Title of Invention

A SURGICAL PATCH THAT RELEASES PACLITAXEL OR AN ANALOGUE OR DERIVATIVE THEREOF

Abstract Surgical patches are described which release an anti-inflammatory agent, an anti-platelet agent, an anticoagulant, a fibrinolytic agent, a cell cycle inhibitor, and/or an antiproliferative agent.
Full Text COATED SURGICAL PATCHES
SURGICAL PATCH THAT RELEASES PACLITAXEL OR AN ANALOGUE OR DERIVATIVE THEREOF
BACKGROUND OF THE INVENTION
Field of the Invention
This invention relates to surgical patches coated with biologically active
agents to prevent adverse tissue reaction to the patch.
Description of the Related Art
Primary closure and patch angioplasty are two techniques of arteriotomy
closure used by surgeons after vascular procedures. In primary closure, the lips of the
arterial wound are directly sutured to each other whereas an extra piece of material is
sutured between the two lips during patch angioplasty. Patch angioplasty is preferred
after procedures with a high rate of postoperative narrowing of the repaired vessel
(endarterectomy of small carotid arteries for example). The added piece of material
maintains the original diameter of the blood vessel and induces favorable local
hemodynamics that otherwise may lead to recurrent stenosis.
Patch angioplasty can be performed with autologous tissue (typically the
patient's saphenous vein) or synthetic material (expanded polytetrafluoroethylene or
Dacron). Vein patches have drawbacks such as aneurismal degeneration and rupture.
They require an additional incision to harvest the vein with associated morbidity. The
patient veins may not be suitable for patching. Most importantly, the vein used for the
patch will not be available for coronary artery bypass grafting should the patient require
arterial reconstruction at a later time. For these reasons, the use of synthetic patches has
become increasingly popular.
However, synthetic materials implanted in the vasculature induce
thrombogenic, inflammatory and hyperproliferative responses. Immediately after
implantation, platelets bind to the luminal surface of the prosthesis, triggering the
coagulation cascade and inducing thrombus formation. Thrombus may grow large
enough to cause distal ischemia (stroke in the case of carotid artery patches).
In the days following the procedure, inflammatory cells such as
macrophages, lymphocytes and neutrophils adhere to the prosthetic lumen and also
migrate into the peri-prosthetic space. These cells release cytokines that promote
smooth muscle cell migration from the adjacent vessel on the luminal surface of the
patch. The cells further proliferate on the patch and secrete extracellular matrix.
Depending on the porosity of the patch material, cells may also migrate through the
pores of the patch from the surrounding tissue into the lumen. In both cases,
hyperplasia causes plaque formation on the luminal surface of the patch and the
adjacent vessels within a few weeks. This reduces luminal area in the treated blood
vessel thus impeding blood flow to the distal tissues.
Therefore, there exists a need for a means and a method to prevent
inflammatory reaction, thrombus formation and intimal hyperplasia on the luminal
surface of synthetic patches. The present invention meets this need, and further,
provides other, related advantages.
SUMMARY OF THE INVENTION
Briefly stated, the present invention involves methods of making and
using surgical patches which release agents that prevent inflammatory reactions,
thrombus formations and/or intimal hyperplasia. Representative examples of such
agents include cell-cycle inhibitors such as taxanes, camptothecins, doxorubicin,
immunosuppressive drugs (rapamycin, cyclosporins), bromocryptine, tubercidine,
beta-lapachone, glucocorticoids, nonsteroidal anti-inflammatory drugs, cell cycle
inhibitors, calcium channel blockers, calcium chelating agents, inhibitors of matrix
metalloproteinases, methotrexate, thrombolytic agents, anti-platelet agents and
anticoagulation agents. The presence of these agents, alone or in combination, on the
patch will effectively prevent or inhibit local inflammatory reaction, prevent thrombus
material from building up on the patch and stop cells from proliferating onto the patch.
Thus, within one aspect of the present invention surgical patches (e.g.,
vascular patches) are provided which release an anti-inflammatory agent, an anti-
platelet agent, an anticoagulant agent, fibrinolytic agents, a cell-cycle inhibitor agent,
and/or an anti-proliferative agent. Within certain embodiments, the vascular patch is a
synthetic patch (e.g., made of Dacron). Within various embodiments, the anti-
infl;unmatory agent is aspirin, ibuprofen, or a glucocorticoid drug, the anti-coagulant
agent is heparin or hirudin, and the fibrinolytic agent is tissue plasminogen activator,
streptokinase, or urokinase. Within other embodiments, the cell-cycle inhibitor agent is
a taxane (e.g., paclitaxel or docetaxel), a vinca alkaloid (e.g., vinblastine or vincristine),
a podophyllotoxin (e.g., etoposide), an anthracycline (e.g., doxorubicin or
mitoxantrone), or a platinum compound (e.g., cisplatin or carboplatin).
Also provided are methods for making surgical patches (e.g., vascular
batches) which release an anti-inflammatory agent, an anti-platelet agent, an
anticoagulant, an anti-fibrinolytic agent, a cell-cycle inhibitor, and/or an anti-
proliferative agent, comprising the step of coating at least a part (all or a portion such as
the ends, or one side) of the patch (e.g., by spraying or dipping) with one of the factors
or agents mentioned above. Alternative methods for generating patches (e.g.,
interweaving a patch with a coated thread, or absorbing a desired agent onto the patch)
are described in more detail below. Within further embodiments, the factor or agent
may be mixed or formulated with another compound or carrier (e.g., polymeric or non-
polymeric). In one embodiment of the present invention, only one side of the patch is
coated leaving the other side and most of the thickness of the patch untreated. In
another embodiment, only parts (the edge for example) of the patch are coated.
Within other aspects of the invention, methods are provided for closing
an opening in the biological tissue (e.g., the vasculature), comprising applying to the
opening in a surgical patch as described herein. Within certain embodiments, the
compound or composition may be applied by itself or in a carrier, which may be either
polymeric, or non-polymeric. Within certain embodiments, the surgical patch is a
vascular patch, which is sutured in place.
These and other aspects of the present invention will become evident
upon reference to the following detailed description and attached drawings. In addition,
various references are set forth herein which describe in more detail certain procedures
or compositions (e.g., compounds, proteins, vectors, and their generation, etc.), and are
therefore incorporated by reference in their entirety. When PCT applications are
referred to it is also understood that the corresponding or cited U.S. applications or U.S.
Patents are also incorporated by reference herein.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a schematic illustration showing sites of action within a
biological pathway where Cell Cycle Inhibitors may act to inhibit the cell cycle.
DETAILED DESCRIPTION OF THE INVENTION
Prior to setting forth the invention, it may be helpful to an understanding
thereof to set forth definitions of certain terms that will be used hereinafter.
"Cell Cycle Inhibitor" as used herein refers to any protein, peptide,
chemical or other molecule which delays or impairs a dividing cell's ability to progress
through the cell cycle and replicate. Cell cycle inhibitors, which prolong or arrest
mitosis (M-phase) or DNA synthesis (S-phase), are particularly effective for the
purposes of this invention as they increase the dividing cell's sensitivity to the effects of
radiation. A wide variety of methods may be utilized to determine the ability of a
compound to inhibit the cell cycle including univariate analysis of cellular DNA content
and multiparameter analysis (see the Examples).
I. PATCHES
Patches are small pieces of material used to mend a tear or a break to
cover a hole or to strengthen a weak place. In medicine, surgical patches are pieces of
synthetic material or biological tissue used to bridge together the defect between the edge
of an incision or a gap in a biological structure (e.g., a vessel wall). Patches are also used
after lung surgery to strengthen the repaired lung.
Synthetic vascular patches are available from medical device companies
such as 1MPRA, WL Gore, Sulzer Vascutek, Shelhigh, Bio Nova International,
Intervascular and Aesculap for example. Tissue-baied vascular patches are available
from Biovascular and St Jude Medical. Representative examples of surgical patches are
described in U.S. Patent Nos. 5,100,422; 5,104,400; 5,437,900; 5,456,711; 5,641,566;
5,645,915; 6,296,657; and 6,322,593.
Vascular patches as described herein can be, among other uses, during
vascular surgery to repair blood vessels.
II. AGENTS
Anti-inflammatory agents
Inflammation occurs when cells of the immune system are activated in
response to foreign agents or antigens. Leucocytes release lysosomal enzymes.
Arachidonic acid is synthesized and eicosanoids, kinins, complement components and
histamine are released. Cytokines have a powerful chemotactic effect on eosinophils,
neutrophils and macrophages. They also promote local hyperemia and vascular
permeability Superoxide anion is formed by the reduction of molecular oxygen, which
stimulates the production of other reactive molecules such as hydrogen peroxide and
hydroxyl radicals. The interaction of these substances with arachidonic acid results in
the generation of more chemotatic substances, thus perpetuating the inflammatory
process. Anti-inflammatory drugs inhibit one or several of the processes described
above thus interfering with the inflammatory reaction.
Examples of anti-inflammatory drugs include but are not limited to
nonsteroidal inflammatory drugs such as aspirin, ibuprofen, naproxen, fenoprofen,
indomethacin, sulindac, meclofenamate, mefenamic acid, tolmetin, phenylbutazone,
piroxicam, diflunisal apazone carprofen, flurbiprofen, diclofenac, ketoprofen; slow-
acting anti-inflammatory drugs such as chloroquinine, hydroxychloroquinine, gold,
penicillamine, levamisole; glucocorticoid drugs such as hydrocortisone, cortisone,
dexamethasone, prednisone, fluocortolone, triamcinolone, fludrocortisone; statins such
as pravastatin, fluvastatin, simvastatin, lovastatin; thromboxane inhibitors such as
triazolopyrimidine; immunosuppressive agents such as rapamycin, sirolimus,
tacrolimus, everolimus, cyclosporin A; anti-inflammatory cytokines such as interleukin-
10
The anti-inflammatory potential of agents can be assessed by studying
their inhibition of cyclooxygenase-1 and cyclooxygenase-2 (Everts et al., 2000. Clin.
Rheumatol. 19: 331-343), their inhibition of phospholipase activity and prostaglandine
release (Sampey et al., Mediators Inflamm. 9:125-132, 2000), their inhibition of tumor
necrosis factor-alpha (TNF-a) synthesis and secretion (Joyce et al., Injlamm Res.
46:447-451, 1997), their inhibition of vasodilation and permeability of the
microcirculation (Perratti and Ahluwalia, 2000 Microcirculation 7: 147-161), their
inhibition of toluene di-isocyanate-induced mast cell proliferation and degranulation, of
anti-CD3-induced T-lymphocyte proliferation, of TNF-a-induced cell adhesion
molecule expression, of oedema formation, of interleukin-5 (IL-5)-induced blood
eosinophilia, of IL-5- or platelet activating factor- stimulated pulmonary eosinophilia,
(Johnson, 1995 Allergy 50: 11-14), with neutrophil activation assays (Jackson et al.,
1997 Immunology 90: 502-510), with cytokine gene expression assays (White et al.,
1998 Cancer Immunol. Immunother. 46:104-112).
Anti-platelet agents
Hemostasis is the spontaneous arrest of bleeding from a damaged blood
vessel. The normal vascular endothelium is not thrombogenic and circulating blood
platelets and clotting factors do not adhere to it. However, within seconds of damage to
a blood vessel, platelets adhere to the site of injury. As platelets become activated, they
secrete agents such as ADP and prostaglandins that enhance recruitment and adherence
of other platelets. The resulting growing thrombus of aggregated platelets reduces
blood flow and triggers fibrin formation. The fibrin network reinforces the initial
platelet plug thus ensuring long-term hemostasis. At a later stage, platelets release
growth factors such as platelet-derived growth factor that promote healing of the
damage blood vessel.
Anti-platelet agents are compounds that interfere with platelet activation,
adhesion or secretion and thus inhibit thrombus formation. Examples of anti-platelet
agents include but are not limited to, aspirin (Awtry, 2000, Circulation, 101: 1206-
1218), ADP receptor antagonists such as clopidogrel, ticlopidine and their active
metabolites (Coukell and Markham, 1997 Drugs 54: 745-750; Muller et al., 2000
Circulation 101: 590-593; Bertrand et al., 2000 Circulation 102: 624-629; Quinn and
F tzgerald, 1999 Circulation 100: 1667-1672), serotonin receptor antagonists (Herbert et
al., 1993 Thromb. Haemostas. 69: 262-2670), platelet glycoprotein receptor antagonists
such as abciximab, tirofiban, eptifibatide, lamifiban, orbofiban, roxifiban, sibrafiban,
lefradafiban, xemilofiban and their active metabolites (Dobesh and Latham, 1998
Pharmacotherapy 18: 663-685; Madan et al., 1998 Circulation 98: 2629-2635), statins
such as pravastatin, fluvastatin, simvastatin, lovastatin (Igarashi et al., 1997 British
Journal of Pharmacology 120: 1172-1178), cAMP phosphodiesterase inhibitors such as
cilostazol (Kimura et al., 1985 Drug Res. 35: 1144-1149); nitric oxyde donors such as
molsidomine, linsidomine, L-arginine 0, alpha-adrenergic antagonists such as
dihydrogeneted ergopeptines, phentolamine, and yohimbin.
The antiplatelet activity of agents can be assayed by monitoring in vitro
platelet aggregation after activation by agonists using turbidimetry or radiolabeled
platelets. In vivo quantification of platelet aggregation can be performed with
radiolabeled platelets in models of arterio-venous shunts, stent placement and graft
implantation. In vivo antiplatelet activity can also be assessed by monitoring arterial
temperature distal to thrombus formation and by determining bleeding time. (Hebert et
al., 1998 Thromb. Haemost. 80: 512-518; Hebert et al., 1993 Arteriosclerosis and
Thrombosis 13: 1171-1179; Harker et al., 1998 Circulation 98: 2461-2469; Yao et al.,
1993 Trans. Associa. AU Physicians 106:110-119).
Anticoagulants
Blood coagulates by the transformation of soluble fibrinogen into
insoluble fibrin. More than a dozen circulating proteins interact in a cascading series of
proteolytic reactions. At each step, an inactive clotting factor undergoes proteolytic
cleavage and become an active protease. This protease activates the next clotting factor.
The end product of the coagulation cascade is the formation of a solid fibrin clot.
Anticoagulants are agents that interfere with the coagulation cascade and
inhibit the formation of fibrin. Examples of anticoagulants include, but are not limited
to, warfarin and coumarin anticoagulants, tissue factor pathway inhibitor, active-site
inactivated factor Vila ( DEGR-VIIa), tick anticoagulant peptide, antithrombin agents
such as heparin, low-molecular-weight-heparin, hirudin, bivalirudin (Jang et al., 1995
Circulation 92: 3041-3050), retinoids such as all-trans-retinoic acid.
The anticoagulation activity of agents can be assayed by measuring the
activated partial thromboplastin time and the prothrombin time (Freund et al., 1993
Thrombosis and Hemostasis 69: 515-521; Jang et al., 1995 Circulation 92: 3041-3050).
Fibrinolytic agents
Fibrinolysis is a naturally occurring process that removes unneeded clots
ones healing has occurred. The critical step in this system is the transformation of
plasminogen into plasmin, a protein-digesting enzyme. Plasmin dissolves thrombus by
lysing fibrin.
Fibrinolytic drugs promote the formation of plasmin. Examples of
fibrinolytic agents include, but are not limited to, tissue plasminogen activator,
uroknase, streptokinase, staphylokinase, anistreplase, reteplase, lanoteplase (Valji,
2000 JVIR 11: 411-420) retinoids such as all-trans-retinoic acid.
Fibrinolysis activity of agents can be assayed by monitoring the
dissolution of thrombus labeled with radioactive fibrin (Herbert et al., 1993 Thrombosis
and Haemostasis 69: 268-271).
Cell Cycle Inhibitors.
Briefly, a wide variety of cell cycle inhibitory agents can be utilized,
either with or without a carrier (e.g., a polymer or ointment or vector), in order to treat
or prevent a hyperproliferative disease. Representative examples of such agents include
taxanes (e.g., paclitaxel (discussed in more detail below) and docetaxel) (Schiffe et al.,
Nature 277:665-667, 1979; Long and Fairchild, Cancer Research 54:4355-4361, 1994;
Fingel and Horwitz, J. Nat'l Cancer Inst. 83(4):288-291, 1991; Pazdur et al, Cancer
Treat. Rev. 19(40):351-386, 1993), Etanidazole, Nimorazole (B.A. Chabner and D.L.
Longo. Cancer Chemotherapy and Biotherapy - Principles and Practice. Lippincott-
Faven Publishers, New York, 1996, p.554), perfluorochemicals with hyperbaric
oxygen, transfusion, erythropoietin, BW12C, nicotinamide, hydralazine, BSO, WR-
2721, IudR, DUdR, etanidazole, WR-2721, BSO, mono-substituted keto-aldehyde
compounds (L.G. Egyud. Keto-aldehyde-amine addition products and method of
making same. U.S. Patent No. 4,066,650, Jan 3, 1978), nitroimidazole (K.C. Agrawal
and M. Sakaguchi. Nitroimidazole radiosensitizers for Hypoxic tumor cells and
compositions thereof. U.S. Patent No. 4,462,992, Jul. 31, 1984), 5-substituted-4-
nitroimidazoles (Adams et ah, Int. J. Radiat. Biol. Relat. Stud. Phys., Chem. Med.
40(2):153-6l, 1981), SR-2508 (Brown et al., Int. J. Radiat. Oncol, Biol Phys.
7t6):695-703, 1981), 2H-isoindolediones (J.A. Myers, 2H-Isoindolediones, their
synthesis and use as radiosensitizers. Patent 4,494,547, Jan. 22, 1985), chiral [[(2-
b]omoethyl)-amino]methyl]-nitro-lH-imidazole-l-ethanol (V.G. Beylin, et al. Process
for preparing chiral [[(2-bromoethyl)-amino]methyl]-nitro-lH-imidazole-l-ethanol and
related compounds. U.S. Patent No. 5,543,527, Aug. 6, 1996; U.S. Patent No.
4,797,397; Jan. 10, 1989; U.S. Patent No. 5,342,959, Aug. 30, 1994), nitroaniline
derivatives (W.A. Denny, et al. Nitroaniline derivatives and their use as anti-tumor
agents. U.S. Patent No. 5,571,845, Nov. 5, 1996), DNA-affinic hypoxia selective
cytotoxins (M.V. Papadopoulou-Rosenzweig. DNA-affinic hypoxia selective
cxotoxins. U.S. Patent No. 5,602,142, Feb. 11, 1997), halogenated DNA ligand (R.F.
Martin. Halogenated DNA ligand radiosensitizers for cancer therapy. U.S. Patent No.
5,641,764, Jun 24, 1997), 1,2,4 benzotriazine oxides (W.W. Lee et al. 1,2,4-
benzotriazine oxides as radiosensitizers and selective cytotoxic agents. U.S. Patent No.
5 616,584, Apr. 1, 1997; U.S. Patent No. 5,624,925, Apr. 29, 1997; Process for
Preparing 1,2,4 Benzotriazine oxides. U.S. Patent No. 5,175,287, Dec. 29,1992), nitric
oxide (J.B. Mitchell et al, Use of Nitric oxide releasing compounds as hypoxic cell
radiation sensitizers. U.S. Patent No. 5,650,442, Jul. 22, 1997), 2-nitroimidazole
derivatives (M.J. Suto et al. 2-Nitroimidazole derivatives useful as radiosensitizers for
hypoxic tumor cells. U.S. Patent No. 4,797,397, Jan. 10, 1989; T. Suzuki. 2-
Nitroimidazole derivative, production thereof, and radiosensitizer containing the same
as active ingredient. U.S. Patent No. 5,270,330, Dec. 14, 1993; T. Suzuki et al. 2-
Nitroimidazole derivative, production thereof, and radiosensitizer containing the same
as active ingredient. U.S. Patent No. 5,270,330, Dec 14, 1993; T. Suzuki. 2-
Nitroimidazole derivative, production thereof and radiosensitizer containing the same as
active ingredient; Patent EP 0 513 351 Bl, Jan. 24, 1991), fluorine-containing
nitroazole derivatives (T. Kagiya. Fluorine-containing nitroazole derivatives and
radiosensitizer comprising the same. U.S. Patent No. 4,927,941, May 22, 1990), copper
(M.J. Abrams. Copper Radiosensitizers. U.S. Patent No. 5,100,885, Mar. 31, 1992),
combination modality cancer therapy (D.H. Picker et al. Combination modality cancer
therapy. U.S. Patent No. 4,681,091, Jul. 21, 1987). 5-CldC or (d)H4U or 5-halo-2'-
halo-2'-deoxy-cytidine or -uridine derivatives (S.B. Greer. Method and Materials for
sensitizing neoplastic tissue to radiation. U.S. Patent No. 4,894,364 Jan. 16, 1990),
platinum complexes (K.A. Skov. Platinum Complexes with one radiosensitizing ligand.
U.S. Patent No. 4,921,963. May 1, 1990; K.A. Skov. Platinum Complexes with one
radiosensitizing ligand. Patent EP 0 287 317 A3), fluorine-containing nitroazole (T.
Kagiya, et al. Fluorine-containing nitroazole derivatives and radiosensitizer comprising
the same. U.S. Patent No. 4,927,941. May 22,1990), benzamide (W.W. Lee.
Substituted Benzamide Radiosensitizers. U.S. Patent No. 5,032,617, Jul. 16, 1991),
autobiotics (L.G. Egyud. Autobiotics and their use in eliminating nonself cells in vivo.
U.S. Patent No. 5,147,652. Sep. 15,1992), benzamide and nicotinamide (W.W. Lee et
al. Benzamide and Nictoinamide Radiosensitizers. U.S. Patent No. 5,215,738, Jun 1
1993), acridine-intercalator (M. Papadopoulou-Rosenzweig. Acridine Intercalator
based hypoxia selective cytotoxins. U.S. Patent No. 5,294,715, Mar. 15,1994),
fluorine-containing nitroimidazole (T. Kagiya et al. Fluorine containing nitroimidazole
compounds. U.S. Patent No. 5,304,654, Apr. 19,1994), hydroxylated texaphyrins (J.L.
Sessler et al. Hydroxylated texaphrins. U.S. Patent No. 5,457,183, Oct. 10, 1995),
hydroxylated compound derivative (T. Suzuki et al. Heterocyclic compound derivative,
production thereof and radiosensitizer and antiviral agent containing said derivative as
active ingredient. Publication Number 011106775 A (Japan), Oct. 22,1987; T. Suzuki
et al. Heterocyclic compound derivative, production thereof and radiosensitizer,
antiviral agent and anti cancer agent containing said derivative as active ingredient.
Publication Number 01139596 A (Japan), Nov. 25, 1987; S. Sakaguchi et al.
Heterocyclic compound derivative, its production and radiosensitizer containing said
derivative as active ingredient; Publication Number 63170375 A (Japan), Jan. 7, 1987),
fluorine containing 3-nitro-l,2,4-triazole (T. Kagitani et al. Novel fluorine-containing
3 nitro-1,2,4-triazole and radiosensitizer containing same compound. Publication
Number 02076861 A (Japan), Mar. 31, 1988), 5-thiotretrazole derivative or its salt (E.
Kano et al Radiosensitizer for Hypoxic cell. Publication Number 61010511 A (Japan),
Jun. 26, 1984), Nitrothiazole (T .Kagitani et al. Radiation-sensitizing agent.
Publication Number 61167616 A (Japan) Jan. 22, 1985), imidazole derivatives (S.
Inayma et al. Imidazole derivative. Publication Number 6203767 A (Japan) Aug.
1,1985; Publication Number 62030768 A (Japan) Aug. 1, 1985; Publication Number
62030777 A (Japan) Aug. 1, 1985), 4-nitro-l,2,3-triazole (T. Kagitani et al.
Radiosensitizer. Publication Number 62039525 A (Japan), Aug. 15, 1985), 3-nitro-
1,2,4-triazole (T. Kagitani et al Radiosensitizer. Publication Number 62138427 A
(Japan), Dec. 12, 1985), Carcinostatic action regulator (H. Amagase. Carcinostatic
action regulator. Publication Number 63099017 A (Japan), Nov. 21, 1986), 4,5-
dirutroimidazole derivative (S. Inayama. 4,5-Dinitroimidazole derivative. Publication
Number 63310873 A (Japan) Jun. 9, 1987), nitrouiazole Compound (T. Kagitanil.
Nitrotriazole Compound. Publication Number 07149737 A (Japan) Jun. 22, 1993),
cisplatin, doxorubin, misonidazole, mitomycin, tiripazamine, nitrosourea,
mercaptopurine, methotrexate, flurouracil, bleomycin, vincristine, carboplatin,
epirubicin, doxorubicin, cyclophosphamide, vindesine, etoposide (I.F. Tannock.
Review Article: Treatment of Cancer with Radiation and Drugs. Journal of Clinical
Oncology 14{12)3156-3174, 1996), camptothecin (Ewend M.G. et al Local delivery
of chemotherapy and concurrent external beam radiotherapy prolongs survival in
metastatic brain tumor models. Cancer Research 56(22):5217-5223, 1996) and
paclitaxel (Tishler R.B. et al. Taxol: a novel radiation sensitizer. International Journal
of Radiation Oncology and Biological Physics 22(3):613-617,1992).
A number of the above-mentioned cell cycle inhibitors also have a wide
variety of analogues and derivatives, including, but not limited to, cisplatin,
cyclophosphamide, misonidazole, tiripazamine, nitrosourea, mercaptopurine,
methotrexate, flurouracil, epirubicin, doxorubicin, vindesine and etoposide. Analogues
and derivatives include (CPA)2Pt[DOLYM] and (DACH)Pt[DOLYM] cisplatin (Choi et
al, Arch. Pharmacol Res. 22(2):151-156, 1999), Cis-[PtCl2(4,7-H-5-methyl-7-
oxo]l,2,4[triazolo[1,5-a]pyrimidine)2] (Navarro et al, J. Med. Chem. 41(3):332-338,
1998), [Pt(cis-l,4-DACH)(trans-Cl2)(CBDCA)] • 1/2MeOH cisplatin (Shamsuddin et al,
inorg. Chem. 36(25):5969-597l, 1997), 4-pyridoxate diammine hydroxy platinum
(Tokunaga et al, Pharm. Sci. 3(7):353-356, 1997), Pt(II)... Pt(H)
(Pt2[NHCHN(C(CH2)(CH3))]4) (Navarro et al, Inorg. Chem. 35(26):7829-7835, 1996),
254-S cisplatin analogue (Koga et al, Neurol Res. 18(3):244-247, 1996), o-
phenylenediamine ligand bearing cisplatin analogues (Koeckerbauer & Bednarski, J.
Inorg. Biochem. 62(4):281-298, 1996), trans, cis-[Pt(OAc)2I2(en)] (Kratochwil et al, J.
Med. Chem. 3P(13):2499-2507, 1996), estrogenic 1,2-diarylethylenediamine ligand
(with sulfur-containing amino acids and glutathione) bearing cisplatin analogues
(Bednarski, J. Inorg. Biochem. 62(1):75, 1996), cis-1,4-diaminocyclohexane cisplatin
analogues (Shamsuddin et al, J. Inorg. Biochem. 67(4):291-301, 1996), 5' orientational
isomer of cis-[Pt(NH3X4-aminoTEMP-0){d(GpG)}] (Dunham & Lippard, J. Am.
Chem. Soc. 117(43): 10702-12, 1995), chelating diamine-bearing cisplatin analogues
(Koeckerbauer & Bednarski, J. Pharm. Sci. 84(7):819-23, 1995), 1,2-
diaylethyleneamine ligand-bearing cisplatin analogues (Otto et al,J. Cancer Res. Clin.
Oncol 121(1 ):31-8, 1995), (ethylenediamine)platinum(II) complexes (Pasini et al, J.
Chem. Soc, Dalton Trans. 4:579-85, 1995), CI-973 cisplatin analogue (Yang et al, Int.
J. Oncol. 5(3):597-602,1994), cis-diarnminedichloroplatinum(II) and its analogues cis-
1,1 -cyclobutanedicarbosylato(2R)-2-methyl-1,4-butanediam-mineplatinum(II) and cis-
diammine(glycolato)pIatinum (Claycamp & Zimbrick, J. Inorg. Biochem. 26(4):257-67,
1986; Fan et al, Cancer Res. 48(11):3135-9, 1988; Heiger-Bernays et al, Biochemistry
29(36):8461-6, 1990; Kikkawa et al, J. Exp. Clin. Cancer Res. 12(4):233-40, 1993;
Murray et al., Biochemistry 31(47): 11812-17, 1992; Takahashi et al, Cancer
Chemother. Pharmacol. 33(l):31-5, 1993), cis-amine-cyclohexylamine-
dichoroplatinum(H) (Yoshida et al, Biochem. Pharmacol. 48(4):793-9, 1994), gem-
diphosphonate cisplatin analogues (FR 2683529), (meso-1,2-bis(2,6-dichloro-4-
hydroxyplenyl)ethylenediamine) dichloroplatinum(II) (Bednarski et al, J. Med. Chem.
35(23):4479-85, 1992), cisplatin analogues containing a tethered dansyl group (Hartwig
et al, J. Am. Chem. Soc. 114(21):S292-3, 1992), platinum(II) polyamines (Siegmann et
al., Inorg. Met.-Containing Polym. Mater., (Proc. Am. Chem. Soc. Int. Symp.), 335-61,
1990), cis-(3H)dichloro(ethylenediamine)pIatinum(II) (Eastman, Anal. Biochem.
197(2):311-15, 1991), trans-diamminedichloroplatinum(II) and cis-(Pt(NH3)2(N3-
cytosine)Cl) (Bellon & Lippard, Biophys. Chem. 35(2-3): 179-88, 1990), 3H-cis-1,2-
diaminocyclohexanedichloroplatinum(II) and 3H-cis-1,2-diaminocyclohexane-
malonatoplatinum (II) (Oswald et al., Res. Commun. Chem. Pathol. Pharmacol.
64(1):41-58, 1989), diaminocarboxylatoplatinum (EPA 296321), trans-(D,1)-1,2-
diaminocyclohexane carrier ligand-bearing platinum analogues (Wyrick & Chaney, J.
Labelled Compd. Radiopharm. 25(4):349-57, 1988), aminoalkylaminoanthraquinone-
derived cisplatin analogues (Kitov et al., Eur. J. Med. Chem. 23(4):381-3, 1988),
sproplatin, carboplatin, iproplatin and JM40 platinum analogues (Schroyen et al, Eur.
J Cancer Clin. Oncol. 24(8): 1309-12, 1988), bidentate tertiary diamine-containing
casplatinum derivatives (Orbell et al, Inorg. Chim. Acta 152(2): 125-34, 1988),
piatinum(II), platinum(IV) (Liu & Wang, Shandong Yike Daxue Xuebao 24(1):35-41,
1)86), cis-diammine(1,1-cyclobutanedicarboxylato-)platinum(II) (carboplatin, JM8)
and ethylenediammine-malonatoplatinum(H) (JM40) (Begg et al, Radiother. Oncol.
9(2): 157-65, 1987), JM8 and JM9 cisplatin analogues (Harstrick et al, Int. J. Androl.
10(1); 139-45, 1987), (NPr4)2((PtCL4).cis-(PtC12-(NH2Me)2)) (Brammer et al, J.
Chem. Soc, Chem. Commun. 6:443-5, 1987), aliphatic, tricarboxylic acid platinum
complexes (EPA 185225), cis-dichloro(amino acidXtert-butylamine)platinum(II)
complexes (Pasini & Bersanetti, Inorg. Chim. Acta i07(4):259-67, 1985); 4-
hydroperoxycylcophosphamide (Ballard et al, Cancer Chemother. Pharmacol.
26(6):397-402, 1990), acyclouridine cyclophosphamide derivatives (Zakerinia et al,
Hdv. Chim. Acta 73(4):912-15, 1990), 1,3,2-dioxa- and -oxazaphosphorinane
cyciophosphamide analogues (Yang et al, Tetrahedron 44(20):6305-14, 1988), C5-
substituted cyclophosphamide analogues (Spada, University of Rhode Island
Dissertation, 1987), tetrahydrooxazine cyclophosphamide analogues (Valente,
University of Rochester Dissertation, 1988), phenyl ketone cyclophosphamide
analogues (Hales et al, Teratology 3P(l):31-7, 1989), phenylketophosphamide
cyclophosphamide analogues (Ludeman et al, J. Med. Chem. 2°(5):716-27, 1986),
ASTA Z-7557 cyclophosphamide analogues (Evans et al, Int. J. Cancer 34(6):883-90,
1984), 3-(1-oxy-2,2,6,6-tetramethyl-4-piperidinyl)cyclophosphamide (Tsui et al, J.
Med. Chem. 25(9): 1106-10, 1982), 2-oxobis(2-ß-hloroemylamino)-4-,6-dimethyl-
1,3,2-oxazaphosphorinane cyclophosphamide (Carpenter et al, Phosphorus Sulfur
12(3):287-93, 1982), 5-fluoro- and 5-chlorocyclophosphamide (Foster et al, J. Med.
Chem. 24(12): 1399-403, 1981), cis- and trans-4-phenylcyclophosphamide (Boyd et al,
J. Med. Chem. 23(4):372-5, 1980), 5-bromocyclophosphamide, 3,5-
dehydrocyclophosphamide (Ludeman et al, J. Med. Chem. 22(2):151-8, 1979), 4-
ethoxycarbonyl cyclophosphamide analogues (Foster, J. Pharm. Sci. 67(5):709-10,
1978), arylaminotetrahydro-2H-l,3,2-oxazaphosphorine 2-oxide cyclophosphamide
analogues (Hamacher, Arch. Pharm. (Weinheim, Gen) 310(5):J,428-34, 1977), NSC-
26271 cyclophosphamide analogues (Montgomery & Struck, Cancer Treat Rep.
60(4):J381-93, 1976), benzo annulated cyclophosphamide analogues (Ludeman & Zon,
J. Med. Chem. 18(12):J1251-3, 1975), 6-trifluoromethylcyclophosphamide (Fanner &
Cox, J. Med. Chem. 18(11):J1106-10, 1975), 4-methylcyclophosphamide and 6-
methycyclophosphamide analogues (Cox et al, Biochem. Pharmacol. 24(5):J599-606,
1975); FCE 23762 doxorubicin derivative (Quaglia et al, J. Liq. Chromatogr.
17(18):3911-3923, 1994), annamycin (Zou et al, J. Pharm. Set 52(11):1151-1154,
19931, ruboxyl (Rapoport et al, J. Controlled Release 58(2):153-162, 1999),
anthracycline disaccharide doxorubicin analogue (Pratesi et al, Clin. Cancer Res.
4(11):2833-2839, 1998), N-(trifluoroacetyl)doxorubicin and 4'-O-acetyl-N-
(triflaoroacetyl)doxorubicin (Berube & Lepage, Synth.. Commun. 28(6): 1109-1116,
1998), 2-pyrrolinodoxorubicin (Nagy et al, Proc. Nat'l Acad. Sci. USA. PJ(4):1794-
1799, 1998), disaccharide doxorubicin analogues (Arcamone et al, J. Nat'l Cancer Inst.
59(16) 1217-1223, 1997), 4-demethoxy-7-O-[2,6-dideoxy-4-O-(2,3,6-trideoxy-3-
5 anmino-a-L-lyxo-hexopyranosyl)-a-L-lyxo-hexopyranosyl]adriamicinone doxorubicin
disaccharide analog (Monteagudo et al, Carbohydr. Res. 300(1):11-16, 1997), 2-
pyrrolinodoxorubicin (Nagy et al, Proc. Nat'l Acad. Sci. U. S. A. 94(2):652-656,1997),
morpholinyl doxorubicin analogues (Duran et al, Cancer Chemother. Pharmacol
38(3):210-216, 1996), enaminomalonyl-ß-alanine doxorubicin derivatives (Seitz et al,
Tetrahedron Lett 36(9):1413-16, 1995), cephalosporin doxorubicin derivatives
(Vrudhuia et al, J Med. Chem. 35(8): 1380-5,1995), hydroxyrubicin (Solary et al, Int.
J. Cancer 58(1):85-94,1994), methoxymorpholino doxorubicin derivative (Kuhl et al,
Cancer Chemother. Pharmacol. 33(1):10-16, 1993), (6-maleimidocaproyl)hydrazone
doxorubicin derivative (Willner et al, Bioconjugate Chem. 4(6):521-7, 1993), N-(5,5-
diacetoxypent-1-yl) doxorubicin (Cherif & Farquhar, J. Med. Chem. 55(17):3208-14,
1992), FCE 23762 methoxymorpholinyl doxorubicin derivative (Ripamonti et al, Br. J.
Cancer 6.5(5):703-7, 1992), N-hydroxysuccinimide ester doxorubicin derivatives
(Demant et al., Biochim. Biophys. Acta 1118(1):83-90, 1991), polydeoxynucleotide
doxorubicin derivatives (Ruggiero et al, Biochim. Biophys. Acta 1129(3):294-302,
1991), morpholinyl doxorubicin derivatives (EPA 434960), mitoxantrone doxorubicin
analogue (Krapcho et al, J. Med. Chem. 54(8):2373-80. 1991), AD198 doxorubicin
analogue (Traganos et al, Cancer Res. 57(14):3682-9, 1991), 4-demethoxy-3'-N-
trifluoroacetyldoxorubicin (Horton et al, Drug Des. Delivery 6(2): 123-9, 1990), 4'-
epidoxorubicin (Drzewoski et al, Pol. J. Pharmacol Pharm. 40(2): 159-65, 1988;
Weenen et al, Eur. J. Cancer Clin. Oncol. 20(7):919-26, 1984), alkylating
cyanomorpholino doxorubicin derivative (Scudder et al, J. Nat'l Cancer Inst.
80((16):1294 8, 1988), deoxydihydroiodooxorubicin (EPA 275966), adriblastin
(Kalishevskaya et al, Vestn. Mosk. Univ., 16(Biol. 1):21-7, 1988), 4'-deoxydoxorubicin
(Schoelzel et al, Leuk. Res. 10(\2): 1455-9, 1986), 4-demethyoxy-4'-o-
methyldoxorubicin (Giuliani et al, Proc. Int. Congr. Chemother. 16:285-70-285-77,
1983), 3'-deamino-3'-hydroxydoxorubicin (Horton et al, J. Antibiot. 37(8):853-8,
1984), 4-demethyoxy doxorubicin analogues (Barbieri et al, Drugs Exp. Clin. Res.
10(2):85-90, 1984), N-L-leucyl doxorubicin derivatives (Trouet et al, Anthracyclines
(Proc. Int. Symp. Tumor Pharmacothen), 179-81, 1983), 3'-deamino-3'-(4-methoxy-1-
piperidinyl) doxorubicin derivatives (4,314,054), 3'-deamino-3'-(4-mortholinyl)
doxorubicin derivatives (4,301,277), 4'-deoxydoxorubicin and 4'-o-methyldoxorubicin
(Giuliani et al, Int. J. Cancer 27(1):5-13, 1981), aglycone doxorubicin derivatives
(Chan & Watson, J. Pharm. Sci. 67(12): 1748-52, 1978), SM 5887 (Pharma Japan
1468:20, 1995), MX-2 (Pharma Japan 1420:19, 1994), 4'-deoxy-13(S)-dihydro-4'-
iododoxorubicin (EP 275966), morpholinyl doxorubicin derivatives (EPA 434960), 3'-
deamino-3'-(4-methoxy-l-piperidinyl) doxorubicin derivatives (4,314,054),
doxorubicin-14-valerate, morpholinodoxorubicin (5,004,606), 3'-deamino-3-(3"-cyano-
4"- morpholinyl doxorubicin; 3-deamino-3,-(3,'-cyano-4"-morpholinyl)-13-
dihydoxorubicin; (3'-deamino-3'-(3"-cyano-4"-morpholinyl) daunorubicin; 3'-deamino-
3'-(3"..cyano-4"-morpholinyl)-3-dihydrodaunorubicin; and 3'-deamino-3'-(4"-
morpholinyl-5-iminodoxorubicin and derivatives (4,585,859), 3'-deamino-3'-(4-
methoxy-1-piperidinyl) doxorubicin derivatives (4,314,054) and 3-deamino-3-(4-
morpholinyl) doxorubicin derivatives (4,301,277); 4,5-dimethylmisonidazole (Born et
al, Biochem. Pharmacol. 43(6): 1337-44, 1992), azo and azoxy misonidazole
derivatives (Gattavecchia & Tonelli, Int. J. Radiat. Biol. Relat. Stud. Phys., Chem. Med.
45(5):469-77,1984); RB90740 (Wardman et al, Br. J. Cancer, 74 Suppl. (27):S70-S74,
1996); 6-bromo and 6-chloro-2,3-dihydro-1,4-benzothiazines nitrosourea derivatives
(Rai et al., Heterocycl. Commun. 2(6):587-592, 1996), diamino acid nitrosourea
derivatives (Dulude et al, Bioorg. Med. Chem. Lett. 4(22):2697-700, 1994; Dulude et
al., Bioorg Med. Chem. 5(2): 151-60, 1995), amino acid nitrosourea derivatives
(Zheleva et al., Pharmazie 50(l):25-6, 1995), 3',4'-didemethoxy-3'4'-dioxo-4-
deoxypodophyllotoxin nitrosourea derivatives (Miyahara et al., Heterocycles 39(1):361-
9 1994), ACNU (Matsunaga et al, Immunopharmacology 23(3): 199-204, 1992),
tertiary phosphine oxide nitrosourea derivatives (Guguva et al, Pharmazie 46(8):603,
1991), sulfamerizine and sulfamethizole nitrosourea derivatives (Chiang et al,
Zhonghua Yaozue Zazhi 43(5):401-6, 1991), thymidine nitrosourea analogues (Zhang et
al. Cancer Commun. 3(4):119-26, 1991), 1,3-bis(2-chloroethyl)-1-nitrosourea (August
et al, Cancer Res. 51(6): 1586-90, 1991), 2,2,6,6-tetramethyl-1-oxopiperidiunium
nitrosourea derivatives (U.S.S.R. 1261253), 2- and 4-deoxy sugar nitrosourea
derivatives (4,902,791), nitroxyl nitrosourea derivatives (U.S.S.R. 1336489),
fotemustine (Boutin et al, Eur. J. Cancer Clin. Oncol 25(9):1311-16, 1989),
pyrimidine (II) nitrosourea derivatives (Wei et at., Chung-hua Yao Hsueh Tsa Chih
41(1)19-26, 1989), CGP 6809 (Schieweck et al, Cancer Chemother. Pharmacol
23(6):341-7, 1989), B-3839 (Prajda et al, In Vivo 2(2):151-4, 1988), 5-
halogenocytosine nitrosourea derivatives (Chiang & Tseng, T'ai-wan Yao Hsueh Tsa
i Chih 38(1):37-43, 1986), 1-(2-chloroethyl)-3-isobutyl-3-(ß-maltosyl)-1-nitrosourea
(Fujinoto & Ogawa, J. Pharmacobio-Dyn. 10(7):341-5, 1987), sulfur-containing
nitrosoureas (Tang et al, Yaoxue Xuebao 21(7):502-9, 1986), sucrose, 6-((((2-
chloroethyl)nitrosoamino-)carbonyl)amino)-6-deoxysucrose (NS-1C) and 6'-((((2-
chloroethyl)nitrosoamino)carbonyl)amino)-6'-deoxysucrose (NS-1D) nitrosourea
) derivatives (Tanoh et al, Chemotherapy (Tokyo) 33(11):969-77, 1985), CNCC, RFCNU
and chlorozotocin (Mena et al, Chemotherapy (Basel) 32(2):131-7, 1986), CNUA
(Edanami et al., Chemotherapy (Tokyo) 33(5):455-61, 1985), 1-(2-chloroethyl)-3-
isobutyl-3-(ß-maltosyl)-1-nitrosourea (Fujimoto & Ogawa, Jpn. J. Cancer Res. (Gann)
76(7):651 6, 1985), choline-like nitrosoalkylureas (Belyaev et al, Izv. Akad. NAUK
SSSR, Sen Khim. 3:553-7, 1985), sucrose nitrosourea derivatives (JP 84219300), sulfa
drug nitrosourea analogues (Chiang et al, Proc. Nat'l Sci. Counc, Repub. China, Part
A 8(1):18-22, 1984), DONU (Asanuma et al, J. Jpn. Soc. Cancer Ther. 17(8):2035-43,
1982), N,N'-bis (N-(2-chloroethyl)-N-nitrosocarbamoyl)cystamine (CNCC) (Blazsek et
al, Toxicol. Appl Pharmacol. 74(2):250-7, 1984), dimethylnitrosourea (Krutova et al.,
Izv. Akad. NAUK SSSR, Ser. Biol. 3:439-45, 1984), GANU (Sava & Giraldi, Cancer
Chemother. Pharmacol. 70(3):167-9,1983), CCNU (Capelli et al., Med., Biol, Environ.
11(1):111-16,1983), 5-aminomethyl-2'-deoxyuridine nitrosourea analogues (Shiau, Shih
To Hsueh Pao (Taipei) 27:681-9, 1982), TA-077 (Fujimoto & Ogawa, Cancer
Chemother. Pharmacol. 9(3):134-9, 1982), gentianose nitrosourea derivatives (JP 82
80396), CNCC, RFCNU, RPCNU AND chlorozotocin (CZT) (Marzin et al, INSERM
Symp., 19(Nitrosoureas Cancer Treat.): 165-74, 1981), thiocolchicine nitrosourea
analogues (George, Shih Ta Hsueh Pao (Taipei) 25:355-62, 1980), 2-chloroethyl-
n trosourea (Zeller & Eisenbrand, Oncology 38(1):39-42,1981), ACNU, (l-(4-amino-2-
methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride) (Shibuya
et al, Gan To Kagaku Ryoho 7(8): 1393-401, 1980), N-deacetylmethyl thiocolchicine
nitrosourea analogues (Lin et al, J. Med. Chem. 23(12): 1440-2, 1980), pyridine and
piperidine nitrosourea derivatives (Crider et al, J. Med. Chem. 23(8):848-51, 1980),
methyl-CCNU (Zimber & Perk, Refit. Vet. 35(1):28, 1978), phensuzimide nitrosourea
derivatives (Crider et al, J. Med. Chem. 23(3):324-6, 1980), ergoline nitrosourea
derivatives (Crider et al, J. Med. Chem. 22(1):32-5, 1979), glucopyranose nitrosourea
derivatives (3P 78 95917), 1-(2-chloroethyl)-3-cyctohexyl-1-nitrosourea (Farmer et al,
J. Med. Chem. 2J(6):514-20, 1978), 4-(3-(2-chloroethyl)-3-nitrosoureid-o)-cis-
cyclohexanecarboxylic acid (Drewinko et al, Cancer Treat. Rep. 6i(8):J1513-18,
1977), RPCNU (ICIG 1163) (Lamicol et al, Biomedicine 26(3):J176-81, 1977), IOB-
252 (Sorodoc et al, Rev. Roum. Med. Virol 25(1):J55-61,1977), 1,3-bis(2-chIoroethyl)-
1-nitrosourea (BCNU) (Siebert & Eisenbrand, Mutat. Res. 42(1):J45-50, 1977), 1-
tetrahydroxycyclopentyl-3-nitroso-3-(2-chloroethyl)-urea (4,039,578), d-1-1-(ß-
chloroethyl)-3-(2-oxo-3-hexahydroazepinyl)-1-nitrosourea (3,859,277) and gentianose
nitrosourea derivatives (JP 57080396); 6-S-aminoacyloxymethyl mercaptopurine
derivatives (Harada et al, Chem. Pharm. Bull. 43(10):793-6, 1995), 6-mercaptopurine
(6 MP) (Kashida et al, Biol. Pharm. Bull. 18(11):1492-7, 1995), 7,8-
polymethyleneimidazo-1,3,2-diazaphosphorines (Nilov et al, Mendeleev Commun.
2:67, 1995), azathioprine (Chifotides et al, J. Inorg. Biochem. 56(4):249-64, 1994),
rnethyl-D-glucopyranoside mercaptopurine derivatives (Da Silva et al, Eur. J. Med.
Chem. 29(2): 149-52, 1994) and s-alkynyl mercaptopurine derivatives (Ratsino et al,
Khim.-Farm. Zh. 15(8):65-7, 1981); indoline ring and a modified ornithine or glutamic
acid-bearing methotrexate derivatives (Matsuoka et al, Chem. Pharm. Bull. 45(1): 1146-
150, 1997), alkyl-substituted benzene ring C bearing methotrexate derivatives
(Matsuoka et al, Chem. Pharm. Bull. 44(12):2287-2293, 1996), benzoxazine or
benzothiazme moiety-bearing methotrexate derivatives (Matsuoka et al, J. Med. Chem.
40(1):105-111, 1997), 10-deazaaminopterin analogues (DeGraw et al, J. Med. Chem.
10(3):370-376, 1997), 5-deazaaminopterin and 5,10-dideazaaminopterin methotrexate
analogues (Piper et al, J. Med. Chem. 40(3):377-384, 1997), indoline moiety-bearing
methotrexate derivatives (Matsuoka et al, Chem. Pharm. Bull. 44(1): 1332-1337,1996),
lipophilic amide methotrexate derivatives (Pignatello et al, World Meet. Pharm.,
Biopharm. Pharm. Technol., 563-4, 1995), L-threo-(2S,4S)-4-fluoroglutamic acid and
DL 3,3-difluoroglutamic acid-containing methotrexate analogues (Hart et al, J. Med.
Chem. 39(l):56-65, 1996), methotrexate tetrahydroquinazoline analogue (Gangjee, et
al J. Heterocycl. Chem. 32(l):243-8,1995), N-(a-aminoacyl) methotrexate derivatives
(Cheung et al., Pteridines 3(1-2): 101-2, 1992), biotin methotrexate derivatives (Fan et
al, Pteridines 3(1-2): 131-2, 1992), D-glutamic acid or D-erythrou, threo-4-
fluoroglutamic acid methotrexate analogues (McGuire et al, Biochem. Pharmacol.
42(l2):2400-3, 1991), p,y-methano methotrexate analogues (Rosowsky et al,
Pteridines 2(3) 133-9,1991), 10-deazaaminopterin (10-EDAM) analogue (Braakhuis et
al, Chem. Biol. Pteridines, Proc. Int. Symp. Pteridines Folic Acid Deriv., 1027-30,
1989), y-tetrazole methotrexate analogue (Kalman et al, Chem. Biol Pteridines, Proc.
Int. Symp. Pteridines Folic Acid Deriv., 1154-7, 1989), N-(L-a-aminoacyl)
methotrexate derivatives (Cheung et al, Heterocycles 2S(2):751-8, 1989), meta and
orthc isomers of aminopterin (Rosowsky et al, J. Med. Chem. 32(12):2582, 1989),
hydroxymethylmethotrexate (DE 267495), y-fluoromethotrexate (McGuire et al,
Cancer Res. 49(16)4517-25, 1989), polyglutamyl methotrexate derivatives (Kumar et
al, Cancer Res 46(10):5020-3, 1986), gem-diphosphonate methotrexate analogues
(WO 88/06158), a- and ?-substiruted methotrexate analogues (Tsushima et al,
Tetrahedron 44(17): 5375-87, 1988), 5-methyl-5-deaza methotrexate analogues
(4,725,687), Nd-acyl-Na-(4-ammo-4-deoxypteroyl)-L-omithine derivatives (Rosowsky
et al, J. Med. Chern. 31(1): 1332-7, 1988), 8-deaza methotrexate analogues (Kuehl et
id., Cancer Res. 48(6): 1481-8,1988), acivicin methotrexate analogue (Rosowsky et al.,
J Med. Chem. 50(8): 1463-9, 1987), polymeric platinol methotrexate derivative
(Garraher et ai, Polym. Sci. Technol. (Plenum), 35(Adv. Biomed. Polym ):311-24,
1987), methotrexate-y-dimyristoylphophatidylethanolamine (Kinsley et ai, Biochim.
Biophys. Acta 9/7(2):211-18, 1987), methotrexate polyglutamate analogues (Rosowsky
et al., Chem. Biol. Pteridines, Pteridines Folid Acid Deriv., Proc. Int. Symp. Pteridines
Folid Acid Deriv.: Chem., Biol. Clin. Aspects: 985-8, 1986), poly-?-glutamyl
methotrexate derivatives (Kisliuk et al., Chem. Biol. Pteridines, Pteridines Folid Acid
Deriv., Proc. Int. Symp. Pteridines Folid Acid Deriv.: Chem., Biol. Clin. Aspects: 989-
91!, 1986), deoxyuridylate methotrexate derivatives (Webber et ai, Chem. Biol.
Pteridines, Pteridines Folid Acid Deriv., Proc. Int. Symp. Pteridines Folid Acid Deriv.:
Chem., Biol. Clin. Aspects: 659-62, 1986), iodoacetyl lysine methotrexate analogue
(Delcamp et al., Chem. Biol. Pteridines, Pteridines Folid Acid Deriv., Proc. Int. Symp.
Pteridines Folid Acid Deriv.: Chem., Biol. Clin. Aspects: 807-9, 1986), 2,.omega.-
diaminoalkanoid acid-containing methotrexate analogues (McGuire et al., Biochem.
Pharmacol 35(15):2607-13, 1986), polyglutamate methotrexate derivatives (Kamen &
Wimck, Methods Enzymol 122(Vitam. Coenzymes, Pt. G):339-46, 1986), 5-methyl-5-
deaza analogues (Piper et al, J. Med. Chem. 29(6); 1080-7, 1986), quinazoline
methotrexate analogue (Mastropaolo et al, J. Med. Chem. 29(l):155-8,1986), pyrazine
methotrexate analogue (Lever & Vestal, J. Heterocycl. Chem. 22(1):5-6, 1985), cysteic
acid and homocysteic acid methotrexate analogues (4,490,529), ?-tert-butyl
methotrexate esters (Rosowsky et al., J. Med. Chem. 28(5):660-7, 1985), fluorinated
methotrexate analogues (Tsushima et al, Heterocycles 23(1):45-9, 1985), folate
methotrexate analogue (Trombe, J. Bacteriol 160(3):849-53, 1984),
phosphonoglutamic acid analogues (Sturtz & Guillamot, Eur. J. Med. Chem.Chim.
Thur 19(3):267-73,1984), poly (L-lysine) methotrexate conjugates (Rosowsky et al, J.
Med Chem. 27(7):888-93, 1984), dilysine and trilysine methotrexate derivates (Forsch
& Rosowsky, J. Org. Chem. 49(7):1305-9, 1984), 7-hydroxymethotrexate (Fabre et al.,
Cancer Res.,43(10):4648-52, 1983), poly-?-glutamyl methotrexate analogues (Piper &
Montgomery, Adv. Exp. Med. Biol, 163(Folyl Antifolyl Polyglutamates):95-100, 1983),
3',5'-dichloromethotrexate (Rosowsky & Yu, J. Med. Chem. 25(10): 1448-52, 1983),
diazoketone and chloromethylketone methotrexate analogues (Gangjee et al, J. Pharm.
Sci. 71(6):717-19, 1982), 10-propargylaminopterin and alkyl methotrexate homologs
(Piper et al, J. Med. Chem. 25(7):877-80, 1982), lectin derivatives of methotrexate (Lin
et al, JNCI 66(3):523-8, 1981), polyglutamate methotrexate derivatives (Galivan, Mol.
Pharmacol. 77(1): 105-10, 1980), halogentated methotrexate derivatives (Fox, JNCI
58(4):J955-8, 1977), 8-alkyl-7,8-dihydro analogues (Chaykovsky et al., J. Med. Chem.
20(10):J1323-7, 1977), 7-methyl methotrexate derivatives and dichloromethotrexate
(Rosowsky & Chen, J. Med. Chem. 77(12):J1308-11, 1974), lipophilic methotrexate
derivatives and 3',5'-dichloromethotrexate (Rosowsky, J. Med. Chem. 16(10):J 1190-3,
1973), deaza amethopterin analogues (Montgomery et al, Ann. N.Y Acad. Sci.
186:1227-34, 1971), MX068 (Pharma Japan, 1658:18, 1999) and cysteic acid and
homocysteic acid methotrexate analogues (EPA 0142220); N3-alkylated analogues of 5-
fliorouracil (Kozai et al, J. Chem. Soc, Perkin Trans. 7(19):3145-3146, 1998), 5-
fluorouracil derivatives with 1,4-oxaheteroepane moieties (Gomez et al, Tetrahedron
54(43):1329543312, 1998), 5-fluorouracil and nucleoside analogues (Li, Anticancer
Res. J 7(1 A):21-27, 1997), cis- and trans-5-fluoro-5,6-dihydro-6-alkoxyuracil (Van der
Wilt et al, Br. J. Cancer 68(4):702-7, 1993), cyclopentane 5-fluorouracil analogues
(Hionowski & Szarek, Can. J. Chem. 70(4):1162-9,1992), A-OT-fluorouracil (Zhang et
al, Zongguo Yiyao Gongye Zazhi 20(11):513-15, 1989), N4-trimethoxybenzoyl-5'-
deoxy-5-fluorocytidine and 5'-deoxy-5-fluorouridme (Miwa et al, Chem. Pharm. Bull
38(4) 998-1003,1990), l-hexylcarbamoyl-5-fluorouracil (Hoshi et al, J. Pharmacobio-
Dun 3(9):478-81, 1980; Maehara et al, Chemotherapy (Basel) 34(6):484-9,1988), B-
3839 (Prajda et al., In Vivo 2(2):151-4, 1988), uracil-1-(2-tetrahydrofuryl)-5-
fluorouracil (Anai et al, Oncology 45(3):144-7, 1988), 1-(2'-deoxy-2'-fluoro-ß-D-
arabinofuranosyl)-5-fluorouracil (Suzuko et al, Mol Pharmacol 31(3)301-6, 1987),
doxilluridine (Matuura et al, Oyo Yakuri 29(5):803-3i,1985), 5'-deoxy-5-fluorouridine
(Bollag & Hartmann, Eur. J. Cancer 16(4):427-32, 1980), 1-acetyl-3-O-toluyl-5-
fluorouracil (Okada, Hiroshima J. Med. Sci. 28(1):49-66, 1979), 5-fluorouracil-m-
formylbenzene-sulfonate (JP 55059173), N'-(2-furanidyl)-5-fluorouracil (JP 53149985)
and]-(2-tetrahydrofuryl)-5-fluorouracil (JP 52089680); 4-epidoxorubiem (Lanius,
Adv. Chemother. Gastrointest. Cancer, (Int. Symp.), 159-67, 1984); N-substituted
deacetyivinblastine amide (vindesine) sulfates (Conrad et al., J. Med, Chem. 22(4):391-
400, 1979); and Cu(II)-VP-16 (etoposide) complex (Tawa et al, Bioorg. Med. Chem.
6(7): 1003-1008, 1998), pyrrolecarboxamidino-bearing etoposide analogues (Ji et al,
Bioorg. Med. Chem. Lett. 7(5):607-612, 1997), 4ß-amino etoposide analogues (Hu,
University of North Carolina Dissertation, 1992), ?-lactone ring-modified arylamino
etoposide analogues (Zhou et al, J. Med. Chem. 37(2):287-92, 1994), N-glucosyl
etoposide anaiogue (Allevi el al, Tetrahedron Lett. 34(45):7313-16, 1993), etoposide
A-ring analogues (Kadow et al, Bioorg. Med. Chem. Lett. 2(1): 17-22, 1992), 4'-
deshydroxy-4'-methyl etoposide (Saulnier et al, Bioorg. Med. Chem. Lett. 2(10): 1213-
18, 1992), pendulum ring etoposide analogues (Sinha et al, Eur. J. Cancer 26(5):590-3,
1990) and E-ring desoxy etoposide analogues (Saulnier et al, J. Med. Chem.
32(7):1418-20,1989).
Within one preferred embodiment of the invention, the cell cycle
inhibitor is taxane such as paclitaxel. Briefly, taxanes are compounds which disrupts
mitosis (M-phase) by binding to tubulin to form abnormal mitotic spindles or an
analogue or derivative thereof. Paclitaxel, the most recognized member of the taxane
family is a highly derivatized diterpenoid (Warn et al, J. Am. Chem. Soc. 93:2325,
1971) which has been obtained from the harvested and dried bark of Taxus brevifolia
(Pacific Yew) and Taxomyces Andreanae and Endophytic Fungus of the Pacific Yew
(Stierle et al, Science 60:214-216, 1993). "Paclitaxel" (which should be understood
herein to include formulations, prodrugs, analogues and derivatives such as, for
example, TAXOL®, TAXOTERE®, docetaxel, 10-desacetyl analogues of paclitaxel and
3'N-desbenzoyl-3'N-t-butoxy carbonyl analogues of paclitaxel) may be readily prepared
utilizing techniques known to those skilled in the art (see, e.g., Schiff et al, Nature
277:665-667, 1979; Long and Fairchild, Cancer Research 54:4355-4361, 1994; Ringel
and Horwitz, J. Nat'l Cancer Inst. 83(4):288-291, 1991; Pazdur et al, Cancer Treat.
Rev. 19(4):351-386, 1993; WO 94/07882; WO 94/07881; WO 94/07880; WO
94/07876; WO 93/23555; WO 93/10076; WO94/00156; WO 93/24476; EP 590267;
WO 94/20089; U.S. Patent Nos. 5,294,637; 5,283,253; 5,279,949; 5,274,137;
5,202,448; 5,200,534; 5,229,529; 5,254,580; 5,412,092; 5,395,850; 5,380,751;
5,350,866; 4,857,653; 5,272,171; 5,411,984; 5,248,796; 5,248,796; 5,422,364;
5,300,638; 5,294,637; 5,362,831; 5,440,056; 4,814,470; 5,278,324; 5,352,805;
5,411,984; 5,059,699; 4,942,184; Tetrahedron Letters 35(52):9709-9712,1994; J. Med.
Chem. 35:4230-4237, 1992; J. Med. Chem. 34:992-99%, 1991; J. Natural Prod.
57(10): 1404-1410, 1994; J. Natural Prod. 57(11):1580-1583, 1994; J. Am. Chem. Soc.
110:6558-6560, 1988), or obtained from a variety of commercial sources, including for
example, Sigma Chemical Co., St. Louis, Missouri (T7402 - from Taxus brevifolia).
Representative examples of paclitaxel derivatives or analogues include
7-deoxy-docetaxol, 7,8-cyclopropataxanes, N-substituted 2-azetidones, 6,7-epoxy
paclitaxels, 6,7-modified paclitaxels, 10-desacetoxytaxol, 10-deacetyltaxol (from 10-
deacetylbaccatin III), phosphonooxy and carbonate derivatives of taxol, taxol 2',7-
di(sodium 1,2-benzenedicarboxylate, 10-desacetoxy-l 1,12-dihydrotaxol-10,12(18)-
diene derivatives, 10-desacetoxytaxol, Protaxol (2'-and/or 7-O-ester derivatives ), (2'-
and/or 7-O-carbonate derivatives), asymmetric synthesis of taxol side chain, fluoro
taxols, 9-deoxotaxane, (13-acetyl-9-deoxobaccatine HI, 9-deoxotaxol, 7-deoxy-9-
deoxotaxol, 10-desacetoxy-7-deoxy-9-deoxotaxol, Derivatives containing hydrogen or
acetyl group and a hydroxy and tert-butoxycarbonylamino, sulfonated 2'-acryloyltaxol
and sulfonated 2'-O-acyl acid taxol derivatives, succinyltaxol, 2'-y-aminobutyryltaxol
iormate, 2'-acetyl taxol, 7-acetyl taxol, 7-glycine carbamate taxol, 2*-OH-7-PEG(5000)
carbamate taxol, 2'-benzoyl and 2',7-dibenzoyl taxol derivatives, other prodrugs (2'-
acetyltaxol; 2',7-diacetyltaxol; 2'succinyltaxol; 2'-(beta-alanyl)-taxol); 2'gamma-
amnobutyryltaxol formate; ethylene glycol derivatives of 2'-succinyltaxol; 2'-
glutaryltaxol; 2'-(N,N-dimethylglycyl) taxol; 2'-(2-(N,N-
dimethylamino)propionyl)taxol; 2'orthocarboxybenzoyl taxol; 2'aliphatic carboxylic
acid derivatives of taxol, Prodrugs {2,(N,N-diethylammopropionyl)taxoI, 2'(N,N-
dimethylglycyl)taxol, 7(N,N-dimethylglycyl)taxol, 2',7-di-(N,N-dimethylglycyl)taxol,
7(N,N-diethylaminopropionyl)taxol, 2',7-di(N,N-diethylaminopropionyl)taxol, 2'-(L-
glycyl)taxoI, 7-(L-glycyl)taxol, 2',7-di(L-glycyl)taxol, 2'-(L-alanyl)taxol, 7-(L-
alanyl)taxol, 2',7-di(L-alanyl)taxol, 2'-(L-leucyl)taxol, 7-(L-leucyl)taxol, 2',7-di(L-
leucyl)taxol, 2' (L-isoleucyl)taxol, 7-(L-isoleucyl)taxol, 2',7-di(L-isoleucyl)taxol, 2'-(L-
valyl)taxol, 7-(L-valyl)taxol, 2'7-di(L-valyl)taxol, 2'-(L-phenylalanyl)taxol, 7-(L-
phecylalanyl)taxol, 2',7-di(L-phenylalanyl)taxol, 2'-(L-prolyl)taxol, 7-(L-prolyl)taxol,
2',7-di(L-prolyl)taxol, 2*-(L-lysyl)taxol, 7-(L-lysyl)taxol, 2',7-di(L-lysyl)taxol, 2'-(L-
glutamyl)taxoI, 7-(L-glutamyl)taxol, 2',7-di(L-glutamyl)taxol, 2'-(L-arginyl)taxol, 7-(L-
arginyl)taxol, 2',7-di(L-arginyl)taxol}, Taxol analogs with modified phenylisoserine
side chains, taxotere, (N-debenzoyl-N-tert-(butoxycaronyl)-10-deacetyltaxol, and
taxanes (e.g., baccatin III, cephalomannine, 10-deacetylbaccatin III, brevifoliol,
yunantaxusin and taxusin); and other taxane analogues and derivatives, including 14-
beta-hydroxy-10 deacetybaccatin III, debenzoyl-2-acyl paclitaxel derivatives, benzoate
paclitaxel derivatives, phosphonooxy and carbonate paclitaxel derivatives, sulfonated
2'-acryloyltaxol; sulfonated 2'-O-acyl acid paclitaxel derivatives, 18-site-substituted
paclitaxel derivatives, chlorinated paclitaxel analogues, C4 methoxy ether paclitaxel
derivatives, sulfenamide taxane derivatives, brominated paclitaxel analogues, Girard
taxane derivatives, nitrophenyl paclitaxel, 10-deacetylated substituted paclitaxel
derivatives, 14- beta -hydroxy-10 deacetylbaccatin III taxane derivatives, C7 taxane
derivatives, C10 taxane derivatives, 2-debenzoyl-2-acyl taxane derivatives, 2-debenzoyl
and -2-acyl paclitaxel derivatives, taxane and baccatin III analogs bearing new C2 and
C4 functional groups, n-acyl paclitaxel analogues, 10-deacetylbaccatin III and 7-
protected-10-deacetylbaccatin III derivatives from 10-deacetyl taxol A, 10-deacetyl
taxol B, and 10-deacetyl taxol, benzoate derivatives of taxol, 2-aroyl-4-acyl paclitaxel
analogues, orthro-ester paclitaxel analogues, 2-aroyl-4-acyl paclitaxel analogues and 1-
deoxy paclitaxel and
1-deoxy paclitaxel analogues.
In one aspect, the Cell Cycle Inhibitor is a taxane having the formula
(CI):
where the gray-highlighted portions may be substituted and the non-highlighted portion
is the taxane core. A side-chain (labeled "A" in the diagram ) is desirably present in
order for the compound to have good activity as a Cell Cycle Inhibitor. Examples of
compounds having this structure include paclitaxel (Merck Index entry 7117), docetaxol
(Taxotere, Merck Index entry 3458), and 3'-desphenyl-3'-(4-ntirophenyl)-N-debenzoyl-
N-(t-butoxycarbonyl)-10-deacetyltaxol.
In one aspect, suitable taxanes such as paclitaxel and its analogs and
derivatives are disclosed in Patent No. 5,440,056 as having the structure (C2):
wherein X may be oxygen (paclitaxel), hydrogen (9-deoxy derivatives), thioacyl, or
dihydroxyl precursors; R1 is selected from paclitaxel or taxotere side chains or alkanoyl
of the formula (C3)
wherein R7 is selected from hydrogen, alkyl, phenyl, alkoxy, amino, phenoxy
(substituted or unsubstituted); Rg is selected from hydorgen, alkyl, hydroxyalkyl,
alkoxyalkyl, aminoalkyl, phenyl (substituted or unsubstituted), alpha or beta-naphthyl;
and R9 is selected from hydrogen, alkanoyl, substituted alkanoyl, and aminoalkanoyl;
where substitutions refer to hydroxyl, sulfhydryl, allalkoxyl, carboxyl, halogen,
thioalkoxyi, N,N-dimethylamino, alkylamino, dialkylamino, nitro, and -OSO3H, and/or
may refer to groups containing such substitutions; R2 is selected from hydrogen or
oxygen-containing groups, such as hydrogen, hydroxyl, alkoyl, alkanoyloxy,
aminoalkanoyloxy, and peptidyalkanoyloxy; R3 is selected from hydrogen or oxygen-
containing groups, such as hydrogen, hydroxyl, alkoyl, alkanoyloxy, aminoalkanoyloxy,
and peptidyalkanoyloxy, and may further be a silyl containing group or a sulphur
containing group; R4 is selected from acyl, alkyl, alkanoyl, aminoalkanoyl,
peptidylalkanoyl and aroyl; R5 is selected from acyl, alkyl, alkanoyl, aminoalkanoyl,
peptidylalkanoyl and aroyl; R6 is selected from hydrogen or oxygen-containing groups,
such as hydrogen, hydroxyl alkoyl, alkanoyloxy, aminoalkanoyloxy, and
peptidyalkanoyloxy.
In one aspect, the paclitaxel analogs and derivatives useful as Cell Cycle
inhibitors in the present invention are disclosed in PCT International Patent Application
No. WO 93/10076. As disclosed in this publication, the analog or derivative should
have a side; chain attached to the taxane nucleus at C13, as shown in the structure below
(formula C4), in order to confer antitumor activity to the taxane.
WO 93/10076 discloses that the taxane nucleus may be substituted at
any position with the exception of the existing methyl groups. The substitutions may
include, for example, hydrogen, alkanoyloxy, alkenoyloxy, aryloyloxy. In addition, oxo
groups may be attached to carbons labeled 2,4, 9, 10. As well, an oxetane ring may be
attached at carbons 4 and 5. As well, an oxirane ring may be attached to the carbon
labeled 4.
In one aspect, the taxane-based Cell Cycle Inhibitor useful in the present
invention is disclosed in U.S. Patent 5,440,056, which discloses 9-deoxo taxanes.
These are compounds lacking an oxo group at the carbon labeled 9 in the taxane
structure shown above (formula C4). The taxane ring may be substituted at the carbons
labeled 1, 7 and 10 (independently) with H, OH, O-R, or O-CO-R where R is an alkyl
or an aminoalkyl. As well, it may be substituted at carbons labeled 2 and 4
(independently) with aryol, alkanoyl, aminoalkanoyl or alkyl groups. The side chain of
formula (C3) may be substituted at R7 and R8 (independently) with phenyl rings,
substituted phenyl rings, linear alkanes/alkenes, and groups containing H, O or N. R9
may be substituted with H, or a substituted or unsubstituted alkanoyl group.
Taxanes in general, and paclitaxel is particular, is considered to function
as a Cell Cycle Inhibitor by acting as a anti-microtuble agent, and more specifically as a
stabilizer.
In another aspect, the Cell Cycle Inhibitor is a VinGa Alkaloid. Vinca
alkaloids have the following general structure. They are indole-dihydroindole dimers.
As disclosed in U.S. Patent Nos. 4,841,045 and 5,030,620, R1 can be a
formyl or methyl group or alternately H. R1 could also be an alkyl group or an
aldehyde-substituted alkyl (e.g., CH2CHO). R2 is typically a CH3 or NH2 group.
However it can be alternately substituted with a lower alkyl ester or the ester linking to
the dihydroindole core may be substituted with C(O)-R where R is NH2, an amino acid
ester or a peptide ester. R3 is typically C(O)CH3, CH3 or H. Alternately, a protein
fragment may be linked by a bifunctional group such as maleoyl amino acid. R3 could
also be substituted to form an alkyl ester which may be further substituted. R4 may be -
C H2- or a single bond. R5 and R6 may be H, OH or a lower alkyl, typically -CH2CH3.
Alternatively R6 and R7 may together form an oxetane ring. R7 may alternately be H.
Further substitutions include molecules wherein methyl groups are substituted with
other alkyl groups, and whereby unsaturated rings may be derivatized by the addition of
a side group such as an alkane, alkene, alkyne, halogen, ester, amide or amino group.
Exemplary Vinca Alkaloids are vinblastine, vincristine, vincristine
sulfate, vindesine, and vinorelbine, having the structures:
Analogs typically require the side group (shaded area) in order to have
activity. These compounds are believed to act as Cell Cycle Inhibitors by functioning
as anti-microtubule agents, and more specifically to inhibit polymerization.
In another aspect, the Cell Cycle Inhibitor is Camptothecin, or an analog
or derivative thereof. Camptothecins have the following general structure.
In this structure, X is typically O, but can be other groups, e.g., NH in
the case of 21-lactam derivatives. R1 is typically H or OH, but may be other groups,
e.g. a terminally hydroxylated C1-3 alkane. R2 is typically H or an amino containing
group such as (CH3)2NHCH2, but may be other groups eg., NO2, NH2, halogen (as
disclosed in, e.g., U.S. Patent 5,552,156) or a short alkane containing these groups. R3
is typrcally H or a short alkyl such as C2H5. R4 is typically H but may be other groups,
e.g., a methylenedioxy group with R1.
Exemplary camptothecin compounds include topotecan, irinotecan
(CPT-11), 9-aminocamptothecin, 21-lactam-20(S)-camptothecin, 10,11-
metbyienedioxycamptothecin, SN-38, 9-nitrocamptothecin, 10-hydroxycamptothecin.
Exemplary compounds have the structures:
Camptothecins have the five rings shown here. The ring labeled E must
be intact (the lactone rather than carboxylate form) for maximum activity and minimum
toxicity. These compounds are useful to as Cell Cycle Inhibitors, where they function
as Topoisomerase I Inhibitors and/or DNA cleavage agents.
In another aspect, the Cell Cycle Inhibitor is a Podophyllotoxin, or a
derivative or an analog thereof. Exemplary compounds of this type are Etoposide or
Teniposide, which have the following structures:
These compounds are believed to function as Cell Cycle Inhibitors by
being Topoisomerase II Inhibitors and/or by DNA cleaving agents.
In another aspect, the Cell Cycle Inhibitor is an Anthracycline.
Anthracyclines have the following general structure, where the R groups may be a
variety of organic groups:
According to U.S. Patent 5,594,158, suitable R groups are: R1 is CH3 or
CH2OH; R2 is daunosamine or H; R3 and R4 are independently one of OH, NO2, NH2, F,
CI, Br, I, CN, H or groups derived from these; R5-7 are all H or R5 and R6 are H and R7
and R8 are alkyl or halogen, or vice versa: R7 and Rg are H and R5 and R6 are alkyl or
halogen.
According to U.S. Patent 5,843,903, R2 may be a conjugated peptide.
According to U.S. Patent Nos. 4,215,062 and 4,296,105, R5 may be OH or an ether
linked alkyl group. R1 may also be linked to the anthracycline ring by a group other
than C(O), such as an alkyl or branched alkyl group having the C(O) linking moiety at
its end, such as -CH2CH(CH2-X)C(O)-R1, wherein X is H or an alkyl group (see, e.g.,
U S. Patent 4,215,062). R2 may alternately be a group linked by the functional group
=-N-NHC(O)-Y, where Y is a group such as a phenyl or substituted phenyl ring.
Alternately R3 may have the following structure:
in which R9 is OH either in or out of the plane of the ring, or is a second sugar moiety
such as R3. R10 may be H or form a secondary amine with a group such as an aromatic
group, saturated or partially saturated 5 or 6 membered heterocyclic having at least one
ring nitrogen (see U.S. Patent 5,843,903). Alternately, R10 may be derived from an
amino acid, having the structure -C(O)CH(NHR11])(R12), in which R11 is H, or forms a
C3-4 membered alkylene with R12- R12 may be H, alkyl, aminoalkyl, amino, hydroxy,
mercapto, phenyl, benzyl or methylthio (see U.S. Patent 4,296,105).
Exemplary Anthracycline are Doxorubicin, Daunorubicin, Idarubicin,
Epirubicin, Pirarubicin, Zorubicin, and Carubicin. Suitable compounds have the
structures:
Other suitable Anthracyclines are Anthramycin, Mitoxantrone,
Menogaril, Nogalamycin, Aclacinomycin A, Olivomycin A, Chromomycin A3, and
Plicamycin having the structures:
These compounds are believed to function as Cell Cycle Inhibitors by
being Topoisomerase Inhibitors and/or by DNA cleaving agents.
In another aspect, the Cell Cycle Inhibitor is a Platinum compound. In
general, suitable platinum complexes may be of Pt(H) or Pt(IV) and have this basic
structure:
wherein X and Y are anionic leaving groups such as sulfate, phosphate, carboxylate,
and halogen; R1 and R2 are alkyl, amine, amino alkyl any may be further substituted,
and are basically inert or bridging groups. For Pt(H) complexes Z1 and Z2 are non-
existent. For Pt(IV) Z1 and Z2 may be anionic groups such as halogen, hydroxy,
carboxylate. ester, sulfate or phosphate. See, e.g., U.S. Patent Nos. 4,588,831 and
4,250,189.
Suitable platinum complexes may contain multiple Pt atoms. See, e.g.,
U.S. Patent Nos. 5,409,915 and 5,380,897. For example bisplatinum and triplatinum
complexes of the type:
Exemplary Platinum compound are Cisplatin, Carboplatin, Oxaliplatin,
and Miboplatin having the structures:
These compounds are believed to function as Cell Cycle Inhibitors by
binding to DNA, i.e., acting as alkylating agents of DNA.
In another aspect, the Cell Cycle Inhibitor is a Nitrosourea.
Nitrosourease have the following general structure (C5), where typical R groups are
shown below.
Other suitable R groups include cyclic alkanes, alkanes, halogen
substituted groups, sugars, aryl and heteroaryl groups, phosphonyl and sulfonyl groups.
As disclosed in U.S. Patent No. 4,367,239, R may suitably be CH2-C(X)(Y)(Z),
wherein X and Y may be the same or different members of the following groups:
phenyl, cyclyhexyl, or a phenyl or cyclohexyl group substituted with groups such as
halogen, lower alkyl (C1-4), trifluore methyl, cyano, phenyl, cyclohexyl, lower alkyloxy
(C1-4)- Z has the following structure: -alkylene-N-R1R2, where R1 and R2 may be the
same or different members of the following group: lower alkyl (C1-4) and benzyl, or
together R1 and R2 may form a saturated 5 or 6 membered heterocyclic such as
pyrrolidine, piperidine, morfoline, thiomorfoline, N-lower alkyl piperazine, where the
heterocyclic may be optionally substituted with lower alkyl groups.
As disclosed in U.S. Patent No. 6,096,923, R and R' of formula (C5)
may be the same or different, where each may be a substituted or unsubstituted
hydrocarbon having 1-10 carbons. Substitutions may include hydrocarbyl, halo, ester,
amide, carboxylic acid, ether, thioether and alcohol groups. As disclosed in U.S. Patent
Nc. 4,472,379, R of formula (C5) may be an amide bond and a pyranose structure (e.g.,
Methyl 2' [N-(N-(-chloroethyl)-N-nitroso-carbamoyl]-glycyljamino-2-deoxy-a-D-
glucopyranoside). As disclosed in U.S. Patent No. 4,150,146, R of formula (C5) may
be an alkyl group of 2 to 6 carbons and may be substituted with an ester, sulfonyl, or
hydroxyl group. It may also be substituted with a carboxylica acid or CONH2 group.
Exemplary Nitrosourea are BCNU (Carmustine), Methyl-CCNU
(Semustine), CCNU (Lomustine), Ranimustine, Nimustine, Chlorozotocin,
Fotemustine, Streptozocin, and Streptozocin, having the structures:
These nitrosourea compounds are believed to function as Cell Cycle
Inhibitor by binding to DNA, that is, by functioning as DNA alkylating agents.
In another aspect, the Cell Cycle Inhibitor is a Nitroimidazole, where
exemplary Nitroimidazoles are Metronidazole, Benznidazole, Etanidazole, and
Misonidazole, having the structures:
Suitable nitroimidazole compounds are disclosed in, e.g., U.S. Patent
Nos. 4,371,540 and 4,462,992.
In another aspect, the Cell Cycle Inhibitor is a Folic acid antagonist, such
as Methotrexate or derivatives or analogs thereof, including Edatrexate, Trimetrexate,
Raltitrexed, Piritrexim, Denopterin, Tomudex, and Pteropterin. Methotrexate analogs
have the following general structure:
The identity of the R group may be selected from organic groups, particularly those
groups set forth in U.S. Patent Nos. 5,166,149 and 5,382,582. For example, R1 may be
N, R2 may be N or C(CH3), R3 and R3' may H or alkyl, e.g., CH3, R4 may be a single
bond or NR, where R is H or alkyl group. R5,6,8 may be H, OCH3, or alternately they
can be halogens or hydro groups. R7 is a side chain of the general structure:
wherein n =1 for methotrexate, n = 3 for pteropterin. The carboxyl groups in the side
chain may be esterified or form a salt such as a Zn2+ salt. R9 and R10 can be NH2 or
may be alkyl substituted.
Exemplary folic acid antagonist compounds have the structures:
These compounds are believed to function as Cell Cycle Inhibitors by
serving as antimetabolites of folic acid.
In another aspect, the Cell Cycle Inhibitor is a Cytidine Analog, such as
Cytarabine or derivatives or analogs thereof, including Enocitabine, FMdC ((E(-2'-
deoxy-2-(fluoromethyIene)cytidine), Gemcitabine, 5-Azacitidine, Ancitabine, and 6-
Azauridine. Exemplary compounds have the structures:
These compounds are believed to function as Cell Cycle Inhibitors as
acting as antimetabolites of pyrimidine.
In another aspect, the Cell Cycle Inhibitor is a Pyrimidine analog. In one
aspect, the Pyrimidine analogs have the general structure:
wherein positions 2', 3' and 5' on the sugar ring (R2, R3 and R4, respectively) can be H,
hydroxyl, phosphoryl (see, e.g., U.S. Patent 4,086,417) or ester (see, e.g., U.S. Patent
3,894,000). Esters can be of alkyl, cycloalkyl, aryl or heterocyclo/aryl types. The 2'
carbon can be hydroxylated at either R2 or R2', the other group is H. Alternately, the 2'
carbon can be substituted with halogens e.g., fluoro or difluoro cytidines such as
Gemcytabine Alternately, the sugar can be substituted for another heterocyclic group
such as a furyl group or for an alkane, an alkyl ether or an amide linked alkane such as
C(0)NH(CH2)5CH3. The 2° amine can be substituted with an aliphatic acyl (R1) linked
with an amide (see, e.g., U.S. Patent 3,991,045) or urethane (see, e.g., U.S. Patent
3,894,000) bond. It can also be further substituted to form a quaternary ammonium salt.
R5 in the pyrimidine ring may be N or CR, where R is H, halogen containing groups, or
alkyl (see, e.g., U.S. Patent No. 4,086,417). R6 and R7 can together can form an oxo
group or R6 := -NH-R1 and R7 = H. R8 is H or R7 and Rg together can form a double
bond or R8 can be X, where X is:
Specific pyrimidine analogs are disclosed in U.S. Patent No. 3,894,000
(see, e.g., 2'-G-palmityl-ara-cytidine, 3'-O-benzoyl-ara-cytidine, and more than 10 other
examples); U.S. Patent No. 3,991,045 (see, e.g., N4-acyl-l-ß-D-
arabinofuranosylcytosine, and numerous acyl groups derivatives as listed therein, such
as palmitoyl.
In another aspect, the Cell Cycle Inhibitor is a Fluoro-pyrimidine
Analog, such as 5-Fluorouracil, or an analog or derivative thereof, including Carmofur,
Doxifluridine, Emitefur, Tegafur, and Floxuridine. Exemplary compounds have the
structures:
Other suitable Fluoropyrimidine Analogs include 5-FudR (5-fluoro-
deoxyuridine), or an analog or derivative thereof, including 5-iododeoxyuridine (5-
IudR), 5-bromodeoxyuridine (5-BudR), Fluorouridine triphosphate (5-FUTP), and
Fliorodeoxyuridine monophosphate (5-dFUMP). Exemplary compounds have the
structures:
These compounds are believed to function as Cell Cycle Inhibitors by
serving as antimetabolites of pyrimidine.
In another aspect, the Cell Cycle Inhibitor is a Purine Analog. Purine
analogs have the following general structure:
wherein X is typically carbon; R1 is H, halogen, amine or a substituted phenyl; R2 is H,
a primary, secondary or tertiary amine, a sulfur containing group, typically -SH, an
alkane, a cyclic alkane, a heterocyclic or a sugar; R3 is H,.a sugar (typically a furanose
or pyranose structure), a substituted sugar or a cyclic or heterocyclic alkane or aryl
group. See, e.g., U.S. Patent No. 5,602,140 for compounds of this type.
In the case of pentostatin, X-R2 is -CH2CH(OH)-. In this case a second
carbon atom is inserted in the ring between X and the adjacent nitrogen atom. The X-N
double bond becomes a single bond.
U.S. Patent No. 5,446,139 describes suitable purine analogs of the type
shown in the following formula:
wherein N signifies nitrogen and V, W, X, Z can be either carbon or nitrogen with the
following provisos. Ring A may have 0 to 3 nitrogen atoms in its structure. If two
nitrogens are present in ring A, one must be in the W position. If only one is present, it
must not be in the Q position. V and Q must not be simultaneously nitrogen. Z and Q
must not be simultaneously nitrogen. If Z is nitrogen, R3 is not present. Furthermore,
R1-7 are independently one of H, halogen, C1-7 alkyl, C1-7 alkenyl, hydroxyl, mercapto,
C1-7 alkylthio, C1-7 alkoxy, C2-7 alkenyloxy, aryl oxy, nitro, primary, secondary or
tertiary amine containing group. R5-8 are H or up to two of the positions may contain
independently one of OH, halogen, cyano, azido, substituted amino, R5 and R7 can
together form a double bond. Y is H, a C1-7 alkylcarbonyl, or a mono- di or tri
phosphate.
Exemplary suitable purine analogs include 6-Mercaptopurine,
Thiguanosine, Thiamiprine, Cladribine, Fludaribine, Tubercidin, Puromycin,
Pentoxyfilline; where these compounds may optionally be phosphorylated. Exemplary
compounds have the structures:
These compounds are believed to function as Cell Cycle Inhibitors by
serving as antimetabolites of purine.
In another aspect, the Cell Cycle Inhibitor is a Nitrogen Mustard. Many
suitable Nitrogen Mustards are known and are suitably used as a Cell Cycle Inhibitor in
the present invention. Suitable nitrogen mustards are also known as
cyclophosphamides.
A preferred nitrogen mustard has the general structure:
or -CH3 or other alkane, or chloronated alkane, typically CH2CH(CH3)Cl, or a
polycyclic group such as B, or a substituted phenyl such as C or a heterocyclic group
such as D.
Suitable nitrogen mustards are disclosed in U.S. Patent No. 3,808,297,
wherein A is:
R1-2 are H or CH2CH2Cl; R3 is H or oxygen-containing groups such as hydroperoxy;
and R4 can be alkyl, aryl, heterocyclic.
The cyclic moiety need not be intact. See, e.g., U.S. Patent Nos.
5,472,956,4,908,356,4,841,085 that describe the following type of structure:
wherein R1 is H or CH2CH2Cl, and R2-6 are various substiruent groups.
Exemplary nitrogen mustards include methylchloroethamine, and
analogs or derivatives thereof, including methylchloroethamine oxide hydrochloride,
Novembichin, and Mannomustine (a halogenated sugar). Exemplary compounds have
the structures:
The Nitrogen Mustard may be Cyclophosphamide, Ifosfamide,
Perfosfamide, or Torofosfamide, where these compounds have the structures:
The Nitrogen Mustard may be Estramustine, or an analog or derivative
thereof, including Phenesterine, Prednimustine, and Estramustine PO4. Thus, suitable
nitrogen mustard type Cell Cycle Inhibitors of the present invention have the structures:
The Nitrogen Mustard may be Chlorambucil, or an analog or derivative
thereof, including Melphalan and Chlormaphazine. Thus, suitable nitrogen mustard
type Cell Cycle Inhibitors of the present invention have the structures:
The Nitrogen Mustard may be Uracil Mustard, which has the structure:
The Nitrogen Mustards are believed to function as Cell Cycle Inhibitors
by serving as alkylating agents for DNA. Nitrogen Mustards have been shown useful in
thu treatment of cell proliferative disorders including, for example, small cell lung,
breast, cervical, head and neck, prostate, retinoblastoma, and soft tissue sarcoma.
The Cell Cycle Inhibitor of the present invention may be a Hydroxyurea.
Hydroxyureas have the following general structure:
Suitable Hydroxyureas are disclosed in, for example, U.S. Patent No.
6,080,874, wherein R1 is:
and R2 is an alkyl group having 1-4 carbons and R3 is one of H, acyl, methyl, ethyl, and
mixtures thereof, such as a methylether.
Other suitable Hydroxyureas are disclosed in, e.g., U.S. Patent No.
5,665,768, wherein R1 is a cycloalkenyl group, for example N-[3-[5-(4-
fluorophenylthio)-furyl]-2-cyclopenten-l-yl]N-hydroxyurea; R2 is H or an alkyl group
having 1 to 4 carbons and R3 is H; X is H or a cation.
Other suitable Hydroxyureas are disclosed in, e.g., U.S. Patent No.
4,299,778, wherein R1 is a phenyl group substituted with on or more fluorine atoms; R2
is a cyclopropyl group; and R3 and X is H.
Other suitable Hydroxyureas are disclosed in, e.g., U.S. Patent No.
5,066,658, wherein R2 and R3 together with the adjacent nitrogen form:
wherein m is 1 or 2, n is 0-2 and Y is an alkyl group.
In one aspect, the hydroxy urea has the structure:
Hydroxyureas are believed to function as Cell Cycle Inhibitors by
serving to inhibit DNA synthesis.
In another aspect, the Cell Cycle Inhibitor is a Belomycin, such as
Bleomycin A2, which have the structures:
Belomycins are believed to function as Cell Cycle Inhibitors by cleaving
DNA.
In another aspect, the Cell Cycle Inhibitor is a Mytomycin, such as
Mitomycin C, or an analog or derivative thereof, such as Porphyromycin. Suitable
compounds have the structures:
These compounds are believed to function as Cell Cycle Inhibitors by
serving as DNA alkylating agents.
In another aspect, the Cell Cycle Inhibitor is an Alkyl sulfonate, such as
Busulfan, or an analog or derivative thereof, such as Treosulfan, Improsulfan,
Piposulfan, and Pipobroman. Exemplary compounds have the structures:
These compounds are believed to function as Cell Cycle Inhibitors by
serving as DNA alkylating agents.
In another aspect, the Cell Cycle Inhibitor is a Benzamide. In yet
another aspect, the Cell Cycle Inhibitor is a Nicotinamide. These# compounds have the
basic structure:
wherein X is either O or S; A is commonly NH2 or it can be OH or an alkoxy group; B
is N or C-R4, where R4 is H or an ether-linked hydroxylated alkane such as
OCH2CH2OH, the alkane may be linear or branched and may contain one or more
hydroxyl groups. Alternately, B may be N-R5 in which case the double bond in the ring
involving B is a single bond. R5 may be H, and alkyl or an aryl group (see, e.g., U.S.
Patent No. 4,258,052); R2 is H, ORe, SRe or NHRg, where Re is an alkyl group; and R3
is H, a lower alkyl, an ether linked lower alkyl such as -O-Me or -O-Ethyl (see, e.g.,
U.S. Patent No. 5,215,738).
. Suitable Benzamide compounds have the structures:
where additional compounds are disclosed in U.S. Patent No. 5,215,738, (listing some
32 compounds).
Suitable Nicotinamide compounds have the structures:
where additional compounds are disclosed in U.S. Patent No. 5,215,738 (listing some
58 compounds, e.g., 5-OH nicotinamide, 5-aminonicotinamide, 5-(2,3-
dihydroxypropoxy) nicotinamide), and compounds having the structures:
and U.S. Patent No. 4,258,052 (listing some 46 compounds, e.g., l-methyl-6-keto-t,6-
dihydronicotinic acid).
In one aspect, the Cell Cycle Inhibitor is a Tetrazine Compound, such as
Temozolomide, or an analog or derivative thereof, including Dacarbazine. Suitable
compounds have the structures:
Another suitable Tetrazine Compound is Procarbazine, including HC1
and HBr saits, having the structure:
In another aspect, the Cell Cycle Inhibitor is Actinomycin D, or other
members of this family, including Dactinomycin, Actinomycin C1, Actinomycin C2,
Actinomycin C3, and Actinomycin F1. Suitable compounds have the structures:
In another aspect, the Cell Cycle Inhibitor is an Aziridine compound,
such as Benzodepa, or an analog or derivative thereof, including Meturedepa, Uredepa,
and Carboquone. Suitable compounds have the structures:
In another aspect, the Cell Cycle Inhibitor is Halogenated Sugar, such as
Mitolactol, or an analog or derivative thereof, including Mitobronitol and
Mannomustine. Suitable compounds have the structures:
In another aspect, the Cell Cycle Inhibitor is a Diazo compound, such as
Azaserine, or an analog or derivative thereof, including 6-diazo-5-oxo-L-norleucine and
5-diazouracil (also a pyrimidine analog). Suitable compounds have the structures:
Other compounds that may serve as Cell Cycle Inhibitors according to
the present invention are Pazelliptine; Wortmannin; Metoclopramide; RSU; Buthionine
sulfoxime; Tumeric; Curcumin; AG337, a thymidylate synthase inhibitor; Levamisole;
Lentnan, a polysaccharide; Razoxane, an EDTA analog; Indomethacin;
Chlorpromazine; a and ß interferon; MnBOPP; Gadolinium texaphyrin; 4-amino-1,8-
naphthalimide; Staurosporine derivative of CGP; and SR-2508.
Thus, in one aspect, the Cell Cycle Inhibitor is a DNA alkylating agent.
In another aspect, the Cell Cycle Inhibitor is an anti-microtubule agent. In another
aspect, the Cell Cycle Inhibitor is a Topoisomerase inhibitor. In another aspect, the Cell
Cycle Inhibitor is a DNA cleaving agent. In another aspect, the Cell Cycle Inhibitor is
an antimetabolite. In another aspect, the Cell Cycle Inhibitor functions by inhibiting
adenosine deaminase (e.g., as a purine analog). In another aspect, the Cell Cycle
Inhibitor functions by inhibiting purine ring synthesis and/or as a nucleotide
interconversion inhibitor (e.g., as a purine analog such as mercaptopurine). In another
aspect, the Cell Cycle Inhibitor functions by inhibiting dihydrofolate reduction and/or
as a thymidine monophosphate block (e.g., methotrexate). In another aspect, the Cell
Cycle Inhibitor functions by causing DNA damage (e.g., Bleomycin). In another
aspect, the Cell Cycle Inhibitor functions as a DNA intercalation agent and/or RNA
synthesis inhibition (e.g., Doxorubicin). In another aspect, the Cell Cycle Inhibitor
functions by inhibiting pyrimidine synthesis (e.g., N-phosphonoacetyl-L-Aspartate). In
another aspect, the Cell Cycle Inhibitor functions by inhibiting ribonucleotides (e.g.,
hydroxyurea). In another aspect, the Cell Cycle Inhibitor functions by inhibiting
thymidine monophosphate (e.g., 5-fluorouracil). In another aspect, the Cell Cycle
Inhibitor functions by inhibiting DNA synthesis (e.g., Cytarabine). In another aspect,
the Cell Cycle Inhibitor functions by causing DNA adduct formation (e.g., platinum
compounds). In another aspect, the Cell Cycle Inhibitor functions by inhibiting protein
synthesis (e.g., L-Asparginase). In another aspect, the Cell Cycle Inhibitor functions by
inhibiting microtubule function (e.g., taxanes). In another aspect, the Cell Cycle
Inhibitors acts at one or more of the steps in the biological pathway shown in Figure 1.
Additional Cell Cycle Inhibitors useful in the present invention, as well
as a discussion of their mechanisms of action, may be found in Hardman J.G., Limbird
L.E. Molinoff R.B., Ruddon R W., Gilman A.G. editors, Chemotherapy of Neoplastic
Diseases m Goodman and Gilman's The Pharmacological Basis of Therapeutics Ninth
Edition, McGraw-Hill Health Professions Division, New York, 1996, pages 1225-1287.
See also U.S. Patent Nos. 3,387,001; 3,808,297; 3,894,000; 3,991,045; 4,012,390;
4,057,548; 4,086,417; 4,144,237; 4,150,146; 4,210,584; 4,215_,062; 4,250,189;
4,258,052; 4,259,242; 4,296,105; 4,299,778; 4,367,239; 4,374,414; 4,375,432;
4,472,379; 4,588,831; 4,639,456; 4,767,855; 4,828,831; 4,841,045; 4,841,085;
4,908,356; 4,923,876; 5,030,620; 5,034,320; 5,047,528; 5,066,658; 5,166,149;
5,190,929; 5,215,738; 5,292,731; 5,380,897; 5,382,582; 5,409,915; 5,440,056;
5,446,139; 5,472,956; 5,527,905; 5,552,156; 5,594,158; 5,602,140; 5,665,768;
5,843,903; 6,080,874; 6,096,923; and RE030561 (all of which, as noted above, are
incorporated by reference in their entirety)
Numerous polypeptides, proteins and peptides, as well as nucleic acids
that encode such proteins, can also be used therapeutically as cell cycle inhibitors. This
s accomplished by delivery by a suitable vector or gene delivery vehicle which encodes
a cell cycle inhibitor (Walther & Stein, Drugs 60(2);249-71, Aug 2000; Kim et al,
Archives of Pharmacal Res. 24(1):1-15, Feb 2001; and Anwer et al., Critical Reviews
in Therapeutic Drag Carrier Systems 17(4):377-424, 2000. Genes encoding proteins
that modulate cell cycle include the INK4 family of genes (US 5,889,169; US
6,033,847), ARF-pl9 (US 5,723,313), p21WAFI/ClPI and p27KIPI (WO 9513375; WO
9835022), p27KIPI (WO 9738091), p57KIPI (US 6,025,480), ATM/ATR (WO 99/04266),
Gadd 45 (US 5,858,679), Mytl (US 5,744,349), Weel (WO 9949061) smad 3 and smad
4 (US 6,100,032), 14-3-30 (WO 9931240), GSK3ß (Stambolic, V. and Woodgett, J. R.,
Biochem Journal 303: 701-704, 1994), HDAC-1 (Furukawa, Y. et al, Cytogenet Cell
Genet 73: 130-133, 1996; Taunton, J. et al., Science 272:408-411,1996), PTEN (WO
9902704), P53 (U.S. 5,532,220), p33INGI (US 5.986.078), Retinoblastoma (EPO
390530), and NF-1 (WO 9200387).
A wide variety of gene delivery vehicles may be utilized to deliver and
express the proteins described herein, including for example, viral vectors such as
retroviral vectors (e.g., U.S. Patent Nos. 5,591,624, 5,716,832, 5,817,491, 5,856,185,
5,888,502,6,013,517, and 6,133,029; as well as subclasses of retroviral vectors such as
lentivral vectors (e.g., PCT Publication Nos. WO 00/66759, WO 00/00600, WO
99/24465, WO 98/51810, WO 99/51754, WO 99/31251, WO 99/30742, and WO
99/45641)), alphavirus based vector systems (e.g., U.S. Patent Nos. 5,789,245,
5,814,482, 5,843,723, and 6,015,686), adeno-associated virus-based system (e.g., U.S.
Patent Nos. 6,221,646, 6,180,613, 6,165,781, 6,156,303, 6,153,436, 6,093,570,
6,040,183, 5,989,540, 5,856,152, and 5,587,308) and adenovirus-based systems (e.g.,
U.S. Patent Nos. 6,210,939, 6,210,922, 6,203,975, 6,194,191, 6,140,087, 6,113,913,
6,080,569, 6,063,622, 6,040,174, 6,033,908, 6,033,885, 6,020,191, 6,020,172,
5,994,128, and 5,994,106), herpesvirus based or "amplicon" systems (e.g., U.S. Patent
No. 5,928,913, 5,501,979, 5,830,727, 5,661,033,4,996,152 and 5,965,441) and, "naked
DNA" based systems (e.g., U.S. Patent Nos. 5,580,859 and 5,910,488) (all of which are,
as noted above, incorporated by reference b their entirety).
Within one aspect of the invention, ribozymes or antisense sequences (as
well as gene therapy vehicles which can deliver such sequences) can be utilized as cell
cycle inhibitors. One representative example of such inhibitors is disclosed in PCT
Publication No. WO 00/32765 (which, as noted above, is incorporated by reference in
its entirety).
Antiproliferative agents.
lntimal hyperplasia is due to the migration and proliferation of cells into
the intima followed by extracellular matrix secretion. The main cell types responsible
for the hyperplastic response in the intima are smooth muscle cells and fibroblasts.
Arterioles and capillaries sprout into the intimal plaque to provide nutrients and oxygen,
thus allowing the plaque to grow. Intimal plaque growth eventually leads to occlusion
of the lumen of the disease blood vessels with accompanying ischemia to the distal
tissues. Hence, within one aspect of the invention, antiproliferative agents may be
coated on or otherwise released from a patch.
The antiproliferative activity of the agents can be assayed by quantifying
cell migration and proliferation in vitro. Antiproliferative activity can also be
determined in vivo by morphometric analysis after vascular injury in various animal
models (Signore et at, 2001 J. Vase. Interv. Radiol. 12: 79-88; Axel et al., 1997
Circulation 96: 636-645; Gregory et al., 1993 Transplantation 1409-1418; Burke et al.,
1999 J. Cardiovasc. Pharm 33: 829-835; Poon et al., 1996 J. Clin. Invest. 2277-2283;
Jones et al., 2001, J. Immunol. Methods, 254: 85-98; Gildea et al., 2000 Biotechniques
29:81-86).
III. MANUFACTURE
Within certain embodiments, the compound or composition may be
applied on the patch by itself or in a carrier, which may be either polymeric, or non-
polymeric. Representative examples of polymeric carriers include poly (ethylene-vinyl
acetate), copolymers of lactic acid and glycolic acid, poly (caprolactone), poly (lactic
acid), copolymers of poly (lactic acid) and poly (caprolactone), gelatin, hyaluronic acid,
collagen matrices, celluloses and albumen. Representative examples of other suitable
carriers include, but are not limited to, ethanol; mixtures of ethanol and glycols (e.g.,
ethylene glycol or propylene glycol); mixtures of ethanol and isopropyl myristate or
ethanol, isopropyl myristate and water (e.g., 55:5:40); mixtures of ethanol and eineol or
D-limonene (with or without water); glycols (e.g., ethylene glycol or propylene glycol)
and mixtures of glycols such as propylene glycol and water, phosphatidyl glycerol,
dioleoylphosphatidyl glycerol, Transcutol®, or terpinolene; mixtures of isopropyl
myristate and l-hexyl-2-pyrrolidone, N-dodecyl-2-piperidinone or 1-hexyl-2-
pyrrolidone. Other representative examples of polymer formulations are described in
U.S. Patent Nos. 5,716,981 and PCT patent application number PCT/CA00/01333,
which are both incorporated by reference in their entirety.
Further examples of patents relating to polymers and their preparation
include PCT Publication Nos. 98/12243, 98/19713, 98/41154, 99/07417, 00/33764,
00/21842, 00/09190,00/09088, 00/09087, 2001/17575 and 2001/15526 (as well as their
corresponding U.S. applications), and U.S. Patent Nos. 4,500,676, 4,582,865,
4,629,623, 4,636,524, 4,713,448, 4,795,741, 4,913,743, 5,069,899, 5,099,013,
5,128,326, 5,143,724, 5,153,174, 5,246,698, 5,266,563, 5,399,351, 5,525,348,
5,800,412, 5,837,226, 5,942,555, 5,997,517, 6,007,833, 6,071,447, 6,090,995,
6,106,473, 6,110,483, 6,121,027, 6,156,345, and 6,214,901, which, as noted above, are
all incorporated by reference in their entirety.
Patches may be coated with compositions of the present invention in a
variety of manners, including for example: (a) by directly affixing to the patch a
formulation (e.g., by either spraying the stent with a polymer/drug film, or by dipping
the stent into a polymer/drug solution), (b) by coating the patch with a substance such
as a hydrogel which will in turn absorb the composition, (c) by interweaving
formulation-coated thread (or the polymer itself formed into a thread) into the patch
structure, (d) by inserting the patch into a sleeve or mesh which is comprised of, or
coated with, a formulation, or (e) constructing the patch itself with a composition.
Within preferred embodiments of the invention, the composition should
firmly adhere to the patch during storage and at the time of implantation, and should not
be dislodged from the patch when it is sutured to the blood vessel. The composition
should also preferably not degrade during storage, prior to implantation, or when
wanned to body temperature after implantation inside the body. In addition, it should
preferably coat the patch smoothly and evenly, with a uniform distribution of agents while
not changing the patch shape. Within certain preferred embodiments of the invention, the
formulation should be applied to only parts of the patch, leaving the rest of the patch
uncoated, for example: (a) only the luminal side of the patch is coated, (b) only the edge
of the patch is coated, (c) only one end of the patch is coated, (d) a stripe is left uncoated
around the patch (e) part of the patch is coated with one agent and the rest of the patch is
coated with another agent.
Within one preferred embodiments of the invention, the composition
should provide a predictable, prolonged release of the factor into the surrounding tissue
for 1 to 12 months after implantation. Within another embodiments of the invention,
the composition should provide a predictable, slow release of the factor into the
surrounding tissue for 1 to 10 years after implantation. Within another embodiments of
the invention, the composition should provide a predictable, prolonged release of the
factor into the surrounding tissue for 1 to 4 weeks after implantation. Within another
embodiments of the invention, the composition should provide a predictable, fast
release of the factor into the surrounding tissue for 1 to 7 days after implantation.
Within another embodiments of the invention, the composition should provide a
predictable, fast release of the factor into the surrounding tissue for 1 to 24 hours after
implantation. Within another embodiments of the invention, the composition is not
released into the surrounding tissue. Its presence on the patch forms a chemical barrier
preventing cellular adhesion to the patch, cell migration onto the patch or cell
proliferation on the patch. Within certain embodiments of the invention, compositions
may be combined in order to achieve a desired effect (e.g., several preparations may be
combined in order to achieve both a quick and a slow or prolonged release of a given
factor).
The compositions of the present invention may be formulated to contain
more than one agent, to contain a variety of additional compounds, to have certain
physical properties (e.g., elasticity, a particular melting point, or a specified release
rate).
In addition to the above properties, the composition should not cause
significant turbulence in blood flow (not more than the patch itself would be expected
to cause if it was uncoated).
The compositions and pharmaceutical compositions provided herein may
be placed within containers, along with packaging material which provides instructions
regarding the use of such materials. Generally, such instructions will include a tangible
expression describing the reagent concentration, as well as within certain embodiments,
relative amounts of excipient ingredients.
IV. APPLICATION
Primary closure and patch angioplasty are two techniques of arteriotomy
closure used by surgeons after vascular procedures. In primary closure, the lips of the
arterial wound are directly sutured to each other whereas an extra piece of material is
sutured between the two lips during patch angioplasty. Patch angioplasty is preferred
after procedures with a high rate of postoperative narrowing of the repaired vessel
(endarterectomy of small carotid arteries or redo operations for example). The added
piece of material maintains the original diameter of the blood vessel and induces
favorable local hemodynamics that otherwise may lead to recurrent stenosis (Clagett et,
1986 J Vase Surg. 3:10-23; Deriu et al., 1984 Stroke, 15: 972-979; Archie 2001 J Vase
Surg. 33: 495-503; Ouriel 1987 J Vase Surg. 5:702-706; AbuRahma et al., 1998 J Vase
Surg 27: 222-234; Riles et al., 1990 Surgery 107: 10-12;).
Patch angioplasty is mainly performed in two vascular procedures at the
present time, carotid endarterectomy and profundaplasty. However, vascular patches
are also used in other vascular procedures, for example to repair iatrogenic or traumatic
arterial injuries or to repair the arterial wall after resection of a saccular aneurysm. The
present invention could be applied to any vascular patching procedure.
Patch angioplasty can be performed with autologous tissue (typically a
segment of the patient's veins) or synthetic material (expanded polytetrafluoroethylene
or Dacron). Vein patches have drawbacks such as aneurysmal degeneration and rupture
(Archie et al., Surgery 1990, 107: 389-396). They require an additional incision to
harvest the vein with associated morbidity. Vein harvest also increases operative time.
The patient's veins may not be suitable for patching. Most importantly, the vein used
for the patch will not be available for coronary artery bypass grafting should the patient
require arterial reconstruction at a later time. For these reasons, the use of synthetic
patches has become increasingly popular.
Patch angioplasty improves clinical outcome in many cases but it does
not afford absolute protection against recurrent carotid stenosis (Awad et al., 1989
Stroke 20: 417-422; Eikelboom et al., 1988 J Vase Surg 7: 240-247; AbuRahma et al.,
1998 J Vase Surg 27: 222-234; AbuRahma et al., 1998 J Vase Surg 27: 222-234; Clagett
et al., 1986 J Vase Surg 3: 10-23). Synthetic patches implanted in the vasculature
induce thrombogenic, inflammatory and hyperproliferative responses. Immediately
after implantation, platelets bind to the luminal surface of the prosthesis, triggering the
coagulation cascade and inducing thrombus formation. Thrombus may grow large
enough to cause distal ischemia. Parts of the thrombus may also become dislodged and
cause embolization of distal arterioles and capillaries. In the case of carotid artery
patches, thrombus occlusion and embolization lead to stroke.
In the days following the procedure, inflammatory cells such as
macrophages, lymphocytes and neutrophils adhere to the prosthetic lumen and also
migrate into the peri-prosthetic space. These cells release cytokines that promote smooth
muscle cell migration from the adjacent vessel on the luminal surface of the patch. The
cells further proliferate on the patch and secrete extracellular matrix. Depending on the
porosity of the patch material, cells may also migrate through the pores of the patch from
the surrounding tissue into the lumen. In both cases, hyperplasia causes plaque formation
on the luminal surface of the patch and the adjacent vessels within a few weeks. This
reduces luminal area in the treated blood vessel, thus impeding blood flow to the distal
tissue. The present invention involves coating synthetic patches with agents preventing
inflammatory reaction, thrombus formation and intimal hyperplasia in order to inhibit
restenosis of the treated vessel.
A. Carotid endarterectomv
A 10-cm long skin incision is made along the anterior border of the
sternocleidomastoid muscle. After retraction of the muscle, the distal common carotid
artery, the carotid bifurcation and the proximal segments of the internal and external
carotid arteries are dissected. The three vessels are clamped. An arteriotomy is made in
the common carotid artery extending antero-laterally through the plaque into the
internal carotid artery beyond the distal extension of the plaque. The intimo-medial
layer of the plaque is transected in the common carotid and the plaque is excised to the
adventitia. A coated patch is trimmed and tapered to appropriate size (typically 7 cm
iong with a 4 mm apex and a 7 mm bulb). The coated patch is placed along the edges
of the arteriotomy to reconstruct the original shape of the vessel and to replace a
significant portion of the endarterectomized wall of the artery. The coated patch is
sutured to the edges of the arteriotomy with a continuous 7-0 polypropylene suture.
Blood flow is restored by releasing all clamps and the skin wound is closed.
B. Profundaplasty
The common femoral artery and the profunda femoris artery (PFA) are
isolated through a vertical groin incision. Once the branches distal to the end of the
occlusive disease are controlled, the common femoral, superficial femoral and the PFA
branches are clamped. An arteriotomy is performed, starting on the common femoral and
extending down the PFA until the plaque ends. Endarterectomy of the involved common
ft moral and PFA is performed as needed. A coated patch is trimmed to size to achieve a
smooth taper in the PFA to re-establish optimal flow characteristics in the repaired vessel.
The coated patch is sutured to the edges of the arteriotomy with a continuous 7-0
polypropylene suture. Blood flow is restored by releasing all clamps and the skin wound
is closed.
It should be obvious to one of skill in the art that the above-described
compositions can be utilized to create variation in the Examples provided below,
without deviating from the spirit and scope of the invention.
EXAMPLES
EXAMPLE 1
Manufacture of Coated Patches
A. Procedure for Sprayed Patches
The following describes a typical method using an oval 2 cm x 0.5 cm
synthetic patch. For larger patches, larger volumes of polymer/drug solution are used.
Briefly, a sufficient quantity of polymer is weighed directly into a 20 mL
glass scintillation vial, and sufficient DCM added in order to achieve a 2% w/v solution.
The vial is then capped and mixed by hand in order to dissolve the polymer. The patch
is then held in a vertical orientation with micro clamps connected to a holding apparatus
6 to 12 inches above the fume hood floor to enable horizontal spraying. Using an
automatic pipette, a suitable volume (minimum 5ml) of the 2% polymer solution is
transferred to a separate 20ml glass scintillation vial. An appropriate amount of
paclitaxel is then added to the solution and dissolved by hand shaking.
To prepare for spraying, remove the cap of this vial and dip the barrel of
a TLC atomizer into the polymer solution. Note that the reservoir of the atomizer need
not be used in this procedure: the 20ml glass vial acts as a reservoir. Connect the
nitrogen tank to the gas inlet of the atomizer. Gradually increase the pressure until
atomization and spraying begins. Note the pressure and use this pressure throughout
the procedure. To spray the patch use 5 second oscillating sprays with a 15 second dry
time between sprays. After 5 sprays, rotate the patch 180° and spray the other side of
the patch. During the dry time, finger crimp the gas line to avoid wastage of the spray.
Spraying is continued until a suitable amount of polymer is deposited on the patch. The
amount may be based on the specific patching application in vivo. To determine the
amount,weigh the patch after spraying has been completed and the patch has dried.
Subtract the original weight of the patch from the finished weight. This produces the
amount of polymer (plus paclitaxel) applied to the patch. Store the coated patch in a
sealed container.
B. Procedure for Dipped Patches
The following describes a typical method using a 2 cm x 0.5 cm oval
synthetic patch. For larger patches, larger volumes of polymer/drug solution are used.
Weigh 2 g of polymer into a 20 mL glass scintillation vial and add 20
mL of DCM. Cap the vial and leave it for 2 hours to dissolve (hand shake the vial
frequently to assist the dissolving process). Weigh a known amount of paclitaxel
directly into an 8 mL glass vial and add 4 mL of the polymeric solution. Using a glass
Pasteur pipette, dissolve paclitaxel by gently pumping the polymer solution. Once
paclitaxel is dissolved, hold the glass vial in a near horizontal position (the sticky
polymer solution will not flow out). Using tweezers, insert the patch into the vial all the
v/ay to the bottom. Allow the polymer solution to flow almost to the mouth of the vial
by angling the mouth below horizontal and then restoring the vial to an angle slightly
above the horizontal. Slowly remove the patch (approximately 30 seconds). Hold the
patch in a vertical position to dry.
EXAMPLE 2
In Vitro Drug Release Rate
Small pieces (0.5x0.5cm) of paclitaxel-coated patches (n=4) are placed
in 14 mL glass tubes followed by 10 mL phosphate buffered saline (PBS, pH=7.4)
containing 0.4 g/L albumin. The tubes are incubated at 37 °C with gentle rotational
mixing at 8 rprn. At regular time intervals, 10 mL' of supernatant are withdrawn for
paclitaxel analysis and replaced with fresh PBS/albumin buffer. One mL of
dichloromethane is added to the withdrawn supernatant and the tube is capped and
shaken by hand for 1 minute to allow all the released paclitaxel to partition into the
separate dichloromethane phase. The tubes are then centrifuged at 500xg for 1 minute,
the 10 mL of top aqueous phase are withdrawn and discarded and the dichloromethane
phase is evaporated under nitrogen at 50 °C for 20 minutes. One mL of a 60%
aeetomtrite in water (v/v) solution is added to each tube to solubilize the dried contents.
These solutions are then analyzed for paclitaxel by HPLC using a Waters C18 Novapak
column with a mobile phase composed of 58% acetonitrite / 5% methanol / 37% water
at a flow rate of 1 mL / minute with detection at 232 nm. The HPLC method for
quantitation of the released drug is chosen over other methods, such as radiolabelled
assays, because the chromatographic method ensures that only paclitaxel molecules in
the intact (non-degraded) form are measured. A standard curve of paclitaxel dissolved
in 60% acetonitrile: 40% water is obtained in the 0-50 µg/mL range and used to directly
quantitate the amount of paclitaxel released.
EXAMPLE 3
In Vivo Patch Efficacy
General anesthesia is induced into domestic swine. The neck region is
shaved and the skin sterilized with cleansing solution. A vertical incision is made under
sterile condition on one side of the neck and the common carotid artery is exposed.
Two vascular clamps are placed on the artery to temporarily stop blood flow and an
arteriotomy is performed between the clamps. The arteriotomy is closed with a
synthetic patch. The animals are randomized into 4 groups of 5 pigs receiving a
synthetic patch coated with (1) carrier polymer alone, (2) carrier polymer loaded with
1% paclitaxel, (3) carrier polymer loaded with 5% paclitaxel or (4) carrier polymer
loaded with 10% paclitaxel. The clamps are released and the skin is closed.
The contralateral carotid artery is prepared in the same manner and a
control uncoated patch is used to repair the arteriotomy. The animal is recovered.
The animals are sacrificed at 1 month and perfused with saline followed
by 10% phosphate buffered formaldehyde for 30 minutes under 100mmHg pressure.
The carotid arteries are removed and kept in the same fixative solution overnight. The
specimens are then prepared for histology. Cross sections are cut and stained with H&E
and Movat's stains. Histopathology of the tissue surrounding the patch is recorded.
Morphometric analysis is performed to measure hyperplasia on the luminal surface of
the patch and in adjacent vessels.
From the foregoing, it will be appreciated that, although specific
embodiments of the invention have been described herein for purposes of illustration,
various modifications may be made without deviating from the spirit and scope of the
invention. Accordingly, the invention is not limited except as by the appended claims.
WE CLAIM:
1. A surgical patch that releases paclitaxel or an analogue or derivative thereof
wherein the surgical patch is a vascular patch, and wherein a luminal side of the patch is coated
with paclitaxel or analogue or derivative thereof.
2. The surgical patch as claimed in claim 1 comprising a polymeric carrier of
paclita.\el or an analogue or derivative thereof.
3. The surgical patch as claimed in claim 2 wherein the polymeric carrier
comprises poly(ethylene-vinyl acetate), copolymers of lactic acid and glycolic acid, poly
(caprolactone), pcly(lactic acid), copolymers of poly(lactic acid) and poly(caprolactone). gelatin,
hyaluronic acid, collagen matrices, celluloses, or albumen.
4. The surgical patch as claimed in any one of claims 1 to 3 wherein the
paclitaxel or an analogue or derivative thereof is paclitaxel.
5. The surgical patch as claimed in any one of claims 1 to 3 wherein the
paclitax.'l or an analogue or derivative thereof is a paclitaxel analogue or derivative.
6. The surgical patch as claimed in any one of claims 1 to 5 wherein said
patch further releases an agent selected from anti-inflammatory agents, anti-platelet agents,
anticoagulant agents, fibrinolytic agents, cell cycle inhibitors and anti-proliferative agents.
7. The surgical patch as claimed in claim 6 wherein the agent is an anti-
inflammatory agent selected from the group consisting of aspirin, ibuprofen, glucocorticoid drugs,
and immunosuppressive agents.
8. The surgical patch as claimed in claim 6 wherein the immunosuppressive
agent in tacrolimus, everolimus, cyclosporine A, or rapamycin.
9. The surgical patch as claimed in claim 6 wherein the agent is an anti-
platelet agent selected from heparin and hirudin.
10. The surgical patch as claimed in claim 6 wherein the agent is a fibrinolytic
agent selected from tissue plasminogen activator, streptokinase and urokinase.
11. The surgical patch as claimed in claim 6 wherein the agent is a cell cycle
inhibitor selected from vinca alkaloids, camptothecin, podophyllotoxin, anthracycline, platinum
compounds, nitrosourea, nitroiidazole, folic acid antagonists, cytidine analogues, pyrimidine
analogues purine analogues, nitrogen mustards, hydroxyurea, mytomycin, benzamide, and
tetrazine.
12. The surgical patch as claimed in any one of claims 1 to 11 wherein said
patch is comprised of a synthetic material.
13. The surgical patch as claimed in any one of claims 1 to 11 wherein said
patch is comprised of a biological tissue.
14. The surgical patch as claimed in claim 2 or any one of claims 3 to 13 when
depending on claim 5, wherein the polymeric carrier is loaded with 10% or less paclitaxel or an
analogue or derivative thereof.
15. The surgical patch as claimed in any one of claims 1 to 13, wherein the
vascular patch is adapted for repairing a blood vessel, and the polymeric carrier provides
prolonged, release of the paclitaxel or an analogue or derivative thereof in an amount effective in
inhibiting intimal hyperplasia in the repaired blood vessel.
16. The surgical patch as claimed in claim 15. wherein the vascular patch is
adapted for repairing a blood vessel, and the polymeric carrier provides prolonged release of the
paclitaxel or an analogue or derivative thereof in an amount effective in inhibiting intimal
hyperplasia in the repaired blood vessel for 1- 4 weeks after implantation of the vascular patch.

Surgical patches are described which release an anti-inflammatory agent, an anti-platelet agent, an anticoagulant, a
fibrinolytic agent, a cell cycle inhibitor, and/or an antiproliferative agent.

Documents:

794-kolnp-2004-granted-abstract.pdf

794-kolnp-2004-granted-assignment.pdf

794-kolnp-2004-granted-claims.pdf

794-kolnp-2004-granted-correspondence.pdf

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

794-kolnp-2004-granted-drawings.pdf

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

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

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

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

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

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

794-kolnp-2004-granted-gpa.pdf

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

794-kolnp-2004-granted-specification.pdf


Patent Number 226788
Indian Patent Application Number 794/KOLNP/2004
PG Journal Number 52/2008
Publication Date 26-Dec-2008
Grant Date 24-Dec-2008
Date of Filing 10-Jun-2004
Name of Patentee ANGIOTECH INTERNATIONAL AG.
Applicant Address BUNDESPLATZ 1, 6304 ZUG
Inventors:
# Inventor's Name Inventor's Address
1 SIGNORE PIERRE E # 207-2155 WEST 7TH AVENUE, VANCOUVER, BRITISH COLUMBIA V6K 1X9
PCT International Classification Number A61L 27/54
PCT International Application Number PCT/CA02/02017
PCT International Filing date 2002-12-30
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 60/344,011 2001-12-28 U.S.A.