US 3,937,839 AGrant
Method for Attenuating Bleeding
Issue Date:1976-02-10
•5 Claims
Abstract
The topical application of 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-3.a lpha.-methyl-1.alpha.-cyclopentyl)-cis-5-heptenoic acid, 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-1.a lpha.-cyclopentyl)-cis-5-heptenoic acid, or 7-(2.beta.-[(3RS)-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclope ntyl)-cis-5-heptenoic acid to a wound surface can be employed to attenuate bleeding. The compounds are prepared from the prostaglandin PGA.sub.2.
Metadata
Assignee
- American Home Products Corporation
Inventors
- Donald P. Strike
- Wenling Kao
- Richard L. Fenichei
Application Information
Application Number:US 5674484
Filing Date:1975-04-11
Priority Date:1974-02-28
Art Unit:125
Classifications
IPC:
A61K 3119
Field of Search:
424317
Patent Drawings
This patent does not have any drawings.
Description
BACKGROUND OF THE INVENTION
The control of bleeding during surgery is of considerable importance for the prevention of blood loss and the maintenance of a clear surgical field. For the prevention of gross bleeding from an exposed severed large artery or vein, where there is considerable intravascular pressure, mechanical means, such as pressure or clamping, or cauterization are employed. For the control of bleeding from small blood vessels, where intravascular pressure does not prevent clotting, various methods may be used. One method comprises the topical application of thrombin to the wound surface whereby clotting is promoted by direct action of the thrombin on fibrinogen. Other methods employ substances which arrest bleeding by providing a mechanical matrix that facilitates clotting. Various absorbable substances used for this purpose are absorbable gelatin sponge (Gelfoam); oxidized cellulose (oxycel), or fibrin foam. A combination of such substances with thrombin (e.g. by saturating a pad of the absorbable substance with a thrombin solution) is especially effective.
The present invention provides an improved method for the attenuation of bleeding at a wound surface. The method comprises the topical application to the wound surface of an effective amount of a prostaglandin derivative selected from the group consisting of:
A. 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-3.a lpha.-methyl-1.alpha. -cyclopentyl)-cis-5-heptenoic acid;
B. 7-(5.alpha.-hydroxy-2.alpha.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-1. alpha.-cyclopentyl)-cis-5-heptenoic acid; and
C. 7-(2.beta.-[(3RS)-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclope ntyl)-cis-5-heptenoic acid.
The invention also contemplates the novel chemical compound:
7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-3.al pha.-methyl-1.alpha.-cyclopentyl)-cis-5-heptenoic acid.
Said compound is useful in the method hereinabove described.
Also contemplated by this invention is the chemical compound 7-[5.alpha.-hydroxy-3.alpha.-methyl-2.beta.-(3-oxo-trans-1-octenyl)-1.alph a.-cyclopentyl]-cis-5-heptenoic acid, which is useful as an intermediate for preparing 7-(5.alpha.-hydroxy-2.beta.-](3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-3-. alpha.-methyl-1.alpha.-cyclopentyl)-cis-5-heptenoic acid.
It is believed that the capacity of the compounds above-described to arrest bleeding is a consequence of their ability to promote platelet aggregation which is the initial step of the clotting process and is necessary for releasing platelet factors that act to convert prothrombin to thrombin. The method of the invention therefore, offers advantages in that the attenuation of bleeding is accomplished by a physiological process which avoids mechanical means and the introduction into the wound of a foreign protein (thrombin). It will be appreciated that the method is less effective in controlling bleeding from larger blood vessels where intravascular pressure might prevent clot formation. The method is especially useful to control bleeding from capillaries or small veins.
In practicing the method of the invention, the particular compound employed for the control of bleeding can be applied topically to the wound surface in a number of ways. The compound can be dissolved in a pharmacologically acceptable, non-toxic, aqueous sterile solution (such as physiological saline or physiological saline buffered to pH 7.4). The solution can be applied by irrigation or spraying. For such purposes, a syringe or an aerosol spray can be employed. Further, the compound, dissolved in a sterile solution, can be applied to a pad of an absorbable substance (absorbable gelatin sponge, oxidized cellulose, or fibrin foam) which is then placed on the wound surface. The pad acts as a preformed network to trap the blood, and it can be kept in place after closure of the wound since the pad is completely absorbed in 4 to 6 weeks.
When the compounds are applied dissolved in an aqueous solution, the active ingredient can be present at a concentration of from about 50 to about 1000 .mu.g/ml. A concentration of from about 200 to about 500 .mu.g/ml is preferred.
The amount of compound required to effect attenuation of bleeding will vary with the size of the wound surface, the source of the bleeding, and the severity of the bleeding. In general, the compound is applied in small incremental amounts until the desired attenuation is achieved.
The compounds utilized in the method of this invention are prepared from the known starting materials PGA.sub.2 or 15-epi-PGA.sub.2. 15-epi-PGA.sub.2 can be obtained from the coral Plexaura homomalla by a procedure as described by A. Weinheimer and R. Spraggins in Tetrahedron Letters, 59, 5185 (1969), and PGA.sub.2 can be prepared from 15-epi-PGA.sub.2 by an epimerization procedure as described by Bundy et al. in Ann. of the New York Acad. of Sci., 180, 76 (1971). 7-(5.alpha.-Hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-1.a lpha.-cyclopentyl)-cis-5-heptenoic acid and 7-(2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclo pentyl)-cis-5-heptenoic acid are described in U.S. Patent Application Ser. No. 383,007, filed July 26, 1973. The preparation of the compounds employed in the method of this invention from readily available starting materials is described below in Examples I to VIII.
EXAMPLE I
7-(5.alpha.-Hydroxy-2.beta.-[(3R)-3-Hydroxy-Trans-1-Octenyl]-1.alpha.-Cyclo pentyl)-Cis-5-Heptenoic Acid
and
7-(5.beta.-Hydroxy-2.beta.-[(3R)-3-Hydroxy-Trans-1-Octenyl]-1.alpha.-Cyclop entyl)-Cis-5-Heptenoic Acid
An ice-cooled solution of 4.0 g. of 7-(2.beta.-[(3R)-3-hydroxy-trans-1-octenyl]-5-oxo-1.alpha.-cyclopent-3-eny l)-cis-5-heptenoic acid (15-epi-PGA.sub.2) in 110 ml. of a 10:1 mixture methanol water is treated with 2.2 g. of sodium borohydride, and stirred at 25.degree. for 7 hours. The mixture is concentrated under vacuum at 40.degree., the residue diluted with water, acidified with acetic acid and the mixture partitioned with ether. After washing and drying, the extract is evaporated and the residue chromatographed on silica. Elution with 35% ethyl acetate-hexane affords the first title product as an oil, .lambda..sub.max.sup.film 2.95, 3.4, 5.8, 7.1, 8.1, 8.8, 9.7, 10.3 .mu.. NMR: .delta. 5.48 (M, 4, olefinic H), 4.62 (2, OH), 4.28 (M, 2, 9 and 15-H) ppm. Mass spectrum: M.sup.+ at m/e 338 (theory 338), M.sup.+-H.sub.2 O at m/e 320.2331 (theory 320.2350).
Further elution with 40% ethyl acetate-hexane gives the second title product as an oil, .lambda..sub.max.sup.film 3.0, 3.4, 5.8, 7.1, 8.1, 9.35, 10.3 .mu.. NMR: .delta. 5.55 (M, 4, olefinic H), 4.58 (s, OH), 4.05 (M, 2, 9 and 15-H) ppm. Mass spectrum: M.sup.+ at m/e 338 (theory 338). M.sup.+-H.sub.2 O at m/e 320.2384 (theory 320.2350).
EXAMPLE II
7-[5.alpha.-Hydroxy-2.beta.-(3-Oxo-Trans-1-Octenyl)-1.alpha.-Cyclopentyl]-C is-5-Heptenoic Acid
A solution of 3.63 g. of 7-(5.alpha.-hydroxy-2.beta.-[(3R-3-hydroxy-trans-1-octenyl]-1.alpha.-cyclo pentyl)-cis-5-heptenoic acid in 250 ml. of dioxane is treated with 3.63 g. of 2,3-dichloro-5,6-dicyano-1,4-benzoquinone and stirred at 55.degree. for 40 hours under nitrogen. The solution is concentrated under vacuum at 40.degree. and the residue chromatographed on silica. Elution with 30% ethyl acetate-hexane yields 1.8 g. of the title product as an oil, .lambda..sub.max.sup.film 3.0 (shoulder), 3.4, 5.8, 6.0 (shoulder), 6.15 (shoulder), 7.1, 8.1, 10.2 .mu.. UV: .lambda..sub.max.sup.EtOH 232 m.mu. (.epsilon. 12,000). NMR: .delta. 6.72 (dd, 1, J=5.3 and 15, 13-H), 6.08 (d, 1, J=15, 14-H), 5.40 (M, 2, 5, and 6-H), 4.25 (M, 1, 9-H) ppm. Mass spectrum: QM.sup.+ at m/e 337 (theory 337), QM.sup.+-H.sub.2 O at m/e 319 (theory 319).
EXAMPLE III
7-(5.alpha.-Hydroxy-2.beta.-[(3RS)-3-Hydroxy-3-Methyl-Trans-1-Octenyl]-1.al pha.-Cyclopentyl)-Cis-5-Heptenoic Acid
An ice-cooled solution of 1.7 g. of 7-[5.alpha.-hydroxy-2.beta.-(3-oxo-trans-1-octenyl)-1.alpha.-cyclopentyl]- cis-5-heptenoic acid in 150 ml. of tetrahydrofuran is treated with 15 ml. of 3M methyl magnesium bromide in ether dropwise over 10 minutes under nitrogen. After stirring at 0.degree. for 45 minutes, the mixture is added to ammonium chloride solution, acidified with acetic acid and extracted with ether. After washing and drying, the extract is evaporated and the residue chromatographed on silica. Elution with 35% ethyl acetate-hexane affords 1.07 g. of the title product as an oil, .lambda..sub.max.sup.film 3.0, 3.4, 5.8, 8.1, 10.3 .mu.. NMR: .delta. 5.42 (M, 4, olefinic H), 5.12 (s, 3, OH), 4.20 (M, 1, 9-H), 1.28 (s, 15-CH.sub.3) ppm. Mass spectrum: QM.sup.+-H.sub.2 O at m/e 335 (theory 335).
EXAMPLE IV
7-(2.beta.-[(3RS)-3-Hydroxy-3-Methyl-Trans-1-Octenyl]-5-Oxo-1.alpha.-Cyclop entyl)-Cis-5-Heptenoic Acid
An ice-cooled solution of 1.02 g. of 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-1.a lpha.-cyclopentyl)-cis-5-heptenoic acid in 80 ml. of acetone is treated dropwise with Jones reagent until the orange color persists. After stirring at 0.degree. for 1/2 hour, the mixture is treated with 5 ml. of methanol and dilute sodium bicarbonate until basic. The mixture is diluted with water, acidified with acetic acid and extracted with ether. After washing and drying, the extract is evaporated and the residue chromatographed on silica. Elution with 30% ethyl acetate-hexane gives 0.12 g. of the title product as an oil, .lambda..sub.max.sup.film 3.0, 3.4, 5.75, 7.1, 8.15, 8.65, 10.3 .mu.. NMR: .delta. 6.80 (s, 2, OH), 5.72 (M, 2, 13 and 14-H), 5.52 (M, 2, 5 and 6-H), 1.30 (s, 15-CH.sub.3) ppm. Mass spectrum: QM.sup.+ at m/e 351 (theory 351 ).
EXAMPLE V
7-[2.beta.-[(3S)-3-Hydroxy-Trans-1-Octenyl]-3.alpha.-methyl-5-Oxo-1.alpha.- Cyclopentyl]-Cis-5-Heptenoic Acid
and
7-[2.beta.-[(3S)-3-Hydroxy-Trans-1-Octenyl]-3.beta.-Methyl-5-Oxo-1.alpha.-c yclopentyl]-Cis-5-Heptenoic Acid
A solution of 3.0 g. of PGA.sub.2 in 60 ml. of THF is added dropwise to an ice-cooled mixture of 24 ml. of 3M methyl magnesium bromide and 5.0 g. of cuprous chloride in 120 ml. of THF and stirred at 0.degree.C for 1 hour. The mixture is added to aqueous ammonium chloride solution and extracted with ether. After washing with water and drying over magnesium sulfate, the extract is concentrated to give crystalline material. Filtration followed by recrystallization from ether-pentane affords 1.2 g. of the first title product, m.p. 68.degree.-70.degree.C; .lambda..sub.max.sup.KBr 3.0 (shoulder), 3.5, 5.8, 6.9, 7.6, 8.05, 8.55, 10.3 .mu.; NMR: .delta. 6.93 (s, 2, OH), 5.54 (m, 13 and 14-H), 5.38 (m, 5 and 6-H), 4.16 (m, 1, 15-H); Mass spectrum: M.sup.+ at m/e 350.2476 (theory 350.2455).
Evaporation of the filtrates and silica chromatography of the residue with 30% ethylacetate in hexane followed by crystallization from ether-pentane gives 0.09 g. of the second title product, m.p. 72.degree.-74.degree.C; UV: .lambda..sub.max.sup.film 3.0 (shoulder), 3.5, 5.8 (shoulder), 5.9, 7.0, 8.15, 8.45, 10.4 .mu.; NMR: .delta. 7.05-6.22 (m, 2, OH), 5.48 (m, 4, olefinic), 4.15 (m, 1, 15-H) ppm; Mass spectrum: M.sup.+ at m/e 350.2460 (theory 350.2455).
EXAMPLE VI
7-(5.alpha.-2.beta.-[(3S)-3-Hydroxy-Trans-1-Octenyl]-3.alpha.-methyl-1.alph a.-cyclopentyl)-Cis-5-Heptenoic Acid
and
7-(5.beta.-Hydroxy-2.beta.-[(3S)-3-Hydroxy-Trans-1-Octenyl]-3.alpha.-methyl -1.alpha.-cyclopentyl)-Cis-5-Heptenoic Acid
An ice-cooled solution of 7.8 g. of 7-(2.beta.-[(3S)-3-hydroxy-trans-1-octenyl]-3.alpha.-methyl-5-oxo-1.alpha. -cyclopentyl)-cis-5-heptenoic acid in 150 ml. of methanol is treated with 3.5 g. of sodium borohydride and stirred at 0.degree.C for 2 hours. The mixture is diluted with water and acidified with acetic acid. Extraction of the resulting mixture with ether, followed by washing, drying and evaporation of the extract gives the crude product. Silica chromatography with 30 % ethyl acetate in hexane affords 3.5 g. of the first title product as an oil; .lambda..sub.max.sup.film 3.0, 3.5, 5.85, 6.9, 7.15, 8.1, 8.9, 9.8, 10.35 .mu.; NMR: .delta. 5.57 (s, 3, OH), 6.0-5.17 (m, 4, olefinic), 4.21 (m, 2, 9 and 15-H), 1.01 (d, J=4.5, 11-methyl) ppm; Mass spectrum: M.sup.+ at m/e 352.2670 (theory 352.2613).
Further elution with 30% ethyl acetate in hexane affords 3.0 g. of the second title product as an oil; UV: .lambda..sub.max.sup.film 3.0, 3.5, 5.85, 6.9, 7.15, 8.2, 10.4 .mu.; NMR: .delta. 5.61 (s, 3, OH), 5.52 (s, 4, olefinic), 4.10 (m, 2, 9 and 15-H), 0.91 (d, J=4.5, 11-methyl) ppm; Mass spectrum: M.sup.+ at m/e 352 (theory 352), M.sup.+-H.sub.2 O at m/e 334.2564 (theory 334.2507).
EXAMPLE VII
7-[5.alpha.-Hydroxy-3.alpha.-methyl-2.beta.-(3-Oxo-Trans-1-Octenyl)-1.alpha .-Cyclopentyl]-Cis-5-Heptenoic Acid
A solution of 3.3 g. of 7-(5.alpha.-hydroxy-2.beta.-[(3S)-3-hydroxy-trans-1-octenyl]-3.alpha.-meth yl-1.alpha.-cyclopentyl)-cis-5-heptenoic acid and 3.0 g. of 2,3-dichloro-5,6-dicyano-1,4-benzoquinone in 100 ml. of dioxane is stirred at 55.degree.C for 22 hours. After filtering, the solution is evaporated and the residue chromatographed on silica. Elution with 25% ethyl actate in hexane affords 2.9 g. of the title product as an oil; .lambda..sub.max.sup.film 3.0 (shoulder), 3.5, 5.85, 6.0, 6.2, 6.9, 8.2 (broad), 10.25 .mu.; UV: .lambda..sub.max.sup.EtOH 233 m.mu. (.epsilon. 14,000); NMR: .delta. 6.75 (dd, J=16, 7.5, 13-H), 6.32 (s, 2, OH), 6.19 (d, J=16, 14-H), 5.48 (m, 2, 5 and 6-H), 4.32 (m, 1, 9-H) ppm; Mass spectrum: M.sup.+ at m/e 350.2499 (theory 350.2455).
EXAMPLE VIII
7-(5.alpha.-Hydroxy-2.beta.-[(3RS)-3-Hydroxy-3-Methyl-Trans-1-Octenyl]-3.al pha.-Methyl-1.alpha.-Cyclopentyl)-Cis-5-Heptenoic Acid
An ice-cooled solution of 1.0 g. of 7-[5.alpha.-hydroxy-3.alpha.-methyl-2.beta.-(3-oxo-trans-1-octenyl)-1.alph a.-cyclopentyl]-cis-5-heptenoic acid in 50 ml. of THF is treated with 8 ml. of 3M methyl magnesium bromide and stirred at 0.degree.C for two hours. The mixture is added to aqueous ammonium chloride solution and extracted with ether. After washing with water and drying over magnesium sulfate, the extract is evaporated and the residue chromatographed on silica. Elution with 25% ethyl acetate in hexane affords the title product as an oil, UV: .lambda..sub.max.sup.film 3.0, 3.5, 5.85, 6.9, 8.95, 9.75, 10.33 .mu.; NMR: .delta.5.8-5.2 (m, 4, olefinic), 5.43 (s, 3, OH), 4.30 (m, 1, 11-H), 1.30 (s, 15-methyl), 1.0 (d, J=5, 11-methyl) ppm; Mass spectrum: M.sup.+-H.sub.2 O at m/e 348.2682 (theory 348.2664).
EXAMPLE IX
Rats are anesthetized and the skin and connective tissue cut through so that a vein is exposed. A standardized nick of the vein 1 to 2 mm. deep is made by a lancet to yield a free flow of blood. Into the bleeding surface is dripped (one drop every 5-6 seconds) a solution of the compound dissolved in physiological saline. The time required (in seconds) for bleeding is measured. A control group of rats are treated simarly with a physiological saline solution which does not contain the test compound. A significant decrease in bleeding time indicates activity.
Using 7-(2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclo pentyl)-cis-5-heptenoic acid dissolved in physiological saline at a concentration of 200 .mu.g/ml., the following results are obtained.
EXAMPLE X
Rats are anesthetized and the abdominal cavity is opened so that a portion of the large intestine is exposed to show an extensive matrix of small blood vessels. A 1-2 cm. superficial cut across the vessels is made with a scalpel. Into the wound is dripped a solution of the test compound dissolved in physiological saline. The time required (in seconds) for bleeding to stop is measured. A control group of rats are treated similarly with a physiological saline solution which does not contain the test compound. A significant decrease in bleeding time indicates activity.
Using 7-(2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclo pentyl)-cis-5-heptenoic acid dissolved in physiological saline at a concentration of 400 .mu.g/ml., the following results are obtained:
EXAMPLE XI
Fasted male rats are given an injection (IV) into the leg vein of the test compound dissolved in physiological saline. Blood is obtained by cardiac puncture at intervals after the injection. Whole blood clotting times (Lee White) are determined. A control group of rats are similarly treated by injection with physiological saline which does not contain the test compound. The results are shown below:
EXAMPLE XII
Human whole blood (containing 3.8% sodium citrate) is centrifuged at about 422 G for 3 minutes at 5.degree.C in a Sorvall Centrifuge (or equivalent) to separate the red blood cells from the platelet rich plasma (PRP). The supernatant PRP is separated and the remainder is centrifuged at 1200 G for 12 minutes to obtain a platelet poor plasma for dilution and standardization of the instrument. In an automated Payton aggregometer, a cell containing 1.0 ml. of PRP is stirred at 1,100 RPM, and the compound to be tested is added dissolved in 0.2 ml. of buffered saline to give a concentration of 1-10 .mu.g/ml. The curve of percent light transmission at 610 m.mu. is followed for six minutes. Active compounds exhibit a significant increase in light transmission over a control run without the addition of the test compound. A standard is also run using adenosine diphosphate (ADP) as the agent added to PRP for inducing platelet aggregation. Using the change in light transmissions obtained with the test compound as compared to the change obtained with ADP, the platelet aggregating activity of the test compounds can be expressed in terms of their equivalency to ADP, which is a potent aggregating agent. The concentrations of the test compounds calculated to be equivalent to ADP for inducing aggregation are given in the following table:
Platelet aggregation is the initial step in the blood clotting process and is necessary for the release of factors from the platelets which act to convert prothrombin to thrombin. Agents which promote platelet aggregation, therefore would be expected to promote clotting and the platelet aggregation test, described above, is useful for predicting in vivo clotting activity.
Claims
What is claimed is:
1. A method for the attenuation of bleeding at a wound surface which comprises the topical application to the wound surface of an effective amount of a compound selected from the group consisting of: a. 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-3.a lpha.-methyl-1.alpha.-cyclopentyl)-cis-5-heptenoic acid; b. 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-1.a lpha.-cyclopentyl)-cis-5-heptenoic acid; and c. 7-(2.beta.-[(3RS)-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclope ntyl)-cis-5-heptenoic acid.
2. A method as defined in claim 1 wherein the compound is 7-(5.alpha.-hydroxy-2.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-3.a lpha.-methyl-1.alpha.-cyclopentyl)-cis-5-heptenoic acid.
3. A method as defined in claim 1 wherein the compound is 7-(5.alpha.-hydroxy-1.beta.-[(3RS)-3-hydroxy-3-methyl-trans-1-octenyl]-1.a lpha.-cyclopentyl)-cis-5-heptenoic acid.
4. A method as defined in claim 1 wherein the compound is 7-(2.beta.-[(3RS)-hydroxy-3-methyl-trans-1-octenyl]-5-oxo-1.alpha.-cyclope ntyl)-cis-5-heptenoic acid.
5. A method as defined in claim 1 wherein the compound is applied dissolved in physiological saline or physiological saline buffered to pH 7.4.
Patent Citations (1)
| Patent | Date | Inventor | Cited By |
|---|---|---|---|
| US3707548 | 1972-12-01 | Bagli et al. |