The present invention provides conformationally-defined macrocyclic
compounds that bind to and/or are functional modulators of the motilin
receptor including subtypes, isoforms and/or variants thereof. These
macrocyclic compounds, at a minimum, possess adequate pharmacological
properties to be useful as therapeutics for a range of disease
indications. In particular, these compounds are useful for treatment and
prevention of disorders characterized by hypermotilinemia and/or
gastrointestinal hypermotility, including, but not limited to, diarrhea,
cancer treatment-related diarrhea, cancer-induced diarrhea,
chemotherapy-induced diarrhea, radiation enteritis, radiation-induced
diarrhea, stress-induced diarrhea, chronic diarrhea, AIDS-related
diarrhea, C. difficile associated diarrhea, traveller's diarrhea,
diarrhea induced by graph versus host disease, other types of diarrhea,
dyspepsia, irritable bowel syndrome, chemotherapy-induced nausea and
vomiting (emesis) and post-operative nausea and vomiting and functional
gastrointestinal disorders. In addition, the compounds possess utility
for the treatment of diseases and disorders characterized by poor stomach
or intestinal absorption, such as short bowel syndrome, celiac disease
and cachexia. The compounds also have use for the treatment of
inflammatory diseases and disorders of the gastrointestinal tract, such
as inflammatory bowel disease, ulcerative colitis, Crohn's disease and
pancreatitis. Accordingly, methods of treating such disorders and
pharmaceutical compositions including compounds of the present invention
are also provided.