Indian Patents
Title of Invention

ACTIVE AGENT DELIVERY SYSTEM AND METHODS FOR PROTECTING AND ADMINISTERING ACTIVE AGENTS
Abstract The present invention relates to ac-tive agent delivery systems and more specifically to compostions that comprise amino acids, as sin-gle amino acids or peptides, covalently attached to active agents and methods for administering conju-gated active agent compositions.
Full Text ACTIVE AGENT DELIVERY SYSTEMS AND METHODS FOR PROTECTING AND ADMINISTERING ACTIVE AGENTS
CROSS REFERENCE TO RELATED APPLICATIONS
[001] This application is a continuation-in-part of U.S. Patent Application
10/156,527 filed May 29, 2002; U.S. Patent Application No. 09/986,426, filed November 8, 2001; U.S. Patent Application No. 09/411,238, filed October 4, 1999 now abandoned; U.S. Patent Application No. 09/265,415 now abandoned; U.S. Patent Application No. 09/642,820, filed August 22, 2000; U.S. Patent Application No. 09/987,458, filed November 14, 2001; U.S. Patent Application No. 09/988,071, filed November 16, 2001; U.S. Patent Application No. 09/988,034, filed November 16, 2001; U.S. Patent Application No. 09/933,708, filed August 22, 2001; PCT Appln. No. PCT/US01/43089, filed November 14, 2001; PCT Appln. No. PCT/US01/43117, filed November 16, 2001; PCT Appln. No. PCT/US01/43115, filed November 16, 2001 and Provisional Appl. Nos. 60/366,258, filed 22/03/2002; 60/358,381, filed 22/02/2002; 60/274,622, filed 14/11/2001; 60/247,621, filed 14/11/2001; 60/247,620, filed 14/11/2001; 60/247,595, filed 14/11/2001; 60/247,594, filed 14/11/2001; 60/247,635, filed 14/11/2001; 60/247,634, filed 14/11/2001; 60/247,606, filed 14/11/2001; 60/247,607, filed 14/11/2001; 60/247,608, filed 14/11/2001; 60/247,609, filed 14/11/2001; 60/247,610, filed 14/11/2001; 60/247,611, filed 14/11/2001; 60/247,702, filed 14/11/2001; 60/247,701, filed 14/11/2001; 60/247,700, filed 14/11/2001; 60/247,699, filed 14/11/2001; 60/247,698, filed 14/11/2001; 60/247,807, filed 14/11/2001; 60/247,833, filed 14/11/2001; 60/247,832, filed 14/11/2001; 60/247,927, filed 14/11/2001; 60/247,926, filed 14/11/2001; 60/247,930, filed 14/11/2001; 60/247,929, filed 14/11/2001; 60/247,928, filed 14/11/2001; 60/247,797, filed 14/11/2001; 60/247,805, filed 14/11/2001; 60/247,804, filed 14/11/2001; 60/247,803, filed 14/11/2001; 60/247,802, filed 14/11/2001; 60/247,801, filed 14/11/2001; 60/247,800, filed 14/11/2001; 60/247,799, filed 14/11/2001; 60/247,798, filed 14/11/2001; 60/247,561, filed 14/11/2001; 60/247,560, filed 14/11/2001; 60/247,559, filed 14/11/2001; 60/247,558, filed 14/11/2001; 60/247,556, filed 14/11/2001; 60/247,612, filed 14/11/2001; 60/247,613, filed
'14/11/2001; 60/247,614, filed 14/11/2001; 60/247,615, filed 14/11/2001; 60/247,616, filed 14/11/2001; 60/247,617, filed 14/11/2001; 60/247,633, filed 14/11/2001; 60/247,632, filed 14/11/2001; 60/247,631, filed 14/11/2001; 60/247,630, filed 14/11/2001; 60/247,629, filed 14/11/2001; 60/247,628, filed 14/11/2001; 60/247,627, filed 14/11/2001; 60/247,626, filed 14/11/2001; 60/247,625, filed 14/11/2001; 60/247,624, filed 14/11/2001; 60/247,806, filed 14/11/2001; 60/247,695, filed 14/11/2001; 60/247,794, filed 14/11/2001; 60/247,793, filed 14/11/2001; 60/247,792, filed 14/11/2001; 60/247,791, filed 14/11/2001; 60/247,790, filed 14/11/2001; 60/247,789, filed 14/11/2001; 60/247,788, filed 14/11/2001; 60/247,787, filed 14/11/2001; 60/247,786, filed 14/11/2001; 60/247,785, filed 14/11/2001; 60/247,784, filed 14/11/2001; 60/247,783, filed 14/11/2001; 60/247,782, filed 14/11/2001; 60/247,781, filed 14/11/2001; 60/247,780, filed 14/11/2001; 60/247,779, filed 14/11/2001; 60/247,778, filed 14/11/2001; 60/247,777, filed 14/11/2001; 60/247,776, filed 14/11/2001; 60/247,775, filed 14/11/2001; 60/247,774, filed 14/11/2001; 60/247,773, filed 14/11/2001; 60/247,772, filed 14/11/2001; 60/247,771, filed 14/11/2001; 60/247,770, filed 14/11/2001; 60/247,769, filed 14/11/2001; 60/247,768, filed 14/11/2001; 60/247,767, filed 14/11/2001; 60/247,766, filed 14/11/2001; 60/247,871, filed 14/11/2001; 60/247,872, filed 14/11/2001; 60/247,873, filed 14/11/2001; 60/247,874, filed 14/11/2001; 60/247,875, filed 14/11/2001; 60/247,981, filed 14/11/2001; 60/247,982, filed 14/11/2001; 60/247,983, filed 14/11/2001; 60/247,984, filed 14/11/2001; 60/247,745, filed 14/11/2001; 60/247,744, filed 14/11/2001; 60/247,743, filed 14/11/2001; 60/247,742, filed 14/11/2001; 60/247,623, filed 14/11/2001; 60/247,985, filed 14/11/2001; 60/247,840, filed 14/11/2001; 60/247,839, filed 14/11/2001; 60/247,838, filed 14/11/2001; 60/247,837, filed 14/11/2001; 60/247,836, filed 14/11/2001; 60/247,889, filed 14/11/2001; 60/247,890, filed 14/11/2001; 60/247,891, filed 14/11/2001; 60/247,892, filed 14/11/2001; 60/247,893, filed 14/11/2001; 60/247,741, filed 14/11/2001; 60/247,740, filed 14/11/2001; 60/247,739, filed 14/11/2001; 60/247,738, filed 14/11/2001; 60/247,737, filed 14/11/2001; 60/247,736, filed 14/11/2001; 60/247,735, filed 14/11/2001;
^50/247,734, filed 14/11/2001; 60/247,733, filed 14/11/2001; 60/247,732, filed 14/11/2001; 60/247,731, filed 14/11/2001; 60/247,730, filed 14/11/2001; 60/247,728, filed 14/11/2001; 60/247,729, filed 14/11/2001; 60/247,727, filed 14/11/2001; 60/247,726, filed 14/11/2001; 60/247,761, filed 14/11/2001; 60/247,760, filed 14/11/2001; 60/247,759, filed 14/11/2001; 60/247,758, filed 14/11/2001; 60/247,757, filed 14/11/2001; 60/247,756, filed 14/11/2001; 60/247,765, filed 14/11/2001; 60/247,764, filed 14/11/2001; 60/247,763, filed 14/11/2001; 60/247,762, filed 14/11/2001; 60/247,755, filed 14/11/2001; 60/247,746, filed 14/11/2001; 60/247,725, filed 14/11/2001; 60/247,724, filed 14/11/2001; 60/247,723, filed 14/11/2001; 60/247,722, filed 14/11/2001; 60/247,721, filed 14/11/2001; 60/247,720, filed 14/11/2001; 60/247,719, filed 14/11/2001; 60/247,718, filed 14/11/2001; 60/247,717, filed 14/11/2001; 60/247,716, filed 14/11/2001; 60/247,754, filed 14/11/2001; 60/247,753, filed 14/11/2001; 60/247,752, filed 14/11/2001; 60/247,751, filed 14/11/2001; 60/247,750, filed 14/11/2001; 60/247,749, filed 14/11/2001; 60/247,748, filed 14/11/2001; 60/247,747, filed 14/11/2001; 60/247,796, filed 14/11/2001; 60/247,815, filed 14/11/2001; 60/247,814, filed 14/11/2001; 60/247,813, filed 14/11/2001; 60/247,812, filed 14/11/2001; 60/247,811, filed 14/11/2001; 60/247,810 filed 14/11/2001; 60/247,809 filed 14/11/2001; 60/247,808 filed 14/11/2001; 60/247,885 filed 14/11/2001; 60/247,884 filed 14/11/2001; 60/247,883 filed 14/11/2001; 60/247,882 filed 14/11/2001; 60/247,881 filed 14/11/2001; 60/247,880 filed 14/11/2001; 60/247,879 filed 14/11/2001; 60/247,878 filed 14/11/2001; 60/247,826 filed 14/11/2001; 60/247,835 filed 14/11/2001; 60/247,834 filed 14/11/2001; 60/247,897 filed 14/11/2001; 60/247,896 filed 14/11/2001; 60/247,895 filed 14/11/2001; 60/247,894 filed 14/11/2001; 60/247,901 filed 14/11/2001; 60/247,900 filed 14/11/2001; 60/247,899 filed 14/11/2001; 60/247,898 filed 14/11/2001; 60/247,903 filed 14/11/2001; 60/247,902 filed 14/11/2001; 60/247,919 filed 14/11/2001; 60/247,918 filed 14/11/2001; 60/247,917 filed 14/11/2001; 60/247,916 filed 14/11/2001 ;60/247,915 filed 14/11/2001; 60/247,914 filed 14/11/2001; 60/247,913 filed 14/11/2001; 60/247,912 filed 14/11/2001; 60/247,911 filed 14/11/2001; 60/247,910 filed 14/11/2001; 60/247,877 filed 14/11/2001;
KO/247,876 filed 14/11/2001; 60/247,707 filed 14/11/2001; 60/247,706 filed 14/11/2001; 60/247,705 filed 14/11/2001; 60/247,704 filed 14/11/2001; 60/247,703 filed 14/11/2001; 60/247,692 filed 14/11/2001; 60/247,691 filed 14/11/2001; 60/247,690 filed 14/11/2001; 60/247,689 filed 14/11/2001; 60/247,688 filed 14/11/2001; 60/247,687 filed 14/11/2001; 60/247,686 filed 14/11/2001; 60/247,685 filed 14/11/2001; 60/247,684 filed 14/11/2001; 60/247,683 filed 14/11/2001; 60/247,694 filed 14/11/2001; 60/247,693 filed 14/11/2001; 60/247,712 filed 14/11/2001; 60/247,711 filed 14/11/2001; 60/247,710 field 14/11/2001; 60/247,709 filed 14/11/2001; 60/247,708 filed 14/11/2001; 60/247,697 filed 14/11/2001; 60/247,696 filed 14/11/2001; 60/247,695 filed 14/11/2001; 60/247,565 filed 14/11/2001; 60/247,564 filed 14/11/2001; 60/247,545 filed 14/11/2001; 60/247,546 filed 14/11/2001; 60/247,547 filed 14/11/2001; 60/247,548 filed 14/11/2001; 60/247,568 filed 14/11/2001; 60/247,570 filed 14/11/2001; 60/247,580 filed 14/11/2001; 60/247,555 filed 14/11/2001; 60/247,554 filed 14/11/2001; 60/247,553 filed 14/11/2001; 60/247,552 filed 14/11/2001: 60/247,551 filed 14/11/2001; 60/247,682 filed 14/11/2001; 60/247,681 filed 14/11/2001; 60/247,680 filed 14/11/2001; 60/247,679 filed 14/11/2001; 60/247,678 filed 14/11/2001; 60/247,677 filed 14/11/2001; 60/247,676 filed 14/11/2001; 60/247,655 filed 14/11/2001; 60/247,645 filed 14/11/2001; 60/247,656 filed 14/11/2001; 60/248,607 filed 16/11/2000; 60/248,611 filed 16/11/2000; 60/248,609 filed 16/11/2000; 60/248,608 filed 16/11/2000; 60/248,606 filed 16/11/2000; 60/248,604 filed 16/11/2000; 60/248,603 filed 16/11/2000; 60/248,601 filed 16/11/2000; 60/248,600 filed 16/11/2000; 60/248,712 filed 16/11/2000; 60/248,711 filed 16/11/2000; 60/248,709 filed 16/11/2000; 60/248,708 filed 16/11/2000; 60/248,707 filed 16/11/2000; 60/248,706 filed 16/11/2000; 60/248,705 filed 16/11/2000; 60/248,704 filed 16/11/2000; 60/248,703 filed 16/11/2000; 60/248,702 filed 16/11/2000; 60/248,701 filed 16/11/2000; 60/248,700 filed 16/11/2000; 60/248,699 filed 16/11/2000; 60/248,698 filed 16/11/2000; 60/248,697 filed 16/11/2000; 60/248,696 filed 16/11/2000; 60/248,695 filed 16/11/2000; 60/248,694 filed 16/11/2000; 60/248,693 filed 16/11/2000; 60/248,692 filed 16/11/2000; 60/248,691 filed 16/11/2000; 60/248,710 filed 16/11/2000; 60/248,689 filed 16/11/2000; 60/248,688 filed
16/11/2000; 60/248,686 filed 16/11/2000; 60/248,720 filed 16/11/2000; 60/248,719 filed 16/11/2000; 60/248,718 filed 16/11/2000; 60/248,717 filed 16/11/2000; 60/248,716 filed 16/11/2000; 60/248,715 filed 16/11/2000; 60/248,714 filed 16/11/2000; 60/248,713 filed 16/11/2000; 60/248,536 filed 16/11/2000; 60/248,535 filed 16/11/2000; 60/248,733 filed 16/11/2000; 60/248,732 filed 16/11/2000; 60/248,731 filed 16/11/2000; 60/248,730 filed 16/11/2000; 60/248,729 filed 16/11/2000; 60/248,728 filed 16/11/2000; 60/248,727 filed 16/11/2000; 60/248,726 filed 16/11/2000; 60/248,725 filed 16/11/2000; 60/248,724 filed 16/11/2000; 60/248,723 filed 16/11/2000; 60/248,722 filed 16/11/2000; 60/248,721 filed 16/11/2000; 60/248,540 filed 16/11/2000; 60/248,539 filed 16/11/2000; 60/248,538 filed 16/11/2000; 60/248,537 filed 16/11/2000; 60/248,533 filed 16/11/2000; 60/248,532 filed 16/11/2000; 60/248,531 filed 16/11/2000; 60/248,530 filed 16/11/2000; 60/248,529 filed 16/11/2000; 60/248,528 filed 16/11/2000; 60/248,527 filed 16/11/2000; 60/248,526 filed 16/11/2000; 60/248,525 filed 16/11/2000; 60/248,524 filed 16/11/2000; 60/248,670 filed 16/11/2000; 60/248,789 filed 16/11/2000; 60/248,599 filed 16/11/2000; 60/248,745 filed 16/11/2000; 60/248,746 filed 16/11/2000; 60/248,747 filed 16/11/2000; 60/248,744 filed 16/11/2000; 60/248,743 filed 16/11/2000; 60/248,756 filed 16/11/2000; 60/248,602 filed 16/11/2000; 60/248,598 filed 16/11/2000; 60/248,597 filed 16/11/2000; 60/248,596 filed 16/11/2000; 60/248,595 filed 16/11/2000; 60/248,594 filed 16/11/2000; 60/248,858 filed 16/11/2000; 60/248,857 filed 16/11/2000; 60/248,856 filed 16/11/2000; 60/248,855 filed 16/11/2000; 60/248,854 filed 16/11/2000; 60/248,853 filed 16/11/2000; 60/248,852 filed 16/11/2000; 60/248,851 filed 16/11/2000; 60/248,850 filed 16/11/2000; 60/248,849 filed 16/11/2000; 60/248,848 filed 16/11/2000; 60/248,792 filed 16/11/2000; 60/248,790 filed 16/11/2000; 60/248,669 filed 16/11/2000; 60/248,668 filed 16/11/2000; 60/248,667 filed 16/11/2000; 60/248,666 filed 16/11/2000; 60/248,665 filed 16/11/2000; 60/248,664 filed 16/11/2000; 60/248,793 filed 16/11/2000; 60/248,791 filed 16/11/2000; 60/248,684 filed 16/11/2000; 60/248,683 filed 16/11/2000; 60/248,682 filed 16/11/2000; 60/248,681 filed 16/11/2000; 60/248,680 filed 16/11/2000; 60/248,671 filed 16/11/2000; 60/248,679 filed 16/11/2000; 60/248,675 filed 16/11/2000; 60/248,676
tiled 16/11/2000; 60/248,677 filed 16/11/2000; 60/248,678 filed 16/11/2000; 60/248,673 filed 16/11/2000; 60/248,674 filed 16/11/2000; 60/248,672 filed 16/11/2000; 60/248,784 filed 16/11/2000; 60/248,785 filed 16/11/2000; 60/248,786 filed 16/11/2000; 60/248,775 filed 16/11/2000; 60/248,773 filed 16/11/2000; 60/248,766 filed 16/11/2000; 60/248,765 filed 16/11/2000; 60/248,833 filed 16/11/2000; 60/248,783 filed 16/11/2000; 60/248,781 filed 16/11/2000; 60/248,780 filed 16/11/2000; 60/248,778 filed 16/11/2000; 60/248,767 filed 16/11/2000; 60/248,787 filed 16/11/2000; 60/248,774 filed 16/11/2000; 60/248,764 filed 16/11/2000; 60/248,782 filed 16/11/2000; 60/248,779 filed 16/11/2000; 60/248,685 filed 16/11/2000; 60/248,772 filed 16/11/2000; 60/248,771 filed 16/11/2000; 60/248,777 filed 16/11/2000; 60/248,776 filed 16/11/2000; 60/248,770 filed 16/11/2000; 60/248,768 filed 16/11/2000; 60/248,769 filed 16/11/2000; 60/248,796 filed 16/11/2000; 60/248,797 filed 16/11/2000; 60/248,795 filed 16/11/2000; 60/248,794 filed 16/11/2000; 60/248,663 filed 16/11/2000; 60/248,662 filed 16/11/2000; 60/248,660 filed 16/11/2000; 60/248,659 filed 16/11/2000; 60/248,658 filed 16/11/2000; 60/248,656 filed 16/11/2000; 60/248,654 filed 16/11/2000; 60/248,653 filed 16/11/2000; 60/248,651 filed 16/11/2000; 60/248,650 filed 16/11/2000; 60/248,648 filed 16/11/2000; 60/248,647 filed 16/11/2000; 60/248,645 filed 16/11/2000; 60/248,643 filed 16/11/2000; 60/248,642 filed 16/11/2000; 60/248,640 filed 16/11/2000; 60/248,637 filed 16/11/2000; 60/248,636 filed 16/11/2000; 60/248,634 filed 16/11/2000; 60/248,632 filed 16/11/2000; 60/248,631 filed 16/11/2000; 60/248,630 filed 16/11/2000; 60/248,629 filed 16/11/2000; 60/248,627 filed 16/11/2000; 60/248,625 filed 16/11/2000; 60/248,763 filed 16/11/2000; 60/248,761 filed 16/11/2000; 60/248,759 filed 16/11/2000; 60/248,757 filed 16/11/2000; 60/248,754 filed 16/11/2000; 60/248,753 filed 16/11/2000; 60/248,749 filed 16/11/2000; 60/248,616 filed 16/11/2000; 60/248,615 filed 16/11/2000; 60/248,614 filed 16/11/2000; 60/248,613 filed 16/11/2000; 60/248,612 filed 16/11/2000; 60/248,605 filed 16/11/2000; 60/248,610 filed 16/11/2000; 60/248,661 filed 16/11/2000; 60/248,657 filed 16/11/2000; 60/248,655 filed 16/11/2000; 60/248,652 filed 16/11/2000; 60/248,649 filed 16/11/2000; 60/248,646 filed 16/11/2000; 60/248,644 filed 16/11/2000; 60/248,641 filed 16/11/2000;
60/248,639 filed 16/11/2000; 60/248,638 filed 16/11/2000; 60/248,635 filed 16/11/2000; 60/248,633 filed 16/11/2000; 60/248,628 filed 16/11/2000; 60/248,626 filed 16/11/2000; 60/248,624 filed 16/11/2000; 60/248,762 filed 16/11/2000; 60/248,760 filed 16/11/2000; 60/248,758 filed 16/11/2000; 60/248,755 filed 16/11/2000; 60/248,752 filed 16/11/2000; 60/248,751 filed 16/11/2000; 60/248,750 filed 16/11/2000; 60/248,742 filed 16/11/2000; 60/248,741 filed 16/11/2000; 60/248,740 filed 16/11/2000; 60/248,739 filed 16/11/2000; 60/248,736 filed 16/11/2000; 60/248,735 filed 16/11/2000; 60/248,734 filed 16/11/2000; 60/248,623 filed 16/11/2000; 60/248,622 filed 16/11/2000; 60/248,621 filed 16/11/2000; 60/248,738 filed 16/11/2000; 60/248,737 filed 16/11/2000; 60/248,620 filed 16/11/2000; 60/248,619 filed 16/11/2000; 60/248,618 filed 16/11/2000; 60/248,617 filed 16/11/2000; 60/248,748 filed 16/11/2000.
BACKGROUND OF THE INVENTION
(i) Field of the Invention
[002] The present invention relates to active agent delivery systems and,
more specifically, to compositions that comprise peptides covalently attached to active agents and methods for administering conjugated active agent compositions.
(ii) Background of the Invention
[003] Active agent delivery systems are often critical for the safe effective
administration of a biologically active agent (active agent). Perhaps the importance of these systems is best realized when patient compliance and consistent dosing are taken under consideration. For instance, reducing the dosing requirement for a drug from four-times-a-day (QID) to a single dose per day would have significant value in terms of ensuring patient compliance. Increasing the stability of the active agent, will assure dosage reproducibility and perhaps may also reduce the number of dosages required. Furthermore, any benefit that modulated absorption can confer on an existing drug would certainly improve the safety of the drug. Finally, improving the absorption of drugs should have a significant impact on the safety and efficacy of the drug.
£004] Absorption of an orally administered active agent is often blocked by
the harshly acidic stomach milieu, powerful digestive enzymes in the gastrointestinal (GI) tract, lack of the agent's permeability and transport across lipid bilayers. These systems respond, in part, to the physicochemical properties of the drug molecule itself. Physical constants describing specific physicochemical properties like lipophilicity (log P) and ionizability (pKa) depend on molecular structure of the active agent. Some drugs are poorly absorbed because they are too hydrophilic and do not effectively cross the plasma membranes of cells. Others are too lipophilic and are insoluble in the intestinal lumen and cannot migrate to the mucosa lining. The entire digestion and absorption process is a complex sequence of events, some of which are closely interdependent. There should exist optimum physicochemical properties by which active agent bioavailability is maximized. However, it is often difficult to optimize these properties without losing therapeutic efficacy. [005] Optimization of a drug's bioavailability has many potential benefits.
For patient convenience and enhanced compliance it is generally recognized that less frequent dosing is desirable. By extending the period through which the drug is absorbed, a longer duration of action per dose is expected. This will then lead to an overall improvement of dosing parameters such as taking a drug twice a day where it has previously required four times a day dosing. Many drugs are presently given at a once a day dosing frequency. Yet, not all of these drugs have pharmacokinetic properties that are suitable for dosing intervals of exactly twenty-four hours. Extending the period through which these drugs are absorbed would also be beneficial.
[006] One of the fundamental considerations in drug therapy involves the
relationship between blood levels and therapeutic activity. For most drugs, it is of primary importance that serum levels remain between a minimally effective concentration and a potentially toxic level, m pharmacokinetic terms, the peaks and troughs of a drug's blood levels ideally fit well within the therapeutic window of serum concentrations. For certain therapeutic agents, this window is so narrow that dosage formulation becomes critical. Such is the case with the drug, digoxin, which is used to treat heart failure.
[007] Digoxin therapeutic blood levels include the range between 0.8
ng/mL (below which the desired effects may not be observed) and about 2 ng/mL (above which toxicity may occur). Among adults in whom clinical toxicity has been observed, two thirds have serum concentrations greater than 2 ng/mL. Furthermore, adverse reactions can increase dramatically with small increases above this maximum level. For example, digoxin-induced arrhythmias occur at 10%, 50%, and 90% incidences at serum drug levels of 1.7, 2.5 and 3.3 ng/mL, respectively. [008] After the oral administration of digoxin, an effect will usually be
evident in 1-2 hours with peak effects being observed between 4 and 6 hours. After a sufficient time, the concentration in plasma and the total body store is dependent on the single daily maintenance dose. It is critical that this dose be individualized for each patient. Having a dosage form of digoxin that provides a more consistent serum level between doses is therefore useful.
[009] Another example of the benefit of more consistent dosing is provided
by the 6-blocker atenolol. The duration of effects for this commonly used drug is usually assumed to be 24 hours. However, at the normal dose range of 25-100 mg given once a day, the effect may wear off hours before the next dose begins acting. For patients being treated for angina, hypertension, or for the prevention of a heart attack, this may be particularly risky. One alternative is to give a larger dose than is necessary in order to get the desired level of action when the serum levels are the lowest. But this may cause side effects related to excessive concentrations in the initial hours of the dosing interval. At these higher levels, atenolol loses its potential advantages. 6-1 selectivity and adverse reactions related to the blockade of 6-2 receptors become more significant.
[010] In the case of anti-HIV nucleoside drugs, metering the absorption of
the drug into the bloodstream has sufficient benefit. Drugs like AZT, for example, depend on phosphorylation to occur after absorption and before uptake into a virus in order to be effective. In normal dosing, drug levels increase rapidly after absorption that the phosphorylation reaction pathways can become saturated. Furthermore, the rate of phosphorylation is dependent on serum concentrations. The reactions occur more rapidly when concentrations are lower. Therefore, nucleoside
analogs which retain lower serum concentrations are more efficiently converted to active drugs than other rapidly absorbed anti-viral drugs.
[01l] Whereas the toxicity of digoxin and atenolol can be viewed as
extensions of their desired activities, toxicity associated with the statins, on the other hand, is seemingly unrelated to the therapeutic effect of the drug. The toxic side effects of statins include, amongst other things, liver problems and rhabdomyolysis. Although the exact cause of statin-induced rhabdomyolysis and liver toxicity is not well understood, they have been linked to potent liver enzymes. The therapeutic effect of the statins is a result of the down-regulation of one of the key enzymes responsible for cholesterol production. Statin overdosing, however, can cause the reduced synthesis of non-sterol products that are important for cell growth, in addition to rhabdomyolysis. So with the statins, a case can be made that by modulating the absorption of the drug, the therapeutic effect can be obtained at lower doses thereby minimizing the risk of producing toxic side effects. [012] Finally, increasing the absorption of an active agent can have a
significant impact on its safety. Taking the example of statins, once more, statins are anywhere between 10 and 30% absorbed and dosing is based on the average of this range so for patients that absorb 30% of the statins administered, deleterious side effects can occur. The risk of manifesting these side effects would be greatly diminished if the bioavailability of the drug were more predictable. [013] In an attempt to address the need for improved bioavailability several
drug release modulation technologies have been developed. Enteric coatings have been used as a protector of Pharmaceuticals in the stomach and microencapsulating active agents using protenoid microspheres, liposomes or polysaccharides have been effective in abating enzyme degradation of the active agent. Enzyme inhibiting adjuvants have also been used to prevent enzyme degradation. [014] A wide range of pharmaceutical formulations purportedly provides
sustained release through microencapsulation of the active agent in amides of dicarboxylic acids, modified amino acids or thermally condensed amino acids. Slow release rendering additives can also be intermixed with a large array of active agents in tablet formulations. For example, formulating diazepam with a copolymer of
' glutamic acid and aspartic acid enables a sustained release of the active agent. As another example, copolymers of lactic acid and glutaric acid are used to provide timed release of human growth hormone. The microencapsulation of therapeutics and diagnostic agents is generally described for example in U.S. 5,238,714 to Wallace et al.
[015] While microencapsulation and enteric coating technologies impart
enhanced stability and time-release properties to active agent substances these technologies suffer from several shortcomings. Incorporation of the active agent is often dependent on diffusion into the microencapsulating matrix, which may not be quantitative and may complicate dosage reproducibility. In addition, encapsulated drugs rely on diffusion out of the matrix or degradation of the matrix, which is highly dependant on the water solubility of the active agent. Conversely, water-soluble microspheres swell by an infinite degree and, unfortunately, may release the active agent in bursts with little active agent available for sustained release. Furthermore, in some technologies, control of the degradation process required for active agent release is unreliable. For example, an enterically coated active agent depends on pH to release the active agent and, as such, is difficult to control the rate of release.
[016] Active agents have been covalently attached to the amino acid side
chains of polypeptides as pendant groups. These technologies typically require the use of spacer groups between the amino acid pendant group and the active agent. An example of a timed and targeted release pharmaceutical administered intravenously, intraperitoneally, or intra-arterially includes the linking of nitrogen mustard, via a stabilizing peptide spacer, to a macromolecular carrier, e.g. poly-[N5-(2-hydroxylethyl)-L-glutamine] (PHEG) which has an improved half-life when attached to the carrier and stabilizing unit.
[017] Dexamethasone has been covalently attached directly to the beta
carboxylate of polyaspartic acid as a colon-specific drug delivery system, which is released by bacterial hydrolytic enzymes residing in the large intestines. The dexamethasone active agent was targeted to treat large bowel disorders and was not intended to be absorbed into the bloodstream. Other examples include techniques
for forming peptide-linked biotin, peptide-linked acridine, naphthylacetic acid bonds to LH-RH, and coumarinic acid cyclic bonds to opioid peptides. [018] Several implantable drug delivery systems have utilized polypeptide
attachment to drugs. An example includes the linking of norethindrone, via a hydroxypropyl spacer, to the gamma carboxylate of a large polyglutamic acid polymeric carrier designed to biodegrade over long periods of time after implantation via injection or surgical procedures. Additionally, other large polymeric carriers incorporating drugs into their matrices are used as implants for the gradual release of drug. Examples of implant delivery systems are generally described in U.S. 4,356,166 to Peterson et al. and 4,976,962 to Bichon et al. Yet another technology combines the advantages of covalent drug attachment with liposome formation where the active ingredient is attached to highly ordered lipid films (known as HARs) via a peptide linker. Further description can be found in WO 97/36616 and U.S. 5,851,536 to Yager et al.
[019] Other systems were designed for the delivery of cytotoxic agents with
specific amino acid sequences so that the drug will not be cleaved until the conjugate comes into contact with specific enzymes or receptors. One such example is the binding of oligopeptides directed toward enzymatically active prostrate specific antigen (PSA), to a cytotoxic agent which also typically contains a protecting group to prevent premature release of die conjugate in the blood. Another system designed for delivery via injection relies on specific peptides directly linked to a polymeric carrier, which is, in turn, attached to the cytotoxic moiety to be internalized by the cell. In this case, the polymeric carrier, typically large, will not enter cells lacking receptors for the specific peptide attached. In another example, gastrin receptor directed tetragastrin and pentagastrin amides were attached to cytotoxic drug for testing in vitro. These systems are generally described in U.S. 5,948,750 to Garsky et al.; U.S. 5,087,616 Myers et al.; and Schmidt et al., Peptide Linked l,3-Dialkyl-3-acyltriazenes: Garstrin Receptor Directed Antineoplastic Alkylating Agents, Journal of Medical Chemistry, Vol. 37, No. 22, pp. 3812-17 (1994).
[020] Several systems have been directed to the treatment of tumor cells.
In one case, Daunorubicin bound poly-L-aspartic acid, delivered intravenously or intraperitoneally, demonstrated lower cytotoxic effect. In another example, Daunorubicin was covalently attached via a methylketone side-chain of the drug to both poly-L-aspartic acid and poly-L-lysine The conjugates were prepared for intravenous and intraperitoneal administration. The poly-L-lysine was found to be ineffective, while the poly-L-aspartic acid conjugate showed preferential tumor cell uptake. In another system, a highly substituted polypetide conjugated to the active agent was designed for introduction into blood vessels that further penetrated the interstitium of tumors through long chain lengths. Further discussion of delivery systems targeted at tumor cells are described in Zunino et al., Comparison of Antitumor Effects of Daunorubicin Covalently Linked to Poly-L-Amino Acid Carriers, Eur. J. Cancer Clin. Oncol, Vol. 20, No. 3, pp. 421-425 (1984); Zunino et al., Anti-tumor Activity of Daunorubicin Linked to Poly-L-Aspartic Acid, Int. J. Cancer, 465-470 (1982); and 5,762,909 to Uzgiris.
[021] Several examples relate to the delivery of paclitaxel, an anti-cancer
drug. One delivery system relies on the drug remaining attached to the conjugate for transport into the cell via a membrane transport system. In another example, the paclitaxel is conjugated to a high molecular weight polyglutamic acid, and was delivered via injection. Paclitaxel conjugates have also been used with implants, coatings and injectables. These systems are further described in U.S. Patent 6,306,993; Li et al. Complete Regression of Well-established Tumors Using a Novel Water-soluble Poly(L-Glutamic Acid)-Paclitaxel Conjugate, pp. 2404-2409; and U.S. 5,977,163 to Li et al.
[022] Delivery systems can be designed to utilize attachment to chemical
moieties that are either specifically recognized by a specialized transporters or have enhanced adsorption into target cells through specific polypeptide sequence. There are seven known intestinal transport systems classified according to the physical properties of the transported substrate. They include the amino acid, oligopeptide, glucose, monocarboxic acid, phosphate, bile acid and the P-glycoprotein transport systems and each has its own associated mechanism of transport. Evidence suggests
-that hydrophilic compounds are absorbed through the intestinal epithelia more efficiently through these specialized transporters than by passive diffusion. Active transport mechanisms can depend on hydrogen ions, sodium ions, binding sites or other cofactors. Facilitation of these transporters can also depend on some sort of specialized adjuvant, which can result in localized delivery of an active agent, increased absorption of the active agent or some combination of both. Incorporating adjuvants such as resorcinol, surfactants, polyethylene glycol (PEG) or bile acids enhance permeability of cellular membranes. Increased bioavailability was found when peptides were bound to modified bile acids. Kramer et al., Intestinal Absorption of Peptides by Coupling to Bile Acids, The Journal of Biological Chemistry, Vol. 269, No. 14, pp. 10621-627 (1994). The use of specific polypeptide sequences to increase absorption is discussed in the literature where attaching the drug to a polypeptide chain enhances the drug's permeability into cells. For example, Paul Wender of Stanford University reported the use of polyarginine tags on cyclosporine and taxol to facilitate diffusion across cell membranes. The penetratin system provides another example. This class of peptides, about 16 residues long, was shown to enhance absorption of oligonucleotides and polypeptides.
[023] It is also important to control the molecular weight, molecular size
and particle size of the active agent delivery system. Variable molecular weights have unpredictable diffusion rates and pharmacokinetics. High molecular weight carriers are digested slowly or late, as in the case of naproxen-linked dextran, which is digested almost exclusively in the colon by bacterial enzymes. High molecular weight microspheres usually have high moisture content which may present a problem with water labile active ingredients. Due to the inherent instability of non-covalent bonds, the bond between the active agent and the microsphere will usually not withstand the vigorous conditions used to reduce the composition's particle size. [024] Thus, there has been no pharmaceutical composition, heretofore
reported, that incorporates the concept of attaching an active agent to a peptide or its pendant group with targeted delivery of the active agent into the general systemic circulation. Furthermore, there has been no pharmaceutical composition that teaches
" fiie release of the active agent from the peptide by enzymatic action in the gastro intestinal tract.
[025] The need still exists for an active agent delivery system that does not
require that the active agent be released within specific cells (e.g. a tumor-promoting cell), but rather results in release of the active agent for general systemic delivery. [026] The need further exists for an active agent delivery system that allows
for the oral delivery of active agents that will survive in the stomach and allow for the release of the reference active agent in the small intestines, the brush border membrane, in the intestinal epithelial cells or by enzymes in the bloodstream. The present invention also addresses the need for an active agent delivery system that is able to deliver active agents as an active agent peptide conjugate so that the molecular mass and physiochemical properties of the conjugate can be readily manipulated to achieve the desired release rate. The need still exists for an active agent delivery system that allows for the active agent to be released over a sustained period of time, which is convenient for patient dosing.
[027] There is a generally recognized need to have an active agent delivery
system that reduces the daily dosing requirement and allows for time released or controlled released absorption of the composition. The present invention accomplishes this by extending the period during which an active agent is absorbed, and providing a longer duration of action per dose than is currently expected. This leads to an overall improvement of dosing parameters such as, for example, taking an active agent twice a day where it has previously required four times a day dosing. Alternatively, many active agents presently given at a once a day dosing frequency lack the pharmacokinetic properties suitable for dosing intervals of exactly, twelve or twenty-four hours. An extended period of active agent adsorption for the current single dose active agents still exists and would be beneficial. [028] Therefore, the need still exists for a drug delivery system that enables
the use of new molecular compositions, which can reduce the technical, regulatory, and financial risks associated with active agents while improving the performance of the active agent in terms of its absorption parameters, as described above, and stability. Further, the need exists for an active agent delivery system targeted to
general systemic circulation wherein the release of the drug from the peptide can occur by enzymatic action on the peptide-drug conjugate in the bloodstream or by enzymatic action on the peptide-drug conjugate in the alimentary tract followed by absorption through the intestines or stomach.
SUMMARY OF THE INVENTION
[029] The present invention provides covalent attachment of active agents
to a peptide. The invention may be distinguished from the above mentioned technologies by virtue of covalently attaching the active agent directly, which includes, for example, pharmaceutical drugs and nutrients, to the N-terminus, the C-terminus or to the side chain of an amino acid, an oligopeptide or a polypeptide, also referred to herein as a carrier peptide. In another embodiment, when the active agent is itself an amino acid active agent, then the active agent may be part of the chain at either the C-terminus or N-terminus through a peptide bond, or interspersed in the polypeptide via peptide bonds on both sides of the active agent. [030] In another embodiment, the peptide stabilizes the active agent,
primarily in the stomach, through conformational protection. In this application, delivery of the active agent is controlled, in part, by the kinetics of unfolding of the carrier peptide. Upon entry into the upper intestinal tract, endigenous enzymes release the active ingredient for absorption by the body by hydrolyzing the peptide bonds of the carrier peptide. This enzymatic action introduces the second phase of the sustained release mechanism.
[031] In another embodiment, the invention provides a composition
comprising a peptide and an active agent covalently attached to the peptide. Preferably, the peptide is (i) an oligopeptide, (ii) a homopolymer of one of the twenty naturally occurring amino acids (L or D isomers), or an isomer, analogue, or derivative thereof, (iii) a heteropolymer of two or more naturally occurring amino acids (L or D isomers), or an isomer, analogue, or derivative thereof, (iv) a homopolymer of a synthetic amino acid, (v) a heteropolymer of two or more synthetic amino acids or (vi) a heteropolymer of one or more naturally occurring amino acids and one or more synthetic amino acids.
[032] The invention provides compositions comprising a carrier peptide
and an active agent covalently attached to the carrier peptide. Preferably, the carrier peptide is (i) an amino acid, (ii) a dipeptide, (iii) a tripeptide, (iv) an oligopeptide, or (v) polypeptide. The carrier peptide may also be (i) a homopolymer of a naturally occurring amino acids, (ii) a heteropolymer of two or more naturally occurring amino acids, (iii) a homopolymer of a synthetic amino acid, (iv) a heteropolymer of two or more synthetic amino acids, or (v) a heteropolymer of one or more naturally occurring amino acids and one or more synthetic amino acids. [033] A further embodiment of the carrier and/or conjugate is that the
unattached portion of the carrier/conjugate is in a free and unprotected state. [034] In another embodiment, the invention further provides a composition
comprising an amino acid, a dipeptide or a tripeptide with an active agent covalently attached. Preferably, the amino acid, dipeptide or tripeptide are (i) one of the twenty naturally occurring amino acids (L or D isomers), or an isomer, analogue, or derivative thereof, (ii) two or more naturally occurring amino acids (L or D isomers), or an isomer, analogue, or derivative thereof, (iii) a synthetic amino acid, (iv) two or more synthetic amino acids or (v) one or more naturally occurring amino acids and one or more synthetic amino acids. Preferably synthetic amino acids with alkyl side chains are selected from alkyls of C1-C17 in length and more preferably from C1-C6 in length.
[035] In one embodiment the active agent conjugate is attached to a single
amino acid which is either naturally occurring or a synthetic amino acid. In another embodiment the active agent conjugate is attached to a dipeptide or tripeptide, which could be any combination of the naturally occurring amino acids and synthetic amino acids. In another embodiment the amino acids are selected from L-amino acids for digestion by proteases.
[036] In another embodiment, the peptide carrier can be prepared using
conventional techniques. A preferred technique is copolymerization of mixtures of amino acid N-carboxyanhydrides. In another embodiment, the peptide can be prepared through a fermentation process of recombinant microorganisms followed by harvesting and purification of the appropriate peptide. Alternatively, if a specific
sequence of amino acids is desired, an automated peptide synthesizer can be used to produce a peptide with specific physicochemical properties for specific performance characteristics.
[037] In a preferred embodiment, the active agent is an inorganic acid or a
carboxylic acid and the carboxylate or the acid group is covalently attached to the N-terminus of the peptide. In another preferred embodiment, the active agent is a sulfonamide or an amine and the amino group is covalently attached to the C-terminus of the peptide. In another preferred embodiment, the active agent is an alcohol and the alcohol group is covalently attached to the C-terminus of the peptide.
[038] In another embodiment, the active agent is itself an amino acid and is
preferably covalently interspersed in the peptide in a peptide-linked manner or covalently attached to a side chain, the N-terminus or the C-terminus of the peptide. In this embodiment when the amino acid active agents are attached to the C-terminus or the N-terminus this results in the active agent being the end amino acid and is considered C-capped or N-capped, respectively.
[039] The active agent can be covalently attached to the side chains of the
polypeptide using conventional techniques. In a preferred embodiment a carboxylic acid containing active agent can be attached to the amine or alcohol group of the peptide side chain to form an amide or ester, respectively. In another preferred embodiment an amine containing active agent can be attached to the carboxylate, carbamide or guanine group of the side chain to form an amide or a new guanine group. In yet another embodiment of the invention, linkers can be selected from the group of all chemical classes of compounds such that virtually any side chain of the peptide can be attached.
[040] In a preferred embodiment the side chain attachment of an active
agent to the polypeptide the amino acids used in either homopolymers or heteropolymers are selected from glutamic acid, aspartic acid, serine, lysine, cysteine, threonine, asparagine, arginine, tyrosine, and glutamine. Preferred examples of peptides include, Leu-Ser, Leu-Glu, homopolymers of Glu and Leu, and heteropolymers of (Glu)n-Leu-Ser.
[041] In another embodiment, direct attachment of an active agent to the
carrier peptide may not form a stable compound therefore the incorporation of a linker between the active agent and the peptide is required. The linker should have a functional pendant group, such as a carboxylate, an alcohol, thiol, oxime, hydraxone, hydrazide, or an amine group, to covalently attach to the carrier peptide. In one preferred embodiment, the active agent is an alcohol and the alcohol group is covalently attached to the N-terminus of the peptide via a linker. In another preferred embodiment the active agent is a ketone or an aldehyde, which is attached to a linker through the formation of a ketal or acetal, respectively, and the linker has a pendant group that is attached to the carrier peptide. In yet another preferred embodiment the active agent is an amide, an imide, an imidazole or a urea where the nitrogen is attached to the linker and the pendant group of the linker is attached to the carrier peptide.
[042] The invention also provides a method for preparing a composition
comprising a peptide and an active agent covalently attached to the peptide. The method comprises the steps of:
[043] (a) attaching the active agent to a side chain (and/or N-terminus
and/or C-terminus) of an amino acid to form an active agent/amino acid complex; [044] (b) forming an amino acid complex N-carboxyanhydride (NCA) or
forming an active agent/amino acid complex NCA from the active agent/amino acid complex; and
[045] (c) polymerizing the active agent/amino acid complex N-
carboxyanhydride (NCA).
[046] In a preferred embodiment, the active agent is a pharmaceutical agent
or an adjuvant. In another preferred embodiment, steps (a) and (b) are repeated with a second active agent prior to step (c). When steps (a) and (b) are repeated with a second agent prior to step (c), the active agent and second active agent can be copolymerized in step (c). Step (b) can include an amino acid (e.g. Glycine, Alanine, etc.), without an active agent attached, such that the product in step (c) is a copolymer of the active agent/amino acid complex and an amino acid interspersed in a peptide-linked manner.
1047] In a further embodiment of the above method, the amino acid itself
can be an active agent (e.g. Thyroxine or DOPA) such that combining the NCA of
this bioactive amino acid NCA with other amino acid NCA's will produce a product
in (c) of the bioactive amino acid interspersed in the peptide with the generic amino
acid in a peptide-linked manner.
[048] Alternatively, the active agent/amino acid complex can serve as a
synthetic module for solid-phase or solution-phase peptide synthesis. Here, the drug
can be attached to the selected amino acid by the a-amino group, the a-carboxylate
or side chain functionality. Using these adducts in resin mounted peptide synthesis
allows greater control of peptide composition, degree of loading, and relative
positioning of the drug. Thus the uses of these modules represent a unique approach
for incorporating specified drugs at specific locations within peptides.
[049] Thus it is a further embodiment of this invention to expand the scope
of current peptide synthesis technology to include novel amino acids derived from
side-chain modified amino acids, hi addition, the N-terminus of an amino acid can
be modified for N-capped drug-peptide conjugate. Similarly, the C-terminus of an
amino acid can be derivatized with the drug to ultimately produce a C-capped
peptide-drug conjugate.
[050] The present invention provides for the synthesis whereby an active
agent is conjugated to an amino acid, a dipeptide, a tripeptide, an oligopeptide or a
polypeptide. Another embodiment of the present invention is dosage form reliability
and batch-to-batch reproducibility.
[051] In another embodiment the active agent delivery is targeted into
general systemic circulation. The release of the active agent from the peptide can
occur by enzymatic action on the peptide-active agent conjugate in the bloodstream
or by enzymatic action on the peptide-active agent conjugate in the alimentary tract
followed by absorption through the intestines or stomach by the regular route of
entry.
[052] In another embodiment, the invention also provides a method for
delivering an active agent to a patient, the patient being a human or a non-human
animal, comprising administering to the patient a composition comprising a peptide
and an active agent covalently attached to the peptide. In a preferred embodiment, the active agent is released from the composition by enzyme catalysis. In another preferred embodiment, the active agent is released in a time-dependent manner based on the pharmacokinetics of the enzyme-catalyzed release. [053] In another preferred embodiment, the generic amino acid is glutamic
acid and the side chain attached active agent/glutamic acid complex is released from the peptide upon hydrolysis of the peptide and then the active agent is released from the glutamic acid by coincident intramolecular transamination. In another preferred embodiment, the glutamic acid is replaced by an amino acid selected from the group consisting of aspartic acid, arginine, asparagine, cysteine, lysine, threonine, and serine, and wherein the active agent is attached to the side chain of the amino acid to form an amide, a thioester, an ester, an ether, a thioether, a carbonate, ah anhydride, an orthoester, a hydroxamic acid, a hydrazone, sulfonamide, sulfonic esters, other derivatives of sulfur, or a carbamate. In yet another preferred embodiment, the glutamic acid is replaced by a synthetic amino acid with a pendant group comprising an amine, an alcohol, a sulfhydryl, an amide, an urea, or an acid functionality. [054] The composition of the invention can also include one or more
microencapsulating agents, adjuvants and pharmaceutically acceptable excipients. The active agent can be bound to the microencapsulating agent, the adjuvant or the pharmaceutically acceptable excipient through covalent, ionic, hydrophilic interactions or by some other non-covalent means. The microencapsulating agent can be selected from polyethylene glycol (PEG), amino acids, carbohydrates or salts. If it is desired to delay peptide digestion, the microencapsulating agents can be used to delay protein unfolding. In another embodiment, when an adjuvant is included in the composition, the adjuvant preferably imparts better absorption either through enhancing permeability of the intestinal or stomach membrane or activating an intestinal transporter.
[055] The intestinal wall is coated with a mucosa lining made primarily of
mucin. Many reagents have been identified that can bind to mucin. In another embodiment, the present invention provides the unique capability of binding a mucin-binding adjuvant to the peptide/drug conjugate to bioadhere the entire
complex to the intestinal wall. The intestinal wall is impregnated with receptors for various reagents including many of the vitamins such as vitamin K. Binding vitamin K, for example, to the peptide-active agent conjugate will retain the entire complex in the intestines for a much longer time. It is the further embodiment of the invention wherein the adjuvant can bioadhere to the mucosal lining of the intestine thereby lengthening the transit time of the drug-peptide conjugate in the gut and maximizing peptide digestion and thus drug bioavailability.
[056] In another preferred embodiment, the composition further comprises
a microencapsulating agent and the active agent conjugate is released from the composition by swelling or dissolution of the microencapsulating agent followed by diffusion of the active agent conjugate which must then be acted upon by enzymes to release the active agent. In yet another preferred embodiment, the composition further comprises an adjuvant covalently attached to the peptide and release of the adjuvant from the composition is controlled by the enzymatic action on the peptide. The adjuvant can be microencapsulated into a carrier peptide-active agent conjugate for biphasic release of active agent. In another preferred embodiment, the peptide-active agent conjugate can be microencapsulated wherein the peptide-active agent conjugate is released in a biphasic manner, first through physicochemical means, such as through solvation or swelling, and then the active agent is released from the peptide carrier by enzymatic action. In yet another preferred embodiment of the invention, the active agent can be covalently attached to the microencapsulating agent via a peptide bond where the active agent is released first by peptidase action followed by migration of the active agent out of the microencapsulating medium. [057] It is another embodiment of the present invention that the active
agents may be combined with peptides of varying amino acid content to impart specific physicochemical properties to the conjugate including, molecular weight, size, functional groups, pH sensitivity, solubility, three dimensional structure and digestibility in order to provide desired performance characteristics. Similarly, a variety of active agents may also be used with specific preferred peptides to impart specific performance characteristics. Significant advantages with respect to the stability, release and/or adsorption characteristics of the active agent that are
imparted through the use of one or more of the 20 naturally occurring amino acids are manifest in the peptide physicochemical properties that impart specific stability, digestibility and release properties to the conjugates formed with active agents. [058] In another embodiment of the invention is the concept that the amino
acids that make up the carrier peptide is a tool set such that the carrier peptide can conform to the pharmacological demand and the chemical structure of the active agent such that maximum stability and optimal performance of the composition are
achieved.
[059] In another preferred embodiment the amino acid chain length can be
varied to suit different delivery criteria. For delivery with increased bioavailability, the active agent may be attached to a single amino acid to eight amino acids, with the range of two to five amino acids being preferred. For modulated delivery or increased bioavailability of active agents, the preferred length of the oligopeptide is between two and 50 amino acids in length. For conformational protection, extended digestion time and sustained release, preferred amino acid lengths may be between 8 and 400 amino acids. In another embodiment, the conjugates of the present invention are also suited for both large and small molecule active agents. In another embodiment of the present invention, the carrier peptide controls the solubility of the active agent-peptide conjugate and is not dependant on the solubility of the active agent. Therefore, the mechanism of sustained or zero-order kinetics afforded by the conjugate-drug composition avoids irregularities of release and cumbersome formulations encountered with typical dissolution controlled sustained release methods.
[060] In another preferred embodiment, the active agent conjugates can
incorporate adjuvants such that the compositions are designed to interact with specific receptors so that targeted delivery may be achieved. These compositions provide targeted delivery in all regions of the gut and at specific sites along the intestinal wall. In another preferred embodiment, the active agent is released as the reference active agent from the peptide conjugate prior to entry into a target cell. In another preferred embodiment, the specific amino acid sequences used are not targeted to specific cell receptors or designed for recognition by a specific genetic
sequence. In a more preferred embodiment, the peptide carrier is designed for recognition and/or is not recognized by tumor promoting cells. In another preferred embodiment, the active agent delivery system does not require that the active agent be released within a specific cell or intracellularly. In a preferred embodiment the carrier and/or the conjugate do result is specific recognition in the body. (e.g. by a cancer cell, by primers, for improving chemotactic activity, by sequence for a specific binding cite for serum proteins(e.g. kinins or eicosanoids). [061] In another embodiment the active agent may be attached to an
adjuvant recognized and taken up by an active transporter. In a more preferred example the active transporter is not the bile acid active transporter. In another embodiment, the present invention does not require the attachment of the active agent to an adjuvant recognized and taken up by an active transporter for delivery. [062] While microsphere/capsules may be used in combination with the
compositions of the invention, the compositions are preferably not incorporated with microspheres/capsules and do not require further additives to improve sustained release.
[063] In another preferred embodiment the active agent is not a hormone,
glutamine, methotrexate, daunorubicin, a trypsin-kallikrein inhibitor, insulin, calmodulin, calcitonin, naltrexone, L-dopa, interleukins, gonadoliberin, norethindrone, tolmetin, valacyclovir, taxol, a GABA analog, an L-aromatic amino acid decarboxylase inhibitor, a catechol O-methyl transferase inhibitor, a naturally occurring amino acid, a bis-(2-chloroethyl)amine containing nitrogen mustard, a polypeptide, a peptidomimetic derived from a linear oligopeptide with greater the three amino acids, an oligonucleotide, a cyclophane derivative, a diehtylenetriaminopentaacetate derivative, histamine, a steroid or silver sulfadiazine. In a preferred embodiment wherein the active agent is a peptidic active agent it is preferred the active agent is unmodified (e.g. the amino acid structure is not substituted).
[064] In a preferred embodiment the invention provides a carrier and active
agent which are bound to each other but otherwise unmodified in structure. This embodiment may further be described as the carrier having a free carboxy and/or
amine terminal and/or side chain groups other than the location of attachment for the
active agent. In a more preferred embodiment the carrier, whether a single arnino
acid, dipeptide, tripeptide, oligopeptide or polypeptide is comprises only naturally
occurring arnino acids.
[065] In a preferred embodiment the carrier is not a protein transporter (e.g.
histone, insulin, transferrin, IGF, albumin or prolactin), Ala, Gly, Phe-Gly, or Phe-
Phe. In a preferred embodiment the carrier is also preferably not a arnino acid
copolymerized with a non-amino acid substitute such as PVP, a poly(alkylene oxide)
arnino acid copolymer, or an alkyloxycarbonyl (polyaspartate/polyglutamate) or an
aryloxycarbonylmethyl(poryaspartate/polyglutamate).
[066] In a preferred embodiment neither the carrier or the conjugate are
used for assay purification, binding studies or enzyme analysis.
[067] In another embodiment, the carrier peptide allows for multiple active
agents to be attached. The conjugates provide the added benefit of allowing
multiple attachments not only of active agents, but of active agents in combination
with other active agents, or other modified molecules which can further modify
delivery, enhance release, targeted delivery, and/or enhance adsorption. In a further
embodiment, the conjugates may also be combined with adjuvants or be
microencapsulated.
[068] In another embodiment the conjugates provide for a wide range of
pharmaceutical applications including drug delivery, cell targeting, and enhanced
biological responsiveness.
[069] hi another embodiment, the invention can stabilize the active agent
and prevent digestion in the stomach. In addition, the pharmacologic effect can be
prolonged by delayed or sustained release of the active agent. The sustained release
can occur by virtue of the active agent being covalently attached to the peptide
and/or through the additional covalent attachment of an adjuvant that bioadheres to
the intestinal mucosa. Furthermore, active agents can be combined to produce
synergistic effects. Also, absorption of the active agent in the intestinal tract can be
enhanced either by virtue of being covalently attached to a peptide or through the
synergistic effect of an added adjuvant.
[070] In another preferred embodiment, the composition of the invention is
in the form of an ingestible tablet or capsule, an intravenous preparation, an intramuscular preparation, a subcutaneous preparation, a depot implant, a transdermal preparation, an oral suspension, a sublingual preparation, an intranasal preparation, inhalers, or anal suppositories. In another embodiment, the peptide is capable of releasing the active agent from the composition in a pH-dependent manner. In another preferred embodiment the active agent is prepared and/or administered through means other than implantation and/or injectables. In a preferred embodiments the active agent conjugate is not bound to an immobilized carrier, rather it is designed for transport and transition through the digestive system. [071] Embodiments of the present invention preferably are not bound to an
adjuvant recognized and/or taken up by active transporters. Preferably, the active agent conjugates of the present invention are not attached to active transporters, or antigenic agents such as receptor recognizing sequences found on cells and tumors. Preferably, the active agent conjugate of the present invention is not connected to or constitutes an implantable polymer, which would not biodegrade in less than 48 hours, preferably between 12 and 24 hours. The active agent conjugates of the present invention are preferably designed to release the active agent into the blood, after absorption from the gut, as the reference active agent.
[072] In another embodiment, following administration of the active agent
conjugate by a method other than oral, first pass metabolism is prevented, by avoiding recognition of liver oxidation enzymes due to its peptidic structure. [073] In another preferred embodiment the active agent is directly attached
to the amino acid without the use of a linker.
[074] The invention also provides a method for protecting an active agent
from degradation comprising covalently attaching the active agent to a peptide such that the peptide will impart conformational protection to the active agent. [075] The invention also provides a method for controlling release of an
active agent from a composition wherein the composition comprises a peptide, the method comprising covalently attaching the active agent to the peptide. It is a further embodiment of the invention that enhancement of the performance of active agents
from a variety of chemical and therapeutic classes is accomplished by extending periods of sustained blood levels within the therapeutic window. For a drug where the standard formulation produces good bioavailability, the serum levels may peak too fast and too quickly for optimal clinical effect as illustrated below. Designing and synthesizing a specific peptide conjugate that releases the active agent upon digestion by intestinal enzymes mediates the release and absorption profile thus maintaining a comparable area under the curve while smoothing out active agent absorption over time.
[076] Conjugate prodrugs may afford sustained or extended release to the
parent compound. Sustained release typically refers to shifting absorption toward slow first-order kinetics. Extended release typically refers to providing zero-order kinetics to the absorption of the compound. Bioavailability may also be affected by factors other than the absorption rate, such as first pass metabolism by the enterocytes and liver, and clearance rate by the kidneys. Mechanisms involving these factors require that the drug-conjugate is intact following absorption. The mechanism for timed release may be due to any or all of a number of factors. These factors include: 1) gradual enzymatic release of the parent drug by luminal digestive
enzymes, 2) gradual release by surface associated enzymes of the intestinal mucosa, 3) gradual release by intacellular enzymes of the intestinal mucosal cells, 4) gradual release by serum enzymes, 5) conversion of a passive mechanism of absorption to an active mechanism of uptake, making drug absorption dependent on the Km for receptor binding as well as receptor density, 6) decreasing the solubility of the parent drug resulting in more gradual dissolution 7) an increase in solubility resulting in a larger amount of drug dissolved and therefore absorption over a longer period of time due to the increased amount available.
[077] The potential advantages of enzyme mediated release technology
extend beyond the examples described above. For those active agents that can benefit from increased absorption, it is the embodiment of this invention that this effect is achieved by covalently bonding those active agents to one or more amino acids of the peptide and administering the drug to the patient as stated earlier. The invention also allows targeting to intestinal epithelial transport systems to facilitate absorption of active agents. Better bioavailability, in turn, may contribute to lower doses being needed. Thus it a further embodiment of the invention that by modulating the release and improving the bioavailability of an active agent in the manner described herein, reduced toxicity of the active agent can be achieved. [078] It is another embodiment of this invention that attachment of an
amino acid, oligopepetide, or polypeptide may enhance absorption/bioavailability of the parent drug by any number of mechanisms, including conversion of the parent drug to a polymer-drug conjugate such that the amino acid-prodrugs may be taken up by amino acid receptors and/or di- and tri-peptide receptors (PEPT transporters). This may also hold true for polymer drug conjugates since by products of enzymatic activity in the intestine may generate prodrugs with 1-3 amino acids attached. Moreover, it is possible that other receptors may be active in binding and uptake of the prodrugs. Adding an additional mechanism(s) for drug absorption may improve its bioavailability, particularly if the additional mechanism is more efficient than the mechanism for absorption of the parent drug. Many drugs are absorbed by passive diffusion. Therefore, attaching an amino acid to the compound may convert the mechanism of absorption from passive to active or in some cases a combination of
active and passive uptake, since the prodrug may be gradually converted to the parent drug by enzymatic activity in the gut lumen.
[079] It is another embodiment of the invention that active agent efficiency
is enhanced by lower active agent serum concentrations. It is yet another embodiment of the invention that conjugating a variety of active agents to a carrier peptide and, thereby sustaining the release and absorption of the active agent, would help achieve true once a day pharmacokinetics. In another embodiment of the invention, peaks and troughs can be ameliorated such as what could be achieved with more constant atenolol levels, for example, following administration of a peptide-atenolol conjugate.
[080] In another embodiment of the present invention the amino acids used
can make the conjugate more or less labile at certain pH's or temperatures depending on the delivery required. Further, in another embodiment, the selection of the amino acids will depend on the physical properties desired. For instance, if increase in bulk or lipophilicity is desired, then the carrier polypeptide will include glycine, alanine, valine, leucine, isoleucine, phenylalanine and tyrosine. Polar amino acids, on the other hand, can be selected to increase the hydrophilicity of the peptide. In another embodiment, the amino acids with reactive side chains (e.g., glutamine, asparagines, glutamic acid, lysine, aspartic acid, serine, threonine and cysteine) can be incorporated for attachment points with multiple active agents or adjuvants to the same carrier peptide. This embodiment is particularly useful to provide a synergistic effect between two or more active agents. [081] In another embodiment, the peptides are hydrolyzed by any one of
several aminopeptidases found in the intestinal lumen or associated with the brush-border membrane and so active agent release and subsequent absorption can occur in the jejunum or the ileum. In another embodiment, the molecular weight of the carrier molecule can be controlled to provide reliable, reproducible and/or increased active agent loading.
[082] In another embodiment, the invention provides methods of testing the
conjugates using Caco-2 cells.
[083] It is to be understood that both the foregoing general description and
the following detailed description are exemplary, but not restrictive, of the invention. These and other aspects of the invention as well as various advantages and utilities will be more apparent with reference to the detailed description of the preferred embodiments and in the accompanying drawings.
[084] The present invention also addresses the need for non-protected
active agents, which provide for ease of manufacture and delivery. The present invention also addresses the need for an active agent delivery system that is able to deliver active agents through the stomach as active agent peptide conjugates so that the molecular mass and physiochemical properties of the conjugates can be readily manipulated to achieve the desired release rate. The present invention also addresses the need for an active agent delivery system that allows for the active agent to be released over an extended period of time, which is convenient for patient dosing. The present invention also addresses the need for an active agent delivery system that will provide protection through the stomach, but not require that the active agent be released within a specific cell or intracellularly. [085] Embodiments of the present invention preferably do not produce an
antigenic response or otherwise stimulate the immune system in the host. In another preferred embodiment the active agent conjugate attached to the carrier peptide is used to create an immune response when administered.
BRIEF DESCRIPTION OF THE DRAWINGS
[086] The invention is best understood from the following detailed
description when read in connection with the accompanying drawing. Included in
the drawing is the following figure:
[087] Figure 1 describes the intramolecular transamination reaction of
Glutamic acid;
[088] Figure 2 illustrates the in situ digestion of Polythroid in intestinal
epithelial cell cultures;
[089] Figure 3 illustrates the improved adsorption of T4 from PolyT4
compared to T4 alone;
[090] Figure 4 illustrates a decrease in the amount of Polythroid on the
apical side over time (4hours) without intact Polythroid crossing the Caco-2 monolayer.
DETAILED DESCRIPTION OF THE INVENTION
[091] Throughout this application the use of "peptide" is meant to include a
single amino acid, a dipeptide, a tripeptide, an oligopeptide, a polypeptide, or the carrier peptide. Oligopeptide is meant to include from 2 amino acids to 70 amino acids. Further, at times the invention is described as being an active agent attached to an amino acid, a dipeptide, a tripeptide, an oligopeptide, or polypeptide to illustrate specific embodiments for the active agent conjugate. Preferred lengths of the conjugates and other preferred embodiments are described herein. The [092] Modulation is meant to include at least the affecting of
change, or otherwise changing total absorption, rate of adsorption and/or target delivery. Sustained release is at least meant to include an increase in the amount of reference drug in the blood stream for a period up to 36 hours following delivery of the carrier peptide active agent composition as compared to the reference drug delivered alone. Sustained release may further be defined as release of the active agent into systemic blood circulation over a prolonged period of time relative to the release of the active agent in conventional formulations through similar delivery routes.
[093] The active agent is released from the composition by a pH-dependent
unfolding of the carrier peptide or it is released from the composition by enzyme-catalysis. In a preferred embodiment, the active agent is released from the composition by a combination of a pH-dependent unfolding of the carrier peptide and enzyme-catalysis in a time-dependent manner. The active agent is released from the composition in a sustained release manner. In another preferred embodiment, the sustained release of the active agent from the composition has zero order, or nearly zero order, pharmacokinetics.
[094] The present invention provides several benefits for active agent
delivery. First, the invention can stabilize the active agent and prevent digestion in the stomach. In addition, the pharmacologic effect can be prolonged by delayed or
sustained release of the active agent. The sustained release can occur by virtue of the active agent being covalently attached to the peptide and/or through the additional covalent attachment of an adjuvant that bioadheres to the intestinal mucosa. Furthermore, active agents can be combined to produce synergistic effects. Also, absorption of the active agent in the intestinal tract can be enhanced either by virtue of being covalently attached to a peptide or through the synergistic effect of an added adjuvant. The invention also allows targeted delivery of active agents to specific sites of action.
[095] A major portion of the enhanced performance imparted to active
agents by the carrier peptide can be explained in terms of the composition's structure. Proteins, oligopeptides, and polypeptides are polymers of amino acids that have primary, secondary, and tertiary structures. The secondary structure of the peptide is the local conformation of the peptide chain and consists of helices, pleated sheets, and turns. The peptide's amino acid sequence and the structural constraints on the conformations of the chain determine the spatial arrangement of the molecule. The folding of the secondary structure and the spatial arrangement of the side chains constitute the tertiary structure.
[096] Peptides fold because of the dynamics associated between
neighboring atoms on the peptide and solvent molecules. The thermodynamics of peptide folding and unfolding are defined by the free energy of a particular condition of the peptide that relies on a particular model. The process of peptide folding involves, amongst other things, amino acid residues packing into a hydrophobic core. The amino acid side chains inside the peptide core occupy the same volume as they do in amino acid crystals. The folded peptide interior is therefore more like a crystalline solid than an oil drop and so the best model for determining forces contributing to peptide stability is the solid reference state.
[097] The major forces contributing to the thermodynamics of peptide
folding are Van der Waals interactions, hydrogen bonds, electrostatic interactions, configurational entropy, and the hydrophobic effect. Considering peptide stability, the hydrophobic effect refers to the energetic consequences of removing apolar groups from the peptide interior and exposing them to water. Comparing the energy
of amino acid hydrolysis with peptide unfolding in the solid reference state, the hydrophobic effect is the dominant force. Hydrogen bonds are established during the peptide fold process and intramolecular bonds are formed at the expense of hydrogen bonds with water. Water molecules are "pushed out" of the packed, hydrophobic peptide core. All of these forces combine and contribute to the overall stability of the folded peptide where the degree to which ideal packing occurs determines the degree of relative stability of the peptide. The result of maximum packing is to produce a center of residues or hydrophobic core that has maximum shielding from solvent.
[098] Since it is likely that a hydrophobic active agent would reside in the
hydrophobic core of a peptide, it would require energy to unfold the peptide before the active agent can be released. The unfolding process requires overcoming the hydrophobic effect by hydrating the amino acids or achieving the melting temperature of the peptide. The heat of hydration is a destabilization of a peptide. Typically, the folded state of a peptide is favored by only 5-15 kcal/mole over the unfolded state. Nonetheless, peptide unfolding at neutral pH and at room temperature requires chemical reagents. In fact, partial unfolding of a peptide is often observed prior to the onset of irreversible chemical or conformation processes. Moreover, peptide conformation generally controls the rate and extent of deleterious chemical reactions.
[099] Conformational protection of active agents by peptides depends on
the stability of the peptide's folded state and the thermodynamics associated with the agent's decomposition. Conditions necessary for the agent's decomposition should be different than for peptide unfolding.
[0100] Selection of the amino acids will depend on the physical properties
desired. For instance, if increase in bulk or lipophilicity is desired, then the carrier peptide will be enriched in the amino acids that have bulky, lipophilic side chains. Polar amino acids, on the other hand, can be selected to increase the hydrophilicity of the peptide.
[100] Ionizing amino acids can be selected for pH controlled peptide
unfolding. Aspartic acid, glutamic acid, and tyrosine carry a neutral charge in the
stomach, but will ionize upon entry into the intestine. Conversely, basic amino acids, such as histidine, lysine, and arginine, ionize in the stomach and are neutral in an alkaline environment.
[101] Other factors such as K-n interactions between aromatic residues,
kinking of the peptide chain by addition of proline, disulfide crosslinking, and hydrogen bonding can all be used to select the optimum amino acid sequence for a desired performance parameter. Ordering of the linear sequence can influence how these interactions can be maximized and is important in directing the secondary and tertiary structures of the polypeptide.
[102] Variable molecular weights of the carrier peptide can have profound
effects on the active agent release kinetics. As a result, low molecular weight active agent delivery systems are preferred. An advantage of this invention is that chain length and molecular weight of the peptide can be optimized depending on the level of conformational protection desired. This property can be optimized in concert with the kinetics of the first phase of the release mechanism. Thus, another advantage of this invention is that prolonged release time can be imparted by increasing the molecular weight of the carrier peptide.
[103] Another, significant advantage of the invention is that the kinetics of
active agent release is primarily controlled by the enzymatic hydrolysis of the key bond between the carrier peptide and the active agent. The enzymes encountered in the lumen of the intestines, on the intestinal cell surface, and within the cells lining the intestine may completely remove the drug from the carrier peptide before it reaches the bloodstream. Accordingly, concerns about the safety of the novel composition are eliminated.
[104] Dextran has been explored as a macromolecular carrier for the
covalent binding of drug for colon specific drug delivery. Generally, it was only possible to load up to 1/10 of the total drug-dextran conjugate weight with drug. As stated earlier, polysaccharides are digested mainly in the colon and drug absorption is mainly limited to the colon. As compared to dextran, this invention has at least two major advantages. First, peptides are hydrolyzed by any one of several aminopeptidases found in the intestinal lumen or associated with the brush-border
membrane and so active agent release and subsequent absorption can occur in the jejunum or the ileum. Second, the molecular weight of the carrier molecule can be controlled and, thus, active agent loading can also be controlled. [105] As a practical example, the Table 1 below lists the molecular weights
of lipophilic amino acids (less one water molecule) and selected analgesics and vitamins.
[106] Lipophilic amino acids are preferred because confonnational
protection through the stomach is important for the selected active agents, which were selected based on ease of covalent attachment to an oligopeptide. Eighteen was subtracted from the amino acid's molecular weight so that their condensation into a peptide is considered. For example, a decamer of glycine (MW=588) linked to aspirin would have a total molecular weight of 750 and aspirin would represent 24% of the total weight of the active agent delivery composition or over two times the maximum drug loading for dextran. This is only for an N- or C- terminus application, for those active agents attached to pendant groups of decaglutamic acid, for instance, a drug with a molecular weight of 180 could conceivably have a loading of 58%, although this may not be entirely practical.
[107] In one embodiment the active agent is attached to a peptide that
ranges between a single amino acid and 450 amino acids in length. In another embodiment two to 50 amino acids are preferred, with the range of one to 12 amino acids being more preferred, and one to 8 amino acids being most preferred. In another embodiment the number of amino acids is selected from 1, 2, 3, 4, 5, 6, or 7
amino acids. In another embodiment of the invention the molecular weight of the carrier portion of the conjugate is below about 2,500, more preferably below about 1,000 and most preferably below about 500.
[108] In another embodiment the active agent conjugate is a dimer, of an
active agent and a single amino acid. In another embodiment the active agent conjugate is attached to a dipeptide or tripeptide.
[109] Compositions of the invention comprise four essential types of
attachment. These types of attachment are termed: C-capped, N-capped, side-chain attached, and interspersed. C-capped comprises the covalent attachment of an active agent to the C-terminus of a peptide either directly or through a linker. N-capped comprises the covalent attachment of an active agent to the N-terminus of a peptide either directly or through a linker. Side-chain attachment comprises the covalent attachment of an active agent to the functional sidechain of a peptide either directly or through a linker. Interspersed comprises the attachment of active agents which themselves are amino acids. In this case the active agent would constitute a portion of the amino acid chain. Interspersed is herein meant to include the amino acid active agent (drug) being at the C-terminus, N-terminus, or interspersed throughout the peptide. When amino acid active agents are attached to the C-terminus or the N-terminus this results in the active agent being the end amino and is considered C-capped or N-capped respectively. Furthermore, amino acids with reactive side chains (e.g., glutamic acid, lysine, aspartic acid, serine, threonine and cysteine) can be incorporated for attaching multiple active agents or adjuvants to the same carrier peptide. This is particularly useful if a synergistic effect between two or more active agents is desired. The present invention also envisions the use of multiple active agents or multiple attachment sites of active agents along a peptide chain. Further embodiments of the invention will become clear from the following disclosure. [110] The alcohol, amine or carboxylic acid group of the active agent is
covalently attached to the N-terminus, the C-terminus or the side chain of the peptide. The location of attachment depends somewhat on the functional group selection. For instance, if the active drug is a carboxylic acid (e.g., aspirin) then the N-terminus of the oligopeptide is the preferred point of attachment. If the active
agent is an amine (e.g., ampicillin), then the C-terminus is the preferred point of attachment in order to achieve a stable peptide linked active agent. In both, the C-and N-terminus examples, one monomeric unit forming a new peptide bond in essence, adds a molecule to the end of the peptide.
[Ill] If the active agent is an amine, an alternate method of attaching the
amine to the C-terminus of the peptide is to allow the amine to initiate polymerization of the amino acid NCA's. If the active agent is an alcohol, then either the C-terminus or the N-terminus is the preferred point of attachment in order to achieve a stable composition. For example, when the active agent is an alcohol, the alcohol can be converted into an alkylchloroformate with phosgene or triphosgene. This intermediate is then reacted with the N-terminus of the peptide carrier to produce an active agent peptide composition linked via a carbamate. The carbamate active ingredient may then be released from the peptide carrier by intestinal peptidases, amidases, or esterases.
[112] Alternatively, an alcohol active agent can be selectively bound to the
gamma carboxylate of glutamic acid and then this conjugate covalently attached to the C-terminus of the peptide carrier. Because the glutamic acid-drug conjugate can be considered a dimer, this product adds two monomeric units to the C-terminus of the peptide carrier where the glutamic acid moiety serves as a spacer between the peptide and the drug. Intestinal enzymatic hydrolysis of the key peptide bond releases the glutamic acid-drug moiety from the peptide carrier. The newly formed free amine of the glutamic acid residue will then undergo an intramolecular transamination reaction, thereby, releasing the active agent with coincident formation of pyroglutamic acid as shown in Figure 1.
[113] Alternatively, the glutamic acid-drug dimer can be converted into the
gamma ester of glutamic acid N-carboxyanhydride. This intermediate can then be polymerized, as described above, using any suitable initiator. The product of this polymerization is polyglutamic acid with active ingredients attached to multiple pendant groups. Hence, maximum drug loading of the carrier peptide can be achieved. In addition, other amino acid-NCA's can be copolymerized with the
gamma ester glutamic acid NCA to impart specific properties to the drug delivery system.
[114] Alternatively, the alcohol can be added to the chloroformate of the
side chain of polyserine as shown in section III of the Examples. The product is a carbonate, which upon hydrolysis of the peptide bond an intramolecular rearrangement occurs releasing the drug much of the same was as described above. [115] If the active agent is a ketone or an aldehyde than a ketal is formed
with a linker that has a pendant group suitable for attachment to the N-terminus, C-terminus or side chain of the peptide. For example, a ketal can be formed by the reaction of methylribofuranoside or glucose with methylnaltrexone as shown in example of glucose reacting with methylnaltrexone. The remaining free hydroxyl from the sugar moiety can then be treated as an alcohol for attachment to the C-terminus or a suitable side chain of the carrier peptide.
[116] The invention also provides a method of imparting the same
mechanism of action for other peptides containing functional side chains. Examples include, but are not limited to, polylysine, polyasparagine, polyarginine, polyserine, polycysteine, polytyrosine, polythreonine and polyglutamine. The mechanism can translate to these peptides through a spacer or linker on the pendant group, which is terminated, preferably, by the glutamic acid-active agent dimer. The side-chain attached carrier peptide-active agent conjugate is preferably releases the active agent moiety through peptidase and not necessarily esterase activity. Alternatively, the active agent can be attached directly to the pendant group where some other indigenous enzymes in the alimentary tract can affect release. [117] If the active agent is an amide or an imide then the nitrogen of the
active agent can add in a Michael fashion to the dihydopyran carboxylic acid alkyl ester as shown in section VII:D of the Examples. The R group can either be an electron-withdrawing group such that transesterification with the side chain of the peptide can occur or the R group can be part of the side chain of the peptide. The release of the active agent from the linker is imparted by hydrolysis of the peptide carboxylate bond followed by a concerted decarboxylation/elimination reaction.
[118] The active agent can be covalently attached to the N-terminus, the C-
terminus or the side chain of the peptide using known techniques. In the case where the active agent is an amino acid (e.g. Thyroxine, Triiodothyronine, DOPA, etc.) the active agent can be interspersed within the peptide chain in a peptide linked manner in addition to be covalently attached to the N-terminus, C-terrninus or the side chains as described above. It is the preferred embodiment of the invention that the interspersed copolymer of the amino acid active agent and neutral amino acid be produced by polymerizing a mixture of the respective amino acid NCA's. [119] The composition of the invention comprises a peptide and an active
agent covalently attached to the peptide. Examples of active agents that may be used with the present invention include, but are not limited to, those active agents listed in Table 2, either alone or in combination with other agents contained within Table 2. As one of skill in the art would readily understand, the active agents listed within Table 2 may exist in modified form to facilitate bioavailability and/or activity (e.g., a Sodium salt, halide-containing derivatives or HC1 forms of an active agent listed in Table 2). Accordingly, the invention encompasses variants (i.e., salts, halide derivatives, HC1 forms) of the active agents listed in Table 2.
[120] The present invention allows for the combination of different active
agents with a variety of peptides to impart specific characteristics according to the desired solubility, pH or folding. Similarly, the variety of peptides may be used to impart specific physicochemical properties to produce specific performance characteristics. The present invention provides significant advantages with respect to the stability and release and/or adsorption characteristics of the active agent(s). The conjugates of the present invention are also suited for delivery of both large and small molecules.
[121] In another embodiment, the use of one or more of the 20 naturally
occurring amino acids as individual amino acids, in oligopeptides, or in polypeptides impart specific stability, digestibility and release characteristics to the conjugates formed with active agents.
[122] In another embodiment, the active agent conjugates are designed to
interact with specific indigenous enzymes so that targeted delivery may be achieved. These conjugates provide targeted delivery in all regions of the gut and at specific sites along the intestinal wall. In another preferred embodiment, the active agent conjugates can incorporate adjuvants such that the compositions are designed to interact with specific receptors so that targeted delivery may be achieved. These compositions provide targeted delivery in all regions of the gut and at specific sites along the intestinal wall. In another preferred embodiment, the active agent is released as the reference active agent from the peptide conjugate prior to entry into a target cell. In another preferred embodiment, the specific amino acid sequences used are not targeted to specific cell receptors or designed for recognition by a specific genetic sequence. In a more preferred embodiment, the peptide carrier is designed for recognition and/or is not recognized by tumor promoting cells. In another preferred embodiment, the active agent delivery system does not require that the active agent be released within a specific cell or intracellularly. [123] In another embodiment, the active agent conjugate allows for
multiple active agents to be attached. The conjugates provide the added benefit of allowing multiple attachment not only of active agents, but of active agents in combination with other active agents, or other modified molecules which can further
modify delivery, enhance release, target delivery, and/or enhance adsorption. By way of example, the conjugates may also be combined with adjuvants or can be microencapsulated.
[124] In another embodiment of the invention, the composition includes
one or more adjuvants to enhance the bioavailability of the active agent. Addition of an adjuvant is particularly preferred when using an otherwise poorly absorbed active agent. Suitable adjuvants, for example, include: papain, which is a potent enzyme for releasing the catalytic domain of aminopeptidase-N into the lumen; glycorecognizers, which activate enzymes in the brush border membrane (BBM); and bile acids, which have been attached to peptides to enhance absorption of the peptides.
[125] In another embodiment absorption may be improved by increasing
the solubility of the parent drug through selective attachment of an amino acid, oligopeptide, or polypeptide. Increasing solubility results in an increase in the dissolution rate. Consequently, there is an increase in the total amount of drug that is available for absorption; since the drug must be in solution for absorption to occur, bioavailability is increased.
[126] In another embodiment the compositions provide for a wide range of
pharmaceutical applications including active agent delivery, cell targeting, and enhanced biological responsiveness.
[127] The present invention provides several benefits for active agent
delivery. First, the invention can stabilize the active agent and prevent digestion in the stomach. In addition, the pharmacologic effect can be prolonged by delayed or sustained release of the active agent. The sustained release can occur by virtue of the active agent being covalently attached to the peptide and/or through the additional covalent attachment of an adjuvant that bioadheres to the intestinal mucosa. Furthermore, active agents can be combined to produce synergistic effects. [128] Absorption of the active agent in the intestinal tract can be enhanced
either by virtue of being covalently attached to a peptide or through the synergistic effect of an added adjuvant. In a preferred embodiment of the invention the absorption of the active agent is increased due to its covalent attachment to a
peptide, hereafter to be referred to as a transporter peptide, which is a specialized example of a carrier peptide. In a further embodiment, the transporter peptide activates a specific peptide transporter. In yet another embodiment the peptide transporter is either the PepTl or the PepT2 transporters. In a preferred embodiment the transporter peptide contains two amino acids. In another preferred embodiment the transporter dipeptide is selected from the list of AlaSer, CysSer, AspSer, GluSer, PheSer, GlySer, HisSer, EeSer, LysSer, LeuSer, MetSer, AsnSer, ProSer, GlnSer, ArgSer, SerSer, ThrSer, ValSer, TrpSer, TyrSer.
[129] In another embodiment, the present invention does not require the
attachment of the active agent to an adjuvant that recognizes or is taken up by an active transporter. The invention also allows targeted delivery of active agents to specifics sites of action.
[130] In another preferred embodiment the chain length of amino acid can
be varied to suit different delivery criteria. In one embodiment, the present invention allows for the delivery of active agents with sustained release. [131] The invention may further be characterized by the following
embodiments wherein the active agent is released as the reference active agent from the amino acid conjugate prior to entry into the target cell for the active agent. In another preferred embodiment the active agent is prepared and/or administered through means other than implantation and/or injectibles. Embodiments of the present invention preferably do not produce and antigenic response or otherwise stimulate the immune system in the host.
[132] Another embodiment of the present invention, for compositions
administered by methods outside the alimentary tract, the intact conjugate may be less susceptible to first pass metabolism by the enterocytes, including biotransformation by cytochrome P450 (CYP) 3A4 and efflux by transporter P-glycoprotein. Immunogenicity and metabolic effects are avoided through maintenance of the three dimensional structure of the composition, maintaining blood levels below the threshold value for expression of these metabolic factors or some other means.
[133] In another preferred embodiment the active agent is directly attached
to the amino acid without the use of a linker.
[134] To predict the absorption of orally delivered drugs monolayers of
Caco-2 human intestinal epithelial cells are increasingly being used. Caco-2 cells are grown on the surface of collagen-coated wells in a 24 well format to form confluent monolayers that represent small segments of the intestine. The wells are removable and contain a top chamber representing the apical side (facing the lumen of the intestine) and a bottom chamber representing the basolateral side (site of serosal drug absorption). Testing the electrical resistance across the monolayer monitors the integrity of the epithelial barrier. Absorption of drugs can be studied by adding sample to the apical side and assaying the concentration of the drug in the basolateral chamber following incubation.
[135] The small intestine has an extremely large surface area covered with
highly specialized epithelial cells that produce both extracellular and intracellular enzymes. The Caco-2 cells also release enzymes similar to the epithelial cells of the small intestine. There is not much precedent for using the Caco-2 cells as models for digesting synthetic peptides. However, drug release from peptides on the apical side of Caco-2 transwell monolayers can be measured. The copolymer of glutamic acid and thyroxine enhanced the absorption of thyroxine across the Caco-2 monolayers.
[136] In another embodiment, the invention provides methods of testing the
conjugates using Caco-2 cells.
[137] The Table 3 provides a list of active agents that have been covalently
attached to a peptide. The table also provides a list of typical areas of use for the active agent conjugate.
A=Alanine, D=Aspartic Acid, E=Glutamic Acid, F=Phenyalanine, G=Glycine, I=Isoleucine, K=Lysine, M=Methionine, S=Serine, T=Threonine, V=Valine
[138] The compositions of the invention can be formulated in
pharmaceutical compositions by combining the compound with a pharmaceutically acceptable excipient known in the art. The conjugates may be employed in powder or crystalline form, in liquid solution, or in suspension. The conjugates of the present invention may be administered by a variety of means, including but not limited to: topically, orally, parenterally by injection (intravenously, intramuscularly or subcutaneously), as a depot implant, an intranasal preparation, an inhaler, or as an anal suppository. The injectable compositions may take such forms as suspensions, solutions, or emulsions in oily or aqueous vehicles, and may contain various formulating agents. Alternatively, the conjugate may be in powder form for reconstitution at the time of delivery with a suitable vehicle, such as sterile water. In injectable compositions, the carrier is typically comprised of sterile water, saline or another injectable liquid, e.g., peanut oil for intramuscular injections. Also, various buffering agents, preservatives and the like can be included. Topical applications may be formulated in carriers such as hydrophobic or hydrophilic bases to form ointments, creams, lotions, in aqueous, oleaginous or in dry diluents to form powders. Oral compositions may take such forms as tablets, capsules, oral suspensions and oral solutions. The oral compositions may utilize carriers such as conventional formulating agents, and may include sustained release properties as well as rapid delivery forms. The dosage to be administered depends to a large extent upon the condition and size of the subject being treated, the route and
" frequency of administration. One embodiment of the methods of administration of the conjugates includes oral and parenteral methods, e.g., i.v. infusion, i.v. bolus and i.m. injection. In a further embodiment of the invention, the composition incorporates a microencapsulating agent. Preferably, the composition of the invention is in the form of an ingestible tablet or capsule, an implantable device, a skin patch, a sublingual preparation, a subcutaneous preparation, an intravenous preparation, an intraperitoneal preparation, an intramuscular preparation or an oral suspension. Most preferably the compositions are formulated for oral delivery. [139] Throughout the applications the figures are meant to describe the
general scheme of attaching active agents through different functional groups to a variety of peptide conjugates resulting in different embodiments of the present invention. One skilled in the art would recognize other reagents, conditions, and properties necessary to conjugate other active agents to other peptides from the schemes, which are meant to be non-limiting examples. The figures further represent the different embodiments of the present invention with regard to length of the active agent conjugate wherein the amino acid, dipeptide, tripeptide, oligopeptide and peptide active agent conjugates can be respectively represented by n=0 for an amino acid, and n>l for other peptide embodiments.
I N-Terminus Attachment of an Active Agents to a Peptide
[140] The N-terminus attachment of active agent to a peptide can be formed
through a plurality of active agent functional groups. Non-limiting examples of active agent functional groups include an alcohol group, a carboxylic acid group, an amine group or other reactive substiuents. The preferred active agent attaching functionalities for N-terminus attachment to a peptide include carboxylic acids, ketones and aldehydes. When the attachment at the N-terminus is to be made with an alcohol or its equivalent, or an amine or its equivalent an insertion of a linker between the functional group and the active agent is typically required. [141] Any amino acid may be used as the N-terminus of the peptide/active
agent conjugate. Preferred amino acids for attachment include glutamic acid, aspartic acid, serine, and lysine.
[142] Specific examples of an active agent attached to the N-terminus
below are meant for example purposes only and are not meant to limit the invention to either specific active agents, amino acids or combinations thereof. Preferred drugs for N-terminus attachment typically provide a carboxylic acid or an inorganic functional group for conjugation. By way of example, ibuprofen, furosemide, gemfibrozil, naproxen may be attached to the N-terminus.
[143] The below schemes depict methods of attaching active agents to the
N-terminus. These figures and procedures describe the general scheme of attaching active agents to the N-terminus of a peptide.
(i) General Mechanism and Description of Conjugation of Acid Drug Attachment to the N-Terminus
- Acid Drug/N-Terminus Scheme -
[144] As depicted an acid bioactive agent can be dissolved in DMF under
nitrogen and cooled to 0 °C. The solution can then be treated with diisopropylcarbodiimide and hydroxybenzotriazole followed by the amine peptide carrier. The reaction can then be stirred for several hours at room temperature, the urea by-product filtered off, and the product precipitated out in ether and purified using gel permeation chromatography (GPC) or dialysis.
(ii) General Mechanism and Description of Conjugation of Alcohol Drug Attachment to the N-Terminus
- Alcohol Drug/N-Terminus Scheme -
[145] As depicted above the combination of the alcohol with triphosgene
produces a chloroformate, which when reacted with the N-terminus of the peptide produces a carbamate. Pursuant to this, an alcohol bioactive agent can be treated with triphosgene in dry DMF under nitrogen. The suitably protected peptide carrier is then added slowly and the solution stirred at room temperature for several hours.
The product is then precipitated out in ether. The crude product is suitably deprotected and purified using GPC.
[146] Other solvents, activating agents, co-catalysts and bases can be used.
Examples of other solvents include dimethylsulfoxide (DMSO), ethers such as tetrahydrofuran(THF) or chlorinated solvents such as chloroform (CHCl3). Examples of other activating agents include dicyclohexylcarbodiimide or thionyl chloride. An example of another co-catalyst is N-hydroxysuccinimide (NHS). Examples of bases include pyrrolidinopyridine, dimethylaminopyridine, triethylamine (Et3N) or tributylamine.
I:A - Example: Attachment of Furosemide via Carboxvlic Acid to the N-terminus of PoIvfSerine)
[147] The below example describes the attachment of an amino acid active
agent to the N-terminus of a peptide. The example uses polySer attached to Furosemide.

[148] To a solution of pSer(OtBu) in N-methyl pyrrolidinone (NMP) was
added Furosemide-OSu and N-methyl morpholine (NMM). The reaction was stirred
overnight at room temperature. Solid material remained so reaction was stirred overnight at 60°C. After cooling, reaction was placed in water (50 mL), solid was collected by filtration and solid was dried (0.480 g, 86% yield).
[149] Deprotection of pSer(OtBu) proceeded by adding 95%TFA/H2O to
the above material. The resulting dark solution was stirred overnight. Solvent was then removed, NaHCO3 (saturated solution) added and the crude product was purified using ultrafiltration (YM1) to obtain Furosemide-pSer (O.lOlg) as a dark green solid.
I:B - Example: Attachment of Enalipril via Carboxylic Acid to the N-terminus of GluGlu.
Synthesis of Enalipril-Glu-Glu
[150] To enalipril maleate (0.200 g, 406 umol), hydroxybenzotriazole
(0.164 g, 1217 umol), Glu(OtBu)Glu(OtBu)OtBu (0.560 g, 1217 umol) and diisopropylethylamine (0.210 ml, 1217 umol) in 7 ml dry DMF was added O-(1H-benzotriazol-lyl)N,N,N',N' tetramethyluronium hexafluorophosphate (0.461 g, 1217 umol). After stirring for 16 h under Argon, 40 ml of saturated NaCl (aq) was added to the black solution. The reaction was extracted 2x10 ml EtOAc (dark colored stayed with the organics). The organics were dried with anhyd. MgSO4, filtered and the solvent removed by rotary evaporation. The residue was purified by flash chromatography (SiO2 1:0-60:1-40:1-30:1-20:1-10:1 ) to provide Enalipril-Glu(OtBu)Glu(OtBu)OtBu as a yellowish gum (0.231 g, 54%): Rf 0.43 (9:1 CHCl3:MeOH + 1 drop HOAc); 1H-NMR (DMSO/CDC13) 7.13 (m, 5H), 4.43-4.09 (m, 5H), 2.20 (m, 7H), 1.97-1.80 (m, 13H), 1.35 (m, 27H), 1.22 (m, 6H); ESMS 803.
[151] Enalipril-Glu(OtBu)Glu(OtBu)OtBu (0.172 g, 214 umol) was stirred
for 7.5 h with 9.5 ml trifluoroacetic acid and 0.5 ml H2O. The solvent was removed by rotary evaporation and the residue dried in vacuum. 'H-NMR (DMSO) 7.13 (m, 5H), 4.43-4.09 (m, 5H), 2.20 (m, 7H), 1.97-1.80 (m, 13H), 1.42 (m, 3H), 1.22 (m, 3H); FABMS calc 635.293, ob 635.490.
II C-Terminus Attachment of Active Agents to a Peptide
[152] The C-terminus attachment of an active agent to a peptide can be
formed through a plurality of active agent functional groups. The functional groups include amines and their equivalents and alcohols and their equivalents. While any amino acid may be used to connect the active agent to the C-terminus, glutamic acid, aspartic acid, serine and lysine are preferred amino acids. Preferred active agents for C-terminus attachment are active agents with alcohol and amino functional groups. More preferred active agents include atenolol, metropolol, propanolol, methylphenidate and sertraline.
[153] The below scheme depicts methods of attaching active agents to the
C-terminus. One skilled in the art would recognize other reagents, conditions, and properties necessary to conjugate other active agents from the schemes, which are meant to be non-limiting examples.
[154] This figure and procedure describe the general scheme of attaching
an amine active agent to the C-terminus of a peptide. In the below scheme the peptide carrier can be dissolved in DMF under nitrogen and cooled to 0 °C. The solution can then be treated with diisopropylcarbodiimide and hydroxybenzotriazole followed by the amine bioactive agent. The reaction can then be stirred for several hours at room temperature, the urea by-product filtered off, and the product precipitated out in ether and purified using GPC or dialysis.
[155] Specific examples of active agent attached to the C-terminus below
are meant for example purposes only and are not meant to limit the invention to either specific active agents, amino acids or combinations thereof.
II;A - Example; Amine-Initiated Polymerization of L-Glutamic Acid NCA
[156] This example can be used to genetically describe the process of an
amine active agent initiating polymerization of an amino acid NCA. The following procedure was successfully used to synthesize the polyglutamic acid conjugate of atenolol through its amine functionality. It should also be noted that atenolol is also an alcohol active agent and can also initiate polymerization of amino acid NCA's. This procedure can readily be applied to other amine drugs described herein.
[157] Table 4 describes the relative proportions that would be used in a
typical atenolol preparation. Other amine drugs that would be used to initiate polymerization of an amino acid NCA would be expected to utilize similar proportions.
[158] The procedure is further described below, although those skilled in
the art would recognize other solvents, proportions and reaction conditions that could be utilzed to achieve the desired results. DMF is dimethylformamide, anhydrous, and was purchased from Aldrich. The glassware was oven-dried prior to use. Glu-NCA (500 mg, 2.89 mmoles) was dissolved in 4 mL of DMF and stirred under argon in a 15 mL round bottom flask equipped with a gas inlet tube. Atenolol, dissolved in 1 mL of DMF, was added to this solution of Glu-NCA and allowed to stir at room temperature for 72 h. In general, the reactions can be run until there is no free amine initiator by Thin Layer Chromatography (TLC). For this reaction, TLC was run using silica plates and eluting with 20% methanol in ethyl acetate. The reaction was quenched by pouring into 20 mL of 10% sodium bicarbonate in water (pH = 8). The water was washed with 3 x 20 mL of methylene chloride and 3 x 20 mL of ethyl acetate. Combined aqueous layers were brought to a pH of 6 with 6N hydrochloric acid (HC1) and reduced to a volume of about 20 mL by rotary evaporation.
[159] This solution was then cooled in the refrigerator for > 3 hours. To
precipitate the polymeric product, the aqueous solution was then acidified to a pH of
about 2 using 6N HC1 and placed back in the refrigerator for 1-2 hours. The suspension was poured by portions into a 10 mL test tube and centrifuged for 15 minutes until the precipitate formed a solid pack at the bottom of the tube from which the water could be decanted. (At this point in the general procedure, it is preferable that the solid be filtered through a filter funnel and washed with acidic water. The centrifuge was used for atenolol because the solid was too thin to filter.) The solid was then resuspended in acidic water (pH about 2) and vortexed before being centrifuged again and the water decanted. This procedure was repeated once more for a total of three washes. The solid was then dried by high vacuum overnight yielding 262 mg (59%) of polymer. NMR analysis indicated that the Glu/Atenolol ratio was about 30/1.
II:B - Example: Preparation of (Glu)n-Cephalexin via an Amine Bond
[160] The below example describes the attachment of an ammo acid active
agent to the C-terminus of a peptide. The example uses glutamic acid NCA to produce a polyGlu attached to Cephalexin. Cephalexin attached to a single amino acid may be produced via the below method if an excess amount of Cephalexin is added to the procedure.
[161] Glu(OtBu)NCA (1.000 g, 4.4 mmol) and Cephalexin»HCl (0.106 g,
0.3 mmol) were dissolved in anhydrous DMF (5 mL). The reaction was then allowed to stir at room temperature under argon. After 3 days, the solvent was removed by rotary-evaporation under vacuum. The resulting solid was then placed under argon and then dissolved in 4N HC1 in Dioxane (2mL) and then allowed to stir at room temperature under a blanket of argon. After 1 hour, the dioxane and HC1 were removed by rotary-evaporation under vacuum. The solid was then suspended in methanol (2 mL) and once more brought to dryness by rotary-evaporation in order to remove residual HC1 and dioxane. This material was then resuspended in methanol (2 mL) and precipitated by the addition of water (20 mL). The aqueous suspension was then stored at 4°C for 4 hours, and the solid isolated by centrifugation. The pelleted material was then allowed to dry under vacuum over night. This process afforded a mixture of (Glu)n and (Glu)n-cephalexin (464mg) as
determined by MALDI MALDI indicates a mixture of polymers (Glu)7-13
and (Glu)5_14-cephalexin. Other chain-lengths may be present but they are not clearly visible in the MALDI spectra. Reversed-phase HPLC (265nm detection, C18 column, 16%MeOH/4%THF/80%water mobile phase) indicated that no free cephalexin was present in the isolated material. "Water" in the HPLC actually refers to an aqueous buffer of 0.1% heptanesulfonic acid and 1.5% triethylamine.
II:C -Example: Synthesis of PolyGlu-Atenolol
[162] The following procedure was successfully used to synthesize the
polyglutamic acid conjugate of atenolol.
DMF is dimethylformamide, anhydrous, and was purchased from Aldrich. Glassware was oven-dried, prior to use.
[163] Glu-NCA (2 g, 11.56 mmoles) was dissolved in 8 mL of DMF and
stirred under Ar in a 25 mL roundbottom flask equipped with a gas inlet tube. Atenolol, dissolved in 2 mL of DMF, was added to this solution of Glu-NCA and allowed to stir at room temperature for 93 h. Bubbles were observed at the beginning of the reaction. The DMF was reduced by rotary evaporation and the oil was transferred into a 125 mL Erlenmeyer, rinsing the round bottom well with water. The pH of the solution was adjusted to 3 with 1 N HC1. This solution (60 mL total volume) was then cooled in the refrigerator for > 3 hours. The suspension was filtered through a sintered glass funnel and washed with 3 X 30 mL of 1% AcOH in methanol followed by 3 X 30 mL of ethanol. The solid was then dried by high vacuum overnight yielding 892 mg (68%) of polymer. NMR analysis indicated
that the Glu/Atenolol ratio was about 15/1. This is based on the relative integrations of the methyl groups on the N-isopropyl substituent of atenolol (6 protons) and the p and ? protons of the Glu (2 each).
H;D - Example; Synthesis of [Glu]15-Carbadopa
[164] To 50 mg of Carbadopa (0.22 mmoles) dissolved in 4 mL of dry
dimethylformamide, add 573 mg (3.3 mmoles) of GluNCA. Stir overnight under Argon. After the addition of 12 mL of H2O, pH = 2.0, the solution was ultrafiltered (regenerated cellulose, Millipore, YM1, NMWL = 1000) with an additional 100 mL of H20, pH = 2. The resulting precipitate was collected by filtration and washed with 30 mL of H2O and dried in a vacuum at room temperature to yield 268 mg of a light brown powder. The Carbadopa to Glu ratio was determined by 1H NMR to be 1:4. 1H NMR (500MHz, DMSO) peak assignments are as follows: 86.61-6.58 (aromatic, Carbadopa), 6.47-6.41 (aromatic, Carbadopa), 4.25 (a, Glu), 2.25 (?, Glu), 2.00-1.65 (p\ Glu), 1.11 (CH3, Carbadopa).
II:E - Example: Preparation of Drug-Glu Conjugate as a starting svnthon for polymerization
[165] The example below is a description C-terminus attachment. The
example describes how to attach a single amino acid to an active agent, one of the preferred embodiments. The example also provides an active agent/amino acid conjugate to which additional amino acids can be added resulting in the desired peptide. Preferred embodiments of the peptide include copolymers of glutamic acid
and N-acetylcysteine.
[166] With non-primary amine drug candidates, formation of the active
agent-poly-Glu conjugate may require the formation of the activate agent/amino acid synthon prior to polymerization. The following scheme was used, wherein the active agent is first conjugated to Glu, and this synthon is then used to initiate
coupling. Examples of this protocol are further described as applied to sertraline, propranolol and metoprolol.
11:F - Protocol for coupling Boc-Glu(OtBu)-OH to Sertraline
[167] Boc-Glu(OtBu)-OH (0.44 g, 1.46 mmol) and PyBOP (0.84 g, 1.60
mmol) were dissolved in dry DMF (15 mL) with stirring. DIEA (0.31 mL, 1.75 mmol) was added and the amino acid derivative was allowed to activate for 15 minutes. Sertraline hydrochloride (0.50 g, 1.46 mmol) was added to the stirring mixture followed by an additional 0.31 mL DIEA. The mixture was allowed to stir for 16 hours. The solution was stripped yielding brown oil. The oil was dissolved in EtOAc (100 mL) and the resulting solution was washed with 10 % HC1 (3 x 30 mL), saturated NaHCO3, 4M NaHSO4, and brine (2 x 30 mL, respectively). The solution was dried over MgSO4, filtered and the solvent was removed by rotary evaporation under reduced pressure, yielding light brown oil. The oil was dried on the vacuum manifold and the product was purified by column chromatography on silica gel using EtOAc/Hexanes 1:5 to 1:4 solvent system. The product fractions were pooled and solvent was again removed by rotary evaporation yielding 0.85 g (99%) of the final product, Sertraline-NH-C(O)-Glu-NH3+. The preparation was dried on the vacuum manifold.
H:G - Synthesis of PolvGlu-Propranolol
(i) Protocol for coupling Boc-Glu(OtBu)-OH to Propranolol
[168] Boc-Glu(OtBu)-OH (0.44 g, 1.46 mmol) and PyBOP (0.84 g, 1.60
mmol) were dissolved in dry DMF (15 mL) with stirring. DIEA (0.31 mL, 1.75 mmol) was added and the amino acid derivative was allowed to activate for 15 minutes. Propranolol hydrochloride (0.43 g, 1.46 mmol) was added to the stirring mixture followed by an additional 0.31 mL DIEA. The mixture was allowed to stir for 16 h. The solution was stripped yielding a brown oil. The oil was dissolved in EtOAc (100 mL) and the resulting solution was washed with 10 % HC1 (3 x 30 mL), saturated NaHCO3, 4M NaHSO4, and brine (2 x 30 mL, respectively). The solution was dried over MgSO/t, filtered and the solvent was removed by rotary evaporation under reduced pressure, yielding light brown oil. The oil was dried on the vacuum manifold and the product was purified by column chromatography on silica gel using EtOAc/Hexanes 1:5 to 1:4 solvent system. The product fractions were pooled
and solvent was again removed by rotary evaporation the final product, Propranolol-NH-C(0)-Glu-NH3+. The preparation was dried on the vacuum manifold.
(ii) Protocol for Initiating Glu-NCA Polymerization with Propranolol-Glu
[169] The above synthon was used in a reaction similar to the one provided
for atenolol.
H;H - Example; Synthesis of PolvGlu-MetroproloI
[170] This synthesis was identical to that described for PolyGlu-
Propranolol.
EE:I - Example: Preparation of PoIvGlu-Prednisone
[171] The example below describes the alcohol initiating polymerization of
Glu-NCA to produce a C-terminus ester/drug conjugate.
[172] To GluNCA (0.128 g, 738 umol) in 4 mL dry DMF was added
Glu(21-Prednisone) (0.045 g, 92 pmol). After stirring for 68 h under Ar, 30 mL
H2O was added. The reaction was acidified to pH 4 with 1 N HC1 and concentrated
under vacuum. *H NMR (DMSO) analysis indicated 13:1 Glu:Prednisone ratio.
1I:.T ¦ Preparation of Glu-Furosemide
[173] This is an example of a sulfonamide attached to the C-
terminus of a peptide.
Glu-Furosemide
[174] To a solution of Furosemide in dioxane was added NMM followed
by Boc-Glu(OtBu)-OSu. The solution was stirred at ambient temperatures for 18hours. Reaction was quenched with sat. NaHCO3 (25ml) and solvent was removed. Crude material was purified using preparative HPLC (Phenomenex Luna C18, 30X250mm, 5uM, 100A; Gradient: 70 0.1%TFA-water/30 0.1% TFA-MeCN 0/100 0-15min.; 30ml/min.). Solid was collected as a white powder (0.054g, 9% yield): *H NMR (DMSO-de) 5 1.40 (m, 18H), 1.53 (m, 1H), 1.62 (m, 1H), 1.85 (m, 2H), 3.95 (m, 1H), 4.60 (d, 2H), 6.42 (d, 2H), 7.00 (d, 1H), 7.07 (s, 1H), 7.62 (s, 1H), 8.47 (s, 1H), 8.83 (t, 1H), 12.31 (br s, 1H).
II: K - Preparation of Ala-Pro-Hvdrocodone through the Enolate of Hydrocodone

Ala-Pro-Hydrocodone
[175] To a solution of Pro-Hydrocodone in DMF was added NMM
followed by Boc-Ala-OSu. The solution was stirred at ambient temperatures for 18hours. Solvent was removed. Crude material was purified using preparative HPLC (Phenomenex Luna C18, 30X250mm, 5uM, 100A; Gradient: 100 water/0 0.1% TFA-MeCN -> 0/100; 30ml/min.). Solid was collected as a slightly yellow powder (0.307g, 85% yield): ]H NMR (DMSO-de) 5 1.16 (d, 3H), 1.35 (s, 9H), 1.51 (m, 2H), 1.86-2.10 (m, 6H), 2.50 (m, 1H), 2.54 (m, 1H), 2.69 (m, 1H), 2.88 (s, 3H), 3.02 (dd, 1H), 3.26 (d, 1H), 3.55 (m, 1H), 3.67 (m, 1H), 3.72 (s, 3H), 3.80 (s, 1H), 4.25 (m, 1H), 4.43 (d, 1H), 5.01 (s, 1H), 5.59 (d, 1H), 6.75 (d, 1H), 6.88 (d, 1H), 6.99 (t, lH),9.91(brs, 1H).
[176] To the Boc-Ala-Pro-Hydrocodone (O.lOOg) was added 10ml of 4N
HC1 in dioxane. The resulting mixture was stirred at ambient temperatures for 18 hours. Solvent was removed and final product dried under vacuum. Solid was collected as a slightly yellow solid (0.56g, 71% yield): JH NMR (DMSO-d6) 8 1.38 (s, 3H), 1.48 (t, 1H), 1.80-2.29 (m, 8H), 2.65 (m, 1H), 2.80 (s, 3H), 2.96 (m, 3H), 3.23 (m, 2H), 3.76 (s, 3H), 3.92 (s,lH), 4.22 (s, 1H), 4.53 (s, 1H), 5.00 (s, 1H), 5.84 (d, 1H), 6.77 (d, 1H), 6.86 (d, 1H), 8.25 (br s, 3H).
II: L - Preparation of Leu-Hvdrocodone

Leu-Hydrocodone
[177] To a solution of hydrocodone in THF was added LiN(TMS)2 in THF
via syringe. The solution was stirred at ambient temperatures for 5 minutes then Boc-Leu-OSu was added. The resulting reaction mixture was stirred at ambient temperatures for 18 hours. Reaction was neutralized to pH 7 with 6M HC1. Solvent was removed. Crude material was taken up in CHCI3 (100ml), washed with sat. NaHCO3 (3X100ml), dried over MgSO4, filtered, and solvent removed. Solid was collected as a yellow powder (1.98g, 95% yield): 1H NMR (DMSO-d6) 8 0.86 (dd, 6H), 1.31 (s, 9H), 1.46 (s, 2H), 1.55 (m, 2H), 1.69 (m, 1H), 1.87 (dt, 1H), 2.07 (dt, 2H), 2.29 (s, 3H), 2.43 (m, 2H), 2.93 (d, 1H), 3.11 (s, 1H), 3.72 (s, 3H), 3.88 (dt, 1H), 4.03 (dt, 1H), 4.87 (s, 1H), 5.51 (d, 1H), 6.65 (d, 1H), 6.73 (d, 1H), 6.90 (s, 1H).
[178] To the Boc-Leu-Hydrocodone was added 25ml of 4N HC1 in
dioxane. The resulting mixture was stirred at ambient temperatures for 18 hours. Solvent was removed and final product dried under vacuum. Solid was collected as a slightly yellow solid (1.96g, 97% yield): 1H NMR (DMSO-d6) 8 0.94 (d, 6H), 1.52 (m, 1H), 1.75-1.90 (m, 4H), 2.22 (dt, 1H), 2.34 (dt, 1H), 2.64 (q, 1H), 2.75 (s, 3H), 2.95-3.23 (m, 4H), 3.74 (s, 3H), 3.91 (d, 1H), 4.07 (s, 1H), 5.10 (s, 1H), 5.72 (d, 1H), 6.76 (d, 1H), 6.86 (d, 1H), 8.73 br s, 3H).
II; M - Preparation of GIv-Glv-Leu-Hydrocodone

Gly-GIy-Leu-Hydrocodone
[179] To a solution of Leu-Hydrocodone in DMF was added NMM
followed by Boc-Gly-Gly-OSu. The solution was stirred at ambient temperatures for 18hours. Solvent was removed. Crude material was purified using preparative HPLC (Phenomenex Luna C18, 30X250mm, 5µM, 100A; Gradient: 90 water/10 0.1% TFA-MeCN ? 0/100; 30ml/min.). Solid was collected as a slightly yellow powder (2.08g, 73% yield): 1H NMR (DMSO-d6) 6 0.88 (dd, 6H), 1.38 (s, 9H), 1.53-1.72 (m, 5H), 1.89 (d, 1H), 2.15 (m, 1H), 2.67 (m, 2H), 2.94 (s, 3H), 3.05 (m, 2H), 3.25 (m, 2H), 3.56 (d, 3H), 3.76 (s, 6H), 3.98 (s, 1H), 4.35 (q, 1H), 5.04 (s, 1H), 5.59 (d, 1H), 6.77 (d, 1H), 6.85 (d, 1H), 7.04 (t, 1H), 8.01 (t, 1H), 8.30 (d, 1H), 9.99 (brs, 1H).
[180] To the Boc-Gly-Gly-Leu-Hydrocodone (2.08g) was added 50ml of
4N HC1 in dioxane. The resulting mixture was stirred at ambient temperatures for 18 hours. Solvent was removed and final product dried under vacuum. Solid was
collected as a slightly yellow solid (1.72g, 86% yield): !H NMR (DMSO-de) 5 0.89 (dd, 6H), 1.50-1.87 (m, 5H), 2.26 (m, 2H), 2.66 (m, 2H), 2.82-2.97 (m, 5H), 3.21 (m, 2H), 3.60 (m, 4H), 3.88 (m, 5H), 4.37 (m, 1H), 5.04 (s, 1H), 5.60 (s, 1H), 6.79 (d, 2H), 8.07 (br s, 3H), 8.54 (br s, 1H), 8.66 (br s, 1H), 11.29 (br s, 1H).
II: N - Preparation of Gly-Gly-Glv-Gly-Leu-Hvdrocodone

Gly-Gly-GIy-Gly-Leu-Hydrocodone
[181] To a solution of Gly-Gly-Leu-Hydrocodone in DMF was added
NMM followed by Boc-Gly-Gly-OSu. The solution was stirred at ambient temperatures for 18hours. Solvent was removed. Crude material was purified using preparative HPLC (Phenomenex Luna C18, 30X250mm, 5µM, lOOA; Gradient: 85 water/15 0.1% TFA-MeCN ? 50/50; 30ml/min.). Solid was collected as a slightly yellow powder (0.304g, 37% yield).
[182] To the Boc-Gly-Gly-Gly-Gly-Leu-Hydrocodone (0.304g) was added
25ml of 4N HC1 in dioxane. The resulting mixture was stirred at ambient temperatures for 18 hours. Solvent was removed and final product dried under vacuum. Solid was collected as a slightly yellow solid (0.247g, 97% yield): 1H NMR (DMSO-de) 8 0.87 (m, 6H), 1.23 (s, 1H), 1.51-1.86 (m, 4H), 2.18 (m, 1H), 2.71 (m, 2H), 2.77 (s, 3H), 2.96 (m, 2H), 3.17 (m, 2H), 3.61 (s, 3H), 3.81-3.84 (m, 10H), 4.22 (m, 1H), 4.36 (m, 1H), 5.09 (m, 1H), 5.59 (d, 1H), 6.74 (dd, 2H), 8.16 (br s, 4H), 8.38 (br s, 1H), 8.74 (br s, 1H), 11.42 (br s, 1H).
III Side-chain attachment of drugs to a Peptide
[183] The attachment of active agents to the side-chain of a peptide can be
formed through a plurality of a combination of functional groups that can be selected from the active agent or amino acid used for conjugation. Unlike, when the active agent is conjugated to the N-terminus or C-terminus, where the functional group of the amino acid is restricted to either an amine or carboxylate group respectively, side-chain attachment allows for variability in the selection of specific amino acid side-chain functionalities. Additionally, where applicable the active agent functional group can be selected to conform to the amino acid side-chain utilized for attachment. The functional groups depend on the functionality on the side chain of a peptide utilized for conjugation. The diversity of side-chain attachment allows any active agent to be directly attached to the side chain of amino acids with appropriate functional groups. Active agents containing alcohols, amines and/or carboxylic acids are directly amenable to attachment through and may dictate the side-chain of the amino acid selected. For active agents that lack these functional groups it is preferred that the incorporation of a linker contain an alcohol, amine, or carboxylic group.
[184] More preferred amino acids used to create the attachment and/or the
peptide are glutamic acid, aspartic acid, serine, lysine, cysteine, threonine, and glutamine. While homopolymers are often used, heteropolymers may be utilized to impart specific performance parameters. These heteropolymers may be of various chain length and degree of heterogeneity. Preferred examples include, but are not limited to, dipetides including Leu-Ser, Leu-Glu, homopolyers of Glu and Leu and heteropolymers of (Glu)n-Leu-Ser.
[185] An example of side-chain attachment conjugation to an acid drug is
depicted in the scheme below:
[186] The below example is a depiction of a side-chain attachment of an
acid drug. In this case the amino acid depicted is lysine:
[187] An example of side-chain attachment conjugation to an amine drug is
depicted in the scheme below:
[188] An example of side-chain attachment conjugation to an alcohol drug
is depicted in the scheme below:
[189] The below examples describe the general procedure for attachment of
an araino acid active agent to the side-chain of a peptide. Examples IE: A - HI:G
) describe the attachment of active agents to a peptide through the alcohol group. One of the examples describes the attachment of Naltrexone to aspartic acid, while the others show different active agents attached to glutamic acid. Examples DI:H - H[:I are illustrative of the conversion of one of the naturally occurring amino acids, in this case Glu, to a glutamic acid derivative for subsequent incorporation into a
5 peptide either through the NCA method or through the use of a peptide synthesizer. Example EQ:J is further illustrative of the conversion of one of the naturally
occurring amino acids, in this case Glu, to a glutamic acid derivative which can be further incorporated into a linear or dendritic peptide either through the NCA method or through the use of a peptide synthesizer. Examples ELK - ELN show a carboxylic acid attached to the side chain of an amino acid. In the present examples, the active agent is attached to Polylysine through the amino group. Example HI:O is describes a sulfonamide attached to the side-chain of a Polyglutamic acid. [190] Specific examples of active agent attached to the side-chain
attachment below are meant for example purposes only and are not meant to limit the invention to either specific active agents, amino acids or combinations thereof. Those skilled in the art would recognize from the present disclosure other active agents, which can be attached to the side-chain of a peptide.
III:A - Attachment of an Active Agent via an Alcohol Group to the Sidechain of Peptide

[191] To a solution of poly(glutamic acid) in DMF was added N-methyl
morpholine and bromo-fm-pyrrolidino-phosphonium hexafluorophosphate (PyBrOP). The resulting mixture was allowed to stir at room temperature for 30-60 minutes. After this time, N-methyl morpholine and DMAP followed by drug were added. The resulting solution was stirred at room temperature or at 60° C for 24 to
48 hours. Solvent and excess base were then removed using reduced pressure evaporation. Water, methanol or i-propanol was then added and the resulting solid was collected and dissolved in NaHCO3(sat.). The crude product was purified using ultrafiltration. Product was then collected from ultrafiltration using acid precipitation, methanol precipitation, acetone precipitation or removal of water under reduced pressure.
HI;B - Example: Naltrexone Derivatives
(i) Boc-Glu(Nal)-OtBu:
[192] The following examples describe the attachment of different alcohol
active agents to the side chain of glutamic acid to produce a new ester bond. [193] The solids Boc-Glu-OtBu (0.96 g, 3.18 mmol), naltrexone (1.00 g,
2.65 mmol) and PyBrop (1.73 g, 3.71 mmol) were dissolved in 5 mL of anhydrous
DMF and stirred at room temperature under argon. Dry N-methylmorpholine (1.08 mL, 9.81 mmol) was added and the reaction allowed to continue stirring at room temperature under argon. After two days additional Boc-Glu-OtBu (0.096 g, 0.32 mmol), PyBrop (0.173 g, 0.37 mmol) and N-methylmorpholine (0.10 mL, 0.981 mmol) were added. After 2 more days, the solvent was removed by rotary-evaporation under high vacuum. The resulting residue was then dissolved in CHCI3, and the resulting organic solution extracted with 2 x 20 mL of saturated NaCl, 3 x 20 mL of 10% Na2CO3 and a final wash with 20 mL of saturated aqueous NaCl. The organic solution was collected, dried over sodium sulfate and then adsorbed onto silica. Pure naltrexone conjugated amino acid (0.486 g, 0.78 mmol, 29%) was then isolated by flash chromatography and a gradient of 0-1.5% CH3OH in CHCI3. The purity of the isolated material was determined by TLC (6:1 CH3OH:CHC13), and 1H NMR confirmed the presence of both the amino acid moiety and the naltrexone. [194] 1H NMR (360 MHz, CDCI3): 5 6.81 (d, 1H, naltrexone aromatic),
6.63 (d, 1H, naltrexone aromatic), 4.3-4.2 (m, 1H, glutamic acid a-proton), 1.7-1.3 (pair of bs, 18H, Boc and OtBu groups.), 0.6-0.4 ppm (m, 2H, naltrexone cyclopropyl) and 0.2-0.0 ppm (m, 2H, naltrexone cyclopropyl).
(ii) Boc-Asp(Nal)-OtBu
[195] Boc-Asp(Nal)-OtBu was obtained in 41% isolate yield using a
similar protocol as the one used to prepare Boc-Glu(Nal)-OtBu. [196] 'H-NMR (360 MHz, CDCI3): 5 6.84 (d, 1H, naltrexone aromatic),
6.66 (d, 1H, naltrexone aromatic), 4.6-4.5 (m, 1H, aspartic acid a-proton), 1.6-1.3 (pair of bs, 18H, Boc and OtBu groups.), 0.7-0.5 ppm (m, 2H, naltrexone cyclopropyl) and 0.4-0.1 ppm (m, 2H, naltrexone cyclopropyl).
[199] To a solution of zidovudine (1.00 g, 3.75 mmol) and Boc-Glu(OSuc)-
OtBu (3.00 g, 7.49 mmol) in dioxane (75 mL) was added DMAP (0.137 g, 1.13 mmol) and N-methyl morpholine (0.82 mL, 7.49 mmol). The solution was heated to reflux for 6 hours and heated at 70°C for 12 hours. Solvent was then removed and the crude product was purified over silica gel (100% CHCl3) to obtain Boc-Glu(AZT)-OtBu (1.09 g, 1.91 mmol, 51%) as a yellow foam.
[200] 1H NMR (360 MHz, CDC13): 5 1.40 (d, 32H, t-Bu), 1.86 (s, 3H, AZT
CH3), 2.11 (m, 2H, Glu-ß H), 2.38 (m, 4H, Glu-yH and AZT 2' CH2), 4.00-4.31 (m,
4H, AZT 4' CH, 5' CH2 and Glu-aH), 5.21 (d, 1H, AZT 3' CH), 6.01 (t, 1H, AZT
V CH), 7.16 (s, 1H, AZT 6 CH).
[201] A solution of Boc-Gru(AZT)-OtBu (1.09 g, 1.91 mmol) in 4N HC1 in
dioxane (20 mL) was stirred for 4 hours and solvent removed. The product,
Glu(AZT) (0.89 g, 1.99 mmol, quant.), was obtained as a yellow glass.
[202] 1H NMR (360 MHz, D2O): 8 1.89 (s. 3H, AZT CH3), 2.21 (m, 4H,
Glu-ß H and AZT 2' CH2), 2.58 (m, 2H, Glu-y H), 3.70 (t, 1H, Glu-ct H), 4.05-4.41
(m, 4H, AZT 4' CH, 3' CH and 5' CH2), 6.18 (t, 1H, AZT 1' CH), 7.51 (s, 1H, AZT
6CH).
[203] To a solution of poly-glui5 (0.600 g, 0.310 mmol) in DMF (25 mL)
was added EDCI (2.07 g, 10.8 mmol). The resulting mixture was allowed to stir at ambient temperature for one hour. Then, N-methyl morpholine (0.51 mL, 4.7 mmol) was added followed by a mixture of acyclovir (1.74 g, 7.75 mmol), DMF (25 mL) and N-methyl morpholine (0.85 mL). The reaction mixture was stirred at ambient temperature for 4 days. After this, water (50 mL) was added and all solvent was removed. To the dried mixture was added water (100 mL) and a precipitate of unreacted acyclovir formed. Solid was centrifuged and the supernatant was purified using ultrafiltration (YM1 membrane). Approximately 300 mL water was allowed to pass through the membrane. NMR has shown an unexpected alkyl-urea side chain attached impurity. Poly-glu(acyclovir) (0.97 Og) was obtained as a light yellow solid.
[204] 1H NMR (360 MHz, D2O): 5 1.11 (br m, 4H, urea), 2.01 (br m, 2H,
Giu-P H), 2.39 (br m, 2H, Glu-yH), 2.72 (br m, 2H, urea), 3.32 (br m, 6H, acyclovir CH2 and urea), 3.83 (br m, 3H, urea), 4.38 (br d, 3H, Glu-a H), 5.47 (br s, 2H, acyclovir 1' CH2), 7.94 (br s, 1H, acyclovir 8 CH).
[205] To a solution of poly-glu15 (0.078 g, 0.040 mmol) in DMF (5 mL)
was added EDCI (0.035 g, 0.18 mmol). After stirring for 30 minutes, N-methyl morpholine was added (0.03 mL, 0.24 mmol). After stirring for 10 minutes, a solution of fexofenadine (0.100 g, 0.20 mmol), N-methyl morpholine (0.07 mL, 0.60 mmol) and DMF (5 mL) was added via a syringe. After stirring reaction at ambient temperatures for three days, sample was dissolved in water (25 mL). A solid precipitate formed which was both drug-conjugate and free fexofenadine. Water was acidified and all solids dissolved. Purification using ultrafiltration (YM1
Mlowed by YM3) and size exclusion chromatography using Sephadex-25 at pH 7 yielded poly-glu(fexofenadine) (0.010 g) as a white solid.
[206] 1H NMR (360 MHz, D2O): 5 1.37 (s, 8H, fex. CH2 and CH3), 1.58 (br
m, 5H, fex. CH and CH2), 1.99 (br m, 24H, Glu-ß H), 2.31 (br m, 24H, Glu-y H), 2.70 (br m, 10H, fex. CH and CH2), 4.14 (br m, 26H, Glu-oc H), 7.25 (br m, 14H, fex. aromatic H).
[207] To a solution of poly-glu15 (0.123 g, 0.060 mmol) in DMF (8 mL)
was added EDCI (0.403 g, 2.10 mmol). After 30 minutes, N-methyl morpholine (0.13 mL, 1.2 mmol) was added. After 35 minutes, a solution of zalcitabine (0.200 g, 0.95 mmol), N-methyl morpholine (0.10 mL, 0.9 mmol) and DMF (2 mL) was
added via a syringe. The resulting mixture was stirred at ambient temperature for 48 hours. Solvent was removed and the residue was dissolved in water (15 mL). Ultrafiltration (YM1 followed with YM3) and size exclusion using Sephadex-25 at pH 7 yielded poly-glu(zalcitabine) (0.083 g) as a light yellow solid. [208] 1H NMR (360 MHz, DMSO-de w/D2O): 5 1.14 (br m, 20H, urea),
1.90 (br m, 30H, Glu-ß H, Glu-y H and CH2 in zalcitabine), 2.66 (br m, 4H, urea), 3.24 (br m, 36H, urea, CH and CH2 in zalcitabine), 4.29 (br m, 8H, Glu-a H), 5.87 (br s, 1H, zalcitabine 1' CH), 7.18 (br s, 1.19H, zalcitabine NH2), 8.52 (br s, 1H, zalcitabine 6 CH).
[209] Preparation was similar to poly-Glu(zalcitabine). Purification using
ultrafiltration (YM1) yielded poly-Glu(stavudine) (0.089 g) as a white solid. [210] 1H NMR (360 MHz, D2O): 8 1.87 (s, 3H, stavudine 5 CH3), 2.06 (br
m, 38H, Glu-ß H and Glu-y H), 2.49 (br m, 12H, Glu-y H), 3.75 (br m, 12H, urea and stavudine 5' CH2), 3.96 (br m, 12H, urea), 4.45 (br d, 13H, Glu-a H), 5.98 (d, 1H, stavudine 1' CH), 6.48 (d, 1H, stavudine 3' CH), 6.96 (d, 1H, stavudine 2' CH), 7.63 (s, 1H, stavudine 6 CH).
[211] To a solution of poly(glutarnic acid) (1.00 g, 7.81 mmol) in DMF (50
mL) was added N-methyl morpholine (1.80 mL, 16.4 mmol) and bromo-tris-pyrrolidino-phosphoniumhexafluorophosphate (PyBrOP) (2.91 g, 6.25 mmol). The resulting mixture was allowed to stir at room temperature for 30 minutes. After this time, N-methyl morpholine (1.11 mL, 10.2 mmol) and 4-dimethylaminopyridine
.(0.191 g, 1.56 mmol) (DMAP) followed by Stavudine (1.57 g, 7.03 mmol) were added. The resulting solution was stirred at room temperature for 24 hours. Solvent and excess base were then removed using reduced pressure evaporation. Water was then added and the resulting solid was collected and dissolved in saturated NaHCO3. The crude product was purified using ultrafiltration. Product was then collected from ultrafiltration using acid precipitation (1.15 g, 48%).
[212] lH NMR (360 MHz, DMSO-dg): 5 1.73 (br s, 3H, stavudine 5 CH3),
1.89 (br s, 4H, Glu-ß H), 2.27 (br s, 4H, Glu-y H), 4.16 (br m, 4H, Glu-a H and stavudine 5' CH2), 4.95 (br s, 1H, stavudine 4'CH), 5.97 (br s, 1H, stavudine l'CH), 6.42 (br s, 1H, stavudine 3'CH), 6.80 (br s, 1H, stavudine 2'CH), 7.20 (br s, 1H, stavudine 6 CH), 8.06 (br s, 2H, Glu- NH), 11.37 (br s, 1H, stavudine NH), 12.14 (br s, 1H, Glu OH).
[213] Stavudine UV A™* (266nm), poly-glu(Stavudine) UV ?max (266nm),
Average % mass of Stavudine in poly-glu(Stavudine) 36%; MALDI: Glun(Stavudine) + NA n=6-8, Glun(Stavudine)2 + NA n=4-7, Glun(Stavudine)3 + NA n=2-8, Glun(Stavudine)4 + NA n=3-10, Glun(Stavudine)5 + NA n=5-13, Glun(Stavudine)6 + NA n=7-14, Glun(Stavudine)7 + NA n=9-14.
[214] Preparation was similar to poly-glu(zalcitabine). Purification using
ultrafiltration (YM1) yielded poly-Glu(metronidazole) (0.326 g) as a yellow solid. [215] 1H NMR (360 MHz, DMSO-ds): 5 1.18 (br d, 13H, urea), 1.93 (br s,
17H, Glu-ß H and Glu-y H), 2.71 (br s, 16H, urea), 4.01 (br m, 18H, Glu-oc H and metronidazole CH2), 4.58 (br s, 2H, metronidazole CH2), 8.05 (br s, 1H, metronidazole 2 CH).
[216] To a solution of poly(glutamic acid) (1.00 g, 7.81 mmol) in DMF (50
mL) was added N-methyl morpholine (1.80 mL, 16.4 mmol) and bromo-tris-pyrrolidino-phosphonium hexafluorophosphate (PyBrOP) (2.55 g, 5.47 mmol). The resulting mixture was allowed to stir at room temperature for 30 minutes. After this time, N-methyl morpholine (1.11 mL, 10.2 mmol) and 4-dimethylaminopyridine CO. 191 g, 1.56 mmol) (DMAP) followed by Quetiapine (1.79 g, 4.69 mmol) were added. The resulting solution was stirred at room temperature for 24 hours. Solvent and excess base were then removed using reduced pressure evaporation. Water was then added and the resulting solid was collected and dissolved in saturated NaHCO3. The crude product was purified using ultrafiltration. Product was then collected from ultrafiltration using acid precipitation (0.965 g, 35%).
[217] 1H NMR (360 MHz, DMSO-d6): 5 1.87 (br d, 12H, Glu-ß H), 2.33
(br m, 12H, Glu-yH), 2.78 (br m, 8H, quetiapine), 3.49 (br m, 6H, quetiapine), 4.13
(br s, 2H, quetiapine), 4.22 (br s, 6H, quetiapine), 6.91 (br s, 1H, quetiapine), 7.01 (br s, 1H, quetiapine), 7.19 (br s, 1H, quetiapine), 7.38 (br m, 4H, quetiapine), 7.54 (br s, 1H, quetiapine), 8.07 (br s, 4H, Glu NH).
[218] Quetiapine UV A.max (250nm), poly-glu(Quetiapine) UV ?max
(250nm), Average % mass of Quetiapine in poly-glu(Quetiapine) 43%.
III:.T - Example; 2-Amino-pentanedioic acid 5-(4-acetylamino-phenyI) ester or GIu(Acetaminophen)
(i) Preparation of Boc-Glu(Acetaminophen)-OtBu
[219] To a solution of Boc-Glu(OSuc)-OtBu (0.500 g, 1.25 mmol) and
acetaminophen (0.944 g, 6.25 mmol) in THF (15 mL) was added N-methyl morpholine (1.40 mL, 12.5 mmol). The reaction was allowed to heat to reflux and stirred at reflux overnight. Solvent was then removed and the crude compound was purified over silica gel (50-75% ethyl acetate in hexanes) to obtain Boc-Glu(Acetaminophen)-OtBu (0.432 g, 0.900 mmol, 72%).
[220] 1H NMR (360 MHz, CDC13): 6 1.43 (d, 18H, t-Bu), 1.97 (m, 1H,
Glu-ß H), 2.12 (s, 3H, acetaminophen CH3), 2.25 (m, 1H, Glu-ß H), 2.60 (m, 2H, Glu-y H), 4.25 (m, 1H, Glu-a H), 7.04 (d, 2H, acetaminophen aromatic), 7.48 (d, 2H, acetaminophen aromatic).
(ii) Preparation of Glu(acetaminophen)
[221] A solution of Boc-Glu(Acetaminophen)-OtBu (0.097 g, 0.20 mmol)
in 4N HC1 in dioxane (10 mL) was stirred at ambient temperatures for 2 hours. Solvent was removed to obtain Glu(acetaminophen) (0.90 g) as the HC1 salt. [222] 1H NMR (360 MHz, D2O): 6 2.19 (s, 3H, acetaminophen CH3), 2.41
(m, 2H, Glu-ß H), 2.97 (t, 2H, Glu-y H), 4.18 (t, 1H, Glu-a H), 7.19 (d, 2H, acetaminophen aromatic), 7.51 (d, 2H, acetaminophen aromatic). [223] 13C NMR (360 MHz, DMSO-de): 8 23.80, 29.25, 51.00, 66.24,
119.68,121.69,137.00,145.35,168.23,170.42,170.79.
(Hi) Preparation of Glu(Acetaminophen) NCA
[224] To a mixture of 2-amino-pentanedioic acid 5-(4-acetylamino-phenyl)
ester (1.54 g, 4.29 mmol) in THF (40 mL) was added triphosgene (1.02 g, 3.43
mmol). The resulting solution was stirred at reflux for 3 hours. During reaction, the
product precipitated and was filtered away to obtain the NCA of
Glu(acetaminophen) (1.02 g, 2.64 mmol, 62%) as an off white solid.
[225] 1H NMR (360 MHz, DMSO-d6): 8 2.01 (s, 3H, acetaminophen CH3),
2.15 (m, 2H, Glu-ß H), 2.81 (m, 2H, Glu-y H), 3.76 (t, 1H, Glu-a H), 7.06 (d, 2H,
acetaminophen aromatic), 7.63 (d, 2H, acetaminophen aromatic), 8.57 (br s, 1H,
amide), 10.19 (s, 1H, amide).
[226] 13C NMR (360 MHz, DMSO-d6): 8 23.81, 29.25, 52.13, 54.62,
119.66,121.71,136.98, 145.35,167.44,168.19,170.46,170.77.
III:K - Example; Preparation of PoIvGlu Prednisone
(i) BocGlu(21-Prednisone)O-tBu
[227] To BocGlu-O-tBu (0.400 g, 1.32 mmol) in 20 mL CHC13 was added
dicyclohexylcarbodiimide (0.544 g, 2.64 mmol). The reaction was stirred for 1 hour and filtered to remove insoluble dicyclohexylurea. N-dimethyl-4-aminopyridine (0.320 g, 2.64 mmol) and prednisone (0.472 g, 1.32 mmol) was added. The reaction was stirred for 60 hours and filtered. The solvent was removed by rotary evaporation and the residue purified by flash chromatography (10:1-0:1 hexane:EtOAc) to provide the target as a clear film (0.256 g, 31%). [228] Rf = 0.54 (6:1 CHCl3:MeOH; 1H NMR (500 MHz, CDCl3): 5 7.68 (d,
1H, 1), 6.16 (d, 1H, 2), 6.04 (s, 1H, 4), 5.15 (d, 1H, NH), 5.03 (d, 1H, 21), 4.71 (d, 1H, 21), 4.08 (t, 1H, a), 1.40 (s, 18H, t-Bu).
(ii) Glu(21-Prednisone)
[229] To BocGlu(21-Prednisone)O-tBu (0.060 g, 93 umol) in 15 mL
CH2Cl2 was stirred for 1 hour with trifluoroacetic acid (1.5 mL). The solvent was removed by rotary evaporation and the residue purified by flash chromatography (8:1 CHCl3:MeOH) to yield a clear film.
[230] Rf = 0.13 (6:1 CHCl3:MeOH).
[231] !H NMR (500 MHz, CDC13): 8 7.72 (d, 1H, 1), 6.25 (d, 1H, 2), 6.14
(s, 1H, 4), 5.14 (d, 1H, 21), 4.75 (d, 1H, 21), 4.10 (t, 1H, a).
(iii) Glu(21-Prednisone)NCA
[232] To Glu(21-Prednisone) (0.044 g, 90 M-mol) in 20 mL dry THF was
added triphosgene (0.021 g, 72 µmol). After gently refluxing for 3 h, the solvent
was removed by rotary evaporation, the residue washed thrice with 15 mL hexane
and then dried under vacuum to yield the NCA as a white solid.
[233] Rf=0.98(EtOAc).
[234] 1H NMR (500 MHz, CDCl3): 8 7.72 (1H), 6.89 (1H), 6.25 (1H), 6.14
(s, 1H, 4), 5.14 (d, 1H, 21), 4.75 (d, 1H, 21), 4.49 (1H, a).
(iv) PolyGlu(21-Prednisone)
[235] Glu(21-Prednisone)NCA (0.037 g, 72 pmol) and Glu(21-Prednisone)
(0.004 g, 8 (xmol) were dissolved in 5 mL dry DMF. After stirring for 88 hours under argon the reaction mixture was poured into 30 mL H2O and extracted thrice with 15 mL CHCI3. The organic layer was concentrated and dried in vacuum to provide a drug bearing polymer with a 1:1 PrednisonerGlutamic acid ratio.
(i) Preparation of Boc-Glu(dipyrimadole)-OtBu
[236] To a solution of dipyrimadole (0.500 g, 0.990 mmol) and Boc-
Glu(OSuc)-OtBu (3.96 g, 9.91 mmol) in THF (35 mL) was added DMAP (0.072 g,
0.60 mmol) and N-methyl moipholine (0.22 mL, 1.98 mmol). The solution was then
refluxed for 48 hours. Solvent was then removed and crude product was purified
over silica gel (25-50% ethyl acetate in hexanes). Two major products were
isolated, one with Rf = 2-3, Boc-Glu(dipyrimadole)-OtBu, (0.57 g) and another with
Rf = 3-4 (2.80 g), as bright yellow oils.
[237] Rf = 2-3, 1H NMR (360 MHz, CDC13): 5 1.41 (s, 42H, t-Bu), 1.64 (br
s, 5H, dipyrimadole), 1.85 (m, 2H, Glu-ß H), 2.07 (m, 2H, Glu-ß H), 2.37 (m, 4H,
Glu-yH), 3.60-4.24 (m, 12H, Glu-a H and dipyrimadole).
[238] (for Rf = 3-4 similar as above except 5 1.44 (s, 56H, t-Bu)).
(ii) Preparation of Glu(dipyrimadole)
[239] A solution of Boc-Glu(dipyrimadole)-OtBu (Rf = 2-3, 0.57 g) and 4N
HC1 in dioxane (20 mL) was stirred at ambient temperature for 2.5 hours. Solvent was removed and the product (0.280 g) was a bright yellow solid. [240] 1H NMR (360 MHz, DMSO-d6): 5 1.65 (br m, 4H, Glu-ß H and
dipyrimadole), 2.04 (br m, 2H, Glu-ß H), 2.40 (br m, 4H, Glu-yH), 3.75 (br m, 8H, dipyrimadole), 3.91 (br m, 2H, Glu-a H), 8.55 (br m, 2H, amide H).
[241] To a solution of poly(glutamic acid) (0.700 g, 5.47 mmol) in DMF
(40 mL) was added N-methyl morpholine (1.26 mL, 11.5 mmol) and bromo-fm-pyrrolidino-phosphonium hexafluorophosphate (PyBrOP) (2.04 g, 4.38 mmol). The resulting mixture was allowed to stir at room temperature for 30 minutes. After this time, N-methyl morpholine (0.78 mL, 7.11 mmol) and 4-dimethylaminopyridine (0.133 g, 1.09 mmol) (DMAP) followed by Furosemide (1.63 g, 4.92 mmol) were added. The resulting solution was stirred at room temperature for 24 hours. Solvent and excess base were then removed using reduced pressure evaporation. Water (100 mL) was then added and the resulting solid was collected and dissolved in saturated NaHCO3. The crude product was purified using ultrafiltration. Product was then collected from ultrafiltration using acid precipitation as a green solid (0.678 g, 32%). [242] 1H NMR (360 MHz. DMSO-d6): 8 1.84 (br d, 8H, Glu-ß H), 2.273
(br m, 8H, Glu-y H), 4.21 (br s, 4H, Glu-a H), 4.57 (br s, 2H, furosemide), 6.37 (br
tl, 2H, furosemide), 7.04 (br s, 1H, furosemide), 7.61 (br s, 1H, furosemide), 8.06 (br m, 4H, Glu NH), 8.51 (br s, 2H, furosemide), 8.80 (br s, 1H, furosemide), 12.25 (br s, 1.5H, Glu and Furosemide COOH). [243] Average % mass of Furosemide in poly-Glu(Furosemide): 39%.
[244] To a stirring solution of ibuprofen (2.06 g, 10 mmol) in 5 mL of
dioxane at room temperature was added a solution of dicyclohexylcarbodiimide (DCC, 2.27 g, 11 mmol) in 25 mL of dioxane. After 10 minutes a solution of N-hydroxysuccinimide (NHS, 1.16 g, 10 mmol) in 15 mL of dioxane was added. The reaction mixture was allowed to stir at room temperature for 5 hours and then filtered through a sintered glass funnel to remove the dicyclohexylurea (DCU). After rotary evaporation, the product was crystallized from methylene chloride/hexanes to yield 2.36 g (78%) of a colorless solid.
[245] 1H NMR (500 MHz, DMSO-d6): 8 0.86 (d, 6, CH3), 1.49 (d, 3,a-
CH3), 1.81 (m, 1, CH), 2.43 (d, 2, CH2), 3.33 (m, 4, CH2CH2), 4.22 (q, 1, CH), 7.16 (d, 2, ArH), 7.28 (d, s, ArH).
[246] Poly-lysine-HBr (Sigma, 100 mg, 34.5 nmol) was dissolved in 1 mL
of water that had been brought to a pH of 8 with sodium bicarbonate, and stirred at room temperature. To this solution was added a solution of ibuprofen-O-succinimide (116 mg, 380 nmol) in 2 mL of dioxane. After stirring overnight, the dioxane was removed by rotary evaporation and diluted with 10 mL of pH 8 sodium bicarbonate in water. The precipitated product was filtered through a sintered glass funnel and washed with 3 x 10 mL of water and 4 x 10 mL of diethyl ether. After drying overnight by high vacuum the solid product was scraped out yielding 105 mg (62%).
[247] 1H NMR (500 MHz, DMSO-d6): 8 0.85 (br s, 6, CH3), 1.27 (br s,
3,oc- CH3), 1.40-1.79 (m, 5, CH of ibu and lysine y and 8 CH2CH2), 2.31 (d, 2, p CH2), 2.41-2.52, under dmso (m, 2, ß CH2), 2.73-3.01 (m, 2, 8 CH2), 3.51-3.85 (m, 1 ibu CH), 4.01-4.43 (m, 1, a CH), 7.14 (d, 2, ArH), 7.6 (d, 2, ArH), 7.90-8.06 (m, 2, NH).
III;O - Example: Synthesis of PoIyLvsine-Naproxen
(i) Synthesis of Naproxen-Succinimide
[248] To Naproxen (2.303 g, 10 mmol) in 5 mL of dioxane was added N-
hydroxysuccinimide (1.16 g, 10 mmol) dissolved in 15 mL of dioxane and dicyclohexylcarbodiimide (2.27 g, 11 mmol) in 25 mL of dioxane. The reaction was stirred overnight and the insoluble dicyclohexylurea removed by filtration. The solvent was removed by rotary evaporation and the residue dissolved in 30—40 mL CH2C12. Approximately 10 mL hexane was added and the mixture was chilled to 4°C for 2 hr. Additional hexane was added dropwise until small planar white crystals began to form and the solution was refrigerated overnight. The activated ester was harvested, washed with hexane and dried in vacuum (2.30 g, 70.0 %) [249] 1H NMR (500MHz, DMSO-d6): 8 1.70 (d, 3H, CH3) 2.9 (s, 4H,
succinimide), 3.91 (s, 3H, OCH3), 4.18 (q, 1H, methine) 7.75-7.12 (m, 6H, aromatic).
(ii) Synthesis of polylysine-Naproxen
[250] To [Lys]114 14 HBr (0.100 g, 35 mmol) in 1 mL of H2O (containing
10 mg/mL Na2CO3) was added Naproxen-Succinimide (0.124 g, 379 mmol) in 2 mL of dioxane. After stirring overnight a precipitate formed. More precipitate was formed by the addition of 30-40 mL of H2O (containing 10 mg/mL Na2CO3), isolated by filtration and washed with 50 mL of EtoO. The fine white powder was dried (0.095 g, 53%).
[251] 1H NMR (500MHz, DMSO-d6): 5 8.1 (m, 1H, lysine; amide), 7.8-7.0
(m, 6H, aromatic), 4.4-4.1 (m, 2H, a.methine), 3.3 (s, 3H, OCH3), 2.8 (m, 2H, e), 1.7-1.0 (m,9H,p,y, 6, CH3).
HI:P - Example; Synthesis of PolyLysine-Gemfibrozil
(i) Synthesis of Gemfibrozil - Succinimide
[252] To Gemfibrozil (GEM) (5.0 g, 20.0 mmol) in 30 mL dioxane was
added N- hydroxysuccinimide (2.3 g, 20.0 mmol) in 20 mL dioxane and dicyclohexylcarbodiimide (4.5 g, 22.0 mmol) in 50 mL dioxane. The reaction was stirred overnight and the insoluble dicyclohexylurea removed by filtration. The solvent was removed by rotary evaporation and the residue dissolved in 15 - 20 mL of CH2Cl2- Hexane was added dropwise until crystal formation was seen and the mixture was chilled to 4° C overnight. Approximately 3 mL of additional n-hexane was added and the mixture chilled to -20° C overnight. The activated ester formed small planer crystals and was harvested, washed with hexane and dried in vacuum (5.8 g, 80%).
[253] 'H NMR (500 MHz, DMSO-d6): 5 1.2, 1.3 (s, 6H, CH3), 1.8-1.5 (m,
6H, GEM CH2), 2.3-2.1 (s, 6H, aromatic CH3) 2.85-2.7 (d, 4H, succinimide CH2), 7.0-6.6 (m, 3H, aromatic).
(ii) Synthesis of polylysine-Gemfibrozil
[254] To [Lys]11 11 HBr (0.100 g, 43.5 ymol) in 1 mL of H2O (containing
10 mg/mL Na2C03) was added Gemfibrozil-succinimide (0.094 g, 261.1 µmol) in 2 mL dioxane. After stirring overnight a precipitate formed. More precipitate was
formed by the addition of 30 mL of H2O (containing 10 mg/mL Na2C03), isolated and washed with 50 mL Et2O. The fine white powder was dried (0.019 g, 1%). [255] 1H NMR (500 MHz, DMSO-d6): 8 1.5-1.0 (m, 12H, p, y, 8,.CH3),
1.85-1.5 (m, 4H, CH2), 2.3, 2.1 (s, 6H, aromatic CH3), 3.35 (s, 2H, e), 3.85 (s, 2H, OCH2), 4.05 (s, 1H, a), 5.6 (d, 1H, carbamate), 7.0-6.7 (m, 3H, aromatic), 8.0 (d, 1H, amide).
ni:O - Example: Preparation of PolvLysine Depakote (Valproic acid)
(i) Synthesis of Valproic acid - Succinimide
[256] To valproic acid (1.0 g, 6.9 mmol) in 14 mL 6:1 CH2C12:DMF was
added N-hydroxysuccinimide (0.8 g, 6.9 mmol), dicyclohexylcarbodiimide (1.6 g,
7.6 mmol) and triethylamine (0.9 g, 8.9 mmol). The reaction was stirred for 60 h
whereupon the solution was filtered to remove the white precipitate and the solvent
removed by rotary evaporation. The residue was purified by flash chromatography
(10:1-2:1 hexane:EtOAc) to provide the succinimidyl ester as a clear oil (1.0 g,
59%).
[257] Rf = 0.43 (3:1 hexane:EtOAc).
[258] 1H NMR (300 MHz, CDC13): 8 2.76 (s, 4H, succinimide), 2.61 (m,
1H, methine), 1.65-1.19 (m, 8H, methylene), 0.88 (t, 6H, methyl).
(ii) Synthesis of PoIyLysine-Valproic acid
[259] To LysuHBr (0.106 g, 37 umol) in 0.8 mL H2O pH 8 was added the
valproic succinimidyl ester (0.104 g, 431 umol) dissolved in 0.4 mL THF. The reaction was stirred overnight whereupon 8 mL HoO was added. The mixture was acidified to pH 3 with 6 M HC1 and extracted twice with 2 mL CH2C12. The aqueous layer was dried and the residue dissolved in 1 mL H2O. The solution was purified by SEC (G-15, 10 mL dry volume) and eluted with water. Those fractions containing conjugate were combined and dried to yield a white solid (0.176 mg) which by lH NMR indicated 28 Lysine for every one drug molecule. [260] !H NMR (300 MHz, D2O): 8 4.29 (m, 1H, a), 3.00 (m, 2H, e), 1.87-
1.68 (m, 4H, P, 5), 1.43 (m, y, methylene), 0.85 (t, methyl).
HI:R — Example; Attachment of Pravastatin to the Side Chain of a Peptide
[261] The example below describes the preparation of [Lys(Pravastatin)]is
where Pravastatin is attached to the side chain fo the peptide to form an mide linked drug/peptide conjugate.
[262] To Pravastatin sodium (0.994 g, 2226 umol) in 10 mL dry DMF was
added dicyclohexylcarbodiimide (0.458 g, 2226 umol). After stirring for 3 hours under argon the solution was filtered through glass wool (to remove insoluble dicyclohexylurea) into a solution of polyLysine (0.288 g, 148 (imol) dissolved in 1 mL H2O pH 8. After stirring overnight the milky white reaction was filtered through glass wool and the solvent removed by rotary evaporation. The resultant syrup was dissolved in 5 mL of 2-propanol and then diluted with 60 mL H2O. The mixture was acidified to pH 6 with 1 N HC1 and extracted thrice with 30 mL CHC13. The organic solvent was removed by rotary evaporation and replaced with 45 mL H2O and 5 mL 2-propanol. This solution was ultrafiltered (Amicon YM1, 1000 MW) with 100 mL H2O and the retentate dried in vacuum to yield a white solid (130 mg). [263] Rf = 0.77 (6:1 CHC13:CH3OH).
[264] 'H NMR (500 MHz, DMSO-d6): 5 5.97 (1H, 5'), 5.85 (1H, 3'), 5.50
(1H, 4'), 5.19 (1H, 8'), 4.78 (1H, 6'), 4.40 (1H, a), 4.15 and 4.01 (2H, 3, 5), 3.45 (2H, e), 2.30 (4H, 2,2, 2', 2"), 1.04 (3H, 2"-CH3), 0.83 (6H, 4", 2'-CH3).
III-.S - Preparation of Boc-Leu-Ser(Boe-Ciprofloxacin)OCEh
[265] The solids Boc-Leu-Ser-OCH3 (500 mg, 1.5 mmol), Boc-Cipro (970
mg, 2.25 mmol), PyBrop (1.05 g, 2.25 mmol) and DMAP (183 mg, 1.5 mmol) were dissolved in anhydrous DMF (15 ml). To this solution/ suspension was added N-methylmorpholine (414 µl, 3.75 mmol). The reaction mixture was then allowed to stir overnight at room temperature under argon. The majority of solvent was then removed under vacuum by rotary evaporation. The remaining oil was dissolved in CHC13 (20 ml), and the organic solution extracted initially with saturated NaHCO3 (3.20 ml) and then with acidic water (pH3 HC1, 3.20 ml). The organic layer was collected and dried over MgSO4 The suspension was then filtered and the CHC13
solution collected. The solvent was then removed under vacuum by rotary evaporation affording a yellow oil. This was redissolved in CHC13 (20 ml), and the organic solution extracted again with saturated NaHCO3 (3x20 ml) and then with 0.1 N NaOH (3.20 ml). The organic solution was then dried over MgSO4, and the suspension filtered with the CHC13 solution collected. The solvent was then removed under vacuum by rotary evaporation affording a yellow oil. this oil was dissolved in a minimal volume of CHCI3 and the solution deposited on a preparative TLC plate. The plate was developed with 19:1 CHCl3/MeOH. The second band was collected and characterized by lH-NMR. (500 MHz, (CD3)2SO) 5 0.868 (d, 6H, Leu5), 1.285-1.096 (m, 2H, Cip), 1.4-1.2 (m, 11H, Boc & Cip), 1.5-1.4 (m, 11H, Boc & Leu), 1.7-1.6 (m, 1H Leup), 3.3-3.1 (m, 4H, Cip), 3.6-3.5 (m, 4H, Cip), 3.660 (bs, 4H, -OCH3 & Cip), 4.05-4.15 (m 1H, Leua), 4.35-4.5 (m, 2H, Serp), 4.7-4.8 (m, 1H Sera), 6.885 (d, 1H, amide), 7.489 (d, 1H, Cip), 7.79 (d, 1H, Cip) and 8.48 (d, 1H, Cip).
III: T - Preparation of Leu-Glu (AZT) (i) Preparation of Boc-Leu-Glu-OtBu

Boc-Leu-Glu-OtBu
[266] To a solution of Boc-Leu-OSu and Glu-OtBu in DMF was added
NMM and DMAP. The solution was stirred at ambient temperatures for 18 hours then the solvent was removed. Crude product was taken up in 100 ml CHCI3,
" washed 3X with pH 3 water (100ml), once with water (100ml) and once with brine (100ml). Organic layer was dried with MgSO4 and filtered. Solvent was removed and solid was dried over vacuum. Solid was collected as a white powder (8.78g, quant, yield, -80% purity TLC). Product was used directly without further characterization.
Boc-Leu-Glu-OtBu
[267] To a solution of Boc-Leu-Glu-OtBu in DMF was added NMM and
PyBrOP. The solution was stirred at ambient temperatures for 0.5 hours then the AZT and DMAP were added. The reaction mixture was then stirred at ambient temperatures for 18 hours. Solvent was removed and crude product was taken up in
400 ml CHC13, washed 3X with pH 3 water (250ml), once with water (250ml) and once with brine (250ml). Organic layer was dried with MgSO4 and filtered. Solvent was removed and solid was dried over vacuum. Product was purified using prep. HPLC [Phenomenex Luna C18, 30X250mm, 5uM, 100A; Gradient: (100 0.1% TFA-water/0 0.1% TFA-MeCN ? 80/20) 0-10 min. (80/20 ? 50/50) 10-25 min.; 30ml/min.]. Product was deprotected using 100ml 95%TFA/water. Product was dried over a vacuum to give a slightly yellow solid (2.45g, 4.04mmoles, 38% yield): lR NMR (DMSO-d6) 8 0.90 (m, 6H), 1.58 (m, 2H), 1.69 (m, 2H), 1.80 (s, 3H), 1.87 (m, 1H), 2.07 (m, 1H), 2.35 (m, 1H), 2.45 (m, 2H), 3.78 (m, 1H), 3.97 (t, 1H), 4.28 (m, 3H), 4.45 (t, 1H), 6.14 (t, 1H), 7.46 (s, 1H), 8.14 (br s, 3H), 8.75 (d, 1H), 11.32 (br s, 1H).
IV Amino Acid Active Agents and their Attachment to a Peptide
[268] Amino acid active agents allow for a distinct embodiment of the
present invention. This embodiment occurs when the active agent itself is an amino acid and thus capable of both amine and carboxylate bonding allowing for the interspersement of the active agent into the peptide chain. Amino acid drugs can be C-capped, N-capped and sidechain attached according to the procedures and mechanisms described above. As a unique aspect to amino acid drugs, the active agent may be interspersed within the peptide chain through a peptide bond at both ends of the active agent.
[269] Most preferred drug conjugates for the interspersed attachment of
amino acid active agents include amoxicillin; amoxicillin and clavulanate; baclofen; benazepril hydrochloride; candoxatril; captopril; carbidopa/Levodapa; cefaclor; cefadroxil; cephalexin; cilastatin sodium and imipenem; ciprofloxacin; diclofenac sodium; diclofenac sodium and misoprostol; enalapril; enapril maleate; gabapentin; levothyroxine; lisinopril; lisinopril and hydroichlorothiazide; loracarbef; mesalamine; pregabalin; quinapril hydrochloride; sitafloxacin; tirofiban hydrochloride; trandolapril; and trovafloxacin mesylate.
IV: A - Preparation of Active Agent Conjugates (N-terminus)
[271] In the following examples the amino acid active agent is attached to
the N-terminus of different amino acids. These examples do not only describe an N-terminus attachment, but also represent the peptide linkage of the amino acid active agent as an amino acid to form either a dipeptide or a peptide conjugate. [272] T4 conjugated to amino acid polymers were either prepared by
coupling (protected) T4 to commercially available amino acid homopolymers or incorporated by addition of T4-NCA to the corresponding polypeptide in situ.
(i) T4 Conjugation to a Commercial Polyglycine
[273] To N-TeocT4 (0.017 g, 17 umol) in 1 mL dry DMF was added
dicyclohexylcarbodiimide (0.004 g, 18 umol). After stirring for 30 minutes N-dimethyl-4-aminopyridine (0.004 g, 36 umol) and Glyi8 (0.017 g, 17 umol) were added and the reaction stirred overnight. The cloudy solution was poured into 20
mL H2O and extracted twice with 10 mL CH2C12. The aqueous component was
acidified to pH 3 with 1 N HC1 and chilled to 4°C. The material was isolated by
centrifugation and the pellet washed 3 times with 8 mL H2O. The pellet was dried in
vacuum to yield dicyclohexylurea and N-TeocT4-Glyig.
[274] 'H NMR (500 MHz, DMSO-d6): 8 7.8 (T4 aromatic), 7.1 (T4
aromatic), 4.1 (a).
[275] To the impure protected polymer was added 2 mL trifluoroacetic
acid. The reaction was stirred for 2 hours at room temperature and the solvent
removed by rotary evaporation. The residue was dissolved in 1 mL DMF and the
insoluble material removed by filtration. The DMF was removed by rotary
evaporation and dried in vacuum to yield a white material (.012 g, 40%).
[276] 1H NMP (500 MHz, DMSO-d6): 5 7.75 (T4 aromatic), 7.08 (T4
aromatic), 4.11 (bs, a).
(ii) Preparation of Amino Acid-NCA
[277] N-carboxyanhydrides (NCA's) of the amino acids listed below were
prepared using a protocol similar to that reported for glutamic acid. Minor variations in their final workups are noted below.
[278] To a mixture of Thr-OtBu (0.500 g, 2.85 mmol) in THF (25mL) was
1 added triphosgene (0.677 g, 2.28 mmol). The resulting solution was stirred at reflux for 3 hours. The solution was evaporated to dryness to obtain Thr-NCA (0.500 g, 2.48 mmol, 87%) as a white solid. Thr-NCA was used without further characterization.
[279] To the L-amino acid (1.5 g) in 100 mL dry THF was added
triphosgene (0.8 eqv). The reaction was vessel was equipped with a reflux condenser and NaOH trap and heated to reflux for 3 h. The solvent was removed by rotary evaporation and the residue washed with hexane to yield the amino acid NCA as white residue.
Leu-NCA: 1H NMR (500 MHz, CDC13): 8 6.65 (s, 1H, NH), 4.33 (dd, 1H, a), 1.82 (m, 2H, P), 1.68 (m, 1H, y), 0.98 (dd, 6H, 8).
Phe-NCA: 1H NMR (500 MHz, CDC13): 8 7.36-7.18 (m, 5H), 5.84 (s, 1H, NH), 4.53 (dd, 1H), 3.28 (dd, 1H, a), 2.98 (dd, 1H, p).
Trp(Boc)-NCA: 1H NMR (500 MHz, CDC13): 8 8.14 (d, 1H), 7.49 (d, 2H), 7.36 (t, 1H), 7.27 (m, 1H), 5.90 (s, 1H, NH), 4.59 (dd, 1H, a), 3.41 (dd, 1H, P), 3.07 (dd, 1H, P), 1.67 (s, 9H, t-Bu).
Ile-NCA: 1H NMR (300 MHz, CDCI3): 8 6.65 (s, 1H, NH), 4.25 (d, 1H, a), 1.94 (m, 1H, P), 1.43 (dm, 2H, y-CH2), 1.03 (d, 3H, y-CH3),0.94 (t, 3H, 5).
Lys(Boc)-NCA: 1H NMR (500 MHz, CDC13): D 6.65 (bs, 1H, NtH), 4.64 (s, 1H, carbamate NH), 4.31 (t, 1H, a), 3.13 (s, 2H, e), 2.04 (m, 2H, P), 1.84 (m, 2H, 5), 1.48 (m, HH,y,t-Bu).
Met-NCA: 1H NMR (500 MHz, CDC13): 8 6.89 (s, 1H, NH), 4.50 (dd, 1H, a), 2.69 (t, 2H, y), 2.10 (m, 1H, P), 2.08 (m, 4H, p, 5).
(iv) T4 Conjugation to Preformed Homopolymer in situ
T4-Aspn
[280] The below example depicts the attachment of T4 to the N-terminus of
peptide conjugate poly Asp in situ. Polyserine and Polythreonine were also prepared using this protocol. The serine reaction mixture contained N-methylmorpholine (1.1 equivalents).
[281] Polyaspartic acid: Asp(Otfiu) (13 mg, 0.07 mmol) and Asp(OtBu)-
NCA (200 mg, 0.93 mmol) were dissolved in anhydrous DMF (5 mL), and the solution allowed to stir over night at room temperature under argon. The following morning, 2.5 mL of the reaction mixture was transferred to separate flask (Flask B). T4-NCA (27 mg, 0.03 mmol) was added to the original flask (Flask A), and both solutions were allowed to continue stirring under argon for an additional 24 hours. Polymer was then precipitated by the addition of water (50 mL) to each flask. The resulting solids were collected by filtration and dried over night under vacuum. [282] The dried Asp(OtBu)n (Flask B) and T4-Asp(OtBu)n (Flask A) were
then dissolved in 95% trifluoroacetic acid in water (3 mL) and allowed to stir at room temperature for 2 hours. The deprotected polymers were then precipitated by the addition of ethyl ether (10 mL) and then storing the suspension at 4 °C for 2 hours. The respective polymers were then collected by filtration and the solids dried over night under vacuum. This afforded 48 mg of Aspn (Flask B) and 12 mg of T4-Aspn (Flask A). MALDI indicated that T4-Aspn (Flask A) consisted of a mixture of polymers of varying lengths: T4-Asp3.12.
(3): The percent yield was estimated based on the total amino acid content in the original reaction prior to splitting the reaction. The Mass Range was determined from MALDI. The yield over 100% could reflect either the presence of salts or uneven distribution when the reaction mixture was split.
Other examples of T4 Conjugation to Preformed Homopolymer in situ are listed below:
T4-Leuis
[283] To DeNCA (0.200 g, 1.3 µmol) in 2.5 mL DMF was added isoleucine
(0.012 g, 0.1 umol). After stirring overnight under Ar T4-NCA (0.037 g, 0.050 umol) was added and the reaction stirred an additional 72 hours. The white solution was added to 8 mL H2O. The heterogeneous solution was chilled to 4°C, centrifuged and the supernatant discarded and the pellet washed with 8 mL H2O. The dried residue was washed with 50 mL ethanol warmed to 50°C to yield after drying, a white powder (0.124 g, 55%).
[284] 1H NMR (500MHz, DMSO-d6): 5 7.75 (s, T4 aromatic), 7.08 (s, T4
aromatic), 4.11 (dd, a), 1.77 (m, |3), 1.38 (m, ß,?-CH), 0.91 (m, ?-CH, ?-CH3,5).
T4-Phe15
White powder (58%).
[285] 1H NMR (360 MHz, DMSO-de): 5 7.0-8.1 (NH, aromatics), 4.5 (a),
3.0 (P); MALDI-MS indicates T4-Phe15.
T4-Met15
White powder (10%).
[28(5] 1H NMR (500MHz, DMSO-d6): 5 8.0-8.5 (amide NH), 4.4 (a) 2.5
(y), 2.05 (e), 2.0-1.7 0).
T4-Val15
White powder (14%).
[287] 1H NMP (500MH?, DMSO-d6): d 7.75 (T4 aromatic), 7.08 (T4
aromatic), 4.35 (a), 3.45 (p), 1.05 (y).
For those conjugates that used a protected NCA an additional, separate deprotection step was necessary:
T4-Lys4.ii
[288] To T4-[Lys(Boc)]4-11 (0.256 g, 61 nmol) in 10 mL of CH2C12 was
stirred with trifluoroacetic acid (10 mL) for 2 h. The solvent was removed by rotary evaporation and the residue dissolved in 3 mL H2O and ultrafiltered (Amicon regenerated cellulose, YM1, NMWL 1000, wash with 30 mL pH 5 H2O). The retentate was dried in vacuum to give a light brown residue.
[289] 1H NMP (500MHz, D2O): 8 7.82 (s, T4 aromatic), 7.41 (s, T4
aromatic), 4.29 (bs, a), 3.00 (bs, e), 2.13-1.70 (m, p, 5, y); MALDI-MS gives a range T4-Lys4-n-
T4-Trpis
!H NMR (500MHz, DMSO-d6): 8 8.25-6.80 (m, aromatic), 4.50 (bs, a), 3.40 (bs, p), 3.00 (bs, p).
IV:B - Preparation of Active Agent Conjugates (C-terminus)
(i) Typical preparation of T4 C-capped homopolymers: Trp15-T4
(290] To T4 (0.078 g, 100 umol) in 10 mL dry DMF was added Trp(Boc)-
NCA (0.500 g, 1.514 mmol). After stirring for 64 hours under argon the reaction was quenched by adding 30 mL H2O. The cloudy white solution was chilled to 4°C, centrifuged and the pellet washed three times with 25 mL H2O. The residue was dried in vacuum to provide Trp(Boc)i5-T4 as a brown solid. This material was further purified by ultrafiltration (Amicon regenerated cellulose, YM1, NMWL 1000, wash with 30 mL pH 5 H2O) to provide [Trp(Boc)]l5-T4 as a brown-gold solid (0.400 g, 79%).
[291] 1H NMP (500 MHz, DMSO-d6): 5 8.25-6.80 (m, aromatic), 4.50 (bs,
a), 3.40 (bs, p), 3.00 (bs, p), 1.50 (bs, t-Bu).
[292] To [Trp(Boc)]15-T4 (0.509 g) in 8 mL of 1:1 CH2Cl2:trifluoroacetic
acid was stirred for 1.5 hours. The solvent was removed by rotary evaporation and the residue dried in vacuum to yield a brown solid (0.347 g, 97%).
[293] 1H NMP (500 MHz, DMSO-d6): 6 8.25-6.80 (m, aromatic), 4.50 (bs,
P), 3.40 (bs, a), 3.00 (bs, p).
Lys15T4
[294] Lysi5-T4 was prepared using a similar protocol than the one used for
Trp15-T4.
[Lys(Boc)]i5-T4:
JH NMR (500MHz, D2O): 8 7.82 (s, T4 aromatic), 7.41 (s, T4 aromatic), 4.29 (bs, a), 3.00 (bs, e), 2.13-1.70 (m, p, 5, y).
Lys15-T4:
1H NMR (500MHz, D2O): 5 7.82 (s, T4 aromatic), 7.41 (s, T4 aromatic), 4.29 (bs, a), 3.00 (bs, s), 2.13-1.70 (m, p, 8, y).
(ii) Synthesis of [Glu]iS - L-dihydroxyphenylalanine or [Glu]is-L-DOPA
[295] L-DOPA (0.050 g, 254 umol) and GluNCA (0.666 g, 3.85 mmol)
were dissolved in 6 mL DMF. After stirring overnight under Argon, the reaction was examined by thin layer chromatography (9:1 H2O: HO Ac) showed some free drug (Rf = 0.70) and a more polar spot presumed to be polymer (Rf = 0.27). The
reaction was quenched by the addition of 12 mL H2O. The pH was adjusted to pH 1-2 using IN HC1. The solvent was removed by rotary evaporation and the viscous residue dried in vacuum. The resultant syrup was transferred to a new vessel in H2O and lyophilized. The resulting crystals were off white to light brown. Yield: 0.470 g, 62%. 1H NMR showed pyroglutamic acid contamination; therefore, the material was suspended in H2O and ultrafiltered (Millipore, regenerated cellulose, YM1, NMWL =1000), and the retentate dried under vacuum. Yield: 0.298 grams. [296] 1H NMR (500MHz, DMSO-de) indicated a relative ratio of 30:1
Glu:L-DOPA: 5 6.6 (L-DOPA aromatic), 6.4 (L-DOPA aromatic), 4.1 (Glu, a), 1.85 (Glu, ß), 2.25 (Glu, ?, L-DOPA), 2.3 (L-DOPA, benzylic), 12.4-11.5 (Glu, CO2H), 8.0 (Glu, amide)
(iii) Synthesis of [GIuho-L-DOPA
[297] As in the synthesis of [Glu]15-L-DOPA except 0.439 grams of
GluNCA were used. The final yield of purified material was 0.007 grams. [298] The 1H NMR (500MHz, DMSO-d6) indicates 8:1 Glu:L-DOPA.
IV:C - Preparation of Interspersed Active Agent/Peptide Conjugates (i) Synthesis of Random Copolymer of T4 and Trp
[299] To T4-NCA (0.065 g, 0.1 mmol) and Trp(Boc)-NCA (0.400 g, 1.2
mmol) were combined in 4 mL dry DMF. Triethylamine (11 uJ, 0.1 mmol) was added and the reaction stirred for 44 hours under argon. After quenching by the addition of 10 mL H2O the heterogeneous mix was chilled to 4°C and centrifuged. The pellet was isolated and washed three times with 10 mL H2O and dried in vacuum.
[300] To the random T4/[Trp(Boc)]15 polymer was added 10 mL 1:1
CH2Cl2:trifluoroacetic acid and the reaction stirred for 1 hour. The solvent was removed by rotary evaporation to provide the deprotected polymer as a brown solid (0.262 g, 91%) which was further purified by ultrafiltration (Amicon regenerated cellulose, YM1, NMWL 1000, wash with 30 mL pH 5 H2O).
[301] 1H NMR (500MHz, DMSO-d6): 5 8.25-6.80 (m, aromatic), 4.50 (bs,
a), 3.40 (bs, P), 3.00 (bs, P).
(ii) Synthesis of Random Copolymer of T4 and Lys
[302] Random T4/Lysis was prepared using a protocol similar to the one
used to prepare Random T4/Trp.
[303] lH NMR (500MHz, D2O): 6 7.82 (s, T4 aromatic), 7.41 (s, T4
aromatic), 4.29 (bs, a), 3.00 (bs, e), 2.13-1.70 (m, p, 5, y).
IV:D - Fatty Acid Acvlation
(i) Preparation of N-Palmitoyl-L-triiodothyronine (C16T3) [304] To palmitic acid (0.500 g, 2.0 mmol) in 5 mL of dichloromethane,
CH2C12, was added DCC (0.201 g, 1.0 mmol). The solution was allowed to stir for 45 minutes whereupon it was filtered through glasswool to remove insoluble 1,3-dicyclohexylurea, DCU, into 3 mL of DMF containing L-triiodothyronine (0.578 g, 0.9 mmol) and N-dimethyl-4-aminopyridine (0.119 g, 1.0 mmol). After stirring for 18h the solvent was removed by rotary evaporation and the residue purified by flash chromatography (30:1-8:1 CHC13:CH3OH with 1 drop HOAc/lOOmL eluent) to provide the target as a white solid (0.242 g, 31%): Rf (6:1 CHC13:CH3OH) 0.27; 1H NMR (CDCl3500 MHz) 8.10 (d, 2H), 7.63 (s, 1H, NH), 7.06-6.48 (m, 3H), 4.64 (bs, 1H, a), 3.12 (m, 2H, P), 2.16 (m, 2H), 1.55 (m, 2H), 1.33-1.10 (bs, 24H), 0.83 (t, 3H).
(ii) Prepartion of N-Octanoyl-L-triiodothyronine(O-octanoyl)
(C8T3(C8))
[305] To octanoic acid (0.30 mL, 1.9 mmol) in 5 mL of CH2C12 was added
DCC (0.201 g, 1.0 mmol). The solution was allowed to stir for 30 minutes whereupon it was filtered through glasswool to remove insoluble DCU into 3 mL of DMF containing L-triiodothyronine (0.578 g, 0.9 mmol) and N-dimethyl-4-aminopyridine (0.217 g, 1.8 mmol). After stirring for 16h the solvent was removed by rotary evaporation and the residue purified by flash chromatography (30:1-8:1 CHC13:CH3OH with 1 drop HOAc/100 mL eluent) to provide the target as a white
solid (0.473 g, 64%): Rf (6:1 CHC13:CH3OH) 0.16; 1H NMR (CDC13 500 MHz) 8.16 (d, 2H), 7.65 (s, 1H, NH), 7.11-6.52 (m, 3H), 4.68 (dd, 1H, a), 3.17 (dd, 1H, P), 3.08 (dd, 1H, p), 2.28 (m, 4H), 1.61 (m, 4H), 1.29-1.20 (bs, 16H), 0.85 (m, 6H).
(iii) Prepartion of Triiodothyronine Octanoate - TFA (T3C8) [306] To TeocT3 (0.300 g, 0.38 mmol) in 3 mL of dry DMF was added
DCC (0.086 g, 0.42 mmol), 1-octanol (0.2 mL, 1.2 mmol) and N-dimethyl-4-aminopyridine (0.051 g, 0.42 mmol). After stirring for 21h the solvent was removed by rotary evaporation and the residue purified by flash chromatography (12:1-0:1 hexane:EtOAc) to provide the target as a white solid (0.187 g, 55%): Rf (1:1 hexane:EtOAc) 0.95; JH NMR (CDC13 500 MHz) 7.62 (s, 2H), 7.11-6.57 (m, 3H), 5.29 (d, 1H, NH), 4.57 (m, 1H, a), 4.08 (m, 4H, C(O)OCH2alkyl, CH2OC(O)N), 2.88 (m, 2H, p), 2.28 (m, 4H), 1.57 (m, 2H, OCH2CH2alkyl), 1.30-1.24 (m, 10H), 0.96 (m, 2H, SiCH2), 0.84 (m, 3H, CH3).
[307] TeocT3C8 material (0.187 g, 0.21 mmol) was dissolved in 10 mL of
CH2C12 and 5 mL of trifluoroacetic acid, TFA. After stirring for lh the solvent was removed by rotary evaporation target as a white solid (0.177 g, 100%): Rf (1:1 hexane:EtOAc) 0.78; 1H NMR (DMSO 500 MHz) 7.83 (s, 2H), 6.95-6.66 (m, 3H), 4.45 (m, 1H, a), 4.13 (m, 2H, C(O)OCH2alkyl), 3.30 (m, 1H, p), 3.06 (m, 1H, P), 2.00 (m, 2H), 1.52 (m, 2H), 1.30-1.25 (m, 10), 0.86 (m, 3H, CH3).
(iv) Preparation of Trioodothyronine hexadeconoate - TFA (T3C16) [308] a) To TeocT3 (0.300 g, 0.38 mmol) in 3 mL of dry DMF was
added DCC (0.086 g, 0.42 mmol), 1-hexadecanol (0.274 g, 1.13 mmol) and N-dimethyl-4-aminopyridine (0.051 g, 0.42 mmol). After stirring for 18.5h the solvent was removed by rotary evaporation and the residue purified by flash chromatography (12:1-0:1 hexane:EtOAc) to provide the target as a white solid contaminated with 1-hexadecanol (0.348 g, 90%): Rf (3:1 hexane:EtOAc) 0.46; 1H NMR (CDCI3 500 MHz) 7.63 (s, 2H), 7.08-6.62 (m, 3H), 5.29 (d, 1H, NH), 4.56 (m, 1H, a), 4.11 (m, 4H, C(O)OCH2alkyl, CH2OC(O)N), 2.99 (m, 2H, P), 2.28 (m, 4H),
' 1.55 (m, 2H, OCH2CH2alkyl), 1.31-1.24 (m, 26H), 0.96 (m, 2H, SiCH2), 0.86 (m, 3H, CH3).
[309] b) The impure TeocT3C16 material (0.348 g) was dissolved in
10 mL of CH2C12 and 5 mL of TFA. After stirring for lh the solvent was removed by rotary evaporation target as a white solid: Rf (1:1 hexane:EtOAc) 0.85; lH NMR (DMSO 500 MHz) 7.84 (s, 2H), 6.95-6.64 (m, 3H), 4.45 (m, 1H, a), 4.10 (m, 2H, C(O)OCH2alkyl), 3.30 (m, 1H, P), 3.06 (m, 1H, p), 2.00 (m, 2H), 1.52 (m, 2H), 1.30-1.25 (m, 10), 0.86 (m, 3H, CH3).
IV:E - Synthesis of mPEG-Amine-Triiodothvronine
(i) Synthesis of mPEG-Teoc-T3
[310] To a stirring solution of Teoc-T3 (88 mg, 0.11 mmol) in 3 mL of dry
DMF under Ar was added DCC (25 mg, 1.20 mmol). After stirring overnight the insoluble DCU was filtered and the solid byproduct was washed with 2 mL of DMF. To the combined clear filtrates was added mPEG-amine (534 mg, 0.10 mmol, average MW = 5336) and 3 mL additional DMF. The solution was heated briefly with a heat gun until all of the amine was dissolved. The reaction was allowed to stir at room temperature overnight. The reaction solution was poured into 50 mL of diethylether causing the product to crash out as a white solid which was filtered. The solid product was then dissolved into 10 mL of DMF and poured into 50 mL of ether once again. This process was repeated one additional time and the filtered solid was dried by high vacuum overnight yielding 340 mg (56%) of the hygroscopic product.
(u) Deprotection of mPEG-Teoc-T3
[311] The dried product from part A was stirred in 3 mL of TFA at room
temperature for one hour. The TFA was removed by rotary evaporation of the azeotrope with hexane. The residue was dissolved in 3 mL of DMF and this solution was poured into 50 mL of ether. This suspension was cooled to 4°C, filtered and dried by high vacuum for 5 hours. This material was further purified by
utrafiltxation (3,000 MW) filter using saturated sodium bicarbonate as a diluent. The product was dissolved in 10 mL of diluent and passed through the filter at 40 psi the rinsed in a similar manner 4 times. The residue was taken up in 3 mL of water and the filter was rinsed two additional times with 3 mL of water. The combined solution was frozen and lyophilized resulting in 162 mg (55%) of a fluffy white powder. T3 quantity present in conjugate by UV potency (?320, 1 M NaOH) was determined to 5.3% of total mass.
IV:F - Preparation of Triiodothyronine Cvclodextrin Ester
[312] To TeocT3 (0.457 g, 0.57 mmol) in 5 mL dry DMF was added DCC
(0.237 g, 1.15 mmol). After stirring for 40 min under Ar was added P-cyclodextrin (0.652 g, 0.57 mmol) and N-dimethyl-4-aminopyridine (0.070 g, 0.57 mmol). After stirring the suspension for 26 h under Ar 20 mL H2O was added. The cloudy white solution was filtered through glasswool and washed with 20 mL EtOAc. The water was removed by lyophilization and the off white residue purified by flash chromatography (C18 CH3OH) to provide roughly a 1:1 mixture of TeocT3-(3-CD (Rf 7:7:5:4 EtOAc:2-propanol:NH40H:H20) 0.64) and unmodified |}-CD (Rf 0.28) as an off-white solid (0.098 g).
V General Preparation of Peptide Adjuvants
[313] While specific examples of active agents describe how to make
different embodiments of the invention the general prepartion of amino acid conjugates are decribed below and may be used in combination or alone with any number of active agents. Formation of the peptide portion of the invention are, in essence, the formation of amides from acids and amines and can be prepared by the following examples, or other known techniques.
V: A - Adjuvant Attachment of Side-Chain Carrier Peptide (i) Preparation of y-AIkyl Glutamate
[314] In reference to the above scheme, there have been over 30 different y-
alkyl glutamates prepared any one of which may be suitable for the drug alcohol of choice. For example, a suspension of glutamic acid, the alcohol and concentrated hydrochloric acid can be prepared and heated for several hours. The ?-alkayl glutamate product can be precipitated out in acetone, filtered, dried and recrystallized from hot water.
(ii) Preparation of y-Alkyl Glutamate-NCA
[315] y-Alkyl glutamate can be suspended in dry THF where triphosgene is
added and the mixture refluxed under a nitrogen atmosphere until the mixture becomes homogenous. The solution can be poured into heptane to precipitate the NCA product, which is filtered, dried and recrystallized from a suitable solvent.
(iii) Preparation of Poly[y-Alkyl Glutamate]
[316] y-Alkyl glutamate-NCA can be dissolved in dry DMF where a
catalytic amount of a primary amine can be added to the solution until it becomes viscous (typically overnight). The product can be isolated from the solution by pouring it into water and filtering. The product can be purified using GPC or dialysis.
(iv) ?-AIkyl GIutamate/C-Terminus Conjugation
[317] Again in reference to the above scheme, the peptide carrier can be
dissolved in DMF under nitrogen and cooled to 0 °C. The solution can then be treated with diisopropylcarbodiimide and hydroxybenzotriazole followed by the y-alkyl glutamate bioactive agent. The reaction can then be stirred for several hours at room temperature, the urea by-product filtered off, and the product precipitated out in ether and purified using GPC or dialysis.
V:B ¦ Specific Example of Preparation of Polv-?-Benzylglutamic Acid (i) Preparation of benzylglutamic acid-NCA (adjuvant)
[318] Benzylglutamic acid (25 grams) was suspended in 400 mL anhydrous
ethyl acetate under nitrogen. The mixture was heated to reflux where 30 grams of triphosgene was added in six (6) equal portions. The reaction was refluxed for three (3) hours until homogenous. The solution was cooled to room temperature, filtered, and concentrated in vacuo. The white powder was recrystallized from 50 mL of hot anhydrous ethyl acetate to yield 17.4 grams (63%) of a white powder.
(ii) Preparation of polybenzylglutamic acid
[319] Benzylglutamic acid (17.4 grams) was dissolved in anhydrous
tetrahydrofuran (THF) under nitrogen where 238 mg of sodium methoxide was added portion wise. The solution was stirred for two (2) days with a marked increase in viscosity. The solution was poured into 1.5 L of petroleum ether with stirring. The petroleum ether was decanted off and an additional 1L of petroleum ether was added back. The mixture was stirred by hand, the petroleum ether was decanted off and the process repeated with 500 mL of petroleum ether. The white solid was air-dried and then vacuum dried to yield 14.7 (95%) of a white fluffy paper-like solid.
V:C - Preparation of Various Peptides
(i) Preparation of Polyglutamic Acid
[320] 1.96 g of Polybenzylglutamic acid added by hand was stirred in 10
mL of 30wt% hydrogen bromide (HBr) in acetic acid. The mixture was stirred at room temperature for one day and was, then, added to 50 mL of ether. The white precipitant was filtered, washed with 4 x 30 mL of ether and dried under a high vacuum to yield 1.11 grams (97%) of a white powder.
(ii) Preparation of Polyarginine
[321] All reagents were used as received. 1H NMR was run on a Bruker
300 MHz (300) or JEOL 500 MHz (500) NMR spectrophotometer using tetramethylsilane as an internal standard. Thin layer chromatography was performed using plates precoated with silica gel 60 F254. Flash chromatography was performed using silica gel 60 (230-400 mesh).
(a) Method 1
[322] To H-Arg(Z) 2-OH (0.300 g, 0.68 mmol) in 3.0 mL dry DMSO was
added diphenylphosphorylazide (219 ul, 1.02 mmol) and triethylamine (236 ul, 1.69 mmol). The reaction was stirred for 48 hours under argon upon which the solution
- was poured into 100 mL H2O. The resulting heterogeneous solution was centrifuged to isolate the white precipitate which was washed 3 x 100 mL H2O, 3 x 100 mL CH2OH and 100 mL Et2O and then vacuumed dried to obtain 172 mg of an off white solid.
[323] 1H NMR (500 MHz, DMSO-dg): 8 7.31 (m, 10H), 5.21 (m, 1H,
benzylic), 5.01 (m, 1H, benzylic), 3.83 (m, 1H, a), 3.34 (m, 2H, 8) 1.54 (m, 4H, %
Y).
[324] This material was dissolved in 1.5 mL dry anisole and stirred with 0.3
mL anhydrous methanesulfonic acid for 3 hours upon which another 0.3 mL anhydrous methanesulfonic acid was added and the solution stirred for 1 hour. The reaction mixture was poured into 6 mL Et2O and refrigerated for 15 minutes. The heterogeneous biphasic mixture was concentrated to 0.5 mL by rotary evaporation. Twice, an additional 8 mL Et2O was added and the biphasic mixture centrifuged and the supernatant removed leaving a yellowish gum. This residue was washed twice with 6 mL acetone, centrifuged and the supernatant discarded leaving behind a white-yellow residue. The residue was dissolved in 0.3 mL H2O and shaken with Amberlite IRA-400. The resin was removed by filtration and washed with 3 mL H2O. The combined eluent and wash were dried in vacuum yielding a yellow film 0.063 g, (90% yield).
[325] 1H NMR (500 MHz, D2O): 8 4.37 (m, 1H, a), 3.22 (m, 2H, 5) 1.94-
1.66 (m, 4H, % y); MALDI-MS shows a degree of polymerization varying between six to fourteen residues.
(b) Method 2
[326] To Boc-Arg(Z) 2-OH (0.025 g, 0.05 mmol) and H-Arg(Z) 2-OH
(0.280 g, 0.63 mmol) in 3.0 mL dry DMSO was added diphenylphosphorylazide (219 ul, 1.02 mmol) and triethylamine (236 ul, 1.69 mmol). The reaction was stirred for 48 hours and then poured into 100 mL H2O. The heterogeneous solution was centrifuged and the precipitate washed 3 x 100 mL H2O, 3 x 100 mL CH3OH and 100 Et2O and then vacuumed dried to obtain 132 mg of solid.
[327] 1H NMR (500 MHz, DMSO-de): 5 7.31 (m, 10H), 5.21 (m, 1H,
benzylic), 5.01 (m, 1H, benzylic), 3.83 (m, 1H, a), 3.34 (m, 2H, 8) 1.54 (m, 4H, ß,
T)-
[328] The protected polymer was dissolved ia 1.5 mL dry anisole and
stirred with 1.3 mL anhydrous methanesulfonic acid for 4 hours. The solution was concentrated to 0.5 mL by rotary evaporation. Et2O (8 mL) was added and the biphasic system centrifuged and the supernatant discarded. Twice, 10 mL acetone was added, the solution centrifuged and the supernatant discarded. The pellet was dried overnight in vacuum and then dissolved in 0.3 mL H2O and shaken with Amberlite IRA-400. The resin was removed by filtration and washed with 3 mL H2O. The combined eluent and wash were dried in vacuum yielding a yellow film 0.019, (24% yield).
[329] 1H NMR (500 MHz, D2O): 5 4.37 (m, 1H, a), 3.22 (m, 2H, 5) 1.94-
1.66 (m, 4H, ß,?); MALDI-MS shows a degree of polymerization varying between five to eleven residues.
VI Mulitple Attachment of Active Agent to a Peptide
[330] In another preferred embodiment of the invention, more than one
active agent may be attached to a peptide. In the case of oligopeptides and polypeptides, the active agents may be distributed randomly or at set intervals along the chain through side-chain attachments, as well as, terminate in either C-capped and/or N-capped active agents. Additionally, in the case of amino acid active agents the amino acid active agent may be interspersed similar to the side-chain distribution. The distribution may further be grouped intervals of active agents at the ends of the chain or throughout the peptide.
[331] The below example provides a description of the attachment of an
active agent to the side chain and C-terminus of a peptide. In the below example, the peptide chain comprises PolyGlu. Additionally, in the below example the active agent is attached through a carboxylate group.
[332] One skilled in the art will appreciate that other peptides can be
substituted depending on the active agent selected. Likewise, one skilled in the art
will appreciate that the attachment of the active agent can be from different functional groups.
[333] The general scheme for attaching an acitive agent to the N-terminus
and the side chain of an amino acid is further illustrated below through the preparation of furosemide conjugated to serine.
VI;A - Preparation of Furosemide Conjugated to Serine
[334] The example below describes the attachment of Furosemide to the
side-chain and N-terminus of Polyserine.

[335] To a solution of pSer in NMP was added Furosemide-OSu and N-
methyl morpholine (NMM). The reaction was stirred overnight at 70°C. After cooling, reaction was placed in ether and solid was collected by filtration. Solid was
suspended in pH 8 water and purified using ultrafiltration. Product was filtered and dried.
[336] The following examples produce an active agent peptide conjugate
which results in the attachment of mevastatin, prednisone and pravastatin to the carboxylate side-chain and C-terminus of the peptide. In these examples the amino acid peptide is a polyGlu peptide.
[337] Through the use of protection/deprotection techniques, one skilled in
the art would appreciate that the drug could be attached only to the side-chain or only to the C-terminus of the amino acid. Additionally, one skilled in the art would appreciate that the drug could be attached to a single amino acid at both the C-terminus and side-chain, provided the amino acid had the require functional groups, as with Glu.
VT;B - Preparation of PolyGlu Mevastatin (i) AcNGluis(3-mevastatin)2
[338] To polyGlu 15 (0.116 g, 69 umol) in 3 mL dry DMF was added 1 mL
pyridine and acetic anhydride (20 ul, 207 umol). After stirring for 21 hours the mixture was acidified with 6 N HC1 until pH 1 and then cooled to 4°C. The white precipitate was collected by centrifugation and washed three times with H2O and then dried under vacuum to yield 11 mg of N-acetylated polyGlms. [339] To N-acetylated polyGlui5 (0.011 g, 7 a mol) in 4.8 mL dry DMF
was added dicyclohexylcarbodiimide (0.022 g, 108 umol). After stirring twenty minutes the heterogeneous solution was filtered to remove insoluble dicyclohexylurea and combined with mevastatin (0.042 g, 108 urnol) and N-dimethyl-4-aminopyridine (0.013 g, 108 nmol). The mixture stirred for 23 h whereupon the reaction was quenched by the addition of 20 mL H2O. The solution was extracted twice with 10 mL CHCI3. The aqueous component was adjusted to pH 3 with 1 N HC1 and cooled to 4°C. The resultant white precipitate was isolated by centrifugation and washed three times with 8 mL H2O. The solid was dissolved in 1 mL H2O and washed with 1 mL CH2C12 and twice with 2 mL EtOAc. The aqueous layer was acidified to pH 3 with 1 N HC1, cooled to 4°C, the precipitate
isolated by centrifugation and washed twice with 2 mL H2O. The dried conjugate (2
mg) was shown by lH NMR to contain fifteen Glu for every two mevastatin
molecules.
[340] 1H NMR (500 MHz, DMSO-de): 8 5.92 (5' mevastatin), 5.72 (3'
mevastatin), 5.19 (4' mevastatin), 5.17 (8' mevastatin), 5.12 (3 mevastatin), 4.41 (5
mevastatin), 4.03 (a, Glu), 2.25 (y, Glu), 1.88 (p, Glu), 0.82 (4",2' allylic methyl
mevastatin), 1.17 (2" mevastatin).
(ii) Glu15(3-mevastatin) (160)
[341] To Glu 15 (0.151 g, 77 pmol) in 3 mL dry DMF was added
dicyclohexylcarbodiimide (0.239 g, 1.159 mmol) and the reaction stirred for 4 hours under argon. The white precipitate was removed and N-dimethyl-4-aminopyridine (0.141 g, 1.159 mmol) and mevastatin (0.222 g, 0.569 mmol) were added dissolved in 10 mL CHCl3. The reaction stirred for 21 hours under argon whereupon the precipitate was removed. The solution was concentrated by rotary evaporation and added to 40 mL saturated NaCl (aq) adjusted to pH 8. The homogeneous solution was extracted three times with 20 mL CHCl3 and then ultrafiltered (Amicon regenerated cellulose, YM1, NMWL 1,000). The retentate was dried in vacuum to yield 8 mg of a white residue which showed a ratio of 15 Glutamic acids to one mevastatin by 1H NMR.
[342] 1H NMR (500MHz, D2O): 8 5.92 (5' mevastatin), 5.72 (3'
mevastatin), 5.19 (4' mevastatin), 5.17 (8' mevastatin), 5.12 (3 mevastatin), 4.41 (5 mevastatin), 4.03 (a, Glu), 2.25 (y, Glu), 1.88 (P, Glu), 0.82 (4",2' allylic methyl mevastatin), 1.17 (2" mevastatin).
(iii) BocGlu(3-mevastatin)O-tBu
[343] To BocGlu(OSu)O-tBu (0.181 g, 453 nmol) and mevastatin (0.177 g,
453 umol) in 40 mL CHCl3 was added N-dimethyl-4-aminopyridine (0.055 g, 453 umol). The reaction was heated to reflux for 7 hours under argon and then allowed to stir at 20° C for 8 hours. The solvent was removed by rotary evaporation and the
Residue purified by flash chromatography (8:1-1:1 hexane:EtOAc) to provide the conjugate as a clear film (0.038 g, 11%).
[344] Rf (3:1 hexane:EtOAc): 0.22; 1H NMR (500 MHz, CDC13): 8 5.97 (d,
1H, 5'), 5.73 (dd, 1H, 3'), 5.55 (s, 1H, 4'), 5.32 (s, 1H, 8'), 5.24 (dd, 1H, 3), 5.09 (d, 1H, NH), 4.48 (m, 1H, 5), 4.20 (m, 1H, a), 2.78 (m, 2H, 2), 2.37 (m. 4H, 2', 2", y), 1.45 (s, 18H, t-Bu), 1.12 (d, 3H, 2"-CH3), 0.88 (m, 6H, 4", 2'-CH3).
VI:C - Preparation of PolvGIu Prednisone
[345] To GIU15 (0.350 g) in 30 mL of DMF was added bromo-tris-
pyrrolindinophosphonium hexafluorophosphate (0.510 g, 1.1 mmol) and N-methylmorpholine (1 mL, 9.3 mmol). The mixture was stirred for 30 min under Ar whereupon N-dimethyl-4-aminopyridine (0.067 g, 0.5 mmol) and prednisone (0.489 g, 1.4 mmol) were added. After stirring for 14 h, the solvent was removed under reduced pressure. The residue was dissolved in 50 mL H2O and acidified with 6 N HC1 to pH 3. The precipitate was filtered and washed with 30 mL CHCl3. The solid was then dissolved in 70 mL H2O pH 8 and extracted twice with 40 mL CHCl3. The aqueous layer was ultrafiltered (Amicon regenerated cellulose, YM1, NMWL 1,000) with 150 mL H2O and the retentate dried in vacuum to provide a white residue. 1H NMR (DMSO) analysis indicated 4:1 Glu:Prednisone ratio.
VI;D - Preparation of Gh15GIv-Pravastatin)
[346] This example describes the C-terrninus attachment of an alcohol to a
single amino acid (glycine) with subsequent attachment to the C-terminus and side-chain of polyglutamic acid.
[347] To N-Boc-Glycine (0.247 g, 1.41 mmol) in 5 mL dry DMF was
added dicyclohexylcarbodiimide (0.138 g, 0.67 mmol). After stirring for 1 h under Ar the solution was filtered through glass wool to remove insoluble urea. Pravastatin sodium (0.300 g, 0.67 mmol) was added followed by N-methylmorpholine (147 \il, 1.34 mmol). The mixture was stirred for an additional 23 hours under argon whereupon the solution was filtered through glass wool and the solvent removed by rotary evaporation. The residue was purified by flash
"ohromatography (30:1-8:1 CHC13:CH3OH) to provide the peracylated statin as a white solid (0.118 g).
[348] Rf = 0.23 (6:1 CHC13:CH3OH); !H NMR (500 MHz, CDC13): 8 5.97
(m, 1H, 5'), 5.89 (m, 1H, 3'), 5.58 (bs, 1H, 6'), 5.40 (bs, 1H, 4'), 5.16 (bs, 1H, 8'), 3.92 (m, 6H, a), 2.69-2.34 (4H, 2, 2, 2\ 2"), 1.43 (s, 18H, t-Bu), 1.09 (d, 3H), 0.87 (m, 6H).
VII General Description of Linker for Attachment to Peptide
[349] For those drugs which are not amenable to attachment through the C-
terminus, N-terminus or side-chain, a linker is required for a stable covalent attachment. For example, direct covalent attachment of an amino acid to a ketone would not produce a stable entity. However, the insertion of a carbonyl between the active agent and the carrier peptide should provide enhanced stability of the Active Agent/Peptide Conjugate. Furthermore, the formation of a ketal using a reagent with the appropriate functionality in the agent provides a link between the active agent and the amino acid conjugate with the desired stability. Another example of this type of linker is the DHP linker. Ideally, these linkers should be removable in vivo. From the below examples one skilled in the art would appreciate how to derive other linkers and attachment functionalities.
[350] Naltrexone-hydrochloride (520 mg, 1.37 mmol) and l-l'-carbonyl-
diimidazole (CDI) (202 mg, 1.25 mmol) were dissolved in anhydrous DMF (5 mL). The reaction was then allowed to stir for 1 hour at room temperature under argon. Glutamic acid-lysine copolymer (GlunLysm , 2.5 mmol of free lysine sidechains*) was then added as a suspension in 15 mL DMF, and the reaction allowed to continue stirring under argon at room temperature for 2 days. The solvent, DMF, was then removed by rotary evaporation under high vacuum, leaving a green solid. The solid was dissolved in water (20 mL), and the aqueous solution filtered/concentrated using ultrafiltration (1000 mw cutoff) to remove small molecular weight starting materials and byproducts. Two aliquots of water (10 mL each) were added and the solution filtered/concentrated after each addition to a final volume of ~2 mL. The remaining solution was freed of solvent by rotary evaporation and the resulting solid dried over night in a vacuum chamber at room temperature. This afforded the carbamate conjugate (642 mg, 43% yield assuming saturation of available lysine sidechains) with an approximate loading of 1:4 (naltrexone/amino acid residue) as estimated by ^-NMR.
[351] 1H NMR (360 MHz, DMSO-d6): 5 6.78 and 6.61 (bs, 1H each,
naltrexone-aromatic); 2.74 (bs, ~8H, ?-Glu); 2.20 (bs, -8H, ß-Glu), 0.50 (bs, 2H, naltrexone-cyclopropyl) and 0.16 (bs, 2H, naltrexone-cyclopropyl). [352] (* mmol of Lysine sidechains is estimated based on a 1:1 Glu/Lys
ratio as previously determined by NMR. This copolymer was prepared from Lys(Boc)-NCA and Glu(OtBu)-NCA using standard NCA polymerization methods. The resulting polymer (1.00 g, 2.5 mmol Lys) was deprotected using 4N HC1 in Dioxane)
[353] CDI (0.522 g, 3.2 mmol) was dissolved at room temperature in 20
mL of dry methylene chloride in a flask charged with argon. The naltrexone (1.00 g, 2.9 mmol) dissolved in mehtylene chloride (20 mL) was then added drop wise to the CDI solution. An additional 10 mL of methylene chloride was used to rinse the vessel that had contained the naltrexone, and the wash added to the reaction mixture. The reaction was heated to 50°C, and allowed to stir over night under argon at a temperature between 40 and 50°C. The solvent was then removed by rotary evaporation under high vacuum. 1H-NMR indicated that the tacky solid contained a mixture of imidazole, the adduct 1 and unreacted starting materials. Imidazole and compound 1 were the dominant components.
[354] 1H NMR (360 MHz, dg-DMSO): 5 8.27 (bm, 1H, 1); 7.74 (bs, 2 H,
imidazole); 7.53 (t, 1H, 1); 7.24 (bs, 1H, imidazole); 7.14 (bm, 1H, 1); 6.95 (d, 1H, 1) and 6.73 (d, 1H, 1).
[355] The solid from step 1 was dissolved in anhydrous N-
methylpyrrolidinone (NMP), and solid Sern (0.51 g, 5.9 mmol) added to the solution. The reaction mixture was then heated to 60 °C under argon, and allowed to stir under argon, over night at a temperature between 50 and 60°C. The organic solution was then diluted into 100 mL of water. Precipitate formed immediately, and the solid (A) was collected by centrifuge, and the pellets then dried over night in a vacuum chamber. The water in the supernatant was removed by rotary evaporation, and the NMP solution that remained was diluted into ether (100 mL). Again, precipitate formed immediately. This solid (B) was collected by filtration and then dried over night in a vacuum chamber. Both solids were hygroscopic and appeared similar in composition by TLC (3:1 CHCI3/CH3OH). Therefore, solids A and B were combined and dissolved/suspended in -50 mL water. Ultrafiltration (1000 mw cutoff) was used to remove impurities such as unreacted naltrexone and imidazole, leaving the Sern and the naltrexone conjugate, Sern.m [Ser(Nal)]m. The suspended material was washed with 5 aliquots of water (10 mL each), and then pelletted by centrifugation. The polymer conjugate was then dried over night in a vacuum chamber. This afforded 80 mg (-5% yield) of material with an estimated loading of 1:19 naltrexone/serine (based on 1H-NMR).
[356] 1H NMR (360 MHz, DMSO-d6): 5 5.03 (bs, ~19H, a-Ser); 0.59 (bs,
2H, naltrexone-cyclopropyl) and 0.34 (bs, 2H, naltrexone-cyclopropyl).
(i) Preparation of 3-Methyl Naltrexone
[357] Naltrexone (6.0 g, 16.5 mmol) was dissolved in 100 mL distilled
water. The solution was titrated with IN NaOH to a final pH of 11.8. In the course of the titration, neutral naltrexone precipitated from solution and then went back into solution. Upon reaching pH 11.8, the solvent was removed by rotary-evaporation under high vacuum, and the resulting solid stored under vacuum over night at room temperature. The solid was then suspended/dissolved in anhydrous tetrahydrofuran (200 mL) and allowed to stir at room temperature under argon. A solution of iodomethane (2.1 mg, 33 mmol) in 50 mL of tetrahydrofuran was added dropwise over the course 30 minutes. The reaction was then allowed to stir an additional 3 hours at room temperature under argon. The solvent was then removed by rotary-evaporation under reduced pressure. The residual solid was then dissolved in 40 mL of CHC13 and the organic solution washed with 30 mL of saturated NaCl, 3 x 30 mL of IN NaOH and finally twice more with 30 mL saturated aqueous NaCl. The organic solution was collected and dried over sodium sulfate. Removal of solvent by rotary-evaporation and drying over night under vacuum afforded pure
-• 3-methylnaltrexone (5.6 g, 15.8 mmol, 96% yield) as a brown residue and composition determined by TLC and 1H-NMR.
[358] !H NMR (360 MHz, CDC13): 5 6.677 (d, 1H, naltrexone aromatic),
6.591 (d, 1H, naltrexone aromatic), 3.874 (s, 3H, methoxy group.), 0.6-0.5 (m, 2H, naltrexone cyclopropyl) and 0.2-0.1 (m, 2H, naltrexone cyclopropyl).
(ii) Preparation of Methyl Naltrexone - Glucose Ketal Conjugate
[359] To a solution of methyl naltrexone (0.200 g, 0.56 mmol) in dioxane
(20 mL) was added D-a-glucose (2.02 g, 11.2 mmol), triflic acid (0.05 mL, 0.62 mmol), and CuSO4 (1-00 g). The reaction mixture was stirred at ambient temperatures for 4 days. Reaction was then filtered, neutralized with saturated NaHCO3 and filtered again. Dioxane and water were removed and the residue was taken up in CHCI3 and extracted with water (3 x lOOmL). The organic layer was dried over MgSO4 and solvents were removed under reduced pressure. Crude product was purified over silica gel (0-10% MeOH in CHCI3) to obtain the ketal conjugate (0.010 g) in a 1:1 mixture with free methyl naltrexone. [360] 1H NMR (360 MHz, CDC13): 5 0.14 (br s, 4H, naltrexone
cyclopropyl), 0.53 (br m, 4H, naltrexone cyclopropyl), 0.90 (m, 2H, naltrexone cyclopropyl), 1.48 (m, 6H, naltrexone), 2.19-2.78 (m, 12H, naltrexone), 3.03 (m, 2H, naltrexone), 3.75 (q, 2H, glucose), 3.87 (m, 8H, naltrexone CH3 and glucose), 3.97 (q, 2H, glucose), 4.14 (q, 1H. glucose), 4.33 (t, 1H, glucose), 4.66 (s, 1H, naltrexone), 6.65 (m, 4H, naltrexone).
[361] All reagents were used as received. 1H NMR was run on a JEOL 500
MHz (500) NMR spectrophotometer using tetramethylsilane as an internal standard. Thin layer chromatography was performed using plates precoated sith silica gel 60 F254. Rash chromatography was performed using silica gel 60 (230-400 mesh).
(i) Method (a)
[362] To 3,4-dihydro-2H-pyran-5-carboxylic acid [M. Hojo, R. Masuda, S.
Sakaguchi, M. Takagawa. 1986, A Convenient Synthetic Method for B-Alkoxy-and B-Phenoxyacrylic Acids and 3,4-Dihydro-2H-pyran-5- and 2,3-Dihydrofuran-4-carboxylic Acids. Synthesis, 1016-17.] (0.044 g, 343 |imol) in 2 mL CHC13 was added phosphorous pentachloride (0.143 g, 687 1Himol). After stirring overnight Fmoc-Ser (0.101 g, 309 |amol) was added. After stirring for an additional 72 hours, 5 mL CH2CI2 was added and the mixture washed with 5 mL saturated NaCl. The solvent was removed by rotary evaporation and the residue purified by flash chromatography (15:1:0-10:1:0-100:10:1 CHCl3:MeOH:HOAc) to provide the target as a white solid (23%).
[363] Rf = 0.23 (6:1 CHCl3:MeOH); 1H NMR (360 MHz, CDC13): 8 7.81-
7.25 (m, 9H, aromatics and vinyl), 5.63 (s, 1H, carbamate), 4.64 (t, 1H, a), 4.47 (m, 2H, serine CH2), 4.23 (m, 3H, Fmoc CH2 and CH), 4.04 (m, 2H, DHP's OCH2), 2.24 (m, 2H, allylic), 1.86 (m, 2H, homoallylic).
(ii) Method (b)
[364] To 3,4-dihydro-2H-pyran-5-carboxylic acid (0.527 g, 4.1 mmol) in
30 mL CHCl3 was added diisopropylcarbodiimide (0.260 g, 2.1 jxmol). After stirring 2hours, Fmoc-Ser (0.673 g, 2.1 mmol) and N-dimethyl-4-aminopyridine (0.502 g, 4.1 mmol) was added and the reaction stirred an additional 14h. More diisopropylcarbodiimide (0.260 g) was added and the reaction mixed for an additional 24 h whereupon an additional diisopropylcarbodiimide (0.130 g) was added and the reaction stirred 24 more hours. The solvent was removed by rotary evaporation and the residue repeatedly purified by flash chromatography to provide the target as a white solid (7%).
VIII In Vitro Performance Studies of Various Active Agents and Amino Acids Conjugates
VIII:A - Materials and Methods of the In Vitro Performance Studies for Peptide Conjugated Active Agents Testing
[365] Esterase (EC 3.1.1.1; from porcine liver), lipase (EC 3.1.1.3; from
porcine pancreas), amidase (EC 3.5.1.4; from Pseudomonas aeruginosa), protease (EC 3.4.24.31; type XIV, bacterial from Streptomyces griseus; also known as pronase), pancreatin (EC 232-468-9; from porcine pancreas), pepsin (EC 3.4.23.1; from porcine stomach mucosa), tris-HCl, methimazole were all purchased from Sigma. Buffers used in the digestive assays were prepared as follows: reducing buffer [110mM sodium chloride, NaCl, 50mM methimazole, 40mM tris-HCl, adjust pH to 8.4 with IN sodium hydroxide, NaOH], Intestinal Simulator (IS) buffer [lOOmM monobasic potassium phosphate, adjust pH to 7.5 with IN NaOH], Gastric Simulator (GS) buffer [69mM NaCl, adjust pH to 1.2 with HC1], esterase buffer
[10mM borate buffer pH to 8 with NaOH], lipase and amidase buffer [100mM monobasic potassium phosphate pH to 7.5 with NaOH].
[366] The proteolytic release of the active agent from the peptide
conjugates was determined in different assays. Peptide conjugates were shaken at 37°C in the presence of pronase, pancreatin, esterase, lipase, or amidase for 24 hours or pepsin for 4 hours. Stock solutions of each conjugate (0.5-2.0 mg/mL) and enzymes (protease, reducing buffer, 6mg/mL; pancreatin, IS buffer, 20 mg/mL; pepsin, GS buffer, 6.40 mg/mL; esterase, esterase buffer, 1.02 mg/mL; lipase, lipase buffer, 0.10 mg/mL; amidase, amidase buffer, 0.10 µl/mL) were prepared. For protease, pancreatin, and pepsin digestion, conjugate and enzyme were diluted 2-fold in the assay in a final volume of 2 mL. After the indicated incubation time for each assay, 2 mL of acetonitrile, MeCN, containing 1% of phosphoric acid, H3PO4, was added to each sample to stop digestion, and samples were centrifuged to remove gross particulate matter. Any remaining paniculate was filtered with a 0.2 urn nylon syringe filter (Whatman) prior to HPLC analysis.
[367] Enzyme digested conjugates were analyzed for the presence of
unconjugated active agent by reversed phase HPLC (C18, 4.6 x 250mm, 5µm, 300A) using the following conditions: mobile phase - Lotus buffer (4.5 mL of H3PO4, 8.8 mL triethylamine, pH = 3.5)/ THF/ MeCN [68.6/4.5/26.9] or TBA-phosphate buffer (lOmM tetrabutyl ammonium chloride, lOmM monobasic sodium phosphate, pH = 6.0)/ MeCN [65/35]; injection volume - 20 µl; flow rate - 1 mL/min; UV - 230 nm. Retention times of active agent were determined from standards in a calibration curve which was used to calculate the concentrations of enzymatically released active agent.
VIII:B -In Vitro Performance Studies Results
[368] The Table 8 below depicts active agent conjugates that were tested
with the stomach, inestine, and pronase simulator.
VIII;C - Caco-2 Human Intestinal Epithelial Cells Studies
[369] Monolayers of Caco-2 human intestinal epithelial cells are
increasingly being used to predict the absorption of orally delivered drugs. The Caco-2 transwell system and other in vitro assays were used to evaluate the performance of Polythroid. Findings indicated that Polythroid enhance oral delivery of thyroid hormones for the treatment of hypothyroid disorders.
(i) Caco-2 human intestinal epithelial cell assay
[370] Caco-2 cells were grown on the surface of collagen coated wells in a
24 well format to form confluent monolayers that represent small segments of the intestine. The wells were removable and contain a top chamber representing the apical side (facing the lumen of the intestine) and a bottom chamber representing the basolateral side (site of serosal drug absorption). The integrity of the epithelial barrier was monitored by testing the electrical resistance across the monolayer.
Absorption of drugs was studied by adding sample to the apical side and assaying the concentration of the drug in the basolateral chamber following incubation.
(ii) Intestinal epithelial cell proteases digest Polythroid
[371] Polythroid is a synthetic polymer of glutamic acid with T4 and T3
covalently attached by a peptide bond linkage. The polymer is the delivery vehicle for the thyroid hormones and is not designed to cross the intestinal barrier itself. Rather, it was designed to release T4 and T3 in a time dependent manner. Release of the thyroid hormones is dependent on the enzymatic cleavage of the glutamic acid polymer. In theory, this will result from Polythroid encountering proteolytic enzymes as it descends the intestinal tract. Proteins are digested into small peptides by gastric pepsin and pancreatic enzymes secreted into the small intestine. Intestinal epithelial cells then function to further breakdown the small peptides. They accomplish this with proteolytic enzymes referred to as brush border proteases that are attached to the cell surface.
[372] Monitoring the effect of brush border peptidases on Polythroid
required development of an assay to specifically distinguish Polythroid from polyglutamic acid and the thyroid hormones. Therefore, we developed an enzyme-linked immunosorbent assay (ELISA) that specifically recognizes Polythroid. The assay employs antibodies against the glutamic acid polymer to capture Polythroid and antibodies to T4 or T3 to detect the presence of Polythroid. The assay has no cross-reactivity with polyglutamic acid or the thyroid hormones themselves. Consequently, proteolytic degradation of Polythroid results in T4 and T3 release from the polymer and a corresponding decrease in ELISA reactivity. The Polythroid specific ELISA can, therefore, be used to monitor the breakdown of Polythroid. [373] The Polythroid specific assay was used to analyze in situ digestion of
Polythroid in Caco-2 cell cultures. Different concentrations of Polythroid were added to the apical side of Caco-2 cells and incubated for 4 hours in PBS at 37°C (n = 4). The apical side Polythroid concentration was measured by Polythroid specific ELISA before and after the 4 hour incubation (Figure 2). At the relatively high concentration of 100 micrograms, 26% of Polythroid was degraded, whereas at a 10-
-'fold lower concentration 84% of the Polythroid was degraded. When a concentration of 0.5 micrograms was added (closer to the concentrations that would be encountered by the intestine in a normal human dose) the amount of Polythroid remaining after 4 hours of incubation was below the limit of detection for the ELIS A (10 ng) indicating essentially complete digestion. The loss of Polymer in the apical chamber was not due to absorption of Polythroid across the monolayer since the basolateral chamber contained no detectable Polythroid in any of the experiments (see below). We cannot rule out cellular uptake of Polythroid, however, enzymatic digestion is likely to account for most, if not all, of the decrease in Polythroid concentration on the apical side. At the higher concentrations, it would be difficult for cellular uptake to account for such a large difference in the remaining Polythroid.
(iii) PolyT4 enhances absorption of T4 across Caco-2 monolayers
[374] Absorption of T4 was monitored in the Caco-2 transwell system (n =
4). PolyT4 (10 micrograms) was added to the apical side of the transwells. T4 was added to the apical side at a concentration equal to the T4 content of PolyT4. A commercial ELIS A for T4 was used to determine the level of T4 in the basolateral chamber following incubation for 4 hours at 37°C (Figure 3). A significantly higher amount of T4 was absorbed from PolyT4 as compared to CaCo-2 cells incubated with the amount of T4 equivalent to that contained in the polymer.
(iv) Polythroid Does Not Cross Caco-2 Monolayers
[375] In order to determine if Polythroid itself crosses the Caco-2
monolayer we used the Polythroid specific ELISA to measure the amount of polymer in the basolateral chamber after incubation with Polythroid at a high concentration (100 micrograms). After 4 hours incubation, samples (n = 4) from the basolateral side showed no reactivity in the ELISA (Figure 4). The limit of detection for Polythroid is 10 ng, therefore, less than 1/10,000 of the Polythroid was absorbed. In conclusion, within the limits of ELISA detection, Polythroid does not cross the Caco-2 monolayer.
(v) Conclusions and Summary
[376] The following discussion recites in vitro performance studies
conducted with regard to specific embodiments of the present invention. Although these performance studies describe specific embodiments of the present invention, it is not limited to these embodiments. Alternative embodiments and modifications which would still be encompassed by the invention may be made by those skilled in the art, particularly in light of the foregoing teachings. Therefore, this invention is intended to cover any alternative embodiments, modifications or equivalents which may be within the spirit and scope of the invention.
[377] The in vitro performance assays provide the following conclusions.
Active agents are released from peptide conjugates by pancreatic and intestinal cell proteases. T4 and T3 released from Polythroid are absorbed across intestinal monolayers. PolyT4 enhances absorption of T4 across intestinal epithelium in vitro. Polythroid itself does not cross the intestinal epithelial barrier in vitro. The kinetics of time release may be controlled by the method of Polythroid synthesis. [378] Data from the in vitro intestinal epithelial model suggests that
attachment of T4 to polymers of glutamic acid may enhance absorption of the thyroid hormones, perhaps by providing a second mechanism of uptake and/or enhancing solubility of the hormones. Polythroid itself does not cross the intestinal epithelial barrier in the in vitro Caco-2 model. Thus, any concerns about systemic effects of the polymer are minimized since it should not be absorbed into the bloodstream.
IX: In Vivo Performance Studies of Various Active Agents and Amino Acids Conjugates
IX:A - In Vivo Performance Studies of Polymer-Drug Conjugates
[379] Pharmacokinetics of various parent drugs and amino acid polymer
drug conjugates containing an equivalent dose were tested in vivo by oral gavage of female Sprague Dawley rats. Doses (mg/kg) were given as solutions in water or sodium bicarbonate buffer. Serum was collected under anesthesia by jugular
venipuncture for the first bleed and cardiac puncture for the second bleed. Collections were taken from 5 animals/set predose (jugular) and at 6 hours (cardiac); 1 hour (jugular) and 9 hours (cardiac); and 3 hours (jugular) and 12 hours (cardiac). Serum drug levels were determined by LC/MS/MS or ELIS A.
[380] Study 6856-120 shows the serum concentration levels of Furosemide
vs. PolySer (Furosemide) conjugate containing an equivalent amount of Furosemide. Furosemide had an (AUC) of 21,174 as compared to the conjugate which had an AUC of 8,269 (39.1 % relative to the parent drug). The figure above shows the serum concentration curves of the parent drug vs. PolySer (Furosemide) conjugate. The 9 hour serum level of the PolySer(Furosemide) conjugate was 95.5% of its 3 hour level, whereas the 9 hour serum level of the parent drug was only 59.8% of its 3 hour level. This and the relative flatness of the PolySer (Furosemide) conjugate serum concentration curve between 3 and 9 hours, as compared to that of the curve for the parent drug, illustrate sustained release by the PolySer (Furosemide) conjugate.
[382] The relative percent of area under the serum concentration curves
(AUCs) of various amino acid polymer drug conjugates compared to parent drug AUCs is shown in Table 9. The relative percents ranged from 9.4% to 42.6% and
varied depending on the amino acid content of the polymer drug conjugate. These examples illustrate the ability to covalently bond various drugs to polymers of various amino acids and affect release and absorption of the bound drug into the sera when given as an oral dose to an animal.
IX In vitro and In vivo performance of Polvserine-Naltrexone conjugate (carbonate linked)
X: A - In Vivo performance of Polvserine-Naltrexone conjugate (rat model)
(Lot no. BB-272,1:6 naltrexone:serine ratio)
[383] Polyserine-naltrexone conjugates were tested in male Sprague
Dawley rats (~ 250 g). Defined doses were delivered orally in gelatin capsules containing purified dry powder polyserine-naltrexone conjugates or naltrexone. No excipients were added to the capsules.
[384] Content of naltrexone in the PolySerine-Naltrexone conjugate was
estimated to be 30% as based on the 1:6 ratio of naltrexone:serine determined by NMR. Polyserine-naltrexone conjugate was given to four rats at a dose of 12 mg which contained 3.6 mg of naltrexone. Doses of naltrexone (3.6 mg) equivalent to the naltrexone content of the conjugate were also given to four rats. Capsules were delivered orally to rats at time-zero using a capsule dosing syringe. Serum was collected from rats 2,4, 6, 9, and 12 hours after capsule delivery. Serum naltrexone concentrations were determined by ELISA using a commercially available kit (Nalbuphine, product #102819, Neogen Corporation, Lansing MI).
Table 10. Serum Concentrations (ng/rnL) of Individual Rats Fed; PolySerine-Naltrexone Conjugate vs. Naltrexone -
[385] Serum levels of individual animals are shown in Table 10. Mean
serum levels are shown in Table 11. As shown in the figure above, serum levels spiked earlier for naltrexone (2 hours) than for the drug administered as a polyserine-naltrexone conjugate (4 hours). Serum levels of naltrexone for the polyserine-naltrexone conjugate remained elevated considerably longer than for naltrexone. Additionally, the peak level was significantly lower for the polyserine-naltrexone conjugate. It should be noted that the 2 hour time point was the first measurement of naltrexone serum levels. Since this was the peak level measured for naltexone it can not be determined whether or not levels peaked at a higher concentration earlier. Consequently, it was not possible to accurately determine the Ctnax or area under serum concentration curve (AUC) for naltrexone in this experiment.
X:B - In Vivo performance of PoIySerine-Naltrexone conjugate
(Lot no. BB-301,1:10 naltrexonerserine ratio)
[386] Polyserine-naltrexone conjugates were tested in Sprague-dawley rats
(~ 250 g). Defined doses were delivered orally in gelatin capsules containing purified dry powder polyserine-naltrexone conjugates or naltrexone. No excipients were added to the capsules.
[387] Content of naltrexone in the polyserine-naltrexone conjugate BB-272
was estimated to be 30% as based on the 1:6 ratio of naltrexone:serine determined by NMR. Polyserine-naltrexone conjugate was given to five rats at a dose of 12.9 mg which contained 3.6 mg of naltrexone. Doses equivalent to the naltrexone contained in the batch of polyserine-naltrexone (BB-301) were also given to five rats. Additionally, half the equivalent dose (1.8 mg) was given at time-zero, followed by a second half-dose at 6.5 hours to five rats.
[388] Capsules were delivered orally to rats at time-zero using a capsule
delivery syringe. Serum was collected at 0.5, 1.5, 3, 5, 8, 12, 15 and 24 hours after capsule delivery for the polyserine-naltrexone (BB-301) and equivalent naltrexone dosed rats. Serum was collected at 0.5, 1.5, 3, 5, 8, 11.5, 14.5 and 24 hours after capsule delivery for rats dosed with half-equivalent doses at 0 and 6.5 hours. Serum naltrexone concentrations were determined by ELISA using a commercially available kit (Nalbuphine, product #102819, Neogen Corporation, Lansing MI).
[389] Serum levels of individual animals are shown in Table 12. Mean
serum levels are shown in Table 13. As shown in the figure above, naltrexone serum levels spiked earlier (0.5 hours) for naltrexone than for the drug administed as a polyserine-naltexone conjugate (5 hours). Serum levels of naltrexone for the polyserine-naltrexone conjugate remained elevated considerably longer (> 12 hours) than for the monomeric naltrexone control ( "concentration (Cmax) was significantly lower for the conjugated naltrexone (Table 14). Further, the mean time to peak concentration (Tmax) was significantly longer for the polyserine-naltrexone conjugate (Table 14). The mean AUC of the polyserine-naltrexone conjugate was approximately 75% of the naltrexone mean AUC (Table 5). Statistically the mean AUCs were not significantly different (P X:C - In Situ Performance of Polvserine-Naltrexone - Caco-2 Cell Digestion
[390] Polyserine-naltrexone conjugates BB-272 and BB-301 were
incubated with monolayers of Caco-2 cells for 4 hours in phosphate buffered saline. Buffer was removed from the monlayers and concentrated on SP-18 columns. Concentrated samples were analyzed for the presence of naltexone by reverse phase HPLC. Each Polyserine-naltrexone conjugate showed significant release of free naltrexone from the polymer conjugate in three separate samples. In conclusion, Caco-2 cellular enzymes affected release of naltrexone from Polyserine-naltrexone conjugates BB-272 and BB-301. Release of carbonate linked drug from a conjugate by intestinal cellular enzymes affords a mechanism for drug absorption following oral administration.
X:D - Treatment of Polyserine-naltrexone conjugates with intestinal enzymes
[391] Polyserine-naltrexone (BB-272 and BB-301) were treated with
enzymes found in the stomach and lumen of the small intestines. The enzymes
1Htested, which included pepsin, pancreatic lipase, and pancreatin were ineffective in releasing naltrexone from the polyserine-naltrexone conjugates. Other enzymes, including protease and amidase, also did not affect drug release. These results suggest that polyserine-naltrexone is resistant to enzymes found in the stomach and lumen of the intestine.
X:E - Conclusion
[392] In conclusion, conjugation of naltrexone to a polymer of serine via
carbonate linkage comprised a pharmaceutical composition that afforded extended release when administered orally. The said conjugates were resistant to a number of enzymes found in the luminal fluids of the intestinal tract. In contrast, incubation of the compositions with Caco-2 human intestinal epithelial cells affected release of naltrexone. In a specific embodiment of the invention, pharmaceutical compositions comprised of a drug covalently bound to a carrier that are resistant to luminal enzymes and depend on intestinal cell associated enzymes for drug release afford extended release characteristics to the bound drug.
XI. In vivo performance of polyglutamic acid-azidothymidine (AZT) conjugate (ester linked)
XI:A - In vivo performance of polyglutamic acid-azidothymidine (AZT) conjugate
(lot no. TM-113,41% AZT content)
[393] Polyglutamic acid-AZT conjugates were tested in male Sprague-
Dawley rats (~ 250 g). Defined doses were delivered orally in sodium bicarbonate solution containing polyglutamic acid-AZT conjugates or AZT. [394] Content of AZT in the conjugate TM-113 was estimated to be 41 % as
based on UV spectrophotometric assay. Polyglutamic acid-AZT conjugate was given to five rats at a dose containing 15 mg/kg of AZT. Doses of AZT equivalent to the AZT contained in polyglutamic acid-AZT (TM-113) were also given to five rats.
[395] Doses were delivered orally to rats at time-zero using an intragastric
delivery syringe. Plasma was collected at 0.5, 1.5, 3, 5, 8, 12, and 24 hours after delivery of polyglutamic acid-AZT (TM-113) and equivalent AZT dosed rats. Plasma AZT concentrations were determined by ELISA using a commercially available kit (AZT ELISA, Product #400110, Neogen Corporation, Lexington, KY).
[396] Plasma levels of individual animals are shown in Table 15. Mean
plasma levels are shown in Table 16. As shown the figure above, AZT plasma levels spiked at 0.5 hours and rapidly droped by 1.5 hours, whereas levels of AZT for the polyglutamic acid-AZT where significantly lower at 0.5 hours and did not drop off rapidly by 0.5 hours. Plasma levels of AZT for the polyglutamic acid-AZT conjugate remained elevated longer (> 3 hours) than for the monomeric AZT control
( XI:B - In vivo performance of polyglutamic acid-azidothymidine (AZT) conjugate (rat model)
(lot no. TM-248,43% AZT content)
[397] Polyglutamic acid-AZT conjugates were tested in male Sprague-
Dawley rats (~ 250 g). Defined doses were delivered orally in sodium bicarbonate solution containing polyglutamic acid-AZT conjugates or AZT. [398] Content of AZT in the conjugate TM-248 was estimated to be 43 %
as based on UV spectrophotometric assay. Polyglutamic acid-AZT conjugate was given to five rats at a dose containing 7.5 mg/kg of AZT. Doses of AZT equivalent to the AZT contained in polyglutamic acid-AZT (TM-248) were also given to five rats.
[399] Doses were delivered orally to rats at time-zero using an oral gavage
syringe. Plasma was collected at 0.5, 1, 2, 3, 4, 6, and 9 hours after delivery of polyglutamic acid-AZT (TM-248) and equivalent AZT dosed rats. Plasma AZT concentrations were determined by ELISA using a commercially available kit (AZT ELISA, Product #400110, Neogen Corporation, Lexington, KY).
[400] Plasma levels of individual animals are shown in Table 18. Mean
plasma levels are shown in Table 19. As shown the figure above, AZT plasma levels spiked at 0.5 hours and rapidly dropped by 1 hour, whereas levels of AZT for the polyglutamic acid-AZT remained elevated until 4 hours. Pharmacokinetic parameters are summarized in Table 20. Cmax of polyglutamic acid-AZT (TM-248) was increased by 149% over AZT. The mean AUC of polyglutamic acid-AZT (TM-248) was increased 598% over AZT. Further, the mean time to peak concentration (Tmax) was substantially longer for the polyglutamic acid-AZT conjugate. This example clearly illustrates that both enhanced absorption and sustained release can be afforded to AZT by covalent attachment to a polymer of glutamic acid.
XII: Active Agent List
[401] The active agent that is attached to the carrier peptide can have one or
more of different functional groups. The functional groups include an amine, carboxylic acid, alcohol, ketone, amido (or its chemical equivalent),thiol or sulfate. Examples of these active agents, their functional groups and site of attachment to the carrier peptide is provided in the section below. XII;A ¦ VIA THE AMINE OR AMINO GROUP Adefovir Dipivoxil
[402] Adefovir dipivoxil is a known pharmaceutical agent that is used in
the treatment of AIDS. Its chemical name is [[[2-(6-amino-9H-purin-9-yl)ethoxy]methyl] phosphinylidene]bis(oxymethylene)-2,2-dimethylpropanoic acid. Its structure is:
Adefovir dipivoxil is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, adefovir dipivoxil is covalently attached to the peptide via the amino group.
Alendronate
[403] Alendronate is a known pharmaceutical agent that is used for
controlling osteoporosis in men. Its chemical name is (4-amino-l-hydroxybutylidene)bisphosphonic acid. Its structure is:

Alendronate is the subject of U.S. Patent Numbers 4,621,077; 5,358,941; 5,681,950; 5,804,570; 5,849,726; 6,008,207; and 6,090,410, herein incorporated by reference, which describe how to make that drug. In the present invention, alendronate is covalently attached to the peptide via the amino group.
Amifostine
[404] Amifostine is a known pharmaceutical agent that is used in the
treatment of head and neck cancer undergoing postoperative radiotherapy. This drug is a cytoprotective agent. It is used as an adjuct to chemotherapy and radiotherapy in cancer treatment. Its chemical name is 2-[(3-
aminopropyl)amino]ethanethiol dihydrogen phosphate. Its structure is:

Amifostine is the subject of U.S. Patent Numbers 5,424,471; 5,591,731; and 5,994,409, herein incorporated by reference, which describes how to make that drug. In the present invention, amifostine is covalently attached to the peptide via the amine group.
Amlodipine besylate
[405] Amlodipine besylate is a known pharmaceutical agent that is used in
the treatment and prevention of myocardial infarction and stroke. Its chemical name is 2-[(2-aminoethoxy)methyl]-4-(2-chlorophenyl)-l,4-dihydro-6-methyl-3,5-
pyridinedicarboxylic acid, 3-ethyl 5-methyl ester monobenzenesulfonate. Its structure is:

Amlodipine besylate is the subject of U.S. Patent Numbers 4,572,909 and 4,879,303, herein incorporated by reference, which describe how to make that drug. In the present invention, amlodipine besylate is covalently attached to the peptide via the amino group.
Astemizole
[406] Astemizole is a known pharmaceutical agent that is used in the
treatment of seasonal allergic rhinitis and chronic idiopathic urticara. Its chemical name is l-[(4-fluorophenyl)methyl]-N-[l-[2-(4-methoxyphenyl)ethyl]-4-
piperidinyl]-lH-benzimidazol-2-amine. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, the astemizole is covalently attached to the peptide via the amine group.
Azathioprene
[407] Azathioprene is a known pharmaceutical agent that is used in the
treatment of transplant organ rejection. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, azathioprene is covalently attached to the peptide via the amine group.
Bile Acid Transport Inhibitor
[408] The bile acid transport inhibitor of the present invention is a known
pharmaceutical agent that is used in the treatment of hypercholesterolemia. Its chemical name is (3R,5R)-l-butyl-3-ethyl-2,3,4,5-tetrahydro-7,8-dimethoxy-5-phenyl-l,4-benzothiazepine-l,l-dioxide. Its structure is:

The bile acid transport inhibitor of the present invention is the subject of WO 96/5188 (1996), based on US application 288527 (1994), herein incorporated by reference, which describes how to make that drug. In the present invention, the bile acid transport inhibitor is covalently attached to the peptide via the amino group.
Bupropion
[409] Bupropion is a known pharmaceutical agent that is used in smoking
cessation therapy and in the treatment of depression. Its chemical name is l-(3-chlorophenyl)-2-[(l,l-dimethylethyl)amino]-l-propanone. Its structure is:

Bupropion is the subject of U.S. Patent Numbers 5,358,970; 5,427,798; 5,731,000; 5,763,493; and Re. 33,994, herein incorporated by reference, which describes how to make that drug. In the present invention, bupropion is covalently attached to the peptide via the amino group.
Cabergoline
[410] Cabergoline is a known pharmaceutical agent that is used in the
treatment of Parkinson's disease. Its chemical name is (8P)-N-[3-
- (dimethylammo)propyl]-N-[(ethylamino)carbonyl]-6-(2-propenyl)ergoline-8-carboxamide. Its structure is:

Cabergoline is the subject of U.S. Patent Number 4,526,892, herein incorporated by reference, which describes how to make that drug. In the present invention, cabergoline is covalently attached to the peptide via the amino group.
Carboplatin
[411] Carboplatin is a known pharmaceutical agent that is used in the
treatment of ovarian cancer. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, carboplatin is covalently attached to the peptide via the amine groups.
Cefpodoxime Proxetil
[412] Cefpodoxime proxetil is a known pharmaceutical agent that is used in
the treatment of mild to moderate infections of the upper and lower respiratory tract,
skin and urinary tract and sexually transmitted diseases. Its chemical name is [6R-[6a7ß(Z)]]-7-[[(2-arnino-4-thiazolyl)(methoxyimino)acetyl]amino]-3-(methoxymethyl)-8-oxo-5-thia-l-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid 1-[[(l-methylethoxy)carbonyl]oxy]ethyl ester. Its structure is:

Cefpodoxime proxetil is the subject of EP 49118 B (1986), herein incorporated by reference, which describes how to make that drug. In the present invention, cefpodoxime proxetil is covalently attached to the peptide via the amino group.
Cefprozil
[413] Cefprozil is a known pharmaceutical agent that is used in the
treatment of upper respiratory tract infections, otitis media, acute exacerbation of chronic bronchitis, and skin infections. Its chemical name is [6R-[6oc,7P(R*)]]-7-[[amino(4-hydroxyphenyl)acetyl]amino-8-oxo-3-(l-propenyl)-5-thia-l-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid. Its structure is:

Cefprozil is the subject of GB 2135305 B (1987), based on US Patent Application Serial Number 461833 (1983), herein incorporated by reference, which describes how to make that drug. In the present invention, cefprozil is covalently attached to the peptide via the carboxylic acid or amino group.
Chlordiazepoxide
[414] Chlordiazepoxide is a known pharmaceutical agent that is used in the
treatment of anxiety and tension. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, chlordiazepoxide is covalently attached to the peptide via the amino group.
Cholinergic Channel Modulator
[415] Cholinergic channel modulator is a known pharmaceutical agent that
is used in the treatment of pain. Its chemical name is (R)-2-chloro-5-(2-azetidinylmethoxy)pyridine. Its structure is:

Cholinergic channel modulator is the subject of WO 96/40682 (1996), based on priority US application 474873, herein incorporated by reference, which describes how to make that drug, hi the present invention, cholinergic channel modulator is covalently attached to the peptide via the amine group.
Cisapride
[416] Cisapride is a known pharmaceutical agent that is used in the
treatment of gastrointestinal motility disease. Its chemical name is cis-4-amino-5-
chloro-N-[l-[3-(4-fluorophenoxy)propyl]-3-methoxy-4-piperidinyl]-2-
methoxybenzamide. Its structure is:
Cisapride is the subject of U.S. Patent Number 4,962,115, herein incorporated by reference, which describes how to make that drug. In the present invention, cisapride is covalently attached to the peptide via the amino group.
Cisplatin
[417] Cisplatin is a known pharmaceutical agent that is used in the
treatment of bladder and ovarian carcinoma. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

Cisplatin is the subject of U.S. Patent Number 5,562,925, herein incorporated by reference, which describes how to make that drug. In the present invention, cisplatin is covalently attached to the peptide via the amino group.
Clozapine
[418] Clozapine is a known pharmaceutical agent that is used in the
treatment of psychotic disorders. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, clozapine is covalently attached to the peptide via the amino group.
Colestipol
[419] Colestipol is a known pharmaceutical agent that is used in the
treatment of hypercholesterolemia. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Colestipol hydrochloride is a copolymer of diethylenetriamine and l-chloro-2,3-epoxypropane that contains secondary and tertiary amines with approximately 1 out of 5 amine nitrogens protonated with chloride. In the present invention, colestipoi is covalently attached to the peptide via one of its amino groups.
Cyclophosphamide
[420] Cyclophosphamide is a known pharmaceutical agent that is used in
the treatment of myeloproliferative and lymphoproliferative disorders and solid malignancies. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, cyclophosphamide is covalently attached to the peptide via the amino group.
Desmopressin
[421] Desmopressin is a known pharmaceutical agent that is used in the
treatment of urinary incontinence. Its chemical name is l-(3-mercaptopropanic acid)-8-D-arginine-vasopressin. Its structure is:

Desmopressin is the subject of U.S. Patent Numbers 5,047,398; 5,500,413; 5,674,850; and 5,763,407, herein incorporated by reference, which describes how to make that drug. In the present invention, desmopressin is covalently attached to the peptide via an amide linkage with the amino group.
Dextroamphetamine
[422] Dextroamphetamine is a known pharmaceutical agent that is used in
the treatment of narcolepsy and attention deficit hyperactivity disorder. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, dextroamphetamine is covalently attached to the peptide via the amino group.
Dolasetrom Mesylate
[423] Dolasetrom mesylate is a known pharmaceutical agent that is used in
the treatment of nausea and vomiting associated with chemotherapy. Its chemical name is lH-indole-3-carboxylic acid trans-octahydro-3-oxo-2,6-methano-2H-quinolizin-8-yl ester. Its structure is:
>
Dolasetrom mesylate is the subject of U.S. Patent Number 4,906,775, herein
incorporated by reference, which describes how to make that drug. In the present invention, the dolasetrom mesylate is covalently attached to the peptide via the amino group
Doxazosin
[424] Doxazosin is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is l-(4-amino-6,7-dimethoxy-2-
quinazolinyl)-4-[(2,3-dihydro-1,4-benzodioxin-2-yl)carbonyl]piperizine. Its
structure is:
Doxazosin is the subject of U.S. Patent Number GB 2007656 B (1982), herein incorporated by reference, which describes how to make that drug. In the present invention, doxazosin is covalently attached to the peptide via the amino group.
Duloxetine
[425] Duloxetine is a known pharmaceutical agent that is used in the
treatment of depression. Its chemical name is (S)-N-methyl-y-(l-naphthalenyloxy)-2-thiophenepropanamine. Its structure is:

Duloxetine is the subject of 273658 B (1990), priority US 945122 (1986), herein incorporated by reference, which describes how to make that drug. In the present invention, duloxetine is covalently attached to the peptide via the amino group.
Famciclovir
[426] Famciclovir is a known pharmaceutical agent that is used in the
treatment of viral infection. Its chemical name is 2-[2-(2-amino-9H-purin-9-yl)ethyl]-l,3-propanediol diacetate. Its structure is:

Famciclovir is the subject of EP 182024 B (1991) and U.S. Patent Number 5,246,937, herein incorporated by reference, which describes how to make that drug. In the present invention, famciclovir is covalently attached to the peptide via the amino group.
Famotidine
[427] Famotidine is a known pharmaceutical agent that is used in the
treatment of ulcers and heartburn. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, famotidine is covalently attached to the peptide via the amino groups.

5 Felodipine
[428] Felodipine is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is 4-(2,3-dichlorophenyl)-l,4-dihydro-2,6-dimethyl-3,5-pyridinedicarboxylic acid ethyl methyl ester. Its structure is:
10 Felodipine is the subject of U.S. Patent Numbers 4,264,611 and 4,803,081, herein incorporated by reference, which describes how to make that drug. In the present invention, the felodipine is covalently attached to the peptide via the amine group.
Flecainide acetate
15 [429] Flecainide acetate is a known pharmaceutical agent that is used in the
treatment of arrythmia. Its chemical name is N-(2-piperidinylmethyl)-2,5-bis(2,2,2-trifluoroethoxy)benzamide. Its structure is:
Flecainide acetate is the subject of U.S. Patent Number 4,642,384, herein 20 incorporated by reference, which describes how to make that drug. In the present invention, flecainide acetate is covalently attached to the peptide via the amino group.

Fluoxetine
[430] Fluoxetine is a known pharmaceutical agent that is used in the
treatment of depression. Its chemical name is (N-methyl 3-(p-trifluoromethylphenoxy)-3-phenylpropylamine. Its structure is:

Fluoxetine is the subject of U.S. Patent Number 4,329,356, herein incorporated by reference, which describes how to make that drug. In the present invention, fluoxetine is covalently attached to the peptide via the amino group.
Fluvoxamine maleate
[431] Fluvoxamine maleate is a known pharmaceutical agent that is used in
the treatment of depression and anxiety. Its chemical name is 5-methoxy-l-[4-(trifluoromethyl)phenyl]-l-pentanone (E)-O-(2-aminoethyl)oxime. Its structure is:

Fluvoxamine maleate is the subject of GB1535226 (1978), herein incorporated by reference, which describes how to make that drug. In the present invention, fluvoxamine maleate is covalendy attached to the peptide via the amino group.
Hydrochlorothiazide and Triamterene
[432] Hydrochlorothiazide and triamterene are known pharmaceutical
agents that are used together in the treatment of edema and hypertension. The chemical structure of triamterene is:

The chemical structure of hydrochlorothiazide is:

In the present invention, triamterene is covalently attached to the peptide via the amine group.
Isradipine
[433] Isradipine is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is 4-(4-benzofurazanyl)-l,4-dihydro-2,6-dimethyl-3,5-pyridinedicarboxylic acid methyl 1-methylethyl ester. Its structure is:
In the present invention, the isradipine is covalently attached to the peptide via the amine group.
Lamotrigine
[434] Lamotrigine is a known pharmaceutical agent that is used in the
treatment of epilepsy, psychosis and depression. Its chemical name is 6-(2,3-dichlorophenyl)-l,2,4-triazine-3,5-diamine. Its structure is:

Lamotrigine is the subject of U.S. Patent Numbers 4,602,017 and 5,698,226, herein incorporated by reference, which describes how to make that drug. In the present invention, lamotrigine is covalently attached to the peptide via the amino group.
D-Methylphenidate
[435] D-methylpheaidate is a known pharmaceutical agent that is used in
the treatment of attention deficit disorder. Its chemical name is (aR,2R)-cc-phenyl-2-piperidineacetic acid methyl ester. Its structure is:

D-methylphenidate is the subject of U.S. Patent Number 2,507,631 (1950) and WO 99/16439 (1999), based on US application Number 937684 (1997), each of which is herein incorporated by reference, which describes how to make that drug. In the present invention, D-methylphenidate is covalently attached to the peptide via the amino group.
Methylphenidate
[436] Methylphenidate is a known pharmaceutical agent that is used in the
treatment of attention deficit disorder. Its structure is:

The composition of the invention comprises methylphenidate covalently attached to a peptide. In the present invention, methylphenidate is covalently attached to the peptide via the amino group.
Metolazone
[437] Metolazone is a known pharmaceutical agent that is used in the
treatment of edema and hypertension. Its structure is:

The composition of the invention comprises metolazone covalently attached to a peptide. In the present invention, metolazone is covalently attached to the peptide via the amine group.
Naratriptan
[438] Naratriptan is a known pharmaceutical agent that is used in the
treatment of migraine. Its chemical name is N-methyl-3-(l-methyl-4-piperidinyl)-lH-indole-5-ethanesulfonamide. Its structure is:

Naratriptan is the subject of U.S. Patent Number 4997841, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises naratriptan covalently attached to a peptide. In the present invention, naratriptan is covalently attached to the peptide via the amino group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Nifedipine
[439] Nifedipine is a known pharmaceutical agent that is used in the
treatment of hypertension and angina. Its structure is:

Nifedipine is the subject of U.S. Patent Numbers 4327725; 4612008; 4765989; 4783337; and 5264446, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nifedipine covalently attached to a peptide. In the present invention, nifedipine is covalently attached to the peptide via the amine group.
Nimodipine
[440] Nimodipine is a known pharmaceutical agent that is used in the
treatment of migraine, cognitive defect, Alzheimer disease and brain ischemia. Its chemical name is l,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-
pyridinedicarboxylic acid 2-methoxyethyl 1-methylethyl ester. Its structure is:

Nimodipine is the subject of U.S. Patent Number 4406906, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nimodipine covalently attached to a peptide. In the present invention, nimodipine is covalently attached to the peptide via the amine group.
Nisoldipine
[441] Nisoldipine is a known pharmaceutical agent that is used in the
treatment of angina and hypertension. Its chemical name is l,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinedicarboxylic acid methyl 2-methylpropyl ester. Its structure is:
Nisoldipine is the subject of U.S. Patent Number 4,892,741, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nisoldipine covalently attached to a peptide. In the present invention, nisoldipine is covalently attached to the peptide via the amine group.
Noradrenalin and Dopamine Reuptake Inhibitor
[442] The noradrenalin and dopamine reuptake inhibitor of the present
invention is used in the treatment of attention deficit hyperactivity disorder (ADHA). Its chemical name is [2S-(2a,3a,5a)]-2-(3,5-difluorophenyl)-3,5-dimethyl-2-morpholinol hydrochloride. Its structure is:

The noradrenalin and dopamine reuptake inhibitor of the present invention is the subject of EP 426416 B (1994), herein incorporated by reference, which describes how to make that drug. In the present invention, the noradrenalin and dopamine reuptake inhibitor is covalently attached to the peptide via the amino group.
Norastemizole
[443] Norastemizole is a known pharmaceutical agent that is used in the
treatment of allergy. Its chemical name is l-[(4-fluorophenyl)methyl]-N-4-piperidinyl-lH-benzimidazol-2-amine. Its structure is:

Norastemizole is the subject of EP 5318 B 1982, priority US 892534 1978, WO 94/7495 1994, priority US 940054 1992, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises norastemizole covalently attached to a peptide. In the present invention, norastemizole is covalently attached to the peptide via any of the amino groups.
Nortriptyline
[444] Nortriptyline is a known pharmaceutical agent that is used in the
treatment of depression. Its structure is:

The composition of the invention comprises nortriptyline covalently attached to a peptide. In the present invention, nortriptyline is covalently attached to the peptide via any of the amino groups.
Octreotide acetate
[445] Octreotide acetate is a known pharmaceutical agent that is used in the
treatment of Alzheimer disease, cancer, viral infection, psoriasis, diarrhea, diabetes, pain and acromegaly. Its chemical name is [R-(R*,R*)]-D-phenylalanyl-L-cysteinyl-L-phenylalanyl-D-tryptophyl-L-lysyl-L-threonyl-N-[2-hydroxy-l-(hydroxymethyl)propyl]-L-cysteinamide cyclic (2-7)-disulfide. Its structure is:

Octreotide acetate is the subject of U.S. Patent Numbers 4,395,403; 5,538,739; 5,639,480; 5,688,530; 5,922,338; and 5922682, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises octreotide acetate covalently attached to a peptide. In the present invention, octreotide acetate is covalently attached to the peptide via the amino group.
Olanzapine
[446] Olanzapine is a known pharmaceutical agent that is used in the
treatment of schizophrenia and psychosis. Its chemical name is 2-methyl-4-(4-methyl-l-piperazinyl)-10H-thieno[2,3-b][l,5]benzodiazepine. Its structure is:

Olanzapine is the subject of U.S. Patent Numbers 5,229,382; 5,605,897; 5,736,541; and 5,919,485, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises olanzapine covalently attached to a peptide. In the present invention, olanzapine is covalently attached to the peptide via the amine group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Pamidronate
[447] Pamidronate is a known pharmaceutical agent that is used in the
treatment of osteoporosis and cancer. Its chemical name is (3-amino-l-hydroxypropylidene) bisphosphonic acid. Its structure is:

Pamidronate is the subject of U.S. Patent Number 4,711,880, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pamidronate covalently attached to a peptide. In the present invention, pamidronate is covalently attached to the peptide via the amino group.
Paroxetine
[448] Paroxetine is a known pharmaceutical agent that is used in the
treatment of depression, obsessive compulsive disorder, anxiety and panic disorder. Its chemical name is (3S,4R)-3-[(l,3-benzodioxol-5-yloxy)methyl]-4-(4-fluorophenyl)piperidine hydrochloride. Its structure is:

Paroxetine is the subject of U.S. Patent Numbers 4,721,723; 4,839,177; 5,422,123; 5,789,449; 5,872,132; 5,900,423; 6,063,927; and 6,080,759, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises paroxetine covalently attached to a peptide. In the present invention, paroxetine is covalently attached to the peptide via the amino group.
Pemoline
[449] Pemoline is a known pharmaceutical agent that is used in the
treatment of attention deficit hyperactivity disorder. Its structure is:

The composition of the invention comprises pemoline covalently attached to a peptide. In the present invention, pemoline is covalently attached to the peptide via the amino group.
Pergolide
[450] Pergolide is a known pharmaceutical agent that is used in the
treatment of Parkinson disease and depression. Its chemical name is (8|5)-8-[(methylthio)methyl]-6-propylergbline. Its structure is:

Pergolide is the subject of U.S. Patent Number 4,166,182; 4,797,405; and 5,114,948, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pergolide covalently attached to a peptide. In the present invention, the active agent is covalently attached to the peptide via the amino group and a linker.
Pramipexole
[451] Pramipexole is a known pharmaceutical agent that is used in the
treatment of Parkinson disease and depression. Its chemical name is (S)-2-amino-4,5,6,7-tetrahydro-6-(propylamino)-benzothiazole . Its structure is:

Pramipexole is the subject of U.S. Patent Number 4,843,086 and 4,886,812, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pramipexole covalently attached to a peptide. In the present invention, pramipexole is covalently attached to the peptide via the amino group.
Remacemide
[452] Remacemide is a known pharmaceutical agent that is used in the
treatment of epilepsy, Parkinson disease, and neurodegeneration. Its chemical name is 2-amino-N-(l-methyl-l,2-diphenylethyl)acetamide. Its structure is:

Remacemide is the subject of EP 279937 B 1991, priority US 11982 1987, and WO 93/21910 1993, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises remacemide covalently attached to a peptide. In the present invention, remacemide is covalently attached to the peptide via the amino group.
Repinotan
[453] Repinotan is a known pharmaceutical agent that is used in the
treatment of stroke and trauma. Its chemical name is (R)-2-[4-[[(3,4-dihydro-2H-l-benzopyran-2-yl)methyl]amino]butyl]-l,2-benzisothiazol-3(2H)-one 1,1-dioxide. Its structure is:
Repinotan is the subject of U.S. Patent Number 5,137,901, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises repinotan covalently attached to a peptide. In the present invention, repinotan is covalently attached to the peptide via the amino group.
Riluzole
[454] Riluzole is a known pharmaceutical agent that is used in the treatment
of amyotrophic lateral sclerosis, Alzheimer disease and Parkinson disease. Its chemical name is 6-(trifluoromethoxy)-2-benzothiazolamine. Its structure is:

Riluzole is the subject of EP 50551 B 1984, EP 282971 A 1988 (priority US 26428 1987), and EP 305277 A 1989, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises riluzole covalently attached to a peptide. In the present invention, riluzole is covalently attached to the peptide via the amino group.
Rimantadine
[455] Rimantadine is a known pharmaceutical agent that is used in the
treatment of viral infection and trypanosomiasis. Its chemical name is a-methyl-1-adamantanemethylamine. Its structure is:

Rimantadine is the subject of GB 1069563 1967, priority US 297233 1963, EP 162444 B 1990, priority US 613374 1984, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rimantadine covalently attached to a peptide. In the present invention, rimantadine is covalently attached to the peptide via the amino group.
Rizatriptan benzoate
[456] Rizatriptan benzoate is a known pharmaceutical agent that is used in
the treatment of migraine. Its chemical name is N,N-dimethyl-5-(lH-l,2,4-triazol-l-ylmethyl)-lH-indole-3-ethanamine. Its structure is:

Rizatriptan benzoate is the subject of U.S. Patent Number 4,371,516; 5,298,520; 5,457,895; and 5,602,162, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rizatriptan benzoate covalently attached to a peptide. In the present invention, rizatriptan benzoate is covalently attached to the peptide via the amino group and a linker.
Satraplatin
[457] Satraplatin is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is Satraplatin. Its structure is:

Satraplatin is the subject of EP 328274 B 1994, priority US 151674 1988, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises satraplatin covalently attached to a peptide. In the present invention, satraplatin is covalently attached to the peptide via the amino group.
Sertraline
[458] Sertraline is a known pharmaceutical agent that is used in the
treatment of depression, obsessive compulsive disorder, anxiety, panic disorder, sexual dysfunction and obesity. Its chemical name is (lS,4S)-4-(3,4-dicMorophenyl)-l,23,4-tetrahydro-N-memyl-l-naphthaleneamine. Its structure is:

Sertraline is the subject of U.S. Patent Number 4,536,518; 4,962,128; and 5,248,699,
herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sertraline covalently attached to a peptide. In the present invention, sertraline is covalently attached to the peptide via die amine group.
Sevelamer
[459] Sevelamer is a known pharmaceutical agent that is used in the
treatment of kidney disease. Its chemical name is 2-propen-l-amine, polymer with (chloromethyl)oxirane. Its structure is:

Sevelamer is the subject of U.S. Patent Number 5,496,545 and 5,667,775, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sevelamer covalently attached to a peptide. In the present invention, sevelamer is covalently attached to the peptide via any of the amino groups.
Sodium Channel Blocker
[460] The sodium channel blocker of the present invention is a
known pharmaceutical agent that is used in the treatment of pain. Its chemical name is (5R)-5-(2,3-dichlorophenyl)-6-(fluoromethyl)-2,4-pyrimidinediamine. Its
structure is:
A sodium channel blocker is the subject of WO 97/9317 (1997), herein incorporated by reference, which describes how to make that drug. In the present invention, a sodium channel blocker is covalently attached to the peptide via any of the amino groups.
Sumatriptan
[461] Sumatriptan is a known pharmaceutical agent that is used in the
treatment of migraine. Its chemical name is 3-[2-(dimethyIamino)ethyl]-N-methyI-1H-indole-5-methanesuIfonamide. Its structure is:

Sumatriptan is the subject of U.S. Patent Number 4816470 and 5037845, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sumatriptan covalently attached to a peptide. In the present invention, sumatriptan is covalently attached to the peptide via the amine group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Tabimorelin
[462] Tabimorelin is a known pharmaceutical agent that is used in the
treatment of hormone deficiency. Its chemical name is N-[(2E)-5-amino-5-methyl-l-oxo-2-hexenyl]-N-methyl-3-(2-naphthalenyl)-D-alanyl-N,N-a-dimethyl-D-phenylalaninamide. Its structure is:

Tabimorelin is the subject of WO 97/23508 1997, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tabimorelin covalently attached to a peptide. In the present invention, tabimorelin is covalently attached to the peptide via the amine group.
Tamsulosin
[463] Tamsulosin is a known pharmaceutical agent that is used in the
treatment of benign prostate hypertrophy. Its chemical name is R-(-)-5-[2-[[2-(2-
ethoxyphenoxy)ethyl]amino]propyl]-2-methoxybenzenesulfonamide. Its structure is:
Tamsulosin is the subject of U.S. Patent Number 4,731,478; 4,703,063; 4,772,475; and 4,868,216, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tamsulosin covalently attached to
a peptide. In the present invention, tamsulosin is covalently attached to the peptide via the amino group.
Tenofovir
[464] Tenofovir disoproxil is a known pharmaceutical agent that is used in
the treatment of HIV infection. Its chemical name is [[(lR)-2-(6-amino-9H-purin-9-yl)-l-methylethoxy]methyl]phosphonic acid. Its structure is:

Tenofovir disoproxil is the subject of WO 94/3467 1994, priority US 925610 1992, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tenofovir disoproxil covalently attached to a peptide. In the present invention, tenofovir disoproxil is covalently attached to the peptide via the amino group.
Terazosin
[465] Terazosin is a known pharmaceutical agent that is used in the
treatment of benign prostate hypertrophy and hypertension. Its chemical name is 1-(4-amino-6,7-dimethoxy-2-quinazolinyl)-4-[(tetrahydro-2-furanyl)carbonyl]piperazine. Its structure is:

Terazosin is the subject of GB 1517403 1978, priority US 621980 1975, GB 1591490 1981, priority US 821675 1977, WO 92/73 1992, priority US 546349 1990, and US 5294615 1994, herein incorporated by reference, which describes how to
make that drag. The composition of the invention comprises terazosin covalently attached to a peptide. In the present invention, terazosin is covalently attached to the peptide via the amino group.
Tirapazamine
[466] Tirapazamine is a known pharmaceutical agent that is used in
the treatment of cancer. Its chemical name is 3-amino-l,2,4-benzotriazine-l,4 dioxide. Its structure is:
Tirapazamine is the subject of WO 91/4028 1991, priority PCT/US/4112 1989, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tirapazamine covalently attached to a peptide. In the present invention, tirapazamine is covalently attached to the peptide via the amine group.
Tizanidine
[467] Tizanidine is a known pharmaceutical agent that is used in the
treatment of muscle spasm. Its chemical name is 5-chloro-N-(4,5-dihydro-lH-imidazol-2-yl)-2,l,3-benzothiadiazol-4-amine. Its structure is:

; Tizanidine is the subject of GB 1429926 1976 and GB 1559811 1980, herein incorporated by reference, which describes how to make that drug. The composition
of the invention comprises tizanidine covalently attached to a peptide. In the present invention, tizanidine is covalently attached to the peptide via the amine groups.
Tomoxetine
[468] Tomoxetine is a known pharmaceutical agent that is used in the
treatment of attention deficit disorder. Its chemical name is (yR)-N-methyl-Y-(2-methylphenoxy)benzenepropanamine. Its structure is:

Tomoxetine is the subject of US 4314081 1980, and EP 52492 B 1984, priority US 206498 198, herein incorporated by reference, which describes how to make that drag. The composition of the invention comprises tomoxetine covalently attached to a peptide. In the present invention, tomoxetine is covalently attached to the peptide via the amine group.
Topiramate
[469] Topiramate is a known pharmaceutical agent that is used in the
treatment of epilepsy, psychosis and depression. Its chemical name is 2,3:4,5-bis-O-(l-methylethylidene)-P-D-fructopyranose sulfamate. Its structure is:

Topiramate is the subject of U.S. Patent Number 4,513,006, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises topiramate covalently attached to a peptide. In the present invention, topiramate is covalently attached to the peptide via the amino group.
Toresemide
[470] Toresemide is a known pharmaceutical agent that is used in the
treatment of hypertension and heart failure. Its chemical name is N-[[(l-methylethyl)aniino]carbonyl]1H-[(3-methylphenyl)amino]-3-pyridinesulfonamide.
Its structure is:
Toresemide is the subject of U.S. Patent Number 4,861,786 and RE34672, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises toresemide covalently attached to a peptide. In the present invention, toresemide is covalently attached to the peptide via the amine group.
Triamterene
[471] Triamterene is a known pharmaceutical agent that is used in the
treatment of edema. Its structure is:

The composition of the invention comprises triamterene covalently attached to a peptide. In the present invention, triamterene is covalently attached to the peptide via an amino group.
Valacyclovir
[472] Valacyclovir is a known pharmaceutical agent that is used in the
treatment of viral infection. Its chemical name is 2-[(2-amino-l,6-dihydro-6-oxo-9H-purin-9-yl) methoxyJ-L-valine ethyl ester. Its structure is:

Valacyclovir is the subject of U.S. Patent Number 4,957,924, herein incorporated by reference, which describes how to make that drug. In the present invention, valacyclovir is covalently attached to the peptide via the amino group.
Valdecoxib
[473] Valdecoxib is a known pharmaceutical agent that is used in the
treatment of arthritis and pain. Its chemical name is 4-(5-methyl-3-phenyl-4-isoxazolyl)benzenesulfonamide. Its structure is:

Valdecoxib is the subject of WO 96/25405 1996, priority US 387680 1995, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises valdecoxib covalently attached to a peptide. In the present invention, valdecoxib is covalently attached to the peptide via the amino group.
Zolmitriptan
[474] Zolmitriptan is a known pharmaceutical agent that is used in the
treatment of migraine. Its chemical name is (4S)-4-[[3-[2-(dimethylamino)ethyl]-lH-indol-5-yl]methyl]-2-oxazolidinone. Its structure is:

Zolmitriptan is the subject of U.S. Patent Number 5,466,699 and 5,863,935, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises zolmitriptan covalently attached to a peptide. In the present invention, zolmitriptan is covalently attached to the peptide via the amine group and a linker
XII:B - VIA THE CARBOXYLIC ACID GROUP
Acetylsalicylic acid
[475] Acetylsalicylic acid is a known pharmaceutical agent that is used in
the treatment of minor aches and pains. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, acetylsalicylic acid is covalently attached to the peptide via the carboxylic acid group.
Acitretin
[476] Acitretin is a known pharmaceutical agent that is used in the
treatment of psoriasis. Its chemical name is (all-E)-9-(4-methoxy-2,3,6-trimethylphenyl)-3,7-dimethyl-2,4,6,8-nonatetraenoic acid. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, acitretin is covalently attached to the peptide via the carboxylic acid group.
Candoxatril
[477] Candoxatril is a known pharmaceutical agent that is used in the
treatment of heart failure and hypertension. Its chemical name is 4-[[[l-[3-[(2,3-dihydro-lH-inden-5-yl)oxy]-2-[(2-methoxyethoxy)methyl]-3-oxopropyl]cyclopentyl]carbonyl]amino]-cyclohexanecarboxylic acid. Its structure is:

Candoxatril is the subject of EP 274234 B (1991), herein incorporated by reference, which describes how to make that drug. In the present invention, candoxatril is covalently attached to the peptide via the carboxylic acid group.
Cefazolin
[478] Cefazolin is a known pharmaceutical agent that is used in the
treatment of respiratory tract infections, urinary tract infections, skin and skin structure infections, biliary tract infections, bone and joint infections, genital infections, septicemia, and endocarditis caused by susceptible bacteria. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, cefazolin is covalently attached to the peptide via the carboxylic acid group.
Cefdinir
[479] Cefdinir is a known pharmaceutical agent that is used in the treatment
of acute maxillary sinusitis, acute exacerbations of chronic bronchitis, pharyngitis, tonsilitis, community-acquired pneumonia and bacterial skin infections. Its chemical name is [6R-[6a,7P(Z)]]-7-[[(2-anuno-4-iiiiazolyl)(hydroxyimino) acetyl]amino]-3-ethenyl-8-oxo-5-thia-l-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid. Its structure is:
Cefdinir is the subject of EP 105459 B (1989), based on US Application Serial Number 428,970 (1982) and EP 304019 B (1995), herein incorporated by reference, which describes how to make that drug. In the present invention, cefdinir is covalently attached to the peptide via the carboxylic acid group.
Cefixime
[480] Cefixime is a known pharmaceutical agent that is used in the
treatment of respiratory tract infections, gonorrhea, biliary tract infection and pediatric otitis media. Its chemical name is [6R-[6a,7|3(Z)]]-7-[[(2-amino-4-thiazolyl) [(carboxymethoxy) imino]acetyl] amino]-3 -ethenyl-8-oxo-5-thia-1 -
azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid. Its structure is:

Cefixime is the subject of EP 30360 B (1987), herein incorporated by reference, which describes how to make that drug. In the present invention, cefixime is covalently attached to the peptide via the carboxylic acid group.
Cefotaxime
[481] Cefotaxime is a known pharmaceutical agent that is used in the
treatment of serious bone and joint infections, serious intra-abdominal and gynecologic infections (including peritonitis, endometritis, pelvic inflammatory disease, pelvic cellulitis), meningitis and other CNS infections, serious lower respiratory tract infections (including pneumonia), bacteremia/septicemia, serious skin and skin structure infections, and serious urinary tract infections caused by susceptible bacteria. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its chemical name is (6J?,7i?)-7-[2-(2-Amino-4-thiazolyl) glyoxylamido]-8-oxo-3-vinyi-5-thia-l-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, 72(Z)-[O-(carboxyrnethyl)oxime]. In the present invention, cefotaxime is covalently attached to the peptide via the carboxylic acid group.
Cefotetan
[482] Cefotetan is a known pharmaceutical agent that is used in the
treatment of septicemia, genitourinary, biliary and respiratory tract infections, and in
postoperativewound infection prophylaxis. Its chemical name is [6R-(6a,7a)]-7-
[[[4-(2-arnino-l-carboxy-2-oxoethylidene)-l,3-dithietan-2-yl]carbonyl]amino]-7-
methoxy-3-[[(l-methyl-lH-tetrazol-5-yl)thio] methyl]-8-oxo-5-thia-l-azabicyclo
[4.2.0]oct-2-ene-2-carboxylic acid. Its structure is:

Cefotetan is the subject of GB 1604739 (1981), herein incorporated by reference, which describes how to make that drug. In the present invention, cefotetan is covalently attached to the peptide via the carboxylic acid group.
Cefoxitin
[483] Cefoxitin is a known pharmaceutical agent that is used in the
treatment of serious infections of the lower respiratory tract, skin and skin structure, bone and joint, and urinary tract; septicemia; gynecologic infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease); and intra-abdominal infections (including peritonitis and intra-abdominal abscess) caused by susceptible bacteria. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, cefoxitin is covalently attached to the peptide via the carboxylic acid group.
Ceftazidime
[484] Ceftazidime is a known pharmaceutical agent that is used in the
treatment of bacterial infections. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, ceftazidime is covalently attached to the peptide via the carboxylic acid group.
Ceftibuten
[485] Ceftibuten is a known pharmaceutical agent that is used in the
treatment of bacterial infections. Its chemical name is [6R-[6oc,7{}(Z)]]-7-[[2-(2-amino-4-thiazolyl)-4-carboxy-l-oxo-2-butenyl]amino]-8-oxo 5-thia-l-
azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid. Its structure is:

Ceftibuten is the subject of EP 136721 B (1993), herein incorporated by reference, which describes how to make that drug. In the present invention, ceftibuten is covalently attached to the peptide via the carboxylic acid group.
Cefuroxime
[486] Cefuroxime is a known pharmaceutical agent that is used in the
treatment of bacterial infection. It is both commercially available and readily
manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, cefuroxime is covalently attached to the peptide via the carboxylic acid group.
Cetirizine
[487] Cetirizine is a known pharmaceutical agent that is used in the
treatment of allergic rhinitis. Its chemical name is [2-[4-[(4-
chlorophenyl)phenylmethyl]-l-piperazinyl] ethoxy]acetic acid. Its structure is:

Cetirizine is the subject of U.S. Patent Number 4,525,358, herein incorporated by reference, which describes how to make that drug. In the present invention, cetirizine is covalently attached to the peptide via the carboxylic acid group.
Chlorazepate Depot
[488] Chlorazepate depot is a known pharmaceutical agent that is used in
the treatment of anxiety disorders. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, chlorazepate depot is covalently attached to the peptide via the carboxylic acid group.
Cholecystokinin antagonist
[489] The cholecystokinin antagonist of the present invention is a known
pharmaceutical agent that is used in the treatment of anxiety. It is a combination of [lS-[la,2|3[S*(S*)],4a]]-4-[[2-[[3-(lH-indol-3-yl)-2-methyl-l-oxo-2-[[[(l,7,7-trimethylbicyclo[2.2.1]hept-2-yl)oxy]carbonyl]amino]propyl]amino]-l-phenylethyl]amino]-4-oxobutanoic acid compound and meglumine (1:1). Its structure is:
The cholecystokinin antagonist is the subject of WO 93/897 1993, priority US 729271 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises a cholecystokinin antagonist covalently attached to a peptide. In the present invention, the components of the cholecystokinin antagonist are covalently attached to the peptide via the carboxylic acid group.
Cilomilast
[490] Cilomilast is a known pharmaceutical agent that is used in the
treatment of asthma. Its chemical name is cis-4-cyano-4-[3-(cyclopentyloxy)-4-methoxyphenyl] cyclohexanecarboxylic acid. Its structure is:

Cilomilast is the subject of WO 93/19749 (1993), based on priority US application 862030 (1992), herein incorporated by reference, which describes how to make that drug. In the present invention, cilomilast is covalently attached to the peptide via the carboxylic acid group.
Divalproex
[491] Divalproex is a known pharmaceutical agent that is used in the
treatment of epilepsy, migraine, schizophrenia and depression. Its chemical name is 2-propylpentanoic acid. Its structure is:

Divalproex is the subject of U.S. Patent Numbers 4,988,731 and 5,212,326, herein incorporated by reference, which describes how to make that drug. In the present invention, divalproex is covalently attached to the peptide via the carboxylic acid group.
Eptifibatide
[492] Eptifibatide is a known pharmaceutical agent that is used in the
treatment of thrombosis, angina, myocardial infarction and restenosis. Its chemical name is N6-(aminoiminomethyl)-N2-(3-mercapto-l-oxopropyl)-L-lysylglycyl-L-a-
aspartyl-L-tryptophyl-L-prolyl-L-cysteinamide cyclic (l-6)-disulfide. Its structure is:
Eptifibatide is the subject of U.S. Patent Numbers 5,686,570; 5,756,451; and 5,807,825, herein incorporated by reference, which describes how to make that drug. In the present invention, eptifibatide is covalently attached to the peptide via the carboxylic acid group.
Etodolac
[493] Etodolac is a known pharmaceutical agent that is used in the
treatment of inflammation. Its chemical name is l,8-diethyl-l,3,4,9-tetrahydropyrano[3,4-b]indole-l-acetic acid. Its structure is:

Etodolac is the subject of U.S. Patent Number 4,966,768, herein incorporated by reference, which describes how to make that drug. In the present invention, etodolac is covalently attached to the peptide via the carboxylic acid group.
Etoposide
[494] Etoposide is a known pharmaceutical agent that is used in the
treatment of inflammation. Its chemical name is l,8-diethyl-l,3,4,9-tetrahydropyrano[3,4-b]indole-l-acetic acid. Its structure is:

Etoposide is the subject of GB 1391005 (1975), based on priority US application 148895 (1971), herein incorporated by reference, which describes how to make that drug. In the present invention, etoposide is covalently attached to the peptide via the carboxylic acid group.
Fexofenadine
[495] Fexofenadine is a known pharmaceutical agent that is used in the
treatment of seasonal allergic rhinitis. Its chemical name is 4-[l-hydroxy-4-[4-(hydroxydiphenylmethyl)-l-piperidinyl]butyl]-a,a-dimethylbenzeneacetic acid. Its structure is:
Fexofenadine is the subject of U.S. Patent Numbers 4,254,129; 5,578,610; 5,855,912; 5,932,247; and 6,037,353, herein incorporated by reference, which describes how to make that drug. In the present invention, fexofenadine is covalently attached to the peptide via the carboxylic acid group.
Fosinopril
[496] Fosinopril is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is [l[S*(R*)],2a.,4P]-4-cyclohexyl-l-
[[[2-methyl-l-(l-oxopropoxy)propoxy](4-phenylbutyl)phosphinyl]acetyl]-L-proline. Its structure is:
Fosinopril is the subject of U.S. Patent Number 4,337,201; 4,384,123; and 5,006,344, herein incorporated by reference, which describes how to make that drug. In the present invention, fosinopril is covalently attached to the peptide via the carboxylic acid group.
Furosemide
[497] Furosemide is a known pharmaceutical agent that is used in the
treatment of edema and hypertension. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, furosemide is covalently attached to the peptide via the carboxylic acid group.
Gemfibrozil
[498] Gemfibrozil is a known pharmaceutical agent that is used in the
treatment of hyperlipidemia. Its chemical name is 5-(2>5-dimethylphenoxy)-2,2-dimethylpentanoic acid. Its structure is:

Gemfibrozil is the subject of GB 1225575 (1971), priority based on US application 73046 (1968), herein incorporated by reference, which describes how to make that drug. In the present invention, gemfibrozil is covalently attached to the peptide via the carboxylic acid group.
Ibuprofen
[499] Ibuprofen is a known pharmaceutical agent that is used in the
treatment of pain and arthritis. Its structure is:

In the present invention, ibuprofen is covalently attached to the peptide via the carboxylic acid group.
Isotretinoin
[500] Isotretinoin is a known pharmaceutical agent that is used in the
treatment of acne. Its structure is:

Isradipine is the subject of EP 150 B (1981) and UK 2037766 B (1983), herein incorporated by reference, which describes how to make that drug. In the present
invention, isotretinoin is covalently attached to the peptide via the carboxylic acid group.
Ketoprofen
[501] Ketoprofen is a known pharmaceutical agent that is used in the
treatment of arthritis and pain. Its structure is:

In the present invention, ketoprofen is covalently attached to the peptide via the carboxylic acid group.
Ketorolac
[502] Ketorolac is a known pharmaceutical agent that is used in the
treatment of pain. Its chemical name is (+,-)-5-benzoyl-2,3-dihydro-lH-pyrrolizine-1-carboxylic acid. Its structure is:

i Ketorolac is the subject of GB 1554057 (1979), based on priority application US 704909 (1976), herein incorporated by reference, which describes how to make that drug. In the present invention, ketorolac is covalently attached to the peptide via the carboxylic acid group.
Levocarnitine
[503] Levocarnitine is a known pharmaceutical agent that is used in the
treatment of cardiovascular disease and septic shock. Its chemical name is (R)-3-carboxy-2-hyd1Hoxy-N,N,N-trimethyl-l-propanarniniurn hydroxide. Its structure is:

The composition of the invention comprises levocarnitine covalently attached to a peptide. In the present invention, levocarnitine is covalently attached to the peptide via the carboxylic acid group.
Levocetirizine
[504] Levocetirizine is a known pharmaceutical agent that is used in the
treatment of rhinitis. Its chemical name is [2-[4-[(R)-(4-
chlorophenyl)phenylmethyl]-l-piperazinyl]ethoxy]acetic acid. Its structure is:

Levocetirizine is the subject of EP 58146 B (1984), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises levocetirizine covalently attached to a peptide. In the present invention, levocetirizine is covalently attached to the peptide via the carboxylic acid group.
Levofloxacin
[505] Levofloxacin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is (S)-9-fluoro-2,3-dihydro-3-
methyl-10-(4-methyl-1 -piperazinyl)-7-oxo-7H -pyrido[ 1,2,3-de]-1,4-benzoxazine-6-carboxylic acid. Its structure is:

Levofloxacin is the subject of EP 206283 B (1993), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises levofloxacin covalently attached to a peptide. In the present invention, levofloxacin is covalently attached to the peptide via the carboxylic acid group.
Meropenem
[506] Meropenem is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is (4R,5S,6S)-3-[[(3S,5S)-5-[(dimethylamii\o)carbonyll-3-pyrrolidinyllthiol-6-[(lR)-l-hydroxyethyI)-4-rnediyl-7-oxo-l-azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid. Its structure is:

Meropenem is the subject of EP 126587 B 1995 and EP 256377 B 1992, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises meropenem covalently attached to a peptide- In the present invention, meropenem is covalently attached to the peptide via the carboxylic acid group.
Mitiglinide
[507] Mitiglinide is a known pharmaceutical agent that is used in the
treatment of diabetes. Its chemical name is [2(S)-cis]-octahydro-gamma-oxo-a-(phenylmethyl)-2H-isoindole-2-butanoic acid. Its structure is:

Mitiglinide is the subject of EP 507534 B 1992, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mitiglinide covalently attached to a peptide. In the present invention, mitiglinide is covalently attached to the peptide via the carboxylic acid group.
Montelukast
[508] Montelukast is a known pharmaceutical agent that is used in the
treatment of asthma. Its chemical name is [R-(E)]- l-[[[l-[3-[2-(7-chloro-2-quinolinyl)ethenyl]phenyl]-3-[2-( 1- hydroxy-1-methylethyl)phenyl]propyl]thio]methyl]-cyclopropaneacetic acid. Its structure is:

Montelukast is the subject of U.S. Patent Number 5,565,473, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises montelukast covalently attached to a peptide. In the present invention, montelukast is covalently attached to the peptide via the carboxylic acid group.
Montelukast and Fexofenadine
[509] Montelukast is a known pharmaceutical agent that is used in the
treatment of asthma. Its chemical name is [R-(E)]- l-[[[l-[3-[2-(7-chloro-2-quinolinyl)ethenyl]phenyl]-3-[2-( 1 -hydroxy-1 -methylethyl)phenyl]propyl]thio]methyl]-cyclopropaneacetic acid. Its structure is:

[510] Fexofenadine is a known pharmaceutical agent that is used in the
treatment of seasonal allergic rhinitis. Its chemical name is 4-[l-hydroxy-4-[4-(hydroxydiphenylmethyl)-l-piperidinyl]butyl]-a,a-dimethylbenzeneacetic acid. Its structure is:
The composition of the invention comprises montelukast and fexofenadine covalently attached to a peptide. In the present invention, montelukast and fexofenadine is covalently attached to the peptide via their respective carboxylic acid groups.
Naproxen
[511] Naproxen is a known pharmaceutical agent that is used in the
treatment of pain and arthritis. Its structure is:

The composition of the invention comprises naproxen covalently attached to a peptide. In the present invention, naproxen is covalently attached to the peptide via the carboxylic acid group.
Ofloxacin
[512] Ofloxacin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is 9-fluoro-2,3-dihydro-3-methyl- 10-(4-methyl-1 -piperazinyl)-7-oxo-7H-pyrido[ 1,2,3-de]-l ,4-benzoxazine-6-carboxylic acid. Its structure is:

Ofloxacin is the subject of U.S. Patent Number 4382892, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ofloxacin covalently attached to a peptide. In the present invention, ofloxacin is covalently attached to the peptide via the carboxylic acid group.
Oxaprozin
[513] Oxaprozin is a known pharmaceutical agent that is used in the
treatment of inflammation. Its chemical name is 4,5-diphenyl-2-oxazolepropanoic acid. Its structure is:

Oxaprozin is the subject of GB 1206403 1970, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises oxaprozin covalently attached to a peptide. In the present invention, oxaprozin is covalently attached to the peptide via the carboxylic acid group.
Pemetrexed
[514] Pemetrexed is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is N-[4-[2-(2-amino-4,7-dihydro-4-oxo-lH-pyrrolo[2,3-d]pyrimidin-5-yl)ethyl]benzoyl]-L-glutamic acid. Its structure is:

Pemetrexed is the subject of EP 432677 B (1996), priority US 448742 (1989), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pemetrexed covalently attached to a peptide. In the present invention, pemetrexed is covalently attached to the peptide via the carboxylic acid group.
Penicillin V
[515] Penicillin V is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its structure is:

The composition of the invention comprises penicillin V covalently attached to a peptide. In the present invention, penicillin V is covalently attached to the peptide via the carboxylic acid group.
Piperacillin
[516] Piperacillin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its structure is:

The composition of the invention comprises piperacillin covalently attached to a peptide. In the present invention, piperacillin is covalently attached to the peptide via the carboxylic acid group.
Repaglinide
[517] Repaglinide is a known pharmaceutical agent that is used in the
treatment of diabetes. Its chemical name is (S)-2-ethoxy-4-[2-[[3-methyl-l-[2-(l-piperidinyl) phenyl]butyl]amino]-2-oxoethyl]benzoic acid. Its structure is:

Repaglinide is the subject of EP 589874 B 1999, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises repaglinide covalently attached to a peptide. In the present invention, repaglinide is covalently attached to the peptide via the carboxylic acid group.
Tiagabine
[518] Tiagabine is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its chemical name is (R)-l-[4,4-bis(3-methyl-2-thienyl)-3-butenyl]-3-piperidinecarboxylic acid. Its structure is:

Tiagabine is the subject of U.S. Patent Number 5,010,090 and 5,354,760, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tiagabine covalently attached to a peptide. In the present
invention, tiagabine is covalently attached to the peptide via the carboxylic acid group or any of its hydroxyl groups.
Valproic acid
[519] Valproic acid is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its structure is:

The composition of the invention comprises valproic acid covalently attached to a peptide. In the present invention, valproic acid is covalently attached to the peptide via the carboxylic acid group.
Valsartan
[520] Valsartan is used together in the treatment of hypertension. Its
chemical name is N-(l-oxopentyl)-N-[[2'-(lH-tetrazol-5-yl)[l,l-biphenyl]-4-yl]methyl]-L-valine. Its structure is:

Valsartan is the subject of U.S. Patent Number 5,399,578, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises valsartan covalently attached to a peptide. La the present invention, valsartan is covalently attached to the peptide via the carboxylic acid group.
Zenarestat
[521] Zenarestat is a known pharmaceutical agent that is used in the
treatment of diabetes, retinopathy and neuropathy. Its chemical name is 3-[(4-bromo-2-fluorophenyl)methyl]-7-chloro-3,4-dihydro-2,4-dioxo-l(2H)-quinazolineacetic acid. Its structure is:

Zenarestat is the subject of EP 218999 B 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises zenarestat covalently attached to a peptide. In the present invention, zenarestat is covalently attached to the peptide via the carboxylic acid group.
XII.C - VIA THE HYDROXYL GROUP
[522] The following compounds are preferably attached via a hydroxyl
group.
Acarbose
[523] Acarbose is a known pharmaceutical agent that is used in the
treatment of type II diabetes. Its chemical name is O-4,6-dideoxy-4-[[[lS-(la,4a,5P,6a)]-4,5,6-trihydroxy-3-(hydroxymethyI)-2-cyclohexen-l-yl]amino]-a-D-glucopyranosyl-(l-4)-0-a-D-glucopyranosyl-(l-4)-D-glucose. Its structure is as follows:
In the present invention, acarbose is covalently attached to the peptide via any of the free hydroxyl groups. Acarbose is the subject of U.S. Patent Number 4,904,769, herein incorporated by reference, which describes how to make that drug.
Acetaminophen
[524] Acetaminophen is a known pharmaceutical agent that is used in the
treatment of minor aches and pains. Its chemical name is N-acetyl-p-aminophenol. Acetaminophen is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, acetaminophen is covalently attached to the peptide via its hydroxyl group.
Acetaminophen with Codeine
[525] Acetaminophen is a known pharmaceutical agent that is used in the
treatment of minor aches and pains. Its chemical name is N-acetyl-p-aminophenol. It is often used in combination with codeine, whose chemical name is 7,8-didehydro-4,5-a-epoxy-3-memoxy-17-memylmephorninan-6a-ol. Both are
commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, both acetaminophen and codeine are covalently attached to the peptide via their hydroxyl groups.
Acyclovir
[526] Acyclovir is a known pharmaceutical agent that is an antiviral drug
used in the treatment of herpes simplex viruses. Acyclovir is both commercially available and readily manufactured using public synthetic schemes by those of ordinary skill in the art. Its chemical name is 2-amino-l,9-dihydro-9-[(2-hydroxyethoxy)methyl]-6H-purin-6-one. Its structure is:

In the present invention, acyclovir is covalently attached to the peptide via the hydroxyl group.
Adenosine
[527] Adenosine is a known pharmaceutical agent that is used as a coronary
vasodilator. Its chemical name is 9-a-D-ribofuranosyl-9H-purin-6-amine. Its structure is:
Adenosine is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, adenosine is covalently attached to the peptide via the ribose hydroxyl group.
Amprenavir
[528] Amprenavir, a proteinase inhibitor, is a known pharmaceutical agent
that is used in the treatment of HIV infection. Its chemical name is [3S-3R*(lR*,2S*)]]-[3-[[(4-aminophenyl)sulfonyl](2-methylpropyl)amino] -2-hydroxy-l-(phenyhnethyl)propyl]carbamic acid tetrahydro-3-furanyl ester. Its structure is:

Amprenavir is the subject of U.S. Patent Numbers 5,585,397; 5,646,180; and 5,723,490, herein incorporated by reference, which describes how to make that drug. In the present invention, amprenavir is covalently attached to the peptide via the hydroxyl group.
Antifungal agent
[529] The antifungal agent of the present invention is a known
pharmaceutical agent that is used in the treatment of fungal infections. Its chemical name is 4,5-dihydroxy-N-2-[4-[5-[4-(pentyloxy)phenyl]-3-
isoxazolyl]benzoyl]omithylthreonyl-4-hydroxyprolyl-4-hydroxy-4-[4-hydroxy-3-(sulfoxy)phenyl]threonyl-3-hydroxyglutaminyl-3-hydroxy-4-methylproline cyclic (6- l)-peptide monosodium salt. Its structure is:

An antifungal agent is the subject of WO 96/11210 1996, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises an antifungal agent covalently attached to a peptide. In the present invention, an antifungal agent is covalently attached to the peptide via any of the hydroxyl groups.
Antisense Oligonucleotides
[530] Antisense oligonucleotides are a class of compounds made of RNA
that is complementary to the mRNA that produces a protein of interest. Their usefulness is primarily for gene therapy. Individual uses include those for the treatment of inflammatory bowel diseases. They are made by chemical RNA synthesis or, alternatively, by using a gene construct containing the antisense orientation of the gene of interest and isolating the RNA of interest. In the present
invention, antisense oligonucleotides are covalentiy attached to the peptide via the ribose hydroxyl group.
Abarelix
[531] Abarelix is a known pharmaceutical agent that is used in the
treatment of prostate cancer, acting as a gonadotropin-releasing hormone antagonist. Its chemical name is N-acetyl-3-(2-naphthalenyl)-D-alanyl-4-chloro-D-phenylalanyl-3-(3-pyridinyl)-D-alanyl-L-seryl-N-methyl-L-tyrosyl-D-asparagynyl-L-N-6-(l-methylethyl)-L-lysyl-L-prolyl-D-alaninamide. Abarelix is both
commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is as follows:

In the present invention, abarelix is covalentiy attached to the peptide via the free hydroxyl group.
Atorvastatin
[532] Atorvastatin is a known pharmaceutical agent that is used in the
treatment of high cholesterol. Its chemical name is (PR,5R)-2-(4-fluorophenyl)-P,5-dihydroxy-5-(l-methylethyl)-3-phenyl-4-[(phenylamino)carbonyl]-lH-pyrrole-l-heptanoic acid. Its structure is:

Atorvastatin is the subject of U.S. Patent Numbers 4,681,893; 5,273,995; 5,686,104; and 5,969,156, herein incorporated by reference, which describes how to make that drug. In the present invention, atorvastatin is covalently attached to the peptide via the hydroxyl group.
Atovaquone
[533] Atovaquone is a known pharmaceutical agent that is used in the
prevention of Pneumocystis carinii pneumonia. Its chemical name is 2-[trans-4-(4-chlorophenyl)cyclohexyl]-3-hydroxy-l,4-naphthalenedione. Its structure is:

Atovaquone is the subject of U.S. Patent Numbers 4,981,874 and 5,053,432, herein incorporated by reference, which describes how to make that drug. In the present invention, atovaquone is covalently attached to the peptide via the hydroxyl group.
Azithromycin
[534] Azithromycin is a known pharmaceutical agent that is used in the
treatment of bacterial infections. Its chemical name is
(2R,3S,4R,5R,8R,10R,llR,12S,13S,14R)-13-[(2,6-dideoxy-3-C-methyl-3-O-methyl-a-l-ribohexopyranosyl)oxy]-2-ethyl-3,4,10-trihydroxy-3,5,6,8,10,12-heptarnethyl-ll-[[3,4,6-trideoxy-3-(dimethylamino)P-D-xylo-hexopyranosyl]oxy]-l-oxa-6-azacyclopentadecan-15-one. Its structure is:

Azithromycin is the subject of GB 2094293 B (1985), herein incorporated by reference, which describes how to make that drug. In the present invention, azithromycin is covalently attached to the peptide via any of the hydroxyl groups.
Befloxatone
[535] Befloxatone is a known pharmaceutical agent that is used in smoking
cessation treatment. Its chemical name is (R)-5-(methoxymethyl)-3-[4-[(R)-4,4,4-trifluoro-3-hydroxybutoxy)phenyl]-2-oxazolidinone. Its structure is:

Befloxatone is the subject of EP 424244 B (1995), herein incorporated by reference, which describes how to make that drug. In the present invention, befloxatone is covalently attached to the peptide via the hydroxyl group.
Betamethasone
[536] Betamethasone is a known pharmaceutical agent that is used
principally as an anti-inflammatory or immunosuppressant agent. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, betamethasone is covalently attached to the peptide via any of the hydroxyl groups.
Bicalutamide
[537] Bicalutamide is a known pharmaceutical agent that is used in the
treatment of locally advanced, non-metastatic prostate cancer, in combination with LHRH. Its chemical name is (+,-)-N-[4-cyano-3-(trifluoromethyl)phenyl]-3-[(4-fluorophenyl)sulfonyl]-2-hydroxy-2-methylpropanamide. Its structure is:

Bicalutamide is the subject of U.S. Patent Numbers 4,472,382; 4,636,505; and 5,389,613, herein incorporated by reference, which describes how to make that drug. In the present invention, bicalutamide is covalently attached to the peptide via the hydroxyl group. LHRH may also be attached to the same peptide to provide the two drugs in combination.
Bisoprolol
[538] Bisoprolol is a known pharmaceutical agent that is used for the
treatment of angina, irregular heartbeat, and hypertension. Its structure is:
In the present invention, Bisoprolol is attached to the peptide via the hydroxyl group.
Bosentan
[539] Bosentan is a known pharmaceutical agent that is used in the
treatment of pulmonary hypertension. Its chemical name is 4-(1,1-dimethylethyl)-N-[6-(2-hydroxyethoxy)-5-(2-methoxyphenoxy)-[2,2'-bipyrimidin3-4-
yl]benzenesulfonamide. Its structure is:
Bosentan is the subject of EP 526708 A (1993), herein incorporated by reference, which describes how to make that drug. In the present invention, bosentan is covalently attached to the peptide via the hydroxyl group.
[ Butorphanol
[540] Butorphanol is a known pharmaceutical agent that is used in the
treatment of pain. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, butorphanol is covalently attached to the peptide via the phenyl hydroxyl group.
Calcitriol
[541] Calcitriol is a known pharmaceutical agent that is used in the
treatment of hypocalcemia. Its structure is:

Calcitriol is the subject of U.S. Patent Numbers 4,308,264 and 6,051,567, herein incorporated by reference, which describes how to make that drug. In the present invention, calcitriol is covalently attached to the peptide via any of the hydroxyl groups.
Capecitabine
[542] Capecitabine is a known pharmaceutical agent that is used in the
treatment of colorectal cancer. Its chemical name is pentyl l-(5-deoxy-p-D-riboruranosyl)-5-fluoro-l,2-dihydro-2-oxo-4-pyrimidinecarbamate. Its structure is:

Capecitabine is the subject of U.S. Patent Numbers 4,966,891 and 5,472,949, herein incorporated by reference, which describes how to make that drug. In the present invention, capecitabine is covalently attached to the peptide via any of the hydroxyl groups.
Carbapenem antibiotic
[543] The carbapenem antibiotic of the present invention is a known
pharmaceutical agent that is used in the treatment of bacterial infection. Its chemical name is [4R-[3(R*),4a,5ß,6ß(R*)]]-6-(l-hydroxyethyl)-4-methyl-7-oxo-3-[(5-oxo-3-pyrrolidinyl)thio]-l-azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid (2,2-dimethyl-l-oxopropoxy)methyl ester. Its structure is:

Carbapenem antibiotic is the subject of EP 599512 A (1994), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises carbapenem antibiotic covalently attached to a peptide. In the present
invention, carbapenem antibiotic is covalently attached to the peptide via the hydroxyl group.
Ciclesonide
[544] Ciclesonide is a known pharmaceutical agent that is used in the
treatment of asthma. Its chemical name is [l1ß,16a (R)]-16,17-[(cyclohexyknethylene)bis(oxy)]-ll-hydroxy-21-(2-methyl-l-oxopropoxy)-pregna-l,4-diene-3,20-dione. Its structure is:

Ciclesonide is the subject of GB 2247680 B (1994), based on US Application Number 578942 (1990), herein incorporated by reference, which describes how to make that drug. In the present invention, ciclesonide is covalently attached to the peptide via the hydroxyl group.
Clarithromycin
[545] Clarithromycin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is 6-O-methylerythromycin. Its structure is:
Clarithromycin is the subject of EP 41355 B (1983) and EP 293885 B (1993), and US application number 58499 (1987), herein incorporated by reference, which
describes how to make that drug. In the present invention, clarithromycin is covalently attached to the peptide via any of the hydroxyl groups.
Codeine
[546] Codeine is a known pharmaceutical agent that is used in the treatment
of pain. The composition of the invention comprises codeine covalently attached to a peptide. In the present invention, codeine is covalently attached to the peptide via the hydroxyl group.
Conjugated Estrogens
[547] In women, oral conjugated estrogens USP and synthetic conjugated
estrogens A are used for the management of moderate to severe vasomotor symptoms associated with menopause. Conjugated estrogens USP is a mixture containing the sodium salts of the water-soluble sulfate esters of estrone and equilin derived wholly or in part from equine urine or may be prepared synthetically from estrone and equilin. Conjugated estrogens USP also contains conjugated estrogenic substances of the type excreted by pregnant mares including 17oc-dihydroequilin, 17a-estradiol, 17p%dihydroequilin, equilenin, 17oc-dihydroequilenin, 17p-dihydroequilenin, S8'9-dehydroestrone, and 17(3-estradiol. Conjugated estrogens USP contains 52.5—61.5% sodium estrone sulfate and 22.5—30.5% sodium equilin sulfate. Conjugated estrogens contains, as sodium sulfate conjugates, 13.5—19.5% 17a-dihydroequilin, 2.5—9.5% 17a-estradiol, and 0.5—4% 17ß-dihydroequilin. They are available from natural sources. The structure of estrone is:

In the present invention, conjugated estrogens are covalently attached to the peptide via the hydroxyl groups.
Conjugated Estrogens and Medroxyprogesterone Acetate [548] Conjugated estrogens and medroxyprogesterone acetate are known
pharmaceutical agents used in hormone replacement therapy. In women, oral conjugated estrogens USP and synthetic conjugated estrogens A are used for the management of moderate to severe vasomotor symptoms associated with menopause. Conjugated estrogens USP is a mixture containing the sodium salts of the water-soluble sulfate esters of estrone and equilin derived wholly or in part from equine urine or may be prepared synthetically from estrone and equilin. Conjugated estrogens USP also contains conjugated estrogenic substances of the type excreted by pregnant mares including 17a-dihydroequilin, 17a-estradiol, 17ß-dihydroequilin, equilenin, 17a-dihydroequilenin, 17(3-dihydroequilenin, 88'9-dehydroestrone, and 17p-estradiol. Conjugated estrogens USP contains 52.5—61.5% sodium estrone sulfate and 22.5—30.5% sodium equilin sulfate. Conjugated estrogens contains, as sodium sulfate conjugates, 13.5—19.5% 17a-dihydroequilin, 2.5—9.5% 17a-estradiol, and 0.5—4% 17(3-dihydroequilin. They are available from natural sources. The structure of estrone is:

[549] Medroxyprogesterone acetate is a synthetic progestin.
Medroxyprogesterone acetate is a derivative of 17 a-hydroxyprogesterone that differs structurally by the addition of a 6 a-methyl group and a 17 a-acetate group. Its structure is:
In the present invention, conjugated estrogens and medroxyprogesterone acetate are covalently attached to the peptide via the hydroxyl groups.
Cyclosporine
[550] Cyclosporine is a known pharmaceutical agent that is used in the
treatment of prevention of rejection of kidney, liver or heart allografts. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art.. Its structure is:

In the present invention, cyclosporine is covalently attached to the peptide via the hydroxyl group.
Dapitant
[551] Dapitant is a known pharmaceutical agent that is used in the
treatment of asthma. Its chemical name is [3aS-[2(R*),3a,4P,7a]]-octahydro-4-(2-methoxyphenyl)-2-[2-(2-methoxyphenyl)-l-oxopropyl]-7,7-diphenyl-lH-isoindol-4-ol. Its structure is:

Dapitant is the subject of WO 93/21155 (1993), herein incorporated by reference, which describes how to make that drug. In the present invention, dapitant is covalently attached to the peptide via the hydroxyl group.
Desogestrel and Ethinyl Estradiol
[552] Desogestrel and ethinyl estradiol are known pharmaceutical agents
used together as a contraceptive. Desogestrel,s chemical name is (17a)-13-ethyl-ll-methylene-18,19-dinorpregn-4-en-20-yn-17-ol. Its structure is:

[553] Ethinyl estradiol's chemical name is (17a)-19-norpregna-l,2,5(10)-
trien-20-yne-3,17-diol. Its structure is:
Desogestrel are the subject of GB 1455270 (1976), herein incorporated by reference, which describes how to make that drug. In the present invention, desogestrel and ethinyl estradiol are covalently attached to the peptide via their hydroxyl groups.
Didanosine
[554] Didanosine is a known pharmaceutical agent that is used in the
treatment of HIV. Its chemical name is 2',3'-dideoxyinosine. Its structure is:

Didanosine is the subject of U.S. Patent Numbers 4,861,759 and 5,616,566, herein incorporated by reference, which describes how to make that drug. In the present invention, didanosine is covalently attached to the peptide via the ribose hydroxyl group.
Dihydrocodeine
[555] Dihydrocodeine is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises dihydrocodeine covalently attached to a peptide. In the present invention, dihydrocodeine is covalently attached to the peptide via the hydroxyl group.
Dihydromorphine
[556] Dihydromorphine is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises dihydromorphine covalently attached to a peptide. In the present invention, dihydromorphine is covalently attached to the peptide via the hydroxyl group.
Digoxin
[557] Digoxin is a known pharmaceutical agent that is used in the treatment
of digitalization and maintenance therapy. It is both commercially available and
readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, digoxin is covalently attached to the peptide via any of the hydroxyl groups.
Dipyridamole
[558] Dipyridamole is a known pharmaceutical agent that is used as an
adjunct to coumarin anticoagulants in the prevention of postoperative thromboembolic complications of cardiac valve replacement. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

236
In the present invention, dipyridamole is covalently attached to the peptide via the hydroxyl group.
Docetaxel
[559] Docetaxel is a known pharmaceutical agent that is used in the
treatment of cancer and malaria. Its chemical name is P-[[(l,l-dimethylethoxy)carbonyl]amino]-a-hydroxybenzenepropanoic acid [2aR-[2a,4ß,4ap,6ß,9a (aR*,ßS*)-lla,12a,12aa ,12ba]]-12b-(acetyloxy)-12-(benzoyloxy)-2a,3,4,4a,5,6,9,10,11,12,12a, 12b-dodecahydro-4,6,11 -trihydroxy-4a,8,13,13-tetramethyl-5-oxo-7,ll-methano-lH-cyclodeca[3,4]benz[l,2-b]oxet-9-yl ester. Its structure is:

Docetaxel is the subject of EP 253738 B 1990 and EP 593656 B 1997, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises docetaxel covalently attached to a peptide. In the present invention, docetaxel is covalently attached to the peptide via any of the hydroxyl groups.
Ecopipam
[560] Ecopipam is a known pharmaceutical agent that is used in the
treatment of obesity. Its chemical name is (6aS,13bR)-ll-chloro-6,6a,7,8,9,13b-hexahydro-7-methyl-5H-benzo[d ]naphth[2,l-b]azepin-12-ol. Its structure is:

Ecopipam is the subject of EP 254737 A (1990), priority U.S. application 820471 (1986), herein incorporated by reference, which describes how to make that drug. In the present invention, ecopipam is covalently attached to the peptide via the hydroxyl group.
Erythromycin
[561] Erythromycin is a known pharmaceutical agent that is used in the
treatment of bacterial infections. Its chemical name is (32?*, 45*, 55*, 62?*, 72?*, 9R*, 112?*, 122?*, 135*, 142?*)-4-((2,6-Dideoxy-3-C-memyl-3-0-methyl-a-L- ribo-hexopyranosyl) -oxy) -14- ethyl-7,12,13- trihydroxy - 3,5,7,9,11,13-hexamethyl-6-((3,4,6-trideoxy-3-(dimethylamino)-b-D-xy/o-
hexopyranosyl)oxy)oxacyclotetradecane-2,10-dione. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, erythromycin is covalently attached to the peptide via a hydroxyl group.
Esatenolol
[562] Esatenolol is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is (S)-4-[2-hydroxy-3-[(l-methylethyl)amino] propoxy]benzeneacetamide. Its structure is:

238
Esatenolol is the subject of GB 1285035 (1972), herein incorporated by reference, which describes how to make that drug. In the present invention, esatenolol is covalently attached to the peptide via the hydroxyl group.
Esterified Estrogens and Methyltestosterone
[563] Esterified estrogens and methyltestosterone are known
pharmaceutical agents that are used together in hormone replacement therapy. Esterified estrogens is a mixture of the sodium salts of the sulfate esters of the estrogenic substances, principally estrone, that are of the type excreted in the urine of pregnant mares. Estrone sodium sulfate is the principal active ingredient in esterified estrogens. Esterified estrogens may be derived from natural sources and/or prepared synthetically. The structure of estrone is:

[564] The structure of methyltestosterone is:

In the present invention, esterified estrogens and methyltestosterone are covalently attached to the peptide via their hydroxyl groups.
Estropipate
[565] Estropipate is a known pharmaceutical agent that is used in hormone
replacement therapy. Estropipate is estrone solubilized as the sulfate and stabilized with piperazine. Conjugation of estrone with sulfate at the 3-hydroxy position on ring A of the steroid nucleus results in the formation of a water-soluble derivative; the pharmacologically inert piperazine moiety acts as a buffer to increase the stability and uniform potency of estrone sulfate. The structure of estrone is:

In the present invention, estropipate is covalently attached to the peptide via the hydroxyl group.
Ethinyl estradiol and dogestrel
[566] Ethinyl estradiol and dogestrel are used together as a contraceptive.
Ethinyl estradiol's chemical name is (17a)-19-norpregna-l,2,5(10)-trien-20-yne-3,17-diol. Its structure is:

[567] Desogestrel's chemical name is (17a)-13-ethyl-ll-methylene-18,19-
dinorpregn-4-en-20-yn-17-ol. Its structure is:

The composition of the invention comprises ethinyl estradiol and dogestrel covalently attached to a peptide. In the present invention, ethinyl estradiol and dogestrel is covalently attached to the peptide via the hydroxyl groups.
Ethinyl Estradiol and Norethindrone
[568] Ethinyl estradiol and norethindrone are known pharmaceutical agents
that are used together as a contraceptive. The structure of ethinylestradiol is:

[569] The structure of norethindrone is:

In the present invention, ethinyl estradiol and norethindrone are covalently attached to the peptide via the hydroxyl groups.
Ethinyl Estradiol and Levonorgestrel
[570] Ethinyl estradiol and levonorgestrel are known pharmaceutical agents
that are used together as a contraceptive. Each is isolatable from natural sources, or
alternatively synthesized, by those of skill in the art. In the present invention, ethinyl estradiol and levonorgestrel are covalently attached to the peptide via the hydroxyl groups.
Ethinyl Estradiol and Norethindrone
[571] Ethinyl estradiol and norethindrone 28 are known pharmaceutical
agents that are used together as a contraceptive. Each is isolatable from natural sources, or alternatively synthesized, by those of skill in the art. In the present invention, ethinyl estradiol and norethindrone 28 are covalently attached to the peptide via the hydroxyl groups.
Ethinyl Estradiol and Norgestimate
[572] Ethinyl estradiol and norgestimate are known pharmaceutical agents
that are used together as a contraceptive. Each is isolatable from natural sources, or alternatively synthesized, by those of skill in the art. In the present invention, ethinyl estradiol and norgestimate are covalently attached to the peptide via the hydroxyl groups.
Ethinyl Estradiol and Norgestrel
[573] Ethinyl estradiol and norgestrel are known pharmaceutical agents that
are used together as a contraceptive. Each is isolatable from natural sources, or alternatively synthesized, by those of skill in the art. In the present invention, ethinyl estradiol and norgestrel are covalently attached to the peptide via the hydroxyl groups.
Ethylmorphine
[574] Ethylmorphine is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises ethylmorphine covalently attached to a peptide. In the present invention, ethylmorphine is covalently attached to the peptide via the hydroxyl group.
Etidronate
[575] Etidronate is a known pharmaceutical agent that is used in the
treatment of moderate to severe symptomatic Paget's disease of bone (osteitis deformans). It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, etidronate is covalently attached to the peptide via the alcohol group.
Fenretinide
[576] Fenretinide is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is N-(4-hydroxyphenyl)retinamide. Its structure is:
Fenretinide is the subject of GB 1543824 (1979) - based on priority US application 628177 (1975), US 4,323,581 (1982), and US 4,665,098 (1987), herein
incorporated by reference, which describes how to make that drug. In the present invention, fenretinide is covalently attached to the peptide via the hydroxyl group.
Fluconazole
[577] Fluconazole is a known pharmaceutical agent that is used in the
treatment of fungal infections. Its chemical name is alpha-(2,4-difluorophenyl)-a-(lH-l,2,4-triazol-l-ylmethyl)-lH-l,2,4-triazole-l-ethanol. Its structure is:

Fluconazole is the subject of U.S. Patent Numbers 4,404,216 and 4,416,682, herein incorporated by reference, which describes how to make that drug. In the present invention, fluconazole is covalently attached to the peptide via the hydroxyl group.
Fluticasone
[578] Fluticasone is a known pharmaceutical agent that is used in the
treatment of dermatitis, rhinitis, asthma, pulmonary obstructive disease and skin disease. Its chemical name is (6a,l1ß,16a,17a)-6,9-difluoro-11-hydroxy-16-methyl-3-oxo-l 7-(l-oxopropoxy)-androsta-l,4-diene-17-carbothioic acid, S-(fluoromethyl) ester. Its structure is:

Fluticasone is the subject of GB 2088877 B 1984, herein incorporated by reference, which describes how to make that drug. The composition of the invention
comprises fluticasone covalently attached to a peptide. In the present invention, fluticasone is covalently attached to the peptide via the hydroxyl group.
Formoterol
[579] Formoterol is a known pharmaceutical agent that is used in the
treatment of asthma. Its chemical name is l-N-[2-hydroxy-5-[(lR)-l-hydroxy-2-[[(lR)-2-(4-methoxypheny)-l-methylethyl]amino]ethyl]phenyl]formamide. Its
structure is:

Formoterol is the subject of GB 1415256 (1975), herein incorporated by reference, which describes how to make that drug, hi the present invention, formoterol is covalently attached to the peptide via any of the hydroxyl groups.
Ganaxolone
[580] Ganaxolone is a known pharmaceutical agent that is used in the
treatment of epilepsy and migraine. Its chemical name is (3a,5a)-3-hydroxy-3-methyl-pregnan-20-one. Its structure is:

Ganaxolone is the subject of DE 2162555 A (1972), WO 93/3732 (1993) - based on priority US application 745216 (1991), WO 93/5786 1993 - based on priority US application 759512 (1991), and WO 94/27608 (1994) - based on priority US application 68378 (1993), herein incorporated by reference, which describes how to
make that drug. In the present invention, ganaxolone is covalently attached to the peptide via the hydroxyl group.
Ganciclovir
[581] Ganciclovir is a known pharmaceutical agent that is used in the
treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients, including patients with acquired immunodeficiency syndrome (AIDS). It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

Ganciclovir is the subject of U.S. Patent Numbers 4,355,032; 4,423,050; 4,507,305; and 4,642,346, herein incorporated by reference, which describes how to make that drug. In the present invention, ganciclovir is covalently attached to the peptide via any of the hydroxyl groups.
Gastroprokinetic compound
[582] The gastroprokinetic compound of the present invention is a known
pharmaceutical agent that is used in the treatment of gastrointestinal motility disease. Its chemical name is 8,9-didehydro-N-demethyl-9-deoxo-6,l l-dideoxy-6,9-epoxy-12-O-methyl-N-(l-methylethyl)-11-oxoerythromycin (E)-2-butenedioate (2:1). Its structure is:
A gastroprokinetic compound is the subject of EP 643068 A 1995, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises a gastroprokinetic compound covalently attached to a peptide. In the present invention, a gastroprokinetic compound is covalently attached to the peptide via any of the hydroxyl groups.
-Haloperidal
[583] Haloperidal is a known pharmaceutical agent that is used in the
treatment of psychotic disorders. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, haloperidal is covalently attached to the peptide via the hydroxyl group.
Heparin
[584] Heparin is a known pharmaceutical agent that is used in the treatment
of blood clots. Heparin is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans having anticoagulant properties. Although others may be present, the main sugars occurring in heparin are:
(1) a-L-iduronic acid 2-sulfate,
(2) 2-deoxy-2-sulfamino-a-D-glucose 6-sulfate,
(3) b-D-glucuronic acid,
(4) 2-acetamido-2-deoxy-a-D-glucose, and
(5) a-L-iduronic acid.
The composition of the invention comprises heparin covalently attached to a peptide. In the present invention, heparin is covalently attached to the peptide via the hydroxyl group.
Hydromorphone
[585] Hydromorphone is a known pharmaceutical agent that is used in the
treatment of cough and pain. Its structure is:

The composition of the invention comprises hydromorphone covalently attached to a peptide. In the present invention, hydromorphone is covalently attached to the peptide via the hydroxyl group.
Hydroxychloroquine Sulfate
[586] Hydroxychloroquine Sulfate is a known pharmaceutical agent that is
used in the treatment of malaria. Its structure is:
In the present invention, hydroxychloroquine Sulfate is covalently attached to the peptide via the hydroxyl group.
Indinavir
[587] Indinavir is a known pharmaceutical agent that is used in the
treatment of HIV infection Its chemical name is 2,3,5-trideoxy-N-[(lS,2R)-2,3-dihydro-2-hydroxy-lH-inden-l-yl]-5-[(2S)-2-[[(l,l-dimethylethyl)amino]carbonyl]-4-(3-pyridinylmemyl)-l-piperazinyl]-2-(phenylmethyl)-D-erythro-pentonamide. Its structure is:

Indinavir is the subject of EP 541168 B (1998), based on priority application US 789508 (1991), and U.S. Patent Number 5,413,999, herein incorporated by reference, which describes how to make that drug. In the present invention, indinavir is covalently attached to the peptide via any of the hydroxyl groups.
Inositol and D-Chiroinositol
[588] Inositol and D-chiroinositol are nutritional supplements. They are
both commercially available. The structure of inositol is:

In the present invention, inositol or D-chiroinositol is attached to the peptide via any of the hydroxyl groups.
lodixanol
[589] lodixanol is a known pharmaceutical agent that is used as a contrast
medium for medical imaging. Its chemical name is 5,5'-[(2-hydroxy-l,3-
propanediyl)bis(acetylamino)]bis[N,N'-bis(2,3-dihydroxypropyl)-2,4,6-triodo-l,3-benzenedicarboxamide]. Its structure is:

lodixanol is the subject of U.S. Patent Number 5,349,085, herein incorporated by reference, which describes how to make that drug. In the present invention, iodixanol is covalently attached to the peptide via any of the hydroxyl groups.
Iopromide
[590] Iopromide is a known pharmaceutical agent that is used as an X-ray
contrast medium. Its chemical name is N,N'-bis(2,3-dihydroxypropyl)-2,4,6-triiodo-5-[(2-methoxyacetyl)amino]-N-methyl-l,3-benzenedicarboxamide. Its structure is:

Iopromide is the subject of U.S. Patent Number 4,364,921, herein incorporated by reference, which describes how to make that drug. In the present invention, iopromide is covalently attached to the peptide via the hydroxyl group.
Ioxaglate
[591] Ioxaglate is a known pharmaceutical agent that is used as a
radiopaque contrast aide. It is usually used as a combination of Ioxaglate
meglumine and Ioxaglate sodium. Both units can be attached to a peptide carrier. In
the present invention, ioxaglate is covalently attached to the peptide via the hydroxyl
group.
Ipratropium
[592] Ipratropium is used as a bronchodilator for the long-term
symptomatic treatment of reversible bronchospasm associated with chronic obstructive pulmonary disease (COPD). Its structure is:

In the present invention, ipratropium is covalently attached to the peptide via the hydroxyl group.
Irinotecan
[593] Irinotecan is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is [l,4'-bipiperidine]-l'-carboxylic acid (S)-4,1 l-diethyl-3,4,12,14-tetrahydro-4-hydroxy-3,14-dioxo-lH-pyrano[3\4':6,7]indolizino[l,2-b]quinolin-9-yl ester. Its structure is:

Irinotecan is the subject of U.S. Patent Number 4,604,463, herein incorporated by reference, which describes how to make that drug. In the present invention, irinotecan is covalently attached to the peptide via the hydroxyl group.
Ketolide Antibiotic
[594] The ketolide antibiotic of the present invention is a known
pharmaceutical agent that is used in the treatment of bacterial infection. Its chemical nameis(3aS,4R,7R,9R,10R,UR)13R,15R,15aR)-4-ethyloctahydro-3a,7,9,ll,13,15-hexamethyl-ll-[[3-(3-quinolinyl)-2-propenyl]oxy]-10-[[3,4,6-trideoxy-3-(dimethylamino)-P-D-xylo-hexopyranosyl]oxy]-2H-oxacyclotetradecino[4,3-d]oxazole-2,6,8,14(lH,7H,9H)~tetrone. Its structure is:

A ketolide antibiotic is the subject of WO 98/9978 (1998), priority US 707776 (1996), herein incorporated by reference, which describes how to make that drug. In the present invention, the ketolide antibiotic is covalently attached to the peptide via the hydroxyl group.
Lamivudine
[595] Lamivudine is a known pharmaceutical agent that is used in the
treatment of hepatitis, viral infection and HIV infection. Its chemical name is (2R-cis)1H-amino-l-[2-(hydroxymethyl)-l,3-oxatWolan-5-yl]-2(lH)-pyrimidinone. Its structure is:
Lamivudine is the subject of U.S. Patent Numbers 5,047,407 and 5,905,082, herein incorporated by reference, which describes how to make that drug. In the present invention, lamivudine is covalently attached to the peptide via the hydroxyl group.
Lamivudine and Zidovudine
[596] Lamivudine is a known pharmaceutical agent that is used in the
treatment of hepatitis, viral infection and HTV infection. Its chemical name is (2R-cis)-4-amino-l-[2-(hydroxymethyl)-l,3-oxathiolan-5-yl]-2(lH)-pyrirnidinone. Its structure is:
[597] Zidovudine has the chemical name 3'-azido-3'-deoxythymidine. Its
structure is:
The two drugs together are used as a fixed-dose combination tablet comprising the reverse transcriptase inhibitors lamivudine and zidovudine for the treatment of HIV infection. Lamivudine is the subject of U.S. Patent Numbers 5,047,407 and 5,905,082, herein incorporated by reference, which describes how to make that drug. Zidovudine is covered by EP 196185 B (1989). The combination is covered by the following U.S. patents, which are hereby incorporated by reference:4,724,232, 4,818,538,4,828,838, 4,833,130,4,837,208 and 6,113,920. In the present invention, lamivudine and zidovudine are covalently attached to the peptide via the hydroxyl group on each.
Leuprolide acetate
[598] Leuprolide acetate is a known pharmaceutical agent that is used in the
treatment of cancer and endometriosis. Its chemical name is 6-D-leucine-9-(N-ethyl-L-prolinamide)-10-deglycinamide luteinizing hormone-releasing factor (swine). Its structure is:
Leuprolide acetate is the subject of U.S. Patent Numbers 5716640, 5643607 and 5631021, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises leuprolide acetate covalently attached to
a peptide. In the present invention, leuprolide acetate is covalently attached to the peptide via the hydroxyl group.
Loperamide
[599] Loperamide is a known pharmaceutical agent that is used in the
treatment of diarrhea and ophthalmic pain. Its chemical name is 4-(4-chlorophenyl)-4-hydroxy-N,N-dimethyl-a,a-diphenyl-l-piperidinebutanamide. Its structure is:

Loperamide is the subject of GB 1319040 (1973), priority US 42530 (1970), EP 523847 B (1996), priority US 715949 (1991), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises loperamide covalently attached to a peptide. In the present invention, loperamide is covalently attached to the peptide via the hydroxyl group.
Lorazepam
[600] Lorazepam is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its structure is:

The composition of the invention comprises lorazepam covalently attached to a peptide. In the present invention, lorazepam is covalently attached to the peptide via the hydroxyl group.
Losartan
[601] Losartan is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is 2-butyl-4-chloro-l-[[2'-(lH-
tetrazol-5-yl)[l,l'-biphenyl]-4-yl]methyl] -lH-imidazole-5-methanol. Its structure
is:

Losartan is the subject of U.S. Patent Number 5,138,069 and 5,153,197, herein incorporated by reference, which describes how to make that drug. In the present invention, losartan is covalently attached to the peptide via the hydroxyl group.
Lovastatin
[602] Lovastatin is a known pharmaceutical agent that is used in the
treatment of hyperlipidemia and cancer. Its chemical name is (S)-2-methylbutyric acid, 8-ester with (4R,6R)-6-[2-[(lS,2S,6R,8S,8aR)-l,2,6,7,8,8a-hexahydro-8-hydroxy-2,6-dimethyl-l-naphthyl]ethyl]tetrahydro-4-hydroxy-2H-pyran-2-one. Its structure is:
Lovastatin is the subject of U.S. Patent Number 4,231,938, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises lovastatin covalently attached to a peptide. In the present invention, lovastatin is covalently attached to the peptide via the hydroxyl group.
Marimastat
[603] Marimastat is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is (2S,3R)-N4-[(lR)-2,2-dimethyl-l-
[(methylamino)carbonyl]propyl]-Nl,,2-dihydroxy-3-(2-
methylpropyl)butanediamide. Its structure is:

Marimastat is the subject of WO 94/2447 1994 and WO 96/25156 1996, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises marimastat covalently attached to a peptide. In the
present invention, marimastat is covalently attached to the peptide via the hydroxyl group.
Methyldihydromorphinone
[604] Methyldihydromorphinone is a known pharmaceutical agent that is
used in the treatment of pain. The composition of the invention comprises methyldihydromorphinone covalently attached to a peptide. In the present invention, methyldihydromorphinone is covalently attached to the peptide via the hydroxyl group.
Methylprednisolone
[605] Methylprednisolone and its derivatives are used principally as anti-
inflammatory or immunosuppressant agents. Because methylprednisolone has only minimal mineralocorticoid properties, the drug is inadequate alone for the management of adrenocortical insufficiency. If methylprednisolone is used in the treatment of this condition, concomitant therapy with a mineralocorticoid is also required. Methylprednisolone, a steroid, is a known pharmaceutical agent that is also used in the treatment of spinal cord injuries. Its chemical name is 11,17,21-trihydroxy-6-methyl-,(6a, ll|3)-pregna-l,4-diene-3,20-dione. Its structure is:

The composition of the invention comprises methylprednisone covalently attached to a peptide. In the present invention, methylprednisone is covalently attached to the peptide via any of the hydroxyl groups.
Metronidazole
[606] Metronidazole is used orally in the treatment of symptomatic and
asymptomatic trichomoniasis. Its structure is:

The composition of the invention comprises metronidazole covalently attached to a peptide. In the present invention, metronidazole is covalently attached to the peptide via the hydroxyl group.
Minocycline
[607] Minocycline is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is 4,7-bis(dimethylamino)-l,4,4a,5,5a,6,ll,12a-octahydro-3,10,12,12a tetrahydroxy-l,ll-dioxo-2-
naphthacenecarboxamide. Its structure is:

Minocycline is the subject of GB 1003474, priority US 147137 1961, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises minocycline covalently attached to a peptide. In the present invention, minocycline is covalently attached to the peptide via any of the hydroxyl groups.
Misoprostol
[608] Misoprostol is a known pharmaceutical agent that is used in the
treatment of gastrointestinal ulcer, allergy and labor induction. Its chemical name is (1 la,13E)-(+,-)-ll,16-dihydroxy-16-methyl-9-oxoprost-13-en-l-oic acid methyl ester. Its structure is:

Misoprostol is the subject of GB 1492426 1974, priority US 454913 1974, US 5252602 1993, US 4301146, and EP 527887 B 1995, priority US 518353 1990, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises misoprostol covalently attached to a peptide. In the present invention, misoprostol is covalently attached to the peptide via the hydroxyl group.
Mitoxantrone
[609] Mitoxantrone is a known pharmaceutical agent that is used in the
treatment of cancer and multiple sclerosis. Its chemical name is l,4-dihydroxy-5,8-bis[[2-[(2-hydroxyethyl)amino]ethyl]amino]-9,10-anthracenedione. Its structure is:

Mitoxantrone is the subject of U.S. Patent Number 4,278,689 and 4,820,738, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mitoxantrone covalently attached to a peptide. In the present invention, mitoxantrone is covalently attached to the peptide via any of the hydroxyl groups.
Morphine
[610] Morphine is a known pharmaceutical agent that is used in the
treatment of pain. Its structure is:

The composition of the invention comprises morphine covalently attached to a peptide. In the present invention, morphine is covalently attached to the peptide via any of the hydroxyl groups.
Mycophenylate mofetil
[611] Mycophenylate mofetil is a known pharmaceutical agent that is used
in the treatment of transplant rejection, rheumatoid arthritis, asthma restenosis, kidney disease, systemic lupus and erythematosus. Its chemical name is (4E)-6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuran yl)-4-methyl-4-hexenoic acid 2-(4-morpholinyl)ethyl ester. Its structure is:

Mycophenylate mofetil is the subject of EP 281713 B 1991, priority US 8717 1987, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mycophenylate mofetil covalently attached to a peptide. In the present invention, mycophenylate mofetil is covalently attached to the peptide via the hydroxyl group.
Naltrexone
[612] Naltrexone is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises naltrexone covalently attached to a peptide. In the present invention, naltrexone is covalently attached to the peptide via the hydroxyl group.
Nelfinavir mesylate
[613] Nelfinavir mesylate is a known pharmaceutical agent that is used in
the treatment of HIV infection. Its chemical name is [3S-[2(2S*,3S*),3a,4ap\8aß]]-N-( 1,1 -dimethylethyl)decahydro-2-[2-hydroxy-3- [(3-hydroxy-2-
methylbenzoyl)amino]-4-(phenylthio)butyl]-3-isoquinolinecarboxamide. Its
structure is:
Nelfmavir mesylate is the subject of U.S. Patent Number 5,484,926 and 5,952,343, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nelfinavir mesylate covalently attached to a peptide. In the present invention, nelfinavir mesylate is covalently attached to the peptide via the hydroxyl group.
Norethindrone acetate
[614] Norethindrone acetate is used for the treatment of secondary
amenorrhea and for the treatment of abnormal uterine bleeding caused by hormonal
imbalance in patients without underlying organic pathology such as fibroids or
uterine cancer. The drug also is used for the treatment of endometriosis. Its structure
is:
The composition of the invention comprises norethindrone covalently attached to a peptide. In the present invention, norethindrone is covalently attached to the peptide via the hydroxyl group.
Orally active carbohydrate
[615] The orally active carbohydrate of the present invention is a known
pharmaceutical agent that is used in the treatment of gastrointestinal ulcer. It is a natural product isolated from human breast milk, as disclosed in U.S. Patent Number 5,514,660, which is incorporated herein by reference. The composition of the invention comprises an orally active carbohydrate covalently attached to a peptide. In the present invention, an orally active carbohydrate is covalently attached to the peptide via any of the hydroxyl groups.
Oxazepam
[616] Oxazepam is a known pharmaceutical agent that is used in the
treatment of anxiety. Its structure is:

The composition of the invention comprises oxazepam covalently attached to a peptide. In the present invention, oxazepam is covalently attached to the peptide via the hydroxyl group.
Oxybutynin chloride
[617] Oxybutynin chloride is used as an antispasmodic in patients with
uninhibited neurogenic or reflex neurogenic bladder for the relief of symptoms associated with voiding, such as urgency, urge incontinence, frequency, nocturia, and incontinence. Its structure is:

Oxybutynin chloride is the subject of U.S. Patent Numbers 4,519,801; 4,612,008; 4,783,337; 5,082,668; 5,674,895; 5,840,754; and 5,912,268, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises Oxybutynin chloride covalently attached to a peptide. In the present invention, Oxybutynin chloride is covalently attached to the peptide via the hydroxyl group.
Oxymorphone
[618] Oxymorphone is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises oxymorphone covalently attached to a peptide. In the present invention, oxymorphone is covalently attached to the peptide via hydroxyl group.
Paclitaxel
[619] Paclitaxel is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is [2aR[2aß,40,4aß,6|3,9a(aR*,ßs*),
1 lß,12a,12aa,12ba]]-ß-(benzoylamino)-ß-hydroxybenzenpropanoic acid 6,12b-
bis(acetyloxy)-12-(benzoyloxy)-2a,3,4,4a,5,6,9,10,n,12,12a,12b-dodecahydro-
4,n-dihydroxy-4a,8>13,13-tetramethyl-5-oxo-7,ll-methano-lH-
cyclodeca[3,4]benz[l,2-b]oxet-9-yl ester. Its structure is:

Paclitaxel is the subject of EP 584001 B 1997 (priority US 923628 1992), EP 645145 B 1997 (priority US 128026 1993), and EP 717041 A 1996 (priority US 355125 1994), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises paclitaxel covalently attached to a peptide. In the present invention, paclitaxel is covalently attached to the peptide via any of the hydroxyl groups.
Paricalcitrol
[620] Paricalcitrol is a known pharmaceutical agent that is used in the
treatment of hyperparathyroidism. Its chemical name is (l,3ß,7E,22E)-19-nor-9,10-secoergosta-5,7,22-triene-l,3,25-triol. Its structure is:

Paricalcitrol is the subject of U.S. Patent Number 5,246,925 and 5,587,497, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises paricalcitrol covalently attached to a peptide. In the present invention, paricalcitrol is covalently attached to the peptide via any of the hydroxyl groups.
Phytoseterol
[621] Phytoseterol is a plant-derived product with potential for the
treatment and prevention of hypercholesterolemia. The product comprises a mixture of four phytosterols and is thought to act by competing with dietary cholesterol for absorption in the intestine. The composition of the invention comprises phytoseterol covalently attached to a peptide. In the present invention, the active agent is covalently attached to the peptide via the hydroxyl group.
Poloxamer 188
[622] Poloxamer 188 is a known pharmaceutical agent that is used in the
treatment of thrombosis, sickle cell anemia, and respiratory distress syndrome. Its chemical name is methyloxirane, block polymer with oxirane. Poloxamer 188 is the subject of U.S. Patent Number 5,523,492, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises
poloxamer 188 covalently attached to a peptide. In the present invention, poloxamer 188 is covalently attached to the peptide via the hydroxyl group.
Posaconazole
[623] Posaconazole is a known pharmaceutical agent that is used in the
treatment of mycosis. Its chemical name is 2,5-anhydro-l,3.4-trideoxy-2-C-(2,4-difluorophenyl)-4-[[4-[4-[4-[l-[(lS,2S)-l-ethyl-2-hydroxypropyl]-l,5-dihydro-5-oxo-4H-l,2,4-triazol-4-yl]phenyl]-l-piperazinyl]phenoxy]methyl]-l-(lH-l,2,4-triazol-l-yl)-D-threo-pentitol. Its structure is:

Posaconazole is the subject of WO 95/17407 1995, priority US 171083 1993, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises posaconazole covalently attached to a peptide. In the present invention, posaconazole is covalently attached to the peptide via the hydroxyl group.
Prednisone
[624] Prednisone is usually considered the oral glucocorticoid of choice for
anti-inflammatory or immunosuppressant effects. Its structure is:

The composition of the invention comprises prednisone covalently attached to a peptide. In the present invention, prednisone is covalently attached to the peptide via any of the hydroxyl groups.
Prinomastat
[625] Prinomastat is a known pharmaceutical agent that is used in the
treatment of cancer and retinopathy. Its chemical name is (3S)-N-hydroxy-2,2-dimethyl-4-[[4-(4-pyridinyloxy)phenyl]sulfonyl]-3-thiomorpholinecarboxamide. Its structure is:

Prinomastat is the subject of U.S. Patent Number 5,753,653, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises prinomastat covalently attached to a peptide. In the present invention, prinomastat is covalently attached to the peptide via the hydroxyl group.
Propofol
[626] Propofol is a known pharmaceutical agent that is used as an
anesthetic. Its chemical name is 2,6-diisopropylphenol. As part of the present
invention, it is provided as a sustained release oral version of the anesthetic with decreased toxicity and increased patient compliance. The composition of the invention comprises propofol covalently attached to a peptide. In the present invention, propofol is covalently attached to the peptide via the hydroxyl group.
Quetiapine fumarate
[627] Quetiapine fumarate is a known pharmaceutical agent that is used in
the treatment of schizophrenia. Its chemical name is 2-[2-(4-
dibenzo[b,f][l,4]thiazepin-ll-yl-l-piperazinyl)ethoxy]ethanol. Its structure is:

Quetiapine fumarate is the subject of EP 240228 B 1990 and 4879288, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises quetiapine fumarate covalently attached to a peptide. In the present invention, quetiapine fumarate is covalently attached to the peptide via the hydroxyl group.
Raloxifene
[628] Raloxifene is a known pharmaceutical agent that is used in the
treatment of osteoporosis and cancer. Its chemical name is [6-hydroxy-2-(4-hydroxyphenyl) benzo[b]thien-3-yl][4-[2-(l-piperidinyl)ethoxy]phenyl]methanone. Its structure is:
271
Raloxifene is the subject of U.S. Patent Numbers 4,418,068; 5,393,763; 5,457,117; 5,466,810; 5,478,847; 5,514,826; 5,569,772; 5,629,425; 5,641,790; 5,659,087; 5,710,285; 5,731,327; 5,731,342; 5,747,510; 5,808,061; 5,811,120; 5,843,984; and 5,972,383, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises raloxifene covalently attached to a peptide. In the present invention, raloxifene is covalently attached to the peptide via any of the hydroxyl groups.
Ranolazine
[629] Ranolazine is a known pharmaceutical agent that is used in the
treatment of angina and peripheral vascular disease. Its chemical name is (+,-)-N-(2,6-dimethylphenyl)-4-[2-hydroxy-3-(2-methoxyphenoxy)propyl]-l-piperazineacetamide. Its structure is:

Ranolazine is the subject of EP 126449 B 1987, priority US 495904 1983, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ranolazine covalently attached to a peptide. In the present invention, ranolazine is covalently attached to the peptide via the hydroxyl group.
Ribavirin
[630] Ribavirin is used via nasal and oral inhalation for the treatment of
severe lower respiratory tract infections (i.e., bronchiolitis, pneumonia) caused by respiratory syncytial virus (RSV) in hospitalized infants and young children. Its structure is:
The composition of the invention comprises ribavirin covalently attached to a peptide. In the present invention, ribavirin is covalently attached to the peptide via any of the hydroxyl groups.
Ritonavir
[631] Ritonavir is a known pharmaceutical agent that is used in the
treatment of HTV infection. Its chemical name is [5S-(5R*,8R*,1OR*,11R*)]- 10-Hydroxy-2-methyl-5-(l-methylethyl)-l-[2-(l-methylethyl)-4-thiazolyl]-3,6-dioxo-

8,1 l-bis(phenylmethyl)-2,4,7.12-tetraazatridecan-13-oic acid, 5-thiazolylmethyl ester. Its structure is:

Ritonavir is the subject of U.S. Patent Number 5,484,801; 5,541,206; 5,635,523; 5,648,497; 5,674,882; 5,846,987; 5,886,036; and 6,037,157, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ritonavir covalently attached to a peptide. In the present invention, ritonavir is covalently attached to the peptide via the hydroxyl group.
Rocuronium
[632] Rocuronium is a known pharmaceutical agent that is used as muscle
relaxant and neuromuscular blocker. Its chemical name is l-[(2|3,3a,5a,16ß,17ßV)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl]-l-(2-propenyl)pyrrolidinium bromide. Its structure is:

Rocuronium is the subject of U.S. Patent Number 4,894,369, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rocuronium covalently attached to a peptide. In the present invention, rocuronium is covalently attached to the peptide via the hydroxyl group.
Rubitecan
[633] Rubitecan is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is (4S)-4-ethyl-4-hydroxy-10-nitro-lH-pyrano[3',4':6,7]indolizino[l,2-b]quinoline-3,14(4H,12H)-dione. Its structure is:

Rubitecan is the subject of JP 91/12069 1991, US 5,922,877 1999 and WO 99/30684 1999 (priority US 989281 1997), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rubitecan covalently attached to a peptide. In the present invention, rubitecan is covalently attached to the peptide via the hydroxyl group.
Saquinavir
[634] Saquinavir is a known pharmaceutical agent that is used in the
treatment of HIV infection. Its chemical name is [3S-
[2[lR*(R*),2S*],3a,4a(3,8a|3]]-Nl-[3-[3-[[(l,l-
dimethylethyl)amino]carbonyl]octahydro-2(lH)-isoquinolinyl]-2-hydroxy-l-(phenylmethyl)propyl]-2-[(2-quinolinylcarbonyl)amino]butanediamide. Its structure is:

Saquinavir is the subject of U.S. Patent Number 5,196,438, herein incorporated by reference, which describes how to make that drug. The composition of the invention
comprises saquinavir covalently attached to a peptide. In the present invention, saquinavir is covalently attached to the peptide via the hydroxyl group.
Simvastatin
[635] Simvastatin is a known pharmaceutical agent that is used in the
treatment of hyperlipidemia and osteoporosis. Its chemical name is 2,2-dimethylbutanoicacid[lS-[la,3a,7p,8p(2S*,4S*)8a|5]]-l,2,3,7,8,8a-hexahydro-3,7-dimethyl-8-[2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl]-l-naphthalenyl ester. Its structure is:
Simvastatin is the subject of U.S. Patent Number 4,444,784, RE36481 and RE36520, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises simvastatin covalently attached to a peptide. In the present invention, simvastatin is covalently attached to the peptide via the hydroxyl group.
Sotalol
[636] Sotalol is a known pharmaceutical agent that is used in the treatment
of arrhythmia. Its chemical name is N-[4-[l-hydroxy-2-[(l-
methylethyl)amino]ethyl]phenyl]methanesulfonamide. Its structure is:

Sotalol is the subject of GB 993584 1965, priority US 168498 1962, and EP 127435 B 1991, priority US 497368 1983, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sotalol covalently attached to a peptide. In the present invention, sotalol is covalently attached to the peptide via the hydroxyl group.
Stavudine
[637] Stavudine is a known pharmaceutical agent that is used in the
treatment of HIV infection. Its chemical name is 2',3'-didehydro-3'-deoxythymidine. Its structure is:

Stavudine is the subject of U.S. Patent Number 4,978,655, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises stavudine covalently attached to a peptide. In the present invention, stavudine is covalently attached to the peptide via the hydroxyl group.
Temazepam
[638] Temazepam is a known pharmaceutical agent that is used in the
treatment of insomnia. Its structure is:

The composition of the invention comprises temazepam covalently attached to a peptide. In the present invention, temazepam is covalently attached to the peptide via the hydroxyl group.
Tepoxalin
[639] Tepoxalin is a known pharmaceutical agent that is used in the
treatment of asthma, inflammation, and inflammatory bowel disease. Its chemical name is 5-(4-chlorophenyl)-N-hydroxy-l-(4-methoxyphenyl)-N-methyl-lH-pyrazole-3-propanamide. Its structure is:

Tepoxalin is the subject of EP 248594 B 1987, priority US 867996 1986, herein incorporated by reference, which describes how to make that drug. The composition
of the invention comprises tepoxalin covalently attached to a peptide. In the present invention, tepoxalin is covalently attached to the peptide via the hydroxyl group.
Terbutaline sulfate
[640] Terbutaline sulfate is a known pharmaceutical agent that is used in
the treatment of asthma and bronchitis. Its structure is:

The composition of the invention comprises terbutaline sulfate covalently attached to a peptide. In the present invention, terbutaline sulfate is covalently attached to the peptide via any of the hydroxyl groups.
Tetracycline
[641] Tetracycline is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its structure is:

The composition of the invention comprises tetracycline covalently attached to a peptide. In the present invention, tetracycline is covalently attached to the peptide via any of the hydroxyl groups.
Tolterodine
[642] Tolterodine is a known pharmaceutical agent that is used in the
treatment of urinary incontinence. Its chemical name is (R)-2-[3-[bis(l-methylethyl)amino]-l-phenylpropyl]-4-methyl-phenol. Its structure is:

Tolterodine is the subject of U.S. Patent Numbers 5,382,600 and 5,559,269, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tolterodine covalently attached to a peptide. In the present invention, tolterodine is covalently attached to the peptide via the hydroxyl group.
Topotecan
[643] Topotecan is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is (S)-10-[(dimethylamino)methyl]-4-ethyl-4,9-dihydroxy-lH-pyrano[3',4':t6,7]indolizino[l,2-b]quinoline-3,14(4H,12H)-dione. Its structure is:
Topotecan is the subject of EP 321122 A 1989, priority US 127148 1987, herein incorporated by reference, which describes how to make that drug. The composition
of the invention comprises topotecan covalently attached to a peptide. In the present invention, topotecan is covalently attached to the peptide via any of the hydroxyl groups.
Tramadol
[644] Tramadol is a known pharmaceutical agent that is used in the
treatment of pain. Its structure is:

The composition of the invention comprises tramadol covalently attached to a peptide. In the present invention, tramadol is covalently attached to the peptide via the hydroxyl group.
Troglitazone
[645] Troglitazone is a known pharmaceutical agent that is used in the
treatment of diabetes. Its chemical name is 5-[[4-[(3,4-dihydro-6-hydroxy-2,5,7,8-tetramethyl-2H-l-benzopyran-2-yl)methoxy]phenyl]methyl]-2,4-thiazolidinedione. Its structure is:

Troglitazone is the subject of EP 139421 B 1988, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises troglitazone covalently attached to a peptide. In the present invention, troglitazone is covalently attached to the peptide via the hydroxyl group.
Venlafaxine
[646] Venlafaxine is a known pharmaceutical agent that is used in the
treatment of anxiety and depression. Its chemical name is (+,-)-1 -[2-(dimethylamino)-l-(4-methoxyphenyl)ethyl]cyclohexanol. Its structure is:

Venlafaxine is the subject of U.S. Patent Number 4,535,186, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises venlafaxine covalently attached to a peptide. In the present invention, venlafaxine is covalently attached to the peptide via the hydroxyl group.
Vinorelbine tartrate
[647] Vinorelbine tartrate is a known pharmaceutical agent that is used in
the treatment of cancer. Its chemical name is 3',4'-didehydro-4'-deoxy-C'-norvincaleukoblastine. Its structure is:

Vinorelbine tartrate is the subject of U.S. Patent Number 4,307,100, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises vinorelbine tartrate covalently attached to a peptide. In
the present invention, vinorelbine tartrate is covalently attached to the peptide via the hydroxyl group.
Vitamin C
[648] Vitamin C is a known pharmaceutical agent that is used in the
treatment of vitamin C deficiency. Its structure is:

The composition of the invention comprises vitamin C covalently attached to a peptide. In the present invention, vitamin C is covalently attached to the peptide via any of the hydroxyl groups.
Voriconazole
[649] Voriconazole is a known pharmaceutical agent that is used in the
treatment of mycosis. Its chemical name is a-(2,4-difluorophenyl)-5-fluoro-|3-methyl-a-(lH-l,2,4-triazol-l-ylmethyl)-4-pyrimidineethanol [R-(R*,S*)]. Its structure is:

Voriconazole is the subject of EP 440372 B 1993, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises voriconazole covalently attached to a peptide. In the present invention, voriconazole is covalently attached to the peptide via the hydroxyl group.
Warfarin
[650] Warfarin is a known pharmaceutical agent that is used in the
treatment of thrombosis and myocardial infarction. Its structure is:

The composition of the invention comprises warfarin covalently attached to a peptide. In the present invention, warfarin is covalently attached to the peptide via the hydroxyl group.
Zidovudine
[651] Zidovudine is a known pharmaceutical agent that is used in the
treatment of HIV infection. Its chemical name is 3'-azido-3'-deoxythymidine. Its structure is:

Zidovudine is the subject of U.S. Patent Number 4,724,232; 4,818,538; 4,828,838; and 4833130, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises zidovudine covalently attached to a peptide. In the present invention, zidovudine is covalently attached to the peptide via the hydroxyl group.
XILD - VIA MULTIPLE SITE OF ATTACHEMENT
[652] The active agents in this category are either active agents with
multiple sites of attachement or combinations of active agents. The preferred site of attachement for the active agents that are part of a combination drug product (such as acetaminophen and hydrocodone) can be found listed in the agents proper category (hydroxyl, amine, etc.)
Alprostadil
[653] Alprostadil is a known pharmaceutical agent that is used in the
treatment of male erectile dysfunction. Its chemical name is (lla,13E,15S)-ll,15-dihydroxy-9-oxoprost-13-en-l-oic acid. Its structure is:

Alprostadil is the subject of U.S. Patent Number 5,741,523, herein incorporated by reference, which describes how to make that drug. In the present invention, alprostadil is covalently attached to the peptide via the carboxylic acid group or any of the hydroxyl groups.
ACE/neutral endopeptidase inhibitor
[654] ACE/neutral endopeptidase inhibitor is a known pharmaceutical
agent that is used in the treatment of hypertension and heart failure. Its chemical name is [S-(R*,R*)]-hexahydro-6-[(2-mercapto-l-oxo-3-phenylpropyl)amino]-2,2-dimethyl-7-oxo-lH-azepine. Its structure is:

ACE /neutral endopeptidase inhibitor is the subject of EP 599444 B (1998), priority based on US application 884664 (1992), herein incorporated by reference, which describes how to make that drug. In the present invention, ACE/neutral endopeptidase inhibitor is covalently attached to the peptide via the carboxylic acid or thiol group.
Abaca vir Sulfate
[655] Abacavir sulfate is a known pharmaceutical agent - a carbocyclic 21-
deoxyguanosine nucleoside analogue that is a reverse transcriptase inhibitor used in the treatment of HIV. Its chemical name is (lS,4R)-4-[2-amino-6-
(cyclopropylamino)-9H-purin-9-yl]-2-cyclopentene-l-methanol. Its structure is as follows:

Abacavir sulfate is the subject of U.S. Patent Numbers 5,034,394 and 5,089,500, herein incorporated by reference, which describes how to make that drug. In the present invention, abacavir sulfate is covalently attached to the peptide via its alcohol group or, alternatively, its amino group.
Acetaminophen and hydrocodone
[656] Acetaminophen and hydrocodone is a known pharmaceutical agent
that is used in the treatment of pain. The chemical name of acetaminophen is N-acetyl-p-aminophenol. The structure of hydrocodone is shown in Figure 1. The composition of the invention comprises acetaminophen and hydrocodone covalently attached to a peptide.
AGI1067
[657] The composite vascular protectant of the present invention is a
known pharmaceutical agent that is used in the treatment of atherosclerosis and restenosis. The compound, AGI1067, is a composite vascular protectant and blocks the production of VCAM-1 and MCP-1 inflammatory genes implicated in the initiation and progression of the condition. The composition of the invention comprises a composite vascular protectant covalently attached to a peptide.
Albuterol
[658] Albuterol is a known pharmaceutical agent that is used for the
symptomatic management of bronchospasm in patients with reversible, obstructive airway disease. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, albuterol is covalently attached to the peptide via one of the hydroxyl groups. Alternatively, albuterol can be covalently attached to the peptide via the amino group.
Amlodipine Besylate and Benazepril
[659] Amlodipine besylate is a known pharmaceutical agent that is used in
the treatment and prevention of myocardial infarction and stroke. Its chemical name is 2-[(2-aminoethoxy)methyl]-4-(2-chlorophenyl)-l,4-dihydro-6-methyl-3,5-
pyridinedicarboxylic acid, 3-ethyl-5-methyl ester monobenzenesulfonate. Its structure is:
Amlodipine besylate is the subject of U.S. Patent Numbers 4,572,909 and 4,879,303, herein incorporated by reference, which describe how to make that drug. In the present invention benazepril are covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug
peptide conjugate. Amlodipine besylate is attached to the peptide via the amino group to provide an additional example of an interspersed drug peptide conjugate.
Amoxicillin
[660] Amoxicillin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, amoxicillin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Amoxicillin and Clarithromicin
[661] Amoxicillin and clarithromicin are used together in the treatment of
duodenal ulcer. The structure of amoxicillin is:

The structure of clarithromycin is:

In the present invention, amoxicillin and clarithromicin are covalently attached to the peptide via the hydroxyl and or amino groups.
Amoxicillin and Clavulanate
[662] Amoxicillin and clavulanate are known pharmaceutical agents used
in the treatment of bacterial infections. Each is available commercially and can be made by those of ordinary skill in the art. The structure of amoxicillin is:

The structure of clavulanate is(Z)-(2#,5R)-3-(2-hydroxyethylidene)-7-oxo-4-oxa-l-azabicyclo[3.2.0]-heptane-2-carboxylate. In the present invention, amoxicillin and clavulanate are each covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Arginine
[663] Arginine is a known pharmaceutical agent that is used as a nutritional
supplement and as a source of nitrogen. The composition of the invention comprises arginine covalently attached to a peptide. In the present invention, arginine is
covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Atenolol
[664] Atenolol is a known pharmaceutical agent that is used in the
treatment of hypertension or chronic stable angina pectoris in patients with chronic obstructive pulmonary disease (COPD) or type 1 diabetes mellitus. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, atenolol is covalently attached to the peptide via the hydroxyl group. Alternatively, atenolol can be covalently attached to the peptide via the amino group.
Baclofen
[665] Baclofen is a known pharmaceutical agent that is used in the
treatment of spasticity. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, baclofen is covalently attached to the peptide via the carboxylic acid group or the amine group or both to provide an example of an interspersed drug peptide conjugate.
Benazepril
[666] Benazepril has the chemical name [S-(R*,R*)]-3-[[l-
(ethoxycarbonyl)-3-phenylpropyl]amino]-2,3,4,5-tetrahydro-2-oxo-lH-l-
benzazepine-1-acetic acid. It is available commercially or can be made by those of
skill in the art. Its structure is as follows:

Benazepril is the subject of U.S. Patent Number 4,410,520, herein incorporated by reference, which describes how to make that drug. In the present invention, benazepril is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Bleomycin
[667] Bleomycin is a known pharmaceutical agent that is used in the
treatment of cancer. Its structure is:

The composition of the invention comprises bleomycin covalently attached to a peptide. In the present invention, bleomycin is covalently attached to the peptide via the amino group or any of the hydroxyl groups.
Bromocriptine
[668] Bromocriptine is a known pharmaceutical agent that is used in the
treatment of dysfunctions associated with hyperprolactinemia including amenorrhea, with or without galactorrhea; hypogonadism; and infertility. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, bromocriptine is covalently attached to the peptide via the hydroxyl group. Alternatively, it is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Carbapenem antibiotic
[669] The carbapenem antibiotic of the present invention is a known
pharmaceutical agent that is used in the treatment of bacterial infection. Its chemical
name is [4R-[3(3S*,5S*),4a,5p,6p(R*)]]-3-[[5-[[(3-
carboxyphenyl)amino]carbonyl]-3-pyrrolidinyl]thio]-6-(l-hydroxyethyl)-4-methyl-
7~oxo-l-azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid. Its structure is:

A carbapenem antibiotic is the subject of WO 93/15078 1993, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises a carbapenem antibiotic covalently attached to a peptide. In the present invention, a carbapenem antibiotic is covalently attached to the peptide via the carboxylic acid or alcohol group.
Carbidopa and Levodopa
[670] Carbidopa and levodopa are known pharmaceutical agents that are
used together in the treatment of Parkinson's disease. Each is commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Levadopa's structure is:
(
In the present invention, carbidopa and levodopa are each covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Carvedilol
[671] Carvedilol is a known pharmaceutical agent that is used in the
treatment of heart failure. Its chemical name is l-(9H-carbazol-4-yloxy)-3-[[2-(2-methoxyphenoxy) ethyl]amino]-2-propanol. Its structure is:

Carvedilol is the subject of U.S. Patent Numbers 4,503,067; 5,760,069; and 5,902,821, herein incorporated by reference, which describes how to make that drug. In the present invention, carvedilol is covalently attached to the peptide via the hydroxyl group. Alternatively, carvedilol can be covalently attached to the peptide via the amino group.
Caspofungin
[672] Caspofungin is a known pharmaceutical agent that is used in the
treatment of bacterial and fungal infections. Its chemical name is l-[(4R,5S)-5-[(2-aminoethyl)amino] -N-2-( 10,12-dimethyl-1 -oxotetradecyl)-4-hydroxy-L-ornithine]-5-[(3R)-3-hydroxy-L-ornithine]pneumocandin B0. Its structure is:

Caspofungin is the subject of WO 94/21677 (1994), based on U.S. Patent Application Number 32847 (1993), herein incorporated by reference, which describes how to make that drug. In the present invention, caspofungin is covalently attached to the peptide via the hydroxyl group. Alternatively, caspofungin can be covalently attached to the peptide via the amino group.
Captopril
[673] Captopril is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is l-(3-mercapto-2-methyl-l-oxopropyl)-L-proline. Its structure is:

Captopril is the subject of U.S. Patent Number 5,238,924, herein incorporated by reference, which describes how to make that drug. In the present invention, captopril is covalently attached to the peptide via the carboxylic acid or thiol group.
CEB925
[674] The lipid lowering agent is a known pharmaceutical agent that is used
in the treatment of hyperlipidemia. It is called CEB 925, a cholesterol ester hydrolase inhibitor produced by American Home Products. The composition of the invention comprises a lipid lowering agent covalently attached to a peptide.
Cefaclor
[675] Cefaclor is a known pharmaceutical agent that is used in the
treatment of bronchitis. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, cefaclor is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Cefadroxil
[676] Cefadroxil is a known pharmaceutical agent that is used in the
treatment of bacterial infections. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, cefadroxil is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Cephalexin
[677] Cephalexin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, cephalexin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Cerivastatin
[678] Cerivastatin is a known pharmaceutical agent that is used in the
treatment of cholesterolemia. Its chemical name is [S-[R*,S*-(E)]]-7-[4-(4-fluorophenyl)-5-(methoxymethyl)-2,6-bis (l-methylethyl)-3-pyridinyl]-3,5-
dihydroxy-6-heptenoic acid. Its structure is:

Cerivastatin is the subject of U.S. Patent Number 5,177,080, herein incorporated by reference, which describes how to make that drug. In the present invention, cerivastatin is covalently attached to the peptide via the carboxylic acid group or any of the hydroxyl groups.
Chlorpheniramine and hydrocodone
[679] Chlorpheniramine and hydrocodone is a known pharmaceutical agent
that is used in the treatment of pain. The composition of the invention comprises chlorpheniramine and hydrocodone covalently attached to a peptide.
Chondroitin
[680] Chondroitin is a nutritional supplement or nutriceutical that is used to
treat osteoarrthritus. Chrondroidtin is available commercially. In the present invention, Chondroitin is attached to the peptide via an alchohol or an amine group or both to provide an example of an interspersed drug peptide conjugate.
Cilastatin and Imipenem
[681] Cilastatin and imipenem are known pharmaceutical agents that are
used together in the treatment of bacterial infections. Cilastatin has no antibacterial activity, but increases the effectiveness of imipenem. Each is commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. The structure of imipenem is:

In the present invention, imipenem is covalently attached to the peptide via the carboxylic acid. Ciliastatin is covalently attached to the peptide via the carboxylic acid group, the ammo group or both to provide an example of an interspersed drug peptide conjugate.
Ciprofloxacin
[682] Ciprofloxacin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is l-cyclopropyl-6-fluoro-l,4-dihydro-4-oxo-7-(l-piperazinyl)-3-quinoUnecarboxylic acid. Its structure is:

Ciprofloxacin is the subject of U.S. Patent Numbers 4,670,444 and 5,286,754, herein incorporated by reference, which describes how to make that drug. In the present invention, ciprofloxacin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Codeine and guaifenesin
[683] Codeine and guaifenesin is a known pharmaceutical agent that is used
in the treatment of coughs. The composition of the invention comprises codeine and guaifenesin covalently attached to a peptide via the hydroxyls of either active agent.
Codeine and promethazine
[684] Codeine and promethazine are known pharmaceutical agents used in
the treatment of coughs. The composition of the invention comprises codeine and promethazine covalently attached to a peptide via functional groups specified in the active agent's respective catagory.
Codeine, guaifenesin and pseudoephidrine
[685] Codeine, guaifenesin and pseudoephidrine are used in the treatment
of coughs and colds. The composition of the invention comprises codeine, guaifenesin and pseudoephidrine covalently attached to a peptide peptide via functional groups specified in the active agent's respective catagory.
Codeine, phenylephrine and promethazine
[686] Codeine, phenylephrine and promethazine is a known pharmaceutical
agent that is used in the treatment of coughs and colds. The composition of the invention comprises codeine, phenylephrine and promethazine covalently attached to a peptide via functional groups specified in the active agent's respective catagory.
Dalteparin
[687] Dalteparin (also known as heparin) is a known pharmaceutical agent
that is used in the treatment of prevention of ischemic complications, due to blood clot formation in patients with unstable angina and non-Q-wave myocardial infarction receiving concurrent aspirin therapy. It is a natural product that is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Dalteparin is the subject of EP 14184 B (1989), herein incorporated by reference, which describes how to make that drug. In the present invention, dalteparin is covalently attached to the peptide via any free hydroxyl, amino, or carboxyl group or, alternatively, via a synthetic linker.
Diclofenac
[688] Diclofenac is a known pharmaceutical agent that is used in the
treatment of acute and chronic rheumatoid arthritis. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its chemical name is potassium (o-(2,6-dichloroanilino)-phenyl)acetate. Its structure is:

In the present invention, diclofenac is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Diclofenac
[689] Diclofenac is a known pharmaceutical agents that is used in the
treatment of pain and inflammation. Diclofenac is commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. The chemical name of diclofenac is potassium (o-(2,6-dichloroanilino)-phenyl)acetate. Its structure is:

In the present invention, Diclofenac is covalently attached to the peptide via the acid or amino groups, or both.
Dopamine
[690] Dopamine is a known pharmaceutical agent that is used used to
increase cardiac output, blood pressure, and urine flow as an adjunct in the treatment of shock that persists after adequate fluid volume replacement. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, dopamine is covalently attached to the peptide via the amino group or either of the hydroxyl groups.
Doxorubicin
[691] Doxorubicin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
Doxorubicin is the subject of U.S. Patent Number 4,837,028, herein incorporated by reference, which describes how to make that drug. Li the present invention, doxorubicin is covalently attached to the peptide via the hydroxyl groups. Alternatively, doxorubicin can be covalently attached to the peptide via the amino group.
Enalapril
[692] Enalapril is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is (S)-l-[N-[l-(ethoxycarbonyl)-3-phenylpropyl]-L-alanyl]-L-proline. Its structure is:

Enalapril is the subject of EP 12401 (1984), priority US application 968249 (1978), herein incorporated by reference, which describes how to make that drug. In the present invention, enalapril is covalently attached to the peptide via the carboxylic
acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Elanapril and Hydrochlorothiazide
[693] Elanapril and hydrochlorothiazide are known pharmaceutical agents
used together in the treatment of hypertension. Elanapril is the subject of of EP 12401 (1984), priority US application 968249 (1978), and U.S. patent numbers 4,374,829 and 4,472,380, herein incorporated by reference, which describes how to make that drug. In the present invention, elanapril is covalently attached to the peptide via the carboxylic acid group; hydrochlorothiazide is attached via its amido group.
Enoxaparin
[694] Enoxaparin is a known pharmaceutical agent that is used in the
treatment of thrombosis and myocardial infarction. It is a low molecular weight heparin, and is described in U.S. Patent Numbers 4,486,420; 4,692,435; and 5,389,619, incorporated herein by reference. In the present invention, enoxaparin is covalently attached to the peptide via any free alcohol, amine or acid groups, or alternatively via linkers.
Ergotamine
[695] Ergotamine is a known pharmaceutical agent that is used in the
treatment of migraines. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in die art. Its structure is:
la the present invention, ergotamine is covalently attached to the peptide via the alcohol or amine groups.
Erythromycin and sulfx
[696] Erythromycin and sulfx together make up a known pharmaceutical
agent that is used in the treatment of bacterial infection. The chemical name of erythromycin is (3R* 45* 55*, 6R* 7R*, 9R*, 11R* 12R*, 135* 14R*)-4-((2,6-Dideoxy-3-C-methyl-3-0-methyl-a-L- ribo- hexopyranosyl) -oxy) -14- ethyl-7,12,13- trihydroxy - 3,5,7,9,11,13-hexa methyl-6- ((3,4,6-trideoxy-3-(dimethylamino)-b-D-xylo- hexopyran osyl)oxy)oxacyclotetradecane-2,10-dione. The composition of the invention comprises erythromycin and sulfx covalently attached to a peptide.
Fluvastatin
[697] Fluvastatin is a known pharmaceutical agent that is used in the
treatment of hyperlipidemia. Its chemical name is (3R,5S,6E)-l-7-[3-(4-fluorophenyl)-l-(l-methylethyl)-lH-indol-2-yl]-3,5-dihydroxy-6-heptenoic acid. Its structure is:
Fluvastatin is the subject of U.S. Patent Number 5,354,772, herein incorporated by reference, which describes how to make that drug. In the present invention, fluvastatin is covalently attached to the peptide via the carboxylic acid group or any of the hydroxyl groups.
Gabapentin
[698] Gabapentin is a known pharmaceutical agent that is used in the
treatment of epilepsy and depression. Its chemical name is 1-(aminomethyl)cyclohexaneacetic acid. Its structure is:
Gabapentin is the subject of U.S. Patent Numbers 4,087,544, 4,894,476, 5,084,479, and 6,054,482, herein incorporated by reference, which describes how to make that drug. In the present invention, gabapentin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Gemcitabine Hydrochloride
[699] Gemcitabine HC1 is a known pharmaceutical agent that is used for the
treatment of lung and pancreatic cancer. Its structure is:

In the present invention, gemcitabine is covalently attached to the peptide via the hydroxyl or amino group or both.
Gentamicin Isoton
[700] Gentamicin isoton is a known pharmaceutical agent that is used in the
treatment of bacterial infections and muscular dystrophy. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, gentamicin isoton is covalently attached to the peptide via the hydroxyl group.
Glucosamine
[701] Glucosamine is a nutritional supplement. It is commercially
available or readily synthesized. In the present invention, glucosamine is attached to the peptide via the amino group or one of the hydroxyl groups or both.
Guaifenesin and hydrocodone
[702] Guaifenesin and hydrocodone is a known pharmaceutical agent that is
used in the treatment of coughs. The composition of the invention comprises guaifenesin and hydrocodone covalently attached to a peptide using functional groups specifally described in the active agents respective category.
Himatropine and hydrocodone
[703] Himatropine and hydrocodone is a known pharmaceutical agent that
is used in the treatment of pain. The composition of the invention comprises himatropine and hydrocodone covalently attached to a peptide using functional groups specifally described in the active agents respective category.
Huperzine A
[704] Huperzine A is an acetylcholinesterase inhibitor that is used to treat
Alzheimer's disease and other forms of dementia. It is commercially available. Its structure is:

In the present invention, Huperzine is covalently attached to the peptide via the ketone or amino group or both.
Hydrocodone and phenylpropanolamine
[705] Hydrocodone and phenylpropanolamine are used in the treatment of
coughs and colds. The composition of the invention comprises hydrocodone and phenylpropanolamine covalently attached to a peptide. In the present invention, hydrocodone and phenylpropanolamine is covalently attached to the peptide via one of the hydroxyl groups. Alternatively, phenylpropanolamine can be covalently attached to the peptide via the amino group.
Ibuprofen and hydrocodone
[706] Ibuprofen and hydrocodone are used in the treatment of pain. The
structure of hydrocodone is shown in Figure 1. The structure of ibuprofen is:

The composition of the invention comprises ibuprofen and hydrocodone covalently attached to a peptide using functional groups specifally described in the active agents respective category.
Idarubicin
[707] Idarubicin is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is (7S,9S)-9-acetyl-7-[(3-amino-2,3,6-trideoxy-a-L-lyxo-hexopyranosyl)oxy]-7,8,9,10-tetrahydro-6,9,ll-trihydroxy-5,12-naphthacenedioone. Its structure is:

Idarubicin is the subject of GB 1467383 (1977), herein incorporated by reference, which describes how to make that drug. In the present invention, idarubicin is covalently attached to the peptide via the hydroxyl group. Alternatively, idarubicin can be covalently attached to the peptide via the amino group.
Ilomastat
[708] Ilomastat is a known pharmaceutical agent that is used in the
treatment of retinopathy, diabetes and cancer. Its chemical name is (2R)-N4-
hydroxy-Nl-[(lS)-(lH-indol-3-ylmemyl)-2-(memylamino)-2-oxoethyl]-2-(2-
methylpropyl)butanediamide. Its structure is:

Ilomastat is the subject of WO 92/9556 (1992), priority application US 615798 (1990), and US Patent 5,114,953, herein incorporated by reference, which describes how to make that drug. In the present invention, ilomastat is covalently attached to the peptide via the amine or hydroxyl group.
Iodothyronine
[709] Iodothyronine is a known pharmaceutical agent that is used in the
treatment of hypothyroidism. The composition of the invention comprises iodothyronine covalently attached to a peptide. In the present invention, iodothyronine is covalently attached to the peptide via a peptide bond. Iodothyronine and thyroxine are known pharmaceutical agents used in the treatment of hypothyroidism. The composition of the invention comprises iodothyronine and thyroxine covalently attached to a peptide. In the present invention, iodothyronine and thyroxine is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Ketotifen
[710] Ketotifen is a known pharmaceutical agent that is used in the
treatment of allergic conjunctivitis. In the present invention, ketotifen is covalently
attached to the peptide via a hydroxyl, amine or carboxylic acid group or, alternatively, via a linker.
Labetalol
[711] Labetalol is a known pharmaceutical agent that is used in the
treatment of hypertension. Its structure is:

In the present invention, labetalol is covalently attached to the peptide via the hydroxyl group. Alternatively, labetalol can be covalently attached to the peptide via the amino group.
Levothyroxine
[712] Levothyroxine is a known pharmaceutical agent that is used in the
treatment of hypothyroidism/ Its structure is:

The composition of the invention comprises levothyroxine covalently attached to a peptide. In the present invention, levothyroxine is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Lisinopril
[713] Lisinopril is a known pharmaceutical agent that is used in the
treatment of hypertension, heart failure, myocardial infarction, retinopathy, diabetes
and kidney disease. Its chemical name is (S)-l-[N2-(l-carboxy-3-phenylpropyl)-L-lysyl]-L-proline. Its structure is:

Lisinopril is the subject of EP 12401 B (1984), priority US 968249 (1978), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises lisinopril covalently attached to a peptide. In the present invention, lisinopril is covalently attached to the peptide via the carboxylic acid group, the amino group of both to provide an example of an interspersed drug peptide conjugate.
Lisinopril and hydrochlorothiazide
[714] Lisinopril and hydrochlorothiazide are used together in the treatment
of hypertension. The composition of the invention comprises lisinopril and hydrochlorothiazide covalently attached to a peptide.
Loracarbef
[715] Loracarbef is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is 7-
[(aminophenylacetyl)amino]-3-chloro-8-oxo-l-azabicyclo-[4,2,0]oct-2- ene-2-
carboxylic acid. Its structure is:

Loracarbef is the subject of EP 14476 B 1983, priority JP 14534 1979, EP 311366 B 1994, priority US 105776 1987, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises loracarbef covalently attached to a peptide. In the present invention, loracarbef is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Losartan and hydrochlorothiazide
[716] Losartan and hydrochlorothiazide are used together in the treatment
of hypertension. Losartan and hydrochlorothiazide are the subject of U.S. Patent Number 5,138,069 and 5,153,197, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises losartan and hydrochlorothiazide covalently attached to a peptide.
Mefloquine
[717] Mefloquine is a known pharmaceutical agent that is used in the
treatment and prevention of malaria. Its structure is:

Mefloquine is the subject of U.S. Patent Number 4,579,855, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mefloquine covalently attached to a peptide. In the present invention, mefloquine is covalently attached to the peptide via the hydroxyl group. Alternatively, mefloquine can be covalently attached to the peptide via the amino group.
Mesalamine
[718] Mesalamine is a known pharmaceutical agent that is used in the
treatment of inflammatory bowel disease. Its chemical name is 5-amino-2-hydroxybenzoic acid. Its structure is:

Mesalamine is the subject of U.S. Patent Number 5,541,170 and 5,541,171, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mesalamine covalently attached to a peptide. In the present invention, mesalamine is covalently attached to the peptide via the carboxylic acid or amino group or both to provide an example of an interspersed drug peptide conjugate.
Metoprolol
[719] Metoprolol is a known pharmaceutical agent that is used in the
treatment of angina and hypertension. It is disclosed in U.S. Patent Numbers 4,957,745 and 5,001,161, incorporated herein by reference. Its structure is:

The composition of the invention comprises metoprolol covalently attached to a peptide. In the present invention, metoprolol is covalently attached to the peptide via the hydroxyl group. Alternatively, metoprolol can be attached to the peptide via the amino group.
Moexipril
[720] Moexipril is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is [3S-[2[R*(R*),3R*]]-2-[2-[[l-
(ethoxycarbonyl)-3-phenylpropyl]amino]-l-oxopropyl]-l,2,3,4-tetrahydro-6,7-dimethoxy-3-isoquinolinecarboxylic acid. Its structure is:

Moexipril is the subject of U.S. Patent Number 4,344,949 and 4,743,450, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises moexipril covalently attached to a peptide. In the present invention, moexipril is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Nadolol
[721] Nadolol is a known pharmaceutical agent that is used in the treatment
of hypertension and angina. Its structure is:

The composition of the invention comprises nadolol covalently attached to a peptide. In the present invention, nadolol is covalently attached to the peptide via any of the hydroxyl groups. Alternatively, nadolol can be covalently attached to the peptide via the amino group.
Nelarabine
[722] Nelarabine is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is 9-P-D-arabinofuranosyl-6-methoxy-9H-purin-2-amine. Its structure is:

Nelarabine is the subject of EP 294114 B 1996, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nelarabine covalently attached to a peptide. In the present invention, nelarabine is covalently attached to the peptide via the hydroxyl or amino group.
Neuraminidase inhibitor
[723] The oral neuraminidase inhibitor of the present invention is a known
pharmaceutical agent that is used in the treatment of viral infection. It is referred to as chemical name is BCX1812. The composition of the invention comprises an oral neuraminidase inhibitor covalently attached to a peptide.
Norfloxacin
[724] Norfloxacin is a known pharmaceutical agent that is used in the
treatment of gonnorhea and urinary tract infections. Its structure is:

319
Norfloxacin is the subject of U.S. Patent Numbers 4,146,719 and 4,639,458, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises norfloxacin covalently attached to a peptide. In the present invention, norfloxacin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Oxycodone and acetaminophen
[725] Oxycodone and acetaminophen are used together in the treatment of
pain. The composition of the invention comprises oxycodone and acetaminophen covalently attached to a peptide.
Potassium channel modulator
[726] The potassium channel modulator is a known pharmaceutical agent
that is used in the treatment of stroke. It is referred to as BMS 204352. The composition of the invention comprises a potassium channel modulator covalently attached to a peptide.
Pravastatin
[727] Pravastatin is a known pharmaceutical agent that is used in the
treatment of hyperlipidemia and myocardial infarction. Its chemical name is [1S-[la(pS*,6S*),2a,6a,8p(R*),8aa]]-l,2,6,7,8,8a-hexahydro-P,5,6-trihydroxy-2-methyl-8-(2-methyl-l-oxobutoxy)-l-naphthaleneheptanoic acid. Its structure is:

Pravastatin is the subject of U.S. Patent Number 4,346,227; 5,030,447, and 5,180,589, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pravastatin covalently attached to a peptide. In the present invention, pravastatin is covalently attached to the peptide via the carboxylic acid group or any of the hydroxyl groups.
Pregabalin
[728] Pregabalin is a known pharmaceutical agent that is used in the
treatment of epilepsy and pain. Its chemical name is (S)-3-(aminomethyl)-5-methyl-hexanoic acid. Its structure is:

Pregabalin is the subject of WO 93/23383 1993, priority US 886080 1992, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pregabalin covalently attached to a peptide. In the present invention, pregabalin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Propranolol
[729] Propranolol is a known pharmaceutical agent that is used in the
treatment of hypertension and angina. Its structure is:

The composition of the invention comprises propranolol covalently attached to a peptide. In the present invention, propranolol is covalently attached to the peptide via the hydroxyl group. Alternatively, propranolol can be covalently attached to the peptide via the amino group.
Pseudoephedrine
[730] Pseudoephedrine is a known pharmaceutical agent that is used in the
treatment of allergy. Its structure is:

The composition of the invention comprises pseudoephedrine covalently attached to a peptide. In the present invention, pseudoephedrine is covalently attached to the peptide via the hydroxyl group. Alternatively, pseudoephedrine can be covalently attached to the peptide via the amino group.
Quinapril
[731] Quinapril is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is [3S-[2[R*(R*)],3R*]]-2-[2-[[l-(ethoxycarbonyl)-3-phenylpropyl] amino]-1 -oxopropyl]-1,2,3,4-tetrahydro-3-isoquinolinecarboxylic acid. Its structure is:

Quinapril is the subject of U.S. Patent Number 4,344,949; 4,743,450; 5,684,016 and 5,747,504, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises quinapril covalently attached to a peptide. Li the present invention, quinapril is covalently attached to the peptide via
the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Quinolone Antibiotic
[732] The quinolone antibiotic of the present invention is a known
pharmaceutical agent that is used in the treatment of bacterial infections. Its chemical name is l-cyclopropyl-8-(difIuoromethoxy)-7-[(lR)-2,3-dihydro-l-methyl-lH-isoindol-5-yl]-l ,4-dihydro-4-oxo-3-quinolinecarboxylic acid
monomethanesulfonate. Its structure is:

A quinolone antibiotic is the subject of EP 882725 Al (1998), herein incorporated by reference, which describes how to make that drug. In the present invention, a quinolone antibiotic is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Ramipril
[733] Ramipril is a known pharmaceutical agent that is used in the
treatment of hypertension and heart failure. Its chemical name is (2S,3aS,6aS)-l-[(S)-N-[(S)-l-carboxy-3-phenylpropyl]alanyl]octahydrocyclopenta[b]pyrrole-2-carboxylic acid 1-ethyl ester. Its structure is:

Ramipril is the subject of U.S. Patent Number 4,587,258 and 5,061,722, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ramipril covalently attached to a peptide. In the present invention, ramipril is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Sitafloxacin
[734] Sitafloxacin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is [lR-[la(S*),2a]]-7-(7-amino-
5-azaspiro[2,41hept-5-yl)-8-chloro-6-fluoro-l-(2-fluorocyclopropyl)-l,4-dihydro-4-
oxo-3-quinoline carboxylic acid. Its structure is:

Sitafloxacin is the subject of EP 341493 A 1989, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sitafloxacin covalently attached to a peptide. In the present invention, sitafloxacin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Sparfosic acid
[735] Sparfosic acid is a known pharmaceutical agent that is used in the
treatment of cancer. The composition of the invention comprises sparfosic acid covalently attached to a peptide. In the present invention, sparfosic acid is covalently attached to the peptide via the hydroxyl or carboxylic acid group.
Tirofiban
[736] Tirofiban is a known pharmaceutical agent that is used in the
treatment of thrombosis and angina. Its chemical name is N-(butylsulfonyl)-O-[4-(4-piperidinyl)butyl]-L-tyrosine. Its structure is:

Tirofiban is the subject of U.S. Patent Numbers 5,292,756; 5,658,929; 5,733,919; 5,880,136; 5,965,581; 5,972,967 and 5,978,698, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tirofiban covalently attached to a peptide. In the present invention, tirofiban is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Tobramycin sulfate
[737] Tobramycin sulfate is a known pharmaceutical agent that is used in
the treatment of bacterial infection. Its structure is:

The composition of the invention comprises tobramycin sulfate covalently attached to a peptide. In the present invention, tobramycin sulfate is covalently attached to the peptide via the hydroxyl or amino groups.
Trandolapril
[738] Trandolapril is a known pharmaceutical agent that is used in the
treatment of hypertension, heart failure, and myocardial infarction -. Its chemical name is [2S-[l[R*(R*)3,2a,3aa,7aß]]-l-[2-[[l-(ethoxycarbonyl)-3-
phenylpropyl] amino]-1 -oxopropyl] octahydro-1 H-indole-2-carboxylic acid. Its structure is:
Trandolapril is the subject of U.S. Patent Number 4,233,361 and 5,744,496, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises trandolapril covalently attached to a peptide. In the present invention, trandolapril is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Trovafloxacin mesylate
[739] Trovafloxacin mesylate is a known pharmaceutical agent that is used
in the treatment of bacterial infection. Its chemical name is (la,5a,6a)-7-(6-amino-3-azabicyclo[3.1.0]hex-3-yl)-1 -(2,4-difluorophenyl)-6-fluoro-l ,4-dihydro-4-oxo-l,8-naphthyridine-3-carboxylic acid. Its structure is:

Trovafloxacin mesylate is the subject of U.S. Patent Number 5,164,402; 5,763,454; and 6,080,756, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises trovafloxacin mesylate covalently attached to a peptide. In the present invention, trovafloxacin mesylate is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Ursodiol
[740] Ursodiol is a known pharmaceutical agent that is used in the
treatment of gall stones. Its chemical name is 3a, 7{5-dihydroxy-5(}-cholan-24-oic acid. The composition of the invention comprises ursodiol covalently attached to a
peptide. In the present invention, ursodiol is covalently attached to the peptide via the carboxylic acid group or any of its hydroxyl groups.
Vancomycin
[741] Vancomycin is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its structure is:

The composition of the invention comprises vancomycin covalently attached to a peptide. hi the present invention, vancomycin is covalently attached to the peptide via the carboxylic acid group, the amino group or both to provide an example of an interspersed drug peptide conjugate.
Vitamin B12
[742] Vitamin B12 is a known pharmaceutical agent that is used in the
treatment of Vitamin B12 deficiency. Its structure is:

The composition of the invention comprises vitamin B12 covalently attached to a peptide. In the present invention, the active agent is covalently attached to the peptide via one of the hydroxyl groups. Alternatively, Vitamin B12 can be covalently attached to the peptide via the amino group.
XILE - VIA A KETONE GROUP
AGE Crosslink Breaker
[743] The AGE crosslink breaker of the present invention is a known
pharmaceutical agent that is used in the treatment of diabetes and cardiovascular disease. Its chemical name is 4,5-dimethyl-3-(2-oxo-2-phenylethyl)thiazolium. Its structure is:
In the present invention, the AGE crosslink breaker is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, alcohols or acids). For example, glucose would be suitable as a linker. AGE crosslink breaker is the subject of WO 96/22095 (1996), priority US application 375155 (1995), herein incorporated by reference, which describes how to make that drug.
Amiodarone
[744] Amiodarone is a known pharmaceutical agent that is used in the
treatment of cardiac arrhythmia. Its chemical name is (2-butyl-3-benzofuranyl)[4-[2-(diemylarnino)ethoxy]-3,5-diiodophenyl]methanone. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, amiodarone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Cilansetron
[745] Cilansetron is a known pharmaceutical agent that is used in the
treatment of irritable bowel syndrome. Its chemical name is (R)-5,6,9,10-tetrahydro-10-[(2-methyl-lH-imidazol-l-yl)methyl]-4H-pyrido[3,2,l-jk]carbazol-
1 l(8H)-one. Its structure is:

Cilansetron is the subject of EP 297651 (1989), herein incorporated by reference, which describes how to make that drug. In the present invention, cilansetron is covalently attached to the peptide via a ketone group and a linker. This linker may
be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Donepezil
[746] Donepezil is a known pharmaceutical agent that is used in the
treatment of Alzheimer's and attention deficit disorder. Its chemical name is 2,3-dihydro-5,6-dimethoxy-2-[[l-(phenyhnethyl)-4-piperidinyl]methyl]-l H-inden-1-one. Its structure is:
Donepezil is the subject of U.S. Patent Number 4,895,841, herein incorporated by reference, which describes how to make that drug. In the present invention, the donepezil is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Fenofibrate
[747] Fenofibrate is a known pharmaceutical agent that is used in the
treatment of hyperlipiemia. Its chemical name is 2-[4-(4-chlorobenzoyl)phenoxy]-2-methylpropanoic acid 1-methylethyl ester. Its structure is:

Fenofibrate is the subject of U.S. Patent Number 4,895,726, herein incorporated by reference, which describes how to make that drug. In the present invention, fenofibrate is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Hydrocodone
[748] Hydrocodone is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises hydrocodone covalently attached to a peptide. In the present invention, hydrocodone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker. Alternatively, hydrocodone may be attached directly through an enolate.
The composition of the invention comprises Kavalactone covalently attached to a peptide. In the present invention, Kavalactone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids).
Medroxyprogesterone acetate
[750] Medroxyprogesterone acetate is used orally to reduce the incidence of
endometrial hyperplasia and the attendant risk of endometrial carcinoma in postmenopausal women receiving estrogen replacement therapy. Its structure is:

The composition of the invention comprises medroxyprogesterone acetate covalently attached to a peptide. In the present invention, medroxyprogesterone acetate is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Megestrol acetate
[751] Megestrol acetate is used in the palliative management of recurrent,
inoperable, or metastatic endometrial carcinoma or breast cancer. The drug is also used as an adjunct to surgery or radiation. Its structure is:

Megestrol acetate is the subject of U.S. Patent Number 5,338,732, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises megestrol acetate covalently attached to a peptide. In the present invention, megestrol acetate is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Melatonin
[752] Melatonin is a nutritional supplement. It is commercially available.
The structure is:

In the present invention, melatonin is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids).
Nabumetone
[753] Nabumetone is a known pharmaceutical agent that is used in the
treatment of pain and inflamation. Its chemical name is 4-(6-methoxy-2-naphthyl)-2-butanone. Its structure is:

Nabumetone is the subject of U.S. Patent Number 4,420,639, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nabumetone covalently attached to a peptide. In the present invention, nabumetone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Ondansetron
[754] Ondansetron is a known pharmaceutical agent that is used in the
treatment of emesis, cognitive defect and eating disorder. Its chemical name is l,2,3,9-tetrahydro-9-methyl-3-[(2-methyl-lH-imidazol-l-yl)methyl]-4H-carbazol-4-one. Its structure is:
Ondansetron is the subject of U.S. Patent Numbers 4695578, 4753789, 5344658, and 5578628, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ondansetron covalently attached to a peptide. In the present invention, ondansetron is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Oxycodone
[755] Oxycodone is a known pharmaceutical agent that is used in the
treatment of pain. The structure of oxycodone is:

The composition of the invention comprises oxycodone covalently attached to a peptide. In the present invention, oxycodone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker. Alternatively, oxycodone may be attached directly through an enolate.
Pagoclone
[756] Pagoclone is a known pharmaceutical agent that is used in the
treatment of anxiety and panic disorder. Its chemical name is (+)-2-(7-chloro-l,8-naphthyridin-2-yl)-2,3-dihydro-3-(5-methyl-2-oxohexyl)-lH-isoindol-l-one. Its structure is:
Pagoclone is the subject of EP 274930 B 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pagoclone covalently attached to a peptide. In the present invention, pagoclone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Pentoxifylline
[757] Pentoxifylline is a known pharmaceutical agent that is used in the
treatment of peripheral vascular disease, stroke, atherosclerosis, and rheumatoid arthritis. Its chemical name is 3,7-dimethyl-l-(5-oxo-hexyl)xanthine. Its structure is:
The composition of the invention comprises pentoxifylline covalently attached to a peptide. In the present invention, pentoxifylline is covalently attached to the peptide
via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
Spironolactone
[758] Spironolactone is a known pharmaceutical agent that is used in the
treatment of edema. Its structure is:

The composition of the invention comprises spironolactone covalently attached to a peptide. In the present invention, spironolactone is covalently attached to the peptide via a ketone group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, glucose would be suitable as a linker.
XII.F - VIA THE AMIDO. IMIDO. IMIDAZO. PYRAZOLO OR UREIDO GROUP AND A LINKER
Adenosine Al receptor antagonist
[759] The adenosine Al receptor antagonist of the present invention is a
known pharmaceutical agent that is used in the treatment of hypertension and heart failure. Its chemical name is 3,7-dihydro-8-(3-oxatricyclo[3.2.1.0 2,4]oct-6-yl)-l,3-dipropyl-lH-purine-2,6-dione. Its structure is:

An adenosine Al receptor antagonist is the subject of WO 95/11904 1995, priority US 144459 1993, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises an adenosine Al receptor antagonist covalently attached to a peptide. In the present invention, an adenosine Al receptor antagonist is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Adrenocorticotropic hormone
[760] Adrenocorticotropic hormone is a known pharmaceutical agent that is
useful for the diagnosis of Addison's disease and other conditions in which the functionality of the adrenal cortex is to be determined. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. In the present invention, adrenocorticotropic hormone is covalently attached to the peptide via an amide bond and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more
heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Allopurinal
[761] Allopurinal is a known pharmaceutical agent that is is a xanthine
oxidase inhibitor used in the treatment of gout and selected hyperuricemias. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, allopurinal is covalently attached to the peptide via its pyrazolo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Anagrelide
[762] Anagrelide is a known pharmaceutical agent that is used as a platelet
reducing drug. Its chemical name is 6,7-dichloro-l,5-dihydroimidazo[2,l-b]quinazolin-2(3H)-one. Its structure is:

Anagrelide is the subject of GB patent 1418822 (1975), (based on U.S. Patent Application Serial Number 223,723, filed in 1972, herein incorporated by reference, which describes how to make that drug. In the present invention, anagrelide is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Angiotensin IE antagonist
[763] The angiotensin II antagonist of the present invention is a known
pharmaceutical agent that is used in the treatment of hypertension. Its chemical name is N-[[4'-[(2-ethyl-5,7-dimethyl-3H-imidazo[4,5-b]pyridin-3-yl)methyl][l,r-biphenyl]-2-yl]sulfonyl]-benzamide. The composition of the invention comprises an angiotensin II antagonist covalently attached to a peptide. In the present invention, the active agent is covalently attached to the peptide via a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Carbamazepine
[764] Carbamazepine is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its structure is:

Carbamazepine is the subject of U.S. Patent Numbers 5,284,662 and Re. 34,990, herein incorporated by reference, which describes how to make that drug. In the present invention, carbamazepine is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Carisoprodol
[765] Carisoprodol is a known pharmaceutical agent that is used in the
treatment of skeletal muscle spasm. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, carisoprodol is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional
groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Cefuroxime Axetil
[766] Cefuroxime axetil is a known pharmaceutical agent that is used in the
treatment of bacterial infection. Its chemical name is [6R-[6a,7p(Z)]]-3-[[(aminocarbonyl) oxy]methyl]-7-[[2-furanyl (methoxyimino)acetyl]amino]-8-oxo-5-thia-l-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, l-(acetyloxy)ethyl ester. Its structure is:

Cefuroxime axetil is the subject of GB 1571683 (1980), herein incorporated by reference, which describes how to make that drug. In the present invention, cefuroxime axetil is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Cimetidine
[767] Cimetidine is a known pharmaceutical agent that is used in the
treatment of duodenal ulcer. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, cimetidine is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Clonazepam
[768] Clonazepam is a known pharmaceutical agent that is used in the
treatment of epilepsy. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, clonazepam is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Clonidine
[769] Clonidine is a known pharmaceutical agent that is used in the
treatment of hypertension. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, clonidine is covalently attached to the peptide via the amino group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Conivaptan
[770] Conivaptan is a known pharmaceutical agent that is used in the
treatment of congestive heart failure and hyponatremia. Its chemical name is N-[l,l'-biphenyl]-2-yl-4-[(4,5-dihydro-2-methylimidazo[4,5-d][l]benzazepin-6(lH)-yl)carbonyl]-benzamide. Its structure is:

Conivaptan is the subject of EP 709386 A (1996), herein incorporated by reference, which describes how to make that drug. In the present invention, the conivaptan is covalently attached to the peptide via a nitrogen-containing group and a linker. This
linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Dutasteride
[771] Dutasteride is a known pharmaceutical agent that is used in the
treatment of benign prostate hypertrophy and alopecia. Its chemical name is (4aR,4bS,6aS,7S,9aS, 9bS,l laR)-N-[2,5-bis(trifluoromethyl)phenyl]-
2,4a,4b,5,6,6a,7,8,9,9a,9b, 10,11,11 a-tetradecahydro-4a,6a-dimethyl-2-oxo-lH-indeno[5,4-f]quinoline-7-carboxamide. Its structure is:

Dutasteride is the subject of WO 95/7927 (1995), priority US 123280 (1993), herein incorporated by reference, which describes how to make that drug. In the present invention, dutasteride is covalently attached to the peptide via the amido groups and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Ecadotril
[772] Ecadotril is a known pharmaceutical agent that is used in the
treatment of hypertension, heart failure and cirrhosis. Its chemical name is (S)-N-[2-t(acetylthio)methyl]-l-oxo-3-phenylpropyl]glycine phenyl methyl ester. Its structure is:

Ecadotril is the subject of EP 318377 B (1993), herein incorporated by reference, which describes how to make that drag. In the present invention, ecadotril is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Efavirenz
[773] Efavirenz is a known pharmaceutical agent that is used in the
treatment of HIV infection. Its chemical name is (S)-6-chloro-4-(cyclopropylethynyl)-l,4-dihydro-4-(trifluoromethyl)-2H -3,l-benzoxazin-2-one. Its structure is:

Efavirenz is the subject of U.S. Patent Numbers 5,519,021; 5,663,169 and 5,811,423, herein incorporated by reference, which describes how to make that drug. In the present invention, efavirenz is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing
2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Emivirine
[774] Emivirine is a known pharmaceutical agent that is used in the
treatment of HIV infection. Its chemical name is l-(ethoxyrnethyl)-5-(l-methylethyl)-6-(phenylmethyl)-2,4(lH,3H)-pyrimidinedione. Its structure is:

Emivirine is the subject of EP 420763 B (1999), herein incorporated by reference, which describes how to make that drug. In the present invention, the emivirine is covalently attached to the peptide via the imido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Eniluracil
[775] Eniluracil is a known pharmaceutical agent that is used in the
treatment of pancreatic and colorectal cancer. Its chemical name is 5-ethynyl-2,4(lH,3H)-pyrimidinedione. Its structure is:

Eniluracil is the subject of WO 92/1452 (1992), herein incorporated by reference, which describes how to make that drug. In the present invention, eniluracil is covalently attached to the peptide via the ureide groups and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more
heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Finasteride
[776] Finasteride is a known pharmaceutical agent that is used in the
treatment of cancer, benign prostate hypertrophy, alopecia and acne. Its chemical name is (5a, 17|3)-N-(1,l-dimethylethyl)-3-oxo-4-azaandrost-l-ene- 17-carboxamide. Its structure is:

Finasteride is the subject of U.S. Patent Numbers 5,377,584; 4,760,071; 5,547,957; 5,571,817 and 5,886,184, herein incorporated by reference, which describes how to make that drug. In the present invention, finasteride is covalently attached to the peptide via an amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Fludrocortisone
[777] Fludrocortisone is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its chemical name is 5,5-diphenyl-3-
[(phosphonooxy)methyl]-2,4-imidazolidinedion. Its structure is:

350
Fludrocortisone is the subject of U.S. Patent Number 4,260,769 (1981), and EP 473687 B (1996), based on priority application US 356948 (1989), herein incorporated by reference, which describes how to make that drug. In the present invention, fludrocortisone is covalently attached to the peptide via the ureido group and a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates. For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Flurouracil
[778] Flurouracil is a known pharmaceutical agent that is used in the
treatment of actinic keratoses. Its structure is:

The composition of the invention comprises flurouracil covalently attached to a peptide. In the present invention, flurouracil is covalently attached to the peptide via the ureide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Flutamide
[779] Flutamide is a known pharmaceutical agent that is used in the
treatment of prostate cancer. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, flutamide is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Fosphenytoin
[780] Fosphenytoin is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its chemical name is 5,5-diphenyl-3-
[(phosphonooxy)methyl]-2,4-imidazolidinedione. Its structure is:

Fosphenytoin is the subject of U.S. Patent Numbers 4,260,769 and 4,925,860, herein incorporated by reference, which describes how to make that drug. In the present invention, fosphenytoin is covalently attached to the peptide via the ureido group and a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made
up of a short chain of either amino acids or carbohydrates. For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Gantofiban
[781] Gantofiban is a known pharmaceutical agent that is used in the
treatment of thrombosis and angina. Its chemical name is 4-[[(5R)-3-[4-[imino[(methoxycarbonyl) amino]methyl]phenyl]-2-oxo-5-oxazolidinyl]methyl]-1 -piperazineacetic acid ethyl ester 2-hydroxy-l,2,3-propanetricarboxylate (1:1. Its structure is:
Gantofiban is the subject of EP 741133 A (1996), herein incorporated by reference, which describes how to make that drug. In the present invention, gantofiban is covalently attached to the peptide via the imido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Glimepiride
[782] Glimepiride is a known pharmaceutical agent that is used in the
treatment of diabetes. Its chemical name is trans-3-ethyl-2,5-dihydxo-4-methyl-N-[2-[4-[[[[(4-methylcyclohexyl)amino]carbonyl]amino]sulfonyl]phenyl]ethyl]-2-oxo-lH-pyrrole-1-carboxamide. Its structure is:

353
Glimepiride is the subject of U.S. Patent Number 4,379,785, herein incorporated by reference, which describes how to make that drug. In the present invention, glimepiride is covalently attached to the peptide via the ureide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Glipizide
[783] Glipizide is a known pharmaceutical agent that is used in the
treatment of diabetes. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, glipizide is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Glyburide
[784] Glyburide is a sulfonylurea antidiabetic agent used in the treatment of
diabetes. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, glyburide is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Goserelin
Goserelin is a known pharmaceutical agent that is used in the treatment of cancer, endometriosis and infertility. Its chemical name is 6-[O-(l,l-dimethylethyl)-D-serine]-l-9-luteinizing hormone-releasing factor (swine) 2-(aminocarbonyl)hydrazide. Its structure is:

A
Goserelin is the subject of GB 1524747 1978, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises goserelin covalently attached to a peptide. In the present invention, goserelin is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Granisetron
[785] Granisetron is a known pharmaceutical agent that is used in the
treatment of nausea and vomiting in cancer patients Its chemical name is endo-1-methyl-N-(9-methyl-9-azabicyclo[3,3,l]non-3-yl)-lH-indazole-3-carboxamide. Its structure is:

Granisetron is the subject of U.S. Patent Number 4,886,808, herein incorporated by reference, which describes how to make that drug. In the present invention, granisetron is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Hydrochlorothiazide
[786] Hydrochlorothiazide is a known pharmaceutical agent that is used in
the treatment of hypertension. The chemical structure of hydrochlorothiazide is:

In the present invention, hydrochlorothiazide is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Itasetron
[787] Itasetron is a known pharmaceutical agent that is used in the
treatment of emesis and anxiety. Its chemical name is endo-2,3-dihydro-N-(8-methyl-8-azabicyclo[3.2.1]oct-3-yl)-2-oxo-lH-benzimidazole-l-carboxamide. Its structure is:

Itasetron is the subject of EP 309423 B (1994), herein incorporated by reference, which describes how to make that drug. In the present invention, itasetron is covalently attached to the peptide via the ureide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Lansoprazole
[788] Lansoprazole is a known pharmaceutical agent that is used in the
treatment of ulcer and bacterial infection. Its chemical name is 2-[[[3-methyl-4-(2,2,2-trifluoroethoxy)-2-pyridinyl]methyl]sulfinyl]-lH-benzimidazole. Its structure
is:

Lansoprazole is the subject of U.S. Patent Number 4,628,098; 4,689,333; 5,026,560; 5,045,321; 5,093,132 and 5,433,959, herein incorporated by reference, which describes how to make that drug. In the present invention, lansoprazole is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more
heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Mercaptopurine
[789] Mercaptopurine is a known pharmaceutical agent that is used in the
treatment of leukemia Its structure is:

The composition of the invention comprises mercaptopurine covalently attached to a peptide. In the present invention, mercaptopurine is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Metaformin
[790] Metformin is a known pharmaceutical agent that is used in the
treatment of diabetes. Its chemical name is N,N-dimethylimidodicarbonimidic diamide. Its structure is:
The composition of the invention comprises Metformin covalently attached to a peptide. In the present invention, Metformin is covalently attached to the peptide via the guanide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more
functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Metaxalone
[791] Metaxalone is a known pharmaceutical agent that is used in the
treatment of skeletal muscular spasm. Its structure is:

The composition of the invention comprises metaxalone covalently attached to a peptide. In the present invention, metaxalone is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Milrinone Iactate
[792] Milrinone Iactate is a known pharmaceutical agent that is used in the
treatment of heart failure. Its chemical name is l,6-dihydro-2-methyl-6-oxo-[3,4'-bipyridine]-5-carbonitrile. Its structure is:

Milrinone Iactate is the subject of U.S. Patent Number 4,313,951, herein incorporated by reference, which describes how to make that drug. The composition
of the invention comprises milrinone lactate covalently attached to a peptide. In the present invention, the milrinone lactate or modified milrinone lactate is covalently attached to the peptide via an amide group and a linker. This Linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Modafintt
[793] Modafinil is a known pharmaceutical agent that is used in the
treatment of neurologic depression. Its chemical name is 2-
[(diphenylmethyl)sulfinyl]acetamide. Its structure is:

Modafinil is the subject of U.S. Patent Number 4,927,855 and 5,618,845, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises modafinil covalently attached to a peptide. In the present invention, modafinil is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Nevirapine
[794] Nevirapine is a known pharmaceutical agent that is used in the
treatment of HIV infection. Its chemical name is ll-cyclopropyl-5,ll-dihydro-4-methyl-6H-dipyrido[3,2-b:2',3'-e][l,4]diazepin-6-one. Its structure is:

Nevirapine is the subject of U.S. Patent Number 5,366,972, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nevirapine covalently attached to a peptide. In the present invention, nevirapine is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Nitrofurantoin
[795] Nitrofurantoin is a known pharmaceutical agent that is used in the
treatment of urinary tract infection. Its structure is:

The composition of the invention comprises nitrofurantoin covalently attached to a peptide. In the present invention, nitrofurantoin is covalently attached to the peptide via the imido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more
functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Nizatidine
[796] Nizatidine is a known pharmaceutical agent that is used in the
treatment of gastrointestinal ulcer. Its chemical name is N-[2-[[[2-[(dimemylamino)methyl]1H-thiazolyl]methyl]thio]ethyl]-N'-methyl-2-nitro-1,1-ethenediamine. Its structure is:

Nizatidine is the subject of U.S. Patent Number 4,375,547; 4,382,090 and 4,760,775, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nizatidine covalently attached to a peptide. In the present invention, nizatidine is covalently attached to a peptide. In the present invention, nizatidine or modified nizatidine is covalently attached to the peptide via the pseudo-ureido group and a linker. For example, dihydropyran-3-carboxylic acid would be a suitable linker.
Omeprezole
[797] Omeprezole is a known pharmaceutical agent that is used in the
treatment of gastrointestinal ulcer and bacterial infection. Its chemical name is 5-methoxy-2-[[(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl]sulfinyl]-lH-benzimidazole. Its structure is:

Omeprezole is the subject of U.S. Patent Numbers 4,255,431; 4,636,499; 4,786,505 and 4,853,230, herein incorporated by reference, which describes how to make that
drag. The composition of the invention comprises omeprezole covalently attached to a peptide. In the present invention, omeprezole is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Orlistat
[798] Orlistat is a known pharmaceutical agent that is used in the treatment
of obesity, diabetes and hyperlipidemia. Its chemical name is N-formyl-L-leucine [2S-[2a(R*),3p]]-l-[(3-hexyl-4-oxo-2-oxetanyl)methyl]dodecyl ester. Its structure is:
Orlistat is the subject of U.S. Patent Numbers 4,598,089 and 6,004,996, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises orlistat covalently attached to a peptide. In the present invention, orlistat is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Phenobarbital
[799] Phenobarbital is a known pharmaceutical agent that is used in the
treatment of anxiety, epilepsy and insomnia. Its structure is:

The composition of the invention comprises phenobarbital covalently attached to a peptide. In the present invention, phenobarbital is covalently attached to the peptide via the imido groups and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Phenytoin
[800] Phenytoin is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its structure is:

The composition of the invention comprises phenytoin covalently attached to a peptide. In the present invention, phenytoin is covalently attached to the peptide via the ureido groups and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Pioglitazone
[801] Pioglitazone is a known pharmaceutical agent that is used in the
treatment of diabetes. Its chemical name is 5-[[4-[2-(5-ethyl-2-
pyridyl)ethoxy]phenyl]methy]-2,4-thiazolidinedione. Its structure is:

Pioglitazone is the subject of U.S. Patent Number 4,687,777, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pioglitazone covalently attached to a peptide. In the present invention, pioglitazone is covalently attached to the peptide via the imido group and a linker.
This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable • as a linker.
Primidone
[802] Primidone is a known pharmaceutical agent that is used in the
treatment of epilepsy. Its structure is:

The composition of the invention comprises primidone covalently attached to a peptide. In the present invention, primidone is covalently attached to the peptide via one of the amido groups and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Rabeprazole
[803] Rabeprazole is a known pharmaceutical agent that is used in the
treatment of gastrointestinal ulcer and bacterial infection. Its chemical name is 2-[[[4-(3-memoxypropoxy)-3-memyl-2-pyridinyl]methyl]sulfinyl]-lH-benzimidazole. Its structure is:
Rabeprazole is the subject of EP 268956 B 1994, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rabeprazole covalently attached to a peptide. In the present invention, rabeprazole is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Ranitidine
[804] Ranitidine is a known pharmaceutical agent that is used in the
treatment of gastrointestinal ulcer. Its chemical name is N-[2-[[[5-[(dimemylarnino)methyl]-2-furanyl]methyl]thio]ethyl]-N'-methyl-2-nitro-l,l-ethenediamine. Its structure is:

Ranitidine is the subject of U.S. Patent Number GB 2220937 B 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ranitidine covalently attached to a peptide. In the present invention, ranitidine or modified ranitidine is covalently attached to the peptide via
the pseudo-ureido group and a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Ropinirole
[805] Ropinirole is a known pharmaceutical agent that is used in the
treatment of Parkinson disease. Its chemical name is (4-2(-dipropylamino)ethyl)-l,3-dihydro-2H-indol-2-one monohydrochloride. Its structure is:

Ropinirole is the subject of U.S. Patent Number 4,452,808 and 4,824,860, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ropinirole covalently attached to a peptide. In the present invention, ropinirole is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Rosiglitazone
[806] Rosiglitazone maleate is a known pharmaceutical agent that is used in
the treatment of diabetes. Its chemical name is 5-[[4-[2-(methyl-2-pyridinylamino)ethoxy]phenyl]methyl]-2,4-thiazolidinedione. Its structure is:

Rosiglitazone maleate is the subject of U.S. Patent Number 5,002,953 and 5,741,803, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rosiglitazone maleate covalently attached to a peptide. In the present invention, rosiglitazone maleate is covalently attached to the peptide via the imido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Sildenafil
[807] Sildenafil citrate is a known pharmaceutical agent that is used in the
treatment of sexual dysfunction. Its chemical name is l-[[3-(4,7-dihydro-l-methyl-7-oxo-3-propyl-lH-pyrazolo[4,3-d]pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]-4-methyl-piperazine. Its structure is:

Sildenafil citrate is the subject of U.S. Patent Number 5,250,534, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sildenafil citrate covalently attached to a peptide. In the
present invention, sildenafil citrate is covalently attached to the peptide via the amido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Thalidomide
[808] Thalidomide is a known pharmaceutical agent that is used in the
treatment of cachexia, diarrhea, leprosy, rheumatoid arthritis, transplant rejection, cancer and Crohn disease. Its chemical name is N-(2,6-dioxo-3-piperidyl)phthalimide. Its structure is:

Thalidomide is the subject of U.S. Patent Number 5,463,063, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises thalidomide covalently attached to a peptide. In the present invention, thalidomide is covalently attached to the peptide via the imido group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Theophylline
[809] Theophylline is a known pharmaceutical agent that is used in the
treatment of asthma. Its structure is:

The composition of the invention comprises theophylline covalently attached to a peptide. In the present invention, theophylline is covalently attached to the peptide via the imidazo group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Valspodar
[810] Valspodar is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is 6-[[R-(E)]-6,7-didehydro-N,4-dimethyl-3-oxo-L-2-aminooctanoic acid]-7-L-valine-cyclosporin A. Its structure is:

Valspodar is the subject of EP 296122 B 1993, herein incorporated by reference, which describes how to make that drug. The composition of the invention
comprises valspodar covalently attached to a peptide. In the present invention, valspodar is covalently attached to the peptide viaone of the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
Zafirlukast
[811] Zafirlukast is a known pharmaceutical agent that is used in the
treatment of asthma and rhinitis. Its chemical name is [3-[[2-methoxy-4-[[[(2-methylpheny1HsutfonyUaminolcarbonyllphenylJmethyll-l-methyl-lH-indol-S-yl]carbamic acid, cyclopentyl ester. Its structure is:

Zafirlukast is the subject of EP 199543 B 1991, EP 490648 B 1995, EP 490649 A 1992and U.S. Patent Numbers 4,859,692; 5,294,636; 5,319,097; 5,482,963; 5,583,152; and 5,612,367, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises zafirlukast covalently attached to a peptide. In the present invention, zafirlukast is covalently attached to the peptide via the amide group and a linker. This linker may be a small linear or cyclic molecule containing 2-6 atoms with one or more heteroatoms and one or more functional groups (such as amines, amides, alcohols or acids). For example, dihydropyran-3-carboxylic acid would be suitable as a linker.
XII.G - VIA THE THIOL GROUP
Mesna
[812] Mesna is used prophylactically as a uroprotective agent to decrease
the incidence of hemorrhagic cystitis in patients receiving ifosfamide. Its structure is:
HS~CH2-CH2-SO3
Mesna is the subject of U.S. Patent Number 4,220,660 and 5,696,172, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mesna covalently attached to a peptide. In the present invention, mesna is covalently attached to the peptide via the thiol group.
Xn.H - VIA A SULFATE GROUP
Etoricoxib
[813] Etoricoxib is a second generation cyclooxygenase n inhibitor. Its
structure is:

The composition of the invention comprises etoricoxib covalently attached to a peptide. In the present invention, etoricoxib is covalently attached to the peptide via the sulfate group.
Pentosan polysulfate
[814] Pentosan polysulfate is a known pharmaceutical agent that is used in
the treatment of arthritis, angina, hyperlipidemia, rheumatoid arthritis, cancer and cystitis. Its chemical name is (l-4)-|3-D-xylan 2,3-bis(hydrogen sulfate). Its structure is:
Pentosan polysulfate is the subject of U.S. Patent Number 5,180,715, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pentosan polysulfate covalently attached to a peptide. In the present invention, pentosan polysulfate is covalently attached to the peptide via the sulfate group.
XII.I -VIA A PROTEIN BOND
Activated Protein C
[815] Activated protein C is a known pharmaceutical agent that is used in
the treatment of blood clots. Its structure is well known and it is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. The carrier peptide attached to proteins are typically formed using standard chemistry.
Alpha 1 Proteinase Inhibitor
[816] Alpha 1 proteinase inhibitor is a known pharmaceutical agent that is
used in the treatment of emphysema. It is a natural product isolated from human
blood, using methods known to those of ordinary skill in the art. The carrier peptide attached to proteins are typically formed using standard chemistry.
Anaritide
[817] Anaritide is a known pharmaceutical agent that is used in the
treatment of oliguric acute renal failure. Its chemical name is N-L-arginyl-8-L-methionine-21 a-L-phenylalanine-2 lb-L-arginine-21 c-L-tyrosine-atriopeptin-21. Its structure is:
The carrier peptide attached to proteins are typically formed using standard chemistry.
Atrial Natriuretic Peptide
[818] Atrial Natriuretic Peptide is a vasodialator and diuretic. Its structure
is ArgSerSerCysPheGlyGly
ArgMetAspArglleGlyAlaGlnSerGlyLeuGlyCysAsnSerPheArgTyr. The carrier peptide is attached to the peptide using standard peptide chemistry.
Bactericidal/Permeability increasing (BPI) protein
[819] The bactericidal/permeability increasing (BPI) protein derivative of
the present invention, specifically the BPI-21 derivative, is a known pharmaceutical agent that is used in the treatment of septic shock. BPI was isolated from human blood cells. The composition of the invention comprises a bactericidal/permeability increasing protein derivative covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Endothelin A receptor antagonist
[820] The selective endothelin A receptor antagonist of the present
invention is a known pharmaceutical agent that is used in the treatment of heart
failure. It is known as BMS193884). The composition of the invention comprises a selective endothelin A receptor antagonist covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Epoetin
[821] Epoetin is a known pharmaceutical agent that is used in the treatment
of anemia. Its chemical name is 1-165-erythropoietin (human clone lambdaHEPOFL13 protein moiety) glycoform alpha. Epoetin is the subject of EP 148605 B (1990), priority US application 561024 (1983), herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Etanercept
[822] Etanercept is a known pharmaceutical agent that is used in the
treatment of arthritis. Its chemical name is 1-235-tumor necrosis factor receptor (human) fusion protein with 236-467-immunoglobulin Gl (human y 1-chain Fc fragment). Etanercept is the subject of EP 418014 B (1995), priority based on US application 403241 (1989), herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Exendin
[823] Exendin-4 is a known pharmaceutical agent that is used in the
treatment of diabetes. It is a synthetic form of a peptide isolated from the salivary secretions of the Gila monster lizard. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Filgrastim
[824] Filgrastim is a known pharmaceutical agent that is used in the
treatment of cancer, HIV infection, pneumonia, leukopenia and skin ulcer. Its
chemical name is N-L-methionyl-colony-stimulating factor (human clone 1034). Filgrastim is the subject of EP 237545 B (1991), based on priority application US 768959 (1985), herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Follitropin
[825] Follitropin is a known pharmaceutical agent that is used in the
treatment of infertility. Its chemical name is follicle-stimulating hormone (human alpha-subunit reduced), complex with follicle-stimulating hormone (human beta-subunit reduced).
Follitropin is the subject of WO 95/19991 (1995) and U.S. Patent Numbers 4,589,402; 5,270,057; and 5,767,251, herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Gastrin Immunogen
[826] Gastrimmune is an immunogenic form of gastrin-17 (G17), a growth
factor for colorectal, stomach and pancreatic cancers. It has use as a vaccine for cancer and gastrointestinal ulcer.
Gastrin 17 immunogen is the subject of U.S. Patent Numbers 5,622,702; 5,785,970; 5,607,676; and 5,609,870, herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Glatiramer Acetate
[827] Glatiramer acetate is a known pharmaceutical agent that is used in the
treatment of multiple sclerosis. Its chemical name is L-glutamic acid polymer with L-alanine, L-lysine and L-tyrosine, acetate.
Glatiramer acetate is the subject of U.S. Patent Number 6,054,430 and 5,981,589, herein incorporated by reference, which describes how to make that drug. The
377
carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Glucagon
[828] Glucagon is a known pharmaceutical agent that is used in the
treatment of diabetes It is a naturally occurring peptide that can either be isolated or synthesized, preferably using recombinant DNA technology. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Humanized monoclonal antibody, hu 1124
[829] Humanized monoclonal antibody, hu 1124, directed against CD1 la is
a known pharmaceutical agent that is used in the treatment of psoriasis and transplant rejection.
Humanized monoclonal antibody, hu 1124, directed against CD1 la is the subject of U.S. Patent Number 5622700, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises humanized monoclonal antibody, hu 1124, directed against CDlla covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Ilodecakin
[830] Ilodecakin is a known pharmaceutical agent that is used in the
treatment of hepatitis, autoimmune disorders and HIV infections. Its chemical name is interleukin 10, and it is both isolatable from natural sources and capable of being synthesized by those of skill in the art. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Imiglucerase
[831] Imiglucerase is a known pharmaceutical agent that is used in the
treatment of Gaucher disease. Its chemical name is glucosyl-(human placenta isoenzyme protein moiety) 495-L-histidine-ceramidase. It is a recombinant
glucocerebrosidase enzyme. Imiglucerase is the subject of EP 401362 B (1996), based on priority application US 289589 (1988), herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Infiiximab
[832] Infiiximab is a known pharmaceutical agent that is used in the
treatment of arthritis and HIV infection. It is a monoclonal antibody targeting tumor necrosis factor alpha. Its chemical name is immunoglobulin G, anti-(human tumour necrosis factor) (human-mouse monoclonal cA2 heavy chain), disulfide with human-mouse monoclonal cA2 light chain, dimer. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Insulin
[833] Human insulin is a known pharmaceutical agent that is used in the
treatment of diabetes. Insulin human is a biosynthetic or semisynthetic protein that is structurally identical to endogenous insulin secreted by the beta cells of the human pancreas. Although structurally identical to endogenous human insulin, commercially available insulin human is not extracted from the human pancreas, but is prepared biosynthetically from cultures of genetically modified Escherichia coli or Saccharomyces cerevisiae or semisynthetically by transpeptidation of pork insulin. Its structure is:

Human insulin is the subject of U.S. Patent Numbers 5,474,978 and 5,514,646, herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Insulin Analogue
[834] The insulin analogue of the present invention is a known
pharmaceutical agent that is used in the treatment of diabetes. Its chemical name is Human 29B-[N6-(l-oxotetradecyl)-L-lysine]-(lA-21A),(lB-29B)-Insulin. The composition of the invention comprises an insulin analogue covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Interferon Alfacon-1
[835] Interferon alfacon-1 is a known pharmaceutical agent that is used in
the treatment of viral infection and cancer. Its chemical name is interferon a 1 (human lymphoblast reduced), N-L-methionyl-22-L-arg-76-L-ala-78-L-asp-79-L-glu-86-L-tyr-90-L-tyr-l 56-L-thr-157-L-asn- 158-L-leu.
Interferon alfacon-1 is the subject of EP 422697 B (1994), based on priority US application 375494 (1982), herein incorporated by reference, which describes how to make that drug. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Interferon Beta-la
[836] Interferon ß-la is a known pharmaceutical agent that is used in the
treatment of multiple sclerosis, viral infection and cancer. It is 145258-61-3 human fibroblast protein moiety 74899-73-3 pre-(human fibroblast protein moiety reduced) 74899-71-1 human fibroblast protein moiety reduced. Biogen was awarded European patent number 41313 for the production of interferon |3 through recombinant technology. The patent covered recombinant DNA molecules, transformed hosts and methods for producing recombinant interferon beta proteins. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Interleukin-2
[837] Merleukin-2 is a known pharmaceutical agent that is used in the
treatment of renal cell carcinoma. IL-2 promotes proliferation, differentiation, and recruitment of T and B cells, natural killer (NK) cells, and thymocytes; IL-2 also causes cytolytic activity in a subset of lymphocytes and subsequent interactions between the immune system and malignant cells; IL-2 can stimulate lymphokine-activated killer (LAK) cells and tumor-infiltrating lymphocytes (TIL) cells. LAK cells (which are derived from lymphocytes from a patient and incubated in IL-2) have the ability to lyse cells which are resistant to NK cells. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Interleukin-12
[838] Interleukin-12 is a heterodimeric cytokine produced by phagocytic
cells, professional antigen-presenting cells such as dendritic cells and skin Langerhans cells, and B cells. Interleukin-12 production is induced by bacteria, intracellular pathogens, fungi, viruses, or their products in a T-cell-independent pathway or a T-cell-dependent pathway, the latter mediated through CD40 ligand-CD40 interaction. Interleukin-12 is produced rapidly after infection and acts as a proinflammatory cytokine eliciting production of interferon gamma, by T and natural killer cells, which activates phagocytic cells. The production of interleukin-12 is strictly regulated by positive and negative feedback mechanisms. If interleukin-12 and interleukin-12-induced interferon gamma are present during early T-cell expansion in response to antigen, T-helper type-1 cell generation is favored and generation of T-helper type-2 cells is inhibited. Thus interleukin-12 is also a potent immunoregulatory cytokine that promotes T-helper type-1 differentiation and is instrumental in the T-helper type-1-dependent resistance to infections by bacteria, intracellular parasites, fungi, and certain viruses. By inhibiting T-helper type-2 cell response, interleukin-12 has a suppressive effect on allergic reactions; by promoting T-helper type-1 responses it participates in the immunopathology responsible for several organ-specific autoimmune diseases. Viruses inducing a permanent or transient immunodepression, such as HIV and measles, may act, in part, by
suppressing interleukin-12 production. Because of its ability to enhance resistance to several infectious diseases and to act as an adjuvant in vaccination, and because of its powerful antitumor effect in vivo, interleukin-12 is currently in clinical trials in cancer patients and HIV-infected patients, and it is being considered for therapeutic use in other diseases. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
LFA3TIP, An immunosuppressant protein
[839] An immunosuppressant protein of the present invention is a known
pharmaceutical agent that is used in the treatment of psoriasis. It is a recombinant human fusion protein, LFA3TIP. An immunosuppressant protein is the subject of U.S. Patent Number 5,547,853, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises an immunosuppressant protein covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Lintuzumab
[840] Lintuzumab is a known pharmaceutical agent that is used in the
treatment of cancer. Its chemical name is immunoglobulin Gl (human-mouse monoclonal HuM195 yl-chain anti-human antigen CD 33), disulfide with human monoclonal HuM195 K-chain, dimer. Lintuzumab is the subject of U.S. Patent Number 5585089 (1996), herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises lintuzumab covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
LYM1
[841] LYM 1 is an antibody that is used in the treatment of cancer. The
novel pharmaceutical compound of the present invention is useful in accomplishing one or more of the following goals: enhancement of the chemical stability of the original compound; alteration of the release profile of an orally administered
product; enhanced digestion or absorption; targeted delivery to particular tissue/cell type; and provision for an oral dosage form when none exists. The novel pharmaceutical compound may contain one or more of the following: another active pharmaceutical agent, an adjuvant, or an inhibitor. The composition of the invention comprises LYM 1 covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Macrophage Colony Stimulating Factor
[842] The macrophage colony stimulating factor of the present invention is
a known pharmaceutical agent that is used in the treatment of mycosis, hyperlipidemia, wounds, and bacterial infection. It is a human clone pcCSF-17 precursor protein that is the subject of European Patent EP 209601 B (1993), which is based on US Patent Application Number 698359 (1985), which is hereby incorporated by reference. The composition of the invention comprises a macrophage colony stimulating factor covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Mecasermin
[843] Mecasermin is a known pharmaceutical agent that is used in the
treatment of hormone disorders, amyotrophic lateral sclerosis, neuropathy, kidney disease and osteoarthritis. Its chemical name is insulin-like growth factor I (human). Mecasermin is the subject of EP 476044 B 1997, priority US 361595 1989, and EP 219814 B 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mecasermin covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Nesiritide
[844] Nesiritide is a known pharmaceutical agent that is used in the
treatment of hypertension and heart failure. Its chemical name is brain natriuretic peptide-32, a natural product. Nesiritide is the subject of EP 418308 B 1995,
priority US 200383 1988, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nesiritide covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Oprelvekin
[845] Oprelvekin is a known pharmaceutical agent that is used in the
treatment of cancer, HIV infection, mucositis and Crohn disease. It is a recombinant interleukin-11. Oprelvekin is the subject of EP 504177 A 1992, priority US 441100 1989, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises oprelvekin covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Palivizumab
[846] Palivizumab, a monoclonal antibody, is a known pharmaceutical
agent that is used in the treatment of respiratory disease and viral infection. Its chemical name is immunoglobulin Gl, anti-(respiratory syncytial virus protein F)(human-mouse monoclonal MEDI-493 y 1-chain), disulfide with human-mouse monoclonal MEDI-493 K-chain, dimmer.
It is the subject of US Patent Number 5585089, which is incorporated herein by reference. The composition of the invention comprises palivizumab covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Prourokinase
[847] Prourokinase is a known pharmaceutical agent that is used in the
treatment of thrombosis. Prourokinase is the subject of U.S. Patent Number 5,741,682, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises prourokinase covalently attached to a
peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Recombinant hepatitis B vaccine
[848] The recombinant hepatitis B vaccine of the present invention is used
for immunization against hepatitis B virus infection. The composition of the invention comprises a recombinant hepatitis B vaccine covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Relaxin
[849] Relaxin is a known pharmaceutical agent that is used in the treatment
of scleroderma, scars, infertility and peripheral vascular disease. It is a recombinant natural protein. Relaxin is the subject of EP 112149 B 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises relaxin covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Rotavirus vaccine
[850] Rotavirus vaccine is a known pharmaceutical agent that is used in the
prevention of viral infection. The composition of the invention comprises rotavirus vaccine covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Sagramostim
[851] Sagramostim is a known pharmaceutical agent that is a granulocyte
macrophage-colony stimulating factor used in the treatment of cancer and HIV infection. Its chemical name is 23-L-leucine colony-stimulating factor 2 (human clone pHG25 protein moiety). Sagramostim is the subject of EP 183350 B 1992, priority US 666041 1984, and EP 212914 B 1992, priority US 763130 1985, herein incorporated by reference, which describes how to make that drug. The composition
of the invention comprises sagramostim covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Sevirumab
[852] Sevirumab is a known pharmaceutical agent that is used in the
treatment of cytomegalic inclusion disease. Its chemical name is immunoglobulin Gl, anti-(cytomegalovirus) (human monoclonal EV2-7 yl-chain), disulfide with human monoclonal EV2-7 K-chain, dimer. Sevirumab is the subject of U.S. Patent Number 5750106, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sevirumab covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Sinapultide
[853] Sinapultide is a known pharmaceutical agent that is used in the
treatment of respiratory distress syndrome. It is a mimic of human surfactant B protein, for the treatment of meconium aspiration syndrome. Its structure is: Lys-Leu-Leu-Leu-Leu-Lys-Leu-Leu-Leu-Leu-Lys-Leu-Leu-Leu-Leu-Lys-Leu-Leu-Leu-Leu-Lys. Sinapultide is the subject of WO 92/22315 1992, priority US 715397 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sinapultide covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Soluble chimeric protein CTLA4Ig
[854] The soluble chimeric protein CTLA4Ig is a known pharmaceutical
agent that is used in the treatment of psoriasis and transplant rejection. The soluble chimeric protein CTLA4Ig is the subject of EP 606217 B 1998, priority US 723617 1991, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises the soluble chimeric protein CTLA4Ig
covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Teriparatide
[855] Teriparatide is a known pharmaceutical agent that is used in the
treatment of thyroid deficiency. It is a parathyroid hormone. The composition of the invention comprises teriparatide covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Thrombopoetin
[856] Thrombopoetin is a human protein that is used in the treatment of
thrombocytopenia. The composition of the invention comprises thrombopoetin covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Thymosin alpha
[857] Thymosin a is a known pharmaceutical agent that is used in the
treatment of hepatitis B. Thymosin a is the subject of U.S. Patent Number 4,079,127, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises thymosin a covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Tifacogin
[858] Tifacogin, a tissue factor pathway inhibitor, is a known
pharmaceutical agent that is used in the treatment of thrombosis and septic shock. Its structure is N-L-alanyl- blood coagulation factor LACI (human clone lambdaP9 protein moiety reduced). Tifacogin is the subject of Canadian application 2196296, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises tifacogin covalently attached to a peptide.
The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
TPA analogue
[859] TPA Analogue is a known pharmaceutical agent that is used in the
treatment of acute myocardial infarction. It is related to naturally occurring tissue plasminogen activator and is disclosed in EP 293934 B 1994, priority US 58217 1987, herein incorporated by reference. The composition of the invention comprises TPA Analogue covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Trastuzumab
[860] Trastuzumab is a monoclonal antibody used in the treatment of
metatstatic breast cancer. Trastuzumab is the subject of U.S. Patent Number 5,677,171, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises trastuzumab covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
Urokinase
[861] Urokinase is used for the lysis of acute massive pulmonary emboli
(obstruction or substantial filling defects involving 2 or more lobar pulmonary arteries or an equivalent amount of emboli in other vessels) and for lysis of emboli accompanied by unstable hemodynamics (i.e., failure to maintain blood pressure without supportive measures) in adults. The drug is generally most effective in lysing recently formed thrombi. Urokinase is an enzyme produced by the kidneys and excreted in urine. Commercially available urokinase is isolated from human kidney tissue cultures and contains both 55,000 dalton high molecular weight and 34,000 dalton low molecular weight forms of urokinase. The drug is soluble in water. Urokinase is commercially available as a lyophilized white powder which also contains albumin human, mannitol, and sodium chloride or gelatin, mannitol,
sodium chloride, and monobasic sodium phosphate anhydrous. The composition of the invention comprises urokinase covalently attached to a peptide. The carrier peptide attached to proteins are typically formed using typical peptide chemistry.
XIL.T - VIA A TERTIARY AMINE
[862] For those drugs that lack a functional group amenable to formation of
a stable bond with a peptide it may be necessary to modify the drug to form a prodrug such that upon release of the prodrug from the carrier peptide the prodrug will rearrange back to the reference drug. The following category of drugs, tertiary amine, fall into this category.
Alprazalom
[863] Alprazalom is a known pharmaceutical agent that is used in the
treatment of anxiety disorders. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
389
In the present invention, alprazalom or modified alprazalom is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Altinicline
[864] Altinicline is a known pharmaceutical agent that is used in the
treatment of Parkinson's disease. Its chemical name is 3-ethynyl-5-[(2S)-l-methyl-2-pyrrolidinyl]pyridine. Its structure is:
In the present invention, altinicline or modified altinicline is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates. Altinicline is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art.
Anastrozole
[865] Anastrozole is a known pharmaceutical agent that is used in the
treatment of breast cancer. Its chemical name is a,a,a',a'-tetramethyl-5-(lH-1,2,4-triazol-l-ylmethyl)-l,3-benzenediacetonitrile. Its structure is:

Anastrozole is the subject of EP 296749 B (1994), priority GB 14013 (1987), herein incorporated by reference, which describes how to make that drug. In the present
invention, the anastrozole or modified anastrozole is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Amitriptyline
[866] Amitriptyline is a known pharmaceutical agent that is used in the
treatment of depression. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, amitriptyline or modified amitriptyline is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Aripiprazole
[867] Aripiprazole is a known pharmaceutical agent that is used in reducing
both the positive and negative symptoms of acutely psychotic patients. Its chemical name is 7-[4-[4-(2,3-dichlorophenyl)-l-piperazinyl]butoxy]-3,4-dihydro-2(lH)-quinolinone. Its structure is:

Aripiprazole is the subject of EP 367141 B (1996)(priority Japan 276953 (1988)), herein incorporated by reference, which describes how to make that drug. In the present invention, the aripiprazole or modified aripiprazole is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Avasimibe
[868] Avasimibe is a known pharmaceutical agent that is used in the
treatment of hyperlipidemia. Its chemical name is N-[[2,6-bis(l-methylethyl)phenoxy]sulfonyl]-2,4,6-tris(l-methylethyl)benzeneacetamide. Its
structure is:
Avasimibe is the subject of WO 94/26702 1994 (priority US 62515 (1993)), herein incorporated by reference, which describes how to make that drug. Li the present invention, avasimibe or modified avasimibe is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Azelastine
[869] Azelastine is a known pharmaceutical agent that is used in the
treatment of itching of the eye associated with allergic conjunctivitis. Its chemical name is 4-[(4-chlorophenyl)methyl]-2-(hexahydro-l-methyl-lH-azepin-4-yl)-l(2H)-phthalazinone. Its structure is:

Azelastine is the subject of U.S. Patent Number 5,164,194, herein incorporated by reference, which describes how to make that drug. In the present invention, the azelastine or modified azelastine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Benzatropine Mesylate
[870] Benzatropine mesylate is a known pharmaceutical agent that is used
in the treatment of Parkinsoniajn syndrome. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, benzatropine mesylate or modified benzatropine mesylate is covalently attached to the peptide via a linker. . This linker may be a small
molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Buspirone
[871] Buspirone is a known pharmaceutical agent that is used in the
treatment of atopic dermatitis. Its chemical name is 8-[4-[4-(2-pyrimidinyl)-l-piperazinyl]butyl]-8-azaspiro[4,5]decane-7,9-dione hydrochloride. Its structure is:

Buspirone is the subject of U.S. Patent Number 4,182,763 and 5,015,646, herein incorporated by reference, which describes how to make that drug. In the present invention, the buspirone or modified buspirone is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Caffeine
[872] Caffeine is a known pharmaceutical agent that is used in the
treatment of neonatal apnea. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, the caffeine or modified caffeine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Candesartan Cilexitil
[873] Candesartan cilexitil is a known pharmaceutical agent that is used in
the treatment of heart failure. Its chemical name is 2-ethoxy-l-[[2'-(lH-tetrazol-5-yl) [ 1,1 -biphenyl] -4-yl]methyl] -1 -H -benzimidazole-7-carboxylic acid 1 -
[[(cyclohexyloxy)carbonyl]oxy]ethyl ester. Its structure is:

Candesartan cilexitil is the subject of U.S. Patent Numbers 5,196,444; 5,534,534; 5,703,110 and 5,705,517, herein incorporated by reference, which describes how to make that drug. In the present invention, the candesartan cilexitil or modified candesartan cilexitil is covalently attached to the peptide via a linker.. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Celecoxib
[874] Celecoxib is a known pharmaceutical agent that is used in the
treatment of osteo- and rheumatoid arthritis. Its chemical name is 4-[5-(4-methylphenyl)-3-(trifluoromethyl)-lH-pyrazol-l-yl]benzenesulfonamide. Its
structure is:
Celecoxib is the subject of U.S. Patent Numbers 5,466,823; 5,563,165; 5,760,068 and 5,972,986, herein incorporated by reference, which describes how to make that drug. In the present invention, the celecoxib or modified celecoxib is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short, chain of either amino acids or carbohydrates.
Chlorpheniramine
[875] Chlorpheniramine is a known pharmaceutical agent that is used in the
treatment of nasal congestion. It is both commercially available and readily
manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, the chlorpheniramine or modified chlorpheniramine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Cisatracurium Besylate
[876] Cisatracurium besylate is a known pharmaceutical agent that is used
as a neuromuscular blocker in surgery. Its chemical name is [1R-[la,2a(l1R*,2'R*)]] -2,2'-[l,5-pentanediylbis[oxy(3-oxoo-3,l-propanediyl)]]bis[l-[(3,4-dimethoxyphenyl) methyl]-1,2,3,4-tetrahydro-6,7-dimethoxy-2-methyl-
isoquinolinium. Its structure is:

Cisatracurium besylate is the subject of U.S. Patent Number 5,453,510 and WO 92/965 (1992), herein incorporated by reference, which describes how to make that drug. In the present invention, the cisatracurium or modified cisatracurium is covalently attached to the peptide via a linker. This linker may be a small molecule i containing 2-6 carbons and one or more functional groups (such as amines, amides,
alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Citalopram
[877] Citalopram is a known pharmaceutical agent that is used in the
treatment of depression. Its chemical name is l-[3-(dimethylamino)propyl]-l-(4-fluorophenyl)-l,3-dihydro-5-isobenzofurancarbonitrile. Its structure is:

Citalopram is the subject of GB 1526331 (1978), GB 1486 (1976), and EP 171943 B (1988), herein incorporated by reference, which describes how to make that drug. In the present invention, the citalopram or modified citalopram is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Clomipramine
[878] Clomipramine is a known pharmaceutical agent that is used in the
treatment of obsessive-compulsive disorder. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, the clomipramine or modified clomipramine is covalently attached to the peptide via a linker. This linker may be a small molecule containing
2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Clopidogrel
[879] Clopidogrel is a known pharmaceutical agent that is used in the
treatment of thrombosis and stroke. Its chemical name is (S)-a-(2-chlorophenyl)-6,7-dihydrothieno[3,2-c]pyridine-5(4H)-acetic acid methyl ester sulfate (1:1). Its structure is:
Clopidogrel is the subject of U.S. Patent Numbers 4,529,596; 4,847,265; and 5,576,328, herein incorporated by reference, which describes how to make that drug. In the present invention, the clopidogrel or modified clopidogrel is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short: chain of either amino acids or carbohydrates.
Cyclobenzaprine
[880] Cyclobenzaprine is a known pharmaceutical agent that is used in the
treatment of muscle spasm. Its chemical name is 3-(5H-dibenzo[a,d]cyclohepten-5-ylidene)-N,N-dimethyl-l-propanamine. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, the cyclobenzaprine or modified cyclobenzaprine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Dextromethorphan
[881] Dextromethorphan is a known pharmaceutical agent that is used in
the treatment of coughs. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
In the present invention, the dextromethorphan or modified dextromethorphan is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides,
alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Diacetylmorphine
[882] Diacetylmorphine is a known pharmaceutical agent that is used in the
treatment of pain. The composition of the invention comprises diacetylmorphine covalently attached to a peptide. In the present invention, diacetylmorphine or modified diacetylmorphine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Diazepam
[883] Diazepam is a known pharmaceutical agent that is used in the
treatment of anxiety. It is both commercially available and readily manufactured
using published synthetic schemes by those of ordinary skill in the art. Its structure
is:
In the present invention, the diazepam or modified diazepam is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Dicyclomine
[884] Dicyclomine is a known pharmaceutical agent that is used in the
treatment of functional disturbances of GI motility such as irritable bowel syndrome. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, the dicyclomine or modified dicyclomine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.

Diltiazem
[885] Diltiazem is a known pharmaceutical agent that is used in the
treatment of hypertension and angina. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:
Diltiazem is the subject of U.S. Patent Number 5,529,791, herein incorporated by reference, which describes how to make that drug. In the present invention, the diltiazem or modified diltiazem is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Fentanyl
[886] Fentanyl is a known pharmaceutical agent that is used in the
treatment of pain. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. Its structure is:

In the present invention, the fentanyl or modified fentanyl is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons
and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Flumazenil
[887] Flumazenil is a known pharmaceutical agent that is used in the
treatment of depression and liver disease. Its chemical name is 8-fluoro-5,6-dihydro-5-methyl-6-oxo-4H-imidazo[l ,5-a] [ 1,4]benzodiazepine-3-carboxylic acid ethyl ester. Its structure is:

Flumazenil is the subject of U.S. Patent Number 4,316,839, herein incorporated by reference, which describes how to make that drug. In the present invention, the flumazenil or modified flumazenil is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Gepirone
[888] Gepirone is a known pharmaceutical agent that is used in the
treatment of anxiety and depression. Its chemical name is 4,4-dimethyl-l-[4-[4-(2-pyrimidinyl)-l-piperazinyl]butyl]-2,6-piperidinedione. Its structure is:

Gepirone is the subject of GB 2114122 B (1985), based on priority US application 334688 (1981), herein incorporated by reference, which describes how to make that drug, In the present invention, the gepirone or modified gepirone is covalently attached to the peptide via a linker. This linker may be a small molecule containing
2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Imipramine
[889] Imipramine is a known pharmaceutical agent that is used in the
treatment of depression. Its structure is:

In the present invention, the imipramine or modified imipramine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Isosorbide Dinitrate
[890] Isosorbide dinitrate is a known pharmaceutical agent that is used in
the treatment of angina. It is made up of the organic nitrates and nitrites are esters of nitrous or nitric acid, primarily amyl nitrite. In the present invention, isosorbide dinitrate is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Irbesartan
[891] Irbesartan is a known pharmaceutical agent that is used in the
treatment of hypertension. Its chemical name is 2-butyl-3-[[2'-(lH-tetrazol-5-yl)[l,r-biphenyl]-4-yl]methyl]-l,3-diazaspiro[4.4]non-l-en-4-one. Its structure is:

Irbesartan is the subject of U.S. Patent Number 5,270,317, herein incorporated by reference, which describes how to make that drug. In the present invention, the irbesartan or modified irbesartan is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Itraconazole
[892] Itraconazole is a known pharmaceutical agent that is used in the
treatment of mycosis. Its chemical name is 4-[4-[4-[4-[[2-(2,4-dichlorophenyl)-2-[(lH-l,2,4-triazol-l-yl)methyl]-l,3-dioxolan-4-yl]methoxy]phenyl]-l-piperazinyl]phenyl]-2,4-dihydro-2-(l-methylpropyl)-3H-l,2,4-triazol-3-one. Its structure is:

Itraconazole is the subject of U.S. Patent Numbers 4,267,179; 4,727,064; and 5,707,975, herein incorporated by reference, which describes how to make that drug. In the present invention, the itraconazole or modified itraconazole is covalently
attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either arnino acids or carbohydrates.
Ketoconazole
[893] Ketoconazole is used in the treatment of blastomycosis, Candida!
infections (i.e., oropharyngeal and/or esophageal candidiasis, vulvovaginal candidiasis, candiduria, chronic mucocutaneous candidiasis), chromomycosis (chromoblastomycosis), coccidioidomycosis, histoplasmosis, and
paracoccidioidomycosis. Its structure is:

In the present invention, the ketoconazole or modified ketoconazole is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Leflunomide
[894] Leflunomide is a known pharmaceutical agent that is used in the
treatment of rheumatoid arthritis. Its chemical name is 5-methyl-N-[4-(trifluoromethyl)phenyl]-4-isoxazolecarboxamide. Its structure is:

Leflunomide is the subject of LT.S. Patent Number 5,679,709, herein incorporated by reference, which describes how to make that drug. In the present invention, the leflunomide or modified leflunomide is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more
functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Lesopitron
[895] Lesopitron is a known pharmaceutical agent that is used in the
treatment of anxiety. Its chemical name is 2-[4-[4-(4-chloro-lH-pyrazol-l-yl)butyl]-l-piperazinyl]pyrimidine dihydrochloride. Its structure is:

Lesopitron is the subject of EP 382637 A (1990), herein incorporated by reference, which describes how to make that drug. In the present invention, the lesopitron or modified lesopitron is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Lipoxygenase inhibitor
[896] The lipoxygenase inhibitor of the present invention is a known
pharmaceutical agent with the chemical name (R)-2-chloro-5-(2-azetidinylmethoxy)pyridine. The composition of the invention comprises a lipoxygenase inhibitor covalently attached to a peptide. In the present invention, the lipoxygenase inhibitor or modified lipoxygenase inhibitor is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Loratidine
[897] Loratidine is a known pharmaceutical agent that is used in the
treatment of allergy and rhinitis. Its chemical name is ethyl 4-(8-chloro-5,6-dihydro-
1 lH-benzo[5,6]cyclohepta[l,2-b]pyridin-l 1-ylidene-l-piperidinecarboxylate. Its structure is:
Loratidine is the subject of U.S. Patent Number 4,282,233; 4,659,716 and 4,863,931, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises loratidine or modified loratidine covalently attached to a peptide. In the present invention, the active agent is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Mirtazapine
[898] Mirtazapine is a known pharmaceutical agent that is used in the
treatment of depression. Its chemical name is l,2,3,4,10,14b-hexahydro-2-methylpyrazino[2,l-a]pyrido[2,3-c]L2]benzazepine. Its structure is:

Mirtazapine is the subject of GB 1543171 1979, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mirtazapine covalently attached to a peptide. In the present invention, the
mirtazapine or modified mirtazapine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Mivacurium
[899] Mivacurium is a known pharmaceutical agent that is used as a
neurolomuscular blocker and muscle relaxant. Its chemical name is [R-[R*,R*-
(E)]]-2,2'-[(l,8-dioxo-4-octene-l,8-diyl)bis(oxy-3,l-propanediyl)]bis[l,2,3,4-
tetrahydro-6,7-dimethoxy-2-methyl-l-[(3,4,5-trimethoxyphenyl)methyl]-
isoquinolinium chloride. Its structure is:

Mivacurium is the subject of U.S. Patent Number 4,761,418, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises mivacurium covalently attached to a peptide. In the present invention, mivacurium or modified mivacurium is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Nefazodone
[900] Nefazodone is a known pharmaceutical agent that is used in the
treatment of depression. Its chemical name is 2-[3-[4-(3-chlorophenyl)-l-
piperazinyl]propyl]-5-ethyl-2,4-dihydro-4-(2-phenoxyethyl)-3H-l,2,4-triazol-3-one. Its structure is:
Nefazodone is the subject of U.S. Patent Number 4,338,317 and 5,256,664, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises nefazodone covalently attached to a peptide. In the present invention, nefazodone or modified nefazodone is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Oral nonsteroidal antiestrogen
[901] The oral nonsteroidal antiestrogen compound of the present
invention is a known pharmaceutical agent that is used in the treatment of cancer. Its chemical name is 2,2-dimethylpropanoic acid (S)-4-[7-(2,2-dimethyl-l-
oxopropoxy)-4-methyl-2-[4-[2-(l-piperidinyl)ethoxy]phenyl]-2H-l-benzopyran-3-yl]phenyl ester. Its structure is:

An oral nonsteroidal antiestrogen compound is the subject of WO 96/26201 1996, priority US 388207 1995, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises an oral nonsteroidal antiestrogen compound covalently attached to a peptide. In the present invention, the oral nonsteroidal antiestrogen compound or modified oral nonsteroidal antiestrogen compound is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Orphenadrine citrate
[902] Orphenadrine citrate is a known pharmaceutical agent that is used in
the treatment of skeletal muscle spasm. Its structure is:

a n
The composition of the invention comprises orphenadrine citrate or modified orphenadrine citrate covalently attached to a peptide. In the present invention, orphenadrine citrate is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Pleconaril
[903] Pleconaril is a known pharmaceutical agent that is used in the
treatment of viral infection. Its chemical name is 3-[3,5-dimethyl-4-[3-(3-methyl-5-isoxazolyl)propoxy]phenyl]-5-(trifluoromethyl)-l,2,4-oxadiazole. Its structure is:

Pleconaril is the subject of EP 566199 A 1993, priority US 869287 1992, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises pleconaril or modified pleconaril covalently attached to a peptide. In the present invention, pleconaril is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Prochlorperazine maleate
[904] Prochlorperazine maleate is a known pharmaceutical agent that is
used in the treatment of nausea and psychotic disorders. Its structure is:

The composition of the invention comprises prochlorperazine maleate covalently attached to a peptide. In the present invention, prochlorperazine maleate or modified prochlorperazine maleate is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Promethazine
[905] Promethazine is used for its sedative and antiemetic effects in surgery
and obstetrics (during labor). The drug reduces preoperative tension and anxiety, facilitates sleep, and reduces postoperative nausea and vomiting. As a preanesthetic medication, promethazine is used in conjunction with reduced doses of an opiate analgesic and a belladonna alkaloid. Promethazine may also be used as a routine sedative and as an adjunct to analgesics for control of pain. Its structure is:

The composition of the invention comprises promethazine covalently attached to a peptide. In the present invention, promethazine or modified promethazine is
covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Propoxyphene
[906] Propoxyphene is a known pharmaceutical agent that is used in the
treatment of pain. It is a mild narcotic analgesic. It is both commercially available and readily manufactured using published synthetic schemes by those of ordinary skill in the art. The structure of propoxyphene is

The composition of the invention comprises propoxyphene covalently attached to a peptide. In the present invention, propoxyphene or modified propoxyphene is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Risperidone
[907] Risperidone is a known pharmaceutical agent that is used in the
treatment of schizophrenia. Its chemical name is 3-[2-[4-(6-fiuoro-l,2-benzisoxazol-3-yl)piperidinyl]ethyl]-6,7,8,9-tetrahydro-2-methyl-4H-pyrido[l,2-a]pyrimidin-4-one. Its structure is:

Risperidone is the subject of U.S. Patent Number 4,804,663 and 5,158,952, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises risperidone covalently attached to a peptide. In the present invention, risperidone or modified risperidone is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Rofecoxib
[908] Rofecoxib is a known pharmaceutical agent that is used in the
treatment of inflammation, rheumatoid arthritis, osteoarthritis, pain, and Alzheimer disease. Its chemical name is 4-[4-(methylsulfonyl)phenyl]-3-phenyl-2(5H)-furanone. Its structure is:
/MA
Rofecoxib is the subject of U.S. Patent Number 5,474,995; 5,691,374; and 6063811, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises rofecoxib covalently attached to a peptide. In the present invention, rofecoxib or modified rofecoxib is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Selegiline
[909] Selegiline is a known pharmaceutical agent that is used in the
treatment of Parkinson disease. Its chemical name is (R)-N,a-dimethyl-N-2-propynylbenzeneethanamine. Its structure is:

The composition of the invention comprises selegiline covalently attached to a peptide. In the present invention, selegiline or modified selegiline is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Sibutramine
[910] Sibutramine is a known pharmaceutical agent that is used in the
treatment of obesity. Its chemical name is l-(4-chlorophenyl)-N,N-dimethyl-a-(2-methylpropyl)cyclobutanemethanamine hydrocbioride monohydrate. Its structure is:

Sibutramine is the subject of U.S. Patent Number 4,746,680 and 4,929,629, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises sibutramine covalently attached to a peptide. In the present invention, sibutramine or modified sibutramine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Tamoxifen
[911] Tamoxifen is a known pharmaceutical agent that is used in the
treatment of breast cancer. Its structure is:

Tamoxifen is the subject of U.S. Patent Number 4,536,516, herein incorporated by reference, which describes how to make that drug. In the present invention, tamoxifen or modified tamoxifen is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Terbinafine
[912] Terbinafine is a known pharmaceutical agent that is used in the
treatment of mycosis. Its chemical name is (E)-N-(6,6-dimethyl-2-hepten-4-ynyl)-N-methyl-1-naphthalenemethanamine. Its structure is:

Terbinafine is the subject of U.S. Patent Number 4,680,291 and 4,755,534, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises terbinafine covalently attached to a peptide. In the present invention, terbinafine or modified terbinafine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Thiotepa
[913] Thiotepa is a known pharmaceutical agent that is used in the
treatment of cancer. Its structure is:

419
The composition of the invention comprises thiotepa covalently attached to a peptide. In the present invention, the active agent is structurally modified for attachement to the peptide. When the modified thiotepa is released from the peptide, the original structure of thiotipa is regenerated.
Ticlopidine
[914] Ticlopidine is a known pharmaceutical agent that is used in the
treatment of stroke and thrombosis. Its chemical name is 5-[(2-chlorophenyl)methyl]-4,5,6,7-tetrahydrothieno[3,2-c]pyridine. Its structure is:

Ticlopidine is the subject of U.S. Patent Number 5,529,791, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises ticlopidine covalently attached to a peptide. In the present invention, ticlopidine or modified ticlopidine is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Trazadone
[915] Trazadone is a known pharmaceutical agent that is used in the
treatment of depression. Its structure is:

The composition of the invention comprises trazadone covalently attached to a peptide. In the present invention, trazadone or modified trazadone is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Vecuronium
[916] Vecuronium is a known pharmaceutical agent that is used for skeletal
muscle relaxation. Its structure is:

The composition of the invention comprises vecuronium covalently attached to a peptide. In the present invention, vecuronium or modified vecuronium is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Verapamil
[917] Verapamil is a known pharmaceutical agent that is used in the
treatment of hypertension. Its structure is:

The composition of the invention comprises verapamil covalently attached to a peptide. In the present invention, verapamil or modified verapamil is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Xaliproden
[918] Xaliproden is a known pharmaceutical agent that is used in the
treatment of Alzheimer disease and amyotrophic lateral sclerosis. Its chemical name is l,2,3,6-tetrahydro-i-[2-(l-naphthalenyl)ethyl]-4-[3-
(trifluoromethyl)phenyl]pyridine. Its structure is:

Xaliproden is the subject of EP 101381 B 1985, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises xaliproden covalently attached to a peptide. In the present invention, xaliproden or modified xaliproden is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols,, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Zaleplon
[919] Zaleplon is a known pharmaceutical agent that is used in the
treatment of insomnia. Its chemical name is N-[3-(3-cyanopyrazolo[l,5-a]pyrimidin-7-yl)phenyl]-N-ethylacetamide. Its structure is:

Zaleplon is the subject of U.S. Patent Number 4,626,538, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises zaleplon covalently attached to a peptide. In the present invention, zaleplon or modified zaleplon is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
Zolpidem
[920] Zolpidem is a known pharmaceutical agent that is used in the
treatment of insomnia. Its chemical name is N,N,6-trimethyl-2-(4-methylphenyl)-imidazol[l,2-a]pyridine-3-acetamide. Its structure is:

Zolpidem is the subject of U.S. Patent Number 4,382,938, EP 50563 B 1984, and EP 251859 B 1990, herein incorporated by reference, which describes how to make that drug. The composition of the invention comprises zolpidem covalently attached to a peptide. In the present invention, zolpidem or modified zolpidem is covalently attached to the peptide via a linker. This linker may be a small molecule containing 2-6 carbons and one or more functional groups (such as amines, amides, alcohols, or acids) or may be made up of a short chain of either amino acids or carbohydrates.
WE CLAIM:
1. A composition comprising:
a unprotected carrier peptide that comprises at least one active agent covalently attached to said carrier peptide, wherein the active agent is attached through the C-terminus, attached through the N-terminus, or attached through the side-chain of the carrier peptide, or a combination thereof;
wherein said carrier peptide comprises fewer than 50 amino acids;
wherein said composition is in a form suitable for release of said active agent into the bloodstream; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders and a platelet anti-aggregation agent.
2. The composition as claimed in claim 1, wherein said carrier peptide is a single amino acid.
3. The composition as claimed in claim 1, wherein said carrier peptide comprises dipetide.
4. The composition as claimed in claim 3, wherein said dipeptide comprises at least one of glutamine, glutamic acid, aspartic acid, serine, lysine, cysteine, threonine, tyrosine, asparagine, or arginine
5. The composition as claimed in claim 1, wherein said carrier peptide is a tripeptide.
6. The composition as claimed in claim 5, wherein said tripeptide comprises at least one of glutamine, aspartic acid, glutamic acid, serine, lysine, cysteine, threonine, tyrosine, asparagine, or arginine.
7. The composition as claimed in claim 1, wherein said carrier peptide has a
length between four and eight amino acids.
8. The composition as claimed in claim 1, wherein said carrier peptide has a length between four and 15 amino acids
9. The composition as claimed in claim 1 wherein said carrier peptide has a length between nine and 50 amino acids.
10. The composition as claimed in claim 1, wherein said active agent is selected from Table 2.
11. The composition as claimed in claim 1, comprising multiple active agents.
12. The composition as claimed in claim 1, wherein said carrier peptide active agent composition is selected from the group of active agent bound to -Ser-Ser, -PolySer, -Lys, -Glu-Glu, Asp-Asp, Asp-Asp-Asp, Asp-Asp-Glu, AspAsp-Ser, Asp-Asp-Lys, Asp-Asp-Cys, Ala-Glu, Ala-Ser, Ala-Asp, Ala-Asn, Ala-Thr, Ala-Arg, Ala-Cys, Ala-Gin, Ala- Tyr, LeuGlu, Leu-Ser; Leu-Asp, Leu-Asn, Leu-Thr, Leu-Arg, Leu-Cys, Leu-Gin, Leu-Tyr, PheGlu, Phe-Ser, Phe-Asp, Phe-Asn, Phe-Thr, Phe-Arg, Phe-Cys, Phe-Gln, Phe-Tyr, Val-Glu, Val-Ser, Val-Asp, Val-Asn, Val-Thr, Val-Arg, Val-Cys, Val-Gln, Val-Tyr.
13. The composition as claimed in claim 1, comprising said carrier peptide covalently attached to a fatty acid.
14. The composition as claimed in claim 1, wherein said carrier peptide is covalently attached to polyethylene glycol.
15. The composition as claimed in claim 1, wherein said carrier peptide is covalently attached to cyclodextrin.
16. The composition as claimed in claim 1, wherein said carrier peptide is non-covalently associated with cyclodextrin.
17. The composition as claimed in claim 1, wherein a polymer formulation affords - sustained release of the active agent.
18. The composition as claimed in claim 1, wherein said carrier peptide enhances absorption.
19. The composition as claimed in claim 1, wherein said carrier peptide is a homopolymer or a heteropolymer.
20. The composition as claimed in claim 1, wherein said carrier peptide is a homopolymer comprising naturally occurring amino acids.
21. The composition as claimed in claim 1, wherein said carrier peptide is a homopolymer comprising synthetic amino acids
22. The composition as claimed in claim 1, wherein said carrier peptide is a heteropolymer comprising two or more naturally occurring amino acids.
23. The composition as claimed in claim 1, wherein said carrier peptide is a heteropolymer comprising two or more synthetic amino acids.
24. The composition as claimed in claim 23, wherein said carrier peptide is a heteropolymer comprising one or more naturally occurring amino acids and one or. more synthetic amino acids.
25. The composition as claimed in claim 1, wherein said composition comprises at least one adjuvant attached to said carrier peptide.
26. The composition as claimed in claim 25, wherein said adjuvant enhances absorption.
27. The composition as claimed in claim 25, wherein said adjuvant enhances bioadhesive properties.
28. The composition as claimed in claim 27, wherein said bioadhesive property of said adjuvant imparts sustained release pharmacokinetics of the active agents in the alimentary tract.
29. The composition as claimed in claim 28, wherein said adjuvant targets delivery of the carrier peptide to specific locations in the alimentary tract, specific cells in the systemic circulation or to specific enzymes in the intestinal lumen or. brush border membrane.
30. The composition as claimed in claim 28, wherein said adjuvant is the peptide itself.
31. The composition as claimed in claim 1, wherein said carrier peptide is in a form which enhances the solubility of the active agent in aqueous or organic solvents.
32. The composition as claimed in claim 35, wherein said solubility allows even dispersion in polymer formulations
33. Tile composition as claimed in claim 1, wherein said carrier peptide is in a form which affords sustained release kinetics of absorption to the parent drug.
34. The composition as claimed in claim 1, wherein said composition is in a form designed to allow release of said active agent according to zero order kinetics.
35. The composition as claimed in claim 1, wherein said composition is in a form that enhances therapeutic efficacy as claimed in said active agent by decreasing toxicity of said active agent, decreasing clearance rate of said active agent, increasing steady state concentration of said active agent, maintaining therapeutic levels for an extended period of the active agent, or avoiding drops in the effective level of said active agent or combinations thereof.
36. The composition as claimed in claim 1, wherein said composition is in a form that enhances the in vivo stability of said active agent.
37. The composition as claimed in claim 1, wherein said composition is in a form that enhances the in vitro stability of said active agent
38. A composition comprising:
an unprotected carrier peptide that comprises at least one active agent covalently attached to said carrier peptide through the N-terminus;
wherein said carrier peptide is not individually Glu, Tyr, Ala, Met, or Gly-Gly and has a length less than 50 amino acids;
wherein said composition is in a form suitable for release of said active agent into the bloodstream; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders and a platelet anti-aggregation agent.
39. A composition comprising:
an unprotected carrier peptide that comprises at least one active agent covalentiy attached to said carrier peptide;
wherein said carrier peptide has a length between 1 and 500 amino acids;
wherein said composition is in a form suitable for release of said active agent into the bloodstream from the alimentary tract; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent
40. A composition comprising,
an unprotected carrier peptide with a length between one and 50 amino acids;
at least one active agent covaiently bound to said carrier peptide;
wherein said composition is in a form suitable for modulation of the pharmacological effect of said composition in the small intestine; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antideppressant,
an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent.
41. A composition comprising:
a unprotected carrier peptide with a length between three and nine amino acids; and at least one active agent covalently bound to said carrier peptide.
42. A composition comprising: an unprotected carrier peptide that comprises
at least one active agent covalently attached to said carrier peptide; wherein said carrier
peptide is a single amino acid; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an
antibiotic agent, an anti-diarrhea agent; a cardiovascular drug, a cough suppressant, an
immunosuppressant agent, a neurological agent, an antidepressant, an agent for
treating gastrointestinal disorders, and a platelet anti-aggregation agent;
with the proviso that the amino acid is not alanine, glutamine, tyrosine, methionine.
43. A composition comprising: an unprotected carrier peptide and at least one active agent covalently attached to said carrier peptide; wherein said carrier peptide is a dipeptide; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuopressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent;
with the proviso that the dipeptide is not gly-gly.
44. A composition comprising: an unprotected carrier peptide that comprises at least one active agent covalently attached to said carrier peptide; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant. an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent; with the proviso that said active agent is not salicylic acid; and wherein said carrier peptide is in a form suitable for release of said active agent into the bloodstream.
45. A composition comprising:
an unprotected carrier peptide wherein said carrier peptide has a length between one and 50 amino acids and is in a form suitable for pharmacological effect in the small intestine of a subject;
at least one active agent covalently bound to said carrier peptide wherein said active agent is released into the bloodstream; and
wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent.
46. A composition comprising:
an unprotected carrier peptide wherein said carrier peptide has a length between one and 50 amino acids and is in a form suitable for release of said active agent into the bloodstream;
at least two active agents covalently bound to said carrier peptide; and wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent.
47. A composition comprising:
an unprotected carrier peptide wherein said carrier peptide has a length between one and 50 amino acids in a form wherein said active agent is delivered into systemic circulation;
an active agent covalently bound to said carrier peptide and wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent.
48. A composition comprising:
an unprotected carrier peptide wherein said carrier peptide has a length between one and 50 amino acids in a form which converts the mechanism of drug adsorption from passive to active uptake;
an active agent covalently bound to said carrier peptide; and wherein the active agent is selected from an analgesic agent, an anti-anxiety drug, an antibiotic agent, an anti-diarrhea agent, a cardiovascular drug, a cough suppressant, an immunosuppressant agent, a neurological agent, an antidepressant, an agent for treating gastrointestinal disorders, and a platelet anti-aggregation agent.
49. A composition comprising at least one active agent covalently bound to polyethylene glycol in a form suitable for modulation in the alimentary tract.
50. The composition as claimed in claim 47, wherein said composition comprises an adjuvant non covalently bound to said carrier peptide.
51. The composition as claimed in claim 47, wherein the parent drug but not the conjugate-drug composition reaches the systemic circulation.
52. The composition as claimed in claim 10, wherein the active agent is selected from the group consisting of morphine, hydromorphone, hydrocodone. oxycodone, fentanyl, valproic acid, mesalamine, dextroamphetamine sulfate, methylphenidate, donepizil, ibuprofen, diclofenac, naproxen, fluoxetine, paroxetene, sertaline, and citalopram.
The present invention relates to ac-tive agent delivery systems and more specifically to compostions that comprise amino acids, as sin-gle amino acids or peptides, covalently attached to active agents and methods for administering conju-gated active agent compositions.

Documents:

1318-kolnp-2004-assignment.pdf

1318-KOLNP-2004-CORRESPONDENCE-1.1.pdf

1318-KOLNP-2004-CORRESPONDENCE.pdf

1318-KOLNP-2004-FORM 16.pdf

1318-KOLNP-2004-FORM 27-1.1.pdf

1318-KOLNP-2004-FORM 27.pdf

1318-KOLNP-2004-FORM-27-1.pdf

1318-KOLNP-2004-FORM-27.pdf

1318-kolnp-2004-granted-abstract.pdf

1318-kolnp-2004-granted-assignment.pdf

1318-kolnp-2004-granted-claims.pdf

1318-kolnp-2004-granted-correspondence.pdf

1318-kolnp-2004-granted-description (complete).pdf

1318-kolnp-2004-granted-examination report.pdf

1318-kolnp-2004-granted-form 1.pdf

1318-kolnp-2004-granted-form 13.pdf

1318-kolnp-2004-granted-form 18.pdf

1318-kolnp-2004-granted-form 3.pdf

1318-kolnp-2004-granted-form 5.pdf

1318-kolnp-2004-granted-gpa.pdf

1318-kolnp-2004-granted-reply to examination report.pdf

1318-kolnp-2004-granted-specification.pdf


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Patent Number 225645
Indian Patent Application Number 1318/KOLNP/2004
PG Journal Number 47/2008
Publication Date 21-Nov-2008
Grant Date 19-Nov-2008
Date of Filing 08-Sep-2004
Name of Patentee NEW RIVER PHARMACETICALS INC.
Applicant Address THE GOVERNOR TYLER, 1881 GROVE AVENUE, RADFORD, VIRGINIA
Inventors:
# Inventor's Name Inventor's Address
1 PICCARIELLO THOMAS 203 MURPHY STREET, BLACKSBURG, VA 24060-2534
2 KIRK RANDAL J P.O BOX 3426, RADFORD, VIRGINIA 24143-3526
3 COLN LAWRENCE P 306 GAL WAY ROAD BRISTOL, TENNESSEE 37620-3034
PCT International Classification Number A6IK 31/485
PCT International Application Number PCT/US03/05524
PCT International Filing date 2003-02-24
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 10/156,527 2002-05-29 U.S.A.
2 60/366,258 2001-03-22 U.S.A.
3 60/358,381 2002-02-22 U.S.A.