U.S. patent application number 12/043845 was filed with the patent office on 2008-09-04 for method of promoting cervical and vaginal secretions.
This patent application is currently assigned to Inspire Pharmaceuticals, Inc.. Invention is credited to David J. Drutz, William Pendergast, Janet L. Rideout, Sammy Ray Shaver, Benjamin R. Yerxa.
Application Number | 20080214490 12/043845 |
Document ID | / |
Family ID | 22739534 |
Filed Date | 2008-09-04 |
United States Patent
Application |
20080214490 |
Kind Code |
A1 |
Pendergast; William ; et
al. |
September 4, 2008 |
METHOD OF PROMOTING CERVICAL AND VAGINAL SECRETIONS
Abstract
The present invention provides a method of stimulating cervical
and vaginal secretions in a mammal by treatment with P2Y.sub.2
and/or P2Y.sub.4 purinergic receptor agonists. Treatment of vaginal
dryness associated with menopause, chemotherapy, and various
disease states as well as the treatment of vulvar pain is
discussed. Suitable agonists such as UTP, CTP, ATP, dinucleotides
and analogs thereof are disclosed.
Inventors: |
Pendergast; William;
(Durham, NC) ; Shaver; Sammy Ray; (Chapel Hill,
NC) ; Drutz; David J.; (Chapel Hill, NC) ;
Rideout; Janet L.; (Fuquay-Varina, NC) ; Yerxa;
Benjamin R.; (Raleigh, NC) |
Correspondence
Address: |
HOWERY LLP
C/O IP DOCKETING DEPARTMENT, 2941 FAIRVIEW PARK DRIVE SUITE 200
FALLS CHURCH
VA
22042
US
|
Assignee: |
Inspire Pharmaceuticals,
Inc.
Durham
NC
|
Family ID: |
22739534 |
Appl. No.: |
12/043845 |
Filed: |
March 6, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09531851 |
Mar 20, 2000 |
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12043845 |
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09199912 |
Nov 25, 1998 |
6462028 |
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09531851 |
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09122516 |
Jul 24, 1998 |
6319908 |
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09199912 |
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60054147 |
Jul 25, 1997 |
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Current U.S.
Class: |
514/47 |
Current CPC
Class: |
C07H 21/00 20130101;
A61K 31/00 20130101; A61P 15/02 20180101 |
Class at
Publication: |
514/47 |
International
Class: |
A61K 31/7076 20060101
A61K031/7076; A61P 15/02 20060101 A61P015/02 |
Claims
1. A method of stimulating cervical and vaginal secretions in a
mammal in need thereof, comprising administering an effective
amount of a purinergic agent of Formula II, or pharmaceutically
acceptable esters of salts thereof, to a mammal in need of
treatment thereof: ##STR00010## wherein: X is oxygen, methylene,
difluoromethylene, imido; n=0, 1, or 2; m=0, 1, or 2; n+m=0, 1, 2,
3, or 4; and B and B' are each independently a purine residue or a
pyrimidine residue linked through the 9- or 1-position,
respectively; Z=OH or N.sub.3; Z'=OH or N.sub.3; Y.dbd.H or OH;
Y'.dbd.H or OH; provided that when Z is N.sub.3, Y is H and when Z'
is N.sub.3, Y' is H.
2. The method of claim 1, wherein the Formula II compounds are
those of Formula IIa: ##STR00011## wherein: X.dbd.O; n+m=1 or 2; Z,
Z', Y, and Y'.dbd.OH; B and B' are defined in Formulas IIc and IId,
or X.dbd.O; n+m=3 or 4; Z, Z', Y, and Y'.dbd.OH; B=uracil; B' is
defined in Formulas IIc and IId; or X.dbd.O; n+m=1 or 2; Z, Y, and
Z'=OH; Y'.dbd.H; B=uracil; B' is defined in Formulas IIc and IId;
or X.dbd.O; n+m=0, 1, or 2; Z and Y.dbd.OH; Z'=N.sub.3; Y'.dbd.H;
B=uracil; B'=thymine; or X.dbd.O; n+m=0, 1, or 2; Z and Z'=N.sub.3;
Y and Y'.dbd.H; B and B'=thymine; or X.dbd.CH.sub.2, CF.sub.2, or
NH; n and m=1; Z, Z', Y, and Y'.dbd.OH; B and B' are defined in
Formulas IIc and IId: ##STR00012## wherein R.sub.1 of the
6-HNR.sub.1 group and R.sub.3 are chosen from the group consisting
of: (a) arylalkyl (C.sub.1-6) groups with the aryl moiety
optionally substituted, (b) alkyl, (c) carbamoylmethyl, (d)
.omega.-amino alkyl (C.sub.2-10), (e) .omega.-hydroxy alkyl
(C.sub.2-10), (f) .omega.-thiol alkyl (C.sub.2-10), (g)
.omega.-carboxy alkyl (C.sub.2-10), (h) the .omega.-acylated
derivatives of (b), (c) or (d) wherein the acyl group is either
acetyl, trifluoroacetyl, benzoyl, or substituted-benzoyl
alkyl(C.sub.2-10), (i) .omega.-carboxy alkyl (C.sub.2-10) as in (e)
above wherein the carboxylic moiety is an ester or an amide, and
(j) hydrogen; R.sub.2 is O or is absent; or R.sub.1 and R.sub.2
taken together may form optionally substituted 5-membered fused
imidazole ring; ##STR00013## wherein: R.sub.4 is hydroxy, mercapto,
amino, cyano, aralkoxy, C.sub.1-6 alkylthio, C.sub.1-6 alkoxy,
C.sub.1-6 alkylamino or dialkylamino, wherein the alkyl groups of
said dialkylamino are optionally linked to form a heterocycle;
R.sub.5 is hydrogen, acyl, C.sub.1-6 alkyl, aroyl, C.sub.1-5
alkanoyl, benzoyl, or sulphonate; R.sub.6 is hydroxy, mercapto,
alkoxy, aralkoxy, C.sub.1-6-alkylthio, C.sub.1-5 disubstituted
amino, triazolyl, alkylamino or dialkylamino, wherein the alkyl
groups of said dialkylamino are optionally linked to form a
heterocycle or linked to N.sup.3 to form an optionally substituted
ring; or R.sub.5-R.sub.6 together forms a 5 or 6-membered saturated
or unsaturated ring bonded through N or O at R.sub.6, wherein said
ring is optionally substituted; R.sub.7 is selected from the group
consisting of: (a) hydrogen, (b) hydroxy, (c) cyano, (d) nitro, (e)
alkenyl, wherein the alkenyl moiety is optionally linked through
oxygen to form a ring optionally substituted with alkyl or aryl
groups on the carbon adjacent to the oxygen, (f) substituted
alkynyl (g) halogen, (h) alkyl, (i) substituted alkyl, (j)
perhalomethyl, (k) C.sub.2-6 alkyl, (l) C.sub.2-3 alkenyl, (m)
substituted ethenyl, (n) C.sub.2-3 alkynyl and (o) substituted
alkynyl when R.sub.6 is other than amino or substituted amino;
R.sub.8 is selected from the group consisting of: (a) hydrogen, (b)
alkoxy, (c) arylalkoxy, (d) alkylthio, (e) arylalkylthio, (f)
carboxamidomethyl, (g) carboxymethyl, (h) methoxy, (i) methylthio,
(j) phenoxy and (k) phenylthio.
3. The method of claim 2, wherein the compounds of Formula II are
those of Formula IIb: ##STR00014## wherein: X is oxygen, methylene,
difluoromethylene, or imido; n=0 or 1; m=0 or 1; n+m=0, 1, or 2;
and provided that when B and B' are uracil, attached at N-1
position to the ribosyl moiety, then the total of m+n equals 3 or 4
when X is oxygen.
4. The method of claim 1, wherein the furanose sugar of Formula II
is in the 13-D-configuration.
5. The method of claim 1, wherein the amount of compound of Formula
II, administered to the mammal is sufficient to achieve a
concentration on the cervical and/or vaginal mucosa of from about
10.sup.-7 moles/liter to about 10.sup.-1 moles/liter.
6. The method of claim 5, wherein the amount is a daily dose of
between 1 to 1000 milligrams.
7. The method of claim 1, wherein said compound is
P.sup.1,P.sup.4-di(uridine 5'-) tetraphosphate.
8. The method of claim 1, wherein said mammal is a human.
9. A method of treating vaginal dryness in a mammal, comprising
administering an effective amount of a purinergic agent of Formula
II, or pharmaceutically acceptable esters of salts thereof, to a
mammal in need of treatment thereof: ##STR00015## wherein: X is
oxygen, methylene, difluoromethylene, imido; n=0, 1, or 2; m=0, 1,
or 2; n+m=0, 1, 2, 3, or 4; and B and B' are each independently a
purine residue or a pyrimidine residue linked through the 9- or
1-position, respectively; Z=OH or N.sub.3; Z'=OH or N.sub.3;
Y.dbd.H or OH; Y'.dbd.H or OH; provided that when Z is N.sub.3, Y
is H and when Z' is N.sub.3, Y' is H.
10. The method of claim 9, wherein the Formula II compounds are
those of Formula IIa: ##STR00016## wherein: X.dbd.O; n+m=1 or 2; Z,
Z', Y, and Y'.dbd.OH; B and B' are defined in Formulas IIc and IId,
or X.dbd.O; n+m=3 or 4; Z, Z', Y, and Y'.dbd.OH; B=uracil; B' is
defined in Formulas IIc and IId; or X.dbd.O; n+m=1 or 2; Z, Y, and
Z'=OH; Y'.dbd.H; B=uracil; B' is defined in Formulas IIc and IId;
or X.dbd.O; n+m=0, 1, or 2; Z and Y.dbd.OH; Z'=N.sub.3; Y'.dbd.H;
B=uracil; B'=thymine; or X.dbd.O; n+m=0, 1, or 2; Z and Z'=N.sub.3;
Y and Y'.dbd.H; B and B'=thymine; or X.dbd.CH.sub.2, CF.sub.2, or
NH; n and m=1; Z, Z', Y, and Y'.dbd.OH; B and B' are defined in
Formulas IIc and IId: ##STR00017## wherein R.sub.1 of the
6-HNR.sub.1 group and R.sub.3 are chosen from the group consisting
of: (a) arylalkyl (C.sub.1-6) groups with the aryl moiety
optionally substituted, (b) alkyl, (c) carbamoylmethyl, (d)
.omega.-amino alkyl (C.sub.2-10), (e) .omega.-hydroxy alkyl
(C.sub.2-10), (f) .omega.-thiol alkyl (C.sub.2-10), (g)
.omega.-carboxy alkyl (C.sub.2-10), (h) the .omega.-acylated
derivatives of (b), (c) or (d) wherein the acyl group is either
acetyl, trifluoroacetyl, benzoyl, or substituted-benzoyl
alkyl(C.sub.2-10), (i) .omega.-carboxy alkyl (C.sub.2-10) as in (e)
above wherein the carboxylic moiety is an ester or an amide, and
(j) hydrogen; R.sub.2 is O or is absent; or R.sub.1 and R.sub.2
taken together may form optionally substituted 5-membered fused
imidazole ring; ##STR00018## wherein: R.sub.4 is hydroxy, mercapto,
amino, cyano, aralkoxy, C.sub.1-6 alkylthio, C.sub.1-6 alkoxy,
C.sub.1-6 alkylamino or dialkylamino, wherein the alkyl groups of
said dialkylamino are optionally linked to form a heterocycle;
R.sub.5 is hydrogen, acyl, C.sub.1-6 alkyl, aroyl, C.sub.1-5
alkanoyl, benzoyl, or sulphonate; R.sub.6 is hydroxy, mercapto,
alkoxy, aralkoxy, C.sub.1-6-alkylthio, C.sub.1-5 disubstituted
amino, triazolyl, alkylamino or dialkylamino, wherein the alkyl
groups of said dialkylamino are optionally linked to form a
heterocycle or linked to N.sup.3 to form an optionally substituted
ring; or R.sub.5-R.sub.6 together forms a 5 or 6-membered saturated
or unsaturated ring bonded through N or O at R.sub.6, wherein said
ring is optionally substituted; R.sub.7 is selected from the group
consisting of: (a) hydrogen, (b) hydroxy, (c) cyano, (d) nitro, (e)
alkenyl, wherein the alkenyl moiety is optionally linked through
oxygen to form a ring optionally substituted with alkyl or aryl
groups on the carbon adjacent to the oxygen, (f) substituted
alkynyl (g) halogen, (h) alkyl, (i) substituted alkyl, (j)
perhalomethyl, (k) C.sub.2-6 alkyl, (l) C.sub.2-3 alkenyl, (m)
substituted ethenyl, (n) C.sub.2-3 alkynyl and (o) substituted
alkynyl when R.sub.6 is other than amino or substituted amino;
R.sub.8 is selected from the group consisting of: (a) hydrogen, (b)
alkoxy, (c) arylalkoxy, (d) alkylthio, (e) arylalkylthio, (f)
carboxamidomethyl, (g) carboxymethyl, (h) methoxy, (i) methylthio,
(j) phenoxy and (k) phenylthio.
11. The method of claim 9, wherein the compounds of Formula II are
those of Formula IIb: ##STR00019## wherein: X is oxygen, methylene,
difluoromethylene, or imido; n=0 or 1; m=0 or 1; n+m=0, 1, or 2;
and provided that when B and B' are uracil, attached at N-1
position to the ribosyl moiety, then the total of m+n equals 3 or 4
when X is oxygen.
12. The method of claim 9, wherein the furanose sugar of Formula II
is in the .beta.-D-configuration.
13. The method of claim 9, wherein the amount of compound of
Formula II, administered to the mammal is sufficient to achieve a
concentration on the cervical and/or vaginal mucosa of from about
10.sup.-7 moles/liter to about 10.sup.-1 moles/liter.
14. The method of claim 13, wherein the amount is a daily dose of
between 1 to 1000 milligrams.
15. The method of claim 9, wherein said compound is
P.sup.1,P.sup.4-di(uridine 5'-) tetraphosphate.
16. The method of claim 9, wherein said mammal is a human.
Description
[0001] This application is a continuation of U.S. application Ser.
No. 09/531,851, filed Mar. 20, 2000; which is a continuation of
U.S. Application of 09/199,912, filed Nov. 25, 1998, now U.S. Pat.
No. 6,462,028; which is a continuation-in-part of U.S. application
Ser. No. 09/122,516, filed Jul. 24, 1998, now U.S. Pat. No.
6,319,908, which claims priority to U.S. Provisional Application
Ser. No. 60/054,147, filed Jul. 25, 1997. The above applications
are incorporated herein by reference in their entirety.
TECHNICAL FIELD
[0002] This invention relates to a method of regulating secretions
in and around the cervix and vagina of a patient by administering
purinergic receptor agonists such as certain uridine, adenine, or
cytidine triphosphates as well as other nucleoside phosphate
containing compounds.
BACKGROUND OF THE INVENTION
[0003] Vaginal dryness is a very common problem which brings
physical and emotional distress to many women (Key, E., Nurs.
Stand. 5:24-27 (1991)). It most commonly manifests itself during
sexual intercourse, which causes dyspareunia and can eventually
lead to apareunia. Although it is traditionally considered to be a
condition which affects postmenopausal women, it can occur during
the premenopausal and perimenopausal years. The use of oral
contraceptives may also cause a reduction in vaginal moisture in
some women (Reginald, W., et al., Br. J. Obstet. Gynaecol.
96:1148-1152 (1989)). Postpartum vaginal dryness, independent of or
as a result of lactation, can be a significant complaint
(Wisniewski, P., et al., Am. J. Obstet. Gynecol. 165:1249-1254
(1991)). Women undergoing chemotherapy or radiotherapy for
malignant diseases such as leukemia often experience vaginal
dryness as a result of treatment (Cust, M., et al., Br. Med. J.
299:1494-1497 (1989)). Many disease states, such as systemic
sclerosis and other systemic autoimmune disorders (Bhadauria, S.,
et al., Am. J. Obstet. Gynecol. 172:580-587 (1995)), Ehlers-Danlos
syndrome (Sorokin, Y., et al., J. Reprod. Med. 39:281-284 (1994)),
diabetes mellitus (Sreebny, L., et al., Diabetes Care 15:900-904
(1992)), and Sjogren's syndrome (Marchesoni, D., et al., Eur. J.
Obstet. Gynecol. Reprod. Biol. 63:49-53 (1995)) have decreased
vaginal hydration and lubrication problems as significant
disease-associated symptoms.
[0004] Vulvar pain is defined as the excessive sensitivity of the
nerves supplying the mucus membrane of the vulva. This persistent
burning and sensitivity in vulvar skin is not caused by
identifiable infection. It cannot be cured by surgery. The diseases
covered under "vulvar pain" are also referred to as
vulvodynia/vulvar vestibulitis, vulvitis, burning vulvar syndrome
and is often associated with fibromylagia, irritable bowel
syndrome, Sjogren's syndrome, chronic inflammation, and Paget's
disease as well as in the absence of any identifiable disease or
infection. R. Paul St. Armad, M.D., an endocrinologist at UCLA, has
successfully treated fibromylagia with uricosuric (gout) drugs,
especially guaifenesin, a drug used to liquefy mucus (Yount, J. J.
et al., Women's Health Digest 3(2) 1997). Dr. Armad has found that
such gout drugs provide an effective treatment for fibromylagia,
even though gout and fibromylagia have no connection. Dr. Armad has
found that 24-hour urine samples taken from patients before and
after treatment exhibited a significant increase in the excretion
of phosphate and a moderate increase of oxalate and calcium after
guaifenesin was started. His hypothesis is that an excess of
intracellular phosphate, and possibly oxalate, builds up in the
cells of fibromylagia sufferers and depresses formation of energy
(ATP) in the mitochondria of the cells. It should be noted that the
role of ATP in Dr. Armad's theory is as an energy source and not an
agonist of the P2Y.sub.2 receptor.
[0005] Current therapies for increasing vaginal moisture are:
lubricating agents such as lubricating creams or jellies, topical
estrogen creams, and HRT (hormone replacement therapy). Lubricating
jellies provide short-lived and temporary relief, as these are
aqueous preparations containing no pharmacologically active agent.
Topical estrogen creams, if used on a regular basis, may be
absorbed into the systemic circulation. This can cause endometrial
stimulation and can lead to endometrial hyperplasia and carcinoma
(Whitehead, M., et al., N. Eng. J. Med. 305:1599-1605 (1981)). HRT
is effective at relieving symptoms of vaginal atrophy and hence
vaginal dryness but has several contraindications and unwanted
risks and side effects. A history of gall bladder disease (N. Eng.
J. Med., 290:15-19 (1974)) or a personal or family history of
reproductive or breast cancer (Harlap, S., Am. J. Obstet. Gynecol.
166:1986-1992 (1992)) are contraindications for estrogen therapy.
Other contraindications are: history of stroke, cardiovascular
disease, deep-vein thrombosis, superficial thrombophlebitis, liver
disease, heavy smoking, high blood pressure, diabetes, uterine
bleeding or large fibroids, hyperlipidemia, and gross obesity
(Lichtman, R., J. Nurse Midwifery 36:30-48 (1991)). One major
disadvantage of HRT is the resumption of monthly withdrawal bleeds,
which many postmenopausal women will not accept. Some women, even
while on HRT, still experience a degree of vaginal dryness (Key,
E., Nurs. Stand. 5:24-27 (1991)).
[0006] It has been shown that uridine 5'-triphosphate (UTP) and
dinucleotides such as diuridine tetraphosphate are potent agonists
of P2Y.sub.2 purinergic receptors found on the surface of human
airway epithelium. UTP has been shown to increase both the rate and
total amount of mucin secreted by goblet cells in vitro (Lethem,
M., et al., Am. J. Respir. Cell Mol. Biol. 9:315-322 (1993)). UTP
has also been shown to increase chloride secretion, and hence,
water secretion from airway epithelial cells in vitro (Mason, S.,
et al., Br. J. Pharmacol. 103:1649-1656 (1991)).
[0007] Thus, as a result of the ineffectiveness and risks of
current therapies, medical researchers have sought to develop
alternatives for the treatment of vaginal dryness. Because of the
demonstrated ability of UTP and dinucleotides, such as diuridine
tetraphosphate, to increase hydration of airway epithelial
secretions and stimulate release of mucins, applicants were
motivated to investigate whether UTP and other P2Y.sub.2 and/or
P2Y.sub.4 purinergic receptor agonists could stimulate hydration
and mucin production in the vaginal and cervical epithelia.
SUMMARY OF THE INVENTION
[0008] A method of stimulating cervical and vaginal secretions in a
subject in need of such treatment is disclosed. The method of the
present invention may be used to increase cervical and vaginal
secretions for any reason, including, but not limited to, treatment
of vaginal dryness and/or treatment of vulvar pain. Vaginal dryness
is associated with but not limited to menopause, childbirth,
breastfeeding, chemotherapy or radiotherapy, diabetes mellitus,
Sjogren's syndrome, Ehlers-Danlos syndrome, systemic sclerosis and
other systemic autoimmune diseases, hysterectomy, urogenital
surgery, psychosomatic disorders, anxiety, psychosexual problems,
and pharmacological drug-related side effects. The method of the
present invention comprises administering a P2Y.sub.2 and/or
P2Y.sub.4 purinergic receptor agonist: uridine 5'-triphosphate,
P.sup.1,P.sup.4 di(uridine-5')tetraphosphate, cytidine
5'-triphosphate or adenosine 5'-triphosphate or analogs thereof, in
an amount effective to stimulate vaginal and cervical
secretions.
[0009] Another aspect of the present invention is the use of
uridine 5'-triphosphate,
P.sup.1,P.sup.4-di(uridine-5')tetraphosphate, cytidine
5'-triphosphate or adenosine 5'-triphosphate or analogs thereof,
for the manufacture of a medicament for carrying out a therapeutic
method of treatment as given above.
[0010] The present invention also discloses pharmaceutical
compositions comprising uridine 5'-triphosphate,
P.sup.1,P.sup.4-di(uridine-5')tetraphosphate, cytidine
5'-triphosphate or adenosine 5'-triphosphate or analogs thereof,
with a pharmaceutical carrier therefor.
DETAILED DESCRIPTION OF THE INVENTION
[0011] Applicants have discovered that uridine 5'-triphosphate
(UTP) and related compounds are potent agonists for purinergic
receptors found in cervical and vaginal epithelia preparations. The
methods of the present invention are an improvement upon the
current most commonly used treatments of vaginal dryness as UTP
stimulates a patient's own production and secretion of mucins as
well as increasing the levels of mucosal hydration, which serve to
maintain the natural protective and lubricant characteristics of
vaginal and cervical mucosa. The methods of the present invention
may also be used exclusive of, or as an adjunct to, hormone
replacement therapy (HRT) or estrogen replacement therapy
(ERT).
[0012] The present invention provides a method of stimulating
cervical and vaginal secretions in a mammal, including a human, in
need thereof by administering an amount of a compound of Formulas
I, II, III, or IV or a pharmaceutically acceptable ester or salt
thereof effective to increase said secretions.
[0013] UTP and its analogs are depicted in general Formula I:
##STR00001##
wherein:
[0014] X.sub.1, X.sub.2 and X.sub.3 are each independently either
O.sup.- or S.sup.-; preferably, X.sub.2 and X.sub.3 are
O.sup.-;
[0015] R.sub.1 is O, imido, methylene or dihalomethylene (e.g.,
dichloromethylene or difluoromethylene); preferably, R.sub.1 is
oxygen or difluoromethylene;
[0016] R.sub.2 is H or Br; preferably, R.sub.2 is H; particularly
preferred compounds of Formula I are uridine 5'-triphosphate (UTP)
and uridine 5'-O-(3-thiotriphosphate) (UTP.gamma.S).
[0017] A dinucleotide is depicted by the general Formula II:
##STR00002##
wherein:
[0018] X is oxygen, methylene, difluoromethylene, imido;
[0019] n=0, 1, or 2;
[0020] m=0, 1, or 2;
[0021] n+m=0, 1, 2, 3, or 4; and
[0022] B and B' are each independently a purine residue or a
pyrimidine residue linked through the 9- or 1-position,
respectively;
[0023] Z=OH or N.sub.3;
[0024] Z'=OH or N.sub.3;
[0025] Y.dbd.H or OH;
[0026] Y'.dbd.H or OH;
[0027] provided that when Z is N.sub.3, Y is H or when Z' is
N.sub.3, Y' is H.
[0028] The furanose sugar is preferably in the
.beta.-configuration.
[0029] The furanose sugar is most preferably in the
.beta.-D-configuration.
[0030] Preferred compounds of Formula II are the compounds of
Formula IIa:
##STR00003##
wherein:
[0031] X.dbd.O;
[0032] n+m=1 or 2;
[0033] Z, Z', Y, and Y'.dbd.OH;
[0034] B and B' are defined in Formulas IIc and IId;
[0035] X.dbd.O;
[0036] n+m=3 or 4;
[0037] Z, Z', Y, and Y'.dbd.OH;
[0038] B=uracil;
[0039] B' is defined in Formulas IIc and IId; or
[0040] X.dbd.O;
[0041] n+m=1 or 2;
[0042] Z, Y, and Y'.dbd.OH;
[0043] Z'=H;
[0044] B=uracil;
[0045] B' is defined in Formulas IIc and IId; or
[0046] X.dbd.O;
[0047] n+m=0, 1, or 2;
[0048] Z and Y.dbd.OH;
[0049] Z'=N.sub.3;
[0050] Y'.dbd.H;
[0051] B=uracil;
[0052] B'=thymine; or
[0053] X.dbd.O;
[0054] n+m=0, 1, or 2;
[0055] Z and Z'=N.sub.3;
[0056] Y and Y'.dbd.H;
[0057] B and B'=thymine; or
[0058] X.dbd.CH.sub.2, CF.sub.2, or NH;
[0059] n and m=1;
[0060] Z, Z', Y, and Y'.dbd.OH;
[0061] B and B' are defined in Formulas IIc and IId.
Another preferred group of the compounds of Formula II are the
compounds of Formula IIb or the pharmaceutically acceptable salts
thereof:
##STR00004##
wherein:
[0062] X is oxygen, methylene, difluoromethylene, or imido;
[0063] n=0 or 1;
[0064] m=0 or 1;
[0065] n+m=0, 1, or 2; and
B and B' are each independently a purine residue, as in Formula
IIc, or a pyrimidine residue, as in Formula IId, linked through the
9- or 1-position, respectively. In the instance where B and B' are
uracil, attached at N-1 position to the ribosyl moiety, then the
total of m+n may equal 3 or 4 when X is oxygen. The ribosyl
moieties are in the D-configuration, as shown, but may be L-, or D-
and L-. The D-configuration is preferred.
##STR00005##
[0066] The substituted derivatives of adenine include adenine
1-oxide; 1,N6-(4- or 5-substituted etheno) adenine; 6-substituted
adenine; or 8-substituted aminoadenine, where R' of the 6- or
8-HNR' groups are chosen from among: arylalkyl (C.sub.1-6) groups
with the aryl moiety optionally functionalized as described below;
alkyl; and alkyl groups with functional groups therein, such as:
([6-aminohexyl]carbamoylmethyl)-, and
.omega.-acylated-amino(hydroxy, thiol and carboxy) derivatives
where the acyl group is chosen from among, but not limited to,
acetyl, trifluororoacetyl, benzoyl, substituted-benzoyl, etc., or
the carboxylic moiety is present as its ester or amide derivative,
for example, the ethyl or methyl ester or its methyl, ethyl or
benzamido derivative. The .omega.-amino(hydroxy, thiol) moiety may
be alkylated with a C.sub.1-4 alkyl group.
[0067] Likewise, B or B' or both in Formula IIb may be a pyrimidine
with the general formula of Formula IId, linked through the
1-position:
##STR00006##
wherein:
[0068] R.sub.4 is hydroxy, mercapto, amino, cyano, aralkoxy,
C.sub.1-6 alkoxy, C.sub.1-6 alkylamino, and dialkylamino, the alkyl
groups optionally linked to form a heterocycle;
[0069] R.sub.5 is hydrogen, acyl, C.sub.1-6 alkyl, aroyl, C.sub.1-5
alkanoyl, benzoyl, or sulphonate;
[0070] R.sub.6 is hydroxy, mercapto, alkoxy, aralkoxy,
C.sub.1-6-alkylthio, C.sub.1-5 disubstituted amino, triazolyl,
alkylamino, or dialkylamino, where the alkyl groups are optionally
linked to form a heterocycle or linked to N-3 to form an optionally
substituted ring;
[0071] R.sub.7 is hydrogen, hydroxy, cyano, nitro, alkenyl, with
the alkenyl moiety optionally linked through oxygen to form a ring
optionally substituted on the carbon adjacent to the oxygen with
alkyl or aryl groups, substituted alkynyl or hydrogen where R.sub.8
is amino or substituted amino and halogen, alkyl, substituted
alkyl, perhalomethyl (e.g., CF.sub.3), C.sub.2-6 alkyl, C.sub.2-3
alkenyl, or substituted ethenyl (e.g., allylamino, bromvinyl and
ethyl propenoate, or propenoic acid), C.sub.2-3 alkynyl or
substituted alkynyl when R.sub.6 is other than amino or substituted
amino and together R.sub.5-R.sub.6 may form a 5- or 6-membered
saturated or unsaturated ring bonded through N or O at R.sub.6,
such a ring may contain substituents that themselves contain
functionalities;
[0072] R.sub.8 is hydrogen, alkoxy, arylalkoxy, alkylthio,
arylalkylthio, carboxamidomethyl, carboxymethyl, methoxy,
methylthio, phenoxy, or phenylthio.
[0073] In the general structure of Formula IId above, the dotted
lines in the 2- to 6-positions are intended to indicate the
presence of single or double bonds in these positions; the relative
positions of the double or single bonds being determined by whether
the R.sub.4, R.sub.6, and R.sub.7 substituents are capable of
keto-enol tautomerism.
[0074] In the general structures of Formula IIc and IId above, the
acyl groups advantageously comprise alkanoyl or aroyl groups. The
alkyl groups advantageously contain 1 to 8 carbon atoms,
particularly 1 to 4 carbon atoms optionally substituted by one or
more appropriate substituents, as described below. The aryl groups
including the aryl moieties of such groups as aryloxy are
preferably phenyl groups optionally substituted by one or more
appropriate substituents, as described below. The above mentioned
alkenyl and alkynyl groups advantageously contain 2 to 8 carbon
atoms, particularly 2 to 6 carbon atoms, e.g., ethenyl or ethynyl,
optionally substituted by one or more appropriate substituents as
described below. Appropriate substituents on the above-mentioned
alkyl, alkenyl, alkynyl, and aryl groups are advantageously
selected from halogen, hydroxy, C.sub.1-4 alkoxy, C.sub.1-4 alkyl,
C.sub.6-12 arylalkoxy, carboxy, cyano, nitro, sulfonamido,
sulfonate, phosphate, sulfonic, amino, and substituted amino
wherein the amino is singly or doubly substituted by a C.sub.1-4
alkyl, and when doubly substituted, the alkyl groups optionally
being linked to form a heterocycle.
[0075] For purposes of further clarifying the foregoing
descriptions of Formulae IIc and IId, the descriptions can be
simplified to the following:
[0076] R.sub.2 is O or is absent; or
[0077] R.sub.1 and R.sub.2 taken together may form optionally
substituted 5-membered fused imidazole ring; or
[0078] R.sub.1 of the 6-HNR.sub.1 group or R.sub.3 of the
8-HNR.sub.3 group is chosen from the group consisting of: [0079]
(a) arylalkyl (C.sub.1-6) groups with the aryl moiety optionally
substituted, [0080] (b) alkyl, [0081] (c)
([6-aminohexyl]carbamoylmethyl), [0082] (d) .omega.-amino alkyl
(C.sub.2-10), [0083] (e) .omega.-hydroxy alkyl (C.sub.2-10), [0084]
(f) .omega.-thiol alkyl (C.sub.2-10), [0085] (g) .omega.-carboxy
alkyl (C.sub.2-10), [0086] (h) the .omega.-acylated derivatives of
(b), (c) or (d) wherein the acyl group is either acetyl,
trifluoroacetyl, benzoyl, or substituted-benzoyl alkyl(C.sub.2-10),
and [0087] (i) .omega.-carboxy alkyl (C.sub.2-10) as in (e) above
wherein the carboxylic moiety is an ester or an amide;
##STR00007##
[0087] wherein:
[0088] R.sub.4 is hydroxy, mercapto, amino, cyano, aralkoxy,
C.sub.1-6 alkylthio, C.sub.1-6 alkoxy, C.sub.1-6 alkylamino or
dialkylamino, wherein the alkyl groups of said dialkylamino are
optionally linked to form a heterocycle;
[0089] R.sub.5 is hydrogen, acyl, C.sub.1-6 alkyl, aroyl, C.sub.1-5
alkanoyl, benzoyl, or sulphonate;
[0090] R.sub.6 is hydroxy, mercapto, alkoxy, aralkoxy,
C.sub.1-6-alkylthio, C.sub.1-5 disubstituted amino, triazolyl,
alkylamino or dialkylamino, wherein the alkyl groups of said
dialkylamino are optionally linked to form a heterocycle or linked
to N.sup.3 to form an optionally substituted ring;
[0091] R.sub.5-R.sub.6 together forms a 5 or 6-membered saturated
or unsaturated ring bonded through N or O at R.sub.6, wherein said
ring is optionally substituted;
[0092] R.sub.7 is selected from the group consisting of: [0093] (a)
hydrogen, [0094] (b) hydroxy, [0095] (c) cyano, [0096] (d) nitro,
[0097] (e) alkenyl, wherein the alkenyl moiety is optionally linked
through oxygen to form a ring optionally substituted with alkyl or
aryl groups on the carbon adjacent to the oxygen, [0098] (f)
substituted alkynyl [0099] (g) halogen, [0100] (h) alkyl, [0101]
(i) substituted alkyl, [0102] (j) perhalomethyl, [0103] (k)
C.sub.2-6 alkyl, [0104] (l) C.sub.2-3 alkenyl, [0105] (m)
substituted ethenyl, [0106] (n) C.sub.2-3 alkynyl and [0107] (o)
substituted alkynyl when R.sub.6 is other than amino or substituted
amino;
[0108] R.sub.8 is selected from the group consisting of: [0109] (a)
hydrogen, [0110] (b) alkoxy, [0111] (c) arylalkoxy, [0112] (d)
alkylthio, [0113] (e) arylalkylthio, [0114] (f) carboxamidomethyl,
[0115] (g) carboxymethyl, [0116] (h) methoxy, [0117] (i)
methylthio, [0118] (j) phenoxy and [0119] (k) phenylthio.
[0120] CTP and its analogs are depicted by general Formula III:
##STR00008##
wherein:
[0121] R.sub.1, X.sub.1, X.sub.2 and X.sub.3 are defined as in
Formula I;
[0122] R.sub.5 and R.sub.6 are H while R.sub.7 is nothing and there
is a double bond between N-3 and C-4 (cytosine), or
[0123] R.sub.5, R.sub.6 and R.sub.7 taken together are
--CH.dbd.CH--, forming a ring from N-3 to N-4 with a double bond
between N-4 and C-4 (3,N.sup.4-ethenocytosine) optionally
substituted at the 4- or 5-position of the etheno ring.
[0124] ATP and its analogs are depicted by general Formula IV:
##STR00009##
wherein:
[0125] R.sub.1, X.sub.1, X.sub.2, and X.sub.3 are defined as in
Formula I;
[0126] R.sub.3 and R.sub.4 are H while R.sub.2 is nothing and there
is a double bond between N-1 and C-6 (adenine), or
[0127] R.sub.3 and R.sub.4 are H while R.sub.2 is O and there is a
double bond between N-1 and C-6 (adenine 1-oxide), or
[0128] R.sub.3, R.sub.4, and R.sub.2 taken together are
--CH.dbd.CH--, forming a ring from N-6 to N-1 with a double bond
between N-6 and C-6 (1,N6-ethenoadenine).
[0129] For simplicity, Formulas I, II, III, and IV herein
illustrate the active compounds in the naturally occurring
D-configuration, but the present invention also encompasses
compounds in the L-configuration, and mixtures of compounds in the
D- and L-configurations, unless otherwise specified. The naturally
occurring D-configuration is preferred.
[0130] The compounds of the invention may be present in the form of
their pharmaceutically acceptable salts, such as, but not limited
to, an alkali metal salt such as sodium or potassium; an alkaline
earth metal salt such as manganese, magnesium, or calcium; or an
ammonium or tetraalkyl ammonium salt, i.e., NX.sub.4.sup.+ (wherein
X is C.sub.1-4). Pharmaceutically acceptable salts are salts that
retain the desired biological activity of the parent compound and
do not impart undesired toxicological effects. The compounds of the
invention may also be present in the form of prodrugs, typically
comprising esters or amide moieties on the heterocyclic and
furanosyl hydroxyls of the compound.
[0131] Another aspect of the present invention is a method of
treating a mammal with vaginal dryness arising from, but not
limited to, menopause, childbirth, breastfeeding, chemotherapy or
radiotherapy, diabetes mellitus, Sjogren's syndrome, Ehlers-Danlos
syndrome, systemic sclerosis and other systemic autoimmune
diseases, hysterectomy, urogenital surgery, psychosomatic
disorders, anxiety, psychosexual problems, and pharmacological
drug-related side effects.
[0132] It is also contemplated that the method of the present
invention can be used to increase vaginal moisture and lubrication
in healthy women for the purpose of facilitating sexual
intercourse. It is further contemplated that the method of the
present invention would be particularly useful for a woman who
wished to accommodate a sexual partner who is undergoing treatment
with Viagra.RTM. or other such drugs used for the treatment of
erectile dysfunction.
[0133] The present invention further provides pharmaceutical
compositions comprising a dosage form containing either P2Y.sub.2
and/or P2Y.sub.4 purinergic receptor agonists selected from the
group consisting of general Formula I, i.e., uridine
5'-triphosphate [UTP] and its analogs, general Formula II, i.e.,
P.sup.1,P.sup.4-di(uridine-5') tetraphosphate [U.sub.2P.sub.4] and
its analogs, general Formula III, i.e., cytidine 5'-triphosphate
[CTP] and its analogs, and general Formula IV, i.e., adenosine
5'-triphosphate [ATP] and its analogs.
[0134] The compounds disclosed herein may be administered to the
cervical and/or vaginal mucosa of a patient by any suitable means,
but are preferably administered by a solution, gel, suspension,
cream, foam, pessary, or tablet containing the active compound.
Alternatively, the active compounds may by administered by
continuous release from a vaginal ring (Stumpf, P., Obstet.
Gynecol. 75:9 S (1990)) or an intrauterine device (Andersson, K.,
et al., Obstet. Gynecol. 79:963 (1992)).
[0135] The topical solution, gel, jelly, ointment, cream, foam,
pessary, or tablet contain the active compound in a physiologically
compatible vehicle, as those skilled in the art of gynecological
topical delivery system development can select using conventional
criteria.
[0136] Solutions formulated for administration to the vagina are
usually referred to as irrigations. These are sterile solutions,
prepared in a manner typical of sterile injections that are
intended for prepared as a single use sterile solution.
[0137] Gels or jellies may be produced using a suitable gelling
agent including, but not limited to, gelatin, tragacanth, or a
cellulose derivative and may include glycerol as a humectant,
emollient, and preservative.
[0138] Ointments are semi-solid preparations that consist of the
active ingredient incorporated into a fatty, waxy, or synthetic
base.
[0139] Examples of suitable creams include, but are not limited to,
water-in-oil and oil-in-water emulsions. Water-in-oil creams may be
formulated by using a suitable emulsifying agent with properties
similar, but not limited, to those of the fatty alcohols such as
cetyl alcohol or cetostearyl alcohol and to emulsifying wax.
Oil-in-water creams may be formulated using an emulsifying agent
such as cetomacrogol emulsifying wax. Suitable properties include
the ability to modify the viscosity of the emulsion and both
physical and chemical stability over a wide range of pH. The water
soluble or miscible cream base may contain a preservative system
and may also be buffered to maintain an acceptable physiological
pH.
[0140] Foam preparations may be formulated to be delivered from a
pressurized aerosol canister, via a suitable applicator, using
inert propellants. Suitable excipients for the formulation of the
foam base include, but are not limited to, propylene glycol,
emulsifying wax, cetyl alcohol, and glyceryl stearate. Potential
preservatives include methylparaben and propylparaben.
[0141] Pessaries are solid unit-dose forms suitably shaped for
insertion into the vagina and may either be composed of a base that
melts at body temperature or which dissolves when in contact with
mucous secretions. Examples of suitable bases include, but are not
limited to, theobroma oil, synthetic fat bases (e.g. Witepsol),
polyethylene glycols (macrogols), and glycerol suppository
basis.
[0142] Vaginal tablets are composed of the active ingredient
contained within a solid dosage form base which may include, but
not be limited to, excipients such as lactose, microcrystalline
cellulose, corn starch, magnesium stearate, silicon dioxide, and
hydroxypropyl methylcellulose.
[0143] In addition to the topical method of administration
described above, there are various methods of administering the
compounds of the present invention systemically. One such means
would involve an aerosol suspension of respirable particles
comprised of the active compound, which the subject inhales. The
active compound would be absorbed into the bloodstream via the
lungs and contact the cervical and/or vaginal tissues in a
pharmaceutically effective amount. The respirable particles may be
liquid or solid, with a particle size sufficiently small to pass
through the mouth and larynx upon inhalation; in general, particles
ranging from about 1 to 10 microns, but more preferably 1-5
microns, in size are considered respirable.
[0144] Another means of systemically administering the active
compounds to the cervical and vaginal tissues of the subject would
involve administering a liquid/liquid suspension in the form of
nasal drops of a liquid formulation, or a nasal spray of respirable
particles which the subject inhales. Liquid pharmaceutical
compositions of the active compound for producing a nasal spray or
nasal drops may be prepared by combining the active compound with a
suitable vehicle, such as sterile pyrogen free water or sterile
saline by techniques known to those skilled in the art.
[0145] Other means of systemic administration of the active
compound would involve oral administration, in which pharmaceutical
compositions containing compounds of Formulas I, II, III, or IV are
in the form of tablets, lozenges, aqueous or oily suspensions,
dispersible powders or granules, emulsion, hard or soft capsules,
or syrups or elixirs. Compositions intended for oral use may be
prepared according to any method known to the art for the
manufacture of pharmaceutical compositions and such compositions
may contain one or more agents selected from the group consisting
of sweetening agents, flavoring agents, coloring agents, and
preserving agents in order to provide pharmaceutically elegant and
palatable preparations. Tablets contain the active ingredient in
admixture with nontoxic pharmaceutically acceptable excipients
which are suitable for the manufacture of tablets. These excipients
may be, for example, inert diluents, such as calcium carbonate,
sodium carbonate, lactose, calcium phosphate, or sodium phosphate;
granulating and disintegrating agents, for example, corn starch or
alginic acid; binding agents, for example, starch, gelatin, or
acacia; and lubricating agents, for example magnesium stearate,
stearic acid, or talc. The tablets may be uncoated or they may be
coated by known techniques to delay disintegration and absorption
in the gastrointestinal tract and thereby provide a sustained
action over a longer period. For example, a time delay material
such as glyceryl monostearate or glyceryl distearate may be
employed. Formulations for oral use may also be presented as hard
gelatin capsules wherein the active ingredient is mixed with an
inert solid diluent, for example, calcium carbonate, calcium
phosphate, or kaolin, or as soft gelatin capsules wherein the
active ingredient is mixed with water or an oil medium, for
example, peanut oil, liquid paraffin, or olive oil.
[0146] Additional means of systemic administration of the active
compound to the cervical and vaginal tissues of the subject would
involve a suppository form of the active compound, such that a
therapeutically effective amount of the compound reaches the
cervical and vaginal tissues via systemic absorption and
circulation.
[0147] The quantity of the active compound included in the
pharmaceutical composition is an amount sufficient to achieve
concentrations of the active compound on the cervical and/or
vaginal mucosa of the subject of from about 10.sup.-7 to about
10.sup.-1 Moles/liter, and more preferably from about 10.sup.-6 to
about 10.sup.-1 Moles/liter.
[0148] Depending on the solubility of the particular formulation of
active compound administered, the daily dose to promote cervical
and/or vaginal mucin production and/or hydration may be divided
among one or several unit dose administrations. The total daily
dose for UTP (for example) may range from 1 to 1000 milligrams,
depending upon the age and state of the subject, given at a regimen
of up to four times per day or on an as needed basis to address
acute exacerbations.
[0149] Some compounds of Formulas I, II, III, and IV can be made by
methods which are well known to those skilled in the art and in
accordance with known procedures (Zamecnik, P., et al., Proc. Natl.
Acad. Sci. USA 89:2370-2373 (1992); Ng, K., et al., Nucleic Acids
Res. 15:3572-3580 (1977); Jacobus, K. M., et al., U.S. Pat. No.
5,789,391 and Pendergast, W., et al., International Patent
Application WO98/34942)); some are commercially available, for
example, from Sigma Chemical Company, PO Box 14508, St. Louis, Mo.
63178. The synthetic methods of U.S. Pat. No. 5,789,391 and
International Patent Application WO98/34942 are incorporated herein
by reference.
EXAMPLES
Example 1
In Vitro Short Circuit (I.sub.sc) Measurements
[0150] The compound UTP is a potent agonist of P2Y.sub.2 and/or
P2Y.sub.4 purinergic receptors in cervical and vaginal tissue
preparations by evaluation in vitro by administering UTP to the
tissue culture sufficient to achieve concentrations of UTP on the
mucosa of from about 10.sup.-7 to about 10.sup.-1 moles/liter.
(Rojanasakul, Y., et al., Pharm. Res. 9:1029-34 (1992); Bechgaard,
E., et al., Int. J. Pharm. 106:237-242 (1994); Gipson, I., et al.,
Biol. Reprod. 56:999-1011, (1997)). Specifically, ovariectomized
female white albino New Zealand rabbits are sacrificed and vaginal
tissue is removed. The tissue is mounted on a supporting ring and
clamped in an Ussing chamber. I.sub.sc is measured as flowing from
the epithelial side to the serosal side of the tissue.
Approximately half of this current corresponds to chloride movement
through the membrane and hence, this is an accurate measure of the
corresponding fluid movement.
Example 2
In Vivo Study in Rabbits
[0151] The compounds of the invention are evaluated in vivo by
administrating UTP, or any of the other P2Y.sub.2 and/or P2Y.sub.4
agonists of the present invention to an animal in an amount
sufficient to achieve concentrations of P2Y.sub.2 and/or P2Y.sub.4
agonist on the cervical and/or vaginal mucosa of the animal of from
about 10.sup.-7 to about 10.sup.-1 moles/liter (Richardson, J., et
al., Int. J. Pharm. 56:29-35 (1989)). Specifically, ovariectomized
female white albino New Zealand rabbits are dosed with a P2Y.sub.2
and/or P2Y.sub.4 agonist such as any of the compounds of the
present invention. A vaginal smear is then obtained with a cotton
swab. The sample is appropriately prepared, an ELISA or a
colorimetric dot blot method is run on the sample, and the relative
amounts of representative cervical mucins are determined as
compared to non-ovariectomized controls. (Gipson, I. et al., Biol.
Reprod. 56:999-1011 (1997)).
Example 3
In Vivo Study Using Ovarectomized Cynologous Monkeys
[0152] The compounds of the present invention are evaluated in vivo
with an animal model of vaginal dryness as follows. Ovariectomized
cynomolgus monkeys are examined before treatment and graded
subjectively using a fabinal atrophy index. The animals are then
dosed intravaginally with 100 to 300 .mu.l mist containing
10.sup.-2 to 1 moles/liter P2Y.sub.2 and/or P2Y.sub.4 agonist, such
as any of the compounds of the present invention. After 10, 20, 30,
60 and 90 minutes the animals are subjected to a gynecological exam
and graded by qualified medical professions with the vaginal
atrophy index on a scale of 1 to 5, including a measurement of
fluid pH. (Hubbard, G. et al., Lab Animal Sci. 47, 36-39,
(1997)).
* * * * *