Pharmaceutical composition and medical uses of dioxopiperidine derivatives, especially as immune response potentiators, antiviral and antibacterial agents

Abstract: Phenyl-3-aminoalkyl-4-methyl-2,6-dioxopiperidines of the Formula I wherein: R₁ represents methoxy, ethoxy or hydroxy, R₂ represents methoxy, ethoxy, hydroxy or hydrogen; each R₃ independently represents methyl or ethyl; R₄ represents hydrogen or methyl; R₅ represents hydrogen or methyl; and n represents 2 or 3, and a pharmacologically acceptable acid addition salt thereof potentiate the immunoresponse of a patient and thereby have antibacterial and antiviral activity.

Description: The invention relates to potentiation of the immunoresponse of a patient with certain 3-phenyl-3-aminoalkyl-4-methyl-2,6-dioxopiperidines and provides the use of said dioxopiperidine compounds in the manufacture of a medicament for potentiating said response. The strength of the immune response is known to be modulated by serotonin (5-hydroxytryptamine; 5HT) acting via peripheral (ie. non-brain) mechanisms (Jackson, J.C. et al Immunology 54 , 505-512 (1985). Thus systemic administration of 5HT or its precursor 5-hydroxytryptophan (5HTP) to mice suppresses the normal immune response to an antigen challenge. Conversely, the known tryptophan hydroxylase inhibitor para-chlorophenylalanine (PCPA) enhances the normal immune response. It has been disclosed in GB-A-1455687 (also AU 480855, BE-A-808958, DE-A-2363052.6, FR-A-7346904, JP-A-6053014 and US-A-3,963,729) that inter alia 3-phenyl-3-aminoalkyl-4-methyl-2,6-dioxopiperidine derivatives of the following Formula I have central nervous system, especially antidepressant, activity:- wherein: R 1 represents methoxy, ethoxy or hydroxy, R 2 represents methoxy, ethoxy, hydroxy or hydrogen; each R 3 independently represents methyl or ethyl; R 4 represents hydrogen or methyl; R 5 represents hydrogen or methyl; and n represents 2 or 3. The specific examples of compounds of Formula I stated in US-A-3,963,729 are 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3'-methoxyphenyl)-3-(2''-N,N-dimethylaminoethyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminoethyl)-4-methyl-2,6-dioxo-piperidine; and 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminoethyl)-4,5-dimethyl-2,6-dioxopiperidine. It has recently been disclosed in US-A-4,461,771 that compounds of Formula I in which R 4 represents methyl and R 5 represents hydrogen reduce in vitro the activity of tryptophan hydroxylase by blocking the depolarization-induced activation of the enzyme in the brain stem and hence are of potential use in the prophylactic treatment of the stressful disorder migraine. More recently, it has been established that at least one compound of Formula I (viz 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine; AGN 2979) also blocks in vitro the activation of tryptophan hydroxylase resulting from exposure of brain stem slices to metabolic inhibitors or methylxanthines or induced by incubation of supernatant preparations of the enzyme under phosphorylating conditions (Boadle-Biber, M.C. et al Biochem. Pharmacol. 35, 1521-6, (1986)). However, AGN 2979 has no significant effect in vitro upon the unactivated enzyme (Boadle-Biber, M.C. et al supra). It is known that the brain levels of 5HT and/or its metabolite 5-hydroxy indoleacetic acid (5HIAA) are abnormally high in certain affective disorders. Examples of such disorders are the Kleine-Levin syndrome (Koerber R.K. et al Neurology 1984, 34, 1597-1600), serotonin-irritation syndrome (Gianniani A.J. et al J. Clin. Psychiatry, 44, 262-4 (1983); Krueger A.P. et al , Science, 1976, 1209) and sleep apnea (Barruzzi, A. et al Sleep 3 , 247-9 (1980); Mangin P. et al Adv . Biosci. 21 , 217-9 (1979); Cromer, H. et al J. Neurol. Neurosurg. Psychiatry 44 , 1165-7 (1981)). It is known that 5HT activation depresses respiration (Lundberg D.B.A. et al J . Pharm. Exp. Therap. 212 397-404 (1980) and it has been suggested that the abnormally high brain levels of 5HT are responsible for the disorders of the Kleine-Levin and sleep apnea syndrome and sudden infant death (Koerber R.K. et al supra). It has now surprisingly been found that the compounds of Formula I enhance the immune response in mice by a mechanism which probably involves a decreased synthesis of 5HT in the periphery. Hence, the compounds of Formula I are of potential use in combatting bacterial and viral infections in animals and in man. It has also unexpectedly been found that the compounds of Formula I can diminish the brain levels of 5HT and 5HIAA under normal conditions and are of use in the treatment of disorders associated with abnormally high levels of 5HT in the brain such as Kleine-Levin, sleep apnea, serotonin-irritation, and sudden infant death syndromes. Thus, according to the present invention, there is provided the use of a compound of Formula I or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for potentiating the immunoresponse, particularly for the treatment of bacterial or viral infections in a patient, and also in the manufacture of a medicament for the reduction of chronic abnormally high brain levels of 5HT or 5HIAA, especially for treating sleep apnea. The compounds of Formula I can be administered in various manners to achieve the desired antibacterial or antiviral effect. The compounds can be administered alone or in the form of pharmaceutical preparations to the patient being treated either orally or parenterally, for example subcutaneously or intravenously. The amount of compound administered will vary and can be any effective amount. Depending upon the patient and the mode of administration, the quantity of compound administered may vary over a wide range to provide from 0.1 mg/kg to 20 mg/kg, usually 0.5 mg/kg to 10 mg/kg, of body weight of the patient per dose. Unit doses of these compounds can contain, for example from 10 mg to 500 mg usually 10 to 100 mg of the compound and may be administered for example from 1 to 4 times daily. The activity of the compounds to potentiate the immunoresponse can be determined by measuring, by the method described by Elliott and Rozmann, ( J . Immunol. 115, 495 (1975), the number of immunoglobin M and G (IgM and IgG) antibody forming spleen cells from mice 3-7 days after immunisation with 5 x 10 8 sheep red blood cells, the mice having been pretreated with three daily doses of the compounds. As an illustration the number of IgM antibody forming spleen cells from mice treated with three daily doses of 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6- dioxopiperidine hydrochloride 10 mg/kg ip was 1128 x 10 6 on day 4 after immunization which was 189% above control values. The activity of the compounds to lower brain 5HT or 5HIAA levels can be assessed by measuring the concentrations of 5HIAA in homogenates of whole brains in 0.4M perchloric acid from animals treated with the compounds following the method described by J. Wagner et al. J. Neurochem ., 38 1241 (1982) and comparing the results with those obtained from animals treated with saline. As an illustration the whole brain level of 5HIAA was reduced by 20% 4.5 hours after treating mice with an ip dose of 10mg/kg of d, 1 3-(3-methoxy-phenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine hydrochloride. The compounds of general Formula I have the phenyl moiety substituted in one or both meta positions by methoxy, ethoxy or hydroxy. It is presently preferred that the substituent(s) should be hydroxy or, especially, methoxy. It is also preferred that there should be only one substituent and that when there are two substituents they should be the same. The amino group of the compounds of Formula I is dimethylamino, diethylamino or methylethylamino with dimethylamino being presently preferred. The amino group is connected to the piperidine ring by a divalent ethylene (i.e. n = 2) or trimethylene (i.e. n = 3) radical with trimethylene being presently preferred. The piperidine ring of the compounds of Formula I is substituted in the 4-position with methyl and optionally by one or two further methyl groups in the 4 and/or 5 positions. It is presently preferred that there is one further methyl group in the 4 or 5 position, especially in the 4-position. Examples of compounds of Formula I include the following:- 3-(3'-methoxyphenyl)-3-(2''-N,N-dimethylaminoethyl)-4,4-dimethyl-2,6-dioxopiperidine 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine (compound 2979 - see later) ; 3-(3'-methoxyphenyl)-3-(2''-N,N-diethylaminoethyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3'-methoxyphenyl)-3-(3''-N,N-diethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine ; 3-(3'-hydroxyphenyl)-3-(2''-N,N-dimethylaminoethyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3'-hydroxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3'-methoxyphenyl)-3-(2''-N,N-dimethylaminoethyl)-4,5-dimethyl-2,6-dioxopiperidine (compound 2939 - see later); 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,5- dimethyl-2,6-dioxopiperidine (compound 3181 - see later); 3-(3'-ethoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3'-ethoxyphenyl)-3-(3''-N,N-diethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3',5'-dimethoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine (compound 3222 - see later); 3-(3',5'-dimethoxy)-3-(2''-N,N-dimethylaminoethyl)-4,4-dimethyl-2,6-dioxopiperidine; 3-(3',5'-dimethoxy)-3-(3''-N,N-dimethylaminopropyl)-4,5-dimethyl-2,6-dioxopiperidine; and 3-(3',5'-dimethoxy)-3-(2''-N,N-dimethylaminoethyl)-4,5-dimethyl-2,6-dioxopiperidine; The above compounds may be administered in free base form, as an alkali metal or alkaline earth metal salt or as a pharmaceutically acceptable acid addition salt with the proviso that an alkali metal or alkaline earth metal salt is not normally combined with an acid addition salt except in a layer formulation. Representative acid addition salt forms include organic acid salt forms such as the maleate and methane sulphonate and mineral acid salt forms such as the hydrochloride and perchlorate. The pharmaceutical formulations in which form the active compounds of the invention will normally be utilized are prepared in a manner well known per se in the pharmaceutical art and usually comprise at least one active compound of Formula I in admixture or otherwise in association with a pharmaceutically acceptable carrier or diluent therefor. For making those formulations the active ingredient will usually be mixed with a carrier, or diluted by a diluent, or enclosed or encapsulated in a capsule, sachet, cachet, paper or other container. A carrier or diluent may be solid, semi-solid or liquid material which serves as a vehicle, excipient or medium for the active ingredient. Suitable carriers or diluents are well known per se . The formulations may be adapted for enteral or parenteral use and may be administered to the patient in the form of tablets, capsules, dragees, suppositories, syrups, suspensions or the like. Preferably the compounds of Formula I are administered orally in the form of a unit dosage. For co-administration, such as a unit dosage may, if desired, have said active agents separately encompassed therein e.g. in separate layers in a layer tablet. Suitably, each unit dose of compound of Formula I is in the range 25 to 200 mg and each unit dose of benzodiazepine agonist or inverse agonist is in the range of 0.05 to 50 mg. The term "unit dosage form" is used herein to mean a single or multiple dose form containing a quantity of the active ingredient in admixture with or otherwise in association with the diluent or carrier, said quantity being such that one or more predetermined units are normally required for a single therapeutic administration. In the case of multiple dose forms such as liquids or scored tablets, said predetermined unit will be one fraction, such as a 5 ml (teaspoon) quantity of a liquid or a half or quarter of a scored tablet, of the multiple dose form. Aside from the active agents the compositions may contain pharmaceutically inert organic or inorganic adjuvants, optionally granulating agents, binding agents lubricants, dispersing agents, wetting agents and preservatives. Moreover, the pharmaceutical compositions may contain colouring, flavouring and sweentening substances. Adjuvants for the production of tablets may be e.g. calcium carbonate, lactose micro-crystalline cellulose, mannitol or talc. Starch and alginic acid or micro-crystalline cellulose may be used as granulating and disintegrating agents, starch, polyvinylpyrrolidone and gelatine may be used as binding agents and magnesium stearate, stearic acid, colloidal silica and talc as lubricants. Tablet formulation may be coated or uncoated, the coating having the purpose of delaying the disintegration and absorption in the gastrointestinal tract. Suitable suspending agents for the production of liquid administration forms are e.g. methyl cellulose and sodium alginate. Capsule formulation may contain the active agents on their own or together with an inert solid diluent e.g. calcium phosphate, corn starch, lactose, or mannitol. The invention is illustrated in the following non-limiting Examples. EXAMPLE 1 Tablets each having the following composition were prepared by conventional techniques: mg/tablet (a) Compound AGN 2979 base 50 (b) Lactose 51.5 (c) Maize starch dried 45 (d) magnesium stearate 1.5 EXAMPLE 2 mg/suppository (a) Compound AGN 2979 HCl 20 (b) Oil of Theobroma (cocoa butter) 980 The compound (a) is powdered and passed through a BS No. 100 sieve and triturated with molten oil of Theobroma at 45°C to form a smooth suspension. The mixture is well stirred and poured into moulds each of nominal 1 G capacity to produce suppositories. EXAMPLE 3 Tablet Formulation (a) Compound AGN 2979 base 100g (b) Tranxene 10g (c) Wheat starch 7g (d) Lactose 20g (e) Magnesium Stearate 1g The mixture is compressed into 1000 tablets each weighing 138 mg. Analogously an equal weight of Compound AGN 2939 or 50g of Compound AGN 3222 can be substituted for Compound AGN 2979. EXAMPLE 4 Pill Formulation per pill (a) Compound AGN 2979 HCl 50mg (b) Diazepam 3mg (c) Corn starch 45mg (d) Liquid glucose 7ml The pills are prepared by blending the active ingredients (a) and (b) and the corn starch, then adding the liquid glucose with thorough kneading to form a plastic mass from which the pills are cut and formed. EXAMPLE 5 Gelatine Capsule Formulation per capsule (a) Compound AGN 2979 HCl 50mg (b) Chlorodiazepoxide HCl 2.5mg (c) Talc 20mg A capsule is prepared by passing dry powdered active ingredients (a) and (b) and powdered talc in the above proportions through a fine mesh screen and mixing them well. The powder is then filled into hard gelatin capsules at a net fill of 72.5mg per capsule. EXAMPLE 6 Suppository mg/suppository (a) Compound 2979 HCl 20 (b) Diazepam 1 (c) Oil of Theobroma (cocoa butter) 979 The compound (a) is powdered and passed through a BS No. 100 sieve and triturated with molten oil of Theobroma at 45°C to form a smooth suspension. The mixture is well stirred and poured into moulds each of nominal 1 G capacity to produce suppositories. EXAMPLE 7 This example illustrates the use of compounds of Formula I in the treatment of sleep apnea. A male subject aged 54 years, height 178cm and weighing 83 kilograms having persistent awakening episodes of obstructive sleep apnea has been treated with compound AGN 2979 at a daily dose level of 120 mg. Sleep apnea episodes at first decreased in intensity and completely disappeared after one week of treatment. The patient has since remained symptom free for 14 months on a single maintenance dose of 120 mg every four days. In the Examples above, the active compound was used in the form of the racemate (d,1). However, as is apparent from Formula I herein, AGN 2979 and other compounds of said formula exist as optical isomers. Experimental work to date indicates that the individual isomers are of substantially equal activity in the medical uses to which this application relates.

Claims: The use of a compound of Formula I wherein: R 1 represents methoxy, ethoxy or hydroxy, R 2 represents methoxy, ethoxy, hydroxy or hydrogen; each R 3 independently represents methyl or ethyl; R 4 represents hydrogen or methyl; R 5 represents hydrogen or methyl; and n represents 2 or 3, or a pharmacologically acceptable acid addition salt thereof in the manufacture of a medicament for potentiating the immunoresponse of a patient. A use as claimed in Claim 1, wherein R 1 represents methoxy or hydroxy and R 2 represents methoxy, hydroxy or hydrogen. A use as claimed in Claim 1 or Claim 2, wherein R 2 represents hydrogen. A use as claimed in any one of the preceding claims, wherein each R 3 represents methyl. A use as claimed in any one of the preceding claims, wherein n is 3. A use as claimed in Claim 1, wherein R 1 represents methoxy or hydroxy, R 2 represents hydrogen, each R 3 represents methyl and n is 3. A use as claimed in any one of the preceding claims, wherein R 4 represents methyl and R 5 represents hydrogen. A use as claimed in Claim 1, wherein the dioxopiperidine is 3-(3'-methoxyphenyl)-3-(3''-N,N-dimethylaminopropyl)-4,4-dimethyl-2,6-dioxopiperidine. A use as claimed in any one of the preceding claims, wherein said medicament is for treating a bacterial infection. A use as claimed in any one of Claims 1 to 8, wherein said medicament is for treating a viral infection. The use of a compound defined in any one of Claims 1-8 in the manufacture of a medicament for the reduction of chronic abnormally high brain levels of serotonin or 5-hydroxyindoleacetic acid. Use as claimed in Claim 11 to treat sleep apnea.

Inventors: GITTOS MAURICE WARD, GITTOS, MAURICE WARD
Applicants: BTG INT LTD, BTG INTERNATIONAL LIMITED
Application year: 1986
Main classification: A61K31
IPC codes: A61K31