U.S. patent application number 13/116988 was filed with the patent office on 2011-12-01 for bile acid recycling inhibitors and satiogens for treatment of diabetes, obesity, and inflammatory gastrointestinal conditions.
This patent application is currently assigned to Satiogen Pharmaceuticals, Inc.. Invention is credited to Bronislava Gedulin, Howard E. Greene, Andrew A. Young.
Application Number | 20110294767 13/116988 |
Document ID | / |
Family ID | 45004845 |
Filed Date | 2011-12-01 |
United States Patent
Application |
20110294767 |
Kind Code |
A1 |
Gedulin; Bronislava ; et
al. |
December 1, 2011 |
BILE ACID RECYCLING INHIBITORS AND SATIOGENS FOR TREATMENT OF
DIABETES, OBESITY, AND INFLAMMATORY GASTROINTESTINAL CONDITIONS
Abstract
Provided herein are methods of utilizing bile acid transport
inhibitors and/or enteroendocrine peptide enhancing agents for the
treatment of obesity, diabetes, and inflammatory gastrointestinal
conditions.
Inventors: |
Gedulin; Bronislava; (Del
Mar, CA) ; Young; Andrew A.; (Chapel Hill, NC)
; Greene; Howard E.; (Frankfort, MI) |
Assignee: |
Satiogen Pharmaceuticals,
Inc.
San Diego
CA
|
Family ID: |
45004845 |
Appl. No.: |
13/116988 |
Filed: |
May 26, 2011 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
61348666 |
May 26, 2010 |
|
|
|
61348669 |
May 26, 2010 |
|
|
|
Current U.S.
Class: |
514/171 ;
514/182; 514/211.09; 514/237.2; 514/249; 514/252.12; 514/277;
514/315; 514/326; 514/408; 514/431; 514/626; 514/636 |
Current CPC
Class: |
A61P 1/00 20180101; A61K
31/42 20130101; A61K 31/55 20130101; C07D 295/13 20130101; A61K
31/38 20130101; A61P 29/00 20180101; A61K 31/18 20130101; A61K
9/286 20130101; A61K 31/191 20130101; A61K 45/06 20130101; A61K
31/155 20130101; A61K 31/495 20130101; A61K 31/454 20130101; A61K
31/4985 20130101; A61K 31/7042 20130101; A61K 31/4995 20130101;
A61K 31/655 20130101; A61P 1/04 20180101; A61K 31/40 20130101; C07D
401/12 20130101; A61P 3/10 20180101; A61K 31/16 20130101; C07D
487/08 20130101; A61K 9/02 20130101; A61K 31/19 20130101; A61K
31/452 20130101; A61P 3/04 20180101; A61K 31/513 20130101; C07C
279/14 20130101; A61K 31/216 20130101; A61K 31/5377 20130101; A61K
31/554 20130101; A61K 9/0031 20130101; A61K 31/496 20130101; A61K
31/575 20130101; A61K 31/38 20130101; A61K 2300/00 20130101; A61K
31/4985 20130101; A61K 2300/00 20130101 |
Class at
Publication: |
514/171 ;
514/211.09; 514/249; 514/431; 514/315; 514/326; 514/408;
514/252.12; 514/626; 514/237.2; 514/636; 514/182; 514/277 |
International
Class: |
A61K 31/554 20060101
A61K031/554; A61K 31/38 20060101 A61K031/38; A61K 31/4453 20060101
A61K031/4453; A61K 31/454 20060101 A61K031/454; A61K 31/40 20060101
A61K031/40; A61K 31/495 20060101 A61K031/495; A61K 31/16 20060101
A61K031/16; A61K 31/5377 20060101 A61K031/5377; A61K 31/155
20060101 A61K031/155; A61K 31/575 20060101 A61K031/575; A61P 1/00
20060101 A61P001/00; A61P 1/04 20060101 A61P001/04; A61K 31/56
20060101 A61K031/56; A61K 31/4418 20060101 A61K031/4418; A61K
31/4995 20060101 A61K031/4995 |
Claims
1. A method for treating an inflammatory intestinal condition
comprising non-systemically administering to the distal ileum of an
individual in need thereof a therapeutically effective amount of an
Apical Sodium-dependent Bile Acid Transporter Inhibitor (ASBTI)
and/or an enteroendocrine peptide enhancing agent and/or a nuclear
farnesoid X receptor (FXR) agonist.
2. The method of claim 1, wherein the inflammatory intestinal
condition is selected from the group consisting of necrotizing
enterocolitis, gastritis, ulcerative colitis, inflammatory bowel
disease, irritable bowel syndrome, gastroenteritis, radiation
induced enteritis, chemotherapy induced enteritis,
gastro-esophageal reflux disease (GERD), peptic ulcer, non-ulcer
dyspepsia (NUD), celiac disease, intestinal celiac disease,
gastrointestinal complications following bariatric surgery, gastric
carcinogenesis, or gastric carcinogenesis following gastric or
bowel resection.
3. The method of claim 1, wherein the inflammatory intestinal
condition is necrotizing enterocolitis.
4. The method of claim 1, wherein less than 10% of the ASBTI or the
enteroendocrine peptide enhancing agent or the FXR agonist is
systemically absorbed.
5. The method of claim 1, further comprising administration of a
second agent selected from a liver receptor homolog 1 (LRH-1), a
DPP-IV inhibitor, a proton pump inhibitor, H2 antagonist,
prokinetic agent, a biguanide, an incretin mimetic, a
thiazolidinone, a mucoadhesive agent, and GLP-1 or an analog
thereof.
6. The method of claim 3, wherein the individual is a prematurely
born infant, an enterally-fed infant, or a formula-fed infant.
7. The method of claim 1, wherein the non-systemically administered
ASBTI and/or an enteroendocrine peptide enhancing agent and/or FXR
agonist reduces intraenterocyte bile acids or reduces necrosis
and/or damage to ileal architecture in an individual in need
thereof.
8. The method of claim 1, wherein the ASBTI is a compound of
Formula I: ##STR00071## wherein: R.sup.1 is a straight chained
C.sub.1-6alkyl group; R.sup.2 is a straight chained C.sub.1-6alkyl
group; R.sup.3 is hydrogen or a group OR.sup.11 in which R.sup.11
is hydrogen, optionally substituted C.sub.1-6alkyl or a C.sub.1-6
alkylcarbonyl group; R.sup.4 is pyridyl or optionally substituted
phenyl or -L.sub.z-K.sub.z; wherein z is 1, 2 or 3; each L is
independently a substituted or unsubstituted alkyl, a substituted
or unsubstituted heteroalkyl, a substituted or unsubstituted
alkoxy, a substituted or unsubstituted aminoalkyl group, a
substituted or unsubstituted aryl, a substituted or unsubstituted
heteroaryl, a substituted or unsubstituted cycloalkyl, or a
substituted or unsubstituted heterocycloalkyl; each K is a moiety
that prevents systemic absorption; R.sup.5, R.sup.6, R.sup.7 and
R.sup.8 are the same or different and each is selected from
hydrogen, halogen, cyano, R.sup.5-acetylide, OR.sup.15, optionally
substituted C.sub.1-6alkyl, COR.sup.15, CH(OH)R.sup.15,
S(O).sub.nR.sup.15, P(O)(OR.sup.15).sub.2, OCOR.sup.15, OCF.sub.3,
OCN, SCN, NHCN, CH.sub.2OR.sup.15, CHO, (CH.sub.2).sub.pCN,
CONR.sup.12R.sup.13, (CH.sub.2).sub.pCO.sub.2R.sup.15,
(CH.sub.2).sub.pNR.sup.12R.sup.13, CO.sub.2R.sup.15, NHCOCF.sub.3,
NHSO.sub.2R.sup.15, OCH.sub.2OR.sup.15, OCH.dbd.CHR.sup.15,
O(CH.sub.2CH.sub.2O).sub.nR.sup.15,
O(CH.sub.2).sub.pSO.sub.3R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13,
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14 and --W--R.sup.31,
wherein W is O or NH, and R.sup.31 is selected from ##STR00072##
wherein p is an integer from 1-4, n is an integer from 0-3 and,
R.sup.12, R.sup.13, R.sup.14 and R.sup.15 are independently
selected from hydrogen and optionally substituted C.sub.1-6alkyl;
or R.sup.6 and R.sup.7 are linked to form a group ##STR00073##
wherein R.sup.12 and R.sup.13 are as hereinbefore defined and m is
1 or 2; and R.sup.9 and R.sup.10 are the same or different and each
is selected from hydrogen or C.sub.1-6alkyl; and salts, solvates
and physiologically functional derivatives thereof.
9. The method of claim 8, wherein the compound of Formula I is
##STR00074##
10. The method of claim 1, wherein the ASBTI is a compound of
Formula II: ##STR00075## wherein: q is an integer from 1 to 4; n is
an integer from 0 to 2; R.sup.1 and R.sup.2 are independently
selected from the group consisting of H, alkyl, alkenyl, alkynyl,
haloalkyl, alkylaryl, arylalkyl, alkoxy, alkoxyalkyl, dialkylamino,
alkylthio, (polyalkyl)aryl, and cycloalkyl, wherein alkyl, alkenyl,
alkynyl, haloalkyl, alkylaryl, arylalkyl, alkoxy, alkoxyalkyl,
dialkylamino, alkylthio, (polyalkyl)aryl, and cycloalkyl optionally
are substituted with one or more substituents selected from the
group consisting of OR.sup.9, NR.sup.9R.sup.10,
N.sup.+R.sup.9R.sup.10R.sup.wA.sup.-, SR.sup.9,
S.sup.+R.sup.9R.sup.10A.sup.-,
P.sup.+R.sup.9R.sup.10R.sup.11A.sup.-, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, CO.sub.2R.sup.9, CN, halogen,
oxo, and CONR.sup.9R.sup.10, wherein alkyl, alkenyl, alkynyl,
alkylaryl, alkoxy, alkoxyalkyl, (polyalkyl)aryl, and cycloalkyl
optionally have one or more carbons replaced by O, NR.sup.9,
N.sup.+R.sup.9R.sup.10A.sup.-, S, SO, SO.sub.2,
S.sup.+R.sup.9A.sup.-, P.sup.+R.sup.9R.sup.10A.sup.-, or phenylene,
wherein R.sup.9, R.sup.10, and R.sup.w are independently selected
from the group consisting of H, alkyl, alkenyl, alkynyl,
cycloalkyl, aryl, acyl, heterocycle, ammoniumalkyl, arylalkyl, and
alkylammoniumalkyl; or R.sup.1 and R.sup.2 taken together with the
carbon to which they are attached form C.sub.3-C.sub.10 cycloalkyl;
R.sup.3 and R.sup.4 are independently selected from the group
consisting of H, alkyl, alkenyl, alkynyl, acyloxy, aryl,
heterocycle, OR.sup.9, NR.sup.9R.sup.10, SR.sup.9, S(O)R.sup.9,
SO.sub.2R.sup.9, and SO.sub.3R.sup.9, wherein R.sup.9 and R.sup.10
are as defined above; or R.sup.3 and R.sup.4 together .dbd.O,
.dbd.NOR.sup.11, .dbd.S, .dbd.NNR.sup.11R.sup.12, .dbd.NR.sup.9, or
.dbd.CR.sup.11R.sup.12, wherein R.sup.11 and R.sup.12 are
independently selected from the group consisting of H, alkyl,
alkenyl, alkynyl, aryl, arylalkyl, alkenylalkyl, alkynylalkyl,
heterocycle, carboxyalkyl, carboalkoxyalkyl, cycloalkyl,
cyanoalkyl, OR.sup.9, NR.sup.9R.sup.10, SR.sup.9, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, CO.sub.2R.sup.9, CN, halogen,
oxo, and CONR.sup.9R.sup.10, wherein R.sup.9 and R.sup.10 are as
defined above, provided that both R.sup.3 and R.sup.4 cannot be OH,
NH.sub.2, and SH, or R.sup.11 and R.sup.12 together with the
nitrogen or carbon atom to which they are attached form a cyclic
ring; R.sup.5 and R.sup.6 are independently selected from the group
consisting of H, alkyl, alkenyl, alkynyl, aryl, cycloalkyl,
heterocycle, quaternary heterocycle, quarternary heteroaryl,
OR.sup.30, SR.sup.9, S(O)R.sup.9, SO.sub.2R.sup.9, SO.sub.3R.sup.9,
and -L.sub.z-K.sub.z; wherein z is 1, 2 or 3; each L is
independently a substituted or unsubstituted alkyl, a substituted
or unsubstituted heteroalkyl, a substituted or unsubstituted
alkoxy, a substituted or unsubstituted aminoalkyl group, a
substituted or unsubstituted aryl, a substituted or unsubstituted
heteroaryl, a substituted or unsubstituted cycloalkyl, or a
substituted or unsubstituted heterocycloalkyl; each K is a moiety
that prevents systemic absorption; wherein alkyl, alkenyl, alkynyl,
aryl, cycloalkyl, heterocycle, quaternary heterocycle, and
quaternary heteroaryl can be substituted with one or more
substituent groups independently selected from the group consisting
of alkyl, alkenyl, alkynyl, polyalkyl, polyether, aryl, haloalkyl,
cycloalkyl, heterocycle, arylalkyl, quaternary heterocycle,
quaternary heteroaryl, halogen, oxo, OR.sup.13, NR.sup.13R.sup.14,
SR.sup.13, S(O)R.sup.13, SO.sub.2R.sup.13, SO.sub.3R.sup.13,
NR.sup.13OR.sup.14, NR.sup.13NR.sup.14R.sup.15, NO.sub.2,
CO.sub.2R.sup.13, CN, OM, SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14,
C(O)NR.sup.13R.sup.14, C(O)OM, CR.sup.13, P(O)R.sup.13R.sup.14,
P.sup.+R.sup.13R.sup.14R.sup.15A.sup.-, P(OR.sup.13)OR.sup.14,
S.sup.+R.sup.13R.sup.14A.sup.-, and
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, wherein: A.sup.- is a
pharmaceutically acceptable anion and M is a pharmaceutically
acceptable cation, said alkyl, alkenyl, alkynyl, polyalkyl,
polyether, aryl, haloalkyl, cycloalkyl, and heterocycle can be
further substituted with one or more substituent groups selected
from the group consisting of OR.sup.7, NR.sup.7R.sup.8,
S(O)R.sup.7, SO.sub.2R.sup.7, SO.sub.3R.sup.7, CO.sub.2R.sup.7, CN,
oxo, CONR.sup.7R.sup.8, N.sup.+R.sup.7R.sup.8R.sup.9A.sup.-, alkyl,
alkenyl, alkynyl, aryl, cycloalkyl, heterocycle, arylalkyl,
quaternary heterocycle, quaternary heteroaryl, P(O)R.sup.7R.sup.8,
P.sup.+R.sup.7R.sup.8R.sup.9A.sup.-, and P(O)(OR.sup.7)OR.sup.8 and
wherein said alkyl, alkenyl, alkynyl, polyalkyl, polyether, aryl,
haloalkyl, cycloalkyl, and heterocycle can optionally have one or
more carbons replaced by O, NR.sup.7, N.sup.+R.sup.7R.sup.8A.sup.-,
S, SO, SO.sub.2, S.sup.+R.sup.7A.sup.-, PR.sup.7, P(O)R.sup.7,
P.sup.+R.sup.7R.sup.8A.sup.-, or phenylene, and R.sup.13, R.sup.14,
and R.sup.15 are independently selected from the group consisting
of hydrogen, alkyl, alkenyl, alkynyl, polyalkyl, aryl, arylalkyl,
cycloalkyl, heterocycle, heteroaryl, quaternary heterocycle,
quaternary heteroaryl, and quaternary heteroarylalkyl, wherein
alkyl, alkenyl, alkynyl, arylalkyl, heterocycle, and polyalkyl
optionally have one or more carbons replaced by O, NR.sup.9,
N.sup.+R.sup.9R.sup.10A.sup.-, S, SO, SO.sub.2,
S.sup.+R.sup.9A.sup.-, PR, P.sup.+R.sup.9R.sup.10A.sup.-,
P(O)R.sup.9, phenylene, carbohydrate, amino acid, peptide, or
polypeptide, and R.sup.13, R.sup.14 and R.sup.15 are optionally
substituted with one or more groups selected from the group
consisting of sulfoalkyl, quaternary heterocycle, quaternary
heteroaryl, OR.sup.9, NR.sup.9R.sup.10,
NR.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo, CO.sub.2R.sup.9, CN,
halogen, CONR.sup.9R.sup.10, SO.sub.2OM, SO.sub.2NR.sup.9R.sup.10,
PO(OR.sup.16)OR.sup.17, P.sup.+R.sup.9R.sup.10R.sup.11A.sup.-,
S.sup.+R.sup.9R.sup.10A.sup.-, and C(O)OM, wherein R.sup.16 and
R.sup.17 are independently selected from the substituents
constituting R.sup.9 and M; or R.sup.14 and R.sup.15, together with
the nitrogen atom to which they are attached, form a cyclic ring;
and is selected from the group consisting of alkyl, alkenyl,
alkynyl, cycloalkyl, aryl, acyl, heterocycle, ammoniumalkyl,
alkylammoniumalkyl, and arylalkyl; and R.sup.7 and R.sup.8 are
independently selected from the group consisting of hydrogen and
alkyl; and one or more R.sup.x are independently selected from the
group consisting of H, alkyl, alkenyl, alkynyl, polyalkyl, acyloxy,
aryl, arylalkyl, halogen, haloalkyl, cycloalkyl, heterocycle,
heteroaryl, polyether, quaternary heterocycle, quaternary
heteroaryl, OR.sup.13, NR.sup.13R.sup.14, SR.sup.13, S(O)R.sup.13,
S(O).sub.2R.sup.13, SO.sub.3R.sup.13,
S.sup.+R.sup.13R.sup.14A.sup.-, NR.sup.13OR.sup.14,
NR.sup.13NR.sup.14R.sup.15, NO.sub.2, CO.sub.2R.sup.13, CN, OM,
SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14, NR.sup.14C(O)R.sup.13,
C(O)NR.sup.13R.sup.14NR.sup.14C(O)R.sup.13, C(O)OM, COR.sup.13,
OR.sup.18, S(O).sub.nNR.sup.18, NR.sup.13R.sup.18,
NR.sup.18R.sup.14, N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-,
P.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, amino acid, peptide,
polypeptide, and carbohydrate; wherein alkyl, alkenyl, alkynyl,
cycloalkyl, aryl, polyalkyl, heterocycle, acyloxy, arylalkyl,
haloalkyl, polyether, quaternary heterocycle, and quaternary
heteroaryl can be further substituted with OR.sup.9,
NR.sup.9R.sup.10, N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9,
S(O)R.sup.9, SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo,
CO.sub.2R.sup.9, CN, halogen, CONR.sup.9R.sup.10, SO.sub.2OM,
SO.sub.2NR.sup.9R.sup.10, PO(OR.sup.16)OR.sup.17,
P.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, S.sup.+R.sup.9,
R.sup.10A.sup.-, or C(O)M, wherein W is O or NH, R.sup.31 is
selected from wherein R.sup.18 is selected from the group
consisting of acyl, arylalkoxycarbonyl, arylalkyl, heterocycle,
heteroaryl, alkyl, wherein acyl, arylalkoxycarbonyl, arylalkyl,
heterocycle, heteroaryl, alkyl, quaternary heterocycle, and
quaternary heteroaryl optionally are substituted with one or more
substituents selected from the group consisting of OR.sup.9,
NR.sup.9R.sup.10, NR.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9,
S(O)R.sup.9, SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo,
CO.sub.3R.sup.9, CN, halogen, CONR.sup.9R.sup.10, SO.sub.3R.sup.9,
SO.sub.2OM, SO.sub.2NR.sup.9R.sup.10, PO(OR.sup.16)OR.sup.17, and
C(O)OM, wherein in R.sup.x, one or more carbons are optionally
replaced by O, NR.sup.13, N.sup.+R.sup.13R.sup.14A.sup.-, S, SO,
SO.sub.2, S.sup.+R.sup.3A.sup.-, PR.sup.13, P(O)R.sup.3,
P.sup.+R.sup.13R.sup.14A.sup.-, phenylene, amino acid, peptide,
polypeptide, carbohydrate, polyether, or polyalkyl, wherein in said
polyalkyl, phenylene, amino acid, peptide, polypeptide, and
carbohydrate, one or more carbons are optionally replaced by O,
NR.sup.9, R.sup.9R.sup.10A.sup.-, S, SO, SO.sub.2,
S.sup.+R.sup.9A.sup.-, PR.sup.9, P.sup.+R.sup.9R.sup.10A.sup.-, or
P(O)R.sup.9; wherein quaternary heterocycle and quaternary
heteroaryl are optionally substituted with one or more groups
selected from the group consisting of alkyl, alkenyl, alkynyl,
polyalkyl, polyether, aryl, haloalkyl, cycloalkyl, heterocycle,
arylalkyl, halogen, oxo, OR.sup.3, NR.sup.13R.sup.14, SR.sup.13,
S(O)R.sup.13, SO.sub.2R.sup.13, SO.sub.3R.sup.13,
NR.sup.13OR.sup.14, NR.sup.13NR.sup.14, R.sup.15, NO.sub.2,
CO.sub.2R.sup.13, CN, OM, SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14,
C(O)NR.sup.13R.sup.14, C(O)OM, COR.sup.13, P(O)R.sup.13R.sup.14,
P.sup.+R.sup.13R.sup.14R.sup.15A.sup.-, P(OR.sup.13)OR.sup.14,
S.sup.+R.sup.13R.sup.14A.sup.-, and
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, provided that both R.sup.5
and R.sup.6 cannot be hydrogen or SH; provided that when R.sup.5 or
R.sup.6 is phenyl, only one of R.sup.1 or R.sup.2 is H; provided
that when q=1 and R.sup.x is styryl, anilido, or anilinocarbonyl,
only one of R.sup.5 or R.sup.6 is alkyl; or a pharmaceutically
acceptable salt, solvate, or prodrug thereof.
11. The ASBTI for use as in claim 10, wherein the compound of
Formula II is ##STR00076## or a salt thereof.
12. The method of claim 10, wherein the compound of Formula II is
##STR00077## or SD-5613, optionally further comprising
sitagliptin.
13. The method of claim 10, wherein the compound of Formula II is
##STR00078## or SA HMR1741.
14. The method of claim 10, wherein the compound of Formula II is
##STR00079## or SAR548304B.
15. The method of claim 1, wherein the ASBTI is a compound of
Formula III: ##STR00080## wherein: each R.sup.1, R.sup.2 is
independently H, hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8,
--YC(.dbd.X)R.sup.8, substituted or unsubstituted alkyl,
substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted alkyl-aryl,
substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, or -L-K; or R.sup.1 and
R.sup.2 together with the nitrogen to which they are attached form
a 3-8-membered ring that is optionally substituted with R.sup.8;
each R.sup.3, R.sup.4 is independently H, hydroxy, alkyl, alkoxy,
--C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8, substituted or
unsubstituted alkyl, substituted or unsubstituted heteroalkyl,
substituted or unsubstituted aryl, substituted or unsubstituted
alkyl-aryl, substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, or -L-K; R.sup.5 is H,
hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8,
substituted or unsubstituted alkyl, substituted or unsubstituted
heteroalkyl, substituted or unsubstituted aryl, substituted or
unsubstituted alkyl-aryl, substituted or unsubstituted cycloalkyl,
substituted or unsubstituted alkyl-cycloalkyl, substituted or
unsubstituted heteroaryl, substituted or unsubstituted
alkyl-heteroaryl, substituted or unsubstituted heterocycloalkyl,
substituted or unsubstituted alkyl-heterocycloalkyl, each R.sup.6,
R.sup.7 is independently H, hydroxy, alkyl, alkoxy,
--C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8, substituted or
unsubstituted alkyl, substituted or unsubstituted heteroalkyl,
substituted or unsubstituted aryl, substituted or unsubstituted
alkyl-aryl, substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, or -L-K; or R.sup.6 and
R.sup.7 taken together form a bond; each X is independently NH, S,
or O; each Y is independently NH, S, or O; R.sup.8 is substituted
or unsubstituted alkyl, substituted or unsubstituted heteroalkyl,
substituted or unsubstituted aryl, substituted or unsubstituted
alkyl-aryl, substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, or -L-K; L is A.sub.n,
wherein each A is independently NR.sup.1, S(O).sub.m, O,
C(.dbd.X)Y, Y(C.dbd.X), substituted or unsubstituted alkyl,
substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted heteroaryl,
substituted or unsubstituted cycloalkyl, or substituted or
unsubstituted heterocycloalkyl; wherein each m is independently
0-2; n is 0-7; K is a moiety that prevents systemic absorption;
provided that at least one of R.sup.1, R.sup.2, R.sup.3 or R.sup.4
is -L-K; or a pharmaceutically acceptable prodrug thereof.
16. The method of claim 1, wherein the ASBTI is a compound of
Formula IV: ##STR00081## wherein R.sup.1 is a straight chain
C.sub.1-6alkyl group; R.sup.2 is a straight chain C.sub.1-6alkyl
group; R.sup.3 is hydrogen or a group OR.sup.11 in which R.sup.11
is hydrogen, optionally substituted C.sub.1-6alkyl or a C.sub.1-6
alkylcarbonyl group; R.sup.4 is pyridyl or an optionally
substituted phenyl; R.sup.5, R.sup.6 and R.sup.8 are the same or
different and each is selected from: hydrogen, halogen, cyano,
R.sup.5-acetylide, OR.sup.15, optionally substituted
C.sub.1-6alkyl, COR.sup.5, CH(OH)R.sup.5, S(O)R.sup.5,
P(O)(OR.sup.5).sub.2, OCOR.sup.15, OCF.sub.3, OCN, SCN, NHCN,
CH.sub.2OR.sup.5, CHO, (CH.sub.2).sub.pCN, CONR.sup.12R.sup.13,
(CH.sub.2).sub.pCO.sub.2R.sup.15,
(CH.sub.2).sub.pNR.sup.12R.sup.13, CO.sub.2R.sup.15, NHCOCF.sub.3,
NHSO.sub.2R.sup.15, OCH.sub.2OR.sup.15, OCH.dbd.CHR.sup.15,
O(CH.sub.2CH.sub.2O)R.sup.15, O(CH.sub.2).sub.pSO.sub.3R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13 and
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14 wherein p is an
integer from 1-4, n is an integer from 0-3 and R.sup.2, R.sup.13,
R.sup.14 and R.sup.15 are independently selected from hydrogen and
optionally substituted C.sub.1-6alkyl; R.sup.7 is a group of the
formula ##STR00082## wherein the hydroxyl groups may be substituted
by acetyl, benzyl, or --(C.sub.1-C.sub.6)-alkyl-R.sup.7, wherein
the alkyl group may be substituted with one or more hydroxyl
groups; R.sup.16 is --COOH, --CH.sub.2--OH, --CH.sub.2--O-Acetyl,
--COOMe or --COOEt; R.sup.17 is H, --OH, --NH.sub.2, --COOH or
COOR.sup.18; R.sup.18 is (C.sub.1-C.sub.4)-alkyl or
--NH--(C.sub.1-C.sub.4)-alkyl; X is --NH-- or --O--; and R.sup.9
and R.sup.10 are the same or different and each is hydrogen or
C.sub.1-C.sub.6alkyl; and salts thereof.
17. The method of claim 1, wherein the ASBTI is a compound of
Formula V: ##STR00083## wherein: R.sup.v is selected from hydrogen
or C.sub.1-6alkyl; One of R.sup.1 and R.sup.2 are selected from
hydrogen or C.sub.1-6alkyl and the other is selected from
C.sub.1-6alkyl; R.sup.x and R.sup.y are independently selected from
hydrogen, hydroxy, amino, mercapto, C.sub.1-6alkyl,
C.sub.1-6alkoxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkylS(O).sub.a wherein
a is 0 to 2; R.sup.z is selected from halo, nitr, cyano, hydroxy,
amino, carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-6alkoxycarbonyl, N--(C.sub.1-6-alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl; n is 0-5; one of R.sup.4 and
R.sup.5 is a group of formula (VA): ##STR00084## R.sup.3 and
R.sup.6 and the other of R.sup.4 and R.sup.5 are independently
selected from hydrogen, halo, nitro, cyano, hydroxy, amino,
carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-6alkoxycarbonyl, N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl; wherein R.sup.3 and R.sup.6
and the other of R.sup.4 and R.sup.5 may be optionally substituted
on carbon by one or more R.sup.17; X is --O--, --N(R.sup.a)--,
--S(O).sub.b-- or --CH(R.sup.a)--; wherein R.sup.a is hydrogen or
C.sub.1-6alkyl and b is 0-2; Ring A is aryl or heteroaryl; wherein
Ring A is optionally substituted on carbon by one or more
substituents selected from R.sup.18; R.sup.7 is hydrogen,
C.sub.1-6alkyl, carbocyclyl or heterocyclyl; wherein R.sup.7 is
optionally substituted on carbon by one or more substituents
selected from R.sup.19; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.20 R.sup.8 is hydrogen or
C.sub.1-6-alkyl; R.sup.9 is hydrogen or C.sub.1-6alkyl; R.sup.10 is
hydrogen, halo, nitro, cyano, hydroxy, amino, carbamoyl, mercapto,
sulphamoyl, hydroxyaminocarbonyl, C.sub.1-10alkyl,
C.sub.2-10alkynyl, C.sub.2-10alkynyl, C.sub.1-10alkoxy,
C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3 ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene).sub.p-R.sup.21--(C.sub.1-10alkylene).sub-
.q- or heterocyclyl-(C.sub.1-10alkylene),
--R.sup.22--(C.sub.1-10alkylene).sub.s-; wherein R.sup.10 is
optionally substituted on carbon by one or more substituents
selected from R.sup.23; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.24; or R.sup.10 is a group of formula
(VB): ##STR00085## wherein: R.sup.11 is hydrogen or
C.sub.1-6-alkyl; R.sup.12 and R.sup.13 are independently selected
from hydrogen, halo, carbamoyl, sulphamoyl, C.sub.1-10alkyl,
C.sub.2-10alkynyl, C.sub.2-10alkynyl, C.sub.1-10alkanoyl,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino, carbocyclyl or
heterocyclyl; wherein R.sup.12 and R.sup.13 may be independently
optionally substituted on carbon by one or more substituents
selected from R.sup.25; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.26; R.sup.14 is selected from hydrogen,
halo, carbamoyl, sulphamoyl, hydroxyaminocarbonyl, C.sub.1-10alkyl,
C.sub.2-10alkenyl, C.sub.2-10alkynyl, C.sub.1-10alkanoyl,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene).sub.p-R.sup.27--(C.sub.1-10alkylene).sub-
.q- or
heterocyclyl-(C.sub.1-10alkylene)-R.sup.28--(C.sub.1-10alkylene).su-
b.s-; wherein R.sup.14 may be optionally substituted on carbon by
one or more substituents selected from R.sup.29; and wherein if
said heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.30; or
R.sup.14 is a group of formula (VC): ##STR00086## R.sup.15 is
hydrogen or C.sub.1-6alkyl; and R.sup.16 is hydrogen or
C.sub.1-6alkyl; wherein R.sup.16 may be optionally substituted on
carbon by one or more groups selected from R.sup.31; or R.sup.15
and R.sup.16 together with the nitrogen to which they are attached
form a heterocyclyl; wherein said heterocyclyl may be optionally
substituted on carbon by one or more R.sup.37; and wherein if said
heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.38; m is 1-3;
wherein the values of R.sup.7 may be the same or different;
R.sup.17, R, R.sup.19, R.sup.23, R.sup.25, R.sup.29, R.sup.31 and
R.sup.37 are independently selected from halo, nitro, cyano,
hydroxy, amino, carbamoyl, mercapto, sulphamoyl,
hydroxyaminocarbonyl, C.sub.1-10alkyl, C.sub.2-10alkenyl,
C.sub.2-10alkynyl, C.sub.1-10alkoxy, C.sub.1-10alkanoyl,
C.sub.1-10alkanoyloxy, N--(C.sub.1-10alkyl)amino,
N,N--(C.sub.1-10alkyl).sub.2amino, N,N,N--(C.sub.1-10alkyl).sub.3
ammonio, C.sub.1-10alkanoylamino, N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene).sub.p-R.sup.32--(C.sub.1-10alkylene).sub-
.q- or
heterocyclyl-(C.sub.1-10alkylene)-R.sup.33--(C.sub.1-10alkylene).su-
b.s-; wherein R.sup.17, R.sup.18, R.sup.19, R.sup.23, R.sup.25,
R.sup.29, R.sup.31 and R.sup.37 may be independently optionally
substituted on carbon by one or more R.sup.34; and wherein if said
heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.35; R.sup.21,
R.sup.22, R.sup.27, R.sup.28, R.sup.32 or R.sup.33 are
independently selected from --O--, --NR.sup.36--, --S(O).sub.x--,
NR.sup.36C(O)NR.sup.36--, --NR.sup.36C(S)NR.sup.36--,
--OC(O)N.dbd.C--, --NR.sup.36C(O)-- or --C(O)NR.sup.36--; wherein
R.sup.36 is selected from hydrogen or C.sub.1-16alkyl, and x is
0-2; p, q, r and s are independently selected from 0-2; R.sup.34 is
selected from halo, hydroxy, cyano, carbamoyl, ureido, amino,
nitro, carbamoyl, mercapto, sulphamoyl, trifluoromethyl,
trifluoromethoxy, methyl, ethyl, methoxy, ethoxy, vinyl, allyl,
ethynyl, formyl, acetyl, formamido, acetylamino, acetoxy,
methylamino, dimethylamino, N-methylcarbamoyl,
N,N-dimethylcarbamoyl, methylthio, methylsulphinyl, mesyl,
N-methylsulphamoyl, N,N-dimethylsulphamoyl, N-methylsulphamoylamino
and N,N-dimethylsulphamoylamino; R.sup.20, R.sup.24, R.sup.26,
R.sup.30, R.sup.35 and R.sup.38 are independently selected from
C.sub.1-6alkyl, C.sub.1-6alkanoyl, C.sub.1-6alkylsulphonyl,
C.sub.1-6alkoxycarbonyl, carbamoyl, N--(C.sub.1-6alkyl)carbamoyl,
N,N--(C.sub.1-6alkyl)carbamoyl, benzyl, benzyloxycarbonyl, benzoyl
and phenylsulphonyl; and wherein a "heteroaryl" is a totally
unsaturated, mono or bicyclic ring containing 3-12 atoms of which
at least one atom is chosen from nitrogen, sulphur and oxygen,
which heteroaryl may, unless otherwise specified, be carbon or
nitrogen linked; wherein a "heterocyclyl" is a saturated, partially
saturated or unsaturated, mono or bicyclic ring containing 3-12
atoms of which at least one atom is chosen from nitrogen, sulphur
and oxygen, which heterocyclyl may, unless otherwise specified, be
carbon or nitrogen linked, wherein a --CH.sub.2-- group can
optionally be replaced by a --C(O)-- group, and a ring sulphur atom
may be optionally oxidised to form an S-oxide; and wherein a
"carbocyclyl" is a saturated, partially saturated or unsaturated,
mono or bicyclic carbon ring that contains 3-12 atoms; wherein a
--CH.sub.2-- group can optionally be replaced by a --C(O) group; or
a pharmaceutically acceptable salt or in vivo hydrolysable ester or
amide formed on an available carboxy or hydroxy group thereof.
18. The method of claim 17, wherein the compound of Formula V is
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N-(2-sulp-
hoethyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4,5-tetrahydro-1,-
2,5-benzothiadiazepine;
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-(R)-hydroxypropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)--
2,3,4,5-tetrahydro-1,2,5-benzothiadiazepine; or
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-methylpropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4-
,5-tetrahydro-1,2,5-benzothiadiazepine.
19. The method of claim 1, wherein the ASBTI is a compound of
Formula VI: ##STR00087## wherein: R.sup.v and R.sup.w are
independently selected from hydrogen or C.sub.1-6alkyl; one of
R.sup.1 and R.sup.2 is selected from hydrogen or C.sub.1-6alkyl and
the other is selected from C.sub.1-6alkyl; R.sup.x and R.sup.y are
independently selected from hydrogen or C.sub.1-6alkyl, or one of
R.sup.x and R.sup.y is hydrogen or C.sub.1-6alkyl and the other is
hydroxy or C.sub.1-6alkoxy; R.sup.z is selected from halo, nitro,
cyano, hydroxy, amino, carboxy, carbamoyl, mercapto, sulphamoyl,
C.sub.1-6alkyl, C.sub.2-6alkenyl, C.sub.2-6alkynyl,
C.sub.1-6alkoxy, C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy,
N--(C.sub.1-6alkyl)amino, N,N-(C.sub.1-6alkyl).sub.2amino,
C.sub.1-6alkanoylamino, N--(C.sub.1-6alkyl)carbamoyl,
N,N--(C.sub.1-6alkyl).sub.2carbamoyl, C.sub.1-6alkylS(O).sub.a
wherein a is 0 to 2, C.sub.1-6alkoxycarbonyl,
N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl; n is 0-5; one of R.sup.4 and
R.sup.5 is a group of formula (VIA): ##STR00088## R.sup.3 and
R.sup.6 and the other of R.sup.4 and R.sup.5 are independently
selected from hydrogen, halo, nitro, cyano, hydroxy, amino,
carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-6alkoxycarbonyl, N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl; wherein R.sup.3 and R.sup.6
and the other of R.sup.4 and R.sup.5 may be optionally substituted
on carbon by one or more R.sup.17; X is --O--, --N(R.sup.a)--,
--S(O).sub.b-- or --CH(R.sup.a)--; wherein R.sup.a is hydrogen or
C.sub.1-6alkyl and b is 0-2; Ring A is aryl or heteroaryl; wherein
Ring A is optionally substituted on carbon by one or more
substituents selected from R.sup.18; R.sup.7 is hydrogen,
C.sub.1-6alkyl, carbocyclyl or heterocyclyl; wherein R.sup.7 is
optionally substituted on carbon by one or more substituents
selected from R.sup.19; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.20; R.sup.8 is hydrogen or
C.sub.1-6alkyl; R.sup.9 is hydrogen or C.sub.1-6alkyl; R.sup.10 is
hydrogen, halo, nitro, cyano, hydroxy, amino, carbamoyl, mercapto,
sulphamoyl, hydroxyaminocarbonyl, C.sub.1-10alkyl,
C.sub.2-10alkenyl, C.sub.2-10alkynyl, C.sub.1-10alkoxy,
C.sub.2-10alkanoyl, C.sub.2-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3 ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene).sub.p-R.sup.21--(C.sub.1-10alkylene).sub-
.q- or
heterocyclyl-(C.sub.1-10alkylene).sub.r-R.sup.22--(C.sub.1-10alkyle-
ne).sub.s-; wherein R.sup.10 is optionally substituted on carbon by
one or more substituents selected from R.sup.23; and wherein if
said heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.24; or
R.sup.10 is a group of formula (VIB): ##STR00089## wherein:
R.sup.11 is hydrogen or C.sub.1-6alkyl; R.sup.12 and R.sup.13 are
independently selected from hydrogen, halo, nitro, cyano, hydroxy,
amino, carbamoyl, mercapto, sulphamoyl, C.sub.1-10alkyl,
C.sub.2-10alkenyl, C.sub.2-10alkynyl, C.sub.1-10alkoxy,
C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
C.sub.1-10alkanoylamino, N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino, carbocyclyl or
heterocyclyl; wherein R.sup.12 and R.sup.13 may be independently
optionally substituted on carbon by one or more substituents
selected from R.sup.25; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.26; R.sup.14 is selected from hydrogen,
halo, nitro, cyano, hydroxy, amino, carbamoyl, mercapto,
sulphamoyl, hydroxyaminocarbonyl, C.sub.1-10alkyl,
C.sub.2-10alkenyl, C.sub.2-10alkynyl, C.sub.1-10alkoxy,
C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3 ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene).sub.q-R.sup.2--(C.sub.1-10alkylene).sub.-
q- or
heterocyclyl-(C.sub.1-10alkylene).sub.r-R.sup.28--(C.sub.1-10alkylen-
e).sub.s-; wherein R.sup.14 may be optionally substituted on carbon
by one or more substituents selected from R.sup.29; and wherein if
said heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.30; or
R.sup.14 is a group of formula (VIC): ##STR00090## R.sup.15 is
hydrogen or C.sub.1-6alkyl; R.sup.16 is hydrogen or C.sub.1-6alkyl;
wherein R.sup.16 may be optionally substituted on carbon by one or
more groups selected from R.sup.31; n is 1-3; wherein the values of
R.sup.7 may be the same or different; R.sup.17, R.sup.18, R.sup.19,
R.sup.23, R.sup.25, R.sup.29 or R.sup.31 are independently selected
from halo, nitro, cyano, hydroxy, amino, carbamoyl, mercapto,
sulphamoyl, hydroxyaminocarbonyl, amidino, C.sub.1-10alkyl,
C.sub.2-10alkenyl, C.sub.2-10alkynyl, C.sub.1-10alkoxy,
C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
(C.sub.1-10alkyl).sub.3silyl, N--(C.sub.1-10alkyl)amino,
N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene)-R.sup.32--(C.sub.1-10alkylene).sub.q-
or heterocyclyl-(C.sub.1-10alkylene),
--R.sup.33--(C.sub.1-10alkylene).sub.s-; wherein R.sup.17,
R.sup.18, R.sup.19, R.sup.23, R.sup.25, R.sup.29 or R.sup.31 may be
independently optionally substituted on carbon by one or more
R.sup.34; and wherein if said heterocyclyl contains an --NH--
group, that nitrogen may be optionally substituted by a group
selected from R.sup.35; R.sup.21, R.sup.22, R.sup.27, R.sup.28,
R.sup.32 or R.sup.33 are independently selected from --O--,
--NR.sup.36--, --S(O).sub.x--, --NR.sup.36C(O)NR.sup.36--,
--NR.sup.36C(S)NR.sup.36--, --OC(O)N.dbd.C--, --NR.sup.36C(O)-- or
--C(O)NR.sup.36--; wherein R.sup.36 is selected from hydrogen or
C.sub.1-6alkyl, and x is 0-2; p, q, r and s are independently
selected from 0-2; R.sup.34 is selected from halo, hydroxy, cyano,
carbamoyl, ureido, amino, nitro, carbamoyl, mercapto, sulphamoyl,
trifluoromethyl, trifluoromethoxy, methyl, ethyl, methoxy, ethoxy,
vinyl, allyl, ethynyl, formyl, acetyl, formamido, acetylamino,
acetoxy, methylamino, dimethylamino, N-methylcarbamoyl,
N,N-dimethylcarbamoyl, methylthio, methylsulphinyl, mesyl,
N-methylsulphamoyl, N,N-dimethylsulphamoyl, N-methylsulphamoylamino
and N,N-dimethylsulphamoylamino; R.sup.20, R.sup.24, R.sup.26,
R.sup.30 or R.sup.35 are independently selected from
C.sub.1-6alkyl, C.sub.1-6alkanoyl, C.sub.1-6alkylsulphonyl,
C.sub.1-6alkoxycarbonyl, carbamoyl, N--(C.sub.1-6alkyl)carbamoyl,
N,N--(C.sub.1-6alkyl)carbamoyl, benzyl, benzyloxycarbonyl, benzoyl
and phenylsulphonyl; or a pharmaceutically acceptable salt, solvate
or solvate of such a salt, or an in vivo hydrolysable ester formed
on an available carboxy or hydroxy thereof, or an in vivo
hydrolysable amide formed on an available carboxy thereof.
20. The method of claim 1, wherein the enteroendocrine peptide
enhancing agent is a bile acid, a bile salt, a bile acid mimic, a
bile salt mimic, or a combination thereof.
21. The method of claim 20, wherein the bile acid or the bile acid
mimic is a compound represented by Formula (VII): ##STR00091##
wherein: each R.sup.1 is independently H, OH, lower alkyl, or lower
heteroalkyl; L is a substituted or unsubstituted alkyl or
substituted or unsubstituted heteroalkyl; each R.sup.2 is
independently H, OH, lower alkyl, or lower heteroalkyl; R.sup.3 is
H, OH, O-lower alkyl, lower alkyl, or lower heteroalkyl; A is
COOR.sup.4, S(O).sub.nR.sup.4, or OR.sup.5; R.sup.4 is H, an anion,
a pharmaceutically acceptable cation, substituted or unsubstituted
alkyl, substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted heteroaryl, or an
amino acid; n is 1-3; R.sup.5 is lower alkyl or H.
22. The method of claim 20, wherein the bile acid mimic is a
TGR5-binding analog, M-BAR agonist, GPR119 agonist, GPR120 agonist,
GPR131 agonist, GPR140 agonist, GPR143 agonist, GPBAR1 agonist,
BG37 agonist, FXR agonist,
6-methyl-2-oxo-4-thiophen-2-yl-1,2,3,4-tetrahydro-pyrimidine-5-c-
arboxylic acid benzyl ester, INT-777, RG-239, oleanolic acid, or
crataegolic acid.
23. The method of claim 20, wherein the bile acid is a cholic acid,
a deoxycholic acid, a glycocholic acid, a glycodeoxycholic acid, a
taurocholic acid, a taurodihydrofusidate, a taurodeoxycholic acid,
a cholate, a glycocholate, a deoxycholate, a taurocholate, a
taurodeoxycholate, a chenodeoxycholic acid, or a salt thereof, or a
combination thereof.
24. The method of claim 1, wherein the FXR agonist is GW4064,
GW9662, INT-747, T0901317, WAY-362450, fexaramine, a cholic acid, a
deoxycholic acid, a glycocholic acid, a glycodeoxycholic acid, a
taurocholic acid, a taurodihydrofusidate, a taurodeoxycholic acid,
a cholate, a glycocholate, a deoxycholate, a taurocholate, a
taurodeoxycholate, a chenodeoxycholic acid, or a salt thereof, or a
combination thereof.
25. The method of claim 1, wherein the ASBTI and/or the
enteroendocrine peptide enhancing agent and/or the FXR agonist is
administered before ingestion of food, optionally wherein the ASBTI
and/or the enteroendocrine peptide enhancing agent and/or the FXR
agonist is administered less than about 60 minutes or less than
about 30 minutes before ingestion of food.
26. The method of claim 1, wherein the ASBTI and/or the
enteroendocrine peptide enhancing agent and/or the FXR agonist is
administered orally, optionally wherein the ASBTI and/or the
enteroendocrine peptide enhancing agent and/or the FXR agonist is
administered as an ileal-pH sensitive release or an enterically
coated formulation.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit under 35 U.S.C.
.sctn.119(e) of U.S. Provisional Application No. 61/348,666, filed
May 26, 2010, and U.S. Provisional Application No. 61/348,669,
filed May 26, 2010, each of which is incorporated herein by
reference in its entirety.
BACKGROUND OF THE INVENTION
[0002] Diabetes and obesity affect numerous humans throughout the
world, and are associated with or induces other diseases or
conditions. In particular, diabetes and obesity are serious risk
factors for diseases and conditions such as hypertension,
gallbladder disease, cancer, polycystic ovary disease and
arteriosclerosis and can contribute to elevated levels of
cholesterol in the blood. Overeating and obesity, which frequently
leads to diabetes, have become a problem in the general population.
Consequently there is interest in reducing food intake, losing
weight, and reducing elevated blood glucose.
[0003] Inflammatory gastrointestinal conditions affect millions of
people. For example, necrotizing enterocolitis (NEC) affects
thousands of newborns each year and is the most common
gastrointestinal emergency of premature infants. Mortality rates of
NEC are between 10 to 50%, and thus NEC remains a major cause of
morbidity and mortality in premature infants. The pathophysiology
of NEC is poorly understood. An effective treatment of NEC as well
as other inflammatory gastrointestinal conditions is needed.
SUMMARY OF THE INVENTION
[0004] Provided herein, in certain embodiments, are therapeutic
methods using compounds that inhibit the Apical Sodium-dependent
Bile Transporter (ASBT) or any recuperative bile salt transporter.
In certain instances, use of the compounds provided herein reduces
or inhibits recycling of bile acid salts in the gastrointestinal
tract. In some embodiments, the methods provided herein reduce
intraenterocyte bile acids or reduce necrosis and/or damage to
ileal architecture. In some embodiments, the bile transport
inhibitors are non-systemic compounds. In other embodiments, the
bile acid transporter inhibitors are systemic compounds. In certain
embodiments, the bile transport inhibitors described herein enhance
L-cell secretion of enteroendocrine peptides.
[0005] In certain embodiments, provided herein are methods for
treating or preventing an inflammatory intestinal condition or a
metabolic disorder comprising administering a therapeutically
effective amount of an ASBT inhibitor (ASBTI) and/or an
enteroendocrine peptide enhancing agent and/or a nuclear farnesoid
X receptor (FXR) agonist to an individual in need thereof. In
certain embodiments, provided herein is an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist for
use in the treatment of an inflammatory intestinal condition
comprising administering a therapeutically effective amount of an
ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist to an individual in need thereof. In some embodiments,
an ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist is minimally absorbed. In some embodiments, an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist is non-systemically administered to the distal ileum of an
individual in need thereof. In some embodiments, an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist is
non-systemically administered to the colon or the rectum of an
individual in need thereof. In some embodiments, less than 50%,
less than 40%, less than 30%, less than 20%, less than 10%, less
than 9%, less than 8%, less than 7%, less than 6%, less than 5%,
less than 4%, less than 3%, less than 2%, or less than 1% of the
ASBTI and/or the enteroendocrine peptide enhancing agent and/or a
FXR agonist is systemically absorbed.
[0006] In some embodiments, the methods provided herein treat
inflammatory intestinal conditions including but not limited to
necrotizing enterocolitis, gastritis, ulcerative colitis,
inflammatory bowel disease, irritable bowel syndrome,
gastroenteritis, radiation induced enteritis, chemotherapy induced
enteritis, gastro-esophageal reflux disease (GERD), peptic ulcer,
non-ulcer dyspepsia (NUD), celiac disease, intestinal celiac
disease, gastrointestinal complications following bariatric
surgery, gastric carcinogenesis, or gastric carcinogenesis
following gastric or bowel resection.
[0007] In some embodiments, the individual is a newborn or
prematurely born infant. In some embodiments, the individual is
enterally-fed infant or formula-fed infant.
[0008] In some embodiments, the methods described herein reduce
intraenterocyte bile acids in an individual in need thereof. In
some embodiments, the methods described herein reduce accumulation
of bile acids in ileal enterocytes of an individual in need
thereof. In some embodiments, the methods described herein inhibit
transport of bile acids from ileal lumen into enterocytes of an
individual in need thereof. In some embodiments, the methods
described herein increase ileal luminal bile acids of an individual
in need thereof. In some embodiments, the methods described herein
reduce necrosis or damage to ileal architecture or ileal cells in
an individual in need thereof.
[0009] In some embodiments of the methods described above, the
ASBTI is a compound of Formula I as described herein. In some
embodiments of the methods described above, the ASBTI is a compound
of Formula II as described herein. In some embodiments of the
methods described above, the ASBTI is a compound of Formula III as
described herein. In some embodiments of the methods described
above, the ASBTI is a compound of Formula IV as described herein.
In some embodiments of the methods described above, the ASBTI is a
compound of Formula V as described herein. In some embodiments of
the methods described above, the ASBTI is a compound of Formula VI
or Formula VID as described herein.
[0010] In certain embodiments, an ASBTI is any compound described
herein that inhibits recycling of bile acids in the
gastrointestinal tract of an individual. In certain embodiments, an
ASBTI is
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide; ("Compound 100A") or any other
salt or analog thereof. In certain of any of the aforementioned
embodiments, an ASBTI is
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydr-
o-4-hydroxy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]4-aza-1-azoniabi-
cyclo[2.2.2]octane methane sulfonate salt ("Compound 100B") or any
other salt or analog thereof. In certain embodiments, an ASBTI is
N,N-dimethylimido-dicarbonimidic diamide ("Compound 100C") or any
salt or analog thereof. In certain embodiments, an ASBTI is any
commercially available ASBTI including but not limited to SD-5613,
A-3309, 264W94, S-8921, SAR-548304, BARI-1741, HMR-1453, TA-7552,
R-146224, or SC-435. In some embodiments, an ASBTI is
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N-(2-sulp-
hoethyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4,5-tetrahydro-1,-
2,5-benzothiadiazepine;
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-(R)-hydroxypropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)--
2,3,4,5-tetrahydro-1,2,5-benzothiadiazepine;
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-methylpropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4-
,5-tetrahydro-1,2,5-benzothiadiazepine;
1-[[5-[[3-[(3S,4R,5R)-3-butyl-7-(dimethylamino)-3-ethyl-2,3,4,5-tetrahydr-
o-4-hydroxy-1,1-dioxido-1-benzothiepin-5-yl]phenyl]amino]-5-oxopentyl]amin-
o]-1-deoxy-D-glucitol; or
Potassium((2R,3R,4S,5R,6R)-4-benzyloxy-6-{3-[3-((3S,4R,5R)-3-butyl-7-dime-
thylamino-3-ethyl-4-hydroxy-1,1-dioxo-2,3,4,5-tetrahydro-1H-benzo[b]thiepi-
n-5-yl)-phenyl]-ureido}-3,5-dihydroxy-tetrahydro-pyran-2-ylmethypsulphate
ethanolate, hydrate.
[0011] In certain embodiments, an enteroendocrine peptide secretion
enhancing agent is a bile acid, a bile salt, a bile acid mimic, a
bile salt mimic, TGR5 agonist, or a combination thereof. In some
embodiments, the enteroendocrine peptide secretion enhancing agent
is a glucagon-like peptide secretion enhancing agent, optionally in
combination with a bile acid, a bile salt, a bile acid mimic, or a
bile salt mimic. In certain embodiments, the glucagon-like peptide
secretion enhancing agent is a glucagon-like peptide-1 (GLP-1)
secretion enhancing agent or a glucagon-like peptide-2 (GLP-2)
secretion enhancing agent, optionally in combination with a bile
acid, a bile salt, a bile acid mimic, or a bile salt mimic. In some
embodiments, the enteroendocrine peptide secretion enhancing agent
is a pancreatic polypeptide-fold peptide secretion enhancing agent,
optionally in combination with a bile acid, a bile salt, a bile
acid mimic, or a bile salt mimic. In some embodiments, the
pancreatic polypeptide-fold peptide secretion enhancing agent is a
peptide YY (PYY) secretion enhancing agent.
[0012] In certain embodiments, the FXR agonist is GW4064, GW9662,
INT-747, T0901317, WAY-362450, fexaramine, a cholic acid, a
deoxycholic acid, a glycocholic acid, a glycodeoxycholic acid, a
taurocholic acid, a taurodihydrofusidate, a taurodeoxycholic acid,
a cholate, a glycocholate, a deoxycholate, a taurocholate, a
taurodeoxycholate, a chenodeoxycholic acid, or a salt thereof, or a
combination thereof.
[0013] Provided in certain embodiments herein are methods and
dosage forms (e.g., oral or rectal dosage form) for use in the
treatment of diabetes, obesity, or an inflammatory intestinal
condition comprising a therapeutically effective amount of a bile
acid, bile salt, or mimetic thereof, and a carrier. In some
embodiments, the bile acid, bile salt, or mimetic thereof is a
minimally absorbed bile acid, bile salt, or mimetic thereof. In
specific embodiments, the dosage form is an enteric formulation, an
ileal-pH sensitive release, or a suppository or other suitable
form.
[0014] In some embodiments, provided herein is a method for
treating diabetes, obesity, or an inflammatory intestinal condition
comprising rectally administering a therapeutically effective
amount of a minimally absorbed bile acid, bile salt, or mimetic
thereof.
[0015] In some embodiments, the methods provided herein further
comprise administering a therapeutically effective amount of an
inhibitor of Dipeptidyl Peptidase-4. In some embodiments, the
inhibitor of Dipeptidyl Peptidase-4 is administered orally or
rectally. In some embodiments, the inhibitor of Dipeptidyl
Peptidase-4 is co-administered with an ASBTI, an enteroendocrine
peptide enhancing agent, a FXR agonist, bile acid, bile salt, or
mimetic thereof. In some embodiments, the inhibitor of Dipeptidyl
Peptidase-4 is an absorbable or systemically absorbed inhibitor of
Dipeptidyl Peptidase-4.
[0016] In certain embodiments, a bile acid mimetic is a TGR5
agonist, M-BAR agonist, GPR119 agonist, GPR120 agonist, GPR131
agonist, GPR140 agonist, GPR143 agonist, GPBAR1 agonist, BG37
agonist, farnesoid-X receptor agonist. In some instances, a bile
acid mimetic promotes L-cell secretions. In certain instances, a
bile acid mimetic promotes the secretion of GLP-1, GLP-2, PYY, OXM,
or a combination thereof.
[0017] In some embodiments, the methods described above further
comprise administration of a second agent selected from a liver
receptor homolog 1 (LRH-1), a DPP-IV inhibitor, a proton pump
inhibitor, H2 antagonist, prokinetic agent, a biguanide, an
incretin mimetic, a thiazolidinone, a mucoadhesive agent, and GLP-1
or an analog thereof, and a TGR5 agonist. In some embodiments, the
second agent is a DPP-IV inhibitor.
[0018] In some embodiments, the composition administered comprises
at least one of a spreading agent or a wetting agent. In some
embodiments, the absorption inhibitor is a mucoadhesive agent
(e.g., a mucoadhesive polymer). In certain embodiments, the
mucoadhesive agent is selected from methyl cellulose,
polycarbophil, polyvinylpyrrolidone, sodium carboxymethyl
cellulose, and combinations thereof. In some embodiments, a
pharmaceutical composition administered further comprises an
enteroendocrine peptide.
[0019] In some embodiments, provided herein is a method for
lowering elevated blood glucose in a mammal resulting from food
intake comprising orally administering to said mammal a
therapeutically effective amount of a minimally absorbed Apical
Sodium-dependent Bile Transporter inhibitor. In some embodiments,
provided herein is a method further comprising administering to
said mammal a therapeutically effective amount of an inhibitor of
Dipeptidyl Peptidase-4.
[0020] In specific instances, provided herein is a method for
lowering elevated body weight or lowering elevated blood glucose in
a mammal resulting from food intake comprising orally administering
to said mammal a therapeutically effective amount of a minimally
absorbed Apical Sodium-dependent Bile Transporter inhibitor and/or
an inhibitor of Dipeptidyl Peptidase-4. In other embodiments,
provided herein is a method for lowering elevated body weight or
lowering elevated blood glucose in a mammal resulting from food
intake comprising orally co-administering to said mammal a
therapeutically effective amount of a minimally absorbed Apical
Sodium-dependent Bile Transporter inhibitor and an inhibitor of
Dipeptidyl Peptidase-4.
[0021] Also provided herein is a method of promoting stimulation of
L-cell secretion in an individual in need thereof, the method
comprising orally or rectally administering an effective amount of
a minimally absorbed bile acid, bile salt, or mimetic thereof. In
specific instances, the individual in need thereof is suffering
from a disorder ameliorated by L-cell secreted products.
[0022] In certain embodiments, increased L-cell secretion of
enteroendocrine peptides is associated with reduced necrosis and/or
reduced damage to ileal architecture. In certain instances,
increased L-cell secretion of enteroendocrine peptides is
associated with induction of satiety and/or reduction of food
intake (caloric intake) and subsequent weight loss. In some
embodiments, increased L-cell secretion of enteroendocrine peptides
is associated with a reduction in blood and/or plasma glucose
levels in a hyperglycemic individual. In some instances, increased
L-cell secretion of enteroendocrine peptides is associated with
increased insulin sensitivity.
[0023] In some embodiments, provided herein is a pharmaceutical
composition formulated for non-systemic ileal, rectal or colonic
delivery of the enteroendocrine peptide secretion enhancing agent.
In certain embodiments, provided herein is an enteroendocrine
peptide secretion enhancing agent such as a TGR5 agonist, a bile
acid, a bile salt, a bile acid mimic, a bile salt mimic, or a
combination thereof. In some embodiments, the enteroendocrine
peptide secretion enhancing agent is a glucagon-like peptide
secretion enhancing agent, optionally in combination with a bile
acid, a bile salt, a bile acid mimic, or a bile salt mimic. In
certain embodiments, the glucagon-like peptide secretion enhancing
agent is a glucagon-like peptide-1 (GLP-1) secretion enhancing
agent or a glucagon-like peptide-2 (GLP-2) secretion enhancing
agent, optionally in combination with a bile acid, a bile salt, a
bile acid mimic, or a bile salt mimic. In some embodiments, the
enteroendocrine peptide secretion enhancing agent is a pancreatic
polypeptide-fold peptide secretion enhancing agent, optionally in
combination with a bile acid, a bile salt, a bile acid mimic, or a
bile salt mimic. In some embodiments, the pancreatic
polypeptide-fold peptide secretion enhancing agent is a peptide YY
(PYY) secretion enhancing agent.
[0024] In certain embodiments, the composition further comprises at
least one of a cholesterol absorption inhibitor, a spreading agent
or a wetting agent. In some embodiments, the absorption inhibitor
is a mucoadhesive agent. In specific embodiments, the polymer
having mucoadhesive properties is selected from methyl cellulose,
polycarbophil, polyvinylpyrrolidone, sodium carboxymethyl
cellulose, and combinations thereof. In some embodiments, the
enteroendocrine peptide secretion enhancing agent is covalently
linked to the absorption inhibitor.
[0025] In certain embodiments, the carrier is a rectally suitable
carrier. In certain embodiments, any pharmaceutical composition
described herein is formulated as a suppository, an enema solution,
a rectal foam, or a rectal gel. In some embodiments, any
pharmaceutical composition described herein comprises an orally
suitable carrier. In certain embodiments, the pharmaceutical
composition comprises an enteric coating.
[0026] Provided in certain embodiments herein is a method for
treating a metabolic disease or a condition associated with a
metabolic disease comprising administering to the lower ileum, the
colon and/or the rectum of an individual in need thereof, a
pharmaceutical composition comprising a therapeutically effective
amount of an enteroendocrine peptide secretion enhancing agent.
Provided in certain embodiments herein is a method for treating a
metabolic disease or a condition associated with a metabolic
disease or an inflammatory intestinal condition comprising
administering (e.g., orally or rectally administering) to an
individual in need thereof, a pharmaceutical composition comprising
a therapeutically effective amount of an enteroendocrine peptide
secretion enhancing agent and a carrier. In some embodiments,
compositions provided herein comprise administering a
therapeutically effective amount of ASBTI. In some embodiments,
administered is a pharmaceutical composition that further comprises
an absorption inhibitor, wherein the absorption inhibitor inhibits
the absorption of the enteroendocrine peptide secretion enhancing
agent across the rectal or colonic mucosa. In some embodiments, the
composition administered comprises an orally suitable carrier. In
certain embodiments, the pharmaceutical composition is formulated
for enteric delivery. In some embodiments, the pharmaceutical
composition comprises an enteric coating.
[0027] Provided in certain embodiments herein is a method for
treating obesity, diabetes, or an inflammatory intestinal condition
comprising administering to the lower ileum, the colon and/or the
rectum of an individual in need thereof, a pharmaceutical
composition comprising a therapeutically effective amount of an
enteroendocrine peptide secretion enhancing agent. Provided in some
embodiments herein is a method for treating obesity, diabetes, or
an inflammatory intestinal condition comprising administering
(e.g., orally or rectally administering) to an individual in need
thereof, a pharmaceutical composition comprising a therapeutically
effective amount of an enteroendocrine peptide secretion enhancing
agent and a carrier. In some embodiments, compositions provided
herein further comprise administering a therapeutically effective
amount of ASBTI. In some embodiments, administered is a
pharmaceutical composition that further comprises an absorption
inhibitor, wherein the absorption inhibitor inhibits the absorption
of the enteroendocrine peptide secretion enhancing agent across the
rectal or colonic mucosa. In some embodiments, the composition
administered comprises an orally suitable carrier. In certain
embodiments, the pharmaceutical composition is formulated for
enteric delivery. In some embodiments, the pharmaceutical
composition comprises an enteric coating.
[0028] In certain other embodiments, provided herein is a method of
treating (e.g., preventing, prophylactically treating or reducing
the incidences of) pancreatic and other cancers comprising
contacting the distal ileum of an individual in need thereof with
an Apical Sodium-dependent Bile Transporter inhibitor.
[0029] Provided in certain embodiments herein is a method for
preventing or treating pancreatic cancers comprising administering
to the lower ileum, the colon and/or the rectum of an individual in
need thereof, a pharmaceutical composition comprising a
therapeutically effective amount of an enteroendocrine peptide
secretion enhancing agent. Provided in some embodiments herein is a
method for preventing or treating pancreatic cancers comprising
administering (e.g., orally or rectally administering) to an
individual in need thereof, a pharmaceutical composition comprising
a therapeutically effective amount of an enteroendocrine peptide
secretion enhancing agent and a carrier. In some embodiments,
administered is a pharmaceutical composition that further comprises
an absorption inhibitor, wherein the absorption inhibitor inhibits
the absorption of the enteroendocrine peptide secretion enhancing
agent across the rectal or colonic mucosa. In some embodiments, the
composition administered comprises an orally suitable carrier. In
certain embodiments, the pharmaceutical composition is formulated
for enteric delivery. In some embodiments, the pharmaceutical
composition comprises an enteric coating.
[0030] In some embodiments, administered according to a method
described herein is a composition comprising a rectally suitable
carrier. In some embodiments, the administered pharmaceutical
composition is formulated as a suppository, an enema solution, a
rectal foam, or a rectal gel.
[0031] In certain embodiments, a composition administered according
to a method described herein comprises an enteroendocrine peptide
secretion enhancing agent that is a bile acid, bile salt, bile acid
mimic or bile salt mimic. In some embodiments, the enteroendocrine
peptide secretion enhancing agent is a glucagon-like peptide
secretion enhancing agent. In certain embodiments, the
enteroendocrine peptide secretion enhancing agent is a
glucagon-like peptide-1 (GLP-1) secretion enhancing agent or a
glucagon-like peptide-2 (GLP-2) secretion enhancing agent. In some
embodiments, the enteroendocrine peptide secretion enhancing agent
is a pancreatic polypeptide-fold peptide secretion enhancing agent.
In specific embodiments, the enteroendocrine peptide secretion
enhancing agent is a peptide YY (PYY) secretion enhancing agent. In
some embodiments, a composition administered according to a method
described herein comprises any one or more of the enteroendocrine
peptide secretion enhancing agents described herein.
[0032] Without limiting their utility to appetite suppression,
agents delivered rectally that invoke enteroendocrine signals will
be termed, for convenience, "rectal satiogens". As an example of
how this definition should not be limiting, the stimulation of
enteroendocrine regulatory peptides can benefit not only metabolic
diseases by the above effects, but can benefit a number of other
conditions via mechanisms that may be entirely independent of the
control of nutrient flux. Examples of conditions in which enhanced
enteroendocrine secretion can be beneficial are described in US
2009/0264808, and include: diabetes, impaired glucose tolerance,
glucose metabolic disorders, insulin resistance, obesity, acute
coronary syndrome, hibernating myocardium, ventricular dysfunction,
cardiac risk, post myocardial infarction mortality, post-surgical
or sepsis-related or critical illness-related catabolism and
mortality, critical illness polyneuropathy, congestive heart
failure, toxic hypervolemia, renal failure, ischemia-reperfusion
injury, mortality and morbidity from stroke and neurodegenerative
disease, neuropathy, inflammatory intestinal conditions,
inflamatory bowel disease, necrotizing enterocolitis, gastritis,
ulcerative colitis, inflammatory bowel disease, irritable bowel
syndrome, gastroenteritis, radiation induced enteritis,
chemotherapy induced enteritis, gastro-esophageal reflux disease
(GERD), peptic ulcer, non-ulcer dyspepsia (NUD), celiac disease,
intestinal celiac disease, gastrointestinal complications following
bariatric surgery, gastric carcinogenesis, or gastric
carcinogenesis following gastric or bowel resection, bowel mucosal
injury, impaired bowel integrity, osteopenia, and bone fractures
and bone disorders.
[0033] Provided herein are methods and uses for treating obesity or
diabetes or an inflammatory intestinal condition comprising
contacting the distal ileum of an individual in need thereof with
an Apical Sodium-dependent Bile Transporter Inhibitor (ASBTI)
and/or enteroendocrine peptide enhancing agent and/or a FXR
agonist.
[0034] In some embodiments of the methods and uses, contacting the
distal ileum of an individual in need thereof with an ASBTI and/or
enteroendocrine peptide enhancing agent and/or a FXR agonist:
[0035] a. reduces intraenterocyte bile acids; [0036] b. reduces
necrosis and/or damage to ileal architecture; [0037] c. reduces
food intake in the individual; [0038] d. induces satiety in the
individual; [0039] e. reduces blood and/or plasma glucose levels in
the individual; [0040] f. treats a metabolic disorder in the
individual; [0041] g. reduces the weight of the individual; [0042]
h. stimulates L-cells in the distal gastrointestinal tract of the
individual; [0043] i. increases the concentration of bile acids and
salts thereof in the vicinity of L-cells in the distal
gastrointestinal tract of the individual; [0044] j. enhances
enteroendocrine peptide secretion in the individual; or [0045] k.
any combination thereof.
[0046] In some embodiments, the ASBTI and/or the enteroendocrine
peptide enhancing agent and/or a FXR agonist is not systemically
absorbed. In some other embodiments, the ASBTI and/or the
enteroendocrine peptide enhancing agent and/or a FXR agonist is
systemically absorbed.
[0047] In some embodiments of the methods, the individual is an
obese or morbidly overweight individual. In some embodiments of the
methods, the individual is a diabetic individual. In some
embodiments of the methods, the individual is a non-diabetic
individual.
[0048] In some embodiments, provided herein are methods for the
treatment of obesity, diabetes, or an inflammatory intestinal
condition comprising administration of a therapeutically effective
amount of a combination of an ASBTI and a DPP-IV inhibitor to an
individual in need thereof. In some embodiments, provided herein
are methods for the treatment of obesity, diabetes, or an
inflammatory intestinal condition comprising administration of a
therapeutically effective amount of a combination of an ASBTI and
an enteroendocrine peptide enhancing agent and/or a FXR agonist to
an individual in need thereof. In some embodiments, provided herein
are methods for the treatment of obesity, diabetes, or an
inflammatory intestinal condition comprising administration of a
therapeutically effective amount of a combination of an ASBTI and a
thiazolidinedione to an individual in need thereof. In some
embodiments, provided herein are methods for the treatment of
obesity, diabetes, or an inflammatory intestinal condition
comprising administration of a therapeutically effective amount of
a combination of an ASBTI and an incretin mimic to an individual in
need thereof. In some embodiments, provided herein are methods for
the treatment of obesity, diabetes, or an inflammatory intestinal
condition comprising administration of a therapeutically effective
amount of a combination of an ASBTI and GLP-1 or an analog thereof
to an individual in need thereof. In some embodiments, provided
herein are methods for the treatment of obesity, diabetes, or an
inflammatory intestinal condition comprising administration of a
therapeutically effective amount of a combination of an ASBTI and a
biguanide to an individual in need thereof.
[0049] In some embodiments, the methods described herein reduce
intraenterocyte bile acids in an individual in need thereof. In
some embodiments, the methods described herein reduce necrosis or
damage to ileal architecture in an individual in need thereof. In
some embodiments, the methods described herein reduce food intake
(caloric intake) in an individual in need thereof. In some
embodiments, the methods described herein induce satiety in an
individual in need thereof. In some embodiments, the methods
described herein treat metabolic disorders in an individual in need
thereof. In some embodiments, the methods described herein reduce
the weight of an individual in need thereof. In some embodiments,
the methods described herein stimulate L-cells in the distal
gastrointestinal tract of an individual in need thereof. In some
embodiments, the methods described herein increase the
concentration of bile acid and salts thereof in the vicinity of
L-cells in the distal gastrointestinal tract of an individual.
[0050] Provided herein are methods for reducing food intake in an
individual in need thereof comprising administration of an Apical
Sodium-dependent Bile Acid Transporter Inhibitor (ASBTI) to an
individual in need thereof wherein the ASBTI is delivered or
released non-systemically in the distal ileum of the
individual.
[0051] Provided herein are methods for reducing circulating blood
or plasma glucose levels in an individual in need thereof
comprising administration of an Apical Sodium-dependent Bile Acid
Transporter Inhibitor (ASBTI) to an individual in need thereof
wherein the ASBTI is delivered or released non-systemically in the
distal ileum of the individual.
[0052] Provided herein are methods for increasing insulin secretion
in an individual in need thereof comprising administration of an
Apical Sodium-dependent Bile Acid Transporter Inhibitor (ASBTI) to
an individual in need thereof wherein the ASBTI is delivered or
released non-systemically in the distal ileum of the
individual.
[0053] In some embodiments, the methods described herein enhance
enteroendocrine peptide secretion in an individual in need thereof.
In some of such embodiments, the enteroendocrine peptide is GLP-1,
GLP-2, PYY, oxyntomodulin, or a combination thereof.
[0054] In some embodiments, contacting the distal ileum of an
individual in need thereof with an ASBTI and/or an enterendocrine
peptide enhancing agent and/or a FXR agonist increases the level of
GLP-1 in the blood and/or plasma of the individual by from about 2
times to about 6 times the level of GLP-1 in the blood and/or
plasma of the individual prior to contacting the distal ileum of
the individual with the ASBTI.
[0055] In some embodiments, contacting the distal ileum of an
individual in need thereof with an ASBTI reduces the level of
glucose in the blood and/or plasma of the individual by at least
30% compared to the level of glucose in the blood and/or plasma of
the individual prior to contacting the distal ileum of the
individual with the ASBTI.
[0056] In some embodiments, contacting the distal ileum of an
individual in need thereof with an ASBTI maintains reduced blood
and/or plasma glucose levels in the individual for at least 24
hours compared to blood and/or plasma glucose levels in the
individual prior to contacting the distal ileum of the individual
with the ASBTI.
[0057] In some embodiments, the ASBTI and/or the enterendocrine
peptide enhancing agent and/or the FXR agonist is administered
orally. In some embodiments, the ASBTI and/or the enterendocrine
peptide enhancing agent and/or the FXR agonist is administered as
an ileal-pH sensitive release formulation that delivers the ASBTI
and/or the enterendocrine peptide enhancing agent and/or the FXR
agonist to the distal ileum, colon and/or rectum of an individual.
In some embodiments, the ASBTI and/or the enterendocrine peptide
enhancing agent and/or the FXR agonist is administered as an
enterically coated formulation. In some embodiments, oral delivery
of an ASBTI and/or an enterendocrine peptide enhancing agent and/or
a FXR agonist provided herein can include formulations, as are well
known in the art, to provide prolonged or sustained delivery of the
drug to the gastrointestinal tract by any number of mechanisms.
These include, but are not limited to, pH sensitive release from
the dosage form based on the changing pH of the small intestine,
slow erosion of a tablet or capsule, retention in the stomach based
on the physical properties of the formulation, bioadhesion of the
dosage form to the mucosal lining of the intestinal tract, or
enzymatic release of the active drug from the dosage form. The
intended effect is to extend the time period over which the active
drug molecule is delivered to the site of action (the ileum) by
manipulation of the dosage form. Thus, enteric-coated and
enteric-coated controlled release formulations are within the scope
of the present invention. Suitable enteric coatings include
cellulose acetate phthalate, polyvinylacetate phthalate,
hydroxypropylmethylcellulose phthalate and anionic polymers of
methacrylic acid and methacrylic acid methyl ester.
[0058] In some embodiments of the methods described above, the
ASBTI and/or the enterendocrine peptide enhancing agent and/or the
FXR agonist is administered before ingestion of food. In some
embodiments of the methods described above, the ASBTI and/or the
enterendocrine peptide enhancing agent and/or the FXR agonist is
administered less than about 60 minutes before ingestion of food.
In some embodiments of the methods described above, the ASBTI
and/or the enterendocrine peptide enhancing agent and/or the FXR
agonist is administered less than about 30 minutes before ingestion
of food. In some embodiments of the methods described above, the
ASBTI and/or the enterendocrine peptide enhancing agent and/or the
FXR agonist is administered after ingestion of food.
[0059] Provided herein are methods for prevention and/or treatment
of congestive heart failure, ventricular dysfunction, toxic
hypervolemia, polycystic ovary syndrome, inflammatory bowel
disease, impaired bowel integrity, short bowel syndrome, gastritis,
peptic ulcer, or irritable bowel disease comprising contacting the
distal ileum of an individual in need thereof with an ASBTI and/or
an enterendocrine peptide enhancing agent and/or a FXR agonist. In
some embodiments, the methods further comprise administration of a
DPP-IV inhibitor, a TGR5 agonist, a biguanide, an incretin mimetic,
or GLP-1 or an analog thereof. Provided herein are methods for
prevention and/or treatment of radiation enteritis comprising
contacting the distal ileum of an individual in need thereof with
an ASBTI and/or an enterendocrine peptide enhancing agent and/or a
FXR agonist. In some embodiments, the methods further comprise
administration of a DPP-IV inhibitor, a TGR5 agonist, a biguanide,
an incretin mimetic, or GLP-1 or an analog thereof.
[0060] Provided herein are compositions for reducing
intraenterocyte bile acids in an individual in need thereof
comprising an Apical Sodium-dependent Bile Acid Transporter
Inhibitor (ASBTI) and/or an enterendocrine peptide enhancing agent
and/or a FXR agonist, and a pharmaceutically acceptable carrier,
wherein the ASBTI is delivered or released non-systemically in the
distal ileum of the individual. Provided herein are compositions
for reducing necrosis and/or damage to ileal architecture in an
individual in need thereof comprising an Apical Sodium-dependent
Bile Acid Transporter Inhibitor (ASBTI) and/or an enterendocrine
peptide enhancing agent and/or a FXR agonist, and a
pharmaceutically acceptable carrier, wherein the ASBTI and/or the
enterendocrine peptide enhancing agent and/or the FXR agonist is
delivered or released non-systemically in the distal ileum of the
individual. Provided herein are compositions for reducing caloric
intake in an individual in need thereof comprising an Apical
Sodium-dependent Bile Acid Transporter Inhibitor (ASBTI) and/or an
enterendocrine peptide enhancing agent and/or a FXR agonist, and a
pharmaceutically acceptable carrier, wherein the ASBTI and/or the
enterendocrine peptide enhancing agent and/or the FXR agonist is
delivered or released non-systemically in the distal ileum of the
individual. Provided herein are compositions for reducing
circulating blood and/or plasma glucose levels in an individual in
need thereof comprising an Apical Sodium-dependent Bile Acid
Transporter Inhibitor (ASBTI) and/or an enterendocrine peptide
enhancing agent and/or a FXR agonist, and a pharmaceutically
acceptable carrier, wherein the ASBTI is delivered or released
non-systemically in the distal ileum of the individual. Provided
herein are compositions for increasing insulin secretion in an
individual in need thereof comprising an Apical Sodium-dependent
Bile Acid Transporter Inhibitor (ASBTI) and/or an enterendocrine
peptide enhancing agent and/or a FXR agonist, and a
pharmaceutically acceptable carrier, wherein the ASBTI is delivered
or released non-systemically in the distal ileum of the individual.
Provided herein are compositions for preventing pancreatic and
other cancers comprising contacting the distal ileum of an
individual in need thereof with an ASBT1. In any of the
aforementioned embodiments, the compositions further comprise a
DPP-IV inhibitor, a TGR5 agonist, a biguanide, an incretin mimetic,
or GLP-1 or an analog thereof.
[0061] Provided herein, in some embodiments, are ASBTIs for
reducing intraenterocyte bile acids, reducing necrosis and/or
damage to ileal architecture, reducing food intake (caloric
intake), or for reducing circulating blood or plasma glucose levels
wherein the ASBTI is not absorbed systemically following oral
administration. In some of such embodiments, the ASBTI is a
compound of Formula I, II, III, IV, V or VI as described herein. In
some of such embodiments, the ASBTI is prevented from being
absorbed in the stomach by its presence in a formulation that
releases it in the ileum. In some of such embodiments, the ASBTI is
administered in combination with a second therapeutic agent
selected from a DPP-IV inhibitor, a biguanide, a thiazolidinedione,
an incretin mimetic, GLP-1 or an analog thereof, or a TGR5
agonist.
[0062] Provided in some embodiments herein is a kit comprising any
composition described herein (e.g., a pharmaceutical composition
formulated for rectal administration) and a device for localized
delivery within the rectum or colon. In certain embodiments, the
device is a syringe, bag, or a pressurized container.
BRIEF DESCRIPTION OF FIGURES
[0063] FIG. 1 illustrates the change in plasma glucose level in
diabetic db/db mice after oral administration of a combination of
the ASBTI
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide at doses of 0, 0.1, 1, 10 mg/kg
and 30 mg/kg sitagliptin (DPP-IV inhibitor) and the ASBTI
alone.
[0064] FIG. 2 illustrates the change in plasma glucose level in
diabetic db/db mice after oral administration of a combination of
the ASBTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate at doses of 0, 3, 30, 100 mg/kg and 30
mg/kg sitagliptin (DPP-IV inhibitor).
[0065] FIG. 3 illustrates the change in plasma glucose level in
diabetic db/db mice after oral administration of a combination of
metformin at doses of 0, 3, 30, 100, 300 mg/kg and 30 mg/kg
sitagliptin (DPP-IV inhibitor).
[0066] FIG. 4 illustrates the change in plasma glucose level in
diabetic db/db mice after oral administration of the ASBTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methanesulfonate salt at doses of 0, 3, 30, and 100
mg/kg.
[0067] FIG. 5 illustrates a time course for dose-dependent increase
in plasma GLP-1 level in normal rats upon administration of a
combination of metformin (0, 30, 100, 300 mg/kg) and 30 mg/kg
sitagliptin (DPP-IV inhibitor).
[0068] FIG. 6 illustrates a dose-dependent increase in plasma GLP-1
level in normal rats upon administration of a combination of the
ASBTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (100B) (0, 3, 30, 100 mg/kg) and 30
mg/kg sitagliptin (DPP-IV inhibitor) and the ASBTI alone.
[0069] FIG. 7A and FIG. 7B illustrate a time course for
dose-dependent increase in plasma GLP-1 level in normal rats upon
administration of a combination of the ASBTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (0, 3, 30, 100 mg/kg) and 30 mg/kg
sitagliptin (DPP-IV inhibitor) and the ASBTI alone.
[0070] FIG. 8 illustrates the change in body weight 24 h after
administration of ASBTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (100B) at doses of 0, 3, 30, 100 mg/kg
in combination with 30 mg/kg sitagliptin (DPP-IV inhibitor).
[0071] FIG. 9 illustrates the change in body weight 24 h after
administration of the ASBTI
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (100A) at doses of 0, 0.1, 1, 10
mg/kg in combination with 30 mg/kg sitagliptin (DPP-IV inhibitor)
and the ASBTI alone.
[0072] FIG. 10 illustrates (1) a comparison of orally administered
combination of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (100A) at doses of 0, 0.1, 1, 10
mg/kg and 30 mg/kg sitagliptin (DPP-IV inhibitor) on blood glucose
levels in diabetic db/db mice at 3 hours after dose; and (2) a
comparison of orally administered combination of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]4-aza-1-azoniabicyclo[2.2-
.2]octane methanesulfonate salt (100B) at doses of 0, 3, 30, 100
mg/kg and 30 mg/kg sitagliptin (DPP-IV inhibitor) on blood glucose
levels in diabetic db/db mice at 3 hours after dose; versus (3)
subcutaneously injected exenatide at doses of 0.02, 0.2 and 2 mg.kg
on blood glucose levels in diabetic db/db mice at 3 hours after
dose.
[0073] FIG. 11 illustrates the response of enteroendocrine peptides
to administration of bile salts. FIG. 1A illustrates the plasma PYY
concentrations in the caecum, transverse colon, and sigmoid as a
result of bile salt administration. FIG. 1B illustrates the plasma
enteroglucagon concentrations in the caecum, transverse colon, and
sigmoid as a result of bile salt administration.
[0074] FIG. 12 illustrates the affect on food intake of pump
infusion of TCA.
[0075] FIG. 13 illustrates the affect on body weight of pump
infusion of TCA.
[0076] FIG. 14 illustrates the affect of the viscosity of a
formulation described herein on the food intake of a subject.
[0077] FIG. 15 illustrates the cumulative food intake of rats with
(dotted lines) and without (solid lines) rectal administration of
taurocholate.
[0078] FIG. 16 illustrates the cumulative food intake of rats with
rectal administration of three concentrations of taurocholate and
the cumulative food intake of rats without rectal administration of
taurocholate.
[0079] FIG. 17 illustrates the dose response in rats for the
anorectic effect of rectally administered taurocholate.
[0080] FIG. 18 illustrates the normal GI distribution of PYY
(pmol/g).
[0081] FIG. 19 illustrates the acute release of GLP-1 in response
to rectal administration of bile acids in obese diabetic humans
treated with a DPP4 inhibitor.
[0082] FIG. 20 illustrates the acute release of PYY in response to
rectal administration of bile acids in obese diabetic humans
treated with a DPP4 inhibitor.
[0083] FIG. 21 illustrates the reduction of spontaneous food intake
in response to rectal administration of bile acids in obese
diabetic humans treated with a DPP4 inhibitor.
[0084] FIG. 22 illustrates the acute release of insulin and in
response to rectal administration of bile acids in obese diabetic
humans treated with a DPP4 inhibitor.
[0085] FIG. 23 illustrates the incremental integrated response of
insulin to rectal administration of bile acids in obese diabetic
humans treated with a DPP4 inhibitor.
[0086] FIG. 24 illustrates the acute reduction of plasma glucose
concentration in response to rectal administration of bile acids in
obese diabetic humans treated with a DPP4 inhibitor.
[0087] FIG. 25 illustrates the incremental integrated response of
plasma glucose concentration to rectally administered bile acids in
obese diabetic humans treated with a DPP4 inhibitor.
[0088] FIG. 26 illustrates delivery of bile acid salts to the lower
gut via a biliary shunt.
DETAILED DESCRIPTION OF THE INVENTION
[0089] Described herein is the use of inhibitors of the Apical
Sodium-dependent Bile Transporter (ASBT) or any recuperative bile
salt transporter that are active in the gastrointestinal (GI)
tract.
[0090] In certain embodiments, the methods provided herein are
utilized in methods for treating or preventing an inflammatory
intestinal condition or induction of weight loss in an individual
in need thereof. In certain embodiments, the methods provided
herein comprise administering a therapeutically effective amount of
an ASBT inhibitor (ASBTI) and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist to an individual in need
thereof. In some embodiments, such ASBT inhibitors and/or
enteroendocrine peptide enhancing agents and/or FXR agonists are
not systemically absorbed. In some embodiments, such ASBT
inhibitiors and/or enteroendocrine peptide enhancing agents and/or
FXR agonists are systemically absorbed. In some of such
embodiments, such bile salt transport inhibitors include a moiety
or group that prevents, reduces or inhibits the systemic absorption
of the compound in vivo. In some embodiments, a charged moiety or
group on the compounds prevents, reduces or inhibits the compounds
from leaving the gastrointestinal tract and reduces the risk of
side effects due to systemic absorption. In some embodiments, the
ASBTIs are formulated for delivery to the distal ileum. In some
embodiments, an ASBTI and/or an enteroendocrine peptide enhancing
agent and/or a FXR agonist is minimally absorbed. In some
embodiments, an ASBTI and/or an enteroendocrine peptide enhancing
agent and/or a FXR agonist is non-systemically administered to the
colon or the rectum of an individual in need thereof. In some
embodiments, less than 50%, less than 40%, less than 30%, less than
20%, less than 10%, less than 9%, less than 8%, less than 7%, less
than 6%, less than 5%, less than 4%, less than 3%, less than 2%, or
less than 1% of the ASBTI and/or the enteroendocrine peptide
enhancing agent and/or a FXR agonist is systemically absorbed. In
certain embodiments, ASBTIs described herein inhibit scavenging of
bile salts by recuperative bile acid salt transporters in the
distal gastrointestinal tract (e.g., the distal ileum, the colon
and/or the rectum).
[0091] In some instances, the inhibition of bile salt recycling
results in higher concentrations of bile salts in the lumen of the
distal gastrointestinal tract or portions thereof (e.g., the distal
small bowel and/or colon and/or rectum). As used herein, the distal
gastrointestinal tract includes the region from the distal ileum to
the anus. In some embodiments, the compounds described herein
reduce intraenterocyte bile acids or accumulation thereof. In some
embodiments, the compounds described herein reduce necrosis and/or
damage to ileal architecture. In certain embodiments, the higher
concentration of bile salts in the distal small bowel and/or colon
and/or rectum modulates (e.g., enhances) the secretion of
enteroendocrine peptides in the distal gastrointestinal tract. In
some embodiments, the compounds described herein enhance the
secretion of enteroendocrine peptides (e.g., GLP-1, GLP-2,
oxyntomodulin, PYY, or a combination thereof) from L-cells that are
present in the distal ileum, colon and/or the rectum. In certain
embodiments, the enhanced secretion of L-cell enteroendocrine
peptides modulates (e.g., slows or inhibits) gastric emptying and
gastric acid secretion. In certain instances the enhanced secretion
of L-cell enteroendocrine peptides induces a feeling of satiety. In
some embodiments, the enhanced secretion of L-cell enteroendocrine
peptides reduces food intake thereby inducing weight loss.
[0092] Also described herein is the use of such compounds for
reducing or maintaining weight in individuals (e.g., individuals
interested in losing weight, reducing weight, and/or maintaining a
healthy body weight and lifestyle). In certain instances, the
compounds described herein are useful in the treatment of diseases
or conditions that are modulated by enteroendocrine peptides
secreted by L-cells of the distal gastrointestinal tract, including
L-cells in the distal ileum, the colon and/or the rectum. In some
instances, enhanced enteroendocrine peptide secretion (e.g.,
increase in GLP-1 secretion) reduces blood or plasma glucose
levels. In some embodiments, the compounds described herein are
also useful in the treatment of metabolic disorders (e.g.,
diabetes, metabolic syndrome or the like) because they do not cause
side effects (e.g., weight gain) that are associated with
conventional therapies for metabolic disorders.
Compounds
[0093] In some embodiments, provided herein are ASBT inhibitors
that reduce or inhibit bile acid recycling in the distal
gastrointestinal (GI) tract, including the distal ileum, the colon
and/or the rectum. In certain embodiments, the ASBTIs are
systemically absorbed. In certain embodiments, the ASBTIs are not
systemically absorbed. In some embodiments, ASBTIs described herein
are modified or substituted (e.g., with a -L-K group) to be
non-systemic. In certain embodiments, any ASBT inhibitor is
modified or substituted with one or more charged groups (e.g., K)
and optionally, one or more linker (e.g., L), wherein L and K are
as defined herein.
[0094] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula I:
##STR00001##
wherein: R.sup.1 is a straight chained C.sub.1-6 alkyl group;
R.sup.2 is a straight chained C.sub.1-6 alkyl group; R.sup.3 is
hydrogen or a group OR.sup.11 in which R.sup.11 is hydrogen,
optionally substituted C.sub.1-6 alkyl or a C.sub.1-6 alkylcarbonyl
group; R.sup.4 is pyridyl or optionally substituted phenyl or
-L.sub.z-K.sub.z; wherein z is 1, 2 or 3; each L is independently a
substituted or unsubstituted alkyl, a substituted or unsubstituted
heteroalkyl, a substituted or unsubstituted alkoxy, a substituted
or unsubstituted aminoalkyl group, a substituted or unsubstituted
aryl, a substituted or unsubstituted heteroaryl, a substituted or
unsubstituted cycloalkyl, or a substituted or unsubstituted
heterocycloalkyl; each K is a moiety that prevents systemic
absorption; R.sup.5, R.sup.6, R.sup.7 and R.sup.8 are the same or
different and each is selected from hydrogen, halogen, cyano,
R.sup.5-acetylide, OR.sup.15, optionally substituted C.sub.1-6
alkyl, COR.sup.15, CH(OH)R.sup.15, S(O).sub.nR.sup.15,
P(O)(OR.sup.15).sub.2, OCOR.sup.15, OCF.sub.3, OCN, SCN, NHCN,
CH.sub.2OR.sup.15, CHO, (CH.sub.2).sub.pCN, CONR.sup.12R.sup.13,
(CH.sub.2).sub.pCO.sub.2R.sup.15,
(CH.sub.2).sub.pNR.sup.12R.sup.13, CO.sub.2R.sup.15, NHCOCF.sub.3,
NHSO.sub.2R.sup.15, OCH.sub.2OR.sup.15, OCH.dbd.CHR.sup.15,
O(CH.sub.2CH.sub.2O).sub.nR.sup.15,
O(CH.sub.2).sub.pSO.sub.3R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13,
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14 and --W--R.sup.31,
wherein W is O or NH and R.sup.31 is selected from
##STR00002## [0095] wherein p is an integer from 1-4, n is an
integer from 0-3 and, R.sup.12, R.sup.13, R.sup.14 and R.sup.15 are
independently selected from hydrogen and optionally substituted
C.sub.1-6 alkyl; or R.sup.6 and R.sup.7 are linked to form a
group
[0095] ##STR00003## [0096] wherein R.sup.12 and R.sup.13 are as
hereinbefore defined and m is 1 or 2; and R.sup.9 and R.sup.10 are
the same or different and each is selected from hydrogen or
C.sub.1-6 alkyl; and salts, solvates and physiologically functional
derivatives thereof.
[0097] In some embodiments of the methods, the compound of Formula
I is a compound
wherein R.sup.1 is a straight chained C.sub.1-6 alkyl group;
R.sup.2 is a straight chained C.sub.1-6 alkyl group; R.sup.3 is
hydrogen or a group OR.sup.11 in which R.sup.11 is hydrogen,
optionally substituted C.sub.1-6 alkyl or a C.sub.1-6 alkylcarbonyl
group; R.sup.4 is optionally substituted phenyl; R.sup.5, R.sup.6
and R.sup.8 are independently selected from hydrogen,
C.sub.1-4alkyl optionally substituted by fluorine, C.sub.1-4
alkoxy, halogen, or hydroxy; R.sup.7 is selected from halogen,
cyano, R.sup.15-acetylide, OR.sup.15, optionally substituted
C.sub.1-6 alkyl, COR.sup.15, CH(OH)R.sup.15, S(O).sub.nR.sup.15,
P(O)(OR.sup.15).sub.2, OCOR.sup.15, OCF.sub.3, OCN, SCN, HNCN,
CH.sub.2OR.sup.15, CHO, (CH.sub.2).sub.pCN, CONR.sup.12R.sup.13,
(CH.sub.2).sub.pCO.sub.2R.sup.15,
(CH.sub.2).sub.pNR.sup.12R.sup.13, CO.sub.2R.sup.15, NHCOCF.sub.3,
NHSO.sub.2R.sup.15, OCH.sub.2OR.sup.15, OCH.dbd.CHR.sup.15,
O(CH.sub.2CH.sub.2O).sub.pR.sup.15,
O(CH.sub.2).sub.pSO.sub.2R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13 and
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14; [0098] wherein n,
p and R.sup.12 to R.sup.15 are as hereinbefore defined; with the
proviso that at least two of R.sup.5 to R.sup.8 are not hydrogen;
and salts solvates and physiologically functional derivatives
thereof.
[0099] In some embodiments of the methods described herein, the
compound of Formula I is a compound
wherein R.sup.1 is a straight chained C.sub.1-6alkyl group; R.sup.2
is a straight chained C.sub.1-6 alkyl group; R.sup.3 is hydrogen or
a group OR.sup.11 in which R.sup.11 is hydrogen, optionally
substituted C.sub.1-6 alkyl or a C.sub.1-6 alkylcarbonyl group;
R.sup.4 is un-substituted phenyl; R.sup.5 is hydrogen or halogen;
R.sup.6 and R.sup.8 are independently selected from hydrogen,
C.sub.1-4alkyl optionally substituted by fluorine, C.sub.1-4alkoxy,
halogen, or hydroxy; R.sup.7 is selected from OR.sup.15,
S(O).sub.nR.sup.15, OCOR.sup.15, OCF.sub.3, OCN, SCN, CHO,
OCH.sub.2OR.sup.15, OCH.dbd.CHR.sup.15,
O(CH.sub.2CH.sub.2O).sub.nR.sup.15,
O(CH.sub.2).sub.pSO.sub.3R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13 and
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14 wherein p is an
integer from 1-4, n is an integer from 0-3, and R.sup.12, R.sup.13,
R.sup.14, and R.sup.15 are independently selected from hydrogen and
optionally substituted C.sub.1-6 alkyl; R.sup.9 and R.sup.10 are
the same or different and each is selected from hydrogen or
C.sub.1-6 alkyl; and salts, solvates and physiologically functional
derivatives thereof.
[0100] In some embodiments of the methods, wherein the compound of
Formula I is a compound
wherein R.sup.1 is methyl, ethyl or n-propyl; R.sup.2 is methyl,
ethyl, n-propyl, n-butyl or n-pentyl; R.sup.3 is hydrogen or a
group OR.sup.11 in which R.sup.11 is hydrogen, optionally
substituted C.sub.1-6 alkyl or a C.sub.1-6 alkylcarbonyl group;
R.sup.4 is un-substituted phenyl; R.sup.5 is hydrogen; R.sup.6 and
R.sup.8 are independently selected from hydrogen, C.sub.1-4alkyl
optionally substituted by fluorine, C.sub.1-4alkoxy, halogen, or
hydroxy; R.sup.7 is selected from OR.sup.15, S(O).sub.nR.sup.15,
OCOR.sup.15, OCF.sub.3, OCN, SCN, CHO, OCH.sub.2OR.sup.15,
OCH.dbd.CHR.sup.15, O(CH.sub.2CH.sub.2O)nR.sup.15,
O(CH.sub.2).sub.pSO.sub.3R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13 and
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14 wherein p is an
integer from 1-4, n is an integer from 0-3, and R.sup.12, R.sup.13,
R.sup.14, and R.sup.15 are independently selected from hydrogen and
optionally substituted C.sub.1-6 alkyl; R.sup.9 and R.sup.10 are
the same or different and each is selected from hydrogen or
C.sub.1-6 alkyl; and salts, solvates and physiologically functional
derivatives thereof.
[0101] In some embodiments of the methods, the compound of Formula
I is a compound wherein
R.sup.1 is methyl, ethyl or n-propyl; R.sup.2 is methyl, ethyl,
n-propyl, n-butyl or n-pentyl; R.sup.3 is hydrogen or a group
OR.sup.11 in which R.sup.11 is hydrogen, optionally substituted
C.sub.1-6 alkyl or a C.sub.1-6 alkylcarbonyl group; R.sup.4 is
un-substituted phenyl; R.sup.5 is hydrogen; R.sup.6 is
C.sub.1-4alkoxy, halogen, or hydroxy; R.sup.7 is OR.sup.15, wherein
R.sup.11 is hydrogen or optionally substituted C.sub.1-6 alkyl;
R.sup.8 is hydrogen or halogen; R.sup.9 and R.sup.10 are the same
or different and each is selected from hydrogen or C.sub.1-6 alkyl;
and salts, solvates and physiologically functional derivatives
thereof.
[0102] In some embodiments of the methods, the compound of Formula
I is [0103]
(3R,5R)-3-Butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phenyl--
1,4-benzothiazepine 1,1-dioxide; [0104]
(3R,5R)-3-Butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phenyl-1,4-ben-
zothiazepin-4-ol 1,1-dioxide; [0105]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phenyl-1,-
4-benzothiazepine 1,1-dioxide; [0106]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phenyl-1,-
4-benzothiazepin-4-ol 1,1-dioxide; [0107]
(3R,5R)-7-Bromo-3-butyl-3-ethyl-2,3,4,5-tetrahydro-8-methoxy-5-phenyl-1,4-
-benzothiazepine 1,1-dioxide; [0108]
(3R,5R)-7-Bromo-3-butyl-3-ethyl-2,3,4,5-tetrahydro-8-methoxy-5-phenyl-1,4-
-benxothiaxepin-4-ol 1,1-dioxide; [0109]
(3R,5R)-3-Butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazepine-7-
,8-diol 1,1-dioxide; [0110]
(3R,5R)-3-Butyl-3-ethyl-2,3,4,5-tetrahydro-8-methoxy-5-phenyl-1,4-benzoth-
iazepin-7-ol 1,1-dioxide; [0111]
(3R,5R)-3-Butyl-3-ethyl-2,3,4,5-tetrahydro-7-methoxy-5-phenyl-1,4-benzoth-
iazepin-8-ol 1,1-dioxide; [0112]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-8-methoxy-5-phenyl-1,4-be-
nzothiazepine 1,1-dioxide; [0113]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazep-
in-8-ol 1,1-dioxide; [0114]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazep-
ine-4,8-diol; [0115]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazep-
in-8-thiol 1,1-dioxide; [0116]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazep-
in-8-sulfonic acid 1,1-dioxide; [0117]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-8,9-dimethoxy-5-phenyl-1,-
4-benzothiazepine 1,1-dioxide; [0118]
(3R,5R)-3-butyl-7,8-diethoxy-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazep-
ine 1,1-dioxide; [0119]
(.+-.)-Trans-3-butyl-8-ethoxy-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-ben-
zothiazepine 1,1-dioxide; [0120]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-8-isopropoxy-5-phenyl-1,4-
-benzothiazepine 1,1-dioxide hydrochloride; [0121]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazep-
in-8-carbaldehyde-1,1-dioxide; [0122]
3,3-Diethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phenyl-1,4-benzothiazepine
1,1-dioxide; [0123]
3,3-Diethyl-2,3,4,5-tetrahydro-8-methoxy-5-phenyl-1,4-benzothiazepine
1,1-dioxide; [0124]
3,3-Diethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazpin-4,8-diol
1,1-dioxide; [0125]
(RS)-3,3-Diethyl-2,3,4,5-tetrahydro-4-hydroxy-7,8-dimethoxy-5-phenyl-1,4--
benzothiazepine 1,1-dioxide; [0126]
(.+-.)-Trans-3-butyl-8-ethoxy-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-ben-
zothiazepin-4-ol-1-dioxide; [0127]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-8-isopropoxy-5-phenyl-1,4-
-benzothiazepin-4-ol 1,1-dioxide; [0128]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8,9-trimethoxy-5-phenyl-
-1,4-benzothiazepin-4-ol 1,1-dioxide; [0129]
(3R,5R)-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazepin-4,-
7,8-triol 1,1-dioxide; [0130]
(.+-.)-Trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-4,7,8-trimethoxy-5-phenyl-
-1,4-benzothiazepine 1,1-dioxide; [0131]
3,3-Diethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazepin-8-ol
1,1-dioxide; [0132]
3,3-Diethyl-2,3,4,5-tetrahydro-7-methoxy-5-phenyl-1,4-benzothiazepin-8-ol
1,1-dioxide; [0133]
3,3-Dibutyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazepin-8-ol
1,1-dioxide; [0134]
(.+-.)-Trans-3-Butyl-3-ethyl-2,3,4,5-tetrahydro-1,1-dioxo-5-phenyl-1,4-be-
nzothiazepin-8-yl hydrogen sulfate; or [0135]
3,3-Diethyl-2,3,4,5-tetrahydro-1,1-dioxo-5-phenyl-1,4-benzothiazepin-8-yl
hydrogen sulfate.
[0136] In some embodiments, the compound of Formula I is
##STR00004## ##STR00005## ##STR00006## ##STR00007## ##STR00008##
##STR00009##
[0137] In some embodiments of the methods, the compound of Formula
I is
##STR00010##
[0138] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula II
##STR00011##
wherein: [0139] q is an integer from 1 to 4; [0140] n is an integer
from 0 to 2; [0141] R.sup.1 and R.sup.2 are independently selected
from the group consisting of H, alkyl, alkenyl, alkynyl, haloalkyl,
alkylaryl, arylalkyl, alkoxy, alkoxyalkyl, dialkylamino, alkylthio,
(polyalkyl)aryl, and cycloalkyl, [0142] wherein alkyl, alkenyl,
alkynyl, haloalkyl, alkylaryl, arylalkyl, alkoxy, alkoxyalkyl,
dialkylamino, alkylthio, (polyalkyl)aryl, and cycloalkyl optionally
are substituted with one or more substituents selected from the
group consisting of OR.sup.9, NR.sup.9R.sup.10,
N.sup.+R.sup.9R.sup.10R.sup.wA.sup.-, SR.sup.9,
S.sup.+R.sup.9R.sup.10A.sup.-,
P.sup.+R.sup.9R.sup.10R.sup.11A.sup.-, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, CO.sub.2R.sup.9, CN, halogen,
oxo, and CONR.sup.9R.sup.10, [0143] wherein alkyl, alkenyl,
alkynyl, alkylaryl, alkoxy, alkoxyalkyl, (polyalkyl)aryl, and
cycloalkyl optionally have one or more carbons replaced by O,
NR.sup.9, N.sup.+R.sup.9R.sup. A.sup.-, SO, SO.sub.2,
S.sup.+R.sup.9A.sup.-, P.sup.+R.sup.9R.sup.10A.sup.-, or phenylene,
[0144] wherein R.sup.9, R.sup.10, and R.sup.w are independently
selected from the group consisting of H, alkyl, alkenyl, alkynyl,
cycloalkyl, aryl, acyl, heterocycle, ammoniumalkyl, arylalkyl, and
alkylammoniumalkyl; or [0145] R.sup.1 and R.sup.2 taken together
with the carbon to which they are attached form C.sub.3-C.sub.10
cycloalkyl; [0146] R.sup.3 and R.sup.4 are independently selected
from the group consisting of H, alkyl, alkenyl, alkynyl, acyloxy,
aryl, heterocycle, OR.sup.9, NR.sup.9R.sup.10, SR.sup.9,
S(O)R.sup.9, SO.sub.2R.sup.9, and SO.sub.3R.sup.9, wherein R.sup.9
and R.sup.10 are as defined above; or [0147] R.sup.3 and R.sup.4
together .dbd.O, .dbd.NOR.sup.11, .dbd.S, .dbd.NNR.sup.11R.sup.12,
.dbd.NR.sup.9, or .dbd.CR.sup.11R.sup.12, [0148] wherein R.sup.11
and R.sup.12 are independently selected from the group consisting
of H, alkyl, alkenyl, alkynyl, aryl, arylalkyl, alkenylalkyl,
alkynylalkyl, heterocycle, carboxyalkyl, carboalkoxyalkyl,
cycloalkyl, cyanoalkyl, OR.sup.9, NR.sup.9R.sup.10, SR.sup.9,
S(O)R.sup.9, SO.sub.2R.sup.9, SO.sub.3R.sup.9, CO.sub.2R.sup.9, CN,
halogen, oxo, and CONR.sup.9R.sup.10, wherein R.sup.9 and R.sup.10
are as defined above, provided that both R.sup.3 and R.sup.4 cannot
be OH, NH.sub.2, and SH, or [0149] R.sup.11 and R.sup.12 together
with the nitrogen or carbon atom to which they are attached form a
cyclic ring; [0150] R.sup.5 and R.sup.6 are independently selected
from the group consisting of H, alkyl, alkenyl, alkynyl, aryl,
cycloalkyl, heterocycle, quaternary heterocycle, quarternary
heteroaryl, OR.sup.30, SR.sup.9, S(O)R.sup.9, SO.sub.2R.sup.9,
SO.sub.3R.sup.9, and -L.sub.z-K.sub.z; [0151] wherein z is 1, 2 or
3; each L is independently a substituted or unsubstituted alkyl, a
substituted or unsubstituted heteroalkyl, a substituted or
unsubstituted alkoxy, a substituted or unsubstituted aminoalkyl
group, a substituted or unsubstituted aryl, a substituted or
unsubstituted heteroaryl, a substituted or unsubstituted
cycloalkyl, or a substituted or unsubstituted heterocycloalkyl;
each K is a moiety that prevents systemic absorption; [0152]
wherein alkyl, alkenyl, alkynyl, aryl, cycloalkyl, heterocycle,
quaternary heterocycle, and quaternary heteroaryl can be
substituted with one or more substituent groups independently
selected from the group consisting of alkyl, alkenyl, alkynyl,
polyalkyl, polyether, aryl, haloalkyl, cycloalkyl, heterocycle,
arylalkyl, quaternary heterocycle, quaternary heteroaryl, halogen,
oxo, OR.sup.13, NR.sup.13R.sup.14, SR.sup.13, S(O)R.sup.13,
SO.sub.2R.sup.13, SO.sub.3R.sup.13, NR.sup.13OR.sup.14,
NR.sup.13NR.sup.14R.sup.15, NO.sub.2, CO.sub.2R.sup.13, CN, OM,
SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14, C(O)NR.sup.13R.sup.14,
C(O)OM, CR.sup.13, P(O)R.sup.13R.sup.14,
P.sup.+R.sup.13R.sup.14R.sup.15A.sup.-, P(OR.sup.13)OR.sup.14,
S.sup.+R.sup.13R.sup.14A.sup.-, and
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-. wherein: [0153] A.sup.- is a
pharmaceutically acceptable anion and M is a pharmaceutically
acceptable cation, said alkyl, alkenyl, alkynyl, polyalkyl,
polyether, aryl, haloalkyl, cycloalkyl, and heterocycle can be
further substituted with one or more substituent groups selected
from the group consisting of OR.sup.7, NR.sup.7R.sup.8,
S(O)R.sup.7, SO.sub.2R.sup.7, SO.sub.3R.sup.7, CO.sub.2R.sup.7, CN,
oxo, CONR.sup.7R.sup.8, N.sup.+R.sup.7R.sup.8R.sup.9A.sup.-, alkyl,
alkenyl, alkynyl, aryl, cycloalkyl, heterocycle, arylalkyl,
quaternary heterocycle, quaternary heteroaryl, P(O)R.sup.7R.sup.8,
P.sup.+R.sup.7R.sup.8R.sup.9A.sup.-, and P(O)(OR.sup.7) OR.sup.8
and [0154] wherein said alkyl, alkenyl, alkynyl, polyalkyl,
polyether, aryl, haloalkyl, cycloalkyl, and heterocycle can
optionally have one or more carbons replaced by O, NR.sup.7,
N.sup.+R.sup.7R.sup.8A.sup.-, S, SO, SO.sub.2,
S.sup.+R.sup.7A.sup.-, PR.sup.7, P(O)R.sup.7,
P.sup.+R.sup.7R.sup.8A.sup.-, or phenylene, and R.sup.13, R.sup.14,
and R.sup.15 are independently selected from the group consisting
of hydrogen, alkyl, alkenyl, alkynyl, polyalkyl, aryl, arylalkyl,
cycloalkyl, heterocycle, heteroaryl, quaternary heterocycle,
quaternary heteroaryl, and quaternary heteroarylalkyl, [0155]
wherein alkyl, alkenyl, alkynyl, arylalkyl, heterocycle, and
polyalkyl optionally have one or more carbons replaced by O,
NR.sup.9, N.sup.+R.sup.9R.sup.10A.sup.-, S, SO, SO.sub.2,
S.sup.+R.sup.9A.sup.-, PR, P.sup.+R.sup.9R.sup.10A.sup.-,
P(O)R.sup.9, phenylene, carbohydrate, amino acid, peptide, or
polypeptide, and [0156] R.sup.13, R.sup.14 and R.sup.15 are
optionally substituted with one or more groups selected from the
group consisting of sulfoalkyl, quaternary heterocycle, quaternary
heteroaryl, OR.sup.9, NR.sup.9R.sup.10,
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo, CO.sub.2R.sup.9, CN,
halogen, CONR.sup.9R.sup.10, SO.sub.2OM, SO.sub.2NR.sup.9R.sup.10,
PO(OR.sup.16)OR.sup.17, P.sup.+R.sup.9R.sup.10R.sup.11A.sup.-,
S.sup.+R.sup.9R.sup.10A.sup.-, and C(O)OM, [0157] wherein R.sup.16
and R.sup.17 are independently selected from the substituents
constituting R.sup.9 and M; or [0158] R.sup.14 and R.sup.15,
together with the nitrogen atom to which they are attached, form a
cyclic ring; and [0159] is selected from the group consisting of
alkyl, alkenyl, alkynyl, cycloalkyl, aryl, acyl, heterocycle,
ammoniumalkyl, alkylammoniumalkyl, and arylalkyl; and [0160]
R.sup.7 and R.sup.8 are independently selected from the group
consisting of hydrogen and alkyl; and [0161] one or more R.sup.x
are independently selected from the group consisting of H, alkyl,
alkenyl, alkynyl, polyalkyl, acyloxy, aryl, arylalkyl, halogen,
haloalkyl, cycloalkyl, heterocycle, heteroaryl, polyether,
quaternary heterocycle, quaternary heteroaryl, OR.sup.13,
NR.sup.13R.sup.14, SR.sup.13, S(O)R.sup.13, S(O).sub.2R.sup.13,
SO.sub.3R.sup.13, S.sup.+R.sup.13R.sup.14A.sup.-,
NR.sup.13OR.sup.14, NR.sup.13NR.sup.14R.sup.15, NO.sub.2,
CO.sub.2R.sup.13, CN, OM, SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14,
NR.sup.14C(O)R.sup.13, C(O)NR.sup.13R.sup.14,
NR.sup.14C(O)R.sup.13, C(O)OM, COR.sup.13, OR.sup.18,
S(O).sub.nNR.sup.18, NR.sup.13R.sup.18, NR.sup.18R.sup.14,
N.sup.+12.sup.9R.sup.11R.sup.12A.sup.-,
P.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, amino acid, peptide,
polypeptide, and carbohydrate, [0162] wherein alkyl, alkenyl,
alkynyl, cycloalkyl, aryl, polyalkyl, heterocycle, acyloxy,
arylalkyl, haloalkyl, polyether, quaternary heterocycle, and
quaternary heteroaryl can be further substituted with OR.sup.9,
NR.sup.9R.sup.10, N.sup.4R.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9,
S(O)R.sup.9, SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo,
CO.sub.2R.sup.9, CN, halogen, CONR.sup.9R.sup.10, SO.sub.2OM,
SO.sub.2NR.sup.9R.sup.10, PO(OR.sup.16)OR.sup.17,
P.sup.+R.sup.9R.sup.11R.sup.12A.sup.-,
S.sup.+R.sup.9R.sup.10A.sup.-, or C(O)M, and [0163] wherein
R.sup.18 is selected from the group consisting ofacyl,
arylalkoxycarbonyl, arylalkyl, heterocycle, heteroaryl, alkyl,
[0164] wherein acyl, arylalkoxycarbonyl, arylalkyl, heterocycle,
heteroaryl, alkyl, quaternary heterocycle, and quaternary
heteroaryl optionally are substituted with one or more substituents
selected from the group consisting of OR.sup.9, NR.sup.9R.sup.10,
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo, CO.sub.3R.sup.9, CN,
halogen, CONR.sup.9R.sup.10, SO.sub.3R.sup.9, SO.sub.2OM,
SO.sub.2NR.sup.9R.sup.10, PO(OR.sup.16)OR.sup.17, and C(O)OM,
[0165] wherein in R.sup.x, one or more carbons are optionally
replaced by O, NR.sup.13, N.sup.+R.sup.13R.sup.14A.sup.-, S, SO,
SO.sub.2, S.sup.+R.sup.13A.sup.-, PR.sup.13, P(O)R.sup.13,
P.sup.+R.sup.13R.sup.14A.sup.-, phenylene, amino acid, peptide,
polypeptide, carbohydrate, polyether, or polyalkyl, [0166] wherein
in said polyalkyl, phenylene, amino acid, peptide, polypeptide, and
carbohydrate, one or more carbons are optionally replaced by O,
NR.sup.9, R.sup.9R.sup.10A.sup.-, S, SO, SO.sub.2,
S.sup.+R.sup.9A.sup.-, PR.sup.9, P.sup.+R.sup.9R.sup.10A.sup.-, or
P(O)R.sup.9; [0167] wherein quaternary heterocycle and quaternary
heteroaryl are optionally substituted with one or more groups
selected from the group consisting of alkyl, alkenyl, alkynyl,
polyalkyl, polyether, aryl, haloalkyl, cycloalkyl, heterocycle,
arylalkyl, halogen, oxo, OR.sup.13, NR.sup.13R.sup.14, SR.sup.13,
S(O)R.sup.13, SO.sub.2R.sup.13, SO.sub.3R.sup.13,
NR.sup.13OR.sup.14, NR.sup.13NR.sup.13R.sup.15, NO.sub.2,
CO.sub.2R.sup.13, CN, OM, SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14,
C(O)NR.sup.13R.sup.14, C(O)OM, COR.sup.13, P(O)R.sup.13R.sup.14,
P.sup.+R.sup.13R.sup.14R.sup.15A.sup.-, P(OR.sup.13)OR.sup.14,
S.sup.+R.sup.13R.sup.14A.sup.-, and
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, [0168] provided that both
R.sup.5 and R.sup.6 cannot be hydrogen or SH; [0169] provided that
when R.sup.5 or R.sup.6 is phenyl, only one of R.sup.1 or R.sup.2
is H; provided that when q=1 and R.sup.x is styryl, anilido, or
anilinocarbonyl, only one of R.sup.5 or R.sup.6 is alkyl; or a
pharmaceutically acceptable salt, solvate, or prodrug thereof.
[0170] In some embodiments of the methods, the compound of Formula
II is a compound wherein
R.sup.5 and R.sup.6 are independently selected from the group
consisting of H, aryl, heterocycle, quaternary heterocycle, and
quarternary heteroaryl [0171] wherein the aryl, heteroaryl,
quaternary heterocycle and quaternary heteroaryl are optionally
substituted with one or more groups selected from the group
consisting of alkyl, alkenyl, alkynyl, polyalkyl, polyether, aryl,
haloalkyl, cycloalkyl, heterocycle, arylalkyl, halogen, oxo,
OR.sup.13, NR.sup.13R.sup.14, SR.sup.13, S(O)R.sup.13,
SO.sub.2R.sup.13, SO.sub.3R.sup.13, NR.sup.13OR.sup.14,
NR.sup.13NR.sup.14R.sup.15, NO.sub.2, CO.sub.2R.sup.13, CN, OM,
SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14, C(O)NR.sup.13R.sup.14,
C(O)OM, COR.sup.13, P(O)R.sup.13R.sup.14,
P.sup.+R.sup.13R.sup.14R.sup.15A.sup.-, P(OR.sup.13)OR.sup.14,
S.sup.+R.sup.13R.sup.14A.sup.-,
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.- and -L.sub.z-K.sub.z.
[0172] In some embodiments of the methods, the compound of Formula
II is a compound
wherein
R.sup.5 or R.sup.6 is --Ar--(R.sup.y).sub.t
[0173] t is an integer from 0 to 5; [0174] Ar is selected from the
group consisting of phenyl, thiophenyl, pyridyl, piperazinyl,
piperonyl, pyrrolyl, naphthyl, furanyl, anthracenyl, quinolinyl,
isoquinolinyl, quinoxalinyl, imidazolyl, pyrazolyl, oxazolyl,
isoxazolyl, pyrimidinyl, thiazolyl, triazolyl, isothiazolyl,
indolyl, benzoimidazolyl, benzoxazolyl, benzothiazolyl, and
benzoisothiazolyl; and [0175] one or more R.sup.y are independently
selected from the group consisting of alkyl, alkenyl, alkynyl,
polyalkyl, polyether, aryl, halo alkyl, cycloalkyl, heterocycle,
arylalkyl, halogen, oxo, OR.sup.13, NR.sup.13R.sup.14, SR.sup.13,
S(O)R.sup.13, SO.sub.2R.sup.13, SO.sub.3R.sup.13,
NR.sup.13OR.sup.14, NR.sup.13NR.sup.14R.sup.15, NO.sub.2,
CO.sub.2R.sup.13, CN, OM, SO.sub.2OM, SO.sub.2NR.sup.13R.sup.14,
C(O)NR.sup.13R.sup.14, C(O)OM, COR.sup.13,
P(O)R.sup.13R.sup.14P.sup.+R.sup.13R.sup.14R.sup.15A.sup.-,
P(OR.sup.13)OR.sup.14, S.sup.+R.sup.13R.sup.14A.sup.-,
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.- and -L.sub.zK.sub.z; [0176]
wherein said alkyl, alkenyl, alkynyl, polyalkyl, polyether, aryl,
haloalkyl, cycloalkyl, and heterocycle can be further substituted
with one or more substituent groups selected from the group
consisting of OR.sup.13, NR.sup.13R.sup.14, SR.sup.13,
S(O)R.sup.13, SO.sub.2R.sup.13, SO.sub.3R.sup.13,
NR.sup.13OR.sup.14, NR.sup.13NR.sup.14R.sup.15, NO.sub.2,
CO.sub.2R.sup.13, CN, oxo, CONR.sup.7R.sup.8,
N.sup.+R.sup.7R.sup.8R.sup.9A.sup.-, alkyl, alkenyl, alkynyl, aryl,
cycloalkyl, heterocycle, arylalkyl, quaternary heterocycle,
quaternary heteroaryl, P(O)R.sup.7R.sup.8,
P.sup.+R.sup.7R.sup.8A.sup.-, and P(O)(OR.sup.7)OR.sup.8, and or
phenylene; [0177] wherein said alkyl, alkenyl, alkynyl, polyalkyl,
polyether, aryl, haloalkyl, cycloalkyl, and heterocycle can
optionally have one or more carbons replaced by O, NR.sup.7,
N.sup.+R.sup.7R.sup.8A.sup.-, S, SO, SO.sub.2,
S.sup.4R.sup.7A.sup.-, PR.sup.7, P(O)R.sup.7,
P.sup.+R.sup.7R.sup.8A.sup.-, or phenylene.
[0178] In some embodiments of the methods, the compound of Formula
II is a compound wherein
R.sup.5 or R.sup.6 is
##STR00012##
[0180] In some embodiments of the methods, the compound of Formula
II is a compound wherein n is 1 or 2. In some embodiments of the
methods, the compound of Formula II is a compound wherein R.sup.1
and R.sup.2 are independently H or C.sub.1-7alkyl. In some
embodiments of the methods, the compound of Formula II is a
compound wherein each C.sub.1-7alkyl is independently ethyl,
n-propyl, n-butyl, or isobutyl. In some embodiments of the methods,
the compound of Formula II is a compound wherein R.sup.3 and
R.sup.4 are independently H or OR.sup.9. In some embodiments of the
methods, compound of Formula II is a compound wherein R.sup.9 is
H
[0181] In some embodiments of the methods, the compound of Formula
II is a compound wherein one or more R.sup.x are in the 7-, 8- or
9-position of the benzo ring of Formula II. In some embodiments of
the methods, the compound of Formula II is a compound wherein
R.sup.x is in the 7-position of the benzo ring of Formula II. In
some embodiments of the methods, the compound of Formula H is a
compound wherein one or more R.sup.11 are independently selected
from OR.sup.13 and NR.sup.13R.sup.14.
[0182] In some embodiments of the methods, the compound of Formula
II is a compound
wherein: [0183] q is 1 or 2; [0184] n is 2; [0185] R.sup.1 and
R.sup.2 are each alkyl; [0186] R.sup.3 is hydroxy; [0187] R.sup.4
and R.sup.6 are hydrogen; [0188] R.sup.5 has the formula
##STR00013##
[0188] wherein [0189] t is an integer from 0 to 5; [0190] one or
more R.sup.y are OR.sup.13; [0191] R.sup.13 is selected from the
group consisting of hydrogen, alkyl, alkenyl, alkynyl, polyalkyl,
aryl, arylalkyl, cycloalkyl, heterocycle, heteroaryl, quaternary
heterocycle, quaternary heteroaryl, and quaternary heteroarylalkyl;
[0192] said R.sup.13 alkyl, alkenyl, alkynyl, arylalkyl,
heterocycle, and polyalkyl groups optionally have one or more
carbons replaced by O, NR.sup.9, N.sup.+R.sup.9R.sup.10A.sup.-, S,
SO, SO.sub.2, S.sup.+R.sup.9A.sup.-, PR.sup.9,
P.sup.+R.sup.9R.sup.10A.sup.-, P(O)R.sup.9, phenylene,
carbohydrate, amino acid, peptide, or polypeptide; [0193] R.sup.13
is optionally substituted with one or more groups selected from the
group consisting of sulfoalkyl, quaternary heterocycle, quaternary
heteroaryl, OR.sup.9, NR.sup.9R.sup.10,
N.sup.+R.sup.9R.sup.11R.sup.12A.sup.-, SR.sup.9, S(O)R.sup.9,
SO.sub.2R.sup.9, SO.sub.3R.sup.9, oxo, CO.sub.2R.sup.9, CN,
halogen, CONR.sup.9R.sup.10, SO.sub.2OM, SO.sub.2NR.sup.9R.sup.10,
PO(OR.sup.16)OR.sup.17, P.sup.+R.sup.9, R.sup.10R.sup.11A.sup.-,
S.sup.+R.sup.9, R.sup.10A.sup.-, and C(O)OM, [0194] wherein A is a
pharmaceutically acceptable anion, and M is a pharmaceutically
acceptable cation, [0195] R.sup.9 and R.sup.10 are independently
selected from the group consisting of H, alkyl, alkenyl, alkynyl,
cycloalkyl, aryl, acyl, heterocycle, ammoniumalkyl, arylalkyl, and
alkylammoniumalkyl; [0196] R.sup.11 and R.sup.12 are independently
selected from the group consisting of H, alkyl, alkenyl, alkynyl,
aryl, arylalkyl, alkenylalkyl, alkynylalkyl, heterocycle,
carboxyalkyl, carboalkoxyalkyl, cycloalkyl, cyanoalkyl, OR.sup.9,
NR.sup.9R.sup.10, SR.sup.9, S(O)R.sup.9, SO.sub.2R.sup.9,
SO.sub.3R.sup.9, CO.sub.2R.sup.9, CN, halogen, oxo, and CONR.sup.9,
R.sup.10, wherein R.sup.9 and R.sup.10 are as defined above,
provided that both R.sup.3 and R.sup.4 cannot be OH, NH.sub.2, and
SH; or [0197] R.sup.11 and R.sup.12 together with the nitrogen or
carbon atom to which they are attached form a cyclic ring; and
[0198] R.sup.16 and R.sup.17 are independently selected from the
substituents constituting R.sup.9 and M; [0199] R.sup.7 and R.sup.8
are hydrogen; and [0200] one or more R.sup.x are independently
selected from the group consisting of alkoxy, alkylamino and
dialkylamino and --W--R.sup.31, wherein W is O or NH and R.sup.31
is selected from
[0200] ##STR00014## [0201] or a pharmaceutically acceptable salt,
solvate, or prodrug thereof.
[0202] In some embodiments, a compound of Formula II is
##STR00015## ##STR00016##
[0203] In some embodiments of the methods, the compound of Formula
II is
##STR00017##
[0204] In certain embodiments, ASBTIs suitable for the methods
described herein are non-systemic analogs of Compound 100C. Certain
compounds provided herein are Compound 100C analogues modified or
substituted to comprise a charged group. In specific embodiments,
the Compound 100C analogues are modified or substituted with a
charged group that is an ammonium group (e.g., a cyclic ar acyclic
ammonium group). In certain embodiments, the ammonium group is a
non-protic ammonium group that contains a quarternary nitrogen.
[0205] In some embodiments, a compound of Formula II is
##STR00018##
[0206] In some embodiments, a compound of Formula II is
1-[[5-[[3-[(3S,4R,5R)-3-butyl-7-(dimethylamino)-3-ethyl-2,3,4,5-tetrahydr-
o-4-hydroxy-1,1-dioxido-1-benzothiepin-5-yl]phenyl]amino]-5-oxopentyl]amin-
o]-1-deoxy-D-glucitol or SA HMR1741 (a.k.a. BARI-1741).
[0207] In some embodiments, a compound of Formula II is
##STR00019##
[0208] In some embodiments, a compound of Formula II is
potassium((2R,3R,4S,5R,6R)-4-benzyloxy-6-{3-[3-((3S,4R,5R)-3-butyl-7-dime-
thylamino-3-ethyl-4-hydroxy-1,1-dioxo-2,3,4,5-tetrahydro-1H-benzo[b]thiepi-
n-5-yl)-phenyl]-ureido}-3,5-dihydroxy-tetrahydro-pyran-2-ylmethyl)sulphate
ethanolate, hydrate or SAR548304B (a.k.a. SAR-548304).
[0209] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula III:
##STR00020##
[0210] wherein: [0211] each R.sup.1, R.sup.2 is independently H,
hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8,
substituted or unsubstituted alkyl, substituted or unsubstituted
heteroalkyl, substituted or unsubstituted aryl, substituted or
unsubstituted alkyl-aryl, substituted or unsubstituted cycloalkyl,
substituted or unsubstituted alkyl-cycloalkyl, substituted or
unsubstituted heteroaryl, substituted or unsubstituted
alkyl-heteroaryl, substituted or unsubstituted heterocycloalkyl,
substituted or unsubstituted alkyl-heterocycloalkyl, or -L-K; or
R.sup.1 and R.sup.2 together with the nitrogen to which they are
attached form a 3-8-membered ring that is optionally substituted
with R.sup.8; [0212] each R.sup.3, R.sup.4 is independently H,
hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8,
substituted or unsubstituted alkyl, substituted or unsubstituted
heteroalkyl, substituted or unsubstituted aryl, substituted or
unsubstituted alkyl-aryl, substituted or unsubstituted cycloalkyl,
substituted or unsubstituted alkyl-cycloalkyl, substituted or
unsubstituted heteroaryl, substituted or unsubstituted
alkyl-heteroaryl, substituted or unsubstituted heterocycloalkyl,
substituted or unsubstituted alkyl-heterocycloalkyl, or -L-K;
[0213] R.sup.5 is H, hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8,
--YC(.dbd.X)R.sup.8, substituted or unsubstituted alkyl,
substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted alkyl-aryl,
substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, [0214] each R.sup.6, R.sup.7
is independently H, hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8,
--YC(.dbd.X)R.sup.8, substituted or unsubstituted alkyl,
substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted alkyl-aryl,
substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, or -L-K; or R.sup.6 and
R.sup.7 taken together form a bond; [0215] each X is independently
NH, S, or O; [0216] each Y is independently NH, S, or O; [0217]
R.sup.8 is substituted or unsubstituted alkyl, substituted or
unsubstituted heteroalkyl, substituted or unsubstituted aryl,
substituted or unsubstituted alkyl-aryl, substituted or
unsubstituted cycloalkyl, substituted or unsubstituted
alkyl-cycloalkyl, substituted or unsubstituted heteroaryl,
substituted or unsubstituted alkyl-heteroaryl, substituted or
unsubstituted heterocycloalkyl, substituted or unsubstituted
alkyl-heterocycloalkyl, or -L-K; [0218] L is A.sub.n, wherein
[0219] each A is independently NR.sup.1, S(O).sub.m, O, C(.dbd.X)Y,
Y(C.dbd.X), substituted or unsubstituted alkyl, substituted or
unsubstituted heteroalkyl, substituted or unsubstituted aryl,
substituted or unsubstituted heteroaryl, substituted or
unsubstituted cycloalkyl, or substituted or unsubstituted
heterocycloalkyl; wherein each m is independently 0-2; [0220] n is
0-7; [0221] K is a moiety that prevents systemic absorption; [0222]
provided that at least one of R.sup.1, R.sup.2, R.sup.3 or R.sup.4
is -L-K;
[0223] or a pharmaceutically acceptable prodrug thereof.
[0224] In some embodiments of a compound of Formula III, R.sup.1
and R.sup.3 are -L-K. In some embodiments, R.sup.1, R.sup.2 and
R.sup.3 are -L-K.
[0225] In some embodiments, at least one of R.sup.1, R.sup.2,
R.sup.3, R.sup.4, R.sup.5, R.sup.6 and R.sup.7 is H. In certain
embodiments, R.sup.5, R.sup.6, R.sup.7 are H and R.sup.1, R.sup.2,
R.sup.3 and R.sup.4 are alkyl, aryl, alkyl-aryl, or heteroalkyl. In
some embodiments, R.sup.1 and R.sup.2 are H. In some embodiments,
R.sup.1, R.sup.2, R.sup.5, R.sup.6 and R.sup.7 are H. In some
embodiments, R.sup.6 and R.sup.7 together form a bond. In certain
embodiments, R.sup.5, R.sup.6 and R.sup.7 are H, alkyl or
O-alkyl.
[0226] In some embodiments, R.sup.1 and R.sup.3 are -L-K. In some
embodiments, R.sup.1, R.sup.2 and R.sup.3 are -L-K. In some
embodiments, R.sup.3 and R.sup.4 are -L-K. In some embodiments,
R.sup.1 and R.sup.2 together with the nitrogen to which they are
attached form a 3-8 membered ring and the ring is substituted with
-L-K. In some embodiments, R.sup.1 or R.sup.2 or R.sup.3 or R.sup.4
are aryl optionally substituted with -L-K. In some embodiments,
R.sup.1 or R.sup.2 or R.sup.3 or R.sup.4 are alkyl optionally
substituted with -L-K. In some embodiments, R.sup.1 or R.sup.2 or
R.sup.3 or R.sup.4 are alky-aryl optionally substituted with -L-K.
In some embodiments, R.sup.1 or R.sup.2 or R.sup.3 or R.sup.4 are
heteroalkyl optionally substituted with -L-K.
[0227] In some embodiments, L is a C.sub.1-C.sub.7alkyl. In some
embodiments, L is heteroalkyl. In certain embodiments, L is
C.sub.1-C.sub.7alkyl-aryl. In some embodiments, L is
C.sub.1-C.sub.7alkyl-aryl-C.sub.1-C.sub.7alkyl.
[0228] In certain embodiments, K is a non-protic charged group. In
some specific embodiments, each K is a ammonium group. In some
embodiments, each K is a cyclic non-protic ammonium group. In some
embodiments, each K is an acyclic non-protic ammonium group.
[0229] In certain embodiments, each K is a cyclic non-protic
ammonium group of structure:
##STR00021##
[0230] In certain embodiments, K is an acyclic non-protic ammonium
group of structure:
##STR00022## [0231] wherein p, q, R.sup.9, R.sup.10 and Z are as
defined above. In certain embodiments, p is 1. In other
embodiments, p is 2. In further embodiments, p is 3. In some
embodiments, q is 0. In other embodiments, q is 1. In some other
embodiments, q is 2.
[0232] The compounds further comprise 1, 2, 3 or 4 anionic
counterions selected from Cl.sup.-, Br.sup.-, I.sup.-,
R.sup.11SO.sub.3.sup.-, (SO.sub.3.sup.---R.sup.11--SO.sub.3.sup.-),
R.sup.11CO.sub.2.sup.-, (CO.sub.2--R.sup.11--CO.sub.2),
(R.sup.11).sub.2(P.dbd.O)O.sup.- and
(R.sup.11)(P.dbd.O)O.sub.2.sup.2- wherein R.sup.11 is as defined
above. In some embodiments, the counterion is Cl.sup.-, Br.sup.-,
I.sup.-, CH.sub.2CO.sub.2.sup.-, CH.sub.3SO.sub.3.sup.-, or
C.sub.6H.sub.5SO.sub.3.sup.- or
CO.sub.2.sup.---(CH.sub.2).sub.2--CO.sub.2.sup.-. In some
embodiments, the compound of Formula III has one K group and one
counterion. In other embodiments, the compound of Formula III has
one K group, and two molecules of the compound of Formula III have
one counterion. In yet other embodiments, the compound of Formula
III has two K groups and two counterions. In some other
embodiments, the compound of Formula III has one K group comprising
two ammonium groups and two counterions.
[0233] Also described herein are compounds having the Formula
IIIA:
##STR00023##
[0234] wherein: [0235] each R.sup.1, R.sup.2 is independently H,
substituted or unsubstituted alkyl, or -L-K; or R.sup.1 and R.sup.2
together with the nitrogen to which they are attached form a
3-8-membered ring that is optionally substituted with R.sup.8;
[0236] and R.sup.3, R.sup.4, R.sup.8, L and K are as defined
above.
[0237] In some embodiments of compounds of Formula IIIA, L is
A.sub.n, wherein each A is substituted or unsubstituted alkyl, or
substituted or unsubstituted heteroalkyl, and n is 0-7. In certain
specific embodiments of the compound of Formula IIIA, R.sup.1 is H.
In some embodiments of Formula IIIA, R.sup.1 and R.sup.2 together
with the nitrogen to which they are attached form a 3-8-membered
ring that is optionally substituted with -L-K.
[0238] Also described herein are compounds having the Formula
IIIB:
##STR00024##
[0239] wherein: [0240] each R.sup.3, R.sup.4 is independently H,
substituted or unsubstituted alkyl, substituted or unsubstituted
heteroalkyl, substituted or unsubstituted aryl, substituted or
unsubstituted alkyl-aryl, or -L-K; [0241] and R.sup.1, R.sup.2, L
and K are as defined above.
[0242] In certain embodiments of Formula IIIB, R.sup.3 is H. In
certain embodiments, R.sup.3 and R.sup.4 are each -L-K. In some
embodiments, R.sup.3 is H and R.sup.4 is substituted or
unsubstituted alkyl, substituted or unsubstituted heteroalkyl,
substituted or unsubstituted aryl, substituted or unsubstituted
alkyl-aryl containing one or two -L-K groups.
[0243] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula IIIC
##STR00025##
[0244] wherein: [0245] each R.sup.1, R.sup.2 is independently H,
hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8,
substituted or unsubstituted alkyl, substituted or unsubstituted
heteroalkyl, substituted or unsubstituted aryl, substituted or
unsubstituted alkyl-aryl, substituted or unsubstituted cycloalkyl,
substituted or unsubstituted alkyl-cycloalkyl, substituted or
unsubstituted heteroaryl, substituted or unsubstituted
alkyl-heteroaryl, substituted or unsubstituted heterocycloalkyl,
substituted or unsubstituted alkyl-heterocycloalkyl, or -L-K; or
R.sup.1 and R.sup.2 together with the nitrogen to which they are
attached form a 3-8-membered ring that is optionally substituted
with R.sup.8; [0246] each R.sup.3, R.sup.4 is independently H,
hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8, --YC(.dbd.X)R.sup.8,
substituted or unsubstituted alkyl, substituted or unsubstituted
heteroalkyl, substituted or unsubstituted aryl, substituted or
unsubstituted alkyl-aryl, substituted or unsubstituted cycloalkyl,
substituted or unsubstituted alkyl-cycloalkyl, substituted or
unsubstituted heteroaryl, substituted or unsubstituted
alkyl-heteroaryl, substituted or unsubstituted heterocycloalkyl,
substituted or unsubstituted alkyl-heterocycloalkyl, or -L-K;
[0247] R.sup.5 is H, hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8,
--YC(.dbd.X)R.sup.8, substituted or unsubstituted alkyl,
substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted alkyl-aryl,
substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, [0248] each R.sup.6, R.sup.7
is independently H, hydroxy, alkyl, alkoxy, --C(.dbd.X)YR.sup.8,
--YC(.dbd.X)R.sup.8, substituted or unsubstituted alkyl,
substituted or unsubstituted heteroalkyl, substituted or
unsubstituted aryl, substituted or unsubstituted alkyl-aryl,
substituted or unsubstituted cycloalkyl, substituted or
unsubstituted alkyl-cycloalkyl, substituted or unsubstituted
heteroaryl, substituted or unsubstituted alkyl-heteroaryl,
substituted or unsubstituted heterocycloalkyl, substituted or
unsubstituted alkyl-heterocycloalkyl, or -L-K; or R.sup.6 and
R.sup.7 taken together form a bond; [0249] each X is independently
NH, S, or O; [0250] each Y is independently NH, S, or O; [0251]
R.sup.8 is substituted or unsubstituted alkyl, substituted or
unsubstituted heteroalkyl, substituted or unsubstituted aryl,
substituted or unsubstituted alkyl-aryl, substituted or
unsubstituted cycloalkyl, substituted or unsubstituted
alkyl-cycloalkyl, substituted or unsubstituted heteroaryl,
substituted or unsubstituted alkyl-heteroaryl, substituted or
unsubstituted heterocycloalkyl, substituted or unsubstituted
alkyl-heterocycloalkyl, or -L-K; [0252] L is A.sub.n, wherein
[0253] each A is independently NR.sup.1, S(O).sub.m, O, C(.dbd.X)Y,
Y(C.dbd.X), substituted or unsubstituted alkyl, substituted or
unsubstituted heteroalkyl, substituted or unsubstituted aryl,
substituted or unsubstituted heteroaryl, substituted or
unsubstituted cycloalkyl, or substituted or unsubstituted
heterocycloalkyl; wherein each m is independently 0-2; [0254] n is
0-7; [0255] K is a moiety that prevents systemic absorption; or a
pharmaceutically acceptable salt thereof.
[0256] In some specific embodiments of Formula I, II or III, K is
selected from
##STR00026##
[0257] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula IV:
##STR00027##
wherein
[0258] R.sup.1 is a straight chain C.sub.1-6 alkyl group;
[0259] R.sup.2 is a straight chain C.sub.1-6 alkyl group;
[0260] R.sup.3 is hydrogen or a group OR.sup.11 in which R.sup.11
is hydrogen, optionally substituted C.sub.1-6 alkyl or a C.sub.1-6
alkylcarbonyl group;
[0261] R.sup.4 is pyridyl or an optionally substituted phenyl;
[0262] R.sup.5, R.sup.6 and R.sup.8 are the same or different and
each is selected from: hydrogen, halogen, cyano,
R.sup.15-acetylide, OR.sup.15, optionally substituted C.sub.1-6
alkyl, COR.sup.15, CH(OH)R.sup.15, S(O).sub.nR.sup.15,
P(O)(OR.sup.15).sub.2, OCOR.sup.15, OCF.sub.3, OCN, SCN, NHCN,
CH.sub.2OR.sup.15, CHO, (CH.sub.2).sub.pCN, CONR.sup.12R.sup.13,
(CH.sub.2).sub.pCO.sub.2R.sup.15,
(CH.sub.2).sub.pNR.sup.12R.sup.13, CO.sub.2R.sup.15, NHCOCF.sub.3,
NHSO.sub.2R.sup.15, OCH.sub.2OR.sup.15, OCH.dbd.CHR.sup.15,
O(CHzCH.sub.2O).sub.nR.sup.15, O(CH.sub.2).sub.pSO.sub.3R.sup.15,
O(CH.sub.2).sub.pNR.sup.12R.sup.13 and
O(CH.sub.2).sub.pN.sup.+R.sup.12R.sup.13R.sup.14 wherein
[0263] p is an integer from 1-4,
[0264] n is an integer from 0-3 and
[0265] R.sup.12, R.sup.13, R.sup.4 and R.sup.15 are independently
selected from hydrogen and optionally substituted C.sup.1-6
alkyl;
[0266] R.sup.7 is a group of the formula
##STR00028## [0267] wherein the hydroxyl groups may be substituted
by acetyl, benzyl, [0268] or --(C.sub.1-C.sub.6)-alkyl-R.sup.17,
[0269] wherein the alkyl group may be substituted with one or more
hydroxyl groups;
[0270] R.sup.16 is --COOH, --CH.sub.2--OH, --CH--O-Acetyl, --COOMe
or --COOEt;
[0271] R.sup.17 is H, --OH, --NH.sub.2, --COOH or COOR.sup.18;
[0272] R.sup.18 is (C.sub.1-C.sub.4)-alkyl or
--NH--(C.sub.1-C.sub.4)-alkyl;
[0273] X is --NH-- or --O--; and
[0274] R.sup.9 and R.sup.10 are the same or different and each is
hydrogen or C.sub.1-C.sub.6alkyl; and salts thereof.
[0275] In some embodiments, a compound of Formula IV has the
structure of Formula IVA or Formula IVB:
##STR00029##
[0276] In some embodiments, a compound of Formula IV has the
structure of Formula IVC:
##STR00030##
[0277] In some embodiments of Formula IV, X is O and R.sup.7 is
selected from
##STR00031##
[0278] In some embodiments, a compound of Formula IV is:
##STR00032##
[0279] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula V:
##STR00033##
wherein:
[0280] R.sup.v is selected from hydrogen or C.sub.1-6alkyl;
[0281] One of R.sup.1 and R.sup.2 are selected from hydrogen or
C.sub.1-alkyl and the other is selected from C.sub.1-6alkyl;
[0282] R.sup.x and R.sup.y are independently selected from
hydrogen, hydroxy, amino, mercapto, C.sub.1-6alkyl,
C.sub.1-6alkoxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkylS(O).sub.a wherein
a is 0 to 2;
[0283] R.sup.z is selected from halo, nitr, cyano, hydroxy, amino,
carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6 alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-6alkoxycarbonyl, N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl;
[0284] n is 0-5;
[0285] one of R.sup.4 and R.sup.5 is a group of formula (VA):
##STR00034##
[0286] R.sup.3 and R.sup.6 and the other of R.sup.4 and R.sup.5 are
independently selected from hydrogen, halo, nitro, cyano, hydroxy,
amino, carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-6alkoxycarbonyl, N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl; [0287] wherein R.sup.3 and
R.sup.6 and the other of R.sup.4 and R.sup.5 may be optionally
substituted on carbon by one or more R.sup.17;
[0288] X is --O--, --N(R.sup.a)--, --S(O).sub.b-- or
--CH(R.sup.a)--; [0289] wherein R.sup.a is hydrogen or
C.sub.1-6alkyl and b is 0-2;
[0290] Ring A is aryl or heteroaryl; [0291] wherein Ring A is
optionally substituted on carbon by one or more substituents
selected from R.sup.18;
[0292] R.sup.7 is hydrogen, C.sub.1-6alkyl, carbocyclyl or
heterocyclyl; [0293] wherein R.sup.7 is optionally substituted on
carbon by one or more substituents selected from R.sup.19; and
wherein if said heterocyclyl contains an --NH-- group, that
nitrogen may be optionally substituted by a group selected from
R.sup.20;
[0294] R.sup.8 is hydrogen or C.sub.1-6-alkyl;
[0295] R.sup.9 is hydrogen or C.sub.1-6alkyl;
[0296] R.sup.10 is hydrogen, halo, nitro, cyano, hydroxy, amino,
carbamoyl, mercapto, sulphamoyl, hydroxyaminocarbonyl,
C.sub.1-10alkyl, C.sub.2-10alkynyl, C.sub.2-10alkynyl,
C.sub.1-10alkoxy, C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3 ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O), wherein
a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl, carbocyclyl-(C.sub.1-10alkylene),
--R.sup.21--(C.sub.1-10alkylene).sub.q- or
heterocyclyl-(C.sub.1-10alkylene),
--R.sup.22--(C.sub.1-10alkylene).sub.s-; wherein R.sup.10 is
optionally substituted on carbon by one or more substituents
selected from R.sup.23; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.24; or R.sup.10 is a group of formula
(VB):
##STR00035##
[0297] wherein:
[0298] R.sup.11 is hydrogen or C.sub.1-6-alkyl;
[0299] R.sup.12 and R.sup.13 are independently selected from
hydrogen, halo, carbamoyl, sulphamoyl, C.sub.1-10alkyl,
C.sub.2-10alkynyl, C.sub.2-10alkynyl, C.sub.1-10alkanoyl,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino, carbocyclyl or
heterocyclyl; wherein R.sup.12 and R.sup.13 may be independently
optionally substituted on carbon by one or more substituents
selected from R.sup.25; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.26;
[0300] R.sup.14 is selected from hydrogen, halo, carbamoyl,
sulphamoyl, hydroxyaminocarbonyl, C.sub.1-10alkyl,
C.sub.2-10alkenyl, C.sub.2-10alkynyl, C.sub.1-10alkanoyl,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene).sub.p-R.sup.27--(C.sub.1-10alkylene).sub-
.q- or
heterocyclyl-(C.sub.1-10alkylene).sub.r-R.sup.28--(C.sub.1-10alkyle-
ne).sub.s-; wherein R.sup.14 may be optionally substituted on
carbon by one or more substituents selected from R.sup.29; and
wherein if said heterocyclyl contains an --NH-- group, that
nitrogen may be optionally substituted by a group selected from
R.sup.30; or R.sup.4 is a group of formula (VC):
##STR00036##
[0301] R.sup.15 is hydrogen or C.sub.1-6alkyl; and R.sup.16 is
hydrogen or C.sub.1-6alkyl; wherein R.sup.6 may be optionally
substituted on carbon by one or more groups selected from
R.sup.31;
[0302] or R.sup.15 and R.sup.16 together with the nitrogen to which
they are attached form a heterocyclyl; wherein said heterocyclyl
may be optionally substituted on carbon by one or more R.sup.37;
and wherein if said heterocyclyl contains an --NH-- group, that
nitrogen may be optionally substituted by a group selected from
R.sup.38;
[0303] m is 1-3; wherein the values of R.sup.7 may be the same or
different;
[0304] R.sup.17, R.sup.18, R.sup.19, R.sup.23, R.sup.25, R.sup.29,
R.sup.31 and R.sup.37 are independently selected from halo, nitro,
cyano, hydroxy, amino, carbamoyl, mercapto, sulphamoyl,
hydroxyaminocarbonyl, C.sub.1-10alkyl, C.sub.2-10alkenyl,
C.sub.2-10alkynyl, C.sub.1-10alkoxy, C.sub.1-10alkanoyl,
C.sub.1-10alkanoyloxy, N--(C.sub.1-10alkyl)amino,
N,N--(C.sub.1-10alkyl).sub.2amino, N,N,N--(C.sub.1-10alkyl).sub.3
ammonio, C.sub.1-10alkanoylamino, N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene)-R.sup.32--(C.sub.1-10alkylene).sub.q-
or
heterocyclyl-(C.sub.1-10alkylene)-R.sup.13--(C.sub.1-10alkylene).sub.s-;
wherein R.sup.17, R.sup.18, R.sup.9, R.sup.23, R.sup.25, R.sup.29,
R.sup.31 and R.sup.37 may be independently optionally substituted
on carbon by one or more R.sup.34; and wherein if said heterocyclyl
contains an --NH-- group, that nitrogen may be optionally
substituted by a group selected from R.sup.35;
[0305] R.sup.21, R.sup.22, R.sup.27, R.sup.28, R.sup.32 or R.sup.33
are independently selected from --O--, --NR.sup.36--,
--S(O).sub.x--, --NR.sup.36C(O)NR.sup.36--,
--NR.sup.36C(S)NR.sup.36--, --OC(O)N.dbd.C--, --NR.sup.36C(O)-- or
--C(O)NR.sup.36--; wherein R.sup.36 is selected from hydrogen or
C.sub.1-6alkyl, and x is 0-2;
[0306] p, q, r and s are independently selected from 0-2;
[0307] R.sup.34 is selected from halo, hydroxy, cyano, carbamoyl,
ureido, amino, nitro, carbamoyl, mercapto, sulphamoyl,
trifluoromethyl, trifluoromethoxy, methyl, ethyl, methoxy, ethoxy,
vinyl, allyl, ethynyl, formyl, acetyl, formamido, acetylamino,
acetoxy, methylamino, dimethylamino, N-methylcarbamoyl,
N,N-dimethylcarbamoyl, methylthio, methylsulphinyl, mesyl,
N-methylsulphamoyl, N,N-dimethylsulphamoyl, N-methylsulphamoylamino
and N,N-dimethylsulphamoylamino;
[0308] R.sup.20, R.sup.24, R.sup.26, R.sup.30, R.sup.35 and
R.sup.38 are independently selected from C.sub.1-6alkyl,
C.sub.1-6alkanoyl, C.sub.1-6alkylsulphonyl,
C.sub.1-6alkoxycarbonyl, carbamoyl, N--(C.sub.1-6alkyl)carbamoyl,
N,N--(C.sub.1-6alkyl)carbamoyl, benzyl, benzyloxycarbonyl, benzoyl
and phenylsulphonyl; and
[0309] wherein a "heteroaryl" is a totally unsaturated, mono or
bicyclic ring containing 3-12 atoms of which at least one atom is
chosen from nitrogen, sulphur and oxygen, which heteroaryl may,
unless otherwise specified, be carbon or nitrogen linked;
[0310] wherein a "heterocyclyl" is a saturated, partially saturated
or unsaturated, mono or bicyclic ring containing 3-12 atoms of
which at least one atom is chosen from nitrogen, sulphur and
oxygen, which heterocyclyl may, unless otherwise specified, be
carbon or nitrogen linked, wherein a --CH.sub.2-- group can
optionally be replaced by a --C(O)-- group, and a ring sulphur atom
may be optionally oxidised to form an S-oxide; and
[0311] wherein a "carbocyclyl" is a saturated, partially saturated
or unsaturated, mono or bicyclic carbon ring that contains 3-12
atoms; wherein a --CH.sub.2-- group can optionally be replaced by a
--C(O) group; or a pharmaceutically acceptable salt or in vivo
hydrolysable ester or amide formed on an available carboxy or
hydroxy group thereof.
[0312] In some embodiments, compound of Formula V is
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N-(2-sulp-
hoethyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4,5-tetrahydro-1,-
2,5-benzothiadiazepine;
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-(R)-hydroxypropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)--
2,3,4,5-tetrahydro-1,2,5-benzothiadiazepine; or
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-methylpropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4-
,5-tetrahydro-1,2,5-benzothiadiazepine.
[0313] In some embodiments, compound of Formula V is
##STR00037##
[0314] In some embodiments, an ASBTI suitable for the methods
described herein is a compound of Formula VI:
##STR00038##
wherein:
[0315] R.sup.v and R.sup.w are independently selected from hydrogen
or C.sub.1-6alkyl; one of R.sup.1 and R.sup.2 is selected from
hydrogen or C.sub.1-6alkyl and the other is selected from
C.sub.1-6alkyl;
[0316] R.sup.x and R.sup.y are independently selected from hydrogen
or C.sub.1-6alkyl, or one of R.sup.x and R.sup.y is hydrogen or
C.sub.1-6alkyl and the other is hydroxy or C.sub.1-6alkoxy;
[0317] R.sup.z is selected from halo, nitro, cyano, hydroxy, amino,
carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-6alkoxycarbonyl, N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl;
[0318] n is 0-5;
[0319] one of R.sup.4 and R.sup.5 is a group of formula (VIA):
##STR00039##
[0320] R.sup.3 and R.sup.6 and the other of R.sup.4 and R.sup.5 are
independently selected from hydrogen, halo, nitro, cyano, hydroxy,
amino, carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-6alkyl,
C.sub.2-6alkenyl, C.sub.2-6alkynyl, C.sub.1-6alkoxy,
C.sub.1-6alkanoyl, C.sub.1-6alkanoyloxy, N--(C.sub.1-6alkyl)amino,
N,N--(C.sub.1-6alkyl).sub.2amino, C.sub.1-6alkanoylamino,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl).sub.2carbamoyl,
C.sub.1-6alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-4alkoxycarbonyl, N--(C.sub.1-6alkyl)sulphamoyl and
N,N--(C.sub.1-6alkyl).sub.2sulphamoyl; wherein R.sup.3 and R.sup.6
and the other of R.sup.4 and R.sup.5 may be optionally substituted
on carbon by one or more R.sup.17;
[0321] X is --O--, --N(R.sup.a)--, --S(O).sub.b-- or
--CH(R.sup.a)--; wherein R.sup.a is hydrogen or C.sub.1-6alkyl and
b is 0-2;
[0322] Ring A is aryl or heteroaryl; wherein Ring A is optionally
substituted on carbon by one or more substituents selected from
R.sup.18;
[0323] R.sup.7 is hydrogen, C.sub.1-6alkyl, carbocyclyl or
heterocyclyl; wherein R.sup.7 is optionally substituted on carbon
by one or more substituents selected from R.sup.9; and wherein if
said heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.20;
[0324] R.sup.8 is hydrogen or C.sub.1-6alkyl;
[0325] R.sup.9 is hydrogen or C.sub.1-6alkyl;
[0326] R.sup.10 is hydrogen, halo, nitro, cyano, hydroxy, amino,
carbamoyl, mercapto, sulphamoyl, hydroxyaminocarbonyl,
C.sub.1-10alkyl, C.sub.2-10alkenyl, C.sub.2-10alkynyl,
C.sub.1-10alkoxy, C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3 ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene)-R.sup.21---(C.sub.1-10alkylene).sub.q-
or
heterocyclyl-(C.sub.1-10alkylene).sub.r-R.sup.22--(C.sub.1-10alkylene)-
-; wherein R.sup.10 is optionally substituted on carbon by one or
more substituents selected from R.sup.23; and wherein if said
heterocyclyl contains an --NH-- group, that nitrogen may be
optionally substituted by a group selected from R.sup.24; or
R.sup.10 is a group of formula (VIB):
##STR00040##
wherein:
[0327] R.sup.11 is hydrogen or C.sub.1-6alkyl;
[0328] R.sup.11 and R.sup.13 are independently selected from
hydrogen, halo, nitro, cyano, hydroxy, amino, carbamoyl, mercapto,
sulphamoyl, C.sub.1-10alkyl, C.sub.2-10alkenyl, C.sub.2-10alkynyl,
C.sub.1-10alkoxy, C.sub.1-10alkanoyl, C.sub.1-10alkanoyloxy,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
C.sub.1-10alkanoylamino, N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino, carbocyclyl or
heterocyclyl; wherein R.sup.Z2 and R.sup.13 may be independently
optionally substituted on carbon by one or more substituents
selected from R.sup.25; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.26;
[0329] R.sup.14 is selected from hydrogen, halo, nitro, cyano,
hydroxy, amino, carbamoyl, mercapto, sulphamoyl,
hydroxyaminocarbonyl, C.sub.1-10alkyl, C.sub.2-10alkenyl,
C.sub.2-10alkynyl, C.sub.1-10alkoxy, C.sub.1-10alkanoyl,
C.sub.1-10alkanoyloxy, N--(C.sub.1-10alkyl)amino,
N,N--(C.sub.1-10alkyl).sub.2amino, N,N,N--(C.sub.1-10alkyl).sub.3
ammonio, C.sub.1-10alkanoylamino, N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl, carbocyclyl-(C.sub.1-10alkylene),
--R.sup.27--(C.sub.1-10alkylene).sub.q- or
heterocyclyl-(C.sub.1-10alkylene),
--R.sup.28--(C.sub.1-10alkylene).sub.s-; wherein R.sup.14 may be
optionally substituted on carbon by one or more substituents
selected from R.sup.29; and wherein if said heterocyclyl contains
an --NH-- group, that nitrogen may be optionally substituted by a
group selected from R.sup.30; or R.sup.14 is a group of formula
(VIC):
##STR00041##
[0330] R.sup.15 is hydrogen or C.sub.1-6alkyl;
[0331] R.sup.16 is hydrogen or C.sub.1-6alkyl; wherein R.sup.16 may
be optionally substituted on carbon by one or more groups selected
from R.sup.31;
[0332] n is 1-3; wherein the values of R.sup.7 may be the same or
different;
[0333] R.sup.17, R.sup.18, R.sup.19, R.sup.23, R.sup.25, R.sup.29
or R.sup.31 are independently selected from halo, nitro, cyano,
hydroxy, amino, carbamoyl, mercapto, sulphamoyl,
hydroxyaminocarbonyl, amidino, C.sub.1-10alkyl, C.sub.2-10alkenyl,
C.sub.2-10alkynyl, C.sub.1-10alkoxy, C.sub.1-10alkanoyl,
C.sub.1-10alkanoyloxy, (C.sub.1-10alkyl).sub.3silyl,
N--(C.sub.1-10alkyl)amino, N,N--(C.sub.1-10alkyl).sub.2amino,
N,N,N--(C.sub.1-10alkyl).sub.3 ammonio, C.sub.1-10alkanoylamino,
N--(C.sub.1-10alkyl)carbamoyl,
N,N--(C.sub.1-10alkyl).sub.2carbamoyl, C.sub.1-10alkylS(O).sub.a
wherein a is 0 to 2, N--(C.sub.1-10alkyl)sulphamoyl,
N,N--(C.sub.1-10alkyl).sub.2sulphamoyl,
N--(C.sub.1-10alkyl)sulphamoylamino,
N,N--(C.sub.1-10alkyl).sub.2sulphamoylamino,
C.sub.1-10alkoxycarbonylamino, carbocyclyl,
carbocyclylC.sub.1-10alkyl, heterocyclyl,
heterocyclylC.sub.1-10alkyl,
carbocyclyl-(C.sub.1-10alkylene)-R.sup.32--(C.sub.1-10alkylene).sub.q-
or
heterocyclyl-(C.sub.1-10alkylene).sub.r-R.sup.33---(C.sub.1-10alkylene).s-
ub.s-; wherein R.sup.17, R.sup.18, R.sup.9, R.sup.23, R.sup.25,
R.sup.29, R.sup.31 may be independently optionally substituted on
carbon by one or more R.sup.34; and wherein if said heterocyclyl
contains an --NH-- group, that nitrogen may be optionally
substituted by a group selected from R.sup.35;
[0334] R.sup.21, R.sup.22, R.sup.27, R.sup.28, R.sup.32 or R.sup.33
are independently selected from --O--, --NR.sup.36--,
--S(O).sub.x--, --NR.sup.36C(O)NR.sup.36--,
--NR.sup.36C(S)NR.sup.36--, --OC(O)N--C--, --NR.sup.36C(O)-- or
--C(O)NR.sup.36; wherein R.sup.36 is selected from hydrogen or
C.sub.1-6alkyl, and x is 0-2;
[0335] p, q, r and s are independently selected from 0-2;
[0336] R.sup.34 is selected from halo, hydroxy, cyano, carbamoyl,
ureido, amino, nitro, carbamoyl, mercapto, sulphamoyl,
trifluoromethyl, trifluoromethoxy, methyl, ethyl, methoxy, ethoxy,
vinyl, allyl, ethynyl, formyl, acetyl, formamido, acetylamino,
acetoxy, methylamino, dimethylamino, N-methylcarbamoyl,
N,N-dimethylcarbamoyl, methylthio, methylsulphinyl, mesyl,
N-methylsulphamoyl, N,N-dimethylsulphamoyl, N-methylsulphamoylamino
and N,N-dimethylsulphamoylamino;
[0337] R.sup.20, R.sup.24, R.sup.26, R.sup.30 or R.sup.35 are
independently selected from C.sub.1-6alkyl, C.sub.1-6alkanoyl,
C.sub.1-6alkylsulphonyl, C.sub.1-6alkoxycarbonyl, carbamoyl,
N--(C.sub.1-6alkyl)carbamoyl, N,N--(C.sub.1-6alkyl)carbamoyl,
benzyl, benzyloxycarbonyl, benzoyl and phenylsulphonyl;
or a pharmaceutically acceptable salt, solvate or solvate of such a
salt, or an in vivo hydrolysable ester formed on an available
carboxy or hydroxy thereof, or an in vivo hydrolysable amide formed
on an available carboxy thereof.
[0338] In some embodiments, a compound of Formula VI has the
structure of Formula VID:
##STR00042##
wherein:
[0339] R.sup.1 and R.sup.2 are independently selected from
C.sub.1-6alkyl; one of R.sup.4 and R.sup.5 is a group of formula
(VIE):
##STR00043##
[0340] R.sup.3 and R.sup.6 and the other of R.sup.4 and R.sup.5 are
independently selected from hydrogen, halo, nitro, cyano, hydroxy,
amino, carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-4alkyl,
C.sub.2-4alkenyl, C.sub.2-4alkynyl, C.sub.1-4alkoxy,
C.sub.1-4alkanoyl, C.sub.1-4alkanoyloxy, N--(C.sub.1-4alkyl)amino,
N,N--(C.sub.1-4alkyl).sub.2amino, C.sub.1-4alkanoylamino,
N--(C.sub.1-4alkyl)carbamoyl, N,N--(C.sub.1-4alkyl).sub.2carbamoyl,
C.sub.1-4alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-4alkoxycarbonyl, N--(C.sub.1-4alkyl)sulphamoyl and
N,N--(C.sub.1-4alkyl).sub.2sulphamoyl; wherein R.sup.3 and R.sup.6
and the other of R.sup.4 and R.sup.5 may be optionally substituted
on carbon by one or more R.sup.14;
[0341] R.sup.7 is carboxy, sulpho, sulphino, phosphono,
--P(O)(OR)(OR.sup.b), P(O)(OH)(OR.sub.a), --P(O)(OH)(R.sup.a) or
P(O)(OR.sup.a)(R.sup.b), wherein R.sup.a and R.sup.b are
independently selected from C.sub.1-6alkyl; or R.sup.7 is a group
of formula (VIF):
##STR00044##
[0342] R.sup.8 and R.sup.9 are independently hydrogen,
C.sub.1-4alkyl or a saturated cyclic group, or R.sup.8 and R.sup.9
together form C.sub.2-6alkylene; wherein R.sup.8 and R.sup.9 or
R.sup.8 and R.sup.9 together may be independently optionally
substituted on carbon by one or more substituents selected from
R.sup.5; and wherein if said saturated cyclic group contains an
--NH-- moiety, that nitrogen may be optionally substituted by one
or more R.sup.20;
[0343] R.sup.10 is hydrogen or C.sub.1-4alkyl; wherein R.sup.10 is
optionally substituted on carbon by one or more substituents
selected from R.sup.24;
[0344] R.sup.11 is hydrogen, C.sup.1-4alkyl, carbocyclyl or
heterocyclyl; wherein R.sup.11 is optionally substituted on carbon
by one or more substituents selected from R.sup.16; and wherein if
said heterocyclyl contains an --NH-- moiety, that nitrogen may be
optionally substituted by one or more R.sup.21;
[0345] R.sup.12 is hydrogen or C.sub.1-4alkyl, carbocyclyl or
heterocyclyl; wherein R.sup.12 optionally substituted on carbon by
one or more substituents selected from R.sup.17; and wherein if
said heterocyclyl contains an --NH-- moiety, that nitrogen may be
optionally substituted by one or more R.sup.22;
[0346] R.sup.13 is carboxy, sulpho, sulphino, phosphono,
--P(O)(OR.sup.c)(OR.sup.d), --P(O)(OH)(OR.sup.c),
--P(O)(OH)(R.sup.c) or --P(O)(OR)(R.sup.d) wherein R.sup.c and
R.sup.d are independently selected from C.sub.1-6alkyl;
[0347] m is 1-3; wherein the values of R.sup.8 and R.sup.9 may be
the same or different;
[0348] n is 1-3; wherein the values of R.sup.11 may be the same or
different;
[0349] p is 1-3; wherein the values of R.sup.12 may be the same or
different;
[0350] R.sup.14 and R.sup.16 are independently selected from halo,
nitro, cyano, hydroxy, amino, carboxy, carbamoyl, mercapto,
sulphamoyl, C.sub.1-4alkyl, C.sub.2-4alkenyl, C.sub.2-4alkynyl,
C.sub.1-4alkoxy, C.sub.1-4alkanoyl, C.sub.1-4alkanoyloxy,
N--(C.sub.1-4 alkyl)amino, N,N--(C.sub.1-4alkyl).sub.2amino,
C.sub.1-4alkanoylamino, N--(C.sub.1-4alkyl)carbamoyl,
N,N--(C.sub.1-4alkyl).sub.2carbamoyl, C.sub.1-4alkylS(O).sub.a
wherein a is 0 to 2, C.sub.1-4alkoxycarbonyl,
N--(C.sub.1-4alkyl)sulphamoyl and N,N--(C.sub.1-4
alkyl).sub.2sulphamoyl; wherein R.sup.14 and R.sup.16 may be
independently optionally substituted on carbon by one or more
R.sup.18;
[0351] R.sup.5 and R.sup.17 are independently selected from halo,
nitro, cyano, hydroxy, amino, carboxy, carbamoyl, mercapto,
sulphamoyl, C.sub.1-4alkyl, C.sub.2-4alkenyl, C.sub.2-4alkynyl,
C.sub.1-4alkoxy, C.sub.1-4alkanoyl, C.sub.1-4alkanoyloxy,
N--(C.sub.1-4 alkyl)amino, N,N--(C.sub.1-4alkyl).sub.2amino,
C.sub.1-4alkanoylamino, N--(C.sub.1-4alkyl)carbamoyl,
N,N--(C.sub.1-4alkyl).sub.2carbamoyl, C.sub.1-4alkylS(O).sub.a
wherein a is 0 to 2, C.sub.1-4alkoxycarbonyl,
N--(C.sub.1-4alkyl)sulphamoyl and
N,N--(C.sub.1-4alkyl).sub.2sulphamoyl, carbocyclyl, heterocyclyl,
sulpho, sulphino, amidino, phosphono, --P(O)(OR.sup.e)(OR.sup.f),
--P(O)(OH)(OR.sup.e), --P(O)(OH)(R.sup.e) or
--P(O)(OR.sup.e)(R.sup.f), wherein R.sup.e and R.sup.f are
independently selected from C.sub.1-6alkyl; wherein R.sup.5 and
R.sup.17 may be independently optionally substituted on carbon by
one or more R.sup.19; and wherein if said heterocyclyl contains an
--NH-- moiety, that nitrogen may be optionally substituted by one
or more R.sup.23;
[0352] R.sup.18, R.sup.19 and R.sup.25 are independently selected
from halo, hydroxy, cyano, carbamoyl, ureido amino nitro, carboxy,
carbamoyl, mercapto, sulphamoyl, trifluoromethyl, trifluoromethoxy,
methyl, ethyl, methoxy, ethoxy, vinyl, allyl, ethynyl,
methoxycarbonyl, formyl, acetyl, formamido, acetylamino, acetoxy,
methylamino, dimethylamino, N-methylcarbamoyl,
N,N-dimethylcarbamoyl, methylthio, methylsulphinyl, mesyl,
N-methylsulphamoyl and N,N-dimethylsulphamoyl;
[0353] R.sup.20, R.sup.21, R.sup.22, R.sup.3 and R.sup.26 are
independently C.sub.1-4alkyl, C.sub.1-4alkanoyl,
C.sub.1-4alkylsulphonyl, sulphamoyl, N--(C.sub.1-4alkyl)sulphamoyl,
N,N--(C.sub.1-4alkyl).sub.2sulphamoyl, C.sub.4alkoxycarbonyl,
carbamoyl, N--(C.sub.1-4alkyl)carbamoyl,
N,N--(C.sub.1-4alkyl).sub.2carbamoyl, benzyl, phenethyl, benzoyl,
phenylsulphonyl and phenyl;
[0354] R.sup.24 is selected from halo, nitro, cyano, hydroxy,
amino, carboxy, carbamoyl, mercapto, sulphamoyl, C.sub.1-4alkyl,
C.sub.2-4alkenyl, C.sub.2-4alkynyl, C.sub.1-4alkoxy,
C.sub.1-4alkanoyl, C.sub.1-4alkanoyloxy, N--(C.sub.1-4alkyl)amino,
N,N--(C.sub.1-4alkyl).sub.2amino, C.sub.1-4alkanoylamino,
N--(C.sub.1-4alkyl)carbamoyl, N,N--(C.sub.1-4alkyl).sub.2carbamoyl,
C.sub.1-4alkylS(O).sub.a wherein a is 0 to 2,
C.sub.1-4alkoxycarbonyl, N--(C.sub.1-4alkyl)sulphamoyl and
N,N--(C.sub.1-4alkyl).sub.2sulphamoyl, carbocyclyl, heterocyclyl;
wherein R.sup.24 may be independently optionally substituted on
carbon by one or more R.sup.25; and wherein if said heterocyclyl
contains an --NH-- moiety, that nitrogen may be optionally
substituted by one or more R.sup.26;
[0355] wherein any saturated cyclic group is a totally or partially
saturated, mono or bicyclic ring containing 3-12 atoms of which 0-4
atoms are chosen from nitrogen, sulphur or oxygen, which may be
carbon or nitrogen linked;
[0356] wherein any heterocyclyl is a saturated, partially saturated
or unsaturated, mono or bicyclic ring containing 3-12 atoms of
which at least one atom is chosen from nitrogen, sulphur or oxygen,
which may be carbon or nitrogen linked, wherein a --CH.sub.2--
group can optionally be replaced by a--C(O)-- or a ring sulphur
atom may be optionally oxidised to form the S-oxides; and
[0357] wherein any carbocyclyl is a saturated, partially saturated
or unsaturated, mono or bicyclic carbon ring that contains 3-12
atoms, wherein a --CH.sub.2-- group can optionally be replaced by a
--C(O)--;
[0358] or a pharmaceutically acceptable salt thereof.
[0359] In some embodiments, any compound described herein is
covalently conjugated to a bile acid using any suitable method. In
some embodiments, compounds described herein are covalently bonded
to a cyclodextrin or a biodegradable polymer (e.g., a
polysaccharide).
[0360] In certain embodiments compounds described herein are not
systemically absorbed. Moreover, provided herein are compounds that
inhibit bile salt recycling in the gastrointestinal tract of an
individual. In some embodiments, compounds described herein, may
not be transported from the gut lumen and/or do not interact with
ASBT. In some embodiments, compounds described herein, do not
affect, or minimally affect, fat digestion and/or absorption. In
certain embodiments, the administration of a therapeutically
effective amount of any compound described herein does not result
in gastrointestinal disturbance or lactic acidosis in an
individual. In certain embodiments, compounds described herein are
administered orally. In some embodiments, an ASBTI is released in
the distal ileum. An ASBTI compatible with the methods described
herein may be a direct inhibitor, an allosteric inhibitor, or a
partial inhibitor of the Apical Sodium-dependent Bile acid
Transporter.
[0361] In certain embodiments, compounds that inhibit ASBT or any
recuperative bile acid transporters are compounds that are
described in EP1810689, U.S. Pat. Nos. 6,458,851, 7,413,536,
7,514,421, US Appl. Publication Nos. 2002/0147184, 2003/0119809,
2003/0149010, 2004/0014806, 2004/0092500, 2004/0180861,
2004/0180860, 2005/0031651, 2006/0069080, 2006/0199797,
2006/0241121, 2007/0065428, 2007/0066644, 2007/0161578,
2007/0197628, 2007/0203183, 2007/0254952, 2008/0070888,
2008/0070892, 2008/0070889, 2008/0070984, 2008/0089858,
2008/0096921, 2008/0161400, 2008/0167356, 2008/0194598,
2008/0255202, 2008/0261990, WO 2002/50027, WO2005/046797,
WO2006/017257, WO2006/105913, WO2006/105912, WO2006/116499,
WO2006/117076, WO2006/121861, WO2006/122186, WO2006/124713,
WO2007/050628, WO2007/101531, WO2007/134862, WO2007/140934,
WO2007/140894, WO2008/028590, WO2008/033431, WO2008/033464,
WO2008/031501, WO2008/031500, WO2008/033465, WO2008/034534,
WO2008/039829, WO2008/064788, WO2008/064789, WO2008/088836,
WO2008/104306, WO2008/124505, and WO2008/130616; the compounds
described therein that inhibit recuperative bile acid transport are
hereby incorporated herein by reference.
[0362] In certain embodiments, compounds that inhibit ASBT or any
recuperative bile acid transporters are compounds described in
WO93/16055, WO94/18183, WO94/18184, WO96/05188, WO96/08484,
WO96/16051, WO97/33882, WO98/38182, WO99/35135, WO98/40375,
WO99/64409, WO99/64410, WO00/01687, WO00/47568, WO00/61568, DE
19825804, WO00/38725, WO00/38726, WO00/38727 (including those
compounds with a 2,3,4,5-tetrahydro-1-benzothiepine 1,1-dioxide
structure), WO00/38728, WO01/66533, WO02/50051, EP0864582 (e.g.
(3R,5R)-3-butyl-3-ethyl-1,1-dioxido-5-Phenyl-2,3,4,5-tetrahydro-1,4-benzo-
-thiazepin-8-yl (.quadrature.-D-glucopyranosiduronic acid,
WO94/24087, WO98/07749, WO98/56757, WO99/32478, WO99/35135,
WO00/20392, WO00/20393, WO00/20410, WO00/20437, WO01/34570,
WO00/35889, WO01/68637, WO01/68096, WO02/082111, WO03/020710,
WO03/022825, WO03/022830, WO03/0222861, JP10072371, U.S. Pat. Nos.
5,910,494; 5,723,458; 5,817,652; 5,663,165; 5,998,400; 6,465,451,
5,994,391; 6,107,494; 6,387,924; 6,784,201; 6,875,877; 6,740,663;
6,852,753; 5,070,103, 6,114,322, 6,020,330, 7,179,792, EP251315,
EP417725, EP489-423, EP549967, EP573848, EP624593, EP624594,
EP624595, EP869121, EP1070703, WO04/005247, compounds disclosed as
having IBAT activity in Drugs of the Future, 24, 425-430 (1999),
Journal of Medicinal Chemistry, 48, 5837-5852, (2005) and Current
Medicinal Chemistry, 13, 997-1016, (2006); the compounds described
therein that inhibit recuperative bile acid transport are hereby
incorporated herein by reference.
[0363] In some embodiments, compounds that inhibit ASBT or any
recuperative bile acid transporter are benzothiepines,
benzothiazepines (including 1,2-benzothiazepines;
1,4-benzothiazepines; 1,5-benzothiazepines; and/or
1,2,5-benzothiadiazepines). In some embodiments, compounds that
inhibit ASBT or any recuperative bile acid transporter include and
are not limited to S-8921 (disclosed in EP597107, WO 93/08155),
264W94 (GSK) disclosed in WO 96/05188; SC-435
(1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydr-
oxy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2-
.2.2]octane methanesulfonate salt), SC-635 (Searle); 2164U90
(3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4-benzothiazepine
1,1-dioxide); BAR1-1741 (Aventis SA), AZD 7508 (Astra Zeneca);
barixibat
(11-(D-gluconamido)-N-{2-[(1S,2R,3S)-3-hydroxy-3-phenyl-2-(2-pyridyl)-1-(-
2-pyridylamino)propyl]phenyl}undecanamide) or the like, or
combinations thereof. In some embodiments, an ASBTI is:
##STR00045## ##STR00046## ##STR00047##
[0364] In certain embodiments, compounds described herein have one
or more chiral centers. As such, all stereoisomers are envisioned
herein. In various embodiments, compounds described herein are
present in optically active or racemic forms. It is to be
understood that the compounds of the present invention encompasses
racemic, optically-active, regioisomeric and stereoisomeric forms,
or combinations thereof that possess the therapeutically useful
properties described herein. Preparation of optically active forms
is achieve in any suitable manner, including by way of non-limiting
example, by resolution of the racemic form by recrystallization
techniques, by synthesis from optically-active starting materials,
by chiral synthesis, or by chromatographic separation using a
chiral stationary phase. In some embodiments, mixtures of one or
more isomer is utilized as the therapeutic compound described
herein. In certain embodiments, compounds described herein contains
one or more chiral centers. These compounds are prepared by any
means, including enantioselective synthesis and/or separation of a
mixture of enantiomers and/or diastereomers. Resolution of
compounds and isomers thereof is achieved by any means including,
by way of non-limiting example, chemical processes, enzymatic
processes, fractional crystallization, distillation,
chromatography, and the like.
[0365] The compounds described herein, and other related compounds
having different substituents are synthesized using techniques and
materials described herein and as described, for example, in Fieser
and Fieser's Reagents for Organic Synthesis, Volumes 1-17 (John
Wiley and Sons, 1991); Rodd's Chemistry of Carbon Compounds,
Volumes 1-5 and Supplementals (Elsevier Science Publishers, 1989);
Organic Reactions, Volumes 1-40 (John Wiley and Sons, 1991),
Larock's Comprehensive Organic Transformations (VCH Publishers
Inc., 1989), March, ADVANCED ORGANIC CHEMISTRY 4.sup.th Ed., (Wiley
1992); Carey and Sundberg, ADVANCED ORGANIC CHEMISTRY 4.sup.th Ed.,
Vols. A and B (Plenum 2000, 2001), and Green and Wuts, PROTECTIVE
GROUPS IN ORGANIC SYNTHESIS 3.sup.rd Ed., (Wiley 1999) (all of
which are incorporated by reference for such disclosure). General
methods for the preparation of compound as described herein are
modified by the use of appropriate reagents and conditions, for the
introduction of the various moieties found in the formulae as
provided herein. As a guide the following synthetic methods are
utilized.
Formation of Covalent Linkages by Reaction of an Electrophile with
a Nucleophile
[0366] The compounds described herein are modified using various
electrophiles and/or nucleophiles to form new functional groups or
substituents. Table A entitled "Examples of Covalent Linkages and
Precursors Thereof" lists selected non-limiting examples of
covalent linkages and precursor functional groups which yield the
covalent linkages. Table A is used as guidance toward the variety
of electrophiles and nucleophiles combinations available that
provide covalent linkages. Precursor functional groups are shown as
electrophilic groups and nucleophilic groups.
TABLE-US-00001 TABLE A Examples of Covalent Linkages and Precursors
Thereof Covalent Linkage Product Electrophile Nucleophile
Carboxamides Activated esters amines/anilines Carboxamides acyl
azides amines/anilines Carboxamides acyl halides amines/anilines
Esters acyl halides alcohols/phenols Esters acyl nitriles
alcohols/phenols Carboxamides acyl nitriles amines/anilines Imines
Aldehydes amines/anilines Hydrazones aldehydes or ketones
Hydrazines Oximes aldehydes or ketones Hydroxylamines Alkyl amines
alkyl halides amines/anilines Esters alkyl halides carboxylic acids
Thioethers alkyl halides Thiols Ethers alkyl halides
alcohols/phenols Thioethers alkyl sulfonates Thiols Esters alkyl
sulfonates carboxylic acids Ethers alkyl sulfonates
alcohols/phenols Esters Anhydrides alcohols/phenols Carboxamides
Anhydrides amines/anilines Thiophenols aryl halides Thiols Aryl
amines aryl halides Amines Thioethers Azindines Thiols Boronate
esters Boronates Glycols Carboxamides carboxylic acids
amines/anilines Esters carboxylic acids Alcohols hydrazines
Hydrazides carboxylic acids N-acylureas or Anhydrides carbodiimides
carboxylic acids Esters diazoalkanes carboxylic acids Thioethers
Epoxides Thiols Thioethers haloacetamides Thiols Ammotriazines
halotriazines amines/anilines Triazinyl ethers halotriazines
alcohols/phenols Amidines imido esters amines/anilines Ureas
Isocyanates amines/anilines Urethanes Isocyanates alcohols/phenols
Thioureas isothiocyanates amines/anilines Thioethers Maleimides
Thiols Phosphite esters phosphoramidites Alcohols Silyl ethers
silyl halides Alcohols Alkyl amines sulfonate esters
amines/anilines Thioethers sulfonate esters Thiols Esters sulfonate
esters carboxylic acids Ethers sulfonate esters Alcohols
Sulfonamides sulfonyl halides amines/anilines Sulfonate esters
sulfonyl halides phenols/alcohols
[0367] In the reactions described, it is necessary to protect
reactive functional groups, for example hydroxy, amino, imino, thio
or carboxy groups, where these are desired in the final product, in
order to avoid their unwanted participation in reactions.
Protecting groups are used to block some or all of the reactive
moieties and prevent such groups from participating in chemical
reactions until the protective group is removed. In some
embodiments it is contemplated that each protective group be
removable by a different means. Protective groups that are cleaved
under totally disparate reaction conditions fulfill the requirement
of differential removal.
[0368] In some embodiments, protective groups are removed by acid,
base, reducing conditions (such as, for example, hydrogenolysis),
and/or oxidative conditions. Groups such as trityl,
dimethoxytrityl, acetal and t-butyldimethylsilyl are acid labile
and are used to protect carboxy and hydroxy reactive moieties in
the presence of amino groups protected with Cbz groups, which are
removable by hydrogenolysis, and Fmoc groups, which are base
labile. Carboxylic acid and hydroxy reactive moieties are blocked
with base labile groups such as, but not limited to, methyl, ethyl,
and acetyl in the presence of amines blocked with acid labile
groups such as t-butyl carbamate or with carbamates that are both
acid and base stable but hydrolytically removable.
[0369] In some embodiments carboxylic acid and hydroxy reactive
moieties are blocked with hydrolytically removable protective
groups such as the benzyl group, while amine groups capable of
hydrogen bonding with acids are blocked with base labile groups
such as Fmoc. Carboxylic acid reactive moieties are protected by
conversion to simple ester compounds as exemplified herein, which
include conversion to alkyl esters, or are blocked with
oxidatively-removable protective groups such as
2,4-dimethoxybenzyl, while co-existing amino groups are blocked
with fluoride labile silyl carbamates.
[0370] Allyl blocking groups are useful in then presence of acid-
and base-protecting groups since the former are stable and are
subsequently removed by metal or pi-acid catalysts. For example, an
allyl-blocked carboxylic acid is deprotected with a
Pd.sup.0-catalyzed reaction in the presence of acid labile t-butyl
carbamate or base-labile acetate amine protecting groups. Yet
another form of protecting group is a resin to which a compound or
intermediate is attached. As long as the residue is attached to the
resin, that functional group is blocked and does not react. Once
released from the resin, the functional group is available to
react.
[0371] Typically blocking/protecting groups are selected from:
##STR00048##
[0372] Other protecting groups, plus a detailed description of
techniques applicable to the creation of protecting groups and
their removal are described in Greene and Wuts, Protective Groups
in Organic Synthesis, 3rd Ed., John Wiley & Sons, New York,
N.Y., 1999, and Kocienski, Protective Groups, Thieme Verlag, New
York, N.Y., 1994, which are incorporated herein by reference for
such disclosure.
[0373] In some embodiments, ASBTIs described herein are synthesized
as described in, for example, WO 96/05188, U.S. Pat. Nos.
5,994,391; 7,238,684; 6,906,058; 6,020,330; and 6,114,322. In some
embodiments, ASBTIs described herein are synthesized starting from
compounds that are available from commercial sources or that are
prepared using procedures outlined herein. In some embodiments,
compounds described herein are prepared according to the process
set forth in Scheme I:
##STR00049##
[0374] In certain embodiments, the synthesis begins with a reaction
of 1,4-diazabicyclo[2.2.2]octane with 4-iodo-1-chloro butane to
provide a compound of structure 1-1. Such compounds are prepared in
any suitable manner, e.g., as set forth in Tremont, S. J. et. al.,
J. Med. Chem. 2005, 48, 5837-5852. The compound of structure 1-1 is
then subjected to a reaction with phenethylamine to provide a
compound of structure I-II. The compound of structure 1-11 is then
allowed to react with dicyanodiamide to provide a compound of
Formula I.
[0375] In some embodiments, a first compound of Formula III is
subjected to a further reaction to provide a second compound of
Formula III as shown in Scheme 2 below.
##STR00050##
[0376] A first compound of Formula III, 1-IA, is alkylated with
iodomethane to provide a second compound of Formula III, 1-IB.
Alkylation of 1-IB with a compound of structure 2-II provides a
further compound of Formula III, IC. In an alternative embodiment,
a first compound of Formula III, 1-IA, is alkylated with a compound
of structure 2-I to provide a second compound of Formula III,
1-IC.
GENERAL DEFINITIONS
[0377] The term "bile acid," as used herein, includes steroid acids
(and/or the carboxylate anion thereof), and salts thereof, found in
the bile of an animal (e.g., a human), including, by way of
non-limiting example, cholic acid, cholate, deoxycholic acid,
deoxycholate, hyodeoxycholic acid, hyodeoxycholate, glycocholic
acid, glycocholate, taurocholic acid, taurocholate,
chenodeoxycholic acid, chenodeoxycholate, lithocholic acid,
lithocolate, and the like. Taurocholic acid and/or taurocholate are
referred to herein as TCA. Any reference to a bile acid used herein
includes reference to a bile acid, one and only one bile acid, one
or more bile acids, or to at least one bile acid. Therefore, the
terms "bile acid," "bile salt," "bile acid/salt," "bile acids,"
"bile salts," and "bile acids/salts" are, unless otherwise
indicated, utilized interchangeably herein. Any reference to a bile
acid used herein includes reference to a bile acid or a salt
thereof. Furthermore, pharmaceutically acceptable bile acid esters
are optionally utilized as the "bile acids" described herein, e.g.,
bile acids conjugated to an amino acid (e.g., glycine or taurine).
Other bile acid esters include, e.g., substituted or unsubstituted
alkyl ester, substituted or unsubstituted heteroalkyl esters,
substituted or unsubstituted aryl esters, substituted or
unsubstituted heteroaryl esters, or the like. For example, the term
"bile acid" includes cholic acid conjugated with either glycine or
taurine: glycocholate and taurocholate, respectively (and salts
thereof). Any reference to a bile acid used herein includes
reference to an identical compound naturally or synthetically
prepared. Furthermore, it is to be understood that any singular
reference to a component (bile acid or otherwise) used herein
includes reference to one and only one, one or more, or at least
one of such components. Similarly, any plural reference to a
component used herein includes reference to one and only one, one
or more, or at least one of such components, unless otherwise
noted. Moreover, as used herein, bile acid/salt mimics or mimetics
described herein are compounds that mimic the agonist signaling
properties of the bile acid/salt, especially at TGR5 (GPBAR1, BG37,
Axor109) receptors. Examples includes those described in WO
2010/014836, which is incorporated herein for such disclosure. In
some embodiments, bile acid mimetics include triterpenoid, such as
oleanoic acid, ursolic acid, or the like.
[0378] The term "subject", "patient" or "individual" are used
interchangeably herein and refer to mammals and non-mammals, e.g.,
suffering from a disorder described herein. Examples of mammals
include, but are not limited to, any member of the mammalian class:
humans, non-human primates such as chimpanzees, and other apes and
monkey species; farm animals such as cattle, horses, sheep, goats,
swine; domestic animals such as rabbits, dogs, and cats; laboratory
animals including rodents, such as rats, mice and guinea pigs, and
the like. Examples of non-mammals include, but are not limited to,
birds, fish and the like. In one embodiment of the methods and
compositions provided herein, the mammal is a human.
[0379] The term "colon," as used herein, includes the cecum,
ascending colon, hepatic flexure, splenic flexure, descending
colon, and sigmoid.
[0380] The term "composition," as used herein includes the
disclosure of both a composition and a composition administered in
a method as described herein. Furthermore, in some embodiments, the
composition of the present invention is or comprises a
"formulation," an oral dosage form or a rectal dosage form as
described herein.
[0381] The terms "treat," "treating" or "treatment," and other
grammatical equivalents as used herein, include alleviating,
inhibiting or reducing symptoms, reducing or inhibiting severity
of, reducing incidence of, prophylactic treatment of, reducing or
inhibiting recurrence of, preventing, delaying onset of, delaying
recurrence of, abating or ameliorating a disease or condition
symptoms, ameliorating the underlying metabolic causes of symptoms,
inhibiting the disease or condition, e.g., arresting the
development of the disease or condition, relieving the disease or
condition, causing regression of the disease or condition,
relieving a condition caused by the disease or condition, or
stopping the symptoms of the disease or condition. The terms
further include achieving a therapeutic benefit. By therapeutic
benefit is meant eradication or amelioration of the underlying
disorder being treated, and/or the eradication or amelioration of
one or more of the physiological symptoms associated with the
underlying disorder such that an improvement is observed in the
patient.
[0382] The terms "prevent," "preventing" or "prevention," and other
grammatical equivalents as used herein, include preventing
additional symptoms, preventing the underlying metabolic causes of
symptoms, inhibiting the disease or condition, e.g., arresting the
development of the disease or condition and are intended to include
prophylaxis. The terms further include achieving a prophylactic
benefit. For prophylactic benefit, the compositions are optionally
administered to a patient at risk of developing a particular
disease, to a patient reporting one or more of the physiological
symptoms of a disease, or to a patient at risk of reoccurrence of
the disease.
[0383] Where combination treatments or prevention methods are
contemplated, it is not intended that the agents described herein
be limited by the particular nature of the combination. For
example, the agents described herein are optionally administered in
combination as simple mixtures as well as chemical hybrids. An
example of the latter is where the agent is covalently linked to a
targeting carrier or to an active pharmaceutical. Covalent binding
can be accomplished in many ways, such as, though not limited to,
the use of a commercially available cross-linking agent.
Furthermore, combination treatments are optionally administered
separately or concomitantly.
[0384] As used herein, the terms "pharmaceutical combination",
"administering an additional therapy", "administering an additional
therapeutic agent" and the like refer to a pharmaceutical therapy
resulting from the mixing or combining of more than one active
ingredient and includes both fixed and non-fixed combinations of
the active ingredients. The term "fixed combination" means that at
least one of the agents described herein, and at least one
co-agent, are both administered to a patient simultaneously in the
form of a single entity or dosage. The term "non-fixed combination"
means that at least one of the agents described herein, and at
least one co-agent, are administered to a patient as separate
entities either simultaneously, concurrently or sequentially with
variable intervening time limits, wherein such administration
provides effective levels of the two or more agents in the body of
the patient. In some instances, the co-agent is administered once
or for a period of time, after which the agent is administered once
or over a period of time. In other instances, the co-agent is
administered for a period of time, after which, a therapy involving
the administration of both the co-agent and the agent are
administered. In still other embodiments, the agent is administered
once or over a period of time, after which, the co-agent is
administered once or over a period of time. These also apply to
cocktail therapies, e.g. the administration of three or more active
ingredients.
[0385] As used herein, the terms "co-administration", "administered
in combination with" and their grammatical equivalents are meant to
encompass administration of the selected therapeutic agents to a
single patient, and are intended to include treatment regimens in
which the agents are administered by the same or different route of
administration or at the same or different times. In some
embodiments the agents described herein will be co-administered
with other agents. These terms encompass administration of two or
more agents to an animal so that both agents and/or their
metabolites are present in the animal at the same time. They
include simultaneous administration in separate compositions,
administration at different times in separate compositions, and/or
administration in a composition in which both agents are present.
Thus, in some embodiments, the agents described herein and the
other agent(s) are administered in a single composition. In some
embodiments, the agents described herein and the other agent(s) are
admixed in the composition.
[0386] The terms "effective amount" or "therapeutically effective
amount" as used herein, refer to a sufficient amount of at least
one agent being administered which achieve a desired result, e.g.,
to relieve to some extent one or more symptoms of a disease or
condition being treated. In certain instances, the result is a
reduction and/or alleviation of the signs, symptoms, or causes of a
disease, or any other desired alteration of a biological system. In
certain instances, an "effective amount" for therapeutic uses is
the amount of the composition comprising an agent as set forth
herein required to provide a clinically significant decrease in a
disease. An appropriate "effective" amount in any individual case
is determined using any suitable technique, such as a dose
escalation study.
[0387] The terms "administer," "administering", "administration,"
and the like, as used herein, refer to the methods that may be used
to enable delivery of agents or compositions to the desired site of
biological action. These methods include, but are not limited to
oral routes, intraduodenal routes, parenteral injection (including
intravenous, subcutaneous, intraperitoneal, intramuscular,
intravascular or infusion), topical and rectal administration.
Administration techniques that are optionally employed with the
agents and methods described herein are found in sources e.g.,
Goodman and Gilman, The Pharmacological Basis of Therapeutics,
current ed.; Pergamon; and Remington's, Pharmaceutical Sciences
(current edition), Mack Publishing Co., Easton, Pa. In certain
embodiments, the agents and compositions described herein are
administered orally.
[0388] The term "pharmaceutically acceptable" as used herein,
refers to a material that does not abrogate the biological activity
or properties of the agents described herein, and is relatively
nontoxic (i.e., the toxicity of the material significantly
outweighs the benefit of the material). In some instances, a
pharmaceutically acceptable material may be administered to an
individual without causing significant undesirable biological
effects or significantly interacting in a deleterious manner with
any of the components of the composition in which it is
contained.
[0389] The term "carrier" as used herein, refers to relatively
nontoxic chemical agents that, in certain instances, facilitate the
incorporation of an agent into cells or tissues.
[0390] The term "non-systemic" or "minimally absorbed" as used
herein refers to low systemic bioavailability and/or absorption of
an administered compound. In some instances a non-systemic compound
is a compound that is substantially not absorbed systemically. In
some embodiments, ASBTI compositions described herein deliver the
ASBTI to the distal ileum, colon, and/or rectum and not
systemically (e.g., a substantial portion of the ASBTI is not
systemically absorbed. In some embodiments, the systemic absorption
of a non-systemic compound is <0.1%, <0.3%, <0.5%,
<0.6%, <0.7%, <0.8%, <0.9%, <1%, <1.5%, <2%,
<3%, or <5% of the administered dose (wt. % or mol %). In
some embodiments, the systemic absorption of a non-systemic
compound is <15% of the administered dose. In some embodiments,
the systemic absorption of a non-systemic compound is <25% of
the administered dose. In an alternative approach, a non-systemic
ASBTI is a compound that has lower systemic bioavailability
relative to the systemic bioavailability of a systemic ASBTI (e.g.,
compound 100A, 100C). In some embodiments, the bioavailability of a
non-systemic ASBTI described herein is <30%, <40%, <50%,
<60%, or <70% of the bioavailability of a systemic ASBTI
(e.g., compound 100A, 100C).
[0391] In another alternative approach, the compositions described
herein are formulated to deliver <10% of the administered dose
of the ASBTI systemically. In some embodiments, the compositions
described herein are formulated to deliver <20% of the
administered dose of the ASBTI systemically. In some embodiments,
the compositions described herein are formulated to deliver <30%
of the administered dose of the ASBTI systemically. In some
embodiments, the compositions described herein are formulated to
deliver <40% of the administered dose of the ASBTI systemically.
In some embodiments, the compositions described herein are
formulated to deliver <50% of the administered dose of the ASBTI
systemically. In some embodiments, the compositions described
herein are formulated to deliver <60% of the administered dose
of the ASBTI systemically. In some embodiments, the compositions
described herein are formulated to deliver <70% of the
administered dose of the ASBTI systemically. In some embodiments,
systemic absorption is determined in any suitable manner, including
the total circulating amount, the amount cleared after
administration, or the like.
[0392] The term "ASBT inhibitor" refers to a compound that inhibits
apical sodium-dependent bile transport or any recuperative bile
salt transport. The term Apical Sodium-dependent Bile Transporter
(ASBT) is used interchangeably with the term Ileal Bile Acid
Transporter (IBAT).
[0393] The term "reducing food intake" refers to consumption of a
lower amount of food by an individual undergoing therapy with any
ASBTI described herein compared to the amount of food consumed in
the absence of ASBTI therapy.
[0394] The term "induction of satiety" or "inducing satiety" or
"satiety" refers to a feeling of fullness and/or a reduction of the
sensation of hunger.
[0395] The term "metabolic disorder" refers to any disorder that
involves an alteration in the normal metabolism of carbohydrates,
lipids, proteins, nucleic acids or a combination thereof. A
metabolic disorder is associated with either a deficiency or excess
in a metabolic pathway resulting in an imbalance in metabolism of
nucleic acids, proteins, lipids, and/or carbohydrates. Factors
affecting metabolism include, and are not limited to, the endocrine
(hormonal) control system (e.g., the insulin pathway, the
enteroendocrine hormones including GLP-1, GLP-2, oxyntomodulin, PYY
or the like), the neural control system (e.g., GLP-1 in the brain)
or the like. Examples of metabolic disorders include and are not
limited to diabetes, insulin resistance, dyslipidemia, metabolic
syndrome, or the like.
[0396] The term "enhancing enteroendocrine peptide secretion"
refers to a sufficient increase in the level of the enteroendocrine
peptide agent to, for example, decrease hunger in a subject, to
curb appetite in a subject and/or decrease the food intake of a
subject or individual and/or treat any disease or disorder
described herein. In some embodiments, enhanced enteroendocrine
peptide secretion reverses or alleviates symptoms of congestive
heart failure, ventricular dysfunction, toxic hypervolemia,
polycystic ovary syndrome, inflammatory bowel disease, impaired
bowel integrity, short bowel syndrome, gastritis, peptic ulcer, or
irritable bowel syndrome.
[0397] In various embodiments, pharmaceutically acceptable salts
described herein include, by way of non-limiting example, a
nitrate, chloride, bromide, phosphate, sulfate, acetate,
hexafluorophosphate, citrate, gluconate, benzoate, propionate,
butyrate, sulfosalicylate, maleate, laurate, malate, fumarate,
succinate, tartrate, amsonate, pamoate, p-toluenenesulfonate,
mesylate and the like. Furthermore, pharmaceutically acceptable
salts include, by way of non-limiting example, alkaline earth metal
salts (e.g., calcium or magnesium), alkali metal salts (e.g.,
sodium-dependent or potassium), ammonium salts and the like.
[0398] The term "optionally substituted" or "substituted" means
that the referenced group substituted with one or more additional
group(s). In certain embodiments, the one or more additional
group(s) are individually and independently selected from amide,
ester, alkyl, cycloalkyl, heteroalkyl, aryl, heteroaryl,
heteroalicyclic, hydroxy, alkoxy, aryloxy, alkylthio, arylthio,
alkylsulfoxide, arylsulfoxide, ester, alkylsulfone, arylsulfone,
cyano, halo, alkoyl, alkoyloxo, isocyanato, thiocyanato,
isothiocyanato, nitro, haloalkyl, haloalkoxy, fluoroalkyl, amino,
alkyl-amino, dialkyl-amino, amido.
[0399] An "alkyl" group refers to an aliphatic hydrocarbon group.
Reference to an alkyl group includes "saturated alkyl" and/or
"unsaturated alkyl". The alkyl group, whether saturated or
unsaturated, includes branched, straight chain, or cyclic groups.
By way of example only, alkyl includes methyl, ethyl, propyl,
iso-propyl, n-butyl, iso-butyl, sec-butyl, t-butyl, pentyl,
iso-pentyl, neo-pentyl, and hexyl. In some embodiments, alkyl
groups include, but are in no way limited to, methyl, ethyl,
propyl, isopropyl, butyl, isobutyl, tertiary butyl, pentyl, hexyl,
ethenyl, propenyl, butenyl, cyclopropyl, cyclobutyl, cyclopentyl,
cyclohexyl, and the like. A "lower alkyl" is a
C.sub.1-C.sub.6alkyl. A "heteroalkyl" group substitutes any one of
the carbons of the alkyl group with a heteroatom having the
appropriate number of hydrogen atoms attached (e.g., a CH.sub.2
group to an NH group or an O group).
[0400] An "alkoxy" group refers to a (alkyl)O-- group, where alkyl
is as defined herein.
[0401] The term "alkylamine" refers to the --N(alkyl).sub.xH.sub.y
group, wherein alkyl is as defined herein and x and y are selected
from the group x=1, y=1 and x=2, y=0. When x=2, the alkyl groups,
taken together with the nitrogen to which they are attached,
optionally form a cyclic ring system.
[0402] An "amide" is a chemical moiety with formula --C(O)NHR or
--NHC(O)R, where R is selected from alkyl, cycloalkyl, aryl,
heteroaryl (bonded through a ring carbon) and heteroalicyclic
(bonded through a ring carbon).
[0403] The term "ester" refers to a chemical moiety with formula
--C(.dbd.O)OR, where R is selected from the group consisting of
alkyl, cycloalkyl, aryl, heteroaryl and heteroalicyclic.
[0404] As used herein, the term "aryl" refers to an aromatic ring
wherein each of the atoms forming the ring is a carbon atom. Aryl
rings described herein include rings having five, six, seven,
eight, nine, or more than nine carbon atoms. Aryl groups are
optionally substituted. Examples of aryl groups include, but are
not limited to phenyl, and naphthalenyl.
[0405] The term "cycloalkyl" refers to a monocyclic or polycyclic
non-aromatic radical, wherein each of the atoms forming the ring
(i.e. skeletal atoms) is a carbon atom. In various embodiments,
cycloalkyls are saturated, or partially unsaturated. In some
embodiments, cycloalkyls are fused with an aromatic ring.
Cycloalkyl groups include groups having from 3 to 10 ring atoms.
Illustrative examples of cycloalkyl groups include, but are not
limited to, the following moieties:
##STR00051##
and the like. Monocyclic cycloalkyls include, but are not limited
to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl,
and cyclooctyl.
[0406] The term "heterocyclo" refers to heteroaromatic and
heteroalicyclic groups containing one to four ring heteroatoms each
selected from O, S and N. In certain instances, each heterocyclic
group has from 4 to atoms in its ring system, and with the proviso
that the ring of said group does not contain two adjacent O or S
atoms. Non-aromatic heterocyclic groups include groups having 3
atoms in their ring system, but aromatic heterocyclic groups must
have at least 5 atoms in their ring system. The heterocyclic groups
include benzo-fused ring systems. An example of a 3-membered
heterocyclic group is aziridinyl (derived from aziridine). An
example of a 4-membered heterocyclic group is azetidinyl (derived
from azetidine). An example of a 5-membered heterocyclic group is
thiazolyl. An example of a 6-membered heterocyclic group is
pyridyl, and an example of a 10-membered heterocyclic group is
quinolinyl. Examples of non-aromatic heterocyclic groups are
pyrrolidinyl, tetrahydrofuranyl, dihydrofuranyl, tetrahydrothienyl,
tetrahydropyranyl, dihydropyranyl, tetrahydrothiopyranyl,
piperidino, morpholino, thiomorpholino, thioxanyl, piperazinyl,
aziridinyl, azetidinyl, oxetanyl, thietanyl, homopiperidinyl,
oxepanyl, thiepanyl, oxazepinyl, diazepinyl, thiazepinyl,
1,2,3,6-tetrahydropyridinyl, 2-pyrrolinyl, 3-pyrrolinyl, indolinyl,
2H-pyranyl, 4H-pyranyl, dioxanyl, 1,3-dioxolanyl, pyrazolinyl,
dithianyl, dithiolanyl, dihydropyranyl, dihydrothienyl,
dihydrofuranyl, pyrazolidinyl, imidazolinyl, imidazolidinyl,
3-azabicyclo[3.1.0]hexanyl, 3-azabicyclo[4.1.0]heptanyl, 3H-indolyl
and quinolizinyl. Examples of aromatic heterocyclic groups are
pyridinyl, imidazolyl, pyrimidinyl, pyrazolyl, triazolyl,
pyrazinyl, tetrazolyl, furyl, thienyl, isoxazolyl, thiazolyl,
oxazolyl, isothiazolyl, pyrrolyl, quinolinyl, isoquinolinyl,
indolyl, benzimidazolyl, benzofuranyl, cinnolinyl, indazolyl,
indolizinyl, phthalazinyl, pyridazinyl, triazinyl, isoindolyl,
pteridinyl, purinyl, oxadiazolyl, thiadiazolyl, furazanyl,
benzofurazanyl, benzothiophenyl, benzothiazolyl, benzoxazolyl,
quinazolinyl, quinoxalinyl, naphthyridinyl, and furopyridinyl.
[0407] The terms "heteroaryl" or, alternatively, "heteroaromatic"
refers to an aryl group that includes one or more ring heteroatoms
selected from nitrogen, oxygen and sulfur. An N-containing
"heteroaromatic" or "heteroaryl" moiety refers to an aromatic group
in which at least one of the skeletal atoms of the ring is a
nitrogen atom. In certain embodiments, heteroaryl groups are
monocyclic or polycyclic. Illustrative examples of heteroaryl
groups include the following moieties:
##STR00052##
and the like.
[0408] A "heteroalicyclic" group or "heterocyclo" group refers to a
cycloalkyl group, wherein at least one skeletal ring atom is a
heteroatom selected from nitrogen, oxygen and sulfur. In various
embodiments, the radicals are with an aryl or heteroaryl.
Illustrative examples of heterocyclo groups, also referred to as
non-aromatic heterocycles, include:
##STR00053##
and the like. The term heteroalicyclic also includes all ring forms
of the carbohydrates, including but not limited to the
monosaccharides, the disaccharides and the oligosaccharides.
[0409] The term "halo" or, alternatively, "halogen" means fluoro,
chloro, bromo and iodo.
[0410] The terms "haloalkyl," and "haloalkoxy" include alkyl and
alkoxy structures that are substituted with one or more halogens.
In embodiments, where more than one halogen is included in the
group, the halogens are the same or they are different. The terms
"fluoroalkyl" and "fluoroalkoxy" include haloalkyl and haloalkoxy
groups, respectively, in which the halo is fluorine.
[0411] The term "heteroalkyl" include optionally substituted alkyl,
alkenyl and alkynyl radicals which have one or more skeletal chain
atoms selected from an atom other than carbon, e.g., oxygen,
nitrogen, sulfur, phosphorus, silicon, or combinations thereof. In
certain embodiments, the heteroatom(s) is placed at any interior
position of the heteroalkyl group. Examples include, but are not
limited to, --CH.sub.2--O--CH.sub.3,
--CH.sub.2--CH.sub.2--O--CH.sub.3, --CH.sub.2--NH--CH.sub.3,
--CH.sub.2--CH.sub.2--NH--CH.sub.3,
--CH.sub.2--N(CH.sub.3)--CH.sub.3,
--CH.sub.2--CH.sub.2--NH--CH.sub.3,
--CH.sub.2--CH.sub.2--N(CH.sub.3)--CH.sub.3,
--CH.sub.2--S--CH.sub.2--CH.sub.3, --CH.sub.2--CH.sub.2,
--S(O)--CH.sub.3, --CH.sub.2--CH.sub.2--S(O).sub.2--CH.sub.3,
--CH.dbd.CH--O--CH.sub.3, --Si(CH.sub.3).sub.3,
--CH.sub.2--CH.dbd.N--OCH.sub.3, and
--CH.dbd.CH--N(CH.sub.3)--CH.sub.3. In some embodiments, up to two
heteroatoms are consecutive, such as, by way of example,
--CH.sub.2--NH--OCH.sub.3 and
--CH.sub.2--O--Si(CH.sub.3).sub.3.
[0412] A "cyano" group refers to a --CN group.
[0413] An "isocyanato" group refers to a --NCO group.
[0414] A "thiocyanato" group refers to a --CNS group.
[0415] An "isothiocyanato" group refers to a --NCS group.
[0416] "Alkoyloxy" refers to a RC(.dbd.O)O-- group.
[0417] "Alkoyl" refers to a RC(.dbd.O)-- group.
[0418] The term "modulate," as used herein refers to having some
affect on (e.g., increasing, enhancing or maintaining a certain
level).
[0419] The term "optionally substituted" or "substituted" means
that the referenced group may be substituted with one or more
additional group(s) individually and independently selected from
C.sub.1-C.sub.6alkyl, C.sub.3-C.sub.8cycloalkyl, aryl, heteroaryl,
C.sub.2-C.sub.6 heteroalicyclic, hydroxy, C.sub.1-C.sub.6alkoxy,
aryloxy, C.sub.1-C.sub.6alkylthio, arylthio,
C.sub.1-C.sub.6alkylsulfoxide, arylsulfoxide,
C.sub.1-C.sub.6alkylsulfone, arylsulfone, cyano, halo,
C.sub.2-C.sub.8acyl, C.sub.2-C.sub.8acyloxy, nitro, C.sub.1-C.sub.6
haloalkyl, C.sub.1-C.sub.6 fluoroalkyl, and amino, including
C.sub.1-C.sub.6alkylamino, and the protected derivatives thereof.
By way of example, an optional substituents may be L.sup.sR.sup.s,
wherein each L.sup.s is independently selected from a bond, --O--,
--C(.dbd.O)--, --S--, --S(.dbd.O)--, --S(.dbd.O).sub.2--, --NH--,
--NHC(.dbd.O)--, --C(.dbd.O)NH--, S(.dbd.O).sub.2NH--,
--NHS(.dbd.O).sub.2--, --OC(.dbd.O)NH--, --NHC(.dbd.O)O--,
--(C.sub.1-C.sub.6alkyl)-, or --(C.sub.2-C.sub.6alkenyl)-; and each
R.sup.s is independently selected from H, (C.sub.1-C.sub.4alkyl),
(C.sub.3-C.sub.8cycloalkyl), heteroaryl, aryl, and
C.sub.1-C.sub.6heteroalkyl. Optionally substituted non-aromatic
groups may be substituted with one or more oxo (.dbd.O). The
protecting groups that may form the protective derivatives of the
above substituents are known to those of skill in the art and may
be found in references such as Greene and Wuts, above. In some
embodiments, alkyl groups described herein are optionally
substituted with an O that is connected to two adjacent carbon
atoms (i.e., forming an epoxide).
[0420] The term "therapeutically effective amount" or an "effective
amount" as used herein, refers to a sufficient amount of a
therapeutically active agent to provide a desired effect in a
subject or individual. In some embodiments, a "therapeutically
effective amount" or an "effective amount" of an enteroendocrine
peptide secretion enhancing agent refers to a sufficient amount of
the enteroendocrine peptide secretion enhancing agent to a treat a
metabolic disorder in a subject or individual. In some embodiments,
a "therapeutically effective amount" or an "effective amount" of an
enteroendocrine peptide secretion enhancing agent refers to a
sufficient amount of the enteroendocrine peptide secretion
enhancing agent to increase the secretion of enteroendocrine
peptide(s) in a subject or individual. In specific embodiments, the
"therapeutically effective amount" is an amount that when delivered
to the colon or rectum it produces an anorectal response (e.g., it
increase the secretion of enteroendocrine peptide(s) in the rectum
and/or colon, particularly in the L-cells, of an individual). In
some embodiments, a "therapeutically effective amount" or an
"effective amount" of an enteroendocrine peptide secretion
enhancing agent refers to a sufficient amount of the
enteroendocrine peptide secretion enhancing agent to decrease
hunger in a subject, to curb appetite in a subject and/or decrease
the food intake of a subject or individual.
L-Cells
[0421] L-cells are scattered throughout the epithelial layer of the
gut from the duodenum to the rectum, with the highest numbers
occurring in the ileum, colon, and rectum. They are characterized
by an open-cell morphology, with apical microvilli facing into the
gut lumen and secretory vesicles located adjacent to the
basolateral membrane, and are therefore in direct contact with
nutrients in the intestinal lumen. Furthermore, L-cells are located
in close proximity to both neurons and the microvasculature of the
intestine, thereby allowing the L-cell to be affected by both
neural and hormonal signals. As well as Glucagon-Like Peptide 1
(GLP-1) and Glucagon-Like Peptide 2 (GLP-2), L-cells also secrete
the anorexigenic hormone, peptide YY (PYY), and glutamate. The
cells are just one member of a much larger family of
enteroendocrine cells that secrete a range of hormones, including
ghrelin, GIP, cholecystokinin, somatostatin, and secretin, which
are involved in the local coordination of gut physiology, as well
as in playing wider roles in the control of insulin release and
appetite. L-cells are unevenly distributed in the gastrointestinal
tract, within higher concentrations in the distal portion of the
gastrointestinal tract (e.g., in the distal ileum, colon and
rectum).
Proglucagon Products
[0422] The proglucagon gene product is expressed in the L-cells of
the small intestine, in O-cells of the pancreas and in the central
nervous system. Tissue-specific expression of isoforms of the
enzyme prohormone convertase directs posttranslational synthesis of
specific proglucagon-derived peptides in the L-cell and
.alpha.-cell. Specifically, cleavage of proglucagon by prohormone
convertase 1/3, which is expressed in the L-cell, forms GLP-1 and
GLP-2, as well as the glucagon-containing peptides, glicentin and
oxyntomodulin. In contrast, .alpha.-cell expression of prohormone
convertase 2 forms glucagon, glicentin-related pancreatic peptide,
and the major proglucagon fragment, which contains within its
sequence both the GLP-1 and GLP-2 sequences.
[0423] Glucagon-like peptide 1 (GLP-1) is an intestinal hormone
that effects in the regulation of glycemia, stimulating
glucose-dependent insulin secretion, proinsulin gene expression,
and .beta.-cell proliferative and anti-apoptotic pathways, as well
as inhibiting glucagon release, gastric emptying, and food intake.
The anorexigenic effect of GLP-1 is mediated by GLP-1 receptors
which are present in both the NTS and hypothalamus, and in the
pancreas, lung, brain, kidney, gastrointestinal tract and heart.
Reduced secretion of GLP-1 contributes to the pathogenesis of
obesity and enhanced/or normal secretion restores satiety.
[0424] The primary physiological stimulus of GLP-1 secretion from
L-cells is ingestion of carbohydrates, luminal glucose (not
systemic glucose) fat, and protein. Protein hydrolysate are also
potent triggers of GLP-1 release, and certain amino acids such as,
but not limited to, alanine, serine, glutamine, asparagine, and
glycine stimulate GLP-1 release. Within the fat group, the
long-chain unsaturated fatty acid and short-chain fatty acid
subgroups are potent triggers of GLP-1 release, while the
short-chain fatty acids also stimulate peptide YY release. In
addition to luminal nutrients, intestinal peptides,
neurotransmitters, as well as systemic hormones, modulate GLP-1
secretion. Such intestinal peptides include, but are not limited
to, somatostatin (forms SS14 and SS28), and such neurotransmitters
include, but are not limited to, acetylcholine and
.quadrature.-aminobutyric acid (GABA) (both of which enhance GLP-1
release), and .quadrature.- and .quadrature.-adrenergic agonists,
(which respectively inhibit and/or stimulate GLP-1 secretion from
L-cells). Peripheral hormones that participate in energy
homeostasis, such as the adipocyte hormone leptin, also stimulate
GLP-1 release. Other GLP-1 secretegoues include bile acids/salts,
insulin, gastrin-releasing peptide (GRP), several gut peptides
including, but not limited to, Gastric Inhibitory Polypeptide (GIP)
and calcitonin gene-related protein (CGRP). CGRP is a peptide found
throughout the enteric nervous system. Thus, GLP-1 secretagogues
include, but are not limited to, nutrients, neurotransmitters,
neuropeptides, intestinal peptide, peripheral hormones, and bile
acis/salts.
[0425] Within about 15 minutes of food ingestion the circulating
GLP-1 levels increase and remain elevated for up to 3 hours,
depending on the composition of the meal. Circulating GLP-1 exists
in two equipotent forms, GLP-1.sup.7-36NH2 and GLP-1.sup.7-37, with
GLP-1.sup.7-36NH2 being the predominant form. Secreted GLP-1 is
rapidly degraded by the ubiquitous enzyme dipeptidyl peptidase-4
(DPP-4), resulting in an extremely short half-life for GLP-1 of
about 30 seconds to about 2 minutes. Therefore, levels of
circulating GLP-1 are maintained by inhibiting DPP-4 activity, or
alternatively, by enhancing GLP-1 secretion.
[0426] In some embodiments, provided herein is a method of
increasing circulating GLP (e.g., GLP-1) levels by administering to
the distal gastrointestinal tract (e.g., distal ileum, colon and/or
rectum) an effective amount of an enteroendocrine peptide secretion
enhancing agent (e.g., a bile acid). In certain embodiments, the
method is included in a method of treating a metabolic disorder. In
some embodiments, the method is included in a method of treating
obesity or diabetes. FIG. 19 illustrates the increase of
circulating GLP-1 levels following rectal administration of an
enteroendocrine peptide secretion enhancing agent (e.g., a bile
acid). FIG. 19 illustrates the increase of circulating GLP-1 levels
following rectal administration of taurocholic acid.
Pancreatic Polypeptide (PP)-Fold Peptides
[0427] The Pancreatic Polypeptide (PP)-fold peptides include
Peptide YY (PYY), Pancreatic Polypeptide (PP) and Neuropeptide Y
(NPY), which all share sequence homology and contain several
tyrosine residues. They have a common tertiary structure which
consists of an .quadrature.-helix and polyproline helix, connected
by a .beta.-turn, resulting in a characteristic U-shaped peptide,
the PP-fold.
[0428] Neuropeptide Y (NPY) is one of the most abundant
neurotransmitters in the brain. Hypothalamic levels of NPY reflect
the body's nutritional status, wherein the levels of hypothalamic
NPY mRNA and NPY release increase with fasting and decrease after
feeding.
[0429] Pancreatic Polypeptide (PP) is produced by cells at the
periphery of the islets of the endocrine pancreas, and to a lesser
extent in the exocrine pancreas, colon and rectum. The release of
PP is biphasic and occurs in proportion to the number of calories
ingested, with the levels remaining elevated for up to 6 hours
post-prandially. The circulating levels of PP are increased by
gastric distension, ghrelin, motilin and secretin and reduced by
somatostatin. In addition, circulating PP exhibits a diurnal
rhythm, with levels low in the early hours of the morning and
highest in the evening. The levels of PP have been found to reflect
long-term energy stores, with lower levels and reduced second phase
of release in obese subjects, and higher levels in anorexic
subjects. Circulating PP is unable to cross the blood-brain
barrier, but exerts its anorectic effect by sending anorectic
signals via brainstem pathways, hypothalamic neuropeptides and by
modulating expression of other gut hormones such as ghrelin.
[0430] Peptide YY (PYY) is secreted predominantly from the distal
gastrointestinal tract, particularly the ileum, colon and rectum.
FIG. 18 illustrates the concentration of PYY at various locations
in the gastrointestinal tract. The L-cells of the intestine release
PYY in proportion to the amount of calories ingested, and occurs
before the nutrients reach the cells in the distal tract. Thus,
release may be mediated via a neural reflex as well as direct
contact with nutrients. Post-prandially, the circulating PYY levels
rise rapidly to a plateau after 1-2 hours and remain elevated for
up to 6 hours. The levels of PYY are also influenced by meal
composition, with higher levels obtained following fat intake
relative to carbohydrate or protein intake. Other signals, such as
gastric acid, CCK and luminal bile salts, insulin-like growth
factor 1, bombesin and calcitonin-gene-related peptide increase PYY
levels, whereas gastric distension has no effect, and levels are
reduced by GLP-1. The N-terminal of circulating PYY allows it to
cross the blood-brain barrier.
[0431] In some embodiments, provided herein is a method of
increasing circulating PYY levels by administering to the distal
gastrointestinal tract (e.g., distal ileum, colon and/or rectum) an
effective amount of an enteroendocrine peptide secretion enhancing
agent (e.g., a bile acid). In certain embodiments, the method is
included in a method of treating a metabolic disorder. In some
embodiments, the method is included in a method of treating obesity
or diabetes. FIG. 20 illustrates the increase of circulating PYY
levels following rectal administration of an enteroendocrine
peptide secretion enhancing agent (e.g., a bile acid).
Enteroendocrine Peptide Secretion Enhanced Treatment
[0432] Intravenous administration of GLP-1 decreases food intake in
both lean and obese individuals in a dose-dependent manner,
although the effect is small when infusions achieve post-prandial
circulating levels. In addition, obese subjects given subcutaneous
GLP-1 prior to each meal, reduce their caloric intake. Thus,
modulation/control of GLP-1 secretion restore satiety and controls
appetite and food intake. Similarly, infusion of PP decreases
appetite and food intake. Obese humans have a relatively low level
of circulating PYY and a relative deficiency of post-prandial
secretion of PYY. Administration of PYY causes a delay in gastric
emptying, a delay in secretions from the pancreas and stomach, and
increases the absorption of fluids and electrolytes from the ileum
after a meal. In addition, intravenous administration of PYY
decreases appetite, inhibits food intake and reduces weight
gain.
[0433] Appetite, weight gain and food intake are controlled by the
circulating or systemic levels of GLP-1, PYY and PP. The methods
and composition described herein use, by way of non-limiting
example, the administration of bile acids/salts and bile
acids/salts mimics to modulate (e.g., increase) the circulating
levels of GLP-1, PYY and PP. In certain embodiments of the present
invention, such administration decreases food intake and weight
gain while suppressing appetite.
Bile Acid
[0434] Bile contains water, electrolytes and a numerous organic
molecules including bile acids, cholesterol, phospholipids and
bilirubin. Bile is secreted from the liver and stored in the gall
bladder, and upon gall bladder contraction, due to ingestion of a
fatty meal, bile passes through the bile duct into the intestine.
Bile acids are critical for digestion and absorption of fats and
fat-soluble vitamins in the small intestine. Adult humans produce
400 to 800 mL of bile daily. The secretion of bile can be
considered to occur in two stages. Initially, hepatocytes secrete
bile into canaliculi, from which it flows into bile ducts and this
hepatic bile contains large quantities of bile acids, cholesterol
and other organic molecules. Then, as bile flows through the bile
ducts, it is modified by addition of a watery, bicarbonate-rich
secretion from ductal epithelial cells. Bile is concentrated,
typically five-fold, during storage in the gall bladder.
[0435] The flow of bile is lowest during fasting, and a majority of
that is diverted into the gallbladder for concentration. When chyme
from an ingested meal enters the small intestine, acid and
partially digested fats and proteins stimulate secretion of
cholecystokinin and secretin, both of which are important for
secretion and flow of bile. Cholecystokinin (cholecysto=gallbladder
and kinin=movement) is a hormone which stimulates contractions of
the gallbladder and common bile duct, resulting in delivery of bile
into the gut. The most potent stimulus for release of
cholecystokinin is the presence of fat in the duodenum. Secretin is
a hormone secreted in response to acid in the duodenum, and it
simulates biliary duct cells to secrete bicarbonate and water,
which expands the volume of bile and increases its flow out into
the intestine.
[0436] Bile acids are derivatives of cholesterol. Cholesterol,
ingested as part of the diet or derived from hepatic synthesis, are
converted into bile acids in the hepatocyte. Examples of such bile
acids include cholic and chenodeoxycholic acids, which are then
conjugated to an amino acid (such as glycine or taurine) to yield
the conjugated form that is actively secreted into cannaliculi. The
most abundant of the bile salts in humans are cholate and
deoxycholate, and they are normally conjugated with either glycine
or taurine to give glycocholate or taurocholate respectively.
[0437] Free cholesterol is virtually insoluble in aqueous
solutions, however in bile it is made soluble by the presence of
bile acids and lipids. Hepatic synthesis of bile acids accounts for
the majority of cholesterol breakdown in the body. In humans,
roughly 500 mg of cholesterol are converted to bile acids and
eliminated in bile every day. Therefore, secretion into bile is a
major route for elimination of cholesterol. Large amounts of bile
acids are secreted into the intestine every day, but only
relatively small quantities are lost from the body. This is because
approximately 95% of the bile acids delivered to the duodenum are
absorbed back into blood within the ileum, by a process is known as
"Enterohepatic Recirculation".
[0438] Venous blood from the ileum goes straight into the portal
vein, and hence through the sinusoids of the liver. Hepatocytes
extract bile acids very efficiently from sinusoidal blood, and
little escapes the healthy liver into systemic circulation. Bile
acids are then transported across the hepatocytes to be resecreted
into canaliculi. The net effect of this eriterohepatic
recirculation is that each bile salt molecule is reused about 20
times, often two or three times during a single digestive phase.
Bile biosynthesis represents the major metabolic fate of
cholesterol, accounting for more than half of the approximate 800
mg/day of cholesterol that an average adult uses up in metabolic
processes. In comparison, steroid hormone biosynthesis consumes
only about 50 mg of cholesterol per day. Much more that 400 mg of
bile salts is required and secreted into the intestine per day, and
this is achieved by re-cycling the bile salts. Most of the bile
salts secreted into the upper region of the small intestine are
absorbed along with the dietary lipids that they emulsified at the
lower end of the small intestine. They are separated from the
dietary lipid and returned to the liver for re-use. Re-cycling thus
enables 20-30 g of bile salts to be secreted into the small
intestine each day.
[0439] Bile acids are amphipathic, with the cholesterol-derived
portion containing both hydrophobic (lipid soluble) and polar
(hydrophilic) moieties while the amino acid conjugate is generally
polar and hydrophilic. This amphipathic nature enables bile acids
to carry out two important functions: emulsification of lipid
aggregates and solubilization and transport of lipids in an aqueous
environment. Bile acids have detergent action on particles of
dietary fat which causes fat globules to break down or to be
emulsified. Emulsification is important since it greatly increases
the surface area of fat available for digestion by lipases which
cannot access the inside of lipid droplets. Furthermore, bile acids
are lipid carriers and are able to solubilize many lipids by
forming micelles and are critical for transport and absorption of
the fat-soluble vitamins.
Pharmaceutical Compositions and Methods of Use
[0440] In some embodiments, compositions described herein are
administered for delivery of enteroendocrine peptide secretion
enhancing agents to a subject or individual. In certain
embodiments, any compositions described herein are formulated for
ileal, rectal and/or colonic delivery. In more specific
embodiments, the composition is formulated for non-systemic or
local delivery to the rectum and/or colon. It is to be understood
that as used herein, delivery to the colon includes delivery to
sigmoid colon, transverse colon, and/or ascending colon. In still
more specific embodiments, the composition is formulated for
non-systemic or local delivery to the rectum and/or colon is
administered rectally. In other specific embodiments, the
composition is formulated for non-systemic or local delivery to the
rectum and/or colon is administered orally.
[0441] In some embodiments, provided herein is a composition
comprising an enteroendocrine peptide secretion enhancing agent
and, optionally, a pharmaceutically acceptable carrier for reducing
food intake in an individual. In some embodiments, provided herein
is a composition comprising an enteroendocrine peptide secretion
enhancing agent and, optionally, a pharmaceutically acceptable
carrier for reducing circulating glucose levels in an individual.
In some embodiments, provided herein is a composition comprising an
enteroendocrine peptide secretion enhancing agent and, optionally,
a pharmaceutically acceptable carrier for increasing insulin levels
in an individual. In specific embodiments, the composition is
formulated for delivering the enteroendocrine peptide secretion
enhancing agent to the distal gastrointestinal tract of the
individual. Generally, a therapeutically effective amount of an
enteroendocrine peptide secretion enhancing agent is provided.
[0442] In certain embodiments, the composition comprises an
enteroendocrine peptide secretion enhancing agent and an absorption
inhibitor. In specific embodiments, the absorption inhibitor is an
inhibitor that inhibits the absorption of the (or at least one of
the) specific enteroendocrine peptide secretion enhancing agent
with which it is combined. In some embodiments, the composition
comprises an enteroendocrine peptide secretion enhancing agent, an
absorption inhibitor and a carrier (e.g., an orally suitable
carrier or a rectally suitable carrier, depending on the mode of
intended administration). In certain embodiments, the composition
comprises an enteroendocrine peptide secretion enhancing agent, an
absorption inhibitor, a carrier, and one or more of a cholesterol
absorption inhibitor, an enteroendocrine peptide, a peptidase
inhibitor, a spreading agent, and a wetting agent.
[0443] In certain embodiments enteroendocrine peptide secretion
enhancing agents are selected from, by way of non-limiting example,
bile acids, bile acid mimic and/or modified bile acids. In more
specific embodiments, compositions described herein are formulated
for non-systemic or local delivery of a bile acid, bile acid mimic
and/or modified bile acid (as the active component or components)
to the rectum and/or colon, including the sigmoid colon, transverse
colon, and/or ascending colon. In certain embodiments, the
compositions described herein are administered rectally for
non-systemic or local delivery of the bile acid active component to
the rectum and/or colon, including the sigmoid colon, transverse
colon, and/or ascending colon. In other embodiments, the
compositions described herein are administered orally for
non-systemic delivery of the bile salt active component to the
rectum and/or colon, including the sigmoid colon, transverse colon,
and/or ascending colon. In specific embodiments, compositions
formulated for oral administration are, by way of non-limiting
example, enterically coated or formulated oral dosage forms, such
as, tablets and/or capsules. It is to be understood that the terms
"subject" and "individual" are utilized interchangeably herein and
include, e.g., humans and human patients in need of treatment.
Enteroendocrine Peptide Enhancing Agents
[0444] In some embodiments, enteroendocrine peptide enhancing
agents provided herein include, by way of non-limiting example,
enteroendocrine peptide secretion (e.g., of the L-cells) enhancing
agents, inhibitors of degradation of enteroendocrine peptides
(e.g., of the L-cells), or combinations thereof.
[0445] In certain embodiments, the enteroendocrine peptide
secretion enhancing agents used in the methods and compositions
described herein include, by way of non-limiting example, a steroid
acid or a nutrient. In specific embodiments, the steroid acid or
nutrient described herein is a steroid acid or nutrient that
enhances the secretion of an enteroendocrine peptide. In specific
embodiments, the steroid acid is an oxidize cholesterol acid. In
some embodiments, an enteroendocrine peptide secretion enhancing
agent, bile acid, or bile acid mimic used in any composition or
method described herein is a compound of Formula VII:
##STR00054##
[0446] In certain embodiments, each R.sup.1 is independently H, OH,
O-lower alkyl (e.g., OCH.sub.3, or OEt). In some embodiments, each
R.sup.1 is independently H, OH, lower (e.g., C.sub.1-C.sub.6 or
C.sub.1-C.sub.3) alkyl, or lower (e.g., C.sub.1-C.sub.6 or
C.sub.1-C.sub.3) heteroalkyl. In certain embodiments, L is a
substituted or unsubstituted alkyl or substituted or unsubstituted
heteroalkyl. In some embodiments, R.sup.2 is H, OH, lower alkyl, or
lower heteroalkyl (e.g., OMe). In certain embodiments, R.sup.3 is
H, OH, O-lower alkyl, lower alkyl, or lower heteroalkyl (e.g.,
OMe). In some embodiments, A is COOR.sup.4, S(O).sub.nR.sup.4, or
OR.sup.5. In certain embodiments, R.sup.4 is H, an anion, a
pharmaceutically acceptable cation (e.g., an alkali metal cation,
alkaline earth metal cation, or any other pharmaceutically
acceptable cation) substituted or unsubstituted alkyl, substituted
or unsubstituted heteroalkyl, substituted or unsubstituted aryl,
substituted or unsubstituted heteroaryl, an amino acid, or the
like; and n is 1-3. Each R.sup.5 is independently selected from
lower alkyl and H.
[0447] In specific embodiments, L is unsubstituted branched or
straight chain alkyl. In more specific embodiments, L is
unsubstituted branched or straight chain lower alkyl. In some
embodiments, L is
(CR.sup.5.sub.2).sub.m--CONR.sup.5--(CR.sup.5.sub.2).sub.p. Each m
is 1-6 and n is 1-6. In specific embodiments, m is 2 and n is 1. In
other specific embodiments, m is 2 and n is 2. In certain
embodiments, A is COOH or COO--. In some embodiments, A is
SO.sub.3H or SO.sub.3--.
[0448] In specific embodiments, the compound of Formula VII has a
structure represented by:
##STR00055##
In some embodiments, bile acid mimics include, by way of
non-limiting example,
6-methyl-2-oxo-4-thiophen-2-yl-1,2,3,4-tetrahydro-phyrimidine-5--
carboxylic acid benzyl ester (or TGR5-binding analogs thereof),
oleanolic acid (or TGR5-binding analogs thereof), crataegolic acid,
6.alpha.-ethyl-23(S)-methylcholic acid (S-EMCA, INT-777),
(3R)-3-Hydroxy-3-(2-propen-1-yl)-lup-20(29)-en-28-oic acid hydrate
(RG-239), or the like.
[0449] In some embodiments, a bile acid mimic is
##STR00056##
[0450] In certain embodiments, enteroendocrine peptide secretion
enhancing agents used in the methods and compositions described
herein enhance the secretion of an enteroendocrine peptide secreted
by L-cells (e.g., GLP-1, GLP-2, PYY, and the like). FIG. 11 (FIGS.
11A and 11B) illustrates the response of enteroendocrine peptides
to administration of bile salts.
[0451] In some embodiments, the enteroendocrine peptide secretion
enhancing agent is a steroid acid, such as a bile acid/salt, a bile
acid/salt mimic, a modified bile acid/salt, or a combination
thereof. The bile acids or salts thereof used in the methods and
compositions described herein include, by way of non-limiting
example, cholic acid, deoxycholic acid, glycocholic acid,
glycodeoxycholic acid, taurocholic acid, taurodihydrofusidate,
taurodeoxycholic acid, cholate, glycocholate, deoxycholate,
taurocholate, taurodeoxycholate, chenodeoxycholic acid,
ursodeoxycholic acid and combinations thereof. In certain
embodiments, bile salts used in the methods and compositions
described herein are pharmaceutically acceptable salts including,
by way of non-limiting example, the sodium and potassium salts
thereof. In specific embodiments, the enteroendocrine peptide
secretion enhancing agent is a pharmaceutically acceptable bile
acid salt including, by way of non-limiting example, sodium
glycocholate, sodium taurocholate and combinations thereof. In some
embodiments, more than one bile acid and/or salt is used in a
methods and/or composition described herein. In certain
embodiments, the bile acid/salt used herein has a low or relatively
low solubility in water.
[0452] Although bile acids facilitate digestion and absorption of
lipids in the small intestine, they are generally used in
pharmaceutical formulations as excipients. As excipients, bile
acids find uses as surfactants and/or as agents that enhance the
transfer of active components across mucosal membranes, for
systemic delivery of a pharmaceutically active compound. In certain
embodiments of the methods and pharmaceutical compositions
described herein, however, a bile acid, a bile acid mimic and/or a
modified bile acid is the active agent used to enhance secretion of
enteroendocrine peptides.
[0453] In certain specific embodiments, the enteroendocrine peptide
secretion enhancing agents used in the methods and compositions
described herein are modified bile acids/salts. In certain
embodiments, the bile acid/salt is modified in such a way so as to
inhibit absorption of the bile acid/salt across the rectal or
colonic mucosa.
[0454] In certain embodiments, the enteroendocrine peptide
secretion enhancing agents described herein are a glucagon-like
peptide secretion enhancing agent. In a specific embodiment, the
glucugen-like peptide secretion enhancing agent is a bile acid, a
bile acid mimic or a modified bile acid. In some embodiments, the
glucagon-like peptide secretion enhancing agents are selected from,
by way of non-limiting example, glucagon-like peptide-1 (GLP-1)
secretion enhancing agents or glucagon-like peptide-2 (GLP-2)
secretion enhancing agents. In some embodiments, the glucagon-like
peptide secretion enhancing agents enhance both GLP-1 and GLP-2. In
a specific embodiment, the GLP-1 and/or GLP-2 secretion enhancing
agent is selected from bile acids, bile acid mimics or modified
bile acids.
[0455] In certain embodiments, the enteroendocrine peptide
secretion enhancing agent described herein is a pancreatic
polypeptide-fold peptide secretion enhancing agent. In more
specific embodiments, the pancreatic polypeptide-fold peptide
secretion enhancing agent is selected from, by way of non-limiting
example, peptide YY (PYY) secretion enhancing agents. In specific
embodiments, the pancreatic polypeptide-fold peptide secretion
enhancing agent or the PYY secretion enhancing agent is selected
from a bile acid, a bile acid mimic, a modified bile acid or a
fatty acid or salt thereof (e.g., a short chain fatty acid).
[0456] In some embodiments, the enteroendocrine peptide secretion
enhancing agent is selected from, by way of non-limiting example,
carbohydrates, glucose, fats, and proteins. In certain embodiments,
the enteroendocrine peptide secretion enhancing agent is selected
from fatty acids, including long chain fatty acids and short chain
fatty acids. Short chain fatty acids and salts include, by way of
non-limiting example, propionic acid, butyric acid, propionate, and
butyrate.
[0457] In some embodiments, the enteroendocrine peptide secretion
enhancing agent is selected from, by way of non-limiting example,
carbohydrates, glucose, fat, protein, protein hydrolysate, amino
acids, nutrients, intestinal peptides, peripheral hormones that
participate in energy homeostasis, such as the adipocyte hormone
leptin, bile acids/salts, insulin, gastrin-releasing peptide (GRP),
gut peptides, gastric acid, CCK, insulin-like growth factor 1,
bombesin, calcitonin-gene-related peptide and combinations thereof
that enhance the secretion of enteroendocrine peptides.
[0458] In certain embodiments, the inhibitors of degradation of
L-cell enteroendocrine peptide products include DPP-IV inhibitors,
TGR5 modulators (e.g., TGR5 agonists), or combinations thereof. In
certain instances, the administration of a DPP-IV inhibitor in
combination with any of the compounds disclosed herein reduces or
inhibits degradation of GLP-1 or GLP-2. In certain instances,
administration of a TGR5 agonist in combination with any of the
compounds disclosed herein enhances the secretion of
enteroendocrine peptide products from L-cells. In some instances,
the enteroendocrine peptide enhancing agent agonizes or partially
agonizes bile acid receptors (e.g., TGR5 receptors or Farnesoid-X
receptors) on in the gastrointestinal tract.
[0459] DPP-IV inhibitors include
(2S)-1-{2-[(3-hydroxy-1-adamantyl)amino]acetyl}pyrrolidine-2-carbonitrile
(vildagliptin),
(3R)-3-amino-1-[9-(trifluoromethyl)-1,4,7,8-tetrazabicyclo[4.3.0]nona-6,8-
-d ien-4-yl]-4-(2,4,5-trifluorophenyl)butan-1-one (sitagliptin),
(1S,3S,5S)-2-[(2S)-2-amino-2-(3-hydroxy-1-adamantyl)acetyl]-2-azabicyclo[-
3.1.0]hexane-3-carbonitrile (saxagliptin), and
2-({6-[(3R)-3-aminopiperidin-1-yl]-3-methyl-2,4-dioxo-3,4-dihydropyrimidi-
n-1(2H)-yl}methyl)benzonitrile (alogliptin). TGR5 modulators (e.g.,
agonists) include the compounds disclosed in, e.g, WO2008/091540,
WO 2008067219 and US Appl. No. 2008/0221161, the TGR5 modulators
(e.g., agonists) of which are hereby incorporated herein by
reference.
[0460] In some embodiments, the enteroendocrine peptide secretion
enhancing agents used in the methods and compositions described
herein may or may not be substrates for bile acid scavenger
systems. In some embodiments, the enteroendocrine peptide secretion
enhancing agents may not form micelles and/or assist in fat
absorption. In certain embodiments, the enteroendocrine peptide
secretion enhancing agents may or may not enhance permeability
and/or promote inflammation. In certain embodiments, the
enteroendocrine peptide secretion enhancing agent may not irritate
the bowel or promote diarrhea. In some embodiments, the
enteroendocrine peptide secretion enhancing agent is selected from,
by way of non-limiting example, toll or toll-like receptor
ligands.
[0461] FIG. 12 illustrates the affect on food intake of pump
infusion of TCA in concentrations of 150 mM and 500 mM. FIG. 13
illustrates the affect on body weight of pump infusion of TCA in
concentrations of 150 mM and 500 mM.
FXR Agonists
[0462] In some embodiments, FXR agonist is GW4064, GW9662, INT-747,
T0901317, WAY-362450, fexaramine, a cholic acid, a deoxycholic
acid, a glycocholic acid, a glycodeoxycholic acid, a taurocholic
acid, a taurodihydrofusidate, a taurodeoxycholic acid, a cholate, a
glycocholate, a deoxycholate, a taurocholate, a taurodeoxycholate,
a chenodeoxycholic acid.
Absorption Inhibitors
[0463] In certain embodiments, the compositions described herein
are and the methods described herein include administering a
composition that is formulated for the non-systemic delivery of
enteroendocrine peptide secretion enhancing agents to the rectum
and/or colon (sigmoid, transverse, and/or ascending colon). As
previously discussed, enteroendocrine peptide secretion enhancing
agents include, by way of non-limiting example, bile acids, bile
salts, bile acid mimics, bile salt mimics, modified bile acids,
modified bile salts and combinations thereof. In certain
embodiments, the composition described herein as being formulated
for the non-systemic delivery of enteroendocrine peptide secretion
enhancing agents further includes an absorption inhibitor. As used
herein, an absorption inhibitor includes an agent or group of
agents that inhibit absorption of the enteroendocrine peptide
secretion enhancing agent across the rectal or colonic mucosa. In
specific embodiments, the absorption inhibitor is an absorption
inhibitor that inhibits the absorption of the specific
enteroendocrine peptide secretion enhancing agent with which it is
combined.
[0464] Suitable bile acid absorption inhibitors (also described
herein as absorption inhibiting agents) include, by way of
non-limiting example, anionic exchange matrices, polyamines,
quaternary amine containing polymers, quaternary ammonium salts,
polyallylamine polymers and copolymers, colesevelam, colesevelam
hydrochloride, CholestaGel
(N,N,N-trimethyl-6-(2-propenylamino)-1-hexanaminium chloride
polymer with (chloromethyl)oxirane, 2-propen-1-amine and
N-2-propenyl-1-decanamine hydrochloride), cyclodextrins, chitosan,
chitosan derivatives, carbohydrates which bind bile acids, lipids
which bind bile acids, proteins and proteinaceous materials which
bind bile acids, and antibodies and albumins which bind bile acids.
Suitable cyclodextrins include those that bind bile acids such as,
by way of non-limiting example, .beta.-cyclodextrin and
hydroxypropyl-.beta.-cyclodextrin. Suitable proteins, include those
that bind bile acids such as, by way of non-limiting example,
bovine serum albumin, egg albumin, casein, .alpha.'-acid
glycoprotein, gelatin, soy proteins, peanut proteins, almond
proteins, and wheat vegetable proteins.
[0465] In certain embodiments the absorption inhibitor is
cholestyramine. In specific embodiments, cholestyramine is combined
with a bile acid. Cholestyramine, an ion exchange resin, is a
styrene polymer containing quaternary ammonium groups crosslinked
by divinylbenzene. In other embodiments, the absorption inhibitor
is colestipol. In specific embodiments, colestipol is combined with
a bile acid. Colestipol, an ion exchange resin, is a copolymer of
diethylenetriamine and 1-chloro-2,3-epoxypropane.
[0466] In certain embodiments of the compositions and methods
described herein the enteroendocrine peptide secretion enhancing
agent is linked to an absorption inhibitor, while in other
embodiments the enteroendocrine peptide secretion enhancing agent
and the absorption inhibitor are separate molecular entities. In
specific embodiments the bile acid, bile acid mimic or the modified
bile acid is linked to a bile acid adsorption inhibitor described
herein.
Cholesterol Absorption Inhibitors
[0467] In certain embodiments, a composition described herein
optionally includes at least one cholesterol absorption inhibitor.
Suitable cholesterol absorption inhibitors include, by way of
non-limiting example, ezetimibe (SCH 58235), ezetimibe analogs, ACT
inhibitors, stigmastanyl phosphorylcholine, stigmastanyl
phosphorylcholine analogues, .dbd.-lactam cholesterol absorption
inhibitors, sulfate polysaccharides, neomycin, plant sponins, plant
sterols, phytostanol preparation FM-VP4, Sitostanol,
.quadrature.-sitosterol, acyl-CoA:cholesterol-O-acyltransferase
(ACAT) inhibitors, Avasimibe, Implitapide, steroidal glycosides and
the like. Suitable enzetimibe analogs include, by way of
non-limiting example, SCH 48461, SCH 58053 and the like. Suitable
ACT inhibitors include, by way of non-limiting example, trimethoxy
fatty acid anilides such as CI-976,
3-[decyldimethylsilyl]-N-[2-(4-methylphenyl)-1-phenylethyl]-propanamide,
melinamide and the like. .quadrature.-lactam cholesterol absorption
inhibitors include, by way of non-limiting example,
(3R-4S)-1,4-bis-(4-methoxyphenyl)-3-(3-phenylpropyl)-2-azetidinone
and the like.
Enteroendocrine Peptides
[0468] In certain embodiments, the compositions described herein
optionally include at least one enteroendocrine peptide. Suitable
enteroendocrine peptides include, by way of non-limiting example,
glucagon-like peptides GLP-- and/or GLP-2, or pancreatic
polypeptide-fold peptides pancreatic polypeptide (PP), neuropeptide
Y (NPY) and/or peptide YY (PYY).
Peptidase Inhibitors
[0469] In some embodiments, the compositions described herein
optionally include at least one peptidase inhibitor. Such peptidase
inhibitors include, but are not limited to, dipeptidyl peptidase-4
inhibitors (DPP-4), neutral endopeptidase inhibitors, and
converting enzyme inhibitors. Suitable dipeptidyl peptidase-4
inhibitors (DPP-4) include, by way of non-limiting example,
Vildaglipti,
2S)-1-{2-[(3-hydroxy-1-adamantyl)amino]acetyl}pyrrolidine-2-carbonitrile,
Sitagliptin,
(3R)-3-amino-1-[9-(trifluoromethyl)-1,4,7,8-tetrazabicyclo[4.3.0]nona-6,8-
-dien-4-yl]-4-(2,4,5-trifluorophenyl)butan-1-one, Saxagliptin, and
(1S,3S,5S)-2-[(2S)-2-amino-2-(3-hydroxy-1-adamantyl)acetyl]-2-azabicyclo[-
3.1.0]hexane-3-carbonitrile. Such neutral endopeptidase inhibitors
include, but are not limited to, Candoxatrilat and Ecadotril.
Spreading Agents/Wetting Agents
[0470] In certain embodiments, the composition described herein
optionally comprises a spreading agent. In some embodiments, a
spreading agent is utilized to improve spreading of the composition
in the colon and/or rectum. Suitable spreading agents include, by
way of non-limiting example, hydroxyethylcellulose,
hydroxypropymethyl cellulose, polyethylene glycol, colloidal
silicon dioxide, propylene glycol, cyclodextrins, microcrystalline
cellulose, polyvinylpyrrolidone, polyoxyethylated glycerides,
polycarbophil, di-n-octyl ethers, Cetiol.TM.OE, fatty alcohol
polyalkylene glycol ethers, Aethoxal.TM.B), 2-ethylhexyl palmitate,
Cegesoft.TM. 24), and isopropyl fatty acid esters.
[0471] In some embodiments, the compositions described herein
optionally comprise a wetting agent. In some embodiments, a wetting
agent is utilized to improve wettability of the composition in the
colon and rectum. Suitable wetting agents include, by way of
non-limiting example, surfactants. In some embodiments, surfactants
are selected from, by way of non-limiting example, polysorbate
(e.g., 20 or 80), stearyl hetanoate, caprylic/capric fatty acid
esters of saturated fatty alcohols of chain length
C.sub.12-C.sub.18, isostearyl diglycerol isostearic acid, sodium
dodecyl sulphate, isopropyl myristate, isopropyl palmitate, and
isopropyl myristate/isopropyl stearate/isopropyl palmitate
mixture.
Methods
[0472] Provided herein, in certain embodiments, are methods for
treating obesity, diabetes, or an inflammatory intestinal condition
comprising administration of a therapeutically effective amount of
an ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist to an individual in need thereof. Provided herein, in
certain embodiments, are methods for treating obesity, diabetes, or
an inflammatory intestinal condition comprising contacting the
distal gastrointestinal tract, including the distal ileum and/or
the colon and/or the rectum, of an individual in need thereof with
an ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist. Also provided herein are methods for reducing
intraenterocyte bile acids, reducing necrosis and/or damage to
ileal architecture, or reducing blood or plasma glucose levels of
an individual comprising administration of a therapeutically
effective amount of an ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist to an individual in need
thereof. Provided herein are methods for stimulating L-cells in the
distal gastrointestinal tract, including L-cells in the distal
ileum and/or colon and/or rectum, of an individual comprising
administration of a therapeutically effective amount of an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist to an individual in need thereof. Provided herein are
methods for enhancing enteroendocrine peptide secretion from
L-cells in the distal gastrointestinal tract, including L-cells in
the distal ileum and/or colon and/or rectum, of an individual
comprising administration of a therapeutically effective amount of
an ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist to an individual in need thereof. Provided herein are
methods for increasing the concentration of bile acids and salts
thereof in the vicinity of L-cells lining the distal
gastrointestinal tract, including L-cells in the distal ileum,
and/or the colon and/or the rectum of an individual, comprising
administration of a therapeutically effective amount of an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist to an individual in need thereof. In some of the
aforementioned embodiments, the ASBTI is contacted with the distal
ileum of the individual in need thereof. In some of the
aforementioned embodiments, the ASBTI is not absorbed systemically.
In some other embodiments, the ASBTI is absorbed systemically.
[0473] In some embodiments of the methods provided herein,
inhibition of bile acid transporters and/or bile acid recycling
increases the concentration of bile acids in the vicinity of
L-cells to concentrations that are higher than physiological levels
of bile acids in individuals that have not been treated with an
ASBTI. In some embodiments of the methods described herein, an
increase in concentration of bile acids in the vicinity of L-cell
increases the secretion of enteroendocrine peptides, including
GLP-1, GLP-2, PYY and/or oxyntomodulin from L-cells. In some
instances a higher concentration of GLP-1 and/or GLP-2 and/or PYY
and/or oxyntomodulin in the blood and/or plasma of an individual,
increases insulin sensitivity of the individual, reduces
intraenterocyte bile acids, reduces necrosis and/or damage to ileal
architecture, and/or slows down gastric emptying and/or induces a
feeling of satiety thereby reducing food intake and/or inducing
weight loss.
[0474] Provided herein are methods for reducing necrosis and/or
damage to ileal architecture or cells comprising administration of
a therapeutically effective amount of an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist to an
individual in need thereof. In certain embodiments, provided herein
are methods for reducing intraenterocyte bile acids comprising
administration of a therapeutically effective amount of an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist to an individual in need thereof. In certain embodiments,
provided herein are methods for reducing food intake in an
individual comprising administration of a therapeutically effective
amount of an ASBTI to an individual in need thereof. In certain
embodiments, provided herein is a method for reducing food intake
in an individual in need thereof comprising contacting the distal
gastrointestinal tract, including the distal ileum and/or colon
and/or rectum, of the individual with a therapeutically effective
amount of an ASBTI. Provided herein are methods for reducing weight
of an individual comprising administration of a therapeutically
effective amount of an ASBTI to an individual in need thereof. In
certain embodiments, provided herein is a method of reducing weight
of an individual in need thereof comprising contacting the distal
gastrointestinal tract, including the distal ileum and/or colon
and/or rectum, of the individual with a therapeutically effective
amount of an ASBT inhibitor. In some embodiments, the method
provides for inhibition of bile salt recycling upon administration
of any of the compounds described herein to an individual. In some
embodiments, an ASBTI described herein is systemically absorbed
upon administration. In some embodiments, an ASBTI described herein
is not absorbed systemically. In some embodiments, an ASBTI
described herein is administered to the individual orally,
enterically or rectally. In some embodiments, an ASBTI described
herein is delivered and/or released in the distal ileum of an
individual. In some embodiments, an ASBTI described herein
increases the concentration of bile acids in the distal ileum, the
colon and/or the rectum thereby increasing secretion of
enteroendocrine peptide products from L-cells in the
gastrointestinal tract. In certain instances administration of a
therapeutically effective amount of an ASBTI described herein to an
individual in need thereof increases the secretion of
enteroendocrine peptide products (e.g., GLP-1, GLP-2, PYY,
oxyntomodulin or the like) from L-cells that line the
gastrointestinal tract. In some embodiments, elevated levels of
GLP-1 slow down gastric emptying, and/or inhibit or reduce
meal-stimulated gastric secretion, thereby reducing food intake in
the individual. In some embodiments, an ASBTI described herein is
administered in combination with a DPP-IV inhibitor. In some
instances, inhibition of DPP-IV reduces the degradation of
enteroendocrine peptide products (e.g. GLP-1) thereby prolonging
the delay in gastric emptying and thereby reducing food intake. In
some of such embodiments, an ASBTI described herein is administered
to a non-diabetic individual for reducing food intake in the
non-diabetic individual. In some of such embodiments, an ASBTI
described herein is administered to a diabetic individual for
reducing food intake in the diabetic individual. In some
embodiments, the methods described herein are methods for reducing
food intake in obese or morbidly overweight individuals. In some
embodiments, a reduction in food intake reduces the weight of an
individual (e.g., an obese or morbidly overweight individual)
[0475] Provided herein are methods for inducing satiety in an
individual comprising administration of a therapeutically effective
amount of an ASBTI to an individual in need thereof. In certain
embodiments, provided herein is a method for inducing satiety in an
individual in need thereof comprising contacting the distal
gastrointestinal tract, including distal ileum and/or the colon
and/or the rectum, of the individual with a therapeutically
effective amount of an ASBT inhibitor. In some embodiments, the
method provides for inhibition of bile salt recycling upon
administration of any of the compounds described herein to an
individual. In some embodiments, an ASBTI described herein is
systemically absorbed upon administration. In some embodiments, an
ASBTI described herein (e.g., a compound of Formula I) is not
absorbed systemically. In some embodiments, an ASBTI described
herein is administered to the individual orally, enterically or
rectally. In some embodiments, an ASBTI described herein is
delivered and/or released in the distal ileum of an individual. In
some embodiments, an ASBTI described herein increases the
concentration of bile acids in the distal ileum, the colon and/or
the rectum and induces secretion of enteroendocrine peptide
products from L-cells of the distal gastrointestinal tract. In
certain instances administration of a therapeutically effective
amount of an ASBTI described herein to an individual in need
thereof increases the secretion of enteroendocrine peptide products
(e.g., GLP-1, GLP-2, PYY, oxyntomodulin or the like) from L-cells
that line the gastrointestinal tract. In some embodiments, elevated
levels of GLP-1 slow down gastric emptying, and induce a feeling of
fullness in an individual. In some embodiments, an ASBTI described
herein is administered in combination with a DPP-IV inhibitor. In
some instances, inhibition of DPP-IV reduces the degradation of
enteroendocrine peptide products (e.g. GLP-1) thereby prolonging
the delay in gastric emptying and sustaining the feeling of satiety
and/or fullness. In some of such embodiments, an ASBTI described
herein is administered to a non-diabetic individual. In some of
such embodiments, an ASBTI described herein is administered to a
diabetic individual. In some of such embodiments, an ASBTI
described herein is administered to an obese or morbidly overweight
individual.
[0476] Provided herein are methods for preventing or treating
metabolic disorders in an individual comprising administration of a
therapeutically effective amount of an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist to an
individual in need thereof. In certain embodiments, the metabolic
disorders include but not limited to necrotizing enterocolitis,
gastritis, ulcerative colitis, inflammatory bowel disease,
irritable bowel syndrome, gastroenteritis, radiation induced
enteritis, chemotherapy induced enteritis, gastro-esophageal reflux
disease (GERD), peptic ulcer, non-ulcer dyspepsia (NUD), celiac
disease, intestinal celiac disease, gastrointestinal complications
following bariatric surgery, gastric carcinogenesis, or gastric
carcinogenesis following gastric or bowel resection. In certain
embodiments, provided herein is a method for treating metabolic
disorders in an individual in need thereof comprising contacting
the distal gastrointestinal tract, including distal ileum and/or
the colon and/or the rectum, of the individual with a
therapeutically effective amount of an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist. In
some embodiments, the method provides for inhibition of bile salt
recycling upon administration of any of the compounds described
herein to an individual. In some embodiments, an ASBTI described
herein is systemically absorbed upon administration. In some
embodiments, an ASBTI described herein (e.g., a compound of Formula
I) is not absorbed systemically. In some embodiments, an ASBTI
described herein is administered to the individual orally,
enterically or rectally. In some embodiments, an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist
described herein is delivered and/or released in the distal ileum
of an individual. In some embodiments, an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist
described herein increases the concentration of bile acids in the
distal ileum, the colon and/or the rectum and induces secretion of
enteroendocrine peptide products from the L-cells of the
gastrointestinal tract. In certain instances administration of a
therapeutically effective amount of an ASBTI described herein to an
individual in need thereof increases the secretion of
enteroendocrine peptide products (e.g., GLP-1, GLP-2, PYY,
oxyntomodulin or the like) from L-cells that line the distal
gastrointestinal tract. In some embodiments, elevated levels of
GLP-1 reduce glucose levels in blood. In some instances, elevated
levels of GLP-1 increase insulin sensitivity in a hyperglycemic
individual. In some embodiments, an ASBTI and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist described herein is
administered in combination with a DPP-IV inhibitor. In some
instances, inhibition of DPP-IV reduces the degradation of
enteroendocrine peptide products (e.g. GLP-1) thereby prolonging
the effect of GLP-1 in reducing blood glucose levels. In some of
such embodiments, an ASBTI described herein is administered to a
non-diabetic individual. In some of such embodiments, an ASBTI
described herein is administered to a diabetic individual. In some
of such embodiments, an ASBTI described herein is administered to
an obese or morbidly overweight individual.
[0477] Provided herein are methods for preventing or treating
radiation induced enteritis in an individual comprising
administration of a therapeutically effective amount of an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist to an individual in need thereof. In certain embodiments,
provided herein is a method for treating radiation enteritis in an
individual in need thereof comprising contacting the distal
gastrointestinal tract, including distal ileum and/or the colon
and/or the rectum, of the individual with a therapeutically
effective amount of an ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist. In some embodiments, the
method provides for inhibition of bile salt recycling upon
administration of any of the compounds described herein to an
individual. In some embodiments, an ASBTI described herein is
systemically absorbed upon administration. In some embodiments, an
ASBTI described herein (e.g., a compound of Formula I) is not
absorbed systemically. In some embodiments, an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist
described herein is administered to the individual orally,
enterically or rectally. In some embodiments, an ASBTI described
herein is delivered and/or released in the distal ileum of an
individual. In some embodiments, an ASBTI and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist described herein
increases the concentration of bile acids in the distal ileum, the
colon and/or the rectum and induces secretion of enteroendocrine
peptide products from the L-cells of the gastrointestinal tract. In
certain instances administration of a therapeutically effective
amount of an ASBTI described herein to an individual in need
thereof increases the secretion of enteroendocrine peptide products
(e.g., GLP-1, GLP-2, PYY, oxyntomodulin or the like) from L-cells
that line the distal gastrointestinal tract. In some embodiments,
elevated levels of GLP-2 has a regenerative effect on
radiation-induced injuries of the gastrointestinal tract (e.g.,
after radiation therapy for treatment of cancer, or accidental
exposure to radiation). In some embodiments, prophylactic
administration of an ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist reduces or prevents intestinal
inflammation (gastrointestinal enteritis), for example in a cancer
patient undergoing radiation therapy. In some embodiments, an ASBTI
described herein is administered in combination with a DPP-IV
inhibitor. In some instances, inhibition of DPP-IV reduces the
degradation of enteroendocrine peptide products (e.g. GLP-2)
thereby prolonging the effect of GLP-2 in regeneration and/or
healing of gastrointestinal tissue.
[0478] Provided herein are methods for preventing or treating
pancreatic and other cancers in an individual comprising
administration of a therapeutically effective amount of an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist to an individual in need thereof. Other cancers include but
are not limited to colon, breast, bowel and lung. In certain
embodiments, provided herein is a method for preventing or treating
pancreatic and other cancers cancer in an individual in need
thereof comprising contacting the distal gastrointestinal tract,
including distal ileum and/or the colon and/or the rectum, of the
individual with a therapeutically effective amount of an ASBTI. In
some embodiments, the method provides for inhibition of bile salt
recycling upon administration of any of the compounds described
herein to an individual. In some embodiments, an ASBTI described
herein is systemically absorbed upon administration. In some
embodiments, an ASBTI described herein (e.g., a compound of Formula
I) is not absorbed systemically. In some embodiments, an ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist described herein is administered to the individual orally,
enterically or rectally. In some embodiments, an ASBTI described
herein is delivered and/or released in the distal ileum of an
individual. In some embodiments, an ASBTI and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist described herein
increases the concentration of bile acids in the distal ileum, the
colon and/or the rectum and induces secretion of enteroendocrine
peptide products from the L-cells of the gastrointestinal tract. In
certain instances administration of a therapeutically effective
amount of an ASBTI described herein to an individual in need
thereof increases the secretion of enteroendocrine peptide products
(e.g., GLP-1, GLP-2, PYY, oxyntomodulin or the like) from L-cells
that line the distal gastrointestinal tract. In some embodiments,
elevated levels of enteroendocrine peptide products have a
protective effect against pancreatic and other cancers. In some
embodiments, prophylactic administration of an ASBTI reduces or
prevents pancreatic and other cancers. In some embodiments, an
ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist described herein is administered in combination with a
DPP-IV inhibitor. In some instances, inhibition of DPP-IV reduces
the degradation of enteroendocrine peptide products (e.g., GLP-1)
thereby prolonging the effect of GLP-1 in prevention of pancreatic
and other cancers. In some of such embodiments, an ASBTI described
herein is administered to an individual with pancreatic and other
cancers. In some of such embodiments, an ASBTI described herein is
administered to an individual at risk of pancreatic and other
cancers. In some of such embodiments, an ASBTI described herein is
administered to an an individual at risk of pancreatic and other
cancers and having other metabolic disorders (e.g., diabetes).
[0479] In some embodiments, administration of an ASBT inhibitor
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist described herein allows for treatment of a metabolic
disorder without the side effects associated with conventional
therapies (e.g., biguanides such as metformin, DDPIV inhibitors or
the like) for metabolic disorders. In some embodiments, the
administration of an ASBT inhibitor described herein reduces the
incidence of gastrointestinal distress and/or lactic acidosis that
is associated with biguanide therapy and/or treatment with a DPP-IV
inhibitor. In some embodiments, the administration of an ASBT
inhibitor described herein avoids weight gain that is associated
with biguanide therapy and/or treatment with a DPP-IV inhibitor
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist. Metabolic disorders that are amenable to treatment with
compounds described herein include diabetes, insulin resistance,
and metabolic syndrome.
[0480] In some embodiments, provided herein is a method of
decreasing the dose of a biguanide or a DPP-IV inhibitor to treat a
metabolic disorder in an individual in need thereof by replacing
treatment with a biguanide (e.g., metformin) or a DPP-IV inhibitor
with a treatment comprising administering a therapeutically
effective amount of an ASBT inhibitor described herein to the
individual. In some embodiments, provided herein is a method for
treating a metabolic disease or disorder comprising administering
to an individual in need thereof a therapeutically effective amount
of an ASBT inhibitor described herein in combination with a reduced
dose of a biguanide (e.g., metformin) or a DPP-IV inhibitor (e.g.,
sitagliptin) or an enteroendocrine peptide enhancing agent or a FXR
agonist.
[0481] In some embodiments of any of the methods described herein,
administration of an ASBT inhibitor and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist described herein
increases the level of GLP-1 in the blood and/or plasma of an
individual by from about 1.1 times to about 30 times compared to
the level of GLP-1 in the blood and/or plasma of the individual
prior to administration of the ASBTI. In some embodiments of any of
the methods described herein, administration of an ASBT inhibitor
described herein increases the level of GLP-1 in the blood and/or
plasma of an individual by from about 1.1 times to about 20 times
compared to the level of GLP-1 in the blood and/or plasma of the
individual prior to administration of the ASBTI. In some
embodiments of any of the methods described herein, administration
of an ASBT inhibitor and/or an enteroendocrine peptide enhancing
agent and/or a FXR agonist described herein increases the level of
GLP-1 in the blood and/or plasma of an individual by from about 1.5
times to about 10 times compared to the level of GLP-1 in the blood
and/or plasma of the individual prior to administration of the
ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist. In some embodiments of any of the methods described
herein, administration of an ASBT inhibitor and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist
described herein increases the level of GLP-1 in the blood and/or
plasma of an individual by from about 2 times to about 8 times
compared to the level of GLP-1 in the blood and/or plasma of the
individual prior to administration of the ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist. In
some embodiments of any of the methods described herein,
administration of an ASBT inhibitor and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist described herein
increases the level of GLP-1 in the blood and/or plasma of an
individual by from about 2 times to about 6 times compared to the
level of GLP-1 in the blood and/or plasma of the individual prior
to administration of the ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist. In some instances, an
increase in GLP-1 level of from about 2 times to about 3 times
following the administration of an ASBT inhibitor and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist
described herein compared to the level of GLP-1 in the blood and/or
plasma of the individual prior to administration of the ASBTI
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist is associated with an anti-diabetic effect. In some
instances, an increase in GLP-1 level of from about 3 times to
about 8 times following the administration of an ASBT inhibitor
and/or an enteroendocrine peptide enhancing agent and/or a FXR
agonist described herein compared to the level of GLP-1 in the
blood and/or plasma of the individual prior to administration of
the ASBTI and/or an enteroendocrine peptide enhancing agent and/or
a FXR agonist is associated with reduction in food intake and/or
induction of satiety and/or weight loss.
[0482] In certain embodiments of any of the methods described
herein, administration of an ASBTI and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist reduces blood and/or
plasma sugar levels by at least 20%, at least 30%, at least 40%, at
least 50% at least 60%, at least 70% or at least 80% compared to
blood and/or plasma sugar levels prior to administration of the
ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist. In some embodiments of any of the methods described
herein, administration of an ASBTI and/or an enteroendocrine
peptide enhancing agent and/or a FXR agonist reduces blood and/or
plasma sugar levels by at least 20% compared to blood and/or plasma
sugar levels prior to administration of the ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist. In
some embodiments of any of the methods described herein,
administration of an ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist reduces blood and/or plasma
sugar levels by at least 30% compared to blood and/or plasma sugar
levels prior to administration of the ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist. In
some embodiments of any of the methods described herein,
administration of an ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist reduces blood and/or plasma
sugar levels by at least 40% compared to blood and/or plasma sugar
levels prior to administration of the ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist.
[0483] In some embodiments of any of the methods described herein,
administration of an ASBTI reduces blood and/or plasma sugar levels
for a longer period of time (e.g., at least 24 hours) compared to
reduction in blood and/or plasma sugar levels upon administration
of metformin or a DPP-IV inhibitor. In some embodiments of any of
the methods described herein, administration of a single dose of an
ASBTI sustains reduced blood and/or plasma sugar levels for at
least 6 hours, at least 12 hours, at least 14 hours, at least 16
hours, at least 18 hours, at least 20 hours, at least 24 hours, at
least 30 hours, at least 36 hours or at least 48 hours compared to
reduction in blood and/or plasma sugar levels upon administration
of a single dose of metformin or a DPP-IV inhibitor.
[0484] In some embodiments of any of the methods described herein,
administration of an ASBTI and/or an enteroendocrine peptide
enhancing agent and/or a FXR agonist results in higher levels of
GLP-1 in blood and/or plasma of an individual compared to levels of
GLP-1 in blood and/or plasma of a normal individual. In some
embodiments of any of the methods described herein, administration
of an ASBTI and/or an enteroendocrine peptide enhancing agent
and/or a FXR agonist results in higher levels of GLP-1 in blood
and/or plasma of an individual compared to levels of GLP-1 in blood
and/or plasma of an individual that has been administered a DPP-IV
inhibitor.
[0485] Also provided herein is a method for treating conditions
that are ameliorated by increased secretion of L-cell
enteroendocrine peptides comprising contacting the distal
gastrointestinal tract, including distal ileum and/or the colon
and/or the rectum, of an individual in need thereof with a
therapeutically effective amount of any ASBTI compound and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist
described herein. L-cells are highly specialized gut
enteroendocrine cells expressed along the gastrointestinal tract.
The majority of L cells are located in the distal gastrointestinal
tract, predominantly in the ileum and colon. The L-cells in the
enteric endocrine system do not secrete their hormone continuously.
Instead, they respond to changes in the environment within the
lumen of the digestive tube, including changes in bile acid
concentrations in the lumen of the digestive tube. The apical
border of L-cells is in contact with the contents of the
gastrointestinal lumen. Enteroendocrine peptides secreted by
L-cells include GLP-1, GLP-2, PYY and oxyntomodulin. In certain
instances, the methods described herein enhance L-cell secretion of
one or more metabolic and/or enteroendocrine hormones. In some
embodiments, the methods described herein enhance L-cell secretion
of GLP-1, GLP-2, PYY or oxyntomodulin or combinations thereof. In
certain embodiments, enhanced secretion of multiple enteroendocrine
hormones (e.g., enhanced secretion of PYY and/or GLP-1 and/or GLP-2
and/or oxyntomodulin) is more effective for long term weight
reduction compared to enhanced secretion of any single
enteroendocrine hormone. In certain embodiments, enhanced secretion
of multiple enteroendocrine hormones (e.g., enhanced secretion of
PYY and/or GLP-1 and/or GLP-2 and/or oxyntomodulin) is more
effective for long term improvement of peripheral insulin
sensitivity compared to enhanced secretion of any single
enteroendocrine hormone. Thus, advantageously, administration of a
single therapeutic agent (e.g., any ASBTI described herein) has the
potential to simultaneously impact multiple metabolic pathways (as
opposed to administration of multiple therapeutic agents each of
which impacts a different metabolic pathway).
[0486] In certain instances, contacting the distal ileum of an
individual with an ASBTI (e.g., any ASBTI described herein)
inhibits bile acid reuptake and increases the concentration of bile
acids in the vicinity of L-cells in the distal ileum and/or colon
and/or rectum, thereby reducing intraenterocyte bile acids,
enhancing the release of enteroendocrine peptides, and/or reducing
necrosis or damage to ileal architecture. Without being limited to
any particular theory, bile acids and/or bile salts interact with
TGR5 receptors on the apical surface of L-cells to trigger the
release of one or more enteroendocrine hormones into systemic
circulation and/or the gastrointestinal lumen. Under physiological
conditions, the concentration of enteroendocrine hormones varies in
the gastrointestinal tract. By way of example, in the absence of an
ASBTI, PYY concentrations in the upper small intestine are about
.about.5 pmol/g tissue, about .about.80 pmol/g tissue in the distal
ileum and ascending colon, .about.200 pmol/g tissue in the sigmoid
colon, and .about.500 pmol/g tissue in the rectum. In some
embodiments, the administration of one or more ASBTIs, according to
methods described herein, increases concentrations of one or more
enteroendocrine peptides in the gastrointestinal lumen and/or
systemic circulation compared to physiological concentrations of
the enteroendocrine peptides in the absence of an ASBTI.
[0487] Conditions that are mediated by L-cell enteroendocrine
peptides include obesity, diabetes, congestive heart failure,
ventricular dysfunction, toxic hypervolemia, polycystic ovary
syndrome, inflamatory bowel disease, impaired bowel integrity,
short bowel syndrome, gastritis, peptic ulcer, necrotizing
enterocolitis, ulcerative colitis, celiac disease, intestinal
celiac disease, gastroenteritis, radiation induced enteritis,
chemotherapy induced enteritis, non-ulcer dyspepsia (NUD),
gastrointestinal complications following bariatric surgery, gastric
carcinogenesis, irritable bowel disease, gastroesophageal reflux
disease (GERD), Barrett's esophagus or the like.
[0488] Administration of a compound described herein is achieved in
any suitable manner including, by way of non-limiting example, by
oral, enteric, parenteral (e.g., intravenous, subcutaneous,
intramuscular), intranasal, buccal, topical, rectal, or transdermal
administration routes. Any compound or composition described herein
is administered in a method or formulation appropriate to treat a
new born or an infant. Any compound or composition described herein
is administered in an oral formulation (e.g., solid or liquid) to
treat a new born or an infant. Any compound or composition
described herein is administered prior to ingestion of food, with
food or after ingestion of food.
[0489] In certain embodiments, a compound or a composition
comprising a compound described herein is administered for
prophylactic and/or therapeutic treatments. In therapeutic
applications, the compositions are administered to an individual
already suffering from a disease or condition, in an amount
sufficient to cure or at least partially arrest the symptoms of the
disease or condition. In various instances, amounts effective for
this use depend on the severity and course of the disease or
condition, previous therapy, the individual's health status,
weight, and response to the drugs, and the judgment of the treating
physician.
[0490] In prophylactic applications, compounds or compositions
containing compounds described herein are administered to an
individual susceptible to or otherwise at risk of a particular
disease, disorder or condition. In certain embodiments of this use,
the precise amounts of compound administered depend on the
individual's state of health, weight, and the like. Furthermore, in
some instances, when a compound or composition described herein is
administered to an individual, effective amounts for this use
depend on the severity and course of the disease, disorder or
condition, previous therapy, the individual's health status and
response to the drugs, and the judgment of the treating
physician.
[0491] In certain instances, wherein following administration of a
selected dose of a compound or composition described herein, an
individual's condition does not improve, upon the doctor's
discretion the administration of a compound or composition
described herein is optionally administered chronically, that is,
for an extended period of time, including throughout the duration
of the individual's life in order to ameliorate or otherwise
control or limit the symptoms of the individual's disorder, disease
or condition.
[0492] In certain embodiments, an effective amount of a given agent
varies depending upon one or more of a number of factors such as
the particular compound, disease or condition and its severity, the
identity (e.g., weight) of the subject or host in need of
treatment, and is determined according to the particular
circumstances surrounding the case, including, e.g., the specific
agent being administered, the route of administration, the
condition being treated, and the subject or host being treated. In
some embodiments, doses administered include those up to the
maximum tolerable dose. In some embodiments, doses administered
include those up to the maximum tolerable dose by a newborn or an
infant. In certain embodiments, about 0.001-5000 mg per day, from
about 0.001-1500 mg per day, about 0.001 to about 100 mg/day, about
0.001 to about 50 mg/day, or about 0.001 to about 30 mg/day, or
about 0.001 to about 10 mg/day of a compound described herein is
administered. In various embodiments, the desired dose is
conveniently presented in a single dose or in divided doses
administered simultaneously (or over a short period of time) or at
appropriate intervals, for example as two, three, four or more
sub-doses per day. In various embodiments, a single dose is from
about 0.001 mg/kg to about 500 mg/kg. In various embodiments, a
single dose is from about 0.001, 0.01, 0.1, 1, or 10 mg/kg to about
10, 50, 100, or 250 mg/kg. In various embodiments, a single dose of
an ASBTI is from about 0.001 mg/kg to about 100 mg/kg. In various
embodiments, a single dose of an ASBTI is from about 0.001 mg/kg to
about 50 mg/kg. In various embodiments, a single dose of an ASBTI
is from about 0.001 mg/kg to about 10 mg/kg. In various
embodiments, a single dose of an ASBTI is administered every 6
hours, every 12 hours, every 24 hours, every 48 hours, every 72
hours, every 96 hours, every 5 days, every 6 days, or once a week.
In some embodiments the total single dose of an ASBTI and/or an
enteroendocrine peptide enhancing agent and/or a FXR agonist is in
the range described above.
[0493] In the case wherein the patient's status does improve, upon
the doctor's discretion an ASBTI is optionally given continuously;
alternatively, the dose of drug being administered is temporarily
reduced or temporarily suspended for a certain length of time
(i.e., a "drug holiday"). The length of the drug holiday optionally
varies between 2 days and 1 year, including by way of example only,
2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 10 days, 12 days,
15 days, 20 days, 28 days, 35 days, 50 days, 70 days, 100 days, 120
days, 150 days, 180 days, 200 days, 250 days, 280 days, 300 days,
320 days, 350 days, or 365 days. The dose reduction during a drug
holiday includes from 10%-100%, including, by way of example only,
10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%,
75%, 80%, 85%, 90%, 95%, or 100%. In some embodiments the total
single dose of an ASBTI and/or an enteroendocrine peptide enhancing
agent and/or a FXR agonist is in the range described above.
[0494] Once improvement of the patient's conditions has occurred
(e.g., weight loss), a maintenance dose is administered if
necessary. Subsequently, the dosage or the frequency of
administration, or both, is reduced, as a function of the symptoms,
to a level at which the improved disease, disorder or condition is
retained. In some embodiments, patients require intermittent
treatment on a long-term basis upon any recurrence of symptoms
(e.g., weight gain).
[0495] In certain instances, there are a large number of variables
in regard to an individual treatment regime, and considerable
excursions from these recommended values are considered within the
scope described herein. Dosages described herein are optionally
altered depending on a number of variables such as, by way of
non-limiting example, the activity of the compound used, the
disease or condition to be treated, the mode of administration, the
requirements of the individual subject, the severity of the disease
or condition being treated, and the judgment of the
practitioner.
[0496] Toxicity and therapeutic efficacy of such therapeutic
regimens are optionally determined by pharmaceutical procedures in
cell cultures or experimental animals, including, but not limited
to, the determination of the LDs.sub.5 (the dose lethal to 50% of
the population) and the EDso (the dose therapeutically effective in
50% of the population). The dose ratio between the toxic and
therapeutic effects is the therapeutic index and it can be
expressed as the ratio between LD.sub.50 and ED.sub.50. Compounds
exhibiting high therapeutic indices are preferred. In certain
embodiments, data obtained from cell culture assays and animal
studies are used in formulating a range of dosage for use in human.
In specific embodiments, the dosage of compounds described herein
lies within a range of circulating concentrations that include the
ED.sub.50 with minimal toxicity. The dosage optionally varies
within this range depending upon the dosage form employed and the
route of administration utilized.
[0497] In some embodiments, the systemic exposure of a
therapeutically effective amount of any non-systemic ASBTI
described herein (e.g., an ASBTI that comprises a group L-K) is
reduced when compared to the systemic exposure of a therapeutically
effective amount of any systemically absorbed ASBTI (e.g. Compounds
100A, 100C). In some embodiments, the AUC of a therapeutically
effective amount of any non-systemic ASBTI described herein (e.g.,
an ASBTI that comprises a group L-K) is at least 10%, at least 20%,
at least 30%, at least 40%, at least 50%, at least 60%, at least
70%, at least 80% or at least 90% reduced when compared to the AUC
of any systemically absorbed ASBTI (e.g. Compounds 100A, 100C).
[0498] In some embodiments, the systemic exposure of a
therapeutically effective amount of a compound of Formula I that is
not systemically absorbed (e.g., a compound of Formula I that
comprises a group L-K) is reduced when compared to the systemic
exposure of a therapeutically effective amount of Compound 100A. In
some embodiments, the AUC of a therapeutically effective amount of
a compound of Formula I that is not systemically absorbed (e.g., a
compound of Formula I that comprises a group L-K) is about 10%,
about 20%, about 30%, about 40%, about 50%, about 60%, about 70%,
about 80% or about 90% reduced when compared to the AUC of a
therapeutically effective amount of Compound 100A. In some
embodiments, the AUC of a therapeutically effective amount of a
compound of Formula I that is not systemically absorbed (e.g., a
compound of Formula I that comprises a group L-K) is about 50%
reduced when compared to the AUC of a therapeutically effective
amount of Compound 100A. In other embodiments, the AUC of a
therapeutically effective amount of a compound of Formula I that is
not systemically absorbed (e.g., a compound of Formula I that
comprises a group L-K) is about 75% reduced when compared to the
AUC of a therapeutically effective amount of Compound 100A.
[0499] In some embodiments, the systemic exposure of a
therapeutically effective amount of a compound of Formula II that
is not systemically absorbed (e.g., a compound of Formula II that
comprises a group L-K) is reduced when compared to the systemic
exposure of a therapeutically effective amount of Compound 100A. In
some embodiments, the AUC of a therapeutically effective amount of
a compound of Formula II that is not systemically absorbed (e.g., a
compound of Formula II that comprises a group L-K) is about 10%,
about 20%, about 30%, about 40%, about 50%, about 60%, about 70%,
about 80% or about 90% reduced when compared to the AUC of a
therapeutically effective amount of Compound 100A. In some
embodiments, the AUC of a therapeutically effective amount of a
compound of Formula II that is not systemically absorbed (e.g., a
compound of Formula II that comprises a group L-K) is about 50%
reduced when compared to the AUC of a therapeutically effective
amount of Compound 100A. In other embodiments, the AUC of a
therapeutically effective amount of a compound of Formula II that
is not systemically absorbed (e.g., a compound of Formula II that
comprises a group L-K) is about 75% reduced when compared to the
AUC of a therapeutically effective amount of Compound 100A.
[0500] In some embodiments, the systemic exposure of a
therapeutically effective amount of a compound of Formula III,
IIIA, IIIB or IIIC is reduced when compared to the systemic
exposure of a therapeutically effective amount of Compound 100C. In
some embodiments, the AUC of a therapeutically effective amount of
a compound of Formula III, IIIA, IIIB or IIIC is about 10%, about
20%, about 30%, about 40%, about 50%, about 60%, about 70%, about
80% or about 90% reduced when compared to the AUC of a
therapeutically effective amount of Compound 100C. In some
embodiments, the AUC of a therapeutically effective amount of a
compound of Formula III, IIIA, IIIB or IIIC is about 50% reduced
when compared to the AUC of a therapeutically effective amount of
Compound 100C. In other embodiments, the AUC of a therapeutically
effective amount of a compound of Formula III, IIIA, IIIB or IIIC
is about 75% reduced when compared to the AUC of a therapeutically
effective amount of Compound 100C.
[0501] In some embodiments, the systemic exposure of a
therapeutically effective amount of a compound of Formula IV that
is not systemically absorbed (e.g., a compound of Formula IV that
comprises a group L-K) is reduced when compared to the systemic
exposure of a therapeutically effective amount of Compound 100A. In
some embodiments, the AUC of a therapeutically effective amount of
a compound of Formula IV that is not systemically absorbed (e.g., a
compound of Formula I that comprises a group L-K) is about 10%,
about 20%, about 30%, about 40%, about 50%, about 60%, about 70%,
about 80% or about 90% reduced when compared to the AUC of a
therapeutically effective amount of Compound 100A. In some
embodiments, the AUC of a therapeutically effective amount of a
compound of Formula IV that is not systemically absorbed (e.g., a
compound of Formula IV that comprises a group L-K) is about 50%
reduced when compared to the AUC of a therapeutically effective
amount of Compound 100A. In other embodiments, the AUC of a
therapeutically effective amount of a compound of Formula IV that
is not systemically absorbed (e.g., a compound of Formula IV that
comprises a group L-K) is about 75% reduced when compared to the
AUC of a therapeutically effective amount of Compound 100A.
[0502] In some embodiments, the systemic exposure of a
therapeutically effective amount of a compound of Formula V that is
not systemically absorbed (e.g., a compound of Formula V that
comprises a group L-K) is reduced when compared to the systemic
exposure of a therapeutically effective amount of Compound 100A. In
some embodiments, the AUC of a therapeutically effective amount of
a compound of Formula V that is not systemically absorbed (e.g., a
compound of Formula V that comprises a group L-K) is about 10%,
about 20%, about 30%, about 40%, about 50%, about 60%, about 70%,
about 80% or about 90% reduced when compared to the AUC of a
therapeutically effective amount of Compound 100A. In some
embodiments, the AUC of a therapeutically effective amount of a
compound of Formula I that is not systemically absorbed (e.g., a
compound of Formula V that comprises a group L-K) is about 50%
reduced when compared to the AUC of a therapeutically effective
amount of Compound 100A. In other embodiments, the AUC of a
therapeutically effective amount of a compound of Formula I that is
not systemically absorbed (e.g., a compound of Formula V that
comprises a group L-K) is about 75% reduced when compared to the
AUC of a therapeutically effective amount of Compound 100A.
[0503] In some embodiments, the systemic exposure of a
therapeutically effective amount of a compound of Formula VI or VID
that is not systemically absorbed (e.g., a compound of Formula VI
or VID that comprises a group L-K) is reduced when compared to the
systemic exposure of a therapeutically effective amount of Compound
100A. In some embodiments, the AUC of a therapeutically effective
amount of a compound of Formula VI or VID that is not systemically
absorbed (e.g., a compound of Formula VI or VID that comprises a
group L-K) is about 10%, about 20%, about 30%, about 40%, about
50%, about 60%, about 70%, about 80% or about 90% reduced when
compared to the AUC of a therapeutically effective amount of
Compound 100A. In some embodiments, the AUC of a therapeutically
effective amount of a compound of Formula VI or VID that is not
systemically absorbed (e.g., a compound of Formula VI or VID that
comprises a group L-K) is about 50% reduced when compared to the
AUC of a therapeutically effective amount of Compound 100A. In
other embodiments, the AUC of a therapeutically effective amount of
a compound of Formula I that is not systemically absorbed (e.g., a
compound of Formula VI or VID that comprises a group L-K) is about
75% reduced when compared to the AUC of a therapeutically effective
amount of Compound 100A.
[0504] In certain embodiments, the Cmax of a therapeutically
effective amount of any non-systemic ASBTI described herein (e.g.,
an ASBTI that comprises a group L-K) is at least 10%, at least 20%,
at least 30%, at least 40%, at least 50%, at least 60%, at least
70%, at least 80% or at least 90% reduced when compared to the Cmax
of any systemically absorbed ASBTI (e.g. Compound 100A).
[0505] By way of example, the Cmax of a therapeutically effective
amount of a compound of Formula III, IIIA, IIIB or IIIC is about
10%, about 20%, about 30%, about 40%, about 50%, about 60%, about
70%, about 80% or about 90% reduced when compared to the Cmax of a
therapeutically effective amount of Compound 100C. In some
embodiments, the Cmax of a therapeutically effective amount of a
compound of Formula III, IIIA, IIIB or IIIC is about 25% reduced
when compared to the Cmax of a therapeutically effective amount of
Compound 100C. In certain embodiments, the Cmax of a
therapeutically effective amount of a compound of Ill, IIIA or IIIB
is about 50% reduced when compared to the Cmax of a therapeutically
effective amount of Compound 100C. In other embodiments, the Cmax
of a therapeutically effective amount of a compound of Formula III,
IlA, IIIB or IIIC is about 75% reduced when compared to the Cmax of
a therapeutically effective amount of Compound 100C.
[0506] In certain embodiments, provided herein is a method of
treating a metabolic disease or a condition associated with a
metabolic disease with an ASBTI and/or enteroendocrine peptide
secretion enhancing agent and an optional carrier. In some
embodiments, provided herein are methods of treating a metabolic
disease comprising administering any composition as described
herein. In some embodiments, provided herein is the use of any of
the pharmaceutical compositions described herein in preparing a
medicament for treating a metabolic disease. In specific
embodiments, the metabolic disease is selected from, by way of
non-limiting example, obesity, diabetes, necrotizing enterocolitis,
gastritis, ulcerative colitis, inflammatory bowel disease,
irritable bowel syndrome, gastroenteritis, radiation induced
enteritis, chemotherapy induced enteritis, gastro-esophageal reflux
disease (GERD), peptic ulcer, non-ulcer dyspepsia (NUD), celiac
disease, intestinal celiac disease, gastrointestinal complications
following bariatric surgery, gastric carcinogenesis, gastric
carcinogenesis following gastric or bowel resection, and a
combination thereof. In some embodiments, provided herein is a
method of treating a condition associated with a metabolic disease.
In certain embodiments, provided herein is the use of any of the
pharmaceutical compositions described herein in preparing a
medicament for treating a condition associated with a metabolic
disease. In some embodiments, conditions associated with a
metabolic disease are selected from, by way of non-limiting
example, necrosis or damage of ileal architecture or ileal cells,
weight gain, food intake, appetite, impaired glucose tolerance, a
glucose metabolic disorder, and insulin resistance. In certain
embodiments, conditions associated with a metabolic disease are
selected from, by way of non-limiting example, acute coronary
syndrome, hibernating myocardium, ventricular dysfunction, cardiac
risk, post myocardial infarction mortality, post-surgical
catabolism, sepsis-related catabolism, critical illness-related
catabolism, post-surgical mortality, sepsis-related mortality,
critical illness-related mortality, critical
illness-polyneuropathy, congestive heart failure, toxic
hypervolemia, renal failure, ischemia-reperfusion injury, mortality
and morbidity from stroke, mortality and morbidity from
neurodegenerative disease, neuropathy, inflammatory bowel disease,
bowel mucosal injury, impaired bowel integrity, irritable bowel
disease, osteopenia, and a bone fracture or a bone disorder. It is
to be understood that the term, "treating" includes controlling,
suppressing, inhibiting, reducing the symptoms of and/or
preventing.
[0507] Furthermore, in certain embodiments, provided herein is a
method of decreasing intraenterocyte bile acids, decreasing
necrosis and/or damage to ileal architecture, decreasing appetite,
decreasing food intake, and/or decreasing appetite by administering
a therapeutically effective amount of any enteroendocrine peptide
secretion enhancing agent or composition described herein. In some
embodiments, provided herein is an enteroendocrine peptide
secretion enhancing agent or a composition used for preparing a
medicament for decreasing appetite, decreasing food intake, and/or
decreasing appetite.
[0508] In some embodiments, provided herein is a method of treating
obesity, diabetes, or an inflammatory intestinal condition in an
individual comprising delivering to ileal, colon, and/or rectal
L-cells of the individual a therapeutically effective amount of any
ASBTI and/or enteroendocrine peptide secretion enhancing agent
described herein. In certain embodiments, the therapeutically
effective amount of enteroendocrine peptide secretion enhancing
agent stimulates or activates the L-cells to which the
enteroendocrine peptide secretion enhancing agent is
administered.
[0509] FIG. 11 illustrates the reduction of food intake in response
to administration of anenteroendocrine peptide secretion enhancing
agent. FIG. 11 illustrates that with increased amounts of
enteroendocrine peptide secretion enhancing agent administered to
the distal gastrointestinal tract, decreased amounts of calories
were consumed by human subjects.
[0510] In some embodiments, provided herein is a method of treating
diabetes in an individual comprising delivering to ileal, colon,
and/or rectal L-cells of an individual in need thereof a
therapeutically effective amount of any enteroendocrine peptide
secretion enhancing agent described herein. In certain embodiments,
provided herein is a method of treating diabetes in an individual
comprising delivering to ileum, colon, and/or rectum of an
individual in need thereof a therapeutically effective amount of
any enteroendocrine peptide secretion enhancing agent described
herein. In some embodiments, provided herein is a method of
elevating insulin levels in an individual comprising delivering to
ileum, colon, and/or rectum of an individual in need thereof (e.g.,
a diabetic individual) a therapeutically effective amount of any
enteroendocrine peptide secretion enhancing agent described herein.
In certain embodiments, provided herein is a method of reducing
glucose levels in an individual comprising delivering to ileum,
colon, and/or rectum of an individual in need thereof (e.g., a
diabetic individual) a therapeutically effective amount of any
enteroendocrine peptide secretion enhancing agent described herein.
In some embodiments, the therapeutically effective amount of
enteroendocrine peptide secretion enhancing agent stimulates or
activates the L-cells of the ileum, colon, and/or rectum to which
the enteroendocrine peptide secretion enhancing agent is
administered.
[0511] FIG. 12 illustrates the insulin response to administration
of an enteroendocrine peptide secretion enhancing agent. FIG. 12
illustrates that with increased amounts of enteroendocrine peptide
secretion enhancing agent administered to the distal
gastrointestinal tract, human diabetics demonstrated increased
levels of insulin. FIG. 13 illustrates the incremental integrated
response of insulin levels to administration of an enteroendocrine
peptide secretion enhancing agent.
[0512] FIG. 14 illustrates the glucose response to administration
of an enteroendocrine peptide secretion enhancing agent. FIG. 14
illustrates that with increased amounts of enteroendocrine peptide
secretion enhancing agent administered to the distal
gastrointestinal tract, human diabetics demonstrated decreased
levels of glucose. FIG. 15 illustrates the incremental integrated
response of glucose levels to administration of an enteroendocrine
peptide secretion enhancing agent.
[0513] In some embodiments, provided herein is a method of
elevating GLP-1, PYY, oxyntomodulin, insulin, or a combination
thereof levels in an individual comprising delivering to ileum,
colon, and/or rectum of an individual in need thereof (e.g., a
diabetic individual) a therapeutically effective amount of any
enteroendocrine peptide secretion enhancing agent described herein.
In some embodiments, provided herein is a method of elevating
GLP-1, PYY, oxyntomodulin, and insulin levels in an individual
comprising delivering to ileum, colon, and/or rectum of an
individual in need thereof (e.g., a diabetic individual) a
therapeutically effective amount of any enteroendocrine peptide
secretion enhancing agent described herein.
[0514] In some embodiments, provided herein is a method of
preventing or treating pancreatic or other cancers in an individual
comprising delivering to ileal, colon, and/or rectal L-cells of an
individual in need thereof a therapeutically effective amount of
any enteroendocrine peptide secretion enhancing agent described
herein. In certain embodiments, provided herein is a method of
preventing or treating pancreatic or other cancers in an individual
comprising delivering to ileum, colon, and/or rectum of an
individual in need thereof a therapeutically effective amount of
any enteroendocrine peptide secretion enhancing agent described
herein. In some embodiments, the therapeutically effective amount
of enteroendocrine peptide secretion enhancing agent stimulates or
activates the L-cells of the ileum, colon, and/or rectum to which
the enteroendocrine peptide secretion enhancing agent is
administered. Other cancers include but are not limited to breast,
rectal, colon and lung cancers.
[0515] In certain embodiments, the pharmaceutical composition
administered includes a therapeutically effective amount of an
enteroendocrine peptide secretion enhancing agent, an absorption
inhibitor and a carrier (e.g., an orally suitable carrier or a
rectally suitable carrier, depending on the mode of intended
administration). In certain embodiments, the pharmaceutical
composition used or administered comprises an enteroendocrine
peptide secretion enhancing agent, an absorption inhibitor, a
carrier, and one or more of a cholesterol absorption inhibitor, an
enteroendocrine peptide, a peptidase inhibitor, a spreading agent,
and a wetting agent.
[0516] In a specific embodiment, the pharmaceutical composition
used to prepare a rectal dosage form or administered rectally
comprises an enteroendocrine peptide secretion enhancing agent, an
absorption inhibitor, a rectally suitable carrier, an optional
cholesterol absorption inhibitor, an optional enteroendocrine
peptide, an optional peptidase inhibitor, an optional spreading
agent, and an optional wetting agent. In certain embodiments,
rectally administered compositions evokes an anorectal response. In
specific embodiments, the anorectal response is an increase in
secretion of one or more enteroendocrine by cells (e.g., L-cells)
in the colon and/or rectum (e.g., in the epithelial layer of the
colon and/or rectum). In some embodiments, the anorectal response
persists for at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,
14, 15, 16, 17, 18, 19, 20, 21, 22, 23 or 24 hours. In other
embodiments the anorectal response persists for a period between 24
hours and 48 hours, while in other embodiments the anorectal
response persists for persists for a period greater than 48
hours.
[0517] In another specific embodiment, the pharmaceutical
composition used to prepare an oral dosage form or administered
orally comprises an enteroendocrine peptide secretion enhancing
agent, an absorption inhibitor, an orally suitable carrier, an
optional cholesterol absorption inhibitor, an optional
enteroendocrine peptide, an optional peptidase inhibitor, an
optional spreading agent, and an optional wetting agent. In certain
embodiments, the orally administered compositions evokes an
anorectal response. In specific embodiments, the anorectal response
is an increase in secretion of one or more enteroendocrine by cells
in the colon and/or rectum (e.g., in L-cells the epithelial layer
of the colon and/or rectum). In some embodiments, the anorectal
response persists for at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,
12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 or 24 hours. In
other embodiments the anorectal response persists for a period
between 24 hours and 48 hours, while in other embodiments the
anorectal response persists for persists for a period greater than
48 hours.
[0518] Provided herein are methods for prevention and/or treatment
of congestive heart failure, ventricular dysfunction, toxic
hypervolemia, polycystic ovary syndrome, inflammatory bowel
disease, impaired bowel integrity, short bowel syndrome, gastritis,
peptic ulcer, or irritable bowel disease comprising contacting the
distal gastrointestinal tract (e.g., colon and/or rectum) of an
individual in need thereof with an enteroendocrine peptide
secretion enhancing agent and an optional absorption inhibitor. In
some embodiments, the methods further comprise administration of a
DPP-IV inhibitor, an enteroendocrine peptide enhancing agent, a
biguanide, an incretin mimetic, or GLP-1 or an analog thereof.
Provided herein are methods for prevention and/or treatment of
radiation enteritis comprising contacting the distal
gastrointestinal tract (e.g., colon and/or rectum) of an individual
in need thereof with an enteroendocrine peptide secretion enhancing
agent and an optional absorption inhibitor. In some embodiments,
the methods further comprise administration of a DPP-IV inhibitor,
an enteroendocrine peptide enhancing agent, a biguanide, an
incretin mimetic, or GLP-1 or an analog thereof. Provided in
certain embodiments herein is a method of promoting regeneration of
the gastrointestinal tract by administering to the distal
gastrointestinal tract (e.g., colon and/or rectum) of the
individual, a therapeutically effective amount of an
enteroendocrine peptide secretion enhancing agent and an optional
absorption inhibitor. In some embodiments, the methods further
comprise administration of a DPP-IV inhibitor, a TGR5 agonist, a
biguanide, an incretin mimetic, or GLP-2 or an analog thereof. In
some instances, radiation enteritis, or an inflammation of the
intestine, is not only major complication of cancer radiation
therapy, but occur after any accidental and intentional radiation
exposure. In certain instances, GLP-2 secreted from L-cells (e.g.,
by administration thereto an enteroendocrine peptide secretion
enhancing agent described herein) plays important role in
regeneration of GI tract injuries.
Routes of Administration and Dosage
[0519] In some embodiments, the compositions described herein and
the compositions administered in the methods described herein are
formulated to enhance enteroendocrine peptide secretion and to
evoke an anorectal response. In certain embodiments, the
compositions described herein are formulated for rectal or oral
administration. In some embodiments, such formulations are
administered rectally or orally, respectively. In some embodiments,
the compositions described herein are combined with a device for
local delivery of the compositions to the rectum and/or colon
(sigmoid colon, transverse colon, or ascending colon). In certain
embodiments, for rectal administration the composition described
herein are formulated as enemas, rectal gels, rectal foams, rectal
aerosols, suppositories, jelly suppositories, or retention enemas.
In some embodiments, for oral administration the compositions
described herein are formulated for oral administration and enteric
delivery to the colon.
[0520] In certain embodiments, the compositions or methods
described herein are non-systemic. In some embodiments,
compositions described herein deliver the enteroendocrine peptide
secretion enhancing agent to the distal ileum, colon, and/or rectum
and not systemically (e.g., a substantial portion of the
enteroendocrine peptide secretion enhancing agent is not
systemically absorbed). In some embodiments, oral compositions
described herein deliver the enteroendocrine peptide secretion
enhancing agent to the distal ileum, colon, and/or rectum and not
systemically (e.g., a substantial portion of the enteroendocrine
peptide secretion enhancing agent is not systemically absorbed). In
some embodiments, rectal compositions described herein deliver the
enteroendocrine peptide secretion enhancing agent to the distal
ileum, colon, and/or rectum and not systemically (e.g., a
substantial portion of the enteroendocrine peptide secretion
enhancing agent is not systemically absorbed). In certain
embodiments, non-systemic compositions described herein deliver
less than 90% w/w of the enteroendocrine peptide secretion
enhancing agent systemically. In certain embodiments, non-systemic
compositions described herein deliver less than 80% w/w of the
enteroendocrine peptide secretion enhancing agent systemically. In
certain embodiments, non-systemic compositions described herein
deliver less than 70% w/w of the enteroendocrine peptide secretion
enhancing agent systemically. In certain embodiments, non-systemic
compositions described herein deliver less than 60% w/w of the
enteroendocrine peptide secretion enhancing agent systemically. In
certain embodiments, non-systemic compositions described herein
deliver less than 50% w/w of the enteroendocrine peptide secretion
enhancing agent systemically. In certain embodiments, non-systemic
compositions described herein deliver less than 40% w/w of the
enteroendocrine peptide secretion enhancing agent systemically. In
certain embodiments, non-systemic compositions described herein
deliver less than 30% w/w of the enteroendocrine peptide secretion
enhancing agent systemically. In certain embodiments, non-systemic
compositions described herein deliver less than 25% w/w of the
enteroendocrine peptide secretion enhancing agent systemically. In
certain embodiments, non-systemic compositions described herein
deliver less than 20% w/w of the enteroendocrine peptide secretion
enhancing agent systemically. In certain embodiments, non-systemic
compositions described herein deliver less than 15% w/w of the
enteroendocrine peptide secretion enhancing agent systemically. In
certain embodiments, non-systemic compositions described herein
deliver less than 10% w/w of the enteroendocrine peptide secretion
enhancing agent systemically. In certain embodiments, non-systemic
compositions described herein deliver less than 5% w/w of the
enteroendocrine peptide secretion enhancing agent systemically. In
some embodiments, systemic absorption is determined in any suitable
manner, including the total circulating amount, the amount cleared
after administration, or the like.
[0521] In certain embodiments, the compositions and/or formulations
described herein are administered at least once a day. In certain
embodiments, the formulations containing the enteroendocrine
peptide secretion enhancing agents are administered at least twice
a day, while in other embodiments the formulations containing the
enteroendocrine peptide secretion enhancing agents are administered
at least three times a day. In certain embodiments, the
formulations containing the enteroendocrine peptide secretion
enhancing agents are administered up to five times a day. It is to
be understood that in certain embodiments, the dosage regimen of
composition containing the enteroendocrine peptide secretion
enhancing agents described herein to is determined by considering
various factors such as the patient's age, sex, and diet.
[0522] The concentration of the enteroendocrine peptide secretion
enhancing agents administered in the formulations described herein
ranges from about 1 mM to about 1 M. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 1 mM to about 750 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 1 mM to about 500 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 5 mM to about 500 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 10 mM to about 500 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 25 mM to about 500 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 50 mM to about 500 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 100 mM to about 500 mM. In certain embodiments the
concentration of the enteroendocrine peptide secretion enhancing
agents administered in the formulations described herein ranges
from about 200 mM to about 500 mM.
[0523] In certain embodiments, any composition described herein
comprises a therapeutically effective amount (e.g., to treat
obesity and/or diabetes) of an enteroendocrine peptide secretion
enhancing agent (e.g., bile acid). In some embodiments,
compositions described herein comprise or methods described herein
comprise administering about 0.01 mg to about 10 g of an
enteroendocrine peptide secretion enhancing agent (e.g., bile
acid). In certain embodiments, a composition described herein
comprises or a method described herein comprises administering
about 0.1 mg to about 500 mg of an enteroendocrine peptide
secretion enhancing agent (e.g., bile acid). In certain
embodiments, a composition described herein comprises or a method
described herein comprises administering about 0.1 mg to about 100
mg of an enteroendocrine peptide secretion enhancing agent (e.g.,
bile acid). In certain embodiments, a composition described herein
comprises or a method described herein comprises administering
about 0.1 mg to about 50 mg of an enteroendocrine peptide secretion
enhancing agent (e.g., bile acid). In certain embodiments, a
composition described herein comprises or a method described herein
comprises administering about 0.1 mg to about 10 mg of an
enteroendocrine peptide secretion enhancing agent (e.g., bile
acid). In certain embodiments, a composition described herein
comprises or a method described herein comprises administering
about 0.5 mg to about 10 mg of an enteroendocrine peptide secretion
enhancing agent (e.g., bile acid). In some embodiments,
compositions described herein comprise or methods described herein
comprise administering about 0.1 mmol to about 1 mol of an
enteroendocrine peptide secretion enhancing agent (e.g., bile
acid). In certain embodiments, a composition described herein
comprises or a method described herein comprises administering
about 0.01 mmol to about 500 mmol of an enteroendocrine peptide
secretion enhancing agent (e.g., bile acid). In certain
embodiments, a composition described herein comprises or a method
described herein comprises administering about 0.11 mmol to about
100 mmol of an enteroendocrine peptide secretion enhancing agent
(e.g., bile acid). In certain embodiments, a composition described
herein comprises or a method described herein comprises
administering about 0.5 mmol to about 30 mmol of an enteroendocrine
peptide secretion enhancing agent (e.g., bile acid). In certain
embodiments, a composition described herein comprises or a method
described herein comprises administering about 0.5 mmol to about 20
mmol of an enteroendocrine peptide secretion enhancing agent (e.g.,
bile acid). In certain embodiments, a composition described herein
comprises or a method described herein comprises administering
about 1 mmol to about 10 mmol of an enteroendocrine peptide
secretion enhancing agent (e.g., bile acid). In certain
embodiments, a composition described herein comprises or a method
described herein comprises administering about 0.01 mmol to about 5
mmol of an enteroendocrine peptide secretion enhancing agent (e.g.,
bile acid). In certain embodiments, a composition described herein
comprises or a method described herein comprises administering
about 0.1 mmol to about 1 mmol of an enteroendocrine peptide
secretion enhancing agent (e.g., bile acid). In various
embodiments, certain enteroendocrine peptide secretion enhancing
agents (e.g., bile acids) have different potencies and dosing is
optionally adjusted accordingly. For example, the investigation in
TGR5-transfected CHO cells of TGR5 agonist potency of natural bile
acids indicates the following rank of potency: Lithocholic acid
(LCA)>deoxycholic acid (DCA)>murocholic acid
(Muro-CA)>lagodeoxycholic acid (lago-DCA)>chenodeoxycholic
(CDCA)>cholic acid (CA)>hyodeoxycholic acid (HDCA
>ursodeoxycholic acid (UDCA); and assays on TGR5-transfected CHO
cells demonstrate that EC.sub.50 (in .mu.M) for UDCA was 36.4,
TauroCA (TCA) 4.95 and LCA 0.58.
[0524] In certain embodiments, by targeting the distal
gastrointestinal tract (e.g., distal ileum, colon, and/or rectum),
compositions and methods described herein provide efficacy (e.g.,
in reducing food intake, treating obesity, treating diabetes) with
a reduced dose of enteroendocrine peptide secretion enhancing agent
(e.g., as compared to an oral dose that does not target the distal
gastrointestinal tract).
Rectal Administration Formulations
[0525] The pharmaceutical compositions described herein for the
non-systemic delivery of enteroendocrine peptide secretion
enhancing agents to the rectum and/or colon are formulated for
rectal administration as rectal enemas, rectal foams, rectal gels,
and rectal suppositories. The components of such formulations are
described herein. It is to be understood that as used herein,
pharmaceutical compositions and compositions are or comprise the
formulations as described herein.
Rectal Enemas
[0526] In certain embodiments, the compositions described herein
are formulated as rectal enema formulations for non-systemic
delivery of enteroendocrine peptide secretion enhancing agents. In
certain embodiments, such rectal enemas are formulated as a
solution, aqueous suspension or emulsion. In some embodiments,
solution enemas contain a carrier vehicle, an enteroendocrine
peptide secretion enhancing agent, an absorption inhibitor (e.g.,
of the enteroendocrine peptide secretion enhancing agent across the
rectal or colonic mucosa), and one or more of the following: a
solubilizer, a preservative, a chelating agent, a buffer for pH
regulation, and a thickener. In certain embodiments, rectal enemas
are formulated as an emulsion or aqueous suspension containing a
carrier vehicle, at least one enteroendocrine peptide secretion
enhancing agent, at least one agent for inhibiting absorption of
the enteroendocrine peptide secretion enhancing agent across the
rectal or colonic mucosa, and one or more of the following: a
preservative, a chelating agent, a buffer for pH regulation, a
solubilizer, a thickener, and an emulsifier/surfactant.
[0527] In certain embodiments, rectal enemas are formulated such
that a enteroendocrine peptide secretion enhancing agent is
dissolved or dispersed in a suitable flowable carrier vehicle,
including but not limited to water, alcohol or an aqueous-alcoholic
mixture. In certain embodiments, the carrier vehicle is thickened
with natural or synthetic thickeners. In further embodiments the
rectal enema formulations also contain a lubricant.
[0528] In some embodiments, unit dosages of such enema formulations
are administered from prefilled bags or syringes.
[0529] In certain embodiments, the volume of enema administered
using such rectal enema formulations is a volume suitable for
achieving a desired result, e.g., from about 10 mL to about 1000
mL. In certain embodiments, the volume of enema administered using
such rectal enema formulations is from about 10 mL to about 900 mL.
In certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 800 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 700 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 600 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 500 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 400 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 300 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 200 mL. In
certain embodiments, the volume of enema administered using such
rectal enema formulations is from about 10 mL to about 100 mL. In
some embodiments, such enemas may have a volume of less than 1 L,
less than 900 mL, less than 700 mL, less than 600 mL, less than 500
mL, less than 250 mL, less than 100 mL, less than 30 mL, less than
10 mL, less than 3 mL, or the like.
Rectal Foams
[0530] In certain instances, leakage is a problem associated with
enemas. As such, it is often desirable or necessary for patients to
lie down during administration of enemas. In some embodiments,
rectal administration using foams overcomes the problem of leakage
from the rectum following administration.
[0531] In certain embodiments, the pharmaceutical compositions are
formulated as rectal foams. In some embodiments, rectal foams are
used for the rectal administration and for local or non-systemic
delivery of enteroendocrine peptide secretion enhancing agents to
the rectum and/or colon. Such rectal foams formulations contain an
enteroendocrine peptide secretion enhancing agent dissolved or
suspended in a liquid carrier vehicle, an absorption inhibitor
(e.g., of the enteroendocrine peptide secretion enhancing agent
across the rectal or colonic mucosa), a surfactant/emulsifier with
foaming properties and a propellant (e.g., a propellant gas). In
certain embodiments, rectal foam formulations also contain one or
more of the following: a suspending/solubilizing agent, a
thickener, a preservative, a chelating agent, a buffer, an
antioxidant, a tonicity modifiers, and a spreading agent. In
certain embodiments, surfactants/emulsifiers include, by way of
non-limiting example, non-ionic surfactants, anionic surfactants,
cationic surfactants, and combinations thereof.
[0532] In certain embodiments, rectal foam formulations are filled
in pressurized containers prior to rectal administration. In
certain embodiments the pressurized container is a can. In certain
embodiments, propellants used herein include, by way of
non-limiting example, hydrocarbons (such as isobutane, N-butane or
propane), fluorocarbons (e.g. dichlorodifluoromethane and
dichlorotetrafluoroethane), chlorofluorocarbons, dimethyl ether,
hydrofluorocarbons, compressed gases, freon (such as freon 12,
freon 114), hydrochlorofluorocarbons, hydrofluorocarbons or
mixtures thereof.
[0533] In some embodiments, the maximum amount of propellant used
is determined by its miscibility with other components in the
composition to form a mixture, such as a homogeneous mixture. In
certain embodiments, the minimal level of propellant used in the
composition is determined by the desired foam characteristics, and
its ability to substantially or completely evacuate the
container.
[0534] In some embodiments, the propellant concentration used in
such rectal foam formulations is about 1%, 2%, 3%, 4%, 5%, 6%, 7%,
8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 25%,
30%, 35%, 40%, 50%, 55% to about 60% (w/w).
[0535] In certain embodiments, rectal foams are formed upon rectal
administration, wherein the dispensing valve of the can allows
rapid expansion of the propellant, triggering the foaming action of
the surfactant and resulting foam forms within the rectum and
colon. In other embodiments, the rectal foams used for rectal
administration of the compositions described herein are formed
within the dispensing container prior to rectal administration.
[0536] The distance the foam can reach within the colon and rectum
is controlled by controlling the foam propelling properties by
varying the type and quantity of propellant used. The volume of
foam administered using such rectal foam formulations is from about
10 mL to about 1000 mL. In certain embodiments, the volume of a
composition described herein (e.g., a foam) described herein or
used in a method described herein (e.g., a foam, enema, or gel) is
from about 10 mL to about 900 mL. In certain embodiments, the
volume of a composition described herein (e.g., a foam) described
herein or used in a method described herein (e.g., a foam, enema,
or gel) is from about 10 mL to about 800 mL. In certain
embodiments, the volume of a composition described herein (e.g., a
foam) described herein or used in a method described herein (e.g.,
a foam, enema, or gel) is from about 10 mL to about 700 mL. In
certain embodiments, the volume of a composition described herein
(e.g., a foam) described herein or used in a method described
herein (e.g., a foam, enema, or gel) is from about 10 mL to about
600 mL. In certain embodiments, the volume of a composition
described herein (e.g., a foam) described herein or used in a
method described herein (e.g., a foam, enema, or gel) is from about
10 mL to about 500 mL. In certain embodiments, the volume of a
composition described herein (e.g., a foam) described herein or
used in a method described herein (e.g., a foam, enema, or gel) is
from about 10 mL to about 400 mL. In certain embodiments, the
volume of a composition described herein (e.g., a foam) described
herein or used in a method described herein (e.g., a foam, enema,
or gel) is from about 10 mL to about 300 mL. In certain
embodiments, the volume of a composition described herein (e.g., a
foam) described herein or used in a method described herein (e.g.,
a foam, enema, or gel) is from about 10 mL to about 200 mL. In
certain embodiments, the volume of a composition described herein
(e.g., a foam) described herein or used in a method described
herein (e.g., a foam, enema, or gel) is from about 10 mL to about
100 mL. In specific embodiments, the volume of a composition
described herein (e.g., a foam) described herein or used in a
method described herein (e.g., a foam, enema, or gel) is about 20
mL to about 60 mL, about 20 mL, about 40 mL, or about 60 mL.
Rectal Gels
[0537] In some embodiments, the pharmaceutical compositions
described herein are formulated as rectal gels. In certain
embodiments, the rectal gels are suitable for the regional or local
non-systemic administration of one or more enteroendocrine peptide
secretion enhancing agents to the rectum and/or colon. In some
embodiments, rectal gel formulations contain at least one
enteroendocrine peptide secretion enhancing agent dissolved or
suspended in a solvent/liquid carrier vehicle, an absorption
inhibitor (e.g., of the enteroendocrine peptide secretion enhancing
agent across the rectal or colonic mucosa) and at least one
thickening agents. In certain embodiments such rectal gel
formulations also contain one or more of the following: a buffering
agent(s), a preservative(s), and an antioxidant(s).
[0538] In certain embodiments, rectal gels have gel-like
consistencies but are sufficiently flowable so as to be capable of
local or regional administration through a catheter, needle,
syringe, or other comparable means of local or regional
administration.
[0539] In some embodiments, the concentration of a thickener used
in a rectal gel formulation is in an amount or concentration
suitable to achieve a desired thickness or viscosity, e.g., from
about 0.05% to about 10% by weight. In certain embodiments, the
concentration of the thickener used in such rectal gel formulations
ranges from about 0.05% to about 8% by weight. In certain
embodiments, the concentration of the thickener used in such rectal
gel formulations ranges from about 0.05% to about 7% by weight. In
certain embodiments, the concentration of the thickener used in
such rectal gel formulations ranges from about 0.05% to about 6% by
weight. In certain embodiments, the concentration of the thickener
used in such rectal gel formulations ranges from about 0.05% to
about 5% by weight. In certain embodiments, the concentration of
the thickener used in such rectal gel formulations ranges from
about 0.05% to about 4% by weight. In certain embodiments, the
concentration of the thickener used in such rectal gel formulations
ranges from about 0.05% to about 3% by weight. In certain
embodiments, the concentration of the thickener used in such rectal
gel formulations ranges from about 0.05% to about 2% by weight. In
certain embodiments, the concentration of the thickener used in
such rectal gel formulations ranges from about 0.05% to about 1% by
weight. In certain embodiments the rectal gel formualtion includes
methyl cellulose having a concentration from about 0.05% to about
2%, while in other embodiments the rectal gel formualtion includes
methyl cellulose having a concentration of about 1%.
[0540] In some embodiments, the any formulation described herein
(e.g., arectal gel formulation) has a viscosity ranging from about
500 to about 50,000 centipoise (cP) at 25 C. In certain
embodiments, the viscosity of the formulation described herein is
from about 500 to about 40,000 centipoise (cP) at 25 C. In certain
embodiments, the viscosity of the formulation described herein is
from about 500 to about 30,000 centipoise (cP) at 25 C. In certain
embodiments, the viscosity of the formulation described herein is
from about 500 to about 20,000 centipoise (cP) at 25 C. In certain
embodiments, the viscosity of the formulation described herein is
from about 500 to about 10,000 centipoise (cP) at 25 C. In some
embodiments, the formulation has a final viscosity of less than
about 40,000 centipoises (cP), 20,000 cP, 15,000 cP, or 10,000 cP
at 25 C. In some embodiments, the formulation has a viscosity of
about 5,000 cP, 6,000 cP, 7,000 cP, 8,000 cP, 9,000 cP, 10,000 cP,
12,000 cP, 15,000 cP, 18,000 cP, 20,000 cP, 25,000 cP, 30,000 cP,
35,000 cP, or 40,000 cP at 25 C. In some embodiments, the
formulation has a viscosity of about 1,000-20,000 cP, 5,000-15,000
cP, 6,000-12,000 cP, 7,000-10,000, 500-3500 cP, 500-300cP,
1,000-2,000 cP, or about 1,500 cP at 25 C. In specific embodiments,
the formulation has a viscosity of 1,000 cP to about 2,500 cP, or
about 1,500 cP at 25 C. In certain embodiments, the amount of
thickener used in a composition described herein is sufficient to
achieve a viscosity as described herein. FIG. 4 illustrates the
affect of the viscosity of a formulation described herein on the
food intake of a subject.
[0541] In some embodiments, unit dosages of such rectal gel
formulations are administered from prefilled bags or syringes.
Rectal Suppositories
[0542] In some embodiments, the pharmaceutical compositions
described herein are also formulated as a suppository. In certain
embodiments, suppositories are formulated for the regional or local
non-systemic administration of one or more enteroendocrine peptide
secretion enhancing agents to the rectum and/or colon.
[0543] In some embodiments, rectal suppository formulations contain
a enteroendocrine peptide secretion enhancing agent, an absorption
inhibitor (e.g., of the enteroendocrine peptide secretion enhancing
agent across the rectal or colonic mucosa) and at least one
pharmaceutically acceptable suppository base. In some embodiments,
suppository formulation are prepared by combining an
enteroendocrine peptide secretion enhancing agent with a
pharmaceutically acceptable suppository base, melted, poured into a
mould or moulds and cooled.
[0544] In certain embodiments, pharmaceutically acceptable
suppository bases include, by way of non-limiting example, cocoa
butter, beeswax, esterified fatty acids, glycerinated gelatin,
semisynthetic glycerides of vegetable saturated fatty acids,
polyethylene glycols, Witepsol, and polyoxyethylene sorbitan fatty
acid esters.
[0545] In certain embodiments, the suppository formulations used to
deliver one or more enteroendocrine peptide secretion enhancing
agents to the rectum and/or colon also contain one or more of the
following: buffering agents, preservatives, antioxidants,
surfactants, and thickeners.
[0546] In some embodiments, suppositories contain from 0.5 to 10 mg
of an enteroendocrine peptide secretion enhancing agent. In
specific embodiments, suppositories contain from 1 to 5 mg of an
enteroendocrine peptide secretion enhancing agent.
Components Used in Rectal Delivery/Administration Formulations
[0547] In certain embodiments, liquid carrier vehicles in the
compositions and/or formulations described herein include, by way
of non-limiting example, purified water, propylene glycol,
polyethyleneglycol, ethanol, 1-propanol, 2-propanol, 1-propen-3-ol
(allyl alcohol), propylene glycol, glycerol, 2-methyl-2-propanol,
formamide, methyl formamide, dimethyl formamide, ethyl formamide,
diethyl formamide, acetamide, methyl acetamide, dimethyl acetamide,
ethyl acetamide, diethyl acetamide, 2-pyrrolidone,
N-methyl-2-pyrrolidone, N-ethyl-2-pyrrolidone, tetramethyl urea,
1,3-dimethyl-2-imidazolidinone, propylene carbonate, 1,2-butylene
carbonate, 2,3-butylene carbonate, dimethyl sulfoxide, diethyl
sulfoxide, hexamethyl phosphoramide, pyruvic aldehyde
dimethylacetal, dimethylisosorbide and combinations thereof.
[0548] In some embodiments, stabilizers used in compositions and/or
formulations described herein include, but are not limited to,
partial glycerides of polyoxyethylenic saturated fatty acids.
[0549] In certain embodiments, surfactants/emulsifiers used in the
compositions and/or formulations described herein include, by way
of non-limiting example, mixtures of cetostearylic alcohol with
sorbitan esterified with polyoxyethylenic fatty acids,
polyoxyethylene fatty ethers, polyoxyethylene fatty esters, fatty
acids, sulfated fatty acids, phosphated fatty acids,
sulfosuccinates, amphoteric surfactants, non-ionic poloxamers,
non-ionic meroxapols, petroleum derivatives, aliphatic amines,
polysiloxane derivatives, sorbitan fatty acid esters, laureth-4,
PEG-2 dilaurate, stearic acid, sodium lauryl sulfate, dioctyl
sodium sulfosuccinate, cocoamphopropionate, poloxamer 188,
meroxapol 258, triethanolamine, dimethicone, polysorbate 60,
sorbitan monostearate, pharmaceutically acceptable salts thereof,
and combinations thereof.
[0550] In some embodiments, non-ionic surfactants used in
compositions and/or formulations described herein include, by way
of non-limiting example, phospholipids, alkyl poly(ethylene oxide),
poloxamers, polysorbates, sodium dioctyl sulfosuccinate,
Brij.TM.-30 (Laureth-4), Brij.TM.-58 (Ceteth-20) and Brij.TM.-78
(Steareth-20), Brij.TM.-721 (Steareth-21), Crillet-1 (Polysorbate
20), Crillet-2 (Polysorbate 40), Crillet-3 (Polysorbate 60),
Crillet 45 (Polysorbate 80), Myrj-52 (PEG-40 Stearate), Myrj-53
(PEG-50 Stearate), Pluronic.TM. F77 (Poloxamer 217). Pluronic.TM.
F87 (Poloxamer 237), Pluronic.TM. F98 (Poloxamer 288), Pluronic.TM.
L62 (Poloxamer 182), Pluronic.TM. L64 (Poloxamer 184), Pluronic.TM.
F68 (Poloxamer 188), Pluronic.TM. L81 (Poloxamer 231), Pluronic.TM.
L92 (Poloxamer 282), Pluronic.TM. L101 (Poloxamer 331),
Pluronic.TM. P103 (Poloxamer 333), Pluracare.TM. F 108 NF
(Poloxamer 338), and Pluracare.TM. F 127 NF (Poloxamer 407) and
combinations thereof. Pluronic.TM. polymers are commercially
purchasable from BASF, USA and Germany.
[0551] In certain embodiments, anionic surfactants used in
compositions and/or formulations described herein include, by way
of non-limiting example, sodium laurylsulphate, sodium dodecyl
sulfate (SDS), ammonium lauryl sulfate, alkyl sulfate salts, alkyl
benzene sulfonate, and combinations thereof.
[0552] In some embodiments, the cationic surfactants used in
compositions and/or formulations described herein include, by way
of non-limiting example, benzalkonium chloride, benzethonium
chloride, cetyl trimethylammonium bromide, hexadecyl trimethyl
ammonium bromide, other alkyltrimethylammonium salts,
cetylpyridinium chloride, polyethoxylated tallow and combinations
thereof.
[0553] In certain embodiments, the thickeners used i in
compositions and/or formulations described herein include, by way
of non-limiting example, natural polysaccharides, semi-synthetic
polymers, synthetic polymers, and combinations thereof. Natural
polysaccharides include, by way of non-limiting example, acacia,
agar, alginates, carrageenan, guar, arabic, tragacanth gum,
pectins, dextran, gellan and xanthan gums. Semi-synthetic polymers
include, by way of non-limiting example, cellulose esters, modified
starches, modified celluloses, carboxymethylcellulose, methyl
cellulose, ethyl cellulose, hydroxyethyl cellulose, hydroxypropyl
cellulose and hydroxypropyl methylcellulose. Synthetic polymers
include, by way of non-limiting example, polyoxyalkylenes,
polyvinyl alcohol, polyacrylamide, polyacrylates,
carboxypolymethylene (carbomer), polyvinylpyrrolidone (povidones),
polyvinylacetate, polyethylene glycols and poloxamer. Other
thickeners include, by way of nonlimiting example,
polyoxyethyleneglycol isostearate, cetyl alcohol, Polyglycol 300
isostearate, propyleneglycol, collagen, gelatin, and fatty acids
(e.g., lauric acid, myristic acid, palmitic acid, stearic acid,
palmitoleic acid, linoleic acid, linolenic acid, oleic acid and the
like).
[0554] In some embodiments, chelating agents used in the
compositions and/or formulations described herein include, by way
of non-limiting example, ethylenediaminetetraacetic acid (EDTA) or
salts thereof, phosphates and combinations thereof.
[0555] In some embodiments, the concentration of the chelating
agent or agents used in the rectal formulations described herein is
a suitable concentration, e.g., about 0.1%, 0.15%, 0.2%, 0.25%,
0.3%, 0.4%, or 0.5% (w/v).
[0556] In some embodiments, preservatives used in compositions
and/or formulations described herein include, by way of
non-limiting example, parabens, ascorbyl palmitate, benzoic acid,
butylated hydroxyanisole, butylated hydroxytoluene, chlorobutanol,
ethylenediamine, ethylparaben, methylparaben, butyl paraben,
propylparaben, monothioglycerol, phenol, phenylethyl alcohol,
propylparaben, sodium benzoate, sodium propionate, sodium
formaldehyde sulfoxylate, sodium metabisulfite, sorbic acid, sulfur
dioxide, maleic acid, propyl gallate, benzalkonium chloride,
benzethonium chloride, benzyl alcohol, chlorhexidine acetate,
chlorhexidine gluconate, sorbic acid, potassium sorbitol,
chlorbutanol, phenoxyethanol, cetylpyridinium chloride,
phenylmercuric nitrate, thimerosol, and combnations thereof.
[0557] In certain embodiments, antioxidants used in compositions
and/or formulations described herein include, by way of
non-limiting example, ascorbic acid, ascorbyl palmitate, butylated
hydroxyanisole, butylated hydroxytoluene, hypophosphorous acid,
monothioglycerol, propyl gallate, sodium ascorbate, sodium sulfite,
sodium bisulfite, sodium formaldehyde sulfoxylate, potassium
metabisulphite, sodium metabisulfite, oxygen, quinones, t-butyl
hydroquinone, erythorbic acid, olive (olea eurpaea) oil,
pentasodium penetetate, pentetic acid, tocopheryl, tocopheryl
acetate and combinations thereof.
[0558] In some embodiments, concentration of the antioxidant or
antioxidants used in the rectal formulations described herein is
sufficient to achieve a desired result, e.g., about 0.1%, 0.15%,
0.2%, 0.25%, 0.3%, 0.4%, or 0.5% (w/v).
[0559] The lubricating agents used in compositions and/or
formulations described herein include, by way of non-limiting
example, natural or synthetic fat or oil (e.g., a tris-fatty acid
glycerate and the like). In some embodiments, lubricating agents
include, by way of non-limiting example, glycerin (also called
glycerine, glycerol, 1,2,3-propanetriol, and trihydroxypropane),
polyethylene glycols (PEGs), polypropylene glycol, polyisobutene,
polyethylene oxide, behenic acid, behenyl alcohol, sorbitol,
mannitol, lactose, polydimethylsiloxane and combinations
thereof.
[0560] In certain embodiments, mucoadhesive and/or bioadhesive
polymers are used in the compositions and/or formulations described
herein as agents for inhibiting absorption of the enteroendocrine
peptide secretion enhancing agent across the rectal or colonic
mucosa. Bioadhesive or mucoadhesive polymers include, by way of
non-limiting example, hydroxypropyl cellulose, polyethylene oxide
homopolymers, polyvinyl ether-maleic acid copolymers, methyl
cellulose, ethyl cellulose, propyl cellulose, hydroxyethyl
cellulose, hydroxypropyl cellulose, hydroxypropylmethyl cellulose,
carboxymethylcellulose, polycarbophil, polyvinylpyrrolidone,
carbopol, polyurethanes, polyethylene oxide-polypropylene oxide
copolymers, sodium carboxymethyl cellulose, polyethylene,
polypropylene, lectins, xanthan gum, alginates, sodium alginate,
polyacrylic acid, chitosan, hyaluronic acid and ester derivatives
thereof, vinyl acetate homopolymer, calcium polycarbophil, gelatin,
natural gums, karaya, tragacanth, algin, chitosan, starches,
pectins, and combinations thereof.
[0561] In some embodiments, buffers/pH adjusting agents used in
compositions and/or formulations described herein include, by way
of non-limiting example, phosphoric acid, monobasic sodium or
potassium phosphate, triethanolamine (TRIS), BICINE, HEPES, Trizma,
glycine, histidine, arginine, lysine, asparagine, aspartic acid,
glutamine, glutamic acid, carbonate, bicarbonate, potassium
metaphosphate, potassium phosphate, monobasic sodium acetate,
acetic acid, acetate, citric acid, sodium citrate anhydrous, sodium
citrate dihydrate and combinations thereof. In certain embodiments,
an acid or a base is added to adjust the pH. Suitable acids or
bases include, by way of non-limiting example, HCL, NaOH and
KOH.
[0562] In certain embodiments, concentration of the buffering agent
or agents used in the rectal formulations described herein is
sufficient to achieve or maintain a physiologically desirable pH,
e.g., about 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.8%, 0.9%, or 1.0%
(w/w).
[0563] The tonicity modifiers used in compositions and/or
formulations described herein include, by way of non-limiting
example o, sodium chloride, potassium chloride, sodium phosphate,
mannitol, sorbitol or glucose.
Devices
[0564] In certain aspects of the methods and pharmaceutical
compositions described herein, a device is used for rectal
administration of the compositions and/or formulations described
herein (e.g., the rectal gels, rectal foams, enemas and
suppositories described herein). In certain embodiments, rectal
gels or rectal enemas are administered using a bag or a syringe,
while rectal foams are administered using a pressurized
container.
[0565] In certain embodiments, a perfusion system is used to
rectally administer the pharmaceutical compositions and/or
formulations described herein. In some embodiments, the system
comprises a tube surrounded by a semi-permeable membrane is
rectally inserted and a solution containing a composition described
herein is pumped into the membrane. In certain embodiments, the
membrane expands to contact the rectal and/or colon walls, wherein
the enterendocrine peptide secretion enhancing agents perfuse from
the inside of the membrane to the outside. In certain embodiments,
the solution is re-circulated as a continuous perfusion system.
Oral Administration for Colonic Delivery
[0566] In certain aspects, the composition or formulation
containing one or more enteroendocrine peptide secretion enhancing
agents is orally administered for local delivery of an ASBTI, a
TGR5 agonist, or an enteroendocrine peptide secretion enhancing
agent to the colon and/or rectum. Unit dosage forms of such
compositions include a pill, tablet or capsules formulated for
enteric delivery to colon. In certain embodiments, such pills,
tablets or capsule contain the compositions described herein
entrapped or embedded in microspheres. In some embodiments,
microspheres include, by way of non-limiting example, chitosan
microcores HPMC capsules and cellulose acetate butyrate (CAB)
microspheres. In certain embodiments, oral dosage forms are
prepared using conventional methods known to those in the field of
pharmaceutical formulation. For example, in certain embodiments,
tablets are manufactured using standard tablet processing
procedures and equipment. An exemplary method for forming tablets
is by direct compression of a powdered, crystalline or granular
composition containing the active agent(s), alone or in combination
with one or more carriers, additives, or the like. In alternative
embodiments, tablets are prepared using wet-granulation or
dry-granulation processes. In some embodiments, tablets are molded
rather than compressed, starting with a moist or otherwise
tractable material.
[0567] In certain embodiments, tablets prepared for oral
administration contain various excipients, including, by way of
non-limiting example, binders, diluents, lubricants, disintegrants,
fillers, stabilizers, surfactants, preservatives, coloring agents,
flavoring agents and the like. In some embodiments, binders are
used to impart cohesive qualities to a tablet, ensuring that the
tablet remains intact after compression. Suitable binder materials
include, by way of non-limiting example, starch (including corn
starch and pregelatinized starch), gelatin, sugars (including
sucrose, glucose, dextrose and lactose), polyethylene glycol,
propylene glycol, waxes, and natural and synthetic gums, e.g.,
acacia sodium alginate, polyvinylpyrrolidone, cellulosic polymers
(including hydroxypropyl cellulose, hydroxypropyl methylcellulose,
methyl cellulose, ethyl cellulose, hydroxyethyl cellulose, and the
like), Veegum, and combinations thereof. In certain embodiments,
diluents are utilized to increase the bulk of the tablet so that a
practical size tablet is provided. Suitable diluents include, by
way of non-limiting example, dicalcium phosphate, calcium sulfate,
lactose, cellulose, kaolin, mannitol, sodium chloride, dry starch,
powdered sugar and combinations thereof. In certain embodiments,
lubricants are used to facilitate tablet manufacture; examples of
suitable lubricants include, by way of non-limiting example,
vegetable oils such as peanut oil, cottonseed oil, sesame oil,
olive oil, corn oil, and oil of theobroma, glycerin, magnesium
stearate, calcium stearate, stearic acid and combinations thereof.
In some embodiments, disintegrants are used to facilitate
disintegration of the tablet, and include, by way of non-limiting
example, starches, clays, celluloses, algins, gums, crosslinked
polymers and combinations thereof. Fillers include, by way of
non-limiting example, materials such as silicon dioxide, titanium
dioxide, alumina, talc, kaolin, powdered cellulose and
microcrystalline cellulose, as well as soluble materials such as
mannitol, urea, sucrose, lactose, dextrose, sodium chloride and
sorbitol. In certain embodiments, stabilizers are used to inhibit
or retard drug decomposition reactions that include, by way of
example, oxidative reactions. In certain embodiments, surfactants
are anionic, cationic, amphoteric or nonionic surface active
agents.
[0568] In some embodiments. ASBTIs, TGR5 agonists, or
ehteroendocrine peptide secretion enhancing agents described herein
are orally administered in association with a carrier suitable for
delivery of the enteroendocrine peptide secretion enhancing agents
to the distal gastrointestinal tract (e.g., distal ileum, colon,
and/or rectum).
[0569] In certain embodiments, a composition described herein
comprises an ASBTI, a TGR5 agonist, or an enteroendocrine peptide
secretion enhancing agent in association with a matrix (e.g., a
matrix comprising hypermellose) that allows for controlled release
of an active agent in the distal part of the ileum and/or the
colon. In some embodiments, a composition comprises a polymer that
is pH sensitive (e.g., a MMX.TM.matrix from Cosmo Pharmaceuticals)
and allows for controlled release of an active agent in the distal
part of the ileum. Examples of such pH sensitive polymers suitable
for controlled release include and are not limited to polyacrylic
polymers (e.g., anionic polymers of methacrylic acid and/or
methacrylic acid esters, e.g., Carbopol.RTM. polymers) that
comprise acidic groups (e.g., --COOH, --SO.sub.3H) and swell in
basic pH of the intestine (e.g., pH of abut 7 to about 8). In some
embodiments, a composition suitable for controlled release in the
distal ileum comprises microparticulate active agent (e.g.,
micronized active agent). In some embodiments, a non-enzymatically
degrading poly(dl-lactide-co-glycolide) (PLGA) core is suitable for
delivery of an enteroendocrine peptide secretion enhancing agent
(e.g., bile acid) to the distal ileum. In some embodiments, a
dosage form comprising an enteroendocrine peptide secretion
enhancing agent (e.g., bile acid) is coated with an enteric polymer
(e.g., Eudragit.RTM. S-100, cellulose acetate phthalate,
polyvinylacetate phthalate, hydroxypropylmethylcellulose phthalate,
anionic polymers of methacrylic acid, methacrylic acid esters or
the like) for site specific delivery to the distal ileum and/or the
colon. In some embodiments, bacterially activated systems are
suitable for targeted delivery to the distal part of the ileum.
Examples of micro-flora activated systems include dosage forms
comprising pectin, galactomannan, and/or Azo hydrogels and/or
glycoside conjugates (e.g., conjugates of D-galactoside,
.beta.-D-xylopyranoside or the like) of the active agent. Examples
of gastrointestinal micro-flora enzymes include bacterial
glycosidases such as, for example, D-galactosidase,
.beta.-D-glucosidase, .alpha.-L-arabinofuranosidase,
.beta.-D-xylopyranosidase or the like.
[0570] The pharmaceutical composition described herein optionally
include an additional therapeutic compound described herein and one
or more pharmaceutically acceptable additives such as a compatible
carrier, binder, filling agent, suspending agent, flavoring agent,
sweetening agent, disintegrating agent, dispersing agent,
surfactant, lubricant, colorant, diluent, solubilizer, moistening
agent, plasticizer, stabilizer, penetration enhancer, wetting
agent, anti-foaming agent, antioxidant, preservative, or one or
more combination thereof. In some aspects, using standard coating
procedures, such as those described in Remington's Pharmaceutical
Sciences, 20th Edition (2000), a film coating is provided around
the formulation of the compound of Formula I. In one embodiment, a
compound described herein is in the form of a particle and some or
all of the particles of the compound are coated. In certain
embodiments, some or all of the particles of a compound described
herein are microencapsulated. In some embodiments, the particles of
the compound described herein are not microencapsulated and are
uncoated.
[0571] In certain embodiments, an oral formulation for use in any
method described herein is, e.g., an ASBTI or an enteroendocrine
peptide secretion enhancing agent in association with a labile bile
acid sequestrant. A labile bile acid sequestrant is a bile acid
sequestrant with a labile affinity for bile acids. In certain
embodiments, a bile acid sequestrant described herein is an agent
that sequesters (e.g., absorbs or is charged with) bile acid,
and/or the salts thereof.
[0572] In specific embodiments, the labile bile acid sequestrant is
an agent that sequesters (e.g., absorbs or is charged with) bile
acid, and/or the salts thereof, and releases at least a portion of
the absorbed or charged bile acid, and/or salts thereof in the
distal gastrointestinal tract (e.g., the colon, ascending colon,
sigmoid colon, distal colon, rectum, or any combination thereof).
In certain embodiments, the labile bile acid sequestrant is an
enzyme dependent bile acid sequestrant. In specific embodiments,
the enzyme is a bacterial enzyme. In some embodiments, the enzyme
is a bacterial enzyme found in high concentration in human colon or
rectum relative to the concentration found in the small intestine.
Examples of micro-flora activated systems include dosage forms
comprising pectin, galactomannan, and/or Azo hydrogels and/or
glycoside conjugates (e.g., conjugates of D-galactoside,
.beta.-D-xylopyranoside or the like) of the active agent. Examples
of gastrointestinal micro-flora enzymes include bacterial
glycosidases such as, for example, D-galactosidase,
.beta.-D-glucosidase, .alpha.-L-arabinofuranosidase,
.beta.-D-xylopyranosidase or the like. In some embodiments, the
labile bile acid sequestrant is a time dependent bile acid
sequestrant (i.e., the bile acid sequesters the bile acid and/or
salts thereof and after a time releases at least a portion of the
bile acid and/or salts thereof). In some embodiments, a time
dependent bile acid sequestrant is an agent that degrades in an
aqueous environment over time. In certain embodiments, a labile
bile acid sequestrant described herein is a bile acid sequestrant
that has a low affinity for bile acid and/or salts thereof, thereby
allowing the bile acid sequestrant to continue to sequester bile
acid and/or salts thereof in an environ where the bile acids and/or
salts thereof are present in high concentration and release them in
an environ wherein bile acids and/or salts thereof are present in a
lower relative concentration. In some embodiments, the labile bile
acid sequestrant has a high affinity for a primary bile acid and a
low affinity for a secondary bile acid, allowing the bile acid
sequestrant to sequester a primary bile acid or salt thereof and
subsequently release a secondary bile acid or salt thereof as the
primary bile acid or salt thereof is converted (e.g., metabolized)
to the secondary bile acid or salt thereof. In some embodiments,
the labile bile acid sequestrant is a pH dependent bile acid
sequestrant. In some embodiments, the pH dependent bile acid
sequestrant has a high affinity for bile acid at a pH of 6 or below
and a low affinity for bile acid at a pH above 6. In certain
embodiments, the pH dependent bile acid sequestrant degrades at a
pH above 6.
[0573] In some embodiments, labile bile acid sequestrants described
herein include any compound, e.g., a macro-structured compound,
that can sequester bile acids and/or salts thereof through any
suitable mechanism. For example, in certain embodiments, bile acid
sequestrants sequester bile acids and/or salts thereof through
ionic interactions, polar interactions, static interactions,
hydrophobic interactions, lipophilic interactions, hydrophilic
interactions, steric interactions, or the like. In certain
embodiments, macrostructured compounds sequester bile acids and/or
sequestrants by trapping the bile acids and/or salts thereof in
pockets of the macrostructured compounds and, optionally, other
interactions, such as those described above. In some embodiments,
bile acid sequestrants (e.g., labile bile acid sequestrants)
include, by way of non-limiting example, lignin, modified lignin,
polymers, polycationic polymers and copolymers, polymers and/or
copolymers comprising anyone one or more of N-alkenyl-N-alkylamine
residues; one or more
N,N,N-trialkyl-N--(N'-alkenylamino)alkyl-azanium residues; one or
more N,N,N-trialkyl-N-alkenyl-azanium residues; one or more
alkenyl-amine residues; or a combination thereof, or any
combination thereof.
Covalent Linkage of the Drug with a Carrier
[0574] In some embodiments, strategies used for colon targeted
delivery include, by way of non-limiting example, covalent linkage
of the ASBTI and/or the enteroendocrine peptide secretion enhancing
agents to a carrier, coating the dosage form with a pH-sensitive
polymer for delivery upon reaching the pH environment of the colon,
using redox sensitive polymers, using a time released formulation,
utilizing coatings that are specifically degraded by colonic
bacteria, using bioadhesive system and using osmotically controlled
drug delivery systems.
[0575] In certain embodiments of such oral administration of a
composition containing an ASBTI and or an enteroendocrine peptide
secretion enhancing agent described herein involves covalent
linking to a carrier wherein upon oral administration the linked
moiety remains intact in the stomach and small intestine. Upon
entering the colon the covalent linkage is broken by the change in
pH, enzymes, and/or degradation by intestinal microflora. In
certain embodiments, the covalent linkage between the ASBTI and/or
enteroendocrine peptide secretion enhancing agent and the carrier
includes, by way of non-limiting example, azo linkage, glycoside
conjugates, glucuronide conjugates, cyclodextrin conjugates,
dextran conjugates, and amino-acid conjugates (high hydrophilicity
and long chain length of the carrier amino acid).
Coating with Polymers: pH-Sensitive Polymers
[0576] In some embodiments, the oral dosage forms described herein
are coated with an enteric coating to facilitate the delivery of an
ASBTI and/or an enteroendocrine peptide secretion enhancing agent
to the colon and/or rectum. In certain embodiments, an enteric
coating is one that remains intact in the low pH environment of the
stomach, but readily dissolved when the optimum dissolution pH of
the particular coating is reached which depends upon the chemical
composition of the enteric coating. The thickness of the coating
will depend upon the solubility characteristics of the coating
material. In certain embodiments, the coating thicknesses used in
such formulations described herein range from about 25 .mu.m to
about 200 .mu.m.
[0577] In certain embodiments, the compositions or formulations
described herein are coated such that an enteroendocrine peptide
secretion enhancing agent of the composition or formulation is
delivered to the colon and/or rectum without absorbing at the upper
part of the intestine. In a specific embodiment, specific delivery
to the colon and/or rectum is achieved by coating of the dosage
form with polymers that degrade only in the pH environment of the
colon. In alternative embodiments, the composition is coated with
an enteric coat that dissolves in the pH of the intestines and an
outer layer matrix that slowly erodes in the intestine. In some of
such embodiments, the matrix slowly erodes until only a core
composition comprising an enteroendocrine peptide secretion
enhancing agent (and, in some embodiments, an absorption inhibitor
of the agent) is left and the core is delivered to the colon and/or
rectum.
[0578] In certain embodiments, pH-dependent systems exploit the
progressively increasing pH along the human gastrointestinal tract
(GIT) from the stomach (pH 1-2 which increases to 4 during
digestion), small intestine (pH 6-7) at the site of digestion and
it to 7-8 in the distal ileum. In certain embodiments, dosage forms
for oral administration of the compositions described herein are
coated with pH-sensitive polymer(s) to provide delayed release and
protect the enteroendocrine peptide secretion enhancing agents from
gastric fluid. In certain embodiments, such polymers are be able to
withstand the lower pH values of the stomach and of the proximal
part of the small intestine, but disintegrate at the neutral or
slightly alkaline pH of the terminal ileum and/or ileocecal
junction. Thus, in certain embodiments, provided herein is an oral
dosage form comprising a coating, the coating comprising a
pH-sensitive polymer. In some embodiments, the polymers used for
colon and/or rectum targeting include, by way of non-limiting
example, methacrylic acid copolymers, methacrylic acid and methyl
methacrylate copolymers, Eudragit L 100, Eudragit S100, Eudragit
L-30D, Eudragit FS-30D, Eudragit L100-55, polyvinylacetate
phthalate, hydroxypropyl ethyl cellulose phthalate, hydroxypropyl
methyl cellulose phthalate 50, hydroxypropyl methyl cellulose
phthalate 55, cellulose acetate trimelliate, cellulose acetate
phthalate and combinations thereof.
[0579] In certain embodiments, oral dosage forms suitable for
delivery to the colon and/or rectum comprise a coating that has a
biodegradable and/or bacteria degradable polymer or polymers that
are degraded by the microflora (bacteria) in the colon. In such
biodegradable systems suitable polymers include, by way of
non-limiting example, azo polymers, linear-type-segmented
polyurethanes containing azo groups, polygalactomannans, pectin,
glutaraldehyde crosslinked dextran, polysaccharides, amylose, guar
gum, pectin, chitosan, inulin, cyclodextrins, chondroitin sulphate,
dextrans, locust bean gum, chondroitin sulphate, chitosan,
poly(-caprolactone), polylactic acid and poly(lactic-co-glycolic
acid).
[0580] In certain embodiments of such oral administration of
compositions containing one or more ASBTIs and/or enteroendocrine
peptide secretion enhancing agents described herein, the
compositions are delivered to the colon without absorbing at the
upper part of the intestine by coating of the dosage forms with
redox sensitive polymers that are degraded by the microflora
(bacteria) in the colon. In such biodegradable systems such
polymers include, by way of non-limiting example, redox-sensitive
polymers containing an azo and/or a disulfide linkage in the
backbone.
[0581] In some embodiments, compositions formulated for delivery to
the colon and/or rectum are formulated for time-release. In some
embodiments, time release formulations resist the acidic
environment of the stomach, thereby delaying the release of the
enteroendocrine peptide secretion enhancing agents until the dosage
form enters the colon and/or rectum.
[0582] In certain embodiments the time released formulations
described herein comprise a capsule (comprising an enteroendocrine
peptide secretion enhancing agent and an optional absorption
inhibitor) with hydrogel plug. In certain embodiments, the capsule
and hydrogel plug are covered by a water-soluble cap and the whole
unit is coated with an enteric polymer. When the capsule enters the
small intestine the enteric coating dissolves and the hydrogels
plug swells and dislodges from the capsule after a period of time
and the composition is released from the capsule. The amount of
hydrogel is used to adjust the period of time to the release the
contents.
[0583] In some embodiments, provided herein is an oral dosage form
comprising a multi-layered coat, wherein the coat comprises
different layers of polymers having different pH-sensitivities. As
the coated dosage form moves along GIT the different layers
dissolve depending on the pH encountered. Polymers used in such
formulations include, by way of non-limiting example,
polymethacrylates with appropriate pH dissolution characteristics,
Eudragit.RTM. RL and Eudragit.RTM.RS (inner layer), and
Eudragit.RTM. FS (outer layer). In other embodiments the dosage
form is an enteric coated tablets having an outer shell of
hydroxypropylcellulose or hydroxypropylmethylcellulose acetate
succinate (HPMCAS).
[0584] In some embodiments, provided herein is an oral dosage form
that comprises coat with cellulose butyrate phthalate, cellulose
hydrogen phthalate, cellulose proprionate phthalate, polyvinyl
acetate phthalate, cellulose acetate phthalate, cellulose acetate
trimellitate, hydroxypropyl methylcellulose phthalate,
hydroxypropyl methylcellulose acetate, dioxypropyl methylcellulose
succinate, carboxymethyl ethylcellulose, hydroxypropyl
methylcellulose acetate succinate, polymers and copolymers formed
from acrylic acid, methacrylic acid, and combinations thereof.
Combination Therapy
[0585] In certain instances, provided herein are combination
compositions and/or therapies comprising any compound described
herein and an additional therapeutic agent. In some embodiments,
the additional therapeutic agent is a L-cell endocrine peptide
enhancer. In some instances, the L-cell endocrine peptide enhancer
is a GLP-1 enhancer. In some embodiments, the GLP-1 enhancer is
GLP-1, a GLP-1 secretion enhancer, a GLP-1 degradation inhibitor,
the like, or a combination thereof. In certain instances, enhanced
GLP-1 concentration provides a reduction in food intake and/or a
reduction in gastric emptying in human subjects.
[0586] In some embodiments, the L-cell endocrine peptide enhancer
is a GLP-2 enhancer. In certain instances, the GLP-2 enhancer is
GLP-2, a GLP-2 secretion enhancer, a GLP-2 degradation inhibitor,
the like, or a combination thereof. In certain instances, enhanced
GLP-2 secretion inhibits gastric emptying and reduces intestinal
permeability. In some instances, enhanced GLP-2 secretion inhibits
gastric acid secretion. In some instances, enhanced GLP-2 secretion
reduces or prevents inflammation in the gastrointestinal tract
(gastrointestinal enteritis). In some instances, enhanced GLP-2
secretion regenerates and/or heals injury to gastrointestinal
tissues (e.g., radiation enteritis).
[0587] In some instances, the L-cell endocrine peptide enhancer is
a PYY enhancer. In some instances, enhanced secretion of PYY
provides a reduction in sensation of hunger. In some instances, the
L-cell endocrine peptide enhancer is an oxyntomodulin enhancer. In
some instances, the enhanced secretion of oxyntomodulin inhibits
meal-stimulated gastric secretion.
TGR5 Receptor Modulators
[0588] In some instances, the additional therapeutic agent
modulates bile acid receptors in the gastrointestinal lumen. In
some embodiments, the additional therapeutic agent agonizes or
partially agonizes bile acid receptors (e.g., TGR5 receptors or
Farnesoid-X receptors) in the gastrointestinal tract. In some
embodiments, the additional therapeutic agent is a bile acid
analog. In certain instances the additional therapeutic agent is a
TGR5 agonist. In certain instances, administration of a TGR5
agonist in combination with any of the compounds described herein
enhances the secretion of enteroendocrine peptides from L-cells.
TGR5 modulators (e.g., agonists) include, and are not limited to,
the compounds described in, WO 2008/091540, WO 2008/067219 and U.S.
Appl. No. 2008/0221161.
Biguanides
[0589] In some embodiments, the additional therapeutic agent is a
biguanide. In some instances, biguanides reduce blood and/or plasma
glucose levels. Examples of biguanides include and are not limited
to metformin, buformin, phenformin, proguanil or the like.
Incretin Mimetics
[0590] In some embodiments, the additional therapeutic agent is an
incretin mimetic. In some embodiments, an incretic mimic augments
pancreas response to ingestion of food, In some instances,
administration of an incretin mimetic in combination with any of
the compounds described herein lowers blood and/or plasma glucose
levels. Examples of incretin mimetics include and are not limited
to exenatide (Byetta.RTM.).
[0591] One currently used therapy for the treatment of diabetes is
a subcutaneous injection of exenatide (Byetta.RTM.). In some
embodiments, an oral combination of an ASBTI and a DPP-IV inhibitor
is equally or more effective than an injection of exenatide in
reducing plasma glucose levels. In some embodiments, an oral
combination of an ASBTI and a DPP-IV inhibitor reduces or
eliminates discomfort associated with injections of
glucose-lowering medications.
Thiazolidinediones
[0592] In some embodiments, the additional therapeutic agent is a
thiazolidinedione. In some instances thiazolidinediones reverse
insulin resistance and lower blood and/or plasma glucose levels.
Examples of thiazolidinediones include and are not limited to
Rosiglitazone (Avandia), Pioglitazone (Actos), Troglitazone
(Rezulin), MCC-555, rivoglitazone, ciglitazone or the like.
Enteroendocrine Peptides
[0593] In some embodiments, the additional therapeutic agent is an
enteroendocrine peptide. In some embodiments, enteroendocrine
peptides reverse insulin resistance and lower blood and/or plasma
glucose levels. Examples of enteroendocrine peptides that are
administered as additional therapeutic agents include and are not
limited to GLP-1 or GLP-1 analogs such as Taspoglutide.RTM.
(Ipsen), or the like.
Combination Therapy with ASBTI and DPP-IV Inhibitor
[0594] In specific embodiments, the additional therapeutic agent
inhibits degradation of L-cell enteroendocrine peptides. In certain
embodiments, the additional therapeutic agent is a DPP-IV
inhibitor. In certain instances, administration of an ASBTI to an
individual in need thereof enhances the secretion of GLP-1;
administration of a DPP-IV inhibitor in combination with the ASBTI
reduces or inhibits degradation of GLP-1 thereby prolonging the
therapeutic benefit of enhanced levels of GLP-1. In some
embodiments, administration of an ASBTI reduces weight of an
individual. In some embodiments, administration of an ASBTI in
combination with a DPP-IV inhibitor reduces weight of an
individual.
[0595] Another therapy that is current standard of care for the
treatment of diabetes is a combination of metformin and sitagliptin
(Janumet.RTM.). At doses of 0, 3, 30, 100, 300 mg/kg doses of
metformin in combination with 30 mg/kg of sitagliption, reductions
in plasma glucose concentrations are observed from 3 hours till
about 6 hours post-dose (FIG. 3). In some embodiments, a
combination of an ASBTI and sitagliptin maintains reduced plasma
glucose concentrations for a longer duration of time (e.g., at
least 24 hours) compared to a combination of metformin and
sitagliptin (about 6 hours) (FIGS. 1 and 2). In some instances
ASBTI therapy eliminates side effects associated with metformin
therapy and/or DPP-IV inhibitor therapy.
[0596] DPP-IV inhibitors suitable for use with the methods
described herein include and are not limited to
(2S)-1-{2-[(3-hydroxy-1-adamantyl)amino]acetyl}pyrrolidine-2-carbonitrile
(vildagliptin),
(3R)-3-amino-1-[9-(trifluoromethyl)-1,4,7,8-tetrazabicyclo[4.3.0]nona-6,8-
-d ien-4-yl]-4-(2,4,5-trifluorophenyl)butan-1-one (sitagliptin),
(1S,3S,5S)-2-[(2S)-2-amino-2-(3-hydroxy-1-adamantyl)acetyl]-2-azabicyclo[-
3.1.0]hexane-3-carbonitrile (saxagliptin), and
2-({6-[(3R)-3-aminopiperidin-1-yl]-3-methyl-2,4-dioxo-3,4-dihydropyrimidi-
n-1(2H)-yl}methyl)benzonitrile (alogliptin).
[0597] In some embodiments of any of the methods described herein,
administration of an ASBT inhibitor described herein in combination
with a DPP-IV inhibitor increases the level of GLP-1 in the blood
and/or plasma of an individual by from about 1.1 times to about 30
times compared to the level of GLP-1 in the blood and/or plasma of
the individual prior to administration of the ASBTI in combination
with the DPP-IV inhibitor. In some embodiments of any of the
methods described herein, administration of an ASBT inhibitor
described herein in combination with a DPP-IV inhibitor increases
the level of GLP-1 in the blood and/or plasma of an individual by
from about 1.1 times to about 20 times compared to the level of
GLP-1 in the blood and/or plasma of the individual prior to
administration of the ASBTI in combination with the DPP-IV
inhibitor. In some embodiments of any of the methods described
herein, administration of an ASBT inhibitor described herein in
combination with a DPP-IV inhibitor increases the level of GLP-1 in
the blood and/or plasma of an individual by from about 1.5 times to
about 10 times compared to the level of GLP-1 in the blood and/or
plasma of the individual prior to administration of the ASBTI in
combination with the DPP-IV inhibitor. In some embodiments of any
of the methods described herein, administration of an ASBT
inhibitor described herein in combination with a DPP-IV inhibitor
increases the level of GLP-1 in the blood and/or plasma of an
individual by from about 2 times to about 8 times compared to the
level of GLP-1 in the blood and/or plasma of the individual prior
to administration of the ASBTI in combination with the DPP-IV
inhibitor. In some embodiments of any of the methods described
herein, administration of an ASBT inhibitor described herein in
combination with a DPP-IV inhibitor increases the level of GLP-1 in
the blood and/or plasma of an individual by from about 2 times to
about 6 times compared to the level of GLP-1 in the blood and/or
plasma of the individual prior to administration of the ASBTI in
combination with the DPP-IV inhibitor. In some instances, an
increase in GLP-1 level of from about 2 times to about 3 times
following the administration of an ASBT inhibitor described herein
in combination with a DPP-IV inhibitor compared to the level of
GLP-1 in the blood and/or plasma of the individual prior to
administration of the ASBTI in combination with the DPP-IV
inhibitor is associated with an anti-diabetic effect. In some
instances, an increase in GLP-1 level of from about 3 times to
about 8 times following the administration of an ASBT inhibitor
described herein in combination with a DPP-IV inhibitor compared to
the level of GLP-1 in the blood and/or plasma of the individual
prior to administration of the ASBTI in combination with a DPP-IV
inhibitor is associated with reduction in food intake and/or
induction of satiety and/or weight loss.
[0598] In certain embodiments of any of the methods described
herein, administration of an ASBTI in combination with a DPP-IV
inhibitor reduces blood and/or plasma sugar levels by at least 20%,
at least 30%, at least 40%, at least 50% at least 60%, at least 70%
or at least 80% compared to blood and/or plasma sugar levels prior
to administration of the ASBTI in combination with a DPP-IV
inhibitor. In some embodiments of any of the methods described
herein, administration of an ASBTI in combination with a DPP-IV
inhibitor reduces blood and/or plasma sugar levels by at least 20%
compared to blood and/or plasma sugar levels prior to
administration of the ASBTI in combination with a DPP-IV inhibitor.
In some embodiments of any of the methods described herein,
administration of an ASBTI in combination with a DPP-IV inhibitor
reduces blood and/or plasma sugar levels by at least 30% compared
to blood and/or plasma sugar levels prior to administration of the
ASBTI in combination with a DPP-IV inhibitor. In some embodiments
of any of the methods described herein, administration of an ASBTI
in combination with a DPP-IV inhibitor reduces blood and/or plasma
sugar levels by at least 40% compared to blood and/or plasma sugar
levels prior to administration of the ASBTI in combination with a
DPP-IV inhibitor.
[0599] In some embodiments of any of the methods described herein,
administration of an ASBTI in combination with a DPP-IV inhibitor
reduces blood and/or plasma sugar levels for a longer period of
time (e.g., at least 24 hours) compared to reduction in blood
and/or plasma sugar levels upon administration of metformin in
combination with a DPP-IV inhibitor. In some embodiments of any of
the methods described herein, administration of a single dose of an
ASBTI in combination with a DPP-IV inhibitor sustains reduced blood
and/or plasma sugar levels for at least 6 hours, at least 12 hours,
at least 14 hours, at least 16 hours, at least 18 hours, at least
20 hours, at least 24 hours, at least 30 hours, at least 36 hours
or at least 48 hours compared to reduction in blood and/or plasma
sugar levels upon administration of a single dose of metformin in
combination with a DPP-IV inhibitor.
[0600] In some embodiments of any of the methods described here in,
administration of an ASBTI in combination with a DPP-IV inhibitor
results in lower levels of intraenterocyte bile acids in an
individual compared to levels of intraenterocyte bile acids in an
individual suffering from necrotizing enterocolitis. In some
embodiments of any of the methods described herein, administration
of an ASBTI in combination with a DPP-IV inhibitor results in lower
levels of necrosis and/or damage to ileal architecture in an
individual compared to levels of necrosis and/or damage to ileal
architecture in an individual suffering from necrotizing
enterocolitis. In some embodiments of any of the methods described
herein, administration of an ASBTI in combination with a DPP-IV
inhibitor results in higher levels of GLP-1 in blood and/or plasma
of an individual compared to levels of GLP-1 in blood and/or plasma
of a normal individual. In some embodiments of any of the methods
described herein, administration of an ASBTI in combination with a
DPP-IV inhibitor results in higher levels of GLP-1 in blood and/or
plasma of an individual compared to levels of GLP-1 in blood and/or
plasma of an individual undergoing therapy with metformin and/or a
DPP-IV inhibitor.
Combination Therapy with ASBTI, Biliary Shunt and DPP-IV
Inhibitor
[0601] In some embodiments, an ASBTI is administered in combination
with a DPP-IV inhibitor and/or a biliary shunt. Examples of biliary
shunts include and are not limited to the shunts described in WO
2007/0050628, the disclosure of biliary shunts described therein is
incorporated herein by reference. In some of such embodiments, a
biliary shunt moves bile acid to the distal ileum and/or the rectum
and/or the colon thereby increasing the concentration of bile acids
in the vicinity of L-cells present in the distal portion of the
gastrointesinal tract. In some instances such an increase in the
concentration of bile acids in the vicinity of L-cells increases
the secretion of GLP-1 from L-cells thereby inducing satiety and/or
reduction in hunger and/or weight loss and/or reduction in plasma
glucose levels or any combination thereof.
[0602] An ASBTI and a second active ingredient are used such that
the combination is present in a therapeutically effective amount.
That therapeutically effective amount arises from the use of a
combination of an ASBTI and the other active ingredient (e.g., a
DPP-IV inhibitor) wherein each is used in a therapeutically
effective amount, or by virtue of additive or synergistic effects
arising from the combined use, each can also be used in a
subclinical therapeutically effective amount, i.e., an amount that,
if used alone, provides for reduced effectiveness for the
therapeutic purposes noted herein, provided that the combined use
is therapeutically effective. In some embodiments, the use of a
combination of an ASBTI and any other active ingredient as
described herein encompasses combinations where the ASBTI or the
other active ingredient is present in a therapeutically effective
amount, and the other is present in a subclinical therapeutically
effective amount, provided that the combined use is therapeutically
effective owing to their additive or synergistic effects. As used
herein, the term "additive effect" describes the combined effect of
two (or more) pharmaceutically active agents that is equal to the
sum of the effect of each agent given alone. A syngergistic effect
is one in which the combined effect of two (or more)
pharmaceutically active agents is greater than the sum of the
effect of each agent given alone. Any suitable combination of an
ASBIT with one or more of the aforementioned other active
ingredients and optionally with one or more other pharmacologically
active substances is contemplated as being within the scope of the
methods described herein.
[0603] In some embodiments, the particular choice of compounds
depends upon the diagnosis of the attending physicians and their
judgment of the condition of the individual and the appropriate
treatment protocol. The compounds are optionally administered
concurrently (e.g., simultaneously, essentially simultaneously or
within the same treatment protocol) or sequentially, depending upon
the nature of the disease, disorder, or condition, the condition of
the individual, and the actual choice of compounds used. In certain
instances, the determination of the order of administration, and
the number of repetitions of administration of each therapeutic
agent during a treatment protocol, is based on an evaluation of the
disease being treated and the condition of the individual.
[0604] In some embodiments, therapeutically-effective dosages vary
when the drugs are used in treatment combinations. Methods for
experimentally determining therapeutically-effective dosages of
drugs and other agents for use in combination treatment regimens
are described in the literature.
[0605] In some embodiments of the combination therapies described
herein, dosages of the co-administered compounds vary depending on
the type of co-drug employed, on the specific drug employed, on the
disease or condition being treated and so forth. In addition, when
co-administered with one or more biologically active agents, the
compound provided herein is optionally administered either
simultaneously with the biologically active agent(s), or
sequentially. In certain instances, if administered sequentially,
the attending physician will decide on the appropriate sequence of
therapeutic compound described herein in combination with the
additional therapeutic agent.
[0606] The multiple therapeutic agents (at least one of which is a
therapeutic compound described herein) are optionally administered
in any order or even simultaneously. If simultaneously, the
multiple therapeutic agents are optionally provided in a single,
unified form, or in multiple forms (by way of example only, either
as a single pill or as two separate pills). In certain instances,
one of the therapeutic agents is optionally given in multiple
doses. In other instances, both are optionally given as multiple
doses. If not simultaneous, the timing between the multiple doses
is any suitable timing, e.g, from more than zero weeks to less than
four weeks. In addition, the combination methods, compositions and
formulations are not to be limited to the use of only two agents;
the use of multiple therapeutic combinations are also envisioned
(including two or more compounds described herein).
[0607] In certain embodiments, a dosage regimen to treat, prevent,
or ameliorate the condition(s) for which relief is sought, is
modified in accordance with a variety of factors. These factors
include the disorder from which the subject suffers, as well as the
age, weight, sex, diet, and medical condition of the subject. Thus,
in various embodiments, the dosage regimen actually employed varies
and deviates from the dosage regimens set forth herein.
[0608] In some embodiments, the pharmaceutical agents which make up
the combination therapy described herein are provided in a combined
dosage form or in separate dosage forms intended for substantially
simultaneous administration. In certain embodiments, the
pharmaceutical agents that make up the combination therapy are
administered sequentially, with either therapeutic compound being
administered by a regimen calling for two-step administration. In
some embodiments, two-step administration regimen calls for
sequential administration of the active agents or spaced-apart
administration of the separate active agents. In certain
embodiments, the time period between the multiple administration
steps varies, by way of non-limiting example, from a few minutes to
several hours, depending upon the properties of each pharmaceutical
agent, such as potency, solubility, bioavailability, plasma
half-life and kinetic profile of the pharmaceutical agent.
[0609] In certain embodiments, ASBTI compounds described herein are
combined with or utilized in combination with one or more of the
following therapeutic agents in any combination: insulin,
insulin-mimetics, incretin mimetics, GLP-1 or analogs thereof,
GLP-2 or analogs thereof, oxyntomodulin, PYY, DPP-IV inhibitors, or
TGR5 modulators.
[0610] In certain embodiments, provided herein are combination
therapies. In certain embodiments, the compositions described
herein comprise an additional therapeutic agent. In some
embodiments, the methods described herein comprise administration
of a second dosage form comprising an additional therapeutic agent.
In certain embodiments, combination therapies the compositions
described herein are administered as part of a regimen. Therefore,
additional therapeutic agents and/or additional pharmaceutical
dosage form can be applied to a patient either directly or
indirectly, and concomitantly or sequentially, with the
compositions and formulations described herein.
[0611] In certain embodiments the compositions described herein are
used in combination with at least one appetite suppressant (e.g., a
5HT transport inhibitor, a NE transport inhibitor, a CB-1
antagonist/inverse agonist, a ghrelin antagonist, a 1-13
antagonist/inverse agonist, a MCH1R antagonist, a MCH2R
agonist/antagonist, a NPY1 antagonist, a NPY2 agonist, a mGluR5
antagonist, leptin, a leptin agonist/modulator, a leptin
derivative, an opiod antagonist, an orexin antagonist, a BRS3
agonist, a CCK-A agonist, CNTF, a CNTF agonist/modulator, a CNTF
derivative, a 5HT2c agonist, a Mc5r agonist, a monoamine reuptake
inhibitor, a serotonin reuptake inhibitor, a GLP-1 agonist,
axokine, fenfluramine, nalmafene, phentermine, rimonabant,
sibutramine, topiramate, phytopharm compound 57, and combinations
thereof). In certain embodiments the compositions or formulations
described herein are used in combination with at least one
metabolic rate enhancing agents (e.g., an ACC2 inhibitor, a .beta.3
agonist, DGATI inhibitor, a DGAT2 inhibitor, a FAS inhibitor, a PDE
inhibitor, a thyroid hormone .beta.1 agonist, an UCP-1, 2, or 3
activator, an acyl-estrogen, a glucocorticoid antagonist, an 11
.beta. HSD-1 inhibitor, a Mc3r agonist, a SCD-1, oleoyl-estrone,
3-[(3,5,7-trimethyl-1-adamantyl)methyl]-6,7,8,9-tetr-ahydro-5H-[1,2,4]tri-
azolo[4,3-a]azepine;
3-(1-adamantyl)-4-ethyl-5-(e-thylthio)-4H-1,2,4-triazole;
3-adamantanyl-4,5,6,7,8,9,10,11,12,3a-de-cahydro-1,2,4-triazolo[4,3-a][11-
]annulene,
3-(1-adamantyl)-5-(3,4,5-trimethoxyphenyl)-4-methyl-4H-1,2,4-tr-
iazole and combinations thereof). In some embodiments, an
enteroendocrine peptide secretion enhancing agent is combined or
administered with a phosphodiesterase inhibitor. In certain
embodiments, an enteroendocrine peptide secretion enhancing agent
is combined or administered with caffeine. In certain embodiments
the compositions or formulations described herein are used in
combination with at least one nutrient absorption inhibitors (e.g.,
a lipase inhibitor; a fatty acid transporter inhibitor; a
dicarboxylate transporter inhibitor; a glucose transporter
inhibitor: a phosphate transporter inhibitor; orlistat and
combinations thereof). In certain embodiments the compositions or
formulations described herein are used in combination with at least
one appetite suppressant and at least one metabolic rate enhancing
agents. In certain embodiments the compositions or formulations
described herein are used in combination with at least one appetite
suppressant and at least one nutrient absorption inhibitors. In
certain embodiments the compositions or formulations described
herein are used in combination with at least one nutrient
absorption inhibitors and at least one metabolic rate enhancing
agents. In certain embodiments the compositions or formulations
described herein are used in combination with at least one appetite
suppressant, at least one metabolic rate enhancing agents and at
least one nutrient absorption inhibitors.
[0612] In some embodiments, enteroendocrine peptide secretion
enhancing agents therapies described herein are used in combination
with biliary shunt treatments. In certain embodiments, a bilary
shunt is a stented thin-walled catheter placed endoscopically
within the common bile duct. In certain embodiments, the catheter
runs a length down the gastrointestinal tract, providing for
delivery of bile acids and/or salts to the distal gastrointestinal
tract. FIG. 16 illustrates placement of a biliary shunt useful for
delivery of endogenous bile acids and/or salts to the distal
gastrointestinal tract (e.g., distal ileum, colon, and/or
rectum).
[0613] In some embodiments, a combination described herein
comprises a DPP-4 (used interchangeably herein with DPP-IV)
inhibitor. In certain embodiments, a method described herein
comprises administering a DPP-4 inhibitor. In some instances,
inhibition of DPP-IV reduces the degradation of enteroendocrine
peptide products (e.g. GLP-1) thereby prolonging the effect of
GLP-1 in reducing blood glucose levels.
[0614] DPP-IV inhibitors suitable for use with the methods
described herein include and are not limited to
(2S)-1-{2-[(3-hydroxy-1-adamantyl)amino]acetyl}pyrrolidine-2-carbonitrile
(vildagliptin),
(3R)-3-amino-1-[9-(trifluoromethyl)-1,4,7,8-tetrazabicyclo[4.3.0]nona-6,8-
-d ien-4-yl]-4-(2,4,5-trifluorophenyl)butan-1-one (sitagliptin),
(1S,3S,5S)-2-[(2S)-2-amino-2-(3-hydroxy-1-adamantyl)acetyl]-2-azabicyclo[-
3.1.0]hexane-3-carbonitrile (saxagliptin), and
2-({6-[(3R)-3-aminopiperidin-1-yl]-3-methyl-2,4-dioxo-3,4-dihydropyrimidi-
n-1(2H)-yl}methyl)benzonitrile (alogliptin).
[0615] In some embodiments of any of the methods described herein,
administration of an enteroendocrine peptide secretion enhancing
agents described herein in combination with a DPP-IV inhibitor
increases the level of GLP-1 in the blood and/or plasma of an
individual by from about 1.1 times to about 30 times compared to
the level of GLP-1 in the blood and/or plasma of the individual
prior to administration of the enteroendocrine peptide secretion
enhancing agent in combination with the DPP-IV inhibitor. In some
embodiments of any of the methods described herein, administration
of an enteroendocrine peptide secretion enhancing agent described
herein in combination with a DPP-IV inhibitor increases the level
of GLP-1 in the blood and/or plasma of an individual by from about
1.1 times to about 20 times compared to the level of GLP-1 in the
blood and/or plasma of the individual prior to administration of
the enteroendocrine peptide secretion enhancing agent in
combination with the DPP-IV inhibitor. In some embodiments of any
of the methods described herein, administration of an
enteroendocrine peptide secretion enhancing agent described herein
in combination with a DPP-IV inhibitor increases the level of GLP-1
in the blood and/or plasma of an individual by from about 1.5 times
to about 10 times compared to the level of GLP-1 in the blood
and/or plasma of the individual prior to administration of the
enteroendocrine peptide secretion enhancing agent in combination
with the DPP-IV inhibitor. In some embodiments of any of the
methods described herein, administration of an enteroendocrine
peptide secretion enhancing agent described herein in combination
with a DPP-IV inhibitor increases the level of GLP-1 in the blood
and/or plasma of an individual by from about 2 times to about 8
times compared to the level of GLP-1 in the blood and/or plasma of
the individual prior to administration of the enteroendocrine
peptide secretion enhancing agent in combination with the DPP-IV
inhibitor. In some embodiments of any of the methods described
herein, administration of an enteroendocrine peptide secretion
enhancing agent described herein in combination with a DPP-IV
inhibitor increases the level of GLP-1 in the blood and/or plasma
of an individual by from about 2 times to about 6 times compared to
the level of GLP-1 in the blood and/or plasma of the individual
prior to administration of the enteroendocrine peptide secretion
enhancing agent in combination with the DPP-IV inhibitor. In some
instances, an increase in GLP-1 level of from about 2 times to
about 3 times following the administration of an enteroendocrine
peptide secretion enhancing agent inhibitor described herein in
combination with a DPP-IV inhibitor compared to the level of GLP-1
in the blood and/or plasma of the individual prior to
administration of the enteroendocrine peptide secretion enhancing
agent in combination with the DPP-IV inhibitor is associated with
an anti-diabetic effect. In some instances, an increase in GLP-1
level of from about 3 times to about 8 times following the
administration of an enteroendocrine peptide secretion enhancing
agent described herein in combination with a DPP-IV inhibitor
compared to the level of GLP-1 in the blood and/or plasma of the
individual prior to administration of the enteroendocrine peptide
secretion enhancing agent in combination with a DPP-IV inhibitor is
associated with reduction in food intake and/or induction of
satiety and/or weight loss.
[0616] In certain embodiments of any of the methods described
herein, administration of an enteroendocrine peptide secretion
enhancing agent in combination with a DPP-IV inhibitor reduces
blood and/or plasma sugar levels by at least 20%, at least 30%, at
least 40%, at least 50% at least 60%, at least 70% or at least 80%
compared to blood and/or plasma sugar levels prior to
administration of the enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor. In some embodiments
of any of the methods described herein, administration of an
enteroendocrine peptide secretion enhancing agent in combination
with a DPP-IV inhibitor reduces blood and/or plasma sugar levels by
at least 20% compared to blood and/or plasma sugar levels prior to
administration of the enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor. In some embodiments
of any of the methods described herein, administration of an
enteroendocrine peptide secretion enhancing agent in combination
with a DPP-IV inhibitor reduces blood and/or plasma sugar levels by
at least 30% compared to blood and/or plasma sugar levels prior to
administration of the enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor. In some embodiments
of any of the methods described herein, administration of an
enteroendocrine peptide secretion enhancing agent in combination
with a DPP-IV inhibitor reduces blood and/or plasma sugar levels by
at least 40% compared to blood and/or plasma sugar levels prior to
administration of the enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor.
[0617] In some embodiments of any of the methods described herein,
administration of an enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor reduces blood and/or
plasma sugar levels for a longer period of time (e.g. at least 24
hours) compared to reduction in blood and/or plasma sugar levels
upon administration of metformin in combination with a DPP-IV
inhibitor. In some embodiments of any of the methods described
herein, administration of a single dose of an enteroendocrine
peptide secretion enhancing agent in combination with a DPP-IV
inhibitor sustains reduced blood and/or plasma sugar levels for at
least 6 hours, at least 12 hours, at least 14 hours, at least 16
hours, at least 18 hours, at least 20 hours, at least 24 hours, at
least 30 hours, at least 36 hours or at least 48 hours compared to
reduction in blood and/or plasma sugar levels upon administration
of a single dose of metformin in combination with a DPP-IV
inhibitor.
[0618] In some embodiments of any of the methods described herein,
administration of an enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor results in higher
levels of GLP-1 in blood and/or plasma of an individual compared to
levels of GLP-1 in blood and/or plasma of a normal individual. In
some embodiments of any of the methods described herein,
administration of an enteroendocrine peptide secretion enhancing
agent in combination with a DPP-IV inhibitor results in higher
levels of GLP-1 in blood and/or plasma of an individual compared to
levels of GLP-1 in blood and/or plasma of an individual undergoing
therapy with metformin and/or a DPP-IV inhibitor.
Kits
[0619] In another aspect, provided herein are kits containing a
device for rectal administration pre-filled a pharmaceutical
composition described herein. In certain embodiments, kits contain
a device for rectal administration and a pharmaceutical composition
(e.g., a rectal dosage form) as described herein. In certain
embodiments the kits includes prefilled bags for administration of
rectal enemas, while in other embodiments the kits incude prefilled
bags for administration of rectal gels. In certain embodiments the
kits includes prefilled syringes for administration of rectal
enemas, while in other embodiments the kits incude prefilled
syringes for administration of rectal gels. In certain embodiments
the kits includes prefilled pressurized cans for administration of
rectal foams.
Pharmaceutical Compositions
[0620] Provided herein, in certain embodiments, is a pharmaceutical
composition comprising a therapeutically effective amount of any
compound described herein. In certain instances, the pharmaceutical
composition comprises an ASBT inhibitor (e.g., any ASBTI described
herein).
[0621] In certain embodiments, pharmaceutical compositions are
formulated in a conventional manner using one or more
physiologically acceptable carriers including, e.g., excipients and
auxiliaries which facilitate processing of the active compounds
into preparations which are suitable for pharmaceutical use. In
certain embodiments, proper formulation is dependent upon the route
of administration chosen. A summary of pharmaceutical compositions
described herein is found, for example, in Remington. The Science
and Practice of Pharmacy, Nineteenth Ed (Easton, Pa.: Mack
Publishing Company, 1995); Hoover, John E., Remington's
Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa. 1975;
Liberman, H. A. and Lachman, L., Eds., Pharmaceutical Dosage Forms,
Marcel Decker, New York, N.Y., 1980; and Pharmaceutical Dosage
Forms and Drug Delivery Systems, Seventh Ed. (Lippincott Williams
& Wilkins 1999).
[0622] A pharmaceutical composition, as used herein, refers to a
mixture of a compound described herein, such as, for example, a
compound of Formula I-VI, with other chemical components, such as
carriers, stabilizers, diluents, dispersing agents, suspending
agents, thickening agents, and/or excipients. In certain instances,
the pharmaceutical composition facilitates administration of the
compound to an individual or cell. In certain embodiments of
practicing the methods of treatment or use provided herein,
therapeutically effective amounts of compounds described herein are
administered in a pharmaceutical composition to an individual
having a disease, disorder, or condition to be treated. In specific
embodiments, the individual is a human. As discussed herein, the
compounds described herein are either utilized singly or in
combination with one or more additional therapeutic agents.
[0623] In certain embodiments, the pharmaceutical formulations
described herein are administered to an individual in any manner,
including one or more of multiple administration routes, such as,
by way of non-limiting example, oral, parenteral (e.g.,
intravenous, subcutaneous, intramuscular), intranasal, buccal,
topical, rectal, or transdermal administration routes.
[0624] In certain embodiments, a pharmaceutical compositions
described herein includes one or more compound described herein as
an active ingredient in free-acid or free-base form, or in a
pharmaceutically acceptable salt form. In some embodiments, the
compounds described herein are utilized as an N-oxide or in a
crystalline or amorphous form (i.e., a polymorph). In some
situations, a compound described herein exists as tautomers. All
tautomers are included within the scope of the compounds presented
herein. In certain embodiments, a compound described herein exists
in an unsolvated or solvated form, wherein solvated forms comprise
any pharmaceutically acceptable solvent, e.g., water, ethanol, and
the like. The solvated forms of the compounds presented herein are
also considered to be described herein.
[0625] A "carrier" includes, in some embodiments, a
pharmaceutically acceptable excipient and is selected on the basis
of compatibility with compounds described herein, such as,
compounds of any of Formula I-VI, and the release profile
properties of the desired dosage form. Exemplary carrier materials
include, e.g., binders, suspending agents, disintegration agents,
filling agents, surfactants, solubilizers, stabilizers, lubricants,
wetting agents, diluents, and the like. See, e.g., Remington: The
Science and Practice of Pharmacy, Nineteenth Ed (Easton, Pa.: Mack
Publishing Company, 1995); Hoover, John E., Remington's
Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa. 1975;
Liberman, H. A. and Lachman, L., Eds., Pharmaceutical Dosage Forms,
Marcel Decker, New York, N.Y., 1980; and Pharmaceutical Dosage
Forms and Drug Delivery Systems, Seventh Ed. (Lippincott Williams
& Wilkins 1999).
[0626] Moreover, in certain embodiments, the pharmaceutical
compositions described herein are formulated as a dosage form. As
such, in some embodiments, provided herein is a dosage form
comprising a compound described herein, suitable for administration
to an individual. In certain embodiments, suitable dosage forms
include, by way of non-limiting example, aqueous oral dispersions,
liquids, gels, syrups, elixirs, slurries, suspensions, solid oral
dosage forms, aerosols, controlled release formulations, fast melt
formulations, effervescent formulations, lyophilized formulations,
tablets, powders, pills, dragees, capsules, delayed release
formulations, extended release formulations, pulsatile release
formulations, multiparticulate formulations, and mixed immediate
release and controlled release formulations.
Release in Distal Ileum and/or Colon
[0627] In certain embodiments, a dosage form comprises a matrix
(e.g., a matrix comprising hypermellose) that allows for controlled
release of an active agent in the distal jejunum, proximal ileum,
distal ileum and/or the colon. In some embodiments, a dosage form
comprises a polymer that is pH sensitive (e.g., a MMX.TM. matrix
from Cosmo Pharmaceuticals) and allows for controlled release of an
active agent in the ileum and/or the colon. Examples of such pH
sensitive polymers suitable for controlled release include and are
not limited to polyacrylic polymers (e.g. anionic polymers of
methacrylic acid and/or methacrylic acid esters, e.g.,
Carbopol.RTM. polymers) that comprise acidic groups (e.g., --COOH,
--SO.sub.3H) and swell in basic pH of the intestine (e.g., pH of
about 7 to about 8). In some embodiments, a dosage form suitable
for controlled release in the distal ileum comprises
microparticulate active agent (e.g., micronized active agent). In
some embodiments, a non-enzymatically degrading
poly(dl-lactide-co-glycolide) (PLGA) core is suitable for delivery
of an ASBTI to the distal ileum. In some embodiments, a dosage form
comprising an ASBTI is coated with an enteric polymer (e.g.,
Eudragit.RTM. S-100, cellulose acetate phthalate, polyvinylacetate
phthalate, hydroxypropylmethylcellulose phthalate, anionic polymers
of methacrylic acid, methacrylic acid esters or the like) for site
specific delivery to the ileum and/or the colon. In some
embodiments, bacterially activated systems are suitable for
targeted delivery to the ileum. Examples of micro-flora activated
systems include dosage forms comprising pectin, galactomannan,
and/or Azo hydrogels and/or glycoside conjugates (e.g., conjugates
of D-galactoside, .beta.-D-xylopyranoside or the like) of the
active agent. Examples of gastrointestinal micro-flora enzymes
include bacterial glycosidases such as, for example,
D-galactosidase, .beta.-D-glucosidase,
.alpha.-L-arabinofuranosidase, .beta.-D-xylopyranosidase or the
like.
[0628] The pharmaceutical solid dosage forms described herein
optionally include an additional therapeutic compound described
herein and one or more pharmaceutically acceptable additives such
as a compatible carrier, binder, filling agent, suspending agent,
flavoring agent, sweetening agent, disintegrating agent, dispersing
agent, surfactant, lubricant, colorant, diluent, solubilizer,
moistening agent, plasticizer, stabilizer, penetration enhancer,
wetting agent, anti-foaming agent, antioxidant, preservative, or
one or more combination thereof. In some aspects, using standard
coating procedures, such as those described in Remington's
Pharmaceutical Sciences, 20th Edition (2000), a film coating is
provided around the formulation of the compound of Formula I-VI. In
one embodiment, a compound described herein is in the form of a
particle and some or all of the particles of the compound are
coated. In certain embodiments, some or all of the particles of a
compound described herein are microencapsulated. In some
embodiments, the particles of the compound described herein are not
microencapsulated and are uncoated.
[0629] An ASBT inhibitor (e.g., a compound of Formula I-V1) is used
in the preparation of medicaments for the prophylactic and/or
therapeutic treatment of obesity and/or diabetes. A method for
treating any of the diseases or conditions described herein in an
individual in need of such treatment, involves administration of
pharmaceutical compositions containing at least one ASBT inhibitor
described herein, or a pharmaceutically acceptable salt,
pharmaceutically acceptable N-oxide, pharmaceutically active
metabolite, pharmaceutically acceptable prodrug, or
pharmaceutically acceptable solvate thereof, in therapeutically
effective amounts to said individual.
Screening Process
[0630] Provided in certain embodiments herein are processes and
kits for identifying compounds suitable for treating obesity,
metabolic disorders or disorders mediated by L-cell enteroendocrine
peptides. In certain embodiments, provided herein are assays for
identifying compounds that selectively inhibit the ASBT, or enhance
the secretion of L-cell enteroendocrine peptides, or a combination
thereof by: [0631] a. providing cells that are a model of
intestinal L-cells (e.g., SLC-1 cells, GLUTag cells, NCI-H-1719
cells); [0632] b. contacting the cells with a compound (e.g., a
compound as described herein); [0633] c. detecting or measuring the
effect of the compound on the secretion of enteroendocrine peptides
(e.g., GLP-1, GLP-2) from the cells.
[0634] In certain embodiments, provided herein are assays for
identifying compounds that are non-systemic compounds by [0635] a.
providing cells that are a model of intestinal permeability (e.g.,
Caco-2 cells); [0636] b. culturing the cells as a monolayer on
semi-permeable plastic supports that are fitted into the wells of
multi-well culture plates; [0637] c. contacting the apical or
basolateral surface of the cells with a compound (e.g., a compound
as described herein) and incubating for a suitable length of time;
[0638] d. detecting or measuring the concentration of the compound
on both sides of the monolayer by liquid-chromatography-mass
spectrometry (LC-MS) and computing intestinal permeability of the
compound.
[0639] In certain embodiments, non-systemic compounds are
identified by suitable parallel artificial membrane permeability
assays (PAMPA).
[0640] In certain embodiments, non-systemic compounds are
identified by use of isolated vascular-perfused gut
preparations.
[0641] In certain embodiments, provided herein are assays for
identifying compounds that inhibit recycling of bile acid salts by
[0642] a. providing cells that are a model of intestinal cells with
apical bile acid tranporters (e.g., BHK cells, CHO cells); [0643]
b. incubating the cells with a compound (e.g. a compound as
described herein) and/or a radiolabeled bile acid (e.g. .sup.14C
taurocholate) for a suitable length of time; [0644] c. washing the
cells with a suitable buffer (e.g. phosphate buffered saline);
[0645] d. detecting or measuring the residual concentration of the
radiolabeled bile acid in the cells.
EXAMPLES
Example 1
Synthesis of
1-phenethyl-1-((1,4-diazabicyclo[2.2.2]octanyl)pentyl)imidodicarbonimidic
diamide, iodide salt
##STR00057##
[0646] Step 1: Synthesis of
5-(1,4-diazabicyclo[2.2.2]octanyl)-1-iodo pentane, iodide salt
##STR00058##
[0648] 1,4-diazabicyclo[2.2.2]octane is suspended in THF.
Diiodopentane is added dropwise and the mixture is refluxed
overnight. The reaction mixture is filtered.
Step 2: Synthesis of
N-phenethyl-5-(1,4-diazabicyclo[2.2.2]octanyl)-1-iodo pentane,
iodide salt
##STR00059##
[0650] 5-(1,4-diazabicyclo[2.2.2]octanyl)-1-iodo pentane, iodide
salt is suspended in acetonitrile. Phenethylamine is added dropwise
and the mixture is refluxed overnight. The reaction mixture is
filtered.
Step 3: Synthesis of
1-phenethyl-1-((1,4-diazabicyclo[2.2.2]octanyl)pentyl)imidodicarbonimidic
diamide, iodide salt
[0651] N-phenethyl-5-(1,4-diazabicyclo[2.2.2]octanyl)-1-iodo
pentane, iodide salt is heated with dicyanodiamide in n-butanol for
4 h. The reaction mixture is concentrated under reduced
pressure.
[0652] The compounds in Table 1 are prepared using methods as
described herein, and using appropriate starting materials.
TABLE-US-00002 TABLE 1 Compound No. Structure 1 ##STR00060## 2
##STR00061## 3 ##STR00062## 4 ##STR00063## 5 ##STR00064## 6
##STR00065## 7 ##STR00066## 8 ##STR00067## 9 ##STR00068## 10
##STR00069## 11 ##STR00070##
Example 2
In Vitro Assay for Inhibition of ASBT-Mediated Bile Acid Uptake
[0653] Baby hamster kidney (1311K) cells are transfected with cDNA
of human ASBT. The cells are seeded in 96-well tissue culture
plates at 60,000 cells/well. Assays are run within 24 hours of
seeding.
[0654] On the day of the assay the cell monolayer is washed with
100 mL of assay buffer. The test compound is added to each well
along with 6 mM [.sup.14C]taurocholate in assay buffer (final
concentration of 3 mM [.sup.14C]taurocholate in each well). The
cell cultures are incubated for 2 h at 37.degree. C. The wells are
washed with PBS. Scintillation counting fluid is added to each
well, the cells are shaken for 30 minutes prior to measuring amount
of radioactivity in each well. A test compound that has significant
ASBT inhibitory activity provides an assay wherein low levels of
radioactivity are observed in the cells.
Example 3
In Vitro Assay for Secretion of GLP-1
[0655] Human NCI-H1-716 cells are used as a model for L-cells. Two
days before each assay experiment, cells are seeded in 12-well
culture plates coated with Matrigel.RTM. to induce cell adhesion.
On the day of the assay, cells are washed with buffer. The cells
are incubated for 2 hours with medium alone, or with test compound.
The extracellular medium is assayed for the presence of GLP-1.
Peptides in the medium are collected by reverse phase adsorption
and the extracts are stored until assay. The presence of GLP-1 is
assayed using an antiserum directed against the carboxyl terminus
of GLP-1 amide (total immunoreactive GLP-1; Affinity Research
Products, Nottingham, UK). The detection of increased levels of
GLP-1 in a well containing a test compound identifies the test
compound as a compound that can enhance GLP-1 secretions from
L-cells.
Example 4
In Vivo Bioavailability Assay
[0656] The test compounds are solubilized in saline solutions.
Sprague Dawley rats are dosed at 2-mg/kg body weight by iv and oral
dosing. Peripheral blood samples are taken from the femoral artery
at selected time periods up to 8 hours. Plasma concentrations of
the compounds are determined by quantitative HPLC and/or mass
spectrometry. Clearance and AUC values are determined for the
compounds.
[0657] For oral dosing, bioavailabilty is calculated by also
drawing plasma samples from the portal vein. Cannulae are inserted
in the femoral artery and the hepatic portal vein to obtain
estimates of total absoprtion of drug without first-pass clearance
in the liver. The fraction absorbed (F) is calculated by
F=AUC.sub.po/AUC.sub.iv
Example 5
In Vivo Animal Model of Necrotizing Enterocolitis and Obesity
[0658] Sprague-Dawley (SD) rats are used as a model of necrotizing
enterocolitis (NEC). NEC is induced by collecting premature SD rats
by cesarean section 1 day prior to scheduled birth. SD rat pups are
fed with cow's milk-based formula and subjected to asphyxia and
cold stress twice daily to develop NEC.
[0659] A non-genetic mouse obesity model is used. Obesity is
induced in a cohort of C57BL/6 (wild-type) mice, by a high-fat
cafeteria diet. The mice are administered 30 mg/kg of compound 8
once daily as an oral solution in saline. The mice are weighed
daily over a period of two weeks. Cafeteria dieting is continued
throughout the experiment. Obese mice administered a saline
solution alone (placebo) serve as negative controls. The weight
gain in the control group is comapared with the weight gain or loss
of the test group.
Example 6
Histological Evaluations of Necrosis or Damage to Ileal
Architecture or Ileal Cells in NEC
[0660] Histological sections are obtained after administration of
an ASBTI and/or an enteroendocrine peptide enhancing agent and/or a
FXR agonist to the ileum of NEC suffering SD rats and compared to
the corresponding histological sections of a normal SD rat.
Histological changes are scored by a blind evaluator and graded
using the following scoring system:
TABLE-US-00003 Score Histological observations 0 Normal, no
necrosis or damage 1 Very mild, slight submucosal and/or lamina
propria separation 2 Mild, some submucosal and/or lamina propria
separation 3 Moderate, moderate submucosal and/or lamina propria
separation 4 Severe, severe submucosal and/or lamina propria
separation and/or severe edema in submucosa and muscular layers,
regional villous sloughing 5 Necrosis, loss of villi and loss of
ileal architecture
Histological scores greater than or equal to 3 are considered to
have developed NEC.
[0661] A single administration of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide is administered to produce a
dose-dependent reduction of the histological score. Control mice
are treated with only the control vehicle (saline in 10% of
DMSO).
Example 6B
Assay to Determine Ileal Intraenterocyte and Luminal Bile Acid
Levels
[0662] Ileal luminal bile acid levels in SD rats are determined by
flushing a 3-cm section of distal ileum with sterile, cold PBS.
After flushing with additional PBS, the same section of ileum is
weighed and then homogenized in fresh PBS for determination of
interenterocyte bile acid levels. A LC/MS/MS system is used to
evaluate cholic acid, DCA, LCA, chenodeoxycholic acid, and
ursodeoxycholic acid levels.
Example 7A
In Vivo Assay for Reduction in Blood Glucose Levels
[0663] Male db/db mice 6-7 weeks (approx 30 g) were fasted for 2 h.
A combination of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (Compound 100A) at doses of 0,
0.1, 1, 10, mg/kg in 10% of DMSO-water and 30 mg/kg sitagliptin
(DPP-IV inhibitor) in a mixture of valine-pyrrolidine in water was
administered orally to male db/db mice (n=7-10 per group). Blood
sample (.about.1 .mu.l from tail for glucose level testing) was
taken at t=-24 h, 0, 60, 180, 240, 300, 360 min and 24 h after
administration.
[0664] A single administration of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide in combination with sitagliptin
produced a dose-dependent reduction of the elevated blood glucose
levels compared to the control mice treated with sitagliptin alone
or with vehicle solution of 10% of DMSO (FIG. 1). Reductions in
plasma glucose concentrations are observed from 3 hours up to 24
hours post-dose and accompanied after 6 hours by a 5.5%, 5.6%, 15%
and 42.3% reduction in plasma glucose from baseline, (doses of 0,
01, 1 and 10 mg/kg of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide respectively). Plasma glucose
concentrations in the control mice treated with only the control
vehicle (saline in 10% of DMSO) increased by 1.5% after 6 h.
Administration of the ASBTI alone also lowers plasma glucose
concentrations in male db/db mice as shown in FIG. 1. Weight loss
is shown in FIG. 9.
Example 7B
In Vivo Assay for Reduction in Blood Glucose Levels
[0665] Male db/db mice 8-9 weeks (approx 40 g) were fasted for 2 h.
A combination of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Compound 100B) at doses of 0, 3, 30,
100 mg/kg in saline-water and 30 mg/kg sitagliptin (DPP-IV
inhibitor) in a mixture of valine-pyrrolidine in water was
administered orally to male db/db mice (n=6-11 per group). Blood
sample (.about.1 .mu.l from tail for glucose level testing) was
taken at t=-24 h, 0, 1, 3, 4, 5, 6 h and 24 h after
administration.
[0666] A single administration of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothicpin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate in combination with sitagliptin
produced a dose-dependent reduction of the elevated blood glucose
levels compared to the control mice treated with sitagliptin alone
or with vehicle solution of saline-water (FIG. 2). Reductions in
plasma glucose concentrations are observed from 3 hours till 24
hours post-dose and accompanied after 6 hours by a 5.5%, 5.6%, 15%
and 42.3% reduction in plasma glucose from baseline, (doses of 0,
3, 30 and 100 mg/kg of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate respectively). Plasma glucose
concentrations in the control mice treated with only the control
vehicle (saline-water) increased by 1.5% after 6 h (FIG. 2). Weight
loss is shown in FIG. 8.
[0667] Administration of doses of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate alone also lowers plasma glucose
levels in dose dependent manner (FIG. 4).
Example 8
Investigation of orally delivered
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phcnoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Compound 100B) and metformin in
combination with DPP-IV inhibitor on plasma GLP-1 levels in normal
rats
[0668] 12-week-old male HSD rats were fasted for 16 h and given
oral dose of 0, 3, 30, 100 mg/kg of the ASBTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Synthesized by Nanosyn Inc., CA. USA)
or metformin (Control, 0, 3, 30, 100, 300 mg/kg) in saline and a
dose of 30 mg/kg sitaglipin in a mixture of valine-pyrrolidine in
water (n=5 per group). Blood samples in volume of 0.6 ml for each
time point were taken from the caudal vein with a heparinized
capillary tube 0, 1, 3 and 5 h after the administration of
compounds and plasma GLP-1 level were determined. Aprotinin and 10
id of DPP-IV inhibitor per ml of blood were used for blood sample
preservation during 10 min centrifugation and for storage at
-70.degree. C. or below. GLP-1 (Active pM) was tested by Millipore
ELISA Kits (Millipore Corporation, 290 Concord Road, Billerica,
Mass.). ASBTI alone or ASBTI in combination with sitagliptin
elicited an elevation in GLP-1 levels in a dose-dependent manner
(FIG. 6, FIG. 7) in normal rats. FIG. 5 shows elevation in GLP-1
levels in plasma of normal rats upon administration of a
combination of metformin and sitagliptin.
Example 9
Investigation of Orally Delivered Compound 100A and 100B in
Combination with DPP-Iv Inhibitor Versus Subcutaneous Exenatide
[0669] A similar experiment as described above is carried out to
test doses of 0, 0.01, 1 and 10 mg/kg of the ASBTI
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine 1,1-dioxide (Compound 100A) in combination
with 30 mg/kg sitagliptin and a subcutaneous injection of
exenatide. An oral dose of a combination of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (10 mg/kg) in combination with 30
mg/kg sitagliptin reduces plasma glucose levels by 35% while a
sub-cutaneous injection of exenatide (0.2 mg/kg) reduces plasma
glucose level by 31% at 3 hours post-dose (FIG. 10).
[0670] A similar experiment as described above is carried out to
compare glucose lowering effect of orally administered doses of 0,
3, 30, and 100, mg/kg of the ABTI
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Compound 100B) in combination with a
30 mg/kg dose of sitagliptin versus 0.02, 0.2 and 2 mg/kg doses of
exenatide. FIG. 10 shows that an oral combination of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate in combination with a 30 mg/kg dose of
sitagliptin reduces blood glucose levels more than a single
subcutaneous injection of 0.02 mg/kg exenatide at 3 hours after
dosing.
Example 10
Tablet Formulation
[0671] 10 kg of a compound of Formula I-VI is first screened
through a suitable screen (e.g. 500 micron). 25 kg Lactose
monohydrate, 8 kg hydroxypropylmethyl cellulose, the screened
compound of Formula I-VI and 5 kg calcium hydrogen phosphate
(anhydrous) are then added to a suitable blender (e.g. a tumble
mixer) and blended. The blend is screened through a suitable screen
(e.g. 500 micron) and reblended. About 50% of the lubricant (2.5
kg, magnesium stearate) is screened, added to the blend and blended
briefly. The remaining lubricant (2 kg, magnesium stearate) is
screened, added to the blend and blended briefly. The granules are
screened (e.g. 200 micron) to obtain granulation particles of the
desired size. In some embodiments, the granules are optionally
coated with a drug release controlling polymer such as
polyvinylpyrrolidine, hydroxypropylcellulose, hydroxypropylmethyl
cellulose, methyl cellulose, or a methacrylic acid copolymer, to
provide an extended release formulation. The granules are filled in
gelatin capsules.
Example 11A
Human Clinical Trial of the effect of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (Compound 100A) on necrotizing
enterocolitis (NEC)
[0672] Objective: The aim of a 6 month study is to show evidence of
the efficacy
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimetho-
xy-5-phenyl-1,4-benzothiazepine1,1-dioxide on reduction of
incidence and severity of NEC in very low birth weight infants.
[0673] Study Design: This is a 6 month study. A cohort of 1000
patients is divided into placebo group and drug treated groups. An
optimized dose of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide will be administered with milk or
formula.
[0674] Inclusion Criteria are: Infants with birth weight less than
1500 grams; gestational age 24 to 33 weeks; diagnosed with
necrotizing enterocolitis based on Bell stage II or greater: or
bowel perforation as evidenced by free intraperitoneal air seen on
abdominal radiograph, stool, bile, or pus found at paracentesis or
clinical evidence of perforation in the joint opinion of the
attending surgeon or neonatologist.
[0675] Exclusion criteria are: healthy infants, major congenital
abnormalities, chronic disorders of other organs, evidence of
gastrointestinal anomaly.
[0676] Patient Response to
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide therapy: Patient response is
assessed via primary and secondary outcome measures.
[0677] Primary Outcome Measures: disease mortality, disease
progression, treatment failure, time to recovery.
[0678] Secondary Outcome Measures: inflammatory cytokine
concentration, duration of inflammation, weight gain, length of
hospital stay.
[0679] Blood Sampling Serial blood is drawn by direct vein puncture
before and after administration of Compound 100 analog. Venous
blood samples (2 mL) for determination of serum concentrations are
obtained at about 10 minutes prior to dosing and at approximately
the following times after dosing: days 1, 2, 3, 4, 5, 6, 7, 14 and
every 14 days later. Each serum sample is divided into two
aliquots. All serum samples are stored at -20.degree. C. Serum
samples are shipped on dry ice.
[0680] Pharmacokinetics: Patients undergo plasma/serum sample
collection for pharmacokinetic evaluation before beginning
treatment and at days 1, 2, 3, 4, 5, 6, 7, 14 and every 14 days
later. Pharmacokinetic parameters are calculated by model
independent methods on a Digital Equipment Corporation VAX 8600
computer system using the latest version of the BIOAVL software.
The following pharmacokinetics parameters are determined: peak
serum concentration (C.sub.max); time to peak serum concentration
(t.sub.max); area under the concentration-time curve (AUC) from
time zero to the last blood sampling time (AUC.sub.0-72) calculated
with the use of the linear trapezoidal rule; and terminal
elimination half-life (t.sub.1/2), computed from the elimination
rate constant. The elimination rate constant is estimated by linear
regression of consecutive data points in the terminal linear region
of the log-linear concentration-time plot. The mean, standard
deviation (SD), and coefficient of variation (CV) of the
pharmacokinetic parameters are calculated for each treatment.
[0681] Statistical Analysis: The association of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide and reduction of necrotizing
enterocolitis is analyzed by .lamda.2 test.
Example 11B
[0682] A Human Clinical Trial similar to the trial in Example 1A is
conducted to determine the effect of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Compound 100B) on reduction of
necrotizing enterocolitis.
Example 11C
[0683] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N-(2-sulp-
hoethyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4,5-tetrahydro-1,-
2,5-benzothiadiazepine on reduction of necrotizing
enterocolitis.
Example 11D
[0684] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-(R)-hydroxypropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)--
2,3,4,5-tetrahydro-1,2,5-benzothiadiazepine on reduction of
necrotizing enterocolitis.
Example 11E
[0685] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-methylpropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4-
,5-tetrahydro-1,2,5-benzothiadiazepine on reduction of necrotizing
enterocolitis.
Example 11F
[0686] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of
1-[[5-[[3-[(3S,4R,5R)-3-butyl-7-(dimethylamino)-3-ethyl-2,3,4,5-tetrahydr-
o-4-hydroxy-1,1-dioxido-1-benzothiepin-5-yl]phenyl]amino]-5-oxopentyl]amin-
o]-1-deoxy-D-glucitol on reduction of necrotizing
enterocolitis.
Example 11G
A Human Clinical Trial similar to the trial in Example 11A is
conducted to determine the effect of
Potassium((2R,3R,4S,5R,6R)-4-benzyloxy-6-{3-[3-((3S,4R,5R)-3-butyl-7-dime-
thylamino-3-ethyl-4-hydroxy-1,1-dioxo-2,3,4,5-tetrahydro-1H-benzo[b]thiepi-
n-5-yl)-phenyl]-ureido}-3,5-dihydroxy-tetrahydro-pyran-2-ylmethyl)sulphate
ethanolate, hydrate on reduction of necrotizing enterocolitis.
Example 11H
[0687] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of SD-5613 (Pfizer, a.k.a.
97-G) on reduction of necrotizing enterocolitis.
Example 11I
[0688] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide and bile acids or mimetics on
reduction of necrotizing enterocolitis.
Example 11J
[0689] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothicpin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Compound 100B1) bile acids or
mimetics on reduction of necrotizing enterocolitis.
Example 11K
[0690] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N-(2-sulp-
hoethyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4,5-tetrahydro-1,-
2,5-benzothiadiazepine bile acids or mimetics on reduction of
necrotizing enterocolitis.
Example 11L
[0691] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-(R)-hydroxypropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)--
2,3,4,5-tetrahydro-1,2,5-benzothiadiazepine bile acids or mimetics
on reduction of necrotizing enterocolitis.
Example 11M
[0692] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
1,1-Dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N--[(R)-.alpha.-[N--((S)-1-
-carboxy-2-methylpropyl)carbamoyl]-4-hydroxybenzyl]carbamoylmethoxy)-2,3,4-
,5-tetrahydro-1,2,5-benzothiadiazepine bile acids or mimetics on
reduction of necrotizing enterocolitis.
Example 11N
[0693] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
1-[[5-[[3-[(3S,4R,5R)-3-butyl-7-(dimethylamino)-3-ethyl-2,3,4,5-tetrahydr-
o-4-hydroxy-1,1-dioxido-1-benzothiepin-5-yl]phenyl]amino]-5-oxopentyl]amin-
o]-1-deoxy-D-glucitol bile acids or mimetics on reduction of
necrotizing enterocolitis.
Example 11O
[0694] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of
Potassium((2R,3R,4S,5R,6R)-4-benzyloxy-6-{3-[3-((3S,4R,5R)-3-butyl-7-dime-
thylamino-3-ethyl-4-hydroxy-1,1-dioxo-2,3,4,5-tetrahydro-1H-benzo[b]thiepi-
n-5-yl)-phenyl]-ureido}-3,5-dihydroxy-tetrahydro-pyran-2-ylmethyl)sulphate
ethanolate, hydrate bile acids or mimetics on reduction of
necrotizing enterocolitis.
Example 11P
[0695] A Human Clinical Trial similar to the trial in Example 11A
is conducted to determine the effect of combination of SD-5613
(Pfizer. a.k.a. 97-G) bile acids or mimetics on reduction of
necrotizing enterocolitis.
Example 12A
[0696] Human Clinical Trial of the effect of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (Compound 100A) on satiety and
reduction in food intake, plasma glucose and insulin levels
[0697] Objective: The aim of the 8 week study is to show evidence
of the efficacy
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimetho-
xy-5-phenyl-1,4-benzothiazepine1,1-dioxide to induce satiety and to
reduce food intake. A secondary objective of the study is to
determine the effect of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimeth-
oxy-5-phenyl-1,4-benzothiazepine1,1-dioxide on food consumption
(amount and composition) during a free meal (dinner); wellness
after one week supplementation; the intermeal interval; and body
weight and waist-hip ratio (WHR).
[0698] Study Design: This is an 8 week study. A cohort of 500
patients is divided into placebo group and drug treated groups. 50
mg of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide will be administered 30 minutes
prior to ingestion of lunch and prior to ingestion of dinner for a
total of 100 mg of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-p-
henyl-1,4-benzothiazepine 1,1-dioxide per day.
[0699] Inclusion Criteria are: a BMI.gtoreq.27, 70 years of age or
less, waist circumference .gtoreq.102 cm for men or .gtoreq.88 cm
for women, eating disorders, diabetes
[0700] Exclusion criteria are: Stroke/MI/unstable cardiovascular
disease within 6 months, clinically significant renal, hepatic or
psychiatric disease, participation in a formal weight loss program
or lifestyle intervention, glaucoma or intraocular pressure, use of
any antidiabetic medication.
[0701] Blood Sampling Serial blood is drawn by direct vein puncture
before and after administration of Compound 100 analog. Venous
blood samples (5 mL) for determination of serum concentrations are
obtained at about 10 minutes prior to dosing and at approximately
the following times after dosing: days 1, 2, 3, 4, 5, 6, 7, and 14.
Each serum sample is divided into two aliquots. All serum samples
are stored at -20.degree. C. Serum samples are shipped on dry
ice.
[0702] Pharmacokinetics: Patients undergo plasma/serum sample
collection for pharmacokinetic evaluation before beginning
treatment and at days 1, 2, 3, 4, 5, 6, 7, and 14. Pharmacokinetic
parameters are calculated by model independent methods on a Digital
Equipment Corporation VAX 8600 computer system using the latest
version of the BIOAVL software. The following pharmacokinetics
parameters are determined: peak serum concentration (C.sub.max);
time to peak serum concentration (t.sub.max); area under the
concentration-time curve (AUC) from time zero to the last blood
sampling time (AUC.sub.0-72) calculated with the use of the linear
trapezoidal rule; and terminal elimination half-life (t.sub.1/2),
computed from the elimination rate constant. The elimination rate
constant is estimated by linear regression of consecutive data
points in the terminal linear region of the log-linear
concentration-time plot. The mean, standard deviation (SD), and
coefficient of variation (CV) of the pharmacokinetic parameters are
calculated for each treatment.
[0703] Patient Response to
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide therapy: Patient response is
assessed via weekly hospital visits, weight and waist measurements
and routine blood tests.
[0704] Primary Outcome Measures: Satiety scores (visual analog
scores), wellness after one week supplementation.
[0705] Secondary Outcome Measures: Demonstrate an improvement over
placebo in absolute weight loss and waist to hip ratio. Demonstrate
an improvement in quality of life.
Example 12B
[0706] A Human Clinical Trial similar to the trial in Example 12A
is conducted to determine the effect of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]4-aza-1-azoniabicyclo[2.2-
.2]octane methane sulfonate (Compound 100B) on satiety and
reduction in food intake, plasma glucose and insulin level
Example 13
Human Phase I Clinical Trial of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine 1,1-dioxide alone or in combination with
sitagliptin on satiety and reduction in food intake, plasma glucose
and insulin levels
[0707] Aim of the study: A phase 1 dose-escalation study
[0708] Patient population: Obese type II diabetic
[0709] Study design: Randomized, double-blind, cross-over,
single-dose placebo controlled
[0710] Ten subjects will be administered a single dose of
sitagliptin ten minutes before administration of a single dose of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide prior to ingestion of food. A
second group of ten subjects will be administered a single dose of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide 30 minutes prior to ingestion of
food. Rising dose levels of the ASBTI (1, 3, 10 and 30 mg/kg) will
be administered at each visit. Each visit to test facility will be
at least 72 hours apart.
[0711] A buffet style breakfast will be presented and ad-libitum
food intake will be measured. Patients will record meal-related
satiation, or hunger, and nausea on a chart. Satiogenic gut
peptides will be measured post-prandially from plasma analytes.
Insulin, glucose, GLP-1 and PYY levels in blood/plasma will be
monitored for 24 hours. Subjects will be asked to record food
intake for 72 hours after each dose.
[0712] Endpoints: Safety and tolerability, pharmacodynamics, food
intake 24 hours after dosing.
Example 14
A Human Phase II Clinical Trial of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (Compound 100A) alone or in
combination with sitagliptin and effect on obesity or diabetes
[0713] Phase 2A: This will be a 16 week double-blind,
parallel-group study. A single dose of sitagliptin in combination
with
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide will be administered as described
above. A second group of subjects will be administered a single
dose of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide 30 minutes prior to ingestion of
food. A buffet style breakfast will be presented as described above
and satiety and food intake will be measured.
[0714] Phase 2A: This will be a 6-week, single-blind,
parallel-group study carried out as described above. Glucose levels
in blood/plasma, body composition and a comprehensive assessment of
food intake will be carried for the duration of the study.
[0715] Phase 2B: This will be a 16-week, double-blind, parallel
group study dose-ranging study carried out as described above.
Safety, dose-tolerance, glucose levels in blood/plasma, weight loss
and HBA1c will be monitored for the duration of the study.
Example 15
[0716] A Human Phase II Clinical Trial similar to the trial in
Example 14 is conducted to determine the effect of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]4-aza-1-azoniabicyclo[2.2-
.2]octane methane sulfonate (Compound 100B) alone or in combination
with sitagliptin and effect on obesity or diabetes
Example 16
A Human Phase II Clinical Trial similar to the trial in Example 14
is conducted to determine the effect of compound 4 alone or in
combination with sitagliptin and effect on obesity or diabetes
Example 17
Human Phase 1 Clinical Trial of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate (Compound 100B) in combination with
sitagliptin on satiety and reduction in food intake, plasma glucose
and insulin level
[0717] Aim of the study: A phase 1 dose-escalation study
[0718] Patient population: Obese type II diabetic
[0719] Study design: Randomized, double-blind, cross-over,
single-dose placebo controlled
[0720] Ten subjects will be administered a single dose of
sitagliptin ten minutes before administration of a single dose of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]4-aza-1-azoniabicyclo[2.2-
.2]octane methane sulfonate prior to ingestion of food. A second
group of ten subjects will be administered a single dose of
1-[4-[4-[(4R,5R)-3,3-dibutyl-7-(dimethylamino)-2,3,4,5-tetrahydro-4-hydro-
xy-1,1-dioxido-1-benzothiepin-5-yl]phenoxy]butyl]-4-aza-1-azoniabicyclo[2.-
2.2]octane methane sulfonate 30 minutes prior to ingestion of food.
Rising dose levels of the ASBTI (1, 3, 10 and 30 mg/kg) will be
administered at each visit. Each visit to test facility will be at
least 72 hours apart.
[0721] A buffet style breakfast will be presented and ad-libitum
food intake will be measured. Patients will record meal-related
satiation, or hunger, and nausea on a chart. Satiogenic gut
peptides will be measured post-prandially from plasma analytes.
Insulin, glucose, GLP-1 and PYY levels in blood/plasma will be
monitored for 24 hours. Subjects will be asked to record food
intake for 72 hours after each dose.
[0722] Endpoints: Safety and tolerability, pharmacodynamics, food
intake 24 hours after dosing.
Example 18
[0723] A Human Phase 1 Clinical Trial similar to the trial in
Example 17 is conducted to determine the effect of compound 2 in
combination with sitagliptin on satiety and reduction in food
intake, plasma glucose and insulin level
Example 19
Human Clinical Trial of the effect of compound 4 on satiety and
reduction in food intake
[0724] Objective: The aim of the 8 week study is to show evidence
of the efficacy of compound 4 to induce satiety and to reduce food
intake. A secondary objective of the study is to determine the
effect of compound 4 on food consumption (amount and composition)
during a free meal (dinner); wellness after one week
supplementation; the intermeal interval; and body weight and
waist-hip ratio (WHR).
[0725] Study Design: This is an 8 week study. A cohort of 500
patients is divided into placebo group and drug treated groups. 50
mg of compound 4 will be administered 30 minutes prior to ingestion
of lunch and prior to ingestion of dinner for a total of 100 mg of
compound 4 per day.
[0726] Inclusion Critera are: a BMI.gtoreq.27, 70 years of age or
less, waist circumference .gtoreq.102 cm for men or .gtoreq.88 cm
for women.
[0727] Exclusion criteria are: Stroke/MI/unstable cardiovascular
disease within 6 months, clinically significant renal, hepatic or
psychiatric disease, participation in a formal weight loss program
or lifestyle intervention, glaucoma or intraocular pressure, use of
any antidiabetic medication, previous bariatric surgery
[0728] Blood Sampling Serial blood is drawn by direct vein puncture
before and after administration of Compound 100 analog. Venous
blood samples (5 mL) for determination of serum concentrations are
obtained at about 10 minutes prior to dosing and at approximately
the following times after dosing: days 1, 2, 3, 4, 5, 6, 7, and 14.
Each serum sample is divided into two aliquots. All serum samples
are stored at -20.degree. C. Serum samples are shipped on dry
ice.
[0729] Pharmacokinetics: Patients undergo plasma/serum sample
collection for pharmacokinetic evaluation before beginning
treatment and at days 1, 2, 3, 4, 5, 6, 7, and 14. Pharmacokinetic
parameters are calculated by model independent methods on a Digital
Equipment Corporation VAX 8600 computer system using the latest
version of the BIOAVL software. The following pharmacokinetics
parameters are determined: peak serum concentration (C.sub.max);
time to peak serum concentration (t.sub.max); area under the
concentration-time curve (AUC) from time zero to the last blood
sampling time (AUC.sub.0-72) calculated with the use of the linear
trapezoidal rule; and terminal elimination half-life (t.sub.1/2),
computed from the elimination rate constant. The elimination rate
constant is estimated by linear regression of consecutive data
points in the terminal linear region of the log-linear
concentration-time plot. The mean, standard deviation (SD), and
coefficient of variation (CV) of the pharmacokinetic parameters are
calculated for each treatment.
[0730] Patient Response to Compound 4 therapy: Patient response is
assessed via weekly hospital visits, weight and waist measurements
and routine blood tests.
[0731] Primary Outcome Measures: Satiety scores (visual analog
scores), wellness after one week supplementation.
[0732] Secondary Outcome Measures: Demonstrate an improvement over
placebo in absolute weight loss and waist to hip ratio. Demonstrate
an improvement in quality of life.
Example 20
Human Clinical Trial of the effect of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide (Compound 100A) on risk of
pancreatic cancer
[0733] Objective: The aim of a 1 year study is to show evidence of
the efficacy
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimetho-
xy-5-phenyl-1,4-benzothiazepine-1,1-dioxide on reduction of risk of
pancreatic cancer.
[0734] Study Design: This is a 1 year study. A cohort of 1000
patients is divided into placebo group and drug treated groups. 50
mg of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide will be administered 30 minutes
prior to ingestion of lunch and prior to ingestion of dinner for a
total of 100 mg of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-p-
henyl-1,4-benzothiazepine 1,1-dioxide per day.
[0735] Inclusion Criteria are: 70 years of age or less, waist
circumference .gtoreq.102 cm for men or .gtoreq.88 cm for women,
pancreatic ductal adenocarcinoma.
[0736] Exclusion criteria are: Stroke/MI/unstable cardiovascular
disease within 6 months, clinically significant renal, hepatic or
psychiatric disease, participation in a formal weight loss program
or lifestyle intervention, glaucoma or intraocular pressure, use of
any antidiabetic medication, prior history with cancer. Patient
Response to
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide therapy: Patient response is
assessed via weekly hospital visits, weight and waist measurements
and routine blood tests.
[0737] Blood Sampling Serial blood is drawn by direct vein puncture
before and after administration of Compound 100 analog. Venous
blood samples (5 mL) for determination of serum concentrations are
obtained at about 10 minutes prior to dosing and at approximately
the following times after dosing: days 1, 2, 3, 4, 5, 6, 7, 14 and
every 14 days later. Each serum sample is divided into two
aliquots. All serum samples are stored at -20.degree. C. Serum
samples are shipped on dry ice.
[0738] Pharmacokinetics: Patients undergo plasma/serum sample
collection for pharmacokinetic evaluation before beginning
treatment and at days 1, 2, 3, 4, 5, 6, 7, 14 and every 14 days
later. Pharmacokinetic parameters are calculated by model
independent methods on a Digital Equipment Corporation VAX 8600
computer system using the latest version of the BIOAVL software.
The following pharmacokinetics parameters are determined: peak
serum concentration (C.sub.max); time to peak serum concentration
(t.sub.max); area under the concentration-time curve (AUC) from
time zero to the last blood sampling time (AUC.sub.0-72) calculated
with the use of the linear trapezoidal rule; and terminal
elimination half-life (t.sub.1/2), computed from the elimination
rate constant. The elimination rate constant is estimated by linear
regression of consecutive data points in the terminal linear region
of the log-linear concentration-time plot. The mean, standard
deviation (SD), and coefficient of variation (CV) of the
pharmacokinetic parameters are calculated for each treatment.
[0739] Patient Response to Compound 4 therapy: Patient response is
assessed via weekly hospital visits, weight and waist measurements
and routine blood tests.
[0740] Statistical Analysis: The association of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide and risk of pancreatic cancer is
analyzed in multivariable logistic regression models including age,
sex, race, smoking, alcohol. BMI, family history of cancer,
duration of diabetes, and insulin use. To control for reversal
causality due to pancreatic cancer-caused diabetes, risk of
pancreatic cancer is estimated after exclusion of those with
duration of diabetes .ltoreq.2 years. HbA1c level (57% or >7%),
a marker of glycemic control, is compared between placebo and users
of
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phen-
yl-1,4-benzothiazepine1,1-dioxide by .chi.2 test. The demographic
and risk factors as well as duration of diabetes and insulin use
are compared between
(-)-(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethox-
y-5-phenyl-1,4-benzothiazepine1,1-dioxide users and placebo by
.chi.2 test.
Example 21
Rectal Foams
a) 500 mM Sodium Taurocholate
Preparation Method:
[0741] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 26.88 grams of sodium
taurocholate, 0.25 grams of potassium metabisulphite, 0.3 grams
EDTA (disodium salt), 0.38 grams of sodium benzoate and 0.2 grams
of xanthan gum are dissolved in 100 mL of purified water. While
stirring, 4 grams of Polysorbate 20 and 4 grams of Polyglycol 300
isostearate are added and stirring is continued for 15 minutes. The
suspension is then pumped into an aerosol cans and is immediately
sealed by clinching the dispenser valve. The can is then
pressurized by pumping 6.5 grams of Freon 12 and 3.5 grams of Freon
114 into the can.
b) 500 mM Sodium Glycocholate
Preparation Method:
[0742] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 24.38 grams of sodium
glycocholate, 0.25 grams of potassium metabisulphite, 0.3 grams
EDTA (disodium salt), 0.38 grams of sodium benzoate and 0.2 grams
of xanthan gum are dissolved in 100 mL of purified water. While
stirring, 4 grams of Polysorbate 20 and 4 grams of Polyglycol 300
isostearate are added and stirring is continued for 15 minutes. The
suspension is then pumped into an aerosol cans and is immediately
sealed by clinching the dispenser valve. The can is then
pressurized by pumping 6.5 grams of Freon 12 and 3.5 grams of Freon
114 into the can.
c) No Bile Salt (Control)
Preparation Method:
[0743] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 0.25 grams of potassium
metabisulphite, 0.3 grams EDTA (disodium salt), 0.38 grams of
sodium benzoate and 0.2 grams of xanthan gum are dissolved in 100
mL of purified water. While stirring, 4 grams of Polysorbate 20 and
4 grams of Polyglycol 300 isostearate are added and stirring is
continued for 15 minutes. The suspension is then pumped into an
aerosol cans and is immediately sealed by clinching the dispenser
valve. The can is then pressurized by pumping 6.5 grams of Freon 12
and 3.5 grams of Freon 114 into the can.
Analysis of Food Intake
[0744] The sodium taurocholate rectal foam described above is
rectally administered to 5 conscious overnight-fasted subjects
(e.g., Sprague Dawley rats) and the control rectal foam without the
sodium taurocholate is rectally administered to 5 conscious
overnight-fasted subjects (e.g., Sprague Dawley rats). Each subject
is exposed to pre-weighed food and the cumulative consumption of
the food is determined over a 6 hour period by weighing the food
every 30 minutes.
[0745] The sodium glycocholate rectal foam described above is
rectally administered to 5 conscious overnight-fasted subjects
(e.g., Sprague Dawley rats) and the control rectal foam without the
sodium taurocholate is rectally administered to 5 conscious
overnight-fasted subject (e.g., Sprague Dawley rats). Each subject
is exposed to pre-weighed food and the cumulative consumption of
the food is determined over a 6 hour period by weighing the food
every 30 minutes.
Example 22
Rectal Enemas
a) 500 mM Sodium Taurocholate
Preparation Method:
[0746] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 26.88 grams of sodium taurocholate, 0.25 grams of
potassium metabisulphite, 0.3 grams EDTA (disodium salt), 0.38
grams of sodium benzoate are dissolved in 100 mL of purified water
and stirring is continued for 10 minutes. The solution is then
pulled into a syringe.
b) 500 mM Sodium Glycocholate
Preparation Method:
[0747] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 24.38 grams of sodium
glycocholate, 0.25 grams of potassium metabisulphite, 0.3 grams
EDTA (disodium salt), 0.38 grams of sodium benzoate are dissolved
in 100 mL of purified water and stirring is continued for 10
minutes. The solution is then pulled into a syringe.
c) No Bile Salt (Control)
Preparation Method:
[0748] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 0.25 grams of potassium
metabisulphite, 0.3 grams EDTA (disodium salt), 0.38 grams of
sodium benzoate are dissolved in 100 mL of purified water and
stirring is continued for 10 minutes. The solution is then pulled
into a syringe.
Analysis of Food Intake
[0749] The sodium taurocholate rectal enema described above is
rectally administered to 5 conscious overnight-fasted subjects
(e.g. Sprague Dawley rats) and the control rectal enema without the
sodium taurocholate is rectally administered to 5 conscious
overnight-fasted subjects (e.g., Sprague Dawley rats). Each subject
is exposed to pre-weighed food and the cumulative consumption of
the food is determined over a 6 hour period by weighing the food
every 30 minutes.
[0750] The sodium glycocholate rectal enema described above is
rectally administered to 5 conscious overnight-fasted subjects
(e.g., Sprague Dawley rats) and the control rectal enema without
the sodium taurocholate is rectally administered to 5 conscious
overnight-fasted subjects (e.g., Sprague Dawley rats). Each subject
is exposed to pre-weighed food and the cumulative consumption of
the food is determined over a 6 hour period by weighing the food
every 30 minutes.
Example 23
Rectal Suppositories
a) Sodium Taurocholate
Preparation Method:
[0751] Using a stainless steel dissolving vessel fitned with a
propeller stirrer 2.69 grams of sodium taurocholate and 0.1 grams
of methyl cellulose are added to 10 grams of higher saturated fatty
acid triglycerides (Witepsol.TM.S55; Dynamic Novel
Aktiengesellschaft, West Germany) and the combination is melted at
50 C and stirred. While the composition is a liquid it is filled
into suppository containers for rats (50 mg per container) and then
quenched in ice-water.
b) 500 mM Sodium Glycocholate
Preparation Method:
[0752] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 2.69 grams of sodium glycocholate and 0.1 grams
of methyl cellulose are added to 10 grams of higher saturated fatty
acid triglycerides (Witepsol.TM.S55; Dynamic Novel
Aktiengesellschaft, West Germany) and the combination is melted at
50 C and stirred. While the composition is a liquid it is filled
into suppository containers for rats (50 mg per container) and then
quenched in ice-water.
c) No Bile Salt (Control)
Preparation Method:
[0753] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 0.1 grams of methyl cellulose is added to 10
grams of higher saturated fatty acid triglycerides
(Witepsol.TM.S55; Dynamic Novel Aktiengesellschaft, West Germany)
and the combination is melted at 50 C and stirred. While the
composition is a liquid it is filled into suppository containers
for rats (50 mg per container) and then quenched in ice-water.
Analysis of Food Intake
[0754] The sodium taurocholate rectal suppository described above
is rectally administered to 5 conscious overnight-fasted subjects
(e.g., Sprague Dawley rats) and the control rectal suppository
without the sodium taurocholate is rectally administered to 5
conscious overnight-fasted subjects (e.g., Sprague Dawley rats).
Each subject is exposed to pre-weighed food and the cumulative
consumption of the food is determined over a 6 hour period by
weighing the food every 30 minutes.
[0755] The sodium glycocholate rectal suppository described above
is rectally administered to 5 conscious overnight-fasted subjects
(e.g., Sprague Dawley rats) and the control rectal suppository
without the sodium glycocholate is rectally administered to 5
conscious overnight-fasted subjects (e.g., Sprague Dawley rats).
Each subject is exposed to pre-weighed food and the cumulative
consumption of the food is determined over a 6 hour period by
weighing the food every 30 minutes.
Example 24
Rectal Gels
Sodium Taurocholate/Control
a) 500 mM Sodium Taurocholate
Preparation Method:
[0756] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 26.88 grams of sodium taurocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and
stirred for 15 minutes. 6 syringes connected to gavage tubes were
then each filled with 3 mL of the composition.
b) No Bile Salt (Control)
Preparation Method:
[0757] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 1 gram of methyl cellulose is dissolved in 100 mL
of purified water and stirred for 15 minutes. 5 syringes connected
to gavage tubes are then each filled with 3 mL of the
composition.
Analysis of Food Intake
[0758] The sodium taurocholate rectal gel described above was
rectally administered to 6 conscious overnight-fasted subjects
(e.g., Sprague Dawley rats) and the control rectal gel without the
sodium taurocholate was rectally administered to 5 conscious
overnight-fasted subjects (e.g., Sprague Dawley rats). Each rat was
then exposed to pre-weighed food and the cumulative consumption of
the food was determined over a 6 hour period by weighing the food
after 30 minutes, 60 minutes, 120 minutes, 240 minutes and 360
minutes.
Results
[0759] The cumulative food intake in rats instilled with
taurocholate containing gels is reduced compared to rats instilled
with gel alone (FIG. 5). FIG. 5 illustrates the individual food
intake in rats with bile sat containing gel per rectum (dotted
lines) or control vehicle (solid lines). The effect of the
taurocholate on food intake is found to be statistically
significant.
Example 5
Rectal Gels
Sodium Taurcholate Dose Response
a) 50 mM Sodium Taurocholate
Preparation Method:
[0760] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 2.688 grams of sodium taurocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and
stirred for 15 minutes. 12 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
b) 150 mM Sodium Taurocholate
Preparation Method:
[0761] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 8.066 grams of sodium taurocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and
stirred for 15 minutes. 12 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
c) 500 mM Sodium Taurocholate
Preparation Method:
[0762] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 26.88 grams of sodium taurocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and
stirred for 15 minutes. 12 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
d) No Bile Salt (Control)
Preparation Method:
[0763] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 1 gram of methyl cellulose is dissolved in 100 mL
of purified water and stirred for 15 minutes. 12 syringes connected
to gavage tubes are then each filled with 3 mL of the
composition.
Analysis of Food Intake
[0764] A 4.times.4 Latin Square design is used to monitor the
effect of the different concentration of taurocholate on the food
uptake of overnight-fasted Sprague Dawley rats. Each concentration
is tested in triplicate with four rats used per replicate.
Therefore, twelve rats were used for each rectal gel composition
(50 mM gel, 150 mM gel. 500 mM gel and the control gel), and all
rats received each of the 4 treatments. Following rectal
administration of the gels, each rat is then exposed to pre-weighed
food and the cumulative consumption of the food is determined over
a 24 hour period by weighing the food after 30 minutes, 1 hour, 2
hours, 4 hours, 6 hours, 8 hours and 24 hours.
Results
[0765] The cumulative food intake in rats instilled with
taurocholate containing gels is observed to be dose dependently
related to the quantity of taurocholate administered (FIG. 6).
Moreover, the differences in food uptake are observed to be
maintained for at least 24 hours.
[0766] The ED50 for inhibition of food intake is obtained by
plotting the normalizing the dose response for the anorectic effect
of taurocholate to the control data as a log of taurocholate dose
vs the percentage of control cumulative intake (FIG. 7). The ED50
for inhibition of food intake at 1 hour is 528 mM for 3 mL doses
(1.6 mmol/rat) while for 24 hour intake the ED50 is 7.2 mmol/rat.
Surprisingly, the dose dependency for inhibition of intake is not
different between 8 and 24 hours, thereby indicating the longevity
of the anorectic response.
Example 26
Rectal Gels
Sodium Glycocholate/Control
a) 500 mM Sodium Glycocholate
Preparation Method:
[0767] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 24.38 grams of sodium glycocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and then
stirred for 15 minutes. 6 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
b) No Bile Salt (Control)
Preparation Method:
[0768] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 1 gram of methyl cellulose is dissolved in 100 mL
of purified water and stirred for 15 minutes. 5 syringes connected
to gavage tubes are then each filled with 3 mL of the
composition.
Analysis of Food Intake
[0769] The sodium glycocholate rectal gel described above is
rectally administered to 6 conscious overnight-fasted subjects
(e.g. Sprague Dawley rats) and the control rectal gel without the
sodium glycocholate is rectally administered to 5 conscious
overnight-fasted subjects (e.g., Sprague Dawley rats). Each subject
is then exposed to pre-weighed food and the cumulative consumption
of the food is determined over a 6 hour period by weighing the food
after 30 minutes, 60 minutes, 120 minutes, 240 minutes and 360
minutes.
Example 27
Rectal Gels
Sodium Glycocholate Dose Response
a) 50 mM Sodium Glycocholate
Preparation Method:
[0770] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 2.44 grams of sodium glycocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and then
stirred for 15 minutes. 12 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
b) 150 mM Sodium Glycocholate
Preparation Method:
[0771] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 7.32 grams of sodium glycocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and then
stirred for 15 minutes. 12 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
c) 500 mM Sodium Glycocholate
Preparation Method:
[0772] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 24.38 grams of sodium glycocholate and 1 gram of
methyl cellulose are dissolved in 100 mL of purified water and then
stirred for 15 minutes. 12 syringes connected to gavage tubes are
then each filled with 3 mL of the composition.
d) No Bile Salt (Control)
Preparation Method:
[0773] Using a stainless steel dissolving vessel fitted with a
propeller stirrer 1 gram of methyl cellulose is dissolved in 100 mL
of purified water and then stirred for 15 minutes. 12 syringes
connected to gavage tubes are then each filled with 3 mL of the
composition.
Analysis of Food Intake
[0774] A 4.times.4 Latin Square design as used to monitor the
effect of the different concentration of glycocholate on the food
uptake of overnight-fasted Sprague Dawley rats. Each concentration
is tested in triplicate with four rats used per replicate.
Therefore, twelve rats are used for each rectal gel composition (50
mM gel, 150 mM gel, 500 mM gel and the control gel), with all rats
receiving each of the 4 treatments. Following rectal administration
of the gels, each rat is then exposed to pre-weighed food and the
cumulative consumption of the food is determined over a 24 hour
period by weighing the food after 30 minutes, 1 hour, 2 hours, 4
hours, 6 hours, 8 hours and 24 hours.
Example 28
Enteric Coated Tablets
a) 5 mg Sodium Taurocholate
Preparation Method:
[0775] Preparation of core: 5 mg sodium taurocholate, 25 mg
microcrystalline cellulose, 20 mg mannitol, and 10 mg
croscarmellose sodium are mixed in a Hobart Mixer for 15 minutes.
The mixture is granulated with 20% polyvinyl pyrrolidone (4 mg)
solution until optimum granulation is obtained. The granulation is
dried overnight at 50.degree. C. The granulation is then passed
through a #30 mesh. The granulation is then blended with 1 mg
magnesium stearate. Using an F-Press 1/4'' standard concave round
punch, the granulation is compressed into a tablet. Preparation of
erodible polymer layer and dual matrix tablets: 415 mg
hydroxypropyl methylcellulose, 75 mg microcrystalline cellulose,
and 6 mg polyvinylpyrrolidone are uniformly mixed with a mortar.
The powder mix is granulated with 50% v/v alcohol solution until
optimum granulation is obtained. The granulation is dried overnight
at 50.degree. C. The granulation is then passed through a #40 mesh
screen. The granulation is then blended with 2.5 mg magnesium
stearate. Using a Carver Press and a 7/16'' standard concave round
punch, half of the granulation is placed in the die cavity, the
core is then placed in the cavity and the other half of the
granulation is placed in the die cavity. The mass is compressed to
5,000 lbs to form the dual matrix tablet. Enteric coating: Using a
propellar mixer, 42 g of hydroxypropyl methylcellulose phthalate
and 4.2 g of distilled acetylated monoglycerides are dissolved in
514 mL of a mixture of acetone and absolute alcohol (1:1). Using a
spray system, the dual matrix tablets are then coated with the
enteric coating solution. Approximately 60 mg of the coating
material (dry basis) is applied per tablet.
b) 500 mM Sodium Glycocholate
Preparation Method:
[0776] Preparation of core: 5 mg sodium glycocholate, 25 mg
microcrystalline cellulose, 20 mg mannitol, and 10 mg
croscarmellose sodium are mixed in a Hobart Mixer for 15 minutes.
The mixture is granulated with 20% polyvinl pyrrolidone (4 mg)
solution until optimum granulation is obtained. The granulation is
dried overnight at 50.degree. C. The granulation is then passed
through a #30 mesh. The granulation is then blended with 1 mg
magnesium stearate. Using an F-Press 1/4'' standard concave round
punch, the granulation is compressed into a tablet. Preparation of
erodible polymer layer and dual matrix tablets: 415 mg
hydroxypropyl methylcellulose, 75 mg microcrystalline cellulose,
and 6 mg polyvinylpyrrolidone are uniformly mixed with a mortar.
The powder mix is granulated with 50% v/v alcohol solution until
optimum granulation is obtained. The granulation is dried overnight
at 50.degree. C. The granulation is then passed through a #40 mesh
screen. The granulation is then blended with 2.5 mg magnesium
stearate. Using a Carver Press and a 7/16'' standard concave round
punch, half of the granulation is placed in the die cavity, the
core is then placed in the cavity and the other half of the
granulation is placed in the die cavity. The mass is compressed to
5,000 lbs to form the dual matrix tablet. Enteric coating: Using a
propeller mixer, 42 g of hydroxypropyl methylcellulose phthalate
and 4.2 g of distilled acetylated monoglycerides are dissolved in
514 mL of a mixture of acetone and absolute alcohol (1:1). Using a
spray system, the dual matrix tablets are then coated with the
enteric coating solution. Approximately 60 mg of the coating
material (dry basis) is applied per tablet.
c) No Bile Salt (Control)
Preparation Method:
[0777] Preparation of core: 25 mg microcrystalline cellulose, 20 mg
mannitol, and 10 mg croscarmellose sodium are mixed in a Hobart
Mixer for 15 minutes. The mixture is granulated with 20% polyvinyl
pyrrolidone (4 mg) solution until optimum granulation is obtained.
The granulation is dried overnight at 50.degree. C. The granulation
is then passed through a #30 mesh. The granulation is then blended
with 1 mg magnesium stearate. Using an F-Press 1/4'' standard
concave round punch, the granulation is compressed into a tablet.
Preparation of erodible polymer layer and dual matrix tablets: 415
mg hydroxypropyl methylcellulose, 75 mg microcrystalline cellulose,
and 6 mg polyvinylpyrrolidone are uniformly mixed with a mortar.
The powder mix is granulated with 50% v/v alcohol solution until
optimum granulation is obtained. The granulation is dried overnight
at 50.degree. C. The granulation is then passed through a #40 mesh
screen. The granulation is then blended with 2.5 mg magnesium
stearate. Using a Carver Press and a 7/16'' standard concave round
punch, half of the granulation is placed in the die cavity, the
core is then placed in the cavity and the other half of the
granulation is placed in the die cavity. The mass is compressed to
5,000 lbs to form the dual matrix tablet. Enteric coating: Using a
propeller mixer. 42 g of hydroxypropyl methylcellulose phthalate
and 4.2 g of distilled acetylated monoglycerides are dissolved in
514 mL of a mixture of acetone and absolute alcohol (1:1). Using a
spray system, the dual matrix tablets are then coated with the
enteric coating solution. Approximately 60 mg of the coating
material (dry basis) is applied per tablet.
Analysis of Food Intake
[0778] The sodium taurocholate tablet described above (or, when
necessary given the size and identity of a subject, a similar
tablet having an appropriate dose and size) is orally administered
to 5 conscious overnight-fasted subjects and the control tablet
without the sodium taurocholate is orally administered to 5
conscious overnight-fasted subjects. Each subject is exposed to
pre-weighed food and the cumulative consumption of the food is
determined over a 6 hour period by weighing the food every 30
minutes.
[0779] The sodium glycocholate tablet described above (or, when
necessary given the size and identity of a subject, a similar
tablet having an appropriate dose and size) is orally administered
to 5 conscious overnight-fasted subjects and the control tablet
without the sodium taurocholate is orally administered to 5
conscious overnight-fasted subjects. Each subject is exposed to
pre-weighed food and the cumulative consumption of the food is
determined over a 6 hour period by weighing the food every 30
minutes.
Example 29
Absorption Inhibitors
a) Control: 500 mM Sodium Taurocholate
Preparation Method:
[0780] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 26.88 grams of sodium
taurocholate, 0.25 grams of potassium metabisulphite, 0.3 grams
EDTA (disodium salt) and 0.38 grams of sodium benzoate dissolved in
100 mL of purified water. While stirring, 4 grams of Polysorbate 20
and 4 grams of Polyglycol 300 isostearate are added and stirring is
continued for 15 minutes. The suspension is then pumped into an
aerosol cans and is immediately sealed by clinching the dispenser
valve. The can is then pressurized by pumping 6.5 grams of Freon 12
and 3.5 grams of Freon 114 into the can.
b) 500 mM Sodium Taurocholate+Candidate Absorption Inhibitor
Preparation Method:
[0781] Using a stainless steel dissolving vessel fitted with a
propeller stirrer and turboemulsifier 26.88 grams of sodium
taurocholate, 0.25 grams of potassium metabisulphite, 0.3 grams
EDTA (disodium salt), 0.38 grams of sodium benzoate and between
0.01 grams and 20 grams of a candidate absorption inhibitor are
dissolved in 100 mL of purified water. While stirring, 4 grams of
Polysorbate 20 and 4 grams of Polyglycol 300 isostearate are added
and stirring is continued for 15 minutes. The suspension is then
pumped into an aerosol cans and is immediately sealed by clinching
the dispenser valve. The can is then pressurized by pumping 6.5
grams of Freon 12 and 3.5 grams of Freon 114 into the can.
Analysis of Absorption Inhibition
[0782] The foams described above are rectally administered to 5
conscious overnight-fasted subjects (e.g., Sprague Dawley rats).
Each subject is exposed to pre-weighed food and the cumulative
consumption of the food is determined over a 6 hour period by
weighing the food every 30 minutes. Food intake is compared between
the groups. The candidate absorption inhibitor inhibits absorption
of the enteroendocrine peptide secretion enhancing agent (in this
case sodium taurocholate) when the enteroendocrine peptide
secretion enhancing agent is able to interact with the L-cells for
a longer period of time (i.e., when it is not systemically
absorbed), thereby reducing food intake when compared to the
control formulation.
[0783] Alternatively, the ability of the absorption inhibitor to
inhibit the absorption of the enteroendocrine peptide secretion
enhancing agent (in this case sodium taurocholate) across the colon
and/or rectum mucosa is determined by measuring the systemic
concentration of enteroendocrine peptide secretion enhancing agent.
Systemic concentration of enteroendocrine peptide secretion
enhancing agent is measured prior to administration and at a time
following administration of the enteroendocrine peptide secretion
enhancing agent (e.g., after one hour). Decreased systemic
concentration of the enteroendocrine peptide secretion enhancing
agent indicate that the candidate absorption inhibitor inhibits the
absorption of the enteroendocrine peptide secretion enhancing
agent.
Example 30
Method of Inhibiting Food Intake
[0784] Studies are undertaken after an overnight fast following
administration (8-10 hours prior to bile salt) of 100 mg Januvia
(sitagliptin), a DDP-4 inhibitor that protects GLP-1 from
inactivation by proteolysis. Dose escalation involves half-log
increases in dose as tolerated. Planned doses are 1, 2, 7 and 20
mmoles of deoxycholic acid. Each dose is administered on a
different day with at least three days between doses.
[0785] Subjects undergo complete physical examination with
laboratory investigations including complete blood count, glucose,
fasting lipids, liver function tests, urea and electrolytes,
prothrombin time and partial thromboplastin time, haemoglobin
A.sub.1C, and urinalysis. Subjects are excluded if the fasting
blood glucose is >300 mg/dl, if the haemoglobin A.sub.1C is
>11%, or if there are abnormal liver function tests (such as
transaminase levels >3.times. the upper limit of normal.
[0786] Subjects on oral medication will not receive such medication
during the fasting period prior to the study or during the study
period.
[0787] Subjects are studied on four separate occasions, e.g. at
weekly intervals with at least three days gap between the different
occasions. Subjects are studied after an overnight (10 hour) fast.
Ten hours before the procedure, each subject will take 100 mg oral
Januvia (sitagliptin), a DDP-4 inhibitor to protect GLP-1 (7-36)
amide from degradation in the circulation. An indwelling catheter
(Intracath) is placed in a forearm vein for blood sampling. An
initial basal blood sample (5 ml) is taken and the catheter kept
patent with normal saline. Blood samples are taken into EDTA
Vacutainers (purple top). After 15 minutes a second blood sample (5
ml) will be collected. Placebo (vehicle) or sodium deoxycholate at
doses of 1, 2, 7 and 20 mmoles, incorporated into 20 mL or 60 mL of
1% carboxymethyl cellulose is placed per rectum by syringe (type)
over a period of one minute. Further 5 ml blood samples are
collected 10, 20, 30, 40, 50 and 60 minutes after instillation of
the placebo or deoxycholate.
[0788] In plasma samples from each time point we will measure
glucose, insulin, GLP-1 (active) and PYY (total), using assay kits
(Linco) from the Millipore Corporation. Measures of these hormones
provide an endpoint for determining efficacy in producing reduced
food intake.
[0789] In addition, measured is food intake for a two hour period
after the end of the infusion study. During this period, the
subjects are offered a buffet lunch with food in such excess that
all appetites will be satisfied. The amount of food is quantified
preprandially and postprandially and the caloric intake calculated.
Before, at the end of the infusion study, and two hours after
presentation of a buffet lunch, appetite ratings are made on a 100
mm visual analogue scale (higher values indicating greater
appetite) with the text expressing the most positive and most
negative ratings at each end of the scale.
Example 31
[0790] In certain instances, placing bile salts or other
enteroendocrine peptide enhancing agents into the rectum has
several advantages and provides substantial information on the
whole process of releasing the distal gut hormones, GLP-1,
oxyntomodulin and PYY. In our human studies we have demonstrated
the following:
[0791] Dose-responsive increase in GLP-1 and PYY levels in the
bloodstream.
[0792] Consequent increase in insulin secretion and reduction in
glucose levels.
[0793] Dose-responsive and substantial reduction in food
intake.
[0794] Elevation of high local concentrations of bile salt in the
rectum without diarrhea.
Example 32
[0795] Studies were undertaken after an overnight fast following
administration (8-10 hours prior to bile salt) of 100 mg
sitagliptin, a DPP-4 inhibitor that protects GLP-1 from
inactivation by proteolysis. Dose escalation involved half-log
increases in dose of taurocholic acid. The doses used were 0.66,
2.0, 6.66 and 20.0 mmoles (358, 1075, 3584, 10,754 mg) of
taurocholic acid. The taurocholic acid was administered into the
rectum by syringe in a total volume of 20 ml of 1% carboxymethyl
cellulose gel. Each dose was administered on a different day with
at least three days between doses. FIG. 9 illustrates the increase
of circulating GLP-1 levels following rectal administration of
taurocholic acid. FIG. 10 illustrates the increase of circulating
PYY levels following rectal administration of taurocholic acid
Example 33
[0796] Objective: The aim of a 1 year study is to show evidence of
the efficacy Sodium Taurocholate on reduction of risk of pancreatic
cancer.
[0797] Study Design: This is a 1 year study. A cohort of 1000
patients is divided into placebo group and drug treated groups. 50
mg of Sodium taurocholate will be rectally administered 30 minutes
prior to ingestion of lunch and prior to ingestion of dinner for a
total of 100 mg of Sodium taurocholate per day.
[0798] Inclusion Criteria are: 70 years of age or less, waist
circumference .gtoreq.102 cm for men or .gtoreq.88 cm for women,
pancreatic ductal adenocarcinoma.
[0799] Exclusion criteria are: Stroke/MI/unstable cardiovascular
disease within 6 months, clinically significant renal, hepatic or
psychiatric disease, participation in a formal weight loss program
or lifestyle intervention, glaucoma or intraocular pressure, use of
any antidiabetic medication, prior history with cancer.
[0800] Patient Response to sodium taurocholate therapy: Patient
response is assessed via weekly hospital visits, weight and waist
measurements and routine blood tests.
[0801] Blood Sampling Serial blood is drawn by direct vein puncture
before and after administration of Compound 100 analog. Venous
blood samples (5 ml.) for determination of serum concentrations are
obtained at about 10 minutes prior to dosing and at approximately
the following times after dosing: days 1, 2, 3, 4, 5, 6, 7, 14 and
every 14 days later. Each serum sample is divided into two
aliquots. All serum samples are stored at -20.degree. C. Serum
samples are shipped on dry ice.
[0802] Pharmacokinetics: Patients undergo plasma/serum sample
collection for pharmacokinetic evaluation before beginning
treatment and at days 1, 2, 3, 4, 5, 6, 7, 14 and every 14 days
later. Pharmacokinetic parameters are calculated by model
independent methods on a Digital Equipment Corporation VAX 8600
computer system using the latest version of the BIOAVL software.
The following pharmacokinetics parameters are determined: peak
serum concentration (C.sub.max); time to peak serum concentration
(t.sub.max); area under the concentration-time curve (AUC) from
time zero to the last blood sampling time (AUC.sub.0-72) calculated
with the use of the linear trapezoidal rule; and terminal
elimination half-life (t.sub.1/2), computed from the elimination
rate constant. The elimination rate constant is estimated by linear
regression of consecutive data points in the terminal linear region
of the log-linear concentration-time plot. The mean, standard
deviation (SD), and coefficient of variation (CV) of the
pharmacokinetic parameters are calculated for each treatment.
[0803] Patient Response to Compound 4 therapy: Patient response is
assessed via weekly hospital visits, weight and waist measurements
and routine blood tests.
[0804] Statistical Analysis: The association of sodium taurocholate
and risk of pancreatic cancer is analyzed in multivariable logistic
regression models including age, sex, race, smoking, alcohol, BMI,
family history of cancer, duration of diabetes, and insulin use. To
control for reversal causality due to pancreatic cancer-caused
diabetes, risk of pancreatic cancer is estimated after exclusion of
those with duration of diabetes 52 years. HbA1c level (.ltoreq.7%
or >7%), a marker of glycemic control, is compared between
placebo and users of sodium taurocholate by .chi.2 test. The
demographic and risk factors as well as duration of diabetes and
insulin use are compared between sodium taurocholate users and
placebo by .chi.2 test.
[0805] While preferred embodiments of the present invention have
been shown and described herein, it will be obvious to those
skilled in the art that such embodiments are provided by way of
example only. Numerous variations, changes, and substitutions will
now occur to those skilled in the art without departing from the
invention. It should be understood that various alternatives to the
embodiments of the invention described herein may be employed in
practicing the invention. It is intended that the following claims
define the scope of the invention and that methods and structures
within the scope of these claims and their equivalents be covered
thereby.
* * * * *