SPECIFICATION
PHARMACEUTICAL COMPOSITIONS FOR
TREATING FATTY LIVER DISEASE
TECHNICAL FIELD
[0001] The present invention relates to a pharmaceutical composition for treating fatty liver
disease, and more particularly relates to a pharmaceutical composition comprising a specific
phenylglucitol derivative or a pharmaceutically acceptable salt thereof.
BACKGROUND ART
[0002] Fatty liver disease, which is also called fatty liver, refers to a disease leading to liver
injury caused by abnormal accumulation of fats (e.g., triglycerides) in liver cells. It is
known that the early-stage pathology of fatty liver disease is simple fatty liver, which shows
only fat deposition in liver cells, followed by development of steatohepatitis (including
hepatic fibrosis) and further cirrhosis and/or hepatocellular carcinoma at more advanced
stages. In general, possible causes of fat deposition in the liver include alcohol ingestion,
obesity, diabetes, abnormal lipid metabolism, drugs (e.g., steroid, tetracycline), Cushing
syndrome, poisoning (e.g., with white phosphorus), serious nutritional disorder, etc. The
causes of fatty liver disease are classified into two major types, i.e., alcoholic and
nonalcoholic, and the liver disease caused by the former is referred to as alcoholic liver
disease (also called alcoholic liver injury), while the liver disease caused by the latter is
referred to as nonalcoholic fatty liver disease (NAFLD). Alcoholic liver disease progresses
from simple fatty liver at the early stage to steatohepatitis and/or cirrhosis at more advanced
stages. Nonalcoholic fatty liver disease has been considered to remain at the stage of simple
fatty liver without progressing to more advanced stages. In recent years, however, it has
been shown that the pathology of nonalcoholic fatty liver disease may also progress from
simple fatty liver to steatohepatitis and/or cirrhosis. Nonalcoholic fatty liver disease is
defined as a disease with fat deposition in the liver, which occurs in patients whose alcohol
ingestion history is not long enough to cause liver injury, except for cases of known etiology,

such as viral hepatitis and autoimmune hepatitis. Nonalcoholic fatty liver disease is further
classified into simple fatty liver, steatohepatitis and cirrhosis. Nonalcoholic steatohepatitis
(NASH) refers to a pathology associated with inflammation, liver cell necrosis, ballooning
and fibrosis, similarly to the case of alcoholic steatohepatitis (ASH). The onset of
nonalcoholic simple fatty liver is induced by fat deposition in liver cells, and this fat
accumulation is defined by the balance between increasing factors (influx and synthesis of
fats in liver cells) and decreasing factors (catabolism of fats and their release from liver cells).
Once damage of liver cells occurs, in addition to this fat deposition, nonalcoholic simple fatty
liver will progress to nonalcoholic steatohepatitis. Nonalcoholic steatohepatitis is
progressive and may finally progress to cirrhosis and hepatocellular carcinoma. Thus,
nonalcoholic steatohepatitis is regarded as a serious type of nonalcoholic fatty liver disease.
As described above, fatty liver disease is separated into alcoholic liver disease and
nonalcoholic fatty liver disease, but these diseases have very similar histopathological
features, for example, in each of the condition of simple fatty liver, steatohepatitis or
cirrhosis. Thus, there is expected a common pathological mechanism to these diseases.
[0003] In the treatment of fatty liver disease, it is important to take away the causes and to
improve fat accumulation in the liver. For the treatment of alcoholic liver disease,
abstinence from alcohol is imperative, but it is difficult to achieve. On the other hand, most
cases of nonalcoholic fatty liver disease are associated with insulin resistance, obesity,
diabetes and hyperlipidemia, as expected from a possible onset mechanism for nonalcoholic
fatty liver disease. If patients have these complications, they are first required to receive
therapy for these complications. The therapeutic principle for nonalcoholic fatty liver
disease is to improve lifestyle habits, including diet therapy and exercise therapy, which are
however difficult to achieve securely under the present circumstances. In the case of
nonalcoholic steatohepatitis, a more aggressive drug therapy is required because it is highly
likely to progress to cirrhosis and/or hepatocellular carcinoma. Although some therapies
have been attempted to improve oxidative stress and/or insulin resistance, which appear to be
important for the onset and progress of nonalcoholic steatohepatitis, there is no therapy based

on well-established scientific grounds under the present circumstances. In Japan,
polyenylphosphatidylcholine (EPL) is used as a drug for simple fatty liver under medical
insurance, but its therapeutic effect on nonalcoholic steatohepatitis has not yet been clarified.
In view of the foregoing, no sufficient therapy has been established for fatty liver disease
under the present circumstances, and there is a demand for the development of a highly
effective therapeutic agent for fatty liver disease.
[0004] Under these circumstances, a document has been published, which discloses an
inhibitor against the progress of diseases caused by abnormal fat accumulation in the liver,
which comprises a sodium/glucose cotransporter (hereinafter referred to as SGLT) 2 inhibitor
as an active ingredient (Patent Document 1). In this document, many O-glycoside
compounds are listed as SGLT2 inhibitors, but there is no disclosure about compounds of
formula (I) or pharmaceutically acceptable salts thereof. Moreover, there is no actual data
showing their efficacy on the treatment of nonalcoholic steatohepatitis.
Likewise, another document has been published, which discloses combination
therapy with an SGLT inhibitor and a PPAR agonist (Patent Document 2). This document
discloses that T-1095, which is known as an SGLT inhibitor, reduced blood triglyceride
levels in db/db mice. However, there is no disclosure about efficacy on the treatment of
fatty liver disease.
[0005] Among compounds of formula (I), a compound in which R3 is azulen-2-yl, i.e., (1S)-
l,5-anhydro-l-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol shows SGLT inhibitory
activity and hypoglycemic effect, and is disclosed to be useful as a therapeutic agent for
various diabetes-related diseases (Patent Document 3). It is also disclosed that its choline
salt has preferred properties as a pharmaceutical drug substance (Patent Document 4).
However, there is no disclosure about efficacy on the treatment of fatty liver disease.
[0006] Among compounds of formula (I), a compound in which R3 is l-benzothiophen-2-yl,
i.e., (lS)-l,5-anhydro-l-[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol shows
SGLT inhibitory activity and hypoglycemic effect, and is disclosed to be useful as a
therapeutic agent for various diabetes-related diseases (Patent Documents 5 and 6). It is

also disclosed that its free form and its co-crystal with L-proline (at 1:1 molar ratio) have
preferred properties as pharmaceutical drug substances (Patent Document 7). However,
there is no disclosure about efficacy on the treatment of fatty liver disease.
[0007] Among compounds of formula (I), a compound in which R is 4-ethoxyphenyl, i.e.,
(lS)-l,5-anhydro-l-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol is disclosed to be usable
as an SGLT inhibitor for treatment of obesity and type 2 diabetes (Patent Document 8).
Moreover, its co-crystal with proline and its propylene glycol hydrate are also reported
(Patent Document 9). However, there is no disclosure about efficacy on the treatment of
fatty liver disease.
[0008] Patent Document 1: International Publication No. WO06/009149
Patent Document 2: International Publication No. WO02/080936
Patent Document 3: International Publication No. WO04/013118
Patent Document 4: International Publication No. WO07/007628
Patent Document 5: International Publication No. WO04/080990
Patent Document 6: International Publication No. WO05/012326
Patent Document 7: International Publication No. WO07/114475
Patent Document 8: International Publication No. WO03/099836
Patent Document 9: International Publication No. WO08/002824
DISCLOSURE OF THE INVENTION
[0009] The present invention provides a pharmaceutical composition, which comprises a
compound of formula (I) or a pharmaceutically acceptable salt thereof, i.e., (lS)-l,5-anhydro-
l-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt
thereof, (lS)-l,5-anhydro-l-[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitolor
a pharmaceutically acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-
(4-ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, and more
particularly provides such a pharmaceutical composition for treating fatty liver disease, such
as nonalcoholic fatty liver disease in one embodiment, or nonalcoholic simple fatty liver
and/or nonalcoholic steatohepatitis in another embodiment.

[0010] As a result of extensive and intensive studies on drugs for ameliorating fatty liver
disease, the inventors of the present invention have found that a compound of formula (I) or a
pharmaceutically acceptable salt thereof, i.e., (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-
hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, (1S)-1,5-anhydro-1-
[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof has an
improving effect on abnormal accumulation of triglycerides in the liver and exerts an
excellent therapeutic effect on fatty liver disease. This finding led to the completion of the
present invention.
[0011] Namely, the present invention provides the following.
[1] A pharmaceutical composition for treating fatty liver disease, which comprises a
compound of formula (I):
[0012] [Formula 1]

wherein R3 is azulen-2-yl, 1-benzothiophen-2-yl, or 4-ethoxyphenyl, provided that when R3
is azulen-2-yl, R1 is -OH and R2 is -H, when R3 is 1-benzothiophen-2-yl, R1 is -H and R2 is -F,
or when R3 is 4-ethoxyphenyl, R1 is -H and R2 is -Cl,
or a pharmaceutically acceptable salt thereof.
[2] The pharmaceutical composition according to [1], wherein the compound of formula
(I) or pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-
2-hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[3] The pharmaceutical composition according to [2], wherein the (1S)-1,5-anhydro-1-

[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or pharmaceutically acceptable salt
thereof is a choline salt of (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-
glucitol.
[4] The pharmaceutical composition according to [1], wherein the compound of formula
(I) or pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-
ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[5] The pharmaceutical composition according to [4], wherein the (1S)-1,5-anhydro-1-
[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or pharmaceutically acceptable
salt thereof is (1S)-1,5-anhydro-1-[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-
glucitol.
[6] The pharmaceutical composition according to [5], wherein the (1S)-1,5-anhydro-1-
[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol is a 1:1 molar ratio co-crystal of
(1S)-1,5-anhydro-1-[3-(l-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol and L-
proline.
[7] The pharmaceutical composition according to [1], wherein the compound of formula
(I) or pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[8] The pharmaceutical composition according to [7], wherein the (1S)-1,5-anhydro-1-
[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or pharmaceutically acceptable salt thereof
is(1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol.
[9] The pharmaceutical composition according to [8], wherein the (1S)-1,5-anhydro-1-
[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol is a 1:1 or 1:2 molar ratio co-crystal of (1S)-
l,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-proline, or is a
propylene glycol hydrate of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-
glucitol.
[10] The pharmaceutical composition according to any one of [1] to [9], wherein the fatty
liver disease is nonalcoholic fatty liver disease.
[11] The pharmaceutical composition according to any one of [1] to [9], wherein the fatty

liver disease is nonalcoholic simple fatty liver.
[12] The pharmaceutical composition according to any one of [1] to [9], wherein the fatty
liver disease is nonalcoholic steatohepatitis.
[13] A method for treating fatty liver disease, which comprises administering to a patient
an effective amount of a compound of formula (I):
[0013] [Formula 2]

wherein R3 is azulen-2-yl, l-benzothiophen-2-yl, or 4-ethoxyphenyl, provided that when R3
is azulen-2-yl, R1 is -OH and R2 is -H, when R3 is l-benzothiophen-2-yl, R1 is -H and R2 is -F,
or when R3 is 4-ethoxyphenyl, R1 is -H and R2 is -Cl,
or a pharmaceutically acceptable salt thereof.
[14] The method according to [13], wherein the compound of formula (I) or
pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-
hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[15] The method according to [14], wherein the (1S)-1,5-anhydro-1-[5-(azulen-2-
ylmethyl)-2-hydroxyphenyl]-D-glucitol or pharmaceutically acceptable salt thereof is a
choline salt of (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol.
[16] The method according to [13], wherein the compound of formula (I) or
pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-
ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[17] The method according to [16], wherein the (1S)-1,5-anhydro-1-[3-(1-
benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or pharmaceutically acceptable salt

thereof is (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol.
[18] The method according to [17], wherein the (1S)-1,5-anhydro-1-[3-(1-
benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol is a 1:1 molar ratio co-crystal of (1S)-
1,5 -anhydro-1 -[3-(1 -benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol and L-proline.
[19] The method according to [13], wherein the compound of formula (I) or
pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[20] The method according to [19], wherein the (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or pharmaceutically acceptable salt thereof is (1S)-1,5-
anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol.
[21] The method according to [20], wherein the (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol is a 1:1 or 1:2 molar ratio co-crystal of (1S)-1,5-anhydro-1-
[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-proline, or is a propylene glycol
hydrate of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol.
[22] The method according to any one of [13] to [21], wherein the fatty liver disease is
nonalcoholic fatty liver disease.
[23] The method according to any one of [13] to [21], wherein the fatty liver disease is
nonalcoholic simple fatty liver.
[24] The method according to any one of [13] to [21], wherein the fatty liver disease is
nonalcoholic steatohepatitis.
[25] Use of a compound of formula (I):
[0014] [Formula 3]

wherein R is azulen-2-yl, l-benzothiophen-2-yl, or 4-ethoxyphenyl, provided that when R
is azulen-2-yl, R1 is -OH and R2 is -H, when R3 is l-benzothiophen-2-yl, R1 is -H and R2 is -F,
or when R3 is 4-ethoxyphenyl, R1 is -H and R2 is -Cl,
or a pharmaceutically acceptable salt thereof for the manufacture of a pharmaceutical
composition for treating fatty liver disease.
[26] The use according to [25], wherein the compound of formula (I) or pharmaceutically
acceptable salt thereof is (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-
glucitol or a pharmaceutically acceptable salt thereof.
[27] The use according to [26], wherein the (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-
2-hydroxyphenyl]-D-glucitol or pharmaceutically acceptable salt thereof is a choline salt of
(1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol.
[28] The use according to [25], wherein the compound of formula (I) or pharmaceutically
acceptable salt thereof is (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-
fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
[29] The use according to [28], wherein the (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-
ylmethyl)-4-fluorophenyl]-D-glucitoI or pharmaceutically acceptable salt thereof is (1S)-1,5-
anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol.
[30] The use according to [29], wherein the (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-
ylmethyl)-4-fluorophenyl]-D-glucitol is a 1:1 molar ratio co-crystal of (1S)-1,5-anhydro-1-
[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol and L-proline.
[31] The use according to [25], wherein the compound of formula (I) or pharmaceutically
acceptable salt thereof is (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol
or a pharmaceutically acceptable salt thereof.
[32] The use according to [31], wherein the (1S)-1,5-anhydro-1-[4-chIoro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or pharmaceutically acceptable salt thereof is (1S)-1,5-
anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol.
[33] The use according to [32], wherein the (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol is a 1:1 or 1:2 molar ratio co-crystal of (1S)-1,5-anhydro-1-

[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-proline, or is a propylene glycol
hydrate of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol.
[34] The use according to any one of [25] to [33], wherein the pharmaceutical
composition for treating fatty liver disease is a pharmaceutical composition for treating
nonalcoholic fatty liver disease.
[35] The use according to any one of [25] to [33], wherein the pharmaceutical
composition for treating fatty liver disease is a pharmaceutical composition for treating
nonalcoholic simple fatty liver.
[36] The use according to any one of [25] to [33], wherein the pharmaceutical
composition for treating fatty liver disease is a pharmaceutical composition for treating
nonalcoholic steatohepatitis.
[0015] The present invention relates to a pharmaceutical composition, which comprises a
compound of formula (I) or a pharmaceutically acceptable salt thereof, i.e., (1S)-1,5-anhydro-
l-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt
thereof, (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or
a pharmaceutically acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-
(4-ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, and more
particularly relates to such a pharmaceutical composition for treating fatty liver disease, such
as nonalcoholic fatty liver disease in one embodiment, or nonalcoholic simple fatty liver
and/or nonalcoholic steatohepatitis in another embodiment. The pharmaceutical
composition of the present invention encompasses a therapeutic agent comprising a
compound of formula (I) or a pharmaceutically acceptable salt thereof, i.e., (1S)-1,5-anhydro-
l-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt
thereof, (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or
a pharmaceutically acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-
(4-ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, and more
particularly encompasses such a therapeutic agent for fatty liver disease, such as nonalcoholic
fatty liver disease in one embodiment, or nonalcoholic simple fatty liver and/or nonalcoholic

steatohepatitis in another embodiment.
[0016] The present invention also relates to the use of a compound of formula (I) or a
pharmaceutically acceptable salt thereof, i.e., (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-
hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, (1S)-1,5-anhydro-1-
[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof for the
manufacture of a pharmaceutical composition for treating fatty liver disease, such as
nonalcoholic fatty liver disease in one embodiment, or nonalcoholic simple fatty liver and/or
nonalcoholic steatohepatitis in another embodiment.
[0017] The present invention also relates to a method for treating fatty liver disease, such as
nonalcoholic fatty liver disease in one embodiment, or nonalcoholic simple fatty liver and/or
nonalcoholic steatohepatitis in another embodiment, which comprises administering to a
patient an effective amount of a compound of formula (I) or a pharmaceutically acceptable
salt thereof, i.e., (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or
a pharmaceutically acceptable salt thereof, (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-
ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, or
alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or a
pharmaceutically acceptable salt thereof.
[0018] The pharmaceutical composition, which comprises a compound of formula (I) or a
pharmaceutically acceptable salt thereof, i.e., (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-
hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, (1S)-1,5-anhydro-1-
[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, has an
improving effect on abnormal accumulation of triglycerides in the liver and can be used as a
pharmaceutical composition for treating fatty liver disease, such as nonalcoholic fatty liver
disease in one embodiment, or nonalcoholic simple fatty liver and/or nonalcoholic

steatohepatitis in another embodiment.
BRIEF DESCRIPTION OF THE DRAWINGS
[0019] Figure 1 shows the results evaluated for the pathology of inflammatory cell
infiltration (in MCD diet-fed rats). The median value for each evaluated group is indicated
by a horizontal line (-) in the figure. It should be noted that an asterisk (*) in the figure
indicates statistical significance over the second group.
Figure 2 shows the results evaluated for the pathology of hepatic fibrosis (in MCD
diet-fed rats). The median value for each evaluated group is indicated by a horizontal line (-
) in the figure. It should be noted that an asterisk (*) in the figure indicates statistical
significance over the second group.
Figure 3 shows the results evaluated for the pathology of hepatic fibrosis (in CDAA
diet-fed rats). The median value for each evaluated group is indicated by a horizontal line (-
) in the figure. It should be noted that an asterisk (*) in the figure indicates statistical
significance over the second group.
BEST MODE FOR CARRYING OUT THE INVENTION
[0020] The present invention will be described in more detail below.
As used herein, the term "fatty liver disease," which is also called fatty liver, is
intended to mean a disease leading to liver injury caused by abnormal fat accumulation in
liver cells, as described in the BACKGROUND ART section. Moreover, fatty liver disease
can be classified into alcoholic liver disease and nonalcoholic fatty liver disease. Diseases
falling within the scope of fatty liver disease in the context of the present invention are
summarized below.
[0021] Diseases falling within the scope of fatty liver disease include:
(1) Alcoholic liver disease (also called alcoholic liver injury): a disease caused by fat
accumulation in liver cells as a result of alcohol ingestion. Examples include diseases such
as alcoholic simple fatty liver, alcoholic steatohepatitis (ASH), alcoholic hepatic fibrosis,
alcoholic cirrhosis and so on. It should be noted that alcoholic steatohepatitis is also called
alcoholic fatty hepatitis and includes alcoholic hepatic fibrosis.

(2) Nonalcoholic fatty liver disease: a disease with fat deposition in the liver, which
occurs in patients whose alcohol ingestion is not enough to cause liver injury, except for
cases of known etiology, such as viral hepatitis and autoimmune hepatitis. Examples
include diseases such as nonalcoholic simple fatty liver, nonalcoholic steatohepatitis (NASH),
nonalcoholic hepatic fibrosis, nonalcoholic cirrhosis and so on.
(2-1) Nonalcoholic simple fatty liver: a disease only with fat deposition in liver cells.
(2-2) Nonalcoholic steatohepatitis (NASH): a disease with liver fatty change, along with
inflammation, liver cell necrosis, ballooning and fibrosis, similarly to the case of alcoholic
steatohepatitis, and also including nonalcoholic hepatic fibrosis.
(2-2-1) Nonalcoholic hepatic fibrosis: a disease with advanced fibrosis in liver tissues, along
with excessive production and accumulation of collagen and other extracellular matrix
components.
(2-3) Nonalcoholic cirrhosis: a disease with reconstructed hepatic lobule structure as a
result of advanced fibrosis.
[0022] Among compounds of formula (I), each serving as an active ingredient in the
pharmaceutical composition of the present invention, a compound in which R3 is azulen-2-yl,
i.e., (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol (hereinafter
also referred to as Compound A) or a pharmaceutically acceptable salt thereof can be easily
obtained, for example, as described in Patent Document 3 (supra) or in a manner obvious to
those skilled in the art or according to modified methods thereof.
[0023] Likewise, among compounds of formula (I), each serving as an active ingredient in
the pharmaceutical composition of the present invention, a compound in which R3 is 1-
benzothiophen-2-yl, i.e., (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-
fluorophenyl]-D-glucitol (hereinafter also referred to as Compound B) or a pharmaceutically
acceptable salt thereof can be easily obtained, for example, as described in Patent Document

3
the pharmaceutical composition of the present invention, a compound in which R is 4-
ethoxyphenyl, i.e., (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol
(hereinafter also referred to as Compound C) or a pharmaceutically acceptable salt thereof
can be easily obtained, for example, as described in Patent Document 8 (supra) or in a
manner obvious to those skilled in the art or according to modified methods thereof.
[0025] The structural formulae of Compounds A, B and C are shown below.
[0026] [Formula 4]

(wherein Et represents an ethyl group)
[0027] As used herein, the term "pharmaceutically acceptable salt" is intended to mean an
acid addition salt or a salt with a base, for example as described in Patent Document 3 or 5
(supra). Specific examples include acid addition salts with mineral acids (e.g., hydrochloric
acid, hydrobromic acid, hydroiodic acid, sulfuric acid, nitric acid, phosphoric acid), organic

acids (e.g., formic acid, acetic acid, propionic acid, oxalic acid, malonic acid, succinic acid,
fumaric acid, maleic acid, lactic acid, malic acid, tartaric acid, citric acid, methanesulfonic
acid, ethanesulfonic acid) or acidic amino acids (e.g., aspartic acid, glutamic acid); salts with
inorganic bases (e.g., sodium, potassium, magnesium, calcium, aluminum), organic bases
(e.g., methylamine, ethylamine, ethanolamine) or basic amino acids (e.g., lysine, ornithine);
as well as ammonium salt, etc.
With respect to "(1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-
glucitol or a pharmaceutically acceptable salt thereof," another embodiment includes a
choline salt of (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol, as
described in Patent Document 4 (supra).
[0028] Moreover, "compounds of formula (I) or pharmaceutically acceptable salts thereof
may be present in any form, i.e., various hydrates, solvates, crystalline polymorphic
substances or co-crystals, all of which fall within the scope of the active ingredient in the
pharmaceutical composition of the present invention. With respect to "(1S)-1,5-anhydro-1-
[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof," another embodiment includes a co-crystal of (1S)-1,5-anhydro-1-[3-
(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol and L-proline (at 1:1 molar ratio),
as described in Patent Document 7 (supra). With respect to "(1S)-1,5-anhydro-1-[4-chloro-
3-(4-ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof," another
embodiment includes the forms as described in Patent Document 9 (supra), for example, a
co-crystal of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-
proline (at 1:1 molar ratio (Compound Ii in Patent Document 9) or at 1:2 molar ratio
(Compound Ih in Patent Document 9)), and yet another embodiment includes a propylene
glycol hydrate of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol
(Compounds Ia and Ib in Patent Document 9) and so on. The present invention also
encompasses pharmaceutical compositions comprising the compounds labeled with various
radioactive or non-radioactive isotopes.
[0029] Furthermore, "compounds of formula (I)" encompass pharmaceutically acceptable

prodrugs thereof. The term "pharmaceutically acceptable prodrug" refers to a compound
having a group which can be converted into a hydroxyl group or the like by solvolysis or
under physiological conditions. Examples of a prodrug-forming group include those
described in Prog. Med., 5, 2157-2161 (1985) or those described in "Development of
Pharmaceuticals" (Hirokawa Publishing, 1990) vol. 7, Molecular Design 163-198.
[0030] Some embodiments of the present invention will be given below.
[0031] (1) A pharmaceutical composition, which comprises a compound of formula (I) or a
pharmaceutically acceptable salt thereof, a therapeutic method, which comprises
administering to a patient an effective amount of a compound of formula (I) or a
pharmaceutically acceptable salt thereof, or the use of a compound of formula (I) or a
pharmaceutically acceptable salt thereof for the manufacture of a pharmaceutical composition,
wherein the compound of formula (I) is a compound in which R1 is -OH, R2 is -H and R3 is
azulen-2-yl; a compound in which R is -H, R is -F and R is l-benzothiophen-2-yl in

another embodiment; or a compound in which R1 is -H, R2 is -Cl and R3 is 4-ethoxyphenyl in
yet another embodiment.
(2) A pharmaceutical composition, which comprises a compound of formula (I) or a
pharmaceutically acceptable salt thereof, a therapeutic method, which comprises
administering to a patient an effective amount of a compound of formula (I) or a
pharmaceutically acceptable salt thereof, or the use of a compound of formula (I) or a
pharmaceutically acceptable salt thereof for the manufacture of a pharmaceutical composition,
wherein the compound of formula (I) or pharmaceutically acceptable salt thereof is (1S)-1,5-
anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof; a choline salt of (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-
hydroxyphenyl]-D-glucitol in another embodiment; (1S)-1,5-anhydro-1-[3-(1-benzothiophen-
2-ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt thereof in yet
another embodiment; (1S)-1,5-anhydro-1 -[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-
D-glucitol in yet another embodiment; a co-crystal (1:1 molar ratio) of (1S)-1,5-anhydro-1-
[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol and L-proline in yet another

embodiment; (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or a
pharmaceutically acceptable salt thereof in yet another embodiment; (1S)-1,5-anhydro-1-[4-
chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol in yet another embodiment; a co-crystal (1:1
molar ratio) of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-
proline in yet another embodiment; a co-crystal (1:2 molar ratio) of (1S)-1,5-anhydro-1-[4-
chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-proline in yet another embodiment; or a
propylene glycol hydrate of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-
glucitol in yet another embodiment.
(3) A pharmaceutical composition for treating fatty liver disease, a method for treating
fatty liver disease, or use for the manufacture of a pharmaceutical composition for treating
fatty liver disease, wherein the fatty liver disease is nonalcoholic fatty liver disease;
nonalcoholic simple fatty liver in another embodiment; nonalcoholic steatohepatitis in yet
another embodiment; nonalcoholic hepatic fibrosis in yet another embodiment; or
nonalcoholic cirrhosis in yet another embodiment.
(4) A pharmaceutical composition, a therapeutic method, or use, which comprises a
combination of two or more of (1) to (3) above.
[0032] A pharmaceutical preparation based on the pharmaceutical composition of the
present invention can be prepared in a conventional manner by using a compound of formula
(I) or a pharmaceutically acceptable salt thereof and a pharmaceutical carrier, a
pharmaceutical excipient or other additives commonly used for formulation purposes. Any
mode of administration may be used, either oral administration in the dosage form of tablets,
pills, capsules, granules, powders, solutions or the like, or parenteral administration in the
dosage form of injections (e.g., intravenous or intramuscular injections) or suppositories or
by the transnasal, transmucosal, percutaneous or other routes.
[0033] Solid compositions used for oral administration according to the present invention
include tablets, powders, granules, etc. In these solid compositions, a compound of fonnula
(I) or a pharmaceutically acceptable salt thereof is mixed with at least one inert diluent, for
example, lactose, mannitol, glucose, hydroxypropylcellulose, microcrystalline cellulose,

starch, polyvinylpyrrolidone, magnesium aluminometasilicate or the like. The compositions
may also comprise additives in addition to the inert diluent(s), as exemplified by lubricants
(e.g., magnesium stearate), disintegrants (e.g., calcium carboxymethyl cellulose), stabilizers,
solubilizers and so on, as in the usual cases. Tablets or pills may optionally be coated with
sugar coating or a gastric or enteric film, as exemplified by sucrose, gelatin, hydroxypropyl
cellulose, hydroxypropyl methylcellulose phthalate or the like.
[0034] Liquid compositions for oral administration include pharmaceutically acceptable
emulsions, solutions, suspensions, syrups, elixirs, etc., and comprise commonly-used inert
diluents such as purified water or ethanol. These compositions may comprise, in addition to
the inert diluents, auxiliaries (e.g., wetting agents, suspending agents), sweeteners, flavors,
aromatics, and/or antiseptics.
Injections for parenteral administration comprise sterile aqueous or non-aqueous
solutions, suspensions or emulsions. Examples of aqueous solutions or suspensions include
injectable distilled water and physiological saline. Examples of non-aqueous solutions or
suspensions include propylene glycol, polyethylene glycol, vegetable oils (e.g., olive oil),
alcohols (e.g., EtOH), Polysorbate 80, etc. These compositions may further comprise
auxiliaries such as antiseptics, wetting agents, emulsifiers, dispersants, stabilizers and/or
solubilizers. They are sterilized, for example, by filtration through a bacteria-retaining filter,
by incorporation with disinfectants or by irradiation. Alternatively, they may be formulated
into sterile solid compositions and reconstituted for use by being dissolved in sterile water or
a sterile injectable solvent before use.
[0035] Formulations for external use include ointments, plasters, creams, jellies, cataplasms,
sprays, lotions, eye drops, eye ointments, etc. They comprise commonly-used ointment
bases, lotion bases, aqueous or non-aqueous solutions, suspensions, emulsions or the like.
Examples of ointment or lotion bases include polyethylene glycol, propylene glycol, white
petrolatum, white beeswax, polyoxyethylene hydrogenated castor oil, glycerine monostearate,
stearyl alcohol, cetyl alcohol, Lauromacrogol, sorbitan sesquioleate and so on.
[0036] Transmucosal formulations such as inhalants or transnasal formulations are used in

solid, liquid or semi-solid form and can be prepared in a conventionally known manner. For
example, such formulations may be supplemented as appropriate with known excipients and
further with pH adjustors, antiseptics, surfactants, lubricants, stabilizers, thickeners and so on.
For their administration, an appropriate device for inhalation or insufflation may be used.
For example, using a known device (e.g., a metered-dose inhalation device) or a nebulizer,
each compound may be administered alone or as a powder of a formulated mixture or as a
solution or suspension in combination with a pharmaceutically acceptable carrier. Dry
powder inhalators or the like may be for single or multiple administration use, and dry
powders or powder-containing capsules may be used in such devices. Alternatively, they
may be in the form of pressurized aerosol sprays which use an appropriate propellant, for
example, a preferred gas such as chlorofluoroalkane, hydrofluoroalkane or carbon dioxide.
[0037] In general, for oral administration, the daily dosage is desirably about 0.001 to
100 mg/kg, preferably 0.1 to 30 mg/kg, and more preferably 0.1 to 10 mg/kg body weight,
given as a single dose or in 2 to 4 divided doses. For intravenous administration, the daily
dosage is desirably about 0.0001 to 10 mg/kg body weight, given in one or several doses per
day. Likewise, for transmucosal formulations, the daily dosage is about 0.001 to 100 mg/kg
body weight, given in one or several doses per day. The dosage may be determined as
appropriate for each case in consideration of symptom, age, sex and so on.
[0038] It should be noted that a pharmaceutical preparation based on the pharmaceutical
composition of the present invention can be used in combination with other drugs which are
used for treatment of fatty liver disease. For example, drugs which can be used in
combination with this pharmaceutical preparation include biguanides (e.g., metformin),
thiazolidine derivatives (e.g., pioglitazone hydrochloride), a-glucosidase inhibitors (e.g.,
voglibose), insulin secretagogues (e.g., nateglinide), vitamins, eicosapentaenoic acid (EPA),
betaine, N-acetylcysteine (NAC), fibrate drugs (e.g., bezafibrate), HMG-CoA reductase
inhibitors (e.g., atorvastatin), probucol, ursodeoxycholic acid (UDCA), taurine, stronger neo-
minophagen C, polyenephosphatidylcholine, angiotensin II receptor antagonists (e.g.,
losartan) or bofutsushosan (oriental herbal medicine), etc. In such combination use, drugs

may be administered simultaneously or separately in succession or at desired time intervals.
Formulations for simultaneous administration may be in either mixed or separate form.
EXAMPLES
[0039] Example 1:
Effect on nonalcoholic simple fatty liver model (KK-Ay mice) (1)
[0040]
KK-Ay mice (female, purchased from CLEA Japan, Inc.) were used. The mice
were fed with CMF (for special breeding, purchased from Oriental Yeast Co., Ltd., Japan) ad
libitum. At 14 weeks of age, they were measured for their body weight, blood glucose
levels, plasma insulin levels, plasma triglyceride levels and plasma alanine aminotransferase
(ALT), and then divided into two groups such that these items were equal between the groups
(8 animals per group). The first group was administered with vehicle (0.5%
methylcellulose) at a dose of 10 mL/kg, and the second group was administered with a
choline salt of (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol (i.e.,
a choline salt of Compound A) at a dose of 3 mg/kg (calculated as Compound A), each being
administered orally once a day for 2 weeks. On the day following the final administration,
the liver was collected from each mouse under ether anesthesia, frozen in liquid nitrogen and
then stored at -80°C.
[0041] Liver triglyceride content was measured in the following manner.
1. A portion (50 to 150 mg) of each liver frozen and stored at -80°C was taken to an
Assist tube.
2. After addition of methanol (2 mL), the liver sample was homogenized with a
POLYTRON (KINEMATICA).
3. To the homogenate, chloroform (4 mL) was added and vigorously stirred at room
temperature for 10 minutes.
4. Milli-Q water (1 mL) was further added and vigorously stirred.
5. The sample was centrifuged in a low speed centrifuge (Hitachi, Ltd., Japan)
(2,500 rpm, 5 min, room temperature).

6. A portion of the lower layer (total volume: 4.5 mL) was taken to an Eppendorf tube
and evaporated in a centrifugal evaporator (Sakuma Seisakusho, Japan) to remove the solvent.
7. The residue in the Eppendorf tube was dissolved again by addition of ethanol
(10 µL).
8. Triglyceride E-Test Wako reagent (1 mL, Wako Pure Chemical Industries, Ltd.,
Japan) was added to the resulting solution, and triglycerides were quantified.
9. From the result obtained above, the triglyceride content per g of liver was calculated
for each sample. The data were expressed as mean ± standard error.
[0042]
The results obtained are as shown in Table 1. In comparison with normal mice
whose liver triglyceride content is 5 to 10 (mg/g liver), KK-Ay mice have a higher liver
triglyceride content and can be diagnosed as having fatty liver. Upon administration of
Compound A, the liver triglyceride content in KK-Ay mice was significantly improved.
This result indicates that Compound A is useful as a therapeutic agent for nonalcoholic
simple fatty liver.
[0043] [Table 1]

* indicates statistical significance over the first group.
[0044] Example 2:
Effect on nonalcoholic simple fatty liver model (KK-Ay mice) (2)
[0045]
The test was conducted in the same manner as shown in Example 1, except that this
test was conducted with 3 groups of 8 animals, and the first group was administered with
vehicle (0.5% methylcellulose) at a dose of 10 mL/kg, the second group was administered

with a co-crystal (1:1 molar ratio) of (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-
fluorophenyl]-D-glucitol (Compound B) and L-proline at a dose of 3 mg/kg (calculated as
Compound B), and the third group was administered with a control compound, 2-(4-
methoxybenzyl)phenyl 6-O-ethoxycarbonyl-pVD-glucopyranoside (hereinafter also referred
to as Compound X, whose structural formula is shown below) disclosed in Patent Document
1 (supra) at a dose of 36 mg/kg, each being administered orally once a day for 2 weeks.
Then, the liver triglyceride content was measured for each group in the same manner as
shown in Example 1.
[0046] [Formula 5]

(wherein Me represents a methyl group, and Et represents an ethyl group)
[0047]
The results obtained are as shown in Table 2. Although KK-Ay mice had fatty liver,
as in the case of Example 1, their liver triglyceride content was significantly improved upon
administration of Compound B. This result indicates that Compound B is useful as a
therapeutic agent for nonalcoholic simple fatty liver.
In contrast, Compound X showed no significant effect in spite of being administered
at a dose 10-fold or higher than that of Compound B.
[0048]

[Table 2]
* indicates statistical significance over the first group.
[0049] Example 3:
Effect on nonalcoholic simple fatty liver model (KK-Ay mice) (3)
[0050]
The test was conducted in the same manner as shown in Example 1, except that this
test was conducted with 3 groups of 8 animals, and the first group was administered with
vehicle (0.5% methylcellulose) at a dose of 10 mL/kg, the second group was administered
with a co-crystal (1:1 molar ratio) of Compound B and L-proline at a dose of 3 mg/kg
(calculated as Compound B), and the third group was administered with a control compound,
T-1095 disclosed in Patent Document 2 (supra), i.e., 3-(benzo[b]furan-5-yl)-2',6'-dihydroxy-
4'-methylpropiophenone 2'-0-(6-0-methoxycarbonyI)-(3-D-gIucopyranoside (hereinafter also
referred to as Compound Y, whose structural formula is shown below) at a dose of 34 mg/kg,
each being administered orally once a day for 2 weeks. Then, the liver triglyceride content
was measured for each group in the same manner as shown in Example 1.
[0051] [Formula 6]


(wherein Me represents a methyl group)
[0052]
The results obtained are as shown in Table 3. Although KK-Ay mice had fatty liver,
as in the case of Example 1, their liver triglyceride content was significantly improved upon
administration of Compound B.
In contrast, Compound Y showed no significant effect in spite of being administered
at a dose 10-fold or higher than that of Compound B.
[0053] [Table 3]
* indicates statistical significance over the first group.
[0054] Example 4:
Effect on nonalcoholic steatohepatitis model (methionine/choline-deficient diet (MCD diet)-
fed rats) (1)
[0055]
This test was conducted by reference to a document (J Hepatol., 2003, 39, 756-764).
Wistar rats (male, purchased from Charles River Japan, Inc.) were used. The rats were fed
with MCD diet (methionine/choline-deficient diet, MP Biochemicals) or normal control diet
(methionine/choline control diet, MP Biochemicals) ad libitum. At 9 weeks of age, they
were measured for their body weight and divided into groups of equal body weight, followed
by initiation of the test (10 animals per group). The first group was fed with normal control
diet and administered with vehicle (0.5% methylcellulose) at a dose of 5 mL/kg. The
second and third groups were fed with MCD diet, and the second group was administered
with vehicle (0.5% methylcellulose) at a dose of 5 mL/kg, while the third group was

administered with a co-crystal (1:1 molar ratio) of Compound B and L-proline at a dose of
3 mg/kg (calculated as Compound B). Each drug was administered orally once a day for
16 weeks. On the day following the final administration, the liver was collected from each
rat under ether anesthesia and a portion of the liver was fixed in 10% neutral buffered
formalin. Paraffin sections (3 µm) were prepared in a standard manner and subjected to HE
staining and van Gieson staining. The HE-stained specimens were used for evaluation of
inflammatory lesions, while the van Gieson-stained specimens were used for evaluation of
fibrosis. Evaluation was made by reference to the NASH activity score (NAS) for
inflammatory lesions and to the Brunt classification for fibrosis (Clinical Practice Guidelines
for NASH/NAFLD, edited by the Japan Society of Hepatology, 2006), based on a five-point
scale of 0,1, 2, 3 and 4 (see Table 4). In Table 4, it should be noted that a visual field at
"200-fold magnification" corresponds to the 1/4 area of a visual field at "100-fold
magnification."
[0056] [Table 4]
[0057]
The results obtained are as shown in Figures 1 and 2. The rats fed with MCD diet
showed significant increases in the pathological scores of inflammatory cell infiltration and
hepatic fibrosis over the rats fed with normal control diet, thus indicating that they had the

condition of nonalcoholic steatohepatitis. Upon administration of Compound B, the
pathological scores of inflammatory cell infiltration and hepatic fibrosis in this model were
significantly improved. This result indicates that Compound B is useful as a therapeutic
agent for nonalcoholic steatohepatitis.
[0058] Example 5:
Effect on nonalcoholic steatohepatitis model (choline-deficient L-amino acid-defined diet
(CDAA diet)-fed rats) (1)
[0059]
This test was conducted by reference to a document (Biochem Biophys Res
Commun., 2004, 315(1), 187-195). Wistar rats (male, purchased from Charles River Japan,
Inc.) were used. The rats were fed with CDAA diet (choline-deficient L-amino acid-defined
diet (Choline Deficient and Iron Supplemented L-Amino Acid Defined Rat Diet, Dyets)) or
normal control diet (Choline and Iron Supplemented L-Amino Acid Defined Rat Diet, Dyets)
ad libitum. At 9 weeks of age, they were measured for their body weight and divided into
groups of equal body weight, followed by initiation of the test (10 animals per group). The
first group was fed with normal control diet and administered with vehicle (0.5%
methylcellulose) at a dose of 5 mL/kg. The second and third groups were fed with CDAA
diet, and the second group was administered with vehicle (0.5% methylcellulose) at a dose of
5 mL/kg, while the third group was administered with a co-crystal (1:1 molar ratio) of
Compound B and L-proline at a dose of 3 mg/kg (calculated as Compound B). Each drug
was administered orally once a day for 5 weeks. On the day following the final
administration, the liver was collected from each rat under ether anesthesia. After a portion
of the liver was fixed in 10% neutral buffered formalin, paraffin sections (3 urn) were
prepared in a standard manner and subjected to van Gieson staining. Fibrosis was evaluated
by reference to the Brunt classification (Clinical Practice Guidelines for NASH/NAFLD,
edited by the Japan Society of Hepatology, 2006), based on a five-point scale of 0,1, 2, 3 and
4 (see Table 4).
[0060]

The results obtained are as shown in Figure 3. The rats fed with CDAA diet
showed a significant increase in the pathological score of hepatic fibrosis over the rats fed
with normal control diet, thus indicating that they had the condition of nonalcoholic
steatohepatitis. Upon administration of Compound B, the pathological score of hepatic
fibrosis in this model was significantly improved. This result indicates that Compound B is
useful as a therapeutic agent for nonalcoholic steatohepatitis.
[0061] Example 6:
Effect on nonalcoholic simple fatty liver model (KK-Ay mice) (4)
[0062]
The test was conducted in the same manner as shown in Example 1. The first
group was administered with vehicle (0.5% mefhylcellulose) at a dose of 10 mL/kg, and the
second group was administered with (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol (Compound C) at a dose of 3 mg/kg, each being
administered orally once a day for 2 weeks. Then, the liver triglyceride content was
measured for each group in the same manner as shown in Example 1.
[0063]
The results obtained are as shown in Table 5. Although KK-Ay mice had fatty liver,
as in the case of Example 1, their liver triglyceride content was significantly improved upon
administration of Compound C. This result indicates that Compound C is useful as a
therapeutic agent for nonalcoholic simple fatty liver.
[0064] [Table 5]
* indicates statistical significance over the first group.
[0065] Example 7:

Effect on nonalcoholic steatohepatitis model (methionine/choline-deficient diet (MCD diet)-
fed rats) (2)
[0066]
(1S)-1,5-Anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or a
pharmaceutically acceptable salt thereof, which serves as an active ingredient in the
pharmaceutical composition of the present invention, can also be confirmed for its effect by
being tested in the same manner as shown in Example 4.
[0067] Example 8:
Effect on nonalcoholic steatohepatitis model (choline-deficient L-amino acid-defined diet
(CDAA diet)-fed rats) (2)
[0068]
(1S)-1,5-Anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or a
pharmaceutically acceptable salt thereof, which serves as an active ingredient in the
pharmaceutical composition of the present invention, can also be confirmed for its effect by
being tested in the same manner as shown in Example 5.
[0069] Example 9:
Effect on nonalcoholic steatohepatitis model (methionine/choline-deficient diet (MCD diet)-
fed rats) (3)
[0070]
(1S)-1,5-Anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a
pharmaceutically acceptable salt thereof, which serves as an active ingredient in the
pharmaceutical composition of the present invention, can also be confirmed for its effect by
being tested in the same manner as shown in Example 4.
[0071] Example 10:
Effect on nonalcoholic steatohepatitis model (choline-deficient L-amino acid-defined diet
(CDAA diet)-fed rats) (3)
[0072]
(1S)-1,5-Anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a

pharmaceutically acceptable salt thereof, which serves as an active ingredient in the
pharmaceutical composition of the present invention, can also be confirmed for its effect by
being tested in the same manner as shown in Example 5.
[0073] The above results indicated that upon administration of compounds of formula (I) or
pharmaceutically acceptable salts thereof, each serving as an active ingredient in the
pharmaceutical composition of the present invention, abnormal accumulation of triglycerides
in the liver (simple fatty liver) was improved and further the condition of nonalcoholic
steatohepatitis (inflammation and fibrosis) caused by abnormal accumulation of triglycerides
in the liver was also improved. In general, alcoholic liver disease and nonalcoholic fatty
liver disease have very similar histopathological features in each condition of simple steatosis,
steatohepatitis (including hepatic fibrosis) and cirrhosis in fatty liver disease, and are
expected to have a common pathological mechanism. Thus, it is evident that the
pharmaceutical compositions of the present invention are useful as therapeutic agents for
fatty liver disease. Moreover, the compounds of formula (I) or pharmaceutically acceptable
salts thereof were confirmed to have a higher improving effect on abnormal accumulation of
triglycerides in the liver than the compounds (Compound X and Compound Y) disclosed in
Patent Documents 1 and 2 (supra). This result suggests that the compounds of formula (I)
or pharmaceutically acceptable salts thereof can also be expected to have a higher effect on
nonalcoholic steatohepatitis than the compounds (Compound X and Compound Y) disclosed
in Patent Documents 1 and 2 (supra).
INDUSTRIAL APPLICABILITY
[0074] A pharmaceutical composition, which comprises a compound of formula (I) or a
pharmaceutically acceptable salt thereof, i.e., (1S)-1,5-anhydro-1-[5-(azuIen-2-ylmethyl)-2-
hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, (1S)-2,5-anhydro-2-
[3-(1-benzothiophen-2-ylmethyI)-4-fluorophenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof, or alternatively, (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, has an
improving effect on abnormal accumulation of triglycerides in the liver and can be used as a

pharmaceutical composition for treating fatty liver disease, such as nonalcoholic fatty liver
disease in one embodiment, or nonalcoholic simple fatty liver and/or nonalcoholic
steatohepatitis in another embodiment.

We Claim:
1. A pharmaceutical composition for treating fatty liver disease, which comprises a
compound of formula (I):
[Formula 1]

wherein R3 is azulen-2-yl, l-benzothiophen-2-yl, or 4-ethoxyphenyl, provided that when R3
is azulen-2-yl, R1 is -OH and R2 is -H, when R3 is l-benzothiophen-2-yl, R1 is -H and R2 is -F,
or when R3 is 4-ethoxyphenyl, R1 is -H and R2 is -Cl,
or a pharmaceutically acceptable salt thereof.
2. The pharmaceutical composition according to claim 1, wherein the compound of
formula (I) or pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[5-(azuien-2-
ylmethyl)-2-hydroxyphenyl]-D-glucitol or a pharmaceutically acceptable salt thereof,
3. The pharmaceutical composition according to claim 2, wherein the (1S)-1,5-
anhydro-1 -[5-(azulen-2-ylmethyl)-2-hydroxyphenyl] -D-glucitol or pharmaceutically
acceptable salt thereof is a choline salt of (1S)-1,5-anhydro-1-[5-(azulen-2-ylmethyl)-2-
hydroxyphenyl] -D-glucitol.
4. The pharmaceutical composition according to claim 1, wherein the compound of
formula (I) or pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[3-(1-
benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt
thereof.
5. The pharmaceutical composition according to claim 4, wherein the (1S)-1,5-

anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol or pharmaceutically
acceptable salt thereof is (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-
fluorophenyl]-D-glucitol.
6. The pharmaceutical composition according to claim 5, wherein the (1S)-1,5-
anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-glucitol is a 1:1 molar ratio
co-crystal of (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-fluorophenyl]-D-
glucitol and L-proline.
7. The pharmaceutical composition according to claim 1, wherein the compound of
formula (I) or pharmaceutically acceptable salt thereof is (1S)-1,5-anhydro-1-[4-chloro-3-(4-
ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically acceptable salt thereof.
8. The pharmaceutical composition according to claim 7, wherein the (1S)-1,5-
anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or pharmaceutically acceptable
salt thereof is (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol.
9. The pharmaceutical composition according to claim 8, wherein the (1S)-1,5-
anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol is a 1:1 or 1:2 molar ratio co-
crystal of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol and L-proline,
or is a propylene glycol hydrate of (1S)-1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-
D-glucitol.
10. The pharmaceutical composition according to any one of claims 1 to 9, wherein the
fatty liver disease is nonalcoholic fatty liver disease.
11. The pharmaceutical composition according to any one of claims 1 to 9, wherein the
fatty liver disease is nonalcoholic simple fatty liver.
12. The pharmaceutical composition according to any one of claims 1 to 9, wherein the
fatty liver disease is nonalcoholic steatohepatitis.

The present invention provides a pharmaceutical composition useful as a therapeutic
agent for fatty liver disease. A pharmaceutical composition, which comprises (1S)-1,5-
anhydro-1-[5-(azulen-2-ylmethyl)-2-hydroxyphenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof, (1S)-1,5-anhydro-1-[3-(1-benzothiophen-2-ylmethyl)-4-
fluorophenyl]-D-glucitol or a pharmaceutically acceptable salt thereof, or alternatively, (1S)-
1,5-anhydro-1-[4-chloro-3-(4-ethoxybenzyl)phenyl]-D-glucitol or a pharmaceutically
acceptable salt thereof, more specifically such a pharmaceutical composition for treating fatty
liver disease, such as nonalcoholic fatty liver disease in one embodiment, or nonalcoholic
simple fatty liver and/or nonalcoholic steatohepatitis in another embodiment.