U.S. patent application number 10/966228 was filed with the patent office on 2005-06-02 for methods and reagents for the treatment of immunoinflammatory disorders.
Invention is credited to Auspitz, Benjamin A., Borisy, Alexis, Foley, Michael A., Hurst, Nicole, Jost-Price, Edward Roydon, Keith, Curtis, Manivasakam, Palaniyandi, Slavonic, Michael S., Smith, Brendan, Zimmermann, Grant R..
Application Number | 20050119160 10/966228 |
Document ID | / |
Family ID | 34465346 |
Filed Date | 2005-06-02 |
United States Patent
Application |
20050119160 |
Kind Code |
A1 |
Keith, Curtis ; et
al. |
June 2, 2005 |
Methods and reagents for the treatment of immunoinflammatory
disorders
Abstract
The invention features a method for treating a patient diagnosed
with, or at risk of developing, an immunoinflammatory disorder by
administering to the patient a tetra-substituted
pyrimidopyrimidine, either alone or in combination with one or more
additional agents. The invention also features a composition
containing a tetra-substituted pyrimidopyrimidine in combination
with one or more additional agents.
Inventors: |
Keith, Curtis; (Boston,
MA) ; Borisy, Alexis; (Arlington, MA) ;
Zimmermann, Grant R.; (Somerville, MA) ; Jost-Price,
Edward Roydon; (West Roxbury, MA) ; Manivasakam,
Palaniyandi; (Brighton, MA) ; Hurst, Nicole;
(Boston, MA) ; Foley, Michael A.; (Chestnut Hill,
MA) ; Slavonic, Michael S.; (Quincy, MA) ;
Smith, Brendan; (Boston, MA) ; Auspitz, Benjamin
A.; (Cambridge, MA) |
Correspondence
Address: |
CLARK & ELBING LLP
101 FEDERAL STREET
BOSTON
MA
02110
US
|
Family ID: |
34465346 |
Appl. No.: |
10/966228 |
Filed: |
October 15, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60512415 |
Oct 15, 2003 |
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Current U.S.
Class: |
514/258.1 ;
514/16.6; 514/165; 514/167; 514/17.9; 514/18.7; 514/220; 514/225.8;
514/251; 514/262.1; 514/406; 514/471; 514/559; 514/570;
514/649 |
Current CPC
Class: |
A61K 9/209 20130101;
A61P 37/08 20180101; A61K 45/06 20130101; A61P 1/04 20180101; A61K
31/565 20130101; A61K 38/13 20130101; A61P 1/16 20180101; A61P
11/06 20180101; A61P 37/02 20180101; A61K 31/519 20130101; A61P
17/00 20180101; A61P 25/00 20180101; A61K 9/0073 20130101; A61K
31/565 20130101; A61P 19/02 20180101; A61P 37/06 20180101; A61K
31/519 20130101; A61K 2300/00 20130101; A61P 9/14 20180101; A61K
2300/00 20130101; A61K 2300/00 20130101; A61K 38/13 20130101; A61P
21/04 20180101; A61P 11/00 20180101; A61P 17/06 20180101; A61P
29/00 20180101; A61P 37/00 20180101; A61P 43/00 20180101 |
Class at
Publication: |
514/002 ;
514/220; 514/225.8; 514/262.1; 514/649; 514/406; 514/471; 514/251;
514/165; 514/570; 514/167; 514/559 |
International
Class: |
A61K 038/00; A61K
031/60; A61K 031/59; A61K 031/551; A61K 031/525; A61K 031/519; A61K
031/5415; A61K 031/415 |
Claims
What is claimed is:
1. A composition comprising a tetra-substituted pyrimidopyrimidine
and a second drug selected from the group consisting of tricyclic
and tetracyclic antidepressants; selective serotonin reuptake
inhibitors (SSRIs); rolipram; ibudilast; non-steroidal
anti-inflammatory drugs (NSAIDs); COX-2 inhibitors; biologics;
small molecule immunomodulators; disease-modifying anti-rheumatic
drugs (DMARDs); xanthines; anticholinergic compounds; beta receptor
agonists; bronchodilators; non-steroidal immunophilin-dependent
immunosuppressants, vitamin D analogs; psoralens; retinoids; and
5-amino salicylic acids, with the proviso that when said
tetra-substituted pyrimidopyrimidine is dipyridamole, said second
drug is not methotrexate or aspirin.
2. The composition of claim 1, wherein said tetra-substituted
pyrimidopyrimidine is dipyridamole.
3. The composition of claim 1, wherein said tetra-substituted
pyrimidopyrimidine is mopidamole, dipyridamole monoacetate,
2,6-di-(2,2-dimethyl-1,3-dioxolan-4-yl)-methoxy-4,8-di-piperidinopyrimido-
pyrimidine,
2,6-bis-(2,3-dimethyoxypropoxy)-4,8-di-piperidinopyrimidopyrim-
idine,
2,6-bis[N,N-di(2-methoxy)ethyl]-4,6-di-piperidinopyrimidopyrimidine-
, or
2,6-bis(diethanolamino)-4,8-di-4-methoxybenzylaminopyrimidopyrimidine-
.
4. The composition of claim 1, wherein said tricyclic
antidepressant is nortryptiline, amoxapine, or desipramine.
5. The composition of claim 1, wherein said SSRI is paroxetine or
fluoxetine.
6. The composition of claim 1, wherein said NSAID is naproxen
sodium, diclofenac sodium, diclofenac potassium, aspirin, sulindac,
diflunisal, piroxicam, indomethacin, ibuprofen, nabumetone, choline
magnesium trisalicylate, sodium salicylate, salicylsalicylic acid,
fenoprofen, flurbiprofen, ketoprofen, meclofenamate sodium,
meloxicam, oxaprozin, sulindac, or tolmetin.
7. The composition of claim 1, wherein said COX-2 inhibitor is
rofecoxib, celecoxib, valdecoxib, or lumiracoxib.
8. The composition of claim 1, wherein said biologic is adelimumab,
etanercept, or infliximab.
9. The composition of claim 1, wherein said DMARD is methotrexate
or leflunomide.
10. The composition of claim 1, wherein said xanthine is
theophylline.
11. The composition of claim 1, wherein said anticholinergic
compound is ipratropium or tiotropium.
12. The composition of claim 1, wherein said beta receptor agonist
is ibuterol sulfate, bitolterol mesylate, epinephrine, formoterol
fumarate, isoproteronol, levalbuterol hydrochloride, metaproterenol
sulfate, pirbuterol scetate, salmeterol xinafoate, or
terbutaline.
13. The composition of claim 1, wherein said vitamin D analog is
calcipotriene or calcipotriol.
14. The composition of claim 1, wherein said psoralen is
methoxsalen.
15. The composition of claim 1, wherein said retinoid is acitretin
or tazoretene.
16. The composition of claim 1, wherein said 5-amino salicylic acid
is mesalamine, sulfasalazine, balsalazide disodium, or olsalazine
sodium.
17. The composition of claim 1, wherein said small molecule
immunomodulator is VX 702, SCIO 469, doramapimod, RO 30201195, SCIO
323, DPC 333, pranalcasan, mycophenylate, or merimepodib.
18. The composition of claim 1, wherein said composition is
formulated for topical administration.
19. The composition of claim 1, wherein said composition is
formulated for systemic administration.
20. The composition of claim 1, wherein said tetra-substituted
pyrimidopyrimidine or said second drug is present in said
composition in a low dosage.
21. The composition of claim 1, wherein said tetra-substituted
pyrimidopyrimidine or said second drug is present in said
composition in a high dosage.
22. The composition of claim 1, wherein said composition further
comprises an NSAID, COX-2 inhibitor, biologic, small molecule
immunomodulator, DMARD, xanthine, anticholinergic compound, beta
receptor agonist, bronchodilator, non-steroidal
immunophilin-dependent immunosuppressant, vitamin D analog,
psoralen, retinoid, or 5-amino salicylic acid.
23. A method for treating a patient diagnosed with or at risk of
developing an immunoinflammatory disorder, said method comprising
administering to the patient a tetra-substituted pyrimidopyrimidine
and a second drug selected from the group consisting of tricyclic
and tetracyclic antidepressants; selective serotonin reuptake
inhibitors; rolipram; ibudilast; NSAIDs; COX-2 inhibitors;
biologics; small molecule immunomodulators; DMARDs; xanthines;
anticholinergic compounds; beta receptor agonists; bronchodilators;
non-steroidal immunophilin-dependent immunosuppressants, vitamin D
analogs; psoralens; retinoids; and 5-amino salicylic acids, with
the proviso that when said tetra-substituted pyrimidopyrimidine is
dipyridamole, said second drug is not methotrexate or aspirin,
wherein said tetra-substituted pyrimidopyrimidine and said second
drug are administered simultaneously or within 14 days of each
other in amounts sufficient to treat said patient.
24. The method of claim 23, wherein said immunoinflammatory
disorder is rheumatoid arthritis, Crohn's disease, ulcerative
colitis, asthma, chronic obstructive pulmonary disease, polymylagia
rheumatica, giant cell arteritis, systemic lupus erythematosus,
atopic dermatitis, multiple sclerosis, myasthenia gravis,
psoriasis, ankylosing spondylitis, cirrhosis, or psoriatic
arthritis.
25. The method of claim 23, wherein said tetra-substituted
pyrimidopyrimidine and said second drug are administered
simultaneously.
26. The method of claim 23, wherein said tetra-substituted
pyrimidopyrimidine is dipyridamole.
27. The method of claim 23, wherein said tetra-substituted
pyrimidopyrimidine is mopidamole, dipyridamole monoacetate,
2,6-di-(2,2-dimethyl-1,3-dioxolan-4-yl)-methoxy-4,8-di-piperidinopyrimido-
pyrimidine,
2,6-bis-(2,3-dimethyoxypropoxy)-4,8-di-piperidinopyrimidopyrim-
idine,
2,6-bis[N,N-di(2-methoxy)ethyl]-4,6-di-piperidinopyrimidopyrimidine-
, or
2,6-bis(diethanolamino)-4,8-di-4-methoxybenzylaminopyrimidopyrimidine-
.
28. The method of claim 23, wherein said tricyclic antidepressant
is nortryptiline, amoxapine, or desipramine.
29. The method of claim 23, wherein said SSRI is paroxetine or
fluoxetine.
30. The method of claim 23, wherein said NSAID is naproxen sodium,
diclofenac sodium, diclofenac potassium, aspirin, sulindac,
diflunisal, piroxicam, indomethacin, ibuprofen, nabumetone, choline
magnesium trisalicylate, sodium salicylate, salicylsalicylic acid,
fenoprofen, flurbiprofen, ketoprofen, meclofenamate sodium,
meloxicam, oxaprozin, sulindac, or tolmetin.
31. The method of claim 23, wherein said COX-2 inhibitor is
rofecoxib, celecoxib, valdecoxib, or lumiracoxib.
32. The method of claim 23, wherein said biologic is adelimumab,
etanercept, or infliximab.
33. The method of claim 23, wherein said DMARD is methotrexate or
leflunomide.
34. The method of claim 23, wherein said xanthine is
theophylline.
35. The method of claim 23, wherein said anticholinergic compound
is ipratropium or tiotropium.
36. The method of claim 23, wherein said beta receptor agonist is
ibuterol sulfate, bitolterol mesylate, epinephrine, formoterol
fumarate, isoproteronol, levalbuterol hydrochloride, metaproterenol
sulfate, pirbuterol scetate, salmeterol xinafoate, or
terbutaline.
37. The method of claim 23, wherein said vitamin D analog is
calcipotriene or calcipotriol.
38. The method of claim 23, wherein said psoralen is
methoxsalen.
39. The method of claim 23, wherein said retinoid is acitretin or
tazoretene.
40. The method of claim 23, wherein said 5-amino salicylic acid is
mesalamine, sulfasalazine, balsalazide disodium, or olsalazine
sodium.
41. The method of claim 23, wherein said small molecule
immunomodulator is VX 702, SCIO 469, doramapimod, RO 30201195, SCIO
323, DPC 333, pranalcasan, mycophenylate, or merimepodib.
42. The method of claim 23, wherein said composition is formulated
for topical administration.
43. The method of claim 23, wherein said composition is formulated
for systemic administration.
44. The method of claim 23, wherein said tetra-substituted
pyripyrimyrimidine or said second drug is administered in a low
dosage.
45. The method of claim 23, wherein said tetra-substituted
pyrimidopyrimidine or said second drug is is administered in a high
dosage.
46. The method of claim 23, wherein said method further comprises
administering a third drug selected from an NSAID, COX-2 inhibitor,
biologic, small molecule immunomodulator, DMARD, xanthine,
anticholinergic compound, beta receptor agonist, bronchodilator,
non-steroidal immunophilin-dependent immunosuppressant, vitamin D
analog, psoralen, retinoid, and 5-amino salicylic acid, wherein
said tetra-substituted pyrimidopyrimidine, said second drug, and
said third drug are administered simultaneously or within 14 days
of each other in amounts sufficient to treat said patient.
47. A kit comprising: (i) a composition comprising a
tetra-substituted pyrimidopyrimidine and a second drug selected
from the group consisting of tricyclic and tetracyclic
antidepressants; selective serotonin reuptake inhibitors; rolipram;
ibudilast; NSAIDs; COX-2 inhibitors; biologics; small molecule
immunomodulators; DMARDs; xanthines; anticholinergic compounds;
beta receptor agonists; bronchodilators; non-steroidal
immunophilin-dependent immunosuppressants, vitamin D analogs;
psoralens; retinoids; and 5-amino salicylic acids, with the proviso
that when said tetra-substituted pyrimidopyrimidine is
dipyridamole, said second drug is not methotrexate or aspirin; and
(ii) instructions for administering said composition to a patient
diagnosed with or at risk of developing an immunoinflammatory
disorder.
48. A kit comprising: (i) a tetra-substituted pyrimidopyrimidine;
(ii) a second drug selected from the group consisting of tricyclic
and tetracyclic antidepressants; selective serotonin reuptake
inhibitors; rolipram; ibudilast; NSAIDs; COX-2 inhibitors;
biologics; small molecule immunomodulators; DMARDs; xanthines;
anticholinergic compounds; beta receptor agonists; bronchodilators;
non-steroidal immunophilin-dependent immunosuppressants, vitamin D
analogs; psoralens; retinoids; and 5-amino salicylic acids, with
the proviso that when said tetra-substituted pyrimidopyrimidine is
dipyridamole, said second drug is not methotrexate or aspirin; and
(iii) instructions for administering said tetra-substituted
pyrimidopyrimidine and said second drug to a patient diagnosed with
or at risk of developing an immunoinflammatory disorder.
49. A kit comprising: (i) a drug selected from the group consisting
of tricyclic and tetracyclic antidepressants; selective serotonin
reuptake inhibitors; rolipram; ibudilast; NSAIDs; COX-2 inhibitors;
biologics; small molecule immunomodulators; DMARDs; xanthines;
anticholinergic compounds; beta receptor agonists; bronchodilators;
non-steroidal immunophilin-dependent immunosuppressants, vitamin D
analogs; psoralens; retinoids; and 5-amino salicylic acids; and
(ii) instructions for administering said drug and a
tetra-substituted pyrimidopyrimidine a patient diagnosed with or at
risk of developing an immunoinflammatory disorder, with the proviso
that when said tetra-substituted pyrimidopyrimidine is
dipyridamole, said second drug is not methotrexate or aspirin.
50. A kit comprising: (i) a tetra-substituted pyrimidopyrimidine;
and (ii) instructions for administering said pyrimidopyrimidine and
a second drug selected from the group consisting of tricyclic and
tetracyclic antidepressants; selective serotonin reuptake
inhibitors; rolipram; ibudilast; NSAIDs; COX-2 inhibitors;
biologics; small molecule immunomodulators; DMARDs; xanthines;
anticholinergic compounds; beta receptor agonists; bronchodilators;
non-steroidal immunophilin-dependent immunosuppressants, vitamin D
analogs; psoralens; retinoids; and 5-amino salicylic acids, with
the proviso that when said tetra-substituted pyrimidopyrimidine is
dipyridamole, said second drug is not methotrexate or aspirin to a
patient diagnosed with or at risk of developing an
immunoinflammatory disorder, with the proviso that when said
tetra-substituted pyrimidopyrimidine is dipyridamole, said second
drug is not methotrexate or aspirin.
51. The kit of claim 50, wherein said tetra-substituted
pyrimidopyrimidine is dipyridamole.
52. The kit of claim 50, wherein said tetra-substituted
pyrimidopyrimidine is mopidamole, dipyridamole monoacetate,
2,6-di-(2,2-dimethyl-1,3-dioxola-
n-4-yl)-methoxy-4,8-di-piperidinopyrimidopyrimidine,
2,6-bis-(2,3-dimethyoxypropoxy)-4,8-di-piperidinopyrimidopyrimidine,
2,6-bis[N,N-di(2-methoxy)ethyl]-4,6-di-piperidinopyrimidopyrimidine,
or
2,6-bis(diethanolamino)-4,8-di-4-methoxybenzylaminopyrimidopyrimidine.
53. The kit of claim 50, wherein said immunoinflammatory disorder
is rheumatoid arthritis, Crohn's disease, ulcerative colitis,
asthma, chronic obstructive pulmonary disease, polymylagia
rheumatica, giant cell arteritis, systemic lupus erythematosus,
atopic dermatitis, multiple sclerosis, myasthenia gravis,
psoriasis, ankylosing spondylitis, cirrhosis, or psoriatic
arthritis.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims benefit from U.S. Provisional
Application No. 60/512,415, filed on Oct. 15, 2003, hereby
incorporated by reference.
BACKGROUND OF THE INVENTION
[0002] The invention relates to the treatment of immunoinflammatory
disorders.
[0003] Immunoinflammatory conditions are characterized by the
inappropriate activation of the body's immune defenses. Rather than
targeting infectious invaders, the immune response targets and
damages the body's own tissues or transplanted tissues. The tissue
targeted by the immune system varies with the disorder. For
example, in multiple sclerosis, the immune response is directed
against the neuronal tissue, while in Crohn's disease the digestive
tract is targeted. Immunoinflammatory disorders affect millions of
individuals and include conditions such as asthma, allergic
intraocular inflammatory diseases, arthritis, atopic dermatitis,
atopic eczema, diabetes, hemolytic anaemia, inflammatory
dermatoses, inflammatory bowel or gastrointestinal disorders (e.g.,
Crohn's disease and ulcerative colitis), multiple sclerosis,
myasthenia gravis, pruritis/inflammation, psoriasis, rheumatoid
arthritis, cirrhosis, and systemic lupus erythematosus.
[0004] Current treatment regimens for immunoinflammatory disorders,
transplanted organ rejection, and graft versus host disease
typically rely on immunosuppressive agents. The effectiveness of
these agents can vary and their use is often accompanied by adverse
side effects. Thus, improved therapeutic agents and methods for the
treatment of immunoinflammatory conditions are needed.
SUMMARY OF THE INVENTION
[0005] The invention features a method for treating an
immunoinflammatory disease by administering to a patient in need
thereof certain tetra-substituted pyrimidopyrimidines, either alone
or in combination with any of a number of companion compounds,
including an antihistamine, a corticosteroid, rolipram, ibudilast,
a tricyclic or tetracyclic antidepressant, an SSRI, a non-steroidal
anti-inflammatory drug, a non-steroidal immunophilin-dependent
immunosuppressant, and an analog of any thereof, as described
herein.
[0006] Accordingly, in one aspect, the invention features a method
of treating a patient having an immunoinflammatory disease by
administering to the patient a tetra-substituted pyrimidopyrimidine
in an amount and for duration to treat the patient.
[0007] In a related aspect, the invention features a method for
treating a patient having an immunoinflammatory disorder by
administering to the patient tetra-substituted pyrimidopyrimidine
and an antihistamine simultaneously or within 14 days of each other
in amounts sufficient to treat the patient.
[0008] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to the patient a tetra-substituted
pyrimidopyrimidine and an antihistamine simultaneously or within 14
days of each other in amounts sufficient to decrease
proinflammatory cytokine secretion or production in the
patient.
[0009] In another aspect, the invention features a composition that
includes a tetra-substituted pyrimidopyrimidine and an
antihistamine. A particularly desirable tetra-substituted
pyrimidopyrimidine is dipyridamole. The composition may be
formulated for topical or systemic administration.
[0010] In another aspect, the invention features a kit that
includes: (i) a composition that includes a tetra-substituted
pyrimidopyrimidine and an antihistamine; and (ii) instructions for
administering the composition to a patient diagnosed with or at
risk of developing an immunoinflammatory disorder.
[0011] In a related aspect, the invention features a kit that
includes: (i) an antihistamine; (ii) a tetra-substituted
pyrimidopyrimidine; and (iii) instructions for administering the
tetra-substituted pyrimidopyrimidine and the antihistamine to a
patient diagnosed with or at risk of developing an
immunoinflammatory disorder.
[0012] In another aspect, the invention features a composition that
includes a tetra-substituted pyrimidopyrimidine and a
corticosteroid. Particularly desirable corticosteroids are
prednisolone, cortisone, dexamethasone, hydrocortisone,
methylprednisolone, fluticasone, prednisone, triamcinolone, and
diflorasone. The composition may be formulated for topical or
systemic administration (e.g., oral administration). One or both of
the drugs may be present in the composition in a low dosage or a
high dosage, each of which is defined herein.
[0013] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to the patient a tetra-substituted
pyrimidopyrimidine and a corticosteroid simultaneously or within 14
days of each other in amounts sufficient to decrease
proinflammatory cytokine secretion or production in the
patient.
[0014] In a related aspect, the invention features a method for
treating a patient diagnosed with or at risk of developing an
immunoinflammatory disorder by administering to the patient a
tetra-substituted pyrimidopyrimidine and a corticosteroid
simultaneously or within 14 days of each other in amounts
sufficient to treat the patient.
[0015] In another aspect, the invention features a kit that
includes: (i) a composition that includes a tetra-substituted
pyrimidopyrimidine and a corticosteroid; and (ii) instructions for
administering the composition to a patient diagnosed with or at
risk of developing an immunoinflammatory disorder.
[0016] In a related aspect, the invention features a kit that
includes: (i) a tetra-substituted pyrimidopyrimidine; (ii) a
corticosteroid; and (iii) instructions for administering the
tetra-substituted pyrimidopyrimidine and the corticosteroid to a
patient diagnosed with or at risk of developing an
immunoinflammatory disorder.
[0017] In another aspect, the invention features a composition that
includes tetra-substituted pyrimidopyrimidine and ibudilast. The
composition may be formulated for topical or systemic
administration.
[0018] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to the patient tetra-substituted
pyrimidopyrimidine and ibudilast simultaneously or within 14 days
of each other in amounts sufficient to decrease proinflammatory
cytokine secretion or production in the patient.
[0019] In a related aspect, the invention features a method for
treating a patient diagnosed with or at risk of developing an
immunoinflammatory disorder by administering to the patient
tetra-substituted pyrimidopyrimidine and ibudilast simultaneously
or within 14 days of each other in amounts sufficient to treat the
patient.
[0020] In another aspect, the invention features a kit that
includes: (i) a composition that includes tetra-substituted
pyrimidopyrimidine and ibudilast; and (ii) instructions for
administering the composition to a patient diagnosed with or at
risk of developing an immunoinflammatory disorder.
[0021] In a related aspect, the invention features a kit that
includes: (i) tetra-substituted pyrimidopyrimidine; (ii) ibudilast;
and (iii) instructions for administering the tetra-substituted
pyrimidopyrimidine and the ibudilast to a patient diagnosed with or
at risk of developing an immunoinflammatory disorder.
[0022] In another aspect, the invention features a composition that
includes tetra-substituted pyrimidopyrimidine and rolipram. The
composition may be formulated for topical or systemic
administration.
[0023] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to the patient a tetra-substituted
pyrimidopyrimidine and rolipram simultaneously or within 14 days of
each other in amounts sufficient to decrease proinflammatory
cytokine secretion or production in the patient.
[0024] In a related aspect, the invention features a method for
treating a patient diagnosed with or at risk of developing an
immunoinflammatory disorder by administering to the patient
tetra-substituted pyrimidopyrimidine and rolipram simultaneously or
within 14 days of each other in amounts sufficient to treat the
patient.
[0025] In another aspect, the invention features a kit that
includes: (i) a composition that includes tetra-substituted
pyrimidopyrimidine and rolipram; and (ii) instructions for
administering the composition to a patient diagnosed with or at
risk of developing an immunoinflammatory disorder.
[0026] In a related aspect, the invention features a kit that
includes: (i) tetra-substituted pyrimidopyrimidine; (ii) rolipram;
and (iii) instructions for administering the tetra-substituted
pyrimidopyrimidine and the rolipram to a patient diagnosed with or
at risk of developing an immunoinflammatory disorder.
[0027] In another aspect, the invention features a composition that
includes a tetra-substituted pyrimidopyrimidine and a tricyclic or
tetracyclic antidepressant. Particularly desirable tricyclic or
tetracyclic antidepressants are nortryptiline, amoxapine, and
desipramine. The composition may be formulated for topical or
systemic administration.
[0028] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to the patient a tetra-substituted
pyrimidopyrimidine and a tricyclic or tetracyclic antidepressant
simultaneously or within 14 days of each other in amounts
sufficient to decrease proinflammatory cytokine secretion or
production in the patient.
[0029] In a related aspect, the invention features a method for
treating a patient diagnosed with or at risk of developing an
immunoinflammatory disorder by administering to the patient a
tetra-substituted pyrimidopyrimidine and a tricyclic or tetracyclic
antidepressant simultaneously or within 14 days of each other in
amounts sufficient to treat the patient.
[0030] In another aspect, the invention features a kit that
includes: (i) a composition that includes a tetra-substituted
pyrimidopyrimidine and a tricyclic or tetracyclic antidepressant;
and (ii) instructions for administering the composition to a
patient diagnosed with or at risk of developing an
immunoinflammatory disorder. In a related aspect, the invention
features a kit that includes: (i) a tetra-substituted
pyrimidopyrimidine; (ii) a tricyclic or tetracyclic antidepressant;
and (iii) instructions for administering the tetra-substituted
pyrimidopyrimidine and the tricyclic or tetracyclic antidepressant
to a patient diagnosed with or at risk of developing an
immunoinflammatory disorder.
[0031] In another aspect, the invention features a composition that
includes a tetra-substituted pyrimidopyrimidine and a selective
serotonin reuptake inhibitor (SSRI). Particularly desirable SSRIs
are paroxetine, fluoxetine, sertraline, and citalopram. The
composition may be formulated for topical or systemic
administration (e.g., oral administration).
[0032] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to the patient a tetra-substituted
pyrimidopyrimidine and an SSRI simultaneously or within 14 days of
each other in amounts sufficient to decrease proinflammatory
cytokine secretion or production in the patient.
[0033] In a related aspect, the invention features a method for
treating a patient diagnosed with or at risk of developing an
immunoinflammatory disorder by administering to the patient an a
tetra-substituted pyrimidopyrimidine and an SSRI simultaneously or
within 14 days of each other in amounts sufficient to treat the
patient.
[0034] In another aspect, the invention features a kit that
includes: (i) a composition that includes a tetra-substituted
pyrimidopyrimidine and an SSRI; and (ii) instructions for
administering the composition to a patient diagnosed with or at
risk of developing an immunoinflammatory disorder.
[0035] In a related aspect, the invention features a kit that
includes: (i) a tetra-substituted pyrimidopyrimidine; (ii) an SSRI;
and (iii) instructions for administering the antihistamine and the
SSRI to a patient diagnosed with or at risk of developing an
immunoinflammatory disorder.
[0036] In particular embodiments of any of the methods of the
invention, the tetra-substituted pyrimidopyrimidine and the
companion compound are administered within 10 days of each other,
within five days of each other, within twenty-four hours of each
other, or even simultaneously. The compounds may be formulated
together as a single composition, or may be formulated and
administered separately. One or both compounds may be administered
in a low dosage or in a high dosage, each of which is defined
herein. If desired, the composition, method, or kit may include one
or more additional compounds (e.g., a glucocorticoid receptor
modulator, NSAID, COX-2 inhibitor, DMARD, biologic, xanthine, small
molecule immunomodulator, anticholinergic compound, beta receptor
agonist, bronchodilator, non-steroidal immunophilin-dependent
immunosuppressant, vitamin D analog, psoralen, retinoid, or 5-amino
salicylic acid). The composition may be formulated, for example,
for topical administration or systemic administration.
[0037] Combination therapies of the invention are especially useful
for the treatment of immunoinflammatory disorders in combination
with other anti-cytokine agents or agents that modulate the immune
response to positively effect disease, such as agents that
influence cell adhesion, or biologics or small molecules that block
the action of IL-6, IL-1, IL-2, IL-12, IL-15 or TNF.alpha. (e.g.,
etanercept, adelimumab, infliximab, or CDP-870). In this example
(that of agents blocking the effect of TNF.alpha.), the combination
therapy reduces the production of cytokines, etanercept or
infliximab act on the remaining fraction of inflammatory cytokines,
providing enhanced treatment. Examples of small molecule agents
that block cytokines or modulate immune response include agents
inhibiting p38 MAP kinase (e.g., Doramapimod, SCIO-469, VX-702),
ICE (e.g., Pralnacasan) and TACE (e.g., BMS-561392).
[0038] In any of the methods, compositions, and kits of the
invention, analogs of certain compounds may be employed in lieu of
the compounds themselves. Analogs of a tetra-substituted
pyrimidopyrimidine and other compounds are described herein.
Structural analogs of a compound (e.g, ibudilast) or class of
compound (e.g., antihistamines) do not need to have the same
activity as the compound or class to which it is related. Thus, an
SSRI analog does not necessarily inhibit serotonin reuptake.
[0039] In a related aspect, the invention features a method for
identifying combinations of compounds useful for suppressing the
secretion of proinflammatory cytokines in a patient in need of such
treatment, said method comprising the steps of: (a) contacting
cells in vitro with a combination of a tetra-substituted
pyrimidopyrimidine, an antihistamine, a corticosteroid, ibudilast,
rolipram, a tricyclic or tetracyclic antidepressant, or an SSRI and
a candidate compound; and (b) determining whether the combination
reduces cytokine levels in blood cells stimulated to secrete the
cytokines relative to cells contacted with the tetra-substituted
pyrimidopyrimidine, antihistamine, corticosteroid, ibudilast,
rolipram, tricyclic or tetracyclic antidepressant, or SSRI but not
contacted with the candidate compound or cells contacted with the
candidate compound but not with the tetra-substituted
pyrimidopyrimidine, antihistamine, corticosteroid, ibudilast,
rolipram, tricyclic or tetracyclic antidepressant, or SSRI, wherein
a reduction of cytokine levels identifies the combination as a
combination that is useful for treating a patient in need of such
treatment.
[0040] In a related aspect, the invention features a method for
suppressing secretion of one or more proinflammatory cytokines in a
cell by contacting the cell with: (i) a tetra-substituted
pyrimidopyrimidine; and (ii) an antihistamine, a corticosteroid,
ibudilast, rolipram, a tricyclic or tetracyclic antidepressant, or
an SSRI simultaneously or within 14 days of each other in amounts
sufficient to suppress secretion of one or more proinflammatory
cytokines in the cell. The preferred cytokines are TNF.alpha.,
IL-1, IL-2 and INF-.gamma..
[0041] In another aspect, the invention features a composition that
includes an antihistamine, a corticosteroid, rolipram, ibudilast, a
tricyclic or tetracyclic antidepressant, an SSRI, a non-steroidal
anti-inflammatory drug, a non-steroidal immunophilin-dependent
immunosuppressant, or an analog of any thereof; and (ii) a compound
selected from the group consisting of a xanthine, small molecule
immunomodulator, anticholinergic compound, biologic, DMARD, COX-2
inhibitor, beta-receptor agonist, bronchodilator, non-steroidal
immunophilin-dependent immunosuppressant, vitamin D analog,
psoralen, retinoid, or 5-amino salicylic acid.
[0042] In another aspect, the invention features a method of
decreasing proinflammatory cytokine secretion or production in a
patient by administering to a patient a tetra-substituted
pyrimidopyrimidine or an analog thereof and an NSAID or an analog
thereof simultaneously or within 14 days of each other in amounts
sufficient to decrease proinflammatory cytokine secretion or
production in the patient, with the proviso that when
tetra-substituted pyrimidopyrimidine is dipyridamole, the NSAID is
not aspirin.
[0043] In yet another aspect, the invention features a method for
treating a patient diagnosed with or at risk of developing an
immunoinflammatory disorder by administering to the patient a
tetra-substituted pyrimidopyrimidine or an analog thereof and an
NSAID or an analog thereof simultaneously or within 14 days of each
other in amounts sufficient to treat the patient, with the proviso
that when tetra-substituted pyrimidopyrimidine is dipyridamole, the
NSAID is not aspirin.
[0044] In one aspect, the invention features a composition
comprising a unit dose form of a tetra-substituted
pyrimidopyrimidine and a second compound selected from an NSAID,
COX-2 inhibitor, biologic, small molecule immunomodulator, DMARD,
xanthine, anticholinergic compound, beta receptor agonist,
bronchodilator, non-steroidal immunophilin-dependent
immunosuppressant, vitamin D analog, psoralen, retinoid, and
5-amino salicylic acid with the proviso that when tetra-substituted
pyrimidopyrimidine is dipyridamole, the second compound is not
methotrexate or aspirin. The unit dose form this composition can be
oral, topical, parenteral, rectal, cutaneous, nasal, vaginal,
inhalant, skin (patch), or ocular administration.
[0045] The invention also features a method for inhibiting
proinflammatory cytokine activity in a patient suffering from or at
risk of suffering from a disorder associated with at least one
immunoinflammatory disorder mediated by the cytokine by
administering to the patient a unit dose of a tetra-substituted
pyrimidopyrimidine in an amount effective to inhibit or decrease
the cytokine activity in the patient, wherein when the
tetra-substituted pyrimidopyrimidine is dipyridamole, the unit dose
is suitable for systemic administration. The cytokine is desirably
selected from TNF.alpha., IL-1, IL-2, IL-6, IL-12, IL-15, and
IFN-.gamma., and The methods and compositions of the invention
desirably have increased effectiveness, safety, tolerability, or
satisfaction of treatment of a patient suffering from or at risk of
suffering from immunoinflammatory disorder, as compared to methods
and compositions using each component of the combination
individually.
[0046] Particularly useful tetra-substituted pyrimidopyrimidines
for use in the methods, kits, and compositions of the invention are
dipyridamole (also known as
2,6-bis(diethanolamino)-4,8-dipiperidinopyrimido(5,4-d)pyr-
imidine); 2,6-disubstituted
4,8-dibenzylaminopyrimido[5,4-d]pyrimidines; mopidamole;
dipyridamole monoacetate; NU3026 (2,6-di-(2,2-dimethyl-1,3-di-
oxolan-4-yl)-methoxy-4,8-di-piperidinopyrimidopyrimidine); NU3059
(2,6-bis-(2,3-dimethyoxypropoxy)-4,8-di-piperidinopyrimidopyrimidine);
NU3060
(2,6-bis[N,N-di(2-methoxy)ethyl]-4,6-di-piperidinopyrimidopyrimidi-
ne); and NU3076
(2,6-bis(diethanolamino)-4,8-di-4-methoxybenzylaminopyrimi-
dopyrimidine). Other tetra-substituted pyrimidopyrimidines are
described in U.S. Pat. Nos. 3,031,450 and 4,963,541, hereby
incorporated by reference.
[0047] By "corticosteroid" is meant any naturally occurring or
synthetic compound characterized by a hydrogenated
cyclopentanoperhydrophenanthrene ring system. Naturally occurring
corticosteroids are generally produced by the adrenal cortex.
Synthetic corticosteroids may be halogenated. Exemplary
corticosteroids are described herein.
[0048] By "tricyclic or tetracyclic antidepressant" is meant a
compound having one the formulas (I), (II), (III), or (IV): 1
[0049] wherein each X is, independently, H, Cl, F, Br, I, CH.sub.3,
CF.sub.3, OH, OCH.sub.3, CH.sub.2CH.sub.3, or OCH.sub.2CH.sub.3; Y
is CH.sub.2, O, NH, S(O).sub.0-2, (CH.sub.2).sub.3, (CH).sub.2,
CH.sub.2O, CH.sub.2NH, CHN, or CH.sub.2S; Z is C or S; A is a
branched or unbranched, saturated or monounsaturated hydrocarbon
chain having between 3 and 6 carbons, inclusive; each B is,
independently, H, Cl, F, Br, I, CX.sub.3, CH.sub.2CH.sub.3,
OCX.sub.3, or OCX.sub.2CX.sub.3; and D is CH.sub.2, O, NH,
S(O).sub.0-2. In preferred embodiments, each X is, independently,
H, Cl, or F; Y is (CH.sub.2).sub.2, Z is C; A is (CH.sub.2).sub.3;
and each B is, independently, H, Cl, or F.
[0050] By "tetra-substituted pyrimidopyrimidine" is meant a
compound having the formula (V): 2
[0051] wherein each Z and each Z' is, independently, N, O, C, 3
[0052] When Z or Z' is O or 4
[0053] then p=1, when Z or Z' is N, 5
[0054] then p=2, and when Z or Z' is C, then p=3. In formula (V),
each R is, independently, X, OH, N-alkyl (wherein the alkyl group
has 1 to 20, more preferably 1-5, carbon atoms); a branched or
unbranched alkyl group having 1 to 20, more preferably 1-5, carbon
atoms; or a heterocycle, preferably as defined in formula (Y),
below. Alternatively, when p>1, two R.sub.1 groups from a common
Z or Z' atom, in combination with each other, may represent
--(CY.sub.2).sub.k-- in which k is an integer between 4 and 6,
inclusive. Each X is, independently, Y, CY.sub.3,
C(CY.sub.3).sub.3, CY.sub.2CY.sub.3, (CY.sub.2).sub.1-5OY,
substituted or unsubstituted cycloalkane of the structure
C.sub.nY.sub.2n-1, wherein n=3-7, inclusive. Each Y is,
independently, H, F, Cl, Br, or I. In one embodiment, each Z is the
same moiety, each Z' is the same moiety, and Z and Z' are different
moieties,
[0055] By "antihistamine" is meant a compound that blocks the
action of histamine. Classes of antihistamines include but are not
limited to ethanolamines, ethylenediamines, phenothiazines,
alkylamines, piperazines, and piperidines.
[0056] By "selective serotonin reuptake inhibitor" or "SSRI" is
meant any member of the class of compounds that (i) inhibit the
uptake of serotonin by neurons of the central nervous system, (ii)
have an inhibition constant (Ki) of 10 nM or less, and (iii) a
selectivity for serotonin over norepinephrine (i.e., the ratio of
Ki(norepinephrine) over Ki(serotonin)) of greater than 100.
Typically, SSRIs are administered in dosages of greater than 10 mg
per day when used as antidepressants. Exemplary SSRIs for use in
the invention are fluoxetine, fluvoxamine, paroxetine, sertraline,
citalopram, and venlafaxine.
[0057] By "non-steroidal immunophilin-dependent immunosuppressant"
or "NsIDI" is meant any non-steroidal agent that decreases
proinflammatory cytokine production or secretion, binds an
immunophilin, or causes a down regulation of the proinflammatory
reaction. NsIDIs include calcineurin inhibitors, such as
cyclosporine, tacrolimus, ascomycin, pimecrolimus, as well as other
agents (peptides, peptide fragments, chemically modified peptides,
or peptide mimetics) that inhibit the phosphatase activity of
calcineurin. NsIDIs also include rapamycin (sirolimus) and
everolimus, which bind to an FK506-binding protein, FKBP-12, and
block antigen-induced proliferation of white blood cells and
cytokine secretion.
[0058] By "small molecule immunomodulator" is meant a
non-steroidal, non-NsIDI compound that decreases proinflammatory
cytokine production or secretion, causes a down regulation of the
proinflammatory reaction, or otherwise modulates the immune system
in an immunophilin-independent manner. Examplary small molecule
immunomodulators are p38 MAP kinase inhibitors such as VX 702
(Vertex Pharmaceuticals), SCIO 469 (Scios), doramapimod (Boehringer
Ingelheim), RO 30201195 (Roche), and SCIO 323 (Scios), TACE
inhibitors such as DPC 333 (Bristol Myers Squibb), ICE inhibitors
such as pranalcasan (Vertex Pharmaceuticals), and IMPDH inhibitors
such as mycophenylate (Roche) and merimepodib (Vertex
Pharamceuticals).
[0059] By a "low dosage" is meant at least 5% less (e.g., at least
10%, 20%, 50%, 80%, 90%, or even 95%) than the lowest standard
recommended dosage of a particular compound formulated for a given
route of administration for treatment of any human disease or
condition. For example, a low dosage of corticosteroid formulated
for administration by inhalation will differ from a low dosage of
corticosteroid formulated for oral administration.
[0060] By a "high dosage" is meant at least 5% (e.g., at least 10%,
20%, 50%, 100%, 200%, or even 300%) more than the highest standard
recommended dosage of a particular compound for treatment of any
human disease or condition.
[0061] By a "moderate dosage" is meant the dosage between the low
dosage and the high dosage.
[0062] By "treating" is meant administering or prescribing a
composition for the treatment or prevention of an
immunoinflammatory disease.
[0063] By "patient" is meant any animal (e.g., a human). Other
animals that can be treated using the methods, compositions, and
kits of the invention include horses, dogs, cats, pigs, goats,
rabbits, hamsters, monkeys, guinea pigs, rats, mice, lizards,
snakes, sheep, cattle, fish, and birds.
[0064] By "an amount sufficient" is meant the amount of a compound,
in a combination of the invention, required to treat or prevent an
immunoinflammatory disease in a clinically relevant manner. A
sufficient amount of an active compound used to practice the
present invention for therapeutic treatment of conditions caused by
or contributing to an immunoinflammatory disease varies depending
upon the manner of administration, the age, body weight, and
general health of the patient. Ultimately, the prescribers will
decide the appropriate amount and dosage regimen. Additionally, an
effective amount may can be that amount of compound in the
combination of the invention that is safe and efficacious in the
treatment of a patient having the immunoinflammatory disease over
each agent alone as determined and approved by a regulary authority
(such as the U.S. Food and Drug Administration).
[0065] By "more effective" is meant that a method, composition, or
kit exhibits greater efficacy, is less toxic, safer, more
convenient, better tolerated, or less expensive, or provides more
treatment satisfaction than another method, composition, or kit
with which it is being compared. Efficacy may be measured by a
skilled practitioner using any standard method that is appropriate
for a given indication.
[0066] The term "immunoinflammatory disorder" encompasses a variety
of conditions, including autoimmune diseases, proliferative skin
diseases, and inflammatory dermatoses. Immunoinflammatory disorders
result in the destruction of healthy tissue by an inflammatory
process, dysregulation of the immune system, and unwanted
proliferation of cells. Examples of immunoinflammatory disorders
are acne vulgaris; acute respiratory distress syndrome; Addison's
disease; allergic rhinitis; allergic intraocular inflammatory
diseases, ANCA-associated small-vessel vasculitis; ankylosing
spondylitis; arthritis, asthma; atherosclerosis; atopic dermatitis;
autoimmune hemolytic anemia; autoimmune hepatitis; Behcet's
disease; Bell's palsy; bullous pemphigoid; cerebral ischaemia;
chronic obstructive pulmonary disease; cirrhosis; Cogan's syndrome;
contact dermatitis; COPD; Crohn's disease; Cushing's syndrome;
dermatomyositis; diabetes mellitus; discoid lupus erythematosus;
eosinophilic fasciitis; erythema nodosum; exfoliative dermatitis;
fibromyalgia; focal glomerulosclerosis; giant cell arteritis; gout;
gouty arthritis; graft-versus-host disease; hand eczema;
Henoch-Schonlein purpura; herpes gestationis; hirsutism; idiopathic
cerato-scleritis; idiopathic pulmonary fibrosis; idiopathic
thrombocytopenic purpura; inflammatory bowel or gastrointestinal
disorders, inflammatory dermatoses; lichen planus; lupus nephritis;
lymphomatous tracheobronchitis; macular edema; multiple sclerosis;
myasthenia gravis; myositis; osteoarthritis; pancreatitis;
pemphigoid gestationis; pemphigus vulgaris; polyarteritis nodosa;
polymyalgia rheumatica; pruritus scroti; pruritis/inflammation,
psoriasis; psoriatic arthritis; rheumatoid arthritis; relapsing
polychondritis; rosacea caused by sarcoidosis; rosacea caused by
scleroderma; rosacea caused by Sweet's syndrome; rosacea caused by
systemic lupus erythematosus; rosacea caused by urticaria; rosacea
caused by zoster-associated pain; sarcoidosis; scleroderma;
segmental glomerulosclerosis; septic shock syndrome; shoulder
tendinitis or bursitis; Sjogren's syndrome; Still's disease;
stroke-induced brain cell death; Sweet's disease; systemic lupus
erythematosus; systemic sclerosis; Takayasu's arteritis; temporal
arteritis; toxic epidermal necrolysis; tuberculosis; type-1
diabetes; ulcerative colitis; uveitis; vasculitis; and Wegener's
granulomatosis.
[0067] "Non-dermal inflammatory disorders" include, for example,
rheumatoid arthritis, inflammatory bowel disease, asthma, and
chronic obstructive pulmonary disease.
[0068] "Dermal inflammatory disorders" or "inflammatory dernatoses"
include, for example, psoriasis, acute febrile neutrophilic
dermatosis, eczema (e.g., asteatotic eczema, dyshidrotic eczema,
vesicular palmoplantar eczema), balanitis circumscripta
plasmacellularis, balanoposthitis, Behcet's disease, erythema
annulare centrifugum, erythema dyschromicum perstans, erythema
multiforme, granuloma annulare, lichen nitidus, lichen planus,
lichen sclerosus et atrophicus, lichen simplex chronicus, lichen
spinulosus, nummular dermatitis, pyoderma gangrenosum, sarcoidosis,
subcomeal pustular dermatosis, urticaria, and transient
acantholytic dermatosis.
[0069] By "proliferative skin disease" is meant a benign or
malignant disease that is characterized by accelerated cell
division in the epidermis or dermis. Examples of proliferative skin
diseases are psoriasis, atopic dermatitis, non-specific dermatitis,
primary irritant contact dermatitis, allergic contact dermatitis,
basal and squamous cell carcinomas of the skin, lamellar
ichthyosis, epidermolytic hyperkeratosis, premalignant keratosis,
acne, and seborrheic dermatitis.
[0070] As will be appreciated by one skilled in the art, a
particular disease, disorder, or condition may be characterized as
being both a proliferative skin disease and an inflammatory
dermatosis. An example of such a disease is psoriasis.
[0071] By "sustained release" or "controlled release" is meant that
the therapeutically active component is released from the
formulation at a controlled rate such that therapeutically
beneficial blood levels (but below toxic levels) of the component
are maintained over an extended period of time ranging from e.g.,
about 12 to about 24 hours, thus, providing, for example, a 12 hour
or a 24 hour dosage form.
[0072] In the generic descriptions of compounds of this invention,
the number of atoms of a particular type in a substituent group is
generally given as a range, e.g., an alkyl group containing from 1
to 7 carbon atoms or C.sub.1-7 alkyl. Reference to such a range is
intended to include specific references to groups having each of
the integer number of atoms within the specified range. For
example, an alkyl group from 1 to 7 carbon atoms includes each of
C.sub.1, C.sub.2, C.sub.3, C.sub.4, C.sub.5, C.sub.6, and C.sub.7.
A C.sub.1-7 heteroalkyl, for example, includes from 1 to 7 carbon
atoms in addition to one or more heteroatoms. Other numbers of
atoms and other types of atoms may be indicated in a similar
manner.
[0073] As used herein, the terms "alkyl" and the prefix "alk-" are
inclusive of both straight chain and branched chain groups and of
cyclic groups, i.e., cycloalkyl. Cyclic groups can be monocyclic or
polycyclic and preferably have from 3 to 6 ring carbon atoms,
inclusive. Exemplary cyclic groups include cyclopropyl, cyclobutyl,
cyclopentyl, and cyclohexyl groups. The C.sub.1-7 alkyl group may
be substituted or unsubstituted. Exemplary substituents include
alkoxy, aryloxy, sulfhydryl, alkylthio, arylthio, halide, hydroxyl,
fluoroalkyl, perfluoralkyl, amino, aminoalkyl, disubstituted amino,
quaternary amino, hydroxyalkyl, carboxyalkyl, and carboxyl groups.
C.sub.1-7 alkyls include, without limitation, methyl; ethyl;
n-propyl; isopropyl; cyclopropyl; cyclopropylmethyl;
cyclopropylethyl; n-butyl; iso-butyl; sec-butyl; tert-butyl;
cyclobutyl; cyclobutylmethyl; cyclobutylethyl; n-pentyl;
cyclopentyl; cyclopentylmethyl; cyclopentylethyl; 1-methylbutyl;
2-methylbutyl; 3-methylbutyl; 2,2-dimethylpropyl; 1-ethylpropyl;
1,1-dimethylpropyl; 1,2-dimethylpropyl; 1-methylpentyl;
2-methylpentyl; 3-methylpentyl; 4-methylpentyl; 1,1-dimethylbutyl;
1,2-dimethylbutyl; 1,3-dimethylbutyl; 2,2-dimethylbutyl;
2,3-dimethylbutyl; 3,3-dimethylbutyl; 1-ethylbutyl; 2-ethylbutyl;
1,1,2-trimethylpropyl; 1,2,2-trimethylpropyl;
1-ethyl-1-methylpropyl; 1-ethyl-2-methylpropyl; and cyclohexyl.
[0074] By "C.sub.2-7 alkenyl" is meant a branched or unbranched
hydrocarbon group containing one or more double bonds and having
from 2 to 7 carbon atoms. A C.sub.2-7 alkenyl may optionally
include monocyclic or polycyclic rings, in which each ring
desirably has from three to six members. The C.sub.2-7 alkenyl
group may be substituted or unsubstituted. Exemplary substituents
include alkoxy, aryloxy, sulfhydryl, alkylthio, arylthio, halide,
hydroxyl, fluoroalkyl, perfluoralkyl, amino, aminoalkyl,
disubstituted amino, quaternary amino, hydroxyalkyl, carboxyalkyl,
and carboxyl groups. C.sub.2-7 alkenyls include, without
limitation, vinyl; allyl; 2-cyclopropyl-1-ethenyl; 1-propenyl;
1-butenyl; 2-butenyl; 3-butenyl; 2-methyl-1-propenyl;
2-methyl-2-propenyl; 1-pentenyl; 2-pentenyl; 3-pentenyl;
4-pentenyl; 3-methyl-1-butenyl; 3-methyl-2-butenyl;
3-methyl-3-butenyl; 2-methyl-1-butenyl; 2-methyl-2-butenyl;
2-methyl-3-butenyl; 2-ethyl-2-propenyl; 1-methyl-1-butenyl;
1-methyl-2-butenyl; 1-methyl-3-butenyl; 2-methyl-2-pentenyl;
3-methyl-2-pentenyl; 4-methyl-2-pentenyl; 2-methyl-3-pentenyl;
3-methyl-3-pentenyl; 4-methyl-3-pentenyl; 2-methyl-4-pentenyl;
3-methyl-4-pentenyl; 1,2-dimethyl-1-propenyl;
1,2-dimethyl-1-butenyl; 1,3-dimethyl-1-butenyl;
1,2-dimethyl-2-butenyl; 1,1-dimethyl-2-butenyl;
2,3-dimethyl-2-butenyl; 2,3-dimethyl-3-butenyl;
1,3-dimethyl-3-butenyl; 1,1-dimethyl-3-butenyl and
2,2-dimethyl-3-butenyl.
[0075] By "C.sub.2-7 alkynyl" is meant a branched or unbranched
hydrocarbon group containing one or more triple bonds and having
from 2 to 7 carbon atoms. A C.sub.2-7 alkynyl may optionally
include monocyclic, bicyclic, or tricyclic rings, in which each
ring desirably has five or six members. The C.sub.2-7 alkynyl group
may be substituted or unsubstituted. Exemplary substituents include
alkoxy, aryloxy, sulfhydryl, alkylthio, arylthio, halide, hydroxy,
fluoroalkyl, perfluoralkyl, amino, aminoalkyl, disubstituted amino,
quaternary amino, hydroxyalkyl, carboxyalkyl, and carboxyl groups.
C.sub.2-7 alkynyls include, without limitation, ethynyl,
1-propynyl, 2-propynyl, 1-butynyl, 2-butynyl, 3-butynyl,
1-pentynyl, 2-pentynyl, 3-pentynyl, 4-pentynyl, 5-hexene-1-ynyl,
2-hexynyl, 3-hexynyl, 4-hexynyl, 5-hexynyl; 1-methyl-2-propynyl;
1-methyl-2-butynyl; 1-methyl-3-butynyl; 2-methyl-3-butynyl;
1,2-dimethyl-3-butynyl; 2,2-dimethyl-3-butynyl;
1-methyl-2-pentynyl; 2-methyl-3-pentynyl; 1-methyl-4-pentynyl;
2-methyl-4-pentynyl; and 3-methyl-4-pentynyl.
[0076] By "C.sub.2-6 heterocyclyl" is meant a stable 5- to
7-membered monocyclic or 7- to 14-membered bicyclic heterocyclic
ring which is saturated partially unsaturated or unsaturated
(aromatic), and which consists of 2 to 6 carbon atoms and 1, 2, 3
or 4 heteroatoms independently selected from the group consisting
of N, O, and S and including any bicyclic group in which any of the
above-defined heterocyclic rings is fused to a benzene ring. The
heterocyclyl group may be substituted or unsubstituted. Exemplary
substituents include alkoxy, aryloxy, sulfhydryl, alkylthio,
arylthio, halide, hydroxy, fluoroalkyl, perfluoralkyl, amino,
aminoalkyl, disubstituted amino, quaternary amino, hydroxyalkyl,
carboxyalkyl, and carboxyl groups. The nitrogen and sulfur
heteroatoms may optionally be oxidized. The heterocyclic ring may
be covalently attached via any heteroatom or carbon atom that
results in a stable structure, e.g., an imidazolinyl ring may be
linked at either of the ring-carbon atom positions or at the
nitrogen atom. A nitrogen atom in the heterocycle may optionally be
quaternized. Preferably when the total number of S and O atoms in
the heterocycle exceeds 1, then these heteroatoms are not adjacent
to one another. Heterocycles include, without limitation,
1H-indazole, 2-pyrrolidonyl, 2H,6H-1,5,2-dithiazinyl, 2H-pyrrolyl,
3H-indolyl, 4-piperidonyl, 4aH-carbazole, 4H-quinolizinyl,
6H-1,2,5-thiadiazinyl, acridinyl, azocinyl, benzimidazolyl,
benzofuranyl, benzothiofuranyl, benzothiophenyl, benzoxazolyl,
benzthiazolyl, benztriazolyl, benztetrazolyl, benzisoxazolyl,
benzisothiazolyl, benzimidazalonyl, carbazolyl, 4aH-carbazolyl,
b-carbolinyl, chromanyl, chromenyl, cinnolinyl,
decahydroquinolinyl, 2H,6H-1,5,2-dithiazinyl,
dihydrofuro[2,3-b]tetrahydrofuran, furanyl, furazanyl,
imidazolidinyl, imidazolinyl, imidazolyl, 1H-indazolyl, indolenyl,
indolinyl, indolizinyl, indolyl, isobenzofuranyl, isochromanyl,
isoindazolyl, isoindolinyl, isoindolyl, isoquinolinyl,
isothiazolyl, isoxazolyl, morpholinyl, naphthyridinyl,
octahydroisoquinolinyl, oxadiazolyl, 1,2,3-oxadiazolyl,
1,2,4-oxadiazolyl, 1,2,5-oxadiazolyl, 1,3,4-oxadiazolyl,
oxazolidinyl, oxazolyl, oxazolidinylperimidinyl, phenanthridinyl,
phenanthrolinyl, phenarsazinyl, phenazinyl, phenothiazinyl,
phenoxathiinyl, phenoxazinyl, phthalazinyl, piperazinyl,
piperidinyl, pteridinyl, piperidonyl, 4-piperidonyl, pteridinyl,
purinyl, pyranyl, pyrazinyl, pyrazolidinyl, pyrazolinyl, pyrazolyl,
pyridazinyl, pyridooxazole, pyridoimidazole, pyridothiazole,
pyridinyl, pyridyl, pyrimidinyl, pyrrolidinyl, pyrrolinyl,
pyrrolyl, quinazolinyl, quinolinyl, 4H-quinolizinyl, quinoxalinyl,
quinuclidinyl, carbolinyl, tetrahydrofuranyl,
tetrahydroisoquinolinyl, tetrahydroquinolinyl, 1,4,5,6-tetrahydro
pyridinyl, 6H-1,2,5-thiadiazinyl, 1,2,3-thiadiazolyl,
1,2,4-thiadiazolyl, 1,2,5-thiadiazolyl, 1,3,4-thiadiazolyl,
thianthrenyl, thiazolyl, thienyl, thienothiazolyl, thienooxazolyl,
thienoimidazolyl, thiophenyl, triazinyl, 1,2,3-triazolyl,
1,2,4-triazolyl, 1,2,5-triazolyl, 1,3,4-triazolyl, xanthenyl.
Preferred 5 to 10 membered heterocycles include, but are not
limited to, pyridinyl, pyrimidinyl, triazinyl, furanyl, thienyl,
thiazolyl, pyrrolyl, pyrazolyl, imidazolyl, oxazolyl, isoxazolyl,
tetrazolyl, benzofuranyl, benzothiofuranyl, indolyl,
benzimidazolyl, 1H-indazolyl, oxazolidinyl, isoxazolidinyl,
benzotriazolyl, benzisoxazolyl, oxindolyl, benzoxazolinyl,
quinolinyl, and isoquinolinyl. Preferred 5 to 6 membered
heterocycles include, without limitation, pyridinyl, pyrimidinyl,
triazinyl, furanyl, thienyl, thiazolyl, pyrrolyl, piperazinyl,
piperidinyl, pyrazolyl, imidazolyl, oxazolyl, isoxazolyl,
1,4,5,6-tetrahydro pyridinyl, and tetrazolyl.
[0077] By "C.sub.6-12 aryl" is meant an aromatic group having a
ring system comprised of carbon atoms with conjugated .pi.
electrons (e.g., phenyl). The aryl group has from 6 to 12 carbon
atoms. Aryl groups may optionally include monocyclic, bicyclic, or
tricyclic rings, in which each ring desirably has five or six
members. The aryl group may be substituted or unsubstituted.
Exemplary subsituents include alkyl, hydroxy, alkoxy, aryloxy,
sulfhydryl, alkylthio, arylthio, halide, fluoroalkyl, carboxyl,
hydroxyalkyl, carboxyalkyl, amino, aminoalkyl, monosubstituted
amino, disubstituted amino, and quaternary amino groups.
[0078] By "C.sub.7-14 alkaryl" is meant an alkyl substituted by an
aryl group (e.g., benzyl, phenethyl, or 3,4-dichlorophenethyl)
having from 7 to 14 carbon atoms.
[0079] By "C.sub.3-10 alkheterocyclyl" is meant an alkyl
substituted heterocyclic group having from 7 to 14 carbon atoms in
addition to one or more heteroatoms (e.g., 3-furanylmethyl,
2-furanylmethyl, 3-tetrahydrofuranylmethyl, or
2-tetrahydrofuranylmethyl).
[0080] By "C.sub.1-7 heteroalkyl" is meant a branched or unbranched
alkyl, alkenyl, or alkynyl group having from 1 to 7 carbon atoms in
addition to 1, 2, 3 or 4 heteroatoms independently selected from
the group consisting of N, O, S, and P. Heteroalkyls include,
without limitation, tertiary amines, secondary amines, ethers,
thioethers, amides, thioamides, carbamates, thiocarbamates,
hydrazones, imines, phosphodiesters, phosphoramidates,
sulfonamides, and disulfides. A heteroalkyl may optionally include
monocyclic, bicyclic, or tricyclic rings, in which each ring
desirably has three to six members. The heteroalkyl group may be
substituted or unsubstituted. Exemplary substituents include
alkoxy, aryloxy, sulfhydryl, alkylthio, arylthio, halide, hydroxyl,
fluoroalkyl, perfluoralkyl, amino, aminoalkyl, disubstituted amino,
quaternary amino, hydroxyalkyl, hydroxyalkyl, carboxyalkyl, and
carboxyl groups.
[0081] By "acyl" is meant a chemical moiety with the formula
R--C(O)--, wherein R is selected from C.sub.1-7 alkyl, C.sub.2-7
alkenyl, C.sub.2-7 alkynyl, C.sub.2-6 heterocyclyl, C.sub.6-12
aryl, C.sub.7-14 alkaryl, C.sub.3-10 alkheterocyclyl, or C.sub.1-7
heteroalkyl.
[0082] By "alkoxy" is meant a chemical substituent of the formula
--OR, wherein R is selected from C.sub.1-7 alkyl, C.sub.2-7
alkenyl, C.sub.2-7 alkynyl, C.sub.2-6 heterocyclyl, C.sub.6-12
aryl, C.sub.7-14 alkaryl, C.sub.3-10 alkheterocyclyl, or C.sub.1-7
heteroalkyl.
[0083] By "aryloxy" is meant a chemical substituent of the formula
--OR, wherein R is a C.sub.6-12 aryl group.
[0084] By "amido" is meant a chemical substituent of the formula
--NRR', wherein the nitrogen atom is part of an amide bond (e.g.,
--C(O)--NRR') and wherein R and R' are each, independently,
selected from C.sub.1-7 alkyl, C.sub.2-7 alkenyl, C.sub.2-7
alkynyl, C.sub.2-6 heterocyclyl, C.sub.6-12 aryl, C.sub.7-14
alkaryl, C.sub.3-10 alkheterocyclyl, and C.sub.1-7 heteroalkyl, or
--NRR' forms a C.sub.2-6 heterocyclyl ring, as defined above, but
containing at least one nitrogen atom, such as piperidino,
morpholino, and azabicyclo, among others.
[0085] By "halide" is meant bromine, chlorine, iodine, or
fluorine.
[0086] By "fluoroalkyl" is meant an alkyl group that is substituted
with a fluorine.
[0087] By "perfluoroalkyl" is meant an alkyl group consisting of
only carbon and fluorine atoms.
[0088] By "carboxyalkyl" is meant a chemical moiety with the
formula --(R)--COOH, wherein R is selected from C.sub.1-7 alkyl,
C.sub.2-7 alkenyl, C.sub.2-7 alkynyl, C.sub.2-6 heterocyclyl,
C.sub.6-12 aryl, C.sub.7-14 alkaryl, C.sub.3-10 alkheterocyclyl, or
C.sub.1-7 heteroalkyl.
[0089] By "hydroxyalkyl" is meant a chemical moiety with the
formula --(R)--OH, wherein R is selected from C.sub.1-7 alkyl,
C.sub.2-7 alkenyl, C.sub.2-7 alkynyl, C.sub.2-6 heterocyclyl,
C.sub.6-12 aryl, C.sub.7-14 alkaryl, C.sub.3-10 alkheterocyclyl, or
C.sub.1-7 heteroalkyl.
[0090] By "alkylthio" is meant a chemical substituent of the
formula --SR, wherein R is selected from C.sub.1-7 alkyl, C.sub.2-7
alkenyl, C.sub.2-7 alkynyl, C.sub.2-6 heterocyclyl, C.sub.6-1.sub.2
aryl, C.sub.7-14 alkaryl, C.sub.3-10 alkheterocyclyl, or C.sub.1-7
heteroalkyl.
[0091] By "arylthio" is meant a chemical substituent of the formula
--SR, wherein R is a C.sub.6-12 aryl group.
[0092] By "quaternary amino" is meant a chemical substituent of the
formula --(R)--N(R')(R")(R'").sup.+, wherein R, R', R", and R'" are
each independently an alkyl, alkenyl, alkynyl, or aryl group. R may
be an alkyl group linking the quaternary amino nitrogen atom, as a
substituent, to another moiety. The nitrogen atom, N, is covalently
attached to four carbon atoms of alkyl and/or aryl groups,
resulting in a positive charge at the nitrogen atom.
[0093] The term "pharmaceutically acceptable salt" represents those
salts which are, within the scope of sound medical judgment,
suitable for use in contact with the tissues of humans and lower
animals without undue toxicity, irritation, allergic response and
the like, and are commensurate with a reasonable benefit/risk
ratio. Pharmaceutically acceptable salts are well known in the art.
The salts can be prepared in situ during the final isolation and
purification of the compounds of the invention, or separately by
reacting the free base function with a suitable organic acid.
Representative acid addition salts include acetate, adipate,
alginate, ascorbate, aspartate, benzenesulfonate, benzoate,
bisulfate, borate, butyrate, camphorate, camphersulfonate, citrate,
cyclopentanepropionate, digluconate, dodecylsulfate,
ethanesulfonate, fumarate, glucoheptonate, glycerophosphate,
hemisulfate, heptonate, hexanoate, hydrobromide, hydrochloride,
hydroiodide, 2-hydroxy-ethanesulfonate, isethionate, lactobionate,
lactate, laurate, lauryl sulfate, malate, maleate, malonate,
mesylate, methanesulfonate, 2-naphthalenesulfonate, nicotinate,
nitrate, oleate, oxalate, palmitate, pamoate, pectinate,
persulfate, 3-phenylpropionate, phosphate, picrate, pivalate,
propionate, stearate, succinate, sulfate, tartrate, thiocyanate,
toluenesulfonate, undecanoate, valerate salts, and the like.
Representative alkali or alkaline earth metal salts include sodium,
lithium, potassium, calcium, magnesium, and the like, as well as
nontoxic ammonium, quaternary ammonium, and amine cations,
including, but not limited to ammonium, tetramethylammonium,
tetraethylammonium, methylamine, dimethylamine, trimethylamine,
triethylamine, ethylamine, and the like.
[0094] Compounds useful in the invention include those described
herein in any of their pharmaceutically acceptable forms, including
isomers such as diastereomers and enantiomers, salts, esters,
amides, thioesters, solvates, and polymorphs thereof, as well as
racemic mixtures and pure isomers of the compounds described
herein. As an example, by "fexofenadine" is meant the free base, as
well as any pharmaceutically acceptable salt thereof (e.g.,
fexofenadine hydrochloride).
[0095] Other features and advantages of the invention will be
apparent from the following detailed description, and from the
claims.
DETAILED DESCRIPTION
[0096] The invention provides therapies useful for the treatment of
immunoinflammatory disorders. According to the invention, any of
the foregoing conditions may be treated by administration of an
effective amount of a tetra-substituted pyrimidopyrimidine or
analog thereof, either alone or in combination with one or more
companion compounds, including an antihistamine, a corticosteroid,
rolipram, ibudilast, a tricyclic or tetracyclic antidepressant, an
SSRI, a non-steroidal anti-inflammatory drug, a non-steroidal
immunophilin-dependent immunosuppressant, and an analog
thereof.
[0097] In one embodiment of the invention, treatment of an
immunoinflammatory disorder (e.g., an inflammatory dermatosis,
proliferative skin disease, organ transplant rejection, or graft
versus host disease) is performed by administering a
tetra-substituted pyrimidopyrimidine (or an analog thereof) and an
antihistamine to a patient in need of such treatment.
[0098] In another embodiment of the invention, treatment of an
immunoinflammatory disorder is performed by administering a
tetra-substituted pyrimidopyrimidine (or an analog thereof) and a
tricyclic or tetracyclic antidepressant to a patient in need of
such treatment.
[0099] In yet another embodiment of the invention, treatment is
performed by administering a tetra-substituted pyrimidopyrimidine
(or an analog thereof) and a selective serotonin reuptake inhibitor
to a patient suffering from any of the foregoing conditions.
[0100] In still other embodiments, treatment is performed by
administering to a patient in need of such treatment, in
conjunction with a tetra-substituted pyrimidopyrimidine or a
tetra-substituted pyrimidopyrimidine analog, a corticosteroid, or
ibudilast, or rolipram, or an analog of any of these compounds.
[0101] Routes of administration for the various embodiments
include, but are not limited to, topical, transdermal, and systemic
administration (such as, intravenous, intramuscular, subcutaneous,
inhalation, rectal, buccal, vaginal, intraperitoneal,
intraarticular, ophthalmic or oral administration). As used herein,
"systemic administration" refers to all nondermal routes of
administration, and specifically excludes topical and transdermal
routes of administration.
[0102] Any of the foregoing therapies may be administered with
conventional pharmaceuticals useful for the treatment of
immunoinflammatory disorders.
[0103] Tetra-Substituted Pyrimidopyrimidines
[0104] We have discovered that certain tetra-substituted
pyrimidopyrimidines are effective in treating immunoinflammatory
diseases, particularly those mediated by TNF.alpha., IL-1, or
IFN-.gamma..
[0105] Tetra-substituted pyrimidopyrimidines have the formula (V):
6
[0106] wherein each Z and each Z' is, independently, N, O, C, 7
[0107] When Z or Z' is O or 8
[0108] then p=1, when Z or Z' is N, 9
[0109] then p=2, and when Z or Z' is C, then p=3. In formula (V),
each R.sub.1 is, independently, X, OH, N-alkyl (wherein the alkyl
group has 1 to 20, more preferably 1-5, carbon atoms); a branched
or unbranched alkyl group having 1 to 20, more preferably 1-5,
carbon atoms; or a heterocycle, preferably as defined in formula
(Y), below. Alternatively, when p>1, two R.sub.1 groups from a
common Z or Z' atom, in combination with each other, may represent
--(CY.sub.2).sub.k-- in which k is an integer between 4 and 6,
inclusive. Each X is, independently, Y, CY.sub.3,
C(CY.sub.3).sub.3, CY.sub.2CY.sub.3, (CY.sub.2).sub.1-5OY,
substituted or unsubstituted cycloalkane of the structure
C.sub.nY.sub.2n-1, wherein n=3-7, inclusive. Each Y is,
independently, H, F, Cl, Br, or I. In one embodiment, each Z is the
same moiety, each Z' is the same moiety, and Z and Z' are different
moieties.
[0110] Tetra-substituted pyrimidopyrimidines that are useful in the
methods, compositions, and kits of this invention include
2,6-disubstituted 4,8-dibenzylaminopyrimido[5,4-d]pyrimidines.
Particularly useful tetra-substituted pyrimidopyrimidines include
dipyridamole (also known as
2,6-bis(diethanolamino)-4,8-dipiperidinopyrim-
ido(5,4-d)pyrimidine); mopidamole; dipyridamole monoacetate; NU3026
(2,6-di-(2,2-dimethyl-1,3-dioxolan-4-yl)-methoxy-4,8-di-piperidinopyrimid-
opyrimidine); NU3059
(2,6-bis-(2,3-dimethyoxypropoxy)-4,8-di-piperidinopyr-
imidopyrimidine); NU3060
(2,6-bis[N,N-di(2-methoxy)ethyl]-4,6-di-piperidin-
opyrimidopyrimidine); and NU3076
(2,6-bis(diethanolamino)-4,8-di-4-methoxy-
benzylaminopyrimidopyrimidine). Other tetra-substituted
pyrimidopyrimidines are described in U.S. Pat. Nos. 3,031,450 and
4,963,541.
[0111] The standard recommended dosage for dipyridamole is 300-400
mg/day.
[0112] In one aspect, the invention relates to a method for
inhibiting proinflammatory cytokine activity in a patient suffering
from or at risk of suffering from a disorder associated with
cytokine activity, comprising administering to the patient a unit
dose of a tetra-substituted pyrimidopyrimidine in an amount
effective to inhibit or decrease the cytokine activity in the
patient, said cytokine selected from TNF.alpha., IL-1, IL-2, IL-6,
IL-12, IL-15, or IFN-.gamma., and wherein when the
tetra-substituted pyrimidopyrimidine is dipyridamole, the unit dose
is suitable for systemic administration.
[0113] Antihistamines
[0114] Antihistamines are compounds that block the action of
histamine. Classes of antihistamines include:
[0115] (1) Ethanolamines (e.g., bromodiphenhydramine,
carbinoxamine, clemastine, dimenhydrinate, diphenhydramine,
diphenylpyraline, and doxylamine);
[0116] (2) Ethylenediamines (e.g., pheniramine, pyrilamine,
tripelennamine, and triprolidine);
[0117] (3) Phenothiazines (e.g., diethazine, ethopropazine,
methdilazine, promethazine, thiethylperazine, and
trimeprazine);
[0118] (4) Alkylamines (e.g., acrivastine, brompheniramine,
chlorpheniramine, desbrompheniramine, dexchlorpheniramine,
pyrrobutamine, and triprolidine);
[0119] (5) piperazines (e.g., buclizine, cetirizine,
chlorcyclizine, cyclizine, meclizine, hydroxyzine);
[0120] (6) Piperidines (e.g., astemizole, azatadine,
cyproheptadine, desloratadine, fexofenadine, loratadine, ketotifen,
olopatadine, phenindamine, and terfenadine);
[0121] (7) Atypical antihistamines (e.g., azelastine,
levocabastine, methapyrilene, and phenyltoxamine).
[0122] In the methods, compositions, and kits of the invention,
both non-sedating and sedating antihistamines may be employed.
Particularly desirable antihistamines for use in the methods,
compositions, and kits of the invention are non-sedating
antihistamines such as loratadine and desloratadine. Sedating
antihistamines can also be used in the methods, compositions, and
kits of the invention. Preferred sedating antihistamines are
methods, compositions, and kits of the invention are azatadine,
bromodiphenhydramine; chlorpheniramine; clemizole; cyproheptadine;
dimenhydrinate; diphenhydramine; doxylamine; meclizine;
promethazine; pyrilamine; thiethylperazine; and tripelennamine.
[0123] Other antihistamines suitable for use in the methods and
compositions of the invention are acrivastine; ahistan; antazoline;
astemizole; azelastine (e.g., azelsatine hydrochloride); bamipine;
bepotastine; bietanautine; brompheniramine (e.g., brompheniramine
maleate); carbinoxamine (e.g., carbinoxamine maleate); cetirizine
(e.g., cetirizine hydrochloride); cetoxime; chlorocyclizine;
chloropyramine; chlorothen; chlorphenoxamine; cinnarizine;
clemastine (e.g., clemastine fumarate); clobenzepam;
clobenztropine; clocinizine; cyclizine (e.g., cyclizine
hydrochloride; cyclizine lactate); deptropine; dexchlorpheniramine;
dexchlorpheniramine maleate; diphenylpyraline; doxepin; ebastine;
embramine; emedastine (e.g., emedastine difumarate); epinastine;
etymemazine hydrochloride; fexofenadine (e.g., fexofenadine
hydrochloride); histapyrrodine; hydroxyzine (e.g., hydroxyzine
hydrochloride; hydroxyzine pamoate); isopromethazine; isothipendyl;
levocabastine (e.g., levocabastine hydrochloride); mebhydroline;
mequitazine; methafurylene; methapyrilene; metron; mizolastine;
olapatadine (e.g., olopatadine hydrochloride); orphenadrine;
phenindamine (e.g., phenindamine tartrate); pheniramine;
phenyltoloxamine; p-methyldiphenhydramine; pyrrobutamine;
setastine; talastine; terfenadine; thenyldiamine; thiazinamium
(e.g., thiazinamium methylsulfate); thonzylamine hydrochloride;
tolpropamine; triprolidine; and tritoqualine.
[0124] Structural analogs of antihistamines may also be used in
according to the invention. Antihistamine analogs include, without
limitation, 10-piperazinylpropylphenothiazine;
4-(3-(2-chlorophenothiazin-10-yl)propy- l)-1-piperazineethanol
dihydrochloride; 1-(10-(3-(4-methyl-1-piperazinyl)p-
ropyl)-10H-phenothiazin-2-yl)-(9CI) 1-propanone;
3-methoxycyproheptadine;
4-(3-(2-Chloro-10H-phenothiazin-10-yl)propyl)piperazine-1-ethanol
hydrochloride;
10,11-dihydro-5-(3-(4-ethoxycarbonyl-4-phenylpiperidino)pr-
opylidene)-5H-dibenzo(a,d)cycloheptene; aceprometazine;
acetophenazine; alimemazin (e.g., alimemazin hydrochloride);
aminopromazine; benzimidazole; butaperazine; carfenazine;
chlorfenethazine; chlormidazole; cinprazole; desmethylastemizole;
desmethylcyproheptadine; diethazine (e.g., diethazine
hydrochloride); ethopropazine (e.g., ethopropazine hydrochloride);
2-(p-bromophenyl-(p'-tolyl)methoxy)-N,N-dim- ethyl-ethylamine
hydrochloride; N,N-dimethyl-2-(diphenylmethoxy)-ethylamin- e
methylbromide; EX-10-542A; fenethazine; fuprazole; methyl
10-(3-(4-methyl-1-piperazinyl)propyl)phenothiazin-2-yl ketone;
lerisetron; medrylamine; mesoridazine; methylpromazine;
N-desmethylpromethazine; nilprazole; northioridazine; perphenazine
(e.g., perphenazine enanthate);
10-(3-dimethylaminopropyl)-2-methylthio-phenothi- azine;
4-(dibenzo(b,e)thiepin-6(11H)-ylidene)-1-methyl-pip eridine
hydrochloride; prochlorperazine; promazine; propiomazine (e.g.,
propiomazine hydrochloride); rotoxamine; rupatadine; Sch 37370; Sch
434; tecastemizole; thiazinamium; thiopropazate; thioridazine
(e.g., thioridazine hydrochloride); and
3-(10,11-dihydro-5H-dibenzo(a,d)cyclohep-
ten-5-ylidene)-tropane.
[0125] Other compounds that are suitable for use in the invention
are AD-0261; AHR-5333; alinastine; arpromidine; ATI-19000;
bermastine; bilastin; Bron-12; carebastine; chlorphenamine;
clofurenadine; corsym; DF-1105501; DF-11062; DF-1111301; EL-301;
elbanizine; F-7946T; F-9505; HE-90481; HE-90512; hivenyl; HSR-609;
icotidine; KAA-276; KY-234; lamiakast; LAS-36509; LAS-36674;
levocetirizine; levoprotiline; metoclopramide; NIP-531;
noberastine; oxatomide; PR-881-884A; quisultazine; rocastine;
selenotifen; SK&F-94461; SODAS-HC; tagorizine; TAK-427;
temelastine; UCB-34742; UCB-35440; VUF-K-8707; Wy-49051; and
ZCR-2060.
[0126] Still other compounds that are suitable for use in the
invention are described in U.S. Pat. Nos. 3,956,296; 4,254,129;
4,254,130; 4,282,833; 4,283,408; 4,362,736; 4,394,508; 4,285,957;
4,285,958; 4,440,933; 4,510,309; 4,550,116; 4,692,456; 4,742,175;
4,833,138; 4,908,372; 5,204,249; 5,375,693; 5,578,610; 5,581,011;
5,589,487; 5,663,412; 5,994,549; 6,201,124; and 6,458,958.
[0127] Standard Recommended Dosages
[0128] Standard recommended dosages for several exemplary
antihistamines are shown in Table 1. Other standard dosages are
provided, e.g., in the Merck Manual of Diagnosis & Therapy
(17th Ed. MH Beers et al., Merck & Co.) and Physicians' Desk
Reference 2003 (57.sup.th Ed. Medical Economics Staff et al.,
Medical Economics Co., 2002).
1 TABLE 1 Compound Standard Dose Desloratadine 5 mg/once daily
Thiethylperazine 10 mg/1-3 times daily Bromodiphenhydramine 12.5-25
mg/every 4-6 hours Promethazine 25 mg/twice daily Cyproheptadine
12-16 mg/day Loratadine 10 mg/once daily Clemizole 100 mg given as
IV or IM Azatadine 1-2 mg/twice daily Cetirizine 5-10 mg/once daily
Chlorpheniramine 2 mg/every 6 hours or 4 mg/every 6 hours
Dimenhydramine 50-100 mg/every 4-6 hours Diphenydramine 25 mg/every
4-6 hours or 38 mg/ every 4-6 hours* Doxylamine 25 mg/once daily or
12.5 mg/ every four hours* Fexofenadine 60 mg/twice daily or 180
mg/ once daily Meclizine 25-100 mg/day Pyrilamine 30 mg/every 6
hours Tripelennamine 25-50 mg/every 4 to 6 hours or 100 mg/twice
daily (extended release)
[0129] Loratadine
[0130] Loratadine (CLARITIN) is a tricyclic piperidine that acts as
a selective peripheral histamine H1-receptor antagonist. We report
herein that loratadine and structural and functional analogs
thereof, such as piperidines, tricyclic piperidines, histamine
H1-receptor antagonists, are useful in the anti-immunoinflammatory
combination of the invention for the treatment of
immunoinflammatory disorders, transplanted organ rejection, and
graft versus host disease.
[0131] Loratadine functional and/or structural analogs include
other H1-receptor antagonists, such as AHR-11325, acrivastine,
antazoline, astemizole, azatadine, azelastine, bromopheniramine,
carebastine, cetirizine, chlorpheniramine, chlorcyclizine,
clemastine, cyproheptadine, descarboethoxyloratadine,
dexchlorpheniramine, dimenhydrinate, diphenylpyraline,
diphenhydramine, ebastine, fexofenadine, hydroxyzine ketotifen,
lodoxamide, levocabastine, methdilazine, mequitazine, oxatomide,
pheniramine pyrilamine, promethazine, pyrilamine, setastine,
tazifylline, temelastine, terfenadine, trimeprazine,
tripelennamine, triprolidine, utrizine, and similar compounds
(described, e.g., in U.S. Pat. Nos. 3,956,296, 4,254,129,
4,254,130, 4,283,408, 4,362,736, 4,394,508, 4,285,957, 4,285,958,
4,440,933, 4,510,309, 4,550,116, 4,692,456, 4,742,175, 4,908,372,
5,204,249, 5,375,693, 5,578,610, 5,581,011, 5,589,487, 5,663,412,
5,994,549, 6,201,124, and 6,458,958).
[0132] Loratadine, cetirizine, and fexofenadine are
second-generation H1-receptor antagonists that lack the sedating
effects of many first generation H1-receptor antagonists.
Piperidine H1-receptor antagonists include loratadine,
cyproheptadine hydrochloride (PERIACTIN), and phenindiamine
tartrate (NOLAHIST). Piperazine H1-receptor antagonists include
hydroxyzine hydrochloride (ATARAX), hydroxyzine pamoate (VISTARIL),
cyclizine hydrochloride (MAREZINE), cyclizine lactate, and
meclizine hydrochloride.
[0133] Loratadine Standard Recommended Dosages
[0134] Loratadine oral formulations include tablets, redi-tabs, and
syrup. Loratadine tablets contain 10 mg micronized loratadine.
Loratadine syrup contains 1 mg/ml micronized loratadine, and
reditabs (rapidly-disintegrating tablets) contain 10 mg micronized
loratadine in tablets that disintegrate quickly in the mouth. While
suggested dosages will vary with a patient's condition, standard
recommended dosages are provided below. Loratadine is typically
administered once daily in a 10 mg dose, although other daily
dosages useful in the anti-immunoinflammatory combination of the
invention include 0.01-0.05 mg, 0.05-1 mg, 1-3 mg, 3-5 mg, 5-10 mg,
10-15 mg, 15-20 mg, 20-30 mg, and 30-40 mg.
[0135] Loratadine is rapidly absorbed following oral
administration. It is metabolized in the liver to
descarboethoxyloratadine by cytochrome P450 3A4 and cytochrome P450
2D6. Loratadine metabolites are also useful in the
anti-immunoinflammatory combination of the invention.
[0136] Corticosteroids
[0137] If desired, one or more corticosteroid may be administered
in a method of the invention or may be formulated with a
tetra-substituted pyrimidopyrimidine or analog thereof in a
composition of the invention. Our data show that dipyridamole in
combination with various corticosteroids is more effective in
suppressing TNF.alpha. in vitro than either agent alone.
Accordingly, this combination may be more effective in treating
immunoinflammatory diseases, particularly those mediated by
TNF.alpha. levels, than either the tetra-substituted
pyrimidopyrimidine or corticosteroid alone. Suitable
corticosteroids include 11-alpha,
17-alpha,21-trihydroxypregn-4-ene-3,20-dione;
11-beta,16-alpha,17,21-tetr- ahydroxypregn-4-ene-3,20-dione;
11-beta,16-alpha, 17,21-tetrahydroxypregn-- 1,4-diene-3,20-dione;
11-beta, 17-alpha,21-trihydroxy-6-alpha-methylpregn--
4-ene-3,20-dione; 1-dehydrocorticosterone; 11-deoxycortisol;
11-hydroxy-1,4-androstadiene-3,17-dione; 11-ketotestosterone;
14-hydroxyandrost-4-ene-3,6,17-trione; 15,17-dihydroxyprogesterone;
16-methylhydrocortisone;
17,21-dihydroxy-16-alpha-methylpregna-1,4,9(11)--
triene-3,20-dione; 17-alpha-hydroxypregn-4-ene-3,20-dione;
17-alpha-hydroxypregnenolone;
17-hydroxy-16-beta-methyl-5-beta-pregn-9(11- )-ene-3,20-dione;
17-hydroxy-4,6,8(14)-pregnatriene-3,20-dione;
17-hydroxypregna-4,9(11)-diene-3,20-dione;
18-hydroxycorticosterone; 18-hydroxycortisone; 18-oxocortisol;
21-deoxyaldosterone; 21-deoxycortisone; 2-deoxyecdysone;
2-methylcortisone; 3-dehydroecdysone; 4-pregnene-17-alpha,20-beta,
21-triol-3,11-dione; 6,17,20-trihydroxypregn- -4-ene-3-one;
6-alpha-hydroxycortisol; 6-alpha-fluoroprednisolone,
6-alpha-methylprednisolone, 6-alpha-methylprednisolone 21-acetate,
6-alpha-methylprednisolone 21-hemisuccinate sodium salt,
6-beta-hydroxycortisol, 6-alpha, 9-alpha-difluoroprednisolone
21-acetate 17-butyrate, 6-hydroxycorticosterone;
6-hydroxydexamethasone; 6-hydroxyprednisolone; 9-fluorocortisone;
alclometasone dipropionate; aldosterone; algestone; alphaderm;
amadinone; amcinonide; anagestone; androstenedione; anecortave
acetate; beclomethasone; beclomethasone dipropionate;
beclomethasone dipropionate monohydrate; betamethasone 17-valerate;
betamethasone sodium acetate; betamethasone sodium phosphate;
betamethasone valerate; bolasterone; budesonide; calusterone;
chlormadinone; chloroprednisone; chloroprednisone acetate;
cholesterol; clobetasol; clobetasol propionate; clobetasone;
clocortolone; clocortolone pivalate; clogestone; cloprednol;
corticosterone; cortisol; cortisol acetate; cortisol butyrate;
cortisol cypionate; cortisol octanoate; cortisol sodium phosphate;
cortisol sodium succinate; cortisol valerate; cortisone; cortisone
acetate; cortodoxone; daturaolone; deflazacort, 21-deoxycortisol,
dehydroepiandrosterone; delmadinone; deoxycorticosterone;
deprodone; descinolone; desonide; desoximethasone; dexafen;
dexamethasone; dexamethasone 21-acetate; dexamethasone acetate;
dexamethasone sodium phosphate; dichlorisone; diflorasone;
diflorasone diacetate; diflucortolone; dihydroelatericin a;
domoprednate; doxibetasol; ecdysone; ecdysterone; endrysone;
enoxolone; flucinolone; fludrocortisone; fludrocortisone acetate;
flugestone; flumethasone; flumethasone pivalate; flumoxonide;
flunisolide; fluocinolone; fluocinolone acetonide; fluocinonide;
9-fluorocortisone; fluocortolone; fluorohydroxyandrostenedione;
fluorometholone; fluorometholone acetate; fluoxymesterone;
fluprednidene; fluprednisolone; flurandrenolide; fluticasone;
fluticasone propionate; formebolone; formestane; formocortal;
gestonorone; glyderinine; halcinonide; hyrcanoside; halometasone;
halopredone; haloprogesterone; hydrocortiosone cypionate;
hydrocortisone; hydrocortisone 21-butyrate; hydrocortisone
aceponate; hydrocortisone acetate; hydrocortisone buteprate;
hydrocortisone butyrate; hydrocortisone cypionate; hydrocortisone
hemisuccinate; hydrocortisone probutate; hydrocortisone sodium
phosphate; hydrocortisone sodium succinate; hydrocortisone
valerate; hydroxyprogesterone; inokosterone; isoflupredone;
isoflupredone acetate; isoprednidene; meclorisone; mecortolon;
medrogestone; medroxyprogesterone; medrysone; megestrol; megestrol
acetate; melengestrol; meprednisone; methandrostenolone;
methylprednisolone; methylprednisolone aceponate;
methylprednisolone acetate; methylprednisolone hemisuccinate;
methylprednisolone sodium succinate; methyltestosterone;
metribolone; mometasone; mometasone furoate; mometasone furoate
monohydrate; nisone; nomegestrol; norgestomet; norvinisterone;
oxymesterone; paramethasone; paramethasone acetate; ponasterone;
prednisolamate; prednisolone; prednisolone 21-hemisuccinate;
prednisolone acetate; prednisolone farnesylate; prednisolone
hemisuccinate; prednisolone-21(beta-D-glucuroni- de); prednisolone
metasulphobenzoate; prednisolone sodium phosphate; prednisolone
steaglate; prednisolone tebutate; prednisolone tetrahydrophthalate;
prednisone; prednival; prednylidene; pregnenolone; procinonide;
tralonide; progesterone; promegestone; rhapontisterone; rimexolone;
roxibolone; rubrosterone; stizophyllin; tixocortol; topterone;
triamcinolone; triamcinolone acetonide; triamcinolone acetonide
21-palmitate; triamcinolone diacetate; triamcinolone hexacetonide;
trimegestone; turkesterone; and wortmannin.
[0138] Standard recommended dosages for various steroid/disease
combinations are provided in Table 2, below.
2TABLE 2 Standard Recommended Corticosteroid Dosages Indication
Route Drug Dose Schedule Psoriasis oral prednisolone 7.5-60 mg per
day or divided b.i.d. oral prednisone 7.5-60 mg per day or divided
b.i.d. Asthma inhaled beclomethasone dipropionate 42 .mu.g/puff)
4-8 puffs b.i.d. inhaled budesonide (200 .mu.g/inhalation) 1-2
inhalations b.i.d. inhaled flunisolide (250 .mu.g/puff) 2-4 puffs
b.i.d. inhaled fluticasone propionate (44, 110 or 220 .mu.g/puff)
2-4 puffs b.i.d. inhaled triamcinolone acetonide (100 .mu.g/puff)
2-4 puffs b.i.d. COPD oral prednisone 30-40 mg per day Crohn's
disease oral budesonide 9 mg per day Ulcerative colitis oral
prednisone 40-60 mg per day oral hydrocortisone 300 mg (IV) per day
oral methylprednisolone 40-60 mg per day Rheumatoid arthritis oral
prednisone 10 mg per day
[0139] Other standard recommended dosages for corticosteroids are
provided, e.g., in the Merck Manual of Diagnosis & Therapy
(17th Ed. MH Beers et al., Merck & Co.) and Physicians' Desk
Reference 2003 (57.sup.th Ed. Medical Economics Staff et al.,
Medical Economics Co., 2002). In one embodiment, the dosage of
corticosteroid administered is a dosage equivalent to a
prednisolone dosage, as defined herein. For example, a low dosage
of a corticosteroid may be considered as the dosage equivalent to a
low dosage of prednisolone.
[0140] Steroid Receptor Modulators
[0141] Steroid receptor modulators (e.g., antagonists and agonists)
may be used as a substitute for or in addition to a corticosteroid
in the methods, compositions, and kits of the invention.
[0142] Thus, in one embodiment, the invention features the
combination of a tetra-substituted pyrimidopyridine and a
glucocorticoid receptor modulator or other steroid receptor
modulator, and methods of treating immunoinflammatory disorders
therewith.
[0143] Glucocorticoid receptor modulators that may used in the
methods, compositions, and kits of the invention include compounds
described in U.S. Pat. Nos. 6,380,207, 6,380,223, 6,448,405,
6,506,766, and 6,570,020, U.S. Patent Application Publication Nos.
2003/0176478, 2003/0171585, 2003/0120081, 2003/0073703,
2002/015631, 2002/0147336, 2002/0107235, 2002/0103217, and
2001/0041802, and PCT Publication No. WO00/66522, each of which is
hereby incorporated by reference. Other steroid receptor modulators
may also be used in the methods, compositions, and kits of the
invention are described in U.S. Pat. Nos. 6,093,821, 6,121,450,
5,994,544, 5,696,133, 5,696,127, 5,693,647, 5,693,646, 5,688,810,
5,688,808, and 5,696,130, each of which is hereby incorporated by
reference.
[0144] Other Compounds
[0145] Other compounds that may be used as a substitute for or in
addition to a corticosteroid in the methods, compositions, and kits
of the invention A-348441 (Karo Bio), adrenal cortex extract
(GlaxoSmithKline), alsactide (Aventis), amebucort (Schering AG),
amelometasone (Taisho), ATSA (Pfizer), bitolterol (Elan), CBP-2011
(InKine Pharmaceutical), cebaracetam (Novartis) CGP-13774 (Kissei),
ciclesonide (Altana), ciclometasone (Aventis), clobetasone butyrate
(GlaxoSmithKline), cloprednol (Hoffmann-La Roche), collismycin A
(Kirin), cucurbitacin E (NIH), deflazacort (Aventis), deprodone
propionate (SSP), dexamethasone acefurate (Schering-Plough),
dexamethasone linoleate (GlaxoSmithKline), dexamethasone valerate
(Abbott), difluprednate (Pfizer), domoprednate (Hoffmann-La Roche),
ebiratide (Aventis), etiprednol dicloacetate (IVAX), fluazacort
(Vicuron), flumoxonide (Hoffmann-La Roche), fluocortin butyl
(Schering AG), fluocortolone monohydrate (Schering AG),
GR-250495.times.(GlaxoSmithKIine), halometasone (Novartis),
halopredone (Dainippon), HYC-141 (Fidia), icomethasone enbutate
(Hovione), itrocinonide (AstraZeneca), L-6485 (Vicuron), Lipocort
(Draxis Health), locicortone (Aventis), meclorisone
(Schering-Plough), naflocort (Bristol-Myers Squibb), NCX-1015
(NicOx), NCX-1020 (NicOx), NCX-1022 (NicOx), nicocortonide
(Yamanouchi), NIK-236 (Nikken Chemicals), NS-126 (SSP), Org-2766
(Akzo Nobel), Org-6632 (Akzo Nobel), P16CM, propylmesterolone
(Schering AG), RGH-1113 (Gedeon Richter), rofleponide
(AstraZeneca), rofleponide palmitate (AstraZeneca), RPR-106541
(Aventis), RU-26559 (Aventis), Sch-19457 (Schering-Plough), T25
(Matrix Therapeutics), TBI-PAB (Sigma-Tau), ticabesone propionate
(Hoffmann-La Roche), tifluadom (Solvay), timobesone (Hoffmann-La
Roche), TSC-5 (Takeda), and ZK-73634 (Schering AG).
[0146] Ibudilast
[0147] A tetra-substituted pyrimidopyrimidine or a
tetra-substituted pyrimidopyrimidine analog may be administered or
formulated with ibudilast or an ibudilast analog, defined by
formula (VI). 10
[0148] In formula (VI) R.sub.1 and R.sub.2 are each, independently,
selected from H, C.sub.1-7 alkyl, C.sub.2-7 alkenyl, C.sub.2-7
alkynyl, C.sub.2-6 heterocyclyl, C.sub.6-12 aryl, C.sub.7-14
alkaryl, C.sub.3-10 alkheterocyclyl, and C.sub.1-7 heteroalkyl;
R.sub.3 is selected from H, halide, alkoxy, and C.sub.1-4 alkyl;
X.sub.1 is selected from C.dbd.O, C.dbd.N--NH--R.sub.4,
C.dbd.C(R.sub.5)--C(O)--R.sub.6, C.dbd.CH.dbd.CH--C(O)--R.sub.6,
and C(OH)--R.sub.7; R.sub.4 is selected from H and acyl; R.sub.5 is
selected from H, halide, and C.sub.1-4 alkyl; R.sub.6 is selected
from OH, alkoxy and amido; and R.sub.7 is selected from H,
C.sub.1-7 alkyl, C.sub.2-7 alkenyl, C.sub.2-7 alkynyl, C.sub.2-6
heterocyclyl, C.sub.6-12 aryl, C.sub.7-14 alkaryl, C.sub.3-10
alkheterocyclyl, and C.sub.1-7 heteroalkyl. Compounds of formula
(VI) include, the compounds described in U.S. Pat. Nos. 3,850,941;
4,097,483; 4,578,392; 4,925,849; 4,994,453; and 5,296,490.
Commercially available compounds of formula (VI) include ibudilast
and KC-764.
[0149] The standard recommended dosage for the treatment of
bronchial asthma is typically 10 mg of ibudilast twice daily, while
in the case of cerebrovascular disorders, the standard recoomended
dosage is 10 mg of ibudilast three times daily. The structure of
ibudilast is shown below: 11
[0150] KC-764 (CAS 94457-09-7) is reported to be a platelet
aggregation inhibitor. The structure of KC-764 is shown below:
12
[0151] KC-764 and other compound of formula (VI) can be prepared
using the synthetic methods described in U.S. Pat. Nos. 3,850,941;
4,097,483; 4,578,392; 4,925,849; 4,994,453; and 5,296,490.
[0152] Rolipram
[0153] In one embodiment of the invention, a tetra-substituted
pyrimidopyrimidine or analog thereof is administered or formulated
with rolipram
(4-[3-(cyclopentyloxy)-4-methoxyphenyl]-2-pyrrolidone) or an analog
of rolipram. Rolipram analogs are described by formula (I) of U.S.
Pat. No. 4,193,926, hereby incorporated by reference.
[0154] Tricyclic and Tetracyclic Antidepressants
[0155] In one embodiment of the invention, a tetra-substituted
pyrimidopyrimidine or analog thereof is administered or formulated
with a tricyclic or tetracyclic antidepressant, or an analog
thereof. By "tricyclic or tetracyclic antidepressant analog" is
meant a compound having one the formulas (I), (II), (III), or (IV):
13
[0156] or a pharmaceutically acceptable salt, ester, amide, or
derivative thereof, wherein each X is, independently, H, Cl, F, Br,
I, CH.sub.3, CF.sub.3, OH, OCH.sub.3, CH.sub.2CH.sub.3, or
OCH.sub.2CH.sub.3;Y is CH.sub.2, O, NH, S(O).sub.0-2,
(CH.sub.2).sub.3, (CH).sub.2, CH.sub.2O, CH.sub.2NH, CHN, or
CH.sub.2S; Z is C or S; A is a branched or unbranched, saturated or
monounsaturated hydrocarbon chain having between 3 and 6 carbons,
inclusive; each B is, independently, H, Cl, F, Br, I, CX.sub.3,
CH.sub.2CH.sub.3, OCX.sub.3, or OCX.sub.2CX.sub.3; and D is
CH.sub.2, O, NH, S(O).sub.0-2.
[0157] In preferred embodiments, each X is, independently, H, Cl,
or F; Y is (CH.sub.2).sub.2, Z is C; A is (CH.sub.2).sub.3; and
each B is, independently, H, Cl, or F.
[0158] Tricyclic or tetracyclic antidepressants, as well as analogs
thereof that are suitable for use in the methods and compositions
of the invention, include
10-(4-methylpiperazin-1-yl)pyrido(4,3-b)(1,4)benzothia- zepine;
11-(4-methyl-1-piperazinyl)-5H-dibenzo(b,e)(1,4)diazepine;
5,10-dihydro-7-chloro-10-(2-(morpholino)ethyl)-11H-dibenzo(b,e)(1,4)diaze-
pin-11-one;
2-(2-(7-hydroxy-4-dibenzo(b,f)(1,4)thiazepine-11-yl-1-piperazi-
nyl)ethoxy)ethanol;
2-chloro-11-(4-methyl-1-piperazinyl)-5H-dibenzo(b,e)(1-
,4)diazepine; 4-(11H-dibenz(b,e)azepin-6-yl)piperazine;
8-chloro-11-(4-methyl-1-piperazinyl)-5H-dibenzo(b,e)(1,4)diazepin-2-ol;
8-chloro-1'-(4-methyl-1-piperazinyl)-5H-dibenzo(b,e)(1,4)diazepine
monohydrochloride;
8-chloro-2-methoxy-11-(4-methyl-1-piperazinyl)-5H-dibe-
nzo(b,e)(1,4)diazepine; (Z)-2-butenedioate; 7-hydroxyamoxapine;
8-hydroxyamoxapine; 8-hydroxyloxapine; Adinazolam; Amineptine;
amitriptyline; amitriptylinoxide; amoxapine; butriptyline;
clomipramine; clothiapine; clozapine; demexiptiline; desipramine;
1'-(4-methyl-1-piperazinyl)-dibenz(b,f)(1,4)oxazepine;
11-(4-methyl-1-piperazinyl)-2-nitro-dibenz(b,f)(1,4)oxazepine;
2-chloro-1'-(4-methyl-1-piperazinyl)-dibenz(b,f)(1,4)oxazepine
monohydro chloride;
11-(4-methyl-1-piperazinyl)-dibenzo(b,f)(1,4)thiazepine;
dibenzepin; dimetacrine; dothiepin; doxepin; fluacizine;
fluperlapine; imipramine; imipramine N-oxide; iprindole
lofepramine; loxapine; loxapine hydrochloride; loxapine succinate;
maprotiline; melitracen; metapramine; metiapine; metralindole;
mianserin; mirtazapine; 8-chloro-6-(4-methyl-1-p-
iperazinyl)-morphanthridine; N-acetylamoxapine; nomifensine;
norclomipramine; norclozapine; nortriptyline; noxiptilin;
octriptyline; opipramol; oxaprotiline; perlapine; pizotyline;
propizepine; protriptyline; quetiapine; quinupramine; tianeptine;
tomoxetine; and trimipramine. Others are described in U.S. Pat.
Nos. 4,933,438 and 4,931,435.
[0159] Standard recommended dosages for several tricyclic
antidepressants are provided in Table 3, below. Other standard
dosages are provided, e.g., in the Merck Manual of Diagnosis &
Therapy (17th Ed. MH Beers et al., Merck & Co.) and Physicians'
Desk Reference 2003 (57.sup.th Ed. Medical Economics Staff et al.,
Medical Economics Co., 2002).
3 TABLE 3 Compound Standard Dose Amoxapine 200-300 mg/day
Nortriptyline 75-150 mg/day Desipramine 100-200 mg/day
[0160] Selective Serotonin Reuptake Inhibitors
[0161] In one embodiment of the invention, a tetra-substituted
pyrimidopyrimidine or analog thereof is administered or formulated
with an SSRI or an analog thereof. Suitable SSRIs include
cericlamine (e.g., cericlamine hydrochloride); citalopram (e.g.,
citalopram hydrobromide); clovoxamine; cyanodothiepin; dapoxetine;
escitalopram (escitalopram oxalate); femoxetine (e.g., femoxetine
hydrochloride); fluoxetine (e.g., fluoxetine hydrochloride);
fluvoxamine (e.g., fluvoxamine maleate); ifoxetine; indalpine
(e.g., indalpine hydrochloride); indeloxazine (e.g., indeloxazine
hydrochloride); litoxetine; milnacipran (e.g., minlacipran
hydrochloride); paroxetine (e.g., paroxetine hydrochloride
hemihydrate; paroxetine maleate; paroxetine mesylate); sertraline
(e.g., sertraline hydrochloride); tametraline hydrochloride;
viqualine; and zimeldine (e.g., zimeldine hydrochloride).
[0162] Cericlamine
[0163] Cericlamine has the following structure: 14
[0164] Structural analogs of cericlamine are those having the
formula: 15
[0165] as well as pharmaceutically acceptable salts thereof,
wherein R.sub.1 is a C.sub.1-C.sub.4 alkyl and R.sub.2 is H or
C.sub.1-4 alkyl, R.sub.3 is H, C.sub.1-4 alkyl, C.sub.2-4 alkenyl,
phenylalkyl or cycloalkylalkyl with 3 to 6 cyclic carbon atoms,
alkanoyl, phenylalkanoyl or cycloalkylcarbonyl having 3 to 6 cyclic
carbon atoms, or R.sub.2 and R.sub.3 form, together with the
nitrogen atom to which they are linked, a heterocycle saturated
with 5 to 7 chain links which can have, as the second heteroatom
not directly connected to the nitrogen atom, an oxygen, a sulphur
or a nitrogen, the latter nitrogen heteroatom possibly carrying a
C.sub.2-4 alkyl.
[0166] Exemplary cericlamine structural analogs are
2-methyl-2-amino-3-(3,4-dichlorophenyl)-propanol,
2-pentyl-2-amino-3-(3,4- -dichlorophenyl)-propanol,
2-methyl-2-methylamino-3-(3,4-dichlorophenyl)-p- ropanol,
2-methyl-2-dimethylamino-3-(3,4-dichlorophenyl)-propanol, and
pharmaceutically acceptable salts of any thereof.
[0167] Citalopram
[0168] Citalopram has the following structure: 16
[0169] Structural analogs of citalopram are those having the
formula: 17
[0170] as well as pharmaceutically acceptable salts thereof,
wherein each of R.sub.1 and R.sub.2 is independently selected from
the group consisting of bromo, chloro, fluoro, trifluoromethyl,
cyano and R--CO--, wherein R is C.sub.1-4 alkyl.
[0171] Exemplary citalopram structural analogs (which are thus SSRI
structural analogs according to the invention) are
1-(4'-fluorophenyl)-1-(3-dimethylaminopropyl)-5-bromophthalane;
1-(4'-chlorophenyl)-1-(3-dimethylaminopropyl)-5-chlorophthalane;
1-(4'-bromophenyl)-1-(3-dimethylaminopropyl)-5-chlorophthalane;
1-(4'-fluorophenyl)-1-(3-dimethylaminopropyl)-5-chlorophthalane;
1-(4'-chlorophenyl)-1-(3-dimethylaminopropyl)-5-trifluoromethyl-phthalane-
;
1-(4'-bromophenyl)-1-(3-dimethylaminopropyl)-5-trifluoromethyl-phthalane-
;
1-(4'-fluorophenyl)-1-(3-dimethylaminopropyl)-5-trifluoromethyl-phthalan-
e; 1-(4'-fluorophenyl)-1-(3-dimethylaminopropyl)-5-fluorophthalane;
1-(4'-chlorophenyl)-1-(3-dimethylaminopropyl)-5-fluorophthalane;
1-(4'-chlorophenyl)-1-(3-dimethylaminopropyl)-5-phthalancarbonitrile;
1-(4'-fluorophenyl)-1-(3-dimethylaminopropyl)-5-phthalancarbonitrile;
1-(4'-cyanophenyl)-1-(3-dimethylaminopropyl)-5-phthalancarbonitrile;
1-(4'-cyanophenyl)-1-(3-dimethylaminopropyl)-5-chlorophthalane;
1-(4'-cyanophenyl)-1-(3-dimethylaminopropyl)-5-trifluoromethylphthalane;
1-(4'-fluorophenyl)-1-(3-dimethylaminopropyl)-5-phthalancarbonitrile;
1-(4'-chlorophenyl)-1-(3-dimethylaminopropyl)-5-ionylphthalane;
1-(4-(chlorophenyl)-1-(3-dimethylaminopropyl)-5-propionylphthalane;
and pharmaceutically acceptable salts of any thereof.
[0172] Clovoxamine
[0173] Clovoxamine has the following structure: 18
[0174] Structural analogs of clovoxamine are those having the
formula: 19
[0175] as well as pharmaceutically acceptable salts thereof,
wherein Hal is a chloro, bromo, or fluoro group and R is a cyano,
methoxy, ethoxy, methoxymethyl, ethoxymethyl, methoxyethoxy, or
cyanomethyl group.
[0176] Exemplary clovoxamine structural analogs are
4'-chloro-5-ethoxyvalerophenone O-(2-aminoethyl)oxime;
4'-chloro-5-(2-methoxyethoxy)valerophenone O-(2-aminoethyl)oxime;
4'-chloro-6-methoxycaprophenone O-(2-aminoethyl)oxime;
4'-chloro-6-ethoxycaprophenone O-(2-aminoethyl)oxime;
4'-bromo-5-(2-methoxyethoxy)valerophenone O-(2-aminoethyl)oxime;
4'-bromo-5-methoxyvalerophenone O-(2-aminoethyl)oxime;
4'-chloro-6-cyanocaprophenone O-(2-aminoethyl)oxime;
4'-chloro-5-cyanovalerophenone O-(2-aminoethyl)oxime;
4'-bromo-5-cyanovalerophenone 0-(2-aminoethyl)oxime; and
pharmaceutically acceptable salts of any thereof.
[0177] Femoxetine
[0178] Femoxetine has the following structure: 20
[0179] Structural analogs of femoxetine are those having the
formula: 21
[0180] wherein R.sub.1 represents a C.sub.1-4 alkyl or C.sub.2-4
alkynyl group, or a phenyl group optionally substituted by
C.sub.1-4 alkyl, C.sub.1-4 alkylthio, C.sub.1-4 alkoxy, bromo,
chloro, fluoro, nitro, acylamino, methylsulfonyl, methylenedioxy,
or tetrahydronaphthyl, R.sub.2 represents a C.sub.1-4 alkyl or
C.sub.2-4 alkynyl group, and R.sub.3 represents hydrogen, C.sub.1-4
alkyl, C.sub.1-4alkoxy, trifluoroalkyl, hydroxy, bromo, chloro,
fluoro, methylthio, or aralkyloxy.
[0181] Exemplary femoxetine structural analogs are disclosed in
Examples 7-67 of U.S. Pat. No. 3,912,743, hereby incorporated by
reference.
[0182] Fluoxetine
[0183] Fluoxetine has the following structure: 22
[0184] Structural analogs of fluoxetine are those compounds having
the formula: 23
[0185] as well as pharmaceutically acceptable salts thereof,
wherein each R.sub.1 is independently hydrogen or methyl; R is
naphthyl or 24
[0186] wherein each of R.sub.2 and R.sub.3 is, independently,
bromo, chloro, fluoro, trifluoromethyl, C.sub.1-4 alkyl, C.sub.1-3
alkoxy or C.sub.3-4 alkenyl; and each of n and m is, independently,
0, 1 or 2. When R is naphthyl, it can be either .alpha.-naphthyl or
naphthyl.
[0187] Exemplary fluoxetine structural analogs are
3-(p-isopropoxyphenoxy)- -3-phenylpropylamine methanesulfonate,
N,N-dimethyl 3-(3',4'-dimethoxyphenoxy)-3-phenylpropylamine
p-hydroxybenzoate, N,N-dimethyl
3-.alpha.-naphthoxy)-3-phenylpropylamine bromide, N,N-dimethyl
3-(.beta.-naphthoxy)-3-phenyl-1-methylpropylamine iodide,
3-(2'-methyl-4',5'-dichlorophenoxy)-3-phenylpropylamine nitrate,
3-(p-t-butylphenoxy)-3-phenylpropylamine glutarate, N-methyl
3-(2'-chloro-p-tolyloxy)-3-phenyl-1-methylpropylamine lactate,
3-(2',4'-dichlorophenoxy)-3-phenyl-2-methylpropylamine citrate,
N,N-dimethyl 3-(m-anisyloxy)-3-phenyl-1-methylpropylamine maleate,
N-methyl 3-(p-tolyloxy)-3-phenylpropylamine sulfate, N,N-dimethyl
3-(2',4'-difluorophenoxy)-3-phenylpropylamine 2,4-dinitrobenzoate,
3-(o-ethylphenoxy)-3-phenylpropylamine dihydrogen phosphate,
N-methyl
3-(2'-chloro-4'-isopropylphenoxy)-3-phenyl-2-methylpropylamine
maleate, N,N-dimethyl
3-(2'-alkyl-4'-fluorophenoxy)-3-phenyl-propylamine succinate,
N,N-dimethyl 3-(o-isopropoxyphenoxy)-3-phenyl-propylamine
phenylacetate, N,N-dimethyl 3-(o-bromophenoxy)-3-phenyl-propylamine
.beta.-phenylpropionate, N-methyl
3-(p-iodophenoxy)-3-phenyl-propylamine propiolate, and N-methyl
3-(3-n-propylphenoxy)-3-phenyl-propylamine decanoate.
[0188] Fluvoxamine
[0189] Fluvoxamine has the following structure: 25
[0190] Structural analogs of fluvoxamine are those having the
formula: 26
[0191] as well as pharmaceutically acceptable salts thereof,
wherein R is cyano, cyanomethyl, methoxymethyl, or
ethoxymethyl.
[0192] Indalpine
[0193] Indalpine has the following structure: 27
[0194] Structural analogs of indalpine are those having the
formula: 28
[0195] or pharmaceutically acceptable salts thereof, wherein
R.sub.1 is a hydrogen atom, a C.sub.1-C.sub.4 alkyl group, or an
aralkyl group of which the alkyl has 1 or 2 carbon atoms, R.sub.2
is hydrogen, C.sub.1-4 alkyl, C.sub.1-4 alkoxy or C.sub.1-4
alkylthio, chloro, bromo, fluoro, trifluoromethyl, nitro, hydroxy,
or amino, the latter optionally substituted by one or two C.sub.1-4
alkyl groups, an acyl group or a C.sub.1-4alkylsulfonyl group; A
represents --CO or --CH.sub.2-- group; and n is 0, 1 or 2.
[0196] Exemplary indalpine structural analogs are indolyl-3
(piperidyl-4 methyl) ketone; (methoxy-5-indolyl-3) (piperidyl-4
methyl) ketone; (chloro-5-indolyl-3) (piperidyl-4 methyl) ketone;
(indolyl-3)-1(piperidyl- -4)-3 propanone, indolyl-3 piperidyl-4
ketone; (methyl-1 indolyl-3) (piperidyl-4 methyl) ketone, (benzyl-1
indolyl-3) (piperidyl-4 methyl) ketone; [(methoxy-5 indolyl-3)-2
ethyl]-piperidine, [(methyl-1 indolyl-3)-2 ethyl]-4-piperidine;
[(indolyl-3)-2 ethyl]-4 piperidine; (indolyl-3 methyl)-4
piperidine, [(chloro-5 indolyl-3)-2 ethyl]-4 piperidine;
[(indolyl-b 3)-3 propyl]-4 piperidine; [(benzyl-1 indolyl-3)-2
ethyl]-4 piperidine; and pharmaceutically acceptable salts of any
thereof.
[0197] Indeloxazine
[0198] Indeloxezine has the following structure: 29
[0199] Structural analogs of indeloxazine are those having the
formula: 30
[0200] and pharmaceutically acceptable salts thereof, wherein
R.sub.1 and R.sub.3 each represents hydrogen, C.sub.1-4 alkyl, or
phenyl; R.sub.2 represents hydrogen, C.sub.1-4 alkyl, C.sub.4-7
cycloalkyl, phenyl, or benzyl; one of the dotted lines means a
single bond and the other means a double bond, or the tautomeric
mixtures thereof.
[0201] Exemplary indeloxazine structural analogs are
2-(7-indenyloxymethyl)-4-isopropylmorpholine;
4-butyl-2-(7-indenyloxymeth- yl)morpholine;
2-(7-indenyloxymethyl)-4-methylmorpholine;
4-ethyl-2-(7-indenyloxymethyl)morpholine,
2-(7-indenyloxymethyl)-morpholi- ne;
2-(7-indenyloxymethyl)-4-propylmorpholine;
4-cyclohexyl-2-(7-indenylox- ymethyl)morpholine;
4-benzyl-2-(7-indenyloxymethyl)-morpholine;
2-(7-indenyloxymethyl)-4-phenylmorpholine;
2-(4-indenyloxymethyl)morpholi- ne;
2-(3-methyl-7-indenyloxymethyl)-morpholine;
4-isopropyl-2-(3-methyl-7-- indenyloxymethyl)morpholine;
4-isopropyl-2-(3-methyl-4-indenyloxymethyl)mo- rpholine;
4-isopropyl-2-(3-methyl-5-indenyloxymethyl)morpholine;
4-isopropyl-2-(1-methyl-3-phenyl-6-indenyloxymethyl)morpholine;
2-(5-indenyloxymethyl)-4-isopropyl-morpholine,
2-(6-indenyloxymethyl)-4-i- sopropylmorpholine; and
4-isopropyl-2-(3-phenyl-6-indenyloxymethyl)morphol- ine; as well as
pharmaceutically acceptable salts of any thereof.
[0202] Milnacipram
[0203] Milnacipram has the following structure: 31
[0204] Structural analogs of milnacipram are those having the
formula: 32
[0205] as well as pharmaceutically acceptable salts thereof,
wherein each R, independently, represents hydrogen, bromo, chloro,
fluoro, C.sub.1-4 alkyl, C.sub.1-4 alkoxy, hydroxy, nitro or amino;
each of R.sub.1 and R.sub.2, independently, represents hydrogen,
C.sub.1-4 alkyl, C.sub.6-12 aryl or C.sub.7-14 alkylaryl,
optionally substituted, preferably in para position, by bromo,
chloro, or fluoro, or R.sub.1 and R.sub.2 together form a
heterocycle having 5 or 6 members with the adjacent nitrogen atoms;
R.sub.3 and R.sub.4 represent hydrogen or a C.sub.1-4 alkyl group
or R.sub.3 and R.sub.4 form with the adjacent nitrogen atom a
heterocycle having 5 or 6 members, optionally containing an
additional heteroatom selected from nitrogen, sulphur, and
oxygen.
[0206] Exemplary milnacipram structural analogs are 1-phenyl
1-aminocarbonyl 2-dimethylaminomethyl cyclopropane; 1-phenyl
1-dimethylaminocarbonyl 2-dimethylaminomethyl cyclopropane;
1-phenyl 1-ethylaminocarbonyl 2-dimethylaminomethyl cyclopropane;
1-phenyl 1-diethylaminocarbonyl 2-aminomethyl cyclopropane;
1-phenyl 2-dimethylaminomethyl N-(4'-chlorophenyl)cyclopropane
carboxamide; 1-phenyl 2-dimethylaminomethyl
N-(4'-chlorobenzyl)cyclopropane carboxamide; 1-phenyl
2-dimethylaminomethyl N-(2-phenylethyl)cyclopropane carboxamide;
(3,4-dichloro-1-phenyl) 2-dimethylaminomethyl
N,N-dimethylcyclopropane carboxamide; 1-phenyl
1-pyrrolidinocarbonyl 2-morpholinomethyl cyclopropane;
1-p-chlorophenyl 1-aminocarbonyl 2-aminomethyl cyclopropane;
1-orthochlorophenyl 1-aminocarbonyl 2-dimethylaminomethyl
cyclopropane; 1-p-hydroxyphenyl 1-aminocarbonyl
2-dimethylaminomethyl cyclopropane; 1-p-nitrophenyl
1-dimethylaminocarbonyl 2-dimethylaminomethyl cyclopropane;
1-p-aminophenyl 1-dimethylaminocarbonyl 2-dimethylaminomethyl
cyclopropane; 1-p-tolyl 1-methylaminocarbonyl 2-dimethylaminomethyl
cyclopropane; 1-p-methoxyphenyl 1-aminomethylcarbonyl 2-aminomethyl
cyclopropane; and pharmaceutically acceptable salts of any
thereof.
[0207] Paroxetine
[0208] Paroxetine has the following structure: 33
[0209] Structural analogs of paroxetine are those having the
formula: 34
[0210] and pharmaceutically acceptable salts thereof, wherein
R.sub.1 represents hydrogen or a C.sub.1-4 alkyl group, and the
fluorine atom may be in any of the available positions.
[0211] Sertraline
[0212] Sertraline has the following structure: 35
[0213] Structural analogs of sertraline are those having the
formula: 36
[0214] wherein R.sub.1 is selected from the group consisting of
hydrogen and C.sub.1-4 alkyl; R.sub.2 is C.sub.1-4 alkyl; X and Y
are each selected from the group consisting of hydrogen, fluoro,
chloro, bromo, trifluoromethyl, C.sub.1-3 alkoxy, and cyano; and W
is selected from the group consisting of hydrogen, fluoro, chloro,
bromo, trifluoromethyl and C.sub.1-3 alkoxy. Preferred sertraline
analogs are in the cis-isomeric configuration. The term
"cis-isomeric" refers to the relative orientation of the
NR.sub.1R.sub.2 and phenyl moieties on the cyclohexene ring (i.e.
they are both oriented on the same side of the ring). Because both
the 1- and 4-carbons are asymmetrically substituted, each
cis-compound has two optically active enantiomeric forms denoted
(with reference to the 1-carbon) as the cis-(1R) and cis-(1S)
enantiomers.
[0215] Particularly useful are the following compounds, in either
the (1S)-enantiomeric or (1S)(1R) racemic forms, and their
pharmaceutically acceptable salts:
cis-N-methyl-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro--
1-naphthalenamine;
cis-N-methyl-4-(4-bromophenyl)-1,2,3,4-tetrahydro-1-nap-
hthalenamine;
cis-N-methyl-4-(4-chlorophenyl)-1,2,3,4-tetrahydro-1-naphtha-
lenamine;
cis-N-methyl-4-(3-trifluoromethyl-phenyl)-1,2,3,4-tetrahydro-1-n-
aphthalenamine;
cis-N-methyl-4-(3-trifluoromethyl-4-chlorophenyl)-1,2,3,4--
tetrahydro-1-naphthalenamine;
cis-N,N-dimethyl-4-(4-chlorophenyl)-1,2,3,4--
tetrahydro-1-naphthalenamine;
cis-N,N-dimethyl-4-(3-trifluoromethyl-phenyl-
)-1,2,3,4-tetrahydro-1-naphthalenamine; and
cis-N-methyl-4-(4-chlorophenyl-
)-7-chloro-1,2,3,4-tetrahydro-1-naphthalenamine. Of interest also
is the (1R)-enantiomer of
cis-N-methyl-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-
-1-naphthalenamine.
[0216] Sibutramine Hydrochloride Monohydrate
[0217] Sibutramine hydrochloride monohydrate (MERIDIA.TM.) is an
orally administered agent for the treatment of obesity. Sibutramine
hydrochloride is a racemic mixture of the (+) and (-) enantiomers
of cyclobutanemethanamine,
1-(4-chlorophenyl)-N,N-dimethyl-(alpha)-(2-methyl- propyl)-,
hydrochloride, monohydrate. Each MERIDIA.TM. capsule contains 5 mg,
10 mg, or 15 mg of sibutramine hydrochloride monohydrate. The
recommended starting dose of MERIDIA.TM. is 10 mg administered once
daily with or without food. If there is inadequate weight loss, the
dose may be titrated after four weeks to a total of 15 mg once
daily. The 5 mg dose is typically reserved for patients who do not
tolerate the 10 mg dose.
[0218] Zimeldine
[0219] Zimeldine has the following structure: 37
[0220] Structural analogs of zimeldine are those compounds having
the formula: 38
[0221] and pharmaceutically acceptable salts thereof, wherein the
pyridine nucleus is bound in ortho-, meta- or para-position to the
adjacent carbon atom and where R.sub.1 is selected from the group
consisting of H, chloro, fluoro, and bromo.
[0222] Exemplary zimeldine analogs are (e)- and
(z)-3-(4'-bromophenyl-3-(2- "-pyridyl)-dimethylallylamine;
3-(4'-bromophenyl)-3-(3"-pyridyl)-dimethyla- llylamine;
3-(4'-bromophenyl)-3-(4"-pyridyl)-dimethylallylamine; and
pharmaceutically acceptable salts of any thereof.
[0223] Structural analogs of any of the above SSRIs are considered
herein to be SSRI analogs and thus may be employed in any of the
methods, compositions, and kits of the invention.
[0224] Metabolites
[0225] Pharmacologically active metabolites of any of the foregoing
SSRIs can also be used in the methods, compositions, and kits of
the invention. Exemplary metabolites are didesmethylcitalopram,
desmethylcitalopram, desmethylsertraline, and norfluoxetine.
[0226] Analogs
[0227] Functional analogs of SSRIs can also be used in the methods,
compositions, and kits of the invention. Exemplary SSRI functional
analogs are provided below. One class of SSRI analogs includes
SNRIs (selective serotonin norepinephrine reuptake inhibitors),
which include venlafaxine, duloxetine, and
4-(2-fluorophenyl)-6-methyl-2-piperazinothie- no
[2,3-d]pyrimidine.
[0228] Venlafaxine
[0229] Venlafaxine hydrochloride (EFFEXOR.TM.) is an antidepressant
for oral administration. It is designated
(R/S)-1-[2-(dimethylamino)-1-(4-met- hoxyphenyl)ethyl] cyclohexanol
hydrochloride or (.+-.)-1-[(alpha)-[(dimeth-
yl-amino)methyl]-p-methoxybenzyl] cyclohexanol hydrochloride.
Compressed tablets contain venlafaxine hydrochloride equivalent to
25 mg, 37.5 mg, 50 mg, 75 mg, or 100 mg venlafaxine. The
recommended starting dose for venlafaxine is 75 mg/day,
administered in two or three divided doses, taken with food.
Depending on tolerability and the need for further clinical effect,
the dose may be increased to 150 mg/day. If desirable, the dose can
be further increased up to 225 mg/day. When increasing the dose,
increments of up to 75 mg/day are typically made at intervals of no
less than four days.
[0230] Venlafaxine has the following structure: 39
[0231] Structural analogs of venlafaxine are those compounds having
the formula: 40
[0232] as well as pharmaceutically acceptable salts thereof,
wherein A is a moiety of the formula: 41
[0233] where the dotted line represents optional unsaturation;
R.sub.1 is hydrogen or alkyl; R.sub.2 is C.sub.1-4 alkyl; R.sub.4
is hydrogen, C.sub.1-4 alkyl, formyl or alkanoyl; R.sub.3 is
hydrogen or C.sub.1-4 alkyl; R.sub.5 and R.sub.6 are,
independently, hydrogen, hydroxyl, C.sub.1-4 alkyl, C.sub.1-4
alkoxy, C.sub.1-4 alkanoyloxy, cyano, nitro, alkylmercapto, amino,
C.sub.1-4 alkylamino, dialkylamino, C.sub.1-4 alkanamido, halo,
trifluoromethyl or, taken together, methylenedioxy; and n is 0, 1,
2, 3 or 4.
[0234] Duloxetine
[0235] Duloxetine has the following structure: 42
[0236] Structural analogs of duloxetine are those compounds
described by the formula disclosed in U.S. Pat. No. 4,956,388,
hereby incorporated by reference.
[0237] Other SSRI analogs are
4-(2-fluorophenyl)-6-methyl-2-piperazinothie- no [2,3-d]pyrimidine,
1,2,3,4-tetrahydro-N-methyl-4-phenyl-1-naphthylamine hydrochloride;
1,2,3,4-tetrahydro-N-methyl-4-phenyl-(E)-1-naphthylamine
hydrochloride; N,N-dimethyl-1-phenyl-1-phthalanpropylamine
hydrochloride;
gamma-(4-(trifluoromethyl)phenoxy)-benzenepropanamine
hydrochloride; BP 554; CP 53261; O-desmethylvenlafaxine; WY 45,818;
WY 45,881; N-(3-fluoropropyl)paroxetine; Lu 19005; and SNRIs
described in PCT Publication No. WO04/004734.
[0238] Standard Recommended Dosages
[0239] Standard recommended dosages for exemplary SSRIs are
provided in Table 4, below. Other standard dosages are provided,
e.g., in the Merck Manual of Diagnosis & Therapy (17th Ed. MH
Beers et al., Merck & Co.) and Physicians' Desk Reference 2003
(57.sup.th Ed. Medical Economics Staff et al., Medical Economics
Co., 2002).
4 TABLE 4 Compound Standard Dose Fluoxetine 20-80 mg/day Sertraline
50-200 mg/day Paroxetine 20-50 mg/day Fluvoxamine 50-300 mg/day
Citalopram 10-80 mg qid Escitalopram 10 mg qid
[0240] Other Compounds
[0241] Other compounds that may be used as a substitute for or in
addition to a corticosteroid in the methods, compositions, and kits
of the invention A-348441 (Karo Bio), adrenal cortex extract
(GlaxoSmithKline), alsactide (Aventis), amebucort (Schering AG),
amelometasone (Taisho), ATSA (Pfizer), bitolterol (Elan), CBP-2011
(InKine Pharmaceutical), cebaracetam (Novartis) CGP-13774 (Kissei),
ciclesonide (Altana), ciclometasone (Aventis), clobetasone butyrate
(GlaxoSmithKline), cloprednol (Hoffmann-La Roche), collismycin A
(Kirin), cucurbitacin E (NIH), deflazacort (Aventis), deprodone
propionate (SSP), dexamethasone acefurate (Schering-Plough),
dexamethasone linoleate (GlaxoSmithKline), dexamethasone valerate
(Abbott), difluprednate (Pfizer), domoprednate (Hoffmann-La Roche),
ebiratide (Aventis), etiprednol dicloacetate (IVAX), fluazacort
(Vicuron), flumoxonide (Hoffmann-La Roche), fluocortin butyl
(Schering AG), fluocortolone monohydrate (Schering AG),
GR-250495.times.(GlaxoSmithKline), halometasone (Novartis),
halopredone (Dainippon), HYC-141 (Fidia), icomethasone enbutate
(Hovione), itrocinonide (AstraZeneca), L-6485 (Vicuron), Lipocort
(Draxis Health), locicortone (Aventis), meclorisone
(Schering-Plough), naflocort (Bristol-Myers Squibb), NCX-1015
(NicOx), NCX-1020 (NicOx), NCX-1022 (NicOx), nicocortonide
(Yamanouchi), NIK-236 (Nikken Chemicals), NS-126 (SSP), Org-2766
(Akzo Nobel), Org-6632 (Akzo Nobel), P16CM, propylmesterolone
(Schering AG), RGH-1113 (Gedeon Richter), rofleponide
(AstraZeneca), rofleponide palmitate (AstraZeneca), RPR-106541
(Aventis), RU-26559 (Aventis), Sch-19457 (Schering-Plough), T25
(Matrix Therapeutics), TBI-PAB (Sigma-Tau), ticabesone propionate
(Hoffmann-La Roche), tifluadom (Solvay), timobesone (Hoffmann-La
Roche), TSC-5 (Takeda), and ZK-73634 (Schering AG).
[0242] Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
[0243] If desired, the tetra-substituted pyrimidopyrimidines of the
invention may be administered in conjunction with one or more of
non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen
sodium, diclofenac sodium, diclofenac potassium, aspirin, sulindac,
diflunisal, piroxicam, indomethacin, ibuprofen, nabumetone, choline
magnesium trisalicylate, sodium salicylate, salicylsalicylic acid
(salsalate), fenoprofen, flurbiprofen, ketoprofen, meclofenamate
sodium, meloxicam, oxaprozin, sulindac, and tolmetin.
[0244] When tetra-substituted pyrimidopyrimidines is administered
in combination with acetylsalicylic acid, it is desirable that the
combination is effective in suppressing TNF.alpha., IL-1, IL-2 or
IFN-.gamma. in vitro. Accordingly, the combination of
tetra-substituted pyrimidopyrimidine or tetra-substituted
pyrimidopyrimidine analog in combination with acetylsalicylic acid
and their analogs may be more effective in treating
immunoinflammatory diseases, particulary those mediated by
TNF.alpha., IL-1, IL-2 or IFN-.gamma. than either agent alone.
[0245] Acetylsalicylic acid, also known by trade name aspirin, is
an acetyl derivative of salicylic acid and has the following
structural formula. 43
[0246] Aspirin is useful in the relief of headache and muscle and
joint aches. Aspirin is also effective in reducing fever,
inflammation, and swelling and thus has been used for treatment of
rheumatoid arthritis, rheumatic fever, and mild infection. Thus in
one aspect, combination of a tetra-substituted pyrimidopyrimidine
or analog thereof (e.g., dipyridamole) and acetylsalicylic acid
(aspirin) or analog thereof can also be administered to enhance the
treatment or prevention of the diseases mentioned above.
[0247] An NSAID may be administered in conjunction with any one of
the combinations described in this application. For example, a
patient suffering from immunoinflammatory disorder may be initially
treated with a combination of a tetra-substituted
pyrimidopyrimidine/SSRI or tetra-substituted
pyrimidopyrimidine/glucocorticoid receptor modulator or
tetra-substituted pyrimidopyrimidine/antihistamine or
tetra-substituted pyrimidopyrimidine/ibudilast combination and then
the patient may also be treated with an NSAID, such as
acetylsalicylic acid, in conjunction with the combinations
described above.
[0248] Dosage amounts of acetylsalicylic acid are known to those
skilled in medical arts, and generally range from about 70 mg to
about 350 mg per day. When a lower or a higher dose of aspirin is
needed, a formulation containing dipyridamole and aspirin may
contain 0-25 mg, 25-50 mg, 50-70 mg, 70-75 mg, 75-80 mg, 80-85 mg,
85-90 mg, 90-95 mg, 95-100 mg, 100-150 mg, 150-160 mg, 160-250 mg,
250-300 mg, 300-350 mg, or 350-1000 mg of aspirin.
[0249] When the combinations of the invention are used for
treatment in conjunction with an NSAIDs it is possible to reduce
the dosage of the individual components substantially to a point
far below the dosages which would be required to achieve the same
effects by administering NSAIDs (e.g., acetylsalicylic acid) or
tetra-substituted pyrimidopyrimidines alone or by administering a
combination of NSAIDs (e.g., acetylsalicylic acid) and
tetra-substituted pyrimidopyrimidines.
[0250] In one aspect, the composition comprising tetra-substituted
pyrimidopyrimidine and an NSAID has increased effectiveness,
safety, tolerability, or satisfaction of treatment of a patient
suffering from or at risk of suffering from immunoinflammatory
disorder as compared to a composition having a tetra-substituted
pyrimidopyrimidine or a NSAID alone.
[0251] Nonsteroidal Immunophilin-Dependent Immunosuppressants
[0252] In one embodiment, the invention features methods,
compositions, and kits employing an SSRI and a non-steroidal
immunophilin-dependent immunosuppressant (NsIDI), optionally with a
corticosteroid or other agent described herein.
[0253] In healthy individuals the immune system uses cellular
effectors, such as B-cells and T-cells, to target infectious
microbes and abnormal cell types while leaving normal cells intact.
In individuals with an autoimmune disorder or a transplanted organ,
activated T-cells damage healthy tissues. Calcineurin inhibitors
(e.g., cyclosporines, tacrolimus, pimecrolimus), and rapamycin
target many types of immunoregulatory cells, including T-cells, and
suppress the immune response in organ transplantation and
autoimmune disorders.
[0254] In one embodiment, the NsIDI is cyclosporine, and is
administered in an amount between 0.05 and 50 milligrams per
kilogram per day (e.g., orally in an amount between 0.1 and 12
milligrams per kilogram per day). In another embodiment, the NsIDI
is tacrolimus and is administered in an amount between 0.0001-20
milligrams per kilogram per day (e.g., orally in an amount between
0.01-0.2 milligrams per kilogram per day). In another embodiment,
the NsIDI is rapamycin and is administered in an amount between
0.1-502 milligrams per day (e.g., at a single loading dose of 6
mg/day, followed by a 2 mg/day maintenance dose). In another
embodiment, the NsIDI is everolimus, administered at a dosage of
0.75-8 mg/day. In still other embodiments, the NsIDI is
pimecrolimus, administered in an amount between 0.1 and 200
milligrams per day (e.g., as a 1% cream/twice a day to treat atopic
dermatitis or 60 mg a day for the treatment of psoriasis), or the
NsIDI is a calcineurin-binding peptide administered in an amount
and frequency sufficient to treat the patient. Two or more NsIDIs
can be administered contemporaneously.
[0255] Cyclosporines
[0256] The cyclosporines are fungal metabolites that comprise a
class of cyclic oligopeptides that act as immunosuppressants.
Cyclosporine A is a hydrophobic cyclic polypeptide consisting of
eleven amino acids. It binds and forms a complex with the
intracellular receptor cyclophilin. The cyclosporine/cyclophilin
complex binds to and inhibits calcineurin, a
Ca.sup.2+-calmodulin-dependent serine-threonine-specific protein
phosphatase. Calcineurin mediates signal transduction events
required for T-cell activation (reviewed in Schreiber et al., Cell
70:365-368, 1991). Cyclosporines and their functional and
structural analogs suppress the T cell-dependent immune response by
inhibiting antigen-triggered signal transduction. This inhibition
decreases the expression of proinflammatory cytokines, such as
IL-2.
[0257] Many different cyclosporines (e.g., cyclosporine A, B, C, D,
E, F, G, H, and I) are produced by fungi. Cyclosporine A is a
commercially available under the trade name NEORAL from Novartis.
Cyclosporine A structural and functional analogs include
cyclosporines having one or more fluorinated amino acids
(described, e.g., in U.S. Pat. No. 5,227,467); cyclosporines having
modified amino acids (described, e.g., in U.S. Pat. Nos. 5,122,511
and 4,798,823); and deuterated cyclosporines, such as ISAtx247
(described in U.S. Patent Application Publication No. 2002/0132763
A1). Additional cyclosporine analogs are described in U.S. Pat.
Nos. 6,136,357, 4,384,996, 5,284,826, and 5,709,797. Cyclosporine
analogs include, but are not limited to, D-Sar (.alpha.-SMe).sup.3
Val.sup.2-DH-Cs (209-825), Allo-Thr-2-Cs, Norvaline-2-Cs,
D-Ala(3-acetylamino)-8-Cs, Thr-2-Cs, and D-MeSer-3-Cs,
D-Ser(O--CH.sub.2CH.sub.2--OH)-8-Cs, and D-Ser-8-Cs, which are
described in Cruz et al. (Antimicrob. Agents Chemother. 44:143-149,
2000). Cyclosporines are highly hydrophobic and readily precipitate
in the presence of water (e.g. on contact with body fluids).
Methods of providing cyclosporine formulations with improved
bioavailability are described in U.S. Pat. Nos. 4,388,307,
6,468,968, 5,051,402, 5,342,625, 5,977,066, and 6,022,852.
Cyclosporine microemulsion compositions are described in U.S. Pat.
Nos. 5,866,159, 5,916,589, 5,962,014, 5,962,017, 6,007,840, and
6,024,978.
[0258] Cyclosporines can be administered either intravenously or
orally, but oral administration is preferred. To overcome the
hydrophobicity of cyclosporine A, an intravenous cyclosporine A is
usually provided in an ethanol-polyoxyethylated castor oil vehicle
that must be diluted prior to administration. Cyclosporine A may be
provided, e.g., as a microemulsion in a 25 mg or 100 mg tablets, or
in a 100 mg/ml oral solution (NEORAL).
[0259] Typically, patient dosage of an oral cyclosporine varies
according to the patient's condition, but some standard recommended
dosages are provided herein. Patients undergoing organ transplant
typically receive an initial dose of oral cyclosporine A in amounts
between 12 and 15 mg/kg/day. Dosage is then gradually decreased by
5% per week until a 7-12 mg/kg/day maintenance dose is reached. For
intravenous administration 2-6 mg/kg/day is preferred for most
patients. For patients diagnosed as having Crohn's disease or
ulcerative colitis, dosage amounts from 6-8 mg/kg/day are generally
given. For patients diagnosed as having systemic lupus
erythematosus, dosage amounts from 2.2-6.0 mg/kg/day are generally
given. For psoriasis or rheumatoid arthritis, dosage amounts from
0.5-4 mg/kg/day are typical. A suggested dosing schedule is shown
in Table 5. Other useful dosages include 0.5-5 mg/kg/day, 5-10
mg/kg/day, 10-15 mg/kg/day, 15-20 mg/kg/day, or 20-25 mg/kg/day.
Often cyclosporines are administered in combination with other
immunosuppressive agents, such as glucocorticoids.
5TABLE 5 Atopic Compound Dermatitis Psoriasis RA Crohn's UC
Transplant SLE CsA N/A 0.5-4 0.5-4 6-8 6-8 .about.7-12 2.2-6.0
(NEORAL) mg/kg/day mg/kg/day mg/kg/day mg/kg/day mg/kg/day
mg/kg/day (oral- (oral) fistulizing) Tacrolimus 0.03-0.1% 0.05-1.15
1-3 0.1-0.2 0.1-0.2 0.1-0.2 N/A cream/twice mg/kg/day mg/day
mg/kg/day mg/kg/day mg/kg/day day (30 and (oral) (oral) (oral)
(oral) (oral) 60 gram tubes) Pimecrolimus 1% 40-60 40-60 80-160
160-240 40-120 40-120 cream/twice mg/day mg/day mg/day mg/day
mg/day mg/day day (15, 30, (oral) (oral) (oral) (oral) (oral)
(oral) 100 gram tubes) Table Legend CsA = cyclosporine A RA =
rheumatoid arthritis UC = ulcerative colitis SLE = systemic lupus
erythamatosus
[0260] Tacrolimus
[0261] Tacrolimus (FK506) is an immunosuppressive agent that
targets T cell intracellular signal transduction pathways.
Tacrolimus binds to an intracellular protein FK506 binding protein
(FKBP-12) that is not structurally related to cyclophilin (Harding
et al. Nature 341:758-7601, 1989; Siekienka et al. Nature
341:755-757, 1989; and Soltoff et al., J. Biol. Chem.
267:17472-17477, 1992). The FKBP/FK506 complex binds to calcineurin
and inhibits calcineurin's phosphatase activity. This inhibition
prevents the dephosphorylation and nuclear translocation of nuclear
factor of activated T cells (NFAT), a nuclear component that
initiates gene transcription required for proinflammatory cytokine
(e.g., IL-2, gamma interferon) production and T cell activation.
Thus, tacrolimus inhibits T cell activation.
[0262] Tacrolimus is a macrolide antibiotic that is produced by
Streptomyces tsukubaensis. It suppresses the immune system and
prolongs the survival of transplanted organs. It is currently
available in oral and injectable formulations. Tacrolimus capsules
contain 0.5 mg, 1 mg, or 5 mg of anhydrous tacrolimus within a
gelatin capsule shell. The injectable formulation contains 5 mg
anhydrous tacrolimus in castor oil and alcohol that is diluted with
0.9% sodium chloride or 5% dextrose prior to injection. While oral
administration is preferred, patients unable to take oral capsules
may receive injectable tacrolimus. The initial dose should be
administered no sooner than six hours after transplant by
continuous intravenous infusion.
[0263] Tacrolimus and tacrolimus analogs are described by Tanaka et
al., (J. Am. Chem. Soc., 109:5031, 1987) and in U.S. Pat. Nos.
4,894,366, 4,929,611, and 4,956,352. FK506-related compounds,
including FR-900520, FR-900523, and FR-900525, are described in
U.S. Pat. No. 5,254,562; O-aryl, O-alkyl, O-alkenyl, and
O-alkynylmacrolides are described in U.S. Pat. Nos. 5,250,678,
532,248, 5,693,648; amino O-aryl macrolides are described in U.S.
Pat. No. 5,262,533; alkylidene macrolides are described in U.S.
Pat. No. 5,284,840; N-heteroaryl, N-alkylheteroaryl,
N-alkenylheteroaryl, and N-alkynylheteroaryl macrolides are
described in U.S. Pat. No. 5,208,241; aminomacrolides and
derivatives thereof are described in U.S. Pat. No. 5,208,228;
fluoromacrolides are described in U.S. Pat. No. 5,189,042; amino
O-alkyl, O-alkenyl, and O-alkynylmacrolides are described in U.S.
Pat. No. 5,162,334; and halomacrolides are described in U.S. Pat.
No. 5,143,918.
[0264] While suggested dosages will vary with a patient's
condition, standard recommended dosages are provided below.
Typically patients diagnosed as having Crohn's disease or
ulcerative colitis are administered 0.1-0.2 mg/kg/day oral
tacrolimus. Patients having a transplanted organ typically receive
doses of 0.1-0.2 mg/kg/day of oral tacrolimus. Patients being
treated for rheumatoid arthritis typically receive 1-3 mg/day oral
tacrolimus. For the treatment of psoriasis, 0.01-0.15 mg/kg/day of
oral tacrolimus is administered to a patient. Atopic dermatitis can
be treated twice a day by applying a cream having 0.03-0.1%
tacrolimus to the affected area. Patients receiving oral tacrolimus
capsules typically receive the first dose no sooner than six hours
after transplant, or eight to twelve hours after intravenous
tacrolimus infusion was discontinued. Other suggested tacrolimus
dosages include 0.005-0.01 mg/kg/day, 0.01-0.03 mg/kg/day,
0.03-0.05 mg/kg/day, 0.05-0.07 mg/kg/day, 0.07-0.10 mg/kg/day,
0.10-0.25 mg/kg/day, or 0.25-0.5 mg/kg/day.
[0265] Tacrolimus is extensively metabolized by the mixed-function
oxidase system, in particular, by the cytochrome P-450 system. The
primary mechanism of metabolism is demethylation and hydroxylation.
While various tacrolimus metabolites are likely to exhibit
immunosuppressive biological activity, the 13-demethyl metabolite
is reported to have the same activity as tacrolimus.
[0266] Pimecrolimus
[0267] Pimecrolimus is the 33-epi-chloro derivative of the
macrolactam ascomyin. Pimecrolimus structural and functional
analogs are described in U.S. Pat. No. 6,384,073. Pimecrolimus is
particularly useful for the treatment of atopic dermatitis.
Pimecrolimus is currently available as a 1% cream. Suggested dosing
schedule for pimecrolimus is shown at Table 5. While individual
dosing will vary with the patient's condition, some standard
recommended dosages are provided below. Oral pimecrolimus can be
given for the treatment of psoriasis or rheumatoid arthritis in
amounts of 40-60 mg/day. For the treatment of Crohn's disease or
ulcerative colitis amounts of 80-160 mg/day pimecrolimus can be
given. Patients having an organ transplant can be administered
160-240 mg/day of pimecrolimus. Patients diagnosed as having
systemic lupus erythamatosus can be administered 40-120 mg/day of
pimecrolimus. Other useful dosages of pimecrolimus include 0.5-5
mg/day, 5-10 mg/day, 10-30 mg/day, 40-80 mg/day, 80-120 mg/day, or
even 120-200 mg/day.
[0268] Rapamycin
[0269] Rapamycin is a cyclic lactone produced by Streptomyces
hygroscopicus. Rapamycin is an immunosuppressive agent that
inhibits T cell activation and proliferation. Like cyclosporines
and tacrolimus, rapamycin forms a complex with the immunophilin
FKBP-12, but the rapamycin-FKBP-12 complex does not inhibit
calcineurin phosphatase activity. The rapamycin immunophilin
complex binds to and inhibits the mammalian kinase target of
rapamycin (mTOR). mTOR is a kinase that is required for cell-cycle
progression. Inhibition of mTOR kinase activity blocks T cell
activation and proinflammatory cytokine secretion.
[0270] Rapamycin structural and functional analogs include mono-
and diacylated rapamycin derivatives (U.S. Pat. No. 4,316,885);
rapamycin water-soluble prodrugs (U.S. Pat. No. 4,650,803);
carboxylic acid esters (PCT Publication No. WO 92/05179);
carbamates (U.S. Pat. No. 5,118,678); amide esters (U.S. Pat. No.
5,118,678); biotin esters (U.S. Pat. No. 5,504,091); fluorinated
esters (U.S. Pat. No. 5,100,883); acetals (U.S. Pat. No.
5,151,413); silyl ethers (U.S. Pat. No. 5,120,842); bicyclic
derivatives (U.S. Pat. No. 5,120,725); rapamycin dimers (U.S. Pat.
No. 5,120,727); O-aryl, O-alkyl, O-alkyenyl and O-alkynyl
derivatives (U.S. Pat. No. 5,258,389); and deuterated rapamycin
(U.S. Pat. No. 6,503,921). Additional rapamycin analogs are
described in U.S. Pat. Nos. 5,202,332 and 5,169,851.
[0271] Rapamycin is currently available for oral administration in
liquid and tablet formulations. RAPAMUNE liquid contains 1 mg/mL
rapamycin that is diluted in water or orange juice prior to
administration. Tablets containing 1 or 2 mg of rapamycin are also
available. Rapamycin is preferably given once daily as soon as
possible after transplantation. It is absorbed rapidly and
completely after oral administration. Typically, patient dosage of
rapamycin varies according to the patient's condition, but some
standard recommended dosages are provided below. The initial
loading dose for rapamycin is 6 mg. Subsequent maintenance doses of
0.5-2 mg/day are typical. Alternatively, a loading dose of 3 mg, 5
mg, 10 mg, 15 mg, 20 mg, or 25 mg can be used with a 1 mg, 3 mg, 5
mg, 7 mg, or 10 mg per day maintenance dose. In patients weighing
less than 40 kg, rapamycin dosages are typically adjusted based on
body surface area; generally a 3 mg/m.sup.2/day loading dose and a
1 mg/m.sup.2/day maintenance dose is used.
[0272] Peptide Moieties
[0273] Peptides, peptide mimetics, peptide fragments, either
natural, synthetic or chemically modified, that impair the
calcineurin-mediated dephosphorylation and nuclear translocation of
NFAT are suitable for use in practicing the invention. Examples of
peptides that act as calcineurin inhibitors by inhibiting the NFAT
activation and the NFAT transcription factor are described, e.g.,
by Aramburu et al., Science 285:2129-2133, 1999) and Aramburu et
al., Mol. Cell 1:627-637, 1998). As a class of calcineurin
inhibitors, these agents are useful in the methods of the
invention.
[0274] Therapy
[0275] The invention features methods for suppressing secretion of
proinflammatory cytokines as a means for treating an
immunoinflammatory disorder, proliferative skin disease, organ
transplant rejection, or graft versus host disease.
[0276] Therapy according to the invention may be performed alone or
in conjunction with another therapy and may be provided at home,
the doctor's office, a clinic, a hospital's outpatient department,
or a hospital. The duration of the therapy depends on the type of
disease or disorder being treated, the age and condition of the
patient, the stage and type of the patient's disease, and how the
patient responds to the treatment. Additionally, a person having a
greater risk of developing an inflammatory disease (e.g., a person
who is undergoing age-related hormonal changes) may receive
treatment to inhibit or delay the onset of symptoms.
[0277] In particular embodiments of any of the methods of the
invention, the compounds are administered within 10 days of each
other, within five days of each other, within twenty-four hours of
each other, or simultaneously. The compounds may be formulated
together as a single composition, or may be formulated and
administered separately. One or both compounds may be administered
in a low dosage or in a high dosage, each of which is defined
herein. It may be desirable to administer to the patient other
compounds, such as a corticosteroid, NSAID (e.g., naproxen sodium,
diclofenac sodium, diclofenac potassium, aspirin, sulindac,
diflunisal, piroxicam, indomethacin, ibuprofen, nabumetone, choline
magnesium trisalicylate, sodium salicylate, salicylsalicylic acid,
fenoprofen, flurbiprofen, ketoprofen, meclofenamate sodium,
meloxicam, oxaprozin, sulindac, and tolmetin), COX-2 inhibitor
(e.g., rofecoxib, celecoxib, valdecoxib, and lumiracoxib),
glucocorticoid receptor modulator, or DMARD. Combination therapies
of the invention are especially useful for the treatment of
immunoinflammatory disorders in combination with other
agents--either biologics or small molecules--that modulate the
immune response to positively affect disease. Such agents include
those that deplete key inflammatory cells, influence cell adhesion,
or influence cytokines involved in immune response. This last
category includes both agents that mimic or increase the action of
anti-inflammatory cytokines such as IL-10, as well as agents
inhibit the activity of pro-inflammatory cytokines such as IL-6,
IL-1, IL-2, IL-112, IL-15 or TNF.alpha.. Agents that inhibit
TNF.alpha. include etanercept, adelimumab, infliximab, and CDP-870.
In this example (that of agents blocking the effect of TNF.alpha.),
the combination therapy reduces the production of cytokines,
etanercept or infliximab act on the remaining fraction of
inflammatory cytokines, providing enhanced treatment. Small
molecule immunodulators include, e.g., p38 MAP kinase inhibitors
such as VX 702, SCIO 469, doramapimod, RO 30201195, SCIO 323, TACE
inhibitors such as DPC 333, ICE inhibitors such as pranalcasan, and
IMPDH inhibitors such as mycophenylate and merimepodib.
[0278] In combination therapy, the dosage and frequency of
administration of each component of the combination can be
controlled independently. For example, one compound may be
administered three times per day, while the second compound may be
administered once per day. Combination therapy may be given in
on-and-off cycles that include rest periods so that the patient's
body has a chance to recover from any as yet unforeseen side
effects. The compounds may also be formulated together such that
one administration delivers both compounds.
[0279] The compound in question may be administered orally in the
form of tablets, capsules, elixirs or syrups, or rectally in the
form of suppositories. Parenteral administration of a compound is
suitably performed, for example, in the form of saline solutions or
with the compound incorporated into liposomes. In cases where the
compound in itself is not sufficiently soluble to be dissolved, a
solubilizer such as ethanol can be applied.
[0280] Desirably, the methods, compositions, and kits of the
invention are more effective than other methods, compositions, and
kits. By "more effective" is meant that a method, composition, or
kit exhibits greater efficacy, is less toxic, safer, more
convenient, better tolerated, or less expensive, or provides more
treatment satisfaction than another method, composition, or kit
with which it is being compared.
[0281] Chronic Obstructive Pulmonary Disease
[0282] In one embodiment, the methods, compositions, and kits of
the invention are used for the treatment of chronic obstructive
pulmonary disease (COPD). If desired, one or more agents typically
used to treat COPD may be used as a substitute for or in addition
to a corticosteroid in the methods, compositions, and kits of the
invention. Such agents include xanthines (e.g., theophylline),
anticholinergic compounds (e.g., ipratropium, tiotropium),
biologics, small molecule immunomodulators, and beta receptor
agonists/bronchdilators (e.g., ibuterol sulfate, bitolterol
mesylate, epinephrine, formoterol fumarate, isoproteronol,
levalbuterol hydrochloride, metaproterenol sulfate, pirbuterol
scetate, salmeterol xinafoate, and terbutaline). Thus, in one
embodiment, the invention features the combination of a
tetra-substituted pyrimidopyrimidine and a bronchodilator, and
methods of treating COPD therewith.
[0283] Psoriasis
[0284] The methods, compositions, and kits of the invention may be
used for the treatment of psoriasis. If desired, one or more
antipsoriatic agents typically used to treat psoriasis may be used
as a substitute for or in addition to a corticosteroid in the
methods, compositions, and kits of the invention. Such agents
include biologics (e.g., alefacept, inflixamab, adelimumab,
efalizumab, etanercept, and CDP-870), small molecule
immunomodulators (e.g., VX 702, SCIO 469, doramapimod, RO 30201195,
SCIO 323, DPC 333, pranalcasan, mycophenylate, and merimepodib),
non-steroidal immunophilin-dependent immunosuppressants (e.g.,
cyclosporine, tacrolimus, pimecrolimus, and ISAtx247), vitamin D
analogs (e.g., calcipotriene, calcipotriol), psoralens (e.g.,
methoxsalen), retinoids (e.g., acitretin, tazoretene), DMARDs
(e.g., methotrexate), and anthralin. Thus, in one embodiment, the
invention features the combination of a tetra-substituted
pyrimidopyrimidine and an antipsoriatic agent, and methods of
treating psoriasis therewith.
[0285] Inflammatory Bowel Disease
[0286] The methods, compositions, and kits of the invention may be
used for the treatment of inflammatory bowel disease. If desired,
one or more agents typically used to treat inflammatory bowel
disease may be used as a substitute for or in addition to a
corticosteroid in the methods, compositions, and kits of the
invention. Such agents include biologics (e.g., inflixamab,
adelimumab, and CDP-870), small molecule immunomodulators (e.g., VX
702, SCIO 469, doramapimod, RO 30201195, SCIO 323, DPC 333,
pranalcasan, mycophenylate, and merimepodib), non-steroidal
immunophilin-dependent immunosuppressants (e.g., cyclosporine,
tacrolimus, pimecrolimus, and ISAtx247), 5-amino salicylic acid
(e.g., mesalamine, sulfasalazine, balsalazide disodium, and
olsalazine sodium), DMARDs (e.g., methotrexate and azathioprine)
and alosetron. Thus, in one embodiment, the invention features the
combination of a tetra-substituted pyrimidopyrimidine and any of
the foregoing agents, and methods of treating inflammatory bowel
disease therewith.
[0287] Rheumatoid Arthritis
[0288] The methods, compositions, and kits of the invention may be
used for the treatment of rheumatoid arthritis. If desired, one or
more agents typically used to treat rheumatoid arthritis may be
used as a substitute for or in addition to a corticosteroid in the
methods, compositions, and kits of the invention. Such agents
include NSAIDs (e.g., naproxen sodium, diclofenac sodium,
diclofenac potassium, aspirin, sulindac, diflunisal, piroxicam,
indomethacin, ibuprofen, nabumetone, choline magnesium
trisalicylate, sodium salicylate, salicylsalicylic acid
(salsalate), fenoprofen, flurbiprofen, ketoprofen, meclofenamate
sodium, meloxicam, oxaprozin, sulindac, and tolmetin), COX-2
inhibitors (e.g., rofecoxib, celecoxib, valdecoxib, and
lumiracoxib), biologics (e.g., inflixamab, adelimumab, etanercept,
CDP-870, rituximab, and atlizumab), small molecule immunomodulators
(e.g., VX 702, SCIO 469, doramapimod, RO 30201195, SCIO 323, DPC
333, pranalcasan, mycophenylate, and merimepodib), non-steroidal
immunophilin-dependent immunosuppressants (e.g., cyclosporine,
tacrolimus, pimecrolimus, and ISAtx247), 5-amino salicylic acid
(e.g., mesalamine, sulfasalazine, balsalazide disodium, and
olsalazine sodium), DMARDs (e.g., methotrexate, leflunomide,
minocycline, auranofin, gold sodium thiomalate, aurothioglucose,
and azathioprine), hydroxychloroquine sulfate, and penicillamine.
Thus, in one embodiment, the invention features the combination of
a tetra-substituted pyrimidopyrimidine with any of the foregoing
agents, and methods of treating rheumatoid arthritis therewith.
[0289] Asthma
[0290] The methods, compositions, and kits of the invention may be
used for the treatment of asthma. If desired, one or more agents
typically used to treat asthma may be used as a substitute for or
in addition to a corticosteroid in the methods, compositions, and
kits of the invention. Such agents include beta 2
agonists/bronchodilators/leukotriene modifiers (e.g., zafirlukast,
montelukast, and zileuton), biologics (e.g., omalizumab), small
molecule immunomodulators, anticholinergic compounds, xanthines,
ephedrine, guaifenesin, cromolyn sodium, nedocromil sodium, and
potassium iodide. Thus, in one embodiment, the invention features
the combination of a tetra-substituted pyrimidopyrimidine and any
of the foregoing agents, and methods of treating asthma
therewith.
[0291] Formulation of Compositions
[0292] The administration of a combination of the invention may be
by any suitable means that results in suppression of
proinflammatory cytokine levels at the target region. The compound
may be contained in any appropriate amount in any suitable carrier
substance, and is generally present in an amount of 1-95% by weight
of the total weight of the composition. The composition may be
provided in a dosage form that is suitable for the oral, parenteral
(e.g., intravenously, intramuscularly), rectal, cutaneous, nasal,
vaginal, inhalant, skin (patch), or ocular administration route.
Thus, the composition may be in the form of, e.g., tablets,
capsules, pills, powders, granulates, suspensions, emulsions,
solutions, gels including hydrogels, pastes, ointments, creams,
plasters, drenches, osmotic delivery devices, suppositories,
enemas, injectables, implants, sprays, or aerosols. The
compositions may be formulated according to conventional
pharmaceutical practice (see, e.g., Remington: The Science and
Practice of Pharmacy, 20th edition, 2000, ed. A. R. Gennaro,
Lippincott Williams & Wilkins, Philadelphia, and Encyclopedia
of Pharmaceutical Technology, eds. J. Swarbrick and J. C. Boylan,
1988-1999, Marcel Dekker, New York).
[0293] Each compound of the combination may be formulated in a
variety of ways that are known in the art. For example, the first
and second agents may be formulated together or separately.
Desirably, the first and second agents are formulated together for
the simultaneous or near simultaneous administration of the agents.
Such co-formulated compositions can include, for example, the
tetra-substituted pyrimidopyrimidine and the antihistamine
formulated together in the same pill, capsule, liquid, etc. It is
to be understood that, when referring to the formulation of
"tetra-substituted pyrimidopyrimidine/antihistamine," the
formulation technology employed is also useful for the formulation
of the individual agents of the combination, as well as other
combinations of the invention (e.g., a tetra-substituted
pyrimidopyrimidine/SSRI or tetra-substituted
pyrimidopyrimidine/glucocorticoid receptor modulator combination).
By using different formulation strategies for different agents, the
pharmacokinetic profiles for each agent can be suitably
matched.
[0294] The individually or separately formulated agents can be
packaged together as a kit. Non-limiting examples include kits that
contain, e.g., two pills, a pill and a powder, a suppository and a
liquid in a vial, two topical creams, etc. The kit can include
optional components that aid in the administration of the unit dose
to patients, such as vials for reconstituting powder forms,
syringes for injection, customized IV delivery systems, inhalers,
etc. Additionally, the unit dose kit can contain instructions for
preparation and administration of the compositions. The kit may be
manufactured as a single use unit dose for one patient, multiple
uses for a particular patient (at a constant dose or in which the
individual compounds may vary in potency as therapy progresses); or
the kit may contain multiple doses suitable for administration to
multiple patients ("bulk packaging"). The kit components may be
assembled in cartons, blister packs, bottles, tubes, and the
like.
[0295] Controlled and/or Extended Release Formulations
[0296] Administration of any one of the combinations of this
invention, for example, the tetra-substituted
pyrimidopyrimidine/antihistamine combination in which one or both
of the active agents is formulated for controlled and/or extended
release is useful where the tetra-substituted pyrimidopyrimidine or
the antihistamine, has (i) a narrow therapeutic index (e.g., the
difference between the plasma concentration leading to harmful side
effects or toxic reactions and the plasma concentration leading to
a therapeutic effect is small; generally, the therapeutic index,
TI, is defined as the ratio of median lethal dose (LD.sub.50) to
median effective dose (ED.sub.50)); (ii) a narrow absorption window
in the gastro-intestinal tract; (iii) a short biological half-life;
or (iv) the pharmacokinetic profile of each component must be
modified to maximize the contribution of each agent, when used
together, to an amount of that is therapeutically effective for
cytokine suppression. Accordingly, a sustained release formulation
may be used to avoid frequent dosing that may be required in order
to sustain the plasma levels of both agents at a therapeutic level.
For example, in preferable oral compositions of the invention,
half-life and mean residency times from 10 to 20 hours for one or
both agents of the combination of the invention are observed.
[0297] Many strategies can be pursued to obtain controlled and/or
extended release in which the rate of release outweighs the rate of
metabolism of the therapeutic compound. For example, controlled
release can be obtained by the appropriate selection of formulation
parameters and ingredients (e.g., appropriate controlled release
compositions and coatings). Examples include single or multiple
unit tablet or capsule compositions, oil solutions, suspensions,
emulsions, microcapsules, microspheres, nanoparticles, patches, and
liposomes. The release mechanism can be controlled such that the
tetra-substituted pyrimidopyrimidine and/or companion compounds
(e.g., antihistamine, corticosteroid, rolipram, ibudilast,
tricyclic and tetracyclic antidepressants, SSRI, non-steroidal
anti-inflammatory drugs, non-steroidal immunophilin-dependent
immunosuppressants and analogs thereof, as described herein) are
released at period intervals, the release could be simultaneous, or
a delayed release of one of the agents of the combination can be
affected, when the early release of one particular agent is
preferred over the other.
[0298] When combined with additional compounds such as an NSAID,
COX-2 inhibitor, biologic, small molecule immunomodulator, DMARD,
xanthine, anticholinergic compound, beta receptor agonist,
bronchodilator, non-steroidal immunophilin-dependent
immunomodulators, vitamin D analog, psoralen, retinoid, and 5-amino
salicylic acid, the release mechanism of additional compounds can
also be controlled like that of the tetra-substituted
pyrimidopyrimidine and/or companion compounds (e.g., antihistamine,
corticosteroid, rolipram, ibudilast, tricyclic and tetracyclic
antidepressants, SSRI, non-steroidal immunophilin-dependent
immunosuppressants and analogs thereof, as described herein) and
are similarly released at period intervals, the release could be
simultaneous, or a delayed release of one of the agents of the
combination can be affected, when the early release of one
particular agent is preferred over the other.
[0299] When it is required to obtain a constant level of
tetra-substituted pyrimidopyrimidine in the blood, it will be
advantageous to start with tetra-substituted pyrimidopyrimidine in
the form of pellets that enable this active substance to be
released at a steady rate. For example, dipyridamole pellets can be
processed together with the acetylsalicylic acid to form
corresponding drug preparations. If it is intended that the
acetylsalicylic acid should be released first, the
dipyridamolepellets may be coated with a coating which delays the
release of this active substance and the cores containing the
acetylsalicylic acid coated with a coating that is soluble in
gastric juices. In the case of dipyridamole pellets with a
controlled release of the active substance it is particularly
advantageous to use pellets prepared according to the instructions
given in U.S. Pat. No. 4,367,217.
[0300] Controlled and/or extended release formulations may include
a degradable or nondegradable polymer, hydrogel, organogel, or
other physical construct that modifies the bioabsorption, half-life
or biodegradation of the agent. The controlled and/or extended
release formulation can be a material that is painted or otherwise
applied onto the afflicted site, either internally or externally.
In one example, the invention provides a biodegradable bolus or
implant that is surgically inserted at or near a site of interest
(for example, proximal to an arthritic joint). In another example,
the controlled release formulation implant can be inserted into an
organ, such as in the lower intestine for the treatment
inflammatory bowel disease.
[0301] Hydrogels can be used in controlled release formulations for
any one of the combinations of this invention. Such polymers are
formed from macromers with a polymerizable, non-degradable, region
that is separated by at least one degradable region. For example,
the water soluble, non-degradable, region can form the central core
of the macromer and have at least two degradable regions which are
attached to the core, such that upon degradation, the
non-degradable regions (in particular a polymerized gel) are
separated, as described in U.S. Pat. No. 5,626,863. Hydrogels can
include acrylates, which can be readily polymerized by several
initiating systems such as eosin dye, ultraviolet or visible light.
Hydrogels can also include polyethylene glycols (PEGs), which are
highly hydrophilic and biocompatible. Hydrogels can also include
oligoglycolic acid, which is a poly(.alpha.-hydroxy acid) that can
be readily degraded by hydrolysis of the ester linkage into
glycolic acid, a nontoxic metabolite. Other chain extensions can
include polylactic acid, polycaprolactone, polyorthoesters,
polyanhydrides or polypeptides. The entire network can be gelled
into a biodegradable network that can be used to entrap and
homogeneously disperse various combinations of the invention for
delivery at a controlled rate.
[0302] Chitosan and mixtures of chitosan with
carboxymethylcellulose sodium (CMC-Na) have been used as vehicles
for the sustained release of drugs, as described by Inouye et al.,
Drug Design and Delivery 1: 297-305, 1987. Mixtures of these
compounds and agents of the any one of the combinations described
above, when compressed under 200 kg/cm.sup.2, form a tablet from
which the active agent is slowly released upon administration to a
subject. The release profile can be changed by varying the ratios
of chitosan, CMC-Na, and active agent(s). The tablets can also
contain other additives, including lactose, CaHPO.sub.4 dihydrate,
sucrose, crystalline cellulose, or croscarmellose sodium. Several
examples are given in Table 6.
6TABLE 6 Materials Tablet components (mg) Active agent 20 20 20 20
20 20 20 20 20 20 20 20 Chitosan 10 10 10 10 10 20 3.3 20 3.3 70 40
28 Lactose 110 220 36.7 CMC-Na 60 60 60 60 60 120 20 120 20 30 42
CaHPO.sub.4 * 2H.sub.2O 110 220 36.7 110 110 110 Sucrose 110
Crystalline 110 Cellulose Croscarmellose 110 Na
[0303] Baichwal, in U.S. Pat. No. 6,245,356, describes a sustained
release oral solid dosage forms that includes agglomerated
particles of a therapeutically active medicament in amorphous form,
a gelling agent, an ionizable gel strength enhancing agent and an
inert diluent. The gelling agent can be a mixture of a xanthan gum
and a locust bean gum capable of cross-linking with the xanthan gum
when the gums are exposed to an environmental fluid. Preferably,
the ionizable gel enhancing agent acts to enhance the strength of
cross-linking between the xanthan gum and the locust bean gum and
thereby prolonging the release of the medicament component of the
formulation. In addition to xanthan gum and locust bean gum,
acceptable gelling agents that may also be used include those
gelling agents well known in the art. Examples include naturally
occurring or modified naturally occurring gums such as alginates,
carrageenan, pectin, guar gum, modified starch,
hydroxypropylmethylcellul- ose, methylcellulose, and other
cellulosic materials or polymers, such as, for example, sodium
carboxymethylcellulose and hydroxypropyl cellulose, and mixtures of
the foregoing.
[0304] In another formulation useful for the combinations of the
invention, Baichwal and Staniforth in U.S. Pat. No. 5,135,757
describe a free-flowing slow release granulation for use as a
pharmaceutical excipient that includes from about 20 to about 70
percent or more by weight of a hydrophilic material that includes a
heteropolysaccharide (such as, for example, xanthan gum or a
derivative thereof) and a polysaccharide material capable of
cross-linking the heteropolysaccharide (such as, for example,
galactomannans, and most preferably locust bean gum) in the
presence of aqueous solutions, and from about 30 to about 80
percent by weight of an inert pharmaceutical filler (such as, for
example, lactose, dextrose, sucrose, sorbitol, xylitol, fructose or
mixtures thereof). After mixing the excipient with a combination,
or combination agent, of the invention, the mixture is directly
compressed into solid dosage forms such as tablets. The tablets
thus formed slowly release the medicament when ingested and exposed
to gastric fluids. By varying the amount of excipient relative to
the medicament, a slow release profile can be attained.
[0305] In another formulation useful for the combinations of the
invention, Shell, in U.S. Pat. No. 5,007,790, describes
sustained-release oral drug-dosage forms that release a drug in
solution at a rate controlled by the solubility of the drug. The
dosage form comprises a tablet or capsule that includes a plurality
of particles of a dispersion of a limited solubility drug (such as,
for example, prednisolone, paroxetine, or any other agent of anyone
or all of the combination of the present invention) in a
hydrophilic, water-swellable, crosslinked polymer that maintains
its physical integrity over the dosing lifetime but thereafter
rapidly dissolves. Once ingested, the particles swell to promote
gastric retention and permit the gastric fluid to penetrate the
particles, dissolve drug and leach it from the particles, assuring
that drug reaches the stomach in the solution state which is less
injurious to the stomach than solid-state drug. The programmed
eventual dissolution of the polymer depends upon the nature of the
polymer and the degree of crosslinking. The polymer is nonfibrillar
and substantially water soluble in its uncrosslinked state, and the
degree of crosslinking is sufficient to enable the polymer to
remain insoluble for the desired time period, normally at least
from about 4 hours to 8 hours up to 12 hours, with the choice
depending upon the drug incorporated and the medical treatment
involved. Examples of suitable crosslinked polymers that may be
used in the invention are gelatin, albumin, sodium alginate,
carboxymethyl cellulose, polyvinyl alcohol, and chitin. Depending
upon the polymer, crosslinking may be achieved by thermal or
radiation treatment or through the use of crosslinking agents such
as aldehydes, polyamino acids, metal ions and the like.
[0306] Silicone microspheres for pH-controlled gastrointestinal
drug delivery that are useful in the formulation of anyone or all
of the combinations of the invention have been described by Carelli
et al., Int. J. Pharmaceutics 179: 73-83, 1999. The microspheres so
described are pH-sensitive semi-interpenetrating polymer hydrogels
made of varying proportions of poly(methacrylic
acid-co-methylmethacrylate) (Eudragit L100 or Eudragit S100) and
crosslinked polyethylene glycol 8000 that are encapsulated into
silicone microspheres in the 500 to 1000 .mu.m size range.
[0307] Slow-release formulations may include a coating that is not
readily water-soluble but is slowly attacked and removed by water,
or through which water can slowly permeate. Thus, for example, a
combination of the invention can be spray-coated with a solution of
a binder under continuously fluidizing conditions, such as describe
by Kitamori et al., U.S. Pat. No. 4,036,948. Water-soluble binders
include pregelatinized starch (e.g., pregelatinized corn starch,
pregelatinized white potato starch), pregelatinized modified
starch, water-soluble celluloses (e.g. hydroxypropyl-cellulose,
hydroxymethyl-cellulose, hydroxypropylmethyl-cel- lulose,
carboxymethyl-cellulose), polyvinylpyrrolidone, polyvinyl alcohol,
dextrin, gum arabicum and gelatin, and organic solvent-soluble
binders, such as cellulose derivatives (e.g., cellulose acetate
phthalate, hydroxypropylmethyl-cellulose phthalate,
ethylcellulose).
[0308] Combinations of the invention, or a component thereof, with
sustained release properties can also be formulated by spray drying
techniques. In one example, as described by Espositio et al.,
Pharm. Dev. Technol. 5: 267-78, 2000, prednisolone was encapsulated
in methyacrylate microparticles (Eudragit RS) using a Mini Spray
Dryer, model 190 (Buchi, Laboratorium Technik AG, Flawil, Germany).
Optimal conditions for microparticle formation were found to be a
feed (pump) rate of 0.5 mL/min of a solution containing 50 mg
prednisolone in 10 mL of acetonitrile, a flow rate of nebulized air
of 600 L/hr, dry air temperature heating at 80.degree. C., and a
flow rate of aspirated drying air of 28 m.sup.3/hr.
[0309] Yet another form of sustained release combinations can be
prepared by microencapsulation of combination agent particles in
membranes which act as microdialysis cells. In such a formulation,
gastric fluid permeates the microcapsule walls and swells the
microcapsule, allowing the active agent(s) to dialyze out (see, for
example, Tsuei et al., U.S. Pat. No. 5,589,194). One commercially
available sustained-release system of this kind consists of
microcapsules having membranes of acacia gum/gelatine/ethyl
alcohol. This product is available from Eurand Limited (France)
under the trade name Diffucaps.TM.. Microcapsules so formulated
might be carried in a conventional gelatine capsule or
tabletted.
[0310] Extended- and/or controlled-release formulations of
combinations of this invention, such as, both tetra-substituted
pyrimidopyrimidine and antihistamine or SSRI are known.
[0311] Other extended-release formulation examples are described in
U.S. Pat. No. 5,422,123. Thus, a system for the controlled release
of an active substance which is an tetra-substituted
pyrimidopyrimidine such as dipyridamole, comprising (a) a
deposit-core comprising an effective amount of the active substance
and having defined geometric form, and (b) a support-platform
applied to the deposit-core, wherein the deposit-core contains at
least the active substance, and at least one member selected from
the group consisting of (1) a polymeric material which swells on
contact with water or aqueous liquids and a gellable polymeric
material wherein the ratio of the swellable polymeric material to
the gellable polymeric material is in the range 1:9 to 9:1, and (2)
a single polymeric material having both swelling and gelling
properties, and wherein the support-platform is an elastic support,
applied to said deposit-core so that it partially covers the
surface of the deposit-core and follows changes due to hydration of
the deposit-core and is slowly soluble and/or slowly gellable in
aqueous fluids. The support-platform may comprise polymers such as
hydroxypropylmethylcellulose, plasticizers such as a glyceride,
binders such as polyvinylpyrrolidone, hydrophilic agents such as
lactose and silica, and/or hydrophobic agents such as magnesium
stearate and glycerides. The polymer(s) typically make up 30 to 90%
by weight of the support-platform, for example about 35 to 40%.
Plasticizer may make up at least 2% by weight of the
support-platform, for example about 15 to 20%. Binder(s),
hydrophilic agent(s) and hydrophobic agent(s) typically total up to
about 50% by weight of the support-platform, for example about 40
to 50%.
[0312] A controlled-release formulation of budesonide (3 mg
capsules) for the treatment of inflammatory bowel disease is
available from AstraZeneca (sold as Entocort.TM.). A
sustained-release formulation useful for corticosteroids is also
described in U.S. Pat. No. 5,792,476, where the formulation
includes 2.5-7 mg of a glucocorticoid as active substance with a
regulated sustained-release such that at least 90% by weight of the
glucocorticoid is released during a period of about 40-80 min,
starting about 1-3 h after the entry of said glucocorticoid into
the small intestine of the patient. To make these low dose levels
of active substance possible, the active substance, i.e. the
glucocorticoid, such as prednisolone or prednisone, is micronised,
suitably mixed with known diluents, such as starch and lactose, and
granulated with PVP (polyvinylpyrrolidone). Further, the granulate
is laminated with a sustained release inner layer resistant to a pH
of 6.8 and a sustained release outer layer resistant to a pH of
1.0. The inner layer is made of Eudragit.RTM.RL (copolymer of
acrylic and methacrylic esters with a low content of quaternary
ammonium groups) and the outer layer is made of Eudragi.RTM.L
(anionic polymer synthesized from methacrylic acid and methacrylic
acid methyl ester).
[0313] A bilayer tablet can be formulated for any one of the
combinations described herein in which different custom
granulations are made for each agent of the combination and the two
agents are compressed on a bi-layer press to form a single tablet.
For example, 12.5 mg, 25 mg, 37.5 mg, or 50 mg of paroxetine,
formulated for a controlled release that results in a paroxetine
t.sub.1/2 of 15 to 20 hours may be combined in the same tablet with
3 mg of predinisolone, which is formulated such that the t.sub.1/2
approximates that of paroxetine. Examples of paroxetine
extended-release formulations, including those used in bilayer
tablets, can be found in U.S. Pat. No. 6,548,084. Cyclodextrins are
cyclic polysaccharides containing naturally occurring
D(+)-glucopyranose units in an .alpha.-(1,4) linkage. Alpha-, beta-
and gamma-cyclodextrins, which contain, respectively, six, seven or
eight glucopyranose units, are most commonly used and suitable
examples are described in WO91/11172, WO94/02518 and WO98/55148.
Structurally, the cyclic nature of a cyclodextrin forms a torus or
donut-like shape having an inner apolar or hydrophobic cavity, the
secondary hydroxyl groups situated on one side of the cyclodextrin
torus and the primary hydroxyl groups situated on the other. The
side on which the secondary hydroxyl groups are located has a wider
diameter than the side on which the primary hydroxyl groups are
located. The hydrophobic nature of the cyclodextrin inner cavity
allows for the inclusion of a variety of compounds. (Comprehensive
Supramolecular Chemistry, Volume 3, J. L. Atwood et al., eds.,
Pergamon Press (1996); Cserhati, Analytical Biochemistry 225:
328-32, 1995; Husain et al., Applied Spectroscopy 46: 652-8, 1992.
Cyclodextrins have been used as a delivery vehicle of various
therapeutic compounds by forming inclusion complexes with various
drugs that can fit into the hydrophobic cavity of the cyclodextrin
or by forming non-covalent association complexes with other
biologically active molecules. U.S. Pat. No. 4,727,064 describes
pharmaceutical preparations consisting of a drug with substantially
low water solubility and an amorphous, water-soluble
cyclodextrin-based mixture in which the drug forms an inclusion
complex with the cyclodextrins of the mixture.
[0314] Formation of a drug-cyclodextrin complex can modify the
drug's solubility, dissolution rate, bioavailability, and/or
stability properties.
[0315] Sulfobutylether-.beta.-cyclodextrin (SBE-.beta.-CD,
commercially available from CyDex, Inc, Overland Park, Kans., and
sold as CAPTISOL.RTM.) can also be used as an aid in the
preparation of sustained-release formulations of agents of the
combinations of the present invention. For example, a
sustained-release tablet has been prepared that includes
prednisolone and SBE-.beta.-CD compressed in a hydroxypropyl
methylcellulose matrix (see Rao et al., J. Pharm. Sci. 90: 807-16,
2001). In another example of the use of various cyclodextrins, EP
1109806 B1 describes cyclodextrin complexes of paroxetine, where
.alpha.-, .gamma.-, or .beta.-cyclodextrins [including
eptakis(2-6-di-O-methyl)-.beta.-cyclodextrin,
(2,3,6-tri-O-methyl)-.beta.- -cyclodextrin, monosuccinyl
eptakis(2,6-di-O-methyl)-.beta.-cyclodextrin, or
2-hydroxypropyl-.beta.-cyclodextrin] in anhydrous or hydrated form
formed complex ratios of agent to cyclodextrin of from 1:0.25 to
1:20 can be obtained.
[0316] Polymeric cyclodextrins have also been prepared, as
described in U.S. patent application Ser. Nos. 10/021,294 and
10/021,312. The cyclodextrin polymers so formed can be useful for
formulating agents of the combinations of the present invention.
These multifunctional polymeric cyclodextrins are commercially
available from Insert Therapeutics, Inc., Pasadena, Calif.
[0317] As an alternative to direct complexation with agents,
cyclodextrins may be used as an auxiliary additive, e.g. as a
carrier, diluent or solubiliser. Formulations that include
cyclodextrins and other agents of the combinations of the present
invention can be prepared by methods similar to the preparations of
the cyclodextrin formulations described herein.
[0318] Liposomal Formulations
[0319] One or both components of any one of the combinations of the
invention, or mixtures of the two components together, can be
incorporated into liposomal carriers for administration. The
liposomal carriers are composed of three general types of
vesicle-forming lipid components. The first includes
vesicle-forming lipids that form the bulk of the vesicle structure
in the liposome. Generally, these vesicle-forming lipids include
any amphipathic lipids having hydrophobic and polar head group
moieties, and which (a) can form spontaneously into bilayer
vesicles in water, as exemplified by phospholipids, or (b) are
stably incorporated into lipid bilayers, with its hydrophobic
moiety in contact with the interior, hydrophobic region of the
bilayer membrane, and its polar head group moiety oriented toward
the exterior, polar surface of the membrane.
[0320] The vesicle-forming lipids of this type are preferably ones
having two hydrocarbon chains, typically acyl chains, and a polar
head group. Included in this class are the phospholipids, such as
phosphatidylcholine (PC), PE, phosphatidic acid (PA),
phosphatidylinositol (PI), and sphingomyelin (SM), where the two
hydrocarbon chains are typically between about 14-22 carbon atoms
in length, and have varying degrees of unsaturation. The
above-described lipids and phospholipids whose acyl chains have a
variety of degrees of saturation can be obtained commercially, or
prepared according to published methods. Other lipids that can be
included in the invention are glycolipids and sterols, such as
cholesterol.
[0321] The second general component includes a vesicle-forming
lipid that is derivatized with a polymer chain which will form the
polymer layer in the composition. The vesicle-forming lipids thta
can be used as the second general vesicle-forming lipid component
are any of those described for the first general vesicle-forming
lipid component. Vesicle forming lipids with diacyl chains, such as
phospholipids, are preferred. One exemplary phospholipid is
phosphatidylethanolamine (PE), which provides a reactive amino
group that is convenient for coupling to the activated polymers. An
exemplary PE is distearyl PE (DSPE).
[0322] The preferred polymer in the derivatized lipid, is
polyethyleneglycol (PEG), preferably a PEG chain having a molecular
weight between 1,000-15,000 daltons, more preferably between 2,000
and 10,000 daltons, most preferably between 2,000 and 5,000
daltons. Other hydrophilic polymers that may be suitable include
polyvinylpyrrolidone, polymethyloxazoline, polyethyloxazoline,
polyhydroxypropyl methacrylamide, polymethacrylamide and
polydimethylacrylamide, polylactic acid, polyglycolic acid, and
derivatized celluloses, such as hydroxymethylcellulose or
hydroxyethylcellulose.
[0323] Additionally, block copolymers or random copolymers of these
polymers, particularly including PEG segments, may be suitable.
Methods for preparing lipids derivatized with hydrophilic polymers,
such as PEG, are well known e.g., as described in U.S. Pat. No.
5,013,556.
[0324] A third general vesicle-forming lipid component, which is
optional, is a lipid anchor by which a targeting moiety is anchored
to the liposome, through a polymer chain in the anchor.
Additionally, the targeting group is positioned at the distal end
of the polymer chain in such a way so that the biological activity
of the targeting moiety is not lost. The lipid anchor has a
hydrophobic moiety which serves to anchor the lipid in the outer
layer of the liposome bilayer surface, a polar head group to which
the interior end of the polymer is covalently attached, and a free
(exterior) polymer end which is or can be activated for covalent
coupling to the targeting moiety. Methods for preparing lipid
anchor molecules of these types are described below.
[0325] The lipids components used in forming the liposomes are
preferably present in a molar ratio of about 70-90 percent vesicle
forming lipids, 1-25 percent polymer derivatized lipid, and 0.1-5
percent lipid anchor. One exemplary formulation includes 50-70 mole
percent underivatized PE, 20-40 mole percent cholesterol, 0.1-1
mole percent of a PE-PEG (3500) polymer with a chemically reactive
group at its free end for coupling to a targeting moiety, 5-10 mole
percent PE derivatized with PEG 3500 polymer chains, and 1 mole
percent alpha-tocopherol.
[0326] The liposomes are preferably prepared to have substantially
homogeneous sizes in a selected size range, typically between about
0.03 to 0.5 microns. One effective sizing method for REVs and MLVs
involves extruding an aqueous suspension of the liposomes through a
series of polycarbonate membranes having a selected uniform pore
size in the range of 0.03 to 0.2 micron, typically 0.05, 0.08, 0.1,
or 0.2 microns.
[0327] The pore size of the membrane corresponds roughly to the
largest sizes of liposomes produced by extrusion through that
membrane, particularly where the preparation is extruded two or
more times through the same membrane. Homogenization methods are
also useful for down-sizing liposomes to sizes of 100 nm or
less.
[0328] The liposomal formulations of the present invention include
at least one surface-active agent. Suitable surface-active agents
useful for the formulation of the various combinations described
herein include compounds belonging to the following classes:
polyethoxylated fatty acids, PEG-fatty acid diesters, PEG-fatty
acid mono-ester and di-ester mixtures, polyethylene glycol glycerol
fatty acid esters, alcohol-oil transesterification products,
polyglycerized fatty acids, propylene glycol fatty acid esters,
mixtures of propylene glycol esters and glycerol esters, mono- and
diglycerides, sterol and sterol derivatives, polyethylene glycol
sorbitan fatty acid esters, polyethylene glycol alkyl ethers, sugar
esters, polyethylene glycol alkyl phenyls,
polyoxyethylene-polyoxypropylene block copolymers, sorbitan fatty
acid esters, lower alcohol fatty acid esters, and ionic
surfactants. Commercially available examples for each class of
excipient are provided below.
[0329] Polyethoxylated fatty acids may be used as excipients for
the formulation of any one of the combinations described herein.
Examples of commercially available polyethoxylated fatty acid
monoester surfactants include: PEG 4-100 monolaurate (Crodet L
series, Croda), PEG 4-100 monooleate (Crodet 0 series, Croda), PEG
4-100 monostearate (Crodet S series, Croda, and Myij Series,
Atlas/ICI), PEG 400 distearate (Cithrol 4DS series, Croda), PEG
100, 200, or 300 monolaurate (Cithrol ML series, Croda), PEG 100,
200, or 300 monooleate (Cithrol MO series, Croda), PEG 400 dioleate
(Cithrol 4DO series, Croda), PEG 400-1000 monostearate (Cithrol MS
series, Croda), PEG-1 stearate (Nikkol MYS-1EX, Nikko, and Coster
KI, Condea), PEG-2 stearate (Nikkol MYS-2, Nikko), PEG-2 oleate
(Nikkol MYO-2, Nikko), PEG-4 laurate (Mapeg.RTM. 200 ML, PPG),
PEG-4 oleate (Mapeg.RTM. 200 MO, PPG), PEG-4 stearate (Kessco.RTM.
PEG 200 MS, Stepan), PEG-5 stearate (Nikkol TMGS-5, Nikko), PEG-5
oleate (Nikkol TMGO-5, Nikko), PEG-6 oleate (Algon OL 60, Auschem
SpA), PEG-7 oleate (Algon OL 70, Auschem SpA), PEG-6 laurate
(Kessco.RTM. PEG300 ML, Stepan), PEG-7 laurate (Lauridac 7,
Condea), PEG-6 stearate (Kessco.RTM. PEG300 MS, Stepan), PEG-8
laurate (Mapeg.RTM. 400 ML, PPG), PEG-8 oleate (Mapeg.RTM. 400 MO,
PPG), PEG-8 stearate (Mapeg.RTM. 400 MS, PPG), PEG-9 oleate
(Emulgante A9, Condea), PEG-9 stearate (Cremophor S9, BASF), PEG-10
laurate (Nikkol MYL-10, Nikko), PEG-10 oleate (Nikkol MYO-10,
Nikko), PEG-12 stearate (Nikkol MYS-10, Nikko), PEG-12 laurate
(Kessco.RTM. PEG 600 ML, Stepan), PEG-12 oleate (Kessco.RTM. PEG
600 MO, Stepan), PEG-12 ricinoleate (CAS # 9004-97-1), PEG-12
stearate (Mapeg.RTM. 600 MS, PPG), PEG-15 stearate (Nikkol TMGS-15,
Nikko), PEG-15 oleate (Nikkol TMGO-15, Nikko), PEG-20 laurate
(Kessco.RTM. PEG 1000 ML, Stepan), PEG-20 oleate (Kessco.RTM. PEG
1000 MO, Stepan), PEG-20 stearate (Mapeg.RTM. 1000 MS, PPG), PEG-25
stearate (Nikkol MYS-25, Nikko), PEG-32 laurate (Kessco.RTM. PEG
1540 ML, Stepan), PEG-32 oleate (Kessco.RTM. PEG 1540 MO, Stepan),
PEG-32 stearate (Kessco.RTM. PEG 1540 MS, Stepan), PEG-30 stearate
(Myij 51), PEG-40 laurate (Crodet L40, Croda), PEG-40 oleate
(Crodet 040, Croda), PEG-40 stearate (Emerest.RTM. 2715, Henkel),
PEG-45 stearate (Nikkol MYS-45, Nikko), PEG-50 stearate (Myrj 53),
PEG-55 stearate (Nikkol MYS-55, Nikko), PEG-100 oleate (Crodet
0-100, Croda), PEG-100 stearate (Ariacel 165, ICI), PEG-200 oleate
(Albunol 200 MO, Taiwan Surf.), PEG-400 oleate (LACTOMUL, Henkel),
and PEG-600 oleate (Albunol 600 MO, Taiwan Surf.). Formulations of
one or both components of anyone or all of the combinations
according to the invention may include one or more of the
polyethoxylated fatty acids above.
[0330] Polyethylene glycol fatty acid diesters may also be used as
excipients for anyone or all of the combinations described herein.
Examples of commercially available polyethylene glycol fatty acid
diesters include: PEG-4 dilaurate (Mapeg.RTM. 200 DL, PPG), PEG-4
dioleate (Mapeg.RTM. 200 DO, PPG), PEG-4 distearate (Kessco.RTM.
200 DS, Stepan), PEG-6 dilaurate (Kessco.RTM. PEG 300 DL, Stepan),
PEG-6 dioleate (Kessco.RTM. PEG 300 DO, Stepan), PEG-6 distearate
(Kessco.RTM. PEG 300 DS, Stepan), PEG-8 dilaurate (Mapeg.RTM. 400
DL, PPG), PEG-8 dioleate (Mapeg.RTM. 400 DO, PPG), PEG-8 distearate
(Mapeg.RTM. 400 DS, PPG), PEG-10 dipalmitate (Polyaldo 2PKFG),
PEG-12 dilaurate (Kessco.RTM. PEG 600 DL, Stepan), PEG-12
distearate (Kessco.RTM. PEG 600 DS, Stepan), PEG-12 dioleate
(Mapeg.RTM. 600 DO, PPG), PEG-20 dilaurate (Kessco.RTM. PEG 1000
DL, Stepan), PEG-20 dioleate (Kessco.RTM. PEG 1000 DO, Stepan),
PEG-20 distearate (Kessco.RTM. PEG 1000 DS, Stepan), PEG-32
dilaurate (Kessco.RTM. PEG 1540 DL, Stepan), PEG-32 dioleate
(Kessco.RTM. PEG 1540 DO, Stepan), PEG-32 distearate (Kessco.RTM.
PEG 1540 DS, Stepan), PEG-400 dioleate (Cithrol 4DO series, Croda),
and PEG-400 distearate Cithrol 4DS series, Croda). Formulations of
anyone of the combinations according to the invention may include
one or more of the polyethylene glycol fatty acid diesters
above.
[0331] PEG-fatty acid mono- and di-ester mixtures may be used as
excipients for the formulation of anyone or all of the combinations
described herein. Examples of commercially available PEG-fatty acid
mono- and di-ester mixtures include: PEG 4-150 mono, dilaurate
(Kessco.RTM. PEG 200-6000 mono, Dilaurate, Stepan), PEG 4-150 mono,
dioleate (Kessco.RTM. PEG 200-6000 mono, Dioleate, Stepan), and PEG
4-150 mono, distearate (Kessco.RTM. 200-6000 mono, Distearate,
Stepan). Formulations of the anyone or all of the combinations
according to the invention may include one or more of the PEG-fatty
acid mono- and di-ester mixtures above.
[0332] In addition, polyethylene glycol glycerol fatty acid esters
may be used as excipients for the formulation of anyone or all of
the combinations described herein. Examples of commercially
available polyethylene glycol glycerol fatty acid esters include:
PEG-20 glyceryl laurate (Tagat.RTM. L, Goldschmidt), PEG-30
glyceryl laurate (Tagat.RTM. L2, Goldschmidt), PEG-15 glyceryl
laurate (Glycerox L series, Croda), PEG-40 glyceryl laurate
(Glycerox L series, Croda), PEG-20 glyceryl stearate (Capmul.RTM.
EMG, ABITEC), and Aldo.RTM. MS-20 KFG, Lonza), PEG-20 glyceryl
oleate (Tagat.RTM. 0, Goldschmidt), and PEG-30 glyceryl oleate
(Tagat.RTM. O2, Goldschmidt). Formulations of anyone or all of the
combinations according to the invention may include one or more of
the polyethylene glycol glycerol fatty acid esters above.
[0333] Alcohol-oil transesterification products may also be used as
excipients for the formulation of anyone or all of the combinations
described herein. Examples of commercially available alcohol-oil
transesterification products include: PEG-3 castor oil (Nikkol
CO-3, Nikko), PEG-5, 9, and 16 castor oil (ACCONON CA series,
ABITEC), PEG-20 castor oil, (Emalex C-20, Nihon Emulsion), PEG-23
castor oil (Emulgante EL23), PEG-30 castor oil (Incrocas 30,
Croda), PEG-35 castor oil (Incrocas-35, Croda), PEG-38 castor oil
(Emulgante EL 65, Condea), PEG-40 castor oil (Emalex C-40, Nihon
Emulsion), PEG-50 castor oil (Emalex C-50, Nihon Emulsion), PEG-56
castor oil (Eumulgin.RTM. PRT 56, Pulcra SA), PEG-60 castor oil
(Nikkol CO-60TX, Nikko), PEG-100 castor oil, PEG-200 castor oil
(Eumulgin.RTM. PRT 200, Pulcra SA), PEG-5 hydrogenated castor oil
(Nikkol HCO-5, Nikko), PEG-7 hydrogenated castor oil (Cremophor
WO7, BASF), PEG-10 hydrogenated castor oil (Nikkol HCO-10, Nikko),
PEG-20 hydrogenated castor oil (Nikkol HCO-20, Nikko), PEG-25
hydrogenated castor oil (Simulsol.RTM. 1292, Seppic), PEG-30
hydrogenated castor oil (Nikkol HCO-30, Nikko), PEG-40 hydrogenated
castor oil (Cremophor RH 40, BASF), PEG-45 hydrogenated castor oil
(Cerex ELS 450, Auschem Spa), PEG-50 hydrogenated castor oil
(Emalex HC-50, Nihon Emulsion), PEG-60 hydrogenated castor oil
(Nikkol HCO-60, Nikko), PEG-80 hydrogenated castor oil (Nikkol
HCO-80, Nikko), PEG-100 hydrogenated castor oil (Nikkol HCO-100,
Nikko), PEG-6 corn oil (Labrafil.RTM. M 2125 CS, Gattefosse), PEG-6
almond oil (Labrafil.RTM. M 1966 CS, Gattefosse), PEG-6 apricot
kernel oil (Labrafil.RTM. M 1944 CS, Gattefosse), PEG-6 olive oil
(Labrafil.RTM. M 1980 CS, Gattefosse), PEG-6 peanut oil
(Labrafil.RTM. M 1969 CS, Gattefosse), PEG-6 hydrogenated palm
kernel oil (Labrafil.RTM. M 2130 BS, Gattefosse), PEG-6 palm kernel
oil (Labrafil.RTM. M 2130 CS, Gattefosse), PEG-6 triolein
(Labrafil.RTM. M 2735 CS, Gattefosse), PEG-8 corn oil
(Labrafil.RTM. WL 2609 BS, Gattefosse), PEG-20 corn glycerides
(Crovol M40, Croda), PEG-20 almond glycerides (Crovol A40, Croda),
PEG-25 trioleate (TAGAT.RTM. TO, Goldschmidt), PEG-40 palm kernel
oil (Crovol PK-70), PEG-60 corn glycerides (Crovol M70, Croda),
PEG-60 almond glycerides (Crovol A70, Croda), PEG-4 caprylic/capric
triglyceride (Labrafac.RTM. Hydro, Gattefosse), PEG-8
caprylic/capric glycerides (Labrasol, Gattefosse), PEG-6
caprylic/capric glycerides (SOFTIGEN.RTM.767, Huls), lauroyl
macrogol-32 glyceride (GELUCIRE 44/14, Gattefosse), stearoyl
macrogol glyceride (GELUCIRE 50/13, Gattefosse), mono, di, tri,
tetra esters of vegetable oils and sorbitol (SorbitoGlyceride,
Gattefosse), pentaerythrityl tetraisostearate (Crodamol PTIS,
Croda), pentaerythrityl distearate (Albunol DS, Taiwan Surf.),
pentaerythrityl tetraoleate (Liponate PO-4, Lipo Chem.),
pentaerythrityl tetrastearate (Liponate PS-4, Lipo Chem.),
pentaerythrityl tetracaprylate tetracaprate (Liponate PE-810, Lipo
Chem.), and pentaerythrityl tetraoctanoate (Nikkol Pentarate 408,
Nikko). Also included as oils in this category of surfactants are
oil-soluble vitamins, such as vitamins A, D, E, K, etc. Thus,
derivatives of these vitamins, such as tocopheryl PEG-1000
succinate (TPGS, available from Eastman), are also suitable
surfactants. Formulations of anyone or all of the combinations
according to the invention may include one or more of the
alcohol-oil transesterification products above.
[0334] Polyglycerized fatty acids may also be used as excipients
for the formulation of anyone or all of the combinations described
herein. Examples of commercially available polyglycerized fatty
acids include: polyglyceryl-2 stearate (Nikkol DGMS, Nikko),
polyglyceryl-2 oleate (Nikkol DGMO, Nikko), polyglyceryl-2
isostearate (Nikkol DGMIS, Nikko), polyglyceryl-3 oleate
(Caprol.RTM. 3GO, ABITEC), polyglyceryl-4 oleate (Nikkol Tetraglyn
1-O, Nikko), polyglyceryl-4 stearate (Nikkol Tetraglyn 1-S, Nikko),
polyglyceryl-6 oleate (Drewpol 6-1-O, Stepan), polyglyceryl-10
laurate (Nikkol Decaglyn 1-L, Nikko), polyglyceryl-10 oleate
(Nikkol Decaglyn 1-O, Nikko), polyglyceryl-10 stearate (Nikkol
Decaglyn 1-S, Nikko), polyglyceryl-6 ricinoleate (Nikkol Hexaglyn
PR-15, Nikko), polyglyceryl-10 linoleate (Nikkol Decaglyn 1-LN,
Nikko), polyglyceryl-6 pentaoleate (Nikkol Hexaglyn 5-O, Nikko),
polyglyceryl-3 dioleate (Cremophor G032, BASF), polyglyceryl-3
distearate (Cremophor GS32, BASF), polyglyceryl-4 pentaoleate
(Nikkol Tetraglyn 5-O, Nikko), polyglyceryl-6 dioleate (Caprol.RTM.
6G20, ABITEC), polyglyceryl-2 dioleate (Nikkol DGDO, Nikko),
polyglyceryl-10 trioleate (Nikkol Decaglyn 3-O, Nikko),
polyglyceryl-10 pentaoleate (Nikkol Decaglyn 5-O, Nikko),
polyglyceryl-10 septaoleate (Nikkol Decaglyn 7-O, Nikko),
polyglyceryl-10 tetraoleate (Caprol.RTM. 10G40, ABITEC),
polyglyceryl-10 decaisostearate (Nikkol Decaglyn 10-IS, Nikko),
polyglyceryl-101 decaoleate (Drewpol 10-10-O, Stepan),
polyglyceryl-10 mono, dioleate (Caprol.RTM. PGE 860, ABITEC), and
polyglyceryl polyricinoleate (Polymuls, Henkel). Formulations of
anyone or all of the combinations according to the invention may
include one or more of the polyglycerized fatty acids above.
[0335] In addition, propylene glycol fatty acid esters may be used
as excipients for the formulation of the tetra-substituted
pyrimidopyrimidine anyone or all of the combinations described
herein. Examples of commercially available propylene glycol fatty
acid esters include: propylene glycol monocaprylate (Capryol 90,
Gattefosse), propylene glycol monolaurate (Lauroglycol 90,
Gattefosse), propylene glycol oleate (Lutrol OP2000, BASF),
propylene glycol myristate (Mirpyl), propylene glycol monostearate
(LIPO PGMS, Lipo Chem.), propylene glycol hydroxystearate,
propylene glycol ricinoleate (PROPYMULS, Henkel), propylene glycol
isostearate, propylene glycol monooleate (Myverol P-O6, Eastman),
propylene glycol dicaprylate dicaprate (Captex.RTM. 200, ABITEC),
propylene glycol dioctanoate (Captex.RTM. 800, ABITEC), propylene
glycol caprylate caprate (LABRAFAC PG, Gattefosse), propylene
glycol dilaurate, propylene glycol distearate (Kessco.RTM. PGDS,
Stepan), propylene glycol dicaprylate (Nikkol Sefsol 228, Nikko),
and propylene glycol dicaprate (Nikkol PDD, Nikko). Formulations of
anyone or all of the combinations to the invention may include one
or more of the propylene glycol fatty acid esters above.
[0336] Mixtures of propylene glycol esters and glycerol esters may
also be used as excipients for the formulation of anyone or all of
the combinations described herein. One preferred mixture is
composed of the oleic acid esters of propylene glycol and glycerol
(Arlacel 186). Examples of these surfactants include: oleic (ATMOS
300, ARLACEL 186, ICI), and stearic (ATMOS 150). Formulations of
anyone or all of the combinations according to the invention may
include one or more of the mixtures of propylene glycol esters and
glycerol esters above.
[0337] Further, mono- and diglycerides may be used as excipients
for the formulation of anyone or all of the combinations described
herein. Examples of commercially available mono- and diglycerides
include: monopalmitolein (C16:1) (Larodan), monoelaidin (C18:1)
(Larodan), monocaproin (C6) (Larodan), monocaprylin (Larodan),
monocaprin (Larodan), monolaurin (Larodan), glyceryl monomyristate
(C14) (Nikkol MGM, Nikko), glyceryl monooleate (C18:1) (PECEOL,
Gattefosse), glyceryl monooleate (Myverol, Eastman), glycerol
monooleate/linoleate (OLICINE, Gattefosse), glycerol monolinoleate
(Maisine, Gattefosse), glyceryl ricinoleate (Softigen.RTM. 701,
Huls), glyceryl monolaurate (ALDO.RTM. MLD, Lonza), glycerol
monopalmitate (Emalex GMS-P, Nihon), glycerol monostearate
(Capmul.RTM. GMS, ABITEC), glyceryl mono- and dioleate (Capmul.RTM.
GMO-K, ABITEC), glyceryl palmitic/stearic (CUTINA MD-A,
ESTAGEL-G18), glyceryl acetate (Lameging EE, Grunau GmbH), glyceryl
laurate (Imwitor.RTM. 312, Huls), glyceryl
citrate/lactate/oleate/linoleate (Imwitorg 375, Huls), glyceryl
caprylate (Imwitor.RTM. 308, Huls), glyceryl caprylate/caprate
(Capmul.RTM. MCM, ABITEC), caprylic acid mono- and diglycerides
(Imwitorg 988, Huls), caprylic/capric glycerides (Imwitor.RTM. 742,
Huls), Mono-and diacetylated monoglycerides (Myvacet.RTM. 9-45,
Eastman), glyceryl monostearate (Aldog MS, Arlacel 129, ICI),
lactic acid esters of mono and diglycerides (LAMEGIN GLP, Henkel),
dicaproin (C6) (Larodan), dicaprin (C10) (Larodan), dioctanoin (C8)
(Larodan), dimyristin (C14) (Larodan), dipalmitin (C16) (Larodan),
distearin (Larodan), glyceryl dilaurate (C12) (Capmul.RTM. GDL,
ABITEC), glyceryl dioleate (Capmul.RTM. GDO, ABITEC), glycerol
esters of fatty acids (GELUCIRE 39/01, Gattefosse), dipalmitolein
(C16:1) (Larodan), 1,2 and 1,3-diolein (C18:1) (Larodan), dielaidin
(C18:1) (Larodan), and dilinolein (C18:2) (Larodan). Formulations
of anyone or all of the combinations according to the invention may
include one or more of the mono- and diglycerides above.
[0338] Sterol and sterol derivatives may also be used as excipients
for the formulation of anyone or all of the combinations described
herein. Examples of commercially available sterol and sterol
derivatives include: cholesterol, sitosterol, lanosterol, PEG-24
cholesterol ether (Solulan C-24, Amerchol), PEG-30 cholestanol
(Phytosterol GENEROL series, Henkel), PEG-25 phytosterol (Nikkol
BPSH-25, Nikko), PEG-5 soyasterol (Nikkol BPS-5, Nikko), PEG-10
soyasterol (Nikkol BPS-10, Nikko), PEG-20 soyasterol (Nikkol
BPS-20, Nikko), and PEG-30 soyasterol (Nikkol BPS-30, Nikko).
Formulations of anyone or all of the combinations according to the
invention may include one or more of the sterol and sterol
derivatives above.
[0339] Polyethylene glycol sorbitan fatty acid esters may also be
used as excipients for the formulation of anyone or all of the
combinations described herein. Examples of commercially available
polyethylene glycol sorbitan fatty acid esters include: PEG-10
sorbitan laurate (Liposorb L-10, Lipo Chem.), PEG-20 sorbitan
monolaurate (Tween.RTM. 20, Atlas/ICI), PEG-4 sorbitan monolaurate
(Tweeng 21, Atlas/ICI), PEG-80 sorbitan monolaurate (Hodag PSML-80,
Calgene), PEG-6 sorbitan monolaurate (Nikkol GL-1, Nikko), PEG-20
sorbitan monopalmitate (Tween.RTM. 40, Atlas/ICI), PEG-20 sorbitan
monostearate (Tween.RTM. 60, Atlas/ICI), PEG-4 sorbitan
monostearate (Tweeng 61, Atlas/ICI), PEG-8 sorbitan monostearate
(DACOL MSS, Condea), PEG-6 sorbitan monostearate (Nikkol TS106,
Nikko), PEG-20 sorbitan tristearate (Tween.RTM. 65, Atlas/ICI),
PEG-6 sorbitan tetrastearate (Nikkol GS-6, Nikko), PEG-60 sorbitan
tetrastearate (Nikkol GS-460, Nikko), PEG-5 sorbitan monooleate
(Tween.RTM. 81, Atlas/ICI), PEG-6 sorbitan monooleate (Nikkol
TO-106, Nikko), PEG-20 sorbitan monooleate (Tween.RTM. 80,
Atlas/ICI), PEG-40 sorbitan oleate (Emalex ET 8040, Nihon
Emulsion), PEG-20 sorbitan trioleate (Tween.RTM. 85, Atlas/ICI),
PEG-6 sorbitan tetraoleate (Nikkol GO-4, Nikko), PEG-30 sorbitan
tetraoleate (Nikkol GO-430, Nikko), PEG-40 sorbitan tetraoleate
(Nikkol GO-440, Nikko), PEG-20 sorbitan monoisostearate (Tween.RTM.
120, Atlas/ICI), PEG sorbitol hexaoleate (Atlas G-1086, ICI),
polysorbate 80 (Tween.RTM. 80, Pharma), polysorbate 85 (Tween.RTM.
85, Pharma), polysorbate 20 (Tweeng 20, Pharma), polysorbate 40
(Tween.RTM. 40, Pharma), polysorbate 60 (Tweeng 60, Pharma), and
PEG-6 sorbitol hexastearate (Nikkol GS-6, Nikko). Formulations of
anyone or all of the combinations according to the invention may
include one or more of the polyethylene glycol sorbitan fatty acid
esters above.
[0340] In addition, polyethylene glycol alkyl ethers may be used as
excipients for the formulation of anyone or all of the combinations
described herein. Examples of commercially available polyethylene
glycol alkyl ethers include: PEG-2 oleyl ether, oleth-2 (Brij
92/93, Atlas/ICI), PEG-3 oleyl ether, oleth-3 (Volpo 3, Croda),
PEG-5 oleyl ether, oleth-5 (Volpo 5, Croda), PEG-10 oleyl ether,
oleth-10 (Volpo 10, Croda), PEG-20 oleyl ether, oleth-20 (Volpo 20,
Croda), PEG-4 lauryl ether, laureth-4 (Brij 30, Atlas/ICI), PEG-9
lauryl ether, PEG-23 lauryl ether, laureth-23 (Brij 35, Atlas/ICI),
PEG-2 cetyl ether (Brij 52, ICI), PEG-10 cetyl ether (Brij 56,
ICI), PEG-20 cetyl ether (BriJ 58, ICI), PEG-2 stearyl ether (Brij
72, ICI), PEG-10 stearyl ether (Brij 76, ICI), PEG-20 stearyl ether
(Brij 78, ICI), and PEG-100 stearyl ether (Brij 700, ICI).
Formulations of anyone or all of the combinations according to the
invention may include one or more of the polyethylene glycol alkyl
ethers above.
[0341] Sugar esters may also be used as excipients for the
formulation of anyone or all of the combinations described herein.
Examples of commercially available sugar esters include: sucrose
distearate (SUCRO ESTER 7, Gattefosse), sucrose
distearate/monostearate (SUCRO ESTER 11, Gattefosse), sucrose
dipalmitate, sucrose monostearate (Crodesta F-160, Croda), sucrose
monopalmitate (SUCRO ESTER 15, Gattefosse), and sucrose monolaurate
(Saccharose monolaurate 1695, Mitsubisbi-Kasei). Formulations of
anyone or all of the combinations according to the invention may
include one or more of the sugar esters above.
[0342] Polyethylene glycol alkyl phenyls are also useful as
excipients for the formulation of anyone or all of the combinations
described herein. Examples of commercially available polyethylene
glycol alkyl phenyls include: PEG-10-100 nonylphenyl series (Triton
X series, Rohm & Haas) and PEG-15-100 octylphenyl ether series
(Triton N-series, Rohm & Haas). Formulations of anyone or all
of the combinations to the invention may include one or more of the
polyethylene glycol alkyl phenyls above.
[0343] Polyoxyethylene-polyoxypropylene block copolymers may also
be used as excipients for the formulation of anyone or all of the
combinations described herein. These surfactants are available
under various trade names, including one or more of Synperonic PE
series (ICI), Pluronicg series (BASF), Lutrol (BASF), Supronic,
Monolan, Pluracare, and Plurodac. The generic term for these
copolymers is "poloxamer" (CAS 9003-11-6). These polymers have the
formula shown below:
HO(C.sub.2H.sub.4O).sub.a(C.sub.3H.sub.6O).sub.b(C.sub.2H.sub.4O).sub.aH
[0344] where "a" and "b" denote the number of polyoxyethylene and
polyoxypropylene units, respectively. These copolymers are
available in molecular weights ranging from 1000 to 15000 daltons,
and with ethylene oxide/propylene oxide ratios between 0.1 and 0.8
by weight. Formulations of anyone or all of the combinations
according to the invention may include one or more of the
polyoxyethylene-polyoxypropylene block copolymers above.
[0345] Polyoxyethylenes, such as PEG 300, PEG 400, and PEG 600, may
be used as excipients for the formulation of anyone or all of the
combinations described herein.
[0346] Sorbitan fatty acid esters may also be used as excipients
for the formulation of anyone or all of the combinations described
herein. Examples of commercially sorbitan fatty acid esters
include: sorbitan monolaurate (Span-20, Atlas/ICI), sorbitan
monopalmitate (Span-40, Atlas/ICI), sorbitan monooleate (Span-80,
Atlas/ICI), sorbitan monostearate (Span-60, Atlas/ICI), sorbitan
trioleate (Span-85, Atlas/ICI), sorbitan sesquioleate (Arlacel-C,
ICI), sorbitan tristearate (Span-65, Atlas/ICI), sorbitan
monoisostearate (Crill 6, Croda), and sorbitan sesquistearate
(Nikkol SS-15, Nikko). Formulations of anyone or all of the
combinations according to the invention may include one or more of
the sorbitan fatty acid esters above.
[0347] Esters of lower alcohols (C.sub.2 to C.sub.4) and fatty
acids (C.sub.8 to C.sub.18) are suitable surfactants for use in the
invention. Examples of these surfactants include: ethyl oleate
(Crodamol EO, Croda), isopropyl myristate (Crodamol IPM, Croda),
isopropyl palmitate (Crodamol IPP, Croda), ethyl linoleate (Nikkol
VF-E, Nikko), and isopropyl linoleate (Nikkol VF-IP, Nikko).
Formulations of anyone or all of the combinations according to the
invention may include one or more of the lower alcohol fatty acid
esters above.
[0348] In addition, ionic surfactants may be used as excipients for
the formulation of anyone or all of the combinations described
herein. Examples of useful ionic surfactants include: sodium
caproate, sodium caprylate, sodium caprate, sodium laurate, sodium
myristate, sodium myristolate, sodium palmitate, sodium
palmitoleate, sodium oleate, sodium ricinoleate, sodium linoleate,
sodium linolenate, sodium stearate, sodium lauryl sulfate
(dodecyl), sodium tetradecyl sulfate, sodium lauryl sarcosinate,
sodium dioctyl sulfosuccinate, sodium cholate, sodium taurocholate,
sodium glycocholate, sodium deoxycholate, sodium taurodeoxycholate,
sodium glycodeoxycholate, sodium ursodeoxycholate, sodium
chenodeoxycholate, sodium taurochenodeoxycholate, sodium glyco
cheno deoxycholate, sodium cholylsarcosinate, sodium N-methyl
taurocholate, egg yolk phosphatides, hydrogenated soy lecithin,
dimyristoyl lecithin, lecithin, hydroxylated lecithin,
lysophosphatidylcholine, cardiolipin, sphingomyelin,
phosphatidylcholine, phosphatidyl ethanolamine, phosphatidic acid,
phosphatidyl glycerol, phosphatidyl serine, diethanolamine,
phospholipids, polyoxyethylene-10 oleyl ether phosphate,
esterification products of fatty alcohols or fatty alcohol
ethoxylates, with phosphoric acid or anhydride, ether carboxylates
(by oxidation of terminal OH group of, fatty alcohol ethoxylates),
succinylated monoglycerides, sodium stearyl fumarate, stearoyl
propylene glycol hydrogen succinate, mono/diacetylated tartaric
acid esters of mono- and diglycerides, citric acid esters of mono-,
diglycerides, glyceryl-lacto esters of fatty acids, acyl
lactylates, lactylic esters of fatty acids, sodium
stearoyl-2-lactylate, sodium stearoyl lactylate, alginate salts,
propylene glycol alginate, ethoxylated alkyl sulfates, alkyl
benzene sulfones, .alpha.-olefin sulfonates, acyl isethionates,
acyl taurates, alkyl glyceryl ether sulfonates, sodium octyl
sulfosuccinate, sodium undecylenamideo-MEA-sulfo- succinate,
hexadecyl triammonium bromide, decyl trimethyl ammonium bromide,
cetyl trimethyl ammonium bromide, dodecyl ammonium chloride, alkyl
benzyldimethylammonium salts, diisobutyl phenoxyethoxydimethyl
benzylammonium salts, alkylpyridinium salts, betaines
(trialkylglycine), lauryl betaine (N-lauryl,N,N-dimethylglycine),
and ethoxylated amines (polyoxyethylene-15 coconut amine). For
simplicity, typical counterions are provided above. It will be
appreciated by one skilled in the art, however, that any
bioacceptable counterion may be used. For example, although the
fatty acids are shown as sodium salts, other cation counterions can
also be used, such as, for example, alkali metal cations or
ammonium. Formulations of anyone or all of the combinations
according to the invention may include one or more of the ionic
surfactants above.
[0349] The excipients present in the formulations of the invention
are present in amounts such that the carrier forms a clear, or
opalescent, aqueous dispersion of the tetra-substituted
pyrimidopyrimidine, or the SSRI or the antihistamine, or anyone or
all of the combination sequestered within the liposome. The
relative amount of a surface active excipient necessary for the
preparation of liposomal or solid lipid nanoparticulate
formulations is determined using known methodology. For example,
liposomes may be prepared by a variety of techniques, such as those
detailed in Szoka et al, 1980. Multilamellar vesicles (MLVs) can be
formed by simple lipid-film hydration techniques. In this
procedure, a mixture of liposome-forming lipids of the type
detailed above dissolved in a suitable organic solvent is
evaporated in a vessel to form a thin film, which is then covered
by an aqueous medium. The lipid film hydrates to form MLVs,
typically with sizes between about 0.1 to 10 microns.
[0350] Other established liposomal formulation techniques can be
applied as needed. For example, the use of liposomes to facilitate
cellular uptake is described in U.S. Pat. Nos. 4,897,355 and
4,394,448.
[0351] Solid Dosage Forms for Oral Use
[0352] Formulations for oral use include tablets containing the
active ingredient(s) in a mixture with non-toxic pharmaceutically
acceptable excipients. These excipients may be, for example, inert
diluents or fillers (e.g., sucrose and sorbitol), lubricating
agents, glidants, and antiadhesives (e.g., magnesium stearate, zinc
stearate, stearic acid, silicas, hydrogenated vegetable oils, or
talc).
[0353] The two compounds may be mixed together in a tablet,
capsule, or other vehicle, or may be partitioned. In one example,
the first compound is contained on the inside of the tablet, and
the second compound is on the outside, such that a substantial
portion of the second compound is released prior to the release of
the first compound.
[0354] Formulations for oral use may also be provided as chewable
tablets, or as hard gelatin capsules wherein the active ingredient
is mixed with an inert solid diluent, or as soft gelatin capsules
wherein the active ingredient is mixed with water or an oil
medium.
[0355] Thus, for compositions adapted for oral use, an oral vehicle
(e.g., a capsule) containing from between 0.01% to 25% (w/w) or
more of a tetra-substituted pyrimidopyrimidine or analog and/or
additional agent, preferably from between 0.01% to 10% (w/w), more
preferably from between 0.05% to 4% (w/w) active agent. The capsule
can be taken one to four times daily, or as needed.
[0356] For example, for dipyridamole adapted for oral
administration, an oral vehicle will contain from between 0.01% to
5% (w/w), preferably from between 0.01% to 2% (w/w), more
preferably from between 0.01% to 1% (w/w) dipyridamole.
[0357] Performing the methods described herein, the oral vehicle
containing a compound of dipyridamole or dipyridamole analog,
and/or the additional agent is preferably taken orally. For
example, a capsule may be taken in the morning and one in the
evening by a subject suffering from an immunoinflammatory disorder
or an immunoinflammatory-related disorder, like anti-platelet
aggregatory activity.
[0358] Topical Formulations
[0359] Compositions can also be adapted for topical use with a
topical vehicle containing from between 0.0001% to 25% (w/w) or
more of tetra-substituted pyrimidopyrimidine and/or analog and
between 0.001% to 25% (w/w) and more of antihistamine and/or
analog. In such combinations, it is preferred that the
tetra-substituted pyrimidopyrimidine is subjected to an
extended-release mechanism.
[0360] In a preferred combination, the antihistamine and/or
tetra-substituted pyrimidopyrimidine are preferably from between
0.0001% to 10% (w/w), more preferably from between 0.0005% to 4%
(w/w) active agent. The cream can be applied one to four times
daily, or as needed. For example, for prednisolone adapted for
topical administration, a topical vehicle will contain from between
0.01% to 5% (w/w), preferably from between 0.01% to 2% (w/w), more
preferably from between 0.01% to 1% (w/w) prednisolone in
combination with tetra-substituted pyrimidopyrimidine, which is
0.0001% to 2% (w/w), more preferably from between 0.0005% to 1%
(w/w).
[0361] Performing the methods described herein, the topical vehicle
containing a compound of antihistamine or antihistamine analog,
and/or the tetra-substituted pyrimidopyrimidine is preferably
applied to the site of discomfort on the subject. For example, a
cream may be applied to the hands of a subject suffering from
arthritic fingers, while topical eye drops may be applied to an eye
of a subject to treat uveitis.
[0362] Inhalation
[0363] For intranasal administration or administration by
inhalation, the active compounds of the invention are conveniently
delivered in the form of a solution or suspension from a pump spray
container that is squeezed or pumped by the patient or as an
aerosol spray presentation from a pressurized container or a
nebulizer, with the use of a suitable propellant, e.g.,
dichlorodifluoromethane, trichlorofluoromethane,
dichlorotetrafluoroethane, carbon dioxide or other suitable gas. In
the case of a pressurized aerosol the dosage unit may be determined
by providing a valve to deliver a metered amount. The pressurized
container or nebulizer may contain a solution or suspension of the
active compound. Capsules and cartridges (made, for example, from
gelatin) for use in an inhaler or insufflator may be formulated
containing a powder mix of a compound of the invention and a
suitable powder base such as lactose or starch.
[0364] Dosages
[0365] Given the enhanced potency of the combinations of the
invention, it is understood that a low dosage (as defined herein)
of the tetra-substituted pyrimidopyrimidine and/or the additional
agents can be used. These dosages will vary depending on the health
and condition of the patient. Thus, a moderate dosage or even a
high dosage of one or both agents can be used.
[0366] Administration of each drug in the combination can,
independently, be one to four times daily for one day to one year,
and may even be for the life of the patient. Chronic, long-term
administration will be indicated in many cases.
[0367] Additional Applications
[0368] The compounds of the invention are also useful as screening
tools. Single agents and combinations of the invention can be
employed in antiproliferative or mechanistic assays to determine
whether other combinations, or single agents are as effective as
the combination in inhibiting the proliferation of proinflammatory
cytokines using assays generally known in the art, e.g.,
TNF.alpha., IL-1, IL-2, IFN-.gamma. etc., specific, non-limiting
examples of which are described in the Examples section. For
example, candidate compounds are combined with a compound from with
either the tetra-substituted pyrimidopyrimidine (or
tetra-substituted pyrimidopyrimidine analog) or the additional
agents described herein, applied to stimulate PBMCs, and at after a
suitable time, the cells are examined for anitproliferative
activity, TNF.alpha. or other assays for proinflammatory cytokine
secretion. The relative effects of the combinations versus each
other, and versus the single agents are compared, and effective
compounds and combinations are identified. The screening method can
be used for comparing the activity of novel single agents or new
combinations of agents (novel or known) for relative activity in
the assays.
[0369] The combinations of the invention are also useful tools in
elucidating mechanistic information about the biological pathways
involved in inflammation or novel targets. Such information can
lead to the development of new combinations or single agents
(mechanistic and/or structural analogs of either the
tetra-substituted pyrimidopyrimidine or companion compound) for
inhibiting proinflammatory cytokine secretion. Methods known in the
art to determine biological pathways can be used to determine the
pathway, or network of pathways affected by contacting cells
stimulated to produce proinflammatory cytokines with the compounds
of the invention.
[0370] Such methods can include, analyzing cellular constituents
that are expressed or repressed after contact with the compounds of
the invention as compared to untreated, positive or negative
control compounds, and/or new single agents and combinations, or
analyzing some other metabolic activity of the cell such as enzyme
activity, nutrient uptake, and proliferation. Cellular components
analyzed can include gene transcripts, and protein expression.
Suitable methods can include standard biochemistry techniques,
radiolabeling the compounds of the invention (e,.g., .sup.14C or
.sup.3H labeling), and observing the compounds binding to proteins,
e.g. using 2d gels, gene expression profiling. Once identified,
such compounds can be used in in vivo models to further validate
the tool or develop new anti-inflammatory agents.
EXAMPLE
[0371] The following example is to illustrate the invention, and is
not meant to limit the invention in any way.
[0372] Methods
[0373] TNF.alpha. Secretion Assay
[0374] The effects of test compound combinations on TNF.alpha.
secretion were assayed in white blood cells from human buffy coat
stimulated with LPS or phorbol 12-myristate 13-acetateand ionomycin
as follows. Human white blood cells from buffy coat were diluted
1:50 in media (RPMI; Gibco BRL, #11875-085), 10% fetal bovine serum
(Gibco BRL, #25140-097), 2% penicillin/streptomycin (Gibco BRL,
#15140-122)) and 50 .mu.L of the diluted white blood cells was
placed in each well of the assay plate. Drugs were added to the
indicated concentration. After 16-18 hours of incubation at
37.degree. C. with 5% CO.sub.2 in a humidified incubator, the plate
was centrifuged and the supernatant transferred to a white opaque
polystyrene 384-well plate (NalgeNunc, Maxisorb) coated with an
anti-TNF.alpha. antibody (PharMingen, #551220). After a two-hour
incubation, the plate was washed (Tecan Powerwasher 384) with PBS
containing 0.1% Tween 20 and incubated for one additional hour with
biotin labeled anti-TNF.alpha. antibody (PharMingen, #554511) and
HRP coupled to streptavidin (PharMingen, #13047E). The plate was
then washed again with 0.1% Tween 20/PBS. An HRP-luminescent
substrate was added to each well, and the light intensity of each
well was measured using a plate luminometer.
[0375] IFN.gamma. Secretion Assay
[0376] The effects of test compound combinations on IFN-.gamma.
secretion were assayed in white blood cells from human buffy coat
stimulated with phorbol 12-myristate 13-acetate as follows. Human
white blood cells from buffy coat were diluted 1:50 in media (RPMI;
Gibco BRL, #11875-085), 10% fetal bovine serum (Gibco BRL,
#25140-097), 2% penicillin/streptomycin (Gibco BRL, #15140-122))
and 50 .mu.L of the diluted white blood cells was placed in each
well of the final assay plate created in the above section. After
16-18 hours of incubation at 37.degree. C. with 5% CO.sub.2 in a
humidified incubator, the plate was centrifruged and the
supernatant transferred to a white opaque polystyrene 384-well
plate (NalgeNunc, Maxisorb) coated with an anti-IFN-.gamma.
antibody (Endogen, M-700-AE). After a two-hour incubation, the
plate was washed (Tecan Powerwasher 384) with PBS containing 0.1%
Tween 20 and incubated for one additional hour with biotin labeled
anti-IFN-.gamma. antibody (Endogen, M-701-B) and HRP coupled to
streptavidin (PharMingen, #13047E). The plate was then washed again
with 0.1% Tween 20/PBS. An HRP-luminescent substrate was added to
each well, and the light intensity of each well was measured using
a plate luminometer.
[0377] IL-1 Secretion Assay
[0378] The effects of test compound combinations on IL-1 secretion
were assayed in white blood cells from human buffy coat stimulated
with LPS, as follows. Human white blood cells from buffy coat were
diluted 1:50 in media (RPMI; Gibco BRL, #11875-085), 10% fetal
bovine serum (Gibco BRL, #25140-097), 2% penicillin/streptomycin
(Gibco BRL, #15140-122)) and 50 .mu.L of the diluted white blood
cells was placed in each well of the final assay plate created in
the above section. After 16-18 hours of incubation at 37.degree. C.
in a humidified incubator, the plate was centrifuged and the
supernatant was transferred to a white opaque 384-well plate
(NalgeNunc, MAXISORB) coated with an anti-IL-1 antibody (R&D
Systems, MAB601). After a two-hour incubation, the plate was washed
(Tecan Powerwasher 384) with PBS containing 0.1% Tween 20 and
incubated for an additional one hour with a biotin labeled
anti-IL-1 antibody (R&D Systems, BAF201) and horse radish
peroxidase coupled to streptavidin (PharMingen, #554066). The plate
was then washed again with 0.1% Tween 20/PBS, and an
HRP-luminescent substrate was added to each well. Light intensity
was then measured using a plate luminometer.
[0379] IL-2 Secretion Assay
[0380] The effects of test compound combinations on IL-2 secretion
were assayed in white blood cells from human buffy coat stimulated
with phorbol 12-myristate 13-acetate, as follows. Human white blood
cells from buffy coat were diluted 1:50 in media (RPMI; Gibco BRL,
#11875-085), 10% fetal bovine serum (Gibco BRL, #25140-097), 2%
penicillin/streptomycin (Gibco BRL, #15140-122)) and 50 .mu.L of
the diluted white blood cells was placed in each well of the final
assay plate created in the above section. After 16-18 hours of
incubation at 37.degree. C. in a humidified incubator, the plate
was centrifuged and the supernatant was transferred to a white
opaque 384-well plate (NalgeNunc, MAXISORB) coated with an
anti-IL-2 antibody (PharMingen, #555051). After a two-hour
incubation, the plate was washed (Tecan Powerwasher 384) with PBS
containing 0.1% Tween 20 and incubated for an additional one hour
with a biotin labeled anti-IL-2 antibody (Endogen, M600B) and horse
radish peroxidase coupled to streptavidin (PharMingen, #13047E).
The plate was then washed again with 0.1% Tween 20/PBS, and an
HRP-luminescent substrate was added to each well. Light intensity
was then measured using a plate luminometer.
[0381] Percent Inhibition
[0382] The percent inhibition (% I) for each well was calculated
using the following formula:
% I=[(avg. untreated wells-treated well)/(avg. untreated
wells)].times.100
[0383] The average untreated well value (avg. untreated wells) is
the arithmetic mean of 40 wells from the same assay plate treated
with vehicle alone. Negative inhibition values result from local
variations in treated wells as compared to untreated wells.
[0384] The results of various combinations of compounds described
on the reduction of TNF.alpha., IL-2, IL-1, or IFN-.gamma.
secretion are shown below in Tables 7-53. The effects of varying
concentrations of single compound or when used in combination with
another compound is shown in individual tables. For example, Table
8 shows the effects of varying concentrations of dipyridamole and a
combination of dipyridamole and bromodiphenhydramine HCl. These
results were compared to control wells. These wells were stimulated
with phorbol 12-myristate 13-acetate and ionomycin, but did not
receive dipyridamole or bromodiphenhydramine HCl. The effects of
the agents alone and in combination are shown as percent inhibition
of TNF.alpha. secretion. In Tables 7-26, TNF-.alpha. suppression
was determined after cells were stimulated with phorbol
12-myristate 13-acetate and ionomycin.
7 TABLE 7 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Bromo- 0 -4.6 3.4 0.92 6.6 12 25 40 54 71 diphen- 0.21 0 4.5 7.7 11
13 24 39 54 73 hydramine 0.43 -4.4 7.6 5.1 11 15 23 41 53 71 HCl
(.mu.M) 0.85 0.72 9 8.6 15 23 25 40 55 71 1.7 -2.4 5.1 7.4 10 20 31
41 54 67 3.4 5.6 17 19 22 30 36 45 58 74 6.8 13 24 25 26 46 47 56
70 75 14 34 45 41 43 47 60 65 67 77 27 61 61 66 72 70 70 77 76
82
[0385]
8 TABLE 8 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Cypro- 0 -4.2 4.5 -0.27 4.3 0.57 12 33 49 63 heptadine 0.24 0.32
-1.3 -1.3 5.7 4.6 15 38 50 71 HCl (.mu.M) 0.48 2 12 4.6 7 13 19 34
52 64 0.96 1.2 12 5.1 9.9 8.7 21 41 54 68 1.9 4.6 9.2 10 15 21 25
43 55 65 3.9 2.4 13 21 22 23 32 47 62 71 7.7 15 32 36 45 40 47 61
66 78 15 29 44 46 50 60 56 70 68 84 31 29 44 46 50 60 73 70 80
84
[0386]
9 TABLE 9 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Loratadine 0 -6.4 6.5 9.6 12 16 30 37 55 70 (.mu.M) 0.2 0 7.5 6.4
11 14 28 40 52 71 0.41 -6.2 3.4 5.5 14 13 29 41 62 70 0.82 -2.1 4.8
3.9 53 11 23 39 54 71 1.6 -2.4 7.4 6 12 13 26 45 58 71 3.3 8.1 17
12 20 24 35 45 61 73 6.5 11 21 25 31 34 44 65 68 80 13 31 44 42 47
49 61 67 77 67 26 31 44 42 47 49 61 67 77 66
[0387]
10 TABLE 10 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Thiethyl- 0 -4.1 6.1 7 9.1 19 27 40 54 71 perazine 0.2 -3.3 6.4 12
11 18 26 42 54 72 maleate 0.39 -3.9 8.2 11 16 18 26 44 55 71
(.mu.M) 0.78 -1 3.8 9.8 16 20 29 42 56 70 1.6 -3.4 5.1 4.6 16 18 28
42 56 71 3.1 1.4 15 16 20 24 37 49 62 70 6.3 15 27 27 34 41 50 61
71 82 13 51 62 61 64 67 72 79 85 89 25 62 75 76 77 88 87 87 90
95
[0388]
11 TABLE 11 Prednisolone (.mu.M) 0 0.0078 0.016 0.031 0.062 0.12
0.25 0.5 1 Dipyridamole (.mu.M) 0 -2.57 1.47 1.37 7.82 15.1 18 21.5
29.9 34 0.3 4.32 12.6 13.1 18.1 21 27.6 32.2 37.8 39.7 0.61 2.88
7.18 14.2 18.5 24.9 29.2 35.6 36.9 42.7 1.2 10.8 12.2 15.5 20.8
28.9 31.7 39 42.4 46.7 2.4 19.3 24.8 28.9 31.5 38.3 38.8 48.6 53.6
50.6 4.9 34.1 42 41.9 46.9 50.8 54.4 58.7 59.8 62.5 9.7 51.4 58.2
57.3 59.3 64.1 69.6 69.3 70.9 74 19 68.8 70.2 73.3 72.6 74.5 79.4
80.8 83.2 82.3 39 80.8 85.5 85.1 87.9 87.6 88.2 88.6 89.8 90.6
[0389]
12 TABLE 12 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Amoxapine (.mu.M) 0 11 19 20 23 30 45 52 63 78 0.25 4.5 25 30 31 40
48 59 70 83 0.5 14 28 25 33 44 51 60 70 84 1 21 36 36 43 50 58 67
74 88 2 35 42 45 49 55 62 73 79 92 4 52 63 56 64 66 71 80 82 94 8
76 76 75 81 83 85 91 93 97 16 92 90 90 91 94 95 96 96 98 32 89 98
97 97 94 98 97 98 97
[0390]
13 TABLE 13 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Fluoxetine (.mu.M) 0 6.6 18 12 17 26 42 49 62 76 0.45 -4 22 18 20
22 40 54 63 77 0.9 4.1 12 9.3 22 31 38 51 64 76 1.8 4.1 16 15 26 33
40 55 67 78 3.6 14 18 17 23 33 46 58 68 81 7.2 37 41 38 47 52 58 68
79 86 14 73 73 73 75 82 82 88 90 93 29 94 93 94 94 90 95 95 96 97
58 98 98 98 93 94 98 98 98 98
[0391]
14 TABLE 14 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Nortriptyl (.mu.M) 0 -2 14 8.6 20 27 43 54 64 80 0.52 -7.2 16 20 18
28 43 55 66 80 1 3.4 20 16 27 34 44 56 69 82 2.1 13 23 24 33 39 48
61 73 85 4.2 25 38 40 48 50 62 74 82 92 8.3 55 57 61 71 70 80 83 89
94 17 83 85 85 86 89 90 94 96 97 33 97 97 97 97 96 97 97 97 98 67
98 98 98 98 98 95 98 98 98
[0392]
15 TABLE 15 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Paroxetine (.mu.M) 0 14 21 24 23 32 45 53 60 76 0.21 9.1 27 15 25
30 42 53 64 76 0.42 3.2 19 14 24 34 37 56 63 77 0.83 4.3 25 22 28
36 45 56 67 78 1.7 13 21 24 32 32 50 59 70 82 3.3 24 36 39 47 52 58
69 79 87 6.7 69 67 70 73 75 80 85 89 94 13 91 88 91 90 91 93 95 96
97 27 92 95 97 97 79 96 97 98 98
[0393]
16 TABLE 16 Ibudilast (.mu.M) 0 0.062 0.12 0.25 0.5 1 2 4 8
Dipyridamole (.mu.M) 0 -5.712 2.754 15.92 14.65 22.88 37.42 42.85
45.88 53.83 0.15 6.492 14.03 18.1 26.02 30.25 39.4 43.67 47.98 54
0.3 4.72 15.87 20.92 26.85 31.68 35.62 45.98 48.62 53.15 0.61 17.75
21.47 18.07 27.9 32.62 42.7 44.95 52.58 52.18 1.2 21.77 24.08 25.17
28.68 32.15 42.2 45.2 48.53 53.25 2.4 30.18 33.2 35.45 36.58 40.28
45.45 47.73 50.23 56.35 4.9 42.1 45.8 49.1 46.48 47.25 51.42 55.22
57 60.45 9.7 59.53 60.5 62.33 61.65 60.95 62.35 63.77 64.88 66.33
19 69.65 72.98 71.9 73 71.83 72.4 74.62 75.4 78
[0394]
17 TABLE 17 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Ro-20-1724 (.mu.M) 0 -10.88 -1.893 -1.961 3.388 2.338 23.67 37.2
53.33 64.05 0.28 5.143 15.46 11.11 10.86 17.73 23.77 41.05 57.15
67.88 0.56 16.35 14.53 23.85 21.85 25.32 32.5 43.7 52 65.78 1.1
21.5 25.85 25.23 29.77 33.42 34.55 48.02 55.22 67.7 2.2 27.4 30.23
33.67 34.38 37.33 40.12 47.72 58.02 68.3 4.5 38.98 37.58 35.03
38.62 41 36.98 52.12 58.88 68.97 9 41.4 41.95 41.4 40.3 44.47 47.08
53.58 63.73 71 18 39.33 46.28 48.9 46.17 49.95 50.1 55.18 59.8
70.15 36 49.38 51.98 52.85 51.3 53.67 51.02 56.38 67.38 74.6
[0395]
18 TABLE 18 Rolipram (.mu.M) 0 0.0079 0.016 0.031 0.063 0.13 0.25
0.5 1 Dipyridamole (.mu.M) 0 -8.49 6.115 5.793 14.26 14.4 25.82
30.73 36.8 38.9 0.15 3.725 9.935 15.98 15.8 23.9 32.25 35.85 41.55
45.35 0.3 2.362 11.36 13.07 19.6 20.55 33.03 35.77 40.77 43.6 0.61
9.21 15.37 19.71 23.27 24.9 33.23 35.1 42.75 42.8 1.2 19.42 22.95
20.25 24.9 27.02 36.55 37.75 42.38 45.73 2.4 29 34.85 33.8 34.75
35.08 39.27 42.62 46.2 48.93 4.9 42.4 44.97 45.95 46.08 46.47 50.28
51 55.18 54.3 9.7 58.05 58.67 60.05 59.9 59.65 59.65 61 63.03 62.55
19 71.15 72.88 72.2 72.95 70.95 74.12 73.53 74.43 75.72
[0396]
19 TABLE 19 Betamethasone (nM) 0 2.4 9.6 38 153 611 Dipyridamole
(.mu.M) 0 -2.86 3.62 15.5 26.3 34.9 35.2 30 -0.43 4.37 15.2 30 34.5
35.8 121 2.49 9.75 21.1 32.6 39.8 40.1 486 7.6 13.9 22.7 33.5 40.3
43.2 1943 12.7 18.4 26.5 38.9 44.1 46 7773 31.7 35.2 43.1 52.7 57
58.5
[0397]
20 TABLE 20 Budesonide (nM) 0 0.54 2.2 8.7 35 139 Dipyridamole
(.mu.M) 0 -3.92 3.31 11.9 25.6 36.3 38.7 30 1.6 4.05 14.1 28.8 37.1
40 121 6.91 10.9 18.4 30.6 39 43 486 9.01 13.2 20.7 32.1 41.3 45.1
1943 14.8 16.4 23.1 36.6 45.7 47.7 7773 36.3 37 43.7 51.8 58.7
61.2
[0398]
21 TABLE 21 Clobetasol propionate (nM) 0 0.33 1.3 5.4 21 86
Dipyridamole (.mu.M) 0 -3.68 12.1 27.4 37.1 41.2 42 30 -0.406 13.6
27.5 39.1 43.6 44.8 121 4.51 16.9 32.5 43.4 47.4 49.2 486 7.76 22.1
35 45.9 49.8 52.1 1943 14.2 26.1 39.5 49.7 52.7 53.4 7773 29.7 42.6
52.2 60 62.2 64.3
[0399]
22 TABLE 22 Dexamethasone (nM) 0 2.4 9.6 38 153 611 Dipyridamole
(.mu.M) 0 -2.26 4.24 11.3 25.1 35.8 39.8 30 -0.75 4.41 13.7 28.7
36.3 41.4 121 3.75 11 18 29.7 39.3 42.5 486 8.17 12 18 32.4 39.4
42.4 1943 12.6 17.2 26.1 35.9 44.2 46.4 7773 33.6 38.7 43.4 51.5
58.9 61
[0400]
23 TABLE 23 Diflorasone diacetate (nM) 0 7.6 30 121 485 1941
Dipyridamole (.mu.M) 0 -2.18 8.02 22.2 33.3 37.6 38.5 30 -2.05 10.4
23.8 31.8 38.3 39.2 121 6.95 16.3 28.4 38.6 41.8 43.4 486 7.66 18.1
28.3 38.6 43.7 44.9 1943 11.6 21.4 32.5 43.1 47.1 47.5 7773 26 32.1
41.7 52.5 56.3 55.8
[0401]
24 TABLE 24 Hydrocortisone (nM) 0 21 83 331 1324 5297 Dipyridamole
0 -2.48 0.846 8.64 22.2 32 37.9 (.mu.M) 30 0.156 4.63 12.3 24.1
33.8 37.9 121 5.34 7.83 15.6 30.4 39.2 42.7 486 8.82 10.8 18.1 30.8
39.2 44.6 1943 13.2 15.7 23.6 36.6 45.5 49.8 7773 30 33.7 41.5 51.5
59.5 60.9
[0402]
25 TABLE 25 Prednisolone (nM) 0 10 42 166 664 2656 Dipyridamole
(.mu.M) 0 -1.15 1.03 7.87 2.29 34.9 39 30 -0.749 4 9.98 25.2 37.3
41 121 7.28 9.96 16.2 30.1 42.1 46.1 486 10.7 14.4 17.4 32.2 44
46.3 1943 17 15.9 25.2 38.1 47.1 51.3 7773 33.5 35.8 40.9 52.4 60.8
62.4
[0403]
26 TABLE 26 Triamcinolone (nM) 0 9.5 38 152 609 2434 Dipyridamole
(.mu.M) 0 -1.64 3.74 12.2 26.4 35.1 37.2 30 -0.021 4.41 15.3 29.1
36.1 40.4 121 4.48 9.43 18.5 31.7 40.9 43.3 486 8.72 13.7 21.7 34.1
42.8 45.5 1943 16 18.1 29.1 39.7 47.1 50.5 7773 30.5 35.1 41.9 53
59 61.9
[0404] In Tables 27-38, TNF.alpha. suppression was determined after
cells were stimulated with LPS.
27 TABLE 27 Prednisolone (.mu.M) 0 0.0078 0.016 0.031 0.062 0.12
0.25 0.5 1 Dipyridamole (.mu.M) 0 -2.05 -0.704 -0.915 8.37 21.7
31.4 41.5 45.5 52.5 0.15 5.72 8.79 6.98 5.76 17 38 47.3 57.9 64.6
0.3 7.3 10.5 13.7 19.9 23.9 39.2 46 52 55.3 0.61 24.9 20.8 13.4
23.9 41.8 34.6 52.5 61.7 63.1 1.2 27.3 15.2 26.3 37.9 35.7 43.5
62.2 58.9 68.3 2.4 37.2 47.4 42.6 42.2 57.4 46.6 68.7 71.5 72.1 4.9
54.3 51.4 53.2 63.9 69.5 61.3 73.1 76.5 78.6 9.7 71.1 71.1 67.5
73.4 75.5 73.3 78.4 79.3 83 19 82.7 79 78.9 72.3 80.3 78 83 86 87.4
39 83 73.6 84 81.7 80.5 80.7 78.8 82.4 80.3
[0405]
28 TABLE 28 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Amoxapine (.mu.M) 0 5.7 14 21 31 30 45 67 77 87 0.25 0.94 11 17 27
27 51 62 76 85 0.5 -9.7 17 11 22 28 48 68 79 86 1 -2.8 17 23 19 38
51 65 77 86 2 1.2 18 19 26 35 54 69 79 88 4 -1.3 24 19 30 46 63 74
78 88 8 13 25 31 38 57 64 78 84 90 16 29 48 54 59 71 77 85 89 92 32
47 76 74 79 85 89 92 94 93
[0406]
29 TABLE 29 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Fluoxetine 0 15 21 17 26 35 52 65 76 85 (.mu.M) 0.45 -4.8 15 8.9 15
25 50 64 78 84 0.9 -8.5 13 8 21 33 55 66 79 86 1.8 -4.5 11 7.6 10
31 50 65 74 83 3.6 -10 10 14 28 34 49 73 79 85 7.2 -11 4.9 9.2 22
33 58 71 80 86 14 -2 -9.3 -6.7 9.9 22 48 73 81 85 29 79 76 75 83 84
88 90 93 86 58 85 87 90 90 92 91 90 95 80
[0407]
30 TABLE 30 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Nortriptyline 0 12 22 18 28 38 54 69 78 87 (.mu.M) 0.52 2 7.7 16 26
32 54 66 80 87 1 -3.2 14 17 20 40 60 72 81 88 2.1 -3.6 7.4 16 26 38
52 70 80 88 4.2 -2.1 24 25 35 45 60 76 81 91 8.3 0.33 17 32 39 55
67 75 82 89 17 12 22 27 42 63 70 81 86 89 33 88 86 87 91 90 93 94
95 96 67 92 94 95 95 94 94 89 92 89
[0408]
31 TABLE 31 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Paroxetine 0 5.5 14 15 16 28 51 64 77 85 (.mu.M) 0.21 -7.2 7 2.6
5.6 28 49 63 76 86 0.42 -5.6 8.9 -1.1 10 30 54 68 78 86 0.83 -8.7
13 8.2 13 26 43 65 77 86 1.7 -10 5.1 4.3 18 26 49 74 79 86 3.3 -11
1.8 18 9 22 59 70 78 87 6.7 -15 -9.8 -4.8 20 28 54 72 80 87 13 9.9
0.92 37 31 48 71 79 88 93 27 73 81 81 81 69 87 87 86 93
[0409]
32 TABLE 32 Ibutilast (.mu.M) 0 0.062 0.12 0.25 0.5 1 2 4 8
Dipyridamole (.mu.M) 0 -12.66 15.85 22.9 34.3 43.8 62.25 76.65
85.05 89.72 0.15 0 22.93 34.02 39.45 60.8 69.9 81.38 86.2 89.3 0.3
5.46 25.31 36.33 47.53 63.88 74 81.57 88.95 90.55 0.61 15.74 29.33
41.7 50.25 61.58 73.65 80.1 88.97 90.62 1.2 21.24 32.42 43.12 57.6
66.33 76.25 81.05 86.95 90.35 2.4 39.73 48.55 49.2 58.87 72.12 76
82.7 86.97 89.77 4.9 49.8 58.62 65.52 68.47 73.67 77.75 84.15 87.73
90.1 9.7 72.85 73.9 74.15 78.97 80.53 84.4 86.28 89.1 91.5 19 84.25
84.18 84.82 86.55 86.88 88.55 89.72 90.93 92.78
[0410]
33 TABLE 33 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Ro-20-1724 (.mu.M) 0 -8.74 -2.06 0.185 -0.311 7.645 21.62 44.48
62.68 79.38 0.28 12.69 17.95 19.85 28.27 32.58 52.27 62.85 74.7
80.5 0.56 28.12 37.1 42.05 44.2 48.32 54.8 68.42 77.97 83.3 1.1
39.03 45.33 49.52 48.55 51.73 60.15 70.17 79.85 84.7 2.2 50.03
60.97 59.82 62.88 65.7 69.38 75.33 80.1 87 4.5 66.55 68.12 69.45
71.75 74.47 74.97 77.5 82.5 85.52 9 76.92 79.33 80.17 82.4 82.05
83.3 82.7 86.62 88.9 18 84.53 85.8 84.53 85.95 86.97 86.3 85.7
87.65 89.9 36 88.12 88.62 88.42 89.15 89.32 88.83 89.28 90.28
92.08
[0411]
34 TABLE 34 Rolipram (.mu.M) 0 0.0079 0.016 0.031 0.063 0.13 0.25
0.5 1 Dipyridamole (.mu.M) 0 -9.488 17.95 19.02 17.96 32.25 45.75
60.2 69.88 80.17 0.15 -0.48 18.12 29.65 31.27 44.05 59.45 67.75
76.55 84.53 0.3 4.848 26.65 34.38 45.78 49.67 63.6 71.08 80.5 84.78
0.61 14.37 27.93 41.5 46.93 52.3 63.85 72.1 83.25 85.97 1.2 25.8
49.02 48.07 53.95 62.55 67.6 75.28 82.97 87.2 2.4 44.1 54.55 56.5
65.1 70.2 72.62 78.95 82.73 87.53 4.9 62.2 69.33 69.92 75.12 77.67
80.9 82.65 86.02 89.18 9.7 77.95 78.88 79.2 81.8 82.97 85 86.95
87.53 89.52 19 86.9 85.63 85.9 87.57 87.5 88.75 89.1 90.3 91.23
[0412]
35 TABLE 35 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Bromodiphenhydramine 0 -2.4 5 21 32 38 63 76 85 90 HCl (.mu.M) 0.21
5.5 9 20 25 47 61 77 86 90 0.43 -0.69 5.2 25 27 49 60 76 85 89 0.85
-8.2 4.1 16 21 40 60 76 85 89 1.7 -20 -8.6 0.15 4.3 42 57 72 81 90
3.4 -20 -13 1 -2.3 32 55 76 83 89 6.8 -20 -20 -6.5 -1.3 30 58 72 84
90 14 -20 -20 -20 0.04 22 51 74 85 90 27 -20 -9.1 -9.1 -8.4 28 53
66 79 89
[0413]
36 TABLE 36 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Cypro- 0 -16 7.5 11 25 37 49 66 77 80 heptadine 0.24 -10 15 19 29
28 52 63 76 79 HCl (.mu.M) 0.48 -8.2 3.7 4.8 23 22 46 61 70 80 0.96
-4.5 -5.6 12 32 29 57 65 78 81 1.9 -7.2 -4.5 3.2 19 26 52 62 72 81
3.9 -3.3 -5.5 23 21 28 51 64 72 80 7.7 -16 -0.26 14 20 41 56 68 70
79 15 -18 -3.7 23 16 39 50 63 67 72 31 -0.89 12 23 21 37 39 58 63
72
[0414]
37 TABLE 37 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Loratadine 0 -3.4 8 22 26 49 59 71 77 86 (.mu.M) 0.2 -8 7.1 29 32
42 50 70 77 84 0.41 -4.7 10 15 27 38 51 68 79 85 0.82 -6.9 9.3 12
19 39 62 65 78 86 1.6 -10 1.7 14 22 40 49 71 76 85 3.3 -15 7.1 14
29 43 54 67 78 84 6.5 -20 0.41 24 22 36 52 66 76 84 13 -20 1 12 14
42 59 68 80 86 26 -4.7 1.7 24 22 34 53 61 75 82
[0415]
38 TABLE 38 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Thiethyl- 0 -0.7 8 22 34 52 60 72 80 86 perazine 0.2 -8.3 5.3 21 32
40 58 71 76 85 maleate 0.39 -9.7 -8.4 17 28 39 56 69 77 87 (.mu.M)
0.78 -11 -4.2 20 17 31 54 67 76 85 1.6 -18 -8.4 5.9 11 36 51 72 76
84 3.1 -18 -10 8.1 15 40 55 69 78 81 6.3 -20 -18 -7.2 7 30 50 64 77
83 13 -20 -20 -18 5.7 16 37 60 65 78 25 -16 -20 -1.9 10 23 34 54 69
74
[0416] The ability of various combinations to suppress IL-2
secretion in vitro was also tested. The results are shown in tables
39 to 47.
39 TABLE 39 Prednisolone (.mu.M) 0 0.0078 0.016 0.031 0.062 0.12
0.25 0.5 1 Dipyridamole (.mu.M) 0 1.99 -3 -4.03 -1.64 -2.42 -1.86
-1.08 -3.96 3.43 0.3 3.22 -- -8.71 3.29 -0.761 1.52 -0.414 3.47
5.24 0.61 2.96 4.99 -6.52 1.17 3.19 -0.735 -6.22 -3 5.75 1.2 3.94
-0.287 -2.22 3.03 -3.51 -4.7 1.35 2.43 12.1 2.4 4.37 -0.595 2.59
-3.44 -1.92 -4.09 4.07 3.68 12.3 4.9 3.32 0.363 -5.51 -2.89 0.346
-1.24 2.44 1.84 12.6 9.7 7.5 4.26 -4.75 3.85 -1.93 5.08 -0.524 4.28
13.9 19 -2.75 -3.19 -3.78 -1.45 -5.31 4.49 0.283 7.98 4.89 39 -2.67
4.48 -0.324 4.71 8.29 7.7 -1.27 7.61 13.3
[0417]
40 TABLE 40 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Amoxapine (.mu.M) 0 -2.4 -18 -12 -17 -14 -11 -3.9 -7.3 -8.8 0.25
-17 -13 -8.1 -12 -13 -7.1 -7.9 -4.4 -1.2 0.5 -15 -12 -14 -19 1.4
-3.4 -7.4 -5.8 8.5 1 -3.1 -13 -6.6 -14 -13 -0.16 -0.39 2.5 23 2
-0.082 -9.6 -0.51 -8.2 -7.4 -0.06 15 18 43 4 1.5 12 10 11 17 17 28
36 70 8 55 38 40 45 58 56 72 77 89 16 83 78 78 81 87 89 91 92 93 32
93 90 94 95 95 95 95 91 94
[0418]
41 TABLE 41 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Fluoxetine hydrochloride 0 6 -6.9 -10 -15 -5.2 -5.2 -- 9.3 9.8
(.mu.M) 0.45 -13 -12 -10 -9.6 -4.5 -11 0.86 7.6 10 0.9 -6.2 -11 -14
-19 -2 -4.5 -1 4.7 9.7 1.8 -8.1 -12 -4.8 -14 -16 3.9 4.4 12 22 3.6
-13 -3.1 -5.2 -7.1 -7.2 1.3 4.6 25 40 7.2 8.3 12 14 12 17 26 31 45
57 14 58 62 62 60 74 69 82 81 87 29 93 92 92 93 92 94 95 96 96 58
97 98 98 98 98 98 98 98 97
[0419]
42 TABLE 42 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Nortripyline hydrochloride 0 -0.24 5.8 3.4 -1.7 3.2 1.8 0.7 14 9.1
(.mu.M) 0.52 9.2 5.2 7 5.8 6.2 2.3 6.8 18 16 1 12 7.6 4.7 -4.1 1.6
6.7 4.1 13 15 2.1 7.8 19 10 -2.4 8.9 16 12 20 26 4.2 14 17 11 6.7
10 14 39 35 56 8.3 38 32 50 45 42 45 62 69 79 17 76 79 78 77 83 84
88 88 92 33 83 90 89 91 91 83 92 91 89 67 88 93 91 94 86 93 93 91
90
[0420]
43 TABLE 43 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Paroxetine (.mu.M) 0 -2 9.1 11 4.7 14 0.58 20 20 24 0.21 11 16 -2.5
6.1 16 24 18 25 22 0.42 4.5 16 8.7 -0.05 -0.2 33 20 26 23 0.83 5.9
12 6.6 2.2 13 18 22 24 29 1.7 -3 18 -0.65 -14 19 20 26 24 30 3.3 21
24 2.7 9.3 28 36 39 49 51 6.7 4.3 61 56 57 70 65 72 42 78 13 88 84
89 90 91 92 92 93 92 27 93 95 95 95 94 95 93 96 90
[0421]
44 TABLE 44 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Bromodiphenhydramine 0 -5 -6.1 -11 0.66 4.6 -4.1 -3.5 8.8 -6.8 HCl
(.mu.M) 0.21 6.1 -1.7 -4.3 2.1 -1.9 -13 7.4 3.5 -3.5 0.43 -0.38
0.68 -2.3 -5.1 -12 -6.8 -1.5 -17 -0.75 0.85 -4.5 -9.5 -7.3 -12 -7.9
-14 3.5 -5.3 15 1.7 3 -6.8 -14 -17 -16 2.1 3.1 0.065 3.5 3.4 4 3.7
-20 -13 -7.3 -1.8 -11 -0.98 16 6.8 6.3 6.6 -3.5 -9.8 -7.1 1.6 -0.43
2.5 16 14 10 6.3 5.8 -15 12 14 4.6 12 13 27 25 22 55 45 34 27 33 33
37
[0422]
45 TABLE 45 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Cyproheptadine HCl (.mu.M) 0 -6 5.2 -7.2 1.4 -2.6 -2.4 0.58 13 -5.3
0.24 8.6 -4.8 9.3 3.1 -15 1.1 2.1 1.7 -17 0.48 8.4 7.2 9.5 -1.8 -12
-14 -1.6 -5.9 5.2 0.96 1.1 7.2 -0.95 -1 -3.8 -7.2 4.2 0.27 -0.7 1.9
4.7 3.9 -1.2 2.2 9.2 0.31 -1 -6.2 -3.7 3.9 6.4 15 2.2 8.8 -7.5 -1.5
11 8.2 14 7.7 27 23 5.5 4 17 16 0.35 1.3 14 15 31 36 31 41 33 28 26
36 29 31 24 29 17 2.4 -4.2 44 35 29 31
[0423]
46 TABLE 46 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Loratadine (.mu.M) 0 -6.7 4.9 -9 -15 -5.1 -14 -5.2 -5.4 3.8 0.2 1.6
-4.5 -2 3.3 -14 -9.5 7.8 -1.6 -7.8 0.41 -1.1 -1.8 -2.6 -12 -4.6 -12
-4.8 -7.4 9 0.82 -10 -9 -8.2 -12 -7.8 -12 -8.8 -16 -7.9 1.6 -5.6
-4.8 -12 -14 -19 -11 -10 -9.8 13 3.3 -0.54 0.04 -13 -18 -15 -12 -12
-20 0.6 6.5 -1.4 -11 -6.8 -8.4 1.9 -1.2 1.3 4.4 8.5 13 -13 5.9 0.15
-9.9 -15 3.9 -5.5 2.6 6.1 26 16 5.9 -11 -20 11 15 15 4.9 2.8
[0424]
47 TABLE 47 Dipyridamole (.mu.M) 0 0.15 0.3 0.61 1.2 2.4 4.9 9.7 19
Thiethylperazine maleate 0 5 -1.9 -11 -8.2 1.3 -10 -0.47 -20 -11
(.mu.M) 0.2 -10 2.6 -9.6 -9.9 -3.8 8.2 -8.5 -11 -17 0.39 -7.9 -15
-16 12 6.8 -4 -12 -6.7 -11 0.78 -17 -8.4 -4.7 -7.3 -8.3 -5.5 -18
-6.2 -2.9 1.6 -7 -11 -15 -19 -7.3 -10 -20 -17 2.5 3.1 -19 -7.8 -7.6
-17 -12 -4.2 -7.5 -5.5 4.1 6.3 3.1 -20 -10 -3.5 -18 -15 -7 -15 12
13 6 4.6 11 0.53 22 11 21 30 36 25 -15 28 22 23 62 67 58 63 72
[0425] The aability of various combinations to suppress IL-1
secretion in vitro was also tested. The results are shown in Tables
48 to 52.
48 TABLE 48 Prednisolone (.mu.M) 0 0.0078 0.016 0.031 0.062 0.12
0.25 0.5 1 Dipyridamole (.mu.M) 0 -8.25 6.42 -5.05 1.3 13.2 36 52.4
61.5 68.8 0.3 3.78 -7.41 3.45 11.8 4.78 42.5 56 59.6 66.5 0.61
-5.65 8.23 10.1 14 31.2 50.5 46.5 59.7 69 1.2 10 14.9 19.2 24.2
26.3 46.9 54.5 59.8 65.9 2.4 18.5 30.8 29 43.4 44.7 55.4 62.7 56.6
75.2 4.9 29.3 31.1 31.7 39.9 43.1 54.9 57.1 66.2 64.9 9.7 35.8 34.4
39.1 41.4 51.4 53.4 63.8 63.8 75.3 19 46.3 44.8 47 49 60.5 64 61.6
71 71.7 39 55.3 53.7 55.4 56.7 56.3 55.2 68.5 73.4 75.6
[0426]
49 TABLE 49 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Amoxapine (.mu.M) 0 12 -1.6 0.15 -16 -5.5 13 36 35 42 0.25 5.5 0.99
-6.7 -5.2 -4.2 18 37 34 39 0.5 6.3 -7 -8.6 -11 3.5 18 25 37 52 1
1.1 -8.7 -14 -0.65 11 18 34 44 49 2 4.6 5.2 3.8 -1.8 12 22 37 48 42
4 10 15 -4.9 11 14 17 36 37 37 8 3.1 9.2 3.3 8.6 16 18 31 28 19 16
17 25 17 27 18 8.8 -3.7 -0.71 -14 32 30 7 10 18 13 -0.7 16 21
35
[0427]
50 TABLE 50 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Fluoxetine HCl (.mu.M) 0 28 -3 -14 5.7 -8.9 14 44 55 64 0.45 7.5
-20 -20 -8.1 14 30 23 56 56 0.9 9.9 26 3.2 -2.5 -3.5 19 34 52 61
1.8 -19 0.79 -7.3 24 13 8.6 33 51 63 3.6 -5.8 1.6 17 32 23 35 41 59
54 7.2 13 21 -0.1 22 23 35 48 56 45 14 -0.095 27 29 14 22 14 6.5
6.6 13 29 48 36 34 42 35 50 44 46 60 58 63 74 65 59 71 63 71 81
83
[0428]
51 TABLE 51 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Nortriptyline HCl (.mu.M) 0 45 -5.9 -8.8 -1.3 8.4 22 35 51 56 0.52
-13 -17 -17 -4.7 -0.34 23 33 54 55 1 -16 -6.9 -12 -2.6 19 22 36 48
51 2.1 -17 -16 -17 -2.9 -0.41 17 33 47 50 4.2 -14 -12 -12 0.11 3.9
27 42 47 42 8.3 -8.8 -10 -1.8 -0.97 13 13 26 19 23 17 11 -4.8 -7.5
2.9 12 25 10 9 11 33 40 38 34 40 42 56 52 57 73 67 61 74 65 71 73
72 70 79 78
[0429]
52 TABLE 52 Dipyridamole (.mu.M) 0 0.3 0.61 1.2 2.4 4.9 9.7 19 39
Paroxetine HCl (.mu.M) 0 39 6.2 -15 -9.5 -7.3 23 31 47 35 0.21 -13
-10 -3.5 -7.6 -1.8 20 29 39 51 0.42 -20 9 14 26 20 12 44 46 54 0.83
-12 -7.7 -7.8 10 2.4 33 32 36 58 1.7 -7.9 -5.5 -14 -2.5 21 44 47 56
68 3.3 -1.8 1.9 -11 -15 21 30 50 50 54 6.7 -14 -2.6 0.8 13 19 4.4
27 37 5.5 13 31 21 25 32 17 6 16 20 4 27 42 45 45 57 45 53 50 62
58
[0430] The ability of the combination of prednisolone and
dipyridamole to suppress IFN-.gamma. secretion in vitro was also
tested. The results are shown in Table 53.
53 TABLE 53 Prednisolone (.mu.M) 0 0.0039 0.0078 0.016 0.031 0.062
0.12 0.25 0.5 Dipyridamole (.mu.M) 0 2.41 2.85 2.65 7.72 9.9 11.8
16.4 14.4 14.8 0.15 -2.89 0.45 2.25 -0.151 8.81 8.41 11.8 10.4 12.4
0.3 -4.9 -1.7 0.543 5.36 6.42 8.75 11.5 13.9 16.2 0.61 -2.5 -3.96
1.24 3.85 3.81 7.13 5.03 10.2 12.1 1.2 -5.45 -3.47 -6.18 1.66 6.21
10.2 5.27 9.36 15.5 2.4 -0.679 -8.62 -0.23 1.97 5.66 5.26 13.6 11.2
13.8 4.9 -1.31 -0.765 7.49 6.78 8.58 15.6 16.9 21.2 23.1 9.7 13.3
11.1 14.5 19.8 19.9 25.7 26.2 31.1 30.8 19 16.3 18 17.5 21.9 30.2
35 37.6 37.7 39.3
Other Embodiments
[0431] Various modifications and variations of the described method
and system of the invention will be apparent to those skilled in
the art without departing from the scope and spirit of the
invention. Although the invention has been described in connection
with specific desired embodiments, it should be understood that the
invention as claimed should not be unduly limited to such specific
embodiments. Indeed, various modifications of the described modes
for carrying out the invention that are obvious to those skilled in
the fields of medicine, immunology, pharmacology, endocrinology, or
related fields are intended to be within the scope of the
invention.
[0432] All publications mentioned in this specification are herein
incorporated by reference to the same extent as if each independent
publication was specifically and individually incorporated by
reference.
* * * * *