Development and Regulation of Connected Combined Products: Reflections From the Medtech & Pharma Platform Association.

PURPOSE: Patients taking a medicinal product in a homecare setting typically use a medical device to facilitate the injection process. Reductions in wireless connectivity costs, combined with the rapid adoption of smartphones with connectivity to cloud-based services, are enabling these drug delivery devices to now be connected to a digital ecosystem as connected combined products (CCPs). The purposes of this article are to identify the challenges in developing and releasing these products when they straddle different regulatory frameworks and standards and to highlight gaps in the European Union regulations. METHODS: Industry subject matter experts from pharmaceutical, medical device, and consultancy companies, who are members of the Medtech & Pharma Platform Association, formed 4 working groups to address current best practice for developing and releasing CCPs and the different relevant regulatory frameworks. The 4 areas studied were clinical and regulatory, usability and human factors engineering, development and life cycle management, and cybersecurity. FINDINGS: Development teams require new skills to create innovative products that have a good safety profile and are simple to use, such as design thinking to understand user needs and systems engineering to manage complexity and ensure interoperability. Risk management process should integrate cybersecurity, data privacy, and data integrity, whereas design control processes should enable asynchronous development cycles for hardware and software components. Regulatory frameworks exist for individual components within the CCP. However, for a complex product, regulatory guidance is needed when combining components with different risk and safety profiles and to ensure that the responsibilities and liabilities of companies contributing components are clear. The efficient management of software changes and product updates, as well as dealing with end-of-life hardware and backward compatibility to older software versions, needs agile approaches when it comes to regulatory updates. IMPLICATIONS: The regulatory uncertainties and development processes outlined in this article need to be addressed. We call for joint discussions among the various stakeholders in the fields of medicinal products, medical devices, and in vitro diagnostics, as well as standalone software, data protection, and cybersecurity experts, together with regulators and lawmakers in the European Union to meet in focused discussion groups with the aim of devising pragmatic solutions and regulations for the benefit of the sector and hence the patients it serves.

Fluorinated 2-Arylcyclopropan-1-amines - A new class of sigma receptor ligands.

Stereoisomeric 2-aryl-2-fluoro-cyclopropan-1-amines have been discovered as a new class of σ receptor ligands showing different selectivity for the two subtypes of the receptor. Generally, compounds substituted in 4-position are much more active than corresponding 3-substituted isomers. trans-2-Fluoro-2-(4-methoxyphenyl)cyclopropan-1-amine (19a) was the most potent (Ki = 4.8 nM) σ1 receptor ligand, while cis-2-fluoro-2-(4-trifluoromethylphenyl)cyclopropan-1-amine (20b) was the most potent (Ki = 95 nM) σ2 receptor ligand.

Conformational preferences and basicities of monofluorinated cyclopropyl amines in comparison to cyclopropylamine and 2-fluoroethylamine.

Fluorine substituents in organic molecules do dramatically influence the electronic structure of neighbouring functional groups and the conformation of molecules. Hence the presence of fluorine in a compound changes its chemical reactivity and biological activity. On the basis of MP2 and SCS-MP2 calculations, we discuss the conformational preferences and basicity of the diastereoisomeric 2-fluorocyclopropylamines (cis-2 and trans-2) in comparison to those of cyclopropylamine (1) and 2-fluoroethylamine (3). 1 and 2 are viewed as model compounds for the antidepressant drug tranylcypromine (trans-2-phenylcyclopropylamine, 1a) and its fluorinated derivatives 2. The potential energy profile for the rotation of the amino group in cis-2 differs from that of trans-2 and 1 which have very similar rotational curves. For 2 the global minimum conformer is trans-2a and the lowest energy cis-conformer 2c is less stable by 2.57 kcal mol(-1). The calculated enthalpy differences between the conformers gauche-1b and s-trans-1a (2.0 kcal mol(-1)) as well as between gauche-3b and gauche-4a (0.2 kcal mol(-1)) agree well with the available experimental data of 2.0 kcal mol(-1) and 0.1 +/- 0.3 kcal mol(-1), respectively. The calculated gas phase proton affinities (PA) of 1 (217.6 kcal mol(-1)), cis-2c (215.6 kcal mol(-1)), and trans-2a (209.3 kcal mol(-1)) follow the trends of the pKa values measured in solution for the diastereomeric 2-phenylcyclopropylamines 1a and 1b and their fluorinated derivatives cis-2 and trans-2. It is shown that the conformational preferences and basicity of the investigated molecules are due to stereoelectronic effects from hyperconjugative interactions which lead to different local charge distributions and different hybridization of the nitrogen lone-pair. The basicity of gauche-3a (PA = 215.3 kcal mol(-1)) and anti-3b (PA = 210.1 kcal mol(-1)) is controlled by the charge of the nitrogen atom, while that of cis-2c and trans-2a is overlap controlled as a result of different hybridization of the nitrogen lone-pair [sp4.34 (cis-2c), sp4.07 (trans-2a)].

Fluorinated phenylcyclopropylamines. Part 5: Effects of electron-withdrawing or -donating aryl substituents on the inhibition of monoamine oxidases A and B by 2-aryl-2-fluoro-cyclopropylamines.

A series of racemic, diastereoisomeric aryl cyclopropylamines substituted with fluorine in the 2-position and electron-donating and electron-withdrawing groups on the aromatic ring have been prepared. These represent analogues of the classic MAO inhibitor tranylcypromine (trans-2-phenylcyclopropylamine, 1). Their activities as inhibitors of recombinant human liver monoamine oxidases A (MAO A) and B (MAO B) were determined. The trans-compounds were low micromolar inhibitors of both MAO A and MAO B with moderate MAO A selectivity while the less active cis-analogues were MAO B selective. In the trans-series, electron-withdrawing para-substituents increased the potency of MAO A inhibition while electron-donating groups such as methyl or methoxy had no influence on this activity. In contrast, aromatic ring substitution in the trans-series had essentially no effect on the inhibition of MAO B. The corresponding cis-compounds were shown to be 10-100 times less active against MAO A, while trans- and cis-compounds were quite similar in terms of inhibition of MAO B. The best MAO A/MAO B selectivity (7:1) in the trans-series was found for trans-2-fluoro-2-(para-trifluoromethylphenyl)cyclopropylamine (7d), while a 1:27 selectivity was found for cis-2-fluoro-2-(para-fluorophenyl)cyclopropylamine (10c). These results are discussed in connection with the pK(a) and logD values, the mechanism of action of tranylcypromines, and the geometry of the active site of the enzymes.

Fluorinated phenylcyclopropylamines. Part 6: Effects of electron withdrawing or donating aryl substituents on the inhibition of tyramine oxidase from Arthrobacter sp. by diastereomeric 2-aryl-2-fluoro-cyclopropylamines.

Diastereomeric arylcyclopropylamines substituted with fluorine in the 2-position and with electron donating or electron withdrawing groups at the aromatic ring were evaluated as inhibitors of microbial tyramine oxidase. The trans-isomers were consistently more potent inhibitors of the enzyme than the cis-isomers. Electron donating substituents increased the potency of tyramine oxidase inhibition, while electron withdrawing substituents decreased the activity. The results obtained are discussed in terms of pK(a) and log D values of the inhibitors as well as the mechanism of action of tranylcypromines and the geometry of the active site of the enzyme.