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`USOU'5990l 10A
`
`United States Patent
`
`119.
`
`|11| Patent Number:
`
`5,990,110
`
`Firestone
`
`|4s] Date of Patent:
`
`Nov. 23, 1999
`
`54] METHOI) FOR TR It'_A'I"ING TU MORS
`HAVING HIGH I.I)I. RI£QUIRl€Ml€NTS
`IiMI’l,()YlN(} MTI’ INHIBITORS
`
`75]
`
`Inventor: Raymond A. Firestone, New Haven,
`Conn.
`
`73] Assignee: Bristill-Meyers Squibb Company,
`Princeton, NJ.
`
`Wunderlieh, M. et al, "The Redox Properties of Protein
`Disullide Isornerase (Dsb/\) ttl‘E.s'cl1eJ'ichir: Cali Result from
`a Tense Conformation of its Uxidiried Form", .1. Mol. Biol.
`(1993) 233, 559-566.
`
`Firestone, RA. et a], “selective Delivery of Cytotoxic
`Compounds to Cells by the LDL Pathway” Journal of
`Medicinal Chem., 1984, vol. 27, No. 8, pp. 1037-1043.
`
`211 App]. No.: 0s;914,052
`
`22]
`
`Filed:
`
`Jul. 15, 1997
`
`
`. AGIK 3l;"495; /\(i'lK 31,445
`Int. CL“
`51]
`. 5l4,l252; 5141326; 514829
`52] U.S. Cl.
`58] Field of Search ................................... .. 5141252, 326,
`514.3329
`
`56]
`
`References Cited
`U.S. PATENT DOCUMENTS
`
`5,212,279
`
`........................... .. 514.-“Z52
`1,-‘I998 Biller et :11.
`OTIIER PUBLICATIONS
`
`Firestoiie, RA. “Lz.Jw—Dei1sity Lipoproteiu as a VL'I]iClU for
`Targeting Antitumor Compounds to Cancer Cells” liiocon-
`jugate Chem., vol. 5, No. 2, I994, pp.
`'I05—I 13.
`
`l"'1'imm'_y Exai:iim=i‘—Raymond Ilenley, III
`Attorney. Agem‘, or F:fmt—Burton Rodney
`
`|57|
`
`ABSTRACT
`
`A method is provided for treating hematologic tumors and
`solid tumors,
`including certain types of leukemias and
`metastatic tumors, having high I.DI_ requirements employ-
`ing a delipidating agent such as an MTP inhibitor to sub-
`stantially reduee IDI. blood levels. In addition, a method is
`provided for treating tumors of the above types having high
`IDI. requirements, especially hematologic tumors such as
`certain leukemias, employing a delipidating compound to
`substantially remove native LDL, and then administering a
`cytotoxic agent Carried in reconstituted LDL.
`
`29 Claims, No Drawings
`
`Iuf22
`
`PENN EX. 2101
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`CFAD V. UPENN
`lPR20l5-01836
`
`

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`5,990,110
`
`1
`MICTHOI) FUR 'I‘REA'l‘IN(} 'l‘UM()RS
`HAVING HIGH LDL REQUIREMENTS
`EN‘II’l,()YIN(} MTI’ INHIBITORS
`
`FIEID OF THE INVENTION
`
`The present invention relates to a method for treating
`cancers having high LDL requirements employing a dclipi-
`dating agent, which preferably is an M11’ inhibitor, alone or
`in combination with a cytotoxic agent.
`BACKGROUND 01" 'I'IIl_i INV1-LNTION
`
`It is known that cancer cells need cholesterol to make new
`
`cell rnenibrane. The cholesterol is supplied by either de novo
`synthesis or from low-density lipoprotein (LDL), or both,
`Firestone, R. A. et al, "Selective Delivery of Cytotoxic
`Compounds to Cells by the IDI. Pathway, J. Med. Chem.,
`1984, 27‘, 1tJ3?—ltt43. Firestone et al describe a series of
`cytotoxic compounds that are compatible with reconstituted
`l.I)I. and may be delivered with reconstituted I.DI. against
`cancers that copiously internalize LDL.
`Firestone, R. A., "l.ow—Density lipoprotein as a Vehicle
`1'or Targeting Antitumor Compounds to Cancer Cells", Bio-
`conjugate Chemistry, 1994, 5, pp 105-113, at page 105, in
`the '’Introduction“, discusses problems associated with can-
`cer treatment as Follows:
`"It
`is cliffictilt to eradicate cancer cells in vivo because
`
`they share with normal cells, for the most part, the same
`biochemical machinery. There is no cytotoxic sub-
`stance that is completely selective for malignant cells,
`and all those presently in use cause dose—limiting toxic
`side effects. For this reason there is a growing emphasis
`on targeting. i.e., selective delivery of drugs to tumors
`in ways that bypass normal body tissues.
`“Among the vehicles that can he used for this purpose is
`low—density lipoprotein (I.DI.),
`a normal blood con-
`stituent that is the body’s principal means for delivery
`of cholesterol to tissues. Cholesterol, a major constitu-
`ent nf mammalian cell membranes, is obtained by cells
`either by making it themselves or by picking it up from
`I.DI. or both. Cancer cells, like all dividing ones, need
`large amounts of cholesterol because they are making
`new membrane. There is ample evidence that many
`types of cancer cells indeed have unusually great LDL
`requirements. The evidence is 2-fold: measurements of
`LDL uptake by tumor cells and depletion of LDL in the
`blood of cancer patients resulting from high uptake by
`the tumor (viae infra). Thus, if [D1, could be made to
`carry antitumor drugs,
`it would serve as a targeting
`vehicle. This coticcpt was proposed in 1981-2 (1,2) and
`has been reviewed several times since then (3—?').”
`(1) Gal, 1)., Uhashi, J., Macllonald, P. (3., Buchsbaum,
`H. J., and Simpson, 1:}. R. (1981) Low—density lipo-
`protein as a potential vehicle for chemotherapeutic
`agents and radionucleotides in the management of
`gynecologic neoplasms. Am.
`J’. 0b.s'ret‘. Gynecol.
`139, 2:77.
`(2) Counsel], R. E., and Pohland, R. C. (1982) Lipo-
`proteins as potential site-specific delivery systems
`for diagnostic and therapeutic agents.J. Med. Chem.
`25, 1115.
`(3) van Berkcl, T. J. C. (1993) Drug targeting: appli-
`cation of endogenous carriers for site—speeifie deliv-
`ery ol drugs. J. Crmtrotllcd Relertse 24, 145.
`(4) Vitols, S. (1991) Uptake of low—density lipoprotein
`by malignant ce]l—possible therapeutic applica-
`tions. Crmccr Cells 3, 488.
`
`1U
`
`I5
`
`30
`
`35
`
`4U
`
`45
`
`SU
`
`55
`
`61]
`
`65
`
`2
`(5) deSmi(it, P. C., and Van Berkel, T. J. C. (199(|)
`I.DI.—mediated drug targeting. Crir. Revs. Thorn.
`Drug Crn'r1'et' Sy.s'i‘. 7, 99.
`(6) Peterson, C., Masquclier, M., Rudling, M., S
`iiderberg, K., and Vitols, S. (1991) Lipoproleiris,
`malignancy and anticancer agents. Iitrgered Dingn.
`Tires (U.S.) 5, 175.
`(1987) Transport of cytotoxic
`(7) Catapano, A.
`I..
`compounds to cells via the LDL receptor pathway.
`Med. Sci. Res. 15, 411.
`. .”, Firestone,
`At page 105 under the topic "I.DI. Uptake .
`supra, lists numerous tumor types that have especially high
`I.l]I. requirements including acute myeloid leukemia
`(AML), human monocytic (FAB—MS) and myelomonocytic
`(F-AB—M4)
`leukemias, chronic myeloid leukemia in blast
`crisis, solid tumors such as epiderrrioid cervical cancer
`I.-EC-50, endometrial adenocarcinoma AC-258, gastric carci-
`noma and parotid arlcnoma, G2 lieptotna, squamous lung
`cancer, choriocarcinorna, brain tumors such as
`medulloblastoma, oligoderidroglioma, glioma V-251M(_},
`and malignant menigioma, as well as tumor cells that are
`exceptionally metastatic
`(Schroeder, I-I, Kier, A. B. Olson, C. D., and Dempsey, N.
`E. (1984) Correlation of tumor metastasis with sterol
`carrier protein and plasma membrane sterol
`levels.
`Bioclrcnt. B.i0plt_v5'. Res. Commun. 124, 283, and
`Cambicn, F., Ducimeticrc, P., and Richard, J. (1980) Total
`serum cholesterol and cancer mortality in a middle-
`aged male population. Am. J. Epidcrrtiol. 112, 388),
`tumor cells that are exceptionally aggressive
`(Rudling, M. J., Stahle, I.., Peterson, C. 0., and Skoog, I..
`(1986) Content of low density lipoprotein receptors in
`breast cancer tissue related to survival of patients. Brit.
`Med. J. 292, S80;
`Peterson, C., Vitols, S., Rudling, M., Blomgren, Il.,
`Lidsmyr, l"., and Skoog, l.. (1985) llypocholesterolemia
`in cancer patinets may be caused by elevated LDL
`receptor activities in malignant cells. Med. Oricoi.
`TwnorPhrIt'rnr:coI.ltet'. 2, 143;
`Muller, C. I-"., Wagner,A. U., Maucher, C., and Steinke, B.
`(1989) Hypocllolesteroleniia, an unfavorable feature of
`prognostic value in chronic myeloid leukemia. Em: J.
`Ilentnrot. 43, 235),
`and tumor cells that are exceptionally undillcrcntialed
`(Ponce. M., Havekes, L., Kempenaar, J., Lavrijsen, S.,
`Wi_jsman, M., Boonstra, J., and Vermeer, B. J. (1985)
`Caleium—mediated regulation of the low density lipo-
`protein receptor and intracellular cholesterol synthesis
`in human epidermal keratinocytcs. J. (frail P)'i_ysioI. "l 25
`98;
`Zyada, I.. E., Hassan, H. T., Recs, .1. K. H., and Ragab, M.
`H. (1990) The relation between hypocholesterolemia
`and degree oi‘ maturation in acute myeloid leukemia.
`Hentrn'ot'. Oncol. 8, 65;
`Ponec, M., Havekes, I.., Kcmpenaar, J., l.avrisen, S., and
`Vermeer, B. J . (1984) Defective low-density lipopro-
`tein metabolism in cultured, normal transformed and
`malignant keratinocytes. J. Im—'cs.=‘. Dcrmmoi. 83, 436).
`Firestone, supra, on page 107 under the topic “Reconsti-
`tution ol‘ I.DI. With Cytotoxic Drugs” states as follows,
`“In order to kill tumors with drugs that are targeted in
`LDL, the drugs must somehow be bound to the LDL in
`such a way that ('1) they cannot escape from it while
`traveling in the blood enroute to the tumor, (2) their
`cytotoxicity is chemically or physically masked while
`l.l)I.-bound, and then restored after entering the target
`
`2uf22
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`5,990,110
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`3
`cells, (3) in quantity X killing power there is enough
`dmg to kill cancer cells contained in the reconstituted
`ID]. (r-I_DI_), whose uptake is limited by the number
`of ID]. receptors on the tumor cells and their rate of
`internalization, and (4) the presence of Apo R and its
`binding power to LDL receptors are retained. Tl'1e
`ability of the drug, once released from its carrier, to
`escape from lysosomcs must also be taken in account
`7'6
`((76) Burton, R., et al (1975) The permeability prop-
`erties of rat liver lysosoincs to nucleotides. Bf()Cft(?i'.Pt.
`Soc. Traits. 3, 1251).
`On page 109, under the topic “llcrnoval of I_l)l. From thc
`Patient Before Treatment”, Firestone, supra, states as
`follows,
`"During treatment, drug—bearing r—I.DI. must compete
`with native IDI. for access to LDL receptors on the
`tumor cells, requiring elevated doses of r-l.Dl.. This
`can be countered by removing LDL from the patients’
`blood (delipidation) prior
`to treatment (139-141).
`Although restoration of normal LDL levels takes days
`(141), it might be best to dclipidatc immediately prior
`to treatment because it induces upregulation of LDL
`receptors throughout the body (142), and it is unknown
`whether upregulation in this way would be greater for
`tumor or normal cells.”
`
`l..,
`(falabresi,
`(}.,
`[i., Busnach,
`I-‘ranceschini,
`((139)
`Chiesa, G., Gianfranceschi, (3., Zoppi, 15., Minetti, L.,
`and Sirtori, C. R. (1991) Predictability of low—density
`lipoprotein levels during apheretie treatment of hyper-
`cholesterolemia. Em‘. J. Clio. it'm‘c.s'i‘. 21, 209.
`(140) Saal, S. 1)., Parker, '1‘. S., Gordon, B. R., Studebaker,
`J., Hudgins, L., Ahrcns, E. H., .lr., and Rubin, A. L.
`(1986) Removal of low—density lipoproteins in patients
`by extracorporeal inntiurioadsurpt ion. Am. J. Med. 80',
`583.
`
`(141) Parker, T. S., Gordon, B. R., Saal, S. D., Rubin, A.
`l.., and Ahrens, E. H., Jr. (1986) Plasma high density
`lipoprotein is increased in man when low density
`lipoprotein (LDL) is lowered by LDL-pheresis. Proc.
`Nat. Acrrd. Sci. U.S.A. 83, 777.
`(142) Goldstein, J. I... and Brown M. S. (197?) Tl1e
`low—density lipoprotein pathway and its relation to
`atherosclerosis. Armtr. Rev. Bioclicm. 46, 897).
`The microsomal triglyceride transfer protein (MTP) cata-
`lyzes the transport of triglyceride (TU), cholesteryl ester
`(CE), and phosphatidylcholinc (PC) between small unila-
`mellar vesicles (SUV). Wetterau «Sc Zilversmit, Chem. t"i'r1>.s'.
`Lipirt'.s' 38, 205-22 (1985). When transfer rates are expressed
`as the percent of the donor lipid transferred per tiuie, MTP
`expresses a distinct preference for neutral
`lipid transport
`("ITS and (TE), relative to phospholipid transport. The protein
`from bovine liver has been isolated and characterized.
`Wctterau & Zilvcrsmit, Chem. Phys. Lipids 38, 205-22
`(1985). Polyacrylamide gel electrophoresis (PAGE) analysis
`of the purified protein suggests that the transfer protein is a
`complex of two subunits of apparent molecular weights
`58,000 and 88,000, since a single band was present when
`purified MTP was clcctrophoresed under nondenaturing
`condition, while two bands of apparent molecular weights
`58,000 and 88,000 were identified when electrophoresis was
`performed in the presence of sodium dodeeyl sulfate (SDS).
`These two polypeptides are hereinafter referred to as 58 kDa
`and 88 klla, respectively, or the 58 kl)a and the 88 kl)a
`component of MTP, respe-ctively, or the low molecular
`weight subunit and the high molecular weight subunit of
`MTP, respectively.
`
`4
`Characterization of the 58,000 molecular weight compo-
`nent of bovine MTP indicates that
`it
`is the previously
`characterized multifunctional protein, protein disuliide
`isomerase (PDI). Wetterau ct al.,J. Biol. Chem. 265, 9800-7
`(1990). The presence of PDI in the transfer protein is
`supported by evidence showing that (1) the amino terminal
`25 amino acids of the bovine 58,000 klJa component of
`MTP is identical to that of bovine PDI, and (2) disulfide
`isomerase activity was expressed by bovine MT1’ following
`the dissociation of the 58 kDa—88 kDa protein complex. In
`addition, antibodies raised against bovine PDI, a protein
`which by itself has no TG transfer activity, were able to
`iinmunoprecipitate bovine 'l'(j transfer activity from a solu-
`tion containing ptlrificd bovine Tl’.
`PDI normally plays a role in the folding and assembly of
`newly synthesized disuliide bonded proteins within the
`lumen of the endoplasmic reticulum. Rulleid & Freedman,
`Nature 335, 649-51 (1988). It catalyzes the proper pairing
`ofcysleine residues into disuliide bonds, thus catalyzing the
`proper folding ofdisulfide bonded proteins. In addition, PDI
`has been reported to be identical
`to the beta subunit of
`human prolyl 4—hydroxylase. Koivu et al., J’. Biol. Cft'€h‘£.
`262, 6447-9 (1987). The role of PD] in the bovine transfer
`protein is not clear.
`It does appear
`to be an essential
`component of the transfer protein as dissociation of PDI
`from the 88 kl)a component of bovine MTP by either low
`concentrations of a denaturant (gu anidine HCI), a ehaotropic
`agent (sodium perchlorate), or a nondenaturing detergent
`(octyl glucoside) results in a loss of transfer activity. Wet-
`terau et al., Biocheiiiistry 30, 9728—35 (1991).
`Isolated
`bovine PDI has no apparent lipid transfer activity, suggest-
`ing that either the 88 kDa polypeptide is the transfer protein
`or that it confers transfer activity to the protein complex.
`The tissue and subcellular distribution of MTP activity in
`rats has been investigated. Wetterau & Lilversmil, Br'()cI'tcm.
`Biophys. zlcm 875, 610-7 (1 986). Lipid transfer activity was
`found in liver and intestine. Little or no transfer activity was
`found in plasma, brain, heart, or kidney. Within the liver,
`MTP was a soluble protein located within the lumen of the
`microsomal fraction. Approximately equal concentrations
`were found in the smooth and rough microsomes.
`Abetalipoproteinemia is an autosomal recessive disease
`characterized by a virtual absence of plasma lipoproteins
`which contain apolipoprotein B (apoB). Kane & Havel in
`The Merrzboiic Basis of Iriiierired Disease, Sixth edition,
`1139-61 (1989). Plasma TG levels may be as low as a few
`mg/dL, and they fail
`to rise after fat
`ingestion. Plasma
`cholesterol levels are often only 20-45 mg;‘dI_. These abnor-
`malities are the result of a genetic defect in the assembly
`andlor secretion of very low density lipoprotcins (VLDL) in
`the liver and chylomicrons in the intestine. The molecular
`basis for this defect has not been previously determined. ln
`subjects examined, triglyceride, pliospholipid, and choles-
`terol synthcsis appear normal. At autopsy, subjects are free
`of atherosclerosis. Schaefer ct al., Ciiri. Cftfilit. 34, B9—l2
`(1988). A link between the apoB gene and abetalipopro-
`teinemia has been excluded in several families. Talmud et
`al_,.I_ Chin. Irrvr-rsr. 82, 1803-6 (1988) and Huang ct al_,.r‘utt_
`J. Hum. Carter. 46, 1141-8 (1990).
`Subjects with abetalipoproteinemia are aillicted with
`numerous maladies. Kane & llavel, supra. Subjects have fat
`malabsorption and TG accumulation in their enterocytes and
`hepatoeytes. Due to the absence of 't‘G—rich plasma
`lipoproteins, there is a defect in the transport of fat-soluble
`vitamins such
`vitamin E. This results in acanthocytosis of
`erythrocytes, spinocerebellar ataxia with degeneration of the
`fasciculus curieatus and gracilis, peripheral neuropathy,
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`degenerative pigmentary retinopathy, and ceroid myopathy.
`Treatment of abctalipoproteinemic subjects includes dietary
`restriction of fat intake and dietary supplementation with
`vitamins A, E and K.
`
`In vitro, MTP catalyzes the transport of lipid molecules
`between phospholipid membranes. Presumably,
`it plays a
`similar role in vivo. and thus plays some role in lipid
`metabolism.
`'lhc- subccllular (lumen of the microsomal
`traction) and tissue distribution (liver and intestine) of MTP
`have led to speculation that it plays a role in the assembly of
`plasma lipoproteins, as these are the sites of plasma lipo-
`protein assembly. Wetterau & Zilversmit, Biochem. Bi0pJ'r_ys.
`A cm 875, 610-7 (1986). The ability of M'l‘1’ to catalyze the
`tran.sport of TG between membranes is consistent with this
`hypothesis, and suggests that MTP tnay catalyze the trans.-
`port ol‘ TG from its site of synthesis in the endoplasmic
`reticulum (ER) membrane to nascent lipoprotein particles
`within the lumen of the ER.
`
`Olofsson and colleagues have studied lipoprotein assem-
`bly in llepG2 cells. Bostrom et al.,.l’. Biol. Client. 263,
`4434-42 (1988). Their results suggest small precursor lipo-
`proteins become larger with time. This would be consistent
`with the addition or transfer of lipid molecules to nascent
`lipoproteins as they are assembled. MTP may play a role in
`this process.
`In support of this hypothesis, Ilowell and
`Palade, J’. Celt’ Biol. 92, 833-45 (1982), isolated nascent
`lipoproteins from the hepatic Golgi fraction of rat
`liver.
`There was a spectrum of sizes of particles present with
`varying lipid and protein compositions. Particles of high
`density lipoprotein (HDL) density, yet containing apoB,
`were found. iggins and Hutson,J'. Lr'pr'dRes. 25, 1295-1305
`(1984), reported lipoproteins isolated from Golgi were ooh-
`sistently larger than those from the endoplasmic reticulum,
`again suggesting the assembly of [ipoproteins is a progres-
`sive event. llowever, there is no direct evidence in the prior
`art demonstrating that MTP plays a role in lipid metabolism
`or the assembly of plasma lipoprotein.
`Recent reports (Science, Vol. 258, page 999, 1992; D.
`Sharp et al, Nature, Vol. 365, page 65, 1993) demonstrate
`that the defect causing abetalipoproteinemia is in the MTP
`gene, and as a result, the M11’ protein. Individuals with
`abetalipoproteinemia have no MTP activity, as a result of
`mutations in the MTP gene, some of which have been
`characterized. These results indicate that MTP is required for
`the syritltesis of apoB corltainiug lipoproteius, such as
`VI.[)I.,
`the precursor to I.[]I..
`It
`therefore follows that
`inhibitors of MTP would inhibit the synthesis of VI .|)I. and
`LDL, thereby lowering VLDL levels, LDL levels, choles-
`terol levels, and triglyceride levels in animals and man.
`Canadian Patent Application No. 2091,'l02 published
`Mar. 2, 1994 [corresponding to U.S. application Ser. No.
`117,362, filed Sep. 3, 1993 (file DC2lb)) which is incorpo-
`rated herein by reference), reports MTP inhibitors which
`also block the ipoproteins in a human hepatic cell
`line
`[I-lepG2 cells). This provides further support for the proposal
`that an MTP inhibitor would lower apoB containing lipo-
`protein and lipid levels in vivo. This Canadian patent
`application discloses a method for identifying the MTP
`inhibitors
`
`5
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`which has the name 2—[1—(3,3—diphenylpropyl)—4—
`piperidinyl]—2,3—dihydro—3—oxo—lH—isoindo1e hydrochloride
`and
`
`OCH;0
`
`.\'
`
`which has the name l-[3—[6—fluoro—l—tetralanyl)methyl]—4—
`O—methoxyphenyl piperazine.
`l}l_'.S(.'Rl}’l'lUN U1‘ 'l'lIl_'L INVLNTIUN
`
`invention, a method is
`In accordance with the present
`provided for treating tumors having high l.l)i. requirements
`which method includes the step of administering to a mam-
`malian species in need of treatment a therapeutically e1l‘ec-
`tive amount of a delipidating agent to substantially reduce
`l.Dl. blood levels.
`
`the delipidating agent may be
`In the above method,
`optionally administered in combination with a cytotoxic
`agent.
`In addition, in accordance with the present invention, a
`method is provided for treating tumors having high LDL
`requirements, especially hematologic tumors, which method
`includes the steps of administering to a mammalian species
`in need of treatment a therapeutically elTective amount of a
`delipidating agent
`to substantially remove IDI. (that
`is,
`native LDL), and administering a cytotoxic agent carried in
`reconstituted LDL (rLDL-drug conjugate).
`The delipidating compound to be employed in the meth-
`ods of the invention may be an IDI. lowering compound
`which lowers ID]. down to less than 20% of normal (that is
`less than 20% of 150 mg/dl that is 30 mgfdlj, preferably
`down to less than 10% of normal (that is less than 15 mg-"dl)
`and most preferably to substantially zero i.DI.. Examples of
`delipidating agents which may be employed herein include
`MTP inhibitors, statins, fibrates and resins or combinations
`thereof, with MTP inhibitors being preferred.
`The reconstituted [.l)[. [employed as a carrier for the
`cytotoxic agent
`in the above method) may be prepared
`according to the procedures described in the review article
`l-‘irestone, R. A., Low—Density Lipoprotein as a Vehicle for
`Targeting Antitumor (Tompounds to Cancer (Tells, BioeorJ-
`jugate Chemistry, 1994, 5, 105-113, such as disclosed in the
`following references cited by Firestone, supra:
`(78) Kricger, M., Brown, M. S., Faust, J. R., and
`Goldstein, J. l.. (1978) Replacement of endogenous
`eholesteryl esters of low density lipoprotein with exog-
`enous cholesteryl linoleate,J. Biol. Chem. 253, 4093.
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`.VI., McPhaul, J. J., Goldstein, J. L., and
`(79) Krieger,
`Brown, M. S. (1979) Replacement of neutral lipids of
`low density lipoprotein with esters of long chain unsat-
`urated fatty acids, J. Biol. Chem. 254, 3845.
`[ltl-4) Lundberg, B. (198?) Preparation of drug-low den-
`sity lipoprotein complexes for delivery of antitu moral
`drugs via the low density lipoprotein pathway, Crmcer
`Res. 47, 4105, and
`
`Gene M. Dubowchik and Raymond A. Firestone, Tet‘. Left.
`35, 4523, "1994.
`The cytotoxic agent may be incorporated in the reconsti-
`tuted LDL to form an L1JL—(|rug conjugate following the
`procedure described in the Firestone review article, supra,
`especially as described in cited refereticc (104) Lundbcrg,
`supra.
`MTP inhibitors to be employed in the methods of the
`invention include MTP inhibitors disclosed in Canadian
`
`Patent Application No. 2,091,102 described hereinbeiore
`[corresponding to U.S. application Ser. No. 117,362), U.S.
`application Ser. No. 472,067, filed Jun. 6, 1995 [file DC21e),
`U.S. application Ser.
`l'\'o. 548,81"! (rile DC2'lh), U.S. pro-
`visional application No. 60g’017,22-'1, (file HX79a“‘), U.S.
`provisional application No. 6(Jf(J17,253, (file IlX82*) and
`U.S. provisional application No. 6(),"()l7',254, (lile IIX84‘).
`All of the above U.S. applications are incorporated herein
`by reference.
`The MTP inhibitors disclosed in U.S. application Ser. No.
`472,067,
`liletl Jun. 6, 1995 (file [)(T2]e) are piperidine
`compounds of the structure
`
`
`
`0
`
`R2
`H/\ X
`/.\I
`R"T
`/ X X
`R"
`(If
`
`R1
`|
`N
`
`_.
`
`R-‘/0\
`Ix
`R5
`
`x—k'_,
`
`(If
`
`R1
`L
`1{s..z‘;\\'/C)
`
`R!
`
`(If
`
`0
`
`R
`
`_
`
`K\N/ 7
`Y/“\)
`
`R-_,
`R T
`I
`
`3
`
`||,\ \
`L7 /
`
`R4
`
`whcrcOis
`
`8
`
`O
`
`||
`—C— or
`
`0
`
`||
`s—
`||0
`
`Xis:CHR“,
`
`{
`
`||
`()
`
`.
`
`'
`
`(IH
`
`J
`R9
`
`(H
`
`I
`R10
`
`or
`
`c7=(‘
`
`I
`R9
`
`I
`RIU
`
`R“, R9 and R” are independently hydrogen, alkyl, alkcnyl,
`alkynyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl,
`cyeloalkyl, or cycloalkylalkyl;
`
`Y is —((IH2)m—or
`
`wherein m is 2 or 3;
`
`R1 is alkyl, alkenyl, alkynyl, aryl, heteroaryl, aryla|.k.yl
`wherein alkyl has at
`least 2 carbons, diarylalkyl,
`arylalkenyl, diarylalkenyl, arylalkynyl, diarylalkynyl,
`diarylalkylaryl, heleroarylalkyl wherein alkyl has at
`least 2 carbons, cycloalkyl, or cycloalkylalkyl wherein
`alkyl has at least 2 carbons, all optionally substituted
`through available carbon atoms with 1._ 2, 3 or 4 groups
`selected from halo, haloalkyl, alkyl, alkenyl, alkoxy,
`aryloxy, aryl, arylalkyl, alkylmereapto, arylmercapto,
`eycloalkyl, cyclo—alkylalkyl, he-tcroaryl,
`fluorenyl,
`heleroarylalkyl, hydroxy or oxo;
`or R‘ is a lluorenyl-type group of the structure
`
`A
`
`B
`
`
`
`OT
`
`1U
`
`I5
`
`30
`
`35
`
`4”
`
`45
`
`so
`
`55
`
`an
`
`5 of 22
`
`PENN EX. 2101
`CFAD V. UPENN
`lPR20l5-01836
`
`

`
`9
`
`—e0ntinucd
`
`5,990,110
`
`10
`
`—eor1tin1.1ed
`
`R15:
`
`Z‘ and Z2 are the same or different and are indepen-
`dently a bond, 0, 5,
`
`S
`H
`0 ,
`'
`
`.
`.- —\H—c— .-
`||
`O
`
`3
`
`.'
`
`C.‘
`H
`O
`
`0-0:
`
`5 |
`
`I
`0
`
`.
`
`Nj(.'
`I
`II
`alkyl 0
`
`with the proviso that with respect to E, at least one of
`Z‘ and Z2 will he other than a bond; R“ is a bond,
`alkylene, alkenyiene or uikynylem; of up to 10 carbon
`atoms; arylcne or mixed ary1ene—aiky1enc; R“ is
`hydrogen, alkyl, alkenyl, ary], haloalkyi, trihaioalkyi,
`trihaloalkylalkyl, heteroaryl, heteroarylalkyl, arylalkyl,
`aryletlkenyl, cyc10—a].kyl, aryloxy, alkoxy, arylalkoxy or
`eyelnalkyl-alkyl, with the pmvisos that
`(I) \§-'hen R” is H, aryloxy, alkoxy or arylalkoxy, then
`2." is
`
`_
`(Ir a bond and
`(2) when Z3 is a bond, R‘: cannot be heteroaryl or
`heleroarylalkyl;
`Z is bond, 0, S, N—a1ky1, 1\'—aryl, or alk Ilene or ztlkcnvicne
`from 1
`to 5 carbon atoms; R”. R1’, R15, and Rf" are
`independently hydrogen, alkyl, halo, halnalkyl, stryl,
`eycloalkyl, cyelnheteroalkyl, alkenyl, alkynyl,
`hydroxy, aikoxy, nitro, amino,
`thio, alkylsulfunyl,
`arylsulibnyl, alkylthio, aryllhio, aminocarhurlyl,
`alkylcarbonyloxy.
`arylcarbonylamine,
`alkylcarhnnylamino, arylalkyl, heleroaryl, hctero:Iry1a—
`lkyl or aryloxy;
`RH” and Iim" are i11L]up::11deI1liy llydruguti, alkyl, halu,
`haloalkyl, aryl. Cycloalkyl, cycloheleroalkyl, alkenyl,
`alkynyl, alkoxy, aikylsulfonyl, arylsulfonyi, alkyithio,
`arylthio, aminoearbonyl, alkylcarbonyioxy,
`arylearbonylamino, alkylearbonylamino, arylalkyl,
`heteroaryl, Iteternarylalkyl, or aryloxy;
`or R1 is :1 group oi" the structure
`
`R17
`—m,,—<R15
`
`1U
`
`I5
`
`.,
`"“
`
`35
`
`3”
`
`35
`
`40
`
`4,;
`"
`
`50
`
`55
`
`6E]
`
`65
`
`1".
`
`G
`
`6 of 22
`
`PENN EX. 2101
`CFAD V. UPENN
`lPR2015-01836
`
`or
`
`R13 /:\ R14
`1 /
`\ /
`
`:R“:Z‘
`1°
`,
`R ’—Z'
`
`R15.
`
`R 15:
`
`or
`
`
`
`

`
`11
`
`5,990,110
`
`wherein p is l to 8 and R” and R” are each indepen-
`dently H, alkyl, alkenyl, aryl, arylalkyl, hetcroaryl,
`heteroarylalkyl, cycloalkyl or cycloalkylalkyl at least
`one of R17 and R18 being other than H;
`or R1 is a group of the structure
`
`12
`
`/\-<‘’
`“Q R‘
`
`thereof; and
`
`1U
`
`pharmaceutically acceptable salts thereof;
`
`with the provisos that where in the tirst formula X is CH2,
`and R2, R7’ and R" are each ll, then R1 will be other than
`3,3—diphenylpropyl, and in the fifth formula, where one of
`R3, R3 and R" is 6—fiuoro, and the others are H, R7 will be
`other than 4-(2-methoxyphenyl).
`
`I5
`
`The MTP inhibitors disclosed in US. application Ser. No.
`548,811 filed Jan. '1 "I, "1996 (file DC2'lh), have the structure
`
`0 I
`
`II
`I
`(:—1x‘—cH3—c‘1~'_,
`
`XI
`
`7.
`
`_ (c113),
`
`IN"
`
`7310
`
`>
`
`E2
`
`R31]
`_Rte_<R2]
`
`wherein R19 is aryl or heteroaryl;
`R2” is aryl or heteroaryl;
`R“ is
`II, alkyl, aryl, alkylaryl, arylalkyl, aryloxy,
`arylalkexy, heteroaryl, heteroarylalkyl,
`heteroarylalkoxy, eycloalkyl, cycloalkylalkyl or
`cycloalkylalkoxy;
`R2, R3, R" are independently hydrogen, halo, alkyl,
`alkenyl, alkexy, arylexy, aryl, arylalkyl, alkylmercapto,
`arylrnercapto, cycloalkyl, cycloalkylalkyl, heteroaryl,
`heteroarylalkyl, hydroxy or haloalkyl;
`R5 is independently alkyl, alkcnyl, alkynyl, aryl, alkoxy,
`aryloxy, arylalkoxy, heteroaryl, arylalkyl,
`heteroarylalkyl, cycloalkyl, cycloalkylalkyl,
`polyeycloalkyl, polyeycloalkylalkyl, cyeloalkenyl,
`cycloheteroalkyl, heteroaryloxy, cycloalkenylalkyl,
`polycycloalkenyl, polycycloalkenylalkyl,
`lieleroarylearlioiiyl, atiiiuu, alkylamino, arylaiiiino,
`heteroarylamino. cycloalkyloxy, cycloalkylamino, all
`optionally substituted through available carbon atoms
`with 1, 2, 3 or 4 groups selected from hydrogen, halo,
`alkyl, haloalkyl, alkoxy, haloalkoxy, alkenyl, alkynyl,
`cycloalkyl, cycloalkylalkyl, cycloheteroalkyl,
`eyeloheteroalkylalkyl, aryl, heteroaryl, arylalkyl,
`arylcycloalkyl, arylalkcnyl, arylalkynyl, aryloxy,
`aryloxyalkyl, arylalkoxy, arylazo, heteroaryloxo,
`heteroarylalkyl. heteroarylalkenyl, hotcroaryloxy,
`hydroxy, nitro, cyario, arnino, substituted amino, thiol,
`alkylthio, arylthio, heteroarylthio, arylthioalkyl,
`alkylcarbonyl. arylcarbonyl, arylaminocarbonyl.
`alkoxycarboriyl,
`aminocarbonyl,
`alkynylaminocarbonyl, alkylaminoearbotiyl,
`alkenylamineearbonyl, alkylearbonyloxy,
`arylcarbonyloxy,
`alliylcarbonylamino,
`arylcarbonylarnirio, arylsuliinyl, arylsullinylalkyl,
`arylsulfonyl, alkylsulfonyl, arylsulionylamino,
`heteroarylcarbonylarriino, heteroarylstllliriyl,
`heteroarylthio, heteroarylsulfonyl, alkylsulfiriyl;
`R” is hydrogen or C1-C4 alkyl or C,—C_. alkenyl; all
`optionally substituted with 1, 2, 3 or 4 groups which
`may independently be any of the substituents listed in
`the definition of R5 set out above;
`R7 is alkyl, aryl or arylalkyl wherein allayl by itself or as
`part of arylalkyl is optionally substituted with oxo
`
`<r)t"dm
`
`are the same or different and are independently selected
`from heteroaryl containing, 5- or 6—ring members; and
`N-oxides
`
`30
`
`35
`
`4U
`
`45
`
`SU
`
`55
`
`oil
`
`65
`
`including the piperitline N—oxide- thereof or a pharmaceuti-
`cally acceptable salt thereof, wherein Z is a bond, (J or S;
`
`X‘ and X3 are independently selected front H or halo;
`3: is an integer from 2 to 6;
`
`R5 is heteroaryl, aryl, heterocyeloalkyl or eyeloalkyl, each
`R5 group being optionally substituted with 1, 2, 3 or 4
`suhstitucnts which may be the same or different.
`The MT!’ inhibitors disclosed in LLS. provisional appli-
`cation No. (i0f0l7,224, filed May 9, 1996 {file HX79a*)
`have the structure
`
`0
`_/i.§\)vl\ /IL‘
`i<-
`A
`is
`OT
`
`R1
`
`{DJ
`ll "
`,5:
`"\B/
`01'
`
`1.‘x.
`
`Rt
`
`R3
`\\L._s_
`
`on
`
`IA
`
`ID
`
`1&3
`
`L‘
`
`\L3%\B/ N.K1
`
`RX
`
`7of22
`
`PENN EX. 2101
`
`CFAD V. UPENN
`lPR20l5-01836
`
`

`
`13
`including pharmaceutieally acceptable salts thereof, wherein
`q is U,
`1 or 2;
`A is
`
`—continued
`
`14
`
`OI’
`
`5,990,110
`
`5
`
`1::
`
`I5
`
`an
`
`H
`
`15
`
`30
`
`35
`
`40
`
`45
`
`SU
`
`55
`
`6!]
`
`
`
`(the above B is also referred to as
`art indenjr]-type ring or moiety):
`
`R‘ is H, alkyl or aryl;
`
`R‘ is alkyl, alkenyl, alkynyl, alkexyl, (alkyl or aryl)3Si
`(where each alkyl or aryl group is
`independent),
`eyeloalkyl, cycloalkenyl, substituted alkylamino, sub-
`stituted arylalkylarnino, aryl. arylalkyl, arylamino,
`aryloxy, heteroaryl, heteroarylamino, heteroaryloxy,
`arylsulfonylarnino, heteroarylsulfonylamino, arylthio,
`arylsulllnyl, arylsulfonyl, alkylthio, alkylsulfinyl,
`alkylsullonyl, heteroarylthio, heteroarylsulllrtyl,
`heleroarylsulfonyl, —l-’O(R13)(R.”), (where R” and
`R" are independently alkyl, aryl, alkoxy, aryloxy,
`heteroaryl, heteroarylalkyl, heteroaryloxy,
`heteroarylalkoxy,
`eyeloheteroalkyl,
`eyeloheteroalkylalkyl, cycloheteroallroxy, or
`eycloheteroalkylalkoxy); R1 can also be arninocarbonyl
`(where the amino may optionally be substituted with
`one or two aryl, alkyl or heteroaryl groups); cyano,
`1,1—(alkoxyl or aryloxy)3alkyl [where the two aryl or
`alkyl substituenls can be independently defined, or
`linked to one another to form a ring, such as 1,3-
`dioxane or 1 ,3—dioxolane, connected to [.1 (or [.2 in the
`ease of R3) at
`the 2—position); 1,3—tliexane or 1,3-
`dioxolane connected to 1.1 (or [.3 in the case of R2) at
`the 4-position.
`
`The R‘ group may have from one to four substituents,
`which can be any of the R3 groups or R1 groups, and any of
`the preferred R1 snbstituents set out below.
`R1 may be substituted with the following preferred sub-
`slituents: alkylcarbonylamirto, cycloalkylcarbonylamino,
`arylcarbonylamino, heteroarylearbonylamino,
`alkoxycarbonylamino, aryloxycarbonylarnino,
`heteroaryloxylcarbenylamino, uric-do (where the uriedo
`nitrogens may be substituted with alkyl, aryl or heteroaryl),
`helerocyclylcarbonylaniino [where the heterocycle is con-
`nected to the carbonyl group Via a nitrogen or carbon atom),
`alkylsullonylarnino,
`arylsulfonylarrtino,
`heleroarylsullonylarnino,
`
`(1) a bond;
`(2) —O—; or
`
`T5-_
`
`|—
`R‘
`
`:
`
`(3:
`
`where R5 is H or lower alkyl or R5 together with R:
`forms :1 carbocyclic or heteroeyclic ring system
`containing 4 to 8 members in the ring.
`B is a [luorenyl—type group of the structure:
`
`R’
`
`[\ \\
`/ / X
`'
`U
`
`R-"
`
`l
`
`10’
`
`\' j
`I /
`1&4
`
`cr
`
`
`
`[the above 13 is also refencd to as a
`flttoiertyl-type ring or ntoietyy. or
`
`B is an indenyl-type group oi" the structure
`
`RM:
`
`R33
`
`8 of 22
`
`PENN EX. 2101
`
`CFAD V. UPENN
`lPR20l5-01836
`
`

`
`15
`
`0
`
`R20
`r\ \
`Ra_:
`l\/ Z J)’
`R21
`
`N_
`
`5,990,110
`
`16
`2, 3 or 4 heteroatorns in