Indian Patents. 216318:A MEDICAMENT SUITABLE FOR THE PREVENTION OF SEQUELAE OF CHROMIC REDUCED CEREBRAL BLOOD SUPPLY.

Title of Invention	A MEDICAMENT SUITABLE FOR THE PREVENTION OF SEQUELAE OF CHROMIC REDUCED CEREBRAL BLOOD SUPPLY.
Abstract	A medicament suitable for the prevention or treatment of the sequelae of chromic reduced cerebral blood supply, wherein the medicament comprises an effective amount of compound I. or its pharmaceutically utilizable salts.

Full Text	The invention relates to the use of 4-amino-4-(4-fluoro-benzylamino)-1-ethoxycarbonylaminobenzene of the formula I or its pharmaceutically utilizable salts for the production of medic"aments for the prophylaxis and treatment of the sequelae of acute and chronic reduced cerebral blood supply and neurodegenerative disorders. Compound I is under development as an anticonvulsive agent. It has a broad spectrum of action against various experimentally produced convulsions and in genetic animal models. The activity in animals is higher than that of many anticonvulsive agents introduced. Muscle-relaxant, antipyretic and analgesic actions have furthermore been described (DE 42 00 259). A problem with many anticonvulsive agents introduced, especially the GABA-increasing substances such as phenobarbital, diazepam and clonazepam but also phenytoin, a blocker of the sodium channel, is the adverse effect on mental powers. By increasing the inhibition in the brain, in addition to the anticonvulsi-re action a central sedation also occurs, which both reduce the power of absorption of the patients. These anticonvulsive agents moreover have neuroprotective activity neither in animal experiments nor in patients. The consequences of a reduced cerebral blood supply, as occurs, for example, in stroke, are not diminished. In epileptic attacks, an undersupply of the affected areas of the brain also occurs which, however, is attributed not to a reduced blood supply, but to the strong cell activation, as a result of which the reserves are stressed and the supply is no longer adequate. An anticonvulsive agent which displays a neuroprotective action in the stressed brain is therefore desirable. A neuroprotective action is also necessary for the therapy of other neurodegenerative disorders. To be counted among these are, for example, Alzheimer"s disease, Huntington"s chorea, multiple sclerosis, AIDS-induced encephalopathy and other infection-related encephalopathies such as [lacuna] by rubella viruses, herpes viruses, borrelia and unknown pathogens, Creutzfeld-Jakob disease, amyotrophic lateral sclerosis (ALS), Parkinson"s disease, trauma-induced neuro-degenerations and neuronal hyperexcitation states, such as in medicament withdrawal, or by intoxication, and neurodegenerative disorders of the peripheral nervous system such as polyneuropathies and polyneuritides. Several strategies are at present followed for the treatment of reduced cerebral blood supply and of stroke. Prophylactically, medicaments can be used which inhibit thrombus formation and increase the flow properties of the blood, such as acetylsalicylic acid. Such a treatment, however, only has a purely prophylactic action; therapy is thus not possible. If there is a chronic reduced cerebral blood supply, medicaments are used which have vasodilatory activity, such as calcium anuagonists. For the therapy of stroke as acute reduced blood supply, preparations can also be employed which have thrombolytical activity in order to eliminate a possible vascular occlusion. However, these can only be employed if in detailed investigations it has been clearly elucidated that the stroke is not caused by cerebral haemorrhage. In clinical testing for the therapy of stroke, preparations having NMDA-antagonistic action are found which directly inhibit the overactivation of the undersupplied cells. These substances, however, have a high side effect potential. According to the present point of view, they can therefore only be employed with intensive medical care after clear diagnosis. Moreover, NMDA antagonists, due to the inhibition of the plasticity of the brain, have a negative effect on learning power. Prophylactic use of these preparations therefore appears to be excluded from the present point of view, despite the good prophylactic action in animal experiments. It is the object of the present invention to make available a medicament having good neuroprotective properties and a low side effect potential for the prophylaxis and treatment of stroke, of reduced cerebral blood supply and of other nerve cell-stressing conditions. Surprisingly, it has now been found that the compound I has important neuroprotective actions in animal experiments. Thus completely new possibilities are opened up for the prophylaxis and treatment of the sequelae of acute and chronic reduced cerebral blood supply, in particular of stroke, and for neurodegenerative disorders. Pharmacological investigations: The aim of the investigation with compound I in models of learning power and neuroprotection was to estimate the possible effects of these parameters, since compound I, inter alia, displays a GABA-ergic action. Since the epilepsy patient as a result of the repeated attacks often already suffers from a learning power deficit, these experiments were carried out on animals which had been exposed to an amnesic factor and whose learning power was thus reduced. To do this, the animals were either repeatedly treated with electroshock or exposed to alcohol withdrawal; to estimate the direct neuroprotective action, a chronic reduced blood supply to the brain was produced by tying off afferent blood vessels. All this damage leads to a reduction in the learning power, which is to be assessed as an indicator of nerve cell damage. GABA-increasing antiepileptically active medicaments such as diazepam and sodium channel blockers such as phenytoin do not have any positive effects in these models and in higher doses adverse effects on the learning power can even occur. Investigation models: Learning power damage due to reduction of the blood supply to the brain In this model, one of the carotid arteries of rats is tied off under anaesthesia. The animals wake from the anaesthesia and then have a decreased learning power. This was determined by means of the rod jumping test. In this test, the animals must learn to escape a slight electric shock to the foot, which is announced to them beforehand by an acoustic signal, by jumping onto a vertical rod suspended above the floor. The learning power of the animals is measured in per cent as the number of reactions caused (jumping onto the rod during the acoustic signal phase). Untreated and sham-operated animals (anaesthetized and vessels exposed, but no ligature performed) learn the combination of acoustic signal and the following unpleasant shock to the foot very rapidly. After 4 test days with 10 exposures daily, the animals react almost with each sound signal with a jump onto the vertical rod. As a result of the ligature of the left carotid, this learning power is reduced approximately to a half. Animals pretreated with 2 mg/kg i.p. of compound I an hour before each test phase unexpectedly learnt just as well despite existing injury due to the ligature, with a tendency to be even better than non-operated animals. However, if the animals were pretreated with diazepam (0.3 mg/kg i.p., 1 hour before each training phase), then the learning power remained just as poor as in the untreated injured animals. The same applies to treatment with the anticonvulsive agent phenytoin (3 and 10 mg/kg); it was not possible to improve the learning power. An improvement in the learning power despite the existing reduced blood supply is to be regarded as an indicator of a cytoprotective action, as only fully functional nerve cells are capable of learning. It is therefore to be expected that compound I manifests a cytoprotective action, for example in the peripheral region of an infarct, where a reduced blood supply is also present or on stressed cells which are subject to a relative energy deficiency. As a result, the infarct volume and thus the damage should remain lower and survival should be made possible for severely stressed cells. Table 1: Number of reactions caused in % in the rod jump test after injury as a result of ligature of the left carotid. Significant differences between the sham-operated control group and the control group with a ligature (t test) are marked by + p Compound I did not only exhibit an excellent action in this model, it was also possible to reduce the decrease in learning power produced by repeated application of electroshock by pretreatment with 2 mg/kg of the compound I an hour before the test. While on the 4th test day injured test animals only showed 32 ± 2.9 % of reactions caused, the treated animals were able to carry out 45 ± 4.5 % of reactions caused correctly. This action was also detectable after a pretreatment time of 2 hours. The number of reactions caused rose here from 35 ± 3.7 % in the control group to 52 + 3.9 % in the treated group. It was also possible to positively affect the decrease in learning power due to alcohol withdrawal. Compound I can thus be employed as a highly-specific active compound for the treatment of the sequelae of acute and chronic reduced cerebral blood supply, in particular of stroke, and in all conditions during and after stressing of nerve cells. On account of the low side effects of the substance in animal experiments, compound I can also be employed for the prophylaxis of the abovementioned disorders and conditions. Compound I is structurally related to flupirtin, a clinically introduced central analgesic agent. While in the case of flupirtin an NMDA-antagonistic action was found (WO 95/05175), it was possible to exclude such an action for compound I [lacuna] in vitro experiments. Neither an affinity for the various binding sites of the NMDA receptor nor a direct effect on the flow induced by NMDA was found. In more involved investigations on the central analgesic action of the compound I in the hot plate test, in contrast to flupirtin it was possible to exclude a central analgesic action, as has been detected in the hot plate test on mice for flupirtin with an average effective dose of 3 0 mg/kg. NMDA antagonists can cause severe psychotic disorders, such as ataxia with stereotypic symptoms. Compound I and processes for its preparation are known (DE 42 00 259). The compound can be converted in a known manner into the customary formulations such as tablets, capsules, coated tablets, pills, granules, syrups, emulsions, suspensions and solutions, using inert, non-toxic, pharmaceutically suitable excipients and/or auxiliaries. The daily dose of the compound I here in the case of oral or parenteral administration should be 50-500 mg. If necessary, it is possible to deviate from the amounts mentioned, namely depending on the body weight and the specific type of administration route. We claim: 1. A medcament suitable for the prevention or treatment of the sequetae of chromic reduced cerebral blood supply, wherein the medicament comprises an effective amount of compound I. or Its pharmaceutically utilizable salts. 2. The medicament as claimed In claim 1 which Is suitable for the prophylaxis or treatment of stroke. 3. A medicament suitable for the prevention or treatment of a neurodegenerative disorder, wherein the medicament comprises an effective amount of compound I or its pharmaceudcally utilizable salts. 4. The medcament as claimed In calm 3 wherein the neurodegeneratlve disorder is Alzheimer"s disease. 5. The medcament as claimed In dalm 3 wherein the neurodegeneratlve disorder is Hunting/ton"s disease. 6. The medcament as claimed In dalm 3 wherein the neurodegenerative disorder is multiple sclerosis. 7. The medcament as claimed In dalm 3 wherein the neurodegenerative disorder is amyotrophic lateral sclerosis, 8. the medcament as claimed in claim 3 wherein the neurodegenerattve disorder is Parkinson"s disease, 9. The medcament as claimed In dalm 3 wherein the neurodegeneratlve disorder is a trauma-Induced neurodegeneration or neuronal hyperexcltatlon state. 10. The medicament as claimed in daim 3 wherein the nourodegenerative disorder is caused by withdrawal from intoxication. 11. The medicament as claimed In claim 3 wherein the neurodegenerative disorder is a disorder of the peripheral nervous system or Is a polyneuropathy or polyneuritide. 12. A medicament suitable for the prevention or treatment of encephalopathy caused by Infection, wherein the medicament comprises an effective amount of compound I or its pharmaceuticaliy utilizable salts. 13. The medlcament as claimed in claim 12, wherein the encephalopathy is induced by an Infection selected from the group consisting of AIDS, rubella viruses, herpes viruses, and borrelia. 14. The medicament as claimed in claim 12, wherein the encephalopathy is caused by Creuzfeld-Jakob disease. 15. A medicament having neuroprotective effect, wherein the medicament comprises an effective amount of compound I or its pharmaceutically utilizable salts. A medicament suitable for the prevention or treatment of the sequelae of chromic reduced cerebral blood supply, wherein the medicament comprises an effective amount of compound I. or its pharmaceutically utilizable salts.

Full Text

The invention relates to the use of 4-amino-4-(4-fluoro-benzylamino)-1-ethoxycarbonylaminobenzene of the formula I

or its pharmaceutically utilizable salts for the production of medic"aments for the prophylaxis and treatment of the sequelae of acute and chronic reduced cerebral blood supply and neurodegenerative disorders.
Compound I is under development as an anticonvulsive agent. It has a broad spectrum of action against various experimentally produced convulsions and in genetic animal models. The activity in animals is higher than that of many anticonvulsive agents introduced. Muscle-relaxant, antipyretic and analgesic actions have furthermore been described (DE 42 00 259).
A problem with many anticonvulsive agents introduced, especially the GABA-increasing substances such as phenobarbital, diazepam and clonazepam but also phenytoin, a blocker of the sodium channel, is the adverse effect on mental powers. By increasing the inhibition in the brain, in addition to the anticonvulsi-re action a central sedation also occurs, which both reduce the power of absorption of the patients.
These anticonvulsive agents moreover have neuroprotective activity neither in animal experiments nor in patients. The consequences of a reduced cerebral
blood supply, as occurs, for example, in stroke, are not diminished.
In epileptic attacks, an undersupply of the affected areas of the brain also occurs which, however, is attributed not to a reduced blood supply, but to the strong cell activation, as a result of which the reserves are stressed and the supply is no longer adequate.
An anticonvulsive agent which displays a neuroprotective action in the stressed brain is therefore desirable.
A neuroprotective action is also necessary for the therapy of other neurodegenerative disorders. To be counted among these are, for example, Alzheimer"s disease, Huntington"s chorea, multiple sclerosis, AIDS-induced encephalopathy and other infection-related encephalopathies such as [lacuna] by rubella viruses, herpes viruses, borrelia and unknown pathogens, Creutzfeld-Jakob disease, amyotrophic lateral sclerosis (ALS), Parkinson"s disease, trauma-induced neuro-degenerations and neuronal hyperexcitation states, such as in medicament withdrawal, or by intoxication, and neurodegenerative disorders of the peripheral nervous system such as polyneuropathies and polyneuritides.
Several strategies are at present followed for the treatment of reduced cerebral blood supply and of stroke. Prophylactically, medicaments can be used which inhibit thrombus formation and increase the flow properties of the blood, such as acetylsalicylic acid. Such a treatment, however, only has a purely prophylactic action; therapy is thus not possible.
If there is a chronic reduced cerebral blood supply, medicaments are used which have vasodilatory activity, such as calcium anuagonists.
For the therapy of stroke as acute reduced
blood supply, preparations can also be employed which
have thrombolytical activity in order to eliminate a
possible vascular occlusion. However, these can only be

employed if in detailed investigations it has been clearly elucidated that the stroke is not caused by cerebral haemorrhage. In clinical testing for the therapy of stroke, preparations having NMDA-antagonistic action are found which directly inhibit the overactivation of the undersupplied cells. These substances, however, have a high side effect potential. According to the present point of view, they can therefore only be employed with intensive medical care after clear diagnosis. Moreover, NMDA antagonists, due to the inhibition of the plasticity of the brain, have a negative effect on learning power. Prophylactic use of these preparations therefore appears to be excluded from the present point of view, despite the good prophylactic action in animal experiments.
It is the object of the present invention to make available a medicament having good neuroprotective properties and a low side effect potential for the prophylaxis and treatment of stroke, of reduced cerebral blood supply and of other nerve cell-stressing conditions.
Surprisingly, it has now been found that the compound I has important neuroprotective actions in animal experiments.
Thus completely new possibilities are opened up for the prophylaxis and treatment of the sequelae of acute and chronic reduced cerebral blood supply, in particular of stroke, and for neurodegenerative disorders.
Pharmacological investigations:
The aim of the investigation with compound I in models of learning power and neuroprotection was to estimate the possible effects of these parameters, since compound I, inter alia, displays a GABA-ergic action. Since the epilepsy patient as a result of the repeated attacks often already suffers from a learning power deficit, these experiments were carried out on

animals which had been exposed to an amnesic factor and whose learning power was thus reduced. To do this, the animals were either repeatedly treated with electroshock or exposed to alcohol withdrawal; to estimate the direct neuroprotective action, a chronic reduced blood supply to the brain was produced by tying off afferent blood vessels. All this damage leads to a reduction in the learning power, which is to be assessed as an indicator of nerve cell damage. GABA-increasing antiepileptically active medicaments such as diazepam and sodium channel blockers such as phenytoin do not have any positive effects in these models and in higher doses adverse effects on the learning power can even occur.
Investigation models:
Learning power damage due to reduction of the blood supply to the brain
In this model, one of the carotid arteries of rats is tied off under anaesthesia.
The animals wake from the anaesthesia and then have a decreased learning power. This was determined by means of the rod jumping test. In this test, the animals must learn to escape a slight electric shock to the foot, which is announced to them beforehand by an acoustic signal, by jumping onto a vertical rod suspended above the floor.
The learning power of the animals is measured in per cent as the number of reactions caused (jumping onto the rod during the acoustic signal phase).
Untreated and sham-operated animals (anaesthetized and vessels exposed, but no ligature performed) learn the combination of acoustic signal and the following unpleasant shock to the foot very rapidly. After 4 test days with 10 exposures daily, the animals react almost with each sound signal with a jump onto the vertical rod.

As a result of the ligature of the left carotid, this learning power is reduced approximately to a half. Animals pretreated with 2 mg/kg i.p. of compound I an hour before each test phase unexpectedly learnt just as well despite existing injury due to the ligature, with a tendency to be even better than non-operated animals. However, if the animals were pretreated with diazepam (0.3 mg/kg i.p., 1 hour before each training phase), then the learning power remained just as poor as in the untreated injured animals.
The same applies to treatment with the anticonvulsive agent phenytoin (3 and 10 mg/kg); it was not possible to improve the learning power.
An improvement in the learning power despite the existing reduced blood supply is to be regarded as an indicator of a cytoprotective action, as only fully functional nerve cells are capable of learning.
It is therefore to be expected that compound I manifests a cytoprotective action, for example in the peripheral region of an infarct, where a reduced blood supply is also present or on stressed cells which are subject to a relative energy deficiency.
As a result, the infarct volume and thus the damage should remain lower and survival should be made possible for severely stressed cells.
Table 1:
Number of reactions caused in % in the rod jump test
after injury as a result of ligature of the left
carotid.
Significant differences between the sham-operated control group and the control group with a ligature (t test) are marked by + p Compound I did not only exhibit an excellent action in this model, it was also possible to reduce the decrease in learning power produced by repeated application of electroshock by pretreatment with 2 mg/kg of the compound I an hour before the test.
While on the 4th test day injured test animals only showed 32 ± 2.9 % of reactions caused, the treated animals were able to carry out 45 ± 4.5 % of reactions caused correctly.
This action was also detectable after a pretreatment time of 2 hours. The number of reactions caused rose here from 35 ± 3.7 % in the control group to 52 + 3.9 % in the treated group.
It was also possible to positively affect the decrease in learning power due to alcohol withdrawal.

Compound I can thus be employed as a highly-specific active compound for the treatment of the sequelae of acute and chronic reduced cerebral blood supply, in particular of stroke, and in all conditions during and after stressing of nerve cells.
On account of the low side effects of the substance in animal experiments, compound I can also be employed for the prophylaxis of the abovementioned disorders and conditions.
Compound I is structurally related to flupirtin, a clinically introduced central analgesic agent. While in the case of flupirtin an NMDA-antagonistic action was found (WO 95/05175), it was possible to exclude such an action for compound I [lacuna] in vitro experiments.
Neither an affinity for the various binding sites of the NMDA receptor nor a direct effect on the flow induced by NMDA was found.
In more involved investigations on the central analgesic action of the compound I in the hot plate test, in contrast to flupirtin it was possible to exclude a central analgesic action, as has been detected in the hot plate test on mice for flupirtin with an average effective dose of 3 0 mg/kg.
NMDA antagonists can cause severe psychotic disorders, such as ataxia with stereotypic symptoms.
Compound I and processes for its preparation are known (DE 42 00 259).
The compound can be converted in a known manner into the customary formulations such as tablets, capsules, coated tablets, pills, granules, syrups, emulsions, suspensions and solutions, using inert, non-toxic, pharmaceutically suitable excipients and/or auxiliaries.
The daily dose of the compound I here in the case of oral or parenteral administration should be 50-500 mg.

If necessary, it is possible to deviate from the amounts mentioned, namely depending on the body weight and the specific type of administration route.
We claim:
1. A medcament suitable for the prevention or treatment of the sequetae of chromic reduced cerebral blood supply, wherein the medicament comprises an effective amount of compound I.
or Its pharmaceutically utilizable salts.
2. The medicament as claimed In claim 1 which Is suitable for the prophylaxis or treatment of stroke.
3. A medicament suitable for the prevention or treatment of a neurodegenerative disorder, wherein the medicament comprises an effective amount of compound I
or its pharmaceudcally utilizable salts.
4. The medcament as claimed In calm 3 wherein the neurodegeneratlve disorder is Alzheimer"s disease.
5. The medcament as claimed In dalm 3 wherein the neurodegeneratlve disorder is Hunting/ton"s disease.
6. The medcament as claimed In dalm 3 wherein the neurodegenerative disorder is multiple sclerosis.
7. The medcament as claimed In dalm 3 wherein the neurodegenerative disorder is amyotrophic lateral sclerosis,
8. the medcament as claimed in claim 3 wherein the neurodegenerattve disorder is Parkinson"s disease,
9. The medcament as claimed In dalm 3 wherein the neurodegeneratlve disorder is a trauma-Induced neurodegeneration or neuronal hyperexcltatlon state.
10. The medicament as claimed in daim 3 wherein the nourodegenerative disorder is caused by withdrawal from
intoxication.
11. The medicament as claimed In claim 3 wherein the neurodegenerative disorder is a disorder of the peripheral nervous system or Is a polyneuropathy or polyneuritide.
12. A medicament suitable for the prevention or treatment of encephalopathy caused by Infection, wherein the medicament comprises an effective amount of compound I

or its pharmaceuticaliy utilizable salts.
13. The medlcament as claimed in claim 12, wherein the encephalopathy is induced by an Infection selected from the group consisting of AIDS, rubella viruses, herpes viruses, and borrelia.
14. The medicament as claimed in claim 12, wherein the
encephalopathy is caused by Creuzfeld-Jakob disease.
15. A medicament having neuroprotective effect, wherein the medicament comprises an effective amount of compound I
or its pharmaceutically utilizable salts.
A medicament suitable for the prevention or treatment of the sequelae of chromic reduced cerebral blood supply, wherein the medicament comprises an effective amount of compound I.
or its pharmaceutically utilizable salts.

Documents:

http://ipindiaonline.gov.in/documentkol/1832-CAL-1996/1832-CAL-1996-FORM-27.pdf

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Patent Number

216318

Indian Patent Application Number

1832/CAL/1996

PG Journal Number

11/2008

Publication Date

14-Mar-2008

Grant Date

12-Mar-2008

Date of Filing

17-Oct-1996

Name of Patentee

VIATRIS GMBH & CO. KG.

Applicant Address

WEISMULLERSTRASSE 45, 063154 FRANKFURT AM MAIN

Inventors:

#	Inventor's Name	Inventor's Address
1	DR. ANGELIKA ROSTOCK	BOTTGERSTRASSE 36, D-01129 DRESDEN
2	CHRISTINE TOBER	BRUCKENSTRASSE 37, D-01689, WEINBOHLA
3	DR. CHRIS RUNDFELDT	MELAN CHTHONSTRASSE 11, D-01640 COSWIG
4	DR. RENIBARTSCH	STEPHENSONSTRASSE 11, D-01257 DRESDEN

PCT International Classification Number

A 61 K 31/27

PCT International Application Number

N/A

PCT International Filing date

PCT Conventions:

#	PCT Application Number	Date of Convention	Priority Country
1	19539861.0	1995-10-26	Germany