SEROTONERGIC 5HT2 AGONISTS FOR TREATING GLAUCOMA

Abstract: Compounds with 5HT2 receptor agonist activity useful for treating glaucoma, including lowering intraocular pressure. Compositions and methods for their use are also disclosed.

Description: SEROTONERGIC 5HT 2 AGONISTS FOR TREATING GLAUCOMA The present invention is directed to the use of compounds with serotonergic 5HT agonist activity (Compound) to treat glaucoma, which includes lowering intraocular pressure. Background of the Invention Serotonin (5-hydroxytryptamine; 5HT) is an endogenous biogenic amine with a well defined neurotransmitter function in many tissues of the body including the eye [Zifa and Fillion, Pharmacol. Rev., 44, 401 (1992); Hoyer et al, Pharmacol. Rev., 46, 157 (1994); Tobin et al., J Neurosci., 8, 3713 (1988)]. 5HT can interact with at least seven major 5HT receptors (5HT] - 5HT 7 ) and additional subtypes within these families to initiate intracellular biochemical events such as stimulation of second messengers (e.g. cAMP, inositol trisphosphate) eventually leading to the final biological response, for example, tissue contraction or hormone release, etc. [Hoyer et al., supra; Martin et al., Trends Pharmacol. Sci., 19, 2 (1998)]. Receptor subtypes within the 5HT] family are negatively coupled to adenylyl cyclase (AC) and cause inhibition of cAMP production, while 5HT 4 , 5HT 6 , and 5HT 7 receptors are positively coupled to AC and thus stimulate cAMP production when activated by 5HT [Martin et al., supra]. The 5HT 3 receptor is unique in that it couples to an ion channel which gates sodium, potassium, and calcium [Hoyer et al., supra]. The receptors in the 5HT 2 family are positively coupled to phospholipase C (PLC) and thus generate inositol phosphates and mobilize intracellular calcium when activated by 5HT. The 5HT 2 receptor classification consists of the 5HT 2A , 5HT 2B , and 5HT 2C receptor subtypes, all of which have highly homologous amino acid sequences. The receptor previously referred to as 5HT]χ in an earlier nomenclature (prior to about 1990), has been reclassified as the 5HT 2 c receptor because of its greater similarity with other PLC coupled receptors of the 5HT 2 family, based on molecular cloning and its pharmacological characteristics (Hoyer, et al, 1994). Serotonergic nerves innervate the eye [Tobin et al., J Neurosci., 8, 3713 (1988)] and 5HT has been found in the aqueous humor of human eyes [Martin et al., Ophthalmol., 95, 1221 (1988)]. In addition, receptor binding sites for [ 3 H]5HT have been demonstrated and pharmacologically characterized in the iris-ciliary body (ICB) of rabbits [Mallorga and Sugrue, Curr. Eye Res., 6, 527 (1987) and Chidlow et al., Invest. Ophthalmol. Vis. Sci., 36, 2238 (1995)]. These 5HT binding sites have been shown to be functionally coupled to second messenger generation in rabbits [Tobin and Osborne, J. Neurochem., 53, 686 (1989) and Tobin et al., J Neurosci, supra]. In the human ICB these binding sites are characterized as 5HT 1A and 5HT 2 receptors [Barnet and Osborne, Exp. Eye Res., 57, 209 (1993)]. In addition, the presence of mRNAs for 5HT 1A and 5HT 7 receptors in the rabbit ICB have been reported [Chidlow et al., Invest. Ophthalmol. Vis. Sci., supra and Osborne and Chidlow, Ophthalmologica, 210, 308 (1996)]. The precise functions of these receptors in the eye are unknown. 5HT or 5-carboxamidotryptamine (5-CT) topically applied to the rabbit eye raise intraocular pressure (IOP) [Meyer-Bothling et al., Invest. Ophthalmol. Vis. Sci., 34, 3035 (1993)]. By contrast, another group has shown that topically applied 5HT decreased IOP in the rabbit; however, when 5HT was administered to the rabbit intracamerally it resulted in an increase in IOP and caused breakdown of the blood-aqueous barrier [Krootila et al., J. Ocular Pharmacol., 3, 279 (1987)]. In addition, the 5HT uptake inhibitor, fluoxetine (Prozac ® ), also raises IOP in human subjects upon oral administration [Costagliola et al., Br. J. Ophthalmol., 80, 678 (1996)] and may cause glaucoma [Ahmad Ann. Pharmacother :, 25, 436 (1992)]. However, the 5HT receptor subtype(s) involved in the IOP-elevating effects of 5HT, 5-CT and fluoxetine are unknown. Studies conducted in rabbits with 8-hydroxy DP AT and MKC-242 (5HT 1A agonists) have shown these compounds lower IOP [Osborne and Chidlow Ophthalmologica, 210, 308 (1996), and EP 0771563-A2]. In addition, 5-methylurapidil (5HT 1A agonist) lowered IOP in glaucomatous monkeys [Wang et al., Curr. Eye Res., 16, 679 (1997)]. Both MICC-242 and 5- methylurapidil are relatively potent αj receptor antagonists (a \ antagonists are known to lower IOP in rabbits, monkeys, and man). The mechanism of action for loweπng IOP by 5- methylurapidil has been attributed to its oti antagonist activity and not its 5HT 1A agonist activity [Wang et al., Invest. Ophthal. Vis. Sci., 39(Suppl), 2236 (1998)]. U.S. Patent No. 5,693,654, discloses 5HTj-like (now designated 5HT !D ) receptor agonists, such as sumatriptan, for lowering IOP. WO92/20338 discloses certain 5HT 1A antagonists for the treatment of glaucoma. Methysergide (5HT 2 antagonist, but with other activities) lowered IOP in rabbits [Krootila et al, Exp. Eye Res., supra]. Ketanserin (5HT 2A c antagonist), also with significant cti antagonist activity, lowers IOP in rabbits and man [Chan et al., J Ocular Pharmacol., 1, 137 (1985) and Costagliola et al., Exp. Eye Res., 52, 507 (1991)]. Sapro< elate (5HT 2A antagonist) lowers IOP in rabbits and in man when dosed topically or orally [Mano et al., Invest. Ophthal. Vis. Sci., 36(Suppl), 3322 (1995) and Takenaka et al., Invest Ophthal. Vis. Sci., 36(Suppl), 3390 (1995)]. EP 522226 and U.S. Patent No. 5,290,781 disclose the use of ketanserin and its derivatives for treating ocular hypertension. U.S. Patent Nos. 5,290,781 and 5,106,555 disclose the use of certain 5HT 2 antagonists for lowering IOP. U.S. Patent No. 5,652,272 discloses saprogrelate for reducing IOP. U.S. Patent No. 5,538,974 discloses ophthalmic compositions of certain 5HT 2 antagonists for lowering IOP. WO/9911619 discloses 5HT 2A antagonists which may be efficacious in treating glaucoma. U.S. Patent No. 5,011,846 discloses certain 5HT 3 receptor antagonists for treating glaucoma. WO 97/17345 discloses that particular compounds with 5HT 4 serotonergic receptor agonist or antagonist activity are useful for treating psychiatric, gastrointestinal, lower urinary, and cardiovascular disorders. The publication mentions the compounds may also be useful for glaucoma. As evidenced by the previous discussion, it is not clear which serotonergic receptor activity is responsible for lowering IOP. Moreover, a number of these compounds are known to have activity at non-serotonergic receptors which are known to be involved in lowering IOP. Summary of the Invention The present invention is directed to the use of compounds with 5HT 2 receptor agonist activity to treat glaucoma, which includes lowering intraocular pressure. Compositions of the compounds are contemplated for such uses. Detailed Description Preferred Embodiments Unexpectedly, it has been found that serotonergic compounds which possess agonist activity at 5HT receptors effectively lower and control elevated IOP and are useful for treating glaucoma. Specific compounds which exemplify the present invention include: 1) (R)-4-iodo- 2,5 dimethoxy-α-methyl-benzeneethanamine [(R)-DOI], the prototypical selective 5HT 2 agonist which is not selective amongst the 5HT 2 receptor subtypes [Baxter et al., Trends. Pharmacol. Sci., 16, 105 (1995)]; 2) α-methyl-serotonin, a potent 5HT 2 agonist with modest receptor subtype selectivity: 5HT 2B >5HT 2C >5HT 2A [Baxter, et al., supra]; 3) 5-methoxy-α- methyltryptamine, with a profile similar to that of α-methyl-serotonin [Nichols et al, J. Med. Chem., 31, 1406 (1998)]. The following references are not limiting, but rather exemplify Compounds useful according to the present invention and are incorporated herein by reference: U.S. Patent Nos. 5,861 ,425; 5,646,173; 5,578,612; 5,571 ,833; 5,545,644 5,494,928; 4,659,706 and 4,487,773; published European Patent Specification No. 863,136 published International Patent Application Nos. WO98/56768; WO98/31354; WO98/30548 WO98/30546. Additionally, compounds disclosed in the following publications further exemplify Compounds useful according to the present invention and are also incorporated herein by reference: Parker et al, J. Med. Chem. 41, 5148 (1998); Vangveravong et al, J. Med. Chem. 41, 4995 (1998); Albertini et al, Mutagenesis, 13, 397 (1998); Monte et al, J. Med. Chem. 40, 2997 (1997); Bos et al., Eur. J Med. Chem., 32, 253 (1997); Bos et al., J. Med. Chem., 40, 2762 (1997); Monte et al, J. Med. Chem. 39, 2952 (1996); Glennon et al., J. Med. Chem., 37, 1929 (1994); Macor et al, Tetrahedron Lett. 35, 45 (1994); Macor et al, J Med. Chem. 35, 4503 (1992); Macor et al. J. Med. Chem., 35, 3625 (1992); Glennon et al, J. Med. Chem. 35, 734 (1992); Seggel et al. J. Med. Chem. 33, 1032 (1990). It is recognized that many of the aforementioned Compounds have asymmetric atoms, therefore all enantiomers and diastereomers are contemplated. Also contemplated are pharmaceutically acceptable salts as well as the free bases of the Compounds. The Compounds are administered to the eye (e.g., topically, intracamerally, or via an implant). The Compounds are preferably incorporated into topical ophthalmic formulations for delivery to the eye. The Compounds may be combined with ophthalmologically acceptable preservatives, surfactants, viscosity enhancers, penetration enhancers, buffers, sodium chloride, and water to form an aqueous, sterile ophthalmic suspension or solution. Ophthalmic solution formulations may be prepared by dissolving a Compound in a physiologically acceptable isotonic aqueous buffer. Further, the ophthalmic solution may include an ophthalmologically acceptable surfactant to assist in dissolving the Compound. Furthermore, the ophthalmic solution may contain an agent to increase viscosity, such as, hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose, methylcellulose, polyvinylpyrrolidone, or the like, to improve the retention of the formulation in the conjunctival sac. Gelling agents can also be used, including, but not limited to, gellan and xanthan gum. In order to prepare sterile ophthalmic ointment formulations, the active ingredient is combined with a preservative in an appropriate vehicle, such as, mineral oil, liquid lanolin, or white petrolatum. Sterile ophthalmic gel formulations may be prepared by suspending the active ingredient in a hydrophilic base prepared from the combination of, for example, carbopol-940, or the like, according to the published formulations for analogous ophthalmic preparations; preservatives and tonicity agents can be incorporated. The Compounds are preferably formulated as topical ophthalmic suspensions or solutions, with a pH of about 5 to 8. The Compounds will normally be contained in these formulations in an amount 0.01% to 5% by weight, but preferably in an amount of 0.25% to 2% by weight. Thus, for topical presentation 1 to 2 drops of these formulations would be delivered to the surface of the eye 1 to 4 times per day according to the routine discretion of a skilled clinician. The Compounds can also be used in combination with other agents for treating glaucoma, such as, but not limited to, β-blockers, prostaglandins, carbonic anhydrase inhibitors, α 2 agonists and miotics. The Compounds can also be used with calcium channel blockers and antagonists for metabotropic and ionotropic glutamate receptors and/or antagonists for their associated binding sites, such as, the polyamine and strychnine- insensitive glycine sites. These agents may be administered topically, but usually systemically. A particularly preferred combination includes the use of a Compound with an α 2 adrenergic agent, such as, apraclonidine or brimonidine or their pharmaceutically acceptable salts. Compounds useful in this invention can be identified using methodology well known to one skilled in the art. The selection is made first by using a 5HT 2 receptor binding assay, an example of which is described below. Compounds of this invention posses high affinity for 5HT 2 receptors (IC 5 o or K, values of about 20nM or less and this affinity is higher than at other 5HT receptors). The second part of this selection is made based on the functional activity of the compound as described below. Compounds of this invention possess agonist EC 50 values of about lμM or less. Antagonists are not contemplated in this invention. Both of these methods are believed to be the best way to identify a compound that would be useful according to this invention; however, it is important to note that some compounds that are identified by these methods may not be as desirable as others as commercial products. One must take into account the nature of the compound in question in terms of its structure, physical properties - e.g., solubility, lipophilicity, and chemical stability and its susceptibility to be metabolized to an inactive compound (or compounds) within the eye. The impact of these parameters is well known to one skilled in the art and can be determined using methods well known in the art. In addition to the above discussion, certain 5HT 2 agonists such as DOI, its isomers, and related compounds are known to cause central nervous system (CNS) side effects in man when dosed systemically. In the present invention it is believed that the Compounds can be dosed topically, at a low enough dose to lower and control IOP, but not cause unwanted CNS side effects which may be associated with some Compounds. Some Compounds are particularly desirable because their physical properties keep them from penetrating the CNS and causing side effects. Also, certain Compounds of this invention may cause local irritation and discomfort upon topical ocular administration that render them less desirable than other more comfortable compounds. This can be readily determined using methods well known in the art. EXAMPLE 1 5HT 2 Receptor Binding Assay In order to determine the relative affinities of serotonergic compounds at the 5HT 2 receptors, their ability to compete for the binding of the agonist radioligand [ 125 I]DOI to brain 5HT 2 receptors is determined as described below with minor modification of the methods of Johnson et al. (Neuropharmacology, 26, 1803 (1987)). Aliquots of post mortem rat or human cerebral cortex homogenates (400 μl) dispersed in 50 mM TrisHCl buffer (pH 7.4) are incubated with [ 125 I]DOI (80 pM final) in the absence or presence of methiothepin (10 μM final) to define total and non-specific binding, respectively, in a total volume of 0.5 ml. The assay mixture is incubated for lhr at 23 °C in polypropylene tubes and the assays terminated by rapid vacuum filtration over Whatman GF/B glass fiber filters previously soaked in 0.3% polyethyleneimine using ice-cold buffer. Test compounds (at different concentrations) are substituted for methiothepin. Filter-bound radioactivity is determined by scintillation spectrometry on a beta counter. The data are analysed using a non-linear, iterative curve- fitting computer program (Bowen & Jerman, Trends Pharmacol. Sci., 16, 413 (1995)) to determine the compound affinity parameter. The concentration of the compound needed to inhibit the [ 125 I]DOI binding by 50% of the maximum is termed the IC 50 or K, value. Compounds are considered to possess high affinity for the 5HT 2 receptor if their IC 50 or K, values are <50 nM. 5HT? Functional Assay: Phosphoinositide (PI) turnover assay The relative agonist activity of serotonergic compounds at the 5HT 2 receptor can be determined in vitro using the ability of the compounds to stimulate the production of [ 3 H] inositol phosphates in [ 3 H]myo-inositol-labeled A7r5 rat vascular smooth uscle cells by their ability to activate the enzyme phospholipase C. These cells are grown in culture plates, maintained in a humidified atmosphere of 5% CO 2 and 95% air and fed semi-weekly with Dulbecco's modified Eagle medium (DMEM) containing 4.5 g/1 glucose and supplemented with 2mM glutamine, 10 μg/ml gentamicin, and 10% fetal bovine serum. For the purpose of conducting the phosphoinositide (PI) turnover experiments, the A7r5 cells are cultured in 24- well plates as previously described (Griffin et al., J. Pharmacol. Expt. Ther., 286, 41 1 (1998)). Confluent cells are exposed for 24-30 hrs to 1.5 μCi [ 3 H]-myo-inositol (18.3 Ci/mmol) in 0.5 ml of serum-free medium. Cells are then rinsed once with DMEM/F-12 containing 10 mM LiCl prior to incubation with the test agent (or solvent as the control) in 1.0 ml of the same medium for 1 hr at 37°C, after which the medium is aspirated and 1 ml of cold 0.1 M formic acid added to stop the reaction. The chromatographic separation of [ 3 H]- inositol phosphates ([ 3 H]-IPs) on an AG- 1-X8 column is performed as previously described (Griffin et al., J. Pharmacol. Expt. Ther., 286, 41 1 (1998)) with sequential washes with H 2 O and 50 mM ammonium formate, followed by elution of the total [ 3 H]-IPs fraction with 1.2 M ammonium formate containing 0.1 M formic acid. The eluate (4 ml) is collected, mixed with 15 ml scintillation fluid, and the total [ 3 H]-IPs determined by scintillation counting on a beta- counter. Concentration-response data are analyzed by the sigmoidal fit function of the Origin Scientific Graphics software (Microcal Software, Northampton, MA) to determine agonist potency (EC 50 value) and efficacy (E max ). Serotonin (5HT) is used as a positive control (standard) agonist compound and the efficacy of test compounds is compared to that of 5HT (set at 100%). The concentration of the compound needed to stimulate the production of [ 3 H]-IPs by 50% of the maximum response is termed the EC 50 value. Compounds are considered potent agonists if their EC 50 values in this functional assay are < 1 μM and are considered full agonists if their efficacy is > 80% of that of 5HT. The above procedures were used to generate the data shown in Table 1. Acute IOP Response in Lasered (Hypertensive) Eyes of Conscious Cynomolgus Monkeys Intraocular pressure (IOP) was determined with an Alcon Pneumatonometer after light corneal anesthesia with 0.1% proparacaine. Eyes were washed with saline after each measurement. After a baseline IOP measurement, test compound was instilled in one 30 μL aliquot to the right eyes only of nine cynomolgus monkeys. Vehicle was instilled in the right eyes of six additional animals. Subsequent IOP measurements were taken at 1, 3, and 6 hours. The profile of the IOP response following topical administration for each of these Compounds is provided in Table 2. The following topical ophthalmic formulations are useful according to the present invention administered 1-4 times per day according to the discretion of a skilled clinician. EXAMPLE 2 EXAMPLE 3 EXAMPLE 4 EXAMPLE 6 EXAMPLE 7 EXAMPLE 8 EXAMPLE 9 EXAMPLE 10

Claims: We Claim: 1. A method for treating glaucoma which comprises administering to a person in need thereof, a composition comprising a pharmaceutically effective amount of a compound with 5HT 2 receptor agonist activity. 2. The method of Claim 1 wherein the 5HT 2 receptor agonist is present at a concentration of 0.01 weight percent to 5 weight percent. 3. The method of Claim 2 wherein the concentration is 0.25 weight percent to 2 weight percent. 4. The method of Claim 1 wherein the 5HT 2 receptor agonist is (R)-DOI, α- Methylserotonin, 5 -Methoxy-α-methyltryptamine . 5. The method of Claim 1 wherein the composition additionally comprises another compound selected from the group consisting of β-blockers, prostaglandins, carbonic anhydrase inhibitors, α 2 agonists, and miotics. 6. The method of Claim 5 wherein the compound is an α 2 agonist. 7. The method of Claim 6 wherein the α 2 agonist is selected from the group consisting of apraclonidine and brimonidine. 8. A composition for treating glaucoma comprising a pharmaceutically effective amount of a compound with 5HT 2 receptor agonist activity. 9. The composition of Claim 8 wherein the 5HT 2 receptor agonists concentration is 0.01 weight percent to 5 weight percent. 10. The composition of Claim 9 wherein the concentration is 0.25 weight percent to 2 weight percent. 11. The composition of Claim 8 wherein the 5HT 2 receptor agonist is selected from the group consisting of (R)-DOI, α-Methylserotonin, 5-Methoxy-α-methyltryptamine. 12. The composition of Claim 8 wherein the composition additionally comprises another compound selected from the group consisting of β-blockers, prostaglandins, carbonic anhydrase inhibitors, α 2 agonists, and miotics. 13. The composition of Claim 12 wherein the compound is an α 2 agonist. 14. The composition of Claim 13 wherein the α 2 agonist is selected from the group consisting of apraclonidine and brimonidine.

Inventors: DEAN THOMAS R, MAY JESSE A, SHARIF NAJAM A, DEAN, THOMAS, R., MAY, JESSE, A., SHARIF, NAJAM, A.
Applicants: ALCON LAB INC, DEAN THOMAS R, MAY JESSE A, SHARIF NAJAM A, ALCON LABORATORIES, INC., DEAN, THOMAS, R., MAY, JESSE, A., SHARIF, NAJAM, A.
Application year: 1999
Main classification: A61K31
IPC codes: A61K31, A61K45, A61P27