Use of a riminophenazine for treating MDR resistance

Abstract: The invention concerns the new use of riminophenazines in the treatment of a patient who has built up, or could build up, resistance to a therapeutically active substance, such as a patient requiring treatment for cancer. The riminophenazine conveniently may be of the general formula (I). R 1 is a hydrogen atom, a halogen atom or an alkyl, alkoxy or fluoroalkyl radical, R 2 is a hydrogen or halogen atom, R 3 is selected from hydrogen, alkyl, substituted alkyl, cycloalkyl, cycloalkylalkyl, or is a substituted or unsubstituted heterocyclic or heterocyclic-alkyl radical, R 4 is a hydrogen or halogen atom or an alkyl, alkoxy or fluoroalkyl radical, and n is 1, 2 or 3. The invention also provides novel riminophenazines of general formula (I), their preparation, and compositions containing them.

Description: BACKGROUND TO THE INVENTION THIS INVENTION relates to substances or compositions for use in therapeutic treatments. More particularly, the invention relates to patients who have built up, or could build up, resistance to therapeutically active substances, to novel compounds for use therein, to therapeutic compositions and their use, as well as to methods of preparing such compounds and compositions and methods of use thereof. A problem in the therapy of diseases which attack cells of the body is that the cells become resistant to drugs used for treating them. For example, in the treatment of cancer, several drugs are often used and the cells become resistant to these drugs. In the case of the chemotherapeutic treatment of tumours, multi-drug resistance mechanisms become operative and render the cells resistant to many treatment agents. The multi-drug resistance may be intrinsic or may be acquired. When it is acquired, the resistance results in relapse after an initially favourable response, and can be mediated by P-glycoprotein, which is an energy dependent multi-drug afflux pump and the product of the MDR 1 gene. As a result of the acquired multi-drug resistance mechanisms, the P-glycoprotein tends to pump out further amounts of drug being utilized and thereby prevents the therapeutic effect of such drugs taking place on the cells. Similarly, in the radiotherapeutic treatment of cancer, P-glycoprotein can be induced by such treatment, with the result that cell resistance to further cancer treatment can result. Such a mechanism of multi-drug resistance is thus operative in cancer patients who develop acquired drug resistance during chemotherapy or radiotherapy, thereby resulting in a pattern of resistance to a wide variety of anti-cancer drugs such as vinca alkaloids, epipodophyllotoxines, actinomycin D, anthracyclines, mithramicin, taxol, and the like. Accordingly, if one can discover substances or compositions which are able to modulate P-glycoprotein, continued treatment of the patient with the therapeutic drugs becomes possible. In this connection, we are aware that cyclosporin A has the property of acting as a multi-drug afflux pump modulator and thereby enabling treatment drugs to remain in the cells and provide a therapeutic effect. We have now surprisingly found that riminophenazines possess multi-drug resistance activity (MDR activity) and the invention includes compounds and compositions for such use as well as novel riminophenazines. DESCRIPTION OF THE PRIOR ART Many riminophenazines are known. Also, therapeutic activity for many riminophenazines is known. The known therapeutic activity usually has been for use in the treatment of tuberculosis or leprosy. The riminophenazines are compounds having a phenazine ring which are substituted on a ring nitrogen and which contain substituents in one or both of the fused benzene rings, one of said substituents being a substituted or unsubstituted imino group. The substituent on the imino group appears to be important in defining the activity, as do a substituted amino group in the same benzene ring and ring the nitrogen substituent. For example, in a series of U.S.A. patent specifications, namely nos. 2,943,089; 2,946,792 and 2,948,726, Barry et al described a number of riminophenazines which had activity against tubercula bacillus and which were stated to be tubercutaostatic. Two of the substituted positions, namely the amino group in the 2-position, the imino group in the 3-position and the nitrogen atom in the 5-position were substituted by phenyl or substituted phenyl groups and the other substituent was a dialkylaminoalkyl, alkoxyphenyl, alkyl or cycloalkyl radical. One such compound is clofamazine, N,5- bis- (4-chlorophenyl)-3,5-dihydro-3-[1-methylethyl)imino]-2-phenazinamine. More recently, many hundreds of riminophenazines have been made with various phenyl or substituted phenyl substituents on the 2-amino and 5-nitrogen positions and with the 3-imino radical having a variety of substituents thereon. Pharmaceutical properties have been found for a number of these known riminophenazines. None of these prior art compounds has been reported to have MDR activity. DESCRIPTION OF THE INVENTION In one aspect, the invention provides the use of a riminophenazine in the manufacture of a medicament to treat a cancer patient who has built up, or could built up, resistance to a therapeutically active substance used in the treatment of cancer. In a second aspect of the invention, the invention provides novel riminophenazines, their use, and a method for their preparation. In a third aspect, the invention provides a composition for the treatment of a cancer patient who has built up, or could build up, resistance to a therapeutically active compound used in the treatment of cancer, said composition containing a novel riminophenazine and a pharmaceutically acceptable carrier. In a fourth aspect, the invention provides a pharmaceutical composition comprising a novel riminophenazine, a known cancer treatment compound and a pharmaceutically acceptable carrier. A riminophenazine is a phenazine containing a substituent on a ring nitrogen atom and a substituted or unsubstituent imino substituent in one of the benzene rings. The imino group conveniently may be in the 2- or 3- position, the nitrogen atoms of the phenazine being in the 5- and 10- positions. Conveniently, there may also be an ammo group in the same benzene ring as the imino group, preferably in the 3- or 2-position. A presently preferred riminophenazine may have a 2-(substituted amino)-3-(substituted imino)-5-aryl grouping, optionally with a further substituent in the 8-position, i.e. a compound of the general formula with appropriate substituents on the free bonds shown: One preferred group of riminophenazines for use in the first aspect of the invention are compounds of general formula (I), in which R 1 and R 4 are the same and each is a hydrogen atom, a halogen atom, or an alkyl radical, R 2 is a hydrogen or halogen atom, R 3 is selected from hydrogen, alkyl, substituted alkyl, cycloalkyl, cycloalkylalkyl or is a heterocyclic or heterocyclic-alkyl radical, n is 1, 2 or 3. The riminophenazines act on cells of the human or animal body to make them susceptible to the action, or continued action, of the therapeutically effective compound. This can be particularly important where a patient has been treated repeatedly with a therapeutically effective compound and has built up resistance to that compound, e.g. during cancer treatment. The radicals R 1 and R 4 in formula (I) may, for example be hydrogen, chlorine, methyl, isopropyl. R 1 may conveniently be in the 3- and/or 4- position. R 2 may conveniently be hydrogen or chlorine. The radical R 3 in the above formula (I) may for example, be hydrogen, C 1 - C 4 - lower alkyl, (e.g. methyl, ethyl, n-propyl or iso-propyl), cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, methylcyclohexyl, hydroxycyclohexyl,cyclooctyl, cyclododecyl, dialkylaminoalkyl, cyclohexylmethyl, piperidyl, alkyl-substituted piperidyl or benzyl substituted pyridyl. A particularly convenient radical R 3 in the above formula (I) is a tetramethylpiperidyl (TMP) radical, e.g. a 4-TMP radical, or a cyclohexyl or a N,N-diethyl- aminopropyl radical. The known riminophenazines may be prepared by methods described in the literature, e.g. in the prior art including that referred to above. The invention particularly provides the use in the manufacture of a medicament to treat a cancer patient who has built up or could build up, resistance to a therapeutically active substance used in the treatment of cancer of a novel riminophenazine of the aforementioned general formula (I), in which: R 1 and R 4 are the same and each is a halogen atom or a (C 1 -C 4 ) lower alkyl, (C 1 -C 4 )-alkoxy, (C 1 -C 4 ) fluoroalkyoxy or haloalkyl, (for example trifluoromethyl) radical, R 2 is a hydrogen or halogen atom, R 3 is a 4-tetramethylpiperidyl radical n is 1, 2 or 3, with the provisos that (a) when n is 2 or 3, (R 1 )n and (R 4 )n are not 3,4-dichloro and that (b) when n is 1, substituents R 1 and R 4 cannot represent (C 1 -C 4 )-alkyl or (C 1 -C 4 )-alkoxy radicals or a halogen in the 4-position. The invention provides such compounds per se, their preparation and their use as pharmaceutically useful compounds in MDR treatment. Subject to provisos (a) and (b), the radicals R 1 and R 4 in the novel compounds may, for example, be chlorine, methyl, isopropyl, methoxy, trifluoromethoxy or trifluonomethyl, R 4 may conveniently be in the 3- and/or 4-position, R 2 may conveniently be hydrogen or methyl and R 3 preferably is the 4-TMP radical. The riminophenazines of the above general formula (I) may be prepared from a 1-anilino-2-nitrobenzene. For example a 1-anilino-2-nitrobenzene of general formula (II) may be reduced, e.g. with hydrogen in the presence of a palladium carbon catalyst, or in zinc and acetic acid, to form the corresponding 1-anilino-2-amino benzene (i.e. 2-amino-diphenylamine) of general formula (III), in which R 1 , R 2 and n have the meanings defined above. Heating at temperatures of 40-55°C can be used. The diphenylamine of formula (III) may be oxidatively condensed, e.g. with ferric chloride and concentrated hydrochloric acid or acetic acid to form a riminophenazine of general formula (IV), i.e. a compound of formula (I) in which R 3 is hydrogen. Ethyl alcohol may be used as a solvent. Stirring at ambient temperatures of, preferably, below 15°C may be carried out. The other riminophenazines of general formula (I), i.e. those which have R 3 equal to other than hydrogen, can be formed from the riminophenazine of general formula (IV) by reaction with an amine of formula R 3 -NH 2 . Refluxing of the reactants, in solution in dioxane, for a period of 3 to 5 hours may be necessary. The overall reaction steps are shown in figure 1 of the accompanying drawings. The 1-anilino-2-nitrobenzene starting material of general formula (II) may be prepared by reacting a 2-halo-nitrobenzene containing a R 2 -radical in the 5-position, with a formylated aniline having a R 1 substituent in the phenyl ring. The reaction may be carried out in the presence of anhydrous potassium carbonate and while boiling the reactants in dimethylformamide. The novel compounds of general formula (I) are particularly suitable in the treatment of human or animal cells to make them susceptible to the action or continued action of a therapeutically effective compound. They may be used as the only active compound with one or more acceptable carriers in a composition, The composition may also contains a known cancer treatment compound which is not a riminophenazine. Particular examples of compounds of general formula (I) are set out in the following Table I: Compound R 1 R 2 R 3 R 4 B283 H H H H B628 4-Cl H H H Clofazimine (B663) 4-Cl H -CH(CH 3 ) 2 4-Cl B669 H H -Cyclohexyl H B670 H H -CH(CH 3 ) 2 H B673 4-Cl H Cyclohexyl 4-Cl B718 H H -C 2 H 5 H B729 H H Cycloheptyl H B741 4-Cl H 4-methylcyclohexyl 4-Cl B746 4-Cl H -C 2 H 5 4-Cl B749 4-Cl H -(CH 2 ) 2 N.(C 2 H 5 ) 2 4-Cl B759 4-Cl H -(CH 2 ) 3 CH 3 4-Cl B796 H H -cyclopentyl H B980 4-F H -CH(CH 3 ) 2 4-F B1865 H Cl -CH(CH 3 ) 2 H B1912 H Cl -cyclohexyl H B3677 4-me H -cyclohexyl 4-me B3763 H H -cyclohexylmethyl H B3779 4-Cl H 4-(N,N-diethylamino)-2-methyl-butyl 4-Cl B3786 Cl H 4'-TMP Cl B3825 4-Cl H 4-hydroxycyclohexyl 4-Cl B3962 H H 4'-TMP H B4019 H Cl 4'-TMP H B4021 H Cl -C 2 H 5 H B4070 4-me H -4-piperidyl 4-me B4090 4-Cl Cl 4'-TMP 4-Cl B4100 3,4-di-Cl H 4'-TMP 3,4-di-Cl B4103 4-CF 3 H 4'-TMP 4-CF 3 B4104 4-Cl Cl Cyclohexyl 4-Cl B4121 3,5-di-Cl H 4'-TMP 3,5-di-Cl B4123 3-Cl Cl 4'-TMP 3-Cl B4126 3-CF 3 H 4'-TMP 3-CF 3 B4127 3-CF 3 Cl 4'-TMP 3-CF 3 B4128 2,4-di-Cl H 4'-TMP 2,4-di-Cl B4154 . 3,4-di-Cl H -(CH 2 ) 3 N.(C 2 H 5 ) 2 3,4-di-Cl B4158 4-CH(CH 3 ) 2 H 4'-TMP 4-CH(CH 3 ) 2 B4159 4-CH(CH 3 ) 2 Cl 4'-TMP 4-CH(CH 3 ) 2 B4163 3-CF 3 -4-Cl H 4'-TMP 3-CF 3 -4-Cl B4166 H H -cyclooctyl H B4169 3,4,5-tri-Cl H 4'-TMP 3,4,5-tri-Cl B4170 H H -cyclopropyl H B4171 H H -cyclododecyl H B4172 H H -cyclobutyl H B4173 H H 4'-(N-benzylpiperidyl) H B4174 4-OCH 3 H 4'-TMP 4-OCH 3 B4175 3,4-di-Cl H Cyclohexyl 3,4-di-Cl B4177 4-OCF 3 H 4'-TMP 4-OCF 3 In the above table, when R 3 is 4'-TMP, the TMP radical is a 4-(2,2,6,6,-tetramethyl piperidyl) radical. The abbreviation "me" has been used for methyl. Presently preferred compounds are those identified as B4103, B4158 and B4169, in view of their good bio-availability and high MDR effects. The invention also provides those compounds in Table 1 which are believed to be new compounds, for example the compounds B3779, B4070, B4103, B4104, B4121 B4123, B4126, B4127, B4128, B4154, B4158, B4159, B4163, B4166, B4169, B4170, B4171, B4172, B4173, B4174, B4175 and B4177. The chemical names for certain of the compounds of Table I are set out in Table II below : B663 N,5- bis -(4-chlorophenyl)-3,5-dihydro-3-[(1-methylethyl)imino]-2-phenazinamine; B796 N,5- bis -phenyl-3,5-dihydro-3-(cyclopentylimino)-2-phenazinamine; B3677 N,5- bis (4-methylphenyl)-3,5-dihydro-3-(cyclohexylimino)-2-phenazinamine; B3763 N,5- bis (phenyl)-3,5-dihydro-3-[(cyclohexylmethyl)imino]-2-phenazinamine; B3779 N,5- bis (4-chlorophenyl)-3,5-dihydro-3-[(4-diethylamino-2-methylbutyl)imino]-2-phenazinamine; B3962 N,5- bis (phenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine; B4070 N,5- bis (4-methylphenyl)-3,5-dihydro-3-[(4-piperidyl)imino]-2-phenazinamine; B4103 N,5- bis (4-trifluoromethylphenyl)-3,5-dihydro-3[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine; B4104 N,5- bis (4-chlorophenyl)-8-chloro-3,5-dihydro-3-(cyclohexylimino)-2-phenazinamine; B4123 N,5- bis (3-chlorophenyl)-8-chloro-3,5-dihydro-3[(2,2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4126 N,5- bis (3-trifluoromethyl-4-phenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4127 N,5- bis (3-trifluoromethylphenyl)-8-chloro-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4154 N,5- bis (3,4-di-chlorophenyl)-3,5-dihydro-3-[(3'-(N,N-diethylamino)-propylimino]-2-phenazinamine; B4158 N,5- bis (4-isopropylphenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4159 N,5- bis (4-isopropylphenyl)-8-chloro-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4163 N,5- bis [(3-trifluoromethyl)-4-chlorophenyl]-3,5-dihydro-3-[(2',2',6',6'-tetramethylpiperidyl)-imino]-2-phenazinamie. B4166 N,5- bis (phenyl)-3,5-dihydro-3-(cyclooctylimino)-2-phenazinamine; B4169 N,5- bis (3,4,5-trichlorophenyl)-3,5-dihydro-3[(2',2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4170 N,5- bis (phenyl)-3,5-dihydro-3-(cyclopropylimino)-2-phenazinamine; B4171 N,5- bis (phenyl)-3,5-dihydro-3-(cyclododecylimino)-2-phenazinamine; B4172 N,5- bis (phenyl)-3,5-dihydro-3-(cyclobutylimino)-2-phenazinamine; B4173 N,5- bis (phenyl)-3,5-dihydro-3-[4'-(N-benzylpiperidyl)-imino]-2-phenazinamine; B4174 N,5- bis (4-methoxyphenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)-imino]-2-phenazinamine; B4175 N,5- bis (3,4-di-chlorophenyl)-3,5-dihydro-3-(cyclohexylimino)-2-phenazinamine; The remaining compounds may be named in a similar manner. Treatment of human or animal cells with a compound of the above general formula (I) results in the reduction of resistance to a wide variety of naturally anti-cancer drugs such as Vinca alkaloids, epipodophyllotoxenes, actinomycin D, anthracyclines, mitocycin C, mitoxantrone, taxol, and the like. Without being bound by theory, the possible reasons for the surprising activity of the riminophenazines used in the invention is that a relationship may exist between riminophenazine mediated enhancement of PLA 2 activity and the inhibition of ATPase of P-glycoprotein, or the inhibition of P-glycoprotein activity may occur as a secondary consequence of the depletion of cellular ATP following prolonged inhibition of Na + , K + , ATPase activity. Thus, a reversal of multi-drug resistance may occur, primarily via activation of phospholipaseA 2 and consequent lysophospholipid-mediated inhibition of the ATPase activity of P-glycoprotein. Alternatively, inhibition of P-glycoprotein activity would be expected to occur as a secondary consequence of the depletion of cellular ATP following prolonged inhibition of Na + , K + -ATPase activity. Both of these mechanisms may be operative. The riminophenazines of the above formula (I), contain an imino group. They are considerably less toxic than cyclosporin A and possess a potent resistant modifying activity in a multi-drug-resistant lung carcinoma cell line when administered in vitro. We have found that they inactivate the drug pump activity in tumour cell lines with acquired multi-drug resistance. The potency of compounds of the above general formula, as inhibitors of multi-drug resistance, was assessed by sensitization of a P-glycoprotein positive cell line to drugs associated with this form of resistance. A human small cell lung cancer cell line H 69/P as well as a multi-drug resistance (MDR) sub-line H69/LX4 were used. These cell lines were obtained from the Medical Research Council Clinical Oncology and Radiotherapeutics Unit, Hills Road, Cambridge, England. The H69/LX4 line was selected in vitro by progressive exposure to increasing concentrations of doxorubicin in order to increase P-glycoprotein expression. A third cell line (562/MMB) used was a MDR leukemia cell line selected in vitro by progressive exposure to increasing concentrations of vinblastine in order to increase P-glycoprotein expression. This cell line was developed in the Department of Immunology, University of Pretoria from K562 (ATTC CCL 243) supplied by Highveld Biological (Pty) Ltd, Sandton. This cell line expresses high levels of P-glycoprotein as determined by flowcytometry using the monoclonal antibody (MRK 16) against this molecule. The multi-drug resistance was increased substantially when using chemotherapeutic drugs such as doxorubicin, daunorubicin, etoposide and mitomycin C which are known to be associated with MDR. However, no increase in sensitivity was observed to any of the drugs tested in the sensitive parent cell line. In addition to being relatively non-toxic, the compounds of the above general formula (I) are non-carcinogenic and non-myelosuppressive. They possess direct antineoplastic activity as well as multi-drug resistance modifying potential. The compositions may be in any suitable form, e.g. a tablet, capsule, solution, sterile solution, or the like. They may contain any suitable known carrier or diluent. They may be introduced orally, intravenously, transdermally, or in any other suitable manner. DESCRIPTION OF THE DRAWINGS Figure 1 is a chart showing the preparation of the riminophenazines of formula (I); Figure 2 is a graph of cell viability against vinblastine concentration for compounds. B663, B669 and cyclosporin, as explained in Example 1 below; Figure 3 is a graph of uptake of vinblastine against concentration of B663, B669 and cyclosporin as explained in Example 2 below; Figure 4, 5, 6 and 7 are graphs of % inhibition against concentration, for the compounds B663, B669, B3962, B4154, B4176, B4100, B4090, B4070, B4174, B4169, B4103, B4126, B4158, B4159, B4163, B4127, B4123, B3786, B4019 and B4177 as explained in Example 3 below using the cell line H69/LX4, and Figure 8 is a graph of % inhibition against concentration for the compounds B4128 and B4121, as explained in Example 4 below, using the cell like K562/MMB. DESCRIPTION OF EXAMPLES The invention is illustrated in non-limiting manner by reference to the following Examples. Example A In the Examples 1 to 3 given below, the potency of the riminophenazines, as well as cyclosporin A (CsA) was examined. A further test using no MDR inhibitor was used as a standard. The potency was assessed by sensitization of a P-glycoprotein positive cell line to doxorubicin, vinblastine, daunorubicin, mitomycin C, methotrexate and cyclophosphamide. The cell lines used were human small cell lung cancer cell line HP69/P and a multi-drug resistant (MDR) sub-line H69/LX4, both of which were supplied by the MRC Clinical Oncology and Radiotherapeutics Unit, Hills Road, Cambridge, England. The maintenance of the cell lines and drug response assays was done as described by Twentyman et al in British Journal of Cancer Volume 65 pages 335-340. The H69/LX4 line was originally described by Twentyman et al in British Journal of Cancer Volume 53, pages 529-637 (1986). The drug resistance modifiers were added at concentrations which possess minimum cytotoxic activity. Example 1 In this Example, the effects were examined of a 7-day exposure of cyclosporin A (CsA) 5µg/mℓ, clofazimine at 1 µg/mℓ and B669 (the riminophenazine defined in Table 1 above) at 0,5µg/mℓ on the sensitivity of the cell line (H69/P) and the resistance cell line (H69/LX4) to the chemotherapeutic agents set out below, using the MTT assay. In this table, the IC50 (µg/mℓ)* of chemotherapeutic agents values are expressed as the mean drug concentration (µg/mℓ) causing 50% cell killing in 2 - 4 experiments. The data in parenthesis represents fold sensitivity compared with the chemotherapeutic agent without the MDR inhibitor. The cells were seeded at 1 x 10 4 cells per well in 96 well microlitre plates in a volume of 200 µℓ of RPMI 1640 medium containing 10% fetal calf serum and incubated with vinblastine (3,2-100 µg/mℓ). The amounts of MDR modulators used were 5 µg/mℓ of CsA, 1 µg/mℓ of clofazimine (B663) or 0,5 µg/mℓ of B669. After incubation at 37°C for 7 days 20 µℓ MTT (ie 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide) at 5 mg/mℓ was added to each well and the plates incubated for a further 4 hours. The cells were washed with phosphate buffered saline and the intracellular formazan crystals solubilized with dimethylsulphoxide, and the absorbence measured spectrophotometrically at a test wavelength of 540 nm and a reference wavelength of 620 nm. The mean percentage inhibition ± SEM of four experiments using the relevant controls was taken. The results obtained as shown in Table III below, are illustrated graphically in Figure 2 of the accompanying drawings. Effects of a 7 day Exposure to CsA (5 µg/ml), Clofazimine (1 µg/ml) and B669 (0.5 µg/ml) on the Sensitivity of Parent (H69/P) and Resistant (H69/LX4) Cells to Various Chemotherapeutic Agents Using the MTT Assay. CHEMOTHERAPEUTIC IC50 (µg/ml) AGENTS MDR INHIBITOR None CsA Clofazimine (B663) B669 H69/P Doxorubicin 0.003 0.003 (1.0) 0.004 (0.8) 0.003 (1.0) Vinblastine 0.001 0.0007 (1.4) 0.0008 (1.3) 0.0009 (1.1) Etoposide 0.0007 0.00009(0.8) 0.00011(0.6) 0.00006(1.2) Daunorubicin 0.002 0.002 (1.0) 0.002 (1.0) 0.0016 (1.2) Mitomycin C 0.007 0.009 (0.8) 0.01 (0.7) 0.01 (0.7) Methotrexate 3.5 2.4 (1.5) 3.7 (0.9) 3.4 (1.0) Cyclophospha -mide 1.8 1.6 (1.1) 1.9 (0.9) 1.8 (1.0) H69/LX4 Doxorubicin 0.11 0.01 (11) 0.01 (11) 0.016 (6.9) Vinblastine 0.120 0.008 (13.7) 0.008 (13.7) 0.008 (13.7) Etoposide 0.013 0.00008(16.3) 0.0026(5.0) 0.00009(14.4) Daunorubicin 0.036 0.004 (9) 0.009 (4) 0.015 (2.4) Mitomycin C 0.1 0.08 (1.3) 0.06 (1.7) 0.04 (2.5) Methotrexate 3.2 4.6 (0.7) 4.4 (0.7) 3.5 (0.9) Cyclophosphamide 1.6 1.7 (0.9) 1.6 (1.0) 1.4 (1.1) As can be seen, clofazimine at (1 µg/mℓ) and B669 (at 0.5 µg/mℓ) compared favourably with cyclosporin A (at the much higher dose of 5 µg/mℓ) in reversing multi-drug resistance by as much as a 13 fold increase of the MDR cell line (H69/LX4) to vinblastine as well as giving similar results with the other MDR-related chemotherapeutic drugs, namely Doxorubicin, Etoposide, Daunorubicin and Mitomycin C, but not with drugs which are not associated with MDR, ie methotrexate and cyclophosphamide. Example 2 The effect of riminophenazines on the accumulation of [ 14 C]-vinblastine was investigated. For these experiments, both of the above cell lines (H69/LX4 and H69/P) were prepared as described by Coley et al (Biochem. Pharmacal 38, 4467-4475 (1989)). After a 1 hour pretreatment with the MDR reversal agents, cells (1 x 10 6 /mℓ) were exposed to 250 µg/mℓ [ 14 C]-vinblastine (1 µCi specific activity) for 30 minutes. Clofazimine, B669 and cyclosporin A caused significant enhancement of vinblastine accumulation in the MDR cell line (H69/LX4). The results are illustrated in Figure 3 of the accompanying drawings. These effects were dose related and observed at concentrations of 0.5 µg/mℓ and upwards with the riminophenazine, and at concentrations of 1 µg/mℓ and greater with cyclosporin A. However, the MDR inhibitors had no effect on vinblastine accumulation in the sensitive parent cell line (H69/P). Total vinblastine uptake by H69/P cells was 3.01 ±0.40 µg/10 6 cells without MDR modifying agents and 2.95 ± 0,10, 2,69 ±0.23 and 2.56 ± 0,07 µg/10 6 cells with 5 µg/mℓ of cyclosporin A, clofazimine and B669 respectively. Example 3 The effects were examined of a 7-day exposure of selected compounds on the sensitivity of the cell line (H69/P) and the resistance cell line (H69/LX4) to the standard chemotherapeutic agents doxorubicin and vinblastine, using the MTT assay. The cells were seeded at 1 x 10 4 cells per well in 96 well microlitre plates in a volume of 200 µℓ of RPMI 1640 medium containing 10% fetal calf serum and incubated with doxorubicin (12,5 ng/ml) or vinblastine (25 ng/ml). The amounts of MDR modulators used were 0,03; 0,06; 0,125; 0,25; 0,5; 1,0 and 2,0 µg/ml. After incubation at 37°C for 7 days, 20 µℓ MTT (ie 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide) at 5 mg/ml was added to each well and the plates incubated for a further 4 hours. The cells were washed with phosphate buffered saline and the intracellular formazan crystals solubilized with dimethylsulphoxide, and the absorbence measured spectrophotometrically at a test wavelength of 540 nm and a reference wavelength of 620 nm. The mean percentage inhibition ± SEM of four experiments using the relevant controls was taken. The results obtained, are illustrated graphically in Figures 4 to 7 of the accompanying drawings. The drawings in Figures 4, 5, 6 and 7 and are graphs for the % inhibition of the compound against the riminophenazine concentration (in µg/mg). The mixed broken and solid line (marked with triangles) is for the compound alone, the solid line (.-.) shows the result when 12,5 ng/ml of doxorubicin are present, and the broken line (x-x) shows the results when 25 ng/ml of vinblastine are present. The concentrations of doxorubicin and vinblastine (present with the riminophenazine) possessed minimal cytotoxic activity (less than 10 %). Of particular interest is the difference between direct cytotoxicity, (i.e. the effects of the compounds alone) and the MDR-reversal properties, (i.e. the effects of the compounds in the presence of vinblastine and dexorubucin). The compounds tested and whose results are shown graphically were B663, B669, B3962, B4070, B4100, B4103, B4123, B4126, B4127, B4154, B4158, B4159, B4163, B4169, B4174 and B4176. Very good MDR reversal properties, (i.e. multi-drug resistance) were shown by this test were for B4169, B4158 and B4103. B4169 appears to be of particular potential in view of its very small cytotoxic activity (only cytotoxic at concentrations above 12,5 µg/ml). Also important is the large differences in % inhibition at a number of concentrations between the riminophenazines tested and vinblastine. Example 4 The effects were examined of a 7-day exposure of selected compounds on the sensitivity of the cell line (K562/MMB) to the standard chemotherapeutic agents doxorubicin and vinblastine, using the MTT assay. The cells were seeded at 1 x 10 4 cells per well in 96 well microlitre plates in a volume of 200 µl of RPMI 1640 medium containing 10 % fetal calf serum and incubated with doxorubicin (12.5 ng/ml) or vinblastine (3 ng/ml). The amounts of MDR modulators used were 0.03, 0.06, 0.125, 0.5, 1.0 and 2.0 µg/ml. After incubation at 37 °C for 7 days, 20 µl MTT (i.e. 3-[4,5-dimethylthiazol-2-yl]2,5-diphenyl-tetrazolium bromide) at 5 mg/ml was added to each well and the plates incubated for a further 4 hours. The cells were washed with phosphate buffered saline and the intracellular formazan crystals solubilized with dimethylsulphoxide, and the absorbency measured spectrophotometrically at a test wavelength of 540 nm and a reference wavelength of 620 nm. The results obtained are shown in Table IV and Figure 8. In this table the IC 50 (µg/ml)* of riminophenazines are expressed as the mean drug concentration (µg/ml) causing 50% cell killing in 2 experiments. The concentrations of doxorubicin and vinblastine (present with the riminophenazine) possessed minimal cytotoxic activity (less than 10%). The compounds tested and whose results are shown in the table are B663, B669, B4100, B4158, B4169, B4103, B4126, B4159, B4163, B4127, B4123, B3962, B4090, B4070, B4174, B4154, B4157, B4121 and B4128. Very good MDR reversal properties (at concentrations less than 0.05 µg/ml causing 50 % cell killing in the presence of 3 ng/ml vinblastine) shown by this test were for B663, B669, B4163, B4123, B4090 and B4121. B4121 and B4169 appear to be of particular potential in view of their very small cytotoxic activity (only causing 50 % cell killing per se at 2.250 and 2.861 µg/ml respectively) whereas B4121 also possesses good MDR reversal properties (causing 50 % cell killing in the presence of 3 ng/ml vinblastine at 0.023 µg/ml). Effects of a 7 day exposure to different concentration of various riminophenazine compounds on the sensitivity of a doxorubicin resistant leukaemia cell line (K562/MMB) to doxorubicin (12 ng/ml) or vinblastine (3 ng/ml) using the MTT assay. Riminophenazine agents IC 50 (µg/ml)* None Doxorubicin Vinblastine B663 0.225 0.135 0.038 B669 0.139 0.069 0.023 B4100 0.335 0.278 0.095 B4158 0.272 0.155 0.058 B4169 2.861 0.969 0.116 B4103 0.351 0.269 0.051 B4126 0.316 0.246 0.071 B4159 0.912 0.514 0.130 B4163 0.340 0.227 0.032 B4127 0.425 0.168 0.070 B4123 0.333 0.181 0.049 B3962 0.285 0.159 0.070 B4090 0.197 0.139 0.027 B4070 0.159 0.193 0.054 B4174 0.316 0.210 0.178 B4154 0.353 0.296 0.118 B4157 >2.0 >2.0 >2.0 B4121 2.250 0.722 0.023 B4128 0.383 0.215 0.059 Example 5 Some compositions of the invention are made up as follows: CAPSULES mg/capsule Riminophenazine 100 - 2000 mg Diluent/Disintegrant 5 - 200 mg Glidants 0 - 15 mg Disintegrants 0 - 20 mg TABLETS mg/tablet Riminophenazine 100 - 2000 mg Diluent 5 - 200 mg Disintegrant 2 - 50 mg Binder 5 - 100 mg Lubricant 2 - 20 mg SYRUP mg/10 ml Riminophenazine 100 - 2000 mg Solvents, solubilisers, stabilisers 5 - 500 mg Colouring agents 0,5 - 150 mg Preservatives/Antioxidants 1 - 150 mg Flavours 5 - 200 mg INTRAVENOUS Riminophenazine 100 - 2000 mg Alkali/buffer, Isotonically agents 5 - 100 µg Stabilisers, solubilisers 0 - 100 µg

Claims: The use of a riminophenazine in the manufacture of a medicament to treat a cancer patient who has built up, or could build up, resistance to a therapeutically active substance used in the treatment of cancer. The use of the riminophenazine as claimed in Claim 1, wherein said riminophenazine is of the following general formula (I) - in which: R 1 and R 4 are the same and each is a halogen atom, or a (C 1 - C 4 )- alkyl, (C 1 -C 4 )-alkoxy, (C 1 -C 4 )-fluoroalkoxy or haloalkyl radical, R 2 is a hydrogen or halogen atom, R 3 is a 4-tetramethylpiperidyl radical and n is 1,2 or 3 with the provisos that (a) when n is 2 or 3, (R 1 )n and (R 4 )n are not 3,4-dichloro and that (b) when n is 1, substituents R 1 and R 4 cannot represent (C 1 -C 4 )-alkyl or (C 1 -C 4 )-alkoxy radicals or a halogen in the 4-position. The use of the riminiophenazine as claimed in Claim 1, wherein said riminophenazine is of the following general formula (I) - in which R 1 and R 4 are the same and each is a hydrogen atom, a halogen atom, or an alkyl radical, R 2 is a hydrogen or halogen atom, R 3 is selected from hydrogen, alkyl, substituted alkyl, cycloalkyl, cycloalkylalkyl, or is a heterocyclic or heterocyclic-alkyl radical, and n is 1, 2 or 3. The use as claimed in claim 2, of a riminophenazine of general formula I, in which R 1 and R 4 are the same and each is a trifluoromethyl radical, R 2 is a hydrogen or halogen atom, R 3 is a 4-tetramethylpiperidyl n is 1, 2 or 3. The use as claimed in Claim 2 or claim 4 wherein R 3 is a 4-(2,2,6,6, - tetramethylpiperidyl) radical. The use as claimed in Claim 2, wherein the haloalkyl radicals R 1 and R 4 are trifluoromethyl radicals. The use of a riminophenazine as claimed in claim 3, wherein R 1 and R 4 are 4-chloro, R 2 is hydrogen, R 3 is isopropyl and n is 1, i.e the compound clofazimine. The use as claimed in claims 2 and 4 of a compound of formula (I), wherein n is 1, R 1 and R 4 each is a trifluoromethyl radical in the 4-position, R 2 is hydrogen and R 3 is a 4-(2,2,6,6,-tetramethylpiperidyl) radical. The use as claimed in Claim 2 of a compound of formula (I), wherein n is 2, R 1 and R 4 are identical and are chlorine atoms in the 2,4 -, 3,4 or 3,5 - positions, R 2 is hydrogen and R 3 is a 4 - (2,2,6,6-tetramethylpiperidyl) radical. The use as claimed in claim 2 of a compound according to formula (I), wherein n is 3, R 1 and R 4 are chlorine atoms in the 3-,4- and 5-positions, R 2 is hydrogen and R 3 is a 4-(2,2,6,6,-tetramethylpiperidyl) radical. A compound of general formula (I) in which - R 1 and R 4 are the same and are selected from halogen, (C 1 -C 4 )-alkyl, (C 1 -C 4 )-alkoxy, (C 1 -C 4 )-fluoroalkoxy and trifluoromethyl radicals n is 1, 2 or 3, R 3 is a 4-(2,2,6,6-tetramethylpiperidyl) radical and R 2 is selected from hydrogen and halogen with the proviso that (a) when n is 2 or 3, (R 1 )n and (R 4 )n are not 3,4 - dichloro and that (b) when n = 1, substituents R 1 and R 4 cannot represent (C 1 -C 4 )-alkyl or (C 1 -C 4 )-alkoxy radicals or a halogen in the 4-position. A compound accordingly to Claim 11, wherein the phenyl rings containing (R 1 )n and (R 4 )n are 3,5-dichlorophenyl rings, R 2 is hydrogen and R 3 is a 4-(2,2,6,6,-tetramethylpiperidyl) radical, i.e. the compound N,5- bis (3,5-dichlorophenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethylpiperidyl)imino]-2-phenazinamine. A compound according to claim 11, wherein the phenyl rings containing (R 1 )n and (R 4 )n are 2,4-dichlorophenyl rings, R 2 is hydrogen and R 3 is a 4-(2,2,6,6-tetramethylpiperidyl) radical, i.e. the compound N,5-bis(2,4 dichlorophenyl)-3,5-dihydro-3-[(2',2',6',6' - tetramethylpiperidyl)imino]-2-phenazinamine. A compound according to claim 11, wherein R 1 and R 4 are chlorine atoms in the 3-,4- and 5-positions, R 2 is hydrogen and R 3 is a 4-(2,2,6,6-tetramethylpiperidyl). radical, i.e. the compound N,5- bis (3,4,5-trichlorophenyl)-3,5-dihydro-3-[(2',2',6',6' -tetramethylpiperidyl)imino]-2-phenazinamine. A compound according to claim 11, wherein the phenyl rings containing (R 1 )n and (R 4 )n are 3-trifluoromethyl-4-chlorophenyl rings, R 2 is hydrogen and R 3 is a 4-(2,2,6,6-tetramethylpiperidyl) radical, i.e. the compound N,5- bis (3-trifluoromethyl-4-chlorophenyl)-3,5-dihydro-3-[(2',2'16',6'-tetramethylpiperidyl) imino]-2-phenazinamine. A compound according to claim 11 and which is N,5- bis (4-trifluoromethylphenyl)-3,5-dihydro-3-[2',2',6,'6'-tetramethylpiperidyl)imino]-2-phenazinamine. A compound according to claim 11 and which is N,5- bis (3-trifluoromethylphenyl)-3,5-dihydro-3[(2',2',6'-tetramethyl-4-piperidyl)imino]-2- phenazinamine. A compound according to claim 11 and which is N,5- bis (4-trifluoromethoxyphenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine. A compound according to claim 11 and which is N,5- bis (3-trifluoromethylphenyl)-8-chloro-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine. A compound of the formula (I) wherein the compound is selected from the group consisting of- (a) compound B4123 i.e. N,5- bis (3-chlorophenyl)-8-chloro-3[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine, (b) compound B4158 i.e. N,5- bis (4-isopropylphenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenzinamine, (c) compound B4159 i.e. N,5- bis (4-isopropylphenyl)-8-chloro-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine and (d) compound B4174 i.e. N,5- bis (4-methoxyphenyl)-3,5-dihydro-3-[(2',2',6',6'-tetramethyl-4-piperidyl)imino]-2-phenazinamine. A composition for the treatment of a cancer patient who has built up, or could build up, resistance to a therapeutically active substance used in the treatment of cancer, said composition containing a compound as claimed in any of claims 11 to 20 and a pharmaceutically acceptable carrier. A composition as claimed in claim 21, wherein the composition also contains a known cancer treatment compound which is not a riminophenazine. A method for the preparation of a compound of the general formula (I) in which R 1 ,R 2 ,R 3 ,R 4 , and n have the meanings defined claim 11, which comprises reacting a compound of formula (IV) - in which with a compound of formula R 3 -NH 2 . in which R 1 , R 2 , R 4 and n are as defined above.

Inventors: ANDERSON RONALD, MEDLEN CONSTANCE ELIZABETH, O'SULLIVAN JOHN FRANCIS, ANDERSON, RONALD, MEDLEN, CONSTANCE ELIZABETH, O'SULLIVAN, JOHN FRANCIS
Applicants: UNIV PRETORIA, UNIVERSITEIT VAN PRETORIA
Application year: 1995
Main classification: A61K31
IPC codes: A61P35, A61P43, C07D241, A61K31