Abstract:
Herein disclosed is a method for treating patients affected by HIV comprising administering N-hydroxy-benzamide-based histone deacetylase inhibitors, such as: diethyl-[6-(4-hydroxycarbamoyl-phenyl-carbamoyloxymethyl)-naphtalen-2-yl-methyl]-ammonium chloride; 4-(2-(S)-benzoylamino-3-naphtalen-2-yl-propionylamino)-N-hydroxy-benzamide; and/or benzo[1,3]dioxole-5-carboxylic acid [1(S)-(4-hydroxycarbamoyl-phenylcarbamoyl)-2-naphtalen-2-yl-ethyl]-amide. Such histone deacetylase inhibitors are administered in a dosage ranging from 50 to 200 mg/day, preferably from 100 to 200 mg/day, so as to obtain a blood concentration between 125 and 250 nM.

Description:
[0001]    The present invention relates to the use of N-hydroxy-benzamide-based histone deacetylase inhibitors for treating humans infected by human immunodeficiency virus (HIV). In particular for the treatment of patients with infection of T CD4 +  cells due to persistent, latent HIV, in combination with a highly active antiretroviral therapy (HAART), with the aim of eliminating the HIV infection. 
       Prior art 
       [0002]    Since the introduction of the highly active antiretroviral therapy (HAART) more than a decade ago, the HIV-1 infection may be efficiently controlled, maintaining the HIV-1 viremia below the detectable values. However, the elimination of HIV-1 infection through extended HAART therapy is not yet possible. Upon interruption of the HAART, there occurs the viremia rebound, typically after two weeks [Imamichi H. et al.  J. Infect. Dis.  183, 36 (2001)]. 
         [0003]    The source of viral rebound is a long-term cell pool, most probably the memory T-cells reservoir which are infected more slowly, which hosts the HIV-1 integrated proviral DNA. Consolidated techniques for quantifying the latent cell pool are available and it is calculated that one memory cell out of a million of an HIV-1 positive patient carries a replication-competent integrated provirus. 
         [0004]    The mechanisms that maintain the proviral DNA transcriptionally inactive in quiescent cells are known. However, it has been long believed that the mechanism includes a chromatin-associated regulation [Quivy V. et al.  Subcell Biochem.  41, 371 (2007)]. In the latent cell, the integrated proviral DNA is densely organised in nucleosomes. The long terminal repeat (LTR) 5′ of HIV-1, containing the promoter and enhancer elements, is the target of the binding of numerous transcription factors and it is organized into two nucleosomes (nuc-0 and nuc-1). The NFκB p50 homodimer, as well as AP-4, YY1 and LSF1, recruits the histone deacetylase/s (HDAC) to LTR, which in turn results in the deacetylation of local histones, in the compaction of chromatin, and in the prevention of the binding of RNA-polymerase II. 
         [0005]    The HDAC inhibitors (HDACi), a new class of synthetic compounds, may invalidate the enzymatic activity of HDACs and the relative repression of the HIV-1 gene expression. Furthermore, contrary to the NFκB cell activators, like IL-2, OKT3 or TNFα, HDACi may facilitate gene expression without the general activation of the T-cells. 
         [0006]    Histone deacetylases (HDACs) are enzymes capable of removing the acetyl group bound to the lysine residues in the N-terminal portion of the histones or in other proteins. 
         [0007]    HDACs may be divided into four classes, according to structural homologies. Class I HDACs (HDAC 1, 2, 3 and 8) are similar to the RPD3 yeast protein and they are found in the cell nucleus. Class II HDACs (HDAC 4, 5, 6, 7, 9 and 10) are similar to the HDA1 yeast protein and they are found both in the nucleus and in the cytoplasm. Class III HDACs are a structurally distinct form of NAD-dependent enzymes correlated to the SIR2 yeast protein. Class IV (HDAC 11) currently consists of a single enzyme having particular structural characteristics. Classes I, II and IV HDACs are enzymes containing zinc and they may be inhibited by various molecular classes: hydroxamic acid derivatives, cyclic tetrapeptides, short chain fatty acids, aminobenzamides, electrophilic ketone derivatives, and the like. Class III HDACs are not inhibited by hydroxamic acids, and the inhibitors thereof have structural characteristics different from those of the other classes. 
         [0008]    For the purposes of the present invention, the expression “histone deacetylase inhibitor” it is meant to indicate any molecule of natural origin, recombinant or synthetic, capable of inhibiting the activity of at least one of the enzymes classified as class I, II or IV histone deacetylase. 
         [0009]    Histone deacetylase inhibitors are a class of molecules having an anti-neoplastic and anti-inflammatory activity. 
         [0010]    In tumour cells, the histone deacetylase inhibitors inhibit the cellular proliferation and induce cellular death and differentiation [Gaofeng Bi and Guosheng Jiang in  Cellular &amp; Molecular Immunology  3, 285-290 (2006)]. 
         [0011]    Histone deacetylase inhibitors are also capable of modulating the production of cytokines and other pro-inflammatory factors by the immunocompetent cells and they have proven, in vivo, anti-inflammatory properties [Frederic Blanchard and Céline Chipoy in  Drug Discovery Today  10, 197-204 (2005); I M Adcock in  British Journal of Pharmacology  150, 829-831 (2007)]. 
         [0012]    Numerous clinical studies that use various inhibitors, both for tumour diseases and for inflammatory diseases, are currently in progress, and they are at different stages of progress [Marielle Paris et al. in  Journal of Medicinal Chemistry  51, 1505-1529 (2008)]. 
         [0013]    Diethyl-[6-(4-hydroxycarbamoyl-phenylcarbamoyloxymethyl)-naphtalen-2-yl-methyl]ammonium chloride, which is described in WO 97/43251 (anhydrous form) and in WO 2004/065355 (monohydrate crystal form), both incorporated herein by reference, is a HDACs inhibitor with good anti-inflammatory activity; the monohydrate crystal form of such an active ingredient is also known as ITF2357 and/or Givinostat. 
         [0014]    Other 4-Amino-N-hydroxy-hydroxybenzamide derivatives, capable of inhibiting HDAC enzymes, are disclosed in WO 2004/063146 and WO 2006/003068, both incorporated herein by reference. 
         [0015]    Various HDAC inhibitors were proven capable of inducing the HIV-1 gene expression from a latently infected cell line; however, concerns about possible toxic effect of the inhibitors, at the concentration required for performing the induction, have been raised [Shehu-Xhilaga, M. et al.  AIDS  23, 2047 (2009)]; regarding this, is it has been recently proposed [Archin, N M et al.  AIDS  23, 1799 (2009)] that selective Class I HDAC inhibitors could be potent inducers of HIV with lower cytotoxicity. 
         [0016]    Valproic acid (VPA), a carboxylic acid HDACi, prescribed for convulsive and mental disorders, was combined with HAART in some clinical studies but without leading to any considerable diminution of the latent reservoir [Lehrman G et al.  Lancet  366 (9485), 549 (2005)]. Thus, these studies with VPA did not resolve the potential of HDACi to eliminate the virus. 
         [0017]    WO 2008/097654 discloses the use of SAHA for the treatment of HIV infection; SAHA is a HDACi, not having a N-hydroxy-benzamide structure, which is available in the market as Vorinostat or Zolinza. In WO 2008/097654 (example 2 and FIG. 1) SAHA is indicated to induce the HIV-1 gene expression in the ACH-2 cell line, with an EC 50  of 0.632 μM. 
         [0018]    The Zolinza package leaflet indicates that a possibly effective circulating concentration of SAHA for treating patients affected by Cutaneous T-Cell Lymphoma may be obtained with a dosage of 400 mg/day. However, at this dosage SAHA may cause numerous, serious adverse effects such as diarrhoea, tiredness, nausea, thrombocytopenia, anorexia and dysgeusia. Furthermore, according to the information on the Zolinza package leaflet, SAHA is mutagenic in vitro in the bacterial back-mutation assays (Ames test), it causes chromosome aberrations in vitro in Chinese Hamster Ovary (CHO) cells and it increases the incidence of micronucleated erythrocytes when administered to mice (Mouse Micronucleus Assay). 
         [0019]    It is thus clear that there arises the need for new HIV-1 expression induction agents, possibly HDAC inhibitors, which are more active and less toxic, preferably both more active and less toxic, than the HDAC inhibitors which are already known to be effective at inducing the HIV-1 gene expression. 
     
    
     DESCRIPTION OF THE INVENTION 
       [0020]    It has now been discovered, and this constitutes an aspect of the present invention, that diethyl-[6-(4-hydroxycarbamoyl-phenylcarbamoyloxymethyl)-naphtalen-2-yl-methyl]-ammonium chloride, preferably in monohydrate form, more preferably in monohydrate crystal form (ITF2357, Givinostat), is capable of inducing the HIV-1 gene expression, in the ACH-2 cell line, at a concentration preferably between 125 and 250 nM. 
         [0021]    ITF2357 revealed to be non-mutagenic [Monzani, V M et al. presented at EUROTOX 2007, 44 th  Congress of toxicology, poster G33]; therapeutic circulating concentrations between 125 and 250 nM may be easily obtained, in the clinical treatment, by administering 50-200 mg of ITF2357. The dosages within this range were used in numerous clinical studies and the detected toxic effects were extremely low; an equivalent dose of 1.5 mg/kg/day was administered to children with systemic onset juvenile idiopathic arthritis (SOJIA) with encouraging results and without detection of any toxic effect [Vojinovic, J. et al. presented at The 72 nd  annual meeting of the American College of Rheumatology, San Francisco, Calif., 29 Oct. 2008]. 
         [0022]    It was thus found, and this is a second aspect of the invention, that some HDAC inhibitors which are 4-amino-N-hydroxy-benzamide derivatives (which include ITF2357) may be extremely effective at inducing the HIV gene expression at concentrations that do not reveal any considerable toxicity; this seems to be in contrast with the previous opinions [Shehu-Xhilaga, M. et al.  AIDS  23, 2047 (2009)] which suggest that the two effects, HIV gene induction and toxicity, may depend on the same structural and/or mechanistic reasons. 
         [0023]    It has also been found, and this is a third aspect of the invention, that some of such 4-amino-N-hydroxy-benzamide derivatives, capable of inhibiting HDAC enzymes, are even more potent than ITF2357 at inducing the HIV-1 gene expression, in the ACH-2 cell line, at a concentration between 125 and 250 nM. Purely by way of example, 4-(2(S)-benzoylamino-3-naphtalen-2-yl-propionylamino)-N-hydroxy-benzamide (compound g) and benzo [1,3]dioxole-5-carboxylic acid [1(S)-(4-hydroxycarbamoyl-phenylcarbamoyl)-2-naphtalen-2-yl-ethy]-amide (compound t), both described in example 2 of the aforementioned WO 2006/003068, induce, in ACH-2 cells, at 250 nM, an increase of the HIV expression 30 times higher with respect to the 15 times higher increase obtained with the same concentration of ITF2357. 
         [0024]    The chemical structures of: 
         [0025]    diethyl- [6-(4-hydroxycarbamoyl-phenylcarbamoyloxymethyl)-naphtalen-2-yl-methyl]-ammonium chloride; 
         [0026]    4-(2-(S)-benzoylamino-3-naphtalen-2-yl-propionylamino)-N-hydroxy-benzamide (compound g); and 
         [0027]    benzo[1,3]dioxole-5-carboxylic acid [1(S)-(4-hydroxycarbamoyl-phenylcarbamoyl)-2-naphtalen-2-yl-ethyl]-amide (compound t); are shown hereinafter. 
         [0000]    
       
                 
         
             
             
         
       
     
         [0028]    Diethyl-[6-(4-hydroxycarbamoyl-phenylcarbamoyloxymethyl)-naphtalen-2-yl-methyl]-ammonium chloride 
         [0000]    
       
                 
         
             
             
         
       
     
         [0029]    Compound g 
         [0000]    
       
                 
         
             
             
         
       
     
         [0030]    Compound t 
         [0031]    Thus, the object of the present invention is represented by a compound of general formula I for use in the treatment of HIV infections, preferably HIV-1 infections, 
         [0000]    
       
                 
         
             
             
         
       
     
         [0000]    wherein:
   X is O, CH or it is absent;   Ar is aryl or saturated, unsaturated or partially unsaturated mono-, di-, tricyclic carbocyclic residue, or a saturated, unsaturated or partially unsaturated mono-, di-, tricyclic heterocyclic residue comprising one or more heteroatoms selected from among N, S and O; said carbocyclic or heterocyclic aryl residue being optionally substituted with one or more identical or different halogens, C 1 -C 4  alkyl, C 1 -C 4  alkoxyl, C 1 -C 4  haloalkyl, alkylsulfonyl, cycloalkyl, (cycloalkyl)alkyl, alkanoyl, amino, (C 1 -C 4 ) mono- or dialkylamino, (C 1 -C 4 ) aminoalkyl mono- or disubstituted with C 1 -C 4  alkyl, carboxy, C 1 -C 4  alkoxylcarbonyl, mercaptoalkoxy, mercaptophenoxy, nitro, cyano, oxo, perfluoroalkoxy, perfluoroalkyl, phenyl, phenoxy, phenylalkoxy, benzoyloxy, phenylalkyl, benzoyl, phenylsulfonyl and hydroxy;   
 
         [0034]    R is absent or it is an R 1 —CO—NH- residue; 
         [0000]    wherein R 1  is aryl, arylalkyl, linear or branched C 1 -C 4  alkyl, or saturated, unsaturated or partially unsaturated mono-, di-, tricyclic carbocyclic residue, or a saturated, unsaturated or partially unsaturated mono-, di-, tricyclic heterocyclic residue comprising one or more heteroatoms selected from among N, S and O; said aryl, arylalkyl, linear or branched C 1 -C 4  alkyl, carbocyclic or heterocyclic residue optionally being selected, with one or more residues, mutually identical or different, from among: halogen, C 1 -C 4  alkyl, C 1 -C 4  alkoxyl, C 1 -C 4  haloalkyl, alkylsulfonyl, cycloalkyl, (cycloalkyl)alkyl, alkanoyl, amino, (C 1 -C 4 ) mono- or dialkylamino, (C 1 -C 4 ) aminoalkyl mono- or disubstituted with C 1 -C 4  alkyl, carboxy, C 1 -C 4  alkoxylcarbonyl, mercaptoalkoxy, mercaptophenoxy, nitro, cyano, oxo, perfluoroalkoxy, perfluoroalkyl, phenyl, phenoxy, phenylalkoxy, benzoyloxy, phenylalkyl, benzoyl, phenylsulfonyl and hydroxy. 
         [0035]    According to a preferred embodiment of the invention,
   X is O or CH, and   Ar is 6-diethylaminomethyl-naphtalen-2-yl or naphtalen-2-yl.   
 
         [0038]    The most preferred compounds being: 
         [0039]    Diethyl-[6-(4-hydroxycarbamoyl-phenyl-carbamoyloxymethyl)-naphtalen-2-yl-methyl]-ammonium chloride, preferably in monohydrate form, more preferably in monohydrate crystal form; 
         [0040]    4-(2-(S)-benzoylamino-3-naphtalen-2-yl-propionylamino)-N-hydroxy-benzamide; and/or 
         [0041]    benzo [1,3]dioxole-5-carboxylic acid [1(S)-(4-hydroxycarbamoyl-phenylcarbamoyl)-2-naphtalen-2-yl-ethyl]-amide. 
         [0042]    The compound of formula I is mainly intended for administration to a human, preferably to obtain a blood concentration between 125 and 250 nM; preferably, such compound is administered at a dosage ranging from 50 to 200 mg/day, more preferably from 100 to 200 mg/day. 
         [0043]    According to an embodiment it is administered at a dosage ranging from 50 mg twice a day to 200 mg once a day. 
         [0044]    According to another embodiment, it is administered in combination and/or in temporal proximity with at least one anti-retroviral agent; preferred anti-retroviral agents include nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, entry inhibitors, integrase inhibitors, co-receptor antagonists, viral adsorption inhibitors, viral specific transcription inhibitors and/or cyclin dependent kinase inhibitors; the most preferred anti-retroviral agents being efavirenz, indinavir sulfate and/or raltegravir potassium. 
       EXAMPLE 1  
     Induction of the HIV-1 Expression in the ACH-2 Cell Line 
       [0045]    ACH2 cells were obtained through AIDS Research and Reference Reagent Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. The cells were cultured in flasks, washed in RPMI and resuspended in RPMI/10% FCS at a concentration of 2×10 6  cells/mL. 250 μL of cells, 200 μL of media and 50 μL of HDAC inhibitors solution at various concentrations (from 0 to 250 nM), containing 0.01% DMSO, were divided into aliquotes in a 48-wells polystyrene tissue culture plate (Falcon, Lincoln Park, N.J.). After 24 hours of incubation at 37° C./5% CO 2 , 50 μL of supernatant were removed for the cytotoxicity assay of the lactate dehydrogenase (LDH) and Triton-X-100 (0.5% vol/vol final concentration) were added to each culture. The p24 assays of the lysates were performed immediately. 
         [0046]    The cellular death as determined by the LDH activity after 24 hours was not considerably different in the cells exposed to HDAC inhibitors with respect to the non-treated cells. p24 was measured using specific antibodies immobilized on magnetic beads as previously described [Nold M. F. et al.  J. Immunol.  181, 557 (2008)]. The levels of p24 for each experiment without HDAC inhibitors were fixed at 1.0 and the increase values by the number of times for each experiment and each analogous were calculated. The results are shown in the table below. 
         [0000]    
       
         
               
             
               
               
               
               
               
             
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 increase of the number of times in the level of p24 expressed in the 
               
               
                 presence of inhibitors with respect to the level obtained in the control 
               
             
          
           
               
                   
                 Conc 
                   
                   
                   
               
               
                   
                 (nM) 
                 ITF2357 
                 Compound g 
                 Compound t 
               
               
                   
                   
               
             
          
           
               
                   
                 31 
                 1 
                 2 
                 1 
               
               
                   
                 63 
                 1 
                 3 
                 2 
               
               
                   
                 125 
                 2 
                 10 
                 10 
               
               
                   
                 250 
                 15 
                 27 
                 33 
               
               
                   
                   
               
             
          
         
       
     
       EXAMPLE 2  
       [0047]    Inhibition of Histone Deacetylase Isoforms 
         [0048]    Recombinant human enzymes were acquired from BPS Biosciences (CA, USA). Isoforms of Class I HDAC1, 2, 3; HDAC6, 10 of Class IIb and Class IV HDAC11 were tested using the Fluor-de-Lys fluorogenic synthetic substrate (Enzo Life Sciences, Plymouth Meeting, Pa.). Isoforms of Class IIa HDAC4, 7, 9 were tested using the Boc-L-Lys(Tfa)-MCA (TFAL) derivative, described as a specific substrate for these enzymes [Jones P. et al.  Bioorg Med Chem Lett.  18, 3456 (2008)]. The recombinant human HDAC8 assay was performed using HDAC8 Fluorimetric Drug Discovery Kit (Enzo) according to the manufacturer instructions. Each inhibitor was dissolved in DMSO and then further diluted in an assay buffer. Concentrations of DMSO lower than 0.5% do not affect the activity of the assay. The assays were performed by pre-incubating each enzyme with the inhibitors for 15 minutes at 37° C. The reaction was started by adding the substrate at 37° C. and allowed to proceed for 60 minutes. The fluorescent signal was generated by adding 50 μL of a twice concentrated developer solution 2 (Enzo) containing trichostatin A 4 μM. The generated fluorescence was detected at 355 nm (excitation) and 460 nm (emission) wavelengths. 
         [0049]    The results, expressed as IC 50  (concentration required to reduce the enzymatic activity by 50%), are shown in the table below (the SAHA values were also measured and they are shown in the table). 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 values of IC 50  (nM) for the inhibition of each HDAC isoform 
               
             
          
           
               
                 ITF 
                 hHD1 
                 hHD2 
                 hHD3 
                 hHD4 
                 hHD6 
                 hHD7 
                 hHD8 
                 hHD9 
                 hHD10 
                 hHD11 
               
               
                   
               
             
          
           
               
                 ITF2357 
                 116.7 
                 119.3 
                 124.0 
                 724 
                 411.0 
                 612.8 
                 940.0 
                 518.0 
                 351.0 
                 307.0 
               
               
                 Compound g 
                 54.7 
                 12.0 
                 245.8 
                 3,107 
                 3,622 
                 2,021 
                 491.9 
                 4,153 
                 132.1 
                 441.4 
               
               
                 Compound t 
                 71.5 
                 29.5 
                 107.2 
                 &gt;10,000 
                 618.2 
                 8,621 
                 161.6 
                 &gt;10,000 
                 275.8 
                 336.3 
               
               
                 SAHA 
                 77.9 
                 287.4 
                 166.9 
                 &gt;10,000 
                 471.0 
                 &gt;10,000 
                 1,676 
                 &gt;10,000 
                 152.0 
                 187.8