METHODS FOR TREATING COGNITIVE AND OTHER DISORDERS
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority to United States provisional patent application
serial number 60/785,654, filed March 24, 2006, and United States provisional patent
application serial number 60/851,278, filed October 12, 2006, the entirety of each of which is
hereby incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention relates to compounds useful in treating disorders associated
with 5HT2C modulation.
BACKGROUND OF THE INVENTION
[0003] Cognition is the ability of one's brain to think, to process and store information,
and to solve problems. Cognitive abilities include memory, language, attention, perception,
and reasoning. Cognition is a high level of behavior unique to humans. Many cognitive
disorders affect the elderly, such as Alzheimer's disease and memory deficit. However, there
are also many cognitive disorders that affect children, adolescents, and young adults.
[0004) There are a variety of brain abnormalities which prevent infants and children from
developing normal social and/or cognitive skills. Disorders of the basic psychological
processes can affect the way a child/adolescent learns. Many children/adolescents with
learning disabilities have average or above average intelligence. However, learning
disabilities may cause difficulties in listening, thinking, talking, reading, writing, spelling, or
arithmetic. Such learning disabilities include perceptual handicaps, dyslexia, dyscalculia,
dysgraphia and developmental aphasia.
[0005] Attention deficit disorders (ADD), also known as attention deficit hyperactivity
disorder (ADHD), is a well-known cognitive disorder that affects children and adults alike. It
is estimated that between 3% and 8% of all children have ADD. ADD is characterized by
symptoms such as hyperactivity, impulsiveness, distractibility and difficulty sustaining
attention for periods of time. Symptoms may be different in each person with ADD. Some
may have more of a problem with inability to focus, while others may have the most difficult
time with impulsiveness. Medications are available to treat ADD, often in the form of
stimulants such as Ritalin, Adderal, and Strattera, to name a few. However, there are certain
side effects associated with such treatments, including decreased appetite and problems
sleeping.
[0006] Accordingly, there remains a need to develop treatments for the variety of
cognitive disorders affecting patients of all ages.
SUMMARY OF THE INVENTION
[0007] The present invention provides methods for treating a cognitive disorder in a
mammal, including methods for treating a learning disorder, an attention deficit disorder, an
impulsivity disorder, or a behavioral addiction, among others. In particular, according to the
present invention, compounds of formula I:
or a pharmaceutically acceptable salt thereof, wherein:
== designates a single or double bond;
n is 1 or 2;
m is 0 or 1;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6
perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R3 and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsaturated 4-8 membered ring, wherein said ring is optionally substituted
with 1-3 groups independently selected from halogen, -R, or OR; and
R5 and R6 are each independently -R,
which are highly specific agonists, or partial agonists, of the 5HT2C receptor, are useful in the
treatment of cognitive and other disorders as described herein.
[00081 The present invention provides, among other things, methods of a cognitive
disorder by administrating to an individual in need thereof a pharmaceutically effective
amount of a compound of formula I. The invention also provides pharmaceutical
compositions of compounds.of formula I formulated and dosed for treatment of a cognitive
disorder, as well as combinations of compounds of formula I with one or more other agents
useful in the treatment of cognitive and/or other disorders or diseases suffered by individuals
with cognitive disorders. Yet other aspects of the present invention will be clear to those of
ordinary skill in the art upon review of the present specification and claims.
BRIEF DESCRIPTION OF THE DRAWING
[0009] Figure 1 shows the effects of Compound 1 in the sexual function evaluation
assay.
[0010] Figure 2 shows the effects of Compound 1 (3-17 mg/kg IP) on reversal of d-
amphetamine (4 mg/kg SC) induced deficits in PPI.
[0011] Figure 3 shows the effects of Compound 1 (3-30 mg/kg IP) on reversal of DOI (3
mg/kg IP) induced deficits in PPI.
[0012} Figure 4 shows the effects of Compound 1 (3-30 mg/kg IP) on reversal of MK-
801 (0.15 mg/kg SC) induced deficits in PPI.
[0013} Figure 5 shows the effects of Compound 1 on schedule-induced polydipsia.
[0014} Figure 6 shows the effects of Compound 1 on acetylcholine in medial prefrontal
cortex.
[0015) Figure 7 shows the effects of Compound 1 on glutamate in medial prefrontal
cortex.
[0016} Figure 8 shows the effects of Compound 1 on novel object recognition.
[0017] Figure 9 shows the effect of Compound 1 on impulsive responding in the 5-
choice serial reaction time test.
DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS OF THE INVENTION
1. Compounds
[0018] Compounds useful for treating cognitive, and other disorders, according to the
present invention include compounds of formula I:
or a pharmaceutically acceptable salt thereof, wherein:
== designates a single or double bond;
n is 1 or 2;
m is 0 or 1;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6
perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R3 and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsaturated 4-8 membered ring, wherein said ring is optionally substituted
with 1-3 groups independently selected from halogen, -R, or OR; and
R5 and R6 are each independently -R.
[0019] As used herein, the term "alkyl" includes, but is not limited to, straight and
branched chains such as methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, or t-
butyl.
[0020] The terms "halogen" or "halo," as used herein, refer to chlorine, bromine, fluorine
or iodine.
[0021] The term "perfluoroalkyl," as used herein refers to an alkyl group, as defined
herein, wherein every hydrogen atom on said alkyl group is replaced by a fluorine atom.
Such perfluoroalkyl groups include -CF3.
[0022] The terms "effective amount" and "therapeutically effective amount," as used
herein, refer to the amount of a compound or combination that, when administered to an
individual, is effective to treat, prevent, delay, or reduce the severity of a condition from
which the patient is suffering. In particular, a therapeutically effective amount in accordance
with the present invention is an amount sufficient to treat, prevent, delay onset of, or
otherwise ameliorate at least one symptom of a cognitive, or other disorder as described
herein.
[0023] The term "pharmaceutically acceptable salts" or "pharmaceutically acceptable
salt" refers to salts derived from treating a compound of formula I with an organic or
inorganic acid such as, for example, acetic, lactic, citric, cinnamic, tartaric, succinic, fumaric,
maleic, malonic, rnandelic, malic, oxalic, propionic, hydrochloric, hydrobromic, phosphoric,
nitric, sulfuric, glycolic, pyruvic, methanesulfonic, ethanesulfonic, toluenesulfonic, salicylic,
benzoic, or similarly known acceptable acids. In certain embodiments, the present invention
provides the hydrochloride salt of a compound of formula I.
[0024] The term "patient," as used herein, refers to a mammal. In certain embodiments,
the term "patient" refers to a human.
[0025] The terms "administer," "administering," or "administration," as used herein, refer
to either directly administering a compound or composition to a patient, or administering a
prodrug derivative or analog of the compound to the patient, which will form an equivalent
amount of the active compound or substance within the patient's body.
[0026] The compounds of formula I, as defined above or in classes and subclasses as
described herein, have affinity for and agonist or partial agonist activity at the 2C subtype of
brain serotonin receptors.
2. Description of Exemplary Compounds:
[0027] In certain embodiments, == designates a single bond. In other embodiments,
== designates a double bond.
[0028] In certain embodiments, the R1 group of formula I is R, OR, halogen, cyano, or -
C1-3 perfluoroalkyl. In other embodiments, the R1 group of formula I is hydrogen, halogen,
cyano, -OR wherein R is C1-3 alkyl, or trifluoromethyl. According to another embodiment,
the R1 group of formula I is hydrogen.
[0029] In certain embodiments, the R2 group of formula I is R, OR, halogen, cyano, or -
C1-3 perfluoroalkyl. In other embodiments, the R2 group of formula I is hydrogen, halogen,
cyano, -OR wherein R is hydrogen, C1-3 alkyl, or trifluoromethyl. According to another
embodiment, the R2 group of formula I is hydrogen.
[0030] According to one aspect of the present invention, at least one of R1 and R2 groups
of formula I is -OH. According to another aspect of the present invention, both of the R1 and
R2 groups of formula I are -OH.
[0031] According to another embodiment, each of the R1 and R2 groups of formula I is
hydrogen. According to yet another embodiment, each of the R5 and R6 groups of formula I
is hydrogen.
[0032] As defined generally above, the R3 and R4 groups of formula I are taken together
to form a saturated or unsaturated 4-8 membered ring, wherein said ring is optionally
substituted with 1 -3 groups independently selected from halogen, -R, or OR. According to
one embodiment, the R3 and R4 groups of formula I are taken together to form a saturated or
unsaturated 5-8 membered ring, wherein said ring is optionally substituted with 1-3 groups
independently selected from halogen, -R, or OR. In certain embodiments, the R3 and R4
groups of formula I are taken together to form a saturated or unsaturated 5-6 membered ring,
wherein said ring is optionally substituted with 1-3 groups independently selected from
halogen, -R, or OR. The 4-8 membered (preferably 5-8 membered, more preferably 5-6
membered) ring is preferably a carbocyclic ring. The 4-8 membered (preferably 5-8
membered, more preferably 5-6 membered) ring is preferably saturated. However if the 4-8
membered (preferably 5-8 membered, more preferably 5-6 membered) ring is unsaturated,
the unsaturation may be olefinic or aromatic.
[0033] As defined generally above, n is 1 or 2. Accordingly, the present invention
provides a compound of formulae I-a and I-b:
or a pharmaceutically acceptable salt thereof, wherein each of m, R1, R2, R3, R4, Rs, and R6 is
as defined above for compounds of formula I and described in classes and subclasses above
and herein.
[0034] As defined generally above, m is 0 or 1. Accordingly, the present invention
provides a compound of formulae I-c and I-d:
or a pharmaceutically acceptable salt thereof, wherein each of n, R1, R2, R3, R4, R5, and R is
as defined above for compounds of formula I and described in classes and subclasses above
and herein.
[0035] In other embodiments, n is 1, m is 1, and the R3 and R4 groups of formula I are
taken together to form a saturated 5-membered ring and said compound is of formula II:
or a pharmaceutically acceptable salt thereof, wherein each of R1, R2, R5, and R6 is as defined
above for compounds of formula I and described in classes and subclasses above and herein.
[0036] According to another aspect of the present invention, a compound is provided,
wherein n is 1, m is 0, and the R3 and R4 groups of formula I are taken together to form a
saturated 5-membered ring and said compound is of formula III:
or a pharmaceutically acceptable salt thereof, wherein each of R1, R2, R5, and R6 is as defined
above for compounds of formula I and described in classes and subclasses above and herein.
[0037] Compounds of the present invention contain asymmetric carbon atoms and thus
give rise to stereoisomers, including enantiomers and diastereomers. Accordingly, it is
contemplated that the present invention relates to all of these stereoisomers, as well as to
mixtures of the stereoisomers. Throughout this application, the name of the product of this
invention, where the absolute configuration of an asymmetric center is not indicated, is
intended to embrace the individual stereoisomers as well as mixtures of stereoisomers.
[0038] According to another aspect, the present invention provides a compound of either
of formulae I-e or I-f:
or a pharmaceutically acceptable salt thereof, wherein each of n, m, R1, R2, R3, R4, R5, and R6
is as defined above for compounds of formula I and described in classes and subclasses
above and herein.
[0039] In certain embodiments, the present invention provides a compound of either of
formulae IV or V:
or a pharmaceutically acceptable salt thereof, wherein each R1, R2, R5, and R6 are as defined
above for compounds of formula I and in classes and subclasses as described above and
herein.
[0040] Where an enantiomer is preferred, it may, in some embodiments be provided
substantially free of the corresponding enantiomer. Thus, an enantiomer substantially free of
the corresponding enantiomer refers to a compound which is isolated or separated via
separation techniques or prepared free of the corresponding enantiomer. "Substantially free,"
as used herein, means that the compound is made up of a significantly greater proportion of
one enantiomer. In certain embodiments the compound is made up of at least about 90% by
weight of a preferred enantiomer. In other embodiments of the invention, the compound is
made up of at least about 99% by weight of a preferred enantiomer. Preferred enantiomers
may be isolated from racemic mixtures by any method known to those skilled in the art,
including chiral high pressure liquid chromatography (HPLC) and the formation and
crystallization of chiral salts or prepared by methods described herein. See, for example,
Jacques, et al., Enantiomers, Racemates and Resolutions (Wiley Interscience, New York,
1981); Wilen, S.H., et al., Tetrahedron 33:2725 (1977); Eliel, EX. Stereochemistry of
Carbon Compounds (McGraw-Hill, NY, 1962); Wilen, S.H. Tables of Resolving Agents and
Optical Resolutions p. 268 (E.L. Eliel, Ed., Univ. of Notre Dame Press, Notre Dame, IN
1972).
[0041] Exemplary compounds useful for methods of the present invention are set forth in
Table 1, below.
Table 1. Exemplary Compounds of Formula I
2-bromo-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino [6,7,1 -if]quinoline;
2-bromo-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c][ 1,4 ]diazepino[6,7,1 -
if]quinoline;
2-chloro-4,5,6,7,9,9a,10,ll,12,12a-decahydrocyclopenta[c][l,4]diazepino[6,7,l-if]quinoline;
2-chloro-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c] [ 1,4] diazepino[6,7,1 -
if]quinoline;
2-phenyl-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c)[1,4]diazepino [6,7,1 -
if]quinoline;
2-methoxy-4,5,6,7,9,9a,l0,11,12,12a-decahydrocyclopenta[c][1,4]diazepino [6,7,1 -
if]quinoline;
1-fluoro-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [1,4]diazepino [6,7,1 -if]quinoline;
1-fluoro-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4] diazepino[6,7,1-
if]quinoline;
1-(trifluoromethyl)-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [1,4] diazepino[6,7,1-
if]quinoline;
1-fluoro-2-methoxy-4,5,6,7,9,9a,10,ll,12,12a-decahydrocyclopenta[c][l,4] diazepino[6,7,l-
if]quinoline;
1-fluoro-2-methoxy-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclo-
hepta[c] [1,4] diazepino[6,7,1 -if] quinoline;
4,5,6,7,9,9a10,11,12,12a-decahydrocyclopenta[c][l,4]diazepino[6,7,1-if] quinoline;
4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4]diazepino [6,7,1-if]quinoline;
(-)-4,5,6,7,9,9a10,11,12,12a-decahydrocyclopenta[c][1,4]diazepino[6,7,1-if] quinoline;
(9aR,14aS)-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4]diazepino[6,7,1-
if]quinoline; or
(9aS,14aR)-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4]diazepino[6,7,1-
if]quinoline;
4,5,6,7,9a,10,11,12,l3,13a-decahydro-9H-[1,4]diazepino[6,7,1-de]phenanthridine;
1,2,3,4,9,10-hexahydro-8H-cyclopenta[b] [1,4]diazepino[6,7,-hi]indole;
1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b] [1,4]diazepino[6,7,1 -hi] indole;
(7bS,10aS)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b][1,4]diazepino[6,7,1-hi]indole;
(7bR, 10aR)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][1,4]diazepino[6,7,1-
hi]indole;
(7bR,10aR)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][1,4]diazepino[6,7,1-hi]indole;
6-methyl-1,2,3,4,9,10-hexahydro-8H-cyclopenta[b] [1,4]diazepino[6,7,1 -hi]indole;
2S)-(rel-7bR, 10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi] indole;
(2S)-(rel-7bR,10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
(2S)-(rel-7bS,10aS)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4)diazepino[6,7,1-hi]indole;
(2R)-(rel-7bR, 10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
(2R)-(rel-7bR, 10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b
][1,4]diazepino[6,7,1-hi]indole;
(2R)-(rel-7bS,10aS)-2-methyl-l,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
rel-(4S,7bS, 10aS)-4-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-
cyclopenta[b] [1,4]diazepino[6,7,1-hi]indole;
rel-(4S,7bS, 10aS)-4-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]-
[1,4]diazepino[6,7,1-hi]indole;
rel-(4R,7bS,10aS)-4-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-
cyclopenta[b] [1,4]diazepino [6,7,1 -hi] indole;
9-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b][1,4]diazepino[6,7,1-bi]indole;
(7bR,9R, 10aR)-9-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b] [1,4]d
iazepino[6,7,1-hi]indole;
9,9-dimethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[l,4]diazepino[6,7, 1-hi]indole;
(7bR, 10aR)-9,9-dimethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b] [1,4]
diazepino[6,7,1-hi]indole; and
(7bS,10aS)-9,9-dimethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b] [1,4]
diazepino[6,7,1-hi] indole;
or a pharmaceutically acceptable salt thereof. Another aspect of the present invention
provides the hydrochloride salt of each of the above compounds.
[0042] Also, it will be appreciated by those of ordinary skill in the art that reference to a
compound herein is intended to include reference to any and all related forms such as
polymorphs, hydrates, etc. Also, compounds may be provided as pro-drugs or other forms
converted into the active agent during manufacture, processing, formulation, delivery, or in
the body.
[0043] It will additionally be appreciated that the principles of the present invention apply
all radiolabelled forms of the compounds recited herein, including, for example, those where
the radiolabels are selected from as 3H, 11C, 14C, 18F, 123I, and 125I. Such radiolabelled
compounds are useful as research and diagnostic tools in metabolism pharmacokinetics
studies and in binding assays in both animals and humans.
[0044] Compounds of formula I for use in accordance with the present invention may be
obtained or produced according to any available means including methods described in detail
in US patent No. 7,129,237 (United States patent application serial number 10/422,524, filed
April 24, 2003), and in WO2006/052768 (claiming priority to United States provisional
patent application serial number 60/625,300, filed November 5, 2004), the entirety of each of
which is hereby incorporated herein by reference.
[0045] Without wishing to be bound by any particular theory, the present inventors note
that compounds of formula I are highly specific agonists, or partial agonists, of the 5HT2C
receptor. The present invention encompasses the recognition that this unique affinity and
selectivity displayed by compounds of formula I renders them particularly useful for treating
cognitive, and other disorders. The present invention also contemplates that compounds of
formula I are associated with a rapid onset of action. In addition, compounds of formula I
lack the side-effect of sexual dysfunction.
2. Pharmaceutical Compositions
[0046] Compounds of formula I may be administered neat in order to treat a cognitive, or
other disorder, in accordance with the present invention. More commonly, however, they are
administered in the context of a pharmaceutical composition, that contains a therapeutically
effective amount of one or more compound of formula I together with one or more other
ingredients known to those skilled in the art for formulating pharmaceutical compositions.
[0047] As used herein, the terms "pharmaceutically effective amount" or "therapeutically
effective amount" mean the total amount of each active component of the pharmaceutical
composition or method that is sufficient to show a meaningful patient benefit, i.e., treatment,
prevention or amelioration of a cognitive, or other disorder. When applied to an individual
active ingredient, administered alone, the term refers to that ingredient alone. When applied
to a combination, the term refers to combined amounts of the active ingredients that result in
the therapeutic effect, whether administered in combination, serially or simultaneously.
[0048] In certain embodiments of the invention, compounds of formula I are
administered with a daily dose in the range of about 0.5 to about 500 mg, or about 1 mg to
about 500 mg. Doses may be administered as a single regimen, such as only prior to bedtime
or before travel, or as a continuous regimen divided by two or more doses over the course of
a day. The dosage levels and other dosage levels herein are for the average human subject
having a weight range of about 65 to 70 kg. The skilled person will readily be able to
determine the dosage levels required for a subject whose weight falls outside this range, such
as children and the elderly.
[0049] The dosage of the combination of the invention in such formulations will depend
on its potency, but can be expected to be in the range of from 1 to 500 mg of 5-HT2C receptor
agonist for administration up to three times a day. In some embodiments, the dose may be in
the range of about 10 to 100 mg (e.g. 10, 25, 50 and 100 mg) of 5-HT2c receptor agonist
which can be administered once, twice or three times a day (preferably once). However the
precise dose will be as determined by the prescribing physician and will depend on the age
and weight of the subject and severity of the symptoms.
[0050] Additional ingredients useful in preparing pharmaceutical compositions in
accordance with the present invention include, for example, carriers (e.g., in solid or liquid
form), flavoring agents, lubricants, solubilizers, suspending agents, fillers, glidants,
compression aids, binders, tablet-disintegrating agents, encapsulating materials, emulsifiers,
buffers, preservatives, sweeteners, thickening agents, coloring agents, viscosity regulators,
stabilizers or osmo-regulators, or combinations thereof.
[0051] Solid pharmaceutical compositions preferably contain one or more solid carriers,
and optionally one or more other additives such as flavoring agents, lubricants, solubilizers,
suspending agents, fillers, glidants, compression aids, binders or tablet-disintegrating agents
or an encapsulating material. Suitable solid carriers include, for example, calcium phosphate,
magnesium stearate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose, methyl cellulose,
sodium carboxymethyl cellulose, polyvinylpyrrolidine, low melting waxes or ion exchange
resins, or combinations thereof. In powder pharmaceutical compositions, the carrier is
preferably a finely divided solid which, is in admixture with the finely divided active
ingredient. In tablets, the active ingredient is generally mixed with a carrier having the
necessary compression properties in suitable proportions, and optionally, other additives, and
compacted into the desired shape and size. Solid pharmaceutical compositions, such as
powders and tablets, preferably contain up to 99% of the active ingredient.
[0052] In certain embodiments, a compound of formula I is provided in a disintegrating
tablet formulation suitable for pediatric administration.
[0053] Liquid pharmaceutical compositions preferably contain one or more compounds
of formula I and one or more liquid carriers to form solutions, suspensions, emulsions,
syrups, elixirs, or pressurized compositions. Pharmaceutically acceptable liquid carriers
include, for example water, organic solvents, pharmaceutically acceptable oils or fat, or
combinations thereof. The liquid carrier can contain other suitable pharmaceutical additives
such as solubilizers, emulsifiers, buffers, preservatives, sweeteners, flavoring agents,
suspending agents, thickening agents, colors, viscosity regulators, stabilizers or osmo-
regulators, or combinations thereof. If the liquid formulation is intended for pediatric use, it
is generally desirable to avoid inclusion of alcohol.
[0054] Examples of liquid carriers suitable for oral or parenteral administration include
water (preferably containing additives such as cellulose derivatives such as sodium
carboxymethyl cellulose), alcohols or their derivatives (including monohydric alcohols or
polyhydric alcohols such as glycols) or oils (e.g., fractionated coconut oil and arachis oil).
For parenteral administration the carrier can also be an oily ester such as ethyl oleate and
isopropyl myristate. The liquid carrier for pressurized compositions can be halogenated
hydrocarbons or other pharmaceutically acceptable propellant.
[0055] In certain embodiments, a liquid pharmaceutical composition is provided wherein
said composition is suitable for pediatric administration. In other embodiments, the liquid
composition is a syrup or suspension.
[0056] Liquid pharmaceutical compositions which are sterile solutions or suspensions can
be administered parenterally, for example by, intramuscular, intraperitoneal, epidural,
intrathecal, intravenous or subcutaneous injection. Pharmaceutical compositions for oral or
transmucosal administration may be either in liquid or solid composition form.
[0057] In some embodiments of the invention, pharmaceutical compositions are provided
in unit dosage form, such as tablets or capsules. In such form, the composition is sub-divided
in unit dose containing appropriate quantities of the active ingredient(s). The unit dosage
forms can be packaged compositions, for example packeted powders, vials, ampoules, pre-
filled syringes or sachets containing liquids. The unit dosage form can be, for example, a
capsule or tablet itself, or it can be an appropriate number of any such compositions in
package form.
[0058] Thus, the present invention also provides a pharmaceutical composition in unit
dosage form for a cognitive, or other disorder, in a patient, where the composition contains a
therapeutically effective unit dosage of at least one compound of formula I. As one skilled in
the art will recognize, the preferred therapeutically effective unit dosage will depend on for
example the method of administration. For example, a unit dosage for oral administration
often ranges from about 0.5 mg to about 500 mg and more typically from about 1 mg to about
500 mg of the compound of formula I.
[0059] The present invention also provides a therapeutic package for dispensing the
compounds of formula I to a patient being treated for a cognitive, or other disorder as
described herein. In some embodiments, the therapeutic package contains one or more unit
dosages of the compound of formula I, a container containing the one or more unit dosages,
and labeling directing the use of the package for treating a cognitive, or other disorder, in a
patient. In certain embodiments, the unit dose is in tablet or capsule form. In some cases,
each unit dosage is a therapeutically effective amount.
3. Other Pharmaceutical Agents
[0060] According to the present invention, compounds of formula I may be administered
alone to treat one or more cognitive, or other disorders, or alternatively may be administered
in combination with (whether simultaneously or sequentially) one or more other
pharmaceutical agents useful to treat one or more cognitive, or other disorders, as described
herein. Alternatively or additionally, the compounds of formula I may be administered in
combination with one or more other pharmaceutical agents useful in the treatment or
prevention of one or more other symptoms, disorders, or diseases suffered by the individual
in need of treatment of one or more cognitive, or other disorders, as described herein.
[0061] An exemplary listing of pharmaceutically active agents that may be administered
in conjunction with one or more compounds of formula I in accordance with the present
invention can be found in the Physicians' Desk Reference, 55 Edition, 2001, published by
Medical Economics Co., Inc., Montvale, NJ. For many of these listed agents,
pharmaceutically effective dosages and regimens are known in the art; many are presented in
the Physicians' Desk Reference itself.
4. Uses
[0062] Methods of this invention are useful for treating one or more cognitive, or other
disorders, as described herein, in a patient.
[0063] In certain embodiments, the present invention provides a method of treating one
or more intellectual deficit disorders comprising administering a compound of the present
invention. In other embodiments, such intellectual deficit disorders include dementia, such as
dementia of aging, vascular dementia, mild cognitive impairment, age-related cognitive
decline, and mild neurocognitive disorder; Alzheimer's disease, and memory deficit,
attention deficit disorders (ADD, also known as Attention Deficit Hyperactivity Disorder or
ADHD) in both children and adults. In certain embodiments, the present invention provides a
method of treating ADD and/or ADHD in a pediatric patient comprising administering to said
patient a compound of formula I or pharmaceutical composition thereof.
{0064] In other embodiments, the present invention provides a method of treating one or
more cognition disorders. According to another aspect, the cognition disorder is a learning
disorder. Such learning disorders are known in the art and include autism, dyslexia,
Asperger's syndrome, a neurobiological disorder similar to autism and characterized by
serious deficits in social and communication skills; specific learning disability, a disorder in
one or more of the basic psychological processes involved in understanding or in using
spoken or written language, which may manifest itself in an imperfect ability to listen, think,
speak, read, write, spell or to do mathematical calculations; dysgraphia, a disorder that causes
difficulty with forming letters or writing within a defined space; dyscalculia, a disorder that
causes people to have problems doing arithmetic and grasping mathematical concepts;
dyspraxia, a problem with the body's system of motion that interferes with a person's ability
to make a controlled or coordinated physical response in a given situation; visual perceptual
deficit, difficulty receiving and/or processing accurate information from the sense of sight,
although there is nothing wrong with vision; and auditory perceptual deficit, difficulty
receiving accurate information through auditory means, even though there is no problem with
hearing.
[0065] In certain embodiments, the present invention provides a method for treating one
or more impulsivity disorders (e.g. borderline personality disorder), disruptive behavior
disorders, or impulse control disorders. In certain embodiments, the present invention
provides a method for treating Tourette's Syndrome (TS), an inherited, neurological disorder
characterized by. repeated and involuntary body movements (tics) and/or uncontrollable vocal
sounds. In other embodiments, the present invention provides a method for treating
trichotillomania.
[0066] According to another aspect, the present invention provides a method for treating
one or more behavioral addictions and addictive disorders. Behavioral addictions and
addictive disorders result from the intoxication one senses from the release of brain
chemicals (e.g., serotonin, adrenaline, epinepherine, etc.) during certain activities. Such
disorders are known in the art and include gambling, sex addiction, eating disorders,
spending addiction, rage/anger, workaholism, exercise addiction, risk taking addictions
(e.g. kleptomania and pyromania), and perfectionism, to name a few.
[0067] In certain embodiments, a compound of the present invention is administered in
combination with one or more cognitive improvement agents. Such agents are well known in
the art and include donepezil hydrochloride (Aircept™) and other acetylcholinesterase
inhibitors; galantamine, neuroprotective agents (e.g., memantine); ADD/ADHD agents (e.g.,
Ritalin™, Strattera™, Concerta™ and Adderall™), and methylphenidate.
[0068] As 5-HT2C modulators, compounds of the present invention are useful for treating
a variety of disorders. Such disorders include premenstrual syndrome (PMS), premenstrual
dysphoric disorder (PMDD), or late luteal phase syndrome, motion or motor disorders such
as Parkinson's disease; chronic fatigue syndrome, anorexia nervosa, disorders of sleep (e.gr,
sleep apnea), and mutism.
[0069] Premenstrual dysphoric disorder, or PMDD, is a severe form of PMS. Like PMS,
PMDD typically occurs the week before the onset of menstruation and disappears a few days
after. PMDD is characterized by severe monthly mood swings and physical symptoms that
interfere with everyday life, especially a woman's relationships with her family and friends.
PMDD symptoms go far beyond what are considered manageable or normal premenstrual
symptoms.
[0070] PMDD is a combination of symptoms that may include irritability, depressed
mood, anxiety, sleep disturbance, difficulty concentrating, angry outbursts, breast tenderness
and bloating. The diagnostic criteria emphasize symptoms of depressed mood, anxiety, mood
swings or irritability. The condition affects up to one in 20 American women who have
regular menstrual periods. According to another embodiment, the present invention provides
a method for treating one or more symptoms associated with PMDD.
[0071] Selective serotonin reuptake inhibitors (SSRIe) are the current preferred method
for treating symptoms associated with PMDD. According to another aspect, the present
invention provides a method for treating PMDD, or one or more symptoms associated with
PMDD, by administering a compound of formula I in combination with an SSRI. In certain
embodiments, the SSRI is fluoxetine, venlafaxine, paroxetine, duloxetine, or sertraline.
[0072] Inventive methods involve delivery of compounds of formula I via any
appropriate route of administration including, for example, oral, buccal, sublingual, rectal,
nasal, parenteral, intravenous, or other modes. In general, the compounds may be formulated
for immediate, delayed, modified, sustained, pulsed, or controlled-release delivery.
[0073] For inventive methods utilizing oral delivery, such delivery may be accomplished
using solid or liquid formulations, for example in the form of tablets, capsules, multi-
particulates, gels, films, ovules, elixirs, solutions or suspensions. In certain embodiments, the
compounds are administered as oral tablets or capsules or neat compound or powdered or
granular pharmaceutical formulations. Such preparations may be mixed chewable or liquid
formulations or food materials or liquids if desirable, for example to facilitate administration
to children, to individuals whose ability to swallow tablets is compromised, or to animals.
Examples of oral formulations contained in hard gelatin capsules can include those in which
the active compound comprises from about 45% to 50%, by weight, of the formulation.
Microcrystalline cellulose comprises from about 43% to about 47%, povidone comprises
from about 3% to about 4%, and silicon dioxide and magnesium stearate each comprise from
about 0.3% to about 0.7%, each by weight.
[0074] Modified release and pulsatile release oral dosage forms may contain excipients
such as those detailed for immediate release dosage forms together with additional excipients
that act as release rate modifiers, these being coated on and/or included in the body of the
device. Release rate modifiers include, but are not exclusively limited to,
hydroxypropylmethyl cellulose, methyl cellulose, sodium carboxymethylcellulose, ethyl
cellulose, cellulose acetate, polyethylene oxide, Xanthan gum, Carbomer, ammonio
methacrylate copolymer, hydrogenated castor oil, carnauba wax, paraffin wax, cellulose
acetate phthalate, hydroxypropylmethyl cellulose phthalate, methacrylic acid copolymer and
mixtures thereof. Modified release and pulsatile release oral dosage forms may contain one
or a combination of release rate modifying excipients. Release rate modifying excipients
may be present both within the dosage form i.e., within the matrix, and/or on the dosage
form, i.e., upon the surface or coating.
[0075] Fast dispersing or dissolving dosage oral formulations (FDDFs) may contain the
following ingredients: aspartame, acesulfame potassium, citric acid, croscarmellose sodium,
crospovidone, diascorbic acid, ethyl acrylate, ethyl cellulose, gelatin, hydroxypropylmethyl
cellulose, magnesium stearate, mannitol, methyl methacrylate, mint flavouring, polyethylene
glycol, fumed silica, silicon dioxide, sodium starch glycolate, sodium stearyl fumarate,
sorbitol, xylitol. The terms dispersing or dissolving as used herein to describe FDDFs are
dependent upon the solubility of the drug substance used i.e. where the drug substance is
insoluble a fast dispersing dosage form can be prepared and where the drug substance is
soluble a fast dissolving dosage form can be prepared.
[0076] . For inventive methods utilizing intravenous delivery, such administration may be,
for example, intracavemous, intravenous, intra-arterial, intraperitoneal, intrathecal,
intraventricular, intraurethral, intrasternal, intracranial, intramuscular or subcutaneous, or via
by infusion or needleless injection techniques. For such parenteral administration, the
compounds of formula I may be prepared and maintained in conventional lyophylized
formulations and reconstituted prior to administration with an intravenously acceptable saline
solution, such as a 0.9% saline solution. The pH of the intravenous formulation can be
adjusted, as is known in the art, with an intravenous and pharmaceutically acceptable acid,
such as methanesulfonic acid.
(00771 The compounds of formula I can also be administered intranasally or by
inhalation and are conveniently delivered- in the form of a dry powder inhaler or an aerosol
spray presentation from a pressurized container, pump, spray, atomizer or nebuliser, with or
without the use of a suitable propellant, e.g. dichlorodifluoromethane,
trichlorofluoromethane, dichlorotetrafluoroethane, a hydrofluoroalkane such as 1,1,1,2-
tetrafluoroethane (HFA 134A™) or 1,1,1,2,3,3,3-heptafluoropropane (HFA 227EA™),
carbon dioxide or other suitable gas. In the case of a pressurized aerosol, the dosage unit may
be determined by providing a valve to deliver a metered amount. The pressurized .container,
pump, spray, atomizer or nebuliser may contain a solution or suspension of the active
compound, e.g. using a mixture of ethanol and the propellant as the solvent, which may
additionally contain a lubricant, e.g. sorbitan trioleate. Capsules and cartridges (made, for
example, from gelatin) for use in an inhaler or insufflator may be formulated to contain a
powder mix of the compounds of the invention and a suitable powder base such as lactose or
starch.
[0078] Aerosol or dry powder formulations are preferably arranged so that each metered
dose or "puff" contains from 1 .mu.g to 50 mg of a compound of the invention for delivery to
the patient. The overall daily dose with an aerosol will be in the range of from 1 .mu.g to 50
mg which may be administered in a single dose or, more usually, in divided doses throughout
the day.
[0079] Alternatively, the compounds of formula I can be administered in the form of a
suppository or pessary, or they may be applied topically in the form of a gel, hydrogel, lotion,
solution, cream, ointment or dusting powder. The compounds of the invention may also be
dennally or transdermally administered, for example, by the use of a skin patch, depot or
subcutaneous injection. They may also be administered by the pulmonary or rectal routes.
[0080] For application topically to the skin, the compounds of formula I can be
formulated as a suitable ointment containing the active compound suspended or dissolved in,
for example, a mixture with one or more of the following: mineral oil, liquid petrolatum,
white petrolatum, propylene glycol, polyoxyethylene polyoxypropylene compound,
emulsifying wax and water. Alternatively, they can be formulated as a suitable lotion or
cream, suspended or dissolved in, for example, a mixture of one or more of the following:
mineral oil, sorbitan monostearate, a polyethylene glycol, liquid paraffin, polysorbate 60,
cetyl esters wax, cetearyl alcohol, 2-octyldodecanol, benzyl alcohol and water.
[0081] The compounds of formula I may also be used in combination with a
cyclodextrin. Cyclodextrins are known to form inclusion and non-inclusion complexes with
drug molecules. Formation of a drug-cyclodextrin complex may modify the solubility,
dissolution rate, bioavailability and/or stability property of a drug molecule. Drug-
cyclodextrin complexes are generally useful for most dosage forms and administration routes.
As an alternative to direct complexation with the drug the cyclodextrin may be used as an
auxiliary additive, e.g. as a carrier, diluent or solubiliser. Alpha-, beta- and gamma-
cyclodextrins are most commonly used and suitable examples are described in published
international patent applications WO91/11172, WO94/02518 and WO98/55148.
EXAMPLES
Assessment of Effect on Sexual Function
[0082] Compound 1, used to exemplify the effect of compounds of
the present invention on sexual function. In summary, male rats were allowed access to
sexually receptive females during a single overnight mating session and then administered
antidepressants with varying degrees of clinically reported sexual deficits. Following
antidepressant treatment, the rats were observed for penile erections in the presence of
sexually receptive females that were not accessible for contact, but served as visual, auditory,
and olfactory stimuli in the testing area. The details of this assay, and results obtained
therefrom, are set forth below.
Animals
[0083] Intact male Sprague-Dawley rats (Charles River Laboratories) arrived at 7 weeks
of age and were allowed to habituate for one week prior to sexual experience or behavioral
testing. Rats were group housed in same-sex colony rooms with food and water provided ad
libitum. All animals were maintained under a 12:12 light-dark cycle (lights on at 6:00 am)
with behavioral experiments performed during the light hours beginning at noon.
[0084] Ovariectomized female Long-Evans rats (Charles River Laboratories) were
individually housed and brought into behavioral estrus weekly by subcutaneous injection of
25 ug 17-B estradiol benzoate in 0.1 ml corn oil 48 hours prior to testing, followed by
subcutaneous administration of 2.5 mg progesterone in 0.1 ml corn oil 4 to 6 hours before
testing.
Establishment of Baseline Conditions
[0085] The first set of experiments were conducted to determine conditions under which
the baseline level of non-contact penile erections could be increased to allow for a greater
window to evaluate potential deficits. Therefore, non-contact penile erections were evaluated
in sexually naive and sexually experienced-rats in the absence and presence of female stimuli
(n = 5 pretreatment group).
[0086] For subjects assigned into the sexually experienced group, the following
procedures were performed. Individual male rats were placed into the home cage of a a
sexually receptive female for overnight mating sessions. The cage was a Plexiglas cage
measuring 10 x 12 inches, with food and water ad libitum. Mating pairs were randomly
assigned. The interaction between the male and female rat was observed for the first hour.
Only males that were observed for intromission within the first hour of paired mating
sessions were included in behavioral studies. Following overnight mating sessions, males
and females were separated from each other and placed back into same-sex colony rooms
where they were group-housed until the time of behavioral testing.
[0087] To determine the effects of female stimuli on non-contact penile erections,
sexually receptive females were brought into the testing room 30 minutes prior to the start of
behavioral testing in order to provide female visual, olfactory, and auditory stimuli for males.
The testing arena for observing non-contact penile erections in male rats consisted of an
empty rat size Plexiglas cage (11x10 inches) containing no bedding, with an aerated plastic
lid and a total ceiling height of 12 inches. Males were observed for non-contact penile
erections in individual test cages. A penile erection consisted of observation of the male rat
in a hunched position grasping the penis with the forepaws and followed by a series of pelvic
thrusts. The number of penile erections were quantified over a 30 minute observation
session.
[0088] Subjects assigned to the nonstimuli group were observed in the same testing
arena as described above, however there were no female rats present in the testing room.
Administration of Compounds
[0089] Following sexual experience (as described above), male subjects (n = 8 per group)
were administered either 10 mg/kg/day fluoxetine or saline vehicle for 14 days. On the 14th
day, fluoxetine treatment was co-administered with either saline, or apomorphine (0.1 - 0.3
mg/kg, sc) or yohimbine (0.1 — 0.3 mg/kg, sc) or sildenafil (0.1 — 0.3 mg/kg, sc) in separate
experiments. Non-contact penile erections were evaluated in 30 minute test sessions in the
presence of sexually receptive female rats.
[0090] Fluoxetine HC1 (Tocris), desipramine (Sigma, St. Louis, MO) and bupropion HC1
(Toronto Research Chemicals, Canada) were dissolved in 0.9% sterile saline vehicle and
injected intraperitoneally (i.p.) once daily. On the day of behavioral testing, antidepressants
were administered intraperitoneally (i.p.) as one hour pretreatments. For reversal
experiments, apomorphine (Sigma, St. Louis, MO), yohimbine (Sigma, St. Louis, MO) or
sildenafil (Toronto Research Chemicals, Canada) were used. Apomorphine was dissolved in
0.9% sterile saline vehicle and injected subcutaneously (s.c). Yohimbine was dissolved in
dH2O facilitated with IN HC1, followed by addition of IN NaOH for titration (pH=7) and
administered intraperitoneally (i.p.). Sildenafil was dissolved in 0.9% sterile saline vehicle
and administered intraperitoneally (i.p.). With the exception of fluoxetine which was
administered in a dose volume of 2 ml/kg, all other test compounds were administered in a
dose volume of 1 ml/kg. On the day of behavioral testing, both fluoxetine and the reversal
agent (apomorphine, yohimbine, or sildenafil) were co-administered as 0 minute
pretreatments.
[0091] Compound 1 was administered at 3 and 10 mg/kg, sub-cutaneously as a solution
in either water or saline.
Statistical analysis
[0092] Data are expressed as mean number of non-contact penile erections per treatment
group, calculated as % of vehicle control + S.E.M. For statistical analysis, data were
subjected to one-way analysis of variance (ANOVA) with a least significant difference (LSD)
post-hoc test as appropriate. Statistical significance was achieved when p < 0.05.
Effects of sexual experience or inexperience in the absence or presence of female stimuli
on non-contact penile erections in male rats
[0093] Sexually naive rats evaluated for non-contact penile erections in the absence of
female stimuli exhibited a mean of 1.33 + 0.33 non-contact penile erections as presented in
Fig. 1. The presence of female stimuli or an overnight sexual experience did not significantly
elevate the number of non-contact penile erections. However, sexually experienced males in
the presence of female stimuli resulted in a 58% increase in the number of non-contact penile
erections to 3.17 + 0.75 (p < 0.05) relative to sexually naive rats in the absence of female
stimuli (F[3,23]= 1.77; p = 0.186). The increased baseline level of non-contact penile
erections allows for a sufficient window .to evaluate potential deficits and all additional
studies were conducted using sexual experienced males in the presence of female stimuli.
[0094] The dopamine and norepinephrine reuptake inhibitor (D/NRI), bupropion, the
tricyclic antidepressant (TCA), desipramine, and the selective serotonin reuptake inhibitor
(SSRI), fluoxetine reduced the number of penile erections, 9%, 43%, and 72%; respectively,
relative to vehicle treated animals. This rank order of the compounds propensity for reducing
the number of penile erections is comparable to the rank order of the compounds' ability to
produce sexual dysfunction clinically. Additionally, compounds with varying mechanisms of
action used clinically to treat antidepressant-induced sexual deficits were effective in
reversing the deficits produced by chronic fluoxetine treatment in this model.
[0095] Table 2, below, summarizes the dose at which antidepressant-like effects are
observed, the dose at which sexual dysfunction occurs, and the therapeutic window.
[0096] These data show, as set forth in Table 2, that the dose of DMI or fluoxetine that
produces an antidepressant-like effect is equal to the dose producing sexual side-effects. For
Compound 1, the dose producing sexual side-effects is at least 30 times the dose required for
an antidepressant-like effect. For bupropion the window is about 2-fold.
Example 2
Assessment of Effect on Attention
[0097] Compound 1, was used to exemplify the effect of compounds of
the present invention on attention. The objective of this study was to characterize the ability
of Compound 1 to attenuate pharmacological disruptions of PPI produced by a variety of
disrupting agents that have been shown to be differentially sensitive to the effects of typical
and atypical antipsychotics. Data generated within our lab has shown that the typical
antipsychotics haloperidol, a selective D2 antagonist, will attenuate a d-amphetamine induced
deficit in PPI, while the atypical antipsychotics risperidone, olanzapine and clozapine, will
attenuate deficits in PPI produced by DOI and MK-801, as well as those caused by d-
amphetamine. The results of the current studies with Compound 1 demonstrate an ability to
attenuate both d-amphetamine and DOI induced gating deficits, in a dose range that has no
effect on baseline PPI when Compound 1 is administrated alone. Although we were not able
to demonstrate an ability of Compound 1 to attenuate an MK-801 induced deficit in PPI,
Compound 1 did attenuate the increased startle reactivity induced by MK-801, and this effect
is similar to that seen with other antipsychotics. The pre-pulse data presented in this
Example, support an atypical antipsychotics-like profile for this compound.
Introduction
[0098] Pre-pulse inhibition (PPI) refers to the attenuation in startle response that occurs
when a weak, non-startling stimulus (the pre-pulse) is paired with a higher intensity, startle-
eliciting pulse. PPI is a cross-species phenomenon, one that can be observed in both humans
and rodents, and it is widely reported to be deficient in schizophrenia patients. It has been
theorized that deficits in the gating of sensory information contribute to both the positive
symptomatology, and the cognitive fragmentation, which are hallmarks of this disease. In the
rat, PPI can be disrupted by the systemic administration of dopamine agonists, serotonin
agonists, as well as glutamate antagonists. The reversal of these deficits by pharmacological
means is proposed to be a model for predicting anti-psychotic activity in novel compounds.
Typical and atypical antipsychotics both treat psychotic symptoms, but atypical
antipsychotics have a reduced extrapyramidal motor symptom liability. Typical
antipsychotics, such as haloperidol, which are primarily selective D2 antagonists, are
efficacious in reversing PPI disruptions elicited by dopamine agonists in animals. Atypical
antipsychotics, by virtue of their activity at multiple receptors, should block not only
dopamine induced deficits in PPI, but those elicited by other classes of disrupting agents.
Published data suggests that PPI deficits in schizophrenics may be influenced by treat- ment
medication, with PPI effects of atypical antipsychotics being differentiated from those of
typicals, depending on experimental design. Typical (haloperidol) and atypical (risperidone,
olanzapine and clozapine) antipsychotics show a differential ability to reverse
pharmacologically induced PPI deficits, with all of the atypicals showing efficacy to reverse
or attenuate amphetamine (an indirect dopamine agonist), DOI (a 5-HT2A agonist) and MK-
801 (a non-competitive NMDA antagonist) induced PPI deficits, while the typical anti-
psychotic haloperidol was effective only against amphetamine PPI deficits. The objective of
this study was to evaluate the effects of Compound 1, a potent and selective 5-HT2C agonist,
in a model where typical and atypical antipsychotics show differential effectiveness in
normalizing various pharmacologically induced deficits in the sensorimotor gating response.
Materials
[0099] Animals: For all studies, male Sprague Dawley CD rats (Charles River) weighing
250-400g were used. Rats were group housed and allowed ad-lib access to food and water.
A 12-h light/dark cycle was imposed with the lights on period-between 0600 and 1800 hours.
All PPI testing occurred during the lights-on phase, typically between 0800 and 1300 hours.
[00100] The animals used in this study are listed in Table 3.
[00101] Drugs: Compound 1 was dissolved in 0.25% Tween 80 and injected in a volume
of 2 ml/kg. MK-801 (S-1319-A-2 or S-1319-A-10), DOI and d-amphetamine (S-204-A-2)
were all dissolved in saline and injected in a volume of 1 ml/kg. All doses refer to active
moiety.
Methods
[00102] Test Equipment Each testing chamber (SR-LAB system, San Diego Instruments)
consisted of a Plexiglas cylinder (8.8 cm in diameter) mounted on a frame and held in
position by four metal pins to a base unit. Movement of the rat within the cylinder was
detected by a piezoelectric accelerometer attached below the frame. A loudspeaker mounted
24 cm above the cylinder provided background white noise, acoustic noise bursts and
acoustic pre-pulses. The entire apparatus was housed in a ventilated enclosure (39x38x56
cm). Presentation of acoustic pulse and pre-pulse stimuli were controlled by the SR-LAB
software and interface system, which also digitized, rectified and recorded the responses from
the accelerometer. Mean startle amplitude was determined by averaging 100, 1 ms readings
taken from the beginning of the pulse stimulus onset. For calibration purpose, sound levels
were measured with a Quest sound level meter, scale "A", with the microphone placed inside
the Plexiglas cylinder.
100103] Test Sessions Test sessions began when the rats were placed in the startle
chambers for a 5-min acclimation period with a 64 dB (A) background of white noise. After
the acclimation period, rats were exposed to four types of stimuli. The startle-eliciting
stimulus was a 20-ms broad band burst at a sound pressure level of 120 dB (A). Three
different intensities of auditory pre-pulse stimuli were utilized. These consisted of a 69, 74 or
79 dB (A), 20-ms broadband burst which was presented 100-ms (onset to onset), prior to the
startle pulse. These four trial types were presented against a constant 64 dB (A) background
of white noise. A.test session consisted of an initial pulse stimulus, followed by 15 sequences
of the four stimulus types, presented in pseudorandom order, for a total of 61 trials. Inter-
trial intervals averaged 15 s.
[00104] Pretreatment Intervals Compound 1 was administered 30 min prior to testing
via an IP route of administration. MK-801 (0.15 mg/kg) and d-amphetamine (4 mg/kg) were
administered 10 min prior to testing via a SC route of administration, while DOI (3 mg/kg)
was administered 15 min prior to testing using an IP route of administration.
Evaluation of Results
[0010S] Startle amplitude was defined as the mean value of pulse alone trials. To evaluate
the effect of drug treatment on startle response, data from the pulse alone trials was analyzed
using one-factor ANOVA (one-way randomized block design), followed by a least significant
difference (LSD) post-hoc test (comparison was made to vehicle/disrupting agent control, and
vehicle control in Compound 1 alone study). Pre-pulse inhibition was defined as 100-[(startle
amplitude on pre-pulse trials/startle amplitude on pulse alone trials) x 100]. Although data
for gating at three different pre-pulse intensities was generated, an averaged gating score
across all pre-pulse intensities was calculated and this was analyzed by one factor ANOVA
with repeated measures (one-way randomized block design). This was followed by a LSD
post-hoc test (comparison was- made to vehicle/disrupting agent control, and vehicle control
in Compound 1 alone study). The criterion for significance for alterations in both startle
amplitude and PPI was set at P<0.05.
Results and Discussion
{00106] Compound 1 (3-17 mg/kg) significantly attenuated (Figure 2) an amphetamine
induced deficit in PPI [F(4,34)=5.913, P=0.0010] at all doses tested, without having a
significant effect on startle alone responding [F(4,34)= 1.175, P=0.3394].
[00107] When tested against a DOI induced deficit, Compound 1 (3-30 mg/kg)
significantly attenuated the disruption in gating [F(5,60)=5.612, P=0.0002] at a dose of 17
mg/kg (Figure 3). There was a significant decrease in startle intensity [F(5,69)=3.423,
P=0.0080) in those animals receiving the 10 and 17 mg/kg dose of Compound 1 relative to a
vehicle/DOI control.
[00108] Against the highest dose of MK-801 test (0.15 mg/kg), Compound 1 (3-30 mg/kg)
did not show an ability to significantly attenuate the MK-801 induced disruption in gating
[F(5,79)=21.078, P<0.001] at any dose tested (Figure 4), but did significantly reduce the
increase in startle produced by MK-801 [F(5,79)=15.456, P<0.001], at all doses tested.
[00109] Compound 1, was used to exemplify the effect of compounds of
the present invention on compulsivity/impuslivity using the Schedule-Induced Polydipsia
assay in rats. The objective of this study was to characterize the effect of Compound 1 (1-
10 mg/kg, ip) on schedule-induced polydipsia in rats. Compound 1 produced dose-dependent
decreases in adjunctive drinking following ip administration with an MED of 3 mg/kg and an
EDso value of 3.16 mg/kg, ip (95% CI: 2.03 - 4.92 mg/kg, ip; Figure 5). These results
suggest that Compound 1 may be an effective treatment for obsessive-compulsive disorder
and impulsivity disorders.
Introduction
[00110] Compound 1 is a potent full agonist at the 5-HT2C receptor (Ki = 3 nM; EC50 = 8
nM). Compound 1 represents a novel therapeutic approach to the treatment of schizophrenia
and depression. Additionally, several lines of evidence suggest that 5-HT2C agonists may be
effective treatments for obsessive-compulsive disorder. For example, 5-HT2C agonists have
been shown to be effective in animal models of compulsive behavior such as schedule-
induced polydipsia (SIP), 8-OH-DPAT-induced scratching in squirrel monkeys, marble
burying, and excessive eating of palatable foods. Additionally, 5-HT2C knockout mice
exhibit compulsive-like behaviors.
[00111] The present studies were conducted to evaluate the effects of Compound 1 in a
SEP model in rats. SIP is a model of obsessive-compulsive disorder. In this model, a food
pellet is delivered once per minute for a two-hour period. A water bottle is available in the
chamber. Under this schedule, water intake is tremendously increased relative to animals that
receive 120 food pellets at the start of a session and are given two hours to eat and drink.
This excessive manifestation of a normal behavior (drinking) provides face validity to the
model. Moreover, since the animals are not water deprived, the adjunctive drinking does not
serve a physiological function. Most importantly, clinically effective drugs for the treatment
of obsessive-compulsive disorder decrease adjunctive drinking.
Materials and Methods
[00112] Animals: Male Sprague-Dawley rats weighing 275 — 325 g were individually
housed in wire hanging cages. Each cage was equipped with a water spigot attached to an
automated watering system which allow free access to water at all times. Body weights were
reduced gradually to 85% of baseline weights by restricting post-session feeding.
[00113] Methods Rats were placed in an operant chamber (Med Associates) equipped
with a pellet dispenser, a food receptacle, a houselight and a water bottle with 100 ml of
water. Houselights were turned on in the chamber and a food pellet (Bioserve, 45 mg) was
delivered on a fixed-time 60 sec schedule, such that one pellet was delivered each minute
during a 2 hour experimental session. At the end of the session, water intake was measured.
[00114] Experiments to control for schedule and baseline water intake were conducted by
placing 120 pellets in the food receptacle at the start of a 2-hour experimental session.
Houselights were turned on, but no additional food pellets were delivered. At the end of the
session, water intake was measured.
[00115] Compound Administration Compound 1 was dissolved in 0.9% saline and was
administered ip in a volume of 1 ml/kg immediately the 2-hour experimental session. Dose
calculations were based on active moiety.
[00116] Evaluation of Results Data were analyzed using a one-way ANOVA. Post hoc
tests comparing vehicle to doses of Compound 1 were conducted using contrasts in a least
squares model. An EDso value (dose decreasing polydipsic intake to 50% of vehicle values)
was calculated using nonlinear regression models.
RESULTS
[00117] Following administration of saline, rats drank 54.0 ± 4.6 ml of water during the 2
hour experimental session during which a food pellet was delivered once per minute.
Compound 1 (1-10 mg/kg, ip) produced dose-dependent decreases in excessive water intake
in the schedule-induced polydipsia procedure (F(3,39)=28.53; p<0.001). Posthoc tests
revealed that 3mg/kg (-43%; p=0.0003) and 10 mg/kg (-87%; p<0.0001) produced significant
decreases in excessive water intake. The ED50 value was 3.16 mg/kg, ip (95% CI: 2.03 —
4.92 mg/kg, ip). At the highest dose, 3 of 10 rats did not eat all of their food pellets during
the 2-hour session.
[00118] The present Example demonstrates that Compound 1 produces dose-dependent.
decreases in adjunctive drinking following ip administration with an MED of 3 mg/kg and an
EDso value of 3.16 mg/kg, ip (95% CI: 2.03 - 4.92 mg/kg, ip). The anti-OCD-like effects of
Compound 1 on SIP occurred following an acute administration. In contrast, the effects of
serotonin reuptake inhibitors require chronic administration in this model.
Example 4
Assessment of Effect on Acetylcholine Levels
[00119] Compound 1, was used to exemplify the effect of compounds of
the present invention on rat brain acetylcholine and glutamate using in vivo microdialysis,
and to evaluate the pro-cognitive effects of Compound 1 in rat novel object recognition
(NOR).
[00120] Compound 1 is a selective 5-HT2C receptor agonist which is effective in animal
models predictive of antidepressant- and antipsychotic-like activity. Furthermore, Compound
1 was previously reported to increase glutamate in the medial prefrontal cortex, suggesting a
potential pro-cognitive effect. To determine whether Compound 1 may cause further
neurochemical changes consistent with pro-cognitive effects, Compound 1 was tested for its
effects on acetylcholine and glutamate in the medial prefrontal cortex of freely moving rats.
Compound 1 was also tested in the rat novel object recognition (NOR) task in order to
determine whether it modified cognitive function in a rodent model of learning and memory.
MATERIALS AND METHODS
[00121] Animals: Adult male Sprague-Dawley rats (Charles River, Wilmington, MA)
weighing 280-350 g at the time of surgery were used for all microdialysis experiments. Adult
male Long-Evans rats (Charles River, Wilmington, MA) weighing 180-220 g were used for
NOR studies. Rats were housed individually for recognition memory studies. All animals
had free access to food and water and were group housed in the AAALAC-accredited facility
that was maintained on a 12 h light dark cycle (lights on at 0600 h) for at least 1 week prior to
surgery or behavioral testing. All in vivo studies were performed in accordance to the 'Guide
for the Care and Use of Laboratory Animals' as adopted and promulgated by the National
Institutes of Health (Pub. 85-23,1985). The animals used in microdialysis are listed in Table
4.1. The animals used in NOR are listed in Table 4.2.
[00122] Stereotaxic Surgery Following induction of anesthesia with 3% halothane
(Fluothane; Zeneca, Cheshire, UK), animals were secured in a stereotaxic frame with ear and
incisor bars (David Kopf, Tujunga, CA). Anesthesia was maintained by continuous
administration of halothane (1 — 2 %) while a microdialysis guide cannula (CMA/12, CMA
Microdialysis, Stockholm, Sweden) was implanted above the medial prefirontal cortex (AP:
3.2mm ML: -0.6mm DV: -3.8mm). The guide cannula was secured to the skull using dental
acrylic (Plastics one, Roanoke, VA, USA) and two small stainless-steel screws (Plastics one,
Roanoke, VA, USA). Following surgery, animals were individually housed in Plexiglas
cages (45 cm sq.), with free access to food and water. The following day rats were used in
microdialysis experiments.
[00123] Microdialysis Microdialysis probes (CMA 12/02; CMA Microdialysis,
Stockholm, Sweden) were equilibrated according to manufacturer's specifications.
Microdialysis probes were perfused with artificial cerebrospinal fluid (aCSF: 125 mM NaCl,
3 mM KC1, 0.8 mM MgCl2, 1.85 mM CaCl2, 1.54 mM Na2HPO4 and 0.225 mM NaH2PO4;
pH 7.4) prior to insertion in the guide cannula. The microdialysis probe was then inserted via
the guide cannula into the dorsal hippocampus or medial prefirontal cortex and perfused with
aCSF at a flow rate of 0.5 ul/min. A 3 h stabilization period was allowed following probe
insertion before dialysate sampling was initiated. Samples were collected every 40 min for
acetylcholine analysis and immediately frozen on dry ice after collection. After baseline
samples were collected (2 h), rats were dosed with Compound 1 or vehicle (t=0). Following
dosing, dialysis samples were collected for 200 min. At the end of the experiment, animals
were euthanized and probe placement was verified histologically. Data from animals with
incorrect probe placement were discarded.
[00124] Analysis of Acetylcholine Dialysate levels of acetylcholine were determined
using LC/MS/MS. The following conditions and equipment were used:
Instrument: Waters Micro mass spectrometer coupled with Agilent HP 1100
Column: Supelco LC-SCX, 2.1 x 150 mm, 5 mM
Mobile phase: A: 60/20/20 of H2O/buffer/ACN; B: 20/80 buffer/ACN
Buffer: 79.5 mM ammonium acetate, 63.5 mM ammonium formate, pH 4.0
Ionization mode: (+) ESI
MRM: Acetylcholine (ACh): 146 => 87 Cone = 20 CID = 15 eV
Iso-ACh: 146=>87 Cone = 20 CID = 15 eV
(3-carboxypropyltrimethylammonhun)
IS: b-methyl-ACh: 160 => 101 Cone = 20, CID = 15 eV
[00125] Acetylcholine data were quantified using peak area against an internal standard
and acquired using Masslynx software (Micromass, Beverly, MA, USA). The mean of the
concentration of baseline samples was calculated and denoted as 0%. All sample values were
expressed as a percent change from this pre-injection mean baseline value (% change from
baseline). Neurochemical data, excluding pre-injection values, were analyzed by a two-way
analysis of variance (ANOVA) with repeated measures (time). All statistical analyses were
performed using SAS (v 1.03) within Excel® (Microsoft).
High Performance Liquid Chromatography (HPLC) Analysis
[00126] Dialysate (10 uL) f was collected and analyzed for extracellular glutamate
concentrations. HPLC methods were conducted using the following methods:
10 uL dialysate containing glutamate was separated by HPLC. These units consisted of two
Jasco PU-980 pumps (Jasco Ltd, Essex, U.K) as the gradient, a BAS sentinel autosampler
(BAS) and a Jasco PF-920 fluorometer with excitation wavelength of 448 nm. The emission
wavelength was 485 nm. Mobile phase A was 0.05 M acetate buffer (pH 6.5) with
20%methanol (V: V) and mobile phase B was a 0.05 M acetate buffer (pH 6.5) with 80%
methanol (V:V). The gradient consisted of a linear transition from 80% mobile phase A to
0% in 18 minutes. The column was allowed to re-equilibrate for 10 min prior to each
injection. Each sample was diluted 1:1 with normal Krebs solution containing 2.5 M alpha-
aminoadipic acid «AA; final concentration 1.25 uM; internal standard). Samples containing
70% correct responses during a 30-
minute baseline session. Once animals reach baseline criteria, a variable stimulus duration
(SD) and variable inter-trial interval (ITI) test can be used to manipulate normal baseline
performance. When the SD is decreased the number of correct responses, a measure of
attention, is significantly decreased. When the ITI is increased from that used during baseline
training impulsivity, as measured by premature responses, is increased. Compounds and
manipulations that improve attention will improve performance and those that decrease
impulsivity will decrease premature responses.
[00137] SCSRT: The test apparatus consisted often 25 x 25 cm aluminum chambers (Med
Associates Inc., St. Albans, VT). The rear wall of each chamber was concavely curved,
containing five accessible apertures, each 2.5 cm square, and 4 cm deep positioned 2 cm
above floor level. Standard 3-watt LEDs located at the rear of each aperture served as
stimulus lights. Opposite to the apertures was the magazine dispenser, into which food
rewards were deposited. The ten chambers were individually housed within sound-
attenuating cabinets and were ventilated by low-level noise fans, which also served to mask
extraneous background noise. Each chamber was illuminated by a 3W house-light mounted
in the center of the roof alongside a small general-purpose loud speaker. The program
controlling the software was developed by Conclusive Solutions (UK).
[00138] SCSRT Training: Prior to drug treatments, rats were trained to discriminate a
brief visual stimulus light presented randomly in one of the five spatial locations. At the
beginning of each test session, the house light was illuminated and free delivery of a single
food pellet was dispensed to the food magazine. Trial initiation was triggered when the rat
opened the magazine to collect this pellet. After a fixed 5 second inter-trial interval (ITI), the
light at the rear of one of the five apertures was illuminated for 500 milliseconds. A single
nose-poke in this opening during the period of illumination (signal period), or during the 5
second afterwards (limited hold) was reinforced by the delivery of a food pellet and a correct
response was recorded. A response in a non-illuminated opening during the signal period
(incorrect response) and failures to respond within the limited hold period (missed trial) were
followed by a period of darkness (time out) and no food pellet was delivered. Premature
responses, defined as nose-pokes into apertures during the ITI period prior to illumination,
reset the ITI. When animals had been trained to perform at a level of 75% correct on the
standard procedure (500 millisecond light duration, 5 second ITI) testing began in the ITI
schedule where animals were exposed to variable inter-trial interval (ITI) durations (10, 7, 5,
and 4 seconds). Equal numbers of each of the 4 ITIs were randomly presented during the 100
trial session. A within subjects design was used such that all animals received all treatments
in a fully counterbalanced regimen. All subjects received drug treatments and testing was
twice a week giving a minimum of 2 days washout period. Interspersed with those treatment
days were standard training days (500 ms stimulus/ 5 second ITI) reinstating baseline
performance until all subjects were back to >75% performance on the percent correct
responding. Using a Latin-square dosing design in which each rat receives each dose of the
compound, the 1TI data was collected over a 10-day testing period.
[00139] Results for Compound 1 are depicted in Figure 9. Compound 1 produced a dose-
dependent decrease in premature responding under the longer ITI conditions (10 and 7 sec)
with a dose of 1 mg/kg, ip producing a statistically significant decrease in premature
responding (p<0.05 vs vehicle in the 10 and 7 sec ITI conditions)
CONCLUSION
[00140] Compound 1 decreases premature responding in the 5-choice serial reaction time
task indicative of efficacy in impulsivity disorders.
CLAIMS
We claim:
1. A method of treating a cognitive disorder in a patient, comprising
administering to said patient a therapeutically effective amount of a compound of formula I:
or a pharmaceutically acceptable salt thereof, wherein:
== designates a single or double bond;
n is 1 or 2;
m is 0 or 1;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6
perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R3 and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsaturated 4-8 membered ring, wherein said ring is optionally substituted
with 1-3 groups independently selected from halogen, -R, or OR; and
R5 and R6 are each independently -R.
2. The method according to claim 1, wherein == designates a single bond.
3. The method according to claim 1 or claim 2, wherein:
R1 is R, OR, halogen, cyano, or -C1-3 perfluoroalkyl; and
R2 is R, OR, halogen, cyano, or -C1-3 perfluoroalkyl.
4. The method according to claim 3, wherein at least one of R1 and R2 is -OH.
5. The method according to any one of claims 1 to 3, wherein R3 and R4 are
taken together, with the carbon atoms to which they are bound, to form a saturated or
unsaturated 5-8 membered ring, wherein said ring is optionally substituted with 1-3 groups
independently selected from halogen, -R, or OR.
6. The method according to any one of claims 1 to 5, wherein said compound is
of formula I-a or I-b:
or a pharmaceutically acceptable salt thereof.
7. The method according to any one of claims 1 to 5, wherein said compound is
of formula I-c or I-d:
or a pharmaceutically acceptable salt thereof.
8. The method according to claim 7, wherein said compound is of formula II or
III:
or a pharmaceutically acceptable salt thereof.
9. The method according to any one of claims 1 to 5, wherein said compound is
of formula I-e or I-f:
or a pharmaceutically acceptable salt thereof.
10. The method according to claim 9, wherein said compound is of formula IV or
V:
or a pharmaceutically acceptable salt thereof.
11. The method according to claim 1, wherein said compound is selected from:
2-bromo-4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c][1,4]diazepino [6,7,1-if]quinoline;
2-bromo-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4]diazepino[6,7,1-
if] quinoline;
2-chloro-4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c] [1,4]diazepino [6,7,1-if]quinoline;
2-chloro-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c] [1,4] diazepino[6,7,1-
if]quinoline;
2-phenyl-4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c][1,4]diazepino [6,7,1-
if]quinoline;
2-methoxy-4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c] [1,4]diazepino [6,7,1-
if]quinoline;
1-fluoro-4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c][1,4]diazepino[6,7,1-if]quinoline;
1-fluoro-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4] diazepino[6,7,1-
if]quinoline;
1-(trifluoromethyl)-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [1,4] diazepino[6,7,1-
if] quinoline;
1-fluoro-2-methoxy-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [1,4] diazepino[6,7,1-
if]quinoline;
1-fluoro-2-methoxy-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclo-
hepta[c] [1,4]diazepino[6,7,1-if]quinoline;
4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c] [1,4] diazepino[6,7,1-if] quinoline;
4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4]diazepino [6,7,1-if]quinoline;
(-)-4,5,6,7,9,9a10,11,12,12a-decahydrocyclopenta[c][1,4]diazepino[6,7,1 -if] quinoline;
(9aR,14aS)-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][1,4] diazepino[6,7,1-
if]quinoline; or
(9aS, 14aR)-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c][1 ,4] diazepino[6,7,1-
if]quinoline;
4,5,6,7,9a,10,11,12,13,13a-decahydro-9H-[1,4]diazepino[6,7,1-de]phenanthridine;
1,2,3,4,9,10-hexahydro-8H-cycIopenta[b] [1,4]diazepino[6,7,-hi]indole;
1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b] [1,4]diazepino[6,7,1-hi]indole;
(7bS, 10aS)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b][1,4]diazepino[6,7,1-hi]indole;
(7bR, 10aR)-l,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][1,4]diazepino[6,7,1-
hi]indole;
(7bR,10aR)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][l,4]diazepino[6,7,1-hi]indole;
6-methyl-1,2,3,4,9,10-hexahydro-8H-cyclopenta[b] [1,4}diazepino[6,7,1 -hi]indole;
2S)-(rel-7bR, 10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
(2S)-(rel-7bR,10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino [6,7,1-hi] indole;
(2S)-(rel-7bS,10aS)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
(2R)-(rel-7bR, 10aR)-2-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
(2R)-(rel-7bR, 10aR)-2-m ethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b
][1,4]diazepino[6,7,1-hi]indole;
(2R)-(rel-7bS,10aS)-2-methyl-l,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]
[1,4]diazepino[6,7,1-hi]indole;
rel-(4S,7bS,10aS)-4-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-
cyclopenta[b][1,4]diazepino[6,7,1-hi]indole;
rel-(4S,7bS, 10aS)-4-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b]-
[1,4] diazepino[6,7,1-hi]indole;
rel-(4R,7bS,10aS)-4-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-
cyclopenta[b] [1,4]diazepino[6,7,1-hi]indole;
9-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta|;b][1,4]diazepino[6,7,1-hi]indole;
(7bR,9R,10aR)-9-methyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b][1,4]d
iazepino[6,7,1-hi]indole;
9,9-dimethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[1,4]diazepino[6,7, 1-hi]indole;
(7bR,10aR)-9,9-dimethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b][1,4]
diazepino[6,7,1-hi]indole; and
(7bS, 10aS)-9,9-dimethyl-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta[b][1,4]
diazepino[6,7,1-hi]indole;
or a pharmaceutically acceptable salt thereof.
12. The method of claim 11, wherein said compound is the hydrochloride salt.
13. The method of any one of claims 1 to 12, wherein the cognitive disorder is
ADD or ADHD.
14. The method of claim 13, wherein the mammal is a pediatric patient.
15. The method of any one of claims 1 to 12, wherein the cognitive disorder is a
learning disorder.
16. The method of claim 15, wherein the learning disorder is autism, dyslexia,
Asperger's Syndrome, a specific learning disability, dysgraphia, dyscalcutia, dyspraxia,
visual perceptual deficit, or auditory perceptual deficit.
17. The method of any one of claims 1 to 12, wherein the cognitive disorder is an
impulsivity disorder.
18. The method of claim 17, wherein the impulsivity disorder is borderline
personality disorder, a disruptive behavior disorder, an impulse control disorders, or
Tourette's Syndrome.
19. The method of any one of claims 1 to 12, wherein the cognitive disorder is a
behavioral addiction or addictive disorder.
20. The method of claim 19, wherein the behavioral addiction or addictive
disorder is gambling, sex addiction, eating disorders, spending addiction, rage/anger,
workaholism, exercise addiction, a risk taking addiction, or perfectionism.
21. The method of any one of claims 1 to 12, further comprising administering an
additional therapeutic agent selected from an acetylcholinesterase inhibitor, galantamine, a
neuroprotective agent, a therapeutic agent for treating ADD/ADHD.
22. The method of claim 21, wherein the additional agent is selected from
donepezil hydrochloride, galantamine, memantine, methylphenidate, atomoxetine, or
amphetamine/dextroamphetamine.
23. A method for treating PMS or PMDD, or one or more symptoms associated
with PMS or PMDD, in a patient, comprising administering to said patient a therapeutically
effective amount of a compound of formula I or a pharmaceutically acceptable salt thereof as
defined in any one of claims 1 to 12.
24. The method of claim 23, wherein said symptom is one or more of irritability,
depressed mood, anxiety, sleep disturbance, difficulty concentrating, angry outbursts, breast
tenderness and bloating.
24. The method of claim 23, further comprising administering to said patient a
selective serotonin reuptake inhibitor.
25. The method of claim 24, wherein said selective serotonin reuptake inhibitor is
fluoxetine, venlafaxine, paroxetine, duloxetine, or sertraline.
26. Use of a compound of formula I or a pharmaceutically acceptable salt thereof
as defined in any one of claims 1 to 12 in the preparation of a medicament for treating a
cognitive disorder in a patient.
27. Use of a compound of formula I or a pharmaceutically acceptable salt thereof
as defined in any one of claims 1 to 12 in the preparation of a medicament for for treating
PMS or PMDD, or one or more symptoms associated with PMS or PMDD, in a patient.
This invention provides methods and pharmaceutical compositions for treating cognitive disorders such as learning
disorders and ADD/ADHD, and other disorders.