HK1129681B - Macrolide-conjugates with anti-inflammatory activity - Google Patents

Description

Priority Claim: This Application claims priority to Croatian patent application HR P20030324 filed April 24, 2003 .

Summary of the Invention

The present invention relates to: a) a new compound having the structure: b) its pharmacologically acceptable salts and solvates; c) intermediates for its preparation and d) its activity and use in the treatment of inflammatory diseases and conditions in humans and animals.

Background of the Invention

Anti-inflammatory medicaments can be classified into those of steroid and of nonsteroidal type. Steroid anti-inflammatory compounds are still the most effective ones in the treatment of inflammatory diseases and conditions such as: asthma, chronic obstructive pulmonary disease, inflammatory nasal diseases such as allergic rhinitis, nasal polyps, intestinal diseases such as Crohn's disease, colitis, ulcerative colitis, dermatological inflammations such as eczema, psoriasis, allergic dermatitis, neurodermatitis, pruritis, conjunctivitis and rheumatoid arthritis. In addition to excellent potency and effectiveness, medicaments of this type also possess numerous unfavourable side-effects, (e.g. disturbance of carbohydrate metabolism, decreased calcium resorption, decreased excretion of endogenous corticosteroids and disturbance of physiological functions of the pituitary gland, adrenal cortex and thymus. Steroids present on the market are highly effective against inflammatory conditions and processes whereas their systemic side-effects are diminished. Patent applications WO 94/13690 ; 94/14834 ; 92/13872 and 92/13873 describe the so-called "soft" steroids or hydrolysable corticosteroids designed for topical application at the inflammation site, whereas their systemic side-effects are diminished due to the hydrolysis in the serum, wherein the active steroid very rapidly hydrolyses into the inactive form. An ideal steroid, however, without unfavourable effects in a long-term and continuous treatment as required for the control of diseases such as asthma or Crohn's disease has yet to be found, so that there are intense efforts on the discovery and development of steroids with improved therapeutic profile.

Macrolide antibiotics accumulate preferentially within different cells of subjects, especially within phagocyte cells such as mononuclear peripheral blood cells, and peritoneal and alveolar macrophages. (Gladue, R. P. et al, Antimicrob. Agents Chemother. 1989, 33, 277-282; Olsen, K. M. et al, Antimicrob. Agents Chemother. 1996, 40, 2582-2585). Anti-inflammatory effects of some macrolides have been described in the literature, although their effects are relatively weak. For example, the anti-inflammatory effect of erythromycin derivatives (J. Antimicrob. Chemother. 1998, 41, 37-46; WO Patent Application No. 00/42055 ) and azithromycin derivatives has been described ( EP Pat. Br. 0283055 ). Anti-inflammatory effects of some macrolides are also known from in vitro and in vivo studies in experimental animal models such as in zymosan-induced peritonitis in mice (J. Antimicrob. Chemother. 1992, 30, 339-348) and endotoxin-induced neutrophil accumulation in rat trachea (J. Immunol. 1997, 159, 3395-4005). The modulating effect of macrolides upon cytokines such as interleukin 8 (IL-8) (Am. J. Respir. Crit. Care. Med. 1997, 156, 266-271) and interleukin 5 (IL-5) ( EP Pat. Br. 0775489 and EP Pat. Br. 771564 ) is known as well.

HR Patent Application No. 20010018 , WO 04/005309 , WO 04/005310 and WO 02/055531 herein incorporated by reference in their entireties describe compounds of the form: wherein M represents a macrolide subunit possessing the property of accumulation in inflammatory cells, A represents an anti-inflammatory subunit which can be steroid or nonsteroidal and L represents a chain linking M and A, and improved therapeutic action of these compounds in the treatment of inflammatory diseases and conditions. The macrolide portion of the conjugate has always one or two sugar moieties.

Compounds in which the steroid or nonsteroidal subunit are linked to the macrolide subunit, via the macrolide nitrogen having only the aglycone moiety, without sugar substituents either in C/3 or C/5 position, also possessing the earlier mentioned therapeutic action, have hitherto not been described.

Detailed Description of the Invention

A characteristic of compounds represented by the compound of the invention is selective accumulation in target organs and cells in the above mentioned inflammatory diseases and conditions. These pharmacokinetic properties enable the compounds represented by the compound of the invention to act at the inflammation site in inflammation cells by inhibiting the production of inflammation mediators. In such a manner, the unfavourable systemic side-effects of corticosteroids or nonsteroidal anti-inflammatory molecules are avoided and the therapeutic action of either the steroid or the NSAID moiety is targeted to the area where it is most needed. Following local or systemic application molecules rapidly accumulate in inflammation cells wherein they act by inhibiting the production of cytokines and chemokines and/or other inflammatory mediators thus suppressing the inflammation.

According to the known and established state of the art, the compound of the invention, its pharmacologically acceptable salts, pharmaceutical compositions comprising it, and processes for making it have hitherto not been described. The compound of the invention has not been described either as anti-inflammatory substance or as an inhibitor of eosinophilic accumulation in inflammation tissues. In one aspect, the present invention relates to:

1. a) a compound having the structure:

In yet another aspect of the invention pharmaceutical compositions comprising a compound of the invention and pharmaceutically acceptable salts or solvates thereof including pharmaceutically acceptable diluent or carrier are contemplated. Examples include but are not limited to carboxymethylcellulose and salts thereof, polyacrylic acid and salts thereof, carboxyvinyl polymers and salts thereof, alginic acid and salts thereof, propylene glycol alginate, chitosan, hydroxypropylcellulose, hydroxypropylmethycellulose, hydroxyethylcellulose, ethylcellulose, methycellulose, polyvinyl alcohol, polyvinyl pyrrolidone, N-vinylacetamide polymer, polyvinyl methacrylate, polyethylene glycol, pluronic, gelatin, methyl vinyl ether-maleic anhydride copolymer, starch, soluble starch, croscarmelose, pullulan and a copolymer of methyl acrylate and 2-ethylhexyl acrylate lecithin, lecithin derivative, propylene glycol fatty acid esters, glycerin fatty acid esters, sorbitan fatty acid esters, polyoxyethylene sorbitan fatty acid esters, polyethylene glycol fatty acid esters, polyoxyethylene hydrated caster oil, polyoxyethylene alkyl ethers, and pluronic. Appropriate buffer system if diluent is used is in pH range of 4 to 8, together with low molecular weight alcohols like isopropanol. The use of preservatives and masking agents is suitable.

Another aspect of the invention is the use of the compound of the invention in the manufacture of a medicament for the treatment of inflamatory diseases, disorders, and conditions characterized by or associated with an undesirable inflammatory immune response and all diseases and conditions induced by or associated with an excessive secretion of TNF-α and IL-1.

Another aspect of the invention is the use of the compound of the invention in the manufacture of a medicament for treating inflammatory conditions and immune or anaphylactic disorders associated with infiltration of leukocytes into inflamed tissues.

In yet another aspect of the invention inflammatory conditions and immune disorders to be treated by the compound of the invention are chosen from the group consisting of asthma, adult respiratory distress syndrome, bronchitis, cystic fibrosis, rheumatoid arthritis, rheumatoid spondylitis, osteoarthritis, gouty arthritis, uveitis, conjunctivitis, inflammatory bowel conditions, Crohn's disease, ulcerative colitis, distal proctitis, psoriasis, eczema, dermatitis, coronary infarct damage, chronic inflammation, endotoxin shock, and smooth muscle proliferation disorders.

In yet another aspect of the invention inflammatory conditions and immune disorders to be treated by the compound of the invention are chosen from the group consisting of asthma, adult respiratory distress syndrome, chronic obstructive pulmonary diseases, inflammatory bowel conditions, Crohn's disease, bronchitis, and cystic fibrosis.

Another aspect of the invention is the use of the compound of the invention in the manufacture of a medicament for the treatment of inflammatory diseases, disorders and conditions characterized by or associated by excessive unregulated production of cytokines or inflamatory mediators. In the preparation of the compound of the present invention of the specified pharmacological activity, in the present invention certain new compounds were prepared as intermediates in the preparation of pharmacologically active compounds. The term "salts" can include acid addition salts or addition salts of free bases. Examples of acids which may be employed to form pharmaceutically acceptable acid addition salts include but are not limited to salts derived from nontoxic inorganic acids such as nitric, phosphoric, sulfuric, or hydrobromic, hydroiodic, hydrofluoric, phosphorous acids, as well as salts derived from nontoxic organic acids such as aliphatic mono- and dicarboxylic acids, phenyl-substituted alkanoic acids, hydroxyl alkanoic acids, alkanedioic acids, aromatic acids, aliphatic and aromatic sulfonic acids, and acetic, maleic, succinic, or citric acids. Non-limiting examples of such salts include napadisylate, besylate, sulfate, pyrosulfate, bisulfate, sulfite, bisulfite, nitrate, phosphate, monohydrogenphosphate, dihydrogenphosphate, metaphosphate, pyrophosphate, chloride, bromide, iodide, acetate, trifluoroacetate, propionate, caprylate, isobutyrate, oxalate, malonate, succinate, suberate, sebacate, fumarate, maleate, mandelate, benzoate, chlorobenzoate, methylbenzoate, dinitrobenzoate, phthalate, benzenesulfonate, toluenesulfonate, phenylacetate, citrate, lactate, maleate, tartrate, methanesulfonate, and the like. Also contemplated are salts of amino acids such as arginate and the like and gluconate, galacturonate (see, for example, Berge S. M. et al. "Pharmaceutical Salts," J. of Pharma. Sci., 1977; 66:1).

The acid addition salts of said basic compounds are prepared by contacting the free base form with a sufficient amount of the desired acid to produce the salt in the conventional manner. The free base form may be regenerated by contacting the salt form with a base and isolating the free base in the conventional manner. The free base forms differ from their respective salt forms somewhat in certain physical properties such as solubility in polar solvents, but otherwise the salts are equivalent to their respective free base for purposes of the present invention.

Pharmaceutically acceptable base addition salts are formed with metals or amines, such as alkali and alkaline earth metals or organic amines. Examples of metals used as cations are sodium, potassium, magnesium, calcium, and the like. Examples of suitable amines are N,N'-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, dicyclohexylamine, ethylenediamine, N-methylglucamine, and procaine.

The base addition salts of said acidic compounds are prepared by contacting the free acid form with a sufficient amount of the desired base to produce the salt in the conventional manner. The free acid form may be regenerated by contacting the salt form with an acid and isolating the free acid in the conventional manner.

The phrase "pharmaceutically acceptable", as used in connection with compositions of the invention, refers to molecular entities and other ingredients of such compositions that are physiologically tolerable and do not typically produce untoward reactions when administered to a mammal (e.g., human). Preferably, as used herein, the term "pharmaceutically acceptable" means approved by a regulatory agency of the Federal or a state government or listed in the U.S. Pharmacopeia or other generally recognized pharmacopeia for use in mammals, and more particularly in humans.

The term "carrier" applied to pharmaceutical compositions of the invention refers to a diluent, excipient, or vehicle with which an active compound is administered. Such pharmaceutical carriers can be sterile liquids, such as water, saline solutions, aqueous dextrose solutions, aqueous glycerol solutions, and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like. However, since memantine is highly soluble, aqueous solutions are preferred. Suitable pharmaceutical carriers are described in "Remington's Pharmaceutical Sciences" by E.W. Martin, 18th Edition. Particularly preferred for the present invention are carriers suitable for immediate-release, i.e., release of most or all of the active ingredient over a short period of time, such as 60 minutes or less, and make rapid absorption of the drug possible. The present invention also encompasses solvates (preferably hydrates) formed by the compound of the invention or its salts. The present invention also relates to all possible tautomeric forms which can be formed by the compound of the invention. The compound of the invention has one or more chirality centers and, depending on the nature of individual substituents, it can also have geometrical isomers. Isomers that differ in the arrangement of their atoms in space are termed "stereoisomers". Stereoisomers that are not mirror images of one another are termed "diastereomers" and those that are non-superimposable mirror images of each other are termed "enantiomers". When a compound has a chiral center, a pair of enantiomers is possible. An enantiomer can be characterized by the absolute configuration of its asymmetric center and is described by the R- and S-sequencing rules of Cahn and Prelog, or by the manner in which the molecule rotates the plane of polarized light and designated as dextrorotatory or levorotatory (i.e., as (+) or (-)-isomer respectively). A chiral compound can exist as either an individual enantiomer or as a mixture of enantiomers. A mixture containing equal proportions of the enantiomers is called a "racemic mixture". The present invention encompasses all individual isomers of the compound of the invention. The description or naming of a particular compound in the specification and claims is intended to include both individual enantiomers and mixtures, racemic or otherwise, thereof. Methods for the determination of stereochemistry and the separation of stereoisomers are well-known in the art.

A "pharmaceutically acceptable excipient" means an excipient that is useful in preparing a pharmaceutical composition that is generally safe, non-toxic and neither biologically nor otherwise undesirable, and includes an excipient that is acceptable for veterinary use as well as human pharmaceutical use. A "pharmaceutically acceptable excipient" as used in the present application includes both one and more than one such excipient. "Treating" or "treatment" of a state, disorder or condition includes:

1. (1) preventing or delaying the appearance of clinical symptoms of the state, disorder or condition developing in a mammal that may be afflicted with or predisposed to the state, disorder or condition but does not yet experience or display clinical or subclinical symptoms of the state, disorder or condition,
2. (2) inhibiting the state, disorder or condition, i.e., arresting or reducing the development of the disease or at least one clinical or subclinical symptom thereof, or
3. (3) relieving the disease, i.e., causing regression of the state, disorder or condition or at least one of its clinical or subclinical symptoms.

The benefit to a subject to be treated is either statically significant or at least perceptible to the patient or to the physician A "therapeutically effective amount" means the amount of a compound that, when administered to a mammal for treating a state, disorder or condition, is sufficient to effect such treatment. The "therapeutically effective amount" will vary depending on the compound, the disease and its severity and the age, weight, physical condition and responsiveness of the mammal to be treated. The four classic symptoms of acute inflammation are redness, elevated temperature, swelling, and pain in the affected area, and loss of function of the affected organ. Symptoms and signs of inflammation associated with specific conditions include:

• rheumatoid arthritis- pain, swelling, warmth and tenderness of the involved joints; generalized and morning stiffness;
• insulin-dependent diabetes mellitus- insulitis; this condition can lead to a variety of complications with an inflammatory component, including: retinopathy, neuropathy, nephropathy; coronary artery disease, peripheral vascular disease, and cerebrovascular disease;
• autoimmune thyroiditis- weakness, constipation, shortness of breath, puffiness of the face, hands and feet, peripheral edema, bradycardia;
• multiple sclerosis- spasticity, blurry vision, vertigo, limb weakness, paresthesias;
• uveoretinitis- decreased night vision, loss of peripheral vision;
• lupus erythematosus- joint pain, rash, photosensitivity, fever, muscle pain, puffiness of the hands and feet, abnormal urinalysis (hematuria, cylinduria, proteinuria), glomerulonephritis, cognitive dysfunction, vessel thrombosis, pericarditis;
• scleroderma- Raynaud's disease; swelling of the hands, arms, legs and face; skin thickening; pain, swelling and stiffness of the fingers and knees, gastrointestinal dysfunction, restrictive lung disease; pericarditis,; renal failure;
• other arthritic conditions having an inflammatory component such as rheumatoid spondylitis, osteoarthritis, septic arthritis and polyarthritis- fever, pain, swelling, tenderness;
• other inflammatory brain disorders, such as meningitis, Alzheimer's disease, AIDS dementia encephalitis- photophobia, cognitive dysfunction, memory loss;
• other inflammatory eye inflammations, such as retinitis- decreased visual acuity;
• inflammatory skin disorders, such as , eczema, other dermatites (e.g., atopic, contact), psoriasis, burns induced by UV radiation (sun rays and similar UV sources)- erythema, pain, scaling, swelling, tenderness;
• inflammatory bowel disease, such as Crohn's disease, ulcerative colitis- pain, diarrhea, constipation, rectal bleeding, fever, arthritis;
• asthma- shortness of breath, wheezing;
• other allergy disorders, such as allergic rhinitis- sneezing, itching, runny nose;
• conditions associated with acute trauma such as cerebral injury following stroke- sensory loss, motor loss, cognitive loss;
• heart tissue injury due to myocardial ischemia- pain, shortness of breath;
• lung injury such as that which occurs in adult respiratory distress syndrome-shortness of breath, hyperventilation, decreased oxygenation, pulmonary infiltrates;
• inflammation accompanying infection, such as sepsis, septic shock, toxic shock syndrome- fever, respiratory failure, tachycardia, hypotension, leukocytosis;
• other inflammatory conditions associated with particular organs or tissues, such as nephritis (e.g., glomerulonephritis)-oliguria, abnormal urinalysis; inflamed appendix- fever, pain, tenderness, leukocytosis; gout- pain, tenderness, swelling and erythema of the involved joint, elevated serum and/or urinary uric acid; inflamed gall bladder- abdominal pain and tenderness, fever, nausea, leukocytosis; chronic obstructive pulmonary disease- shortness of breath, wheezing; congestive heart failure- shortness of breath, rales, peripheral edema; Type II diabetes- end organ complications including cardiovascular, ocular, renal, and peripheral vascular disease; lung fibrosis- hyperventilation, shortness of breath, decreased oxygenation; vascular disease, such as atherosclerosis and restenosis- pain, loss of sensation, diminished pulses, loss of function; and alloimmunity leading to transplant rejection- pain, tenderness, fever.

Subclinical symptoms include without limitation diagnostic markers for inflammation the appearance of which may precede the manifestation of clinical symptoms. One class of subclinical symptoms is immunological symptoms, such as the invasion or accumulation in an organ or tissue of proinflammatory lymphoid cells or the presence locally or peripherally of activated pro-inflammatory lymphoid cells recognizing a pathogen or an antigen specific to the organ or tissue. Activation of lymphoid cells can be measured by techniques known in the art. "Delivering" a therapeutically effective amount of an active ingredient to a particular location within a host means causing a therapeutically effective blood concentration of the active ingredient at the particular location. This can be accomplished, e.g., by local or by systemic administration of the active ingredient to the host.

The term "host" or "subject in need thereof" as used herein refers to a mammal preferably a human. The term "leaving group" refers to a chemical group which is capable of being displaced by a nucleophile. Examples of such groups include but are not limited to halogen, mesylate, tosylate and ester groups.

The compound of the invention can be used as anti-inflammatory, anti-anaphylactic and immunomodulating agents which can be administered in different ways, depending on the inflammation site, e.g. percutaneously, orally, buccally, rectally, parenterally or by inhalation when application within the respiratory tract is intended.

Further, the present invention relates to pharmaceutical compositions containing an effective dose of the compound of the present invention as well as pharmaceutically acceptable excipients, such as carriers or diluents.

The preparation of the pharmaceutical compositions of the invention can include mixing, granulating, tabletting and dissolving the ingredients. Chemical carriers can be in solid or liquid form. Solid carriers can be lactose, sucrose, talc, gelatine, agar, pectin, magnesium stearate, fatty acids without limitation. Liquid carriers can be syrups, oils such as olive, sunflower seed or soybean oils, water, or physiologic saline without limitation. Similarly, carriers may also contain a component for a sustained release of the active component such as glyceryl monostearate or glyceryl distearate. Several forms of pharmaceutical compositions can be prepared. If a solid carrier is used, these forms can include tablets, caplets, solid gelatinous capsules, powders or granules without limitation that can be administered orally. The amount of the solid carrier can vary but mainly it is in the range from 25 mg to 1 g. If a liquid carrier is used, the formulation can be in the form of a syrup, emulsion, soft gelatinous capsules, or sterile injectable liquids, or nonaqueous liquid suspensions topically or systemically, e.g., orally, parenterally, percutaneously, mucosally, e.g., buccally, intranasally, intrarectally and intravaginally. "Parenterally" means by intravenous, intramuscular or subcutaneous route. The corresponding preparations of the compound of the present invention can be used in the prophylaxis as well as in the therapeutic treatment (prevention, delay, inhibition or relief) of several disorders (diseases and other pathological inflammatory conditions) caused by or associated with an abnormal or undesirable (excessive, nonregulated, or dysregulated) inflammatory immune response involving the production of inflammatory cytokines or other inflammation mediators, including without limitation TNF-α and IL-1β. These disorders include autoimmune diseases such as rheumatoid arthritis, insulin-dependent diabetes mellitus, autoimmune thyroiditis, multiple sclerosis, uveoretinitis, lupus erythematosus, scleroderma; other arthritic conditions having an inflammatory component such as rheumatoid spondylitis, osteoarthritis, septic arthritis and polyarthritis; other inflammatory brain disorders, such as meningitis, Alzheimer's disease, AIDS dementia encephalitis, other inflammatory eye inflammations, such as retinitis; inflammatory skin disorders, such as eczema, other dermatites (e.g., atopic, contact), psoriasis, bums induced by UV radiation (sun rays and similar UV sources); inflammatory bowel disease, such as Crohn's disease, ulcerative colitis; asthma; other allergy disorders, such as allergic rhinitis; conditions associated with acute trauma such as cerebral injury following stroke, heart tissue injury due to myocardial ischemia, lung injury such as that which occurs in adult respiratory distress syndrome; inflammation accompanying infection, such as sepsis, septic shock, toxic shock syndrome, other inflammatory conditions associated with particular organs or tissues, such as nephritis (e.g., glomerulonephritis), inflamed appendix, gout, inflamed gall bladder, chronic obstructive pulmonary disease, congestive heart failure, Type II diabetes, lung fibrosis, vascular disease, such as atherosclerosis and restenosis; and alloimmunity leading to transplant rejection. The compound can also be administered by inhalation when application within the respiratory tract is intended. A further object of the present invention relates to the preparation of various pharmaceutical forms of the compound to achieve the optimal bioavailability of the active compound of the invention.

For percutaneous or mucosal external administration, the compound of the invention can be prepared in a form of an ointment or cream, gel or lotion. Ointments, creams and gels can be formulated using a water or oil base with addition of an appropriate emulsifier or gelling agent Formulation of the present compound is especially significant for respiratory inhalation, wherein the compound of the invention is to be delivered in the form of an aerosol under pressure. It is preferred to micronize the compound of the invention after it has been homogenised, e.g., in lactose, glucose, higher fatty acids, sodium salt of dioctylsulfosuccinic acid or, most preferably, in carboxymethyl cellulose, in order to achieve a microparticle size of 5 µm or less for the majority of particles. For the inhalation formulation, the aerosol can be mixed with a gas or a liquid propellant for dispensing the active substance. An inhaler or atomizer or nebulizer may be used. Such devices are known. See, e.g., Newman et al., Thorax, 1985, 40:61-676, Berenberg, M., J. Asthma USA, 1985, 22:87-92. A Bird nebulizer can also be used. See also U.S. Patents 6,402,733 ; 6,273,086 ; and 6,228,346 .

The compound of the invention for inhalation is preferably formatted in the form of a dry powder with micronized particles, as described herein.

The compound can also be incorporated into a formulation for treating inflammation localized in an organ or tissue, e.g., Crohn's disease, where it can be administered orally or rectally. Formulations for oral administration can incorporate excipients enabling bioavailability of the compound at the site of inflammation. This can be achieved by different combinations of enteric and delayed release formulations. The compound of the invention can also be used in the treatment of Crohn's disease and intestinal inflammation disease if the compound is applied in the form of a clyster, for which a suitable formulation can be used, as is well known in the field.

A therapeutically effective amount of the compound of the present invention can be determined by methods known in the art. Since the compound of the present invention is more efficiently delivered to the desired site than the corresponding anti-inflammatory steroid alone, a lesser amount of the compound on a molar basis than of the steroid can be administered while still achieving the same therapeutic effect. Furthermore, since administration of the compound results in fewer side effects than with the corresponding steroid, the steroid amount can be increased. Thus, the table below serves only as a guide. A threshold therapeutically effective amount of the compound, a pharmaceutically salt thereof, or a solvate thereof, is generally equal to or less than a therapeutically effective amount of the anti-inflammatory drug on a molar basis. Broad and preferred effective amounts of the compound, a pharmaceutically salt thereof, or a solvate thereof, are shown in the table below.

	Amount of Compound, Pharmaceutically Acceptable Salt Thereof, or Solvate Thereof
	mg/kg body weight/day of the steroid (had it been administered alone)	µmol/kg body weight/day of the hybrid of the steroid
Broad	from about 0.001 to about 1000	from about 0.004 to about 4000
Preferred	from about 0.01 to about 100	from about 0.04 to about 400
More Preferred	from about 1 to about 100	from about 4 to about 400
Most Preferred	from about 3 to about 30	from about 12 to about 120

For example, if the preferred amount range for prednisone is 1-50 mg/day, this corresponds to a range of 2.79 µmol to 139.5 µmol per day. The starting amount range for a hybrid steroid-macrolide conjugate according to the invention will be also 2.79 µmol to 139.5 µmol of conjugate per day. This dosage can be fine-tuned in light of the present specification using the ordinary skill in the act.

The efficacy of the present compound can be assessed by any method for assessing inflammation or anti-inflammatory effect. There are many known methods for this purpose including without limitation use of contrast ultrasound in conjunction with injection of microbubbles, measurement of inflammatory cytokines (such as TNF-α, IL-1, IFN-γ), measurement of activated immune system cells (activated T cells, cytotoxic T cells specifically recognizing the inflamed or transplanted tissue) as well as by observation (reduction of oedema, reduction of erythema, reduction of pruritus or burning sensation, reduction of body temperature, improvement in function of the afflicted organ) as well as any of the methods provided below as well as any of the methods provided below.

The therapeutic effect of the compound of the present invention was determined in in vitro and in vivo experiments such as the following.

The beneficial antiinflammatory effect of the compound of the present invention was determined in the following in vitro and in vivo experiments:

• Formulations for oral administration can be so designed to enable bioavailability of the compound at the site of inflammation in the intestines. This can be achieved by different combinations of delayed release formulations. The compound of the invention can also be used in the treatment of Crohn's disease and intestinal inflammation disease if the compound is applied in the form of an enema, for which a suitable formulation can be used.

The corresponding preparations of the compound of the present invention can be used in the prophylaxis (including without limitation the prevention, delay or inhibition of recurrence of one or more of the clinical or subclinical symptoms discussed and defined in connection with the definitions of "treatment" above) as well as in the therapeutic treatment of several diseases and pathological inflammatory conditions including: asthma, chronic obstructive pulmonary disease, inflammatory nasal diseases such as allergic rhinitis, nasal polyps, intestinal diseases such as Crohn's disease, colitis, intestinal inflammation, ulcerative colitis, dermatological inflammations such as eczema, psoriasis, allergic dermatitis, neurodermatitis, pruritis, conjunctivitis and rheumatoid arthritis.

The biological effect of the compound of the present invention was determined in the following in vitro and in vivo experiments:

Assay of Binding to Human Glucocorticoid Receptor

The gene for the alpha isoform of human glucocorticoid receptor was cloned by reverse polymerase chain reaction. The total RNA was isolated from human peripheral blood lymphocytes according to the instructions of the manufacturer (Qiagen), transcripted into cDNA with AMV reverse transcriptase (Roche) and the gene was multiplied by specific primers 1) 5'ATATGGATCCCTGATGGACTCCAAAGAATCATTAACTCC3' and 2) 5'ATAT-CTCGAGGGCAGTCACTTTTGATGAAACAGAAG3'. The reaction product obtained was cloned into the XhoI/BamHI site of Bluescript KS plasmid (Stratagene), subjected to sequencing by the dideoxy fluorescent method with M13 and M13rev primers (Microsynth) and then it was cloned into the XhoI/BamHI site of pcDNA3.1 Hygro(+)plazmid (Invitrogen). 1x10⁵ COS-1 cells were seeded onto a 12-well plate (Falcon) in DMEM medium (Life Technologies) with 10% FBS (Biowhitaker) and cultivated to a 70% confluence at 37 °C in an atmosphere with 5% CO₂. The medium was removed and 1 µg of DNA, 7 µl of PLUS reagent and 2 µl of Lipofectamin (Life Technologies) in 500 µl of DMEM were added per well. The cells were incubated at 37 °C in an atmosphere with 5% CO₂ and after 5 hours the same volume of 20% FBS/DMEM was added. After 24 hours, the medium was completely changed. 48 hours after transfection, the test compounds in different concentrations and 24 nM [³H]dexamethazone (Pharmacia) in DMEM medium were added. The cells were incubated for 90 minutes at 37 °C in an atmosphere with 5% CO₂ washed three times with PBS buffer (Sigma) cooled to 4 °C (pH=7,4), and then lysed in Tris buffer (pH=8,0) (Sigma) with 0.2% of SDS (Sigma). After the addition of UltimaGold XR (Packard) scintillation liquid, the residual radioactivity was read in a Tricarb (Packard) β-scintillation counter.

Compound 1 has the affinity for glucocorticoid receptor since in the assay it displaces radioactive dexamethasone from the glucocorticoid receptor.

Assay of Inhibition of Mouse T-cell Hybridoma 13 Proliferation as a Result of Apoptosis Induction

In a 96-well plate, triplicates of test steroid dilution in RPMI medium (Institute of Immunology, Zagreb) with 10% FBS were performed. To the solutions of compounds, 20000 cells per well were added and incubated overnight at 37 °C in an atmosphere with 5% CO₂, then 1 µCi of [³H]thymidine (Pharmacia) was added and the mixture was incubated for additional 3 hours. The cells were harvested by applying a vacuum over GF/C filter (Packard). Onto each well, 30 µl of Microscynt O scintillation liquid (Packard) was added and the incorporated radioactivity was measured on a β-scintillation counter (Packard). The specificity of apoptosis induction by glucocorticoids was proven by antagonizing the proliferation inhibition with mifepristone (Sigma). Compound 1 exhibits inhibition of T-cell hybridoma 13 proliferation in the concentrations from 1 µM to 1 nM.

Measurement of the inhibition of interleukin 4, interleukin 5 and interferon production by γ concanavalin-A induced murine splenocytes

Splenocytes were isolated from the spleen of Balb/C mice sacrificed by thiopental injection (Pliva). Spleens were chopped and mononuclear cells separated on Histopaque 1083 (Sigma Diagnostics, Cat. No 1083-1). Into a 96-well plate, compounds diluted in RPMI medium (Institute of Immunology) were pipetted with 10% foetal bovine serum (Biowhittaker) and cells (200000 per well) in the same medium, and concanavalin-A stimulator (Sigma cat No C5275) at the final concentration of 5 µg/ml were added. Positive control, in place of the dilution of compounds, consisted of RPMI medium with 10% foetal bovine serum and concanavalin-A in the same concentration. Cells were incubated for 72 hours at 37 °C, 95% humidity and in an atmosphere with 5% CO₂. Until determination of cytokines, the cells were frozen at -70°C. Cytokines interleukin 4, interleukin 5 and interferon γ were determined by the specific ELISA method, according to manufacturer's recommendations (R&D). Inhibition (as percentage) was calculated using the following formula: $\%inh=\left(1,-,c,,o,,n,,c,,e,,n,,t,,r,,a,,t,,i,,o,,n,o,,f,c,,y,,t,,o,,k,,i,,n,,e,,s,i,,n,s,,a,,m,,p,,l,,e,/,c,,o,,n,,c,,e,,n,,t,,r,,a,,t,,i,,o,,n,o,,f,c,,y,,t,,o,,k,,i,,n,,s,i,,n,p,,o,,s,,i,,t,,i,,v,,e,c,,o,,n,,t,,r,,o,,l\right)*100$

Compound 1 inhibits the production of cytokines in concentrations from 1 µM to 1 nM.

Model of Lung Eosinophilia in Mice

Male Balb/C mice with a body weight of 20-25 g were randomly divided into groups, and sensitised by an i.p. injection of ovalbumin (OVA, Sigma) on day zero and day fourteen. On the twentieth day, the mice were subjected to a challenge test by i.n. (intranasal) application of OVA (positive control or test groups) or PBS (negative control). 48 hours after i.n. application of OVA, the animals were anaesthetized and the lungs were rinsed with 1 mL of PBS. The cells were separated on Cytospin 3 cytocentrifuge (Shandon). The cells were stained in Diff-Quick (Dade) and the percentage of eosinophils was determined by differential counting of at least 100 cells. Fluticasone (GlaxoWellcome) and beclomethasone (Pliva d.d.) were used as standard substances, with positive and negative control. The compounds were administered daily i.n. or i.p. in different doses 2 days before the challenge test and up to the completion of the test. Compound 1 statistically significantly reduced (t-test, p<0.05) the number of eosinophils in the lung rinse with respect to positive control.

Cold Stress Model

Male Wistar rats with a body weight of 200 - 250 g (our own breeding) were randomly divided into groups. The carrier (lactose) in the volume of 0.5 mL/100 g s.c. was applied to the negative and positive control group. Test substances and the standard were applied once daily over three days in the dose of 2 mg/kg in the volume of 0.5 mL/100 g of body weight. The standard was applied in the dose of 1 mg/kg, in the volume of 0.5 mL/100 g of body weight.

On day three, 2 hours after the last treatment, all animals, except for the negative control group, were subjected to cold stress at 4 °C for 1 hour. After the stress, the animals were anaesthetized with thiopental (Pliva d.d.) and blood from all animals was drawn on K2 EDTA into test tubes. Plasma samples were frozen at -70 °C. Corticosterone levels were determined by fluorimetric method according to Silber. Thymuses were removed from animals and weighed, and their weights were compared with the negative and positive control. Standards, fluticasone (GlaxoWellcome) and budesonide (Steraloids), statistically significantly reduced corticosterone plasma levels and reduced the weight of the thymus (P< 0.05; T-test).

SYNTHETIC METHODS AND EXAMPLES PRECURSORS

In the following example of methods of preparation, which in no way limit the uniqueness of the invention, the synthesis of the compound of the invention from macrolide precursors M1, M2 and M4 and steroid precursor D5 is described.

Macrolide subunits

Macrolide subunits M1, M2 and M4 are represented by the following general structure: Table 1

	H		420.2
			473.3
			477.4

Method A

1. a) Compound M1 (480 mg; 1.1 mmol) was dissolved in 10 mL of acrylonitrile and the reaction mixture was heated at 95 °C for 24 hours. Subsequently, the solvent was evaporated under reduced pressure. 500 mg of the compound M2 was obtained, which was used for further synthesis without previous purification.
2. b) Compound M2 (500 mg) was dissolved in 20 mL of absolute ethanol and hydrated with the catalyst PtO₂ (60 mg) for two days at the pressure of 40 atm. The mixture was purified on a silica gel column, eluent CHCl₃:MeOH:NH₄OH=6:1:0.1. 193 mg of compound M4 was obtained.

The properties of compounds M1, M2 and M4 are given in Table 1. Steroid subunits

Steroid subunit D5 is represented by the following general structure: Table 2

	double	F	H	H		OH

Example 1 Compound 1: (I; M = M4, D = D5)

Compound D5 (57.8 mg; 0.16 mmol) was dissolved in 5 mL of dry dichlormethane in a flow of argon. 0.209 mL of triethylamine was added to the solution, clarifying it. Subsequently, 43.9 mg of hydroxybenzotriazole, macrolide M4 (76 mg; 0.1595 mmol) and 129.2 g of 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride were added. The reaction mixture was stirred at room temperature overnight. The solvent was evaporated under reduced pressure. The mixture obtained was purified on a silica gel column, eluent CHCl₃:MeOH:NH₄OH=6:1:0.1. 32 mg of compound 1 was obtained; MS (m/z): 821.4 [MH]⁺. IR (KBr) cm^-1: 3423, 2939, 2876, 1718, 1664, 1625, 1560, 1541, 1458, 1376, 1353, 1296, 1249, 1178, 1089, 1054, 975, 959, 928, 889, 828, 811, 750, 669 .

Claims (19)

1. A compound having the structure or a pharmaceutically acceptable salt or solvate thereof.
2. A compound as claimed in claim 1 having the structure or a pharmaceutically acceptable salt thereof.
3. A compound as claimed in claim 1 having the structure
4. A pharmaceutical composition comprising a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 as well as a pharmaceutically acceptable diluent or carrier.
5. A compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 for use in medical therapy.
6. A compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 for use in the treatment of asthma.
7. A compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 for use in the treatment of chronic obstructive pulmonary disease.
8. A compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 for use in the treatment of inflammatory bowel disease.
9. A compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 for use in the treatment of psoriasis.
10. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of inflammatory diseases, disorders and conditions characterized by or associated with an undesirable inflammatory immune response, and all diseases and conditions induced by or associated with an excessive secretion of TNF-α and IL-1.
11. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of inflammatory conditions and immune or anaphylactic disorders associated with infiltration of leukocytes into inflamed tissue.
12. Use according to claim 11, wherein inflammatory conditions and immune disorders are selected from the group consisting of asthma, adult respiratory distress syndrome, chronic obstructive pulmonary disease, inflammatory bowel conditions, Crohn's disease, bronchitis, and cystic fibrosis.
13. Use according to claim 11, wherein said inflammatory conditions and immune disorders are selected from the group consisting of inflammatory conditions or immune disorders of the lungs, joints, eyes, bowel, skin, and heart.
14. Use according to claim 11, wherein said inflammatory conditions and immune disorders are selected from the group consisting of asthma, adult respiratory distress syndrome, bronchitis, cystic fibrosis, rheumatoid arthritis, rheumatoid spondylitis, osteoarthritis, gouty arthritis, uveitis, conjunctivitis, inflammatory bowel conditions, Crohn's disease, ulcerative colitis, distal proctitis, psoriasis, eczema, dermatitis, coronary infarct damage, chronic inflammation, endotoxin shock, and smooth muscle proliferation disorders.
15. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of inflammatory diseases, disorders and conditions characterized by or associated with excessive unregulated production of cytokines or inflammatory mediators.
16. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of asthma.
17. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of chronic obstructive pulmonary disease.
18. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of inflammatory bowel disease.
19. Use of a compound or a pharmaceutically acceptable salt or solvate thereof as claimed in any of claims 1 to 3 in the manufacture of a medicament for the treatment of psoriasis.