Immunomodulation by IAP Inhibitors

Abstract

The present invention is directed to immune adjuvants containing IAP inhibitors, including Smac mimetics. The invention further provides pharmaceutical compositions and vaccines containing an IAP inhibitor and an antigen. Methods of enhancing an immune response by administration of an IAP inhibitor, methods of treating or preventing cancer, methods of treating or preventing infections, methods of treating autoimmune disorders, and methods of potentiating cytokine or antibody production are also provided.

What is claimed: 
     
         1 . A method of enhancing an immune response of a subject to an antigen, comprising the steps of:
 (a) administering to the subject an immunogenic quantity of an antigen, wherein the antigen comprises a pathogen, an attenuated pathogen, or a portion thereof; and   (b) administering an immune enhancing amount of an IAP inhibitor.   
     
     
         2 . A method of treating a solid tumor in a subject, comprising administering to a subject in need thereof a therapeutically effective amount of an IAP inhibitor and an immunogenic quantity of an antigen, wherein administration of the IAP inhibitor and the antigen enhances the immune response of the subject to the solid tumor. 
     
     
         3 . The method of  claim 2 , wherein the antigen comprises a cancer cell. 
     
     
         4 . The method of  claim 3 , wherein the cancer cell is obtained from the subject. 
     
     
         5 . The method of  claim 3 , wherein the cancer cell is proliferation incompetent. 
     
     
         6 . A method of treating an infection caused by an infectious agent, comprising administering to a subject in need thereof a therapeutically effective amount of an IAP inhibitor and an immunogenic quantity of an antigen, wherein administration of said IAP inhibitor and said antigen enhances the immune response of the subject to the infectious agent. 
     
     
         7 . The method of  claim 6 , wherein the infectious agent is selected from the group consisting of a bacterium, a virus, a protozoan, a fungus, and a parasite. 
     
     
         8 . The method of  claim 6 , wherein the antigen and the IAP inhibitor are administered sequentially. 
     
     
         9 . The method of  claim 6 , wherein the antigen and the IAP inhibitor are administered simultaneously. 
     
     
         10 . The method of  claim 6 , wherein the antigen and the IAP inhibitor are administered as a single composition. 
     
     
         11 . A method of treating an autoimmune disorder in a subject, comprising administering to the subject a composition comprising an IAP inhibitor, such that the autoimmune disorder is treated. 
     
     
         12 . A method of enhancing an immune activity of an activated immune cell, comprising contacting an activated immune cell with an IAP inhibitor. 
     
     
         13 . The method of  claim 12 , wherein the immune activity comprises potentiating proliferation. 
     
     
         14 . The method of  claim 13 , wherein the activated immune cell is selected from the group consisting of a dendritic cell, a B cell, a T cell, an NK cell, an NKT cell, a macrophage, a CD4+ T cell, and a CD8+ T cell. 
     
     
         15 . The method of  claim 12 , wherein the immune activity comprises potentiating cytokine production. 
     
     
         16 . The method of  claim 15 , wherein the activated immune cell is selected from the group consisting of a dendritic cell, a B cell, a T-cell, an NK cell, an NKT cell, a macrophage, a CD4+ T cell, and a CD8+ T cell. 
     
     
         17 . The method of  claim 12 , wherein the immune activity comprises potentiating antibody production. 
     
     
         18 . The method of  claim 17 , wherein the activated immune cell is selected from the group consisting of a B-cell, a plasma cell, and a hybridoma cell. 
     
     
         19 . The method of  claim 12 , wherein said contacting comprises administering said compound to a subject. 
     
     
         20 . The method of  claim 19 , wherein the IAP inhibitor is a compound of Formula I: 
       
         
           
           
               
               
           
         
         or pharmaceutically acceptable salts, enantiomers, stereoisomers, rotamers, tautomers, diastereomers, or racemates thereof; 
         wherein 
         R 1  is H, C 1 -C 4  alkyl, C 2 -C 4  alkenyl, C 2 -C 4  alkynyl or C 3 -C 10  cycloalkyl, wherein R 1  may be unsubstituted or substituted; 
         R 2  is H, C 1 -C 4  alkyl, C 2 -C 4  alkenyl, C 2 -C 4  alkynyl, C 3 -C 10  cycloalkyl, wherein R 2  may be unsubstituted or substituted; 
         R 3  is H, CF 3 , C 2 F 5 , C 1 -C 4  alkyl, C 2 -C 4  alkenyl, C 2 -C 4  alkynyl, CH 2 —Z, or R 2  and R 3 , taken together with the nitrogen atom to which they are attached, form a heterocyclic ring, 
         wherein the alkyl, alkenyl, alkynyl groups or het ring may be unsubstituted or substituted; 
         Z is H, OH, F, Cl, CH 3 , CH 2 Cl, CH 2 F or CH 2 OH; 
         R 4  is C 1-10  alkyl, C 1-10  alkenyl, C 1-10  alkynyl, C 3 -C 10  cycloalkyl, wherein the C 1-10  alkyl, or cycloalkyl groups are unsubstituted or substituted; 
         A is het, which may be substituted or unsubstituted; 
         D is C 1 -C 7  alkylene or C 2 -C 9  alkenylene, C(O), O, NR 7 , S(O) r , C(O)—C 1 -C 10  alkyl, O—C 1 -C 10  alkyl, S(O) r -C 1 -C 10  alkyl, C(O)C 0 -C 10  arylalkyl, OC 0 -C 10  arylalkyl, or S(O) r C 0 -C 10  arylalkyl, 
         wherein alkyl and aryl groups may be unsubstituted or substituted; 
         r is 0, 1 or 2; 
         A 1  is a substituted or unsubstituted aryl or unsubstituted or substituted het, wherein substituents on aryl and het are halo, alkyl, lower alkoxy, NR 5 R 6 , CN, NO 2  or SR 5 ; 
         each Q is independently H, C 1 -C 10  alkyl, C 1 -C 10  alkoxy, aryl C 1 -C 10  alkoxy, OH, O—C 1 -C 10  alkyl, (CH 2 ) 0-6 —C 3 -C 7  cycloalkyl, aryl, aryl C 1 -C 10  alkyl, O—(CH 2 ) 0-6  aryl, (CH 2 ) 1-6  het, het, O—(CH 2 ) 1-6  het, C(O)R 11 , —C(O)N(R 11 )(R 12 ), N(R 11 )(R 12 ), SR 11 , S(O)R 11 , S(O) 2 R 11 , S(O) 2 —N(R 11 )(R 12 ), or NR 11 —S(O) 2 —(R 12 ), wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; 
         n is 0, 1, 2 or 3, 4, 5, 6 or 7; 
         R 11  and R 12  are independently H, C 1 -C 10  alkyl, (CH 2 ) 0-6 —C 3 -C 7  cycloalkyl, (CH 2 ) 0-6 —(CH) 0-1 (aryl) 1-2 , C(O)—C 1 -C 10  alkyl, —C(O)—(CH 2 ) 1-6 —C 3 -C 7  cycloalkyl, —C(O)—O—(CH 2 ) 0-6 -aryl, —C(O)—(CH 2 ) 0-6 —O-fluorenyl, C(O)—NH—(CH 2 ) 0-6 -aryl, C(O)—(CH 2 ) 0-6 -aryl, C(O)—(CH 2 ) 1-6 -het, —C(S)—(CH 2 ) 1-6 —C 3 -C 7  cycloalkyl, —C(S)—O—(CH 2 ) 0-6 -aryl, —C(S)—(CH 2 ) 0-6 —NH—(CH 2 ) 0-6 -aryl, —C(S)—(CH 2 ) 0-6 -aryl or C(S)—(CH 2 ) 1-6 -het, C(O)R 15 , C(O)NR 15 R 16 , C(O)OR 15 , S(O) m R 15 , S(Om N R 15 R 16 , m=1 or 2, C(S)R 15 , C(S)NR 15 R 16 , C(S)OR 15 , wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; or R 11  and R 12  are a substituent that facilitates transport of the molecule across a cell membrane, or 
         R 11  and R 12  together with the nitrogen atom form het, 
         wherein 
         the alkyl substituents of R 11  and R 12  may be unsubstituted or substituted by one or more substituents selected from C 1 -C 10  alkyl, halogen, OH, O—C 1 -C 6  alkyl, —S—C 1 -C 6  alkyl, CF 3  or NR 15 R 16 ; 
         substituted cycloalkyl substituents of R 11  and R 12  are substituted by one or more substituents selected from a C 2 -C 10  alkene; C 1 -C 6  alkyl; halogen; OH; O—C 1 -C 6  alkyl; S—C 1 -C 6  alkyl, CF 3 ; or NR 15 R 16  and 
         substituted het or substituted aryl of R 11  and R 12  are substituted by one or more substituents selected from halogen, hydroxy, C 1 -C 4  alkyl, C 1 -C 4  alkoxy, nitro, CNO—C(O)—C 1 -C 4 alkyl and C(O)—O—C 1 -C 4 -alkyl; 
         R 5 , R 6  and R 7  are independently hydrogen, lower alkyl, aryl, aryl lower alkyl, cycloalkyl, or cycloalkyl lower alkyl, C(O)R 15 , S(O)R 15 , C(O)OR 15 , C(O)NR 15 R 16; and 
         the substituents on R 1 , R 2 , R 3 , R 4 , Q, and A and Ai groups are independently halo, hydroxy, lower alkyl, lower alkenyl, lower alkynyl, lower alkanoyl, lower alkoxy, aryl, aryl lower alkyl, amino, amino lower alkyl, diloweralkylamino, lower alkanoyl, amino lower alkoxy, nitro, cyano, cyano lower alkyl, carboxy, lower carbalkoxy, lower alkanoyl, aryloyl, lower arylalkanoyl, carbamoyl, N-mono- or N,N-dilower alkyl carbamoyl, lower alkyl carbamic acid ester, amidino, guanidine, ureido, mercapto, sulfo, lower alkylthio, sulfoamino, sulfonamide, benzosulfonamide, sulfonate, sulfanyl lower alkyl, aryl sulfonamide, halogen substituted aryl sulfonate, lower alkylsulfinyl, arylsulfinyl; aryl-lower alkylsulfinyl, lower alkylarylsulfinyl, lower alkylsulfonyl, arylsulfonyl, aryl-lower alkylsulfonyl, lower aryl alkyl lower alkylarylsulfonyl, halogen-lower alkylmercapto, halogen-lower alkyl sulfonyl, phosphono (—P(═O)(OH) 2 ), hydroxy-lower alkoxy phosphoryl or di-lower alkoxyphosphoryl, (R 9 )NC(O)—NR 10 R 13 , lower alkyl carbamic acid ester or carbamates or —NR 8 R 14 , 
         wherein 
         R 8  and R 14  can be the same or different and are independently H or lower alkyl, or 
         R 8  and R 14 , together with the N atom, form a 3- to 8-membered heterocyclic ring containing nitrogen heteroring atoms and may optionally contain one or two additional heteroring atoms selected from nitrogen, oxygen and sulfur, wherein the heterocyclic ring may be unsubstituted or substituted with lower alkyl, halo, lower alkenyl, lower alkynyl, hydroxy, lower alkoxy, nitro, amino, lower alkyl, amino, diloweralkyl amino, cyano, carboxy, lower carbalkoxy, formyl, lower alkanoyl, oxo, carbarmoyl, N-lower or N,N-dilower alkyl carbamoyl, mercapto, or lower alkylthio; 
         R 9 , R 10  and R 13  are independently hydrogen, lower alkyl, halogen substituted lower alkyl, aryl, aryl lower alkyl, halogen substituted aryl, halogen substituted aryl lower alkyl; 
         wherein R 15  and R 16  are independently hydrogen, lower alkyl, aryl, aryl lower alkyl, cycloalkyl, or cycloalkyl lower alkyl; and 
         het is a 5- to 7-membered monocyclic heterocyclic ring containing 1-4 heteroring atoms selected from N, O and S or an 8- to 12-membered fused ring system that includes one 5- to 7-membered monocyclic heterocyclic ring containing 1, 2 or 3 heteroring atoms selected from N, O and S, wherein het is unsubstituted or substituted. 
       
     
     
         21 . The method of  claim 19 , wherein the IAP inhibitor is a compound of Formula II: 
       
         
           
           
               
               
           
         
         or pharmaceutically acceptable salts, enantiomers, stereoisomers, rotamers, tautomers, diastereomers, or racemates thereof; 
         wherein 
         R′ 1  is H; 
         R′ 2  is C 1 -C 4  alkyl; which may be unsubstituted or substituted; 
         R′ 3  is C 1 -C 4  alkyl; 
         R′ 4  is —C 3 -C 10 cycloalkyl; which may be unsubstituted or substituted; 
         R′ 5  is H; C 1 -C 10 -alkyl; aryl; phenyl; C 3 -C 7 cycloalkyl; —(CH 1-6 —C 3 -C 7 cycloalkyl; —(CH 2 ) 0-6 -C 3 -C 7 cycloalkyl-(CH 2 ) 0-6 -phenyl; —(CH 2 ) 0-4 CH 4 CH 2 ) 1-4 -phenyl) 2 ; —(CH 2 ) 0-6 —CH(phenyl) 2 , -indanyl; —C(O)—C 1 -C 10 alkyl; —C(O)—(CH 2 ) 1-6 -C 3 -C 7 -cycloalkyl; —C(O)—(CH 2 ) 0-6 -phenyl; —(CH 2 ) 0-6 —C(O)-phenyl; —(CH 2 ) 0-6 -het; —C(O)—(CH 2 ) 1-6 -het; or R′ 5  is a residue of an amino acid, wherein the alkyl, cycloalkyl, phenyl and aryl substituents are unsubstituted or substituted; 
         U is as shown in structure III: 
       
       
         
           
           
               
               
           
         
         wherein 
       
       R′ 5  is attached to Rc or Rd;
 each n is, independently, 0-5; 
 X is C or N; 
 Ra and Rb are independently an O, S, or N atom or C 0-8  alkyl wherein one or more of the carbon atoms in the alkyl chain may be replaced by a heteroatom selected from O, S or N, and where the alkyl may be unsubstituted or substituted; 
 Rd is selected from:
   -Re-Q-(Rf) p (Rg) q ; or   (a)
 
   (b) Ar 1 -D-Ar 2 ;   (b)
 
 
 Rc is H or Rc and Rd may together form a cycloalkyl or het; where if Rd and Rc form a cycloalkyl or het, R′ 5  is attached to the formed ring at a C or N atom; 
 p and q are independently 0 or 1; 
 Re is C 1-8  alkyl or alkylidene, and Re which may be unsubstituted or substituted; 
 Q is N, O, S, S(O), or S(O) 2 ; 
 Ar 1  and Ar 2  are substituted or unsubstituted aryl or het; 
 Rf and Rg are each independently H; —C 1 -C 10 alkyl; C 1 -C 10 alkylaryl; —OH; —O—C 1 -C 10 alkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl; —O—(CH 2 ) 0-6 -aryl; phenyl; aryl; phenyl-phenyl; —(CH 2 ) 1-6 -het; —O—(CH 2 ) 1-6 -het; —OR 11 ; —C(O)—R 11 ; —C(O)—N(RH)(R 12 ); —N(RH)(R 12 ); —S—RH; —S(O)—RH; —S(O) 2 —R 11 ; —S(O) 2 —NR 11 R 12 ;—NR 11 —S(O) 2 —R 12 ; S—C 1 -C 10 alkyl; aryl-C 1 -C 4 alkyl; het-C 1 -C 4 -alkyl wherein alkyl, cycloalkyl, het and aryl are unsubstituted or substituted; —SO 2 -C 1 -C 2 alkyl; —SO 2 —C 1 -C 2 alkylphenyl; —O—C 1 -C 4 alkyl; or R g  and R f  form a ring selected from het or aryl; 
 D is —CO—; —C(O)—C 1-7  alkylene or arylene; —CF 2 —; —O—; —S(O) r  where r is 0-2; 1,3-dioaxolane; or C 1-7  alkyl-OH; where alkyl, alkylene or arylene may be unsubstituted or substituted with one or more halogens, OH, —O—C 1 -C 6 alkyl, —S—C 1 -C 6 alkyl or —CF 3 ; or D is —N(Rx)- wherein Rx is H; C 1-7  alkyl (unsubstituted or substituted); aryl; —O(C 1-7 cycloalkyl) (unsubstituted or substituted); C(O)—C 1 -C 10 alkyl; C(O)—C 0 -C 10 alkyl-aryl; C—O—C 1 -C 10 alkyl; C—O—C 0 -C 10 alkyl-aryl or SO 2 —C 1 -C 10 -alkyl; SO 2 —(C 0 -C 10 -alkylaryl); 
 R″ 6 , R″ 7 , R′ 6  and R′ 7  are each independently H; —C 1 -C 10  alkyl; —C 1 -C 10  alkoxy; aryl-C 1 -C 10  alkoxy; —OH; —O—C 1 -C 10 alkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl; —O—(CH 2 ) 0-6 -aryl; phenyl; —(CH 2 ) 1-6 -het; —O—(CH 2 ) 1-6 -het; —ORH; —C(O)—R′ 11 ; —C(O)—N(R′ 11 )(R′ 12 ); —N(R′ 11 )(R′ 12 ); —S—RH; —S(O)—R′ 11 ; —S(O) 2 —R′ 11 ; —S(O) 2 -NR′ 11 R′ 12 ; —NR′ 11 —S(O) 2 —R′ 12 ; wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; and R″ 6 , R″ 7 , R′ 6  and R′ 7  can be united to form a ring system; 
 R′ 11  and R′ 12  are independently H; C 1 -C 10  alkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl; —(CH 2 ) 0-6 —(CH) 0-1 (aryl) 1-2 ; —C(O)—C 1 -C 10 alkyl; —C(O)—(CH 2 ) 1-6 —C 3 -C 7 cycloalkyl; —C(O)—O—(CH 2 ) 0-6 -aryl; —C(O)—(CH 2 ) 0-6 —O-fluorenyl; —C(O)—NH—(CH 2 ) 0-6 -aryl; —C(O)—(CH 2 ) 0-6 -aryl; —C(O)—(CH 2 ) 1-6 -het; —C(S)—C 1 -C 10 alkyl; —C(S)—(CH 2 ) 1-6 —C 3 -C 7 cycloalkyl; —C(S)—O—(CH 2 ) 0-6 -aryl; —C(S)—(CH 2 ) 0-6 —O-fluorenyl; —C(S)—NH—(CH 2 ) 0-6 -aryl; —C(S)—(CH 2 ) 0-6 -aryl; —C(S)—(CH 2 ) 1-6 -het; wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; or R′ 11  and R′ 12  are a substituent that facilitates transport of the molecule across a cell membrane; or R′ 11  and R′ 12  together with the nitrogen atom form het; 
 
       wherein the alkyl substituents of R′ 11  and R′ 12  may be unsubstituted or substituted by one or more substituents selected from C 1 -C 10 alkyl, halogen, OH, —O—C 1 -C 6 alkyl, —S—C 1 -C 6 alkyl or -CF3;
 substituted cycloalkyl substituents of R′ 11  and R′ 12  are substituted by one or more substituents selected from a C 1 -C 10  alkene; C 1 -C 6 alkyl; halogen; OH; —O—C 1 -C 6 alkyl; —S—C 1 -C 6 alkyl or —CF 3 ; 
 substituted phenyl or aryl of R′ 11  and R′ 12  are substituted by one or more substituents selected from halogen; hydroxy; C 1 -C 4  alkyl; C 1 -C 4  alkoxy; nitro; —CN; —O—C(O)—C 1 -C 4 alkyl and —C()—O—C 1 -C 4 -aryl; and wherein 
 het is a 5-7 membered heterocyclic ring containing 1-4 heteroatoms selected from N, O and S, or an 8-12 membered fused ring system including at least one 5-7 membered heterocyclic ring containing 1, 2 or 3 heteroatoms selected from N, O, and S, which heterocyclic ring or fused ring system is unsubstituted or substituted on a carbon or nitrogen atom. 
 
     
     
         22 . The method of  claim 20 , wherein the IAP inhibitor is N-[1-cyclohexyl-2-oxo-2-(6-phenethyl-octahydro-pyrrolo[2,3-c]pyridin-1-yl)-ethyl]-2-methylamino-propionamide. 
     
     
         23 . The method of  claim 20 , wherein the IAP inhibitor is (S)-N-((S)-1-Cyclohexyl-2-{(S)-2-[4-(4-(4-fluoro-benzoyl)-thiazol-2-yl]-pyrrolidin-1-yl}-2-oxo-ethyl)-2-methylamino-propionamide. 
     
     
         24 . A kit comprising:
 (a) a pharmaceutical composition comprising an IAP inhibitor and a pharmaceutically acceptable carrier;   (b) a packaging material enclosing said pharmaceutical composition; and   (c) instructions for use of said pharmaceutical composition for the enhancement of an immune response of a subject.   
     
     
         25 . The kit of  claim 24 , wherein the instructions indicate that said pharmaceutical composition is to be administered to the subject with an antigen. 
     
     
         26 . The kit of  claim 25 , further comprising an antigen. 
     
     
         27 . The kit of  claim 24 , wherein the kit contains instructions for use of said pharmaceutical composition in the treatment of cancer in a subject in need thereof. 
     
     
         28 . The kit of  claim 24 , wherein the IAP inhibitor is a compound of Formula I: 
       
         
           
           
               
               
           
         
         or pharmaceutically acceptable salts, enantiomers, stereoisomers, rotamers, tautomers, diastereomers, or racemates thereof; 
         wherein 
         R 1  is H, C 1 -C 4  alkyl, C 2 -C 4  alkenyl, C 2 -C 4  alkynyl or C 3 -C 10  cycloalkyl, wherein R 1  may be unsubstituted or substituted; 
         R 2  is H, C 1 -C 4  alkyl, C 2 -C 4  alkenyl, C 2 -C 4  alkynyl, C 3 -C 10  cycloalkyl, wherein R 2  may be unsubstituted or substituted; 
         R 3  is H, CF 3 , C 2 F 5 , C 1 -C 4  alkyl, C 2 -C 4  alkenyl, C 2 -C 4  alkynyl, CH 2 —Z, or 
         R 2  and R 3 , taken together with the nitrogen atom to which they are attached, form a heterocyclic ring, 
         wherein the alkyl, alkenyl, alkynyl groups or het ring may be unsubstituted or substituted; 
         Z is H, OH, F, Cl, CH 3 , CH 2 Cl, CH 2 F or CH 2 OH; 
         R 4  is C 1-10  alkyl, C 1-10  alkenyl, C 1-10  alkynyl, C 3 -C 10  cycloalkyl, wherein the C 1-10  alkyl, or cycloalkyl groups are unsubstituted or substituted; 
         A is het, which may be substituted or unsubstituted; 
         D is C 1 -C 7  alkylene or C 2 -C 9  alkenylene, C(O), O, NR 7 , S(O) r , C(O)—C 1 -C 10  alkyl, O—C 1 -C 10  alkyl, S(O) r —C 1 -C 10  alkyl, C(O)C 0 -C 10  arylalkyl, OC 0 -C 10  arylalkyl, or S(O) r C 0 -C 10  arylalkyl, 
         wherein alkyl and aryl groups may be unsubstituted or substituted; 
         r is 0, 1 or 2; 
         A 1  is a substituted or unsubstituted aryl or unsubstituted or substituted het, wherein substituents on aryl and het are halo, alkyl, lower alkoxy, NR 5 R 6 , CN, NO 2  or SR 5 ; 
         each Q is independently H, C 1 -C 10  alkyl, C 1 -C 10  alkoxy, aryl C 1 -C 10  alkoxy, OH, O—C 1 -C 10  alkyl, (CH 2 ) 0-6 —C 3 -C 7  cycloalkyl, aryl, aryl C 1 -C 10  alkyl, O—(CH 2 ) 0-6  aryl, (CH 2 ) 1-6  het, het, O—(CH 2 ) 1-6  het, C(O)R 11 , —C(O)N(R 11 )(R 12 ), N(R 11 )(R 12 ), SR 11 , S(O)R 11 , S(O) 2 R 11 , S(O) 2 —N(R 11 )(R 12 ), or NR 11 —S(O) 2 —(R 12 ), wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; 
         n is 0, 1 , 2 or 3, 4, 5, 6 or 7; 
         R 11  and R 12  are independently H, C 1 -C 10  alkyl, (CH 2 ) 0-6 —C 3 -C 7  cycloalkyl, (CH 2 ) 0-6 —(CH) 0-1 (aryl) 1-2 , C(O)—C 1 -C 10  alkyl, —C(O)—(CH 2 ) 1-6 —C 3 -C 7  cycloalkyl, —C(O)—O—(CH 2 ) 0-6 -aryl, —C(O)—(CH 2 ) 0-6 —O-fluorenyl, C(O)—NH—(CH 2 ) 0-6 -aryl, C(O)—(CH 2 ) 0-6 -aryl, C(O)—(CH 2 ) 1-6 -het, —C(S)—(CH 2 ) 1-6 -C 3 -C 7  cycloalkyl, —C(S)—O—(CH 2 ) 0-6 -aryl, —C(S)—(CH 2 ) 0-6 —O-fluorenyl, C(S)—NH—(CH 2 ) 0-6 -aryl, —C(S)—(CH 2 ) 0-6 -aryl or C(S)—(CH 2 ) 1-6 -het, C(O)R 15 , C(O)NR 15 R 16 , C(O)OR 15 , S(O) m R 15 , S(O) m NR 15 R 16 , m=1 or 2, C(S)R 15 , C(S)NR 15 R 16 , C(S)OR 15 , wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; or R 11  and R 12  are a substituent that facilitates transport of the molecule across a cell membrane, or 
         R 11  and R 12  together with the nitrogen atom form het, 
         wherein 
         the alkyl substituents of R 11  and R 12  may be unsubstituted or substituted by one or more substituents selected from C 1 -C 10  alkyl, halogen, OH, O—C 1 -C 6  alkyl, —S—C 1 -C 6  alkyl, CF 3  or NR 15 R 16 ; 
         substituted cycloalkyl substituents of R 11  and R 12  are substituted by one or more substituents selected from a C 2 -C 10  alkene; C 1 -C 6  alkyl; halogen; OH; O—C 1 -C 6  alkyl; S—C 1 -C 6  alkyl, CF 3 ; or NR 15 R 16  and 
         substituted het or substituted aryl of R 11  and R 12  are substituted by one or more substituents selected from halogen, hydroxy, C 1 -C 4  alkyl, C 1 -C 4  alkoxy, nitro, CNO—C(O)—C 1 -C 4 alkyl and C(O)—O—C 1 -C 4 -alkyl; 
         R 5 , R 6  and R 7  are independently hydrogen, lower alkyl, aryl, aryl lower alkyl, cycloalkyl, or cycloalkyl lower alkyl, C(O)R 15 , S(O)R 15 , C(O)OR 15 , C(O)NR 15 R 16 ; and 
         the substituents on R 1 , R 2 , R 3 , R 4 , Q, and A and Ai groups are independently halo, hydroxy, lower alkyl, lower alkenyl, lower alkynyl, lower alkanoyl, lower alkoxy, aryl, aryl lower alkyl, amino, amino lower alkyl, diloweralkylamino, lower alkanoyl, amino lower alkoxy, nitro, cyano, cyano lower alkyl, carboxy, lower carbalkoxy, lower alkanoyl, aryloyl, lower arylalkanoyl, carbamoyl, N-mono- or N,N-dilower alkyl carbamoyl, lower alkyl carbamic acid ester, amidino, guanidine, ureido, mercapto, sulfo, lower alkylthio, sulfoamino, sulfonamide, benzosulfonamide, sulfonate, sulfanyl lower alkyl, aryl sulfonamide, halogen substituted aryl sulfonate, lower alkylsulfinyl, arylsulfinyl; aryl-lower alkylsulfinyl, lower alkylarylsulfinyl, lower alkylsulfonyl, arylsulfonyl, aryl-lower alkylsulfonyl, lower aryl alkyl lower alkylarylsulfonyl, halogen-lower alkylmercapto, halogen-lower alkyl sulfonyl, phosphono (—P(═O)(OH) 2 ), hydroxy-lower alkoxy phosphoryl or di-lower alkoxyphosphoryl, (R 9 )NC(O)—NR 10 R 13 , lower alkyl carbamic acid ester or carbamates or —NR 8 R 14 , 
         wherein 
         R 8  and R 14  can be the same or different and are independently H or lower alkyl, or 
         R 8  and R 14 , together with the N atom, form a 3- to 8-membered heterocyclic ring containing nitrogen heteroring atoms and may optionally contain one or two additional heteroring atoms selected from nitrogen, oxygen and sulfur, wherein the heterocyclic ring may be unsubstituted or substituted with lower alkyl, halo, lower alkenyl, lower alkynyl, hydroxy, lower alkoxy, nitro, amino, lower alkyl, amino, diloweralkyl amino, cyano, carboxy, lower carbalkoxy, formyl, lower alkanoyl, oxo, carbarmoyl, N-lower or N,N-dilower alkyl carbamoyl, mercapto, or lower alkylthio; 
         R 9 ,  10  and R 13  are independently hydrogen, lower alkyl, halogen substituted lower alkyl, aryl, aryl lower alkyl, halogen substituted aryl, halogen substituted aryl lower alkyl; 
         wherein R 15  and R 16  are independently hydrogen, lower alkyl, aryl, aryl lower alkyl, cycloalkyl, or cycloalkyl lower alkyl; and 
         het is a 5- to 7-membered monocyclic heterocyclic ring containing 1-4 heteroring atoms selected from N, O and S or an 8- to 12-membered fused ring system that includes one 5- to 7-membered monocyclic heterocyclic ring containing 1, 2 or 3 heteroring atoms selected from N, 0 and S, wherein het is unsubstituted or substituted. 
       
     
     
         29 . The kit of  claim 24 , wherein the IAP inhibitor is a compound of Formula II: 
       
         
           
           
               
               
           
         
         or pharmaceutically acceptable salts, enantiomers, stereoisomers, rotamers, tautomers, diastereomers, or racemates thereof; 
         wherein 
         R′ 1  is H; 
         R′ 2  is C 1 -C 4  alkyl; which may be unsubstituted or substituted; 
         R′ 3  is C 1 -C 4  alkyl; 
         R′ 4  is −C 3 -C 10 cycloalkyl; which may be unsubstituted or substituted; 
         R′ 5  is H; C 1 -C 10 -alkyl; aryl; phenyl; C 3 -C 7 cycloalkyl; —(CH 2 ) 1-6 -C 3 -C 7 cycloalkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl-(CH 2 ) 0-6 -phenyl; —(CH 2 ) 0-4 CH 4 CH 2 ) 1-4 -phenyl) 2 ; —(CH 2 ) 0-6 —CH(phenyl) 2 , -indanyl; —C(O)—C 1 -C 10 alkyl; —C(O)—(CH 2 ) 1-6 -C 3 -C 7 -cycloalkyl; —C(O)—(CH 2 ) 0-6 -phenyl; —(CH 2 ) 0-6 —C(O)-phenyl; —(CH 2 ) 0-6 -het; —C(O)—(CH 2 ) 1-6 -het; or R′ 5  is a residue of an amino acid, wherein the alkyl, cycloalkyl, phenyl and aryl substituents are unsubstituted or substituted; 
         U is as shown in structure III: 
       
       
         
           
           
               
               
           
         
         wherein 
       
       R′ 5  is attached to Rc or Rd;
 each n is, independently, 0-5; 
 X is C or N; 
 Ra and Rb are independently an O, S, or N atom or C 0-8  alkyl wherein one or more of the carbon atoms in the alkyl chain may be replaced by a heteroatom selected from O, S or N, and where the alkyl may be unsubstituted or substituted; 
 Rd is selected from:
   -Re-Q-(Rf) p (Rg) q ; or   (a)
 
   Ar 1 -D-Ar 2 ;   (b)
 
 
 Rc is H or Rc and Rd may together form a cycloalkyl or het; where if Rd and Rc form a cycloalkyl or het, R′ 5  is attached to the formed ring at a C or N atom; 
 p and q are independently 0 or 1; 
 Re is C 1-8  alkyl or alkylidene, and Re which may be unsubstituted or substituted; 
 Q is N, O, S, S(O), or S(O) 2 ; 
 Ar 1  and Ar 2  are substituted or unsubstituted aryl or het; 
 Rf and Rg are each independently H; —C 1 -C 10 alkyl; C 1 -C 10 alkylaryl; —OH; —O—C 1 -C 10 alkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl; —O—(CH 2 ) 0-6 -aryl; phenyl; aryl; phenyl-phenyl; —(CH 2 ) 1-6 -het; —O—(CH 2 ) 1-6 -het; —OR 11 ; —C(O)—R 11 ; —C(O)—N(RH)(R 12 ); —N(RH)(R 12 ); —S—RH; —S(O)—RH; —S(O) 2 —R 11 ; —S(O) 2 —NR 11 R 12 ;—NR 11 —S(O) 2 —R 12 ; S—C 1 -C 10 alkyl; aryl-C 1 -C 4 alkyl; het-C 1 -C 4 -alkyl wherein alkyl, cycloalkyl, het and aryl are unsubstituted or substituted; —SO 2 -C 1 -C 2 alkyl; —SO 2 —C 1 -C 2 alkylphenyl; —O—C 1 -C 4 alkyl; or R g  and R f  form a ring selected from het or aryl; 
 D is —CO—; —C(O)—C 1-7  alkylene or arylene; —CF 2 —; —O—; —S(O) r  where r is 0-2; 1,3-dioaxolane; or C 1-7  alkyl-OH; where alkyl, alkylene or arylene may be unsubstituted or substituted with one or more halogens, OH, —O—C 1 -C 6 alkyl, —S—C 1 -C 6 alkyl or —CF 3 ; or D is —N(Rx)- wherein Rx is H; C 1-7  alkyl (unsubstituted or substituted); aryl; —O(C 1-7 cycloalkyl) (unsubstituted or substituted); C(O)—C 1 -C 10 alkyl; C(O)—C 0 -C 10 alkyl-aryl; C—O—C 1 -C 10 alkyl; C—O—C 0 -C 10 alkyl-aryl or SO 2 —C 1 -C 10 -alkyl; SO 2 —(C 0 -C 10 -alkylaryl); 
 R″ 6 , R″ 7 , R′ 6  and R′ 7  are each independently H; —C 1 -C 10  alkyl; —C 1 -C 10  alkoxy; aryl-C 1 -C 10  alkoxy; —OH; —O—C 1 -C 10 alkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl; —O—(CH 2 ) 0-6 -aryl; phenyl; —(CH 2 ) 1-6 -het; —O—(CH 2 ) 1-6 -het; —ORH; —C(O)—R′ 11 ; —C(O)—N(R′ 11 )(R′ 12 ); —N(R′ 11 )(R′ 12 ); —S—RH; —S(O)—R′ 11 ; —S(O) 2 —R′ 11 ; —S(O) 2 -NR′ 11 R′ 12 ; —NR′ 11 —S(O) 2 —R′ 12 ; wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; and R″ 6 , R″ 7 , R′ 6  and R′ 7  can be united to form a ring system; 
 R′ 11  and R′ 12  are independently H; C 1 -C 10  alkyl; —(CH 2 ) 0-6 —C 3 -C 7 cycloalkyl; —(CH 2 ) 0-6 —(CH) 0-1 (aryl) 1-2 ; —C(O)—C 1 -C 10 alkyl; —C(O)—(CH 2 ) 1-6 —C 3 -C 7 cycloalkyl; —C(O)—O—(CH 2 ) 0-6 -aryl; —C(O)—(CH 2 ) 0-6 —O-fluorenyl; —C(O)—NH—(CH 2 ) 0-6 -aryl; —C(O)—(CH 2 ) 0-6 -aryl; —C(O)—(CH 2 ) 1-6 -het; —C(S)—C 1 -C 10 alkyl; —C(S)—(CH 2 ) 1-6 —C 3 -C 7 cycloalkyl; —C(S)—O—(CH 2 ) 0-6 -aryl; —C(S)—(CH 2 ) 0-6 —O-fluorenyl; —C(S)—NH—(CH 2 ) 0-6 -aryl; —C(S)—(CH 2 ) 0-6 -aryl; —C(S)—(CH 2 ) 1-6 -het; wherein alkyl, cycloalkyl and aryl are unsubstituted or substituted; or R′ 11  and R′ 12  are a substituent that facilitates transport of the molecule across a cell membrane; or ′ 11  and R′ 12  together with the nitrogen atom form het; 
 
       wherein the alkyl substituents of R′ 11  and R′ 12  may be unsubstituted or substituted by one or more substituents selected from Ci-Cioalkyl, halogen, OH, —O—C 1 -C 6 alkyl, —S—C 1 -C 6 alkyl or —CF 3 ;
 substituted cycloalkyl substituents of R′ 11  and R′ 12  are substituted by one or more substituents selected from a C 1 -C 10  alkene; C 1 -C 6 alkyl; halogen; OH; —O—C 1 -C 6 alkyl; —S—C 1 -C 6 alkyl or —CF 3 ; 
 substituted phenyl or aryl of R′ 11  and R′ 12  are substituted by one or more substituents selected from halogen; hydroxy; C 1 -C 4  alkyl; C 1 -C 4  alkoxy; nitro; —CN; —O—C(O)—C 1 -C 4 alkyl and —C(O)—O—C 1 -C 4 -aryl; and wherein 
 het is a 5-7 membered heterocyclic ring containing 1-4 heteroatoms selected from N, O and S, or an 8-12 membered fused ring system including at least one 5-7 membered heterocyclic ring containing 1, 2 or 3 heteroatoms selected from N, O, and S, which heterocyclic ring or fused ring system is unsubstituted or substituted on a carbon or nitrogen atom. 
 
     
     
         30 . The kit of  claim 28 , wherein the IAP inhibitor is N-[1-cyclohexyl-2-oxo-2-(6-phenethyl-octahydro-pyrrolo[2,3-c]pyridin-1-yl)-ethyl]-2-methylamino-propionamide. 
     
     
         31 . The kit of  claim 28 , wherein the IAP inhibitor is (S)-N-((S)-1-Cyclohexyl-2-{(S)-2-[4(4-(4-fluoro-benzoyl)-thiazol-2-yl]-pyrrolidin-1-yl}-2-oxo-ethyl)-2-methylamino-propionamide.