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The selective inhibition of coagulation factor Xa has emerged as an attractive strategy for the discovery of novel antithrombotic agents. Here we describe highly potent benzamidine factor Xa inhibitors based on a vicinally-substituted heterocyclic core.

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3,4,5-Trisubstituted isoxazolines (2) and isoxazoles (3) were prepared and evaluated for their in vitro and in vivo antithrombotic efficacy. They were compared to 3,5,5-trisubstituted isoxazolines (1) for Factor Xa selectivity and potency. They were also compared in an arterio-venous (A-V) shunt model of thrombosis.

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Thrombosis is a major cause of mortality in the industrialized world. Therefore, the prevention of blood coagulation has become a major target for new therapeutic agents. One attractive approach is the inhibition of factor Xa (FXa), the enzyme directly responsible for prothrombin activation. We report a series of novel biaryl-substituted isoxazoline derivatives in which the biaryl moiety was designed to interact with the S(4) aryl-binding domain of the FXa active site. Several of the compounds herein have low nanomolar affinity for FXa, have good in vitro selectivity for FXa, and show potent antithrombotic efficacy in vivo. The three most potent compounds (33, 35, and 37) have inhibition constants for human FXa of 3.9, 2.3, and 0.83 nM, respectively, and ID(50)'s ranging from 0.15 to 0.26 micromol/kg/h in the rabbit arterio-venous thrombosis model.

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Substituted pyrazoles, 1,2,4-triazoles, and tetrazoles are good surrogates for cis-amide bonds in a series of boronate ester thrombin inhibitors.

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The potent boropeptide thrombin inhibitor DuP 714 caused side effects in laboratory animals that appear to be related to its ability to inhibit complement factor I, thereby activating the complement cascade. Using X-ray crystal structure information, we have designed compounds that have greater selectivity for thrombin over factor I and that have reduced tendency to produce these side effects.

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DMP 811 is a diacidic angiotensin II antagonist. It has relatively low oral bioavailability in rats. A prodrug approach to improving oral bioavailability was tested. Five esters were synthesized and their stability in rat plasma in vitro was determined. The hydrolysis rates of these five esters ranged from almost immediate to negligible. A simple n-propyl ester was hydrolyzed very slowly (< 10% in 24 hr) in rat plasma in vitro, and after oral dosing in rats plasma prodrug concentrations were much greater than DMP 811 concentrations. A pivaloyloxymethyl ester (1) was hydrolyzed relatively rapidly in rat plasma in vitro. Prodrug 1 was rapidly hydrolyzed by the intestine in vitro, and the intestinal permeation of DMP 811 was increased. DMP 811 oral bioavailability was 47% in rats dosed with 10 mg/kg 1, compared to 11% for rats dosed with 10 mg/kg DMP 811. However, DMP 811 bioavailability was only 27% after a 2 mg/kg dose of 1. In vitro plasma hydrolysis of 1 was highly species-dependent, with a half-life of 13 hr in human plasma but only 1 min in rat plasma. The prodrug approach has potential for improving the oral bioavailability of DMP 811, but selection of the optimal prodrug must be done in humans or in a species, such as dogs, with hydrolysis characteristics closer to humans.

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A 28-month-old black male died with severe complications of mental and motor deterioration, seizures, and aspiration. Autopsy demonstrated moderate liver enlargement, normal spleen and kidneys, small testes, and a grossly normal brain. Further examination showed irregular macrogyrae with evidence of a storage or sclerotic process. Thin layer chromatography of the lipids in formalin-fixed tissue demonstrated elevated levels of ceramide trihexoside and possibly sulfatides in liver and a decrease in the ratio of galactosylceramide to sulfatide in brain. Examination of the gangliosides in formalin-fixed brain indicated a slight increase in the percentage of GM1 ganglioside and a clear elevation in GM2 and GM3 gangliosides. Cultured skin fibroblasts had a normal activity for a large number of lysosomal enzymes including arylsulfatase A and galactocerebrosidase. When the cells were loaded with [14C]sulfatide only about 12% of the sulfatide was metabolized after 3 days. Extracts of the cells were subjected to SDS-PAGE and immunoblotting with antisphingolipid activator protein-1 (SAP-1) rabbit antiserum, and no cross-reacting material was detected confirming the diagnosis of metachromatic leukodystrophy caused by SAP-1 deficiency. This patient was clinically more severe than the other patients described previously with this deficiency. Further studies are underway to define the nature of the mutation in this patient.

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In Part I of this paper, a description of the problems confronted in resuscitation from immersion hypothermia was presented and the debate between passive and active rewarming approaches was summarized. In this paper, a review of the literature concerning selected specific rewarming protocols is given. The protocols considered are: peritoneal irrigation, gastrointestinal rewarming, extracorporeal blood rewarming, airway rewarming, and diathermy.

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The performance of inhalation, heating pads, plumbed garment, inhalation + heating pads, inhalation + plumbed garment, and body-to-body heat exchange rewarming were compared to trunk immersion and spontaneous rewarming under laboratory conditions with mildly cooled volunteers. The experiment included 72 rewarmings. Trunk immersion exhibited the smallest afterdrop, shortest recovery period, and most rapid rewarming. Of the therapies suitable for use in the field, small afterdrops were seen with inhalation, inhalation + plumbed garment, inhalation + heating pads, and spontaneous rewarming. The largest afterdrops were seen with the heating pads and plumbed garment. Body-to-body heat exchange was seen to produce somewhat larger afterdrops than spontaneous rewarming. It is concluded that heating pads and plumbed garment should not be used in treatment of profound hypothermia. It is further concluded that, because of the depression in respiratory minute volume accompanying profound hypothermia, the heating pads and plumbed garment in combination with inhalation therapy should not be used. This leaves inhalation therapy alone as the recommended treatment for profound hypothermia in the field.

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Disk-shaped implants of spinel, alumina, mullite, zircon, a cast Co-Cr-Mo alloy, and ultra-high molecular weight polyethylene (UHMWPE), were implanted in the paraspinalis muscle of 12 adult, male, white New Zealand rabbits. Prior to implantation the implants were characterized with respect to size and shape, weight and surface roughness. After periods of 1 month, 2 months, and 4 months, the rabbits were sacrificed and the tissue specimens were retrieved with the implants still intact. Histological examination of the tissues surrounding the implants along with changes in the size and shape, weight, and surface roughness of the implants were used as criteria for evaluating these materials for implant purposes. No surfaces degradation of any of the materials was detected using scanning electron microscopy. Fibrous tissue seemed to adhere to the UHMWPE implants more than any other material used in this study. Large amounts of fibrous tissue were also found to adhere to the cast Co-Cr-Mo alloy implants. The histological results indicated that within the limits of this investigation, the biocompatibility of the ceramic materials used in this study compared favorably with the clinically used Co-Cr-Mo alloy implants and the UHMWPE implants.

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