WO2005034847A2 - Methods of reducing risk of infection from pathogens - Google Patents

Methods of reducing risk of infection from pathogens Download PDF

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Publication number
WO2005034847A2
WO2005034847A2 PCT/US2004/026963 US2004026963W WO2005034847A2 WO 2005034847 A2 WO2005034847 A2 WO 2005034847A2 US 2004026963 W US2004026963 W US 2004026963W WO 2005034847 A2 WO2005034847 A2 WO 2005034847A2
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Prior art keywords
chor
independently
prophylactic treatment
treatment method
link
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PCT/US2004/026963
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French (fr)
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WO2005034847A3 (en
Inventor
Michael R. Johnson
Samuel E. Hopkins
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Parion Sciences, Inc.
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Priority to JP2006524050A priority Critical patent/JP2007512229A/en
Priority to EP04809587A priority patent/EP1656096A4/en
Priority to AU2004279329A priority patent/AU2004279329A1/en
Priority to CA002533886A priority patent/CA2533886A1/en
Publication of WO2005034847A2 publication Critical patent/WO2005034847A2/en
Publication of WO2005034847A3 publication Critical patent/WO2005034847A3/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/4965—Non-condensed pyrazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/4965—Non-condensed pyrazines
    • A61K31/497—Non-condensed pyrazines containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A61K31/52—Purines, e.g. adenine
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    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/53—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with three nitrogens as the only ring hetero atoms, e.g. chlorazanil, melamine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A61P31/14—Antivirals for RNA viruses
    • A61P31/16—Antivirals for RNA viruses for influenza or rhinoviruses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D241/00—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings
    • C07D241/02—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings not condensed with other rings
    • C07D241/10—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings not condensed with other rings having three double bonds between ring members or between ring members and non-ring members
    • C07D241/14—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings not condensed with other rings having three double bonds between ring members or between ring members and non-ring members with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to ring carbon atoms
    • C07D241/24—Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals
    • C07D241/26—Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals with nitrogen atoms directly attached to ring carbon atoms
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    • C07D—HETEROCYCLIC COMPOUNDS
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    • C07D241/02—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings not condensed with other rings
    • C07D241/10—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings not condensed with other rings having three double bonds between ring members or between ring members and non-ring members
    • C07D241/14—Heterocyclic compounds containing 1,4-diazine or hydrogenated 1,4-diazine rings not condensed with other rings having three double bonds between ring members or between ring members and non-ring members with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to ring carbon atoms
    • C07D241/24—Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals
    • C07D241/26—Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals with nitrogen atoms directly attached to ring carbon atoms
    • C07D241/28—Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals with nitrogen atoms directly attached to ring carbon atoms in which said hetero-bound carbon atoms have double bonds to oxygen, sulfur or nitrogen atoms
    • C07D241/34—(Amino-pyrazine carbonamido) guanidines
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
    • C07D401/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings
    • C07D401/12—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings linked by a chain containing hetero atoms as chain links
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
    • C07D401/14—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing three or more hetero rings
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D403/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00
    • C07D403/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings
    • C07D403/12—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings linked by a chain containing hetero atoms as chain links
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
    • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
    • C07D405/12—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a chain containing hetero atoms as chain links
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
    • C07D405/14—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing three or more hetero rings
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
    • C07D413/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings
    • C07D413/12—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings linked by a chain containing hetero atoms as chain links
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
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    • C07D417/14—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and sulfur atoms as the only ring hetero atoms, not provided for by group C07D415/00 containing three or more hetero rings
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

  • the present invention relates to the use of sodium channel blockers for prophylactic, post-exposure prophylactic, preventive or therapeutic treatment against diseases or conditions caused by pathogens, particularly pathogens which may be used in bioterrorism.
  • a prophylactic treatment method comprising administering a prophylactically effective amount of a sodium channel blocker according to Formula I:
  • X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl;
  • Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R ) 2 ;
  • R 1 is hydrogen or lower alkyl;
  • R 3 and R 4 are each, independently, hydrogen, a group represented by formula (A), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R 3 and R 4 is a group represented by formula (A):
  • each o is, independently, an integer from 0 to 10;
  • each p is an integer from 0 to 10;
  • Link -(CH 2 ) n -CAP Link -(CH 2 ) n (CHOR 8 )(CHOR 8 ) n -CAP, Link - (CH 2 CH 2 O) m -CH 2 -CAP, Link -(CH 2 CH 2 O) m -CH 2 CH 2 -CAP, Link -(CH 2 ) resort- (Z) g -CAP, Link - (CH 2 ) n (Z) g -(CH 2 ) m -CAP , Link -(CH 2 ) favor-NR 13 - CH 2 (CHOR 8 )(CHOR 8 ) n -CAP, Link -(CH 2 ) n -(CHOR 8 ) m CH 2 -NR 13 -(Z) g -CAP, Link -(CH 2 ) n NR 13 -(CH 2 ) m (CHOR 8 ) n CH 2 NR ,3 -(Z) g -CAP, Link -(
  • Ar is, independently, phenyl; substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH 3 , NR 13 R 13 , Cl, F, CH 3 ; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic ring systems as defined below;
  • heteroaryl is selected from one ofthe following heteroaromatic systems:
  • each R 6 is, independently, -R 7 , -OR 7 ,-OR u , -N(R 7 ) 2 , -(CH 2 ) m -OR 8 , -O-(CH 2 ) m -OR 8 , -(CH 2 ) contend-NR 7 R 10 , -O-(CH 2 ) m -NR 7 R 10 , -(CH2)n(CHOR 8
  • each R is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH 2 (CHOR) 8 m -R 10 ;
  • each R 11 is, independently, lower alkyl
  • each R 13 is, independently, hydrogen, R 7 , R 10 , -(CH 2 ) m -NR 13 R 13 , + -(CH 2 ) m - NR 13 R 13 R 13 , -CCH 2 ) m -(CHOR 8 ) m -(CH 2 ) m NR 13 R 13 , -(CH 2 ) m -NR ,0 R 10 + -(CH 2 ) m -(CHOR 8 ) m -(CH 2 ) m NR 13 R ,3 R 13 ,
  • NR I3 R 13 can be joined on itself to form a ring comprising one ofthe following:
  • each Het is independently, -NR 13 , -S-, -SO-, or -SO 2 -; -O-, -SO 2 NR 13 -, -NHSO 2 -, -NR 13 CO-, -CONR 13 -; [0035] each g is, independently, an integer from 1 to 6; [0036] each m is, independently, an integer from 1 to 7; [0037] each n is, independently, an integer from 0 to 7; [0038] each Q is, independently, C-R 5 , C-R 6 , or a nitrogen atom, wherein at [0039] most three Q in a ring are nitrogen atoms;
  • each V is, independently, -(CH 2 ) friendship,-NR 7 R 10 , -(CH 2 ) m -NR 7 R 7 , -(CH 2 ) m - + NR'V'R 11 , -(CH 2 ) complicat-(CHOR 8 ) m -(CH 2 ) m NR 7 R 10 , -CCH 2 ) admir-NR 10 R 10 + -(CH 2 ) n -(CHOR 8 ) m -(CH 2 ) m NR 7 R 7 ,-(CH 2 ) n -(CHOR 8 ) m -(CH 2 ) m NR 1 ! R> 'R 1 '
  • V can also be, independently, R 7 , R 10 , or (R u ) 2 ; [0042] wherein for any ofthe above compounds when two -CH 2 OR 8 groups are located 1,2- or 1,3- with respect to each other the R 8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1 ,3-dioxolane, or a pharmaceutically acceptable salt thereof to an individual in need of prophylactic treatment against infection from one or more airborne pathogens.
  • a prophylactic treatment method comprising administering a prophylactically effective amount of a sodium channel blocker according to Formula II:
  • X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl;
  • Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R ) 2 ;
  • R 1 is hydrogen or lower alkyl
  • each R 2 is, independently, -R 7 , -(CH 2 ) m -OR 8 , -(CH 2 ) m -NR 7 R 10 ,
  • R 3 and R 4 are each, independently, hydrogen, a group represented by formula (A'), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R 3 and R 4 is a group represented by formula (A 1 ): — (C(R L ) 2 ) 0 --X-(C(R L )2)P--CR 5 'R 6 'R 6 ' (A') where [0049] each R L is, independently, -R 7 , -(CH 2 ) n -OR 8 , -O-(CH 2 ) m -OR 8 , -(CH 2 ) n -NR
  • each o is, independently, an integer from 0 to 10;
  • each p is an integer from 0 to 10;
  • each R 5' is also, independently, -(CH 2 ) n -NR 12 R 12 , -O-(CH 2 ) m -NR 12 R 12 ,
  • Link -(CH 2 ) n -CAP Link -(CH 2 ) n (CHOR 8 )(CHOR 8 ) n -CAP, Link - (CH 2 CH 2 O) m -CH 2 -CAP, Link -(CH 2 CH 2 O) m -CH 2 CH 2 -CAP, Link -(CH 2 ) favor- (Z) g -CAP, Link - (CH 2 ) n (Z) g -(CH 2 ) m -CAP , Link -(CH 2 ) favor-NR 13 - CH 2 (CHOR 8 )(CHOR 8 ) n -CAP, Link -(CH 2 ) n -(CHOR 8 ) m CH 2 -NR 1 -(Z) g -CAP, Link -(CH 2 ) n NR ,3 -(CH 2 ) m (CHOR 8 ) n CH 2 NR ,3 -(Z) g -CAP, Link
  • each CAP is, independently,
  • Ar is, independently, phenyl; substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH 3 , NR 13 R 13 , Cl, F, CH 3 ; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic nng systems as defined below;
  • heteroaryl is selected from one ofthe following heteroaromatic systems:
  • each R 6' is, independently, -R 5' , -R 7 , -OR 8 , -N(R 7 ) 2 , -(CH 2 ) m -OR 8 , -O-(CH 2 ) m -OR?, -(CH 2 ) n -NR 7 R 10 , -O-(CH 2 ) m -NR 7 R 10 , -(CH 2 )n(CHOR 8 )(CHOR 8 )n-CH 2 OR 8 , -O-(CH2) m (CHOR 8 )(CHOR 8 ) n -CH 2 OR 8 , -(CH 2 CH 2 O) m -R 8
  • each R 7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH 2 (CHOR) 8 m -R 10 ;
  • each R 11 is, independently, lower alkyl;
  • each R 13 is, independently, hydrogen, R 7 , R 10 , -(CH 2 ) m -NR I3 R 13 , + -(CH 2 ) m - NR ,3 R 13 R 13 , -(CH 2 ) m -(CHOR 8 ) m -(CH 2 ) m NR 13 R 13 , -(CH2) m -NR ,0 R'°
  • NR I3 R 13 can be joined on itself to form a ring comprising one ofthe following:
  • each Het is independently, -NR 13 , -S-, -SO-, or -SO 2 -; -O-, -SO 2 NR 13 -, -NHSO 2 -, -NR 13 CO-, -CONR 13 -;
  • each g is, independently, an integer from 1 to 6;
  • each m is, independently, an integer from 1 to 7;
  • each n is, independently, an integer from 0 to 7;
  • each V is, independently, -CCH 2 ) m -NR 7 R 10 , -(CH 2 ) m -NR 7 R 7 , -(CH 2 ) m - + NR n R n R n , -(CH 2 ) n -(CHOR 8 ) m -(CH 2 ) m NR 7 R 10 , -(CH 2 ) n -NR 10 R 10 + -(CH 2 ) admir-(CHOR 8 ) m -(CH 2 ) m NR 7 R 7 ,-(CH 2 ) ⁇ -(CHOR 8 ) m -(CH 2 ) m NR 1 'R 1 'R 1 ' with the proviso that when V is attached directly to a nitrogen atom, then V can also be, independently, R 7 , R 10 , or (R ⁇ ) 2 ;
  • R 8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof to an individual in need of prophylactic treatment against infection from one or more airborne pathogens.
  • a prophylactic treatment method comprising administering a prophylactically effective amount of a sodium channel blocker according to Formula III:
  • X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl;
  • Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R ) 2 ;
  • R 1 is hydrogen or lower alkyl
  • each R 2 is, independently, -R 7 , -(CH 2 ) m -OR 8 , -(CH 2 ) m -NR 7 R 10 , -(CH 2 )n(CHOR 8 )(CHOR 8 ) n -CH 2 OR 8 , -(CH 2 CH 2 O) m -R 8 ,
  • R 3 and R 4 are each, independently, hydrogen, a group represented by formula (A"), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)-lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl-lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R 3° and R 4" is a group represented by formula (A"):
  • each R L is, independently, -R 7 , -(CH 2 ) n -OR 8 , -O-(CH 2 ) m -OR 8 , -(CH 2 ) n -NR 7 R 10 , -O-(CH 2 ) m -NR 7 R 10 , -(CH 2 ) n (CHOR 8 )(CHOR 8 ) n -CH 2 OR 8 , -O-(CH 2 ) m (CHOR 8 )(CHOR 8 ) n -CH 2 OR 8 , -(CH 2 CH 2 O) m -R 8 , -O-(CH 2 CH 2 O) m -R 8 , -(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 5 -O-(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 5 -O-(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 5
  • each o is, independently, an integer from 0 to 10;
  • each p is an integer from 0 to 10;
  • each R 5' is also, independently, -(CH 2 ) n -NR 12 R 12 , -O-(CH 2 ) m -NR 12 R 12 ,
  • CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane,
  • each R 5 is also, independently, Link -(CH 2 ) n -CAP, Link -(CH 2 ) n (
  • each CAP is, independently,
  • Ar is, independently, phenyl; Substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH 3 , NR 13 R 13 , Cl, F, CH 3 ; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic ring systems as defined below;
  • heteroaryl is selected from one ofthe following heteroaromatic systems:
  • Imidazole Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline, Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1 ,2,4-Triazine, 1,3,5- Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
  • each R 6' is, independently, -R 5' , -R 7 , -OR 8 , -N(R 7 ) 2 , -(CH 2 ) m -OR 8 , -O-(CH 2 ) m -OR 8 , -(CH 2 ) n -NR 7 R ,() , -O-(CH 2 ) m -NR 7 R 10 , -(CH 2 ) n (CHOR 8 )(CHOR 8 )n-CH 2 OR 8 , -O-(CH 2 ) m (CHOR 8 )(CHOR 8 )n-CH 2 OR 8 , -(CH 2 CH 2 O) m -R 8 , -O-(CH 2 CH 2 O) m -R 8 , -(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 , -O-(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 ,
  • each R 7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH 2 (CHOR) 8 m -R 10 ;
  • each R 11 is, independently, lower alkyl
  • each R 13 is, independently, hydrogen, R 7 , R 10 , -(CH 2 ) m -NR 13 R 13 , + -(CH 2 ) m - NR 13 R 13 R 13 , -(CH 2 ) m -(CHOR 8 ) m -(CH 2 ) m NR 13 R 13 , -(CH 2 ) m -NR ,0 R 10 + -(CH 2 ) m -(CHOR 8 ) m -(CH 2 ) m NR 13 R I3 R 13 ,
  • each Het is independently, -NR 13 , -S-, -SO-, or -SO 2 -; -O-, -SO 2 NR 13 -,
  • each g is, independently, an integer from 1 to 6;
  • each m is, independently, an integer from 1 to 7;
  • each n is, independently, an integer from 0 to 7;
  • each Q' is, independently, -CR 6 R 5' , -CR 6' R 6' , N, -NR 13 , -S-, -SO-, or -SO 2 -; [0125] wherein at most three Q' in a ring contain a heteroatom and at least one Q' must be -CR 5' R 6' or NR 5' ;
  • each V is, independently, -(CH 2 ) m -NR 7 R 10 , - ⁇ CH 2 ) m -NR 7 R 7 , -(CH 2 ) m - + NR n R ⁇ R ⁇ , -(CH 2 ) n -(CHOR 8 ) m -(CH 2 ) m NR 7 R 10 , -(CH ⁇ n -NR' 0
  • V can also be, independently, R 7 , R 10 , or (R ⁇ ) 2 ; wherein for any ofthe above compounds when two -CH 2 OR 8 groups are located 1,2- or 1,3- with respect to each other the R 8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof, to an individual in need of prophylactic treatment against infection from one or more airborne pathogens.
  • a prophylactic treatment method for reducing the risk of infection from an airborne pathogen which can cause a disease in a human, said method comprising administering an effective amount of a sodium channel blocker of Formula I, II or III, or a pharmaceutically acceptable salt thereof, to the lungs ofthe human who may be at risk of infection from the airborne pathogen but is asymptomatic for the disease, wherein the effective amount ofa sodium channel blocker or a pharmaceutically acceptable salt is sufficient to reduce the risk of infection in the human.
  • a post-exposure prophylactic treatment or therapeutic treatment method for treating infection from an airborne pathogen comprising administering an effective amount of a sodium channel blocker of Formula I, II or III, or a pharmaceutically acceptable salt thereof to the lungs of an individual in need of such treatment against infection from an airborne pathogen.
  • the prophylactic or therapeutic treatment methods ofthe present invention may be used in situations where a segment ofthe population has been, or is believed to have been, exposed to one or more airborne pathogens.
  • the prophylactic or therapeutic treatment methods may additionally be used in situations of ongoing risk of exposure to or infection from airborne pathogens. Such situations may arise due to naturally occurring pathogens or may arise due to a bioterrorism event wherein a segment ofthe population is intentionally exposed to one or more pathogens.
  • the individuals or portion ofthe population believed to be at risk from infection can be treated according to the methods disclosed herein. Such treatment preferably will commence at the earliest possible time, either prior to exposure if imminent exposure to a pathogen is anticipated or possible or after the actual or suspected exposure.
  • the prophylactic treatment methods will be used on humans asymptomatic for the disease for which the human is believed to be at risk.
  • asymptomatic as used herein means not exhibiting medically recognized symptoms ofthe disease, not yet suffering from infection or disease from exposure to the airborne pathogens, or not yet testing positive for a disease.
  • the treatment methods may involve post-exposure prophylactic or therapeutic treatment, as needed.
  • NIAID Many ofthe pathogenic agents identified by NIAID have been or are capable of being aerosolized such that they may enter the body through the mouth or nose, moving into the bodily airways and lungs. These areas ofthe body have mucosal surfaces which naturally serve, in part, to defend against foreign agents entering the body.
  • the quantity ofthe liquid layer on a mucosal surface reflects the balance between epithelial liquid secretion, often reflecting anion (Cl " and/or HCO 3 " ) secretion coupled with water (and a cation counter-ion), and epithelial liquid absorption, often reflecting Na + absorption, coupled with water and counter anion (Cf and/or HCO 3 " ).
  • R. C. Boucher in U.S. Patent No. 6,264,975, describes methods of hydrating mucosal surfaces, particularly nasal airway surfaces, by administration of pyrazinoylguanidine sodium channel blockers.
  • U.S. Patent No. 5,656,256 describes methods of hydrating mucous secretions in the lungs by administration of benzamil or phenamil, for example, to treat diseases such as cystic fibrosis and chronic bronchitis.
  • U.S. Patent No. 5,725,842 is directed to methods of removing retained mucus secretions from the lungs by administration of amiloride.
  • sodium channel blockers which are classes of pyrazinoylguanidine compounds described and exemplified herein as Formulas I, II and III, and in U.S. Provisional Patent Applications 60/495,725, filed August 19, 2003, 60/495,712, filed August 19, 2003 and 60/495,720, filed August 19, 2003, incorporated herein in their entirety, may be used in prophylactic treatment methods to protect humans in whole or in part, against the risk of infection from pathogens which may or may not have been purposely introduced into the environment, typically into the air, of a populated area.
  • Such treatment may be effectively used to protect those who may have been exposed where a vaccine is not available or has not been provided to the population exposed and/or in situations where treatments for the infection resulting from the pathogen to which a population has been subjected are insufficient or unavailable altogether.
  • the sodium channel blockers disclosed herein surprisingly may be used on substantially normal or healthy lung tissue to prevent or reduce the uptake of airborne pathogens and/or to clear the lungs of all or at least a portion of such pathogens.
  • the sodium channel blockers will prevent or reduce the viral or bacterial uptake of airborne pathogens.
  • sodium channel blockers to hydrate mucosal surfaces is believed to function to first hydrate lung mucous secretions, including mucous containing the airborne pathogens to which the human has been subjected, and then facilitate the removal ofthe lung mucous secretions from the body.
  • the sodium channel blocker thus prevents or, at least, reduces the risk of infection from the pathogen(s) inhaled or brought into the body through a bodily airway.
  • the present invention is concerned primarily with the prophylactic, post exposure, rescue and therapeutic treatment of human subjects, but may also be employed for the treatment of other mammalian subjects, such as dogs and cats, for veterinary purposes, and to the extent the mammals are at risk of infection or disease from airborne pathogens.
  • airway refers to all airways in the respiratory system such as those accessible from the mouth or nose, including below the larynx and in the lungs, as well as air passages in the head, including the sinuses, in the region above the larynx.
  • pathogen and "pathogenic agent” are interchangeable and, as used herein, means any agent that can cause disease or a toxic substance produced by a pathogen that causes disease.
  • the pathogenic agent will be a living organism that can cause disease.
  • a pathogen may be any microorganism such as bacterium, protozoan or virus that can cause disease.
  • airborne pathogen means any pathogen which is capable of being transmitted through the air and includes pathogens which travel through air by way ofa carrier material and pathogens either artificially aerosolized or naturally occurring in the air.
  • prophylactic means the prevention of infection, the delay of infection, the inhibition of infection and/or the reduction ofthe risk of infection from pathogens and includes pre- and post-exposure to pathogens.
  • the prophylactic effect may, wter alia, involve a reduction in the ability of pathogens to enter the body, or may involve the removal of all or a portion of pathogens which reach airways and airway surfaces in the body from the body prior to the pathogens initiating or causing infection or disease.
  • the airways from which pathogens may be removed, in whole or part, include all bodily airways and airway surfaces with mucosal surfaces, including airway surfaces in the lungs.
  • terapéutica means to alleviate disease or infection from pathogens.
  • the compounds useful in this invention include sodium channel blockers such as those represented by Formulas I, II and III.
  • the sodium channel blockers disclosed may be prepared by the procedures described herein, in combination with procedures known to those skilled in the art.
  • sodium channel blocker as used herein includes the free base and pharmaceutically acceptable salts thereof.
  • Pharmaceutically acceptable salts are salts that retain the desired biological activity ofthe parent compound and do not impart undesired toxicological effects. Examples of such salts are (a) acid addition salts formed with inorganic acids, for example, hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid and the like; (b) salts formed with organic acids such as, for example, acetic acid, oxalic acid, tartaric acid, succinic acid, maleic acid, fumaric acid, gluconic acid, citric acid, malic acid, ascorbic acid, benzoic acid, tannic acid, palmitic acid, alginic acid, polyglutamic acid, naphthalenesulfonic acid, methanesulfonic acid, p-toluenesulfonic acid, naphthalenedisulfonic acid, polygalacturonic acid, mal
  • halogen examples include fluorine, chlorine, bromine, and iodine. Chlorine and bromine are the preferred halogens. Chlorine is particularly preferred. This description is applicable to the term "halogen" as used throughout the present disclosure.
  • the term "lower alkyl” means an alkyl group having less than 8 carbon atoms. This range includes all specific values of carbon atoms and subranges there between, such as 1 ,2, 3, 4, 5, 6, and 7 carbon atoms.
  • alkyl embraces all types of such groups, e.g., linear, branched, and cyclic alkyl groups. This description is applicable to the term “lower alkyl” as used throughout the present disclosure. Examples of suitable lower alkyl groups include methyl, ethyl, propyl, cyclopropyl, butyl, isobutyl, etc.
  • Y may be hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, lower cycloalkyl, mononuclear aryl, or - N(R 2 ) 2 .
  • the alkyl moiety ofthe lower alkoxy groups is the same as described above.
  • mononuclear aryl include phenyl groups.
  • the phenyl group may be unsubstituted or substituted as described above.
  • the preferred identity of Y is - N(R 2 ) 2 . Particularly preferred are such compounds where each R 2 is hydrogen.
  • R 1 may be hydrogen or lower alkyl. Hydrogen is preferred for R 1 .
  • Hydrogen and lower alkyl, particularly C 1 -C 3 alkyl are preferred for R 2 . Hydrogen is particularly preferred.
  • R 3 and R 4 may be, independently, hydrogen, a group represented by formula (A), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl-lower alkyl, provided that at least one of R 3 and R 4 is a group represented by formula (A).
  • Preferred compounds are those where one of R 3 and R 4 is hydrogen and the other is represented by formula (A).
  • formula (A) the moiety -(C(R ) 2 ) 0 -x-(C(R L ) 2 ) p - defines an alkylene group bonded to the aromatic ring.
  • the variables o and p may each be an integer from 0 to 10, subject to the proviso that the sum of o and p in the chain is from 1 to 10.
  • o and p may each be 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10.
  • the sum of o and p is from 2 to 6.
  • the sum of o and p is 4.
  • Each R L in Formula I may be, independently, -R 7 , -(CH 2 ) n -OR 8 , -O-(CH 2 ) m - OR 8 , -(CH 2 ) n -NR 7 R 10 , -O-(CH 2 ) m -NR 7 R 10 , -(CH 2 ) n (CHOR 8 )(CHOR 8 ) n -CH 2 OR 8 , -O- (CH 2 ) m (CHOR 8 XCHOR 8 ) n -CH 2 OR 8 , -(CH 2 CH 2 O) m -R 8 , -O-(CH 2 CH 2 O) m -R 8 , -(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 , -O-(CH 2 CH 2 O) m -CH 2 CH 2 NR 7 R 10 , -O-(CH 2 CH 2 O) m -CH 2 CH 2
  • the preferred R L groups for Formula I include -H, -OH, -N(R 7 ) 2 , especially where each R 7 is hydrogen.
  • the alkylene chain in formula (A) it is preferred that when one R L group bonded to a carbon atoms is other than hydrogen, then the other R L bonded to that carbon atom is hydrogen, i.e., the formula -CHR L -. It is also preferred that at most two R L groups in an alkylene chain are other than hydrogen, where in the other R L groups in the chain are hydrogens. Even more preferably, only one R L group in an alkylene chain is other than hydrogen, where in the other R L groups in the chain are hydrogens. In these embodiments, it is preferable that x represents a single bond. [0156] In another particular embodiment of Formula I, all ofthe R L groups in the alkylene chain are hydrogen.
  • each R 5 is, independently, Link-(CH 2 ) n -CAP, Link -(CH 2 ) n (CHOR 8 )(CHOR 8 ) n -CAP, Link - (CH 2 CH 2 O) m -CH 2 -CAP, Link -(CH 2 CH 2 O) m -CH 2 CH 2 -CAP, Link -(CH 2 ) n - (Z) g -CAP, Link - (CH 2 ) n (Z) g -(CH 2 ) m -CAP , Link -(CH 2 ) n -NR 13 - CH 2 (CHOR 8 )(CHOR 8 ) n -CAP, Link -(CH 2 ) ⁇ -(CHOR 8 ) m CH 2 -NR 13 -(Z) g -CAP, Link -(CH 2 ) n NR 13 -(CH 2 -(CH 2 )
  • Link is, independently, -O-, (CH 2 ) n -, -O(CH 2 )
  • each CAP is, independently,
  • Ar is, independently, phenyl; Substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH 3 , NR R , Cl, F, CH 3 ; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic ring systems as defined below;
  • heteroaryl is selected from one ofthe following heteroaromatic systems: Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole, Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline,
  • Triazine Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
  • each R 6 is, independently, -R 7 , -OR 7 ,-OR ⁇ , -N(R 7 ) 2 , -(CH 2 ) m -OR 8 , -O-(CH 2 ) m -OR 8 , -(CH 2 ) n -NR 7 R'°, -O-(CH 2 ) m -NR 7 R 10 , -(CH 2 ) n (CHOR 8 )(CHOR 8 ) n -CH 2 OR 8 , -O-(CH 2 ) m (CHOR 8 )(CHOR 8 )
  • the R 8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane.
  • one of more ofthe R 6 groups can be one ofthe R 5 groups which fall within the broad definition of R 6 set forth above.
  • the alkyl moieties ofthe two R 6 groups may be bonded together to form a methylenedioxy group, i.e., a group ofthe formula -O-CH 2 -O-.
  • R 6 may be hydrogen. Therefore, 1, 2, 3, or 4 R 6 groups may be other than hydrogen. Preferably at most 3 ofthe R 6 groups are other than hydrogen. [0168]
  • Each g is, independently, an integer from 1 to 6. Therefore, each g may be 1,
  • each m is an integer from 1 to 7. Therefore, each m may be 1, 2, 3, 4, 5, 6, or 7.
  • each n is an integer from 0 to 7. Therefore, each n may be 0, 1 , 2, 3, 4, 5, 6, or 7.
  • Each Q in formula (A) is C-R 5 , C-R 6 , or a nitrogen atom, where at most three
  • each Q in a ring are nitrogen atoms.
  • at most two Q are nitrogen atoms. More preferably, at most one Q is a nitrogen atom.
  • the nitrogen atom is at the 3- position ofthe ring.
  • each Q is either C-R 5 or C-R 6 , i.e., there are no nitrogen atoms in the ring.
  • n is an integer from 1 to 10 and R 5 is as defined above;
  • n is an integer from 1 from 10 and R 5 is as defined above; where o, x, p, and R 5 are as defined above.
  • Y is -NH2.
  • R 2 is hydrogen.
  • R 1 is hydrogen.
  • X is chlorine.
  • R 3 is hydrogen.
  • R L is hydrogen.
  • o is 4.
  • p is 0.
  • the sum of o and p is 4.
  • x represents a single bond.
  • R 6 is hydrogen.
  • at most one Q is a nitrogen atom.
  • no Q is a nitrogen atom.
  • X is halogen; Y is -N(R 7 ) 2 ; R 1 is hydrogen or C 1 -C 3 alkyl; R 2 is -R 7 , -OR 7 , CH 2 OR 7 , or -CO 2 R 7 ; R 3 is a group represented by formula (A); and R 4 is hydrogen, a group represented by formula (A), or lower alkyl.
  • X is chloro or bromo; Y is -N(R 7 ) 2 ; R 2 is hydrogen or C 1 -C 3 alkyl; at most three R 6 are other than hydrogen as described above; at most three R L are other than hydrogen as described above; and at most 2 Q are nitrogen atoms.
  • Y is -NH 2 .
  • R 4 is hydrogen; at most one R L is other than hydrogen as described above; at most two R 6 are other than hydrogen as described above; and at most 1 Q is a nitrogen atom.
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula:
  • the compound of formula (I) is represented by the formula
  • the compound of formula (I) is represented by the formula:
  • each R 5 falls within the scope ofthe structures described above and is, independently, -O-CH 2 CHOHCH 2 O-glucuronide, -OCH2CHOHCH3, -OCH 2 CH 2 NH 2 , -OCH 2 CH 2 NHCO(CH 3 ) 3 , -CH 2 CH 2 OH, -OCH 2 CH 2 OH, -O-(CH 2 ) m -Boc, -(CH 2 ) m -Boc, -OCH 2 CH 2 OH, -OCH 2 CO 2 H,
  • R 5 in the embodiments of Formula II described above include: -N(SO 2 CH 3 )2,
  • R 5 also include: -N(SO 2 CH 3 ) 2 ,
  • Y is -N(R 2 ) 2 .
  • Particularly preferred are such compounds where each R 2 is hydrogen.
  • R 1 in Formula II may be hydrogen or lower alkyl. Hydrogen is preferred for R 1 .
  • R 3 and R 4 may be, independently, hydrogen, a group represented by formula (A'), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl- lower alkyl, provided that at least one of R 3 and R 4 is a group represented by formula (A').
  • Preferred compounds of Formula II are those where one of R 3 and R 4 is hydrogen and the other is represented by formula (A 1 ).
  • the moiety -(C(R L ) 2 ) 0 -x-(C(R L ) 2 ) p - defines an alkylene group.
  • the variables o and p may each be an integer from 0 to 10, subject to the proviso that the sum of o and p in the chain is from 1 to 10.
  • o and p may each be 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10.
  • the sum of o and p is from 2 to 6. In a particularly preferred embodiment, the sum of o and p is 4.
  • the preferred R L groups in Formula II include -H, -OH, -N(R 7 ) 2 , especially where each R 7 is hydrogen.
  • the alkylene chain in formula (A 1 ) it is preferred that when one R L group bonded to a carbon atoms is other than hydrogen, then the other R L bonded to that carbon atom is hydrogen, i.e., the formula -CHR L -. It is also preferred that at most two R L groups in an alkylene chain are other than hydrogen, where in the other R L groups in the chain are hydrogens. Even more preferably, only one R L group in an alkylene chain is other than hydrogen, where in the other R L groups in the chain are hydrogens. In these embodiments, it is preferable that x represents a single bond. [0227] In another particular embodiment of Formula II, all ofthe R L groups in the alkylene chain are hydrogen. In these embodiments, the alkylene chain is represented by the formula
  • R 6' may be hydrogen. Therefore, 1 or 2 R 6 groups may be other than hydrogen. Preferably at most 3 ofthe R 6 groups are other than hydrogen.
  • each g is, independently, an integer from 1 to 6. Therefore, each g may be 1,
  • each m is an integer from 1 to 7. Therefore, each m may be 1, 2, 3, 4, 5, 6, or 7.
  • each n is an integer from 0 to 7. Therefore, each n maybe 0, 1, 2, 3, 4, 5, 6, or 7.
  • Y is -NH 2 .
  • R 2 is hydrogen.
  • R 1 is hydrogen.
  • X is chlorine
  • R 3 is hydrogen
  • R L is hydrogen
  • o is 4.
  • p is 0.
  • x represents a single bond.
  • R 6 is hydrogen
  • X is chloro or bromo; Y is -N(R 7 ) 2 ; R 2 is hydrogen or C 1 -C 3 alkyl; at most three R 6' are other than hydrogen as described above; at most three R L are other than hydrogen as described above.
  • Y is -NH 2 .
  • R 4 is hydrogen; at most one R L is other than hydrogen as described above; at most two R 6 are other than hydrogen as described above.
  • formula (II) is represented by the formula:
  • the compound of formula (II) is represented by the formula: 0-CH 2 -( ⁇ etaCHOH)-CH 2 OH [0254] In another preferred embodiment, the compound of formula (II) is represented by the formula:
  • the compound of formula (II) is represented by the formula: OCH 2 CHOHCH 2 NH 2
  • each R 5 falls within the scope ofthe structures described above and is, independently, -O-CH 2 CHOHCH 2 O-glucuronide, -OCH 2 CHOHCH 3 , -OCH 2 CH 2 NH 2 .
  • R 5 in the embodiments described above include: -N(SO 2 CH 3 ) 2 , -CH 2 -CHNHBocCO 2 CH 3 ( ⁇ ), -O-CH 2 -CHNH 2 CO 2 H ( ⁇ ), -O-
  • R 5 also include: -N(SO 2 CH 3 ) 2 ,
  • Substituents for the phenyl group where applicable in Formula III include halogens. Particularly preferred halogen substituents are chlorine and bromine.
  • Y in Formula III may be hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, lower cycloalkyl, mononuclear aryl, or -N(R 2 ) 2 .
  • the alkyl moiety ofthe lower alkoxy groups is the same as described above. Examples 05/034847
  • R 1 may be hydrogen or lower alkyl in Formula III. Hydrogen is preferred for R 1 .
  • Hydrogen and lower alkyl, particularly C 1 -C 3 alkyl are preferred for R 2 in Formula III. Hydrogen is particularly preferred.
  • Preferred compounds of Formula III are those where one of R 3 and R 4 is hydrogen and the other is represented by formula (A").
  • formula (A") the moiety -(C(R L ) 2 ) o -x-(C(R L ) 2 ) p - defines an alkylene group bonded to the cyclic ring.
  • the variables o and p may each be an integer from 0 to 10, subject to the proviso that the sum of o and p in the chain is from 1 to 10.
  • o and p may each be 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10.
  • the sum of 0 and p is from 2 to 6.
  • the sum of o and p is 4.
  • the preferred R L groups in Formula III include -H, -OH, -N(R 7 ) 2 , especially where each R 7 is hydrogen.
  • the alkylene chain in formula (A) it is preferred that when one R L group bonded to a carbon atoms is other than hydrogen, then the other R L bonded to that carbon atom is hydrogen, i.e., the formula -CHR L -. It is also preferred that at most two R L groups in an alkylene chain are other than hydrogen, where in the other R L groups in the chain are hydrogens. Even more preferably, only one R L group in an alkylene chain is other than hydrogen, where in the other R L groups in the chain are hydrogens. In these embodiments, it is preferable that x represents a single bond. [0321] In another particular embodiment ofthe invention, all ofthe R L groups in the alkylene chain are hydrogen. In these embodiments, the alkylene chain is represented by the formula
  • Each g is, independently, an integer from 1 to 6. Therefore, each g may be 1,
  • each m is an integer from 1 to 7. Therefore, each m may be 1, 2, 3, 4, 5, 6, or 7.
  • Each n is an integer from 0 to 7. Therefore, each n maybe 0, 1, 2, 3, 4, 5, 6, or 7.
  • Each Q' is, independently, -CHR 5' , -CHR 6' , -NR 7 , -NR 10 , -S-, -SO-, or -SO 2 -; wherein at most three Q' in a ring contain a heteroatom and at least one Q' must be - CHR 5 .
  • at most two Q' are nitrogen atoms.
  • Y is -NH 2 .
  • R 2 is hydrogen
  • R 1 is hydrogen.
  • X is chlorine.
  • R is hydrogen
  • R L is hydrogen
  • x represents a single bond.
  • R 6 is hydrogen
  • Formula III at most 2 Q' are nitrogen atoms. [0338] In another preferred embodiment Formula III, at most one Q' is a nitrogen atom.
  • no Q' is a nitrogen atom.
  • X is halogen
  • Y is -N(R 7 ) 2
  • R 1 is hydrogen or CrC 3 alkyl
  • R 2 is -R 7 , -OR 7 , CH 2 O 7 , or -CO 2 R 7
  • R is a group represented by formula (A")
  • R 4 is hydrogen, a group represented by formula (A"), or lower alkyl.
  • X is chloro or bromo; Y is -N(R 7 ) 2 ; R 2 is hydrogen or C 1 -C 3 alkyl; at most three R 6 are other than hydrogen as described above; at most three R are other than hydrogen as described above; and at most 2 Q' are nitrogen atoms.
  • Y is -NH 2 ;
  • R 4 is hydrogen; at most one R L is other than hydrogen as described above; at most two R 6 are other than hydrogen as described above; and at most 1 Q' is a nitrogen atom.
  • the compound is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compoimd of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula: [0385] In another preferred embodiment, the compound of formula (I I) is represented by the formula:
  • the compound of formula (III) is represented by the formula: [0390] In another preferred embodiment, the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the compound of formula (III) is represented by the formula:
  • the active compounds disclosed herein may be administered to the lungs of a patient by any suitable means, but are preferably administered by administering an aerosol suspension of respirable particles comprised ofthe active compound, which the subject inhales.
  • the compounds may be inhaled through the mouth or the nose.
  • the active compound can be aerosolized in a variety of forms, such as, but not limited to, dry powder inhalants, metered dose inhalants or liquid/liquid suspensions.
  • the quantity of sodium channel blocker included may be an amount sufficient to achieve the desired effect and as described in the attached applications.
  • Solid or liquid particulate sodium channel blocker prepared for practicing the present invention should include particles of respirable size: that is, particles ofa size sufficiently small to pass through the mouth and larynx upon inhalation and into the bronchi and alveoli ofthe lungs. In general, particles ranging from about 1 to 5 microns in size (more particularly, less than about 4.7 microns in size) are respirable. Particles of non-respirable size which are included in the aerosol tend to be deposited in the throat and swallowed, and the quantity of non-respirable particles in the aerosol is preferably minimized. For nasal administration, a particle size in the range of 10-500 ⁇ m is preferred to ensure retention in the nasal cavity.
  • Nasal administration may be useful where the pathogen typically enters through the nose. However, it is preferred to administer at least a portion ofthe sodium channel blocker in a dosage form which reaches the lungs to ensure effective prophylactic treatment in cases where the pathogen is expected to reach the lungs.
  • the dosage of active compound will vary depending on the prophylactic effect desired and the state ofthe subject, but generally may be an amount sufficient to achieve dissolved concentrations of active compound on the airway surfaces of the subject as described in the attached applications. Depending upon the solubility ofthe particular formulation of active compound administered, the daily dose may be divided among one or several unit dose administrations. The dosage may be provided as a prepackaged unit by any suitable means (e.g., encapsulating in a gelatin capsule). [0403] Pharmaceutical formulations suitable for airway administration include formulations of solutions, emulsions, suspensions and extracts. See generally, J. Nairn, Solutions, Emulsions, Suspensions and Extracts, in Remington: The Science and practice of Pharmacy, chap.
  • compositions suitable for nasal administration may be prepared as described in U.S. Patent Nos. 4,389,393 to Schor; 5,707,644 to Ilium, 4,294,829 to Suzuki, and 4,835,142 to Suzuki.
  • active agents or the physiologically acceptable salts or free bases thereof are typically admixed with, inter alia, an acceptable carrier.
  • the carrier must, of course, be acceptable in the sense of being compatible with any other ingredients in the formulation and must not be deleterious to the patient.
  • the carrier may be a solid or a liquid, or both, and is preferably formulated with the compound as a unit-dose formulation, for example, a capsule, which may contain from 0.5% to 99% by weight ofthe active compound.
  • One or more active compounds may be incorporated in the formulations ofthe invention, which formulations may be prepared by any ofthe well-known techniques of pharmacy consisting essentially of admixing the components.
  • Aerosols or mists of liquid particles comprising the active compound may be produced by any suitable means, such as, for nasal administration, by a simple nasal spray with the active compound in an aqueous pharmaceutically acceptable carrier such as sterile saline solution or sterile water.
  • Nebulizers are commercially available devices which transform solutions or suspensions ofthe active ingredient into a therapeutic aerosol mist either by means of acceleration of compressed gas, typically air or oxygen, through a narrow venturi orifice or by means of ultrasonic agitation.
  • Suitable formulations for use in nebulizers may consist of the active ingredient in a liquid carrier.
  • the carrier is typically water (and most preferably sterile, pyrogen-free water) or a dilute aqueous alcoholic solution, preferably made isotonic with body fluids by the addition of, for example, sodium chloride.
  • Aerosols or mists of solid particles comprising the active compound may likewise be produced with any solid particulate medicament aerosol generator.
  • Aerosol generators for administering solid particulate medicaments to a subject produce particles which are respirable, as explained above, and generate a volume of aerosol containing a predetermined metered dose of a medicament at a rate suitable for human administration.
  • Such aerosol generators are known in the art. By way of example, see U.S. Patent No. 5,725,842.
  • One illustrative type of solid particulate aerosol generator is an insufflator.
  • Suitable formulations for administration by insufflation include finely comminuted powders which may be delivered by means of an insufflator or taken into the nasal cavity in the manner ofa snuff.
  • the powder e.g., a metered dose thereof effective to carry out the treatments described herein
  • capsules or cartridges typically made of gelatin or plastic, which are either pierced
  • the powder employed in the insufflator consists either solely ofthe active ingredient or of a powder blend comprising the active ingredient, a suitable powder diluent, such as lactose, and an optional surfactant.
  • a second type of illustrative aerosol generator comprises a metered dose inhaler.
  • Metered dose inhalers are pressurized aerosol dispensers, typically containing a suspension or solution formulation ofthe active ingredient in a liquefied propellant. During use these devices discharge the formulation through a valve adapted to deliver a metered volume, typically from 10 to 150 ⁇ l to produce a
  • Any propellant may be used in carrying out the present invention, including both chlorofluorocarbon-containing propellants and non-chlorofluorocarbon-containing propellants.
  • Suitable propellants include certain chlorofluorocarbon compounds, for example, dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane and
  • the formulation may additionally contain one or more co-solvents, for example, ethanol, surfactants, such as oleic acid or sorbitan trioleate, antioxidants, preservatives such as methyl hydroxybenzoate, volatile oils, buffering agents and suitable flavoring agents.
  • co-solvents for example, ethanol, surfactants, such as oleic acid or sorbitan trioleate, antioxidants, preservatives such as methyl hydroxybenzoate, volatile oils, buffering agents and suitable flavoring agents.
  • compositions containing respirable dry particles of sodium channel blockers as described in the attached applications may be prepared as detailed in those applications.
  • the active compound may be formulated alone (i.e., the solid particulate composition may consist essentially ofthe active compound) or in combination with a dispersant, diluent or carrier, such as sugars (i.e., lactose, sucrose, trehalose, mannitol) or other acceptable excipients for lung or airway delivery, which may be blended with the active compound in any suitable ratio (e.g., a 1 to 1 ratio by weight).
  • the dry powder solid particulate compound may be obtained by methods known in the art, such as spray-drying, milling, freeze-drying, and the like.
  • the aerosol or mist may be produced by the aerosol generator at a rate of from about 10 to about 150 liters per minute, more preferably from about 30 to about 150 liters per minute, and most preferably about 60 liters per minute. Aerosols containing greater amounts of medicament may be administered more rapidly.
  • Other medicaments may be administered with the active compounds disclosed if such medicament is compatible with the active compound and other ingredients in the formulation and can be administered as described herein.
  • the pathogens which may be protected against by the prophylactic post exposure, rescue and therapeutic treatment methods ofthe invention include any pathogens which may enter the body through the mouth, nose or nasal airways, thus proceeding into the lungs.
  • the pathogens will be airborne pathogens, either naturally occurring or by aerosolization.
  • the pathogens may be naturally occurring or may have been introduced into the environment intentionally after aerosolization or other method of introducing the pathogens into the environment.
  • Many pathogens which are not naturally transmitted in the air have been or may be aerosolized for use in bioterrorism.
  • the pathogens for which the treatment ofthe invention may be useful includes, but is not limited to, category A, B and C priority pathogens as set forth by the NIAID. These categories correspond generally to the lists compiled by the Centers for Disease Control and Prevention (CDC). As set up by the CDC, Category A agents are those that can be easily disseminated or transmitted person-to-person, cause high mortality, with potential for major public health impact. Category B agents are next in priority and include those that are moderately easy to disseminate and cause moderate morbidity and low mortality. Category C consists of emerging pathogens that could be engineered for mass dissemination in the future because of their availability, ease of production and dissemination and potential for high morbidity and mortality.
  • CDC Centers for Disease Control and Prevention
  • Category A Bacillus anthracis (anthrax), Clostridium botulinum (botulism), Yersinia pestis (plague), Variola major (smallpox) and other pox viruses, Francisella tularensis (tularemia), Viral hemorrhagic fevers Arenaviruses, LCM (lymphocytic choriomeningitis), Junin virus, Machupo virus, Guanarite virus, Lassa Fever, Bunyaviruses, Hantavirus, Rift Valley Fever, Flaviviruses, Dengue, Filoviruses, Ebola Marburg; [0416] Category B: Burkholderia pseudomallei (melioidosis), Coxiella burnetii (Q fever), Brucella species (brucellosis), Burkholderia mallei (glanders), Ricin toxin from Ricinus communis, Epsilon toxin of Clostridium perfringens, St
  • Category C emerging infectious disease threats such as Nipah virus and additional hantaviruses, tickborne hemorrhagic fever viruses such as Crimean Congo hemorrhagic fever virus, tickborne encephalitis viruses, yellow fever, multi-drug resistant tuberculosis, influenza, other rickettsias and rabies.
  • Additional pathogens which may be protected against or the infection risk therefrom reduced include influenza viruses, rhinoviruses, adenoviruses and respiratory syncytial viruses, and the like.
  • a further pathogen which may be protected against is the coronavirus which is believed to cause severe acute respiratory syndrome (SARS).
  • SARS severe acute respiratory syndrome
  • a number ofthe above-listed pathogens are known to be particularly harmful when introduced into the body through the air.
  • Bacillus anthracis the agent which causes anthrax
  • Bacillus anthracis has three major clinical forms, cutaneous, inhalational, and gastrointestinal. All three forms may lead to death but early antibiotic treatment of cutaneous and gastrointestinal anthrax usually cures those forms of anthrax.
  • Inhalational anthrax is a potentially fatal disease even with antibiotic treatment. Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. For naturally occurring or accidental infections, even with appropriate antibiotics and all other available supportive care, the historical fatality rate is believed to be about 75 percent, according to the NIAID.
  • Inhalational anthrax develops after spores are deposited in alveolar spaces and subsequently ingested by pulmonary alveolar macrophages. Surviving spores are then transported to the mediastinal lymph nodes, where they may germinate up to 60 days or longer. After germination, replicating bacteria release toxins that result in disease. This process is interrupted by administration of a prophylactically effective amount of a sodium channel blocker, as the spores may be wholly or partially eliminated from the body by removal of lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to smallpox virus or other pox virus comprising the administration of a prophylactically effective amount of a sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the Variola major virus or other pox virus present in the aerosolized saliva droplets to which the individual was exposed to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • the bacterium Yersinia pestis causes plague and is widely available throughout the world. NIAID has reported that infection by inhalation of even small numbers of virulent aerosolized Y.
  • An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized Y. pestis bacilli comprising the administration ofa sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the aerosolized Y.
  • Botulinum toxin is another substance believed to present a major bioterrorism threat as it is easily released into the environment. Antibiotics are not effective against botulinum toxin and no approved vaccine exists. Although the toxin may be transmitted through food, the botulinum toxin is absorbed across mucosal surfaces and, thus, embodiments ofthe present invention provide a method of prophylactically treating one or more individuals exposed or potentially exposed to botulinum toxin comprising the administration of a sodium channel blocker.
  • the NIAID has identified the bacteria that causes tularemia as a potential bioterrorist agent because Francisella tularensis is capable of causing infection with as few as ten organisms and due to its ability to be aerosolized. Natural infection occurs after inhalation of airborne particles. Tularemia may be treated with antibiotics and an experimental vaccine exists but knowledge of optimal therapeutic approaches for tularemia is limited because very few investigators are working on this disease.
  • An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized Francisella tularensis comprising the administration of a sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the aerosolized Francisella tularensis to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • the Category B and C bacteria most widely believed to have the potential to infect by the aerosol route include gram negative bacteria such as Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii, and select Rickettsia spp. Each of these agents is believed to be capable of causing infections following inhalation of small numbers of organisms. Brucella spp. may cause brucellosis. Four ofthe six Brucella spp., B.
  • Burkholderia pseudomallei may cause melioidosis in humans and other mammals and birds.
  • Burkholderia mallei is the organism that causes glanders, normally a disease of horses, mules and donkeys but infection following aerosol exposure has been reported, according to NIAID.
  • Coxiella burnetii may cause Q fever and is highly infectious. Infections have been reported through aerosolized bacteria and inhalation of only a few organisms can cause infections.
  • R. prowazekii, R. rickettsii, R. conorrii and R. typhi have been found to have low-dose infectivity via the aerosol route.
  • Methods are provided of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized gram negative bacteria such as Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii, and select Rickettsia spp comprising the administration of a sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the aerosolized gram negative bacteria to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • a number of typically arthropod-borne viruses are believed to pose a significant threat as potential bioterrorist weapons due to their extreme infectivity following aerosolized exposure.
  • viruses include arboviruses which are important agents of viral encephalitides and hemonhagic fevers.
  • Such viruses may include alphaviruses such as Venezuelan equine encephalitis virus, eastern equine encephalitis virus and western equine encephalitis virus.
  • Other such viruses may include flaviviruses such as West Nile virus, Japanese encephalitis virus, Kyasanur forest disease virus, tick-borne encephalitis virus complex and yellow fever virus.
  • An additional group of viruses which may pose a threat include bunyaviruses such as California encephalitis virus, or La Crosse virus, Crimean-Congo hemorrhagic fever virus.
  • vaccines or effective specific therapeutics are available for only a very few of these viruses.
  • arbovirus infection is usually initially asymptomatic or causes nonspecific flu-like symptoms such as fever, aches and fatigue.
  • An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized arboviruses comprising the administration of a sodium channel blocker.
  • the administration of an effective amount ofa sodium channel blocker will function to allow the arboviruses to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • Certain category B toxins such as ricin toxin from Ricinus communis, epsilon toxin of Clostridium perfringens and Staphylococcal enterotoxin B, also are viewed as potential bioterrorism tools.
  • Each of these toxins may be delivered to the environment or population by inhalational exposure to aerosols.
  • Low dose inhalation of ricin toxin may cause nose and throat congestion and bronchial asthma while higher dose inhalational exposure caused severe pneumonia, acute inflammation and diffuse necrosis ofthe airways in nonhuman primates.
  • Clostridium perfringens is an anaerobic bacterium that can infect humans and animals. Five types of bacteria exist that produce four major lethal toxins and seven minor toxins, including alpha toxin, associated with gas gangrene, beta toxin, responsible for necrotizing enteritis, and epsilon toxin, a neurotoxin that leads to hemorrhagic enteritis in goats and sheep.
  • An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized toxins comprising the administration ofa sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the aerosolized toxins to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • Mycobacterium tuberculosis bacteria causes tuberculosis and is spread by airborne droplets expelled from the lungs when a person with tuberculosis coughs, sneezes or speaks.
  • An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to Mycobacterium tuberculosis bacteria comprising the administration of a sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the Mycobacterium tuberculosis bacteria to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • the methods disclosed may also be used against more common pathogens such as influenza viruses, rhinoviruses, adenoviruses and respiratory syncytial viruses (RSV).
  • RSV respiratory syncytial viruses
  • An embodiment ofthe present invention provides a method of prophylactically or therapeutically treating one or more individuals exposed or potentially exposed to one of these viruses comprising the administration of a sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the virus to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
  • the methods ofthe present invention may further be used against the virus believed to be responsible for SARS, the coronavirus.
  • Severe acute respiratory syndrome is a respiratory illness that is believed to spread by person-to-person contact, including when someone coughs or sneezes droplets containing the virus onto others or nearby surfaces.
  • the CDC currently believes that it is possible that SARS can be spread more broadly through the air or by other ways that are not currently known.
  • SARS begins with a fever greater than 100.4°F.
  • Other symptoms include headache and body aches. After two to seven days, SARS patients may develop a dry cough and have trouble breathing.
  • the present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to the SARS virus comprising the administration of a sodium channel blocker.
  • the administration of an effective amount of a sodium channel blocker will function to allow the virus to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action of the sodium channel blocker.
  • One assay used to assess mechanism of action and/or potency ofthe compounds ofthe present invention involves the determination of lumenal drug inhibition of airway epithelial sodium currents measured under short circuit current (Isc) using airway epithelial monolayers mounted in Ussing chambers.
  • Isc short circuit current
  • Cells obtained from freshly excised human, dog, sheep or rodent airways are seeded onto porous 0.4 micron SnapwellTM Inserts (CoStar), cultured at air-liquid interface (ALI) conditions in hormonally defined media, and assayed for sodium transport activity (Isc) while bathed in Krebs Bicarbonate Ringer (KBR) in Using chambers.
  • All test drug additions are to the lumenal bath with half-log dose addition protocols (from 1 x 10 "11 M to 3 x 10 '5 M), and the cumulative change in Isc (inhibition) recorded.
  • All drugs are prepared in dimethyl sulfoxide as stock solutions at a concentration of 1 x 10 "2 M and stored at -20° C. Eight preparations are typically run in parallel; two preparations per run inco ⁇ orate amiloride and/or benzamil as positive controls. After the maximal concentration (5 x 10 "5 M) is administered, the lumenal bath is exchanged three times with fresh drug-free KBR solution, and the resultant Isc measured after each wash for approximately 5 minutes in duration. Reversibility is defined as the percent return to the baseline value for sodium current after the third wash. All data from the voltage clamps are collected via a computer interface and analyzed off-line.
  • Bronchial cells dog, human, sheep, or rodent cells are seeded at a density of
  • the disappearance assay is conducted under conditions that mimic the "thin" films in vivo (-25 ⁇ l) and is initiated by adding experimental sodium channel blockers or positive controls (amiloride, benzamil, phenamil) to the apical surface at an initial concentration of 10 ⁇ M.
  • a series of samples (5 ⁇ l volume per sample) is collected at various time points, including 0, 5, 20, 40, 90 and 240 minutes. Concentrations are determined by measuring intrinsic fluorescence of each sodium channel blocker using a Fluorocount Microplate Flourometer or HPLC. Quantitative analysis employs a standard curve generated from authentic reference standard materials of known concentration and purity. Data analysis ofthe rate of disappearance is performed using nonlinear regression, one phase exponential decay (Prism V 3.0).
  • Airway epithelial cells have the capacity to metabolize drugs during the process of transepithelial absorption. Further, although less likely, it is possible that drugs can be metabolized on airway epithelial surfaces by specific ectoenzyme activities. Perhaps more likely as an ecto-surface event, compounds may be metabolized by the infected secretions that occupy the airway lumens of patients with lung disease, e.g. cystic fibrosis. Thus, a series of assays is performed to characterize the compound metabolism that results from the interaction of test compounds with human airway epithelia and/or human airway epithelial lumenal products.
  • test compounds in KBR as an "ASL" stimulant are applied to the apical surface of human airway epithelial cells grown in the T-Col insert system.
  • metabolism generation of new species
  • HPLC high performance liquid chromatography
  • a test solution 25 ⁇ l KBR, containing 10 ⁇ M test compound is placed on the epithelial lumenal surface.
  • Sequential 5 to 10 ⁇ l samples are obtained from the lumenal and serosal compartments for HPLC analysis of (1) the mass of test compound permeating from the lumenal to serosal bath and (2) the potential formation of metabolites from the parent compound.
  • radiolabeled compounds are used for these assays.
  • the rate of disappearance and/or formation of novel metabolite compounds on the lumenal surface and the appearance of test compound and/or novel metabolite in the basolateral solution is quantitated.
  • the data relating the chromatographic mobility of potential novel metabolites with reference to the parent compound are also quantitated.
  • Aerosols of 9 m Tc-Human serum albumin (3.1 mg/ml; containing approximately 20 mCi) were generated using a Raindrop Nebulizer which produces a droplet with a median aerodynamic diameter of 3.6 ⁇ m.
  • the nebulizer was connected to a dosimetry system consisting of a solenoid valve and a source of compressed air (20 psi).
  • the output ofthe nebulizer was directed into a plastic T connector; one end of which was connected to the endotracheal tube, the other was connected to a piston respirator. The system was activated for one second at the onset ofthe respirator's inspiratory cycle.
  • the respirator was set at a tidal volume of 500 mL, an inspiratory to expiratory ratio of 1 : 1 , and at a rate of 20 breaths per minute to maximize the central airway deposition.
  • the sheep breathed the radio-labeled aerosol for 5 minutes.
  • a gamma camera was used to measure the clearance of 99m Tc-Human serum albumin from the airways. The camera was positioned above the animal's back with the sheep in a natural upright position supported in a cart so that the field of image was perpendicular to the animal's spinal cord. External radio-labeled markers were placed on the sheep to ensure proper alignment under the gamma camera. All images were stored in a computer integrated with the gamma camera.
  • a region of interest was traced over the image corresponding to the right lung ofthe sheep and the counts were recorded. The counts were corrected for decay and expressed as percentage of radioactivity present in the initial baseline image.
  • the left lung was excluded from the analysis because its outlines are superimposed over the stomach and counts can be swallowed and enter the stomach as radio-labeled mucus.
  • Treatment Protocol (Assessment of activity at t-zero): A baseline deposition image was obtained immediately after radio-aerosol administration. At time zero, after acquisition ofthe baseline image, vehicle control (distilled water), positive control (amiloride), or experimental compounds were aerosolized from a 4 ml volume using a Pari LC JetPlus nebulizer to free-breathing animals. The nebulizer was driven by compressed air with a flow of 8 liters per minute. The time to deliver the solution was 10 to 12 minutes. Animals were extubated immediately following delivery ofthe total dose in order to prevent false elevations in counts caused by aspiration of excess radio-tracer from the ETT. Serial images of the lung were obtained at 15-minute intervals during the first 2 hours after dosing and hourly for the next 6 hours after dosing for a total observation period of 8 hours. A washout period of at least 7 days separated dosing sessions with different experimental agents.
  • Treatment Protocol (Assessment of Activity at t-4hours): The following variation ofthe standard protocol was used to assess the durability of response following a single exposure to vehicle control (distilled water), positive control compounds (amiloride or benzamil), or investigational agents. At time zero, vehicle control (distilled water), positive control (amiloride), or investigational compounds were aerosolized from a 4 ml volume using a Pari LC JetPlus nebulizer to free- breathing animals. The nebulizer was driven by compressed air with a flow of 8 liters per minute. The time to deliver the solution was 10 to 12 minutes. Animals were restrained in an upright position in a specialized body harness for 4 hours. At the end ofthe 4-hour period animals received a single dose of aerosolized 99m Tc- Human serum albumin (3.1 mg/ml; containing approximately 20 mCi) from a
  • Flash chromatography was performed on a Flash Elute system from Elution Solution (PO Box 5147, Charlottesville, Virginia 22905) charged with a 90 g silica gel cartridge (40M FSO-0110-040155, 32-63 ⁇ m) at 20 psi (N 2 ).
  • GC-analysis was performed on a Shimadzu GC-17 equipped with a Heliflex Capillary Column (Alltech); Phase: AT-1, Length: 10 meters, ID: 0.53 mm, Film: 0.25 micrometers.
  • GC Parameters Injector at 320 °C, Detector at 320 °C, FID gas flow: H 2 at 40 ml/min., Air at 400 ml/min.
  • Carrier gas Split Ratio 16:1, N 2 flow at 15 ml/min., N 2 velocity at 18 cm/sec.
  • the temperature program is 70 °C for 0-3 min, 70-300 °C from 3-10 min,
  • HPLC analysis was performed on a Gilson 322 Pump, detector UV/Vis-156 at 360 nm, equipped with a Microsorb MV C8 column, 100 A, 25 cm.
  • Gradient program 95:5 B:A for 1 min, then to 20:80 B:A over 7 min, then to 100% A over 1 min, followed by washout with 100% A for 11 min, flow rate: 1 ml/min.
  • the following examples depict the synthesis of compounds according to Formula I. FORMULA I EXAMPLES:
  • a suspension of sodium hydride (60% in mineral oil, 0.44 g, 0.11 mmol) in anhydrous DMF (10 mL) was cooled to 0 °C and added to a solution of 2-[4-(4- hydroxyphenyl)-butyl]isoindole-l,3-dione 8 (2.95 g, 10 mmol) in DMF (15 mL). The mixture was stirred at 0 °C for 30 min and then at room temperature for an additional one hour. A solution of dimethylthiocarbamic acid chloride (1.35 g, 11 mmol) in DMF (10 mL) was then added.
  • reaction mixture was stirred at room temperature first for 16 h and then at 50 °C for 1 h, cooled back to room temperature and quenched with methanol (10 mL).
  • methanol 10 mL
  • the mixture was concentrated under vacuum and the residue was purified by flash silica gel column chromatography eluting with CH 2 Cl 2 hexanes/EtOAc (10:1 :0.2, v/v) to give the desired product 9 as a yellowish solid (2.27 g, 59% yield).
  • the filter cake was purified by flash silica gel column chromatography eluting with dichloromethane/methanol/concentrated ammonium hydroxide (500:10:0, 500:10:1, 200:10:1, v/v) to give 2-(4- ⁇ 4-[N-(3,5- diamino-6-chloro-pyrazine-2-carbonyl)guanidino] butyl ⁇ phenoxy)-N- phenylacetamide (20, PSA 17482) as a yellow solid (120 mg, 67 % yield), mp 168- 170 °C.
  • 'H ⁇ MR 300 MHz, DMSO-_i 6 ) ⁇ 1.55 (m, 4H), 2.55 (m, 2H), 3.16 (m,
  • Compoimd 2 (0.156 g, 0.425 mmol) was dissolved in anhydrous ethanol (10 mL). To the solution was bubbled anhydrous HCl gas for 3 min. The reaction vessel was sealed and the mixture was stirred at room temperature for 48 h, and then concentrated to dryness under vacuum. The resulting residue was dissolved in anhydrous methanol (5 mL). To the newly formed solution was added 2,2- dimethoxyethylamine (0.097 mL, 0.891 mmol) in one portion. After stirring at room temperature overnight, temperature was raised to reflux which was maintained for another 3 h before the mixture was cooled to ambient temperature.
  • the filter cake was purified by flash silica gel column chromatography eluting with dichloromethane/methanol/concentrated ammonium hydroxide (200:10:0, 200:10:1, v/v) to give 2-(4- ⁇ 4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]butyl ⁇ -phenoxy)-NN-dimethylacetamide as a yellow solid (35 mg, 28% yield). This solid was dissolved in methanol (2 mL) and added to 4 ⁇ aqueous HCl (4 drops).
  • the HCl salt was made using the following procedure: 45 mg ofthe free base was suspended in ethanol (2 mL) and treated with concentrated HCl (12 N, 0.5 mL) for 10 min. All liquid was then completely removed under vacuum to afford 39 (47 mg). mp 178-180 °C (decomposed).
  • Example 17 Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
  • Example 23 [0546] Sodium Channel Blocking Activity of Selected Capped Pyrazinoylguanidines .
  • the compound containing Boc-protected amino or guanidino group was dissolved in methanol. The solution was then treated with concentrated HCl (12 N) at room temperature for 1 to 2 hours. All liquid in the reaction mixture was then completely removed under vacuum. The resulting residue was further dried under vacuum and generally directly used in the next step without purification.
  • Method D Coupling of un-protected amine with l-(3,5-diamino-6- chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (Cragoe compound)
  • the un-protected amine was dissolved in anhydrous ethanol.
  • Hunig's base DIPEA, 3 equiv
  • the newly resulting solution was heated at 65 °C for 15 min.
  • the Cragoe compound (1.2 equiv) was then added.
  • the reaction mixture was stirred at 65 °C for an additional 2 to 3 hours, and then cooled to room temperature before it was concentrated under vacuum.
  • the resulting residue was chromatographed on silica gel eluting with CMA. The appropriate fractions were collected and concentrated under vacuum.
  • the desired product typically a yellow solid
  • Example 7 Sodium Channel Blocking Activity of Selected Cyclic Pyrazinoylguanidines.

Abstract

Prophylactic treatment methods are provided for protection of individuals and/or populations against infection from airborne pathogens. In particular, prophylactic treatment methods are provided comprising administering a sodium channel blocker or pharmaceutically acceptable salts thereof to one or more members of a population at risk of exposure to or already exposed to one or more airborne pathogens, either from natural sources or from intentional release of pathogens into the environment.

Description

METHODS OF REDUCING RISK OF INFECTION FROM PATHOGENS BACKGROUND Cross Reference to Related Applications
[0001] This application claims the benefit of U.S. Provisional Application Nos. 60/496,481, filed August 20, 2003, 60/495,725, filed August 19, 2003, 60/495,712, filed August 19, 2003 and 60/495,720, filed August 19, 2003, each of which is incorporated herein by reference in its entirety.
Field ofthe Invention
[0002] The present invention relates to the use of sodium channel blockers for prophylactic, post-exposure prophylactic, preventive or therapeutic treatment against diseases or conditions caused by pathogens, particularly pathogens which may be used in bioterrorism.
Description ofthe Related Art
[0003] In recent years, a variety of research programs and biodefense measures have been put into place to deal with concerns about the use of biological agents in acts of terrorism. These measures are intended to address concerns regarding bioterrorism or the use of microorganisms or biological toxins to kill people, spread fear, and disrupt society. For example, the National Institute of Allergy and Infectious Diseases (MAID) has developed a Strategic Plan for Biodefense Research which outlines plans for addressing research needs in the broad area of bioterrorism and emerging and reemerging infectious diseases. According to the plan, the deliberate exposure ofthe civilian population ofthe United States to Bacillus anthracis spores revealed a gap in the nation's overall preparedness against bioterrorism. Moreover, the report details that these attacks uncovered an unmet need for tests to rapidly diagnose, vaccines and immunotherapies to prevent, and drugs and biologies to cure disease caused by agents of bioterrorism.
[0004] Much ofthe focus ofthe various research efforts has been directed to studying the biology ofthe pathogens identified as potentially dangerous as bioterrorism agents, studying the host response against such agents, developing vaccines against infectious diseases, evaluating the therapeutics currently available and under investigation against such agents, and developing diagnostics to identify signs and symptoms of threatening agents. Such efforts are laudable but, given the large number of pathogens which have been identified as potentially available for bioterrorism, these efforts have not yet been able to provide satisfactory responses for all possible bioterrorism threats. Additionally, many ofthe pathogens identified as potentially dangerous as agents of bioterrorism do not provide adequate economic incentives for the development of therapeutic or preventive measures by industry. Moreover, even if preventive measures such as vaccines were available for each pathogen which may be used in bioterrorism, the cost of administering all such vaccines to the general population is prohibitive.
[0005] Until convenient and effective treatments are available against every bioterrorism threat, there exists a strong need for preventative, prophylactic or therapeutic treatments which can prevent or reduce the risk of infection from pathogenic agents.
BRIEF SUMMARY
[0006] The present invention provides such methods of prophylactic treatment. In one embodiment, a prophylactic treatment method is provided comprising administering a prophylactically effective amount of a sodium channel blocker according to Formula I:
Figure imgf000003_0001
wherein [0007] X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl;
[0008] Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R )2; [0009] R1 is hydrogen or lower alkyl;
[0010] each R2 is, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10, -(CH2)n(CHOR8XCHOR8)„-CH2OR8, -(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R,0, -(CH2)n-C(=O)NR7R,0, -(CH2)n-Zg-R7,-(CH2)m- NR10-CH2(CHOR8χCHOR8)n-CH2OR8, -(CH2)„-CO2R7, or (CH2)n _A ( )A7 7 . R '
[0011] R3 and R4 are each, independently, hydrogen, a group represented by formula (A), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R3 and R4 is a group represented by formula (A):
Figure imgf000004_0001
wherein
[0012] each RL is, independently, -R7, -(CH2)n-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8 5 -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)„-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000005_0001
[0013] each o is, independently, an integer from 0 to 10; [0014] each p is an integer from 0 to 10;
[0015] with the proviso that the sum of o and p in each contiguous chain is from 1 to 10; [0016] each x is, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond; [0017] wherein each R5 is, independently,
Link -(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)„- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)„-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)n-(CHOR8)mCH2-NR13-(Z)g-CAP, Link -(CH2)nNR13-(CH2)m(CHOR8)nCH2NR,3-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR13-(CH2)m-C(=O)NR10R10, Link -(CH2)m-C(=O)NR13-(CH2)m-CAP, Link ACH2)m-C(=O)NRnRπ, Link -(CH2)m-C(=O)NRI2R12, Link -(CH2) n-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP;
[0018] wherein Link is, independently,
-O-, (CH2)„-, -O(CH2)m-, -NR,3-C(=O)-NR13, -NR13-C(=O)-(CH2)m-, -C(=O)NR13-(CH2)m, -(CH2)n-Zg-(CH2)n, -S-, -SO-, -SO2-, SO2NR7-, SO2N 10-, -Het-; [0019] wherein each CAP is, independently,
thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R13 R13 , heteroaryl-CAP, -CN, -O-C(=S)NR13 R13, -ZgR13, -CR10(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N R13Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(R13R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides,
Figure imgf000006_0001
[0020] wherein Ar is, independently, phenyl; substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH3, NR13R13, Cl, F, CH3; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic ring systems as defined below;
[0021] wherein heteroaryl is selected from one ofthe following heteroaromatic systems:
Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole, Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline, Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1,2,4-Triazine, 1,3,5- Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine; [0022] each R6 is, independently, -R7, -OR7,-ORu, -N(R7)2, -(CH2)m-OR8, -O-(CH2)m-OR8, -(CH2)„-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n- CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m- CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=0)NR7R10, -O-(CH2)m-C(0)NR7R10, -(CH2)„-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000007_0001
[0023] where when two R6 are -OR11 and are located adjacent to each other on a phenyl ring, the alkyl moieties ofthe two R6 may be bonded together to form a methylenedioxy group; with the proviso that when at least two -CH2OR8 are located adjacent to each other, the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane,
[0024] each R is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH2(CHOR)8 m-R10; [0025] each R8 is, independently, hydrogen, lower alkyl, -C(=O)-Ru, glucuronide, 2-tetrahydropyranyl, or
Figure imgf000007_0002
[0026] each R9 is, independently, -CO R13, -CON(R13)2, -SO2CH2R13, or -C(=O)R13;
[0027] each R10 is, independently, -H, -SO2CH3, -CO2R13, -C(=O)NR13R13, [0028] -C(=O)R13, or -<CH2) m-(CHOH)n-CH2OH;
[0029] each Z is, independently, CHOH, C(=O), -(CH2)n-,CHNR13R13, C=NR13, or
NR13;
[0030] each R11 is, independently, lower alkyl;
[0031] each R12 is independently, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -CH2-(CHOH)n-CH2OH;
[0032] each R13 is, independently, hydrogen, R7, R10, -(CH2)m-NR13R13, + -(CH2)m- NR13R13R13, -CCH2)m-(CHOR8)m-(CH2)mNR13R13, -(CH2)m-NR,0R10 + -(CH2)m-(CHOR8)m-(CH2)mNR13R,3R13,
Figure imgf000008_0001
-(CH2)„ < N V , -(CH2; — N NR'3
Figure imgf000008_0002
[0033] with the proviso that NRI3R13 can be joined on itself to form a ring comprising one ofthe following:
(CH2)m(CHOR)8 m-(CH2)nR13 ,
(CH2)m(CHOR)8 m-(CH2)nR11 ,
(CH2)m(CHOR)V(CH2)nR11R11 ;
Figure imgf000009_0001
[0034] each Het is independently, -NR13, -S-, -SO-, or -SO2-; -O-, -SO2NR13-, -NHSO2-, -NR13CO-, -CONR13-; [0035] each g is, independently, an integer from 1 to 6; [0036] each m is, independently, an integer from 1 to 7; [0037] each n is, independently, an integer from 0 to 7; [0038] each Q is, independently, C-R5, C-R6, or a nitrogen atom, wherein at [0039] most three Q in a ring are nitrogen atoms;
[0040] each V is, independently, -(CH2)„,-NR7R10, -(CH2)m-NR7R7, -(CH2)m- + NR'V'R11, -(CH2)„-(CHOR8)m-(CH2)mNR7R10, -CCH2)„-NR10R10 + -(CH2)n-(CHOR8)m-(CH2)mNR7R7,-(CH2)n-(CHOR8)m-(CH2)mNR1 !R> 'R1 '
[0041] with the proviso that when V is attached directly to a nitrogen atom, then V can also be, independently, R7, R10, or (Ru)2; [0042] wherein for any ofthe above compounds when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1 ,3-dioxolane, or a pharmaceutically acceptable salt thereof to an individual in need of prophylactic treatment against infection from one or more airborne pathogens.
[0043] In another embodiment, a prophylactic treatment method is provided comprising administering a prophylactically effective amount of a sodium channel blocker according to Formula II:
Figure imgf000010_0001
where
[0044] X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl;
[0045] Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R )2;
[0046] R1 is hydrogen or lower alkyl;
[0047] each R2 is, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10,
-(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8,
-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R,0, -(CH2)n-Zg-R7,-(CH2)m- NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)„-CO2R7, or
Figure imgf000010_0002
[0048] R3 and R4 are each, independently, hydrogen, a group represented by formula (A'), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R3 and R4 is a group represented by formula (A1): — (C(RL)2)0--X-(C(RL)2)P--CR5'R6'R6' (A') where [0049] each RL is, independently, -R7, -(CH2)n-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R,0 5 -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R,(), -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR,0-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000011_0001
[0050] each o is, independently, an integer from 0 to 10; [0051] each p is an integer from 0 to 10;
[0052] with the proviso that the sum of o and p in each contiguous chain is from 1 to 10;
[0053] each x is, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond;
[0054] each R5' is, independently, -O-(CH2)m-OR8, -(CH2)„-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)„-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)„-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)tn-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000012_0001
[0055] each R5' is also, independently, -(CH2)n-NR12R12, -O-(CH2)m-NR12R12,
-O-(CH2)n-NR12R12, -O-(CH2)m-(Z)gR12, -(CH2)nNR11Rπ, -O-(CH2)mNRπRπ, -(CH2)n-N®-(Rn)3, -O-(CH2)m-N*-(Rn)3, -(CH2)„-(Z)g-(CH2)m-NR10R10, -O-(CH2)m- (Z)g-(CH2)m-NR10R10, -(CH2CH2O)m-CH2CH2NR12R12, -O-(CH2CH2O)m-
CH2CH2NR,2R12, -(CH2)n-(C=O)NR,2R12, -O-(CH2)m-(C=O)NR12R12,-O-(CH2)m- (CHOR8)mCH2NR10-(Z)g-R10, -(CH2)n-(CHOR8)mCH2-NR10-(Z)g-R10, -(CH2)nNR10- O(CH2)m(CHOR8)nCH2NR10-(Z)g-R10, -O(CH2)m-NR10-(CH2)m-(CHOR8)nCH2NR10- (Z)g-R10, -(Het)-(CH2)m-OR8, -(Het)-(CH2)m-NR7R10, -(Het)- (CH2)m(CHOR8)(CHOR8)„-CH2OR8, -(Het)-(CH2CH2O)m-R8, -(Het)-(CH2CH2O)m- CH2CH2NR7R10, -(Het)-(CH2)m-C(=O)NR7R10,-(Het)-(CH2)m-(Z)g-R7, -(Het)- (CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(Het)-(CH2)m-CO2R7, -(Het)- (CH2)m-NRI RI2, -(Het)-(CH2)n-NR12R12, -(Het)-(CH2)m-(Z)gR12, -(Het)- (CH2)mNR11R11, -(Het)-(CH2)m-N Rn)3, -(Het)-(CH2)m-(Z)g-(CH2)m-NR10R10, - (Het)-(CH2CH2O)m-CH2CH2NR12R12, -(Het)-(CH2)m-(C=O)NR12R12, -(Het)-(CH2)m- (CHOR8)mCH2NR10-(Z)g-R10, -(Het)-(CH2)m-NR10-(CH2)m-(CHOR8)πCH2NR,0-(Z)g- R10, [0056] wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane,
[0057] -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two - CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane,
[0058] -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two - CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, [0059] -(CH2)n-NR10-CH2(CHOR8)(CHOR8)„-CH2OR8, with the proviso that at least two -CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, or [0060] -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; [0061] wherein each R5 is also, independently,
Link -(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)„- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)„-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)n-(CHOR8)mCH2-NR1 -(Z)g-CAP, Link -(CH2)nNR,3-(CH2)m(CHOR8)nCH2NR,3-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR13-(CH2)m-C(=O)NR10R10, Link -CCH2)m-C(=O)NR13-(CH2)m-CAP, Link -(CH2)m-C(=O)NRl lRn, Link -(CH2)m-C(=O)NR12R12 5 Link — (CH2) n-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP; [0062] wherein Link is, independently,
-O-, (CH2)„-, -O(CH2)m-, -NR13-C(=O)-NR13, -NRI3-C(=O)-(CH2)m-, -C(=O)NR13-(CH2)m, -(CH2)n-Zg-(CH2)n) -S-, -SO-, -SO2-, SO2NR7-, SO2NR10-, -Het-;
[0063] wherein each CAP is, independently,
thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R1 R13 , heteroaryl-CAP, -CN, -O-C(=S)NR13 R13, -ZgR13, -CR10(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N RI3Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(R13R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides,
Figure imgf000014_0001
[0064] wherein Ar is, independently, phenyl; substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH3, NR13R13, Cl, F, CH3; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic nng systems as defined below;
[0065] wherein heteroaryl is selected from one ofthe following heteroaromatic systems:
Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole, Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline, Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1 ,2,4-Triazine, 1,3,5- Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
[0066] wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane, [0067] each R6' is, independently, -R5', -R7, -OR8, -N(R7)2, -(CH2)m-OR8, -O-(CH2)m-OR?, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)πι-C(=O)NR7R10,-(CH2)n-(Z)g-R7,-O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)„-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000015_0001
[0068] wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1 ,3-dioxolane; [0069] each R7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH2(CHOR)8 m-R10;
[0070] each R8 is, independently, hydrogen, lower alkyl, -C(=O)-Rn, glucuronide, 2-tetrahydropyranyl, or
Figure imgf000015_0002
[0071] each R9 is, independently, -CO2R13, -CON(R13)2) -SO2CH2R13, or -C(=O)R13; [0072] each R10 is, independently, -H, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -(CH2) m-(CHOH)n-CH2OH; [0073] each Z is, independently, CHOH, C(=O), -(CH2)n-,CHNR13R13, C=NR13, or NR13; [0074] each R11 is, independently, lower alkyl;
[0075] each R12 is independently, -SO2CH3, -CO2R13, -C(=O)NRI3R13, -C(=O)R13, or -CH2-(CHOH)n-CH2OH;
[0076] each R13 is, independently, hydrogen, R7, R10, -(CH2)m-NRI3R13, + -(CH2)m- NR,3R13R13, -(CH2)m-(CHOR8)m-(CH2)mNR13R13, -(CH2)m-NR,0R'°
Figure imgf000016_0001
(CH2)n <v /) , , or
Figure imgf000016_0002
Figure imgf000016_0003
[0077] with the proviso that NRI3R13 can be joined on itself to form a ring comprising one ofthe following:
Figure imgf000017_0001
\ /N (CH2)m(CHOR)8 m-(CH2)nR13
(CH2)m(CHOR)8 m-(CH2)nR11R11 ;
Figure imgf000017_0002
[0078] each Het is independently, -NR13, -S-, -SO-, or -SO2-; -O-, -SO2NR13-, -NHSO2-, -NR13CO-, -CONR13-;
[0079] each g is, independently, an integer from 1 to 6;
[0080] each m is, independently, an integer from 1 to 7;
[0081] each n is, independently, an integer from 0 to 7;
[0082] each V is, independently, -CCH2)m-NR7R10, -(CH2)m-NR7R7, -(CH2)m- + NRnRnRn, -(CH2)n-(CHOR8)m-(CH2)mNR7R10, -(CH2)n-NR10R10 + -(CH2)„-(CHOR8)m-(CH2)mNR7R7,-(CH2)π-(CHOR8)m-(CH2)mNR1 'R1 'R1 ' with the proviso that when V is attached directly to a nitrogen atom, then V can also be, independently, R7, R10, or (Rπ)2;
[0083] wherein for any ofthe above compounds when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof to an individual in need of prophylactic treatment against infection from one or more airborne pathogens.
[0084] In another embodiment, a prophylactic treatment method is provided comprising administering a prophylactically effective amount of a sodium channel blocker according to Formula III:
Figure imgf000018_0001
where
[0085] X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl;
[0086] Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R )2;
[0087] R1 is hydrogen or lower alkyl;
[0088] each R2 is, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8,
-(CH2CH2θ)m-CH2CH2NR7RI0, -(CH2)n-C(-O)NR7R10, -(CH2)π-Zg-R7,-(CH2)m-
NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)„-CO2R7, or
Figure imgf000018_0002
[0089] R3 and R4 are each, independently, hydrogen, a group represented by formula (A"), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)-lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl-lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R3° and R4" is a group represented by formula (A"):
-(C(RL)2)o-χ-(C(R )2) - (A")
Figure imgf000019_0001
where [0090] each RL is, independently, -R7, -(CH2)n-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10 5 -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)„-C(=O)NR7R10, -O-(CH2)m-C(=0)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)„-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000019_0002
[0091] each o is, independently, an integer from 0 to 10; [0092] each p is an integer from 0 to 10;
[0093] with the proviso that the sum of o and p in each contiguous chain is from 1 to 10;
[0094] each x is, independently, O, NR10, C(=O), CHOH, C(=N-R10), [0095] CHNR7R10, or represents a single bond;
[0096] each R5' is, independently, independently, -O-(CH2)m-OR8, -(CH2)„-NR7R10 5 -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8χCHOR8)n-CH2θR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000020_0001
[0097] each R5' is also, independently, -(CH2)n-NR12R12, -O-(CH2)m-NR12R12,
-O-(CH2)n-NR12R12, -O-(CH2)m-(Z)gR12, -(CH2)n uRH, -O-(CH2)mNRHRn, - (CH2)n-N®-(Rn)3, -O-(CH2)m-N®-(Ru)3, -(CH2)n-(Z)g-(CH2)m-NR10R10, -O-(CH2)„
(Z)g-(CH2)m-NR,0R10, -(CH2CH2O)m-CH2CH2NR12R12, -O-(CH2CH2O) m
Figure imgf000020_0002
(CHOR8)mCH2NR,0-(Z)g-R10, -(CH2)„-(CHOR8)mCH2-NR10-(Z)g-R10, -(CH2)„NR10- O(CH2)m(CHOR8)nCH2NR10-(Z)g-R10, -O(CH2)m-NR10-(CH2)m-(CHOR8)nCH2NR10- (Z)g-R10, -(Het)-(CH2)m-OR8, -(Het)-(CH2)m-NR7R10, -(Het)- (CH2)m(CHOR8)(CHOR8)n-CH2θR8, -(Het)-(CH2CH2θ)m-R8, -(Het)-(CH2CH2O)m- CH2CH2NR7R10, -(Het)-(CH2)m-C(=O)NR7R10,-(Het)-(CH2)m-(Z)g-R7, -(Het)- (CH2)m-NR,0-CH2(CHOR8)(CHOR8)n-CH2OR8, -(Het)-(CH2)m-CO2R7, -(Het)- (CH2)m-NR12R12, -(Het)-(CH2)„-NR12R12, -(Het)-(CH2)m-(Z)gR12, -(Het)- (CH2)mNRuRn, -(Het)-(CH2)m-N®-(Rn)3, -(Het)-(CH2)m-(Z)g-(CH2)m-NR10R10, - (Het)-(CH2CH2O)m-CH2CH2NR12R12, -(Het)-(CH2)m-(C=O)NR,2R12, -(Het)-(CH2)m- (CHOR8)mCH2NR10-(Z)g-R10, -(Het)-(CH2)m-NR10-(CH2)m-(CHOR8)nCH2 R10-(Z)g- R10,
[0098] wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane, [0099] -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -
CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane,
[0100] -O-(CH2)m(CHOR8χCHOR8)n-CH2OR8, with the proviso that at least two - CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane,
[0101] -(CH2)n-NR,0-CH2(CHOR8XCHOR8)n-CH2OR8, with the proviso that at least two -CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, or [0102] -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; [0103] wherein each R5 is also, independently, Link -(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)„- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)n-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)n-(CHOR8)mCH2-NR13-(Z)g-CAP, Link -(CH2)nNR13-(CH2)m(CHOR8)nCH2NR13-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR,3-(CH2)m-C(=O)NR10R10, Link -(CH2)m-C(=O)NR13-(CH2)m-CAP, Link -(CH2)m-C(=O)NR, 1R11, Link -(CH2)m-C(=O)NR12R12, Link -(CH2) n-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP;
[0104] wherein Link is, independently,
-O-, (CH2)n-, -O(CH2)m-,-NR13-C(=O)-NR13, -NR13-C(=O)-(CH2)m-, - C(=O)NR13-(CH2)m, -(CH2)n-Zg-(CH2)n,-S-,-SO-,-SO2-, SO2NR7-, SO2NR10-, -Het-; [0105] wherein each CAP is, independently,
thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R13 R13 ,heteroaryl-CAP, -CN, -O-C(=S)NR13 R13, -ZεR13, -CR10(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N RI3Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(RI3R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides,
CONR13R1
Figure imgf000022_0001
[0106] wherein Ar is, independently, phenyl; Substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH3, NR13R13, Cl, F, CH3; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic ring systems as defined below;
[0107] wherein heteroaryl is selected from one ofthe following heteroaromatic systems:
Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole,
Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline, Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1 ,2,4-Triazine, 1,3,5- Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
[0108] wherein when two -(CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane;
[0109] each R6' is, independently, -R5', -R7, -OR8, -N(R7)2, -(CH2)m-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R,(), -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10,-(CH2)n-(Z)g-R7,-O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000023_0001
[0110] wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane;
[0111] each R7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH2(CHOR)8 m-R10;
[0112] each R8 is, independently, hydrogen, lower alkyl, -C(=O)-R", glucuronide, 2-tetrahydropyranyl, or
Figure imgf000023_0002
[0113] each R9 is, independently, -CO2R13, -CON(R13)2, -SO2CH2R13, or -C(=O)R13;
[0114] each R10 is, independently, -H, -SO2CH3, -CO2R13, -C(=O)NR13R13,
C(=O)R13, or -(CH2) m-(CHOH)n-CH2OH;
[0115] each Z is, independently, CHOH, C(=O), -(CH2)n-,CHNRI3R13, C=NR13, or NR13;
[0116] each R11 is, independently, lower alkyl;
[0117] each R12 is independently, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -CH2-(CHOH)n-CH2OH;
[0118] each R13 is, independently, hydrogen, R7, R10, -(CH2)m-NR13R13, + -(CH2)m- NR13R13R13, -(CH2)m-(CHOR8)m-(CH2)mNR13R13, -(CH2)m-NR,0R10 + -(CH2)m-(CHOR8)m-(CH2)mNR13RI3R13,
Figure imgf000024_0001
"(CH2)n <v /) V , _(CH2). N NR13 , or
Figure imgf000024_0002
[0119] with the proviso that NR13R13 can be joined on itself to form a ring
comprising one ofthe following:
Figure imgf000025_0001
-N Λ N (CH2)m(CHOR) ,8 m-(CH2)nR „11 .
(CH2)m(CHOR)8 m-(CH2)nR11R11 ;
Figure imgf000025_0002
[0120] each Het is independently, -NR13, -S-, -SO-, or -SO2-; -O-, -SO2NR13-,
-NHSO2-, -NR13CO-, -CONR13-;
[0121] each g is, independently, an integer from 1 to 6;
[0122] each m is, independently, an integer from 1 to 7;
[0123] each n is, independently, an integer from 0 to 7;
[0124] each Q' is, independently, -CR6R5', -CR6'R6', N, -NR13, -S-, -SO-, or -SO2-; [0125] wherein at most three Q' in a ring contain a heteroatom and at least one Q' must be -CR5'R6' or NR5';
[0126] each V is, independently, -(CH2)m-NR7R10, -{CH2)m-NR7R7, -(CH2)m- + NRnRπRπ, -(CH2)n-(CHOR8)m-(CH2)mNR7R10, -(CH^n-NR' 0
+ -(CH2)n-(CHOR8)m-(CH2)mNR7R7,-(CH2)n-(CHOR8)m-(CH2)mNR11R11R11 with the proviso that when V is attached directly to a nitrogen atom, then V can also be, independently, R7, R10, or (Rπ)2; wherein for any ofthe above compounds when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof, to an individual in need of prophylactic treatment against infection from one or more airborne pathogens. [0127] In another embodiment, a prophylactic treatment method is provided for reducing the risk of infection from an airborne pathogen which can cause a disease in a human, said method comprising administering an effective amount of a sodium channel blocker of Formula I, II or III, or a pharmaceutically acceptable salt thereof, to the lungs ofthe human who may be at risk of infection from the airborne pathogen but is asymptomatic for the disease, wherein the effective amount ofa sodium channel blocker or a pharmaceutically acceptable salt is sufficient to reduce the risk of infection in the human.
[0128] In another embodiment, a post-exposure prophylactic treatment or therapeutic treatment method is provided for treating infection from an airborne pathogen comprising administering an effective amount of a sodium channel blocker of Formula I, II or III, or a pharmaceutically acceptable salt thereof to the lungs of an individual in need of such treatment against infection from an airborne pathogen.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0129] The prophylactic or therapeutic treatment methods ofthe present invention may be used in situations where a segment ofthe population has been, or is believed to have been, exposed to one or more airborne pathogens. The prophylactic or therapeutic treatment methods may additionally be used in situations of ongoing risk of exposure to or infection from airborne pathogens. Such situations may arise due to naturally occurring pathogens or may arise due to a bioterrorism event wherein a segment ofthe population is intentionally exposed to one or more pathogens. The individuals or portion ofthe population believed to be at risk from infection can be treated according to the methods disclosed herein. Such treatment preferably will commence at the earliest possible time, either prior to exposure if imminent exposure to a pathogen is anticipated or possible or after the actual or suspected exposure. Typically, the prophylactic treatment methods will be used on humans asymptomatic for the disease for which the human is believed to be at risk. The term "asymptomatic" as used herein means not exhibiting medically recognized symptoms ofthe disease, not yet suffering from infection or disease from exposure to the airborne pathogens, or not yet testing positive for a disease. The treatment methods may involve post-exposure prophylactic or therapeutic treatment, as needed.
[0130] Many ofthe pathogenic agents identified by NIAID have been or are capable of being aerosolized such that they may enter the body through the mouth or nose, moving into the bodily airways and lungs. These areas ofthe body have mucosal surfaces which naturally serve, in part, to defend against foreign agents entering the body. The mucosal surfaces at the interface between the environment and the body have evolved a number of "innate defense", i.e., protective mechanisms. A principal form of such innate defense is to cleanse these surfaces with liquid. Typically, the quantity ofthe liquid layer on a mucosal surface reflects the balance between epithelial liquid secretion, often reflecting anion (Cl" and/or HCO3 ") secretion coupled with water (and a cation counter-ion), and epithelial liquid absorption, often reflecting Na+ absorption, coupled with water and counter anion (Cf and/or HCO3 "). [0131] R. C. Boucher, in U.S. Patent No. 6,264,975, describes methods of hydrating mucosal surfaces, particularly nasal airway surfaces, by administration of pyrazinoylguanidine sodium channel blockers. These compounds, typified by amiloride, benzamil and phenamil, are effective for hydration ofthe mucosal surfaces. U.S. Patent No. 5,656,256, describes methods of hydrating mucous secretions in the lungs by administration of benzamil or phenamil, for example, to treat diseases such as cystic fibrosis and chronic bronchitis. U.S. Patent No. 5,725,842 is directed to methods of removing retained mucus secretions from the lungs by administration of amiloride.
[0132] It has now been discovered that certain sodium channel blockers which are classes of pyrazinoylguanidine compounds described and exemplified herein as Formulas I, II and III, and in U.S. Provisional Patent Applications 60/495,725, filed August 19, 2003, 60/495,712, filed August 19, 2003 and 60/495,720, filed August 19, 2003, incorporated herein in their entirety, may be used in prophylactic treatment methods to protect humans in whole or in part, against the risk of infection from pathogens which may or may not have been purposely introduced into the environment, typically into the air, of a populated area. Such treatment may be effectively used to protect those who may have been exposed where a vaccine is not available or has not been provided to the population exposed and/or in situations where treatments for the infection resulting from the pathogen to which a population has been subjected are insufficient or unavailable altogether. [0133] Without being bound by any theory, it is believed that the sodium channel blockers disclosed herein surprisingly may be used on substantially normal or healthy lung tissue to prevent or reduce the uptake of airborne pathogens and/or to clear the lungs of all or at least a portion of such pathogens. Preferably, the sodium channel blockers will prevent or reduce the viral or bacterial uptake of airborne pathogens. The ability of sodium channel blockers to hydrate mucosal surfaces is believed to function to first hydrate lung mucous secretions, including mucous containing the airborne pathogens to which the human has been subjected, and then facilitate the removal ofthe lung mucous secretions from the body. By functioning to remove the lung mucous secretions from the body, the sodium channel blocker thus prevents or, at least, reduces the risk of infection from the pathogen(s) inhaled or brought into the body through a bodily airway. [0134] The present invention is concerned primarily with the prophylactic, post exposure, rescue and therapeutic treatment of human subjects, but may also be employed for the treatment of other mammalian subjects, such as dogs and cats, for veterinary purposes, and to the extent the mammals are at risk of infection or disease from airborne pathogens. [0135] The term "airway" as used herein refers to all airways in the respiratory system such as those accessible from the mouth or nose, including below the larynx and in the lungs, as well as air passages in the head, including the sinuses, in the region above the larynx. [0136] The terms "pathogen" and "pathogenic agent" are interchangeable and, as used herein, means any agent that can cause disease or a toxic substance produced by a pathogen that causes disease. Typically, the pathogenic agent will be a living organism that can cause disease. By way of example, a pathogen may be any microorganism such as bacterium, protozoan or virus that can cause disease. [0137] The term "airborne pathogen" means any pathogen which is capable of being transmitted through the air and includes pathogens which travel through air by way ofa carrier material and pathogens either artificially aerosolized or naturally occurring in the air.
[0138] The term "prophylactic" as used herein means the prevention of infection, the delay of infection, the inhibition of infection and/or the reduction ofthe risk of infection from pathogens and includes pre- and post-exposure to pathogens. The prophylactic effect may, wter alia, involve a reduction in the ability of pathogens to enter the body, or may involve the removal of all or a portion of pathogens which reach airways and airway surfaces in the body from the body prior to the pathogens initiating or causing infection or disease. The airways from which pathogens may be removed, in whole or part, include all bodily airways and airway surfaces with mucosal surfaces, including airway surfaces in the lungs.
[0139] The term "therapeutic" as used herein means to alleviate disease or infection from pathogens.
[0140] The compounds useful in this invention include sodium channel blockers such as those represented by Formulas I, II and III. The sodium channel blockers disclosed may be prepared by the procedures described herein, in combination with procedures known to those skilled in the art.
[0141] The term sodium channel blocker as used herein includes the free base and pharmaceutically acceptable salts thereof. Pharmaceutically acceptable salts are salts that retain the desired biological activity ofthe parent compound and do not impart undesired toxicological effects. Examples of such salts are (a) acid addition salts formed with inorganic acids, for example, hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid and the like; (b) salts formed with organic acids such as, for example, acetic acid, oxalic acid, tartaric acid, succinic acid, maleic acid, fumaric acid, gluconic acid, citric acid, malic acid, ascorbic acid, benzoic acid, tannic acid, palmitic acid, alginic acid, polyglutamic acid, naphthalenesulfonic acid, methanesulfonic acid, p-toluenesulfonic acid, naphthalenedisulfonic acid, polygalacturonic acid, malonic acid, sulfosalicylic acid, glycolic acid, 2-hydroxy-3-naphthoate, pamoate, salicylic acid, stearic acid, phthalic acid, mandelic acid, lactic acid and the like; and (c) salts formed from elemental anions for example, chlorine, bromine, and iodine. [0142] It is to be noted that all enantiomers, diastereomers, and racemic mixtures of compounds within the scope of formulas (I), (II) and (III) are embraced by the present invention and are included within any reference to Formulas (I), (II) or (III) or compounds thereof. Additionally, all mixtures of such enantiomers and diastereomers are within the scope ofthe present invention and are included within any reference to Formulas (I), (II) or (III) or compounds thereof.
[0143] In the compounds represented by these formulas, examples of halogen include fluorine, chlorine, bromine, and iodine. Chlorine and bromine are the preferred halogens. Chlorine is particularly preferred. This description is applicable to the term "halogen" as used throughout the present disclosure. [0144] As used herein, the term "lower alkyl" means an alkyl group having less than 8 carbon atoms. This range includes all specific values of carbon atoms and subranges there between, such as 1 ,2, 3, 4, 5, 6, and 7 carbon atoms. The term "alkyl" embraces all types of such groups, e.g., linear, branched, and cyclic alkyl groups. This description is applicable to the term "lower alkyl" as used throughout the present disclosure. Examples of suitable lower alkyl groups include methyl, ethyl, propyl, cyclopropyl, butyl, isobutyl, etc.
[0145] As to Formula I, Y may be hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, lower cycloalkyl, mononuclear aryl, or - N(R2)2. The alkyl moiety ofthe lower alkoxy groups is the same as described above. Examples of mononuclear aryl include phenyl groups. The phenyl group may be unsubstituted or substituted as described above. The preferred identity of Y is - N(R2)2. Particularly preferred are such compounds where each R2 is hydrogen. [0146] R1 may be hydrogen or lower alkyl. Hydrogen is preferred for R1. [0147] Each R2 may be, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10, -(CH2)π(CHOR8)(CHOR8)„-CH2OR8, -(CH2CH2O)m-R8, -(CH2CH2O)m- CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -(CH2)n-Zg-R7,-(CH2)m-NR10- CH2(CHOR8)(CHOR8)„-CH2OR8, -(CH2)n-CO2R7, or
Figure imgf000031_0001
[0148] Hydrogen and lower alkyl, particularly C1-C3 alkyl are preferred for R2. Hydrogen is particularly preferred.
[0149] R3 and R4 may be, independently, hydrogen, a group represented by formula (A), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl-lower alkyl, provided that at least one of R3 and R4 is a group represented by formula (A).
[0150] Preferred compounds are those where one of R3 and R4 is hydrogen and the other is represented by formula (A). [0151] In formula (A), the moiety -(C(R )2)0-x-(C(RL)2)p- defines an alkylene group bonded to the aromatic ring. The variables o and p may each be an integer from 0 to 10, subject to the proviso that the sum of o and p in the chain is from 1 to 10. Thus, o and p may each be 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10. Preferably, the sum of o and p is from 2 to 6. In a particularly preferred embodiment of Formula I, the sum of o and p is 4. [0152] The linking group in the alkylene chain, x, may be, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond; therefore, when x represents a single bond, the alkylene chain bonded to the ring is represented by the formula -(C(RL)2)0+P-, in which the sum o+p is from 1 to 10. [0153] Each RL in Formula I may be, independently, -R7, -(CH2)n-OR8, -O-(CH2)m- OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O- (CH2)m(CHOR8XCHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n- C(=O)NR7R10, -O-(CH2)ra-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, - (CH2)„-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10- CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O- glucuronide, -O-glucose,
Figure imgf000032_0001
[0154] The preferred RL groups for Formula I include -H, -OH, -N(R7)2, especially where each R7 is hydrogen.
[0155] In the alkylene chain in formula (A), it is preferred that when one RL group bonded to a carbon atoms is other than hydrogen, then the other RL bonded to that carbon atom is hydrogen, i.e., the formula -CHRL-. It is also preferred that at most two RL groups in an alkylene chain are other than hydrogen, where in the other RL groups in the chain are hydrogens. Even more preferably, only one RL group in an alkylene chain is other than hydrogen, where in the other RL groups in the chain are hydrogens. In these embodiments, it is preferable that x represents a single bond. [0156] In another particular embodiment of Formula I, all ofthe RL groups in the alkylene chain are hydrogen. In these embodiments, the alkylene chain is represented by the formula
Figure imgf000032_0002
[0157] In Formula I, each R5 is, independently, Link-(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)n- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)n-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)π-(CHOR8)mCH2-NR13-(Z)g-CAP, Link -(CH2)nNR13-(CH2)m(CHOR8)„CH2NR13-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR13-(CH2)m-C(=O)NR10R10, Link -(CH2)m-C(=O)NR13-(CH2)m-CAP, Link -(CH2)m-C(=O)NRuRπ, Link -{CH2)m-C(0)NR12R12, Link -(CH2) „-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP;
[0158] wherein Link is, independently, -O-, (CH2)n-, -O(CH2)m-,-NR13-C(=O)-NR13, -NR13-C(=O)-(CH2)m-, - C(=O)NR13-(CH2)m, -(CH2)n-Zg-(CH2)„,-S-,-SO-,-SO2-, SO2NR7-, SO2NR10-, -Het-;
[0159] wherein each CAP is, independently,
thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R R , heteroaryl-CAP,
-CN, -O-C(=S)NR13 R13, -ZgR13, -CR10(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N R13Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(R13R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides,
Figure imgf000033_0001
[0160] wherein Ar is, independently, phenyl; Substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH3, NR R , Cl, F, CH3; heteroaryl, e.g., pyridine, pyrazine, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione and imidazoyl ( A ) and other heteroaromatic ring systems as defined below;
[0161] wherein heteroaryl is selected from one ofthe following heteroaromatic systems: Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole, Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline,
Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1 ,2,4-Triazine, 1,3,5-
Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
[0162] each R6 is, independently, -R7, -OR7,-ORπ, -N(R7)2, -(CH2)m-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R'°, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)„-
CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)„-NR ' 1,0υ- rCXHJ2 f(nCτHrθ\πR&8)(mCHιrO\τR>t8)n-CH2ORδ, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000034_0001
[0163] where when two R6 are -OR11 and are located adjacent to each other on a phenyl ring, the alkyl moieties ofthe two R6 may be bonded together to form a methylenedioxy group;
[0164] with the proviso that when at least two -CH2OR are located adjacent to each other, the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane.
[0165] In addition, one of more ofthe R6 groups can be one ofthe R5 groups which fall within the broad definition of R6 set forth above.
[0166] When two R6 are -OR11 and are located adjacent to each other on a phenyl ring, the alkyl moieties ofthe two R6 groups may be bonded together to form a methylenedioxy group, i.e., a group ofthe formula -O-CH2-O-.
[0167] As discussed above, R6 may be hydrogen. Therefore, 1, 2, 3, or 4 R6 groups may be other than hydrogen. Preferably at most 3 ofthe R6 groups are other than hydrogen. [0168] Each g is, independently, an integer from 1 to 6. Therefore, each g may be 1,
2, 3, 4, 5, or 6.
[0169] Each m is an integer from 1 to 7. Therefore, each m may be 1, 2, 3, 4, 5, 6, or 7.
[0170] Each n is an integer from 0 to 7. Therefore, each n may be 0, 1 , 2, 3, 4, 5, 6, or 7.
[0171] Each Q in formula (A) is C-R5, C-R6, or a nitrogen atom, where at most three
Q in a ring are nitrogen atoms. Thus, there may be 1, 2, or 3 nitrogen atoms in a ring. Preferably, at most two Q are nitrogen atoms. More preferably, at most one Q is a nitrogen atom. In one particular embodiment, the nitrogen atom is at the 3- position ofthe ring. In another embodiment ofthe invention, each Q is either C-R5 or C-R6, i.e., there are no nitrogen atoms in the ring.
[0172] More specific examples of suitable groups represented by formula (A) are shown in formulas (B)-(E) below:
Figure imgf000035_0001
where o, x, p, R5, and R6, are as defined above;
•
Figure imgf000035_0002
where n is an integer from 1 to 10 and R5 is as defined above;
Figure imgf000035_0003
where n is an integer from 1 from 10 and R5 is as defined above;
Figure imgf000035_0004
where o, x, p, and R5 are as defined above.
[0173 In a preferred embodiment of Formula I, Y is -NH2. [0174 In another preferred embodiment of Formula I, R2 is hydrogen. [0175 In another preferred embodiment of Formula I, R1 is hydrogen. [0176 In another preferred embodiment of Formula I, X is chlorine. [0177 In another preferred embodiment of Formula I, R3 is hydrogen. [0178 In another preferred embodiment of Formula I, RL is hydrogen. [0179 In another preferred embodiment of Formula I, o is 4. [0180 In another preferred embodiment of Formula I, p is 0. [0181 In another preferred embodiment of Formula I, the sum of o and p is 4. [0182 In another preferred embodiment of Formula I, x represents a single bond. [0183 In another preferred embodiment of Formula I, R6 is hydrogen. [0184] In another preferred embodiment of Formula I, at most one Q is a nitrogen atom.
[0185] In another preferred embodiment of Formula I, no Q is a nitrogen atom. [0186] In a preferred embodiment of Formula I: X is halogen; Y is -N(R7)2; R1 is hydrogen or C1-C3 alkyl; R2 is -R7, -OR7, CH2OR7, or -CO2R7; R3 is a group represented by formula (A); and R4 is hydrogen, a group represented by formula (A), or lower alkyl.
[0187] In another preferred embodiment of Formula I: X is chloro or bromo; Y is -N(R7)2; R2 is hydrogen or C1-C3 alkyl; at most three R6 are other than hydrogen as described above; at most three RL are other than hydrogen as described above; and at most 2 Q are nitrogen atoms. [0188] In another preferred embodiment of Formula I: Y is -NH2. [0189] In another preferred embodiment of Formula I: R4 is hydrogen; at most one RL is other than hydrogen as described above; at most two R6 are other than hydrogen as described above; and at most 1 Q is a nitrogen atom. [0190] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000036_0001
[0191] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000037_0001
[0192] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000037_0002
[0193] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000037_0003
[0194] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000037_0004
[0195] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000037_0005
[0196] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000038_0001
[0197] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000038_0002
[0198] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000038_0003
[0199] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000038_0004
[0200] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000039_0001
[0201] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000039_0002
[0202] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000039_0003
[0203] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000039_0004
[0204] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000039_0005
[0205] In another preferred embodiment, the compound of formula (I) is represented by the formula
Figure imgf000040_0001
[0206] In another preferred embodiment, the compound of formula (I) is represented by the formula:
[0207] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000040_0003
[0208] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000040_0004
[0209] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000041_0001
[0210] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000041_0002
[0211] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000041_0003
[0212] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000041_0004
[0213] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000042_0001
[0214] In another preferred embodiment, the compound of formula (I) is represented by the formula:
Figure imgf000042_0002
[0215] As to Formula II, in a preferred embodiment, each -(CH2)n-(Z)g-R7 falls within the scope ofthe structures described above and is, independently, -(CH2)n-(C=N)-NH2, -(CH2)n-NH-C(=NH)NH2, -(CH2)n-CONHCH2(CHOH)n-CH2OH, -NH-C(=O)-CH2-(CHOH)nCH2OH.
[0216] In another a preferred embodiment of Formula II, each -O-(CH2)m-(Z)g-R7 falls within the scope ofthe structures described above and is, independently, -O-(CH2)M-NH-C(=NH)-N(R7)2, -O-(CH2)m-CHNH2-CO2NR7R10
[0217] In another preferred embodiment of Formula II, each R5 falls within the scope ofthe structures described above and is, independently, -O-CH2CHOHCH2O-glucuronide, -OCH2CHOHCH3, -OCH2CH2NH2, -OCH2CH2NHCO(CH3)3, -CH2CH2OH, -OCH2CH2OH, -O-(CH2)m-Boc, -(CH2)m-Boc, -OCH2CH2OH, -OCH2CO2H,
-O-(CH2)m-NH-C(=NH)-N(R7)2,
-(CH2)n-NH-C(=NH)-N(R7)2,
-NHCH2(CHOH)2-CH2OH, -OCH2CO2Et,
Figure imgf000043_0001
-(CH2)m-NH-C(=O)-OR7,
-O-(CH2)m-NH-C(=O)-OR7,
-(CH2)n-NH-C(=O)-Rn, -O-(CH2)m-NH-C(=O)-Rn,
-O-CH2C(=O)NH2,
Figure imgf000043_0002
-NHCO2Et,
-OCH2CH2CH2CH2OH,
Figure imgf000043_0003
-OCH2CH2CHOHCH2OH,
-OCH2CH2NHCO2Et,
-NH-C(=NH2)-NH2,
-OCH2-(o.-CHOH)2-CH2OH -OCH2CHOHCH2NH2,
Figure imgf000043_0004
-(CH2)m-CHOH-CH2-NHBoc, -O-(CH2)m-CHOH-CH2-NHBoc, -(CH2)m-NHC(O)OR7, -O-(CH2)m-NHC(O)OR7,
-OCH2CH2CH2NH2, -OCH2CH2NHCH2(CHOH)2CH2OH, -OCH2CH2NH(CH2[(CHOH)2CH2OH)]2, -(CH2)4-NHBoc, -(CH2)4-NH2, -(CH2)4-OH, -OCH2CH2NHSO2CH3, -O-(CH2)m-C(=NH)-N(R7)2, -(CH2)n-C(=NH)-N(R7)2, -(CH2)3-NH Boc, -(CH2)3NH2, -O-(CH2)m-NH-NH-C(=NH)-N(R7)2, -(CH2)n-NH-NH-C(=NH)-N(R7)2, or -O-CH2-CHOH-CH2-NH-C(=NH)-N(R7)2;
[0218] Preferred examples of R5 in the embodiments of Formula II described above include: -N(SO2CH3)2,
-CH2-CHNHB0CCO2CH3 (α), -O-CH2-CHNH2CO2H (α), -O-CH2-CHNH2CO2CH3 (α),
Figure imgf000044_0001
-C(=O)NH-(CH2)2-NH2, and -C(=O)NH-(CH2)2-NH-C(=NH)-NH2. Preferred examples of R5 also include: -N(SO2CH3)2,
-CH2-CHNHBocCO2CH3 (α), -O-CH2-CHNH2CO2H (α), -O-CH2-CHNH2CO2CH3 (α),
Figure imgf000044_0002
-C(=O)NH-(CH2)2-NH2, -C(=O)NH-(CH2)2-NH-C(=NH)-NH2, and
O— H2C-CH CH — CH3
[0219] In Formula II, the preferred identity of Y is -N(R2)2. Particularly preferred are such compounds where each R2 is hydrogen.
[0220] R1 in Formula II may be hydrogen or lower alkyl. Hydrogen is preferred for R1.
[0221] R3 and R4 may be, independently, hydrogen, a group represented by formula (A'), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- lower alkyl, or pyridyl- lower alkyl, provided that at least one of R3 and R4 is a group represented by formula (A'). [0222] Preferred compounds of Formula II are those where one of R3 and R4 is hydrogen and the other is represented by formula (A1).
[0223] In formula (A'), the moiety -(C(RL)2)0-x-(C(RL)2)p- defines an alkylene group. The variables o and p may each be an integer from 0 to 10, subject to the proviso that the sum of o and p in the chain is from 1 to 10. Thus, o and p may each be 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10. Preferably, the sum of o and p is from 2 to 6. In a particularly preferred embodiment, the sum of o and p is 4.
[0224] The linking group in the alkylene chain of Formula II, x, may be, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond; therefore, when x represents a single bond, the alkylene chain bonded to the ring is represented by the formula -(C(RL)2)0+P-. in which the sum o+p is from 1 to 10.
[0225] The preferred RL groups in Formula II include -H, -OH, -N(R7)2, especially where each R7 is hydrogen.
[0226] In the alkylene chain in formula (A1), it is preferred that when one RL group bonded to a carbon atoms is other than hydrogen, then the other RL bonded to that carbon atom is hydrogen, i.e., the formula -CHRL-. It is also preferred that at most two RL groups in an alkylene chain are other than hydrogen, where in the other RL groups in the chain are hydrogens. Even more preferably, only one RL group in an alkylene chain is other than hydrogen, where in the other RL groups in the chain are hydrogens. In these embodiments, it is preferable that x represents a single bond. [0227] In another particular embodiment of Formula II, all ofthe RL groups in the alkylene chain are hydrogen. In these embodiments, the alkylene chain is represented by the formula
Figure imgf000046_0001
[0228] As discussed above, R6' may be hydrogen. Therefore, 1 or 2 R6 groups may be other than hydrogen. Preferably at most 3 ofthe R6 groups are other than hydrogen.
[0229] Each g is, independently, an integer from 1 to 6. Therefore, each g may be 1,
2, 3, 4, 5, or 6.
[0230] Each m is an integer from 1 to 7. Therefore, each m may be 1, 2, 3, 4, 5, 6, or 7.
[0231] Each n is an integer from 0 to 7. Therefore, each n maybe 0, 1, 2, 3, 4, 5, 6, or 7.
[0232] In a preferred embodiment of Formula II, Y is -NH2.
[0233] In another preferred embodiment of Formula II, R2 is hydrogen. [0234] In another preferred embodiment of Formula II, R1 is hydrogen.
[0235] In another preferred embodiment of Formula II, X is chlorine.
[0236] In another preferred embodiment of Formula II, R3 is hydrogen.
[0237] In another preferred embodiment of Formula II, RL is hydrogen.
[0238] In another preferred embodiment of Formula II, o is 4. [0239] In another preferred embodiment of Formula II, p is 0.
[0240] In another preferred embodiment of Formula II, the sum of o and p is 4.
[0241] In another preferred embodiment of Formula II, x represents a single bond.
[0242] In another preferred embodiment of Formula II, R6 is hydrogen.
[0243] In a preferred embodiment of Formula II: X is halogen; Y is -N(R7)2; R1 is hydrogen or C1-C3 alkyl; R2 is -R7, -OR7, CH2O7, or -CO2R7; R3 is a group represented by formula (A'); and R4 is hydrogen, a group represented by formula (A1), or lower alkyl. [0244] In another preferred embodiment of Formula II: X is chloro or bromo; Y is -N(R7)2; R2 is hydrogen or C1-C3 alkyl; at most three R6' are other than hydrogen as described above; at most three RL are other than hydrogen as described above. [0245] In another preferred embodiment of Formula II: Y is -NH2. [0246] In another preferred embodiment of Formula II: R4 is hydrogen; at most one RL is other than hydrogen as described above; at most two R6 are other than hydrogen as described above. In another preferred embodiment, formula (II) is represented by the formula:
Figure imgf000047_0001
[0247] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000047_0002
[0248] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000047_0003
[0249] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000047_0004
[0250] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000048_0001
[0251] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000048_0002
[0252] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000048_0003
[0253] In another preferred embodiment, the compound of formula (II) is represented by the formula: 0-CH2-(βetaCHOH)-CH2OH
Figure imgf000048_0004
[0254] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000048_0005
[0255] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000048_0006
[0256] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000049_0001
[0257] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000049_0002
[0258] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000049_0003
[0259] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000049_0004
[0260] In another preferred embodiment, the compound of formula (II) is represented by the formula: OCH2CHOHCH2NH2
Figure imgf000049_0005
[0261] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000049_0006
[0262] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000050_0001
[0263] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000050_0002
[0264] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000050_0003
[0265] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000050_0004
[0266] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000050_0005
[0267] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000050_0006
[0268] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000051_0001
[0269] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000051_0002
[0270] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000051_0003
[0271] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000051_0004
[0272] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000051_0005
[0273] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000052_0001
[0274] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000052_0002
[0275] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000052_0003
[0276] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000052_0004
[0277] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000052_0005
[0278] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000053_0001
[0279] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000053_0002
[0280] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000053_0003
[0281] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000053_0004
[0282] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000053_0005
[0283] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000053_0006
[0284] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000054_0001
[0285] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000054_0002
[0286] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000054_0003
[0287] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000054_0004
[0288] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000054_0005
[0289] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000054_0006
' " "
[0290] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000055_0001
[0291] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000055_0002
[0292] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000055_0003
[0293] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000055_0004
[0294] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000055_0005
[0295] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000056_0001
[0296] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000056_0002
[0297] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000056_0003
[0298] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000056_0004
[0299] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000056_0005
[0300] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000056_0006
[0301] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000057_0001
[0302] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000057_0002
[0303] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000057_0003
[0304] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000057_0004
[0305] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000057_0005
[0306] In another preferred embodiment, the compound of formula (II) is represented by the formula:
Figure imgf000058_0001
[0307] As to Formula III, in a preferred embodiment, each -(CH2)n-(Z)g-R7 falls within the scope ofthe structures described above and is, independently, -(CH2)„-(C=N)-NH2,, -(CH2)n-NH-C(=NH)NH2, -(CH2)n-CONHCH2(CHOH)n-CH2OH, -NH-C(=O)-CH2-(CHOH)nCH2OH. [0308] In another a preferred embodiment of Formula III, each -O-(CH2)m-(Z)g-R7 falls within the scope ofthe structures described above and is, independently, -O-(CH2)M-NH-C(=NH)-N(R7)2, -O-(CH2)m-CHNH2-CO2NR7R10
[0309] In another preferred embodiment of Formula III, each R5 falls within the scope ofthe structures described above and is, independently, -O-CH2CHOHCH2O-glucuronide, -OCH2CHOHCH3, -OCH2CH2NH2. -OCH2CH2NHCO(CH3)3, -CH2CH2OH,
Figure imgf000058_0002
-O-(CH2)m-Boc, -(CH2)m-Boc, -OCH2CH2OH, -OCH2CO2H, -O-(CH2)m-NH-C(=NH)-N(R7)2, -(CH2)π-NH-C(=NH)-N(R7)2, -NHCH2(CHOH)2-CH2OH, -OCH2CO2Et, -NHSO2CH3, -(CH2)m-NH-C(=O)-OR7, -O-(CH2)m-NH-C(=O)-OR7,
-(CH2)„-NH-C(=O)-Rπ, -O-(CH2)m-NH-C(=O)-R", -O-CH2C(=O)NH2, -CH2NH2, -NHCO2Et,
-OCH2CH2CH2CH2OH, -CH2NHSO2CH3, -OCH2CH2CHOHCH2OH, -OCH2CH2NHCO2Et, -NH-C(=NH2)-NH2,
-OCH2-((X-CHOH)2-CH2OH -OCH2CHOHCH2NH2,
O ^O 0— H2C-CH — CH — CH3
-(CH2)m-CHOH-CH2-NHBoc, -O-(CH2)m-CHOH-CH2-NHBoc,
-(CH2)m-NHC(O)OR7,
-O-(CH2)m-NHC(O)OR7,
-OCH2CH2CH2NH2,
-OCH2CH2NHCH2(CHOH)2CH2OH, -OCH2CH2NH(CH2[(CHOH)2CH2OH)]2,
-(CH2)4-NHBoc,
-(CH2)4-NH2,
-(CH2)4-OH,
Figure imgf000059_0001
-O-(CH2)m-C(=NH)-N(R7)2, -(CH2)„-C(=NH)-N(R7)2, -(CH2)3-NH Boc, -(CH2)3NH2, -O-(CH2)m-NH-NH-C(=NH)-N(R7)2, -(CH2)n-NH-NH-C(=NH)-N(R7)2, or -O-CH2-CHOH-CH2-NH-C(=NH)-N(R7)2; [0310] Preferred examples of R5 in the embodiments described above include: -N(SO2CH3)2, -CH2-CHNHBocCO2CH3 (α), -O-CH2-CHNH2CO2H (α), -O-CH2-CHNH2CO2CH3 (α),
Figure imgf000060_0001
-C(=O)NH-(CH2)2-NH2, and -C(=O)NH-(CH2)2-NH-C(=NH)-NH2.
[0311] Preferred examples of R5 also include: -N(SO2CH3)2,
-CH2-CHNHBocCO2CH3 (α), -O-CH2-CHNH2CO2H (α), -O-CH2-CHNH2CO2CH3 (α), -O-(CH2)2-N+(CH3)3, -C(=O)NH-(CH2)2-NH2, -C(=O)NH-(CH2)2-NH-C(=NH)-NH2, and
Figure imgf000060_0002
[0312] Substituents for the phenyl group where applicable in Formula III include halogens. Particularly preferred halogen substituents are chlorine and bromine. [0313] Y in Formula III may be hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, lower cycloalkyl, mononuclear aryl, or -N(R2)2. The alkyl moiety ofthe lower alkoxy groups is the same as described above. Examples 05/034847
of mononuclear aryl include phenyl groups. The phenyl group may be unsubstituted or substituted as described above. The preferred identity of Y is -N(R2)2. Particularly preferred are such compounds where each R is hydrogen. [0314] R1 may be hydrogen or lower alkyl in Formula III. Hydrogen is preferred for R1.
[0315] Hydrogen and lower alkyl, particularly C1-C3 alkyl are preferred for R2 in Formula III. Hydrogen is particularly preferred.
[0316] Preferred compounds of Formula III are those where one of R3 and R4 is hydrogen and the other is represented by formula (A"). [0317] In formula (A"), the moiety -(C(RL)2)o-x-(C(RL)2)p- defines an alkylene group bonded to the cyclic ring. The variables o and p may each be an integer from 0 to 10, subject to the proviso that the sum of o and p in the chain is from 1 to 10. Thus, o and p may each be 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10. Preferably, the sum of 0 and p is from 2 to 6. In a particularly preferred embodiment, the sum of o and p is 4. [0318] The linking group in the alkylene chain, x, may be, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond; therefore, when x represents a single bond, the alkylene chain bonded to the ring is represented by the formula -(C(RL)2)0+P-, in which the sum o+p is from 1 to 10. [0319] The preferred RL groups in Formula III include -H, -OH, -N(R7)2, especially where each R7 is hydrogen.
[0320] In the alkylene chain in formula (A"), it is preferred that when one RL group bonded to a carbon atoms is other than hydrogen, then the other RL bonded to that carbon atom is hydrogen, i.e., the formula -CHRL-. It is also preferred that at most two RL groups in an alkylene chain are other than hydrogen, where in the other RL groups in the chain are hydrogens. Even more preferably, only one RL group in an alkylene chain is other than hydrogen, where in the other RL groups in the chain are hydrogens. In these embodiments, it is preferable that x represents a single bond. [0321] In another particular embodiment ofthe invention, all ofthe RL groups in the alkylene chain are hydrogen. In these embodiments, the alkylene chain is represented by the formula
Figure imgf000062_0001
[0322] Each g is, independently, an integer from 1 to 6. Therefore, each g may be 1,
2, 3, 4, 5, or 6.
[0323] Each m is an integer from 1 to 7. Therefore, each m may be 1, 2, 3, 4, 5, 6, or 7.
[0324] Each n is an integer from 0 to 7. Therefore, each n maybe 0, 1, 2, 3, 4, 5, 6, or 7.
[0325] Each Q' is, independently, -CHR5', -CHR6' , -NR7, -NR10, -S-, -SO-, or -SO2-; wherein at most three Q' in a ring contain a heteroatom and at least one Q' must be - CHR5. Thus, there may be 1 , 2, or 3 nitrogen atoms in a ring. Preferably, at most two Q' are nitrogen atoms.
[0326] In a preferred embodiment of Formula III, Y is -NH2.
[0327] In another preferred embodiment Formula III, R2 is hydrogen.
[0328] In .mother preferred embodiment Formula III, R1 is hydrogen. [0329] In another preferred embodiment Formula III, X is chlorine.
[0330] In another preferred embodiment Formula III, R is hydrogen.
[0331] In another preferred embodiment Formula III, RL is hydrogen.
[0332] In another preferred embodiment Formula III, o is 4.
[0333] In another preferred embodiment Formula III, p is 0. [0334] In another preferred embodiment Formula III, the sum of o and p is 4.
[0335] In another preferred embodiment Formula III, x represents a single bond.
[0336] In another preferred embodiment Formula III, R6 is hydrogen.
[0337] In another preferred embodiment Formula III, at most 2 Q' are nitrogen atoms. [0338] In another preferred embodiment Formula III, at most one Q' is a nitrogen atom.
[0339] In another preferred embodiment Formula III, no Q' is a nitrogen atom.
[0340] In a preferred embodiment of Formula III: X is halogen; Y is -N(R7)2; R1 is hydrogen or CrC3 alkyl; R2 is -R7, -OR7, CH2O7, or -CO2R7; R is a group represented by formula (A"); and R4 is hydrogen, a group represented by formula (A"), or lower alkyl. [0341] In another preferred embodiment of Formula III: X is chloro or bromo; Y is -N(R7)2; R2 is hydrogen or C1-C3 alkyl; at most three R6 are other than hydrogen as described above; at most three R are other than hydrogen as described above; and at most 2 Q' are nitrogen atoms. In another preferred embodiment of Formula III: Y is -NH2; [0342] In another preferred embodiment of Formula III: R4 is hydrogen; at most one RL is other than hydrogen as described above; at most two R6 are other than hydrogen as described above; and at most 1 Q' is a nitrogen atom. [0343] In another preferred embodiment of Formula III, the compound is represented by the formula:
Figure imgf000063_0001
[0344] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000063_0002
[0345] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000064_0001
[0346] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000064_0002
[0347] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000064_0003
[0348] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000064_0004
[0349] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000064_0005
[0350] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000065_0001
[0351] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000065_0002
[0352] In another preferred embodiment, the compound of formula (III) is represented by the formula: H
Figure imgf000065_0003
[0353] In .mother preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000065_0004
[0354] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000065_0005
[0355] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000066_0001
[0356] In another preferred embodiment, the compoimd of formula (III) is represented by the formula:
Figure imgf000066_0002
[0357] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000066_0003
[0358] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000066_0004
[0359] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000066_0005
[0360] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000067_0001
[0361] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000067_0002
[0362] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000067_0003
[0363] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000067_0004
[0364] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000067_0005
[0365] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000068_0001
[0366] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000068_0002
[0367] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000068_0003
[0368] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000068_0004
[0369] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000068_0005
[0370] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000069_0001
[0371] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000069_0002
[0372] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000069_0003
[0373] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000069_0004
[0374] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000069_0005
[0375] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000070_0001
[0376] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000070_0002
[0377] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000070_0003
[0378] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000070_0004
[0379] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000070_0005
[0380] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000071_0001
[0381] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000071_0002
[0382] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000071_0003
[0383] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000071_0004
[0384] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000072_0001
[0385] In another preferred embodiment, the compound of formula (I I) is represented by the formula:
Figure imgf000072_0002
[0386] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000072_0003
[0387] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000072_0004
[0388] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000072_0005
[0389] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000073_0001
[0390] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000073_0002
[0391] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000073_0003
[0392] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000073_0004
[0393] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000073_0005
[0394] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000073_0006
[0395] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000074_0001
[0396] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000074_0002
[0397] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000074_0003
[0398] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000074_0004
[0399] In another preferred embodiment, the compound of formula (III) is represented by the formula:
Figure imgf000074_0005
[0400] The active compounds disclosed herein may be administered to the lungs of a patient by any suitable means, but are preferably administered by administering an aerosol suspension of respirable particles comprised ofthe active compound, which the subject inhales. The compounds may be inhaled through the mouth or the nose. The active compound can be aerosolized in a variety of forms, such as, but not limited to, dry powder inhalants, metered dose inhalants or liquid/liquid suspensions. The quantity of sodium channel blocker included may be an amount sufficient to achieve the desired effect and as described in the attached applications. [0401] Solid or liquid particulate sodium channel blocker prepared for practicing the present invention should include particles of respirable size: that is, particles ofa size sufficiently small to pass through the mouth and larynx upon inhalation and into the bronchi and alveoli ofthe lungs. In general, particles ranging from about 1 to 5 microns in size (more particularly, less than about 4.7 microns in size) are respirable. Particles of non-respirable size which are included in the aerosol tend to be deposited in the throat and swallowed, and the quantity of non-respirable particles in the aerosol is preferably minimized. For nasal administration, a particle size in the range of 10-500 μm is preferred to ensure retention in the nasal cavity. Nasal administration may be useful where the pathogen typically enters through the nose. However, it is preferred to administer at least a portion ofthe sodium channel blocker in a dosage form which reaches the lungs to ensure effective prophylactic treatment in cases where the pathogen is expected to reach the lungs.
[0402] The dosage of active compound will vary depending on the prophylactic effect desired and the state ofthe subject, but generally may be an amount sufficient to achieve dissolved concentrations of active compound on the airway surfaces of the subject as described in the attached applications. Depending upon the solubility ofthe particular formulation of active compound administered, the daily dose may be divided among one or several unit dose administrations. The dosage may be provided as a prepackaged unit by any suitable means (e.g., encapsulating in a gelatin capsule). [0403] Pharmaceutical formulations suitable for airway administration include formulations of solutions, emulsions, suspensions and extracts. See generally, J. Nairn, Solutions, Emulsions, Suspensions and Extracts, in Remington: The Science and practice of Pharmacy, chap. 86 (19th ed. 1995). Pharmaceutical formulations suitable for nasal administration may be prepared as described in U.S. Patent Nos. 4,389,393 to Schor; 5,707,644 to Ilium, 4,294,829 to Suzuki, and 4,835,142 to Suzuki. [0404] In the manufacture of a formulation according to the invention, active agents or the physiologically acceptable salts or free bases thereof are typically admixed with, inter alia, an acceptable carrier. The carrier must, of course, be acceptable in the sense of being compatible with any other ingredients in the formulation and must not be deleterious to the patient. The carrier may be a solid or a liquid, or both, and is preferably formulated with the compound as a unit-dose formulation, for example, a capsule, which may contain from 0.5% to 99% by weight ofthe active compound. One or more active compounds may be incorporated in the formulations ofthe invention, which formulations may be prepared by any ofthe well-known techniques of pharmacy consisting essentially of admixing the components. [0405] Aerosols or mists of liquid particles comprising the active compound may be produced by any suitable means, such as, for nasal administration, by a simple nasal spray with the active compound in an aqueous pharmaceutically acceptable carrier such as sterile saline solution or sterile water. Other means include producing aerosols with a pressure-driven aerosol nebulizer or an ultrasonic nebulizer. See, e.g., U.S. Pat. No. 4,501,729. Nebulizers are commercially available devices which transform solutions or suspensions ofthe active ingredient into a therapeutic aerosol mist either by means of acceleration of compressed gas, typically air or oxygen, through a narrow venturi orifice or by means of ultrasonic agitation. Suitable formulations for use in nebulizers may consist of the active ingredient in a liquid carrier. The carrier is typically water (and most preferably sterile, pyrogen-free water) or a dilute aqueous alcoholic solution, preferably made isotonic with body fluids by the addition of, for example, sodium chloride.
[0406] Aerosols or mists of solid particles comprising the active compound may likewise be produced with any solid particulate medicament aerosol generator. Aerosol generators for administering solid particulate medicaments to a subject produce particles which are respirable, as explained above, and generate a volume of aerosol containing a predetermined metered dose of a medicament at a rate suitable for human administration. Such aerosol generators are known in the art. By way of example, see U.S. Patent No. 5,725,842. [0407] One illustrative type of solid particulate aerosol generator is an insufflator. 5 Suitable formulations for administration by insufflation include finely comminuted powders which may be delivered by means of an insufflator or taken into the nasal cavity in the manner ofa snuff. In the insufflator, the powder (e.g., a metered dose thereof effective to carry out the treatments described herein) is contained in capsules or cartridges, typically made of gelatin or plastic, which are either pierced
10 or opened in situ and the powder delivered by air drawn through the device upon inhalation or by means ofa manually-operated pump. The powder employed in the insufflator consists either solely ofthe active ingredient or of a powder blend comprising the active ingredient, a suitable powder diluent, such as lactose, and an optional surfactant.
15 [0408] A second type of illustrative aerosol generator comprises a metered dose inhaler. Metered dose inhalers are pressurized aerosol dispensers, typically containing a suspension or solution formulation ofthe active ingredient in a liquefied propellant. During use these devices discharge the formulation through a valve adapted to deliver a metered volume, typically from 10 to 150 μl to produce a
20 fine particle spray containing the active ingredient. Any propellant may be used in carrying out the present invention, including both chlorofluorocarbon-containing propellants and non-chlorofluorocarbon-containing propellants. Suitable propellants include certain chlorofluorocarbon compounds, for example, dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane and
25 mixtures thereof. [0409] The formulation may additionally contain one or more co-solvents, for example, ethanol, surfactants, such as oleic acid or sorbitan trioleate, antioxidants, preservatives such as methyl hydroxybenzoate, volatile oils, buffering agents and suitable flavoring agents.
30. [0410] Compositions containing respirable dry particles of sodium channel blockers as described in the attached applications may be prepared as detailed in those applications. The active compound may be formulated alone (i.e., the solid particulate composition may consist essentially ofthe active compound) or in combination with a dispersant, diluent or carrier, such as sugars (i.e., lactose, sucrose, trehalose, mannitol) or other acceptable excipients for lung or airway delivery, which may be blended with the active compound in any suitable ratio (e.g., a 1 to 1 ratio by weight). The dry powder solid particulate compound may be obtained by methods known in the art, such as spray-drying, milling, freeze-drying, and the like. [0411] The aerosol or mist, whether formed from solid or liquid particles, may be produced by the aerosol generator at a rate of from about 10 to about 150 liters per minute, more preferably from about 30 to about 150 liters per minute, and most preferably about 60 liters per minute. Aerosols containing greater amounts of medicament may be administered more rapidly. [0412] Other medicaments may be administered with the active compounds disclosed if such medicament is compatible with the active compound and other ingredients in the formulation and can be administered as described herein. [0413] The pathogens which may be protected against by the prophylactic post exposure, rescue and therapeutic treatment methods ofthe invention include any pathogens which may enter the body through the mouth, nose or nasal airways, thus proceeding into the lungs. Typically, the pathogens will be airborne pathogens, either naturally occurring or by aerosolization. The pathogens may be naturally occurring or may have been introduced into the environment intentionally after aerosolization or other method of introducing the pathogens into the environment. Many pathogens which are not naturally transmitted in the air have been or may be aerosolized for use in bioterrorism.
[0414] The pathogens for which the treatment ofthe invention may be useful includes, but is not limited to, category A, B and C priority pathogens as set forth by the NIAID. These categories correspond generally to the lists compiled by the Centers for Disease Control and Prevention (CDC). As set up by the CDC, Category A agents are those that can be easily disseminated or transmitted person-to-person, cause high mortality, with potential for major public health impact. Category B agents are next in priority and include those that are moderately easy to disseminate and cause moderate morbidity and low mortality. Category C consists of emerging pathogens that could be engineered for mass dissemination in the future because of their availability, ease of production and dissemination and potential for high morbidity and mortality.
[0415] Category A: Bacillus anthracis (anthrax), Clostridium botulinum (botulism), Yersinia pestis (plague), Variola major (smallpox) and other pox viruses, Francisella tularensis (tularemia), Viral hemorrhagic fevers Arenaviruses, LCM (lymphocytic choriomeningitis), Junin virus, Machupo virus, Guanarite virus, Lassa Fever, Bunyaviruses, Hantavirus, Rift Valley Fever, Flaviviruses, Dengue, Filoviruses, Ebola Marburg; [0416] Category B: Burkholderia pseudomallei (melioidosis), Coxiella burnetii (Q fever), Brucella species (brucellosis), Burkholderia mallei (glanders), Ricin toxin from Ricinus communis, Epsilon toxin of Clostridium perfringens, Staphylococcal enterotoxin B, Typhus fever (Rickettsia prowazekii), Food and water-borne pathogens bacteria: Diarrheagenic Escherichia coli, Pathogenic vibrios, Shigella species, Salmonella species, Listeria monocytogenes, campylobacter jejuni, Yersinia enterocolitica; Viruses Caliciviruses, Hepatitis A; Protozoa Cryptosporidium parvum, Cyclospora cayatenensis, Giardia lamblia, Entamoeba histolytica, Toxoplasma, Microsporidia, and Additional viral encephalitides West Nile virus, LaCrosse, California encephalitis, Venezuelan equine encephalitis, Eastern equine encephalitis, Western equine encephalitis, Japanese encephalitis virus and Kyasanur forest virus, and
[0417] Category C: emerging infectious disease threats such as Nipah virus and additional hantaviruses, tickborne hemorrhagic fever viruses such as Crimean Congo hemorrhagic fever virus, tickborne encephalitis viruses, yellow fever, multi-drug resistant tuberculosis, influenza, other rickettsias and rabies. [0418] Additional pathogens which may be protected against or the infection risk therefrom reduced include influenza viruses, rhinoviruses, adenoviruses and respiratory syncytial viruses, and the like. A further pathogen which may be protected against is the coronavirus which is believed to cause severe acute respiratory syndrome (SARS).
[0419] A number ofthe above-listed pathogens are known to be particularly harmful when introduced into the body through the air. For example, Bacillus anthracis, the agent which causes anthrax, has three major clinical forms, cutaneous, inhalational, and gastrointestinal. All three forms may lead to death but early antibiotic treatment of cutaneous and gastrointestinal anthrax usually cures those forms of anthrax. Inhalational anthrax, on the other hand, is a potentially fatal disease even with antibiotic treatment. Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. For naturally occurring or accidental infections, even with appropriate antibiotics and all other available supportive care, the historical fatality rate is believed to be about 75 percent, according to the NIAID. Inhalational anthrax develops after spores are deposited in alveolar spaces and subsequently ingested by pulmonary alveolar macrophages. Surviving spores are then transported to the mediastinal lymph nodes, where they may germinate up to 60 days or longer. After germination, replicating bacteria release toxins that result in disease. This process is interrupted by administration of a prophylactically effective amount of a sodium channel blocker, as the spores may be wholly or partially eliminated from the body by removal of lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0420] Another pathogen of primary concern as one ofthe most dangerous potential biological weapons because it is easily transmitted from person to person, no effective therapy exists and few people carry full immunity to the virus, is the small pox virus, Variola major. Smallpox spreads directly from person to person, primarily by aerosolized saliva droplets expelled from an infected person. Initial symptoms include high fever, fatigue, headache and backache followed in two or three days by a characteristic rash.
[0421] An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to smallpox virus or other pox virus comprising the administration of a prophylactically effective amount of a sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the Variola major virus or other pox virus present in the aerosolized saliva droplets to which the individual was exposed to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0422] The bacterium Yersinia pestis causes plague and is widely available throughout the world. NIAID has reported that infection by inhalation of even small numbers of virulent aerosolized Y. pestis bacilli can lead to pneumonic plague, which has a mortality rate of almost 100% if left untreated. Pneumonic plague has initial symptoms of fever and cough which resemble other respiratory illnesses. Antibiotics are effective against plague but success with antibiotics depends on how quickly drug therapy is started, the dose of inhaled bacteria and the level of supportive care for the patient; an effective vaccine is not widely available. [0423] An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized Y. pestis bacilli comprising the administration ofa sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the aerosolized Y. pestis bacilli to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0424] Botulinum toxin is another substance believed to present a major bioterrorism threat as it is easily released into the environment. Antibiotics are not effective against botulinum toxin and no approved vaccine exists. Although the toxin may be transmitted through food, the botulinum toxin is absorbed across mucosal surfaces and, thus, embodiments ofthe present invention provide a method of prophylactically treating one or more individuals exposed or potentially exposed to botulinum toxin comprising the administration of a sodium channel blocker. [0425] The NIAID has identified the bacteria that causes tularemia as a potential bioterrorist agent because Francisella tularensis is capable of causing infection with as few as ten organisms and due to its ability to be aerosolized. Natural infection occurs after inhalation of airborne particles. Tularemia may be treated with antibiotics and an experimental vaccine exists but knowledge of optimal therapeutic approaches for tularemia is limited because very few investigators are working on this disease. An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized Francisella tularensis comprising the administration of a sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the aerosolized Francisella tularensis to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0426] The Category B and C bacteria most widely believed to have the potential to infect by the aerosol route include gram negative bacteria such as Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii, and select Rickettsia spp. Each of these agents is believed to be capable of causing infections following inhalation of small numbers of organisms. Brucella spp. may cause brucellosis. Four ofthe six Brucella spp., B. suis, B. melitensis, B. abortus and B. canis, are known to cause brucellosis in humans. Burkholderia pseudomallei may cause melioidosis in humans and other mammals and birds. Burkholderia mallei, is the organism that causes glanders, normally a disease of horses, mules and donkeys but infection following aerosol exposure has been reported, according to NIAID. Coxiella burnetii, may cause Q fever and is highly infectious. Infections have been reported through aerosolized bacteria and inhalation of only a few organisms can cause infections. R. prowazekii, R. rickettsii, R. conorrii and R. typhi have been found to have low-dose infectivity via the aerosol route.
[0427] Methods are provided of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized gram negative bacteria such as Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii, and select Rickettsia spp comprising the administration of a sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the aerosolized gram negative bacteria to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0428] A number of typically arthropod-borne viruses are believed to pose a significant threat as potential bioterrorist weapons due to their extreme infectivity following aerosolized exposure. These viruses include arboviruses which are important agents of viral encephalitides and hemonhagic fevers. Such viruses may include alphaviruses such as Venezuelan equine encephalitis virus, eastern equine encephalitis virus and western equine encephalitis virus. Other such viruses may include flaviviruses such as West Nile virus, Japanese encephalitis virus, Kyasanur forest disease virus, tick-borne encephalitis virus complex and yellow fever virus. An additional group of viruses which may pose a threat include bunyaviruses such as California encephalitis virus, or La Crosse virus, Crimean-Congo hemorrhagic fever virus. According to the NIAID, vaccines or effective specific therapeutics are available for only a very few of these viruses. In humans, arbovirus infection is usually initially asymptomatic or causes nonspecific flu-like symptoms such as fever, aches and fatigue.
[0429] An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized arboviruses comprising the administration of a sodium channel blocker. The administration of an effective amount ofa sodium channel blocker will function to allow the arboviruses to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0430] Certain category B toxins such as ricin toxin from Ricinus communis, epsilon toxin of Clostridium perfringens and Staphylococcal enterotoxin B, also are viewed as potential bioterrorism tools. Each of these toxins may be delivered to the environment or population by inhalational exposure to aerosols. Low dose inhalation of ricin toxin may cause nose and throat congestion and bronchial asthma while higher dose inhalational exposure caused severe pneumonia, acute inflammation and diffuse necrosis ofthe airways in nonhuman primates. Clostridium perfringens is an anaerobic bacterium that can infect humans and animals. Five types of bacteria exist that produce four major lethal toxins and seven minor toxins, including alpha toxin, associated with gas gangrene, beta toxin, responsible for necrotizing enteritis, and epsilon toxin, a neurotoxin that leads to hemorrhagic enteritis in goats and sheep. Inhalation of Staphylococcus aureus has resulted in extremely high fever, difficulty breathing, chest pain and headache. [0431] An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to aerosolized toxins comprising the administration ofa sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the aerosolized toxins to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0432] Mycobacterium tuberculosis bacteria causes tuberculosis and is spread by airborne droplets expelled from the lungs when a person with tuberculosis coughs, sneezes or speaks. An embodiment ofthe present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to Mycobacterium tuberculosis bacteria comprising the administration of a sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the Mycobacterium tuberculosis bacteria to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker. [0433] The methods disclosed may also be used against more common pathogens such as influenza viruses, rhinoviruses, adenoviruses and respiratory syncytial viruses (RSV). An embodiment ofthe present invention provides a method of prophylactically or therapeutically treating one or more individuals exposed or potentially exposed to one of these viruses comprising the administration of a sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the virus to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action ofthe sodium channel blocker.
[0434] The methods ofthe present invention may further be used against the virus believed to be responsible for SARS, the coronavirus. Severe acute respiratory syndrome is a respiratory illness that is believed to spread by person-to-person contact, including when someone coughs or sneezes droplets containing the virus onto others or nearby surfaces. The CDC currently believes that it is possible that SARS can be spread more broadly through the air or by other ways that are not currently known. Typically, SARS begins with a fever greater than 100.4°F. Other symptoms include headache and body aches. After two to seven days, SARS patients may develop a dry cough and have trouble breathing.
[0435] To the extent SARS is caused by an airborne pathogen, the present invention provides a method of prophylactically treating one or more individuals exposed or potentially exposed to the SARS virus comprising the administration ofa sodium channel blocker. The administration of an effective amount of a sodium channel blocker will function to allow the virus to be wholly or partially removed from the body by removal of hydrated lung mucous secretions hydrated through the action of the sodium channel blocker.
[0436] The compounds of formulas (I), (II) and (III) may be synthesized according to procedures known in the art. A representative synthetic procedure is shown in the scheme below:
Figure imgf000086_0001
[0437] These procedures are described in, for example, E.J. Cragoe, "The Synthesis of Amiloride and Its Analogs" (Chapter 3) in Amiloride and Its Analogs, pp. 25-36, incorporated herein by reference. Other methods of preparing the compounds are described in, for example, U.S. 3,313,813, incorporated herein by reference. See in particular Methods A, B, C, and D described in U.S. 3,313,813. Other methods useful for the preparation of these compounds, are described in, for example, U.S. Provisional Applications 60/495,725, filed August 19, 2003, 60/495,712, filed August 19, 2003 and 60/495,720, filed August 19, 2003, incorporated herein by reference. Several assays may be used to characterize the compounds ofthe present invention. Representative assays are discussed below.
In Vitro Measure of Sodium Channel Blocking Activity and Reversibility [0438] One assay used to assess mechanism of action and/or potency ofthe compounds ofthe present invention involves the determination of lumenal drug inhibition of airway epithelial sodium currents measured under short circuit current (Isc) using airway epithelial monolayers mounted in Ussing chambers. Cells obtained from freshly excised human, dog, sheep or rodent airways are seeded onto porous 0.4 micron Snapwell™ Inserts (CoStar), cultured at air-liquid interface (ALI) conditions in hormonally defined media, and assayed for sodium transport activity (Isc) while bathed in Krebs Bicarbonate Ringer (KBR) in Using chambers. All test drug additions are to the lumenal bath with half-log dose addition protocols (from 1 x 10"11 M to 3 x 10'5 M), and the cumulative change in Isc (inhibition) recorded. All drugs are prepared in dimethyl sulfoxide as stock solutions at a concentration of 1 x 10"2 M and stored at -20° C. Eight preparations are typically run in parallel; two preparations per run incoφorate amiloride and/or benzamil as positive controls. After the maximal concentration (5 x 10"5 M) is administered, the lumenal bath is exchanged three times with fresh drug-free KBR solution, and the resultant Isc measured after each wash for approximately 5 minutes in duration. Reversibility is defined as the percent return to the baseline value for sodium current after the third wash. All data from the voltage clamps are collected via a computer interface and analyzed off-line.
[0439] Dose-effect relationships for all compounds are considered and analyzed by the Prism 3.0 program. IC50 values, maximal effective concentrations, and reversibility are calculated and compared to amiloride and benzamil as positive controls.
Pharmacological Assays of Absorption
(1) Apical Disappearance Assay
[0440] Bronchial cells (dog, human, sheep, or rodent cells) are seeded at a density of
0.25 x 106/cm2 on a porous Transwell-Col collagen-coated membrane with a growth area of 1.13 cm2 grown at an air-liquid interface in hormonally defined media that promotes a polarized epithelium. From 12 to 20 days after development of an air- liquid interface (ALI) the cultures are expected to be > 90% ciliated, and mucins will accumulate on the cells. To ensure the integrity of primary airway epithelial cell preparations, the transepithelial resistance (Rt) and transepithelial potential differences (PD), which are indicators ofthe integrity of polarized nature ofthe culture, are measured. Human cell systems are preferred for studies of rates of absorption from apical surfaces. The disappearance assay is conducted under conditions that mimic the "thin" films in vivo (-25 μl) and is initiated by adding experimental sodium channel blockers or positive controls (amiloride, benzamil, phenamil) to the apical surface at an initial concentration of 10 μM. A series of samples (5 μl volume per sample) is collected at various time points, including 0, 5, 20, 40, 90 and 240 minutes. Concentrations are determined by measuring intrinsic fluorescence of each sodium channel blocker using a Fluorocount Microplate Flourometer or HPLC. Quantitative analysis employs a standard curve generated from authentic reference standard materials of known concentration and purity. Data analysis ofthe rate of disappearance is performed using nonlinear regression, one phase exponential decay (Prism V 3.0).
2. Confocal Microscopy Assay of Amiloride Congener Uptake
[0441] Virtually all amiloride-like molecules fluoresce in the ultraviolet range. This property of these molecules may be used to directly measure cellular update using x- z confocal microscopy. Equimolar concentrations of experimental compounds and positive controls including amiloride and compounds that demonstrate rapid uptake into the cellular compartment (benzamil and phenamil) are placed on the apical surface of airway cultures on the stage ofthe confocal microscope. Serial x-z images are obtained with time and the magnitude of fluorescence accumulating in the cellular compartment is quantitated and plotted as a change in fluorescence versus time.
3. In vitro Assays of Compound Metabolism [0442] Airway epithelial cells have the capacity to metabolize drugs during the process of transepithelial absorption. Further, although less likely, it is possible that drugs can be metabolized on airway epithelial surfaces by specific ectoenzyme activities. Perhaps more likely as an ecto-surface event, compounds may be metabolized by the infected secretions that occupy the airway lumens of patients with lung disease, e.g. cystic fibrosis. Thus, a series of assays is performed to characterize the compound metabolism that results from the interaction of test compounds with human airway epithelia and/or human airway epithelial lumenal products. [0443] In the first series of assays, the interaction of test compounds in KBR as an "ASL" stimulant are applied to the apical surface of human airway epithelial cells grown in the T-Col insert system. For most compounds, metabolism (generation of new species) is tested for using high performance liquid chromatography (HPLC) to resolve chemical species and the endogenous fluorescence properties of these compounds to estimate the relative quantities of test compound and novel metabolites. For a typical assay, a test solution (25 μl KBR, containing 10 μM test compound) is placed on the epithelial lumenal surface. Sequential 5 to 10 μl samples are obtained from the lumenal and serosal compartments for HPLC analysis of (1) the mass of test compound permeating from the lumenal to serosal bath and (2) the potential formation of metabolites from the parent compound. In instances where the fluorescence properties ofthe test molecule are not adequate for such characterizations, radiolabeled compounds are used for these assays. From the HPLC data, the rate of disappearance and/or formation of novel metabolite compounds on the lumenal surface and the appearance of test compound and/or novel metabolite in the basolateral solution is quantitated. The data relating the chromatographic mobility of potential novel metabolites with reference to the parent compound are also quantitated.
[0444] To analyze the potential metabolism of test compounds by CF sputum, a "representative" mixture of expectorated CF sputum obtained from 10 CF patients (under IRB approval) has been collected. The sputum has been be solubilized in a 1 :5 mixture of KBR solution with vigorous vortexing, following which the mixture was split into a "neat" sputum aliquot and an aliquot subjected to ultracentrifugation so that a "supernatant" aliquot was obtained (neat=cellular; supernatant^liquid phase). Typical studies of compound metabolism by CF sputum involve the addition of known masses of test compound to "neat" CF sputum and aliquots of CF sputum "supernatant" incubated at 37 °C, followed by sequential sampling of aliquots from each sputum type for characterization of compound stability/metabolism by HPLC analysis as described above. As above, analysis of compound disappearance, rates of formation of novel metabolites, and HPLC mobilities of novel metabolites are then performed. 4. Pharmacological Effects and Mechanism of Action ofthe Drug in
Animals [0445] The effect of compounds for enhancing mucociliary clearance (MCC) can be measured using an in vivo model described by Sabater et al., Journal of Applied Physiology, 1999, pp. 2191-2196, incorporated herein by reference.
[0446] Animal Preparation: Adult ewes (ranging in weight from 25 to 35 kg) were restrained in an upright position in a specialized body harness adapted to a modified shopping cart. The animals' heads were immobilized and local anesthesia ofthe nasal passage was induced with 2% lidocaine. The animals were then nasally intubated with a 7.5 mm internal diameter endotracheal tube (ETT). The cuff of the ETT was placed just below the vocal cords and its position was verified with a flexible bronchoscope. After intubation the animals were allowed to equilibrate for approximately 20 minutes prior to initiating measurements of mucociliary clearance.
[0447] Administration of Radio-aerosol: Aerosols of 9 mTc-Human serum albumin (3.1 mg/ml; containing approximately 20 mCi) were generated using a Raindrop Nebulizer which produces a droplet with a median aerodynamic diameter of 3.6 μm. The nebulizer was connected to a dosimetry system consisting of a solenoid valve and a source of compressed air (20 psi). The output ofthe nebulizer was directed into a plastic T connector; one end of which was connected to the endotracheal tube, the other was connected to a piston respirator. The system was activated for one second at the onset ofthe respirator's inspiratory cycle. The respirator was set at a tidal volume of 500 mL, an inspiratory to expiratory ratio of 1 : 1 , and at a rate of 20 breaths per minute to maximize the central airway deposition. The sheep breathed the radio-labeled aerosol for 5 minutes. A gamma camera was used to measure the clearance of 99mTc-Human serum albumin from the airways. The camera was positioned above the animal's back with the sheep in a natural upright position supported in a cart so that the field of image was perpendicular to the animal's spinal cord. External radio-labeled markers were placed on the sheep to ensure proper alignment under the gamma camera. All images were stored in a computer integrated with the gamma camera. A region of interest was traced over the image corresponding to the right lung ofthe sheep and the counts were recorded. The counts were corrected for decay and expressed as percentage of radioactivity present in the initial baseline image. The left lung was excluded from the analysis because its outlines are superimposed over the stomach and counts can be swallowed and enter the stomach as radio-labeled mucus.
[0448] Treatment Protocol (Assessment of activity at t-zero): A baseline deposition image was obtained immediately after radio-aerosol administration. At time zero, after acquisition ofthe baseline image, vehicle control (distilled water), positive control (amiloride), or experimental compounds were aerosolized from a 4 ml volume using a Pari LC JetPlus nebulizer to free-breathing animals. The nebulizer was driven by compressed air with a flow of 8 liters per minute. The time to deliver the solution was 10 to 12 minutes. Animals were extubated immediately following delivery ofthe total dose in order to prevent false elevations in counts caused by aspiration of excess radio-tracer from the ETT. Serial images of the lung were obtained at 15-minute intervals during the first 2 hours after dosing and hourly for the next 6 hours after dosing for a total observation period of 8 hours. A washout period of at least 7 days separated dosing sessions with different experimental agents.
[0449] Treatment Protocol (Assessment of Activity at t-4hours): The following variation ofthe standard protocol was used to assess the durability of response following a single exposure to vehicle control (distilled water), positive control compounds (amiloride or benzamil), or investigational agents. At time zero, vehicle control (distilled water), positive control (amiloride), or investigational compounds were aerosolized from a 4 ml volume using a Pari LC JetPlus nebulizer to free- breathing animals. The nebulizer was driven by compressed air with a flow of 8 liters per minute. The time to deliver the solution was 10 to 12 minutes. Animals were restrained in an upright position in a specialized body harness for 4 hours. At the end ofthe 4-hour period animals received a single dose of aerosolized 99mTc- Human serum albumin (3.1 mg/ml; containing approximately 20 mCi) from a
Raindrop Nebulizer. Animals were extubated immediately following delivery ofthe total dose of radio-tracer. A baseline deposition image was obtained immediately after radio-aerosol administration. Serial images ofthe lung were obtained at 15- minute intervals during the first 2 hours after administration ofthe radio-tracer (representing hours 4 through 6 after drug administration) and hourly for the next 2 hours after dosing for a total observation period of 4 hours. A washout period of at least 7 days separated dosing sessions with different experimental agents.
[0450] Statistics: Data were analyzed using SYSTAT for Windows, version 5. Data were analyzed using a two-way repeated ANOVA (to assess overall effects), followed by a paired t-test to identify differences between specific pairs.
Significance was accepted when P was less than or equal to 0.05. Slope values (calculated from data collected during the initial 45 minutes after dosing in the t-zero assessment) for mean MCC curves were calculated using linear least square regression to assess differences in the initial rates during the rapid clearance phase.
EXAMPLES
[0451] Having generally described this invention, a further understanding can be obtained by reference to certain specific examples which are provided herein for purposes of illustration only and are not intended to be limiting unless otherwise specified. Preparation of Sodium Channel Blockers [0452] Materials and methods. All reagents and solvents were purchased from Aldrich Chemical Corp. and used without further purification. NMR spectra were obtained on either a Bruker WM 360 (Η NMR at 360 MHz and 13C NMR at 90 MHz) or a Bruker AC 300 (Η NMR at 300 MHz and 13C NMR at 75 MHz). Flash chromatography was performed on a Flash Elute system from Elution Solution (PO Box 5147, Charlottesville, Virginia 22905) charged with a 90 g silica gel cartridge (40M FSO-0110-040155, 32-63 μm) at 20 psi (N2). GC-analysis was performed on a Shimadzu GC-17 equipped with a Heliflex Capillary Column (Alltech); Phase: AT-1, Length: 10 meters, ID: 0.53 mm, Film: 0.25 micrometers. GC Parameters: Injector at 320 °C, Detector at 320 °C, FID gas flow: H2 at 40 ml/min., Air at 400 ml/min. Carrier gas: Split Ratio 16:1, N2 flow at 15 ml/min., N2 velocity at 18 cm/sec. The temperature program is 70 °C for 0-3 min, 70-300 °C from 3-10 min,
Figure imgf000093_0001
[0453] HPLC analysis was performed on a Gilson 322 Pump, detector UV/Vis-156 at 360 nm, equipped with a Microsorb MV C8 column, 100 A, 25 cm. Mobile phase: A = acetonitrile with 0.1% TFA, B = water with 0.1% TFA. Gradient program: 95:5 B:A for 1 min, then to 20:80 B:A over 7 min, then to 100% A over 1 min, followed by washout with 100% A for 11 min, flow rate: 1 ml/min. [0454] The following examples depict the synthesis of compounds according to Formula I. FORMULA I EXAMPLES:
Scheme 1. Synthesis of PSA 17926 (Formula I)
Figure imgf000094_0001
Br' "CN I K2C03, DMF
Figure imgf000094_0002
Pd/C, H2 MeOH, CH2C12
Figure imgf000094_0003
5, PSA 17926
10 Scheme 2. Synthesis of PSA 17846 (Formula I)
Figure imgf000095_0001
MeNH, MeOH
Figure imgf000095_0002
Scheme 3. Synthesis of PSA 19008 (Formula I)
Figure imgf000096_0001
16, PSA 19008 Scheme 4. Synthesis of PSA 17482 (Formula I)
Figure imgf000097_0001
20, PSA 17482
10 Scheme 5. Synthesis of PSA 23022 (Formula I)
Figure imgf000098_0001
(1) HCl/EtOH (3) HCl/H2O OMe (2) H,N OMe MeOH
Figure imgf000098_0002
10
Scheme 6. Synthesis of PSA 16826 (Formula I)
Figure imgf000099_0001
H2, Pd/C J EtOH/AcOH
Figure imgf000099_0002
EtOH/DIPEA
Figure imgf000099_0003
Figure imgf000099_0004
Scheme 7. Synthesis of PSA 16313 (Formula I)
Figure imgf000100_0001
Scheme 8. Synthesis of PSA 16437 (Formula I)
Figure imgf000101_0001
Scheme 9. Synthesis of PSA 16314 (Formula I)
Figure imgf000102_0001
37
H2/Pd/C EtOH/THF
Figure imgf000102_0002
Scheme 10. Synthesis of PSA 16208 (Formula I)
Figure imgf000103_0001
40
TFA/CH2C12
Figure imgf000103_0002
41
EtOH/DIPEA
Figure imgf000103_0003
Figure imgf000103_0004
42, PSA 16208
Scheme 11. Synthesis of PSA 15143 (Formula I)
Figure imgf000104_0001
H /Pd/C EtOH
Figure imgf000104_0002
45, PSA 15143
Example 1.
[0455] Synthesis ofN-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N-(4-{4-[3-(lH- tetrazol-5-yl)propoxy]phenyl}butyl)guanidine hydrochloride (PSA 17926)
Figure imgf000105_0001
[0456] {4-[4-(3-Cyanopropoxy)phenyl]butyl}carbamic acid benzyl ester (2). A mixture of [4-(4-hydroxyphenyl)butyl]carbamic acid benzyl ester 1 (2.00 g, 6.70 mmol), 4-bromobutyronitrile (0.70 mL, 6.70 mmol), and potassium carbonate (1.00 g, 7.4 mmol) in DMF (10 mL), was stirred at 65 °C for 16 h. Solvent was removed by rotary evaporation and the residue was taken up in ethyl acetate, washed with water and brine, and concentrated under vacuum. The crude product was purified by flash silica gel column chromatography eluting with ethyl acetate/CH2Cl2 (1 :9, v/v) to give the desired product 2 as a white solid (1.80 g, 75% yield). Η NMR (300 MHz, CDC13) δ 1.56 (m, 4H), 2.15 (m, 2H), 2.55 (m, 4H), 3.15 (m, 2H), 4.00 (m, 2H), 4.70 (br s, IH), 5.10 (s, 2H), 6.80 (d, 2H), 7.05 (d, 2H), 7.30 (m, 5H). m/z (ESI): 367 [C22H26N2O3 + H]+.
[0457] (4-{4-[3-(lH-Tetrazol-5-yl)propoxy]phenyl}butyl)carbamic acid benzyl ester
(3).
[0458] A mixture of {4-[4-(3-cyanopropoxy)phenyl]butyl}carbamic acid benzyl ester 2 (0.90 g, 2.5 mmol), sodium azide (0.50 g, 7.5 mmol), and ammonium chloride (0.40 g, 7.5 mmol) in DMF (7 mL), was stirred at 120 °C for 16 h. Inorganics were removed by vacuum filtration. The filtrate was diluted with ethyl acetate, and washed with water and brine. The organic solution was dried over Na2SO4, filtered and concentrated. The residue was taken up in ethyl acetate (5 mL) and diluted with hexanes (10 mL). Solid precipitates were collected by suction filtration and purified by flash silica gel column chromatography eluting with methanol/dichloromethane (1 :50, v/v) to give the desired product 3 as a white solid (0.78 g, 76% yield). Η NMR (300 MHz, CD3OD) δ 1.51 (m, 4H), 2.20 (m, 2H), 2.50 (m, 2H), 3.10 (m, 4H), 4.00 (m, 2H), 5.00 (s, 2H), 6.75 (d, 2H), 7.05 (d, 2H), 7.30 (m, 5H). m/z (ESI): 410 [C22H27N5O3 + H]+.
[0459] 4-{4-[3-(lH-Tetrazol-5-yl)propoxy]phenyl}butylamine (4). [0460] A solution of (4-{4-[3-(lH-tetrazol-5-yl)propoxy]phenyl}butyl)carbamic acid benzyl ester 3 (0.30 g, 0.73 mmol) in methanol (20 mL) and dichloromethane (5 L) was stirred at room temperature overnight under hydrogen atmosphere in the presence of 10% palladium- on-carbon catalyst (0.1 g, 50% wet). The catalyst was removed by suction filtration, and the filtrate was concentrated in vacuo to give the desired product 4 as a white solid (200 mg, 99% yield) which was used for the next step without further purification, m/z (ESI): 276 [Cι4H2ιN5O + H]+.
[0461] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N-(4-{4-[3-(lH-tetrazol-5- yl)-propoxy] phenyl }butyl)guanidine hydrochloride (5, PSA 17926).
[0462] A solution of 4-{4-[3-(lH-tetrazol-5-yl)propoxy]phenyl}butylamine 4 (100 mg, 0.36 mmol) and triethylamine (0.15 mL, 0.39 mmol) in absolute ethanol (2 mL ) was stirred at 60 °C for 5 min, after which l-(3,5-diamino-6-chloropyrazine-2- carbonyl)-2-methyl-isothiourea hydriodide (150 mg, 0.39 mmol) was added in one portion. The reaction mixture was stirred at that temperature for 4 h and then cooled to room temperature. The reaction mixture was concentrated by rotary evaporation. The crude residue was washed with water and filtered. The filter cake was further washed with dichloromethane. A dark yellow solid (140 mg, 80% yield) thus obtained was slurried in a mixture of methanol and dichloromethane (5/95, v/v). The solid was collected by suction filtration, and 40 mg of such solid was mixed with 3% aqueous HC1 (4 mL). The mixture was sonicated, stirred at room temperature for 15 min and filtered. The filter cake was dried under high vacuum to give N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-Ν'-(4-{4-[3-(lH-tetrazol-5- yl)propoxy]p__enyl}butyl)guanidine hydrochloride (5, PSA 17926) as a yellow solid, mp 125-127 °C (decomposed). 1H NMR (300 MHz, CD3OD) δ 1.70 (m, 4H), 2.22 (m, 2H), 2.60 (m, 2H), 3.10 (m, 2H), 4.00 (m, 2H), 6.70 (d, 2H), 7.09 (d, 2H). m/z (ESI): 488 [C20H26ClNι ,O2 + H]+. Example 2.
[0463] Synthesis of dimethylthiocarbamic acid O-(4-{4-[N-(3,5-diamino-6- chloropyrazine-2-carbonyl)guanidino]butyl}phenyl) ester (PSA 17846)
Figure imgf000107_0001
[0464] 2-[4-(4-Hydroxypheny_)butyl]isoindole-l,3-dione (8)
[0465] A mixture of 4-(4-aminobutyl)phenol hydrobromide 6 (8.2 g, 33.5mmol), phthalic anhydride 7 (5.0 g, 33.8 mmol), and triethylamine (4.6 mL, 33.5 mmol) in chloroform (50 mL) was stirred at reflux for 18 h, cooled to room temperature and concentrated by rotary evaporation. The residue was dissolved in acetic acid (50 mL) and stirred at 100 °C for 3 h. Solvent was evaporated and the resulting residue was purified by flash silica gel column chromatography eluting with CH2Cl2/EtOAc/hexanes (8:1:1, v/v) to give the desired product 8 as a white powder (4.1 g, 41% yield). 1H NMR (300 MHz, DMSO- .) δ 1.57 (m, 4H), 2.46 (m, 2H), 3.58 (m, 2H), 6.64 (d, 2H), 6.95 (d, 2H), 7.82 (m, 4H), 9.12 (s, IH). m/z (ESI): 296 [C18H17NO3 + H]+.
[0466] Dimethylthiocarbamic acid O-{4-[4-(l,3-dioxo-l,3-dihydroisoindol-2- yl)butyl] -phenyl} ester (9)
[0467] A suspension of sodium hydride (60% in mineral oil, 0.44 g, 0.11 mmol) in anhydrous DMF (10 mL) was cooled to 0 °C and added to a solution of 2-[4-(4- hydroxyphenyl)-butyl]isoindole-l,3-dione 8 (2.95 g, 10 mmol) in DMF (15 mL). The mixture was stirred at 0 °C for 30 min and then at room temperature for an additional one hour. A solution of dimethylthiocarbamic acid chloride (1.35 g, 11 mmol) in DMF (10 mL) was then added. The reaction mixture was stirred at room temperature first for 16 h and then at 50 °C for 1 h, cooled back to room temperature and quenched with methanol (10 mL). The mixture was concentrated under vacuum and the residue was purified by flash silica gel column chromatography eluting with CH2Cl2 hexanes/EtOAc (10:1 :0.2, v/v) to give the desired product 9 as a yellowish solid (2.27 g, 59% yield). Η NMR (300 MHz, CDC13) δ 1.72 (m, 4H), 2.67 (m, 2H), 3.33 (s, 3H), 3.45 (s, 3H), 3.71 (m, 2H), 6.95 (d, 2H), 7.18 (d, 2H), 7.70 (m, 2H), 7.84 (m, 2H). m/z (ESI): 383 [C21H2 N2O3S + H]+.
[0468] Dimethylthiocarbamic acid O-[4-(4-aminobutyl)phenyl] ester (10)
[0469] A mixture of dimethylthiocarbamic acid O-{4-[4-(l,3-dioxo-l,3- dihydroisoindol-2-yl)-butyl]phenyl} ester 9 (0.30 g, 0.80 mmol) and methylamine
(2M in methanol, 10 mL, 20 mmol) was stirred at room temperature overnight.
Solvent was removed by rotary evaporation and the residue was purified by flash silica gel column chromatography (Biotage) eluting with chloroform/methanol/concentrated ammonium hydroxide (10:1 :0.1, v/v) to give dimethylthiocarbamic acid O-[4-(4-aminobutyl)phenyl] ester (10) as a clear colorless oil (118 mg, 46% yield). Η NMR (300 MHz, CD3OD) δ 1.70 (m, 4H), 2.70 (m,
4H), 3.34 (s, 3H), 3.46 (s, 3H), 6.96 (d, 2H), 7.20 (d, 2H). m/z (ESI): 253
[C,3H20N2OS + H]+.
[0470] Dimethylthiocarbamic acid O-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)-guanidino]butyl}phenyl) ester (11, PSA 17846)
[0471] A solution of dimethylthiocarbamic acid O-[4-(4-aminobutyl)phenyl] ester 10 (115 mg, 0.45 mmol), triethylamine (0.30 mL, 2.2 mmol), and l-(3,5-diamino-6- chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (175 mg, 0.45 mmol) in anhydrous THF (6 mL) was stirred at reflux for 3 h and then cooled to room temperature. The reaction mixture was concentrated by rotary evaporation. The crude residue was purified by flash silica gel column chromatography (Biotage) eluting with chloroform/methanol/concentrated ammonium hydroxide (15:1 :0.1, v/v) to give the desired product 11 as a yellow solid (180 mg, 86% yield), mp 102-105 °C. Η ΝMR (300 MHz, CD3OD) δ 1.70 (m, 4H), 2.65 (m, 2H), 3.20 (m, 2H), 3.30 05/034847
(s, 3H), 3.40 (s, 3H), 6.95 (d, 2H), 7.20 (d, 2H). m/z (ESI): 465 [C19H25ClNgO2S +
H]+.
Example 3. [0472] Synthesis of (2S)-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino] -butyl } benzenesulfonylamino)-3 -methylbutyramide (PSA 19008).
Figure imgf000109_0001
PSA 19008
[0473] 4-[4-(l ,3-Dioxo-l ,3-dihydroisoindol-2-yl)butyl]benzenesulfonyl chloride (13)
[0474] 2-(4-Phenylbutyl)isoindole-l,3-dione 12 (1.9 g, 6.8 mmol) was added to chlorosulfonic acid (10 mL, 138 mmol) at 0 °C and the mixture was stirred for 1 h at the temperature. After storing in refrigerator at -5 °C overnight, the reaction mixture was poured onto crushed ice (100 g) and precipitates were collected by a suction filtration and dried under high vacuum to afford the desired product 13 (2.48 g, 99% yield). Η NMR (300 MHz, CDC13) δ 1.70 (m, 4H), 2.78 (m, 2H), 3.70 (m, 2H), 7.40 (d, 2H) 7.70 (d, 2H), 7.85 (d, 2H), 7.95 (d, 2H).
[0475] (2S)-{4-[4-(l,3-Dioxo-l,3-dihydroisoindol-2- yl)butyl]benzenesulfonylamino}-3-methylbutyramide (14)
[0476] 4-[4-(l,3-Dioxo-l,3-dihydroisoindol-2-yl)butyl]benzenesulfonyl chloride 13 (0.45 g, 1.19 mmol) was dissolved in dry DMF (5 mL), and added to a solution of N-methylmorpholine (3 mL) and (2S)-amino-3-methylbutyramide (0.18 g, 1.19 mmol) in DMF (10 mL). The reaction mixture was stirred at room temperature for 66 h. Solvent was removed by rotary evaporation and the residue was purified by flash silica gel chromatography eluting with chloroform/methanol/concentrated ammonium hydroxide (15:1:0.1, v/v) to give the desired product 14 as a white powder (0.41 g, 73% yield). Η NMR (300 MHz, DMSO--i6) δ 0.72 (d, 3H), 0.76 (d, 3H), 1.77 (m, 4H), 1.79 (m, IH), 2.68 (m, 2H), 3.40 (m, IH), 3.60 (m, 2H), 6.92 (s, IH), 7.21 (s, IH), 7.34 (d, 2H) 7.50 (d, IH), 7.65 (d, 2H), 7.82 (m, 4H).
[0477] (2S)-[4-(4-Aminobutyl)benzenesulfonylamino]-3-methylbutyramide (15) [0478] A mixture of (25)-{4-[4-(l,3-dioxo-l,3-dihydroisoindol-2-yl)butyl]- benzenesulfonylamino}-3-methylbutyramide 14 (0.40 g, 0.87 mmol) and methylamine (2 M in methanol, 20 mL, 40 mmol) was stirred at room temperature overnight. Solvent was removed by rotary evaporation and the residue was purified by flash silica gel column chromatography eluting with chloroform/methanol/concentrated ammonium hydroxide (3:1:0.1, v/v) to give (2S)- [4-(4-aminobutyl)benzenesulfonylamino]-3-methyl-butyramide (15) as a white powder (156 mg, 54% yield). 1H NMR (300 MHz, CD3OD) δ 0.85 (d, 3H), 0.87 (d, 3H), 1.66 (m, 4H), 1.90 (m, IH), 2.69 (m, 4H), 3.51 (d, IH), 7.35 (d, 2H) 7.75 (d, 2H). m/z (ESI): 328 [C15H25N3O3S + H]+.
[0479] (2S)-(4-{4-[N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)guanidino]butyl}- benzenesulfonylamino)-3-methylbutyramide (16, PSA 19008) [0480] A solution of (2S)-[4-(4-aminobutyl)benzenesulfonylamino]-3- methylbutyramide 15 (156 mg, 0.47 mmol), diisopropylethylamine (0.60 mL, 3.0 mmol), and 1 -(3,5-diamino-6-chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (230 mg, 0.61 mmol) in absolute ethanol (8 mL) was stirred at 70 °C for 5 h and then cooled to room temperature. The reaction mixture was concentrated by rotary evaporation. The crude residue was washed with water, filtered and the crude solid product was purified by flash silica gel column chromatography eluting with chloroform/methanol/concentrated ammonium hydroxide (5:1 :0.1, v/v) to give the desired product as a yellow solid (137 mg, 54% yield). Part ofthe solid (86 mg) was further purified by semi-preparative HPLC (acetonitrile/water/0.1% TFA) to give the analytical pure sample which was then co-evaporated with 5% aqueous HCl to give the hydrochloride salt 16. mp 154-156 °C (decomposed). Η NMR (300 MHz, CD3OD) δ 0.85 (d, 3H), 0.86 (d, 3H), 1.70 (m, 4H), 1.90 (m, IH), 2.75 (m, 2H), 3.32 (m, 2H), 3.52 (d, IH), 7.35 (d, 2H), 7.75 (d, 2H). m/z (ESI): 540 [C21H30C1N9O4S + H]+. [α]D 25 +5.2° (c 0.50, MeOH).
Example 4.
[0481] Synthesis of 2-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]-butyl}phenoxy)-N-phenylacetamide (PSA 17482)
Figure imgf000111_0001
[0482] [4-(4-Phenylcarbamoylmethoxyphenyl)butyl]carbamic acid benzyl ester (18) [0483] A mixture of [4-(4-benzyloxycarbonylaminobutyl)phenoxy]acetic acid (300 mg, 0.84 mmol), aniline (0.15 mL, 1.70 mmol), DMAP (60 mg, 0.50 mmol) and EDC'HCl (320 mg, 1.70 mmol) in CH2C12 (30 mL) was stirred at room temperature for 66 h. The reaction mixture was concentrated under vacuum and the residue was subjected to flash silica gel column chromatography eluting with methanol/CH2Cl2 (1 :99, v/v) to give the desired amide 18 as a white solid (360 mg, 99% yield). Η NMR (300 MHz, CDCI3) δ 1.55 (m, 4H), 2.60 (m, 2H), 3.20 (m, 2H), 4.58 (s, 2H), 4.70 (br s, IH), 5.10 (s, 2H), 6.88 (d, 2H), 7.15 (m, 3H), 7.35 (m, 7H), 7.58 (d, 2H), 8.25 (s, IH). m/z (ESI): 433 [C26H28N2O4 + H]+.
[0484] 2-[4-(4-Aminobutyl)phenoxy]-N-phenylacetamide (19). [0485] A solution of [4-(4-phenylcarbamoylmethoxyphenyl)butyl]carbamic acid benzyl ester 18 (0.30 g, 0.69 mmol) in ethanol (10 mL), THF (6 mL), and acetic acid (2 mL) was stirred at room temperature for 2 h under hydrogen atmosphere in the presence of 10% Pd C catalyst (0.2 g, 50% wet). The catalyst was removed by suction filtration and the filtrate was concentrated in vacuo. The residue was purified by flash silica gel column chromatography eluting with CH2Cl2/methanol/concentrated ammonium hydroxide (30:1:0, 30:1:0.3, v/v) to give the desired amine 19 as a white solid (200 mg, 97% yield). Η NMR (300 MHz, CD3OD) δ 1.60 (m, 4H), 2.55 (m, 2H), 2.70 (m, 2H), 4.60 (s, 2H), 6.88 (d, 2H), 7.15 (m, 3H), 7.35 (m, 2H), 7.58 (d, 2H), 8.25 (s, IH). m/z (ESI): 299 [Cι8H22N2O2 + H]+.
[0486] 2-(4-{4-[N-(3,5-Diamino-6-chloropyrazine-2- carbonyl)guanidino]butyl}phenoxy)-N-phenylacetamide (20, PSA 17482).
[0487] A solution of 2-[4-(4-aminobutyl)phenoxy]-N-phenylacetamide 19 (100 mg, 0.35 mmol) and triethylamine (0.14 mL, 1.00 mmol) in absolute ethanol (2 mL) was stirred at 60 °C for 30 min, after which l-(3,5-diamino-6-chloropyrazine-2- carbonyl)-2-methyl-isothiourea hydriodide (140 mg, 0.37 mmol) was added in one portion. The reaction mixture was stirred at that temperature for 4 h, cooled to room temperature, and concentrated by rotary evaporation. The crude residue was triturated with water and filtered. The filter cake was purified by flash silica gel column chromatography eluting with dichloromethane/methanol/concentrated ammonium hydroxide (500:10:0, 500:10:1, 200:10:1, v/v) to give 2-(4-{4-[N-(3,5- diamino-6-chloro-pyrazine-2-carbonyl)guanidino] butyl } phenoxy)-N- phenylacetamide (20, PSA 17482) as a yellow solid (120 mg, 67 % yield), mp 168- 170 °C. 'H ΝMR (300 MHz, DMSO-_i6) δ 1.55 (m, 4H), 2.55 (m, 2H), 3.16 (m,
2H), 4.65 (s, 2H), 6.60 (br s, 2H), 6.90 (d, 2H), 7.08 (m, 2H), 7.15 (d, 2H), 7.30 (m, 5H), 7.60 (d, 2H), 9.00 ( br s, IH), 10.00 (br s, IH). m/z (ESI): 511 [C24H27ClΝ8O3 + H]+.
Example 5.
[0488] Synthesis of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N-(4-{4-[3-(lH- imidazol-2-yl)propoxy]phenyl}butyl)guanidine (PSA 23022)
Figure imgf000113_0001
4-{4-[3-(lH-Imidazol-2-yl)propoxy]phenyl}butylamine (21)
[0489] Compoimd 2 (0.156 g, 0.425 mmol) was dissolved in anhydrous ethanol (10 mL). To the solution was bubbled anhydrous HCl gas for 3 min. The reaction vessel was sealed and the mixture was stirred at room temperature for 48 h, and then concentrated to dryness under vacuum. The resulting residue was dissolved in anhydrous methanol (5 mL). To the newly formed solution was added 2,2- dimethoxyethylamine (0.097 mL, 0.891 mmol) in one portion. After stirring at room temperature overnight, temperature was raised to reflux which was maintained for another 3 h before the mixture was cooled to ambient temperature. Solvent was removed under vacuum and the residue was treated with 1.2 N HCl aqueous solution at 80 °C for 2 hours. The mixture was then cooled to ambient temperature again and neutralized to pH ~9 with powder K2CO3. Water was completely removed under vacuum and the residue was dissolved in methanol. The methanol solution was loaded onto silica gel, and the product was eluted with a mixture of concentrated ammonium hydroxide/MeOH/CH2Cl2 (1.8:18:81.2, v/v), affording the product 21 (27 mg, 23% overall yield) as an off-white solid. Η NMR (300 MHz, CD3OD): δ 1.60 (m, 4H), 2.14 (m, 2H), 2.56 (t, 2H), 2.76 (t, 2H), 2.86 (t, 2H), 3.94 (t, 2H), 6.79 (d, 2H), 6.91 (s, 2H), 7.08 (d, 2H). m/z (APCI): 274 [Cι6H23N3O + H]+. iV-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N1-(4-{4-[3-(lH-imidazol- 2-yl)propoxy]phenyl}butyl)guanidine (22, PSA 23022)
[0490] Compound 21 (23 mg, 0.084 mmol) was dissolved in a mixture of ethanol (3 mL) and Hunig's base (0.074 mL, 0.421 mmol) at 65 °C over 15 min. To the solution was added l-(3,5-diamino-6-chloropyrazine-2-carbonyl)-2- methylisothiourea hydriodide (43 mg, 0.109 mmol) and the resulting mixture was stirred at the above temperature for an additional 3 h before all liquid was removed under vacuum. The residue was chromatographed on silica gel, eluting with a mixture of concentrated ammonium hydroxide/methanol/dichloromethane (1.5:15:63.5, v/v), to afford the desired product 22 (34 mg, 83% yield) as a yellow solid, mp 123-126 °C (decomposed), Η NMR (300 MHz, CD3OD): δ 1.62 (m, 4H), 2.14 (m, 2H), 2.58 (t, 2H), 2.88 (t, 2H), 3.21(t, 2H), 3.94(t, 2H), 6.77 (d, 2H), 6.90 (s, 2H), 7.06 (d, 2H). m/z (APCI): 486 [C22H28ClN9O2 + H]+.
Example 6.
[0491] Synthesis of 2-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]-butyl}phenoxy)-N^V-bis-(2-hydroxyethyl)acetamide (PSA
16826)
Figure imgf000114_0001
[0492] [4-(4-{[N;N-Bis-(2-hydroxyethyl)carbamoyl]methoxy}phenyl)butyl]carbamic acid benzyl ester (25)
[0493] A solution of [4-(4-benzyloxycarbonylaminobutyl)phenoxy] acetic acid ethyl ester 23 (0.3 g, 0.78 mmol), 2-(2-hydroxyethylamino)ethanol 24 (0.15 mL, 1.6 mmol), and ethanol (20 mL) was heated at 70 °C for 72 hours. Solvent was evaporated in vacuo. The residue was purified by flash chromatography (silica gel, dichloromethane/methanol, 100:5, v/v) to provide [4-(4-{[NN-bis-(2- hydroxyethyl)carbamoyl]methoxy}phenyl)-butyl]carbamic acid benzyl ester 25 [0.19 g, 100% based on the recovered starting material (0.13 g)] as a pale yellow solid. Η ΝMR (300 MHz, CD3OD) δ 1.65 (m, 4H), 2.50 (m, 2H), 3.20 (m, 2H), 3.55 (m, 4H), 3.75 (m, 4H), 4.80 (s, 2H), 5.10 (s, 2H), 6.85 (d, 2H), 7.10 (d, 2H), 7.40 (m, 5H). m/z (ESI): 445 [C24H32Ν2O6 + H]+. [0494] 2-[4-(4-Aminobutyl)phenoxy]-N V-bis-(2-hydroxyethyl)acetamide (26) [0495] To a degassed solution of [4-(4-{[NN-bis-(2- hydroxyethyl)carbamoyl]methoxy}phenyl)-butyl]carbamic acid benzyl ester 25 (0.19 g, 0.43 mmol) in ethanol (4 mL) was added 10% palladium on activated carbon (0.1 g, 50% wet). The mixture was hydrogenated overnight at atmospheric hydrogen. The catalyst was filtered through a pad of diatomaceous earth and the solvent was evaporated in vacuo. The residue was purified by flash chromatography (silica gel, 20-5:1 :0.1-1 dichloromethane/methanol/ concentrated ammonium hydroxide, v/v) to provide 26 (0.09 g, 72%) as a colorless oil. Η ΝMR (300 MHz, CD3OD) δ 1.56 (m, 4H), 2.56 (t, 2H), 2.65 (t, IH), 3.29 (m, IH), 3.55 (m, 4H), 3.72 (m, 4H), 4.90 (s, 2H), 6.86 (d, 2H), 7.09 (d, 2H). m/z (ESI): 311 [C,6H26Ν2O4 + H]+.
[0496] 2-(4-{4-[N-(3,5-Diamino-6-chloropyrazine-2- carbonyl)guanidino]butyl}phenoxy)-N,N-bis-(2-hydroxyethyl)acetamide (27, PSA 16826)
[0497] l-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (0.13 g, 0.33 mmol) was added to a solution of 2-[4-(4- aminobutyl)phenoxy]-N,N-bis-(2-hydroxyethyl)acetamide 26 (0.09 g, 0.3 mmol), triethylamine (0.12 mL), and ethanol (1.7 mL). The reaction mixture was stirred at 60 °C for 3 h. The solvent was evaporated in vacuo. The residue was triturated with water and then purified by flash chromatography (silica gel, 20-10: 1 :0-0.2 CH2Cl2/methanol/concentrated ammonium hydroxide, v/v) to provide 2-(4-{4-[N- (3,5-diamino-6-chloropyrazine-2-carbonyl)guanidino]butyl}-phenoxy)-N,N-bis-(2- hydroxyethyl)acetamide 27 (0.1 g, 64%) as a yellow solid, mp 114-116 °C. Η ΝMR (300 MHz, CD3OD) δ 1.70 (m, 4H), 2.60 (m, 2H), 3.32 (m, 2H), 3.50 (m, 4H), 3.70 (m, 4H), 4.81 (s, 2H), 6.85 (d, 2H), 7.10 (d, 2H). m/z (ESI): 523
Figure imgf000115_0001
Example 7. [0498] Synthesis of 2-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino] -butyl }phenoxy)-NN-dimethylacetamide hydrochloride (PSA 16313)
Figure imgf000116_0001
[0499] [4-(4-Dimethylcarbamoylmethoxyphenyl)butyl]carbamic acid benzyl ester
(28).
[0500] A mixture of [4-(4-benzyloxycarbonylaminobutyl)phenoxy] acetic acid ethyl ester 23 (0.50 g, 1.3 mmol) and dimethylamine (2.0 M in THF, 10 mL, 20 mmol) in a sealed tube was heated at 55 °C for 48 h. The solvent was evaporated in vacuo. The residue was purified by flash chromatography (silica gel, ethyl acetate/CH2θ2, 1:4, 1:3, v/v) to provide [4-(4-dimethylcarbamoylmethoxyphenyl)butyl]carbamic acid benzyl ester 28 (0.26 g, 52% yield) as a white solid. Η NMR (300 MHz, CDC13) δ 1.55 (m, 4H), 2.55 (m, 2H), 2.90 (s, 3H), 3.05 (s, 3H), 3.20 (m, 2H), 4.65 (s, 2H), 5.08 (s, 2H), 6.80 (d, 2H), 7.05 (d, 2H), 7.35 (m, 5H).
[0501] 2-[4-(4-Aminobutyl)phenoxy]-N,N-dimethylacetamide (29). [0502] To a degassed solution of [4-(4- dimethylcarbamoylmethoxyphenyl)butyl]carbamic acid benzyl ester (28) (0.26 g, 0.68 mmol) in ethanol (10 mL) was added 10% palladium on activated carbon (0.1 g, 50% wet). The mixture was stirred at room temperature overnight under atmospheric hydrogen. The catalyst was filtered through a pad of diatomaceous earth and the solvent was evaporated in vacuo. The residue was purified by flash chromatography (silica gel, dichloromethane/methanol/concentrated ammonium hydroxide, 100:5:1, v/v) to provide 2-[4-(4-aminobutyl)phenoxy]-NrV- dimethylacetamide 29 (100 mg, 60% yield) as a white solid. !H ΝMR (300 MHz, CD3OD) δ 1.55 (m, 4H), 2.55 (m, 2H), 2.66 (m, 2H), 2.90 (s, 3H), 3.05 (s, 3H), 4.70 (s, 2H), 6.80 (d, 2H), 7.05 (d, 2H). m/z (ESI): 251 [C,4H22N2O2 + H]+.
[0503] 2-(4-{4-[N'-(3,5-Diamino-6-chloroρyrazine-2- carbonyl)guanidino]butyl } phenoxy)-N,N-dimethylacetamide hydrochloride (30, PSA 16313).
[0504] A solution of 2-[4-(4-aminobutyl)phenoxy]-NN-dimethylacetamide 29 (67 mg, 0.27 mmol) in absolute ethanol (1 mL) was stirred at 65 °C for 30 min, after which 1 -(3 ,5-diamino-6-chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (110 mg, 0.29 mmol) was added in one portion. The reaction mixture was stirred at that temperature for 3 h and then cooled to room temperature. The reaction mixture was concentrated by rotary evaporation. The crude residue was triturated with water and filtered. The filter cake was purified by flash silica gel column chromatography eluting with dichloromethane/methanol/concentrated ammonium hydroxide (200:10:0, 200:10:1, v/v) to give 2-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]butyl}-phenoxy)-NN-dimethylacetamide as a yellow solid (35 mg, 28% yield). This solid was dissolved in methanol (2 mL) and added to 4 Ν aqueous HCl (4 drops). Concentration in vacuo gave 2-(4-{4-[N-(3,5-diamino-6- chloropyrazine-2-carbonyl)-guanidino]butyl}phenoxy)-N!N-dimethylacetamide hydrochloride (30, PSA 16313). mp 130-132 °C (decomposed). 1H ΝMR (300 MHz, CD3OD) δ 1.69 (m, 4H), 2.60 (m, 2H), 2.95 (s, 3H), 3.10 (s, 3H), 3.35 (m, 2H), 4.75 (s, 2H), 6.80 (d, 2H), 7.10 (d, 2H). m/z (ESI): 463 [C2oH27ClΝ8O3 + H]+.
Example 8.
[0505] Synthesis of 2-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino] -butyl } phenoxy)-N-( 1 H-imidazol-2-yl)acetamide dihydrochloride (PSA 16437)
Figure imgf000118_0001
[0506] [4-(4-tert-Butoxycarbonylaminobutyl)phenoxy] acetic acid methyl ester (32) [0507] A mixture of [4-(4-hydroxyphenyl)butyl]carbamic acid tert-butyl ester 31 (1.00 g, 3.78 mmol), potassium carbonate (0.627 g, 4.54 mmol), sodium iodide (0.567 g, 3.78 mmol), and methyl bromoacetate (0.40 mL, 4.21 mmol) in anhydrous DMF (8 mL) was stirred at room temperature for 14 h. The reaction mixture was then diluted with ethyl acetate (100 mL) and hexanes (20 mL), washed with water (20 mL x 4) and brine (30 mL), and concentrated under reduced pressure to afford the desired product 32 as a yellow oil (1.28 g, 100% yield) which was used for the next step without further purification. Η NMR (300 MHz, CDC13) δ 1.40 (s, 9H), 1.41-1.65 (m, 4H), 2.49-2.60 (m, 2H), 3.02-3.16 (m, 2H), 3.79 (s, 3H), 4.45 (br s, IH), 4.59 (s, 2H), 6.79 (d, 2H), 7.05 (d, 2H). m/z (ESI): 338 [C18H27NO5 + H]+.
[0508] [4-(4-tert-Butoxycarbonylaminobutyl)phenoxy]acetic acid (33). A solution of [4-(4-tert-butoxycarbonylaminobutyl)phenoxy] acetic acid methyl ester 32 (1.28 g, 3.78 mmol) in methanol (80 mL) was added with crushed potassium hydroxide (2.50 g, 85%, 37.8 mmol) and the mixture was stirred at room temperature for 5 h. Solvent was removed by rotary evaporation. The residue was taken up in water and acidified to pH ~1 with 6N aqueous HCl, and extracted with dichloromethane. The combined organics were washed with brine, dried over
Na2SO4, and concentrated to complete dryness to afford the desired product 33 as a white solid (1.19 g, 97% yield). Η NMR (300 MHz, CD3OD) δ 1.41 (s, 9H), 1.42- 1.70 (m, 4H), 2.45-2.60 (m, 2H), 3.00-3.20 (m, 2H), 4.60 (s, 2H), 6.80 (d, 2H), 7.08 (d, 2H). m/z (ESI): 322 [C17H25NO5 - H]\
[0509] (4-{4-[(lH-Imidazol-2-yl-carbamoyl)methoxy]phenyl}butyl)carbamic acid tert-butyl ester (34). [0510] [4-(4-tert-Butoxycarbonylaminobutyl)phenoxy]acetic acid 33 (1.19 g, 3.68 mmol) was dissolved in anhydrous THF (10 mL), CH2C12 (10 mL) and CH3CN (5 mL). To the solution were sequentially added HOAt (200 mg, 1.47 mmol), DMAP (135 mg, 1.10 mmol), and diisopropylethylamine (3.2 mL, 18.40 mmol), followed by the addition of EDC»HC1 (1.03 g, 5.35 mmol). The reaction mixture was stirred at room temperature for 15 min. Amino imidazole sulfate (583 mg, 4.41 mmol) was then added and stirring was continued for 48 h. Solvents were removed by rotary evaporation. The residue was taken up in CH2C12 (250 mL), washed with water and brine, and concentrated under reduced pressure. Flash silica gel column chromatography eluting with methanol/dichloromethane (1 :30, 1 :20, v/v) gave the desired amide as a white solid (0.95 g, 66% yield). 1H NMR (300 MHz, CD3OD) δ 1.40 (s, 9H), 1.42-1.70 (m, 4H), 2.48-2.60 (m, 2H), 3.00-3.20 (m, 2H), 4.65 (s, 2H), 6.79-6.89 (m, 4H), 7.10 (d, 2H). m/z (ESI): 389 [C20H28N4O4 + H]+.
[0511] 2-[4-(4-Aminobutyl)phenoxy]-N-(lH-imidazol-2-yl)acetamide dihydrochloride (35)
[0512] (4-{4-[(lH-Imidazol-2-yl-carbamoyl)methoxy]phenyl}butyl)carbamic acid tert-butyl ester 34 (950 mg, 2.45 mmol) was treated with HCl (4 M in dioxane, 24 mL, 96 mmol) at room temperature for 12 h. The reaction mixture was concentrated in vacuo and further co-evaporated with dichloromethane and methanol, and dried under high vacuum. The desired product was obtained as a white solid (779 mg, 98%) and used directly without further purification. 1H ΝMR (300 MHz, CD3OD) δ 1.59-1.74 (m, 4H), 2.55-2.67 (m, 2H), 2.85-2.98 (m, 2H), 4.80 (s, 2H), 7.00 (d, 2H), 7.18 (d, 2H), 7.19 (s, 2H). m/z (ESI): 289 [Cι5H20Ν4O2 + H]+.
[0513] 2-(4-{4-[N-(3,5-Diamino-6-chloropyrazine-2- carbonyl)guanidino]butyl}phenoxy)-N-(lH-imidazol-2-yl)acetamide dihydrochloride (36, PSA 16437). [0514] A solution of 2-[4-(4-aminobutyl)phenoxy]-N-(lH-imidazol-2-yl)acetamide dihydrochloride 35 (99 mg, 0.27 mmol) and diisopropylethylamine (0.27 mL, 1.53 mmol) in absolute ethanol (4 mL) and anhydrous methanol (3 mL) was stirred at 70 °C for 30 min, after which l-(3,5-diamino-6-chloropyrazine-2-carbonyl)-2- methylisothiourea hydriodide (130 mg, 0.34 mmol) was added in one portion. The reaction mixture was stirred for 3 h and then cooled to room temperature. The yellow insolubles were removed by suction filtration and the liquid filtrate was concentrated by rotary evaporation. The crude residue was purified by flash silica gel column chromatography eluting with dichloromethane/methanol/concentrated ammonium hydroxide (200:10:0, 200:10:1, 150:10:1, and 100:10:1, v/v) to give 2- (4-{4-[N-(3,5-diamino-6-chloropyrazine-2-carbonyl)guanidino]butyl}phenoxy)-N- (lH-imidazol-2-yl)-acetamide as a yellow solid (44 mg, 29% yield). The free base thus obtained was dissolved in methanol and treated with 4 drops of 4 Ν aqueous HCl. The solution was concentrated under reduced pressure and further dried under vacuum to give the final compound 36. mp 172-174 °C. 1H ΝMR (300 MHz, CD3OD) δ 1.61-1.77 (m, 4H), 2.58-2.70 (m, 2H), 3.32-3.40 (m, 2H), 4.80 (s, 2H), 7.00 (d, 2H), 7.18 (d, 2H), 7.20 (s, 2H). m/z (ESI): 501 [C21H25C1Ν,0O3 + H]+.
Example 9.
[0515] Synthesis of N-carbamoylmethyl-2-(4-{4-[N -(3, 5-diamino-6-chloropyrazine- 2-carbonyl)guanidino]butyl}phenoxy)acetamide (PSA 16314)
Figure imgf000120_0001
[0516] (4-{4-[(Carbamoylmethylcarbamoyl)methoxy]phenyl}butyl)carbamic acid benzyl ester (37)
[0517] Compound 1 (0.50 g, 1.77 mmol) was dissolved in DMF (10 mL). To the solution was added crushed NaOH (0.107 g, 2.66 mmol). The mixture was stirred at room temperature for 30 min. 2-Bromoacetamide (0.367 g, 2.66 mmol) was added. The reaction was further stirred at room temperature overnight, quenched with water (2 mL) and partitioned between water and dichloromethane (each 50 mL). The organic layer was separated, washed with water (2 x 50 mL), dried over anhydrous Na2SO4 and concentrated under vacuum. The residue was purified on silica gel, eluting with a mixture of methanol/dichloromethane (7:93, v/v), to afford the desired product 37 (0.131 g, 18% yield) as a white solids. Η NMR (300 MHz, CDC13): δ 1.58 (m, 4H), 2.60 (t, 2H), 3.20 (m, 2H), 4.04 (d, 2H), 4.54 (s, 2H), 4. 75 (br, 2H), 5.12 (s, 2H), 5.43 (br, IH), 5.80 (br, IH), 6.85 (d, 2H), 7.12 (d, 2H), 7.36 (m, 5H). m/z (APCI): 414 [C22H27N3O5 + H]+. [0518] 2-[4-(4-Aminobutyl)phenoxy]-N-carbamoylmethylacetamide (38) Compound 37 (130 mg, 0.314 mmol) was dissolved in EtOH and THF (14 mL, 1/1 ratio). The reaction vessel was purged with nitrogen both before and after the catalyst (100 mg, 10% Pd/C, 50% wet) was added. The mixture was stirred under hydrogen atmosphere (1 atm) overnight. After purging with nitrogen, the catalyst was vacuum filtered and washed with ethanol (3 x 5 mL). The combined filtrates were concentrated under vacuum. The residue was chromatographed on silica gel, eluting with a mixture of concentrated ammonium hydroxide/methanol/dichloromethane (2:20:88, v/v), to afford the desired product 38 (80 mg, 91% yield) as a white solid. Η ΝMR (300 MHz, CD3OD): δ 1.62 (m, 4H), 2.60 (t, 2H), 2.75 (t, 2H), 3.92 (s, 2H), 4.54 (s, 2H), 6.92 (d, 2H), 7.14 (d, 2H).
[0519] N-Carbamoylmethyl-2-(4-{4-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)-guanidino]butyl}phenoxy)acetamide (39, PSA 16314) [0520] Compound 38 (79 mg, 0.283 mmol) was dissolved in a mixture of absolute ethanol (5 mL) and Hunig's base (0.25 mL, 1.41 mmol) at 65 °C over 10 min. To the solution was added l-(3,5-diamino-6-chloropyrazine-2-carbonyl)-2- methylisothiourea hydriodide (132 mg, 0.34 mmol) in one portion. The newly resulting reaction mixture was continuously stirred for an additional 2 h before it was cooled down to ambient temperature and subsequently concentrated under vacuum. The resulting residue was purified by chromatography eluting with methanol/dichloromethane/concentrated ammonium hydroxide (10/2/88, v/v) to afford the free base (93 mg, 67% yield) as a yellow solid. The HCl salt was made using the following procedure: 45 mg ofthe free base was suspended in ethanol (2 mL) and treated with concentrated HCl (12 N, 0.5 mL) for 10 min. All liquid was then completely removed under vacuum to afford 39 (47 mg). mp 178-180 °C (decomposed). Η NMR (300 MHz, DMSO-de): δ 1.61 (m, 4H), 2.58 (t, 2H), 3.32 (m, 2H), 3.70 (s, 2H), 4.48 (s, 2H), 6.93 (d, 2H), 7.08 (br, IH), 7.13 (d, 2H), 7.36 (br, IH), 7.44 (br, 2H), 8.17 (t, IH), 8.74 (br, IH), 8.90 (br, 2H), 9.18 (t, IH), 10.48 (br, IH). m/z (APCI): 492 [C20H26C1N9O4 + H]+. Example 10.
[0521] Synthesis of N-[4-(4-cyanomethoxyphenyl)butyl]-N-(3,5-diamino-6-chloro- pyrazine-2-carbonyl)guanidine (PSA 16208)
Figure imgf000122_0001
[0522] [4-(4-Cyanomethoxyphenyl)butyl]carbamic acid tert-butyl ester (40) [0523] A mixture of [4-(4-hydroxyphenyl)butyl]carbamic acid tert-butyl ester 31 (0.365 g, 1.37 mmol) and Cs2CO3 (0.672 g, 2.06 mmol) in anhydrous DMF (8 mL) was heated at 65 °C for 30 min. lodoacetonitrile (0.276 g, 1.651 mmol) was then added to the mixture in one portion. The mixture was stirred at 65 °C overnight, and then cooled to room temperature. The precipitated solid was filtered, and the filtrate was partitioned between water and dichloromethane (each 50 mL). The organic layer was separated, washed with brine (3 x 50 mL), dried over anhydrous Na2SO4 and concentrated under vacuum. The residue was chromatographed on silica gel, eluting with a mixture of diethyl ether/dichloromethane (6:94, v/v), to afford the desired product 40 (0.109 g, 38% yield) as a colorless viscous oil. Η NMR (300 MHz, CDC13): δ 1.43 (s, 9H), 1.57 (m, 4H), 2.60 (t, 2H), 3.15 (m, 2H), 4.49 (br, IH), 4.75 (s, 2H), 6.91 (d, 2H), 7.13 (d, 2H).
[0524] [4-(4-Aminobutyl)phenoxy] acetonitrile (41 ) [0525] Compound 40 (0.105 g, 0.345 mmol) was dissolved in dichloromethane (10 mL). Trifluoroacetic acid (2 mL) was added in one portion. The mixture was stirred at room temperature for 2 h, and then concentrated under vacuum to dryness. The crude residue was used directly without further purification. 1H NMR (300 MHz, CD3OD): δ 1.60-1.75 (m, 4H), 2.65 (t, 2H), 2.92 (t, 2H), 4.38 (s, 2H), 6.96 (d, 2H), 7.20 (d, 2H). m/z (APCI): 205 [Cι2Hι6N2O + H]+.
[0526] N-[4-(4-Cyanomethoxyphenyl)butyl]-N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidine (42, PSA 16208) [0527] A mixture of compound 41 (0.070 g, 0.345 mmol) and Hunig's base (0.3 mL, 1.72 mmol) in anhydrous ethanol was heated at 65 °C for 20 min. To the solution was added 1 -(3,5-diamino-6-chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (0.148 g, 0.379 mmol) in one portion. The heating was continued for another 2 h. The reaction mixture was then concentrated under vacuum. The residue was chromatographed by flash column chromatography and further purified by preparative TLC, eluting with methanol/dichloromethane/ concentrated ammonium hydroxide (10/1/89, v/v), to afford the desired product 42 (0.031 g, 22%) as a yellow solid, mp 129-132 °C. Η ΝMR (300 MHz, CD3OD): δ 1.72 (m, 4H), 2.68 (t, 2H), 3.32 (m, 2H), 4.92 (s, 2H), 6.95 (d, 2H), 7.22 (d, 2H); m/z (APCI): 417 [C18H2ιClΝ8θ2 + H]+.
Example 11.
[0528] Synthesis ofN-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N-(4-{4-[3-(2,3- dihydroxypropoxy)-2-hydroxypropoxy]phenyl}butyl)guanidine (PSA 15143)
Figure imgf000123_0001
[0529] (4-{4-[3-(2,3-Dihydroxypropoxy)-2-hydroxypropoxy]phenyl}butyl)carbamic acid benzyl ester (43)
[0530] A solution containing compound 1 (2.0 g, 6.68 mmol), triethylamine (0.093 mL, 0.668 mmol) and anhydrous ethanol (2.2 mL) was heated at 70 °C for 1 h. Oxiranylmethanol (0.5 mL, 6.68 mmol) was added every hour for a total of 4 h (the total amount of oxiranylmethanol added was 2.0 ml, 26.72 mmol). The reaction was concentrated under vacuum. The residue was chromatographed on silica gel with the elution of a mixture of methanol/dichloromethane (3:97, v/v) to provide 168 mg (4.6% yield) ofthe desired product 43. m/z (APCI): 448 [C24H33NO7 + H]+.
[0531] 3-{3-[4-(4-Aminobutylphenoxy]-2-hydroxypropoxy}propane-l,2-diol (44) [0532] A solution containing the compound 43 (0.15 g, 0.34 mmol) in ethanol (1.5 mL) was purged with nitrogen before and after the catalyst (0.15 g, 10% Pd/C, 50% wet) was added. The reaction mixture was placed under hydrogenation atmosphere for 45 min. The catalyst was vacuum filtered through diatomaceous earth and washed with ethanol (3 x 2 mL). The combined filtrates were concentrated under vacuum. The residue was chromatographed on silica gel, eluting with methanol/dichloromethane/concentrated ammonium (25/2.5/73.5, v/v), to afford the desired product 44 (0.053 g, 51% yield) as a colorless, viscous oil. Η NMR (300 MHz, CD3OD): δ 1.52 (m, 4H), 2.55 (t, 2H), 2.65 (t, 2H), 3.61 (m, 10H), 6.85 (d, 2H), 7.09 (d, 2H). m/z (APCI): 314 [C16H27NO5 + H]+.
[0533] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N-(4-{4-[3-(2,3- dihydroxypropoxy)-2-hydroxypropoxy]phenyl}butyl)guanidine (45, PSA 15143) [0534] Compound 44 (50 mg, 0.159 mmol) was dissolved in a mixture of absolute ethanol (0.5 mL) and triethylamine (0.076 mL, 0.541 mmol) at 65 °C over 15 min. To the solution was added l-(3,5-diamino-6-chloropyrazine-2-carbonyl)-2- methylisothiourea hydriodide (74 mg, 0.191 mmol). The reaction mixture was stirred at the above temperature for an additional 50 min, cooled down to ambient temperature and subsequently concentrated under vacuum. The residue was chromatographed on silica gel, eluting with methanol/dichloromethane/concentrated ammomum hydroxide (10/1/40, v/v) to afford the desired product 45 (53 mg, 36% yield) as a yellow solid, mp 73-82 °C (decomposed). Η NMR (300 MHz, CD3OD): δ 1.70 (m, 4H), 2.55 (m, 2H), 3.22 (m, 2H), 3.65 (m, 7H), 3.98 (m, 3H), 6.86 (d, 2H), 7.08 (d, 2H). m/z (APCI): 526 [C22H32ClN7O6 + H]+.
Example 12. [0535] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000125_0001
PSA 17927
Figure imgf000125_0002
Example 13. [0536] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000126_0001
PSA18211
Figure imgf000126_0003
Example 14. [0537] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000126_0002
PSA18212
Figure imgf000127_0002
Example 15. [0538] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000127_0001
PSA18229
Figure imgf000127_0003
Example 16. [0539] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000128_0001
PSA18361
Figure imgf000128_0003
Example 17. [0540] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000128_0002
PSA18592
Figure imgf000129_0002
Example 18. [0541] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000129_0001
PSA18593
Figure imgf000129_0003
Example 19. [0542] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000130_0001
Figure imgf000130_0003
Example 20. [0543] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000130_0002
PSA 19912
Figure imgf000131_0002
Example 21. [0544] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000131_0001
PSA 24406
Figure imgf000131_0003
Example 22. [0545] Utilizing the procedures set forth above, the following Capped Pyrazinoylguanidine was prepared.
Figure imgf000132_0001
Figure imgf000132_0002
Example 23. [0546] Sodium Channel Blocking Activity of Selected Capped Pyrazinoylguanidines .
Figure imgf000133_0001
**Relative potency for PSA 4022=100 using EC50 from PSA 4022 in same run [0547] The following examples depict the synthesis of compounds according to Formula II. FORMULA II EXAMPLES:
Scheme 1. (Formula II) H N^(^/NH2
Boc2O/DIPEA MeOH H2 sA' NHBoc la, n = 6, lb, n = 7, lc, n = 8 1
l
l
l
Figure imgf000135_0001
HCl/MeOH
l
Figure imgf000135_0002
Scheme 2. (Formula II)
Figure imgf000136_0001
NTf BocHN A NHBoc DIPEA/MeOH
H 2 NAA"Y NHBoc NBoc 6a, n = 6, 6b, n = 7, 6c, n - 8 6 6d,n = 9, 6e,n=10,6f,n=ll
Figure imgf000136_0002
HCl/MeOH
Figure imgf000136_0003
Scheme 3. (Formula II) H2N -' V^A^0 /"\A^ miι
Boc2O/DIPEA CH2C12
H,N' *0' * NHBoc
Figure imgf000137_0001
NTf BocHN A NHBoc MeOH/DIPEA
Figure imgf000137_0002
HCl/MeOH
Figure imgf000137_0003
11, PSA 19334 Scheme 4. (Formula II)
Figure imgf000138_0001
NTf BocHN A NHBoc MeOH/DIPEA
Figure imgf000138_0002
HCl/MeOH
Figure imgf000138_0003
General procedures
[0548] Method A. Mono-protection of symmetrical diamine by Boc-protecting group The diamine was dissolved in anhydrous methanol. To the solution was added Hunig's base (DIPEA, 3 equiv). The newly resulting solution was stirred at room temperature for 30 min. To the reaction mixture was slowly added (over 2 to 4 hours) a solution of Boc2O (1 equiv) dissolved in anhydrous methanol. After the addition, the reaction mixture was stirced for an additional 2 hours, then quenched with water. The product was extracted with dichloromethane. The combined extracts were washed with brine, dried over anhydrous Na2SO4 and concentrated. The residue was chromatographed on silica gel eluting with a mixture of methanol and dichloromethane. The fractions containing the desired product were collected and concentrated under vacuum. The product was spectroscopically characterized.
[0549] Method B. Removal of Boc-protecting group from amino or guanidino group
The compound containing Boc-protected amino or guanidino group was dissolved in methanol. The solution was then treated with concentrated HCl (12 N) at room temperature for 1 to 2 hours. All liquid in the reaction mixture was then completely removed under vacuum. The resulting residue was further dried under vacuum and generally directly used in the next step without purification.
[0550] Method C. Guanylation of free amine by reaction with (tert- butoxycarbonylamino-trifluoromethanesulfonyliminomethyl)carbamic acid tert-butyl ester (Goodman's reagent)
To a solution containing the free amine dissolved in anhydrous methanol was added Hunig's base (DIPEA, 3 equiv). The newly resulting solution was stined at room temperature for 30 min before the Goodman's reagent was added (1.5 equiv). The stirring was continued for an additional 3 to 5 hours. The reaction mixture was concentrated. The resulting residue was chromatographed on silica gel eluting with a mixture of dichloromethane, methanol, and concentrated ammonium hydroxide (CMA). The fractions containing the desired product were collected and concentrated. The product was characterized by spectroscopic methods.
[0551] Method D. Coupling of un-protected amine with l-(3,5-diamino-6- chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (Cragoe compound) The un-protected amine was dissolved in anhydrous ethanol. To the solution was added Hunig's base (DIPEA, 3 equiv). The newly resulting solution was heated at 65 °C for 15 min. The Cragoe compound (1.2 equiv) was then added. The reaction mixture was stirred at 65 °C for an additional 2 to 3 hours, and then cooled to room temperature before it was concentrated under vacuum. The resulting residue was chromatographed on silica gel eluting with CMA. The appropriate fractions were collected and concentrated under vacuum. The desired product (typically a yellow solid) was characterized by spectroscopic methods.
Example 1
[0552] Synthesis ofN-(6-aminohexyl)-N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidine dihydrochloride (PSA 18706)
Figure imgf000140_0001
PSA 18706
[0553] {6-[Λr'-(3,5-Diamino-6-chloropyrazine-2- carbonyl)guanidino]hexyl}carbamic acid tert-butyl ester (2a) [0554] Compound 2a was synthesized from la, 6-aminohexylcarbamic acid tert- butyl ester (Scheme 1), in 90% yield using method D. 1H NMR (300 MHz, CD3OD): δ 1.42 (s, 9H), 1.46-1.65 (m, 8H), 3.04 (t, 2H), 3.22 (t, 2H). m/z (APCI): 429 [C17H29ClN8O3 + H]+.
[0555] N-(6-Aminohexyl)-N-(3,5-diamino-6-chloropyrazine-2-carbonyl)guanidine dihydrochloride (3a, PSA 18706)
[0556] Compound 3a was synthesized from compoimd 2a in 34% yield using method B. mp >240 °C. 1H NMR (300 MHz, CD3OD): δ 1.42-1.54 (m, 4H), 1.65- 1.78 (m, 4H), 2.94 (t, 2H), 3.34 (t, 2H). m/z (APCI): 329 [C12H21ClN8O + H]+.
Example 2
[0557] Synthesis ofN-(7-aminoheptyl)-N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidine (PSA 18705)
Figure imgf000141_0001
PSA 18705
[0558] Compound 3b (PSA 18705) was synthesized from heptane- 1,7-diamine in 65% yield using method D. mp 185-187 °C (decomposed). 1H NMR (300 MHZ, CD3OD): δ 1.40-1.55 (m, 6H), 1.58-1.76 (m, 4H), 2.80 (t, 2H), 3.30 (m, 2H). m/z (ESI): 343 [Ci3H23ClN8O + H]+.
Example 3
[0559] Synthesis of N-{7-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]heptyl}guanidine dihydrochloride (PSA 19155)
Figure imgf000141_0002
PSA 19155
[0560] N-(7-Aminoheptyl)-[N^V '-bis-(tert-butoxycarbonyl)]guanidine (6b) [0561] Compound 6b was synthesized from heptane- 1,7-diamine (Scheme 2) in 43% yield using method C. Η ΝMR (300 MHz, CDCI3): δ 1.44-1.50 (m, 10H), 1.55 (s, 18H), 1.84 (t, 2H), 2.78 (t, 2H), 3.46 (t, 2H). m/z (ESI): 373 [C18H36Ν4O4 + H]+. [0562] N-{7-[N-(3,5-Diam_no-6-chloropyrazine-2- carbonyl)guanidino]heptyl}guanidine dihydrochloride (5b, PSA 19155) [0563] Compound 6b was reacted with the Cragoe compound according to method D (Scheme 2). The product ofthe reaction, after chromatographic purification, was directly treated with concentrated HCl using method B to afford the desired compound 5b in 17% overall yield, mp 140-142 °C. Η ΝMR (300 MHz, CD3OD): δ 1.42-1.54 (m, 6H), 1.60-1.82 (m, 4H), 3.18 (t, 2H), 3.34 (m, 2H). m/z (ESI): 385 [C14H25C1Ν,0O + H]+.
Example 4
[0564] Synthesis of {8-[N'-(3,5-d_amino-6-chloropyrazine-2- carbonyl)guanidino]octyl}carbamic acid tert-butyl ester (PSA 19156)
Figure imgf000142_0001
PSA 19156
[0565] Octane- 1,8-diamine was mono-protected by Boc-protecting group using method A (Scheme 1). The product from this step was directly reacted with the Cragoe compound using method D, which afforded the desired product 2c (PSA 19156) in 81% yield, mp 189-191 °C. . 1H NMR (300 MHz, CD3OD): δ 1.38-1.56 (m, 19H), 1.70 (m, 2H), 3.02 (t, 2H), 3.24 (t, 2H). m/z (ESI): 457 [Cι9H33ClN8O3 + H]+.
Example 5
[0566] Synthesis of N-(8-aminooctyl)-N-(3,5-diamino-6-chloropyrazine-2- carbonyl)-guanidine dihydrochloride (PSA 19336)
Figure imgf000143_0001
PSA 19336
[0567] Compound 3c (PSA 19336) was synthesized from 2c using method B. mp 253-255 °C. Η NMR (300 MHz, CD3OD) δ 1.40 (m, 8H), 1.66 (m, 4H), 2.90 (m, 2H), 3.32 (m, 2H). m/z (ESI): 357 [C14H25ClNgO + H]+.
Example 6
[0568] Synthesis of N-{8-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]octyl} {N'-N"-bis-(tert-butoxycarbonyl)}guanidine (PSA 19486)
Figure imgf000143_0002
PSA 19486
[0569] Compound 4c (PSA 19486) was synthesized from 3c in 52% yield using method C. mp 208-210 °C (decomposed). 1H NMR (300 MHz, CD3OD) δ 1.33- 1.72 (m, 30H), 3.18-3.39 (m, 4H). m/z (ESI): 599 [CzjHuClNioOs + H]+.
Example 7
[0570] Synthesis of N-{8-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]octyl}-guanidine dihydrochloride (PSA 19604)
Figure imgf000143_0003
PSA 19604
[0571] Compound 5c (PSA 19604) was synthesized from 4c in quantitative yield using method B. mp 130-132 °C. 1H NMR (300 MHz, CD3OD) δ 1.33-1.72 (m, 12H), 3.18-3.39 (m, 4H). m/z (ESI): 399 [C,5H27C1N10O + H]+.
Example 8 [0572] Synthesis of {9-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]nonyl}-carbamic acid tert-butyl ester (PSA 19484)
Figure imgf000144_0001
[0573] Compound 2d (PSA 19484) was synthesized in a similar method to compound 2c (PSA 19156). mp 187-189 °C. 1H NMR (500 MHz, CD3OD) δ 1.35 (m, 12H), 1.41 (s, 9H), 1.60 (m, 2H), 3.00 (m, 2H), 3.20 (m, 2H). m/z (ESI): 471 [C20H35C1N8O3 + H]+.
Example 9 [0574] Synthesis of N-(9-aminononyl)-N-(3,5-diamino-6-chloropyrazine-2- carbonyl)-guanidine dihydrochloride (PSA 19335)
Figure imgf000144_0002
PSA 19335
[0575] Compound 3d (PSA 19335) was synthesized in quantitative yield from 2d (PSA 19484) using method B. mp 155-157 °C (decomposed). Η NMR (300 MHz, CD3OD) δ 1.40 (m, 10H), 1.70 (m, 4H), 2.90 (m, 2H), 3.32 (m, 2H). m/z (ESI): 357 [C15H27ClN8O + H]+.
Example 11 [0576] Synthesis of N-{9-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]nonyl}guanidine dihydrochloride (PSA 19006)
Figure imgf000145_0001
PSA 19006
[0577] Compound 5d (PSA 19006) was synthesized similarly to compound 5c (PSA 19155). mp 178-180 °C. 1H NMR (300 MHz, CD3OD): δ 1.44-1.54 (m, 10H), 1.58- 1.80 (m, 4H), 3.20 (t, 2H), 3.34 (m, 2H). m/z (ESI): 413 [C16H29C1N10O + H]+.
Example 12 [0578] Synthesis of {10-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]decyl}-carbamic acid tert-butyl ester (PSA 19485)
Figure imgf000145_0002
[0579] Compound 2e (PSA 19485) was synthesized in a similar method to compound 2c. mp 186-188 °C. Η NMR (300 MHz, CD3OD) δ 1.29-1.51 (m, 23H), 1.59-1.70 (m, 2H), 3.02 (t, 2H), 3.19-3.28 (m, 2H). m/z (ESI): 485 [C21H37ClN8O3 + H]+.
Example 13
[0580] Synthesis ofN-(10-aminodecyl)-N-(3,5-diamino-6-chloropyrazine-2- carbonyl)-guanidine dihydrochloride (PSA 19487)
Figure imgf000146_0001
PSA 19487
[0581] Compound 3e (PSA 19487) was synthesized from compound 2e using method B. mp 168-170 °C. Η NMR (300 MHz, CD3OD) δ 1.41(m, 12H), 1.57- 1.79 (m, 4H), 2.84-2.99 (m, 2H), 3.34-3.40 (m, 2H); m/z (ESI): 385 [Cι6H29ClN8O + H]+.
Example 14
[0582] Synthesis of N-{10-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]-decyl}guanidine dihydrochloride (PSA 23608)
Figure imgf000146_0002
PSA 23608
[0583] Compound 3e (PSA 19487) was reacted with the Goodman's reagent (Scheme 1) according to method C. The product ofthe reaction, after chromatographic purification, was directly treated with concentrated HCl using method B to afford the desired product 5e (PSA 23608). mp 156-158 °C. 1H NMR (500 MHz, CD3OD) δ 1.31-1.48 (m, 12H), 1.55-1.62 (m, 2H), 1.65-1.76 (m, 2H), 3.11-3.19 (m, 2H), 3.34-3.38 (m, 2H). m/z (ESI): 427 [C,7H31ClNι0O + H]+.
Example 15
[0584] Synthesis of { 1 l-[N'-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]undecyl}carbamic acid tert-butyl ester (PSA 23777)
Figure imgf000147_0001
[0585] Compound 2f (PSA 23777) was synthesized in a similar method to compound 2c (PSA 19156). mp 82-84 °C. Η NMR (500 MHz, CD3OD) δ 1.27 (s, 12H), 1.45 (s, 13H), 1.65 (m, 2), 2.95 (m, 2H), 3.21 (m, 2H). m/z (APCI): 499 [C22H39ClN8O3 + H]+.
Example 16
[0586] Synthesis of N-(l l-aminoundecyl)-N'-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidine dihydrochloride (PSA 23682)
Figure imgf000147_0002
PSA 23682
[0587] Compound 3f (PSA 23682) was synthesized from 2f using method B. mp 220- 222 °C. Η NMR (500 MHz, CD3OD) δ 1.35 (m, 14H), 1.65 (m, 4H), 2.91 (m, 2H), 3.31 (m, 2H). m/z (APCI): 399 [Cι7H3ιClN8O + H]+.
Example 17
[0588] Synthesis ofN-{l l-[N'-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]-undecyl}guanidine dihydrochloride (PSA 23991)
Figure imgf000147_0003
PSA 23991 [0589] Compoimd 5f (PSA 23991) was synthesized in a similar manner to compound 5e. mp 151-153 °C. Η NMR (300 MHz, DMSO-c/6) δ 1.27 (m, 18H), 1.45 (m, 2H), 1.55 (m, 2H), 3.07 (m, 2H), 3.27 (m, 2H), 7.43 (m, 2H), 7.66 (m, 1H), 8.78 (br, IH), 8. 94(br, IH), 9.25 (br, IH), 10.5 (br, IH). m/z (APCI): 441 [C18H33ClN,oO + H]+.
Example 18
[0590] Synthesis of { 12-[N'-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino] dodecyl }-carbamic acid tert-butyl ester (PSA 23776)
Figure imgf000148_0001
PSA 23776
[0591] Compound 2g (PSA 23776) was synthesized similarly to compound 2c. mp 154-156 °C. 'H NMR (500 MHz, CD3OD) δ 1.25 (m, 14H), 1.47 (m, 13H), 1.65 (m, 2H), 2.98 (m, 2H), 3.21 (m, 2H). m/z (APCI): 513 [C23H4ιClN8O3 + H]+.
Example 19 [0592] Synthesis of N-(12-aminododecyl)-N'-(3,5-diamino-6-chloropyrazine-2- carbonyl)-guanidine dihydrochloride (PSA 23609)
Figure imgf000148_0002
PSA 23609
[0593] Compound 3g (PSA 23609) was synthesized from compound 2g using method B. mp 235-237 °C. 1H NMR (500 MHz, CD3OD) δ 1.35 (m, 16H), 1.65 (m, 4H), 2.89 (m, 2H), 3.31 (m, 2H). m/z (ESI): 413 [C18H33ClN8O + H]+.
Example 20 [0594] Synthesis of N-{12-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]dodecyl)guanidine dihydrochloride (PSA 23683)
PSA 23683
[0595] Compound 5g (PSA 23683) was synthesized from compound 3g in a similar method to 5b. mp 145-147 °C. 1H NMR (500 MHz, CD3OD) δ 1.30-1.48 (m, 16H), 1.64 (t, 2H), 1.75 (t, 2H), 3.18 (t, 2H), 3.35 (m, 2H). m/z (APCI): 455 [C19H35C1N10O + H]+.
Example 21
[0596] Synthesis of (3-{3-[N-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]propoxy}propyl])carbamic acid tert-butyl ester (PSA 19333)
Figure imgf000149_0002
PSA 19333
[0597] [3-(3-Aminopropoxy)propyl]carbamic acid tert-butyl ester (7) Compound 7 was synthesized from 3-(3-aminopropoxy)propylamine (Scheme 3) using method A. Η NMR (300 MHz, CDC13) δ 1.40 (m, 2H), 1.44 (s, 9H), 1.74 (m, 4H), 2.81 (m, 2H), 3.23 (m, 2H), 3.48 (m, 4H), 5.03 (br s, IH).
[0598] (3-{3-[N-(3,5-Diamino-6-chloropyrazine-2- carbonyl)guanidino]propoxy}propyl)-carbamic acid tert-butyl ester (8, PSA 19333) Compound 8 was synthesized from compound 7 using method D. mp 62-65 °C
(decomposed). Η NMR (300 MHz, CD3OD) δ 1.40 (s, 9H), 1.80 (m, 4H), 3.12 (m, 2H), 3.32 (m, 2H), 3.52 (m, 4H). m/z (ESI): 445 [C H29ClN8O4 + H]+.
Example 22 [0599] Synthesis of N-[3-(3-aminopropoxy)propyl]-N-(3,5-diamino-6- chloropyrazine-2-carbonyl)guanidine dihydrochloride (PSA 19157)
Figure imgf000150_0001
PSA 19157
[0600] Compound 9 (PSA 19157) was synthesized from compound 8 (PSA 19333) using method B. mp 164-166 °C (decomposed). ]H NMR (300 MHz, CD3OD) δ 1.95 (m, 4H), 3.05 (m, 2H), 3.48 (m, 2H), 3.60 (m, 4H). m/z (ESI): 345 [C12H2)ClN8O2 + H]+.
Example 23
[0601] Synthesis of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N-[3-(3- {N ',N "-bis-(tert-butoxycarbonyl)guanidino}propoxy)propyl]guanidine (PSA 19488)
Figure imgf000150_0002
PSA 19488
[0602] Compound 10 (PSA 19488) was synthesized from compound 9 (PSA 19157) using method C. mp 89-93 °C. Η NMR (300 MHz, CD3OD) δ 1.46 (s, 9H), 1.50 (s, 9H), 1.90 (m, 4H), 3.40 (m, 4H), 3.55 (m, 4H). m/z (ESI): 587 [C23H39C1NIOO6 + H]+.
Example 24 [0603] Synthesis of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N-[3-(3- guanidino-propoxy)propyl]guanidine dihydrochloride (PSA 19334) 05/034847
Figure imgf000151_0001
PSA 19334
[0604] Compound 11 (PSA 19334) was synthesized from compound 10 (PSA 19488) using method B. mp 72-75 °C (decomposed). Η NMR (300 MHz, CD3OD) δ 1.91 (m, 4H), 3.30 (m, 2H), 3.50 (m, 2H), 3.60 (m, 4H). m/z (ESI): 387
Figure imgf000151_0002
Example 25
[0605] Synthesis of N-{2-[2-(2-aminoethoxy)ethoxy]ethyl}-N'-(3,5-diamino-6- c__loro-pyrazine-2-carbonyl)guanidine (PSA 18848)
Figure imgf000151_0003
[0606] Compound 12 (PSA 18848) was synthesized from 2-[2-(2- aminoethoxy)ethoxy]-ethylamine (Scheme 4) in 86% yield using method D. mp 87- 90 °C. Η NMR (300 MHz, CD3OD): δ 2.84 (t, 2H), 3.45 (t, 2H), 3.54-3.66 (m, 8H). m/z (APCI): 361 [C12H2,ClN8O3 + H]+.
Example 26
[0607] Synthesis of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N-{2-[2-(2- guanidinoethoxy)ethoxy]ethyl}guanidine dihydrochloride (PSA 18849)
Figure imgf000151_0004
PSA 18849
[0608] Compound 14 (PSA 18849) was synthesized from compound 12 by a similar method used to prepared compound 5e. mp 108-112 °C (decomposed). 1H NMR (300 MHz, CD3OD): δ 1.38 (t, 2H), 3.38 (t, 2H), 3.57 (t, 2H), 3.67 (t, 2H), 3.75 (m, 4H). m/z (APCI): 403 [C,3H23ClNιoO3 + H]+.
Example 27 .
[0609] Sodium Channel Blocking Activity of Selected Alaphatic Pyrazinoylguanidines.
Figure imgf000153_0001
** Relative potency for PSA 4022=100 using EC50 from PSA 4022 in same run
[0610] The following examples depict the synthesis of compounds according to
Formula III.
FORMULA III EXAMPLES:
Scheme 1 (Formula III)
Figure imgf000155_0001
Br •^ . -nA TEA, CH2C12
Figure imgf000155_0002
Figure imgf000155_0003
Scheme 2 (Formula III)
5c, n = 1, R = NHBoc 5d, n = 2, R = NHBoc
Figure imgf000156_0001
= NHBoc
Figure imgf000156_0002
= NHBoc
HCl/MeOH
Figure imgf000156_0003
Scheme 3 (Formula III)
Figure imgf000157_0001
7 N M MeOH
Figure imgf000157_0002
10
LAH/THF
Figure imgf000157_0003
11 o s -CH, clyγVAH_ EtOH, DIPEA H,N N NH, HI
12, PSA 25456
Scheme 4. Synthesis of PSA 25795 (Formula III)
Figure imgf000158_0001
8d, PSA 25510
Figure imgf000158_0002
Example 1
[0611] Synthesis of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(2- hydroxyethyl)piperidin-4-yl]butyl}guanidine dihydrochloride (PSA 25193)
Figure imgf000158_0003
PSA 25193
[0612] 4-(Piperidin-4-yl)butyric acid methyl ester (2)
[0613] A solution of 1 (2.00 g, 9.50 mmol) and chlorotrimethylsilane (2.30 g, 20.1 mmol) in methanol (30 mL) was stirred at room temperature overnight (Scheme 1). After that, the solvent was removed under reduced pressure and the residue was purified by Flash™ chromatography (BIOTAGE, Inc) (9:1 dichloromethane/methanol, v/v) to provide 2 (1.73 g, 98%) as a light yellow solid. Η NMR (300 MHz, CD3OD) δ 1.39 (m, 4H), 1.66 (m, 3H), 1.95 (d, 2H), 2.39 (m, 2H), 3.02 (m, 2H), 3.40 (m, 2H), 3.69 (s, 3H). m/z (ESI): 186 [C10H19NO2+ H]+.
[0614] 4-[l -(2 -Benzyloxyethyl)piperidin-4-yl] butyric acid methyl ester (3a)
[0615] A solution of 2 (2.00 g, 10.8 mmol), (2-bromoethoxymethyl)benzene (2.31 g,
10.8 mmol), and triethylamine (4.5 ml, 32.4 mmol) in dichloromethane (30 mL) was stirred at room temperature overnight. Solvent was evaporated and the residue was purified by Flash™ chromatography (BIOTAGE, Inc) (9.3:0.7 dichloromethane/methanol, v/v) to provide 3a (1.3 g, 42%) as a yellow oil. 1H NMR (300 MHz, CD3OD) δ 1.30 (m, 5H), 1.66 (m, 2H), 1.87 (d, 2H), 2.37 (m, 2H), 2.58 (m, 2H), 3.04 (m, 2H), 3.39 (m, 2H), 3.65 (s, 3H), 3.80 (m, 2H), 4.55 (s, 2H), 7.37 (m, 5H). m/z (ESI): 320 [C19H29NO3 + H]+.
[0616] 4-[l-(2-Benzyloxyethyl)piperidin-4-yl]butyramide (4a)
[0617] Compound 3a (1.30 g, 4.0 mmol) was dissolved in 7 N NH3 in methanol (25 mL) in a sealed tube. The resulting solution was stirred at 50 °C for 3 days. After that the solvent was removed under vacuum and the residue was purified by Flash™ chromatography (BIOTAGE, Inc) (9.5:0.45:0.05 dichloromethane/methanol/concentrated ammonium hydroxide, v/v) to provide 4a (0.93 g, 78%) as a white solid. 1H NMR (300 MHz, CD3OD) δ 1.27 (m, 5H), 1.65 (m, 4H), 2.11 (m, 4H), 2.65 (m, 2H), 2.96 (d, 2H), 3.62 (m, 2H), 4.51 (s, 2H), 7.37 (m, 5H). m/z (ESI): 305 [Ci8H28N2O2 + H]+.
[0618] 4-[l-(2-Benzyloxyethyl)piperidin-4-yl]butylamine (5a) [0619] To a solution of BH3'THF (2.2 mL, 2.2 mmol) cooled to 0 °C was added compound 4a (100 mg, 0.3 mmol). The resulting mixture was stirred for 30 min, then warmed to room temperature and stirred overnight. The reaction was quenched with water, and extracted with Et2O. The organic solution was dried over Na2SO4 and concentrated under vacuum to provide 5a (85.2 mg, 89%) which was used directly without further purification. Η NMR (500 MHz, CD3OD) δ 1.39 (m, 2H), 1.45 (m, 4H), 1.62 (m, IH), 1.71 (m, 2H), 1.95 (m, 2H), 2.87 (m, 2H), 2.97 (m, 2H), 3.25 (m, 2H), 3.45 (d, 2H), 3.82 (m, 2H), 4.61 (s, 2H), 7.39 (m, 5H). m/z (ESI): 291 [C18H30N2O + H]+.
[0620] 2-[4-(4-Aminobutyl)piperidin-l-yl]ethanol (6a)
[0621] A suspension of 5a (0.3 g, 1.03 mmol) and catalyst (10% palladium on carbon, 0.8 g, 50% wet) in methanol (25 mL) was placed in a Parr shaker bottle. The system was vacuumed and flushed with nitrogen. The procedure was repeated three times. The mixture was then shaken at room temperature overnight under 40 psi hydrogen atmosphere. The system was then vacuumed again and flushed with nitrogen. The procedure was repeated three times. The catalyst was filtered under vacuum and washed with methanol (2 x 10 mL). The filtrate and washings were combined and concentrated under reduced pressure to provide 6a (186 mg, 90%). The crude product was used directly without purification, m/z (ESI): 201 [C11H24N2O + H]+.
[0622] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(2- hydroxyethyl)piperidin-4-yl] butyl }guanidine dihydrochloride (7a, PSA 25193) [0623] l-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-2-methylisothiourea hydriodide (290 mg, 0.73 mmol) was added to a solution of compound 6a (130 mg, 0.65 mmol) and DIPEA (0.34 mL, 1.95 mmol) in ethanol (5 mL). The reaction mixture was stirred at 65 °C for 5 h. Solvent was removed under reduced pressure and the residue was purified by semi-preparative HPLC (water/acetonitrile/0.1% TFA). The purified product was dissolved in 5% HCl aqueous solution and stirred at room temperature for 30 min. The mixture was then concentrated and further dried under high vacuum to provide 7a (15 mg, 6%) as a light yellow solid. Η ΝMR (500 MHz, CD3OD) δ 1.50 (m, 9H), 2.01 (d, 2H), 3.05 (m, 2H), 3.20 (m, 2H), 3.61 (m, 2H), 3.89 (s, 2H). m/z (ESI): 413 [Cι7H29ClN8O2 + H]+. mp 168-170 °C.
Example 2
[0624] Synthesis of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(3- hydroxypropyl)piperidin-4-yl] butyl }guanidine dihydrochloride (PSA 25310)
Figure imgf000161_0001
PSA 25310
[0625] 4-[l-(3-Benzyloxypropyl)piρeridin-4-yl]butyric acid methyl ester (3b)
[0626] Following the same procedure described for the preparation of compound 3a, the compound 3b was synthesized in 40% yield from compound 2 as a yellow oil. Η NMR (300 MHz, CD3OD) δ 1.21 (m, 4H), 1.42 (m, IH), 1.49 (m, 2H), 1.83 (d, 2H), 1.93 (m, 2H), 2.31 (m, 2H), 2.69 (m, 2H), 2.99 (m, 2H), 3.35 (m, 2H), 3.60 (m, 5H), 4.50 (m, 2H), 7.28 (m, 5H). m/z (ESI): 334
Figure imgf000161_0002
+ H]+.
[0627] 4-[l-(3-Benzyloxypropyl)piperidin-4-yl]butyramide (4b) [0628] Following the same procedure described for the preparation of compound 4a, compound 4b was synthesized in 69% yield from compound 3b as a yellow solid. Η NMR (500 MHz, DMSO- 6) δ 1.25 (m, 5H), 1.49 (m, 2H), 1.68 (m, 2H), 1.85 (m, 2H), 2.01 (m, 2H), 2.40 (m, 2H), 2.75 (m, 2H), 3.13 (m, 3H), 3.45 (m, 3H), 4.47 (m, 2H), 7.37 (m, 5H). m/z (ESI): 319 [Cι9H3oN2O2 + H]+.
[0629] 4-[l-(3-Benzyloxypropyl)piperidin-4-yl]butylamine (5b) [0630] Following the same procedure described for the preparation of compound 5a, compound 5b was synthesized in 70% yield from compound 4b as a light yellow solid. 1H NMR (500 MHz, CDC13) δ 1.16 (m, 5H), 1.29 (m, 2H), 1.43 (m, 2H), 1.61 (m, 3H), 1.85 (m, 5H), 2.60 (m, 3H), 2.70 (m, IH), 2.95 (m, 2H), 3.50 (m, 2H), 4.51 (s, 2H), 7.39 (m, 5H). m/z (ESI): 305 [C19H32N2O + H]+.
[0631] 3-[4-(4-Aminobutyl)piperidin-l-yl]propan-l-ol (6b) [0632] Following the same procedure described for the preparation of compound 6a, compound 6b was synthesized in 90% yield from compound 5b as a light yellow solid. Η NMR (500 MHz, CDC13) δ 1.20 (m, 7H), 1.41 (m, 2H), 1.65 (m, 5H), 1.89 (m, 2H), 2.60 (m, 4H), 3.00 (m, 4H), 3.79 (m, 2H). m/z (ESI): 215 [C12H26N2O + H]+.
[0633] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(3- hydroxypropyl)piperidin-4-yl] butyl }guanidine dihydrochloride (7b, PSA 25310) [0634] Following the same procedure described for the preparation of compound 7a, compound 7b was synthesized in 40% yield from compound 6b as a yellow solid. Η ΝMR (500 MHz, DMSO-ck) δ 1.25 (m, 5H), 1.52 (m, 5H), 1.85 (m, 4H), 2.85 (m, 2H), 3.00 (m, 2H), 3.15 (m, IH), 3.31 (m, 2H), 3.45 (m, 4H), 7.41 (m, 3H), 8.90 (m, 2H), 9.40 (m, IH). m/z (ESI): 427 [C18H31ClΝ8O2 + H]+. mp 165-167 °C.
Example 3 [0635] Synthesis of N-{4-[l-(2-aminoethyl)piperidin-4-yl]butyl}-N-(3,5-diamino-6- chloro-pyrazine-2-carbonyl)guanidine trihydrochloride (PSA 25455)
Figure imgf000162_0001
PSA 25455
[0636] 4-[l-(2-tert-Butoxycarbonylaminoethyl)piperidin-4-yl]butyric acid methyl ester (3c).
[0637] Following the same procedure described for the preparation of compound 3a, compound 3c was synthesized from compound 2 as an off white solid. Η NMR (300 MHz, CD3OD) δ 1.18-1.35 (m, 7H), 1.41 (m, 9H), 1.59-1.84 (m, 5H), 2.29- 2.37 (m, 2H), 2.41-2.52 (m, 2H), 2.86-3.02 (m, 2H), 3.13-3.24 (m, 2H), 3.67 (s, 3H). m/z (ESI): 329 [Cι7H32N2O4+ H]+.
[0638] {2-[4-(3-Carbamoylpropyl)piperidin-l-yl]ethyl}carbamic acid tert-butyl ester (4c)
[0639] Following the same procedure described for the preparation of compound 4a, compound 4c was synthesized from compound 3c as an off-white solid. Η NMR (300 MHz, CD3OD) δ 1.18-1.35 (m, 7H), 1.41 (m, 9H), 1.59-1.84 (m, 5H), 2.29- 2.37 (m, 2H), 2.41-2.52 (m, 2H), 2.86-3.02 (m, 2H), 3.13-3.24 (m, 2H). m/z (ESI): 314 [Cι6H3ιN3O3 + H]+.
[0640] {2-[4-(4-Aminobutyl)piperidin-l-yl]ethyl}carbamic acid tert-butyl ester (5c) [0641] A solution of compound 4c (250 mg, 0.80 mmol) in dichloromethane (10 mL) was cooled to 0 °C, then DIBA1-H (7.4 mL, 7.4 mmol of IM in toluene) was added dropwise into the solution over 45 min. The mixture was stirred for 1 hour, then warmed to room temperature and stirred for 14 h. The reaction was quenched with potassium sodium tartrate aqueous solution. The mixture was extracted with dichloromethane (3 x 10 mL). The combined extracts were washed with water and brine, dried over sodium sulfate and concentrated under vacuum to afford an oil. Purification by column chromatography (silica; 90:10, v/v, dichloromethane/methanol followed by 89:10:1 dichloromethane/methanol/ammonium hydroxide) produced the desired product 5c (54 mg, 23% un-optimized yield) as a clear colorless oil. Η NMR (500 MHz, CDCI3) δ 1.21-1.26 (m, 8H), 1.42-1.46 (m, 11H), 1.64-1.67 (m, 3H), 1.91-1.99 (m, 2H), 2.41-2.48 (m, 2H), 2.67-2.70 (m, 2H), 2.83-2.86 (m, 2H), 3.20-3.22 (m, 2H), 5.00 (br s, IH). m/z (ESI): 300 [C16H33N3O2 + H]+.
[0642] [3 -(4- {4- [N'-(3 ,5 -Diamino-6-chloropyrazine-2- carbonyl)guanidino] butyl }piperidin-l-yl)ethyl]carbamic acid tert-butyl ester (7c) [0643] Following the same procedure described for the preparation of compound 7a, compound 7c was synthesized in 54% yield from compound 5c as a yellow solid (Scheme 2). Η NMR (500 MHz, CDC13) δ 1.21-1.26 (m, 8H), 1.41-1.46 (m, 11H), 1.64-1.67 (m, 7H), 1.91-1.99 (m, 2H), 2.41-2.48 (m, 2H), 2.83-2.86 (m, 2H), 3.20- 3.22 (m, 2H), 5.00 (br s, 2H). m/z (ESI): 512 [C22H38ClN9O3 + H]+.
[0644] N-{4-[l-(2-Aminoethyl)piperidin-4-yl]butyl}-N'-(3,5-diamino-6- chloropyrazine-2-carbonyl)guanidine trihydrochloride (8c, PSA 25455)
[0645] A solution of compound 7c (37 mg, 0.0723 mmol) dissolved in methanol (2 mL) was cooled to 0 °C (Scheme 2). To the stirring solution was added dropwise 1 Ν HCl in diethyl ether (1 mL). The resulting mixture was stirred for 2 h, then the solvent was removed under vacuum and the residue was dried under high vacuum to provide 8c (36 mg, quant) as a yellow solid: mp >200 °C. Η ΝMR (500 MHz, DMSO- ;) δ 1.24-1.92 (m, 12H), 2.82-3.02 (m, 2H), 3.51-3.72 (m, 4H), 7.45-7.58 (m, 2H), 8.42 (br s, 3H), 8.75-9.09 (m, 2H), 9.29 (br s, IH), 10.55 (br s, IH), 10.75 (m, IH). m/z (APCI): 412 [C,7H30C1Ν9O + H]+.
Example 4
[0646] Synthesis ofN-{4-[l-(3 -aminopropyl)piperidin-4-yl] butyl } -N'-(3 , 5 -diamino- 6-chloropyrazine-2-carbonyl)guanidine trihydrochloride (PSA 25510)
Figure imgf000164_0001
PSA 25510
[0647] 4-[l-(3-tert-Butoxycarbonylaminopropyl)piperidin-4-yl]butyric acid methyl ester (3d)
[0648] Following the same procedure described for the preparation of compound 3a, compound 3d was synthesized in 64% yield from compound 2 as a yellow solid. Η NMR (500 MHz, CDC13) δ 1.30 (m, 3H), 1.41 (m, 12H), 1.65 (m, 3H), 1.78 (m, 2H), 1.95 (m, 2H), 2.25 (m, 3H), 2.75 (m, IH), 3.17 (m, 4H), 3.67 (m, 3H), 4.98 (s, IH). m/z (ESI): 343 [Cι8H3 N2O4+ H]+.
[0649] {3-[4-(3-Carbamoylpropyl)piperidin-l-yl]propyl}carbamic acid tert-butyl ester (4d)
[0650] Following the same procedure described for the preparation of compound 4a, compound 4d was synthesized in 66% yield from compound 3d as a yellow solid. Η NMR (500 MHz, CDC13) δ 1.22 (m, 7H), 1.45 (s, 9H), 1.65 (m, 6H), 1.87 (m, 2H), 2.19 (m, 2H), 2.39 (m, 2H), 2.90 (d, 2H), 5.40 (s, 2H), 5.62 (s, IH). m/z (ESI): 328 [C,7H33N3O3 + H]+.
[0651] {3-[4-(4-Aminobutyl)piperidin-l-yl]propyl}carbamic acid tert-butyl ester (5d)
[0652] Following the same procedure described for the preparation of compound 5c, compound 5d was synthesized in 82% yield from compound 4d as an off- white solid. 1H NMR (500 MHz, CDC13) δ 1.20 (m, 5H), 1.35 (m, 3H), 1.46 (m, 12H), 1.65 (m, 2H), 1.84 (m, 2H), 2.46 (m, 2H), 2.68 (m, IH), 2.87 (d, 2H), 3.18 (d, 2H), 3.45 (s, IH), 5.65 (s, 2H), 7.49 (m, IH). m/z (ESI): 314 [C,7H35N3O2 + H]+.
[0653] [3-(4-{4-[N'-(3,5-diamino-6-chloropyrazine-2- carbonyl)guanidino]butyl}piperidin-l-yl)propyl]carbamic acid tert-butyl ester (7d,
PSA 25452)
[0654] Following the same procedure described for the preparation of compound 7c, compound 7d was synthesized from compound 5d as a yellow solid (Scheme 2). Η ΝMR (500 MHz, DMSO-tf6) δ 1.12 (m, 6H), 1.31 (m, 1 IH), 1.47 (m, 4H), 1.60 (d,
2H), 1.77 (m, 2H), 2.20 (m, 2H), 2.79 (d, 2H), 2.91 (m, 2H), 3.10 (m, 3H), 6.55 (m,
3H), 6.79 (s, 2H), 9.05 (s, IH). m/z (APCI): 527 [C23H40C1Ν9O3 + H]+. mp 98-102
°C.
[0655] N-{4-[l-(3-Aminopropyl)piperidin-4-yl]butyl}-N'-(3,5-diamino-6- chloropyrazine-2-carbonyl)guanidine trihydrochloride (8d, PSA 25510) [0656] Following the same procedure described for the preparation of compound 8c, compound 8d was synthesized in 91% yield from compound 7d as a yellow solid (Scheme 2). Η NMR (500 MHz, DMSO-rf6) δ 1.30 (m, 4H), 1.55 (m, 5H), 1.85 (d, 2H), 2.07 (m, 2H), 2.85 (m, 3H), 3.12 (m, 2H), 3.31 (m, 2H), 3.44 (m, 2H), 7.45 (m, 2H), 8.19 (s, 3H), 8.90 (d, 2H), 9.35 (s, IH), 10.55 (s, IH), 10.75 (s, IH). m/z (ESI): 426 [C,8H32ClN9O + H]+. mp 105-108 °C.
Example 5 [0657] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N-{4-[l-(2,3- dihydroxypropyl)-piperidin-4-yl]butyl}guanidine (PSA 25456)
Figure imgf000166_0001
[0658] 4-[l-(2,3-Dihydroxypropyl)piperidin-4-yl]butyramide (10)
[0659] Following the same procedure as described for the preparation of compound 4, compound 10 (263 mg, 71% yield, Scheme 3) was prepared from compound 9 as a clear orange oil. Η NMR (500 MHz, CDC13) δ 1.21-1.29 (m, 6H), 1.65-1.70 (m, 6H), 2.92-2.98 (m, IH), 2.19-2.34 (m, 3H), 2.51-2.53 (m, IH), 2.78-2.82 (m, IH), 2.96-3.02 (m, IH), 3.45-3.75 (m, 3H), 5.28 (m, 2H). m/z (ESI): 245 [C,2H24N2O3 + H]+.
[0660] 3-[4-(4-Aminobutyl)piperidin-l-yl]propane-l,2-diol (11) [0661] Compound 10 (263 mg, 1.07 mmol) was dissolved in tetrahydrofuran (12 mL) under a nitrogen atmosphere. Lithium aluminum hydride (3.7 mL of a 1 M solution in THF) was added dropwise over 20 min. The reaction was refluxed for 8 h, and then cooled to room temperature. It was quenched by successively adding water (1 mL, dropwise), 20% sodium hydroxide solution (1 mL), and then 25% ammonium hydroxide solution (2 mL). The resulting mixture was stirred for 30 min and then filtered through diatomaceous earth. The filtrate was dried over sodium sulfate and concentrated under vacuum to give the amine 11 (183 mg, 74% yield) as a red oil which was carried on without further purification: Η NMR (500 MHz, CDC13) δ 1.21-1.68 (m, 12H), 1.88-1.95 (m, 3H), 2.20-2.33 (m, 4H), 2.49-2.53 (m, IH), 2.66-2.70 (m, IH), 2.78-2.82 (m, IH), 2.96-3.02 (m, IH), 3.48-3.94 (m, 3H). m/z (ESI): 231 [C12H26N2O2+ H]+.
[0662] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(2,3- dihydroxypropyl)-piperidin-4-yl]butyl} guanidine (12, PSA 25456)
[0663] Following the same procedure described for the preparation of compound 7a, compound 12 was synthesized in 28% yield from compound 11 as a yellow solid, mp 188-191 °C. 1H ΝMR (500 MHz, DMSO-^) δ 1.09-1.32 (m, 8H), 1.45-1.61 (m, 4H), 1.90 (br s, 2H), 2.20-2.30 (m, 2H), 3.75-3.92 (m, 2H), 3.11 (br s, 2H), 3.57 ( br s, IH), 4.31 (br s, IH), 4.56-4.57 (m, IH), 6.60 (br s, 3H), 9.06 (br s, IH). m/z (APCI): 443 [C18H3ιClΝ8O3 + H]+.
Example 6
[0664] Synthesis ofN-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(3- guanidino-propyl)piperidin-4-yl] butyl} guanidine trihydrochloride (PSA 25795)
Figure imgf000167_0001
PSA 25795
[0665] N-(3,5-Diamino-6-chloropyrazine-2-carbonyl)-N'-{4-[l-(3-[N' W"-bis-tert- butoxycarbonyl]guanidinopropyl)piperidin-4-yl] butyl} guanidine (13, PSA 25569) [0666] The Goodman's reagent, (tert-Butoxycarbonylamino- trifluoromethanesulfonylimino-methyl)c∑ιrbamic acid tert-butyl ester, (368 mg, 0.94 mmol) was added to a solution of compound 8d (360 mg, 0.67 mmol) and DIPEA (0.47 mL, 2.69 mmol) in methanol (20 mL). The reaction mixture was stirred at room temperature overnight. Solvent was removed under reduced pressure and the residue was purified by flash silica gel chromatography (9:0.9:0.1 dichloromethane/methanol/concentrated ammonium hydroxide, v/v) to provide 13 (327 mg, 73%) as a yellow solid, mp 122-125 °C. Η NMR (500 MHz, OMSO-d6) δ 1.25 (m, 9H), 1.40 (m, 21H), 1.59 (m, 4H), 1.75 (m, 2H), 2.25 (m, 2H), 2.82 (m, 2H), 3.11 (m, 2H), 6.60 (m, 3H), 8.55 (s, 2H), 9.05 (s, IH), 11.55 (s, 2H). m/z (ESI) 668 [C29H5oClNiiO5 + H]+. 0667] N-(3 , 5 -Diamino-6-chloropyrazine-2-carbonyl)-N'- { 4- [ 1 -(3 - guanidinopropyl)piperidin-4-yl] butyl} guanidine trihydrochloride (14, PSA 25795) [0668] To a solution of compound 13 (250 mg, 0.37 mmol) in methanol (5 mL) cooled at 0 °C was added dropwise 12 Ν HCl (2.5 mL). It was stirred first at 0 °C for 0.5 h, then allowed to warm up to room temperature. The stirring was continued for an additional 3 h. Complete removal of solvent under vacuum provided 14 (215 mg, 94%) as a yellow solid, mp 176-178 °C. Η ΝMR (500 MHz, DMSO-rf6) δ 1.29 (m, 2H), 1.30 (m, 3H), 1.54 (m, 6H), 1.82 (m, 2H), 1.93 (m, 2H), 2.84 (m, 2H), 3.02 (m, 2H), 3.15 (s, IH), 3.24 (m, 5H), 7.17 (m, 3H), 7.99 (s, IH), 8.90 (d, 2H), 9.30 (s, IH), 10.54 (s, IH), 10.62 (s, IH). m/z (ESI) 468 [Cι9H34ClΝπO + H]+.
Example 7. [0669] Sodium Channel Blocking Activity of Selected Cyclic Pyrazinoylguanidines.
Figure imgf000168_0001
Figure imgf000169_0001
♦♦Relative potency for PSA 4022=100 using EC50 from PSA 4022 in same run
[0670] While the invention has been described with reference to preferred aspects or embodiments, it is to be understood that variations and modifications may be resorted to as will be apparent to those skilled in the art. Such variations and modifications are to be considered within the purview and the scope ofthe claims appended hereto.

Claims

Atty. Dkt. No. PASC.013 WHAT IS CLAIMED IS: 1. A prophylactic treatment method comprising: administering a prophylactically effective amount of a sodium channel blocker according to Formula I:
Figure imgf000170_0001
wherein X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl; Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R )2; R1 is hydrogen or lower alkyl; each R2 is, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10, -(CH2)π(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R,0, -(CH2)n-Zg-R7,-(CH2)m- NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, or
Figure imgf000170_0002
R and R4 are each, independently, hydrogen, a group represented by formula (A), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)- lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl- Atty. Dkt. No. PASC.013 lower alkyl, or pyridyl- lower alkyl, with the proviso that at least one of R3 and R4 is a group represented by formula (A):
(A)
Figure imgf000171_0001
wherein each RL is, independently, -R7, -(CH2)n-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)π-CH2OR8 -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000171_0002
each o is, independently, an integer from 0 to 10; each p is an integer from 0 to 10; with the proviso that the sum of o and p in each contiguous chain is
Figure imgf000171_0003
each x is, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR , 7r R> 10 , or represents a single bond; Atty. Dkt. No. PASC.013 wherein each R5 is, independently,
Link -(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)n- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)n-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)n-(CHOR8)mCH2-NR13-(Z)g-CAP, Link -(CH2)nNR13-(CH2)m(CHOR8)„CH2NR13-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR13-(CH2)m-C(=O)NR10R10, Link -(CH2)m-C(=O)NR13-(CH2)m-CAP, Link -(CH2)m-C(=O)NRnRn, Link -(CH2)m-C(=O)NR,2R12, Link -(CH2) n-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP; wherein Link is, independently, -O-, (CH2)n-, -O(CH2)m-, -NR13-C(=O)-NR13, -NR13-C(=O)-(CH2)m-, -C(=O)NR13-(CH2)m, -(CH2)n-Zg-(CH2)n,-S-, -SO-, -SO2-, SO2NR7-, SO2NR10-, -Het-; wherein each CAP is, independently,
thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R13 R13 , heteroaryl-CAP, -CN, -O-C(=S)NR13 R13, -ZgR13, -CR,0(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N R13Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(R13R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides,
Figure imgf000172_0001
wherein Ar is, independently, phenyl; substituted phenyl, wherein said Atty. Dkt. No. PASC.013 substituent is 1-3 groups selected, independently, from OH, OCH3, NR13R13, Cl, F,
CH3; or heteroaryl, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione, or imidazoyl ( v ); wherein heteroaryl is selected from one ofthe following heteroaromatic systems:
Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole, Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline, Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1 ,2,4-Triazine, 1,3,5- Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine; each R6 is, independently, -R7, -OR7,-ORn, -N(R7)2, -(CH2)m-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)„-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n- CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000173_0001
where when two R6 are -OR11 and are located adjacent to each other on a phenyl ring, the alkyl moieties ofthe two R6 may be bonded together to form a methylenedioxy group; Atty. Dkt. No. PASC.013 with the proviso that when at least two -CH2OR8 are located adjacent to each other, the R groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or
1,3-dioxolane, each R7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH2(CHOR)8 m-R'°; each R8 is, independently, hydrogen, lower alkyl, -C(=O)-Rπ, glucuronide, 2-tetrahydropyranyl, or
Figure imgf000174_0001
each R9 is, independently, -CO2R13, -CON(R13)2, -SO2CH2R13, or -C(=O)R13; each R10 is, independently, -H, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -(CH2) m-(CHOH)n-CH2OH; each Z is, independently, CHOH, C(=O), -(CH2)n-,CHNR13R13, C=NR13, or
NR13; each R1 ' is, independently, lower alkyl; each R12 is independently, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -CH2-(CHOH)n-CH2OH; each R13 is, independently, hydrogen, R7, R10, -(CH2)m-NR13R13, + -CCH2)m- NR13R13R13, -(CH2)m-(CHOR8)m-(CH2)mNR13R13, -(CH2)m-NR10R10 + -(CH2)m-(CHOR8)m-(CH2)mNR13R13R13, Atty.Dkt.No.PASC.013
Figure imgf000175_0001
_(CH25 N NR13 ,or
Figure imgf000175_0002
with the proviso that NR13R13 can be joined on itself to form a ring comprising one ofthe following:
Atty. Dkt. No. PASC.013
Figure imgf000176_0001
N ΓΛ N (CH2)m(CHOR)8 m-(CH2)nR11R11
each Het is independently, -NR13, -S-, -SO-, or -SO2-; -O-, -SO2NR13-, -NHSO2-, -NR13CO-, -CONR13-; each g is, independently, an integer from 1 to 6; each m is, independently, an integer from 1 to 7; each n is, independently, an integer from 0 to 7; each Q is, independently, C-R5, C-R6, or a nitrogen atom, wherein at most three Q in a ring are nitrogen atoms; each V is, independently, -<CH2)m-NR7R10, -(CH2)m-NR7R7, - (CH2)m- + NR' VR", -(CH2)n-(CHOR8)m-(CH2)mNR7R10, -(CH2)n-NR10R10
+ -(CH2)n-(CHOR8)m-(CH2)mNR7R7,-(CH2)n-(CHOR8)m-(CH2)mNR1 'R1 'R1 ' with the proviso that when V is attached directly to a nitrogen atom, then V Atty. Dkt. No. PASC.013 can also be, independently, R7, R10, or (Rπ)2; wherein for any ofthe above compounds when two -CH2OR8 groups are located 1 ,2- or 1 ,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof, to an individual in need of prophylactic treatment against infection or disease from one or more airborne pathogens.
2. The prophylactic treatment method of claim 1 wherein the pathogen is Bacillus anthracis.
3. The prophylactic treatment method of claim 1 wherein the pathogen is Variola major.
4. The prophylactic treatment method of claim 1 wherein the pathogen is Yersinia pestis.
5. The prophylactic treatment method of claim 1 wherein the pathogen is Francisella tularensis.
6. The prophylactic treatment method of claim 1 wherein the pathogen is a gram negative bacteria.
7. The prophylactic treatment method of claim 6 wherein the gram negative bacteria is selected from the group consisting of Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii and Rickettsia.
8. The prophylactic treatment method of claim 1 wherein the pathogen is an alphavirus, a flavivirus or a bunyavirus.
9. The prophylactic treatment method of claim 1 wherein the pathogen is ricin toxin from Ricinus communis, epsilon toxin of Clostridium perfringens or Staphylococcal enterotoxin B.
10. The prophylactic treatment method of claim 1 wherein the pathogen is Mycobacterium tuberculosis bacteria.
11. The prophylactic treatment method of claim 1 wherein the pathogen is an influenza virus, rhinovirus, adenovirus or respiratory syncytial virus.
12. The prophylactic treatment method of claim 1 wherein the pathogen is Atty. Dkt. No. PASC.013 coronavirus.
13. The prophylactic treatment method of claim 1 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered in an aerosol suspension of respirable particles which the individual inhales.
14. The prophylactic treatment method of claim 1 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered for reducing the risk of infection from an airborne pathogen which can cause a disease in a human to the lungs of the human who may be at risk of infection from the airborne pathogen but is asymptomatic for the disease, wherein the effective amount of sodium channel blocker or a pharmaceutically acceptable salt is sufficient to reduce the risk of infection in the human.
15. The prophylactic treatment method of claim 1 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered post- exposure to the one or more airborne pathogens.
16. The prophylactic treatment method of claim 1 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000178_0001
Figure imgf000178_0002
Figure imgf000179_0001
17. The prophylactic treatment method of claim 1 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000179_0002
Figure imgf000180_0001
and
Figure imgf000180_0002
18. The prophylactic treatment method of claim 1 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000180_0003
Atty. Dkt. No. PASC.013
Figure imgf000181_0001
19. A prophylactic treatment method comprising: administering a prophylactically effective amount of a sodium channel blocker according to Formula II: Atty. Dkt. No. PASC.013
Figure imgf000182_0001
where X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl; Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R2)2; R1 is hydrogen or lower alkyl; each R2 is, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -(CH2)n-Zg-R7,-(CH2)m- NR10-CH2(CHOR8)(CHOR8)π-CH2OR8, -(CH2)n-CO2R7, or
Figure imgf000182_0002
R3 and R4 are each, independently, hydrogen, a group represented by formula (A'), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)-lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl-lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R3 and R4 is a group represented by formula (A1): — (C(RL)2)0-X-(C(RL)2)P-CR5'R6'R6' (A') Atty. Dkt. No. PASC.013 where each RL is, independently, -R7, -(CH2)n-OR8, -O-(CH2)m-OR8, -(CH2)π-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8 : -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)„-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000183_0001
each o is, independently, an integer from 0 to 10; each p is an integer from 0 to 10; with the proviso that the sum of o and p in each contiguous chain is from 1 to 10; each x is, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond; each R5' is, independently, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)„(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)„-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, Atty. Dkt. No. PASC.013 -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000184_0001
each R5' is also, independently, -(CH2)„-NR12R12, -O-(CH2)m-NR12R12,
-O-(CH2)n-NR12R12, -O-(CH2)m-(Z)gR12, -(CH2)nNRπRn, -O- (CH2)mNRnRπ, -(CH2)n-N®-(Ru)3, -O-(CH2)m-N®-(Rπ)3, -(CH2)n-(Z)g- (CH2)m-NR10R10, -O-(CH2)m-(Z)g-(CH2)m-NR,0R10, -(CH2CH2O)m- CH2CH2NR12R12, -O-(CH2CH2O)m-CH2CH2NR12R12, -(CH2)„- (C=O)NR1 R12, -O-(CH2)m-(C=O)NR12R12,-O-(CH2)m-(CHOR8)mCH2NR10- (Z)g-R10, -(CH2)n-(CHOR8)mCH2-NR10-(Z)g-R10, -(CH2)„NR10- O(CH2)m(CHOR8)„CH2NR10-(Z)g-R10, -O(CH2)m-NR10-(CH2)m- (CHOR8)nCH2NR10-(Z)g-R10, -(Het)-(CH2)m-OR8, -(Het)-(CH2)m-NR7R10, - (Het)-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(Het)-(CH2CH2O)m-R8, -(Het)- (CH2CH2O)m-CH2CH2NR7R10, -(Het)-(CH2)m-C(=O)NR7R10,-(Het)-(CH2)m- (Z)g-R7, -(Het)-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(Het)- (CH2)m-CO2R7, -(Het)-(CH2)m-NR12R12, -(Het)-(CH2)n-NR,2R12, -(Het)- (CH2)m-(Z)gR12, -(Het)-(CH2)mNR1 ,R11, -(Het)-(CH2)m-N®-(Ru)3, -(Het)- (CH2)m-(Z)g-(CH2)m-NR10R10, -(Het)-(CH2CH2O)m-CH2CH2NR12R12, -(Het)- (CH2)m-(C=O)NR12R12, -(Het)-(CH2)m-(CHOR8)mCH2NR10-(Z)g-R10, -(Het)- (CH2)m-NR10-(CH2)m-(CHOR8)„CH2NR10-(Z)g-R10, wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to Atty. Dkt. No. PASC.013 each other the R8 groups may be joined to form a cyclic mono- or di- substituted 1,3-dioxane or 1,3-dioxolane, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -
CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -
CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, or -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; wherein each R5 is also, independently,
Link -(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)„- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)n-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)n-(CHOR8)mCH2-NR13-(Z)g-CAP, Link -(CH2)nNR13-(CH2)m(CHOR8)nCH2NR13-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR13-(CH2)m-C(=O)NR10R10, Link -(CH2)m-C(=O)NR13-(CH2)m-CAP, Link -(CH2)m-C(=O)NR1 IR11, Link -(CH2)m-C(=O)NR12R12, Link -(CH2) n-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP; wherein Link is, independently, Atty. Dkt. No. PASC.013
-O-, (CH2)n-, -O(CH2)m-, -NR13-C(=O)-NR13, -NR13-C(=O)-(CH2)m-,
-C(=O)NR13-(CH2)m, -(CH2)n-Zg-(CH2)n, -S-, -SO-, -SO2-, SO2NR7-, SO2NR10-, -
Het-. wherein each CAP is, independently, thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R13 R13 , heteroaryl-CAP, -CN, -O-C(=S)NR13 R13, -ZgR13, -CR10(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N R13Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(R13R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides,
Figure imgf000186_0001
wherein Ar is, independently, phenyl; substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH3, NR13R13, Cl, F,
CH3; heteroaryl, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione, or imidazoyl ( A ); wherein heteroaryl is selected from one ofthe following heteroaromatic systems:
Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole,
Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline,
Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1 ,2,4-Triazine, 1,3,5-
Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
each R6' is, independently, -R5', -R7, -OR8, -N(R7)2, -(CH2)m-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10,
-(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10,-(CH2)n-(Z)g-R7,-O-(CH2)m-(Z)g-R7, Atty. Dkt. No. PASC.013 -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8,
-O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8,
-(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000187_0001
wherein when two -CH2OR groups are located 1,2- or 1 ,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1 ,3- dioxane or 1,3-dioxolane; each R7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH2(CHOR)8 m-R10; each R8 is, independently, hydrogen, lower alkyl, -C(=O)-Rπ, glucuronide, 2-tetrahydropyranyl, or
Figure imgf000187_0002
each R9 is, independently, -CO2R13, -CON(R13)2, -SO2CH2R13, or -C(=O)R13; each R10 is, independently, -H, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -(CH2) m-(CHOH)n-CH2OH; each Z is, independently, CHOH, C(=O), -(CH2)n-,CHNR13R13, C=NR13, or
NR 13. each R11 is, independently, lower alkyl; each R12 is independently, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -CH2-(CHOH)n-CH2OH; each R13 is, independently, hydrogen, R7, R10, -(CH2)m-NR13R13, + -(CH2)m- NR , 1I3JτR> 1"3rR> 1I3J, Atty. Dkt. No. PASC.013 -(CH2)m-(CHOR8)m-(CH2)mNR13R13, -(CH2)m-NR10R10 + -(CH2)m-(CHOR8)m-(CH2)mNR13R13R13,
Figure imgf000188_0001
-(CH2)n <v ,) , .(CH2)-. N NR13 , or
Figure imgf000188_0002
with the proviso that NR , 13r R, 13 c. an be joined on itself to form a ring comprising one ofthe following:
Atty. Dkt. No. PASC.013
(CH2)m(CHOR)8 m-(CH2)nR11R11 .
Figure imgf000189_0001
each Het is independently, -NR13, -S-, -SO-, or -SO2-; -O-, -SO2NR13-,
-NHSO2-, -NR13CO-, -CONR13-; each g is, independently, an integer from 1 to 6; each m is, independently, an integer from 1 to 7; each n is, independently, an integer from 0 to 7; each V is, independently, -(CH2)m-NR7R10, -(CH2)m-NR7R7, -(CH2)m- + MWR11, -(CH2)π-(CHOR8)m-(CH2)mNR7R10, -(CH2)n-NR10R10 + -(CH2)n-(CHOR8)m-(CH2)mNR7R7,-(CH2)π-(CHOR8)m-(CH2)mNR1 ' with the proviso that when V is attached directly to a nitrogen atom, then V can also be, independently, R7, R10, or (Rπ)2; wherein for any ofthe above compounds when two -CH2OR8 groups are located 1,2- or 1 ,3- with respect to each other the R8 groups may be joined to form a cyclic Atty. Dkt. No. PASC.013 mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof, to an individual in need of prophylactic treatment against infection or disease from one or more airborne pathogens.
20. The prophylactic treatment method of claim 19 wherein the pathogen is Bacillus anthracis.
21. The prophylactic treatment method of claim 19 wherein the pathogen is Variola major.
22. The prophylactic treatment method of claim 19 wherein the pathogen is Yersinia pestis .
23. The prophylactic treatment method of claim 19 wherein the pathogen is Francisella tularensis.
24. The prophylactic treatment method of claim 19 wherein the pathogen is a gram negative bacteria.
25. The prophylactic treatment method of claim 24 wherein the gram negative bacteria is selected from the group consisting of Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii and Rickettsia.
26. The prophylactic treatment method of claim 19 wherein the pathogen is an alphavirus, a flavivirus or a bunyavirus.
27. The prophylactic treatment method of claim 19 wherein the pathogen is ricin toxin from Ricinus communis, epsilon toxin of Clostridium perfringens or Staphylococcal enterotoxin B.
28. The prophylactic treatment method of claim 19 wherein the pathogen is Mycobacterium tuberculosis bacteria.
29. The prophylactic treatment method of claim 19 wherein the pathogen is an influenza virus, rhinovirus, adenovirus or respiratory syncytial virus.
30. The prophylactic treatment method of claim 19 wherein the pathogen is coronavirus.
31. The prophylactic treatment method of claim 19 wherein the sodium Atty. Dkt. No. PASC.013 channel blocker or pharmaceutically acceptable salt thereof is administered in an aerosol suspension of respirable particles which the individual inhales.
32. The prophylactic treatment method of claim 19 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered for reducing the risk of infection from an airborne pathogen which can cause a disease in a human to the lungs ofthe human who may be at risk of infection from the airborne pathogen but is asymptomatic for the disease, wherein the effective amount of sodium channel blocker or a pharmaceutically acceptable salt is sufficient to reduce the risk of infection in the human.
33. The prophylactic treatment method of claim 19 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered post- exposure to the one or more airborne pathogens.
34. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000191_0001
Figure imgf000192_0001
and
35. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000192_0003
OCH2CHOHCH2NH2
Figure imgf000193_0001
Figure imgf000193_0002
36. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000193_0003
Figure imgf000193_0004
and
Figure imgf000193_0005
37. The prophylactic treatment method of claim 19 wherein the sodium
Atty. Dkt. No. PASC.013 channel blocker is selected from the group consisting of:
Figure imgf000194_0001
and
Figure imgf000194_0002
38. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000194_0003
Atty. Dkt. No. PASC.013
Figure imgf000195_0001
and
Figure imgf000195_0002
39. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Atty. Dkt. No. PASC.013
Figure imgf000196_0001
Figure imgf000197_0001
40. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000197_0002
Figure imgf000197_0003
41. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000197_0004
Figure imgf000198_0001
Figure imgf000198_0002
42. The prophylactic treatment method of claim 19 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000198_0003
Atty. Dkt. No. PASC.013
Figure imgf000199_0001
Figure imgf000199_0002
43. A prophylactic treatment method comprising: administering a prophylactically effective amount of a sodium channel blocker according to Formula III:
Figure imgf000199_0003
where Atty. Dkt. No. PASC.013 X is hydrogen, halogen, trifluoromethyl, lower alkyl, unsubstituted or substituted phenyl, lower alkyl-thio, phenyl-lower alkyl-thio, lower alkyl-sulfonyl, or phenyl-lower alkyl-sulfonyl; Y is hydrogen, hydroxyl, mercapto, lower alkoxy, lower alkyl-thio, halogen, lower alkyl, unsubstituted or substituted mononuclear aryl, or -N(R2)2; R1 is hydrogen or lower alkyl; each R2 is, independently, -R7, -(CH2)m-OR8, -(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -(CH2)„-Zg-R7,-(CH2)m- NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, or
Figure imgf000200_0001
R3 and R4 are each, independently, hydrogen, a group represented by formula (A"), lower alkyl, hydroxy lower alkyl, phenyl, phenyl-lower alkyl, (halophenyl)-lower alkyl, lower-(alkylphenylalkyl), lower (alkoxyphenyl)-lower alkyl, naphthyl-lower alkyl, or pyridyl-lower alkyl, with the proviso that at least one of R3 and R4 is a group represented by formula (A"):
-(C(RL)2)0_χ_(C(RL)2) (A")
Figure imgf000200_0002
where each RL is, independently, -R7, -(CH2)n-OR8, -O-(CH2)m-OR8, -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)„-CH2OR8, Atty. Dkt. No. PASC.013 -O-(CH2)m-NR10-CH2(CHOR8XCHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000201_0001
each o is, independently, an integer from 0 to 10; each p is an integer from 0 to 10; with the proviso that the sum of o and p in each contiguous chain is from 1 to 10; each x is, independently, O, NR10, C(=O), CHOH, C(=N-R10), CHNR7R10, or represents a single bond; each R is, independently, independently, -O-(CH2)m-OR , -(CH2)n-NR7R10, -O-(CH2)m-NR7R10, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10, -O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10, -O-(CH2)m-C(=O)NR7R10, -(CH2)n-(Z)g-R7, -O-(CH2)m-(Z)g-R7, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)„-CH2OR8, -O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(CH2)n-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose,
Figure imgf000201_0002
Atty. Dkt. No. PASC.013 each R5' is also, independently, -(CH2)n-NR12R12, -O-(CH2)m-NR,2R12,
-O-(CH2)n-NR12R12, -O-(CH2)m-(Z)gR12, -(CH^NR1^11, -O- (CH2)mNRπRπ, -(CH2)n-N®-(Rπ)3, -O-(CH2)m-N®-(Rn)3, -(CH2)n-(Z)g- (CH2)m-NR10R10, -O-(CH2)m-(Z)g-(CH2)m-NR10R10, -(CH2CH2O)m- CH2CH2NR12R12, -O-(CH2CH2O)m-CH2CH2NR12R12, -(CH2)„- (C=O)NR12R12, -O-(CH2)m-(C=O)NR12R12,-O-(CH2)m-(CHOR8)mCH2NR10- (Z)g-R10, -(CH2)n-(CHOR8)mCH2-NR10-(Z)g-R10, -(CH2)nNR10- O(CH2)m(CHOR8)nCH2NR10-(Z)g-R10, -O(CH2)m-NR10-(CH2)m- (CHOR8)nCH2NR10-(Z)g-R10, -(Het)-(CH2)m-OR8, -(Het)-(CH2)m-NR7R10, - (Het)-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, -(Het)-(CH2CH2O)m-R8, -(Het)- (CH2CH2O)m-CH2CH2NR7R10, -(Het)-(CH2)m-C(=O)NR7R10,-(Het)-(CH2)m- (Z)g-R7, -(Het)-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, -(Het)- (CH2)m-CO2R7, -(Het)-(CH2)m-NR12R12, -(Het)-(CH2)n-NR12R12, -(Het)- (CH2)m-(Z)gR12, -(Het)-(CH2)mNR11R11, -(Het)-(CH2)m-N®-(Ru)3, -(Het)- (CH2)m-(Z)g-(CH2)m-NR10R10, -(Het)-(CH2CH2O)m-CH2CH2NR12R12, -(Het)- (CH2)m-(C=O)NR12R12, -(Het)-(CH2)m-(CHOR8)mCH2NR10-(Z)g-R10, -(Het)- (CH2)m-NR10-(CH2)m-(CHOR8)nCH2NR10-(Z)g-R10, wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di- substituted 1,3-dioxane or 1,3-dioxolane, -(CH2)n(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -
CH2OR are located adjacent to each other and the R groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two - CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, -(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8, with the proviso that at least two -CH2OR8 are located adjacent to each other and the R8 groups are joined to Atty. Dkt. No. PASC.013 form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane, or -O-(CH2)m-NR10-CH2(CHOR8XCHOR8)n-CH2OR8, with the proviso that at least two -CH2OR8 are located adjacent to each other and the R8 groups are joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; wherein each R5 is also, independently,
Link -(CH2)n-CAP, Link -(CH2)n(CHOR8)(CHOR8)n-CAP, Link - (CH2CH2O)m-CH2-CAP, Link -(CH2CH2O)m-CH2CH2-CAP, Link -(CH2)„- (Z)g-CAP, Link - (CH2)n(Z)g-(CH2)m-CAP , Link -(CH2)n-NR13- CH2(CHOR8)(CHOR8)n-CAP, Link -(CH2)n-(CHOR8)mCH2-NR13-(Z)g-CAP, Link -(CH2)nNR13-(CH2)m(CHOR8)nCH2NR13-(Z)g-CAP, Link -(CH2)m-(Z)g- (CH2)m-CAP, Link NH-C(=O)-NH-(CH2)m-CAP, Link -(CH2)m- C(=O)NR13-(CH2)m-C(=O)NR10R10, Link -(CH2)m-C(=O)NR13-(CH2)m-CAP, Link -(CH2)m-C(=O)NR, 1R11, Link -(CH2)m-C(=O)NR12R12, Link -(CH2) „-(Z)g-(CH2)m-(Z)g-CAP, Link -Zg-(CH2)m-Het-(CH2)m-CAP; wherein Link is, independently,
-O-, (CH2)n-, -O(CH2)m-,-NR13-C(=O)-NR13, -NR13-C(=O)-(CH2)m-, - C(=O)NR13-(CH2)m, -(CH2)„-Zg-(CH2)n,-S-,-SO-,-SO2-, SO2NR7-, SO2NR10-, -Het-; wherein each CAP is, independently,
thiazolidinedione, oxazolidinedione, heteroaryl-C(=O)N R13 R13 ,heteroaryl-CAP, -CN, -O-C(=S)NR13 R13, -ZgR13, -CRI0(ZgR13)(ZgR13), -C(=O)OAr ,-C(=O)N R13Ar, imidazoline, tetrazole, tetrazole amide, -SO2NHR13, -SO2NH-C(R13R13 )-(Z)g-R13 , cyclic sugars and oligosaccharides, including cyclic amino sugars and oligosaccharides, Atty. Dkt. No. PASC.013
Figure imgf000204_0001
wherein Ar is, independently, phenyl; substituted phenyl, wherein said substituent is 1-3 groups selected, independently, from OH, OCH3, NR13R13, Cl, F,
CH3; heteroaryl, tinazine, furyl, furfuryl-, thienyl, tetrazole, thiazolidinedione or imidazoyl ( — <r nNJ7I ); wherein heteroaryl is selected from one ofthe following heteroaromatic systems:
Pyrrole, Furan, Thiophene, Pyridine, Quinoline, Indole, Adenine, Pyrazole,
Imidazole, Thiazole, Isoxazole, Indole, Benzimidazole, Purine, Quinoline,
Isoquinoline, Pyridazine, Pyrimidine, Pyrazine, 1,2,3-Triazine, 1,2,4-Triazine, 1,3,5-
Triazine, Cinnoline, Phthalazine, Quinazoline, Quinoxaline and Pterdine;
wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane;
each R6' is, independently, -R5', -R7, -OR8, -N(R7)2, -(CH2)m-OR8,
-O-(CH2)m-OR8, -(CH2)„-NR7R10, -O-(CH2)m-NR7R10,
-(CH2)n(CHOR8)(CHOR8)n-CH2OR8, -O-(CH2)m(CHOR8)(CHOR8)n-CH2OR8,
-(CH2CH2O)m-R8, -O-(CH2CH2O)m-R8, -(CH2CH2O)m-CH2CH2NR7R10,
-O-(CH2CH2O)m-CH2CH2NR7R10, -(CH2)n-C(=O)NR7R10,
-O-(CH2)m-C(=O)NR7R10,-(CH2)n-(Z)g-R7,-O-(CH2)m-(Z)g-R7,
-(CH2)n-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8,
-O-(CH2)m-NR10-CH2(CHOR8)(CHOR8)n-CH2OR8,
-(CH2)„-CO2R7, -O-(CH2)m-CO2R7, -OSO3H, -O-glucuronide, -O-glucose, Atty. Dkt. No. PASC.013
Figure imgf000205_0001
wherein when two -CH2OR8 groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3- dioxane or 1,3-dioxolane; each R7 is, independently, hydrogen lower alkyl, phenyl, substituted phenyl or -CH2(CHOR)8 m-R10; each R is, independently, hydrogen, lower alkyl, -C(=O)-R , glucuronide, 2-tetrahydropyranyl, or
Figure imgf000205_0002
each R9 is, independently, -CO2R13, -CON(R13)2, -SO2CH2R13, or -C(=O)R13; each R10 is, independently, -H, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -(CH2) m-(CHOH)n-CH2OH; each Z is, independently, CHOH, C(=O), -(CH2)n-,CHNR13R13, C=NR13, or
NR13; each R11 is, independently, lower alkyl; each R12 is independently, -SO2CH3, -CO2R13, -C(=O)NR13R13, -C(=O)R13, or -CH2-(CHOH)n-CH2OH; each R13 is, independently, hydrogen, R7, R10, -(CH2)m-NR13R13, + -(CH2)m- NR13R13R13,
-{CH2)m-(CHOR8)m-(CH2)mNR13R13, -(CH2)m-NR10R10 + -(CH2)m-(CHOR8)m-(CH2)mNR13R13R13, Atty. Dkt. No. PASC.013
Figure imgf000206_0001
"(CH2)n x ) V , ,or
Figure imgf000206_0002
Figure imgf000206_0003
with the proviso that NR13R13 can be joined on itself to form a ring comprising one ofthe following:
Atty. Dkt. No. PASC.013
Figure imgf000207_0001
(CH2)m(CH0R)8 m-(CH2)nR11R11 ;
Figure imgf000207_0002
each Het is independently, -NR13, -S-, -SO-, or -SO2-; -O-, -SO2NR13-,
-NHSO2-, -NR13CO-, -CONR13-; each g is, independently, an integer from 1 to 6; each m is, independently, an integer from 1 to 7; each n is, independently, an integer from 0 to 7; each Q' is, independently, -CR6R5', -CR6'R6', N, -NR13, -S-, -SO-, or -SO2-; wherein at most three Q' in a ring contain a heteroatom and at least one Q' must be -CR5'R6' or NR5'; each V is, independently, -(CH2)m-NR7R10, -(CH2)m-NR7R7, -(CH2)m- + NR'^'R", -(CH2)n-(CHOR8)m-(CH2)mNR7R10, -(CH2)π-NR10R10
+ -(CH2)n-(CHOR8)m-(CH2)mNR7R7,-(CH2)n-(CHOR8)m-(CH2)mNR1 'R1 ' with the proviso that when V is attached directly to a nitrogen atom, then V Atty. Dkt. No. PASC.013 can also be, independently, R7, R1 , or (R )2; wherein for any of the above compounds when two -CH2OR groups are located 1,2- or 1,3- with respect to each other the R8 groups may be joined to form a cyclic mono- or di-substituted 1,3-dioxane or 1,3-dioxolane; or a pharmaceutically acceptable salt thereof, to an individual in need of prophylactic treatment against infection or disease from one or more airborne pathogens.
44. The prophylactic treatment method of claim 43 wherein the pathogen is Bacillus anthracis.
45. The prophylactic treatment method of claim 43 wherein the pathogen is Variola major.
46. The prophylactic treatment method of claim 43 wherein the pathogen is Yersinia pestis.
47. The prophylactic treatment method of claim 43 wherein the pathogen is Francisella tularensis.
48. The prophylactic treatment method of claim 43 wherein the pathogen is a gram negative bacteria.
49. The prophylactic treatment method of claim 48 wherein the gram negative bacteria is selected from the group consisting of Brucella species, Burkholderia pseudomallei, Burkholderia mallei, Coxiella burnetii and Rickettsia.
50. The prophylactic treatment method of claim 43 wherein the pathogen is an alphavirus, a flavivirus or a bunyavirus.
51. The prophylactic treatment method of claim 43 wherein the pathogen is ricin toxin from Ricinus communis, epsilon toxin of Clostridium perfringens or Staphylococcal enterotoxin B.
52. The prophylactic treatment method of claim 43 wherein the pathogen is Mycobacterium tuberculosis bacteria.
53. The prophylactic treatment method of claim 43 wherein the pathogen is Atty. Dkt. No. PASC.013 an influenza virus, rhinovirus, adenovirus or respiratory syncytial virus.
54. The prophylactic treatment method of claim 43 wherein the pathogen is coronavirus.
55. The prophylactic treatment method of claim 43 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered in an aerosol suspension of respirable particles which the individual inhales.
56. The prophylactic treatment method of claim 43 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered for reducing the risk of infection from an airborne pathogen which can cause a disease in a human to the lungs ofthe human who may be at risk of infection from the airborne pathogen but is asymptomatic for the disease, wherein the effective amount of sodium channel blocker or a pharmaceutically acceptable salt is sufficient to reduce the risk of infection in the human.
57. The prophylactic treatment method of claim 43 wherein the sodium channel blocker or pharmaceutically acceptable salt thereof is administered post- exposure to the one or more airborne pathogens.
58. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000209_0001
Atty. Dkt. No. PASC.013
Figure imgf000210_0001
Figure imgf000210_0002
59. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000210_0003
Atty. Dkt. No. PASC.013
Figure imgf000211_0001
60. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000211_0002
Figure imgf000212_0001
61. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000212_0002
Atty. Dkt. No. PASC.013
Figure imgf000213_0001
62. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000213_0002
Figure imgf000214_0001
63. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of: H
Figure imgf000214_0002
and Atty. Dkt. No. PASC.013
Figure imgf000215_0001
64. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000215_0002
Figure imgf000216_0001
65. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000216_0002
Atty. Dkt. No. PASC.013
Figure imgf000217_0001
66. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000217_0002
67. The prophylactic treatment method of claim 43 wherein the sodium channel blocker is selected from the group consisting of:
Figure imgf000217_0003
Figure imgf000218_0001
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