Materials and methods for the treatment of gastroesophageal reflux disease

Abstract

The subject invention provides novel compounds and compositions for the safe and effective treatment of gastroesophageal reflux and related conditions. In a preferred embodiment, the compositions of the subject invention comprise esterified cisapride derivatives. These compositions possess potent activity in treating gastroesophageal reflux disease and substantially reduce adverse effects associated with the administration of cisapride. These adverse effects include, but are not limited to, diarrhea, abdominal cramping and elevations of blood pressure and heart rate.

1 . A method for treating a disease state which can be improved by stimulating the motility of the gastrointestinal system wherein said method comprises administering, to an individual in need of such a treatment, a compound, or an analog or salt thereof, wherein said compound has the following structure:  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is H, C 1-4  alkyl, OH, OC 1-4 alkyl, —COOH, —COOC 1-4 alkyl, —O(C═O)OC 1-4 alkyl, —O(C═O)C 1-4 alkyl, or —C 1-4 alkylNR 7 R 8  where R 7  and R 9  are, independently, H or C 1-4  alkyl;  
 R 2  is H, C 1-4  alkyl, —OC 1-4 alkyl, —COOH, or —(C═O)OC 1-4 alkyl;  
 X is O or N;  
 R 3  is H or C 1-3  alkyl (if X is an oxygen atom, then R 3  does not exist);  
 R 4 , R 5 , and R 6  are each, independently, selected from the group consisting of hydrogen, C 1-4  alkyl, —OC 1-4 alkyl, halogen atom, hydroxy, cyano, nitro, amino, mono- and di(lower alkyl)amino, aminocarbonyl, arylcarbonylamino, alkylcarbonylamino, lower-alkyl carbonyl, lower-alkyl carbonyloxy, aminosulfonyl, lower-alkylsulfinyl, lower-alkylsulfonyl, lower-alkylthio and mercapto; and  
 wherein L has the formula —C n H 2n —X—C m H 2m —(CR 9 R 10 ) p —(C═O)O—Y, wherein  
 n is an integer from 1 to 4 inclusive;  
 X is —CH(OH)—, —NH—, —S—, —O—, or a direct bond;  
 m is an integer from 0 to 4 inclusive;  
 p is 0 or 1;  
 R 9  and R 10  are, independently, H, C 1-4  alkyl, or R 9 R 10  are linked and together form a 5- or a 6-membered cycloalkyl ring; and  
 Y is H, C 1-4  alkyl or cycloalkyl optionally substituted by 1 or more heteroatoms selected from the group consisting of O; N; S; or aryl or heteroaryl optionally substituted by 1 or more halogen atoms, C 1-4  alkyl, C 1-4 alkoxy, hydroxy, cyano, amino, alkylamino, dialkylamino, trifluoromethyl, —COOH, or —COOC 1-4 alkyl.  
 
     
     
         2 . The method, according to  claim 1 , wherein said disease state is selected from the group consisting of gastroesophageal reflux disease, dyspepsia, gastroparesis, constipation, post-operative ileus, and intestinal pseudo-obstruction.  
     
     
         3 . The method, according to  claim 2 , wherein said disease state is gastroesophageal reflux disease.  
     
     
         4 . The method, according to  claim 1 , wherein said individual is a human.  
     
     
         5 . The method, according to  claim 1 , wherein R 4 , R 5 , and R 6  are, independently, selected from the group consisting of halo, amino, mono- and dialkylamino, and lower alkyloxy.  
     
     
         6 . The method, according to  claim 1 , wherein R 4  is methoxy, R 5  is amino or methylamino, and R 6  is chloro, in the 2-, 4-, and 5-position of the phenyl ring, respectively.  
     
     
         7 . The method, according to  claim 1 , wherein said compound is selected from the group consisting of:  
       
         
           
           
               
               
           
         
       
       where IIIa and IIIb are mirror images of each other (enantiomers), and where L is defined as shown in Formula (II):  
       
         
           
           
               
               
           
         
       
       where n—1 to 4, m—O to 4, X is a direct bond and Y is hydrogen, lower alkyl, or substituted aryl.  
     
     
         8 . The method, according to  claim 1 , wherein R 1 ═OCH 3 ; R 2 —H; X═O or N (if X═N, then R 3 ═H); R 4 , R 5 , and R 6  are methoxy, amino, and chlorine at the 2, 4, and 5-position of the phenyl ring, respectively.  
     
     
         9 . The method, according to  claim 1 , wherein both asymmetric centers are in the cis-configuration.  
     
     
         10 . A compound, or an analog or salt thereof, wherein said compound has the following structure:  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is H, C 1-4  alkyl, OH, OC 1-4 alkyl, —COOH, —COOC 1-4 alkyl, —O(C═O)OC 1-4 alkyl, —O(C═O)C 1-4 alkyl, or —C 1-4 alkylNR 7 R 8  where R 7  and R 8  are, independently, H or C 1-4  alkyl;  
 R 2  is H, C 1-4  alkyl, —OC 1-4 alkyl, —COOH, or —(C═O)OC 1-4 alkyl;  
 X is O or N;  
 R 3  is H or C 1-3  alkyl (if X is an oxygen atom, then R 3  does not exist);  
 R 4 , R 5 , and R 6  are each, independently, selected from the group consisting of hydrogen, C 1-4  alkyl, —OC 1-4 alkyl, halogen atom, hydroxy, cyano, nitro, amino, mono- and di(lower alkyl)amino, aminocarbonyl, arylcarbonylamino, alkylcarbonylamino, lower-alkyl carbonyl, lower-alkyl carbonyloxy, aminosulfonyl, lower-alkylsulfinyl, lower-alkylsulfonyl, lower-alkylthio and mercapto; and  
 wherein L has the formula —C n H 2n —X—C m H 2m —(CR 9 R 10 ) p —(C═O)O—Y, wherein  
 n is an integer from 1 to 4 inclusive;  
 X is —CH(OH)—, —NH—, —S—, —O—, or a direct bond;  
 m is an integer from 0 to 4 inclusive;  
 p is 0 or 1;  
 R 9  and R 10  are, independently, H, C 1-4  alkyl, or R 9 R 10  are linked and together form a 5- or a 6-membered cycloalkyl ring; and  
 Y is H, C 1-4  alkyl or cycloalkyl optionally substituted by 1 or more heteroatoms selected from the group consisting of O; N; S; or aryl or heteroaryl optionally substituted by 1 or more halogen atoms, C 1-4  alkyl, C 1-4 alkoxy, hydroxy, cyano, amino, alkylamino, dialkylamino, trifluoromethyl, —COOH, or —COOC 1-4 alkyl.  
 
     
     
         11 . A method for treating a condition which is susceptible to treatment by modulation of serotonergic systems wherein said method comprises administering to an individual in need of such treatment, an effective amount of a compound, or an analog or salt thereof, wherein said compound has the following structure:  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is H, C 1-4  alkyl, OH, OC 1-4 alkyl, —COOH, —COOC 1-4 alkyl, —O(C═O)OC 1-4 alkyl, —O(C═O)C 1-4 alkyl, or —C 1-4 alkylNR 7 R 8  where R 7  and R 8  are, independently, H or C 1-4  alkyl;  
 R 2  is H, C 1-4  alkyl, —OC 1-4 alkyl, —COOH, or —(C═O)OC 4 alkyl;  
 X is O or N;  
 R 3  is H or C 1-3  alkyl (if X is an oxygen atom, then R 3  does not exist);  
 R 4 , R 5 , and R 6  are each, independently, selected from the group consisting of hydrogen, C 1-4  alkyl, —OC 1-4 alkyl, halogen atom, hydroxy, cyano, nitro, amino, mono- and di(lower alkyl)amino, aminocarbonyl, arylcarbonylamino, alkylcarbonylamino, lower-alkyl carbonyl, lower-alkyl carbonyloxy, aminosulfonyl, lower-alkylsulfinyl, lower-alkylsulfonyl, lower-alkylthio and mercapto; and  
 wherein L has the formula —C n H 2n —X—C m H 2m —(CR 9 R 10 ) p —(C═O)O—Y, wherein  
 n is an integer from 1 to 4 inclusive;  
 X is —CH(OH)—, —NH—, —S—, —O—, or a direct bond;  
 m is an integer from 0 to 4 inclusive;  
 p is 0 or 1;  
 R 9  and R 10  are, independently, H, C 1-4  alkyl, or R 9 R 10  are linked and together form a 5- or a 6-membered cycloalkyl ring; and  
 Y is H, C 1-4  alkyl or cycloalkyl optionally substituted by 1 or more heteroatoms selected from the group consisting of O; N; S; or aryl or heteroaryl optionally substituted by 1 or more halogen atoms, C 1-4  alkyl, C 1-4 alkoxy, hydroxy, cyano, amino, alkylamino, dialkylamino, trifluoromethyl, —COOH, or —COOC 1-4 alkyl.  
 
     
     
         12 . The method, according to  claim 11 , wherein said condition is selected from the group consisting of 1) cognitive disorders, 2) behavioral disorders, 3) mood disorders, and 4) disorders of control of autonomic function.  
     
     
         13 . The method, according to  claim 12 , wherein said cognitive disorder is Alzheimer's disease.  
     
     
         14 . The method, according to  claim 12 , wherein said behavioral disorder is selected from the group consisting of schizophrenia, mania, obsessive-compulsive disorder, and psychoactive substance use disorders.  
     
     
         15 . The method, according to  claim 12 , wherein said mood disorder is selected from the group consisting of depression and anxiety.  
     
     
         16 . The method, according to  claim 12 , wherein said disorder of control of autonomic function is selected from the group consisting of essential hypertension and sleep disorders.  
     
     
         17 . The method, according to  claim 11 , wherein said individual is a human.  
     
     
         18 . The method, according to  claim 11 , wherein R 4 , R 5 , and R 6  are, independently, selected from the group consisting of halo, amino, mono- and dialkylamino, and lower alkyloxy.  
     
     
         19 . The method, according to  claim 11 , wherein R 4  is methoxy, R 5  is amino or methylamino, and R 6  is chloro, in the 2-, 4-, and 5-position of the phenyl ring, respectively.  
     
     
         20 . The method, according to  claim 11 , wherein said compound is selected from the group consisting of:  
       
         
           
           
               
               
           
         
       
       where IIIa and IIIb are mirror images of each other (enantiomers), and where L is defined as shown in Formula (II):  
       
         
           
           
               
               
           
         
       
       where n=1 to 4, X is a direct bond and Y is hydrogen, lower alkyl, or substituted aryl.  
     
     
         21 . The method, according to  claim 11 , wherein R 1 ═OCH 3 ; R 2 ═H; X═O or N (if X═N, then R 3 ═H); R 4 , R 5 , and R 6  are methoxy, amino, and chlorine at the 2, 4, and 5-position of the phenyl ring, respectively.  
     
     
         22 . The method, according to  claim 11 , wherein both asymmetric centers are in the cis-configuration.