In particular it relates to drugs which are used at lower but equally effective doses than those commonly used for the treatment of said therapy, and combined with fewer side effects, in particular as far as the absence of hypotension and algogenic activity is concerned.

It is well known in the art that the available therapies for treating male impotence are based on different approaches depending on the aetiology.

In the case of impotence due to endocrine causes treat- ment with testosterone is used.

In the case of impotence due to vascular alterations, or following from some neurological alterations, it is used an intracavernous injection of vasoactive compounds made by the patient himself before sexual intercourse. This method of administration allows a local pharmacological activity and reduces to a minimum any interference with the other vascular areas of the body which could lead to severe side effects including vasodilation and hypotension. The drugs more frequently used with said method include the association papaverine-phentolamine and Prostaglandin E1 (PGE1). This is a useful approach from the therapeutic point of view, but it has the disadvantage to presenting side effects. In fact, papaverine induces local fibrosis, prolonged erections and hepatic alterations; Prostaglandin E1 induces pain in 20W of cases and prolonged erections in 1-2W of cases. PGE1 is anyhow at the moment the drug most used for this type of therapy.

Besides clinical drug treatments, are well known in the art the use of prostheses and mechanical devices.

At the present time, the available drugs solve the pro- blem only in a limited number of cases. Research is being made on the basis of various hypothesis. However, the drugs which have been proposed up to now are less active than pro- staglandin-based drugs.

It was felt the need to have drugs as effective in the treatment of impotence as least as those based on prostaglandin but without presenting the side effects possessed by said known drugs as described above.

It has been surprisingly and unexpectedly found a class of drugs as herein below defined which has an improved activity than prostaglandin and the advantage of being used at lower doses with less side effects, in particular it does not cause any hypotension or algogenic activity.

It is an object of the invention the compounds, or their compositions having the general formula A - X1- NO2 (I) for use as medicaments, in particular as drugs for the treat- ment of impotence, wherein: A = R(CRaRbO)U(COX)t (II) wherein: t and u are integers and are equal to 0 or 1; X = o, NH, NRic wherein Ric is a linear or branched alkyl having from 1 to 10 carbon atoms; <BR> <BR> <BR> <BR> Ra and Rb, equal or different from each other, are H, C1 C3 alkyl; R is a radical having the following formula: where ma is an integer and can have a value of 0 or 1; where the meaning of the various substituents of formula III is as it follows when t = 1, u = 0 and m = 1: R1 = H; an alkyl having from 1 to 6 carbon atoms, preferably from 1 to 3, or a free valence; R2 = OH; 0- such as to form with Rl, when R1 is a free va- lence, and with the carbon atom at position 15, a group C=O; R3, R4, equal or different one from the other, are equal to R1, or one of them is a bond 0-, and the other is a free valence so that with the carbon atom C6 they form a group C=O; R5, R6, equal or different one from the other, are equal to R1, in particular when both R5 and R3 are each a free valence, R5 and R3 form a double bond between C5 and C6; R7, RB, R9, R1o, equal or different one from the other, have the same meaning of R1; when R7 or R9, and at the same time R6 or R10 are each a free valence, there is a double bond between C13 and C14 R11 =R1; R12 = R11 or OH; R13, R14, Rls, R16, equal or different one from the other, are equal to R1; when R13 or R15, and at the same time R14 or R16, are each a free valence, there is a double bond between C3 and Q; R17, R18, equal or different one from the other, are equal to R1; R19, R20, equal or different one from the other, are equal to R1; when R6 or R5 is a free valence, and at the same time Rl9 or R20 is a free valence, there is a double bond between C4 and Cs; R21, R22, R23, R24, equal or different one from the other, are equal to Rl; R26, R26, equal or different one from the other, are equal to R1, but both R25 and R26 cannot be a free valence; R27 is a linear or whenever possible branched alkyl having from one to six carbon atoms; B is equal to the group 0= (a keto group with the carbon atom at position 9 of the prostaglandin molecule), OH, or -O-; when no aliphatic chain C7-C2 is found attached at position 8, in its place there is the alkylaromatic residue: wich is bound to formula (III) (B = -o-) in the following way: wherein m1 is an integer from 1 to 6, preferably from 1 to 3; Ra and Rb, equal or different from each other, are as above defined; when t = 0. u = 1 and m = 1 the meanings of the various substituents are as above defined; when t = 1. u = 0 and m = 0 the meanings of the various sub- stituents are as above defined and C16 is bound, optionally by a bridging group -0-, to an aro- matic radical or an alkyl-aril radical, where the aryl can be substituted, preferably with halogens, preferably with Cl, F; said aryl radical can also contain heteroatoms, such as O, N; the alkyl of the alkyl-aril radical is an aliphatic chain from 1 to 3 carbon atoms, preferably -CH2-; X1 of formula A -X1 - NO2 is a bivalent connecting bridge, chosen from the following: y Y is a linear or whenever possible branched C1-C20 alkylene oxygen terminated, preferably having from 2 to 5 carbon atoms or is a C5-C7 cycloalkylene oxygen terminated optionally substituted; where n3 is an integer from 0 to 3; where nf'is an integer from 1 to 6, preferably fron 2 to 4; where R1f = H, CH3 and nf is an integer from 1 to 6, preferably from 2 to 4.

When in formula (II) t = 1 u = 0 and in formula (III) the the preferred prostaglandin residues R are the following: when B is O= (keto group with C9); R7, R8, R9 and R10 are such as to give a double bond between C13 and C14; R2 is OH; R27 is CH3; the substituents of the carbon atoms of the C2-C7 and C16- C19 aliphatic chains are H; R thus defined is known as the residue of Prostaglandin El; or, by putting in the formula of Prostaglandin E1 R1 = CH3 and R3, R4, R5, R6 such as to give a double bond between C5 and C R thus defined it is known as the residue of Arbaprostil; or, by putting in the formula of Arbaprostil R7 = R9 = R9 = Rlo = H; R1 and R2 are such as to form the group C=O with C1s; B is OH; R27 = C3H7, R thus defined it is known as the residue of Unoprostone; or, by putting in the formula of Arbaprostil R1l = R12 = CH3 R1 = H, R thus defined it is known as the residue of Trimoprostil; or, when in the formula of Arbaprostil B is OH; R1 = H; R thus defined it is known as the residue of Prostaglandin F2; or, when in the formula of Prostaglandin F2α B is O= (keto group with C9), R thus defined it is known as the residue of Prostaglandin E2; or, when in the formula of Arbaprostil B is OH; R thus defined it is known as the residue of Carboprost; or, by putting in the formula of Arbaprostil R1 = H; R17 = H; R19 = CH3 R3 = R4 = R6 = R6 = H; R2? = C2H5; R13 = R16 = H and R14 = R15 being free valences such as to form a double bond between C2 and C3; R thus defined it is known as the residue of Limaprost; or, by putting in the formula of Trimoprostil R3 = R4 = R5 = R6 = H and positioning the double bond between C2 and C3 instead that between C5 and C6; R thus defined it is known as the residue of Gemeprost; or, by putting in the formula of Arbaprostil R1 = R2 = H; R12 = OH; R11 = CH3 R3 = R5 = R4 = R6 = H; R thus defined it is known as the residue of Misoprost; or, by putting in the formula of Arbaprostil R1 = H; Rl8 = CH3; R2, = C2H5; R3 and R4 are such that one of them is a free valence and the other is a single bond with an oxygen atom so so that together with the carbon atom C6 they form a keto group C=O; R5 = R6 = H; R thus defined it is known as the residue of Ornoprostil; or, as in Arbaprostil, without the C7 -C aliphatic chain and the carbon atoms Cg-C8 being linked to the group of formula (IV) as shown in (v); R1 = H; R1l = CH3; R21, R221 R23 and R24 being each a free valence so to form a triple bond between C18 and C19; R thus defined it is known as the residue of Beraprost; when t = 0; u = 1 and m = 1: Ra = Rb = H and R is the residue of Misoprostol; R thus defined it is known as the residue of Rioprostil; when t = 1, u = 0 and m = 0: when R is the residue of Arbaprostil except that R1 = H, R19 or R20 is a free valence or is H, so that between C4 and C5 there is a double bond; C16 is linked to a group -O-A, wherein Ar = phenyl; R thus defined it is known as the residue of Enprostil; when R is the residue of Arbaprostil except that B is OH; R = H; C16 is linked to a group -CH2-Ar where Ar is phenyl; it is defined a radical known as the residue of Latanaprost; or, when in the formula of Enprostil R20 = R19 = H; it is defined a radical known as the residue of Sulprostone.

The products of the invention are obtained starting from the precursors in which R is as above defined and containing at least one carboxylic function, usually at position 2 of the corresponding formula (III); in the case of Beraprost the function -COOH is in the residue of formula (IV).

When the precursor has no free function -COOH, reactions to obtain it which are well known in the art are performed, for example by reaction of an esther or by oxidation of an alcohol.

The above substances may already exist as such (e.g.

Arbaprostil, Prostaglandin El, Rioprostil, as described above) For the precursors described in the literature, which have the carboxylic function substituted in various ways, in order to perform the synthesis according to the present invention it is preferable to start from the corresponding precursors in the acid form, i.e. bearing e free carboxylic group.

In particular, as preferred precursors one may mention Prostaglandin E1, Arbaprostil, Unoprostone, Trimoprostil, Prostaglandin F2a, Prostaglandin E2, Carboprost, Limaprost, Misoprostol, Gemeprost, Latanoprost, Ornoprostil, Beraprost, Enprostil, Rioprostil, Sulpostrone. These substances are prepared according to the methods described in "The Merck Index", Ed. 12, herein fully incorporated by reference.

The products of the present invention having the general formula A-X1-NO2 with the connecting bridge X1 as above defined, are obtainable by using the methods of the known art described, for example, in WO 92/01668 and wO 95/30641, herein fully incorporated by reference. In general, the connection between A and X1 is of the ester -C(O)O- type or amide -C(O)NH- or -C(O)N(R1c)- type, as defined in X of formula (II) above, and can be obtained by using known synthetic routes.

The most direct synthetic route includes reaction of acyl chlorides R-CO-Cl in halogen alcohols of the type HO-Y-Cl, HO-Y-Br, HO-Y-I, Y being X1 without oxygen, in experimental conditions which are part of the known art.

The reaction products of formula R-CO-O-Y-C1 (Br, I) can also be obtained by reaction of the sodium or potassium salts of said acids RCOOH with dihalogen derivatives of the general formula YC12, YBr2 or YI2.

The reaction products are converted into the final products by reaction with AgNO3, in acetonitrile, according to the known methods of literature.

The general scheme is as follows: R-CO-Cl + HO-Y-Br < R-CO-O-Y-Br + AgNO3 < A-X1NO2 where Xl = YO.

Another general scheme is as follows: R-CO-ONa + Br2Y < R-CO-O-Y-Br + AgNO3 < A-X1NO2 where X1 = YO.

In the case of amides, the synthetic sequence includes reaction of the same acyl chlorides RCOCl with aminoalcohols of the general formula: NH2-Y-OH, NHR1c -Y-OH to give amides of the general formula: R-CO-NH-Y-OH and R-CO-NR1C-Y-OH according to known methods.

The reaction of these amides with halogenating agents such as, for example, PCl5, PBr3, SOCl2, and others, leads to halogen derivatives of the general formula: R-CO-NH-Y-Br(Cl) and R-CO-NR1c-Y-Br(Cl).

By reaction with ARNO, in acetonitrile according to methods reported in the literature, are obtained the final products A-X1-NO2.

The sequence of the reaction can be schematised as follows: R-CO-NRlc-Y-Br + AgNO3 ---> R-CO-NRlc-Y-ONC2 where YO is X1.

An alternative route to formation of the esters is reaction of the sodium or potassium salts of the acids with the nitric esters of halogen alcohols of the general formula: NO2-O-Y-Cl(Br,l) to directly give the products of the invention.

The reaction scheme is as follows: where YO is X1.

According to a further process for the preparation of the compounds of the invention the acid derivatives RCOOH are reacted with alcohols containing in the molecule a group -ONO2 in the presence of aromatic sulphochlorides, in the presence of bases, such as trialkylamine, which neutralize the HCl released by the reaction.

Can also be used synthetic routes similar to those described above, where the di-halogen derivative Br2Y is reacted with -ONa. The reaction products are then converted into acetonitrile by reaction with AgNO3 according to the above shownreactions.

The general scheme is shown below In addition to being used in the treatment of male impotence as explained at the beginning, the products of the invention can also be used in the known therapeutic applications of drugs containing prostaglandins as the active ingredient, such as in the treatment of cerebrovascular and cardiovascular disorders, glaucoma, peptic ulcer and as abortifacients In particular, the derivatives of Prostaglandin B1 are preferred.

Following treatment of experimental animals with the new substances, no hypotension reactions nor the algogenic activity possessed by prostaglandins were observed. In fact, differently from PGE1 the new derivatives of the invention were inactive in pain-induction tests.

The examples below explain the purpose of the invention and should not be understood as a limitation of same.

Example 1 Synthesis of 2-nitroxyethyl ester of prostaglandin E1 19,1 mg (0,0539 mmoles) of PGE1 was dissolved in 0,7 ml of absolute acetone in a 5-ml flask. 11,5 mg(0,0604 mmol) of p-toluenesulphochloride, 12 mg(0,01188 mmoles) of triethylamine and 8 mg(0,0748 mmoles) of 2-nitroethanol were then added to the solution. The flask was closed and the reaction mixture was stirred for 22 hours at room temperature.

At the end the solvent was evaporated off under vacuum, the residue was treated with 3 ml of water and the mixture was extracted with ethyl acetate three times using 7 ml each time.

The pooled organic extracts were washed with 1 ml of water and then 1,5 ml of a saturated NaC1 solution. After drying over sodium sulphate, they were evaporated off to dryness under vacuum.

The oily residue which was obtained was dissolved in the lowest amount of dichloromethane and chromatographed using a small column packed with 4 g of silica gel (Silica Gel 60 A, 230-400 mesh). Dichloromethane was used as the initial eluant followed by a mixture of dichloromethane and ethyl acetate which was gradually enriched with the second component up to eluting with pure ethyl acetate. The column was then eluted with a mixture of ethylacetate/methanol, gradually enriched with methanol, up to using the pure alcohol. The fractions were analysed by TLC on silica gel (Silica Gel 60 F254), using the eluting mixture ethyl-acetate/acetic-acid 20/0,5. The test tubes containing the reaction product were those containing the eluates with pure ethyl acetate. Said eluates were joined together and the solvent was evaporated off to obtain 6 mg of a colourless oil (yield 25%) having an Rf in the above TLC elution system equal to 0,38. The 1H NMR spectrum (CD3OD) shows all signals corresponding to PGE1 (ppm) : 5,6 (m, 2H), 4- 4,2(m,2H), 2,6-2,8(quartet, 1H) , 2,0-2,4(m), 1,2-1,8(m).

Furthermore, two multiplets centred at 6 = 4,75(2H) and 6 = 4,4(2H) respectively, corresponding to the two methylene groups of 2-nitroethanol esterified with the carboxylic group of PGE1, were observed.

I.R. spectrum: 3382 cm1(OH) , 2858-2930 cm1 (-CH-, -CH2, - CH3-), 1774 cm~1(C = 0 ester), 1773 cm1(group C = o in a five atom ring), 1634 and 1280 cm-1(-O-NO2) 12,4 mg (65% of the starting amount) of unreacted PGE1 was recovered from the chromatographic fractions eluted with the ethylacetate/methanol mixture.

Pharmacological tests In the pharmacological tests, the products were administered to animals by local injection in a physiological solution.

The control groups were treated with a physiological solution.

Prostaglandin El, sodium nitroprusside and SIN-1, chemically defined as 3- (4-morpholinyl) sydnone imine, which is the active metabolite of molsidomine, were used as reference products.

Example 2 Relaxing effect in vitro on isolated human cavernosus artery and cavernosus corpus.

The method described by Hempelmann R.G. et al., European Journal of Pharmacology, 1995,276, 277-280, was followed using erectile tissues from patients subjected to surgery.

The cavernosus arteries were isolated and cleaned of the surrounding connective tissue. Segments about 2-mm long were obtained and mounted in a myograph.

After building a diameter/tension curve, the artery segments were adjusted to a diameter corresponding to 90W of that reached in the presence of a trasluminal pressure of 100 mmHg. After a stabilisation period of about 60 minutes, a contraction was induced by the addition of 3x10-6M adrenaline.

After 15 minutes, the test compounds were administered at a concentration of 10-6M and the per-cent relaxation induced by the administration of the test product was recorded for each.

The results are shown in Table 1.

Another set of experiments was conducted according to the same methodology, using isolated strips of cavernous tissue about 3x3x5 mm in size suspended isometrically, with application of a 5-10 mN tension in baths for isolated organs.

The results are shown in Table 2.

In both experimental models an inhibitory effect of the adrenalin-induced contraction following either treatment with PGE or administration of the nitric-acid-donor SIN-1 was found. The PGE1 derivative according to the present invention is shown in the tables by the abbreviation NO-PGE1.

This compound showed an effect superior to both native prostaglandin and SIN-1.

Table 1: Inhibitory effect of some derivatives on isolated human cavernosus artery pre-contracted with 3x10-6 M adrenalin (for each treatment group n = 5 replications) Treatment inhibition of contraction (%) 0-6M PGE1 19+4 106M SIN-1 36+7 10-6M NO-PGE1 41+9 Table 2: Inhibitory effect of some derivatives on isolated human cavernosus tissue pre-contracted with 3x10-6M adrenaline (for each treatment group n = 4) Treatment inhibition of contraction (%) 10-6M PGE 52+5 3x106M SIN-1 41+6 10-6M NO-PGE1 71+6 Example 3 Evaluation of induced erection activity and of hypotensive effect in rats.

The method described by Pineiro et al., European Urology 1993, 24, 492-499, was used. Male rats weighing about 350 g (5 animals/group) were anaesthetised with urethane and maintained at a temperature of 370C throughout the test. The cavernosus corpuses were exteriorized by perineal section. The right cavernosus corpus was connected to a pressure transducer using a heparinised catheter and the left one was connected using a PE-10 plastic tube to a syringe by which the products were administered.

The right carotide artery was cannulated and connected to a pressure transducer to measure the systemic blood pressure.

The products were administrated intracavernously at a volume of 0,03 ml at a 10-3M concentration and the intracavernous pressure and systemic blood pressure were monitored. The results given in Table 3 show that PGE1 was slightly active in this model, while sodium nitroprusside induced a remarkable erection activity. Both derivatives caused a drop in systemic blood pressure, which was particularly marked in the case of nitroprusside. NO-PGE1 showed an effect superior to both PGE1 and sodium nitroprusside on intracavernous pressure, while causing a non significant drop in systemic blood pressure, which was comparable to that of starting Prostaglandin, and was significantly lower than that of nitroprusside.

As a result, the products of the invention have been shown to possess a pharmacodynamic profile which is more favourable compared to the reference compounds.

Table 3 Effect of intracavernosus treatment of various derivatives on intracavernosus pressure (P) and systematic blood pressure (P) in anaesthetised rats (n=4) Treatment Increase in Drop in intracavernous systemic P P (cm H2O) 103M sodium nitroprusside 27+3,7 51+7,8 10-3M PGE1 0,7+0,4 18,2+2,2 103M NO-PGE1 36+1,4 9,1+3,1 Example 4 Induced erection activity in rabbits The method described by Stackl w. et al., Urological Research 1988, 455-458, was used. Male rabbits weighing about 2 Kg (n. 6 animals/group) were injected 1 ml of physiological solution containing 20jig of the test products into the right cavernosus corpus. During the injection, complete penis protrusion was observed, which was considered as 100W erection.

After injection, at pre-determined time intervals (0,5, 1,2 and 3 hours), the animals were observed for the presence of erection and evaluation of the relevant per-cent extent according to the following scheme: 0%=penis not visible 25%=glans visible 50%=penis protrusion equal to about half the complete lenght 75=penis protrusion not complete, but greater than half the lenght 100%=complete penis protrusion The results are given in Table 4 and show that the compound of the invention had a superior activity to that of the reference compound.

Table 4: Average per-cent values of extent of erection observed at different time intervals after intracavernosus administration of PGE1 derivatives in rabbits Treatement n 30 1 hour 2 hours 3 hours minutes Controls 4 6 0% 0% 0W w 20 jig 6 13W 4W 0% 0% NO-PGEl 6 92% 79% 67% 46% 20 yg EXAMPLE 5 Effect on painful response of the compound of the invention in rats The conventional method of Randall-Selitto modified as described by Duarte I.D. G. et al., European Journal of Pharmacology, 1990, 186, 289-293, was used to determine the potential activity on painful response of the compound. The test includes the application of a steady 20-mmHg pressure to a back paw of rats. Pressure application was discontinued when the animals appeared to react and the response latency time, which was the parameter used to evaluate the analgesic or hyperalgesic effect of the test product, was recorded.

Immediately after, the product was administered by the intradermal route in the subplantar area (administration volume 2,5 jil containing 0,1 jig of the test product). The test was repeated 3 hours later.

The results given in Table 5 show that PGE1 reduced the latency time, i.e. acted as a hyperalgesic agent. Sodium nitroprusside caused a slight nonsignificant increase in latency time. NO-PGE1 was inactive, thus showing that the NO group in the PGE1 molecule reduced the hyperalgesic property.

In the table, the column identified by an "n" shows the number of animals used for each treatment.

Table 5: Effect of the compound of invention and reference substances on modified Randal-Selitto test Product (jig/paw) n reaction time change (seconds) PGE1 (0,1) 8 -17+2 Sodium 8 +4+2 nitroprusside (5) NO-PGEl(0,1) 10 0 The derivatives were active in various tests useful to evaluate the potential pharmacological induced-erection activity versus reference compounds.

Unlike sodium nitroprusside, the invention compounds induced no hypotension at the pharmacologically active doses in the experimental impotency models.

The invention compounds showed no pain effects which could be found after the administration of PGE1 in experimental tests in rats.