Patent Application
20200345746
The present invention relates to an oxazine derivative, and pharmaceutical compositions comprising such oxazine derivative, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease; and, in particular, where the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
Alzheimer's disease (AD) is one of the most prevalent neurological disorders worldwide and the most common and debilitating age-related condition, causing progressive amnesia, dementia, and ultimately global cognitive failure and death. Currently, the only pharmacological therapies available are symptomatic drugs such as cholinesterase inhibitors or other drugs used to control the secondary behavioral symptoms of AD. Investigational treatments targeting the AD pathogenic cascade include those intended to interfere with the production, accumulation, or toxic sequelae of amyloid-β (Aβ) species (Kramp V P, Herrling P, 2011). Strategies that target decreasing Aβ by: (1) enhancing the amyloid clearance with an active or passive immunotherapy against Aβ; (2) decreasing production through inhibition of Beta-site-APP cleaving enzyme-1 (BACE-1, an enzyme involved in the processing of the amyloid precursor protein [APP]), are of potential therapeutic value.
Based on animal data and limited benefits in recent clinical trials targeting dementia stages of the disease, there is a growing belief that the Aβ-lowering therapies might be most effective in preventing or slowing the progression of AD in the preclinical stages. This approach allows participants to be treated before, or in the very earliest stages of, symptoms and disease onset, prior to plateau of fibrillary Aβ, extensive appearance of tau (neurofibrillary) pathology and irreversible synaptic or neuronal loss.
The ε4 allele of the apolipoprotein E (ApoE4) gene is the main risk factor for Alzheimer's disease (AD). The APOE gene exists in three polymorphic alleles, ε2, ε3 and ε4, where ε3 is the most frequent. The APOE isoforms affect Aβ clearance, aggregation and deposition differently; ε2 seems to be protective whereas ε4 carriers have enhanced pathology and accelerated age-dependent cognitive decline (for review see Liu C C et al., 2013)).
Human ApoE is located on chromosome 19 (gene APOE, Uniprot P02649, gene codes for 317 amino acids, including a pro-peptide of 18 amino acids), the mature form is composed of 299 amino acids, and has 2 separate N-terminal and C-terminal domains joined by a flexible linker. While the N-terminal domain contains the binding domain for receptor binding (aa 136-150), the lipid binding domain (aa 240-260) is located in the C-terminal part. Three major isoforms (apoE2, -3 and -4) are known in humans, the allele frequency of ApoE3 (having Cys at position 112 and Arg at position at position 158) is approximately 50-90% in humans. ApoE2 (with Cys at positions 112 and 158) has an allele frequency of 1-5%, and ApoE4 (with Arg at positions 112 and 158) has an allele frequency of 5-35% in humans. ApoE3 and 4 bind to the LDL receptor with high affinity, while ApoE2 (due to the Cys-158) has only low affinity.
ApoE4 homozygotes are estimated to represent about 2 to 3% of the general population and are at much higher risk of developing symptoms of AD, with a mean age of 68 years at onset, than people with other APOE genotypes (Corder E H et al., 1993). By age 85, the lifetime risk of symptomatic AD may be as high as 51% for male homozygotes and 60-68% for female homozygotes. The corresponding percentage risks for 85 year old ApoE4 heterozygotes are 23% and 30% for males and females respectively carrying an ApoE3/4 genotypes and 20% and 27% for males and females respectively carrying an ApoE2/4 genotype (Genin E et al., 2011). It is proposed that the presence of the ApoE4 gene enhances the risk for AD by affecting Aβ clearance, aggregation, and deposition (Liu C C et al., 2013). It is expected that the presence of brain amyloid pathology in ApoE4 heterozygotes significantly increases the risk of developing clinical symptoms of AD comparable to homozygotes.
The compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, referred to herein as “Compound 1”, is an orally active BACE inhibitor, previously described in WO 2012/095469 A1, with an approximately 3-fold selectivity for BACE-1 over BACE-2 and no relevant off-target binding or activity.
Given the high rate of setback and disappointment in the field to date (Cummings J L et al., 2014), there is a high degree of uncertainty as to whether any experimental disease-modifying AD therapy will prove effective in at-risk patients. However, the high degree of effectiveness demonstrated herein by Compound 1 in: (i) lowering Aβ levels in ApoE4 transgenic mice and human ApoE4 carriers, in the absence of undesirable side effects, for example hair discolouration; (ii) reducing amyloid-β deposition in the APP23 mouse model; and, especially, (iii) in raising the ratio of Aβ42/Aβ40 in cerebrospinal fluid, indicative of an effect on the underlying AD pathology; strongly suggests that Compound 1 will be effective in the prevention of AD in a patient at risk of developing clinical symptoms of AD, and in particular, those patients carrying one or two copies of the ApoE4 allele.
A Phase II/III clinical trial is described herein which has been designed to demonstrate the effectiveness of Compound 1 in the prevention of AD in cognitively unimpaired ApoE4 homozygote patients or cognitively unimpaired, amyloid positive, ApoE4 heterozygote patients. Based on current knowledge, the findings from this proposed clinical trial and the results described herein may be generalised and applicable to AD in at-risk patients beyond ApoE4 homozygotes and heterozygotes (for example in patients carrying mutations in the genes for amyloid precursor protein (APP), presenilin-1 and -2 (O'Brien R J, Wong P C, 2011) or in Down Syndrome patients (Head E et al., 2012)) since a BACE inhibitor therapy would be expected to reduce and/or prevent amyloid plaque accumulation independent of the multiple potential causes of amyloid deposition.
In a first aspect of the invention, there is therefore provided the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
In a second aspect of the invention, there is provided a pharmaceutical composition comprising N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
In a third aspect of the invention, there is provided a method for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease which method comprises administering to such patient a therapeutically effective amount of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof.
In a fourth aspect of the invention, there is provided a method for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease which method comprises administering to such patient a pharmaceutical composition comprising a therapeutically effective amount of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof.
In a fifth aspect of the invention, there is provided the use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
In a sixth aspect of the invention, there is provided the use of a pharmaceutical composition comprising the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
In a seventh aspect of the invention, there is provided the use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
SEM. Comparison was performed with Dunnett's multiple comparison test.
Various Embodiments of the present invention are herein described.
The compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A1, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease or has Down syndrome.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A2, wherein the patient carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease and the genetic predisposition is:
(i) a mutation in the gene for amyloid precursor protein, presenilin-1 or presenilin-2; or
(ii) the presence of one or two copies of the ApoE4 allele.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A3, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A4, wherein the patient carries one copy of the ApoE4 allele.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A4, wherein the patient carries two copies of the ApoE4 allele.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A6, wherein the patient is amyloid-positive.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A7, wherein the amyloid-positivity is determined by PET or CSF measurement.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A3 to A8, wherein the patient is between 60 and 75 years of age.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a daily dose which results in at least a 70% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
Embodiment A11: The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a daily dose which results in at least a 50% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a dose of between 10 and 30 mg per day.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a dose of between 30 and 50 mg per day.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a dose of 15 mg per day.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a dose of 50 mg per day.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 70 and 170 ng/ml.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 200 and 500 ng/ml.
The compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
The compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele, and wherein the compound is used at a dose of 15 or 50 mg per day.
The compound for the use according to any one of Embodiments A1 to A19, wherein the compound is in free form.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A20, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to any one of Embodiments A1 to A20, wherein the patient is not simultaneously treated with a CYP3A4 inhibitor or inducer for a period longer than three months.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A21 or A22, wherein the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4.
The compound, or a pharmaceutically acceptable salt thereof, for the use according to Embodiment A23, wherein the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4.
A pharmaceutical composition comprising the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of
Alzheimer's disease.
The pharmaceutical composition for the use according to Embodiment B1, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease or has Down syndrome.
The pharmaceutical composition for the use according to Embodiment B2, wherein the patient carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease and the genetic predisposition is:
(i) a mutation in the gene for amyloid precursor protein, presenilin-1 or presenilin-2; or
(ii) the presence of one or two copies of the ApoE4 allele.
The pharmaceutical composition for the use according to Embodiment B3, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
The pharmaceutical composition for the use according to Embodiment B4, wherein the patient carries one copy of the ApoE4 allele.
The pharmaceutical composition for the use according to Embodiment B4, wherein the patient carries two copies of the ApoE4 allele.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B6, wherein the patient is amyloid-positive.
The pharmaceutical composition for the use according to Embodiment B7, wherein the amyloid-positivity is determined by PET or CSF measurement.
The pharmaceutical composition for the use according to any one of Embodiments B3 to B8, wherein the patient is between 60 and 75 years of age.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a daily dose which results in at least a 70% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a daily dose which results in at least a 50% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a dose of between 10 and 30 mg per day.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a dose of between 30 and 50 mg per day.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a dose of 15 mg per day.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a dose of 50 mg per day.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 70 and 170 ng/ml.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 200 and 500 ng/ml.
A pharmaceutical composition comprising the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
A pharmaceutical composition comprising the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele, and wherein the compound is used at a dose of 15 or 50 mg per day.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B19, wherein the compound is in free form.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B20, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4.
The pharmaceutical composition for the use according to any one of Embodiments B1 to B20, wherein the patient is not simultaneously treated with a CYP3A4 inhibitor or inducer for a period longer than three months.
The pharmaceutical composition for the use according to Embodiment B21 or B22, wherein the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4.
The pharmaceutical composition for the use according to Embodiment B23, wherein the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4.
A method for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease which method comprises administering to such patient a therapeutically effective amount of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof.
The method according to Embodiment C1, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease or has Down syndrome.
The method according to Embodiment C2, wherein the patient carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease and the genetic predisposition is:
(i) a mutation in the gene for amyloid precursor protein, presenilin-1 or presenilin-2; or
(ii) the presence of one or two copies of the ApoE4 allele.
The method according to Embodiment C3, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
The method according to Embodiment C4, wherein the patient carries one copy of the ApoE4 allele.
The method according to Embodiment C4, wherein the patient carries two copies of the ApoE4 allele.
The method according to any one of Embodiments C1 to C6, wherein the patient is amyloid-positive.
The method according to Embodiment C7, wherein the amyloid-positivity is determined by PET or CSF measurement.
The method according to any one of Embodiments C3 to C8, wherein the patient is over 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74 or 75 years of age.
The method according to any one of Embodiments C3 to C8, wherein the patient is between 60 and 75 years of age.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in at least 10, 20, 30, 40, 50, 60, 70 or 80% lowering of Aβ 1-40 in CSF, blood, or plasma, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in at least a 70% lowering of Aβ 1-40 in CSF, blood, or plasma, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in at least a 50% lowering of Aβ 1-40 in CSF, blood, or plasma, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in a lowering of Aβ 1-40 in CSF, blood or plasma, in the range of 10, 20, 30, 40, 50, 60, 70 or 80% to 99, 97, 95, 93, 90, 87, 85, 80, 75, 70, 65, 60, 55, or 50%, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in a lowering of Aβ 1-40 in CSF, blood or plasma, in the range of 40 to 70%, 45 to 65%, or 50 to 60%, or of at least 50% in at least 80, 85, 90, 93, 95, 97, or 99% of the patients or in 80, 85, or 90 to 99, 97, 95, or 93% of the patients.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in a lowering of Aβ 1-40 in CSF, blood or plasma, in the range of 65 to 95%, 75 to 90%, or 80 to 90%, or of at least 80% in at least 80, 85, 90, 93, 95, 97, or 99% of the patients or in 80, 85, or 90 to 99, 97, 95, or 93% of the patients.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a dose of between 5 and 10; 10 and 15; 15 and 20; 20 and 25; 25 and 30; 30 and 35; 35 and 40; 45 and 50; 50 and 55 mg; 55 and 60 mg; 60 and 100 mg; 100 and 200; 200 and 300 mg; 15 and 85 mg; 50 and 85 mg; 15 and 300 mg; or 50 and 300 mg per day.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a dose of between 10 and 30 mg per day.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a dose of between 30 and 50 mg per day.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a dose of 15 mg per day.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a dose of 50 mg per day.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 0 and 50; 50 and 100; 100 and 150; 150 and 200; 200 and 250; 250 and 300; 300 and 350; 350 and 400; 400 and 450; 450 and 500; 500 and 550; 550 and 600; 600 and 650; or 650 and 700 ng/ml.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 70 and 170 ng/ml.
The method according to any one of Embodiments C1 to C10, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 200 and 500 ng/ml.
A method for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease which method comprises administering to such patient a therapeutically effective amount of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
A method for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease which method comprises administering to such patient a therapeutically effective amount of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele, and wherein the compound is used at a dose of 15 or 50 mg per day.
The method according to any one of Embodiments C1 to C26, wherein the compound is in free form.
The method according to any one of Embodiments C1 to C27 wherein Compound 1 is comprised within a pharmaceutical composition.
The method according to any one of Embodiments C1 to C28, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4.
The method according to any one of Embodiments C1 to C28, wherein the patient is not simultaneously treated with a CYP3A4 inhibitor or inducer for a period longer than three months.
The method according to Embodiment C29 or C30, wherein the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4.
The method according to Embodiment C31, wherein the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4.
Use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
The use according to Embodiment D1, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease or has Down syndrome.
The use according to Embodiment D2, wherein the patient carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease and the genetic predisposition is:
(i) a mutation in the gene for amyloid precursor protein, presenilin-1 or presenilin-2; or
(ii) the presence of one or two copies of the ApoE4 allele.
The use according to Embodiment D3, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
The use according to Embodiment D4, wherein the patient carries one copy of the ApoE4 allele.
The use according to Embodiment D4, wherein the patient carries two copies of the ApoE4 allele.
The use according to any one of Embodiments D1 to D6, wherein the patient is amyloid-positive.
The use according to Embodiment D7, wherein the amyloid-positivity is determined by PET or CSF measurement.
The use according to any one of Embodiments D3 to D8, wherein the patient is between 60 and 75 years of age.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a daily dose which results in at least a 70% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a daily dose which results in at least a 50% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a dose of between 10 and 30 mg per day.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a dose of between 30 and 50 mg per day.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a dose of 15 mg per day.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a dose of 50 mg per day.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 70 and 170 ng/ml.
The use according to any one of Embodiments D1 to D9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 200 and 500 ng/ml.
Use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
Use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele, and wherein the compound is used at a dose of 15 or 50 mg per day.
The use according to any one of Embodiments D1 to D19, wherein the compound is in free form.
The use according to any one of Embodiments D1 to D20, wherein the compound is comprised within a pharmaceutical composition.
The use according to any one of Embodiments D1 to D21, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4.
The use according to any one of Embodiments D1 to D21, wherein the patient is not simultaneously treated with a CYP3A4 inhibitor or inducer for a period longer than three months.
The use according to Embodiment D22 or D23, wherein the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4.
The use according to Embodiment D24, wherein the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4.
Use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease.
The use according to Embodiment E1, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease or has Down syndrome.
The use according to Embodiment E2, wherein the patient carries a genetic predisposition for the development of the clinical symptoms of Alzheimer's disease and the genetic predisposition is:
(i) a mutation in the gene for amyloid precursor protein, presenilin-1 or presenilin-2; or
(ii) the presence of one or two copies of the ApoE4 allele.
The use according to Embodiment E3, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
The use according to Embodiment E4, wherein the patient carries one copy of the ApoE4 allele.
The use according to Embodiment E4, wherein the patient carries two copies of the ApoE4 allele.
The use according to any one of Embodiments E1 to E6, wherein the patient is amyloid-positive.
The use according to Embodiment E7, wherein the amyloid-positivity is determined by PET or CSF measurement.
The use according to any one of Embodiments E3 to E8, wherein the patient is between 60 and 75 years of age.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a daily dose which results in at least a 70% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a daily dose which results in at least a 50% lowering of Aβ 1-40 in CSF following two weeks of compound exposure.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a dose of between 10 and 30 mg per day.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a dose of between 30 and 50 mg per day.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a dose of 15 mg per day.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a dose of 50 mg per day.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 70 and 170 ng/ml.
The use according to any one of Embodiments E1 to E9, wherein the compound is used at a daily dose which results in a plasma steady state Cmax value of between 200 and 500 ng/ml.
Use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele.
Use of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the prevention of Alzheimer's disease in a patient at risk of developing clinical symptoms of Alzheimer's disease, wherein the patient at risk of developing clinical symptoms of Alzheimer's disease carries one or two copies of the ApoE4 allele, and wherein the compound is used at a dose of 15 or 50 mg per day.
The use according to any one of Embodiments E1 to E19, wherein the compound is in free form.
The use according to any one of Embodiments E1 to E20, wherein the medicament is a pharmaceutical composition.
The use according to any one of Embodiments E1 to E21, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4.
The use according to any one of Embodiments E1 to E21, wherein the patient is not simultaneously treated with a CYP3A4 inhibitor or inducer for a period longer than three months.
The use according to Embodiment E22 or E23, wherein the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4.
The use according to Embodiment E24, wherein the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4.
In a further invention, there is provided a method for the treatment or prevention of Alzheimer's disease which method comprises administering to a patient in need thereof a therapeutically effective amount of the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4. In one embodiment, the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4 for a period longer than three months. In one embodiment, the patient is simultaneously treated with a CYP3A4 inhibitor or inducer for a period no longer than three months. In one embodiment, the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4. In one embodiment, the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4. In one embodiment, the patient is over 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74 or 75 years of age. In one embodiment, the patient is between 60 and 75 years of age. In one embodiment, the compound is used at a daily dose which results in at least 10, 20, 30, 40, 50, 60, 70 or 80% lowering of Aβ 1-40 in CSF, blood, or plasma, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure. In one embodiment, the compound is used at a daily dose which results in at least a 70% lowering of Aβ 1-40 in CSF, blood, or plasma, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure. In one embodiment, the compound is used at a daily dose which results in at least a 50% lowering of Aβ 1-40 in CSF, blood, or plasma, following 2, 13, 26, 52, 78, 104, 130, 156, 182, 208, 234, 260, 286, 312, 338, 332, 390, or 416 weeks of compound exposure. In one embodiment, the compound is used at a dose of between 5 and 10; 10 and 15; 15 and 20; 20 and 25; 25 and 30; 30 and 35; 35 and 40; 45 and 50; 50 and 55 mg; 55 and 60 mg; 60 and 100 mg; 100 and 200; 200 and 300 mg; 15 and 85 mg; 50 and 85 mg; 15 and 300 mg; or 50 and 300 mg per day. In one embodiment, the compound is used at a dose of between 10 and 30 mg per day. In one embodiment, the compound is used at a dose of between 30 and 50 mg per day. In one embodiment, the compound is used at a dose of 15 mg per day. In one embodiment, the compound is used at a dose of 50 mg per day. In one embodiment, the compound is used at a daily dose which results in a plasma steady state Cmax value of between 0 and 50; 50 and 100; 100 and 150; 150 and 200; 200 and 250; 250 and 300; 300 and 350; 350 and 400; 400 and 450; 450 and 500; 500 and 550; 550 and 600; 600 and 650; or 650 and 700 ng/ml. In one embodiment, the compound is used at a daily dose which results in a plasma steady state Cmax value of between 70 and 170 ng/ml. In one embodiment, the compound is used at a daily dose which results in a plasma steady state Cmax value of between 200 and 500 ng/ml. In a further embodiment, the compound is used in free form.
In a further invention, there is provided the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyrid in-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use as a medicament, wherein the patient treated with the medicament is not simultaneously treated with an inhibitor or inducer of CYP3A4. In another aspect of the further invention, there is provided the compound N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide, or a pharmaceutically acceptable salt thereof, for use in the treatment or prevention of Alzheimer's disease, wherein the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4. In one embodiment of this further invention, the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4 for a period longer than three months. In one embodiment of this further invention, the patient is simultaneously treated with a CYP3A4 inhibitor or inducer for a period no longer than three months. In a further embodiment, the CYP3A4 inhibitor is a strong, moderate, or weak inhibitor of CYP3A4; and the CYP3A4 inducer is a strong, moderate, or weak inducer of CYP3A4. In a further embodiment, the CYP3A4 inhibitor is a strong inhibitor of CYP3A4; and the CYP3A4 inducer is a strong inducer of CYP3A4. In a further embodiment, the compound is used at a dose of 15 or 50 mg per day. In a further embodiment, the compound is used in free form. In another embodiment, the compound is comprised within a pharmaceutical composition.
As used herein, the term “Compound 1” or “Cmpd 1” refers to N-(6-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-5-fluoropyridin-2-yl)-3-chloro-5-(trifluoromethyl)picolinamide and having the following structural formula:
In Example 1, using an alternative chemical naming format, “Compound 1” is also referred to as 3-chloro-5-trifluoromethyl-pyridine-2-carboxylic acid [6-((3R,6R)-5-amino-3,6-dimethyl-6-trifluoromethyl-3,6-dihydro-2H-[1,4]oxazin-3-yl)-5-fluoro-pyridin-2-yl]-amide.
The terms “Compound 1”, “Cmpd 1” and its corresponding full chemical name are used interchangeably throughout the description of the invention. It is intended that the term refers to the compound in either free form or pharmaceutically acceptable salt form, unless the context clearly indicates that only one form of the compound is intended. Compound 1 is described in WO 2012/095469 A1, Example 34. WO 2012/095469 A1 is incorporated herewith by reference in its entirety, in particular the disclosure related to the synthesis of Example 34.
As used herein, the term “Alzheimer's disease” or “AD” encompasses both preclinical and clinical Alzheimer's disease unless the context makes clear that either only preclinical Alzheimer's disease or only clinical Alzheimer's disease is intended.
As used herein, the term “clinical Alzheimer's disease” or “clinical AD” encompasses both Mild Cognitive Impairment (MCI) due to AD and dementia due to AD, unless the context makes clear that either only MCI due to AD or dementia due to AD is intended.
As used herein, the term “preclinical Alzheimer's disease” or “preclinical AD” refers to the presence of in vivo molecular biomarkers of AD in the absence of clinical symptoms. The National Institute on Aging and Alzheimer's Association provide a scheme, shown in Table 1 below, which sets out the different stages of preclinical AD (Sperling et al., 2011).
As used herein, the term “prevention of Alzheimer's disease” refers to the prophylactic treatment of AD; or delaying the onset or progression of AD. For example, the onset or progression of AD is delayed for at least 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 years. In one embodiment, “prevention of Alzheimer's disease” refers to the prophylactic treatment of preclinical AD; or delaying the onset or progression of preclinical AD. In a further embodiment, the onset or progression of preclinical AD is delayed for at least 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 years. In another embodiment, “prevention of Alzheimer's disease” refers to the prophylactic treatment of clinical AD; or delaying the onset or progression of clinical AD. In a further embodiment, the onset or progression of clinical AD is delayed for at least 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 years.
Delay in the onset or progression of preclinical AD may be assessed by measuring in vivo molecular biomarkers relative to an initial baseline value, for example, by measuring:
Delay in the onset or progression of preclinical AD may also be assessed relative to an initial baseline value using a sensitive cognitive measure to track changes in the preclinical stages of the disease, for example, using the Alzheimer's Prevention Initiative (API) preclinical composite cognitive (APCC) test battery. The APCC was developed as a sensitive tool to detect and track cognitive decline in individuals at risk to progress to the clinical stages of late onset AD (LOAD) (Langbaum J B et al., 2014).
Delay in the onset of clinical AD may be assessed by measuring a delay in cognitive and functional impairment due to AD, for example, by measuring a delay in the time to clinical diagnosis of Mild Cognitive Impairment (MCI) due to AD and/or dementia due to AD. The core clinical diagnostic criteria proposed by the National Institute on Aging—Alzheimer's Association Working Group may, for example, be used for the diagnosis of MCI (Albert M S et al., 2011) or dementia (McKhann G M et al., 2011). The European Medicines Agency (EMA) in its “Draft guidelines on the clinical investigation of medicines for the treatment of AD and other dementias” (EMA/Committee for Medicinal Products for Human Use (CHMP)/539931/2014) summarises the National Institute on Aging criteria for the diagnosis of MCI due to AD and AD dementia as set out below.
Diagnosis of MCI due to AD requires evidence of intra-individual decline, manifested by:
Diagnosis of AD dementia requires:
Cognitive impairment and decline in the diagnosis of MCI due to AD and AD dementia may be measured using a sensitive cognitive measure to track changes in the clinical stages of the disease, for example, using:
Suitable Aβ biomarkers for use in the diagnosis of MCI due to AD and AD dementia include, for example, CSF Aβ 1-40, Aβ 1-42 or PET imaging of beta amyloid neuritic plaques in the brain, as described above.
Suitable degeneration biomarkers for use in the diagnosis of MCI due to AD and AD dementia are described above in relation to the in vivo molecular biomarkers used to assess delay in the onset or progression of preclinical AD and include, for example, an effect on the underlying tau pathology; an effect on neuronal glucose metabolism; or a slower decline in brain volume loss.
As used herein, the term “patient” refers to a human subject.
As used herein, the term “patient at risk of developing clinical symptoms of Alzheimer's disease” refers to:
As used herein, the term “amyloid-positive” refers to a patient who has detectable levels of accumulated Aβ in the brain. In one embodiment, a patient is “amyloid-positive” if the patient has detectable levels of accumulated Aβ in the brain based on an assessment of Aβ in the CSF or amyloid PET imaging, or both. As used herein, the term “amyloid-positivity determined by PET” refers to an increased level of amyloid PET tracer retention compared to background. Suitable PET tracers for the measurement of amyloid-positivity include 18F-florbetapir (Palmqvist S et al., 2015), 18F-florbetaben (NeuraCeq) and 18F-flutemetamol (Vizamyl). For example, an SUVR of 1.1 or higher on a brain 18F-florbetapir PET scan (260 MBq for each scan) may be used as an amyloid-positivity diagnostic threshold (Schreiber S et al., 2015). An SUVR of 1.2 or 1.3 could also be used as a threshold value.
As used herein, the term “amyloid-positivity determined by CSF measurement” refers to a reduced CSF Aβ 1-42 value compared to that observed in a healthy control group. For example, amyloid-positivity may be determined by an Aβ 1-42 value of 192 ng/L or less in CSF (Mattsson N et al., 2015). However, the CSF Aβ 1-42 cut-off value used to determine amyloid-positivity will vary depending on the particular technique used (Forlenza O V et al., 2015). Amyloid positivity may also be determined by an Aβ 1-42/Aβ 1-40 ratio of less than 0.09 in CSF (Janelidze S et al., 2016). In one embodiment, the Aβ 1-42/Aβ 1-40 or Aβ42/Aβ40 ratio is less than 0.20, 0.15, 0.10, 0.09, 0.08, 0.07, 0.06 or 0.05 or between 0.20 and 0.01, 0.15 and 0.01, 0.10 and 0.01, or 0.05 and 0.01. Aβ 1-40 and Aβ 1-42 values may be measured using standard immunoassay techniques, for example using a monoclonal single antibody sandwich enzyme-linked immunosorbent (ELISA) assay on the Luminex platform (Herskovitz A Z et al., 2013) or the Meso Scale Discovery (MSD) 96-well MULTI-ARRAY human/rodent (6E10) Aβ40 and 42 sandwich immunoassays (Meso Scale Discovery, Rockville, Md., USA).
As used herein, the term “CYP3A4” refers to Cytochrome P450 3A4. CYP3A4 is an enzyme which plays a major role in the metabolism of a large variety of drugs (Luo G et al., 2004).
As used herein, the term “inducer of CYP3A4” refers to a drug which causes CYP3A4 activity levels to increase. Examples of CYP3A4 inducers include, but are not limited to, carbamazepine, phenytoin, rifampicin, and St John's wort. Techniques suitable for the measurement of CYP3A4 activity are well known (see, for example, Sevrioukova I F and Poulos T L, 2015). “Strong”, “moderate”, and “weak” inducers of CYP3A4 are drugs that decrease the plasma area under the curve (AUC) of Compound 1 (calculated as the area under the curve from 0 to infinity (AUCinf)) by ≥80%, ≥50% to <80%, and ≥20% to <50%, respectively. In one embodiment, the “inducer of CYP3A4” is a “strong inducer of CYP3A4.” Examples of strong inducers of CYP3A include, but are not limited to, carbamazepine, enzalutamide, mitotane, phenytoin, rifampin (also known as rifampicin), and St. John's wort. Examples of moderate inducers of CYP3A include, but are not limited to, bosentan, efavirenz, etravirine, and modafinil, Examples of weak inducers of CYP3A include, but are not limited to, armodafinil and rufinamide. See http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Drug InteractionsLabeling/ucm093664.htm#table3-3 (last visited Oct. 11, 2016).
As used herein, the term “inhibitor of CYP3A4” refers to a drug which causes CYP3A4 activity levels to decrease. Techniques suitable for the measurement of CYP3A4 activity are well known (see, for example, Sevrioukova I F and Poulos T L, 2015). Examples of CYP3A4 inhibitors include, but are not limited to, clarithromycin, grapefruit juice, and itraconazole. “Strong”, “moderate”, and “weak” inhibitors of CYP3A4 are drugs that increase the plasma AUC of Compound 1 (calculated as the area under the curve from 0 to infinity (AUCinf)) fold, to <5-fold, and 1.25 to <2-fold, respectively. In one embodiment the “inhibitor of CYP3A4” is a “strong inhibitor of CYP3A4.” Examples of strong inhibitors of CYP3A include, but are not limited to, boceprevir, cobicistat, conivaptan, danoprevir and ritonavir, elvitegravir and ritonavir, grapefruit juice, indinavir and ritonavir, itraconazole, ketoconazole, lopinavir and ritonavir, paritaprevir and ritonavir and (ombitasvir and/or dasabuvir), posaconazole, ritonavir, saquinavir and ritonavir, telaprevir, tipranavir and ritonavir, troleandomycin, voriconazole, clarithromycin, diltiazem, idelalisib, nefazodone, and nelfinavir. Examples of moderate inhibitors of CYP3A include, but are not limited to, aprepitant, cimetidine, ciprofloxacin, clotrimazole, crizotinib, cyclosporine, dronedarone, erythromycin, fluconazole, fluvoxamine, imatinib, tofisopam, and verapamil. Examples of weak inhibitors of CYP3A include, but are not limited to, chlorzoxazone, cilostazol, fosaprepitant, istradefylline, ivacaftor, lomitapide, ranitidine, ranolazine, tacrolimus, and ticagrelor. See http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm093664.htm#table3-2 (last visited Oct. 11, 2016).
As used herein, term “simultaneously treated with an inhibitor or inducer of CYP3A4” refers to a situation where a patient is subjected to a therapeutic regimen with an inhibitor or inducer of CYP3A4 while also subjected to a therapeutic regimen with Compound 1. In one embodiment, the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4 and Compound 1 for longer than 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 or 16 weeks. In another embodiment, the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4 and Compound 1 for longer than 1, 2, 3, 4, 5, 7, 10, or 12 months. In a certain embodiment, the patient is not simultaneously treated with an inhibitor or inducer of CYP3A4 and Compound 1 for longer than 3 months.
As used herein, the term “pharmaceutically acceptable salt” refers to salts that retain the biological effectiveness of the compound of this invention and which typically are not biologically or otherwise undesirable (Pharmaceutical Salts: Properties, Selection, and Use, 2nd Revised Edition (2011) P. Heinrich Stahl, Camille G. Wermuth).
As used herein, a “pharmaceutical composition” comprises the compound of this invention, or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable carrier, in a solid form (typically a gelatin capsule) suitable for oral administration. An example of a pharmaceutical composition suitable for use in the prevention of AD in patients at risk of developing clinical symptoms of AD, and its method of preparation, is provided herein in Example 11.
The term “a therapeutically effective amount” of a compound of the present invention refers to an amount of the compound of the present invention that will elicit inhibition of BACE-1 in a patient as evidenced by a reduction in CSF or plasma Aβ 1-40 levels relative to an initial baseline value.
For clarification, whenever a range is provided herein, said range is meant to include the endpoints. For example, a dose range between 30 and 50 mg per day comprises also doses of 30 and 50 mg per day.
The following Examples illustrate how Compound 1 may be prepared (Example 1) and formulated (Example 11); demonstrate that Compound 1 is effective in reducing Aβ levels in wild type mice in the absence of an undesirable hair discolouration side effect observed with comparator compound NB-360 (Example 2); show the PK/PD effects of Compound 1 in an APOE4 transgenic mouse model (Example 3); show the PD effects of Compound 1 in a First in human clinical study (Example 4); demonstrate the safety and tolerability of Compound 1 in a 3-month clinical study (Example 5); show the effect of ApoE4 genotype on Compound 1 PD response in the 3-month clinical study (Example 6); demonstrate the therapeutic effectiveness of Compound 1 in reducing amyloid plaque number and area in the APP23 AD mouse model (Example 7); illustrate how a Compound efficacy study could be performed in ApoE4 homozygote at-risk patients (Example 8); show how the AUC of Compound 1 is affected when given in combination with a strong inhibitor or inducer of CYP3A4 (Example 9); and demonstrate how treatment with Compound 1 affects the underlying AD pathology in both ApoE4 carrier and non-carrier patients (Example 10).
The preparation of Compound 1 is described in WO 2012/095469 A1 (Example 34). Compound 1 may also be prepared as described below.
NMR Methodology
Proton spectra are recorded on a Bruker 400 MHz ultrashield spectrometer unless otherwise noted. Chemical shifts are reported in ppm relative to methanol (δ 3.31), dimethyl sulfoxide (δ 2.50), or chloroform (δ 7.29). A small amount of the dry sample (2-5 mg) is dissolved in an appropriate deuterated solvent (0.7 mL). The shimming is automated and the spectra obtained in accordance with procedures well known to the person of ordinary skill in the art.
General Chromatography Information
HPLC Method H1 (RtH1):
LCMS Method H2 (RtH2):
UPLCMS Method H3 (RtH3):
LCMS Method H4 (RtH4):
LCMS Method H5 (RtH5):
LCMS Method H6 (RtH6):
a) 2-Bromo-5-fluoro-4-triethylsilanyl-pyridine
A solution of diisopropylamine (25.3 g, 250 mmol) in 370 ml THF was cooled with a dry-ice acetone bath at −75° C. BuLi (100 ml, 250 mmol, 2.5 M in hexanes) was added dropwise while maintaining the temperature below −50° C. After the temperature of the mixture had reached −75° C. again, a solution of 2-bromo-5-fluoropyridine (36.7 g, 208 mmol) in 45 ml THF was added dropwise. The mixture was stirred for 1 h at −75° C. Triethylchlorosilane (39.2 g, 260 mmol) was added quickly. The temperature stayed below −50° C. The cooling bath was removed and the reaction mixture was allowed to warm to −15° C., poured onto aq. NH4Cl (10%). TBME was added and the layers were separated. The organic layer was washed with brine, dried with MgSO4.H2O, filtered and evaporated to give a brown liquid which was distilled at 0.5 mm Hg to yield the title compound as a slightly yellow liquid (b.p. 105-111° C.). HPLC: RtH4=2.284 min; ESIMS: 290, 292 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 8.14 (s, 1H), 7.40 (d, 1H), 1.00-0.82 (m, 15H).
b) 1-(6-Bromo-3-fluoro-4-triethylsilanyl-pyridin-2-yl)-ethanone
A solution of diisopropylamine (25.4 g, 250 mmol) in 500 ml THF was cooled to −75° C. BuLi (100 ml, 250 mmol, 2.5 M in hexanes) was added dropwise while maintaining the temperature below −50° C. After the reaction temperature had reached −75° C. again, a solution of 2-bromo-5-fluoro-4-triethylsilanyl-pyridine (56.04 g, 193 mmol) in 60 ml THF was added dropwise. The mixture was stirred in a dry ice bath for 70 minutes. N,N-dimethylacetamide (21.87 g, 250 mmol) was added quickly, the reaction temperature rose to −57° C. The reaction mixture was stirred in a dry ice bath for 15 min and then allowed to warm to −40° C. It was poured on a mixture of 2M aq. HCl (250 ml, 500 mmol), 250 ml water and 100 ml brine. The mixture was extracted with TBME, washed with brine, dried over MgSO4.H2O, filtered and evaporated to give a yellow oil which was purified on a silica gel column by eluting with hexane/0-5% TBME to yield 58.5 g of the title compound as a yellow liquid. TLC (Hex/TBME 99/1): Rf=0.25; HPLC: RtH4=1.921 min; ESIMS: 332, 334 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 7.57 (d, 1H), 2.68 (s, 3H), 1.00-0.84 (m, 15H).
c) (S)-2-(6-Bromo-3-fluoro-4-triethylsilanyl-pyridin-2-yl)-2-trimethylsilanyloxy-propionitrile
At first, the catalyst solution was prepared by dissolving water (54 mg, 3.00 mmol) in 100 ml dry DCM (≤0.001% water). This wet DCM (44 ml, 1.32 mmol water content) was added to a well stirred solution of titanium(IV) butoxide (500 mg, 1.47 mmol) in 20 ml dry DCM. The resulting clear solution was refluxed for 1 h. This solution was then cooled to rt and 2,4-di-tert-butyl-6-{[(E)-(S)-1-hydroxymethyl-2-methyl-propylimino]-methyl}-phenol [CAS 155052-31-6] (469 mg, 1.47 mmol) was added. The resulting yellow solution was stirred at rt for 1 h. This catalyst solution (0.023 M, 46.6 ml, 1.07 mmol) was added to a solution of 1-(6-bromo-3-fluoro-4-triethylsilanyl-pyridin-2-yl)-ethanone (35.53 g, 107 mmol) and trimethylsilyl cyanide (12.73 g, 128 mmol) in 223 ml dry DCM. The mixture was stirred for 2 days and evaporated to give 47 g of the crude title compound as an orange oil. HPLC: RtH5=2.773 min; ESIMS: 431, 433 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 7.46 (d, 1H), 2.04 (s, 3H), 1.00 (t, 9H), 1.03-0.87 (m, 15H), 0.20 (s, 9H).
d) (R)-1-Amino-2-(6-bromo-3-fluoro-4-triethylsilanyl-pyridin-2-yl)-propan-2-ol hydrochloride
Borane dimethyl sulfide complex (16.55 g, 218 mmol) was added to a solution of crude (S)-2-(6-bromo-3-fluoro-4-triethylsilanyl-pyridin-2-yl)-2-trimethylsilanyloxy-propionitrile (47 g, 109 mmol) in 470 ml THF. The mixture was refluxed for 2 h. The heating bath was removed and the reaction mixture was quenched by careful and dropwise addition of MeOH. After the evolution of gas had ceased, aq. 6M HCl (23.6 ml, 142 mmol) was added slowly. The resulting solution was evaporated and the residue was dissolved in MeOH and evaporated (twice) to yield 44.5 g of a yellow foam, pure enough for further reactions. HPLC: RtH1=2.617 min; ESIMS: 363, 365 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 7.93 (s, br, 3H), 7.53 (d, 1H), 6.11 (s, br, 1H), 3.36-3.27 (m, 1H), 3.18-3.09 (m, 1H), 1.53 (s, 3H), 0.99-0.81 (m, 15H).
e) (R)—N-(2-(6-bromo-3-fluoro-4-(triethylsilyl)pyridin-2-yl)-2-hydroxypropyl)-4-nitrobenzenesulfonamide
To a solution of crude (R)-1-amino-2-(6-bromo-3-fluoro-4-triethylsilanyl-pyridin-2-yl)-propan-2-ol hydrochloride (43.5 g, 109 mmol) in 335 ml THF was added a solution of NaHCO3 (21.02 g, 250 mmol) in 500 ml water. The mixture was cooled to 0-5° C. and a solution of 4-nitrobenzenesulfonyl chloride (26.5 g, 120 mmol) in 100 ml THF was added in a dropwise. The resulting emulsion was stirred overnight while allowing the temperature to reach rt. The mixture was extracted with TBME. The organic layer was dried with MgSO4.H2O, filtered and evaporated to give an orange resin which was purified on a silca gel column by eluting with Hexanes/10-20% EtOAc to yield 37.56 g of the title compound as a yellow resin. TLC (Hex/EtOAc 3/1): Rf=0.34; HPLC: RtH4=1.678 min; ESIMS: 548, 550 [(M+H)+, 1Br]; 1H-NMR (400 MHz, DMSO-d6): 8.40 (d, 2H), 8.06 (t, 1H), 7.97 (d, 2H), 7.45 (d, 1H), 5.42 (s, 1H), 3.23 (d, 2H), 1.44 (s, 3H) 0.97-0.81 (m, 15H); Chiral HPLC (Chiralpak AD-H 1213, UV 210 nm): 90% ee.
f) 6-Bromo-3-fluoro-2-[(S)-2-methyl-1-(4-nitro-benzenesulfonyl)-aziridin-2-yl]-4-triethylsilanyl-pyridine
A solution of triphenylphosphine (21.55 g, 82 mmol) and (R)—N-(2-(6-bromo-3-fluoro-4-(triethylsilyl)pyridin-2-yl)-2-hydroxypropyl)-4-nitrobenzenesulfonamide (37.56 g, 69 mmol) in 510 ml THF was cooled to 4° C. A solution of diethyl azodicarboxylate in toluene (40% by weight, 38.8 g, 89 mmol) was added in a dropwise while maintaining the temperature below 10° C. The cooling bath was removed and the reaction mixture was stirred at rt for 1 h. The reaction mixture was diluted with approx. 1000 ml toluene and THF was removed by evaporation at the rotavap. The resulting toluene solution of crude product was pre-purified on a silca gel column by eluting with hexanes/5-17% EtOAc. Purest fractions were combined, evaporated and crystallized from TBME/hexane to yield 29.2 g of the title compound as white crystals. HPLC: RtH4=2.546 min; ESIMS: 530, 532 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 8.40 (d, 2H), 8.19 (d, 2H), 7.39 (d, 1H), 3.14 (s, 1H), 3.02 (s, 1H), 2.01 (s, 3H) 1.03-0.83 (m, 15H); α[D] −35.7° (c=0.97, DCM).
g) 6-Bromo-3-fluoro-2-[(S)-2-methyl-1-(4-nitro-benzenesulfonyl)-aziridin-2-yl]-pyridine
Potassium fluoride (1.1 g, 18.85 mmol) was added to a solution of 6-bromo-3-fluoro-2-[(S)-2-methyl-1-(4-nitro-benzenesulfonyl)-aziridin-2-yl]-4-triethylsilanyl-pyridine (5 g, 9.43 mmol) and AcOH (1.13 g, 9.43 mmol) in 25 ml THF. DMF (35 ml) was added and the suspension was stirred for 1 h at rt. The reaction mixture was poured onto a mixture of sat. aq. NaHCO3 and TBME. The layers were separated and washed with brine and TBME. The combined organic layers were dried over MgSO4.H2O, filtered and evaporated to give a yellow oil which was crystallized from TBME/hexane to yield 3.45 g of the title compound as white crystals. HPLC: RtH6=2.612 min; ESIMS: 416, 418 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 8.41 (d, 2H), 8.19 (d, 2H), 7.48 (dd, 1H), 7.35 (t, 1H), 3.14 (s, 1H), 3.03 (s, 1H), 2.04 (s, 3H); α[D] −35.7° (c=0.89, DCM).
h) (R)-2-[(R)-2-(6-Bromo-3-fluoro-pyridin-2-yl)-2-(4-nitro-benzenesulfonylamino)-propoxy]-3,3,3-trifluoro-2-methyl-propionic acid ethyl ester
A solution of (R)-3,3,3-trifluoro-2-hydroxy-2-methyl-propionic acid ethyl ester (11.93 g, 64.1 mmol) in DMF (158 ml) was evacuated/flushed with nitrogen twice. A solution of KOtBu (6.21 g, 55.5 mmol) in DMF (17 ml) was added dropwise while maintaining a reaction temperature of ca 25° C. using cooling with a water bath. After 15 min solid 6-bromo-3-fluoro-2-[(S)-2-methyl-1-(4-nitro-benzenesulfonyl)-aziridin-2-yl]-pyridine (17.78 g, 42.7 mmol) was added and stirring was continued for 3 h. The reaction mixture was poured onto a mixture of 1M HCl (56 ml), brine and TBME. The layers were separated, washed with brine and TBME. The combined organic layers were dried over MgSO4H2O, filtered and evaporated. The crude reaction product was purified via chromatography on silica gel (hexanes/25-33% TBME) to yield 16.93 g of the title compound as a yellow resin that was contaminated with an isomeric side-product (ratio 70:30 by 1H-NMR).
HPLC: RtH6=2.380 min; ESIMS: 602, 604 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 8.32 (d, 2H), 8.07 (d, 2H), 7.46-7.41 (m, 1H), 7.30-7.23 (m, 1H), 6.92 (s, 1H), 3.39-4.30 (m, 2H), 3.95 (d, 1H), 3.84 (d, 1H), 1.68 (s, 3H), 1.56 (s, 3H), 1.40-1.34 (m, 3H)+ isomeric side-product.
i) (R)-2-[(R)-2-(6-Bromo-3-fluoro-pyridin-2-yl)-2-(4-nitro-benzenesulfonylamino)-propoxy]-3,3,3-trifluoro-2-methyl-propionamide
A solution of (R)-2-[(R)-2-(6-bromo-3-fluoro-pyridin-2-yl)-2-(4-nitro-benzenesulfonylamino)-propoxy]-3,3,3-trifluoro-2-methyl-propionic acid ethyl ester (16.93 g, 28.1 mmol) in a NH3/MeOH (7M, 482 ml) was stirred at 50° C. in a sealed vessel for 26 h. The reaction mixture was evaporated and the residue was crystallized from DCM to yield 9.11 g of the title compound as colorless crystals.
HPLC: RtH6=2.422 min; ESIMS: 573, 575 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 8.33 (d, 2H), 8.06 (d, 2H), 7.42 (dd, 1H), 7.30-7.26 (m, 1H), 7.17 (s, br, 1H), 6.41 (s, 1H), 5.57 (s, br, 1H), 4.15 (m, 2H), 1.68 (s, 3H), 1.65 (s, 3H).
j) N—[(R)-1-(6-Bromo-3-fluoro-pyridin-2-yl)-2-((R)-1-cyano-2,2,2-trifluoro-1-methyl-ethoxy)-1-methyl-ethyl]-4-nitro-benzenesulfonamide
A suspension of (R)-2-[(R)-2-(6-bromo-3-fluoro-pyridin-2-yl)-2-(4-nitro-benzenesulfonylamino)-propoxy]-3,3,3-trifluoro-2-methyl-propionamide (8.43 g, 14.70 mmol) and triethylamine (5.12 ml, 36.8 mmol) in 85 ml DCM was cooled to 0-5° C. Trifluoroacetic anhydride (2.49 ml, 17.64 mmol) was added dropwise over 30 min. Additional triethylamine (1.54 ml, 11.07 mmol) and trifluoroacetic anhydride (0.75 ml, 5.29 mmol) were added to complete the reaction. The reaction mixture was quenched by addition of 14 ml aqueous ammonia (25%) and 14 ml water. The emulsion was stirred for 15 min, more water and DCM were added and the layers were separated. The organic layer was dried with MgSO4 H2O, filtered and evaporated. Purification by column chromatography on a silica gel (hexanes/10-25% EtOAc) gave 8.09 g of the title compound as a yellow resin.
HPLC: RtH6=3.120 min; ESIMS: 555, 557 [(M+H)+, 1Br]; 1H-NMR (400 MHz, CDCl3): 8.35 (d, 2H), 8.11 (d, 2H), 7.50 (dd, 1H), 7.32 (dd, 1H), 6.78 (s, 1H), 4.39 (d 1H), 4.22 (d, 1H), 1.68 (s, 6H).
k) (2R,5R)-5-(6-Bromo-3-fluoro-pyridin-2-yl)-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-ylamine
A solution of N—[(R)-1-(6-bromo-3-fluoro-pyridin-2-yl)-2-((R)-1-cyano-2,2,2-trifluoro-1-methyl-ethoxy)-1-methyl-ethyl]-4-nitro-benzenesulfonamide (9.18 g, 16.53 mmol) and N-acetylcysteine (5.40 g, 33.10 mmol) in 92 ml ethanol was evacuated and flushed with nitrogen. K2CO3 (4.57 g, 33.1 mmol) was added and the mixture was stirred at 80° C. for 3 days. The reaction mixture was concentrated in vacuo to about ¼ of the original volume and partitioned between water and TBME. The organic layer was washed with 10% aq. K2CO3 solution, dried over Na2SO4, filtered and evaporated to give a yellow oil. Column chromatography on silica (hexanes/14-50% (EtOAc:MeOH 95:5)) gave 4.55 g of the title compound as an off-white solid.
HPLC: RtH2=2.741 min; ESIMS: 370, 372 [(M+H)+, 1Br]; 1H-NMR (400 MHz, DMSO-d6): 7.71-7.62 (m, 2H), 5.97 (s, br, 2H), 4.02 (d 1H), 3.70 (d, 1H), 1.51 (s, 3H), 1.47 (s, 3H).
l) (2R, 5R)-5-(6-Amino-3-fluoro-pyridin-2-yl)-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-yl amine
A glass/stainless steel autoclave was purged with nitrogen, Cu2O (0.464 g, 3.24 mmol), ammonia (101 ml, 25%, aq., 648 mmol, 30 equivalents) and (2R,5R)-5-(6-Bromo-3-fluoro-pyridin-2-yl)-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-ylamine (8 g, 21.6 mmol) in ethylene glycol (130 ml) was added. The autoclave was closed and the suspension heated up to 60° C. and the solution was stirred for about 48 hours (max. pressure 0.7 bar, inside temperature 59-60° C.). The reaction mixture was diluted with ethyl acetate and water. The organic phase was washed with water and 4 times with 12% aq. ammonia and finally with brine, dried over sodium sulfate, filtered and evaporated. The crude product (7 g, containing some ethylen glycol, quantitative yield) was used in the next step without further purification. HPLC: RtH3=0.60 min; ESIMS: 307 [(M+H)+].
m) [(2R, 5R)-5-(6-Amino-3-fluoro-pyridin-2-yl)-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-yl]-carbamic acid tert-butyl ester
A solution of (2R, 5R)-5-(6-amino-3-fluoro-pyridin-2-yl)-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-yl amine (6.62 g, 21.6 mmol), Boc2O (4.72 g, 21.6 mmol) and Hunig's base (5.66 ml, 32.4 mmol) in dichloromethane (185 ml) was stirred at rt for 18 hours. The reaction mixture was washed with sat. aq. NaHCO3 and brine. The aqueous layers were back extracted with dichloromethane and the combined organic layers were dried over sodium sulfate, filtered and evaporated to give a light green solid (14 g). The crude product was chromatographed over silicagel (cyclohexane:ethyl acetate 95:5 to 60:40) to afford 7.68 g of the title compound.
TLC (cyclohexane:ethyl acetate 3:1): Rf=0.21; HPLC: RtH3=1.14 min; ESIMS: 408 [(M+H)+]; 1H-NMR (400 MHz, CDCl3): 11.47 (br. s, 1H), 7.23 (dd, J=10.42, 8.78 Hz, 1H), 6.45 (dd, J=8.78, 2.64 Hz, 1H), 4.50 (br. s, 2H), 4.32 (d, J=2.38 Hz, 1H), 4.10 (d, J=11.80 Hz, 1H), 1.69 (s, 3H, CH3), 1.65 (s, 3H, CH3), 1.55 (s, 9H).
n) ((2R, 5R)-5-{6-[(3-Chloro-5-trifluoromethyl-pyridine-2-carbonyl)-amino]-3-fluoro-pyridin-2-yl}-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-yl)-carbamic acid tert-butyl ester
A mixture of [(2R, 5R)-5-(6-amino-3-fluoro-pyridin-2-yl)-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-yl]-carbamic acid tert-butyl ester (3.3 g, 8.12 mmol), 3-chloro-5-trifluoromethylpicolinic acid (2.2 g, 9.74 mmol), HOAt (1.99 g, 14.62 mmol) and EDC hydrochloride (2.33 g, 12.18 mmol) was stirred in DMF (81 ml) at rt for 48 hours. The reaction mixture was diluted with ethyl acetate and washed with water and brine, dried over sodium sulfate, filtered and evaporated. The crude product (12 g) was chromatographed over silicagel (cyclohexane to cyclohexane:ethyl acetate 1:1) to yield 5.2 g of the title compound. TLC (silica, cyclohexane:ethyl acetate 3:1): Rf=0.47; HPLC: RtH3=1.40 min; ESIMS: 615, 616 [(M+H)+, 1Cl]; 1H-NMR (400 MHz, CDCl3): 11.68 (s, 1H), 10.41 (s, 1H), 8.81 (dd, J=1.82, 0.69 Hz, 1H), 8.45 (dd, J=8.91, 3.14 Hz, 1H), 8.19 (dd, J=1.88, 0.63 Hz, 1H), 7.59 (dd, J=9.79, 9.16 Hz, 1H), 4.38 (d, J=2.13 Hz, 1H), 4.18 (d, J=11.80 Hz, 1H), 1.75 (s, 3H), 1.62 (s, 3H), 1.60 (s, 9H).
o) 3-Chloro-5-trifluoromethyl-pyridine-2-carboxylic acid [6-((3R,6R)-5-amino-3,6-dimethyl-6-trifluoromethyl-3,6-dihydro-2H-[1,4]oxazin-3-yl)-5-fluoro-pyridin-2-yl]-amide
A mixture of ((2R, 5R)-5-{6-[3-chloro-5-trifluoromethyl-pyridine-2-carbonyl)-amino]-3-fluoro-pyridin-2-yl}-2,5-dimethyl-2-trifluoromethyl-5,6-dihydro-2H-[1,4]oxazin-3-yl)-carbamic acid tert-butyl ester (4.99 g, 8.13 mmol) and TFA (6.26 ml, 81 mmol) in dichloromethane (81 ml) was stirred at rt for 18 hours. The solvent was evaporated and the residue diluted with a suitable organic solvent, such as ethyl acetate and aq. ammonia. Ice was added and the organic phase was washed with water and brine, dried over sodium sulfate, filtered and evaporated to yield 3.78 g of the title compound.
HPLC: RtH3=0.87 min; ESIMS: 514, 516 [(M+H)+, 1Cl]; 1H-NMR (400 MHz, DMSO-d6): δ 11.11 (s, 1H), 9.06 (s, 1H), 8.69 (s, 1H), 8.13 (dd, J=8.8, 2.6 Hz, 1H), 7.80-7.68 (m, 1H), 5.88 (br. s, 2H), 4.12 (d, J=11.5 Hz, 1H), 3.72 (d, J=11.4 Hz, 1H), 1.51 (s, 3H), 1.49 (s, 3H).
The studies described herein were carried out in commercial wildtype mice in order to investigate the chronic treatment effects of Compound 1, especially on discoloration of the fur, to determine an efficacious dose in wildtype mice, and to compare the window between efficacy and fur colour changes with that of comparator BACE-1 inhibitor compound NB-360 (N-(3-((3R,6R)-5-amino-3,6-dimethyl-6-(trifluoromethyl)-3,6-dihydro-2H-1,4-oxazin-3-yl)-4-fluorophenyl)-5-cyano-3-methylpicolinamide) (Neumann U et al., 2015; and Shimshek D R et al., 2016).
Animals C57BL/6 mice were ordered at Charles River Laboratories, France.
Compound Formulation and Dosing
Compound 1 and NB-360 were formulated as a suspension. Vehicle, Compound 1 or NB-360 were given per os in a volume of 10 ml/kg once daily (mornings) for 8 weeks. Vehicle: 0.1 Tween80 in 0.5% methylcellulose in water.
Body Weight and Fur Colour Scoring
Body weight was taken 3 times per week (Monday, Wednesday, Friday). Subjective scoring of any hair colour changes was performed once weekly (Wednesday). Scores (% of body with grey fur): 0: No change; 1: Spots; 2: >30%; 3: >50%; 4: >75%; 5: 100%. Animals were photo-documented when fur color change was observed. Final fur color scoring was performed blinded and by a person not involved in the study.
Ex-Vivo Samples and Sample Harvest Methodology
Blood samples were used to analyze whole-blood compound levels and were obtained either from tail-vein during the in-life part into EDTA tubes (CB300, Sarstedt, Germany) or from trunk blood at the day of necropsy into EDTA Eppendorf tubes (Milian S A, CatNoTOM-14, Fisher Scientific, Wohlen, Switzerland), or into serum tubes (CB300Z, Sarstedt, Nümbrecht, Germany).
Plasma for amyloid-β (Aβ) analysis was collected by centrifugation of EDTA blood (8000 rpm/6800×g, 15 min, 4° C.) and collected into protein Lo-Bind Eppendorf tubes (003 0108.116, Eppendorf, Hamburg, Germany).
After 20 min at room temperature, serum was separated by centrifugation (8000×g, 15 min, 4° C.) and collected into protein Lo-Bind Eppendorf tubes to check for kidney toxicity biomarkers. All blood/plasma/serum samples were frozen on dry ice and stored at −80° C. until analysis.
Brain was removed immediately after decapitation, rinsed with saline and sectioned sagitally down the midline. The left half of the cerebellum was used to analyze compound level and was placed into a glass tube (Chromacol, 125×5-SV T051, Welwyn Garden City, United Kingdom), weighed and frozen in dry-ice, the left half of the forebrain (without olfactory bulb) was used for Aβ analysis, and was frozen on a metal plate on dry ice and placed into protein Lo-bind tube (003 0108.116, Eppendorf, Hamburg, Germany).
Ventral and dorsal skin were taken to analyze compound level, weighed and frozen on dry-ice.
Analysis of Compound Levels
Compound 1 and NB-360 levels in biological samples were quantified in blood, brain and skin by liquid chromatography/tandem mass spectrometry (HPLC/MS/MS). Brain samples were mixed with 2 volumes of KH2PO4 buffer and homogenized using the Covaris® device. Skin samples were mixed with approx. 6-fold volumes of methanol/water and homogenized using a Precellys tube. Either 30 μL of blood, brain or skin homogenate were spiked with a structurally related internal standard and subsequently mixed with an at least 6-fold excess volume acetonitrile for protein precipitation. The supernatant was injected directly into the LC/MS/MS system for analysis.
Analysis of Aβ40 in Mouse Brain
Brain Homogenization
Frozen mouse forebrains were weighed and homogenized in 9 volumes (w/v) of ice-cold TBS-Complete (20 mM Tris-HCl pH 7.4, 137 mM NaCl, 1× Complete [Protease Inhibitor Cocktail Tablets: 1 836 145, Roche Diagnostics GmbH, Penzberg, Germany]) by sonication (90% duty cycle, output control 5, 40-55 pulses, [Sonifier 450, Branson]). After homogenization several 50 μl aliquots were prepared for analysis and were stored at −80° C.
Preparation of Synthetic Aβ1-40 Solutions as Standards
Human Aβ peptide (1-40) trifluoroacetate salt (H 1194.1000, Bachem, Bubendorf, Switzerland) was used as calibration curve for Aβ1-40. It was solubilized in water-free DMSO (41647, Fluka) at a concentration of 1 mg/ml for approximately 30 min at room temperature (RT) and then visually checked for complete solubilization.
20×5 μl aliquots and 100 μl aliquots of the remaining solution were prepared in LoBind tubes (0030 108.094, Eppendorf, Hamburg, Germany), overlaid with nitrogen gas in order to protect the Aβ peptide from oxidation and stored at −80° C. For the calibration curves a 5 μl aliquot was used just once and then discarded.
Determination of Aβ40 in Mouse Brain
Endogenous Aβ40 in mice was determined with the Meso Scale Discovery (MSD) 96-well MULTI-ARRAY human/rodent (4G8) Aβ40 Ultrasensitive Assay (#K110FTE-3, Meso Scale Discovery, Gaithersburg, USA). The assay was performed according to the manufacturer's instructions except for the calibration curve and the sample preparations. TritonX-100 (TX-100) soluble Aβ40 was extracted from forebrain with 1% TX-100 using a 50 μl aliquot of each 1:10 forebrain homogenate, mixed with 50 μl 2% TX-100 in TBS complete (20 mM Tris-HCl pH 7.4, 137 mM NaCl, 1× Complete [Protease Inhibitor Cocktail Tablets: 1 836 145, Roche Diagnostics GmbH, Penzberg Germany]) to reach a final concentration of 1% TX-100 and a 1:20 forebrain dilution. The samples were incubated for 15 min on ice and vortexed every 5 min. The samples were ultra-centrifuged (100000×g, 4° C., 15 min) and 50 μl of the clear supernatants were transferred to fresh tubes. For the Aβ40 assay the supernatants were further diluted 1:5 in 3% Blocker A solution (from kit) to a final forebrain dilution of 1:100 and applied to the plate.
The calibration curve was prepared in a corresponding dilution of 1% Blocker A solution spiked with synthetic Aβ1-40 peptide (1.56-100 pg/ml) except for non-transgenic mouse brain samples: In this case, the calibration curve was prepared in a correspondingly diluted APP knockout mouse forebrain spiked with synthetic Aβ1-40 peptide (1.56-100 pg/ml). For all samples and standards 25 μl were applied per well. For each determination duplicate wells were performed. The mean values from the duplicate wells were used for calculations. Since MSD did not provide quantification software, the relative units for samples and standards were imported into SOFTmax PRO 4.0 for calculation of standard curves and quantification of samples.
Results
Effects on Body Weight and Fur Colour in C57BL/6 Mice Chronically Treated with NB-360 or Compound 1
Wild-type, naive mice (C57BL/6) were chronically treated for 8 weeks with Compound 1 or NB360 and body weight was measured every 3rd day (Monday, Wednesday, Friday). No overall significant body weight difference of the treatment group compared to vehicle could be observed as well as no significant difference at the end of the study at day 56. Nevertheless, for the treatment group a significant body weight gain (body weight comparison of day 0 to day 56) could be observed.
During the course of the study fur colour changes were observed in mice treated with NB-360. The black fur of C57BL/6 turned slowly grey in patches. These grey patches were visible on the ventral part of the animals while the dorsal part was unaffected. The appearance of grey patches was apparent after 3 weeks of treatment and present at different degrees in the high and low dose NB-360 group. A subjective scoring system was implemented to quantitate the fur discoloration. All animals in the NB-360 group showed fur discoloration. While the low dose NB-360 group (20 μmol/kg) showed only a slight but significant fur score change, the high dose NB-360 group (100 μmol/kg) displayed a more severe and profound fur color change,
Exposure in Blood and Tissues
Compound 1 exposure in blood was determined at day 1 after the first dose, at interim at day 14, and at the end of the study after the last dose. Exposure at the last day was consistently lower than at the beginning of the experiment. Exposure was reduced by around 35% for Compound 1.
Exposure of Compound 1 over the last 24 hours, expressed as AUC0-24h in the different tissues, is summarized in Table 4. For blood, AUC was calculated form the data at 1, 4, 7, and 24 hours, as well as a ‘mini’ AUC only from the data at 4 and 24 hours. Comparison of the two values does not show a big difference. For tissue exposure, only data at 4 and 24 h were available. It was concluded that the ‘mini’ AUC sufficiently well represented the tissue exposure.
For both Compound 1 and NB-360, exposure in brain and skin was much higher than in blood, Table 4. In particular, the skin exposure was several fold higher than blood exposure. In addition, there seemed to be a higher exposure in ventral than in dorsal parts of the skin, especially for NB-360, Table 5. In all tissues, there was a good dose proportionality of the exposure.
aAUC from 1, 4, 7, and 24 h time points;
bAUC from 4 and 24 h time points;
cn = 2 for 24 h
Amyloid-Beta Lowering in Mouse Brain
At the last day of the study, groups of n=4 mice were sacrificed 4 hours and 24 hours after having received the last dose. Forebrain was separated, and analyzed for β-amyloid peptide 1-40. Concentrations of Aβ40 for the vehicle and treatment groups are summarized in Table 6 and visualised in
NB-360 is a dual BACE-1/BACE-2 inhibitor, as indicated by the BACE-1 and BACE-2 enzyme inhibition in vitro assays (Neumann U et al., (2015)) which give a 1.0-fold selectively for BACE-1 over BACE-2. In the same assays, Compound 1 was found to have a 3 fold selectivity for BACE-1 over BACE-2. In conclusion, moderate variations in enzyme selectivity and tissue distribution between Compound 1 and NB-360 are believed to have an effect on the occurrence of hair discoloration in chronic mouse studies. Despite being active in vivo, Compound 1 did not show signs of hair discoloration in mice.
To investigate the effects of Compound 1 on APP metabolism in the human APOE4 context, PK/PD studies in transgenic mice carrying the human APOE4 allele were performed (mouse Apoe gene was replaced by human APOE4; APOE4-TR; (Knouff C et al., 1999)).
In this study, male and female APOE4-TR animals at the age of 3-5 months were treated acutely with Compound 1 at different doses (3, 10, 30 u mol/kg) and sacrificed at 4h and 24 after treatment.
Animals
Male and female transgenic homozygous APOE4-TR (B6.129P2-Apoetm3(APOE*4)Mae N8, Taconic, Model 001549, 3-5 months old, n=48) were obtained from Taconic.
Dose Selection
Compound 1 was administered at 3, 10 and 30 μmol/kg.
Compound Form, Formulation and Dosing
Compound 1 was formulated as a suspension. Vehicle or compound was given by oral administration in a volume of 10 ml/kg once. Vehicle: 0.1% Tween80 in 0.5% Methylcellulose in water.
Body Weight
Body weight was taken once before dosing.
Ex Vivo Samples and Sample Harvest Methodology
Blood samples were used to analyze whole blood compound levels and were obtained from trunk blood at the day of necropsy into EDTA Eppendorf tubes (Milian SA, CatNoTOM-14, Fisher Scientific, Wohlen, Switzerland), or into serum tubes (CB300Z, Sarstedt, Nümbrecht, Germany).
Plasma for amyloid-β (Aβ) analysis was collected by centrifugation of EDTA blood (8000 rpm/6800×g, 15 min, 4° C.) and collected into protein Lo-Bind Eppendorf tubes (003 0108.116, Eppendorf, Hamburg, Germany).
All blood/plasma/serum samples were frozen on dry ice and stored at −80° C. until analysis.
Brain was removed immediately after decapitation, rinsed with saline and sectioned sagitally down the midline. The left cerebellum was used to analyze compound level and was placed into a glass tube (Chromacol, 125×5-SV T051, Welwyn Garden City, United Kingdom), weighed and frozen in dry-ice, the left half of the forebrain (without olfactory bulb) was used for Aβ analysis, and was frozen on a metal plate on dry ice and placed into protein Lo-bind tube (003 0108.116, Eppendorf, Hamburg, Germany). The right brain was fixed in 4% paraformaldehyde, washed in PBS and then embedded in paraffin for possible future histological analyses.
Tails were collected at the end of the study and stored at −20° C.
Analysis of Aβ40 in Mouse Brain and Aβ40 and Aβ42 in CSF
Brain Homogenization
Frozen mouse forebrains were weighed and homogenized in 9 volumes (w/v) of ice-cold TBS-Complete (20 mM Tris-HCl pH 7.4, 137 mM NaCl, 1× Complete [Protease Inhibitor Cocktail Tablets: 1 836 145, Roche Diagnostics GmbH, Penzberg, Germany]) by sonication (90% duty cycle, output control 5, 40-55 pulses, [Sonifier 450, Branson]). After homogenization several 50 μl aliquots were prepared for analysis and were stored at −80° C.
Preparation of Synthetic Aβ 1-40 Solutions as Standards
Human Aβ 1-40 trifluoroacetate salt (H 1194.1000, Bachem, Bubendorf, Switzerland) was used as calibration curve for Aβ1-40. It was solubilized in water-free DMSO (41647, Fluke) at a concentration of 1 mg/ml for approximately 30 min at room temperature (RT) and then visually checked for complete solubilization.
20×5 μl aliquots and 100 μl aliquots of the remaining solution were prepared in LoBind tubes (0030 108.094, Eppendorf, Hamburg, Germany), overlaid with nitrogen gas in order to protect the Aβ peptide from oxidation and stored at −80° C. For the calibration curves a 5 μl aliquot was used just once and then discarded.
Determination of Aβ40 in Mouse Brain
Endogenous Aβ40 in mice was determined with the Meso Scale Discovery (MSD) 96-well MULTI-ARRAY human/rodent (4G8) Aβ40 Ultrasensitive Assay (#K110FTE-3, Meso Scale Discovery, Gaithersburg, USA). The assay was performed according to the manufacturer's instructions except for the calibration curve and the sample preparations. TritonX-100 (TX-100) soluble Aβ40 was extracted from forebrain with 1% TX-100 using a 50 μl aliquot of each 1:10 forebrain homogenate, mixed with 50 μl 2% TX-100 in TBS complete (20 mM Tris-HCl pH 7.4, 137 mM NaCl, 1× Complete [Protease Inhibitor Cocktail Tablets: 1 836 145, Roche Diagnostics GmbH, Penzberg Germany]) to reach a final concentration of 1% TX-100 and a 1:20 forebrain dilution. The samples were incubated for 15 min on ice and vortexed every 5 min. The samples were ultra-centrifuged (100000×g, 4° C., 15 min) and 50 μl of the clear supernatants were transferred to fresh tubes. For the Aβ40 assay the supernatants were further diluted 1:5 in 3% Blocker A solution (from kit) to a final forebrain dilution of 1:100 and applied to the plate.
The calibration curve was prepared in a corresponding dilution of 1% Blocker A solution spiked with synthetic Aβ1-40 peptide (1.56-100 pg/ml) except for non-transgenic mouse brain samples: In this case, the calibration curve was prepared in a correspondingly diluted APP knockout mouse forebrain spiked with synthetic Aβ1-40 peptide (1.56-100 pg/ml). For all samples and standards 25 μl were applied per well. For each determination duplicate wells were done. The mean values from the duplicate wells were used for calculations. Since MSD did not provide quantification software, the relative units for samples and standards were imported into SOFTmax PRO 4.0 for calculation of standard curves and quantification of samples.
Results
APOE4-TR mice (mouse Apoe gene was replaced by human APOE4) were acutely treated with three different doses (3, 10 and 30 μmol/kg) of the BACE inhibitor Compound 1. Animals were sacrificed 4h and 24h after last the last dose and forebrains were separated. Concentrations of Aβ40 and Aβ42 for the various groups are summarized in
PK data are shown in
The brain pharmacokinetic/pharmacodynamic relationship for the individual animals for all dose groups is shown in
Conclusion
Studies presented in this experimental example demonstrate that Compound 1 is an orally-available, centrally active and potent inhibitor of BACE in vivo in APOE4-TR mice. APOE4-TR mice that express human APOE4 from the mouse endogenous Apoe locus were used to investigate PK/PD relationship of Compound 1. ApoE4 has been implicated to be a high risk factor for Alzheimer's disease and APOE4-TR mice resemble the ApoE4 effect in the Alzheimer's brain.
The PK properties of Compound 1 in APOE4-TR mice did not differ to those observed in wildtype mice. A dose-dependent Compound 1 exposure in blood and brain, with much higher brain levels, was observed. Furthermore, the exposure decrease after 24h was similar to that observed in wildtype mice. Compound 1 at 30 μmol/kg resulted in the maximal effect on Aβ reduction (>70%) in the brain of APOE4-TR, with similar extent lasting over 24h for acute dosing. The PK/PD relationship was very comparable to wildtype mice and rats. There was a slightly lower maximal efficacy effect on Aβ reduction in the brain apparent in APOE4-TR mice at the highest dose (30 μmol/kg). This might be due to a lower clearance rate of amyloid-β observed in APOE-4 TR mice (Castellano J M et al., 2011).
This study has been clinically completed and was a randomised, double-blind, placebo-controlled, single and multiple ascending oral dose study to primarily assess the safety and tolerability as well as the pharmacokinetics and pharmacodynamics of Compound 1 in healthy adult and elderly subjects. The purpose of this study was to determine the single and multiple maximum tolerated dose of Compound 1 and to assess the pharmacokinetic/pharmacodynamic (PK/PD) relationship using Aβ in CSF as primary PD biomarker.
In healthy elderly subjects 60 years of age, the highest tested doses of 750 mg single dose and 300 mg QD over two weeks were determined to be safe and tolerated. Pharmacodynamic assessments using Aβ concentrations in CSF as primary biomarker of drug action were also been applied in healthy elderly subjects. Dose-dependent lowering of Aβ40 concentrations was determined up to approximately 80% and 90% after single and multiple dosing, respectively (Tables 14 and 15,
Compound 1 was administered to healthy elderly subjects 60 years or over in a Phase I clinical dose-ranging safety and tolerability study. This study is listed in ClinicalTrials.gov under the NCT02576639 Identifier code.
This randomized, double-blind, placebo-controlled study had a parallel-group design and Compound 1 was administered as once-daily, oral doses to five treatment groups (Compound 1: 2 mg, 10 mg, 35 mg or 85 mg QD and placebo).
The primary purpose of this study was to expand on previous safety and tolerability data obtained over 2-week and 4-week duration in the first in human study and thereby allow initiation of future long-term efficacy trials in subjects at risk of AD. In addition, data relevant for Pharmacokinetic/Pharmacodynamic modeling was obtained in order to support dose selection decisions for future efficacy studies.
In this study, Compound 1 was found to be safe and tolerated at once-daily doses of 2, 10, 35 and 85 mg over three months. The pharmacodynamics effects of Compound 1 administration on CSF Aβ levels are shown in Table 16 and
The pharmacokinetic parameters of Compound 1 following three months (91 days) daily dosing at 2, 10, 35 and 85 mg are shown in Table 17.
Based on these results, a once daily dose of 15 mg of Compound 1 is expected to result in a plasma Cmax,ss value of between 70 and 170 ng/ml, and a once daily dose of 50 mg of Compound 1 is expected to result in a plasma Cmax,ss value of between 200 and 500 ng/ml.
Based on the data presented in Example 4 and 5, pharmacometric modelling predicts a daily dose of 50 mg to reach 80% CSF Aβ40 lowering and a dose of 15 mg to achieve 60% CSF Aβ40 lowering, in 90% of the subjects.
In the completed first-in-human and 3-month dose-ranging safety and tolerability clinical studies described in Examples 5 and 6, Aβ concentrations in CSF were obtained by means of lumbar punctures before the first dose (baseline) and respectively after 2 weeks and 3 months of multiple dosing. ApoE4 genotype also was obtained in the subjects who consented. The percent change from baseline in Aβ40 and Aβ42 concentrations was calculated in subjects who took the study treatment and had no major protocol deviation with potential impact on the evaluation of the pharmacodynamic effect. Tables 18 to 21 below provide summary statistics of the percent change from baseline by treatment group and ApoE genotype (E4 heterozygotes versus E4 non-carriers). Only one subject with CSF data was E4 homozygote (from the 3-month dose-ranging safety and tolerability study). This subject was treated with placebo and showed 11% decrease in both Aβ40 and Aβ42 concentrations and is not included in the tables below. The data shows that there is no difference in CSF Aβ40 and Aβ42 response to treatment with Compound 1 between ApoE4 carriers and non-carriers.
Summary
Compound 1 was chronically administrated to APP23 transgenic mice at plaque bearing age (12 months) for 6 months, at two doses. Compared with a group that received vehicle only, the administration of Compound 1 at 0.03 g/kg food resulted in a slight, and the administration of 0.3 g/kg food resulted in a strong reduction of amyloid-β 40 and 42 compared to the vehicle group. The amount of Aβ in the mice brains was similar to the mice at baseline (12 months of age). Soluble Aβ in plasma and CSF were only significantly reduced in the high dose group. Plaque load as detected by immunohistochemistry, was also slightly (˜20%) reduced in the low dose group, and strongly (˜70%) reduced in the high dose group. The number of small, medium and large plaques responded equally to the treatment. The number of activated astrocytes was determined by GFAP staining. Total GFAP immunoreactivity was reduced by treatment with Compound 1 in a dose-dependent manner. While the majority of GFAP positive astrocytes was not associated with plaques, plaque associated astrocytes responded stronger to the Compound 1 treatment, compared to those distal from the plaques. Activated microglia cells were detected by staining with IBA1. The number of IBA1 positive microglia was dose dependently reduced by Compound 1 treatment. Microglia in close vicinity to amyloid plaques were more reduced by the treatment compared to microglia distal from plaques.
In summary, Compound 1 treatment showed a dose-dependent reduction of brain amyloid-β load, compared to untreated vehicle, and a correlating reduction of two neuroinflammation markers, the numbers of activated astrocytes and microglia cells in the mouse brains.
Methods
Animals and Dose Selection
Male transgenic, heterozygous APP23 (B6,D2-Tg(Thy1App)23Sdz (Sturchler-Pierrat C et al., 1997), 12-14 months old, n=64) were treated with 0.3 g/kg or at 0.03 g/kg Compound 1 in food pellets.
Ex Vivo Samples and Sample Harvest Methodology
Blood samples were used to analyze whole blood compound levels and were obtained from trunk blood at the day of necropsy into EDTA Eppendorf tubes (Milian SA, CatNoTOM-14, Fisher Scientific, Wohlen, Switzerland), or into serum tubes (CB300Z, Sarstedt, Nümbrecht, Germany).
Plasma for amyloid-β (Aβ) analysis was collected by centrifugation of EDTA blood (8000 rpm/6800×g, 15 min, 4° C.) and collected into protein Lo-Bind Eppendorf tubes (003 0108.116, Eppendorf, Hamburg, Germany).
All blood/plasma/serum samples were frozen on dry ice and stored at −80° C. until analysis.
Brain was removed immediately after decapitation, rinsed with saline and sectioned sagitally down the midline. The left half of the brain was used to analyze compound level and was placed into a glass tube (Chromacol, 125×5-SV T051, Welwyn Garden City, United Kingdom), weighed and frozen in dry-ice, the left half of the forebrain (without olfactory bulb) was used for Aβ analysis, and was frozen on a metal plate on dry ice and placed into protein Lo-bind tube (003 0108.116, Eppendorf, Hamburg, Germany).
Tails were collected at the end of the study and stored at −20° C.
Analysis of Compound Levels
Compound 1 levels in biological samples were quantified in blood and brain by liquid chromatography/tandem mass spectrometry (HPLC/MS/MS). Brain samples were mixed with 2 volumes of KH2PO4 buffer and homogenized using the Covens® device. Either 30 μL of blood or brain homogenate were spiked with a structurally related internal standard and subsequently mixed with an at least 6-fold excess volume acetonitrile for protein precipitation. The supernatant was injected directly into the LC/MS/MS system for analysis.
Analysis of Aβ40 and Aβ42 in Mouse Tissue
Brain Homogenization
Frozen mouse forebrains were weighed and homogenized in 9 volumes (w/v) of ice-cold TBS-Complete (20 mM Tris-HCl pH 7.4, 137 mM NaCl, 1× Complete [Protease Inhibitor Cocktail Tablets: 1 836 145, Roche Diagnostics GmbH, Penzberg, Germany]) by sonication (90% duty cycle, output control 5, 40-55 pulses, [Sonifier 450, Branson]). After homogenization several 50 μl aliquots were prepared for analysis and were stored at −80° C.
Preparation of Synthetic Aβ Solutions as Standards
Human Aβ peptide (1-40) trifluoroacetate salt (H 1194.1000, Bachem, Bubendorf, Switzerland) was used as calibration curve for Aβ1-40. It was solubilized in water-free DMSO (41647, Fluke) at a concentration of 1 mg/ml for approximately 30 min at room temperature (RT) and then visually checked for complete solubilization.
20×5 μl aliquots and 100 μl aliquots of the remaining solution were prepared in LoBind tubes (0030 108.094, Eppendorf, Hamburg, Germany), overlaid with nitrogen gas in order to protect the Aβ peptide from oxidation and stored at −80° C. For the calibration curves a 5 μl aliquot was used just once and then discarded.
Determination of Triton X-100 Soluble Aβ in APP23 Mouse Brain
Human Aβ40 and 42 in mice was determined with the Meso Scale Discovery (MSD) 96-well MULTI-ARRAY human/rodent (6E10) Aβ40/42 Assay (Meso Scale Discovery, Rockville, Md., USA). The assay was performed according to the manufacturer's instructions except for the calibration curve and the sample preparations. TritonX-100 (TX-100) soluble Aβ40 and 42 was extracted from forebrain with 1% TX-100 using a 50 μl aliquot of each 1:10 forebrain homogenate, mixed with 50 μl 2% TX-100 in TBS complete (20 mM Tris-HCl pH 7.4, 137 mM NaCl, 1× Complete [Protease Inhibitor Cocktail Tablets: 1 836 145, Roche Diagnostics GmbH, Penzberg Germany]) to reach a final concentration of 1% TX-100 and a 1:20 forebrain dilution. The samples were incubated for 15 min on ice and vortexed every 5 min. The samples were ultra-centrifuged (100000×g, 4° C., 15 min) and 50 μl of the clear supernatants were transferred to fresh tubes. The supernatants were further diluted 1:5 in 3% Blocker A solution (from kit) to a final forebrain dilution of 1:100 and applied to the plate.
The calibration curve was prepared in a corresponding dilution of 1% Blocker A solution spiked with synthetic Aβ1-40 peptide (1.56-100 pg/ml) except for non-transgenic mouse brain samples: In this case, the calibration curve was prepared in a correspondingly diluted APP knockout mouse forebrain spiked with synthetic Aβ1-40 peptide (1.56-100 pg/ml). For all samples and standards 25 μl were applied per well. For each determination duplicate wells were done. The mean values from the duplicate wells were used for calculations. The relative units for samples and standards were imported into SOFTmax PRO 4.0 for calculation of standard curves and quantification of samples.
Determination of Formic Acid Soluble Aβ40 in APP23 Mouse Brain
Fifty microliter of forebrain homogenate was mixed with 116.6 μl 100% formic acid, resulting in a final formic acid concentration of 70%. Samples were stored on ice and vortexed every 5 minutes. For neutralization, 50 μl of the mixture were pipetted into a new tube, and 950 μl of 1 M Tris base, containing 1× Complete Protease inhibitor, was added. Tubes were stored at room temperature overnight and then centrifuged for 15 minutes at 14000 rpm in an Eppendorf Microzentrifuge at 4° C. From the top layer, 100 μl are removed and mixed with 100 μl of 3% Blocker A solution (part of the MesoScale assay kit). This sample was either directly applied to the assay plate (dilution 1:1332) or further diluted in 1% Blocker A solution.
Analysis of Aβ40 in Mouse CSF
Mouse CSF samples (3 μl) was diluted with 57 μL 1% Blocker A (MSD) and 25 μl were applied to the assay plate.
Analysis of Aβ40 in Mouse Plasma
Plasma samples (30 μl) were mixed with 30 μl of 3% Blocker A (MSD) and 25 μl were applied to the assay plate.
Histological Analysis of Amyloid-Beta Plaques and Activated Astrocytes Using Double Fluorescence Immunohistochemistry
Amyloid plaques were stained using a rabbit anti-Aβ primary antibody which recognizes the C-terminal part of the amyloid peptide (the antibody was raised as described in Schrader-Fischer G, Paganetti P A, 1996; Schrader-Fischer G et al., 1997). Activated astrocytes were detected using a commercial rabbit anti-GFAP (reference Z0334 from Dako Schweiz GmbH, Baar, Switzerland).
All stainings were performed using the fully automated instrument Ventana Discovery® Ultra (Roche Diagnostics Schweiz AG, Rotkreuz, Switzerland). All chemicals were provided by Roche Diagnostic.
All study animals were used and brain tissue sections of 3 micrometers were freshly cut and collected on SuperFrost+ slides. The tissues sections were de-paraffinized and rehydrated under solvent-free conditions (EZprep solution) followed by antigen retrieval (demasking) performed by heat retrieval cycles for 32 min in an EDTA based buffer (CC1 solution). Subsequently, slides were blocked for 4 min using the DISCOVERY Inhibitor (reference 07017944001 (Roche)). The primary antibody diluted at 1/20,000 in antibody diluent was manually added on tissue sections and incubated for 1h at room temperature. A short post-fixation (glutaraldehyde at 0.05%) was performed before applying the multimer UltraMap-anti Rabbit HRP ready to use antibody (reference 05269717001) for 16 min.
Detection was performed using the DISCOVERY FITC® following the manufacturer's recommendations. Slides were then heat denaturated at 92° C. for 20 min before a manual application of the second primary antibody (anti-GFAP diluted at 1/2,000) and incubated for 1 h. UltraMap-anti-Rabbit HRP antibody was used again for 20 min to detect GFAP in combination with the DISCOVERY Rhodamine kit (reference 07259883001).
The slides were washed and mounted using Prolong® Gold antifade reagent (reference P36931, ThermoFisher, Switzerland) and further scanned with the Hamamatsu slide scanner instrument (NanoZoomer 2.0 HT, scanning software NDP-Scan Vers. 2.5, Hamamatsu Photonics France, Swiss Office, Solothurn, Switzerland) at the 40× objective. The scanning settings were as follows: the exposure time with the DAPI filter was set at 57 ms as well as for the FITC filter. The exposure time for the TRITC filter (detection of Rhodamine) was set at 14.2 ms.
Analysis of Amyloid-Beta Plaques and Activated Microglia Cells Using Double Fluorescence Immunohistochemistry
Amyloid plaques were stained using the same antibody and the microglia cells were detected using a rabbit anti-IBA1 antibody (reference 019-19741) from Wako Chemicals GmbH (Neuss, Germany) and diluted at 1/200 in antibody diluent. The staining protocol was exactly similar to the protocol for amyloid-beta plaques and astrocytes. The slides were scanned with the same settings.
Image Analysis
For the quantitative plaque evaluation based on image analysis, a proprietary image analysis platform (ASTORIA, Automated Stored Image Analysis) was developed based on MS Visual Studio 2010 and many functions from Matrox MIL V9 libraries (Matrox Inc, Quebec, Canada).
For the beta-amyloid plaque and neuroinflammation analysis, the following sequence of steps was performed:
Image Batch Processing:
(FITC-labeled Aβ plaques)
4 Object Categories
Computation of several morphometric and densitometric features for valid plaques
Results
Blood concentrations of Compound 1 were determined after 2 and 4 months of dosing, and at the end of the study at 6 months. As shown in Table 24, there was constant exposure over the course of the study with acceptable variation between animals, 18% (8-36%) on average. Average Compound 1 blood concentration was 0.25±0.13 μM (mean±SD) for the 0.03 g/kg food dosing group, and 2.10±0.47 μM for the 0.3 g/kg dosing group, in good agreement with the 10-fold difference in compound dose. The exposure observed in this study roughly corresponded to a 5 and a 45 mg/kg daily oral dose of Compound 1. The brain/blood ratio, determined at the end of the experiment, was 2.7 for the 0.03 g/kg group, and 3.3 for the 0.3 g/kg group.
Biochemical Determination of APP Metabolites: Triton TX-100-Soluble APP Metabolites from Mouse Brain
Brain homogenates were extracted with 1% Triton X-100 in buffer and the resulting supernatant was considered to represent soluble forms of APP metabolites. In addition to Aβ40 and 42, we determined the N-terminal APP fragments sAPPα (direct cleavage product of α-secretase) and sAPPβ (Swe) (direct product of BACE1 cleavage). As shown in Table 25, soluble Aβ40 and 42 moderately (less than 2-fold) increase over the course of the study in the non-treated groups. Since no change in the APP expression and Aβ generation is known to happen during this age, it is assumed that the increased values in the vehicle group (18-20 mo old) arise from “leakage” out of the Aβ deposits (which increase several fold, see below). Also the values for the soluble APP metabolites sAPPα and β did not change significantly in the non-treated groups.
Mice treated with Compound 1 at the low dose (0.03 g Compound 1/kg food) showed a weak, but not significant reduction of soluble Aβ40 and 42 and a moderate increase in sAPPα (Tables 25 and 26,
Taken together, Compound 1 treatment resulted in a dose-dependent reduction of all soluble BACE1 cleavage products and in a dose dependent increase in sAPPα.
APP Metabolites in CSF
CSF was collected from all mice at necropsy. Samples from the baseline group were stored for approximately 6 months, and analyzed together with the rest of the samples at the end of the study. Data in Table 27 and
Formic Acid Soluble Amyloid-Beta Peptides in Forebrain
Treatment effects of Compound 1 on deposited forms of amyloid-β in the APP23 mouse brains were investigated after extraction of insoluble Aβ species with formic acid. As shown in Tables 28 and 29 and
Histological Assessment of Amyloid Pathology and Neuroinflammation: Plaque Numbers and Plaque Area
Amyloid plaques on APP23 brain slices were stained with an anti-Aβ antibody which recognizes the C-terminal part of the amyloid peptide. For a more detailed data analysis, the various forms of amyloid-β depositions in APP23 mice were classified into “small”, “medium” and “large” plaques. Furthermore, total immuno-stained area was determined. Quantification results are shown in Tables 30 and 31 and
Effects on Activated Astrocytes
GFAP (Glial Acidic Fibrillary Protein) is found in resting as well as in activated astrocytes. GFAP immunoreactivity is often used as a marker of astrocyte number and activation. In APP23 mice, the normalized GFAP positive area increased with mouse age approximately 2-fold, and this increase was reduced by Compound 1 treatment in a dose-dependent manner (Tables 32 and 33 and
Effects on IBA1 Positive Microglia
IBA1 (Ionized calcium binding adaptor molecule 1) is a microglia/macrophage specific protein. IBA1 immunoreactivity is often used as a marker of microglia number and activation. In APP23 mice, the normalized IBA1 positive area increased with mouse age approximately 5-fold, and this increase was reduced by Compound 1 treatment in a dose-dependent manner (Tables 34 and 35). IBA1 immunoreactivity was further dissected with respect to association with amyloid plaques. This analysis shows that approximately 75% of IBA1 immunoreactivity is non-plaque associated (distal), and only 25% is plaque associated or proximal. The fraction of plaque-associated and proximal IBA1 immuno-reactivity was increased in the vehicle group. To a lesser extent, also distant and not plaque associated IBA1 positive staining increased with mouse age. The effect of Compound 1 treatment was also distinct between the plaque-associated and the non-plaque associated IBA1 immunoreactivity: The effects on the plaque-associated/proximal IBA1 immunoreactivity were strong and significant. No significant effects were found on the non-plaque associated/distal staining. This is further illustrated in
In the clinical trial described herein, the identification of ApoE4 homozygotes is employed as a prognostic enrichment strategy to select individuals with a greater likelihood of having substantial worsening in cognition, in a reasonable timeframe, that can be practically assessed within the setting of a clinical trial. This study is listed in ClinicalTrials.gov under the NCT02565511 Identifier code. In the alternative, this example may be conducted with cognitively unimpaired ApoE4 carriers (homozygotes; or heterozygotes with additional enrichment for brain amyloid (“amyloid-positivity”) determined, for example, by PET or CSF measurement), aged 60 to 75 years, at a once daily oral dose of 15 or 50 mg Compound 1. This study is listed in ClinicalTrials.gov under the NCT03131453 Identifier code.
During the treatment duration of at least 5 years in the proposed clinical trial, it is expected that a significant proportion of the participants will be diagnosed with mild cognitive impairment (MCI) or dementia due to AD. The majority of the diagnoses are expected to be MCI, which is expected to precede diagnosis of dementia by 2-4 years.
In a drug-drug interaction (DDI) study in healthy volunteers, the effect of a strong CYP3A4 inhibitor (itraconazole) and a strong CYP3A4 inducer (rifampicin) on the PK of Compound 1 was evaluated. The DDI study design is outlined in
Increased Aβ deposition in the brain can be determined by PET imaging of cortical Aβ using an established PET tracer, for example 11C-Pittsburgh compound B, 18F-florbetaben, or 18F-flutemetamol, and also as a decrease in CSF Aβ 1-42. Several studies have shown high concordance between PET imaging vs CSF Aβ 1-42 analysis for the detection of amyloid-β pathology in the brain (Weigand S D et al., 2011; Barthel H et al., 2011; Schipke C G et al., 2017). The correlation suggests that the reduction in CSF Aβ 1-42 is a result of increased amyloid-β deposition in the brain. In contrast to Aβ 1-42, the CSF concentration of Aβ 1-40, which is less prone to accumulate in cortical amyloid deposits, remains practically constant, even in patients with high cortical amyloid-β load. In agreement with this, it has been demonstrated that a more robust PET-CSF correlation is obtained when the CSF Aβ1-42/Aβ1-40 ratio is used (Pannee J et al., 2016; Janelidze S et al., 2016), instead of Aβ 1-42 alone. While the use of the Aβ 1-42/Aβ 1-40 ratio as a diagnostic tool for the detection of amyloid-β pathology in the brain is well established, a change of this parameter in response to treatment with an anti-amyloid agent has not previously been described.
In the completed 3-month dose-ranging safety and tolerability clinical study in healthy elderly subjects described in Example 5, Aβ 40 and Aβ 42 concentrations in CSF were obtained by means of lumbar punctures before the first dose (baseline) and after 3 months of multiple dosing. It was found that a significant number of subjects have a baseline CSF Aβ 42/Aβ 40 below normal (below a cut-off of 0.09) indicative of cortical amyloid deposition. The percentage of subjects with a ratio below 0.09 is higher in the group of ApoE4 carriers (33%), compared to the non-carriers (15%). This is in agreement with the enhanced risk of ApoE4 carriers developing amyloidosis.
The CSF Aβ42/Aβ40 ratio at the end of a 3-month treatment with Compound 1 was determined in subjects having a baseline CSF Aβ42/Aβ40 ratio below 0.09,
This result is indicative of increased transport of Aβ42 from the brain to CSF, corresponding to a reduced cortical amyloid-β load in subjects treated with the higher doses of Compound 1. The reduction in cortical amyloid-β load demonstrates that Compound 1 is capable of modifying the amyloid pathology characteristic of AD in both carriers and non-carriers of the ApoE4 allele and, therefore, is expected to be effective in the prevention of AD in either of these patient groups.
The pharmaceutical composition used in the clinical studies described in Examples 4 and 5 was formulated as a hard gelatin capsule (e.g. Capsugel, size 3) comprising the ingredients shown in Table 39 and prepared as described below.
1Corresponding to a corrected drug substance content (=cc) of 100%. A compensation of drug substance is performed if the corrected drug substance content is ≤99.5%. The difference in weight is adjusted with Mannitol. The cc is calculated as given below:
2Removed during processing
Other batch sizes or dosage strengths may be prepared depending on clinical requirements and/or available equipment. The weight of individual components for other batch sizes corresponds proportionally to the stated composition.
Description of Manufacturing Process of Compound 1: 1 mg and 10 mg Hard Gelatin Capsules
Description of Manufacturing Process of Compound 1: 75 mg Hard Gelatin Capsules
The processes described above may be reasonably adjusted, while maintaining the same basic production steps, to compensate for different batch sizes, dosage strengths, and/or equipment characteristics. Granulation steps may be divided in sub-batches to utilise the qualified range of the equipment.
All references, e.g., a scientific publication or patent application publication, cited herein are incorporated herein by reference in their entirety and for all purposes to the same extent as if each reference was specifically and individually indicated to be incorporated by reference in its entirety for all purposes. Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it will be readily apparent to those of ordinary skill in the art in light of the teachings of this invention that certain changes and modifications may be made thereto without departing from the spirit or scope of the appended claims.
| Number | Date | Country | Kind |
|---|---|---|---|
| 16180233.5 | Jul 2016 | EP | regional |
| 16193779.2 | Oct 2016 | EP | regional |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16695289 | Nov 2019 | US |
| Child | 16931783 | US | |
| Parent | 15651845 | Jul 2017 | US |
| Child | 16695289 | US |
