Cypros Pharmaceutical Corp.

Gensia Pharmaceuticals, Inc.

Questcor Pharmaceuticals, Inc.

Paul J Marangos

Anthony W Fox

Harry E Gruber

Angel K Markov

Brian W Sullivan

Bernhard Riedel

David Royston

Lewis R Makings

Ronald R Tuttle

Bheemarao G Ugarkar

Clinton E Browne

Ernest K Metzner

Edward J Cragoe, Jr

Jack W Reich

Torsten R Weimann

Torsten Wiemann

Anne M Danks

Marina Sragovicz

Fructose-1,6-diphosphate (FDP) has been shown, in double-blinded controlled clinical trials on patients with sickle cell anemia, to substantially reduce the pain suffered by such patients during the recurrent ischemic crises that are caused by red blood cell sickling. Tests on patients who have been hospitalized for such crises demonstrated that when they received an intravenous injection of FDP, they reported substantially lower pain levels during their hospital stays than control groups that received identical treatment without any FDP. Apparently, FDP has never previously been used or even tested in human clinical trials, to treat sickle cell anemia. In addition, FDP has never previously been reported to have any analgesic (pain-reducing) activity.

Treatment of sickle cell anemia crises with fructose-1,6-diphosphate as an analgesic drug

Newly-created fluorenone drugs can be used to prevent, treat, or otherwise reduce damage to a brain or spinal cord following a medical crisis. These new drugs are markedly improved analogs of previously-known fluorenone compounds that were never commercialized or developed into medically useful treatments. The new analogs have the following structure:

Medical use of fluorenone derivatives for treating and preventing brain and spinal injury

Fructose-1,6-diphosphate (FDP) is used to treat patients who are undergoing coronary artery bypass grafting (CABG) surgery. Before cardiopulmonary bypass begins, a liquid that contains FDP is intravenously infused in the patient, preferably for about 10 to 30 minutes, to allow the FDP to enter the heart and lung tissue while the heart is still beating. FDP can also be added to cardioplegia solution; in addition, FDP can be injected after bypass is terminated, but if post-bypass injection is used, steps should be taken to avoid excess lactic acid accumulation, which appears to increase the risk of atrial fibrillation. To prevent or control lactic acidosis, a buffering or alkalizing agent, such as sodium bicarbonate, or an agent which reduces lactic acid formation, such as dichloroacetate, can be used. In double-blinded trials, this use of FDP substantially reduced heart damage and improved overall outcomes, as shown by lower levels of creatine kinase in blood, improvements in pumping performance, reduced requirements for vasodilator and inotropic drugs, and shorter stays in intensive care units. Certain dosages also reduced the likelihood of atrial fibrillation; however, FDP at high dosages increased the likelihood of A-fib. FDP also helped reduce pulmonary vascular resistance (PVR); this is an important finding, since pulmonary hypertension following cardiopulmonary bypass is a very difficult and often intractable problem, and is a contributing factor in nearly all deaths following CPB surgery.

Injection of fructose-1,6-diphosphate (FDP) prior to coronary artery

Treatment of sickle cell anemia crises with fructose-1, 6-diphosphate as

Neuroprotective drugs are disclosed with at least 3 branches extending outwardly from a center atom or group, each branch having a guanidino group at its terminus. All branches preferably should be identical, and distributed around the center atom or group in a radial manner. Three branches can be bonded to a nitrogen atom, or four branches can be coupled to a carbon atom; other center groups include stable aromatic, cycloalkyl, heterocyclic, or bicyclic structures. Starting reagents are disclosed with a center atom or group, and with reactive groups (such as primary amines or hydroxyl groups) at the ends of short 'spacer chains' bonded to the center atom or group. Reagents derived from arginine (an amino acid having a terminal guanidino group) can be bonded to these center components, using protective groups on the arginyl reagents to ensure desired final products with accessible guanidino groups at the ends of spacer chains. Alternately, guanylating agents can be used to directly convert primary amine groups at the ends of spacer chains, on starting reagents, into guanidino groups. These drugs can be injected intravenously into patients suffering from ischemic or hypoxic crises (stroke, cardiac arrest, loss of blood, suffocation, etc.), and can penetrate the blood-brain barrier and suppress the entry of calcium into CNS neurons via N-type and P/Q-type calcium channels, thereby reducing excitotoxic damage in the CNS. These drugs are also useful for suppressing other types of unwanted excessive neuronal activation, such as neuropathic pain.

Neuroprotective poly-guanidino compounds which block presynaptic N and

A method is disclosed for using fructose-1,6-diphosphate (FDP) to reduce and prevent two very serious problems caused by surgery that requires cardiopulmonary bypass. Before bypass begins, a liquid that contains FDP is intravenously injected into the patient, preferably over a period such as about 10 to 30 minutes, to allow the FDP to permeate in significant quantity into the heart and lungs while the heart is still beating. FDP can be added to the cardioplegia solution that is pumped through the heart to stop the heartbeat, and/or during bypass. This treatment was found to reduce two very important and serious problems that have unavoidably plagued CPB surgery in the past, which are: (1) elevated levels of pulmonary vascular resistance (PVR), which includes pulmonary hypertension; and (2) high occurrence rates for atrial fibrillation. Prior to this discovery, there has never been any satisfactory treatment which could reduce the severity and occurrence rates for these two major problems. FDP also can be co-administered in this manner, along with (1) a buffering or alkalizing agent that counteracts acidosis, such as sodium bicarbonate or THAM, and/or (2) a drug that reduces the formation of lactic acid, such as dichloroacetate.

Method of reducing pulmonary hypertension and atrial fibrillation after

When fructose-1,6-diphosphate (FDP) is used as an inotropic drug in patients who have undergone surgery involving cardiopulmonary bypass, it can increase the pumping strength of a struggling heart, without increasing the heartbeat rate. As such, FDP can reduce the dosages of (and in some some cases eliminate the need for) other inotropic drugs such as dobutamine, epinephrin, or amrinone lactate, which have undesired and potentially dangerous side effects, mainly involving increasing the heartbeat rate, which imposes substantial additional stresses on hearts that are struggling to regain strength after cardiopulmonary bypass surgery.

Use of fructose-1 6-diphosphate as an inotrope drug after

A method and device are disclosed which enable on-site pre-diagnostic emergency treatment of people suffering from life-threatening injuries (such as victims of auto accidents, shootings, stabbings, and near-drownings), or from a collapse or loss of consciousness that might be due to a heart attack, stroke, cardiac arrest, internal hemorrhage, or various other causes that cannot be diagnosed until after a physician or ambulance has arrived on the scene. This on-site pre-diagnostic emergency treatment involves intravenous injection of fructose-1,6-diphosphate (FDP, a naturally-occurring chemical which functions as an intermediate in glycolysis) into the patient. Such injections can be administered by police, firemen, military personnel, lifeguards, nursing home attendants, ambulance attendants, or anyone else who has been trained to administer intravenous injections. The FDP should be injected into the patient as soon as possible, without delaying until the patient can be diagnosed and treated by a doctor. When administered immediately, intravenously injected FDP can reduce ischemic or hypoxic damage to the internal organs, without having any adverse effects or posing any significant risks for patients who may not need it. Injection kits which include vials containing partially lyophilized FDP (which does not require refrigeration), sterile water for reconstitution of the freeze-dried FDP, and a syringe with hypodermic needles are also disclosed, in a hard-shell case that can withstand rough handling, as might occur in a police car or firetruck.

On-site emergency treatment of injured or unconscious patients, using

A method is disclosed for preparing a partially lyophilized (freeze-dried) powder or solidified cake containing fructose-1,6-diphosphate (FDP), a naturally-occurring intermediate in glycolysis. Preferably, about 10% to 25% residual water (by weight) is left in the powder or cake. This high moisture content does not degrade or limit FDP's stability or shelf life, and it provides for faster, less expensive processing. The methods disclosed herein also allow direct lyophilization inside a vial or other sealed container that will hold the lyophilized FDP, to avoid any need for milling, handling, or other treatment under conditions that might endanger its sterility. Lyophilized FDP can be used to create emergency injection kits which also contain aqueous solutions for mixing, and syringes and needles for injection. These kits can be carried in ambulances, police cars, firetrucks, etc., and can be stored at nursing homes, swimming pools, and in the homes of people suffering from various conditions such as heart disease or sicle cell anemia. These kits will allow rapid (even pre-diagnostic) injection of FDP into people suffering medical crises such as heart attacks, severe blood loss, suffocation, etc.

Partially lyophilized fructose-1,6-diphosphate (FDP) for injection into

A method is disclosed for reducing excitotoxic damage to neurons, which can occur as a result of stroke, cardiac arrest, or other events or conditions. This method involves administering an aminoglycoside that suppresses the flow of calcium ions into neurons through N-type calcium channels. To be effective for such use, an aminoglycoside must suppress N-channel activity at a potency greater than streptomycin. Aminoglycosides which meet this criterion (which includes neomycin and Gentamicin) can suppress the depolarizing activation of neurons, which in turn controls the release of glutamate, a neurotransmitter that becomes an endogenous toxin under excitotoxic conditions. Numerous aminoglycosides were tested in in vitro screening tests using brain cell membrane fragments to evaluate N-channel blocking potency. Aminoglycosides with the highest N-channel blocking potency were then tested using (1) in vitro tests on hippocampal brain tissue, to evaluate recovery of neuronal activity after a period of oxygen deprivation; (2) in vivo tests to evaluate the control of induced seizures in intact adult mammals; and (3) in vivo tests to evaluate the reduction of brain damage due to surgically-induced ischemia in intact adult mammals. The results showed that (1) aminoglycosides which are more potent than streptomycin in blocking N-channel ion flow are effective in reducing excitotoxic brain damage, without causing undesired side effects, and (2) the effectiveness of all BBB-permeable aminoglycosides tested to date in preventing excitotoxic brain damage is directly correlated with their potency in suppressing N-channel activity. Evaluation of chemical structures also indicates a correlation between the number of primary amino groups on an aminoglycoside, and its potency as an N-channel blocker and neuroprotective agent.

Use of aminoglycosides to protect against excitotoxic neuron damage

AICA riboside and prodrugs of AICA riboside are provided which lower blood glucose for the treatment of various pathologic conditions, including hypoglycemia, insulin deficiency, insulin resistance diabetes and Syndrome X. Prodrugs of AICA riboside provide AICA riboside in an orally bioavailable form. The use of adenosine kinase inhibition and ZMP enhancement for lowering blood glucose are also described.

Method and compounds for aica riboside delivery and for lowering blood

This invention discloses a rapid-diffusion injectable formulation, comprising disulfiram or a suitable salt or analog of disulfiram. Unlike slow-release injectable formulations designed to ensure that chronic alcoholics have significant quantities of disulfiram in their blood at all time, the rapid-diffusion injectable formulation disclosed herein is designed to reduce the hypoxic or ischemic damage caused by crisis events such as stroke, heart attack, cardiac arrest, or asphyxiation. A rapid-diffusion injectable formulation can contain disulfiram mixed with water, an organic compound having a plurality of hydroxyl groups (such as pharmaceutically acceptable glycols or polysaccharides; propylene glycol, dextrans, and cyclodextrins are often used for such purposes), and a buffer. When a rapid-release formulation is injected during or immediately after a hypoxic/ischemic crisis or before a patient is subjected to controlled cardiac arrest or bypass during surgery, it can suppress damage by oxygenated free radicals, it can chelate copper and iron which would otherwise promote lipid peroxidation of cell membranes, and it can generate metabolites such as tryptophol that can suppress metabolic activity and demands in neurons and affected tissue.

Use of disulfiram for Neuronal Protection

A method is disclosed for reducing cardiovascular damage caused by hypoxic or ischemic events such as heart attack and cardiac arrest. This method involves the administration of disulfiram, or a suitable salt or analog of disulfiram, to a mammal in need of such treatment. Disulfiram can inhibit enzymes such as xanthine oxidase which would otherwise generate oxygenated free radicals, which are highly reactive chemical compounds that non-specifically attack and damage essential molecules and cells. It can also chelate copper and iron, thereby suppressing lipid peroxidation and protecting cell membranes from destruction. It also generates metabolites such as tryptophol which reduce the rate of metabolic activity in neurons and affected tissue, which can be useful during cytotoxic events. This invention also discloses injectable formulations that rapidly release disulfiram into the circulating blood.

Use of disulfiram to prevent cardiovascular damage

A test method for identifying for and evaluating anti-seizure activity of candidate compounds is provided which shows superior sensitivity for adenosinergic activity and which is believed to be predictive of other adenosine releasing activities for the candidate compounds.

Anti-seizure compounds

Methods of preventing neural tissue damage caused by excitotoxicity due to increased release of excitatory amino acids by increasing extracellular concentrations of adenosine in and around the neural tissue are provided. These methods are especially useful in treating neurodegenerative diseases such as Parkinson's Disease, Alzheimer's Disease, Amyotrophic Lateral Sclerosis or Huntington's Disease.

Growing community of inventors

Encinitas, CA, United States of America

Paul J Marangos