lipase through an enzyme-linked assay (G. Bucolo et
al., Clin. Chem., 19, 476-482 (1973), herein incorporated by
reference).
[0160] Atherosclerosis
[0161] Animals are killed by pentobarbital injection. Thoracic
aortas are rapidly removed, immersion fixed in 10% neutral buffered
formalin, and stained with oil red O (0.3%). After a single
longitudinal incision along the wall opposite the arterial ostia,
the vessels are pinned open for evaluation of the plaque area. The
percent plaque coverage is determined from the values for the total
area examined and the stained area, by threshold analysis using a
true color image analyzer (Videometric 150; American Innovision,
Inc., San Diego, Calif.) interfaced to a color camera (Toshiba
3CCD) mounted on a dissecting microscope. Tissue cholesterol will
be measured enzymatically as described, after extraction with a
chloroform/methanol mixture (2:1) according to the method of Folch
et al. (J. Biol. Chem., 226, 497-509 (1957), herein incorporated by
reference).
[0162] In Vitro Vascular Response
[0163] The abdominal aortas are rapidly excised, after injection of
sodium pentobarbital, and placed in oxygenated Krebs-bicarbonate
buffer. After removal of perivascular tissue, 3-mm ring segments
are cut, placed in a 37.degree. C. muscle bath containing
Krebs-bicarbonate solution, and suspended between two stainless
steel wires, one of which is attached to a force transducer (Grass
Instrument Co., Quincy, Mass.). Force changes in response to
angiotensin II added to the bath will be recorded on a chart
recorder.
[0164] CETP Activity Assay in Human Plasma (Tritiated Cholesteryl
Ester)
[0165] Blood is to be obtained from healthy volunteers. Blood is
collected in tubes containing EDTA (EDTA plasma pool). The EDTA
human plasma pool previously stored at -20.degree. C., is to be
thawed at room temperature, and centrifuged for 5 minutes to remove
any particulate matter. Tritiated HDL, radiolabeled in the
cholesteryl ester moiety ([.sup.3H]CE-HDL) as described by Morton
and Zilversmit (J. Biol. Chem., 256, 11992-95 (1981)), is to be
added to the plasma to a final concentration of (25 .mu.g/ml
cholesterol). Inhibitor compounds are to be added to the plasma as
follows: Equal volumes of the plasma containing the [.sup.3H]CE-HDL
(396 .mu.l) are added by pipette into micro tubes (Titertube.RTM.,
Bio-Rad laboratories, Hercules, Calif.). Compounds, usually
dissolved as 20-50 mM stock solutions in DMSO, are to be serially
diluted in DMSO (or an alternative solvent in some cases, such as
dimethylformamide or ethanol). Four .mu.l of each of the serial
dilutions of inhibitor compounds or DMSO alone are then added to
each of the plasma tubes. The tubes are immediately mixed.
Triplicate aliquots (100 .mu.l) from each plasma tube are then
transferred to wells of 96-well round-bottomed polystyrene
microtiter plates (Corning, Corning, N.Y.). Plates are sealed with
plastic film and incubated at 37.degree. C. for 4 hours. Test wells
are to contain plasma with dilutions of inhibitor compounds.
Control wells are to contain plasma with DMSO alone. Blank wells
are to contain plasma with DMSO alone that are left in the micro
tubes at 4.degree. C. for the 4 hour incubation and are added to
the microtiter wells at the end of the incubation period. VLDL and
LDL are precipitated by the addition of 10 .mu.l of precipitating
reagent (1% (w/v) dextran sulfate (Dextralip50)/0.5 M magnesium
chloride, pH 7.4) to all wells. The wells are mixed on a plate
mixer and then incubated at ambient temperature for 10 min. The
plates are then centrifuged at 1000.times.g for 30 min at
10.degree. C. The supernatants (50 .mu.l) from each well are then
transferred to Picoplate.TM. 96 plate wells (Packard, Meriden,
Conn.) containing 250:1 Microscint.TM.-40 (Packard, Meriden,
Conn.). The plates are heat-sealed (TopSeal.TM.-P, Packard,
Meriden, Conn.) according to the manufacturer's directions and
mixed for 30 min. Radioactivity will be measured on a microplate
scintillation counter (TopCount, Packard, Meriden, Conn.).
IC.sub.50 values will be determined as the concentration of
inhibitor compound inhibiting transfer of [.sup.3H]CE from the
supernatant [.sup.3H]CE-HDL to the precipitated VLDL and LDL by 50%
compared to the transfer obtained in the control wells. The maximum
percentage transfer (in the control wells) will be determined using
the following equation: 1 % Transfer = [ dpm blank - dpm control ]
.times. 100 dpm blank
[0166] The percentage of control transfer determined in the wells
containing inhibitor compounds is determined as follows: 2 %
Control = [ dpm blank - dpm test ] .times. 100 dpm blank - dpm
control
[0167] IC.sub.50 values will be calculated from plots of % control
versus concentration of inhibitor compound.
[0168] CETP Activity In Vitro
[0169] The ability of compounds to inhibit CETP activity are
assessed using an in vitro assay that measures the rate of transfer
of radiolabeled cholesteryl ester ([.sup.3H]CE) from HDL donor
particles to LDL acceptor particles. Details of the assay are
provided by Glenn et al. (Glenn and Melton, "Quantification of
Cholesteryl Ester Transfer Protein (CETP): A) CETP Activity and B)
Immunochemical Assay of CETP Protein," Meth. Enzymol., 263, 339-351
(1996)). CETP can be obtained from the serum-free conditioned
medium of CHO cells transfected with a cDNA for CETP (Wang, S. et
al. J. Biol. Chem. 267, 17487-17490 (1992)). To measure CETP
activity, [.sup.3H]CE-labeled HDL, LDL, CETP and assay buffer (50
mM tris(hydroxymethyl)aminomethane, pH 7.4; 150 mM sodium chloride;
2 mM ethylenediamine-tetraacetic acid; 1% bovine serum albumin) are
incubated in a volume of 200 .mu.l, for 2 hours at 37.degree. C. in
96 well plates. LDL is differentially precipitated by the addition
of 50 .mu.l of 1% (w/v) dextran sulfate/0.5 M magnesium chloride,
mixed by vortex, and incubated at room temperature for 10 minutes.
The solution (200 .mu.l) is transferred to a filter plate
(Millipore). After filtration, the radioactivity present in the
precipitated LDL is measured by liquid scintillation counting.
Correction for non-specific transfer or precipitation is made by
including samples that do not contain CETP. The rate of [.sup.3H]CE
transfer using this assay is linear with respect to time and CETP
concentration, up to 25-30% of [.sup.3H]CE transferred.
[0170] The potency of test compounds can be determined by
performing the above described assay in the presence of varying
concentrations of the test compounds and determining the
concentration required for 50% inhibition of transfer of
[.sup.3H]CE from HDL to LDL. This value is defined as the
IC.sub.50. The IC.sub.50 values determined from this assay are
accurate when the IC.sub.50 is greater than 10 nM. In the case
where compounds have greater inhibitory potency, accurate
measurements of IC.sub.50 may be determined using longer incubation
times (up to 18 hours) and lower final concentrations of CETP
(<50 nM).
[0171] Inhibition of CETP Activity In Vivo.
[0172] Inhibition of CETP activity by a test compound can be
determined by administering the compound to an animal by
intravenous injection or oral gavage, measuring the amount of
transfer of tritium-labeled cholesteryl ester ([.sup.3H]CE) from
HDL to VLDL and LDL particles, and comparing this amount of
transfer with the amount of transfer observed in control
animals.
[0173] Male golden Syrian hamsters are maintained on a diet of chow
containing 0.24% cholesterol for at least two weeks prior to the
study. For animals receiving intravenous dosing, immediately before
the experiment, animals are anesthetized with pentobarbital.
Anesthesia is maintained throughout the experiment. In-dwelling
catheters are inserted into the jugular vein and carotid artery. At
the start of the experiment all animals will receive 0.2 ml of a
solution containing [.sup.3H]CE-HDL into the jugular vein.
[.sup.3H]CE-HDL is a preparation of human HDL containing
tritium-labeled cholesteryl ester, and is prepared according to the
method of Glenn et al. (Meth. Enzymol., 263, 339-351 (1996)). Test
compound is dissolved as a 80 mM stock solution in vehicle (2%
ethanol: 98% PEG 400, Sigma Chemical Company, St. Louis, Mo., USA)
and administered either by bolus injection or by continuous
infusion. Two minutes after the [.sup.3H]CE-HDL dose is
administered, animals receive 0.1 ml of the test solution injected
into the jugular vein. Control animals receive 0.1 ml of the
intravenous vehicle solution without test compound. After 5
minutes, the first blood samples (0.5 ml) are taken from the
carotid artery and collected in standard microtainer tubes
containing ethylenediamine tetraacetic acid. Saline (0.5 ml) is
injected to flush the catheter and replace blood volume. Subsequent
blood samples are taken at two hours and four hours by the same
method. Blood samples are mixed well and kept on ice until the
completion of the experiment. Plasma is obtained by centrifugation
of the blood samples at 4.degree. C. The plasma (50 .mu.l) is
treated with 5 .mu.l of precipitating reagent (dextran sulfate, 10
g/l; 0.5 M magnesium chloride) to remove VLDL/LDL. After
centrifugation, the resulting supernatant (25 .mu.l) containing the
HDL is analyzed for radioactivity using a liquid scintillation
counter.
[0174] The percentage [.sup.3H]CE transferred from HDL to LDL and
VLDL (% transfer) is calculated based on the total radioactivity in
equivalent plasma samples before precipitation. Typically, the
amount of transfer from HDL to LDL and VLDL in control animals is
20% to 35% after 4 hours.
[0175] Alternatively, conscious, non-anesthetized animals can
receive an oral gavage dose of test compound as a suspension in
0.1% methyl cellulose in water. At a time determined for each
compound at which plasma levels of the test substance reach their
peak (C.sub.max) after oral dosing, the animals are anesthetized
with pentobarbital and then dosed with 0.2 ml of a solution
containing [.sup.3H]CE-HDL into the jugular vein as described
above. Control animals receive 0.25 ml of the vehicle solution
without test compound by oral gavage. After 4 hours, the animals
are sacrificed, blood samples are collected, and the percentage
[.sup.3H]CE transferred from HDL to LDL and VLDL (% transfer) is
assayed as described above.
[0176] Alternatively, inhibition of CETP activity by a test
compound can be determined by administering the compound to mice
that have been selected for expression of human CETP (hCETP) by
transgenic manipulation (hCETP mice). Test compounds can be
administered by intravenous injection, or oral gavage and the
amount of transfer of tritium-labeled cholesteryl ester
([.sup.3H]CE) from HDL to VLDL and LDL particles is determined, and
compared to the amount of transfer observed in control animals.
C57Bl/6 mice that are homozygous for the hCETP gene are maintained
on a high fat chow diet, such as TD 88051, as described by Nishina
et al. (J Lipid Res., 31, 859-869 (1990)) for at least two weeks
prior to the study. Mice receive an oral gavage dose of test
compound as a suspension in 0.1% methyl cellulose in water or an
intravenous bolus injection of test compound in 10% ethanol and 90%
polyethylene glycol. Control animals receive the vehicle solution
without test compound by oral gavage or by an intravenous bolus
injection. At the start of the experiment all animals receive 0.05
ml of a solution containing [.sup.3H]CE-HDL into the tail vein.
[.sup.3H]CE-HDL is a preparation of human HDL containing
tritium-labeled cholesteryl ester, and is prepared according to the
method of Glenn et al. (Meth. Enzymol., 263, 339-351 (1996)). After
30 minutes, the animals are exsanguinated and blood collected in
standard microtainer tubes containing ethylenediamine tetraacetic
acid. Blood samples are mixed well and kept on ice until the
completion of the experiment. Plasma is obtained by centrifugation
of the blood samples at 4.degree. C. The plasma is separated and
analyzed by gel filtration chromatography and the relative
proportion of [.sup.3H]CE in the VLDL, LDL and HDL regions is
determined.
[0177] The percentage [.sup.3H]CE transferred from HDL to LDL and
VLDL (% transfer) is calculated based on the total radioactivity in
equivalent plasma samples before precipitation. Typically, the
amount of transfer from HDL to LDL and VLDL in control animals is
20% to 35% after 30 min.
[0178] Intestinal Cholesterol Absorption Assay
[0179] A variety of compounds are shown to inhibit cholesterol
absorption from the intestinal tract. These compounds lower serum
cholesterol levels by reducing intestinal absorption of cholesterol
from both exogenous sources (dietary cholesterol) and endogenous
cholesterol (secreted by the gall bladder into the intestinal
tract).
[0180] In hamsters the use of a dual-isotope plasma ratio method to
measure intestinal cholesterol absorption has been refined and
evaluated as described by Turley et al. (J. Lipid Res. 35, 329-339
(1994), herein incorporated by reference).
[0181] Male hamsters weighing 80-100 g are given food and water ad
libitum in a room with 12 hour alternating periods of light and
dark. Four hours into the light period, each hamster is
administered first an intravenous dose of 2.5 .mu.Ci of
[1,2-.sup.3H]cholesterol suspended in Intralipid (20%) and then an
oral dose of [4-.sup.14C]cholesterol in an oil of medium chain
triglycerides (MCT). The i.v. dose is given by injecting a 0.4 ml
volume of the Intralipid mixture into the distal femoral vein. The
oral dose is given by gavaging a 0.6 ml volume of the MCT oil
mixture introduced intragastrically via a polyethylene tube. After
72 hours the hamsters are bled and the amount of .sup.3H and
.sup.14C in the plasma and in the original amount of label
administered are determined by liquid scintillation spectrometry.
The cholesterol absorption will be calculated based on the
following equation: 3 Percent cholesterol absorbed = % of oral dose
per ml of 72 hour plasma sample _ .times. 100
[0182] % of i.v. dose per ml of 72 hour plasma sample
[0183] The examples herein can be performed by substituting the
generically or specifically described therapeutic compounds or
inert ingredients for those used in the preceding examples.
[0184] The invention being thus described, it is apparent that the
same can be varied in many ways. Such variations are not to be
regarded as a departure from the spirit and scope of the present
invention, and all such modifications and equivalents as would be
obvious to one skilled in the art are intended to be included
within the scope of the following claims.
* * * * *