Patent Application
20090076151
Researchers at the Centers for Disease Control and Prevention (CDC) estimated that as many as 47 million Americans may exhibit a cluster of medical conditions (a “metabolic syndrome”) characterized by abdominal obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and elevated fasting blood glucose [1]. Having three or more traits of metabolic syndrome significantly increases the risk of dying from coronary heart disease or cardiovascular disease. It has also been reported that patients with even one or two metabolic syndrome traits, or those with metabolic syndrome but without diabetes also were at increased risk for death from coronary heart disease or cardiovascular disease.
Obesity and atherosclerosis have a major impact on morbidity and mortality in the United States and many other countries. Elevated cholesterol, particularly low-density lipoprotein (LDL) cholesterol, is a major risk factor for atherosclerosis. Thyroid hormone replacement in hypothyroid individuals reduces total cholesterol and LDL-cholesterol [2-4]. An excess of thyroid hormone in thyrotoxicosis causes weight loss. The weight loss consists not only of fat but also muscle mass and even myopathy can be observed [5].
The ability of thyroid hormone to lower cholesterol when given to hypothyroid individuals prompted efforts to design analogs that take advantage of these properties in the treatment of hypercholesterolemia. This action is the result of an accelerated LDL-cholesterol clearance rate [6-8]. T3 increases levels of both the hepatic LDL receptor [9] and its mRNA [10]. Additional thyroid hormone actions on lipid metabolism include increasing the activity of lipoprotein lipase [11].
Numerous studies have been carried out to synthesize thyroid hormone analogs that mimic the actions of the natural hormones. The objective of most of these efforts has been to develop thyromimetics that lower plasma cholesterol without adverse cardiac effects. A series of thyroxine analogs and methods of synthesis are described in U.S. Pat. No. 3,109,023. Thyroid hormone agonists that are highly selective for the thyroid hormone receptor (TR) β-subtype are described in U.S. Pat. No. 5,883,294 and WO 00/39077. U.S. Pat. No. 5,284,971 describes a class of thyromimetics, which have the distinguishing characteristic of a sulfonyl bridge in the diphenyl core.
The usual method employed in treating obesity has been reduction of caloric intake either by reduced caloric diet or appetite suppression. An alternative method is to stimulate metabolic rate in adipose tissue. For example U.S. Pat. Nos. 4,451,465, 4,772,631, 4,977,148 and 4,999,377 disclose compounds possessing thermogenic properties at dosages causing few or no deleterious side-effects, such as cardiac stimulation. Further pharmaceutical compositions including those selective for the β-type thyroid hormone receptor have been taught by Cornelius et al. in US 2002/0035153 A1. A representative compound of this type, N-[4-[3′[(4-fluorophenyl)hydroxymethyl]-4′-hydroxyphenoxy]-3,5-dimethylphenyl]oxamate (CGS-26214) reportedly is devoid of significant cardiovascular effects but possess significant thermogenic properties. Accordingly, CGS-26214 and related compounds are useful in the treatment of obesity and related conditions in humans and companion animals. According to Cornelius et al. compounds related to CGS-26214 may be combined with an anorectic agent such as phenylpropanolamine, ephedrine, pseudoephedrine, phentermine, a Neuropeptide Y antagonist, a cholecystokinin-A agonist, etc. Whereas administration of a selective β-agonist would compensate for endogenous hormones in terms of TRβ stimulation it may not significantly activate TRα, which could cause a relative hypothyroidism or could cause increased hepatic toxicity. Also, there is no information on whether weight loss would be selective for fat or would include muscle as well.
Goglia and Lanni in WO2005009433 describe the use of a breakdown product of thyroid hormone (3,5-diiodothyronine) as a regulator of lipid metabolism to stimulate burning of fatty acid in mitochondria. T3, which is largely derived from T4 by the action of monodeiodinases, has been thought to be the major active form of thyroid hormone. It has been reported that 3,5-diiodothyronine (3,5-T2) is able to directly increase mitochondrial respiration by increasing the burning of fatty acids. In keeping with the stimulation of mitochondrial respiration, fatty acid oxidation rate was increased by 3,5-T2. In rats fed a high-fat diet long-term treatment with 3,5-T2 reportedly decreased weight gain. These effects were observed without suppression of TSH or evidence of hyperthyroidism. 3,5-T2 also was given to four volunteers in daily doses between 15 and 90 microgram/kg. There was a reduction in plasma levels of triglycerides from 140-70 mg/dL and cholesterol from 241 mg/dL to 210 mg/dL. The resulting metabolic rate increased in a dose dependent manner reaching a maximum increase of 40% (from 1770 Kcal to 2400 Kcal per day). Fat mass was reduced in the range of 10 to 15%. There was no significant change in plasma levels of free T3 and free T4.
The actions of 3,5-T2 and T3 on mitochondrial respiration can be distinguished by differences in the time course of the response [12]. Changes in resting metabolic rate in hypothyroid rats treated with a single injection of 3,5-T2 started 6-12 hours after infection with the maximal stimulation at 28-30 hours. By contrast injection of T3 increased resting metabolic rate that started 25-30 hours after injection and lasted 5-6 days. At the mitochondrial level stimulation is very rapid after injection of 3,5-T2, occurring within 1 hour.
In my parent application, now U.S. Pat. No. 6,534,676, I describe and claim the use of a thyroid hormone analog 3,5-diiodothyropropionic acid (DITPA) for treating patients with congestive heart failure. More particularly, as reported in my aforesaid U.S. Pat. No. 6,534,676, DITPA has been shown to improve left ventricular (LV) performance in post-infarction experimental models of heart failure when administered alone or in combination with an angiotension I-converting enzyme inhibitor. Cholesterol was significantly reduced in heart failure patients receiving DITPA after two and four weeks treatment, P<0.05 and P<0.1, respectively. In addition, it was noted that triglycerides were significantly reduced in these heart failure patients at two and four weeks of treatment with P<0.05 and P<0.005, respectively.
3,5-T2 and DITPA differ only in the side chain attached to the inner phenolic ring. In each case, the side chain consists of 3 carbons, ending in an amino acid group in 3,5-T2 and a carboxylic acid in DITPA. The structural similarity suggests the compounds should have some physiologic similarities. As reported in my aforesaid U.S. Pat. No. 6,534,676 normal volunteers and patients with heart failure indicate two such similarities: 1) There was significant weight loss in heart failure patients, who were obese and poorly conditioned, but no significant loss in volunteers who were more active and free of significant heart disease; and 2) Unexpectedly, there was a decrease not only in total cholesterol and LDL-cholesterol but also a highly significant decrease in triglycerides (P=0.005). A decrease in triglycerides also was seen with administration of 3,5-T2, but to my knowledge, has not previously been reported either with thyroid replacement in hypothyroidism or in the case of thyroid hormone analogs [13].
The new and surprising effect I have found is that administration of 3,5-diiodothyropropionic acid (DITPA) not only reduces total cholesterol and low-density lipoprotein (LDL) cholesterol when it is administered to overweight euthyroid individuals, it stimulates weight loss, and also reduces triglycerides, particularly in overweight individuals.
Adipose tissue is the largest storehouse of energy in the body (in the form of triglycerides) and typically makes up 15-20% or more of the body weight in men and 20-25% or more of the body weight in women. Thyroid hormones exert a wide range of effects on lipid metabolism. In the thyrotoxic state lipid mobilization, synthesis and degradation are all accelerated. Degradation of most lipids is stimulated out of proportion to synthesis and as a consequence body lipid deposits are depleted. Thus, administration of DITPA is seen to stimulate weight loss and lower hypertriglyceridemia, particularly in overweight patients, and may be used to treat or to reduce risk of death or progression of coronary heart disease (CHD) in patients with metabolic syndrome.
DITPA was synthesized following good manufacturing procedures by coupling dianisoleiodium trifluoroacetate with ethyl-3-(3,5-diiodo-4-hydroxyphenyl)-propionate followed by removal of the methyl and ethyl protective groups as described in my aforesaid U.S. Pat. No. 6,534,676.
The effects of administering DITPA were studied in 7 volunteers all but one of whom had normal weight. Study participants were men between the ages of 27 and 52 years. Of note, there was an average weight loss of only 0.6 kg for the group, or 0.7% of their initial weight, which did not attain statistical significant (P=0.13). Body Mass Index (BMI) was calculated as a meaning of judging obesity. BMI is a measure of body fat based on height and weight that applies to both men and women. Excluding the one overweight individual BMI ranged from 21.0 to 26.7 (average 25.0). (The range of normal weight for men is 20.7 to 26.4, marginally over weight 26.4 to 27.8, overweight 27.8 to 31.1, and very obese is greater than 31.1). BMI was calculated using the BMI calculator at the National Heart, Lung, and Blood Institute web site (nhlbisupport/com/bmi/). BMI and lipid data for the six volunteers of normal body weight are summarized in Table I A&B:
Cholesterol levels ranged from 133 mg/dL to 320 mg/dL (average 202.2±25.4 mg/dL), LDL-cholesterol 121.6±14.2, HDL-cholesterol 33.7±7.5. Triglycerides levels ranged from 83 mg/dL to 538 mg/dL (average 189.8±71.1 mg/dL) before treatment. On day 1, these normal volunteers were started on 1.875 mg/kg DITPA in two divided doses per day. This treatment regimen was continued for two weeks. At the end of the second week, the dose was doubled to 3.75 mg/kg and the volunteers were treated for two additional weeks.
After two weeks of treatment with DITPA cholesterol levels were decreased to an average of 172.8±28.2 mg/dL, LDL-cholesterol to 98.3±13.3 mg/dL. HDL-cholesterol and triglycerides were unchanged at 35.5±3.3 mg/dL and 195.2±81.2 mg/dL, respectively. After four weeks of treatment cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were essentially unchanged from values after 2 weeks of treatment. Note that triglyceride levels in the one individual (K. L.) with very high triglyceride levels, was unaffected by treatment. Thus treatment with DITPA in individuals of normal body weight lowered cholesterol and LDL-cholesterol but did not cause weight loss or a decrease in triglycerides.
Treatment was repeated with a second group of 8 patients with heart failure. (One patient with heart failure treated with DITPA reported in U.S. Pat. No. 6,716,877 was excluded because no lipid data were available at baseline.) Those in the second group had Body Mass Indices ranging from 21.0 to 30.3 (average 32.2, which was in the obese range). The patients in this group received an initial dose of 1.875 mg/kg for two weeks, which was doubled to 3.75 mg/kg for two additional weeks. As reported earlier, heart failure patients receiving DITPA experienced an average weight loss of 4 kg or 4.0% of their initial body weight (P=0.059).
At baseline average cholesterol values were 185.8±16.6 mg/dL, LDL-cholesterol 107.1±15.1 mg/dL, HDL-cholesterol 32.8±2.8 mg/dL and triglycerides 228.6±39.8 mg/dL. After two weeks of treatment with DITPA cholesterol decreased to 166.5±14.8 mg/dL, LDL-cholesterol to 93.1±13.9 mg/dL and triglycerides to 216.9±30.6 mg/dL. After four weeks of treatment cholesterol decreased to 145.1±17.7, LDL-cholesterol to 84.3±14.9 and triglycerides to 148.4±23.3. The decrease in triglycerides of 35% is comparable to that reported by Goglia and Lanni in normal volunteers treated with 3,5-T2. Of particular interest, the two patients (J. G. and J. D.), with triglycerides of greater than 300, had decreases in triglycerides of 60% and 36%, respectively.
It is thus seen that administration of DITPA caused a greater decrease in weight of overweight individuals than those of normal body weight. Triglycerides also were decreased to a greater extent in overweight individuals. In these individuals, the triglycerides were decreased both in those with normal and elevated triglycerides levels.
As used herein, the terms “overweight individuals” and “overweight patients” are those individuals or patients having a Body Mass Index of 30 or more.
As used herein, “therapeutically effective amounts” or “effective dose levels” for achieving weight loss and lowering of triglyceride levels of overweight individuals were 0.1 to 10.0 mg/kg daily, preferably 1.875 to 3.75 mg/kg daily. Preferably, the daily doses were divided in half and administered twice daily.
While the invention has been described in detail in treating humans in accordance with certain preferred embodiments the invention also advantageously may be used for treating overweight animals such as dogs and cats, and other domesticated animals. Also, while administration of DITPA appears to reduce triglycerides, particularly in overweight individuals, individuals of normal weight also may benefit by a reduction of triglycerides from administration of DITPA in accordance with the present invention. Moreover, DITPA advantageously may be combined with one of the conventional lipid/triglyceride lowering therapeutic agents such as HMG CoA reductase inhibitors commonly referred to as ‘statins’, e.g., atorvastatin (Lipitor), simvastatin (Zocor), fluvastatin (Lescol), lovastatin (Mevacor), rosuvastatin (Crestor), and pravastatin (Pravachol) or the like. Niacin and inhibitors of cholesterol absorption such as ezetimibe (Zetia) also may be combined with DITPA. For treatment of hypertriglyceridemia fibric acid derivative such as gemfibrozil (Lopid), fenofibrate (Tricor), etc. may be combined with DITPA. Still other modifications and changes therein may be made without departing from the spirit and scope of the invention.
This application is a continuation-in-part of co-pending application Ser. No. 10/818,541, filed Apr. 5, 2004, which is, in turn a continuation-in-part of U.S. application Ser. No. 10/368,755, filed Feb. 18, 2003, now U.S. Pat. No. 6,716,877 issued Apr. 6, 2004, which is, in turn a continuation-in-part of U.S. application Ser. No. 09/774,994, filed Jan. 31, 2001, now U.S. Pat. No. 6,534,676, issued Mar. 18, 2003.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 11104900 | Apr 2005 | US |
| Child | 12323405 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10818541 | Apr 2004 | US |
| Child | 11104900 | US | |
| Parent | 10368755 | Feb 2003 | US |
| Child | 10818541 | US | |
| Parent | 09774994 | Jan 2001 | US |
| Child | 10368755 | US |
