Patent Application
20160318844
Pulmonary hypertension (PH) is characterized by an abnormally high blood pressure in the lung vasculature. It is a progressive, lethal disease that leads to heart failure and can occur in the pulmonary artery, pulmonary vein, or pulmonary capillaries. Symptomatically patients experience shortness of breath, dizziness, fainting and other symptoms, all of which are made worse by exertion. There are multiple causes, and can be of unknown origin, idiopathic, and can lead to hypertension in other systems, for example, portopulmonary hypertension in which patients have both portal and pulmonary hypertension.
Pulmonary hypertension has been classified into five groups by the World Health Organization (WHO). Group I is called pulmonary arterial hypertension (PAHX and includes PAH that has no known cause (idiopathic), inherited PAH (i.e., familial PAH or FPAH), PAH that is caused by drugs or toxins, and PAH caused by conditions such as connective tissue diseases, HIV infection, liver disease, and congenital heart disease. Group II pulmonary hypertension is characterized as pulmonary hypertension associated with left heart disease. Group II pulmonary hypertension is characterized as PH associated with lung diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, as well as PH associated with sleep-related breathing disorders (e.g., sleep apnea). Group IV PH is PH due to chronic thrombotic and/or embolic disease, e.g., PH caused by blood clots in the lungs or blood clotting disorders. Group V includes PH caused by other disorders or conditions, e.g., blood disorders (e.g., polycythemia vera, essential thrombocythemia), systemic disorders (e.g., sarcoidosis, vasculitis), metabolic disorders (e.g., thyroid disease, glycogen storage disease).
Pulmonary arterial hypertension (PAH) afflicts approximately 200,000 people globally with approximately 30,000-40,000 of those patients in the United States. PAH patients experience constriction of pulmonary arteries which leads to high pulmonary arterial pressures, making it difficult for the heart to pump blood to the lungs. Patients suffer from shortness of breath and fatigue which often severely limits the ability to perform physical activity.
The New York Heart Association (NYHA) has categorized PAH patients into four functional classes, used to rate the severity of the disease. Class I PAH patients as categorized by the NYHA, do not have a limitation of physical activity, as ordinary physical activity does not cause undue dyspnoea or fatigue, chest pain, or near syncope. Treatment is not needed for class I PAH patients. Class II PAH patients as categorized by the NYHA have a slight limitation on physical activity. These patients are comfortable at rest, but ordinary physical activity causes undue dyspnoea or fatigue, chest pain or near syncope. Class III PAH patients as categorized by the NYHA have a marked limitation of physical activity. Although comfortable at rest, class III PAH patients experience undue dyspnoea or fatigue, chest pain or near syncope as a result of less than ordinary physical activity. Class IV PAH patients as categorized by the NYHA are unable to carry out any physical activity without symptoms. Class IV PAH patients might experience dyspnoea and/or fatigue at rest, and discomfort is increased by any physical activity. Signs of right heart failure are often manifested by class IV PAH patients.
Patients with PAH are treated with an endothelin receptor antagonist (ERA), phosphodiesterase type 5 (PDE-5) inhibitor, a guanylate cyclase stimulator, a prostanoid (e.g., prostacyclin), or a combination thereof. ERAs include abrisentan (Letairis®), sitaxentan, bosentan (Tracleer®), and macitentan (Opsumit®). PDE-5 inhibitors indicated for the treatment of PAH include sildenafil (Revatio®), tadalafil (Adcirca®). Prostanoids indicated for the treatment of PAH include iloprost, epoprosentol and treprostinil (Remodulin®, Tyvaso®). The one approved guanylate cyclase stimulator is riociguat (Adempas®). Additionally, patients are often treated with combinations of the aforementioned compounds.
Portopulmonary hypertension is defined by the coexistence of portal and pulmonary hypertension, and is a serious complication of liver disease. The diagnosis of portopulmonary hypertension is based on hemodynamic criteria: (1) portal hypertension and/or liver disease (clinical diagnosis-ascites/varices/splenomegaly), (2) mean pulmonary artery pressure >25 mmHg at rest, (3) pulmonary vascular resistance >240 dynes s/cm5, (4) pulmonary artery occlusion pressure <15 mmHg or transpulmonary gradient >12 mmHg. PPH is a serious complication of liver disease, and is present in 0.25 to 4% of patients suffering from cirrhosis. Today, PPH is comorbid in 4-6% of those referred for a liver transplant.
Despite there being treatments for PAH and PPH, the current prostacyclin therapies are associated with severe toxicity and tolerability issues, as well as the requirement for inconvenient dosing schedules. The present invention overcomes addresses these factors by providing compounds and treatment schedules that provide for less toxicity, better tolerability and more convenient dosing schedules.
In one aspect, a method of treating pulmonary hypertension, e.g., pulmonary arterial hypertension (PAH) in a pateint in need thereof is provided. In one embodiment, the method comprises administering to the patient an effective amount of a prostacyclin compound described herein via subcutaneous and/or intravenous infusion. The pulmonary hypertension may be pulmonary arterial hypertension (PAH) or portopulmonary hypertension (PPH). In one embodiment, the subcutaneous and/or intravenous infusion is a continuous infusion.
In one embodiment, the PAH treatable by the methods provided herein, for example, treatable via continuous intravenous or subcutaneous infusion, is WHO Group I PAH, for example, to diminish symptoms associated with exercise in a patient in need thereof. In another embodiment, the PAH is NYHA class II, NYHA class III or NYHA class IV. In even another embodiment, the PAH is associated with congenital systemic-topulmonary shunts or PAH associated with connective tissue diseases.
An infusion pump is also provided herein. The pump is designed for subcutaneous infusion (e.g., continuous subcutaneous infusion) or intravenous infusion (e.g., continuous intravenous infusion). The pump in one embodiment, is small and lightweight, adjustable to provide different programmable infusion rates, comprises one or more alarms to monitor occlusion, delivery progress, low battery, programming error and motor malfunction. In one embodiment, the infusion pump comprises a drug reservoir. In a further embodiment, the reservoir comprises one of the prostacyclin compounds provided herein, or a pharmaceutically acceptable salt (e.g., one of the prodrugs described herein together with a pharmaceutically acceptable excipient). In a further embodiment, the device comprises a monitor to monitor the dosage of delivered prostacydin compound.
The infusion pump provided herein, in one embodiment, is ambulatory, has a delivery accuracy of ±6% or better and is positive pressure driven. In a further embodiment, the pump comprises a reservoir and the reservoir is made of polyvinyl choride, polypropylene or glass.
In another embodiment, the infusion pump (subcutaneous or intravenous) comprises a pump, a reservoir containing the prostacyclin composition, an infusion set for subcutaneous infusion of the composition, and an optional monitor mearuing concentration of prostacyclin or metabolites thereof. In another embodiment, the infusion device provides an open-loop or closed-loop system.
In another embodiment, the infusion device provides an open-loop or closed-loop system.
In another embodiment the infusion device continuously infuses the prostacyclin composition for a predetermined interval; wherein at the end of the predetermined interval the predetermined infusion interval may repeat or initiate a new predetermined infusion interval. In another embodiment, the predetermined interval is about 24 hours, about 36 hours, or less than about 96 hours.
In another embodiment, the subcutaneous infusion of the prostacyclin compound occurs at eather a continuous rate of volume or a variable rate of volume.
In one embodiment, a kit for the administration of a prostacyclin composition described herein in amounts effective to treat pulmonary hypertension. e.g., pulmonary arterial hypertension. The kit comprises a composition comprising one of the prostacylcin compounds described herein, a subcutaneous infusion pump, and instructions for the administration of a prostacyclin compound.
In another embodiment, the subcutaneous infusion pump of the kit is a continuous subcutaneous infusion pump.
In one aspect of the invention, a prostacyclin compound of Formula (I), or a pharmaceutically acceptable salt, is provided:
wherein R1 is NH, O or S; R2 is H, a linear C2-C18 alkyl, branched C3-C18 alkyl, linear C2-C18 alkenyl, branched C3-C18 alkenyl, aryl; aryl-C1-C18 alkyl; an amino acid or a peptide; R3 is H, OH, O-alkyl or O-alkenyl; R4 is an optionally substituted linear or branched C1-C15 alkyl, or an optionally substituted linear or branched C2-C15 alkenyl; and n is an integer from 0 to 5, with the proviso that the prostacyclin compound is not treprostinil.
In a one embodiment, a compound of Formula (I) is provided and R2 is a linear C2-C10 alkyl. In even a further embodiment, R2 is a linear C2-C8 alkyl. In even a further embodiment, the compound is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump.
In a one embodiment, a compound of Formula (I) is provided and R2 is a linear C4-C10 alkyl. In even a further embodiment, R2 is a linear C4-C10 alkyl. In even a further embodiment, the compound is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump.
In a one embodiment, a compound of Formula (I) is provided and R2 is a linear C4-C10 alkyl. In even a further embodiment, R2 is a linear C6-C10 alkyl. In even a further embodiment, the compound is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump.
In a one embodiment, a compound of Formula (I) is provided and R2 is a linear C6-C10 alkyl. In even a further embodiment, R2 is a linear C7-C10 alkyl. In even a further embodiment, the compound is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump.
In a one embodiment, a compound of Formula (I) is provided and R2 is a linear C5-C18 alkyl. In even a further embodiment, R2 is a linear C13-C18 alkyl.
In a one embodiment, a compound of Formula (I) is provided and R2 is a linear C2-C10 alkyl. In even a further embodiment, R2 is a linear C2-C8 alkyl. In a further embodiment, a composition comprising an amphiliphic agent and the compound of Formula (I), where R2 is a linear C2-C8 alkyl is provided. In even a further embodiment, the composition is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump.
In another aspect of the invention, a prostacyclin compound of Formula (II), or a pharmaceutically acceptable salt, is provided:
wherein R1 is NH, O or S; R2 is a linear or branched C2-C18 alkyl, a linear C2-C18 alkenyl or a branched C3-C18 alkenyl, aryl, aryl-C1-C18 alkyl, an amino acid or a peptide; and n is an integer from 0 to 5.
In a one embodiment, a compound of Formula (II) is provided and R2 is a linear C2-C10 alkyl. In even a further embodiment, R2 is a linear C2-C8 alkyl. In even a further embodiment, the compound is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump.
In one embodiment, a compound of Formula (II) is provided and R2 is a linear C5-C18 alkyl. In even a further embodiment. R2 is a linear C13-C18 alkyl.
In one embodiment, a compound of Formula (I) and/or (II) is provided, wherein one or more hydrogen atoms is substituted with a deuterium. Accordingly, in one embodiment, the present invention relates to an isotopologue of Formula (I) and/or (II), substituted with one or more deuterium atoms. The isotopologue of Formula (I) and/or (II) may be used to accurately determine the concentration of compounds of Formula (I) and/or (II) in biological fluids and to determine metabolic patterns of compounds of Formula (I) and/or (II) and its isotopologues. The invention further provides compositions comprising these deuterated isotopologues and methods of treating diseases and conditions, as set forth herein.
In one embodiment of the invention, a compound of Formula (I) or (II), or a pharmaceutically acceptable salt, is provided, wherein R1 is N and n is 1. In a further embodiment, R2 is a linear C5-C18 alkyl or a branched C5-C18 alkyl. In a further embodiment, R2 is a linear C6-C12 alkyl or a branched C6-C12 alkyl.
Another embodiment of the invention provides a compound of Formula (I) or (II), wherein R1 is O and n is 1. In a further embodiment, R2 is a linear C2-C10 alkyl. In even a further embodiment, R2 is a linear C2-C8 alkyl. In even a further embodiment, the compound is administered via continuous intravenous or subcutaneous infusion, e.g., with an infusion pump. In another embodiment, a compound of Formula (I) or (II) is provided, wherein R1 is S and n is 1. In yet another embodiment of the invention, a compound of Formula (I) or (II) is provided, wherein R1 is N and n is 0.
Another embodiment of the invention provides a prostacyclin compound of Formula (I) or (II), wherein R2 is a linear C5-C18 alkyl. In a further embodiment, n is 0 or 1. In even a further embodiment, R1 is N or O. In yet a further embodiment, R2 is a linear C6-C16 alkyl. Yet another embodiment provides a prostacyclin compound of Formula (I) or (II), wherein R1 is N, R2 is a linear C6-C18 alkyl, and n is 1. In even a further embodiment, R2 is a linear C6, C8 C10. C12, or C14 alkyl.
Another embodiment of the invention provides a prostacyclin compound of Formula (I) or (II), or a pharmaceutically acceptable salt, wherein R2 is a branched C5-C8 alkyl. In a further embodiment, n is 0 or 1. In yet a further embodiment, R, is N or O. In even a further embodiment, the branched alkyl is hexyl, octyl, decyl, dodecyl, tetradecyl, hexadecyl or octadecyl.
In yet another embodiment, a prostacyclin compound of Formula (I) or (II), or a pharmaceutically acceptable salt, is provided, wherein R2 is a linear C5-C18 alkenyl. In a further embodiment, n is 0 or 1. In yet a further embodiment, R, is N or O. In even a further embodiment, the branched alkyl is hexyl, octyl, decyl, dodecyl, tetradecyl, hexadecyl or octadecyl.
In yet another embodiment, a prostacyclin compound of Formula (I) or (II), or a pharmaceutically acceptable salt, is provided, wherein R2 is a branched C5-C18 alkenyl. In a further embodiment, n is 0 or 1. In yet a further embodiment, R, is N or O. In yet a further embodiment, the branched alkenyl is pentenyl, hexenyl, heptenyl, octenyl, nonenyl, decenyl, undecenyl, dodecenyl, tridecenyl, tetradecenyl, pentadecenyl, hexadecenyl, heptadecenyl or octadeceayl.
In one embodiment, a prostacyclin compound of Formula (I) or (II), or a pharmaceutically acceptable salt, is provided, wherein R2 is a branched chain alkyl that is either a symmetrical branched alkyl or an asymmetrical branched alkyl. In one embodiment of Formula (I) or (II), R is O or N and R2 is
where m1 and m2 are independently an integer selected from 1 to 9 and each occurrence of R′ is independently H, a linear or branched C1-C8 alkyl, or a linear or branched C1-C8 alkenyl. When m1 and/or m2 is an integer from 2-9, the m1/m2 at the end of the carbon chain is CH3, while the remaining m1/m2 groups are CH2. In a further embodiment, n is 0 or 1. In even a further embodiment, n is 1, R1 is O, R2 is
and the following compound is provided:
or a pharmaceutically acceptable salt thereof. In one embodiment, m1 and m2 are both 4. In another embodiment, m1 is 3 and m2 is 4. In even a further embodiment, n is 1.
In one embodiment, a compound of Formula (I) or (II) is provided, R1 is O and R2 is
In yet another embodiment of Formula (I) or (II), R1 is O and R2 is
In one embodiment, a compound of Formula (I) or (II) is provided, R1 is N and R2 is
In yet anth embodiment of Formula (I) or (II), R1 is N and R is
In a further embodiment, n is 1 and the following compound is provided:
(referred to herein as 5-nonanyl-treprostinil or 5C9-TR).
In one embodiment, the prostacyclin compounds of the formulae provided herein having a branched alkyl or branched alkenyl (e.g., where R2 of the formulae provided herein is 5-nonanyl, 3-heptyl, 4-heptyl, 4-octyl, 3-octyl, 2-octyl, 2-dimethyl-1-propyl, 3,3-dimethyl-1-butyl, 2-ethyl-1-butyl, 3-pentyl) at position R2 exhibit a slower conversion rate relative to a prostacyclin compound having a linear alcohol chain at position R2, and have the further advantage of high solubility.
Yet another embodiment of the invention relates to a prostacyclin compound of Formula (III), or a pharmaceutically acceptable salt:
wherein R1 and R2 are defined above for Formulae (I) and (II), and
R5 and R6 are independently selected from H, optionally substituted linear or branched C1-C15 alkyl, optionally substituted linear or branched C2-C18 alkenyl, (C═O)-optionally substituted linear or branched C1-C15 alkyl, or (C═O)-optionally substituted linear or branched C2-C15 alkenyl, with the proviso that the prostacyclin compound of Formula (III) is not treprostinil.
Another aspect of the invention relates to a prostacyclin composition comprising a prostacyclin compound of Formula (I), (II) or (III). In one embodiment, the prostacyclin composition comprises a prostacyclin compound of Formula (I), (II) or (III) and a hydrophobic additive. In a further embodiment, the hydrophobic additive is a hydrocarbon, a terpene or a hydrophobic lipid. In another embodiment, the hydrophobic additive is cholesteryl acetate, ethyl stearate, palmitate, myristate, palmityl palmitate, tocopheryl acetate, a monoglyceride, a diglyceride, a triglyceride like palmitate, myristate, dodecanoate, decanoate, octanoate or squalane. In even a further embodiment, the hydrophobic additive is squalane.
In another aspect of the invention, a composition comprising a prostacyclin compound of Formula (I), (II) or (III), and an amphiphilic agent is provided. For example, in one embodiment, the compound is a compound of Formula (I), (II) or (III) where R2 is a linear C2-C10 alkyl, e.g., linear C3-C10 alkyl, linear C4-C10 alkyl, linear C5-C10 alkyl, linear C4-C10 alkyl, linear C7-C10 alkyl, linear C8-C10 alkyl, or linear C2-C10 alkyl. In one embodiment, the amphiphilic agent is a PEGylated lipid, a surfactant or a block copolymer. In a further embodiment, the prostacyclin composition comprises a prostacyclin compound of Formula (I), (II) or (III), and a PEGylated lipid. In a further embodiment, the PEGylated lipid comprises PEG400, PEG500, PEGl000, PEG2000, PEG3000, PEG4000, or PEG5000. In a further embodiment the lipid component of the PEGylated lipid comprises PEG covalently linked to dimyristoyl phosphatidylethanolamine (DMPE), dipalmitoyl phosphoethanolamine (DPPE), distearoylphosphatidylethanolamine (DSPE), dimyristoylglycerol glycerol (DMG), diphosphatidylglycerol (DPG), disteraroylglycerol (DSG). The composition, in one embodiment, is stored as a suspension, e.g., 4° C., or lyophilized and stored as a dried powder and reconstituted at the time of use. The composition, in one embodiment, is stored frozen (e.g., −20° C. or −80° C.) and thawed just prior to use.
In another embodiment of the invention, a composition comprising a prostacyclin compound of Formula (I), (II) or (III), a hydrophobic additive and an amphiphilic agent is provided. In one embodiment, the amphiphilic agent is a PEGylated lipid, a surfactant or a block copolymer. In a further embodiment, the hydrophobic additive is squalane. In a further embodiment, a PEGylated lipid is present in the composition and comprises PEG400, PEG500, PEG1000, PEG2000, PEG3000, PEG4000 or PEG5000.
In another aspect of the invention, a method for treating pulmonary hypertension (PH) is provided. The treatment methods include treatment of group I (PAH), group II, group II, group IV or group V PH. In one embodiment, the method for treating PH comprises treatment of pulmonary arterial hypertension (PAH) in a patient in need thereof. In one embodiment, the method for treating PAH comprises administering to the patient in need of treatment, a prostacyclin compound of Formula (I), (II) or (III), or a pharmaceutically acceptable salt thereof, or a composition comprising a prostacyclin compound of Formula (I), (II) or (III), or a pharmaceutically acceptable salt thereof. In a further embodiment, the administration is subcutaneous, oral, nasal, intravenous or a pulmonary route of administration. In the case of pulmonary administration, the compound of Formula (I), (II) or (III), or the composition comprising the prostacydin compound of Formula (I), (II) or (III) is administered to the patient via a nebulizer, dry powder inhaler, or metered dose inhaler.
In another aspect of the invention, a method for treating portopulmonary hypertension (PPH) in a patient in need thereof is provided. In one embodiment, the method for treating PPH comprises administering to the patient in need of treatment, a prostacyclin compound of Formula (I), (II) or (III), or a pharmaceutically acceptable salt thereof, or a composition comprising a prostacyclin compound of Formula (I), (II) or (III), or a pharmaceutically acceptable salt thereof. In a further embodiment, the administration is subcutaneous (e.g., via continuous subcutaneous infusion with an infusion pump), oral, nasal, intravenous (e.g., via continuous intravenous) infusion with an infusion pump) or a pulmonary route of administration. In the case of pulmonary administration, the compound of Formula (I), (II) or (II), or a pharmaceutically acceptable salt thereof, or the composition comprising the prostacyclin compound of Formula (I), (II) or (III) is administered to the patient via a nebulizer, dry powder inhaler, or metered dose inhaler.
In one embodiment of the invention, a method for treating PH, PAH or PPH in a patient in need thereof is provided, comprises administering to the lungs of the patient a prostacyclin compound of Formula (I), (II) or (III), or a pharmaceutically acceptable salt thereof, via a metered dose inhaler comprising a propellant. In a further embodiment, the propellant is a fluorocarbon. In one embodiment, the compound of Formula (I), (II) or (III) or pharmaceutically acceptable salt thereof is administered via a metered dose inhaler to the lungs of a patient in need of PH, PAH or PPH treatment, and administration occurs once, twice or three times daily. In embodiments where the compound of Formula (I), (II) or (III), or a composition comprising the compound of Formula (I), (II) or (III), is administered orally, nasally, subcutaneously, intravenously or to the lungs (e.g., via nebulization, dry powder inhaler or metered dose inhaler), administration to the patient is either once or twice daily. In one embodiment, the compound of Formula (I), (II) or (III), or a composition comprising the compound of Formula (I), (II) or (III) is administered once daily to the patient in need of treatment, and administration is subcutaneous, intravenous, oral, nasal, or to the lungs via aerosolization using a nebulizer, dry powder inhaler, or metered dose inhaler.
In one embodiment, the patient treated for PH, PAH or PPH with the compounds, compositions and methods described herein experiences a decreased number of side effect(s) or a reduction in severity of side effect(s), compared to the number of side effect(s) or severity of side effect(s) experienced when the patient is administered treprostinil. In one embodiment, the side effect is the patient's cough response, and the frequency and/or severity is reduced, as compared to the frequency and/or severity of cough response experienced by the patient when administered treprostinil.
In one embodiment, where the route of administration is continuous subcuntaeous infusion, a patient administered one or more of the compounds of the present invention experiences a reduction in site pain (i.e., the site of infusion) and/or reaction, as compared to the site pain and/or reaction experienced by a patient when treprostinil is administered via continuous subcutaneous infusion. In another embodiment, where the route of administration is continuous subcuntaeous infusion, a patient administered one or more of the compounds of the present invention experiences a decreased number of adverse reactions (e.g., headache, diarrhea, nausea, jaw pain, vasodiation, edema and/or hypotension), as compared to the side effects experienced by a patient when treprostinil is administered via continuous subcutaneous infusion.
In another embodiment, the prostacyclin compound administered to a patient in need thereof via a pulmonary route by the PH, PAH or PPH treatment methods described herein provides a greater pulmonary elimination half-life (t1/2) of the prostacyclin compound and/or its metabolite treprostinil, compared to the pulmonary elimination half-life (t1/2) of treprostinil, when treprostinil is administered via a pulmonary route (e.g., by nebulization, dry powder inhaler, or a metered dose inhaler) to the patient.
In another embodiment, the prostacyclin compound administered to a patient in need thereof, via the PH, PAH or PPH treatment methods described herein provides a greater systemic half-life (t1/2) of the prostacyclin compound and/or its metabolite treprostinil, compared to the systemic elimination half-life (t1/2) of treprostinil, when treprostinil is administered to the patient. In a further embodiment, administration of the prostacyclin compound and treprostinil comprises subcutaneous or intravenous administration.
In another embodiment, the prostacyclin compound administered to a patient in need of PH, PAH or PPH treatment provides a greater mean pulmonary Cmax and/or lower plasma Cmax of treprostinil for the patient, compared to the respective pulmonary or plasma Cmax of treprostinil, when treprostinil is administered to the patient.
In another embodiment, the prostacyclin compound administered to a patient in need of PH (e.g., PAH) or PPH treatment provides a greater mean pulmonary or plasma area under the curve (AUC0-t) of the prostacyclin compound and/or its metabolite treprostinil, compared to the mean pulmonary or plasma area under the curve (AUC0-t) of treprostinil, when treprostinil is administered to the patient. In yet another embodiment, the prostacyclin compound administered to a patient in need thereof provides a greater pulmonary or plasma time to peak concentration (tmax) of the prostacyclin compound and/or its metabolite treprostinil, compared to the pulmonary or plasma time to peak concentration (tmax) of treprostinil, when treprostinil is administered to the patient.
The term “about,” as used herein, refers to plus or minus ten percent of the object that “about” modifies. Thus the phrase “about 10, 20, or 30” encompasses 8-11, 18-22, and 27-33, respectively.
The term “alkyl” as used herein refers to both a straight chain alkyl, wherein alkyl chain length is indicated by a range of numbers, and a branched alkyl, wherein a branching point in the chain exists, and the total number of carbons in the chain is indicated by a range of numbers. In exemplary embodiments, “alkyl” refers to an alkyl chain as defined above containing 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 carbons (i.e., C2-C18 alkyl). In one embodiment, where the compound is administered via continuous subcutaneous or continuous intravenous infusion. “alkyl” refers to an alkyl chain containing 2, 3, 4, 5, 6, 7, 8, 9, 10 carbons (i.e., C2-C10 alkyl). In one embodiment, “alkyl” refers to an alkyl chain containing 13, 14, 15, 16, 17 or 18 carbons (i.e., C13-C18 alkyl).
The term “alkenyl” as used herein refers to a carbon chain containing one or more carbon-carbon double bonds.
The term “aryl” as used herein refers to a cyclic hydrocarbon, where the ring is characterized by delocalized π electrons (aromaticity) shared among the ring members, and wherein the number of ring atoms is indicated by a range of numbers. In exemplary embodiments, “aryl” refers to a cyclic hydrocarbon as described above containing 6, 7, 8, 9, or 10 ring atoms (i.e., C6-C10 aryl). Examples of an aryl group include, but are not limited to, benzene, naphthalene, tetralin, indene, and indane.
The term “alkoxy” as used herein refers to —O-(alkyl), wherein “alkyl” is as defined above.
The term “substituted” in connection with a moiety as used herein refers to a further substituent which is attached to the moiety at any acceptable location on the moiety. Unless otherwise indicated, moieties can bond through a carbon, nitrogen, oxygen, sulfur, or any other acceptable atom.
The term “amino acid” refers to both natural (genetically encoded) and non-natural (non-genetically encoded) amino acids, and moieties thereof. Of the twenty natural amino acids, 19 have the general structure:
where R is the amino acid sidechain. The 20th amino acid, proline, is also within the scope of the present invention, and has the following structure:
Of the twenty natural amino acids, all but glycine is chiral, and both the D- and L-amino acid isomers, as well as mixtures thereof, are amenable for use with the prostacyclin compounds described herein. It is also noted that an amino acid moiety is encompassed by the term “amino acid.” For example, the amino acid moieties
are encompassed by the term “amino acid.”
Examples of non-natural amino acids amenable for use with the present invention include β-alanine (β-Ala); 2,3-diaminopropionic acid (Dpr); nipecotic acid (Nip); pipecolic acid (Pip); ornithine (Om); citrulline (Cit); t-butylalanine (t-BuA); 2-tbutylglycine (t-BuG); N-methylisoleucine (Melle); phenylglycine (PhG); cyclohexylalanine (ChA); norleucine (Nle); naphthylalanine (Nal); 4-chlorophenylalanine (Phe(4-Cl)); 2-fluorophenylalanine (Phe(2-F)); 3-fluorophen ylalanine (Phe(3-F)); 4-fluorophenylalanine (Phe(4-F)); penicillamine (Pen); 1,2,3,4-tetrahydroisoquinoline-3-carboxylic acid (Tic); β-2-thienylalanine (Thi); methionine sulfoxide (MSO); homoarginine (hArg); N-acetyllysine (AcLys); 2,4-diaminobutyric acid (Dbu); 2,3-diaminobutyric acid (Dab); p-aminophenylalanine (Phe (pNH2)); N-methyl valine (MeVal); homocysteine (hCys), homophenylalanine (hPhe); homoserine (hSer); hydroxyproline (Hyp); homoproline (hPro); and the corresponding D-enantiomer of each of the foregoing. Other non-genetically encoded amino acid residues include 3-aminopropionic acid; 4-aminobutyric acid; isonipecotic acid (Inp); aza-pipecolic acid (azPip); aza-proline (azPro); α-aminoisobutyric acid (Aib); ε-aminohexanoic acid (Aha); δ-aminovaleric acid (Ava); N-methylglycine (MeGly).
A “peptide” is a polymer of amino acids (or moieties thereof) linked by a peptide bond. Peptides for use with the present invention, comprise from about two to about fifteen amino acids, for example, two, three, four, five, six, seven, eight, nine or ten amino acids (or moieties thereof).
The term “salt” or “salts” as used herein encompasses pharmaceutically acceptable salts commonly used to form alkali metal salts of free acids and to form addition salts of free bases. The nature of the salt is not critical, provided that it is pharmaceutically acceptable. Suitable pharmaceutically acceptable acid addition salts may be prepared from an inorganic acid or from an organic acid. Exemplary pharmaceutical salts are disclosed in Stahl, P. H., Wermuth. C. G., Eds. Handbook of Pharmacetical Salts: Properties. Selection and Use; Verlag Helvetica Chimica Acta/Wiley-VCH: Zurich, 2002, the contents of which are hereby incorporated by reference in their entirety. Specific non-limiting examples of inorganic acids are hydrochloric, hydrobromic, hydroiodic, nitric, carbonic, sulfuric and phosphoric acid. Appropriate organic acids include, without limitation, aliphatic, cycloaliphatic, aromatic, arylaliphatic, and heterocyclyl containing carboxylic acids and sulfonic acids, for example formic, acetic, propionic, succinic, glycolic, gluconic, lactic, malic, tartaric, citric, ascorbic, glucuronic, maleic, flumaric pynruvic, aspartic, glutamic, benzoic, anthranilic, mesylic, stearic, salicylic, p-hydroxybenzoic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, ethanesulfonic, benzenesulfonic, pantothenic, toluenesulfonic, 2-hydroxyethanesulfonic, sulfanilic, cyclohexylaminosulfonic, algenic, 3-hydroxybutyric, galactaric or galacturonic acid. Suitable pharmaceutically acceptable salts of free acid-containing compounds disclosed herein include, without limitation, metallic salts and organic salts. Exemplary metallic salts include, but are not limited to, appropriate alkali metal (group Ia) salts, alkaline earth metal (group IIa) salts, and other physiological acceptable metals. Such salts can be made from aluminum, calcium, lithium, magnesium, potassium, sodium and zinc. Exemplary organic salts can be made from primary amines, secondary amines, tertiary amines and quaternary ammonium salts, for example, tromethamine, diethylamine, tetra-N-methylammonium, N,N′-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine (N-methylglucamine) and procaine.
The term “dosed-loop system,” as used herein, refers to an integrated system for providing an infusion of a composition. Closed-loop systems contain a mechanism for measuring prostacyclins, or metabolites thereof, a mechanism for delivering one or more compositions, including a prostacyclin composition, and a mechanism for determining the amount of the one or more compositions needed to be delived to achieve desired results. A closed-loop system may contain a prostacyclin sensor, a prostacyclin composition delivery device, such as a pump or infuser, and a controller that receives information from the sensor and provides commands to the delivery device. The commands can be generated by software in the controller. The software may include an algorithm to determine the amount of a prostacyclin composition to be delivered, based upon the prostacyclin detected by the prostacyclin sensor or anticipated by the user.
The term “open-loop system,” as used herein, refers to devices similar to a closed-loop system, except that open-loop system devices do no automatically measure and respond to prostacyclin composition levels. In an open-loop system a pump, infuser, or other similar device is programmed to infuse a composition continuously, and where the patient is able, by means of a user input on the pump or other means to administer an increase or decrease of the one or more compositions.
The term “infusion set,” as used herein, refers to a system attached to a pump that directly delivers one or more compositions from a reservoir in the pump or infuser subcutaneously or intravenously.
In one aspect, the present invention provides a prostacyclin compound, for example, a treprostinil derivative, or a composition comprising the same, that is effective when administered via continuous intravenous or continuous subcutaneous infusion, or in a once-daily, twice-daily or three-times daily dosing regimen, for example, for the treatment of pulmonary arterial hypertension (PAH) or portopulmonary hypertension in a patient in need thereof. The prostacyclin compound provided herein, in one embodiment, can be administered less frequently than treprostinil, with equal or greater efficacy. Moreover, in one embodiment, the side effect profile of the compounds provided herein is less deleterious than the side effect profile resulting from treprostinil administration (via the same or a different administration method). These advantages, in one embodiment, allow for greater patient compliance. Treatment, in one embodiment, occurs through pulmonary administration of one of the compounds provided herein, for example via a nebulizer, dry powder inhaler, or a metered dose inhaler. In some embodiments, a composition comprising one of the compounds provided herein is administered via a nebulizer to a patient in need of PH treatment. In some embodiments a compound described herein is suspended in a propellant and delivered to a patient via a metered dose inhaler.
In one aspect of the invention described herein, a prostacyclin compound of Formula (I), or a pharmaceutically acceptable salt thereof, is provided:
wherein R1 is NH, O or S;
R2 is H, a linear C2-C18 alkyl, branched C3-C18 alkyl, linear C2-C18 alkenyl, branched C3-C18 alkenyl, aryl, aryl-C1-C18 alkyl; an amino acid or a peptide;
R3 is H, OH, optionally substituted linear or branched C1-C15 alkyoxy, O-optionally substituted linear or branched C2-C15 alkenyl, O—(C═O-optionally substituted linear or branched C1-C15 alkyl, or O—(C═O)-optionally substituted linear or branched C2-C15 alkenyl;
R4 is an optionally substituted linear or branched C1-C15 alkyl, or an optionally substituted linear or branched C2-C15 alkenyl; and
n is an integer from 0 to 5, with the proviso that the prostacyclin compound of Formula (I) is not treprostinil.
In a further embodiment, a prostacyclin compound of Formula (I) is provided, wherein R3 is OH and n is 0 or 1. In even a further embodiment, R4 is an optionally substituted linear or branched C1-C15 alkyl. In even a further embodiment, R1 is NH or O.
In one embodiment of Formula (I), where the compound is intended for continuous subcutaneous or continuous intravenous infusion, R2 is C2-C10 linear alkyl, e.g., C2-C8, e.g., C2, C3, C4, C5, C6, C7 or C8 linear alkyl. In a further embodiment, R, is NH, O or S; and n is 1.
In one embodiment, a prostacyclin compound of Formula (I) is provided, wherein R1 is NH, O or S; R2 is a linear C5-C18 alkyl, branched C5-C18 alkyl, linear C2-C18 alkenyl, branched C3-C18 alkenyl; R3 is H, OH or O-alkyl; R4 is an optionally substituted linear or branched C1-C15 alkyl, or an optionally substituted linear or branched C2-C15 alkenyl; and n is an integer from 0 to 5. In even a further embodiment, R, is NH or O and R2 is a linear C5-C18 alkyl or a branched C5-C18 alkyl. In even a further embodiment, R2 is a linear C13-C18 alkyl.
In one embodiment, R2 is aryl or aryl-C1-C18 alkyl; R3 is OH and n is 0 or 1. In even a further embodiment, R4 is an optionally substituted linear or branched C1-C15 alkyl.
In one embodiment, the present invention provides a prostacyclin compound of Formula (I), wherein the compound is a compound of one of Formulae (Ia), (Ib), (Ic) or (Id), or a pharmaceutically acceptable salt thereof:
wherein, R2 is H, a linear C2-C18 alkyl, branched C2-C18 alkyl, linear C2-C18 alkenyl, or a branched C3-C18 alkenyl;
R3 is H, OH, optionally substituted linear or branched C1-C18 alkyoxy, O-optionally substituted linear or branched C2-C15 alkenyl, —O(C═O)-optionally substituted linear or branched C1-C15 alkyl, or —O(C═O)-optionally substituted linear or branched C2-C15 alkenyl; and
R4 is
an optionally substituted linear or branched C1-C15 alkyl, or an optionally substituted linear or branched C2-C15 alkenyl, where R5 is H, optionally substituted linear or branched C1-C15 alkyl, optionally substituted linear or branched C2-C15 alkenyl, (C═O)-optionally substituted linear or branched C1-C15 alkyl, or (C═O)-optionally substituted linear or branched C2-C15 alkenyl. In a further embodiment, R4 is
with the proviso that the compound is not treprostinil, i.e., R2 and R5 cannot both be H.
In one embodiment of Formula (Ia), Formula (Ib), Formula (Ic) and Formula (Id), R2 is a linear or branched C5-C15 alkyl. In even a further embodiment. R2 is
where m1 and m2 are each independently an integer selected from 1 to 9 and each occurrence of R′ is independently H, a linear or branched C1-C8 alkyl, or a linear or branched C1-C8 alkenyl. In even a further embodiment. R2 is
and m1 and m2 are both 4. In another embodiment, R2 is
and m1 is 3 and m2 is 4, or m1 is 2 and m2 is 3.
When m1 and/or m2 is an integer from 2-9, the m1/m2 at the end of the carbon chain is CH3, while the remaining m1/m2 groups are CH2.
In one embodiment of Formula (Ia), Formula (Ib), Formula (Ic) and Formula (Id), R2 is
In a further embodiment, R3 is OH and R4 is
where R5 is H, optionally substituted linear or branched C1-C15 alkyl, optionally substituted linear or branched C2-C15 alkenyl, (C═O)-optionally substituted linear or branched C1-C15 alkyl, or (C═O)-optionally substituted linear or branched C2-C15 alkenyl.
In one embodiment of Formulae (Ia), (Ib), (Ic) or (Id), R2 is H, R3 is OH and R4 is
where m1 and m2 are each independently an integer selected from 1 to 9 and each occurrence of R′ is independently H, a linear or branched C1-C8 alkyl, or a linear or branched C1-C8 alkenyl. When m1 and/or m2 is an integer from 2-9, the m1/m2 at the end of the carbon chain is CH3, while the remaining m1/m2 groups are CH2.
In another embodiment, a prostacyclin compound of one of Formula (Ia), (Ib), (Ic) or (Id) is provided wherein R3 is OH, as provided in one of Formulae (Ia′), (Ib′), (Ic′) or (Id′):
wherein, R2 is H, a linear or branched C5-C18 alkyl, or a linear or branched C5-C18 alkenyl; and R4 is
an optionally substituted linear or branched C1-C15 alkyl, or an optionally substituted linear or branched C2-C15 alkenyl, wherein R5 is H, optionally substituted linear or branched C1-C15 alkyl, optionally substituted linear or branched C2-C15 alkenyl, (C═O)-optionally substituted linear or branched C1-C15 alkyl, or (C═O)-optionally substituted linear or branched C2-C15 alkenyl, with the proviso that R2 and R5 are not both H. In one embodiment of Formula (Ia′), Formula (Ib′), Formula (Ic′) and Formula (Id′), R4 is
where m1 and m2 are each independently an integer selected from 1 to 9 and each occurrence of R′ is independently H, a linear or branched C1-C8 alkyl, or a linear or branched C1-C8 alkenyl. In even a further embodiment, R2 is
Yet another embodiment of the invention relates to a prostacyclin compound of one of Formula (Ia″), (Ib″), (Ic″) or (Id″), or a pharmaceutically acceptable salt thereof:
wherein,
R2 is H, a linear or branched C5-C18 alkyl, linear C2-C18 alkenyl, branched C3-C18 alkenyl, aryl, aryl-C1-C18 alkyl: an amino acid or a peptide; and
R3 is H, OH, optionally substituted linear or branched C1-C15 alkyoxy, O-optionally substituted linear or branched C2-C15 alkenyl, O—(C═O)-optionally substituted linear or branched C1-C15 alkyl, or O—(C═O)-optionally substituted linear or branched C2-C15 alkenyl: and
R5 is H, optionally substituted linear or branched C1-C15 alkyl, optionally substituted linear or branched C2-C15 alkenyl, (C═O)-optionally substituted linear or branched C1-C15 alkyl, or (C═O)-optionally substituted linear or branched C2-C15 alkenyl, with the proviso that R2 and R5 are not both H. In a further embodiment, R3 is OH and R2 is 5-nonanyl, 4-heptyl, 4-octyl, 3-octyl, 2-dimethyl-1-propyl, 3,3-dimethyl-1-butyl, 2-ethyl-1-butyl, 3-pentyl, pentyl, hexyl, heptyl, octyl, nonyl, decyl, undecyl, dodecyl, tridecyl, tetradecyl, pentadecyl, hexadecyl, heptadecyl or octadecyl. In even a further embodiment, R2 is decyl, undecyl, dodecyl, tridecyl, tetradecyl, pentadecyl, hexadecyl, heptadecyl or octadecyl. In even a further embodiment, R2 is a linear alkyl.
One embodiment of the present invention is directed to compounds of Formula (Ic), (Ic′) and (Ic″). In a further embodiment, R2 is a linear C5-C18 alkyl or a branched C1-C18 alkyl. In even a further embodiment, R2 is a linear C6-C18 alkyl or a branched C5-C18 alkyl. In yet a further embodiment, R2 is a linear C6-C14 alkyl, e.g., a linear C6 alkyl, C8 alkyl, C10 alkyl, C12 alkyl or C14 alkyl.
In one embodiment, a compound of Formula (Ic″) is provided wherein R2 is a linear C5-C18 alkyl; R3 is OH and R5 is H. In another embodiment, a compound of Formula (Ic″) is provided wherein R2 is a linear C6-C18 alkyl; R3 is OH and R5 is H. In yet embodiment, a compound of Formula (Ic″) is provided wherein R2 is a linear C6-C16 alkyl; R3 is OH and R5 is H. In even another embodiment, a compound of Formula (Ic″) is provided wherein R2 is a linear C8-C14 alkyl; R3 is OH and R5 is OH.
In one embodiment, a compound of Formula (Ic″) is provided wherein R2 is a linear C5-C18 alkyl; R3 is OH and R5 is H. In another embodiment, a compound of Formula (Ic″) is provided wherein R, is a branched C6-C18 alkyl; R3 is OH and R5 is H. In yet embodiment, a compound of Formula (Ic″) is provided wherein R2 is a branched C6-C16 alkyl; R3 is OH and R5 is H. In even another embodiment, a compound of Formula (Ic″) is provided wherein R2 is a branched C1-C14 alkyl; R3 is OH and R5 is H.
In even a further embodiment, a compound of Formula (Ic), (Ic′) and (Ic″) is administered to a patient in need of PH treatment via a metered dose inhaler.
In yet another embodiment of Formula (Ia″), (Ib″), (Ic″) or (Id″), R3 is OH, R5 is H and R2 is
where m1 and m2 are each independently an integer selected from 1 to 9. In even a further embodiment, R2 is
In yet another embodiment of Formula (Ia″), (Ib″), (Ic″) or (Id″), R2 is H, R3 is OH, and R5 is
where m1 and m2 are each independently an integer selected from 1 to 9. In even a further embodiment, R2 is
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id) is provided where R2 is a linear or branched C5-C18 alkyl. In a further embodiment, R2 is 5-nonanyl, 4-heptanyl, 4-octanyl, 3-octanyl, 2-dimethyl-1-propanyl, 3,3-dimethyl-1-butanyl, 2-ethyl-1-butanyl, 3-pentanyl, pentyl, hexyl, heptyl, octyl, nonyl, decyl, undecyl, dodecyl, tridecyl, tetradecyl, pentadecyl, hexadecyl, heptadecyl or octadecyl.
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″) or (Id″) is provided where R2 is a linear or branched C5-C18 alkyl. In even a further embodiment, R2 is a linear C5-C18 alkyl. In another embodiment, R2 is
where m1 and m2 are each independently an integer selected from 1 to 9 and each occurrence of R′ is independently H, a linear or branched C1-C8 alkyl, or a linear or branched C1-C8 alkenyl. In even a further embodiment, R2 is
In another embodiment, a prostacyclin compound of Formula (I) (Ia), (Ib), (Ic) or (Id) is provided wherein R2 is a branched C5-C18 alkyl. In a further embodiment, R2 is 5-nonanyl, 4-heptyl, 4-octyl, 3-octyl, 2-dimethyl-1-propyl, 3,3-dimethyl-1-butyl, 2-ethyl-1-butyl, 3-pentyl, pentyl, hexyl, heptyl, octyl, nonyl, decyl, undecyl, dodecyl, tridecyl, tetradecyl, pentadecyl, hexadecyl, beptadecyl or octadecyl.
In one embodiment of the invention, the prostacyclin compound of the invention has the following structure:
wherein R1 is NH, O or S.
For example, R1 is O or N, and one of the following compounds (5-nonanyl treprostinil (alkyl ester, 5C9-TR) or 5-nonanyl treprostinil (amide linked; 5C9-TR-A), is provided:
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id) is provided wherein R2 is
where m1 and m2 are each independently each an integer selected from 1 to 9 and each occurrence of R′ is independently H, a linear or branched C1-C8 alkyl, or a linear or branched C1-C8 alkenyl.
When m1 and/or m2 is an integer from 2-9, the m1/m2 at the end of the carbon chain is CH3, while the remaining m1/m2 groups are CH2.
In even another embodiment, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″) or (Id″) is provided and R2 is
The compounds provided herein can include a symmetrical branched alkyl or an asymmetrical branched alkyl as the R2 moiety. For example, where R2 is
m1 and m2 can be the same integer and R2 is therefore a symmetrical branched alkyl. R2 is an assymetrical branched alkyl when m1 and m2 are different.
In another embodiment, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″) or (Id″) is provided, R2 is
m1 is 2 and m2 is 3, m1 and m2 are each independently 4, or m1 and m2 are each independently 3.
In another embodiment, the prostacyclin compound comprises an asymmetrical branched alkyl at the R2 position, such as, for example, 3-hexanyl (3C6), 2-heptanyl (2C7), 3-heptanyl (3C7), 2-octanyl (2C8), 3-octanyl (3C8), or 4-octanyl (4C8).
In another embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id) is provided wherein R2 is a branched alkyl selected from 2,2-diethyl-1-pentyl, 3-pentyl, 4-octyl, 5-nonanyl, 2-ethyl-1-butyl, 2-propyl-1-pentyl, 12-butyl-1-octyl, 2-dimethyl-1-propyl, and 3,3-dimethyl-1-butyl.
In another embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′) or (Id′) is provided, wherein, R2 is a linear or branched C5-C18 alkenyl. For example, in one embodiment, R2 is a linear C5-C18 alkenyl selected from pentenyl, hexenyl, heptenyl, octenyl, nonenyl, decenyl, undecenyl, tridecenyl, tetradecenyl, pentadecenyl, hexadecenyl, heptadecenyl or octadecenyl. In a further embodiment, R5 is OH. In another embodiment, R2 is a branched C5-C18 alkenyl selected from pentenyl, hexenyl, heptenyl, octenyl, nonenyl, decenyl, undecenyl, tridecenyl, tetradecenyl, pentadecenyl, hexadecenyl, heptadecenyl or octadecenyl. In a further embodiment, R3 is OH.
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id) is provided and R4 is
In a further embodiment, R4 is
In one embodiment, a prostacyclin compound of Formula (I), (a), (Ib) (Ic) or (Id) is provided and R2 a linear C5-C8 alkyl, R3 is OH and R4 is
In a further embodiment, R2 is 5-nonanyl, 4-heptyl, 4-octanyl, 3-octanyl, 2-dimethyl-1-propyl, 3,3-dimethyl-1-butyl, 2-ethyl-1-butyl, 3-pentyl, pentyl, hexyl, heptyl, octyl, nonyl, decyl, undecyl, dodecyl, tridecyl, tetradecyl, pentadecyl, hexadecyl, heptadecyl or octadecyl.
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib, (Ic) or (Id) is provided and R2 hexyl, dodecyl, tetradecyl, hexadecyl, 5-nonanyl, 4-heptanyl, 4-octanyl, 3-octanyl, 2-dimethyl-1-propyl, 3,3-dimethyl-1-butyl, 2-ethyl-1-butyl, 3-pentyl, R3 is OH and R4 is
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id) is provided and R2 hexyl, R3 is OH and R4 is
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id) is provided and R2 hexyl, R3 is OH and R4 is
In another embodiment, a prostacyclin compound of Formula (Ia″), (Ib″), (Ic″) or (Id″) is provided and R2 hexyl, R3 is OH R4 is H. In a further embodiment, the compound is a compound of Formula (Ic″). In yet another embodiment, a prostacyclin compound of Formula (Ia″), (Ib″), (Ic″) or (Id″) is provided and R2 dodecyl, tetradecyl, pentadecyl or hexadecyl, R3 is OH R4 is H. In a further embodiment, the compound is a compound of Formula (Ia″). In even a further embodiment, the compound is present in a lipid nanoparticle formulation as described in more detail below.
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 heptyl, R3 is OH and R is
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 octyl, R3 is OH and R4 is
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 nonyl, R3 is OH and R4 is
In another embodiment, a prostacyclin compound of Formula (I), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 decyl, R3 is OH and R4 is
In yet another embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 undecyl, R3 is OH and R4 is
In even another embodiment, a prostacyclin compound of Formula (I), (a), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 dodecyl, R3 is OH and R4 is
In one embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 tridecyl, R3 is OH and R4 is
In another embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), or Id or pharmaceutically acceptable salt, is provided, and R2 tetradecyl, R3 is OH and R4 is
In even another embodiment, a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or pharmaceutically acceptable salt, is provided, and R2 pentadecyl, R, is OH and R4
Another embodiment of the invention concerns a prostacyclin compound of Formula (I), (Ia) (Ib), (Ic) or (Id), aor pharmaceutically acceptable salt, wherein R2 hexadecyl, R3 is OH and R4 is
Yet another embodiment of the invention concerns a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), a or pharmaceutically acceptable salt, wherein R2 heptadecyl, R3 is OH and R4 is
Yet another embodiment of the invention concerns a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or a pharmaceutically acceptable salt, wherein R2 octadecyl, R3 is OH and R4 is
In one embodiment, a compound of Formula (I), (Ia), (Ib), (Ic) or (Id), or a pharmaceutically acceptable salt, is provided, wherein one or more hydrogen atoms is substituted with a deuterium. Accordingly, in one embodiment, the present invention relates to an isotopologue of Formula (I), (Ia) (Ib), (Ic) or (Id), substituted with one or more deuterium atoms. The isotopologue of Formula (I), (Ia), (Ib) (Ic) or (Id) may be used to accurately determine the concentration of compounds of Formula (I), (Ia) (Ib), (Ic) or (Id) in biological fluids and to determine metabolic patterns of compounds of Formula (I), (Ia), (Ib), (Ic) or (Id) and its isotopologues. The invention further provides compositions comprising these deuterated isotopologues and methods of treating diseases and conditions, as set forth herein.
In another aspect of the invention, a prostacyclin compound of Formula (II), or a pharmaceutically acceptable salt thereof, is provided:
wherein R1 is NH, O or S; R2 is a linear C2-C18 alkyl, branched C3-C18 alkyl, linear C2-C18 alkenyl or a branched C3-C18 alkenyl, aryl, aryl-C1-C18 alkyl, an amino acid or a peptide; and n is an integer from 0 to 5.
In one embodiment, a prostacyclin compound of Formula (II), or a pharmaceutically acceptable salt thereof, is provided, wherein R1 is NH, O or S; R2 is a linear or branched C5-C18 alkyl, a linear C2-C18 alkenyl or a branched C3-C18 alkenyl; and n is an integer from 0 to 5. In a further embodiment, n is 1 and R1 is NH or O.
In another embodiment, a prostacyclin compound of Formula (II), or a pharmaceutically acceptable salt thereof, is provided, wherein R1 is NH, O or S; n is 1 and R2 is a linear C2-C18 alkyl. In a further embodiment, R2 is a linear C2-C10 alkyl. e.g., a linear C2-C8 alkyl, n is 1. In a further embodiment, the compound is administered to a patient in need of treatment of PAH via continuous subcutaneous infusion.
In one embodiment, the present invention relates to the prostacyclin compound of Formula (II), wherein the compound is a compound of formula (IIa), (IIb), (IIc) or (IId), or a pharmaceutically acceptable saltthereof:
wherein R2 is a linear C2-C18 alkyl, branched C2-C18 alkyl, a linear C2-C18 alkenyl or a branched C3-C18 alkenyl, aryl, aryl-C1-C18 alkyl, an amino acid or a peptide. In a further embodiment, a compound of formula (IIa), (IIb), (IIc) or (IId) is provided wherein R2 is a linear or branched C5-C18 alkyl, a linear C2-C18 alkenyl or a branched C3-C18 alkenyl. In one embodiment, a compound of Formula (II), (IIa), (IIb), (IIc) or (IId) is provided, wherein one or more hydrogen atoms is substituted with a deuterium. Accordingly, in one embodiment, the present invention relates to an isotopologue of Formula (II), (IIa), (IIb), (IIc) or (IId), substituted with one or more deuterium atoms. The isotopologue of Formula (II), (IIa), (IIb), (IIc) or (IId) may be used to accurately determine the concentration of compounds of Formula (II), (IIa), (IIb), (IIc) or (IId) in biological fluids and to determine metabolic patterns of compounds of Formula (II), (IIa), (IIb), (IIc) or (IId) and its isotopologues. The invention further provides compositions comprising these deuterated isotopologues and methods of treating diseases and conditions, as set forth herein.
In one embodiment, the prostacyclin derivative is a compound of Formula (IIc). In a further embodiment, R2 is a linear C5-C18 alkyl or a branched C5-C8 alkyl. For example, in one embodiment, R2 is a linear C6-C18 alkyl. In another embodiment of Formula (IIc), R2 is a linear C6-C10 alkyl. In even a further embodiment of Formula (IIc), R2 is a hexyl, heptyl or octyl.
Compounds of Formula (IIa) and Formula (IId) are provided in tables A and B below. Table C provides compounds of Formula (IIa) intended to be delivered to a patient in need of PAH treatment via continuous intravenous infusion or continuous subcutaneous infusion, e.g., via an intravenous infusion pump through a central venous catheter or a subcutaneous infusion pump.
Yet another embodiment of the invention relates to a prostacyclin compound of Formula (III), or a pharmaceutically acceptable salt thereof:
wherein R1 and R2 are defined as provided for Formula (I) and (II), and
R5 and R6 are independently selected from H, optionally substituted linear or branched C1-C15 alkyl, optionally substituted linear or branched C2-C15 alkenyl, (C═O)-optionally substituted linear or branched C1-C15 alkyl, or (C═O)-optionally substituted linear or branched C2-C15 alkenyl, with the proviso that the prostacyclin compound of Formula (III) is not treprostinil.
In one embodiment, the branched chain prostacyclin compounds provided herein exhibit both higher solubility and slower enzymatic conversion to treprostinil relative to a linear chain derivatized prostacyclin compound. In one embodiment, an asymmetrical branched chain prostacyclin compound is provided, wherein the asymmetrical branched chain prostacyclin compound is more stable than a corresponding symmetrical branched chain prostacyclin compound.
In one embodiment, the present invention provides prostacyclin compounds that contain a chiral moiety at one or more of the R2, R5 and/or R6 positions. For example, the moiety at position R2, in one embodiment, is a chiral moiety and comprises either the R isomer, the S isomer, or a mixture thereof. An optical isomer at position R2, R5 and/or R6 can also be classified with the D/L nomenclature. For example, where R2 is an amino acid or an amino acid moiety, the amino acid or amino acid moiety can be the D-isomer, L-isomer, or a mixture thereof.
In one embodiment, one or more of the R2, R5 and/or R6 moieties is the R isomer or S isomer. In another embodiment, one or more of the R2, R5 and/or R6 moieties provided herein comprise a mixture of R and S moieties. The “R isomer” or “S isomer” as used herein refers to an enantiomerically pure isomer. An “enantiomerically pure isomer” has at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% pure R- or S-isomer or when using the D/L nomenclature, D- or L-isomer. A racemic compound is a compound having a mixture in equal amounts of both enantiomers.
The treprostinil derivatives of the formulae provided above can be made by methods known to those of ordinary skill in the art. For example, a treprostinil derivative (e.g., alkyl ester derivative) of the formula
in one embodiment is esterified by mixing the appropriate alcohol (i.e., R2—OH where the R2 is a linear or branched C5-C18 alkyl, a linear C2-C18 alkenyl or a branched C3-C18 alkenyl) with treprostinil or a compound of the formula
in the presence of an acid catalyst. As provided throughout R3 is H, OH, optionally substituted linear or branched C1-C15 alkyoxy, O-optionally substituted linear or branched C2-C15 alkenyl, O—(C═O)-optionally substituted linear or branched C1-C15 alkyl, or O—(C═O)-optionally substituted linear or branched C2-C15 alkenyl; R4 is an optionally substituted linear or branched C1-C18 alkyl, or an optionally substituted linear or branched C2-C15, alkenyl; and n is an integer from 0 to 5. It will be appreciated by one of ordinary skill in the art that the purity of the final product will depend in part on the purity of the reagants employed in the esterification reaction, and/or the cleanup procedure after the reaction has completed. For example, a high purity alcohol will give a higher purity treprostinil ester derivative than a lower purity alcohol. Similarly, a higher purity product is obtained through clean-up procedures such as HPLC, diafiltration, etc.
The acid catalyst in one embodiment is a resin or in some other solid form. However, in other embodiment, the acid catalyst is in liquid form. The acid catalyst in one embodiment is sulfuric acid or sulfonic acid. Other acid catalysts (in solid, e.g., a resin, or liquid form) include but are not limited to hydrofluoric acid, phosphoric acid, toluenesulfonic acid, polystyrene solfonate, hyeteropoly acid, zeolites, metal oxides, and graphene oxygene.
Acid catalyst resins, e.g., sulfonic acid resin catalysts are available commercially, e.g., from Sigma-Aldrich, under the trade name AMBERLYST. Other resins are available commercially, e.g., from Purolite®, and are amenable for use with the methods described herein.
In some embodiments, the treprostinil or the treprostinil compound of the formula
(where R3, R4 and n are defined above) and/or alcohol R2—OH is dissolved in a solvent prior to the esterification reaction. For example, in one embodiment, where treprostinil is esterified with an alkyl group having 12 carbon atoms or more, treprostinil is first dissolved in a solvent such as dioxane prior to the esterification reaction. Other solvents besides dioxane, or in combination with dioxane can also be used. For example, acetonitrile (MeCN), N,N′-dimethylformamide (DMF), dichloromethane (DCM), or a combination thereof can be used. Various examples of solvents are provided in the table below.
Carboxylic acid esterification reactions other than the ones described above are known to those of ordinary skill in the art and are amenable for use in manufacturing the treprostinil alkyl esters described herein. For example, the Mitsunobu reaction can be used, where a mixture of triphenylphosphine (PPh3) and diisoprpyl azodicarboxylate (DIAD or its diethyl analogue, DEAD) convert an alcohol and carboxylic acid to the ester. In this reaction, the DIAD is reduced as it serves as the hydrogen acceptor, and the PPh3 is oxidized to OPPh.
In yet anotherembodiment, N, N′-dicyclohexylcarbodiimide (DCC) or N, N′-diisopropylcarbodiimide (DIC) is used in combination with 4-dimethylaminopyridine (DMAP) in an esterification reaction (sometimes referred to as Steglich esterification). In this reaction, DCC or DIC and the carboxylic acid (treprostinil or its non-esterified derivative) are able to form an O-acylisourea activated carboxylic acid intermediate. The alcohol is added to the activated compound to form the stable dicyclohexylurea and the ester. In one embodiment, the treprostinil or its non-esterified derivative is first dissolved in solvent, e.g., one of the solvents described above, prior to performing the Steglich esterification.
Other esterification reactions can be employed. For example, 1-[Bis (dimethylamino) methylene]-1H-1,2,3-triazolo[4,5-b] pyridinium 3-oxid hexafluorophosphate (HATU) or benzotriazol-1-yl-oytripyrrolidinophosphonium hexafluorophosphate (PyBOP) can be used as a coupling reagent. These reagants can be used with or without an additive to facilitate the coupling. For example, triethylamine (TEA) can be used in some embodiments in conjunction with either HATU orPyBOP to form a treprostinil alkyl ester. As with the other esterification reactions described herein, the treprostinil or non-esterified treprostinil derivative can first be dissolved in solvent prior to performing the esterification reaction.
Treprostinil amide derivatives (e.g., of the formula:
can be manufactured according to well known protocols of amide functionalization of a carboxylic acid group. For example, treprostinil (or a compound of the formula
(for example, dissolved in dioxane) is combined with HATU or PyBOP and alkylamine R2—NH2 R2, R3, R4 and n are defined above.
Other reaction conditions for forming treprostinil amide derivatives with alkylamine R2—NH2, are provided below.
In another aspect of the invention, the prostacyclin compound described herein is provided in a composition, for example, for delivery to a patient for the treatment of pulmonary hypertension (PH). Compositions can include the compound, a pharmaceutically acceptable salt of the compound, or a combination thereof. In one embodiment, the PH is pulmonary arterial hypertension (PAH). Prostacyclin compositions (so called “lipid nanoparticle compositions”) and formulations comprising a prostacyclin, a cationic compound, and a surfactant have been described in PCT publication no. WO 2014/085813, the disclosure of which is hereby incorporated by reference in its entirety for all purposes. The compositions described in WO 2014/085813 are amenable for use with the prostacyclin derivative compounds provided herein.
In one embodiment, the composition comprises one of the prostacyclin compounds described herein, i.e., a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), and an amphiphilic agent. When formulated together, in one embodiment, the prostacyclin compound and amphiphilic agent form micro- or nanoparticles. In one embodiment, the amphiphilic agent is a PEGylated lipid, a surfactant or a block copolymer. In another embodiment, the prostacyclin composition provided herein comprises two or more of the prostacyclin compounds described herein (e.g., a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb) (IIc) (IId), or (III), including deuterated compounds) and an amphiphilic agent (e.g., PEGylated lipid, a lipid, a surfactant or a block copolymer). In one embodiment, the prostacyclin composition comprising the prostacyclin compound component and amphiphilic agent, when formulated together, comprise a plurality of nanoparticles. In a further embodiment, the mean diameter of the plurality of nanoparticles is from about 20 nm to about 700 nm, for example about 50 nm to about 500 nm, about 100 nm to about 600 nm or about 100 nm to about 500 nm. When the amphiphilic agent comprises a lipid, e.g., a PEGylated lipid such as Cholesterol-PEG or distearoylphosphatidylethanolamine-PEG (DSPE-PEG), the composition is described as comprising lipid nanoparticles.
In a further embodiment, the prostacyclin composition comprises a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), and a PEGylated lipid as the amphilphilic agent. In a further embodiment, the PEGylated lipid comprises PEG400-PEG5000. For example, in one embodiment, the PEGylated lipid comprises PEG400, PEG500, PEG1000, PEG2000, PEG3000, PEG4000, or PEG5000. In a further embodiment the lipid component of the PEGylated lipid comprises cholesterol, dimyristoyl phosphatidylethanolamine (DMPE), dipalmitoyl phosphoethanolamine (DPPE), distearoylphosphatidylethanolamine (DSPE), dimyristoylglycerol glycerol (DMG) diphosphatidylglycerol (DPG) or disteraroylglycerol (DSG). In even a further embodiment, the PEGylated lipid is cholesterol-PEG2000 or DSPE-PEG2000.
Depending on its molecular weight (MW), PEG is also referred to in the art as polyethylene oxide (PEO) or polyoxyethylene (POE). The PEGylated lipid can include a branched or unbranched PEG molecule, and is not limited by a particular PEG MW.
For example, the PEGylated lipid, in one embodiment, comprises a PEG molecule having a molecular weight of 300 g/mol, 400 g/mol, 500 g/mol, 1000 g/mol, 1500 g/mol, 2000 g/mol, 2500 g/mol, 3000 g/mol, 3500 g/mol, 4000 g/mol, 4500 g/mol, 5000 g/mol or 10,000 g/mol. In one embodiment, the PEG has a MW of 1000 g/mol or 2000 g/mol.
The lipid component of the PEGylated lipid, can have a net-charge (e.g., cationic or anionic), or can be net-neutral. The lipids used in the PEGylated lipid component of the present invention can be synthetic, semi-synthetic or naturally-occurring lipid, including a phospholipid, a sphingolipid, a glycolipid, a ceramide, a tocopherol, a sterol, a fatty acid, or a glycoprotein such as albumin. In one embodiment, the lipid is a sterol. In a further embodiment, the sterol is cholesterol. In another embodiment, the lipid is a phospholipid. Phospholipids include, but are not limited to phosphatidylcholine (PC), phosphatidylglycerol (PG), phosphatidylinositol (PI), phosphatidylserine (PS), phosphatidylethanolamine (PE), and phosphatidic acid (PA). In one embodiment, the phospholipid is an egg phospholipid, a soya phospholipid or a hydrogenated egg and soya phospholipid. In one embodiment, the PEGylated lipid comprises a phospholipid. In a further embodiment, the phospholipid comprises ester linkages of fatty acids in the 2 and 3 of glycerol positions containing chains of 12 to 26 carbon atoms and different head groups in the 1 position of glycerol that include choline, glycerol, inositol, serine, ethanolamine, as well as the corresponding phosphatidic acids. The chains on these fatty acids can be saturated or unsaturated, and the phospholipid can be made up of fatty acids of different chain lengths and different degrees of unsaturation. In particular, in one embodiment, the PEGylated lipid of the prostacyclin composition provided herein comprises distearoylphosphoethanolamine (DSPE), dipalmitoylphosphatidylcholine (DPPC), dioleoylphosphatidylcholine (DOPC) dimyristoyl phosphatidylethanolamine (DMPE), dipalmitoylphosphoethanolamine (DPPE), distearoylphosphatidylethanolamine (DSPE), dimyristoylglycerol (DMG), diphosphatidylglycerol (DPG) or disteraroylglycerol (DSG).
Other examples of lipids for use in the compositions comprising PEGylated lipids disclosed herein include dimyristoylphosphatidylcholine (DMPC), dimyristoyiphosphatidylglycerol (DMPG), dipalmitoylphosphatidylglycerol (DPPG), distearoylphosphatidylcholine (DSPC), distearoylphosphatidylglycerol (DSPG) dioleylphosphatidylethanolamine (DOPE), and mixed phospholipids such as palmitoylstearoylphosphatidylcholine (PSPC) and palmitoylstearoylphosphatidylglycerol (PSPG), triacylglycerol, diacylglycerol, ceramide, sphingosine, sphingomyelin and single acylated phospholipids such as mono-oleoyl-phosphatidylethanolamine (MOPE). In another embodiment lipid portion of the PEGylated lipid comprises an ammonium salt of a fatty acid, a phospholipid, a glyceride, a phospholipid and glyceride, a sterol (e.g., cholesterol), phosphatidylglycerol (PG), phosphatidic acid (PA), a phosphotidylcholine (PC), a phosphatidylinositol (PI), a phosphatidylserine (PS), or a combination thereof. The fatty acid, in one embodiment, comprises fatty acids of carbon chain lengths of 12 to 26 carbon atoms that are either saturated or unsaturated. Some specific examples include: myristylamine, palmitylamine, laurylamine and stearylamine, dilauroyl ethylphosphocholine (DLEP), dimyristoyl ethylphosphocholine (DMEP), dipalmitoyl ethylphosphocholine (DPEP) and distearoyl ethylphosphocholine (DSEP), N-(2,3-di-9(Z)-octdecenyloxy)-prop-1-yl-N,N,N-trimethylammonium chloride (DOTMA) and 1,2-bis(oleoyloxy)-3-(trimethylammonio)propane (DOTAP). Examples of sterols for use in the compositions provided herein include cholesterol and ergosterol. Examples of PGs, PAs, PIs, PCs and PSs for use in the compositions provided herein include DMPG, DPPG, DSPG, DMPA, DPPA, DSPA, DMPI, DPPI, DSPI, DMPS, DPPS and DSPS, DSPC, DPPG, DMPC, DOPC, egg PC and soya PC.
In one embodiment, the PEGylated lipid is cholesterol-PEG2000, DSPE-PEG 1000 or DSG-PEG2000.
In another embodiment, the prostacyclin composition provided herein comprises a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), and a hydrophobic additive. In a further embodiment, the composition comprises an amphiphilic agent, e.g., a PEGylated lipid, as described above.
In yet another embodiment, two or more of the prostacyclin compounds described herein (e.g., a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III) an amphiphilic agent (e.g., PEGylated lipid, a lipid, a surfactant or a block copolymer) and a hydrophobic additive are provided in a composition.
In one embodiment, the prostacyclin composition comprises a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId) or (III) and a PEGylated lipid. In another embodiment, the prostacyclin composition comprises a prostacyclin compound of Formula (I), (Ia) (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″) (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III) and a surfactant. In yet another embodiment, the prostacyclin composition comprises a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), a hydrophobic additive and an amphiphilic agent. In a further embodiment, the amphiphilic agent is a surfactant, a PEGylated lipid or a block copolymer. In even a further embodiment, the amphiphilic agent is a PEGylated lipid.
In one embodiment, the prostacyclin compound is present in the composition at 5 mol %-99 mol %. In a further embodiment, the prostacyclin compound is present in the composition at 40 mol %-95 mol %. In a further embodiment, the prostacyclin compound is present in the composition at 40 mol %-60 mol %. In one embodiment, the prostacyclin compound is present in the composition at about 40 mol % or about 45 mol %.
The amphiphilic agent, e.g., a PEGylated lipid, when present in the composition, in one embodiment, is present at 10 mol %-30 mol %, for example, 10 mol %-20 mol % or 15 mol %-25 mol %. In even a further embodiment, the PEGylated lipid is present in the composition at about 10 mol % or 20 mol %.
The hydrophobic additive, when present in the composition, in one embodiment, is present in the composition at 25 mol %-50 mol %, for example, 30 mol %-50 mol %, 35 mol %-45 mol %. In even a further embodiment, the hydrophobic additive is present in the composition at about 40 mol % or about 45 mol %.
The prostacyclin composition, in one embodiment, comprises a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (Id), or (III), or a pharmaceutically acceptable salt thereof, as described herein, an amphilphilic agent and a hydrophobic additive. In one embodiment, the hydrophobic additive (e.g., an additive that is at least partially hydrophobic) is a hydrocarbon, a terpene compound or a hydrophobic lipid (e.g., tocopherol, tocopherol acetate, sterol, sterol ester, alkyl ester, vitamin A acetate, a triglyceride, a phospholipid). In one embodiment, the composition comprises a prostacyclin compound, for example, a compound of Formula (I) or (II), an amphiphilic agent, and a hydrocarbon. The hydrocarbon can be aromatic, an alkane, alkene, cycloalkane or an alkyne. In one embodiment, the hydrocarbon is an alkane (i.e., a saturated hydrocarbon). In another embodiment, the hydrocarbon is a C15-C50 hydrocarbon. In a further embodiment, the hydrocarbon is a C15, C20, C25, C30, C35, C40, C45 or C50 hydrocarbon. In yet another embodiment, the hydrophobic additive is a C15-C25 hydrocarbon, C15-C35 hydrocarbon, C15-C45 hydrocarbon, C15-C20 hydrocarbon, C20-C23 hydrocarbon, C25-C30 hydrocarbon, C30-C35 hydrocarbon, C35-C40 hydrocarbon, C40-C45 hydrocarbon or a C45-C50 hydrocarbon.
In one embodiment, a composition comprising a prostacyclin compound, an amphiphilic agent and a terpene compound (e.g., the hydrophobic additive) is provided. The composition, in a further embodiment, comprises a PEGylated lipid as the amphiphilic agent. However, as noted above, block copolymers as well as surfactants can be used as the amphiphilic component of the composition. The terpene compound (hydrophobic additive), in one embodiment, is a hydrocarbon (e.g., isoprene, squalaneor squalene). In another embodiment, the terpene compound is a hemiterpene (C5H8), monoterpene (C10H16), sesquiterpene (C15H24), diterpene (C20H32) (e.g., cafestol, kahweol, cembrene, taxadiene), sesterterpene (C25H40) triterpene (C30H48), sesquaterpene (C35H56), tetraterpene (C40H64), polyterpene (e.g., a polyisoprene with trans double bonds) or a norisoprenoid (e.g., 3-oxo-α-ionol, 7,8-dihydroionone derivatives). The terpene compound, in another embodiment, is selected from one of the compounds provided in Table 1, below. In one embodiment, the hydrophobic additive is squalane.
As provided above, the composition provided herein, in one embodiment, comprises a prostacyclin compound and one or more PEGylated lipids. In a further embodiment, the composition comprises a hydrophobic additive, as described above. In one embodiment, the composition provided herein comprises a prostacyclin compound of one of Formula (I), (Ia), (Ib), (Ic) (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), a hydrophobic additive and a PEGylated lipid. In a further embodiment, the hydrophobic additive comprises a hydrocarbon e.g. a terpene compound.
In one embodiment, the treprostinil derivative composition provided herein includes the components provided in Table D, below.
The present invention also provides methods for treating a patient in need thereof, with one of the prostacyclin compounds or compositions described herein. It is understood that reference to a prostacyclin compound in a treatment method includes the use of a pharmaceutically acceptable salt of the compound. Similarly, administration of a prostacyclin composition comprising a prostacyclin compound includes the use of a pharmaceutically acceptable salt in the composition.
In one aspect, a method for treating pulmonary hypertension (PH) is provided. The method comprises, in one embodiment, administration of a compound, pharmaceutically acceptable salt thereof, or composition provided herein to a patient in need thereof. Administration, in one embodiment, is pulmonary administration and can be, for example, with a metered dose inhaler (MDI), dry powder inhaled (DPI), or a nebulizer. The World Health Organization (WHO) has classified PH into five groups. WHO Group I PH includes pulmonary arterial hypertension (PAH), idiopathic pulmonary arterial hypertension (IPAH), familial pulmonary arterial hypertension (FPAH), and pulmonary arterial hypertension associated with other diseases (APAH). For example, pulmonary arterial hypertension associated with collagen vascular disease (e.g., scleroderma) congenital shunts between the systemic and pulmonary circulation, portal hypertension and/or HIV infection are included in group I PH. The methods provided herein, in one embodiment, are provided to treat a WHO Group I PH patient in need thereof, for example a PAH patient, an IPAH patient, a FPAH patient or an APAH patient. Administration, in one embodiment, is via continuous subcutaneous or continuous intravenous infusion, e.g., with an infusion pump.
WHO Group II PH includes pulmonary hypertension associated with left heart disease, e.g., atrial or ventricular disease, or valvular disease (e.g., mitral stenosis). The methods provided herein, in one embodiment, are provided to treat a WHO Group II patient in need thereof. WHO group III pulmonary hypertension is characterized as pulmonary hypertension associated with lung diseasea, e.g., chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and/or hypoxemia. The methods provided herein, in one embodiment, are provided to treat a WHO Group II patient in need thereof. WHO Group IV pulmonary hypertension is pulmonary hypertension due to chronic thrombotic and/or embolic disease. Group IV PH is also referred to as chronic thromboembolic pulmonary hypertension. Group IV PH patients experience blocked or narrowed blood vessels due to blood clots. The methods provided herein, in one embodiment, are provided to treat a WHO Group IV patient in need thereof. Administration to a WHO Group IV patient, in one embodiment, is via continuous subcutaneous or continuous intravenous infusion, e.g., with an infusion pump.
WHO categorizes Group V PH as the “miscellaneous” category, and includes PH caused by blood disorders (e.g., polycythemia vera, essential thrombocythemia), systemic disorders (e.g., sarcoidosis, vasculitis) and/or metabolic disorders (e.g., thyroid disease, glycogen storage disease). The methods provided herein, in one embodiment, are provided to treat a WHO Group V patient in need thereof. Administration to a WHO Group V patient, in one embodiment, is via continuous subcutaneous or continuous intravenous infusion, e.g., with an infusion pump.
The methods provided herein can be used to treat a WHO Group I (i.e., pulmonary arterial hypertension or PAH), Group II, Group III, Group IV or Group V PH patient, for example, by inhalation delivery or continuous subcutaneous or continuous intravenous infusion. In one embodiment of the method for treating PH, a method of treating pulmonary arterial hypertension (PAH) is provided. In another embodiment, a method for treating chronic thromboembolic pulmonary hypertension patient is provided. In one embodiment, the method for treating PH (e.g., PAH) comprises administering an effective amount of one of the compounds described herein via a pulmonary (inhalation, e.g., via an MDI or nebulizer or dry powder inhaler), a subcutaneous (e.g., via an infusion pump), oral, nasal or an intravenous (e.g., via an infusion pump) route of administration, to a patient in need thereof. In one embodiment, administration is via inhalation via an MDI or nebulizer. In one embodiment, where compound delivery is via a nebulizer, the compound is provided to the patient as a composition, for example, as a lipid nanoparticle composition, as described above.
In another aspect of the invention, a method for treating portopulmonary hypertension (PPH) is provided. In one embodiment, the method comprises administering an effective amount of one of the compounds described herein (or a pharmaceutically acceptable salt thereof), via a pulmonary (inhalation), a subcutaneous, oral, nasal or an intravenous route of administration, to a patient in need thereof. In one embodiment, administration is via inhalation via an MDI or nebulizer. In one embodiment, where compound delivery is via a nebulizer, the compound is provided to the patient as a composition, for example, as a lipid nanoparticle composition, as described above. In another embodiment, administration to a PPH patient in need of treatment comprises continuous subcutaneous or continuous intravenous infusion, e.g., with an infusion pump.
Methods for administering treprostinil and analogs thereof for treatment of pulmonary hypertension have been described in U.S. Pat. Nos. 5,153,222, 6,521,212; 7,544,713 and U.S. Patent Application Publication No. 2010/0076083, the disclosure of each are incorporated by reference in their entireties for all purposes.
The method for treating a patient for PH (e.g., PAH) or PPH comprises, in one embodiment, administering to a patient in need thereof, one of the prostacyclin compounds or compositions provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″) (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), a pharmaceutically acceptable salt thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a pharmaceutically acceptable salt thereof. In one embodiment, the method for treating PH (e.g., PAH) or PPH comprises administering to a patient in need thereof, one of the prostacyclin compounds or compositions provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″) (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III). Routes of administration to the patient include pulmonary (inhalation), subcutaneous, oral, nasal and intravenous. In one embodiment, administration of a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a pharmaceutically acceptable salt thereof, is via inhalation via an MDI or nebulizer. In one embodiment, where compound delivery is via a nebulizer, the compound is provided to the patient as a composition, for example, as a lipid nanoparticle composition, as described above. In one embodiment, administration of one of the prostacydin compounds or compositions provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), a pharmaceutically acceptable salt thereof is via continuous subcutaneous or continuous intravenous infusion, e.g., with an infusion pump.
In one embodiment, the method for treating PH, PAH or PPH comprises administering to a patient in need thereof, an effective amount of the prostacyclin compound or prostacyclin composition described herein. In a further embodiment, the compound, or a pharmaceutically acceptable salt of the compound, is administered to the patient via a pulmonary (inhalation), a subcutaneous, oral, nasal or an intravenous route of administration. In a further embodiment, administration is via inhalation and the prostacyclin compound or composition is administered with a nebulizer, dry powder inhaler, or MDI. In even a further embodiment the prostacyclin composition or composition comprises a prostacyclin compound of Formula (I), (Ia), (Ib), (Ic) (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″) (II), (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof or a pharmaceutically acceptable salt of the compound.
In one embodiment, administration of an effective amount of a prostacyclin compound or composition of the present invention for the treatment of PH, PAH or PPH via inhalation, oral, nasal, subcutaneous or intravenous administration results in a decreased number of side effects, or a reduced severity of one or more side effects (also referred to herein as “adverse events”), compared to the administration of an effective amount of treprostinil, when an effective amount of treprostinil is administered via inhalation, oral, nasal, subcutaneous, or intravenous administration. For example, in one embodiment, a PH, PAH or PPH patient experiences a reduced severity and/or frequency in cough or a reduced cough response when administered a prostacylin compound or composition of the invention via inhalation (e.g., nebulization, dry powder inhaler, or via a metered dose inhaler), compared to the severity and/or frequency of cough or cough response elicited by inhalation administration of treprostinil to the patient. In one embodiment, where administration is via continuous subcutaneous infusion, the PH. PAH or PPH patient experiences a reduced infusion site pain or infusion reaction, compared to the infusion site pain or infusion reaction as compared to a PH, PAH or PPH patient administered treprostinil via continuous subcutaneous infusion.
In another embodiment, oral, nasal, intravenous, subcutaneous or inhalation administration of an effective amount of the prostacyclin compound or composition of the invention, compared to oral, nasal, subcutaneous, intravenous or inhalation administration of treprostinil, results in a reduced severity of one or more of the following adverse events, or a decreased occurrence of one or more of the following adverse events: headache, throat irritation/pharyngolaryngeal pain, nausea, flushing and/or syncope, diarrhea, jaw pain, vasodialation, edema and/or hypotension, as compared to administration of treprostinil. In a further embodiment, administration is via continuous subcutaneous infusion and the adverse event is headache, diarrhea, nausea, jaw pain, vasodialation, edema or hypotension. In even a further embodiment, the prostacyclin compound of the invention is a C2-C10 alkyl ester of treprostinil.
In another embodiment, oral, nasal, intravenous, subcutaneous or inhalation administration of an effective amount of the prostacyclin compound or composition of the invention, for the treatment of PH, PAH or PPH, compared to oral, nasal, subcutaneous, intravenous or inhalation administration of treprostinil, results in a reduced severity of a systemic adverse events, or a decreased occurrence of a systemic adverse event, as compared to the systemic adverse events experienced by a patient administered treprostinil via the same administration route.
Without wishing to be bound by theory, it is believed that the improved adverse event profile of the prostacylin compounds and compositions of the invention exhibited patients, as compared to treprostinil, results in improved compliance of the patients.
In one embodiment, the prostacyclin compounds and compositions of the present invention are administered on a less frequent basis, as compared to currently approved therapies for PH, PAH (e.g., Tyvaso®, Remodulin®) or PPH, while still achieving a substantially equivalent or better therapeutic response. Routes of administration to the patient include pulmonary (inhalation), subcutaneous (e.g., continuous subcutaneous infusion via an infusion pump) oral, nasal and intravenous (e.g., continuous intravenous infusion via an infusion pump). The therapeutic response of the patient, in one embodiment, is a reduction in the pulmonary vascular resistance index (PVRI) from pretreatment value, a reduction in mean pulmonary artery pressure from pretreatment value, an increase in the hypoxemia score from pretreatment value, a decrease in the oxygenation index from pretreatment values, improved right heart function, as compared to pretreatment or improved exercise capacity (e.g., as measured by the six-minute walk test) compared to pretreatment. The therapeutic response, in one embodiment, is an improvement of at least 10%, at least 20%, at least 30%, at least 40% or at least 50%, as compared to pretreatment values. In another embodiment, the therapeutic response is an improvement of about 10% to about 70%, about 10% to about 60%, about 10% to about 50%, about 10% to about 40%, about 10% to about 30%, about 10% to about 20%, about 20% to about 70%, about 20% to about 60% or about 10% to about 50%, as compared to pretreatment levels.
Without wishing to be bound by theory, the less frequent administration of the compounds and compositions of the invention allows for improved patient compliance, as compared to the compliance of patients being administered a different PH, PAH or PPH treatment (e.g., treprostinil-Tyvaso®, Remodulin®).
In one embodiment, a composition or compound of the present invention is administered via a metered dose inhaler (MDI) to a patient in need of PH, PAH or PPH treatment. The composition or compound, in one embodiment, is delivered via a MDI by the use of a propellant, for example, a chloro-fluorocarbon (CFC) or a fluorocarbon. In one embodiment, where delivery is via an MDI, the compound is not formulated as a lipid nanoparticle composition, and instead, is suspended or dissolved directly in a propellant solution. The patient, in one embodiment, is administered the prostacyclin compound or composition of the invention once daily, twice daily or three times daily. In one embodiment, the administration is with food. In one embodiment, each administration comprises 1 to 5 doses (puffs) from an MDI, for example 1 dose (1 puff), 2 dose (2 puffs), 3 doses (3 puffs), 4 doses (4 puffs) or 5 doses (5 puffs). The MDI, in one embodiment, is small and transportable by the patient.
In another embodiment, the prostacyclin compound or prostacydin composition is administered via a nebulizer to a patient in need of PH, PAH or PPH treatment. The administration occurs in one embodiment, once daily, twice daily, three times daily or once every other day.
In one embodiment, a composition or compound of the present invention is administered via a dry powder inhaler (DPI) to a patient in need of PH, PAH or PPH treatment. The patient, in one embodiment, is administered the prostacyclin compound or composition of the invention once daily, twice daily or three times daily. In one embodiment, the administration is with food. In one embodiment, each administration comprises 1 to 5 doses (puffs) from a DPI, for example 1 dose (1 puff), 2 dose (2 puffs), 3 doses (3 puffs), 4 doses (4 puffs) or 5 doses (5 puffs). The DPI, in one embodiment, is small and transportable by the patient.
In another embodiment, the prostacyclin compound administered to a patient in need thereof via a pulmonary route by the PH, PAH or PAH treatment methods described herein provides a greater pulmonary elimination half-life (t1/2) of the prostacyclin compound or its treprostinil metabolite, compared to the pulmonary elimination half-life (t1/2) of treprostinil, when treprostinil is administered via a pulmonary route (e.g., by nebulization, dry powder inhaler, or a metered dose inhaler) to the patient in need of PH. PAH or PPH treatment.
In another embodiment, the prostacyclin compound administered to a patient in need thereof, via the PH, PAH or PPH treatment methods described herein provides a greater systemic half-life (t1/2) of the prostacyclin compound or its treprostinil metabolite, compared to the systemic elimination half-life (t1/2) of treprostinil, when treprostinil is administered to the patient. In a further embodiment, administration of the prostacyclin compound and treprostinil comprises oral, nasal, subcutaneous or intravenous administration. In a further embodiment, the administration is continuous subcutaneous infusion via an infusion pump).
In another embodiment, the prostacyclin compound administered to a patient in need of PH, PAH or PPH treatment provides a greater mean pulmonary Cmax and/or lower plasma Cmax of treprostinil for the patient, compared to the respective pulmonary or plasma Cmax of treprostinil, when treprostinil is administered to the patient. In a further embodiment, administration of the prostacyclin compound and treprostinil comprises intravenous administration (e.g., continuous intravenous infusion via a pump) or subcutaneous administration (e.g., continuous subcutaneous infusion via a pump).
In another embodiment, the prostacyclin compound administered to a patient in need of PH, PAH or PPH treatment provides a greater mean pulmonary or plasma area under the curve (AUC0-4) of the prostacyclin compound or its treprostinil metabolite, compared to the mean pulmonary or plasma area under the curve (AUC0-4) of treprostinil, when treprostinil is administered to the patient. In yet another embodiment, the prostacyclin compound administered to a patient in need thereof provides a greater pulmonary or plasma time to peak concentration (tmax) of treprostinil, compared to the pulmonary or plasma time to peak concentration (tmax) of treprostinil, when treprostinil is administered to the patient. In a further embodiment, the administration is continuous subcutaneous infusion via an infusion pump).
In another aspect of the invention, a method of treating a disease, disorder or condition other than PH, PAH or PPH is provided. U.S. Pat. No. 5,153,222, incorporated by reference herein in its entirety, describes use of treprostinil for treatment of pulmonary hypertension. Treprostinil is approved for the intravenous as well as subcutaneous route, the latter avoiding potential septic events associated with continuous intravenous catheters. U.S. Pat. Nos. 6,521,212 and 6,756,033, each incorporated by reference herein in their entireties, describe administration of treprostinil by inhalation for treatment of pulmonary hypertension, peripheral vascular disease and other diseases and conditions. U.S. Pat. No. 6,803,386, incorporated by reference herein in its entirety, discloses administration of treprostinil for treating cancer such lung, liver, brain, pancreatic, kidney, prostate, breast, colon and head-neck cancer. U.S. Patent Application Publication No. 2005/0165111, incorporated by reference herein in its entirety, discloses treprostinil treatment of ischemic lesions. U.S. Pat. No. 7,199,157, incorporated by reference herein in its entirety, discloses that treprostinil treatment improves kidney functions. U.S. Pat. No. 7,879,909, incorporated by reference herein in its entirety, discloses treprostinil treatment of neuropathic foot ulcers. U.S. Patent Application Publication No. 2008/0280986, incorporated by reference herein in its entirety, discloses treprostinil treatment of pulmonary fibrosis, interstitial lung disease with treprostinil and asthma. U.S. Pat. No. 6,054,486, incorporated by reference herein in its entirety, discloses treatment of peripheral vascular disease with treprostinil. U.S. patent application publication no. 2009/0036465, incorporated by reference herein in its entirety, discloses combination therapies comprising treprostinil. U.S. Patent Application Publication No. 2008/0200449 discloses delivery of treprostinil using a metered dose inhaler. U.S. Pat. Nos. 7,417,070, 7,384,978 and 7,544,713 as well as U.S. Patent Application Publication Nos. 2007/0078095, 2005/0282901, and 2008/0249167, each incorporated by reference herein in their entireties, describe oral formulations of treprostinil and other prostacyclin analogs as well as their use for treatment of a variety of conditions. U.S. Patent Application Publication No. 2012/0004307, incorporated by reference herein, discloses the use of orally administered treprostinil for treatment of Raynaud's phenomenon, systemic sclerosis and digital ischemic lesions. Each of the indications recited above can be treated with the compounds and compositions provided herein. Routes of administration to a patient in need of treatment include pulmonary (inhalation), subcutaneous, oral, nasal and intravenous. In one embodiment, one of the indications described herein is treated with one of the treprostinil alkyl esters described herein via continuous subcutaneous infusion via an infusion pump. In a further embodiment, the treprostinil alkyl ester is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9 or C10 linear alkyl ester.
Additionally, the following references are incorporated by reference in their entireties for all purposes for practicing the embodiments of the present invention: J. Org. Chem. 2004, 69, 1890-1902, Drug of the Future, 2001, 26(4), 364-374, U.S. Pat. Nos. 5,153,222, 6,054,486, 6,521,212, 6,756,033, 6,803,386, and 7,199,157, U.S. Patent Application Publication Nos. 2005/0165111, 2005/0282903, 2008/0200449, 2008/0280986, 2009/0036465 and 2012/0010159.
In one embodiment, a method is provided for treating a patient in need thereof for congestive heart failure, peripheral vascular disease, asthma, severe intermittent claudication, immunosuppression, proliferative diseases, e.g., cancer such as lung, liver, brain, pancreatic, kidney, prostate, breast, colon and head-neck cancer, ischemic lesions, neuropathic foot ulcers, and pulmonary fibrosis, kidney function and/or interstitial lung disease. In one embodiment, the method comprises administering an effective amount of one of the prostacyclin compounds or compositions provided herein, for example, a compound of Formula (I), (Iak (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (Id), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′) (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III) to the patient. Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), subcutaneous, oral, nasal or intravenous. In a further embodiment, the compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9 or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In some embodiments, the pharmaceutical formulation may comprise a second active agent, in addition to the treprostinil derivative described herein.
In one embodiment, a method is provided for treating and/or preventing interstitial lung disease (e.g., pulmonary fibrosis) or asthma, or a condition associated with interstitial lung disease or asthma in a patient in need of such treatment. In a further embodiment, the method comprises administering to the patient an effective amount of one of the prostacyclin compounds or compositions provided herein, for example, a compound of Formula (I), (Ia), (Ib) (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II) (IIa), (IIb), (IIc) (Id), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (Id), or (III). The composition or compound, in one embodiment, is delivered via a MDI by the use of a propellant, for example, a chlor-fluorocarbon (CFC) or a fluorocarbon. The patient, in one embodiment, is administered the prostacyclin compound or composition of the invention once daily, twice daily or three times daily. In one embodiment, the administration is with food. In one embodiment, each administration comprises 1 to 5 doses (puffs) from an MDI, for example 1 dose (I puff), 2 dose (2 puffs), 3 doses (3 puffs), 4 doses (4 puffs) or 5 doses (5 puffs). The MDI, in one embodiment, is small and transportable by the patient. In another embodiment, administration is oral, nasal, subcutaneous or intravenous. In another embodiment, oral, nasal, intravenous, subcutaneous or inhalation administration of the effective amount of the prostacyclin compound or composition of the invention, for the treatment of interstitial lung disease (e.g., pulmonary fibrosis) or asthma, or a condition associated with interstitial lung disease or asthma, compared to oral, nasal, subcutaneous, intravenous or inhalation administration of treprostinil, results in a reduced severity of a systemic adverse events, or a decreased occurrence of a systemic adverse event. In a further embodiment, the prostacyclin compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9, or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In one embodiment, a method for treating an ischemic disease or condition, such as scleroderma, including systemic sclerosis, or Raynaud's Phenomenon in a patient in need of such treatment is provided. In a further embodiment, the method comprises administering an effective amount of one of the prostacyclin compounds or compositions provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II) (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (Id), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib) (Ic), (Id), (Ia′) (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (Dc) (IId), or (III), to the patient. Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), oral, nasal subcutaneous or intravenous administration. In another embodiment, oral, nasal, intravenous, subcutaneous or inhalation administration of an effective amount of the prostacyclin compound or composition of the invention, for the treatment of ischemic disease or condition, such as scleroderma, including systemic sclerosis, or Raynaud's Phenomenon, compared to oral, nasal, subcutaneous, intravenous or inhalation administration of treprostinil, results in a reduced severity of a systemic adverse events, or a decreased occurrence of a systemic adverse event. In a further embodiment, the prostacyclin compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9 or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
The prostacyclin compounds or compositions provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (H), (IIa), (UIb), (IIc) (IId), or (III), in one embodiment, are used for treating a patient for a digital ischemic lesion, such as a digital ulcer or a necrotic lesion, or for ameliorating a symptom or functional deficit and/or reducing the number of symptoms and/or functional deficit(s) associated with a digital ischemic lesion. The term “digital ischemic lesion” refers to a lesion on a digit, i.e., a toe or a finger, ofa subject, such as a human being. In one embodiment, the digital ischemic lesion may be caused by or associated with an ischemic disease or condition, such as scleroderma, including systemic sclerosis, or Raynaud's Phenomenon. The symptom that may be ameliorated and/or reduced may be, for example, a pain associated with a digital ischemic ulcer and/or scleroderma. In some embodiments, administering a prostacyclin compound or composition provided herein, upon administration to a patient in need of treatment, provides amelioration or reduction of one or more functional deficits associated with a digital ischemic lesion. For example, in one embodiment, the prostacyclin compound or composition provided herein ameliorates or reduces a hand function deficit, i.e., provides an improvement in the hand function of the treated patient. Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), oral, nasal, subcutaneous or intravenous administration. In another embodiment, oral, nasal intravenous, subcutaneous or inhalation administration of an effective amount of the prostacyclin compound or composition of the invention, for the treatment of digital ischemic lesions, compared to oral, nasal, subcutaneous, intravenous or inhalation administration of treprostinil, results in a reduced severity of a systemic adverse events, or a decreased occurrence of a systemic adverse event. In a further embodiment, the prostacyclin compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9 or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In one embodiment, a method for improving kidney function or treating symptoms associated with kidney malfunction or failure in a patient in need thereof is provided. In a further embodiment, the method comprises administering to a subject in need thereof an effective amount of a prostacyclin compound or composition provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), to the patient. Specific symptoms associated with reduced kidney functions include, for example, abnormally low urination, increased blood levels of creatinine and urea nitrogen, protein leakage in urine and/or pain. Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), oral, nasal, subcutaneous or intravenous administration. In another embodiment, oral, nasal, intravenous, subcutaneous or inhalation administration of an effective amount of the prostacyclin compound or composition of the invention, for improvement of kidney functions or amelioration of symptoms associated with kidney malfunction or failure, compared to oral, nasal, intravenous, subcutaneous or inhalation administration of treprostinil, results in a reduced severity of a systemic adverse events, or a decreased occurrence of a systemic adverse event. In a further embodiment, the prostacyclin compound is a C1-C10 linear alkyl ester of treprostinil, e.g., C2, C3, Ca, C5, C6, Ct, C8, C9 or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In one embodiment, a method of treating a cardiovascular disease including congestive heart failure comprises is provided. The method, in one embodiment, comprises administering to a patient in need thereof, a prostacyclin compound or composition provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (a), (IIb) (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III). Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), subcutaneous, oral, nasal or intravenous administration. In a further embodiment, the prostacyclin compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9, or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In one embodiment, a method for treating a peripheral vascular disease, including peripheral arterial occlusive disease and intermittent claudication is provided. In one embodiment, the method comprises administering to a patient in need thereof a prostacyclin compound or composition provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (Ia), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″) (Ic″), (Id″) (II), (IIa), (IIb), (IIc) (IId), or (III). In addition to the prostacyclin compounds and compositions provided herein, other pharmacologically active substances may be present in the formulations of the present invention which are known to be useful for treating peripheral vascular disease. For example, the compounds of the invention may be present in combination with trental, a substance known to increase red blood cell deformability. Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), subcutaneous, oral, nasal or intravenous administration. In a further embodiment, the prostacyclin compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9 or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In one embodiment, a method for treating and/or preventing neuropathic diabetic foot ulcer is provided. In one embodiment, the method comprises administering to a patient in need thereof, a prostacyclin compound or composition provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, or a composition comprising a compound of Formula (I) (Ia), (Ib) (Ic), (Id) (Ia′) (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a composition comprising a deuterated compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III). Administration, in one embodiment, is via inhalation (e.g., with a nebulizer or metered dose inhaler), subcutaneous, oral, nasal or intravenous administration. In addition to the prostacyclin compounds and compositions provided herein, other pharmacologically active substances may be present in the formulations of the present invention which are known to be useful for treating and/or preventing foot ulcers in patients with diabetic neuropathy. For example, the compounds of the invention may be present in combination with analgesics to treat pain, dressing changes, vasodilator medications, and topical or oral antibiotics. In a further embodiment, the prostacyclin compound is a C2-C10 linear alkyl ester of treprostinil, e.g., C2, C3, C4, C5, C6, C7, C8, C9 or C10 linear alkyl ester and is administered via continuous subcutaneous infusion.
In one embodiment, administration of an effective amount of a prostacyclin compound or composition of the present invention for the treatment of the various diseases and indications described throughout, by inhalation, subcutaneous, oral, nasal or intravenous administration, results in a decreased number of side effects, or a reduced severity of one or more side effects (also referred to herein as “adverse events”), compared to the administration of an effective amount of treprostinil, when an effective amount of treprostinil is administered by inhalation, subcutaneous, oral, nasal or intravenous administration. For example, in one embodiment, a patient treated by the methods provided herein experiences a reduced severity and/or frequency in cough or a reduced cough response when administered a prostacylin compound or composition of the invention via inhalation (e.g., nebulization, dry powder inhaler, or via a metered dose inhaler), compared to the severity and/or frequency of cough or cough response elicited by inhalation administration of treprostinil to the patient.
In another embodiment, the prostacyclin compound administered to a patient in need of treatment provides a greater mean pulmonary Cmax and/or lower plasma Cmax of treprostinil for the patient, compared to the respective pulmonary or plasma Cmax of treprostinil, when treprostinil is administered to the patient. In a further embodiment, administration of the prostacyclin compound and treprostinil comprises intravenous administration.
In another embodiment, the prostacyclin compound administered to a patient in need of treatment provides a greater mean pulmonary or plasma area under the curve (AUC0-4) of the prostacyclin compound or its treprostinil metabolite, compared to the mean pulmonary or plasma area under the curve (AUC0-4) of treprostinil, when treprostinil is administered to the patient. In yet another embodiment, the prostacyclin compound administered to a patient in need thereof provides a greater pulmonary or plasma time to peak concentration (tmax) of treprostinil, compared to the pulmonary or plasma time to peak concentration (tmax) of treprostinil, when treprostinil is administered to the patient.
In one embodiment, a prostacyclin compound or composition provided herein, for example, a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (II), or a deuterated version thereof, or a composition comprising a compound of Formula (I), (Ia), (Ib), (Ic), (Id), (Ia′), (Ib′), (Ic′), (Id′), (Ia″), (Ib″), (Ic″), (Id″), (II), (IIa), (IIb), (IIc) (IId), or (III), or a deuterated version thereof, is administered in combination with one or more additional active agents. In some embodiments, such one or more additional active agents can be also administered together with a prostacyclin compound or composition provided herein using a metered dose inhaler. In one embodiment, such one or more additional active agents can be administered separately, i.e., prior to, or subsequent to, the prostacyclin compound or composition provided herein. Particular additional active agents that can be administered in combination with treprostinil may depend on a particular disease or condition for treatment or prevention of which treprostinil is administered. In some cases, the additional active agent can be a cardiovascular agent such as a cox-2 inhibitor, a rho kinase inhibitor, a calcium channel blocker, a phosphodiesterase inhibitor, an endothelial antagonist, or an antiplatdelet agent.
As provided above, the prostacyclin compounds and compositions of the present invention can be delivered to a patient in need thereof via an oral, nasal, pulmonary, intravenous or subcutaneous route. With respect to the pulmonary route, the prostacycin compounds and compositions) of the present invention may be used in any dosage dispensing device adapted for such administration. The device, in one embodiment, is constructed to ascertain optimum metering accuracy and compatibility of its constructive elements, such as container, valve and actuator with the formulation and could be based on a mechanical pump system, e.g., that of a metered-dose nebulizer, dry powder inhaler, soft mist inhaler, or a nebulizer. For example, pulmonary delivery devices include a jet nebulizer, electronic nebulizer, a soft mist inhaler, and a capsule-based dry powder inhaler.
Suitable propellants, e.g., for MDI delivery, may be selected among such gases as fluorocarbons, chlorofluorocarbons (CFCs), hydrocarbons, hydrofluoroalkane propellants (e.g., HFA-134a and HFA-227), nitrogen and dinitrogen oxide or mixtures thereof.
The inhalation delivery device can be a nebulizer, dry powder inhaler, or a metered dose inhaler (MDI), or any other suitable inhalation delivery device known to one of ordinary skill in the art. The device can contain and be used to deliver a single dose of the prostacyclin composition or the device can contain and be used to deliver multi-doses of the composition of the present invention.
A nebulizer type inhalation delivery device can contain the compositions of the present invention as a solution, usually aqueous, or a suspension. For example, the prostacyclin compound or composition can be suspended in saline and loaded into the inhalation delivery device. In generating the nebulized spray of the compositions for inhalation, the nebulizer delivery device may be driven ultrasonically, by compressed air, by other gases, electronically or mechanically (e.g., vibrating mesh or aperture plate). Vibrating mesh nebulizers generate fine particle, low velocity aerosol, and nebulize therapeutic solutions and suspensions at a faster rate than conventional jet or ultrasonic nebulizers. Accordingly, the duration of treatment can be shortened with a vibrating mesh nebulizer, as compared to a jet or ultrasonic nebulizer. Vibrating mesh nebulizers amenable for use with the methods described herein include the Philips Respironics I-Neb®, the Omron MicroAir, the Nektar Aeroneb®, and the Pari eFlow®.
The nebulizer may be portable and hand held in design, and may be equipped with a self contained electrical unit. The nebulizer device may comprise a nozzle that has two coincident outlet channels of defined aperture size through which the liquid formulation can be accelerated. This results in impaction of the two streams and atomization of the formulation. The nebulizer may use a mechanical actuator to force the liquid formulation through a multiorifice nozzle of defined aperture size(s) to produce an aerosol of the formulation for inhalation. In the design of single dose nebulizers, blister packs containing single doses of the formulation may be employed.
In the present invention the nebulizer may be employed to ensure the sizing of particles is optimal for positioning of the particle within, for example, the pulmonary membrane.
Upon nebulization, the nebulized composition (also referred to as “aerosolized composition”) is in the form of aerosolized particles. The aerosolized composition can be characterized by the particle size of the aerosol, for example, by measuring the “mass median aerodynamic diameter” or “fine particle fraction” associated with the aerosolized composition. “Mass median aerodynamic diameter” or “MMAD” is normalized regarding the aerodynamic separation of aqua aerosol droplets and is determined by impactor measurements, e.g., the Anderson Cascade Impactor (ACI) or the Next Generation Impactor (NGI). The gas flow rate, in one embodiment, is 28 Liter per minute for the ACI and 15 liter per minute for the NGI.
“Geometric standard deviation” or “GSD” is a measure of the spread of an aerodynamic particle size distribution. Low GSDs characterize a narrow droplet size distribution (homogeneously sized droplets), which is advantageous for targeting aerosol to the respiratory system. The average droplet size of the nebulized composition provided herein, in one embodiment is less than 5 μm or about 1 μm to about 5 μm, and has a GSD in a range of 1.0 to 2.2, or about 1.0 to about 2.2, or 1.5 to 2.2, or about 1.5 to about 2.2.
“Fine particle fraction” or “FPF,” as used herein, refers to the fraction of the aerosol having a particle size less than 5 μm in diameter, as measured by cascade impaction. FPF is usually expressed as a percentage.
In one embodiment, the mass median aerodynamic diameter (MMAD) of the nebulized composition is about 1 μm to about 5 μm, or about 1 μm to about 4 μm, or about 1 μm to about 3 μm or about 1 μm to about 2 μm, as measured by the Anderson Cascade Impactor (ACI) or Next Generation Impactor (NGI). In another embodiment, the MMAD of the nebulized composition is about 5 μm or less, about 4 μm or less, about 3 μm or less, about 2 μm or less, or about 1 μm or less, as measured by cascade impaction, for example, by the ACI or NGI.
In one embodiment, the MMAD of the aerosol of the pharmaceutical composition is less than about 4.9 μm, less than about 4.5 μm, less than about 4.3 μm, less than about 4.2 μm, less than about 4.1 μm, less than about 4.0 μm or less than about 3.5 μm, as measured by cascade impaction.
In one embodiment, the MMAD of the aerosol of the pharmaceutical composition is about 1.0 μm to about 5.0 μm, about 2.0 μm to about 4.5 μm, about 2.5 μm to about 4.0 μm, about 3.0 μm to about 4.0 μm or about 3.5 μm to about 4.5 μm, as measured by cascade impaction (e.g., by the ACI or NGI).
In one embodiment, the FPF of the aerosolized composition is greater than or equal to about 50%, as measured by the ACI or NGI, greater than or equal to about 60%, as measured by the ACI or NGI or greater than or equal to about 70%, as measured by the ACI or NGI. In another embodiment, the FPF of the aerosolized composition is about 50% to about 80%, or about 50% to about 70% or about 50% to about 60%, as measured by the NGI or ACI.
In one embodiment, a metered dose inhalator (MDI) is employed as the inhalation delivery device for the compositions of the present invention. In a further embodiment, the prostacyclin compound is suspended in a propellant (e.g., hydroflourocarbon) prior to loading into the MDI. The basic structure of the MDI comprises a metering valve, an actuator and a container. A propellant is used to discharge the formulation from the device. The composition may consist of particles of a defined size suspended in the pressurized propellant(s) liquid, or the composition can be in a solution or suspension of pressurized liquid propellant(s). The propellants used are primarily atmospheric friendly hydroflourocabons (HFCs) such as 134a and 227. The device of the inhalation system may deliver a single dose via, e.g., a blister pack, or it may be multi dose in design. The pressurized metered dose inhalator of the inhalation system can be breath actuated to deliver an accurate dose of the lipid-containing formulation. To insure accuracy of dosing, the delivery of the formulation may be programmed via a microprocessor to occur at a certain point in the inhalation cycle. The MDI may be portable and hand held.
In one embodiment, a dry powder inhaler (DPI) is employed as the inhalation delivery device for the compositions of the present invention. In one embodiment, the DPI generates particles having an MMAD of from about 1 μm to about 10 μm, or about 1 μm to about 9 μm, or about 1 μm to about 8 μm, or about 1 μm to about 7 μm, or about 1 μm to about 6 μm, or about 1 μm to about 5 μm, or about 1 μm to about 4 μm, or about 1 μm to about 3 μm, or about 1 μm to about 2 μm in diameter, as measured by the NGI or ACI. In another embodiment, the DPI generates a particles having an MMAD of from about 1 μm to about 10 μm, or about 2 μm to about 10 μm, or about 3 μm to about 10 μm, or about 4 μm to about 10 μm, or about 5 μm to about 10 μm, or about 6 μm to about 10 μm, or about 7 μm to about 10 μm, or about 8 μm to about 10 μm, or about 9 μm to about 10 μm, as measured by the NGI or ACI.
In one embodiment, the MMAD of the particles generated by the DPI is about 1 μm or less, about 9 μm or less, about 8 μm or less, about 7 μm or less, 6 μm or less, 5 μm or less, aboutbout 3 μm or less, about 2 μm or less, or about 1 μm or less, as measured by the NGI or ACI.
In one embodiment, the MMAD of the particles generated by the DPI is less than about 9.9 μm, less than about 9.5 μm, less than about 9.3 μm, less than about 9.2 μm, less than about 9.1 μm, less than about 9.0 μm, less than about 8.5 μm, less than about 8.3 μm, less than about 8.2 μm, less than about 8.1 μm, less than about 8.0 μm, less than about 7.5 μm, less than about 7.3 μm, less than about 7.2 μm, less than about 7.1 μm, less than about 7.0 μm, less than about 6.5 μm, less than about 6.3 μm, less than about 6.2 μm, less than about 6.1 μm, less than about 6.0 μm, less than about 5.5 μm, less than about 5.3 μm, less than about 5.2 μm, less than about 5.1 μm, less than about 5.0 μm, less than about 4.5 μm, less than about 4.3 μm, less than about 4.2 μm, less than about 4.1 μm, less than about 4.0 μm or less than about 3.5 μm, as measured by the NGI or ACI.
In one embodiment, the MMAD of the particles generated by the DPI is about 1.0 μm to about 10.0 μm, about 2.0 μm to about 9.5 μm, about 2.5 μm to about 9.0 μm, about 3.0 μm to about 9.0 μm, about 3.5 μm to about 8.5 μm or about 4.0 μm to about 8.0 μm.
In one embodiment, the FPF of the prostacyclin particulate composition generated by the DPI is greater than or equal to about 40%, as measured by the ACI or NGI, greater than or equal to about 50%, as measured by the ACI or NGI, greater than or equal to about 60%, as measured by the ACI or NGI, or greater than or equal to about 70%, as measured by the ACI or NGI. In another embodiment, the FPF of the aerosolized composition is about 40% to about 70%, or about 50% to about 70% or about 40% to about 60%, as measured by the NGI or ACI.
In one embodiment, a compound of the present invention is administered to a patient in need thereof via continuous intravenous or continuous subcutaneous infusion, e.g., via an infusion pump. The patient in one embodiment is a WHO Group I PAH, for example, to diminish symptoms associated with exercise in a patient in need thereof, or to increase exercise capacity. In another embodiment, the PAH is NYHA class II, NYHA class WI or NYHA class IV. In even another embodiment, the PAH is associated with congenital systemic-to-pulmonary shunts or PAH associated with connective tissue diseases.
In another embodiment, the patient requires transition from Flolan® (epoprostenol sodium) or Remodulin® (treprostinil) treatment. For example, the patient, in one embodiment, requires transition to treatment with one of the compounds provided herein, to reducte the rate of clinical deterioration.
In further embodiments, subcutaneous infusion devices deliver a treprostinil pro-drug composition just beneath the surface of the skin. The use of a treprostinil pro-drug composition in the subcutaneous infusion is advantageous over the use of a non-pro-drug treprostinil composition given that the pharmacodnetic and pharmacodynamic modeling and assaying of the treprostinil pro-drug reveals a stability that translates to stable concentrations of treprostinil in plasma as compared to the non-pro-drug treprostinil. In one embodiment, the side effect profile of the compounds provided herein is less deleterious than the side effect profile resulting from treprostinil administration.
In one embodiment, an infusion device continusously infuses a prostacyclin composition subcutaneously for a predetermined interval, the predetermined interval may be at or about 1 hour, 2 hou 3 hours, 4, hours, 5, hours, 6 hours, 7 hours, 8 hours, 9 hours, 10 hours, 11 hours, 12 hours, 13 hours, 14 hours, 15 hours, 16 hours, 17 hours, 18 hours, 19 hours, 20 hours, 21 hours, 22 hours, 23 hours, 24 hours, 25 hours, 26 hours, 27 hours, 28 hours, 29 hours, 30 hours, 31 hours, 32 hours, 33 hours, 34 hours, 35 hours, 36 hours, 37 hours, 38 hours, 39 hours, 40 hours, 41 hours, 42 hours, 43 hours, 44 hours, 45 hours, 46 hours, 47 hours, 48 hours, 49 hours, 50 hours, 51 hours, 52 hours, 53 hours, 54 hours, 55 hours, 56 hours, 57 hours, 58 hours, 59 hours, 60 hours, 61 hours, 62 hours, 63 hours, 64 hours, 65 hours, 66 hours, 67 hours, 68 hours, 69 hours, 70 hours, 71 hours 72 hours, 76 hours, 80 hours, 84 hours, 88 hours, 92 hours, or 96 hours.
In one embodiment, the present invention encompasses a subcutaneous infusion device to deliver one or more of the prostacyclin compounds described herein. Subcutaneous infusion devices provide an ease of use in delivering pharmaceutical compositions to patients that would otherwise require repeated penetration of the integument to deliver pharmaceutical compositions throughout a short period of time. The use of subcutaneous infusion devices further provide a greater degree of mobility as compared to patients that rely upon an I.V. drip system for drug delivery. An advantage of subcutaneous infusion over other delivery methods is that blood plasma levels of a drug are considerably more stable, and appropriate symptom control can be achieved without the potentially toxic effects of the peaks and troughs resulting from episodic drug administration. The use of subcutaneous infusion allows for a continuous infusion of drugs over a calculated period of time and can provide constant dosing of a drug or composition of interest.
An infusion pump provided herein is designed for subcutaneous infusion (e.g., continuous subcutaneous infusion) and/or intravenous infusion (e.g., continuous intravenous infusion). The pump in one embodiment, is small and lightweight, adjustable to provide different programmable infusion rates, comprises one or more alarms to monitor occlusion, delivery progress, low battery, programming error and motor malfunction. In one embodiment, the infusion pump comprises a drug reservoir. In a further embodiment, the reservoir comprises one of the prostacyclin compounds provided herein, or a pharmaceutically acceptable salt (e.g., one of the prodrugs described herein together with a pharmaceutically acceptable excipient). In a further embodiment, the device comprises a monitor to monitor the dosage of delivered prostacyclin compound.
The infusion pump provided herein, in one embodiment, is ambulatory, has a delivery accuracy of ±6% or better and is positive pressure driven. In a further embodiment, the pump comprises a reservoir and the reservoir is made of polyvinyl choride, polypropylene or glass.
In another embodiment, the infusion pump (subcutaneous or intravenous) comprises a pump, a reservoir containing the prostacyclin composition, an infusion set for subcutaneous infusion of the composition, and an optional monitor mearuing concentration of prostacyclin or metabolites thereof. In another embodiment, the infusion device provides an open-loop or dosed-loop system.
In another embodiment, the infusion device provides an open-loop or closed-loop system.
In another embodiment the infusion device continuously infuses the prostacyclin composition for a predetermined interval; wherein at the end of the predetermined interval the predetermined infusion interval may repeat or initiate a new predetermined infusion interval. In another embodiment, the predetermined interval is about 24 hours, about 36 hours, or less than about 96 hours.
In another embodiment, the subcutaneous infusion of the prostacyclin compound occurs at eather a continuous rate of volume or a variable rate of volume.
In one embodiment, a kit for the administration of a prostacyclin composition described herein in amounts effective to treat pulmonary hypertension, e.g., pulmonary arterial hypertension. The kit comprises a composition comprising one of the prostacylcin compounds described herein, a subcutaneous infusion pump, and instructions for the administration of a prostacyclin compound. In another embodiment, the subcutaneous infusion pump of the kit is a continuous subcutaneous infusion pump
In one embodiment, the present invention encompasses an intravenous (IV) infusion in the delivery of one or more of the prostacydin compounds described herein. IV delivery can range from an intravenous infusion with or without an infusion pump, intravenous cannula with an injection port, or intravenous through a central venous line. IV delivery provides a direct rought to the bloodstream which allows for the administration of any number of compounds to be quickly disseminated by the circulatory system.
In a further embodiment, the intravenous infusion may be carried out with a hypodermic needle which is connected to a syringe or a continous drip reservoir (e.g., I.V. bag). In a further embodiment, the intravenous infusion is carried out with the insertion of a peripheral cannula or a central line. In a further embodiment, the intravenous infusion is carried out with infusion pump. The intravenous infusion can be performed intermittently or continuously.
The present invention is further illustrated by reference to the following Examples. However, it should be noted that these Examples, like the embodiments described above, are illustrative and are not to be construed as restricting the scope of the invention in any way.
Treprostinil compounds derivatized with alkyl groups at the carboxylic acid moiety were prepared. Specifically, treprostinil was derivatized at the carboxylic acid moiety with C2, C3, C4, C5, C6, C8, C10, C12, C16, and C18 alkyl chains (i.e., R2 in Formula (A), below, is C2, C3, C4, C5, C6, C8, C10, C12, C16 or C18 alkyl) to make treprostinil alkyl esters of various ester chain lengths. Treprostinil can be synthesized, for example, by the methods disclosed in U.S. Pat. Nos. 6,765,117 and 8,497,393. Synthesis of prostaglandin derivatives is described in U.S. Pat. No. 4,668,814. The disclosures of U.S. Pat. Nos. 6,765,117; 8,497,393 and 4,668,814 are each incorporated by reference in their entireties for all purposes.
Scheme 1:
Treprostinil esterification was catalyzed by strongly acidic resin Amberlyst® 15 (Rohm and Haas). Treprostinil acid was dissolved in anhydrous dioxane/alcohol at a concentration 10 mg/mL (typically 4 mL). Alcohol (RrOH) added was appropriate to make corresponding chain length at the R2 group. By way of example, for the C2 (ethyl ester) compound, the alcohol was ethanol. The molar amount of alcohol in the solvent was ten times the molar amount of treprostinil.
Treprostinil in dioxane/alcohol solution was added to washed and dry Amberlyst resin. Per each 40 mg treprostinil, 1 g resin in a glass vial was added. The mixture was placed on a shaker and incubated overnight at 40° C. Next, the liquid portion was taken out of the vial, washed twice with 3 mL dioxane. All recovered solvent was then collected. The solvent was dried by nitrogen stream until the evaporation stopped. The remaining treprostinil alkyl ester and nonvolatile alcohol (if long chain alcohol used) was dissolved in 2 mL hexan/fethyl acetate 1:1, and cleaned by liquid-liquid extraction vs. equal volume of phosphate buffer, and then water. Next, the organic layer was separated and dried by nitrogen stream and further in vacuum. If a long chain alcohol used, an additional purification step was required to separate alcohol by liquid chromatography. ACE CN, 5 μm, Ultra-Inert HPLC Column, 100×21.2 mm was used, with mobile phase of hexane/propanol 98:2%.
Scheme 2:
To a solution of (1R,2R,3aS,9aS)-[[2,3,3a,4,9,9a-hexahydro-2-hydroxy-1-[(3S)-3-hydroxyoctyl]-1H-benz[f]inden-5-yl]oxy]acetic acid (treprostinil) (78.1 mg, 200 μmoles) dissolved in 1,4-dioxane (2.0 mL) was added Amberlyst® 15 resin (2.0 g) and alcohol R2—OH (2.0 mmoles, 10 equivalents). The reaction mixture was heated to 40° C. and allowed to shake at approximately 100 rpm for 18-196 hours. Solvent was removed and the resin was washed with acetonitrile (MeCN) (3×3 mL). The 1,4-dioxane and MeCN extracts were combined and dried using a gentle stream of warmed N2 gas and gentle heat to yield a thick waxy solid. The crude material was dissolved in 20% “PrOH/Hexanes and submitted to preparatory HPLC purification. Solvent was removed from the purified material using a gentle stream of warmed N2 gas and gentle heat to yield an off-white waxy solid. The pure material was suspended in ethyl lactate for storage and was submitted to analytical HPLC for concentration determination.
By way of example, the following compounds of Formula (A) were synthesized by the method of scheme 2.
A general diagram for synthesis of the ethyl ester of treprostinil is shown in Scheme 1, below. The alcohol can be modified based on the desired alkyl ester chain length (e.g., C5-C18 alkyl esters of even or odd chain length, straight chain or branched).
Spontaneous and/or esterase-mediated hydrolysis was measured for the prostacyclin alkyl ester compositions provided in Table 2. Cx indicates the alkyl chain length at position R2 of the compound of Formula (A), provided above.
Additionally, spontaneous hydrolysis was measured for 200 μM of treprostinil compounds derivatized at the carboxylic acid group with either a C3, C4, C5, C8, or C10 alkyl group in 20% ethanol at 40° C. at six time points (0 hr., 1 hr., 2 hr., 4 hr., 6 hr., 24 hr.).
Each sample was prepared as a 200 μM solution in 20% ethanol. At each time point, an aliquot was removed for HPLC analysis to resolve remaining reactants (C3, C4, C5, C6, C8, C10) or their degradation product (treprostinil). For each sample, hydrolysis was calculated from the measured reactant and product peak areas:
% hydrolysis=(product peak area/(reactant peak area+product peak area)*100).
The results of the time course experiment are provided at
Esterase mediated hydrolysis of treprostinil compounds and compositions was measured for compounds derivatized at the carboxylic acid group with C2, C4, C6, C8 and C10, C12, C14 and C16 alkyl groups, and compositions comprising the same (Tables 2 and/or 3 provide the components of these compositions). Experiments were conducted at 37° C., and hydrolysis was measured at 15 min., 30 min., and 1 hour after addition of the esterase to the compound solution. The reaction mixture for each sample was prepared at a final volume of 500 μL containing, 200 μM treprostinil compound, 0.05 U esterase, 20% ethanol, and PBS. Hydrolysis was measured as described above.
The results of this experiment are provided at
Treprostinil alkyl ester (C10-TR, C12-TR, C14-TR) conversion to treprostinil was also measured in the presence of rat, dog and monkey lung tissue homogenate at 37° C. Here, data were calculated based on fit of exponential increase to the maximum (experiments performed in duplicate). The results of this study are provided below in Table 2A and
The compositions in Table 3 were subject to particle size characterization. Cx indicates the alkyl chain length at position R2 of Formula (A), provided above.
All particle size measurements were performed using a Wyatt Technology Mobius™ Zeta Potential/Particle Sizing Instrument in Quasi-elastic light scattering (QELS) mode. Composition aliquots were diluted 10-fold in pre-filtered (0.02 μm pore filter) ultrapure of deionized H2O. Light scattering data was collected and converted into particle size and size distribution using Dynamics® v. 7.2.4 instrument software. Reported average particle size diameter is based on the cumulants model, which mathematically fits particle diffusion constants (determined by the raw scattering intensities of particles in a suspension) to obtain the particle size mean and a distribution of particle sizes around the mean diameter.
It was found that the particle size (average particle diameter) of treprostinil compositions increases in size in compositions comprising C2-C5 alkyl ester derivatized treprostinil, and decreases in size in compositions comprising C6-C12 alkyl ester derivatized treprostinil. These results are provided in
Under the conditions utilized here it was also found that longer chain derivatized treprostinil compounds formed more uniform particles than compounds having shorter alkyl ester chains. Particle uniformity was determined using the software-calculated polydispersity (% PD). Polydispersity is defined as the standard deviation of the particle size distribution from the mean particle size value. % PD normalizes the polydispersity to the mean diameter by dividing by the mean size and multiplying by 100. These parameters indicate whether a particle suspension has one or more size populations of particles (monomodal versus multimodal). It also gives insight into the width of particle size distribution (or degree particle uniformity) around the mean for the respective particle populations.
Dynamics@ polydispersity parameter represents a monodisperse population of particles if % PD ≦15. A calculated % PD ≧57% represents a polydisperse population of particles. For instance, the % PD data plotted in
A cell based Chinese hamster ovary-K1 (CHO-K1) assay based on the GloSensor™ cAMP assay (Promega) was used to characterize the effect of treprostinil alkyl ester compounds on cAMP levels.
cAMP is a second messenger involved in signal transduction of G-protein coupled receptors (GPCRs) acting through Gα-s and Gα-i proteins. Because the treprostinil receptor is a GPCR, the assay provides an indication of whether the respective prostacyclin compound (or metabolite thereof) binds its receptor and activates the GPCR cell signaling cascade.
The GloSensor™ assay harnesses a genetically modified form of firefly luciferase into which a cAMP-binding protein moiety has been inserted. Upon binding of cAMP, a conformational change is induced leading to increased light output.
The EP2 prostanoid receptor was cotransfected with the GioSensorm plasmid (Promega) into CHO-K cells as follows. CHO-K cells were harvested when the monoloayer was at 50-90% confluence. First, cells were washed with 5 mL PBS. Two mL of pre-warmed (37° C.) 0.05% trypsin-EDTA (Life Technologies, Cat #: 25300054) was added, and cells were dislodged by tapping the flask on the side. Next, 10 mL of antibiotic free growth media (Life Tech, Cat #: 31765092) containing 10% fetal bovine serum (FBS; Hyclone, Cat #: SH30071.03) was added, and cells were centrifuged at 250×g for 5 minutes at room temperature. The media was aspirated, and the cell pellet was resuspended in 10 mL of growth media. Cell number was determined using a hemacytometer. Each well of a culture treated 96 well flat bottom plate (Costar, Cat #: 3917) was seeded with 1×104 cells per 100 μL antibiotic-free growth media. The cells were incubated overnight at 37° C. and 5% CO2 in a water-jacketed incubator.
For small scale transfections of up to 20 wells, the pGLoSensor-22F cAMP plasmid (Promega, Cat #: E2301) (2 apg): (EP2) (10 ng) (Origene. Cat #: SC126558): pGEM-3Zf(+) (10 ng) (Promega, Cat #: P2271) ratio was diluted to a final concentration of 12.6 ng/μL (total plasmid) in Opti-MEM I reduced-serum medium (Life Technologies, Cat #: 1985062). Next, 6 μL of FuGENE HD transfection reagent (Promega, Cat #: E2311) was added to 160 μL of diluted plasmid and mixed carefully by gentle pipetting. The complex was incubated at room temperature for 0 to 10 minutes, and then 8 μL of the complex was added per well of a 96 well white assay plate (Costar, Cat #: 3917) and gently mixed without disturbing the cell monolayer. The plates were incubated for 20-24 hours at 37° C. and 5% CO2 in a water-jacketed incubator. Following incubation, cells were treated and analyzed.
For larger scale transfections, the aforementioned steps were scaled up accordingly, and cells were frozen following the last incubation. In order to prepare frozen transfected CHO-K cells, the media was aspirated from culture flasks and cells were rinsed with 5 mL PBS. As above, 2 mL of pre-warmed (37° C.) 0.05% trypsin-EDTA (Life Technologies, Cat #: 25300054) was added, and cells were dislodged by tapping the flask on the side. Next, 10 mL of antibiotic free growth media (Life Technologies, Cat #: 31765092) containing 10%. FBS (Hydone, Cat #: SH30071.03) was added, and cells were centrifuged at 250×g for 5 minutes at room temperature. Cell number was determined using a hemacytometer. The media was aspirated, and the cell pellet was resuspended in freezing media (Millipore, cat #: S-002-SF) at 2.5×104 cells/vial. Transfected cells were incubated overnight at −80° C. before transfer to liquid nitrogen for long term storage. The frozen stocks were then thawed one day prior to use for assays, and cells were seeded at 2.5×104 cells per well in 100 μL of antibiotic-free complete media (F12 (Life Technologies, Cat #: 31765092)+10% FBS (Hyclone, Cat #: SH30071.03)). Following an overnight incubation at 37° C. and 5% CO2 in a water-jacketed incubator, the cells were ready for use in cAMP response assays.
In preparation for cAMP measurement, the cells were equilibrated with the GloSensor cAMP reagent prior to treatment. For equilibration, the medium was carefully removed from the individual well. Next, 100 μL of equilibration medium (6% v/v of Glosensor Reagent stock solution (Promega, Cat #: E291), 10% FBS (Hydone, Cat #: SH30071.03) and 88% CO2 independent medium (Life Technologies, Cat #: 18045088)) was added per well of the 96-well plate, and added to the side of each well. The plate was then incubated for 2 hours at room temperature. A first pre-read measurement was taken using a microplate reader (MicroLumat Plus). Plates were incubated for an additional 10 minutes at room temperature, followed by a second pre-read measurement.
Working solutions of free treprostinil and treprostinil alkyl ester compounds were prepared at 10× concentration so that the final concentration was 1× once added to the cells. Following treatment, each plate was read every 5 minutes for the duration of the assay using a microplate reader (MicroLumat Plus). In order to determine the fold change in cAMP relative to the control, the transfection efficiency was first determined by dividing the second pre-read measurement by the average of the corresponding pre-read measurements. Next, the normalized relative light units (RLUs) of the samples were determined by dividing the plate read measurement by the transfection efficiency. The fold change in cAMP relative to the control was then determined by dividing the normalized RLU of the samples by the normalized RLU of the control.
Validation of cAMP Assay Using Free Treprostinil
The cAMP assay was validated using free treprostinil. Treprostinil (10 μM, 1 μM, 0.1 μM, 0.01 μM, 0.001 μM, 0.0001 μM, 0.00001 μM, and 0.000001 μM) was added to equilibrated CHO-K1 cells, and the cells were then incubated for 30 minutes. Luminescence was then measured at room temperature.
Alkyl Ester treprostinil Compositions
CHO-K1 cells co-transfected with the EP2 receptor and GloSensor™ plasmid were challenged with free treprostinil (10 μM, 1 μM, 0.1 μM, 0.01 μM, 0.001 μM, 0.0001 μM, 0.00001 μM, 0.000001 μM) and treprostinil alkyl ester compounds, i.e., compounds having either a C6, C8 or C10 straight chain alkyl group at the R2 position of the compound of Formula (A), shown above.
The following concentrations of compounds were measured: 10 μM, 1 μM, 0.1 μM, 0.01 μM, 0.001 μM, 0.0001 μM, 0.00001 μM, 0.000001 μM. cAMP levels were then measured every 5 minutes over a time course of 8 hours. Results from the three highest concentrations are provided at
cAMP levels in response to the treprostinil decyl ester (C10-TR) (10 μM) were equivalent to free treprostinil and the levels were sustained for at least 6 hours. The sustained cAMP level was not exhibited in response to free treprostinil.
CHO-K1 cells co-transfected with the EP2 receptor and GloSensor™ plasmid were challenged with free treprostinil (5 μM) and treprostinil compositions having either a treprostinil derivatized at the R2 position of the above compound with a C2, C6, C8, C10, or C12 straight chain group (5 μM). The components of the treprostinil compositions are provided in Table 5, below. cAMP levels were then measured every 5 minutes over a time course of 8 hours.
Results of these experiments using the 5 μM dose are provided at
The cell based (CHO-K1) cAMP assay was also used to characterize the effect of unformulated treprostinil compounds (i.e., compounds without a hydrophobic additive and/or an amphiphilic agent such as a PEGylated lipid) on cAMP levels.
CHO-K1 cells co-transfected with the EP2 receptor and GloSensor™ plasmid were challenged with free treprostinil (5 μM) and treprostinil derivatives having either a C2, C3, C4, C5, C6, C8, C10, or C12 straight chain alkyl ester moiety (5 μM). cAMP levels were then measured every 5 minutes over a time course of 8 hours.
Results of these experiments are provided at
The cell based (CHO-K1) cAMP assay described above was also used to characterize the effect of nebulization of various treprostinil compositions on cAMP levels.
CHO-K1 cells co-transfected with the EP2 receptor and GloSensor™ plasmid were challenged with 10 μM free treprostinil (control or nebulized) and 10 μM treprostinil compositions comprising a compound derivatized with either a C2, C8, C10, or C12 straight chain alkyl group at position R2 of the compound of Formula (A), provided above (control or nebulized).
The compositions tested in this experiment are provided in Table 6 below (results in
Nebulizer Aeroneb Pro (Aerogen) was used to nebulize treprostinil derivative compositions. Desired volume of the formulation (usually 3 mL) was loaded to the mesh head of the nebulizer. The head was connected directly to the glass impinger with air-tight seal. Nebulization was carried out using factory settings until the entire sample was nebulized. After nebulization was complete, the head was disconnected; impinger capped and centrifuged 5 min at 600×g to settle the aerosol inside the impinger. The procedure provided nearly 100% yield in collecting the nebulized sample.
As shown in
The half maximal effective concentrations (EC50) of the various treprostinil compounds were determined using the results from the cAMP assays. Table 7 (below) summarizes the EC50 data for cAMP response in CHO-K1 cells for the following compositions and compounds:
T554 (C2-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T501 (C8-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 20 mol %),
T601 (C6-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T555 (C8-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T556 (C10-TR 40 mol %, squalane 40 mol %. Chol-PEG2k 10 mol %, DOPC 10 mol %).
T568 (C12-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T623 (C16-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
free treprostinil.
A subset of the dose response curves for selected treprostinil compounds and compositions are provided in
In order to determine any effect of treprostinil compounds on cell proliferation, cell based assays using CHO-K1 cells and rat alveolar cells (NR8383 cells) were performed.
CHO-K1 cells were harvested when the cell monolayer was 50-90% confluent (use passage 4-11). Media was aspirated out of the flask, and cells were rinsed with 2 mL of F12 media. Next, 1 mL of pre-warmed (37° C.) 0.25% trypsin-EDTA (Life Technologies, Cat#: 25300054) was added, and cells were dislodged from the flask by tapping it on the side. Complete growth media (F12 (Life Technologies, Cat #: 31765092)+10% FBS (Hyclone, Cat #: SH30071.03)+1× Pen-Strep (Life Technologies, cat #15140-122) was then added at a volume of 10 mL. Cells were centrifuged at 250×g for 5 minutes at room temperature, and the media was aspirated. The cell pellet was resuspended in 10 mL complete growth media. Cell number was determined using a hemacytometer. Cells were then seeded at 2000 cells per well of a 96-well plate in 100 μL of complete growth media. The plate was incubated overnight at 37° C. and 5% CO2 in a water-jacketed incubator.
The next day, 80 μL of fresh complete media was added to each well, and CHO-K1 cells were challenged with treprostinil compound and composition treatments. The working solutions were prepared at 10× concentration, and following 2 fold serial dilutions, 20 μL aliquots were added per well to arrive at a final 1× concentration. Following a 48 hour incubation at 37° C. and 5% CO2 in a water-jacketed incubator, the inhibitory effect on cell proliferation was determined. Plates were analyzed using 20 μL of Presto Blue reagent (Life Technologies, cat #: A13262) per well. The reagent was mixed, and plates were incubated for 1 hour at 37° C. and 5% CO2 in a waterjacketed incubator. Plates were read using either a CytoFluor Series 4000 (PerSeptive BioSystems) or Synergy Neo microplate reader (BioTek) with emission λ: 590 nm and excitation λ: 560 nm. The percent inhibition was determined using the following formula: % inhibition−100%−(treated samples/control×100%).
Rat alveolar NR8383 cells were harvested when the monolayer was 50-90% confluent (use passage 5-11). Because the NR8383 cells include both adherent and non-adherent cells, media was transferred to a 50 mL Falcon tube. To obtain the cells remaining in the flask, 2 mL of plain media was added, and the remaining cells were scraped out of the 75 cm2 flask with a cell scraper and added to the 50 mL tube. Cells were centrifuged at 200×g for 5 minutes at room temperature, and the media was aspirated. The cell pellet was resuspended in 10 mL complete growth media (F12 (Life Technologies, Cat #: 31765092)+15% FBS-heat inactivated (Hyclone, Cat #: SH30071.03)+1×Pen-Strep (Life Technologies, cat #: 15410-122)). Cell number was determined using a hemacytometer. Cells were then seeded at 4000 cells per well of a 96-well plate in 100 μL of complete growth media. The plate was incubated overnight at 37° C. and 5% CO2 in a water-jacketed incubator.
The next day, 80 μL of fresh complete media was added to each well, and the NR8383 cells were challenged with treprostinil compound treatments. Following a 72 hour incubation at 37° C. and 5%, CO2 in a water-jacketed incubator, the inhibitory effect on cell proliferation was determined. Measurements and calculations were made as described above for the CHO-K1 cells.
CHO-K1 cells were challenged with compositions comprising treprostinil alkyl ester derivatives:
T554 (C2-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T555 (C2-TR 40 mol %, squalane 40 mol %. Chol-PEG2k 10 mol %, DOPC 10 mol %),
T556 (C10-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T568 (C12-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
T623 (C16-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %),
at concentrations ranging from 0.55 μM to 125 μM. Following a 48 hour incubation period, the inhibitory effect of the treprostinil derivative compositions on cell proliferation was determined.
Table 8 below summarizes the effect of the above treprostinil compositions on CHO-K1 cell proliferations. At the highest concentration of 100 μM, only T543 (C6-TR) and T623 (C16-TR) exhibited a significant inhibitory effect on cell proliferation.
Rat alveolar NR8383 cells were challenged with the same treprostinil derivative compositions:
T543 (C6-TR 40 mol %, Toco Ace 40 mol %, Chol-PEG2k 20 mol %), T554 (C2-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %), T555 (C8-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %), T556 (C10-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %), T568 (C12-TR 40 mol %, squalane 40 meol %, Chol-PEG2k 10 mol %, DOPC 10 mol %), and T623 (C16-TR 40 mol %, squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %), at the same concentrations (0.55 μM to 125 μM) as the CHO-K1 cells above. Following a 72 hour incubation period, the inhibitory effect of the treprostinil derivative compositions on cell proliferation was determined.
Table 8 above summarizes the effect of the above treprostinil compositions on NR8383 cell proliferation. At the highest dose of 100 μM, all of the treprostinil derivative compositions demonstrated some inhibition of cell proliferation, and T543 (C6-TR) exhibited the greatest inhibitory effect.
In order to determine any effect of treprostinil derivative compounds (unformulated) on cell proliferation, the cell based assays described above, using CHO-K1 cells and rat alveolar cells (NR8383 cells) were performed.
CHO-K1 cells were challenged with treprostinil alkyl esters, i.e., TR compounds of Formula (A), having the following R2 groups:
C2, C3, C4, C5, C6, C8, C10 or C12 straight chain alkyl, at dosages ranging from 0.098 μM to 25 μM. Following a 48 hour incubation period, the inhibitory effect on cell proliferation was determined.
Table 9 below summarizes the effect of the above treprostinil alkyl esters on CHO-K1 and NR8383 cell proliferation. At the highest concentration, only the treprostinil octyl ester compound showed inhibition of cell proliferation.
Rat alveolar NR8383 cells were challenged with treprostinil compounds derivatized at the R2 position of Formula (A) with a C2, C3, C4, C5, C6, C8, C10 or C12 straight chain alkyl moiety at concentrations ranging from 0.195 μM to 25 μM. Following a 72 hour incubation period, the inhibitory effect on cell proliferation was determined.
Table 11 above summarizes the effect of the above treprostinil alkyl esters on NR8383 cell proliferation. Similar to the CHO-K1 cell assay, only the treprostinil octyl ester showed some inhibition of cell proliferation at the highest concentration.
In order to determine the effect of treprostinil derivative compositions on cell proliferation, cell based assays using CHO-K1 cells and rat alveolar cells (NR8383 cells) were performed.
Effect of Treprostinil Compositions on CHO Cell proliferation
CHO-K1 cells were challenged with treprostinil derivative compositions: T596 (C2-TR 45 mol %, DSG-P2K 55 mol %), T597 (C6-TR 45 mol %, DSG-P2K 55 mol %), T598 (C-TR 45 mol %, DSG-P2K 55 mol %), T599 (C10-TR 45 mol/e, DSG-P2K 55 mol %), and T600 (C12-TR 45 mol %. DSG-P2K 55 mol %), T612 (C2-TR 10 mol %, DMPE-PIK 90 mol %), T613 (C2-TR 10 mol %, DMPE-PIK 90 mol %), at concentrations ranging from 0.23 μM to 29 μM. Following a 72 hour incubation period, the inhibitory effect on cell proliferation was determined. Following a 48 hour incubation period, the inhibitory effect on cell proliferation was determined.
Table 10 below summarizes the effect of the treprostinil compositions on CHO-K1 cell proliferation. None of the compositions tested exhibited a significant inhibitory effect on CHO-K1 cell proliferation.
Similarly, CHO-K1 cells were challenged with the treprostinil compositions T612 (R2=C2), T613 (R2=C8) at concentrations ranging from 1.41 μM to 180 μM. After 48 hours, the inhibitory effect on cell proliferation was determined, and all four of the treprostinil compositions exhibited 100% inhibition of cell proliferation at the higher concentrations.
Rat alveolar NR8383 cells were challenged with the same treprostinil compositions (above) as well as T596 (C-TR 45 mol %, DSG-P2K 55 mol %), T612 (C2-TR 10 mol %, DMPE-PlK 90 mol %), T597 (C6-TR 45 mol % DSG-P2K 55 mol %), T598 (C8-TR 45 mol %, DSG-P2K 55 mol %), T613 (C8-TR 10 mol %, DMPE-PIK 90 mol %), T599 (C10-TR 45 mol %, DSG-P2K 55 mol %), T600 (C2-TR 45 mol %, DSG-P2K 55 mol %), and at the same concentrations (0.23 μM to 29 μM) as the CHO-K1 cells above. Following a 72 hour incubation period, the inhibitory effect on cell proliferation was determined.
Table 10 above summarizes the effect of the treprostinil composition on NR8383 cell proliferation. AU of the treprostinil compositions demonstrated some (≦10%) inhibition of NR8383 cell proliferation.
The effect of treprostinil derivative compounds in vivo was determined by using rat models. Young male rats Sprague Dawley (Charles River) were used for the study. Rats anesthetized with ketamine/xylazine, placed on a heating pad and after surgical isolation and catheterization of the trachea, mechanically ventilated throughout the study.
A catheter was placed in the femoral artery for measurement of systolic (sys) and diastolic (dias) blood pressures. A thoracotomy was performed and a catheter inserted into the right ventricle and positioned in the pulmonary artery for the measurement of pulmonary arterial systolic and diastolic blood pressures. Oxygen saturation (SaO2) was measured with a pulse oximeter placed on the paw.
With the rats ventilated on room air (FlO2-0.21), cardiovascular measurements were made under these normoxic conditions. In order to induce hypoxia the FIO2 was reduced over a 30 min period until SaO2 fell to values between 50-60%, and a baseline hypoxia value for each of the parameters was determined.
Groups of four rats each received either PBS, free treprostinil (1.7 μg/kg and 10 μg/kg), or a composition comprising C2-TR (T554); C8-TR (T555: C8-TR 40 mol %, squalane 40 mol %. Chol-PEG2k 10 mol %, DOPC 10 mol %) (38.6 μg/kg), C10-TR (T556: C10-TR 40 mol % squalane 40 mol %, Chol-PEG2k 10 mol %, DOPC 10 mol %) (40.8 μg/kg)) C12-TR (T568).
The target dose varied slightly by weight due to the differences in molecular weight of the treprostinil derivative compositions as shown in Table 11 below. The actual achieved lung dose was about 5× lower than provided in Table 11 (e.g., administration of 10 pglkg yielded about 2 μg/kg in the lungs). The various treatments were delivered (via inhalation of nebulized drug to the lungs of the rats. The pulmonary arterial pressure (PAP), systemic arterial pressure (SAP), and heart rate of the rats were measured continuously for 180 minutes. The PAP signal was collected at 200 points per second.
The normalized variation of mean PAP (mPAP) is shown as a percentage from the hypoxic baseline value at (T=0) in
A cell based Chinese hamster ovary-K1 (CHO-K1) assay based on the GloSensor™ cAMP assay (Promega) was used as described above in Example 4 to characterize the effect of the following compounds on cAMP levels:
C16-TR i.e., the compund of Formula (A in R2=C16 alkyl
CHO-K1 cells co-transfected with the EP2 receptor and GloSensor™ plasmid were challenged with 5-nonanyl-treprostinil (branched chain, 5C9-TR) or treprostinil alkyl ester compounds having either a C12, C14 or C16 straight chain alkyl group at the R2 position of the above compound. cAMP levels were then measured every 5 minutes over a time course of 8 hours. Dose response curves at 0.5 hr, 1 hr, 2 hr, 3 hr, 4 hr, 5 hr, 6 hr, 7 hr, and 8 hr incubation time for 5-nonanyl-TR, C14-TR, and C16-TR are provided in
Kinetic profile results from the 10 μM (top panel) and 5 μM (bottom panel) concentrations of C12-TR, C14-TR, C16-TR, or 5-nonanyl-TR are provided at
The results of the study showed that like the treprostinil alkyl ester compounds having a C12, C14 or C16 straight chain alkyl ester group, 5-nonanyl-TR, is functional and exhibits sustained cAMP activity. Thus, unlike free treprostinil (see Example 4), 5-nonanyl-TR has a delayed release profile.
A cell based Chinese hamster ovary-K1 (CHO-K1) assay based on the GloSensor™ cAMP assay (Promega) was used as described above in Example 4 to characterize the effect of different C14-TR formulations on cAMP levels. The C14-TR formulations are shown below in Table 12. Composition T679 does not comprise DOPC; composition T647 does not comprise DOPC or squalane.
The structure of C14-TR is as follows:
CHO-K1 cells co-transfected with the EP2 receptor and GioSensor™ plasmid were challenged with treprostinil alkyl ester formulations having a C14 straight chain alkyl ester group at the carboxylic acid position and having the components as indicated in Table 12. cAMP levels were then measured every 5 minutes over a time course of 8 hours.
A dose response curve at 0.5 hr, 1 hr, 2 hr, 3 hr, 4 hr, 5 hr, 6 hr, 7 hr, and 8 hr incubation time for compound T679 is provided in
Kinetic profile comparisons for free treprostinil, T631, and T679 at 10 μM (top panel) and 5 μM (bottom panel) are shown in
A dose response curve at 0.5 hr, 1 hr, 2 hr, 3 hr, 4 hr, 5 hr, 6 hr, 7 hr, and 8 hr incubation time for compound T647 is provided in
Kinetic profile comparisons for free treprostinil, T631, and T647 at 10 μM (top panel) and 5 μM (bottom panel) are shown in
A cell based Chinese hamster ovary-K1 (CHO-K1) assay based on the GloSensor™ cAMP assay (Promega) was used as described above in Example 4 to characterize the effect of treprostinil compositions on cAMP levels. The cAMP profiles of the following treprostinil compositions were tested in this study (see also Table 13):
CHO-K1 cells cotransfected with the EP2 receptor and GloSensor™ plasmid were challenged with the treprostinil alkyl ester compositions listed above. cAMP levels were then measured every 5 minutes over a time course of 8 hours.
A dose response curve at 0.5 hr, 1 hr, 2 hr, 3 hr, 4 hr, 5 hr, 6 hr, 7 hr, and 8 hr incubation time for composition T637 (C8-TR) is provided in
Kinetic profile comparisons for free treprostinil, T555, T556, T568, T631, T623, and T637 at 10 μM (top panel) and 5 μM (bottom panel) are shown in
A set of studies was conducted to determine the conversion kinetics to treprostinil of linear treprostinil compounds versus various branched treprostinil compounds. 0.4 mM of linear C8-TR or branched treprostinil compounds 2-dimethyl-1-propanyl-TR, 3,3-dimethyl-1-butanyl-TR, 2-ethyl-1-butanyl-TR, 5-nonanyl-TR, or 3-pentanyl-TR (see below for structures) were incubated with 0.2 U esterase at 37° C. for 1 hour, and the conversion (% of total) was calculated at 0.25, 0.5, 0.75, or 1 hour incubation time.
Each of the branched compounds 4C7-TR, 4C8-TR, and 5C9-TR exhibited a slower conversion rate than the linear compound C-TR. The asymmetrical branched compound (4C8-TR) exhibited a slower conversion rate than the symmetrical compounds (4C7-TR and 5C9-TR). Further, there was no significant difference between the conversion rates of R and S isomers of 2C8-TR ((R)-2C8-TR versus (S)-2C8-TR).
Table 14 provides the treprostinil alkyl ester formulations used in this study. The first three compositions (T568, T631 and T623) are believed to form lipid nanoparticles, while the last three compositions (T630, T635 and T636) are believed to form micelles.
T568 and T630: C12-TR (i.e., the compound of Formula (A) wherein R2=
T631 and T635: C14-TR (i.e., the compound of Formula (A) wherein R2=
T623 and T636: C16-TR (i.e., the compound of Formula (A) wherein R2=
Nebulized treprostinil (TRE) solution and treprostinil alkyl ester formulations were administered (at 15 nmol/kg, or 6 mg/kg TRE equivalent) to anaesthetised-ventilated rats (6-hour studies) or to conscious rats by nose-only inhalation (24-hour studies). Blood and lung samples were collected at specified time points. TRE and treprostinil alkyl ester concentrations in blood plasma and lung tissue were measured by HPLC/MS/MS analysis.
Male Sprague Dawley rats were anaesthetised and prepared with endotracheal tube for ventilation. The right femoral vein was cannulated to facilitate blood collections. Terminal lung samples were taken for analysis only 6 hours after dosing. Aeroneb® nebulizer and a controller (Aerogen, Galway, Ireland) were used to produce aerosol of a mass median aerodynamic diameter (MMAD) between 2.5 μm and 4 μm and at a rate of 0.1 mL/min to provide an estimated pulmonary dose of 6 μg/kg. A SAR-830/AP Small Animal Ventilator (CWE Inc., Ardmore, Pa.) set up at ventilator tidal volume (VT) of 8 mL/kg, rate of 90 breaths/min, was used to deliver nebulized test articles of volume 250 μL. Systemic blood pressure (mSAP), heart rate (HR), and arterial oxygen saturation (Sa02). Physiologic parameters were measured during normoxia (fraction of inspired oxygen [FrO2]=0.21, SaO2≈90%) and for 2 to 3 hours during hypoxia (FrO2=0.10, SaO2≈50%).
Male Sprague Dawley rats were placed in restraining tubes and exposed to nebulised drugs via the Jaeger-NYU Nose-Only Directed-Flow Inhalation Exposure System (CH Technologies, Westwood, N.J.) (
Ventilated rats treated with nebulized TRE solution had the highest blood plasma concentration (Cmax) (3.5 ng/mL), which occurred immediately after dosing (
Inhaled TPDs are present in the lungs for an extended duration and are associated with a slow, sustained release of TRE into the blood. This duration of activity is increased with TPD formulated in lipid nanoparticles.
Twelve beagle dogs of either sex were randomly assigned to different inhaled doses of treprostinil in PBS or the compound of Formula (A) wherein R2=
(C16-TR) formulated in a lipid nanoparticle formulation (T623) that is suspended in PBS (see Table 14), with both given by nebulizer. Formulations were nebulized with an Aeroneb nebulizer (MMAD: 2.5-4 μm) delivered into a 500 m1 expansion chamber. Formulations were nebulized for 2 min at ventilator settings of 90 ml/breath, 15 breaths/min (delivered volume=2.7 L) and collected on a filter. Drug amount (μg) on the filter was measured by HPLC to calculate the concentration of drug delivered through the ventilator circuit (μg/L).
Dosimetry was performed in propofol-anesthetized dogs in which nebulized drugs were introduced into a mixing chamber interposed on the inspiratory limb of a canine respirator. Technical trials were performed before each experiment to measure the concentration of drug (μg/L) delivered for each breath. The inhaled drug dose (μg/kg) was calculated using the formula: Inhaled Drug Dose (μg/kg)=Drug Conc. (μg/L)×Minute Ventilation (L/min.)×Time (min.)/Body Weight (kg). After delivery of the drugs, the dogs were disconnected from the respirator and blood samples were collected over a 72 h period to measure the treprostinil plasma concentrations by HPLC/MS/MS. Clinical signs were monitored over this 72 hr. period.
Use of the anesthetized, intubated and ventilated approach provided reproducibility between dogs to achieve the targeted inhaled dose for both treprostinil (5±1 and 16±2 μg/kg) and C16-TR (7±1, 22±1, 46±1 and 95±1 μg/kg). At inhaled doses of 5 and 16 μg/kg, treprostinil plasma Cmax values for dogs dosed with treprostinil (2.7 and 5.9 ng/ml, respectively) were between 15-20 fold higher compared to treprostinil levels achieved upon dosing with similar inhaled doses (7 and 22 μg/kg) of C16-TR in the T623 formulation (0.2 and 0.3 ng/mL, respectively) (
Comparison of C16 Alkyl Ester Lipid Nanoparticle Treprostinil Formulation to C12 and C14 Alkyl Ester Lipid Nanoparticle Treprostinil Formulations
Twelve beagle dogs were exposed to inhaled treprostinil and three treprostinil alkyl ester lipid nanoparticle formulations: T568 (dodecyl-treprostinil, C12-TR), T631 (tetradecyl-treprostinil, C14-TR) and T623 (hexadecyl-treprostinil, C16-TR). The components of each formulation are provided in Table 14, above.
Dosimetry was performed in propofol-anesthetized, artificially ventilated dogs in which nebulized drugs were introduced into a mixing chamber interposed on the inspiratory limb of the respirator. Technical trials were performed before each experiment measuring the concentration of drug (μg/L) per breath, minute ventilation and time required to achieve a targeted pulmonary dose. After recovery from the anesthesia, blood samples were collected over 72 h and plasma levels of TRE measured by HPLC/MS/MS. Clinical signs (cough, rapid shallow breathing, emesis and pale gums) were also monitored.
At a targeted pulmonary dose of 18 μg/kg, plasma levels of treprostinil were highest for free treprostinil (Cmax=5.9±0.6 ng/ml) immediately after dosing but corresponding Cmax values for C12-TR, C14-TR and C16-TR were 5-, 13- and 20-fold lower. Plasma treprostinil was below the level of quantification by 4 h after inhaled free treprostinil, but was sustained for 48-72 h after inhaled treprostinil alkyl ester formulations.
Dosedependent increases in Cmax and AUC were seen with inhaled C16-TR (6-90 μg/kg) with a prolonged presence of treprostinil in the plasma for up to 72 h at higher doses. Adverse clinical signs were seen with free treprostinil and C12-TR at a targeted dose of 18 μg/kg, but not with C14-TR and C16-TR. In the dose-response study with C16-TR, adverse clinical signs were seen in only 1 dog at a targeted pulmonary dose of 90 μg/kg.
Based upon this PK study in dogs, inhaled C16-TR in a nanoparticle formulation provides sustained presence of treprostinil in the plasma and lower side effect potential than inhaled free treprostinil at comparable doses.
T748, a lipid nanoparticle C16 alkyl ester treprostinil formulation having the following components, was characterized.
Assessment of the Tolerability and Pharmacokinetics (PK) of Treprostinil in Rats administerd T748 lipid nanoparticle formulation
To assess whether repeated dosing with inhaled C16-TR is well tolerated and alters PK, rats were exposed to C16-TR for 14-consecutive days.
5 groups (n=4 per group) of Sprague Dawley rats were exposed to inhaled phosphate buffered saline (PBS) or 4 doses of C16-TR (0.6, 1.8, 6 and 18 μg/kg) given by nebulization in a nose-only inhalation chamber. Cohorts of rats were studied after 1, 7 and 14 daily inhaled doses of C16-TR and blood samples were collected at 1, 3, 6 and 24 hr., and lungs harvested at 24 hr. after the last dose of the drug. Concentrations of treprostinil and C16-TR in the plasma and lungs were measured by HPLC/MS/MS. Body weights were recorded daily and organ weights (lungs, heart, liver) were measured 24 hr. after the last drug dose.
There were no tolerability issues or significant changes (relative to PBS) in body weights and organ weights after inhalation of C16-TR for 14-consecutive days. Increasing inhaled doses of C16-TR (0.6-18 μg/kg) increased the plasma Cmax and AUC but this was not consistently affected upon repeated dosing. There was some variability in AUC between days 1 and 14 within the different dosing groups with 2 of the 4 doses (1.8 and 18 μg/kg) showing no difference, and the other 2 doses (0.6 and 6 μg/kg) showing a 3- to 4-fold increase in AUC by day 14. The presence of C16-TR was not detected in the plasma at any dose. However, relatively high concentrations of C16-TR (approximately 1.000-fold higher than plasma treprostinil) were found in the lungs. Inhaled C16-TR produced a dose-dependent increase in the concentration of C16-TR in the lungs, but this was not changed by repeated dosing for 14-consecutive days.
Inhaled C16-TR (0.6-18 μg/kg) was well tolerated with no evidence of body weight and organ weight change after dosing for 14 consecutive days.
Effect of C16 Alkyl Ester Lipid Nanoparticle Treprostinil Formulation on the Cough Reflex in Guinea Pigs
In this study, the tussive effects of inhaled treprostinil and a lipid nanoparticle formulation of the alkyl ester hexadecyl-treprostinil (C16-TR), were studied in guinea pigs.
Three groups of male Dunkin Hartley guinea pigs were placed in a whole body plethysmograph and exposed to aerosolized phosphate buffered saline (PBS), TRE (1-300 μg/ml) and C16-TR lipid nanoparticle formulation T748 (30 μg/ml), respectively. T623 has the following components: C16-TR 40 mol e %, squalane 40 mol %, chol-PEG2k 10 mol %, DOPC 10 mol %).
Aerosols were generated with an Ultra-Neb Pro nebulizer (nebulizer output 0.36 mL/min.) that was mixed with inspired air delivered at a rate of 2 L/min. The PBS or drugs were delivered for 10 min. and the number of coughs recorded during and for 20 min. after the delivery. Coughs were detected by visual observations, plethysmograph recordings and cough sounds.
Exposure to aerosolized PBS did not induce cough. TRE exposure did not consistently evoke cough in the animals tested until the exposure concentration was equal to or greater than 30 μg/mL. The cough response was characterized by bouts of high frequency cough with lowered cough sounds compared to the typical cough sound induced by citric acid or capsaicin. TRE at a nebulized concentration of 30 μg/mL produced consistent cough in 7 of 7 guinea pigs with 1-4 cough bouts and a total number of coughs averaging 36±9 coughs. In contrast, inhaled C16-TR lipid nanoparticle formulation at a nebulized concentration of 30 μg/mL did not induce cough, no events, in 6 of 6 guinea pigs.
The results in this study demonstrate that inhaled TRE induces cough in guinea pigs, the profile of which is somewhat similar to that previously described (Type II coughs) with inhaled prostaglandins in guinea pigs (Maher and Belvisi, 2010). On the other hand, inhaled C16-TR lipid nanoparticle formulation, did not induce cough and suggests that this formulation may eliminate some of the local adverse side effects such as cough seen with inhaled TRE therapy in humans.
Treprostinil or treprostinil ester derivatives (e.g., derivatized with alkyl or alkenyl groups at the carboxylic acid moiety as prepared in Example 1) are acylated as follows.
The compound of Example 1 (0.05 mol) or treprostinil is dissolved in 10 mL of dichloromethane at 0° C. Dimethylaminopyridine is added (20 mol %, and then a solution of an acyl chloride R(CO)Cl (2.1 equivalents) at 0° C. (wherein R is R5 or R6 as described herein) is added to the compound of Example 1 or treprostinil. The solution is allowed to stir and warm to 23° C. over 1 hour. The reaction is monitored by thin layer chromatography, and when no further change is observed, the reaction is quenched with NaHCO3 (sat) and the quenched mixture is extracted with dichloromethane (3×10 mL). The combined organic extracts are dried over anhydrous sodium sulfate, and the solvent is removed under vacuum to afford the crude product. Purification is effected by column chromatography on silica gel with 2% methanol in dichloromethane.
A general scheme for synthesis of the acylated treprostinil-derivatives is shown below (R2 is described herein, for example as H or a linear or branched alkyl group):
Other acylation techniques known in the art, including selective acylation of each of the secondary alcohols, can be employed. In addition, R2 can be selected such that the R2 group can be selectively removed from the compound of Example 11 after acylation of the secondary hydroxyl functionalities. Such protecting group strategies are well known to those skilled in the art, and are described in, e.g., Peter G. M. Wutes and Theodora W. Greene, Greene's Protective Groups in Organic Synthesis, 4th Edition, Wiley (2006), which is incorporated herein by reference in its entirety for all purposes. An exemplary scheme of such a process is shown below:
Synthesis of C16TR-OAc:
To a solution of (1R,2R,3aS,9aS)-[[2,3,3a,4,9,9a-heahydro-2-hydroxy-1-[(3S)-3-hydroxyoctyl]-1H-benz[f]inden-5-yl]oxy]acetic acid (treprostinil) (78.1 mg, 200 μmoles) dissolved in 1,4-Dioxane (2.0 mL) was added tiethylamine (TEA) (98 μL, 700 μmoles, 3.5 equivalents), acetic anhydride (166 μL, 1,760 μmoles, 8.8 equivalents), and a catalytic amount of dimethylaminopyrdine (DMAP). The reaction mixture was allowed to shake at 40° C. for 72 hours. Solvent was removed under reduced pressure to yield a thick colorless oil. The crude material was dissolved in hexanes and washed with a solution of saturated NaHCO3 (3×5 mL). The organic layers were combined and solvent was removed using a gentle stream of warmed N2 gas and gentle heat to yield a thick colorless oil. The crude material was dissolved in 20% “PrOH/Hexanes, passed through a 0.45 μm syringe filter, and submitted to preparatory HPLC purification. Solvent was removed from the purified material using a gentle stream of warmed N2 gas and gentle heat to yield a thick colorless oil. The pure material was suspended in ethyl lactate for storage and was submitted to analytical HPLC for concentration determination.
C16-TR-OAc: 73% overall yield. The compound was also characterized by NMR spectroscopy:
1H NMR (500 MHz, CDCl3) δ 0.89 (t, J=7.0 Hz, 6H), 1.17-1.32 (m, 33H), 1.43-1.46 (m, 2H), 1.49-1.66 (m, 8H), 1.89-1.93 (m, 1H), 1.99 (s, 3H), 2.06 (s, 3H), 2.30-2.35 (m, 2h), 2.47 (d of d, J=14.5 Hz, J=6.0 Hz, 1H), 2.55 (d of d, J=15.0 Hz, J=6.0 Hz, 1H), 2.76 (d, of d, J=14.5 Hz, J=6.0 Hz, 1H), 2.90 (d of d, J=15.0 Hz, J=6.0 Hz, 1H), 4.19 (t, J=7.0 Hz, 2H), 4.62 (s, 2H), 4.70-4.74 (m, 1H), 4.87 (p, J=6.0 Hz, 1H), 6.63 (d, J=8.0 Hz, 1H), 6.82 (d, J=8.0 Hz, 1H), 7.08 (t, J=8.0 Hz, 1H) ppm; 13C NMR (125 MHz, CDCl3) δ 14.2, 14.3, 21.5 (2), 22.7, 22.9, 25.1, 26.0 (2), 28.3, 28.8, 29.4, 29.6, 29.7, 29.8, 29.9, 31.9, 32.1, 33.6, 33.7, 34.3, 37.8, 40.7, 49.0, 65.6, 66.2, 74.6, 79.0, 109.8, 121.8, 126.4, 127.6, 140.7, 155.1, 169.6, 171.0, 171.1 ppm.
Treprostinil is available commercially, and can be synthesized, for example, by the methods disclosed in U.S. Pat. Nos. 6,765,117 and 8,497,393. Synthesis of prostaglandin derivatives is described in U.S. Pat. No. 4,668,814. The disclosures of U.S. Pat. Nos. 6,765,117; 8,497,393 and 4,668,814 are each incorporated by reference in their entireties for all purposes.
To a solution of (1R,2R,3aS,9aS)-[[2,3,3a,4,9,9a-hexahydro-2-hydroxy-1-[(3 S)-3-hydroxyoctyl]-1H-benz[f]inden-5-yl]oxy]acetic acid (i.e., treprostinil) (78.1 mg, 200 μmoles) dissolved in 1,4-Dioxane (2.0 mL) was added triethylamine (TEA) (98 μL, 700 μmoles, 3.5 equivalents), alkylamine R1—NH2 (240 μmoles, 1.2 equivalents), and a solution of PyBOP (364 mg, 700 μmoles, 3.5 equivalents) dissolved in 2.0 mL MeCN (acetonitrile).
The reaction mixture was heated to 40° C. and allowed to shake at approximately 100 rpm overnight. Solvent was removed under reduced pressure to yield the crude product as a thick yellow oil. The product was extracted (1-1 extraction) from the oil by repeated washings with 20% “PrOH/Hexanes (3×3 mL). Solvent was removed from the organic extract using a gentle stream of warmed N2 gas and gentle heat to yield a thick, slightly yellow oil. The crude material was dissolved in 20% “PiOH/Hexanes, passed through a 0.45 μm syringe filter, and submitted to preparatory HPLC purification. Solvent was removed from the purified material using a gentle stream of warmed N2 gas and gentle heat to yield a thick, colorless oil. The pure material was suspended in ethyl lactate for storage and was submitted to analytical HPLC for concentration determination.
The following treprostinil amide derivatives of Formula B were made by the synthesis scheme provided above. (Table 17) Percentage yield is also provided in parentheses.
tC8-TR-A
cC7-TR-A
C6-TR-A and C12-TR-A were characterized by NMR spectroscopy.
1H NMR (500 MHz, CDCl3) δ 0.90 (q, J=7.0 Hz, 6H), 1.17 (q. J=12.0 Hz, 1H), 1.30-1.70 (m, 18H), 1.81-1.83 (m, 1H), 1.80-1.93 (m, 1H), 2.20 (p, J=6.0 Hz, 1H), 2.22-2.23 (m, 1H), 2.47-2.54 (m, 2H), 2.75-2.82 (m, 2H), 3.16 (sextet, J=4.0 Hz, 1H), 3.35 (q, J=7.0 Hz, 2H) 3.63 (s, 1H), 3.70-3.80 (m, 1H), 4.48 (s, 2H), 6.55 (s, 1H), 6.70 (d, J=7.5 Hz, 1H), 6.85 (d, J=7.5 Hz, 1H), 7.11 (t, J=7.5 Hz, 1H) ppm; 13C NMR (125 MHz, CDCl3) δ 14.2, 14.3, 22.8, 22.9, 25.6, 26.4, 26.7(2) 28.8, 29.7, 31.6, 32.1, 33.0, 33.8, 35.1, 37.7, 39.2, 41.4, 41.6, 46.5, 52.4, 68.4, 72.8, 110.4, 122.2, 126.8, 127.3, 141.2, 154.5, 168.7 ppm; HRMS (ESI, 2:2:1 MeCN, MeOH, H2O): m/z=474.35717 ([M+H]+).
HRMS (ESI, 2:2:1 MeCN, MeOH, H2O): m/z=558.45099 ([M+H]+).
Selected treprostinil derivatives were evaluated for the use in a metered dose inhaler (MDI). Four ester derivatives, dodecyl-treprostinil (C12-TR), tetradecyl-treprostinil (C4-TR), hexdecyl-treprostinil (C16-TR), and the branched chain nonanyl-treprostinil (5C9-TR), and two amide derivatives, C16-TR-A and C12-TR-A (see Table 17) were tested for solubility in hydrolluoroalkane propellants HFA-134a and HFA-227 with added ethanol.
5 mg of each treprostinil compound was added in a glass bottle. Specific amount of ethanol was added by weight. An MDI valve was crimped to each bottle, and HFA propellant added through the valve to the total volume of 5 mL. Compounds were allowed to dissolve for 24 hours at room temperature. The formulations were assessed visually for solubility. The goal was to estimate the minimum ethanol concentration required to solubilize each compound in propellant.
Soluble samples presented as clear and colorless solutions. Less than soluble samples had a thin liquid-vapor ring of various density visible on the bottle surface at the liquid-vapor interface. Non-soluble samples had white precipitate or crystals formed. Ethanol was added as a solubility aid. As it can be seen from the solubility tables below (Table 18 and Table 19), compounds that were not soluble at 3% added ethanol became soluble at 10 or 13% added ethanol.
Male Sprague Dawley rats (N=3) were anesthetized and prepared with endotracheal tube for ventilation. The right femoral vein was cannulated to facilitate blood collections. Rats were administered the lipid nanoparticle formulation T763, which has the following components: (C12-TR-A 45 mol %, squalane 45 mol %, DSPE-PEG2000 10 mol %).
Aeroneb® nebulizer and a controller (Aerogen, Dangan, Galway. Ireland) were used to produce aerosol of a mass median aerodynamic diameter (MMAD) between 2.5 μm and 4 μm and at a rate of 0.1 mL/min.
A SAR-830/AP Small Animal Ventilator (CWE Inc., Ardmore, Pa.) set up at ventilator tidal volume (VT) of 8 mL/kg, rate of 90 breaths/min was used to deliver nebulized test articles of volume 300 μL. The targeted dose was 6 ug/kg of Treprostinil equivalent.
The plasma level of treprostinil were significantly lower than when nanoparticle formulation T568 (C2-TR 40 mol %, squalane 40 mol %, chol-PEG2k 10 mol %, DOPC 10 mol %), containing C12-TR alkyl ester was used with the same dose. This suggests that the conversion rate of the amide prodrug is much slower than the rate for the ester prodrug of treprostinil.
While the described invention has been described with reference to the specific embodiments thereof it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the true spirit and scope of the invention. In addition, many modifications may be made to adopt a particular situation, material, composition of matter, process, process step or steps, to the objective spirit and scope of the described invention. All such modifications are intended to be within the scope of the claims appended hereto.
Patents, patent applications, patent application publications, journal articles and protocols referenced herein are incorporated by reference in their entireties, for all purposes.
This application claims priority from U.S. Provisional Application Ser. No. 62/154,563, filed Apr. 29, 2015, which is incorporated by reference herein in its entirety for all purposes.
| Number | Date | Country | |
|---|---|---|---|
| 62154563 | Apr 2015 | US |
