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EP1112072A2 - Derives de methimazole et thiones cycliques tautomeres permettant de traiter les maladies auto-immunes - Google Patents

Derives de methimazole et thiones cycliques tautomeres permettant de traiter les maladies auto-immunes

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Publication number
EP1112072A2
EP1112072A2 EP99945325A EP99945325A EP1112072A2 EP 1112072 A2 EP1112072 A2 EP 1112072A2 EP 99945325 A EP99945325 A EP 99945325A EP 99945325 A EP99945325 A EP 99945325A EP 1112072 A2 EP1112072 A2 EP 1112072A2
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EP
European Patent Office
Prior art keywords
pharmaceutical composition
class
composition according
cells
alkyl
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Application number
EP99945325A
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German (de)
English (en)
Inventor
Leonard D. Kohn
Robert W. Curley
John M. Rice
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
US Department of Health and Human Services
Sentron Medical Inc
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US Department of Health and Human Services
Sentron Medical Inc
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Priority claimed from US09/382,960 external-priority patent/US6365616B1/en
Application filed by US Department of Health and Human Services, Sentron Medical Inc filed Critical US Department of Health and Human Services
Publication of EP1112072A2 publication Critical patent/EP1112072A2/fr
Withdrawn legal-status Critical Current

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D233/00—Heterocyclic compounds containing 1,3-diazole or hydrogenated 1,3-diazole rings, not condensed with other rings
    • C07D233/54—Heterocyclic compounds containing 1,3-diazole or hydrogenated 1,3-diazole rings, not condensed with other rings having two double bonds between ring members or between ring members and non-ring members
    • C07D233/66—Heterocyclic compounds containing 1,3-diazole or hydrogenated 1,3-diazole rings, not condensed with other rings having two 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
    • C07D233/91—Nitro radicals
    • C07D233/92—Nitro radicals attached in position 4 or 5
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A61K31/4166—1,3-Diazoles having oxo groups directly attached to the heterocyclic ring, e.g. phenytoin
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/42—Oxazoles
    • A61K31/421—1,3-Oxazoles, e.g. pemoline, trimethadione
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/425—Thiazoles
    • A61K31/426—1,3-Thiazoles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6844—Nucleic acid amplification reactions
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6897—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids involving reporter genes operably linked to promoters

Definitions

  • This invention relates to the treatment of autoimmune diseases and transplantation rejection in mammals. More specifically, the present invention relates to the use of a narrowly-defined group of methimazole derivatives and tautomeric cyclic thiones for the purposes described herein.
  • MHC major histocompatibility complex
  • MHC Class I molecules are found on virtually all somatic cell types, although at different levels in different cell types.
  • MHC Class II molecules are normally expressed only on a few cell types, such as lymphocytes, macrophages and dendritic cells.
  • Antigens are presented to the immune system by antigen presenting cells in the context of Class I or Class II cell surface molecules, for example, CD4 + helper T-lymphocytes recognize antigens in association with Class II MHC molecules, and CD8 + cytotoxic lymphocytes (CTL) recognize antigens in association with Class I gene products. It is currently believed that MHC Class I molecules function primarily as the targets of the cellular immune response, while Class II molecules regulate both the humoral and cellular immune response (Klein, J.
  • MHC Class I and Class II molecules have been the focus of much study with respect to research in autoimmune diseases because of their roles as mediators or initiators of immune response.
  • MHC Class II antigens have been the primary focus of research in the etiology of autoimmune diseases, whereas MHC Class I antigens have historically been the focus of research in transplantation rejection.
  • MHC Class I and MHC Class II antigens have linked aberrant expression and/or function of MHC Class I and MHC Class II antigens to the autoimmune disease process, for example, insulin-dependent diabetes mellitus (IDDM) (Tisch and McDevitt, Cell 85: 291-297 (1996)), systemic lupus erythematosus (SLE) (Kotzin, Cell 85: 303-306 (1996)), and uveoretinitis (Prendergast et al., Invest. Opthalmol. Vis. Sci. 39: 754-762 (1998)).
  • IDDM insulin-dependent diabetes mellitus
  • SLE systemic lupus erythematosus
  • uveoretinitis Prendergast et al., Invest. Opthalmol. Vis. Sci. 39: 754-762 (1998).
  • MHC Class I and/or Class ⁇ expression and disease has been examined in many of these model systems using a variety of biochemical and genetic approaches.
  • the strongest evidence for aberrant MHC gene function as a mediator of autoimmune disease stems from transgenic animal models in which the MHC genes have been inactivated.
  • MHC Class I deficient animals resistance to the autoimmune disease process - and hence the dependence of autoimmunity upon MHC gene expression - can be directly demonstrated in animal models for IDDM (Serreze et al., Diabetes 43: 505-509 (1994)), and SLE (Mozes et al., Science 261: 91-93 (1993)).
  • TGF-betal deficient transgenic mice Shull et al., Nature 359: 693-699 (1992); Kulkarni et al., Proc. Natl. Acad. Sci. 90: 770-774 (1993); Boivin et al., Am. J. Pathol. 146: 276-288 (1995)
  • MHC Class II deficient animals TGF-betal deficient animals lacking MHC Class II expression are without evidence of inflammatory infiltrates, circulating antibodies, or glomerular immune complex deposits (Letterio et al., J. Clin. Invest. 98: 2109-2119 (1996)).
  • Graves' disease is a relatively common autoimmune disorder of the thyroid.
  • autoantibodies against thyroid antigens particularly the thyrotropin receptor (TSHR)
  • TSHR thyrotropin receptor
  • Thyrocytes from patients with Graves' disease have aberrant MHC Class II expression and elevated MHC Class I expression (Hanafusa et al.
  • thionamides contain a thiourea group; the most potent are thioureylenes (W.L. Green, in Werner and Ingbar's "The Thyroid”: A Fundamental Clinical Text, 6 th Edition, L. Braverman and R. Utiger (eds), J.B. Lippincott Co., 1991, p. 324).
  • the basis for thionamide therapy has, however, not focused on immune suppression. Rather, the basis has been suppression of thyroid hormone formation. Experiments suggesting an effect on immune cells, to inhibit antigen presentation or antibody formation, are largely discounted as nonphysiologic in vitro artifacts of high MMI concentration. MMI activity under those circumstances is suggested to be based on free-radical scavenger activity. See D.S. Cooper, in Werner E. Ingbar's "The Thyroid", op. cit., pp. 712-734.
  • SLE Systemic lupus erythematosus
  • SLE is a chronic autoimmune disease that, like Graves' disease, has a relatively high rate of occurrence. SLE affects predominantly women, the incidence being 1 in 700 among women between the ages of 20 and 60 (Abbus, A.K., Lichtman, A.H., Pober, J.S. (eds), "Cellular and Molecular Immunology", W.B. Saunders Company, Philadelphia, 1991, pp. 360- 370). SLE is characterized by the formation of a variety of autoantibodies and by multiple organ system involvement (Stites and Terr, ibid, pp. 438-443).
  • Immunosuppressive drugs such as cyclosporin, FK506 or rapamycin suppress the immune system by reducing T cell numbers and function (Morris, P.J., Curr. Qpin. in lmmun.. 3:748-751 (1991)). While these immunosuppressive therapies alleviate the symptoms of SLE and other autoimmune diseases, they have numerous severe side effects. In fact, extended therapy with these agents may cause greater morbidity than the underlying disease. A link between MHC Class I expression and SLE in animal models has been established.
  • Diabetes Mellitus is a disease characterized by relative or absolute insulin deficiency and relative or absolute glucagon excess (Foster, D.W., Diabetes Mellitus. In Stanbury, J.B., et al., The Metabolic Basis of Inherited Disease. Ch. 4, pp 99-117, 1960).
  • Type I diabetes appears to require a permissive genetic background and environmental factors.
  • Islet cell antibodies are common in the first months of the disease. They probably arise in part to ⁇ cell injury with leakage cell antigens but also represent a primary autoimmune disease.
  • the preeminent metabolic abnormality in Type I diabetes is hyperglycemia and glucosuria.
  • Late complications of diabetes are numerous and include increased atherosclerosis with attendant stroke and heart complications, kidney disease and failure, and neuropathy which can be totally debilitating.
  • the link to HLA antigens has been known since 1970. Certain HLA alleles are associated with increased frequency of disease, others with decreased frequency.
  • Increased MHC class I and aberrant MHC class II expression in islet cells has been described (Bottazzo et al., NEJM 313: 353-360 (1985); Foulis and Farquharson, Diabetes 35: 1215-1224 (1986)).
  • a definitive link to MHC class I has been made in a genetic animal model of the disease.
  • MHC class I deficiency results in resistance to the development of diabetes in the NOD mouse (Sereze et al., Diabetes 43: 505-509 (1994); Wicker et al., Diabetes 43: 500- 504 (1994)).
  • a wealth of genetic, biochemical and animal model data support a contributory role of inflammatory cytokines (e.g., IL-12, IL-18; and particularly IFN-gamma) in the autoimmune process (Sarvetnick, J Clin Invest 99: 371-372 (1997)).
  • IL-12 and IL-18 are known to act synergistically in stimulating production of IFN-gamma in T cells (Micallef et al., Eur. J. Immunol. 26: 1647-1651 (1996)).
  • IFN-gamma inducing factor IFN-gamma inducing factor
  • IL-18 In diabetic NOD mice the systemic expression of IL-18 (Rothe et al., J. Autoimmun. 10: 251-256 (1997)) and islet expression of IL-12 are increased (Rabinovitch et al., J. Autoimmun. 9: 645-651 (1996)).
  • additional IL-12 accelerates autoimmune diabetes in NOD mice (Trembleau et al., J. Exp. Med. 181: 817-821 (1995)).
  • IFN-gamma The role of IFN-gamma in the autoimmune process is further substantiated by studies where IFN-gamma's signaling capacity was abrogated in some manner.
  • transgenic NOD mice deficient in the cellular receptor for IFN-gamma Wang et al., Proc. Natl. Acad. Sci. 94: 13844-13849 (1997)) do not develop autoimmune diabetes.
  • NOD mice treated with a neutralizing antibody for IFN- gamma (Debray-Sachs et al., J. Autoimmun. 4:237-248 (1991)) also do not develop autoimmune diabetes.
  • IFN-gamma has been reported to be associated with the development of an SLE-like disease (Graninger et al., J. Rheumatol. 18: 1621-1622 (1991)).
  • MMI can inhibit IFN-increased class I and class II expression in thyroid (Saji et al., J. Clin. Endocrinology. Metab. 75: 871-878 (1992); Montani et al., Endocrinology. 139: 290-302 (1998)). Finally, it has been shown that MMI decreases expression of CIITA increased class II expression and this appears to be related to the action of MMI to enhance Y box protein gene expression; the Y box protein suppresses class II gene expression (Montani et al., Endocrinology 139: 280-289 (1998)).
  • Transplantation rejection occurs as a result of histoincompatibility between the host and the donor; it is the major obstacle in successful transplantation of tissues.
  • Current treatment for transplantation rejection, as for autoimmune disease, involves the use of a variety of immunosuppressant drugs and corticosteroid treatment.
  • Kjellin and Sandstrom Acta Chemica Scandinavica, 23: 2879-2887 and 2888-2899 (1969), discloses a series of tautomeric cyclic thiones, i.e., oxazoline - , thiazoline-, and imidazoline-2-(3)-thiones, having methyl and phenyl groups in the 4 and 5 positions.
  • the compounds were used for a study of thione-thiol equilibria. No pharmaceutical, or any other utility, is disclosed or suggested for these compounds.
  • the dimethyl compound is also said to exhibit antiviral properties against herpes simplex and vaccinia viruses.
  • Illustrative compounds include l-(4-fluorophenyl)-5- methyl-2-mercaptoimidazole and l-methyl-5-phenyl-2-mercaptoimidazole.
  • Faustman, et al. contends that fragments or whole viruses can be transfected into donor cells, prior to transplantation into the host, to suppress HLA Class I expression.
  • use of whole or fragments of virus presents potential complications to the recipient of such transplanted tissue since some viruses, SV40 in particular, can increase Class I expression (Singer and Maguire, Crit. Rev. Immunol.. 10:235-237 (1991), see particularly Table 2).
  • MMI myeloma, atopic dermatitis .
  • Akt. Endokrin. Primw. 8:119 (1987) Several autoimmune diseases have been treated with methimazole with potential success.
  • MMI was deemed as good as cyclosporin in treating juvenile diabetes (W. Waldhausl, et al., Akt. Endokrin. Stoffw. 8:119 (1987), and psoriasis has also been treated with MMI.
  • U.S. Patent 5,310,742 Elias, issued May 10, 1994, describes the use of thioureylene compounds to treat psoriasis and autoimmune diseases.
  • Propylthiouracil, methimazole, and thiabendazole are the only specific compounds disclosed in the patent. Examples show the use of methimazole to treat psoriasis in humans and the use of thioureylene to treat rheumatoid arthritis, lupus and transplant rejection.
  • No methimazole analogs or derivatives are disclosed or discussed.
  • No tautomeric cyclic thiones are disclosed or discussed.
  • U.S. Patent 5,010,092, Elfarra, issued April 23, 1991 describes a method of reducing the nephrotoxicity of certain drugs via the coadministration of methimazole or carbimazole (which is taught to be the pro-drug of methimazole) together with the nephrotoxic drug. No methimazole analogs or derivatives are discussed in this patent. No tautomeric cyclic thiones are disclosed or discussed.
  • U.S. Patent 5,587,369 Daynes, et al., issued December 24, 1996, describes a method for preventing or reducing ischemia following injury. This is accomplished by introducing dehydroepiandrosterone (DHEA), DHEA derivatives or DHEA congeners to a patient as soon as possible after the injury.
  • DHEA dehydroepiandrosterone
  • methimazole is a thromboxane inhibitor which has been shown to prevent vascular changes in burn wounds.
  • Methimazole therefore, is known in the art for a variety of pharmaceutical utilities: for the treatment of psoriasis (Elias), as an immunostimulant (Renoux, et al.), for the reduction of nephrotoxicity of certain drugs (Elfarra), for the miriimization of side effects found with certain analgesics (Oskinasi, et al), as a thyroid inhibitor (USP Dictionary), and as a thromboxane inhibitor (Daynes, et al.). It is also taught in the Singer, et al. patent as being useful in the treatment of autoimmune diseases, such as rheumatoid arthritis and systemic lupus. While the Singer, et al.
  • methimazole derivatives and tautomeric cyclic thiones are effective in treating autoimmune diseases and suppressing the rejection of transplanted organs, and that these compounds show clear and unexpected benefits over the use of methimazole itself.
  • these compounds are more effective in inhibiting basal and IFN-induced Class I RNA expression and in inhibiting IFN-induced Class II RNA expression than methimazole; (b) inhibit the action of IFN by acting on the CIITA/Y-box regulatory system; (c) may be significantly more soluble than methimazole, leading to significant formulation flexibility and advantages; (d) have less adverse effects on thyroid function than methimazole; (e) have an enhanced ability to bind to targets affected by MMI; and (f) exhibit therapeutic activities in. vivo. These properties are unexpected based on the known properties of methimazole and particularly the tautomeric cyclic thiones.
  • the present invention relates to the method by which these agents inhibit interferon-gamma actions, specifically those related to increase MHC Class I and MHC Class II expression and mediation of pro-inflammatory processes, and more specifically those processes related to the induction of autoimmune disease and/or transplant rejection.
  • Y is H, C r C 4 alkyl, C r C 4 substituted alkyl, -NO 2 , or the phenyl moiety
  • R 1 is selected from H, -OH, halogens (F, Cl, Br or I), C,-C 4 alkyl, C,-C 4 substituted alkyl, C,-C 4 ester or C r C 4 substituted ester;
  • R 2 is selected from H, C,-C 4 alkyl or C,-C 4 substituted alkyl;
  • R 3 is selected from H, C r C 4 alkyl, C,-C 4 substituted alkyl or -CH 2 Ph (wherein Ph is phenyl);
  • R 4 is selected from H, C,-C 4 alkyl or C r C 4 substituted alkyl;
  • X is selected from S or O;
  • Z is selected from -SR 3 , -OR 3 , S(O)R 3 or C r C 4 alkyl; and wherein at least two of the R 2 and R 3 groups on said compound are C r C 4 alkyl when Y is not a
  • Y is selected from H and C,-C 4 alkyl or C,-C 4 substituted alkyl
  • R 1 is selected from H, -OH, halogens (F, Cl, Br, or I), or C,-C 4 alkyl, C,-C 4 substituted alkyl, C r C 4 ester or C,-C 4 substituted ester
  • R 2 is selected from H or C r C 4 alkyl or C,-C 4 substituted alkyl
  • R 3 is selected from H, C r C 4 alkyl, C,-C 4 substituted alkyl, or -CH 2 Ph
  • R 4 is selected from H, C r C- 4 alkyl or C,-C 4 substituted alkyl
  • X is selected from S or O
  • Z is selected from -SR 3 or -OR 3 .
  • Particularly preferred compounds are those which have the formulae
  • Preferred compounds also include those of the formulae:
  • R 9 is selected from -OH, -M and MCH 2 COO-; and M is selected from F, Cl, Br and I.
  • the present invention also relates to the method of treating autoimmune diseases or transplantation rejection in a patient in need of such treatment by the administration of a safe and effective amount of the active compounds and pharmaceutical compositions described above.
  • the present invention also relates to in vivo assay methods which permit high efficiency screening of the effects of compounds on the expression of MHC Class I and Class II proteins.
  • the present invention relates to the method by which the compounds defined herein inhibit gamma interferon actions to increase MHC class I or class ⁇ expression.
  • Gamma interferon has been linked to expression of immune disease.
  • Figure 1 Diagrammatic representation of the upstream silencer/enhancer region of the MHC Class I PD1 gene (Panel A), the downstream silencer region of the Class I PD1 gene (Panel B), and the regulatory region of the HLA-DR ⁇ MHC Class II promoter (Panel C).
  • Figure 2 Effect of methimazole and several of the active compounds used herein on formation of protein/DNA silencer complexes with Fragment 140 (- 770 to -636 bp) of the MHC (Class I) 5 '-flanking region, which contains within it the upstream silencer/enhancer which controls constitutive MHC class I expression in different tissues.
  • Figure 4 Effect of treating FRTL-5 cells with MMI or a representative compound studied herein, compound 8 (see Table 1), on the formation of protein/DNA complexes with radiolabeled Fragment 127 (see Fig. 1) of the MHC 5'-flanking region, -127 to + 1 bp, as a function of time.
  • Figure 5. Nucleotide sequence of the 176 bp 5 '-flanking region of the
  • Electrophoretic mobility shift analysis (EMS A) of the ability of a 32 P-radiolabeled DR ⁇ -5 '-flanking region probe to form protein/DNA complexes with extracts from FRTL-5 cells maintained with and without TSH and treated or not with y-IFN.
  • Figure 7. Effect of MMI on the ability of Y-IFN to increase the formation of protein/DNA complexes with the 32 P-radiolabeled DR ⁇ -5 '-flanking region probe.
  • Figure 8. Effect of 1 mM MMI or 1 mM concentrations of representative compounds studied herein on the ability of y-IFN to increase the formation of protein/DNA complexes with the 32 P-radiolabeled DR ⁇ -5 '-flanking region probe.
  • Figure 9 Effect of MMI and/or TSH on exogenous class I promoter activity in FRTL-5 cells.
  • Figure 10 Effect of MMI and TSH on the promoter activity of CAT chimeras of 5 '-deletion mutants of the swine class I promoter in FRTL-5 cells.
  • FIG. 11 Effect of tf-interferon (IFN) on class II expression in FRTL-5 thyroid cells measured using the -176 bp HLA-DR ⁇ -CAT construct and 5 '-deletions thereof (A) or the -176 bp DR ⁇ -CAT construct having mutations with the S, X tract X 2 , and Y boxes (B).
  • IFN tf-interferon
  • Figure 14 Effect of MMI on y-IFN-increased class II expression in FRTL-5 thyroid cells as a function of MMI concentration.
  • Figure 17 Model of the development of autoimmune disease and the effect of the MMI, MMI derivatives or tautomeric cyclic thiones on the development process.
  • the present invention relates to pharmaceutical compositions which may be used to treat autoimmune diseases and to suppress the rejection of transplanted tissue.
  • the methods of treating autoimmune diseases and of suppressing rejection of transplanted tissue utilizing these pharmaceutical compositions are also covered, as are specific methimazole derivatives and tautomeric cyclic thione compounds which may be used to make these pharmaceutical compositions.
  • specific methimazole derivatives and tautomeric cyclic thione compounds which may be used to make these pharmaceutical compositions.
  • the following terms shall have the definitions given below.
  • safe and effective amount means a sufficient amount of pharmaceutically active compound to desirably affect the treatment of autoimmune diseases or to suppress the rejection of transplanted tissue, at a reasonable benefit/risk ratio attendant with any medical treatment.
  • the required dosage of a pharmaceutically active agent or of the pharmaceutical composition containing that active agent will vary with the severity of the condition being treated, the duration of the treatment, the nature of adjunct treatment, the age and physical condition of the patient, the specific active compound employed, and like considerations discussed more fully hereinafter.
  • the use of MMI at high doses can induce side effects, such as aplastic anemia, agranulocytosis, hepatic dysfunction and dermatitis, in certain patients.
  • these risks must be taken into consideration, as well as the fact that the compounds described herein provide pharmaceutical activity at lower dosage levels than conventional methimazole compounds.
  • “Pharmaceutically-acceptable” shall mean that the pharmaceutically active compound and other ingredients used in the pharmaceutical compositions and methods defined herein are suitable for use in contact with the tissues of humans and lower animals without undue toxicity, irritation, allergic response, and the like, commensurate with a reasonable benefit/risk ratio.
  • administration of the pharmaceutically active compounds and the pharmaceutical compositions defined herein includes systemic use, as by injection (especially parenterally), intravenous infusion, suppositories and oral administration thereof, as well as topical application of the compounds and compositions. Oral administration is particularly preferred in the present invention.
  • compositions and methods of this invention means that various other compatible drugs and medicaments, as well as inert ingredients, can be conjointly employed in the pharmaceutical compositions and methods of this invention, as long as the defined pharmaceutically active compounds and carriers are used in the manner disclosed.
  • comprising thus encompasses and includes the more restrictive terms “consisting of” and “consisting essentially of .
  • patient as used herein, is intended to encompass any mammal, animal or human, which may benefit from treatment with the compounds, compositions and methods of the present invention.
  • ком ⁇ онент herein is meant that the components of the compositions which comprise the present invention are capable of being comingled without interacting in a manner which would substantially decrease the efficacy of the pharmaceutically active compound under ordinary use conditions.
  • compositions of the present invention comprise specifically-defined methimazole derivatives and tautomeric cyclic thiones, used in a safe and effective amount, together with a pharmaceutically-acceptable carrier.
  • methimazole derivatives used in the compositions of the present invention are those having the following structural formulae:
  • Y is selected from H, C,-C 4 alkyl, C,-C 4 substituted alkyl, -NO 2 , and the phenyl moiety
  • Y is preferably H, the phenyl moiety or -NO 2 , and is most preferably H or the phenyl moiety
  • R 1 is selected from H, -OH, halogens (F, Cl, Br and I), C r C 4 alkyl, C,-C 4 substituted alkyl, C,-C 4 ester and C,-C 4 substituted ester; preferably R 1 is H, -OH, halogen, -OOC CH 2 M (where M is H or a halogen); and is most preferably H.
  • R 2 is selected from H, C C 4 alkyl and C r C 4 substituted alkyl; preferably one or both of the R 2 groups is methyl.
  • substituted alkyl or “substituted ester” is intended to include alkyl, aryl or ester groups which are substituted in one or more places with hydroxyl or alkoxyl groups, carboxyl groups, halogens, nitro groups, amino or acylamino groups, and mixtures of those moieties.
  • Preferred "substituted alkyl” groups are C r C 4 hydroxyl or alkoxyl groups, as well as groups substituted with halogens.
  • R 3 groups in the above formulae are selected from H, C r C 4 alkyl, C r C 4 substituted alkyl and -CH 2 Ph (wherein Ph is phenyl); in preferred compounds, R 3 is H or C,-C 4 alkyl; most preferably R 3 is C r C 4 alkyl, particularly methyl. R 4 is selected from H, C,-C 4 alkyl and C,-C 4 substituted alkyl, and preferably is H.
  • X may be S or O, and is preferably S.
  • Z is selected from C,-C 4 alkyl, -SR 3 , -S(O)R 3 and -OR 3 , is preferably -SR 3 , -OR 3 , and -S(O)R 3 ; most preferably -SR 3 and -OR 3 ; and particularly -SR 3 .
  • at least two of the R 2 and R 3 groups on the compound must be C,-C 4 alkyl when Y is not a phenyl moiety. Further, at least one of the Y groups should be -NO 2 , when Z is C,-C 4 alkyl.
  • Compounds useful in the present invention include the tautomeric cyclic thiones, disclosed in Kjellin and Sandstrom, Acta Chemica Scandanavica 23: 2879- 2887 (1969), incorporated herein by reference, having the formulae
  • R 5 , R 6 CH 3 , CH 3 ; Ph, H; H, Ph
  • Preferred compounds for use in the compositions of the present invention include those having the formulae:
  • compositions include those having the formulae:
  • R 10 is selected from H, NO 2 , Ph, 4-HOPh and 4-m-Ph (wherein m is F, Cl, Br, or I).
  • a particularly preferred subset of the pharmaceutical compounds defined herein are those wherein one of the Y groups is the phenyl moiety defined above. These compounds have the following formulae:
  • Y is selected from H, C r C 4 alkyl and C,-C 4 substituted alkyl, and is preferably H.
  • R 1 is selected from H, -OH, halogens (F, Cl, Br and I), C,-C 4 alkyl, C,-C 4 substituted alkyl, C,-C 4 ester, and C,-C 4 substituted ester, and is preferably H, -OH, halogen, -OOCCH 2 M (where) M is H or a halogen), and is not preferably H.
  • R 2 is selected from H, C r C 4 alkyl and C r C 4 substituted alkyl, and it is preferred that at least one of the R 2 groups be methyl.
  • R 3 is selected from H, C r C 4 alkyl, C,-C 4 substituted alkyl, and -CH 2 Ph; preferred R 3 moieties are H and methyl.
  • R 4 is selected from H, C,-C 4 alkyl and C r C 4 substituted alkyl, and is preferably H.
  • X is selected from S and O, and is preferably S.
  • the Z moiety is selected from -SR 3 and -OR 3 , and is preferably -SR 3 .
  • Particularly preferred compounds are those having the structural formulae
  • R 9 is selected from -OH, -M and -OOCCH 2 M; and M is selected from F, Cl, Br and I.
  • the compound having the structure given below has demonstrated an unexpectedly high activity in terms of suppressing the expression of MHC Class I and Class II proteins. Further, this compound has shown a different effect on thyroid gene expression, i.e., thyroglobin, when compared to MMI. This suggests that it may be used to treat autoimmune diseases and even Graves' Disease, without requiring thyroid hormone supplementation.
  • methimazole derivatives and tautomeric cyclic thiones described above can be synthesized using techniques well known to those skilled in the art. For example, the synthesis of several tautomeric cyclic thiones is described in Kjellin and Sandstrom, Acta Chemica Scandanavica 23: 2879-2887 (1969), incorporated herein by reference.
  • a representative methimazole derivative may be synthesized using the following procedure.
  • Appropriately substituted analogs of acetaldehyde are brominated in the 2-position by treatment with bromine and UV light, followed by formation of the corresponding diethylacetal using absolute ethanol.
  • the bromine is then displaced from this compound by treatment with anhydrous methylamine, or other suitable amine, in a sealed tube at about 120° for up to about 16 hours.
  • compositions of the present invention comprise a safe and effective amount of one or more of the methimazole derivatives or tautomeric cyclic thione compounds (i.e., the active compounds).
  • Preferred compositions contain from about 0.01% to about 25% of the active compounds, with most preferred compositions containing from about 0.1% to about 10% of the active compounds.
  • the pharmaceutical compositions of the present invention may be administered in any way conventionally known, for example, intraperitoneally, intravenously, intramuscularly, or topically, although oral administration is preferred.
  • Preferred compositions are in unit dosage form, i.e., pharmaceutical compositions which are available in a pre-measured form suitable for single dosage administration without requiring that the individual dosage be measured out by the user, for example, pills, tablets or ampules.
  • compositions of the present invention additionally include a pharmaceutically-acceptable carrier compatible with the methimazole derivatives or tautomeric cyclic thiones described above.
  • a pharmaceutically-acceptable carrier compatible with the methimazole derivatives or tautomeric cyclic thiones described above.
  • the pharmaceutical compositions may contain, at their art accepted levels, additional compatible ingredients, such as additional pharmaceutical actives, excipients, formulational aids (e.g., tabletting aids), colorants, flavorants, preservatives, and other materials well known to those skilled in the art.
  • the term "pharmaceutical carrier” denotes a solid or liquid filler, diluent or encapsulating substance. These materials are well known to those skilled in the pharmaceutical arts.
  • Some examples of the substances which can serve as pharmaceutical carriers are sugars, such as lactose, glucose, and sucrose; starches, such as corn starch and potato starch; cellulose and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose, and cellulose acetate; powdered tragacanth; malt; gelatin; talc; stearic acid; magnesium stearate; calcium sulfate; vegetable oils, such as peanut oil, cottonseed oil, sesame oil, olive oil, corn oil and oil of theobroma; polyols, such as propylene glycol, glycerine, sorbitol, mannitol, and polyethylene glycol; agar; alginic acid; pyrogen-free water; isotonic saline;
  • the pharmaceutical carrier employed in conjunction with the pharmaceutical compositions of the present invention is used at a concentration sufficient to provide a practical size-to-dosage relationship.
  • the pharmaceutical carrier comprises from about 75% to about 99.99%, preferably from about 90% to about 99.9%, by weight of the total pharmaceutical composition.
  • the methimazole derivatives or tautomeric cyclic thiones defined in the present application may surprisingly be more soluble than methimazole in conventional carrier materials. This provides significant benefits in allowing greater flexibility in the formulation of pharmaceutical compositions containing those methimazole derivatives, and may allow the use of significantly lower doses of the active compound.
  • the present invention also provides a method for treating autoimmune diseases and for preventing or treating rejection of tissue in a transplant recipient. More specifically, this invention relates to methods for administering to a mammal in need of such treatment a drug or drugs, as defined herein, capable of suppressing expression of MHC Class I or Class II molecules.
  • autoimmune diseases examples include, but are not limited to, rheumatoid arthritis, psoriasis, juvenile or type I diabetes, primary idiopathic myxedema, systemic lupus erythematosus, DeQuervains thyroiditis, thyroiditis, autoimmune asthma, myasthenia gravis, scleroderma, chronic hepatitis, Addison's disease, hypogonadism, pernicious anemia, vitiligo, alopecia areata, Coeliac disease, autoimmune enteropathy syndrome, idiopathic thrombocytic purpura, acquired splenic atrophy, idiopathic diabetes insipidus, infertility due to antispermatazoan antibodies, sudden hearing loss, sensoneural hearing loss, Sjogren's syndrome, polymyositis, autoimmune demyelinating diseases such as multiple sclerosis, transverse myelitis, ataxic sclerosis, pe
  • methimazole derivatives of the present invention are administered in a dosage range of from about 0.001 to about 100 milligrams, preferably from about 0.05 to about 50 milligrams, per day.
  • the pharmaceutical compositions of the present invention are administered such that appropriate levels of pharmaceutical active are achieved in the bloodstream.
  • the precise dosage level required in a given case will depend upon, for example, the particular methimazole derivative used, the nature of the disease being treated, and the size, weight, age and physical condition of the patient.
  • an active compound of the present invention for example 5-phenylmethimazole
  • a mammal preferably a human
  • Suitable therapeutic amounts of the methimazole derivatives are in the range of from about 0.05 to about 20 milligrams per day.
  • a preferred dosage is from about 0.05 to about 10 milligrams per day.
  • the dosage can be administered daily, in approximately equally divided amounts at 8 hour intervals or with breakfast, lunch and dinner. Therapy can be continuous, for example, for periods up to one year or longer. Alternatively, therapy can be tapered, for example, starting at a higher dosage level and tapering to a lower daily dosage level within four to ten weeks.
  • Thyroid hormone thyroxin T 4 or triiodothyronine T 3
  • TSH thyroid stimulating hormone
  • the dosage administered to a mammal afflicted with an autoimmune disease may vary depending on the mammal's age, severity of the disease and response to the course of treatment.
  • One skilled in the art will know the clinical parameters to evaluate to determine proper dosage for an afflicted mammal.
  • an active compound described herein is administered to a mammal, preferably a human, afflicted with systemic lupus erythematosus (SLE).
  • SLE systemic lupus erythematosus
  • a preferred therapeutic amount is in the range of from about 0.05 to about 20 milligrams per day, administered over two to twelve months, but can be administered in discontinuous treatment periods of similar length over a five- year period or for as long as necessary.
  • the compositions of the present invention may be administered in conjunction with the current therapies for SLE, hydrocortisone and cytotoxic drugs, to suppress the disease.
  • SLE patients with breast cancer cannot be readily treated with radiation therapy since they are already immunosuppressed by the current conventional treatment for SLE.
  • SLE may be associated with unusual sensitivity to radiation complications and therefore radiation therapy exacerbates the disease. It is anticipated, therefore, that the use of the methimazole derivatives and tautomeric cyclic thiones of the present invention to treat SLE individuals with breast cancer will allow radiation therapy to be administered to such individuals without radiation complications or exacerbation of their condition.
  • methimazole derivatives, cyclic tautomeric thiones, and pharmaceutical compositions of the present invention are administered to a mammal, preferably a human, afflicted with type I or juvenile diabetes.
  • methimazole derivatives, tautomeric cyclic thiones, and pharmaceutical compositions of the present invention are administered to a mammal, preferably a human, afflicted with an autoimmune disease associated with the development of thyroid autoantibodies in the sera of these animals.
  • methimazole derivatives, tautomeric cyclic thiones, and pharmaceutical compositions of the present invention are administered to a mammal, preferably a human, afflicted with an autoimmune disease characterized by the development of receptor autoantibodies.
  • an autoimmune disease characterized by the development of receptor autoantibodies.
  • autoimmune asthma is associated with ⁇ -adrenergic receptor autoantibodies.
  • Treatment with the compositions of the present invention will alleviate the disease.
  • myasthenia gravis is associated with acetylcholine receptor autoantibodies. Individuals afflicted with myasthenia gravis have a higher frequency of thyroid autoimmunity. Because of the structural and functional relationship between the TSH and acetylcholine receptors, treatment of an animal, preferably a human, afflicted with myasthenia gravis with a drug able to suppress both MHC Class I and Class II, such as the methimazole derivatives or tautomeric cyclic thiones of the present invention, will help suppress the disease.
  • the method of this invention is also suitable for preventing or treating rejection of a transplanted tissue in a recipient mammal, preferably a human.
  • tissues which may be transplanted include, but are not limited to, heart, lung, kidney, bone marrow, skin, pancreatic islet cells, thyroid, liver and all endocrine tissues, neural tissue, muscle, fibroblast, and adipocytes.
  • pancreatic islet cells are isolated from a donor and treated with a methimazole derivative or tautomeric cyclic thione of the present invention prior to transplantation into a recipient suffering from diabetes. Diabetes is caused by loss of islet cells as a result of autoimmune disease. Transplantation of islet cells will correct such a deficiency. Islet cells may be treated with from about 0.05 to about 20 milligrams of active compound per day, for example, in the form of an aqueous solution for from about 24 to about 72 hours or longer as necessary to suppress expression of MHC Class I molecules on the islet cells. After transplantation, the recipient may be further treated with a methimazole derivative or tautomeric cyclic thione together with hydrocortisone and/or other immunosuppressive agents.
  • the present invention also relates to an in vitro assay for assessing the ability of a drug to suppress expression of MHC Class I and MHC Class II proteins by measuring the activity of a reporter gene operably linked downstream of a MHC Class I and MHC Class II promoter and its regulatory sequences.
  • the reporter gene operably linked to an MHC Class I and MHC Class II promoter and its regulator sequence is introduced into mammalian cells, said mammalian cells are treated with the candidate drug and the activity of the reporter gene in lysates from treated and untreated mammalian cells is measured.
  • a decrease of activity of the reporter gene in cell lysates from treated versus nontreated cells is predictive of the usefulness of the candidate drug in suppressing MHC Class I and MHC Class II expression and, in turn, suppressing an autoimmune disease or preventing transplant rejection.
  • Preferred regulatory sequences that may be operably linked to the reporter gene are sequences corresponding to the regulatory region of the class I gene, -1 Kb to + 1 bp; upstream silencer/enhancer region of the MHC Class I, PD1 gene, -769 to -673 bp ( Figure 1A); the downstream regulatory region of the PD1 gene, -203 or -127 to -lbp; the downstream silencer region of the PD1 gene, -127 to -80 bp ( Figure IB); and the regulatory region of the MHC Class II gene containing the S,Y,X, and X 2 boxes, -137 to -50 bp ( Figure IC). These sequences are shown in Figure 1, with their cognate promoters.
  • reporter genes include, but are not limited to, the chloramphenicol acetyltransferase (CAT) gene, the ⁇ -galactosidase gene, the luciferase gene and human growth hormone (hGH) (Sambrook, J. et al., Molecular Cloning: A Laboratory Manual, Vol. 2, 2 nd ed.; Cold Spring Harbor Press, NY (1989); Ausubel, F. et al. in "Current Protocols in Molecular Biology: Supplement 14, section 9.6 (1987); John Wiley and Sons, New York (1990)).
  • CAT chloramphenicol acetyltransferase
  • hGH human growth hormone
  • mammalian cells examples include, but are not limited to, mammalian cell thyrocytes, hepatocytes, neural tissue, muscle, fibroblasts, adipocytes and HELA cells.
  • the means by which the regulatory sequence operably linked to the reporter gene may be introduced into cells are the same as those described above.
  • the luciferase gene is operably linked to one of the above mentioned PD1 sequences and introduced into FRTL-5 cells.
  • the ability of a candidate drug to suppress expression of MHC Class I and MHC Class II molecules can also be assessed by comparing levels of cellular mRNA in mammalian cells treated with the candidate drug versus cells not treated with the candidate drug.
  • methods for determining cellular mRNA levels include, but are not limited to, Northern blotting (Alwine, J.C. et al. Proc. Natl. Acad. Sci.. 74:5350-5354 (1977)), dot and slot hybridization (Kafatos, F.C. et al. Nucleic Acids Res.. 7: 1541- 1522 (1979)), filter hybridization (Hollander, M.C. et al.
  • 5-phenylmethimazole The preferred compound 5-phenylmethimazole is synthesized as follows: Step 1 - Synthesis of 2-Bromophenylacetaldehyde diethylacetal The bromination of phenylacetaldehyde may be performed according to the method of P. Duhamel, L. Duhamel and J-Y Valnot, Bull. Soc. Chim. Fr. 1973, 1465.
  • This material may be synthesized using the method of Jones, et al., J. Am. Chem. Soc, 1949, 71:4000.
  • a 200 mL heavy walled glass reaction vessel is cooled in dry ice/acetone and charged with approximately 25 mL anhydrous methylamine. To this is added approximately 25 mL (32g) of 2-bromophenylacetaldehyde diethylacetal. The mixture is solidified in liquid nitrogen and the reaction vessel evacuated on a vacuum pump. The reaction vessel is closed and heated in an oil bath at 110°C overnight. The reaction vessel is cooled in dry ice/acetone followed by liquid nitrogen and the methylamine vented to an aqueous solution. Crude reaction product is taken up in methanol and extracted with IN aqueous KOH solution and dried over solid KOH. The solution is evaporated in vacuo and the crude material is purified by distillation. The product is distilled at 100°C under 255 ⁇ of pressure. Yield of material is 89.7 % .
  • This material may be synthesized using the method of R.G. Jones, J. Am. Chem. Soc, 1949, 71: 383-386.
  • the reaction mixture is stripped to near-dryness.
  • To the residue is added 150 mL of water.
  • the resulting suspension is suction filtered and 80 g of yellow solids is collected. This filter cake is slurried in 500 mL of IN NaOH solution. .
  • the insolubles are filtered off.
  • To the filtrate is added approximately 100 mL of 37% HCl.
  • the resulting suspension is suction filtered and the solids recrystallized from 50 mL of a 25 % aqueous ethanol solution.
  • Precipitation occurrs after placing the reaction mixture in the freezer for 1 hr.
  • the resulting mixture is suction filtered.
  • 13.2 g of solids are collected, m.p. 105°C.
  • This (along with 10.4 g of product from another prep.) is recrystallized from approximately 150 mL of absolute ethanol.
  • 12.5 g of white solids are collected, m.p. 126-127°C.
  • Purified bovine TSH was from the NIH program (NIDDK-bTSH-I-1, 30U/mg) or was prepared as described previously (Kohn, L.D. and Winand, R.J. Biol. Chem.. 250:6503-6508 (1975)). Insulin, hydrocortisone, human transferrin, somatostatin, and glycyl-L-histidyl-L-lysine acetate were from Sigma Chemical Co. St. Louis, MO.
  • TSH (lxlO 10 M), gamma-interferon (100 U/ml), MMI (5 mM), and different concentrations of MMI derivatives or tautomeric cyclic thiones (0.0001 to 10 mM) were added as appropriate for 24-48 hours.
  • Cells were then harvested and extracts were made by a modification of a method of Dignam, J., et al. Methods in Enzymology. 101:582-598 (1983). In brief, cells were harvested by scraping after being washed twice with cold phosphate-buffer saline (PBS). Subsequently they were pelleted, washed in cold PBS and then pelleted again.
  • PBS cold phosphate-buffer saline
  • the pellet was resuspended in Dignam buffer C (20 mM Hepes buffer at pH 7.9, 1.5 mM MgCl 2 , 0.42 M NaCl, 25% glycerol, 0.5 mM dithiotreitol (DTT), 0.5 mM phenylmethylsulfonylfluoride (PMSF), 1 ⁇ g/L leupeptin, 1 ⁇ g/L pepstatin).
  • the final NaCl concentration was adjusted on the basis of cell pellet volume to 0.42 M and cells were lysed by repeated cycles of freezing and thawing. Extracts were then centrifuged at 10,000 xg at 4°C for 20 min. The supernatant was recovered, aliquoted and stored at -70°C.
  • Probes were labeled with [ ⁇ 32P] deoxy CTP by Klenow enzyme (In Vitro labeling kit, Amersham) following the manufacturer's instructions, or by [r 32 ?] ATP using T4 polynucleotide kinase. Labeled probes were then purified either through G-50 columns (5 prime ⁇ Prime) or on an 8% polyacrylamide gel.
  • electrophoretic mobility shift assays were performed in the same way. Oligonucleotides used for EMSA were synthesized (Operon Technologies, Inc.) or were purified from 2 % agarose gels using either QIAEX (Qiagen, Chatsworth, CA) or Jet Sorb (Genomed) following restriction enzyme treatment of chimeric HLA-DR ⁇ -CAT constructs (Montani et al., 1998a, b).
  • the oligonucleotides were dephosphorylated with calf intestinal alkaline phosphatase, labeled with
  • Binding reactions for class II EMSA used similar conditions as well. They were carried out in a volume of 20 ⁇ l for 30 min at room temperature. The reaction mixtures contained 1.5 fimol of [ 32 P]DNA, 3 ⁇ g cell extract and 1.5 to 3 ⁇ g poly(dI- dC) in 10 mM Tris-Cl at pH 7.9, 1 mM MgCl 2 , 1 mM DTT, 1 mM EDTA, and 5% glycerol. Where indicated, unlabeled double- or single-stranded oligonucleotides were added to the binding reaction as competitors and incubated with the extract for 20 min at room temperature prior to the addition of labeled DNA.
  • extracts were also incubated in the same buffer containing antiserum or normal rabbit serum for 20 min at room temperature before being processed as above. Following incubations, reaction mixtures were subjected to electrophoresis on 3.5 or 5 % native polyacrylamide gels at 160 V in 0.5xTBE, at room temperature, for 1.5 to 2 h. Gels were dried and autoradiographed at -80°C overnight unless otherwise noted.
  • Regulatory elements responsive to MMI have been identified in the promoter of the swine MHC class I gene, PDI.
  • Two regulatory domains have been identified in the 5' flanking region of the PDI gene.
  • a downstream regulatory domain is between approximately -203 and -1 bp from the transcriptional start site ( Figure IB).
  • This region contains an interferon response element and a major enhancer (Enhancer A), as well as a site homologous to a cyclic AMP response element (CRE) element.
  • CRE cyclic AMP response element
  • Studies using gel mobility shift assays have demonstrated that MMI-induced or modified proteins interact with this region and can regulate transcription initiation (Saji, et al. ibid., 20096-20107 (1997); Singer et al., U.S. Patent 5,556,754, issued Sep. 17, 1996) particularly Y box proteins.
  • Another complex regulatory region, showing overlapping silencer and enhancer activity has been mapped between -769 and -673 base pairs upstream of
  • MMI increases the appearance of a normal complex with the downstream regulatory domain and decreases the appearance of the silencer complex of the upstream regulatory domain. These changes result in decreased constitutive control (upstream regulatory domain) and dominant hormonal control (downstream regulatory domain).
  • the MMI action is additive to TSH which acts on the downstream regulatory domain (Saji, et al., ibid, 20096-20107 (1997) and Singer, et al., U.S. Patent 5,556,754 (1996)).
  • the FRTL-5 thyroid cell system is therefore a good system to identify the regulatory DNA sequence elements and trans-acting factors involved in the MMI effect.
  • PDI Gel shift mobility assays were performed using the 5' flanking region of the PDI gene and cell extracts from FRTL-5 cells treated or not with y-interferon and treated with MMI and MMI derivatives and tautomeric cyclic thiones (see Table 1).
  • Figure 1 A shows the silencer and enhancer regions of the 140 region oliogonucleotide used to map the region for the MMI derivative or tautomeric cyclic thione activity of the gel shifts.
  • the silencer and enhancer regions of relevance are noted by the arrows.
  • the 140 fragment is derived from the PDI promoter of the PDI Class I MHC gene (Singer, D.S., et al. Proc Natl. Acad. Sci. USA. 79:1403- 1407 (1982)).
  • Figure 2 shows a gel shift using the radio labeled 140 fragment noted in Figure 1 and shows the silencer complex regulated by MMI.
  • Lane 2 shows the complex formed between the silencer region and cell extracts from FRTL-5 rat thyroid cells maintained in the presence of 5H medium (no TSH) plus 5% serum.
  • 5H medium no TSH
  • the effect of the addition of 5 mM MMI to cells for 48 hours prior to extract preparation from cells maintained in 5H medium is shown in lane 1 of Figure 2.
  • the effect of the addition of 1 mM concentration of representative MMI derivatives to cells maintained in 5H medium for 48 hours prior to extract preparation is shown in lanes 3 to 8 in Figure 2.
  • the structures and names of the representative numbered compounds are in Table 1.
  • the MMI or its derivatives decrease the silencer complex. The decrease can be quantitated by densitometry of autoradiograms or phosphoimaging on a Bas 1500 imager (for example). Quantitation is based on the decrease relative to the control and normalized by the unchanged faster migrating complexes.
  • Table 2 summarizes results from experiments with the compounds described in Table 1 but modified to include different concentrations of active compounds in the EMSA. Compound 10 is the most effective.
  • Figure 3 denotes the sequence of the downstream region of the PDI promoter.
  • the location of enhancer A (-180 to -170 bp), the interferon response element (IRE; -161 to -150 bp), and the cAMP response element (CRE; -107 to - 100 bp) are noted.
  • the downstream silencer is between -127 and -80 bp (Saji, et al., ibid, 20096-20107 (1997)).
  • MMI lane 4
  • TSH lane 10
  • MMI derivatives can also increase this complex, as illustrated for compound 8 in Figure 4 (lanes 1 to 3).
  • the time most suitable for measurement is 24 to 48 h (Fig. 4) and the complex can be quantitated by comparison to control (lane 7 or 9) using densitometry or the phosphoimager as noted earlier.
  • the increase over control (set at 1) is measured in arbitrary units relative to the maximal increase induced by 5 mM MMI which is arbitrarily set at 10.
  • Table 3 The results using all 11 compounds in Table 1, each added to cells at different concentrations 48 hours before extracts were prepared, are summarized in Table 3. Compound 10 clearly is again most effective when several experimental sets using extracts from different batches of cells were evaluated.
  • MHC Major histocompatibility complex
  • Class II antigens are usually expressed on antigen presenting cells such as B cells, macrophages or dendritic cells; the class II molecules present antigenic peptides to CD4 positive T lymphocytes, causing T cell activation (German RM, et al., ibid, (1986); Schwartz RS, et al., ibid, (1989); Benoist C, et al., ibid, (1990); Glimcher LH, et al., ibid, (1992); Ting JP-Y, et al., ibid, (1993)).
  • Class II expression is normally not evident on epithelial cells, such as thyrocytes, synovial cells, or islet cells; abnormal or aberrant expression of class II molecules on thyrocytes, synovial cells, or islet cells is associated with autoimmune thyroid diseases, rheumatoid arthritis, and diabetes, respectively (Bottazzo GF, et al., Lancet 2:1115-1119 (1983); Bottazzo GF, et al., N. Engl. J. Med. 313:353-360 (1985); Todd I, et al., Ann. NY Acad. Sci.
  • autoimmune thyroid disease is Graves' disease, wherein autoantibodies develop to the TSHR and induce hyperthyroidism by mimicking the action of TSH.
  • Graves' disease Numerous attempts to develop a Graves' disease model by immunizing animals with the extracellular domain of the TSHR have largely failed (see, for example, Seetharamaiah, G.S. et al., Autoimmunity 14: 315-320 (1993); Costagliola et al., J. Mol. Endocrinol. 13: 11-21 (1994); Costagliola et al., Biochem. Biophys. Res. Commun.
  • mice immunizing mice with fibroblasts transfected with the human TSHR and a MHC class II molecule, but not either alone, has induced ATD with the major humoral and histological features of Graves' (Shimojo N, et al., ibid, 11074-11079 (1996)): stimulating TSHR antibodies (TSHRAbs), thyrotropin binding inhibiting immunoglobulins (TBII) which are different from stimulating TSHRAbs, increased thyroid hormone levels, thyroid enlargement, and thyrocyte hypercellularity.
  • TSHRAbs stimulating TSHR antibodies
  • TBII thyrotropin binding inhibiting immunoglobulins
  • -IFN antigen presenting cells of the immune system which normally express MHC class II, the highly conserved S, X,, X 2 , and Y boxes on its 5 '-flanking region, -137 to -65 bp (Benoist C, et al., ibid (1990); Glimcher LH, et al., ibid (1992); Ting JP-Y, et al., ibid (1993); Reith W, et al., Immunobiology 193:248-253 (1995); Montani V., et al, ibid (1998a, b)).
  • CUT A class II transactivator
  • Y box binding protein Ting JP-Y, et al., ibid (1993); Reith W, et al., ibid (1995)
  • CIITA is a non DNA-binding protein transactivator that functions as a molecular switch to control constitutive and inducible MHC class II gene expression in immune cells; CIITA expression is induced by * -IFN and is believed to be involved in its activity (Steimle V, et al. , Science 265:106-109 (1994); Reith W, et al., ibid (1995); Chang CH, et al., J. Exp. Med.
  • the human Y box protein, YB-1 was cloned based on its ability to bind to the Y box, an inverted CCAAT box, of the MHC class II gene (Didier DK, et al., Proc. Natl. Acad. Sci. USA 85:7322-7326 (1988)) and has been shown to suppress HLA-DR gene expression in human glioblastoma cells (Ting J P-Y, et al., J. Exp. Med. 179:1605-1611 (1994); MacDonald GH, et al., J.
  • CIITA can induce the formation of the complex induced by y-IFN and associated with aberrant class II gene expression in FRTL-5 cells (Montani V. , et al., ibid (1998b)); overexpression of the Y box protein in FRTL-5 cells suppresses the formation of this complex (Montani V., et al., ibid (1978b)). It is reasonable to presume, therefore, that this complex is involved in aberrant class II expression associated with ATD and is related to aberrant class II expression in other autoimmune diseases.
  • Methimazole is an agent effective in treating Graves' disease and preventing experimental thyroiditis in rats or mice (Cooper DS, N. Engl. J. Med. 311:1353-1362 (1984); Davies TF, et al., J. Clin. Invest. 73:397-404 (1984); Reinhardt W, et al., Endocrinol. Invest. 12:559-563 (1989)).
  • the action of methimazole on MHC class II gene expression in thyrocytes has, however, been controversial.
  • iodide is an agent which like MMI can be used to treat Graves' patients and has been used extensively to prepare Graves' patients for thyroidectomies (Nagataki S, et al., Autoregulation: effects of iodide. In: Braverman LE, Utiger RD (Eds) Werner and Ingbar's The Thyroid: a fundamental and clinical text. Lippencott-Raven, Philadelphia, 241-247 (1996)).
  • Figure 5 depicts the nucleotide sequence of the 5 '-flanking region of the HLA-DR gene from -176 bp.
  • Figure 6 depicts the electrophoretic mobility shift analysis of the ability of a 32 P-radiolabeled DR ⁇ -5' -flanking region probe to form protein/DNA complexes with extracts from FRTL-5 cells maintained with and without TSH and treated or not with y-IFN.
  • the probe was excised by restriction enzyme treatment of a -137 to +45 bp DR -CAT chimera (Reimold AM, et al., ibid (1993); Montani V., et al., ibid (1998a, b)) and is diagrammatically represented at the bottom of the Figure. Extracts were from FRTL-5 rat thyroid cells grown to near confluency in TSH or maintained 6 days in 5H medium; duplicate cultures of each were treated with 100
  • Figure 7 depicts the effect of MMI on the ability of y-IFN to increase the formation of protein/DNA complexes with the 32 P-radiolabeled DR ⁇ 5' -flanking region probe.
  • the radiolabeled probe is the same as that used and diagrammatically presented in Figure 6; it contains -137 bp to +45 bp of the 5'-flanking region of DRoc -CAT chimera. Extracts were from FRTL-5 rat thyroid cells grown to near confluency in TSH, maintained 6 days in 5H medium, then treated with 100 U/ml y - IFN, 5 mM MMI, or both for the last 48 h before the experiment was terminated.
  • a nested series of 5' deletions of the upstream regulator region of the PDI gene were generated by Bal3 digestion; the series 5' termini ranged from -1012 base pairs to -68 base pairs, but all had a common 3' boundary at + 15 base pairs.
  • the deletion series was also cloned into the pSV3CAT reporter construct to assess promoter activities (Weisman JD, et al. ibid (1991); Maguire, J. et al., Mol. Cell. Biol.. 12:3078-3086 (1992)).
  • MMI MMI derivatives or tautomeric cyclic thiones on Class I promoter activity
  • three clones are commonly used: p(-1100) CAT, p(-203) CAT, and ⁇ (-127) CAT, preferably p(-203) CAT.
  • the number denotes the most 5' -residue in the 5' - flanking region of the PDI promoter.
  • HLA-DR promoter constructs have also been described as have been their characteristics (Reimold AM, et al., ibid (1993)). Additional CAT constructs were constructed by PCR, using the HLA-DR ⁇ -CAT chimera containing -176 to +45 of 5 '-flanking region as template and various primers (Montani V. et al., ibid (1998a,b)).
  • a plasmid containing -38 to +45 bp of the 5'- flanking region of HLA-DR ⁇ was constructed with the following primers: a 5' primer with a 5' Sph I restriction site, 5'-ACATGCATGCGGTCAGACTCTATTACACCCCAC-3' and a 3' primer, 5'- CTAGTCTAGTTTGGGAGTCAGTAGAGCTCG-3', with an Xba I restriction site (Montani V., et al., ibid (1998a,b)).
  • PCR products were purified by phenol- chloroform extraction, digested with Xba I and Sph I, purified from a 2% agarose gel with Jet Sorb (Genomed, Frederick, MD), dephosphorylated with calf intestinal alkaline phosphatase (New England Biolabs, Beverly, MA), and religated (DNA ligation kit, Takara Biochemical, Inc., Berkeley, CA) into the pCAT-Basic Vector (Promega, Madison, WI) at the Sph I and Xba I sites as described (Reimold AM, et al., ibid (1993); Montani V., et al., ibid (1998a,b)).
  • TG-688-CAT The thyroglobulin (TG)-CAT construct, pTG-688-CAT, was derived by substituting the TG promoter insert from a previously described pTG-CAT chimera (Shimura H, et al., Mol. Endocrinol. 8:1049-1069 (1994)) into the HLA-DR ⁇ -CAT chimera from which the class II promoter insert was excised.
  • the vector containing the CAT reporter gene but no insert was the control.
  • Cell Culture FRTL-5 rat thyroid cells were the same subclone (FI) used in the gel shift experiments described earlier. They were grown in the following medium: Coon's modified F- 12 medium containing 5% heat-treated, mycoplasma-free calf serum, 1 mM nonessential amino acids, and a mixture of six hormones (6H) containing bovine TSH (1 x 10 "10 M), insulin (10 ⁇ g/ml), cortisol (0.4 ng/ml), transferrin (5 ⁇ g/ml), glycyl-L-histidyl-L-lysine acetate (10 ng/ml), and somatostatin (10 ng/ml).
  • 6H six hormones containing bovine TSH (1 x 10 "10 M), insulin (10 ⁇ g/ml), cortisol (0.4 ng/ml), transferrin (5 ⁇ g/ml), glycyl-L-histidyl-L-lysine acetate (10
  • Cells were diploid and between their 5* and 25 th passage. Fresh medium was added every 2 or 3 days and cells were passaged every 7-10 days. In some experiments, cells were grown to near confluency in 6H medium then maintained for 5-8 days, before experiments were initiated, in 5H medium with no TSH.
  • FRTL-5 cells were grown to 80% confluence, put in fresh 6H medium containing 5% calf serum for 12 hours, harvested, washed and suspended at 1.5xl0 7 cells/ml in 0.8 ml electroporation buffer (272 mM sucrose, 7 mM sodium phosphate at pH 7.4, and 1 mM MgCl 2 ). Twenty ⁇ g of the full-length CAT construct were added with 5 ⁇ g pSVGH. Cells were then pulsed (330 volts, capacitance 25 ⁇ farad), plated (approximately 6xl0 6 cell/dish), and cultured for 12 hours in 6H medium containing 5% calf serum.
  • CAT activity was normalized to GH activity and/or cell protein before data were compared.
  • transient transfections used the same class I-CAT chimeras and a DEAE-dextran procedure (Lopata MA, et al., Nucleic Acids Res. 12:5707-5717 (1984); Giuliani C, et al., ibid (1995)).
  • FRTL-5 cells were cultivated in 6H medium to approximately 80% confluency, harvested, washed, and resuspended (1.5xl0 7 cells/ml) in 0.85 ml electroporation buffer (272 mM sucrose, 7 mM sodium phosphate buffer pH 7.4, and 1 mM MgCl 2 ).
  • Plasmid DNA was added, 20 ⁇ g of the CAT chimera together with 2 ⁇ g pRSV-luciferase which is used to measure the efficiency of transfection.
  • Cells were pulsed (330 V; capacitance 25 ⁇ farad), plated (6x 10 6 cells/10 cm dish), and cultured in 6H medium plus 5% calf serum supplemented or not with y-IFN. At the times noted, cells were harvested for CAT and luciferase assays.
  • the second procedure differed as follows. FRTL-5 cells were grown to 80% confluency in 6H medium, then maintained 6 days in 5H medium plus 5% calf serum.
  • MMI derivatives or tautomeric cyclic thiones were tested for the effect of MMI, MMI derivatives or tautomeric cyclic thiones on y-IFN-increased class II expression in FRTL-5 thyroid cells.
  • Transient transfections with the -137 bp or -176 bp DR ⁇ -CAT chimeras were performed as described and treated with 100 U/ml y-IFN for the noted times starting 12 hours after transfection.
  • 5 mM MMI or the noted concentrations of MMI derivatives or tautomeric cyclic thiones were added simultaneously with the y-IFN and CAT activity was measured 48 hours later. Cell viability was approximately 85 ⁇ 5% in all samples.
  • Results were expressed relative to the vector control in the absence of y-IFN or MMI, after CAT activities were corrected both for luciferase activity and cell protein. These corrections in all cases resulted in less than 5% changes in activity. The same results were obtained using the alternative transfection protocol involving cells maintained in medium with no TSH.
  • FRTL-5 cells maintained in 5H medium plus 5% calf serum were transfected with a CAT chimera containing 1100 bp of 5 '-flanking region of the swine class I promoter by electroporation as described. After 12 h the medium was changed to fresh 5H medium in the presence or absence of lxl0 "10 M TSH, 5 mM MMI, or both. Cells were assayed 36 hours later. The value from the transfectant with no TSH or MMI in the medium was the control and was set at 100% .
  • a second experiment (Fig. 10, Panel A), we tested the effect of MMI and TSH on the promoter activity of CAT chimeras of 5 '-deletion mutants of the swine class I promoter in FRTL-5 cells.
  • FRTL-5 cells grown in 6H medium (+TSH) were transfected by electroporation with the different constructs of the PDI 5'- flanking region. After 12 hours, the medium was changed to fresh 6H medium (+TSH), fresh 6H medium plus 5 mM MMI (+TSH/+MMI), or fresh 5H medium with no TSH or MMI; CAT activity was measured 36 hours later.
  • Regulatory elements noted include the following: (a) the upstream silencer/enhancer region important in regulating constitutive class I levels in different tissues; (b) serum response element; (c) Enhancer A; (d) the interferon response element; (e) the 38 bp constitutive silencer containing the CRE-like sequence within the constitutive silencer element (Giuliani C, et al., ibid (1995); Saji M favor et al., ibid (1997)). Also noted are (f) the CCAAT and (g) TATA box important in initiation of transcription.
  • MMI y-interferon
  • FRTL-5 cells were grown to near confluency in 6H medium (plus TSH) and then were maintained in 5H medium (no TSH) for 7 days before being treated with y-IFN or y-IFN plus MMI for 40 hours.
  • Control cells were those maintained in 5H medium for the same 40 hours.
  • CAT activity was measured as described above.
  • the y-IFN treatment increased CAT activity significantly (P ⁇ 0.05 or 0.01) in cells transfected with all the CAT plasmids except the pSVO control.
  • the MMI significantly decreased the ability of y- IFN treatment to increase CAT activity (P ⁇ 0.01) in cells transfected with all the CAT plasmids except the pSVO control.
  • Table 6 presents results of the effect of MMI, multiple MMI derivatives or tautomeric cyclic thiones on basal class I activity;
  • Table 7 presents results of the effect of MMI, multiple MMI derivatives or tautomeric cyclic thiones on IFN- increased class I promoter activity.
  • the action of compound 10 is clearly best in both cases, followed by compounds 11, 7, and 8.
  • HLA-DR ⁇ -176 bp or -137 bp nrinimal promoter class II chimeras coupled to CAT were used to evaluate the expression of the HLA-class ⁇ gene in FRTL-5 thyrocytes.
  • HLA-DR ⁇ is not expressed in transiently transfected FRTL-5 thyrocytes, by comparison to the vector control, unless the cells are treated with rat recombinant y-IFN (Fig. 11, first and second set of open and closed bars in each Panel).
  • the action of rat y-IFN is not duplicated by human y-IFN and is associated with an increase in endogenous class II expression measured by flow cytometry using fluorescent all partner analysis (Fig. 12).
  • the y-IFN action is specific and appears to reflect effects on the endogenous class ⁇ antigen.
  • Evaluation of progressive 5' deletions of the -176 bp DR ⁇ -CAT chimera to -137, -122, -111, -97, and -38 bp showed that, like immune cells, y-IFN- induction is lost once the S box, -137 to -123 bp is removed (Fig. 11 Panel A).
  • y-IFN- induction requires not only the S box, but also the X,, X 2 , and Y boxes for activity.
  • mutation of each element individually also resulted in the loss (Fig. 11 Panel B, MUT S, MUT X tract and MUT Y) or a significant decrease (Fig. 11B, MUT X 2 ) in the y-IFN response.
  • transient transfections were performed in FRTL-5 cells grown to near confluency in medium with TSH (6H medium) and treated with 100 U/ml y-IFN for 24 h after transfection.
  • Results are expressed relative to the vector control in the absence of Y-IFN (first open bar in each panel), after CAT activities were corrected both for luciferase activity and cell protein. These corrections in all cases resulted in less than 5% changes in activity.
  • Results are the mean ⁇ SD of 3 separate experiments performed on 3 different batches of cells.
  • a single asterisk (*) denotes a statistically significant increase (P ⁇ 0.01) in DR ⁇ promoter activity induced by y -IFN; two asterisks (**) denote a statistically significant decrease (P ⁇ 0.01) in y-IFN-induced DR ⁇ promoter activity when the -176 bp DR ⁇ minimal promoter contained mutations in the S, X,, X 2 , and Y boxes.
  • P ⁇ 0.01 a statistically significant increase
  • y-IFN-induced DR ⁇ promoter activity when the -176 bp DR ⁇ minimal promoter contained mutations in the S, X,, X 2 , and Y boxes.
  • Figure 11 (top left) is a diagrammatic presentation of the -176 bp DR ⁇ - CAT chimera with the locations of the S, X,, X 2 , and Y boxes noted by black boxes and the locations of the 5 '-termini of the deletions noted; on the top right of the Figure, the mutations made in S, X,, X 2 , and Y boxes are presented.
  • y-IFN can increase HLA-DR ⁇ promoter expression in FRTL-5 cells and the action of interferon requires the same highly conserved 5 '-flanking region elements, S, X,, X 2 , and Y, present in all class II genes for this effect
  • Bottazzo GF et al., ibid (1983); Todd I, et al., ibid (1985); Bottazzo GF, et al., ibid (1985); Todd I, et al., ibid (1986); Burmester GR, et al., ibid (1987); Schwartz RS, et al., ibid (1989); Benoist C, et al., ibid (1990); Glimcher LH, et al., ibid (1992); Ting JP-Y, et al., ibid (1993)).
  • y-IFN The ability of y-IFN to increase class II gene expression is dependent on its concentration, whether the -176 bp (data not shown) or -137 bp (Fig. 13) DR ⁇ -CAT chimera is used in transient transfection assays.
  • the maximal effect was in each case evident at 100 U/ml y-IFN (Fig. 13, Panel A).
  • MMI prevents the ability of a maximally effective concentration of y-IFN to increase the activity of the -137 bp DR ⁇ -CAT chimera as a function of time.
  • CAT activity induced by 100 U/ml y-IFN was progressively decreased 24 and 48 h after MMI addition (Fig. 13, Panel B).
  • CAT activity was measured 48 h after the addition of y-IFN and results are expressed relative to the vector control in the absence of y-IFN after CAT activities were corrected both for luciferase activity and cell protein. These corrections in all cases resulted in less than 5% changes in activity. Results are the mean ⁇ SD of 3 separate experiments performed on 3 different batches of cells.
  • Panel A a single asterisk (*) denotes a statistically significant increase (P ⁇ 0.01) in DR promoter activity induced by y-IFN.
  • Panel B two asterisks (**) denote a statistically significant decrease in y-IFN-induced DR ⁇ promoter activity with 24 or 48 hours of methimazole exposure.
  • FRTL-5 cells were grown to near confluency in TSH, maintained 8 days in 5H medium, then treated with 100 U/ml Y-IFN, 5 mM MMI, or both for the last 48 hours, as described in Figures 13 and 14.
  • Cells were stained with a fluorescein isothiocyanate conjugated class Il-specific monoclonal antibody to RT1.B (clone OX-6, Sera Labs, UK) for 60 min at 4°C, washed twice with Dulbecco's phosphate buffered saline, and subjected to laser flow cytometry.
  • Table 9 summarizes results of experiments evaluating the effect of MMI, MMI derivatives or tautomeric cyclic thiones on Y-IFN induced class II activity in FRTL-5 thyrocytes.
  • the effectiveness of inhibition is similar to that of class I derivatives: compound 10 > compound 11 > compounds 7 and 8 > compound 2 > MMI.
  • Measuring CAT activity of the chimeric CAT constructs of the Class I or Class II promoter is, therefore, another way to assay the effect of MMI, MMI derivatives or tautomeric cyclic thiones on Class I or Class II activity. These assays can be used for evaluating agents able to mimic MMI in therapeutic actions related to treatment of autoimmune disease or transplantation therapy.
  • TABLE 9 EFFECT OF DIFFERENT CONCENTRATIONS OF ACTIVE COMPOUNDS ON THE EXOGENOUS PROMOTER ACTIVITY OF FRTL-5 CELLS TRANSFECTED WITH THE CLASS II CAT CHIMERA, P(-137) CAT AND TREATED WITH 100 U/ML y-INTERFERON.
  • the swine PDI 5'-flanking sequence-CAT chimeras (-1100, -203, and -127), as well as two mutants with the CRE site with -107 to -100 bp deleted (-203 ⁇ CRE and -127 ⁇ CRE) were used to create luciferase reporter gene constructs.
  • the inserts were released by restriction enzyme digestion, purified from agarose gel using QIAEX (QIAGEN, Chatsworth, CA) and ligated in the Nhel-Hindm site of the PGL-2 basic vector (PROMEGA, Madison, WI) using a DNA ligation kit from TAKARA biomedicals (TAKARA SHUZO Co).
  • JM109 bacterial competent cells (PROMEGA, Madison, WI) were transformed with the ligation reaction and plated in agar plates for 12 h at 37°C. The colonies were picked and screened with minipreps using QIAprep spin plasmid kit (QIAGEN, Chatsworth, CA) and restriction enzyme digestion. The plasmids were then purified by CsCl gradient centrifugation.
  • HLA DR ⁇ promoter constructs p(-176)CAT and p(-137)CAT, inserted into the pCAT-Basic vector were released by restriction enzyme digestion, purified from agarose gel using QIAEX (QIAGEN, Chatsworth, CA), and used as templates for the construction by PCR of inserts with a 5' flanking Mlul restriction site.
  • the PCR products were purified by phenol-chloroform extraction, digested with Mlul and Xbal, purified from agarose gels using QIAEX (QIAGEN, Chatsworth, CA) and ligated in the Mlul-Nhel site of the PGL-2 basic vector (PROMEGA, Madison, WI) using the DNA ligation kit from TAKARA biomedicals (TAKARA SHUZO Co.). JM109 bacterial competent cells (PROMEGA, Madison, WI) were transformed with the ligation reaction and plated in agar plates for 12 h at 37°C. The colonies were picked and screened with minipreps using QIAprep spin plasmid kit (QIAGEN, Chatsworth, CA) and restriction enzyme digestion. The plasmids were then purified by CsCl gradient centrifugation.
  • the PD1-PGL-2 basic constructs and the Class II-PGL-2 basic constructs were stably transfected in the FRTL-5 cells using a Lipofectamine (GIBCO, Life Technologies, Inc.) method. Near confluent cells in 6H medium were cotransfected with 20 ⁇ g of plasmid DNA and 2 ⁇ g of a pcDNA3neo or a pPUR selection vector (CLONTECH, Palo Alto, CA). After 24-48 hours, 400 ⁇ g/ml of G418 (GIBCO, Life Technologies, Inc.) or 10 ⁇ M of puromycin (SIGMA) were added to the medium.
  • G418 GIBCO, Life Technologies, Inc.
  • SIGMA puromycin
  • Luciferase activity was measured using the Luciferase assay system (PROMEGA, Madison, WI). Briefly, treated or untreated cells from a 100 mm culture dish were washed with PBS, scraped and collected in microfuge tubes. The pellet was dissolved in 100 ⁇ l lx reporter lysis buffer and incubated at room temperature for 15 minutes. Cells were frozen in dry ice plus ethanol and thawed in water at room temperature. After vortexing for 10 sec, tubes were centrifuged at 12,000xg for 5 min. Twenty ⁇ l of the supernatant were mixed with 100 ⁇ l of Luciferase assay reagent and immediately placed in a luminometer. Light was measured for a period of 10 sec after a 2 sec delay.
  • interferon-induced class I activity requires the presence of the CRE; this is consistent with recent results indicating that interferon-induced CIITA is the mediator of the increase in class I as well as class II activity and requires the CRE for its activity (Saji et al. , ibid (1997); Montani V. , et al. , ibid (1998a, 1998b); Balducci-Silano et al., Endocrinology 139: 2300-2313 (1998)).
  • FRTL-5 cells stably transfected with MHC class I or class II promoter constructs preferably p(-203)MHC-class I-LUC or p(-137)MHC class II- LUC, respectively, are grown in complete 6H medium plus 5% calf serum and 400 ⁇ g/ml G418 (GIBCO, Life Technologies, Inc.) or 10 ⁇ M of puromycin (SIGMA), as appropriate, and in either 6, 12, 24 or 96 well plates, according to the numbers of assays required.
  • the cells are treated with 100 U/ml Y- interferon with or without MMI derivatives, tautomeric cyclic thiones, or other compounds at 5 mM or lower concentrations together with fresh medium.
  • a range of concentrations is tested from 5 mM to 5 riM, in duplicate.
  • the pellet is dissolved in 20, 50 or 100 ⁇ l lx reporter lysis buffer respectively, by repetitive micropipetting or vortexing, and incubated at room temperature for 15 minutes.
  • the luciferase raw data may be normalized by measuring protein concentrations in the supernatant solution.
  • the cells may be shifted to 5H medium (no TSH) for 2 to 7 days after reaching 60% confluency, then returned to 6H medium 12 hours before treatment is started.
  • the ability of the MMI derivatives and tautomeric cyclic thiones to decrease the exogenous MHC class I and MHC class II promoter activity in transiently or stably transfected FRTL-5 cells is paralleled by the ability of the derivatives to similarly decrease MHC class I and class II RNA levels in the same cells.
  • the promoter activity measurements reflect phenomena within the cell, despite the use of materials from other species such as human or swine promoters or probes and the different assay technologies measuring changes in exogenous vs endogenous gene expression.
  • the data are also consistent with gel shift changes and MHC surface expression (Fig. 12) measuring the protein products regulating gene expression.
  • the FRTL-5 rat thyroid cells were the same fresh subclone (F,) used previously in the gel shift and transfection studies and had all properties detailed therein. With TSH, their doubling time was 36 ⁇ 6 hours; in its absence, they did not proliferate. After 6 days in 5H medium with no TSH, lxlO '10 M TSH elevated cAMP levels, iodide uptake, and thymidine incorporation into DNA > 10 fold.
  • RNA Isolation and Northern Analysis Total cellular RNA was isolated, Northern analyses performed, and filters sequentially hybridized with the following cDNA probes (0.5-1.0 x 10 6 cpm/mL) as described (Isozaki O, et al., Mol Endocrinol 3:1681-1692 (1989); Saji, M., et al., Proc. Natl. Acad. Sci. U.S.A., 89: 1944-1948 (1992); Saji, M., et al., J. Clin. Endocrinol. Metab., 75: 871-878 (1992)).
  • the MHC class II DNA probe was a PCR amplified 546 bp product, from between 74 and 619 bp of the class II sequence, which was derived from interferon-treated rat FRTL-5 cell RNA using a sense primer having the nucleotide sequence, 5'-AGCAAGCCAGTCACAGAAGG-3', and an antisense primer with the sequence, 5'-GATTCGACTTGGAAGATGCC-3', two regions which are highly conserved in the class II nucleotide and protein sequence. After amplification using Pfu DNA polymerase, the product was purified on Agarose gels and then random prime radiolabeled using [ 32 P]dCTP and Klenow enzyme.
  • the MMI derivatives and tautomeric cyclic thiones tested decreased both basal class I and interferon-induced class I and class II RNA levels.
  • the effect of the MMI derivatives and tautomeric cyclic thiones on basal class I RNA levels in cells maintained without TSH is presented in Table 14.
  • the effect on Y-interferon- induced class I RNA levels in cells maintained with TSH is presented in Table 15 and on Y-interferon-induced class II RNA levels in cells maintained with TSH in Table 16.
  • RNA levels are quantitated by laser densitometry of autoradiograms or by BAS phosphoimaging relative to ⁇ -actin.
  • the class I or class II ratio to ⁇ -actin levels in control cells determines the 100% level; the % inhibition reflects an effect of the MMI derivative or tautomeric cyclic thiones to decrease this ratio.
  • the effect of the derivatives was similar in potency in all RNA assays: compound 10 > 11 > 7 or 8 > 2> MMI. More importantly, this order matched the effects of the derivatives, with respect to potency, both on class I and class II gene expression measured in transfection studies testing effects on promoter activity.
  • MMI increases TG RNA levels nearly 2-fold (Table 17) rather than decreasing RNA levels as is the case for class I and class II (Tables 14-16). Unexpectedly, this is not the case for most MMI derivatives and tautomeric cyclic thiones where no comparable increase is evident, particularly in the case of the most effective compounds (10, 11, 7 and 8) in decreasing class I and class II RNA levels.
  • MMI protein/DNA complexes and promoter activity
  • MMI derivatives and tautomeric cyclic thiones also decreased y-IFN-induced MHC class I and class II antigen expression as measured by flow cytometry.
  • MMI MMI derivatives (2-mercaptoimidazole) or tautomeric cyclic thiones (Compound 10) to prevent proteinuria in (NZBxNZW)F x Mice or
  • the objective of these experiments was to determine the effect of MMI and the tautomeric cyclic thiones (compound 10) on the development of lupus in NZB mice or diabetes in NOD mice by comparison to a methimazole derivative, 2- mercaptoimidazole.
  • Compound 10 was the most effective agent determined in the multiplicity of in vitro assays to suppress class I and class II gene expression; in contrast, 2-mercaptoimidazole was less effective than MMI and had negligible ability to suppress class I and class II gene expression.
  • mice spontaneously develop an autoimmune disease resembling human systemic lupus erythematosus (SLE) with age (Mozes et al., Clinical Immunology 18:106-113 (1998)).
  • SLE systemic lupus erythematosus
  • female NOD mice develop a disease resembling type 1 diabetes with age (Makino et al., Exp. Anim. 29:1-13 (1980); Wicker, L.S., et al., Diabetes 35:855-860 (1986)).
  • proteinuria is a measure of the onset of disease
  • glucosuria is a measure of the onset of disease.
  • mice Female (NZB x NZW)F, mice were obtained from Jackson Labs. Animals were followed with AMES 2855 Uristix (Miles) to semiquantitatively measure proteinuria. Proteinuria was taken as a measure of development of SLE and MMI suppression of proteinuria as suppression of renal complexes in kidney (Mozes et al., J. Clin Immunology 18:106-113 (1998)). At 7-8 mos. mice develop proteinuria reflecting renal disease. Treatment was from 2 mos to 6 mos of age. Treatment was oral. Each group had 8 animals to start. Female NOD mice were also obtained from Jackson Labs, along with control mice from which the strain was developed (Makino et al., Exp. Ai m.
  • mice In an experiment with Female (NZB x NZW)F, mice (Table 19) all surviving control animals and all 2-mercaptoimidazole-treated animals developed significant proteinuria at 7.5 mos. In contrast, both MMI and compound 10 (5- phenylmethimazole), at a fifth the MMI concentration, significantly prevented proteinuria. Animals were sacrificed from each group and kidneys evaluated for immune complexes; data revealed that control animals had significant numbers of immune complexes in their kidneys, whereas this was not true for MMI or compound 10 treated animals ( Figure 15).
  • mice Female NOD mice (5 animals were in each group) to develop glucosuria and diabetes when treated with MMI and compound 10 (5-phenylmethimazole) at a fifth the MMI concentration, by comparison to no treatment or treatment with 2-mercaptoimidazole.
  • Mice were from Jackson Labs in this experiment. Animals showing urine Tes-Tape positivity greater than 1 + were considered positive and to have diabetes.
  • Compound 10 and MMI are therefore effective in preventing diabetes in the NOD mouse example of diabetes. Death of animals for technical reasons, i.e. flooding of cages, handling, etc., was similar in control and experimental groups and did not effect results.
  • the human Y box protein, YB-1 was cloned based on its ability to bind to the Y box of the MHC class II gene, an inverted CCAAT box (Didier, D.K., et al. Proc. Natl. Acad. Sci. USA 85:7322-7326 (1988)).
  • YB-1 Transfection of YB-1 was shown to suppress HLA-DR ⁇ gene expression in human glioblastoma cells and FRTL-5 thyrocytes (Ting, J.P-Y., et al., ibid (1994); MacDonald, G.H., et al., J. Biol. Chem. 270:3527-3533 (1995); Montani, V., et al., ibid (1998a)).
  • the Y box protein in FRTL-5 cells was cloned based on its ability to suppress thyrotropin receptor (TSHR) gene expression (Shimura, H. , et al., J. Biol. Chem.
  • TSEP-1 TSHR suppressor element binding protein-1
  • TSEP-1 is a component of the thyroid autoregulatory system wherein TSH/cAMP decreases TSHR and MHC class I gene expression as FTRL-5 thyroid cells progress through the functional and growth phases of the cell cycle after TSH challenge (Shimura, H., et al. ibid (1993); Ohmori, M., et al., ibid (1996); Kohn, L.D., et al., ibid (1995)).
  • TSH/cAMP increase Y box gene expression, the Y box is a suppressor of TSHR and class I gene expression, and, as a result, TSHR and class I gene expression is decreased.
  • Y-IFN decreases Y box protein RNA levels in FRTL-5 cells
  • MMI can reverse this action (Fig. 16).
  • FRTL-5 cells were maintained in complete 6H medium plus 5 % calf serum and treated with 100 Units/ml y -IFN, an active selected from 5 mM methimazole, 0.1 mM compound 10, 0.25 mM compound 11, 0.5 mM or 0.25 mM compounds 7, 8 and 9, or 0.5 mM compound 3, or both IFN and the different actives for 40 hours before total cellular RNA was isolated and northern analysis performed as described (Isozaki, O., et al., ibid (1989); Saji, M.
  • rat TSEP-1 probe was the clone 31 insert, residues 5 to 1395 of the rat TSEP-1 nucleotide sequence reported (Ohmori, M., et al., ibid (1996)); rat ⁇ -actin was kindly provided by Dr. B. Paterson (NCI, Bethesda, MD).
  • Radiolabeling of all probes, hybridization (0.5-1.0xl0 6 cpm/ml), and washing were as described (Isozaki, O., et al., ibid (1989); Saji, M., et al., ibid (1992); Ohmori, M., et al., ibid (1996)).
  • YB-1 is the prototype Y box binding protein. It was cloned using the radiolabeled Y box element of the class II promoter to screen a ⁇ gtll expression DNA library (Didier, D.K., et al., ibid (1988)). Direct evidence of the ability of
  • YB-1 to suppress Y-IFN-induced class II gene expression was provided in glioblastoma and FRTL-5 cells (Ting, J.P-Y., et al., ibid (1998a)). Separate studies also showed it suppressed MHC class I gene expression (Saji, M., et al., ibid (1997)). These data show that y-IFN decreases Y-box RNA levels. Were Y box protein to also decrease, it is reasonable to presume that decreased Y-box suppression of class I and class II would result, since Y box suppresses class I and class II gene expression. In short, it is reasonable to presume that one means by which y-IFN increases MHC expression is to decrease Y box suppression of both genes.
  • MMI, MMI derivatives and tautomeric cyclic thiones reverse the Y-IFN induced decrease in Y box RNA levels coincident with their action to decrease Y-IFN-induced increases in MHC gene expression estimated by gel shifts, RNA levels, or promoter activity.
  • Y-IFN simultaneously reduces class II suppressive action by decreasing TSEP-1 RNA levels and increases class II expression by increasing CIITA RNA levels. The net result is "aberrant" expression of MHC class II and abnormal class I expression.
  • Methimazole reverses this by reversing the effect of Y-IFN on TSEP-1 (Y box) RNA levels and eliminating the Y-IFN-induced complexes with the HLA-DR ⁇ 5'- flanking region (Montani, V., ibid (1998a)).
  • the derivatives shown herein to be more active in suppressing IFN-increased class I and class II gene expression have greater abilities than MMI to reverse the effect of IFN on Y box gene expression.
  • One effect of these agents is thus to prevent or reverse the action of interferon to alter MHC gene expression and exacerbate the autoimmune response (Fig. 17).
  • the agents are also likely to decrease the initial or primary insult on the target tissue which initiates the autoimmune process (Fig. 17) as evidenced by decreases in basal class I gene expression.
  • the MMI, MMI derivatives, and tautomeric cyclic thiones have a minimal effect on basal Y box RNA levels. This reinforces the possibility that the action of the compounds is selective in its effect on Y-IFN-induced changes in Y box RNA levels and will not harm normal physiologic processes controlled by Y box.
  • Means of administering active compounds of the invention include, but are not limited to, oral, sublingual, intravenous, intramuscular, intraperitoneal, percutaneous, intranasal, intrathecal, subcutaneous, or enteral.
  • Local administration to the afflicted site may be accomplished through means known in the art, including, but not limited to, topical application, injection, infusion and implantation of a porous device in which the active compound(s) or compositions of the invention are contained.
  • the active compounds of the invention will generally be administered as a pharmaceutical composition comprising one or more active compounds of the invention in combination with a pharmaceutically acceptable excipient and other formulational aids.
  • compositions may be aqueous solutions, emulsions, creams, ointments, suspensions, gels, liposomal suspensions, and the like.
  • Suitable excipients include water, saline, Ringer's solution, dextrose solution, and solutions of ethanol, glucose, sucrose, dextran, mannose, mannitol, sorbitol, polyethylene glycol (PEG), phosphate, acetate, gelatin, collagen, Carbopol ® , vegetable oils, and the like.
  • PEG polyethylene glycol
  • phosphate acetate
  • gelatin collagen
  • Carbopol ® vegetable oils
  • One may additionally include suitable preservatives, stabilizers, antioxidants, antimicrobials, and buffering agents, for example, BHA, BHT, citric acid, ascorbic acid, tetracycline, and the like.
  • Cream or ointment bases useful in formulation include lanolin, Silvadene ® (Marion), Aquaphor ® (Duke Laboratories), and the like.
  • Other devices include indwelling catheters and devices such as the Alzet ® minipump.
  • Opthalmic preparations may be formulated using commercially available vehicles such as Sorbi-care ® (Allergan), Neodecdron ® (Merck, Sharp & Dohme), Lacrilube ® , and the like.
  • bulking agents for example human serum albumin, sucrose, mannitol, and the like.
  • the active compounds of the invention can be administered both orally and parenterally in accordance with conventional procedures for the treatment of autoimmune disease and performance of organ and/or tissue transplantation.
  • the amount of active compound required to treat any particular autoimmune and/or transplant disorder will, of course, vary depending upon the nature and severity of the disorder, the age and condition of the subject, and other factors readily determined by one of ordinary skill in the art.
  • Active compounds are administered in dosage units, preferably divided dosage units, containing the active compound with a suitable physiologically acceptable carrier or excipient, many of which are well known to those in the art and are described above.
  • the dosage units can be in the form of a liquid preparation, e.g., solutions, suspensions, dispersions, or emulsions, or they may be in solid form such as pills, tablets, capsules or the like.
  • Compositions in unit dosage form i.e., pharmaceutical compositions which are available in a pre-measured form suitable for single dose administration without requiring that the individual dosage be measured out by the user, for example, pills, tablets, capsules, or ampules are particularly preferred methods of administration of the active compounds of the current invention.
  • compositions in dosage unit form comprise an amount of composition which provides from about 0.05 to about 60 milligrams, preferably from about 0.05 to about 20 milligrams, of active compound per day.
  • the active compound of the invention or a salt thereof is combined, e.g., with solid powdered carriers such as lactose, sucrose, mannitol; starches such as potato starch, corn starch or amylopectin, as well as laminaria powder and citrus pulp powder; cellulose derivatives of gelatin, also lubricants such as magnesium or calcium sterate of polyethylene glycols (carbo waxes) of suitable molecular weights may be added, to form compressed tablets or core tablets for sugar coating.
  • solid powdered carriers such as lactose, sucrose, mannitol
  • starches such as potato starch, corn starch or amylopectin, as well as laminaria powder and citrus pulp powder
  • cellulose derivatives of gelatin also lubricants such as magnesium or calcium sterate of
  • the latter are coated, for example, with concentrated sugar solutions which, e.g., can contain gum arabic, talcum and/or titinium dixoide, or they are coated with a lacquer dissolved in easily volatile organic solvents or mixture of organic solvents.
  • Dyestuffs can be added to these coatings, for example, to distinguish between different contents of active substance.
  • Capsules useful herein include, for example, soft gelatin capsules (pearl-shaped closed capsules), geltabs, other capsules which consist, for example, of a mixture of gelatin and glycerin and contain, e.g., mixtures of the active substances or a suitable salt thereof with solid, powdered carriers such as, e.g., lactose, sucrose, sorbital, mannitol; starches such as potato starch corn starch or amylopectin, cellulose derivatives or gelatin, as well as magnesium sterate or steric acid. Suppositories are employed as dosage units for rectal application.
  • gelatin rectal capsules consist of a combination of the active substance or a suitable salt thereof with a neutral fatty base, or also gelatin rectal capsules can be employed which consist of a combination of the active substance or a suitable salt thereof with polyethylene glycols (carbowaxes) of suitable molecular weight.
  • Ampoules for parenteral, particularly intramuscular administration preferably contain an active compound or a water soluble salt thereof and suitable stabilizing agents, and, if necessary, buffer substances in aqueous solution.
  • Anti-oxidizing agents such as sodium bisulfite, sodium sulfite, ascorbic acid or Rongalit (formaldehyde-sodium bisulfite compound), and the like are suitable as stabilizing agents either alone or combined, in total concentrations between 0.01 and about 0.05 percent of the composition. Because of its ability to form chelates, ascorbic acid has an additional stabilizing effect; in this function it can also be replaced by other chelate-formers.
  • the best suitability of the active ingredient is attained, e.g., by mixtures in suitable ratio of sodium sulfite, sodium bisulfite and/or ascorbic acid, or by the addition of other buffer substances such as citric acid and/or salts thereof.
  • the ampoules can contain a slight amount of a preservative.
  • Useful pharmaceutical formulations for administration of the active compounds of this invention may be illustrated below. They are made using conventional techniques.
  • This tablet can be sugar coated according to conventional art practices. Colors may be added to the coating.
  • Active ingredient 0.05 to 60 mg Polyethylene glycol 600 1.0 cc Sodium bisulfite, U.S.P. 0.4 mg Water for injection, U.S.P. (q.s.) 2.0 cc
  • active compound(s) of the present invention are administered, preferably orally, but administration may also be parenterally, at a dose of up to 100 mg per day initially.
  • Initial dosing can be followed by a step-wise reduction program, to 50 mg for 20 days, 40 mg for up to 20 days, 35 mg for up to 30 to 60 days, decreasing progressively to 5 mg-30 mg per day.
  • a maintenance dose of 5 mg-10 mg per day for up to 1 year or longer may also be used. Dosages may be decreased by 50 to 100 fold, at least, for preferred active compounds.
  • Patients can be monitored for alleviation of clinical signs and symptoms of active disease.
  • Specifically monitored parameters can include, autoantibodies, particularly DNA antibodies; PBL cell surface markers, leukopenia; proteinuria; hyperimmunoglobulinemia; and levels of immune complexes in the kidney by punch biopsy.
  • TSH or T 3 /T 4 levels may be monitored to access the therapeutic levels of active compounds of the invention required for control of disease in the SLE patient.
  • TSH levels increase significantly above the normal range, indicative of the effective action of the active compound, dosage can be decreased to the next dose level.
  • thyroid hormone levels decrease significantly from the normal range, this also can be used as an indication to lower dosage. If patients exhibit a decrease in thyroid hormones or an increase in TSH, they can be treated with thyroid hormone (T 3 or T 4 ) plus active compounds to maintain a euthyroid state. The TSH level is a better index. The same parameters may be assessed in children.
  • EXAMPLE 10 Treatment of Humans Suffering From or at Increased Risk of Developing
  • Humans discovered to be suffering from juvenile diabetes, Type I diabetes, or determined by those skilled in the art to possess an increased risk of developing IDDM may be treated by administration of active compound(s) of the present invention, preferably orally (although they may also be administered parenterally), at a dose of up to 100 mg per day initially. Initial dosing can be followed by a step- wise reduction program, to 50 mg for 20 days, 40 mg for up to 20 days, 35 mg for up to 30 to 60 days, decreasing progressively to 5 mg-30 mg per day. A maintenance dose of 5 mg-10 mg per day for up to 1 year or longer can also be used. Dosages may however be lowered by 50 to 100 fold, at least, for preferred active compounds.
  • Patients can be monitored for alleviation of clinical signs and symptoms of active disease.
  • Specifically monitored parameters can include glucosuria, glucosemia, autoantibodies, particularly antibodies known to those skilled in the art to possess positive correlation to disease progression and/or known to those skilled in the art to possess predictive value with regard to an individual's predisposition, and hence increased risk, for IDDM disease; PBL cell surface markers; leukopenia; and glucosuria.

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Abstract

L'invention concerne des procédés relatifs au traitement de maladies auto-immunes chez les mammifères et à la prévention ou au traitement du rejet de greffe chez un receveur. Lesdits procédés consistent à utiliser des dérivés de méthimazole à définition spécifique et des composés à base de thiones cycliques tautomères, ainsi que des compositions renfermant ce type de composé. Les composés et les compositions en question apparaissent comme étant au moins aussi efficaces que la méthimazole en termes d'activité pharmaceutique, mais affectant moins défavorablement la fonction thyroïde. Par ailleurs leur solubilité dans les vecteurs pharmaceutiques classiques est supérieure à celle de la méthimazole. L'invention concerne également une analyse de criblage relative à l'activité des composés utiles contre les maladies auto-immunes (aptitude à inhiber l'expression des molécules du CMH de classe I et II).
EP99945325A 1998-08-31 1999-08-27 Derives de methimazole et thiones cycliques tautomeres permettant de traiter les maladies auto-immunes Withdrawn EP1112072A2 (fr)

Applications Claiming Priority (5)

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US14431198A 1998-08-31 1998-08-31
US144311 1998-08-31
US09/382,960 US6365616B1 (en) 1998-08-31 1999-08-25 Methimazole derivatives and tautomeric cyclic thiones to treat autoimmune diseases
US382960 1999-08-25
PCT/US1999/019862 WO2000012175A2 (fr) 1998-08-31 1999-08-27 Derives de methimazole et thiones cycliques tautomeres permettant de traiter les maladies auto-immunes

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AUPP438598A0 (en) 1998-06-29 1998-07-23 Garvan Institute Of Medical Research NPY-Y7 receptor gene
AU2004201249B2 (en) * 1998-09-11 2007-06-07 Sentron Medical, Inc. Immune activation by double-stranded polynucleotides
US20060211752A1 (en) 2004-03-16 2006-09-21 Kohn Leonard D Use of phenylmethimazoles, methimazole derivatives, and tautomeric cyclic thiones for the treatment of autoimmune/inflammatory diseases associated with toll-like receptor overexpression
AU2004317993A1 (en) * 2004-03-16 2005-10-13 Interthyr Corporation Methimazole derivatives and tautomeric cyclic thiones to inhibit cell adhesion
US9339403B2 (en) 2004-11-12 2016-05-17 Icon Medical Corp. Medical adhesive for medical devices
US7455688B2 (en) 2004-11-12 2008-11-25 Con Interventional Systems, Inc. Ostial stent
US9107899B2 (en) 2005-03-03 2015-08-18 Icon Medical Corporation Metal alloys for medical devices
US8398916B2 (en) 2010-03-04 2013-03-19 Icon Medical Corp. Method for forming a tubular medical device
WO2015066490A1 (fr) 2013-10-31 2015-05-07 Ohio University Prévention et traitement de stéatose hépatique non alcoolique
BR112016030273A2 (pt) 2014-06-24 2017-08-22 Icon Medical Corp Dispositivo médico e método para formar o referido dispositivo
US20170202818A1 (en) 2014-07-18 2017-07-20 Ohio University Methods and compositions to modify gsk-3 activity
WO2017151548A1 (fr) 2016-03-04 2017-09-08 Mirus Llc Endoprothèse pour spondylodèse

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AU5794199A (en) 2000-03-21
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AU775606B2 (en) 2004-08-05
CA2339090C (fr) 2009-11-17
WO2000012175A2 (fr) 2000-03-09

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