Abstract:
This invention relates to a method of treating patients suffering from the inflammatory bowel disorders. The method includes administering to a patient in need of treatment an effective amount of a thiol or reducible disulfide compound according to the formula set forth in the specification.

Description:
FIELD OF THE INVENTION 
     This invention relates to a method for treating inflammatory gastrointestinal diseases, and will have application to a method for treating inflammatory bowel disease. The method involves administering effective amounts of a disulfide or thiol-containing compound to a patient suffering from an inflammatory gastrointestinal disease. 
     BACKGROUND OF THE INVENTION 
     Inflammatory bowel disease (IBD) is the medical term that is used generically to identify idiopathic conditions known commonly as ulcerative colitis (UC) and Crohn&#39;s Disease (CD). Other forms of IBD include viral, bacterial and parasitic infections; diverticulitis; radiation induced enteritis or colitis; drug or toxin induced enterocolitis; or vasculitis of the intestinal tract. 
     UC and CD are disorders of generally unknown etiology, and involve genetic and immunologic influences on the ability of the GI tract to distinguish foreign from self-antigens and/or to downregulate the mucosal immune response. Both are chronic, medically incurable conditions, although UC is cured by an intensive surgical procedure commonly known as a proctocolectomy. 
     Both UC and CD cause considerable discomfort and pain in the everyday lives of persons afflicted with one or the other. Painful and at times life-threatening complications include constipation and/or diarrhea, cramping, infections, internal bleeding, tachycardia, dehydration, higher risk of developing colon cancers, and others. 
     Mesna (sodium 2-mercaptoethene sulfonate) and dimesna (disodium 2,2′-dithiobis ethane sulfonate) are known therapeutic compounds that have heretofore demonstrated a wide variety of therapeutic uses. Both mesna and dimesna have been shown to be effective protective agents against certain specific types of toxicity associated with the administration of cytotoxic drugs used to treat patients for various types of cancer. 
     In particular, mesna has been used with some success in mitigating the toxic effects of cytotoxic agents such as ifosfamide, oxazaphosphorine, melphalane, cyclophosphamide, trofosfamide, suifosfamide, chlorambucil, busulfan, triethylene thiophosphamido, triaziquone, and others, as disclosed in U.S. Pat. No. 4,220,660, issued Sep. 2, 1980. 
     The near absence of toxicity of dimesna further underscores the usefulness of this compound, as large doses can be given to a patient without increasing the risk of adverse effects from the protective agent itself. 
     Further, pharmacological profiles of each compound indicate that, if proper conditions are maintained, mesna and diimesna do not prematurely inactivate primary therapeutic drugs to a significant degree. Thus, neither compound will significantly reduce activity of the chemotherapeutic agent, and in many cases, act to potentiate the effect of the main drug on targeted cancer cells. 
     The molecular structures of both mesna and dimesna are shown below as Structure I and Structure II respectively. 
     
       
         HS—CH 2 —CH 2 —SO 3 Na  (I) 
       
     
     
       
         NaSO 3 —CH 2 —CH 2 —S—S—CH 2 —CH 2 —SO 3 Na  (II) 
       
     
     As shown, dimesna is a dimer of mesna, with the optimum conditions for oxidation occurring in the slightly basic (pH ˜7.3), oxygen rich environment found in blood plasma. In mildly acidic, low oxygen conditions, in the presence of a reducing agent such as glutathione reductase, conditions prevalent in the kidneys, the primary constituent is mesna. 
     Mesna acts as a protective agent for a number of cytotoxic agents by substituting a nontoxic sulfhydryl moiety for a toxic hydroxy (or aguo) moiety. This action is particularly evidenced in the coadministration of mesna and oxazaphosphorine, and in the administration of dimesna along with certain platinum agents and/or taxanes. 
     Dimesna, as well as some analogues, have excellent toxicity profiles in mammalian species. In fact, dimesna has been administered intravenously to mice and dogs in doses higher than the accepted oral LD 50  for common table salt (3750 mg/kg), with no adverse effects. Dimesna has also been administered to humans in doses exceeding 40 g/m 2 , with no adverse effects. 
     Mesna, and other analogues with free thiol moieties, constitute the more physiologically active form of the two types of compounds described in this specification. These compounds manifest their activity by providing free thiol moieties for terminal substitution at locations where a terminal leaving group of appropriate configuration, usually a hydroxy, aquo or superoxide is located. Mesna also tends to form conjugates with naturally occurring biochemicals that contain a free thiol moiety, such as cysteine, glutathione, homocysteine, and others. 
     Dimesna and other disulfides can be activated intracellulary by glutathione reductase, a ubiquitous enzyme, thereby generating high concentrations of intracellular free thiols. These free thiols act to scavenge the free radicals and other nucleophillic compounds often responsible for causing cell damage. 
     This profile is especially significant in explaining the success of dimesna in controlling and mitigating the toxic effects of platinum complex antitumor drugs. The mechanism for action in the case of cisplatin (cis-diammine dicloro platinum) is explained in U.S. Pat. No. 5,789,000, which is incorporated herein by reference. 
     Mesna, dimesna, and analogues of these compounds have been the subject of several prior pharmaceutical uses described in the literature and in prior patents, both in the United States and around the world. In addition to the cytotoxic agent protection uses, one or more of these compounds have proven effective, in vitro, against a multiplicity of biological targets, and have been effective, in vivo, in the treatment of sickle cell disease, radiation exposure, chemical agent exposure, and other uses. 
     Mesna, dimesna, and analogues thereof are synthesized from commonly available starting materials, using acceptable routes well known in the art. One such method involves the two-step, single pot synthetic process for making dimesna and like compounds of the following formula: 
     
       
         R 1 —S—R 2 ; 
       
     
     wherein: 
     R 1  is hydrogen, X-lower alkyl, or X-lower alkyl-R 3 ; 
     R 2  is -lower alkyl-R 4 ; 
     R 3  and R 4  are each individually SO 3 M or PO 3 M 2 ; 
     X is absent or X is sulfur; and 
     M is an alkali metal. 
     The process essentially involves a two-step single pot synthetic process, which results in the conversion of an alkenyl sulfonae salt or acid to the desired formula I compound. The process in the case of mesna is a single step process that converts the alkenyl sulfonate salt to mesna or a mesna derivative by reacting with an alkali metal sulfide or with hydrogen sulfide. 
     If the desired end product is dimesna or a dimesna analogue, a two-step single pot process is involved. Step 1 is as described above. Step 2 of the process is performed in the same reaction vessel as Step 1 without the need to purify or isolate the mesna formed during that step. Step 2 includes the introduction of oxygen gas into the vessel, along with an increase in pressure and temperature above ambient values, at least 20 pounds per square inch (psi) and at least 60° C. Dimesna or a derivative thereof is formed in essentially quantitative yield. 
     Other processes, well known and documented in the prior art, may be employed to make either mesna or dimesna, or derivatives and analogues thereof. 
     SUMMARY OF THE INVENTION 
     This invention involves the administration of an effective amount of a compound of formula 1, below, for treating a patient afflicted with an inflammatory bowel disorder:                           
     wherein: 
     R 1  is hydrogen, lower alkyl or                           
     R 2  and R 4  are each individually SO 3   − M + , PO 3   2− M 2   2+ , or PO 2 S 2− M 2   2+ ; 
     R 3  and R 5  are each individually hydrogen, hydroxy or sulfhydryl; 
     Each m is individually 1, 2, 3, 4, 5 or 6 with the proviso that if m is 1, then R 3  is hydrogen; and 
     M is hydrogen or an alkali metal ion; or 
     a pharmaceutically acceptable salt thereof. 
     Effective amounts of the formula I compound to be administered according to the method of this invention are variable, and depend upon the individual patient&#39;s response. Due to the excellent toxicity profile of the formula I compounds, large amounts of drug may be administered without risk of untoward side effects commonly associated with other drugs used to treat this condition. The formula I compound may be administered by oral routes, allowing the patient to self-administer the agent, adding to convenience of use. 
     Accordingly, it is an object of this invention to provide for a method of safely and effectively treating IBD in a patient. 
     Another object is to provide a method of treating TEfD by administration of a thiol or reducible disulfide to the patient desirous of treatment. 
    
    
     Other objects will become apparent upon a reading of the following description. 
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     The preferred embodiments herein described are not intended to be exhaustive or to limit the invention to the precise form disclosed. They are chosen and described to explain the principles of the invention, and its application and practical use to best enable others skilled in the art to follow its teachings. 
     The method of this invention involves the administration of an effective amount of a formula I compound to a patient suffering from an inflammatory bowel disorder. The effective amount of the formula I compound will necessarily depend upon the individual patient&#39;s response. Since the formula I compounds are essentially nontoxic, large amounts can be safely administered. The preferred dosage to treat IBD may be as low as 0.1 mg/kg up to 3,000 mg/kg. 
     For pareniteral administration, the formula I compound is dissolved in a suitable solvent, most preferably water, to produce a solution. One or more pharmaceutically acceptable excipients may also be added to provide for an elegant formulation. The formulation may also be incorporated into a continuous delivery device, such as an intrathecal pump or similar device. The formula I compound may also be delivered subdermally, by a skin patch. Skin patches have the advantage of providing continuous drug delivery without the need to remember taking a pill, without the invasive procedure needed to install a pump. 
     For oral administration the formula I compound is preferably combined with one or more pharmaceutically acceptable excipients, fillers and/or diluents. Oral dosage forms may include pills, caplets, tablets, and others. Alternatively, the formula I compound may be contained in a deglutable container such as a gelatin capsule or the like. Since the half-life of the formula I compound is relatively short, slow-release oral dosage forms are most preferred. 
     The formula I compounds are believed to alleviate IBD by scavenging cell-damaging free radicals in the digestive tract. It is known that the formula I compounds enter intestinal cells, and therefore can provide protection against IBD crises and/or complications of the disease. 
     Administration of the formula I compound should preferably be started as soon as possible after the patient is diagnosed with IBD. The preferred initial dose is between 10 mg/kg and 1000 mg/kg. high doses may be repeated ad libitum until positive results are achieved. 
     Careful observation and analysis is performed regularly throughout treatment. Dose rate may he altered depending upon the patient&#39;s response. If any adverse effects appear, the dose may be lowered or the timing changed. Dose alteration is well within the purview of one skilled in the medical arts. Slow release formulations of oral dosage forms are preferred to provide for longer protection. 
     Also, due to the excellent safety profile, additional doses of the formula I compound may be administered safely if the initial dose does not produce a positive response. Treatment may be repeated as often as necessary. 
     It is understood that the above description is in no way limiting of the invention, which may be modified within the scope of the following claims.