Central cholecystokinin antagonists for treatment of psychiatric disorders

Abstract: Pharmaceutical compositions and methods of using cholecystokinin-ligands (e.g. lorglumide) as antipsychotic, antianxiety drugs and agents useful in the treatment or prevention of withdrawal symptoms caused by withdrawal of chronic or long term use of diazepam, alcohol, cocaine or nicotine are described.

Description: Agents acting at central cholecystokinin (CCK) receptors induce satiety (Schick, Yaksh and Go, Regulatory Peptides 14:277-291, 1986. They are also expected to act as analgesics (Hill, Hughes and Pittaway, Neuropharmacology 26:289-300, 1987, and as anticonvulsants (MacVicar, Kerrin and Davison, Brain Research , 406:130-135, 1987. Reduced levels of CCK-peptides have been found in the brains of schizophrenic patients compared with controls (Roberts, Ferrier, Lee, Crow, Johnstone, Owens, Bacarese-Hamilton, McGregor, O'Shaughnessey, Polak and Bloom. Brain Research 288, 199-211, 1983). It has been proposed that changes in the activity of CCK neurones projecting to the nucleus accumbens may play a role in schizophrenic processes by influencing dopaminergic function (Totterdell and Smith, Neuroscience 19, 181-192, 1986). This is consistent with numerous reports that CCK peptides modulate dopaminergic function in the basal ganglia and particularly the nucleus accumbens (Weiss, Tanzer, and Ettenberg, Pharmacology, Biochemistry and Behaviour 30, 309-317, 1988; Schneider, Allpert and Iversen, Peptides 4, 749-753, 1983). It may therefore be expected that agents modifying CCK receptor activity may have therapeutic value in conditions associated with disturbed function of central dopaminergic function such as schizophrenia and Parkinson's disease. CCK and gastrin peptides share a common carboxy terminal pentapeptide sequence and CCK peptides can bind to the gastrin receptor of the stomach mucosa and elicit acid secretion in many species including human (Konturek, Gastrointestinal Hormones, Ch. 23, pp 529-564, 1980, ed. G.B.J. Glass, Raven Press, NY). Antagonists of the CCK-8 receptor would also be expected to be antagonists at the stomach gastrin receptor and thus be of value for conditions involving excessive acid secretion. CCK and gastrin peptides have trophic effects on the pancreas and various tissues of the gastrointestinal tract (Johnson, ibid. , pp 507-527), actions which are associated with increased DNA and RNA synthesis. Moreover, gastrin secreting cells are associated with certain gastrointestinal tumors as in the Zollinger-Ellison syndrome (Stadil, ibid., pp 279-739), and some colorectal tumors may also be gastrin/CCK dependent (Singh, Walker, Townsend and Thompson, Cancer Research , 46, 1612 (1986), and Smith, J.P., Gastroenterology , 95:1541 (1988)). Antagonists of CCK/gastrin receptors could therefore be of therapeutic value as antitumor agents. The cholecystokinin peptides are widely distributed in various organs of the body including the gastrointestinal tract, endocrine glands, and the nerves of the peripheral and central nervous systems. Various biologically active forms have been identified including a 33-amino acid hormone and various carboxyl-terminus fragments of this peptide (e.g., the octapeptide CCK26-33 and the tetrapeptide CCK30-33). (G.J. Dockray, Br. Med. Bull. , 38 (No. 3):253-258, 1982). The various CCK peptides are thought to be involved in the control of smooth muscle contractility, exocrine and endocrine gland secretion, sensory nerve transmission, and numerous brain functions. Administration of the native peptides cause gall bladder contraction, amylase secretion, excitation of central neurons, inhibition of feeding, anticonvulsive actions and other behavioral effects. ("Cholecystokinin: Isolation, Structure and Functions," G.B.J. Glass, Ed., Raven Press, New York, 1980, pp 169-221; J.E. Morley, Life Sciences 27:355-368, 1980; "Cholecystokinin in the Nervous System," J. de Belleroche and G.J. Dockray, Ed., Ellis Horwood, Chichester, England, 1984, pp 110-127). The high concentrations of CCK peptides in many brain areas also indicate major brain functions for these peptides (G.J. Dockray, Br. Med. Bull. , 38 (No. 3):253-258, 1982). The most abundant form of brain CCK found is CCK26-33, although small quantities of CCK30-33 exist (Rehfeld and Gotterman, J. Neurochem. , 32:1339-1341, 1979). The role of central nervous system CCK is not known with certainty, but it has been implicated in the control of feeding (Della-Fera and Baile, Science 206:471-473, 1979). CCK is known to be present in some cortical interneurones which also contain gamma-aminobutyric acid (GABA) (H. Demeulemeester, et al, J Neuroscience 8:988-1000, 1988). Agents that modify GABA action may have utility as anxiolytic or hypnotic agents (S.C. Harvey, The Pharmacological Basis of Therapeutics (7th ed.) 1985, pp 339-371, MacMillan). Thus, agents which modify CCK action may have parallel anxiolytic or hypnotic activities. It has now been found that certain CCK ligands are useful as antianxiety agents. The present invention is related to the use of certain CCK-ligands and pharmaceutically acceptable salts thereof in the treatment of anxiety. The compounds and methods of preparing them are found in United States Patent 4,820,834 and European Application 167,919. The uses disclosed are gastric acid secretion disorders, gastrointestinal motility, pancreatic secretions, dopaminergic functions, analgesics, psychic disturbances, anorexia, weight increases in farm animals, and pathological cellular growth such as tumors. The present invention relates to the use of a derivative selected from L-364718 which is 3(S)-(-)-N-(2,3-dihydro-1-methyl-2-oxo-5-phenyl-1H-1,4-benzodiazepin-3-yl)-1H-indole-2-carboxamide, and L-365,260 which is (R)-N-(2,3-dihydro-1-methyl-2-oxo-5-phenyl-1H-1,4-benzodiazapine-3-yl)-N'-(3-methylphenyl)urea or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment or the prevention of anxiety. The compounds of use in the instant invention may be administered in an amount of from 0.05 mg/kg to 50 mg/kg. The compounds of use in the instant invention may be administered as a composition which is in oral dosage form. The compounds used in the instant invention include solvates, hydrates and pharmaceutically acceptable salts thereof. The pharmaceutically acceptable salts of the compounds used in the present invention include conventional non-toxic salts or quarternary ammonium salts. The usefulness of the compounds of the instant invention as agents for treating anxiety is demonstrated in the following pharmacological test procedure. METHODS The compounds of the instant invention are useful as anxiolytic agents as described and discussed below. Figure I illustrates the effectiveness of orally administered compound L-365260. Anxiolytic activity was assessed in the light/dark exploration test in the mouse (B.J. Jones, et al, Br. J. Pharmacol. 93:985-993, 1988). Generally the number of mice used was 5 and the pretreatment time was about 40 minutes. The compound was given p.o. in 1- and 10-mg/kg doses. The apparatus was an open-topped box, 45 cm long, 27 cm wide, and 27 cm high, divided into a small (2/5) area and a large (3/5) area by a partition that extended 20 cm above the walls. There was a 7.5 x 7.5 cm opening in the partition at floor level. The small compartment was painted black and the large compartment white. The floor of each compartment was marked into 9 cm squares. The white compartment was illuminated by a 100-watt tungsten bulb 17 cm above the box and the black compartment by a similarly placed 60-watt red bulb. The laboratory was illuminated with red light. All tests were performed between 13 hundred hours, 0 minutes and 18 hundred hours, 0 minutes. Each mouse was tested by placing it in the center of the white area and allowing it to explore the novel environment for five minutes. Its behavior was recorded on videotape and the behavioral analysis was performed subsequently from the recording. Five parameters were measured: the latency to entry into the dark compartment, the time spent in each area, the number of transitions between compartments, the number of lines crossed in each compartment, and the number of rears in each compartment. In this test an increase in the time spent in the white area is a sensitive measure of the anxiolytic effects of several standard anxiolytic drugs. Drugs were dissolved in water or saline and administered either subcutaneously, intraperitoneally, or by mouth (PO) via a stomach needle. The results obtained with L-365,260 are shown in Figure 1. Control mice, not treated with L-365,260, but subjected to the aversive stimulus, showed a high level of rearing and line crossing activity in the black compartment compared to the white compartment. Treatment with L-365,260 10 mg/kg orally reversed this response and the mice now showed higher rearing and line crossing activity in the white compartment than in the black compartment. Figure 1 also shows that L-365,260 reduced the total time spent by the mice in the black compartment and increased the time latency of the mice moving from the white side to the black side. These results show that L-365,260 possesses anxiolytic activity in this test. For preparing pharmaceutical compositions from the compounds of use in the invention, inert, pharmaceutically acceptable carriers can be either solid or liquid. Solid form preparations include powders, tablets, dispersible granules, capsules, cachets, and suppositories. A solid carrier can be one or more substances which may also act as diluents, flavoring agents, solubilizers, lubricants, suspending agents, binders, or tablet disintegrating agents; it can also be an encapsulating material. In powders, the carrier is a finely divided solid which is in a mixture with the finely divided active component. In tablets, the active component is mixed with the carrier having the necessary binding properties in suitable proportions and compacted in the shape and size desired. For preparing suppository preparations, a low-melting wax such as a mixture of fatty acid glycerides and cocoa butter is first melted and the active ingredient is dispersed therein by, for example, stirring. The molten homogeneous mixture is then poured into convenient sized molds and allowed to cool and solidify. The powders and tablets preferably contain 5 to 70% of the active component. Suitable carriers are magnesium carbonate, magnesium stearate, talc, lactose, sugar, pectin, dextrin, starch, tragacanth, methyl cellulose, sodium carboxymethyl cellulose, a low-melting wax, cocoa buffer, and the like. The term "preparation" is intended to include the formulation of the active component with encapsulating material as a carrier providing a capsule in which the active component (with or without other carriers) is surrounded by a carrier which is thus in association with it. Similarly, cachets are included. Tablets, powders, cachets, and capsules can be used as solid dosage forms suitable for oral administration. Liquid form preparations include solutions, suspensions, and emulsions. Sterile water or water-propylene glycol solutions of the active compounds may be mentioned as an example of liquid preparations suitable for parenteral administration. Liquid preparations can also be formulated in solution in aqueous polyethylene glycol solution. Aqueous solutions for oral administration can be prepared by dissolving the active component in water and adding suitable colorants, flavoring agents, stabilizers, and thickening agents as desired. Aqueous suspensions for oral use can be made by dispersing the finely divided active component in water together with a viscous material such as natural synthetic gums, resins, methyl cellulose, sodium carboxymethyl cellulose, and other suspending agents known to the pharmaceutical formulation art. Preferably the pharmaceutical preparation is in unit dosage form. In such form, the preparation is divided into unit doses containing appropriate quantities of the active component. The unit dosage form can be a packaged preparation, the package containing discrete quantities of the preparation, for example, packeted tablets, capsules, and powders in vials or ampoules. The unit dosage form can also be a capsule, cachet, or tablet itself, or it can be the appropriate number of any of these packaged forms. When a compound of use in the invention is used in a human subject, the daily dosage will normally be determined by the prescribing physician with the dosage generally varying according to the age, weight, and response of the individual patient, as well as the severity of that patient's symptoms. However, in most instances, an effective daily dosage will be in the range of from 0.05 mg/kg to 50 mg/kg of body weight, and preferably, of from 0.5 mg/kg to 20 mg/kg of body weight, administered in single or divided doses. In some cases, however, it may be necessary to use dosages outside these limits. Examples of formulations of compounds or salts thereof of use in the instant invention are: Example 1 Syrups 200 mg /5 ml syrup Compound 12.5 g Purified Water USP 200 ml Cherry Syrup qu 1000 ml The compound is dissolved in water and to the resulting solution the syrup is added with mild stirring. Example 2 Capsules 50 mg, 100 mg, or 200 mg Compound 250 g Lactose USP, Anhydrous q.s. or 250 g Sterotex Powder HM 5 g Combine the compound and the lactose in a tumble blend for two minutes, blend for one minute with the intensifier bar and then tumble blend again for one minute. A portion of the blend is then mixed with the Sterotex Powder, passed through a #30 screen and added back to the remainder of the blend. The mixed ingredients are then blended for one minute, blended with the intensifier bar for thirty seconds and tumble blended for an additional minute. The appropriately sized capsules are filled with 141 mg, 352.5 mg, or 705 mg of the blend, respectively, for the 50 mg, 125 mg, and 250 mg containing capsules. Example 3 Tablets 50 mg, 100 mg, or 200 mg Corn Starch NF 200 g Cellulose, Microcrystalline 46 g Sterotex Powder HM 4 g Purified Water q.s. or 300 ml Combine the corn starch, the cellulose, and Compound together in a planetary mixer and mix for two minutes. Add the water to this combination and mix for one minute. The resulting mix is spread on trays and dried in a hot air oven at 50 °C until a moisture level of 1 to 2 percent is obtained. The dried mix is then milled with a Fitzmill through a #RH2B screen, and added back to the milled mixture and the total blended for five minutes by drum rolling. Compressed tablets of 150 mg, 375 mg, and 750 mg, respectively, of the total mix are formed with appropriate sized punches the 50 mg, 125 mg, or 500 mg containing tablets.

Claims: Use of a derivative selected from 3(S)-(-)-N-(2,3-dihydro-1-methyl-2-oxo-5-phenyl-1H-1,4-benzodiazepin-3-yl)-1H-indole-2-carboxamide, (R)-N-(2,3-dihydro-1-methyl-2-oxo-5-phenyl-1H-1,4-benzodiazapine-3-yl)-N'-(3-methylphenyl)urea or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment or the prevention of anxiety.

Inventors: HORWELL DAVID CHRISTOPHER, HUGHES JOHN, WOODRUFF GEOFF NEIL, HORWELL, DAVID CHRISTOPHER, HUGHES, JOHN, WOODRUFF, GEOFF NEIL
Applicants: MERCK SHARP & DOHME, MERCK SHARP & DOHME LTD.
Application year: 1990
Main classification: A61K31
IPC codes: C07C233, C07D403, C07D243, A61K31, A61P25, C07D405, C07D401, C07D263, C07D211, C07D409