Use of prodrugs of fumarates in treating heart failure diseases

Abstract

Methods and pharmaceutical compositions comprising one or more prodrugs (e.g., aminoalkyl prodrugs) of monomethyl fumarate (MMF) thereof are provided herein for the treatment of a heart failure disease, including heart failure with preserved ejection fraction. The compounds of the present disclosure are configured to be converted in vivo, upon oral administration, to monomethyl fumarate. Upon conversion, the active moiety (i.e., monomethyl fumarate) of various embodiments is effective in treating subjects suffering from a heart failure disease, including heart failure with preserved ejection fraction.

1 - 20 . (canceled) 
     
     
         21 . A method of treating heart failure with preserved ejection fraction in a subject having heart failure with preserved ejection fraction, the method comprising administering to the subject a therapeutically effective amount of one or more prodrugs of monomethyl fumarate comprising a compound of Formula (I), or a pharmaceutically acceptable salt, polymorph, hydrate, solvate, or co-crystal thereof: 
       
         
           
           
               
               
           
         
         wherein: 
         R 1  is unsubstituted C 1 -C 6  alkyl; 
         L a  is substituted or unsubstituted C 1 -C 6  alkyl linker, substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted C 6 -C 10  aryl, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S; and 
         R 2  and R 3  either:
 (a) are each, independently, H, substituted or unsubstituted C 1 -C 6  alkyl, substituted or unsubstituted C 2 -C 6  alkenyl, substituted or unsubstituted C 2 -C 6  alkynyl, substituted or unsubstituted C 6 -C 10  aryl, substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S; or 
 (b) together with the nitrogen atom to which they are attached, form a substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S or a substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S. 
 
       
     
     
         22 . The method of claim  1 , wherein a pharmaceutical composition is administered to the subject, wherein said pharmaceutical composition comprises a therapeutically effective amount of the one or more prodrug of monomethyl fumarate that is shown to provide MMF plasma exposure comparable to dimethyl fumarate 120 mg to 720 mg per day. 
     
     
         23 . The method of claim  1 , wherein said pharmaceutical composition comprises 210 mg to 1260 mg of the compound. 
     
     
         24 . The method of claim  1 , wherein the one or more prodrugs of monomethyl fumarate are administered in combination with one or more second agents useful for treating heart failure, 
     
     
         25 . The method of  claim 24 , wherein the second agent is selected from the group consisting of: a diuretic, an ACE-inhibitor, a beta-blocker, an angiotensin receptor blocker, isosorbide dinitrate, hydralazine, an angiotensin receptor-neprilysin inhibitor, an aldosterone antagonist, a PDE5 inhibitor, a statin, a neprilysin inhibitor, an aldosterone inhibitor, and an antitumor necrosis factor-alpha therapy. 
     
     
         26 . The method of  claim 25 , wherein the second agent is the statin. 
     
     
         27 . The method of  claim 21 , wherein treating comprises reducing mortality or improving survival in the subject having heart failure with preserved ejection fraction. 
     
     
         28 . The method of  claim 21 , wherein treating comprises increasing maximum myocardial oxygen consumption in the subject. 
     
     
         29 . The method of  claim 28 , wherein the maximum myocardial oxygen consumption is increased to greater than 14 mL/g/min. 
     
     
         30 . The method of  claim 21 , wherein treating comprises one or more of: reducing ventricular stiffness and improving ventricular relaxation in the subject. 
     
     
         31 . A method of treating heart failure with preserved ejection fraction in a subject having heart failure with preserved ejection fraction, the method comprising administering to the subject a therapeutically effective amount of one or more prodrugs of monomethyl fumarate comprising a compound of Formula (III), or a pharmaceutically acceptable salt, polymorph, hydrate, solvate, or co-crystal thereof: 
       
         
           
           
               
               
           
         
         wherein: 
         R 1  is unsubstituted C 1 -C 6  alkyl; 
       
       
         
           
           
               
               
           
         
         is selected from the group consisting of: 
           
       
       
         
           
           
               
               
           
         
         X is N, O, S, or SO 2 ; 
         Z is C or N; 
         m is 0, 1, 2, or 3; 
         n is 1 or 2; 
         w is 0, 1, 2, or 3; 
         t is 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10; 
         R 6 , R 7 , R 8  and R 9  are each, independently, H, substituted or unsubstituted C 1 -C 6  alkyl, substituted or unsubstituted C 2 -C 6  alkenyl, substituted or unsubstituted C 2 -C 6  alkynyl or C(O)OR a ; and 
         R a  is H or substituted or unsubstituted C 1 -C 6  alkyl; and either:
 (a) each R 10  is, independently, H, halogen, substituted or unsubstituted C 1 -C 6  alkyl, substituted or unsubstituted C 2 -C 6  alkenyl, substituted or unsubstituted C 2 -C 6  alkynyl, substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S; or 
 (b) two R 10  attached to the same carbon atom, together with the carbon atom to which they are attached, form a carbonyl, substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S; or 
 (c) two R 10  attached to different atoms, together with the atoms to which they are attached, form a substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S. 
 
       
     
     
         32 . A method of treating heart failure with preserved ejection fraction in a subject having heart failure with preserved ejection fraction, the method comprising administering to the subject a therapeutically effective amount of one or more prodrugs of monomethyl fumarate comprising a compound of Formula (Ib), or a pharmaceutically acceptable polymorph, hydrate, solvate, or co-crystal thereof: 
       
         
           
           
               
               
           
         
         A −  is a pharmaceutically acceptable anion; 
         R 1  is unsubstituted C 1 -C 6  alkyl; 
         L a  is substituted or unsubstituted C 1 -C 6  alkyl linker, substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted C 6 -C 10  aryl, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S; 
         R 3 ′ is substituted or unsubstituted C 1 -C 6  alkyl; and either:
 (a) R 2  and R 3  are each, independently, H, substituted or unsubstituted C 1 -C 6  alkyl, substituted or unsubstituted C 2 -C 6  alkenyl, substituted or unsubstituted C 2 -C 6  alkynyl, substituted or unsubstituted C 6 -C 10  aryl, substituted or unsubstituted C 3 -C 10  carbocycle, substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O and S; or 
 (b) R 2  and R 3 , together with the nitrogen atom to which they are attached, form a substituted or unsubstituted heteroaryl comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O, and S, or a substituted or unsubstituted heterocycle comprising one or two 5- or 6-member rings and 1-4 heteroatoms selected from N, O and S. 
 
       
     
     
         33 . The method of  claim 32 , wherein a pharmaceutical composition is administered to the subject, wherein said pharmaceutical composition comprises a therapeutically effective amount of the one or more prodrug of monomethyl fumarate that is shown to provide MMF plasma exposure comparable to dimethyl fumarate 120 mg to 720 mg per day. 
     
     
         34 . The method of  claim 32 , wherein said pharmaceutical composition comprises 210 mg to 1260 mg of the compound. 
     
     
         35 . The method of  claim 32 , wherein the one or more prodrugs of monomethyl fumarate are administered in combination with one or more second agents useful for treating heart failure. 
     
     
         36 . The method of  claim 35 , wherein the second agent is selected from the group consisting of: a diuretic, an ACE-inhibitor, a beta-blocker, an angiotensin receptor blocker, isosorbide dinitrate, hydralazine, an angiotensin receptor-neprilysin inhibitor, an aldosterone antagonist, a PDE5 inhibitor, a statin, a neprilysin inhibitor, an aldosterone inhibitor, and an antitumor necrosis factor-alpha therapy. 
     
     
         37 . The method of  claim 32 , wherein treating comprises reducing mortality or improving survival in the subject having heart failure with preserved ejection fraction. 
     
     
         38 . The method of  claim 32 , wherein treating comprises increasing maximum myocardial oxygen consumption in the subject. 
     
     
         39 . The method of  claim 38 , wherein the maximum myocardial oxygen consumption is increased to greater than 14 mL/g/min. 
     
     
         40 . The method of  claim 32 , wherein treating comprises one or more of: reducing ventricular stiffness and improving ventricular relaxation in the subject.