CA2235603A1 - Methods and compositions using butyrate esters of threitol - Google Patents

Abstract

The present invention relates to the use of butyrate esters of threitol, alone or in combination with other agents, in pharmaceutical compositions and methods for increasing fetal hemoglobin and gamma globin in a patient. These methods are particularly useful in treating .beta.-hemoglobinopathies, such as sickle cell syndromes and .beta.-thalassemia syndromes. Compositions comprising butyrate esters of threitol, alone or in combination antiproliferative and differentiating agents are also useful in methods for inducing cell differentiation in malignant cells. These methods are useful in treating cancer, particularly the tetrabutyrate ester.

Description

CA 0223~603 1998-04-23 W O 97/16180 PCTAUS96/17244 ' METHODS AND COMPOSITIONS
USING BUTYRATE ESTERS OF THREITOL

TECHNICAL FIELD OF THE INVENTION

The present invention relates to the use of butyrate esters of threitol, alone or in combination with other agents, in pharmaceutical compositions and methods for increasing fetal hemoglobin and gamma globin in a patient. These methods are particularly useful in treating ~-hemoglobinopathies, such as sickle cell syndromes and ~-thalassemia syndromes. Compositions comprising butyrate esters of threitol, alone or in combination with antiproliferative and differentiating agents are also useful in methods for inducing cell-differentiation in malignant cells. These methods are useful in treating cancer, particularly the tetrabutyrate ester.
BACKGROUND OF THE INVENTION

~-hemoglobinopathies are a group of inherited ~ disorders of ~-globin biosynthesis. Although efforts have concentrated on a variety of therapeutic regimens, feasible clinical treatments for these debilitating diseases remain scarce.

CA 0223~603 1998-04-23 Various therapies have been utilized in the treatment of ~-hemoglobinopathies, each accompanied by drawbacks [G.P. Rogers et al., "Current and Future Strategies for the Managements of Hemoglobinopathies and Thalassemia", Hematology 1994, Education Program American Society of Hematology, pp. 9-20 (1994)]. Although hydroxyurea stimulates fetal hemoglobin production and reduc~s sickling crisis in sickle cell ane~a p~tients, its use is potentially limited by myelotoxicity and the risk of carcinogenesis. Potential long term carcinogenicity is also a drawback of 5-azacytidine-based therapies. Red blood cell transfusions expose patients to the potential of a wide range of infectious viral agents, allo;~ml~nization and iron overload. Bone marrow transplants are not a readily available option for a large number of patients. Erythropoietin-based therapies have not proved consistent among a range of patient populations. Such varying drawbacks contraindicate the long term use of such agents or therapies.
It is clear from multicenter studies involving numerous patients with sickle cell disease that increased blood levels of fetal hemoglobin are associated with lower events of sickle cell crisis and longer survival time [Platt et al., "Pain in Sickle Cell Disease, New Eng. J. Med., 325, pp. 11-16 (1991); Platt et al., "Mortality ion Sickle Cell Disease", New Eng. J. Med., 330, pp. 1639-44 (1994)~. Accordingly., in an effort to avoid the disadvantages of conventional therapies for ~-hemoglobinopathies, therapies have centered around ways to increase fetal hemoglobin production. Recent clinical trials have focused on the use of butyrate analogs, including arginine butyrate and isobutyramide, to stimulate fetal hemoglobin production as a means of '12 CA 0223~603 1998-04-23 treatment [S. Perrine et al., "A Short Term Trial of Butyrate to Stimulate Fetal-Globin-Gene Expression in the ~-globin Disorders", N. Eng. J. Med., 328, pp. 81-86 (1993); S.P. Perrine et al., "Isobutyramide, an Orally Bioavailable Butyrate Analogue, Stimulates Fetal Globin Gene Expression in vitro and in vivo," British J.
Haematology, 88, pp. 555-61 (1994); A.F. Collins et al., "Or~l Sodi~m Phenyl~utyrate Therapy in Homo2ygous 8-Thalassemia: A Clinical Trial", Blood, 85, pp. 43-49 (1995)]. Clinical trials have also employed sodium phenylbutyrate as a hemoglobin switching agent for 8-thalassemia [Collins et al., supra].
Following the observation that butyric acid induces cell differentiation in vitro [A. Leder and P.
Leder, "Butyric Acid, a Potent Inducer of Erythroid Differentiation in Cultured Erythroleukemic Cells", Cell, 5, pp. 319-22 (1975)], that compound was found to demonstrate promising effects in leukemia patients, by inducing cell differentiation [A. Novogrodsky et al., "Effect of Polar Organic Compounds on Leukemic Cells", Cancer, 51, pp. 9-14 (1983)]. Aside from their use in treating ~-hemoglobinopathies, butyrate derivatives such as arginine butyrate, an arginine salt of butyric acid, have been shown to exert anti-tumor and anti-leukemia effects in mice [C. Chany and I. Cerutti, "Antitumor Effect Of Arginine Butyrate in Conjunction with Corynebacterium Parvum and Interferon", Int. J. Cancer, 30, pp. 489-93 (1982); M. Otaka et al., "Antibody-Mediated Targeting of Differentiation Inducers To Tumor Cells: Inhibition of Colonic Cancer Cell Growth in vitro and in vivo", Biochem. Biophys. Res. Commun.,158, pp.
202-08 (1989)].

CA 0223~603 1998-04-23 W O 97/16180 PCTrUS96/17244 -Butyrate salts induce differentiation of colon cancer cell lines and arrest the growth of neoplastic colonocytes tO. C. Velazquez, H. M. Lederer, and J. L.
Rombeau, "Butyrate and the Colonocyte. Implications for Neoplasia", Dig. Dis. Sci., 41, pp.727-39 (1996)].
Sodium butyrate has been shown to induce apoptosis in colorectal carcinoma cell lines [A. Hague, D. J. Elder, D. J. Hicks, and C. Paraskeva, "Apoptosis in Colorectal Tumour Cells: Induction by the Short Chain Fatty Acids Butyrate, Propionate And Acetate and by the Bile Salt Deoxycholate", Int. J. Cancer, 60, pp.400-6 (1995)].
Although butyrate salts have the advantage of low toxicity as compared with conventional chemotherapeutic agents, their short half-lives in vivo have been viewed as a potential obstacle in clinical settings [A. Miller et al., "Clinical Pharmacology of Sodium Butyrate in Patients with Acute Leukemia", Eur. J.
Clin. Oncol., 23, pp. 1283-87 ~1987); Novogrodsky et al., supra]. The rapid clearance of these agents results in an inability to deliver and maintain high plasma levels of butyrate and necessitates administration by intravenous infusion. Another potential obstacle to the use of butyrate salts is salt overload and its physiological sequelae.
In view of these observations, various prodrugs of butyric acid have been proposed for use in 8-hemoglobinopathy and leukemia differentiation therapies.
Such prodrugs include tributyrin and n-butyric acid mono-and polyesters derived from monosaccharides [Z. Chen and T. Breitman, "Tributyrin: A Prodrug of Butyric Acid for Potential Clinical Application in Differentiation Therapy", Cancer Res., 54, pp. 3494-99 (1994); H. Newmark et al., "Butyrate as a Differentiating Agent:

CA 0223~603 1998-04-23 Pharmacokinetics, Analogues and Current Status", Cancer Letts., 78, pp. 1-5 (1994); P. Pouillart et al., "Pharmacokinetic Studies of N-Butyric Acid Mono- and Polyesters Derived From Monosaccharides", J. Pharm.
Sci., 81, pp. 241-44 (1992)]. Such prodrugs have not proved useful as therapeutics, however, due to factors such as low bioavailability, lack of effective oral deliverability, short half life, low CmaX or high pharmacokinetic variability. Other prodrugs, such as AN9 and AN-10, elicit metabolites that may produce formaldehyde in vivo, which may lead to toxic effects in patients.
To date, conventional methods and therapeutic agents have not proved to be safe and effective for all patients in the long term treatment of ~-hemoglobinopathies. This is also the case for diseases characterized by neoplastic, tumorigenic or malignant cell growth, or malignant hematological disorders.
Accordingly, the need exists for alternatives having advantages over, and avoiding the disadvantages of, such conventional methods and agents, while providing effective therapy for those target diseases.

DISCLOSURE OF THE INVENTION
The present invention solves these problems by providing methods and compositions utilizing butyrate esters of threitol for increasing fetal hemoglobin and gamma globin production in a patient. These butyrate esters demonstrate good bioavailability, effective oral deliverability, good half-life, good Cmax and surprisingly low pharmacokinetic variability between individual patients. This last factor increases their utility as CA 0223~603 1998-04-23 agents to deliver therapeutically effective amounts of systemic butyrate.
The compositions and methods of the invention are especially useful for treating or reducing the advancement, severity, symptoms or effects of ~-hemoglobinopathies, including sickle cell syndromes and ~-thalassemia syndromes. In addition, the methods and ~om~osit Gns accordins to the present inventior. are useful for stimulating cell differentiation in malignant cells. Such compositions and methods are useful for treating cancer.
Accordingly, the methods and compositions of this invention are not beset by the variety of side effects which typically characterize conventional therapy regimens.

DETAILED DESCRIPTION OF THE INVENTION

In order that the invention herein described may be more fully understood, the following detailed description is set forth.
According to one embodiment, this invention provides pharmaceutical compositions comprising a butyrate ester of threitol represented by the formula:
OR
RO ~ OR

O
~~ .

CA 0223~603 1998-04-23 W O 97/16180 PCT~US96/17244 -wherein R is or hydrogen, provided that at o least one R is ~ ; and the stereochemistry at the chiral carbons is independently selected from R or S and a phArm~ceutically acceptable o carrier or adjuvant. Preferably each R is More preferably, the pharmaceutical compositions of this invention comprise an approximately equimolar mixture of (R) and (S) configurations represented by the following Fischer projections:
O o OC ( CH2 ) 2CH3 OC ( CH2 ) 2CH3 O O
CH3(CH2)2CO - OC(CH2)2CH
O O
OC(CH2)2CH3 CH3(CH2)2CO
O O

OC (CH2) 2CH3 --OC (cH2) 2CH3 The tetrabutyrate esters of threitol and the partially esterified analogs of threitol useful in the methods and compositions of the present invention may be synthesized by conventional techniques. Advantageously, these compounds are conveniently synthesized from commercially available starting materials. For example, they may be prepared from the D-, L- or D,L-forms of threitol using an appropriate activated reagent, such as an activated butyric acid derivative, in conventional c esterification techniques. For instance, reaction with an activated carboxylate, such as an acyl halide (e.g., acid fluorides, acid chlorides, and acid bromides), an CA 0223~603 1998-04-23 W O 97/16180 PCT~US96/17244 -acyl cyamide of acyl imidazolide, an activated ester such as nitrophenyl ester or 1-hydroxysuccinimide (HOSU) ester, an anhydride such as the symmetrical anhydride or isobutyl mixed carbonic anhydride, or mixed carbonic-phosphoric or carbonic-phosphonic anhydrides with an appropriate alcohol, will yield the corresponding ester.
Other methods of forming esters from alcohols and carboxylic acids or their derivatives are also well known to those of skill in the art. These include removal of water by Dean-Stark distillation, Fischer esterification and transesterification. Various catalysts and additives, including protic and/or Lewis acids, bases or zeolites may be used to increase the ease or efficiency of these reactions. Enzymatic methods to form esters are also well known in the art.
Specific modifications of these methods, as well as other means of forming esters are known by those of skill in the art. It will be readily recognized that in order to facilitate specific reactions, the protection of one or more potentially reactive groups followed by subsequent removal of that group may be required. Such modifications are within the skill of the art.
In any synthesis method, the desired compound may be isolated by any technique, including, for example, distillation, chromatographic techniques, such as normal phase, reverse phase, ion-exchange, affinity, or gel permeation, as well as extraction, crystallization, or other means. The relative ease of synthesis of the compounds of this invention represents an advantage in their large scale production.
It should also be understood that the butyrate esters of threitol used in the compositions of this CA 0223~603 1998-04-23 invention may be modified by appending appropriate functionalities to enhance selective biological properties. Such modifications are well recognized in the art and include sustenance of plasma and/or whole blood butyrate concentration, increased oral availability, altered metabolism and altered rate of excretion of butyric acid or butyric acid prodrugs.
The ph~rm~ceutical compositions of this invention are characterized by the presence of a butyrate ester of threitol in an amount effective to increase the production of fetal hemoglobin or stimulate cell differentiation in a patient and a pharmaceutically acceptable carrier or adjuvant. More specifically, these compositions are designed to treat a patient suffering from a ~-hemoglobinopathy or a malignant disease. The term "malignant disease", as used herein denotes a condition characterized by neoplastic, tumorigenic or malignant cell growth, or a hematological disorder.
An amount effective to increase the production fetal hemoglobin or stimulate cell differentiation in a patient will depend, of course, on the particular disease to be treated, the severity of the disease, the physical condition of the patient and the judgment of the treating physician. Preferably, the prodrug of Formula I will be present in an amount capable of producing a plasma butyric acid concentration of between about 0.03 mM and 3.0 mM within 8 hours of administration. More preferably, the prodrug of formula I is present in an amount that produces a plasma butyric acid concentration of between about 0.1 mM and 1.O mM within 6 hours of administration. Most preferably, the prodrug in the composition is present in an amount that produces a CA 0223~603 1998-04-23 W O97tl6180 PCTAUS96/17244 -plasma butyric acid concentration of between about 0.1 mM
and 1.O mM within 2 hours of administration and the concentration r~m~; ns at those levels for at least 2 hours. Dosages of between 25 mg/kg and 3000 mg/kg body weight of butyrate ester of threitol administered one or more time per day will produce the desired serum butyrate concentration. Preferably, the patient will be administered the prodrug between 1 and 4 times per day.
In a preferred embodiment, these compositions additionally comprise a conventional agent used in the treatment of ~-hemoglobinopathies. The conventionaL
agent may be present in the same amount or less than that normally required to treat ~-hemoglobinopathies in a monotherapy. The normal dosages of these conventional agents are well known in the art. Such agents include hydroxyurea, clotrimazole, isobutyramide, erythropoietin and salts of short-chain fatty acids, such as phenylacetic acid, phenylbutyric acid and valproic acid.
According to an alternate preferred embodiment, the compositions comprise a butyrate ester of threitol and a conventional agent used in the treatment of diseases characterized by neoplastic, tumorigenic or malignant cell growth, or a hematological disorder in a patient. This additional agent may be present in an amount equal to or less than that normally required to treat such diseases in a monotherapy. The normal dosages of these conventional agents are well known in the art.
Such agents include, erythropoietin, or cancer chemotherapeutic agents, such as hydroxyurea or 5-azacytidine.
The carriers and adjuvants useful in thepharmaceutical compositions of this invention include, CA 0223~603 1998-04-23 W O 97/16180 PCT~US96/17244 -for example, ion exchangers, alumina, aluminum stearate, lecithin, serum proteins, such as human serum albumin, buffer substances, such as phosphates, glycine, sorbic acid, potassium sorbate, partial glyceride mixtures of saturated vegetable fatty acids, water, salts or electrolytes such as prolamine sulfate, disodium hydrogen phosphate, sodium chloride, zinc salts, colloidal silica, magnesium, trisilicate, polyvinyl pyrrolidone, cellulose-based substances and polyethylene glycol. Adjuvants for topical or gel base forms may be selected from the group consisting of sodium carboxymethylcellulose, polyacrylates, polyoxyethylene-polyoxypropylene-block polymers, polyethylene glycol and wood wax alcohols.
The compositions of the present invention may be in a variety of conventional depot forms. These include, for example, solid, semi-solid and liquid dosage forms, such as tablets, pills, powders, liquid solutions or suspensions, emulsions, oil dilutions, liposomes, capsules, suppositories, injectable and infusible solutions. The preferred form depends upon the intended mode of administration and therapeutic application.
For example, oral administration may be by any orally acceptable dosage form including, but not limited to, capsules, tablets, and aqueous or non-aqueous suspensions and solutions. In the case of tablets for oral use, carriers which are commonly used include lactose and corn starch. Lubricating agents, such as magnesium stearate, are also typically added. For oral administration in a hard gelatin capsule form, useful diluents include lactose and dried corn starch. Soft gelatin capsules incorporating oils and/or polyethylene glycols as excipients may also be used. Fluid unit dosage forms for oral administration include shakes, CA 0223~603 1998-04-23 W O 97/16180 PCT~US96/17244 -syrups and suspensions. For example, the butyrate ester of threitol may be dissolved in an aqueous vehicle together with sugar, sweetening or flavoring agents and preservatives to form a shake or a syrup. Suspensions may be prepared with an aqueous vehicle and a dispersing agent, such as acacia, tragacanth or methylcellulose.
Preferably, the pharmaceutical compositions of this invention are formulated for oral or rectal administration. A preferred form of oral administration employs emulsions comprising between about 5 to 40% (w/w) of the prodrug of formula I and an ionic or non-ionic surfactant with the resulting composition having an HLB
value of between 0-40. Preferred surfactants include Tween-20, Tween-80, Spam20, Spam-40 and poloxamers, such as S-108.
A preferred form of rectal administration uses a rectal suppository or an enema using a suitable fluid dosage form. An enema is a more preferred form of rectal administration.
The butyrate esters of threitol which characterize the compositions of this invention are characterized by several advantages. They are metabolized to yield therapeutic butyric acid plasma concentrations over a sustained period of time, resulting in therapeutically effective exposure to butyric acid.
Additionally, they are orally bioavailable, unlike sodium butyrate -- which is rapidly cleared before therapeutic plasma concentration levels can be reached. They are also non-toxic, thus avoiding, for example, sodium overload and irritation which may be associated with injections of hyperosmolalic solutions.
The most surprising and unexpected feature of the butyrate esters of threitol that characterize the -CA 0223~603 1998-04-23 W O 97/16180 PCTrUS96/17244 -pharmaceutical compositions of this invention is that they exhibit significantly lower pharmacokinetic variability over conventional prodrugs of butyric acid.
Pharmacokinetic variability is the measure of differences in the serum butyrate concentrations between different patients administered the same amount of butyrate esters of threitol. Pharmacokinetic variability is quantified by dividing the stAn~rd deviation for a ~iven parameter, such as Cmax or AUC, by the mean value of that parameter, in a series of patients given dose the same dosage of butyrate ester of threitol.
In particular, the tetrabutyrate ester of mesothreitol is characterized by a pharmacokinetic variability of 35-40~, as compared with conventional prodrugs of butyric acid, such as tributyrin, which has a pharmacokinetic variability of 70%. This reduced variability means that the compositions of this invention provide sustained release and produce more consistent plasma concentrations of butyric acid among individual patients. This, in turn, m;n;m; zes the potential for cellular toxicity, which, based on our own in vitro cell culture studies, has been observed at butyric acid concentrations above 3.0 mM under certain in vitro conditions.
According to another e-m-bodiment~ the invention provides methods for treating a ~-hemoglobinopathy in a patient. This method comprises the step of treating the patient with any of the compositions described above.
The term "treating", as used herein includes reducing the severity, symptoms or effects of the ~-hemoglobinopathy.
Preferably, the method provides a serum butyric acid concentration of between about 0.03 mM and 3.0 mM within about 8 hours of administration. More preferably, this CA 0223~603 1998-04-23 W O 97/16180 PCTrUS96/17244 -produces a plasma butyric acid concentration of between about 0.1 mM and 1.0 mM within about 6 hours of administration. Most preferably, the prodrug in the composition is present in an amount that produces a plasma butyric acid concentration of between about 0.1 mM
and 1.0 mM within 2 hours of administration and the concentration r~m~; nS within that range for at least 2 hours. These plasma levels are achieved by administering a butyrate ester of threitol to the patient at a dose of between about 25-3000 mg/kg body weight one or more times per day. Preferably, the patient will be administered the prodrug between 1 and 4 times per day.
The ~-hemoglobinopathies which may be treated by this method include sickle cell syndromes, such as sickle cell anemia, hemoglobin SC disease, hemoglobin SS
disease and sickle ~-thalassemia; ~-thalassemia syndromes, such as ~-thalassemia; other genetic mutations of the ~-globin gene locus that lead to unstable hemoglobins, such as congenital Heinz body anemia, ~-globin mutants with abnormal oxygen affinity and structural mutants of ~-globin that result in thalassemic phenotype. These diseases are described in The Molecular Basis of Blood Disease, vol. II, G. Stamatoyannopoulos et al., eds., pp. 157-244 (1994).
According to a preferred embodiment, the above-described method comprises the additional step of treating the patient with an agent that is normally used to such ~-hemoglobinopathies. That agent may be administered prior to, se~uentially with or after treatment with the butyrate prodrug-cont~in;ng composition. Of course, if the composition used to treat CA 0223~603 1998-04-23 the disease is one that already contains such conventional agent, this additional step can be omitted.
The amount of conventional agent administered in these methods is preferably less than that normally required to treat such diseases in a monotherapy. The normal dosages of these conventional agents are well known in the art. Such agents include hydroxyurea, clotrimazole, isobutyramide, erythropoietin and salts of short-chain fatty acids, such as phenylacetic acid, phenylbutyric acid and valproic acid.
According to another embodiment, the invention provides a method for treating diseases characterized by neoplastic, tumorigenic or malignant cell growth, as well as malignant hematological disorders. Treatment includes prevention of the progression the disease or its recurrence. Such diseases include carcinomas, myelomas, mel~nsm~s, lymphomas and leukemias. According to a preferred embodiment, the present invention provides a method for treating colo-rectal cancer and prostate cancer. According to a more preferred embodiment, the method of the present invention is used to treat colo-rectal cancer and prostate cancer using a formulation suitable for oral or rectal administration.
According to another preferred embodiment, the method of the present invention is used to treat prostate cancer using a formulation suitable for oral or rectal administration.
According to a preferred embodiment, the above-described method comprises the additional step of treating the patient with an agent that is normally used to such malignancies. That agent may be administered prior to, sequentially with or after treatment with the butyrate prodrug-containing composition. Of course, if CA 0223~603 1998-04-23 W O 97/16180 PCT~US96/17244 -the composition used to treat the disease is one that already contains such conventional agent, this additional step can be omitted.
The amount of conventional agent administered in these methods is preferably less than that normally required to treat such diseases in a monotherapy. In those instances, the occurrence of any side effects associated with that agent may be reduced or avoided.
The normal dosages of these conventional agents are well known in the art. Such agents include, erythropoietin, or cancer chemotherapeutic agents, such as hydroxyurea or 5-azacytidine.
Combination therapies with conventional agents according to this invention (whether part of a single composition or administered separate from the prodrugs of this invention) may also exert an additive or synergistic effect, particularly when each component acts to treat or prevent the target disease via a different mechanism.
In order that the invention described herein may be more fully understood, the following examples are set forth. It should be understood that these examples are set forth for illustrative purposes only and are not to be construed as limiting this invention in any manner.

Synthesis of d-, l- and d,l-Threitol Tetrabutyrate Esters We synthesized d-threitol tetrabutyrate ester as follows. We added 17 ml of Et3N to 3.0 g of D-threitol dissolved in CH2Cl2 and cooled the mixture to O~C. We then added 11 ml of CH3(CH2)2COCl in 5 ml CH2Cl2 over 30 minutes. The reaction mixture was stirred at room temperature overnight. We then diluted the reaction with CA 0223~603 1998-04-23 ether and filtered the resulting material. The precipitate was washed once over a filter with ether.
The filtrates were combined, washed twice with water, once with saturated NaCl and dried over MgSO4, filtered and concentrated.
The resulting yellow oil was run on an MPLC
column in 90:10 (hexane:EtOAc). The yield of purified product was 8.35g of a light yellow oil.
We synthesized d-, 1-threitol tetrabutyrate ester using the same methodology replacing D-threitol with D,L-threitol using the same ratio of equivalents (1:5:4.5i threitol:Et3N:CH3(CH2)2COCl).
The structure of the purified compounds was confirmed by NMR.

Oral Availability of Butyrate Esters of Threitol in Rats We evaluated oral bioavailability and sustenance of plasma concentrations of butyric acid in rats receiving tetrabutyrate esters of threitol and tributyrin by oral gavage.
This assay was carried out according to the protocol described in Daniel et al., Clinica Chimica A ., 181, pp. 255-64 (1989); Planchon et al., J. Pharm.
Sci., 82, pp. 1046-48 (1993); Pouillart et al., J. Pharm.
Sci., 81, pp. 241-44 (1992). Each compound was tested in five to six rats (Sprague Dawley; Harlan Labs, Inc.) weighing approximately 300 grams each. The relevant pharmacokinetic parameters for these agents are listed in the table below. In that table, data are expressed as mean + standard deviation (range) and were compared using the unpaired Student's t-test.

CA 0223~603 1998-04-23 wo 97/16180 PCT~US96/17244 -Table 1. Pharmacokinetics of butyrate esters of threitol in rats Dose Nu Tber of AUC C~ Plasma tu2 Compound (arrl/kg) animals (mM.hr) (mM) (mins) ~butyrin 3.0 6 1.59iO.930.51iO.46157.2i70.2 -threitol tetr~bubrate 2.4 5 1.20iO.400.58iO.1366.0~12.0 ~6~
d-threitol tetra-butyrate2.8 6 0.~26 0.47iO.1458.8~19.8 ester dl-threitol tetra-butyrate 3.0 5 1.25~0.220.39iO.12 106~+~
ester ' Si~nificanUy differentfrom l-threitol tetrabutyrate ester and d-threitol tetrabutyrate ester (p<0.01).

As shown above, the tetrabutyrate esters of threitol were found to release butyric acid in vivo with lower variability than tributyrin. oral administration of each of those prodrugs of butyric acid also increased the "apparent" plasma half-life of butyric acid to significantly longer than the 6 minutes observed in leukemia patients after continuous infusions of sodium butyrate [Miller et al., supra]. The area under the plasma concentration-time curve and the observed Cmax 15 values for butyric acid were not significantly different for any of the tetrabutyrate esters or tributyrin (following dose-normalization). Advantageously and unexpectedly, the butyrate ester of D,L-threitol was found to have an "apparent" butyric acid plasma half-life which was significantly longer than that observed for the tetrabutyrate ester of either D-threitol or L-threitol.
A closer ~x~m;n~tion of the data showed that the release of butyric acid from tributyrin was more variable when compared to that obtained following oral CA 0223~603 1998-04-23 W O 97/16180 PCT~US96/17244 -administration of the tetrabutyrate ester of D,L-threitol. The pharmacokinetic variability with tributyrin oral administration is demonstrated by the wide range of C~x (0.295 to 1.46 mM) ; AUC (0.72 to 3.23 mM.hr); and plasma half-life (67.2 to 259.8 minutes). on the other hand, the ranges for Cm~x AUC and plasma half-life for orally administered tetrabutyrate ester of D,L-threitol were 0.26 to 0.545 mM, 0.95 to 1.53 mm.hr and 79.2 to 126.9 minutes, respectively. Thus, both tributyrin and the tetrabutyrate ester of D,L-threitol are orally bioavailable to provide therapeutic plasma levels of butyric acid. However, a clear advantage of that tetrabutyrate ester is its reduced pharmacokinetic variability -- signifying a consistent pharmacokinetic profile which, in turn, enables more reliable clinical treatment regimens than those based on tributyrin.
While we have hereinbefore described a number of embodiments of this invention, it is apparent that our basic constructions can be altered to provide other embodiments which utilize the processes and compositions of this invention. Therefore, it will be appreciated that the scope of this invention is to be defined by the claims appended hereto rather than by the specific embodiments which have been presented hereinbefore by way of example.

Claims (31)

We claim:

1. A pharmaceutical composition comprising:
a. an amount of a butyrate ester of threitol effective to increase fetal hemoglobin formation, increase gamma globin synthesis, or induce differentiation in malignant cells in a patient; and b. a pharmaceutically acceptable adjuvant or carrier;
said butyrate ester of threitol having the formula:

wherein each R is independently selected from or hydrogen, provided that at least one R is and the stereochemistry at the chiral carbons is independently selected from R or S.

2. The pharmaceutical composition according to claim 1, wherein each R is

3. The pharmaceutical composition according to claim 2, comprising an mixture of and

4. The pharmaceutical composition according to any one of claims 1 to 3, wherein said composition is an emulsion formulated for oral administration.

5. The pharmaceutical composition according to any one of claims 1 to 3, additionally comprising a conventional agent for treating a .beta.-hemoglobinopathy in a patient.

6. The pharmaceutical composition according to claim 5, wherein said conventional agent is a hydroxyurea.

7. The pharmaceutical composition according to any one of claims 1 to 3, additionally comprising a conventional agent for treating cancer in a patient.

8. A method of increasing fetal hemoglobin formation and inducing production of gamma globin in a patient comprising the step of administering to said patient a pharmaceutical composition according to any one of claims 1 to 4.

9. The method according to claim 8, wherein said method is used to treat a .beta.-hemoglobinopathy in a patient.

10. The method according to claim 8, wherein said .beta.-hemoglobinopathy is selected from the group consisting of sickle cell anemia, hemoglobin SC disease, hemoglobin SS disease, sickle .beta.-thalassemia, .beta.-thalassemia and congenital Heinz body anemia.

11. The method according to claim 8, wherein said method produces a serum butyric acid concentration of between about 0.1 mM and 1.0 mM within 2 hours of administration and the serum butyric acid concentration remains between about 0.1 mM and 1.0 mM for at least 2 hours.

12. The method according to claim 9, comprising the additional step of administering to said patient a conventional agent for treating a .beta.-hemoglobinopathy in a patient in an amount equal to or less than an amount used in a monotherapy.

13. The method according to claim 12, wherein said conventional agent is a hydroxyurea.

14. A method of inducing differentiation in a malignant cell comprising the step of contacting said cell with a pharmaceutical composition according to any one of claims 1 to 4.

15. The method according to claim 14, wherein said method is used to treat cancer in a patient.

16. The method according to claim 15, wherein said method produces a serum butyric acid concentration of between about 0.1 mM and 1.0 mM within 2 hours of administration and the serum butyric acid concentration remains between about 0.1 mM and 1.0 mM for at least 2 hours.

17. The method according to claim 15, comprising the additional step of administering to said patient a conventional chemotherapeutic agent, in an amount equal to or less than an amount used in a monotherapy.

18. The method according to 15, wherein said cancer is colo-rectal cancer.

19. The method according to claim 15, wherein said cancer is prostate cancer.

20. The method according to claim 14, wherein said composition is administered orally or rectally.

21. A use of a composition according to any one of claims 1 to 3 for the manufacture of a medicament for increasing fetal hemoglobin formation and inducing production of gamma globin or for inducing differentiation in a malignant cell.

22. The use of according to claim 21, wherein said medicament is used for treating .beta.-hemoglobinopathy in a patient.

23. The use according to claim 22, wherein said medicament is used for treating sickle cell anemia, hemoglobin SC disease, hemoglobin SS disease, sickle .beta.-thalssemia, .beta.-thalassemia or congenital Heinz body anemia.

24. The use according to claim 21, wherein said medicament produces a serum butyric acid concentration of between about 0.1 mM and 1.0 mM within 2 hours of administration and remains between about 0.1 mM
and 1.0mM for at least 2 hours.

25. The use according to claim 22, wherein said medicament further comprises a conventional agent for treating .beta.-hemoglobinopathy in a patient in an amount equal to or less than an amount used in a monotherapy.

26. The use according to claim 25, wherein said conventional agent is hydroxyurea.

27. The use according to claim 21, wherein said medicament is used for treating cancer in a patient.

28. The use according to claim 27, wherein said medicament further comprises a conventional chemotherapeutic agent in a amount equal to or less than an amount used in monotherapy.

29. The use according to claim 27 or 28, wherein said cancer is colo-rectal cancer.

30. The use according to claim 27 or 28, wherein said cancer is prostate cancer.

31. The use according to claim 29, wherein said medicament is formulated for oral or rectal administration.