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`WORLD I.\'Tr-.1_I.r:c"I'L.'m. l’R{JP|iRT‘u' ORG.-\MzA110.~:
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`
`
`l1'\"l'ERl\'ATlONAI. APPLlC2\'I‘l0.\' PL-'BLISHF-D UNI)!-LR THE PATENT COOPliRA'I"[(.)\l TREATY (PCT)
`wo 99!385li1_
`
`[Ill lnti.-rnational Publication ;‘\'umber:
`
`(SI) International Patent (flussilicalion 5 :
`
`AGIK 31100
`
`A2
`(43) International Publication Date:
`5 August 1999 (tJ_‘i.t'}8.99)
`
`(22) International Filing Date:
`
`2 February 1999 ((1232.99)
`
`I-’C'l‘.=' US99.'l}2294
`
`(ZI)InternationalApplicationNumber:
`
`(fill) Priority Data:
`60"075.409
`
`3 l‘ebI‘uar_\' I998 {U2.02.93)
`
`{TS
`
`. (71) Applicant {for all .r2’c.i'lgu.um1 Slates i9_\'c:c*,')t US): TRUSTILIES
`'
`OF TUFTS LlNIVl'€RSl'l'Y |l.5SI'US|', Tufts {..'ni\'emily, Med-
`!
`ford, MA 02155 (us).
`I (72) Inventors; and
`(75) lnventttrso’.-tpplicnnts(jhrUSnm’yJ: BACIIDVCIIIN. William.
`W.
`[L.'S.*'US];
`1' Warwick Street. Melrose,
`l\-IA E.l2l'i'6
`(US). PLALTT. Andrew. G.
`|US.'US]'_. 22 PC£lL"Ot‘l\
`l"unn
`Road.
`l.exingt<'m, MA 0242! (118). DRIICKER, D-uuicl, J.
`[CA-"C.-\]:
`I9 Femwood Road, ‘forcnto. Ontario l\rl6B 3(}_i
`(CA).
`
`(ill) Designated States: AL. AM. :'\'|', AU. AZ, BA. BB. HG. HR,
`BY. CA. CH, (TN. CU. CZ, DE, DK, EE, ES, Fl, GB. GD,
`GE. GH, GM.
`I-TR, ill‘, ID. IL. IN. IS, JP, KE. KG. Kl’.
`KR. KZ. LC. LK, LR. LS, LT. LU. LV, MD. MG. MK.
`NIX, MW. MK. NO. NZ. PL, PT. RO. RU, SD. SE, 5G.
`Si. SK. SL. TJ. TM. TR. TT. CA. L-"G. US. L-‘Z.
`\.’i\i. YLE.
`zw. ARIPO pateiat win. GM. Kli, LS, MW. SD. sz_ um.
`KW). Euraiiian patent (AMI, AZ, BY, KG. KZ. MD. RU. TJ.
`'l"7\«’I). European: patent (AT. BE. CH, CY. DE. DK. 133, FI.
`FR. GB. GR. IE. IT. LL", MC. NL. PT, SE), 0.»\Pl patent
`E1517. Bl, CF. CG. (fl, FM, GA, GN, GVV, ML. MR, NE,
`SN, TD, 'I'G).
`
`I
`I
`'
`I
`
`l‘ub|i:i|1ed
`
`Without iriteriiarmnuf .cerir.c'h report and to be rc'publi'.rhm‘
`upon reccfgit of Ilia! report.
`
`iloag ti: Eliot.
`(7-I} Agents: VINCENT. Muttlu-\v_ P. ct nix. Foley.
`LLP. One Post Office Siquzurc. Boston. MA 02109 (115).
`
`(5-1] Title: METHOD Oi" RliGULA'l'lN(J GLUCOSE METABOLISM. AND REAGERTS REl.ATiEI) TlllERliTO
`
`(57) Abstract
`
`The present invention provides methods und compositions fur Iltotlificzitiolt and regulation cl" glucose and lipid nletabolism, gene-I'ull_\'
`to reduce in.-suiin l't3Si5l:1ll.CC.ll}'[}t3l'gl}'Ct3ml:J,
`i1_VpEfl.I1.*iLtlil'1tZ‘l‘|'IlEi.0b{‘5ll}-'. hyperlipidcmia, l'l_Y[)Cl'llpO[.‘rT0l(‘ll‘|.-—€|‘Ilifl
`(such as cliylonlicrtms. VLDI.
`and LDL}. and to regulate body fut and more generally lipltl stores, anti. more generally. for the ilnplnvetiicnt of metabolism Llisorclers.
`especially those associatcti with diulietes. obesityandfor alIicI(isL'1cI'tuei5.
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:20)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
`Sun-Amneal-IPR2016-01104- Ex. 1011, p. 1 of 72
`
`EXHIBIT
`
`Ex. 1011
`
`

`
`
`FOR THE PURPOSES OF INFORMATION ONLY
`
`Codes used to identify States party to the PCT on the front pages of pamphlets publishing international applications under the PCT.
`
`
`
`Lesotho
`Lithuania
`Luxembourg
`Latvia
`Monaco
`Republic of Moldova
`Madagascar
`The former Yugoslav
`Republic of Macedonia
`Mali
`Mongolia
`Mauritania
`Malawi
`Mexico
`Niger
`Netherlands
`Norway
`New Zealand
`Poland
`Portugal
`Romania
`Russian Federation
`Sudan
`Sweden
`Singapore
`
`SI
`SK
`SN
`SZ
`TD
`TG
`TJ
`TM
`TR
`TT
`UA
`UG
`US
`UZ
`VN
`YU
`ZW
`
`Slovenia
`Slovakia
`Senegal
`Swaziland
`Chad
`Togo
`Tajikistan
`Turkmenistan
`Turkey
`Trinidad and Tobago
`Ukraine
`Uganda
`United States of America
`Uzbekistan
`Viet Nam
`Yugoslavia
`Zimbabwe
`
`
`
`
`
`
`
`LS
`LT
`LU
`LV
`MC
`MD
`MG
`MK
`
`ML
`MN
`MR
`MW
`MX
`NE
`NL
`N0
`NZ
`PL
`PT
`R0
`RU
`SD
`SE
`SG
`
`KR
`KZ
`LC
`LI
`LK
`LR
`
`
`
`
`
`
`Spain
`Albania
`ES
`
`AM
`Armenia
`Fl
`Finland
`AT
`Austria
`FR
`France
`AU
`Australia
`GA
`Gabon
`AZ
`Azerbaijan
`GB
`United Kingdom
`BA
`Bosnia and Herzegovina
`GE
`Georgia
`BB
`Barbados
`GH
`Ghana
`BE
`Belgium
`GN
`Guinea
`BF
`Eurkina Faso
`GR
`Greece
`BG
`Bulgaria
`HU
`Hungary
`BJ
`Benin
`IE
`Ireland
`BR
`Brazil
`IL
`Israel
`BY
`Belarus
`IS
`Iceland
`CA
`Canada
`IT
`Italy
`CF
`Central African Republic
`JP
`Japan
`CG
`Congo
`KE
`Kenya
`CH
`Switzerland
`KG
`Kyrgyzstan
`CI
`Cote d’Ivoire
`KP
`Democratic People’s
`CM
`Cameroon
`Republic of Korea
`CN
`China
`Republic of Korea
`CU
`Cuba
`Kazakstan
`CZ
`Czech Republic
`Saint Lucia
`DE
`Germany
`Liechtenstein
`DK
`Denmark
`Sri Lanka
`EE
`Estonia
`Liberia
`
`
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:21)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
`Sun-Amneal-lPR2016-01104- Ex. 1011, p. 2 of 72
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`

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`wo 99/33501
`
`PCT/US99/02294
`
`Method ofRegulating Glucose Metabolism, and Reagents Related Thereto
`
`Funding
`
`Work described herein was supported by funding from the National Institutes of
`
`Health. The United States Government has certain rights in the invention.
`
`Background of the Invention
`
`Diabetes adversely affects the way the body uses sugars and starches which, during
`
`digestion, are converted into glucose. Insulin, a hormone produced by the pancreas, makes
`
`the glucose available to the body's cells for energy. In muscle, adipose (fat) and connective
`
`tissues,
`insulin facilitates the entry of glucose into the cells by an action on the cell
`membranes. The ingested glucose is normally converted in the liver to CO2 and H20
`
`(50%); to glycogen (5%); and to fat (30-40%), the latter being stored in fat depots. Fatty
`
`acids from the adipose tissues are circulated, returned to the liver for re-synthesis of
`
`triacylglycerol and metabolized to ketone bodies for utilization by the tissues. The fatty
`
`acids are also metabolized by other organs. Fat formation is a major pathway for
`
`carbohydrate utilization.
`
`The net effect of insulin is to promote the storage and use of carbohydrates, protein
`
`and fat. Insulin deficiency is a common and serious pathologic condition in man. In insulin-
`
`dependent (IDDM or Type I) diabetes the pancreas produces little or no insulin, and insulin
`
`must be injected daily for the survival of the diabetic. In noninsulin-dependent (NIDDM or
`
`Type II) diabetes the pancreas retains the ability to produce insulin and in fact may produce
`
`higher than normal amounts of insulin, but the amount of insulin is relatively insufficient,
`
`or less than fully effective, due to cellular resistance to insulin.
`
`Diabetes mellitus (DM) is a major chronic illness found in humans with many
`
`consequences. Some complications arising from long-standing diabetes are blindness,
`
`kidney failure, and limb amputations. Insulin—dependent diabetes mellitus (IDDM) accounts
`
`for 10 to 15% of all cases of diabetes mellitus. The action of IDDM is to cause
`
`hyperglycemia (elevated blood glucose concentration) and a tendency towards diabetic
`
`ketoacidosis (DKA). Currently treatment requires chronic administration of insulin. Non-
`
`insulin dependent diabetes mellitus (NIDDM) is marked by hyperglycemia that is not
`
`linked with DKA. Sporadic or persistent incidence of hyperglycemia can be controlled by
`
`administering insulin. Uncontrolled hyperglycemia can damage the cells of the pancreas
`
`which produce insulin (the [3-islet cells) and in the long term create greater insulin
`
`deficiencies. Currently, oral sulfonylureas and insulin are the only two therapeutic agents
`
`10
`
`15
`
`20
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`25
`
`30
`
`35
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:22)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`PCT/US99/02294
`
`-2-
`
`available in the United States. for treatment of Diabetes mellitus. Both agents have the
`
`potential
`
`for producing hypoglycemia as a side effect,
`
`reducing the blood glucose
`
`concentration to dangerous levels. There is no generally applicable and consistently
`
`effective means of maintaining an essentially normal fluctuation in glucose levels in DM.
`
`The resultant treatment attempts to minimize the risks of hypoglycemia while keeping the
`
`glucose levels below a target value. The drug regimen is combined with control of dietary
`
`intake of carbohydrates to keep glucose levels in control.
`
`In either form of diabetes there are widespread abnormalities. In most NIDDM
`
`subjects, the fundamental defects to which the abnormalities can be traced are (1) a reduced
`
`10
`
`entry of glucose into various "peripheral" tissues and (2) an increased liberation of glucose
`
`into the circulation from the liver. There is therefore an extracellular glucose excess and an
`
`intracellular glucose deficiency. There is also a decrease in the entry of amino acids into
`
`muscle and an increase in lipolysis. Hyperlipoproteinemia is also a complication of
`
`diabetes. The cumulative effect of these diabetes—associated abnormalities is severe blood
`
`15
`
`vessel and nerve damage.
`
`Endocrine secretions of pancreatic islets are regulated by complex control
`
`mechanisms driven not only by blood—bome metabolites such as glucose, amino acids, and
`
`catecholamines, but also by local paracrine influences.
`
`Indeed, pancreatic OL- and B—cells
`
`are critically dependent on hormonal signals generating cyclic AMP (CAMP) as a
`
`synergistic messenger for nutrient-induced hormone release. The major pancreatic islet
`
`hormones, glucagon, insulin and somatostatin, interact with specific pancreatic cell types to
`
`modulate the secretory response. Although insulin secretion is predominantly controlled by
`
`blood glucose levels, somatostatin inhibits glucose-mediated insulin secretion.
`
`The human hormone glucagon is a polypeptide hormone produced in pancreatic A-
`
`cells. The hormone belongs to a multi-gene family of structurally related peptides that
`
`include secretin, gastric inhibitory peptide, vasoactive intestinal peptide and glicentin.
`
`These peptides variously regulate carbohydrate metabolism, gastrointestinal motility and
`
`secretory processing. However, the principal recognized actions of pancreatic glucagon are
`
`to promote hepatic glycogenolysis and glyconeogenesis, resulting in an elevation of blood
`
`sugar levels. In this regard, the actions of glucagon are counter regulatory to those of insulin
`
`and may contribute to the hyperglycemia that accompanies Diabetes mellitus (Lund et al.
`
`(1982) PNAS, 79:345—349).
`
`Prcproglucagon, the zymogen form of glucagon, is translated from a 360 base pair
`
`gene and is processed to form proglucagon (Lund, et al., supra). Patzelt, et al. (Nature,
`
`282:260-266 (1979)) demonstrated that proglucagon is further processed into glucagon and
`
`20
`
`25
`
`30
`
`35
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:23)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`-3-
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`a second peptide. Later experiments demonstrated that proglucagon is cleaved carboxyl to
`
`Lys-Arg or Arg-Arg residues (Lund et al., sum; and Bell et al. (l983) lie 3022716-
`
`718). Bell et al. also discovered that proglucagon contained three discrete and highly
`
`homologous peptide regions which were designated glucagon, glucagon—like peptide 1
`
`(GLP-1), and glucagon-like peptide 2 (GLP-2). GLP-1 has attracted increasing attention as
`
`a humoral stimulus of insulin secretion. In humans, this 29-amino acid peptide, cleaved
`
`from proglucagon by cells of the intestinal mucosa, is released into the circulation after
`
`nutrient intake (Holst et al. (1987) E_EB_S_@ 211:l69; Orskov et al. (1987) Diabetologia
`
`302874; Conlon J (1988) Diabetologia 31 :563).
`
`GLP-1 has been found to be a glucose—dependent insulinotropic agent (Gutniak et
`
`al. (1992) N. Engl. J. Bled. 32621316-1322).
`
`GLP-1 is now known to stimulate insulin
`
`secretion (insulinotropic action) causing glucose uptake by cells which decreases serum
`
`glucose levels (see, e.g., Mojsov, S., Int. J. Peptide Protein Research, 40:333—343 (1992)).
`
`For instance, it has been shown to be a potent insulin secretagogue in experimental models
`
`and when infused into humans (Gutniak et al., supra; Mojsov et al. (1988) J_Clin Invest
`
`792616; Schmidt et al. (l985) Diabetologia 28:704; and Kreymann et al. (1987) Lancet
`
`221300). Thus, GLP—l
`
`is a candidate for the role of an “incretin”, having augmentary
`
`effects on glucose-mediated insulin release.
`
`It
`
`is also noted that numerous GLP—l analogs have been demonstrated which
`
`demonstrate insulinotropic action are known in the art. These variants and analogs include,
`for example, GLP-l(7-36), Gln9-GLP—1(7—37), D-Gln9-GLP-l(7-37), acetyl-Lys9-GLP-l(7-
`
`37), Thr16—Lys13-GLP-l(7—37), and Lyslg-GLP-l(7-37). Derivatives of GLP-l include, for
`
`example, acid addition salts, carboxylate salts, lower alkyl esters, and amides (see, e.g.,
`
`W091/11457).
`
`Objects of the Invention
`
`It is one object of this invention to provide improved methods for reducing in
`
`animal subjects (including humans) in need of such treatment at
`
`least one of insulin
`
`resistance, hyperinsulinemia, and hyperglycemia and abating Type II diabetes. Another
`
`object
`
`is to provide improved methods for reducing at
`
`least one of body fat stores,
`
`hyperlipidemia, hyperlipoproteinemia, and for abating atherosclerosis. It is another object
`
`of this invention to provide methods for interfering with glucose and/or lipid metabolism in
`a manner beneficial to the host.
`
`10
`
`I5
`
`20
`
`25
`
`30
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:24)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`
`It is yet another object of this invention to provide improved methods for the long-
`
`term reduction and abatement of at
`
`least one of the foregoing disorders based on a
`
`therapeutic regimen administered over the short-term.
`
`It is still another object of the present invention to provide a method for regulating,
`
`and altering on a long term basis, the glucose and lipogenic responses of vertebrate animals,
`
`including humans.
`
`In particular, it is an object of the invention to provide methods for producing long
`
`lasting beneficial changes in one or more of the following: the sensitivity of the cellular
`
`response of a species to insulin (reduction of insulin resistance), blood insulin levels,
`
`10
`
`hyperinsulinemia, blood glucose levels, the amount of body fat stores, blood lipoprotein
`
`levels, and thus to provide effective treatments for diabetes, obesity and/or atherosclerosis.
`
`Brief Description of the Drawings
`
`Figure l
`
`is a diagrammatic representation of the synthesis of a boro proline
`
`15
`
`compound.
`
`Figure 2 is a glucose tolerance curve which shows that a single injection of PBP-1
`
`improves glucose levels in blood. The glucose concentration is measured before and at 30-
`
`minute intervals after the test dose of glucose. This figure demonstrates that a single
`
`injection of PBP-l potentiates the response to a sub-therapeutic dose of GLP-1.
`
`20
`
`25
`
`30
`
`Figure 3 shows that a single injection of PBP-2 improves glucose levels in blood.
`
`Figure 4 shows that treatment with PBP-3 under “chronic” conditions also results in
`
`lowering of the blood sugar levels.
`
`Figures 5Aand 5B compare the ability of Pro-boro-pro to lower plasma glucose
`
`levels in GLP-l receptor -/- transgenic mice.
`
`Detailed Description of the Invention
`
`Glucose-induced insulin secretion is modulated by a number of hormones and
`
`neurotransmitters.
`
`In particular, two gut hormones, glucagon-like peptide—l (GLP-l) and
`
`gastric inhibitory peptide (GIP) are insulinotropic agents, e.g., being agents which can
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:25)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`-5-
`
`stimulate, or cause the stimulation of, the synthesis or expression of the hormone insulin,
`
`are thus called gluco-incretins (Dupre, in The Endocrine Pancreas, E. Samois Ed. (Raven
`
`Press, New York, (1991), 253-281); and Ebert et al. (1987) Diabetes Metab. Rev. p3).
`
`Glucagon-like peptide—1 is a glucoincretin both in man and other mammals (Dupre et al.
`
`fl;)1‘_a, and Kreymarm et al. (1987) I5z1nj<:et 2:300). It is part of the preproglucagon molecule
`
`(Bell et al. (1983) LIE 3042368) which is proteolytically processed in intestinal L cells to
`
`GLP-1(1-37) and GLP-1(7—36)amide or GLP-l(7—37) (Mojsov et al. (1986) J. Biol. Chem.
`
`261 :1 1880; and Habener et al.: The Endocrine Pancreas, E. Samois Ed. (Raven Press, New
`
`York (1991), 53-71). Only the truncated forms of GLP—1 are biologically active and both
`
`have identical effects on insulin secretion in beta cells (Mojsov et al. (1987) J_._Clin. Invest
`
`792616; and Weir et al. (1989) Diabetes 38:338). They are the most potent gluco-incretins
`
`so far described and are active at concentrations as low as one to ten picomolar.
`
`The metabolic fate of exogenous GLP-1 has been studied in nondiabetic and type II
`
`diabetic subjects. Subcutaneous and intravenous GLP-1 are both rapidly degraded in a time-
`
`dependent manner, for instance, having a half—life in diabetic patients of substantially less
`
`than 30 minutes. See, for example, Deacon et al. (1995) Diabetes 4421126-1 131.
`
`i. Overview of the Invention
`
`The present invention provides methods and compositions for modification and
`
`regulation of glucose and lipid metabolism, generally to reduce insulin resistance,
`
`hyperglycemia, hyperinsulinemia, obesity, hyperlipidemia, hyperlipoprotein-emia (such as
`
`chylomicrons, VLDL and LDL), and to regulate body fat and more generally lipid stores,
`
`and, more generally, for the improvement of metabolism disorders, especially those
`
`associated with diabetes, obesity and/or atherosclerosis. As described in greater detail
`
`below, the subject method includes the administration, to an animal, of a composition
`
`including one or more dipeptidylpeptidase inhibitors, especially inhibitors of the
`
`dipeptidylpeptidase IV (DPIV) enzyme or other enzyme of similar specificity, which are
`
`able to inhibit the proteolysis of GLP-1 and accordingly increase the plasma half-life of that
`hormone.
`
`Preferably, the compounds utilized in the subject method will produce an EC50 for
`
`the desired biological effect of at least one, two, three and even four orders of magnitude
`
`less than the EC50 for that compound as an immunosuppressant.
`
`Indeed, a salient feature
`
`of such compounds as the peptidyl boronates is that the inhibitors can produce, for example,
`
`an EC50 for inhibition of glucose tolerance in the nanomolar or less range, whereas the
`
`compounds have EC50’s for immunosuppression in the 1.1M or greater range. Thus, a
`
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`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:26)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`favorable therapeutic index can be realized with respect to the unwanted sideeffect of
`
`immunosuppression.
`
`While not wishing to bound by any particular theory, it is observed that compounds
`
`which inhibit DPIV are, correlatively, able to improve glucose tolerance,
`
`though not
`
`necessarily through mechanisms involving DPIV inhibition per se.
`
`Indeed, the results
`
`described in Example 6 (and Figure 5) demonstrating an effect in mice lacking a GLP-1
`
`receptor suggest that the subject method may not include a mechanism of action directly
`
`implicating GLP-1 itself, though it has not been ruled out that GLP-1 may have other
`
`receptors. However,
`
`in light of the correlation with DPIV inhibition,
`
`in preferred
`
`embodiments, the subject method utilizes an agent with a Ki for DPIV inhibition of 1.0 nm
`
`or less, more preferably of 0.1 nm or less, and even more preferably of 0.01 nM or less.
`
`Indeed,
`
`inhibitors with Ki values in the picomolar and even femtamolar range are
`
`contemplated. Thus, while the active agents are described herein, for convience, as “DPIV
`
`inhibitors”, it will be understood that such nomenclature is not intending to limit the subject
`
`invention to a particular mechanisim of action.
`
`10
`
`15
`
`For instance, in certain embodiments the method involves administration of a DPIV
`
`inhibitor, preferably at a predetermined time(s) during a 24-hour period,
`
`in an amount
`
`effective to improve one or more aberrant indices associated with glucose metabolism
`
`disorders (e.g., glucose intolerance,
`
`insulin resistance, hyperglycemia, hyperinsulinemia
`
`20
`
`and Type II diabetes).
`
`In other embodiments, the method involves administration of a DPIV inhibitor in an
`
`amount effective to improve aberrant indices associated with obesity. Fat cells release the
`
`hormone leptin, which travels in the bloodstream to the brain and, through leptin receptors
`
`there, stimulates production of GLP-1. GLP-1, in turn, produces the sensation of being full.
`
`The leading theory is that the fat cells of most obese people probably produce enough
`
`leptin, but leptin may not be able to properly engage the leptin receptors in the brain, and so
`
`does not stimulate production of GLP-1. There is accordingly a great deal of research
`
`towards utilizing preparations of GLP-1 as an apepitite suppressant. The subject method
`
`provides a means for increasing the half-life of both endogenous and ectopically added
`
`GLP-1 in the treatment of disorders associated with obesity.
`
`25
`
`30
`
`In a more general sense, the present invention provides methods and compositions
`
`for altering the pharmokinetics of a variety of different polypeptide hormones by inhibiting
`
`the proteolysis of one or more peptide hormones by DPIV or some other proteolytic
`
`activity. Post—secretory metabolism is an important element in the overall homeostasis of
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:27)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`regulatory peptides, and the other enzymes involved in these processes may be suitable
`
`targets for pharmacological intervention by the subject method.
`
`For example, the subject method can be used to increase the half-life of other
`
`proglucagon-derived
`
`peptides,
`
`such
`
`as
`
`glicentin
`
`(corresponding
`
`to
`
`PG 1-69),
`
`oxyntomodulin (PG 33-69), glicentin-related pancreatic polypeptide (GRPP, PG 1-30),
`
`intervening peptide-2 (IP-2, PG lll-l22amide), and g1ucagon—like peptide-2 (GLP-2, PG
`
`126-158).
`
`GLP-2, for example, has been identified as a factor responsible for inducing
`
`proliferation of intestinal epithelium.
`93:7911.
`
`See, for example, Drucker et al. (1996) PNAS
`
`The subject method can be used as part of a regimen for treating injury,
`
`inflammation or resection of intestinal tissue, e.g., where enhanced growth and repair of the
`
`intestinal mucosal epithelial is desired.
`
`DPIV has also been implicated in the metabolism and inactivation of growth
`
`hormone-releasing factor (GHRF). GHRF is a member of the family of homologous
`
`peptides that
`
`includes glucagon, secretin, vasoactive intestinal peptide (VIP), peptide
`
`histidine isoleucine (PHI), pituitary adenylate cyclase activating peptide (PACAP), gastric
`
`inhibitory peptide (GIP) and helodermin. Kubiak et al. (1994) Peptide Res 7:153. GHRF is
`
`secreted by the hypothalamus, and stimulates the release of growth hormone (GH) from the
`
`anterior pituitary. Thus, the subject method can be used to improve clinical therapy for
`
`certain growth hormone deficient children, and in clinical therapy of adults to improve
`
`nutrition and to alter body composition (muscle vs. fat). The subject method can also be
`
`used in veterinary practice, for example, to develop higher yield milk production and higher
`
`yield, leaner livestock.
`
`Likewise, the DPIV inhibitors of the subject invention can be used to alter the
`
`plasma half-life of secretin, VIP, PHI, PACAP, GIP and/or helodermin. Additionally, the
`
`subject method can be used to alter the pharmacokinetics of Peptide YY and neuropeptide
`
`Y, both members of the pancreatic polypeptide family, as DPIV has been implicated in the
`
`processing of those peptides in a manner which alters receptor selectivity.
`
`Another aspect of the present invention relates to pharmaceutical compositions of
`
`dipeptidylpeptidase inhibitors, particularly DPIV inhibitors, and their uses in treating and/or
`
`preventing disorders which can be improved by altering the homeostasis of peptide
`
`hormones.
`
`In a preferred embodiment, the inhibitors have hypoglycemic and antidiabetic
`
`activities, and can be used in the treatment of disorders marked by abberrant glucose
`
`metabolism (including storage). In particular embodiments, the compositions of the subject
`
`methods are useful as insulinotropic agents, or to potentiate the insulinotropic effects of
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:28)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
`Sun-Amneal-lPR2016-01104- Ex. 1011, p. 9 of 72
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`such molecules as GLP-1. In this regard, the present method can be useful for the treatment
`
`and/or prophylaxis of a variety of disorders,
`
`including one or more of: hyperlipemia,
`
`hyperglycemia, obesity, glucose tolerance insufficiency,
`
`insulin resistance and diabetic
`
`complications.
`
`In general, the inhibitors of the subject method will be small molecules, e.g., with
`
`molecular weights less than 7500 amu, preferably less than 5000 amu, and even more
`
`preferably less than 2000 amu and even 1000 amu.
`
`In preferred embodiments,
`
`the
`
`inhibitors will be orally active.
`
`In certain embodiments, the subject inhibitors are peptidyl compounds (including
`
`peptidomimetics) which are optimized, e.g., generally by selection of the Cot substituents,
`
`for the substrate specificity of the targeted proteolytic activity. These peptidyl compounds
`
`will
`
`include a functional group, such as in place of the scissile peptide bond, which
`
`facilitates inhibition of a serine-, cysteine- or aspartate—type protease, as appropriate. For
`
`example, the inhibitor can be a peptidyl or-diketone or a peptidyl on-keto ester, a peptide
`
`haloalkylketone, a peptide sulfonyl fluoride, a peptidyl boronate, a peptide epoxide, a
`
`peptidyl diazomethanes,
`
`a peptidyl phosphonate,
`
`isocoumarins, benzoxazin-4-ones,
`
`carbamates, isocyantes, isatoic anhydrides or the like. Such functional groups have bee
`
`provided in other protease inhibitors, and general routes for their synthesis are known. See,
`
`for example, Angelastro et al., J_. Med Chem. 33:11-13 (1990); Bey et al., EPO 363,284;
`
`Bey et al., EPO 364,344; Grubb et al., W0 88/ 10266; Higuchi et al., EPO 393,457; Ewoldt
`
`et al., Molecular Immunology 29(6):713-721 (1992); Hernandez et al., Journal of Medicinal
`
`Chemistgg 35(6): 1121-1129 (1992); Vlasak et al., J Virology 63(5):2056-2062 (1989);
`
`Hudig et al., J_Immunol 147(4):1360-1368 (1991); Odakc et al., Biochemistry 30(8):2217—
`
`2227 (1991); Vijayalakshmi et al., Biochemistry 30(8):2l75—2183 (1991); Kam et al.
`
`,
`
`Thrombosis and Haemostasis 64(l):133-137 (1990); Powers et al.,
`
`J_Q_<:L Biochem
`
`39(1):33-46 (1989); Powers et al., Proteinase Inhibitors, Barrett et al., Eds., Elsevier, pp.
`
`55-152 (1986); Powers et al., Biochemistry 29(12):3l08-3118 (1990); Oweida et al.,
`
`Thrombosis Research 58(2):39l-397 (1990); Hudig et al., Molecular
`
`Immunology
`
`26(8):793-798 (1989); Orlowski
`
`et al., Archives of Biochemistry and Biophysics
`
`269(l):l25-136 (1989); Zunino et al., Biochimica et Biophysica Acta. 967(3):331-340
`
`(1988); Kam et al., Biochemistfl 27(7):2547-2557 (1988); Parkes et al., Biochem J.
`
`230:509—516 (1985); Green et al., J. Biol. Chem. 256:l923-1928 (1981); Angliker et al.,
`
`Biochem. J. 241:87l—875 (1987); Puri et al., Ar_c_li_Biochem. Biophys. 27:346-358 (1989);
`
`Hanada et al., Proteinase Inhibitors: Medical and Biological Aspects, Katunuma et al., Eds,
`
`Springer—Verlag pp. 25-36 (1983); Kajiwara et al., Biochem. Int. 15:935-944 (1987); Rao et
`
`al., Thromb. Res. 471635-637 (1987); Tsujinaka ct al., Biochem. Biophys. Res. Commun.
`
`10
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`30
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`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:20)(cid:19)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`PCT/US99/02294
`
`_ 9 _
`
`153:l20l—l208 (1988)). See also U.S. Patents Bachovchin et al. 4,935,493; Bachovchin et
`
`al. 5,462,928; Powers et al. 5,543,396; Hanko et al. 5,296,604; and the PCT publication of
`
`Ferring PCT/GB94/02615.
`
`In other embodiments, the inhibitor is a non-peptidyl compound, e.g., which can be
`
`5
`
`identified by such drug screening assays as described herein. These inhibitors can be,
`
`merely to illustrate, synthetic organis, natural products, nucleic acids or carbohydrates.
`
`A representative class of compounds for use in the method of the present invention
`
`are represented by the general formula;
`
`R2
`
`A
`
`R3
`
`1 0
`
`wherein
`
`A represents a 4-8 membered heterocycle including the N and the Co: carbon;
`
`Z represents C or N;
`
`W represents a functional group which reacts with an active site residue of the
`
`15
`
`targeted protease, as for example, -CN, -CH=NR5,
`
`“'$—X
`
`o
`H
`
`0
`
`11
`
`0
`H
`
`Y
`/ 1
`
`""P"X '—B\
`
`1,
`
`Y2
`
`I
`
`R
`H
`
`—_E|)_R52
`
`R
`
`U1 |-‘
`
`or
`
`‘—'|"l\
`
`R1 represents a C-terminally linked amino acid residue or amino acid analog, or a
`
`C-
`
`terminally linked peptide or peptide analog, or
`
`an amino—protecting group, or
`
`‘R
`
`E
`
`‘R
`
`O
`
`20
`
`R2 is absent or represents one or more substitutions to the ring A, each of which can
`
`independently be a halogen, a lower alkyl, a lower alkenyl, a lower alkynyl, a carbonyl
`
`(cid:54)(cid:88)(cid:81)(cid:16)(cid:36)(cid:80)(cid:81)(cid:72)(cid:68)(cid:79)(cid:16)(cid:44)(cid:51)(cid:53)(cid:21)(cid:19)(cid:20)(cid:25)(cid:16)(cid:19)(cid:20)(cid:20)(cid:19)(cid:23)(cid:16)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:20)(cid:19)(cid:20)(cid:20)(cid:15)(cid:3)(cid:83)(cid:17)(cid:3)(cid:20)(cid:20)(cid:3)(cid:82)(cid:73)(cid:3)(cid:26)(cid:21)
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`
`(such as a carboxyl, an ester, a forrnate, or a ketone), a thiocarbonyl (such as a thioester, a
`
`thioacetate, or a thioformate), an amino, an acylamino, an amido, a cyano, a nitro, an azido,
`
`a sulfate, a sulfonate, a sulfonamido, -(CH2)m-R7, -(CH2)m-OH, -(CH2)m-O—lower alkyl, -
`
`(CH2)m-O-lower alkenyl, —(CH2)n-O—(CH2)m—R7, —(CH2)m—SH, —(CH2)m-S-lower alkyl,
`
`-
`
`(CH2)m—S—lower alkenyl, —(CH2)n—S—(CH2)m-R7;
`
`if X is N, R3 represents hydrogen, if X is C, R3 represents hydrogen or a halogen, a
`
`lower alkyl, 21 lower alkenyl, a lower alkynyl, a carbonyl (such as a carbox