Source: http://patents.com/us-8029815.html
Timestamp: 2013-12-12 14:52:28
Document Index: 197608183

Matched Legal Cases: ['art 1', 'art 91', 'Application No. 60', 'Application No. 60', 'art 1', 'art 91', 'art 91']

US Patent # 8,029,815. Methods for treating or preventing restenosis and other vascular
proliferative disorders - Patents.com
United States Patent 8,029,815
Methods for treating or preventing restenosis and other vascular
Described herein is the use of ribonucleotide reductase inhibitors in the
prevention or treatment of restenosis and other vascular proliferative
Inventors: Elford; Howard L. (Richmond, VA), Cardounel; Arturo J. (Gainesville, FL) Appl. No.:
11/587,706
PCT/US2005/014581
PCT Pub. No.: WO2005/115405
Related U.S. Patent Documents Application NumberFiling DatePatent NumberIssue Date 60566004Apr., 2004 Current U.S. Class:
424/422 ; 424/423; 600/483
Current International Class: A61F 13/00 (20060101); A61B 5/00 (20060101); A61F 2/00 (20060101)
Vydrin et al.
Van't Riet et al.
Rakhit et al.
5569666
Pietrzkowski et al.
Levina et al.
Capaccioli et al.
6046319
Nugiel et al.
2004/0126400
2009/0047250
32 37 253
1 362 511
WO 94/00135
WO 98/20864
WO 99/06009
WO 99/30699
WO 01/10454
WO 01/49281
WO 02/44321
WO 02/055017
WO 03/070188
WO 03/103583
WO 2004/006841
WO 2004/080377
WO 2005/027972
WO 2005/115405
WO 2005/123053
WO 2006/128142
WO 2007/104242
WO 2007/128442
WO 2008/021210
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The research leading to this invention was funded in part by National
Institute of Neurological Disorders and Stroke, Grant No. 1 R43
NS044780-01A1 and the National Institutes of Health, Grants NS044780 and
HL63744. The U.S. Government may have certain rights in this invention.
Application No. 60/566,004, filed Apr. 28, 2004. U.S. Provisional
Application No. 60/566,004 is incorporated by reference herein in its
Claims What is claimed is: 1. A method of treating or preventing restenosis comprising administering to a subject who has restenosis, or a subject who is undergoing or has undergone a vascular
procedure, in an amount effective to treat restenosis or prevent restenosis due to the vascular procedure, a composition that inhibits ribonucleotide reductase, wherein the composition comprises N-3,4-trihydroxybenzamide or a pharmaceutically acceptable
10. The method of claim 1, further comprising determining the degree of restenosis after administering the composition. Description FIELD
Restenosis is the narrowing of the blood vessels, which can occur after injury to the vessel wall, for example, injury caused by surgical techniques employed to achieve revascularization. Restenosis can occur following a number of surgical
procedures, for example, balloon angioplasty, transplant surgery, vein grafting, coronary by-pass grafting, and most frequently by percutaneous transluminal vascular intervention (PTVI). Unfortunately, many of these techniques are plagued by a high
incidence of vessel renarrowing or restenosis. Restenosis is mediated by internal hyperplasia and is characterized by excessive proliferation of vascular smooth muscle cells in the walls of the treated blood vessel.
The vascular changes observed following PTVI involve a cascade of molecular and cellular events occurring within the vessel wall involving the release of a variety of vasoactive, thrombogenic, and mitogenic factors. These factors, acting in
concert, stimulate the migration and proliferation of vascular smooth muscle cells (VSMC) and production of extracellular matrix material, which accumulate to occlude the blood vessel. Within this cascade are two processes that stand out as potential
therapeutic targets; vascular remodeling and neointimal hyperplasia. Vascular remodeling, defined as any enduring change in the size and/or composition of a blood vessel, allows adaptation and repair. On the other hand, inappropriate remodeling,
including its absence, underlies the pathogenesis of major cardiovascular diseases, such as atherosclerosis and restenosis. Experimental evidence acquired in vitro and in vivo suggests that the major drivers of vascular remodeling: inflammation,
partially a result of oxidative stress and free radical formation; and inappropriate cell migration and proliferation are all key regulators in the remodeling process and ultimately lead to vessel restenosis.
It has been demonstrated that cytokines can trigger much of the inflammatory component of injury. Cytokines are molecules that mediate the migration of leukocytes into inflamed tissues and control the inflammatory reactions in various
immune-mediated diseases. Both in animal models and in human specimens, chemokine expression is associated with atherosclerotic lesion development and vascular remodeling and restenosis after angioplasty. Activation of these inflammatory and
procoagulant mechanisms is thought to contribute significantly to the initiation of restenosis. During this process, expression of tissue factor (TF) represents another one of the major physiologic triggers of coagulation that results in thrombus
formation and the generation of additional signals leading to VSMC proliferation and migration.
In addition, the activity of NF-kappa B, a transcriptional regulatory factor, has been demonstrated to be involved in the inflammatory activation of endothelial cells and their adhesiveness and also appears to regulate apoptosis in smooth muscle
cells (SMC) by coordinating anti-apoptotic processes. The level of activity of NF-kappa B has been shown to be enhanced within human atheromas or following angioplasty as compared with healthy vessels. Thus, the inhibition of NF-kappa B mobilization
through therapeutic intervention can act to suppress endothelial activation and to induce SMC apoptosis. As mentioned, free radicals and oxidant stress also play a role in vascular pathology. Increased oxidative stress is a major characteristic of
restenosis after angioplasty. The oxidative stress is mainly created by oxidants such as reactive oxygen species (ROS), which are assumed to play a role in neointima formation and smooth muscle proliferation. Once oxidant stress is invoked,
characteristic pathophysiologic features follow, namely compromised vessel reactivity, vascular smooth muscle cell proliferation, macrophage adhesion, platelet activation, and lipid peroxidation, all perpetrators in the restenosis process. Evidence
suggests that this complex cascade of molecular and cellular events occurring within the vessel wall culminates in cellular proliferation.
In accordance with the purposes of the disclosed materials, compounds, compositions, and methods, as embodied and broadly described herein, the disclosed subject matter, in one aspect, relates to compounds and compositions and methods for
preparing and using such compounds and compositions. In another aspect, disclosed herein is the use of ribonucleotide reductase inhibitors for medical therapy in the prevention or treatment of restenosis.
The advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the aspects described below. The advantages described below will be
and are not restrictive. DESCRIPTION OF THE FIGURES
FIG. 1 is a series of photographs showing the effects of Didox, Imidate, and Hydroxyurea (HU) on the histopathology associated with balloon dilatation injury. Examples are from carotid artery sections stained with hematoxylin and eosin. Panel
(A) represents a control (uninjured) section of rat carotid artery. Panel (B) demonstrates the marked neointimal hyperplasia present at 2 weeks post balloon dilatation injury. Panel (C) demonstrates the inhibitory effects of Didox (200 mg kg.sup.-1
d.sup.-1) on neointimal proliferation in response to balloon injury. Panel (D) demonstrates the inhibitory effects of Imidate (200 mg kg.sup.1 d.sup.-1) on neointimal proliferation in response to balloon injury. Panel (E) demonstrates the inhibitory
effects of HU (200 mg kg.sup.1 d.sup.-1) on neointimal proliferation in response to balloon injury. Note the marked reduction in neointimal (NI) thickness following Didox, Imidate, and HU treatment.
FIGS. 2 A, B, and C are graphs showing the effects of Didox, Imidate, and HU on histopathological changes following balloon injury of the rat carotid artery at 2 weeks post injury. Morphometric analysis was performed at the conclusion of the
study. FIG. 2A compares neointima formation (mm.sup.2). FIG. 2B compares medial wall thickness (mm.sup.2). FIG. 2C compares intima to media ratio. "Control" represents the uninjured contralateral artery. "Injured" represents the ipsilateral balloon
dilated artery. "Didox" represents groups that were administered Didox immediately following injury followed by daily administration for 6 days. "Imidate" represents groups that were administered Imidate immediately following injury followed by daily
administration for 6 days. "HU" represents groups that were administered HU immediately following injury followed by daily administration for 6 days. The data represent the mean.+-.SD. "*" indicates significantly different at p<0.05 as compared to
injured (untreated). ".dagger-dbl." indicats significantly different at p<0.05 among treated groups.
FIGS. 3 A, B, and C are graphs showing the effects of Didox, Imidate, and HU on histopathological changes following balloon injury of the rat carotid artery at 6 weeks post injury. Morphometric analysis was performed at the conclusion of the
study. FIG. 3A compares neointima formation (mm.sup.2). FIG. 3B compares medial wall thickness (mm.sup.2). FIG. 3C compares intima to media ratio. "Control" represents the uninjured contralateral artery. "Injured" represents the ipsilateral balloon
FIG. 4 is a graph showing the effect of Didox, Imidate, and HU on SMC proliferation. The graph compares percent SMC growth inhibition as a function of drug concentration (.mu.M). Didox (0-200 .mu.M), Imidate (0-200 .mu.M), and HU (0-1000
.mu.M) were added to the SMC culture during the log phase of growth and incubated for 24 hours. Cells were then counted using a flow cytometer. Values represent the mean. (n=4).
FIG. 5 is a graph showing the effects of Didox, Imidate, and HU on SMC migration. The graph compares migration rate (.mu.m/hr) as a function of concentration (.mu.M). Didox (0-100 .mu.M), Imidate (0-100 .mu.M), and HU (0-1000 .mu.M) were added
to the SMC culture in media containing 0.1% serum and 10 ng/mL platelet derived growth factor (PDGF). A wound scrape was then made and SMC migration was monitored for an additional 24 hours. The data represent the mean.+-.SD. "*" indicates
significantly different at p<0.05 as compared to control.
The materials, compounds, compositions, articles, devices, and methods described herein can be understood more readily by reference to the following detailed description of specific aspects of the disclosed subject matter and the Examples
included herein and to the Figures.
Before the present materials, compounds, compositions, components, and/or methods are disclosed and described, it is to be understood that the aspects described below are not limited to specific compounds, synthetic methods, or uses as such may,
of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting.
Throughout the specification and claims the word "comprise" and other forms of the word, such as "comprising" and "comprises," means including but not limited to, and is not intended to exclude, for example, other additives, components,
integers, or steps.
As used in the description and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "a compound" includes mixtures of two or more
such compounds, reference to "an agent" includes mixtures of two or more such agents, reference to "the moiety" includes mixtures of two or more such moieties, and the like.
values are also disclosed, as appropriately understood by the skilled artisan. For example, if the value "10" is disclosed then "less than or equal to 10" as well as "greater than or equal to 10" is also disclosed. It is also understood that throughout
the application, data are provided in a number of different formats, and that this data, represent endpoints and starting points, and ranges for any combination of the data points. For example, if a particular data point "10" and a particular data point
"15" are disclosed, it is understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15 are considered disclosed as well as between 10 and 15.
the composition or article for which a part by weight is expressed. Thus, in a compound containing 2 parts by weight of component X and 5 parts by weight component Y, X and Y are present at a weight ratio of 2:5, and are present in such ratio regardless
By "inhibit" or other forms of the word such as "inhibiting" or "inhibition" is meant to hinder or restrain a particular characteristic. It is understood that this is typically in relation to some standard or expected value, in other words it
is relative, but that it is not always necessary for the standard or relative value to be referred to. For example, "inhibits ribonucleotide reductase" means hindering or restraining the activity of the enzyme relative to a standard or a control. "Inhibits ribonucleotide reductase" can also mean to hinder or restrain the synthesis or expression of the enzyme relative to a standard or control.
"Treatment" or "treating" means to administer a composition to a subject or a system with an undesired condition (e.g., restenosis or other vascular proliferative disorder). The condition can include a disease. "Prevention" or "preventing"
means to administer a composition to a subject or a system at risk for the condition. The condition can include a predisposition to a disease. The effect of the administration of the composition to the subject (either treating and/or preventing) can
be, but is not limited to, the cessation of a particular sysmptom of a condition, a reduction or prevention of the symptoms of a condition, a reduction in the severity of the condition, the complete ablation of the condition, a stabilization or delay of
the development or progression of a particular event or characteristic, or minimization of the chances that a particular event or characteristic will occur. It is understood that where treat or prevent are used, unless specifically indicated otherwise,
the use of the other word is also expressly disclosed.
By "subject" is meant an individual. The subject can be a mammal such as a primate or a human. The term "subject" can also include domesticated animals including, but not limited to, cats, dogs, etc., livestock (e.g., cattle, horses, pigs,
sheep, goats, etc.), and laboratory animals (e.g., mouse, rabbit, rat, guinea pig, etc.).
Disclosed herein are materials, compounds, compositions, and components that can be used for, can be used in conjunction with, can be used in preparation for, or are products of the disclosed methods and compositions. These and other materials
are disclosed herein, and it is understood that when combinations, subsets, interactions, groups, etc. of these materials are disclosed that while specific reference of each various individual and collective combinations and permutation of these
compounds may not be explicitly disclosed, each is specifically contemplated and described herein. For example, if a composition is disclosed and a number of modifications that can be made to a number of components or moieties of the compositions are
discussed, each and every combination and permutation that are possible are specifically contemplated unless specifically indicated to the contrary. Thus, if a class of components or moieties A, B, and C are disclosed as well as a class of components or
moieties D, E, and F, and an example of a combination composition A-D is disclosed, then even if each is not individually recited, each is individually and collectively contemplated. Thus, in this example, each of the combinations A-E, A-F, B-D, B-E,
B-F, C-D, C-E, and C-F are specifically contemplated and should be considered disclosed from disclosure of A, B, and C; D, E, and F; and the example combination A-D. Likewise, any subset or combination of these is also specifically contemplated and
disclosed. Thus, for example, the sub-group of A-E, B-F, and C-E are specifically contemplated and should be considered disclosed from disclosure of A, B, and C; D, E, and F; and the example combination A-D. This concept applies to all aspects of this
disclosure including, but not limited to, steps in methods of making and using the disclosed compositions. Thus, if there are a variety of additional steps that can be performed it is understood that each of these additional steps can be performed with
any specific aspect or combination of aspects of the disclosed methods, and that each such combination is specifically contemplated and should be considered disclosed.
Certain materials, compounds, compositions, and components disclosed herein can be obtained commercially or readily synthesized using techniques generally known to those of skill in the art. For example, the starting materials and reagents used
in preparing the disclosed compounds and compositions are either available from commercial suppliers such as Aldrich Chemical Co., (Milwaukee, Wis.), Acros Organics (Morris Plains, N.J.), Fisher Scientific (Pittsburgh, Pa.), or Sigma (St. Louis, Mo.) or
are prepared by methods known to those skilled in the art following procedures set forth in references such as Fieser and Fieser's Reagents for Organic Synthesis, Volumes 1-17 (John Wiley and Sons, 1991); Rodd's Chemistry of Carbon Compounds, Volumes 1-5
and Supplementals (Elsevier Science Publishers, 1989); Organic Reactions, Volumes 1-40 (John Wiley and Sons, 1991); March's Advanced Organic Chemistry, (John Wiley and Sons, 4th Edition); and Larock's Comprehensive Organic Transformations (VCH Publishers
Inc., 1989).
As used herein, the term "substituted" is contemplated to include all permissible substituents of organic compounds. In a broad aspect, the permissible substituents include acyclic and cyclic, branched and unbranched, carbocyclic and
heterocyclic, and aromatic and nonaromatic substituents of organic compounds. Illustrative substituents include, for example, those described below. The permissible substituents can be one or more and the same or different for appropriate organic
compounds. For purposes of this disclosure, the heteroatoms, such as nitrogen, can have hydrogen substituents and/or any permissible substituents of organic compounds described herein which satisfy the valencies of the heteroatoms. This disclosure is
not intended to be limited in any manner by the permissible substituents of organic compounds. Also, the terms "substitution" or "substituted with" include the implicit proviso that such substitution is in accordance with permitted valence of the
substituted atom and the substituent, and that the substitution results in a stable compound, e.g., a compound that does not spontaneously undergo transformation such as by rearrangement, cyclization, elimination, etc. Also, as used herein "substitution"
or "substituted with" is meant to encompass configurations where one substituent is fused to another substituent. For example, an alkyl group substituted with an aryl group can mean that the aryl group is bonded to the alkyl group via a single sigma
bond and also that the aryl group and alkyl group are fused, e.g., two carbons of the alkyl group are shared with two carbons of the aryl group.
"A," "A.sup.1," "A.sup.2," "A.sup.3," and "A.sup.4" are used herein as generic symbols to represent various specific substituents. These symbols can be any substituent, not limited to those disclosed herein, and when they are defined to be
certain substituents in one instance, they can, in another instance, be defined as some other substituents.
The term "alkyl" as used herein is a branched or unbranched saturated hydrocarbon group of 1 to 30 carbon atoms, such as methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, t-butyl, pentyl, hexyl, heptyl, octyl, nonyl, decyl, dodecyl,
tetradecyl, hexadecyl, eicosyl, tetracosyl, and the like. The alkyl group can also be substituted or unsubstituted. The alkyl group can be substituted with one or more groups including, but not limited to, alkyl, halogenated alkyl, alkoxy, alkenyl,
alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid, ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonylamino, nitro, silyl, or thiol, as described below.
Throughout the specification "alkyl" is generally used to refer to both unsubstituted alkyl groups and substituted alkyl groups; however, substituted alkyl groups are also specifically referred to herein by identifying the specific
substituent(s) on the alkyl group. For example, the term "halogenated alkyl" specifically refers to an alkyl group that is substituted with one or more halides, e.g., fluorine, chlorine, bromine, or iodine. In another example, the term "alkylalcohol"
specifically refers to an alkyl group that is substituted with one or more hydroxyl groups, as described below, and the like. When "alkyl" is used in one instance and a specific term such as "alkylalcohol" is used in another, it is not meant to imply
that the term "alkyl" does not also refer to specific terms such as "alkylalcohol" and the like.
This practice is also used for other groups described herein. That is, while a term such as "acyl" refers to both unsubstituted and substituted acyl moieties, the substituted moieties can, in addition, be specifically identified herein; for
example, a particular substituted acyl can be referred to as, e.g., an "acylamino." Similarly, a substituted alkoxy can be specifically referred to as, e.g., a "halogenated alkoxy," a particular substituted alkenyl can be, e.g., an "alkenylalcohol," and
the like. Again, the practice of using a general term, such as "acyl," and a specific term, such as "acylamino," is not meant to imply that the general term does not also include the specific term.
The term "alkoxy" as used herein is an alkyl group bound through a single, terminal ether linkage; that is, an "alkoxy" group may be defined as --OA where A is alkyl as defined above.
The term "alkenyl" as used herein is a hydrocarbon group of from 2 to 30 carbon atoms with a structural formula containing at least one carbon-carbon double bond. Asymmetric structures such as (A.sup.1A.sup.2)C.dbd.C(A.sup.3A.sup.4) are
intended to include both the E and Z isomers. This may be presumed in structural formulae herein wherein an asymmetric alkene is present, or it may be explicitly indicated by the bond symbol C.dbd.C. The alkenyl group can be substituted with one or
more groups including, but not limited to, alkyl, halogenated alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid, ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonylamino, nitro, silyl, or thiol, as described
The term "alkynyl" as used herein is a hydrocarbon group of 2 to 30 carbon atoms with a structural formula containing at least one carbon-carbon triple bond. The alkynyl group can be substituted with one or more groups including, but not
limited to, alkyl, halogenated alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic a cid, ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonylamino, nitro, silyl, or thiol, as described below.
The term "aryl" as used herein is a group that contains any carbon-based aromatic group including, but not limited to, benzene, naphthalene, phenyl, biphenyl, phenoxybenzene, and the like. The term "aryl" also includes "heteroaryl," which is
defined as a group that contains an aromatic group that has at least one heteroatom incorporated within the ring of the aromatic group. Examples of heteroatoms include, but are not limited to, nitrogen, oxygen, sulfur, and phosphorus. Likewise, the
term "non-heteroaryl," which is also included in the term "aryl," defines a group that contains an aromatic group that does not contain a heteroatom. The aryl group can be substituted or unsubstituted. The aryl group can be substituted with one or more
groups including, but not limited to, alkyl, halogenated alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid, ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonylamino, or thiol as described herein. The term
"biaryl" is a specific type of aryl group and is included in the definition of aryl. Biaryl refers to two aryl groups that are bound together via a fused ring structure, as in naphthalene, or are attached via one or more carbon-carbon bonds, as in
The term "cycloalkyl" as used herein is a non-aromatic carbon-based ring composed of at least three carbon atoms. Examples of cycloalkyl groups include, but are not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, etc. The term
"heterocycloalkyl" is a cycloalkyl group as defined above where at least one of the carbon atoms of the ring is substituted with a heteroatom such as, but not limited to, nitrogen, oxygen, sulfur, or phosphorus. The cycloalkyl group and heterocycloalkyl
group can be substituted or unsubstituted. The cycloalkyl group and heterocycloalkyl group can be substituted with one or more groups including, but not limited to, alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid,
ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonylamino, nitro, silyl, or thiol as described herein.
The term "cycloalkenyl" as used herein is a non-aromatic carbon-based ring composed of at least three carbon atoms and contains at least one double bound, e.g., C.dbd.C. Examples of cycloalkenyl groups include, but are not limited to,
cyclopropenyl, cyclobutenyl, cyclopentenyl, cyclopentadienyl, cyclohexenyl, cyclohexadienyl, and the like. The term "heterocycloalkenyl" is a type of cycloalkenyl group as defined above, and is included within the meaning of the term "cycloalkenyl,"
where at least one of the carbon atoms of the ring is substituted with a heteroatom such as, but not limited to, nitrogen, oxygen, sulfur, or phosphorus. The cycloalkenyl group and heterocycloalkenyl group can be substituted or unsubstituted. The
cycloalkenyl group and heterocycloalkenyl group can be substituted with one or more groups including, but not limited to, alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid, ester, ether, halide, hydroxy, ketone,
sulfo-oxo, sulfonylamino, nitro, silyl, or thiol as described herein.
The term "cyclic group" is used herein to refer to either aryl groups, non-aryl groups (i.e., cycloalkyl, heterocycloalkyl, cycloalkenyl, and heterocycloalkenyl groups), or both. Cyclic groups have one or more ring systems that can be
substituted or unsubstituted. A cyclic group can contain one or more aryl groups, one or more non-aryl groups, or one or more aryl groups and one or more non-aryl groups.
The term "acyl" as used herein is represented by the formula A-C.dbd.O, where A can be an alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid, ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonylamino,
nitro, silyl, or thiol as described herein.
The terms "amine" or "amino" as used herein are represented by the formula NA.sup.1A.sup.2A.sup.3, where A.sup.1, A.sup.2, and A.sup.3 can be, independently, hydrogen, an alkyl, halogenated alkyl, alkenyl, alkynyl, aryl, heteroaryl, cycloalkyl,
cycloalkenyl, heterocycloalkyl, or heterocycloalkenyl group described above.
The term "ester" as used herein is represented by the formula --OC(O)A or --C(O)OA, where A can be an alkyl, halogenated alkyl, alkenyl, alkynyl, aryl, heteroaryl, cycloalkyl, cycloalkenyl, heterocycloalkyl, or heterocycloalkenyl group described
The term "ether" as used herein is represented by the formula A.sup.1OA.sup.2, where A.sup.1 and A.sup.2 can be, independently, an alkyl, halogenated alkyl, alkenyl, alkynyl, aryl, heteroaryl, cycloalkyl, cycloalkenyl, heterocycloalkyl, or
heterocycloalkenyl group described above.
The term "ketone" as used herein is represented by the formula A.sup.1C(O)A.sup.2, where A.sup.1 and A.sup.2 can be, independently, an alkyl, halogenated alkyl, alkenyl, alkynyl, aryl, heteroaryl, cycloalkyl, cycloalkenyl, heterocycloalkyl, or
The term "halide" or "halo" as used herein refers to the halogens fluorine, chlorine, bromine, and iodine.
The term "silyl" as used herein is represented by the formula --SiA.sup.1A.sup.2A.sup.3, where A.sup.1, A.sup.2, and A.sup.3 can be, independently, hydrogen, alkyl, halogenated alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, cycloalkyl,
The term "sulfo-oxo" as used herein is represented by the formulas --S(O)A (sulfoxide), --S(O).sub.2A (sulfonyl), --OS(O).sub.2A (sulfone), or --OS(O).sub.2OA, where A can be hydrogen, an alkyl, halogenated alkyl, alkenyl, alkynyl, aryl,
heteroaryl, cycloalkyl, cycloalkenyl, heterocycloalkyl, or heterocycloalkenyl group described above.
"X," "X.sup.n," "Z," "P," "R," and "R.sup.n," where n is some integer, as used herein can, independently, possess two or more of the groups listed above. These and other specific examples are disclosed herein. For example, if R is a straight
chain alkyl group, one of the hydrogen atoms of the alkyl group can optionally be substituted with a hydroxyl group (OH), an alkoxy group, halide, etc. Depending upon the groups that are selected, a first group can be incorporated within second group or,
alternatively, the first group can be pendant (i.e., attached) to the second group.
Reference will now be made in detail to specific aspects of the disclosed materials, compounds, compositions, components, and methods, examples of which are illustrated in the following description and examples, and in the figures and their
Disclosed herein, in one aspect, are methods of treating or preventing restenosis and other vascular proliferative disorders by administering one or more ribonucleotide reductase inhibitors. Ribonucleotide reductase catalyzes the reductive
conversion of ribonucleotides to deoxynucleotides. This reductive reaction is a rate limiting step in the biochemical pathway leading to DNA synthesis and thus cell replication (Elford et al., (1970) J Biol Chem 245:5228-5233; Elford et al., (1979)
Cancer Res 39:844-851; Takeda and Weber, (1981) Life Sci 28:1007-1014; Natsumeda et al., (1985) Cancer Res 45:2556-2559; Anderson et al., (1993) J Interv Cardiol 6:187-202; Tanaka et al., (2000) Nature 404:42-49). DNA synthesis cannot occur without
invoking this reaction since the endogenous pools of dNTP in mammalian cells are inadequate to support new DNA synthesis (Elford et al., (1970) J Biol Chem 245:5228-5233; Elford et al., (1979) Cancer Res 39:844-851). As disclosed herein, ribonucleotide
reductase is a prime target for impeding cellular proliferation, and is amenable to inhibiting VSMC replication and leukocyte production. It has been shown that rate of uncontrolled cell growth is closely associated with the specific activity of this
enzyme. Because restenosis is ultimately a proliferative disease, ribonucleotide reductase inhibitors can serve as novel therapeutic agents in the treatment of restenosis following vascular trauma or injury. Also ribonucleotide reductase inhibitors can
serve as novel therapeutic agents in the treatment of other disorder caused by abnormal vascular proliferation.
The ribonucleotide reductase inhibitors disclosed herein can be used for the treatment or prevention of restenosis or a vascular proliferative disorder in a subject. By "ribonucleotide reductase inhibitor" is meant any composition that impairs
or inhibits the enzyme ribonucleotide reductase or any of its subunits, which, as noted herein, catalyzes the reductive reaction that converts ribonucleotides into deoxyribonucleotides. Such inhibitors can, for example, act by binding to the enzyme,
preventing the enzyme from becoming active, degrade the enzyme, alter expression of the enzyme, or alter the production of the enzymer.
The reductive reaction that converts ribonucleotides into deoxyribonucleotides primarily occurs at the diphosphate form of the nucleotides. Suitable ribonucleotide reductase inhibitors can be small molecules that bind to or associate with the
reductase, nucleic acid based inhibitors that reduce or prevent the expression of ribonucleotide reductase, or polypeptide based molecules that interact with the reductase to inhibit enzyme activity. Also included are deoxynucleosides that are converted
in vivo to deoxynucleotide di- or tri-phosphates that interact with RR holoenzyme or it subunits to interfere with the activity of the enzyme. In one aspect, suitable examples of ribonucleotide reductase inhibitors include, but are not limited to,
nucleoside inhibitors (e.g., fludarabine, 2-fluoromethylene-2' deoxycitidine-5' diphoshate, gemcitibine, 2' azido-2' deoxynucleoside of cytosine, and uracil thionucleotides), Fe-chelators (e.g., Desferrol, Desferoxamine, Desferri-Exochelin, and IC202C),
thiosemicarbazides such as Triapine, small peptide inhibitors such as P7, and hydroxamic acids such as hydroxyurea. These and other ribonucleotide reductase inhibitors are described more fully herein.
##STR00001## wherein n is from 2 to 5, m is 0 or 1, R is NH.sub.2, NHOH, OC.sub.1-3 alkyl, or O-phenyl, R.sup.1 is O, NH, NOH, or S and R.sup.2 is H, OH, SH, or NH.sub.2. It is contemplated that Formula I includes the tautomeric form where the
C.dbd.R.sup.1 moiety exists as a single bond (C--R.sup.1), and the double bond exists in the moiety (CR.sup.2).sub.m.dbd.C. In this tautomeric form, the variables are the same as disclosed above and further include R.sup.1 being SH. In another aspect,
prodrugs of the compounds having the Formula I can be used. For example, phenolic acetyl derivatives of compounds according to Formula I can be used as the ribonucleotide reductase inhibitors. In this aspect, the acetyl derivatives act as "pro-drugs"
in that they are converted by the subject to the corresponding ribonucleotide reductase inhibitor having entirely unesterified phenolic hydroxyls, which are the therapeutically active drugs.
Examples of ribonucleotide reductase inhibitors covered under Formula I include, but are not limited to, 2,3-dihydroxyphenyl, 3,4-dihydroxyphenyl, 2,5-dihydroxyphenyl, 2,6-dihydroxyphenyl, 2,3,4-trihydroxyphenyl, 2,3,5-trihydroxyphenyl,
3,4,5-trihydroxyphenyl, 2,4,5-trihydroxyphenyl, 2,3,4,5-tetrahydroxyphenyl, pentahydroxyphenyl and the like groups.
In one aspect, when the ribonucleotide reductase inhibitor has the Formula I, m is 1 and R.sup.2 is H (a phenylacetic acid derivative). In another aspect, when the ribonucleotide reductase inhibitor has the Formula I, m is 1 and R.sup.2 is OH
(a mandelic acid derivative). In a further aspect, when the ribonucleotide reductase inhibitor has the Formula I, m is 0, R is NHOH and R.sup.1 is O (an N-hydroxybenzamide (formerly, a benzohydroxamic acid)). In another aspect, when the ribonucleotide
reductase inhibitor has the Formula I, R is NH.sub.2 and R.sup.1 is NH (a benzimidamide (formerly a benzamidine)). In a further aspect, when the ribonucleotide reductase inhibitor has the Formula I, R is NHOH and R.sup.1 is NH (an N-hydroxy
benzimidamide (formerly a benzamidoxime)). In another aspect, when the ribonucleotide reductase inhibitor has the Formula I, R is NHOH and R.sup.1 is NOH (an N,N'-dihydroxy benzimidamide (formerly, an hydroxyamidoxime)). In a further aspect, when the
ribonucleotide reductase inhibitor has the Formula I, R is O-alkyl or O-phenyl and R.sup.1 is NH (a benzimidate). In another aspect, when the ribonucleotide reductase inhibitor has the Formula I, R is OC.sub.1-10 alkyl, wherein the alkyl groups include,
but are not limited to, methyl, ethyl, isopropyl, and n-propyl.
Compounds represented by Formula I are disclosed in U.S. Pat. Nos. 6,248,782; 4,253,322; 4,623,659; 2,848,430 and 3,629,443, which are incorporated by reference in their entireties. Methods for their preparation are also fully disclosed in
these patents as well as in the many references cited therein. In another aspect, the polyphenolic compounds N-3,4-trihydroxybenzamide (Didox) and ethyl-3,4,5-trihydroxybenzenecarboximidate-HCl (Imidate) can be used herein as ribonucleotide reductase
##STR00002## wherein n is from 2 to 5 and P can be COOH or the pharmaceutically-acceptable salt or ester thereof, CN, C.sub.1-8 alkyl, aryl-substituted C.sub.1-8 alkyl, acylamino, HOC.sub.2H.sub.4--NH--CH.sub.2--C(.dbd.O)--,
C.sub.1-C.sub.2H.sub.4--NCH.sub.3--CH.sub.2--C(.dbd.O)--, C(S)OC.sub.2H.sub.5, C(O)--NH--C.sub.1-3 alkyl, C(.dbd.NH)--N(OH)--C.sub.1-3 alkyl, and substituted variants thereof. In one aspect, phenolic blocking groups such as, for example, alkanoic acids,
phenacyl esters and the like can be employed to yield pro-drugs which are removed by the subject upon administration to yield drugs containing only free phenolic hydroxyls.
In another aspect, ribonucleotide reductase inhibitors useful herein have the formula R.sup.3Z, wherein R.sup.3 can be H, NH.sub.2, NH.sub.2--NH, NHOH, NOH--R.sup.6, C.sub.1-6 alkyl, OC.sub.1-6 alkyl, aryl-substituted with C.sub.1-6 alkyl,
phenyl, naphthyl, pyridyl, pyrimidyl or thienyl, and wherein Z can be C(.dbd.O)NOH--R.sup.4, C(.dbd.S)--NOH--R.sup.4, C(.dbd.NH)--NOH--R.sup.4, C(.dbd.NOH)--C.sub.1-3 alkyl, C(.dbd.NOH)--R.sup.4 and C(.dbd.NOH)--R.sup.5, wherein R.sup.4 can be H,
C.sub.1-6 alkyl and substituted C.sub.1-6 alkyl, wherein R.sup.4 can be substituted with hydroxy, alkoxy, amino or halo, and wherein R.sup.5 is NH.sub.2 or NHOH, wherein R.sup.6 is C.sub.1-6 acyl, alkyl and substituted C.sub.1-6 alkyl substituted with
hydroxyl, alkoxy, amino or halo and the like. The above group of compounds are generally referred to as "hydroxyureas." The compounds disclosed in by Young, et al., (1967) Cancer Res. 27(Part 1):635, which is incorporated by reference in its entirety,
can be used herein. In one aspect, the ribonucleotide reductase inhibitors can be hydroxyurea.
In another aspect, ribonucleotide reductase inhibitors useful in the methods herein include semithiocarbazones such as, for example, 2-formylpyridine, 2-acetylpyridine, 1-formylisoquinoline, 1-acetylisoquinoline, and their ring substituted
analogs. Formulae III and IV below illustrate these compounds
##STR00003## wherein Formula III represents pyridine-type compounds and Formula IV represents isoquinoline-semithiocarbazones, where X.sup.1 can be H or CH.sub.3, X.sup.2 can be H, OH, NH.sub.2, F, CF.sub.3, C.sub.1-3 alkyl, OX.sup.3,
NHX.sup.3N(X.sup.3).sub.2, and O(O.dbd.C)X.sup.4, in which X.sup.3 denotes C.sub.1-3 alkyl and X.sup.4 can be aryl, C.sub.1-6 alkyl including substitutions on the alkyl chain of the carboxylic acid with C.sub.1-3 alkoxy, C.sub.1-3 mono- or di-alkylamino,
aryloxy, also those in which the aryl ring is substituted with one or more hydroxy, amino or chloro groups. Both E and Z isomers of the compounds and their mixtures can be used herein.
In one aspect, 2-formylpyridine and 2-acetylpyridine thiosemicarbazone derivatives useful herein include 3-hydroxy, 3-amino, 3-methyl, 3-methoxy, 3-acetoxy, 3-ethoxy, 3-fluoro, 5-hydroxy, 5-amino, 5-fluoro, 5-trifluoromethyl, 5-methoxy,
5-ethoxy, 5-dimethylamino, 5-pivaloyloxy, 5-phenoxyacetoxy, 5-N,N-dimethylaminoacetoxy, and 3,4-dihydroxybenzoyloxy as ring substituents. In another aspect, 1-formylisoquinoline and 1-acetylisoquinoline thiosemicarbazone derivatives useful herein
include 4-hydroxy, 4-methyl, 4-amino, 5-fluoro, 5-trifluoromethyl, 5-amino and 5-acetylamino as ring substituents. The 2-formylpyridine and 1-formylisoquinoline thiosemicarbazone derivatives disclosed in French et al, (1974) J Med Chem 17:172, which is
incorporated by reference in its entirety, can be used herein. Other examples of thiosemicarbazone derivatives that can be used in the compositons and methods disclosed herein are described in U.S. Pat. Nos. 5,869,676, and 5,767,134, which are
incorpored by reference herein for at least their teachings of thiosemicarbazone derivatives.
Still other examples of small molecule ribonucleotide reductase inhibitors that can be used in the disclosed compositions and methods are disclosed in U.S. Pat. Nos. 5,760,210, 5,569,666, 5,589,587, 5,550,144, 5,545,650, 5,545,649, 5,541,207,
5,536,739, 5,536,738, 5,519,041, 5,514,695, 5,508,393, 5,498,622, 5,496,841, 5,496,840, 5,496,839, 5,496,838, 5,496,837, 5,476,841, 5,466,702, 5,391,563, 5,292,775, 5,198,425, 5,173,505, 5,128,353, 5,071,835, 4,845,195, 4,837,304, 4,814,432, which are
incorporated by reference herein for at least their teachings of ribonucleotide reductase inhibitors.
In another aspect, a suitable ribonucleotide reductase inhibitor can be a nucleic acid based inhibitor. There are a variety of molecules disclosed herein that are nucleic acid based. The disclosed nucleic acids are made up of for example,
nucleotides, nucleotide analogs, or nucleotide substitutes. Non-limiting examples of these and other molecules are discussed herein. It is understood that for example, when a vector is expressed in a cell, that the expressed mRNA will typically be made
up of A, C, G, and U. Likewise, it is understood that if, for example, an antisense molecule is introduced into a cell or cell environment through for example exogenous delivery, it is advantageous that the antisense molecule be made up of nucleotide
analogs that reduce the degradation of the antisense molecule in the cellular environment.
A nucleotide is a molecule that contains a base moiety, a sugar moiety and a phosphate moiety. Nucleotides can be linked together through their phosphate moieties and sugar moieties creating an internucleoside linkage. The base moiety of a
nucleotide can be adenine-9-yl (A), cytosine-1-yl (C), guanine-9-yl (G), uracil-1-yl (U), and thymine-1-yl (T). The sugar moiety of a nucleotide is a ribose or a deoxyribose. The phosphate moiety of a nucleotide is pentavalent phosphate. An
non-limiting example of a nucleotide would be 3'-AMP (3'-adenosine monophosphate) or 5'-GMP (5'-guanosine monophosphate).
A nucleotide analog is a nucleotide which contains some type of modification to either the base, sugar, or phosphate moieties. Modifications to nucleotides are well known in the art and would include for example, 5-methylcytosine (5-me-C),
5-hydroxymethyl cytosine, xanthine, hypoxanthine, and 2-aminoadenine as well as modifications at the sugar or phosphate moieties.
Nucleotide substitutes are molecules having similar functional properties to nucleotides, but which do not contain a phosphate moiety, such as peptide nucleic acid (PNA). Nucleotide substitutes are molecules that will recognize nucleic acids in
a Watson-Crick or Hoogsteen manner, but which are linked together through a moiety other than a phosphate moiety. Nucleotide substitutes are able to conform to a double helix type structure when interacting with the appropriate target nucleic acid.
It is also possible to link other types of molecules (conjugates) to nucleotides or nucleotide analogs to enhance for example, cellular uptake. Conjugates can be chemically linked to the nucleotide or nucleotide analogs. Such conjugates
include but are not limited to lipid moieties such as a cholesterol moiety. (Letsinger et al., Proc Natl Acad Sci USA (1989) 86:6553-6556).
Antisense molecules are one example of suitable nucleic acid based ribonucleotide reductase inhibitors that can be used in the disclosed methods and compositions. Antisense molecules are designed to interact with a target nucleic acid molecule
through either canonical or non-canonical base pairing. The interaction of the antisense molecule and the target molecule (e.g., ribonucleotide reductase or a subunit thereof) is designed to promote the destruction of the target molecule through, for
example, RNAseH mediated RNA-DNA hybrid degradation. Alternatively the antisense molecule is designed to interrupt a processing function that normally would take place on the target molecule, such as transcription or replication. Antisense molecules
can be designed based on the sequence of the target molecule. Numerous methods for optimization of antisense efficiency by finding the most accessible regions of the target molecule exist. Exemplary methods would be in vitro selection experiments and
DNA modification studies using DMS and DEPC. It is preferred that antisense molecules bind the target molecule with a dissociation constant (k.sub.d) less than or equal to 10.sup.-6, 10.sup.-8, 10.sup.-10, or 10.sup.-12. A representative sample of
methods and techniques which aid in the design and use of antisense molecules can be found in the following non-limiting list of U.S. Pat. Nos. 5,135,917, 5,294,533, 5,627,158, 5,641,754, 5,691,317, 5,780,607, 5,786,138, 5,849,903, 5,856,103,
5,919,772, 5,955,590, 5,990,088, 5,994,320, 5,998,602, 6,005,095, 6,007,995, 6,013,522, 6,017,898, 6,018,042, 6,025,198, 6,033,910, 6,040,296, 6,046,004, 6,046,319, and 6,057,437.
To design antisense oligonucleotides, a host mRNA sequence is examined. Regions of the sequence containing multiple repeats, such as TTTTTTTT, are not as desirable because they will lack specificity. Several different regions can be chosen. Of those, oligonucleotides are selected by the following characteristics: those having the best conformation in solution; those optimized for hybridization characteristics; and those having less potential to form secondary structures. Antisense
molecules having a propensity to generate secondary structures are less desirable.
Suitable antisense molecules for the disclosed methods and compositions impair ribonucleotide reductase synthesis or activity. Antisense molecules that can be used in the disclosed methods and compositions can also be obtained commercially. For example, Lorus Therapeutics (Toronto, Canada) has developed antisense molecules which are specific for either R1 or R2 mRNA, the two subunits of ribonucleotide reductase. Specific examples of antisense molecules from Lorus that can be used in the
disclosed methods and compositions include GTI-2040 and GTI-2501. Recent toxicology studies with rodents and monkeys have indicated that this compound is likely to be safe in humans at concentrations that exceed therapeutic doses. GTI-2040 (having
following sequence 5'-GGCTAAATCGCTCCACCAAG-3' (SEQ ID NO:1)) is currently in a Phase II clinical trial for patients with advanced or metastatic renal cell carcinoma. GTI-2501 is in Phase II clinical trials for use in hormone-refractory prostate cancer
in combination with docetaxel. Other examples of suitable antisense molecules that can be used in the disclosed methods and compositions are disclosed in U.S. Pat. Nos. 6,593,305, 6,121,000, and 5,998,383, which are incorporated by reference herein
in for at least their teachings of antisense ribonucleotide reductase inhibitors.
Short interfering RNAs (siRNAs) are another example of suitable nucleic acid based ribonucleotide reductase inhibitors that can be used in the disclosed methods and compositions. siRNAs are double-stranded RNAs that can induce sequence-specific
post-transcriptional gene silencing, thereby decreasing or even inhibiting gene expression.
In one example, an siRNA triggers the specific degradation of homologous RNA molecules, such as mRNAs, within the region of sequence identity between both the siRNA and the target RNA. For example, WO 02/44321 discloses siRNAs capable of
sequence-specific degradation of target mRNAs when base-paired with 3' overhanging ends. The direction of dsRNA processing determines whether a sense or an antisense target RNA can be cleaved by the produced siRNA endonuclease complex. Thus, siRNAs can
be used to modulate transcription, for example, by silencing genes, such as B-chimerin rho-GTPase or Rab9. The effects of siRNAs have been demonstrated in cells from a variety of organisms, including Drosophila, C. elegans, insects, frogs, plants,
fungi, mice and humans (for example, WO 02/44321; Gitlin et al., (2002) Nature 418:430-4; Caplen et al., (2001) Proc. Natl. Acad. Sci. 98:9742-9747; and Elbashir et al., (2001) Nature 411:494-8). In certain examples, siRNAs are directed against
certain target genes, such as ribonucleotide reductase.
Examples of siRNA that can be used to inhibit the expression of ribonucleotide reductase, as disclosed herein, are disclosed in Duxbury et al., (2004) Oncogene. 23(8):1539-1548; Duxbury et al., (2004) Surgery. 136(2):261-269; Lin et al.,
(2004) Biol. Chem., 279(26):27030-27038; which are incorporated by reference herein for at least their teachings of siRNA.
In yet another aspect, a suitable ribonucleotide reductase inhibor can be a polypeptide (for example, an antibody specific for ribonucleotide reductase or subunits R1, R2, or p53 thereof). Examples of polypeptide based ribonucleotide reductase
inhibitors are disclosed in U.S. Pat. Nos. 6,030,942 and 5,885,830, which are incorporated by reference herein for at least their teachings of polypeptide based ribonucleotide inhibitors. In one example, P7 is a suitable peptide based ribonucleotide
reductase inhibitor having the sequence TLDADF (SEQ ID NO:2). P7 corresponds to the C-terminus of mR2 and competes with mR2 for binding to mR1.
Where possible, any of the compounds described herein can be the pharmaceutically acceptable salt or ester thereof. In one aspect, pharmaceutically acceptable salts are prepared by treating the free acid with an appropriate amount of a
pharmaceutically acceptable base. Representative pharmaceutically acceptable bases are ammonium hydroxide, sodium hydroxide, potassium hydroxide, lithium hydroxide, calcium hydroxide, magnesium hydroxide, ferrous hydroxide, zinc hydroxide, copper
hydroxide, aluminum hydroxide, ferric hydroxide, isopropylamine, trimethylamine, diethylamine, triethylamine, tripropylamine, ethanolamine, 2-dimethylaminoethanol, 2-diethylaminoethanol, lysine, arginine, histidine, and the like. In one aspect, the
reaction is conducted in water, alone or in combination with an inert, water-miscible organic solvent, at a temperature of from about 0.degree. C. to about 100.degree. C. such as at room temperature. The molar ratio of ribonucleotide reductase
inhibitor to base used is chosen to provide the ratio desired for any particular salts. For preparing, for example, the ammonium salts of the free acid starting material, the starting material can be treated with approximately one equivalent of
pharmaceutically acceptable base to yield a neutral salt.
Ester derivatives are typically prepared as precursors to the acid form of the compounds and accordingly can serve as prodrugs. Generally, these derivatives will be lower alkyl esters such as methyl, ethyl, and the like. Amide derivatives
--(CO)NH.sub.2, --(CO)NHR and --(CO)NR.sub.2, where R is an alkyl group defined above, can be prepared by reaction of the carboxylic acid-containing compound with ammonia or a substituted amine.
Some of the ribonucleotide reductase inhibitors may potentially be administered as a pharmaceutically acceptable acid- or base-addition salt, formed by reaction with inorganic acids such as hydrochloric acid, hydrobromic acid, perchloric acid,
nitric acid, thiocyanic acid, sulfuric acid, and phosphoric acid, and organic acids such as formic acid, acetic acid, propionic acid, glycolic acid, lactic acid, pyruvic acid, oxalic acid, malonic acid, succinic acid, maleic acid, and fumaric acid, or by
reaction with an inorganic base such as sodium hydroxide, ammonium hydroxide, potassium hydroxide, and organic bases such as mono-, di-, trialkyl and aryl amines and substituted ethanolamines. In another aspect, the ribonucleotide reductase inhibitor is
in the form of the sodium or potassium salt. In another embodiment, the ribonucleotide reductase inhibitors can be converted to the corresponding pharmaceutically-acceptable ester such as, for example, the methyl ester.
As an example, the disclosed ribonucleotide reductase inhibitors can be used to treat or prevent restenosis and other vascular proliferation disorders in a subject in need thereof. In one aspect, a subject can be identified as being at risk for
restenosis or other vascular proliferation disorders. Subjects at risk for restenosis are generally those who have undergon or are undergoing a vascular trauma, for example, following percutaneous transluminal coronary angioplasty (PTCA). The use of
PTCA has greatly reduced the number of fatalities in patients who suffer myocardial infarction (Fischman et al., (1994) N Engl J Med 331:496-501; Elezi et al., (1998) Circulation 98:1875-1880; Bennett and O'Sullivan, (2001) Pharmacol Ther 91:149-166). During PTCA, the artery walls are expanded by several times their original diameter in an attempt to increase lumen diameter and improve flow. Unfortunately, this technique is plagued by a high incidence of vessel renarrowing or restenosis occurring in
30-40% of patients within 6 months of the procedure (Anderson et al., (1993) J Interv Cardiol 6:187-202; Fischman et al., (1994) N Engl J Med 331:496-501; Elezi et al., (1998) Circulation 98:1875-1880; Bennett and O'Sullivan, (2001) Pharmacol Ther
91:149-166; Heckenkamp et al., (2002) J Cardiovasc Surg (Torino) 43:349-357). Prevention of restenosis after successful PTCA remains one of the most challenging tasks in the treatment of obstructive coronary artery disease. Attempts to ameliorate this
proliferative response involve the use coronary stents, which have significantly improved both short term and long term outcome following interventional coronary revascularization procedures. Despite a reduction in restenosis rate with stent deployment,
restenosis still occurs in 15-30% of patients within 6 months (Fischman et al., (1994) N Engl J Med 331:496-501; Elezi et al., (1998) Circulation 98:1875-1880). This incidence of in-stent restenosis is expected to increase as coronary stenting is
becoming more frequent and is used in less ideal lesions. Therefore, in addition to mechanical intervention, pharmacological approaches to reduce the incidence and degree of restenosis, such as those disclosed herein, are needed.
The vascular trauma associated with PTCA involves a cascade of molecular and cellular events occurring within the vessel wall involving the release of a variety of vasoactive, thrombogenic, and mitogenic factors (Bauters and Isner, (1997) Prog
Cardiovasc Dis 40:107-116; Libby and Tanaka, (1997) Prog Cardiovasc Dis 40:97-106; Goldschmidt-Clermont and Moldovan, (1999) Gene Expr 7:255-260). Within this cascade, several mechanisms contribute to restenosis including elastic recoil, thrombosis,
smooth muscle cell migration/proliferation and matrix formation. The result of these vascular events is intimal hyperplasia, whereby vascular smooth muscle cells (VSMC's) migrate from the media to the intima, proliferate, and consequently form the
neointima. During this proliferative response, SMCs undergo a phenotypic modulation from a contractile to a synthetic phenotype (differentiation) (Epstein et al., (1991) Circulation 84:778-787; Noda-Heiny and Sobel, (1995) Am J Physiol 268:C1195-1201;
Ueda et al., (1995) Coron Artery Dis 6:71-81; Farb et al., (2002) Circulation 105:2974-2980; Indolfi et al., (2003) Trends Cardiovasc Med 13:142-148). While not wishing to be bound by theory, the compounds and compositions are believed to be effective
because they target/impede smooth muscle cell migration and cell proliferation, critical components of restenosis injury. Thus, the disclose ribonucleotide reductase inhibitors can be used to treat or prevent restenosis and other vascular proliferative
As used throughout, administration of any of the ribonucleotide reductase inhibitors described herein can occur in conjunction with other therapeutic agents. Thus, the ribonucleotide reductase inhibitors can be administered alone or in
combination with one or more therapeutic agents. For example, a subject can be treated with a ribonucleotide reductase inhibitor alone, or in combination with chemotherapeutic agents, antibodies, antibiotics, antivirals, steroidal and non-steroidal
anti-inflammatories, conventional immunotherapeutic agents, cytokines, chemokines and/or growth factors. Combinations can be administered either concomitantly (e.g., as an admixture), separately but simultaneously (e.g., via separate intravenous lines
into the same subject), or sequentially (e.g., one of the compounds or agents is given first followed by the second). Thus, the term "combination" or "combined" is used to refer to either concomitant, simultaneous, or sequential administration of two or
more agents. In one aspect, the ribonucleotide reductase inhibitors can be combined with other agents such as, for example, Paclitaxel, Taxotere, other taxoid compounds, other anti proliferative agents such as Methotrexate, anthracyclines such as
doxorubicin, immunosuppressive agents such as Everolimus and Serolimus, and other rapamycin and rapamycin derivatives.
The ribonucleotide reductase inhibitors can be administered in a number of ways depending on whether local or systemic treatment is desired, and on the area to be treated. Administration can be topically (including opthamalically, vaginally,
rectally, intranasally), orally, by inhalation, or parenterally, for example by intravenous drip, subcutaneous, intraperitoneal or intramuscular injection. The disclosed compounds can be administered intravenously, intraarterialy, intraperitoneally,
intramuscularly, subcutaneously, intracavity, transdermally, intratracheal, extracorporeally, or topically (e.g., topical intranasal administration or administration by inhalant). As used herein, "topical intranasal administration" means delivery of the
compositions into the nose and nasal passages through one or both of the nares and can comprise delivery by a spraying mechanism or droplet mechanism, or through aerosolization of the ribonucleotide inhibitor or mendicant. The latter can be effective
when a large number of subjects are to be treated simultaneously. Administration of the compositions by inhalant can be through the nose or mouth via delivery by a spraying or droplet mechanism. Delivery can also be directly to any area of the
respiratory system (e.g., lungs) via intubation.
Parenteral administration of the composition, if used, is generally characterized by injection. Injectables can be prepared in conventional forms, either as liquid solutions or suspensions, solid forms suitable for solution of suspension in
liquid prior to injection, or as emulsions. A more recently revised approach for parenteral administration involves use of a slow release or sustained release system such that a constant dosage is maintained. See, e.g., U.S. Pat. No. 3,610,795, which
is incorporated by reference herein in its entirety for the methods taught.
The compositions can be in solution or in suspension (for example, incorporated into microparticles, liposomes, or cells). These compositions can be targeted to a particular cell type via antibodies, receptors, or receptor ligands. The
following references are examples of the use of this technology to target specific proteins to given tissue (Senter et al., (1991) Bioconjugate Chem., 2:447-451; Bagshawe, (1989) Br. J. Cancer, 60:275-281; Bagshawe et al., (1988) Br. J. Cancer,
58:700-703; Senter et al., (1993) Bioconjugate Chem., 4:3-9; Battelli et al., (1992) Cancer Immunol. Immunother. 35:421-425; Pietersz and McKenzie, (1992) Immunolog. Reviews, 129:57-80; Roffler et al., (1991) Biochem. Pharmacol., 42:2062-2065). Vehicles such as "stealth" and other antibody conjugated liposomes (including lipid mediated drug targeting to colonic carcinoma), receptor mediated targeting of DNA through cell specific ligands, lymphocyte directed tumor targeting, and highly specific
therapeutic retroviral targeting of murine glioma cells in vivo. In general, receptors are involved in pathways of endocytosis, either constitutive or ligand induced. These receptors cluster in clathrin-coated pits, enter the cell via clathrin-coated
vesicles, pass through an acidified endosome in which the receptors are sorted, and then either recycle to the cell surface, become stored intracellularly, or are degraded in lysosomes. The internalization pathways serve a variety of functions, such as
nutrient uptake, removal of activated proteins, clearance of macromolecules, opportunistic entry of viruses and toxins, dissociation and degradation of ligand, and receptor-level regulation. Many receptors follow more than one intracellular pathway,
depending on the cell type, receptor concentration, type of ligand, ligand valency, and ligand concentration. Molecular and cellular mechanisms of receptor-mediated endocytosis has been reviewed (Brown and Greene, (1991) DNA and Cell Biology 10:6,
399-409).
When nucleic acid based ribonucleotide inhibitors are used in the disclosed methods, these compositions can be administrated and taken up into the cells of a subject (i.e., gene transduction or transfection) in the form of naked DNA or RNA, or
the nucleic acids can be in a vector for delivering the nucleic acids to the cells, as would be well understood by one of ordinary skill in the art. The vector can be a commercially available preparation, such as an adenovirus vector (Quantum
Biotechnologies, Inc. (Laval, Quebec, Canada). Delivery of the nucleic acid or vector to cells can be via a variety of mechanisms. As one example, delivery can be via a liposome, using commercially available liposome preparations such as LIPOFECTIN,
LIPOFECTAMINE (GIBCO-BRL, Inc., Gaithersburg, Md.), SUPERFECT (Qiagen, Inc. Hilden, Germany) and TRANSFECTAM (Promega Biotec, Inc., Madison, Wis.), as well as other liposomes developed according to procedures standard in the art. In addition, the
disclosed nucleic acid or vector can be delivered in vivo by electroporation, the technology for which is available from Genetronics, Inc. (San Diego, Calif.) as well as by means of a SONOPORATION machine (ImaRx Pharmaceutical Corp., Tucson, Ariz.).
As one example, vector delivery can be via a viral system, such as a retroviral vector system which can package a recombinant retroviral genome (see e.g., Pastan et al., (1988) Proc. Natl. Acad. Sci. U.S.A. 85:4486; Miller et al., (1986)
Mol. Cell. Biol. 6:2895). The recombinant retrovirus can then be used to infect and thereby deliver to the infected cells nucleic acid encoding a broadly neutralizing antibody (or active fragment thereof). The exact method of introducing the altered
nucleic acid into mammalian cells is, of course, not limited to the use of retroviral vectors. Other techniques are widely available for this procedure including the use of adenoviral vectors (Mitani et al., (1994) Hum. Gene Ther. 5:941-948),
adeno-associated viral (AAV) vectors (Goodman et al., (1994) Blood 84:1492-1500), lentiviral vectors (Naidini et al., (1996) Science 272:263-267), pseudotyped retroviral vectors (Agrawal et al., (1996) Exper. Hematol. 24:738-747). Physical
transduction techniques can also be used, such as liposome delivery and receptor-mediated and other endocytosis mechanisms (see, for example, Schwartzenberger et al., (1996) Blood 87:472-478). This disclosed compositions and methods can be used in
conjunction with any of these or other commonly used gene transfer methods.
Parenteral administration of the nucleic acid or vector, if used, is generally characterized by injection. Injectables can be prepared in conventional forms, either as liquid solutions or suspensions, solid forms suitable for solution of
suspension in liquid prior to injection, or as emulsions. A more recently revised approach for parenteral administration involves use of a slow release or sustained release system such that a constant dosage is maintained. For additional discussion of
suitable formulations and various routes of administration of therapeutic compounds, see, e.g., Remington: The Science and Practice of Pharmacy (19th ed.) ed. A. R. Gennaro, Mack Publishing Company, Easton, Pa. 1995.
As disclosed herein, the ribonucleotide reductase inhibitors are administered to a subject in an effective amount. By "effective amount" is meant a therapeutic amount needed to achieve the desired result or results, e.g., treating or preventing
restenosis or other vascular proliferation disorders. The exact amount of the compositions required will vary from subject to subject, depending on the species, age, weight and general condition of the subject, the severity of the disorder being
treated, its mode of administration and the like. Thus, it is not possible to specify an exact amount for every composition. However, an appropriate amount can be determined by one of ordinary skill in the art using only routine experimentation given
The ribonucleotide reductase inhibitors can be used therapeutically in combination with a pharmaceutically acceptable carrier. Pharmaceutical carriers are known to those skilled in the art. These most typically would be standard carriers for
administration of drugs to humans, including solutions such as sterile water, saline, and buffered solutions at physiological pH. The compositions can be administered intramuscularly or subcutaneously. Other compounds will be administered according to
In one aspect, any of the ribonucleotide reductase inhibitors described herein can be combined with at least one pharmaceutically-acceptable carrier to produce a pharmaceutical composition. The pharmaceutical compositions can be prepared using
techniques known in the art. In one aspect, the composition is prepared by admixing the ribonucleotide reductase inhibitor having with a pharmaceutically-acceptable carrier. The term "admixing" is defined as mixing the two components together so that
there is no chemical reaction or physical interaction. The term "admixing" also includes the chemical reaction or physical interaction between the ribonucleotide reductase inhibitor and the pharmaceutically-acceptable carrier.
Pharmaceutical compositions can include carriers, thickeners, diluents, buffers, preservatives, surface active agents and the like in addition to the molecule of choice. Pharmaceutical compositions can also include one or more active
ingredients such as antimicrobial agents, anti-inflammatory agents, anesthetics, and the like.
Preparations for parenteral administration include sterile aqueous or non-aqueous solutions, suspensions, and emulsions. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and
injectable organic esters such as ethyl oleate. Aqueous carriers include water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media. Parenteral vehicles include sodium chloride solution, Ringer's dextrose,
dextrose and sodium chloride, lactated Ringer's, or fixed oils. Intravenous vehicles include fluid and nutrient replenishers, electrolyte replenishers (such as those based on Ringer's dextrose), and the like. Preservatives and other additives can also
Formulations for topical administration can include ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders. Conventional pharmaceutical carriers, aqueous, powder or oily bases, thickeners and the like may be
In one aspect, disclosed are methods for treating or preventing restenosis and other vascular proliferation disorders in a subject, comprising administering to the subject an effective amount of a ribonucleotide reductase inhibitor. In one
aspect, ribonucleotide reductase inhibitors can be used for the treatment of restenosis injury following a number of surgical techniques including, but not limited to, transplant surgery, vein grafting, coronary by-pass grafting, PTCA, and angioplasty.
In other aspects, ribonucleotide reductase inhibitors can be used for the treatment of benign vascular proliferative disorders. Examples of such disorders include, but are not limited to, vascular proliferation involved in atherosclerosis,
vascular proliferation following intravascular device implantation, vascular proliferation at the site of vascular anastamosis as generally occurs following revascularization procedure or A-V shunting, vascular proliferation following carotid
endarderectomy, and transplant vasculopathy.
Not wishing to be bound by theory, it is believed that ribonucleotide reductase inhibitors possess chemical and biological properties that can impair several processes that contribute to the restenosis process or other vascular proliferative
disorders. For example, members of the polyphenolic series such as 3,4-dihydroxy- and 3,4,5-trihydroxy-compounds have been shown to be good anti-inflammatory agents by inhibiting NF-kappa B activation and, therefore, down regulating cytokines
contributing to the inflammation process and chemoattractant production. Also these compounds can inhibit tissue factor production. This synergistic concept can be a vasoprotective approach to the prevention of restenosis or other vascular
proliferation disorders by attenuating inflammatory reactions, SMC proliferation, and neointima formation following vascular injury.
In one aspect, polyhydroxy phenolic compounds described herein have the ability to modulate several of the biological events contributing to the development of restenosis, uncontrolled SMC proliferation, leukocyte migration, NF-kappa B
activation and tissue factor expression, leading to inflammation. These compounds being excellent free-radical scavengers, are able to modulate the above mentioned deleterious processes. Having these properties make these compounds unique to limit the
restenosis process or other vascular proliferation disorders.
In one aspect, a medical device can comprise one or more ribonucleotide reductase inhibitors in order to treat or prevent restenosis or other vascular proliferation disorders. In one aspect, an implant of a medical device such as, for example,
a stent, can contain the ribonucleotide reductase inhibitor. In other examples, the medical device can be a needle, cannula, catheter, shunt, balloon, or valve. The ribonucleotide reductase inhibitor can be formulated to permit its incorporation onto
the medical device, which can apply the ribonucleotide reductase inhibitor directly to the site to prevent or treat such restenosis or other vascular proliferation disorder. In one aspect, the ribonucleotide reductase inhibitor can be formulated by
including it within a coating on the medical device. There are various coatings that can be utilized such as, for example, polymer coatings that can release the ribonucleotide reductase inhibitor over a prescribed time period. In another aspect, the
ribonucleotide reductase inhibitor can be embedded directly into the medical device.
In another aspect, the ribonucleotide reductase inhibitors can play a further positive role in preventing restenosis in organ transplantation or other surgical procedures where the incidence of viral infection is possible. Examples of viral
infections include, but are not limited to, Herpes viruses, particularly cytomegalovirus, herpes I and II, hepatitis B and C, as well as HIV I and II. Viral infections can contribute to the restenosis process caused by the surgical vascular procedures
listed above. Therefore, in this aspect, the ribonucleotide reductase inhibitors can prevent restenosis by inhibiting viruses such as herpes and HIV replication and the possible inflammatory aspect of hepatitis C that contribute to restenosis.
The following example is put forth so as to provide those of ordinary skill in the art with a complete disclosure and description of how the compounds, compositions, and methods described and claimed herein are made and evaluated, and are
intended to be purely exemplary and are not intended to limit the scope of what the inventors regard as their invention. Efforts have been made to ensure accuracy with respect to numbers (e.g., amounts, temperature, etc.) but some errors and deviations
should be accounted for. Unless indicated otherwise, parts are parts by weight, temperature is in .degree. C. or is at ambient temperature, and pressure is at or near atmospheric. There are numerous variations and combinations of reaction conditions,
e.g., component concentrations, desired solvents, solvent mixtures, temperatures, pressures and other reaction ranges and conditions that can be used to optimize the product purity and yield obtained from the described process. Only reasonable and
routine experimentation will be required to optimize such process conditions.
The following examples test the ability of three ribonucleotide reductase inhibitors to limit the degree of restenosis following balloon mediated dilatation injury in the rat. Specifically, the ability of the polyhydroxy-phenolic compounds,
Didox (3,4-dihydroxybenzohydraxamic acid), Imidate (3,4,5-hydroxybenzimidate), and hydroxyurea have been examined to limit the degree of restenosis following vascular injury.
To determine the ability of the ribonucleotide reductase inhibitors to affect restenosis, a rat model of balloon mediated carotid artery injury was utilized. Percutaneous transluminal carotid angioplasty (PTCA) was performed using a 2F Fogarty
Embolectomy Catheter, which was inserted through the right, external carotid artery and inflated (2 atm) and deflated four times inside the right common carotid artery and rotated to cause endothelial injury. Immediately following the carotid injury,
the rats received ribonucleotide reductase inhibitors, Didox (N,3,4-trihydroxybenzamide) Imidate (ethyl-3,4,5-trihydroxybenzenecarboximidate.HCl), or Hydroxyurea via intraperitoneal injection. The degree of restenosis was assessed using morphometric
analysis at two weeks post injury. For example, ribonucleotide reductase inhibition with Didox resulted in a 19% increase in lumen area, 84% decrease in neointimal formation, 48% reduction in total wall thickness and an 85% reduction in the intima/media
ratio as compared to the untreated injured artery (Table 1). These results suggest that ribonucleotide reductase does serve as a novel therapeutic target in the treatment of post PTCA restenosis.
TABLE-US-00001 TABLE 1 Effects of Ribonucleotide Reductase Inhibitors on Restenosis-Data presented as % change as compared to injured vessel. Wall Neointima/ Group Lumen Neointima Thickness Media Didox .uparw. 19 .+-. 3% .dwnarw. 84 .+-. 2%
.dwnarw. 48 .+-. 3% .dwnarw. 85 .+-. 4% Imidate .uparw. 19 .+-. 5% .dwnarw. 65 .+-. 7% .dwnarw. 41 .+-. 7% .dwnarw. 69 .+-. 8% Hydroxyurea .uparw. 22 .+-. 5% .dwnarw. 91 .+-. 6% .dwnarw. 54 .+-. 9% .dwnarw. 93 .+-. 7%
Didox, Imidate, and Hydroxyurea were provided by Molecules for Health Inc. (Richmond, Va.). Rat vascular smooth muscle cells and culture media were purchased from ATCC (Manassas, Va.). Fogarty embolectomy catheters were purchased from M & I
medical (Miami, Fla.). All other reagents were purchased from Sigma Chemical Co. (St. Louis, Mo.).
Male Wistar rats, weighing 400-450 g (Harlan) were fed standard pellet feed and given water ad libitum. The experimental protocol was designed in accordance with Institutional ILACUC standards. Animals were anesthetized with Isoflurane
(1.5-2%) in air. The right carotid artery was exposed and a 2F Fogarty balloon embolectomy catheter (Baxter) was inserted via an external carotid arteriotomy incision. The catheter was advanced to the common carotid artery, inflated to a pressure of 2
atm and rotated in a forward and retrograde direction. The catheter was then deflated and the process repeated three times. Treatment cohorts were divided into 5 groups (n=6-8/group): Control (sham operated), Didox (200 mgkg.sup.-1 d.sup.-1), Imidate
(200 mg kg.sup.-1 d.sup.-1), HU (200 mg kg.sup.-1 d.sup.-1) and vehicle (saline). Drugs were administered daily by i.p. injection for a period of 7 days after injury. At 2 weeks post-injury, rats were euthanized by pentobarbital overdose and perfused
with 10% buffered formalin. Carotid arteries were removed and placed in the same fixative. Tissues were then embedded in paraffin, and 4 to 5 sections (4 .mu.m) were cut at multiple levels. These sections were then stained with hematoxylin-eosin or
elastic-van Gieson stain. Sections were examined microscopically and the cross-sectional areas of the lumen, neointima (from the internal elastic lamina to the lumen), and media were determined using digital microscopy with Spot Advanced software. The
intima-to-media (I/M) ratio was then calculated from the determined mean. The data represent the mean.+-.SD.
SMC were plated on 6 well dishes at a density of 2.times.10.sup.5 cells per well. Cells were then treated with Didox (0-200 .mu.M), Imidate (0-200 .mu.M) or HU (0-1000 .mu.M) and incubated for 24 hours. Following the 24 hour incubation period,
the cells were trypsinized and collected in 15 mL centrifuge tubes. The cells were then centrifuged 5 minutes at 800.times.g. The supernatant was discarded and the pellet was resuspended in 5 ml PBS. The cells were centrifuged 6 minutes at
200.times.g. The supernatant was removed and the pellet was then thoroughly resuspended in 0.5 ml PBS. The cell suspension was transferred into tubes containing 70% ethanol, keeping the cells in fixative for greater than about 2 hours. The ethanol
suspended cells were centrifuged 5 minutes at 200.times.g, and the ethanol was decanted. The cell pellet was resuspended in 5 ml PBS and after one minute was centrifuged 5 min at 200.times.g. The top layer of liquid was again removed and the cell
pellet was resuspended in 1 ml PI/Triton X-100 staining solution with RNAse A. This staining solution was then incubated at room temperature for 30 minutes. Flow cytometry was then performed using a FACS Calibur (Becton Dickenson). The data are
presented as the mean.
SMC were plated in T150 flasks and treated with Didox (0-200 .mu.M), Imidate (0-200 .mu.M) or HU (0-1000 .mu.M) and incubated for 24 hours. Following the 24 hour incubation period, the cells were trypsinized and collected in 50 mL centrifuge
tubes along with the incubation media. All the extraction steps were performed on ice. Immediately before processing, cells were counted and viability determined using the trypan blue exclusion method. The cells were then centrifuged 5 minutes at
800.times.g. The cell pellet was then deproteinized with the same volume of 6% TCA, vortexed for 20s and incubated on ice for 10 minutes. The acid cell extracts were centrifuged 10 min at 2000.times.g. The supernatants were then supplemented with an
equal volume of distilled water, vortexed for 60 s and neutralized by the addition of 5M K.sub.2CO.sub.3 prior to HPLC analysis. dNTP detection was carried out using an ESA (Chelmsford, Mass.) HPLC chromatographic system with UV-Vis detection. Chromatographic separations were performed using a TosoHaas C18 reverse phase column (ODS 80Tm 250.times.4.6 mm, 5 .mu.m pore). The mobile phase was delivered at a rate of 1.0 mL/min during the analysis using the following stepwise gradient elution
program: A-B (80-20) at 0 min; (40-60) at 30 min; (40-60) at 40 min and (80-20) at 45 min. Buffer A contained 10 mM tetrabutylammonium sulfate, 10 mM KH.sub.2PO.sub.4 and 0.25% MeOH, and adjusted to pH 6.9. Buffer B consisted of 5.6 mM
tetrabutylammonium sulfate, 50 mM KH.sub.2PO.sub.4 and 30% MeOH, and neutralized to pH 7.0. The injection volume for analysis was 50 .mu.L. Detection was carried out at 254 nm.
A wound scrape assay was performed using rat vascular SMC. The cells were grown to confluence on 60 mm dishes. The cells were then made quiescent by incubating them in media containing 0.1% serum for 24 hrs followed by treatment with Didox,
Imidate (0-100 .mu.M), or HU (0-1000 .mu.M) in media containing 0.1% serum and platelet derived growth factor (PDGF) at concentration of 10 ng/mL. Linear wounds were made by scraping each plate with the tip of a 20 .mu.L pipette. The ability of cells
to migrate across the wound area was measured using digital microscopy. SPOT advanced software (Diagnostic Instruments, Inc., Sterling Heights, Mich.) was used to measure the wound immediately, 2, 4, 12 and 24 hrs following injury. The data are
presented as rate of migration and represent the mean.+-.SD.
The effects of Didox, Imidate, and Hydroxyurea (HU) on the vascular remodeling process following arterial injury were determined using a rat model of balloon mediated carotid injury. Each compound (200 mg kg.sup.-1 d.sup.-1) was delivered via
i.p. injection for a period of 7 days post injury. These dosages are based on previously published reports and represent 1/2 the maximum tolerated dose of Hydroyurea in rats (Gupta and Yaffe, (1982) Pediatr Pharmacol (New York) 2:85-91; Vaughan et al.,
(1989) Cancer Chemother Pharmacol 23:26-30). Furthermore, it has previously been demonstrated that these doses are sufficient to inhibit ribonucleotide reductase activity without causing significant toxicity in mice and rats (Mayhew et al., (2002)
Antivir Chem Chemother 13:305-314; Mayhew et al., (1999) Stem Cells 17:345-356; Horvath et al., (2004) Cancer Chemother Pharmacol. 54(2):139-145).
At 14 days post injury the animals were sacrificed and morphometric analysis was carried out in order to asses the histopathological changes in the vessel wall (FIG. 1). Didox treatment resulted in a 62% decrease in neointimal area and a 61%
decrease in intima/media ratio (FIG. 2). Imidate treated groups demonstrated a 57% decrease in neointimal area and a 55% decrease in the intima/media ratio (FIG. 2). Because Didox and Imidate possess other chemical attributes in addition to their
effects on ribonucleotide reductase (Fritzer-Szekeres et al., (2000) Exp Hematol 28:924-930; Fritzer-Szekeres et al., (1997) Life Sci 61:2231-2237; Fritzer-Szekeres et al., (2002) Biochem Pharmacol 64:481-485; Lee et al., (1997) Virology 234:277-290;
Inayat et al., (2002) Cancer Biol Ther 1:539-545) the commercially available ribonucleotide reductase inhibitor, HU (200 mg kg.sup.-1 d.sup.-1), was also tested. HU afforded similar vascular protective effects to those observed with Didox and Imidate,
resulting in a 55% decrease in neointimal area and a 63% decrease in intima/media ratio (FIG. 2). These results indicate that ribonucleotide reducatase inhibition can modulate the remodeling process following vascular injury. However, because the
remodeling process occurs over a prolonged period of time, additional studies were performed in order to determine whether the vascular protective effects observed would be mitigated over time.
To further investigate long-term efficacy of the one week dosing regimen, the duration of the study period was increased to 6 weeks. It was found that the degree of neointimal thickening at 6 weeks post-injury was increased by 57% as compared
to the 2 week study paradigm (FIG. 3). The beneficial effect of ribonucleotide reductase inhibition persisted over the long term. Each compound (200 mg kg.sup.-1 d.sup.-1) was given i.p. for a period of 7 days followed by a 5 week recovery period. At
the end of the 6 week period, the Didox treated group exhibited a 64% decrease in neointimal area and a 71% decrease in intima/media ratio (FIG. 3). Similarly, Imidate offered a 61% reduction in neointimal area and a 62% reduction in intima/media ratio
(FIG. 3). HU treatment reduced neointimal formation by 71% and decreased the intima/media ratio by 75% (FIG. 3). These results suggest that activation of ribonucleotide reductase is an early trigger in the vascular response to injury and that
inhibition of this enzyme can limit the neointimal proliferation associated with restenosis.
Didox, Imidate, and to a much lesser degree, HU, are known to be ribonucleotide reductase inhibitors (Elford, (1968) Biochem Biophys Res Commun 33:129-135; Elford et al., (1970) J Biol Chem 245:5228-5233; Elford et al., (1979) Cancer Res
39:844-851). ribonucleotide reductase catalyzes the reductive conversion of ribonucleotides to deoxynucleotides. This reductive reaction is a prime target for impeding cellular proliferation, and therefore amenable to inhibiting VSMC replication,
because it is a rate limiting step in the biochemical pathway leading to DNA synthesis (Elford et al., (1970) J Biol Chem 245:5228-5233; Elford et al., (1979) Cancer Res 39:844-851; Takeda and Weber, (1981) Life Sci 28:1007-1014; Natsumeda et al., (1985)
Cancer Res 45:2556-2559). The ability of Didox and Imidate to inhibit ribonucleotide reductase activity has been documented with published reports demonstrating an IC.sub.50 of 3-30 .mu.M for this class of compounds (Elford et al., (1979) Cancer Res
39:844-851). These values represent a greater than 10 fold increased effectiveness over the classical ribonucleotide reductase inhibitor HU (Elford, (1968) Biochem Biophys Res Commun 33:129-135). Based on this evidence, experiments were performed in
order to determine whether the ability of these compounds to reduce neointimal formation was due to their ability to inhibit SMC proliferation in-vitro. Therefore, the IC.sub.50 of each compound on inhibition of smooth muscle cell growth was determined. Cells were incubated in the presence of Didox (0-200 .mu.M), Imidate (0-200 .mu.M), and HU (0-1000 .mu.M) for 24 hours. Cell numbers were then counted using flow cytometry and the concentration at which cell division was inhibited by 50% (IC.sub.50) was
calculated. Didox yielded an IC.sub.50 of 67 .mu.M, Imidate was slightly less potent exhibiting an IC.sub.50 of 82 .mu.M, while HU was the least potent with an IC.sub.50 of 266 .mu.M (FIG. 4). These results are consistent with ribonucleotide reductase
activity data and demonstrate that Didox and Imidate are 3-4 times more potent than HU at arresting cell division in vascular smooth muscle cells.
In order to further validate that the observed anti-proliferative properties afforded by these compounds was through inhibition of ribonucleotide reductase activity, the effects of these compounds on intracellular dATP pools were measured. Results demonstrated that Didox (0-200 .mu.M), Imidate (0-200 .mu.M), and HU (0-1000 .mu.M) dose dependently depleted the endogenous dNTP pools with maximal reductions in dATP content of 58%, 42% and 69%, respectively (Table 2).
TABLE-US-00002 TABLE 2 Effects of Didox, Imidate and HU on SMC dATP pools. Didox (0-200 .mu.M), Imidate (0-200 .mu.M) and HU (0-1000 .mu.M) were added to the SMC culture during the log phase of growth and incubated for 24 hours. dNTP's were
extracted and samples subjected to HPLC analysis. The data are presented as pmoles dATP/107 cells and represent the mean .+-.SD. "*" indicates significantly different at p < 0.05 as compared to control. Hydroxyurea Control Didox (.mu.M) Imidate
(.mu.M) (.mu.M) Dose 0 5 10 50 100 200 5 10 50 100 200 5 100 500 1000 dATP 303 297 260 203* 140* 126* 293 311 210 184* 173* 320 266 93 92 levels (Pmoles/ 10.sup.7 cells) S.D. 50 35 26 20 40 31 31 17 47 41 39 30 42 11 17
The concentrations at which these drugs afford their in-vitro biological effects are well below the range of the peak plasma levels (300-400 .mu.M) measured following Didox and Imidate infusion (200 mg kg.sup.-1 d.sup.-1) and would be expected
to inhibit ribonucleotide reductase activity based on the published and observed K.sub.i's for these compounds (Elford et al., (1979) Cancer Res 39:844-851). These results indicate that part of the vascular protective effects of these compounds is due
to their ability to impede SMC proliferation.
SMC migration is also a component of neointimal proliferation. Therefore, additional studies were performed in order to determine the effects of these compounds on SMC migration. Using a wound scrape assay, SMC migration studies were carried
out in the presence of Didox, Imidate, and HU. VSMC's were cultured to confluence on 60 mm dishes. The cells were made quiescent by incubating in media containing 0.1% serum. Following 24 hours of serum deprivation, Didox, Imidate, and HU were added
to the wells (10-1000 .mu.M) in the presence of PDGF (10 ng/mL) and a linear wound was made across the plate. SMC migration across the wound was monitored by digital microscopy over a 24 hour period. Results from these studies demonstrated that Didox
(100 .mu.M) and Imidate (100 .mu.M) treatment almost completely inhibited SMC migration, decreasing the migratory rate from 15.8 .mu.M/hr in the control to 1.7 .mu.M/hr and 0.9 .mu.M/hr, respectively (FIG. 5). In contrast, HLT (100 .mu.M) had little
effect on SMC migration, resulting in a migratory rate of 15.1 .mu.M/hr (FIG. 4). No further inhibition was seen with HU concentrations up to 1 mM. These results demonstrate that Didox and Imidate significantly impair SMC migration. This would be
expected to contribute to the vascular protective effects afforded by these drugs. However, ribonucleotide reductase inhibition appears to be the principal mechanism as the rat arterial injury data demonstrated similar efficacy with HU.
Although PTCA and coronary artery stenting have had a tremendous impact on the treatment of coronary vascular disease, these procedures are marked by a high incidence of restenosis (Anderson et al., (1993) J Interv Cardiol 6:187-202; Fischman et
al., (1994) N Engl J Med 331:496-501; Elezi et al., (1998) Circulation 98:1875-1880; Bennett and O'Sullivan, (2001) Pharmacol Ther 91:149-166; Heckenkamp et al., (2002) J Cardiovasc Surg (Torino) 43:349-357). This process of vessel re-narrowing is
characterized by neointimal hyperplasia resulting in lumen loss and impaired vascular function. The vascular response to injury triggers a migratory and proliferative response within the smooth muscle cells resulting in intimal thickening (Noda-Heiny
and Sobel, (1995) Am J Physiol 268:C1195-1201; Libby and Tanaka, (1997) Prog Cardiovasc Dis 40:97-106; Elezi et al., (1998) Circulation 98:1875-1880; Ward et al., (2000) Circulation 102:1186-1191; Bennett and O'Sullivan, (2001) Pharmacol Ther 91:149-166;
Heckenkamp et al., (2002) J Cardiovasc Surg (Torino) 43:349-357; Lanza et al., (2002) Circulation 106:2842-2847; Segev et al., (2002) Cardiovasc Res 53:232-241; Bhargava et al., (2003) Bmj 327:274-279; Crook and Akyurek (2003) Trends Cardiovasc Med
13:102-106; Indolfi et al., (2003) Trends Cardiovasc Med 13:142-148). In this regard, emphasis has been placed on developing pharmacological therapy aimed at reducing the proliferative response. Currently, two pharmacological agents have been approved
for clinical use in the treatment of post-PTCA restenosis (Drachman et al., (2000) J Am Coll Cardiol 36:2325-2332; Heldman et al., (2001) Circulation 103:2289-2295; Suzuki et al., (2001) Circulation 104:1188-1193). Taxol and Rapamyacin are being
delivered through the use of coated coronary stents. Preliminary results suggest that these approaches offer significant protection against the restenosis process and validate the use of antiproliferative agents in the treatment of vascular
proliferative disorders such as restenosis (Sousa et al., (2001) Circulation 103:192-195; Gershlick et al., (2004) Circulation 109:487-493; Stone et al., (2004) Circulation 109:1942-1947).
The use of ribonucleotide reductase inhibition has been demonstrated herein as a new therapeutic target in ameliorating balloon mediated restenosis injury. The biochemical attributes of this enzyme make it amenable for the treatment of
proliferative disorders since inhibition of ribonucleotide reductase blocks DNA synthesis and thus cell replication. These results herein demonstrate that following balloon injury, one week of systemic administration of the ribonucleotide reductase
inhibitors, Didox and Imidate, largely inhibited neointimal formation resulting in a 60% reduction in the intima/media ratio. Morphometric analysis revealed an about 60% reduction in neointimal area with no significant change in the medial area between
treated and untreated groups. However, there was a small but statistically significant decrease in medial area following Imidate dosing when this cohort was compared against HU and Didox. These results indicate that Imidate can have some negative
effects on smooth muscle remodeling following medial injury that result in medial wall thinning.
These disclosed in-vivo studies demonstrate that inhibition of ribonucleotide reductase limits the extent of intimal hyperplasia following mechanical injury. Also, these compounds possess a variety of chemical attributes that can contribute to
their protective effects. Didox has been shown to inhibit NF-kappa B and Tissue Factor expression. In addition both Didox and Imidate compounds are potent free radical scavengers (Fritzer-Szekeres et al., (1997) Life Sci 61:2231-2237; Lee et al.,
(1997) Virology 234:277-290; Duilio et al., (2001) Am J Physiol Heart Circ Physiol 280:H2649-2657; Shet et al., (2003) Blood 102:2678-2683; Turchan et al., (2003) Neurology 60:307-314; Inayat Cancer Biol Ther. (2002) 1(5):539-545). Because of the
myriad of effects elicited by these compounds, further experiments were carried out using the commercially available ribonucleotide reductase inhibitor, HU. Following the same dosing regimen for Didox and Imidate, HU afforded similar anti-restenotic
efficacy, further supporting the observation described herein regarding the importance of ribonucleotide reductase in the vascular response to injury.
Because the vascular response to injury is a chronic process, additional studies were performed in order to assess whether the protective effects elicited by early ribonucleotide reductase inhibition are maintained throughout the remodeling
period. The ribonucleotide reductase inhibitors (Didox, Imidate, and HU) were administered daily for one week and the extent of injury assessed at 6 weeks after balloon dilatation. This additional recovery time resulted in a greater than 50% increase
in the intima/media ratio demonstrating the progression of the lesion over time. Interestingly, Didox and HU treatment reduced the intima/media ratio by greater than 70%, while slightly less efficacy was observed with Imidate. Moreover, the degree of
protection afforded by these compounds was significantly increased when compared to the results of the two week study. This suggests that ribonucleotide reductase is an early target in the vascular response to injury and that inhibition of this enzyme
affects the long term vascular remodeling associated with restenosis.
These results demonstrate that ribonucleotide reductase inhibition limits the degree of restenosis following arterial dilation injury. While not wishing to be bound by theory, it is believed that these effects are mediated through an inhibition
of SMC proliferation, as this process precedes neointimal formation. Therefore, studies were performed using a cell proliferation assay. Didox, Imidate, and HU treatment resulted in arrest of cell division. Analysis of dNTP pools demonstrated a
greater than 50% reduction in dATP levels further supporting that the observed effects of these drugs are mediated at least in part through the inhibition of ribonucleotide reductase. These effects were independent of any cytotoxic action these
compounds may posses as flow cytometry revealed less than 3% apoptotic cells following the dosing regimes tested. In addition, prior to dNTP analysis, cells were counted and viability assessed using trypan blue exclusion. Cell viability was greater
than 95% among all groups.
As previously stated, Didox and Imidate possess various chemical attributes in addition to ribonucleotide reductase inhibition, many of which can confer protection against restenosis (Fritzer-Szekeres et al., (1997) Life Sci 61:2231-2237; Lee et
al., (1997) Virology 234:277-290; Duilio et al., (2001) Am J Physiol Heart Circ Physiol 280:H2649-2657; Shet et al., (2003) Blood 102:2678-2683; Turchan et al., (2003) Neurology 60:307-314). Among these is their ability to scavenge free radicals, which
can modulate SMC migration, a component of neointimal proliferation (Duilio et al., (2001) Am J Physiol Heart Circ Plzysiol 280:H2649-265; Turchan et al., (2003) Neurology 60:307-314). Therefore, the effects of Didox and Imidate were tested on SMC
proliferation using a wound scrape assay. Results demonstrated that both compounds almost completely inhibited SMC migration. This indicates that inhibition of SMC proliferation can contribute to the protection afforded by these compounds. Similarly,
a number of studies have demonstrated that HU, when oxidized, can release NO. (Stolze and Nohl, (1990) Biochem Pharmacol 40:799-802; Pacelli et al., (1996) Lancet 347:900). Because NO has been shown to inhibit cell migration, it was tested whether HU
possesses anti-migratory properties which could be involved in its anti-restenotic effects (Sarkar et al., (1997) Am J Physiol 272:H1810-1818; Sarkar and Webb, (1998) J Vasc Res 35:135-142). HU at concentrations up to 1 mM had no effect on SMC
migration. This observation indicates that inhibition of ribonucleotide reductase is the principal mechanism through which these compounds afford their protection as similar efficacy was seen with all compounds. However, if the in-vivo results are
interpreted on a molar basis, HU (2.6 mmoles kg.sup.-1 d.sup.-1) doses are 2-3 fold higher than that of Didox (1.2 mmoles kg.sup.1 d.sup.-1) and Imidate (0.9 mmoles kg.sup.1 d.sup.-1) and suggests that the effects of Didox and Imidate on SMC migration
can contribute to the vascular protective effects observed with these two compounds.
Taken together, the in-vivo and in-vitro data demonstrate that activation of ribonucleotide reductase is an early component in the proliferative response associated with vascular injury and that inhibition of this enzyme can reduce the vascular
pathology associated with restenosis injury. Although the incidence of restenosis has markedly decreased with the advent of drug coated stents, restenosis still occurs in up to 20% of patients within the first year while results on late lumen loss are
still being gathered (Drachman et al., (2000) J Am Coll Cardiol 36:2325-2332; Heldman et al., (2001) Circulation 103:2289-2295; Grube et al., (2003) Circulation 107:38-42; Kastrati et al., (2005) JAMA 293:165-171; Kim et al., (2005) Heart 91:e15). In
addition, because the use of coated stents may increase the risk of thrombosis there is a need for agents which can be administered systemically with or without stents in patients at high risk for thrombotic events (Morice, (2005) JACC 45). Inhibition
of ribonucleotide reductase can be a pathway that can be therapeutically targeted through either local or systemic delivery based on the low toxicity associated with current ribonucleotide reductase inhibitor therapy using HU. Additionally, the data
disclosed herein suggest that ribonucleotide reductase is an early target in the restenosis process and as such, early pharmacological intervention can preclude chronic therapy and its associated adverse side effects. It is believed that these
observations have therapeutic potential and implicate ribonucleotide reductase as a promising therapeutic target in the treatment of vascular proliferative disorders.
Throughout this application, various publications are referenced. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the compounds, compositions
Various modifications and variations can be made to the compounds, compositions and methods described herein. Other aspects of the compounds, compositions and methods described herein will be apparent from consideration of the specification and
practice of the compounds, compositions and methods disclosed herein. It is intended that the specification and examples be considered as exemplary.
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