US2007191283A1PendingUtilityA1

Method of stimulating the motility of the gastrointestinal system using growth hormone secretagogues

Assignee: SAPPHIRE THERAPEUTICSPriority: Aug 12, 2004Filed: Aug 12, 2005Published: Aug 16, 2007
Est. expiryAug 12, 2024(expired)· nominal 20-yr term from priority
A61K 31/33A61K 38/08A61P 5/02A61P 1/14A61P 1/10A61P 1/00A61K 9/0019
62
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Claims

Abstract

The present invention relates to a method of stimulating the motility of the gastrointestinal system in a subject in need thereof, wherein the subject suffers from maladies (i.e., disorders or diseases) of the gastrointestinal system. The method comprises administering to a subject in need thereof a therapeutically effective amount of a growth hormone secretagogue compound or a pharmaceutically acceptable salt, hydrate or solvate thereof. The growth hormone secretagogue can be co-administered with a laxative, a H 2 receptor antagonist, a serotonin 5-HT 4 agonist, an antacid, an opioid antagonist, a proton pump inhibitor, a motilin receptor agonist, dopamine antagonist, a cholinergic agonist, a cholinesterase inhibitor, somatostatin, octreotide, or any combination thereof.

Claims

exact text as granted — not AI-modified
1 . A method of treating opioid induced constipation in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogue compound or a pharmaceutically acceptable salt, hydrate or solvate thereof.  
     
     
         2 . The method of  claim 1 , wherein the growth hormone secretagogue is represented by the structural Formula I:  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 ═CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —O—(CH 2 ) k —R 8 ,  
                     
 J is —O+(CH 2 ) l —R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —NR 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 —, —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         3 . The method of  claim 2 , wherein the growth hormone secretagogue is represented by the structural Formula II:  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         4 . The method of  claim 2 , wherein the growth hormone secretagogue is represented by the structural Formula III:  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         5 . The method of  claim 1 , wherein the growth hormone secretagogue is represented by the structural Formula IV:  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) l —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         6 . The method of  claim 5 , wherein the growth hormone secretagogue is represented by the structural Formula V:  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         7 . The method of  claim 1 , wherein the growth hormone secretagogue is selected from the group consisting of Formula VI,  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         8 . The method of  claim 1 , wherein the subject is a human.  
     
     
         9 . The method of  claim 1 , wherein the growth hormone secretagogue is orally administered.  
     
     
         10 . The method of  claim 1 , wherein the subject is using opioids for post-surgical pain management.  
     
     
         11 . The method of  claim 1 , wherein the subject is using opioids for chronic pain management.  
     
     
         12 . The method of  claim 1 , wherein the opioid is selected from the group consisting of: percocet; morphine; vicoden; methadone; oxycodone; and fentanyl.  
     
     
         13 . The method of  claim 1 , wherein the method further comprises administering a therapeutically effective amount of a laxative, peripherally acting opioid antagonist, or any combination thereof.  
     
     
         14 . A method of stimulating the motility of the gastrointestinal system in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogue compound, wherein the growth hormone secretagogue compound is represented by the structural Formula I  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 ═CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —O—(CH 2 ) k —R 8 ,  
                     
 J is —O—(CH 2 ) l —R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —R 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 —, —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         15 . The method of  claim 14 , wherein the growth hormone secretagogue compound is represented by the structural Formula II  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         16 . The method of  claim 14 , wherein the growth hormone secretagogue compound is represented by the structural Formula III  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         17 . A method of stimulating the motility of the gastrointestinal system in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue compound is represented by the structural Formula IV  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) l —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         18 . The method of  claim 17 , wherein the growth hormone secretagogue compound is represented by the structural Formula V  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         19 . The method of  claim 17 , wherein the growth hormone secretagogue compound is represented by the structural Formula VI  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         20 . A method of stimulating the motility of the gastrointestinal system in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue is selected from the group consisting of Formula VII,  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         21 . The method of any one of claims  14 ,  17  and  20 , wherein the subject is a human.  
     
     
         22 . The method of any one of claims  14 ,  17  and  20 , wherein the growth hormone secretagogue is orally administered.  
     
     
         23 . A method of treating diabetes related gastroparesis in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogue compound, wherein the growth hormone secretagogue compound is represented by the structural Formula I  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 ═CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —(CH 2 ) k —R 8 ,  
                     
 J is —(CH 2 ) l —R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —NR 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 , —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         24 . The method of  claim 23 , wherein the growth hormone secretagogue compound is represented by the structural Formula II  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         25 . The method of  claim 23 , wherein the growth hormone secretagogue compound is represented by the structural Formula III  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         26 . A method of treating diabetes related gastroparesis in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogue compound, wherein the growth hormone secretagogue compound is represented by the structural Formula IV  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) 1 —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         27 . The method of  claim 26 , wherein the growth hormone secretagogue compound is represented by the structural Formula V  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         28 . The method of  claim 26 , wherein the growth hormone secretagogue compound is represented by the structural Formula VI  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         29 . A method of stimulating the motility of the gastrointestinal system in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue is selected from the group consisting of Formula VII  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         30 . The method of any one of claims  23 ,  26  and  29 , wherein the subject is a human.  
     
     
         31 . The method of any one of claims  23 ,  26  and  29 , wherein the growth hormone secretagogue is orally administered.  
     
     
         32 . The method of any one of claims  23 ,  26  and  29 , wherein the method further comprises administering a therapeutically effective amount of a dopamine antagonist.  
     
     
         33 . A method of treating gastroesophageal reflux disease in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula I,  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 ═CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —O—(CH 2 ) k —R 8 ,  
                     
 J is —O—(CH 2 ) l —R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —NR 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 —, —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         34 . The method of  claim 33 , wherein the growth hormone secretagogue compound is represented by the structural Formula II  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         35 . The method of  claim 33 , wherein the growth hormone secretagogue compound is represented by the structural Formula III,  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         36 . A method of treating gastroesophageal reflux disease in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula IV  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) l —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         37 . The method of  claim 36 , wherein the growth hormone secretagogue compound is represented by the structural Formula V  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         38 . The method of  claim 36 , wherein the growth hormone secretagogue compound is represented by the structural Formula VI  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         39 . A method of stimulating the motility of the gastrointestinal system in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue is selected from the group consisting of Formula VII,  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         40 . The method of any one of claims  33 ,  36  and  39 , wherein the subject is a human.  
     
     
         41 . The method of any one of claims  33 ,  36  and  39 , wherein the growth hormone secretagogue is orally administered.  
     
     
         42 . The method of any one of claims  33 ,  36  and  39 , wherein the gastroesophageal reflux disease is nocturnal gastroesophageal reflux disease.  
     
     
         43 . The method of any one of claims  33 ,  36  and  39 , wherein the method further comprises administering to said subject a therapeutically effective amount of a H 2  receptor antagonist; an antacid; a proton pump inhibitor; or any combination thereof.  
     
     
         44 . The method of treating irritable bowel syndrome in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula I:  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 ═CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —O—(CH 2 ) k —R 8 ,  
                     
 J is —O—(CH 2 ) l —R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —NR 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 —, —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         45 . The method of  claim 44 , wherein the growth hormone secretagogue compound is represented by the structural Formula II  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         46 . The method of  claim 44 , wherein the growth hormone secretagogue compound is represented by the structural Formula III  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         47 . A method of treating irritable bowel syndrome in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula IV:  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) n —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         48 . The method of  claim 47 , wherein the growth hormone secretagogue compound is represented by the structural Formula V  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         49 . The method of  claim 47 , wherein the growth hormone secretagogue compound is represented by the structural Formula VI  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         50 . A method of treating irritable bowel syndrome in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue is selected from the group consisting of Formula VII,  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         51 . The method of any one of claims  44 ,  47  and  50 , wherein the subject is a human.  
     
     
         52 . The method of any one of claims  44 ,  47  and  50 , wherein the growth hormone secretagogue is orally administered.  
     
     
         53 . The method of any one of claims  44 ,  47  and  50 , wherein the irritable bowel syndrome is constipation-predominant irritable bowel syndrome.  
     
     
         54 . The method of any one of claims  44 ,  47  and  50 , wherein the irritable bowel syndrome is alternating constipation/diarrhea irritable bowel syndrome.  
     
     
         55 . The method of any one of claims  44 ,  47  and  50 , wherein the method further comprises administering to said subject a therapeutically effective amount of a H 2  receptor antagonist; a serotonin 5-HT 4  agonist; a laxative; or any combination thereof.  
     
     
         56 . A method of treating constipation in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula I  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —O—(CH 2 ) k —R 8 ,  
                     
 J is —O—(CH 2 ) l —R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —NR 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 —, —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         57 . The method of  claim 56 , wherein the growth hormone secretagogue compound is represented by the structural Formula II  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         58 . The method of  claim 56 , wherein the growth hormone secretagogue compound is represented by the structural Formula III  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         59 . A method of treating constipation in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula IV  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) l —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         60 . The method of  claim 59 , wherein the growth hormone secretagogue compound is represented by the structural Formula V  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         61 . The method of  claim 59 , wherein the growth hormone secretagogue compound is represented by the structural Formula VI  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         62 . A method of treating constipation in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue is selected from the group consisting of Formula VII,  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         63 . The method of any one of claims  56 ,  59  and  62 , wherein the subject is a human.  
     
     
         64 . The method of any one of claims  56 ,  59  and  62 , wherein the growth hormone secretagogue is orally administered.  
     
     
         65 . The method of any one of claims  56 ,  59  and  62 , wherein the method further comprises administering to said subject a therapeutically effective amount of a laxative.  
     
     
         66 . A method of treating post-operative ileus in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula I:  
       
         
           
           
               
               
           
         
       
       wherein: 
 R 1  is hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 a and d are independently 0, 1, 2 or 3;  
 b and c are independently 0, 1, 2, 3, 4 or 5, provided that b+c is 3, 4 or 5;  
 D is R 2 —NH—(CR 3 R 4 ) e —(CH 2 ) f -M-(CHR 5 ) g —(CH 2 ) h — 
 wherein:  
 R 2 , R 3 , R 4  and R 5  are independently hydrogen or C 1-6  alkyl optionally substituted with one or more halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 2  and R 3  or R 2  and R 4  or R 3  and R 4  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j are independently 1 or 2 and U is —O—, —S— or a valence bond;  
 h and f are independently 0, 1, 2, or 3;  
 g and e are independently 0 or 1;  
 M is a valence bond, —CR 6 ═CR 7 —, arylene, hetarylene, —O— or —S—;  
 R 6  and R 7  are independently hydrogen, or C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl;  
 G is —O—(CH 2 ) k —R 8 ,  
                     
 J is —O—(CH 2 ) l R 13 ,  
                     
 wherein:  
 R 8 , R 9 , R 10 , R 11 , R 12 , R 13 , R 14 , R 15 , R 16  and R 17  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 k and l are independently 0, 1 or 2;  
 E is —CONR 18 R 19 , —COOR 19 , —(CH 2 ) m —NR 18 SO 2 R 20 , —(CH 2 ) m —NR 18 —COR 20 , —(CH 2 ) m —OR 19 , —(CH 2 ) m —OCOR 20 , —CH(R 18 )R 19 , —(CH 2 ) m —NR 18 —CS—NR 19 R 21  or —(CH 2 ) m —NR 18 —CO—NR 19 R 21 ; or  
 E is —CONR 22 NR 23 R 24 , wherein R 22  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; R 23  is C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl, or C 1-7 -acyl; and R 24  is hydrogen, C 1-6 -alkyl optionally substituted with one or more aryl or hetaryl; or aryl or hetaryl optionally substituted with one or more C 1-6 -alkyl; or  
 R 22  and R 23  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 22  and R 24  together with the nitrogen atoms to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6 -alkyl, halogen, amino, hydroxyl, aryl or hetaryl; or  
 R 23  and R 24  together with the nitrogen atom to which they are attached can form a heterocyclic system optionally substituted with one or more C 1-6  alkyl, halogen, amino, hydroxyl, aryl or hetaryl;  
 wherein m is 0, 1, 2 or 3,  
 R 18 , R 19  and R 21  independently are hydrogen or C 1-6 -alkyl optionally substituted with halogen, —N(R 25 )R 26 , wherein R 25  and R 26  are independently hydrogen or C 1-6  alkyl; hydroxyl, C 1-6 -alkoxy, C 1-6 -alkoxycarbonyl, C 1-6 -alkylcarbonyloxy or aryl;  
 or R 19  is  
                     
 wherein  
 Q is —CH< or —N<,  
 K and L are independently —CH 2 —, —CO—, —O—, —S—, —NR 27 — or a valence bond, where R 27  is hydrogen or C 1-6  alkyl;  
 n and o are independently 0, 1, 2, 3 or 4;  
 R 20  is C 1-6  alkyl, aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof;  
 with the proviso that if M is a valence bond then E is —CONR 22 NR 23 R 24 .  
 
     
     
         67 . The method of  claim 66 , wherein the growth hormone secretagogue compound is represented by the structural Formula II  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         68 . The method of  claim 66 , wherein the growth hormone secretagogue compound is represented by the structural Formula III  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         69 . A method of treating post-operative ileus in a subject in need thereof comprising administering to said subject a therapeutically effective amount of a growth hormone secretagogues compound, wherein the growth hormone secretagogue compound is represented by the structural Formula IV  
       
         
           
           
               
               
           
         
       
       wherein 
 R 1  is hydrogen or C 1-6 -alkyl;  
 R 2  is hydrogen or C 1-6 -alkyl;  
 L is  
                     
 wherein  
 R 4  is hydrogen or C 1-6  alkyl;  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein:  
 o is 0, 1 or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl or hetaryl;  
 Or L is  
                     
 wherein  
 p is 0 or 1;  
 q, s, t, u are independently 0, 1, 2, 3, or 4;  
 r is 0 or 1;  
 the sum q+r+s+t+u is 0, 1, 2, 3, or 4;  
 R 9 , R 10 , R 11 , and R 12  are independently hydrogen or C 1-6  alkyl;  
 Q is >N—R 13  or  
                     
 wherein  
 o is 0, 1, or 2;  
 T is —N(R 15 )(R 16 ) or hydroxyl;  
 R 13 , R 15 , and R 16  are independently from each other hydrogen or C 1-6  alkyl;  
 R 14  is hydrogen, aryl, or hetaryl;  
 G is —O—(CH 2 )—R 17 ,  
                     
 wherein:  
 R 17 , R 18 , R 19 , R 20  and R 21  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 K is 0, 1 or 2;  
 J is —O—(CH 2 ) l —R 22 ,  
                     
 wherein:  
 R 22 , R 23 , R 24 , R 25  and R 26  independently are hydrogen, halogen, aryl, hetaryl, C 1-6 -alkyl or C 1-6 -alkoxy;  
 l is 0, 1 or 2;  
 a is 0, 1, or 2;  
 b is 0, 1, or 2;  
 c is 0, 1, or 2;  
 d is 0 or 1;  
 e is 0, 1, 2, or 3;  
 f is 0 or 1;  
 R 5  is hydrogen or C 1-6 -alkyl optionally substituted with one or more hydroxyl, aryl or hetaryl;  
 R 6  and R 7  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 8  is hydrogen or C 1-6 -alkyl, optionally substituted with one or more halogen, amino, hydroxyl, aryl, or hetaryl;  
 R 6  and R 7  or R 6  and R 8  or R 7  and R 8  can optionally form —(CH 2 ) i —U—(CH 2 ) j —, wherein i and j independently are 1, 2 or 3 and U is —O—, —S—, or a valence bond;  
 M is arylene, hetarylene, —O—, —S— or —CR 27 ═CR 28 —;  
 R 27  and R 28  are independently hydrogen or C 1-6 -alkyl, optionally substituted with one or more aryl or hetaryl;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         70 . The method of  claim 69 , wherein the growth hormone secretagogue compound is represented by the structural Formula V  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         71 . The method of  claim 69 , wherein the growth hormone secretagogue compound is represented by the structural Formula VI  
       
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         72 . A method of treating post-operative ileus in a subject in need thereof comprising administering to said subject a therapeutically effective amount of growth hormone secretagogue compound, wherein the growth hormone secretagogue is selected from the group consisting of Formula VII,  
       
         
           
           
               
               
           
         
         
           
           
               
               
           
         
       
       or a pharmaceutically acceptable salt, solvate or hydrate thereof.  
     
     
         73 . The method of any one of claims  66 ,  69  and  72 , wherein the subject is a human.  
     
     
         74 . The method of any one of claims  66 ,  69  and  72 , wherein the growth hormone secretagogue is orally administered.  
     
     
         75 . The method of any one of claims  66 ,  69  and  72 , wherein the method further comprises administering to said subject a therapeutically effective amount of a dopamine antagonist.

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