Methods of treating or controlling cytotoxic cerebral edema consequent to an ischemic stroke
The present invention relates to the use of selective aquaporin inhibitors, e.g., of aquaporin-4 or aquaporin-2, e.g., certain phenylbenzamide compounds, for the prophylaxis, treatment and control of aquaporin-mediated conditions, e.g., diseases of water imbalance, for example edema (particularly edema of the brain and spinal cord, e.g., following trauma or ischemic stroke, as well as the edema associated with glioma, meningitis, acute mountain sickness, epileptic seizures, infections, metabolic disorders, hypoxia, water intoxication, hepatic failure, hepatic encephalopathy, diabetic ketoacidosis, abscess, eclampsia, Creutzfeldt-Jakob disease, and lupus cerebritis, as well as edema consequent to microgravity and/or radiation exposure, as well as edema consequent to invasive central nervous system procedures, e.g., neurosurgery, endovascular clot removal, spinal tap, aneurysm repair, or deep brain stimulation, as well as retinal edema), as well as hyponatremia and excess fluid retention, and diseases such as epilepsy, retinal ischemia and other diseases of the eye associated with abnormalities in intraocular pressure and/or tissue hydration, myocardial ischemia, myocardial ischemia/reperfusion injury, myocardial infarction, myocardial hypoxia, congestive heart failure, sepsis, and neuromyelitis optica, as well as migraines, as well as to novel assays for identifying aquaporin inhibitors.
1. A method of treating or controlling cytotoxic cerebral edema consequent to an ischemic stroke in a human patient in need thereof, wherein the method comprises administering to the human patient a phenylbenzamide of formula 1a:
wherein R 1 is selected from trifluoromethyl, chloro, fluoro, and bromo;
R 3 and R 5 are the same or different and selected from trifluoromethyl, chloro, fluoro, and bromo;
R 2 and R 4 are both H; and
R 6 is selected from H and physiologically hydrolysable and acceptable acyl;
in free or pharmaceutically acceptable salt form,
and treating the human patient with intravenous thrombolysis and/or mechanical clot removal.
2. The method of claim 1 , wherein R 1 is selected from chloro and bromo; R 3 and R 5 are both trifluoromethyl; and R 2 , R 4 and R 6 are all H.
3. The method of claim 1 , wherein R 6 is H.
4. The method of claim 1 , wherein R 1 , R 3 and R 5 are each trifluoromethyl, and R 2 , R 4 and R 6 are each H.
5. The method of claim 1 , wherein R 6 is a phosphono group, which may be substituted or unsubstituted.
6. The method of claim 1 , wherein the phenylbenzamide is selected from:
7. The method of claim 1 , wherein the phenylbenzamide is:
in free or pharmaceutically accepable salt form.
8. The method of claim 1 , wherein the phenylbenzamide is:
in free form.
9. The method of claim 1 , wherein the phenylbenzamide is:
in free or pharmaceutically acceptable salt form.
10. The method of claim 1 , wherein the method comprises treating the human patient with intravenous thrombolysis and the intravenous thrombolysis is with rtPA.
11. The method of claim 7 , wherein the method comprises treating the human patient with intravenous thrombolysis and the intravenous thrombolysis is with rtPA.
12. The method of claim 8 , wherein the method comprises treating the human patient with intravenous thrombolysis and the intravenous thrombolysis is with rtPA.
13. The method of claim 9 , wherein the method comprises treating the human patient with intravenous thrombolysis and the intravenous thrombolysis is with rtPA.
14. The method of claim 7 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 12 hours of the stroke.
15. The method of claim 8 , wherein the phenylbenzamide, in free form, is administered within 12 hours of the stroke.
16. The method of claim 9 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 12 hours of the stroke.
17. The method of claim 7 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 6 hours of the stroke.
18. The method of claim 8 , wherein the phenylbenzamide, in free form, is administered within 6 hours of the stroke.
19. The method of claim 9 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 6 hours of the stroke.
20. The method of claim 11 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 12 hours of the stroke.
21. The method of claim 12 , wherein the phenylbenzamide, in free form, is administered within 12 hours of the stroke.
22. The method of claim 13 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 12 hours of the stroke.
23. The method of claim 11 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 6 hours of the stroke.
24. The method of claim 12 , wherein the phenylbenzamide, in free form, is administered within 6 hours of the stroke.
25. The method of claim 13 , wherein the phenylbenzamide, in free or pharmaceutically acceptable salt form, is administered within 6 hours of the stroke.