Abstract:
Methods of inhibiting plasminogen activator inhibitor 1 comprising administering to a human in need thereof an effective amount of a compound having the formula I: ##STR1## wherein R 1  and R 2  are, independently, --H, --C 1  -C 4  alkyl, or taken together with the nitrogen to which they are attached form a pyrrolidine, piperidine, or hexamethyleneimino ring; 
     or a pharmaceutically acceptable salt or solvate thereof.

Description:
This application claims the benefit under 35 USC 119(e) of provisional application Ser. No. 60/022,375 filed Jul. 29, 1996. 
     BACKGROUND OF THE INVENTION 
     The fibrinolytic system plays a key role in maintaining normal hemostatic balance. A critical factor in this system is plasminogen activator inhibitor I (PAI-1), which reduces the endogenous ability to remove fibrin by inhibiting plasminogen activators such as tissue type plasminogen-activator (tPA). Studies have documented that elevations of PAI-1 are associated with increased risk of deep venous thrombosis. Further, elevations in PAI-1 are found in patients suffering from myocardial infarction and septicemia. Because impaired fibrinolytic capacity is associated with increased cardiovascular risk, lowering PAI-1 should result in cardioprotection. In fact, recent studies on the analysis of PAI-1 levels in pre- and post-menopausal women in the Framingham Offspring Study have demonstrated that post-menopausal women have markedly higher PAI-1 levels, which can be reduced to pre-menopausal levels with estrogen therapy. This reduction in PAI-1 effect is believed to contribute to the overall effect of estrogen replacement therapy on the reduced risk of heart disease. 
     While PAI-1 can be produced in a variety of tissues, substantial levels are secreted by the vascular endothelial cell. The vascular endothelium constitutes a major organ that functions in the regulation of blood coagulation, inflammation and in the exchange of fluids and mediators between the intravascular compartment and parenchyma tissues. As such, the proper function of the endothelium is critical to overall homeostasis. Because PAI-1 can be increased in endothelial cells in response to certain stimuli, including cytokines, it contributes to a dysfunctional state that can result in coagulation defects, local and systemic vascular inflammation, and enhancement in the progression and rupture of atherosclerotic plaque. These effects can further result in conditions including myocardial infarction, deep venous thrombosis, and disseminated intravascular thrombosis. 
     Because the local control of PAI-1 at the endothelial cell/plasma interface can play a major role in many pathological processes, agents that inhibit the expression of PAI-1 in the endothelium could be useful in treating or preventing conditions such as sepsis, injuries involving major tissue damage and trauma, systemic inflammatory response syndrome, sepsis syndrome, septic shock and multiple organ dysfunction syndrome (including DIC) as well as myocardial infarction, deep venous thrombosis, disseminated intravascular thrombosis, atherosclerotic plaque rupture and its associated sequela. 
     In addition, tPA (tissue Plasiminogen Activator) is currently administered to patients who have suffered from conditions which place them at risk of detrimental thrombotic events. Exogenously administered tPA has been shown to be effective and is commercially available for treatment of such patients. However, efficacy with this therapy can be limited because PAI-1 inhibits the exogenously given tPA as well as the endogenously derived tPA. Therefore, it would be of great value if an agent were available which could either prolong the half-life or reduce the amount of exogenously administered tPA. 
     Further, because of the critical role of fibrin in tumor cell biology, agents that modulate PAI-1 may find use as anti-metastatic agents. 
     SUMMARY OF THE INVENTION 
     This invention provides methods for inhibiting plasminogen activator inhibitor-1 comprising administering to a human in need thereof an effective amount of a compound of formula I. ##STR2## wherein R 1  and R 2  are, independently, --H, --C 1  -C 4  alkyl, or taken together with the nitrogen to which they are attached form a pyrrolidine, piperidine, or hexamethyleneimino ring; 
     or a pharmaceutically acceptable salt or solvate thereof. 
     DETAILED DESCRIPTION OF THE INVENTION 
     The current invention concerns the discovery that a select group of triphenyl ethylenes, those of formula I, are useful for inhibiting PAI-1. The methods of use provided by this invention are practiced by administering to a human in need thereof a dose of a compound of formula I or a pharmaceutically acceptable salt or solvate thereof, that is effective to inhibit PAI-1 or a physiological condition associated with an excess thereof. The term &#34;inhibit&#34; includes its generally accepted meaning which includes prohibiting, preventing, restraining, and slowing, stopping, reversing progression or severity, or ameliorating a resultant symptom or effect. 
     General terms used in the description of compounds herein described bear their usual meanings. For example, &#34;C 1  -C 4  alkyl&#34; refers to straight or branched aliphatic chains of 1 to 4 carbon atoms including methyl, ethyl, propyl, iso-propyl, n-butyl, and the like. 
     The compounds of formula I are known in the art and may be prepared by the methods described in U.S. Pat. No. 5,047,431, which is incorporated by reference, herein. 
     A preferred embodiment of the present invention is where R 1  and R 2  are methyl and as its citrate salt, viz., (E)-1- 4&#39;-(2-dimethylaminoethoxy) phenyl!-1-(3-hydroxyphenyl)-2-phenyl-but-1-ene citrate. This compound is known as droloxifene which has been described previously as an anti-estrogen useful in the treatment of estrogen dependent cancer (U.S. Pat. No. 5,047,431) and for inhibiting the loss of bone caused by estrogen deficiency (U.S. Pat. No. 5,254,594). ##STR3## 
     Although the free-base form of formula I compounds can be used in the methods of the present invention, it is preferred to prepare and use a pharmaceutically acceptable salt form. Thus, the compounds used in the methods of this invention primarily form pharmaceutically acceptable acid addition salts with a wide variety of organic and inorganic acids, and include the physiologically acceptable salts which are often used in pharmaceutical chemistry. Such salts are also part of this invention. Typical inorganic acids used to form such salts include hydrochloric, hydrobromic, hydroiodic, nitric, sulfuric, phosphoric, hypophosphoric, and the like. Salts derived from organic acids, such as aliphatic mono and dicarboxylic acids, phenyl substituted alkanoic acids, hydroxyalkanoic and hydroxyalkandioic acids, aromatic acids, aliphatic and aromatic sulfonic acids, may also be used. Such pharmaceutically acceptable salts thus include acetate, phenylacetate, trifluoroacetate, acrylate, ascorbate, benzoate, chlorobenzoate, dinitrobenzoate, hydroxybenzoate, methoxybenzoate, methylbenzoate, o-acetoxybenzoate, naphthalene-2-benzoate, bromide, isobutyrate, phenylbutyrate, b-hydroxybutyrate, butyne-1,4-dioate, hexyne-1,4-dioate, caprate, caprylate, chloride, cinnamate, citrate, formate, fumarate, glycollate, heptanoate, hippurate, lactate, malate, maleate, hydroxymaleate, malonate, mandelate, mesylate, nicotinate, isonicotinate, nitrate, oxalate, phthalate, terephthalate, phosphate, monohydrogenphosphate, dihydrogenphosphate, metaphosphate, pyrophosphate, propiolate, propionate, phenylpropionate, salicylate, sebacate, succinate, suberate, sulfate, bisulfate, pyrosulfate, sulfite, bisulfite, sulfonate, benzenesulfonate, p-bromophenylsulfonate, chlorobenzenesulfonate, ethanesulfonate, 2-hydroxyethanesulfonate, methanesulfonate, naphthalene-1-sulfonate, naphthalene-2-sulfonate, p-toluenesulfonate, xylenesulfonate, tartarate, and the like. A preferred salt is the citrate salt. 
     The pharmaceutically acceptable acid addition salts are typically formed by reacting a compound of formula I with an equimolar or excess amount of acid. The reactants are generally combined in a mutual solvent such as diethyl ether or ethyl acetate. The salt normally precipitates out of solution within about one hour to 10 days and can be isolated by filtration or the solvent can be stripped off by conventional means. 
     The pharmaceutically acceptable salts generally have enhanced solubility characteristics compared to the compound from which they are derived, and thus are often more amenable to formulation as liquids or emulsions. 
     Pharmaceutical formulations can be prepared by procedures known in the art. For example, the compounds can be formulated with common excipients, diluents, or carriers, and formed into tablets, capsules, suspensions, powders, and the like. Examples of excipients, diluents, and carriers that are suitable for such formulations include the following: fillers and extenders such as starch, sugars, mannitol, and silicic derivatives; binding agents such as carboxymethyl cellulose and other cellulose derivatives, alginates, gelatin, and polyvinyl pyrrolidone; moisturizing agents such as glycerol; disintegrating agents such as calcium carbonate and sodium bicarbonate; agents for retarding dissolution such as paraffin; resorption accelerators such as quaternary ammonium compounds; surface active agents such as cetyl alcohol, glycerol monostearate; adsorptive carriers such as kaolin and bentonite; and lubricants such as talc, calcium and magnesium stearate, and solid polyethyl glycols. 
     The compounds can also be formulated as elixirs or solutions for convenient oral administration or as solutions appropriate for parenteral administration, for instance by intramuscular, subcutaneous or intravenous routes. Additionally, the compounds are well suited to formulation as sustained release dosage forms and the like. The formulations can be so constituted that they release the active ingredient only or preferably in a particular part of the intestinal tract, possibly over a period of time. The coatings, envelopes, and protective matrices may be made, for example, from polymeric substances or waxes. 
     The particular dosage of a compound of formula I required to inhibit PAI-1, or any other use disclosed herein, and according to this invention will depend upon the severity of the condition, the route of administration, and related factors that will be decided by the attending physician. Generally, accepted and effective daily doses will be from about 0.1 to about 1000 mg/day, and more typically from about 10 to about 100 mg/day. Such dosages will be administered to a subject in need thereof from once to about three times each day, or more often as needed to effectively inhibit PAI-1, or any other use disclosed herein. 
    
    
     FORMULATIONS 
     In the formulations which follow, &#34;Active ingredient&#34; means a compound of formula I. 
     Formulation 1 
     Gelatin Capsules 
     Hard gelatin capsules are prepared using the following: 
     
         ______________________________________Ingredient          Quantity (mg/capsule)______________________________________Active ingredient   0.1-1000Starch, NF          0-650Starch flowable powder               0-650Silicone fluid 350 centistokes               0-15______________________________________ 
    
     The ingredients are blended, passed through a No. 45 mesh U.S. sieve, and filled into hard gelatin capsules. 
     The specific formulations above may be changed in compliance with the reasonable variations provided. 
     A tablet formulation is prepared using the ingredients below: 
     Formulation 2 
     Tablets 
     
         ______________________________________Ingredient           Quantity (mg/tablet)______________________________________Active ingredient    0.1-1000Cellulose, microcrystalline                0-650Silicon dioxide, fumed                0-650Stearate acid        0-15______________________________________ 
    
     The components are blended and compressed to form tablets. 
     Alternatively, tablets each containing 0.1-1000 mg of active ingredient are made up as follows: 
     Formulation 3 
     Tablets 
     
         ______________________________________Ingredient           Quantity (mg/tablet)______________________________________Active ingredient    0.1-1000Starch               45Cellulose, microcrystalline                35Polyvinylpyrrolidone 4(as 10% solution in water)Sodium carboxymethyl cellulose                4.5Magnesium stearate   0.5Talc                 1______________________________________ 
    
     The active ingredient, starch, and cellulose are passed through a No. 45 mesh U.S. sieve and mixed thoroughly. The solution of polyvinylpyrrolidone is mixed with the resultant powders which are then passed through a No. 14 mesh U.S. sieve. The granules so produced are dried at 50°-60° C. and passed through a No. 18 mesh U.S. sieve. The sodium carboxymethyl starch, magnesium stearate, and talc, previously passed through a No. 60 U.S. sieve, are then added to the granules which, after mixing, are compressed on a tablet machine to yield tablets. 
     Suspensions each containing 0.1-1000 mg of medicament per 5 mL dose are made as follows: 
     Formulation 4 
     Suspensions 
     
         ______________________________________Ingredient           Quantity (mg/5 ml)______________________________________Active ingredient    0.1-1000 mgSodium carboxymethyl cellulose                50 mgSyrup                1.25 mgBenzoic acid solution                0.10 mLFlavor               q.v.Color                q.v.Purified water to    5 mL______________________________________ 
    
     The medicament is passed through a No. 45 mesh U.S. sieve and mixed with the sodium carboxymethyl cellulose and syrup to form a smooth paste. The benzoic acid solution, flavor, and color a re diluted with some of the water and added, with stirring. Sufficient water is then added to produce the required volume. 
     To demonstrate the utility for the compounds of formula I in inhibiting PAI-1, the following experimental procedure was performed. 
     Endothelial cell PAI-1 assay 
     96 well tissue culture plates were prepared with 1×10 4  human endothelial cells (HUVEC) per well in Clonetics&#39; Endothelial Cell Growth Medium (EGM) supplemented with 2% FBS. Following incubation overnight at 37 --  C, the medium was replaced with serum-free medium (DMEM/F-12 medium, 20 mM-HEPES, pH 7.5, 50 μg/ml gentamicin, 1 μg/ml human transferrin and 1 μg/ml bovine insulin) with or without a compound of formula I and with or without 1 nM IL-1-beta. Following incubation overnight at 37 --  C, samples of culture medium were assayed for secreted PAI-1 using the Imubind Plasma PAI-1 ELISA (American Diagnostic Inc. #822/1S). 
     Results 
     Human umbilical vein endothelial cells (HUVEC) were treated with compound 1 (droloxifene citrate) concurrent to the induction of PAI-1 with IL-1. In initial experiments with several lots of cells obtained from a commercial supplier (Clonetics), we found that not all lots were responsive to 17-beta estradiol, and were thus not used in experiments to determine the effect of compound 1 on PAI-1 secretion. As shown in Table 1, using an estrogen-responsive line, we observed that compound 1 significantly reduced the induction of PAI-1 by IL-1 at a concentration of 1 nM. These data demonstrate that compound 1 is a potent inhibitor of the induction of PAI-1 from activated endothelial cells and should result in a cardioprotective effect, i.e. reduction in the incidence of cardiovascular events, due to enhancing fibrinolytic potential. Further the positive effect of compound 1 on reducing PAI-1 may provide for acute and chronic uses in conditions where elevated levels are associated with pathology or may be used to prevent such pathological conditions. 
     
                       TABLE 1______________________________________Effect of compound 1 on PAI-1 secretion fromhuman endothelial cells              PAI-1 InductionTreatment          % of IL-1 Control +/- SE*______________________________________IL-1 Control       100IL-1 &amp; 1 nM compound 1              67 +/- 4IL-1 &amp; 10 nM compound 1              20 +/- 4______________________________________ *(drug treated  untreated control)/(Il1 treated  untreated control) × 100%