# Patent

## Title
Diagnosis and treatment of type 2 diabetes and other disorders

## Abstract

The present application features the use of the somatostatin subtype 3 receptor (SST3) as a target for affecting insulin secretion and for diagnosing diabetes related disorders. Glucose stimulated insulin secretion was found to be stimulated by knocking down expression of SST3 and through the use of a SST3 selective antagonist.

## Background
CROSS REFERENCE TO RELATED APPLICATIONS
This application is the National Stage of International Application No. PCT/US2006/044939, filed 17 Nov. 2006, which claims the benefit under 35 U.S.C. 119(e) of U.S. Provisional Application No. 60/738,527, filed 21 Nov. 2005.


BACKGROUND OF THE INVENTION
The references cited in the present application are not admitted to be prior art to the claimed invention.
The inability to properly use or produce insulin can result in different metabolic disorders, such as diabetes and Metabolic syndrome (also called Syndrome X). Insulin is a hormone produced by pancreatic beta cells in the islets of Langerhans. Insulin decreases blood glucose levels, modulates carbohydrate and lipid metabolism, and influences the biosynthesis of protein and RNA.
Diabetes mellitus is a syndrome characterized by hyperglycemia resulting from the impairment of insulin secretion and/or insulin action. Impairment of insulin secretion causes type I diabetes mellitus, also known as juvenile insulin-dependant DM (IDDM) or juvenile-onset diabetes. (Merck Manual Sec. 2, Chapter 13, 2005 online version.)
Impairment of insulin action and insulin secretion results in type 2 diabetes mellitus, also know as non-insulin-dependent mellitus. Type 2 diabetes mellitus is characterized by hyperglycemia and insulin resistance. The hyperglycemia results from both an impaired insulin secretory response to glucose and decreased insulin effectiveness in stimulating skeletal muscle glucose uptake and in restraining hepatic glucose production. The beta cells within the pancreatic islets initially compensate for insulin resistance by increasing insulin output. (Polonsky, Int. J. Obes. Relat. Metab. Disord. 24 Suppl 2:S29-31, 2000.)
Eventually, a patient may be become diabetic due to the inability to properly compensate for insulin resistance. In humans, the onset of type 2 diabetes due to insufficient increases (or actual declines) in beta cell mass is apparently due to increased beta cell apoptosis relative to non-diabetic insulin resistant individuals. (Butler et al., Diabetes 52:102-110, 2003.)
SUMMARY OF THE INVENTION
The present application features the use of the somatostatin subtype 3 receptor (SST3) as a target for affecting insulin secretion and for diagnosing diabetes related disorders. Glucose stimulated insulin secretion was found to be stimulated by knocking down expression of SST3 and through the use of a SST3 selective antagonist.
Thus, a first aspect of the present invention features a method for stimulating insulin secretion in a patient in need thereof. The method comprises the step of administering to the patient an effective amount of a SST3 antagonist or an agent that reduces expression of SST3.
An SST3 antagonist binds to SST3 and inhibits receptor activity. In the treatment of a patient, the overall degree of inhibition of SST3 receptor activity should be sufficient to provide a useful physiological effect such as increasing insulin secretion leading to a reduction in blood glucose level.
An agent reducing SST3 expression acts at the nucleic acid level to inhibit transcription, translation, or processing of SST3 encoding nucleic acids. Examples of such agents include short inhibitory RNA (siRNA), ribozymes, and antisense nucleic acid. In the treatment of a patient, the overall degree of inhibition should be sufficient to provide a useful physiological effect such as increasing insulin secretion leading to a reduction in blood glucose level.
Another aspect of the present invention features a method of screening for a compound affecting at least one of: insulin secretion or glucose uptake. The method involves: (a) identifying a compound binding to, or inhibiting the activity or expression of SST3; and (b) determining the ability of the compound identified in step (a) to affect at least one of one: insulin secretion or glucose uptake.
The initial identification of a compound binding to, or inhibiting the activity or expression of a SST3, can be performed experimentally or based on known information. Information on the SST3 is available in the scientific literature. Preferably, the compound is initially identified experimentally as inhibiting SST3 activity or expression.
Another aspect of the present invention features a method of determining progression of diabetes. The method involves: (a) using a selective SST3 ligand to measure β-cell mass and (b) determining whether there is a low or a decrease in β-cell mass. A low amount of β-cell mass can be determined with respect to the β-cell mass occurring in the general population. A decrease in β-cell mass can be determined with respect to a particular patient over the course of time.
Reference to open-ended terms such as “comprises” allows for additional elements or steps. Occasionally phrases such as “one or more” are used with or without open-ended terms to highlight the possibility of additional elements or steps.
Unless explicitly stated, reference to terms such as “a” or “an” is not limited to one. For example, “a cell” does not exclude “cells”. Occasionally phrases such as one or more are used to highlight the possible presence of a plurality.
Other features and advantages of the present invention are apparent from the additional descriptions provided herein including the different examples. The provided examples illustrate different components and methodology useful in practicing the present invention. The examples do not limit the claimed invention. Based on the present disclosure the skilled artisan can identify and employ other components and methodology useful for practicing the present invention.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 illustrates the effect of Compound 2 on mouse islets insulin secretion. “G 16” refers to 16 mM glucose. “GSIS” refers to glucose-stimulated insulin secretion.
FIG. 2 illustrates the effect of Compound 2 on blood glucose levels during the intraperitoneal glucose tolerance test (IPGTT) in C57BL/6 mice.



DETAILED DESCRIPTION OF THE INVENTION
The SST3 is identified herein as a target for affecting insulin secretion and assessing beta-cell mass. Glucose stimulated insulin secretion was found to be stimulated by knocking down expression of SST3 and through the use of an SST3 selective antagonist. An important physiological action of insulin is to decrease blood glucose levels. Based on the present application, targeting the SST3 has different uses including therapeutic applications, diagnostic applications, and evaluation of potential therapeutics.
I. Somatostin And Somatostin Receptors
Somatostatin is a hormone that exerts a wide spectrum of biological effects mediated by a family of seven transmembrane (TM) domain G-protein-coupled receptors. (Lahlou et al., Ann. N.Y. Acad. Sci. 1014:121-131, 2004, Reisine et al., Endocrine Review 16:427-442, 1995.) The predominant active forms of somatostatin are somatostatin-14 and somatostatin-28. Somatostatin-14 is a cyclic tetradecapeptide. Somatostatin-28 is an extended form of somatostatin-14.
SST3 is the third, of five, related G-protein receptor subtypes responding to somatostatin. The other receptors are the somatostatin subtype 1 receptor (SST1), somatostatin subtype 2 receptor (SST2), somatostatin subtype 4 receptor (SST4) and somatostatin subtype 5 receptor (SST5). The five distinct subtypes are encoded by separate genes segregated on different chromosomes. (Patel et al., Neuroendocrinol. 20:157-198, 1999.) All five receptor subtypes bind somatostatin-14 and somatostatin-28, with low nanomolar affinity. The ligand binding domain for somatostatin is made up of residues in TMs III-VII with a potential contribution by the second extracellular loop. Somatostatin receptors are widely expressed in many tissues, frequently as multiple subtypes that coexist in the same cell.
The five different somatostatin receptors all functionally couple to inhibition of adenylate cyclase by a pertussin-toxin sensitive protein (Gαi1-3). (Lahlou et al., Ann. N.Y. Acad. Sci. 1014:121-131, 2004.) Somatostatin-induced inhibition of peptide secretion results mainly from a decrease in intracellular Ca2+.
Among the wide spectrum of somatostatin effects, several biological responses have been identified with different receptor subtypes selectivity. These include growth hormone (GH) secretion mediated by SST2 and SST5, insulin secretion mediated by SST 1 and SST5, glucagon secretion mediated by SST2, and immune responses mediated by SST2. (Patel et al., Neuroendocrinol. 20:157-198, 1999; Crider et al., Expert Opin. Ther. Patents 13:1427-1441, 2003.)
Different somatostatin receptor sequences from different organisms are well known in the art. (See for example, Reisine et al., Endocrine Review 16:427-442, 1995.) Human, rat, and murine SST3 sequences and encoding nucleic acid sequences are provided in SEQ ID NO: 3 (human sst3 cDNA gi|44890055|ref|NM—001051.2| CDS 526:. 1782); SEQ ID NO: 4 (human sst3 AA gi|4557861|ref|NP—01042.1|); SEQ ID NO: 5 (mouse sst3 cDNA gi|66780401|ref|NM—009218.1| CDS 1 . . . 1287); SEQ ID NO: 6 (mouse sst3 AA gi|6678041|ref|NP—03244.1|); SEQ ID NO: 7 (rat sst3 cDNA gi|19424167|ref|NM—133522.1| CDS 656 . . . 1942); SEQ ID NO: 8 (rat sst3 A gi|19424168|ref|NP—598206.1|).
II. Measuring SST3 Antagonist Activity
SST3 antagonists can be identified using SST3 and nucleic acid encoding for SST3. Suitable assays include detecting compounds competing with a SST3 agonist for binding to SST3 and determining the functional effect of compounds on a SST3 cellular or physiologically relevant activity.
SST3 cellular activities include cAMP inhibition, phospholipase C increase, tyrosine phsophatases increase, eNOS decrease, K+ channel increase, Na+/H+ exchange decrease, and ERK decrease. (Lablou et al., Ann. N.Y. Acad. Sci. 1014:121-131, 2004.) Functional activity can be determined using cell lines expressing SST3 and determining the effect of a compound on one or more SST3 activity. (Poitout et al., J. Med. Chem. 44:29900-3000, 2001; Hocart et al., J. Med. Chem. 41:1146-1154, 1998.)
SST3 binding assays can be performed, for example, by labeling somatostatin and determining the ability of a compound to inhibit somatostatin binding. (Poitout et al., J. Med. Chem. 44:29900-3000, 2001; Hocart et al., J. Med. Chem. 41:1146-1154, 1998.) Additional formats for measuring binding of a compound to a receptor are well-known in the art.
A physiologically relevant activity for SST3 inhibition, identified herein, is stimulating insulin secretion. Stimulation of insulin secretion can be evaluated in vitro or in vivo.
III. SST3 Antagonists
SST3 antagonists can be identified experimentally or based on available information. A variety of different SST3 antagonists are well known in the art. Examples of such antagonists include peptide antagonists, β-carboline derivatives, and a decahydroisoquinoline derivative. (Poitout et al., J. Med. Chem. 44:29900-3000, 2001, Hocart et al., J. Med. Chem. 41:1146-1154, 1998, Reubi et al., PNAS 97:13973-13978, 2000, Bänziger et al., Tetrahedron: Assymetry 14:3469-3477, 2003, Crider et al., Expert Opin. Ther. Patents 13:1427-1441, 2003, Troxler et al., International Publication No. WO 02/081471, International Publication Date Oct. 17, 2002) The different known SST3 antagonists can be used as starting points for obtaining additional antagonists.
Antagonists can be characterized based on their ability to bind to SST3 (Ki) and effect SST3 activity (IC50), and to selectively bind to SST3 and selectively affect SST3 activity. Preferred antagonists strongly and selectively bind to SST3 and inhibit SST3 activity.
In different embodiments concerning SST3 binding, the antagonist has a Ki (nM) less than 100, preferably less than 50, more preferably less than 25 or more preferably less than 10. Ki can be measured as described by Poitout et al., J. Med. Chem. 44:29900-3000, 2001 and Example 7 infra.
A selective SST3 antagonist binds SST3 at least 10 times more than is binds SST1, SST2, SST4, and SST5. In different embodiments concerning selective SST3 binding, the antagonist binds to each of SST1, SST2, SST4, and SST5 with a Ki greater than 1000, or preferably greater than 2000 nM and/or binds SST3 at least 40 times, more preferably at least 50 times, more preferably at least 100 times, or more preferably at least 500 times, greater than it binds to SST1, SST2, SST4, and SST5.
In different embodiment concerning SST3 activity, the antagonist has an IC50 (nM) less than 500, preferably less than 100, more preferably less than 50, or more preferably less than 10 nM. IC50 can be determined by measuring inhibition of somatostatin-14 induced reduction of cAMP accumulation due to forskolin (1 μM) in CHO-K1 cells expressing SST3, as described by Poitout et al., J. Med. Chem. 44:29900-3000, 2001.
Preferred antagonists have a preferred or more preferred Ki, a preferred or more preferred IC50, and a preferred or more preferred selectivity. More preferred antagonists have a Ki (nM) less than 25; are at least 100 times selective for SST3 compared to SST1, SST2, SST4 and SST5; and have a IC50 (nM) less than 10.
In an embodiment, the antagonist is a β-carboline derivative having the structure of Formula I (Troxler et al., International Publication No. WO 02/081471, International Publication Date Oct. 17, 2002):




wherein R1 is selected from the group consisting of:




wherein R2 and R3 is each independently selected from the group consisting of: (C1-4)alkoxy(C1-4)alkyl, (C3-7)cycloakyl(C1-4)alkyl and, if R1 is not an optionally substituted phenyl, (C1-12)alkyl;
R4 is selected from the group consisting of: hydrogen, (C1-4)alkyl, (C1-4)alkoxy, halogen, and trifluoromethyl;
R5 is selected from the group consisting of: hydrogen and (C1-4)alkyl;
R6 is (C1-4)alkyl,
R7 and R8 is each independently selected from the group consisting of: hydrogen and (C1-4)alkyl; and
X is selected from the group consisting of hydrogen, (C1-4)alkoxy, (C1-4)alkylamino, and di(C1-4)alkylamino,
or a pharmaceutically acceptable salt or solvate thereof.
Examples of different Formula I compounds are provided in Troxler et al., International Publication No. WO 02/081471, International Publication Date Oct. 17, 2002. One such example is (R)-1,1-bis-ethoxymethyl-3-(4-phenyl-1H-imidazol-2-yl)-2,3,4,9-tetrahydro-1H-β-carboline.
Included within Formula I are the different optical isomers that may be present at one or more chiral carbon, racemic mixtures, and tautomeric forms. Each chiral carbon can be independently either R, S, or racemic.
A halogen is selected from the group consisting of fluorine, chlorine, bromine and chlorine. Preferably, the halogen is either fluorine or chlorine.
A pharmaceutically acceptable salt is a salt suitable for administration to a patient. The salt should be non-toxic in the amount employed.
A solvate refers to association with a solvent such as water. Solvate examples include hydrates, hemihydrates, and trihydrates. Reference to solvate include a solvate of a salt.
Another set of examples are imidazolyl tetrahydro-β-carboline derivatives based on the compounds provided in Poitout et al., J. Med. Chem. 44:29900-3000, 2001. The compounds can generically be described by Formula II:




wherein R10 is selected from the group consisting of: 4-MeOPh, 4-NMe2Ph, methyl, ethyl, n-butyl, n-pentyl, n-hexyl, and cyclohexyl; R11 is independently selected from the group consisting of: hydrogen, ethyl, n-butyl, n-pentyl, n-hexyl, and cyclohexyl; or R10 and R11 are together 2-adamantyl, 2-indanyl, or 1-acetyl-4-piperidine;
R12 is selected from the group consisting of: hydrogen, halogen, methyl and PhCH2O;
or a pharmaceutically acceptable salt or solvate thereof.
Included within Formula II are the different optical isomers that may be present at one or more different chiral carbon, racemic mixtures, and tautomeric forms. Each chiral carbon can be independently either R, S, or racemic.
Examples of Formula II compounds from Poitout et al., J. Med. Chem. 44:29900-3000, 2001 are provided in Table 1.







TABLE 1







Examples of Formula II Compounds












Compound
R10
R11
R12







4b
4-MeOPh
H
H



4c
4-NMe2Ph
H
H



4e
n-pentyl
H
H



4f
Cyclohexyl
H
H











4g
2-adamantyl
H



4h
2-indanyl
H



4i
1-acetyl-4piperidine
H












4j
Ethyl
ethyl
H



4k
n-butyl
n-butyl
H



4m*
n-butyl
n-butyl
H



4n
n-pentyl
n-pentyl
H



4p
n-hexyl
n-hexyl
H



4q
methyl
cyclohexyl
H



4r**
n-butyl
n-butyl
PhCH2O



4s**
n-butyl
n-butyl
Cl



4t**
n-pentyl
n-pentyl
CH3







Unless otherwise indicated, the C3 configuration is R.



*indicates a C3 S configuration.



**indicates a C3 racemic mixture.






Decahydroisoquinoline derivatives can be based on Compound 1 (NVP-ACQ090) (Bänziger et al., Tetrahedron: Assymetry 14:3469-3477, 2003):




or a pharmaceutically acceptable salt or solvate thereof.

IV. Agents Targeting SST3 Expression

SST3 encoding nucleic acid provides a target for compounds able to hybridize to the nucleic acid. Examples of compounds able to hybridize to a nucleic acid sequence include siRNA, ribozymes, and antisense nucleic acid. The mechanism of inhibition varies depending upon the type of compound. Techniques for producing and using siRNA, ribozymes, and antisense nucleic acid are well known in the art. (E.g., Probst, Methods 22:271-281, 2000; Zhang et al., Methods in Molecular Medicine Vol. 106. Antisense Therapeutics 2nd Edition, p. 11-34, Edited by I. Philips, Humana Press Inc., Totowa, N.J., 2005.)
Vectors for delivering nucleic acid based compounds include plasmid and viral based vectors. Preferred vectors for therapeutic applications are retroviral and adenovirus based vectors. (Devroe et al., Expert Opin. Biol. Ther. 4(3):319-327, 2004, Zhang et al., Virology 320:135-143, 2004.)
V. Protein Production
SST3 can be produced using techniques well, known in the art including those involving chemical synthesis and those involving recombinant production. (See e.g., Vincent, Peptide and Protein Drug Delivery, New York, N.Y., Decker, 1990; Current Protocols in Molecular Biology, John Wiley, 1987-2002, and Sambrook et al., Molecular Cloning, A Laboratory Manual, 2nd Edition, Cold Spring Harbor Laboratory Press, 1989.)
Recombinant nucleic acid techniques for producing a protein involve introducing, or producing, a recombinant gene encoding the protein in a cell and expressing the protein. A purified protein can be obtained from cell. Alternatively, the activity of the protein in a cell or cell extract can be evaluated.
A recombinant gene contains nucleic acid encoding a protein along with regulatory elements for protein expression. The recombinant gene can be present in a cellular genome or can be part of an expression vector.
The regulatory elements that may be present as part of a recombinant gene include those naturally associated with the protein encoding sequence and exogenous regulatory elements not naturally associated with the protein encoding sequence. Exogenous regulatory elements such as an exogenous promoter can be useful for expressing a recombinant gene in a particular host or increasing the level of expression. Generally, the regulatory elements that are present in a recombinant gene include a transcriptional promoter, a ribosome binding site, a terminator, and an optionally present operator. A preferred element for processing in eukaryotic cells is a polyadenylation signal.
Expression of a recombinant gene in a cell is facilitated through the use of an expression vector. Preferably, an expression vector in addition to a recombinant gene also contains an origin of replication for autonomous replication in a host cell, a selectable marker, a limited number of useful restriction enzyme sites, and a potential for high copy number. Examples of expression vectors are cloning vectors, modified cloning vectors, specifically designed plasmids and viruses.
Due to the degeneracy of the genetic code, a large number of different encoding nucleic acid sequences can be used to code for a particular protein. The degeneracy of the genetic code arises because almost all amino acids are encoded by different combinations of nucleotide triplets or “codons”. Amino acids are encoded by codons as follows:

    A=Ala=Alanine: codons GCA, GCC, GCG, GCU
    C=Cys=Cysteine: codons UGC, UGU
    D=Asp=Aspartic acid: codons GAC, GAU
    E=Glu=Glutamic acid: codons GAA, GAG
    F=Phe=Phenylalanine: codons UUC, UUU
    G=Gly=Glycine: codons GGA, GGC, GGG, GGU
    H=His=Histidine: codons CAC, CAU
    I=Ile=lsoleucine: codons AUA, AUC, AUU
    K=Lys=Lysinc: codons AAA, AAG
    L=Leu=Leucine: codons UUA, UUG, CUA, CUC, CUG, CUU
    M=Met=Methionine: codon AUG
    N=Asn=Asparagine: codons AAC, AAU
    P=Pro=Proline: codons CCA, CCC, CCG, CCU
    Q=Gln=Glutamine: codons CAA, CAG
    R=Arg=Arginine: codons AGA, AGG, CGA, CGC, CGG, CGU
    S=Ser=Serine: codons AGC, AGU, UCA, UCC, UCG, UCU
    T=Thr=Threonine: codons ACA, ACC, ACG, ACU
    V=Val=Valine: codons GUA, GUC, GUG, GUU
    W=Trp=Tryptophan: codon UGG
    Y=Tyr=Tyrosine: codons UAC, UAU


If desired, expression in a particular host can be enhanced through codon optimization. Codon optimization includes use of more preferred codons. Techniques for codon optimization in different hosts are well known in the art.
VI. Therapeutic Applications
Therapeutic applications of targeting SST3 include treatment of disease or disorders associated with at least one of an insulin deficiency or a hyperglycemic state. Examples of such diseases include hyperglycemia, diabetes and metabolic syndrome. A preferred therapeutic application is treatment of type 2 diabetes in a patient.
Reference to “patient” indicates a mammal capable of contracting a disease or disorder. Preferably, the patient is a human.
VII. Combination Treatment
SST3 antagonists can be used alone or in conjunction with other therapeutic compounds. Available agents that have been used to try to help treat type 2 diabetes include sulfonylureas and related K-ATP channel blockers; glucagon-like peptide 1 (GLP-1) agonists such as GLP-1 and exendin-4; metformin; PPARγ-selective agonists; DP-IV; and insulin. (Inzucchi JAMA 287:360-372, 2002; Doyle et al., Pharmacol Rev. 55:105-131, 2003; Hoist et al., Curr. Med. Chem. 6:1005-1017, 1999; Baggio et al., Treat. Endocrinol 1:117-125, 2002; Nauck et al., Regul. Pept. 128:135-148, 2005.)
VIII. Compound Preparation And Administration
Compounds can be formulated and administered to a patient using the guidance provided herein along with techniques well known in the art. The preferred route of administration ensures that an effective amount of compound reaches the target. Guidelines for pharmaceutical administration of a therapeutic compound in general are provided in, for example, Remington's Pharmaceutical Sciences 20th Edition, Ed. Gennaro, Mack Publishing, 2000; and Modern Pharmaceutics 2nd Edition, Eds. Banker and Rhodes, Marcel Dekicker, Inc., 1990.
Compounds having appropriate functional groups can be prepared as acidic or base salts. Pharmaceutically acceptable salts (in the form of water- or oil-soluble or dispersible products) include conventional non-toxic salts or the quaternary ammonium salts that are formed, e.g., from inorganic or organic acids or bases. Examples of such salts include acid addition salts such as acetate, adipate, alginate, aspartate, benzoate, benzenesulfonate, bisulfate, butyrate, citrate, camphorate, camphorsulfonate, cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate, fumarate, glucoheptanoate, glycerophosphate, hemisulfate, heptanoate, hexanoate, hydrochloride, hydrobromide, hydroiodide, 2-hydroxyethanesulfonate, lactate, maleate, methanesulfonate, 2-naphthalenesulfonate, nicotinate, oxalate, pamoate, pectinate, persulfate, 3-phenylpropionate, picrate, pivalate, propionate, succinate, tartrate, thiocyanate, tosylate, and undecanoate; and base salts such as ammonium salts, alkali metal salts such as sodium and potassium salts, alkaline earth metal salts such as calcium and magnesium salts, salts with organic bases such as dicyclohexylamine salts, N-methyl-D-glucamine, and salts with amino acids such as arginine and lysine.
Compounds can be administered using different routes including oral, nasal, by injection, transdermal, and transmucosally. Active ingredients to be administered orally as a suspension can be prepared according to techniques well known in the art of pharmaceutical formulation and may contain microcrystalline cellulose for imparting bulk, alginic acid or sodium alginate as a suspending agent, methylcellulose as a viscosity enhancer, and sweeteners/flavoring agents. As immediate release tablets, these compositions may contain microcrystalline cellulose, dicalcium phosphate, starch, magnesium stearate and lactose and/or other excipients, binders, extenders, disintegrants, diluents and lubricants.
When administered by nasal aerosol or inhalation, compositions can be prepared according to techniques well known in the art of pharmaceutical formulation. Such compositions may be prepared for example, as solutions in saline, employing benzyl alcohol or other suitable preservatives, absorption promoters to enhance bioavailability, fluorocarbons, and/or other solubilizing or dispersing agents.
The compounds may also be administered in intravenous (both bolus and infusion), intraperitoneal, subcutaneous, topical with or without occlusion, or intramuscular form. When administered by injection, the injectable solutions or suspensions may be formulated using suitable non-toxic, parenterally-acceptable diluents or solvents, such as Ringer's solution or isotonic sodium chloride solution, or suitable dispersing or wetting and suspending agents, such as sterile, bland, fixed oils, including synthetic mono- or diglycerides, and fatty acids, including oleic acid.
When rectally administered in the form of suppositories, these compositions may be prepared by mixing the drug with a suitable non-irritating excipient, such as cocoa butter, synthetic glyceride esters or polyethylene glycols, which are solid at ordinary temperatures, but liquidify and/or dissolve in the rectal cavity to release the drug.
Suitable dosing regimens for the therapeutic applications can be selected taking into account factors well known in the art including age, weight, sex and medical condition of the patient; the severity of the condition to be treated; the route of administration; the renal and hepatic function of the patient; and the particular compound employed.
Optimal precision in achieving concentrations of drug within the range that yields efficacy without toxicity requires a regimen based on the kinetics of the drug's availability to target sites. This involves a consideration of the distribution, equilibrium, and elimination of a drug. The daily dose for a patient is expected to be between 0.01 and 1,000 mg per adult patient per day.
IX. Diagnostic Applications
A diagnostic application involves determining the progression of diabetes using a SST3 ligand. Radiolabeled SST3 ligands can be used for non-invasive measurement of pancreatic islet, or more specifically, beta-cell mass in patients with type 2 diabetes by either Positron-Emission Tomography (PET) or High-Resolution Magnetic Resonance Imaging (MRI). The same measurement can also be used in type 1 diabetic patients who have received islet transplantation. Preferably, the ligand is a selective SST3 antagonist.
An SST3 ligand binds selectivity to SST3, but need not affect SST3 activity. In different embodiments concerning SST3 binding, the ligand has a Ki (nM) less than 100, preferably less than 50, more preferably less than 25 or more preferably less than 10; and the ligand binds SST3 at least 10 times more than it binds SST1, SST2, SST4, and SST5. In different embodiments concerning selective SST3 binding, the ligand binds to each of SST1, SST2, SST4, and SST5 with a Ki greater than 1000, or preferably greater than 2000 nM and/or binds SST3 at least 40 times, more preferably at least 50, more preferably at least 100 times, and more preferably at least 500 times, greater than it binds to SST1, SST2, SST4, and SST5. In an additional embodiment, the ligand is an SST3 antagonist as described above in Section III supra.
X. EXAMPLES
Examples are provided below to further illustrate different features of the present invention. The examples also illustrate useful methodology for practicing the invention. These examples do not limit the claimed invention.
Example 1
Up-Reputation of SST3 by High Glucose in INS-1 (832/13) Cells
Regulation of the gene encoding SST3 was evaluated by measuring gene expression in INS-1 (832/13) cells. INS-1 (832/13) is a glucose responsive insulinoma β-cell line. (Hohmeier et al., Diabetes 49:424-430, 2000.)
INS-1 (832/13) were cultured in RPMI medium with low (2 mM) and high (16 mM) glucose for 24 hours before being collected for RNA extraction. Insulin secretion from the 832/13 INS-1 cell was very low at 2 mM glucose, but is several-fold higher at 16 mM glucose. Each treatment was performed in triplicate (i.e., three experiments on three separate days).
The collected RNA samples were hybridized to oligonucleotide microarrays to identify glucose signature genes. Agilent 60-mer oligo microarray technology, which is a two-channel platform, was used. With this technology, two RNA samples are separately labeled with different fluorescent dyes (Cy5 and Cy3) and are then competitively hybridized on a single array. Dye-swap replicates (fluor-reverse pairs) are produced and averaged to cancel any dye labeling bias resulting in the ratio data values.
In this example, the three 2 mM glucose RNA replicate samples were pooled and used as a common reference pool for all the hybridization. The relative expression of genes in the 16 mM, glucose samples to the 2 mM glucose samples were obtained by comparing the intensities of each of the 16 mM glucose samples to that of the common reference pool. The individual ratio values were then combined using the “replicate combined” feature in the Rosetta Resolver system to generate error-weighted mean ratios with associated p values (a hybrid error model or AHEM).
An Agilent Rat 25k v1.2 Chip A array was used. Of about 23 thousands rat genes represented on this chip, the SST3 gene was represented by one probe (SEQ ID NO: 1). Numerous genes were found to be up-regulated by high glucose (totally 1559 for FC>1.2). The SST3 gene was up-regulated by high glucose with a fold change=1.22, and p-value=0.00157.
Example 2
SST3 Gene Expression is Highly Enriched in Mouse and Rat Islets
The relative expression level of SST3 gene expression in pancreatic islets versus various other tissues was assessed by DNA microarray using a Body-Atlas. The Body-Atlas is a molecular anatomic atlas detailing the expression level of different genes in each tissue or cell-type.
Total RNA samples were extracted from a comprehensive collection of tissues (including the pancreatic islets) for normal C57BL/6 mice and Sprague-Dawley rats and hybridized to microarrays (Mouse TOE 75k v1.0 and Rat 50k v2.1) to generate the mouse and rat islet body atlas data, respectively. In each version of the body-atlas, a reference pool of RNA sample was composed by pooling an equal amount of RNA from 10 different tissues. Samples from each tissue (such as islets) were hybridized against the reference pool to obtain the relative expression of each gene.
On the mouse microarray used to construct the mouse body atlas, the probe (SEQ ID NO: 2), representing sst3, showed high islet enrichment (Table 2). There were 422 genes showing high islet enrichment. The data fields included are the ratios of islets' intensity to the intensity of the species-specific reference pool as well as the absolute hybridization intensities. The Tau values are probe- and array-specific background intensities and represent the intensity at which detection of a transcript achieves 90% confidence.
On the rat body atlas (Rat 50k v2.1) the probe (SEQ ID NO: 1) representing the SST3 gene was also identified as highly enriched in rat islets and the insulinoma INS-1 (832/13) cells (Table 3). About 600 other genes also showed high islet and INS-1 enrichment.







TABLE 2







SST3 Gene Expression Profile in a Mouse Body Atlas












SEQ ID NO: 2



Expression in Mouse
Ratio
Intensity
Tau













islets of Langerhans
25.32
82.68
0.32


brain, hippocampus
7.68
3.92
0.20


brain, telencephalon
4.09
2.14
0.15


Pituitary gland
3.69
1.75
0.25


spinal cord
2.09
1.67
0.23


brain, cerebellum
3.37
1.53
0.23


brain, hypothalamus
3.42
1.41
0.15


Pancreas
0.70
0.36
0.31


Vagina
0.27
0.20
0.26


Ovary
0.34
0.18
0.30


Stomach
0.34
0.15
0.23


muscle, soleus
0.21
0.15
0.28


small intestine, jejunum, smooth muscle
0.24
0.15
0.27


colon, rectum
0.38
0.14
0.17


Salivary gland
0.17
0.13
0.32


Prostate
0.26
0.13
0.24


lymph node, mesenteric
0.23
0.12
0.27


muscle, toes, long extensor
0.24
0.12
0.26


Eye
0.29
0.12
0.21


Trachea
0.18
0.12
0.27


Liver
0.26
0.12
0.22


Penis
0.29
0.11
0.27


Colon
0.31
0.11
0.26


adrenal gland
0.31
0.10
0.21


small intestine, ileum, epithelium
0.26
0.10
0.20


Tongue
0.20
0.09
0.25


Thymus
0.17
0.09
0.22


Heart
0.21
0.08
0.21


small intestine, ileum, smooth muscle
0.18
0.08
0.24


Adipose tissue, white, retroperitoneal
0.25
0.08
0.22


muscle, thigh, quadriceps
0.24
0.07
0.19


Adipose tissue, brown, interscapular
0.20
0.07
0.23


small intestine, jejunum, epithelium
0.20
0.07
0.22


Epididymis
0.14
0.07
0.22


Testis
0.15
0.06
0.26


Kidney
0.19
0.06
0.21


Adipose tissue, white, epididymal
0.21
0.06
0.22


colon, cecum
0.21
0.06
0.23


Gallbladder
0.15
0.06
0.22


Spleen
0.16
0.06
0.19


Aorta
0.14
0.05
0.25


bone marrow
0.16
0.05
0.23


seminal vesicle
0.10
0.04
0.25


Lung
0.13
0.04
0.17
















TABLE 3







SST3 Gene Expression Profile in a Rat Body Atlas












SEQ ID NO: 1



Expression in Rat
Ratio
Intensity
Tau













islets of Langerhans
11.81
3.27
0.34


Insulinoma, INS-1 cells
10.56
5.60
0.23


brain, cerebellum
7.54
3.18
0.22


lymph node, cervical
6.50
3.28
0.26


Thymus
6.03
3.53
0.22


Spleen
4.31
2.29
0.24


brain, forebrain
2.75
1.17
0.31


Pituitary gland
2.23
1.04
0.26


Tibia
1.99
0.67
0.26


brain, hypothalamus
1.18
0.42
0.29


Lung
1.17
0.25
0.20


bone marrow
1.15
0.50
0.26


spinal cord
1.13
0.45
0.26


Testis
0.75
0.24
0.32


Colon
0.74
0.27
0.25


Insulinoma, RIN-m5F cells
0.73
0.25
0.30


Mammary gland
0.65
0.13
0.23


Adipose tissue, white, epididymal
0.62
0.21
0.24


Ovary
0.61
0.24
0.26


adrenal gland
0.58
0.25
0.27


Epididymis
0.46
0.18
0.28


Heart
0.45
0.16
0.30


small intestine, jejunum
0.44
0.15
0.30


colon, cecum
0.43
0.14
0.27


muscle, soleus
0.41
0.13
0.23


small intestine, ileum
0.40
0.15
0.32


venae cavae
0.39
0.13
0.29


Skin
0.37
0.06
0.21


small intestine, duodenum
0.36
0.12
0.33


Prostate, ventral
0.35
0.13
0.26


Aorta
0.35
0.10
0.32


Eye
0.34
0.15
0.27


muscle, thigh, quadriceps
0.33
0.10
0.22


Esophagus
0.33
0.12
0.23


thyroid/parathyroid gland
0.32
0.12
0.25


Liver
0.32
0.11
0.28


Salivary gland
0.29
0.09
0.34


dorsal root ganglia
0.29
0.09
0.28


Stomach
0.28
0.12
0.28


Uterus
0.28
0.11
0.25


Kidney
0.28
0.10
0.25


Bladder
0.27
0.09
0.29


Harderian gland
0.22
0.06
0.24









Example 3
Detection of SST3 Gene Expression in Human Islets by Fluorescence-Based Real-Time PCR
The expression levels of all five somatostatin receptor subtype in human islets from two different donors and 7 non-islet tissues were determined by the Taqman real-time PCR method. Fluorogenic Taqman probes specific for human sst1, sst2, sst3, sst4 and sst5 were purchased from Applied Biosystems (Foster City, Calif., the catalog numbers are Hs0265617_s1, Hs00265624_s1, Hs00265633_s1, Hs00265639_s1 and Hs00265647_s1 respectively). Absolute mRNA levels for the genes of interest were determined by real-time reverse transcription reaction using the ABI PRISM 7900 Sequence Detection System from Applied Biosystems (Foster City, Calif.) through 40 cycles. β-Actin probe was used as reference to determine the relative abundance of the each gene in different tissues.
The Taqman results showed that sst3, along with sst5, are the two most abundant SST expressed genes in two separate human islet samples, and sst4 is not expressed in human islets. SST3 gene expression was also observed brain (Table 4).







TABLE 4







Relative expression level of SSTs in human tissues












SST1
SST2
SST3
SST5

















Hs. Islet 2
11.7
29.6
219.0
124.0



Hs. Islet 4
3.4
6.6
51.2
46.5



Placenta
0.3
0.1
0.0
0.0



Pancreas
0.9
1.0
0.7
0.0



Jejunum
1.7
0.7
0.2
0.0



Liver
4.4
1.0
0.1
0.0



Sk. muscle
0.6
0.4
0.0
0.0



Lymph node
0.1
0.3
1.4
0.0



Brain
4.2
13.0
7.0
1.0










Example 4
siRNA Mediated Gene Knockdown of Genes Whose Expression is Required for Normal Glucose-Stimulated Insulin Secretion
RNAi mediated gene knockdown has proven to be useful in elucidating the biological function of different genes. To study the function of candidate target genes in pancreatic beta-cell, we developed a robust method of siRNA mediated gene knockdown that can be used to screen for genes whose expression is required for normal glucose-stimulated insulin secretion (GSIS) function in the rat insulinoma cell line INS-1 (832/13).
Three 21-mer siRNA oligos were designed against each candidate gene and used as a pool at the final concentration of 20 uM. The siRNA oligos were delivered to the cells by Nucleofector Device (Amaxa, Gaithersburg, Md.). The INS-1 (832/13) cells were trypsinized, centrifuged, and resuspended in 100 ul Nucleofector solution V (2.25×106 cells per reaction). Seven and a half microliters of pooled siRNA were then added to the cell suspension. The cells were electroporated with Amaxa Nucleofector Device program T21. After electroporation, the cells were transferred and split into 9 wells in 96-well plate with 200 ul of regular culture medium (RPMI 1640 with 10% FCS and 11 mM glucose).
GSIS assays were performed after 48 hours. Prior to the assay, cells were washed once with glucose-free Krebs-Ringer Bicarbonate (KRB) medium and cells were incubated with the KRB medium for another 2 hours. The medium were replaced with fresh KRB supplemented with 2, 8, and 16 mM glucose and the cells were incubated for another 2 hours. Supernatants were taken out at the end of incubation for insulin measurement by Ultrasensitive Rat Insulin ELISA kit (ALPCO, Salem, N.H.).
The degree of gene knockdown by the siRNA oligos was quantified by Taqman real-time PCR also at 48 hours after electroporation. The method consistently obtained >70% knockdown of the target genes mRNA. We used PDE3b (phosphodiesterase 3B) and GCK (glucokinase) as two positive controls. As shown in Example 5, Table 6 (infra), compared to control-shocked INS-1 cells (using random sequence siRNA oligos), knocking down PDE3b increased GSIS by 1.5 to 3 fold, consistent with its role in hydrolyzing cAMP, a key positive mediator of GSIS. On the other hand, knocking down the key glycolytic enzyme, glucokinase, generally suppressed GSIS by 30 to 60%.
This method can also be used in other insulin secreting cells lines such as the murine insulinoma cell line MIN6 cells.
Example 5
SiRNA-Mediated Suppression of SST3 Gene Expression Enhances GSIS in INS-1 Cells
To study the role of SST3 in GSIS, we designed three pairs of siRNA oligos against rat sst3 (see Table 5 for sequences) and introduced the oligos into the INS-1 832/13 cells by electroporation as described in Example 4 supra.







TABLE 5







siRNA Oligo Sequences Targeting Rat sst3










siRNA





start
Sense Sequence
Antisense Sequence













986
rCrCUUUrCrGrGrCUrCUrCUrCrAUrGUTT
RArCrAUrGrArGrArGrArGrCrCrGrArArArGrGTT




(SEQ ID NO: 9)
(SEQ ID NO: 12)


 


829
RGrGrGUUUrGrCUrGrGrGrCrArAUUrCrATT
UrGrArAUUrGrCrCrCrArGrCrArArArCrCrCTT



(SEQ ID NO: 10)
(SEQ ID NO: 13)


 


924
RCUrGrArCrGrArArCUrCUUrCrAUrGrCUTT
RArGrCrAUrGrArArGrArGUUrCrGUrCrArGTT



(SEQ ID NO: 11)
(SEQ ID NO: 14)









GSIS assays were performed 48 hours after electroporation. The ratios of insulin concentration measured between 8 mM and 2 mM (G8/G2) and 16 mM and 2 mM (G16/G2) glucose treatments are functional readouts for GSIS. These two ratios for each gene were compared to the sample treated with random sequence siRNA oligos. GCK and PDE3b served as functional controls. A ratio of 0.5 represents fifty percent reduction of GSIS, and a ratio of 2 represents one hundred percent increase of GSIS. Sst3 siRNA treated samples showed 2.7 to 4.4 fold enhancements of GSIS. The results from four independent experiments were summarized in the Table 6.







TABLE 6







Normalized fold of stimulation of GSIS











si-GCK
si-PDE3B
si-SST3














G8/G2
G16/G2
G8/G2
G16/G2
G8/G2
G16/G2

















Exp. 1
0.5
0.5
Na
na
2.9
4.4


Exp. 2
0.5
0.4
2.2
3.2
3
2.9


Exp. 3
0.6
0.7
2.2
1.5
3
2.7


Exp. 4
0.5
0.7
1.8
2.3
2.8
4.3









The degree of sst3 knockdown was also examined 48 hours after siRNA treatment using Taqman real-time PCR. The rat sst3 specific probes were designed using Primer Express Software (Applied Biosystem) based on SEQ ID NO: 7 (Forward Primer: CTGAGCCATCTGTAAGAACCTTCA (SEQ ID NO: 15); Reverse Primer: CGTGCCTTAGGTCAAGCATAGC (SEQ ID NO: 16); Probe: TCTGCTCTCTTCAGGATCATGCTGGCT (SEQ ID NO: 17)). We observed about 55-75% reduction of sst3 mRNA in siRNA-treated cells.
Example 6
SST3 Specific Antagonist Enhances GSIS in Isolated Mouse Islets
Pancreatic islets of Langerhans were isolated from the pancreas of normal C57BL/6J mice (Jackson Laboratory, Maine) by collagenase digestion and discontinuous Ficoll gradient separation, a modification of the original method of Lacy and Kostianovsky (Lacy et al., Diabetes 16:35-39, 1967). The islets were cultured overnight in RPMI 1640 medium (11 mM glucose) before GSIS assay.
To measure GSIS, islets were first preincubated for 30 minutes in the Krebs-Ringer bicarbonate (KRB) buffer with 2 mM glucose (in petri dishes). The KRB medium contains 143.5 mM Na+, 5.8 mM K+, 2.5 mM Ca2+, 1.2 mM Mg2+, 124.1 mM Cl−, 1.2 mM PO43−, 1.2 mM SO42+, 25 mM CO32−, 2 mg/ml bovine serum albumin (pH 7.4). The islets were then transferred to a 96-well plate (one islet/well) and incubated at 37° C. for 60 minutes in 200 μl of KRB buffer with 2 or 16 mM glucose, and other agents to be tested such as octreotide and a SST3 antagonist. (Zhou et al., J. Biol. Chem. 278:51316-51323, 2003.) Insulin was measured in aliquots of the incubation buffer by ELISA with a commercial kit (ALPCO Diagnostics, Windham, N.H.).
The SST3 specific antagonist (R)-1,1-bis-ethoxymethyl-3-(4-phenyl-1H-imidazol-2-yl)-2,3,4,9-tetrahydro-1H-β-carboline (racemic structure shown below) was used to evaluate the role of SST3 in glucose stimulated insulin secretion from the β-cell. Compound 2 is described in Troxler et al., International Publication No. WO 02/081471, International Publication Date Oct. 17, 2002:




As show in FIG. 1, Compound 2 significantly enhanced GSIS with or without the presence of octreotide (a somatostatin analogue). The enhancement of GSIS was observed at low concentration (0.1 and 1 uM) of the SST3 antagonist. As expected, GSIS was significantly suppressed by 10 nM of Octreotide in isolated islets. The effect of octreotide was fully blocked by 0.1 to 1 uM of Compound 2.
Example 7
Specific Binding of Compound 2 to SST3
The receptor-ligand binding assays of all 5 subtype of SSTRs were performed with membranes isolated from Chinese hamster ovary—(CHO) K1 cells stably expressing the cloned human somatostatin receptors in 96-well format as previous reported. (Yang et al. PNAS 95:10836-10841, 1998, Birzin et al. Anal. Biochem. 307:159-166, 2002.)
The stable cell lines for sst1-sst5 were developed by stably transfecting with DNA for all five ssts using Lipofectamine. Neomycin-resistant clones were selected and maintained in medium containing 400 μg/ml G418 (Rohrer et al. Science 282:737-740, 1998). Binding assays were performed using (3-125I-Tyr11)-SRIF-14 as the radioligand (used at 0.1 nM) and The Packard Unifilter assay plate. The assay buffer consisted of 50 mM Tris HCl (pH 7.8) with 1 mM EGTA, 5 mM MgCl2, leupeptin (10 μg/ml), pepstatin (10 μg/ml), bacitracin (200 μg/ml), and aprotinin (0.5 μg/ml). CHO-K1 cell membranes, radiolabeled somatostatin, and unlabeled test compounds were resuspended or diluted in this assay buffer. Unlabeled test compounds were examined over a range of concentrations from 0.01 nM to 10,000 nM. The Ki values for compounds were determined as described by Cheng and Prusoff Biochem Pharmacol. 22:3099-3108, 1973.
As show in Table 7, Compound 2 exhibits very high and specific binding to SST3 (IC50=7.8 nM).







TABLE 7







Binding Potencies of Compound 2 on


Somatostatin Receptor Subtypes










Receptor
IC50 (nM)














SST1
>1300



SST2
150,000



SST3
7.8



SST4
>490



SST5
>1500










Example 8
SST3 Antagonist Reduces Blood Glucose Levels During Glucose Tolerance Tests in Mice
Glucose tolerance tests were performed using an SST3 antagonist in normal C57B1/6 mice. Mice were purchased from Taconic Farm, Inc. (Germantown, N.Y.). Mice were group housed and allowed access to diet and autoclaved water. Mice were fasted for 14 hours prior to glucose tolerance tests. Compound 2 was dosed orally 30 minutes before glucose challenge at 3 mpk [mg drug per kg of body weight]. Control mice were gavaged with same volume of the vehicle (0.25% methylcellulose). At time zero glucose was injected intraperitoneally at the dose of 2 g/kg of body weight. Glucose levels were measured from tail bleeds with a glucometer (Lifescan, Milpitas, Calif.) at specified time points after glucose administration. As shown in FIG. 2, Compound 2 significantly reduced glucose levels during the glucose tolerance test in normal mice.
Other embodiments are within the following claims. While several embodiments have been shown and described, various modifications may be made without departing from the spirit and scope of the present invention.

## Claims

1. A method for increasing insulin secretion in patient in need thereof comprising the step of administering to said patient an effective amount of a somatostatin subtype 3 receptor (SST3) antagonist of Formula 1:



wherein is R1 is selected from the group consisting of:





wherein R2 and R3 is each independently selected from the group consisting of: (C1-4)alkoxy(C1-4)alkyl, (C3-7)cycloakyl(C1-4)alkyl, and, if R1 is not an optionally substituted phenyl, (C1-12)alkyl;
R4 is selected from the group consisting of: hydrogen, (C1-4)alkyl, (C1-4)alkoxy, halogen, and trifluoromethyl;
R5 is selected from the group consisting of: hydrogen and (C1-4)alkyl;
R6 is (C1-4)alkyl;
R7 and R8 is each independently selected from the group consisting of: hydrogen and (C1-4)alkyl; and
X is selected from the group consisting of: hydrogen, (C1-4)alkoxy, (C1-4)alkylamino, and di(C1-4)alkylamino;
or a pharmaceutically acceptable salt or solvate thereof.

2. The method of claim 1, wherein said SST3 antagonist is used and said antagonist binds SST3 at least 40 times more than it binds somatostatin subtype 1, 2, 4 and 5 receptor.

3. The method of claim 2, wherein said method reduces blood glucose levels.

4. The method of claim 3, wherein said patient suffers from type 2 diabetes mellitus.