WO2006091697A1 - Dopamine transporter inhibitors for use in treatment of movement disorders and other cns indications - Google Patents

Dopamine transporter inhibitors for use in treatment of movement disorders and other cns indications Download PDF

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Publication number
WO2006091697A1
WO2006091697A1 PCT/US2006/006338 US2006006338W WO2006091697A1 WO 2006091697 A1 WO2006091697 A1 WO 2006091697A1 US 2006006338 W US2006006338 W US 2006006338W WO 2006091697 A1 WO2006091697 A1 WO 2006091697A1
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inhibitor
dat
disease
dopamine
movement disorder
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PCT/US2006/006338
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English (en)
French (fr)
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James R. Hauske
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Psychenomics, Inc.
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Priority to CA002609440A priority Critical patent/CA2609440A1/en
Priority to US11/884,965 priority patent/US8258305B2/en
Priority to AU2006216646A priority patent/AU2006216646B2/en
Priority to EP06720985A priority patent/EP1853560A1/en
Priority to KR1020077021627A priority patent/KR101233030B1/ko
Priority to JP2007557139A priority patent/JP5199678B2/ja
Publication of WO2006091697A1 publication Critical patent/WO2006091697A1/en
Priority to IL185383A priority patent/IL185383A/en
Priority to US13/603,150 priority patent/US20120329829A1/en

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D211/00—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings
    • C07D211/04—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings with only hydrogen or carbon atoms directly attached to the ring nitrogen atom
    • C07D211/06—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings with only hydrogen or carbon atoms directly attached to the ring nitrogen atom having no double bonds between ring members or between ring members and non-ring members
    • C07D211/08—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings with only hydrogen or carbon atoms directly attached to the ring nitrogen atom having no double bonds between ring members or between ring members and non-ring members with hydrocarbon or substituted hydrocarbon radicals directly attached to ring carbon atoms
    • C07D211/18—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings with only hydrogen or carbon atoms directly attached to the ring nitrogen atom having no double bonds between ring members or between ring members and non-ring members with hydrocarbon or substituted hydrocarbon radicals directly attached to ring carbon atoms with substituted hydrocarbon radicals attached to ring carbon atoms
    • C07D211/20—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings with only hydrogen or carbon atoms directly attached to the ring nitrogen atom having no double bonds between ring members or between ring members and non-ring members with hydrocarbon or substituted hydrocarbon radicals directly attached to ring carbon atoms with substituted hydrocarbon radicals attached to ring carbon atoms with hydrocarbon radicals, substituted by singly bound oxygen or sulphur atoms
    • C07D211/22—Heterocyclic compounds containing hydrogenated pyridine rings, not condensed with other rings with only hydrogen or carbon atoms directly attached to the ring nitrogen atom having no double bonds between ring members or between ring members and non-ring members with hydrocarbon or substituted hydrocarbon radicals directly attached to ring carbon atoms with substituted hydrocarbon radicals attached to ring carbon atoms with hydrocarbon radicals, substituted by singly bound oxygen or sulphur atoms by oxygen atoms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
    • A61P25/16—Anti-Parkinson drugs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/20—Hypnotics; Sedatives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/24—Antidepressants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/04—Anorexiants; Antiobesity agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D295/00—Heterocyclic compounds containing polymethylene-imine rings with at least five ring members, 3-azabicyclo [3.2.2] nonane, piperazine, morpholine or thiomorpholine rings, having only hydrogen atoms directly attached to the ring carbon atoms
    • C07D295/04—Heterocyclic compounds containing polymethylene-imine rings with at least five ring members, 3-azabicyclo [3.2.2] nonane, piperazine, morpholine or thiomorpholine rings, having only hydrogen atoms directly attached to the ring carbon atoms with substituted hydrocarbon radicals attached to ring nitrogen atoms
    • C07D295/06—Heterocyclic compounds containing polymethylene-imine rings with at least five ring members, 3-azabicyclo [3.2.2] nonane, piperazine, morpholine or thiomorpholine rings, having only hydrogen atoms directly attached to the ring carbon atoms with substituted hydrocarbon radicals attached to ring nitrogen atoms substituted by halogen atoms or nitro radicals
    • C07D295/073—Heterocyclic compounds containing polymethylene-imine rings with at least five ring members, 3-azabicyclo [3.2.2] nonane, piperazine, morpholine or thiomorpholine rings, having only hydrogen atoms directly attached to the ring carbon atoms with substituted hydrocarbon radicals attached to ring nitrogen atoms substituted by halogen atoms or nitro radicals with the ring nitrogen atoms and the substituents separated by carbocyclic rings or by carbon chains interrupted by carbocyclic rings
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
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    • G06Q99/00—Subject matter not provided for in other groups of this subclass

Definitions

  • a movement disorder is a neurological disturbance that involves one or more muscles or muscle groups. Movement disorders affect a significant portion of the population, causing disability as well as distress. Movement disorders include Parkinson's disease, Huntington's chorea, progressive supranuclear palsy, Wilson's disease, Tourette's syndrome, epilepsy, tardive dyskinesia, and various chronic tremors, tics and dystonias. Different clinically observed movement disorders can be traced to' the same or similar areas of the brain. For example, abnormalities of basal ganglia (a large cluster of cells deep in the hemispheres of the brain) are postulated as a causative factor in diverse movement disorders.
  • basal ganglia a large cluster of cells deep in the hemispheres of the brain
  • Parkinson's disease is a movement disorder of increasing occurrence in aging populations. Parkinson's disease is a common disabling disease of old age affecting about one percent of the population over the age of 60 in the United States. The incidence of Parkinson's disease increases with age and the cumulative lifetime risk of an individual developing the disease is about 1 in 40. Symptoms include pronounced tremor of the extremities, bradykinesia, rigidity and postural change. A perceived pathophysiological cause of Parkinson's disease is progressive destruction of dopamine producing cells in the basal ganglia which comprise the pars compartum of the substantia nigra, basal nuclei located in the brain stem. Loss of dopamineric neurons results in a relative excess of acetylcholine.
  • Parkinson's disease is a progressive disorder which can begin with mild limb stiffness and infrequent tremors and progress over a period of ten or more years to frequent tremors and memory impairment, to uncontrollable tremors and dementia.
  • Tardive dyskinesia is a chronic disorder of the nervous system, characterized by involuntary, irregular rhythmic movements of the mouth, tongue, and facial muscles. The upper extremities also may be involved. These movements may be accompanied, to a variable extent, by other involuntary movements and movement disorders. These include rocking, writhing, or twisting movements of the trunk (tardive dystonia), forcible eye closure (tardive blepharospasm), an irresistible impulse to move continually (tardive akathisia), jerking movements of the neck (tardive spasmodic torticollis), and disrupted respiratory movements (respiratory dyskinesia).
  • TD TD cases are caused by the prolonged use of antipsychotic drugs (neuroleptics).
  • a relatively small number are caused by the use of other medications, such as metoclopramide, that, like neuroleptics, block dopamine receptors.
  • TD often manifests or worsens in severity after neuroleptic drug therapy is discontinued. Resumption of neuroleptic therapy will temporarily suppress the involuntary movements, but may aggravate them in the long run.
  • Tardive dyskinesia affects approximately 15-20% of patients treated with neuroleptic drugs (Khot et al., Neuroleptics and Classic Tardive Dyskinesia, in Lang AE, Weiner WJ (eds.): Drug Induced Movement Disorders, Futura Publishing Co., 1992, pp 121-166). Therefore, the condition affects hundreds of thousands of people in the United States alone. The cumulative incidence of TD is substantially higher in women, in older people, and in those being treated with neuroleptics for conditions other than schizophrenia, such as bipolar disorder (manic-depressive illness) (see, e.g., Hayashi et al., Clin. Neuropharmacol, 19:390, 1996; Jeste et al., Arch. Gen.
  • TD does not respond in general to antiparkinson drugs (Decker et al., New Eng. J Med., Oct. 7, p. 861, 1971).
  • Focal dystonias are a class of related movement disorders involving the intermittent sustained contraction of a group of muscles.
  • the prevalence of focal dystonias in one US county was estimated as 287 per million (Monroe County Study); this suggests that at least 70,000 people are affected in the US alone.
  • the spasms of focal dystonia can last many seconds at a time, causing major disruption of the function of the affected area.
  • Some of the focal dystonias are precipitated by repetitive movements; writer's cramp is the best known example.
  • Focal dystonia can involve the face (e.g., blepharospasm, mandibular dystonia), the neck (torticollis), the limbs (e.g., writer's cramp), or the trunk.
  • Dystonia can occur spontaneously or can be precipitated by exposure to neuroleptic drugs and other dopamine receptor blockers (tardive dystonia). No systemic drug therapy is generally effective, but some drugs give partial relief to some patients. Those most often prescribed are anticholinergics, baclofen, benzodiazepines, and dopamine agonists and antagonists. The most consistently effective treatment is the injection of botulinum toxin into affected muscles.
  • a tic is an abrupt repetitive movement, gesture, or utterance that often mimics a normal type of behavior.
  • Motor tics include movements such as eye blinking, head jerks or shoulder shrugs, but can vary to more complex purposive appearing behaviors such as facial expressions of emotion or meaningful gestures of the arms and head.
  • the movement can be obscene (copropraxia) or self injurious.
  • Phonic or vocal tics range from throat clearing sounds to complex vocalizations and speech, sometimes with coprolalia (obscene speech) (Leckman et al., supra).
  • Tics are irregular in time, though consistent regarding the muscle groups involved. Characteristically, they can be suppressed for a short time by voluntary effort.
  • Tics are estimated to affect 1% to 13% of boys and 1% to 11% of girls, the male-female ratio being less than 2 to 1. Approximately 5% of children between the ages of 7 and 11 years are affected with tic behavior (Leckman et al., Neuropsychiatry of the Bas. Gang, December, 20(4): 839-861, 1997). The estimated prevalence of multiple tics with vocalization, i.e. Tourette's syndrome, varies among different reports, ranging from 5 per 10,000 to 5 per 1,000. Tourette's syndrome is 3- 4 times more common in boys than girls and 10 times more common in children and adolescents than in adults (Leckman et al., supra; Esper et al, Tenn. Med. 90:18-20, 1997).
  • Gilles de Ia Tourette syndrome is the most severe tic disorder. Patients with TS have multiple tics, including at least one vocal (phonic) tic. TS becomes apparent in early childhood with the presentation of simple motor tics, for example, eye blinking or head jerks. Initially, tics may come and go, but in time tics become persistent and severe, and begin to have adverse effects on the child and the child's family. Phonic tics manifest, on average, 1 to 2 years after the onset of motor tics. By the age of 10, most children have developed an awareness of the premonitory urges that frequently precede a tic. Such premonitions may enable the individual to voluntary suppress the tic, yet premonition unfortunately adds to the discomfort associated with having the disorder. By late adolescence/early adulthood, tic disorders can improve significantly in certain individuals. However, adults who continue to suffer from tics often have particularly severe and debilitating symptoms. (Leckman et al., supra).
  • the present invention relates to the discovery of certain dopamine transporter inhibitors (collectively referred to herein as the subject "DAT inhibitors”), and the use of those inhibitors in methods of treatment, and the production of packaged pharmaceuticals and pharmaceutical preparations.
  • DAT inhibitors are represented by Formula I, or are a pharmaceutically acceptable salt, solvate, metabolite or pro-drug thereof:
  • Ar independently for each occurrence, represents a substituted or unsubstituted aryl or heteroaryl ring;
  • X represents -H or -OR;
  • Y represents -O-, -S-, -C(R) 2 -, or -N(R)-;
  • R independently for each occurrence, represents -H or lower alkyl
  • R 1 represents one or more substituents to the ring to which it is attached, such as halogen, amino, acylamino, amidino, cyano, nitro, azido, ether, thioether, sulfoxido, -J-R 2 , -J-OH, -J-lower alkyl, -J-lower alkenyl, -J-
  • R 2 -J-SH, -J-NH 2 , or substituted or unsubstituted lower alkyl, lower alkenyl, cycloalkyl, heterocyclyl, cycloalkylalkyl, heterocyclylalkyl, aryl, heteroaryl, aralkyl, or heteroaralkyl, or protected forms of the above;
  • R 2 independently for each occurrence, represents H or substituted or unsubstituted lower alkyl, cycloalkyl, heterocyclyl, aralkyl, heteroaralkyl, aryl, or heteroaryl;
  • J represents, independently for each occurrence, a chain having from 0-8 (preferably from 0-4) units selected from -C(R) 2 -, -N(R)-, -O-, and -S-; n is an integer from 0 to 2; p is 0 or 1 ; and q is an integer from 0 to 2, preferably 1.
  • the invention provides a packaged pharmaceutical comprising: a DAT inhibitor of any of the invention in an amount sufficient to treat or prevent a movement disorder and formulated in a pharmaceutically acceptable carrier; and instructions (written and/or pictorial) describing the use of the formulation for treating the patient.
  • the movement disorder may be selected from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics, Tourette's syndrome, olivopontocerebellar atrophy (OPCA), diffuse Lewy body disease, hemibalismus, hemi-facial spasm, restless leg syndrome, Wilson's disease, stiff man syndrome, akinetic mutism, psychomotor retardation, painful legs moving toes syndrome, a gait disorder, a drug-induced movement disorder, or other movement disorder.
  • CBGD corticobasal gang
  • the DAT inhibitor may be provided in an amount sufficient to treat or prevent a movement disorder in a patient by a statistically significant amount when assessed by one or more of Hoehn and Yahr Staging of Parkinson's Disease, Unified Parkinson Disease Rating Scale (UPDRS), and Schwab and England Activities of Daily Living Scale.
  • the DAT inhibitor may be provided in an amount sufficient to treat or prevent a movement disorder in a patient by a statistically significant amount when assessed by a standardized test in combination with an empirical test selected from computer tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET).
  • CT computer tomography
  • MRI magnetic resonance imaging
  • PET positron emission tomography
  • the packaged pharmaceutical may further comprise another medication selected from dopamine precursors, dopaminergic agents, dopaminergic and anti-cholinergic agents, anti-cholinergic agents, dopamine agonists, MAO-B (monoamine oxidase B) inhibitors, COMT (catechol O- methyltransferase) inhibitors, muscle relaxants, sedatives, anticonvulsant agents, dopamine reuptake inhibitors, dopamine blockers, ⁇ -blockers, carbonic anhydrase inhibitors, narcotic agents, GABAergic agents, or alpha antagonists.
  • the packaged pharmaceutical is provided in an escalating dose which produces an escalating serum concentration of said DAT inhibitor(s) over a period of at least 4 hours.
  • the invention provides for the use of a DAT inhibitor of the invention in the manufacture of a pharmaceutical composition for prophylaxis or treatment of a patient susceptible to or suffering from a movement disorder.
  • the movement disorder may be selected from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics, Tourette's syndrome, olivopontocerebellar atrophy (OPCA), diffuse Lewy body disease, hemibalismus, hemi-facial spasm, restless leg syndrome, Wilson's disease, stiff man syndrome, akinetic gang
  • the packaged pharmaceutical or use may be for oral administration.
  • the DAT inhibitor may be formulated as a transdermal patch.
  • the invention provides a method for treating a movement disorder comprising administering to the patient a composition of a DAT inhibitor of the invention in an amount sufficient to treat the movement disorder in the animal as evaluated by a standardized test.
  • the movement disorder may be selected from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics, Tourette's syndrome, olivopontocerebellar atrophy (OPCA), diffuse Lewy body disease, hemibalismus, hemi-facial spasm, restless leg syndrome, Wilson's disease, stiffer
  • the DAT inhibitor may be provided in an amount sufficient to treat a movement disorder in a patient by a statistically significant amount when assessed by one or more of Hoehn and Yahr Staging of Parkinson's Disease, Unified Parkinson Disease Rating Scale (UPDRS), and Schwab and England Activities of Daily Living Scale.
  • the DAT inhibitor may be provided in an amount sufficient to treat or prevent a movement disorder in a patient by a statistically significant amount when assessed by a standardized test in combination with an empirical test selected from computer tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET).
  • CT computer tomography
  • MRI magnetic resonance imaging
  • PET positron emission tomography
  • the method may comprise coadministation of the DAT inhibitor with one or more of a dopamine precursor, a dopaminergic agent; a dopaminergic and anti-cholinergic agent, an anti-cholinergic agent, a dopamine agonist, a MAO-B (monoamine oxidase B) inhibitor, a COMT (catechol O- methyltransferase) inhibitor, a muscle relaxant, a sedative, an anticonvulsant agent, a dopamine reuptake inhibitor, a dopamine blocker, a ⁇ -blocker, a carbonic anhydrase inhibitor, a narcotic agent, a GABAergic agent, or an alpha antagonist.
  • a dopamine precursor e.g., a dopaminergic agent
  • a dopaminergic and anti-cholinergic agent an anti-cholinergic agent
  • a dopamine agonist e.g., a MAO-B (monoamine oxidas
  • the invention provides a method for conducting a pharmaceutical business, comprising: (a) manufacturing the packaged pharmaceutical of the invention; and (b) marketing to healthcare providers the benefits of using the package or preparation to treat patients suffering from a movement disorder.
  • the invention provides a method for conducting a pharmaceutical business, comprising: (a) providing a distribution network for selling the packaged pharmaceutical of the invention; and (b) providing instruction material to patients or physicians for using the package or preparation to treat patients suffering from a movement disorder.
  • the invention provides a method for conducting a pharmaceutical business, comprising: (a) determining an appropriate dosage of an DAT inhibitor of the invention to enhance function performance in a class of patients suffering from a movement disorder; (b) conducting therapeutic profiling of one or more formulations of the DAT inhibitor identified in step (a), for efficacy and toxicity in animals; and (c) providing a distribution network for selling a the formulations identified in step (b) as having an acceptable therapeutic profile.
  • the method may include an additional step of providing a sales group for marketing the preparation to healthcare providers.
  • the invention provides a method for conducting a medical assistance reimbursement program, comprising: (a) providing a reimbursement program which permits, for prescription of a DAT inhibitors of the invention for treating a movement order, at least partial reimbursement to a healthcare provider or patient, or payment to a drug distributor; (b) processing one or more claims for prescription of an DAT inhibitors for treating a movement order; and (c) reimbursing the healthcare provider or patient, or paying a drug distributor, at least a portion of the cost of said prescription.
  • the invention provides a method for treating depression, a sleep disorder, obesity, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), sexual dysfunction, or substance abuse comprising administering to the patient a composition of a DAT inhibitor of the invention in an amount sufficient to treat the movement disorder in the animal as evaluated by a standardized test.
  • ADD attention deficit disorder
  • ADHD attention deficit hyperactivity disorder
  • the practice of the present invention will employ, unless otherwise indicated, conventional techniques of synthetic chemistry, organic chemistry, inorganic chemistry, organometallic chemistry, pharmaceutical chemistry, and behavioral science, which are within the skill of the art. Such techniques are described in the literature. See, for example, Advanced Organic Chemistry: Reactions, Mechanisms, And Structure by J. March (John Wiley and Sons, N.
  • Figure 1 shows a few illustrative dopamine transporter inhibitors, CNS-27100,
  • Figures 2-4 show in vivo efficacy of four illustrative dopamine transporter inhibitors, CNS-27,100, -28,002, -28,100, and -28,200, as measured by forced swim test using rats.
  • the present invention relates to the discovery of certain dopamine transporter inhibitors (collectively referred to herein as the subject "DAT inhibitors") which can be used to prevent or reduce conditions associated with a movement disorder.
  • DAT inhibitors include Parkinson's disease.
  • the subject DAT inhibitors can also be effective as part of a therapy for treating depression, sleep disorders, obesity, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), certain sexual dysfunctions, and substance abuse (such as for the treatment of cocaine abuse).
  • ADD attention deficit disorder
  • ADHD attention deficit hyperactivity disorder
  • substance abuse such as for the treatment of cocaine abuse.
  • One aspect of the invention features a pharmaceutical package comprising one or more of the subject DAT inhibitor(s) in an amount sufficient to treat or prevent a movement disorder in a patient, a pharmaceutically acceptable carrier, and instructions (written and/or pictorial) describing the use of the formulation for treating the patient, wherein the patient suffers from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics, Tourette's syndrome, olivopontocerebellar atrophy (OPCA), diffuse Lewy body disease, hemibalismus, hemi-fa
  • the invention features a pharmaceutical preparation comprising one or more of the subject DAT inhibitors provided as a single oral dosage formulation in an amount sufficient to treat or prevent a movement disorder in a patient.
  • the invention features a pharmaceutical preparation comprising one or more DAT inhibitors provided in the form of a transdermal patch and formulated for sustained release of the amphetamine(s) in order to administer an amount sufficient to treat or prevent a movement disorder in a patient.
  • the invention features one or more DAT inhibitor(s) provided in an amount sufficient to treat or prevent a movement disorder in a patient by a statistically significant amount when assessed by a standardized performance test.
  • the subject DAT inhibitor(s) are provided in an amount sufficient to treat or prevent a movement disorder in a patient by a statistically significant amount when assessed by one or more of Hoehn and Yahr Staging of Parkinson's Disease, Unified Parkinson Disease Rating Scale (UPDRS), and Schwab and England Activities of Daily Living Scale.
  • UPDRS Unified Parkinson Disease Rating Scale
  • the invention features one or more DAT inbibitor(s) provided in an amount sufficient to treat or prevent a movement disorder in a patient by a statistically significant amount when assessed by a standardized test in combination with an empirical test selected from computer tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET).
  • CT computer tomography
  • MRI magnetic resonance imaging
  • PET positron emission tomography
  • Another aspect of the invention features the use of the pharmaceutical composition of DAT inhibitors in the manufacture of a medicament for prophylaxis or treatment of an animal susceptible to or suffering from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics, Tourette's syndrome, olivopontocerebellar atrophy (OPCA) 3 diffuse Lewy body disease, hemibalismus, hemi-facial spasm, restless leg syndrome, Wilson's disease, stiff man syndrome, akinetic mutism, psychomotor retardation, painful legs moving toe
  • Another aspect of the invention relates to a method for conducting a pharmaceutical business, which includes: (a) manufacturing the packages, preparations, and compositions of the present invention; and (b) marketing to healthcare providers the benefits of using the packages, preparations, and compositions of the present invention to treat or prevent a movement disorder of treated patients.
  • Another aspect of the invention relates to a method for conducting a pharmaceutical business, comprising: (a) providing a distribution network for selling the packages, preparations, and compositions of the present invention; and (b) providing instruction material to patients or physicians for using the packages, preparations, and compositions of the present invention to treat or prevent a movement disorder of treated patients.
  • Yet another aspect of the invention relates to a method for conducting a pharmaceutical business, comprising: (a) determining an appropriate dosage of an DAT inhibitor to treat or prevent a movement disorder in a class of patients; (b) conducting therapeutic profiling of one or more formulations of the DAT inhibitor identified in step (a), for efficacy and toxicity in animals; and (c) providing a distribution network for selling the formulations identified in step (b) as having an acceptable therapeutic profile, wherein the patient suffers from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics,
  • the subject business method can include an additional step of providing a sales group for marketing the preparation to healthcare providers.
  • Another aspect of the invention relates to a method for conducting a medical assistance reimbursement program, comprising: (a) providing a reimbursement program which permits, for prescription of an DAT inhibitors for treating a movement order, at least partial reimbursement to a healthcare provider or patient, or payment to a drug distributor; (b) processing one or more claims for prescription of an DAT inhibitors for treating a movement order; and (c) reimbursing the healthcare provider or patient, or paying a drug distributor, at least a portion of the cost of said prescription.
  • Another aspect of the invention relates to a method for conducting a pharmaceutical business, comprising: (a) determining an appropriate dosage of an DAT inhibitor to treat or prevent a movement disorder function in a class of patients; and (b) licensing, to a third party, the rights for further development and sale of the DAT inhibitor for treating or preventing a movement disorder, wherein the patient suffers from ataxia, corticobasal ganglionic degeneration (CBGD), dyskinesia, dystonia, tremors, hereditary spastic paraplegia, Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, Sydenham's chorea, other choreas, athetosis, ballism, stereotypy, tardive dyskinesia/dystonia, tics, Tourette's syndrome, olivopontocerebellar atrophy (OPCA), diffuse Lewy body disease
  • movement disorders includes akinesias and akinetic-rigid syndromes, dysldnesias and medication-induced parkinsonism (such as neuroleptic-induced parkinsonism, neuroleptic malignant syndrome, neuroleptic- induced acute dystonia, neuroleptic-induced acute akathisia, neuroleptic-induced tardive dyskinesia and medication-induced postural tremor).
  • akinetic- rigid syndromes include Parkinson's disease, drug-induced parkinsonism, postencephalitic parkinsonism, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, parkinsonism-ALS dementia complex and basal ganglia calcification.
  • Examples of “dyskinesias” include tremor (including rest tremor, postural tremor and. intention tremor), chorea (such as Sydenham's chorea, Huntington's disease, benign hereditary chorea, neuroacanthocytosis, symptomatic chorea, drug-induced chorea and hemiballism), myoclonus (including generalised myoclonus and focal myoclonus), tics (including simple tics, complex tics and symptomatic tics),and dystonia (including generalised dystonia such as iodiopathic dystonia, drug-induced dystonia, symptomatic dystonia and paroxymal dystonia, and focal dystonia such as blepharospasm, oromandibular dystonia, spasmodic dysphonia, spasmodic torticollis, axial dystonia, dystonic writer's cramp and hemiplegic dystonia).
  • chorea such as Sydenham's chorea, Hunt
  • depression includes depressive disorders, for example, single episodic or recurrent major depressive disorders, and dysthymic disorders, depressive neurosis, and neurotic depression; melancholic depression including anorexia, weight loss, insomnia and early morning waking, and psychomotor retardation; atypical depression (or reactive depression) including increased appetite, hypersomnia, psychomotor agitation or irritability, seasonal affective disorder, or bipolar disorders or manic depression, for example, bipolar I disorder, bipolar II disorder and cyclothymic disorder.
  • an "effective amount” of, e.g., an DAT inhibitor, with respect to the subject method of treatment refers to an amount of the inhibitor in a pharmaceutical preparation which, when applied as part of a desired dosage regimen, brings about improved state according to clinically acceptable standards.
  • treat means to counteract a medical condition (e.g., a movement disorder) to the extent that the medical condition is improved according to clinically acceptable standard(s).
  • a medical condition e.g., a movement disorder
  • to treat a movement disorder means to improve the movement disorder or relieve symptoms of the particular movement disorder in a patient, wherein the improvement and relief are evaluated with a clinically acceptable standardized test (e.g., a patient self-assessment scale) and/or an empirical test (e.g., PET scan).
  • a clinically acceptable standardized test e.g., a patient self-assessment scale
  • an empirical test e.g., PET scan
  • amelioration in the case of a movement disorder refers to a decrease in the abnormal involuntary movements characterizing these two types of dyskinesia, as can be determined for example, by using the Abnormal Involuntary Movement Scale (AIMS) as will be specified hereinbelow.
  • AIMS Abnormal Involuntary Movement Scale
  • prevent means reducing the probability / risk of developing a condition in a subject (e.g., a human), or delaying the onset of a condition in the subject, or lessening the severity of one or more symptoms of a condition (e.g., a movement disorder) that may develop in the subject, or any combination thereof.
  • a condition e.g., a movement disorder
  • a "patient” or “subject” to be treated by the subject method can mean either a human or non-human animal.
  • prodrug represents compounds which are rapidly transformed in vivo, for example, by hydrolysis in blood into the therapeutically active agents of the present invention.
  • a common method for making a prodrug is to include selected moieties which are converted under physiologic conditions (enzymatic or nonenzymatic) to reveal the desired molecule.
  • transdermal patch is meant a system capable of delivery of a drug to a patient via the skin, or any suitable external surface, including mucosal membranes, such as those found inside the mouth.
  • delivery systems generally comprise a flexible backing, an adhesive, and a drug-retaining matrix, the backing protecting the adhesive and matrix, and the adhesive holding the whole on the skin of the patient.
  • the drug-retaining matrix delivers drug to the skin, the drag then passing through the skin into the patient's system.
  • alkenyl and alkynyl refer to unsaturated aliphatic groups analogous in length and possible substitution to the alkyls described below, but that contain at least one double or triple bond respectively.
  • alkoxyl or alkoxy refer to an alkyl group, as defined below, having an oxygen radical attached thereto. Representative alkoxy groups include methoxy, ethoxy, propyloxy, tert-butoxy, and the like.
  • An “ether” is two hydrocarbons covalently linked by an oxygen.
  • the substituent of an alkyl that renders that alkyl an ether is or resembles an alkoxyl, such as can be represented by one of -O-alkyl, -O-alkenyl, -O-alkynyl, -0-(CH 2 )In-Rs, where R 8 represents an aryl, a cycloalkyl., a cycloalkenyl, a heterocycle, or a polycycle, and m is zero or an integer in the range of 1 to 8.
  • alkyl refers to the radical of saturated aliphatic groups, including straight-chain alkyl groups, branched-chain alkyl groups, cycloalkyl (alicyclic) groups, alkyl-substituted cycloalkyl groups, and cycloalkyl-substituted alkyl groups.
  • a straight chain or branched chain alkyl has 8 or fewer carbon atoms in its backbone ⁇ e.g., C1-C8 for straight chains, C3-C8 for branched chains), and more preferably 5 or fewer.
  • preferred cycloalkyls have from 3-10 carbon atoms in their ring structure, and more preferably have 5, 6, or 7 carbons in the ring structure.
  • alkyl (or “lower alkyl) as used throughout the specification, examples, and claims is intended to include both “unsubstituted alkyls” and “substituted alkyls,” the latter of which refers to alkyl moieties having substituents replacing a hydrogen on one or more carbons of the hydrocarbon backbone.
  • Such substituents can include, for example, a halogen, a hydroxyl, a carbonyl (such as a carboxyl, an alkoxycarbonyl, a formyl, or an acyl), a thiocarbonyl (such as a thioester, a thioacetate, or a thioformate), an alkoxyl, a phosphoryl, a phosphate, a phosphonate, a phosphinate, an amino, an amido, an amidine, an imine, a cyano, a nitro, an azido, a sulfhydryl, an alkylthio, a sulfate, a sulfonate, a sulfamoyl, a sulfonamido, a sulfonyl, a heterocyclyl, an aralkyl, or an aromatic or heteroaromatic moiety.
  • a halogen
  • the moieties substituted on the hydrocarbon chain can themselves be substituted, if appropriate.
  • the substituents of a substituted alkyl may include substituted and unsubstituted forms of amino, azido, imino, amido, phosphoryl (including phosphonate and phosphinate), sulfonyl (including sulfate, sulfonamido, sulfamoyl, and sulfonate), and silyl groups, as well as ethers, alkylthios, carbonyls (including ketones, aldehydes, carboxylates, and esters), -CF 3 , -CN, and the like.
  • Cycloalkyls can be further substituted with alkyls, alkenyls, alkoxys, alkylthios, aminoalkyls, carbonyl- substituted alkyls, -CF 3 , -CN, and the like.
  • lower alkyl as used herein means an alkyl group, as defined above, but having from one to eight carbons, more preferably from one to five carbon atoms, in its backbone structure. Likewise, “lower alkenyl” and “lower alkynyl” have similar chain lengths. Throughout the application, preferred alkyl groups are lower alkyls. In preferred embodiments, a substituent designated herein as alkyl is a lower alkyl.
  • aralkyl refers to an alkyl group substituted with an aryl group (e.g., an aromatic or heteroaromatic group).
  • aryl as used herein includes 5-, and 6-membered single-ring aromatic groups that may include from zero to four heteroatoms, for example, benzene, pyrrole, furan, thiophene, imidazole, oxazole, thiazole, triazole, pyrazole, pyridine, pyrazine, pyridazine, and pyrimidine, and the like.
  • aryl groups having heteroatoms in the ring structure may also be referred to as "aryl heterocycles," “heteroaryls,” or “heteroaromatics.”
  • the aromatic ring can be substituted at one or more ring positions with such substituents as described above, for example, halogen, azide, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, alkoxyl, amino, nitro, sulfhydryl, imino, amido, phosphate, phosphonate, phosphinate, carbonyl, carboxyl, silyl, ether, alkylthio, sulfonyl, sulfonamido, ketone, aldehyde, ester, heterocyclyl, aromatic or heteroaromatic moieties, -CF 3 , - CN 5 or the like.
  • aryl also includes polycyclic ring systems having two or more cyclic rings in which two or more carbons are common to two adjoining rings (the rings are "fused rings") wherein at least one of the rings is aromatic, e.g., the other cyclic rings can be cycloalkyls, cycloalkenyls, cycloalkynyls, aryls and/or heterocyclyls.
  • heteroatom means an atom of any element other than carbon or hydrogen. Preferred heteroatoms are nitrogen, oxygen, and sulfur.
  • heterocyclyl or “heterocyclic group” refer to 3- to 10-membered ring structures, more preferably 3- to 7-membered rings, whose ring structures include one to four heteroatoms. Heterocycles can also be polycycles.
  • Heterocyclyl groups include, for example, thiophene, thianthrene, furan, pyran, isobenzofuran, chromene, xanthene, phenoxathiin, pyrrole, imidazole, pyrazole, isothiazole, isoxazole, pyridine, pyrazine, pyrimidine, pyridazine, indolizine, isoindole, indole, indazole, purine, quinolizine, isoquinoline, quinoline, phthalazine, naphthyridine, quinoxaline, quinazoline, cinnoline, pteridine, carbazole, carboline, phenanthridine, acridine, pyrimidine, phenanthroline, phenazine, phenarsazine, phenothiazine, furazan, phenoxazine, pyrrolidine, o
  • the heterocyclic ring can be substituted at one or more positions with such substituents as described above, for example, halogen, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, amino, nitro, sulfhydryl, imino, amido, phosphate, phosphonate, phosphinate, carbonyl, carboxyl, silyl, ether, alkylthio, sulfonyl, ketone, aldehyde, ester, a heterocyclyl, an aromatic or heteroaromatic moiety, -CF 3 , -CN, or the like.
  • substituents as described above, for example, halogen, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, amino, nitro, sulfhydryl, imino, amido, phosphate, phosphonate, phosphinate,
  • metabolites refers to active derivatives produced upon introduction of a compound into a biological milieu, such as a patient.
  • nitro means -NO 2 ;
  • halogen designates - F, -Cl, -Br or -I;
  • sulfhydryl means -SH;
  • hydroxyl means -OH;
  • sulfonyl means -SO 2 -.
  • polycyclyl or “polycyclic group” refer to two or more rings (e.g., cycloalkyls, cycloalkenyls, cycloalkynyls, aryls, and/or heterocyclyls) in which two or more carbons are common to two adjoining rings, e.g., the rings are "fused rings.” Rings that are joined through non-adjacent atoms are termed "bridged" rings.
  • Each of the rings of the polycycle can be substituted with such substituents as described above, for example, halogen, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, amino, nitro, sulfhydryl, imino, amido, phosphate, phosphonate, phosphinate, carbonyl, carboxyl, silyl, ether, alkylthio, sulfonyl, ketone, aldehyde, ester, a heterocyclyl, an aromatic or heteroaromatic moiety, -CF 3 , -CN, or the like.
  • substituents as described above, for example, halogen, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, amino, nitro, sulfhydryl, imino, amido, phosphate, phosphonate, phosphinate, carbonyl
  • protecting group means temporary substituents which protect a potentially reactive functional group from undesired chemical transformations.
  • protecting groups include esters of carboxylic acids, silyl ethers of alcohols, and acetals and ketals of aldehydes and ketones, respectively.
  • the field of protecting group chemistry has been reviewed (Greene, T.W.; Wuts, P.G.M. Protective Groups in Organic Synthesis, 2nd ed.; Wiley: New York, 1991).
  • the term "substituted" is contemplated to include all permissible substituents of organic compounds.
  • the permissible substituents include acyclic and cyclic, branched and unbranched, carbocyclic and heterocyclic, aromatic and nonaromatic substituents of organic compounds.
  • Illustrative substituents include, for example, those described herein above.
  • the permissible substituents can be one or more and the same or different for appropriate organic compounds.
  • heteroatoms such as nitrogen may have hydrogen substituents and/or any permissible substituents of organic compounds described herein which satisfy the valences of the heteroatoms. This invention is not intended to be limited in any manner by the permissible substituents of organic compounds.
  • substitution includes the implicit proviso that such substitution is in accordance with permitted valence of the substituted atom and the substituent, and that the substitution results in a stable compound, e.g., which does not spontaneously undergo transformation such as by rearrangement, cyclization, elimination, etc.
  • each expression e.g., alkyl, m, n, etc., when it occurs more than once in any structure, is intended to be independent of its definition elsewhere in the same structure.
  • Contemplated equivalents of the compounds described above include compounds which otherwise correspond thereto, and which have the same general properties thereof ⁇ e.g., the ability to affect movement disorders), wherein one or more simple variations of substituents are made which do not adversely affect the efficacy of the compound.
  • the compounds of the present invention may be prepared by the methods described below, or by modifications thereof, using readily available starting materials, reagents, and conventional synthesis procedures. In these reactions, it is also possible to make use of variants which are in themselves known, but are not mentioned here.
  • hydrocarbon is contemplated to include all permissible compounds having at least one hydrogen and one carbon atom.
  • permissible hydrocarbons include acyclic and cyclic, branched and unbranched, carbocyclic and heterocyclic, aromatic and nonaromatic organic compounds which can be substituted or unsubstituted.
  • the subject DAT inhibitors are represented by Formula I, or are a pharmaceutically acceptable salt, solvate, metabolite or pro-drug thereof:
  • Ar independently for each occurrence, represents a substituted or unsubstituted aryl or heteroaryl ring
  • X represents -H or -OR
  • Y represents -O-, -S-, -C(R) 2 -, or -N(R)-;
  • R independently for each occurrence, represents -H or lower alkyl;
  • R 1 represents one or more substituents to the ring to which it is attached, such as halogen, amino, acylamino, amidino, cyano, nitro, azido, ether, thioether, sulfoxido, -J-R 2 , -J-OH, -J-lower alkyl, -J-lower alkenyl, -J- R 2 , -J-SH, -J-NH 2 , or substituted or unsubstituted lower alkyl, lower alkenyl, cycloalkyl, heterocyclyl, cycloalkylalkyl, heterocyclylalkyl, aryl, heteroaryl, aralkyl, or heteroaralkyl, or protected forms of the above;
  • R 2 independently for each occurrence, represents H or substituted or unsubstituted lower alkyl, cycloalkyl, heterocyclyl, aralkyl, heteroaralkyl, aryl, or heteroaryl;
  • J represents, independently for each occurrence, a chain having from 0-8 (preferably from 0-4) units selected from -C(R) 2 -, -N(R)-, -O-, and -S-; n is an integer from 0 to 2; p is 0 or 1 ; and q is an integer from 0 to 2, preferably 1.
  • R 1 comprises one or more lower alkyl groups, e.g., positioned at the 2-, A-, and/or 6-position of the piperidine ring.
  • substituents on Ar are selected from halogen, cyano, alkyl (including perfluoroalkyl), alkenyl, alkynyl, aryl, hydroxyl, alkoxy, silyloxy, amino, nitro, thiol, amino, imino, amido, phosphoryl, phosphonate, carboxyl, carboxamide, silyl, thioether, alkylsulfonyl, arylsulfonyl, sulfoxide, selenoether, ketone, aldehyde, ester, or -(CH 2 ) m R 2 , where m is an integer from 0 to 4.
  • non-hydrogen substituents are selected from halogen, cyano, alkyl (including perfluoroalkyl), hydroxyl, alkoxy, alkenyl, alkynyl, aryl, nitro, thiol, imino, amido, carboxyl, thioether, alkylsulfonyl, arylsulfonyl, ketone, aldehyde, and ester.
  • non-hydrogen substituents are selected from halogen, cyano, alkyl (including perfluoroalkyl), alkenyl, alkynyl, nitro, amido, carboxyl, alkylsulfonyl, ketone, aldehyde, and ester.
  • substituents on Ar are located at the para position.
  • one or both occurrences of Ar are phenyl rings.
  • the phenyl rings are substituted by one or more electron- withdrawing substituents, such as halogen, cyano, nitro, perfluoroalkyl ⁇ e.g., CF 3 , C 2 F 5 , etc.), acyl, etc.
  • dopamine transporter inhibitors are shown in Figure 1, including CNS-27100, CNS-27200, CNS-28100, CNS-28200, CNS- 28001, and CNS-28002. These are the preferred embodiments of the DAT inhibitors. The structures of these compounds are shown below:
  • Still another aspect of the invention relates to the use of DAT inhibitors for lessening the severity or prophylactically preventing the occurrence of movement disorders in an animal, and thus, altering the mental or physical state of the animal.
  • the compounds of the present invention may also be useful for treating and/or preventing memory impairment due to a movement disorder.
  • the movement disorder is Parkinson's disease.
  • DAT inhibitors of the invention are for illustrative purpose only, and should not be construed to be limiting to only the compounds described. A skilled artisan could readily synthesize other related compounds of the invention with (or without) minor modifications of the schemes described below.
  • the ethyl acetate layer was dried over anhydrous magnesium sulfate, then filtered. The filtrate was evaporated under reduced pressure to dryness to give a crude product (4.0 g).
  • the crude product was placed on a 40 mm diameter flash column, packed with silica gel (220 g) using 460:60:3 chloroform/ethyl acetate/2 M ammonia in methanol. The column was eluted with 460:60:3 chloroform/ethyl acetate/2 M ammonia in methanol.
  • the first portion was placed on a 100 mm diameter flash column, packed with silica gel (700 g) using 60:30:1 CHC 1 3 /EtO Ac/MeOH This column was eluted with 60:30:1 CHCl 3 /EtOAc/MeOH.
  • the second portion was placed on a 100 mm diameter flash column, packed with silica gel (700 g) using 160:40:1 CHCls/EtOAc/MeOH. This column was eluted with 160:40:1 CHCb/EtOAc/MeOH.
  • the fractions containing the purest product were combined and the solvents evaporated to dryness under reduced pressure.
  • the mixture was stirred for 16 h under argon, allowing the mixture to warm to ambient temperature.
  • the mixture was cooled to O 0 C and water (300 mL) was cautiously added.
  • 15% sulfuric acid was added, which dropped the pH to pH 3.5.
  • Solid sodium bicarbonate was added to adjust pH to pH 7.6.
  • the solids were filtered through diatomaceous earth/paper in a Buchner funnel in portions (very sluggish).
  • the filter cake was washed with ethyl acetate (1 x 250 mL, 2 x 400 mL). These washes were each used to re-extract the aqueous layer.
  • the ethyl acetate layer was dried over anhydrous magnesium sulfate, then filtered. The filtrate was evaporated under reduced pressure to dryness to give a crude product (3.8 g).
  • the crude product was placed on a 40 mm diameter flash column, packed with silica gel (215 g) using 460:60:3 chloroform/ethyl acetate/2 M ammonia in methanol. The column was eluted with 460:60:3 chloroform/ethyl acetate/2 M ammonia in methanol.
  • 6-Me-4 (60.6 g) was added slowly at O 0 C.
  • 6-Me-4 (17.8 g) from three lots (7.5 g, 21.4 mmol; 7.4 g, 21.2 mmol; 2.9 g, 8.3 mmol) was dissolved in tetrahydrofuran (400 mL). This solution of 6-Me-4 was added to the cold slurry of
  • the crude product was placed on a 100 mm diameter flash column, packed with silica gel (800 g) using 60:30:1 CHC1 3 /Et ⁇ Ac/MeOH.
  • the column was eluted with 60:30:1 CHCU/EtOAc/MeOH.
  • the reaction mixture was evaporated to dryness under reduced pressure to give crude product (8.5 g).
  • the crude product was placed on a 40 mm diameter flash column, packed with silica gel (230 g) using 230:30:2 chloroform /ethyl acetate/2 M ammonia in MeOH.
  • the column was eluted with 230:30:2 chloroform/ethyl acetate/2 M ammonia in MeOH.
  • the method includes administering, conjointly with the pharmaceutical preparation, one or more of physical therapy, occupational therapy, or speech/language therapy.
  • An agent to be administered conjointly with a subject compound may be formulated together with a subject compound as a single pharmaceutical preparation, e.g., as a pill or other medicament including both agents, or may be administered as a separate pharmaceutical preparation.
  • the invention further comprises one or more therapeutic agents for treating Parkinson's disease selected from a dopamine precursor, such as L-dopa; a dopaminergic agent, such as Levodopa- carbidopa (Sinemet®, Sinemet CR®) or Levodopa-benzerazide (Prolopa®, Madopar®, Madopar HBS®); a dopaminergic and anti-cholinergic agent, such as amantadine (Symmetryl®, Symadine®); an anti-cholinergic agent, such as trihexyphenidyl (Artane®), benztropine (Cogentin®), ethoproprazine (Parsitan®), or procyclidine (Kemadrin®); a dopamine agonist, such as apomorphine, bromocriptine (Parlodel®), cabergoline (Dostinex
  • a dopaminergic agent such as Levodopa- carbidopa (
  • the invention further comprises one or more therapeutic agents for treating dystonia selected from an anticholinergic agent, such as trihexyphenidyl (Artane®), benztropine (Cogentin®), ethoproprazine (Parsitan®), or procyclidine (Kemadrin®); a dopaminergic agent, such as Levodopa-carbidopa (Sinemet®, Sinemet CR®) or Levodopa-benzerazide (Prolopa®, Madopar®, Madopar HBS®); a muscle relaxant, such as baclofen (Lioresal®); a sedative, such as Clonazepam (Rivotril®); an anticonvulsant agent, such as carbamazepine (Tegretol®); a dopamine reuptake inhibitor, such as tetrabenazine (N)
  • an anticholinergic agent such as trihexyphenidyl (Artane
  • the invention further comprises one or more therapeutic agents for treating tremor selected from a ⁇ -blocker, such as propranolol (Inderal®, Inderal-LA®); an anticonvulsant agent, such as primidone
  • a ⁇ -blocker such as propranolol (Inderal®, Inderal-LA®)
  • an anticonvulsant agent such as primidone
  • the invention further comprises one or more therapeutic agents for treating myoclonus selected from a sedative, such as clonazepam (Rivotril®); or an anticonvulsant agent, such as valproic acid
  • a sedative such as clonazepam (Rivotril®)
  • an anticonvulsant agent such as valproic acid
  • the invention further comprises one or more therapeutic agents for treating chorea selected from a dopamine blocker, such as haloperidol (Haldol®); or a dopamine reuptake inhibitor, such as tetrabenazine (Nitoman®).
  • a dopamine blocker such as haloperidol (Haldol®)
  • a dopamine reuptake inhibitor such as tetrabenazine (Nitoman®).
  • the invention further comprises one or more therapeutic agents for treating restless leg syndrome selected from a dopaminergic, such as Levodopa-carbidopa (Sinemet®, Sinemet CR®) or
  • Levodopa-benzerazide Prolopa®, Madopar®, Madopar HBS®
  • a sedative such as clonazepam (Rivotril®)
  • a dopamine agonists such as bromocriptine (Parlodel®), pergolide (Permax®), pramipexole (Mirapex®), or ropinirole (Requip®)
  • a narcotic agent such as codeine (Tylenol # 3®)
  • GABAergic such as gabapentin
  • the invention further comprises one or more therapeutic agents for treating tics selected from a sedative, such as clonazepam (Rivotril®); an alpha antagonist, such as clonidine (Catapress®); a dopamine reuptake inhibitor, such as tetrabenazine (Nitoman®); or a dopamine blocker, such as haloperidol (Haldol®) or perphenazine.
  • a sedative such as clonazepam (Rivotril®)
  • an alpha antagonist such as clonidine (Catapress®)
  • a dopamine reuptake inhibitor such as tetrabenazine (Nitoman®)
  • a dopamine blocker such as haloperidol (Haldol®) or perphenazine.
  • the invention further comprises one or more cyclooxygenase-2-selective inhibitors.
  • the present invention provides pharmaceutical preparations comprising the subject DAT inhibitors.
  • the DAT inhibitors for use in the subject method may be conveniently formulated for administration with a biologically acceptable, non-pyrogenic, and/or sterile medium, such as water, buffered saline, polyol (for example, glycerol, propylene glycol, liquid polyethylene glycol, and the like) or suitable mixtures thereof.
  • a biologically acceptable, non-pyrogenic, and/or sterile medium such as water, buffered saline, polyol (for example, glycerol, propylene glycol, liquid polyethylene glycol, and the like) or suitable mixtures thereof.
  • the optimum concentration of the active ingredient(s) in the chosen medium can be determined empirically according to procedures well known to behavioral scientists.
  • biologically acceptable medium includes any and all solvents, dispersion media, and the like which may be appropriate for the desired route of administration of the pharmaceutical preparation. The use of such media for pharmaceutically active substances is known in the art.
  • compositions of the present invention can also include veterinary compositions, e.g., pharmaceutical preparations of the DAT inhibitors suitable for veterinary uses, e.g., for the treatment of livestock or domestic animals, e.g., dogs.
  • Methods of introduction may also be provided by rechargeable or biodegradable devices.
  • Various slow release polymeric devices have been developed and tested in vivo in recent years for the controlled delivery of drugs.
  • a variety of biocompatible polymers including hydrogels), including both biodegradable and non-degradable polymers, can be used to form an implant for the sustained release of an DAT inhibitor at a particular target site.
  • a dosage form and a method can be provided that administers an DAT inhibitor in a program that substantially lessens or completely compensates for tolerance in a patient. Tolerance, as defined in Pharmacology in Medicine, by Brill, p.
  • the selected DAT inhibitor is one which may produce tolerance, e.g., acute tolerance, in the patient
  • the subject DAT inhibitors are formulated to deliver a sustained and increasing dose, e.g., over at least 4 hours, and more preferably, over at least 8 or even 16 hours.
  • representative dosage forms include hydrogel matrix containing a plurality of tiny pills.
  • the hydrogel matrix comprises a hydrophilic polymer, such as a polysaccharide, agar, agarose, natural gum, alkali alginate including sodium alginate, carrageenan, fucoidan, furcellaran, laminaran, hypnea, gum arabic, gum ghatti, gum karaya, gum tragacanth, locust bean gum, pectin, amylopectin, gelatin, and a hydrophilic colloid.
  • a hydrophilic polymer such as a polysaccharide, agar, agarose, natural gum, alkali alginate including sodium alginate, carrageenan, fucoidan, furcellaran, laminaran, hypnea, gum arabic, gum ghatti, gum karaya, gum tragacanth, locust bean gum, pectin, amylopectin
  • the hydrogel matrix comprises a plurality of tiny pills (such as 4 to 50), each tiny pill comprising an increasing dose population of from 100 ng ascending in dose, such as 0.5 mg, 1 mg, 1.2 mg, 1.4 mg, 1.6 mg, 1.8 mg, etc.
  • the tiny pills comprise a release rate controlling wall of 0.0 mm to 10 mm thickness to provide for the timed ascending release of drug.
  • Representative wall-forming materials include a triglyceryl ester selected from glyceryl tristearate, glyceryl monostearate, glyceryl dipalmitate, glyceryl laureate, glyceryl didecenoate, and glyceryl tridecenoate.
  • Other wall forming materials comprise polyvinyl acetate phthalate, methylcellulose phthalate, and microporous vinyl olefins. Procedures for manufacturing tiny pills are disclosed in U.S. Pat. Nos. 4,434,153; 4,721,613; 4,853,229; 2,996,431; 3,139,383, and 4,752,470, which are incorporated by reference herein.
  • the drug releasing beads are characterized by a dissolution profile wherein 0 to 20% of the beads undergo dissolution and release the drug in 0 to 2 hours, 20 to 40% undergo dissolution and release the drug in 2 to 4 hours, 40 to 60% exhibit dissolution and release in 4 to 6 hours, 60 to 80% in 6 to 8 hours, and 80 to 100% in 8 to 10 hours.
  • the drug releasing beads can include a central composition or core comprising a drug and pharmaceutically acceptable composition forming ingredients including a lubricant, antioxidant, and buffer.
  • the beads comprise increasing doses of drug, for example, 1 mg, 2 mg, 5 mg, and so forth to a high dose, in certain preferred embodiments, of 15 to 100 mg.
  • the beads are coated with a release rate controlling polymer that can be selected utilizing the dissolution profile disclosed above.
  • the manufacture of the beads can be adapted from, for example, Liu et al. (1994) Inter. J. of Pharm., 112:105-116; Liu et al. (1994) Inter. J. of Pharm., 112:117-124; Pharm. Sci., by Remington, 14th Ed. pp. 1626-1628 (1970); Fincher et al. (1968) J. Pharm. Sci., 57:1825-1835; and U.S. Pat. No. 4,083,949.
  • Another exemplary dosage form provided by the invention comprises a concentration gradient of DAT inhibitor from 1 mg to 15-600 mg coated from the former low dose to the latter high dose on a polymer substrate.
  • the polymer can be an erodible or a nonerodible polymer.
  • the coated substrate is rolled about itself from the latter high dose at the center of the dosage form, to the former low dose at the exposed outer end of the substrate.
  • the coated substrate is rolled from the high dose to the low dose to provide for the release of from low to high dose as the substrate unrolls or erodes.
  • 1 mg to 600 mg of amphetamine is coated onto an erodible polymer such as an polypeptide, collagen, gelatin, or polyvinyl alcohol, and the substrate rolled concentrically from the high dose rolled over and inward to adapt a center position, and then outward towards the low dose to form an outer position.
  • the dosage form erodes dispensing an ascending dose of amphetamine that is released over time.
  • Another dosage form provided by the invention comprises a multiplicity of layers, wherein each layer is characterized by an increasing dose of drug.
  • the phrase "multiplicity of layers" denotes 2 to 6 layers in contacting lamination.
  • the multiplicity of layers are positioned consecutively, that is, one layer after another in order, with a first exposed layer, the sixth layer in contact with the fifth layer and its exposed surface coated with a drug impermeable polymer.
  • the sixth layer is coated with a drug impermeable polymer to insure release of the DAT inhibitor from the first layer to the sixth layer.
  • the first layer comprises, for example, 1 to 50 mg of drug and each successive layer comprises an additional 1 to 50 mg of drug.
  • the biodegradable polymers undergo chemical decomposition to form soluble monomers or soluble polymer units.
  • biodegradation of polymers usually involves chemically or enzymatically catalyzed hydrolysis.
  • biodegradable polymers acceptable for an increase drug loading in each layer of from 5 to 50 wt % over the first and successive layers wherein the first layer comprises 100 ng.
  • Representative biodegradable polymers comprise biodegradable poly(amides), poly(amino acids), poly(esters), poly(lactic acid), poly(glycolic acid), poly(orthoesters), poly(anhydrides), biodegradable poly(dehydropyrans), and poly(dioxinones).
  • the polymers are known to the art in Controlled Release of Drags, by Rosoff, Ch. 2, pp. 53-95 (1989); and in U.S. Pat. Nos. 3,811,444; 3,962,414; 4,066,747; 4,070,347; 4,079,038; and 4,093,709.
  • the invention employs a dosage form comprising a polymer that releases a drug by diffusion, flux through pores, or by rupture of a polymer matrix.
  • the drug delivery polymeric system comprises a concentration gradient, wherein the gradient is an ascent in concentration from a beginning or initial concentration to a final, or higher concentration.
  • the dosage form comprises an exposed surface at the beginning dose and a distant nonexposed surface at the final dose. The nonexposed surface is coated with a pharmaceutically acceptable material impermeable to the passage of drug.
  • the dosage form structure provides for a flux increase delivery of drug ascending from the beginning to the final delivered dose.
  • the dosage form matrix can be made by procedures known in the polymer art.
  • each casting composition comprises an increasing dose of drug with each composition overlayered from a low to the high dose. This provides a series of layers that come together to provide a unit polymer matrix with a concentration gradient.
  • the higher dose is cast first followed by laminating with layers of decreasing dose to provide a polymer matrix with a drug concentration gradient.
  • An example of providing a dosage form comprises blending a pharmaceutically acceptable carrier, like polyethylene glycol, with a known dose of an DAT inhibitor and adding it to a silastic medical grade elastomer with a cross-linking agent, like stannous octanoate, followed by casting in a mold. The step is repeated for each successive layer.
  • the system is allowed to set, e.g., for 1 hour, to provide the dosage form.
  • Representative polymers for manufacturing the dosage form comprise olefin and vinyl polymers, condensation polymers, carbohydrate polymers, and silicon polymers as represented by poly(ethylene), poly(propylene), poly(vinyl acetate), poly(methyl acrylate), poly(isobutyl methacrylate), poly(alginate), poly(amide), and poly(silicone).
  • the polymers and manufacturing procedures are known in Polymers, by Coleman et al., Vol. 31, pp. 1187-1230 (1990); Drug Carrier Systems, by Roerdink et al., Vol. 9, pp. 57-109 (1989); Adv.
  • the subject formulations can be a mixture of different prodrug forms of one or more different DAT inhibitors, each prodrug form having a different hydrolysis rate, and therefore activation rate, to provide an increasing serum concentration of the active DAT inhibitors.
  • the subject formulations can be a mixture of different DAT inhibitors, each compound having a different rate of adsorption (such as across the gut or epithelia) and/or serum half-life.
  • the dose-escalation regimen of the present invention can be used to compensate for the loss of a therapeutic effect of an DAT inhibitor, if any, by providing a method of delivery that continually compensates for the development of acute tolerance, by considering the clinical effect (E) of a drug at time (t) as a function of the drug concentration (C) according to Equation 1 :
  • the rate of drug delivered (A), in mg per hour, is inversely proportional to the concentration times the clearance of the drug. As the effect varies with time and the functionality is expressed, then, according to this invention, (A) can be governed to ensure the therapeutic effect is maintained at a clinical value.
  • Effect(t) Effect(ini) - keffect *t
  • Effect(ini) is the clinical effect observed initially at the start of drug administration
  • Effect(t) is the effect observed at time (t) hours
  • keffect is a proportionality constant ascertained by measuring the clinical effect (El) at time (tl) hours and (E2) at time (t2) hours while maintaining a constant plasma concentration followed by dividing (El) minus (E2) by (tl) minus (t2).
  • (A) must be adjusted with the same functionality according to Equation 3:
  • A(t) A(ini) + keffect *t wherein A(ini) is the initial drug input in mg per hour at the start of the therapy and A(t) is the drug input at time (t) hours, and keffect is the proportionality constant presented above. If the therapeutic effect is found to decline exponentially with time, this relationship is expressed by Equation 4:
  • preparations of the present invention may be given orally, parenterally, topically, or rectally. They are of course given by forms suitable for each administration route. For example, they are administered in tablets or capsule form, by injection, infusion, inhalation, rectal suppository, or controlled release patch. Oral and controlled release patch administrations are preferred.
  • the subject therapeutic is delivered by way of a transdermal patch.
  • a patch is generally a flat hollow device with a permeable membrane on one side and also some form of adhesive to maintain the patch in place on the patient's skin, with the membrane in contact with the skin so that the medication can permeate out of the patch reservoir and into and through the skin.
  • the outer side of the patch is formed of an impermeable layer of material, and the membrane side and the outer side are joined around the perimeter of the patch, forming a reservoir for the medication and carrier between the two layers.
  • Patch technology is based on the ability to hold an active ingredient in constant contact with the epidermis. Over substantial periods of time, drug molecules, held in such a state, will eventually find their way into the bloodstream.
  • patch technology relies on the ability of the human body to pick up drug molecules through the skin.
  • Transdermal drug delivery using patch technology has recently been applied for delivery of nicotine in an effort to assist smokers in quitting, the delivery of nitroglycerine to angina sufferers, the delivery of replacement hormones in post menopausal women, etc.
  • These conventional drug delivery systems comprise a patch with an active ingredient such as a drug incorporated therein, the patch also including an adhesive for attachment to the skin so as to place the active ingredient in close proximity to the skin.
  • Exemplary patch technologies are available from Ciba-Geigy Corporation and Alza Corporation. Such transdermal delivery devices can be readily adapted for use with the subject DAT inhibitors.
  • the flux of the subject DAT inhibitors across the skin can be modulated by changing either (a) the resistance (the diffusion coefficient), or (b) the driving force (the solubility of the drug in the stratum corneum and consequently the gradient for diffusion).
  • Various methods can be used to increase skin permeation by the subject DAT inhibitors, including penetration enhancers, use of pro-drug versions, superfluous vehicles, iontophoresis, phonophoresis, and thermophoresis. Many enhancer compositions have been developed to change one or both of these factors. See, for example, U.S. Pat. Nos.
  • U.S. Pat. No. 4,863,970 shows penetration-enhancing compositions for topical application comprising an active permeant contained in a penetration-enhancing vehicle containing specified amounts of one or more cell-envelope disordering compounds such as oleic acid, oleyl alcohol, and glycerol esters of oleic acid; a C2 or C3 alkanol; and an inert diluent such as water.
  • parenteral administration and “administered parenterally” as used herein mean modes of administration other than enteral and topical administration, usually by injection, and include, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticular, subcapsular, subarachnoid, intraspinal and intrasternal injection and infusion.
  • systemic administration "administered systemically,”
  • peripheral administration and “administered peripherally” as used herein mean the administration of a compound, drug, or other material other than directly into the central nervous system, such that it enters the patient's system and, thus, is subject to metabolism and other like processes, for example, subcutaneous administration.
  • These compounds may be administered to humans and other animals for therapy by any suitable route of administration, including orally, nasally, as by, for example, a spray, rectally, intravaginally, parenterally, intracisternally, and topically, as by powders, ointments or drops, including buccally and sublingually.
  • the compounds of the present invention which may be used in a suitable hydrated form, and/or the pharmaceutical compositions of the present invention, are formulated into pharmaceutically acceptable dosage forms such as described below or by other conventional methods known to those of skill in the art.
  • Actual dosage levels of the active ingredients in the pharmaceutical compositions of this invention may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration without being toxic to the patient.
  • the selected dosage level will depend upon a variety of factors including the activity of the particular compound of the present invention employed, or the ester, salt or amide thereof, the route of administration, the time of administration, the rate of excretion of the particular compound being employed, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular DAT inhibitors employed, the age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well known in the medical arts.
  • a physician or veterinarian having ordinary skill in the art can readily determine and prescribe the effective amount of the pharmaceutical composition required. For example, the physician or veterinarian could start doses of the compounds of the invention employed in the pharmaceutical composition at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved.
  • a suitable daily dose of a compound of the invention will be that amount of the compound which is the lowest dose effective to produce a therapeutic effect. Such an effective dose will generally depend upon the factors described above. Generally, intravenous, intracerebroventricular, and subcutaneous doses of the compounds of this invention for a patient will range from about 0.0001 to about 100 mg per kilogram of body weight per day. If desired, the effective daily dose of the active compound may be administered as two, three, four, five, six, or more sub-doses administered separately at appropriate intervals throughout the day, optionally, in unit dosage forms.
  • treatment is intended to encompass also prophylaxis, therapy, and cure.
  • the patient receiving this treatment is any animal in need, including primates, in particular, humans and other mammals such as equines, cattle, swine, and sheep; and poultry and pets in general.
  • the compound of the invention can be administered as such or in admixtures with pharmaceutically acceptable carriers and can also be administered in conjunction with other drugs such as dopamine precursors, dopaminergic agents, dopaminergic and anti-cholinergic agents, anti-cholinergic agents, dopamine agonists, MAO-B (monoamine oxidase B) inhibitors, COMT (catechol O- methyltransferase) inhibitors, muscle relaxants, sedatives, anticonvulsant agents, dopamine reuptake inhibitors, dopamine blockers, ⁇ -blockers, carbonic anhydrase inhibitors, narcotic agents, GABAergic agents, or alpha antagonists.
  • Conjunctive therapy thus includes sequential, simultaneous and separate administration of the active compound in a way that the therapeutic effects of the first one administered are not entirely absent when the subsequent is administered.
  • composition While it is possible for a compound of the present invention to be administered alone, it is preferable to administer the compound as a pharmaceutical formulation (composition).
  • the DAT inhibitors according to the invention may be formulated for administration in any convenient way for use in human or veterinary medicine.
  • compositions comprising a therapeutically effective amount of one or more of the compounds described above, formulated together with one or more pharmaceutically acceptable carriers (additives) and/or diluents.
  • the pharmaceutical compositions of the present invention may be specially formulated for administration in solid or liquid form, including those adapted for the following: (1) oral administration, for example, drenches (aqueous or non-aqueous solutions or suspensions), tablets, boluses, powders, granules, or pastes for application to the tongue; (2) parenteral administration, for example, by subcutaneous, intramuscular, or intravenous injection as, for example, a sterile solution or suspension; (3) topical application, for example, as a cream, ointment, or spray applied to the skin; or (4) intravaginally or intrarectally, for example, as a pessary, cream, or foam.
  • the subject compounds may be simply dissolved or suspended in sterile
  • pharmaceutically acceptable carrier means a pharmaceutically acceptable material, composition, or vehicle, such as a liquid or solid filter, diluent, excipient, solvent, or encapsulating material, involved in carrying or transporting the subject regulators from one organ or portion of the body to another organ or portion of the body.
  • a pharmaceutically acceptable material, composition, or vehicle such as a liquid or solid filter, diluent, excipient, solvent, or encapsulating material, involved in carrying or transporting the subject regulators from one organ or portion of the body to another organ or portion of the body.
  • Each carrier must be “acceptable” in the sense of being compatible with the other ingredients of the formulation and not injurious to the patient.
  • materials which can serve as pharmaceutically acceptable carriers include (1) sugars, such as lactose, glucose, and sucrose; (2) starches, such as corn starch and potato starch; (3) cellulose and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose, and cellulose acetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7) talc; (8) excipients, such as cocoa butter and suppository waxes; (9) oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil, and soybean oil; (10) glycols, such as propylene glycol; (11) polyols, such as glycerin, sorbitol, mannitol, and polyethylene glycol; (12) esters such as ethyl oleate and ethyl laurate; (13) agar; (14) buffering agents, such as magnesium hydroxide and aluminum hydroxide
  • certain embodiments of the present DAT inhibitors may contain a basic functional group, such as amino or alkylamino, and are, thus, capable of forming pharmaceutically acceptable salts with pharmaceutically acceptable acids.
  • pharmaceutically acceptable salts refers to the relatively non-toxic, inorganic and organic acid addition salts of compounds of the present invention. These salts can be prepared in situ during the final isolation and purification of the compounds of the invention, or by separately reacting a purified compound of the invention in its free base form with a suitable organic or inorganic acid and isolating the salt thus formed.
  • Representative salts include but are not limited to following: 2-hydroxyethanesulfonate, 2-naphthalenesulfonate, 3-hydroxy- 2-naphthoate, 3-phenylpropionate, acetate, adipate, alginate, amsonate, aspartate, benzenesulfonate, benzoate, besylate, bicarbonate, bisulfate, bitartrate, borate, butyrate, calcium edetate, camphorate, camphorsulfonate, camsylate, carbonate, citrate, clavulariate, cyclopentanepropionate, digluconate, dodecylsulfate, edetate, edisylate, estolate, esylate, ethanesulfonate, fumarate, gluceptate, glucoheptanoate, gluconate, glutamate, glycerophosphate, glycollylarsanilate, hemisulf
  • the pharmaceutically acceptable salts of the subject compounds include the conventional non-toxic salts of the compounds, e.g., from non-toxic organic or inorganic acids. Particularly suitable are salts of weak acids.
  • such conventional non-toxic salts include those derived from inorganic acids such as hydrochloric, hydrobromic, hydriodic, cinnamic, gluconic, sulfuric, sulfamic, phosphoric, nitric, and the like; and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, maleic, tartaric, citric, ascorbic, palmitic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicyclic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, isothionic, and the like.
  • inorganic acids such as hydrochloric, hydrobromic, hydriodic, cinnamic, gluconic, sulfuric, sulfamic, phospho
  • the compounds of the present invention may contain one or more acidic functional groups and, thus, are capable of forming pharmaceutically acceptable salts with pharmaceutically acceptable bases.
  • pharmaceutically acceptable salts refers to the relatively non-toxic, inorganic and organic base addition salts of compounds of the present invention. These salts can likewise be prepared in situ during the final isolation and purification of the compounds, or by separately reacting the purified compound in its free acid form with a suitable base, such as the hydroxide, carbonate, or bicarbonate of a pharmaceutically acceptable metal cation, with ammonia, or with a pharmaceutically acceptable organic primary, secondary or tertiary amine.
  • Representative alkali or alkaline earth salts include the lithium, sodium, potassium, calcium, magnesium, and aluminum salts, and the like.
  • Representative organic amines useful for the formation of base addition salts include ethylamine, diethylamine, ethylenediamine, ethanolamine, diethanolamine, piperazine, and the like. (See, for example, Berge et al., supra).
  • wetting agents such as sodium lauryl sulfate and magnesium stearate, as well as coloring agents, release agents, coating agents, sweetening, flavoring and perfuming agents, preservatives, and antioxidants can also be present in the compositions.
  • antioxidants examples include: (1) water soluble antioxidants, such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite, and the like; (2) oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, alpha-tocopherol, and the like; and (3) metal chelating agents, such as citric acid, ethylenediamine tetraacetic acid (EDTA), sorbitol, tartaric acid, phosphoric acid, and the like.
  • water soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite, and the like
  • oil-soluble antioxidants such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT
  • Formulations of the present invention include those suitable for oral, nasal, topical (including buccal and sublingual), rectal, vaginal, and/or parenteral administration.
  • the formulations may conveniently be presented in unit dosage form and may be prepared by any methods well known in the art of pharmacy.
  • the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will vary depending upon the host being treated and the particular mode of administration.
  • the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will generally be that amount of the compound which produces a therapeutic effect. Generally, out of one hundred per cent, this amount will range from about 1 per cent to about ninety- nine percent of active ingredient, preferably from about 5 per cent to about 70 per cent, most preferably from about 10 per cent to about 30 per cent.
  • Methods of preparing these formulations or compositions include the step of bringing into association a compound of the present invention with the carrier and, optionally, one or more accessory ingredients.
  • the formulations are prepared by uniformly and intimately bringing into association a compound of the present invention with liquid carriers, or finely divided solid carriers, or both, and then, if necessary, shaping the product.
  • Formulations of the invention suitable for oral administration may be in the form of capsules, cachets, pills, tablets, lozenges (using a flavored basis, usually sucrose and acacia or tragacanth), powders, granules, or as a solution or a suspension in an aqueous or non-aqueous liquid, or as an oil-in- water or water-in-oil liquid emulsion, or as an elixir or syrup, or as pastilles (using an inert base, such as gelatin and glycerin, or sucrose and acacia), and/or as mouth washes, and the like, each containing a predetermined amount of a compound of the present invention as an active ingredient.
  • a compound of the present invention may also be administered as a bolus, electuary, or paste.
  • the active ingredient is mixed with one or more pharmaceutically acceptable carriers, such as sodium citrate or dicalcium phosphate, and/or any of the following: (1) fillers or extenders, such as starches, lactose, sucrose, glucose, mannitol, and/or silicic acid; (2) binders, such as carboxymethylcellulose, alginates, gelatin, polyvinyl pyrrolidone, sucrose, and/or acacia; (3) humectants, such as glycerol; (4) disintegrating agents, such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; (5) solution retarding agents, such as paraffin; (6) absorption accelerators, such as quaternary ammonium compounds; (7) wetting agents, such as cetyl alcohol and gly
  • the pharmaceutical compositions may also comprise buffering agents.
  • Solid compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugars, as well as high molecular weight polyethylene glycols and the like.
  • a tablet may be made by compression or molding, optionally with one or more accessory ingredients.
  • Compressed tablets may be prepared using binder (for example, gelatin or hydroxypropylmethyl cellulose), lubricant, inert diluent, preservative, disintegrant (for example, sodium starch glycolate or cross-linked sodium carboxymethyl cellulose), or surface-active or dispersing agent.
  • Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
  • the tablets, and other solid dosage forms of the pharmaceutical compositions of the present invention may optionally be scored or prepared with coatings and shells, such as enteric coatings and other coatings well known in the pharmaceutical-formulating art. They may also be formulated so as to provide slow or controlled release of the active ingredient therein using, for example, hydroxypropylmethyl cellulose in varying proportions to provide the desired release profile, other polymer matrices, liposomes, and/or microspheres.
  • compositions may be sterilized by, for example, filtration through a bacteria- retaining filter, or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved in sterile water, or some other sterile injectable medium immediately before use.
  • These compositions may also optionally contain opacifying agents and may be of a composition that they release the active ingredient(s) only, or preferentially, in a certain portion of the gastrointestinal tract, optionally, in a delayed manner.
  • embedding compositions which can be used include polymeric substances and waxes.
  • the active ingredient can also be in micro-encapsulated form, if appropriate, with one or more of the above-described excipients.
  • Liquid dosage forms for oral administration of the compounds of the invention include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups, and elixirs.
  • the liquid dosage forms may contain inert diluents commonly used in the art, such as water or other solvents, solubilizing agents, and emulsifiers, such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, oils (in particular, cottonseed, groundnut, com, germ, olive, castor, and sesame oils), glycerol, tetrahydrofuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
  • inert diluents commonly used in the art, such as water or other solvents, solubilizing agents, and emul
  • the oral compositions can also include adjuvants such as wetting agents, emulsifying and suspending agents, and sweetening, flavoring, coloring, perfuming, and preservative agents.
  • adjuvants such as wetting agents, emulsifying and suspending agents, and sweetening, flavoring, coloring, perfuming, and preservative agents.
  • Suspensions in addition to the active compounds, may contain suspending agents, such as ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, and tragacanth, and mixtures thereof.
  • suspending agents such as ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, and tragacanth, and mixtures thereof.
  • Formulations of the pharmaceutical compositions of the invention for rectal or vaginal administration may be presented as a suppository, which may be prepared by mixing one or more compounds of the invention with one or more suitable nonirritating excipients or carriers comprising, for example, cocoa butter, polyethylene glycol, a suppository wax, or a salicylate, and which is solid at room temperature, but liquid at body temperature and, therefore, will melt in the rectum or vaginal cavity and release the active DAT inhibitor.
  • Formulations of the present invention which are suitable for vaginal administration also include pessaries, tampons, creams, gels, pastes, foams, or spray formulations containing such carriers as are known in the art to be appropriate.
  • Dosage forms for the topical or transdermal administration of a compound of this invention include powders, sprays, ointments, pastes, creams, lotions, gels, solutions, patches, and inhalants.
  • the active compound may be mixed under sterile conditions with a pharmaceutically acceptable carrier, and with any preservatives, buffers, or propellants which may be required.
  • the ointments, pastes, creams, and gels may contain, in addition to an active compound of this invention, excipients, such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc, and zinc oxide, or mixtures thereof.
  • Powders and sprays can contain, in addition to a compound of this invention, excipients such as lactose, talc, silicic acid, aluminum hydroxide, calcium silicates, and polyamide powder, or mixtures of these substances.
  • Sprays can additionally contain customary propellants, such as chlorofluorohydrocarbons and volatile unsubstituted hydrocarbons, such as butane and propane.
  • the subject compound(s) are formulated as part of a transdermal patch.
  • Transdermal patches have the added advantage of providing controlled delivery of a compound of the present invention to the body.
  • Such dosage forms can be made by dissolving or dispersing the DAT inhibitors in the proper medium.
  • Absorption enhancers can also be used to increase the flux of the DAT inhibitors across the skin. The rate of such flux can be controlled by either providing a rate-controlling membrane or dispersing the compound in a polymer matrix or gel.
  • the "free base form" of the subject compound relates to a form in which the compound is not complexed with an acid, e.g., is not an ammonium salt. Such forms may be incorporated into a patch. It will be appreciated that the DAT inhibitors may be complexed, for example, with elements of the drug-retaining matrix of the patch and, as such, the DAT inhibitors may not necessarily be in the form of the free base, when actually retained by the patch.
  • the patch preferably comprises a drug-impermeable backing layer.
  • drug-impermeable backing layers which may be used for transdermal or medicated patches include films or sheets of polyolefins, polyesters, polyurethanes, polyvinyl alcohols, polyvinyl chlorides, polyvinylidene chloride, polyamides, ethylene-vinyl acetate copolymer (EVA), ethylene-ethylacrylate copolymer (EEA), vinyl acetate-vinyl chloride copolymer, cellulose acetate, ethyl cellulose, metal vapour deposited films or sheets thereof, rubber sheets or films, expanded synthetic resin sheets or films, non- woven fabrics, fabrics, knitted fabrics, paper, and foils.
  • Preferred drug-impermeable, elastic backing materials are selected from polyethylene tereplithalate (PET), polyurethane, ethylene-vinyl acetate copolymer (EVA) 5 plasticized polyvinylchloride, and woven and non-woven fabric. Especially preferred is non- woven polyethylene tereplithalate (PET).
  • PET polyethylene tereplithalate
  • EVA ethylene-vinyl acetate copolymer
  • Other backings will be readily apparent to those skilled in the art.
  • block copolymer in the preferred adhesives of the invention, refers to a macromolecule comprised of two or more chemically dissimilar polymer structures, terminally connected together (Block Copolymers: Overview and Critical Survey, Noshay and McGrath, 1977). These dissimilar polymer structures, sections or segments, represent the "blocks" of the block copolymer.
  • the blocks may generally be arranged in an A-B structure, an A-B-A structure, or a multi-block -(A- B)n- system, wherein A and B are the chemically distinct polymer segments of the block copolymer.
  • block copolymer is of an A-B-A structure, especially wherein one of A and B is an acrylic-type polymeric unit. It will be appreciated that the present invention is also applicable using block copolymers which possess three or more different blocks, such as an A-B-C block copolymer. However, for convenience, reference hereinafter to block copolymers will assume that there are only A and B sub-units, but it will be appreciated that such reference also encompasses block copolymers having more than two different sub-units, unless otherwise specified. It will be appreciated that the properties of block copolymers are very largely determined by the nature of the A and B blocks. Block copolymers commonly possess both 'hard' and 'soft' segments.
  • a 'hard' segment is a polymer that has a glass transition temperature (Tg) and/or a melting temperature (Tm) that is above room temperature
  • a 'soft' segment is a polymer that has a Tg (and possibly a Tm) below room temperature.
  • the block copolymers useful in the present invention preferably are acrylic block copolymers.
  • acrylic block copolymers at least one of the blocks of the block copolymer is an acrylic acid polymer or a polymer of an acrylic acid derivative.
  • the polymer may be composed of just one repeated monomer species. However, it will be appreciated that a mixture of monomeric species may be used to form each of the blocks, so that a block may, in itself, be a copolymer. The use of a combination of different monomers can affect various properties of the resulting block copolymer.
  • variation in the ratio or nature of the monomers used allows properties such as adhesion, tack, and cohesion to be modulated, so that it is generally advantageous for the soft segments of the block copolymer to be composed of more than one monomer species.
  • alkyl acrylates and alkyl methacrylates are polymerized to form the soft portion of the block copolymer. Alkyl acrylates and alkyl methacrylates are thought to provide properties of tack and adhesion.
  • Suitable alkyl acrylates and alkyl methacrylates include n-butyl acrylate, n-butyl methacrylate, hexyl acrylate, 2-ethylbutyl acrylate, isooctyl acrylate, 2-ethylhexyl acrylate, 2- ethylhexyl methacrylate, decyl acrylate, decyl methacrylate, dodecyl acrylate, dodecyl methacrylate, tridecylacrylate, and tridecyl methacrylate, although other suitable acrylates and methacrylates will be readily apparent to those skilled in the art.
  • the acrylic block copolymer comprises at least 50% by weight of alkyl acrylate or alkyl methacrylate(co)polymer.
  • Variation in the components of the soft segment affects the overall properties of the block copolymer, although the essential feature remains the cross-linking of the soft segments.
  • soft segments essentially consisting of diacetone acrylamide with either butyl acrylate and/or 2-ethylhexyl acrylate, in approximately equal proportions, work well, and a ratio by weight of about 3 : 4 : 4 provides good results.
  • diacetone acrylamide or other polar monomer such as hydroxyethylmethacrylate or vinyl acetate
  • diacetone acrylamide or other polar monomer such as hydroxyethylmethacrylate or vinyl acetate
  • the acrylate component may generally be varied more freely, with good results observed with both 2-ethylhexyl acrylate and butyl acrylate together or individually.
  • ratios of the various monomers are generally preferred to be approximately equal.
  • this is preferred to be with a polar component of 50% or less of the soft segment, with the apolar portion forming up to about 85% w/w, but preferably between about 50 and 70% w/w. In the example above, this is about 72% (4+4) polar to about 18% (3) polar.
  • Adhesives of the invention are preferably essentially neutral, avoiding any unnecessary degeneration of the DAT inhibitors.
  • polymers suitable for use as the hard portion of the block copolymer possess glass transition temperatures above room temperature.
  • Suitable monomers for use in forming the hard segment polymer include styrene, x- methylstyrene, methyl methacrylate, and vinyl pyrrolidone, although other suitable monomers will be readily apparent to those skilled in the art.
  • Styrene and polymethylmethacrylate have been found to be suitable for use in the formation of the hard segment of the block copolymers. It is preferred that the hard portion of the block copolymer forms from 3-30% w/w of the total block copolymer, particularly preferably from 5-15% w/w.
  • the block copolymer is further characterized in that the soft portions contain a degree of chemical cross-linking.
  • Such cross-linking may be effected by any suitable cross-linking agent. It is particularly preferable that the cross-linking agent be in the form of a monomer suitable for incorporation into the soft segment during polymerization.
  • the cross-linking agent has two or more radically polymerizable groups, such as a vinyl group, per molecule of the monomer, at least one tending to remain unchanged during the initial polymerization, thereby permitting cross-linking of the resulting block copolymer.
  • Suitable cross-linking agents for use in the present invention include divinylbenzene, methylene bis-acrylamide, ethylene glycol di(meth)acrylate, ethyleneglycol tetra(meth)acrylate, propylene glycol di(meth)acrylate, butylene glycoldi(meth)acrylate, or trimethylolpropane tri(meth)acrylate, although other suitable cross-linking agents will be readily apparent to those skilled in the art.
  • a preferred cross-linking agent is tetraethylene glycol dimethacrylate. It is preferred that the cross-linking agent comprises about 0.01 - 0.6% by weight of the block copolymer, with 0.1 - 0.4% by weight being particularly preferred.
  • block copolymer portions of the present invention may be produced by any suitable method, such as step growth, anionic, cationic, and free radical methods (Block Copolymers, supra). Free radical methods are generally preferred over other methods, such as anionic polymerization, as the solvent and the monomer do not have to be purified.
  • Suitable initiators for polymerization include polymeric peroxides with more than one peroxide moiety per molecule. An appropriate choice of reaction conditions is well within the skill of one in the art, once a suitable initiator has been chosen.
  • the initiator is preferably used in an amount of 0.005 - 0.1% by weight of the block copolymer, with 0.01 - 0.05% by weight being particularly preferred, although it will be appreciated that the amount chosen is well within the skill of one in the art. hi particular, it is preferred that the amount should not be so much as to cause instant gelling of the mix, nor so low as to slow down polymerization and to leave excess residual monomers. A preferred level of residual monomers is below 2000 ppm.
  • the amount of initiator will vary substantially, depending on such considerations as the initiator itself and the nature of the monomers.
  • the block copolymers are adhesives, and preferably are pressure sensitive adhesives.
  • Pressure sensitive adhesives can be applied to a surface by hand pressure and require no activation by heat, water, or solvent. As such, they are particularly suitable for use in accordance with the present invention.
  • the block copolymers may be used without tackifiers and, as such, are particularly advantageous. However, it will be appreciated that the block copolymers may also be used in combination with a tackifier, to provide improved tack, should one be required or desired. Suitable tackifiers are well known and will be readily apparent to those skilled in the art. Without being constrained by theory, it is thought that the combination of chemical cross-links between the soft segments of the copolymer combined with the, generally, hydrophobic interaction, or physical cross-linking, between the hard portions results in a "matrix-like" structure. Copolymers having only physical cross- linking of the hard segments are less able to form such a matrix. It is believed that the combination of both forms of cross-linking of the block copolymers provides good internal strength (cohesion) and also high drug storage capacity.
  • the hard segments associate to form "islands,," or nodes, with the soft segments radiating from and between these nodes.
  • the block copolymer preferably cross-links as the solvent is removed, so that cross-linking can be timed to occur after coating, this being the preferred method.
  • the process preferably comprises polymerizing the nionomeric constituents of each soft segment in solution, then adding the constituents of the hard segment to each resulting solution and polymerizing the resulting mix, followed by cross-linking by removal of any solvent or solvent system, such as by evaporation. If the solution is to be stored for any length of time, it may be necessary to keep the polymer from precipitating out which may be achieved by known means, such as by suspending agents or shaking. It may also be necessary to select the type of polymers that will be subject to substantially no cross-linking until the solvent is evaporated.
  • the adhesive possesses a minimum number of functionalities having active hydrogen, in order to avoid undesirable reactions/interactions, such as with any drug that it is desired to incorporate into the adhesive material. It will be appreciated that this is only a preferred restriction, and that any adhesive may be tailored by one skilled in the art to suit individual requirements.
  • Suitable monomers for use in forming the hard segment include styrene, a- methylstyrene, methyl methacrylate, and vinyl pyrrolidone, with the preferred proportion of the hard segment being between 5 and 15% w/w.
  • styrene a- methylstyrene
  • methyl methacrylate methyl methacrylate
  • vinyl pyrrolidone a vinyl pyrrolidone
  • plasticizer such as isopropyl myristate (IPM). This has the advantage of helping solubilize the IPM.
  • DAT inhibitor(s) as well as rendering the adhesive less rough on the skin.
  • plasticizers may also be used, and suitable plasticizers will be readily apparent to those skilled in the art.
  • Plasticizers generally take the form of oily substances introduced into the adhesive polymer.
  • the effect of the introduction of such oily substances is to soften the physical structure of the adhesive whilst, at the same time, acting at the interface between the adhesive and the skin, thereby helping to somewhat weaken the adhesive, and to reduce exfoliation.
  • the free base oil may be obtained by basifying salts of the subject compounds, or any other suitable salt, with a suitable base, in the presence of a hydrophilic solvent, especially water, and an organic solvent.
  • a hydrophilic solvent especially water, and an organic solvent.
  • water and ethyl acetate in approximately equal proportions, work well, with ammonia serving as the basifying agent.
  • the water may then be removed and the preparation washed with further water, or other aqueous preparation, after which the preparation may be suitably extracted with ether, for example, after having removed the ethyl acetate. It is preferred to keep the preparation under an inert atmosphere, especially after completion.
  • patches of the present invention may be removed from the patient at any time once it is desired to terminate a given dose, this can have the disadvantage of providing an opportunity for potential drug abuse of the partially discharged patch. Abuse of the subject compounds is highly undesirable.
  • the drug delivery profile has first order kinetics, so that the majority of the drug is delivered during the main part of the day and, even if the patient omits to remove the patch, the amount of drug is moving towards exhaustion by the end of the day, and the amount of drug is dropping rapidly.
  • patches of the invention may be constructed in any suitable manner known in the art for the manufacture of transdermal patches.
  • the patches may simply comprise adhesive, drug, and backing, or may be more complex, such as having edging to prevent seepage of drug out of the sides of the patch. Patches may also be multi-layered.
  • Ophthalmic formulations are also contemplated as being within the scope of this invention.
  • compositions of this invention suitable for parenteral administration comprise one or more compounds of the invention in combination with one or more pharmaceutically acceptable sterile isotonic aqueous or nonaqueous solutions, dispersions, suspensions or emulsions, or sterile powders which may be reconstituted into sterile injectable solutions or dispersions just prior to use, which may contain antioxidants, buffers, bacteriostats, solutes which render the formulation isotonic with the blood of the intended recipient, or suspending or thickening agents.
  • aqueous and nonaqueous carriers examples include water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), and suitable mixtures thereof, vegetable oils, such as olive oil, and injectable organic esters, such as ethyl oleate.
  • polyols such as glycerol, propylene glycol, polyethylene glycol, and the like
  • vegetable oils such as olive oil
  • injectable organic esters such as ethyl oleate.
  • Proper fluidity can be maintained, for example, by the use of coating materials, such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
  • compositions may also contain adjuvants such as preservatives, wetting agents, emulsifying agents, and dispersing agents. Prevention of the action of microorganisms may be ensured by the inclusion of various antibacterial and antifungal agents, for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents, such as sugars, sodium chloride, and the like into the compositions. In addition, prolonged absorption of the injectable pharmaceutical form may be brought about by the inclusion of agents which delay absorption such as aluminum monostearate and gelatin.
  • adjuvants such as preservatives, wetting agents, emulsifying agents, and dispersing agents.
  • Prevention of the action of microorganisms may be ensured by the inclusion of various antibacterial and antifungal agents, for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents, such as sugars, sodium
  • Injectable depot forms are made by forming microencapsule matrices of the subject compounds in biodegradable polymers such as polylactide-polyglycolide.
  • the rate of drug release can be controlled.
  • biodegradable polymers include poly(orthoesters) and poly(anhydrides).
  • Depot injectable formulations are also prepared by entrapping the drug in liposomes or microemulsions which are compatible with body tissue.
  • the compounds of the present invention are administered as pharmaceuticals, to humans and animals, they can be given per se or as a pharmaceutical composition containing, for example, 0.1 to 99.5% (more preferably, 0.5 to 90%) of active ingredient in combination with a pharmaceutically acceptable carrier.
  • the addition of the active compound of the invention to animal feed is preferably accomplished by preparing an appropriate feed premix containing the active compound in an effective amount and incorporating the premix into the complete ration.
  • an intermediate concentrate or feed supplement containing the active ingredient can be blended into the feed.
  • feed premixes and complete rations can be prepared and administered are described in reference books (such as "Applied Animal Nutrition,” W.H. Freedman and Co., San Francisco, U.S.A., 1969 or “Livestock Feeds and Feeding” O and B books, Corvallis, Ore., U.S.A., 1977).
  • Assaying processes are well known in the art in which a reagent is added to a sample, and measurements of the sample and reagent are made to identify sample attributes stimulated by the reagent.
  • one such assay process concerns determining in a chromogenic assay the amount of an enzyme present in a biological sample or solution.
  • Such assays are based on the development of a colored product in the reaction solution. The reaction develops as the enzyme catalyzes the conversion of a colorless chromogenic substrate to a colored product.
  • Another assay useful in the present invention concerns determining the ability of a ligand to bind to a biological receptor utilizing a technique well known in the art referred to as a radioligand binding assay.
  • This assay accurately determines the specific binding of a radio-ligand to a targeted receptor through the delineation of its total and nonspecific binding components.
  • Total binding is defined as the amount of radio-ligand that remains following the rapid separation of the radio- ligand bound in a receptor preparation (cell homogenates or recombinate receptors) from that which is unbound.
  • the nonspecific binding component is defined as the amount of radio-ligand that remains following separation of the reaction mixture consisting of receptor, radio-ligand and an excess of unlabeled ligand.
  • radio-ligand binding assay for ⁇ -opioid receptor, see Wang, J. B. et al. FEBS Letters 1994, 338, 217.
  • Assays useful in the present invention concern determining the activity of receptors the activation of which initiates subsequent intracellular events in which intracellular stores of calcium ions are released for use as a second messenger.
  • Activation of some Q-protein-coupled receptors stimulates the formation of inositol triphosphate (IP3, a G-protein-coupled receptor second messenger) through phospholipase C-mediated hydrolysis of phosphatidylinositol, Berridge and Irvine (1984). Nature 312:315-21.
  • IP3 in turn stimulates the release of intracellular calcium ion stores.
  • a change in cytoplasmic calcium ion levels caused by release of calcium ions from intracellular stores is used to determine G-protein-coupled receptor function. This is another type of indirect assay.
  • G-protein-coupled receptors are muscarinic acetylcholine receptors (mAChK), adrenergic receptors, sigma receptors, serotonin receptors, dopamine receptors, angiotensin receptors, adenosine receptors, bradykinin receptors, metabotropic excitatory amino acid receptors and the like.
  • Cells expressing such G-protein-coupled receptors may exhibit increased cytoplasmic calcium levels as a result of contribution from both intracellular stores and via activation of ion channels, in which case it may be desirable although not necessary to conduct such assays in calcium-free buffer, optionally supplemented with a chelating agent such, as EGTA, to distinguish fluorescence response resulting from calcium release from internal stores.
  • Another type of indirect assay involves determining the activity of receptors which, when activated, result in a change in the level of intracellular cyclic nucleotides, e.g., cAMP, cGMP. For example, activation of some dopamine, serotonin, metabotropic glutamate receptors and muscarinic acetylcholine receptors results in a decrease in the cAMP or cGNIP levels of the cytoplasm.
  • cyclic nucleotide-gated ion channels e.g., rod photoreceptor cell channels and olfactory neuron channels [see, Altenhofen, W. et al. (1991) Proc. Natl. Acad. Sci U.S.A. 88:9868-9872 and Dhallan et al. (1990) Nature 347:184-187] that are permeable to cations upon activation by binding of cAMP or cGMP.
  • a change in cytoplasmic ion levels caused by a change in the amount of cyclic nucleotide activation of photo-receptor or olfactory neuron channels is used to determine function of receptors that cause a change in CAMP or cGMP levels when activated.
  • activation of the receptor results in a decrease in cyclic nucleotide levels, it may be preferable to expose the cells to agents that increase intracellular cyclic nucleotide levels, e.g., forskolin, prior to adding a receptor-activating compound to the cells in the assay.
  • Cell for this type of assay can be made by co-transfection of a host cell with DNA encoding a cyclic nucleotide-gated ion channel and a DNA encoding a receptor (e.g., certain metabotropic glutamate receptors, muscarinic acetylcholine receptors, dopamine receptors, serotonin receptors and the like, which, when activated, causes a change in cyclic nucleotide levels in the cytoplasm.
  • a receptor e.g., certain metabotropic glutamate receptors, muscarinic acetylcholine receptors, dopamine receptors, serotonin receptors and the like, which, when activated, causes a change in cyclic nucleotide levels in the cytoplasm.
  • Any cell expressing a receptor protein which is capable, upon activation, of directly increasing the intracellular concentration of calcium, such as by opening gated calcium channels, or indirectly affecting the concentration of intracellular calcium as by causing initiation of a reaction which utilizes Ca 2+ as a second messenger (e.g., G-protein-coupled receptors), may form the basis of an assay.
  • Cells endogenously expressing such receptors or ion channels, and cells which may be transfected with a suitable vector encoding one or more such cell surface proteins are known to those of skill in the art, or may be identified by those of skill in the art.
  • HEK human embryonic kidney
  • CRL1573 Chinese hamster ovary (CHO) cells (ATCC Nos. CRL9618, CCL61, CRL9096), PC12 cells (ATCC No. CRL1721) and COS-7 cells (ATCC No. CRL1651).
  • Preferred cells for heterologous cell surface protein expression are those that can be readily and efficiently transfected.
  • Preferred cells include HEK 293 cells, such as those described in U.S. Pat. No. 5,024,939.
  • Any compound which is known to activate ion channels or receptors of interest may be used to initiate an assay. Choosing an appropriate ion channel- or receptor-activating reagent depending on the ion channel or receptor of interest is within the skill of the art.
  • Direct depolarization of the cell membrane to determine calcium channel activity may be accomplished by adding a potassium salt solution having a concentration of potassium ions such that the final concentration of potassium ions in the cell-containing well is in the range of about 50-150 mM (e.g., 50 mM KCI).
  • ligands are known which have affinity for and activate such receptors.
  • nicotinic acetylcholine receptors are known to be activated by nicotine or acetylcholine; similarly, muscarinic and acetylcholine receptors may be activated by addition of muscarine or carbamylcholine.
  • Agonist assays may be carried out on cells known to possess ion channels and/or receptors to determine what effect, if any, a compound has on activation or potentiation of ion channels or receptors of interest. Agonist assays also may be carried out using a reagent known to possess ion channel- or receptor-activating capacity to determine whether a cell expresses the respective functional ion channel or receptor of interest.
  • a functional receptor or ion channel with agonist typically activates a transient reaction; and prolonged exposure to an agonist may desensitize the receptor or ion channel to subsequent activation.
  • assays for determining ion channel or receptor function should be initiated by addition of agonist (i.e., in a reagent solution used to initiate the reaction).
  • the potency of a compound having agonist activity is determined by the detected change in some observable in the cells (typically an increase, although activation of certain receptors causes a decrease) as compared to the level of the observable in either the same cell, or substantially identical cell, which is treated substantially identically except that reagent lacking the agonist (i.e., control) is added to the well.
  • an agonist assay is performed to test whether or not a cell expresses the functional receptor or ion channel of interest
  • known agonist is added to test-cell-containing wells and to wells containing control cells (substantially identical cell that lacks the specific receptors or ion channels) and the levels of observable are compared.
  • cells lacking the ion channel and/or receptor of interest should exhibit substantially no increase in observable in response to the known agonist.
  • a substantially identical cell may be derived from the same cells from which recombinant cells are prepared but which have not been modified by introduction of heterologous DNA. Alternatively, it may be a cell in which the specific receptors or ion channels are removed. Any statistically or otherwise significant difference in the level of observable indicates that the test compound has in some manner altered the activity of the specific receptor or ion channel or that the test cell possesses the specific functional receptor or ion channel.
  • individual wells contain a distinct cell type, or distinct recombinant cell line expressing a homogeneous population of a receptor or ion channel of interest, so that the compound having unidentified activity may be screened to determine whether it possesses modulatory activity with respect to one or more of a variety of functional ion channels or receptors. It is also contemplated that each of the individual wells, may contain the same cell type so that multiple compounds (obtained from different reagent sources in the apparatus or contained within different wells) can be screened and compared for modulating activity with respect to one particular receptor or ion channel type.
  • Antagonist assays may be carried out by incubating cells having functional ion channels and/or receptors in the presence and absence of one or more compounds, added to the solution bathing the cells in the respective wells of the microtiter plate for an amount of time sufficient (to the extent that the compound has affinity for the ion channel and/or receptor of interest) for the compound(s) to bind to the receptors and/or ion channels, then activating the ion channels or receptors by addition of known agonist, and measuring the level of observable in the cells as compared to the level of observable in either the same cell, or substantially identical cell, in the absence of the putative antagonist.
  • assays are thus useful for rapidly screening compounds to identify those that modulate any receptor or ion channel in a cell.
  • assays can be used to test functional ligand-receptor or ligand-ion channel interactions for cell receptors including ligand-gated ion channels, voltage-gated ion channels, G-protein-coupled receptors and growth factor receptors.
  • assays may encompass measuring a detectable change of a solution as a consequence of a cellular event which allows a compound, capable of differential characteristics, to change its characteristics in response to the cellular event.
  • various assays may be performed. For example, assays for determining the capacity of a compound to induce cell injury or cell death may be carried out by loading the cells with a pH-sensitive fluorescent indicator such as BCECF (Molecular Probes, Inc., Eugene, Oreg. 97402, Catalog #B1150) and measuring cell- injury or-cell-death as a function of changing fluorescence over time.
  • BCECF pH-sensitive fluorescent indicator
  • the function of receptors whose activation results in a change in the cyclic nucleotide levels of the cytoplasm may be directly determined in assays of cells that express such receptors and that have been injected with a fluorescent compound that changes fluorescence upon binding cAMP.
  • the fluorescent compound comprises cAMPdependent-protein kinase in which the catalytic and regulatory subunits are each labelled with a different fluorescent-dye [Adams et al. (1991) Nature 349:694-697].
  • cAMP binds to the regulatory subunits, the fluorescence emission spectrum changes; this change can be used as an indication of a change in cAMP concentration.
  • the function of certain neurotransmitter transporters which are present at the synaptic cleft at the junction between two neurons may be determined by the development of fluorescence in the cytoplasm of such neurons when conjugates of an amine acid and fluorescent indicator (wherein the fluorescent indicator of the conjugate is an acetoxymethyl ester derivative e.g., 5-(aminoacetamido)fluorescein; Molecular Probes, Catalog #A1363) are transported by the neurotransmitter transporter into the cytoplasm of the cell where the ester group is cleaved by esterase activity and the conjugate becomes fluorescent.
  • the fluorescent indicator of the conjugate is an acetoxymethyl ester derivative e.g., 5-(aminoacetamido)fluorescein; Molecular Probes, Catalog #A1363
  • a reporter gene construct is inserted into an eukaryotic cell to produce a recombinant cell which has present on its surface a cell surface protein of a specific type.
  • the cell surface receptor may be endogenously expressed or it may be expressed from a heterologous gene that has been introduced into the cell.
  • Methods for introducing heterologous DNA into eukaryotic cells are-well known in the art and any such method may be used.
  • DNA encoding various cell surface proteins is known to those of skill in the art or it may be cloned by any method known to those of skill in the art.
  • the recombinant cell is contacted with a test compound and the level of reporter gene expression is measured.
  • the contacting may be effected in any vehicle and the testing may be by any means using any protocols, such as serial dilution, for assessing specific molecular interactions known to those of skill in the art.
  • the level of gene expression is measured.
  • the amount of time to effect such interactions may be empirically determined, such as by running a time course and measuring the level of transcription as a function of time.
  • the amount of transcription may be measured using any method known to those of skill in the art to be suitable. For example, specific mRNA expression may be detected using Northern blots or specific protein product may be identified by a characteristic stain.
  • the amount of transcription is then compared to the amount of transcription in either the same cell in the absence of the test compound or it may be compared with the amount of transcription in a substantially identical cell that lacks the specific receptors.
  • a substantially identical cell may be derived from the same cells from which the recombinant cell was prepared but which had not been modified by introduction of heterologous DNA. Alternatively, it may be a cell in which the specific receptors are removed. Any statistically or otherwise significant difference in the amount of transcription indicates that the test compound has in some manner altered the activity of the specific receptor.
  • the assay may be repeated and modified by the introduction of a step in which the recombinant cell is first tested for the ability of a known agonist or activator of the specific receptor to activate transcription if the transcription is induced, the test compound is then assayed for its ability to inhibit, block or otherwise affect the activity of the agonist.
  • the transcription based assay is useful for identifying compounds that interact with any cell surface protein whose activity ultimately alters gene expression.
  • the assays can be used to test functional ligand-receptor or ligand-ion channel interactions for a number of categories of cell surface-localized receptors, including: ligand-gated ion channels and voltage-gated ion channels, and G protein-coupled receptors.
  • Any transferable cell that can express the desired cell surface protein in a manner such the protein functions to intracellularly transduce an extracellular signal may be used.
  • the cells may be selected such that they endogenously express the cell surface protein or may be genetically engineered to do so. Many such cells are known to those of skill in the art. Such cells include, but are not limited to Ltk " cells, PC 12 cells and COS-7 cells.
  • cell surface protein that is known to those of skill in the art or that may be identified by those of skill in the art may be used in the assay.
  • the cell surface protein may be endogenously expressed on the selected cell or it may be expressed from cloned DNA.
  • Exemplary cell surface proteins include, but are not limited to, cell surface receptors and ion channels.
  • Cell surface receptors include, but are not limited to, muscarinic receptors (e.g., human M2 (GenBank accession #M16404); rat M3 (GenBank accession #M16407); human M4 (GenBank accession #M16405); human M5 (Bonner et al.
  • Neuron 1 :403-410 (1988) Neuron 1 :403-410); and the like); neuronal nicotinic acetylcholine receptors (e.g., the alpha 2, alpha 3 and beta 2 subtypes disclosed in U.S. Ser. No. 504,455 (filed Apr. 3, 1990), hereby expressly incorporated by reference herein in its entirety); the rat alpha 2 subunit (Wada et al.
  • adrenergic receptors e.g., human beta 1 (Frielle et al. (1987) Proc. Natl. Acad. Sci. 84.:7920-7924); human alpha 2 (Kobilka et al. (1987) Science 238:650-656); hamster beta 2 (Dixon et al. (1986) Nature 321:75-79); and the like); dopamine receptors ⁇ e.g., human D2 (Stormann et al.
  • NGF receptors ⁇ e.g., human NGF receptors (Johnson et al. (1986) Cell 47:545-554); and the like); serotonin receptors ⁇ e.g., human 5HTIa (Kobilka et al. (1987) Nature 329:75-79); rat 5HT2 (Julius et al. (1990) PNAS 87:928-932); rat 5HTIc (Julius et al. (1988) Science 241 :558-564); and the like).
  • Reporter gene constructs are prepared by operatively linking a reporter gene with at least one transcriptional regulatory element. If only one transcriptional regulatory element is included, it must be a regulatable promoter. At least one of the selected transcriptional regulatory elements must be indirectly or directly regulated by the activity of the selected cell-surface receptor whereby activity of the receptor can be monitored via transcription of the reporter genes.
  • the construct may contain additional transcriptional regulatory elements, such as a FIRE sequence, or other sequence, that is not necessarily regulated by the cell surface protein, but is selected for its ability to reduce background level transcription or to amplify the transduced signal and to thereby increase the sensitivity and reliability of the assay.
  • additional transcriptional regulatory elements such as a FIRE sequence, or other sequence, that is not necessarily regulated by the cell surface protein, but is selected for its ability to reduce background level transcription or to amplify the transduced signal and to thereby increase the sensitivity and reliability of the assay.
  • reporter genes and transcriptional regulatory elements are known to those of skill in the art and others may be identified or synthesized by methods known to those of skill in the art.
  • a reporter gene includes any gene that expresses a detectable gene product, which may be RNA or protein. Preferred reporter genes are those that are readily detectable.
  • the reporter gene may also be included in the construct in the form of a fusion gene with a gene that includes desired transcriptional regulatory sequences or exhibits other desirable properties. Examples of reporter genes include, but are not limited to CAT
  • luciferase and other enzyme detection systems, such as beta-galactosidase; firefly luciferase (deWet et al. (1987), Mot. Cell. Biol. 7:725-737); bacterial luciferase (Engebrecht and Silverman (1984), PNAS 1: 4154-4158; Baldwin et al. (1984), Biochemistry 23: 3663-3667); alkaline phosphatase (Toh et al. (1989) Eur. J. Biochem. 182: 231-238, Hall et al. (1983) J.
  • Transcriptional control elements include, but are not limited to, promoters, enhancers, and repressor and activator binding sites.
  • Suitable transcriptional regulatory elements may be derived from the transcriptional regulatory regions of genes whose expression is rapidly induced, generally within minutes, of contact between the cell surface protein and the effector protein that modulates the activity of the cell surface protein. Examples of such genes include, but are not limited to, the immediate early genes (see, Sheng et al. (1990) Neuron 4: 477-485), such as c- fos, Immediate early genes are genes that are rapidly induced upon binding of a ligand to a cell surface protein.
  • the transcriptional control elements that are preferred for use in the gene constructs include transcriptional control elements from immediate early genes, elements derived from other genes that exhibit some or all of the characteristics of the immediate early genes, or synthetic elements that are constructed such that genes in operative linkage therewith exhibit such characteristics.
  • the characteristics of preferred genes from which the transcriptional control elements are derived include, but are not limited to, low or undetectable expression in quiescent cells, rapid induction at the transcriptional level within minutes of extracellular simulation, induction that is transient and independent of new protein synthesis, subsequent shut-off of transcription requires, new protein synthesis, and mRNAs transcribed from these genes have a short half-life. It is not necessary for all of these properties to be present.
  • the present invention contemplates modes of treatment and prophylaxis which utilize one or more of the subject DAT inhibitors. These agents may be useful for decreasing or preventing the effects of defects in an animal which cause a movement disorder.
  • the present invention contemplates modes of treatment and prophylaxis which utilize one or more of the subject DAT inhibitors to alter defects which cause a movement disorder.
  • the improvement and/or restoration of mental or physical state in an organism has positive behavioral, social, and psychological consequences.
  • the subject method can be used to treat patients who have been diagnosed as having or at risk of developing movement disorders.
  • Parkinson's disease is the second most common neurodegenerative disorder, affecting nearly 1 million people in North America. The disease is characterized by symptoms such as muscle rigidity, tremor and bradykinesia.
  • Parkinson's disease Early studies of Parkinson's disease showed unusual inclusions in the cytoplasm of neurons (i.e., Lewy bodies), occurring predominantly in the substantia nigra, which innervate the striatal region of the forebrain. Although Lewy bodies were also found in other neurodegenerative conditions, the presence of Lewy bodies in Parkinson's disease is accompanied by cell loss in the substantia nigra. This cell loss is considered to be the defining pathological feature of Parkinson's disease. Epidemiological studies have reported geographic variation in Parkinson's disease incidence, leading to the search for environmental factors (Olanow and Tatton, Ann. Rev. Neurosci., 22:123-144 [1998]).
  • Parkinson's disease may be caused by environmental factors (e.g., toxins and causative agents). (See e.g., Langston, Ann. Neurol., 44:S45-S52 [1998]).
  • Parkinson's disease has also identified genes associated with Parkinson's disease (Mizuno et al., Biomed. Pharmacother., 53(3):109-l 16 [1999]; Dunnett and Bjorklund, Nature 399 (6738 Suppl):A32-A39 [1999]); namely, the ⁇ -synuclein gene (Polymeropouos et al., Science 276:2045-2047 [1997]), the parkin gene (Kitada et al., Nature 392:605-608 [1998]), and the UCH-Ll thiol protease gene (Leroy et al., Nature 395:451-452 [1998]).
  • Parkinson's disease Mizuno et al., Biomed. Pharmacother., 53(3):109-l 16 [1999]; Dunnett and Bjorklund, Nature 399 (6738 Suppl):A32-A39 [1999]
  • Parkinson's disease is associated with the progressive loss of dopamine neurons in the ventral mesencephalon of the substantia nigra (Shoulson, Science 282: 1072-1074 [1998]), which innervates the major motor-control center of the forebrain, the striatum.
  • a gradual decline in the number of neurons and dopamine content of the basal ganglia is normally associated with increasing age, progressive dopamine loss is pronounced in people suffering from Parkinson's disease, resulting in the appearance of symptoms when about 70-80% of striatal dopamine and 50% of nigral dopamine neurons are lost (Dunnett and Bjorklund, supra).
  • Parkinson's disease This loss of dopamine-producing neurons resulting in a dopamine deficiency is believed to be responsible for the motor symptoms of Parkinson's disease.
  • dopaminergic cell death is affected by a combination of necrotic and apoptotic cell death.
  • Mechanisms and signals responsible for the progressive degeneration of nigral dopamine neurons in Parkinson's disease have been proposed (Olanow et al., Ann. Neurol., 44:S1-S196 [1998]), and include oxidative stress (from the generation of reactive oxygen species), mitochondrial dysfunction, excitotoxicity, calcium imbalance, inflammatory changes and apoptosis as contributory and interdependent factors in Parkinson's disease neuronal cell death.
  • Apoptosis i.e., programmed cell death
  • plays a fundamental role in the development of the nervous system (Oppenheim, Ann. Rev. Neurosci., 14: 453-501 [1991])
  • accelerated apoptosis is believed to underlie many neurodegenerative diseases, including Parkinson's disease (Barinaga, Science 281: 1303-1304 [1998]; Mochizuki et al., J. Neurol. Sci., 137: 120-123 [1996]; and Oo et al., Neuroscience 69: 893-901 [1995]).
  • Parkinson's disease Barinaga, Science 281: 1303-1304 [1998]
  • Oo et al., Neuroscience 69: 893-901 [1995] In living systems, apoptotic death can be initiated by a variety of external stimuli, and the biochemical nature of the
  • L-dopa levo-dihydroxy-phenylalanine
  • Sinemet is a dopamine precursor which can cross the blood-brain barrier and be converted to dopamine in the brain.
  • L-dopa has a short half life in the body and it is typical after long use (i.e., after about 4-5 years) for the effect of L- dopa to become sporadic and unpredictable, resulting in fluctuations in motor function, dyskinesias and psychiatric side effects. Additionally, L-dopa can cause B vitamin deficiencies to arise.
  • Selegiline (Deprenyl, Eldepryl) has been used as an alternative to L-dopa, and acts by reducing the breakdown of dopamine in the brain. Unfortunately, selegiline becomes ineffective after about nine months of use.
  • Apomorphine a dopamine receptor agonist, has been used to treat Parkinson's disease, although is causes severe vomiting when used on its own, as well as skin reactions, infection, drowsiness and some psychiatric side effects.
  • Systemically administered anticholinergic drugs have also been used to treat Parkinson's disease and act by reducing the amount of acetylcholine produced in the brain and thereby redress the dopamine/acetylcholine imbalance present in Parkinson's disease.
  • systemically administered anticholinergics develop serious neuropsychiatric side effects, including hallucinations, as well as dyskinetic movements, and other effects resulting from wide anticholinergic distribution, including vision effects, difficulty swallowing, dry mouth, and urine retention. See e.g. Playfer, J. R., Parkinson's Disease, Postgrad Med J, 73;257-264:1997 and Nadeau, S. E., Parkinson's Disease, J Am Ger Soc, 45;233-240:1997.
  • Newer drug refinements and developments include direct-acting dopamine agonists, slow-release L-dopa formulations, inhibitors of the dopamine degrading enzymes catechol-O-methyltransferase (COMT) and monoamine oxidase B (MAO- B), and dopamine transport blockers.
  • These treatments enhance central dopaminergic neurotransmission during the early stages of Parkinson's disease, ameliorate symptoms associated with Parkinson's disease, and temporarily improve the quality of life.
  • L-dopa for treating Parkinson's disease, the benefits accorded by these dopaminergic therapies are temporary, and their efficacy declines with disease progression.
  • thalamotomy a malignant neoplasm originating from thalamic cells.
  • thalamotomy a malignant neoplasm originating from thalamic cells.
  • Thalamotomy destroys part of the thalamus, a brain region involved in movement control.
  • Unilateral stereotactic thalamotomy has proven to be effective for controlling contralateral tremor and rigidity, but carries a risk of hemiparesis.
  • Bilateral thalamotomy carries an increased risk of speech and swallowing disorders resulting.
  • Pallidotomy surgical ablation of part of the globus pallidus (a basal ganglia), has also be used with some success.
  • Pallidotomy is performed by inserting a wire probe into the globus pallidus and heating the probe to destroy nearby tissue.
  • Pallidotomy is most useful for the treatment of peak-dose diskinesias and for dystonia that occurs at the end of a dose.
  • high frequency stimulating electrodes placed in the ventral intermedialis nucleus has been found to suppress abnormal movements in some cases.
  • a variety of techniques exist to permit precise location of a probe including computed tomography and magnetic resonance imaging.
  • Parkinson's disease Unfortunately, the akinesia, speech and gait disorder symptoms of Parkinson's disease, are little helped by these surgical procedures, all of which result in destructive brain lesions. Despite the development of modem imaging and surgical techniques to improve the effectiveness of these neurosurgical interventions for the treatment of Parkinson's disease tremor symptoms, the use of neurosurgical therapies is not widely applicable. For example, thalamotomy does not alleviate the akinetic symptoms which are the major functional disability for many people suffering from Parkinson's disease (Marsden et si., Adv. Neurol., 74:143-147 [1997]).
  • Therapeutic methods aimed at controlling suspected causative factors associated with Parkinson's disease have also been developed.
  • Clinical trials have shown that administration of antioxidative agents vitamin E and deprenyl provided little or no neuroprotective function (Shoulson et al., Ann. Neurol., 43:318-325 [1998]).
  • Glutamate-receptor blockers and neuronal nitric oxide synthase (NOS) inhibitors have been proposed as therapies for Parkinson's disease, however, no experimental results from human studies have yet been published (Rodriguez, Ann. Neurol., 44:S175-S188 [1998]).
  • GDNF glial cell line-derived neurotrophic factor
  • neurotrophic factors which may have therapeutic value have been proposed based on in vitro and animal model systems, including neurturin, basic fibroblast growth factor (bFGF), brain-derived neurotrophic factor (BDNF), neurotrophins 3 and 4/5, ciliary neurotrophic factor and transforming growth factor ⁇ (TGF- ⁇ ).
  • bFGF basic fibroblast growth factor
  • BDNF brain-derived neurotrophic factor
  • TGF- ⁇ transforming growth factor ⁇
  • dopaminergic neurons for use in the transplantation process have been tried in animal experiments, including the use of mesencephalic dopamine neurons obtained from human embryo cadavers, immature neuronal precursor cells (i.e., neuronal stem cells), dopamine secreting non-neuronal cells, terminally differentiated teratocarcinoma-derived neuronal cell lines (Dunnett and Bjorkland, supra), genetically modified cells (Raymon et al., Exp- Neurol., 144:82- 91 [1997]; and Kang, Mov. Dis.
  • Parkinson's disease in a patient, no more than 5-20% of the transplanted dopamine neurons survive. Additional therapies are also available, such as physical therapy, occupational therapy, or speech/language therapy. Exercise, diet, nutrition, patient/caregiver education, and psychosocial interventions have also been shown to have a positive effect on the mental and/or physical state of a person suffering from Parkinson's disease.
  • Various methods of evaluating Parkinson's disease in a patient include
  • a person suffering from Parkinson's disease should avoid contraindicated and potentially contraindicated drugs such as antipsychotic drugs, Haloperidol (Haldol), Perphenazine (Trilafon), Chlorpromazine (Thorazine), Trifluoperazine (Stelazine), Flufenazine (Prolixin, Permitil) Thiothixene (Navane), Thioridazine (Mellaril); antidepressant drug, combination of Perphenazine and Amitriptyline (Triavil); anti-vomiting drugs, Prochlorperazine (Compazine), Metoclopramide (Reglan, Maxeran), Thiethylperazine (Torecan), Reserpine (Serpasil), Tetrabenazine (Nitoman); blood pressure drug, Alpha-methyldopa (Aldomet); anti-seizure drug, Phenytoin (Dilantin); mood stabilizing drug, lithium; and anti-
  • Example 1 Antagonism of Dopamine Receptors or Transporters & Functional Activity
  • CNS-28,100 is a 200-fold and 825-fold more selective inhibitor for DAT than for NET and 5-HT, respectively.
  • the selectivity for CNS-27,100 is 1000-fold (NET) and 5000-fold (5-HT), respectively.
  • the selectivity for CNS-28,001 is 1000-fold (NET) and 1000-fold (5-HT), respectively.
  • R-DDMS is only 2-fold more selective for DAT over NET, and 15-fold more selective for DAT over 5-HT.
  • R-DMS is 10-fold more selective for DAT over NET, and 50-fold more selective for DAT over 5-HT.
  • the assay is performed at room temperature in Krebs-Ringer's-HEPES (KRH) buffer (125 mM NaCl, 4.8 mM KCl, 1.2 mM MgSO 4 , 1.2 mM KH 2 PO 4 , 1.3 mM CaCl 2 , and 25 mM HEPES, pH 7.4), supplemented with 0.1% D-glucose, 1 mM ascorbic acid, 1 mM tropolone [catechol-O-methyltransferase (EC 2.1.1.6)-inhibitor] and 10 ⁇ M pargyline (monoamine oxidase-B inhibitor).
  • KRH Krebs-Ringer's-HEPES
  • cells expressing DAT are washed once with KRH and equilibrated for 5 min.
  • the cells may be assayed in 24-well plates and incubated for 2-5 min. with tritiated amines. Nontransported inhibitors were preincubated for 5 min, and substrates were applied together with the tritiated substrate.
  • the uptake assay is terminated with two washes of ice-cold KRH, and the accumulated radioactivity is recovered by lysing the cells in 0.2% SDS and 0.1 N NaOH and counting on a Liquid Scintillation Analyzer 1900 TR (Packard, Meriden, CT). Nonspecific uptake can be determined in the presence of 10 ⁇ M GBRl 2909 (for hDAT).
  • Vmax values for amine uptake in stable transfected DAT-cells are determined in parallel assays for at least two amines per experiment and expressed as relative values.
  • Table II represents a typical result in table form. Specifically, the IC 50 for CNS-28,100 against DAT (SLC6A3) is 1 nM, while the IC 50 for the related NET (norepinephrine transporter or SLC6A2) and 5-HT receptors are 150 nM and 550 nM, respectively, indicating that the inhibitory effect of CNS-28, 100 against DAT is not only highly effective, but also very specific (over 150-550 fold selectivity against related receptors).
  • Example 2 In vivo Efficacy of Several Illustrative Dopamine Transporter Inhibitors
  • mice or rats
  • mice are forced to swim in a cylinder from which no escape is possible, they readily adopt a characteristic immobile posture and make no further attempts to escape except for small movements needed to keep floating.
  • the immobility is considered by some to reflect a "depressive mood" (Porsolt et al., Nature 266: 730-732, 1977) in which animals cease to struggle to escape the aversive situation.
  • the immobility induced by the procedure is influenced by a wide variety of antidepressants (Porsolt et al, in Psychopharmacology, Olivier, Mos, and Sans (eds) Birkhauser Verlag, Basel, pp. 137-159, 1991) and has a good predictive validity in that it detects antidepressants with different mechanisms of action (TCAs, SSRIs, MAOIs 5 and other atypical ones).
  • TCAs, SSRIs, MAOIs 5 and other atypical ones The test is sensitive to muscle-relaxant (benzodiazepines) and sedative (neuroleptics) effects, leading to enhanced immobility (Porsolt et ah, supra).
  • mice are placed singly into a cylinder ⁇ e.g. 46 x 30 cm) containing fresh water at about 2O 0 C for 6 minutes.
  • the activity (or immobility) of the animal is measured by an observer minute by minute.
  • the animals were preconditioned in a pretest session, where the rats were individually forced to swim inside a vertical plexiglass cylinder containing water maintained at 19-2O 0 C. After 15 minutes in the water, they were allowed to dry for 15 minutes in a heated enclosure. Twenty four hours later, the compounds were administered either intraperitoneally or orally to the animals. One hour after administration of the test compound, animals were put back into the cylinder containing water.
  • the total duration of immobility was measured during the last 4 minutes of a 6 minute test.
  • one test inhibitor (CNS-27,100, CNS-28,100, or CNS-28,200) was injected i.p. as racemic mixtures of diastereomers into the animals, at various doses ⁇ e.g. 7.5 and 15 mg/kg).
  • Sibutramine 2.0 and 2.5 mg/kg
  • Bupropion 7.5 and 10 mg/kg
  • Imipramine (30 mg/kg) were similarly administered as controls.
  • Figure 2 indicates that at the doses tested, these DAT inhibitors performed equally well, if not better, than the commercial drugs Sibutramine, Bupropion, and Imipramine. Asterisks indicate highly statistical significant results.
  • a fourth DAT inhibitor, CNS-28,002 was administered p.o. as a racemic mixture of diastereomers at either 35 or 75 mg/kg.
  • Sibutramine (5.0 and 3.75 mg/kg), Bupropion (30 and 40 mg/kg), and Imipramine (100 mg/kg) were similarly administered as controls.
  • Figure 4 indicates that at the doses tested, CNS-28,002 performed equally well, if not better, than the commercial drugs Sibutramine, Bupropion, and Imipramine.
  • CNS-27,100 was also administered p.o. as a racemic mixture of enriched (95:5) diastereomer at either 35 or 75 mg/kg.
  • Sibutramine (5.0 and 3.75 mg/kg), Bupropion (30 and 40 mg/kg), and Imipramine (100 mg/kg) were similarly administered as controls.
  • Figure 3 indicates that at the doses tested, CNS-27,100 performed equally well, if not better, than the commercial drugs Sibutramine, Bupropion, and Imipramine. Asterisks indicate highly statistical significant results.
  • DAT inhibitors of the instant invention CNS-27,100, CNS-28,002, and CNS- 28,200.
  • mice were administered with various doses of respective DAT inhibitors (e.g. 30, 90, 120, and 200 mg/kg), and the observed toxicological effects were recorded.
  • DAT inhibitors e.g. 30, 90, 120, and 200 mg/kg
  • rats tolerate doses below 120 mg/kg of CNS-27,100 well, with no significant observed symptoms associated with drug administration. At 200 mg/kg, animals showed decreased grip strength, and slight depression. Animals tolerates CNS-28,002 rather well, with no observed symptoms at the highest dose of 200 mg/kg. However, rats administered with CNS-28,200 showed decreased grip strength and limb tone and convulsions at 120 mg/kg, and convulsions at 200 mg/kg. But this dose is about 10 times the effective dose as shown in Figure 2.
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US8258305B2 (en) 2012-09-04
CA2609440A1 (en) 2006-08-31
KR101233030B1 (ko) 2013-02-13
JP5199678B2 (ja) 2013-05-15
JP2008531577A (ja) 2008-08-14
KR20080012830A (ko) 2008-02-12
AU2006216646A1 (en) 2006-08-31
US20120329829A1 (en) 2012-12-27
CN101163676A (zh) 2008-04-16
AU2006216646B2 (en) 2012-05-31
EP1853560A1 (en) 2007-11-14
EP2338881A1 (en) 2011-06-29
IL185383A (en) 2012-07-31
IL185383A0 (en) 2008-01-06
US20100217727A1 (en) 2010-08-26

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