# Patent

## Title
Compounds that stimulate glucose utilization and methods of use

## Abstract

The invention provides novel compounds of the Formula (I) that stimulate rates of glucose oxidation in myocardial cells. The invention also relates to pharmaceutical compositions comprising compounds capable of stimulation of glucose oxidation, methods for increasing glucose oxidation rates in myocardial cells, and methods of treatment of myocardial ischemia




wherein

    
    
        W is C1–C6 alkyl, halogen, or aryl;
        Cyc is C3 or C4 cycloalkyl;
        p is 0–3 for Cyc being C4 cycloalkyl and p=0–2 for Cyc being C3 cycloalkyl;
        Y is O, S, or NR, where R═H, alkyl or aryl;
        X is O, S, NR, or CR3R4;
        Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkylcarbonyl;
        R1 is H, alkyl, aryl or O;
        R2 is H, alkyl or aryl;
        R3 and R4 are, independently, H, alkyl or aryl; and
        n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof.

## Background
This application is a 371 of PCT/IB02/02525, filed Apr. 1, 2002 and claims priority to U.S. Provisional Application No. 60/280,616, filed Mar. 30, 2001,


FIELD OF THE INVENTION
The invention relates to novel compounds that stimulate rates of glucose oxidation in myocardial cells. The invention also relates to pharmaceutical compositions comprising compounds capable of stimulation of glucose oxidation, methods for increasing glucose oxidation rates in myocardial cells, and methods of treatment of myocardial ischemia.
BACKGROUND OF THE INVENTION
Myocardial ischemia is a common clinical pathology that occurs in the setting of angina pectoris, acute myocardial infarction, or during cardiac surgery. Myocardial ischemia is a major clinical problem, with its complications being the major cause of mortality and morbidity in Western society.
It has been shown that stimulating glucose oxidation both during and following ischemia can benefit the ischemic heart. Br J Pharmacol 128: 197–205, 1999, Am J Physiol 275: H1533–41, 1998. Biochimica et Biophysica Acta 1225: 191–9, 1994, Pediatric Research 34: 735–41, 1993, Journal of Biological Chemistry 270: 17513–20, 1995. Biochimica et Biophysica Acta 1301: 67–75, 1996, Am J Cardiol 80: 11A–16A, 1997, Molecular & Cellular Biochemistry 88: 175–9, 1989, Circ Res 65: 378–87, 1989, Circ Res 66: 546–53, 1990, American Journal of Physiology 259: H1079–85, 1990, American Journal of Physiology 261: H1053–9, 1991, Am J Physiol Heart Circ Physiol 280: H1762–9., 2001, J Am Coll Cardiol 36: 1378–85., 2000.
To meet the high energy demands of the contracting muscle, the heart must produce a constant and plentiful supply of the free energy carrier, adenosine triphosphate (ATP). This energy is produced by the metabolism of a variety of carbon substrates, including carbohydrates such as glucose. The metabolism of fatty acid is the other major source of energy for the heart.
Glucose metabolism in the heart consists of two important pathways, namely glycolysis and glucose oxidation.
It has been shown that during ischemia (such as that produced by angina pectoris, myocardial infarction or heart surgery) the levels of circulating fatty acids in the plasma can be dramatically elevated. Am Heart J 128: 61–7, 1994.
As a result, during ischemia and reperfusion the heart is exposed to high levels of fatty acids, which results in the preferential use of fatty acids as an oxidative substrate over glucose. It further has been shown that this over-reliance on fatty acids as a major source of ATP contributes to fatty acid-induced ischemic damage. This observation has sparked numerous approaches directed at switching substrate utilization back to glucose in an attempt to protect the heart from fatty acid-induced ischemic damage. J Cardiovasc Pharmacol 31: 336–44., 1998, Am Heart J 134: 841–55., 1997, Am J Physiol 273: H2170–7., 1997, Cardiovasc Drugs Ther 14: 615–23., 2000, Cardiovasc Res 39: 381–92., 1998, Am Heart J 139: S115–9., 2000, Coron Artery Dis 12: S8–11., 2001, Am J Cardiol 82: 14K–17K., 1998, Molecular & Cellular Biochemistry 172: 137–47, 1997, Circulation 95: 313–5., 1997, Gen Pharmacol 30: 639–45., 1998, Am J Cardiol 82: 42K–49K., 1998, Coron Artery Dis 12: S29–33., 2001, Coron Artery Dis 12: S3–7., 2001, J Nucl Med 38: 1515–21., 1997. Current approaches that are used to manipulate myocardial energy metabolism involve either stimulating glucose metabolism directly or indirectly (i.e., inhibiting fatty acid metabolism).
Since high fatty acid oxidation rates markedly decrease glucose oxidation, one approach to increasing glucose oxidation is to inhibit fatty acid oxidation. This has proven effective both during and following ischemia, and this pharmacological approach is starting to see clinical use. Although a number of pharmacological agents designed to inhibit fatty acid oxidation have recently been developed, the direct β-oxidation inhibitor, trimetazidine, was the first anti-anginal agent widely used that has a mechanism of action that can be attributed to an optimization of energy metabolism Circulation Research. 86: 580–8, 2000.
Trimetazidine primarily acts by inhibiting fatty acid oxidation, thereby stimulating glucose oxidation in the heart.
A second clinically effective agent that switches energy metabolism from fatty acid to glucose oxidation is ranolazine. It has been shown that this agent stimulates glucose oxidation secondary to an inhibition of fatty acid oxidation Circulation 93: 135–42., 1996.
The detrimental effects of fatty acids on mechanical function during and following ischemia are also attenuated by agents that increase glucose oxidation directly. Numerous experimental studies have demonstrated that stimulation of glucose oxidation by using dichloroacetate (DCA) following ischemia (at the expense of fatty acids) can benefit the ischemic heart. Am Heart J 134: 841–55, 1997. Although DCA is an effective compound designed to stimulate glucose oxidation, it has a short biological half-life.
Therefore, there is need to develop novel class of compounds and to identify compounds that can stimulate glucose oxidation, have long biological life, and be effective in treatment or prevention of myocardial ischemia
SUMMARY OF THE INVENTION
The invention is directed to novel compounds represented by the Formula (I):




wherein

    
    
        W is C1–C6 alkyl, halogen, or aryl;
        Cyc is C3 or C4 cycloalkyl;
        p is 0 to 3;
        Y is O, S, or NR, where R═H, alkyl or aryl;
        X is O, S, NR, or CR3R4;
        Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkylcarbonyl;
        R1 is H, alkyl or aryl;
        R2 is H, alkyl, aryl or O;
        R3 and R4 are, independently, H, alkyl or aryl; and
        n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof.
    
    


The invention is further directed to methods for increasing or improving glucose utilization in myocardial or other types of cells, tissue or organs of warm blooded animals, especially those which are capable of high glucose metabolism (e.g., heart and other muscles). The method comprises treating cells, tissue or organs with substituted or unsubstituted cyclopropane carboxylic acid or cyclobutane carboxylic acid represented by the Formula (II) or their derivative compounds according to Formula (I).




wherein W, Cyc and p are as defined above.

The invention if also directed to pharmaceutical compositions comprising compounds according to the Formula (I) and suitable pharmaceutical carriers, excipients or fillers.
The invention is further directed to a method of treatment of physiological conditions or disorders known to be effectively treated by increasing of cell glucose utilization. The method comprises administering to patients in need of such treatment effective amounts of pharmaceutical compositions comprising substituted or unsubstituted cyclopropane carboxylic acid or cyclobutane carboxylic acid according to Formula (II) or their derivative compounds according to the Formula (I).
The invention is further directed to kits including the pharmaceutical compositions according to the invention.
Invention methods are applicable for treating any warm blooded animal subjects, such as mammals, e.g., humans, primates, etc.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows glucose oxidation in an isolated perfused working rat heart model with the indicated concentrations of cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester (MM054).
FIG. 2 shows glucose oxidation in an isolated perfused working rat heart model with the indicated concentrations of cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester (MM056).
FIG. 3 shows glucose oxidation in an isolated perfused working rat heart model with increasing concentrations of cyclopropanecarboxylic acid, 2-isopropoxy-ethyl ester (MM070).
FIG. 4 shows glucose oxidation in an isolated perfused working rat heart model with increasing concentrations of cyclopropanecarboxylic acid (MM001).



DETAILED DESCRIPTION OF THE INVENTION
The present invention provides novel compounds based on cyclopropane carboxylic acid or cyclobutane carboxylic acid. The compounds exhibit glucose oxidation stimulating activity in myocardial cells and other types of cells. The compounds according to the present invention are represented by the Formula (I):




wherein

    
    
        W is C1–C6 alkyl halogen, or aryl;
        Cyc is C3 or C4 cycloalkyl;
        p is 0–3 when Cyc is C4 cycloalkyl, and p is 0–2 when Cyc is C3 cycloalkyl;
        Y is O, S, or NR , where R═H, alkyl or aryl;
        X is O, S, NR, or CR3R4;
        Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkyl carbonyl;
        R1 is H, alkyl or aryl;
        R2 is H, alkyl, aryl or O;
        R3 and R4 are, independently, H, alkyl or aryl and
        n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof.
    
    


As used herein, the term “alkyl” means straight or branched alkane chain, which may be, optionally substituted with, for example, halogens, cyclic or aromatic substituents.
As used herein, the terms “aryl” or “aromatic” refer to mono- and bi-cyclic structures comprising 5–12 carbon atoms, preferably monocyclic rings containing six carbon atoms. The ring may be optionally substituted with alkyl, alkeny, halogen, alkoxy, or haloalkyl substituents.
The compounds according to the present invention can be obtained from substituted or unsubstituted cyclopropane carbonyl chloride or cyclobutane carbonyl chloride according to the following reaction scheme:




or their substituted derivatives and





where R1, R2, Y, X, Z and n are as defined above.

Preferred solvent is dichloromethane and preferred base catalysts are triethylamine and pyridine.
Reaction conditions may be varied depending on the starting materials and the desired end product. Optimization of the reaction conditions would be apparent for one of ordinary skill.
Preferred compounds have unsubstituted cycloalkyl rings.
In the preferred embodiments Y is O, and X is N or O, n is 1–4, p is 0, R1, R2, R3 and R4 are hydrogens, and Z is lower alkyl, cycloalkyl or phenyl; or Y is N, and X is O, n is 1 or 2, p is 0, R1, R2, R3 and R4 are hydrogens, and Z is hydrogen.
The compounds according to the present invention can be exemplified by the following compounds:

    -cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
    -cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
    -(cyclobutanecarbonyl-amino)-acetic acid;
    -cyclopropanecarboxylic acid 2-(2-benzyloxy-ethoxy)-ethyl ester;
    -2-(cyclopropanecarbonyl-amino)-propionic acid;
    -cyclobutanecarboxylic acid 2-(2-benzyloxy-ethoxy)-ethyl ester;
    -cyclobutanecarboxylic acid, 2-(2-butoxy-ethoxy)-ethyl ester;
    -cyclobutanecarboxylic acid, 2-(2-ethoxy-ethoxy)-ethyl ester;
    -cyclopropanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
    -cyclobutanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
    -cyclopropanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethoxy)-ethyl ester;
    -cyclobutanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethyl ester;
    -cyclopropanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
    -cyclobutanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
    -cyclopropanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
    -cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
    -cyclopropanecarboxylic acid 2-isopropoxy-ethyl ester;
    -cyclobutanecarboxylic acid 2-isopropoxy-ethyl ester;
    -cyclopropanecarboxylic acid, 2-(2-cyclobutanecarbonyloxy-ethoxy)-ethyl ester;
    -cyclopropanecarboxylic acid, 2-[2-(2-cyclopropanecarbonyloxy-ethoxy)-ethoxy]-ethyl ester; and
    -cyclobutanecarboxylic acid, 2-[2-(2-cyclobutanecarbonyloxy-ethoxy)-ethoxy]-ethyl ester.


The invention further provides a method for increasing the rate of glucose oxidation and improving glucose utilization in myocardial and other cells, tissue or organs of humans and animals. It has been discovered that substituted or unsubstituted cyclopropanecarboxylic acid, cyclopropanecarboxylic acid represented by the Formula (II) and cyclobutanecarboxylic acid derivatives, such as cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester and cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester and other compounds represented by the Formula (I) can increase glucose utilization in myocardial an other types of cells, tissue or organs of warm blooded animals, including humans.




wherein W is C1–C6alkyl, halogen, or aryl;

    
    
        Cyc is C3 or C4 cycloalkyl; and
        p is 0–3 when Cyc is C4 cycloalkyl, or p is 0–2 when Cyc is C3 cycloalkyl;
    
    


The method according to the present invention comprises treating cells, tissue or organs of the animal with at least one compound represented by Formula (I) or Formula (II). The compounds of the Formula (I) or Formula (II) can be delivered to the cells, tissues or organs by oral administration, injection or infusion, etc., of the compounds of the Formula (I) or (II) to the animals.
The invention further provides pharmaceutical compositions comprising, as its active component, at least one compound according to the Formulas (I) or (II), their pharmaceutically acceptable salt, ester or prodrugs. Pharmaceutical compositions comprising more than one compound according to the Formulas (I) or (II), their various mixtures and combinations are also within the scope of the present invention.
Pharmaceutical compositions or formulations include carriers and excipients compatible with oral, intravenous, intramuscular, intraarterial, intracranial, and intracavity administration. Pharmaceutical formulations further include colloidal dispersion systems, or lipid formulations (e.g., cationic or anionic lipids), micelles, microbeads, etc.
Pharmaceutical compositions of the invention include pharmaceutically acceptable and physiologically acceptable carriers, diluents or excipients. Examples of suitable carriers, diluents and excipients include solvents (aqueous or non-aqueous), solutions, emulsions, dispersion media, coatings, isotonic and absorption promoting or delaying agents, compatible with pharmaceutical administration, and other commonly used carriers known in the art.
Compositions can also include carriers to protect the composition against rapid degradation or elimination from the body, such as a controlled release formulation, including implants and microencapsulated delivery systems. For example, a time delay material such as glyceryl monostearate or glyceryl stearate alone, or in combination with a wax, may be employed.
Pharmaceutical compositions can be formulated to be compatible with a particular route of administration. For oral administration, a composition can be incorporated with excipients and used in the form of tablets, pills or capsules, e.g., gelatin capsules. Pharmaceutically compatible binding agents, and/or adjuvant materials can be included in oral formulations. The tablets, pills, capsules, etc., can contain any of the following ingredients, or similar compounds: a binder such as microcrystalline cellulose, gum tragacanth or gelatin; an excipient such as starch or lactose, a disintegrating agent such as alginic acid, Primogel, or corn starch; a lubricant such as magnesium stearate or Sterotes; a glidant such as colloidal silicon dioxide; or a flavoring or sweetening agent.
Pharmaceutical compositions for parenteral, intradermal, or subcutaneous administration can include a sterile diluent, such as water, saline solution, fixed oils, polyethylene glycols, glycerine, propylene glycol or other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or sodium bisulfite; chelating agents such as ethylenediaminetetraacetic acid; buffers such as acetates, citrates or phosphates and agents for the adjustment of tonicity such as sodium chloride or dextrose.
Pharmaceutical compositions for injection include sterile aqueous solutions (where water-soluble) or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion. For intravenous administration, suitable carriers include physiological saline, bacteriostatic water, Cremophor ELTM (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS). Antibacterial and antifungal agents include, for example, parabens, chlorobutanol, phenol, ascorbic acid and thimerosal. Isotonic agents, for example, sugars, polyalcohols such as manitol, sorbitol, sodium chloride may be included in the composition. Including an agent which delays absorption, for example, aluminum monostearate and gelatin can prolong absorption of injectable compositions.
The pharmaceutical formulations can be packaged in dosage unit form for ease of administration and uniformity of dosage. Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the subject to be treated; each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the pharmaceutical carrier or excipient.
The compositions can be administered by any route compatible with a desired outcome. Thus, routes of administration include oral (e.g., ingestion or inhalation), intraperitoneal, intradermal, subcutaneous, intravenous, intraarterial, intracavity, intracranial, and parenteral. The compositions can also be administered using implants and microencapsulated delivery systems.
Compositions, including pharmaceutical formulations can further include particles or a polymeric substance, such as polyesters, polyamine acids, hydrogel, polyvinyl pyrrolidone, ethylene-vinylacetate, methylcellulose, carboxymethylcellulose, protamine sulfate, or lactide/glycolide copolymers, polylactide/glycolide copolymers, or ethylenevinylacetate copolymers. Cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and derivatives and modified forms thereof can be entrapped in microcapsules, for example, by the use of hydroxymethylcellulose or gelatin-microcapsules, or poly (methylmethacrolate) microcapsules, respectively, or in a colloid drug delivery system.
In instances where cell, tissue or organ targeting is desired, a composition of the invention can of course be delivered to the target cell, organ or tissue by injection or infusion or the like. Targeting can be achieved by injection or infusion in practicing the methods of the invention. Targeting can also be achieved by using proteins that bind to a cell surface protein (e.g., receptor or matrix protein) present on the cell or population of cell types. For example, antibodies or antibody fragments (e.g., Fab region) that bind to a cell surface protein can be included in the delivery systems in order to facilitate cell, tissue or organ targeting. Viral coat proteins that bind particular cell surface proteins can be used for targeting. For example, naturally occurring or synthetic (e.g. recombinant) retroviral envelope proteins with known cell surface protein binding specificity can be employed in the liposomes in order to intracytoplasmically deliver cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and derivatives and modified forms thereof into target cells, tissue or organs. Thus, delivery vehicles, including colloidal dispersion systems, can be made to have a protein coat in order to facilitate targeting or intracytoplasmic delivery of cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and derivatives and modified forms thereof.
The invention further provides a method for prophylactic and therapeutic treatments of various physiological condition or disorder treatable by increasing or improving glucose utilization in cells, tissue or organs of a patient by administering to the patient in need of such treatment, effective amounts of pharmaceutical compositions comprising substituted or unsubstituted cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and cyclobutanecarboxylic acid derivative compounds represented by the Formulas (I) and (II).
Disorders or conditions that can be treated with a method according to the present invention include, for example, ischemic/reperfusion injury, post myocardial infarction, angina, heart failure, a cardiomyopathy, peripheral vascular disease, diabetes, and lactic acidosis, or symptoms or side effects associated with heart surgery (e.g., open heart surgery, bypass surgery, heart transplant).
The method according to the present invention includes administering a pharmaceutical compositions comprising effective amounts of substituted or unsubstituted cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and cyclobutanecarboxylic acid derivative compounds represented by the Formulas (I) and (II) in a single daily dose, or the total daily dosage may be administered in divided doses several times daily. Furthermore, the pharmaceutical compositions may be administered as a single dose or over a period of time.
Patients that can be treated with the method according to the present invention include all known kind of mammals, including non human primates (apes, gibbons, chimpanzees, orangutans, macaques), companion animals (dogs and cats), farm animals (horses, cows, goats, sheep, pigs), experimental animals (mouse, rat, rabbit, guinea pig), and humans.
The dosage regiment utilizing the pharmaceutical compositions according to the present invention is selected based on various factors such as type of physiological condition to be treated, age, weight, sex of the patient, severity of the conditions to be treated, the route of administration, and particular compound contained in the pharmaceutical composition. A physician or veterinarian of ordinary skill can readily determine and prescribed the effective amount of the pharmaceutical composition to prevent or to treat the specific physiological condition.
The daily dosage may be varied over wide range and can be such that the amount of the active compound selected from substituted or unsubstituted cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and cyclobutanecarboxylic acid derivative compounds represented by the Formulas (I) and/or Formula (II) is sufficient to increase glucose utilizationin a cell, tissue or organ of a warm blooded animal and to achieve the desired effect of alleviating or preventing fatty acid-induced ischemic damage.
The invention provides kits containing substituted or unsubstituted cyclopropanecarboxylic acid, cyclopropanecarboxylic acid and derivatives and modified forms thereof represented by the Formulas (I) and Formula (II), including pharmaceutical formulations, packaged into a suitable set. A kit typically includes a label or packaging insert including instructions for use, in vitro, in vivo, or ex vivo, of the components therein.
The term “packaging material” refers to a physical structure housing the components of the kit, such as cyclopropanecarboxylic acid, cyclopropanecarboxylic acid or derivatives or modified forms thereof. The packaging material can maintain the components sterilely, and can be made of material commonly used for such purposes (e.g., paper, corrugated fiber, glass, plastic, foil, ampules, etc.). The label or packaging insert can include appropriate written instructions, for example, practicing a method of the invention.
Kits of the invention therefore can additionally include instructions for using the kit components in a method of the invention. Instructions can include instructions for practicing any of the methods of the invention described herein. Thus, for example, a kit can include a cyclopropanecarboxylic acid, cyclopropanecarboxylic acid or a derivative or modified form thereof in a pharmaceutical formulation in a container, pack, or dispenser together with instructions for administration to a human subject. Instructions may additionally include indications of a satisfactory clinical endpoint or any adverse symptoms that may occur, or any additional information required by the Food and Drug Administration for use in humans.
A kit may include instructions for increasing or improving glucose utilization in vitro, ex vivo or in vivo. In other embodiments, a kit includes instructions for treating a disorder associated with deficient or inefficient glucose utilization. In one aspect, the instructions comprise instructions for treating a subject having or at risk of having ischemic/reperfusion injury, post myocardial infarction, angina, heart failure, a cardiomyopathy, peripheral vascular disease, diabetes, or lactic acidosis. In another aspect, the instructions comprise instructions for treating a subject having or at risk of having heart surgery (e.g., open heart surgery, bypass surgery, heart transplant and angioplasty).
The instructions may be on “printed matter,” e.g., on paper or cardboard within the kit, or on a label affixed to the kit or packaging material, or attached to a vial or tube containing a component of the kit. Instructions may additionally be included on a computer readable medium, such as a disk (floppy diskette or hard disk), optical CD such as CD- or DVD-ROM/RAM, magnetic tape, electrical storage media such as RAM and ROM and hybrids of these such as magnetic/optical storage media.
Kits can additionally include a buffering agent, a preservative, or a stabilizing agent. Each component of the kit can be enclosed within an individual container and all of the various containers can be within a single package.
The present invention is further illustrated in the following examples wherein all parts, percentages, and ratios are in equivalents, all temperatures are in ° C., and all pressures are atmospheric unless otherwise indicated:
EXAMPLE 1
Preparation of Cyclopropanecarboxylic Acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl Ester




Triethylene glycol monomethyl ether (1.1 eq, 5.26 mmol, 0.84 ml), triethylamine (1.1 eq, 5.26 mmol, 0.73 ml) was taken in a 10 ml round bottom flask and dichloromethane (3 ml) was added. This mixture was cooled to 0° C. and then cyclopropanecarbonyl chloride (4.78 mmol, 0.5 g, 0.43 ml) was added in a dropwise fashion maintaining the temperature at 0° C. with constant stirring.

A yellowish-orange solid was observed after some time. Stirring was continued for 1 hr at 0° C. The reaction was monitored by thin layer chromatography, and then quenched with saturated ammonium chloride solution. It was then transferred to a separatory funnel, washed with 5% sodium bicarbonate (2×5 ml), 1:1 hydrochloric acid (2×5 ml) and then with brine (5 ml). The dichloromethane layer was separated from the aqueous layer, dried over anhydrous sodium sulphate, filtered, and evaporated in vacuo to give the title product as a pale yellow liquid. Purification was attempted by flash chromatography and vacuum distillation (b.p.=144° C., 3.0 mm of Hg) which afforded the pure product as a colorless liquid (527.0 mg, 48%).

Thus obtained compound was characterized by 1H NMR and mass spec.
1H NMR (300 MHz, CDCl3) δ 4.2 (m, 2H), 3.68 (m, 2H), 3.64 (m, 6H), 3.52 (m, 2H), 3.36 (s, 3H), 1.62 (m, 1H), 0.99 (m, 2H), 0.84 (m, 2H); MS (ES, MNa+) Calcd for C11H20O5Na 255.11, found 255.1.
EXAMPLE 2
Preparation of Cyclobutanoylglycine (or (cyclobutanecarbonyl-amino)-acetic acid)




Methyl ester glycine hydrochloride (1 eq, 2.39 mmol, 300 mg), pyridine (2 eq, 4.78 mmol, 0.39 ml), was suspended in (5 ml) of dichloromethane followed by addition of DMAP (1.5 eq, 218.5 mg) in one portion and the reaction was stirred for 30 min at room temperature. After 30 min, cyclobutanecarbonyl chloride (2 eq, 4.77 mmol, 0.54 ml) was added slowly and the reaction mixture was stirred for 4 hrs at room temperature. The solvent was evaporated in vacuo and the residue extracted with ethyl acetate. The ethyl acetate layer was dried and concentrated to dryness. The crude material obtained was purified by flash chromatography to yield pure compound A (358 mg, 87%).

To a solution of A in (6 ml) THF, was added lithium hydroxide (1.1 eq, 2.3 mmol, 2.3 ml, 1M) at room temperature and the reaction mixture was stirred for 1.5 hrs. The reaction mixture was then concentrated in vacuo and acidified to pH=3 with 2N HCl. The crude product was then extracted with ethyl acetate and purified by recrystallization, using ethyl acetate/hexane mixture. The product obtained after recrystallization was further purified by flash chromatography and again recrystallization to give the title compound B as a white solid (196 mg, 59%).
Thus obtained compound was characterized by 1H NMR and mass spec.
1HNMR (300 MHz, CD3OD) δ 3.87 (s, 2H), 3.14 (quintet, 1H), 1.84–2.2 (m, 6H); HRMS (ES, MNa+) Calcd for C7H11NO3Na 180.06311 found 180.06290.
EXAMPLE 3
Preparation of Cyclobutanecarboxylic Acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl Ester




Triethylene glycol monomethyl ether (1.1 eq, 4.64 mmol, 0.74 ml), triethylamine (1.1 eq, 4.64 mmol, 0.65 ml) was taken in a 25 ml round bottom flask and dichloromethane (3 ml) was added. This mixture was cooled to 0° C. and then cyclobutanecarbonyl chloride (4.22 mmol, 0.5 g, 0.48 ml) was added in a dropwise fashion maintaining the temperature at 0° C. with constant stirring (Vigorous reaction).

A pink colored solution was observed after some time. An extra 4 ml of dichoromethane was added to maintain proper stirring (reaction mixture becomes thick). Stirring was continued for 1 hr at 0° C. The reaction was monitored by thin layer chromatography and then quenched with saturated ammonium chloride solution. It was then transferred to a separatory funnel, washed with 5% sodium bicarbonate (2×5 ml), 1:1 hydrochloric acid (2×5 ml) and then with brine (5 ml). The dichloromethane layer was separated from the aqueous layer, dried over anhydrous sodium sulphate, filtered, and evaporated in vacuo to give the title product as a pale yellowish-pink liquid. The liquid was purified by flash chromatography and vacuum distillation (b.p.=189° C., 3.0 mm of Hg) to yield the pure product as a colorless liquid (679.6 mg, 65.34%).
The product was characterized by 1H NMR and mass spec.
1HNMR (300 MHz, CDCl3) δ 4.18 (m, 2H), 3.4 (m, 2H), 3.6 (m, 6H), 3.5 (m, 2H), 3.32 (s, 3H), 3.1 (quintet, 1H), 2.2 (m, 4H), 1.86 (m, 2H); MS (ES, MNa+) Calcd for C12H22O5Na 269.13, found 269.1.
EXAMPLES 4, 6–16, AND 18–22
Preparation of Cyclopropanecarboxylic Acid and of Cyclobutanecarboxylic Acid Derivatives




    
    
        where, R=
    
    






    
    
        
        
            R′—OH=Corresponding Alcohols
            Base=Triethylamine or Pyridine
            Solvent=Dichloromethane
        
        
    
    


The procedures of Example 1 and Example 3 were followed for preparation cyclopropanecarboxylic acid and of cyclobutanecarboxylic acid derivatives respectively, except that various starting alcohols were used in place of triethylene glycol monomethyl ether. All obtained compounds were characterized by 1H NMR and mass spec. The results are summarized in TABLE 1.
EXAMPLE 5
Preparation of Cyclopropanoylalanine




The procedure of Example 2 was followed except that 2.5 equivalents of pyridine was used instead of 2 equivalents, cyclopropanecarbonyl chloride was used in place of cyclobutanecarbonylchloride and methyl ester alanine hydrochloride was used in palce of methyl ester glycine hydrochloride.
Purified compound B (321 mg, 87%) was characterized by 1H NMR and mass spec.
1HNMR (300 MHz, CD3OD) δ 8.25 (br s, 1H), 4.38 (m, 1H), 3.25 (s, 1H), 1.64 (m, 1H), 1.39 (dd, 3H), 0.7–0.9 (m, 4H); HRMS (ES, M) Calcd for C7H12NO3 158.08117, found 158.08123.
EXAMPLE 17
Preparation of Cyclopropanecarboxylic Acid 2-isopropoxy-ethyl Ester




2-Isopropoxy-ethanol (1.1 eq, 5.26 mmol, 0.55 g, 0.61 ml), Pyridine (1.1 eq, 5.26 mmol, 0.42 g, 0.43 ml) was taken in a 25 ml round bottom flask and dichloromethane (6 ml) was added. This mixture was cooled to 0° C. and then cyclopropanecarbonyl chloride (4.78 mmol, 0.5 g, 0.43 ml) was added in a dropwise fashion maintaining the temperature at 0° C. with constant stirring.

An orange-yellow colored solution was observed after sometime. An extra 2 ml of dichoromethane was added to maintain proper stirring (reaction mixture becomes thick). Stirring was continued for 1 hr at 0° C. The reaction was monitored by thin layer chromatography and then quenched with saturated ammonium chloride solution. It was then transferred to a separatory funnel, washed with 5% sodium bicarbonate (2×5 ml), 1:1 Hydrochloric acid (2×5 ml), and then with brine (5 ml). The dichloromethane layer was separated from the aqueous layer, dried over anhydrous magnesium sulphate, filtered, and evaporated in vacuo to give the title product as a pale yellowish-orange liquid. Purification was attempted by flash chromatography and vacuum distillation (b.p.=33° C., 2.9 mm of Hg) which afforded the pure product as a colorless liquid (630.2 mg, 76.40%).
Characterization of the resulting compound was done by 1H NMR and mass spec.
1HNMR (400 MHz, CDCl3) δ 4.2 (m, 2H), 3.6 (m, 3H), 1.65 (m, 1H), 1.15 (d, 6H), 1.0 (m, 2H), 0.85 (m, 2H); MS (ES, MNa+) Calcd for C9H16O3Na 195.09, found 195.0











TABLE 1








Starting
Starting R′-




Molecular
Carbonyl
YH


Example
Compound
Weight
Chloride
compound







1MM054




232.28
P*
2-[2-(2-Methoxy-ethoxy)-ethoxy]-ethanol


 


2MM055




157.17
B**
Methyl esterglycinehydrochloride---(Amino Acid)


 


3MM056




246.31
B
2-[2-(2-Methoxy-ethoxy)-ethoxy]-ethanol


 


4MM057




264.31
P
2-(2-Benzyloxy-ethoxy)-ethanol


 


5MM058




157.17
P
Methyl esteralaninehydrochloride(Amino Acid)


 


6MM059




278.34
B
2-(2-Benzyloxyethoxy)-ethanol


 


7MM060




244.32
B
2-(2-Butoxy-ethoxy)-ethanol


 


8MM061




216.27
B
2-(2-ethoxy-ethoxy)-ethanol


 


9MM062




201.26
P
2-(2-dimethylamino-ethoxy)-ethanol


 


10MM063




215.29
B
2-(2-dimethylamino-ethoxy)-ethanol


 


11MM064




258.35
P
2-(2-hexyloxy-ethoxy)-ethanol


 


12MM065




272.39
B
2-(2-hexyloxy-ethoxy)-ethanol


 


13MM066




188.23
P
2-(2-methoxy-ethoxy)-ethanol


 


14MM067




202.25
B
2-(2-methoxy-ethoxy)-ethanol


 


15MM068




158.20
P
2-(2-ethoxy-ethoxy)-ethanol


 


16MM069




172.23
B
2-(2-ethoxy-ethoxy)-ethanol


 


17MM070




172.23
P
2-Isopropoxy-ethanol


 


18MM071




186.25
B
2-Isopropoxy-ethanol


 


19MM072




242.27
P
2-(2-Hydroxy-ethoxy)-ethanol


 


20MM073




270.32
B
2-(2-Hydroxy-ethoxy)-ethanol


 


21MM074




286.32
P
2-[2-(2-Hydroxy-ethoxy)-ethoxy]-ethanol


 


22MM075




314.37
B
2-[2-(2-Hydroxy-ethoxy)-ethoxy]-ethanol





a. P* Cyclopropanecarbonyl chloride


b. B** Cyclobutanecarbonyl chloride






EXAMPLE 23
Glucose oxidation stimulation in untreated myocardium cells and myocardium cells treated with cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester. Rat hearts were cannulated for isolated working heart 60 min aerobic perfusions as described in J Pharmacol Exp Ther. 1993; 264:135–144, the entire disclosure of which is incorporated herein by reference.
Male Sprague-Dawley rats (0.3–0.35 kg) were anesthetized with pentobarbital sodium (60 mg/kg IP) and hearts were quickly excised, the aorta was cannulated and a retrograde perfusion at 37° C. was initiated at a hydrostatic pressure of 60 mm Hg. Hearts were trimmed of excess tissue, and the pulmonary artery and the opening to the left atrium were then cannulated. After 15 min of Langendorff perfusion, hearts were switched to the working mode by clamping the aortic inflow line from the Langendorff reservoir and opening the left atrial inflow line. The perfusate was delivered from an oxygenator into the left atrium at a constant preload pressure of 11 mm Hg. Perfusate was ejected from spontaneously beating hearts into a compliance chamber (containing 1 ml of air) and into the aortic outflow line. The afterload was set at a hydrostatic pressure of 80 mm Hg. All working hearts were perfused with Krebs'-Henseleit solution containing calcium 2.5 mmol/L, glucose 5.5 mmol/L, 3% bovine serum albumin (fatty acid free, initial fractionation by heat shock, Sigma), and with 1.2 mmol/L palmitate. Palmitate was bound to the albumin as described in J Bio Chem. 1992; 267:3825–3831, the entire disclosure of which is incorporated herein by reference.
The perfusate was recirculated, and pH was adjusted to 7.4 by bubbling with a mixture containing 95% O2 and 5% CO2.
Spontaneously beating hearts were used in all perfusions. Heart rate and aortic pressure were measured with a Biopac Systems Inc. blood pressure transducer connected to the aortic outflow line. Cardiac output and aortic flow were measured with Transonic T206 ultrasonic flow probes in the preload and afterload lines, respectively. Coronary flow was calculated as the difference between cardiac output and aortic flow. Cardiac work was calculated as the product of systolic pressure and cardiac output.
Measurement of Glucose Oxidation: Glucose oxidation was measured simultaneously by perfusing hearts with [U-14C] glucose according to the procedures discussed in Saddik M, et al., J Bio Chem. 1992; 267:3825–3831. The entire disclosure of this reference is incorporated herein by reference. The total myocardial 14CO2 production was determined at 10-min intervals from the 60-min aerobic period. Glucose oxidation rates were determined by quantitative measurement of 14CO2 production as described in Barbour R L, et al., Biochemistry. 1984; 1923:6503–6062. The entire disclosure of this reference is incorporated herein by reference. 14CO2 production for the control group were compared with the 14CO2 production for the group treated with cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester. Results are shown on FIG. 1 and TABLE 2.
EXAMPLE 25
Glucose oxidation stimulation in myocardium cells treated with cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester.
The procedure of Example 23 for was followed except that cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester in 1 μM, 10 μM, 100 μM and 1000 μM amounts was added to the buffer in place of the cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester. The results are illustrated in FIG. 2 and TABLE 2.
EXAMPLE 26
Glucose oxidation stimulation in myocardium cells treated with cyclopropanecarboxylic acid, 2-isopropoxy ethyl ester.
The procedure of Example 23 was followed except that cyclopropanecarboxylic acid, 2-isopropoxy-ethyl ester in 1 μM, 10 μM, 100 μM and 1000 μM amounts was added to the buffer in place of the cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxyl]-ethyl ester. The results are illustrated in FIG. 3 and TABLE 2.
EXAMPLES 24, 27–41 AND 43
Glucose oxidation stimulation in myocardium cells treated with various cyclopropanecarboxylic acid and cyclobutanecarboxylic acid derivatives.
The procedure of Example 23 was followed except that various cyclobutanecarboxylic acid derivatives, cyclopropanecarboxylic acid derivatives and cyclobutanecarboxylic acid in the amounts of 100 μM or 1000 μM was added to the buffer in place of the cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester. The results are illustrated in TABLE 2.
EXAMPLE 42
Glucose oxidation stimulation in myocardium cells treated with cyclopropanecarboxylic acid.
The procedure of Example 23 was followed except that cyclobutanecarboxylic acid the amounts of 0.001 μM, 0.01 μM, 01 μM, 1 μM, 10 μM, and 100 μM was added to the buffer in place of the cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester. The results are illustrated in FIG. 4 and TABLE 2.










TABLE 2







Screening
Glucose




Concentration
Oxidation


Example
Compound
(μM)
(% above control)


















23MM054




100
102%


 


24MM055




1000 μM 
58%


 


25MM056.




100 μM
54%


 


26MM057




100 μM
104%


 


27MM058




1000 μM 
40%


 


28MM059




100 μM
68%


 


29MM060




100 μM
65%


 


30MM062




100 μM
77%


 


31MM063




100 μM
41%


 


32MM064




100 μM
83%


 


33MM065




100 μM
0%


 


34MM066




100 μM
20%


 


35MM067




100 μM
50%


 


36MM068




100 μM
416%


 


37MM069




100 μM
162%


 


38MM070




100 μM
208%


 


40MM071




100 μM
97%


 


41MM072




100 μM
97%


 


42MM001




1000 μM 
121%


 


43MM002




1000 μM 
239%









A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention.

## Claims

1. A sterile aqueous solution, dispersion or suspension of an injectable pharmaceutical composition comprising a physiologically acceptable carrier and a glucose utilization increasing amount of at least one compound represented by Formula (I)



W is C1–C6 alkyl, halogen, or aryl;
Cyc is C3 or C4 cycloalkyl;
p is 0–3 for Cyc being C4 cycloalkyl, or p=0–2 for Cyc being C3 cycloalkyl;
Y is O, S, or NR , where R═H, alkyl or aryl;
X is O, S, NR, or CR3R4;
Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkylcarbonyl;
R1 is H, alkyl, aryl;
R2 is H, alkyl, aryl or ═O;
R3 and R4 are, independently, H, alkyl or aryl; and
n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof; and a pharmaceutically acceptable carrier, diluent, excipient or mixtures thereof.

2. The pharmaceutical composition as claimed in claim 1, wherein said compound is represented by Formula (I), and wherein p=0;
Y is O;
X is N or O;
R1, R2, R3 and R4 are hydrogens;
n is 1–4; and
Z is lower alkyl, cycloalkyl or phenyl.

3. The pharmaceutical composition as claimed in claim 1, wherein said compound is represented by the Formula (I), and wherein p=0;
Y is N;
X is O;
R1, R2, R3 and R4 are hydrogens;
n is 1 or 2; and
Z is hydrogen.

4. The pharmaceutical compositions as claimed in claim 1, wherein said composition is in the form of sterile suspensions or solutions.

5. The pharmaceutical composition according to claim 1, wherein said at least one compound is selected from the group consisting of
cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclopropanecarboxylic acid, 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-butoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-isopropoxy-ethyl ester; and
cyclobutanecarboxylic acid 2-isopropoxy-ethyl ester.

6. A method for increasing glucose utilization in a cell, tissue or organ of a warm blooded animal comprising treating said cell, tissue or organ with glucose utilization effective amount of at least one compound represented by Formula (I)




wherein
W is C1–C6 alkyl, halogen, or aryl;
Cyc is C3 or C4 cycloalkyl;
p is an integer from 0 to 3 when Cyc is C4 cycloalkyl, or p is an integer from 0 to 2 when Cyc is C3 cycloalkyl;
Y is O, S, or NR, where R is H, alkyl, or aryl;
X is O, S, NR, or CR3R4;
Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkylcarbonyl;
R1 is H, alkyl or aryl;
R2 is H, alkyl, aryl or O;
R3 and R4 are, independently, H, alkyl or aryl; and
n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof.

7. The method as claimed in claim 6, wherein said compound is represented by Formula (I), and wherein p=0;
Y is O;
X is N or O;
R1, R2, R3 and R4 are hydrogens;
n is 1–4; and
Z is lower alkyl, cycloalkyl or phenyl.

8. The method as claimed in claim 6, wherein said compound is represented by Formula (I), and wherein p=0;
Y is N;
X is O;
R1, R2, R3 and R4 are hydrogens;
n is 1 or 2; and
Z is hydrogen.

9. The method as claimed in claim 6, wherein said organ is heart.

10. The method according to claim 6, wherein said cell is a myocardial cell.

11. The method according to claim 6, wherein said at least one compound is selected from the group consisting of
cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclopropanecarboxylic acid, 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-butoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-isopropoxy-ethyl ester; and
cyclobutanecarboxylic acid 2-isopropoxy-ethyl ester.

12. A method for treatment of physiological conditions or disorders treatable by increasing glucose utilization comprising:
administering to a patient in need of such treatment, effective amount to increase glucose utilization of a pharmaceutical composition comprising at least one compound represented by Formula (I)





wherein
W is C1–C6 alkyl, halogen, or aryl;
Cyc is C3 or C4 cycloalkyl;
p is an integer from 0 to 3 when Cyc C4 cycloalkyl, or p is an integer from 0 to 2 when Cyc is C3 cycloalkyl;
Y is O, S, or NR, where R is H, alkyl, or aryl;
X is O, S, NR, or CR3R4;
Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkylcarbonyl;
R1 is H, alkyl, or aryl;
R2 is H, alkyl aryl or O;
R3 and R4 are, independently, H, alkyl or aryl; and
n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof.

13. The method as claimed in claim 12, wherein said disorder or condition is ischemic/reperfusion injury, post myocardial infarction, angina, heart failure, a cardiomyopathy, peripheral vascular disease, diabetes, and lactic acidosis, or symptoms or side effects associated with open heart surgery, bypass surgery, or heart transplant.

14. The method as claimed in claim 13, wherein said disorder or condition is ischemic/reperfusion injury.

15. The method as claimed in claim 12, wherein said compound is represented by the Formula (I), and wherein p=0;
Y is O;
X is N or O;
R1, R2, R3 and R4 are hydrogens;
n is 1–4; and
Z is lower alkyl, cycloalkyl or phenyl.

16. The method as claimed in claim 12, wherein said compound is represented by the Formula (I), and wherein p=0;
Y is N;
X is O;
R1, R2, R3 and R4 are hydrogens;
n is 1 or 2; and
Z is hydrogen.

17. The method according to claim 12, wherein said at least one compound is selected from the group consisting of
cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclopropanecarboxylic acid, 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-butoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-isopropoxy-ethyl ester; and
cyclobutanecarboxylic acid 2-isopropoxy-ethyl ester.

18. A kit containing a pharmaceutical composition as claimed in claim 1.

19. The kit as claimed in claim 18, wherein said kit comprises a label or packaging insert containing instructions for use, in vitro, in vivo, or ex vivo, of components of said kit.

20. A composition according to claim 1 wherein Y is O, X is NR or O, n is 1 to 4, p is 0; R1, R2, R3 and R4 are hydrogen and Z is cycloalkylcarbonyl.

21. A composition according to claim 20 wherein n is 3.

22. A composition according to claim 21 wherein Cyc is C3 cycloalkyl.

23. A composition according to claim 22 wherein Z is cyclopropylcarbonyl.

24. An oral pharmaceutical composition for treatment of physiological conditions or disorders treatable by increasing glucose utilization in unit dosage form comprising a glucose utilization increasing amount of at least one compound represented by Formula (I):




wherein
W is C1–C6 alkyl, halogen, or aryl;
Cyc is C3 or C4 cycloalkyl;
p is an integer from 0 to 3 when Cyc C4 cycloalkyl, or p is 0 to 2 when Cys is C3 cycloalkyl;
Y is O, S, or NR, where R is H, alkyl, or aryl;
X is O, S, NR, or CR3R4;
Z is H, alkyl, cycloalkyl, aryl or (cyclo)alkylcarbonyl;
R1 is H, alkyl, or aryl;
R2 is H, alkyl aryl or O;
R3 and R4 are, independently, H, alkyl or aryl; and
n is an integer from 1 to 10; or a pharmaceutically acceptable salt, ester or prodrug thereof; and a pharmaceutically acceptable carrier, diluent, excipient or mixtures thereof.

25. The pharmaceutical composition as claimed in claim 24, wherein said compound is represented by Formula (I), and wherein p=0;
Y is O;
X is N or O;
R1, R2, R3 and R4 are hydrogens;
n is 1–4; and
Z is lower alkyl, cycloalkyl or phenyl.

26. The pharmaceutical composition as claimed in claim 24, wherein said compound is represented by the Formula (I), and wherein p=O;
Y is N;
X is O;
R1, R2, R3 and R4 are hydrogens;
n is 1 or 2; and
Z is hydrogen.

27. The pharmaceutical compositions as claimed in claim 24, wherein said composition is in the form of tablets, pills, or capsules.

28. the pharmaceutical composition according to claim 24, wherein said at least one compound is selected from the group consisting of
cyclopropanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclobutanecarboxylic acid, 2-[2-(2-methoxy-ethoxy)-ethoxy]-ethyl ester;
cyclopropanecarboxylic acid, 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-benzyloxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-butoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-dimethylamino-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-hexyloxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-methoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclobutanecarboxylic acid 2-(2-ethoxy-ethoxy)-ethyl ester;
cyclopropanecarboxylic acid 2-isopropoxy-ethyl ester; and
cyclobutanecarboxylic acid 2-isopropoxy-ethyl ester.

29. A kit containing a pharmaceutical composition as claimed in claim 24.

30. The kit as claimed in claim 29, wherein said kit comprises a label or packaging insert containing instructions for use, in vitro, in vivo, or ex vivo, of components of said kit.

31. A composition according to claim 24 wherein Y is O, X is NR or O, n is 1 to 4, p is 0; R1, R2, R3 and R4 are hydrogen; and Z is cyclopropylcarbonyl.

32. A composition according to claim 31 wherein n is 3.

33. A composition according to claim 32 wherein Cyc is C3 cycloalkyl.

34. A composition according to claim 33 wherein Z is cyclopropylcarbonyl.