U.S. patent application number 16/057586 was filed with the patent office on 2018-12-06 for method of treating bipolar i and ii disorders.
The applicant listed for this patent is Otsuka Pharmaceutical Co., Ltd.. Invention is credited to Tsuyoshi Hirose, Shaun Jordan, Tetsuro Kikuchi, Katsura Tottori, Yasufumi Uwahodo.
Application Number | 20180344731 16/057586 |
Document ID | / |
Family ID | 26734754 |
Filed Date | 2018-12-06 |
United States Patent
Application |
20180344731 |
Kind Code |
A1 |
Jordan; Shaun ; et
al. |
December 6, 2018 |
METHOD OF TREATING BIPOLAR I AND II DISORDERS
Abstract
The present invention relates to a method of treating a patient
suffering from a disorder of the central nervous system associated
with 5-HT.sub.1A receptor subtype, comprising as an active
ingredient a carbostyril derivative or a salt thereof represented
by the formula (1) ##STR00001## wherein the carbon-carbon bond
between 3- and 4-positions in the carbostyril skeleton is a single
or a double bond.
Inventors: |
Jordan; Shaun; (Germantown,
MD) ; Kikuchi; Tetsuro; (Tokushima-shi, JP) ;
Tottori; Katsura; (Kamiita-cho, JP) ; Hirose;
Tsuyoshi; (Tokushima-shi, JP) ; Uwahodo;
Yasufumi; (Tokushima-shi, JP) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Otsuka Pharmaceutical Co., Ltd. |
Tokyo |
|
JP |
|
|
Family ID: |
26734754 |
Appl. No.: |
16/057586 |
Filed: |
August 7, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15494877 |
Apr 24, 2017 |
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16057586 |
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13426886 |
Mar 22, 2012 |
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15494877 |
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12202208 |
Aug 29, 2008 |
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13426886 |
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10876605 |
Jun 28, 2004 |
8030312 |
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12202208 |
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10055915 |
Jan 28, 2002 |
7053092 |
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10876605 |
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60331370 |
Jan 29, 2001 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61P 25/06 20180101;
A61P 1/08 20180101; A61K 45/06 20130101; A61K 31/496 20130101; A61P
15/00 20180101; A61P 25/28 20180101; A61P 25/18 20180101; A61P
25/00 20180101; A61K 2300/00 20130101; A61P 25/24 20180101; A61P
43/00 20180101; A61P 25/16 20180101; A61K 31/496 20130101; A61P
3/04 20180101; A61K 31/4704 20130101 |
International
Class: |
A61K 31/496 20060101
A61K031/496 |
Claims
1-8. (canceled)
9. A method of treating a patient suffering from a disorder of the
central nervous system, selected from (i) bipolar I disorder with
most recent mixed, depressed or unspecified episode, and (ii)
bipolar II disorder with recurrent major depressive episodes with
hypomanic episodes, the method comprises: administering to said
patient a pharmaceutical composition comprising a therapeutically
effective amount of a carbostyril compound of formula (1), or a
pharmaceutically acceptable salt or solvate thereof, wherein said
patient is a mammal: ##STR00003## wherein the carbostyril compound
of formula (I) is both a partial D.sub.2 receptor agonist and a
partial 5-HT.sub.1A receptor agonist facilitating treatment of both
mania and depression of bipolar I and bipolar II disorders, further
wherein the compound of formula (I) is the only antipsychotic
administered to said patient.
10. The method of claim 9, wherein the disorder is bipolar I
disorder as defined in (i).
11. The method of claim 9, wherein the disorder is bipolar II
disorder as defined in (ii).
12. The method according to claim 9, wherein the carbostyril
compound is
7-{4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxyl}-3,4-dihydrocarbostyri-
l.
13. The method according to claim 10, wherein the carbostyril
compound is
7-{4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxyl}-3,4-dihydrocarbostyri-
l.
14. The method according to claim 11, wherein the carbostyril
compound is
7-{4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxyl}-3,4-dihydrocarbostyri-
l.
Description
[0001] This is a division of application Ser. No. 10/876,605, filed
Jun. 28, 2004, which is a division of application Ser. No.
10/055,915, filed Jan. 28, 2002, now U.S. Pat. No. 7,053,092, which
claims benefit of U.S. Provisional Application No. 60/331,370,
filed Jan. 29, 2001, all of which are incorporated herein by
reference.
BACKGROUND OF THE INVENTION
Field of the Invention
[0002] The present invention relates to a method of treating a
patient suffering from a-disorder of the central nervous system
associated with the 5-HTIA receptor subtype. The active ingredient
comprise a carbostyril derivative or a salt thereof.
Related Art
[0003] U.S. Pat. No. 5,006,528: European Patent No. 367,141 and
Japanese Patent Kokai (Laid-open) 7-304,740 (1995) contain the same
chemical structural formula as the carbostyril derivatives in the
present invention, and their pharmacological properties are
beneficial drug treatments for schizophrenia.
[0004] Carbostyril compounds, as well as those disclosed in
Japanese Patent Kokai (Laid-open) 9-301,867 (1997) are useful for
the treatment of anxiety.
[0005] The carbostyril derivatives disclosed in European Patent No.
226,441 have the genus of the carbostyril derivatives in the
present invention, and they are useful for the treatment of
hypoxia.
[0006] In addition to the above, the carbostyril derivatives
disclosed in U.S. Pat. No. 4,734,416; Canadian Patent No.
1,117,110; British Patent No. 2,017,701; German Patent Nos.
2,912,105 and 2,953,723; Japanese Patent Kokai (Laid-open) Nos.
54-130,587 (1979), 55-127,371 (1980) and 62-149,664 (1987) have the
genus of the carbostyril derivatives in the present invention, and
they have antihistaminic activities and central nervous controlling
activities.
[0007] It is reported that aripiprazole
(7-{4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxy}-3,4-dihydrocarbostyri-
l, also known as, OPC-14597, BMS-337,039 and OPS-31) binds with
high affinity to dopamine D.sub.2 receptors and with moderate
affinity to dopamine D.sub.3 and 5-HT.sub.7 receptors (Masashi Sasa
et al., CNS Drug Reviews, Vol. 3, No. 1, pp. 24-33).
[0008] Further, it is reported that aripiprazole possesses
presynaptic dopaminergic autoreceptor agonistic activity,
postsynaptic D.sub.2 receptor antagonistic activity, and D.sub.2
receptor partial agonistic activity (T. Kikuchi, K. Tottori, Y.
Uwahodo, T. Hirose, T. Miwa, Y. Oshiro and S. Morita: J. Pharmacol.
Exp. Ther., Vol. 274, pp. 329, (1995); T. Inoue, M. Domae, K.
Yamada and T. Furukawa: J. Pharmacol. Exp. Ther., Vol. 277, pp.
137, (1996)).
[0009] However, it has not been reported that compounds in the
present invention have agonistic activity at 5-HT.sub.1A receptor
subtype.
[0010] It has been reported that therapeutic interventions using
5-HT.sub.1A receptor ligands may be useful drug treatments for
alcohol abuse (Mark Kleven et al., European Journal of
Pharmacology, Vol. 281, (1995) pp. 219-228).
[0011] It is also reported that 5-HT.sub.1A agonist drugs may be
useful for the treatment and/or prophylaxis of disorders associated
with neuronal degeneration resulting from ischemic events in
mammals (U.S. Pat. No. 5,162,375).
[0012] It is also reported that 5-HT.sub.1A receptor
hypersensitivity could be the biological basis for the increased
frequency of migraine attack in stressful and anxious conditions
(Massimo Leone et al., Neuro Report, Vol. 9, pp.
2605-2608(1998)).
[0013] It has recently been reported that
(-)-(R)-2-[4-[[(3,4-dihydro-2H-1-benzopyran-2-yl)methyl]amino]-butyl]-1,2-
-benzisothiazol-3(2H)-one 1,1-dioxide monohydrochrolide (BAY-3702),
a 5-HT.sub.1A receptor agonist, has neuroprotective, anxiolytic-
and antidepressant-like effects in animal models (Jean De Vry et
al., European Journal of Pharmacology, Vol. 357, (1998), pp.
1-8).
[0014] It is also reported that 5-HT.sub.1A receptor agonists
appear to be broad spectrum antiemetic agents (Mary C. Wolff et
al., European Journal of Pharmacology, Vol. 340, (1997), pp.
217-220; AB Alfieri et al., British Journal of Cancer, (1995), Vol.
72, pp. 1013-1015; Mary C. Wolff et al., Pharmacology Biochemistry
and Behavior, 1995, Vol. 52, No. 3, pp. 571-575; James B. Lucot,
European Journal of Pharmacology, 1997, Vol. 253, pp. 53-60).
[0015] Serotonin plays a role in several neurological and
psychiatric disorders, including Alzheimer's disease, depression,
nausea and vomiting, eating disorders, and migraine. (See Rasmussen
et al., "Chapter 1. Recent Progress in Serotonin 5HT.sub.1A
Receptor Modulators", in Annual Reports in Medicinal Chemistry,
Vol. 30, Section I, pp. 1-9, 1995, Academic Press, Inc.). WO
00/16777 discloses that a 5HT.sub.1A receptor agonist, buspirone is
efficacious in treating a variety of symptoms associated with ADHD,
and that combined use of a D2 receptor agonist and 5-HT.sub.1A
agonist provides effective treatments for ADHD and Parkinson's
disease.
[0016] 5HT.sub.1A agonists are effective in the treatment of
cognitive impairment in Alzheimer's disease, Parkinson's disease or
senile dementia. U.S. Pat. No. 5,824,680 discloses that a
5-HT.sub.1A agonist, ipsapirone, is effective in treating
Alzheimer's disease by improving memory. U.S. Pat. No. 4,687,772
describes that a 5-HT.sub.1A partial agonist, buspirone, is useful
for improving short term memory in patients in need of treatment.
WO 93/04681 discloses that use of 5-HT.sub.1A partial agonists have
been used for the treatment or prevention of cognitive disorders
associated with Alzheimer's disease, Parkinson's disease or senile
dementia.
[0017] 5HT.sub.1A agonists are also effective in the treatment of
depression. U.S. Pat. No. 4,771,053 describes that a 5-HT.sub.1A
receptor partial agonist, gepirone, is useful in alleviation of
certain primary depressive disorders, such as severe depression,
endogenous depression, major depression with melancholia, and
atypical depression. WO 01/52855 discloses that the combined use of
the 5-HT.sub.1A receptor partial agonist gepirone with an
antidepressant can effectively treat depression.
[0018] The 5-HT.sub.1A receptor partial agonist buspirone
alleviates motor disorders such as neuroleptic induced parkinsonism
and extrapyramidal symptoms. These observations are disclosed in
U.S. Pat. No. 4,438,119. Furthermore 5-HT.sub.1A agonists reverse
neuroleptic-induced catalepsy in rodents, which mimic movement
impairments observed in Parkinson's disease (Mark J. Millan,
Journal of Pharmacology and Experimental Therapeutics, 2000, Vol.
295. p 853-861). Thus, aripiprazole can be used to manage psychosis
in geriatric patients, Alzheimer's disease, Parkinson's disease or
senile dementia, since it possesses potent, partial agonistic
activities at D.sub.2 and 5-HT.sub.1A receptors. In addition, these
patients might not experience extrapyramidal symptoms due to this
property of aripiprazole.
[0019] Heretofore, schizophrenia is understood to be caused by
hyperactivity in the brain dopaminergic system. For this reason,
some drugs were developed with strong dopaminergic receptor
blocking activity. These typical antipsychotic drugs are effective
in the treatments for the positive symptoms of schizophrenia, which
include hallucinations, delusions and the like. During the last
decade, a variety of atypical anti-psychotic drugs have been
developed, which include clozapine, risperidone, olanzapine,
quetiapine. These drugs have less extrapyramidal side effects, and
have other activities in addition to their DA-receptor blocking
activities. In contrast to typical anti-psychotic drugs, such as
chlorpromazine, haloperidol, etc., it is reported that atypical
antipsychotic drugs are more effective against the negative
symptoms and cognitive impairments associated with schizophrenia
than typical antipsychotic drugs, and atypical antipsychotic drugs
also have less extrapyramidal side effects (S. Miyamoto, G. E.
Duncan, R. B. Mailman and J. A. Lieberman: Current Opinion in CPNS
Investigational Drugs, Vol. 2, pp. 25, (2000)). However, even
though atypical antipsychotic drugs provide a suitable
pharmacotherapy for schizophrenia, certain patients are resistant
to the antipsychotic therapies of these drugs. These patients may
either not respond or may become refractory (i.e. may feel more
anxious, depressed or cognitive dysfunction) in response to
antipsychotic therapy. These treatment-resistant patients pose a
problem for how a physician may provide an appropriate therapy.
[0020] At present, a number of treatment-resistant and
treatment-refractory schizophrenic patients display symptoms that
do not respond adequately to a variety of known effective classes
and doses of typical or atypical antipsychotic drugs. Furthermore,
these patients may also be inveterate schizophrenia or chronic
schizophrenics who are often repeatedly admitted to and discharged
from hospitals (R. R. Conely and R. W. Buchanan: Schizophr. Bull.,
Vol. 23, pp. 663, (1997)).
[0021] Symptoms of patients corresponding to treatment-resistant
and treatment-refractory schizophrenics involve not only the
positive symptoms, but also the negative symptoms and emotional
disorders, as well as cognitive impairments (i.e., cognitive
dysfunction or cognitive disturbances) (K. Akiyama and S. Watanabe:
Jpn. J. Clin. Psychopharmacol., Vol. 3, pp. 423, (2000)).
[0022] Cognitive impairment exists separately from the psychic
symptoms in a schizophrenic individual. Thus, medical treatment is
therefore quite important, because the cognitive impairment may
disturb the socially adaptable behavior of these individuals (C.
Hagger, P. Buckley, J. T. Kenny, L. Friedman, D. Ubogy and H. Y.
Meltzer: Biol. Psychiatry, Vol. 34, pp. 702, (1993); T. Sharma and
D. Mockler: J. Clin. Psycho-pharmacol., Vol. 18, (Suppl. I), pp.
128, (1998)).
[0023] At present, clozapine is an antipsychotic drug that is
effective against treatment-resistant schizophrenia. Clozapine
(marketed under the name of Clozaril) was approved in 1990 by FDA
for the treatment and management of severely ill schizophrenics who
failed to respond adequately to standard antipsychotic therapy (M.
W. Jann: Pharmacotherapy, Vol. 11, pp. 179, (1991)). Clozapine has
been reported to be effective against cognitive impairments in
treatment-resistant schizophrenics (C. Hagger, P. Buckley, J. T.
Kenny, L. Friedman, D. Ubogy and H. Y. Meltzer: Biol. Psychiatry,
Vol. 34, pp. 702, (1993); M. A. Lee, P. A. Thompson and H. Y.
Meltzer: J. Clin. Psychiatry, Vol. 55 (Suppl. B), pp. 82, (1994);
D. E. M. Fujii, I. Ahmed, M. Jokumsen and J. M. Compton: J.
Neuropsychiatry Clin. Neurosci., Vol. 9, pp. 240, (1997)). For
example, it is reported that clozapine improves cognitive
impairments in attention, response time, fluent-speech, etc. in
treatment-resistant schizophrenics (M. A. Lee, P. A. Thompson and
H. Y. Meltzer: J. Clin. Psychiatry, Vol. 55 (Suppl. B), pp. 82,
(1994)). It has been also reported that clozapine provides
effective improvements in cognitive impairments in an objective
evaluation scale of the Wechsler Adult Intelligence Scale-Revised
Full Scale (D. E. M. Fujii, I. Ahmed, M. Jokumsen and J. M.
Compton: J. Neuropsychiatry Clin. Neurosci., Vol. 9, pp. 240,
(1997)).
[0024] The 5-HT.sub.1A receptor has been demonstrated to play a
role in the therapeutic efficacy of clozapine against
treatment-resistant schizophrenia and cognitive impairments. This
relation ship was revealed by a binding experiment using human the
5-HT.sub.1A receptors (S. L. Mason and G. P. Reynolds: Eur. J.
Pharmacol., Vol. 221, pp. 397, (1992)). Further, in accordance with
progress in molecular pharmacology, it is clearly understood that
5-HT.sub.1A receptor agonistic activity or 5-HTIA receptor partial
agonistic activity plays an important role in treatment-resistant
schizophrenia and cognitive impairments (A. Newman-Tancredi, C.
Chaput, L. Verriele and M. J. Millan: Neuropharmacology, Vol. 35,
pp. 119, (1996)). Additionally, it was reported that the number of
5-HT.sub.1A receptor is increased in the prefrontal cortex of
chronic schizophrenics who were classified treatment-resistant.
This observation was explained by a compensatory process where by
the manifestation of severe symptoms of chronic schizophrenia are a
result of impaired neuronal function mediated by hypofunctional
5-HT.sub.1A receptors (T. Hashimoto, N. Kitamura, Y. Kajimoto, Y.
Shirai, O. Shirakawa, T. Mita, N. Nishino and C. Tanaka:
Psycho-pharmacology, Vol. 112, pp. S35, (1993)). Therefore, a
lowering in neuronal transmission mediated through 5-HT.sub.1A
receptors is expected in treatment-resistant schizophrenics. Thus
the clinical efficacy of clozapine may be related to its partial
agonist efficacy at the 5-HT.sub.1A receptors (A. Newman-Tancredi,
C. Chaput, L. Verriele and M. J. Millan: Neuropharmacology, Vol.
35, pp. 119, (1996)). 5-HT.sub.1A receptor agonistic activity may
be related to the clinical effects of clozapine, and this
hypothesis is supported by a positron emission tomography study in
primates which showed that clozapine interacts with brain
5-HT.sub.A receptors at a therapeutically effective dose (Y. H.
Chou, C. Halldin and L. Farde: Int. J. Neuropsycho-pharmacol., Vol.
4 (Suppl. 3), pp. S130, (2000)). Furthermore tandospirone, which is
known as a selective 5-HT.sub.1A receptor agonist, improved
cognitive impairments in chronic schizophrenic patients (T.
Sumiyoshi, M. Matsui, I. Yamashita, S. Nohara, T. Uehara, M.
Kurachi and H. Y. Meltzer: J. Clin. Pharmacol., Vol. 20, pp. 386,
(2000)). While, in animal tests, all reports do not always suggest
that 5-HT.sub.1A receptor agonist activity may be related to
cognitive impairment, however, 8-OH-DPAT
(8-hydroxy-2-(di-n-propylamino)tetralin), which is known as a
selective 5-HT.sub.1A receptor agonist, improves learning and
memory impairments induced by scopolamine known as a muscarinic
receptor antagonist, suggesting a relationship between 5-HT.sub.1A
receptor agonistic activity and improvements in cognitive
impairments (M. Carli, P. Bonalumi, R. Samanin: Eur. J. Neurosci.,
Vol. 10, pp. 221, (1998); A. Meneses and E. Hong: Neurobiol. Learn.
Mem., Vol. 71, pp. 207, (1999)).
[0025] Atypical antipsychotic drugs, such as risperidone and
olanzapine, were marketed after clozapine, and it is reported that
these drugs improve treatment-resistant schizophrenia or cognitive
impairments in treatment-resistant schizophrenics (M. F. Green, B.
D. Marshall, Jr., W. C. Wirshing, D. Ames, S. R. Marder, S.
McGurck, R. S. Kern and J. Mintz: Am. J. Psychiatry, Vol. 154, pp.
799, (1997); G. Bondolifi, H. Dufour, M. Patris, J. P. May, U.
Billeter, C. B. Eap. and P. Baumann, on behalf of the risperidone
Study Group: Am. J. Psychiatry, Vol. 155, pp. 499, (1998); A.
Breier, S. H. Hamilton: Biol. Psychiatry, Vol. 45, pp. 403,
(1999)).
[0026] In contrast to reports that clozapine was moderately
effective against treatment-resistant schizophrenia, risperidone
and olanzapine were not consistently superior to typical
antipsychotic drugs in their effectiveness against
treatment-resistant schizophrenia. Thus, risperidone and olanzapine
bind with lower affinity to human 5-HT.sub.1A receptors (S.
Miyamoto, G. E. Duncan, R. B. Mailman and J. A. Lieberman: Current
Opinion in CPNS Investigational Drugs, Vol. 2, pp. 25, (2000)), and
as such these drugs can not clearly perform activities through
human 5-HT.sub.1A receptors at clinical effective doses.
[0027] Therefore, at present, it is understood that clozapine is
effective against treatment-resistant schizophrenia (D. W.
Bradford, M. H. Chakos, B. B. Sheitman, J. A. Lieberman: Psychiatry
Annals, Vol. 28, pp. 618, (1998); A. Inagaki: Jpn. J. Clin.
Psychopharmacol., Vol. 3, pp. 787, (2000)).
[0028] As explained above, 5-HT.sub.1A receptor agonistic activity
is important for improving treatment-resistant schizophrenia or
cognitive impairment caused by treatment-resistant schizophrenia.
Clozapine is effective against treatment-resistant schizophrenia,
however, its use is limited due to its severe side-effect of
producing agranulocytosis which requires patients to undergo
periodical blood tests. Under these circumstances, the development
of a safe anti-psychotic drug with potent, full or partial agonist
activity at 5-HT.sub.1A receptors is earnestly desired.
[0029] The carbostyril compound in the present invention binds with
high affinity and displays a potent, partial agonist activity at
the 5-HT.sub.1A receptors and it has higher intrinsic activity
(about 68%) as compared with that of clozapine. Therefore, the
compound in the present invention has a 5-HT.sub.1A receptor
agonistic activity that is more potent than the agonistic activity
of clozapine. Thus, the present carbostyril compound may represent
a more potent and highly safe drug for curing treatment-resistant
schizophrenia, cognitive impairments caused by treatment-resistant
schizophrenia, inveterate schizophrenia, cognitive impairments
caused by inveterate schizophrenia, chronic schizophrenia,
cognitive impairments caused by chronic schizophrenia and the like,
as compared with other currently available pharmacotherapeutic
treatments. That is, the compound in the present invention may
prove to be a potent and safer drug therapy for treatment-resistant
schizophrenia, cognitive impairments caused by treatment-resistant
schizophrenia, inveterate schizophrenia, cognitive impairments
caused by inveterate schizophrenia, chronic schizophrenia, or
cognitive impairments caused by chronic schizophrenia, etc., which
fail to respond adequately to currently available antipsychotic
drugs such as chlorpromazine, haloperidol, sulpiride, fluphenazine,
perphenazine, thioridazine, pimozide, zotepine, risperidone,
olanzapine, quetiapine, amisulpride, etc.
[0030] In particular, the carbostyril compound in the present
invention may be a potent and highly safe drug therapy against
treatment-resistant schizophrenia, cognitive impairments caused by
treatment-resistant schizophrenia, inveterate schizophrenia,
cognitive impairments caused by inveterate schizophrenia, chronic
schizophrenia or cognitive impairments caused by chronic
schizophrenia, etc. which fail to respond adequately to both of 1
to 3 typical antipsychotic drugs selected from the group consisting
of chlorpromazine, haloperidol and perphenazine, and one atypical
antipsychotic drug selected from the group consisting of
risperidone, olanzapine, quetiapine and amisulpride.
[0031] Moreover, the compound in the present invention may be a
potent and highly safe drug therapy against treatment-resistant
schizophrenia, cognitive impairments caused by treatment-resistant
schizophrenia, inveterate schizophrenia, cognitive impairment
caused by inveterate schizophrenia, chronic schizophrenia or
cognitive impairment caused by chronic schizophrenia, etc. which
fail to respond adequately to both of 2 typical antipsychotic drugs
selected from the group consisting of chlorpromazine, haloperidol
and perphenazine, and one atypical antipsychotic drug selected from
the group consisting of risperidone, olanzapine, quetiapine and
amisulpride.
[0032] Moreover, the compound in the present invention may be a
potent and highly safe drug therapy against treatment-resistant
schizophrenia, cognitive impairments caused by treatment-resistant
schizophrenia, inveterate schizophrenia, cognitive impairments
caused by inveterate schizophrenia, chronic schizophrenia, or
cognitive impairment caused by chronic schizophrenia, etc. which
fail to respond adequately to both of 1 to 2 typical antipsychotic
drugs selected from the group consisting of chlorpromazine and
haloperidol, and one atypical antipsychotic drug selected from the
group consisting of risperidone, olanzapine, quetiapine and
amisulpride.
[0033] Moreover, the compound in the present invention may be a
potent and highly safe drug therapy against treatment-resistant
schizophrenia, cognitive impairments caused by treatment-resistant
schizophrenia, inveterate schizophrenia, cognitive impairment
caused by inveterate schizophrenia, chronic schizophrenia or
cognitive impairment caused by chronic schizophrenia, etc. which
fail to respond adequately to both of 2 typical antipsychotic drugs
selected from the group consisting of chlorpromazine and
haloperidol, and one atypical antipsychotic drug selected from the
group consisting of risperidone, olanzapine, quetiapine and
amisulpride.
SUMMARY OF THE INVENTION
[0034] It is an object of the present invention to provide a method
of treating a patient suffering from a disorder of the central
nervous system associated with the 5-HT.sub.1A receptor
subtype.
DETAILED DESCRIPTION OF THE INVENTION
[0035] As the 5-HT.sub.1A receptor subtype agonist compound for use
in accordance with the present invention, carbostyril derivatives
represented by the following formula (1) are used:
##STR00002##
wherein the carbon-carbon bond between 3- and 4-positions in the
carbostyril skeleton is a single or a double bond.
[0036] The compounds of the forgoing general formula (1) are known
compounds, which are disclosed in publication such as U.S. Pat. No.
5,006,528 or which can be readily prepared by the processes
described in the above publication.
[0037] The carbostyril derivative represented by the formula (1) in
the present invention can easily be converted into its
acid-addition salt by reacting it with a pharmaceutically
acceptable acid. Examples of such acid include inorganic acids,
such as hydrochloric acid, sulfuric acid, phosphoric acid,
hydrobromic acid and the like; organic acids, such as oxalic acid,
maleic acid, fumaric acid, malic acid, tartaric acid, citric acid,
benzoic acid and the like.
[0038] The solvent of solvates is a solvent conventionally used in
recrystallization. Examples of solvates include hemihydrates,
hydrates, and alcoholates, such as ethanolates, methanolates,
isopropanolates and the like.
[0039] The desired compounds, prepared by the reactions mentioned
above, can easily be isolated and purified by usual separation
procedures such as solvent extraction, dilution, recrystallization,
column chromatography, preparative thin layer chromatography and
the like.
[0040] The potent, partial 5-HT.sub.1A receptor agonist in the
present invention is useful for various disorders of the central
nervous system associated with the 5-HT.sub.1A receptor subtype
that induces bipolar disorders, such as bipolar I disorder with
most recent hypomanic, manic, mixed, depressed or unspecified
episode; bipolar II disorder with recurrent major depressive
episodes with hypomanic episodes, and cyclothymic disorder;
depression, such as endogenous depression, major depression,
melancholia, and treatment-resistant depression; panic disorder;
obsessive compulsive disorder (OCD); sleep disorders; sexual
dysfunction; alcohol abuse and drug addiction; cognitive
impairment; neurodegenerative diseases, such as Alzheimer's
disease, Parkinson's disease and the like, cognitive impairments
caused by neurodegenerative diseases such as Alzheimer's disease,
Parkinson's disease and related disorders; emesis; motion sickness;
obesity; migraine; autism; Down's syndrome; attention-deficit
hyperactivity disorder (ADHD); treatment-resistant, inveterate or
chronic schizophrenia, (which fail to respond adequately to
currently available antipsychotic drugs); cognitive impairments
caused by treatment-resistant schizophrenia, inveterate
schizophrenia or chronic schizophrenia and the like.
[0041] Compounds of the present invention may be suitably prepared
into pharmaceutically acceptable formulations (see U.S. Pat. No.
5,006,528, European Patent No. 367,141 and Japanese Kokai
(Laid-open) 7-304,740 (1995), and Japanese Patent Application No.
2000-194976 incorporated by reference herein).
[0042] The dosage of these pharmaceutical preparations of the
invention may be selected appropriately depending on the method of
administration, the patient's age, sex and other factors, severity
of the disease and other factors. Generally, however, the daily
dose of the active ingredient compound is preferably within the
range of about 0.0001 to about 50 mg per kilogram of body weight.
It is desirable that the active ingredient compound be contained in
each unit dosage form in an amount of about 0.001 to about 1,000
mg, particularly 0.01 to 100 mg, more particularly 0.1 to 50 mg,
yet more particularly 1 mg to 20 mg.
Pharmacological Tests
1. Materials and Methods
[0043] 1.1 Test Compound
[0044]
7-{4-[4-(2,3-Dichlorophenyl)-1-piperazinyl]-butoxy}-3,4-dihydrocarb-
ostyril (aripiprazole) was used as test compound.
[0045] 1.2 Reference Compounds
[0046] Serotonin (5-HT) and WAY-100635
(N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-(2-pyridimyl)-cyclohexa-
necarboxamide, a 5-HT.sub.1A receptor antagonist, manufactured by
RBI (Natick, Mass.) were used as reference compounds.
[0047] 1.3 Vehicle
[0048] Dimethyl sulfoxide (DMSO) manufactured by Sigma Chemical Co.
(St. Louis, Mo.) was used as vehicle.
[0049] 1.4 Preparation of Test and Reference Compounds
[0050] Test compound was dissolved in 100% dimethyl sulfoxide
(DMSO) to yield 100 .mu.M stock solutions (final concentration of
DMSO in all tubes containing test compound was 1%, v/v). All other
reference compounds were prepared by the same method using
double-distilled water rather than DMSO.
[0051] 1.5 Experimental Procedure for the
[.sup.35S]GTP.sub..gamma.S Binding Assay
[0052] Test and reference compounds were studied in triplicate at
10 different concentrations (0.01, 0.1, 1, 5, 10, 50, 100, 1000,
10000 and 50000 nM) for their effects upon basal
[.sup.35S]GTP.sub..gamma.S binding to h5-HT.sub.1A CHO cell
membranes. Reactions were performed in 5 ml glass test tubes
containing 8 .mu.l of test/reference drug mixed with 792 .mu.l of
buffer (25 mM Tris HCl, 50 mM NaCl, 5 mM MgCl.sub.2, 0.1 mM EGTA,
pH=7.4) containing GDP (1 LM). [.sup.35S]GTP.sub..gamma.S (0.1 nM)
and h5-HT.sub.1A CHO cell membranes (10 .mu.g protein/reaction; NEN
Life Science Products, Boston, Mass.; catalog # CRM035, lot
#501-60024, GenBank # X13556). Reactions proceeded for 60 min at
room temperature and were terminated by rapid filtration through
Whatman GF/B filter paper, using a Brandel harvester and 4.times.3
ml ice-cold buffer washes. .sup.35S radio-activity bound to the
filter paper was measured using liquid scintillation counting (1272
Clinigamma, LKB/Wallach).
[0053] 1.6 Experimental Procedure to Determine the Binding Affinity
of Test compound (Aripiprazole) at the h5-HT.sub.1A Receptor
[0054] Test compound was studied in triplicate at 10 different
concentrations (0.01, 0.1, 1, 10, 50, 100, 500, 1000, 5000 and
10000 nM) to determine its displacement of [.sup.3H] 8-OH-DPAT (1
nM; NEN Life Sciences; catalog # NET 929, lot #3406035, Specific
Activity=124.9 Ci/mmol) binding to h5-HT.sub.1A receptors in CHO
cell membranes (15-20 .mu.g protein; NEN Life Science Products,
catalog # CRM035, lot #501-60024). Membranes (396 .mu.l) were
incubated in 5 ml glass tubes containing [.sup.3H] 8-OH-DPAT (396
.mu.l), test compound or vehicle (8 .mu.l) and buffer A (50 mM
Tris.HCl, 10 mM MgSO.sub.4, 0.5 mM EDTA, 0.1% (w/v) ascorbic acid,
pH=7.4). All assays proceeded for 60 min at room temperature and
were terminated by rapid filtration through Whatman GF/B filter
paper (presoaked in buffer B; 50 mM Tris.HCl, pH=7.4), using a
Brandel harvester and 4.times.1 ml ice-cold washes with buffer B.
Non-specific binding was determined in the presence of 10 .mu.M (+)
8-OH-DPAT.
[0055] 1.7 Parameters Determined
[0056] Serotonin (5-HT) is a full 5-HT.sub.1A receptor agonist
which stimulates increases in basal [.sup.35S]GTP.sub..gamma.S
binding to h5-HT.sub.1A receptors in recombinant CHO cell
membranes. Test compound was studied at 10 concentrations to
determine their effects upon basal [.sup.35S]GTP.sub..gamma.S
binding relative to that produced by 10 .mu.M 5-HT. The relative
potency (EC.sub.50, 95% confidence interval) and intrinsic agonist
activity (% of E.sub.max for 10 .mu.M 5-HT) was calculated for each
compound by computerized non-linear regression analysis of complete
concentration-effect data. The binding affinity of test compound at
the h5-HT.sub.1A receptor was determined by its ability to prevent
[.sup.3H] 8-OH-DPAT binding to CHO cell membranes that express this
receptor. Non-linear regression analysis of the competition binding
data was used to calculate an inhibition constant (IC.sub.50, 95%
confidence interval), which is the concentration of test compound
that occupies half of the h5-HT.sub.1A sites specifically bound by
[.sup.3H] 8-OH-DPAT. The affinity of h5-HT.sub.1A receptors for
test compound (Ki, 95% confidence interval) was calculated by the
equation, Ki=(IC.sub.50)/(1+([[.sup.3H] 8-OH-DPAT]/Kd), where the
Kd for [.sup.3H] 8-OH-DPAT at h5-HT.sub.1A=0.69 nM (NEN Life
Sciences). All estimates of drug binding affinity, potency and
intrinsic efficacy at the h5-HT.sub.1A receptor were calculated
using GraphPad Prism version 3.00 for Windows (GraphPad Software,
San Diego, Calif.).
2. Results
[0057] Test compound and 5-HT produced concentration-dependent
increases above basal [.sup.35S]GTP.sub..gamma.S binding. 1% DMSO
tested alone had no effect upon basal or drug-induced
[.sup.35S]GTP.sub..gamma.S binding.
[0058] Test compound (EC.sub.50=2.12 nM), 5-HT (EC.sub.50-3.67 nM),
potently stimulated, basal [.sup.35S]GTP.sub..gamma.S binding.
Potency and intrinsic agonist efficacy estimates were derived by
non-linear regression analysis with correlation coefficients
(r.sup.2)>0.98 in each case (Table 1). Test compound exerted
partial agonist efficacies in the 65-70% range. WAY-100635 produced
no significant change (unpaired Student's t-test) in basal
[.sup.35S]GTP.sub..gamma.S binding at all concentrations tested
(Table 1). WAY-100635 did, however, completely inhibit the effects
of 5-HT and test compound upon [.sup.35S]GTP.sub..gamma.S binding
to h5-HT.sub.1A receptors in CHO cell membranes (Table 2). Tables 1
and 2 are shown below.
[0059] Test compound demonstrated high affinity binding to
h5-HT.sub.1A receptors in CHO cell membranes (IC.sub.50=4.03 nM,
95% confidence interval=2.67 to 6.08 nM; Ki=1.65 nM, 95% confidence
interval=1.09 to 2.48 nM).
TABLE-US-00001 TABLE 1 Potency (EC.sub.50) and Intrinsic Agonist
Efficacy (E.sub.max) of Test compound and Reference Drugs in a
h5-HT.sub.1A [.sup.35S]GTP.sub..gamma.S CHO-cell Membrane Binding
Assay. EC.sub.50, nM (95% Confidence E.sub.max Goodness of Fit Drug
Interval) (% .+-. SEM) (r.sup.2) Test 2.12 68.13 .+-. 3.16 0.986
Compound (0.87 to 5.16) 5-HT 3.67 98.35 .+-. 4.47 0.986 (1.56 to
8.63) WAY-100635 -- -- --
TABLE-US-00002 TABLE 2 Inhibitory Potency (IC.sub.50) of WAY-100635
versus 1 .mu.M Concentration of 5-HT and Test compound in a
h5-HT.sub.1A [.sup.35S] GTP.gamma.S CHO-cell Membrane Binding
Assay. WAY-100635 Inhibition Potency, IC.sub.50, nM (95% Goodness
of Fit Drug Combination Confidence Interval) (r.sup.2) 5-HT +
WAY-100635 217.1 0.988 (127.4 to 369.7) Test compound + 392.2 0.989
WAY-100635 (224.1 to 686.2)
* * * * *