AU2002300904B2 - Arylsubstituted piperazines useful in the treatment of benign prostatic hyperplasia - Google Patents

Description

-1-

AUSTRALIA

PATENTS ACT 1990 COMPLETE SPECIFICATION FOR A STANDARD PATENT

ORIGINAL

Name of Applicant: Actual Inventors: Address for Service:

CCN:

Ortho-McNeil Pharmaceutical, Inc.

Alan Reitz and Linda Jolliffe and William Murray and Virginia Pulito and Xiaobing Li and Linda Mulcahy and Cynthia Maryanoff and Frank Villani BALDWIN SHELSTON WATERS MARGARET STREET SYDNEY NSW 2000 3710000352 ARYLSUBSTITUTED PIPERAZINES USEFUL IN THE TREATMENT OF BENIGN PROSTATIC HYPERLASIA Invention Title: Details of Original Application No. 73669/98 dated 08 May 1998 The following statement is a full description of this invention, including the best method of performing it known to me/us:- File: 26011AUP01 5846/2 -1A- ARYLSUBSTITUTED PIPERAZINES USEFUL IN THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA This invention relates to a series of arylsubstituted piperazines, pharmaceutical compositions containing them and intermediates used in their manufacture. The compounds of the invention selectively inhibit binding to the a-la adrenergic receptor, a receptor which has been implicated in benign prostatic hyperplasia. In addition, compounds of the invention reduce intraurethral pressure in an in vivo model. As such the compounds are useful in the treatment of this disease.

BACKGROUND

Any discussion of the prior art throughout the specification should in no way be considered as an admission that such prior art is widely known or forms part of common general knowledge in the field.

Benign prostatic hyperplasia (BPH), a non-malignant enlargement of the prostate, is the most common benign tumor in men. Approximately 50% of all men older than 65 years have some degree of BPH and a third of these men have clinical symptoms consistent with bladder outlet obstruction (Hieble and Caine, 1986). In the benign and malignant diseases of the prostate are responsible for more surgery than diseases of any other organ in men over the age of fifty.

There are two components of BPH, a static and a dynamic component. The static component is due to enlargement of the prostate gland, which may result in compression of the urethra and obstruction to the flow of urine from the bladder. The dynamic component is due to increased smooth muscle tone of the bladder neck and the prostate itself (which interferes with emptying of the bladder) and is regulated by alpha 1 adrenergic receptors (al-ARs). The medical treatments available for BPH address these components to varying degrees, and the therapeutic choices are expanding.

Surgical treatment options address the static component of BPH and include transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), open prostatectomy, balloon dilatation, hyperthermia, stents and laser ablation.

TURP is the preferred treatment for patients with BPH and approximately 320,000 TURPs were performed in the U.S. in 1990 at an estimated cost of $2.2 billion (Weis et al., 1993). Although an effective treatment for most men with symptomatic BPH, approximately 20 25% of patients do not have a satisfactory long-term outcome (Lepor and Rigaud, 1990). Complications include retrograde ejaculation (70-75% of patients), impotence postoperative urinary tract infection and some degree of urinary incontinence (Mebust et al., 1989). Furthermore, the rate of reoperation is approximately 15-20% in men evaluated for years or longer (Wennberg et al., 1987).

Apart from surgical approaches, there are some drug therapies which address the static component of this condition. Finasteride (Proscar®, Merck), is one such therapy which is indicated for the treatment of symptomatic BPH. This drug is a competitive inhibitor of the enzyme reductase which is responsible for the conversion of testosterone to dihydrotestosterone in the prostate gland (Gormley et al., 1992).

Dihydrotestosterone appears to be the major mitogen for prostate growth, and agents which inhibit 5a-reductase reduce the size of the prostate and improve urine flow through the prostatic urethra. Although finasteride is a potent reductase inhibitor and causes a marked decrease in serum and tissue concentrations of dihydrotestosterone, it is only moderately effective in treating symptomatic BPH (Oesterling, 1995). The effects of finasteride take 6-12 months to become evident and for many men the clinical improvement is minimal (Barry, 1997).

The dynamic component of BPH has been addressed by the use of adrenergic receptor blocking agents (al-AR blockers) which act by decreasing the smooth muscle tone within the prostate gland itself. A variety of al-AR blockers (terazosin, prazosin, and doxazosin) have been investigated for the treatment of symptomatic bladder outlet obstruction due to BPH, with terazosin (Hytrin", Abbott) being the most extensively studied.

Although the al-AR blockers are well-tolerated, approximately 10-15% of patients develop a clinically adverse event (Lepor, 1995). The undesirable effects of all members of this class are similar, with postural hypotension being the most commonly experienced side effect (Lepor et al., 1992). In comparison to the 5a-reductase inhibitors, the al-AR blocking agents have a more rapid onset of action (Steers, 1995). However, their therapeutic effect, as measured by improvement in the symptom score and the peak urinary flow rate, is moderate. (Oesterling, 1995) The use of al-AR antagonists in the treatment of BPH is related to their ability to decrease the tone of prostatic smooth muscle, leading to relief -of the obstructive symptoms. Adrenergic receptors are found throughout the body play a dominant role in the control of blood pressure, nasal congestion, prostrate function and other processes (Harrison et al., 1991). However, there are a number of cloned c1-AR receptor subtypes: axl,-AR, alb-AR and aid-AR (Bruno et al., 1991; Forray et al., 1994; Hirasawa et al., 1993; Ramarao et al., 1992; Schwinn et al., 1995; Weinberg et al., 1994). A number of labs have characterized the al-ARs in human prostate by functional, radioligand binding, and molecular biological techniques (Forray et al., 1994; Hatano et al., 1994; Marshall et al., 1992; Marshall et al., 1995; Yamada et al., 1994). These studies provide evidence in support of the concept that the cl,-AR subtype comprises the majority of al1-ARs in human prostatic smooth muscle and mediates contraction in this tissue. These findings suggest that the development of a subtype-selective c1l,-AR antagonist might result in a therapeutically effective agent with greater selectivity for the treatment of

BPH.

-4- SSUMMARY OF THE INVENTION CAccording to a first aspect the present invention provides a compound of Formula I.

R,

0 R2 A N N N wherein: A is (CH 2 )n where n is 1-6; R, is C 1 6 alkyl, phenyl, substituted phenyl where the phenyl substituents are independently selected from one or more of the group consisting of C 1 .salkyl, C 1 .salkoxy and halogen, phenylC 1 .salkyl, or substituted phenylC-.salkyl where the phenyl substituents are independently selected from one or more of the group consisting of C 1 s 5 alkyl, C 1 .alkoxy and halogen;

R

2 is hydrogen, C 1 6 alkyl, C2-alkenyl, C2-5alkynyl, phenylC 1 -salkyl, or substituted phenylC 1 lsalkyl where the phenyl substituents are independently selected from one or more of the group consisting of C 1 .salkyl, C,, 5 alkoxy and halogen; E is (CH2)m 4 R4 or

R

3

-N

R4 where: m is R, is hydrogen, C .alkyl or oxygen, where if R, is oxygen, the hashed line represents a bond and if R, is C,,alkyl the hashed line is absent; R, oxygen, hydrogen, C,-alkyl, formyl, carboxy, C,.alkylcarbonyl, C,.alkoxycarbonyl, phenylC,.alkoxy, substituted phenylC,-alkoxy where the phenyl substituents are independently selected from one or more of the group consisting of

C,

1 .alkyl, C,,.alkoxy and halogen, amido, and substituted amido where the nitrogen substituents are independently selected from one or more of the group consisting or hydrogen, C,-,alkyl, C,.,alkoxy and hydroxy, where if R 4 is oxygen, the hashed line represents a bond and if R 4 is any other substituent, the hashed line is absent; RS is hydrogen, CI.salkyl or taken together with R 6 to form a cyclohexane, cyclopentane or cyclopropane ring; Re is hydrogen, Ci.salkyl or taken together with Rs to form a cyclohexane, cyclopentane or cyclopropane ring; -6and pharmaceutically acceptable salts thereof.

These compounds are useful as adrenergic receptor modulating agents. The compounds of this invention selectively bind to the ala-AR receptor, modulate the activity of said receptor and are selective for prostate tissue over aortic tissue. As such, they represent a viable treatment for ala-AR receptor modulated disorders which include but are not limited to BPH.

In addition this invention contemplates pharmaceutical compositions containing compounds of Formula I, and methods of treating disorders mediated by ala-AR receptor with compounds of Formula I.

Accordingly, a second aspect of the present invention provides a compound and pharmaceutically acceptable salts thereof selected from the group consisting of N- [ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-[ '(2-oxy-piperdinyl)]acetamide,N-[ethyl- 2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-N-methyl-[ '-(2-oxy-piperdinyl)]acetamide, and N-[propyl-3-(2-iso-propyloxphenyl)piperazin-4-yl)]-[1'-(2-oxy-piperdinyl)]acetamide.

According to a third aspect, the present invention provides a compound N- [ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-[1 '-(2-oxy-piperdinyl)]acetamide and pharmaceutically acceptable salts thereof.

According to a fourth aspect, the present invention provides a pharmaceutical composition comprising a compound according to the first aspect and a pharmaceutically acceptable carrier or diluent.

According to a fifth aspect, the present invention provides a pharmaceutical composition comprising a compound according to the third aspect and a pharmaceutically acceptable carrier or diluent.

-6a- 0 According to a sixth aspect, the present invention provides a method of treating a disease mediated by the a-la adrenergic receptor comprising administering a compound

O

according to the first aspect to a patient at an effective dose.

According to a seventh aspect, the present invention provides a method of treating a disease mediated by the a-a adrenergic receptor comprising administering a compound according to the third aspect to a patient at an effective dose.

0According to an eighth aspect, the present invention provides a method of treating benign prostatic hyperplasia comprising administering an effective dose of a compound according to the first aspect.

According to a ninth aspect, the present invention provides a compound of Formula II SR7 N N A A NH wherein: A is (CH 2 )n where n is 1-6, R, is branched C2-6alkyl, phenyl, substituted phenyl where the phenyl substituents are independently selected from one or more of the group consisting of C 15 salkyl, C 1 lsalkoxy and halogen, phenylC 1 -5alkyl, or substituted phenylCl 5 alkyl where the phenyl substituents are independently selected from one or more of the group consisting of C 1 .salkyl, C 1 .,alkoxy and halogen; -6b

R

7 is hydrogen, BOC or CBZ.

These intermediates are useful in the preparation of compound of Formula I.

O

According to a tenth aspect, the present invention provides a compound selected from the group consisting of 1-(2-aminoethyl)-4-(2-2-iso- O 5 propyloxphenyl)piperazine, 1-( 3 -aminopropyl)-4-(2-2-iso-propyloxphenyl)piperazine, and 1-( 4 -aminobutyl)-4-(2-2-iso-propyloxyphenyl)piperzine.

SAccording to an eleventh aspect, the present invention provides a compound 1- (aminoethyl)-4-(2-2-iso-propyloxphenyl)piperazine.

According to a twelfth aspect, the present invention provides a compound of Formula III 0 o O K(CH2)m Ill wherein: m is 1, 3, 4, or These compounds are useful as intermediates in the preparation of compounds of Formula 1.

-7-

O

O

c According to a thirteenth aspect, the present invention provides a compound, 1- O t-butoxycarbonylmethyl-2-piperidone.

According to a fourteenth aspect, the present invention provides use of a compound according to the first aspect of the present invention or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for treating a disease O mediated by the a-l adrenergic receptor.

C According to a fifteenth aspect, the present invention provides use of a compound according to the third aspect of the present invention or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for treating a disease mediated by the a-1a adrenergic receptor.

According to a sixteenth aspect, the present invention provides use of a compound according to the first aspect of the present invention or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for treating benign prostatic hyperplasia.

Unless the context clearly requires otherwise, throughout the description and the claims, the words 'comprise', 'comprising', and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of "including, but not limited to".

DETAILED DESCRIPTION OF THE INVENTION The terms used in describing the invention are commonly used and known to those skilled in the art. "HBSS" refers to Hank's Balanced Salt Solution. "Independently" means that when there are more than one substituent, the substituents may be different. The term "alkyl" refers to straight, cyclic and branched-chain alkyl groups and "alkoxy" refers O-alkyl where alkyl is as known ala-AR antagonists defined supra.

"LDA" refers to lithium diiopropylamide, and "BOP" refers to bezotriazole-1-yl-oxy-tris- (dimethylamino)-phoxphoniumhexafluorophosphate. "BOC" refers to t-butoxycarbonyl, "PyBroP" refer to bromo-tris-pyrrolidino-phosphonium-hexafluorophosphate,

"CBZ"

7a

O

C refers to benzyloxycarbonyl, and "Ts" refers to toluenesulfonyl. "DCC" refers to 1,3- O dicyclohexylcarbodiimide, "DMAP" refers to 4-N'N-dimethylaminopyridine, "EDCI" refers to 1-(3-dimethylamionpropyl)-3-ethylcarbodiimide hydrochloride, and "HOBT" refer to 1hydroxybenzotriazole hydrate. The symbol "Ph" refer to phenyl and "PHT" refers to phthalimido. The term "effective dose" refers to an amount of a compound of Formula I 0 which binds to an/or antagonizes the activity of the ax-1l adrenergic receptor. In addition, Cthe term "effective dose" refers to an amount of a compound of Formula I which reduces the symptoms of diseases associated with the a-1a adrenergic receptor.

-8- The compounds of the invention may be prepared by the following schemes, where some schemes produce more than one embodiment of the invention. In those cases, the choice of scheme is a matter of discretion which is within the capabilities of those of synthetic chemists.

Compounds of Formula I where R, is phenyl, R, is hydrogen, R, is oxygen, A is (CH 2 and m is 4, may be prepared as illustrated by Scheme 1.

In this scheme, the molecules of Formula I are prepared in a convergent synthesis where two halves of the molecule are assembled and ultimately coupled together.

The starting material for one half is a mono N-substituted piperazine of type la. Treatment of la with a mild base such as K 2 CO, and an alkylating agent, such as acrylonitrile in an inert solvent such as MeOH at room temperature for 2-24 hours gives the nitrile Ib. This intermediate may be hydrogenated using Rainy Nirkel as a catalyst to give the propylamine intermediate 1c. The other half of the molecule is assembled using compounds of type 1c as starting materials. e-Caprolactam is treated with a strong base such as NaH, in an inert solvent at 0 "C for about 30 minutes.

The formed anion is treated with an alkylating agent such as tbutylbromoacetate in an inert solvent such as acetonitrile at room temperature for two hours to 2 days to give the ester 1 e. Hydrolysis of le with an acid such as trifluoroacetic acid at room temperature over 2-16 hours gives the acid if. Treatment of the amine ic and the acid If with a peptide coupling agent such as BOP and a suitable amine such as DMAP at room temperature over 1-16 hours gives a compound of Formula I, 1g. Other coupling agents may be substituted for BOP. Such agents include but are not limited to, PyBroP, EDCI, HOBt and the like. Suitable DMAP replacements include but are not limited to N-methylmorpholine, imidazole, DABCO and the like.

Scheme 1 may be used to prepare compounds aside from 1g. To prepare compounds where m is 1-5, known lactams of the appropriate ring size such as 2-azacyclooctanone, replace E-caprolactam in Scheme 1.

-9- Scheme 1 OPh OPh -N NH N C N la Ib OPh Ic N.H N 2CO 2 Bu Id le o OPh

O

cCO2H -C N N N H 0O If lg To prepare compounds where R, is other than phenoxy, la is replaced with known phenyl piperazine derivatives such as N-(2-t-butoxyphenyl)piperazine. To prepare compounds where A is and n is 1-6, acrylonitrile may be replaced with alkylating agents such as 4-chlorobutyronitrile. Alternatively, intermediate 1 c may be prepared by another route as illustrated in Scheme 2.

Piperazine derivative 1a is treated with a mild base and known phthalimido derivatives such as N-(4-bromobutyl)phthalimide to give intermediate 2a. Treatment of 2a with a hydrazine such as N-methyl hydrazine in a suitable solvent such as MeOH or EtOH at reflux, gives intermediates of type 1c. Alternatively, piperazine 1a is treated with a mild base and an N-BOC protected amine such as N-tert-butoxycarbonyl-4bromobutylamine to give the corresponding BOC protected amine. This amine can be deprotected by treatment with an acid such as TFA to give intermediates of type 1c.

Scheme 2 OPh 0 1g N N 0 2a OPh -N N

NH

2 To prepare compounds where R 2 is other than hydrogen, Scheme 3 may be used. Treatment of compounds of type 1g with a strong base such as NaH, followed by an alkylating agent such as benzyl bromide gives compounds of type 3a in 1-5 hours at temperatures from about 0-35 °C.

Scheme 3 OPh O I g N N N 3a o Compounds where R, is oxygen, C,.alkyl, formyl, carboxy, C,.salkylcarbonyl, C, .alkoxycarbonyl, phenylC alkoxy, substituted phenylC,.alkoxy, amido and substituted amido may be synthesized by Scheme 4. For example to prepare compounds where R 4 is ethoxycarbonyl, m is 2, and R 3 is carbonyl, treat ethyl-2-pyrrolidone-5-carboxylate with a strong base such as NaH, in an inert solvent at 0 °C for about 30 minutes.

-11- The formed anion is treated with an alkylating agent such as tbutylbromoacetate in an inert solvent such as acetonitrile at room temperature for two hours to 2 days to give the ester 4a. Acidic hydrolysis of 4a with trifluoroacetic acid at room temperature over 2-16 hours gives the acid 4b. Coupling of the acid 4b and the intermediate amine ic with a peptide coupling agent such as PryBOP gives a compound of Formula I, 4c.

The ethyl ester of compound 4c may be treated with a variety of agents to give derivatives such as amides, carboxylic acids, aldehydes etc, where the reagents and reaction conditions are within the knowledge of those skilled in the art.

Scheme 4

CO

2 t-Bu

C

2

H

CO

2 Et O=C OEt C 0 2 H 4a O= CO2Et 4b 4b O Ph O N N N

N

H EtO 2

C

4c Although the claimed compounds are useful as modulators of al -AR, some compounds are either preferred or particularly preferred. The preferred compounds of the invention include: -12- 0 CH 3 0 00 N N N N O H O 0 NN N 0 o o N -N H N and 0 O H O N N N 0 H 0

N

The particularly preferred are C,.,alkyl.

The particularly preferred are hydrogen, C,.,alkenyl and Cl.-alkynyl.

The particularly preferred "E"s are

R

3

S

R 3

S

(CH

2 )m R4 and R 4 The particularly preferred is 3.

The particularly preferred R 3 is oxygen.

The particularly preferred R 4 is hydrogen.

The particularly preferred "A"s are (CH where n is 2-4.

-13- The particularly preferred compounds of Formula II include compounds where A is 2 or 3, R 1 is C2-.alkyl, and R 7 is hydrogen.

The particularly preferred compounds of Formula III include compounds where m is 3.

The compounds of Formula I may be used in pharmaceutical compositions to treat patientswith disorders related to modulating the activity of the a1 adrenergic receptor. The preferred route is oral administration, however compounds of the invention may be administered by other methods, including but not limited to intravenous infusion. Oral doses range from about 0.01-100 mg/kg daily. The preferred oral dosage range is from about 0.05-1.0 mg/kg daily. Infusion doses can range from about 0.001- 100 mg/kg/min of inhibitor, with a pharmaceutical carrier over a period ranging from several minutes to several days.

The pharmaceutical compositions can be prepared using conventional pharmaceutical excipients and compounding techniques. Oral dosage forms may be elixers, syrups, capsules tablets and the like. Where the typical solid carrier is an inert substance such as lactose, starch, glucose, methyl cellulose, magnesium sterate, dicalcium phosphate, mannitol and the like; and typical liquid oral excipients include ethanol, glycerol, water and the like.

All excipients may be mixed as needed with disintegrants, diluents, granulating agents, lubricants, binders and the like using conventional techniques known to those skilled in the art of preparing dosage forms.

Parenteral dosage forms may be prepared using pharmaceutically acceptable carriers or diluents, including but not limited to water or another sterile carrier.

Typically the compounds of Formula I are isolated and used as free bases, however the compounds may be isolated and used as their pharmaceutically acceptable salts. Examples of such salts include but are not limited to hydrobromic, hydroiodic, hydrochloric, perchloric, sulfuric, maleic, fumaric, malic, tartatic, citric, benzoic, mandelic, methanesulfonic, hydroethanesulfonic, benzenesulfonic, oxalic, pamoic, 2-naphthalenesulfonic, p-toluenesulfonic, cyclohexanesulfamic and saccharinic.

-14- In order to illustrate the invention the following examples are included.

These examples do not limit the invention. They are meant only to suggest a method of practicing the invention. Those skilled in the art may find other methods of practicing the invention, which will be readily apparent to them.

However those methods are deemed to be within the scope of this invention.

PREPARATIVE EXAMPLES Example 1 O O N N

N

O

1 -(2-phthalimidoethyl)-4-(2-isopropyloxyphenyl)piperazine Cpd. 1 N-(2-Bromoethyl)phthalimide (7.6 g, 30 mmol) and K 2 CO3 (6.2 g, mmol) were added to a solution of N-1-(2-isopropoxyphenyl)piperazine (6.6 g, 30 mmol) in acetonitrile (100 mL) and the resulting mixture was heated at reflux for 2 days. The mixture was concentrated in vacuo and purified by column chromatography on silica gel using EtOAc/hexanes (30:70) as an eluent gave the title compound as a solid: MS m/z 394 Example 2 N N NH 2 0 1-(2-Aminoethyl)-4-(2-2-iso-propyloxyphenyl)piperazine Cpd. 2 A solution of compound 1 (7.5 g, 19 mmol) in EtOH (70 mL) was stirred for 10 minutes at room temperature. Methylhydrazine (20 mL) was added and the mixture was heated at reflux for 2.5 hours. The mixture was cooled to room temperature and the resulting solid precipitate was removed by filtration. The filtrate was concentrated in vacuo yielded the title compound as solid which was used without purification: MS m/z 264 Example 3 ON CNCO-Bu 1-t-Butoxycarbonylmethyl-2-piperidone Cpd. 3 Sodium Hydride (1.67 g, 66 mmol) was added to a stirred solution of 5-valerolactam (5.95 g, 60 mmol) in toluene (100 mL) at 0 "C and the resulting suspension was stirred for 1 hours. t-Butylbromoacetate (8.86 mL, mmol) was added dropwise and the reaction mixture was warmed to room tempeature and stirred for 10 hours. Saturated NH 4 CI aq was added and the resulting organic layer was washed with successive portions of brine and The combined organic layers were dried (Na 2 SO4) and concentrated in vacuo to give compound 3 as an oil.

Example 4 0 N CO 2

H

1 -Carboxymethyl-2-piperdone Cpd 4 Trifluoroacetic acid (15 mL) was added to a stirred solution of compound 2 (12.93 g, 61 mmol) in methylene chloride (30 mL) under N2.

This mixture was stirred for 4 hours and concentrated in vacuo to give the title compound as a solid: MS m/z 158 -16- Example 0 H 0 N N N N N-[Ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]- [1'-(2-oxy-piperdinyl)]acetamidemide Cpd. A solution of compound 2 (3.61 g, 23 mmol) in methylene chloride mL) was added to a solution of compound 4 (5.0 g, 19 mmol) in methylene chloride (10 mL). PyBroP (10.72 g, 23 mmol), DMAP (3.85 g, 31 mmol) and N-methylmorpholine (2.53 mL, 23 mmol) were added and the mixture was stirred at room temperature under N 2 for 10 hours. The resulting mixture was washed with one portion of aqueous sodium bicarbonate, brine and H 2 0.

The combined organic layer was dried (Na 2 SO4) and concentrated in vacuo.

The residue was purified by MPLC on silica gel using EtOAclMeOH/triethylamine (90:5:5) as an eluent to give the title compound as an oil: MS m/z 403 Treatment of the isolated compound with an equimolar portion of citric acid in ethyl acetate gave the citrate salt of the title compound as a solid.

Example 6 0 CH 3

O

N-[Ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-N-methyl- [1'-(2-oxy-piperdinyl)]acetamidemide Cpd. 6 Sodium hydride (95% tech. 10.6 mg, 0.44 mmol) was added to a stirred solution of compound 5 (140.5 mg, 0.35 mmol) in THF (5 mL) at 0 "C and the -17resulting suspension was stirred for 30 minutes. Methyl iodide (0.37 mmol) was added dropwise and the mixture was stirred overnight at room temperature. The residue was concentrated in vacuo, dissolved in ethyl acetate and washed with successive portions of aqueous, sat. ammonium chloride solution, brine and water. The combined organic layer was dried (Na 2

SO

4 and concentrated in vacuo to give the title compound as a solid: MS m/z 417 BIOLOGICAL

EXAMPLES

Biological activity and selectivity of compounds of the invention was demonstrated by the following in vitro assays; The first assay tested the ability of compounds of Formula I to bind to membrane bound receptors al,- AR, alb-AR and ald-AR.

Example 14 The DNA sequences of the three cloned human al -AR subtypes have been published. Furthermore, the cloned cDNAs have been expressed both transiently in COS cells and stably in a variety of mammalian cell lines (HeLa, LM(tk-), CHO, rat -1 fibroblast) and have been shown to retain radioligand binding activity and the ability to couple to phosphoinositide hydrolysis. We used published DNA sequence information to design primers for use in RT- PCR amplification of each subtype to obtain cloned cDNAs. Human poly A+ RNA was obtained from commercially available sources and included hippocampus and prostate samples, sources which have been cited in the literature. For the primary screen a radio ligand binding assay was used which employed membrane preparations from cells expressing the individual cloned receptor cDNAs. Radiolabeled ligands with binding activity on all three subtypes (non-selective) are commercially available ([1251]-HEAT, [3H)prazosin).

Each al receptor subtype was cloned from poly A+ RNA by the standard method of reverse transcription-polymerase chain reaction (RT- PCR). The following sources of polyA+ RNA were used for the cloning of the a1 receptor subtypes: c I.-AR, human hippocampus and prostate, alb-AR, human hippocampus, aid-AR, human hippocampus. The resulting cDNAs -18were cloned into the pcDNA3 mammalian expression vector (Invitrogen Corp., San Diego CA). Each DNA was sequenced for verification and to detect any possible mutations introduced during the amplification process.

Any deviation in sequence from the published consensus for each receptor subtype was corrected by site-directed mutagenesis.

The three al-AR subtypes b, d) were transfected into COS cells using a standard DEAE-dextran procedure with a chloroquine shock. In this procedure, each tissue culture dish (100mm) was inoculated with 3.5 x 106 cells and transfected with 10 ig of DNA. Approximately 72 hours posttransfection, the cells were harvested and COS membranes were prepared.

Transfected COS cells from 25 plates (100mm) were scraped and suspended in 15mL of TE buffer (50mM Tris-HCl, 5mM EDTA, pH7.4). The suspension was disrupted with a homogenizer. It was then centrifuged at 1000xg for minutes at 4 The supernatant was centrifuged at 34,500xg for 20 minutes at 4 The pellet was resuspended in 5mL TNE buffer (50mM Tris-HCI, EDTA, 150mM NaCI, pH7.4). The resulting membrane preparation was aliquoted and stored at -70aC. The protein concentration was determined following membrane solubilization with TritonX-100.

The ability of each compound to bind to each of the acl-AR subtypes was assessed in a receptor binding assay. [1251]-HEAT, a non-selective al- AR ligand, was used as the radiolabeled ligand. Each well of a 96-well plate received: 140 pL TNE, 25 p.L [1251]-HEAT diluted in TNE (50,000 cpm; final concentration 50 pM), 10 pIL test compound diluted in DMSO (final concentration 1 pM-10 25 mL COS cell membrane preparation expressing one of the three xal-AR subtypes (0.05-0.2 mg membrane protein). The plate was incubated for 1 hour at room temperature and the reaction mixtures were filtered through a Packard GFIC Unifilter filter plate.

The filter plate was dried for 1 hour in a vacuum oven. Scintillation fluid mL) was added to each well, and the filter plate was counted in a Packard Topcount scintillation counter. Data was analyzed using GraphPad Prism software.

19 Tables A B list the IC 5 0 values expressed in nanomolar concentration for select compounds of the invention in all receptor subtypes.

Table A A N2 N N ANN d- tr-P'I In-2.AP wI-vhAP cyld-AR I, pda. A r1- [4 6 7 8 9 11 12 "9*#I i-prop CH 2

H

i-prop OH 2

OH

3 i-prop OH 2

OH

2

CHCH

2 i-prop CH 2 CH2AQ)CH i-prop OH 2

OH

2 Ph i-prop CH 2

H

i-prop CH 2

H

OH

3

(OH

2 2

H

indicates a citrate salt

H

H

H

H

H

C0 2

C

2

H

5

H

H

46120 763900 172500 170200 4226 26310 3536 109000 372 650 372 358 348 260 505 30530 Table B 0 R1 al n-AR ryi1b-AR aid-AR r, 14 C A R kJ 1 1 51 13 i-prop CH 2 1616 Example The antagonist activity of select compounds of Formula I was demonstrated by the following screen. Binding of an agonist to al-ARs causes the activation of PLC through G-protein coupled mechanisms (Minneman and Esbenshade, 1994). PLC catalyzes the hydrolysis of phosphatidyl inositol 4,5-bisphosphate (PIP2) generating two second messenger molecules, inositol 1,4,5-triphosphate (IP3) and diacylglycerol (DAG) and ultimately resulting in mobilization of intracellular calcium stores.

Hits from the primary screening assay that showed selectivity in inhibiting radioligand binding to the acL,-AR were evaluated for the ability to antagonize the mobilization of cytosolic calcium in cell lines stably expressing individual receptor subtypes.

Preparation of stable cell lines expressing each receptor subtype: The alpha 1 adrenergic receptor subtypes b, d) in the pcDNA3 vector were transfected into HEK 293s (human embryonic kidney) cells to form stable receptor-expressing cell lines. Transfection was performed using DMRIE-C (GibcoBRL) cationic lipid reagent mixed with 2-3 ug of DNA and reduced serum OPTI-MEM 1 medium (GibcoBRL). Cells in 100mm tissue culture plates were overlayed with the lipid-DNA complex and incubated at 37C,

CO

2 for 5-6 hours. Serum-containing growth medium was then added and cells were incubated for an additional 48 hours. Following this incubation, each plate was split 1:5 into selection medium containing 250, 300 or 350 ug/ml of G418 (geneticin) antibiotic. Plates were fed every 4 days with the appropriate selection medium. After approximately 3 weeks, colonies were picked for each subtype from the 300 ug/ml G418 selection plates. Colonies were expanded and frozen. Twelve cell lines of each subtype were screened for alpha 1 adrenergic receptor binding using a whole cell receptor binding assay. Positive cultures were subsequently analyzed by the calcium mobilization assay.

HEK 293s cells expressing human a1 a-AR were lifted with trypsin and washed once with HBSS. The cell pellet was resuspended in HBSS with 0.05% BSA to 1-5x10 6 cells/ml. A 5 mM Fluo-3 solution (in 2/3 vol. DMSO and 113 vol Pluronic acid) was added to the cell suspension, giving a final Fluo-3 concentration of 5 Cells were then incubated with gentle rocking at room temperature for 1 hr in the dark. After incubation, the cells were -21washed 3x with HBSS and resuspended in HBSS with 1.25 mM CaCI 2 to 0.7x10 6 cell/ml. Cell aliquots (100 iLl) were pippetted into each well of a 96well microplate. Calcium mobilization was induced with norepinephrine uM) at room temperature. Two minutes prior to assay, antagonists were added to cells utilizing a 96-well pipettor. Afterward, the agonist was added and fluorescent signal was monitored for 2-3 minutes using FLIPR (Molecular Devices, USA). Compound 5 inhibited the mobilization of cytosolic calcium at an ICso of 99 pM.

Example 16 The antagonist activity and the selectivity of compounds of the invention for prostate tissues over aortic tissues as well as their antagonists was demonstrated as follows. The contractile responses of rat prostatic tissue and rat aorta tissues were examined in the presence and absence of antagonist compounds. As an indication of the selectivity of antagonism, test compound effects on vascular smooth muscle contractility (ca1b-AR and ald- AR) were compared to the effects on prostatic smooth muscle (ci1a-AR).

Strips of prostatic tissue and aortic rings were obtained from Long Evans derived male rats weighing 275 grams and sacrificed by cervical dislocation.

The prostate tissue was placed under 1 gram tension in a 10 ml bath containing phosphate buffered saline pH 7.4 at 32 C and isometric tension was measured with force transducers. The aortic tissue was placed under 2 grams tension in a 10 ml bath containing phosphate buffered saline pH 7.4 at 37 The ability of test compound to reduce the norepinephrine-induced contractile response by 50 (ICso) was determined. Compound 5 inhibited the contractile response in aortic tissue with an ICso of 31.9 pM and in prostate tissue with an ICso of 1.3 p.M.

Example 17 Select compounds of the invention were tested for their ability to antagonize phenylephrine (PE) induced increases in intraurethral pressure in dogs. The selectivity of these compounds was demonstrated by comparing their effect upon PE induced increases in mean arterial pressure (MAP) in the dog.

-22- Male beagle dogs were anesthetized and catheterized to measure intraurethral pressure (IUP) in the prostatic urethra. Mean arterial pressure (MAP) was measured using a catheter placed in the femoral artery. Dogs were initially administered six i.v. bolus doses (1 to 32mg/kg) of phenylephrine (PE) to establish a control agonist dose-response curve. IUP and MAP were recorded following each dose until the IUP returned to baseline. The dogs then were given an i.v. bolus dose of the antagonist compound, followed by i.v. PE challenges of ascending doses, as in the control agonist dose-response curve. IUP and MAP measurements following each PE challenge were recorded. The antagonist compound was tested over a dose range of 3 to 300 ug/kg in half-log increments. The interval between antagonist doses was at least 45 minutes and three experiments were performed per dose level for each test compound. The graphs below illustrates the mean percentage reductions in IUP and MAP for compounds and 12 respectively.

100c m oL 0.1 1.0 10.0 100.0 1000.0 Dose (ug/kg, i.v.) Effects of Compound 5 upon IUP and MAP at 10 lig/kg PE in dogs a IUP A MAP -23- 100- S U 0) 0 1 10 100 1000 Dose (ug/kg, i.v.) Effects of Compound 12 upon IUP and MAP at 10 pg/kg PE in dogs a IUP A MAP

REFERENCES

Breslin D, Fields DW, Chou T-C, Marion DN, Kane M, Vaughan ED, and Felsen D (1993) Investigative urology: medical management of benign prostatic hyperplasia: a canine model comparing the in vivo efficacy of alpha- 1 adrenergic antagonists in the prostate. J. Urol. 149: 395-399.

Bruno JF, Whittaker J, Song J, and Berelowitz M. (1991) Molecuar cloning and sequencing of a cDNA encoding a human aclA adrenergic receptor.

Biochem. Biophys. Res. Commun. 179: 1485-1490.

Bylund DB, Eikenberg DC, Hieble JP, Langer SZ, Lefkowitz RJ, Minneman KP, Molinoff PB, Ruffolo RR, and Trendelenburg U (1994) IV. International Union of Pharmacology nomenclature of adrenoceptors. Pharmacol. Rev. 46: 121-136.

Carruthers SG (1994) Adverse effects of cL1-adrenergic blocking drugs. Drug Safety 11: 12-20.

-24- Faure C, Gouhier C, Langer SZ, and Graham D (1995) Quantification of ca1adrenoceptor subtypes in human tissues by competitive RT-PCR analysis.

Biochem. Biophys. Res. Commun. 213: 935-943.

Flavahan NA and VanHoutte PM (1986) c-Adrenoceptor classification in vascular smooth muscle. Trends Pharmacol. Sci. 7: 347-349.

Ford APDW, Arredondo NF, Blue DR, Bonhaus DW, Jasper J Dava MS, Lesnick J, Pfister JR, Shieh IA, Vimont RL, Williams RJ, McNeal JE, Stamey TA, and Clarke DE (1996) RS-17053 a-dimethyl-1H-indole-3ethanamine hydrochloride), a selective alA-adrenoceptor antagonist, displays low affinity for functional al -adrenoceptors in human prostate: Implications for adrenoceptor classification. Mol. Pharmacol. 49: 209-215.

Forray C, Bard JA, Wegzel JM, Chiu G, Shapiro E, Tang R, Lepor H, Hartig PR, Weinshank RL, Branchek TA, and Gluchowski C (1994) The acladrenergic receptor that mediates smooth muscle contraction in human prostate has the pharmacological properties of the cloned human a1c subtype. Mol. Pharmacol. 45: 703-708.

Gormley G, Stoner E, Bruskewitz RC et al. (1992) The effects of finasteride in men with benign prostatic hyperplasia. N. Engl. J. Med. 327: 1185-1191.

Hatano A Takahashi H, Tamaki M, Komeyama T, Koizumi T, and Takeda M (1994) Pharmacological evidence of distinct al-adrenoceptor subtypes mediating the contraction of humanprostatic urethra and peripheral artery.

Br. J. Pharmacol. 113: 723-728.

Harrison JK, Pearson WR, and Lynch KR (1991) Molecular characterization of al- and al-adrenoceptors. Trends Pharmacol. Sci. 12: 62-67.

Hieble JP and Caine M (1986) Etiology of benign prostatic hyperplasia and approaches to pharmacological management. Fed. Proc. 45: 2601.

Hirasawa A, Horie K, Tanaka T, Takagaki K, Murai M, Yano J, and Tsujimoto G (1993) Cloning, functional expression and tissue distribution of human .cDNA for the al c-adrenergic receptor. Biochem. Biophys. Res. Commun.

195: 902-909.

Holck CM, Jones CHM, and Haeusler G (1983) Differential interactions of clonidine and methoxamine with postsynaptic ca-adrenoceptors of rabbit main pulmonary artery. Cardiovasc. Res. 5: 240-248.

Lepor H and Rigaud G (1990) The efficacy of transurethral resection of the prostate in men with moderate symptoms of prostatism. J. Urol. 143: 533- 537.

Lepor H, Auerbach S, Puras-Baez A et al. (1992) A randomized, placebocontrolled multi-center study of the efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia. J. Urol. 148: 1467-1474.

Lepor H (1995) a-Blockade for benign prostatic hyperplasia (BPH) J. Clin.

Endocrinol. Metab. 80: 750-753.

Marshall I, Burt RP, Andersson PO, Chapple CR, Greengrass PM, Johnson GI, and Wyllie MG (1992) Human alc-adrenoceptor: functional characterisation in prostate. Br. J. Pharmacol. 112: 59P.

Marshall I, Burt RP, and Chapple CR (1995) Noradrenaline contraction of human prostate by alA- (calC-)adrenoceptor subtype. Br. J. Pharmacol. 115: 781-786.

-26- Mebust WK, Holtgrewe HL, Cockett ATK, and Peters PC (1989) Transurethral prostatectomy: immediate and postoperative complication: a cooperative study of 13 participating institutions evaluating 3,885 patients J. Urol. ,141: 243-247.

Minneman KP, Han C and Abel PW (1988) Comparison of al-adrenergic receptor subtypes distinguished by chloroethylclonidine and WB4101. Mol.

Pharmacol. 33: 509-514.

Minneman KP and Esbenshade TA (1994) al-Adrenergic receptor subtypes.

Annu. Rev. Pharmacol. Toxicol. 34: 117-133.

Morrow AL and Creese I (1986) Characterization of alpha 1-adrenergic receptor subtypes in rat brain: A reevaluation of [3H]WB4101 and [3H]prazosin binding. Mol. Pharmacol. 29: 321-330.

Muramatsu I (1992) A pharmacological perspective of cal-adrenoceptors: subclassification and functional aspects, in ac-Adrenoceptors (Fujiwara M, Sugimoto T, and Kogure K, eds.). Excerpta Medica Ltd., Tokyo, 193-202.

Muramatsu I, Oshita M, Ohmura T, Kigoshi S, Akino H, Gobara M, and Okada K (1994) Pharmacological characterization of cl.-adrenoceptor subtypes in the human prostate: functional and binding studies. Br. J. Urol. 74: 572-577.

Oesterling JE (1995) Benign prostatic hyperplasia. Medical and minimally invasive treatment options. N. Engl. J. Med. 332: 99-109.

Price DT, Lefkowitz RJ, Caron MG, Berkowitz D, and Schwinn DA (1994) Localization of mRNA for three distince al -adrenergic receptor subtypes in human tissues: implications for human a-adrenergic physiology. Mol.

Pharmacol. 45: 171-175.

-27- Ramarao CS, Kincade Denker JM, Perez DM, Gaivin RJ, Riek RP, and Graham RM (1992) Genomic organization and expression of the human a lB-adrenergic receptor. J. Biol. Chem. 267: 21936-21945.

Schwinn DA, Johnston GI, Page SO, Mosley MJ, Wilson KH, Worman NP, Campbell S, Fidock MD, Furness LM, Parry-Smith DJ, Peter B, and Bailey DS (1995) Cloning and pharmacological characterization of human alpha-i adrenergic receptors: sequence corrections and direct comparison with other species homologues. JPET272: 134-142.

Weinberg DH, Trivedi P, Tan CP, Mitra S, Perkins-Barrow A, Borkowski D, Strader CD, and Bayne M (1994) Cloning, expression and characterization of human a adrenergic receptors alA, alB, and a.1C. Biochem. Biophys. Res.

Commun. 201: 1296-1304.

Weis KA, Epstein RS, Huse DM, Deverka PA and Oster G (1993) The costs of prostatectomy for benign prostatic hyperplasia. Prostate 22: 325-334.

Wennberg JE, Roos N, Sola L, Schori A, and Jaffe R (1987) Use of claims data systems to evaluate health care outcomes: mortality and reoperation following prostatectomy. JAMA 257: 933-936.

Yamada S, Tanaka C, Kimura R, and Kawabe K (1994) Alpha 1adrenoceptors in human prostate: characterization and binding characteristics of alpha 1-antagonists. Life Sci. 54: 1845-1854.

Claims (27)

1. A compound of Formula I eo 2 A N N N E 8 Oc, O wherein: A is (CH 2 )n where n is 1-6; R 1 is C 1 .ealkyl, phenyl, substituted phenyl where the phenyl substituents are independently selected from one or more of the group consisting of C 1 salkyl, Ci. 5 alkoxy and halogen, phenylC 1 -salkyl, or substituted phenylC 1 .salkyl where the phenyl substituents are independently selected from one or more of the group consisting of C 1 5 alkyl, C 1 5 alkoxy and halogen; R 2 is hydrogen, C1-6alkyl, C25alkenyl, C 2 5 alkynyl, phenylCl.salkyl, or substituted phenylC 1 where the phenyl substituents are independently selected from one or more of the group consisting of C 15 alkyl, C 1 alkoxy and halogen; E is -29- "4 "4 or R 3 R -N R4 where: m is R, is hydrogen, C,,alkyl or oxygen, where if R, is oxygen, the hashed line represents a bond and if R, is alkyl the hashed line is absent; R, oxygen, hydrogen, C,,alkyl, formyl, carboxy, C,.,alkylcarbonyl, C alkoxycarbonyl, phenylC,-,alkoxy, substituted phenylC 1 .alkoxy where the phenyl substituents are independently selected from one or more of the group consisting of alkyl, C .salkoxy and halogen, amido, and substituted amido where the nitrogen substituents are independently selected from one or more of the group consisting or hydrogen, C, .alkyl, C, ,alkoxy and hydroxy, where if R 4 is oxygen, the hashed line represents a bond and if R 4 is any other substituent, the hashed line is absent; R s is hydrogen, C,.salkyl or taken together with R 6 .to form a cyclohexane, cyclopentane or cyclopropane ring; Re is hydrogen, C 1 .salkyl or taken together with Rs to form a cyclohexane, cyclopentane or cyclopropane ring; O cN and pharmaceutically acceptable salts thereof. S2. The compounds of claim 1 where R 1 is Cldalkyl, n is 2-4, and R 2 is hydrogen or C 1 -6alkyl, C26alkenyl.

3. The compounds of claim 2 SR3 S\ RR3 N N I -(CH)m Swhere E is or

4. The compounds of claim 2 where R 3 is oxygen and R 4 is hydrogen, C 1 5 alkoxycarbonyl, or oxygen. The compounds of claim 4 where R 4 is hydrogen and E is R3 N 3 I(CH")m R4

6. The compounds of claim 5 where m is 2 to

7. A compound and pharmaceutically acceptable salts thereof selected from the group consisting of N-[ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-[1'-(2-oxy- piperdinyl)]acetamide, N-[ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-N-methyl-[1'- (2-oxy-piperdinyl)]acetamide, and N-[propyl-3-(2-iso-propyloxyphenyl)piperazin-4-yl)]- [1'-(2-oxy-piperdinyl)]acetamide.

8. A compound N-[ethyl-2-(2-iso-propyloxyphenyl)piperazin-4-yl)]-[1'-(2-oxy- piperdinyl)]acetamide and pharmaceutically acceptable salts thereof.

9. A pharmaceutical composition comprising a compound according to claim 1 and a pharmaceutically acceptable carrier or diluent. -31- O c 10. A pharmaceutical composition comprising a compound according to claim 6 and U a pharmaceutically acceptable carrier or diluent.

11. A pharmaceutical composition comprising a compound according to claim 8 and a pharmaceutically acceptable carrier or diluent.

12. A method of treating a disease mediated by the a-1l adrenergic receptor 0 comprising administering a compound of claim 1 to a patient at an effective dose. C 13. A method of treating a disease mediated by the a-la adrenergic receptor Scomprising administering a compound of claim 6 to a patient at an effective dose.

14. A method of treating a disease mediated by the a-1a adrenergic receptor comprising administering a compound of claim 8 to a patient at an effective dose. The method of any one of claims 12 to 14 where the compound is administered orally and an effective dose is 0.01-100 mg/kg daily.

16. The method of claim 15 where the dose is 0.05-1.0 mg/kg daily.

17. A method of treating benign prostatic hyperplasia comprising administering an effective dose of a compound of claim 1.

18. A compound of Formula II RI R\ R7 N NNH wherein: A is (CH 2 )n where n is 1-6; R 1 is branched C2 6 alkyl, phenyl, substituted phenyl -32- O eC where the phenyl substituents are independently selected from one or 0 more of the group consisting of Cl 1 salkyl, C 1 5alkoxy and halogen, 0 phenylC 1 lsalkyl, or substituted phenylC 1 -salkyl O where the phenyl substituents are independently selected from one or more of the group consisting of C 1 .salkyl, C 1 -alkoxy and halogen; R 7 is hydrogen, BOC or CBZ. g 19. The compounds of claim 18 where n is 2-4 and R, is branched C26alkyl. The compounds of claim 18 where R 7 is hydrogen or BOC.

21. A compound selected from the group consisting of 1-(2-aminoethyl)-4-(2-2-iso- propyloxyphenyl)piperazine, 1-( 3 -aminopropyl)-4-(2-2-iso-propyloxyphenyl)piperazine, and 1-(4-aminobutyl)-4-(2-2-iso-propyloxyphenyl)piperazine.

22. A compound 1-(2-aminoethyl)-4-(2-2-iso-propyloxyphenyl)piperazine.

23. A compound of Formula III 0 N L (CH 2 )m III wherein: m is 1, 3, 4, or

24. The compounds of claim 23 where m is A compound, 1-t-butoxycarbonylmethyl-2-piperidone.

26. Use of a compound of claim 1 or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for treating a disease mediated by the a-la adrenergic receptor.

27. Use of a compound of claim 6 or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for treating a disease mediated by the a-1a adrenergic receptor. -33- S28. Use of a compound of claim 8 or a pharmaceutically acceptable salt thereof in d) the manufacture of a medicament for treating a disease mediated by the a- 1 a adrenergic receptor.

29. Use according to any one of claims 26 to 28 where the compound is suitable for oral administration in a dose of 0.01-100 mg/kg daily. Use according to claim 29, where the dose is 0.05-1.0 mg/kg daily. t'q S31. Use of a compound of claim 1 or a pharmaceutically acceptable salt thereof in Sthe manufacture of a medicament for treating benign prostatic hyperplasia.

32. A compound of Formula I R1 A N N N "rE 0 or a pharmaceutically acceptable salt thereof, substantially as herein defined with reference to any one of the Examples but excluding comparative Examples.

33. A pharmaceutical composition comprising a compound of Formula I, substantially as herein defined with reference to any one of the Examples but excluding comparative Examples.

34. A method of treating a disease mediated by the a-1a adrenergic receptor, substantially as herein defined with reference to any one of the Examples but excluding comparative Examples.

35. A method of treating benign prostatic hyperplasia, substantially as herein defined with reference to any one of the Examples but excluding comparative Examples.

36. A compound of Formula II 34- R, R, o7 S N A NH II 0 or a pharmaceutically acceptable salt thereof, substantially as herein defined \with reference to any one of the Examples but excluding comparative Examples.

37. A compound of Formula III 0 0 0 L(C 2)m III or a pharmaceutically acceptable salt thereof, substantially as herein defined with reference to any one of the Examples but excluding comparative Examples.

38. Use of a compound of Formula I or a pharmaceutically acceptable salt thereof in the manufacture of a medicament, substantially as herein defined with reference to any one of the Examples but excluding comparative Examples. DATED this 9th day of December 2004 Shelston IP Attorneys for: ORTHO-MCNEIL PHARMACEUTICAL, INC.