Title of Invention

"STEREOISOMERIC COMPOUNDS AND METHODS FOR THE TREATMENT OF GASTROINTESTINAL AND CENTRAL NERVOUS SYSTEM DISORDERS"

Abstract The subject invention provides stereoisomeric compounds of formula (X): wherein the variables are as defined herein, and compositions for the safe and effective treatment of various gastrointestinal disorders including, but not limited to, gastroparesis, gastroesophageal reflux and related conditions. The compounds of the subject invention are also useful in treating a variety of conditions involving the central nervous system.
Full Text DESCRIPTION
This application claims priority from U.S. Provisional Patent Application number
60/534,892, filed January 7, 2004, and U.S. Provisional Patent Application number
60/560,938, filed April 9,2004.
Background of Invention
Cisapride is one of a class of compounds known as benzamide derivatives, the parent
compound of which is metoclopramide. U.S. Patent Nos. 4,962,115 and 5,057,525
(collectively "Van Daele" and incorporated by reference in their entireties) disclose N-(3-
hydroxy-4-piperidenyI) benzamides of cisapride. Van Daele discloses that these compounds,
the pharmaceutically acceptable acid addition salts thereof and the stereochemically isomeric
forms thereof, stimulate the motility of the gastrointestinal system.
As a class, these benzamide derivatives have several prominent pharmacological
actions. The prominent pharmacological activities of the benzamide derivatives are due to
their effects on the neuronal systems which are modulated by the neurotransmitter serotonin.
The role of serotonin, and thus the pharmacology of the benzamide derivatives, has been
broadly implicated in a variety of conditions for many years. Thus, research has focused on
locating the production and storage sites of serotonin as well as the location of serotonin
receptors in the human body in order to determine the connection between these sites and
various disease states or conditions.
In this regard, it was discovered that a major site of production and storage of
serotonin is the enterochromaffin cell of the gastrointestinal mucosa. It was also discovered
that serotonin has a powerful stimulating action on intestinal motility by stimulating intestinal
smooth muscle, speeding intestinal transit, and decreasing absorption time, as in diarrhea.
This stimulating action is also associated with nausea and vomiting.
Because of their modulation of the serotonin neuronal system in the gastrointestinal
tract, many of the benzamide derivatives are effective anti-emetic agents and are commonly
used to control vomiting during cancer chemotherapy or radiotherapy, especially when highly
emetogenic compounds such as cisplatin are used. This action is almost certainly the result
of the ability of the compounds to block the actions of serotonin (5HT) at specific sites of

action, called the 5HT3-receptor, which was classically designated in the scientific literature
as the serotonin M-receptor. Chemotherapy and radiation therapy may induce nausea and
vomiting by the release of serotonin from damaged enterochromaffin cells in the
gastrointestinal tract. Release of the neurotransmitter serotonin stimulates both afferent vagal
nerve fibers (thus initiating the vomiting reflex) and serotonin receptors in the chemoreceptor
trigger zone of the area postrema region of the brain. The anatomical site for this action of
the benzamide derivatives, and whether such action is central (CNS), peripheral, or a
combination thereof, remains unresolved (Barnes et al., J. Pharm. Pharmacol. 40: 586-588,
1988). Cisapride, like the other benzamide derivatives would appear to be an effective anti-
emetic agent based on its ability to modulate the activity of serotonin at the 5HT3 receptor.
A second prominent action of the benzamide derivatives is in augmenting
gastrointestinal smooth muscle activity from the esophagus through the proximal small
bowel, thus accelerating esophageal and small intestinal transit as well as facilitating gastric
emptying and increasing lower esophageal sphincter tone (Decktor et al., Eur. J. Pharmacol.
147: 313-316, 1988). Although the benzamide derivatives are not cholinergic receptor
agonists per se, the aforementioned smooth muscle effects may be blocked by muscarinic
receptor blocking agents such as atropine or neuronal transmission inhibitors of the
tetrodotoxin type which affect sodium channels. Similar blocking activity has been reported
for the contractile effects of serotonin in the small intestine. It is currently- believed that the
primary smooth muscle effects of the benzamide derivatives are the result of an agonist
action upon a new class of serotonin receptors referred to as 5HT4 receptors which are
located on interneurons in the myenteric plexus of the gut wall. Activation of these receptors
subsequently enhances the release of acetylcholine from parasympathetic nerve terminals
located near surrounding smooth muscle fibers, and it is the combination of acetylcholine
with its receptors on smooth muscle membranes which is the actual trigger for muscle
contraction.
A discussion of various 5HT receptors, including the 5HT4 receptor can be found in,
for example, U.S. Patent Nos. 6, 331,401 and 6,632,827, which are incorporated by reference
herein in their entirety.
Cisapride has been used primarily to treat gastroesophageal reflux disease (GERD).
This disease is characterized as the backward flow of the stomach contents into the
esophagus. One of the most important factors in the pathogenesis of gastroesophageal reflux

disease is a reduction in the pressure barrier due to the failure of the lower esophageal
sphincter. Failure of the lower esophageal sphincter can arise due to a low basal pressure,
sphincter relaxation, or to a non-compensated increase in intragastric pressure. Other factors
in the pathogenesis of the disease are delayed gastric emptying, insufficient esophageal
clearing due to impaired peristalsis and the corrosive nature of the reflux material which can
damage esophageal mucosa. Cisapride is thought to strengthen the anti-reflux barrier and
improve esophageal clearance by increasing the lower esophageal sphincter pressure and
enhancing peristaltic contractions.
Because of its activity as a prokinetic agent, cisapride would also appear to be useful
to treat dyspepsia, gastroparesis, constipation, post-operative ileus, and intestinal pseudo-
obstruction. Dyspepsia is a condition characterized by an impairment of the power or
function of digestion that can arise as a symptom of a primary gastrointestinal dysfunction or
as a complication due to other disorders such as appendicitis, gallbladder disturbances, or
malnutrition. Gastroparesis is a paralysis of the stomach brought about by a motor
abnormality in the stomach or as a complication of diseases such as diabetes, progressive
systemic sclerosis, anorexia nervosa or myotonic dystrophy. Constipation is a condition
characterized by infrequent or difficult evacuation of feces resulting from conditions such as
lack of intestinal muscle tone or intestinal spasticity. Post-operative ileus is an obstruction in
the intestine due to a disruption in muscle tone following surgery. Intestinal pseudo-
obstruction is a condition characterized by constipation, colicky pain, and vomiting, but
without evidence of physical obstruction.
Drug toxicity is an important consideration in the treatment of humans and animals.
Toxic side effects (adverse effects) resulting from the administration of drugs include a
variety of conditions which range from low grade fever to death. Drug therapy is justified
only when the benefits of the treatment protocol outweigh the potential risks associated with
the treatment. The factors balanced by the practitioner include the qualitative and
quantitative impact of the drug to be used as well as the resulting outcome if the drug is not
provided to the individual. Other factors considered include the physical condition of the
patient, the disease stage and its history of progression, and any known adverse effects
associated with a drug.
Drug elimination is typically the result of metabolic activity upon the drug and the
subsequent excretion of the drug from the body. Metabolic activity can take place within the

vascular supply and/or within cellular compartments or organs. The liver is a principal site of
drug metabolism. The metabolic process can be categorized into synthetic and nonsynthetic
reactions. In nonsynthetic reactions, the drug is chemically altered by oxidation, reduction,
hydrolysis, or any combination of the aforementioned processes. These processes are
collectively referred to as Phase I reactions.
In Phase II reactions, also known as synthetic reactions or conjugations, the parent
drug, or intermediate metabolites thereof, are combined with endogenous substrates to yield
an addition or conjugation product. Metabolites formed in synthetic reactions are, typically,
more polar and biologically inactive. As a result, these metabolites are more easily excreted
via the kidneys (in urine) or the liver (in bile). Synthetic reactions include glucuronidation,
amino acid conjugation, acetylation, sulfoconjugation, and methylation.
More than 90% of a dose of cisapride is metabolized by oxidative N-dealkylation at
the piperidine nitrogen or by aromatic hydroxylation occurring on either the 4-fluorophenoxy
or benzamide rings.
The administration of cisapride to a human has been found to cause serious adverse
effects including CNS disorders, increased systolic pressure, interactions with other drugs,
diarrhea, and abdominal cramping. Further, it has been reported that intravenous
administration of cisapride demonstrates the occurrence of additional adverse effects not
experienced after oral administration of cisapride (Stacher et al. [1987] Digestive Diseases
and Sciences 32(11):1223-1230). It is believed that these adverse effects are caused by the
metabolites that result from the oxidative dealkylation or aromatic hydroxylation of the
compound which occurs in the cytochrome P450 detoxification system. Cisapride is also
subject to a number of undesirable drug/drug interactions that are also a result of metabolism
by the cytochrome P450 system.
Between July 1993 and December 1999, cisapride (PROPULSID, Janssen
Pharmaceutica Products, L.P.) was reportedly associated with at least 341 serious cardiac
arrhythmias. These arrhythmias include ventricular tachycardia, ventricular fibrillation,
torsades de pointes, and QT prolongation. Eighty (80) deaths have been reported. As a result
of these adverse effects, the product was voluntarily withdrawn from the open market in the
United States; however, the drug is available through an investigational limited access
program.

The safety of 5HT4 receptor agonists with gastrointestinal (GI) prokinetic activity has
been limited due to cardiac effects (prolongation of QTc intervals, tachycardia, torsades de
pointes) and adverse drug interactions due to hepatic cytochrome P-450 metabolism. A GI
prokinetic agent of this class that lacks these liabilities would be very valuable in several
therapeutic areas including GERD and gastric emptying disorders. Certain cisapride
derivatives have been described in U.S. Pat. No. 6,552,046 and WO 01/093849 (incorporated
by reference herein in their entireties), however further compounds with even more
advantageous properties would be desirable.
It has now been discovered that certain stereoisomers of one such esterified structural
and/or functional analog of cisapride have distinct and particularly advantageous properties.
Brief Summary
The subject invention provides compounds and compositions of formula (X), which
stereoisomeric esterified cisapride analogs, for the safe and effective treatment of various
gasisointestinal disorders including, but not limited to, gastroparesis, gastroesophageal reflux
and related conditions. The compounds of the subject invention are also useful in treating a
variety of conditions involving the central nervous system.
The compounds of the invention comprise compounds of formula X:

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
L is -(C1-C6 alkyl)- (in one aspect, -(C3-C5 alkyl)-), -(C1-C6 alkyl)-C(O)-, or -C(O)-
(C1-C6 alkyl)-, wherein each of the alkyl groups is optionally substituted with 1 or 2 groups
that are independently halogen, C1-C4 alkoxy, or OH and wherein one carbon in the alkyl
portion of L may be replaced by -N(R9)-;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 aIkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;

R4 is H or methyl; and
R5 is -O-C3-C8 cycloalkyl, -O-heterocycloalkyl, heterocycloalkyl, aryl, -O-aryl, -
N(R9)-(C0-C6 alkyl)-C(O)-aryl, or-N(R9)-CO-C6 alkyl-aryl, -O-heteroaryl, -N(R9)-C1-C6(O)-
heteroaryl, or -N(R9)-CO-C6 alkyl-heteroaryl, wherein each of the cyclic groups is
unsubstituted or substituted at one or more substitutable positions with C1-C6 alkyl, C1-C6
alkoxy, halogen, C1-C6 haloalkyl, C1-C6 haloalkoxy, hydroxyl, hydroxy-C1-C4-alkyl, amino,
-NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)R11, or-O-(C0-C6 alkyl)-
C(O)R11, methylsulfone, C0-C6-sulfonamide, or NO2; wherein
R9 at each occurrence is independently H or C1-C4 alkyl;
R11 is C1-C6 alkyl, OH, or
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-
C(O)N(R9)-heterocycloaIkyl, -O-heterocycloalkyl, -C1-C6(O)N(R9)-heteroaryl, or heteroaryl,
wherein
the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6
alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3,
the heteroaryl group is optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-
C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted with
1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; and
R20 is C1-C6 alkoxy (preferably C1-C4 alkoxy, more preferably methoxy), or OH.
The invention also encompasses compositions comprising at least one compound of
formula (X) and at least one pharmaceutically acceptable excipient, adjuvant, carrier, or
solvent.
The compounds of formula (X) are useful in the treatment or prevention of
gastroesophageal reflux disease and substantially reduce adverse effects associated with the
administration of cisapride. These adverse effects include, but are not limited to, diarrhea,
abdominal cramping and elevations of blood pressure and heart rate.

Additionally, the compounds and compositions of the invention are useful in treating
emesis and other conditions, including but not limited to dyspepsia, gastroparesis,
constipation, post-operative ileus and intestinal pseudo-obstruction. As an added benefit,
adverse effects associated with the administration of cisapride are also reduced in these
methods of treatment.
Advantageously, the compounds of the subject invention are ligands for the 5HT4
receptor and, accordingly, can be used to treat conditions mediated through this receptor.
These receptors are located in several areas of the central nervous system and the modulation
of these receptors can be used to effect desired modulations of the CMS.
Advantageously, the subject invention provides stereoisomeric compounds which
contain an ester moiety that does not detract from the ability of these compounds to provide a
therapeutic benefit, but which makes them more susceptible to degradation by serum and/or
cytosolic esterases, thereby avoiding the cytochrome P450 drug detoxification system
associated with adverse effects caused by cisapride and reducing the incidence of such
adverse events.
The subject invention further provides methods of treatment comprising the
administration of the compounds of formula (X) and therapeutically effective amounts to
individuals in need of treatment for gastroesophageal reflux disease, dyspepsia, gastroparesis,
constipation, post-operative ileus, and intestinal pseudo-obstruction; and related conditions.
Advantageously, the therapeutic compounds of the subject invention are stable in
storage and provide for safer metabolism of the drugs as compared to other drugs; therefore,
the compounds of the subject invention can be used with a lower incidence of side effects and
toxicity.
In a further aspect, the subject invention pertains to the breakdown products
(preferably metabolic breakdown products) which are formed when the therapeutic
compounds of the subject invention are acted upon by esterases. These breakdown products
can be used as described herein to monitor the clearance of the therapeutic compounds from a
patient.
In yet a further aspect, the subject invention provides methods for synthesizing the
therapeutic stereoisomeric compounds of the subject invention, as well as intermediates
useful in preparing the compounds of interest.

Brief Description of the Accompanying Drawing:
Figure 1 is a graph representing the Concentration-Response Curves for 5-HT4 Receptor
Agonism of ATI-7505, serotonin, Cisapride, and ATT-7500.
Figure 2 is a graph representing gastric emptying in fed dogs. The data shown are
normalized to the averaged vehicle control times of MMC return values. Values represent
mean + SEM of 5 dogs. *p Figure 3 is a graph representing the metabolism of ATI-7505 and ATI-7500, with and
without the CYP450 dependent Cofactor, NADPH. The plots show mean and SD µM
concentrations of ATI-7505 and ATI-7500. ATI-7505 (2 µM) was incubated with human
microsomal protein (1 mg) in the presence or absence of NADPH regenerating system
(cofactor).
Detailed Disclosure
In a further aspect, the invention provides compounds of Formula (X), wherein
R5 is -O-C3-C8 cycloalkyl, -O-heterocycloalkyl, heterocycloalkyl, wherein the
heterocycloalkyl group is selected from piperidinyl, piperazinyl, pyrrolidinyl, aza-bicyclo-
octyl, in certain embodiments aza-bicyclo[2.2.2]octyl, aza-bicyclo[3.2.I]octyl, aza-bicyclo-
nonyl, aza-bicyclo-decyl, indolinyl, morpholinyl, thiomorpholinyl, S,S-
dioxothiomorpholinyl, and imidazolidinyl, -O-aryl, -N(R9)-C(O)-aryl, or -N(R9)-C0-C6 alkyl-
aryl, wherein each of the cyclic groups is unsubstituted or substituted at one or more
substitutable positions with C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6 haloalkyl, C1-C6
haloalkoxy, hydroxyl, hydroxy-C1-C4-alkyl, amino, -NH(C1-C6 alkyl), -N(C1-C6 aIkyl)(C1-C6
alkyl), -C(O)R11, or NO2; wherein
R9 at each occurrence is independently H or C1-C4 alkyl; and
R11 is C1-C6 alkyl, OH, or
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -C(O)N(R9)-
heterocycloalkyl, heterocycloalkyl or heteroaryl, wherein
the heterocycloalkyl group is selected from pyrrolidinyl, piperidinyl,
piperazinyl, morpholinyl, aza-bicyclo-octyl, in certain embodiments aza-

bicyclo[2.2.2]octyl, aza-bicyclo[3.2.1]octyl, aza-bicyclo-nonyl and aza-bicyclo-decyl,
wherein the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6
alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3,
the heteroaryl group is selected from pyridyl, pyrimidyl, quinolinyl,
isoquinolinyl, and indolyl, wherein the heteroaryl groups are optionally substituted
with 1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy,
hydroxy, hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is selected from piperidinyl,
pyrrolidinyl, imidazolidinyl, morpholinyl, aza-bicyclo-octyl, in certain embodiments aza-
bicyclo[2.2.2]octyl, aza-bicyclo[3.2.1]octyl, aza-bicyclo-nonyl, aza-bicyclo-decyl, and
tetrahydrofuranyl, and wherein each heterocycloalkyl group is optionally substituted with 1,
2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy
C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3.
In another aspect, the invention provides compounds of Formula (X), wherein R1 is
chloro.
In yet another aspect, the invention provides compounds of Formula (X), wherein R2
is amino.
In still another aspect, the invention provides compounds of Formula (X), wherein R3
is methoxy..
In another aspect, the invention provides compounds of Formula (X), wherein R4 is H
or methyl.
In still yet another aspect, the invention provides compounds of Formula (X), wherein
R1 is chloro; R2 is amino; R3 is methoxy; and R4 is H or methyl.
In yet another aspect, the invention provides compounds of Formula (X), wherein R1
is chloro; R2 is amino; R3 is methoxy; R4 is H, and L is -(C4-C6 alkyl)-C(O)-.
In another aspect, the invention provides compounds of formula (X), wherein two or
more previously described aspects are combined.
In another aspect, the invention provides compounds of Formula (XI), which are
compounds of formula (X) wherein L is -(CH2)5-C(O)-:


In yet still another aspect, the invention provides compounds of formula (XI), wherein
R1 is chloro; R2 is amino; R3 is methoxy; and R4 is H or methyl.
In still another aspect, the invention provides compounds of formula (XI), wherein R5
is-O-heterocycloalkyl, wherein the heterocycloalkyl group is selected from aza-bicyclo-octyl,
in certain embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicycio[3.2.1]oct-3-yl, aza-
bicyclo-nonyl, aza-bicyclo-decyl, where the aza nitrogen, is optionally substituted with
methyl or ethyl; and R4 is H or methyl.
In still yet another aspect, the invention provides compounds of formula (XI), wherein
R5 is -O-heterocycloalkyl, wherein the heterocycloalkyl group is selected from piperidinyl,
piperazinyl, or pyrrolidinyl, each of which is unsubstituted or substituted at one or two
positions with groups that are independently C1-C4 alkyl, C1-C4 alkoxy, halogen, C1-C4
haloalkyl (in one aspect, CF3), C1-C4 haloalkoxy (in one aspect OCF3), hydroxyl, hydroxy
C1-C4 alkyl, amino, -NH(C1-C4 alkyl), -N(C1-C4 alkyl)(C1-C4 alkyl), -(C1-C6 alkyl)-C(O)R11,
or NO2; and R4 is H or methyl.
In yet another aspect, the invention provides compounds of formula (XI), wherein R5
is -O-heterocycloalkyl, wherein the heterocycloalkyl group is selected from indolinyl,
morpholinyl, thiomorpholinyl, S,S-dioxothiomorpholinyl, and imidazolidinyl, each of which
is unsubstituted or substituted at one or two positions with groups that are independently C1-
C4 alkyl, C1-C4 alkoxy, halogen, C1-C4 haloalkyl (in one aspect, CF3), C1-C4 haloalkoxy (in
one aspect OCF3), hydroxyl, hydroxy C1-C4 alkyl, amino, -NH(C1-C4 alkyl), -N(C1-C4
alkyl)(C1-C4 alkyl), -(C0-C6 alkyl)-C(O)R11, or NO2; and R4 is H or methyl.
In yet another aspect, the invention provides compounds of formula (XI), wherein R5
is -O-phenyl, N(R9)-(C0-C6 alkyl)-C(O)-phenyl, or -N(R9)-CO-C4 alkyl-phenyl, wherein the
phenyl group is substituted with one or two groups that are independently C1-C4 alkyl, C1-C4
alkoxy, halogen, C1-C4 haloalkyl (in one aspect, CF3), C1-C4 haloalkoxy (in one aspect
OCF3), hydroxyl, hydroxy C1-C4 alkyl, amino, -NH(C1-C4 alkyl), -N(C1-C4 alkyl)(C1-C4
alkyl), -(C0-C6 alkyl)-C(O)R11, or NO2; and R4 and R9 are independently H or methyl.

In another aspect, the invention provides compounds of formula (XI), wherein R4 is
H.
In yet another aspect, the invention provides compounds of formula (XI), wherein R11
is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently C1-C4
alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, or heterocycloalkyl wherein the heterocycloalkyl group is selected from
pyrrolidinyl, piperidinyl, piperazinyl, and morpholinyl, wherein the heterocycloalkyl groups
are optionally substituted with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl,
C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3.
In another aspect, the invention provides compounds of formula (XI), wherein two or
more previously described aspects are combined.
In another aspect, the invention provides compounds of Formula (XII), i.e.,
compounds of formula (X), of the formula:

wherein R15 is H, C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6 haloalkyl (in one aspect CF3) ,
C1-C6 haloalkoxy (in one aspect OCF3), hydroxyl, hydroxy C1-C4 alkyl, amino, -NH(C1-C6;
alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), methylsulfone, C0-C6-sulfonamide or NO2, and R16 is H
or-O-(C0-C6 alkyl)-C(O)R11. In another aspect, R15 is H.
In yet another aspect, the invention provides compounds of formula (XII), wherein R4
and R9 are independently H or methyl and R11 is OH.
In still yet another aspect, the invention provides compounds of formula (X1T),
wherein R4 and R9 are independently H or methyl and R11 is C1-C6 alkoxy, optionally
substituted with 1 or 2 groups that are independently C1-C4 alkoxy, amino, -NH(C1-C6 alkyl),
-N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-heterocycloalkyl, or
heterocycloalkyl wherein the heterocycloalkyl group is selected from aza-bicyclo-octyl, in
certain embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-
bicyclo-nonyl, aza-bicyclo-decyl, where the aza nitrogen is optionally substituted with methyl

or ethyl, pyrrolidinyl, piperidinyl, piperazinyl, and morpholinyl, wherein the heterocycloalkyl
groups are optionally substituted with 1,2, or 3 groups that are independently halogen, C1-C6
alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or
OCF3, and R4 and R9 are independently H or methyl. In another aspect, R4, R9, and R11 are as
previously defined and R15 is H, R1 is chloro; R2 is amino; and R3 is methoxy.
In yet still another aspect, the invention provides compounds of formula (XII),
wherein R4 and R9 are independently H or methyl and R11 is C1-C6 alkoxy, optionally
substituted with 1 or 2 groups that are independently C1-C4 alkoxy, amino, -NH(C1-C6 alkyl),
-N(C1-C6 alkyl)(C1-C6 alkyl), or heteroaryl, wherein the heteroaryl group is selected from
pyridyl, pyrimidyl, quinolinyl, isoquinolinyl, and indolyl, wherein the heteroaryl groups are
optionally substituted with 1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-
C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; and
R4 and R9 are independently H or methyl. In another aspect, R4, R9, and R11 are as previously
defined and R15 is H, R1 is chloro; R2 is amino; and R3 is methoxy.
In still another aspect, the invention provides compounds of formula (XII), wherein at
least one of R4 and R9 is H.
In another aspect, the invention provides compounds of formula (XII), wherein two or
more previously described aspects are combined.
In another aspect, the invention provides compounds of Formula (XIII), i.e.,
compounds of formula (XII), of the formula:

wherein R15 is H, C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6 haloalkyl (in one aspect CF3),
C1-C6 haloalkoxy (in one aspect OCF3), hydroxyl, hydroxy C1-C4 alkyl, amino, -NH(C1-C6
alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), or methylsulfone, C0-C6-sulfonamide, NO2, and R16 is H
or -O-(C0-C6 alkyl)-C(O)R11. In another aspect, R15 is H.
In yet another aspect, the invention provides compounds of formula (XIII), wherein

R4 and R9 are independently H or methyl, and R11 is OH, C1-C4 alkoxy (in another aspect, C1-
C3 alkoxy), or C1-C2 alkoxy-C1-C3 alkoxy-. In another aspect, R4, R9, and R11 are as
previously defined and R1 is chloro; R2 is amino; and R3 is methoxy.
In still yet another aspect, the invention provides compounds of formula (XIII),
wherein R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with
amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), aza-bicyclo-octyl, in certain
embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl,
aza-bicyclo-decyl, where the aza nitrogen is optionally substituted with methyl or ethyl; and
R4 is H or methyl, pyrrolidinyl, piperidinyl, morpholinyl, pyridyl, or -(C0-C6 alkyl)-C(O)NH-
pyrid-4-yl. In another aspect, R4, R9, and R11 are as previously defined and R1 is chloro; R2 is
amino; and R3 is methoxy.
In still another aspect, the invention provides compounds of formula (XIII), wherein
R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with amino,
-NH(C1-C6 alkyl), or -N(C1-C6 alkyl)(C1-C6 alkyl). In another aspect, R4, R9, and R11 are as
previously defined and R1 is chloro; R2 is amino; and R3 is methoxy.
In yet another aspect, the invention provides compounds of formula (XIII), wherein
R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with
pyrrolidinyl, piperidinyl, morpholinyl, pyridyl, or -(C0-C6 alkyl)-C(O)NH-pyrid-4-yl. In
another aspect, R4, R9, and R11 are as previously defined and R1 is chloro; R2 is amino; and
R3 is methoxy.
In still another aspect, the invention provides compounds of formula (XIII), wherein
at least one of R4 and R9 is H.
In another aspect, the invention provides compounds of formula (XIII), wherein two
or more previously described aspects are combined.
In another aspect, the invention provides compounds of formula (XIV), i.e.,
compounds of formula (X), of the formula:


wherein R15 is H, C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6 haloalkyl (in one aspect CF3),
C1-C6 haloalkoxy (in one aspect OCF3), hydroxy], hydroxy C1-C4 alkyl, amino, -NH(C1-C6
alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), methylsulfone, C0-C6-sulfonamide, or NO2, and R16 is H
or -O-(C0-C6 alkyl)-C(O)R11. In another aspect, R15 is H.
In still another aspect, the invention provides compounds of formula (XIV), wherein
R4 and R9 are independently H or methyl, and R11 is OH, C1-C4 alkoxy (in another aspect, C1-
C3 alkoxy) or C1-C2 alkoxy-C1-C3 alkoxy-. In another aspect, R4, R9, and R11 are as
previously defined and R1 is chloro; R2 is amino; and R3 is methoxy. In still another aspect,
at least one of R4 and R9 is H.
In yet still another aspect, the invention provides compounds of formula (XIV),
wherein R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with
amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), aza-bicyclo-octyl, in certain
embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl,
aza-bicyclo-decyl, where the aza nitrogen is optionally substituted with methyl or ethyl; and
R4 is H or methyl, pyrrolidinyl, piperidinyl, morpholinyl, pyridyl, or -(C0-C6 alkyl)-C(O)NH-
pyrid-4-yl. In another aspect, R4, R9, and R11 are as previously defined and R1 is chloro; R2 is
amino; and R3 is methoxy.
In still another aspect, the invention provides compounds of formula (XIV), wherein
R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with amino,
-NH(C1-C6 alkyl), or -N(C1-C6 alkyl)(C1-C6 alkyl). In another aspect, R4, R9, and R11 are as
previously defined and R1 is chloro; R2 is amino; and R3 is methoxy.
In yet another aspect, the invention provides compounds of formula (XIV), wherein
R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with
pyrrolidinyl, piperidinyl, morpholinyl, pyridyl, or -(C0-C6 alkyl)-C(O)NH-pyrid-4-yl. In

another aspect, R4, R9, and R11 are as previously defined and R1 is chloro; R2 is amino; and
R3 is methoxy.
In still another aspect, the invention provides compounds of formula (XIV), wherein
at least one of R4 and R9 is H.
In another aspect, the invention provides compounds of formula (XIV), wherein two
or more previously described aspects are combined.
In another aspect, the invention provides compounds of formula (XV), i.e.,
compounds of formula (X) of the formula:

wherein n is 1 or 2.
In still another aspect, the invention provides compounds of formula (XV), wherein
R4 is H or methyl, and R11 is OH, C1-C4 alkoxy (in another aspect, C1-C3 alkoxy) or C1-C2
alkoxy-C1-C3 alkoxy-. In another aspect, R4 and R11 are as previously defined and R1 is
chloro; R2 is amino; and R3 is methoxy. In still another aspect, at least one of R4 and R9 is H.
In yet still another aspect, the invention provides compounds of formula (XV),
wherein R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with
amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), aza-bicyclo-octyl, in certain
embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl,
aza-bicyclo-decyl, where the aza nitrogen is optionally substituted with methyl or ethyl; and
Rt is H or methyl, pyrrolidinyl, piperidinyl, morpholinyl, pyridyl, or-C(O)NH-pyrid-4-yl. In
another aspect, R4, R9, and R11 are as previously defined and R1 is chloro; R2 is amino; and
R3 is methoxy.
In still another aspect, the invention provides compounds of formula (XV), wherein
R4 and R9 are independently H or methyl, and R11 is C1-C4 alkoxy substituted with amino,
-NH(C1-C6 alkyl), or -N(C1-C6 alkyl)(C1-C6 alkyl). In another aspect, R4, R9, and R11 are as
previously defined and R1 is chloro; R2 is amino; and R3 is methoxy.

In yet another aspect, the invention provides compounds of formula (XV), wherein R4
is H or methyl, and R11 is C1-C4 alkoxy substituted with aza-bicyclo-octyl, in certain
embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl,
aza-bicyclo-decyl, where the aza nitrogen is optionally substituted with methyl or ethyl; and
R4 is H or methyl, pyrrolidinyl, piperidinyl, morpholinyl, pyridyl, or-(C0-C6 alkyl)-C(O)NH-
pyrid-4-yl. In another aspect, R4, R9, and R11 are as previously defined and R1 is chloro; R2 is
amino; and R3 is methoxy.
In another aspect, the invention provides compounds of formula (XV), wherein two or
more previously described aspects are combined .
In another aspect, the invention provides compounds according to any one of
formulas (X), (XI), (XII), (XIII), (XIV) or (XV), wherein R1, R2, and R3 are oriented on the
phenyl ring as follows:

In another aspect, the invention provides compounds according to any one of
formulas (X), (XI), (XII), (XIII), (XIV) or (XV), wherein bond 3 has the "S" configuration
and bond 4 has the "R" configuration.
In still another aspect, the invention provides compounds according to any one of
formulas (X), (XI), (XII), (XIII), (XIV) or (XV), wherein R1, R2, and R3 are oriented on the
phenyl ring as follows:

and bond 3 has the "S" configuration and bond 4 has the "R" configuration.
In another aspect, the invention provides compounds according to any one of
formulas (X), (XI), (XII), (XIII), (XIV) or (XV), wherein bond 3 has the "R" configuration
and bond 4 has the "S" configuration.
In another aspect, the invention provides compounds according to any one of
formulas (X), (XI), (XII), (XIII), (XIV) or (XV), wherein R1, R2, and R3 are oriented on the
phenyl ring as follows:


and bond 3 has the "R" configuration and bond 4 has the "S" configuration.
In still another aspect, the invention provides compounds of formula (X), wherein
R1 is chloro; R2 is amino; R3 is methoxy; R4 is H, and R1, R2, and R3 have the following
orientation on the phenyl ring:

L is -(C3-C5 alkyl)- wherein one carbon may be replaced by -N(R9)-, or -(C2-C6
alkyl)-C(O)-. In yet another aspect, the R1, R2, and R3 are as defined and oriented on the
phenyl ring as previously described, R4 is as previously defined and R5 is-O-heterocycloalkyl,
wherein the heterocycloalkyl group is selected from aza-bicyclo-octyl, in certain
embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl,
aza-bicyclo-decyl, where the aza nitrogen is optionally substituted with methyl or ethyl,
piperidinyl, piperazinyl, and pyrrolidinyl, wherein the piperidinyl, piperazinyl, and
pyrrolidinyl groups are unsubstituted or substituted at one or two positions with groups that
are independently C1-C4 alkyl, C1-C4 alkoxy, halogen, C1-C4 haloalkyl, C1-C4 haloalkoxy,
hydroxyl, hydroxy C1-C4 alkyl, amino, -NH(C1-C4 alkyl), -N(C1-C4 alkyl)(C1-C4 alkyl), -(C0-
C6 alkyl)-C(O)R11, or NO2. wherein
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-
C(O)N(R9)-heterocycloalkyl, or heterocycloalkyl wherein the heterocycloalkyl group is
selected from aza-bicyclo-octyl, in certain embodiments l-aza-bicyclo[2.2.2]oct-3-yl or 8-
aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl, aza-bicyclo-decyl, where the aza nitrogen is
optionally substituted with methyl or ethyl; and R4 is H or methyl, pyrrolidinyl, piperidinyl,
piperazinyl, and morpholinyl, wherein the heterocycloalkyl groups are optionally substituted
with 1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3.
In still yet another aspect, the invention provides compounds of formula (X), wherein

R1 is chloro; R2 is amino; R3 is methoxy; R4 is H, and R1, R2, and R3 have the following
orientation on the phenyl ring:

L is -(C3-C5 alkyl)- wherein one carbon may be replaced by -N(R9)-, or -(C2-C6
alkyl)-C(O)-. In yet another aspect, the R1, R2, and R3 are as defined and oriented on the
phenyl ring as previously described, R4 is as previously defined and R5 is heterocycloalkyl,
which is selected from aza-bicyclo-octyl, in certain embodiments 1-aza-bicycIo[2.2.2]oct-3-
yl or 8-aza-bicyclo[3.2.1]oct-3-yl, aza-bicyclo-nonyl, aza-bicyclo-decyl, where the aza
nitrogen, is optionally substituted with methyl or ethyl.
In still yet another aspect, the invention provides compounds of formula (X), wherein
R1 is chloro; R2 is amino; R3 is methoxy; R4 is H, and R1, R2, and R3 have the following
orientation on the phenyl ring:

L is -(C3-C5 alkyl)- wherein one carbon may be replaced by —N(R9)-, or-(C2-C6
aIkyl)-C(O)-. In yet another aspect, the R1, R2, and R3 are as defined and oriented on the
phenyl ring as previously described, R4 is as previously defined and R5 is-N(R9)-C0-C4 alkyl-
aryl or -N(R9)-(C0-C6 alkyl)-C(O)-aryl, wherein the aryl group is unsubstituted or substituted
at one or more substitutable positions with C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6
haloalkyl, C1-C6 haloalkoxy, hydroxyl, hydroxyalkyl, amino, -NH(C1-C6 alkyl), -N(C1-C6
alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)R11, or NO2. In still another aspect, the aryl group is
a phenyl substituted with -(C1-C6 alkyl)-C(O)R11 and optionally substituted with 1 or 2
groups independently selected from C1-C6 alkyl, C1-C6 alkoxy, halogen, CF3, OCF3,
hydroxyl, hydroxyalkyl, amino, -NH(C1-C4 alkyl), -N(C1-C4 alkyl)(C1-C4 alkyl), or NO2,
wherein
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-
C(O)N(R9)-heterocycloalkyl, or heterocycloalkyl wherein the heterocycloalkyl group is
selected from pyrrolidinyl, piperidinyl, piperazinyl, and morpholinyl, wherein the

heterocycloalkyl groups are optionally substituted with 1,2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3. In a preferred aspect the -(C0-C6 alkyl)-C(O)R11
group is attached to position 4 of the phenyl ring.
In still another aspect, the orientation of bonds 3 and 4 is as follows:

In a preferred aspect, the orientation of bonds 3 and 4 is as follows:

The invention further provides methods for treating emesis, dyspepsia, gastroparesis,
constipation, intestinal pseudo-obstruction, gastroesophageal reflux, or post-operative ileus,
the method comprising administering a therapeutically effective amount of a compound or
salt according of formula (X) to a patient in need of such treatment.
The subject invention provides compounds that are more susceptible to degradation
by serum and/or cytosolic esterases than cisapride, thus avoiding the adverse effects
associated with metabolism by cytochrome P450.
Advantageously, the therapeutic compounds of the subject invention are stable in
storage but have a relatively short half-life in the physiological environment; therefore, the
compounds of the subject invention can be used with a lower incidence of side effects and
toxicity.
In a preferred aspect of the subject invention, therapeutic stereoisomeric compounds
are provided that are useful in the treatment of gastroesophageal reflux disease and that
contain an ester group, which is susceptible to degradation by esterases, thereby breaking
down the compound and facilitating its efficient removal from the treated individual. In a
preferred aspect, the therapeutic stereoisomeric compounds are metabolized by the Phase I
drug detoxification system.
A further aspect of the subject invention pertains to the breakdown products
(preferably metabolic breakdown products, i.e., metabolites, generally acids of parent esters)

that are produced when the therapeutic compounds of the subject invention are acted upon by
an esterase. The presence of these breakdown products in the urine or serum can be used to
monitor the rate of clearance of the therapeutic compound from a patient.
Degradation of the compounds of the subject invention by esterases is particularly
advantageous for drug metabolism because these enzymes are ubiquitously distributed and
their activity is not dependent on age, gender, or disease state to the same extent as oxidative
hepatic drug metabolism.
The subject invention further provides methods of treating disorders, such as
gastroesophageal reflux disease comprising the administration of a therapeutically effective
amount of at least one stereoisomeric structural and/or functional analog of cisapride to an
individual in need of treatment. In a specific aspect, the subject invention provides
stereoisomeric structural and/or functional analogs of cisapride and pharmaceutical
compositions of these esterified compounds.
The subject invention further provides materials and methods for the treatment of
emesis and such other conditions, including but not limited to dyspepsia, gastroparesis,
constipation, and intestinal pseudo-obstruction, while substantially reducing adverse effects
associated with the administration of cisapride.
In a preferred aspect of the subject invention, therapeutic stereoisomeric compounds
are provided which are useful in the treatment of gastroesophageal reflux, dyspepsia,
gastroparesis, constipation, post-operative ileus, and intestinal pseudo-obstruction and which
contain an ester group which is acted upon by esterases thereby breaking down the compound
and facilitating its efficient removal from the treated individual.
The subject invention further provides methods of synthesizing the unique and
advantageous compounds of the subject invention. Particularly, methods of producing and
purifying such stereoisomeric compounds are taught. Methods of adding such ester moieties
and of producing and purifying stereoisomers, are well known to the skilled artisan and can
be readily carried out utilizing the guidance provided herein.
Preferred Compounds
In a preferred aspect, the present invention provides isolated stereoisomers of
Compound I, which contains three chiral centers.


6-[4-(4-Amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1 -y l]-hexanoic acid 1 -aza-
bicyclo[2.2.2]oct-3-yl ester
Compound I
Two of the chiral centers exist in cisapride and norcisapride and are in the cis
configuration in the active drugs:

Thus, for example, pharmaceutically active norcisapride is a racemic mixture of the
two cis enantiomers:

In one aspect, the current invention is particularly concerned with the configuration at
the third chiral center, in the quinuclidinol moiety. This group is eliminated in the conversion
to the acid metabolite referred to herein as ± Compound II:


The preferred Compound I stereoisomers of the present invention are made by
conjugating R or S quinuclidinol to (+)- or (-)-norcisapride, giving Compounds III, IV, V and
VI.

(3R,4S,3'R)-6-[4-(4-Amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1 -yl]-hexanoic acid 1 -aza-
bicyclo[2.2.2]oct-3-yl ester
compound III: (-I)(R)-compound I

(3S,4R,3'R)-6-[4-(4-Amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-yl]-hexanoic acid 1-
aza-bicyclo[2.2.2]oct-3-yl ester
compound IV: (+)(R)-compound I

(3R,4S,3'S)-6-[4-(4-Amino-5-chloro-2-methoxy-benzoyIarnino)-3-methoxy-piperidin-1-yl]-hexanoic acid 1-
aza-bicyclo[2.2.2]oct-3-yl ester
compound V: (-)(S)-compound

(3S.4F id 1-
In a preferred aspect, the subject invention pertains to stereoisomerically isolated
compounds, and compositions comprising the compounds. The isolated stereoisomeric forms
of the compounds of the invention are substantially free from one another (i.e., in
stereoisomeric excess). In other words, the "R" forms of the compounds are substantially
free from the "S" forms of the compounds and are, thus, in stereoisomeric excess of the "S"
forms. Conversely, "S" forms of the compounds are substantially free of "R" forms of the
compounds and are, thus, in stereoisomeric excess of the "R" forms. In one aspect of the
invention, the isolated stereoisomeric compounds are in at least about 80% stereoisomeric
excess.. In a preferred aspect, the compounds are in at least about 90% stereoisomeric excess.
In a more preferred aspect, the compounds are in at least about 95% stereoisomeric excess.
In an even more preferred aspect, the compounds are in at least about 97.5% stereoisomeric
excess. In a most preferred aspect, the compounds are in at least about 99% stereoisomeric
excess. Similarly, the "(+)" and "(-)" forms of the compounds are also provided in
stereoisomeric excess.
As described herein, the various stereoisomers have particular unexpected properties
that, advantageously, can be used to customize treatment for a particular set of circumstances.
Thus, for example, compounds containing the (3'R)-isomer in the quinuclidinyl ester moiety,
i.e., compounds III and IV, are rapidly metabolized by esterases in human plasma, whereas

compounds containing the (3'S)-isomer of quinuclidinol, i.e., compounds V and VI, undergo
a much slower metabolism.
Thus, the (3'R)-isomers of compound I can be used when a short-duration of action is
preferred, for example stimulation of gastric motility in an acute episode, such as pulsatile
administration to patients with acute gastroparesis, or in acute gastroesophageal reflux.
Another advantage of rapid metabolism by esterases to an substantially less active
metabolites, i.e., compound II, is the very low probability of drug-drug interactions and
toxicity. Therefore these short-acting (R)-isomers can be advantageously used as an
intravenous formulation for treating gastroesophageal reflux in premature newborn who
notoriously are not able to metabolize drugs as well as adults because their CYP450 system is
not fully developed. In these newborn, a drug having rapid metabolism by a system other
than CYP450, e.g., esterases, is a great advantage. On the other hand, the (3'S)-isomers of
compound I are best used in chronic situations of the same ailments, for example
gastroparesis in diabetic patients or cancer patients under opiates, or in chronic
gastroesophageal reflux in patients who need 24-hour coverage.
In addition to their differences in metabolic fate, these separate isomers also have
different binding affinities for the 5-HT4 receptor, thus suggesting different activities as well,
and therefore different therapeutic uses. Thus, in a decreasing order of affinity for the 5-HT4
receptor, the isomers can be ranked as follows (in parentheses are the binding constant Ki
values); compound IV (1.4nM), compound VI (3.4nM), compound III (28nM), and
compound V (72nM). These binding experiments were performed using the radiolabel
displacement method described in standard textbooks and easily reproducible by persons
skilled in the art of molecular biology.
As a conclusion to these considerations: when the 3 and 4 positions are cis relative to
each other, compound I is a mixture of 4 isomers, consisting of 2 pairs of enantiomers. The
first pair of enantiomers is (+)(R)-compound I and (-)(S)-compound I (compounds IV and V,
respectively), the second pair of enantiomers is (-)(R)-compound I and (+)(S)-compound I
(compounds III and VI, respectively). Within each enantiomeric pair, each separate
enantiomer has different properties regarding both their rate of hydrolysis by esterases and
regarding their affinity at the 5-HT4 receptor. These different properties give them separately
advantageous therapeutic uses which are not interchangeable, i.e., which are specific to each
isomer, and which are not applicable to the racemic mixture. These differences of affinity at

the receptor and these differences in metabolic rates are not predictable and neither is it
possible to dissect these properties when testing the racemic mixture.
Definitions
As used herein, the term "alkyl" includes those alkyl groups of a designed number of
carbon atoms. Alkyl groups may be straight, or branched. Examples of "alkyl" include
methyl, ethyl, propyl, isopropyl, butyl, iso-, sec- and tert-butyl, pentyl, hexyl, heptyl, 3-
ethylbutyl, and the like. If the number of carbon atoms is not specified, the subject "alkyl"
moiety has from 1 to 6 carbons.
The term "alkoxy" represents an alkyl group of indicated number of carbon atoms
attached to the parent molecular moiety through an oxygen bridge. Examples of alkoxy
groups include, for example, methoxy, ethoxy, propoxy and isopropoxy.
By "aryl" is meant an aromatic carbocyclic group having a single ring (e.g., phenyl)
that is optionally fused or otherwise attached to other aromatic hydrocarbon rings or non-
aromatic hydrocarbon rings. "Aryl" includes multiple condensed rings in which at least one
is aromatic, (e.g., 1,2,3,4-tetrahydronaphthyl, naphthyl), wherein each ring is optionally
mono-, di-, or trisubstituted with the groups identified below, as well as multiple rings that
are not fused, such as, for example, biphenyl or binaphthyl. Preferred aryl groups of the
present invention are phenyl, 1-naphthyl, 2-naphthyl, indanyl, indenyl, dihydronaphthyl,
fluorenyl, tetralinyl or 6,7,8,9-tetrahydro-5H-benzo[a]cyc!oheptenyl. More preferred are
phenyl, biphenyl, and naphthyl. Most preferred is phenyl. The aryl groups herein are
unsubstituted or, as specified, substituted in one or more substitutable positions with various
groups. For example, such aryl groups may be optionally substituted with, for example, C1-
C6 alkyl, C1-C6 alkoxy, halogen, hydroxy, cyaho, nitro, amino, mono(C1-C6)alkylamino,
di(C1-C6)alkylamino, C2-C6alkenyl, C2-C6alkynyl, C1-C6 haloalkyl, C1-C6 haloalkoxy,
amino(C1-C6)alkyl, mono(C1-C6)alkylamino(C1-C6)alkyl or di(C1-C6)alkylamino(C1-
C6)alkyl.
The term "haloalkoxy" refers to an alkoxy group substituted with at least one halogen
atom and optionally further substituted with at least one additional halogen atom, where each
halogen is independently F, CI, Br or I. Preferred halogens are F or CI. Preferred haloalkoxy
groups contain 1-6 carbons, more preferably 1-4 carbons, and still more preferably 1-2
carbons. "Haloalkoxy" includes perhaloalkoxy groups, such as OCF3 or OCF2CF3.

The term "heteroaryl" refers to an aromatic ring system containing at least one
heteroatom selected from nitrogen, oxygen, and sulfur. The heteroaryl ring may be fused or
otherwise attached to one or more heteroaryl rings, aromatic or non-aromatic hydrocarbon
rings or heterocycloalkyl rings. Examples of heteroaryl groups include, for example, pyridyl,
pyrimidinyl, quinolinyl, benzothienyl, indolyl, indolinyl, pyridazinyl, pyrazinyl, isoindolyl,
isoquinolyl, quinazolinyl, quinoxalinyl, phthalazinyl, imidazolyl, isoxazolyl, pyrazolyl,
oxazolyl, thiazolyl, indolizinyl, indazolyl, benzothiazolyl, benzimidazolyl, benzofuranyl,
furanyl, thienyl, pyrrolyl, oxadiazolyl, thiadiazolyl, benzo[1,4]oxazinyl, triazolyl, tetrazolyl,
isothiazolyl, naphthyridinyl, isochromanyl, chromanyl, tetrahydroisoquinolinyl, isoindolinyl,
isobenzotetrahydrofuranyl, isobenzotetrahydrothienyl, isobenzothienyl, benzoxazolyl,
pyridopyridinyl, benzotetrahydrofuranyl, benzotetrahydrothienyl, purinyl, benzodioxolyl,
triazinyl, pteridinyl, benzothiazolyl, imidazopyridinyl, imidazothiazolyl,
dihydrobenzisoxazinyl, benzisoxazinyl, benzoxazinyl, dihydrobenzisothiazinyl,
benzopyranyl, benzothiopyranyl, chromonyl, chromanonyl, pyridinyl-N-oxide,
tetrahydroquinolinyl, dihydroquinolinyl, dihydroquinolinonyl, dihydroisoquinolinonyl,
dihydrocoumarinyl, dihydroisocoumarinyl, isoindolinonyl, benzodioxanyl, benzoxazolinonyl,
pyrrolyl N-oxide„ pyrimidinyl N-oxide, pyridazinyl N-oxide, pyrazinyl N-oxide, quinolinyl
N-oxide, indolyl N-oxide, indolinyl N-oxide, isoquinolyl N-oxide, quinazolinyl N-oxide,
quinoxalinyl N-oxide, phthalazinyl N-oxide, imidazolyl N-oxide, isoxazolyl N-oxide, oxazolyl
N-oxide, thiazolyl N-oxide, indolizinyl N-oxide, indazolyl N-oxide, benzothiazolyl N-oxide,
benzimidazolyl N-oxide, pyrrolyl N-oxide, oxadiazolyl N-oxide, thiadiazolyl N-oxide,
triazolyl N-oxide, tetrazolyl N-oxide, benzothiopyranyl S-oxide, benzothiopyranyl S,S-
dioxide. Preferred heteroaryl groups include pyridyl, pyrimidyl, quinolinyl, indolyl, pyrrolyl,
furanyl, thienyl, and imidazolyl. More preferred heteroaryl groups include pyridyl, pyrrolyl,
and indolyl. The heteroaryl groups herein are unsubstituted or, as specified, substituted in
one or more substitutable positions with various groups. For example, such heteroaryl groups
may be optionally substituted with, for example, C1-C6 alkyl, C1-C6 alkoxy, halogen,
hydroxy, cyano, nitro, amino, mono(C1-C6)alkylamino, di(C1-C6)alkylamino, C2-C6alkenyl,
C2-C6alkynyl, C1-C6 haloalkyl, C1-C6 haloalkoxy, amino(C1-C6)alkyl, mono(C1-
C6)alkylamino(C1-C6)alkyl or di(C1-C6)alkylamino(C1-C6)alkyl.
The term "heterocycloalkyl" refers to a ring or ring system containing at least one
heteroatom that is preferably selected from nitrogen, oxygen, and sulfur, wherein said

heteroatom is in a non-aromatic ring. The heterocycloalkyl ring is optionally fused to or
otherwise attached to other heterocycloalkyl rings and/or non-aromatic hydrocarbon rings
and/or phenyl rings. Preferred heterocycloalkyl groups have from 3 to 7 members. More
preferred heterocycloalkyl groups have 5 or 6 members. Examples of heterocycloalkyl
groups include, for example, aza-bicyclo[2.2.2]octyl, aza-bicyclo[3.2.1]octyI, morpholinyl,
thiomorpholinyl, thiomorpholinyl S-oxide, thiomorpholinyl S,S-dioxide, piperazinyl,
homopiperazinyl, pyrrolidinyl, pyrrolinyl, tetrahydropyranyl, piperidinyl, tetrahydrofuranyl,
tetrahydrothienyl, homopiperidinyl, homomorpholinyl, homothiomorpholinyl,
homothiomorpholinyl S,S-dioxide, oxazolidinonyl, dihydropyrazolyl, dihydropyrrolyl,
dihydropyrazinyl, dihydropyridinyl, dihydropyrimidinyl, dihydrofuryl, dihydropyranyl,
tetrahydrothienyl S-oxide, tetrahydrothienyl S,S-dioxide and homothiomorpholinyl S-oxide.
Preferred heterocycloalkyl groups include aza-bicyclo[2.2.2]octyl, aza-bicyclo[3.2.1]octyl,
piperidinyl, piperazinyl, pyrrolidinyl, thiomorpholinyl, S,S-dioxothiomorpholinyl,
morpholinyl, and imidazolidinyl. More preferred are aza-bicyclo[2.2.2]octyl, aza-
bicyclo[3.2.1]octyl, piperidinyl, piperazinyl, pyrrolidinyl, imidazolidinyl, and morpholinyl.
The heterocycle groups herein are unsubstituted or, as specified, substituted in one or more
substitutable positions with various groups. For example, such heterocycle groups may be
optionally substituted with, for example, C1-C6 alkyl, C1-C6 alkoxy, halogen, hydroxy, cyano,
nitro, amino, mono(C1-C6)alkylamino, di(C1-C6)alkylamino, C2-C6 alkenyl, C2-C6 alkynyl,
C1-C6 haloalkyl, C1-C6 haloalkoxy, amino(C1-C6)alkyl, mono(C1-C6)alkylamino(C1-C6)alkyl,
di(C1-C6)alkylamino(C1-C6)alkyl or =O.
The term "pharmaceutically acceptable salts" or "a pharmaceutically acceptable salt
theregf' refer to salts prepared from pharmaceutically acceptable non-toxic acids or bases
including inorganic acids and bases and organic acids and bases. Since the compound of the
present invention is basic, salts may be prepared from pharmaceutically acceptable non-toxic
acids. Suitable pharmaceutically acceptable acid addition salts for the compound of the
present invention include acetic, benzenesulfonic (besylate), benzoic, camphorsulfonic, citric,
ethenesulfonic, fumaric, gluconic, glutamic, hydrobromic, hydrochloric, isethionic, lactic,
maleic, malic, mandelic, methanesulfonic, mucic, nitric, pamoic, pantothenic, phosphoric,
succinic, sulfuric, tartaric, p-toluenesulfonic, and the like. Preferred acid addition salts are the
chloride and sulfate salts. In the most preferred aspect, structural and/or functional analogs of
cisapride are administered as the free base or as the mono or dihydrochloride salt.

As used herein, the terms "treatment" and "treating" encompass prophylactic
administration of the compound or a pharmaceutical composition comprising the compound
("prophylaxis") as well as remedial therapy to reduce or eliminate a disease or disorder
mentioned herein. Prophylactic administration is intended for prevention of disorders and
may be used to treat a subject that is at risk of having or suffering from one or more disorders
mentioned herein. Thus, as used herein, the term "treatment", or a derivative thereof,
contemplates partial or complete inhibition of the stated disease state, when an active
ingredient of the invention is administered prophylactically or following the onset of the
disease state for which such active ingredient of the is administered. "Prophylaxis" refers to
administration of the active ingredient(s) to a mammal to protect the mammal from any of the
disorders set forth herein, as well as others.
The term "therapeutically effective amount" refers to an amount necessary to achieve
a derived therapeutic effect such as: 1) an amount sufficient to alleviate reflux disease, 2) an
amount sufficient to alleviate nausea and vomiting, or 3) an amount sufficient to alleviate a
condition caused by gastrointestinal motility dysfunction. Therapeutically effective amounts
of structural and/or functional analogs of cisapride are encompassed by the above-described
dosage amounts and dose frequency schedule.
A "mammal" may be, for example, a mouse, rat, pig, horse, rabbit, goat, cow, cat,
dog, or human. In a preferred aspect, the mammal is a human.
The term "individual(s)" is defined as a single mammal to which is administered a
compound of the present invention. The mammal may be, for example, a mouse, rat, pig,
horse, rabbit, goat, cow, cat, dog, or human. In a preferred aspect, the individual is a human.
The term "esterified cisapride" means therapeutic compounds of the subject invention
that are structural and/or functional analogs of cisapride, which contain a hydrolysable group,
generally an ester, that does not detract from the ability of these compounds to provide a
therapeutic benefit, but which makes these compounds more susceptible to degradation by
hydrolases, particularly serum and/or cytosolic esterases, and which reduces the interaction of
the cytochrome P-450 drug detoxification system with the cisapride compounds. Esterase-
mediated metabolism of esterified cisapride compounds reduces the role of the cytochrome P-
450 drug detoxification system in cisapride metabolism and reduces or eliminates adverse
effects caused by cisapride.

The term "structural analog" as used herein means that a described compound shares
structural characteristics with a parent compound. For example, a structural analog of
cisapride may share one or more structural characteristics with the parent cisapride
compound, such as a substituted aryl ring connected to a piperdine ring through an amide
linker, but differ structurally in other ways, such as the inclusion or deletion of one or more
other chemical moieties.
The term "functional analog" as used herein means that a described compound shares a
functional characteristic with a parent compound. For example, a functional analog of
cisapride may share few, if any, structural characteristics with cisapride, but affect a similar
function, for example, 5-HT4 agonism.
The term "adverse effects" includes, but is not limited to, gastrointestinal disorders
such as diarrhea, abdominal cramping, and abdominal grumbling; tiredness; headache;
increased systolic pressure; death; ventricular tachycardia; ventricular fibrillation; torsades de
pointes; QT prolongation; increased heart rate; neurological and CNS disorders; and
interaction of cisapride with other drugs given concurrently such as but not limited to
digoxin, diazepam, ethanol, acenocoumarol, cimetidine, ranitidine, paracetamol, and
propranolol.
The term "gastroesophageal reflux disease" as used herein means the incidence of,
and the symptoms of, those conditions causing the backward flow of the stomach contents
into the esophagus.
The terms "eliciting an anti-emetic effect" and "anti-emetic therapy" as used herein
mean providing relief from or preventing the symptoms of nausea and vomiting induced
spontaneously or associated with emetogenic cancer chemotherapy or irradiation therapy.
The term "treating a condition caused by gastrointestinal motility dysfunction" as used
herein means treating the symptoms and conditions associated with this disorder which
include, but are not limited to, gastroesophageal reflux disease, dyspepsia, gastroparesis,
constipation, post-operative ileus, and intestinal pseudo-obstruction.
The term "prokinetic" as used herein means the enhancement of peristalsis in, and
thus the movement through the gastrointestinal tract.
The term "dyspepsia" as used herein means a condition characterized by an
impairment of the power or function of digestion that can arise as a symptom of a primary

gastrointestinal dysfunction or as a complication due to other disorders such as appendicitis,
gallbladder disturbances, or malnutrition.
The term "gastroparesis" as used herein means a paralysis of the stomach brought
about by a motor abnormality in the stomach or as a complication of diseases such as
diabetes, progressive systemic sclerosis, anorexia nervosa, or myotonic dystrophy.
The term "constipation" as used herein means a condition characterized by infrequent
or difficult evacuation of feces resulting from conditions such as lack of intestinal muscle
tone or intestinal spasticity.
The term "post-operative ileus" as used herein means an obstruction in the intestine
due to a disruption in muscle tone following surgery.
The term "intestinal pseudo-obstruction" as used herein means a condition
characterized by constipation, colicky pain, and vomiting, but without evidence of physical
obstruction.
Preparation of Compounds
The chemical synthesis of various analogs of cisapride can be performed by the
methods described in European Patent Application No. 0,076,530 A2 published Apr. 13,
1983, U.S. Pat. Nos. 4,962,115 and 5,057,525 and in Van Daele et al., Drug Development
Res. 8: 225-232 (1986), the disclosures of which are incorporated herein by reference in their
entireties, and modified by the incorporation of an ester group at a point convenient in the
synthesis of the disclosed compounds. Exemplary, non-limiting synthesis schemes for
certain esterified cisapride analogs of the subject invention are provided in WO 01/093849.
The invention is illustrated further by the following examples, which are not to be
construed as limiting the invention in scope or spirit to the specific procedures described in
them. Those having skill in the art will recognize that the starting materials may be varied
and additional steps employed to produce compounds encompassed by the invention, as
demonstrated by the following examples. Those skilled in the art will also recognize that it
may be necessary to utilize different solvents or reagents to achieve some of the above
transformations. In some cases, protection of reactive functionalities may be necessary to
achieve the above transformations. In general, such need for protecting groups, as well as the
conditions necessary to attach and remove such groups, will be apparent to those skilled in
the art of organic synthesis. When a protecting group is employed, deprotection step may be
required. Suitable protecting groups and methodology for protection and deprotection such

as those described in Protecting Groups in Organic Synthesis by T. Greene are well known
and appreciated in the art.
Unless otherwise specified, all reagents and solvents are of standard commercial
grade and are used without further purification. The appropriate atmosphere to run the
reaction under, for example, air, nitrogen, hydrogen, argon and the like, will be apparent to
those skilled in the art.
Example 1
Preparation of 6-[4R-(4-amino-5-chloro-2-methoxy-benzoylamino)-3S-methoxy-
piperidin-l-yl]-hexanoic acid l-aza-bicyclo[2.2.2]oct-3'R-yl ester, dihydrochloride salt (ATI-
7505 Dihydrochloride Salt)


Step 1: Resolution of Racemic Norcisapride
(-)-Dibenzoyl-L-tartaric acid ((-)-DBT, about 1 part by weight) was dissolved in
ethanol and filtered to remove residual particulates. Separately, racemic norcisapride (about
0.8 part by weight) was dissolved in a mixture of ethanol and water and then filtered. The
filtrate was heated to about 75°C before adding the (-)-DBT solution. After stirring at this
temperature for about 30 minutes, the mixture was slowly cooled for several hours to about 5
°C and the product salt was collected under vacuum filtration and washed with EtOH/H2O
mixture. The wetcake was recrystallized from EtOH/H2O by heating to about 79 °C and slow

cooling to about 5 °C as before. The product was collected on a vacuum filter and washed
with EtOH/H2O to give a wetcake.
The wetcake was suspended in water and the pH was adjusted to about 12 using 7%
(WAV) aq. NaOH. The resulting suspension was stirred for about 3 hours at room
temperature before filtering under vacuum and washing the solid material with water and
drying under vacuum. The product was then retreated with (-)-DBT to form the salt by the
same general procedure described above. The isolated salt was then neutralized with aq.
NaOH as described above. The product was isolated on a filter and dried as before to provide
(+)-norcisapride base (about 0.25 parts by weight). The e.e. by chiral HPLC analysis was
about 100% (+)-norcisapride. The optical rotation was about +5° (methanol; 25°C and
589 nm), confirming the positive isomer of norcisapride.
Step 2: Coupling with Ethyl 6-bromobexanoate
(+)-Norcisapride (about 1 part by weight), potassium carbonate (about 0.48 part by
weight) and potassium iodide (about 0.063 part by weight) were suspended in anhydrous USP
ethanol. Ethyl 6-bromohexanoate (about 0.76 part by weight) was added slowly to the
suspension at room temperature. The mixture was heated to reflux until completion of the
reaction. Subsequent cooling to room temperature the reaction mixture was filtered to
remove, e.g., inorganic solids, and the filtrate was concentrated under reduced pressure to
about one-half the volume. The product was precipitated by slowly adding the crude material
to cold water (about 13 parts by weight) with rapid stirring. The precipitate was filtered
under vacuum and washed with water and then reprecipitated twice more by dissolution in
anhydrous ethanol and slow addition into cold water as before. The resulting wetcake was
washed with n-heptane and resuspended in ethyl acetate and n-heptane (1:9; v/v) and stirred
for about 1 hour and before filtering and drying under vacuum to yield 0.73 parts by weight
of the coupled product as a white solid.
Step 3: Coupling with (R)-3-Quinuclidinol and Dihydrochloride Salt Formation
The ester (1 part by weight) and (R)-3-Quinuclidinol (about 1.12 part by weight)
were suspended in toluene before slowly adding titanium (IV) ethoxide (about 0.5 part by
weight) to the stirred suspension. The mixture was heated to about 91 °C under a stream of
nitrogen, and partial vacuum was applied to the flask through a distillation apparatus in order
to azeotropically remove the ethanol. Additional toluene was added as needed to maintain a

minimum solvent volume in the flask. The reaction was considered complete after about 33
hours.
The mixture was cooled to about room temperature and extracted five times with
water. The organic layer was concentrated under reduced pressure and the resulting residue
was redissolved in EtOH/iPrOH (about 1:1 v/v) and then filtered through a 0.45 micron
membrane filter to remove any particulates. Concentrated hydrochloric acid was added
slowly to the stirred filtrate to precipitate out the desired product as the dihydrochloride salt.
The resulting suspension was stirred for several hours at room temperature and collected
under vacuum filtration and rinsed with EtOH/iPrOH (1:1; v/v) to provide 0.53 part by
weight of the crude product salt.
Crude dihydrochloride salt was resuspended in ethanol and heated to reflux before
cooling to room temperature over about 1 hour. The product was collected under vacuum
filtration and rinsed with ethanol and then air-dried.- The solids were resuspended in ethanol
and warmed to about 55 °C to give a clear solution before adding warm isopropanol and the
product was allowed to precipitate by slow cooling to room temperature. The resulting
suspension was stirred for several hours before vacuum filtering and rinsing with, e.g.,
isopropanol. The product was vacuum dried, initially at room temperature for several hours
and then at about 55 °C until a constant weight was achieved.
Example 2
Preparation of (R)-quinuclidin-3-yl 6-((3 S,4R)-4-(4-amino-2-chloro-6-
methoxybenzamido)-3-methoxypiperidin-1-yl)hexanoate
Step 1: Synthesis of ethyl 4-(dibenzylamino)-3-methoxypiperidine-l-carboxylate (1):

To a solution of racemic ethyl 4-amino-3-methoxypiperidine-l-carboxylate (1 part by
mole) in DMF were added benzyl bromide (about 2.2 part by mole), potassium carbonate
(about 2.4 part by mole) and potassium iodide (about 0.2 part by mole) respectively. The
reaction was heated to about 80 °C. After about 6 hours, the reaction was slowly diluted with

water (about 12 parts by volume) and extracted with, for example, ethyl acetate. The organic
layer was washed with brine and then dried over anhyh. Na2SO4. Subsequent filtration and
concentration of the solvent provided the 1 as the yellow-orange oil (1 part by mole).
Step 2. Synthesis of N,N-dibenzyl-3-methoxypiperidin-4-amine (2):

To a solution of 1 was added NaOH (about 10 part by mole) in isopropanol and the
mixture was stirred and heated to reflux. After about 3 to about 5 hours, the reaction was
cooled to room temperature and the alcoholic solvent was removed via rotary evaporation.
The mixture was diluted with water and extracted with ethyl acetate. The organic layer was
brined washed before drying over anhyh. Na2SO4. Subsequent filtration and concentration
of the solvent provided a crude oil which was purified over SiO2 (CH2Cl2 : MeOH: NH4OH;
(about) 15:1:0.01) to furnish 2.
Step 3. Synthesis of (3S,4R)-N,N-dibenzyl-3-methoxypiperidin-4-amine (3):

(-)-Dibenzoyl-L-tartaric acid (about 1.2 part by weight) is dissolved in ethanol before
slowly adding to a solution of 2 (about 1 part by weight). The solution is gently warmed and
then allowed to cool to room temperature to crystallize the salt product. The salt is filtered
and washed with EtOH/H2O before suspending in water and basifying by adding aq. NaOH
(7%, wt/wt) until the pH reaches about 12. The suspension is stirred vigorously at rt and the
solid is filtered away, washed with water and vacuum dried to furnish the cis-isomer 3.
Step 4. Synthesis of ethyl 6-((3S,4R)-4-(dibenzylamino)-3-methoxypiperidin-1-yl)hexanoate
(4):


To a solution of 3 (1 part by mole) in DMF are added ethyl bromohexanoate (about
1.2 part by mole), potassium carbonate (about 1.4 part by mole) and potassium iodide (about
0.2 part by mole) respectively. The reaction is then heated to 80 °C. After about 8 h, the
reaction is slowly diluted with water (about .12 part by volume) and extracted with ethyl
acetate. The organic layer is washed with brine and then dried over anhyd. Na2SO4.
Subsequent filtration and concentration of the solvent furnishes the crude material.
Purification over SiO2 and gives the alkylated material 4.
Step 5. Synthesis of (R)-quinuclidin-3-yl 6-((3S,4R)-4-(dibenzylamino)-3-methoxypiperidin-
l-yl)hexanoate (5):

Titanium tetraethoxide is added to a mixture of 4 (1 part by mole) and (R)-(-)-3-
quinuclidinol (1 part by mole) in toluene. The reaction mixture is equipped with a dean-stark
apparatus before heating to about 90 oC and partial vacuum is then applied (additional toluene
is added as needed to main the requisite solvent level). The mixture is then cooled to rt and
the reaction is diluted with ethyl acetate and then water is added to the resulting mixture. The
organic layer is separated, brine washed, dried over anhyd. Na2SO4, filtered and concentrated.
Purification over SiO2 gives the enantiomerically enriched 5.
Step 6. Synthesis of (R)-quinuclidin-3-yl 6-((3S,4R)-4-amino-3-methoxypiperidin-1-
yl)hexanoate (6):


A solution of 5 (1 part by mole) in EtOH is added to a reaction flask containing
palladium on carbon (about 0.2 part by mole). The mixture is then evacuated of air before
subjecting to hydrogenolysis condition by using atmospheric H2. Upon completion of the
reaction, the palladium is filtered off under a pad of celite followed by EtOH washes. The
filtrated is concentrated via rotary evaporation to furnish 6.
Step 7. Synthesis of (R)-quinuclidin-3-yl 6-((3S,4R)-4-(4-amino-2-chloro-6-
methoxybenzamido)-3-methoxypiperidin-l-yl)hexanoate(7):

To a solution of, for example, ethyl chloroformate (1 part by mole) in THF at about 0
°C is added the benzoic acid (1 part by mole) in portions. The mixture is warmed to rt for
about 1 h before cooling to about 0 °C and adding dropwise a solution of 6 (1 part by mole).
The reaction is then warmed to rt. Upon completion of the reaction, reaction is quenched by
addition of a sat'd solution of NaHCO3 and extracting over EA. The organic layer is brine
washed, dried over anhyd. Na2SO4, filtered and concentrated to furnish the desired product 7.
Example 3
Alternate synthesis of ATI-7505:

Under acidic conditions, l-benzylpiperidin-4-one (1) and hydrobromic acid are
reacted in the presence of acetic acid to generate N-benzyl-3-bromopiperidin-4-one (2).
Treatment of 2 with a sodium methoxide and methanol solution provides 1-benzyl-4,4-
dimethoxypiperidin-3-ol (3). [The presence of the beta-amino group negates the possibility
of a Favorskii-type reaction.] Methylation of the hydroxyl group is done using a hydride base
followed by treatment with iodomethane in the presence of DMF as the solvent to furnish
compound 4.


Subsequent acetal hydrolysis using 1% sulfuric acid in the presence of heat yields a
piperidine 5, which can then undergo a reductive amination using, for example, sodium
cyanoborohydride and ammonium acetate in methanol to yield l-benzyl-3-methoxypiperidin-
4-amine (6). At this stage, 6 can undergo a chiral resolution technique. This can be
accomplished, for example, using (-)-DBT or other variant of tartaric acid in the presence of
the suitable solvent to afford exclusively asymmetrically pure compound 7. Boc group
protection of the primary amine in 7 can be accomplished using Boc anhydride in the
presence of THF solvent to obtain 8. A debenzylation reaction by hydrogenolysis using Pd/C
in methanol in the presence of atmospheric hydrogen gas set the stage for the alkylation step.
Treatment of 6-bromohexanenitrile in the presence of mild base and DMF generates
compound 10. A nitrile to ester conversion using (R)-quinuclidinol in the presence of dilute
acid generates 11. Subsequent removal of the Boc group using TFA furnishes the free amine,

which can undergo a coupling reaction with requisite benzoic acid in the presence of a
coupling reagent such as ethyl chloroformate to afford ATI-7505 as an enantiomerically pure
material.

Alternatively, compound 9 can be alkylated using ethyl 6-bromohexanoate in the presence of
mild base. Subsequent removal of the Boc group yields compound 13. Titanium mediated
transesterification of 13 using (R)-quinuclidinol and titanium tetraethoxide in toluene solvent
generates ATI-7505. Carlsburg esterase hydrolyzes esters that are of the S-configuration,
therefore leaving intact esters that are of the R configuration. Therefore treatment of
diasteriomeric mixtures of 14 with the Carlsburg esterase may also yield ATI-7505.
Example 4
(+) and (-)-norcisapride can be made from its racemic mixture by resolution of the
enantiomers using conventional means such as optically resolving acids, according to the
method described in US Patent 6,147,093, or in "Enantiomers, Racemates and Resolutions",
by J. Jacques, A. Collet, and S.H. Wilen (Wiley-Interscience, New York, NY), or in S.H.
Wilen et al., Tetrahedron (1977) 33:2725.
The 4 isomers were obtained in low-mg amounts by using preparative column
chromatography followed by evaporation of the solvent. This method is useful for preparing
small amounts for analytical and characterization purposes. This is a standard separation
method used routinely in analytical labs in order to isolate and characterize metabolites.
Possible synthetic routes to Compound IV, Compound VI and (+)-Compound II are
described below using (+)-norcisapride as a starting material. The routes to Compound III,

Compound V and (-)-Compound II are identical except that they use (-)-norcisapride as a
starting material.
Example 5
Production of (+)-Compound II, ethyl ester
A equimolar mixture of (+)-norcisapride and ethyl 6-bromohexanoate (1 equivalent
each), a catalytic amount of KI, and K2CO3 (2 equivalents) in DMF is heated at about 60 C
for several hours or until TLC analysis indicates that the reaction is over. After cooling to
room temperature, water is added and the mixture is extracted with EtOAc. The combined
organic extracts are washed successively with water, 10% LiCl(aq) solution and brine, then
dried over Na2SO4. Concentration gives (+)-compound II, ethyl ester.
Production of (+)-Compound II
A mixture of crude (+)-compound II, ethyl ester, from above (1 eq.), KOH (2M, 5 eq.)
in MeOH and THF (enough to dissolve) is stirred at room temperature for approximately 1 to
2 hours. The MeOH and THF are removed under vacuum, and the residue is diluted with
water. Wash with an organic solvent such as EtOAc. The aqueous layer is acidified to pH ~5
using HC1. The precipitate is filtered off and dried to give (+)-Compound II.
Production of Compound IV and Compound VI
A mixture of (+)-Compound II (I eq.), (R)-(-)-3-quinuclidinol HC1 salt (1 eq.), EDAC
(1 eq.) and DMAP (1 eq.) in DMF iss heated at around 50C overnight. After cooling and
diluting with water, the mixture is purified by chromatography or by crystallization to
provide Compound IV. Similarly, using (S)-(+)-quinuclidinol, Compound VI is obtained.
The following compounds are prepared essentially according to methods and
procedures described above. The compound names were generated using either ChemDraw
Ultra version 8.03, which is available from Cambridgesoft Corporation or ACD Namepro
software, version 6.0.





Dosage rates and routes of administration of the disclosed compounds are similar to
those already used in the art and known to the skilled artisan (see, for example, Physicians'
Desk Reference, 54th Ed., Medical Economics Company, Montvale, NJ, 2000).
The magnitude of a prophylactic or therapeutic dose of structural and/or functional
analog of cisapride in the acute or chronic management of diseases and/or disorders described
herein will vary with the severity of the condition to be treated, and the route of
administration. The dose, and perhaps the dose frequency, will also vary according to the age,
body weight, and response of the individual patient. In general, the total daily dose range for
structural and/or functional analogs of cisapride, for the conditions described herein, is from
about 1 mg to about 200 mg, in single or divided doses. Preferably, a daily dose range should
be between about 5 mg to about 100 mg, in single or divided doses, while most preferably, a
daily dose range should be between about 5 mg to about 75 mg, in single or divided doses. It
is preferred that the doses are administered from 1 to 4 times a day. In managing the patient,
the therapy should be initiated at a lower dose, perhaps about 5 mg to about 10 mg, and
increased up to about 50 mg or higher depending on the patient's global response. It is further
recommended that children, and patients over 65 years, and those with impaired renal or
hepatic function, initially receive low doses, and that they be titrated based on individual
response(s) and blood level(s). It may be necessary to use dosages outside these ranges in

some cases as will be apparent to those skilled in the art. Further, it is noted that the clinician
or treating physician will know how and when to interrupt, adjust, or terminate therapy in
conjunction with individual patient response.
The compounds of the subject invention can be formulated according to known
methods for preparing pharmaceutically useful compositions. Formulations are described in
detail in a number of sources which are well known and readily available to those skilled in
the art. For example, Remington's Pharmaceutical Science by E.W. Martin describes
formulations which can be used in connection with the subject invention. In general, the
compositions of the subject invention are formulated such that an effective amount of the
bioactive compound(s) is combined with a suitable carrier in order to facilitate effective
administration of the composition.
The compositions of the subject invention include compositions such as suspensions,
solutions and elixirs; aerosols; or carriers such as starches, sugars, microcrystalline cellulose,
diluents, granulating agents, lubricants, binders, disintegrating agents, and the like, in the case
of oral solid preparations (such as powders, capsules, and tablets) with the oral solid
preparations being preferred over the oral liquid preparations. A preferred oral solid
preparation is capsules.. The most preferred oral solid preparation is tablets. Preferred
amounts of active ingredient (i.e., an structural and/or functional analog of cisapride) in a
solid dosage form are about 5 mg, 10 mg, and 25 mg.
Further, acceptable carriers can be either solid or liquid. Solid form preparations
include powders, tablets, pills, capsules, cachets, suppositories and dispersible granules. A
solid carrier can be one or more substances which may act as diluents, flavoring agents,
solubilizers, lubricants, suspending agents, binders, preservatives, tablet disintegrating agents
or encapsulating materials.
The disclosed pharmaceutical compositions may be subdivided into unit doses
containing appropriate quantities of the active_component. The unit dosage form can be a
packaged preparation, such as packeted tablets, capsules, and powders in paper or plastic
containers or in vials or ampules. Also, the unit dosage can be a liquid based preparation or
formulated to be incorporated into solid food products, chewing gum, or lozenge.
In addition to the common dosage forms set out above, the compounds of the present
invention may also be administered by controlled release means and/or delivery devices such

as those described in U.S. Pat. Nos.: 3,845,770; 3,916,899; 3,536,809; 3,598,123; and
4,008,719, the disclosures of which are hereby incorporated by reference in their entirety.
Any suitable route of administration may be employed for providing the patient with
an effective dosage of a structural and/or functional analog of cisapride. For example, oral,
rectal, parenteral (subcutaneous, intramuscular, intravenous), transdermal, and like forms of
administration may be employed. Dosage forms include tablets, troches, dispersions,
suspensions, solutions, capsules, patches, and the like.
One aspect of the invention provides a method of treating gastroesophageal reflux
disease in a mammal, while substantially reducing the concomitant adverse effects associated
with the administration of cisapride, which comprises administering to a human in need of
such treatment, a therapeutically effective amount of a structural and/or functional analog of
cisapride, or a pharmaceutically acceptable salt thereof. A preferred aspect is the treatment of
gastroesophageal reflux disease in humans.
Another aspect of the invention provides a composition for the treatment of a human
suffering from gastroesophageal reflux disease, which comprises a therapeutically effective
amount of a structural and/or functional analog of cisapride, or a pharmaceutically acceptable
salt thereof.
Yet another aspect of the present invention provides a method of eliciting an anti-
emetic effect in a mammal, while substantially reducing the adverse effects associated with
the administration of cisapride, which comprises administering to a mammal in need of such
anti-emetic therapy, a therapeutically effective amount of structural and/or functional analogs
of cisapride, or a pharmaceutically acceptable salt thereof. Preferably, the mammal is a
human.
In an additional aspect, the present invention encompasses an anti-emetic composition
for the treatment of a mammal in need of anti-emetic therapy, which comprises a
therapeutically effective amount of a structural and/or functional analog of cisapride, or a
pharmaceutically acceptable salt thereof.
A further aspect of the present invention includes a method of treating a condition
caused by gastrointestinal motility dysfunction in a mammal which comprises administering
to a mammal in need of treatment for gastrointestinal motility dysfunction, a therapeutically
effective amount of a structural and/or functional analog of cisapride, or a pharmaceutically
acceptable salt thereof. Conditions caused by gastrointestinal motility dysfunction include,

but are not limited to, dyspepsia, gastroparesis, constipation, post-operative ileus, and
intestinal pseudo-obstruction. Preferably, the mammal is a human.
The observation that cisapride enters the central nervous system and binds to 5HT4
receptors indicates that cisapride may have centrally-mediated effects. Cisapride is a potent
ligand at 5HT4 receptors, and these receptors are located in several areas of the central
nervous system. Modulation of serotonergic systems has a variety of behavioral effects.
Accordingly, the compounds of the subject invention can be used in the treatment of: 1)
cognitive disorders, including but not limited to Alzheimer's disease; 2) behavioral disorders,
including but not limited to schizophrenia, mania, obsessive-compulsive disorder, and
psychoactive substance use disorders; 3) mood disorders, including but not limited to
depression and anxiety; and 4) disorders of control of autonomic function, including but not
limited to essential hypertension and sleep disorders.
Accordingly, the present invention also provides methods of treating cognitive,
behavioral, mood, or autonomic function control disorders in a mammal comprising the
administration of a therapeutically effective amount of structural and/or functional analog of
cisapride, or a.pharmaceutically acceptable salt thereof. Preferably, the mammal is a human.
A TI-7S05 Binds with High Affinity to 5-HT4 Receptors
The 5-HT4 receptor is known to be the major receptor subtype involved in the
prokinetic activity of cisapride in the gut. ATI-7505 has a high binding affinity for 5-HT4
receptor, with a low nanomolar IC50. As shown in Table 1, the affinity of ATI-7505 for the
5-HT4 receptor was 18-fold greater than cisapride and at least 360-fold greater than the
ATI-7505 major metabolite, ATI-7500.


A TI- 7505 is a Highly Potent Partial Agonist at Human 5-HT4 Receptor
ARYx performed in vitro assays based on adenylyl cyclase stimulation in cells
engineered to stably express human 5-HT4 receptor. ATI-7505 proved to be a highly potent
5-HT4 receptor agonist, whereas its major metabolite, ATI-7500 was relatively weak (Figure
1 and Table 2). The estimated EC50 of ATI-7505 (4 nM) was approximately 10-fold lower
than that of cisapride (49 nM), and approximately 100-fold lower than that of ATI-7500 (395
nM). Based on its estimated Emax value, ATI-7505 had 85% of the efficacy of 5-HT
(serotonin) (Table 2), demonstrating that ATI-7505 is a partial agonist of HT4 receptors.

ATI-7505 Accelerates Gastric Emptying in Fed Dogs To characterize the effects of ATI-
7505 on gastric emptying, experiments were performed in a post-prandial model involving
conscious dogs instrumented with sets of strain gauge transducers placed on the stomach and
small bowel. The objective of the experiments was to measure the time required for
migrating motor contractions (MMCs) to return to baseline following ingestion of a solid
meal. A drug-induced shortening of MMC return time indicated an early end of the digestive
period due to accelerated gastric emptying. Immediately after completion of an MMC in the
mid-small intestine, various doses of test drugs (vehicle, ATI-7505, or cisapride) were
infused intravenously (IV) over 20 minutes. At the end of the drug infusion, the dogs were
fed a meal. Gut contractions were recorded for a minimum of 60 minutes prior to the start of
the drug infusion to establish the fasting state and to identify the onset of MMC in the
duodenum, and at least 30 minutes after the return of MMC in the duodenum. Quantitative
comparisons of the treatments were based on the time of MMC return as an index of gastric
emptying following ingestion of a solid meal. As summarized in Figure 2, ATI-7505
significantly shortened the time of MMC return, indicating an acceleration of gastric
emptying in normal fed dogs. Cisapride showed a similar pattern of action.

A TJ- 7505 Increases Gastric and Small Intestinal Motor Activity with Negligible Effect on
Colonic Activity
Experiments were performed in fasted, conscious dogs to evaluate the gastric, small
intestinal and colonic motor activity of ATI-7505 compared to cisapride. A specific goal was
to determine the dose sizes of ATI-7505 (IV and PO) that most closely mimic the pattern and
magnitude of contractile activity caused by cisapride at typical therapeutic doses in dogs (0.5
mg/kg IV; lmg/kgPO).
When given IV and PO, both ATI-7505 and cisapride caused prokinetic effects in the
dog gut. The onset of action typically occurred within 1 to 2 minutes and 25 to 30 minutes
following IV and PO administration, respectively. The effect of ATI-7505 on gastric and
small intestinal motor activity mimicked cisapride. Like cisapride, ATI-7505 appeared to
cause dose-dependent stimulation of antral and small bowel contractility with relatively little
effect on colonic motor activity. The prokinetic effects caused by ATI-7505 in the upper GI
tract occurred along with a small but significant (p migrating contractions (GMC).
ATI-7505 was not associated with the development of retrograde giant migrating
contractions (RGC). Like cisapride, ATI-7505 had a minimal effect on migrating motor
complex (MMC) characteristics in the antrum as well as proximal, mid and distal small
intestine. With regard to MMC frequency and phase III duration, only one significant
difference was noted: PO ATI-7505 increased MMC frequency in the proximal small
intestine relative to the controls. The dogs tolerated the IV and PO doses of ATI-7505 well
and exhibited no side effects such as diarrhea, anorexia, or weight loss.
Overall, the results showed that on a mg/kg-basis, ATI-7505 was approximately twice
as potent as cisapride. In addition, the actions of ATI-7505, like those of cisapride, were
consistent with a mechanism involving the facilitation of acetylcholine release from enteric
neurons rather than a direct smooth muscle action. In conclusion, ATI-7505 increases gastric
and small intestinal motor activity in a cisapride-like manner with minimal-to-no effect on
colonic activity.
The Metabolism of ATI-7505 is CYP450-Independent
Based on data from pooled human microsomes, ATI-7505 undergoes
biotransformation to a single metabolite, ATI-7500, which does not appear to be subject to
further metabolism. The conversion of ATI-7505 to ATI-7500 was not dependent on the

presence of NADPH. Thus the major biotransformation pathway for ATI-7505 occurs
independently of CYP450 enzymes.
ATI-7505 Does Not Inhibit CYP450 Enzymes
To test the potential for ATI-7505 and/or its main metabolite, ATI-7500 to act as
CYP450 inhibitors, these two molecules were screened using Gentest Supersomes™.
Consistent with published reports, cisapride had significant inhibitory activity against
CYP450 enzyme isoforms, CYP3A4,2D6 and to a lesser extent 2C9. Neither ATI-7505 nor
its primary metabolite, ATI-7500 displayed significant inhibitory activity against these three
CYP450 isoforms, nor against a panel of other isoforms known to play a role in drug
metabolism.
ATI-7505 Has Negligible Affinity for the Cardiac Channel, IKr
The rapidly activating delayed rectifier potassium (K+) current in humans (human Ikr)
is a K+ channel that is encoded by the human-ether-a-go-go-related gene (hERG). Cisapride
is known to produce QT interval prolongations via a blockade of Ikr, and it was therefore of
interest to determine if ATI-7505 and ATI-7500 have important inhibitory effects on human
IKr. The test system was mammalian HEK-293 cells expressing the hERG K+ channels, in
which the potassium current was measured by whole cell patch-clamp technique. The ranking
of the IC50 values was: cisapride (9.5 nM) > ATI-7505 (24,521 nM) > ATI-7500 (204,080
nM) (Table 3). Overall, the findings indicate that ATI-7505 has a significantly lower pro-
arrhythmic potential than cisapride and suggest that both ATI-7505 and ATI-7500 have
negligible affinity for human Ikr channels.


ATI-7505 Does not Induce Important Electrophysiological Changes in Guinea Pig
Hearts
The cardiac electrophysiological effects of ATI-7505 were examined in isolated,
perfused guinea pig hearts. The study examined ATI-7505, ATI-7500 and cisapride, all of
which were each tested at concentrations up to 10,000 nM. The no observed effect level
(NOEL) was defined as the highest concentration of test compound not showing a response
that was significantly different from baseline (p were tested: (1) QT interval; (2) MAPD90; (3) SA interval; (4) QRS interval; (5) AH interval;
and (6) HV. While ATI-7505 was a very weak modulator of cardiac electrophysiologic
parameters, its metabolite, ATI-7500 entirely lacked electrophysiological activity (Table 4).
The NOEL for ATI-7500 was > 10,000 nM for the entire set of 6 cardiovascular parameters.
Since cisapride had a NOEL of 10 nM for the combined set of 6 cardiac parameters tested,
while ATI-7505 had a combined NOEL of 1,000 nM, ATI-7505 appears to lack the potency
of cisapride in modulating cardiac electrophysiologic parameters. Overall, the findings
demonstrate that ATI-7505 is significantly safer than cisapride with regard to the potential to
induce important cardiac electrophysiologic fluctuations.

Metabolism in human microsomal preparations
The metabolism of these compounds was studied in pooled human microsomes in the
presence and absence of the Cytochrome P-450 cofactor NADPH and both the disappearance
of parent and the appearance of the corresponding acid metabolite, i.e., the corresponding
compound-II isomer, monitored with time.

As shown in Table 5, Compounds III and IV were rapidly hydrolyzed by esterase to
their respective metabolites (+) and (-)-Compound II The metabolism was not dependent on
CYP450 since the rate of hydrolysis was independent on NADPH presence, which is a
necessary cofactor for CYP450 to function. In contrast, (±)-S Compounds V and VI
appeared to be quite stable with time under the same conditions. In this experiment, the
amount of substrate (compounds III, IV, V, and VI) remaining in the reaction after 5, 60, and
90 minutes were evaluated by a tandem HPLC-MS method. This remaining amount was
correlated with the appearance of the metabolite compound II. The sum of remaining
substrate and compound II was constant over time and equal to the amount of starting
material at time zero, therefore indicating that hydrolysis was the only metabolic reaction
taking place.

Metabolism in fresh human blood.
Test compounds were dissolved in DMSO to make 12.5 mM stock solution and
diluted with water to a final concentration of 2.5mM (DMSO/H20 =20/80). Fresh blood was
collected into heparinized tubes from 3 human donors and blood was stored on ice until
incubation. Separate aliquots of blood from each donor were pipetted into 1.5 mL centrifuge
tubes and the tubes were pre-incubated in a shaking water bath at 37°C for 5 minutes. The
reaction was initiated by the addition of 10 µL of the appropriate test compound stock to each
tube (final concentration = 100 µM). Incubations were quenched after 0, 5, 15, 30 and 60
minutes, by the addition of acetonitrile (750 mL), centrifuged at 12,000 rpm for 2 minutes
and the supernatant analyzed on an Agilent 1100 HPLC system. Separations were
accomplished on a Keystone Intersil ODS2, 250X4.6mm, 5 m column. The aqueous mobile
phase consisted of 20 mM ammonium acetate buffer (pH 5.7) and the organic phase
acetonitrile. A gradient was used: initial condition consisted of 20% acetonitrile for 1

minute. The acetonitrile concentration was increased linearly to 90% over the next 8 minutes
and held there for 1 minute. The system was then recycled to initial conditions over the
course of 1 minute and held there for 4 minutes before the next injection. The peak area for
the parent peak was determined by monitoring absorbance at 240, 254 and 290 nM. The
results were expressed as amount of initial compound remaining and data subjected to kinetic
analysis using WinNonLin. The half-lives for the individual compounds are given below in
Table 6.

It should be understood that the examples and aspects described herein are for
illustrative purposes only and that various modifications or changes in light thereof will be
suggested to persons skilled in the art and are to be included within the spirit and purview of
this application and the scope of the appended claims. Further, all patents, patent
applications, provisional applications, and publications referred to or cited herein are
incorporated by reference in their entirety to the extent they are not inconsistent with the
explicit teachings of this specification.

The invention and the manner and process of making and using it, are now described
in such full, clear, concise and exact terms as to enable any person skilled in the art to which
it pertains, to make and use the same. It is to be understood that the foregoing describes
preferred aspects of the invention and that modifications may be made therein without
departing from the spirit or scope of the invention as set forth in the claims. To particularly
point out and distinctly claim the subject matter regarded as invention, the following claims
conclude this specification.

We claim:
1. A compound selected from

(3R,4S,3'R)-6-[4-(4-Amino-5-chloro-2-method-benzoylamino)-3-methoxy-piperidin-1-
yl]-hexanoic acid 1-aza-bicyclo[2.2.2]oct-3-yl ester
and pharmaceutically acceptable salts thereof.
2. A compound selected from

(3S,4R,3'R)-6-[4-(4-Amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-
yl]-hexanoic acidl-aza-bicyclo[2.2.2]oct-3-yl ester
and pharmaceutically acceptable salts thereof.
3. A compound selected from

(3R,4S,3'S)-6-[4-(4-Amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1-
yl]-hexanoic acid 1-aza-bicyclo[2.2.2]oct-3-yl ester
and pharmaceutically acceptable salts thereof.

4. A compound selected from

(3S,4R,3'S)-6-[4-(4-Amino-5-chloro-2-methoxy-benzoylamino)-3-methoxy-piperidin-1 -
yl]-hexanoic acid 1-aza-bicyclo[2.2.2]oct-3-yl ester
andpharmaceutically acceptable salts thereof.
5. A compound as claimed in claim 1, -wherein the compound is a dihydrochloride salt
form.
6. A compound as claimed in claim 2, wherein the compound is a dihydrochloride salt
form.
7. A compound as claimed in claim 3, wherein the compound is a dihydrochloride salt
form.
8. A compound as claimed in claim 4, wherein the compound is a dihydrochloride salt
form.
9. A composition comprising the compound as claimed in claim 1, wherein the compound is
present in 90% stereoisomeric excess.
10. A composition comprising the compound as claimed in claim 2, wherein the compound is
present in 90% stereoisomeric excess.
11. A composition comprising the compound as claimed in claim 3, wherein the compound is
present in 90% stereoisomeric excess.
12. A composition comprising the compound as claimed in claim 4, wherein the compound is
present in 90% stereoisomeric excess.
13. A composition comprising the compound as claimed in claim 5, wherein the compound is
present in 90% stereoisomeric excess.
14. A composition comprising the compound as claimed in claim 6. wherein the compound is
present in 90% stereoisomeric excess.

15. A composition comprising the compound as claimed in claim 7, wherein, the compound is
present in 90% stereoisomeric excess.
16. A composition comprising the compound as claimed in claim 8, wherein the compound is
present in 90% stereoisomeric excess.
17. A composition comprising the compound as claimed in claim 1, and a pharmaceutically
acceptable excipient adjuvant, carrier, or solvent.
18. A composition comprising the compound as claimed in claim 2, and a pharmaceutically
acceptable excipient, adjuvant, carrier, or solvent.
19. A composition comprising the compound as claimed in claim 3, and a pharmaceutically
acceptable excipient, adjuvant, carrier, or solvent.
20. A composition comprising the compound as claimed in claim 4, and a pharmaceutically
acceptable excipient, adjuvant, carrier, or solvent.
21. A composition comprising the composition as claimed in claim 5, and a pharmaceutically
acceptable excipient, adjuvant, carrier, or solvent
22. A composition comprising the composition as claimed in claim 6, and a pharmaceutically
acceptable excipient, adjuvant, carrier, or solvent
23. A composition comprising the composition as claimed in claim 7, and a pharmaceutically
acceptable excipient adjuvant carrier, or solvent
24. A composition comprising the composition as claimed in claim 8, and a pharmaceutically
acceptable excipient adjuvant carrier, or solvent
25. A composition comprising the compound as claimed in claim 9, and a pharmaceutically
acceptable excipient adjuvant carrier, or solvent.
26. A composition comprising the compound as claimed in claim 10, and a pharmaceutically
acceptable excipient adjuvant carrier, or solvent
27. A composition comprising the compound as claimed in claim 11, and a pharmaceutically
acceptable excipient adjuvant carrier, or solvent.
28. A composition comprising the compound as claimed in claim 12, and a pharmaceutically
acceptable excipient adjuvant carrier, or solvent.

29. A composition comprising the composition as claimed in claim 13, and a
pharmaceutically acceptable excipient, adjuvant, carrier, or solvent.
30. A composition comprising the composition as claimed in claim 14, and a
pharmaceutically acceptable excipient, adjuvant, carrier, or solvent
31. A composition comprising the composition as claimed in claim 15, and a
pharmaceutically acceptable excipient, adjuvant, carrier, or solvent.
32. A composition comprising the composition as claimed in claim 16, and a
pharmaceutically acceptable excipient, adjuvant, carrier, or solvent.
33. A compound of formula:

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
L is -(C2-C6 alkyl)-C(O)- or -(C3-C5alkyl)- wherein one carbon of the -(C3-C5 alkyl)-
group may be replaced by —N(R9)-;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 alkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;
R4 is H or methyl; and
R5 is -O-heterocycloalkyl or heterocycloalkyl, wherein the heterocycloalkyl is aza-
bicyclo-octyl, aza-bicyclo-nonyl, aza-bicyclo-decyl, piperidinyl, piperazinyl, or pyrrolidinyl,
wherein the piperidinyl, piperazinyl, and pyrrolidinyl groups are optionally substituted at
one or two positions with groups that are independently C1-C4 alkyl, C1-C4 alkoxy, halogen, C1-C4
haloalkyl, C1-C4 haloalkoxy, hydroxyl, hydroxy C1-C4 alkyl, amino, -NH(C1-C4 alkyl), -N(C1-C4
alkyl)(C1-C4 alkyl), -(C0-C6 alkyl)-C(O)R11, or NO2, wherein the aza-bicyclo-octyl, aza-bicyclo-
nonyl, and aza-bicyclo-decyl nitrogen is optionally substituted with methyl or ethyl;

R9 at each occurrence is independently H or C1-C4 alkyl;
R11 is C1-C6 alkoxy optionally substituted with 1 or 2 groups that are interdependently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, or heterocycloalkyl, wherein the heterocycloalkyl is pyrrolidinyl, piperidinyl,
piperazinyl, or morpholinyl, wherein the heterocycloalkyl groups are optionally substituted
with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; and
R20 is C1-C6 alkoxy or OH.
34. A compound as claimed in claim 33, wherein R1 is chloro.
35. A compound as claimed in claim 33, wherein R2 is amino.
36. A compound as claimed in claim 33, wherein R3 is methoxy.
37. A compound as claimed in claim 33 , wherein R4 is H.
38. A compound as claimed in claim 33, wherein
R1 is chloro; R2 is amino; R3 is methoxy; R4 is H, and R1, R2, and R3 have the following
orientation on the phenyl ring:

39. A compound as claimed in claim 33, wherein
R3 is heterocycloalkyl wherein the heterocycloalkyl is 1-aza-bicyclo[2.2.2]oct-3-yl or 8-aza-
bicyclo[3.2.1]oct-3-yl, wherein the 1-aza-bicyclo[2.2.2]oct-3-yl, or 8-aza-bicyclo[3.2.1]oct-3-yl
nitrogen is optionally substituted with methyl or ethyl.
40. A composition comprising a therapeutically effective amount of a compound as claimed
in claim 33, or a pharmaceutically acceptable salt thereof and pharmaceutically
acceptable carrier, solvent, adjuvant, or excipient.

41. A compound of formula:

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
L is-(C4-C6 alkyl)-C(O)s
R1 is chloro;
R2 is amino;
R3 is methoxy;
R4 is H; and
R5 is -O-C3-C8 cycloalkyl, -O-heterocycloalkyl, heterocycloalkyl, aryl, -O-aryl, -N(R9)-
(C0-C6 alkyl)-C(O)-aryl, or-N(R9)-C0-C6 alkyl-aryl, -O-heteroaryl, -N(R9)-C1-C6C(O)-
heteroaryl, or -N(R9)-C0-C6 alkyl-heteroaryl, wherein each of the cyclic groups is
optionally substituted at substitutable positions with C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-
C6 haloalkyl, C1-C6 haloalkoxy, hydroxyl, hydroxy-C1-C4-alkyl, amino, -NH(C1-C6 alkyl), -N(C1-
C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)R11, or-O-(C0-C6 alkyl)-C(O)R11, methylsulfone, C0-
C6-sulfonamide, or NO2; wherein
R9 at each occurrence is independently H or C1-C4 alkyl;
R11 is C1-C6 alkyl, OH, or
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, -O-heterocycloalkyl, -C1-C6(O)N(R9)-heteroaryl, or heteroaryl, wherein
the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3,

the heteroaryl group is optionally substituted with 1,2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted
with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl. -CO2H, CF3, or OCF3; and
R20 is C1-C6 alkoxy (preferably C1-C4 alkoxy, more preferably methoxy), or OH.
42. The compound of formula

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 alkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;
R4 is H or methyl; and
R5 is -O-C3-C8 cycloalkyl, -O-heterocycloalkyl, heterocycloalkyl, aryl, -O-aryl, -N(R9)-
(C0-C6 alkyl)-C(O)-aryl, or-N(R9)-C0-C6 alkyl-aryl, -O-heteroaryl, -N(R9)-C1-C6C(O)-
heteroaryl, or -N(R9)-C0-C6 alkyl-heteroaryl, wherein each of the cyclic groups is
optionally substituted at substitutable positions with C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-
C6 haloalkyl, C1-C6 haloalkoxy, hydroxyl, hydroxy-C1-C4-alkyl, amino, -NH(C1-C6 alkyl), -N(C1-
C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)R11, or-O-(C0-C6 alkyl)-C(O)R11, methylsulfone, C0-
C6-sulfonamide, or NO2; wherein
R9 at each occurrence is independently H or C1-C4 alkyl;
R11 is C1-C6 alkyl, OH, or

R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, -O-heterocycloalkyl, -C1-C6(O)N(R9)-heteroaryl, or heteroaryl, wherein
the heterocycloalkyl groups are optionally substituted with 1,2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3,
the heteroaryl group is optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted
with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; and
R20 is C1-C6 alkoxy (preferably C1-C4 alkoxy, more preferably methoxy), or OH.
43. The compound as claimed in claim 42, wherein
R5 is-O-heterocycloalkyl wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-bicyclo-
nonyl, or aza-bicyclo-decyl, wherein the aza-bicyclo-octyl, aza-bicyclo-nonyl, or aza-bicyclo-
decyl nitrogen is optionally substituted with methyl or ethyl.
44. The compound as claimed in claim 42, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy, and
R5 is-O-heterocycloalkyl wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-bicyclo-
nonyl, or aza-bicyclo-decyl, wherein the aza-bicyclo-octyl. aza-bicyclo-nonyl, or aza-bicyclo-
decyl nitrogen is optionally substituted with methyl or ethyl.
45. The compound as claimed in claim 42, that is 8-methy1-8-azabicyclo[3.2.1]oct-3-yl 6-
{(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1-yl}hexanoate
and pharmaceutically acceptable salts thereof.

46. A composition comprising a therapeutically effective amount of a compound as claimed
in claim 42, or a pharmaceutically acceptable salt thereof and a pharmaceutically
acceptable carrier, solvent, adjuvant, or excipient.
47. The composition as claimed in claim 46, wherein the compound is
(3S)-1 -azabicyclo[2.2.2]oct-3-yl 6-{(3S,4S)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl}hexanoate;
(3S)-1-azabicyclo[2.2.2]oct-3-yl 6-{(3R,4R-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl}hexanoate;
(3R)-1-azabicyclo[2.2.2]oct-3-yl 6-{(3R,4S)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-l-yl}hexanoate; or
(R)-quinuclidin-3-yl 6-((3S,4R)-4-(4-amino-5-chloro-2-methoxybenzamido)-3-
methoxypiperidin-1-yl)hexanoate; or a pharmaceutically acceptable salt thereof.
48. A compound of formula:

and pharmaceutically acceptable salts thereof, wherein

the bonds at positions 3 and 4 are cis relative to each other;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 alkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;
R4 is H or methyl;
R9 is H or C1-C4 alkyl;
R11 is C1-C6 alkyl, OH, or
R11 is C1-C6 alkoxy optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH (C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, -O-heterocycloalkyl, heterocycloalkyl, -C1-C6(O)N(R9)-heteroaryl, or
heteroaryl, wherein
the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3,
the heteroaryl groups are optionally substituted with 1, 2, or 3 groups that
are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted
with 1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3;
R15 is H, C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6 haloalkyl, C1-C6 haloalkoxy, hydroxyl,
hydroxy C1-C4 alkyl, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), methylsulfone, C0-
C6-sulfonamide, or NO2; and
R16 is H or-O-(C0-C6 alkyl)-C(O)R11.
49 . The compound as claimed in claim 42, wherein
R4 and R9 are independently H or methyl; and

R11 is OH.
50. The compound as claimed in claim 48, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy;
R4 and R9 are independently H or methyl;
R11 is OH; and
R15 and R16 are H.
51. The compound as claimed in claim 48, wherein
R4 and each R9 are independently H or methyl; and
R11 is C1-C6 alkoxy optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, or heterocycloalkyl, wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-
bicyclo-nonyl, aza-bicyclo-decyl, pyrrolidinyl, piperidinyl, piperazinyl, or morpholinyl, wherein
the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3, wherein the aza-bicyclo-octyl, aza-bicyclo-nonyl, or aza-
bicyclo-decyl nitrogen is optionally substituted with methyl or ethyl.
52. The compound as claimed in claim 4S, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy,
R4 and each R9 are independently H or methyl;
R11 is C1-C6 alkoxy optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, or heterocycloalkyl wherein the heterocycloalkyl group is selected from aza-

bicyclo-octyl, aza-bicyclo-nonyl, aza-bicyclo-decyl, pyrrolidinyl, piperidinyl, piperazinyl, and
morpholinyl, wherein the heterocycloalkyl groups are optionally substituted with 1,2, or 3
groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3, wherein the nitrogen of the aza-bicyclo-octyl, aza-
bicyclo-nonyl, and aza-bicyclo-decyl is optionally substituted with methyl or ethyl; and
R15 and R16 are H,
53. The compound as claimed in claim 48, wherein
R4 and each R9 are independently H or methyl; and
R11 is C1-C6 alkoxy optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), or heteroaryl, wherein the
heteroaryl is pyridyl, pyrimidyl, quinolinyl, isoquinolinyl, or indolyl, wherein the heteroaryl is
optionally substituted with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-
C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3.
54. The compound as claimed in claim 48, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy;
R4 and each R9 are independently H or methyl;
R11 is C1-C6 alkoxy optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), or heteroaryl, wherein the
heteroaryl is pyridyl, pyrimidyl, quinolinyl, isoquinolinyl, or indolyl, wherein the heteroaryl is
optionally substituted with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-
C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; and
R15 and R16 are H.
55. The compound as claimed in claim 48, wherein,
R4 and R9 are independently H or methyl; and

R11 is OH, C1-C4 alkoxy, or C1-C2 alkoxy-C1-C3 alkoxy-.
56. The compound as claimed in claim 48, wherein
R4 and each R9 are independently H or methyl; and
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-bicyclo-
nonyl, aza-bicyclo-decyl, pyrrolidinyl, piperidinyl, piperazinyl, or morpholinyl, wherein the
heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3, wherein the aza-bicyclo-octyl, aza-bicyclo-nonyl, or aza-
bicyclo-decyl nitrogen is optionally substituted with methyl or ethyl.
57. The compound as claimed in claim 48., wherein
R1 is chloro;
R2 is amino;
R3 is methoxy,
R4 and each R9 are independently H or methyl;
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-bicyclo-
nonyl, aza-bicyclo-decyl, pyrrolidinyl, piperidinyl, piperazinyl, or morpholinyl, wherein the
heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3, wherein the aza-bicyclo-octyl, aza-bicyclo-nonyl, or aza-
bicyclo-decyl nitrogen is optionally substituted with methyl or ethyl.
R15 and R16 are H.
58. The compound as claimed in claim 48, that is
4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)arnmo]-3-memoxypiperidin-1-
yl}acetyl)amino]benzoic acid;
methyl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1 -
yl}acetyl)amino]benzoate;

60. A compound of formula

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 alkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;
R4 is H or methyl;
R9 is H or C1-C4 alkyl;
R11 is C1-C6 alkyl, OH, or
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, -O-heterocycloalkyl, -C1-C6(O)N(R9)-heteroaryl, or heteroaryl,
wherein the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that
are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3;
the heteroaryl group are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted
with 1,2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3;

and pharmaceutically acceptable salts thereof.
64 . A composition comprising a therapeutically effective amount of a compound as claimed
in claim 60 or a pharmaceutically acceptable salt thereof and pharmaceutically
acceptable carrier, solvent, adjuvant, or excipient.
65. The compound of formula

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
n is 1 or 2;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 alkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;
R4 is H or methyl;
R9 is H or C1-C4 alkyl; and
R11 is C1-C6 alkyl, OH, or
R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are independently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, -O-heterocycloalkyl, -C1-C6(O)N(R9)-heteroaryl, or heteroaryl, wherein
the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that

are independently halogen. C1-C6 alkyl, C1-C6 alkoxy. hydroxy, hydroxy C1-C6 alkyl.
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3;
the heteroaryl group are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted
with 1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl. -CO2H, CF3, or OCF3.
66. The compound as claimed in claim 65, wherein
R4 is H or methyl; and
R11 is OH, C1-C4 alkoxy, or C1-C2 alkoxy-C1-C3 alkoxy-.
67. The compound as claimed in claim 65, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy;
R4 is H or methyl; and
R11 is OH, C1-C4 alkoxy, or C1-C2 alkoxy-C1-C3 alkoxy-.
68. The compound as claimed in claim 65, that is
1-({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1-
yl} acetyl)piperidine-4-carboxylic acid;
methyl 1 -({(3S,4R)-4- [(4-amino-5-chloro-2-methoxybenzoyl)arnino]-3 -methoxypiperidin-1 -
yl}acetyl)piperidine-4-carboxylate;
ethyl l-({(3iS,4i?)^-[(4-amino-5-crJoro-2-meth.oxybenzoyl)ammo]-3-methoxypiperidin-l-
yl} acetyl)piperidme-4-carboxylate; I(gf««-^*^****w

ethyl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1 -
yl} acetyl)amino]benzoate;
isopropyl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1 -
yl} acetyl)amino]benzoate;
2-methoxyethyl-4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoy])amino]-3-
methoxypiperidin-1-yl}aceryl)amino]benzoate;
2-pyrrolidin-1-ylethyl 4- [({(3S,4R)-4- [(4-amino-5-chloro-2-methoxybenzoyl)amino] -3 -
methoxypiperidin-1-yl} acetyl)amino]benzoate;
2-pyridin-2-ylethyl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1 -yl} acetyl)amino]benzoate;
2-(dimethylamino)ethyl 4-[({(35,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl} acetyl)amino]benzoate;
2-morpholin-4-ylethyl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)arnino]-3-
methoxypiperidin-1-yl} acetyl)amino]benzoate;
2-oxo-2-(piperidin-4-ylamino)ethyl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-
methoxybenzoyl)amino]-3-methoxypiperidin-1-yl}acetyl)amino]benzoate;
1-methylpiperidin-4-yl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl} acetyl)amino]benzoate;
1-methylpiperidin-3-yl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl} acetyl)amino]benzoate;
1,4-dimethylpiperidin-4-yl 4-[({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl} acetyl)amino]benzoate;
and pharmaceutically acceptable salts thereof.
59. A composition comprising a therapeutically effective amount of a compound as claimed
in claim 48 or a pharmaceutically acceptable salt thereof and pharmaceutically
acceptable carrier, solvent, adjuvant, or excipient.

R15 is H, C1-C6 alkyl, C1-C6 alkoxy, halogen. C1-C6 haloalkyl, C1-C6 haloalkoxy, hydroxyl,
hydroxy C1-C4 alkyl, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6 alkyl), methylsulfone, C0-
C6-sulfonamide, or NO2; and
R16 is H or -O-(C0-C6 alkyl)-C(O)R11.
61. The compound as claimed in claim 60, wherein
R4 and R9 are independently H or methyl; and
R11 is OH, C1-C4 alkoxy, or C1-C2 alkoxy-C1-C3 alkoxy-.
62. The compound as claimed in claim 60, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy,
R4 and each R9 are independently H or methyl;
R11 is OH, C1-C4 alkoxy, or C1-C2 alkoxy-C1-C3 alkoxy-; and
R15 and R16 are H.
63. The compound as claimed in claim 60, that is
4-{[(2-{(3S,4R)-4-[(4-amino-5-chloro-2-memoxybenzoyl)amino]-3-methoxypiperidin-1-
yl}ethyl)(methyl)amino]methyl}benzoic acid;
methyl-{[(2-{(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1-
yl}ethyl)(methyl)arnino]methyl}benzoate;
methyl 4-{[(2-{(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1 -
yl} ethyl)amino]methyl} benzoate;
isopropyl 4-{[(2-{(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-
1-yl}emyl)amino]methyl}benzoate;
ethyl 4- {[(2- {(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1 -
yl} ethyl)amino]methyl} benzoate Dihydrochloride;

2-methoxyethyl 1-({(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-
methoxypiperidin-1-yl}acetyl)piperidine-4-carboxylate;
and pharmaceutically acceptable salts thereof.
69. A composition comprising a therapeutically effective amount of a compound as claimed
in claim 65 or a pharmaceutically acceptable salt thereof and pharmaceutically
acceptable carrier, solvent, adjuvant, or excipient.
70. A compound of formula:

and pharmaceutically acceptable salts thereof, wherein
the bonds at positions 3 and 4 are cis relative to each other;
Lis-(C1-C6 alkyl)-;
R1 is halogen;
R2 is amino, NH(C1-C4 alkyl) or N(C1-C4 alkyl)(C1-C4 alkyl);
R3 is OH or C1-C4 alkoxy;
R4 is H or methyl;
R5 is -N(R9)-(C0-C6 alkyl)-C(O)-aryl wherein the aryl is optionally substituted with
1 or 2 groups that are independently C1-C6 alkyl, C1-C6 alkoxy, halogen, C1-C6 haloalkyl, C1-C6
haloalkoxy, hydroxyl, hydroxy-C1-C4-alkyl, amino, -NH(C1-C6 alkyl), -N(C1-C6 alkyl)(C1-C6
alkyl), -(C0-C6 alkyl)-C(O)R11, or-O-(C0-C6 alkyl)-C(O)R11, methylsulfone, C0-C6-sulfonamide,
or NO2;
R9 at each occurrence is independently H or C1-C4 alkyl;
R11 is C1-C6 alkyl, OH, or

R11 is C1-C6 alkoxy, optionally substituted with 1 or 2 groups that are interdependently
C1-C4 alkoxy, amino, -NH(C1-C6 alkyl), -N(C1-C6 aIkyl)(C1-C6 alkyl), -(C0-C6 alkyl)-C(O)N(R9)-
heterocycloalkyl, -O-heterocycloalkyk, -C1-C6(O)N(R9)-heteroaryl, or heteroaryl, wherein
the heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups
that
are independently halogen, C1-C6 alkyl. C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3,
the heteroaryl group is optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl,
C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; or
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is optionally substituted
with 1, 2, or 3 groups that are independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy,
hydroxy C1-C6 alkyl, C1-C6 alkoxycarbonyl, -CO2H, CF3, or OCF3; and
R20 is C1-C6 alkoxy (preferably C1-C4 alkoxy, more preferably methoxy), or OH.
71. The compound as claimed in claim 70, wherein
R5 is -N(R9)-(C0-C6 alkyl)-C(O)-aryl wherein the aryl is substituted with -(C0-C6 alkyl)-
C(O)R11; and
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-bicyclo-
nonyl, aza-bicyclo-decyl, pyrrolidinyl, piperidinyl, piperazinyl, or morpholinyl, wherein the
heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3, wherein the aza-bicyclo-octyl, aza-bicyclo-nonyl, or aza-
bicyclo-decyl nitrogen is optionally substituted with methyl or ethyl.
72. The compound as claimed in claim 70, wherein
R1 is chloro;
R2 is amino;
R3 is methoxy;

R5 is -N(R9)-(C0-C6 alkyl)-C(O)-aryl wherein the aryl is substituted with -(C0-C6 alkyl)-
C(O)R11; and
R11 is -O-heterocycloalkyl wherein the heterocycloalkyl is aza-bicyclo-octyl, aza-bicyclo-
nonyl, aza-bicyclo-decyl, pyrrolidinyl, piperidinyl, piperazinyl, or morpholinyl, wherein the
heterocycloalkyl groups are optionally substituted with 1, 2, or 3 groups that are
independently halogen, C1-C6 alkyl, C1-C6 alkoxy, hydroxy, hydroxy C1-C6 alkyl, C1-C6
alkoxycarbonyl, -CO2H, CF3, or OCF3, wherein the aza-bicyclo-octyl, aza-bicyclo-nonyl, or aza-
bicyclo-decyl nitrogen is optionally substituted with methyl or ethyl.
73. The compound as claimed in claim 70, that is (3R)-1-azabicyclo[2.2.2]oct-3-yl 4-{[(2-
{(3S,4R)-4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-3-methoxypiperidin-1-
yl}ethyl)arnino]carbonyl}benzoate.
74. A composition comprising a therapeutically effective amount of a compound as claimed
in claim 71 or a pharmaceutically acceptable salt thereof and pharmaceutically
acceptable carrier, solvent, adjuvant, or excipient.
75. A composition comprising a therapeutically effective amount of 6-((3S,4R)-4-(4-amino-5-
chloro-2-memoxybenzamido)-3-methoxypiperidin-l-yl)hexanoic acid or a pharmaceutically
acceptable salt thereof and pharmaceutically acceptable carrier, solvent, adjuvant, or
excipient.


The subject invention provides stereoisomeric compounds of formula
(X): wherein the variables are as defined herein, and compositions for the safe and
effective treatment of various gastrointestinal disorders including, but not limited to,
gastroparesis, gastroesophageal reflux and related conditions. The compounds of the
subject invention are also useful in treating a variety of conditions involving the central
nervous system.

Documents:

01767-kolnp-2006 correspondence others-1.1.pdf

01767-kolnp-2006 form-1-1.1.pdf

01767-kolnp-2006 form-13.pdf

01767-kolnp-2006 form-3-1.1.pdf

01767-kolnp-2006 form-5-1.1.pdf

01767-kolnp-2006-abstract.pdf

01767-kolnp-2006-assignment.pdf

01767-kolnp-2006-claims.pdf

01767-kolnp-2006-correspondence other.pdf

01767-kolnp-2006-correspondence-1.2.pdf

01767-kolnp-2006-correspondence-1.3.pdf

01767-kolnp-2006-description (complete).pdf

01767-kolnp-2006-drawings.pdf

01767-kolnp-2006-form-1-1.2.pdf

01767-kolnp-2006-form-1.pdf

01767-kolnp-2006-form-13.pdf

01767-kolnp-2006-form-18.pdf

01767-kolnp-2006-form-3.pdf

01767-kolnp-2006-form-5-1.2.pdf

01767-kolnp-2006-form-5.pdf

01767-kolnp-2006-international publication.pdf

01767-kolnp-2006-international search authority report.pdf

01767-kolnp-2006-pct form.pdf

01767-kolnp-2006-priority document-1.1.pdf

01767-kolnp-2006-priority document.pdf

1767-KOLNP-2006- GRANTED FORM 5.pdf

1767-KOLNP-2006-ABSTRACT 1.2.pdf

1767-kolnp-2006-abstract 1.3.pdf

1767-KOLNP-2006-ABSTRACT.1.1.pdf

1767-kolnp-2006-amanded claims 1.2.pdf

1767-KOLNP-2006-AMANDED CLAIMS.pdf

1767-KOLNP-2006-AMANDED PAGE OF SPECIFICARTION.pdf

1767-KOLNP-2006-ASSIGNMENT.pdf

1767-KOLNP-2006-CANCELLED PAGES 1.2.pdf

1767-KOLNP-2006-CLAIMS.1.1.pdf

1767-KOLNP-2006-CORRESPONDENCE 1.1.pdf

1767-KOLNP-2006-CORRESPONDENCE 1.2.pdf

1767-kolnp-2006-correspondence 1.4.pdf

1767-KOLNP-2006-CORRESPONDENCE.pdf

1767-KOLNP-2006-DESCRIPTION (COMPLETE) 1.2.pdf

1767-kolnp-2006-description (complete) 1.3.pdf

1767-KOLNP-2006-DESCRIPTION (COMPLETE).1.1.pdf

1767-KOLNP-2006-DRAWINGS.1.1.pdf

1767-KOLNP-2006-EXAMINATION REPORT REPLY RECIEVED.pdf

1767-KOLNP-2006-EXAMINATION REPORT.pdf

1767-KOLNP-2006-FORM 1 1.2.pdf

1767-kolnp-2006-form 1 1.3.pdf

1767-KOLNP-2006-FORM 1.1.1.pdf

1767-KOLNP-2006-FORM 13-1.2.pdf

1767-KOLNP-2006-FORM 13-1.3.pdf

1767-KOLNP-2006-FORM 13.1.1.pdf

1767-KOLNP-2006-FORM 13.pdf

1767-KOLNP-2006-FORM 18.pdf

1767-KOLNP-2006-FORM 2 1.2.pdf

1767-kolnp-2006-form 2 1.3.pdf

1767-KOLNP-2006-FORM 2.pdf

1767-KOLNP-2006-FORM 3.1.1.pdf

1767-KOLNP-2006-FORM 3.pdf

1767-KOLNP-2006-FORM 5.1.1.pdf

1767-KOLNP-2006-FORM 5.pdf

1767-KOLNP-2006-GPA.pdf

1767-KOLNP-2006-GRANTED-ABSTRACT.pdf

1767-KOLNP-2006-GRANTED-CLAIMS.pdf

1767-KOLNP-2006-GRANTED-DESCRIPTION (COMPLETE).pdf

1767-KOLNP-2006-GRANTED-DRAWINGS.pdf

1767-KOLNP-2006-GRANTED-FORM 1.pdf

1767-KOLNP-2006-GRANTED-FORM 2.pdf

1767-KOLNP-2006-GRANTED-FORM 5.pdf

1767-KOLNP-2006-GRANTED-SPECIFICATION.pdf

1767-KOLNP-2006-OTHERS 1.1.pdf

1767-kolnp-2006-others 1.3.pdf

1767-KOLNP-2006-OTHERS DOCUMENTS.pdf

1767-KOLNP-2006-PA.pdf

1767-KOLNP-2006-PETITION UNDER RULE 137.pdf

1767-KOLNP-2006-REPLY TO EXAMINATION REPORT 1.1.pdf

abstract-01767-kolnp-2006.jpg


Patent Number 252877
Indian Patent Application Number 1767/KOLNP/2006
PG Journal Number 23/2012
Publication Date 08-Jun-2012
Grant Date 06-Jun-2012
Date of Filing 23-Jun-2006
Name of Patentee ARYX THERAPEUTICS
Applicant Address 6300 DUMBARTON CIRCLE, FREMONT, CA 94555, UNITED STATES OF AMERICA
Inventors:
# Inventor's Name Inventor's Address
1 IRWIN, IAN 800, COWPER STREET, PALO ALTO, CALIFORNIA 94301
2 BECKER, CYRUS 4675 FRONTENAC CT., FRAMONT, CALIFORNIA 94538, UNITED STATE OF AMERICA
3 PALME, MONICA 37819 FERNWOOD COURT FREMONT, CALIFORNIA 94536, UNITED STATE OF AMERICA
4 PASCAL, DRUZGALA 120 HATONA DRIVE, SANTA ROSA, CALIFORNIA 95403, UNITED STATE OF AMERICA
5 COURTNEY, RUBENS 420-15 CAMILLE CIRCLE, SAN JOSE, CALIFORNIA 95134,UNITED STATE OF AMERICA
PCT International Classification Number C07D 453/02
PCT International Application Number PCT/US2005/000510
PCT International Filing date 2005-01-07
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 60/534,892 2004-01-07 U.S.A.
2 60/560,938 2004-04-09 U.S.A.