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WO2006105795A1 - Nouveaux dérivés d'indolinone - Google Patents

Nouveaux dérivés d'indolinone Download PDF

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Publication number
WO2006105795A1
WO2006105795A1 PCT/DK2006/000198 DK2006000198W WO2006105795A1 WO 2006105795 A1 WO2006105795 A1 WO 2006105795A1 DK 2006000198 W DK2006000198 W DK 2006000198W WO 2006105795 A1 WO2006105795 A1 WO 2006105795A1
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nhc
alkyl
heteroaryl
aryl
heterocyclyl
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PCT/DK2006/000198
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English (en)
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Laetitia Maud Elysa Bouerat Duvold
Sophie Elisabeth Havez
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Leo Pharma A/S
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Publication of WO2006105795A1 publication Critical patent/WO2006105795A1/fr

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D209/00—Heterocyclic compounds containing five-membered rings, condensed with other rings, with one nitrogen atom as the only ring hetero atom
    • C07D209/02—Heterocyclic compounds containing five-membered rings, condensed with other rings, with one nitrogen atom as the only ring hetero atom condensed with one carbocyclic ring
    • C07D209/04—Indoles; Hydrogenated indoles
    • C07D209/30—Indoles; Hydrogenated indoles with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, directly attached to carbon atoms of the hetero ring
    • C07D209/32—Oxygen atoms
    • C07D209/34—Oxygen atoms in position 2
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
    • C07D401/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings
    • C07D401/06—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
    • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
    • C07D405/06—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms

Definitions

  • the present invention relates to derivatives of indolinone compounds and their inclusion in pharmaceutical compositions intended for oral administration as well as their use in the treatment of inflammatory autoimmune diseases such as multiple sclerosis.
  • Multiple sclerosis is an autoimmune inflammatory disease of the central nervous system characterised by T-cell infiltration, demyelination of white matter and axonal injury. The disease mostly affects young adults with an onset at 20-40 years of age and affects twice as many women as men (A. Compton and A. Coles, The Lancet 359, 6 April 2002, pp. 1221-1231). Multiple sclerosis is more common in temperate climate zones and thus has a prevalence of 50-130 out of 100,000 in northern Europe and North America (N. Hellings et al., Immunologic Research 25(1), 2002, pp. 27-51). While the higher incidence and prevalence of multiple sclerosis in certain European populations has not been adequately explained, it is believed that increased genetic susceptibility in these populations is partly responsible.
  • certain antigens present on pathogenic organisms such as viral or bacterial epitopes which structurally resemble autoantigenic epitopes of, for instance, myelin basic protein, proteolipid protein, myelin-associated glycoprotein or oligodendrocyte glycoprotein, which are all components of the myelin sheath, may lead to activation of T-cells that are reactive with such antigenic epitopes and initiating the inflammatory process eventually resulting in clinical manifestations of multiple sclerosis.
  • This phenomenon is generally referred to as molecular mimicry (Hellings et al., supra; A. Bar-Or et al., J. Neuroimmunol. 100, 1999, pp. 252-259; A. Kami and H. L. Weiner, "Organ-Specific Inflammatory Diseases” Chapter 77 in Clinical Immunology; Principles and Practice, 2 nd Ed. (R.R. Rich et al., Eds.), Mosby, London, 2001).
  • Multiple sclerosis is usually defined as either a relapsing-remitting or a progressive disease.
  • the relapsing-remitting form with which 80% of the patients are initially afflicted is characterised by discrete attacks with full or partial recovery between relapses. In 40-50% of the patients, the disease eventually becomes progressive (secondary progressive stage).
  • the disease may also be progressive from the outset (primary progressive form) characterised by a gradual decline in neurological function with no periods of remission.
  • the clinical symptoms of the relapsing-remitting form of multiple sclerosis may vary widely from one patient to the other, but commonly affected individuals initially experience some degree of visual and sensory impairment, limb paresthesias, limb weakness, clumsiness, fatigue and gait ataxia, while in the later stages cognitive impairment, progressive quadriparesis, sensory loss, ataxic tremors, pain and spasticity are more common (Noseworthy et al., supra).
  • the primary progressive form may initially manifest as one or more of these symptoms, gradually declining into quadriparesis, cognitive decline, visual loss, brainstem syndromes and cerebellar, bowel and bladder dysfunction (Noseworthy et al., supra).
  • multiple sclerosis is characterised by the presence of demyelinated plaques or sclerotic lesions where the myelin sheath surrounding the axons is destroyed.
  • the inflammatory infiltrate in the lesions is composed of T-cells, B-cells, microglia and macrophages which interact with the myelin sheath and participate in the demyelinating process by local production of immune-related molecules such as adhesion molecules, cytokines and chemokines as well as demyelinating antibodies, oxygen free radicals and nitric oxide (Kami and Weiner, supra).
  • T-cells become activated, possibly by cross-reactivity with bacterial or viral antigens that structurally resemble myelin antigens (i.e. the phenomenon known as molecular mimicry) and/or by bacterial superantigens, and persist in an enhanced state of activation (Hellings et al., supra). It has been found that the autoreactive T-cells are predominantly CD4+ T helper cells type 1 (ThI) producing interleukin-2 (IL-2), interferon ⁇ (IFN- ⁇ ) and tumour necrosis factor (TNF- ⁇ ) (B. Gran and A. Rostami, Current Neurology and Neuroscience Reports 1, 2001, pp. 263-270).
  • ThI T helper cells type 1
  • IL-2 interleukin-2
  • IFN- ⁇ interferon ⁇
  • TNF- ⁇ tumour necrosis factor
  • T-cells In order for such proinflammatory T-cells to migrate to the central neurvous system, they express chemokine receptors, adhesion molecules and matrix metalloproteinases that enable them to cross the blood-brain barrier.
  • chemokines which are chemotactic for ThI cells, IP-10 and RANTES, and their corresponding receptors, CXCR3 and CCR5
  • CXCR3 and CCR5 are elevated in sclerotic lesions and cerebrospinal fluid of multiple sclerosis patients (Bar-Or et al., supra).
  • Altered levels of the adhesion molecules ICAM-I and VCAM-I have been identified on endothelial cells of multiple sclerosis lesions (O'Connor et al., supra).
  • ICAM-I and VCAM-I are important for endothelial-leukocyte interactions and leukocyte extravasation.
  • Matrix metalloproteinases expressed by activated T-cells, monocytes and astrocytes may disrupt the basement membrane of the blood-brain barrier and facilitate transmigration of T-cells and breakdown of the extracellular matrix (O'Connor et al., supra).
  • the inflammatory process leads to up-regulation of MHC class II expression and adhesion molecules on the blood-brain barrier endothelium, facilitating a further influx of T-cells, B-cells and macrophages and hence an amplification of the inflammatory response (Hellings et al., supra).
  • This theory is supported by the finding that myelin basic protein reactive T-cell clones from multiple sclerosis patients were found to secrete increased amounts of different cytokines such as TNF- ⁇ , IL-2 and IL-IO (Hellings et al., supra).
  • Demyelination (myelin destruction) is believed to be brought about by the combined effects of cytotoxic cells (macrophages and T-cells), oxygen free radicals, demyelinating autoantibodies and cytokine-induced toxicity (Hellings et al., supra).
  • corticosteroids such as prednisolone have been administered intravenously to multiple sclerosis patients during acute relapses in order to attenuate the inflammatory response. It has been found that treatment with corticosteroids during relapses reduces the duration of relapses and their short-term morbidity, but not the permanent disabilities resulting from repeated relapses (Compton and Coles, supra). Furthermore, treatment with potent corticosteroids at high doses has serious side effects, notably osteoporosis, aseptic bone necrosis, skin atrophy, striae cutis, insomnia, myopathy, posterior and capsular cataract and glaucoma as well as reactivation of the disease upon cessation of treatment.
  • glatiramer acetate In a double-blind trial of relapsing- remitting multiple sclerosis, glatiramer acetate was found to decrease the rate of relapse. Glatiramer acetate is believed to be most effective for mildly disabled patients with a recent diagnosis of multiple sclerosis. Fewer treatment options exist for patients in the progressive phase of the disease. Immunosuppressive therapy, e.g. with cyclophosphamide or methotrexate, is frequently attempted, but it is generally recognised that once the disease enters the progressive stage treatment is very difficult. IFN- ⁇ has been in clinical trials for secondary progressive multiple sclerosis but the results did not show that the treatment slowed progression of disability and the benefits of this treatment in secondary progressive disease are controversial.
  • IFN- ⁇ and glatiramer acetate are peptidic in nature and as such must be administered parenterally, e.g. by injection. This is clearly less convenient to patients than an oral treatment. It would therefore constitute a significant improvement compared to existing multiple sclerosis therapies if a medicament suitable for oral administration were to be developed.
  • the present invention relates to a compound of formula I
  • Ri is -OC(O)R 9 , -NR 10 Ru, -C(O)NR 10 Ru, -OC(O)NRi 0 Rn, -NHC(O)Ri 0 , -NHC(O)ORi 0 , - NHC(O)NR 10 Ru, -S(O)R 9 , -S(O) 2 R 9 , -S(O)OR 9 , -S(O) 2 NR 10 R 11 , -OR 12 , -C(O)R 12 , - C(O)OR 12 , -OC(O)OR 12 , -P(O)(OR 10 )(OR 11 ), -OP(O)(OR 10 )(ORu), polyoxyethylene, C 1-10 alkyl, C 2-I0 alkenyl, C 2 -io alkynyl, aryl, carbocyclyl, heteroaryl or heterocyclyl, said Ci -10 alkyl, C 2-10 alken
  • Rg is C 1-10 alkyl, C 2-10 alkenyl, C 2-I0 alkynyl, aryl, heteroaryl, carbocyclyl or heterocyclyl, said C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl, aryl, heteroaryl, carbocyclyl or heterocyclyl being optionally substituted with one or more substituents selected from the group consisting of halogen, trihalomethyl, C 1-6 alkyl, C 2-6 alkenyl, C 2-6 alkynyl, hydroxy, carboxy, formyl, aryl, heteroaryl, carbocyclyl, heterocyclyl, amino, carbamoyl, cyano, guanidino, carbamido, polyoxyethylene, -ORi 3 , -C(O)Ri 3 , -C(O)ORi 3 , -OC(O)R 13 , - OC(O)OR 13 , -NR 13 R 14
  • Ri 2 is Ci-io alkyl, C 2- io alkenyl, C 2-I0 alkynyl, aryl or carbocyclyl substituted with hydroxy, amino, cyano, halogen, carboxy, nitro, amido, polyoxyethylene, -ORi 3 , -C(O)Ri 3 , - C(O)ORi 3 , -OC(O)Ri 3 , -OC(O)ORi 3 , -NR 13 Ri 4 , -C(O)NRi 3 Ri 4 , -OC(O)NRi 3 Ri 4 , -NHC(O)Ri 3 , -NHC(O)ORi 3 , -NHC(O)NRi 3 Ri 4 , -P(O)(ORi 3 )(OR 14 ), -OP(O)(ORi 3 )(ORi 4 ), -SR i3 , -S(O)R i3 , -S(O) 2
  • Ri 3 and R i4 are the same or different and independently selected from the group consisting of hydrogen, Ci -6 -alkyl, C 2-6 -alkenyl, C 4-6 -alkadienyl, C 2-6 -alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl, or wherein R i3 and Ri 4 , together with the nitrogen atom to which they are attached form a heterocyclic or heteroaryl ring, each Ci- 6 alkyl, C 2-6 alkenyl, C 2-6 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl substituent being optionally substituted with one or more, same or different substituents selected from the group consisting of hydrogen, hydroxy, Ci -4 alkyl, Ci -4 alkoxy, nitro, cyano, amino, oxo, halogen, trihalomethyl, Ci -4 alkylthio, Ci -4 alkylamino, Ci -4 alkoxy
  • R 2/ R 3 , R 4 and R 5 are the same or different and independently selected from the group consisting of hydrogen, halogen, trihalomethyl, Ci -10 alkyl, C 2-I0 alkenyl, C 2- io alkynyl, hydroxy, carboxy, formyl, aryl, heteroaryl, carbocyclyl, heterocyclyl, amino, carbamoyl, cyano, guanidino, carbamido, -ORi 5 , -C(O)Ri 5 , -C(O)ORi 5 , -OC(O)Ri 5 , -OC(O)OR 15 , - NR 15 R 16 , -C(O)NR 15 R 16 , -OC(O)NR 15 R 16 , -NHC(O)R 15 , -NHC(O)ORi 5 , -NHC(O)NRi 5 Ri 6 , - SRi 5 , -S(O)Ri 5
  • Re is hydrogen, C 1-6 alkyl, cycloalkyl, aryl, heteroaryl, heterocyclyl, halogen, -OR 7 , - C(O)R 7 , -C(O)OR 7 , -NR 7 R 8 , S(O) 2 NR 7 R 8 , wherein R 7 and R 8 are independently hydrogen, C 1-6 alkyl, aryl or heterocyclyl, said C 1-6 alkyl or heterocyclyl being optionally substituted by heterocyclyl, -OR 7 , -C(O)R 7 or -C(O)OR 7 ;
  • R 15 and R 16 are the same or different and independently selected from the group consisting of hydrogen, C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl, or wherein R 15 and R 16 , together with the nitrogen atom to which they are attached form a heterocyclic or heteroaryl ring, said C 1-10 alkyl, C 2-I0 alkenyl, C 2-I0 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl being optionally substituted with one or more, same or different substituents selected from the group consisting of hydrogen, halogen, trihalomethyl, C 1-6 -alkyl, C 2- 6-alken
  • the invention in another aspect, relates to a pharmaceutical composition
  • a pharmaceutical composition comprising one or more compounds of formula I together with a pharmaceutically acceptable excipient or vehicle.
  • the invention relates to the use of a compound of general formula I for the preparation of a medicament for preventing, treating or ameliorating multiple sclerosis, or delaying the onset of or reducing the relapse rate in multiple sclerosis.
  • the invention relates to a method of preventing, treating or ameliorating multiple sclerosis, or delaying the onset of or reducing the relapse rate in multiple sclerosis, the method comprising administering to a patient in need thereof an effective amount of a compound of formula I.
  • Ci-u-alkyl is intended to mean a linear or branched hydrocarbon group having 1 to 12 carbon atoms, such as methyl, ethyl, propyl, iso- propyl, butyl, te/t-butyl, /so-butyl, pentyl, hexyl, etc.
  • C 1-10 alkyl and “C 1-6 -alkyl” are intended to denote a linear or branched hydrocarbon group having 1 to 10 or 1 to 6 carbon atoms, respectively, such as methyl, ethyl, propyl, /so-propyl, pentyl or hexyl
  • C 1-4 -alkyl is intended to cover linear or branched hydrocarbon groups having 1 to 4 carbon atoms, e.g. methyl, ethyl, propyl, /so-propyl, butyl, /so-butyl, te/t-butyl.
  • C 2- i 2 -alkenyl are intended to cover linear, cyclic or branched hydrocarbon groups having 2 to 12, 4 to 12 or 6 to 12 carbon atoms and comprising one, two or three unsaturated bonds.
  • alkenyl groups are vinyl, allyl, butenyl, pentenyl, hexenyl, heptenyl, octenyl, heptadecaenyl, butadienyl, pentadienyl, hexadienyl, heptadienyl, heptadecadienyl, hexatrienyl, heptatrienyl, octatrienyl and heptadecatrienyl.
  • Preferred examples of alkenyl are vinyl, allyl, butenyl, especially allyl.
  • aryl is intended to mean a fully or partially aromatic carbocyclic ring or ring system, such as phenyl, naphthyl, 1,2,3,4-tetrahydronaphthyl, anthracyl, phenanthracyl, pyrenyl, benzopyrenyl, fluorenyl and xanthenyl, among which phenyl is a preferred example.
  • heteroaryl groups are oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, pyrrolyl, imidazolyl, pyrazolyl, pyridinyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, coumaryl, furyl, thienyl, quinolyl, benzothiazolyl, benzotriazolyl, benzodiazolyl, benzooxazolyl, phthalazinyl, phthalanyl, triazolyl, tetrazolyl, isoquinolyl, acridinyl, carbazolyl, dibenzazepinyl, indolyl, benzopyrazolyl, phenoxazonyl.
  • heterocyclyl groups examples include imidazolidine, piperazine, hexahydropyridazine, hexahydropyrimidine, diazepane, diazocane, pyrrolidine, piperidine, azepane, azocane, aziridine, azirine, azetidine, pyroline, tropane, oxazinane (morpholine), azepine, dihydroazepine, tetrahydroazepine, hexahydroazepine, oxazolane, oxazepane, oxazocane, thiazolane, thiazinane, thiazepane, thiazocane, oxazetane, diazetane, thiazetane, tetrahydrofuran, tetrahydropyran, oxepane, tetrahydrothiophene, tetrahydro
  • polyoxyethylene is intended to indicate a group of formula R*(OCH 2 CH 2 ) S -, wherein R* is hydrogen or alkyl as defined above and s is an integer of 1-200, such as 1- 100, 1-80, 1-70, 1-60, 1-50, 1-40, 1-30, 1-20, 1-10, 1-8, 1-6, 1-5, 1-4 or 1-3.
  • alkylaryl is intended to indicate an alkyl group covalently joined to an aryl group.
  • carbamoyl is intended to indicate the group -C(O)NH 2 .
  • pharmaceutically acceptable salt is intended to indicate salts prepared by reacting a compound of formula I with a suitable inorganic or organic acid, e.g. hydrochloric, hydrobromic, hydroiodic, sulfuric, nitric, acetic, phosphoric, lactic, maleic, phthalic, citric, propionic, benzoic, glutaric, gluconic, methanesulfonic, salicylic, succinic, tartaric, toluenesulfonic, sulfamic or fumaric acid.
  • a suitable inorganic or organic acid e.g. hydrochloric, hydrobromic, hydroiodic, sulfuric, nitric, acetic, phosphoric, lactic, maleic, phthalic, citric, propionic, benzoic, glutaric, gluconic, methanesulfonic, salicylic, succinic, tart
  • indolinone compound (used synonymously with “oxindole compound” herein) is intended to include compounds of formula I and formula I' as shown herein as well as other, structurally related compounds, such as the compounds disclosed in WO
  • prodrug is intended to indicate a derivative of an active compound of formula I' which does not, or does not necessarily, exhibit the physiological activity of the active compound, but which may be subjected to enzymatic or other type of cleavage such as hydrolysis in vivo so as to release the active compound of formula I' on administration of the prodrug.
  • the prodrug comprises the active compound which in itself is highly lipophilic provided with a side chain with predominantly hydrophilic properties imparting improved solubility characteristics to the prodrug, thereby making it more suitable for parenteral administration in the form of a solution or for oral administration to obtain an improved bioavailability, cf. H. Bundgaard, Design of Prodrugs, Elsevier, 1985; H.
  • EAE experimentally induced autoimmune encephalomyelitis
  • EAE experimentally induced autoimmune encephalomyelitis
  • EAE may be induced by injection of antigenic peptides of myelin such as myelin basic protein, proteolipid protein and myelin oligodendrocyte glycoprotein.
  • EAE is an inflammatory condition of the central nervous system characterised by T-cell infiltration and focal demyelination.
  • EAE can also be induced by transfer of myelin reactive T-cells to normal individuals.
  • ameliorate is intended to mean reducing the severity of the neurological symptoms during relapses of multiple sclerosis by administering an effective amount of an active compound whereby it may be possible to reduce or delay permanent disability resulting from neurological damage sustained during relapse, in particular demyelination.
  • delay the onset of multiple sclerosis is used to indicate a prophylactic administration of an effective amount of an active compound to prolong the period where no symptoms, or at least no severe symptoms, of multiple sclerosis are observed in susceptible individuals, e.g. in first-degree relatives of multiple sclerosis patients.
  • the term "reduce the relapse rate in multiple sclerosis” is intended to mean reducing the frequency with which relapses occur or, in other words, prolong the periods of remission. This may make it possible to reduce or delay the accumulation of disabilities resulting from the neurological damage sustained during each relapse, in particular demyelination which eventually leads to increasingly severe disability.
  • Ri is -OC(O)R 9 , -C(O)NR 10 R 11 , - OC(O)NR 10 R 11 , -S(O) 2 R 9 , -OR 12 , -C(O)R 12 , -C(O)OR 12 , -OC(O)OR 12 , -P(O)(OR 10 )(OR 11 ), - OP(O)(OR 10 )(OR 11 ), polyoxyethylene, C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl or aryl, said C 1-10 alkyl, C 2-10 alkenyl, C 2-10 alkynyl or aryl being substituted with one or more substituents selected from the group consisting of -OR 10 , -C(O)R 10 , -C(O)OR 10 , - OC(O)R 10 , -OC(O)OR 10 , -NR 10
  • Ri may be -OC(O)R 9 , -0R i2 , -C(O)Ri 2 or Ci -I0 alkyl, said Ci -I0 alkyl being substituted with one or more substituents selected from the group consisting of polyoxyethylene, heterocyclyl, -OR i0 , -C(O)Ri 0 , -C(O)ORi 0 , -OC(O)Ri 0 , -OC(O)ORi 0 , - NRi 0 Ri I , -C(O)NRi 0 R 11 , -OC(O)NR 1O R 1I rOP(O)(ORi O )(ORi I ) ⁇ P(O)(OR 1O )(OR 1I ), NHC(O)Ri 0 , -NHC(O)ORi 0 , -NHC(O)NR I0 R U , "SR I0 , -S(O
  • the compounds of formula I may be prodrugs, i.e. converted in vivo to compounds of formula I'
  • R 10 , Rio' and R u are the same or different and independently selected from the group consisting of hydrogen, Ci -I0 alkyl, C 2-I0 alkenyl, C 2-I0 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl, or wherein Ri 0 and R u , together with the nitrogen atom to which they are attached form a heterocyclic or heteroaryl ring, each of Ci -I0 alkyl, C 2-I0 alkenyl, C 2-I0 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl being optionally substituted with one or more, same or different substituents selected from the group consisting of hydrogen, halogen, trihalomethyl, Ci- 6 alkyl, C 2-6 alkenyl, C 2-6 alkynyl, hydroxy, carboxy, formyl, aryl, heteroaryl, carbocyclyl, heterocyclyl, amino, carbamoyl,
  • Ri 0 and R 10 ' are the same or different and independently selected from the group consisting of hydrogen, Ci -I0 alkyl, C 2-I0 alkenyl, C 2-I0 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl, each of Ci -I0 alkyl, C 2-i0 alkenyl, C 2-I0 alkynyl, aryl, heteroaryl, carbocyclyl and heterocyclyl being optionally substituted with one or more, same or different substituents selected from the group consisting of hydrogen, halogen, trihalomethyl, Ci -6 alkyl, C 2-6 alkenyl, C 2-6 alkynyl, hydroxy, carboxy, formyl, aryl, heteroaryl, carbocyclyl, heterocyclyl, amino, carbamoyl, cyano, guanidino, carbamido, - ORi 3 , -C(O)Ri 3 , -C(O)
  • R 6 is hydrogen.
  • R 1 ', R 2 ', R 3 ', R 4 ' and R 5 ' are the same or different and independently selected from the group consisting of hydrogen, C 1- io alkyl, Ci -10 alkoxy, aryl, heteroaryl, aryloxy, Ci -I0 alkylaryl, Ci -10 alkylaryloxy, halogen, trihalomethyl, S(O)R 20 , S(O) 2 R 20 , S(O) 2 NR 20 R 2I , S(O) 2 OR 20 , SR 20 , NO 2 , NR 20 R 21 , OR 20 , CN, CH 2 OH, C(O)R 20 , C(O)OR 20 , OC(O)R 20 , NHC(O)R 20 , -NHC(O)OR 20 , -NHC(O)NR 20 R 21 , (CH 2 )
  • R 1 ', R 2 ', R 3 ', R 4 ' and R 5 ' may the same or different and independently selected from the group consisting of hydrogen, C 1-6 alkyl, C 1-6 alkoxy and halogen.
  • T-cells contribute to the development of several chronic inflammatory and autoimmune diseases. Initially in the disease process, naive T-cells are activated by antigens and produce the proinflammatory cytokine interleukin-2 (IL-2) leading to clonal expansion and production of other inflammatory cytokines involved in the generation of the inflammatory or autoimmune response. Excessive T-cell activity is involved in allergies and immunoinflammatory diseases such as asthma, psoriasis, rheumatoid arthritis and multiple sclerosis. IL-2 has been found to have an important role in promoting the growth of T-cells in that it is a growth factor for both CD4+ and CD8+ T-cells as well as natural killer cells.
  • IL-2 has been found to have an important role in promoting the growth of T-cells in that it is a growth factor for both CD4+ and CD8+ T-cells as well as natural killer cells.
  • IL-2 influences the differentiation of T helper cells into ThI and Th2 cells and potentiates the production of cytokines by each cell type.
  • IL-2 appears to be initially produced by activated CD4+ T- cells, inducing proliferation of CD8+ T-cells and production of proinflammatory cytokines such as IL-I, IL-6 and TNF- ⁇ .
  • compounds of formula I may be used in the prevention and treatment of other ThI mediated inflammatory diseases and conditions apart from multiple sclerosis, such as inflammatory bowel disease, Crohn's disease, allergies, asthma, arthritis, e.g. gout or rheumatoid arthritis, inflammatory skin diseases, e.g. psoriasis or atopic dermatitis, neuroinflammatory diseases, systemic vasculitis, arteritis, glomerulonephritis, synovitis, osteomyelitis, autoimmune inner ear disease or sepsis and septic conditions.
  • ThI mediated inflammatory diseases and conditions apart from multiple sclerosis such as inflammatory bowel disease, Crohn's disease, allergies, asthma, arthritis, e.g. gout or rheumatoid arthritis, inflammatory skin diseases, e.g. psoriasis or atopic dermatitis, neuroinflammatory diseases, systemic vasculitis, arteritis, glomerulonephritis,
  • compounds of formula I may be used as modifiers of angiogenesis, e.g. in the treatment pathological conditions and diseases associated with deregulated angiogenesis such as rosacea, atherosclerosis, hemangioma, warts, pyogenic granuloma, scarring, nasal polyps, transplantation, liver regeneration, bone and cartilage destruction, pannus growth, osteophyte formation, endometriosis, dysfunctional uterine bleeding, follicular cysts, ovarian hyperstimulation, thyroiditis, thyroid enlargement, obstructive lung disease, diabetic or ischemic retinopathy, neovascular glaucoma, age-related macular degeneration, acute macular degeneration, retinitis, cytomegalovirus retinitis, macular edema, choroidal neovascularisation, or cerebral ischemia reperfusion injury.
  • angiogenesis e.g. in the treatment pathological conditions and diseases associated with deregulated angiogenesis such as
  • the compound or compounds of formula I may be formulated into a pharmaceutical composition together with a pharmaceutically acceptable vehicle and optionally one or more other therapeutic agents.
  • a pharmaceutically acceptable vehicle such as corticosteroids or non-steroid anti-inflammatory drugs, or immunosuppressive drugs such as methotrexate or cyclophosphamide.
  • anti-inflammatory drugs such as corticosteroids or non-steroid anti-inflammatory drugs
  • immunosuppressive drugs such as methotrexate or cyclophosphamide.
  • the vehicle must be "pharmaceutically acceptable” in the sense of being compatible with the other ingredients of the formulation and not deleterious to the recipient thereof.
  • the formulation may be in a form suitable for oral or parenteral (including subcutaneous, intramuscular, interperitoneal, intraarticular and intravenous) administration.
  • the formulations may conveniently be presented in dosage unit form and may be prepared by any of the methods well known in the art of pharmacy, e.g. as disclosed in Remington, The Science and Practise of Pharmacy, 20 th Ed., 2000. All methods include the step of bringing the active ingredient into association with the vehicle which constitutes one or more excipients. In general, the formulations are prepared by uniformly and intimately bringing the active ingredient into association with a liquid vehicle or a finely divided solid vehicle or both, and then, if necessary, shaping the product into the desired formulation.
  • the compounds of formula I are small organic molecules and may therefore be administered orally. This represents a clear benefit for the patient as it permits self-medication and is less painful than for instance injections of IFN- ⁇ which often cause pain at the site of injection.
  • Compounds of formula I have surprisingly exhibited an excellent oral bioavailability and EAE inhibitory activity, cf. Table 1 below, and may therefore be suitable for oral administration.
  • Suitable dispersing or suspending agents for aqueous suspensions include synthetic or natural gums such as tragacanth, alginate, acacia, dextran, sodium carboxymethylcellulose, gelatin, methylcellulose and polyvinylpyrrolidone.
  • the active ingredient may also be administered in the form of a bolus, electuary or paste.
  • a tablet may be prepared by compressing or moulding the active ingredient optionally with one or more excipients.
  • Compressed tablets may be prepared by compressing, in a suitable machine, the active ingredient(s) in a free-flowing form such as a powder or granules, optionally mixed with a binder, such as lactose, glucose, starch, gelatine, acacia gum, tragacanth gum, sodium alginate, carboxymethylcellulose polyethylene glycol, waxes, hydroxypropylmethylcellulose, microcrystalline cellulose or the like; a lubricant such as sodium oleate, sodium stearate, magnesium stearate, calcium stearate, sodium benzoate, sodium acetate, sodium chloride or the like; a disintegrating agent such as starch, methyl cellulose, agar, bentonite, xanthan gum, croscarmellose, crospovidone, sodium starch glycolate, alginic acid, guar gum, carboxymethylcellulose
  • Moulded tablets may be made by moulding, in a suitable machine, a mixture of the powdered active ingredient and suitable carrier moistened with an inert liquid diluent.
  • Capsule formulations may be in the form of hard or soft capsules, e.g. gelatin capsules, containing the active ingredient in a suitable dry or liquid vehicle.
  • Hard capsules typically contain the active ingredient in powder or crystalline form together with one or more dry excipients which may conveniently be selected from the excipients indicated above for use in tablet formulations.
  • Soft capsules typically contain a solution, suspension or emulsion comprising the active ingredient. Suitable excipients for soft capsules include, for instance, suspension vehicles such as vegetable, animal or mineral oils, e.g.
  • the compounds of formula I may also be included as a solid solution or dispersion, e.g. prepared by dissolving the active ingredient in a molten carrier, filling the molten mixture into the capsules and letting it cool.
  • the formulations comprising a compound of formula I may include one or more additional ingredients such as buffers, flavouring agents, colourants, thickeners, preservatives, e.g. methyl hydroxy benzoate (including anti-oxidants), emulsifying agents and the like.
  • Tablets or capsules may optionally be provided with a coating for modifying the release of the active ingredient therefrom.
  • Suitable coating materials comprise, e.g. mixtures of wax with stearic acid, glyceryl monostearate, palmitic acid, glyceryl monopalmitate, cetyl alcohol, shellac, zein, ethylcellulose, acrylic resins or cellulose acetate or diacetate.
  • daily doses of from 0.001-100 mg/kg body weight, preferably from 0.002-15 mg/kg body weight, for example 0.003-10 mg/kg of a compound of formula I are administered, typically corresponding to a daily dose for an adult human of from 0.2 to 750 mg of the active ingredient.
  • Oral compositions are formulated, preferably as tablets, capsules, or drops, containing from 0.05-250 mg, preferably from 0.1-125 mg, of a compound of formula I per dosage unit.
  • the compounds of general formula I can be prepared in a number of ways well known to those skilled in the art of organic synthesis.
  • the compounds of formula I can be synthesised using the methods outlined below, together with methods known in the art of synthetic organic chemistry, or variations thereof as appreciated by those skilled in the art. Preferred methods include, but are not limited to, those described below.
  • the compounds of formula I can be prepared by techniques and procedures readily available to one of ordinary skill in the art, for example by following the procedures as set forth in the following schemes.
  • the reactions are performed in solvents appropriate to the reagents and materials employed and suitable for the transformations being effected.
  • all proposed reaction conditions including choice of solvent, reaction atmosphere, reaction temperature, duration of experiment and work-up procedures, are chosen to be conditions of standard for that reaction, which should be readily recognised by one skilled in the art.
  • the functionalities present on various portions of the starting molecules in a reaction must be compatible with the reagents and reactions proposed. Not all compounds of formula I falling into a given class may be compatible with some of the reaction conditions required in some of the methods described. Such restrictions to the substituents which are compatible with the reaction conditions will be readily apparent to one skilled in the art and alternative methods can be used.
  • R 1 R 1 ⁇ H
  • the introduction of R 1 may occur at different stage of the synthesis.
  • the precursor of R 1 may be purchased or synthesised as a reactive species.
  • R 1 may be chemically modified after its introduction on the indolinone, before or after condensation to the benzaldehyde / benzoketone.
  • Base such as nitrogen base or inorganic base.
  • nitrogen bases are selected from acyclic and cyclic amines. Examples of nitrogen bases include, but are not limited to, ammonia, methylamine, trimethylamine, triethylamine, aniline, 1,8- diazabicyclo-[5.4.1]-undec-7-ene, diisopropyl ethylamine, pyrrolidine, piperidine, morpholine, and pyridine or substituted pyridine (e.g., 2,6-di-te/tbutylpyridine).
  • Inorganic bases are bases that do not contain any carbon atoms. Examples of inorganic bases include, but are not limited to, hydroxide, phosphate, bisulfate, hydrosulfide (SH " ), and amide anions. Preferred nitrogen bases are piperidine and morpholine. Preferred inorganic bases are hydroxide anion, preferably used as its sodium or potassium salt.
  • the reaction generally takes place in a protic solvent such as water or alcohols or in an aprotic solvent such as toluene, CH 2 CI 2 , THF, DMF. Most preferred solvents are alcohols such as ethanol, and CH 2 CI 2 .
  • R 1 X Alkylation by R 1 X in the presence of a base such as NEt 3 , NaH, NaOH, KOH, carbonates in an appropriate solvent such as DMF, pyridine, DMSO, CH 3 CN, acetone, toluene.
  • a base such as NEt 3 , NaH, NaOH, KOH, carbonates in an appropriate solvent such as DMF, pyridine, DMSO, CH 3 CN, acetone, toluene.
  • X is a leaving group such as chloride, bromide, and iodide.
  • reaction with an alcohol R x OH may also be considered.
  • Such reaction is run in the presence of a phosphine such as PBu 3 , PPh 3 and the like, an azodicarboxylate or an azodicarboxamide in an aprotic solvent, typically THF.
  • a phosphine such as PBu 3 , PPh 3 and the like
  • an azodicarboxylate or an azodicarboxamide in an aprotic solvent, typically THF.
  • reaction with an aldehyde such as formaldehyde, acetaldehylde, and the like, and a suitable amine affords a compound of general formula II.
  • the solvent in which the reaction is carried out may be a protic or an aprotic solvent, preferably it is a protic solvent such as an alcohol e.g., methanol or ethanol, or an aqueous alcohol.
  • the reaction may be carried out at temperatures greater than room temperature. The temperature is generally from about 20 0 C to about 100 0 C, preferably about 40 0 C to about 80 0 C.
  • Suitable amines include acyclic and cyclic secondary amines such as diethyl amine, ⁇ /-te/t-butyl methylamine, diisobutylamine, piperidine, morpholine, ⁇ /-methyl piperazine, 3,3- dimethylpiperidine and the like.
  • a preformed Mannich reagent such as an aminal, an /V,O-acetal, a benzotriazole aminal or an iminium salt in the presence of a base such as NEt 3 , t-BuOK, n-BuLi.
  • Scheme 4 is depicting the synthesis of compounds of general formula III.
  • acetyl chloride, propionyl chloride and carboxylic acid active esters (e.g. p-nitrophenyl ester, pentafluorophenyl ester).
  • the reaction is carried out in an organic base such as pyridine, DMAP and the like.
  • IHb can be obtained by reaction with chloroformates; IUc may be obtained by reaction with carbamoyl chlorides or icocyanates.
  • Formation of IHd may be achieved by alkylation of the intermediate alcohol following b. f. To obtain Ilia reaction with an aldehyde and a suitable acylating agent as described in d. and e., respectively without isolating the intermediate alcohol.
  • R 1 CHR 10 OC(O)R 10
  • R 1 CHR 10 OC(O)OR 10
  • Rl CHR 10 OC(O)NR 10
  • a synthesis of R 1 CI is exemplified in scheme 5
  • Scheme 5 is an example but one skilled in the art may consider alternative method for the synthesis of such alkylating agent.
  • Scheme 5 exemplifies the synthesis of carboxylic esters, carbonic esters, and carbamates.
  • the chlorine atom may be interchanged with iodide with methods known to those skilled in the art such as NaI in acetone.
  • Acylation may be obtained via reaction with an acylating agent such as acid anhydride (e.g. acetic anhydride, succinic anhydride), acid halides (e.g. acetyl chloride, propionyl chloride), carboxylic acid active esters (e.g. p-nitrophenyl ester, pentafluorophenyl ester), chloroformates and carbamoyl chlorides.
  • the reaction is carried out in an organic base such as pyridine, DMAP and the like or in an aprotic solvent such as CH 3 CN, DMF in the presence of a base such as NEt 3 , DMAP, pyridine or NaH.
  • reaction may be catalysed by bases or by acids such as p-toluene sulfonic acid, pyridinium p-toluenesulfonate, POCI 3 , trimethylsilyliodide and the like.
  • the hydroxyl functionality may be acylated following e.
  • Ri contains a carboxylic functionality, it may be modified as described in the following scheme, wherein n is an integer of from 1 to 10.
  • n Standard hydrolysis conditions using first a base such as an aqueous solution of LiOH or NaOH followed by treatment with an acid such as an aqueous solution of HCI.
  • Esterification using classical esterification conditions see March's Advanced Organic Chemistry Reactions, mechanisms, and Structure, 5 th edition, by M. B. Smith and 3. March chapter 10-23 p. 484, chapter 10-26 p. 488 and chapter 10- 28 p. 490) such as acid catalysed esterification (e.g. using sulphuric acid as a catalyst in MeOH), or such as base catalyzed esterification (e.g.
  • Preferred coupling agents include 1,1'- carbonyldiimidazole (CDI), diphenylphoshinic chloride (DPP-CI), benzotriazol- yloxy-tripyrolidinophosphonium hexafluorophosphate (PyBOP), benzotriazol-1- yloxy-tris(dimethylamino)-phosphonium hexafluorophosphate (BOP), N, N'- dicyclohexylcarbodiimide (DCC), or l-ethyl-3-(3-dimethylaminopropyl)- carbodiimide; hydrochloride (EDCI).
  • CDI 1,1'- carbonyldiimidazole
  • DPP-CI diphenylphoshinic chloride
  • PyBOP benzotriazol- yloxy-tripyrolidinophosphonium hexafluorophosphate
  • BOP benzotriazol-1- yloxy-tris
  • Preferred bases include diisopropylethylamine, triethylamine, 4-methylmorpholine, or pyridine or a substituted pyridine, for example 4-dimethylaminopyridine or 2,6- dimethylpyridine.
  • Preferred solvents are solvents such as diethylether, dichloromethane, tetrahydrofuran, l-methyl-2-pyrrolidinone, dimethylsulfoxyde or dimethylformamide.
  • the reactions are generally carried out in the presence of a base such as Et 3 N or Bu 3 N and in the presence of an activator such as HOBt (for example where HOBt is used to improve reactions rates, see Windridge, G. C; Jorgensen, E. C. JACS 1971, 93, 6318), at a temperature between about -78 0 C to about 60 0 C, and are normally complete within about 2 hours to about 5 days.
  • Example 12 l-[(Diisobutylamino)-methyl]-3-(2,5-dimethyl-benzylidene)-l,3-dihydro- indol-2-one
  • Example 13 l-[l,4']Bipiperidinyl-l'-ylmethyl-3-(2,5-dimethyl-benzylidene)-l,3-dihydro- indol-2-one
  • Example 17 Acetic acid l-[3-(2,5-dimethoxy-benzylidene)-2-oxo-2,3-dihydro-indol-l- yl]-ethyl ester
  • Example 18 Acetic acid [3-(2,5-dimethoxy-benzylidene)-2-oxo-2,3-dihydro-indol-l-yl]- (2,2-dimethyl-[l,3]dioxolan-4-yl)-methyl ester
  • Example 20 3-[Hydroxy-(4-nitro-phenyl)-methylene]-2-oxo-2,3-dihydro-indole-l- carboxylic acid phenyl ester
  • Compound A 3-(2,5-Dimethoxy-benzylidene)-l-piperidin-l-ylmethyl-l,3-dihydro-indol- 2-one;
  • Compound B l-[l,4']Bipiperidinyl-l'-ylmethyl-3-(2,5-dimethoxy-benzylidene)-l,3- dihydro-indol-2-one;
  • Compound C 3-(2,5-dimethoxy-benzylidene)-l,3-dihydro-indol-2-one (compound 110 in PCT/DK2004/000875)
  • Peptide The following peptide from myelin proteolipid protein was used; PLPi 39-I53 H- HCLGKWLGHPDKFVG-OH.
  • the peptide was synthesized by Fmoc chemistry (Schafer-N, Copenhagen, Denmark). Purity (>95%) was verified by reversed-phase HPLC and integrity by mass spectrometry.
  • mice Female SJL/J (H-2 S ) inbred mice purchased from Charles River.
  • mice (about 8 weeks old) were immunized on day 0 with the PLPi 39 -i 53 peptide (dissolved in sterile NaCI) emulsified 1:1 (vol/vol) in Complete Freund's Adjuvant (5 mg Mycobacterium tuberculosis/ ' ml) (SSI, Copenhagen, Denmark).
  • Intradermal injections corresponding to 100 ⁇ g peptide and 125 ⁇ g Mycobacterium tuberculosis were given at the base of the tail in a total volume of 50 ⁇ l.
  • the mice were additionally given an i.v. injection with 100 ng pertussis toxin (Sigma) dissolved in sterile NaCI on day 0 and day 2, injection volume was 100 ⁇ l.
  • mice were dosed daily with compounds (50 mg/kg p.o.) in suspension vehicle (4 g Tween-80, 2 g Carboxy-methyl cellulose 7H4XF, 8 g NaCI, 1 liter H 2 O), starting on day 1.
  • suspension vehicle 4 g Tween-80, 2 g Carboxy-methyl cellulose 7H4XF, 8 g NaCI, 1 liter H 2 O
  • Control groups were given either suspension vehicle or dexamethasone (Dexadreson Vet, Intervet, Holland) (1 mg/kg).
  • AUC Area-under-curve

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Abstract

La présente invention concerne de nouveaux dérivés d'indolinone de formule I où X, Ri, R2, R3, R4, Rs, Re, Ri', FV/ FV/ IV et R5' sont tels que présentés dans la présente invention, ainsi que leur application au traitement de maladies inflammatoires auto-immunes telles que la sclérose en plaques, en particulier par administration par voie orale.
PCT/DK2006/000198 2005-04-08 2006-04-07 Nouveaux dérivés d'indolinone WO2006105795A1 (fr)

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Publication number Priority date Publication date Assignee Title
CN104211632A (zh) * 2013-05-31 2014-12-17 中国人民解放军军事医学科学院放射与辐射医学研究所 具有酪氨酸激酶抑制活性的2-吲哚酮衍生物及其制备方法与应用
CN104402792A (zh) * 2014-11-13 2015-03-11 中国科学院南海海洋研究所 一种吲哚-3-甲醛类化合物的制备方法和应用
JP2018514572A (ja) * 2015-04-30 2018-06-07 エムユーエスシー ファウンデーション フォー リサーチ ディベロップメント オキシンドール化合物およびその医薬組成物

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EP0252713A1 (fr) * 1986-07-10 1988-01-13 Pfizer Inc. Dérivés de l'indolinone
US5124347A (en) * 1991-07-31 1992-06-23 Warner-Lambert Co. 3-5-ditertiarybutylphenyl-4-hydroxymethylidene derivatives of 1,3-dihydro-2H-indole-2-ones as antiinflammatory agents
US5206261A (en) * 1989-07-25 1993-04-27 Taiho Pharmaceutical Company, Limited Oxindole derivative
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EP0815859A1 (fr) * 1996-01-17 1998-01-07 Taiho Pharmaceutical Company Limited Inhibiteurs d'epaississement de l'intima
WO1998024766A1 (fr) * 1996-12-06 1998-06-11 Pfizer Inc. Derives de 6-phenylpyridyl-2-amine utilises comme inhibiteurs de nos
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EP0252713A1 (fr) * 1986-07-10 1988-01-13 Pfizer Inc. Dérivés de l'indolinone
US5206261A (en) * 1989-07-25 1993-04-27 Taiho Pharmaceutical Company, Limited Oxindole derivative
US5124347A (en) * 1991-07-31 1992-06-23 Warner-Lambert Co. 3-5-ditertiarybutylphenyl-4-hydroxymethylidene derivatives of 1,3-dihydro-2H-indole-2-ones as antiinflammatory agents
US5382593A (en) * 1992-07-21 1995-01-17 Adir Et Compagnie New 3-(hydroxybenzylidenyl)-indolin-2-ones
EP0815859A1 (fr) * 1996-01-17 1998-01-07 Taiho Pharmaceutical Company Limited Inhibiteurs d'epaississement de l'intima
WO1998024766A1 (fr) * 1996-12-06 1998-06-11 Pfizer Inc. Derives de 6-phenylpyridyl-2-amine utilises comme inhibiteurs de nos
US20020028936A1 (en) * 1999-04-12 2002-03-07 Gerhard Sperl 1,3-disubstituted indolin-2-ones for neoplasia
US20020099208A1 (en) * 2000-12-20 2002-07-25 Kuo-Long Yu Heterocyclic substituted 2-methyl-benzimidazole antiviral agents
WO2005058309A1 (fr) * 2003-12-16 2005-06-30 Leo Pharma A/S Nouvelle utilisation therapeutique de derives d'indolinone

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Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104211632A (zh) * 2013-05-31 2014-12-17 中国人民解放军军事医学科学院放射与辐射医学研究所 具有酪氨酸激酶抑制活性的2-吲哚酮衍生物及其制备方法与应用
CN104402792A (zh) * 2014-11-13 2015-03-11 中国科学院南海海洋研究所 一种吲哚-3-甲醛类化合物的制备方法和应用
JP2018514572A (ja) * 2015-04-30 2018-06-07 エムユーエスシー ファウンデーション フォー リサーチ ディベロップメント オキシンドール化合物およびその医薬組成物
US10370328B2 (en) 2015-04-30 2019-08-06 Musc Foundation For Research Development Oxindole compounds and pharmaceutical compositions thereof
JP2020019786A (ja) * 2015-04-30 2020-02-06 エムユーエスシー ファウンデーション フォー リサーチ ディベロップメント オキシンドール化合物およびその医薬組成物

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