New Drug Approvals

Home » 2014 » October (Page 4)

Monthly Archives: October 2014

DRUG APPROVALS BY DR ANTHONY MELVIN CRASTO .....FOR BLOG HOME CLICK HERE

Blog Stats

  • 4,799,006 hits

Flag and hits

Flag Counter

Enter your email address to follow this blog and receive notifications of new posts by email.

Join 37.9K other subscribers
Follow New Drug Approvals on WordPress.com

Archives

Categories

Recent Posts

Flag Counter

ORGANIC SPECTROSCOPY

Read all about Organic Spectroscopy on ORGANIC SPECTROSCOPY INTERNATIONAL 

Enter your email address to follow this blog and receive notifications of new posts by email.

Join 37.9K other subscribers
DR ANTHONY MELVIN CRASTO Ph.D

DR ANTHONY MELVIN CRASTO Ph.D

DR ANTHONY MELVIN CRASTO, Born in Mumbai in 1964 and graduated from Mumbai University, Completed his Ph.D from ICT, 1991,Matunga, Mumbai, India, in Organic Chemistry, The thesis topic was Synthesis of Novel Pyrethroid Analogues, Currently he is working with AFRICURE PHARMA, ROW2TECH, NIPER-G, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Govt. of India as ADVISOR, earlier assignment was with GLENMARK LIFE SCIENCES LTD, as CONSUlTANT, Retired from GLENMARK in Jan2022 Research Centre as Principal Scientist, Process Research (bulk actives) at Mahape, Navi Mumbai, India. Total Industry exp 32 plus yrs, Prior to joining Glenmark, he has worked with major multinationals like Hoechst Marion Roussel, now Sanofi, Searle India Ltd, now RPG lifesciences, etc. He has worked with notable scientists like Dr K Nagarajan, Dr Ralph Stapel, Prof S Seshadri, etc, He did custom synthesis for major multinationals in his career like BASF, Novartis, Sanofi, etc., He has worked in Discovery, Natural products, Bulk drugs, Generics, Intermediates, Fine chemicals, Neutraceuticals, GMP, Scaleups, etc, he is now helping millions, has 9 million plus hits on Google on all Organic chemistry websites. His friends call him Open superstar worlddrugtracker. His New Drug Approvals, Green Chemistry International, All about drugs, Eurekamoments, Organic spectroscopy international, etc in organic chemistry are some most read blogs He has hands on experience in initiation and developing novel routes for drug molecules and implementation them on commercial scale over a 32 PLUS year tenure till date Feb 2023, Around 35 plus products in his career. He has good knowledge of IPM, GMP, Regulatory aspects, he has several International patents published worldwide . He has good proficiency in Technology transfer, Spectroscopy, Stereochemistry, Synthesis, Polymorphism etc., He suffered a paralytic stroke/ Acute Transverse mylitis in Dec 2007 and is 90 %Paralysed, He is bound to a wheelchair, this seems to have injected feul in him to help chemists all around the world, he is more active than before and is pushing boundaries, He has 100 million plus hits on Google, 2.5 lakh plus connections on all networking sites, 100 Lakh plus views on dozen plus blogs, 227 countries, 7 continents, He makes himself available to all, contact him on +91 9323115463, email amcrasto@gmail.com, Twitter, @amcrasto , He lives and will die for his family, 90% paralysis cannot kill his soul., Notably he has 38 lakh plus views on New Drug Approvals Blog in 227 countries......https://newdrugapprovals.wordpress.com/ , He appreciates the help he gets from one and all, Friends, Family, Glenmark, Readers, Wellwishers, Doctors, Drug authorities, His Contacts, Physiotherapist, etc He has total of 32 International and Indian awards

Verified Services

View Full Profile →

Archives

Categories

Flag Counter

QUALITY BY DESIGN (QBD) IN API


QUALITY BY DESIGN (QBD) IN API

http://www.slideshare.net/anthonycrasto64/qbd-by-anthony-crasto

“OPERATION” AND “SURGICAL INTERVENTION” HOBBY ; MOST PEOPLE’S SEEKS ALWAYS FOR “OPERATION” METHODS IN ALL DISEASE CONDITIONS ; “आपरेशन” कराने का शौक ; बहुत से ऐसे लोग है जो हर बीमारी के इलाज के लिये “आपरेशन” कराना सबसे बेहतर समझते है


Dr.D.B.Bajpai's avatar**आधुनिक युग आयुर्वेद ** ई०टी०जी० आयुर्वेदास्कैन ** DIGITAL AYURVEDA TRIDOSHO SCANNER**AYURVED H. T. L. WHOLE-BODY SCANNER**आयुषव्यूज रक्त केमिकल केमेस्ट्री परीक्षण अनालाइजर ** डिजिटल हैनीमेनियन होम्योपैथी स्कैनर **

आपरेशन कराने का शौक भी दूसरे शौक की तरह से ही है /

दुनिया मे तरह तरह के लोग है जिनको किसी न किसी बात का शौक होता है , किसी को पतम्ग ऊड़ाने का शौक, किसी को सिगरेट पीने का शौक, किसी को मन्दिर जाने का शौक, किसी को ज्वेलरी का शौक, किसी को पेन्टिन्ग का शौक , किसी को पढने का शौक, किसी को बहस करने का शौक और किसी को कुछ और किसी को कुछ दूसरा शौक होता है /

इसी तरह से मुझे बहुत ऐसे मरीज मिले जिनको आप्रेशन कराने का शौक होता है / इन मरीजो को ऐसे ही आपरेशन करने वाले डाक्टर भी मिल जाते है / कहावत है जहां चाह है वही राह है / आप्रेशन कराने  के लिये बेताब मरीज  मौजूद है तो उनके लिये आपरेशन करने वाले डाक्टर और सर्जन भी मौजूद है / क्यो न हो ? आपरेशन कराने के…

View original post 42 more words

Vibegron ビベグロン


Chemical structure for Vibegron (USAN)

 

Vibegron, MK-4618, KRP 114V

update FDA APPROVED 12/23/2020, GEMTESA, To treat overactive bladder

UNII-M5TSE03W5U; M5TSE03W5U; D10433
Molecular Formula: C26H28N4O3   Molecular Weight: 444.52552
phase 2 for the treatment of overactive bladder
 (6S)-N-[4-([(2S,5R)-5-[(R)-Hydroxy(phenyl)methyl]pyrrolidin-2-yl]methyl)phenyl]-4-oxo-4,6,7,8-tetrahydropyrrolo[1,2-a]pyrimidine-6-carboxamide
(6S)-N-[4-[[(2S,5R)-5-[(R)-hydroxy(phenyl)methyl]pyrrolidin-2-yl]methyl]phenyl]-4-oxo-7,8-dihydro-6H-pyrrolo[1,2-a]pyrimidine-6-carboxamide

Target-based Actions Beta 3 adrenoceptor agonist
Indications Overactive bladder; Urinary incontinence

UPDATE 2018/9/21  pmda Beova JAPAN 2018Kyorin Pharmaceutical, under license from Merck, is developing vibegron (phase II, September 2014) for the treating of overactive bladder. In July 2014, Merck has granted to Kyorin an exclusive license to develop, manufacture and commercialize vibegron in Japan.

MK-4618 is being developed in phase II clinical trials at Merck & Co. for the treatment of overactive bladder. The company had been developing the compound for the treatment of endocrine disorders and hypertension; however, recent progress reports are not available at present.

In 2014, Merck licensed the product to Kyorin for development and commercialization in Japan.

The function of the lower urinary tract is to store and periodically release urine. This requires the orchestration of storage and micturition reflexes which involve a variety of afferent and efferent neural pathways, leading to modulation of central and peripheral neuroeffector mechanisms, and resultant coordinated regulation of sympathetic and parasympathetic components of the autonomic nervous system as well as somatic motor pathways. These proximally regulate the contractile state of bladder (detrusor) and urethral smooth muscle, and urethral sphincter striated muscle.

β Adrenergic receptors (βAR) are present in detrusor smooth muscle of various species, including human, rat, guinea pig, rabbit, ferret, dog, cat, pig and non-human primate. However, pharmacological studies indicate there are marked species differences in the receptor subtypes mediating relaxation of the isolated detrusor; β1AR predominate in cats and guinea pig, β2AR predominate in rabbit, and β3AR contribute or predominate in dog, rat, ferret, pig, cynomolgus and human detrusor. Expression of βAR subtypes in the human and rat detrusor has been examined by a variety of techniques, and the presence of β3AR was confirmed using in situ hybridization and/or reverse transcription-polymerase chain reaction (RT-PCR). Real time quantitative PCR analyses of β1AR, β2AR and β3AR mRNAs in bladder tissue from patients undergoing radical cystectomy revealed a preponderance of β3AR mRNA (97%, cf 1.5% for β1AR mRNA and 1.4% for β2AR mRNA). Moreover, β3AR mRNA expression was equivalent in control and obstructed human bladders. These data suggest that bladder outlet obstruction does not result in downregulation of β3AR, or in alteration of β3AR-mediated detrusor relaxation. β3AR responsiveness also has been compared in bladder strips obtained during cystectomy or enterocystoplasty from patients judged to have normal bladder function, and from patients with detrusor hyporeflexia or hyperreflexia. No differences in the extent or potency of β3AR agonist mediated relaxation were observed, consistent with the concept that the β3AR activation is an effective way of relaxing the detrusor in normal and pathogenic states.

Functional evidence in support of an important role for the β3AR in urine storage emanates from studies in vivo. Following intravenous administration to rats, the rodent selective β3AR agonist CL316243 reduces bladder pressure and in cystomeric studies increases bladder capacity leading to prolongation of micturition interval without increasing residual urine volume.

Overactive bladder is characterized by the symptoms of urinary urgency, with or without urgency urinary incontinence, usually associated with frequency and nocturia. The prevalence of OAB in the United States and Europe has been estimated at 16 to 17% in both women and men over the age of 18 years. Overactive bladder is most often classified as idiopathic, but can also be secondary to neurological condition, bladder outlet obstruction, and other causes. From a pathophysiologic perspective, the overactive bladder symptom complex, especially when associated with urge incontinence, is suggestive of detrusor overactivity. Urgency with or without incontinence has been shown to negatively impact both social and medical well-being, and represents a significant burden in terms of annual direct and indirect healthcare expenditures. Importantly, current medical therapy for urgency (with or without incontinence) is suboptimal, as many patients either do not demonstrate an adequate response to current treatments, and/or are unable to tolerate current treatments (for example, dry mouth associated with anticholinergic therapy). Therefore, there is need for new, well-tolerated therapies that effectively treat urinary frequency, urgency and incontinence, either as monotherapy or in combination with available therapies. Agents that relax bladder smooth muscle, such as β3AR agonists, are expected to be effective for treating such urinary disorders.

PATENT

http://www.google.com/patents/WO2013062881A1?cl=en

Figure imgf000013_0001

EXAMPLE 3

To a three neck flask equipped with a N2 inlet, a thermo couple probe was charged pyrrolidine i-11 (10.0 g), sodium salt i-12 (7.87 g), followed by IPA (40 mL) and water (24 mL). 5 N HC1 (14.9 mL) was then slowly added over a period of 20 min to adjust pH = 3.3- 3.5, maintaining the batch temperature below 35 °C. Solid EDC hydrochloride (7.47 g) was charged in portions over 30 min. The reaction mixture was aged at RT for additional 0.5 – 1 h, aqueous ammonia (14%) was added dropwise to pH ~8.6. The batch was seeded and aged for additional 1 h to form a slurry bed. The rest aqueous ammonia (14%, 53.2 ml total) was added dropwise over 6 h. The resulting thick slurry was aged 2-3 h before filtration. The wet-cake was displacement washed with 30% IPA (30 mL), followed by 15% IPA (2 x 20mL) and water (2 X 20mL). The cake was suction dried under N2 overnight to afford 14.3 g of compound of Formula (I)-

1H NMR (DMSO) δ 10.40 (s, NH), 7.92 (d, J = 6.8, 1H), 7.50 (m, 2H), 7.32 (m, 2H), 7.29 (m, 2H), 7.21 (m, 1H), 7.16 (m, 2H), 6.24 (d, J = 6.8, 1H), 5.13 (dd, J = 9.6, 3.1, 1H), 5.08 (br s, OH), 4.22 (d, J = 7.2, 1H), 3.19 (p, J = 7.0, 1H), 3.16-3.01 (m, 3H), 2.65 (m, 1H), 2.59-2.49 (m, 2H), 2.45 (br s, NH), 2.16 (ddt, J = 13.0, 9.6, 3.1, 1H), 1.58 (m, 1H), 1.39 (m, 1H), 1.31-1.24 (m, 2H).

13C NMR (DMSO) δ 167.52, 165.85, 159.83, 154.56, 144.19, 136.48, 135.66, 129.16, 127.71, 126.78, 126.62, 119.07, 112.00, 76.71, 64.34, 61.05, 59.60, 42.22, 31.26, 30.12, 27.09, 23.82.

HPLC method – For monitoring conversion

Column: XBridge C18 cm 15 cm x 4.6 mm, 3.5 μιη particle size;

Column Temp. : 35 °C; Flow rate: 1.5 mL/min; Detection: 220 nm;

Mobile phase: A. 5 mM Na2B407.10 H20 B: Acetonitrile

Gradient:

HPLC method – For level of amide epimer detection

Column: Chiralpak AD-H 5 μηι, 250 mm x 4.6 mm.

Column Temp: 35 °C; Flow rate: 1.0 mL/min; Detection: 250 nm;

Mobile phase: Isocratic 30% Ethanol in hexanes + 0.1% isobutylamine

PATENT

WO 2009124167

http://www.google.com/patents/WO2009124167A1?cl=en

EXAMPLE 103

(6y)-N-r4-({(25′. 5R)-5-r(R)-hvdroxy(phenvnmethyl1pyrrolidin-2-yl}methvnphenyl1-4-oxo- 4,6J,8-tetrahydropyiτolori,2-α1pyrimidine-6-carboxamide

ter?-butyl(2R. 55f)-2-rCR)-hvdroxy(phenvnmethyl1-5-r4-({r(65f)-4-oxo-4.6.7.8-

tetrahydropyrrolof 1.2-alpyrimidin-6- yl]carbonyl} amino)benzyl]pyrrolidine- 1 – carboxylate

To a solution of i-13a (21.4 g, 55.9 mmol) in N,N-dimethylformamide (100 ml) at O0C was added [(65)-4-oxo-4,6,7,8-tetrahydropyrrolo[l,2-α]pyrimidine-6-carboxylic acid (11.1 g, 61.5 mmol), followed by 1 -hydroxybenzotriazole (i-44, 7.55 g, 55.9 mmol), N-(3- dimethylaminopropyl)-Nl-ethylcarbodiimide hydrochloride (16.1 g, 84.0 mmol) and N,N- diisopropylethylamine (29.2 ml, 168 mmol). The reaction mixture was stirred from O0C to ambient temperature for 2 h. Water (600 ml) was added and it was extracted with dichloromethane (600 ml x 2). The combined organic layers were dried over Na2SO4. After removal of the volatiles, the residue was purified by using a Biotage Horizon® system (0-5% then 5% methanol with 10% ammonia/dichloromethane mixture) to afford the title compound which contained 8% of the minor diastereomer. It was further purified by supercritical fluid chromatography (chiral AS column, 40% methanol) to afford the title compound as a pale yellow solid (22.0 g, 72%). 1H NMR (CDCl3): δ 9.61 (s, IH), 7.93 (d, J = 6.6 Hz, IH), 7.49 (d, J = 8.4 Hz, 2H), 7.35-7.28 (m, 5H), 7.13 (d, J = 8.5 Hz, 2H), 6.40 (d, J = 6.7 Hz, IH), 5.36 (d, J = 8.6 Hz, IH), 4.38 (m, IH), 4.12-4.04 (m, 2H), 3.46 (m,lH), 3.15-3.06 (m, 2H), 2.91 (dd, J = 13.1, 9.0 Hz, IH), 2.55 (m, IH), 2.38 (m, IH), 1.71-1.49 (m, 13H). LC-MS 567.4 (M+23).

(6S)-N-\4-( U2S. 5R)-5-r(R)-hvdroxy(phenyl)methyl1pyrrolidin-2-

yl}methyl)phenyl1-4-oxo-4,6J,8-tetrahvdropyrrolori,2-α1pyrimidine-6- carboxamide

To a solution of the intermediate from Step A (2.50 g, 4.59 mmol) in dichloromethane (40 ml) was added trifluoroacetic acid (15 ml). The reaction mixture was stirred at ambient temperature for 1.5 h. After removal of the volatiles, saturated NaHCCh was added to make the PH value to 8-9. The mixture was then extracted with dichloromethane. The combined organic layers were dried over Na2SO4. After concentration, crystallization from methanol/acetonitrile afforded the title compound as a white solid (1.23g, 60%). 1H NMR (DMSO-Cl6): δ 10.40 (s, IH), 7.91 (d, J = 6.7 Hz, IH), 7.49 (d, J = 8.3 Hz, 2H), 7.32-7.26 (m, 4H), 7.21 (m, IH), 7.15 (d, J = 8.4 Hz, 2H), 6.23 (d, J = 6.7 Hz, IH), 5.11 (dd, J = 9.6, 2.9 Hz, IH), 5.10 (br, IH), 4.21 (d, J = 7.1 Hz, IH), 3.20-3.00 (m, 4H), 2.66-2.51 (m, 3H), 2.16 (m, IH), 1.57 (m, IH), 1.38 (m, IH), 1.29-1.23 (m, 2H). LC-MS 445.3 (M+l).

Using the Biological Assays described above, the human β3 functional activity of Example 103 was determined to be between 11 to 100 nM.

PATENT

CHECK STRUCTURE…………….CAUTION

http://www.google.com/patents/US8247415

Figure US08247415-20120821-C00547

Figure US08247415-20120821-C00015

CAUTION…………….

Example 103(6S)-N-[4-({(2S,5R)-5-[(R)-hydroxy(phenyl)methyl]pyrrolidin-2-yl}methyl)phenyl]-4-oxo-4,6,7,8-tetrahydropyrrolo[1,2-α]pyrimidine-6-carboxamide

Step A: tert-butyl(2R,5S)-2-[(R)-hydroxy(phenyl)methyl]-5-[4-({[(6S)-4-oxo-4,6,7,8-tetrahydropyrrolo[1,2-α]pyrimidin-6-yl]carbonyl}amino)benzyl]pyrrolidine-1-carboxylate

To a solution of i-13a (21.4 g, 55.9 mmol) in N,N-dimethylformamide (100 ml) at 0° C. was added [(6S)-4-oxo-4,6,7,8-tetrahydropyrrolo[1,2-α]pyrimidine-6-carboxylic acid (11.1 g, 61.5 mmol), followed by 1-hydroxybenzotriazole (i-44, 7.55 g, 55.9 mmol), N-(3-dimethylaminopropyl)-N′-ethylcarbodiimide hydrochloride (16.1 g, 84.0 mmol) and N,N-diisopropylethylamine (29.2 ml, 168 mmol). The reaction mixture was stirred from 0° C. to ambient temperature for 2 h. Water (600 ml) was added and it was extracted with dichloromethane (600 ml×2). The combined organic layers were dried over Na2SO4. After removal of the volatiles, the residue was purified by using a Biotage Horizon® system (0-5% then 5% methanol with 10% ammonia/dichloromethane mixture) to afford the title compound which contained 8% of the minor diastereomer. It was further purified by supercritical fluid chromatography (chiral AS column, 40% methanol) to afford the title compound as a pale yellow solid (22.0 g, 72%). 1H NMR (CDCl3): δ 9.61 (s, 1H), 7.93 (d, J=6.6 Hz, 1H), 7.49 (d, J=8.4 Hz, 2H), 7.35-7.28 (m, 5H), 7.13 (d, J=8.5 Hz, 2H), 6.40 (d, J=6.7 Hz, 1H), 5.36 (d, J=8.6 Hz, 1H), 4.38 (m, 1H), 4.12-4.04 (m, 2H), 3.46 (m, 1H), 3.15-3.06 (m, 2H), 2.91 (dd, J=13.1, 9.0 Hz, 1H), 2.55 (m, 1H), 2.38 (m, 1H), 1.71-1.49 (m, 13H). LC-MS 567.4 (M+23).

Step B: (6S)-N-[4-({(2S,5R)-5-[(R)-hydroxy(phenyl)methyl]pyrrolidin-2-yl}methyl)phenyl]-4-oxo-4,6,7,8-tetrahydropyrrolo[1,2-α]pyrimidine-6-carboxamide

To a solution of the intermediate from Step A (2.50 g, 4.59 mmol) in dichloromethane (40 ml) was added trifluoroacetic acid (15 ml). The reaction mixture was stirred at ambient temperature for 1.5 h. After removal of the volatiles, saturated NaHCO3 was added to make the PH value to 8-9. The mixture was then extracted with dichloromethane. The combined organic layers were dried over Na2SO4. After concentration, crystallization from methanol/acetonitrile afforded the title compound as a white solid (1.23 g, 60%). 1H NMR (DMSO-d6): δ 10.40 (s, 1H), 7.91 (d, J=6.7 Hz, 1H), 7.49 (d, J=8.3 Hz, 2H), 7.32-7.26 (m, 4H), 7.21 (m, 1H), 7.15 (d, J=8.4 Hz, 2H), 6.23 (d, J=6.7 Hz, 1H), 5.11 (dd, J=9.6, 2.9 Hz, 1H), 5.10 (br, 1H), 4.21 (d, J=7.1 Hz, 1H), 3.20-3.00 (m, 4H), 2.66-2.51 (m, 3H), 2.16 (m, 1H), 1.57 (m, 1H), 1.38 (m, 1H), 1.29-1.23 (m, 2H). LC-MS 445.3 (M+1).

Using the Biological Assays described above, the human β3 functional activity of Example 103 was determined to be between 11 to 100 nM.

PATENT

WO2014150639

http://patentscope.wipo.int/search/en/detail.jsf?docId=WO2014150639&recNum=4&docAn=US2014023858&queryString=EN_ALL:nmr%20AND%20PA:merck&maxRec=11148

Step 6. Preparation of Compound 1-7 from Compound 1-6 and Compound A-2

To a three neck flask equipped with a N2 inlet, a thermo couple probe was charged pyrrolidine hemihydrate 1-6 (10.3 g), sodium salt A-2 (7.87 g), followed by IPA (40 mL) and water (24 mL). 5 N HC1 (14.9 mL) was then slowly added over a period of 20 minutes to adjust pH = 3.3-3.5, maintaining the batch temperature below 35°C. Solid EDC hydrochloride (7.47 g) was charged in portions over 30 minutes. The reaction mixture was aged at RT for additional 0.5 – 1 hour, aqueous ammonia (14%) was added dropwise to pH -8.6. The batch was seeded and aged for additional 1 hour to form a slurry bed. The rest aqueous ammonia (14%, 53.2 ml total) was added dropwise over 6 hours. The resulting thick slurry was aged 2-3 hours before filtration. The wet-cake was displacement washed with 30% IPA (30 mL), followed by 15% IPA (2 x 20mL) and water (2 X 20mL). The cake was suction dried under N2 overnight to afford 14.3 g of compound 1-7.

1H NMR (DMSO) δ 10.40 (s, NH), 7.92 (d, J = 6.8, 1H), 7.50 (m, 2H), 7.32 (m, 2H), 7.29 (m, 2H), 7.21 (m, 1H), 7.16 (m, 2H), 6.24 (d, J = 6.8, 1H), 5.13 (dd, J = 9.6, 3.1, 1H), 5.08 (br s, OH), 4.22 (d, J = 7.2, 1H), 3.19 (p, J = 7.0, 1H), 3.16-3.01 (m, 3H), 2.65 (m, 1H), 2.59-2.49 (m, 2H), 2.45 (br s, NH), 2.16 (ddt, J = 13.0, 9.6, 3.1, 1H), 1.58 (m, 1H), 1.39 (m, 1H), 1.31-1.24 (m, 2H).

13C NMR (DMSO) δ 167.52, 165.85, 159.83, 154.56, 144.19, 136.48, 135.66, 129.16, 127.71, 126.78, 126.62, 119.07, 112.00, 76.71, 64.34, 61.05, 59.60, 42.22, 31.26, 30.12, 27.09, 23.82.

The crystalline freebase anhydrous form I of Compound 1-7 can be characterized by XRPD by

PATENT

WO-2014150633
Merck Sharp & Dohme Corp
Process for preparing stable immobilized ketoreductase comprises bonding of recombinant ketoreductase to the resin in a solvent. Useful for synthesis of vibegron intermediates. For a concurrent filling see WO2014150639, claiming the method for immobilization of ketoreductase. Picks up from WO2013062881, claiming the non enzymatic synthesis of vibegron and intermediates.

PAPER

Discovery of Vibegron: A Potent and Selective β3 Adrenergic Receptor Agonist for the Treatment of Overactive Bladder

Merck Research Laboratories, 2015 Galloping Hill Road, PO Box 539, Kenilworth, New Jersey 07033, United States
J. Med. Chem., Article ASAP
DOI: 10.1021/acs.jmedchem.5b01372
Publication Date (Web): December 27, 2015
Copyright © 2015 American Chemical Society
*Telephone: (908) 740-0287. E-mail scott.edmondson@merck.com.

http://pubs.acs.org/doi/abs/10.1021/acs.jmedchem.5b01372

http://pubs.acs.org/doi/suppl/10.1021/acs.jmedchem.5b01372/suppl_file/jm5b01372_si_001.pdf

Abstract Image

The discovery of vibegron, a potent and selective human β3-AR agonist for the treatment of overactive bladder (OAB), is described. An early-generation clinical β3-AR agonist MK-0634 (3) exhibited efficacy in humans for the treatment of OAB, but development was discontinued due to unacceptable structure-based toxicity in preclinical species. Optimization of a series of second-generation pyrrolidine-derived β3-AR agonists included reducing the risk for phospholipidosis, the risk of formation of disproportionate human metabolites, and the risk of formation of high levels of circulating metabolites in preclinical species. These efforts resulted in the discovery of vibegron, which possesses improved druglike properties and an overall superior preclinical profile compared to MK-0634. Structure–activity relationships leading to the discovery of vibegron and a summary of its preclinical profile are described.

Reference
1 H.P. Kaiser, et al., “Catalytic Hydrogenation of Pyrroles at Atmospheric Pressure“, J. Org. Chem., vol. 49, No. 22, p. 4203-4209 (1984).
A study of the efficacy and safety of MK-4618 in patients with overactive bladder (OAB) (MK-4618-008 EXT1) (NCT01314872)
ClinicalTrials.gov Web Site 2011, April 28
WO2011043942A1 * Sep 27, 2010 Apr 14, 2011 Merck Sharp & Dohme Corp. Combination therapy using a beta 3 adrenergic receptor agonist and an antimuscarinic agent
US20090253705 * Apr 2, 2009 Oct 8, 2009 Richard Berger Hydroxymethyl pyrrolidines as beta 3 adrenergic receptor agonists
US20110028481 * Apr 2, 2009 Feb 3, 2011 Richard Berger Hydroxymethyl pyrrolidines as beta 3 adrenergic receptor agonists
 
Citing Patent Filing date Publication date Applicant Title
US8642661 Aug 2, 2011 Feb 4, 2014 Altherx, Inc. Pharmaceutical combinations of beta-3 adrenergic receptor agonists and muscarinic receptor antagonists
US8653260 Jun 20, 2012 Feb 18, 2014 Merck Sharp & Dohme Corp. Hydroxymethyl pyrrolidines as beta 3 adrenergic receptor agonists
US20120202819 * Sep 27, 2010 Aug 9, 2012 Merck Sharp & Dohme Corporation Combination therapy using a beta 3 adrenergic receptor agonists and an antimuscarinic agent
US20020028835 Jul 12, 2001 Mar 7, 2002 Baihua Hu Cyclic amine phenyl beta-3 adrenergic receptor agonists
US20070185136 Feb 2, 2007 Aug 9, 2007 Sanofi-Aventis Sulphonamide derivatives, their preparation and their therapeutic application
US20110028481 Apr 2, 2009 Feb 3, 2011 Richard Berger Hydroxymethyl pyrrolidines as beta 3 adrenergic receptor agonists
WO2003072572A1 Feb 17, 2003 Sep 4, 2003 Jennifer Anne Lafontaine Beta3-adrenergic receptor agonists
8-22-2012
Hydroxymethyl pyrrolidines as [beta]3 adrenergic receptor agonists

////////////C1CC(NC1CC2=CC=C(C=C2)NC(=O)C3CCC4=NC=CC(=O)N34)C(C5=CC=CC=C5)O

Artesunate, the antimalarial


Artesunate.svg

ARTESUNATE
Butanedioic acid mono[(3R,5aS,6R,8aS,9R,10R,12R,12aR)-decahydro-3,6,9-trimethyl-3,12-epoxy-12H-pyrano[4,3-j]-1,2-benzodioxepin-10-yl] ester
(3R,5aS,6R,8aS,9R,10S,12R,12aR)-Decahydro-3,6,9-trimethyl-3,12-epoxy-12H-pyrano(4,3-j)-1,2-benzodioxepin-10-ol, hydrogen succinate
Butanedioic acid, mono((3R,5aS,6R,8aS,9R,10S,12R,12aR)-decahydro-3,6,9-trimethyl-3,12-epoxy-12H-pyrano(4,3-j)-1,2-benzodioxepin-10-yl) ester
Additional Names: artesunic acid; dihydroqinghaosu hemisuccinate, Succinic ester of artemether.
Molecular Formula: C19H28O8
Molecular Weight: 384.42
Percent Composition: C 59.36%, H 7.34%, O 33.30%
Artesunate (superseded RN); Dihydroartemisinine-12-alpha-succinate; Succinyl dihydroartemisinin; Quinghaosu reduced succinate ester
Therap-Cat: Antimalarial.

Artesunate (INN) is part of the artemisinin group of drugs that treat malaria. It is a semi-synthetic derivative of artemisinin that is water-soluble and may therefore be given by injection. It is sometimes abbreviated AS.

It is on the World Health Organization’s List of Essential Medicines, a list of the most important medication needed in a basic health system.[1]

Artesunate

  • Arinate
  • Armax 200
  • Arsuamoon
  • Arsumax
  • Artesunata
  • Artesunate
  • Artesunato
  • Artesunato [INN-Spanish]
  • Artesunatum
  • Artesunatum [INN-Latin]
  • Artesunic acid
  • Asumax
  • Cosinate
  • Dihydroqinghasu hemsuccinate
  • Gsunate Forte
  • HSDB 7458
  • Plasmotrin
  • Qinghaozhi
  • Quinghaosu reduced succinate ester
  • Saphnate
  • SM 804
  • Succinyl dihydroartemisinin
  • UNII-60W3249T9M
  • WR 256283
  • Zysunate
SODIUM ARTESUNATE Structure
SODIUM ARTESUNATE;
Dihydroartemisinin alpha-hemisuccinate sodium salt;
Sodium dihydroarteannuin hydrogen succinate monoester;
Butanedioic acid 1-[(3R,5aα,8aα,12aR)-decahydro-3,6α,9β-trimethyl-3β,12α-epoxypyrano[4,3-j]-1,2-benzodioxepin-10α-yl]4-sodium salt;
Butanedioic acid, mono(decahydro-3,6,9-trimethyl-3,12-epoxy-12H-pyrano(4,3-J)-1,2-benzodioxepin-10-yl)ester, sodium salt, (3R-(3-alpha,5A-beta,6-beta,8A-beta,9-alpha,10-alpha,12-beta,12ar*))-
CAS 82864-68-4
Derivative Type: Sodium salt
Manufacturers’ Codes: SM-804
Molecular Formula: C19H27NaO8
Molecular Weight: 406.40
Percent Composition: C 56.15%, H 6.70%, Na 5.66%, O 31.49%
Properties: Poor stability in aqueous solutions. LD50 in mice (mg/kg): 520 i.v.; 475 i.m. (China Cooperative Research Group); also reported as 699 ± 58.5 i.v. (Zhao, 1985).
Toxicity data: LD50 in mice (mg/kg): 520 i.v.; 475 i.m. (China Cooperative Research Group); also reported as 699 ± 58.5 i.v. (Zhao, 1985)

Medical uses

The World Health Organization recommends intramuscular or intravenous artesunate as the first line treatment for severe malaria.[2]Artesunate was shown to prevent more deaths from severe malaria than quinine in two large multicentre randomized controlled trials from Africa[3] and Asia.[4] A subsequent systematic review of seven randomized controlled trials found this beneficial effect to be consistent across all trials.[5]

For severe malaria during pregnancy, there is less certainty about the safety of artesunate during the first trimester but artesunate is recommended as first-line therapy during the second and third trimesters.[6]

Artesunate is also used to treat less severe forms of malaria when it can be given orally, but should always be taken with a second antimalarial such as mefloquine or amodiaquine to avoid the development of resistance.[2]

While artesunate is used primarily as treatment for malaria, there is some evidence that it may also have some beneficial effects inSchistosoma haematobium infection,[7] but this needs confirming in large randomized trials.

Adverse effects

Artesunate is generally safe and well-tolerated. The best recognised side effect of the artemesinins that they lower reticulocyte counts.[8] This is not usually of clinical relevance.

Delayed haemolysis (occurring around two weeks after treatment) has been observed in patients treated with artesunate for severe malaria.[9] Whether or not this haemolysis is due to artesunate, or to the malaria itself is unclear.[10]

The safety of artesunate in pregnancy is unclear. There is evidence of embryotoxicity in animal models (defects in long bones and ventricular septal defects in the heart in rates and monkeys). However, observational evidence from 123 human first-trimester pregnancies showed no evidence of damage to the fetus.[11]

Synthesis

Artesunate is prepared from dihydroartemisinin (DHA) by reacting it with succinic acid anhydride in basic medium. Pyridine as base/solvent, sodium bicarbonate in chloroform and catalyst DMAP (N,N-dimethylaminopyridine) and triethylamine in 1,2-dichloroethane have been used, with yields of up to 100%. A large scale process involves treatment of DHA indichloromethane with a mixture of pyridine, a catalytic amount of DMAP and succinic anhydride. The dichloromethane mixture is stirred for 6–9 h to get artesunate in quantitative yield. The product is further re-crystallized from dichloromethane. alpha-Artesunate is exclusively formed (m.p 135–137˚C).

Artemisinin and its ether and ester derivatives show antimalarial activity against multidrug resistant strains. Ether derivatives like arteether and artemether shows better activity but they suffer from some limitation like solubility, short half life. Unlike ether derivatives, ester derivatives like artesunate has increased solubility and improved pharmacokinetic properties. The water insoluble dihydroartimisinin hemisuccinate is given orally in tablet form and water soluble artesunate sodium is given as LV.

Artesunate was first prepared by Chinese scientists, using different methods. One of them describes acylation of dihydroartemisinin by succinic anhydride in pyridine at 300C for 24 hr with yield of 60%. In another method, described in Acta. Chim. Sinica 40(6), 557-561., ester derivatives of dihydroartemisinin was prepared in presence of 4- (N, N-dimethylamino) pyridine and triethylamine as basic catalyst and 1 ,2 dichloroethane as solvent. The reaction is continued until complete conversion of dihydroartemisinin and product is isolated and purified by silica gel column giving overall yield 60-90%.

Another improved method disclosed in US patent 5654446, describes preparation of artesunate from dihydroartemisinin and succinic anhydride in presence of triethylamine as basic catalyst and in low boiling water miscible dry solvent like acetone. After completion of reaction, mixture is acidified and diluted with water to get artesunate. The yield of esterification is 96%.

U.S. patent 6677463 discloses one pot method for preparation of artesunate from artemisinin. Method describes reduction of artermisinin to dihydroartemisinin in presence of polyhydroxy compound and sodium borohydride. After completion of reaction succinic anhydride and anion exchange resin was added to reaction mass and stirred for 2 hrs. Then cold water was added and product was extracted with ethylacetate hexane mixture in pH range of 6-7. Distilling off the solvent yields the crude artesunate which on silica gel column purification gives 96 % of pure artesunate. The process is complex and time consuming as it involves chromatographic purification step.

……………………………..

Chemical structure for artesunate

http://www.google.com/patents/WO2008087667A1?cl=en

Example 1 discloses the process for obtaining artesunate. The process involves reducing artemisinin to dihydroartemisinin in presence of 1, 2-propanediol and sodium borohydride in a solvent mixture of hexane and isopropanol to give dihydroartemisinin in a yield of 92%. The ratio of artemisinin to 1 , 2-propanediol is 1 :0.66 w/w and the ratio of artemisinin to sodium borohydride is 1 :0.33 w/w. The high yield is attributed to the combination of 1 , 2-propanediol and sodium borohydride in a solvent mixture of hexane and isopropanol that could not be derived from prior art. The dihydroartemisinin is esterified using succinic anhydride and imidazole to give the artesunate in a yield of 100% in 40 min. The ratio of artemisinin to succinic anhydride is 1 :0.52 w/w and that of artemisinin to imidazole is 1 :0.2 w/w. Further, high yield of artesunate obtained in less time was due to imidazole catalyst that accelerates the rate of reaction. Moreover, the process of the present disclosure does not employ purification over silica gel as is in the prior art, but the pure compound is obtained by simple crystallization using suitable solvent.

Example 2 describes the process for obtaining artesunate. The process involves reducing artemisinin to dihydroartemisinin as in example 1. The dihydroartemisinin is esterified using succinic anhydride and imidazole to give the artesunate in a yield of

100% in 25 min. The ratio of artemisinin to succinic anhydride is 1 :0.52 w/w and that of artemisinin to imidazole is 1 :0.3 w/w.

Example 3 describes the process for obtaining artesunate involving reducing artemisinin to dihydroartemisinin in presence of 1, 2-propanediol and sodium borohydride in a solvent mixture of hexane and isopropanol to give dihydroartemisinin in a yield of 88% in 40 min. The ratio of artemisinin to 1, 2-propanediol is 1 :0.8 w/w and the ratio of artemisinin to sodium borohydride is 1 :0.4 w/w. The dihydroartemisinin is esterified using succinic anhydride and imidazole to give the artesunate in a yield of 86%. The ratio of artemisinin to succinic anhydride is 1 :0.52 w/w and that of artemisinin to imidazole is 1 :0.2 w/w.

Example 4 describes the process for obtaining artesunate involving reducing artemisinin to dihydroartemisinin as in example 1. The dihydroartemisinin is esterified using succinic anhydride and imidazole to give the artesunate in a yield of 90% in 210 min. The ratio of artemisinin to succinic anhydride is 1 :0.52 w/w and that of artemisinin to imidazole is 1 :0.1 w/w.

Example 5 describes the process for obtaining artesunate involving reducing artemisinin to dihydroartemisinin as in example 1. The dihydroartemisinin is esterified using succinic anhydride and imidazole in dichloromethane to give the artesunate in a yield of 92% in 60 min. The ratio of artemisinin to succinic anhydride is 1:0.44 w/w and the ratio of artemisinin to imidazole is 1 :0.2 w/w.

Example 6 describes the process for obtaining artesunate involving reducing artemisinin to dihydroartemisinin as in example 1. The dihydroartemisinin is esterified using succinic anhydride and imidazole in acetonitrile to give the artesunate in a yield of 92% in 180 min. The ratio of artemisinin to succinic anhydride is 1:0.52 w/w and that of artemisinin to imidazole is 1 :0.2 w/w.

Example 1 Artemisinin (1.0 g) and 1, 2-propanediol (0.66 g) was added to a mixture of isopropanol (3.5 ml) and hexane (10 ml) and the suspension was stirred for 2 minutes at 2O0C followed by the addition of Sodium borohydride (0.33 gm). After 2 minutes of stirring, dihydroartemisinin started precipitating and the reaction mixture was further stirred for about 8 minutes at 2O0C. Water (10 ml) was added to the reaction mixture and stirred for 10 minutes at 100C. Solid was filtered, washed with hexane (2 * 20 ml) and dried to yield 0.92 g (92% w/w) dihydroartemisinin.

Dihydroartemisinin (0.92 g) was stirred in dichloromethane (10 ml) for 2 minutes at room temperature. Succinic anhydride (0.52 g) and imidazole (0.2 g) were added to this solution and stirred for 40 minutes. The pH of reaction mixture was adjusted to 5-6 and organic layer was washed with water, dried and concentrated to oily mass. The oily mass was dissolved in methanol (1.5 ml) and stirred for 2 min to obtain a clear solution. Water (ImI) was added dropwise to this solution to start the precipitation of artesunate and the suspension was stirred for 5 minutes. The solid was filtered, washed with cold water (2 x 2ml) and dried to yield 1.0 g of artesunate. The overall yield of artesunate was 100 % w/w.

Example 2

Reduction of artemisinin to dihydroartemisinin was carried out as described in Example 1. Dihydroartemisinin (0.92 g) was stirred in dichloromethane (10 ml) for 2 minutes at room temperature. Succinic anhydride (0.52 g) and imidazole (0.3 g) were added to this solution and stirred for 25 minutes. The pH of reaction mixture was adjusted to 5-6 and organic layer was washed with water, dried and concentrated to oily mass. The oily mass was dissolved in methanol (1.5 ml) and stirred for 2 min to obtain a clear solution. Water (ImI) was added dropwise to this solution to start the precipitation of artesunate and the suspension was stirred for 5 minutes. The solid was filtered, washed with cold water (2 χ 2 ml) and dried to yield 1.0 g of artesunate. The overall yield of artesunate was 100 % w/w.

Example 3

Artemisinin (1.0 g) and 1, 2-propanediol (0.8 g) was added to a mixture of isopropanol (3.5 ml) and hexane (10 ml) and the suspension was stirred for 2 minutes at 2O0C followed by the addition of Sodium borohydride (0.4 g). After 2 minutes of stirring, dihydroartemisinin started precipitating and the reaction mixture was further stirred for about 8 minutes at 200C. Water (7.5 ml) was added to the reaction mixture and stirred for 10 minutes at 100C. Solid was filtered, washed with hexane (2 ^ 2 ml) and dried to yield 0.88 g (88% w/w) dihydroartemisinin.

Dihydroartemisinin (0.88 g) was stirred in dichloromethane (10 ml) for 2 minutes at room temperature. Succinic anhydride (0.52 g) and imidazole (0.2 g) were added to this solution and stirred for 40 minutes. The pH of reaction mixture was adjusted to 5-6 and organic layer was washed with water, dried and concentrated to oily mass. The oily mass was dissolved in methanol (1.5 ml) and stirred for 2 min to obtain a clear solution. Water (ImI) was added dropwise to this solution to start the precipitation of artesunate and the suspension was stirred for 5 minutes. The solid was filtered, washed with cold water (2 x 2ml) and dried to yield 0.86 g of artesunate. The overall yield of artesunate was 86 % w/w.

Example 4

Reduction of artemisinin to dihydroartemisinin was carried out as described in Example 1. Dihydroartemisinin (0.92 g) was stirred in dichloromethane (10 ml) for 2 minutes at room temperature. Succinic anhydride (0.52 g) and imidazole (0.1 g) were added to this solution and stirred for 210 minutes. The pH of reaction mixture was adjusted to 5-6 and organic layer was washed with water, dried and concentrated to oily mass. The oily mass was dissolved in methanol (1.5 ml) and stirred for 2 min to obtain a clear solution. Water (ImI) was added dropwise to this solution to start the precipitation of artesunate and the suspension was stirred for 5 minutes. The solid was filtered, washed with cold water (2 x 2 ml) and dried to yield 0.9 g of artesunate. The overall yield of artesunate was 90 % w/w.

Example 5

Reduction of artemisinin to dihydroartemisinin was carried out as described in Example 1. Dihydroartemisinin (0.92 g) was stirred in dichloromethane (10 ml) for 2 minutes at room temperature. Succinic anhydride (0.44 g) and imidazole (0.2 g) were added to this solution and stirred for 60 minutes. The pH of reaction mixture was adjusted to 5-6 and organic layer was washed with water, dried and concentrated to oily mass. The oily mass was dissolved in methanol (1.5 ml) and stirred for 2 min to obtain a clear solution. Water (ImI) was added dropwise to this solution to start the precipitation of artesunate and the suspension was stirred for 5 minutes. The solid was filtered, washed with cold water (2 x 2 ml) and dried to yield 0.92 g of artesunate. The overall yield of artesunate was 92 % w/w. Example 6

Reduction of artemisinin to dihydroartemisinin was carried out as described in

Example 1. Dihydroartemisinin (0.92 g) was stirred in acetonitrile (10 ml) for 2 minutes at room temperature. Succinic anhydride (0.52 g) and imidazole (0.2gm) were added to this solution and stirred for 180 minutes. The pH of reaction mixture was adjusted to 5-6 and it was extracted with dichloromethane (10 ml). The organic layer was washed with water (20 ml), dried and concentrated to oily mass. The oily mass was dissolved in methanol (1.5 ml) and stirred for 2 min to obtain a clear solution. Water (ImI) was added dropwise to this solution to start the precipitation of artesunate and the suspension was stirred for 5 minutes. The solid was filtered, washed with cold water (2 x 2 ml) and dried to yield 0.92 g of artesunate. The overall yield of artesunate was 92 % w/w.

Mechanisms of action

In a hematin dependent manner, artesunate has been shown to potently inhibit the essential Plasmodium falciparum exported protein 1 (EXP1), a membrane glutathione S-transferase.[12]

Drug resistance

Clinical evidence of drug resistance has appeared in Western Cambodia, where artemisinin monotherapy is common.[13] There are as yet no reports of resistance emerging elsewhere.

…………………………………

http://www.google.com/patents/WO2004050661A1?cl=en

Malaria is caused by protozoan parasites, notably Plasmodium falciparum. The range of drugs available in the market for prevention and treatment of malaria is limited, and there are problems of drag resistance. Artemisinin and its derivatives: artemether and arteether (oil soluble), artelinate and artesunate (water soluble), are a class of anti-malarial compounds derived from Artemisia annua which are now proving their promising activity and are being used for the treatment of uncomplicated/severe complicated/cerebral and multi drug resistant malaria. The chemistry and the anti-protozoal action of these compounds, described in the publications are listed as references cited.

The water-insoluble artesunic acid is customarily administered orally in the form of tablets or rectally in the form of suppositories, while the water- soluble artesunate is administered intravenously.

Artesunic acid together with a number of other Cio-ester and CiQ-ether” derivatives of dihydroartemisinin, were prepared for the first time by Chinese scientists at the end of 1979 to the beginning of 1980. Shaofeng et al., H Labeling of QHS Derivatives, Bull. Chin. Materia Medica 6 (4), 25-27 (1981) and Li et al, Synthesis of Ethers. Carboxylic esters and carbonates of Dihydroartemisinin, Acta Pharm. Sin 16(6), 429-39, 1981) describe the preparation of artesunic acid by acylation of dihydroartemisinin with succinic anhydride in pyridine. The above mentioned publications describe a general method for preparing various dihydroartemisinin Cι0-esters and also provide a process for preparing artesunic acid in a yield of 60% by means of warming dihydroartemisinin and succinic anhydride in pyridine at 30° C for 24 hours.

Ying et al. in the Synthesis of some carboxylic esters and carbonates of Dihydroartemisinin by using 4-(N, N-Dimethylamino) pyridine as an active acylation catalyst, Acta Chim Sinica 40 (6), 557-561 982) proposed an improved version of the acylation of dihydroartemisinin. The said publication described in detail with the aid of the preparation of dihydroartemisinin – 10-valerate the aforesaid process. In this process dihydroartimisinin was dissolved in 1,2-dichloroethane and treated with valeric anhydride, 4-(N, N-dimethylamino) pyridine and triethylamine, and the mixture was stirred at room temperature until dihydroartemisinin had been used up. The reaction mixture was then acidified with dilute hydrochloric acid and the aqueous phase was separated off. The oily residue, obtained after washing and drying the organic phase and distilling off the solvent, was purified by chromatography on silica gel using petroleum ether 60-80° C degree/ethyl acetate (10:1) as an eluent. The use of this procedure for the preparation of the artesunic acid from dihydroartemisinin with succinic anhydride and 4-(N, N-dimethylamino) pyridine afforded artesunic acid in a yield of 65% in 5 hours.

U.S. Patent No. 5,654,446 granted to Ognyanov et al. titled “Process for preparation of Dihydroartemisinin Hemisuccinate (artesunic acid)”, dated August 5, 1997 teaches a process for preparing o α-artesunic acid by acylation of dihydroartemisinin with succinic anhydride, in the presence of trialkylamines and their mixture in a low boiling, neutral water miscible, inert organic solvent or solvent mixture at 20-60°C in 0.5 hours and the artesunic acid is then isolated directly at pH 5 to 8 in 91.8 to 97.2% yield.

The above mentioned methods carry some disadvantages being less cost effective and more time consuming as compared to the present invention it should be noted that all the above referenced methods require two separate steps to convert artemisinin into 10-esters of dihydroartemisinin i.e. (a) reduction of artemisinin into dihydroartemisinin in the first pot following by isolation of dihydroartemisinin, and (b) esterification of dihydroartemisinin into different esters in the second pot.

Further, solvent pyridine or 1,2 dichloroethane and catalyst, 4 (N, N-dimethylamino) pyridine used in these processes are not acceptable according to the health standard. Hence there is a need to provide a single step process that overcomes the above-mentioned disadvantages.

EXAMPLE 1

Artemisinin (500mg) and polyhydroxy compound (dextrose, 2.5g) are stirred in 1,4-dioxan (15ml) at room temperature for 5 minutes. Sodium borohydride (2.5g) is added slowly for 10 minutes and the reaction mixture is stirred for about 2 hours at room temperature (20- 30° C). After completion of the reaction (Checked by TLC), succinic anhydride (250 mg) and anion exchange (basic) resin (1.5g) are added at room temperature and the reaction mixture is stirred further for 2 hours at room temperature. Cold water (50 ml) is added to the reaction mixture and pH is adjusted between 6-7 with dilute acetic acid and extracted with 40% ethyl acetate in hexane (3 x 25 ml). The combined extract is washed with water (50 ml). The ethyl acetate π-hexane extract is dried over anhydrous sodium sulphate and evaporation of the solvent yield 655 mg of crude artesunic acid which upon purification over silica gel (1:5 ratio) with 20-30% ethyl acetate in hexane, furnish pure artesunic acid in 93% w/w (465 mg) yield (according to CO-TLC). After drying the pure α-artesunic acid, mp 140-142° C is characterized by spectral analysis.

EXAMPLE 2

Artemisinin (500 mg), polyhydroxy compound (dextrose, 2.0g) are stirred in 1,4-dixan (10 ml). Sodium borohydride (2.5g) is added slowly for 10 minutes and the reaction mixture is stirred for about 2 hours at room temperature (20-30° C). After completion of the reduction step, succinic anhydride (250 mg) and triethylamine (1ml) are added and the reaction mixture is further stirred for 2 hours at room temperature (20-30 degree C). After usual work up and purification of crude product (690mg) through column chromatography (1:4 ratio) 91.2%) pure artesunic acid is obtained.

EXAMPLE 3 Artemisinin (500 mg), polyhydroxy compound (dextrose, 2.0g) are stirred in tetrahydrofuran (10 ml). Sodium borohydride (2.5g) is added slowly for 10 minutes and the reaction mixture is stirred for about 2 hours at room temperature. After completion of the reduction step succinic anhydride (250 mg) and triethylamine (1ml) are added and the reaction mixture is further stirred for 2 hours at room temperature. After usual work up and purification of the crude product (615mg) through column chromatography 87.4% pure artesunic acid is obtained.

EXAMPLE 4

Artemisinin (500 mg) and polyhydroxy compound (dextrose, 2g) are stirred in dioxan (15 ml) for 5 minutes. Sodium borohydride (2.4gm) is added slowly and the reaction mixture is stirred for 2 hours at room temperature (20-30 degree C). After completion of the reduction step succinic anhydride (250 mg) and sodium bicarbonate (3.5g) are added and the reaction mixture is further stirred for 2 hours. After usual workup and purification of impure reaction product (650 mg), 89.6%w/w pure artesunic acid is obtained.

EXAMPLE 5

Artemisinin (500mg) and cation exchange resin (lg) are stirred in tetrahydrofuran (10ml) at room temperature for 5 minutes. Sodium borohydride (250mg) is added slowly for 10 minutes and the reaction mixture is stirred for about 30 minutes at room temperature (20- 35 degree C). After completion of the reaction succinic anhydride (250mg) and triethylamine (0.7ml) are added at room temperature and the reaction mixture is stirred further for 1 hours at room temperature. The resin is filtered. After usual workup and column chromatography of the crude product (710mg), 480mg of pure artesunic acid (yield

= 96%w/w) is obtained.

EXAMPLE 6

Artemisinin (500mg) and cation exchange resin (lg) are stirred in 1,4 dioxan (10ml) at room temperature for 5 minutes. Sodium borohydride (250mg) is added slowly for 10 minutes and the reaction mixture is stirred for about 30 minutes at room temperature (20-35 degree C). After completion of the reaction succinic anhydride (250mg) and triethylamine (0.7ml) are added slowly at room temperature and the reaction mixture is stirred further for 1.25 hours at room temperature. After usual work up and purification of the crude artesunic acid (680mg) pure product in 91.7% w/w is obtained.

EXAMPLE 7

Artemisinin (500 mg), cation exchange resin (lOg) are stirred in 1,4 dioxan (10 ml). Sodium borohydride (250mg) is added slowly for 10 minutes and the reaction mixture is stirred for about 45minutes at room temperature (20-35 degree C). After completion of the reduction step succinic anhydride (250 mg) and sodium bicarbonate (2.5g) are added and the reaction mixture is further stirred for 1.5 hours at room temperature (20-35 degree C). After usual work up and purification of the crude artesunic acid (630mg) pure product in 85%o w/w yield is obtained.

EXAMPLE 8 Artemisinin (500 mg) and cation exchange resin (lg) are stirred in tetrahydrofuran (15 ml) for 5 minutes. Sodium borohydride (2.4gm) is added slowly and the reaction mixture is stirred for 45 minutes at room temperature (20-35 degree C). After completion of the reduction reaction, succinic anhydride (245 mg) and sodium bicarbonate (3.5g) are added and the reaction mixture is further stirred for 1.25 hours. After usual workup and purification of impure reaction product (650 mg), pure artesunic acid in 93%w/w yield is obtained.

EXAMPLE 9

Artemisinin (lOOmg) and cation exchange resin (200mg) are stirred in tetrahydrofuran (3ml) at room temperature for 5 minutes. Sodium borohydride (50mg) is added slowly for 10 minutes and the reaction mixture is stirred for about 30 minutes at room temperature (20-35 degree C). After completion of the reaction propionic anhydride (0.5ml) and triethylamine (0.2ml) are added at room temperature and the reaction mixture is stirred further for 1.5 hours at room temperature. After usual workup and purification of the crude products through preparative TLC 44 mg of pure dihydroartemisinin 10- propionate characterized by its spectral analysis is obtained.

EXAMPLE 10

Artemisinin (lOOmg) and cation exchange resin (200mg) are stirred in tetrahydrofuran (3ml) at room temperature for 5 minutes. Sodium borohydride (50mg) is added slowly for

10 minutes and the reaction mixture is stirred for about 30 minutes at room temperature (20-35 degree C). After completion of the reaction chloroacetic anhydride (50mg) and triethylamine (0.2ml) are added at room temperature and the reaction mixture is stirred further for 1.5 hours at room temperature. After usual workup and purification of the crude products through preparative TLC 35mg of pure dihydroartemisinin 10- chloroacetate characterized by its spectral analysis is obtained.

EXAMPLE 11

Artemisinin (lOOmg) and cation exchange resin (200mg) are stirred in tetrahydrofuran (3ml) at room temperature for 5 minutes. Sodium borohydride (50mg) is added slowly for 10 minutes and the reaction mixture is stirred for about 30 minutes at room temperature (20-35 degree C). After completion of the reaction acetic anhydride (50mg) and triethylamine (0.2ml) are added at room temperature and the reaction mixture is stirred further for 1.5 hours at room temperature. After usual workup and purification of the crude products through preparative TLC 42mg of pure dihydroartemisinin 10-acetate identified by its spectral analysis is obtained.

EXAMPLE 12

Artemisinin (5g) and cation exchange resin (lOg) are stirred in tetrahydrofuran (60ml) at room temperature for 5 minutes. Sodium borohydride (2.5g) is added slowly for 20 minutes and the reaction mixture is stirred for about 1 hour at room temperature (20-35 degree C). After completion of the reaction succinic anhydride (2.5g) and triethylamine (6ml) are added at room temperature and the reaction mixture is stirred further for 1.5 hours at room temperature. After usual workup and purification of the crude product

(6.92g) through CC pure artesunic acid in 94.6%w/w yield is obtained.

ADVANTAGES OF THE PRESENT INVENTION

1. The two pot reactions: reduction of artemisinin into dihydroartemismin and esterification of dihydroartemisinin to artesunic acid carried out in one pot avoids the process of isolation of dihydroartemisinin is avoided which saves chemicals, labour and losses of dihydroartemisinin in isolating it.

2. Conversion of artemisinin into artesunic acid in one pot takes place in about 2-5 hours and is a less time consuming method as compared to previously reported methods in which conversion of artemisinin into dihydroartemisinin in first pot followed by isolation of dihydroartemisinin and its esterification into artesunic acid in the second pot is also a long process. 3. The conversion of artemisinin into artesunic acid in one pot is carried out at room temperature (20-35 degree C) and thereby avoids use of cooling unit.

4. The solvent used to carry out the reduction reaction is also being used in esterification and thus enabling the process cost effective.

5. The catalysts, polyhydroxy compound or cation exchange resin used to carry out the reduction of artemisinin into dihydroartemisinin at room temperature (20-35°C) are cost effective.

6. The conversion of artemisinin into crude artesunic acid followed by workup and purification to yield pure product takes 6-10 hours as compared to previously reported methods (about 20-40 hours) and thus the process is less time consuming.

7. The yield of final product in the present invention i.e. pure artesunic acid is upto 96%, w/w.

8. Thus, this improved process which avoids the disadvantages of previously known process is suitable for the preparation of artesunic acid in large scale.

References

  1.  “WHO Model List of EssentialMedicines”. World Health Organization. October 2013. Retrieved 22 April 2014.
  2.  World Health Organization. “Guidelines for the treatment of malaria; Second edition 2010”. World Health Organization. Retrieved 10 January 2014.
  3.  Dondorp AL, et al. (2010). “Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial”.The Lancet 376 (9753): 1647–1657. doi:10.1016/S0140-6736(10)61924-1.PMC 3033534. PMID 21062666.
  4.  South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) (2005). “Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial”. The Lancet 366 (9487): 717–725. doi:10.1016/S0140-6736(05)67176-0. PMID 16125588.
  5. Jump up^ Sinclair, D; Donegan, S; Isba, R; Lalloo, DG (Jun 13, 2012). “Artesunate versus quinine for treating severe malaria.”. The Cochrane database of systematic reviews 6: CD005967.doi:10.1002/14651858.CD005967.pub4. PMID 22696354.
  6. Jump up^ WHO (2007). Assessment of the safety of artemisinin compounds in pregnancy. World Health Organization, Geneva.
  7. Jump up^ Boulangier D, Dieng Y, Cisse B, et al. (2007). “Antischistosomal efficacy of artesunate combination therapies administered as curative treatments for malaria attacks”. Trans R Soc Trop Med Hyg 101 (2): 113–16. doi:10.1016/j.trstmh.2006.03.003.PMID 16765398.
  8. Jump up^ Clark RL (2012). “Effects of artemisinins on reticulocyte count and relationship to possible embryotoxicity in confirmed and unconfirmed malarial patients”. Birth defects research. Part A, Clinical and molecular teratology 94 (2): 61–75.doi:10.1002/bdra.22868.
  9.  Rolling T, Agbenyega T, Issifou S, et al. (2013). “Delayed hemolysis after treatment with parenteral artesunate in African children with severe malaria—a double-center prospective study.”. J Infect Dis 209 (12): 1921–8. doi:10.1093/infdis/jit841.PMID 24376273.
  10.  Clark RL (2013). “Hypothesized cause of delayed hemolysis associated with intravenous artesunate.”. Med Hypotheses 82 (2): 167–70.doi:10.1016/j.mehy.2013.11.027. PMID 24370269.
  11.  Clark RL (2009). “Embryotoxicity of the artemisinin antimalarials and potential consequences for use in women in the first trimester.”. Reprod Toxicol 28 (3): 285–96.doi:10.1016/j.reprotox.2009.05.002. PMID 19447170.
  12.  Lisewski, A. M.; Quiros, J. P.; Ng, C. L.; Adikesavan, A. K.; Miura, K; Putluri, N; Eastman, R. T.; Scanfeld, D; Regenbogen, S. J.; Altenhofen, L; Llinás, M; Sreekumar, A; Long, C; Fidock, D. A.; Lichtarge, O (2014). “Supergenomic Network Compression and the Discovery of EXP1 as a Glutathione Transferase Inhibited by Artesunate”. Cell 158(4): 916–28. doi:10.1016/j.cell.2014.07.011. PMID 25126794. edit
  13. White NJ (2008). “Qinghaosu (Artemisinin): The price of success”. Science 320 (5874): 330–334. doi:10.1126/science.1155165. PMID 18420924.

Literature References:

Derivative of artemisinin, q.v. Prepn: China Cooperative Research Group on Qinghaosu, J. Tradit. Chin. Med. 2, 9 (1982).

Absolute configuration: X.-D. Luo et al., Helv. Chim. Acta 67, 1515 (1984).

GC/MS determn.: A. D. Theoharideset al., Anal. Chem. 60, 115 (1988);

HPLC determn in plasma: H. Naik et al., J. Chromatogr. B 816, 233 (2005).

Pharmacology: Y. Zhao, J. Trop. Med. Hyg. 88, 391 (1985). Antimalarial activity: W. Peters et al., Ann. Trop. Med. Parasitol. 80, 483 (1986); A. J. Linet al., J. Med. Chem. 30, 2147 (1987).

Inhibition of cytochrome oxidase: Y. Zhao et al., J. Nat. Prod. 49, 139 (1986).

Toxicology: China Cooperative Research Group on Qinghaosu, J. Tradit. Chin. Med. 2, 31 (1982).

Series of articles on chemistry, pharmacology, and antimalarial efficacy: ibid. 3-50.

Clinical trial as add-on therapy in pediatric malaria: L. von Seidlein et al.,Lancet 355, 352 (2000).

Review: R. N. Price, Expert Opin. Invest. Drugs 9, 1815-1827 (2000).

THE CHEMISTRY AND SYNTHESIS OF QINGHAOSU DERIVATIVES” JOURNAL OF TRADITIONAL CHINESE MEDICINE, BEIJING, CN, vol. 2, no. 1, 1982, pages 9-16, XP008019918 ISSN: 0255-2922
2 * DATABASE CAPLUS [Online] CHEMICAL ABSTRACTS SERVICE, COLUMBUS, OHIO, US; PHAN DINH CHAU ET AL: “Semisynthesis of an antimalarial artesunate” retrieved from STN Database accession no. 119:249761 XP002250029 -& TAP CHI DUOC HOC (1992), (5), 10-12 , XP001162710
3 * HAYNES, RICHARD K. ET AL: “C-10 ester and ether derivatives of dihydroartemisinin – 10-.alpha. artesunate, preparation of authentic 10-.beta. artesunate, and of other ester and ether derivatives bearing potential aromatic intercalating groups at C-10” EUROPEAN JOURNAL OF ORGANIC CHEMISTRY (2002), (1), 113-132 , XP002250027
4 * LI Y ET AL: “Studies on artemisinine analogs. I. Synthesis of ethers, carboxylates and carbonates of dihydroartemisinine” YAO HSUEH HSUEH PAO – ACTA PHARMACEUTICA SINICA, BEIJING, CN, vol. 16, no. 6, June 1981 (1981-06), pages 429-439, XP002119789 ISSN: 0513-4870

Artesunate

How does Artesunate kill cancer?

Artesunate is a drug that was initially designed for combating malaria, however, recently it has shown great promise as a cancer therapy1,2,3. It has been used in combination with some chemotherapies to improve outcomes in advanced cancer patients5. When fighting cancer it is important to use every tool at your disposal to weaken the cancer and strengthen your own cells. Artesunate is another weapon in the arsenal of natural remedies that can make a significant difference in the fight against cancer.

The mechanism of action for artesunate in the context of cancer therapy is very well defined. Cancer cells have a tendency to absorb iron at high levels and this is thought to accelerate the mutation rate within these cells. Iron reacts with oxygen to form free radicals, which are reactive molecules that damage DNA. In normal cells this reaction is a problem; in cancer cells it allows them to mutate and develop resistance to therapies. Artesunate activates mitochondrial apoptosis by iron catalyzed lysosomal reactive oxygen species production4. In other words, this drug will use the iron within the cancer cells against them.

http://yaletownnaturopathic.com/how-does-artesunate-kill-cancer/

Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, First Nations Healer, Motivational Speaker and International Best Selling Author. He currently practices at his clinic in Vancouver, British Columbia where he focuses on integrative oncology. http://www.yaletownnaturopathic.com
References:

1) MIYACHI, HAYATO, and CHRISTOPHER R. CHITAMBAR. “The anti-malarial artesunate is also active against cancer.” International journal of oncology 18 (2001): 767-773.

2) Michaelis, Martin, et al. “Anti-cancer effects of artesunate in a panel of chemoresistant neuroblastoma cell lines.” Biochemical pharmacology 79.2 (2010): 130-136.

3) Du, Ji-Hui, et al. “Artesunate induces oncosis-like cell death in vitro and has antitumor activity against pancreatic cancer xenografts in vivo.” Cancer chemotherapy and pharmacology65.5 (2010): 895-902.

4) Efferth, Thomas, et al. “Enhancement of cytotoxicity of artemisinins toward cancer cells by ferrous iron.” Free Radical Biology and Medicine 37.7 (2004): 998-1009.

5) Zhang, Z. Y., et al. “[Artesunate combined with vinorelbine plus cisplatin in treatment of advanced non-small cell lung cancer: a randomized controlled trial].” Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine 6.2 (2008): 134-138.

WormwoodArtesunate is…

a water-soluble ‘artemesinin’ drug derived from the ‘sweet wormwood’ plant, Artemsia annua, an herb used to treat infections and other illnesses in China for centuries. Interestingly, according to Wikipedia artemsia was lost as an herbal remedy in China until 1970 when an ancient Chinese medical manual dating back to 340 AD was found. The active ingredient in the plant – artemesinin – was isolated by scientists and it anti-malarial properties were quickly noted (1972). It is now used to treat malaria and schistosoma infections.

Artesunate also reduces anti-oxidant activity in the red blood cell thus exposing the cell to high free radical levels. Artesunate is currently being studied as an adjunct to chemotherapeutic agents because of its ability to induce cancerous cells to commit suicide (apoptosis) by inducing high rates of oxidative stress. The ability of the antioxidant NAC to thwart Artesunate’s effects in one study substantiated the important role increased free radical production plays in the drugs effect.

Malaria – Artemesia annua is native to China but has become naturalized around the world including the eastern United States. Artesunate was recently approved for emergency use in patients with severe malaria in the United States.

In April 2009 the FDA approved CoArtem which contains a derivative of artemesinin and a broad spectrum antibiotic called lumefantrine. Upon binding to infected red blood cells artesunate triggers the release of oxygen and carbon-based free radicals that attack proteins in the parasites.

Herpesviruses – Recent culture cell experiments indicated Artesunate was effective at significantly reducing viral protein production in HHV-6A infected cells. A 2005 in vitro study suggested Artesunate significantly reduced cytomegalovirus replication in cells. Because Artesunate effects HHV-6 early in its life cycle it may hold special promise in the kind of smoldering infections that may occur in chronic fatigue syndrome (ME/CFS).

Artesunate’s effects on herpesviruses, however, have not been well studied with just five studies published to date. Interest in this drug appears to be increasing, however, three of the five studies were published in 2008.

Artesunate May Work in Chronic Fatigue Syndrome (ME/CFS) Because..

it may be able to reduce herpesvirus activity in some patients. It’s use, however, is highly experimental.

LANOCONAZOLE


Lanoconazole

  • Latoconazole, Lanoconazole, TJN-318, NND-318, Astat,

Nihon Nohyaku (Originator), Tsumura (Licensee)

Synonym: 2-[4-(2-Chlorophenyl)-1,3-dithiolan-2-ylidene]-2-imidazol-1-yl-acetonitrile
Application: An antifungal compound
CAS Number: 101530-10-3
Molecular Weight: 319.83
Molecular Formula: C14H10ClN3S2

Brief background information

Technical Information
Appearance: Crystalline
Physical State: Solid
Solubility: Soluble in chloroform, and methanol. Insoluble in water.
Storage: Store at -20° C
Melting Point: 129-132 °C
Boiling Point: ~477.6 °C at 760 mmHg (Predicted)
Density: ~1.4 g/cm3 (Predicted)
Refractive Index: n20D 1.73 (Predicted)
pK Values: pKb: 3.76 (Predicted)
Safety and Reference Information
WGK Germany: 3
RTECS: NI3393500
PubChem CID: 3002820
Merck Index: 14: 5357
MDL Number: MFCD00865590
Beilstein Registry: 4819111
Salt ATC Formula MM CAS
D01 14 H 10 ClN 3 S 2 319.84 g / mol 101530-10-3

Lanoconazole

Application

  • antifungal

Synthesis pathway

Synthesis a)

Synthetic route
The reaction of 2- (1-imidazolyl) acetonitrile (I) with CS2 and KOH in DMF gives the dithiolate (II), which is then cyclized with 1- (2-chlorophenyl) -1,2-di (methanesulfonyloxy) ethane . (III) A column chromatography over silicagel allows the separation of the (E) -.? and (Z) -isomers (1-5)
Description Crystals, mp 141-5 Manufacturer Nihon Nohyaku Co., Ltd. (Japan) and Tsumura Juntendo (Japan).
References 1. Seo, A., Kanno, H., Hasegawa, N. et al. (Nihon Nohyaku Co., Ltd.). Antimycotic agent and fungicidal agent. US 4738976. 2. Seo, A ., Sugano, H., Hasegawa, C., Ikeda, K., Munechica, Y., Konoe, T., Konaka, M. (Nihon Nohyaku Co., Ltd.). Antifungal agent. JP 87093227. 3. Seo , A., Sugano, H., Hasegawa, C., Ikeda, K., Nishimura, A., Miyashiro, Y. (Nihon Nohyaku Co., Ltd.). Non-medicinal bactericidal agents and method for their preparation. JP 87093204. 4. Seo, A., Sugano, H., Hasegawa, C., Miyashiro, Y., Nishimura, A., Ikeda, K. (Nihon Nohyaku Co., Ltd.). Ketene S, S-acetals. JP 85218387. 5. Seo, A., Kanno, H., Hasegawa, N. et al. (Nihon Nohyaku Co., Ltd.). A novel ketene S, S-acetal deriv., a process for manufacturing thereof and a method for curing mycosis by administering it. EP 218736.

Trade Names

Country Trade name Manufacturer
Japan Astatine Tsumura
Ukraine No No

Formulations

  • 1% cream;
  • 1% ointment;
  • 1% solution

Links

  • EP 218 736 (Nihon Nohyaku; EP-prior. 9.10.1985).
References

1. Oka, H., et al., 1992. Therapeutic efficacy of latoconazole in formulations of clinical use on experimental dermatophytosis in guinea pigs. Arzneimittel-Forschung. 42(3): 345-9. PMID: 1497697
2. Niwano, Y., et al., 1994. Therapeutic efficacy of lanoconazole, a new imidazole antimycotic agent, for experimental cutaneous candidiasis in guinea pigs. Antimicrobial agents and chemotherapy. 38(9): 2204-6. PMID: 7811048

http://aac.asm.org/content/38/9/2204.full.pdf

References 1. Seo, A., Kanno, H., Hasegawa, N. et al. (Nihon Nohyaku Co., Ltd.). Antimycotic agent and fungicidal agent. US 4738976. 2. Seo, A ., Sugano, H., Hasegawa, C., Ikeda, K., Munechica, Y., Konoe, T., Konaka, M. (Nihon Nohyaku Co., Ltd.). Antifungal agent. JP 87093227. 3. Seo , A., Sugano, H., Hasegawa, C., Ikeda, K., Nishimura, A., Miyashiro, Y. (Nihon Nohyaku Co., Ltd.). Non-medicinal bactericidal agents and method for their preparation. JP 87093204. 4. Seo, A., Sugano, H., Hasegawa, C., Miyashiro, Y., Nishimura, A., Ikeda, K. (Nihon Nohyaku Co., Ltd.). Ketene S, S-acetals. JP 85218387. 5. Seo, A., Kanno, H., Hasegawa, N. et al. (Nihon Nohyaku Co., Ltd.). A novel ketene S, S-acetal deriv., a process for manufacturing thereof and a method for curing mycosis by administering it. EP 218736.

Title: Lanoconazole
CAS Registry Number: 101530-10-3
CAS Name: (E)-(±)-a-[4-(2-Chlorophenyl)-1,3-dithiolan-2-ylidene]-1H-imidazole-1-acetonitrile
Additional Names: latoconazole
Manufacturers’ Codes: TJN-318; NND-318
Trademarks: Astat (Nihon Nohyaku)
Molecular Formula: C14H10ClN3S2
Molecular Weight: 319.83
Percent Composition: C 52.57%, H 3.15%, Cl 11.08%, N 13.14%, S 20.05%
Literature References: Prepn: A. Soe et al., JP Kokai 85 218387idem et al., US 4636519 (1985, 1987 both to Nihon Nohyaku).In vivo antifungal activity: H. Oka et al., Arzneim.-Forsch. 42, 345 (1992); Y. Niwano et al., Antimicrob. Agents Chemother. 38,2204 (1994). Toxicity study: P. L. Munt et al., Oyo Yakuri 43, 195 (1992).
Properties: Light yellow crystals, mp 141.5°. LD50 in male, female mice, rats (mg/kg): 3224, 2715, 993, 652 orally; 2158, 1743, 1655, 2596 i.p.; >5000 both species s.c. LD50 dermally in rats: >5000 mg/kg (Munt).
Melting point: mp 141.5°
Toxicity data: LD50 in male, female mice, rats (mg/kg): 3224, 2715, 993, 652 orally; 2158, 1743, 1655, 2596 i.p.; >5000 both species s.c.; LD50 dermally in rats: >5000 mg/kg (Munt)
Therap-Cat: Antifungal.
Keywords: Antifungal (Synthetic); Imidazoles.

Metformin, thyroid-pituitary axis, diabetes mellitus, and metabolism


larryhbern's avatarLeaders in Pharmaceutical Business Intelligence Group, LLC, Doing Business As LPBI Group, Newton, MA

Metformin, thyroid-pituitary axis, diabetes mellitus, and metabolism

Larry H, Bernstein, MD, FCAP, Author and Curator
and Aviva Lev-Ari, PhD, RN

http://pharmaceuticalintelligence.com/9/27/2014/Metformin,_thyroid-pituitary_ axis,_diabetes_mellitus,_and_metabolism

The following article is a review of the central relationship between the action of
metformin as a diabetic medication and its relationship to AMPK, the important and
essential regulator of glucose and lipid metabolism under normal activity, stress, with
its effects on skeletal muscle, the liver, the action of T3 and more.

We start with a case study and a publication in the J Can Med Assoc.  Then we shall look
into key literature on these metabolic relationships.

Part I.  Metformin , Diabetes Mellitus, and Thyroid Function

Hypothyroidism, Insulin resistance and Metformin
May 30, 2012   By Janie Bowthorpe
The following was written by a UK hypothyroid patient’s mother –
Sarah Wilson.

My daughter’s epilepsy is triggered by unstable blood sugars. And since taking
Metformin to control her blood sugar, she has significantly reduced the number of
seizures. I have been doing research and read numerous academic medical journals,
which got me thinking about natural thyroid hormone and Hypothyroidism. My hunch
was that when patients develop hypothyroid symptoms, they are actually becoming
insulin resistant (IR). There are many symptoms in common between women with
polycystic ovaries and hypothyroidism–the hair loss, the weight gain, etc.
(http://insulinhub.hubpages.com/hub/PCOS-and-Hypothyroidism).

A hypothyroid person’s body behaves as if it’s going into starvation mode and so, to
preserve resources and prolong life, the metabolism changes. If hypothyroid is prolonged
or pronounced, then perhaps, chemical preservation mode becomes permanent even
with the reintroduction of thyroid hormones. To get back to normal, they need
a “jump-start” reinitiate a higher rate of metabolism. The kick start is initiated through
AMPK, which is known as the “master metabolic regulating enzyme.”
(http://en.wikipedia.org/wiki/AMP-activated protein kinase).

Guess what? This is exactly what happens to Diabetes patients when Metformin is
introduced. http://en.wikipedia.org/wiki/Metformin
Suggested articles: http://www.springerlink.com/content/r81606gl3r603167/  and
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2011.04029.x/pdf

Note the following comments/partial statements:
“Hypothyroidism is characterized by decreased insulin responsiveness”;
“the pivotal regulatory role of T3 in major metabolic pathways”.

The community knows that T3/NTH (natural thyroid hormone [Armour]) makes
hypothyroid patients feel better – but the medical establishment is averse to T3/NTH
(treating subclinical hypoT (T3/T4 euthyroid) with natural dessicated thyroid (NDT).
The medical establishment might find an alternative view about impaired metabolism
more if shown real proof that the old NDT **was/is** having the right result –i.e., the
T3 is jump-starting the metabolism by re-activating
 AMPK.

If NDT also can be used for hypothyroidism without the surmised “dangers” of NTH,
then they should consider it. [The reality in the choice is actually recombinant TH
(Synthroid)]. Metformin is cheap, stable and has very few serious side effects. I use the
car engine metaphor, and refer to glucose as our petrol, AMPK as the spark plug and
both T3 and Metformin as the ignition switches. Sometimes if you have flat batteries in
the car, it doesn’t matter how much you turn the ignition switch or pump the petrol
pedal, all it does is flatten the battery and flood the engine.

Dr. Skinner in the UK has been treating “pre-hypothyroidism” the way that some
doctors treat “pre-diabetes”. Those hypothyroid patients who get treated early
might not have had their AMPK pathways altered and the T4-T3 conversion still works.
There seems to be no reason why thyroid hormone replacement therapy shouldn’t
logically be given to ward off a greater problem down the line.

It’s my belief that there is clear and abundant academic evidence that the AMPK/
Metformin research should branch out to also look at thyroid disease.

Point – direct T3 is kicking the closed -down metabolic process back into life,
just like Metformin does for insulin resistance.
http://www.hotthyroidology.com/editorial_79.html
There is serotonin resistance! http://www.ncbi.nlm.nih.gov/pubmed/17250776

Metformin Linked to Risk of Low Levels of Thyroid Hormone

CMAJ (Canadian Medical Association Journal) 09/22/2014

Metformin, the drug commonly for treating type 2 diabetes,

  • is linked to an increased risk of low thyroid-stimulating hormone
    (TSH) levels
  • in patients with underactive thyroids (hypothyroidism),

according to a study in CMAJ (Canadian Medical Association Journal).

Metformin is used to lower blood glucose levels

  • by reducing glucose production in the liver.

previous studies have raised concerns that

  • metformin may lower thyroid-stimulating hormone levels.

Study characteristics:

  1. Retrospective  long-term
  2. 74 300 patient who received metformin and sulfonylurea
  3. 25-year study period.
  4. 5689 had treated hypothyroidism
  5. 59 937 had normal thyroid function.

Metformin and low levels of thyroid-stimulating hormone in
patients with type 2 diabetes mellitus

Jean-Pascal Fournier,  Hui Yin, Oriana Hoi Yun Yu, Laurent Azoulay  +
Centre for Clinical Epidemiology (Fournier, Yin, Yu, Azoulay), Lady Davis Institute,
Jewish General Hospital; Department of Epidemiology, Biostatistics and Occupational
Health (Fournier), McGill University; Division of Endocrinology (Yu), Jewish General
Hospital; Department of Oncology (Azoulay), McGill University, Montréal, Que., Cananda

CMAJ Sep 22, 2014,   http://dx.doi.org:/10.1503/cmaj.140688

Background:

  • metformin may lower thyroid-stimulating hormone (TSH) levels.

Objective:

  • determine whether the use of metformin monotherapy, when compared with
    sulfonylurea monotherapy,
  • is associated with an increased risk of low TSH levels(< 0.4 mIU/L)
  • in patients with type 2 diabetes mellitus.

Methods:

  • Used the Clinical Practice Research Datalink,
  • identified patients who began receiving metformin or sulfonylurea monotherapy
    between Jan. 1, 1988, and Dec. 31, 2012.
  • 2 subcohorts of patients with treated hypothyroidism or euthyroidism,

followed them until Mar. 31, 2013.

  • Used Cox proportional hazards models to evaluate the association of low TSH
    levels with metformin monotherapy, compared with sulfonylurea monotherapy,
    in each subcohort.

Results:

  • 5689 patients with treated hypothyroidism and 59 937 euthyroid patients were
    included in the subcohorts.

For patients with treated hypothyroidism:

  1. 495 events of low TSH levels were observed (incidence rate 0.1197/person-years).
  2. 322 events of low TSH levels were observed (incidence rate 0.0045/person-years)
    in the euthyroid group.
  • metformin monotherapy was associated with a 55% increased risk of low TSH
    levels 
    in patients with treated hypothyroidism (incidence rate 0.0795/person-years
    vs.0.1252/ person-years, adjusted hazard ratio [HR] 1.55, 95% confidence
    interval [CI] 1.09– 1.20), compared with sulfonylurea monotherapy,
  • the highest risk in the 90–180 days after initiation (adjusted HR 2.30, 95% CI
    1.00–5.29).
  • No association was observed in euthyroid patients (adjusted HR 0.97, 95% CI 0.69–1.36).

Interpretation: The clinical consequences of this needs further investigation.

Crude and adjusted hazard ratios for suppressed thyroid-stimulating hormone
levels (< 0.1 mIU/L) associated with the use metformin monotherapy, compared

View original post 1,073 more words

More than 40 plant-based compounds can turn on genes that slow the spread of cancer


Ralph Turchiano's avatarCLINICALNEWS.ORG

07 SEP 0212

WSU researcher documents links between nutrients, genes and cancer spread

More than 40 compounds turn on genes slowing metastasis

PULLMAN, Wash.—More than 40 plant-based compounds can turn on genes that slow the spread of cancer, according to a first-of-its-kind study by a Washington State University researcher.

Gary Meadows, WSU professor and associate dean for graduate education and scholarship in the College of Pharmacy, says he is encouraged by his findings because the spread of cancer is most often what makes the disease fatal. Moreover, says Meadows, diet, nutrients and plant-based chemicals appear to be opening many avenues of attack.

“We’re always looking for a magic bullet,” he says. “Well, there are lots of magic bullets out there in what we eat and associated with our lifestyle. We just need to take advantage of those. And they can work together.”

Meadows started the study, recently published online in…

View original post 523 more words

Over 700 biosimilars now in development worldwide: report


More than 700 follow-on biologic therapies are currently in development, and they are expected to account for around a quarter of the $100 billion-worth of sales stemming from off-patent biologic drugs by the end of this decade, according to new research.

read at

http://www.pharmatimes.com/Article/14-09-30/Over_700_biosimilars_now_in_development_worldwide_report.aspx