TREATMENT OF GLC1A GLAUCOMA WITH NON-STEROIDAL GLUCOCORTICOID ANTAGONISTS

Abstract: Compositions of non-steroidal glucocorticoid antagonists for treating GLC1A glaucoma and methods for their use are disclosed.

Description: TREATMENT OF GLC1A GLAUCOMA WITH NON-STEROIDAL GLUCOCORTICOID ANTAGONISTS This application is a continuation-in-part of U.S. Patent Application Serial No. 08/858,298 filed May 19, 1997, which is a continuation of U.S. Patent Application Serial No. 08/631,041 filed April 12, 1996, which is a continuation of U.S. Patent Application Serial No. 08/268,086 filed June 28, 1994. This invention is directed to the use of non-steroidal glucocorticoid antagonists for treating glaucoma or ocular hypertension resulting from altered expression of the GLCl A gene (hereinafter GLCl A or lq glaucoma) in an individual. BACKGROUND OF THE INVENTION The glaucomas are a heterogeneous group of optic neuropathies characterized by cupping of the optic nerve head, thinning of the retinal nerve fiber layer due to loss of retinal ganglion cells, and specific pathognomonic changes in visual fields. Elevated intraocular pressure (IOP) is a very important risk factor for the development of most common forms of glaucoma (Sommer A, et al. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. Arch. Ophthalmol. 109:1090-1095, 1991). A family history of glaucoma also is an important risk factor for the development of glaucoma. It appears that a significant portion of glaucoma is inherited (or at least the risk for developing glaucoma is inherited) although it is often difficult to establish clear inheritance patterns for most of the glaucomas because of the disease onset late in life and the slowly progressive clinical manifestations of the disease. Despite these problems, a number of families with heritable forms of glaucoma have been identified and these families have been used to map a variety of glaucoma genes (Sheffield, et al., "Genetic Linkage of Familial Open Angle Glaucoma to Chromosome Iq21-q31," Nature Genetics, 4:47-50 (1993); Sarfarazi, et al., "Assignment of a Locus (GLC3A) for Primary Congenital Glaucoma (Buphthalmos) to 2p21 and Evidence for Genetic Heterogeneity," Genomics, 30:171- 177 (1995); Akarsu, et al., "A Second Locus (GLC3B) for Primary Congenital Glaucoma (Buphthalmos) Maps to the lp36 Region," Human Molecular Genetics, 5(8): 1199-1203 (1996); Stoilova, et al., "Localization of a Locus (GLC1B) for Adult- Onset Primary Open Angle Glaucoma to the 2cen-ql3 Region," Genomics, 36:142- 150 (1996); Wirtz, et al., "Mapping a Gene for Adult-Onset Primary Open- Angle Glaucoma to Chromosome 3q," Am. J. Hum. Genet, 60:296-304 (1997); Andersen, et al, "A Gene Responsible for the Pigment Dispersion Syndrome Maps to Chromosome 7q35-q36," Arch. Ophthalmol, 115:384-388 (1997)). The first glaucoma gene mapped (GLCl A) was in a large family with autosomal dominant inherited juvenile glaucoma (JG). This disease is characterized by an early disease onset (late teens to early 20s), relatively high IOPs, and general resistance to conventional pharmacological IOP lowering therapy. The GLCl A gene was mapped by positional cloning and linkage analysis to chromosome Iq22-q25 (Sheffield et al, Id) and a number of other groups have confirmed the lq location of this juvenile glaucoma gene (Richards, et al., "Mapping of a Gene for Autosomal Dominant Juvenile-Onset Open- Angle Glaucoma to Chromosome lq," Am. J. Hum. Genet, 54:62-70 (1994); Morissette, et al., "A Common Gene for Juvenile and Adult-Onset Primary Open- Angle Glaucomas Confined on Chromosome lq," Am. J. Hum. Genet, 56:1431-1442 (1995); Wiggs, et al., "Genetic Linkage of Autosomal Dominant Juvenile Glaucoma to Iq21-q31 in Three Affected Pedigrees," Genomics, 21:299-303 (1994); Meyer, et al., "Age-Dependent Penetrance and Mapping of the Locus for Juvenile and Early-Onset Open- Angle Glaucoma on Chromosome lq (GLCl A) in a French Family," Hum. Genet, 98:567-571 (1996); Graff, et al, "Confirmation of Linkage to lq21-31 in a Danish Autosomal Dominant Juvenile-Onset Glaucoma Family and Evidence of Genetic Heterogeneity," Hum. Genet, 96:285-289 (1995)). Glaucoma due to the GLCl A gene is often referred to as lq glaucoma. The GLCl A gene was identified as encoding a 57 kD protein expressed in the trabecular meshwork (TM) (Stone, et al., "Identification of a Gene That Causes Primary Open Angle Glaucoma," Science, 275:668-670 (1997)). The expression of the GLCl A gene, and the encoded TM protein, is up-regulated by glucocorticoids (Polansky, et al., "Eicosanoid Production and Glucocorticoid Regulatory Mechanisms in Cultured Human Trabecular Meshwork Cells," The Ocular Effects of Prostaglandins and Other Eicosanoids, pp. 113-138 (1989); Polansky, et al., "In Vitro Correlates of Glucocorticoid Effects on Intraocular Pressure," Glaucoma Update IV (1991); and Polansky, et al., "Cellular Pharmacology and Molecular Biology of the Trabecular Meshwork Inducible Glucocorticoid Response Gene Product," Ophthalmologica, 211 :126-139 (1997)). This TM protein is also known as TIGR (trabecular meshwork inducible glucocorticoid response) (Polansky, Id.). The glucocorticoid-induction of this TM protein has been suggested to be involved in the generation of glucocorticoid-induced ocular hypertension and glaucoma (Polansky, Id.). The GLCl A gene is expressed in other ocular tissues such as the ciliary epithelium (Ortego, et al., "Cloning and Characterization of Subtracted cDNAs from a Human Ciliary Body Library Encoding TIGR, a Protein Involved in Juvenile Open Angle Glaucoma with Homology to Myosin and Olfactomedin," FERS Letters, 413:349-353 (1997)) and the retina (Kubota, et al., "A Novel Myosin-like Protein (Myocilin) Expressed in the Connecting Cilium of the Photoreceptor: Molecular Cloning, Tissue Expression, and Chromosomal Mapping," Genomics, 41:360-369 (1997)). The gene is referred to by several names including GLCl A (Sheffield, supra; Sunden, et al., "Fine Mapping of the Autosomal Dominant Juvenile Open Angle Glaucoma (GLCl A) Region and Evaluation of Candidate Genes," Genome Research, 6:862-869 (1996); Stone, et al., supra), TIGR (Polansky supra; Ortego, supra), and myocilin (Kubota, supra). Mutations GLCl A are not only responsible for juvenile glaucoma, but also a significant subset of adult onset primary open angle glaucoma (Stone, et al., supra; Adam, et al, "Recurrent Mutations in a Single Exon Encoding the Evolutionarily Conserved Olfactomedin-Homology Domain of TIGR in Familial Open-Angle Glaucoma," Human Molecular Genetics, 6(12):2091-2097 (1997)). The lq glaucoma gene (GLC1A, TIGR) is the subject of Nguyen, et al., U.S. Patent No. 5,606,043, issued February 25, 1997. Glucocorticoids have been associated with the development of ocular hypertension and primary open angle glaucoma (Kass, et al., "Corticosteroid-Induced Glaucoma, In Ritch, R, Shields, M. B., Krupin, T. (eds.)," The Glaucomas, The C. V. Mosby Company, St. Louis, MO, pp. 1161-1168 (1989); DeSantis, et al., "Dexamethasone-Induction of Ocular Hypertension in the Primate, ARVO Abstracts. Invest. Ophthalmol. Vis. Set, 31(Suppl.):99 (1990); Knepper, et al., "Intraocular Pressure and Glycosaminoglycan Distribution in the Rabbit Eye: Effect of Age and Dexamethasone," Exp. Eye Res., 27: 567-575 (1978); Francois, et al., "Ultrastructural and Morphometric Study of Corticosteroid Glaucoma in Rabbits, Ophthalmic Res., 16:168-178 (1984); Lorenzetti, O. J., "Effects of Corticosteroids on Ocular Dynamics in Rabbits," J. Pharmacol. Exp. Therap., 175:763-772 (1970); and Zhan, et al., "Steroid Glaucoma: Corticosteroid-Induced Ocular Hypertension in Cats," Exp. Eye Res., 54:211-218 (1992)). Glaucoma patients have also been reported to have higher levels of the endogenous glucocorticoid, cortisol (Rozsival, et al., "Aqueous Humour and Plasma Cortisol Levels in Glaucoma and Cataract Patients," Current Eye Research, 1:391-396 (1981); Ray, et al., "Plasma Cortisol in Glaucoma," Ann. Ophthalmol, 9:1151-1154 (1977); and Schwartz, et al., "Increased Plasma Free Cortisol in Ocular Hypertension and Open Angle Glaucoma," Arch. Ophthalmol, 105:1060-1065 (1987)). It is known that trabecular meshwork cells have glucocorticoid receptors and that glucocorticoid binding with these receptors causes a change in trabecular meshwork cell gene expression. Known manifestations of this change include a reorganization of the cytoskeleton (Wilson, et al., "Dexamethasone Induced Ultrastructural Changes in Cultured Human Trabecular Meshwork Cells, Cur. Eye Res., 12:783-793 (1993), and Clark, et al., "Glucocorticoid-Induced Formation of Cross- Linked Actin Networks in Cultured Human Trabecular Meshwork Cells," Invest. Ophthalmol. Vis. Set, 35:281-294 (1994)) and increased deposition of the extracellular matrix material in trabecular meshwork cells. As a result, the trabecular meshwork becomes "clogged" and unable to perform one of its most critical functions, that is, serving as a gateway for aqueous humor flow from the anterior chamber of the eye. When the aqueous humor flow out of the eye via the trabecular meshwork is diminished, the intraocular pressure of the eye rises. If this state of elevated intraocular pressure is maintained or frequently occurs, the optic nerve head can be damaged resulting in the loss of visual field. Loss of visual field is the hallmark symptom associated with glaucoma. Endogenous glucocorticoids may be responsible for producing the changes in the trabecular meshwork that lead to ocular hypertension and glaucoma. In the present case, it is believed that non-steroidal glucocorticoid antagonists bind to the glucocorticoid receptor in trabecular meshwork cells, and thereby prevent binding of endogenous glucocorticoids to the glucocorticoid receptor. They may also displace endogenous glucocorticoids which are bound to glucocorticoid receptors. In summary, the GLCl A gene product can lead to the development of ocular hypertension and glaucoma in one of two ways: (1) mutations in GLC1A are responsible for most forms of juvenile glaucoma and a subset of adult onset POAG or (2) exposure of some individuals to glucocorticoids leads to increased GLCl A expression in the TM which causes increased aqueous humor outflow resistance and the development of ocular hypertension. The precise mechanism(s) responsible for GLCl A effects on IOP are currently unknown. SUMMARY OF THE INVENTION Non-steroidal glucocorticoid antagonists (NSGAs) and their pharmaceutical formulations are useful for treating GLCl A glaucoma. The invention is also directed to methods for controlling GLC1A glaucoma using NSGAs, some of which are novel. DESCRIPTION OF THE PREFERRED EMBODIMENTS Agents which alter the expression of GLCl A in the glaucomatous eye are expected to lower IOP and thereby prevent or inhibit the glaucomatous optic neuropathy which is being driven by elevated IOP. Glucocorticoids upregulte GLCl A expression in the TM of certain individuals. There have been several reports of elevated levels of the natural glucocorticid cortisol in the aqueous humor and plasma of glaucoma patients (Schwartz, et al., supra; Rozsival, et al., supra). In addition, certain mutations in GLCl A may alter the expression of GLCl A in the TM tissue of lq glaucoma patients. Unexpectedly, it has been discovered that certain non-steroidal glucocorticoid antagonists (NSGA) inhibit the expression of GLCl A in cultured human TM cells and lower elevated IOP in certain animal models of ocular hypertension. The NSGAs appear to work by inhibiting glucocorticoids from binding to the glucocorticoid receptor or displacing prebound steroids from the glucocorticoid receptor in the trabecular meshwork. The NSGAs thereby prevent the expression of GLCl A and the subsequent development of ocular hypertension. Ketoconazole and clotrimazole are known glucocorticoid antagonists. (Loose, et al., "Ketoconazole Binds to Glucocorticoid Receptors and Exhibits Glucocorticoid Antagonist Activity in Cultured Cells," J. Clin. Invest, 72:404-408 (1983)). They are not known to be useful in treating or controlling glaucoma. Non-steroidal glucocorticoid antagonists which are particularly useful in treating GLCl A glaucoma have the following structure: WHEREIN: n = 0,1,2; X = CH or N; Rl = H, F, Cl, Br, R2, OR2, N(R2) 2 , COOH, CONH 2 , CONHR2, CON(R2) 2 , CH 2 N(CH 2 CH 2 )O; R2 = C,-C 6 alkyl; Y = N-imidazolyl, N-pyrrolidinyl, N-(2-hydroxymethyl)pyrrolidinyl, N-triazolyl, N-pyrazolyl each optionally substituted with CH 3 , SH or S-C(4-C1-C 6 H 4 ) 3 ; OH, O(CH 2 ) 2 N(CH 2 CH 2 ) 2 O, O(CH 2 ) 2 N(CH 2 CH 2 ) 2 N(CH 2 ) 2 OH; and all pharmaceutically acceptable salts and esters. Most preferred compounds include the following specific compounds: (16) (17) Names of Compounds: 1 Clotrimazole 2 N-(Triphenylmethyl)imidazole 3 N-([2-Fluoro-9-phenyl]fluorenyl)imidazole 4 N-([2-Pyridyl]diphenylmethyl)imidazole 5 N-(2-[4,4',4"-Trichlorotrityl]oxyethyl)mo holine 6 1 -(2[4,4',4"-Trichlorotrityl]oxyethyl)-4-(2-hydroxyethyl)piperazine dimaleate 7 N-([4,4',4"]-Trichlorotrityl)imidazole 8 9-(3 -Mercapto- 1 ,2 ,4-trazolyl)-9-phenyl-2 ,7-difluorofluorenone 9 l-(2-Chlorotrityl)-3,5-dimethylpyrazole 10 4-(Morpholinomethyl)-A-(2-ρyridyl)benzhydrol 11 5-(5-Methoxy-2-(N-methylcarbamoyl)phenyl)dibenzosuberol 12 N-(2-Chlorotrityl)-L-prolinol acetate 13 1 -(2-Chlorotrityl)-2-methylimidazole 14 l-(2-Chlorotrityl)-l,2,4-triazole 15 1, S-Bis(4,4 , ,4"-trichlorotrityl)-l,2,4-triazole-3-thiol 16 N-((2,6-dichloro-3-methylphenyl)diphenyl)methylimidazole 17 Ketoconazole Topical formulations contain about 0.05 to 5 wt.% of a non-steroidal glucocorticoid antagonist. Systemic formulations contain about 10 to 1000 mg. The formulations can be administered systemically or topically, preferably topically, one to four times daily according to the discretion of a skilled clinician. The following examples are not meant to be limiting. Example 1 N-(Triphenylmethyl)imidazole (2). A stirred suspension of triphenylmethanol (2.6 g, 10 mmol) and 1.36 g (20 mmol) of imidazole in 10 mL of HO Ac was heated to 100°C under N 2 for 1 h. The cooled mixture was diluted with Et 2 O and washed with water, saturated Na 2 CO 3 , water (until neutral), brine, dried (MgSO 4 ), filtered and concentrated. The crude product was purified by flash chromatography (110 g SiO 2 , 25%-50% EtOAc-hexanes) to give 0.78 g (25%) of a solid. This was recrystallized from EtOAc to give 0.20 g of (2), m.p. 221°-223°C. IR (KBr) 1489, 1443, 1210, 1072, 750, 701, 662 cm "1 . NMR (CDC1 3 ): d 6.82, 7.07, 7.47 (all t, J = 1, imidazole CH); 7.14 (m, 6H); 7.32 (m, 9H). Anal. Calc'd (C 22 H 18 N 2 ): C, 85.13; H, 5.84; N, 9.03. Found: 85.16; 5.87; 9.02. Example 2 N-([2-Fluoro-9-phenyl]fluorenyl)imidazole (3). a. To a stirred, ice-cooled solution of 2-fluorofluorenone (2.0 g, 10 mmol) in 15 mL of dry THF under N 2 was added 10 mL of 2.4 M phenyllithium solution in cyclohexane-EtjO (7:3), keeping T < 20°C. The mixture was quenched with water and the product isolated with EtOAc and purified by flash chromatography (7% EtOAc-hexanes) to give 2.52 g (90%) of 2-fluoro-9-phenylfluoren-9-ol. b. A solution of the above alcohol (0.57 g, 2.1 mmol) and imidazole (0.56 g, 8.4 mmol) in 6 mL of HO Ac was heated to reflux under N 2 for 9.5 h. The crude product was isolated as described for (2) and purified by flash chromatography (30 g SiO 2 , 50% EtOAc-hexanes) giving 0.40 g (59%) of a foam. This material was recrystallized from EtOAc to give 0.19 g of (3), m.p. 191.5°-194°C. IR (KBr)1594, 1493, 1468, 1455, 1274, 1259, 1226, 1074, 862, 820, 766, 756, 744, 724, 702, 661 cm "1 . NMR (CDC1 3 ): d 6.95 (s, 1H); 7.0-7.5 (m, 12H); 7.7 (m, 2H). Anal. Calc'd (C 22 H 15 N 2 F): C, 80.96; H, 4.63; N, 8.59. Found: 80.93; 4.69; 8.53. Example 3 N-( 2-Pyridyl] diphenylmethyl)imidazole (4) . A solution of diphenyl-2-pyridylmethanol (0.50 g, 1.9 mmol) and imidazole (0.50 g, 7.4 mmol) in 2 mL of EtCO 2 H was heated to reflux under N 2 for 7 h. The crude product was isolated as described for (2) and purified by flash chromatography (60 g SiO 2 , EtOAc) to give 0.08 g (13.5%) of a yellow solid. This material was further purified by trituration (4: 1 hexanes-Et 2 O) followed by recrystallization from EtOAc to give 0.03 g of (4), m.p. 214.5°-216.5°C. IR (KBr) 1584, 1487, 1462, 1444, 1430, 1212, 1066, 760, 710, 702, 666 cm "1 . NMR (CDClj): d 7.05 (m, 7H); 7.3 (m, 7H); 7.65 (m, 2H); 8.70 (d, J - 4, further split, 1H). Anal. Calc'd (C 21 H 17 N 3 ): C, 81.00; H, 5.50; N, 13.50. Found: 81.17; 5.50; 13.69. Example 4 N-([4,4',4"l-Trichlorotrityl)imidazole (7). To a stirred solution of tris(4-chlorophenyl)methanol (0.36 g, 1.0 mmol) and imidazole (0.20 g, 2.9 mmol) in 2 mL of CH 2 C1 2 under N 2 at RT was added 0.40 mL (2.0 mmol) of trimethylsilyl triflate. After 1 h, the crude product was isolated as described for (2) and purified by flash chromatography (10% EtOAc-hexanes® EtOAc) to give 0.25 g of a semisolid. This material was triturated with 5% Et 2 O-hexanes to give 0.20 g of (7) as a white solid, m.p. 153°-155°C. IR (KBr) 1490, 1399, 1217, 1097, 1080, 1013, 815 cm 1 . NMR (CDC1 3 ): d 6.77, 7.10, 7.41 (each s, 1H, imidazole CH); 7.04 (dt, 6H); 7.33 (dt, 6H). Anal. Calc'd (C 22 H 15 N 2 C1 3 ): C, 63.86; H, 3.65; N, 6.77. Found: 63.96; 3.95; 6.70. Example 5 9-(3-Mercapto- 1 ,2,4-trazolyl)-9-phenyl-2,7-difluorofluorenone (8). a. To a stirred, ice-cooled suspension of 2,7-difluorofluorenone (1.45 g, 6.7 mmol) in 50 mL of dry THF under N 2 was added 3.0 mL of 3.0 M ethereal phenylmagnesium bromide. The solution was diluted with Et 2 O and washed with water, 0.5 M H 2 SO 4 , water (until neutral), brine, dried (MgSO 4 ), filtered and concentrated to give 1.99 g (100%) of an oil. This material was triturated (5% Et 2 O-hexanes) giving 1.11 g (56%) of 2,7-difluoro-9-phenylfluoren-9-ol. b. To a stirred solution of the above alcohol (1.10 g, 3.74 mmol) and l,2,4-triazole-3-thiol (0.56 g, 5.5 mmol) in 4.5 mL of dry CH 2 C1 2 under N 2 was added 1.25 mL (10 mmol) of BF 3 etherate. After 20 rnin, the mixture was poured into saturated aqueous KH 2 PO 4 and the crude product was isolated with EtOAc and purified by flash chromatography (100 g SiO 2 , 10%®50% EtOAc-hexanes) giving 0.41 g of a solid. This material was recrystallized from MeOH to give 0.25 g of (8), m.p. 209°-211°C (dec). IR (KBr) 1614 (w), 1595, 1466, 1436, 1259, 1210, 816, 740 cm "1 . NMR (DMSO-d 6 ): d 7.2 (m, 7H); 7.5 (m, 2H); 7.83 (q, 2H); 8.28 (s, 1H, triazole CH); 14.0 (br s, 1H, SH). Anal. Calc'd (C 21 H 13 N 3 F 2 S): C, 66.83; H, 3.47; N, 11.13. Found: 66.79; 3.84; 11.23. Example 6 1, S-Bis(4,4',4"-trichlorotrityl)-l,2,4-triazole-3-thiol (15). The procedure of Example 5(b) was followed, using 1.26 g (3.47 mmol) of tris(4-chlorophenyl)methanol, 0.52 g (5.1 mmol) of l,2,4-triazole-3-thiol, 4.0 mL of CH 2 C1 2 and 1.25 mL (10 mmol) of BF 3 etherate. Isolation followed by flash chromatography (75 g SiO 2 , 40% EtOAc-hexanes) gave 0.51 g of the title compound, followed by 0.71 g of an unstable product that turned into the title compound upon standing in solution. A 0.44 g sample of the first-eluted material was recrystallized from MeOH giving 0.18 g of (15), m.p. 219°-221°C (dec). IR (KBr) 1490, 1399, 1257, 1097, 1013, 815 cm "1 . NMR (CDC1 3 ): d 6.75 (d, J = 9, 6H); 7.05-7.3 (m, 18H); 7.59 (s, 1H). Anal. Calc'd (C 40 H 25 C1 6 N 3 S): C, 60.62; H, 3.18; N, 5.30. Found: 60.72; 3.41; 5.23. Example 7 1 -(2-Chlorotrityl)-3 ,5-dimethylpyrazole (9). a. To a stirred, ice-cooled solution of 2-chlorobenzophenone (21.6 g, 100 mmol) in 150 mL of dry Et,O under N 2 was added 60 mL (120 mmol) of 2.0 M phenyllithium solution in cyclohexane-EtjO (7:3), keeping T < 15°C. After stirring for a further 1 h at 15°C, the solution was poured onto crushed ice and extracted with EtjO. The organic solution was washed with 0.2 M H 2 SO 4 , water (until neutral), brine, dried (MgSO 4 ), filtered and concentrated. The residue was recrystallized from hexanes containing a few per cent EtOAc to give 23.1 g (78%) of (2-chlorophenyl)diphenylmethanol as an off-white solid. NMR (CDC1 3 ): d 4.43 (s, 1H, OH); 6.70 (dd, J = 7.8 and 1.7, 1H); 7.11 (dt, J=7.8 and 1.5, 1H); 7.2-7.45 (m, 12H). b. The above alcohol (4.20 g, 14.3 mmol) was dissolved in SOCl 2 (5.0 mL, 68 mmol) under N 2 . The nitrogen line was replaced with a CaSO 4 drying tube. After a 1-min induction period, gas was rapidly evolved (CAUTION!). A further 3.4 mL (47 mmol) of SOCl 2 was added, followed by 4 mL of toluene. Stirring was continued for 6 h. The solution was then concentrated under reduced pressure, the residue dissolved in toluene, concentrated and vacuum pumped to give 4.40 g (99%) of (2-chlorophenyl)diphenylchloromethane as a solid. o NMR (CDC1 3 ): d 6.80 (dd, J - 7.7 and 1.7, 1H); 7.10 (dt, J = 7.3 and 1.5, 1H); 7.2-7.45 (m, 12H). This material contained 10% of the starting alcohol by NMR. c. A solution of the above chloride (0.63 g, 2.0 mmol), 3,5-dimethylpyrazole (0.38 5 g, 4.0 mmol) and ethyldiisopropylamine (0.70 mL, 4.0 mmol) in dry DMF was stirred under N 2 for 16 h, then heated to 50°C for 2 h. The mixture was poured into saturated Na 2 CO 3 and the crude product isolated by EtOAc extraction and purified by flash chromatography (125 g SiO 2 , 10% EtOAc-hexanes, then 50 g SiO 2 , 5% EtOAc-hexanes) giving 0.18 g of a solid. This material was triturated o with Et 2 θ, then recrystallized from EtOAc-MeOH to give 0.09 g of (9), m.p. 195°-197°C. IR (KBr) 1557, 1493, 1445, 1434, 1349, 1044, 906, 764, 746, 704, 696 cm "1 . NMR (CDC1 3 ): d 1.40, 2.20 (each s, 3H); 5.90 (s, 1H, pyrazole CH); 7.0-7.5 (m, 14H). 5 Anal. Calc'd (C 24 H 21 N 2 C1): C, 77.30; H, 5.68; N, 7.51. Found: 77.42; 5.86; 7.46. Example 8 1 -(2-Chlorotrityl)-2-methylimidazole (13). A solution of the chloride of Example 7(b) (0.93 g, 3.0 mmol), 2-methylimidazole (0.50 g, 6.1 mmol) and ethyldiisopropylamine (1.1 mL, 6.3 mmol) in 5 mL of dry DMF was stirred at RT under N 2 for 2.5 h. The crude product was isolated by EtOAc extraction and purified by flash chromatography (100 g SiO 2 , 70% EtOAc-hexanes) followed by spontaneous crystallization from EtOAc to give 0.6 g of (13), m.p. 177°C. IR (KBr) 1492, 1444, 1432, 1397, 1238, 766, 753, 710 cm "1 . NMR (CDC1 3 ): d 1.57 (s, 3H); 6.82 (d, 2H); 7.0-7.5 (m, 14H). Anal. Calc'd (C 23 H 19 N 2 C1): C, 76.97; H, 5.34; N, 7.81. Found: 76.95; 5.49; 7.67. Example 9 1 -(2-Chlorotrityl)- 1 ,2,4-triazole (14). The procedure described for (13) was followed, substituting 1 ,2,4-triazole (0.42 g, 6.1 mmol) for 2-methylimidazole. The crude product was recrystallized from acetone giving 0.6 g of (14), m.p. 160°C. IR(KBr) 1497, 1446, 1434, 1277, 1142, 768, 751, 697 cm 1 . NMR (CDCI 3 ): d 6.9 (d, 1H); 7.0-7.5 (m); 8.06 and 8.18 (each s, 1H). Anal. Calc'd (C 21 H 16 N 3 C1): C, 72.93; H, 4.66; N, 12.15. Found: 72.95; 4.70; 12.07. Example 10 N-(2-Chlorotrityl)-L-prolinol acetate (12). The procedure described for (13) was followed, using 1.47 g (4.7 mmol) of the chloride of Example 7(b), 0.55 g (5.5 mmol) of L-prolinol, 1.1 mL (6.3 mmol) of ethyldiisopropylamine and 10 mL of dry DMF. After 24 h, the crude product was isolated with EtOAc and purified by flash chromatography giving 0.84 g of a foam (major rotamer). A 0.30 g (0.79 mmol) sample of this material was acetylated (2 mL Ac 2 O, 4 mL pyridine, RT, 16 h), the product was isolated (EtOAc) and recrystallized (MeOH) giving 0.24 g of (12), m.p. 102°-104°C. IR (KBr) 1736, 1444, 1240, 1040, 756, 707 cm "1 . NMR (CDC1 3 ): d 0.43 (m, 1H); 1.1-1.5 (3H); 2.00 (s, 3H); 2.8, 3.1 (AB, 2H, CH 2 N); 3.5 (m, 1H, CHN); 3.9 (t, J - 9, 1H) and 4.05 (dd, 1H); 7.0-7.5 (m, 11H); 7.7 (dd, J = 8, 1.2, 2H); 8.35 (d, J = 8, 1H). Anal. Calc'd (C 26 H 26 ClO 2 N): C, 74.36; H, 6.24; N, 3.34. Found: 74.17; 6.31; 3.31. Example 11 N-(2- 4,4',4"-Trichlorotritylloxyethyl)moφholine (5). a. Dry DMSO (20 mL) was added to 14 mmol of hexane-washed KH under Ar with stirring at RT. After H 2 evolution ceased, a solution of tris-(p-chlorophenyl) methanol (3.63 g, 10 mmol) in 25 mL dry DMSO was added, giving a deep red anion solution. After 5 min, l-bromo-3-methyl-2-butene (2.0 mL, 19 mmol) was added and stirring continued for 1 h. The crude product was isolated by Et 2 O extraction and purified by flash chromatography (75 g SiO 2 , 5% EtOAc-hexanes) giving 3.93 g (91%) of (3-methyl-2-butenyl) tris-(4-chlorophenyl)methyl ether as an oil. NMR (CDC1 3 ): d 1.47, 1.72 (each s, 3H); 3.54 (d, 2H); 5.4 (t, 1H), 7.1-7.4 (m, 12H). b. m-Chloroperoxybenzoic acid (80%, 2.15 g, 10 mmol) was added to a stirred suspension of 3.06 g (7.1 mmol) of the above allylic ether and 0.84 g (10 mmol) of NaHCO 3 in 50 mL of CH 2 C1 2 . After 17 h, the mixture was diluted with EtOAc, washed with saturated Na 2 CO 3 , water (until neutral), brine, dried (MgSO 4 ) filtered and concentrated. The crude product was purified by flash chromatography (100 g SiO 2 , 10% EtOAc-hexanes) giving 2.90 g (91%) of the epoxy ether as a white solid. NMR (CDC1 3 ): d 1.13, 1.33 (each s, 3H); 3.03 (m, 1H, epoxy); 3.2 (m, 2H); 7.2-7.4 (m, 12H). c. Periodic acid (1.90 g, 8.33 mmol) was added to a stirred solution of the above epoxy ether (2.87 g, 6.4 mmol) in 60 mL of dry Et 2 O and 15 mL of CH 2 C1 2 . After 1 h, the solution was washed with saturated NaHCO 3 , water (until neutral), brine, dried (MgSO 4 ), filtered and concentrated giving 2.63 g of crude aldehyde as a foam. This material was dissolved at once in 60 mL of MeCN. d. Morpholine (0.23 mL, 2.6 mmol) was added to a 12 mL portion of the above aldehyde/MeCN solution, followed by NaBH 3 CN (0.25 g, 4.0 mmol). After 30 min the reaction was quenched with HO Ac (2 mL), allowed to stand for 15 min, and poured into saturated Na 2 CO 3 . The crude product was isolated by EtOAc extraction and purified by flash chromatography (70 g SiO 2 , 40% EtOAc-hexanes) giving 0.32 g of a solid. This material was recrystallized from EtOH, giving 0.21 g of (5), m.p. 151°-153°C. IR (KBr) 1490, 1117, 1093, 1066, 1014, 817 cm "1 . NMR (CDC1 3 ): d 2.46 (br t, J = 4.6, 4H); 2.62 (t, J = 6, 2H); 3.14 (t, J = 6, 2H); 3.70 (br t, J = 4.6, 4H); 7.3 (m, 12H). Anal. Calc'd: C, 62.97; H, 5.07; N, 2.94. Found: 62.93; 5.06; 2.91. Example 12 1 -(2[4,4',4"-Trichlorotrityl]oxyethyl)-4-(2-hydroxyethyl)piperazine dimaleate (6). N-(2-hydroxyethyl)piperazine (0.32 mL, 2.6 mmol) was added to a 12 mL portion of the aldehyde/MeCN solution of Example 11(c). The mixture was quenched and extracted as above, and the crude free base dissolved in EtOH and treated with maleic acid (0.085 g, 0.73 mmol). The resulting solution was concentrated and triturated with EtzO giving a white solid, which was recrystallized (EtOH-EtOAc) to give 0.05 g of (6), m.p. 173°-176°C (dec). IR (KBr) 3409 (br), 1702 (w), 1616 (m), 1578, 1488, 1356, 1094, 920 cm '1 . Anal. Calc'd (C 27 H 29 N 2 O 2 Cl 3 • [C 4 H 4 O 4 ] 2 ): C, 55.89; H, 4.96; N, 3.73. Found: 55.72; 5.17; 3.73. Example 13 N-((2 ,6-Dichloro-3 -methylphenyl)diphenyl)methylimidazole (16). A solution of (2,6-dichloro-3-methylphenyl)diphenylmethanol (0.40 g, 1.2 mmol) and imidazole (0.50 g, 7.4 mmol) in 2 mL of acetic acid was heated to reflux for 2 h and then allowed to stand at RT for two days. The product was isolated by EtOAc/H 2 O partition followed by chromatography (75 g SiO 2 , 50% EtOAc-hexane) to give 0.40 g (87%) of (16) as a white foam. NMR (CDCI 3 ): d 2.36 (s, 3H); 6.56 (s, 1H); 7.3 (m, 12H); 7.83 (s, 1H). Example 14 Topical Ocular Formulation of Non-steroidal Glucocorticoid Antagonist. Ingredient Amount (wt. %) Clotrimazole 1.00 Mannitol 2.40 Sodium Chloride 0.40 Carbopol 974P 0.50 Polysorbate 80 0.05 Edetate Sodium 0.01 Benzalkonium Chloride 0.01 Sodium Hydroxide Adjust pH to 7.2 Purified Water qs to 100% Example 15 Formulation for Oral Administration. Tablet: 10-1000 mg of non-steroidal glucocorticoid antagonist with inactive ingredients such as cornstarch, lactose, colloidal silicon dioxide, microcrystalline cellulose, and magnesium stearate can be formulated according to procedures known to those skilled in the art of tablet formulation.

Claims: I Claim: 1. A method for treating GLCl A glaucoma which comprises administering a pharmaceutically effective amount of a non-steroidal glucocorticoid antagonist. 2. The method of Claim 1 wherein the non-steroidal glucocorticoid antagonist has the formula: WHEREIN: n = 0,1,2; X = CH orN; Rl = H, F, Cl, Br, R2, OR2, N(R2) 2 , COOH, CONH 2 , CONHR2, CON(R2) 2 , CH 2 N(CH 2 CH 2 )O; R2 = C,-C 6 alkyl; Y = N-imidazolyl, N-pyrrolidinyl, N-(2-hydroxymethyl)pyrrolidinyl, N-triazolyl, N-pyrazolyl each optionally substituted with CH 3 , SH or S-C(4-C1-C 6 H 4 ) 3 ; OH, O(CH 2 ) 2 N(CH 2 CH 2 ) 2 O, O(CH 2 ) 2 N(CH 2 CH 2 ) 2 N(CH 2 ) 2 OH; and all pharmaceutically acceptable salts and esters. 3 The method of Claim 2 wherein the non-steroidal glucocorticoid antagonist is selected from the group consisting of Clotπmazole, N-(Tnphenylmethyl)ιmιdazole, N-([2-Fluoro-9-phenyl]fluorenyl)ιmιdazole, N-([2-Pyπdyl]dφhenylmethyl)ιmιdazole, N-(2-[4,4',4"-Tπchlorotπtyl]oxyethyl)mo holιne, l-(2[4,4',4"-Tπchlorotπtyl]oxyethyl)-4- (2-hydroxyethyl)pιperazιne dimaleate, N-([4,4',4"]-Tπchlorotntyl)ιmιdazole, 9-(3-Mercapto- 1 ,2,4-trazolyl)-9-phenyl-2,7-dιfluorofluorenone, 1 -(2-Chlorotπtyl)-3,5- dimethylpyrazole, 4-(Moφholιnomethyl)-A-(2-pyπdyl)benzhydrol, 5-(5-Methoxy-2- (N-methylcarbamoyl)-phenyl)dιbenzosuberol, N-(2-Chlorotπtyl)-L-prolιnol acetate, l-(2-Chlorotπtyl)-2-methyhmιdazole, l-(2-Chlorotπtyl)-l,2,4-tπazole, l,S-Bιs(4,4',4"- tnchlorotπtyl)- 1 ,2,4-tnazole-3-thιol, and N-((2,6-dιchloro-3-methylphenyl)dιphenyl) methyhmidazole 4 The method of Claim 1 wherein the non-steroidal glucocorticoid antagonist is ketoconazole 5 A composition for controlling GLCl A glaucoma compπsing a pharmaceutically effective amount of a non-steroidal glucocorticoid antagonist 6 The composition of Claim 5 wherein the non-steroidal glucocorticoid antagonist has the formula WHEREIN: n = 0,1,2; X - CH orN; Rl = H, F, Cl, Br, R2, OR2, N(R2) 2 , COOH, CONH 2 , CONHR2, CON(R2) 2 , CH 2 N(CH 2 CH 2 )O; R2 = C,-C 6 alkyl; Y = N-imidazolyl, N-pyrrolidinyl, N-prolinolyl, N-triazolyl, N-pyrazolyl each optionally substituted with CH 3 , SH or S-C(4-C1-C 6 H 4 ) 3 ; OH, O(CH 2 ) 2 N(CH 2 CH 2 ) 2 O, O(CH 2 ) 2 N(CH 2 CH 2 ) 2 N(CH 2 ) 2 OH; 0 and all pharmaceutically acceptable salts and esters. 7. The composition of Claim 6 wherein the non-steroidal glucocorticoid antagonist is selected from the group consisting of Clotrimazole; N-(Triphenylmethyl)imidazole; N-([2-Fluoro-9-phenyl]fluorenyl)imidazole; N-([2-Pyridyl]diphenylmethyl)imidazole; 5 N-(2-[4,4',4"-Trichlorotrityl]oxyethyl)morpholine; 1 -(2[4,4',4"-Trichlorotrityl]oxyethyl)- 4-(2-hydroxyethyl)piperazine dimaleate; N-([4,4',4"]-Trichlorotrityl)imidazole; 9-(3-Mercapto- 1 ,2,4-trazolyl)-9-phenyl-2,7-difluorofluorenone; 1 -(2-Chlorotrityl)-3,5- dimethylpyrazole; 4-(Morpholinomethyl)-A-(2-pyridyl)benzhydrol; 5-(5-Methoxy-2- o (N-methylcarbamoyl)phenyl)dibenzosuberol; N-(2-Chlorotrityl)-L-prolinol acetate; l-(2-Chlorotrityl)-2-methylimidazole; l-(2-Chlorotrityl)-l,2,4-triazole; l,S-Bis(4,4',4"- trichlorotrityl)- 1 ,2,4-triazole-3-thiol; and N-((2,6-dichloro-3-methylphenyl)diphenyl) methylimidazole. 5 8. The composition of Claim 5 wherein the non-steroidal glucocorticoid antagonist is ketoconazole.

Inventors: CLARK ABBOT F, CLARK, ABBOT, F.
Applicants: ALCON LAB INC, CLARK ABBOT F, ALCON LABORATORIES, INC., CLARK, ABBOT, F.
Application year: 1998
Main classification: A61K31
IPC codes: A61K31, A61K45, A61P27